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Direct Test For Pneumocystis Pneumonia

Massachusetts 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?

$15.14

Typical negotiated rate. In Massachusetts, July 2026.

Insurers have agreed to pay about $15.14 for this service. The price depends on where it is billed: about $12.02 from a physician practice, and about $29.51 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 9 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$12.02$11.22 to $18.20
FacilityA hospital or hospital-owned outpatient department$29.51$16.98 to $38.02

How much rates vary

Facilitymedian $30 · 10th to 90th $11 to $71Professionalmedian $12 · 10th to 90th $10 to $35
$10$50$200$1Kfacility $30professional $12

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
$12.02
Median
$30.20
Typical High
$123.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$11.22
Typical High
$51.29
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$16.98
Typical High
$70.79
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$7.24
Median
$12.02
Typical High
$29.51
BCBS
Setting
Facility
Modifier
Global
Typical Low
$23.44
Median
$29.51
Typical High
$46.77
BCBS
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$11.22
Typical High
$14.79
Cigna
Setting
Facility
Modifier
Global
Typical Low
$9.33
Median
$19.05
Typical High
$30.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$13.49
Typical High
$31.62
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$91.20
Typical High
$7,079.46
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$17.38
Typical High
$20.42
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$34.67
Health New England
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$16.98
Typical High
$70.79
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$7.24
Median
$12.02
Typical High
$29.51
United
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$12.02
Typical High
$17.38
United
Setting
Professional
Modifier
Global
Typical Low
$7.24
Median
$12.02
Typical High
$30.20

Where Massachusetts 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.

Massachusetts· 10th of 51

$15.14

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.