The anatomy scan (Level II ultrasound or 20-week scan) is a standard, non-invasive procedure performed during the second trimester of pregnancy. This routine examination provides a detailed assessment of the developing fetus and is a normal part of prenatal care. The final cost is highly variable, depending on where the scan is performed and the patient’s health insurance coverage.
Defining the Anatomy Scan
The primary function of the anatomy scan is to confirm that fetal development is progressing as expected. It is a comprehensive check of the baby’s structural anatomy, including the brain, heart, spine, kidneys, and limbs. This detailed evaluation looks for potential congenital anomalies or structural issues that may require further monitoring. The procedure is typically timed between 18 and 22 weeks of gestation, when the fetus is large enough for detailed imaging. The sonographer also assesses the position of the placenta, the amount of amniotic fluid, and takes measurements to confirm the baby’s growth.
National Average Cost Range
Before any insurance adjustments, the gross charge for a routine anatomy scan in the United States shows significant disparity. Nationally, the cost for this procedure can range widely from approximately $200 to upwards of $1,200. This range represents the “sticker price” or billed charge a facility submits, which is often much higher than the amount ultimately paid. The wide variance is due to the lack of transparent, standardized pricing across different healthcare settings.
Variables That Change the Price
Several non-insurance factors directly impact the initial price of the anatomy scan.
Facility Type
The type of facility where the procedure is done is a major determinant of cost. Scans performed within a large hospital system or an outpatient hospital clinic generally carry a higher fee. This is typically more expensive than those done at a standalone, independent imaging center or a private maternal-fetal medicine (MFM) clinic. This difference often reflects the hospital’s higher operational overhead costs.
Geographic Location
Geographic location also plays a significant role in price variation. A scan performed in a major metropolitan area with a high cost of living, such as New York or San Francisco, will typically be more expensive. This contrasts with the same procedure performed in a rural or less populated region.
Scan Complexity
The complexity of the scan is a final variable. If a pregnancy is deemed high-risk, the scan may require specialized equipment or a longer time. This potentially involves a more detailed billing code than the standard CPT code 76805, increasing the total charge. For instance, CPT code 76811 is reserved for known or suspected fetal abnormalities and results in a greater billed amount than a routine screening scan.
Navigating Insurance and Out-of-Pocket Payments
For most patients, the anatomy scan is classified as a medically necessary diagnostic test and is covered by health insurance. However, the final out-of-pocket expense depends entirely on the patient’s individual plan structure. This includes their deductible, co-insurance, and co-pay amounts. Patients on high-deductible plans may be responsible for the full cost until their deductible is met.
The billed charge submitted by the provider is distinct from the negotiated rate the insurance company contracts with the facility. An in-network provider agrees to accept this lower rate. The difference between the billed charge and the negotiated rate is known as a contractual write-off. Patients should review their Explanation of Benefits (EOB) to confirm they are charged the negotiated rate, not the higher gross charge.
Patients who are uninsured or have not met a high deductible should proactively inquire about a self-pay or “cash price” before the scan. Many facilities offer a significant discount, sometimes 30% or more, if the patient agrees to pay the entire cost upfront. Asking for this discounted rate can result in a final cost substantially lower than the initial billed price.