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Direct Test For Pneumocystis Pneumonia

South 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?

$16.60

Typical negotiated rate. In South Carolina, October 2026.

Insurers have agreed to pay about $16.60 for this service. The price depends on where it is billed: about $15.85 from a physician practice, and about $41.69 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$15.85$12.02 to $25.12
FacilityA hospital or hospital-owned outpatient department$41.69$31.62 to $72.44

How much rates vary

Facilitymedian $42 · 10th to 90th $17 to $85Professionalmedian $16 · 10th to 90th $9 to $30
$10$20$50$100facility $42professional $16

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
$9.33
Median
$9.33
Typical High
$19.05
Aetna
Setting
Professional
Modifier
None
Typical Low
$9.33
Median
$9.33
Typical High
$9.55
BCBS South Carolina
Setting
Facility
Modifier
None
Typical Low
$31.62
Median
$47.86
Typical High
$87.10
BCBS South Carolina
Setting
Professional
Modifier
None
Typical Low
$12.02
Median
$15.85
Typical High
$30.20
Cigna
Setting
Facility
Modifier
None
Typical Low
$22.91
Median
$30.20
Typical High
$74.13
Cigna
Setting
Professional
Modifier
None
Typical Low
$6.03
Median
$7.76
Typical High
$15.14
Medcost
Setting
Facility
Modifier
None
Typical Low
$8.91
Median
$12.02
Typical High
$19.95
Medcost
Setting
Professional
Modifier
None
Typical Low
$12.88
Median
$20.42
Typical High
$21.88
United
Setting
Facility
Modifier
None
Typical Low
$10.72
Median
$10.72
Typical High
$14.45
United
Setting
Professional
Modifier
None
Typical Low
$5.01
Median
$8.51
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
$4.68
Median
$4.68
Typical High
$4.79
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$1.86
Median
$1.86
Typical High
$1.91

Where South 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.

South Carolina· 11th of 51

$16.60

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.