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.
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.
Imaging, lab, and procedure departments located in or owned by a hospital, including off-campus hospital departments
MRI Without Contrast
CPT 70551Magnetic resonance imaging, brain (including brain stem); without contrast material
Physician Fee Schedule anchor
$193.67
Global (professional + technical)
- Professional (26)
- $68.81
- Technical (TC)
- $124.86
CMS Physician Fee Schedule CY2025 via WPS GHA, Michigan Locality 01 - CY2025. Verified 2026-10-04.
Hospital outpatient (OPPS) anchor
$540.27
APC 8007 - MRI and MRA without Contrast Composite (facility portion only)
Composite APC paid to the hospital facility when multiple imaging services on the same claim meet composite rules; single-service imaging APCs 5521 to 5524 also apply depending on the claim. Professional fee is billed separately.
CMS OPPS CY2025 Final Rule CMS-1809-FC - CY2025. Verified 2026-10-04.
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.
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.
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.
Assumptions printed
- PFS anchors are CY2025 Physician Fee Schedule amounts for Michigan Locality 01, verified 2026-10-04. Your locality amount will differ.
- OPPS anchors, where shown, are CY2025 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.