Post Delivery Care

Medicare Payment (avg)
$166.15
What Medicare actually pays
Billed Charge (avg)
$498.61
What providers submit
Markup
3.0x
200% above Medicare rate
501
Total Services
452
Beneficiaries
427
Providers
13
States with Data

Price Range Across States

Lowest State Avg
$142.21
Minnesota
Highest State Avg
$205.46
Florida

What You Might Pay

Est. Commercial Insurance
$510.74
Range: $357.51 – $715.03
Est. Cash / Self-Pay
$308.12
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Maternity/Obstetric procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Prices by State

State Medicare Payment Billed Charge
Florida $205.46 $625.25
Maryland $196.89 $401.50
California $183.30 $324.82
Texas $180.68 $468.63
South Carolina $180.54 $511.43
Illinois $172.32 $540.27
Pennsylvania $170.22 $507.86
North Carolina $168.59 $449.49
Indiana $168.19 $290.93
Ohio $165.42 $519.94
Michigan $162.61 $435.24
New York $155.05 $509.13
Minnesota $142.21 $811.47

What the Data Says About Post Delivery Care

Across 13 states with reporting providers, CPT code 59430 (Post Delivery Care) shows a national average Medicare payment of $166.15 against an average billed charge of $498.61. That gap — a 3.0x markup, or 200% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Maternity/Obstetric procedures like this one saw 501 services billed to Medicare in 2023 by 427 distinct providers, serving 452 unique beneficiaries. State-level variation is significant: Minnesota reports the lowest average payment at $142.21, while Florida reports the highest at $205.46. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Maternity/Obstetric category (2.24x), the estimated commercial insurance price lands near $510.74, with self-pay cash discounts commonly bringing the figure closer to $308.12. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Post Delivery Care cost?

The national average Medicare payment for Post Delivery Care (CPT 59430) is $166.15, while providers typically bill $498.61. Prices vary significantly by state, ranging from $142.21 to $205.46.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Post Delivery Care cost with insurance?

With commercial insurance, Post Delivery Care costs an estimated $510.74 on average (range: $357.51 – $715.03). Without insurance, the estimated cash price is $308.12. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Post Delivery Care?

Minnesota has the lowest average Medicare payment for Post Delivery Care at $142.21, while Florida has the highest at $205.46. This $63.25 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Post Delivery Care?

Nationally, 427 providers billed Medicare for Post Delivery Care in 2023, performing 501 total services for 452 beneficiaries across 13 states and territories.

What is the billed-to-Medicare markup for Post Delivery Care?

Providers bill 3.0x what Medicare pays for Post Delivery Care — a 200% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial