Outpatient prices - Medicare anchors - Facility-type explained
The same scan can cost more at a hospital. See the anchor before you book.
MyCarePrice shows the verified Medicare rate for common outpatient procedures and explains, in plain billing language, why the setting changes the bill. Prices only here. We do not diagnose, recommend treatment, or tell you whether you should get a test.
How to use this site: Find your procedure, note the CPT code and the Medicare anchor, then ask the facility for the cash price for that exact code in that exact setting. Confirm the all-in price in writing before service.
- CMS CY2025 sources named
- Verified 2026-10-04
- No invented self-pay ranges
- Prices only - no medical advice
Price Anchor Explorer
Pick a procedure and a facility type. You will see the verified Medicare anchor and what changes with the setting. No invented self-pay numbers.
Example - pick your procedure. The first procedure and the hospital outpatient setting are preselected only to show how the explorer works. Change either one to see your own anchor.
Imaging, lab, and procedure departments located in or owned by a hospital, including off-campus hospital departments
Saved on this device only. Nothing you pick here is sent or shared.
MRI Without Contrast
CPT 70551Magnetic resonance imaging, brain (including brain stem); without contrast material
Physician Fee Schedule anchor
$193.67
Global (professional + technical)
- Professional (26)
- $68.81
- Technical (TC)
- $124.86
CMS Physician Fee Schedule CY2025 via WPS GHA, Michigan Locality 01 - CY2025. Verified 2026-10-04.
Hospital outpatient (OPPS) anchor
$540.27
APC 8007 - MRI and MRA without Contrast Composite (facility portion only)
Composite APC paid to the hospital facility when multiple imaging services on the same claim meet composite rules; single-service imaging APCs 5521 to 5524 also apply depending on the claim. Professional fee is billed separately.
CMS OPPS CY2025 Final Rule CMS-1809-FC - CY2025. Verified 2026-10-04.
What this means for Hospital outpatient
In a hospital outpatient department Medicare pays two parts: the OPPS facility payment (when an APC applies) and the PFS professional fee. That two-part structure is why the same CPT code usually costs more at a hospital than at an imaging center or office that bills a single global amount. Your cash quote should list facility and professional portions separately. Confirm the all-in price in writing before service.
Facility lever: Ask whether the MRI will be performed in a hospital outpatient department or a freestanding imaging center, and get the cash price for each setting in writing. The scan and report are the same CPT code in both places.
Summary: MRI Without Contrast at each facility type
Take this summary to your booking call. CPT 70551. Ask each setting for its all-in cash price for this exact code, and confirm it in writing before service.
Hospital Outpatient Department
Anchor that applies: OPPS facility anchor $540.27 (APC 8007, facility portion only), plus the professional fee.
How Medicare pays: OPPS (APC-based facility payment) + Physician Fee Schedule professional fee
Facility fee: Yes - separate OPPS facility payment to the hospital
Ambulatory Surgery Center
Anchor that applies: No facility professional anchor is published for this code. Ask the ASC for its all-in cash price by CPT code.
How Medicare pays: ASC payment system (procedure-based, generally below OPPS) + Physician Fee Schedule professional fee
Facility fee: Yes - ASC facility fee, typically lower than hospital OPPS for the same procedure
Independent Imaging Center
Anchor that applies: PFS global anchor $193.67 (professional plus technical in one amount).
How Medicare pays: Physician Fee Schedule global payment when the center owns the equipment and employs or contracts the radiologist
Facility fee: No separate hospital facility fee - the technical component is inside the global PFS payment
Physician Office
Anchor that applies: PFS global anchor $193.67 (professional plus technical in one amount).
How Medicare pays: Physician Fee Schedule nonfacility payment (higher practice-expense component than facility rate)
Facility fee: No separate facility fee - office overhead is inside the nonfacility PFS rate
Anchors: CMS Physician Fee Schedule CY2025 via WPS GHA, Michigan Locality 01 - CY2025, verified 2026-10-04; OPPS CMS OPPS CY2025 Final Rule CMS-1809-FC - CY2025, verified 2026-10-04. Medicare anchors only, not self-pay prices.
This explorer shows Medicare anchors only. Medicare payment is not your self-pay price. Self-pay cash prices are set by each facility and are not published on this page unless verified from a public source under Procedure Price Method v1.0. Always confirm your price in writing before service, including whether professional, facility, anesthesia, and pathology are included.
Next step for the booking call
30 procedures
All proceduresEach page gives the CPT code, what the price includes and excludes, why prices vary, and the facility-type lever. Where a Medicare anchor was verified from a named CMS source, it is shown. Self-pay ranges are not invented.
MRI Without Contrast
Magnetic resonance imaging, brain (including brain stem); without contrast material
Medicare PFS global anchor $193.67
MRI With Contrast
Magnetic resonance imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences
Medicare PFS global anchor $314.74
CT Abdomen and Pelvis
Computed tomography, abdomen and pelvis; with contrast material(s)
Medicare PFS global anchor $296.94
CT Head
Computed tomography, head or brain; without contrast material
Medicare PFS global anchor $105.31
Ultrasound Abdomen
Ultrasound, abdominal, real time with image documentation; complete
Medicare PFS global anchor $112.22
Screening Mammogram
Screening mammography, bilateral (2-view study of each breast), including computer-aided detection when performed
Medicare PFS global anchor $124.39
Colonoscopy
Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
Medicare PFS nonfacility $335.06
Upper Endoscopy (EGD)
Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
Medicare PFS nonfacility $279.91
X-Ray Chest
Radiologic examination, chest; 2 views
Medicare PFS global anchor $32.81
Echocardiogram
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography and with color flow Doppler echocardiography
Medicare PFS global anchor $187.76
MRI Lumbar Spine
Magnetic resonance imaging, spinal canal and contents, lumbar; without contrast material
Medicare PFS global anchor $188.57
MRI Knee
Magnetic resonance imaging, any joint of lower extremity; without contrast material
Medicare PFS global anchor $200.30
CT Chest
Computed tomography, thorax, diagnostic; without contrast material
Medicare PFS global anchor $131.18
CT Abdomen and Pelvis Without Contrast
Computed tomography, abdomen and pelvis; without contrast material
Medicare PFS global anchor $181.61
Ultrasound Pelvis
Ultrasound, pelvic (nonobstetrical), real time with image documentation; complete
Medicare PFS global anchor $101.71
Ultrasound Transvaginal
Ultrasound, transvaginal
Medicare PFS global anchor $114.15
Ultrasound Abdomen Limited
Ultrasound, abdominal, real time with image documentation; limited (for example single organ, quadrant, or follow-up)
Medicare PFS global anchor $84.20
Diagnostic Mammogram
Diagnostic mammography, including computer-aided detection when performed; bilateral
Medicare PFS global anchor $153.47
DXA Bone Density
Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (for example hips, pelvis, spine)
Medicare PFS global anchor $38.22
Ultrasound Thyroid and Neck
Ultrasound, soft tissues of head and neck (for example thyroid, parathyroid, parotid), real time with image documentation
Medicare PFS global anchor $106.10
X-Ray Lumbar Spine
Radiologic examination, spine, lumbosacral; 2 or 3 views
Medicare PFS global anchor $38.55
Echocardiogram Limited
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study
Medicare PFS global anchor $94.37
Sleep Study (Polysomnography)
Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
Medicare PFS global anchor $606.98
Colonoscopy With Biopsy
Colonoscopy, flexible; with biopsy, single or multiple
Medicare PFS nonfacility $421.96
Upper Endoscopy (EGD) With Biopsy
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple
Medicare PFS nonfacility $360.29
Carpal Tunnel Release
Neuroplasty and/or transposition; median nerve at carpal tunnel
Medicare PFS nonfacility $463.75
Cataract Surgery
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (for example irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation
Medicare anchor on page
Knee Arthroscopy (Meniscectomy)
Arthroscopy, knee, surgical; with meniscectomy (medial and lateral, including any meniscal shaving) including debridement or shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed
Medicare anchor on page
Physical Therapy Evaluation
Physical therapy evaluation: low complexity, typically 20 minutes face-to-face with the patient and/or family
Medicare PFS nonfacility $98.43
Cardiovascular Stress Test
Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report
Medicare PFS nonfacility $71.21
Why the facility matters more than the machine
Medicare pays imaging and endoscopy under two different logics. A hospital outpatient department bills a facility payment under OPPS plus a professional fee. An imaging center or office usually bills one global amount under the Physician Fee Schedule. Same CPT code, different payment system.
Hospital Outpatient Department
OPPS (APC-based facility payment) + Physician Fee Schedule professional fee
Facility fee: Yes - separate OPPS facility payment to the hospital
Ambulatory Surgery Center
ASC payment system (procedure-based, generally below OPPS) + Physician Fee Schedule professional fee
Facility fee: Yes - ASC facility fee, typically lower than hospital OPPS for the same procedure
Independent Imaging Center
Physician Fee Schedule global payment when the center owns the equipment and employs or contracts the radiologist
Facility fee: No separate hospital facility fee - the technical component is inside the global PFS payment
Physician Office
Physician Fee Schedule nonfacility payment (higher practice-expense component than facility rate)
Facility fee: No separate facility fee - office overhead is inside the nonfacility PFS rate
Start with How Prices Work, then compare settings on the facility-type pages.
Check a price, then line up your quotes
Two new tools work with the anchors above. The directory lists the official places to check a price, run by CMS, state governments, and insurers. The worksheet holds the quotes you obtained yourself and lines them up side by side.
Price-Check Resources Directory
16 official resources: CMS Care Compare and other federal tools, state price portals and claims databases, and insurer transparency tools. Every entry shows who runs it, what it checks, its source, and its verified date.
Procedure Quote Comparison Worksheet
Enter the cash price, Good Faith Estimate, or insurer negotiated estimate you personally obtained from each facility. The worksheet compares them against the Medicare anchor. Your entries stay in your browser.
Patient playbook
Short, printable guides for the money conversation. No medical advice, only billing questions.
How to ask for the cash price
Exact questions, what to write down, and what a complete quote includes.
Good Faith Estimates and the No Surprises Act
When you are entitled to an estimate, what it should list, and how dispute resolution works.
Questions to ask billing before your procedure
A printable-style checklist for CPT code, setting, anesthesia, pathology, and what happens if the plan changes.
Sources and verification
- Medicare (CMS) rates are shown as a separate anchor, never blended into a self-pay range. Physician Fee Schedule anchors are CY2025, Michigan Locality 01, verified 2026-10-04. Your locality amount will differ.
- A self-pay range appears only where it can be verified from a public source. At launch, most pages ship the Medicare anchor plus facility-type education and state that self-pay ranges are not published yet.
- Hospital machine-readable file list prices are not presented as what patients pay. See Methodology - Procedure Price Method v1.0 for limits.
- Every price page repeats the same rule: confirm your price in writing before service.