{"id":62289,"date":"2023-12-26T17:20:06","date_gmt":"2023-12-26T22:20:06","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=62289"},"modified":"2025-01-02T16:03:10","modified_gmt":"2025-01-02T21:03:10","slug":"mri-cost","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/mri-cost\/","title":{"rendered":"MRI costs: What you\u2019ll pay with and without insurance"},"content":{"rendered":"

Magnetic resonance imaging (MRI) is a common imaging technique that can develop detailed images of organs and structures using magnets and radio waves. With the detailed images from an MRI, a healthcare provider can detect and diagnose conditions such as tumors, infections, and injuries. They can also track the progression of diseases and whether treatment is effective. This technology is effective, but expensive.<\/span><\/p>\n

The national average cost of an MRI in the United States is $1,325, but you could pay much less or much more depending on various factors. We\u2019ll give you an idea of what you can expect to pay and how to lower your out-of-pocket cost for an MRI.<\/span><\/p>\n

How much does an MRI cost without insurance?<\/span><\/h2>\n

There\u2019s a wide price range for an MRI scan because many factors can impact the cost. According to <\/span>Michael Yudelevich, MD<\/span><\/a>, an independent patient advocate at <\/span>My Personal Health Advocate<\/span><\/a> in New York City, an MRI can range from $400\u2013$12,000 without insurance.\u00a0<\/span><\/p>\n

How much does an MRI cost with insurance?<\/span><\/h2>\n

Insurance coverage varies by plan, but most health insurance policies cover at least part of the cost of an MRI if it\u2019s medically necessary. However, you may need to meet your deductible first. A deductible is <\/span>what you pay for covered health services<\/span><\/a> before your insurance provider starts to pay.\u00a0<\/span>
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Once you\u2019ve paid your deductible, you\u2019ll only be responsible for paying coinsurance or a copay. If you have a high-deductible health plan (HDHP), you may pay more out-of-pocket expenses, leaving you to cover most or all of the cost of your MRI if you haven\u2019t yet met your deductible for the year. If you\u2019re unsure, contact your health insurance provider.<\/span><\/p>\n

Do Medicaid and Medicare cover MRIs?<\/span><\/h3>\n

Both Medicaid and Medicare provide partial or complete coverage for MRI costs. \u201cMedicaid, which is state medical insurance for those with low income, covers all medical services, including MRIs, without cost to patients,\u201d says <\/span>Virgie Bright Ellington, MD<\/span><\/a>, a medical billing expert based in New York City and author of <\/span>What Your Doctor Wants You Know to Crush Medical Debt<\/span><\/i><\/a>. However, Medicaid coverage varies since states can establish their own eligibility rules and requirements.\u00a0<\/span><\/p>\n

Medicare Part B <\/span>covers diagnostic non-laboratory tests<\/span><\/a>, including MRI procedures. After meeting your deductible, you will need to pay 20% of the Medicare-approved amount. Medicare beneficiaries <\/span>spend an average<\/span><\/a> of $60 for MRIs at ambulatory surgical centers and $94 at hospital outpatient departments.<\/span>
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\u201cThe only time I see Medicaid and Medicare not covering an MRI is because they believe that it is not required,\u201d says <\/span>Adria Goldman Gross<\/span><\/a>, a medical bill advocate and CEO and president of <\/span>MedWise Insurance Advocacy<\/span><\/a> in Monroe, New York. \u201cMany times, they recommend other avenues before they will agree to pay for an MRI.\u201d<\/span><\/p>\n

Factors that affect the cost of an MRI<\/span><\/h2>\n

The primary factors that can affect the cost of an MRI include insurance coverage, type of facility (inpatient or outpatient), location of the MRI (area of the body), and geographic location.<\/span><\/p>\n

In addition to these factors, Dr. Ellington shares that features such as radio-opaque contrast agents, which are <\/span>drugs<\/span><\/a> used to diagnose certain medical conditions, can impact MRI costs. They contain gadolinium, an element to help increase the effect of the MRI\u2019s magnetic field.<\/span><\/p>\n

Insurance coverage<\/span><\/h3>\n

If you have insurance coverage, your out-of-pocket expenses for an MRI will vary depending on what your health plan or policy covers. Your insurance deductibles, coinsurance, and copays all can contribute to the costs of an MRI.\u00a0<\/span><\/p>\n

Another factor that impacts your MRI cost with insurance is whether you visit an in-network facility. Check your health insurance policy\u2019s <\/span>provider network<\/span><\/a> to find an in-network facility. You can also call the phone number on the back of your health insurance card for assistance choosing a provider in your network.<\/span>
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Keep in mind that your insurance company has the right to determine whether your MRI is medically necessary, and if they don\u2019t, they can refuse to cover your costs. When this occurs, you may need to request a \u201c<\/span>letter of medical necessity<\/span><\/a>\u201d from your healthcare provider, who can send it to your insurance company as part of their certification or utilization review process. After submitting documentation, your insurance provider will review your requested medical services to determine if they\u2019ll help cover your MRI’s partial or total costs or if you\u2019ll be responsible for out-of-pocket costs.<\/span><\/p>\n

\u201cPrior authorizations may be necessary both with Medicare and Medicaid, which are usually submitted by the ordering physician prior to the diagnostic imaging study,\u201d Dr. Yudelevich says. \u201cEach insurance plan will have specific requirements for these authorizations.\u201d<\/span><\/p>\n

Type of MRI<\/span><\/h3>\n

Several types of MRIs are administered for various medical reasons and on certain parts of the body. Below are <\/span>examples<\/span><\/a> of the different types of MRIs by body part:<\/span><\/p>\n