Why MRI Prices Differ Between Hospitals

The same scan can show up as several different prices

Two people can have an MRI of the same body part and see very different amounts on their paperwork. That does not always mean one hospital is doing something unusual. An MRI price can depend on how the scan is coded, where it is performed, who is paying, and whether a cash discount applies. Looking at each piece can help the numbers make sense.

This guide walks through four common reasons. To see real hospital numbers first, browse the procedures list or start from the Texas hub or the Florida hub.

Billing codes: MRI with contrast, without contrast, or both

Hospitals bill imaging using codes rather than plain descriptions. The American Medical Association maintains CPT (Current Procedural Terminology), a set of five-character codes, and most MRI scans are identified by one of them. CMS maintains a second set, HCPCS Level II, which generally covers things like supplies, drugs and certain services, and a contrast agent can fall into that group. A hospital bill may also list revenue codes that show the department or type of service.

For MRI, the code generally reflects the body part and whether contrast is used. Contrast is a substance given during some scans to make certain structures easier to see. A scan without contrast, with contrast, or done both ways can each have its own code, and each code can carry its own price. The contrast agent itself may also appear as a separate item on a bill.

So two prices that look like they describe the same scan may belong to different codes. When comparing, it helps to confirm the code attached to each price. Our guide on what CPT codes are explains how to read them.

Hospital outpatient department versus a freestanding imaging center

The same type of MRI machine can sit in a hospital outpatient department or in a separate imaging center. Hospitals and hospital outpatient departments can bill a facility fee. Physicians such as radiologists, who read the images, usually bill a separate professional fee.

That means one scan can produce more than one bill. The MRI figures shown on Clear Hospital Costs are facility charges, pulled from each hospital's own published files, and they are not the full cost of a scan. When a hospital figure is set beside a quote from an imaging center, it can be worth asking whether the quote includes the radiologist's reading or only the facility side. The facility fee versus professional fee guide covers this in more detail.

Payer contracts: why insurers pay different rates

Every hospital keeps a master list of gross charges, called a chargemaster. Gross charges are list prices, and insurers generally pay negotiated rates instead. Each insurer negotiates its own rate with each hospital, so the same MRI can have a different negotiated rate for each plan at each hospital. You can read more in our explainer on the chargemaster.

Cash prices and the self-pay option

Many hospitals offer a discounted cash price, which is separate from the gross charge and from any insurer rate. It appears in the hospital's price file. Depending on the hospital and the insurer, the cash price may be lower than, close to, or higher than a negotiated rate, so looking at both can be useful. Our guide on cash price versus insured rate explains the tradeoffs.

People who are considering paying cash can ask the hospital for its self-pay price directly. The guide on how to ask for the self-pay price offers sample wording.

Ways to compare prices before a scheduled MRI

CMS describes a shoppable service as one a patient can schedule in advance, and many MRIs fit that description. The same rule requires hospitals to provide a consumer-friendly display of 300 shoppable services, or an online price estimator tool instead. A hospital that falls short of the rule can face warning notices, corrective action plans or civil monetary penalties from CMS. You can read more in our guide on shoppable services.

Some steps people take when comparing:

• Look up the hospital's own price file, or use our guide to price transparency files to read it.
• Check local pages such as MRI cost in Houston, MRI cost in Miami and Fort Lauderdale, or MRI cost in Dallas and Fort Worth.
• Confirm the exact code, whether contrast is included, and whether a figure is a facility charge only.
• Use how to compare hospitals by price as a checklist.

Clear Hospital Costs refreshes its Texas, Florida and Tennessee pages from the hospitals' files twice a week. Pages show gross charges, cash prices and insurer negotiated rates by hospital, and clear data errors are left out as described on our methodology page.

Getting an estimate and reviewing the bill afterward

Under the No Surprises Act, people who are uninsured or who choose not to use their insurance can generally get a good faith estimate of expected charges for scheduled items and services. A provider must supply one when the scan is booked at least 3 business days in advance, and also whenever a patient requests one. Should the final bill from a provider or facility come in at least $400 above its good faith estimate, the patient may be able to use the patient-provider dispute resolution process, which in general has to be started within 120 calendar days of the bill date. CMS runs a No Surprises help desk. Details are in our good faith estimate guide.

After a scan, the bill can be compared line by line against the estimate and the codes, and our guide to reading an itemized hospital bill can help. For bills that are hard to manage, some people ask about hospital financial assistance or look at negotiating a hospital bill. Nonprofit hospitals must meet IRS section 501(r) requirements, including a written financial assistance policy, and many other hospitals also offer assistance. Each hospital sets its own eligibility rules, and terms vary.