OBJECTIVES: A high percentage of patients recalled after screening mammography do not have cancer. The goal of this study is to describe the prevalence and cost to health plans of patient recall in the 6 months following screening mammography. METHODS: The Truven Health MarketScan Commercial and Medicare Supplemental Databases were used to identify women aged 40-75 years undergoing screening mammography (index event) in 2010-2012. Women were required to have 12 months pre- and 6 months post-index continuous enrollment. Women with mammography or a breast cancer diagnosis in the 12 month pre-index period were excluded. Recall was defined as receipt of a second breast-related imaging procedure, coinciding with an abnormal mammogram diagnosis code or a breast-related diagnosis in the 6 months following the index screen. Payer cost per recall (2012 US$) was the sum of breast-related imagining procedures and associated visit costs in the 6 months post-index, excluding patient payments. Breast cancer treatment costs were not included in recall costs.  RESULTS: Of the 1,553,044 women who met the study inclusion criteria, 246,233 (15.9%) had an abnormal mammogram or related diagnosis code and had a subsequent imaging procedure in the 6 months post-index. The average cost per patient recalled was $1,082 in the 6 months following screening mammography. The majority of recalls included diagnostic mammography (71.8%) or ultrasound (51.9%), which accounted for 12% and 9% of recall costs, respectively. Office visits and pathology services accounted for 42% of recall costs. Biopsy was performed in 19.3% of recalled patients and accounted for 27% of recall costs. MRI, fine needle aspiration, and ductogram accounted for <5% of recall costs.  CONCLUSIONS: Approximately one-in-six women undergoing screening mammography were recalled for further imaging within 6 months, with an average cost to health plans of $1,082 per patient. Improving breast cancer screening with a more accurate mammogram may significantly reduce payer costs.