The 20-week anatomy scan, often called a Level 2 ultrasound, is a standard non-invasive procedure performed during the middle of pregnancy. Its primary purpose is to conduct a detailed assessment of the developing fetus, checking for proper growth and examining the internal anatomy. This routine prenatal appointment’s financial obligation varies significantly based on insurance coverage and the location where the procedure is performed. Understanding the potential costs and influencing factors is important for navigating the financial aspects of pregnancy.
Typical Costs of the Anatomy Scan
The overall charge for a second-trimester obstetrical ultrasound typically ranges between $200 and $1,200 for patients without insurance or a negotiated rate. While a national average is cited around $400, the total billed amount can be higher, especially in hospital settings. The actual out-of-pocket cost for insured patients is highly dependent on their specific health plan’s structure.
Patients may pay a small co-pay, often under $50, if their deductible has been met. However, in high-deductible plans, the full negotiated cost may be applied toward the deductible. This leaves the patient responsible for hundreds of dollars, with reported out-of-pocket costs ranging from $200 up to $700 or more. Patients must investigate the specific cost-sharing requirements of their policy before the appointment.
Key Variables Affecting Pricing
The location where the anatomy scan is performed is a major determinant of the overall price. Hospitals, especially large university or medical center-affiliated facilities, have higher overhead costs, which translates to substantially higher billed amounts compared to stand-alone imaging centers or private obstetrics clinics. The facility fee often accounts for the largest portion of the total cost.
Geographic location also plays a significant role in pricing variability, as ultrasound costs reflect the general cost of living and healthcare in a specific area. Prices in major metropolitan areas are usually higher than those in rural communities. Furthermore, the involvement of a specialist can increase the cost. While a standard scan is performed by a sonographer and interpreted by an obstetrician or radiologist, a high-risk pregnancy may require a Maternal-Fetal Medicine (MFM) specialist, which is billed at a higher rate.
Navigating Insurance Coverage and Self-Pay
The majority of routine prenatal care, including the anatomy scan, is considered a covered benefit under most health insurance plans in the United States. The routine second-trimester ultrasound is typically reported using CPT code 76805, which designates a complete obstetrical ultrasound for low-risk pregnancies. This code covers the required evaluation of the fetus and the maternal anatomy, distinguishing it from CPT code 76811, which is reserved for high-risk cases with a known or suspected fetal abnormality.
Even when the procedure is covered, the patient’s financial responsibility is determined by cost-sharing mechanisms like deductibles, co-pays, and co-insurance. A deductible is the fixed amount a patient must pay annually before their insurance begins to pay. If the deductible has not yet been met, the full negotiated price may be due. After the deductible is satisfied, co-insurance requires the patient to pay a percentage of the total cost, such as 20%. Uninsured or self-pay patients should directly contact the provider to inquire about a cash discount, as many facilities offer a reduced fee for upfront payment.
The Anatomy Scan Procedure and Duration
The anatomy scan is a comprehensive ultrasound examination requiring significant time and technical expertise. The procedure typically lasts between 30 and 60 minutes, though it can take longer if the baby is positioned unfavorably or if the sonographer needs to encourage movement. The extended duration is necessary to capture and measure specific structures required by the CPT code 76805, which covers a thorough survey of the fetal head, chest, abdomen, spine, and extremities.
The examination involves assessing detailed biometrics to ensure growth is on track, such as the fetal head circumference, abdominal circumference, and femur length. The sonographer also assesses the four chambers of the heart, the kidneys, the stomach, and the umbilical cord insertion site. Additionally, the placenta’s location and the volume of amniotic fluid are evaluated. The need for a highly trained sonographer and specialized equipment contributes directly to the overall cost.