MRI Without Contrast price: Medicare anchor and facility lever
Anchor for MRI Without Contrast - CPT 70551
$192.65
Professional (26) $69.04 plus technical (TC) $123.61.
Hospital OPPS facility anchor, this code billed alone: $243.77 (APC 5523, Level 3 Imaging without Contrast; national unadjusted, before wage-index adjustment).
Composite APC 8007: $537.85 (multi-study only, national unadjusted).
A brain MRI without contrast is one of the codes where the hospital and imaging-center bills diverge the most, because the hospital side can be paid two different ways. Billed alone, CPT 70551 maps to a single-service imaging APC; billed with another MRI on the same claim, the hospital can be paid the MRI composite instead. Ask which of the two your hospital quote assumes.
CPT code
70551
Magnetic resonance imaging, brain (including brain stem); without contrast material
CPT 70551 is the brain MRI without contrast code used as the anchor example on this page. Other body areas use different CPT codes (for example lumbar spine 72148, knee 73721) with different Medicare anchors.
The codes this visit can be billed under
| CPT | PFS office or global | PFS facility (professional) | Global period | Hospital single-service APC | Minimum Medicare copay at hospital |
|---|---|---|---|---|---|
| 70551 (this page) | $192.65 | $192.65 | not a surgical global | $243.77 (APC 5523) | $48.76 |
| 70552 | $264.39 | $264.39 | not a surgical global | $356.43 (APC 5572) | $71.29 |
| 70553 | $312.34 | $312.34 | not a surgical global | $356.43 (APC 5572) | $71.29 |
The single-service hospital anchor for 70551 is APC 5523 at $243.77, with a minimum unadjusted Medicare copayment of $48.76. The composite APC shown at the top of this page applies only when the composite rules are met, typically two or more MRI or MRA services on one claim. A one-scan order is priced against the single-service APC, not the composite.
If the radiologist decides during the visit that contrast is needed, the code changes. Contrast only is 70552 ($264.39 global) and without followed by with is 70553 ($312.34 global). Ask the scheduler whether the order allows the radiologist to add contrast on the day, and what code and price would apply if that happens.
For a Medicare patient, the hospital line for 70551 billed alone carries a minimum unadjusted copayment of $48.76, and the radiologist's coinsurance is figured on $69.04. At an imaging center billing globally, coinsurance applies once to $192.65.
Inside and outside the 70551 anchor
Covered by the anchor
- Scanner time and image acquisition
- Radiologist interpretation and written report (professional component, modifier 26)
- Standard image storage and transmission to the ordering clinician
Billed outside it
- Contrast material and injection, when a follow-up with-contrast study is ordered separately
- Sedation or anesthesia, when used
- The ordering visit and any follow-up visit
- Additional sequences or a second body area billed under a separate CPT code
Why prices vary for CPT 70551
The same CPT code is paid under two different Medicare systems. In a hospital outpatient department the facility bills OPPS and the radiologist bills the professional fee separately. In an independent imaging center the service is usually billed globally under the Physician Fee Schedule, with the technical component inside the same payment. Equipment, staffing, and hospital overhead are priced into OPPS APC rates at a higher level than the PFS technical component for many imaging codes, which is the main facility-type lever patients can shop on.
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.
Questions specific to MRI without contrast
- Is this quote for 70551 alone, or does it assume a second MRI on the same day that would trigger composite billing?
- If contrast is added during the scan, will the code become 70553, and what is the written price for that code?
- Does the price include the radiologist's report, or will a reading group send its own bill?
- Is the scanner in a hospital department or a freestanding center, and does the quote name that setting?
MRI Without Contrast: billing questions
Why does the hospital anchor for 70551 show two different numbers?
Medicare pays hospitals a single-service APC for one MRI and a composite APC when several MRI or MRA services are billed together. For CPT 70551 alone the CY2026 single-service anchor is APC 5523; the composite applies only to qualifying multi-scan claims. Ask the hospital which one its estimate assumes.
What happens to the price if the radiologist adds contrast?
The service is no longer 70551. A study done without and then with contrast is billed as 70553, which carries a higher anchor in both settings. Ask before the appointment whether contrast could be added and get the written price for both codes.
Does a Medicare patient pay 20 percent of the brain MRI anchor?
For a diagnostic MRI under Part B, the general rule on Medicare.gov is 20 percent of the Medicare-approved amount after the yearly Part B deductible. In a hospital the facility copayment is figured on the OPPS amount and the radiologist's coinsurance on the professional fee, so a hospital visit produces two coinsurance amounts.
Is a brain MRI with and without contrast the same price as without?
No. Without then with contrast is 70553, with a CY2026 global anchor of $312.34 against $192.65 for 70551, and a higher hospital APC when billed alone.