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Direct Test For Pneumocystis Pneumonia

Kentucky 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?

$10.00

Typical negotiated rate. In Kentucky, October 2026.

Insurers have agreed to pay about $10.00 for this service. The price depends on where it is billed: about $10.00 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$10.00$9.77 to $14.45
FacilityA hospital or hospital-owned outpatient department$12.02$10.00 to $25.12

How much rates vary

Facilitymedian $12 · 10th to 90th $10 to $26Professionalmedian $10 · 10th to 90th $7 to $17
$10$20$50facility $12professional $10

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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
$10.00
Typical High
$12.02
Aetna
Setting
Professional
Modifier
None
Typical Low
$9.55
Median
$10.00
Typical High
$12.02
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$7.41
Median
$12.02
Typical High
$12.59
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$7.59
Median
$10.00
Typical High
$16.60
CareSource
Setting
Facility
Modifier
None
Typical Low
$12.02
Median
$14.45
Typical High
$16.60
CareSource
Setting
Professional
Modifier
None
Typical Low
$12.02
Median
$15.14
Typical High
$23.99
Cigna
Setting
Facility
Modifier
None
Typical Low
$9.33
Median
$25.70
Typical High
$25.70
Cigna
Setting
Professional
Modifier
None
Typical Low
$6.17
Median
$81.28
Typical High
$81.28
United
Setting
Professional
Modifier
None
Typical Low
$5.01
Median
$9.55
Typical High
$16.60
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
$4.79
Median
$5.01
Typical High
$6.03
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$1.95
Median
$2.00
Typical High
$2.40

Where Kentucky 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.

Kentucky· 38th of 51

$10.00

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.