The Cost of an Ultrasound or Sonogram for Pregnancy

The images produced from an ultrasound, a milestone in many pregnancies, are called sonograms. They're part of routine pregnancy care, but you may pay some-out-pocket costs, even if you have insurance. Expectant mothers without insurance have to pay for all charges. Ultrasounds performed in some settings, such as a hospital, can result in both a procedure charge and a physician fee, with the patient responsible for a copay or coinsurance for each.

Ultrasounds for pregnancy

Ultrasounds use high-frequency sound waves to produce images of the body's internal structures. Pregnancy ultrasounds are done either internally or over the abdomen to see the fetus, placenta and amniotic fluid.

Ultrasounds estimate the age of the fetus and the mother's due date. They can also pick up problems like ectopic pregnancies or birth defects, as well as monitor fetal size and position as the due date approaches. Most pregnant women in the United States will get at least one or two ultrasounds before giving birth. Women who have a suspected problem or high-risk pregnancy will get many more.

How much does a pregnancy ultrasound cost?

The "sticker price" of an ultrasound can vary dramatically, depending on where you live and who's providing the service.

Healthcare Bluebook, which estimates fair prices of medical procedures in different parts of the country, suggests that a reasonable cost for a fetal ultrasound is $202, but it depends on the city or state. According to Healthcare Bluebook, a fetal ultrasound in New Jersey could cost around $350, but in Missouri, it drops to $157.

The amount you're charged can also change by provider. Large hospitals, with higher administrative costs, may charge more than a doctor's office or stand-alone clinic would. If you want to know how much your ultrasound will cost, call your provider. Make sure you stay in network to minimize costs.

If you're uninsured, you'll need to ask your medical provider up front. You could also try to negotiate the cost or set up a payment plan. The US Food and Drug Administration and several medical groups — like the American Medical Association and The American College of Obstetricians and Gynecologists — warn women against "keepsake sonograms," which may be offered by private companies.

How much does a sonogram cost?

To comply with the Affordable Care Act, health insurance companies must cover preventive care, including "many services necessary for prenatal care," with no cost sharing, according to the US Department of Health and Human Services.

That means no out-of-pocket cost to insured people beyond the monthly premium. Certain tests are mentioned in the legislation and subsequent guidance, including screening for gestational diabetes. However, there's no specific mention of radiology, which includes ultrasounds.

Most insurance companies have interpreted the Affordable Care Act's requirements on prenatal coverage with no cost sharing as excluding ultrasounds. For example, UnitedHealthcare Community Plans "considers ultrasounds not medically necessary if done solely to determine the fetal sex or to provide parents with a view and photograph of the fetus." Ultrasounds are not listed as a service for pregnant women on its website.

Doctor-prescribed ultrasounds (but not strictly elective, keepsake ones) will still be covered by your insurance, meaning they're considered medically necessary and part of acceptable care. However, depending on your plan's specifics, you may have to pay for a portion — or all — yourself.

What to expect, when you're expecting to pay some part of your sonograms

Exactly how much you'll have to chip in for your ultrasounds depends on the procedure's cost at your provider and the payment structure of your health insurance plan.

Again, if you don't have health insurance or are getting an elective sonogram (perhaps to find out the sex of your baby), you'll have to pay the entire cost out of pocket, with no help from insurance. In these cases, it's possible to negotiate directly with ultrasound providers.

If your ultrasound was prescribed by your doctor, you may have to pay for it if your deductible hasn't been met. Otherwise, you'll pay your plan's predetermined copay or coinsurance percentage. You're only home free after you've reached your plan's out-of-pocket limits for the year. After that, insurance should fully pay for all of your health care. Ultrasounds conducted at a larger hospital can also tack on a physician or radiologist fee.

Copays and coinsurance costs

Because every plan is different, it's important to check the details of your own, so you understand your coverage. If you want to minimize your costs, it's also essential to get all of your care from in-network providers, since out-of-network options usually means higher out-of-pocket costs.

And keep in mind, if your pregnancy spans two calendar years (like if you become pregnant in September and deliver the following June), you'll be subject to your deductible, copays and coinsurance for both calendar years.

To calculate your worst-case scenario (which is not uncommon if you need many tests throughout your pregnancy), multiply your out-of-pocket max by two for a ballpark estimate.

Also consider what you're paying annually in premiums, which are not included in the out-of-pocket max. It may make sense to switch to a plan with a lower cap on out-of-pocket costs, if you know you'll be getting a lot of medical care.