How much does a mammogram cost?
The average total cost of a mammogram is $266. Get a cost estimate based on your location, insurance, and doctor below.
If you’re a woman over 45, or are a younger woman with a high risk for breast cancer, doctors recommend getting a mammogram every year or every other year. Mammograms are routine tests used to check for breast cancer.
Mammograms can be for screening (as a routine check up) or diagnostic (if you show signs of breast cancer). For the purposes of this post, we’ll be discussing cost estimates for mammogram screenings.
Amino’s median network rate for a mammogram screening is $266. Keep in mind—this is an estimate for what you and your health insurance company might pay together (combined) for the procedure, not the amount you’ll pay out-of-pocket.
All women need to get mammograms at some point in their lifetime because early detection of breast cancer can be life-saving. You can use Amino to find a doctor and estimate your out-of-pocket cost below. Then, read on to learn more about what a mammogram is and what affects the overall cost, including the Affordable Care Act (ACA) guidelines for insurance coverage.
Find a doctor and calculate what you'll pay
Use Amino (below) to find an OB/GYN or family practitioner who can refer you for a mammogram. After entering your information, select a doctor and click “calculate what you’ll pay” to see a cost estimate customized to your insurance.
What is a mammogram?
A mammogram is an X-ray image of your breasts that is used to screen for signs of breast cancer. During the screening, a doctor will compress your breasts between two surfaces (to spread out the breast tissue) and then they will use an X-ray machine to capture black and white images. The doctor uses these images to check for signs of breast cancer.
The point of this common test is to detect signs early which, according to the American Cancer Society (ACS), improves the probability of successful treatment.
Who needs a mammogram?
If you’re at a normal risk for breast cancer, the ACS recommends that women ages 40-44 should consider getting an annual mammogram (but that ultimately the choice is up to them, if they’d like to start early), women age 45-54 should get mammograms every year, and that women 55 and older should switch to mammograms every 2 years. (Other groups, like the American College of Obstetricians and Gynecologists, recommend that starting annual mammograms at age 40.) If you’re at high risk of breast cancer, these guidelines can change, and you may need to get a mammogram annually no matter how old you are.
Here are some reasons you may need to get a mammogram more often:
- Dense breast tissue
- A family history of breast cancer
- Starting menstruation before age 12
- A personal history of breast cancer
- A history of benign breast conditions
- Previous chest radiation
How much does a mammogram cost, and what determines the price of a mammogram?
Determining the price of a mammogram can be complicated. The Affordable Care Act (ACA) requires health plans that started on or after September 23, 2010 to cover preventative health services like mammograms. Although many insurance plans cover the costs for mammograms as a screening test, you still might be charged for some services that happen during a mammogram screening.
According to the MD Anderson Cancer Center, you may get billed for part of your mammogram screening under a few different circumstances:
- If cancer is detected and removed during the mammogram (this is called a biopsy). Our estimates find that about a third of all biopsies happen on the same day as the mammogram. If you go in for a colonoscopy screening and need a biopsy, your doctor may use a different billing code that would convert the procedure into a “therapeutic” one instead of a screening.
- When a mammogram is performed as part of a diagnostic process following a biopsy, or you are having a mammogram to evaluate a problem (this is may classify your mammogram as diagnostic care, not preventative).
- When you’re at increased risk for breast cancer and may need to get earlier/more frequent screening compared to average risk adults.
Whether or not your screening mammogram is 100% covered may ultimately come down to what medical code the doctor uses when they are billing insurance for the procedure. There are two types of mammograms: screening and diagnostic. Screening mammograms use a low dose of radiation, giving your doctor a quick view of your breast to check for any abnormalities. If they find something out of the ordinary, they will order a diagnostic mammogram. This exam will allow your doctor to look in more detailed images of your breast and you’ll be exposed to a slightly higher dose of radiation. It gets complicated when your free preventive exam turns into a diagnostic exam and you can end up with medical charges.
If you’re trying to plan for healthcare costs ahead of time, this can be frustrating.
So, what should you do to determine the cost of your mammogram? Here are some best practices for minimizing your out-of-pocket costs:
- Call your doctor to ask how much of your mammogram will be covered. Make sure you ask if coverage includes the visit and the screening procedure itself. Don’t forget to ask if the amount could change based on findings during the procedure.
- Double check all of this with your insurance company before you get the procedure—ask about your specific costs, like co-insurance, copays, and deductibles. And ask if your provider is on your insurance company’s list of in-network providers. Out-of-network doctors cost more and results in you getting balance billed.
If you don’t have insurance, the ACA guidelines unfortunately don’t apply, and you may have to pay out-of-pocket for the screening. The federal Centers for Disease Control and Prevention runs a program that offers free mammograms in all 50 states and 11 tribal areas, although rules for eligibility can vary by state. You can call the American Cancer Society National Cancer Information Center at 1-800-ACS-2345 to ask.
If you have to pay out-of-pocket, how much does a mammogram cost?
Amino’s cost estimates for mammograms
If you are required to pay out-of-pocket for your mammogram, Amino can help you understand what goes into the total cost and how the cost varies depending on where you live.
Our median network range for a mammogram is $266. If you are required to share the burden of cost, this is the total estimated amount that you and your insurance company would together pay the doctor for the screening.
We found that the breakdown of costs are as follows:
- Estimated cost for facility charges: $147
- Estimated cost for the procedure: $119
You’ll see that the largest portion of the cost ($147) comes from the facility charges, so where you get care (which doctor and facility you go to) may affect the total cost of your procedure.
The cost of a mammogram in the US
The median network rate range across the US we found was $165 to $287 depending on where the screening took place. Where you live makes a difference, because it may determine which health plan you’re on and which health insurance networks are available to you.
Using Amino’s health insurance claims database, here’s the estimated network rate for mammograms in the largest metro areas (the ones with more than 1 million residents):
Top 10 least expensive metro areas for a mammogram
- New Orleans-Metairie, LA — $165
- Buffalo-Cheektowaga-Niagara Falls, NY — $168
- Columbus, OH — $169
- Nashville-Davidson-Murfreesboro-Franklin, TN — $194
- St. Louis, MO-IL — $197
- Pittsburgh, PA — $205
- Salt Lake City, UT — $206
- Birmingham-Hoover, AL — $206
- Washington-Arlington-Alexandria, DC-VA-MD-WV — $211
- Detroit-Warren-Dearborn, MI — $213
Top 10 most expensive metro areas for a mammogram
- Portland-Vancouver-Hillsboro, OR-WA — $468
- Boston-Cambridge-Newton, MA-NH — $445
- Denver-Aurora-Lakewood, CO — $388
- Raleigh, NC — $386
- Hartford-West Hartford-East Hartford, CT — $385
- Baltimore-Columbia-Towson, MD — $382
- Indianapolis-Carmel-Anderson, IN — $332
- Atlanta-Sandy Springs-Roswell, GA — $325
- Los Angeles-Long Beach-Anaheim, CA — $319
- San Jose-Sunnyvale-Santa Clara, CA — $307
Ultimately, the cost of your mammogram is determined by many factors. You can use Amino’s cost estimates for mammogram screenings as a guide to help you understand how much mammograms cost in your area, what goes into the total cost, and how much you might be responsible out-of-pocket—but you should always check with your doctor and insurance company. You can also use Amino to find doctors in your city with the most experience in mammogram screenings.