Hospital outpatient vs imaging center: why the same scan carries two payment logics
The scanner can be identical and the CPT code can be identical, yet the Medicare anchor changes completely with the setting. This guide shows the split for the imaging and testing procedures on this site, using only the verified anchors already published on the procedure pages.
Prices only. No diagnosis or treatment advice. Confirm your price in writing before service. Medicare anchors are not your bill.
Two payment logics for one code
In a hospital outpatient department, Medicare pays two separate layers. The facility is paid under the Outpatient Prospective Payment System (OPPS), through an Ambulatory Payment Classification (APC); a single imaging study billed alone is paid through its own single-service APC, and a composite APC applies only when several qualifying studies are billed together. The clinician who interprets the study is paid separately under the Physician Fee Schedule (PFS), as the professional component, modifier 26. In a freestanding imaging center or a physician office, the same study is usually billed as one PFS global amount that covers both the technical component (the scanner, the technologist, the image storage) and the professional component in a single figure. Neither logic is a patient price. They are the two structures your cash quote or your insured bill will be built from, which is why a facility-only quote from a hospital and a global quote from an imaging center cannot be compared until each one states what it includes.
The anchors, side by side
Every figure below is taken from the checked-in data behind this site (src/data/procedures.json) and is printed on the matching procedure page. OPPS amounts are CY2026 national unadjusted single-service facility payment rates before wage-index adjustment, from the CMS OPPS October 2026 Addendum A and B (verified 2026-10-22); the composite rate, which applies only to multi-study claims, is shown in brackets where one exists. PFS amounts are CY2026 Physician Fee Schedule amounts for Michigan Locality 01, published by WPS GHA, effective January 1, 2026; another locality will differ. Verified 2026-10-18. The columns are shown side by side on purpose. This site never adds the layers into a total that no source published.
| Procedure and CPT | Hospital outpatient: OPPS facility anchor (CY2026) | Imaging center or office: PFS global anchor (CY2026) | Professional component inside the PFS split (modifier 26) |
|---|---|---|---|
| MRI without contrast, brain - 70551 | $243.77 (APC 5523) [multi-study composite $537.85] | $192.65 | $69.04 |
| MRI with contrast, brain - 70553 | $356.43 (APC 5572) [multi-study composite $867.08] | $312.34 | $107.27 |
| MRI lumbar spine without contrast - 72148 | $243.77 (APC 5523) [multi-study composite $537.85] | $189.10 | $69.69 |
| MRI knee without contrast - 73721 | $243.77 (APC 5523) [multi-study composite $537.85] | $200.97 | $63.82 |
| CT abdomen and pelvis with contrast - 74177 | $356.43 (APC 5572) [multi-study composite $438.90] | $294.96 | $85.62 |
| CT head without contrast - 70450 | $106.81 (APC 5522) [multi-study composite $226.07] | $105.23 | $40.21 |
| CT chest without contrast - 71250 | $106.81 (APC 5522) [multi-study composite $226.07] | $130.87 | $50.38 |
| Ultrasound, abdomen, complete - 76700 | $106.81 (APC 5522) [multi-study composite $300.57] | $112.60 | $37.99 |
| Ultrasound, pelvis, non-obstetric - 76856 | $106.81 (APC 5522) [multi-study composite $300.57] | $103.52 | $33.01 |
| DXA bone density, axial - 77080 | $106.81 (APC 5522) | $38.75 | $9.50 |
| Sleep study, polysomnography - 95810 | $877.34 (APC 5724) | $659.23 | $120.89 |
One pattern in the table is worth naming. Three different MRI studies, brain without contrast (70551), lumbar spine (72148), and knee (73721), carry the same $243.77 OPPS facility anchor when each is billed alone, because Addendum B assigns all three to the same single-service APC 5523. If two or more qualifying MRI studies are billed on one claim, the hospital can instead be paid the MRI and MRA without Contrast Composite APC 8007 at $537.85 (multi-study only, national unadjusted). The PFS global anchors for those three studies differ ($192.65, $189.10, and $200.97), because the Physician Fee Schedule prices each code on its own components. The two systems group the same work differently. That grouping, not the scanner, is most of the structural gap between the columns.
How to read a quote against this table
Start with the exact CPT code on your order, and find its row. If you are quoted by a hospital outpatient department, expect at least two layers: a facility charge built on the OPPS logic and a professional charge for the interpretation. Ask whether the number you were given is the facility layer only, and who bills the professional layer. If you are quoted by an imaging center, expect one global number, and ask whether the radiologist reading is inside it or billed separately by an outside group. Then write down, for each setting, the code, the setting, each layer, and the name of whoever quoted it. The cash price guide gives the exact sentence to use, and the Price Anchor Explorer lets you pull the same anchors up by procedure and setting.
What these anchors cannot tell you
An anchor is an order of magnitude and a structure, not a quote and not a prediction. OPPS amounts here are national unadjusted rates; a real hospital payment is wage-index adjusted, and a real patient bill runs through a plan contract or a facility cash price that Medicare never published. PFS amounts here are one locality, Michigan Locality 01; another locality will differ. Contrast, sedation, additional body areas, and follow-up visits sit outside these rows, exactly as each procedure page lists under what the anchor excludes. If a figure on a quote surprises you, the useful question is not whether it matches an anchor. It is which layer the figure represents, for which code, in which setting. Those three answers make any two quotes comparable.
Questions to ask each setting
- "Is this facility a hospital outpatient department, including an off-campus department owned by a hospital, or a freestanding imaging center?" The answer decides which payment logic applies, and off-campus hospital departments are not always obvious from the building.
- "Is your price a facility-only price or a global price, and who bills the professional interpretation fee?"
- "Does the price include contrast if the order changes to a with-contrast code on the day, and what will that code cost?"
- "Can you send the price in writing with the CPT code, the setting, and the inclusions named?"
Each question is billing only. None of them asks whether the study should happen, and this guide takes no position on that. The facility-type pages walk through each setting in more detail, and the billing checklist covers the day-of-change and separate-billing traps that sit outside imaging.
Comparisons that mislead
- Comparing a hospital facility-only quote with an imaging-center global quote and calling the hospital cheaper, before the professional layer arrives.
- Assuming an off-campus clinic is a freestanding center when it is billed as a hospital outpatient department.
- Quoting the without-contrast code when the order allows a with-contrast study, which moves the row in the table above from $243.77 to $356.43 on the single-service OPPS side for a brain MRI.
- Treating any anchor on this page as the price. Anchors frame the question; only the facility, in writing, gives the price.
The facility fee: the layer that follows the building, not the scan
Patients often use the words facility fee for the hospital layer in the table above, and billing offices use the same words for the charge that pays for the building, the equipment, and the staff who are not the clinician reading your study. Whatever the label on your quote, the structure is the one Medicare publishes. In a hospital outpatient department, the facility layer is paid under OPPS and the clinician is paid separately under the Physician Fee Schedule. In an imaging center or office, one global amount usually covers both parts. The fee follows the billing identity of the place, not the scanner inside it. Two rooms can run the same machine, take the same image, and bill under different logics because one room is billed as a hospital outpatient department and the other is not.
Under Original Medicare, that split reaches the patient as two kinds of cost sharing, not one. Medicare guidance for hospital outpatients says you generally pay a copayment to the hospital for each outpatient hospital service, and, after the Part B deductible, 20 percent of the Medicare-approved amount for doctor services. In most cases the copayment for a single service cannot be more than the Part A hospital stay deductible, but copayments across several services can add past that amount. A freestanding setting has no second hospital copayment in that structure. Your plan may price these layers differently, so treat this as the structure to ask about, not as a prediction of your own share. What Medicare patients pay for an outpatient procedure turns the split into dollar shares for five codes.
The billing identity can also change without the room changing at all. When a hospital buys a freestanding center or a physician practice, the same address can start billing as an off-campus hospital outpatient department, and the facility layer appears on quotes that used to be global. CMS is aware of the pattern: in the CY2026 OPPS final rule, CMS said it would use its authority to align payments for certain services delivered in hospitals and in off-campus facilities, in part so patients are not penalized with additional copayments simply based on where they receive care. Alignment for certain services is not equal prices for every scan today. For your booking, the practical point is narrower: ask whether the location bills as a hospital outpatient department today, not what it was called when you last used it.
You can surface the layer before you book. If the setting is a hospital, its price transparency posting is the first place to look: since January 1, 2021, hospitals have had to post standard charges, including the discounted cash price, free of charge and in a consumer-friendly display for at least 300 shoppable services, and CMS lists imaging among them. Note which location and setting the posted charge belongs to, and whether the professional reading is inside it. A freestanding imaging center is not covered by that hospital posting, so for that side of the comparison there is no posting to check. Ask the center directly, in writing, whether its price is global. Then line the two answers up in three rows: facility layer, professional layer, and all-in price for the exact CPT code.
A labelled illustration shows why the third row decides. Suppose, purely as arithmetic and not as a price for any code or facility, an imaging center quotes a global $380, and a hospital quotes $340 for the facility layer with the $85 professional layer billed separately. The hospital figure looks $40 lower until the layers are added: $340 plus $85 is $425, which is $45 more than the $380 global quote. Neither figure here is a real quote. The arithmetic is the lesson: a facility-only figure and a global figure are not the same kind of number, and only the all-in row can be compared.
Source: Centers for Medicare and Medicaid Services, CY2026 OPPS final rule press release on modernizing hospital payments, November 21, 2025, and Hospital Price Transparency consumer guidance, both checked October 16, 2026. Medicare, Medicare Hospital Benefits fact sheet on what outpatients pay, checked October 16, 2026.
The same outpatient payment system that prices a hospital scan also prices an overnight stay under observation. For people with Medicare, our guide to observation status versus inpatient status shows how the outpatient label changes the hospital share and the 3-day rule for skilled nursing care, and the ER visit level guide applies the facility-plus-professional split to emergency visits.
Setting comparison questions
Is the hospital outpatient anchor my price at a hospital?
No. The OPPS figure is a Medicare facility payment anchor: a national unadjusted CY2026 rate before wage-index adjustment, published to show order of magnitude and payment structure. Your cash price or insured cost is set by the facility and your plan. Confirm your price in writing before service.
Why is the same CPT code priced under two different systems?
Medicare pays for the setting as well as the service. In a hospital outpatient department the facility is paid under OPPS and the clinician is paid separately under the Physician Fee Schedule. In a freestanding imaging center or office, one global Physician Fee Schedule amount usually covers both parts. The scan and the CPT code are the same; the payment logic is not.
Can I add the OPPS amount and the professional fee to get a hospital total?
Not as a published figure. This site never adds payment layers into a total that no source published, because real bills involve wage adjustments, plan contracts, and cost-sharing rules the anchors do not capture. Read the two layers side by side to understand the structure, then ask the facility for its own all-in price in writing.
Does the imaging center anchor include the radiologist?
The Physician Fee Schedule global amount is the single amount paid when one entity bills both the technical component (scanner, technologist, image storage) and the professional component (the radiologist interpretation, modifier 26). The procedure pages on this site print both components separately so you can see the split inside the global figure.
Which setting should I choose?
This site does not answer that. It writes about prices, not medicine, and the right setting can depend on your clinical situation, which is a conversation for your ordering clinician. What this guide gives you is the billing structure to compare, and the exact questions to ask each setting before you book.
If a hospital bought the imaging center I used before, can my price change even though the room and scanner are the same?
Yes, the billing structure can change even when the room does not. If the center now bills as a hospital outpatient department, including an off-campus provider-based department, a facility layer paid under OPPS can appear alongside the separate professional fee, where the center previously billed one global Physician Fee Schedule amount. Under Original Medicare that structure also means a hospital copayment for the outpatient service in addition to cost sharing for the doctor services. Ask the location, in writing, whether it bills as a hospital outpatient department for your CPT code, which layers its price includes, and what the all-in price is. Confirm your price in writing before service.
Next: How to ask for the cash price - Procedure pages with anchors by setting - How the anchors are sourced.