True cost of care · not insurer talking points

Health-care prices, in dollars — not insurer talking points.

What insured patients actually pay vs. what the same care costs on a cash-pay basis — for MRI, ER visits, urgent care, and specialist consults. Real figures from public price-transparency data, so you can see the spread before you schedule.

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What four common procedures actually cost.

Insured shows the typical patient out-of-pocket (after deductible and coinsurance) when a claim goes through insurance. Cash shows the same procedure's price when you pay the hospital or imaging center directly, bypassing the insurer. The gap is what people find surprising.

Imaging
MRI — brain w/ contrastCPT 70553
Insured patient pays ~$1,400–$2,200
Cash-pay price $400–$700

High-deductible plans push the full negotiated rate to the patient until the deductible is met. Cash-pay MRI centers publish transparent pricing — typically 60–75% less than the insured rate.

Source: CMS Physician Fee Schedule lookup (CPT 70553), Turquoise Health MRF aggregates (top-50 US hospitals), FAIR Health Consumer national median.
Emergency
ER visitLevel 3–4 facility + physician
Insured patient pays $1,800–$4,200
Cash-pay price $600–$1,800

Out-of-network ER denials or post-stabilization denials shift the full facility + physician fee onto the patient. Stand-alone emergency centers publish bundled cash prices that often run a third of the insured total.

Source: CMS Hospital Price Transparency machine-readable files (cms.gov/price-transparency), national median ER level-3/4 facility fees; FAIR Health Consumer ER cost benchmarks.
Same-day
Urgent care visitCPT 99214 / S9083
Insured patient pays $200–$400
Cash-pay price $100–$200

Insured copays of $50–$100 are common when in-network, but high-deductible plans and out-of-network urgent care routinely land in the $200–$400 range. Cash visits at chain clinics publish a flat fee on the front door.

Source: CMS PFS lookup (CPT 99214), Turquoise Health urgent-care MRF aggregates, FAIR Health Consumer urgent-care benchmarks.
Specialist
Specialist consultCPT 99243 / new-patient office
Insured patient pays $350–$600
Cash-pay price $150–$300

Once your plan's specialist coinsurance kicks in, a single new-patient visit runs $300+. Direct-care and concierge specialists publish flat-rate pricing on their site — typically half what you'd owe through insurance.

Source: AMA National Health Insurer Report Card (specialist coinsurance averages); CMS PFS RVU pricing for CPT 99243; FAIR Health Consumer specialist consult benchmarks.

Figures are illustrative national medians and vary by region, network status, plan, and provider.

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