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
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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
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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
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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
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New to the two payment systems? Read How Prices Work first, then return here for the per-setting detail.