Physician office: nonfacility rate, overhead inside the payment
In a physician office, Medicare pays the Physician Fee Schedule nonfacility amount. Practice expense - rent, staff, equipment - is inside that payment. There is no separate facility bill.
Confirm your price in writing before service. Ask whether the quote is facility-only or all-in.
- Setting
- In-office ultrasound, echocardiography, X-ray, and some endoscopy performed in office procedure rooms
- Payment system
- 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
The nonfacility amount is higher than the facility professional amount for the same code, because the office bears the overhead. For upper endoscopy (CPT 43235) the verified CY2025 anchors are nonfacility $279.91 and facility professional $123.95. The facility amount looks lower only because the hospital or ASC bills its own facility fee on top of it.
Offices commonly perform ultrasound, echocardiography, X-ray, and selected endoscopy in office procedure rooms. The cash quote should be a single global amount when the office provides both the technical and professional portions. Ask whether an outside radiologist or cardiologist will bill the interpretation separately.
If your clinician offers the same study in an office and in a hospital department, ask for the all-in cash price in each setting for the same CPT code. Confirm the chosen price 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?