UnitedHealthcare negotiated rates in North Carolina
How UnitedHealthcare's North Carolina rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
UnitedHealthcare in North Carolina at a glance
What the data shows
UnitedHealthcare ranks 1st of 4 payers in North Carolina with a rate index of 111 (100 = the North Carolina market median), across 228 procedure codes.
UnitedHealthcare has the highest median for only 46% of codes in North Carolina; UnitedHealthcare leads with an index of 111 in the files analyzed.
UnitedHealthcare's North Carolina rates sit 12% above its own national level, the 17th highest of its 51 states.
Largest premium over the North Carolina market: CPT 52648 (Laser surgery of prostate) at 194% of market; largest discount: CPT 88313 (Special stains group 2) at 81%.
How the four payers compare in North Carolina
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| UnitedHealthcare | 111 | 1 | 46% | 747 | |
| Cigna | 103 | 2 | 31% | 851 | |
| Blue Cross Blue Shield | 100 | 3 | 22% | 976 | |
| Aetna | 64 | 4 | 1% | 568 |
Where UnitedHealthcare pays most and least against the North Carolina market
Highest above market
| Code | UHC | Market | Gap | Prov. |
|---|---|---|---|---|
| 52648 Laser surgery of prostate | $2,957 | $1,520 | +94% | 88 |
| 52332 Cystoscopy and treatment | $831 | $451 | +84% | 88 |
| 92014 Compre oph exam est pt 1/> | $137 | $78 | +76% | 88 |
| 92004 Compre oph exam new pt 1/> | $163 | $93 | +74% | 88 |
| 93458 L hrt artery/ventricle angio | $2,484 | $1,487 | +67% | 97 |
| 26055 Incise finger tendon sheath | $1,040 | $648 | +60% | 99 |
| 93016 Cv stress test supvj only | $54 | $34 | +60% | 97 |
| 92012 Intrm oph exam est patient | $97 | $61 | +59% | 88 |
Furthest below market
| Code | UHC | Market | Gap | Prov. |
|---|---|---|---|---|
| 88313 Special stains group 2 | $46 | $57 | -19% | 93 |
| 88342 Imhchem/imcytchm 1st antb | $64 | $75 | -14% | 110 |
| 43242 Egd us fine needle bx/aspir | $505 | $585 | -14% | 93 |
| 96413 Chemo iv infusion 1 hr | $195 | $226 | -14% | 93 |
| 96574 Dbrdmt prmlg les w/pdt | $257 | $294 | -13% | 110 |
| 88305 Tissue exam by pathologist | $48 | $55 | -13% | 203 |
| 51798 Us urine capacity measure | $24 | $27 | -11% | 88 |
| 67028 Injection eye drug | $158 | $176 | -10% | 88 |
Where UnitedHealthcare pays above and below its national level
Frequently asked questions
Does UnitedHealthcare pay more or less than the other payers in North Carolina?
UnitedHealthcare ranks 1st of 4 in North Carolina with an index of 111. It is highest on 46% of codes.
Are UnitedHealthcare's North Carolina rates above or below its national level?
About 12% above.
Which procedure does UnitedHealthcare pay most above market in North Carolina?
CPT 52648 (Laser surgery of prostate), at 194% of the North Carolina median.
Methodology
- 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.
Is your UnitedHealthcare contract at market in North Carolina?
Compare your negotiated rates for these codes with North Carolina medians for each payer.