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Direct Test For Pneumocystis Pneumonia

Pennsylvania 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?

$11.48

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $11.48 for this service. The price depends on where it is billed: about $9.77 from a physician practice, and about $28.18 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 8 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$9.77$9.55 to $11.22
FacilityA hospital or hospital-owned outpatient department$28.18$14.45 to $46.77

How much rates vary

Facilitymedian $28 · 10th to 90th $10 to $54Professionalmedian $10 · 10th to 90th $9 to $21
$10$20$50$100facility $28professional $10

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
$10.23
Median
$28.84
Typical High
$50.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$9.77
Typical High
$28.18
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$79.43
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$10.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.71
Median
$18.62
Typical High
$41.69
Cigna
Setting
Professional
Modifier
Global
Typical Low
$7.08
Median
$15.14
Typical High
$28.84
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$8.13
Typical High
$17.38
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$12.02
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$12.30
Typical High
$20.89
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$28.84
Typical High
$50.12
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$9.77
Typical High
$35.48
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$44.67
Typical High
$93.33
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$12.02
Typical High
$15.85
United
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$12.02
Typical High
$14.45
United
Setting
Professional
Modifier
Global
Typical Low
$5.37
Median
$9.33
Typical High
$19.50

Where Pennsylvania 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.

Pennsylvania· 32nd of 51

$11.48

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.