Ambulatory surgery center: lower facility fee for same-day procedures
An ambulatory surgery center (ASC) is a freestanding facility for same-day surgery and endoscopy. Medicare pays the facility portion under the ASC payment system, generally below the hospital OPPS rate for the same procedure family.
Confirm your price in writing before service. Ask whether the quote is facility-only or all-in.
- Setting
- Freestanding centers focused on same-day surgery and endoscopy
- Payment system
- 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
The endoscopist or surgeon professional fee is the Physician Fee Schedule facility amount. For example, diagnostic colonoscopy (CPT 45378) has a verified CY2025 PFS facility professional anchor of $186.75, versus a nonfacility amount of $335.06 in an office (WPS GHA, Michigan Locality 01). The ASC facility fee is separate from that professional anchor. Anesthesia and pathology, when they apply, bill as additional layers.
ASCs are built for scheduled, same-day cases. They do not carry the same standby and emergency overhead as a hospital, which is reflected in the lower facility payment. That does not automatically make every ASC quote lower than every hospital quote for every patient. It means the facility lever is worth asking about when the clinician performs the same procedure in both settings.
Ask the ASC for the all-in cash price by layer: professional, facility, anesthesia, and pathology. Ask what happens to the price if a diagnostic procedure becomes a biopsy or polyp removal on the day. Confirm the final quote in writing before service.
Medicare anchors to compare
Use these verified anchors to judge the facility lever. They are Medicare amounts, not cash prices.
| Procedure | CPT | PFS anchor | OPPS facility anchor where verified |
|---|---|---|---|
| MRI Without Contrast | 70551 | $193.67 global | $540.27 (APC 8007) |
| MRI With Contrast | 70553 | $314.74 global | $854.83 (APC 8008) |
| CT Abdomen and Pelvis | 74177 | $296.94 global | $435.12 (APC 8006) |
| CT Head | 70450 | $105.31 global | $224.55 (APC 8005) |
| Ultrasound Abdomen | 76700 | $112.22 global | $306.50 (APC 8004) |
| Screening Mammogram | 77067 | $124.39 global | See procedure page |
Full anchors for all 10 procedures are on the procedure pages and in the Price Anchor Explorer. Method and source limits are in Methodology.
How facility fees work, in one paragraph
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 OPPS, ASCs under the ASC system, and imaging centers and offices fold it into the technical or nonfacility PFS 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 costs more at a hospital
The scan 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. Hospital OPPS payment plus a separate professional fee will usually exceed a single PFS 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. We explain the price structure so you can ask an informed question.
Questions to ask in this 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?