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Direct Test For Pneumocystis Pneumonia

Illinois rates for HCPCS 87281

A laboratory test that looks directly for Pneumocystis, a fungus that causes serious pneumonia in people whose immune systems are weakened, in a sample of sputum or fluid washed from the lungs. Antibodies tagged with a fluorescent dye attach to the organism, making it visible under a special microscope. It gives a rapid answer because this organism cannot be grown in ordinary culture.

Rates data updated July 2026.

How much does Direct Test For Pneumocystis Pneumonia cost?

$10.96

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $10.96 for this service. The price depends on where it is billed: about $9.12 from a physician practice, and about $22.39 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$9.12$7.41 to $12.02
FacilityA hospital or hospital-owned outpatient department$22.39$14.45 to $27.54

How much rates vary

Facilitymedian $22 · 10th to 90th $11 to $66Professionalmedian $9 · 10th to 90th $3 to $25
$5$10$20$50$100facility $22professional $9

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$19.95
Typical High
$35.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$10.23
Typical High
$25.12
BCBS
Setting
Facility
Modifier
Global
Typical Low
$15.85
Median
$32.36
Typical High
$123.03
BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$8.32
Typical High
$9.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$13.49
Median
$27.54
Typical High
$54.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$13.80
Typical High
$21.88
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$23.99
Typical High
$151.36
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$15.49
Typical High
$15.49
Molina
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$15.14
United
Setting
Facility
Modifier
Global
Typical Low
$8.91
Median
$12.02
Typical High
$23.99
United
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$8.91
Typical High
$16.60

Where Illinois sits

The same service costs 2.5 times more in Hawaii than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Illinois· 39th of 51

$10.96

HI $21.88DC $8.91

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.