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Direct Test For Pneumocystis Pneumonia

North Carolina 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?

$9.55

Typical negotiated rate. In North Carolina, October 2026.

Insurers have agreed to pay about $9.55 for this service. The price depends on where it is billed: about $9.55 from a physician practice, and about $16.60 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$9.55$7.76 to $12.02
FacilityA hospital or hospital-owned outpatient department$16.60$9.55 to $31.62

How much rates vary

Facilitymedian $17 · 10th to 90th $10 to $55Professionalmedian $10 · 10th to 90th $6 to $17
$10$20$50facility $17professional $10

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
$9.55
Median
$9.55
Typical High
$31.62
Aetna
Setting
Professional
Modifier
None
Typical Low
$9.55
Median
$9.55
Typical High
$12.02
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$4.79
Median
$4.79
Typical High
$5.13
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$1.91
Median
$1.91
Typical High
$2.04
BCBS
Setting
Facility
Modifier
None
Typical Low
$31.62
Median
$48.98
Typical High
$48.98
BCBS
Setting
Professional
Modifier
None
Typical Low
$8.91
Median
$10.72
Typical High
$14.79
Cigna
Setting
Facility
Modifier
None
Typical Low
$8.51
Median
$26.30
Typical High
$54.95
Cigna
Setting
Professional
Modifier
None
Typical Low
$6.17
Median
$8.13
Typical High
$18.20
Medcost
Setting
Professional
Modifier
None
Typical Low
$10.00
Median
$20.89
Typical High
$26.30
Medcost
Setting
Facility
Modifier
None
Typical Low
$9.33
Median
$9.55
Typical High
$23.99
Medcost
Setting
Professional
Modifier
None
Typical Low
$9.55
Median
$16.60
Typical High
$20.89
Oscar Health
Setting
Facility
Modifier
None
Typical Low
$8.71
Median
$8.71
Typical High
$8.71
United
Setting
Professional
Modifier
None
Typical Low
$5.01
Median
$7.94
Typical High
$16.22

Where North Carolina 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.

North Carolina· 47th of 51

$9.55

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.