Aetna · South Carolina · commercial in-network

Aetna negotiated rates in South Carolina

How Aetna's South Carolina rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.

Aetna in South Carolina at a glance

Across 228 procedure codes for 8 specialties
Rate index vs state market
76
24% below the South Carolina median
Rank in state
4 of 4
BCBS 116 · UHC 111 · Cigna 100 · Aetna 76
vs own national
87
Aetna's level vs its national median
Codes where highest
5%
of 228 codes
627 sampled providers492 TINs228 codesMedian 101% of Medicare · method

What the data shows

Generated from South Carolina and Aetna data only
1

Aetna ranks 4th of 4 payers in South Carolina with a rate index of 76 (100 = the South Carolina market median), across 228 procedure codes.

2

Aetna has the highest median for only 5% of codes in South Carolina; Blue Cross Blue Shield leads with an index of 116 in the files analyzed.

3

Aetna's South Carolina rates sit 13% below its own national level, the 44th highest of its 51 states.

4

Largest premium over the South Carolina market: CPT 88313 (Special stains group 2) at 127% of market; largest discount: CPT 64566 (Neuroeltrd stim post tibial) at 49%.

How the four payers compare in South Carolina

Rate index: 100 = the state four-payer median for the same codes
PayerIndexRankLevelHighest onProviders
Blue Cross Blue Shield1161
116
48%311
UnitedHealthcare1112
111
31%733
Cigna1003
100
22%778
Aetna764
76
5%627

Where Aetna pays most and least against the South Carolina market

Codes with the largest gap to the state median

Highest above market

CodeAetnaMarketGapProv.
88313
Special stains group 2
$59$46+27%67
88312
Special stains group 1
$82$64+27%145
65820
Goniotomy
$1,024$840+22%67
66821
After cataract laser surgery
$394$340+16%86
65756
Corneal trnspl endothelial
$1,467$1,267+16%54
67036
Removal of inner eye fluid
$1,112$964+15%59
88342
Imhchem/imcytchm 1st antb
$73$64+14%77
71271
Ct thorax lung cancer scr c-
$275$243+13%68

Furthest below market

CodeAetnaMarketGapProv.
64566
Neuroeltrd stim post tibial
$35$72-51%44
74174
Cta abd&plvs w/contrast
$275$556-51%69
99457
Rpm tx mgmt 1st 20 min
$25$51-50%70
99348
Home/res vst est low mdm 30
$54$105-48%27
99349
Home/res vst est mod mdm 40
$91$175-48%30
99350
Home/res vst est high mdm 60
$132$255-48%30
77080
Dxa bone density axial
$32$60-46%69
52332
Cystoscopy and treatment
$210$372-44%69

Where Aetna pays above and below its national level

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

Highest states

StateIndexProv.
Alaska306
211
Idaho152
491
Washington142
708
Mississippi138
608
Montana136
80

Lowest states

StateIndexProv.
Indiana80
698
South Dakota82
147
Florida82
758
Minnesota84
774
North Dakota85
211

Frequently asked questions

Does Aetna pay more or less than the other payers in South Carolina?

Aetna ranks 4th of 4 in South Carolina with an index of 76. It is highest on 5% of codes.

Are Aetna's South Carolina rates above or below its national level?

About 13% below.

Which procedure does Aetna pay most above market in South Carolina?

CPT 88313 (Special stains group 2), at 127% of the South 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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