Emergency visit, moderate (level 3) at Pali Momi Medical Center. CPT 99283.
What Pali Momi Medical Center publishes for this service, straight from its standard-charges file, last updated February 12, 2026.
Outpatient / ER
$1,029cash price (self-pay)
$1,715list price
$271–$1,573range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Alohacare | Medicare Advantage | $271 |
| Hmsa | Medicare Advantage | $271 |
| Mdx | Humana Medicare | $271 |
| Mdx | UHC Medicare | $271 |
| Ohana | Medicare Advantage | $282 |
| Devoted | Medicare Advantage | $285 |
| Ohana | Quest - Non-Abd | $328 |
| Alohacare | Non-Abd - Adult | $377 |
| Alohacare | Non-Abd - Pediatric | $377 |
| Hmsa | Quest Non-Abd | $780 |
| Blended Rate UHC | All Products | $840 |
| Hmsa | Quest Abd | $847 |
| Alohacare | Abd - Adult | $906 |
| Alohacare | Abd - Pediatric | $906 |
| Ohana | Quest - Abd | $968 |
| UHC | All Products | $1,181 |
| Calvos | Select Care | $1,286 |
| Mimoh | All Products | $1,286 |
| Hwmg/Hmaa | All Products | $1,293 |
| Hcha | All Products | $1,372 |
| Kaiser | All Products | $1,372 |
| Mdx | All Products | $1,372 |
| Pac Admin | All Products | $1,372 |
| Verdegard | Union Trust Fund | $1,372 |
| Coventry | All Products | $1,458 |
| Mccp | All Products | $1,458 |
| Multiplan | All Products | $1,458 |
| Hmsa | All Products | $1,460 |
| Uha | All Products | $1,573 |
Inpatient
$1,029cash price (self-pay)
$1,715list price
$840–$1,458range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Multiplan | All Products | $1,372 |
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