OBJECTIVES: Digital breast tomosynthesis (DBT) and breast ultrasound (US) are increasingly used for breast cancer screening. The objective was to describe utilization trends and health plan costs of these tests compared to the use of traditional full-field digital mammography alone (FFDM). METHODS:  The Truven Health MarketScan Commercial Database was used to identify women aged 40-64 years undergoing screening mammography in 2005-2015. Women were required to have 12 months pre- and 6 months post-index continuous enrollment. For each screening scenario (FFDM alone, FFDM+DBT, and FFDM+US), an annual screening rate was estimated and the average annual cost was determined. Also, the rate of diagnostic mammography performed within 180 days for 2015 was estimated. RESULTS:  Approximately 5,000,000 women met the inclusion criteria in each year for the trend analysis. Screening mammogram rates rose from 38.9% in 2005 to 45.8% in 2009, but have remained relatively stable recently (2011-2015 range: 42.8%-43.6%). The percentage of screened women who received US+FFDM on the same day increased from 0.7% in 2005 to 3.8% in 2015. In 2015, the year in which a DBT code became available, 9.5% of screened women received FFDM+DBT and 0.4% received FFDM, DBT and US on the same day. Diagnostic mammography rates following a screening exam were 8.9% for FFDM alone, 7.3% for FFDM+DBT, and 14.0% for FFDM+US. Average screening regimen costs were $178.93 for FFDM, $242.55 for FFDM+DBT and $420.20 for FFDM+US. CONCLUSIONS:  While FFDM+US is less common than FFDM+DBT, utilization of FFDM+US is growing and average costs are higher for FFDM+US than FFDM+DBT. Diagnostic mammography is more commonly performed after FFDM+US than after FFDM+DBT or FFDM alone. Additional research should be conducted to understand factors contributing to this difference.