Does NOVANT HEALTH BALLANTYNE MEDICAL CTR publish its standard charges and chargemaster?

Yes. NOVANT HEALTH BALLANTYNE MEDICAL CTR publishes a machine-readable file with 13,363 standard-charge rows — gross charges, cash prices, and payer-negotiated rates, earning a CMS price transparency compliance grade of A. Browse the negotiated rates by procedure and payer on this page.

How much does NOVANT HEALTH BALLANTYNE MEDICAL CTR charge for procedures?

NOVANT HEALTH BALLANTYNE MEDICAL CTR (Charlotte, NC) publishes a separately negotiated rate for each insurance payer, plus a discounted cash price and a gross (list) charge, for every procedure in its price transparency file. This page compares each procedure's negotiated median against the national median so you can see whether a price is above or below market.

▸ Hospital · NC · CCN 340195

NOVANT HEALTH BALLANTYNE MEDICAL CTR

Charlotte, NC, 340195

36 beds

Compliance grade

100/100

Rates published

13,363

last crawl 2026-05-23

Procedures tracked

194

of 209 target codes

Payers

with negotiated rates

Procedures tracked

...

Payers

...

▸ Compare with other hospitals All NC hospitalsJSON

The report bundles all published codes × every payer rate + compliance grade as a downloadable PDF + CSV with a data-version manifest.

Source MRF: https://www2.novanthealth.org/Public_Files/regulatory/863305323_novant-health-ballantyne-medical-center-llc-dba-novant-health-ballantyne-medical-center_standardcharges.json · JSON

Procedures & rates

vs nat'l shows this hospital's negotiated median against the national median for that code (green = at/below market, amber = 1–1.5×, red = >1.5× the national median).

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	vs nat'l	Neg max
behavioral
Psychoses	MS-DRG	885	22	—	—	$31.78	$72	0.01×	$28,175
Psychiatric diagnostic evaluation	CPT	90791	22	—	—	$20.39	$70.5	0.40×	$344.96
Psychiatric eval with medical services	CPT	90792	22	—	—	$20.39	$70.5	0.41×	$344.96
Psychotherapy 30 minutes	CPT	90832	22	—	—	$20.39	$70.5	0.47×	$344.96
Psychotherapy 45 minutes	CPT	90834	22	—	—	$20.39	$70.5	0.44×	$344.96
Psychotherapy 60 minutes	CPT	90837	22	—	—	$20.39	$70.5	0.37×	$344.96
Crisis psychotherapy 60 minutes	CPT	90839	22	—	—	$20.39	$70.5	0.44×	$344.96
emergency
ED visit level 1	CPT	99281	22	$282	$141	$51.5	$174.84	1.2×	$273.54
ED visit level 2	CPT	99282	22	$573	$286.5	$51.5	$355.26	1.5×	$555.81
ED visit level 3	CPT	99283	22	$1,726	$863	$51.5	$1,070.12	2.6×	$1,674.22
ED visit level 4	CPT	99284	22	$2,455	$1,227.5	$51.5	$1,522.1	2.3×	$2,381.35
ED visit level 5	CPT	99285	22	$3,453	$1,726.5	$51.5	$2,140.86	2.1×	$3,349.41
Critical care, first hour	CPT	99291	22	$4,644	$2,322	$51.5	$2,879.28	2.7×	$4,504.68
imaging
CT head without contrast	CPT	70450	22	$2,148	$1,074	$51.5	$446.78	2.2×	$2,083.56
CT head with contrast	CPT	70460	22	$2,551	$1,275.5	$51.5	$530.6	2.3×	$2,474.47
CT head with and without contrast	CPT	70470	22	$2,929	$1,464.5	$51.5	$609.23	2.3×	$2,841.13
CT neck with contrast	CPT	70491	22	$2,978	$1,489	$51.5	$619.42	2.3×	$2,888.66
MRI brain without contrast	CPT	70551	22	$3,243	$1,621.5	$51.5	$1,475.12	3.7×	$3,145.71
MRI brain with contrast	CPT	70552	22	$3,801	$1,900.5	$51.5	$790.6	1.7×	$3,686.97
MRI brain with and without contrast	CPT	70553	22	$5,036	$2,518	$51.5	$1,047.48	1.8×	$4,884.92
Chest X-ray single view	CPT	71045	22	$392	$196	$51.5	$243.04	2.6×	$380.24
Chest X-ray 2 views	CPT	71046	22	$465	$232.5	$51.5	$288.3	2.9×	$451.05
Chest X-ray 3 views	CPT	71047	22	$560	$280	$51.5	$347.2	3.6×	$543.2
CT chest without contrast	CPT	71250	22	$2,123	$1,061.5	$51.5	$858.7	4.0×	$2,059.31
CT chest with contrast	CPT	71260	22	$2,865	$1,432.5	$51.5	$595.92	2.1×	$2,779.05
CT chest with and without contrast	CPT	71270	22	$3,504	$1,752	$51.5	$728.83	2.5×	$3,398.88
MRI chest without contrast	CPT	71550	22	$3,213	$1,606.5	$51.5	$668.3	1.6×	$3,116.61
MRI chest with contrast	CPT	71551	22	$3,369	$1,684.5	$51.5	$780.82	0.96×	$3,267.93
MRI chest with and without contrast	CPT	71552	22	$4,540	$2,270	$51.5	$944.32	1.6×	$4,403.8
Lumbosacral spine X-ray	CPT	72100	22	$560	$280	$34.12	$116.48	1.1×	$543.2
CT cervical spine without contrast	CPT	72125	22	$2,600	$1,300	$51.5	$540.8	2.7×	$2,522
CT thoracic spine without contrast	CPT	72128	22	$2,234	$1,117	$51.5	$464.67	2.3×	$2,166.98
CT lumbar spine without contrast	CPT	72131	22	$2,768	$1,384	$51.5	$575.74	2.8×	$2,684.96
MRI cervical spine without contrast	CPT	72141	22	$3,922	$1,961	$51.5	$815.77	2.1×	$3,804.34
MRI thoracic spine without contrast	CPT	72146	22	—	—	$20.39	$80	0.21×	$470.72
MRI lumbar spine without contrast	CPT	72148	22	—	—	$20.39	$80	0.21×	$463.72
MRI lumbar spine with and without contrast	CPT	72149	22	—	—	$20.39	$80	0.18×	$678.04
MRI cervical spine with and without contrast	CPT	72156	22	—	—	$20.39	$80	0.15×	$731.94
MRI lumbar spine with contrast	CPT	72158	22	—	—	$20.39	$80	0.15×	$721.21
CT pelvis without contrast	CPT	72192	22	$2,377	$1,188.5	$51.5	$1,081.94	5.4×	$2,305.69
CT pelvis with contrast	CPT	72193	22	$2,874	$1,437	$51.5	$597.79	2.1×	$2,787.78
Shoulder X-ray	CPT	73030	22	$465	$232.5	$26.41	$96.72	1.0×	$451.05
Humerus X-ray	CPT	73060	22	$465	$232.5	$25.81	$98.45	1.1×	$451.05
Hand X-ray 3 views	CPT	73130	22	$560	$280	$27.07	$116.48	1.3×	$543.2
MRI upper extremity joint without contrast	CPT	73221	22	—	—	$20.39	$80	0.19×	$477.48
MRI upper extremity joint with and without contrast	CPT	73223	22	—	—	$20.39	$80	0.13×	$709.78
Knee X-ray 1-2 views	CPT	73560	22	$465	$232.5	$25.81	$169.14	1.8×	$451.05
Ankle X-ray 3 views	CPT	73610	22	$560	$280	$27.07	$116.48	1.3×	$543.2
MRI lower extremity joint without contrast	CPT	73721	22	—	—	$20.39	$80	0.17×	$486.17
MRI lower extremity joint with and without contrast	CPT	73723	22	—	—	$20.39	$80	0.13×	$708.33
CT abdomen without contrast	CPT	74150	22	$2,488	$1,244	$51.5	$517.5	2.7×	$2,413.36
CT abdomen with contrast	CPT	74160	22	$3,216	$1,608	$51.5	$668.92	2.3×	$3,119.52
CT abdomen with and without contrast	CPT	74170	22	$3,703	$1,851.5	$51.5	$1,703.38	5.1×	$3,591.91
CT abdomen and pelvis without contrast	CPT	74176	22	$4,585	$2,292.5	$51.5	$953.68	2.6×	$4,447.45
CT abdomen and pelvis with contrast	CPT	74177	22	$5,640	$2,820	$51.5	$1,173.12	2.1×	$5,470.8
CT abdomen and pelvis with and without contrast	CPT	74178	22	$6,497	$3,248.5	$51.5	$1,351.37	2.4×	$6,302.09
MRI abdomen without contrast	CPT	74181	22	—	—	$20.39	$80	0.20×	$463.72
MRI abdomen with and without contrast	CPT	74183	22	—	—	$20.39	$80	0.14×	$747.17
Abdominal ultrasound complete	CPT	76700	22	$1,322	$661	$101.59	$274.97	1.8×	$1,282.34
Abdominal ultrasound limited	CPT	76705	22	$959	$479.5	$87.62	$199.47	1.4×	$930.23
Retroperitoneal ultrasound complete	CPT	76770	22	$1,128	$564	$101.59	$234.62	1.6×	$1,094.16
Obstetric ultrasound first trimester	CPT	76801	22	$791	$395.5	$101.59	$164.52	1.2×	$767.27
Obstetric ultrasound after first trimester	CPT	76805	22	$791	$395.5	$101.59	$164.52	1.1×	$767.27
Obstetric ultrasound with fetal anatomy	CPT	76811	22	$1,122	$561	$162.27	$238.24	1.0×	$1,088.34
Transvaginal ultrasound	CPT	76830	22	$1,028	$514	$101.44	$213.82	1.4×	$997.16
Pelvic ultrasound complete	CPT	76856	22	$1,294	$647	$101.59	$269.15	1.9×	$1,255.18
Scrotal ultrasound	CPT	76870	22	$1,035	$517.5	$101.53	$215.28	1.6×	$1,003.95
Diagnostic mammography unilateral	CPT	77065	20	$360	$180	$51.5	$223.2	1.5×	$349.2
Diagnostic mammography bilateral	CPT	77066	20	$457	$228.5	$51.5	$283.34	1.5×	$443.29
Screening mammography bilateral	CPT	77067	20	$376	$188	$51.5	$233.12	1.5×	$364.72
EKG complete	CPT	93000	20	—	—	$18.02	$33	1.3×	$97
EKG tracing only	CPT	93005	22	—	—	$9.96	$52	0.44×	$114.66
EKG interpretation only	CPT	93010	20	—	—	$20.39	$62	3.4×	$97
Transthoracic echocardiogram complete	CPT	93306	22	$2,926	$1,463	$206.8	$1,317.96	2.2×	$2,838.22
Transthoracic echocardiogram	CPT	93307	22	$2,266	$1,133	$133.09	$1,034.31	4.2×	$2,198.02
Stress echocardiogram	CPT	93350	22	$2,926	$1,463	$176.25	$1,317.96	2.6×	$2,838.22
inpatient
Respiratory infections & inflammations w MCC	MS-DRG	177	22	—	—	$46	$76.5	0.00×	$31,521
COPD w MCC	MS-DRG	190	22	—	—	$46	$76.5	0.01×	$22,343
COPD w CC	MS-DRG	191	22	—	—	$46	$76.5	0.01×	$17,004
COPD w/o CC/MCC	MS-DRG	192	22	—	—	$46	$76.5	0.01×	$12,950
Simple pneumonia & pleurisy w CC	MS-DRG	194	22	—	—	$46	$76.5	0.01×	$16,256
Simple pneumonia & pleurisy w/o CC/MCC	MS-DRG	195	22	—	—	$46	$76.5	0.01×	$12,677
AMI discharged alive w MCC	MS-DRG	280	22	—	—	$46	$76.5	0.00×	$32,356
AMI discharged alive w CC	MS-DRG	281	22	—	—	$46	$76.5	0.01×	$28,491
AMI discharged alive w/o CC/MCC	MS-DRG	282	22	—	—	$46	$76.5	0.01×	$22,732
Heart failure & shock w MCC	MS-DRG	291	22	—	—	$46	$76.5	0.01×	$25,896
Heart failure & shock w CC	MS-DRG	292	22	—	—	$46	$76.5	0.01×	$17,125
Heart failure & shock w/o CC/MCC	MS-DRG	293	22	—	—	$46	$76.5	0.01×	$11,417
Cardiac arrhythmia w MCC	MS-DRG	308	22	—	—	$46	$76.5	0.01×	$24,286
Cardiac arrhythmia w CC	MS-DRG	309	22	—	—	$46	$76.5	0.01×	$14,840
Cardiac arrhythmia w/o CC/MCC	MS-DRG	310	22	—	—	$46	$76.5	0.01×	$11,419
GI hemorrhage w CC	MS-DRG	378	22	—	—	$46	$76.5	0.01×	$19,782
GI hemorrhage w/o CC/MCC	MS-DRG	379	22	—	—	$46	$76.5	0.01×	$12,716
Esophagitis/gastroenteritis w/o MCC	MS-DRG	392	22	—	—	$46	$76.5	0.01×	$15,725
Fractures of femur w/o MCC	MS-DRG	533	22	—	—	$46	$76.5	0.01×	$31,622
Kidney/UTI w MCC	MS-DRG	689	22	—	—	$46	$76.5	0.01×	$23,404
Kidney/UTI w/o MCC	MS-DRG	690	22	—	—	$46	$76.5	0.01×	$16,328
Septicemia or severe sepsis w MV 96+ hrs	MS-DRG	871	22	—	—	$46	$76.5	0.00×	$39,182
Septicemia or severe sepsis w/o MV 96+ hrs	MS-DRG	872	22	—	—	$46	$76.5	0.01×	$20,641
Initial hospital care, low complexity	CPT	99221	20	—	—	$20.39	$62	0.67×	$97
Initial hospital care, moderate complexity	CPT	99222	20	—	—	$20.39	$62	0.37×	$97
Initial hospital care, high complexity	CPT	99223	20	—	—	$20.39	$62	0.28×	$97
Hospital discharge, <30 min	CPT	99238	20	—	—	$20.39	$62	0.72×	$97
Hospital discharge, >30 min	CPT	99239	20	—	—	$20.39	$62	0.51×	$97
lab
Basic metabolic panel (BMP)	CPT	80048	22	$131	$65.5	$8.46	$81.22	2.5×	$127.07
General health panel	CPT	80050	20	$294	$147	$51.5	$182.28	1.7×	$285.18
Electrolyte panel	CPT	80051	22	$104	$52	$7.01	$64.48	2.7×	$100.88
Comprehensive metabolic panel	CPT	80053	22	$157	$78.5	$10.56	$97.34	2.2×	$152.29
Lipid panel	CPT	80061	22	$200	$100	$13.39	$124	3.2×	$194
Renal function panel	CPT	80069	22	$132	$66	$8.68	$81.84	3.0×	$128.04
Hepatic function panel	CPT	80076	22	$131	$65.5	$8.17	$81.22	3.1×	$127.07
Urinalysis non-automated	CPT	81002	22	$63	$31.5	$3.48	$37.17	5.3×	$61.11
Urinalysis automated	CPT	81003	22	$43	$21.5	$2.25	$26.66	1.9×	$51.5
Glucose quantitative	CPT	82947	22	$94	$47	$3.93	$41.76	2.4×	$91.18
Hemoglobin A1c	CPT	83036	22	$145	$72.5	$9.71	$89.9	3.3×	$140.65
Thyroid stimulating hormone (TSH)	CPT	84443	22	$240	$120	$16.8	$148.8	3.1×	$232.8
Complete blood count with automated differential	CPT	85025	22	$229	$114.5	$7.77	$86.4	3.3×	$222.13
Complete blood count without differential	CPT	85027	22	$97	$48.5	$6.47	$60.14	2.8×	$94.09
Urine culture bacterial	CPT	87086	22	$120	$60	$8.07	$74.4	3.2×	$116.4
Urine culture identification	CPT	87088	22	$120	$60	$8.09	$74.4	3.3×	$116.4
Tissue exam by pathologist level IV	CPT	88305	22	$658	$329	$50.64	$407.96	4.0×	$638.26
maternity
Fetal non-stress test	CPT	59025	22	$679	$339.5	$127.02	$420.98	2.2×	$658.63
Routine obstetric care including vaginal delivery	CPT	59400	20	—	—	$20.39	$62	0.03×	$97
Vaginal delivery only	CPT	59409	22	—	—	$20.39	$70.5	0.03×	$6,291.42
Vaginal delivery with postpartum	CPT	59410	20	—	—	$20.39	$62	0.06×	$97
Routine obstetric care with C-section	CPT	59510	20	—	—	$20.39	$62	0.02×	$97
C-section delivery only	CPT	59514	20	—	—	$20.39	$62	0.06×	$97
C-section with postpartum	CPT	59515	20	—	—	$20.39	$62	0.05×	$97
office
Office visit, new patient, 15-29 min	CPT	99202	20	—	—	$20.39	$62	0.72×	$97
Office visit, new patient, 30-44 minutes	CPT	99203	20	—	—	$20.39	$62	0.51×	$97
Office visit, new patient, 45-59 min	CPT	99204	20	—	—	$20.39	$62	0.36×	$97
Office visit, new patient, 60-74 min	CPT	99205	20	—	—	$20.39	$62	0.28×	$97
Office visit, established patient, 5 min	CPT	99211	20	—	—	$20.39	$62	0.96×	$97
Office visit, established patient, 10-19 min	CPT	99212	20	—	—	$20.39	$62	0.78×	$97
Office visit, established patient, 20-29 minutes	CPT	99213	20	—	—	$20.39	$62	0.54×	$97
Office visit, established patient, 30-39 minutes	CPT	99214	20	—	—	$20.39	$62	0.41×	$97
Office visit, established patient, 40-54 min	CPT	99215	20	—	—	$20.39	$62	0.33×	$97
preventive
Upper GI endoscopy diagnostic	CPT	43235	22	—	—	$20.39	$70.5	0.08×	$1,762.74
Upper GI endoscopy with biopsy	CPT	43239	22	—	—	$20.39	$70.5	0.07×	$1,762.74
Sigmoidoscopy diagnostic	CPT	45330	22	—	—	$20.39	$70.5	0.08×	$1,807.4
Sigmoidoscopy with biopsy	CPT	45331	22	—	—	$20.39	$70.5	0.08×	$1,807.4
Colonoscopy diagnostic	CPT	45378	22	—	—	$20.39	$70.5	0.08×	$1,807.4
Colonoscopy with biopsy	CPT	45380	22	—	—	$20.39	$70.5	0.06×	$2,325.7
Colonoscopy with polyp removal	CPT	45385	22	—	—	$20.39	$70.5	0.06×	$2,325.7
surgery
Total shoulder arthroplasty	CPT	23472	22	—	—	$20.39	$70.5	0.02×	$34,077
Hip hemiarthroplasty	CPT	27125	22	—	—	$20.39	$70.5	0.06×	$24,952
Total hip replacement	CPT	27130	22	—	—	$20.39	$70.5	0.02×	$24,952
Total knee replacement	CPT	27447	22	—	—	$20.39	$70.5	0.02×	$24,952
Knee revision arthroplasty single component	CPT	27486	22	—	—	$20.39	$70.5	0.04×	$24,952
Knee revision arthroplasty all components	CPT	27487	22	—	—	$20.39	$70.5	0.04×	$34,077
Shoulder arthroscopy with decompression	CPT	29826	20	—	—	$20.39	$62	0.19×	$97
Shoulder arthroscopy with rotator cuff repair	CPT	29827	22	—	—	$20.39	$70.5	0.02×	$14,103
Knee arthroscopy with meniscectomy	CPT	29881	22	—	—	$20.39	$70.5	0.03×	$6,359.2
ACL reconstruction	CPT	29888	22	—	—	$20.39	$70.5	0.02×	$14,103
Major small/large bowel procedures w MCC	MS-DRG	329	22	—	—	$46	$76.5	0.00×	$97,593
Major small/large bowel procedures w CC	MS-DRG	330	22	—	—	$46	$76.5	0.00×	$50,897
Major small/large bowel procedures w/o CC/MCC	MS-DRG	331	22	—	—	$46	$76.5	0.00×	$35,731
CABG single arterial graft	CPT	33533	20	—	—	$20.39	$62	0.03×	$97
CABG 2 arterial grafts	CPT	33534	20	—	—	$20.39	$62	0.03×	$97
CABG 3 arterial grafts	CPT	33535	20	—	—	$20.39	$62	0.03×	$97
CABG 4+ arterial grafts	CPT	33536	20	—	—	$20.39	$62	0.03×	$97
Laparoscopic cholecystectomy w/o CDE w MCC	MS-DRG	418	22	—	—	$46	$76.5	0.00×	$35,916
Laparoscopic cholecystectomy w/o CDE w CC	MS-DRG	419	22	—	—	$46	$76.5	0.01×	$28,999
Laparoscopic cholecystectomy w/o CDE w/o CC/MCC	MS-DRG	420	22	—	—	$46	$76.5	0.00×	$72,340
Open appendectomy	CPT	44950	22	—	—	$20.39	$70.5	0.06×	$12,582
Laparoscopic appendectomy	CPT	44970	22	—	—	$20.39	$70.5	0.05×	$11,750
Major joint replacement w MCC	MS-DRG	469	22	—	—	$46	$76.5	0.00×	$81,548
Major joint replacement w/o MCC	MS-DRG	470	22	—	—	$46	$75	0.00×	$49,743
Laparoscopic cholecystectomy	CPT	47562	22	—	—	$20.39	$70.5	0.04×	$11,750
Lap cholecystectomy with cholangiography	CPT	47563	22	—	—	$20.39	$70.5	0.04×	$11,750
Hip & femur procedures except major joint w MCC	MS-DRG	480	22	—	—	$46	$76.5	0.00×	$61,834
Hip & femur procedures except major joint w CC	MS-DRG	481	22	—	—	$46	$76.5	0.00×	$44,470
Hip & femur procedures except major joint w/o CC/MCC	MS-DRG	482	22	—	—	$46	$76.5	0.00×	$34,629
Lap inguinal hernia repair	CPT	49650	22	—	—	$20.39	$70.5	0.06×	$11,750
Total abdominal hysterectomy	CPT	58150	20	—	—	$20.39	$62	0.06×	$97
Vaginal hysterectomy	CPT	58260	22	—	—	$20.39	$70.5	0.04×	$9,722.38
Lap-assisted vaginal hysterectomy	CPT	58550	22	—	—	$20.39	$70.5	0.05×	$11,750
Lap-assisted vaginal hysterectomy >250g	CPT	58552	22	—	—	$20.39	$70.5	0.03×	$20,659
Lap salpingo-oophorectomy	CPT	58661	22	—	—	$20.39	$70.5	0.03×	$11,750
OR procedure for obesity w MCC	MS-DRG	619	22	—	—	$46	$80	0.00×	$61,305
OR procedure for obesity w CC	MS-DRG	620	22	—	—	$46	$80	0.00×	$33,978
OR procedure for obesity w/o CC/MCC	MS-DRG	621	22	—	—	$46	$80	0.01×	$32,026
Complex cataract surgery	CPT	66982	22	—	—	$20.39	$70.5	0.03×	$4,485.3
Cataract surgery with lens implant	CPT	66984	22	—	—	$20.39	$70.5	0.03×	$4,485.3
Intravitreal injection	CPT	67028	22	—	—	$20.39	$70.5	0.21×	$641.96
Vitrectomy mechanical	CPT	67042	22	—	—	$20.39	$70.5	0.03×	$8,033.4
Uterine & adnexa procedures w CC/MCC	MS-DRG	743	22	—	—	$46	$76.5	0.01×	$26,343
Uterine & adnexa procedures w/o CC/MCC	MS-DRG	744	22	—	—	$46	$76.5	0.00×	$43,506
PCI single major coronary artery	CPT	92920	22	—	—	$20.39	$70.5	0.01×	$11,062
PCI with drug-eluting stent	CPT	92928	22	—	—	$20.39	$70.5	0.01×	$22,436
PCI bypass graft	CPT	92937	22	—	—	$20.39	$70.5	0.01×	$22,436
Left heart catheterization	CPT	93452	22	—	—	$20.39	$70.5	0.02×	$6,300.76
Coronary angiography with cath	CPT	93455	22	—	—	$20.39	$70.5	0.02×	$6,300.76
Coronary angiography with bypass cath	CPT	93458	22	—	—	$20.39	$70.5	0.02×	$6,300.76

Rate history available after the next quarterly refresh. We re-crawl all hospital MRFs each quarter to track rate changes over time.

Payer mix (top 22)

Payer	Codes covered	Median rate
Aetna	194	$80
amerihealth	194	$74.88
amps	194	$55
atlantic corporation dba atlantic packaging	194	$46
bcbsfl	194	$72
Blue Cross Blue Shield	194	$201.52
CareSource	194	$124.08
carolina complete	194	$73.4
Cigna	194	$177.65
employers choice network	194	$97
Humana	194	$170.45
UnitedHealthcare	194	$231.86
WellCare	194	$74.88
medcost	194	$75
Multiplan	194	$75
nc department of public safety	194	$344.96
phcs	194	$75
plotkin health	194	$60
primary physician care	194	$74
three rivers provider network	194	$97
liberty health	163	$355.97
pace of the southern piedmont	163	$339.02

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