189 - Disparities in Maternity Care Pricing Across California Hospitals: A Cross-Sectional Analysis

Publication Number: 1178.189

Chaitra Manjunath, Children's Hospital Of Orange County, ORANGE, CA, United States; Devdhar Patil, IIT Kanpur, Kanpur, Uttar Pradesh, India; Larry Ngo, Loma Linda University Childrens Hospital, Loma Linda, CA, United States; Senthil K. Nachimuthu, University of Utah School of Medicine, Salt Lake City, UT, United States; Akash Gupta, California State University - Northridge, Fontana, CA, United States

Background: The Goal of healthcare price transparency law is to empower patients with cost information before obtaining healthcare services. Under the CMS Transparency in Coverage (TiC) Rule-2021, the negotiated rates for medical services between hospitals and insurers must be made public. Studies examining the true costs of maternity care across facilities, payers, and geographic regions within California’s diverse healthcare market highlight substantial disparities in healthcare pricing based on institution type, insurance payer, and region.

Objective: Using publicly available negotiated rates data, systematically examine negotiated rates for common obstetric services across California hospitals. Describe pricing trends by payer, facility attributes, billing class, and region.

Design/Methods: A retrospective cross-sectional analysis of TiC machine-readable files was done (2023–2024) for six common maternity CPT codes (vaginal delivery: 59400, 59409, 59410; c-section delivery: 59510, 59514, 595515) throughout California. The following steps were taken to filter the raw data (n=5,005 negotiated rates) from 237 facilities and 4 commercial payers (Aetna, Cigna, Medica, and UHC): (1) eliminate rows with no direct dollar value pricing (e.g., percentage of charge values); (2) exclude billing modifiers; (3) consolidated negotiated types; (4) validate billing classes; and (5) identify outliers using Medicare rates. There were 2,916 rates in the final dataset. Descriptive statistics, coefficient of variation computations, and comparisons across several dimensions were the other analyses.

Results: The average negotiated rate was $3,451 (range: $271–$22,500, median: $2,076). The coefficient of variation for pricing was 87.3%, which indicates significant variation. Payer comparisons showed significant variations: Cigna mean $2065 vs Aetna $5413 (162% difference; p< 0.001). According to geographic analysis, Bay Area mean was $6,789, while Central Valley mean was $1,568 (4.3-fold difference; p< 0.001). Professional billing was $2,346 and institutional billing was $5,679 on average (142% difference; p< 0.001). Community hospitals spent $1,457 on average, while academic medical centers spent $8,901 (a 6.1-fold difference). On average, c-section deliveries were 30% more expensive than vaginal.

Conclusion(s): Significant variation in maternity care pricing across payers, facilities, and regions reflects underlying healthcare disparities. Higher costs in urban and academic settings suggest inequities in affordability and access, emphasizing the need for greater price transparency and policy action to promote equitable maternal care

Heat map showing the distribution of average negotiated rates across payers for various CPT codes.
IMG_5141.tiff.pdf