Analysis for antibody to herpes simplex virus, type 2
Medicare pricing data for 662 providers across 40 states
This procedure has a 6.5x markup — hospitals charge $122.99 but Medicare allows only $18.93. Uninsured patients may face bills 6.5 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 2 (HCPCS code 86696) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $18.93, but hospitals typically charge $122.99 — a 6.5x 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 $18.93, your out-of-pocket cost would be approximately $3.79. 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 6.5x more than what Medicare allows for this procedure. Medicare actually pays $18.93 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Minnesota | $20 | $115 | 51 | 287 | +5.5% |
| Illinois | $19 | $139 | 25 | 710 | +0.2% |
| Indiana | $19 | $59 | 10 | 70 | +0.2% |
| Iowa | $19 | $42 | 5 | 26 | +0.2% |
| Kansas | $19 | $144 | 5 | 674 | +0.2% |
| Kentucky | $19 | $69 | 4 | 27 | +0.2% |
| Maine | $19 | $47 | 4 | 15 | +0.2% |
| Maryland | $19 | $130 | 24 | 481 | +0.2% |
| Massachusetts | $19 | $146 | 36 | 847 | +0.2% |
| Nevada | $19 | $132 | 13 | 346 | +0.2% |
| New Mexico | $19 | $59 | 2 | 41 | +0.2% |
| Pennsylvania | $19 | $95 | 7 | 316 | +0.2% |
| Rhode Island | $19 | $51 | 3 | 31 | +0.2% |
| South Carolina | $19 | $49 | 5 | 43 | +0.2% |
| Utah | $19 | $44 | 4 | 13 | +0.2% |
| Washington | $19 | $114 | 12 | 324 | +0.2% |
| West Virginia | $19 | $125 | 1 | 98 | +0.2% |
| Wisconsin | $19 | $101 | 7 | 64 | +0.2% |
| Colorado | $19 | $126 | 5 | 172 | +0.2% |
| Connecticut | $19 | $70 | 3 | 28 | +0.2% |
| New York | $19 | $146 | 89 | 2,376 | +0.1% |
| Puerto Rico | $19 | $21 | 45 | 124 | +0.1% |
| New Jersey | $19 | $117 | 47 | 5,802 | +0.1% |
| North Carolina | $19 | $121 | 11 | 3,199 | +0.1% |
| Texas | $19 | $123 | 55 | 2,794 | +0.1% |
| Florida | $19 | $136 | 30 | 3,033 | 0.0% |
| Ohio | $19 | $117 | 12 | 685 | 0.0% |
| Arizona | $19 | $120 | 4 | 967 | -0.1% |
| California | $19 | $115 | 44 | 4,807 | -0.1% |
| Georgia | $19 | $152 | 12 | 1,191 | -0.1% |
| Oklahoma | $19 | $113 | 8 | 202 | -0.3% |
| Virginia | $19 | $73 | 6 | 158 | -0.4% |
| Tennessee | $19 | $97 | 9 | 282 | -0.4% |
| Alabama | $19 | $128 | 8 | 972 | -0.4% |
| Oregon | $19 | $55 | 7 | 101 | -0.6% |
| South Dakota | $19 | $98 | 2 | 14 | -0.8% |
| Louisiana | $19 | $107 | 5 | 59 | -1.5% |
| Mississippi | $19 | $80 | 6 | 23 | -2.2% |
| Hawaii | $18 | $62 | 2 | 84 | -4.0% |
| Michigan | $18 | $47 | 13 | 209 | -4.6% |
⚠️ 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