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Understanding Ultrasound Costs in Australia: A Comprehensive Guide

An ultrasound machine is a wonderful piece of technology that allows doctors to ‘see’ inside of patients. While it is common to believe that ultrasounds are mostly used for pregnancy-related checkups for expecting parents, ultrasounds are also used for other check-ups such as abdominal, kidney, breast, pelvic and more.

Megan Fraser

Fact Checked

Updated: 16 May 2024

The cost of an ultrasound in Australia can vary based on a few factors. These factors may include the type of ultrasound, the healthcare facility, the location, and the insurance coverage a patient may have. This blog will dive into all the information you need to understand what an ultrasound is and the average costs.

Key facts

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Understanding Ultrasounds

Ultrasounds provide a good look into the interesting workings of a patient’s body, much like an X-ray would, but without the radiation. This type of procedure is referred to as ‘diagnostic imaging’.An ultrasound is a noninvasive imaging test, which means that no instruments are used that will cut or poke a patient. The ultrasound uses sound waves to create pictures or videos of a patient’s internal organs or soft tissues. This machine is fantastic because it allows doctors to perform check-ups on internal organs without having to cut, poke, prod or do anything invasive.

Ultrasounds are commonly thought to only be used on expecting parents to ‘see’ their child’s growth. While this is the most widely associated use of the ultrasound machine, it is not the only thing that this machine can do. An ultrasound machine can also be used to: 

  • Identify and diagnose the possible reasons why a patient may be having abdominal issues.
  • To detect issues in a patient’s kidneys, such as tumors, obstructions, infections, and cysts.
  • To identify issues behind breast bumps and cysts.
  • Monitoring and assessing the flow of blood through a patient’s veins to ensure that the body is functioning as it should.
  • Check for lesions or nodules in your thyroid.

As we can see, the ultrasound machine can do many wildly interesting things to ensure that a patient’s body is functioning at its absolute best. Each one of these points mentioned will often come with a different cost and a differently labelled procedure. Understanding the procedure type will give you a good grasp of what may or may not be covered by Medicare and your private health insurance provider.

Types of Ultrasounds and Their Costs

Now that we have discussed the many different uses for an ultrasound machine, let’s have a closer look at each of these procedures and talk about the costs that are usually involved. Being equipped with the right information on overall prices and potential out-of-pocket costs may provide you with the right questions to ask your insurance provider or healthcare professional before the procedure to ensure that you lower unexpected costs.

There are usually 4 pregnancy scans over 16 weeks, one every 3 – 4 weeks, one morphology scan to check the size. If expecting parents are having a single child, twins, or triplets, the cost of this procedure will vary. It is important to note that each scan will be billed separately, and the cost for each scan varies. This will be a broad overview of the costs that a patient may incur throughout the duration.

Some of the other procedures and their costs include:

The Role of Healthcare Facilities in Determining Costs

The choice of healthcare facility plays a large determining factor in the overall cost of the procedure. Private clinics will often be more expensive than public hospitals. There are benefits and drawbacks to both decisions. 

The benefit of a private facility is that the patient gets to choose their doctor. This doctor will often be there throughout the patient’s journey, making it more comfortable. The healthcare facility’s location could also be closer and more comfortable for the patient. Appointment times are often easier to make and are faster than in public hospitals. The drawbacks are that private facilities are much more costly, often have additional costs not included in certain coverage types, and can be quite expensive if the patient does not have private health insurance.

The choice between public and private is completely up to the patient. Still, the costs involved, as well as the comfortability and personal requirements of the patient, should be weighed before making a decision. Speaking with the chosen healthcare facility and the health insurance provider can help shine some light on potential costs, services, and coverage.

How it works

As mentioned before, an obstetric ultrasound uses sound waves to create images or videos of the internal ongoings of a patient’s body. This can be used to check a patient’s uterus or ovaries without the harmful effects that may come with radiation. 

To prepare for the procedure, the patient must wear a comfortable, loose-fitting, two-piece outfit. The lower abdomen is the only area that will be visible for this procedure.

You may ask,  ‘How do sound waves create images and videos?’ which is a very good question. The sound waves travel in and through the body before bouncing off surfaces or echoing. Based on these bounces and echoes, the machine can determine the size of something, its shape, consistency, and even movement.

Geographic Variations in Ultrasound Costs

As we know, the cost of services can greatly vary across different states. These variations exist due to several different factors. Funding can sometimes be a mix of commonwealth and state government funding and services funded by private health insurance. The public sector will also notice a much lower cost average than the private sector. Let’s look at the average cost for an ultrasound across a few states and the average out-of-pocket costs.

Insurance and Medicare Coverage

Medicare assists with ultrasound costs and most fees that may surround the other necessary services. Medicare will assist in covering your doctor or GP fees, ultrasounds and blood tests, obstetric fees, and public health or birth centre fees. It is important to note that Medicare does not cover the entire amount, and without private health insurance, the patient may need to pay some steep out-of-pocket fees.

Private health insurance can assist in covering the costs of the remaining amounts that Medicare cannot cover. Depending on your coverage type, this can greatly lower the overall out-of-pocket cost you may have to pay at the end of the procedure. Private health insurance also has various policies and ‘no-gap’ assistance structures that also help you in lowering the out-of-pocket costs of ultrasounds. Patients should discuss their coverage with their insurance providers to understand what is and isn’t covered. If the insurance provider or your policy does not cover certain procedures, they will not assist with the costs. 

Understanding Medicare Rebates

The Medicare Benefits Schedule (MBS) is a structure put in place by the Australian Government to help Australian residents with financial assistance for their medical services. To be eligible for Medicare, a patient must be an Australian or New Zealand citizen. If the patient is an Australian permanent resident or has applied for permanent residency, they are also eligible to apply for Medicare.

Health Insurance to cover Ultrasound Costs

By law, private health insurance cannot offer coverage for out-of-hospital medical services such as diagnostic imaging and tests. Although this may be the case, private health insurance can help you cover related costs such as ultrasounds as a private patient or necessary accommodation if you are a Gold tier policyholder.

It is crucial that patients always consult with their private health insurer about the potential costs and benefits of their policy. Consulting with your insurer before proceeding with the procedure ensures that patients are aware of the costs involved while also lowering the out-of-pocket costs as much as possible.

Managing Ultrasound Costs in Australia

There are many ways that a patient could manage ultrasound costs in Australia. Some of these solutions could include:

  • Comparing the prices of each healthcare institution.
  • Speaking with the insurer and healthcare institution to understand the costs and policies.
  • Asking as many important questions as possible such as, “What does my policy not cover?”
  • Seeking financial assistance when the costs become too high.

Ultrasounds and your private health insurance

Private health insurance can potentially help cover the cost of ultrasounds. All health funds have a 12-month waiting period for obstetric services, so if you’re admitted to the hospital before that, you’re on your own. You’ll, therefore, need to take out insurance at least three months before you get pregnant. That way, you’ll have insurance if you get pregnant during that waiting period. 

However, if you have private health insurance, your level of coverage will determine if your policy covers the ultrasound costs. Most silver or gold-tiered hospital policies cover most of the costs. It’s important to contact and ask your health insurance provider if your policy covers ultrasound procedures. 

Does Medicare cover ultrasounds?

Medicare can help cover the cost of some routine ultrasounds. The Medicare Benefits Schedule (MBS) lists all the medical services that the federal government subsidises. This includes certain ultrasound services and specifically includes obstetric and gynaecological ultrasounds. To be eligible for a rebate, patients must be referred by a GP or specialist, and an accredited sonographer must perform the ultrasound.

The rebate is means-tested, so patients who earn above a certain amount will receive a lower rebate, and those who earn below a certain amount may be eligible for a higher rebate. Medicare also covers the cost of some diagnostic ultrasounds, which are used to diagnose specific medical conditions. These include abdominal ultrasounds, breast ultrasounds and pelvis ultrasounds.

Frequently Asked Questions and Answers

The factors that contribute the most to the cost of an ultrasound are the type of ultrasound procedure, the location of the patient, the healthcare facility, the type of healthcare facility, and the availability of sufficient health insurance coverage.

Health insurance can assist in greatly lowering the cost of an ultrasound. Depending on the policy type, there coverage provided will vary. The hospital and ultrasound type will also play a large role in this. Some health insurers provide additional assistance in the form of ‘no-gap’, which lowers the out-of-pocket costs that may incur.

Medicare will assist in covering a large portion of the ultrasound procedure. Alongside this, private health insurance can also assist in further lowering the costs. Choosing a healthcare facility, such as a public hospital, can also greatly reduce overall costs.

It is important to ask the right questions. Asking about the average prices, the procedure process within the healthcare facility, and avenues for financial assistance can assist patients in choosing the right healthcare facility. There are also numerous online sources that a patient could use. Customer reviews often paint a good picture of what to expect from a facility. Comparing prices, processes, customer reviews, and locations could help patients choose the right facility.

What are the costs that are involved? Are there any hidden fees or services I may need to pay for? What does the process look like, and how do I prepare for the procedure? Are the appointment dates flexible or structured? Does the facility offer some form of financial assistance? Is the healthcare facility covered by a specific insurer or does any insurer provide benefits for using their services?

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Specialist

Megan has extensive experience writing about health and life insurance in Australia. Megan has a special interest in health and wellness. She relies on her background in counselling psychology to convey the latest findings in a manner that is most beneficial to ComparingExperts readers. In every article she writes, Megan aims to uphold the standards of the Private Health Insurance Intermediaries Association (PHIAA) which ComparingExpert is part of.

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