UnitedHealthcare · North Carolina · commercial in-network

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

Across 228 procedure codes for 8 specialties
Rate index vs state market
111
11% above the North Carolina median
Rank in state
1 of 4
UHC 111 · Cigna 103 · BCBS 100 · Aetna 64
vs own national
112
UHC's level vs its national median
Codes where highest
46%
of 228 codes
747 sampled providers424 TINs228 codesMedian 207% of Medicare · method

What the data shows

Generated from North Carolina and UnitedHealthcare data only
1

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.

2

UnitedHealthcare has the highest median for only 46% of codes in North Carolina; UnitedHealthcare leads with an index of 111 in the files analyzed.

3

UnitedHealthcare's North Carolina rates sit 12% above its own national level, the 17th highest of its 51 states.

4

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

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
UnitedHealthcare1111
111
46%747
Cigna1032
103
31%851
Blue Cross Blue Shield1003
100
22%976
Aetna644
64
1%568

Where UnitedHealthcare pays most and least against the North Carolina market

Codes with the largest gap to the state median

Highest above market

CodeUHCMarketGapProv.
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

CodeUHCMarketGapProv.
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

Index vs the payer's own national median (100 = national)

Highest states

StateIndexProv.
Alaska193
164
Wisconsin173
610
Minnesota166
618
Oregon164
683
Massachusetts152
772

Lowest states

StateIndexProv.
Alabama73
719
Florida78
744
Arizona82
699
Louisiana83
808
Delaware83
379

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

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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