Analysis for antibody to herpes simplex virus, type 1
Medicare pricing data for 633 providers across 40 states
This procedure has a 6.6x markup — hospitals charge $85.48 but Medicare allows only $12.91. Uninsured patients may face bills 6.6 times higher than what insurance negotiates. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Analysis for antibody to herpes simplex virus, type 1 (HCPCS code 86695) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $12.91, but hospitals typically charge $85.48 — a 6.6x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $12.91, your out-of-pocket cost would be approximately $2.58. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 6.6x more than what Medicare allows for this procedure. Medicare actually pays $12.91 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Minnesota | $13 | $86 | 51 | 286 | +0.3% |
| Illinois | $13 | $89 | 24 | 647 | +0.2% |
| Indiana | $13 | $80 | 10 | 70 | +0.2% |
| Iowa | $13 | $35 | 5 | 28 | +0.2% |
| Kansas | $13 | $95 | 5 | 634 | +0.2% |
| Kentucky | $13 | $46 | 4 | 26 | +0.2% |
| Maine | $13 | $32 | 4 | 15 | +0.2% |
| Maryland | $13 | $90 | 24 | 444 | +0.2% |
| Massachusetts | $13 | $90 | 36 | 792 | +0.2% |
| Nevada | $13 | $90 | 10 | 323 | +0.2% |
| New Mexico | $13 | $41 | 2 | 41 | +0.2% |
| New York | $13 | $102 | 79 | 2,264 | +0.2% |
| Pennsylvania | $13 | $61 | 7 | 308 | +0.2% |
| Rhode Island | $13 | $39 | 2 | 26 | +0.2% |
| South Carolina | $13 | $39 | 5 | 41 | +0.2% |
| South Dakota | $13 | $88 | 2 | 13 | +0.2% |
| Utah | $13 | $30 | 4 | 13 | +0.2% |
| Washington | $13 | $73 | 12 | 301 | +0.2% |
| West Virginia | $13 | $85 | 1 | 87 | +0.2% |
| Wisconsin | $13 | $97 | 7 | 55 | +0.2% |
| Puerto Rico | $13 | $15 | 43 | 118 | +0.2% |
| Colorado | $13 | $81 | 5 | 165 | +0.2% |
| Connecticut | $13 | $48 | 3 | 24 | +0.2% |
| New Jersey | $13 | $85 | 47 | 5,484 | +0.1% |
| North Carolina | $13 | $82 | 11 | 2,937 | +0.1% |
| Florida | $13 | $96 | 29 | 2,940 | 0.0% |
| Ohio | $13 | $82 | 13 | 652 | 0.0% |
| Texas | $13 | $92 | 52 | 2,638 | 0.0% |
| California | $13 | $78 | 39 | 4,449 | 0.0% |
| Georgia | $13 | $96 | 10 | 1,027 | -0.1% |
| Tennessee | $13 | $91 | 8 | 260 | -0.1% |
| Arizona | $13 | $82 | 4 | 915 | -0.2% |
| Oklahoma | $13 | $79 | 8 | 196 | -0.3% |
| Virginia | $13 | $41 | 6 | 155 | -0.4% |
| Oregon | $13 | $41 | 7 | 106 | -0.5% |
| Alabama | $13 | $88 | 8 | 882 | -0.6% |
| Louisiana | $13 | $81 | 5 | 57 | -1.6% |
| Mississippi | $13 | $76 | 6 | 23 | -2.2% |
| Michigan | $13 | $33 | 14 | 200 | -2.4% |
| Hawaii | $12 | $49 | 2 | 84 | -3.9% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber