It's only an upcharge if you have an option of doing it the old way. Our hospital got rid of all their old machines, and just had the new ones. So if you had an order for a mammogram, that's what you got. You do have to tell the techs if it's at a bad height though, because at least when I had mine done, they were still learning the nuances. One side, I was standing on tip-toes, and when she noticed, she lowered it for the other side. The machine does assume you have full range of motion to lift your arm up and out of the way, though, so that might be problematic for some people.