Tool
Price Anchor Explorer
Pick a procedure and a facility type. The explorer shows the verified Medicare anchor for that CPT code and explains how the setting changes what you will be asked to pay. It does not invent a self-pay number.
How to use the result: take the CPT code and anchor to the facility, ask for the all-in cash price for that code in that setting, and confirm your price in writing before service.
Short answer: the anchor is not your price. Check a price in an official tool next.
This explorer shows the verified Medicare anchor for a CPT code in a setting. For an official place to check a price before you call, use the price-check resources directory: 24 official resources (5 federal, 15 state, and 4 insurer tools), listing official price-check resources only and no facility prices. Then line up the quotes you obtain in the procedure quote worksheet.
Start with a national federal or Medicare tool Start with a price tool run by my state
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
$192.65
Global (professional + technical)
- Professional (26)
- $69.04
- Technical (TC)
- $123.61
CMS Physician Fee Schedule CY2026 via WPS GHA, Michigan Locality 01 - CY2026. Verified 2026-10-18.
Hospital outpatient (OPPS) anchor
$243.77
APC 5523 - Level 3 Imaging without Contrast (single-service, national unadjusted, facility portion only)
Composite APC 8007: $537.85 (multi-study only, national unadjusted).
Single-service APC paid to the hospital when this code is billed on its own (status indicator Q3). Composite APC 8007 (MRI and MRA without Contrast Composite) applies only when the composite rules are met, typically two or more qualifying studies on one claim; it is shown separately as multi-study only. Professional fee is billed separately.
CMS OPPS CY2026, October 2026 Addendum A and B - CY2026. Verified 2026-10-22.
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 single-service facility anchor $243.77 (APC 5523, national unadjusted, 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 $192.65 (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 $192.65 (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 CY2026 via WPS GHA, Michigan Locality 01 - CY2026, verified 2026-10-18; OPPS CMS OPPS CY2026, October 2026 Addendum A and B - CY2026, verified 2026-10-22. 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
What the anchor is
The Physician Fee Schedule (PFS) anchor is what Medicare pays the clinician side of the service. For imaging it splits into professional (modifier 26) and technical (TC) components, or a single global amount when one entity provides both. The OPPS anchor, where shown, is what Medicare pays the hospital facility under the Outpatient Prospective Payment System. The professional fee bills on top of OPPS. Sources, years, and verification dates are printed inside the explorer and on every procedure page.
What the anchor is not
The anchor is not your cash price, not your insurance allowed amount, and not a prediction of your bill. Cash prices are set by each facility and must be asked for directly. This explorer will never blend the Medicare anchor into a self-pay range or present a hospital list price as what patients pay. Where a self-pay range cannot be verified from a public source, the explorer says so and shows the Medicare anchor plus facility education instead. See Methodology - Procedure Price Method v1.0.
Next steps
- Read the full procedure page for inclusions, exclusions, and day-of-change questions.
- Compare settings on the facility-type pages.
- Use the billing checklist when you call.
- Check the official tools in the price-check resources directory, then line up the quotes you obtain in the procedure quote worksheet.
Assumptions printed
- PFS anchors are CY2026 Physician Fee Schedule amounts for Michigan Locality 01, verified 2026-10-18. Your locality amount will differ.
- OPPS anchors, where shown, are CY2026 national unadjusted facility rates before the hospital wage index. The professional fee bills on top.
- The explorer never blends a Medicare anchor into a self-pay range and never presents a hospital list price as what a patient pays.
Frequently asked questions
Is the anchor my price?
No. It is the verified Medicare payment for that code and setting, shown for order of magnitude and facility comparison. Your cash price is set by the facility. Ask for it by CPT code and confirm it in writing before service.
Why does the hospital column show two amounts?
A hospital outpatient department bills a facility payment under OPPS plus a professional fee under the Physician Fee Schedule. An imaging center or office usually bills one global amount. Same code, different payment system.
Why is there no self-pay estimate?
Self-pay ranges are published only where verified from a public source under Procedure Price Method v1.0. Until then the explorer shows the Medicare anchor plus facility education rather than inventing a range.
What should I do with the result?
Take the CPT code and anchor to the facility, ask for the all-in cash price in that setting with professional, facility, anesthesia, and pathology listed, and get it in writing. The cash price guide gives the exact wording.