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Hospital Profile Critical Access Hospital Voluntary non-profit - Private 4 Beds · urban Updated: 8/11/2025

Lanai Community Hospital

628 7Th Street, Lanai City, HI 96763 · 78 Priced Procedures

CMS Overall Rating No CMS Rating
Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Above Fair Market · Negotiate
1.42×vs. Fair Market Price
Position vs. 1.00× Fair Price+42% Above Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

Typical commercial prices here are +42% above the fair benchmark (1.42×) even after accounting for local nurse/doctor wages and patient complexity.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).74/100 · Corroborated
74/100Self-Pay Cash Beats Insurance 4% of the Time
File Completeness51Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic81Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment72Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing70Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount100Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.High-Markup · Check Safety
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score85/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER Wait78 minMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintMedian-Gamed · High Captive Markup

Loss-Leader / Captive Ancillary Cross-Subsidizer

Lanai Community Hospital prices routine shoppable procedures near 1.3× Medicare (p50 1.26×) while skewing captive emergency, lab, and upper-quartile codes to 2.2× Medicare (p75 1.93×, +53% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.

#17 of 20 in HI · 80th State Percentile#2,505 of 3,385 in U.S. · 73rd National Percentile
Advantage

Where They're Good (Patient & Payer Edge)

  • Bottom-quartile procedures (Q25) price at 0.88× the peer BaseRate benchmark
  • Self-pay cash beats commercial insurance on 4% of shoppable procedures (99/100 Cash Honesty)
  • CMS clinical safety score (85/100 safety score) with 72% patient recommendation
  • IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (12.0% AGB cap)
Watchout

Where You Can Get Burned (Markup Traps)

  • Outpatient surgery & OR suites carry a 1.6× markup over Medicare rates
  • Captive ER (1.9×) & laboratory (2.7×) services average 1.69× higher multiples than routine shoppable care (1.3×)
  • Upper-quartile procedures (Q75 1.93×) jump +53% above the median procedure ratio (Q50 1.26×)
  • Consolidated metro market (HHI 9,671) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Front-Door ShoppableElective / Imaging
1.3× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER1.69× Divergence
2.2× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+53% Upper Tail
Q25 0.88× · Q50 1.26× · Q75 1.93×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.
Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×
Front-Door Shoppable CareFront-Door Shoppable
1.3× MedicareGood
Outpatient Surgery & ORBack-Door Captive
1.6× MedicareGood
Diagnostic Imaging (CT/MRI)Front-Door Shoppable
1.6× MedicareGood
Back-Door Captive ER VisitsBack-Door Captive
1.9× MedicareGood
Inpatient Lab & PathologyBack-Door Captive
2.7× MedicareFair
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
0.5× MedicareGood
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
4% Cash Edge · 99/100Good
CMS Clinical Safety & Star ValueIntegrity & Outcomes
3 CMS · 85/100Good

Procedure Prices at Lanai Community Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 78 published procedures.

Sort:
Audit a Bill & 501(r) Cap ↓
Procedure & Billing Code This Hospital vs. Fair
Blood transfusion
CPT Code: 36430
 $1,353 unverified
CT scan, abdomen and pelvis (with contrast)
CPT Code: 74177
 $626 1.4×
CT scan, head (with and without contrast)
CPT Code: 70470
 $426 1.7×
CT scan, abdomen and pelvis (no contrast)
CPT Code: 74176
 $414 1.4×
CT scan, head (with contrast)
CPT Code: 70460
 $411 unverified
CT scan, pelvis
CPT Code: 72192
 $262 1.6×
CT scan, chest (no contrast)
CPT Code: 71250
 $266 1.6×
CT scan, neck (cervical spine)
CPT Code: 72125
 $266 1.6×
CT scan, lower back (lumbar spine)
CPT Code: 72131
 $247 1.5×
Hepatitis B immune globulin
HCPCS Code: 90371
 $200 1.3×
CT scan, head (no contrast)
CPT Code: 70450
 $203 1.3×
CT scan, sinuses
CPT Code: 70486
 $209 1.3×
Breathing treatment (nebulizer)
CPT Code: 94640
 $215 unverified
Ultrasound, abdomen (complete)
CPT Code: 76700
 $146 1.1×
Hospital observation (per hour)
HCPCS Code: G0378
 $113 1.3×
Ultrasound, pelvis
CPT Code: 76856
 $126 1.0×
Ultrasound, thyroid and neck
CPT Code: 76536
 $121 0.9×
Ultrasound, abdomen (limited)
CPT Code: 76705
 $110 0.9×
Orthotic fitting and training
CPT Code: 97760
 $83 1.6×
Typhoid vaccine
HCPCS Code: 90675
 $487 1.4×
Drug screening test
HCPCS Code: G0480
 $239 2.1×
Blood test, vitamin D
CPT Code: 82306
 $182 5.9×
Varicella (chickenpox) vaccine
HCPCS Code: 90716
 $198 1.0×
Pneumococcal vaccine
HCPCS Code: 90732
 $126 0.9×
Hepatitis C antibody test
CPT Code: 86803
 $97 6.5×
Showing top 25 high-impact procedures of 78 total
Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 12.0%

Audit a Bill or Quote at Lanai Community Hospital (Zero PHI Required)

CMS CCN: 121305
CPT 36430
Fair BaseRate™ $498
Medicare Rate $451
Self-Pay Cash $581
Insurer Median $1,353
Pre-filled with Lanai Community Hospital’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $179 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $179

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (12.0% of gross = $179).

Step 2 · Cash vs. Insurance Arbitrage Save $909 Paying Cash

Self-Pay Cash Rate ($581) Beats Your Bill

Lanai Community Hospital's published 45 CFR § 180 self-pay cash rate is $581 (vs. $1,353 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$992 Above Fair BaseRate

Negotiate Toward $498 Fair BaseRate ($451 Medicare)

Your bill ($1,490) is $992 above the denoised Fair BaseRate ($498) and 3.3× the $451 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold
Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier
Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported
26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (12.0% of gross charges)

Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑
CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

Safety Composite85/100
Median ER Wait78 min

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Lanai Community Hospital. Prior administrative notices do not necessarily reflect current compliance status.

  • 2026-05-21·warning_notice

    Warning Notice

    Recorded
  • 2025-09-08·administrative_or_closure

    Closure Notice

    Recorded
  • 2025-06-05·warning_notice

    Warning Notice

    Recorded

Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Regional Value & Quality Leader Pareto Frontier (Price + Quality)

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Lanai Community Hospital.

Price Index: 0.99× regional baseline
Quality: 54/100 CMS composite
Median Household Income$95,076U.S. Census ACS
Local Uninsured Share4.5%Regional ACS estimate
200% FPL (1 Person)$36,720Common free-care ceiling
400% FPL (Family of 4)$147,920Common AGB cap ceiling
45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 74/100 · Corroborated CMS CCN 121305

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 121305) ↗ CMS HCRIS Cost Reports ↗
Published MRF FileCMS_45_CFR_180_FILING.json
Publication / Vintage8/11/2025
Validated Rate Rows274 (CMS v2.0.0)
File Integrity DigestVerified · CCN 121305

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy