How Much Does a Diagnostic Mammogram Cost in Pennsylvania?
Dx mammo incl cad bi
$154.97Pennsylvania physician fee2026 Medicare office rateUnder 2026 Medicare rates, a diagnostic mammogram costs about $155 in Pennsylvania at an imaging center or office, from $147 in Rest of Pennsylvania to $163 in Metropolitan Philadelphia. In a hospital, the doctor is paid about $47 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
Pennsylvania Medicare physician rate (2026)
-1.3% vs nationalAverage of 2 localities. Office range $146.87–$163.07.
Your ZIP in Pennsylvania
Look up your ZIP to see whether metro Philadelphia or rest-of-state pricing applies, from Philadelphia and its collar counties to Pittsburgh, Harrisburg, Allentown, Scranton, Erie, and the rural center.
What diagnostic mammogram costs at hospitals near you
Everything above is a national average. The hospital you pick in Pennsylvania 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 15001.
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. In Pennsylvania the office and hospital physician lines for this CPT differ by $108.35.
National vs Pennsylvania
Where Pennsylvania ranks for this CPT
CPT 77066 by Pennsylvania locality
| Locality | Office |
|---|---|
| metropolitan philadelphia | $163.07 |
| rest of pennsylvania | $146.87 |
PE GPCI ranges from 0.918 to 1.041 in Pennsylvania. That index is why the same CPT is not one price statewide.
Diagnostic Mammogram and how Pennsylvania is priced
Pennsylvania's fee schedule separates metro Philadelphia from the rest of the state, giving the southeast its own higher-cost locality while Pittsburgh, Harrisburg, Allentown, Erie, and rural Pennsylvania share rest-of-state adjustments. That means the state's second-largest medical market, Pittsburgh, is priced with rural counties rather than with Philadelphia. The Philadelphia locality's premium reflects the metro's wage and rent levels, which lead the state by a wide margin. For patients, the key locality question in Pennsylvania is simply whether care happens in the Philadelphia area.
Philadelphia is one of America's historic centers of academic medicine, dense with teaching hospitals, while Pittsburgh is dominated by a pair of large integrated systems whose rivalry has defined that market for years. The rural middle of the state, sometimes called the T, has far fewer options, and hospital closures there have drawn statewide attention. Residents near the edges use New York, Baltimore, or Ohio providers when convenient.
This procedure: 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 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.
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?
Other featured procedures in Pennsylvania
Diagnostic Mammogram in other states
Diagnostic Mammogram in Pennsylvania: questions
Under 2026 Medicare rates, a diagnostic mammogram costs about $155 in Pennsylvania at an imaging center or office, from $147 in Rest of Pennsylvania to $163 in Metropolitan Philadelphia. In a hospital, the doctor is paid about $47 for the reading and the hospital bills separately for the test. Enter a ZIP for the exact Pennsylvania locality.
Yes. CMS splits Pennsylvania into 2 payment localities. For this CPT the office physician fee spans $16.20 from the lowest to highest locality. Look up your ZIP to see whether metro Philadelphia or rest-of-state pricing applies, from Philadelphia and its collar counties to Pittsburgh, Harrisburg, Allentown, Scranton, Erie, and the rural center.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $31 for the office physician line or $9 for the hospital physician line in Pennsylvania. Medigap may cover that 20%. This is not the hospital facility fee.
At an imaging center or office, $154.97 is Medicare's full rate in Pennsylvania, covering the test and the reading. In a hospital, the physician bills only the reading (about $46.62) and the hospital bills separately for the test. Pennsylvania ranks #27 of 51 states on this rate (within 2% of the national office rate of $156.98).