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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 October 2026.

How much does Direct Test For Pneumocystis Pneumonia cost?

$11.22

Typical negotiated rate. In Washington, October 2026.

Insurers have agreed to pay about $11.22 for this service. The price depends on where it is billed: about $10.72 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 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$10.72$7.76 to $12.02
FacilityA hospital or hospital-owned outpatient department$17.78$13.18 to $23.99

How much rates vary

Facilitymedian $18 · 10th to 90th $11 to $33Professionalmedian $11 · 10th to 90th $5 to $14
$10$20$50facility $18professional $11

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
$11.22
Median
$11.22
Typical High
$16.98
Aetna
Setting
Professional
Modifier
None
Typical Low
$11.22
Median
$11.22
Typical High
$13.49
Asuris Northwest Health
Setting
Facility
Modifier
None
Typical Low
$8.91
Median
$13.80
Typical High
$33.11
Asuris Northwest Health
Setting
Professional
Modifier
None
Typical Low
$8.91
Median
$10.72
Typical High
$12.02
Cigna
Setting
Facility
Modifier
None
Typical Low
$12.59
Median
$21.88
Typical High
$38.90
Cigna
Setting
Professional
Modifier
None
Typical Low
$7.41
Median
$12.88
Typical High
$16.98
Molina
Setting
Professional
Modifier
None
Typical Low
$7.59
Median
$10.47
Typical High
$10.47
Pacific Source
Setting
Facility
Modifier
None
Typical Low
$12.02
Median
$13.49
Typical High
$23.99
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$12.02
Median
$20.89
Typical High
$33.11
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$10.72
Median
$10.72
Typical High
$14.45
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$12.02
Median
$19.95
Typical High
$33.11
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$8.91
Median
$10.72
Typical High
$12.02
United
Setting
Facility
Modifier
None
Typical Low
$12.02
Median
$14.45
Typical High
$14.45
United
Setting
Professional
Modifier
None
Typical Low
$5.01
Median
$5.37
Typical High
$13.49
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$5.37
Median
$12.02
Typical High
$21.38
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
$5.62
Median
$5.62
Typical High
$5.75
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$2.24
Median
$2.24
Typical High
$2.29

Where Washington 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.

Washington· 30th of 51

$11.22

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.