What to expect when you’re expecting pregnancy ultrasounds
Amino’s data shows that most pregnant women in 2016 received 3 ultrasounds, and the national median cost estimate for a pregnancy ultrasound at a hospital is $686.
If you’re expecting, you’ll likely have an ultrasound at some point during your pregnancy. (Fun fact: some people use the term “sonogram” interchangeably with ultrasound—sonograms are the images created during an ultrasound!)
Ultrasounds offer an exciting first glimpse of your baby’s face and fodder for any #ultrasound Instagram baby announcements, but they can also give you peace of mind that everything is progressing normally. The imaging is used to detect fetal heartbeat, confirm your baby’s growth milestones and anatomical health, and can also help determine if you’re in preterm labor.
At the time of writing, I’m currently in my third trimester. Throughout my pregnancy, it’s been extremely difficult for me to figure out what types of ultrasounds I’ll need, how often I’ll need them, when I should expect to get them, or how much they’ll cost. While there’s no such thing as a “universal” pregnancy experience—every woman’s body and pregnancy is unique—there is data that can help pregnant women understand what’s baseline for a typical pregnancy.
This is where Amino comes in. We looked at 308,000 pregnancies in Amino’s insurance claims database with at least one pregnancy-related ultrasound documented in 2016. From this data, we’re able to see a few trends.
Most women received 3 ultrasounds during the course of their pregnancy. (In other words, the median number of ultrasounds among the 308,000 pregnancies we looked at was 3.) These 3 ultrasounds tend to happen between weeks 8-14, weeks 20-22, and in the last few weeks leading up to delivery.
Most women pregnant with multiples (twins, triplets, or more) received 7 ultrasounds. Having multiples is considered higher risk, so doctors tend to check in on each baby’s growth and development more frequently.
Most women over 35 years old received 4 ultrasounds. Women who were over 35 and pregnant with multiples received 8 ultrasounds.
Amino’s national median cost estimate for a pregnancy ultrasound taken at a hospital is $686. Since pregnancy ultrasounds are not fully covered by the Affordable Care Act’s prenatal care benefits (more on that later), you might have to pay out-of-pocket for each ultrasound, depending on your insurance coverage.
The most expensive states for ultrasounds at hospitals: Alaska, Wisconsin, and Nebraska. The least expensive: Nevada, Arkansas, and Alabama.
Analyzing pregnancy data is tricky because a woman's estimated due date is a moving target—and not all women deliver at 40 weeks! Our team spent a lot of time thoughtfully analyzing insurance claims to come up with the numbers you see here. You can read our full methodology below.
The different types of pregnancy ultrasounds and when you might get them
To say that there are a lot of different types of pregnancy ultrasounds is an understatement. You’ve probably heard of the “dating ultrasound” (which confirms your pregnancy and gives you an estimated due date) and “anatomy scan” (an exam of your baby’s growth and health, and when you can often determine gender).
We found nearly 20 insurance claims codes that corresponded with different types of pregnancy ultrasounds! One reason we see so many codes is that each ultrasound usually has one code for single babies and one for multiples, like twins or triplets.
These are the most typical pregnancy ultrasounds that you might see on your medical bills (but keep in mind—if you have a normal pregnancy, you most likely just need a pre-14 week scan and a post-14 week scan):
Transvaginal ultrasound. An internal ultrasound that involves your doctor or technician inserting an ultrasound probe into your vaginal canal. This could be your “dating ultrasound” depending on how many weeks you’re at, since transvaginal ultrasounds are often given to women earlier in their pregnancy. In fact, our data shows that most women who received a transvaginal ultrasound in 2016 got one between weeks 7-10. There are some cases where doctors recommend a transvaginal ultrasound later in pregnancy; for example, to check on your cervix or if you’re overweight (since that might make it difficult to see the baby with an abdominal scan).
Pre-14 week scan. A standard ultrasound via a wand on your abdomen, which you’ll typically get during your first trimester. This could also be your “dating ultrasound,” if it’s the first ultrasound you’re receiving.
Nuchal translucency ultrasound. This is a measurement of the translucent space at the back of the baby’s neck that assesses the baby’s risk for Down Syndrome (Trisomy 21), Trisomy 18, and other genetic disorders. It’s recommended that you get a nuchal translucency ultrasound between weeks 11-14, and our data confirms this—most women got one between weeks 13-14.
Post-14 week scan. A standard ultrasound which you may get during your second or third trimester. Some doctors will provide an ultrasound during your check-ups, and some may not. I actually got billed for a “post-14 week scan” at my 20 week ultrasound, which was when they told me the gender of my baby!
Quick look. This is a limited version of the “post-14 week scan.” It doesn’t require a complete exam and is simply used to check out the baby’s heartbeat, position, your placental location, or amniotic fluid volume.
Detailed anatomy scan. This includes everything you’d see during the “post-14 week scan” plus provides a more complete anatomic evaluation of the baby’s brain, face, heart, organs, and limbs—as well as an evaluation of your placenta.
Follow-up scan. A re-evaluation of the baby’s size, organs, or previous abnormalities seen on prior ultrasounds.
Fetal biophysical profile. A check on amniotic fluid volume, breathing, body movements, and fine motor movements. This type of ultrasound can happen with or without non-stress test (NST)—a noninvasive test that monitors the fetal heart rate. A NST may be recommended if you have diabetes, high blood pressure, a less active baby, or a baby who’s not growing properly.
Artery doppler. There are two different types of artery dopplers—umbilical arterial doppler and middle cerebral artery doppler. Doppler assessment helps doctors check how much blood flow your baby is getting during the third trimester. You may need an artery doppler if your doctor suspects you have pre-eclampsia.
How many ultrasounds do you need during pregnancy?
Across the 308,000 pregnancies we analyzed, we found that most women got 3 ultrasounds. There are many medical reasons why you might need to get more than the typical number of ultrasounds, including:
Multiple babies. Most women pregnant with twins, triplets, or other variations of multiples received 7 ultrasounds.
Age. While I personally find the phrase “geriatric pregnancy” insulting, women over 35 years old are reported to be at higher risk of complications, according to Mayo Clinic. Amino’s data found that most pregnant women over 35 received 4 ultrasounds, and most women who were over the age of 35 and pregnant with multiples received 8 ultrasounds.
Risk for other complications. You may need more ultrasounds if you’ve had previous miscarriages or stillbirths, bleeding during pregnancy, genetic or developmental issues detected at an early ultrasound, or if you get diagnosed with gestational diabetes.
The American College of Obstetricians and Gynecologists recommends only 1-2 ultrasounds in low-risk pregnancies, but our data suggests that many pregnant women are getting nearly double that.
According to a study published in the Wall Street Journal, pregnant women are getting more ultrasounds on average than they were 10 years ago. It’s important to keep in mind that although they’re incredibly helpful for keeping a watchful eye on your baby’s development, ultrasounds might not always be medically necessary.
Where to get pregnancy ultrasounds
Where you get an ultrasound during your pregnancy really varies based on where you live, the type of prenatal care you’re receiving, and the technology your doctor or midwife has access to. Here are the different places you may receive an ultrasound:
The office of your OB/GYN, primary care doctor, or midwife: According to BabyCenter, most women have their check-ups at their doctor's office or midwifery clinic. Your doctor or midwife may have access to a portable, low-resolution ultrasound machine for in-office appointments, but they might have to refer you to a hospital or freestanding clinic that can do more advanced imaging for detailed ultrasounds, like a nuchal translucency scan.
Freestanding imaging center: A freestanding imaging center is a facility that is not affiliated with a hospital, and because of that it’s often cheaper to get imaging services like ultrasounds there. If your doctor refers you to a freestanding imaging center for your ultrasound, make sure that the facility is in-network and takes your insurance plan. Similar to hospitals, freestanding imaging centers employ technologists and radiologists. You can use Amino (below) to find an imaging center in your area that offers pregnancy ultrasounds and estimate your cost.
Hospital: If your doctor is affiliated with a nearby hospital, they might refer you to that hospital for pregnancy ultrasounds—this will likely be the same hospital you deliver at if you’re planning a hospital delivery. You may only need to visit the hospital for advanced ultrasounds, such as a nuchal translucency or detailed anatomy scan. Keep in mind that ultrasounds done at hospitals are often more expensive than ultrasounds done at freestanding imaging centers for a number of reasons: higher overhead and operating costs (you might get billed for both a physician fee and a facility fee), different billing rules, and costlier imaging equipment.
Fetal portrait studios: Don’t confuse these with freestanding imaging centers that operate for medical purposes! There’s a rise in “keepsake ultrasounds” — ultrasounds performed at imaging “studios” that capture 3D and 4D ultrasounds that are purely souvenirs and not medically necessary. You might be thinking about getting additional ultrasounds if you aren’t able to clearly see the face of your baby in previous ultrasounds, or if your doctor only performed one ultrasound and you’d like additional imaging. But “recreational ultrasounds” may be unsafe (and your insurance probably won’t cover them). While these centers often employ technicians who used to operate at medical facilities, the American Congress of Obstetricians and Gynecologists has spoken out against fetal portrait studios.
How much pregnancy ultrasounds cost, and using Amino to help you research
Since many prenatal care services—like folic acid supplements, gestational diabetes screenings, and breast pumps—are covered by the Affordable Care Act, I figured that my pregnancy ultrasounds would be covered by my insurance plan.
After my first ultrasound at 8 weeks, however, I found out I was wrong when I got a bill for "radiology performed at the office.” To make matters more confusing, the amount my doctor billed was $480; the “allowed amount” for my Blue Shield of California insurance network was $319.19; my insurance reimbursed $152.27; and—because I hadn’t met my deductible—I had to pay the remaining $166.92.
In short, there is no requirement for insurance companies to pay for your pregnancy ultrasounds—your insurance plan might cover all, some, or none of the cost. As United Healthcare explains on their site:
“Prenatal services not covered under the women’s preventive coverage include, but are not limited to, radiology services, delivery and high-risk prenatal services. While radiology services like obstetrical ultrasounds may be part of routine prenatal care, they are not included under the health reform law. A copayment, coinsurance, or deductible may apply for these services.”
Amino recently announced national cost estimates for imaging services like MRIs, X-rays, ultrasounds, and CT scans. You can also use Amino to explore regional cost estimates for pregnancy ultrasounds to see cost differences for the procedures in neighboring cities.
Because you can get a pregnancy ultrasound at a number of different facilities, and because the price varies based on the type of ultrasound you need, it’s tough to estimate exactly how much an ultrasound might cost you. If you get an ultrasound at a hospital, you’ll likely be billed for both a physician and facility fee; if you get an ultrasound at a freestanding imaging center or at your doctor’s office, it might be cheaper.
For example, the “allowed amount” for the ultrasound I got at my doctor’s office when I was 8 weeks pregnant was $319.19, and the “allowed amount” for the nuchal translucency ultrasound I received at a hospital was $885.24 (it included both a facility and physician fee). Since hospital ultrasounds are typically more expensive, we decided to focus our analysis on hospital costs.
We found that Alaska ($1,869), Wisconsin ($1,208), and Nebraska ($1,151) are the most expensive states for ultrasounds at hospitals. Nevada ($486), Arkansas ($495), and Alabama ($528) were the three least expensive states.
The cost estimate that Amino shows is the “network rate”—this is the amount that you and your insurance company together would pay a provider for the ultrasound (it generally aligns with the “allowed amount” you see on a medical bill). You might be responsible for paying that amount if you haven’t met your deductible. Even if you have met your deductible, you’ll likely have a copay (fixed amount you pay up-front at the visit) or co-insurance (percentage of the bill that you have to pay for the service).
For example, now that I’m in my third trimester and have met my deductible for the year, I still have to pay a 10% coinsurance (10% of what the provider bills insurance) every time I have an ultrasound. Your coinsurance might be more expensive, so make sure to double check your insurance.
5 tips for dealing with medical bills while pregnant
Pregnancy is a whirlwind experience, and things like medical bills might not be the first concern you have when you get pregnant. However, pregnancy might be the first major medical experience you go through, and it requires you to interact with the healthcare system frequently—from insurance, to doctors’ offices, to hospitals.
So far, despite having a low $150 deductible and a good health insurance plan, I’ve had to pay nearly $800 out of pocket for doctor’s visits, ultrasounds, blood work, and other screenings.
Here are my 5 tips for dealing with medical bills while pregnant based on my experience:
Plan ahead. If you’re planning on having a baby soon, check your insurance plan so there will be no surprises! What is your deductible? How much is your copay for office and ER visits? How much is your coinsurance for services like ultrasounds, labs and blood work, and hospital stays?
Start saving. Once you get pregnant, start setting aside the amount of your deductible in a separate bank account so that you know you won’t accumulate a lot of debt during the next 40 weeks. I’d also recommend setting aside a few hundred dollars beyond your deductible for those coinsurance payments and any emergencies that come up along the way. For more saving tips, read our article on budgeting for healthcare.
Take notes! Starting with your very first doctor’s appointment to confirm your pregnancy, take notes every time you go into a doctor’s office or hospital. Keep track of what happens during your appointment, what tests you receive, and how much you pay at the office. Bills might come weeks later, and your notes will help you double check for errors.
Track everything. Start a spreadsheet online as well as a physical folder where you keep track of each encounter with the healthcare system. What did you get billed for? How much was the allowed amount? How much is your patient responsibility? It’s helpful to refer back to these if you need to negotiate with your doctor or insurance.
For this analysis, we looked at every woman in our database between the ages of 15 and 49 that delivered a baby (vaginal or C-section) between October 1, 2016 and December 31, 2016. For each of these patients, we analyzed all insurance claims related to pregnancy ultrasounds that occurred in the 40 weeks prior to delivery, using the following Current Procedural Terminology (CPT) codes:
|Category||Current Procedural Terminology (CPT) code|
|Transvaginal ultrasound (TVU)||76817|
|Pre-14 week scan||76801, 76802|
|Post-14 week scan||76805, 76810|
|Nuchal translucency||76813, 76814|
|Detailed anatomy scan||76811, 76812|
|Fetal biophysical profile||76818, 76819|
|Artery doppler||76820, 76821|
Patients for which we did not observe any claims related to pregnancy ultrasounds in our database were excluded from our analysis, yielding a sample of 308,000 patients.
We indexed the week of delivery as “week 40” and counted backwards from that point to assign the relative timing of each pregnancy ultrasound, as a delivery is one of the clearest observable signals of a pregnancy in our claims database.
However, this approach has its limitations. Specifically, not all deliveries happen exactly 40 weeks after a woman’s last period. As a result, the timeframes for each type of ultrasound are expressed in ranges.
For the heatmap visualization “What to expect when you’re expecting ultrasounds,” bands in gray represent weeks where only 100-200 patients were observed as receiving an ultrasound, while the darkest purple bands represent 10,000+ patient observations.
To determine patients who were pregnant with multiples, we looked for CPT codes 76802, 76810, 76812, and 76814. These codes are used to signify additional gestations for pre-14 week scans, post-14 week scans, detailed anatomy scans, and nuchal translucency scans, respectively.
We observed that in many claims, multiple ultrasound codes were documented for a given patient on the same day. For example, a claim could show that a woman received a post-14 week scan, a fetal biophysical profile, and an artery doppler all on the same day. For each patient, we grouped all codes that occurred on the same day as one ultrasound “encounter” and computed the median number of “encounters” across all patients to produce our estimates for typical number of ultrasounds received during normal and high-risk pregnancies.
Data analysis and visualizations for this blog post by Sohan Murthy