North Carolina's new Health Care Affordability Commission was given a mandate for transparency and data. This report measures what the state's published hospital prices already show.
The share of 155,422 benchmarkable list prices published by hospitals operating in North Carolina that currently sit above 260% of the corresponding Medicare rate, the line Indiana wrote into law.
On June 30, 2026, Executive Order 39 established the North Carolina Health Care Affordability Commission. It is co-chaired by DHHS Secretary Dev Sangvai and State Treasurer Brad Briner. The Commission's first priority is transparency and data. It aims to understand what drives the cost of health care in North Carolina and identify where the state can act.
This report delivers a starting point. The Solomon Report applies the same instrument it has used in four states: the 260% of Medicare threshold from Indiana's HEA 1004, the most direct hospital pricing benchmark enacted in the country.
This report also extends the series for the first time into inpatient hospital pricing, measuring North Carolina's inpatient charges and negotiated rates on a per-hospital, wage-adjusted basis against Medicare's diagnosis-related group payments. It further introduces a comparison: SCAN Health Plan, a California Medicare Advantage plan whose published inpatient contracts stay under the line that most North Carolina prices exceed.
Indiana's House Enrolled Act 1004 requires the state's largest nonprofit hospital systems to offer employers health care arrangements priced at or below 260% of what Medicare pays. It is the most direct hospital list pricing benchmark enacted in the country. North Carolina has no equivalent benchmark and no North Carolina hospital is required to price against one.
Report No. 1 measured Indiana's published hospital prices against the 260% of Medicare benchmark in Indiana's own law and found 86.8% above the line. Report No. 2 applied the same line to Ohio and found 93.2%. Report No. 3 applied it to Texas and found 94.1%. Report No. 4 applied it to Michigan and found 62.6%. This report applies it to North Carolina. The state has no obligation under Indiana's law. The line is applied here for comparability.
Across hospitals operating in North Carolina, 85.1% of the 155,422 published list prices that can be directly benchmarked against a Medicare rate currently exceed 260% of that rate. The figure is computed conservatively. Each price is compared against the higher of Medicare's two applicable payment rates for the same billing code, so a price is counted as above the line only when it clears both.
Of the same benchmarkable list prices, 90.2% exceed 200% of Medicare and 81.5% exceed 300%.
The variation across facilities is wide. Among hospitals with robust samples of at least 2,000 benchmarkable list prices, the share above the line runs from 34.7% at the lowest facility to 98.1% at the highest.
The Research Triangle is home to three of North Carolina's major health systems: Duke Health, UNC Health, and WakeMed. Across six facilities in the Triangle with benchmarkable data, 89.5% of 15,309 list prices exceed the 260% line. The Triangle runs above the statewide average.
Charlotte, the state's largest metro, runs higher still. Across twelve facilities and 22,679 benchmarkable list prices, 91.4% exceed the line. The two largest population centers in North Carolina both exceed the statewide figure, and Charlotte exceeds it by more than six points.
A complete abdominal ultrasound is one of the most common imaging tests in medicine, a standardized exam ordered in hospitals across the country. Across 94 North Carolina hospitals, its published price is:
| Abdominal ultrasound (CPT 76700) | Lowest | Highest |
|---|---|---|
| Published list price, NC hospitals | $210 | $4,433 |
| As a multiple of Medicare | 2.0x | 41.5x |
The lowest price sits at twice the Medicare rate. The highest sits at more than forty-one times Medicare. One billing code, one routine imaging exam, a 21-fold spread across hospitals in a single state.
Reports No. 1 through No. 4 measured outpatient prices against Medicare's Physician Fee Schedule. This report extends the measurement to inpatient hospital pricing for the first time in the series.
Medicare does not pay every hospital the same amount for the same procedure. A fair comparison requires measuring each hospital's prices against its own Medicare payment. This report does that.
On that basis, North Carolina's gross (list) inpatient charges sit at a median of 3.98 times Medicare across 30 providers that publish DRG-level gross charges. Seventy-one percent of those providers exceed the 260% line.
SCAN Health Plan is a California Medicare Advantage plan that publishes its inpatient contracted rates at the DRG level. Among its three contracted California hospitals, SCAN's negotiated rates sit at a median of 1.12 times each hospital's own wage-adjusted Medicare payment. Zero percent of its rates cross the 260% line. SCAN's outpatient rates are published only as an algorithm, so this comparison is limited to inpatient by necessity.
North Carolina's negotiated inpatient rates tell a different story. Across 69 providers, the lowest negotiated rate per DRG (the floor across all payers reporting for that hospital) sits at a median of 1.14 times Medicare, with 1% exceeding the 260% line. The highest negotiated rate per DRG (the ceiling across all payers) sits at a median of 3.02 times Medicare, with 70% exceeding it.
| Measure | Median | % above 260% | Providers |
|---|---|---|---|
| SCAN CA negotiated | 1.12x | 0% | 3 |
| NC negotiated (min across payers) | 1.14x | 1% | 69 |
| NC negotiated (max across payers) | 3.02x | 70% | 69 |
| NC gross charge (list) | 3.98x | 71% | 30 |
Two of SCAN's three hospitals share a parent organization and carry identical rate schedules.
This report makes no compliance determination about any hospital anywhere. It measures distance. Every number in this report can be verified from publicly available data.
More than eight in ten outpatient list prices exceed the line. On the inpatient side, more than seven in ten gross charges do the same.
Five states, one instrument. In each, the Solomon Report measured how many benchmarkable published list prices exceed 260% of Medicare.
| Report | State | Above 260% |
|---|---|---|
| No. 1 | Indiana | 86.8% |
| No. 2 | Ohio | 93.2% |
| No. 3 | Texas | 94.1% |
| No. 4 | Michigan | 62.6% |
| No. 5 | North Carolina | 85.1% |
North Carolina falls in the middle of the series, above Michigan and below Indiana, Ohio and Texas. In five states, across every region of the country, the majority of published hospital list prices exceed the line Indiana drew. Will the other forty-five states reveal the same?
The Solomon Report intends to keep measuring.
Solomon Report outpatient findings are computed from hospitals' federally required price transparency files and the public Medicare Physician Fee Schedule. Each published hospital charge for a given billing code is compared against the higher of Medicare's facility and nonfacility payment rates for the same code, so that all figures are conservative. Prices published without a matchable billing code are excluded rather than estimated. List prices are distinct from negotiated rates. This report uses the identical outpatient computation as Reports No. 1 through No. 4, all of which were re-run and reproduced exactly at the time of this analysis. Removing extreme outliers does not change the finding. Excluding list prices below one tenth or above one hundred times the corresponding Medicare rate yields 84.9% on 153,290 prices, a 0.2 percentage-point movement.
Inpatient findings measure each hospital's published DRG-level prices against that hospital's own FY2026 wage-adjusted operating base rate from the CMS IPPS Impact File, multiplied by the corresponding MS-DRG weight. This per-hospital approach accounts for geographic differences in Medicare payment and ensures that a hospital in a high-wage area is measured against its own higher Medicare benchmark. Negotiated rates reported as "minimum" and "maximum" represent the floor and ceiling across all payers reporting for a given hospital and DRG, not a single insurer's contract. SCAN Health Plan's contracted rates were drawn from SCAN's published machine-readable files for its contracted California hospitals, computed on the same per-hospital wage-adjusted basis. All inpatient medians are computed per facility (one median per hospital), then summarized across facilities.
The quoted per-code example was selected as a standardized, high volume imaging service whose published list prices represent full global charges (technical and professional components combined) and whose Medicare benchmark is drawn from the Physician Fee Schedule rather than a clinical laboratory fee schedule.
The Solomon Report is an ongoing public reporting series from Solomon Copilot that measures what public healthcare pricing data actually shows. Hospital prices and Medicare rates are public records. The Report puts them side by side.