Health Plan - Highmark Delaware
Imaging/Radiology Services
Save time and money by having your outpatient imaging/radiology services completed at in-network non-hospital affiliated freestanding facilities. These facilities provide similar quality as hospital affiliated locations and are often more convenient.
Non-Hospital Facilities in Delaware
Highmark Delaware Comprehensive PPO Plan
Basic Imaging / Radiology (i.e., X-Ray, Ultrasound, Diagnostic 2D/3D Mammography)
| Site of Care | Average Cost Per Visit | Your Cost Per Visit |
|---|---|---|
| In-network non-hospital affiliated freestanding facility | $155 | $0 copay |
| In-network hospital affiliated facility | $321 | $50 copay |
High-Tech Imaging / Radiology (i.e., MRI, CT Scan)
Note: Requires a prior authorization
| Site of Care | Average Cost Per Visit | Your Cost Per Visit |
|---|---|---|
| In-network non-hospital affiliated freestanding facility | $366 | $0 copay |
| In-network hospital affiliated facility | $1,064 | $100 copay |
Highmark Delaware First State Basic Plan
Basic Imaging / Radiology (i.e., X-Ray, Ultrasound, Diagnostic 2D/3D Mammography)
| Site of Care | Average Cost Per Visit | Your Cost Per Visit |
|---|---|---|
| In-network non-hospital affiliated freestanding facility | $155 | 10% coinsurance after deductible is met |
| In-network hospital affiliated facility | $321 | 10% coinsurance after deductible is met |
High-Tech Imaging / Radiology (i.e., MRI, CT Scan)
Note: Requires a prior authorization
| Site of Care | Average Cost Per Visit | Your Cost Per Visit |
|---|---|---|
| In-network non-hospital affiliated freestanding facility | $366 | 10% coinsurance after deductible is met |
| In-network hospital affiliated facility | $1,064 | 10% coinsurance after deductible is met |
Frequently Asked Questions (FAQ)