How much does a mammogram cost? As with everything in health care, that depends.
The cost can be $0 or it can be as high as $2,786.95. Why the differences? Let us help you sort it out.
First, is it a screening mammogram or a diagnostic one?
First, screening (preventive) mammograms for women over 40 should be covered by your insurance if you have a plan that is compliant with the Affordable Care Act – which guarantees coverage for preventive health care in several major categories. That’s a mammogram every 2 years for women 50 and over, and as recommended by a provider for women 40 to 49, or women at higher risk for breast cancer.
Second, did you have one mammogram and then receive a notification that you have to return for a second?
It’s likely that the second one will be counted not as a screening mammogram but as a diagnostic one, or a “sick person” visit, rather than the preventive, or screening mammograms. They’re searching for a diagnosis because something not quite right was seen on the first one.
You might also have a diagnostic mammogram because you have a symptom that the doctor wants to examine – or if you have a family history of breast cancer, making this not a garden-variety screening but instead a higher level of scrutiny because of a problem or a family history.
“Screening mammograms (routine mammograms, not those performed if you have a lump or any other problem or a history of breast cancer) are typically interpreted by the radiologist after they are performed,” Dr. Geraldine McGinty, a radiologist who specializes in breast imaging, wrote in an article for ClearHealthCosts.. “About 10% of women screened can expect to be called back for additional testing (either additional diagnostic mammogram pictures or ultrasound). That doesn’t mean there was anything wrong with the initial mammogram, just that because of overlapping shadows or a change since the previous mammogram, more information is needed.
“If a woman has to return for additional ‘diagnostic’ mammogram pictures or an ultrasound those exams are not included in the ‘no co-pay’ ruling. Many insurance plans now have higher deductibles, so women who are called back may find themselves paying the entire cost of the diagnostic mammogram or ultrasound if they have not met their deductible even though the service is technically ‘covered’ by their insurance company. The cost of that diagnostic mammogram or ultrasound can vary widely. Often hospital radiology departments charge higher prices than radiologists’ offices in the community.”
If the mammogram’s cost is covered, why do you care about the price?
For people whose mammograms are covered by insurance with no co-pay, there may be no need to know the price. But millions of mammograms are performed in the United States every year, and millions of people are not covered by insurance. Also you might choose to pay cash – or you might be responsible for a percentage of the cost, depending on your insurance.
If your plan is not A.C.A. compliant, you may very likely face charges.
Here are prices for a screening mammogram in the New York area, ranging from $60 to $421. Here are prices for a screening mammogram in the San Francisco area, ranging from $150 to $470.
Here are prices for a screening mammogram in the Philadelphia area, ranging from $60 to $421. Here are prices for a screening mammogram in the Dallas-Fort Worth area, ranging from $139 to $508.
Our WNYC series on mammogram costs
We did a crowdsourcing investigation with WNYC public radio in New York on the cost of a mammogram in 2013.
“We asked people to send in prices of routine mammograms for our project with WNYC, we wrote in our introduction to the results. “People told us what they were charged, what they paid and what their insurers paid. We knew that there would be some variation in what people considered a routine mammogram, and some variation in the price — but we never expected the range to run from $0 to $2,786.95!…
“Thanks to the nearly 400 of you who shared your bills. We went on the air with Brian Lehrer at WNYC public radio here in New York to talk about health prices, and asked you to send in your information. When you did, we learned a lot, and we are honored that you joined in with us.“
Dense breast tissue
About 40 percent of women have what’s known as “dense breast tissue.” The upshot for them is quite often that the first, screening mammogram is not determinant, and they are called back for that second exam – either another mammogram, or a breast MRI or an ultrasound. That quite often brings an extra charge.
In some states, that follow-up exam must be covered by law. In other states, it’s not. The patchwork nature of health care regulation, with some state laws taking precedence over federal laws, has brought a push for nationwide dense breast mammogram coverage laws. Read more about dense breast tissue at Densebreast-info.org.
We did this story with our partners at CBS This Morning: “Women shocked by cost of mammograms: ‘I wasn’t expecting a bill at all.’” After the segment ran, we received hundreds of emails and shares from women with similar problems, and charges ranging into the thousands of dollars. Many of them said they’d stopped getting mammograms because the cost was so high. A similar segment ran on CBS Evening News, “The hidden cost of mammograms.”
A pair of follow-up pieces about a month later ran on CBS Evening News, “Breast cancer survivors hit with unexpected costs for diagnostic mammograms.” and CBS This Morning, “‘I was being penalized for having breast cancer’: Survivor fights with insurance over follow-up tests.”
In our series with WNYC, we examined the topic of “when is a mammogram not a mammogram,” as well as the do-over phenomenon. Many of the women we talked to thought they should not be charged for having dense breast tissue, or having been a cancer patient – which often brings the heightened scrutiny of a diagnostic mammogram on a regular basis, as opposed to the screening mammogram as a preventive procedure.
McGinty explored some of the same issues from the breast specialist’s perspective explaining how to choose a breast health center.
Here’s some of our other coverage on mammogram costs.
Part 2: How to argue a bill.