A mammogram is a low-dose X-ray examination of the breast tissue used to screen for or diagnose breast cancer. While this imaging procedure is a standard tool in preventative healthcare, the cost for a patient without insurance is highly unpredictable. The final out-of-pocket price varies significantly based on the type of exam, the facility providing the service, and the specific technology utilized.
Base Cost: Screening Versus Diagnostic Exams
The most significant factor influencing the cost of a mammogram is the clinical reason for the examination, determining if it is billed as a screening or a diagnostic procedure. A screening mammogram is a routine, preventative measure performed on patients with no symptoms, typically as an annual check-up. For an uninsured patient, the charge for a two-dimensional (2D) screening mammogram generally falls between $150 and $300.
A diagnostic mammogram is a more focused procedure ordered when a patient has specific symptoms, such as a lump or pain, or following an abnormal screening result. Because the diagnostic exam requires more imaging and intensive review, it is billed under a different medical code and commands a higher price. Without insurance, the cost of a digital diagnostic mammogram can range from approximately $243 to $491. This higher cost reflects the complexity of the examination, which often includes additional specialized views and rapid interpretation.
Insurance Coverage and Preventative Care Mandates
Insurance coverage dramatically changes the financial structure of a mammogram, particularly for screening exams. Federal legislation, specifically the Affordable Care Act (ACA), mandates that most private health insurance plans must cover certain preventative services without any cost-sharing. For women over 40, a routine screening mammogram is covered at 100%—the patient is not responsible for a copayment, deductible, or coinsurance.
This zero-cost rule only applies to the screening portion of the visit. If an abnormality is found or the patient presents with symptoms, the procedure immediately shifts to a diagnostic exam, which is treated differently by insurance. Diagnostic procedures are considered treatment rather than preventative care, meaning they become subject to the patient’s regular insurance cost structure. The patient is typically responsible for paying their deductible, copay, or coinsurance for the diagnostic mammogram.
This distinction between screening and diagnostic services represents a significant coverage gap that can surprise many patients. Even with insurance, a patient may face unexpected bills if the initial screening leads to further diagnostic imaging on the same day.
Price Variation Based on Facility and Technology
Beyond the clinical designation, the final cost of a mammogram is heavily influenced by where the procedure is performed and the technology used. The type of facility is a major driver of cost, with hospital outpatient departments typically charging significantly more than independent imaging centers. Hospitals often include a “facility fee” in their billing, which contributes to a higher overall charge for the same procedure performed elsewhere.
The choice of imaging technology also impacts the bill, specifically the difference between two-dimensional (2D) and three-dimensional (3D) mammography, also known as tomosynthesis. While 2D mammography produces a flat image, 3D technology takes multiple “slices” of the breast, which can be beneficial for patients with dense breast tissue. Although 3D mammography is increasingly common, it typically costs more than a standard 2D exam, sometimes adding $60 or more to the charge.
Even when a 3D exam is performed as a screening, it is not universally covered by insurance at no cost, unlike the 2D screening. While some states mandate coverage for 3D screening, in other areas, the patient may be billed for the difference between the 2D and 3D charge. Patients without insurance should be aware that requesting the more advanced technology will likely result in a higher self-pay price.
Resources for Lowering Mammogram Costs
Patients who are uninsured or facing high out-of-pocket costs have several options for reducing the expense of a mammogram. One important resource is the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which provides free or low-cost screening services to low-income, uninsured, and underinsured women. Eligibility for this program varies by state, typically based on age and income level.
Non-profit organizations dedicated to breast health, such as the Susan G. Komen Foundation and the National Breast Cancer Foundation, offer grants and financial assistance programs. Local health departments and Federally Qualified Health Centers (FQHCs) often have patient assistance programs or can direct patients to facilities offering reduced-cost services. Uninsured patients should always inquire about a “prompt-pay” or “self-pay” discount when scheduling, as many imaging centers offer a lower rate for patients who pay the full bill upfront.