Hawaii · state market

Commercial healthcare reimbursement in Hawaii

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

State indexSnapshot Aug 2026

Hawaii at a glance

227 procedure codes, 8 specialties

Index vs national

102

2% above the national median

State rank

21 of 51

1 = highest

Median % of Medicare

138%

across tracked codes

Payers

524 sampled providers

What the data shows

Generated from this state's numbers

Hawaii ranks 21st of 51 states for commercial reimbursement, with an index of 102 (100 = national median) across 227 procedure codes; the West region averages 118.

Commercial rates in Hawaii run a median 138% of Medicare.

Blue Cross Blue Shield has the highest index in the state (109) and Aetna the lowest (97), a 12-point gap, in the files analyzed.

CPT 93298 (Rem interrog dev eval scrms) is the strongest relative to the national median (244% of it, a 144% premium); CPT 55866 (Laps surg prst8ect rpbic rad) is furthest below (65% of the national median, 35% lower).

By specialty, Hawaii is strongest for dermatology (ranks 11th of 50 states for that specialty) and weakest for diagnostic radiology (34th of 51).

Against Medicare, diagnostic radiology has the highest ratio in Hawaii (146% of Medicare) and internal medicine the lowest (121%).

Payer ranking in Hawaii

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

Payer	Index	Rank	Codes	Providers	TINs
Blue Cross Blue Shield	109	1	132	472	581
UnitedHealthcare	100	2	226	453	430
Cigna	100	2	221	413	384
Aetna	97	4	53	114	240

Reimbursement index by specialty in Hawaii

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
Dermatology	139	11 of 50	133%	44	46
Urology	108	16 of 50	141%	36	29
Gastroenterology	109	17 of 50	138%	36	47
Ophthalmology	115	17 of 50	130%	42	89
Internal medicine	109	17 of 51	121%	25	79
Orthopedic surgery	101	24 of 51	137%	39	71
Cardiology	94	32 of 51	131%	38	57
Diagnostic radiology	93	34 of 51	146%	49	106

Specialty by payer in Hawaii

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	109	n/a	109	86
Dermatology	139	n/a	139	n/a
Ophthalmology	116	n/a	116	146
Cardiology	94	n/a	91	111
Orthopedic surgery	101	n/a	101	104
Diagnostic radiology	93	94	93	90
Urology	109	n/a	109	n/a
Gastroenterology	109	n/a	111	n/a

Hawaii compared with West region states

Closest states in the West region by index; the region averages 118

State	Index	Rank	% of Medicare	Providers
Hawaii	102	21	138%	524
Montana	100	24	160%	448
Utah	100	25	154%	818
Colorado	105	19	162%	948
Idaho	109	17	165%	618
New Mexico	94	33	141%	622

Procedures that pay most and least in Hawaii vs the nation

Median across payers; the 15 largest gaps in each direction

Highest vs national

Code	Hawaii	National	Gap	Prov.
93298 Rem interrog dev eval scrms	$128	$52	+144%	56
64566 Neuroeltrd stim post tibial	$152	$69	+120%	28
52224 Cystoscopy and treatment	$995	$459	+117%	28
11102 Tangntl bx skin single les	$132	$65	+104%	41
11104 Punch bx skin single lesion	$164	$81	+103%	41
11301 Shave skin lesion 0.6-1.0 cm	$159	$85	+88%	41
11302 Shave skin lesion 1.1-2.0 cm	$180	$98	+83%	41
43255 Egd control bleeding any	$812	$459	+77%	45
17313 Mohs 1 stage t/a/l	$845	$515	+64%	41
92014 Compre oph exam est pt 1/>	$164	$101	+63%	89
88342 Imhchem/imcytchm 1st antb	$152	$95	+60%	46
88313 Special stains group 2	$112	$71	+59%	45
92004 Compre oph exam new pt 1/>	$193	$124	+56%	89
88312 Special stains group 1	$152	$97	+56%	91
17311 Mohs 1 stage h/n/hf/g	$897	$577	+55%	41

Lowest vs national

Code	Hawaii	National	Gap	Prov.
55866 Laps surg prst8ect rpbic rad	$1,461	$2,237	-35%	27
93656 Compre ep eval abltj atr fib	$1,095	$1,615	-32%	54
43242 Egd us fine needle bx/aspir	$318	$454	-30%	45
43264 Ercp remove duct calculi	$440	$622	-29%	45
43246 Egd place gastrostomy tube	$241	$338	-29%	45
43259 Egd us exam duodenum/jejunum	$275	$384	-28%	45
72141 Mri neck spine w/o dye	$279	$390	-28%	105
70551 Mri brain stem w/o dye	$288	$402	-28%	105
27447 Total knee arthroplasty	$1,594	$2,190	-27%	68
72148 Mri lumbar spine w/o dye	$280	$382	-27%	176
22633 Arthrd cmbn 1ntrspc lumbar	$2,197	$2,991	-27%	67
43238 Egd us fine needle bx/aspir	$283	$383	-26%	45
27130 Total hip arthroplasty	$1,596	$2,158	-26%	68
51798 Us urine capacity measure	$16	$21	-26%	28
22551 Arthrd ant ntrbdy cervical	$2,058	$2,778	-26%	68

Frequently asked questions

Answers use this page's data

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

Hawaii ranks 21st of 51 states with an index of 102, across 227 procedure codes. Median commercial rates run 138% of the Medicare rate.

Which payer has the highest rates in Hawaii?

In the files we analyzed, Blue Cross Blue Shield has the highest index (109) and Aetna the lowest (97). 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 Hawaii?

Dermatology ranks 11th of 50 states.

How many providers does this Hawaii page cover?

524 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 Hawaii and the national median?

CPT 93298 (Rem interrog dev eval scrms) is highest relative to the nation at 244% of the national median; CPT 55866 (Laps surg prst8ect rpbic rad) is lowest at 65%.

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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