What Healthcare Actually Costs

Why the same scan can cost wildly different amounts

The identical test can cost three or four times more at one place than another, and it usually comes down to a few things:

• Where you go. A freestanding imaging center is almost always cheaper than a hospital outpatient department, and an emergency room is the most expensive of all for the same scan. For anything non-urgent, the facility you choose is the biggest lever on price.
• Contrast and complexity. A scan "with contrast" costs more than one without, and a more involved study (more body parts or views) costs more than a focused one.
• Where you live. Prices vary by region and even by neighborhood - you can see the regional breakdown on each scan's guide.
• Whether it's bundled. Some prices include the radiologist's reading; others bill it separately.

Because the price usually isn't tied to quality, comparing a couple of clinics is the simplest way to save.

Paying for care with insurance

When you use health insurance, you usually don't pay the clinic the full price directly. Your plan has already negotiated a rate with in-network providers, and you pay a share of it:

• Deductible - what you pay yourself each year before your plan starts covering costs.
• Copay or coinsurance - a flat fee or a percentage you owe once coverage kicks in.
• Out-of-pocket maximum - the most you'll pay in a year; after that, your plan covers 100%.

The hard part is that you often won't know your cost until after the visit, when you get an Explanation of Benefits (EOB) and a bill. And until you've met your deductible, you're typically paying that full negotiated rate yourself - so it pays to know the price ahead of time.

Paying without insurance: cash and self-pay

If you don't have insurance - or choose not to use it - you pay the clinic directly. You'll hear this called the cash price, self-pay rate, or cash-pay; they all mean the same thing: the price you pay out of pocket, without a claim going through insurance.

Many clinics offer a discounted self-pay rate, and it's sometimes lower than what insurance would charge, because there's no claim to file or paperwork to process. The biggest advantage is certainty - you know the price before you book.

People often choose to pay cash when:

• They're uninsured.
• They have a high-deductible plan and haven't met the deductible yet (so they'd pay the full rate either way).
• The cash price is lower than their copay or their plan's negotiated rate.
• They simply want a clear, upfront price.

To use it, just ask the clinic for their cash or self-pay price and pay at the time of service.

How to get the cash price (and what to ask)

Getting the self-pay price is usually as simple as asking - here's how to do it well:

1. Ask for the cash or self-pay price directly, even if you have insurance - many clinics quote a lower rate when no claim is involved.
2. Get the all-in price. Confirm whether it includes the radiologist's reading and any contrast, so there are no add-ons later.
3. Give the exact study. Name the body part and whether you need contrast - that's what the price depends on.
4. Compare two or three clinics. Prices for the identical scan can differ a lot, so a few calls - or a quick look on our finder - can save real money.
5. Ask about prompt-pay or package discounts. Some centers lower the price further if you pay at the time of service.

Use our price guides to see the typical range first, then find a clinic near you to compare and book.

Can a cash payment count toward your deductible?

Sometimes - and it's worth asking. Some plans let you submit a self-pay visit so it counts toward your deductible or out-of-pocket maximum. You'd ask the clinic for a superbill (an itemized receipt with the medical billing codes) and send it to your insurer as a claim. This is most common with plans that have out-of-network benefits.

Because it depends on your plan, check two things before you pay:

• Ask your insurer whether self-pay or out-of-network services can be submitted toward your deductible.
• Ask the clinic for a superbill with the procedure (CPT) codes.

And if you have an HSA or FSA, you can usually use those pre-tax dollars to pay cash prices directly.