Hospital facility fees explained
Care in a hospital usually comes with two bills: one from the hospital for its own facility fee, and one from the doctor. Medicare pays each separately, so a hospital charge should be compared with the hospital rate, not the doctor's fee alone.
Office rate or facility rate
Office is the rate when the service is done in a clinic, office or imaging center, and covers the whole service. Facility is the doctor's part when it is done in a hospital or surgery center, which bills its own facility fee separately. The hospital outpatient rate is Medicare's rate for that facility fee.
Medicare's national hospital outpatient (OPPS) rate for the hospital's own facility fee, before each hospital's local wage adjustment, which raises it in high-cost areas and lowers it in low-cost ones. The doctor bills separately under the fee schedule.
Emergency room visits
Medicare's 2026 national rates for each ER visit level, split into the hospital's part and the doctor's part:
| Code | Hospital facility fee | Doctor's part | Together |
|---|---|---|---|
| 99281 | $86.15 | $11.02 | $97.17 |
| 99282 | $156.87 | $40.42 | $197.29 |
| 99283 | $278.89 | $69.47 | $348.36 |
| 99284 | $426.30 | $118.24 | $544.54 |
| 99285 | $608.43 | $171.35 | $779.78 |
Hospital-owned clinics: code G0463
For code G0463, hospital outpt clinic visit, Medicare's 2026 national rate for the hospital's facility fee is about $136. The hospital and the doctor usually send separate bills. Medicare rates are a common benchmark, not what every plan pays.
For code 99213, established patient office or other outpatient visit with low level of decision making, Medicare's 2026 rate for the doctor's part in a hospital nationally is about $57. In 2024, providers nationally typically billed about $176. Hospitals also bill their own facility fee on top of this, and Medicare rates are a common benchmark, not what every plan pays. A hospital-owned clinic usually adds its own facility fee as code G0463, which Medicare pays at about $136 nationally.
When Med Bill Check sees G0463 on a bill, it suggests asking whether the clinic is billed as a hospital department, and whether a lower office rate applies. More on G0463.
Scans, procedures and other services in a hospital
| Code | Hospital facility fee 2026 | Doctor's part 2026 | Office rate 2026 |
|---|---|---|---|
| 71045 X-ray of chest, 1 view | $88.91 | $8.35 | $25.38 |
| 71046 X-ray of chest, 2 views | $88.91 | $10.02 | $33.07 |
| 70450 CT scan head or brain without contrast | $106.81 | $39.41 | $106.55 |
| 71250 CT scan of chest without contrast | $106.81 | $49.43 | $132.60 |
| 72148 MRI scan of lower spinal canal without contrast | $243.77 | $68.47 | $191.72 |
| 70551 MRI scan of brain without contrast | $243.77 | $67.80 | $195.40 |
| 73721 MRI scan of leg joint without contrast | $243.77 | $62.79 | $204.41 |
| 74177 CT scan of abdomen and pelvis with contrast | $356.43 | $83.84 | $300.27 |
| 76700 Complete ultrasound scan of abdomen | $106.81 | $37.41 | $114.23 |
| 76856 Complete ultrasound scan of pelvis | $106.81 | $32.40 | $105.21 |
| 93306 Ultrasound of heart with color-depicted blood flow… | $558.25 | $67.47 | $196.73 |
| 45378 Diagnostic exam of large bowel using a flexible… | $950.10 | $164.67 | $378.10 |
| G0121 Colorectal cancer screening; colonoscopy on… | $950.10 | $165.00 | Not usual |
| 43239 Biopsy of esophagus, stomach, and/or upper small… | $926.63 | $123.58 | $418.85 |
| 29881 Removal of knee cartilage using an endoscope | $3,342.87 | $515.71 | Not usual |
| 66984 Removal of cataract with insertion of prosthetic lens | $2,357.81 | $462.60 | Not usual |
| 20610 Aspiration and/or injection of fluid from large joint | $313.60 | $39.75 | $68.81 |
| 12001 Simple repair of surface wound of scalp, neck… | $204.98 | $44.09 | $113.90 |
| 98941 Chiropractic manipulative treatment, 3-4 spinal regions | $22.06 | $28.06 | $38.41 |
| 90791 Psychiatric diagnostic evaluation | $181.34 | $137.28 | $173.35 |
| 90834 Psychotherapy, 45 minutes | $181.34 | $91.85 | $113.90 |
| 90837 Psychotherapy, 1 hour | $181.34 | $135.27 | $167.00 |
| 96372 Injection of drug or substance under skin or into… | $73.56 | $15.36 | $15.36 |
For scans, the doctor's part in a hospital is the professional (reading) part. Office rates cover the whole service. Hospital rates are national and unadjusted: each hospital's local wage adjustment raises them in high-cost areas and lowers them in low-cost ones.
Sources
- CMS Hospital Outpatient Prospective Payment System (OPPS) Addendum B, July 2026 (cms.gov), national unadjusted payment rates
- CMS Medicare Physician Fee Schedule, 2026 (pfs.data.cms.gov)
General information, not medical, legal or financial advice. Medicare rates are a common benchmark, not what every plan or provider charges. For your own bill, check with the billing office, your insurer or your doctor.
Ask Med Bill Check yourself
Say whose bill it is, the hospital's or the doctor's, and Med Bill Check compares it with the right rate. Open Med Bill Check, free, no sign-up.
In Claude or any app that takes MCP connectors, add https://goodturn-mcp.pages.dev/medbillcheck/mcp and ask: “I got a $3,000 ER bill for 99284, is that high?”