How Much Does a CT Scan Cost With Insurance

The cost of a CT scan can be a significant financial concern for many, even with insurance. Prices for the procedure vary depending on several factors, including the type of insurance coverage, the facility where the scan is performed, and whether it’s done on an inpatient or outpatient basis.

In the US, CT scan costs can range from as low as $300 to over $6,750, which can be a burden for many patients. Even with insurance, individuals may face out-of-pocket expenses, such as deductibles or copays, which can add to the overall cost.

This article will explore the various factors that influence the price of a CT scan when using insurance, and steps to manage potential costs.

Factors Influencing the Cost of a CT Scan

Several factors impact the cost of a CT scan, even when insurance is involved. These factors are based on the setting, insurance status, and location.

1. Facility Setting

The cost of a CT scan varies significantly depending on where the scan is performed. Inpatient facilities, such as hospitals, typically charge more due to higher operational costs. The national average for an inpatient CT scan is $4,750, compared to $525 at outpatient centers, which offer the same procedure at a much lower cost.

2. Insured vs. Uninsured

Insured patients usually share costs with their insurance provider, depending on factors like deductibles and copayments.

Uninsured patients are responsible for covering the entire cost, which can be a substantial financial burden, particularly if the scan is performed in a hospital setting.

3. Geographic Location

Location also plays a role in cost variations. Prices for a CT scan can differ greatly based on geographic region. For instance, in New York, a CT scan can range from $550 to $1,400, while in Dallas, the same procedure could cost anywhere from $460 to $1,200.

Urban areas tend to have more options, leading to potentially lower prices, while rural areas with fewer facilities may charge more due to limited availability.

Cost Breakdown of a CT Scan with Insurance

The total cost of a CT scan with insurance depends on several factors, such as the type of scan, the facility where it's performed, whether it’s done in an inpatient or outpatient setting, and the structure of the patient’s insurance plan.

Most patients are responsible for paying part of the cost, such as deductibles, co-pays, or coinsurance, which vary by plan.

Average National Costs for Different CT Scans

The cost of a CT scan can range significantly depending on the body part being scanned and the facility type. For instance:

• A brain CT scan can range between $825 and $4,800.
• A CT scan of the abdomen can cost between $1,750 and $9,500.
• CT scans for other areas, like the chest, pelvis, or spine, follow similar ranges. For example, a chest CT scan can vary from $675 to $8,600.

Facility type also affects the cost:

• Outpatient facilities have a lower average cost of around $525.
• Inpatient hospital facilities have a significantly higher average cost, approximately $4,750.

Geographic Differences in CT Scan Costs

Location plays a big role in determining the price of a CT scan. Here’s a breakdown of average costs in various cities:

• New York, NY: $375.65
• Los Angeles, CA: $378.51
• Chicago, IL: $295.81
• Dallas, TX: $629.55
• Houston, TX: $412.91
• Phoenix, AZ: $421.24
• Washington, DC: $325.56
• Miami, FL: $365.44

Rural areas often have higher costs due to fewer available facilities, while urban areas with more competition tend to have lower prices.

Deductibles, Co-pays, and Coinsurance

Patients with insurance typically need to meet a deductible before their coverage kicks in. For instance, Medicare Part B has a $240 deductible for 2024.

After meeting this deductible, Medicare covers 80% of the approved cost, leaving the patient responsible for the remaining 20%. Private insurance plans may have different deductible amounts, and after meeting the deductible, co-pays or coinsurance amounts are still required.

Contrast and Additional Fees

Some CT scans require the use of contrast dye, which can increase the overall cost. The national average for a CT scan with contrast is around $695, but it can vary based on the specific scan and the facility.

Additionally, there may be extra charges for initial consultations, follow-up visits, and other related services like blood tests to ensure safety before administering contrast materials.

In-Network vs. Out-of-Network Costs

The cost of a CT scan can increase dramatically if the procedure is done out-of-network. In-network providers have pre-negotiated rates with insurance companies, which help keep costs down.

Patients using in-network facilities may pay significantly less, while those opting for out-of-network providers might face higher costs, or in some cases, no coverage at all.

For example, insurance plans like HMO or PPO have networks that influence coverage for out-of-network visits, leading to higher out-of-pocket expenses if patients go outside the network.

Mitigating the Costs of a CT Scan

There are several ways to reduce the overall cost of a CT scan, whether you have insurance or not. Patients can take steps to find more affordable options based on their insurance network and by considering different facilities.

1. Using In-Network Providers

In-network providers have agreements with insurance companies to offer services at pre-negotiated rates, which usually results in lower costs for patients.

For example, UnitedHealthcare and Aetna provide directories where insured individuals can search for in-network hospitals and imaging centers. Facilities like Kaiser Permanente or Cleveland Clinic may be included in these networks, depending on the specific plan and location.

Patients in New York, for example, using Blue Cross Blue Shield insurance, might access in-network hospitals at reduced rates. Insurance agreements between providers and insurers often help lower the final cost of a CT scan.

2. Exploring Financial Assistance Programs

For those without insurance or with limited coverage, many hospitals offer financial assistance. Programs from health systems like Baylor Scott & White Health helps patients by offering reduced rates or deferred payment plans based on income and need.

Eligibility often requires submitting documentation of financial status, and details can be found on the hospital’s website or through the billing department.

Non-profit organizations may also provide help through grants or other forms of financial aid, especially for essential diagnostic procedures like CT scans.

3. Payment Plans and Alternative Diagnostic Options

For those who need time to cover the cost, many healthcare providers offer payment plans. CareCredit is one such service that provides financing options, allowing patients to pay for their CT scans over time. Hospitals often have their own internal plans that break the cost into smaller payments, making it easier to manage larger medical bills.

In cases where a CT scan might not be the only diagnostic option, doctors may suggest alternatives like X-rays or ultrasounds, which tend to cost less.

For example, an X-ray can provide sufficient information in many situations for a lower price, which can reduce the financial burden on patients.

Wrap Up

The cost of a CT scan can vary greatly depending on several factors, even for those with insurance. These factors include the facility where the scan is performed, whether it is done on an inpatient or outpatient basis, and the type of scan itself. Inpatient facilities often have higher costs, averaging around $4,750, while outpatient centers can charge as little as $525. Geographic location also impacts pricing, with significant differences between urban and rural areas.

Even with insurance, patients might face out-of-pocket expenses such as deductibles, co-pays, and coinsurance, which can add to the total cost. For some, using in-network providers, seeking financial assistance programs, or exploring payment plans can help manage these expenses. Additionally, alternatives like X-rays or ultrasounds might be recommended in some cases to reduce costs.

Frequently Asked Questions

How long does a CT scan usually take?

A typical CT scan takes about 10 to 30 minutes to complete, depending on the specific body part being scanned and whether or not contrast is used. Preparation time, such as receiving contrast dye, generally takes the bulk of time, while the scan itself is typically brief.

Can I eat or drink before a CT scan?

For most CT scans, patients can eat and drink normally. However, if contrast dye is required, doctors may recommend fasting for a few hours before the procedure to avoid complications.

What happens if my insurance does not cover the full cost of the CT scan?

If insurance does not cover the entire cost, patients may explore financial assistance programs offered by hospitals, such as Baylor Scott & White’s Financial Assistance Program or Cleveland Clinic’s Patient Financial Assistance. These programs often offer reduced rates or deferred payment options based on income levels.