A mammogram is a breast X-ray used for early detection of breast cancer. It is recommended yearly starting at age 40. A clinical breast examination, in which a doctor or nurse examines the breast for lumps or irregularities, is recommended once every three years starting at age 20, then once a year at age 40 and up.
Typical costs:
For an uninsured patient, typical full-price cost of a mammogram ranges from $80 to $120 or more, with an average of about $102, according to Blue Cross Blue Shield of North Carolina. Some providers charge more, and some offer an uninsured discount. For example, at the Kapiolani Medical Center in Aiea, Hawaii, where the full price is about $212, an uninsured patient would pay about $127 to $148.
Mammograms usually are covered by health insurance for women in the recommended age bracket. Many states require health insurance companies to cover regular mammograms, usually after age 40. The National Women's Law Center offers a state-by-state chart.
For women covered by health insurance, some plans require no out-of-pocket expenses, while others charge a copay, generally between $10 and $35.
A clinical breast exam is much less expensive, and usually is included as part of a general or gynecological check-up.
What should be included:
The mammogram technician places the breast between two plastic plates, which compress the breast tissue so a clear X-ray can be taken. The procedure takes about 20 minutes.
The American Cancer Society offers a primer on early detection of breast cancer. Only two to four of every 1,000 women who undergo a mammogram end up receiving a diagnosis of cancer.
In a clinical breast exam, the doctor or nurse manually checks the breasts, lymph nodes and nipples for any palpable irregularities.
Additional costs:
Women at high risk for breast cancer, such as those with a known breast cancer gene mutation, should consider getting an MRI each year in addition to a mammogram, according to the American Cancer Society.
If an irregularity is found, more testing or follow-up testing might be required. About 10 percent of women who have a mammogram require more tests, usually just another mammogram. However, about 8 to 10 percent do require a biopsy.
Discounts:
During the month of October, Breast Cancer Awareness Month, some community or women's groups offer free or very low-cost mammograms, sometimes using a mobile clinic. To find a program, call the Susan G. Komen for the Cure Breast Care Helpline at 1-800 I'M AWARE (1-800-462-9273). Or contact the YWCA's ENCOREplus program any time for a referral for a free or low-cost mammogram.
For mammorgrams, the American Cancer Society recommends using a facility that performs many mammograms each day, and is authorized by the U.S. Food and Drug Administration to perform mammograms.
Material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.
Went for a yearly Gyno visit and doctor said I was due for mommorgram. Noted I had slight soreness in left breast so she wrote for a 'diagnostic" mam. instead of a "screening" mam. Screening is free but apparently diagnostic costs $776! Thank goodness no cancer but feel completely hoodwinked and cheated. Put off getting a mammo because I did't have any money for copay. This year though my 100% coverage for yearly screening would be a great time for mammo. Guess I am just another uneduacted consumer. Follow up in 6 months? Not likely.
Have been going there for 11 years for annual screening never paid anything because ins. covered 100% screening. This year was in and out faster than ever and got a bill for an additional view coded as a medical mammo in addition to the annual screening so not part of the 100% a doc never ordered this and all was normal they say the tech must have thought it was needed, so i asked if i will need to stop a tech after 4 images so i will not have to pay for additional mammo going forward she said "well if you are comfortable with that"..something is so wrong here.
Spent an hour on the phone with gyno, radiologist and ins. co. Went in for a routine gyno exam, and doctor felt a fibrocystic area on left breast. So he wrote RX for a routine mammo and a diagnostic ultrasound just to be safe. I am entitled to one routine mammo per year under my insurance, but I am not sure if it will be covered because gyno wrote routine and a diagnostic code. Very frustrating as I could not get an answer from insurance carrier. Told me it would be paid depending upon how the radiologist billed the claim!!!???
The routine breast exam pre calendar year listed as a benefit in my policy as a benefit is bulshit.
They lied and told me diferent stupid lies. In 2010 this exam was covered, this year they ask me to pay. I canceled my insurance. I wouldn't go to Alpine Surgical ever again.
Much of the info posted on this site is based on an individuals view of the system--from the outside. These billing issues are very complicated and constantly changing.
Bottom line: if you tell your doctor or technologist that you have a breast complaint, if you are recent breast cancer patient or you had previous abnormal mammo recommending follow up, then you are DIAGNOSTIC and copays and deductibles apply. If you are asymptomatic and have no recent surgery or abnormality on mammo then you can be a SCREENING which under obamacare is a covered preventative service. The imaging center and the radiologist get paid nearly the same for each type of exam regardless. Unfortunately, due to this artificially created distinction between exam types, the patient feels a huge difference as the preventive exam is "free" to you. If everyone voiced their opinion to their politicians we could maybe get this changed. This is going to get worse with the new government task force recommendations.
I had 2 mammograms done, one preventive, another diagnostic, because the first one showed a shadow and they needed to take another look (which turned out to be nothing). The network provider negotiated cost was around $100 per each procedure, which I would have no problem paying, but Golden Rule has a new policy that BOTH preventive and diagnostic mammos are covered no deductible, so I ended up paying zero. Very happy so far with my insurance. They also pay for breast ultrasound with no deductible.
UHC Mammogram - Not a Covered Benefit, as stated in their policy
Amount: $95.00
Posted by: a user UHC in Boulder, CO.
Posted: March 7th, 2012 06:03PM
Clinic or Doctor: Boulder, Colorado
Insurance Carrier: Golden Rule
Type of Policy: UHC One
After I went for my routine annual mammogram, which was supposed to be covered by my insurance,as stated under the section 8:covered benefits of my policy, I got a bill. From the isurace I was told that it was reported as a doctors visit,a disease problem etc. rnAs I specifically requested, before I schedule my appointment that I would like to have my annual breast exam, the doctors office reported it as a disease problem. And when I called the doctors office, the medical assisstant told me they reported it as usual. The medical assistant promissed she will call my insurance to confirm it was annual breast exam so I could have it covered. From the insurance: she's been told that I was charged because I didnt meet my deductable, and the previous year I had it covered because I had met my deductable. (This is not true because I went to a doctor only once in 2010 - for the mammogram, and I had it covered). In the policy its is stated that I can have one routine or diagnostic mammogram per calendar year as a covered benefit and does not go against the deductible.rnIn 2012, in the difficult times, it isn't. (Why am I surprised? My fault). rnI went to Europe and had everithing done perfect for about 30 dollars, no problems, no unexpected bills. rnI didnt have the mammogram done in Boulder Community Hospital(a hospital from the UHC network), when I found out that I will be charged for the doctors visit, as I suspected they won't cover it. And I was right. I ended up paying only the repriced amount of $95 for the doctors visit. So I had the job done in EU. :)))
Clinic or Doctor: Evergreen Hospital, Kirkland, WA
Insurance Carrier: None
It was shocking to see two bills totaled $740.00 for a diagnostic mammogrạm. I wonder if there might be a conspiracy to rip patients off? I do not like Evergreen Hospital anymore, they are way too expensive!
This is just to comment on the post from a user in Boulder, CO. I live in Washington, DC and UHC Golden Rule clearly confirmed to me that annual AND diagnostic mammograms and breast ultrasounds are covered, no deductible applies (and they paid all my annual screenings and diagnostics for breast mammogram). Not sure why in CO they have a different coverage, probably, it's due to different consumer regulations in your state, or you may had used a non-network provider. However, if you go to any EU country, the cost of mammogram can not be less than EUR 150, which is still much more than $90 repriced amount of the Golden Rule network providers. I lived in Germany for a long time, and know their prices quite well. Therefore, the $90 negotiated network provider cost for mammogram from Golden Rule is a great deal, by any standards.
I found a lump and my doc says I need a Diagnostic....I currently don't have insurance. She says "she doesn't like the feel of the edges". But looking at these posts I'm concerned that I won't be able to pay to have it done. Maybe I shouldn't have it done.
Total cost was $598.77 for hospital and physicians fee. My share was 119.75. I am going to check other centers, this is ridiculous for the ins carrier and me to pay this kind of money. Articles on internet state average costs about $250, Where?
So far I have been billed $564.71 for a mammogram, performed at Wesley Hospital in Hattiesburg, Mississippi during May 2012. $439.71 from the hospital and $125 from the radiologist. If you add the gyn doctor's yearly visit (150.00), the total comes to $714.71.
Where is the love? Grateful to be healthy. At this rate who can pay for medical care?
United Health Care Insurance doesn\'t cover routine mammograms
Amount: $0.00
Posted by: forget-me-not in Boulder, CO.
Posted: June 22nd, 2012 06:06AM
Clinic or Doctor:
Insurance Carrier: Golden Rule
Type of Policy: UHC One
The comment made after I published my experience with UHC was made by them. It looks like they cannot profit from informed people, but its good to know who they realy are. Mammogram benefits along with their other covered benefits might turn to be a baloon.
Posted by: Emily in SF Bay Area in San Francisco, CA.
Posted: September 13th, 2012 04:09PM
Clinic or Doctor: CMPC California Campus Breast Center
Insurance Carrier: UnitedHealthCare
Type of Policy: Choice PPO
Just want to show you guys the expensive costs of breast health care in SF bay area in CA. rnrnI am 41 yrs old and this was my first mammogram. I went in on 8/2 for screening. But they found something and asked me to come again for additional images. So I went again on 8/10 for diagnostic mammogram on both breasts and then the technician said they needed ultra sound. After that, the nurse told me that they need biopsy on both breasts so I went there again on 8/16. rnSo the costs for all these medical services:rn8/2 billed as Lab Service $49rn8/10 Additional images $49rn Diagnositic mammogram $403rn Ultra sound $755rn Fees to radiologist $149rn TOTAL = $1,356rn8/16 all billed as Lab Services $407 + $300 + $897 = $1,604rnrnAfter UHC applied some plan discounts and the amount of my PPO plan paid, I have to pay $281.23 out of my pocket. I feel lucky to have insurance from my husband, since I am currently unemployed... I just could not imagine how women without proper insurance to get preventive care... Look at how expensive for the diagnostic mammo and ultra sound? it only took about 10 mins for taking the ultra sound!
First of all, I would like to state that I am blessed that I do not have cancer and that my husband has a job. My complaint is as follows: In 2011 when I found the lump in my breast my insurance carrier was Aetna Insurance. My doctor ordered a mammogram & ultrasound. Of course, it was not covered as it was considered diagnostic. The original amount was applied to my deductible. rnMy husband's employer changed insurance carriers to Cigna and again my mammogram & ultrasound amount was considered diagnostic. The insurance company paid nothing as my deductible is $1500.00 per person. Since they have found an area of concern they want to monitor every 6 months. I owe the breast center approximately $800.00 of which I cannot afford to pay no job and living on one income. This whole healthcare thing is a rip off. The health insurance companies spend millions on political campaigns but cannot pay a claim. Wait until the healthcare bill gets a rolling. Many people are going to be surprised.
After having my first screening mammogram, the radiologist wanted more films. Apparently this is common with a first mammogram since they have no history. Unfortunately, this is considered a diagnostic mammogram and is therefore no longer considered preventative by insurance. Since I new this would now be subject to my $3000 deductable, I asked about the costs. I was told that the fee could be upwards of $400 and that most insurance pays around $200 but they also offer a discounted self pay program which costs $130. When registering for my appointment I was told that through my insurance I would have to pay $176.09 (which would be applied to my deductable). I opted to just do the self pay program and paid only $130. (Note, if an ultrasound would have also been required, that would be another $130). When you do the self pay program, they make you sign something saying that you will not turn it in to your insurance.
Posted by: Suspicious of the diagnostic need! $$$$$ in Baltimore, MD.
Posted: October 18th, 2012 11:10AM
Clinic or Doctor: Mercy Medical Center, Baltimore, MD
Insurance Carrier: BC/BS
I have a family history and a biopsy 5 plus years ago showed benign but questionable cells. I think questionable so that I continue to get diagnostic mammograms. My insurance has changed over the years,but I wanted to stay with the same service. I just got billed for a mammogram over a year ago. The whopping bill was $750.00. So now I am due again, and I am not going to do it. It is a racket. Even though the test saved my Mother twice, I feel that they have women living in fear and just charge whatever they want. Our health care is just wrong.
2010, 46 yrs., Had found a lump I had lumps before so I wasn't to scared. I am blessed, thank you God! I called told them I found a lump they got me right in. was charged a minimal fee. 2012 Mammogram, Ultras Sound at the same place. 48yrs old now found 6 plus lumps, this time I did the same thing called did not need a referral got right in, received a bill for $1,600 plus, because I haven't received the charge yet for the radiologist. when I called the billing department she told me it was because I said I found a lump, so next time I wont call it a lie but omit information, you can learn a lot from your kids.... rnI will be disputing this, why do you think our insurance is out of control, realistically its the medical... that screw us and the insurance companies with these big claims. if we don't dispute these fees its our fault for not standing up. I feel like I am being punished because I found some thing. rnI am married and have 5 children 1 income, who can afford to work and pay for child care now days. you cant say well why did you have so many kids, you cant predict the future who new our country would be where it is today.
I had to cancel the appt and we also looking into canceling our insurance policy. We have an outstanding bill for $3000. due to a kidney stone ( 2 yrs ago and a mental health issue (ME). Money issues brings out the demon of my feelings and I don't want any more expenses to pay on.
I was shocked at the bills I got after having a diagnostic mammogram done recently. $778 per breast! Then all sorts of hospital fees, etc. The amount is over $2,000 all deductible, so all out of our pockets. No one ever explained that cost of this type of mammo was so much greater than a screening one...I too feel tricked, having a hard time finding any organizations that can help with payment, since I was blessed to not have any cancer found. I will take health over money, but sure would be great if someone could do something about these insane costs.
Routine mammos are 100% but forget it if you need diagnostic. I found a lump at 35 yrs old and was diagnostic mammo so it wasnt free. Was getting billed and was required 6 month follow ups and ultrasounds and fine needle done evr6mo. Im about to be 40, still having issues, no cancer thankfully but if I want to get checked, I have to pay. I go to work everyday and pay medical insurance and I am no longer seeking medical attention because the costs are so high and now the hospital wont bill me, they want payment upfront. I now have a huge lump and wont go get checked. i know I sound ignorant by saying that but the costs have been thousands and im still paying insurance. Its just not fair. Mammos whether preventative or diagnostic should be covered at 100%. Its so sad that being a responsible person is like a punishment. I work, pay my bills, have insurance coverage and because i have a lump in my breast i feel like i cannot get the testing done because i will be further in debt.
WIsh I had known mine was "diganostic" before I went
Amount: $758.19
Posted by: SW in Ann Arbor, MI.
Posted: February 12th, 2013 09:02AM
Clinic or Doctor: University of Michigan
Insurance Carrier: Blue Cross/Shield
Type of Policy: PPO
I have been having annual screenings for three years since an initial cyst was found three years ago. I understand that the first would be considered diagnostic but since cysts are my normal I would think that an annual screening would be all that's needed for me unless they found evidence to the contrary. We used to have Blue Care Network HMO and everything was convered including ultrasounds on any suspicious areas (first done during the initial mammogram). Imagine my surprise at opening my mail yesterday and finding this huge bill!rnrnI've contacted the insurance, the hospital billing system, the imaging center, the primary care physician's office - and get varying degrees of "This was diagnostic, not routine, you should have known that, too bad, you have to pay." When it's all been covered in the past, and I had no way of knowing they considered EACH subsequent once-only mammogram diagnostic, and I called BCBS two days before my appointment to ensure it was covered - how was I to know the difference? It's never been pointed out they were all diagnostic and I don't think most patients are aware of the significant differnce that little bit of language gymnastics will have on their pocketbooks. I don't consider myself dumb, but I've been treated this way consistently while questioning this bill that I was totally not expecting and am unprepared to pay.
My annual was no charge but they want a diagnostic view. I know this is out of pocket because I have a high deductable. Im trying to find a free clinic or discount but cant seem to get answers. Apparently this is only available if you are on medicaid. Why not keep us taxpayers alive? Sadly I will take my chances and pay my car insurance, buy gas and a few groceries. GRRRRR
Four months ago I had my annual screening mammogram. It showed an area that needed further study. I had a diagnostic mammogram followed by ultrasound. The area appears to be benign but I am scheduled for a six month follow-up mammogram and ultrasound. My doctors, nurses and technicians have been supportive all the way. Everything has been well explained to me and I have incurred no out of pocket expenses. I love my HMO.