Incision Of Tendon Of Finger
What Medicare pays for 26455, what providers bill, and how the price varies across 5 states, drawn from CMS 2023 claims data.
26455 · the short answer
For incision of tendon of finger, Medicare pays about $281.39 while providers bill $2,530.06 on average, a 9.0× markup, a higher-than-typical markup. State-level Medicare rates range 21% from lowest to highest.
- Medicare pays
- $281.39
- Providers bill
- $2,530.06
- Markup
- 9.0×
- Markup percentile
- 82th
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Musculoskeletal Surgery procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
9 Among the most affordable more affordable than 82% of 8,901 procedures
Each bar is a band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Pennsylvania | $317.39 | $2,202.91 |
| Texas | $313.39 | $2,715.65 |
| California | $293.77 | $2,295.03 |
| Florida | $277.89 | $3,450.74 |
| New York | $261.80 | $3,729.42 |
What the Data Says About Incision Of Tendon Of Finger
Across 5 states with reporting providers, CPT code 26455 (Incision Of Tendon Of Finger) shows a national average Medicare payment of $281.39 against an average billed charge of $2,530.06. That gap, a 9.0x markup, or 799% above the Medicare allowed amount, runs well above the median for tracked procedures, a sign the chargemaster rate here is more aspirational than transactional.
Musculoskeletal Surgery procedures like this one saw 438 services billed to Medicare in 2023 by 217 distinct providers, serving 233 unique beneficiaries. State-level variation is significant: New York reports the lowest average payment at $261.80, while Pennsylvania reports the highest at $317.39. The 21% spread here is a moderate, fairly ordinary GPCI effect, local cost-of-practice adjustments nudging the allowed amount up or down without reshaping it.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Musculoskeletal Surgery category (2.24x), the estimated commercial insurance price lands near $792.44, with self-pay cash discounts commonly bringing the figure closer to $961.09. Within Musculoskeletal Surgery, Incision Of Tendon Of Finger ranks #1016 of 1411 tracked procedures by national average Medicare payment.
What to do with this
If you may have incision of tendon of finger done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare incision of tendon of finger costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Incision Of Tendon Of Finger cost?
Incision Of Tendon Of Finger (CPT 26455) is priced fairly consistently nationwide: Medicare pays $281.39 on average, and the $261.80-$317.39 state range stays relatively tight. Providers typically bill $2,530.06.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Incision Of Tendon Of Finger cost with insurance?
With commercial insurance, incision of tendon of finger costs an estimated $792.44 on average (range: $554.71-$1,109.42), a moderate premium over Medicare's $281.39. Without insurance, the estimated cash price is $961.09.
Which state has the lowest cost for Incision Of Tendon Of Finger?
New York and Pennsylvania bookend the range for Incision Of Tendon Of Finger, at $261.80 and $317.39 respectively - a relatively tight $55.59 spread nationwide.
How many providers perform Incision Of Tendon Of Finger?
Incision Of Tendon Of Finger is comparatively uncommon: only 217 providers nationally billed Medicare for it in 2023, serving 233 beneficiaries via 438 total services.
What is the billed-to-Medicare markup for Incision Of Tendon Of Finger?
Providers bill 9.0x what Medicare pays for Incision Of Tendon Of Finger - a higher-than-typical markup at 799% above the Medicare rate.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.