The out-of-pocket price of an MRI scan of the knee varies widely across outpatient imaging centers locally and around the U.S., with some imaging centers charging eight times more for the same procedure, according to a study in the May issue of the Journal of the American College of Radiology.

However, some imaging center leaders questioned whether the study and its methodology paint an accurate picture.

In March and April 2013, researchers from the Mayo Clinic in Rochester, Minn., contacted 122 outpatient radiology centers in 43 different locations in each state’s highest-population area, based on 2010 U.S. Census data. The centers were chosen at random using the ACR MRI Accreditation Program database and divided into three population brackets — 50,000 to 500,000, 500,000 to 1 million, and more than 1 million — to show price trends.
The researchers calling the centers posed as a 21-year-old college student who had recently hurt his knee playing football. Following a script, each caller asked the same essential question: "What is the best price for a non-contrast knee MRI with all discounts included if I am uninsured and paying completely out of pocket?”

They found that prices ranged from $259 to $2,042 across all the imaging centers. The median cost differences between localities ranged from a low of $325 in the Midwest to a high of $1,488 in the West. Within one locality in the South, the price of the procedure varied among imaging centers by nearly $1,600.

Among regions, the differences in median cost were not statistically significant — the median cost for the West, Northeast, Midwest, and South region was $690, $500, $550, and $550, respectively. The researchers found that the out-of-pocket costs tended to be higher in regions with smaller populations and lower in more highly populated areas.

The researchers wrote that determining the variability of pricing for an outpatient procedure was important due to the increase of people covered by high-deductible insurance plans.

“Given the rapid increases in the proportion of the insured population being covered by high-deductible insurance plans, out-of-pocket expense information will gain substantially greater relevance,” the authors wrote.

Responding to the study results, Mark Stolper, the chief financial officer of RadNet, a Los Angeles company with a network of more than 250 outpatient imaging centers on the East and West Coasts, said it’s possible that imaging centers quoted their gross charge to the “uninsured” patient and that could explain the wide variability in price.

“Clearly, these imaging centers would or should negotiate a cash price with the non-insured patient that is more in line with what it generally receives from the private payors,” Stolper told DOTmed News.

Stolper also noted that people with high-deductible insurance plans generally pay a lower, negotiated rate. The real concern, he said, is the variation in cost between imaging done at hospitals and imaging centers, as hospitals are often able to negotiate prices with insurance companies that are much higher than the prices at independent imaging centers.

“It’s often two to three times more expensive to get a procedure done at a hospital than a freestanding center,” Stolper said. “That’s the real tragedy of the imaging industry right now.”

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