Positron emission tomography — better known as a PET scan — is a nuclear imaging procedure that measures metabolic processes and identifies abnormal tissue in different parts of the body. PET scans are typically used to detect cancer as well as brain and heart conditions. They can also be combined with other imaging studies, such as MRI and CT scans.
Because a PET scan is a type of nuclear medicine, a tiny amount of radioactive substance is injected during the procedure to assist in examining tissue.
How much does a PET scan cost?
Many factors may impact the price of a PET scan, including:
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Whether you have insurance
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Your location
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The type of facility where you have the procedure
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Procedure cost
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Facility fees
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Medications for pain and/or a sedative
MDsave, a price-shopping tool for people without insurance and those who have high-deductible health plans, lists national and regional price ranges for a PET scan. Without insurance, the national average for this procedure was about $4,637 at the time of publication.
Here are some regional averages for a PET scan purchased through MDsave (redeemable at participating providers) at the time of publication:
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Atlanta: $2,845
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Chicago: $2,652
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Dallas: $2,130
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Denver: $2,000
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Orlando: $1,808
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Phoenix: $1,336
New Choice Health, another online marketplace where consumers can comparison-shop for procedure costs, estimates that the national average cost for a PET scan is $5,750. The organization’s data determined that the target fair price for a PET scan is $2,000, with or without insurance. Going to an outpatient facility instead of a hospital can save you thousands of dollars — $2,250 versus $7,275, according to New Choice Health data. Whether you have a full-body PET scan or imaging on a smaller section of the body also can influence your cost.
Does Medicare cover PET scans?
If you have original Medicare, a PET scan is covered by Part B when your doctor or healthcare provider orders one to treat a medical condition. After you meet your Part B deductible, you pay 20% of the Medicare-approved amount if you get the PET scan in a doctor’s office or independent diagnostic testing facility.
If you get the PET scan at a hospital as an outpatient, you will also pay the hospital a copayment that may be more than 20% of the Medicare-approved amount. In most cases, this amount can’t be more than the Part A hospital stay deductible.
Before October 2023, original Medicare coverage for amyloid PET scans (which are not invasive) was limited to once in a lifetime. The only other covered test to measure amyloids in the brain involved an invasive spine puncture. Now, amyloid PET scans can be covered by Medicare, because confirmation of these plaques is required to prescribe new treatments that slow the progression of Alzheimer’s disease.
If you have Medicare Advantage, check your plan to determine if PET scans are covered.
How do other insurance plans cover PET scans?
Many health insurance plans cover PET scans. Here’s more about how yours may be covered:
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Medicaid has mandatory benefits that don’t include PET scans, but the procedure may be covered by the program in your state or territory.
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Private health insurance plans typically cover PET scans, but you may be responsible for meeting a deductible as well as other costs, such as copays and coinsurance.
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Tricare covers PET scans in certain circumstances, such as for the detection of particular cancers, as well as diagnosis and management of seizure disorders.
How can I shop for PET scan prices?
Hospital price transparency can help you shop for PET scan pricing information. But, as mentioned earlier, having this imaging procedure at a hospital could be more costly than having a PET scan in an outpatient setting.
If you self-pay or don’t have insurance, you can request a Good Faith Estimate (GFE) for your PET scan to find out expected charges and fees. You can ask for a GFE from facilities such as:
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Hospitals
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Some surgical centers
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Lab centers
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Imaging centers
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Federally qualified health centers
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Rural health centers
If the final bill for your PET scan is $400 or more above the GFE you received before the procedure, reach out to the healthcare facility or provider. Ask if they can update the bill to match the GFE, or try to negotiate a lower price. You also should ask if you’re eligible for any financial assistance programs.
Are PET scans worth it?
PET scans have a distinct advantage over other types of imaging, since they can detect signs of conditions that can’t be seen on other imaging studies.
Are there any potential additional costs?
You may need to take time off work for a PET scan, which typically takes 2 hours or longer, and to recover from having the scan. Losing time on the job can be a hidden cost of outpatient care.
Additionally, a follow-up appointment may be necessary to discuss results. If a condition is found that requires treatment, you may have substantial additional costs.
