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A few weeks back, I reviewed how much an obstetric ultrasound should cost in the first trimester. We learned this service could run between $250 – $1,200 in the hospital setting in the United States. It is a much more reasonable $150 – $325 in a clinic or imaging center setting. The take-home was that unless it was an emergency, it might make sense to steer clear of the hospital for this kind of service.
It’s always best to get the right care, at the right place, at the right time.
But what if that place is Canada?
Since the Max Out of Pocket crew is expecting in April 2021, we needed one of these ultrasounds back in September. It was September 18th, to be exact. Mrs. Max OOP happened to be studying meat cutting in Alberta at the time.
Unfortunately, I was not physically there to witness the first images of our baby.
But don’t worry, I still ran the numbers.
Although my wife is a Canadian citizen, she did not have her Canadian health insurance activated at this point. Evidently, it takes about three months and a commitment to stay in Alberta to become eligible. So, she had to pay cash. And when I say cash, I mean cold hard cash. They wouldn’t accept a credit card for payment.
Here in the United States, finance people like me would classify her as a “private pay” or “self-pay” patient.
But how much did we have to pay for this?
The CPT code that represents this first ultrasound in the States is 76801. It is an abdominal ultrasound of a uterus that has been pregnant for less than 14 weeks. The radiologist reviews the images of the fetus, pregnant uterus, and maternal pelvic structures and provides a written interpretation of the images back to the OBGYN.
In the States, there is a facility fee and a professional fee for this service.
The facility fee represents the equipment, supplies, and trained technician performing the actual ultrasound. You might also hear this called the “technical” component of the service. Unlike what you might have seen on daytime television, the obstetrician or midwife normally would not do the formal ultrasound where they take measurements. It is often farmed out to a trained sonographer.
Then there is also a professional fee. This fee is for a radiologist to write a written report of their interpretation of the image. This is sometimes called a “read” fee for “reading” the image. Again, generally, the obstetrician or midwife wouldn’t necessarily do the formal interpretation of the image.
If there are any providers reading, please chime in if your experience is different.
We would have gone to one of our local hospital here in New England for this first ultrasound. They would have charged us about $900 for the service. My $20,000 health insurance plan would negotiate that rate down to about $470 for the facility fee.
Subsequently, we would have been charged another fee for the radiologist to read the image. My insurance would get that portion of the fee to about $70.
$470 Facility Fee + $70 Professional Fee = $540
Since it was late in the year and we had not received any healthcare services in 2020, both fees would have hit our family deductible of $3,300.
In other words, $540 would have come out of our pocket.
For this same ultrasound in the clinic or imaging center setting, my insurance would allow about $170. This payment would include both the facility (technical) fee and the professional fee for interpreting the ultrasound. When you combine these, it is considered the “global” fee.
That’s almost a $370 difference between the hospital and clinic setting.
We would have needed to travel about an hour and a half both to and from the ultrasound clinic to get this price.
As much as I hate to admit this, I would not have thought to send Mrs. Max OOP to an imaging center for a routine ultrasound. If the service were high-tech imaging services like an MRI or CT, sure, I would have researched it. But I just would not have thought the pricing would vary so much from the hospital to a clinic/imaging center for a simple ultrasound.
I am a so-called expert and would have definitely been hit by the system here. The hospital’s imaging department is extremely convenient and close to the women’s health clinic we would go to. Taking an expensive walk down the hall to the hospital would have just been automatic.
Sure, it would also have taken a long and inconvenient drive to get the cheaper service. But that would certainly be worth it, considering all of this would be hitting our deductible.
Luckily, Mrs. Max OOP happened to be in Canada at the time.
Cash Price in Canada
My wife set up a temporary physician during her time in Canada. This OBGYN handled her early care while she completed the meat cutting program.
Her doctor ordered an abdominal ultrasound after her first telehealth phone visit. It was provided at the local imaging center. As I mentioned, she was not on the Canadian insurance at this point, so she had to pay cash.
Drum roll please.
The total cash price came in at $109.06 (CAD). After a little google currency conversion, that came to a rock bottom price of $82 (USD) and included both the ultrasound and the professional read. I clarified with my wife, and she confirmed Canada did away with the penny and rounded this down to $109.05.
A penny saved is a penny earned.
This saved us over $450 compared to what my insurance would “allow” at my local hospital.
$540 United States – $82 Canada = $458 in savings
Even if I had thought to go to an imaging center, we still saved $88. Here is proof if you need it.
Since this was late in the calendar year, all of the services Mrs. Max OOP needed would hit our family deductible of $3,300. That deductible would then re-set on 1/1/2021, and we would start all over. For us, it sometimes pays to price these things out. For a routine ultrasound, we would have mistakenly gone to the hospital for this service.
But we lucked out. Mrs. Max OOP was in Canada until late December, and we accidentally saved $450.
I will be the first to admit that this is somewhat anecdotal. This is just one ultrasound in one imaging center in Canada. I have no idea how the rest of the country looks. So, I am not ready to declare Canada the go-to place for ultrasounds.
That said, I am beginning to wonder how much money we saved by having the wave of antepartum services provided in Canada. This one test alone easily covered the cost of her flights and even some lodging.
But now that we are safely in 2021 and fully expect to meet our max out-of-pocket, we will likely place convenience ahead of the price for the rest of the year.
Would you go to Canada for an ultrasound?