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Direct Test For Pneumocystis Pneumonia

Indiana 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 October 2026.

How much does Direct Test For Pneumocystis Pneumonia cost?

$9.77

Typical negotiated rate. In Indiana, October 2026.

Insurers have agreed to pay about $9.77 for this service. The price depends on where it is billed: about $8.32 from a physician practice, and about $12.02 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$8.32$5.89 to $12.02
FacilityA hospital or hospital-owned outpatient department$12.02$11.75 to $26.30

How much rates vary

Facilitymedian $12 · 10th to 90th $10 to $40Professionalmedian $8 · 10th to 90th $6 to $21
$10$50$200$1Kfacility $12professional $8

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$9.77
Median
$16.60
Typical High
$44.67
Aetna
Setting
Professional
Modifier
None
Typical Low
$8.91
Median
$9.77
Typical High
$81.28
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$9.55
Median
$12.02
Typical High
$36.31
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$5.89
Median
$7.24
Typical High
$16.60
CareSource
Setting
Facility
Modifier
None
Typical Low
$15.14
Median
$15.14
Typical High
$15.14
Cigna
Setting
Facility
Modifier
None
Typical Low
$7.76
Median
$12.02
Typical High
$39.81
Cigna
Setting
Professional
Modifier
None
Typical Low
$7.59
Median
$15.49
Typical High
$36.31
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$21.38
Median
$30.20
Typical High
$2,187.76
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
None
Typical Low
$7.76
Median
$9.77
Typical High
$11.22
United
Setting
Professional
Modifier
None
Typical Low
$5.01
Median
$9.77
Typical High
$14.45
2 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$4.47
Median
$4.90
Typical High
$40.74
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$1.82
Median
$1.95
Typical High
$16.22

Where Indiana sits

The same service costs 4.5 times more in Kansas than in New Jersey. 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.

Indiana· 41st of 51

$9.77

KS $38.02NJ $8.51

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.