Imaging services are capturing policy attention because they are central to a wide range of health care services – a critical part of how medical issues are diagnosed and monitored. At the same time, they make up an increasing proportion of outpatient spending and often have higher prices when provided in a hospital outpatient department than in a physician’s office even though there should be no clinical difference between services in those two settings.
Use of imaging services is captured in both professional and outpatient care. In fact, among professional and outpatient services, imaging is the fifth most frequent service, as seen in Figure 1.
Previous HCCI analysis has shown that spending on imaging services increased by almost 9% from 2018 to 2022, the result of nearly equal growth in price and use (Figure 2). Because imaging can capture such a broad range of services, this analysis explores price, use, and spending trends for the larger categories of imaging services.
MRIs, CT scans, and nuclear medicine, are the most expensive imaging services (Figure 3). The average price of an MRI in 2022 was $1,959 and a CT scan cost $1,438 on average. In contrast, a standard x-ray cost just under $300 on average.
At the same time, x-rays were the most frequently used imaging service in 2022, as seen in Figure 4. There were 1,000 x-rays performed per 1,000 enrollees on average, making up 56% of imaging visits in 2022. Ultrasounds were the second most commonly used imaging service with 464 visits per 1,000 enrollees. They made up 21% of imaging visits.
Total spending on a health care service is the result of the price of that service and how frequently it is used. High spending could be the result of high prices, high utilization, or both. Within imaging, the highest priced service (MRI) was one of the less commonly used. The most frequently used imaging service (x-rays), in contrast, was the lowest price service. It could stand to reason, then, that they would be the imaging services with the most spending.
Instead, in 2022, the imaging category with the highest spending per person was CT scans ($116 in 2022). CT scans were the second highest priced service, and only the third most commonly used service. Ultrasounds were the service with the next highest spending per person ($113). They were the second lowest priced imaging service but were the second most commonly used service. X-rays made up the third highest spending per person in 2022 ($112). X-rays were the most used imaging service and the least expensive. See Figures 5 and 6.
Overall, spending across imaging categories is growing in a similar pattern. Use of imaging services also follow very similar patterns. Although the average price of all imaging services increased from 2018 to 2022, nuclear medicine grew faster (12% from 2018 to 2022) than the rest of the imaging services, as seen in Figure 7.
As evidenced by the recent series of Congressional committee hearings on the affordability of health care, policymakers are looking for ways to spend less on health care. Imaging is one clinical service that makes up a lot of spending, that has high prices relative to Medicare, and that has different prices in outpatient departments than physician offices. The growing trend in private equity acquisition of radiology groups could be an indicator of future spending growth.
Increasing prices and use of services are both together driving up spending on imaging.