There's no shortage of high-end services in Westchester for wealthy women who want to spend big on spa treatments, private bathing-suit fittings or valet parking at the mall. Now add to the roster of perks the luxury mammogram.

The medical screening test - recommended yearly to detect breast cancer in women 40 and over - is covered by most private insurance policies.

Mira Women's Imaging opened in Harrison last month with the expectation that affluent women in the Lower Hudson Valley will opt to pay $300 out of their own pockets for a mammogram that comes with a more personalized experience than what you'd get at a hospital or general radiology center.

Mira's amenities include spring water, gourmet coffee, soothing music, a water wall in the waiting area and roomy waffle-weave gowns more reminiscent of the spa than the doctor's office.

But the biggest benefit for women who are already nervous about the test will be getting their results on the spot during a sit-down with Mira's founder, Dr. Catherine S. Giess.

"What I am trying to do is step away from the more typical general radiology practice where they do a high volume of patients rapidly, read their studies later and send the results out in the mail. That's very difficult for many women because breast cancer is so frightening, and that's because it's so common. Everybody has had someone they know or love have breast cancer," Giess said.

Breast cancer statistics

The National Cancer Institute estimates that 182,460 women will be diagnosed with breast cancer, and 40,480 women will die of the disease, this year. One in eight women will be diagnosed with breast cancer at some time in their lives.

Giess, a Rye resident and longtime breast imaging specialist, said she started Mira to practice the kind of medicine that's not possible when you take insurance.

"That was really a necessity, frankly. In order to provide this high level of personal care for patients, we really have to be out of insurance, and the reason for that is because the mammography insurance reimbursement is often lower than the cost of providing the test," she said.

Giess said insurance reimbursement for a mammogram is usually between $60 and $150.

She said the industry estimates that a mammogram costs about $105 to perform, including the costs of complying with government regulations, buying or leasing equipment and accounting for staff and physician expenses.

"At best, people are making a very modest sum on mammography," Giess said.

Mira accepts Medicare

While she won't take private insurance, Giess said she does accept Medicare because she wants to serve older women. "They are a retired population on a fixed income, so to me that seems appropriate," she said.

Before she started Mira, Giess was co-director of breast imaging at Hudson Valley Radiology Associates in Rockland County, where on some days she would read 130 mammograms during a shift.

"They did a high volume of patients, and it wasn't always possible to spend as much time as you'd like with patients," she said. "We're obviously never going to see that volume at Mira, because we're going to see and talk to every patient."

If a patient's mammogram is suspicious, Giess will do an ultrasound of the breast immediately - and operate the machine herself.

"Then I am going to sit down with each patient. They are going to get a personal consultation," she said.

Giess said she isn't putting a time limit on her sessions. "We're not going to rush them out the door. I think for some women, if they spend 5 or 10 minutes with me and they understand their results, they are perfectly happy. For other women, who may be at high risk or debating whether they should be screened for risk status, they will spend longer," she said.

One patient's experience

Katie Berry, a social worker from Nyack, said she was shopping around for a new place to have her mammogram when she saw an advertisement for Mira in her local newspaper.

"I gave them a call and I got to speak to Dr. Giess personally, which impressed me because it's not often you get to speak to the physician. I very much liked her energy and attitude, so I decided to go across the bridge, which for me is a little bit of a hassle because of time constraints," Berry said.

Berry, 55, has been getting regular mammograms since she turned 40. In years past, she went to a women's breast care center in Englewood, N.J., and to Nyack Hospital.

She wasn't happy with her experience at Nyack Hospital, Berry said, because she didn't get personal interaction with a doctor after her test.

That unhappiness sparked Berry's desire to visit Mira, even though her insurance would have paid for a test elsewhere. "Obviously, it was a big issue for me because I do not get covered through Dr. Giess. I was covered at Nyack and I was covered at Englewood as well. But I decided that for the $300 annually, it was worth it for my peace of mind and the thoroughness of the kind of care I was getting," she said. "I'm in a position where I can do it financially."

Berry said she also views her decision to patronize Mira as a consumer choice.

"It was my personal protest to the lack of care that insurance companies provide to patients. It's not that the people at Nyack Hospital care less about their patients, but that insurance restricts the level of care they can provide," Berry said.

Poor insurance reimbursement is one of the factors contributing to a shortage of radiologists who specialize in mammography, said Dr. Stamatia Destounis, a Rochester radiologist active in the Radiology Society of North America.

About 10 percent of all radiologists, or about 2,700, are breast specialists, according to the American College of Radiology. As a result, just 30 percent of mammograms are interpreted by breast imaging specialists.

In metropolitan New York City, where waiting lists for mammograms are common, patients who want immediate access to a specialist and have the cash to spend could make Mira a viable alternative, Destounis said.

"While most people are going to say, 'I'm going to go down the street and get my screening mammogram because I don't want to pay $300,' in the high-end places where patients may be wealthier, they will maybe be looking for more specialized care. It's all about location," Destounis said.

Word-of-mouth advertising

Marianne Matthews, editor of Medical Imaging magazine, said the radiologists who read her publication are creating more specialized centers. A center that caters exclusively to women's breast health falls into that trend, and could be a smart business move, she said.

"It's a marketing fact that women are really good at word-of-mouth advertising, so the same holds true of something like breast imaging. Your own physician might tell you to go to so and so, but if your girlfriend or your sister just went to this place and they treated her right, she's more likely to go there," Matthews said.

Refusing insurance is less common and raises questions about broader access to high-quality health care, she said.

"If I'm a woman working at Wal-Mart, I'm not going to pay $300 for a mammo, and so it comes back to the same old question as far as the patient goes: Who has and who does not have access to health care in America? So, that's the flip side. That's not such a happy story. That's not to say this private practice won't find a niche. They may find a niche with more affluent women," Matthews said.

Giess said she agrees that access to mammography is a concern.

"Although it's not a perfect test, it's a good screening test and it's one of our few medical tests that's been shown to save lives," she said. "We know it decreases mortality from breast cancer. It is disappointing that it's not reimbursed at a higher rate. But you know, our country is experiencing a huge health care discussion right now in terms of the overall rising health care costs. So I don't really know what the answer is on a nationwide basis."

While Giess expects that her patients might include those who have extra cash, she also thinks it will appeal to women at higher risk from breast cancer, including those with a genetic tendency for the disease or who have dense breasts that benefit from the state-of-the-art digital mammography she is offering.

"I anticipate my practice will appeal to women who are at higher risk for breast cancer or who have a higher level of anxiety over it. But really, it's for all women who want more of a connection with their doctor," she said.

That was the case for Nancy Rieger of Harrison, who said she learned about Mira from a girlfriend who attended a talk given by Giess.