CMS Price Transparency Data

CT scan, sinuses

Facility: Hospital Metropolitano Dr Pila

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $99
Cash Discount Price: $300
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Hospital Metropolitano Dr Pila is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $300. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.93x the Medicare baseline. Located in 2435 Boulevard Luis A Ferre, Ponce, PR.

Cash / Self-Pay

$300

Average discount available for prompt cash payment at this facility.

Insurance Median

$99

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $300 (281%)

Insurance Median: $99 (93%)

Cash: $300 (281% of Medicare)

Ins. Median: $99 (93% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
First Medical	$38 - $162	36%
Triple S	$38 - $138	36%
Mso	$44 - $69	41%
Privado	$48	45%
Va	$62	58%
Auxilio Mutuo	$69	65%
Acaa	$82	77%
Hospicio	$88	82%
Humana	$96 - $206	90%
Mcs	$96 - $131	90%
Tricare	$96	90%
Ch	$98	92%
Salud Correccional	$98	92%
Fondo Del Seguro Estado	$99	93%
Plan De Salud Menonita	$118 - $150	110%
Prossam	$124	116%
Bl	$138	129%
Cigna	$139	130%
Comerciales	$150	140%
Life Link	$150	140%
Mc	$150	140%
Wellcare	$150	140%
Aarp	$275	257%
Mapfre	$300	281%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $300.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70486.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Hospital Metropolitano Dr Pila is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70486.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.