by Leslie Ramirez, MD
I am often asked how we get the prices for the radiology imaging tests, such as MRI’s and mammograms, or ultrasounds. Most people assume that my day job as a doc gives me some sort of special access to this info. But that’s just not the case. Anyone can find out testing prices.
However, over the last year, those of us working at LesliesList.org have gotten more experienced and better at getting these imaging prices, so I thought I would share with you how we go about it — so you can try it yourself if you need to.
Please note that these are prices for out-of-pocket payment. If you are going through your insurer, all bets are off. (As an aside: you might be surprised to find that sometimes paying out of pocket for a radiology test will cost you less than going through your insurer, if your insurer demands that you only use certain facilities.)
How to find out the price of a test
1. Start with finding out the CPT code of the test your doctor has ordered. This stands for Current Procedural Terminology and is a unique identifier for every medical test that exists — whether it be an MRI, mammogram, blood test, etc. Ask your doctor to provide it — and often it is written on the order form. If that doesn’t work, you can try Googling for this info here CPT codes –but there are a lot of procedures/codes that sound alike — so be careful going this route.
We also provide a limited number of CPT codes in the LesliesList.org Testing Section that you can feel free to use. Just click on the type of test you need and you can see the code for it on the far right of the screen. Please note that a test that requires the use of contrast dye is a different CPT code than a test that does not require contrast dye.
2. It’s always easier to get prices from the stand alone radiology facilities or basically any center that is not directly owned by a hospital. (Notice I said ALWAYS, not almost always — and I meant it!) You just call the imaging center and ask the person that answers the phone how much a person who has to pay out of pocket will pay for such-and-such a test.
Often they don’t even need a CPT code — they have one standard price for a standard MRI or a standard CT scan or X-ray — no matter the body part. Often this includes physician reading fees, i.e. is a “global fee”. If your doctor has requested that the test include contrast dye be sure to tell them that as well- as this is usually a little bit more expensive.
3. Getting a testing price from a hospital is always much more difficult than from a free standing imaging center. Probably because hospital facilities are much bigger organizations and have a lot more to keep track of. To get the price from a hospital you really must have the aforementioned CPT code.
When you call the main number of the hospital ask for either the Cashier’s Office or the Billing Office. It is impossible to predict which one will have access to this info — so if the first place you reach doesn’t have the info, ask to be transferred to the other office. Also ask about the physician’s reading fees, as these are almost never included in the cost of a radiology test at a hospital — but don’t be surprised if the person you are speaking to doesn’t know the answer. It’s not their fault.
Frequently physician’s fee billing is done through the physician’s private office. Also, always ask if there is a discount for self-pay patients, and how to qualify for this discount, as sometimes this entails additional paperwork.
How do you know if you should to go to an independent, and usually lower cost, imaging center? The answer is, of course, ask your doctor.
Leslie Ramirez is an internal medicine physician and founder of Leslie’s List, which provides information that enables all patients, but especially the uninsured and underinsured, to find more affordable medications and health care services.
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