Hospital outpatient department: OPPS facility fee plus professional fee
A hospital outpatient department bills the facility portion under the Hospital Outpatient Prospective Payment System and the clinician bills the professional fee separately under the Physician Fee Schedule. That two-part structure is the main reason the same CPT code costs more here.
Confirm your price in writing before service. Ask whether the quote is facility-only or all-in.
- Setting
- Imaging, lab, and procedure departments located in or owned by a hospital, including off-campus hospital departments
- Payment system
- OPPS (APC-based facility payment) + Physician Fee Schedule professional fee
- Facility fee
- Yes - separate OPPS facility payment to the hospital
Under OPPS, CMS groups the facility service into an Ambulatory Payment Classification. For imaging, composite APCs apply when multiple imaging services are billed together. In CY2025 the national unadjusted composite for MRI without contrast (APC 8007) is $540.27, for MRI with contrast (APC 8008) $854.83, for CT with contrast (APC 8006) $435.12, for CT without contrast (APC 8005) $224.55, and for the ultrasound composite (APC 8004) $306.50. The professional fee is not inside those amounts. It bills separately.
Hospital outpatient departments carry standby capacity, emergency coverage, and facility overhead that CMS prices into OPPS rates. A cash quote from a hospital may name only the facility portion. Ask whether the radiologist, cardiologist, or endoscopist fee is included, and ask the same question about anesthesia and pathology for endoscopy.
Use the Medicare anchors on this site to judge order of magnitude, then get the hospital cash price for your exact CPT code in writing. Ask what the same code would cost if performed in an imaging center, ASC, or office when your clinician offers that choice.
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?