What a PET scan costs depends on your insurance plan, your deductible, and whether the facility is in your network

A PET scan (positron emission tomography scan) typically costs between $3,000 and $6,000 before insurance pays anything. What you actually pay out of pocket depends on three things: whether your insurance covers PET scans at all, whether you've met your deductible, and whether the imaging center is in your plan's network. Most insurance plans do cover PET scans when a doctor orders them for cancer diagnosis, dementia evaluation, or cardiac imaging — but the coverage rules and your share of the cost vary widely between plans.

Your out-of-pocket cost is usually a percentage of the bill (called coinsurance) or a fixed amount per scan (called a copay), whichever your plan specifies. If you haven't met your deductible yet that year, you'll pay the full cost until you do, then your coinsurance kicks in. In-network facilities cost less because they've negotiated rates with your insurance company; out-of-network facilities can cost 40 to 60 percent more, and you may have to pay the difference between what insurance allows and what the facility charges.

Key Takeaways

  • A PET scan costs $3,000 to $6,000 before insurance, but your out-of-pocket cost depends on your deductible, coinsurance percentage, and whether the facility is in-network.
  • Most insurance plans cover medically necessary PET scans for cancer, dementia, and heart disease, but you should confirm coverage with your insurer before scheduling.
  • Using an in-network imaging center typically saves 20 to 40 percent compared to out-of-network facilities.
  • Your insurance company can tell you the exact cost you'll owe once they know your deductible status and the specific scan your doctor ordered.

How to find out what your plan will pay

Call the customer service number on the back of your insurance card and tell them you need a cost estimate for a PET scan. Have your doctor's order or the specific reason for the scan ready — insurance companies need to know whether it's for cancer staging, dementia workup, or cardiac imaging, because coverage rules differ. Ask three questions: Is a PET scan covered under my plan? Have I met my deductible this year? What is my coinsurance percentage after the deductible?

The representative can then give you a rough estimate of what you'll owe. If your deductible is $1,500 and you haven't paid anything yet, you'll pay $1,500 out of pocket before coinsurance starts. If your coinsurance is 20 percent and the in-network cost is $4,000, you'll owe $1,500 (deductible) plus $500 (20 percent of the remaining $2,500), for a total of $2,000.

Ask the representative which imaging centers in your area are in-network. Some insurance plans have preferred imaging partners that offer even lower costs. Get the facility name and confirm it's in-network before you schedule, because a facility that's in-network for one insurance company may not be for yours.

In-network versus out-of-network costs

An in-network PET scan facility has a contract with your insurance company that sets a negotiated rate — typically $3,500 to $4,500 for a standard whole-body scan. Your coinsurance is calculated on that negotiated rate. An out-of-network facility may charge $5,000 to $7,000 or more, and your insurance may only pay based on what they consider "reasonable and customary" in your area, which is often less than the facility's actual bill. You then owe the difference.

For example, if an out-of-network facility charges $6,000 but your insurance considers $4,500 reasonable, your insurance might pay 80 percent of $4,500 ($3,600) and you'd owe $2,400 — plus potentially the $1,500 difference between what the facility charged and what insurance allowed. Always confirm in-network status before scheduling to avoid surprise bills.

What happens if your plan doesn't cover PET scans

Some insurance plans, particularly older or lower-cost plans, don't cover PET scans at all, or they cover them only for specific conditions like cancer. If your plan doesn't cover the scan your doctor ordered, you have a few options. You can ask your doctor whether a different imaging test — like a CT scan or MRI — would answer the same question and might be covered instead. You can also ask your doctor to submit a request for prior authorization or an appeal to your insurance company, explaining why the PET scan is medically necessary.

If your insurance denies coverage and you decide to have the scan anyway, you'll pay the full facility cost out of pocket. Some imaging centers offer cash-pay discounts for uninsured or out-of-pocket patients — typically 20 to 30 percent off the standard rate. It's worth asking the facility what they charge for self-pay patients before you schedule.

Deductibles and how they affect your PET scan bill

Your deductible is the amount you pay out of pocket before your insurance starts sharing costs with you. If your plan has a $2,000 annual deductible and you haven't used any of it yet, you'll pay the first $2,000 of the PET scan cost yourself. Once you've paid $2,000 toward your deductible, your coinsurance kicks in — typically 20 percent — and your insurance pays the rest.

Deductibles reset every January 1st (or on your plan's anniversary date), so timing matters. If you're early in the year and haven't met your deductible, a PET scan will count toward it. If you're late in the year and have already paid your deductible, you'll only owe your coinsurance percentage. Check your insurance statement or online account to see how much of your deductible you've used so far.

Coinsurance and copays explained

After you meet your deductible, your insurance plan pays a percentage of the cost and you pay the rest — that's coinsurance. Most plans use 20 percent coinsurance for imaging, meaning you pay 20 percent and insurance pays 80 percent. Some plans use 15 percent or 25 percent instead. A few older plans use a flat copay — for example, $250 per scan — instead of a percentage.

Coinsurance applies to the in-network negotiated rate, not the full facility charge. So if the in-network rate is $4,000 and your coinsurance is 20 percent, you owe $800 (plus any remaining deductible). Your insurance pays $3,200. This is why in-network facilities matter: the negotiated rate is lower, so your 20 percent coinsurance is lower too.

When to ask about payment plans

If your out-of-pocket cost is more than a few hundred dollars, ask the imaging facility whether they offer payment plans. Many hospitals and imaging centers will let you pay your bill in installments over three to six months, sometimes without interest. Some facilities have financial counselors who can discuss options if you're facing a large bill.

Before you schedule the scan, ask the facility's billing department what payment options are available. If you're uninsured or underinsured, some facilities have charity care programs or sliding-scale fees based on income. It's easier to set up a payment plan before the scan than to negotiate after you've received a bill.

Frequently Asked Questions

Does Medicare cover PET scans?

Yes, Medicare covers PET scans for cancer, dementia, and cardiac imaging when a doctor orders them as medically necessary. You'll pay 20 percent coinsurance after you meet your Part B deductible ($240 in 2024, though this amount changes yearly). If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower.

What if I get a bill after insurance pays?

If you used an in-network facility and received a bill for more than your estimated coinsurance, contact the facility's billing department and your insurance company. In-network facilities are not supposed to bill you for the difference between their charge and what insurance allows. If they do, file a complaint with your state's insurance commissioner.

Can I negotiate the cost of a PET scan before I have it?

Yes. Call the imaging facility and ask what they charge for a PET scan and whether they offer discounts for cash-pay or uninsured patients. You can also ask your doctor whether a less expensive imaging test might work instead. Some facilities will reduce their charge if you pay upfront.

Do I need prior authorization from my insurance before scheduling?

Many insurance plans require prior authorization for PET scans, meaning your doctor must get approval before you schedule. Your doctor's office usually handles this, but confirm with your insurance company before your appointment. If your doctor orders the scan without authorization and your insurance denies it, you could be responsible for the full cost.

What if my insurance plan has a maximum out-of-pocket limit?

Your plan's out-of-pocket maximum is the most you'll pay in deductibles and coinsurance in a year. Once you reach it, your insurance pays 100 percent of covered services for the rest of that year. A PET scan counts toward your out-of-pocket maximum, so if you're close to reaching it, the scan may cost you less than you expect.