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Direct Test For Pneumocystis Pneumonia

New York 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 New York, October 2026.

Insurers have agreed to pay about $10.00 for this service. The price depends on where it is billed: about $9.55 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 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$9.55$5.89 to $15.49
FacilityA hospital or hospital-owned outpatient department$12.02$8.13 to $25.70

How much rates vary

Facilitymedian $12 · 10th to 90th $8 to $34Professionalmedian $10 · 10th to 90th $5 to $26
$5$10$20$50$100$200facility $12professional $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
$6.46
Median
$10.23
Typical High
$37.15
Aetna
Setting
Professional
Modifier
None
Typical Low
$6.46
Median
$6.46
Typical High
$10.96
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$12.02
Median
$12.02
Typical High
$30.90
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$5.89
Median
$9.12
Typical High
$27.54
CDPHP
Setting
Professional
Modifier
None
Typical Low
$12.02
Median
$12.02
Typical High
$12.02
Cigna
Setting
Facility
Modifier
None
Typical Low
$11.75
Median
$26.30
Typical High
$95.50
Cigna
Setting
Professional
Modifier
None
Typical Low
$8.32
Median
$16.98
Typical High
$81.28
Emblem Health
Setting
Facility
Modifier
None
Typical Low
$10.00
Median
$15.14
Typical High
$26.92
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$5.62
Median
$8.13
Typical High
$23.44
Excellus BCBS
Setting
Facility
Modifier
None
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
Excellus BCBS
Setting
Professional
Modifier
None
Typical Low
$8.13
Median
$11.48
Typical High
$13.49
MVP Health Care
Setting
Facility
Modifier
None
Typical Low
$12.02
Median
$19.95
Typical High
$257.04
MVP Health Care
Setting
Professional
Modifier
None
Typical Low
$9.55
Median
$9.55
Typical High
$24.55
United
Setting
Facility
Modifier
None
Typical Low
$10.72
Median
$12.02
Typical High
$15.14
United
Setting
Professional
Modifier
None
Typical Low
$5.01
Median
$7.24
Typical High
$17.78
Univera
Setting
Facility
Modifier
None
Typical Low
$7.94
Median
$8.13
Typical High
$28.84
Univera
Setting
Professional
Modifier
None
Typical Low
$7.94
Median
$11.48
Typical High
$13.49
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
$3.24
Median
$3.24
Typical High
$5.13
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$1.29
Median
$1.29
Typical High
$2.04

Where New York 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.

New York· 37th 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.