The Same Brain MRI’s Facility Charge Is 91% Higher at the Hospital. A Patient’s 20% Rises With It.
A casual referral from your doctor can quietly inflate what you owe Medicare for the exact same brain scan, and the building where it happens matters far more than most patients realize before the bill arrives.
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Your doctor hands you a prescription for a brain MRI and says, “Get it done at the hospital across the street, they can fit you in Thursday.” That referral sounds casual, but it can also raise your out-of-pocket cost by more than half.
Under Original Medicare you owe 20% of whatever amount Medicare approves. Move the same scan into a hospital outpatient department and the approved amount rises, so your part increases with it. The gap between those two settings is real. But the number that matters to you is smaller than the one that makes headlines, and knowing the difference is what matters.
Two Price Lists, One Scan
Medicare runs parallel outpatient payment systems. Hospital outpatient departments bill under the Outpatient Prospective Payment System. Physician offices and freestanding imaging centers bill under the Physician Fee Schedule. Rates diverge sharply for identical work on identical equipment.
Take CPT 70551, a brain MRI without contrast. Using 2026 national unadjusted figures, the hospital’s facility component alone runs $243.77 against roughly $127.59 for the freestanding technical component. That’s the 91% gap, and it’s the number that gets quoted. Your bill works differently. A radiologist’s interpretation is billed in both settings, which narrows the spread considerably once everything is totaled:
| Setting | Medicare-approved | Your 20% after deductible |
|---|---|---|
| Freestanding imaging center | About $195.40 | About $39.08 |
| Hospital outpatient department | About $311.57 | About $62.31 |
So the facility charge is 91% higher while your total coinsurance is roughly 59% higher. Both are true, but only one of them reaches the patient’s bottom line.
Who Actually Pays
This lands on people with Original Medicare and no supplement. That’s the whole audience for this problem. If you carry Medigap Plan G, your policy pays the 20% after the Part B deductible, so the site-of-service gap is absorbed by the insurer rather than by you. Medicare Advantage plans typically set flat imaging copays, so the same arbitrage happens invisibly inside the plan’s books. Neither group feels this at the counter.
Without a supplement, it’s direct. Original Medicare applies your $283 annual Part B deductible first, then covers 80% of the approved amount. Every scan after that carries your share at whatever rate the building commands, on top of the $202.90 standard Part B premium. Two or three studies in a year and the setting premium compounds.
Current estimates put the 2027 Social Security COLA in the mid-3% range, with the official figure due next month. Healthcare costs have been running ahead of that. Site-of-service pricing is one of several Medicare traps we mapped in a free guide to the program’s hidden bills.
Why the Building Sets the Price
Health systems spent the last decade acquiring physician practices and imaging centers, then converting them to hospital-based billing because the hospital rate pays more. The scanner stayed put. The staff stayed. The billing designation changed. Congress limited the practice in 2015 by moving new off-campus departments onto the lower rate, though existing sites were grandfathered. CMS has narrowed that exception since, starting with clinic visits, then drug administration.
The 2027 proposal now targets specified non-contrast imaging at certain off-campus hospital departments, applying a Physician Fee Schedule equivalent. CMS estimates alignment would save Medicare and beneficiaries roughly $260 million in the first year, about $70 million of it in patient cost-sharing. Note what that means for timing: the non-contrast scans are the ones CMS proposes to fix. Contrast studies sit outside it.
Three Questions Before Your Next Scan
None of this requires arguing with your doctor. Instead, it requires three questions, posed before the appointment rather than after the bill.
- Ask where the scan will be billed, not just where it happens. An imaging suite inside a hospital’s medical office park often bills as a hospital outpatient department. Ask the scheduler for the facility’s Medicare billing classification and the CPT code on the order.
- Get the approved amount from each site directly. Medicare’s Procedure Price Lookup compares hospital outpatient departments with ambulatory surgical centers, not with freestanding imaging centers, so it won’t answer this question. Call both facilities with the CPT code and ask what Medicare’s approved amount is at their location.
- If your doctor specifies a hospital site, ask why. For routine imaging with no unusual clinical requirement, an accredited freestanding center produces diagnostic-quality images read by a board-certified radiologist. If the answer is referral habit rather than medicine, the difference is yours to keep.
Original Medicare is fee-for-service, so the price follows the building rather than the medicine performed inside it. The referral pad stops being a bill you passively accept once you know that.
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Gerelyn Terzo is the author of dividend investing handbook "Dividend Investing Strategies: How to Have Your Cake & Eat It Too." A veteran financial journalist, she covers agri-finance for outlets like Global AgInvesting and the broader stock market and personal finance for 24/7 Wall Street. She began at CNBC and later helped launch Fox Business in New York. Gerelyn currently resides in Woodland Park, Colorado and dabbles in nature photography as a hobby.
