Teleradiology pricing models: per-report vs per-RVU

Commit to 1,200 studies a month and send 900, and you've paid for 300 signed reports that were never written. That shortfall, billed at full rate, is the quiet cost inside most imaging contracts, and it's the fault line that separates the four teleradiology pricing models. Per signed report and per work RVU bill for work delivered, so the vendor carries volume risk. Subscription minimums and FTE blocks bill for capacity reserved, so you carry it, and a slow month costs exactly what a busy one does. AstraRad uses the first of those structures: one price per signed report, and nothing billed for capacity.

This page covers the structure of the four models and the math for comparing them. For per-read dollar ranges by modality, see teleradiology cost per read; for the wider vendor evaluation, see how to choose a teleradiology company.

How do teleradiology companies charge for reads?

Every teleradiology contract on the market is a variation of four structures: per signed report, per work RVU, subscription or monthly minimum, and FTE-equivalent coverage blocks.

Model	What you pay for	What a slow month costs
Per signed report	A fixed price per study, set by study type and turnaround tier	Only the reports you received
Per work RVU	A dollar rate times each study's work RVU value, so complex studies bill higher	Only the work delivered, weighted by complexity
Subscription or minimum	A committed monthly spend or study floor, traded for a lower headline rate	The full commitment, whatever you sent
FTE-equivalent	Blocks of dedicated radiologist capacity, priced like staffing	The full block, whatever arrived

The first two are output models; the last two are capacity models. Capacity buys you a lower headline rate and sometimes a guaranteed reader. Output buys you an invoice that tracks your worklist, which is why everything else in this comparison follows from that split.

Turning a per-RVU quote into a cost per study

Converting a per-RVU quote means computing your blended work RVU per study: each study type's work RVU times its monthly volume, totalled, then divided by total studies. Multiply that blend by the quoted dollar rate and you get a cost per study you can set beside any per-report quote. Skip the conversion and you're comparing prices in two different currencies.

The spread across study types is wide. Work is only one of the three relative value components Medicare assigns to a service, alongside practice expense and malpractice, and 42 CFR 414.20 turns those units into a payment amount by multiplying them by a geographic adjustment factor and the conversion factor. In the CY 2026 CMS Physician Fee Schedule relative value files, a two-view chest X-ray carries 0.21 work RVUs, a CT head without contrast 0.83, a CT abdomen and pelvis with contrast 1.77, and an MRI brain with and without contrast 2.23. An MRI brain is roughly ten times the interpretation work of a chest X-ray. A vendor quoting one dollar figure per RVU is quoting ten different prices at once. Confirm the current year's fee schedule for your exact CPT codes before you run your own numbers, because the values move: CMS finalized a 2.5 percent efficiency adjustment to work RVUs for non-time-based services in the CY 2026 final rule, to be reapplied every three years.

Here's the conversion on a plausible 1,200-study month: 600 plain films at 0.22, 200 ultrasounds at 0.81, 250 CTs averaging 1.30, 130 MRIs averaging 1.80, and 20 PET-CTs at 1.93 total about 892 work RVUs, a blend of 0.74 work RVUs per study. Shift the same 1,200 studies toward advanced cross-sectional imaging and the blend can pass 1.2, raising your bill more than 60 percent with study count flat.

One caution about the figures radiologists post publicly. Dollars per work RVU in the low-to-mid tens circulate constantly in compensation threads, and those numbers describe what radiologists are paid, not what a facility pays a vendor. Use them to check the mechanics of your conversion and for nothing else; they aren't AstraRad's prices or anyone's contract quote.

Breakeven math at 300, 1,200, and 4,000 studies a month

A committed model breaks even where the commitment, divided by your per-report cost, equals the studies you'd have sent anyway; below that volume you're paying for capacity you didn't use. Sticker rates are confidential across most of this market, so run the comparison in relative terms. Call your blended per-report cost B. Assume a subscription that trades a 15 percent discount for a 1,200-study monthly minimum, and an FTE block priced at 1,200 studies' worth of coverage for up to 2,000. At 300 studies a month, per-report costs 1.00 B per study. The subscription costs 3.40 B and the FTE block 4.00 B, because the full commitment bills against a quarter of the volume, and this is where most facilities sit for after-hours and weekend work even when daytime volume is heavy. At 1,200 studies the models converge within about 15 percent of each other, and the decision shifts from price to turnaround, subspecialty coverage, and exit rights. At 4,000 studies the FTE model wins on paper at 0.60 B, with the second block assumed full. Now run that same client through a month that comes in at 1,900 studies: both blocks still bill, and 2,400 B spread across 1,900 signed reports is 1.26 B per study, a 26 percent premium in a month the client believed was covered. The discount was real at 4,000 and gone at 1,900, which is why the volume to model is your slowest month of the past two years.

Where committed models earn their keep

Subscription and FTE models pay off when volume is high, steady, and provably above the commitment in your slowest month. Three situations meet that bar.

A floor you never break. If your slowest month in the past twenty-four still cleared the commitment, the discount holds; take it.

A named reader every day. FTE blocks are the cleanest way to buy continuity when the same radiologist should follow the same service line daily, which matters most in oncologic follow-up and complex musculoskeletal work.

A shift you can't hire for. If the alternative is an unfilled position, weigh the FTE price against recruiting, salary, benefits, malpractice, and vacation coverage; that full calculation lives in in-house vs outsourced radiology.

The mirror image loses badly: seasonal volume, overflow work, a backlog you'll clear once, a new service line whose volume is still a guess, or a first contract with a vendor you've never tested.

When per-report pricing is the wrong choice

Per-report pricing, which is what AstraRad sells, fits badly when you need a person on duty, a budget fixed to the dollar, or a discount you can safely earn. Say that out loud during the evaluation and you'll get sharper answers from every vendor.

You need presence. Per-report pricing buys final signed reports against a turnaround SLA. An FTE arrangement buys a specific radiologist at a workstation from 10pm to 6am, whatever arrives, and if the requirement is the person, buy the person.

Finance must forecast to the dollar. A fixed monthly number is easier to budget than a variable one, even when the variable one averages cheaper. If certainty matters more to you than the spread, a commitment buys certainty.

Volume is flat, high, and boring. At consistently high volume with a stable mix, a well-negotiated commitment usually beats an unnegotiated per-study rate. The load-bearing word is consistently; check your slowest month before you sign.

The discount is large and the term is short. A meaningful discount on a commitment you can exit in ninety days is a reasonable bet. The same discount on a three-year term with an annual escalator is a different bet entirely.

Every quote reduced to one number

The number that makes competing quotes comparable is effective cost per study delivered, at your real volume, over twelve months. Convert per-RVU quotes to per-study using your blend from above, then apply your true priority mix, so a STAT multiplier on 20 percent of your studies hits 20 percent of the volume. Fold in every fixed charge, because platform fees, PACS or portal access, integration and VPN fees, minimum shortfalls, and annual escalators all land on the invoice eventually. Run each quote at your lowest month of the past two years, where committed models are most exposed. Divide total twelve-month cost by total twelve-month studies, and read the exit terms before you admire the result; a low effective cost you can't escape is a liability.

Ask every vendor for the same three documents: a written rate card covering every study type, every priority and after-hours multiplier stated in writing, and a list of any fees that live off the rate card. A vendor who won't produce all three has answered a different question.

AstraRad's teleradiology pricing model: per signed report

AstraRad charges a fixed price per signed report by study type, with no minimums, no subscriptions, and no platform fees. You select the turnaround tier per study, STAT under 1 hour, Urgent under 4 hours, or Routine under 24 hours, each measured from last-image arrival to radiologist signature. Every tier price sits on the same written rate card. There are no separate nights, weekend, or holiday fees, which matters because nighthawk and weekend and holiday coverage are precisely the volume patterns that punish committed models.

Every study is read by a fellowship-trained subspecialist licensed in the state where your patients are located, and every report is final and physician-signed. One in twenty signed reports is independently double-read, major discrepancies run under 0.3 percent of signed reports, and performance against each tier is published on the SLA page. Capacity is priced the way it's delivered: there's headroom for about 25,000 additional studies per month, and an 8,000-study backlog clears in under 30 days at rate card prices with no surge premium.

Run the twelve-month normalization on your own volume, then put AstraRad in the same column: ask us for a rate card and you'll have every study type and every multiplier on one page inside a business day. The structure behind per-report pricing is set out in full on one page. However the quotes land, keep the test that decides every comparison of teleradiology pricing models. A discount you have to earn every month isn't a discount you own.