CPT 26055 · professional fee

Incise finger tendon sheath (CPT 26055): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 26055, from their published in-network rate files.

Orthopedic surgerySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$614

P10 to P90: $354 to $1,266

vs Medicare

213%

facility rate $287.58

Payer spread

2.04×

UHC $953 vs Aetna $467

State spread

3.8×

AK $1,623 to OK $428

5,054 sampled providers6,108 TINs51 statesSample-based · how this is calculated

What the data shows

Generated from this code's own numbers

UnitedHealthcare has the highest median for CPT 26055 in the files analyzed, at $953, 104% above Aetna ($467), the lowest of the 4 payers shown.

The state spread is 3.8×: Alaska has the highest median at $1,623 and Oklahoma the lowest at $428, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 213% of the Medicare facility rate ($287.58), which ranks 24th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $217) and widest within Blue Cross Blue Shield ($380).

This is a top-31 code for orthopedic surgery by Medicare allowed dollars, so it carries real revenue weight for that specialty.

The Medicare comparison uses the facility rate: the non-facility rate ($629.61) is 2.2× higher because it includes device or supply cost that professional-fee contracts do not.

Rates by payer

Median of per-provider median rates, with interquartile range

Payer	Median	P25	P75	vs national	Rank	Providers	Position
UnitedHealthcare	$953	$729	$1,288	+55%	1	4,255	331% of Medicare
Blue Cross Blue Shield	$574	$434	$814	-6%	2	3,907	200% of Medicare
Cigna	$546	$437	$722	-11%	3	4,034	190% of Medicare
Aetna	$467	$363	$580	-24%	4	3,077	162% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($287.58)

Rates by state

Median across payers · 51 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$1,623	+164%	Aetna	BCBS	65
2	Wisconsin	$1,139	+86%	UHC	Aetna	97
3	Nebraska	$980	+60%	UHC	Aetna	95
4	Wyoming	$867	+41%	UHC	Cigna	65
5	Vermont	$837	+36%	UHC	BCBS	35
6	Washington	$814	+33%	UHC	Aetna	101
7	Minnesota	$800	+30%	UHC	Aetna	102
8	Massachusetts	$794	+29%	UHC	Aetna	111
9	Hawaii	$785	+28%	Cigna	BCBS	68
10	North Dakota	$770	+26%	UHC	Aetna	46
11	Oregon	$764	+24%	UHC	Aetna	93
12	South Dakota	$734	+20%	UHC	Cigna	97
13	Iowa	$729	+19%	UHC	Aetna	104
14	Connecticut	$723	+18%	UHC	Aetna	114
15	New Jersey	$709	+16%	UHC	Aetna	95
16	Georgia	$699	+14%	UHC	BCBS	124
17	District of Columbia	$698	+14%	UHC	BCBS	35
18	New Hampshire	$683	+11%	UHC	Aetna	118
19	Mississippi	$682	+11%	BCBS	Cigna	112
20	New York	$663	+8%	UHC	Aetna	111
21	North Carolina	$648	+6%	UHC	Aetna	128
22	Rhode Island	$639	+4%	UHC	Aetna	98
23	Michigan	$623	+2%	UHC	Aetna	102
24	South Carolina	$619	+1%	UHC	Aetna	106
25	Tennessee	$615	+0%	UHC	Aetna	115
26	Idaho	$599	-2%	UHC	Cigna	120
27	Nevada	$597	-3%	UHC	Aetna	109
28	Pennsylvania	$580	-5%	UHC	Aetna	103
29	Maine	$580	-6%	UHC	BCBS	94
30	Colorado	$572	-7%	UHC	BCBS	103
31	Illinois	$568	-8%	UHC	Aetna	104
32	Arizona	$563	-8%	UHC	BCBS	99
33	Delaware	$554	-10%	UHC	Aetna	59
34	Maryland	$549	-11%	UHC	BCBS	105
35	Kentucky	$525	-14%	UHC	Aetna	124
36	Virginia	$523	-15%	UHC	BCBS	105
37	Louisiana	$511	-17%	UHC	Aetna	103
38	Missouri	$508	-17%	UHC	Aetna	112
39	New Mexico	$506	-18%	UHC	BCBS	104
40	California	$505	-18%	UHC	Aetna	109
41	Arkansas	$491	-20%	UHC	Aetna	119
42	Kansas	$489	-20%	UHC	BCBS	108
43	Ohio	$485	-21%	UHC	BCBS	110
44	Alabama	$483	-21%	UHC	Cigna	118
45	Florida	$483	-21%	UHC	Cigna	108
46	Indiana	$481	-22%	UHC	BCBS	115
47	West Virginia	$477	-22%	UHC	BCBS	89
48	Texas	$476	-22%	UHC	Aetna	121
49	Utah	$475	-23%	UHC	Aetna	97
50	Montana	$472	-23%	UHC	BCBS	79
51	Oklahoma	$428	-30%	UHC	Aetna	100

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 26055?

In the files we analyzed, UnitedHealthcare, at a median of $953 across 4,255 sampled providers. Aetna is lowest at $467, 104% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 213% of the 2026 Medicare facility rate of $287.58.

Which state has the highest median for CPT 26055?

Alaska has the highest median at $1,623; Oklahoma has the lowest at $428.

Is this the surgeon, physician or facility payment?

These are professional (physician) fees only. Facility, device and implant payments are priced separately and are not included.

How current is this data?

It is the August 2026 snapshot of each payer's in-network rate file. Sources and filters are listed in the methodology below.

Methodology

How these numbers are calculated

Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.

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