CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Hospital Pavia Hato Rey, Inc

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $124
Cash Discount Price: $712
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Hospital Pavia Hato Rey, Inc is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $712. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.16x the Medicare baseline. Located in Ave Ponce De Leon 435, Hato Rey, PR.

Cash / Self-Pay

$712

Average discount available for prompt cash payment at this facility.

Insurance Median

$124

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: $712 (667%)

Insurance Median: $124 (116%)

Cash: $712 (667% of Medicare)

Ins. Median: $124 (116% 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
Tricare	$43	40%
First Medical	$56 - $162	52%
Plan De Salud Menonita	$57 - $150	53%
Mso	$64 - $100	60%
Triple S	$79 - $124	74%
Acaa	$82	77%
Fondo Del Seguro Estado	$92	86%
Mcs	$105 - $131	98%
Prossam	$107	100%
Auxilio Salud Plus	$112	105%
Plan Socios Auxilio	$112	105%
Va	$113	106%
Humana	$132 - $138	124%
Bl	$138	129%
Cigna	$139	130%
Mapfre	$150	140%
Mc	$150	140%
Corvel Network	$151	141%
Ch	$165	154%
Bella Vista	$225	211%
Privado	$265	248%
Aarp	$275	257%

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 $712.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72131.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Hospital Pavia Hato Rey, Inc is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72131.
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.