Blue Cross Blue Shield · Hawaii · commercial in-network
Blue Cross Blue Shield negotiated rates in Hawaii
How Blue Cross Blue Shield's Hawaii rates compare with the other three national payers, across the procedures that matter most to high-revenue specialties.
Blue Cross Blue Shield in Hawaii at a glance
Across 132 procedure codes for 8 specialties
Rate index vs state market
109
9% above the Hawaii median
Rank in state
1 of 4
BCBS 109 · UHC 100 · Cigna 100 · Aetna 97
vs own national
105
BCBS's level vs its national median
Codes where highest
52%
of 132 codes
What the data shows
Generated from Hawaii and Blue Cross Blue Shield data only
1
Blue Cross Blue Shield ranks 1st of 4 payers in Hawaii with a rate index of 109 (100 = the Hawaii market median), across 132 procedure codes.
2
Blue Cross Blue Shield has the highest median for 52% of codes in Hawaii.
3
Blue Cross Blue Shield's Hawaii rates sit 5% above its own national level, the 19th highest of its 51 states.
4
Largest premium over the Hawaii market: CPT 76512 (Oph us dx b-scan) at 259% of market; largest discount: CPT 92004 (Compre oph exam new pt 1/>) at 54%.
5
In Hawaii, BCBS rates come from 37 licensee file sets; the largest is BCBS HI (379 sampled providers).
How the four payers compare in Hawaii
Rate index: 100 = the state four-payer median for the same codes
| Payer | Index | Rank | Level | Highest on | Providers |
|---|---|---|---|---|---|
| Blue Cross Blue Shield | 109 | 1 | 52% | 472 | |
| UnitedHealthcare | 100 | 2 | 64% | 453 | |
| Cigna | 100 | 2 | 63% | 413 | |
| Aetna | 97 | 4 | 23% | 114 |
Where Blue Cross Blue Shield pays most and least against the Hawaii market
Codes with the largest gap to the state median
Highest above market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 76512 Oph us dx b-scan | $175 | $68 | +159% | 78 |
| 92250 Fundus photography w/i&r | $103 | $48 | +113% | 78 |
| 73221 Mri joint upr extrem w/o dye | $629 | $304 | +107% | 158 |
| 92136 Ophthalmic biometry | $126 | $62 | +104% | 78 |
| 72148 Mri lumbar spine w/o dye | $562 | $280 | +101% | 158 |
| 93000 Electrocardiogram complete | $36 | $18 | +97% | 465 |
| 92020 Gonioscopy | $67 | $35 | +90% | 78 |
| 73721 Mri jnt of lwr extre w/o dye | $569 | $302 | +89% | 158 |
Furthest below market
| Code | BCBS | Market | Gap | Prov. |
|---|---|---|---|---|
| 92004 Compre oph exam new pt 1/> | $105 | $193 | -46% | 80 |
| 99212 Office o/p est sf 10 min | $46 | $74 | -37% | 149 |
| 92014 Compre oph exam est pt 1/> | $105 | $164 | -36% | 80 |
| 99213 Office o/p est low 20 min | $80 | $118 | -32% | 149 |
| 99215 Office o/p est hi 40 min | $161 | $230 | -30% | 149 |
| 99214 Office o/p est mod 30 min | $117 | $165 | -29% | 149 |
| 71045 X-ray exam chest 1 view | $26 | $37 | -28% | 72 |
| 99203 Office o/p new low 30 min | $108 | $143 | -24% | 149 |
Where Blue Cross Blue Shield pays above and below its national level
Index vs the payer's own national median (100 = national)
Highest states
| State | Index | Prov. | |
|---|---|---|---|
| Alaska | 243 | 290 | |
| Wisconsin | 192 | 733 | |
| Minnesota | 171 | 671 | |
| North Dakota | 148 | 329 | |
| Wyoming | 145 | 256 |
Lowest states
| State | Index | Prov. | |
|---|---|---|---|
| Maryland | 63 | 758 | |
| Arizona | 66 | 479 | |
| Texas | 69 | 1,003 | |
| District of Columbia | 69 | 484 | |
| New Mexico | 74 | 562 |
Blue Cross Blue Shield licensees in Hawaii
File sets contributing rates; licensees are different companies
| Licensee file set | Sampled providers |
|---|---|
| BCBS HI | 379 |
| Community Insurance Company | 127 |
| HealthKeepers, Inc. | 71 |
| BCBS TX | 52 |
| Healthy Alliance Life Insurance Company | 28 |
| BCBS NC | 28 |
| BCBS RI | 24 |
| Wellmark | 22 |
| BCBS KS | 22 |
| Anthem (Elevance) | 21 |
| Blue Shield of California Life & Health Insurance Company | 18 |
| BS CA | 18 |
| Blue Cross Blue Shield of Wyoming | 15 |
| Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. | 15 |
| BCBS MA | 15 |
| BCBS IL | 15 |
| Matthew Thornton Health Plan, Inc. | 14 |
| Compcare Health Services Insurance Corporation | 11 |
| Premera | 10 |
| BCBS NM | 9 |
| Regence | 8 |
| Capital BlueCross | 8 |
| BCBS MN | 8 |
| Capital BC | 8 |
| Carefirst BCBS | 7 |
| HMO Colorado, Inc. | 7 |
| BCBS MI | 5 |
| BCBS MT | 3 |
| Horizon Healthcare of New Jersey | 3 |
| BCBS NJ (Horizon) | 3 |
| Excellus BCBS | 2 |
| Blue Cross Blue Shield of North Dakota | 2 |
| Blue Cross and Blue Shield of Nebraska | 2 |
| HMO Missouri, Inc. | 2 |
| BCBS AZ | 1 |
| BCBS OK | 1 |
| BCBS TN | 1 |
Frequently asked questions
Does Blue Cross Blue Shield pay more or less than the other payers in Hawaii?
Blue Cross Blue Shield ranks 1st of 4 in Hawaii with an index of 109. It is highest on 52% of codes.
Are Blue Cross Blue Shield's Hawaii rates above or below its national level?
About 5% above.
Which procedure does Blue Cross Blue Shield pay most above market in Hawaii?
CPT 76512 (Oph us dx b-scan), at 259% of the Hawaii 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.
Is your Blue Cross Blue Shield contract at market in Hawaii?
Compare your negotiated rates for these codes with Hawaii medians for each payer.