Mammogram
Mount Sinai West
What goes into a price?
Prices across providers
Self pay or cash prices vary by provider when paying out of pocket without insurance benefits. The chart shows you how the lowest and highest amounts providers 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 77067 | Base Code | Mammogram |
| HCPCS 77067 | Professional Fee | Mammogram |
| HCPCS 77063 | Professional Fee | Digital breast tomosynthesis bilateral screening examination |
| RC 0403 | Facility Fee | Other Imaging Services - Screening mammography |
| HCPCS 77063 | Facility Fee | Digital breast tomosynthesis bilateral screening examination |