Radiology tests, and how to find their price

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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  • http://kevinMD.com vickie

    There is something wrong if your out of pocket price can be cheaper than going through your insurance…that is what you said…..so insurance companies are taking advantage of some people….My insurance negotiates a price and so far I haven’t had to pay a thing……..why does one person pay 75 dollars for an x-ray and another pay 329 dollars for the same x-ray?…. Its wrong…. that’s why we need reform,now.

    • ErnieG

      Out of Pocket should be cheaper than insurance for several reasons
      1) no middle man and therefore
      2) less paperwork to submit to insurance
      3) instant cashflow for practice

      Health care reform that expands the role of the middle man (including single payer, which introduces middle man as both payer and rationer) will increase the percentage of expenses attributable to non-medical administration. Health care cost can only come down if EXTREME rationing at a bureaucratic/insurance levels (which increases in adminstrative costs and cuts medical costs). Obama and the democrats missed the boat big time.

  • ninguem

    In the UK, home of the National Health Service, the private hospitals are quite open about their pricing, just ask.

    http://www.nuffieldhealth.com/Individuals/Hospitals/About-Our-Hospitals/self-pay/

    So yes, it CAN be done. To the extent that there’s ANY price transparency in USA healthcare, it is because of consumer-directed healthcare (HSA’s).

    What remains to be seen is whether the Obamacare “reforms” will kill off consumer-directed healthcare. The one reform of recent years that has a track record of working, of course the current Administration and Congress have ignored it. I suspect it will be killed off. Leaving consumers in direct control of their healthcare dollars is an existential threat to the left.

    • http://kevinMD.com vickie

      What reform has a track record of working?

      • ninguem

        vickie – “What reform has a track record of working?”

        I was referring to Consumer-Directed Healthcare, the High-deductible Health Plans (HDHP) and Health Savings Accounts (HSA).

  • Doc99

    Obamacare will phase out HSA’s. Sorry.

  • Thomas

    Just out of curiosity, How many doctors are there currently in the US. Can you put out a graf as to how many are in each state and how many people to doctors ratio in each state?

  • Walter Quiring

    Public Health care can work in the USA as well as in the rest of the developed World. I’m in Canada and we’re doing just fine.
    Doctor Shortages can be overcome by doubling spaces in Medical Schools and restricting their enrollments to prospective PRIMARY Health care workers. Special Government Grants can also entice young students in that direction.
    Why don’t you people thank God that you finally have a true Christian in the White House?
    God bless America!
    Sincerely, A 70 year old.
    Walter Quiring.

  • imdoc

    good for you for Dr Ramirez for putting together something to assist in price transparency. The next great accomplishment would be to get a network of legitimate “re-pricing” agreements with existing hospitals and doctors for the uninsured so they don’t pay the highest prices out there.

  • Jake

    Ramirez says: “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.”
    Then he says: “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.”
    Doesn’t there seem to be an inconsistency here?

    • W

      That was my reaction as well. The author suggests that any patient can find out the cost, then proceeds to describe a litany of obstacles consisting of people who can’t help and shouldn’t be blamed. The thesis was attractive but it sure wasn’t supported by any evidence.

    • http://www.leslieslist.org/ Leslie Ramirez

      The answer to the question, “How do you know if you should go to an independent, and usually lower cost imaging center?” is included in another blogpost that I wrote a while back. The link to this article was left out by the editors at KevinMD for the sake of brevity. You can see a detailed answer to this question here:
      http://www.chicagonow.com/blogs/leslieslist/2010/02/is-it-safe-to-go-to-an-independent-radiology-testing-center.html

      • ninguem

        Chicago is probably the biggest producer of doctors in the USA. Net exporter of physicians, producing far more than they need locally, which is fine…..but….competitive market, and usually ends up consolidating into the bigger entities, universities, government entities, HMO’s etc. That’s the side effect, for better or worse.

        Nice to be able to find the independent places. I found that hard when I lived in Chicago. They were there, but good luck finding them. Surrounded by 800-lb gorillas.

        So…….great…….nice to see what you’re doing Leslie, props to ya.

  • R Davenport

    I totally agree. The need for primary care doctors in the near future will be astronomical. It is good to allow more people to able to obtain medical coverage. it will be as if everyone in America is given a car, but one can only buy gas in selected locations. We are in for a rough future in healthcare.

  • Frank Drackman

    Dear Dr. Quirring:
    a “True Christian” in the White House?
    Did the President(Peace be upon Him) die overnight??
    Doubling spaces in Medical School isn’t needed, we already take the cream of India’s crop of M.D.s, FP training spots have actually decreased, that whole supply/demand thing.
    And why did that Canadian Politician come to Florida for his Heart Surgery???

    Frank, M.D.

  • hypnoid

    Well, he came because he wanted a minimally-invasive technique which was most readily available by going to the US. I don’t see a problem with that.

  • ninguem

    “…….And why did that Canadian Politician come to Florida for his Heart Surgery???……”

    For the same reason Jean Chrétien went to Mayo.

    http://ezralevant.com/2010/02/danny-williams-flies-to-us-hea.html

    Some are more equal than others. I don’t have a problem with Danny Williams, not because of the flimsy excuse of the minimally invasive surgery, but because he wanted it done outside of Canada. Didn’t want to wait in line. Can’t say as I blame him.

    Chrétien felt he had to keep it secret. Some BS story about skiing the Canadian Rockies when he failed to show up at King Hussein’s funeral.

    Williams is rich, he can do what he wants. Why does Chaoulli have to sue to allow Canadians of more moderate means to insure themselves, so they can have the same opportunity?

    Some are more equal than others.