Emergency visit, high (level 4) at Pali Momi Medical Center. CPT 99284.
What Pali Momi Medical Center publishes for this service, straight from its standard-charges file, last updated February 12, 2026.
Outpatient / ER
$1,577cash price (self-pay)
$2,628list price
$417–$2,294range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Alohacare | Medicare Advantage | $417 |
| Hmsa | Medicare Advantage | $417 |
| Mdx | Humana Medicare | $417 |
| Mdx | UHC Medicare | $417 |
| Ohana | Medicare Advantage | $434 |
| Devoted | Medicare Advantage | $438 |
| Ohana | Quest - Non-Abd | $505 |
| Alohacare | Non-Abd - Adult | $580 |
| Alohacare | Non-Abd - Pediatric | $580 |
| Hmsa | Quest Non-Abd | $780 |
| Hmsa | Quest Abd | $847 |
| UHC | All Products | $1,181 |
| Blended Rate UHC | All Products | $1,288 |
| Alohacare | Abd - Adult | $1,389 |
| Alohacare | Abd - Pediatric | $1,389 |
| Hmsa | All Products | $1,460 |
| Ohana | Quest - Abd | $1,484 |
| Calvos | Select Care | $1,971 |
| Mimoh | All Products | $1,971 |
| Hwmg/Hmaa | All Products | $1,982 |
| Hcha | All Products | $2,102 |
| Kaiser | All Products | $2,102 |
| Mdx | All Products | $2,102 |
| Pac Admin | All Products | $2,102 |
| Verdegard | Union Trust Fund | $2,102 |
| Coventry | All Products | $2,234 |
| Mccp | All Products | $2,234 |
| Multiplan | All Products | $2,234 |
| Uha | All Products | $2,294 |
Inpatient
$1,577cash price (self-pay)
$2,628list price
$1,288–$2,234range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Multiplan | All Products | $2,102 |
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