Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Hawaii for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Hawaii only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Hawaii (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Kona Hospital (NPI 1952332991)

Field	Value
Entity Type	Organization
Organization	Kona Hospital
Address	79-1019 Haukapila St
City	Kealakekua
State	HI
ZIP	96750
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 6, 2006

Payer Source	Total Paid
Medicaid	$22.3M
Medicare	$0

Key Findings

KONA HOSPITAL has no Medicare billing on file and records $22.3M in lifetime Medicaid revenue, making its public payer activity effectively single-payer Medicaid; this profile will concentrate payer risk and contracting sensitivity around state Medicaid policy and utilization. The absence of Medicare line items means national Medicare benchmarks are not applicable when assessing this facility's payer performance.

Medicaid revenue is highly concentrated in emergency department evaluation-and-management services: the top three Medicaid codes 99284, 99283, and 99285 together account for 72.8% of the provider's total Medicaid revenue. Those three codes individually generate $6.9M (31.1%), $5.7M (25.6%), and $3.6M (16.1%) respectively, indicating that the hospital's Medicaid earnings depend heavily on ED visit volumes and acuity mix.

The code mix points to an ED-centric operating model: 99284, 99283, and 99285 are all emergency department E/M codes covering moderate, low, and high medical decision making levels. Substantial revenue from 74177 (2.6K claims, $784 avg, $2.1M, 9.3%) and CT head 70450 (3.4K claims, $36 avg, $123.9K, 0.6%) shows on-site imaging capability supporting acute presentations, while observation hours G0378 (1.7K claims, $551 avg, $949.9K, 4.3%) indicates use of short-stay inpatient/observation workflows tied to ED throughput.

Competitive standing for the top ED codes is moderate within the state: 99284 ranks #13 of 47 (74th percentile) and is described as typical, unremarkable volume for this code; 99283 ranks #13 of 45 (73th percentile) and is described as typical, unremarkable volume for this code; 99285 ranks #16 of 39 (61th percentile) and is described as typical, unremarkable volume for this code. These ranks place KONA HOSPITAL as a steady, mid-tier statewide participant for ED services rather than a dominant statewide leader on those codes.

Ancillary and higher-acuity services contribute but do not dominate revenue: critical care 99291 yields $257.2K (1.2%), observation G0378 yields $949.9K (4.3%), and CT abdomen/pelvis 74177 contributes $2.1M (9.3%). The presence of 99291 and multiple CT codes confirms capability to manage higher-acuity patients, but each of these lines is materially smaller than the ED E/M revenue pool.

There are modest specialty or atypical procedure lines present in the Medicaid mix that may reflect local service needs, for example dental/procedural code 41899 (580 claims, $819 avg, $475K, 2.1%) which ranks #2 of 5 (75th percentile) and is described as typical, unremarkable volume for this code. These non-ED items are secondary contributors to total Medicaid revenue and suggest some procedural breadth beyond emergency care.

Given an NPI enumeration date of 2006-07-06 (approximately 20 years ago), KONA HOSPITAL is an established provider in the market; its longevity supports interpretation of current patterns as stable operating behavior rather than a nascent or newly entered facility. Historical tenure combined with the ED-centric revenue mix suggests entrenched emergency services as the hospital's primary Medicaid-facing business line.

The heavy dependence on three ED codes for 72.8% of Medicaid revenue implies concentration risk: changes in ED utilization, state Medicaid reimbursement for E/M levels, or referral patterns could disproportionately affect total revenue. For payer strategy and network planning, KONA HOSPITAL should be treated as an ED-focused Medicaid provider with modest statewide share on those codes rather than a broad-service Medicaid revenue leader.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

160 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	15,510	$450	$6.9M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	17,160	$330	$5.7M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	6,250	$570	$3.6M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	2,630	$780	$2.1M
G0378	Hospital observation service, per hour	1,720	$550	$949.9K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	3,190	$240	$777.6K
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	780	$680	$527K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	580	$820	$475K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	350	$740	$257.2K
99281	The provider sees a patient for the lowest level emergency department visit.	960	$170	$166.8K

Showing 1–10 of 160

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Hawaii providers billing the same CPT/HCPCS codes.

Claims Volume vs. Hawaii Distribution

Kona Hospital — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

160 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	13	50	8,590	$340	$5.2M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	13	50	3,740	$290	$3.8M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	16	40	3,820	$330	$3.3M
G0378	Hospital observation service, per hour	10	10	3,250	$480	$2.3M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	14	30	2,660	$330	$1.5M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	12	40	1,050	$510	$1.3M
J3490	Unclassified drugs	30	50	160	$200	$740.3K
99281	The provider sees a patient for the lowest level emergency department visit.	9	20	950	$220	$651.2K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	2	10	140	$1,690	$601.5K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	12	20	1,060	$60	$547.3K

Showing 1–10 of 160

Nearby Providers

Other providers in the same ZIP code as Kona Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Affordable Care LLC	HI	Home Health Agency	$0	$1.5M
West Hawaii Community Health Center, Inc.	HI	Federally Qualified Health Center (FQHC)	$0	$257.6K
Yaser Alsaadi	HI	Dental Clinic/Center	$0	$208.7K
Sound Physicians Of Hawaii Inc	HI	Internal Medicine Physician	$0	$195K
Timothy Kale	HI	Optometrist	$71.7K	$103.7K
Nathan King	HI	Internal Medicine Physician	$116.9K	$45.3K
S.sira,m.d.,facog,inc	HI	Clinic/Center	$0	$140.9K
Bradon Kimura	HI	Family Medicine Physician	$135.6K	$0
Wesley J. Sugai, M.d., Inc.	HI	Pediatrics Physician	$0	$131.6K
Ginelle Sakima Roberts	HI	Pediatric Dentistry	$0	$129.9K

Kona Hospital — Billing Profile & Reimbursement Data

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Kona Hospital — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References