How Much Does a Diagnostic Mammogram Cost in Wisconsin?
Dx mammo incl cad bi
$150.03Wisconsin physician fee2026 Medicare office rateUnder 2026 Medicare rates, a diagnostic mammogram costs about $150 in Wisconsin at an imaging center or office. In a hospital, the doctor is paid about $45 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
Wisconsin Medicare physician rate (2026)
-4.4% vs nationalSingle statewide locality.
Your ZIP in Wisconsin
Check your ZIP code for your part of Wisconsin, whether Milwaukee, Madison, Green Bay and the Fox Valley, La Crosse, Eau Claire, or the rural Northwoods.
What diagnostic mammogram costs at hospitals near you
Everything above is a national average. The hospital you pick in Wisconsin 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 53001.
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 Wisconsin the office and hospital physician lines for this CPT differ by $105.48.
National vs Wisconsin
Where Wisconsin ranks for this CPT
Diagnostic Mammogram and how Wisconsin is priced
Wisconsin's Medicare pricing runs through a single statewide locality with indices near the national average, so Milwaukee, Madison, and the Northwoods share the same approved amounts. The unified locality sits atop one of the more regionally organized care systems in the country, with strong integrated groups serving defined territories. No metro premium exists in the fee schedule, so Milwaukee's higher practice costs are averaged into the statewide factors. The published rates here travel unchanged across all seventy-two counties.
Milwaukee and Madison hold the state's academic medicine and largest systems, while integrated clinics in Marshfield, La Crosse, and the Fox Valley have long histories of serving rural Wisconsin through hub-and-spoke networks. The far north is lake and forest country where specialty care means a long drive south, and some western residents use Twin Cities or Rochester, Minnesota providers. Wisconsin's tradition of clinic-based integrated care tends to keep billing relatively coordinated.
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 Wisconsin
Diagnostic Mammogram in other states
Diagnostic Mammogram in Wisconsin: questions
Under 2026 Medicare rates, a diagnostic mammogram costs about $150 in Wisconsin at an imaging center or office. In a hospital, the doctor is paid about $45 for the reading and the hospital bills separately for the test. Wisconsin is a single Medicare locality, so the physician rate is the same statewide.
Not on the physician fee schedule. Wisconsin uses one locality, so the Medicare physician rate is the same from one end of the state to the other. What still changes is site of service (office vs hospital) and any facility fee the hospital bills on its own claim.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $30 for the office physician line or $9 for the hospital physician line in Wisconsin. Medigap may cover that 20%. This is not the hospital facility fee.
At an imaging center or office, $150.03 is Medicare's full rate in Wisconsin, covering the test and the reading. In a hospital, the physician bills only the reading (about $44.55) and the hospital bills separately for the test. Wisconsin ranks #20 of 51 states on this rate (4% below the national office rate of $156.98).