Facility types: where the price lever lives
Same CPT code, four settings, four different facility-fee logics. Pick a setting to see how Medicare pays there and what to ask before you book.
Confirm your price in writing before service, including whether the quote is facility-only or all-in.
Hospital Outpatient Department
Imaging, lab, and procedure departments located in or owned by a hospital, including off-campus hospital departments
Payment: OPPS (APC-based facility payment) + Physician Fee Schedule professional fee
Facility fee: Yes - separate OPPS facility payment to the hospital
Read the spread page
Ambulatory Surgery Center
Freestanding centers focused on same-day surgery and endoscopy
Payment: 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
Read the spread page
Independent Imaging Center
Freestanding MRI, CT, ultrasound, mammography, and X-ray centers
Payment: 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
Read the spread page
Physician Office
In-office ultrasound, echocardiography, X-ray, and some endoscopy performed in office procedure rooms
Payment: 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
Read the spread page
What a facility fee pays for
A facility fee pays for the room, equipment, nursing and technologist time, supplies, and recovery: everything except the clinician's own work. Hospitals bill it under the Outpatient Prospective Payment System, surgery centers under the ASC payment system, and imaging centers and offices fold it into the technical or nonfacility Physician Fee Schedule payment. When a quote looks unusually low, ask which layers it leaves out. When a quote looks unusually high, ask which facility system produced it.
Why the same scan can cost more at a hospital
The protocol for a given CPT code is standardized. The price difference comes from the payment system, the overhead priced into that system, and what is bundled into the quote. A hospital OPPS payment plus a separate professional fee will usually exceed a single fee schedule global payment for the same code. That is a payment-system fact, not a claim about quality. MyCarePrice does not rate facilities or recommend where you should go; the four setting pages explain the price structure so you can ask an informed question.
The four questions that work in any setting
- What CPT code will be billed, and is this quote for that exact code?
- Is this an all-in price, or will professional, anesthesia, or pathology bill separately?
- What would the same code cost in the other settings your practice uses?
- Can I have the price in writing, with code, setting, and inclusions listed, before service?
New to the two payment systems? Read How Prices Work first, then return here for the per-setting detail.