26055

Incision of tendon covering of finger

Medicare pricing data for 10,511 providers across 52 states

🤖AI Overview

This procedure has a 7.8x markup — hospitals charge $2,846 but Medicare allows only $364.75. Uninsured patients may face bills 7.8 times higher than what insurance negotiates. Prices vary significantly by location — from $213 in South Dakota to $493 in Alaska. Where you get this procedure matters more than almost any other factor. 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

Incision of tendon covering of finger (HCPCS code 26055) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $364.75, but hospitals typically charge $2,846 — a 7.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$72.95

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $364.75, your out-of-pocket cost would be approximately $72.95. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$364.75
Average Hospital Charge
$2,846
Markup Ratio
7.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$2,846.00
Medicare Allowed$364.75
Medicare Payment$286.30

Hospitals charge 7.8x more than what Medicare allows for this procedure. Medicare actually pays $286.30 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$493$6,45241392+35.2%
Hawaii$452$1,72633366+23.8%
California$443$3,33588910,972+21.3%
Maryland$420$3,0832053,765+15.1%
New Jersey$413$5,4982763,983+13.1%
Connecticut$409$3,4661341,830+12.1%
Colorado$401$3,8521993,628+10.1%
Rhode Island$397$2,57932515+8.8%
Oregon$395$2,1311451,762+8.3%
Delaware$395$2,693291,350+8.2%
Wyoming$394$2,49658612+8.0%
Utah$393$2,1221311,570+7.8%
New York$389$3,7024386,191+6.6%
Illinois$388$3,9543816,031+6.4%
New Hampshire$383$2,980581,275+5.1%
Washington$380$1,6552344,160+4.3%
Florida$379$3,25370112,354+3.8%
Minnesota$376$2,3612232,232+3.1%
Iowa$369$2,2851091,842+1.2%
Arizona$369$3,3132054,969+1.2%
Michigan$366$2,1323243,519+0.2%
Virginia$360$2,7142574,696-1.2%
North Carolina$360$2,2393905,005-1.2%
Georgia$359$3,3193494,532-1.5%
Montana$358$1,60953943-1.7%
Massachusetts$357$2,3002263,190-2.1%
Nevada$357$3,664641,205-2.1%
Indiana$357$2,9312463,699-2.1%
Nebraska$350$2,545771,363-3.9%
Maine$338$1,40849451-7.5%
Tennessee$335$2,5362684,135-8.1%
Pennsylvania$335$2,2114706,940-8.1%
Wisconsin$333$3,5152382,630-8.8%
Mississippi$331$2,4201171,877-9.1%
South Carolina$330$2,0701723,534-9.5%
Kansas$327$2,4591482,028-10.3%
Ohio$327$2,1454505,450-10.3%
Alabama$327$1,9042002,578-10.5%
Texas$326$2,8177528,518-10.7%
District of Columbia$326$1,62813226-10.7%
Missouri$324$2,9882362,669-11.1%
Idaho$321$1,450911,224-12.0%
Vermont$317$1,63118301-13.0%
New Mexico$308$1,90866719-15.5%
Louisiana$307$2,3371651,741-15.7%
Arkansas$305$1,8411181,481-16.5%
Kentucky$295$2,0281481,380-19.0%
North Dakota$283$1,83121500-22.4%
Puerto Rico$280$421638-23.2%
Oklahoma$271$1,3141401,616-25.7%
West Virginia$258$1,42559363-29.2%
South Dakota$213$1,57744660-41.6%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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