South Carolina · state market

Commercial healthcare reimbursement in South Carolina

How South Carolina compares with the nation, by payer, specialty and procedure.

State indexSnapshot Aug 2026

South Carolina at a glance

228 procedure codes, 8 specialties

Index vs national

8% below the national median

State rank

38 of 51

1 = highest

Median % of Medicare

140%

across tracked codes

Payers

872 sampled providers

What the data shows

Generated from this state's numbers

South Carolina ranks 38th of 51 states for commercial reimbursement, with an index of 92 (100 = national median) across 228 procedure codes; the South region averages 94.

Commercial rates in South Carolina run a median 140% of Medicare.

Blue Cross Blue Shield has the highest index in the state (116) and Aetna the lowest (76), a 40-point gap, in the files analyzed.

CPT 70450 (Ct head/brain w/o dye) is the strongest relative to the national median (118% of it, a 18% premium); CPT 88313 (Special stains group 2) is furthest below (66% of the national median, 34% lower).

By specialty, South Carolina is strongest for internal medicine (ranks 28th of 51 states for that specialty) and weakest for dermatology (43rd of 50).

Against Medicare, gastroenterology has the highest ratio in South Carolina (172% of Medicare) and dermatology the lowest (83%).

Payer ranking in South Carolina

Index: 100 = the four-payer state median; counts are sampled providers and TINs

Payer	Index	Rank	Codes	Providers	TINs
Blue Cross Blue Shield	116	1	196	311	446
UnitedHealthcare	111	2	228	733	382
Cigna	100	3	227	778	484
Aetna	76	4	228	627	492

Reimbursement index by specialty in South Carolina

100 = the specialty's national median; the Medicare column compares median rates with the CY2026 Medicare rate

Specialty	Index	Rank among states	% of Medicare	Codes	Providers
Internal medicine	96	28 of 51	117%	25	102
Orthopedic surgery	95	30 of 51	135%	39	106
Diagnostic radiology	96	31 of 51	147%	49	115
Urology	95	32 of 50	153%	37	101
Gastroenterology	93	35 of 50	172%	36	118
Cardiology	89	39 of 51	130%	38	117
Ophthalmology	87	40 of 50	108%	42	104
Dermatology	85	43 of 50	83%	44	109

Specialty by payer in South Carolina

Index: 100 = the specialty's national median for the same codes; bold = highest payer for that specialty; n/a = fewer than 10 codes with enough data

Specialty	UHC	Aetna	Cigna	BCBS
Internal medicine	124	61	99	102
Dermatology	94	74	81	113
Ophthalmology	87	88	82	106
Cardiology	101	64	89	109
Orthopedic surgery	109	66	93	109
Diagnostic radiology	103	66	128	95
Urology	117	63	90	112
Gastroenterology	101	70	85	123

South Carolina compared with South region states

Closest states in the South region by index; the region averages 94

State	Index	Rank	% of Medicare	Providers
South Carolina	92	38	140%	872
Virginia	91	39	139%	907
Arkansas	93	36	144%	788
West Virginia	93	34	146%	608
Louisiana	89	41	132%	917
Kentucky	88	42	133%	977

Procedures that pay most and least in South Carolina vs the nation

Median across payers; the 15 largest gaps in each direction

Highest vs national

Code	South Caroli	National	Gap	Prov.
70450 Ct head/brain w/o dye	$230	$194	+18%	113
71271 Ct thorax lung cancer scr c-	$243	$208	+17%	113
20611 Drain/inj joint/bursa w/us	$133	$117	+14%	106
72131 Ct lumbar spine w/o dye	$275	$248	+11%	113
72125 Ct neck spine w/o dye	$275	$249	+11%	113
71250 Ct thorax dx c-	$275	$250	+10%	113
43255 Egd control bleeding any	$497	$459	+8%	115
20550 Njx 1 tendon sheath/ligament	$80	$74	+8%	106
65778 Cover eye w/membrane	$73	$70	+5%	101
99497 Advncd care plan 30 min	$113	$108	+4%	97
64566 Neuroeltrd stim post tibial	$72	$69	+4%	100
43239 Egd biopsy single/multiple	$363	$349	+4%	116
52332 Cystoscopy and treatment	$372	$360	+3%	100
99350 Home/res vst est high mdm 60	$255	$247	+3%	100
51798 Us urine capacity measure	$22	$21	+3%	94

Lowest vs national

Code	South Caroli	National	Gap	Prov.
88313 Special stains group 2	$46	$71	-34%	113
88312 Special stains group 1	$64	$97	-34%	219
88305 Tissue exam by pathologist	$47	$70	-33%	220
88342 Imhchem/imcytchm 1st antb	$64	$95	-32%	106
93297 Rem interrog dev eval icpms	$35	$52	-32%	117
93298 Rem interrog dev eval scrms	$37	$52	-29%	117
99202 Office o/p new sf 15 min	$53	$70	-23%	109
92235 Fluorescein angrph mltiframe	$113	$145	-22%	102
77280 Ther rad simulaj field smpl	$238	$302	-21%	105
92014 Compre oph exam est pt 1/>	$80	$101	-21%	103
92242 Fluorescein&icg angiography	$230	$288	-20%	100
92012 Intrm oph exam est patient	$61	$76	-19%	103
11102 Tangntl bx skin single les	$53	$65	-19%	109
11104 Punch bx skin single lesion	$66	$81	-18%	109
97110 Therapeutic exercises	$26	$31	-17%	106

Frequently asked questions

Answers use this page's data

How do commercial reimbursement rates in South Carolina compare with the rest of the country?

South Carolina ranks 38th of 51 states with an index of 92, across 228 procedure codes. Median commercial rates run 140% of the Medicare rate.

Which payer has the highest rates in South Carolina?

In the files we analyzed, Blue Cross Blue Shield has the highest index (116) and Aetna the lowest (76). 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 South Carolina?

Internal medicine ranks 28th of 51 states.

How many providers does this South Carolina page cover?

872 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 South Carolina and the national median?

CPT 70450 (Ct head/brain w/o dye) is highest relative to the nation at 118% of the national median; CPT 88313 (Special stains group 2) is lowest at 66%.

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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