Commercial healthcare reimbursement in North Carolina
How North Carolina compares with the nation, by payer, specialty and procedure.
North Carolina at a glance
What the data shows
North Carolina ranks 15th of 51 states for commercial reimbursement, with an index of 115 (100 = national median) across 228 procedure codes; the South region averages 94.
Commercial rates in North Carolina run a median 175% of Medicare.
UnitedHealthcare has the highest index in the state (111) and Aetna the lowest (64), a 47-point gap, in the files analyzed.
CPT 51702 (Insert temp bladder cath) is the strongest relative to the national median (168% of it, a 68% premium); CPT 88312 (Special stains group 1) is furthest below (69% of the national median, 31% lower).
By specialty, North Carolina is strongest for diagnostic radiology (ranks 5th of 51 states for that specialty) and weakest for dermatology (30th of 50).
Against Medicare, gastroenterology has the highest ratio in North Carolina (214% of Medicare) and dermatology the lowest (95%).
Payer ranking in North Carolina
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 111 | 1 | 228 | 747 | 424 | |
| Cigna | 103 | 2 | 227 | 851 | 525 | |
| Blue Cross Blue Shield | 100 | 3 | 224 | 976 | 1,246 | |
| Aetna | 64 | 4 | 227 | 568 | 466 |
Reimbursement index by specialty in North Carolina
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Diagnostic radiology | 127 | 5 of 51 | 198% | 49 | 139 | |
| Urology | 119 | 9 of 50 | 185% | 37 | 123 | |
| Internal medicine | 117 | 13 of 51 | 139% | 25 | 124 | |
| Gastroenterology | 115 | 14 of 50 | 214% | 36 | 124 | |
| Cardiology | 118 | 16 of 51 | 176% | 38 | 127 | |
| Orthopedic surgery | 110 | 17 of 51 | 172% | 39 | 128 | |
| Ophthalmology | 98 | 26 of 50 | 120% | 42 | 119 | |
| Dermatology | 97 | 30 of 50 | 95% | 44 | 125 |
Specialty by payer in North Carolina
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 144 | 74 | 119 | 116 |
| Dermatology | 102 | 84 | 92 | 109 |
| Ophthalmology | 107 | 83 | 101 | 94 |
| Cardiology | 155 | 72 | 123 | 102 |
| Orthopedic surgery | 123 | 73 | 123 | 105 |
| Diagnostic radiology | 145 | 83 | 156 | 82 |
| Urology | 138 | 62 | 113 | 109 |
| Gastroenterology | 123 | 69 | 102 | 129 |
North Carolina compared with South region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| North Carolina | 115 | 15 | 175% | 1,009 | |
| Mississippi | 111 | 16 | 159% | 778 | |
| District of Columbia | 104 | 20 | 154% | 521 | |
| Georgia | 125 | 11 | 188% | 978 | |
| Tennessee | 96 | 29 | 143% | 944 | |
| West Virginia | 93 | 34 | 146% | 608 |
Procedures that pay most and least in North Carolina vs the nation
Highest vs national
| Code | North Caroli | National | Gap | Prov. |
|---|---|---|---|---|
| 51702 Insert temp bladder cath | $102 | $61 | +68% | 123 |
| 51700 Irrigation of bladder | $122 | $77 | +58% | 123 |
| 74183 Mri abd w/o cntr flwd cntr | $967 | $634 | +52% | 124 |
| 72197 Mri pelvis w/o & w/dye | $953 | $634 | +50% | 123 |
| 51720 Treatment of bladder lesion | $166 | $111 | +50% | 123 |
| 52287 Cystoscopy chemodenervation | $535 | $367 | +46% | 123 |
| 52000 Cystourethroscopy | $305 | $210 | +45% | 123 |
| 52281 Cystoscopy and treatment | $482 | $334 | +44% | 123 |
| 77080 Dxa bone density axial | $94 | $66 | +42% | 124 |
| 71250 Ct thorax dx c- | $351 | $250 | +40% | 124 |
| 72125 Ct neck spine w/o dye | $348 | $249 | +40% | 124 |
| 72131 Ct lumbar spine w/o dye | $345 | $248 | +39% | 124 |
| 45384 Colonoscopy w/lesion removal | $718 | $519 | +38% | 124 |
| 52310 Cystoscopy and treatment | $438 | $317 | +38% | 123 |
| 64566 Neuroeltrd stim post tibial | $95 | $69 | +38% | 123 |
Lowest vs national
| Code | North Caroli | National | Gap | Prov. |
|---|---|---|---|---|
| 88312 Special stains group 1 | $68 | $97 | -31% | 220 |
| 92004 Compre oph exam new pt 1/> | $93 | $124 | -25% | 118 |
| 92014 Compre oph exam est pt 1/> | $78 | $101 | -23% | 118 |
| 88305 Tissue exam by pathologist | $55 | $70 | -22% | 220 |
| 88342 Imhchem/imcytchm 1st antb | $75 | $95 | -22% | 117 |
| 92012 Intrm oph exam est patient | $61 | $76 | -19% | 118 |
| 88313 Special stains group 2 | $57 | $71 | -19% | 103 |
| 66821 After cataract laser surgery | $327 | $393 | -17% | 119 |
| 92202 Opscpy extnd on/mac draw | $14 | $17 | -16% | 117 |
| 96910 Photchmtx tar&uvb/ptrltm&uvb | $107 | $125 | -15% | 125 |
| 77280 Ther rad simulaj field smpl | $258 | $302 | -14% | 117 |
| 97110 Therapeutic exercises | $27 | $31 | -14% | 128 |
| 67904 Repair eyelid defect | $717 | $816 | -12% | 118 |
| 92235 Fluorescein angrph mltiframe | $127 | $145 | -12% | 100 |
| 99487 Cplx chrnc care 1st 60 min | $109 | $121 | -10% | 122 |
Frequently asked questions
How do commercial reimbursement rates in North Carolina compare with the rest of the country?
North Carolina ranks 15th of 51 states with an index of 115, across 228 procedure codes. Median commercial rates run 175% of the Medicare rate.
Which payer has the highest rates in North Carolina?
In the files we analyzed, UnitedHealthcare has the highest index (111) and Aetna the lowest (64). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in North Carolina?
Diagnostic radiology ranks 5th of 51 states.
How many providers does this North Carolina page cover?
1,009 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between North Carolina and the national median?
CPT 51702 (Insert temp bladder cath) is highest relative to the nation at 168% of the national median; CPT 88312 (Special stains group 1) is lowest at 69%.
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.
Benchmark your North Carolina contracts
Compare your negotiated rates with these state medians by payer and specialty.