Why does a knee X-ray cost so much more at a hospital than an independent imaging center?

Hospital-based imaging adds a facility fee on top of the professional (reading) fee. The physician fee at a hospital is $22.26, but the hospital facility fee can add $100 to $250. At an independent imaging center, there is no separate facility fee because overhead is included in the $49.43 office rate. Total cost at a hospital can be 2 to 3 times higher than an independent center for the same X-ray.

CPT (Current Procedural Terminology) codes are five-digit numbers that describe every medical service or procedure. Your doctor, hospital, and insurance company use them to communicate exactly what was done. Every line on your medical bill has a CPT code, and knowing the code lets you look up what Medicare pays for that same service.

Why do providers charge so much more than Medicare pays?

Providers set their own "chargemaster" prices, which are essentially list prices. Medicare pays a fixed rate based on the resources each service actually requires (the RVU system for procedures, or the Clinical Lab Fee Schedule for lab tests). Commercial insurers typically pay 150% to 250% of Medicare rates. Uninsured patients are often billed the full chargemaster price, which can be 2x to 30x what Medicare pays.

Can I use Medicare rates to negotiate my bill?

Yes. Medicare rates are the closest thing to a "fair price" benchmark in U.S. healthcare. When negotiating, ask the provider what they accept from Medicare for the same CPT code. Most providers will accept 150% to 200% of Medicare for cash-pay patients, which is still far less than their chargemaster price. Many hospital financial assistance policies also use a multiple of Medicare as their discount floor.

How are Medicare rates calculated?

For most procedures, Medicare uses the Resource-Based Relative Value Scale (RBRVS). Each CPT code gets three RVU components: Work (physician time and skill), Practice Expense (overhead), and Malpractice. These are multiplied by geographic adjustment factors (GPCIs) and a conversion factor ($33.4009 in 2026). Lab tests (80000-89999 range) use a separate Clinical Laboratory Fee Schedule with flat national rates.

CPT 73564

X-Ray of Knee, 4 or More Views

CPT 73564 is a comprehensive knee X-ray with 4 or more views, used nearly 940,000 times per year for Medicare beneficiaries alone. Providers charge an average of $143.82, but Medicare pays only $49.43 in an office setting (2.9x markup). The additional views beyond a standard 3-view study add about $26 to the bill. More views does not always mean a better diagnosis, so it is worth understanding when the extra imaging is clinically justified.

Updated May 2026Source: CMS Physician Fee Schedule

CPT 73564 at a Glance

Average provider charge: $143.82
Medicare rate (office): $49.43
Medicare rate (hospital): $22.26 + facility fee
Typical markup: 2.9x over Medicare office rate

Views included: 4 or more (AP, lateral, oblique, sunrise/tunnel)
Common uses: Complex injuries, pre-surgical planning
Related code: 73562 (3 views, $118 avg)
Beneficiaries (2023): 939,715

How the Medicare Rate Is Calculated

Medicare values every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). Here is the exact math for CPT 73564:

Component	What It Covers	Office (Non-Facility)	Hospital (Facility)
Work RVU	Radiologist interpretation time	0.20	0.20
Practice Expense RVU	X-ray equipment, technician, film	1.18	0.39
Malpractice RVU	Professional liability insurance	0.05	0.05
Total RVU		1.43	0.64
x $33.4009	2026 conversion factor	$49.43	$22.26

Why the hospital rate is much lower but you may pay more: The $22.26 facility rate only covers the radiologist's interpretation. The hospital bills a separate facility fee (typically $100 to $250) for the equipment and technician. Combined, a knee X-ray at a hospital-owned clinic often costs patients more than the same study at an independent imaging center ($49.43 all-inclusive).

Medicare Rate by State

Medicare adjusts the national rate by location using Geographic Practice Cost Indices (GPCIs). Here is how the 73564 rate varies across states in the office (non-facility) setting:

Medicare Rate by State (2026)

Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.

Sample State Rates (Office Setting)

State	Medicare Pays	Avg. Charge	Markup
Texas (Austin)	$40.40	$143.82	3.6x
California (Los Angeles)	$42.28	$143.82	3.4x
New York (Manhattan)	$42.26	$143.82	3.4x
Florida (Fort Lauderdale)	$40.79	$143.82	3.5x
Ohio	$37.60	$143.82	3.8x
Mississippi	$36.07	$143.82	4.0x
Arkansas	$35.78	$143.82	4.0x
Alaska	$46.36	$143.82	3.1x

Rates shown are for the non-facility (office) setting using 2026 GPCIs and the $33.4009 conversion factor. The average provider charge of $143.82 is the 2023 national average from CMS utilization data. Actual charges vary by provider.

Do You Need 4+ Views? Comparing Knee X-Ray Codes

The number of views determines which CPT code is billed, and each level costs more. Here is the comparison:

Code	Views	Avg. Charge	When It's Appropriate
73560	1-2 views	$95	Quick screening, follow-up of known fracture
73562	3 views	$118	Standard evaluation, routine arthritis monitoring
73564	4+ views	$143.82	Complex injuries, pre-surgical planning, patella evaluation

Patient action item: If you are getting routine knee X-rays for arthritis monitoring or chronic knee pain follow-up, ask your provider: "Are 4 views necessary, or would 2 to 3 views be sufficient?" The standard 3-view (AP, lateral, and oblique) is adequate for most routine assessments. The 4th+ views (sunrise for the patella, tunnel view) are needed for specific clinical questions.

Common Billing Problems with 73564

Ordering more views than clinically needed

Some orthopedic offices routinely order 4+ view studies as their standard knee X-ray protocol, regardless of the clinical question. For a routine follow-up on known osteoarthritis, a 3-view study (73562 at $118) provides the same diagnostic information. The difference is about $26 in average charges, and it adds unnecessary radiation exposure (though small for X-rays).

Hospital vs. independent imaging center pricing

The same knee X-ray at a hospital-owned imaging center can cost 2 to 3 times more than an independent center due to the facility fee. If your orthopedist sends you to a hospital-based radiology department for a knee X-ray, ask if an independent imaging center is an option. The images are the same quality, and the radiologist reading them may even be the same person.

Bilateral knee X-rays billed separately

If both knees are X-rayed, the provider should bill 73564 with modifier -50 (bilateral) or two units. Some providers bill two separate 73564 charges at full price. With modifier -50, the second side is typically reimbursed at 150% of one side total (not 200%). Check your bill: if you had both knees done, you should not see two full-price charges.

Frequently Asked Questions

How much does a knee X-ray (4+ views) cost without insurance?

Without insurance, a 4+ view knee X-ray costs $90 to $200 depending on the provider and location. The national average charge is $143.82. Medicare pays $49.43 in an office setting. Independent imaging centers frequently offer cash-pay rates of $60 to $100, which is significantly less than hospital-based facilities.

What is the difference between a 3-view and 4-view knee X-ray?

A 3-view study (CPT 73562) includes the standard AP (front), lateral (side), and oblique views. A 4+ view study (CPT 73564) adds specialized views like the sunrise view (looking at the kneecap from above) or tunnel view (looking through the notch between the thigh bone and shin bone). The cost difference is about $26 in average charges. For routine arthritis monitoring, 3 views are usually sufficient.

When are 4 or more views of the knee necessary?

Four or more views are most appropriate for complex knee injuries (suspected fractures with multiple fragments), pre-surgical planning for knee replacement or ligament reconstruction, evaluation of patellofemoral tracking problems, and when specific angles are needed to visualize structures that standard views cannot show. If your doctor orders 4+ views for routine follow-up, it is reasonable to ask if fewer views would suffice.

Why does a knee X-ray cost so much more at a hospital?

Hospital-based imaging splits the charge into a professional fee (radiologist reading, $22.26) and a facility fee ($100 to $250 for equipment and overhead). At an independent imaging center, everything is bundled into the $49.43 office rate. The total at a hospital can be $150 to $300, while an independent center may charge $60 to $100 cash-pay. Same X-ray, same quality, but very different billing.

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