What steps should I take before I have my MRI to determine the cost?

  1. Find out what the CPT code is for your exam from your doctor. For example: Knee MRI = CPT 73721 or Lumbar Spine MRI without contrast = 72148.
  2. Contact your insurance company for your out-of-pocket costs for the location of your choice.

*Your insurance company has all of the information about your plan, contracted rates, co-pays, co-insurance, reimbursement rates and your deductible.

How is my out-of-pocket cost of an MRI exam calculated?

There are several contributing factors that determine what your MRI will cost.

  • The contracted rate between your insurance company and a provider
  • Your remaining deductible
  • Coinsurance
  • Co-pay

I am a price-conscious consumer, can I shop around?

Yes, but it is difficult to get accurate figures. You as a consumer cannot be a wise healthcare shopper without information on quality and price. You will need to understand the total payment for service, including what the plan (insurance company) pays and the remaining price minus your deductible, co-pays, etc.

What do I need to know before shopping around?

You need to be very specific.

  • Insurance companies negotiate different rates with different facilities.
  • There is a specific code for the test or procedure your doctor has requested. For example, a routine Brain MRI code without contrast is 70551. A routine Brain MRI with and without contrast is 70553.
  • In some cases there will be several billing codes, resulting in several bills.
  • The professional fee is the radiologist’s charge for interpretation of your exam.
  • The technical fee is the charge for your actual MRI exam.
  • There may be a fee for contrast separate from the other codes, depending on where the injection takes place. This is common for MR arthrograms.
  • MR-guided procedures may have a charge for supplies.
  • Sometimes the charges are bundled into one fee (bundled fee).

Can anyone at Metro MRI Center help me obtain this information?

Our insurance specialist can provide you with a comprehensive estimate of your out-of-pocket expense. We do not have access to this information until we receive an order from your doctor. We can provide anyone with our commercial rate, but this is not a true cost projection.

What is a commercial rate?

A commercial rate is a base rate/fee for an exam, or a retail rate. This does not take into consideration what your insurance company’s contracted rate is.

What is a contracted rate?

A contracted rate is an agreed upon price between an insurance company and a facility. The contract states that a provider can only bill the insured a negotiated/contracted rate of service.

What is a co-pay?

A payment defined in your insurance policy and paid by you each time a medical service is accessed.

What is co-insurance?

A percentage that you pay after the insurance policy’s deductible is met.

How do I know if I am receiving quality MRI services?

There are several measures of quality. Our healthcare system has an immense variation in care delivery, a wide range of services and products, and different approaches for measuring outcomes.

Some measures of quality are listed here:

  • Facility accreditations
  • Patient-submitted reviews
  • Certified staff meeting continuing education standards
  • Board certified radiologists
  • State of the art equipment
  • Updated software and hardware

What is pricing transparency?

Pricing transparency is knowing what the price you will be charged for a service or product. Price transparency exists when, prior to seeking care, a consumer knows what his out-of-pocket expense will be.

Clearly focused on you.