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Hospital Profile Acute Care Hospital Proprietary 115 Beds · urban Updated: 2025-04-10

Hospital Metropolitano Dr Pila

2435 Boulevard Luis A Ferre, Ponce, PR 00717 · 57 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.Good Deal · Below Fair Market
0.92×vs. Fair Market Price
Position vs. 1.00× Fair Price8% Below 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 8% below the fair benchmark (0.92×) 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).61/100 · Caution
61/100Self-Pay Cash Beats Insurance 4% of the Time
File Completeness66Provenance (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 Logic79Coherence (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 Alignment67Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing77Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount6Cash 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.Regional Value Leader
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score65/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian 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

Hospital Metropolitano Dr Pila prices routine shoppable procedures near 0.7× Medicare (p50 0.75×) while skewing captive emergency, lab, and upper-quartile codes to 1.5× Medicare (p75 1.39×, +85% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.

#4 of 17 in PR · 17th State Percentile#808 of 3,385 in U.S. · 23rd National Percentile
Advantage

Where They're Good (Patient & Payer Edge)

  • Elective shoppable care is priced 8% below peer Fair BaseRate (0.92×)
  • Self-pay cash beats commercial insurance on 4% of shoppable procedures (25/100 Cash Honesty)
  • CMS clinical safety score (65/100 safety score) with 72% patient recommendation
  • Binding Good Faith Estimate rights under 45 CFR § 149.610 protect self-pay patients before scheduling
Watchout

Where You Can Get Burned (Markup Traps)

  • Even at low-cost facilities (0.92× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
  • Captive ER (1.0×) & laboratory (0.9×) services average 2.14× higher multiples than routine shoppable care (0.7×)
  • Upper-quartile procedures (Q75 1.39×) jump +85% above the median procedure ratio (Q50 0.75×)
  • Consolidated metro market (HHI 2,435) limits in-network hospital competition (Moderately Concentrated (1,500–2,500))
Front-Door ShoppableElective / Imaging
0.7× Medicare

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

Back-Door Captive & ER2.14× Divergence
1.5× Medicare

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

Quantile Tail Spread+85% Upper Tail
Q25 0.48× · Q50 0.75× · Q75 1.39×

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
0.7× MedicareGood
Outpatient Surgery & ORBack-Door Captive
0.9× MedicareGood
Diagnostic Imaging (CT/MRI)Front-Door Shoppable
0.5× MedicareGood
Back-Door Captive ER VisitsBack-Door Captive
1.0× MedicareGood
Inpatient Lab & PathologyBack-Door Captive
0.9× MedicareGood
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
1.1× MedicareGood
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
4% Cash Edge · 25/100Watchout
CMS Clinical Safety & Star ValueIntegrity & Outcomes
3 CMS · 65/100Fair

Procedure Prices at Hospital Metropolitano Dr Pila

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 57 published procedures.

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Audit a Bill & 501(r) Cap ↓
Procedure & Billing Code This Hospital vs. Fair
Colonoscopy with biopsy
CPT Code: 45380
 $410 0.3×
MRI, brain (with and without contrast)
CPT Code: 70553
 $261 0.5×
MRI, brain (no contrast)
CPT Code: 70551
 $207 0.6×
MRI, knee or other leg joint
CPT Code: 73721
 $211 0.6×
MRI, lower back (no contrast)
CPT Code: 72148
 $184 0.5×
Upper endoscopy with biopsy
CPT Code: 43239
 $200 0.2×
CT scan, abdomen and pelvis (with contrast)
CPT Code: 74177
 $168 0.4×
CT scan, neck (cervical spine)
CPT Code: 72125
 $126 0.7×
CT scan, lower back (lumbar spine)
CPT Code: 72131
 $125 0.7×
CT scan, pelvis
CPT Code: 72192
 $120 0.7×
CT scan, head (no contrast)
CPT Code: 70450
 $115 0.7×
CT scan, chest (no contrast)
CPT Code: 71250
 $120 0.7×
CT scan, sinuses
CPT Code: 70486
 $108 0.7×
CT scan, head (with and without contrast)
CPT Code: 70470
 $132 0.5×
CT scan, head (with contrast)
CPT Code: 70460
 $117 0.5×
CT scan, abdomen and pelvis (no contrast)
CPT Code: 74176
 $116 0.4×
New patient office visit (30-44 min)
CPT Code: 99203
 $87 unverified
X-ray, chest (single view)
CPT Code: 71045
 $46 0.5×
X-ray, shoulder
CPT Code: 73030
 $46 0.5×
X-ray, chest (two views)
CPT Code: 71046
 $46 0.5×
X-ray, neck (cervical spine)
CPT Code: 72040
 $46 0.5×
X-ray, hand
CPT Code: 73130
 $46 0.5×
X-ray, hip
CPT Code: 73502
 $46 0.5×
X-ray, ankle
CPT Code: 73610
 $46 0.5×
Diagnostic mammogram (both breasts)
CPT Code: 77066
 $70 0.5×
Showing top 25 high-impact procedures of 57 total
Inline Bill X-Ray & 501(r) Calculator For-Profit Facility · Cash & Fair BaseRate Audit

Audit a Bill or Quote at Hospital Metropolitano Dr Pila (Zero PHI Required)

CMS CCN: 400003
CPT 45380
Fair BaseRate™ $1,256
Medicare Rate $1,223
Self-Pay Cash $410
Insurer Median $410
Pre-filled with Hospital Metropolitano Dr Pila’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 274% of 2026 FPL

Above Standard 400% FPL Financial-Assistance Ceiling

At 274% FPL, you exceed the standard 400% FPL tier, though medical-hardship caps (when bills exceed 10% of annual income) may still apply.

Step 2 · Cash vs. Insurance Arbitrage Published Cash: $410

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Hospital Metropolitano Dr Pila's published 45 CFR § 180 self-pay cash rate is $410 (vs. $410 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target Target: $1,256 Fair BaseRate

Negotiate Toward $1,256 Fair BaseRate ($1,223 Medicare)

Your entered amount is at or below the modeled Fair BaseRate benchmark ($1,256).

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) For-Profit / Non-501(c)(3)

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

Public IRS & CMS ownership records classify Hospital Metropolitano Dr Pila as a non-501(c)(3) facility. Federal 26 U.S.C. § 501(r) statutory charity-care caps apply specifically to tax-exempt nonprofit hospitals, though state hospital fair-pricing statutes and prompt-pay self-pay discounts may still apply.

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 Composite65/100
30-Day Mortality vs U.S.same
Unplanned Readmissionsame

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 Hospital Metropolitano Dr Pila.

Price Index: 1.00× regional baseline
Quality: 54/100 CMS composite
Median Household Income$18,827U.S. Census ACS
Local Uninsured Share4.7%Regional ACS estimate
200% FPL (1 Person)$31,920Common free-care ceiling
400% FPL (Family of 4)$128,600Common AGB cap ceiling
45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 61/100 · Caution CMS CCN 400003

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 400003) ↗ CMS HCRIS Cost Reports ↗
Published MRF FileCMS_45_CFR_180_FILING.json
Publication / Vintage2025-04-10
Validated Rate Rows1,318 (CMS v3.0.0)
File Integrity DigestVerified · CCN 400003

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