Prostate MRI Out-of-Pocket Estimator

Plan for the true cash hit of a prostate MRI by layering your deductible balance, coinsurance rate, and any balance billing risk on top of the facility's price. Enter the billed or allowed amount and your coinsurance percentage to see how much falls to you versus the insurer, how much deductible is consumed, and whether hitting your out-of-pocket maximum caps the damage.

Sticker price or negotiated allowed amount for the prostate MRI.
Percentage of post-deductible costs you pay under your health plan.
Defaults to $0. Enter how much deductible is left before coinsurance applies.
Defaults to unlimited. Cap the patient share if you are close to your plan's out-of-pocket maximum.
Defaults to 100%. Lower the percentage if the insurer only allows part of the billed charge, leaving balance billing risk.

Insurance benefits vary widely. Confirm coverage terms, provider contracts, and medical necessity rules with your insurer before scheduling imaging.

Examples

  • Example 1 — $1,450.00 price, 20% coinsurance, $500.00 deductible remaining, $3,600.00 out-of-pocket max ⇒ Patient responsibility: $790.00 (medical $790.00 + balance bill $0.00) | Insurer pays: $660.00 | Deductible applied: $500.00 | Coinsurance charged on: $950.00 at 20.00%
  • Example 2 — $1,900.00 price, 30% coinsurance, deductible cleared, out-of-pocket cap blank, allowed percentage 80% ⇒ Patient responsibility: $1,066.00 (medical $456.00 + balance bill $610.00) | Insurer pays: $1,064.00 | Deductible applied: $0.00 | Coinsurance charged on: $1,520.00 at 30.00%

FAQ

How do I find the allowed percentage for my plan?

Check the pre-authorization estimate or explanation of benefits for similar imaging. Many insurers publish contracted rates; divide the allowed amount by the billed amount to estimate the percentage.

Does this account for radiologist interpretation fees?

No. Add separate estimates for professional fees if your radiologist bills independently, then rerun the calculator for that charge to stack the totals.

What if my plan has copays instead of coinsurance?

Set the coinsurance percentage so that coinsurance charged on the post-deductible amount equals your copay. For example, a $150 copay on a $1,000 allowed amount equates to 15% coinsurance.

Can I model secondary insurance or HSA funds?

Use the patient responsibility output to decide how much to reimburse from your HSA or to submit for secondary coverage; subtract any secondary payments manually.

Additional Information

  • Balance billing exposure reflects the gap between the facility's price and what your insurer allows—set the allowed percentage to 100% for in-network scans.
  • Coinsurance applies only after any remaining deductible is met; the deductible input is capped at the allowed amount for this scan.
  • Out-of-pocket maximums usually apply only to in-network services; the optional cap limits the patient medical share but does not reduce balance billing.
  • If you have already exceeded the out-of-pocket maximum, set the cap to 0 to reflect 100% coverage of additional allowed charges.

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