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Direct Test For Pneumocystis Pneumonia

Virginia 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 Virginia, October 2026.

Insurers have agreed to pay about $9.55 for this service. The price depends on where it is billed: about $8.32 from a physician practice, and about $17.78 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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$8.32$6.17 to $9.77
FacilityA hospital or hospital-owned outpatient department$17.78$12.02 to $30.20

How much rates vary

Facilitymedian $18 · 10th to 90th $11 to $58Professionalmedian $8 · 10th to 90th $6 to $15
$10$100$1K$10Kfacility $18professional $8

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
$8.91
Median
$26.92
Typical High
$32.36
Aetna
Setting
Professional
Modifier
None
Typical Low
$8.91
Median
$10.96
Typical High
$11.22
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$12.02
Median
$12.02
Typical High
$58.88
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$5.89
Median
$7.24
Typical High
$9.12
CareFirst
Setting
Professional
Modifier
None
Typical Low
$8.71
Median
$9.55
Typical High
$15.49
Cigna
Setting
Facility
Modifier
None
Typical Low
$12.30
Median
$28.84
Typical High
$47.86
Cigna
Setting
Professional
Modifier
None
Typical Low
$6.61
Median
$9.12
Typical High
$16.98
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$12.02
Median
$14.45
Typical High
$17.78
Medcost
Setting
Professional
Modifier
None
Typical Low
$10.00
Median
$19.95
Typical High
$23.44
Medcost
Setting
Facility
Modifier
None
Typical Low
$10.00
Median
$11.22
Typical High
$24.55
Medcost
Setting
Professional
Modifier
None
Typical Low
$9.12
Median
$9.12
Typical High
$9.12
Sentara
Setting
Facility
Modifier
None
Typical Low
$10.72
Median
$17.38
Typical High
$10,232.93
Sentara
Setting
Professional
Modifier
None
Typical Low
$10.72
Median
$16.98
Typical High
$10,232.93
United
Setting
Facility
Modifier
None
Typical Low
$14.45
Median
$14.45
Typical High
$14.45
United
Setting
Professional
Modifier
None
Typical Low
$5.01
Median
$7.08
Typical High
$12.02
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
$4.47
Median
$5.50
Typical High
$5.62
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$1.82
Median
$2.19
Typical High
$2.24

Where Virginia 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.

Virginia· 45th 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.