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Direct Test For Pneumocystis Pneumonia

Washington 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?

$13.18

Typical negotiated rate. In Washington, July 2026.

Insurers have agreed to pay about $13.18 for this service. The price depends on where it is billed: about $11.22 from a physician practice, and about $19.95 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 9 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$11.22$10.72 to $14.45
FacilityA hospital or hospital-owned outpatient department$19.95$12.02 to $31.62

How much rates vary

Facilitymedian $20 · 10th to 90th $11 to $65Professionalmedian $11 · 10th to 90th $7 to $25
$10$20$50$100facility $20professional $11

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
$11.22
Median
$27.54
Typical High
$75.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$11.22
Typical High
$79.43
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$15.14
Typical High
$33.11
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$8.91
Median
$10.72
Typical High
$12.30
Cigna
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$25.70
Typical High
$42.66
Cigna
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$12.88
Typical High
$19.05
Molina
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$10.47
Typical High
$64.57
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$23.99
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$10.72
Typical High
$10.72
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$20.89
Typical High
$33.11
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$10.72
Typical High
$14.45
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$17.78
Typical High
$32.36
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$8.91
Median
$10.72
Typical High
$12.02
United
Setting
Facility
Modifier
Global
Typical Low
$11.48
Median
$14.45
Typical High
$14.45
United
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$6.92
Typical High
$16.60
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$5.37
Median
$6.17
Typical High
$21.38

Where Washington 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.

Washington· 23rd of 51

$13.18

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.