By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    headphones can create health problems
    The Harmful Health Effects of Using Headphones
    September 24, 2021
    Headache causes
    4 Causes Of Headache You Probably Didn’t Know About
    December 28, 2021
    follow these steps to recover from your injury
    What Steps Should You Take to Recover More Quickly from an Injury?
    April 12, 2022
    Latest News
    Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
    May 16, 2025
    Learn how to Renew your Medical Card in West Virginia
    May 16, 2025
    Choosing the Right Supplement Manufacturer for Your Brand
    May 1, 2025
    Engineering Temporary Hospitals for Extreme Weather
    April 24, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Do You Know What’s in Your Pain Pill?
    May 11, 2011
    Depression and Diabetes Linked
    June 23, 2011
    Positive Health and the Heart
    July 28, 2011
    Latest News
    Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
    May 18, 2025
    The Critical Role of Healthcare in Personal Injury Recovery: A Comprehensive Guide for Victims
    May 14, 2025
    The Backbone of Successful Trials: Clinical Data Management
    April 28, 2025
    Advancing Your Healthcare Career through Education and Specialization
    April 16, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: How Much Does an MRI Cost? $425 to $2530
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > Finance > How Much Does an MRI Cost? $425 to $2530
BusinessFinanceHealth ReformHospital AdministrationNews

How Much Does an MRI Cost? $425 to $2530

Jeanne Pinder
Last updated: March 8, 2014 9:00 am
Jeanne Pinder
Share
8 Min Read
SHARE

SUMMARY: Dear Insurance Co., Patient X called and he wants to know why you’re paying $425 and $2,530 for the same thing. Keep reading for a mini-mystery story, or…

Contents
A bit of background explanationAn MRI can cost from $425 to $2,530Other procedures too
Culture change is here: People have awakened to the wide disparities in pricing in the health-care marketplace. Even if they’re insured, they’re upset.

Let’s call him Patient X. He wanted to talk about the coinsurance charges for his new health insurance plan. He wanted me to know a few things.

SUMMARY: Dear Insurance Co., Patient X called and he wants to know why you’re paying $425 and $2,530 for the same thing. Keep reading for a mini-mystery story, or…

Culture change is here: People have awakened to the wide disparities in pricing in the health-care marketplace. Even if they’re insured, they’re upset.

Let’s call him Patient X. He wanted to talk about the coinsurance charges for his new health insurance plan. He wanted me to know a few things.

More Read

Merck To Cut 13,000 More Jobs in The Next 4 Years
BioPharma Beat: Is Commercial Support of CME A Bad Idea?
Economists on the Left Discover … Well … Economics
Community Management that Works – Featured on SlideShare
Challenges of Healthcare of Gays & Lesbians under Reform

For an MRI in his neighborhood, his insurance company’s site tells him, the insurance company is paying anywhere from $425 to $2,530.

How does he know that?

Well, he’s responsible for 10 percent of the contracted fee. And the insurance company tells him what that 10 percent would be, should he choose Provider A, Provider B, Provider C and so on.

Helpful? Yes. Maddening? Also yes.

A bit of background explanation

Health-care providers have a number of prices for procedures. Their charged price (often known as the chargemaster price) is something like a manufacturer’s suggested retail price in electronics or the rack rate at a hotel, prices that are seldom paid because there are so many discounts available.

Full-pay patients, those who pay the charged price, are rare. What the provider actually receives is either a fixed price from the government (Medicare, Medicaid, or Tri-Care, for military personnel) or a negotiated or contract price, so called because it’s negotiated by the provider (doc or hospital, let’s say) by contract with the payer – an insurance company, like Blue Cross, Cigna, Aetna or United Healthcare.

The negotiated rates are secret, protected by gag clauses in most contracts. The insurers don’t want Provider A, who’s getting $425 for a procedure, to know that Provider B is getting $2,530. So there are penalties to providers for disclosing what they get.

That information has long been available on people’s bills, and explanations of benefits, but for a great deal of time no one cared because it might all have been covered by a $20 copay. Also, because you weren’t able to compare what your provider received with what another provider received, you might not have known of the disparities.

But! With the new 10 percent disclosure, Patient X now knows that for an MRI, his co-insurance will be 10 percent of the contracted rate. Multiply the co-insurance by 10, and you have the contracted rate.

An MRI can cost from $425 to $2,530

Here are some of the prices, derived from multiplying his anticipated 10 percent coinsurance, as listed on the site, by 10:

Provider A: $425

Provider B: $753

Provider C: $1,495

Provider D: $1,760

Provider E: $1,708

Provider F: $2,530

What does Medicare pay? This is in the New York area, so it’s between $497 and $516. This is important because the Medicare rate is the closest thing to a fixed or benchmark price in the marketplace — it’s set by the government under a fairly convoluted equation described in this blog post.

This insurance company is undercutting Medicare at Provider A.

Does this mean that Provider F gives an MRI that is 6 times better than the MRI at Provider A? Well, not necessarily. It probably means that Provider F has more power in the marketplace – perhaps a bigger reputation, more patients, “must-have” status or something else. (Here’s a blog post about a paper my friend Chapin White wrote recently about higher-paid providers: the actual paper is behind a paywall, but the gist is that higher-priced hospitals don’t have better outcomes).

Does this mean that Provider A is getting taken to the cleaners? Well, maybe.

Does this mean that if you – as an insured person on this plan from this company, choose a less expensive provider, your premiums are subsidizing higher-priced providers? Yes.

But in our pricing survey of MRI providers in the New York City area, we learned that prices for cash or self-pay customers can range from $400 to $2,500.

So why do Providers C, D, E and F get more money than a cash customer would pay? And in some cases a lot more? Interesting question.

Note: We are not naming the insurer or the providers. Patient X gave us this information on the condition that we would not name the insurance company, and we agreed. If we named the providers, that would identify the insurance company. So we’re not naming them either.

Moving toward transparency

It should be noted here that we think transparency is good. All prices (or costs or charges) should be revealed, and all quality metrics too.

There’s no compelling argument we’ve heard for keeping all this information secret.

We are big supporters of complete transparency. Partial transparency? We’re less enthusiastic about that.

Other procedures too

By the way, Patient X told us, other procedures also vary: For one, judging from the 10 percent coinsurance, the total cost at Provider A is $120, and at Provider B it’s $370.

For another procedure, the range is from $129 to $349.

If you extrapolate this set of numbers to the entire marketplace, and to much more complicated procedures – appendectomies, knee replacements, cancer care? – you can start to see how explosive the release of a 10 percent coinsurance charge might be for a thinking person.

Patient X is not exactly a cynic, but he’s pretty clear about pointing out that the insurance company is not directing him or anyone else toward lower-cost care.

Provider A and B, we’d like to talk.

Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Clinical Expertise
Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
Health care
May 18, 2025
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Health
May 15, 2025
Learn how to Renew your Medical Card in West Virginia
Learn how to Renew your Medical Card in West Virginia
Health
May 15, 2025
Dr. Klaus Rentrop Shares Acute Myocardial Infarction heart treatment
Dr. Klaus Rentrop Shares Acute Myocardial Infarction
Cardiology
May 13, 2025

You Might also Like

Medical Tests You May Not Need

August 9, 2012

There’s No Business Like the Healthcare Business

August 5, 2014

Report: Avoidable ‘Never Events’ Increase in Minnesota Hospitals

January 20, 2012
medical scribe secrets
BusinessFinanceHospital AdministrationPolicy & LawPublic Health

The Disturbing Confessions of a Medical Scribe: Adding to the Bill

August 13, 2014
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?