Diagnostic Mammogram Cost
Dx mammo incl cad bi
$156.98Medicare physician fee2026 national office rateUnder 2026 Medicare rates, a diagnostic mammogram costs about $157 nationally at an imaging center or office, before a ZIP code adjusts it to your area. In a hospital, the doctor is paid about $46 for the reading and the hospital bills separately for the test.
- ✓Your ZIP's wage-adjusted hospital and surgery center rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
National Medicare physician rate (2026)
Get the rate for your ZIP
CMS adjusts this CPT by locality. A five-digit ZIP is enough: no account, no insurance card.
What diagnostic mammogram costs at hospitals near you
Everything above is a national average. The hospital you pick in your area moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
For example 90001.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery center rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. For this code the office and hospital physician lines differ by $110.55.
How CMS prices CPT 77066
Work is about 21% of the office total RVU; practice expense is about 77%. Localities with a high PE GPCI move this code more when practice expense is a large share.
Office vs hospital for this code
Office (non-facility) physician rate: $156.98. Hospital (facility) physician rate: $46.43.
Medicare patients typically owe 20% of the allowed amount after the Part B deductible, about $31 for the office physician fee, before any Medigap coverage. That coinsurance does not include a hospital facility fee.
Labeled private-plan and cash ranges on this page are arithmetic multiples of Medicare, not negotiated quotes. Ask the billing office for the CPT code, the site of service, and a good-faith estimate.
Diagnostic Mammogram cost by state
2026 Medicare office rate for CPT 77066, averaged across each state's localities. Open a state for its locality table and full cost breakdown.
What Is Diagnostic Mammogram?
A diagnostic bilateral mammogram is a focused X-ray examination of both breasts performed because something needs a closer look: a lump, pain, nipple discharge, or an abnormality flagged on a screening mammogram. Unlike screening, a radiologist is typically on site directing extra angled or magnified views in real time, and you often receive results before leaving. Each breast is compressed briefly for each view, and the appointment usually runs 30 to 45 minutes.
What Affects the Cost
- –Unlike free screening, diagnostic mammography is subject to deductible and coinsurance on most plans, making the same machines suddenly cost money.
- –Same-day breast ultrasound is frequently added to work up the finding, billed as its own study.
- –3D tomosynthesis views, now common, add a separate code and charge on top of the 2D study.
- –Hospital breast centers bill facility fees that independent breast imaging centers do not.
- –If a biopsy is recommended, that follow-on procedure with pathology is a substantial next cost.
How It Is Billed
CPT 77066 covers diagnostic views of both breasts; a one-sided workup uses 77065 instead, and 3D tomosynthesis appears as an add-on code when performed. Breast ultrasound done the same visit is billed separately, so a single problem-solving appointment often generates two or three imaging claims plus the radiologist's professional fees. Results letters and BI-RADS reporting are included, not billed extras.
Insurance & Coverage Notes
This is the classic screening-to-diagnostic trap: once your mammogram is labeled diagnostic, ACA free-screening protection no longer applies and normal cost sharing kicks in, even when the diagnostic study was triggered by a screening callback. A growing number of states require insurers to cover diagnostic breast imaging with no cost sharing, so check your state's rules and your plan type, since self-funded employer plans are exempt from state mandates. Medicare covers diagnostic mammograms at standard Part B cost sharing.
Questions to Ask Before Booking
- 1.Does my state or plan waive cost sharing for diagnostic breast imaging, or will I owe deductible and coinsurance?
- 2.Will ultrasound or 3D views be added today, and what does each cost?
- 3.What is the facility fee at this breast center compared with an independent imaging center?
- 4.If a biopsy is recommended, what would that procedure and pathology cost?
- 5.Can you give me the total for all imaging performed before I leave today?
Diagnostic Mammogram (CPT 77066): questions
Under 2026 Medicare rates, a diagnostic mammogram costs about $157 nationally at an imaging center or office, before a ZIP code adjusts it to your area. In a hospital, the doctor is paid about $46 for the reading and the hospital bills separately for the test.
Outside a hospital, one global fee pays for the equipment, the staff and the doctor's reading, so the office or imaging center rate for CPT 77066 is $156.98. In a hospital the physician bills only the reading, about $46.43, and the hospital is paid for the rest on its own claim.
A diagnostic bilateral mammogram is a focused X-ray examination of both breasts performed because something needs a closer look: a lump, pain, nipple discharge, or an abnormality flagged on a screening mammogram. Unlike screening, a radiologist is typically on site directing extra angled or magnified views in real time, and you often receive results before leaving. Each breast is compressed briefly for each view, and the appointment usually runs 30 to 45 minutes. CMS bills it as “Dx mammo incl cad bi.”
At an imaging center or office, $156.98 is Medicare's full national rate, covering the test and the reading. In a hospital, the physician bills only the reading (about $46.43) and the hospital bills separately for the test. Private-plan allowed amounts are often higher than Medicare; your deductible and coinsurance still apply.
For cash-pay surgery shopping, use this CPT as the Medicare floor when you compare written quotes. How cash-price shopping works.