Mammogram
What goes into a price?
Negotiated prices across insurers
Self pay or cash prices vary by facility when paying out of pocket without insurance benefits. The chart shows you how the lowest and highest amounts facilities charge for this service if you were paying without insurance benefits. If you're uninsured or not submitting a claim to insurance, you also have the right to a Good Faith Estimate under federal law. Contact the provider for a copy of your Good Faith Estimate or to better understand payment options available to you.
Procedures included in this package
This list includes the services and fees bundled into the Mammogram Standard Service Package (SSP RA010). The final price for the procedure will depend on which services your provider ultimately performs, your insurance plan and your medical benefits.
| Code | Code Type | Description |
|---|---|---|
| HCPCS 76642 | Facility Fee | Ultrasound Imaging of One Breast Including Axilla with Image Documentation |
| HCPCS G0279 | Facility Fee | Tomosynthesis Mammogram Imaging for Diagnosis, Unilateral or Bilateral |
| HCPCS 77066 | Facility Fee | Diagnostic Mammography, Including Cad, Bilateral, Both Breasts |