Obstetrics & Gynecology reimbursement rates by service line
Compare national obstetrics & gynecology reimbursement benchmarks calculated from price transparency data. Reference benchmarks cover 59400, 59510 and 76801 across Aetna, Anthem, Cigna and United. Reporting periods: Jun–Jul 2026.
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Compare national obstetrics and gynecology rates by payer
Review maternity and delivery benchmarks alongside ultrasound, office, preventive, and reproductive service lines without blending unlike payment structures.
Aetna state variation for 59400
National 59400 rate distribution
Each marker shows the national median published rate across billing entities for that payer.
National 59400 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Jun–Jul 2026 | 61,943 | $2,800 | $3,269.18 | |||
| Cigna | Jun–Jul 2026 | 70,313 | $3,358.10 | $3,897.57 | |||
| United | Jun–Jul 2026 | 72,137 | $3,308.14 | $3,634.12 | |||
| Anthem | Jun–Jul 2026 | 60,022 | $3,666.29 | $4,411.89 |
- Source
- Negotiated or fee-schedule amounts published directly by payers in their machine-readable files.
- Rate shown
- Published commercial rate for routine obstetric care with vaginal delivery (59400).
- Method
- Eligible rates are grouped by payer and billing entity so the benchmarks use a consistent service and billing basis.
The state map uses one consistent Aetna reference series; it does not average already-aggregated payer values. The service-line table keeps unlike codes, settings, and billing units in separate comparisons.
Confirm coverage for your codes, payers and markets.
How do specific OB/GYN providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: OB/GYN provider rates by payer (CPT 59400)
| Provider entity | State | Size | $ per reported maternity code | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| UNIVERSITY HEALTH PHYSICIANSNPI 1003819137 · Tax ID 431009163 | MO | 786 | $1,781.04 | -$1,018.96 | Below P25 |
| FRANKLIN HEALTHCARE FOR WOMEN PLLCNPI 1639183155 · Tax ID 200752862 | TN | 2 | $2,013.05 | -$786.95 | Below P25 |
| ALLCARE IPANPI 1598843096 · Tax ID 770243333 | CA | 880 | $2,197.76 | -$602.24 | Below P25 |
| MOSAIC MEDICAL CENTER - MARYVILLENPI 1184189797 · Tax ID 832249459 | MO | 481 | $2,453.72 | -$346.28 | P25 to median |
| PHYSICIANS FOR WOMEN PLLCNPI 1578579652 · Tax ID 320097050 | MI | 6 | $2,800 | +$0 | Median to P75 |
| SUTTER COAST HOSPITALNPI 1942388830 · Tax ID 942988520 | CA | 129 | Above P75 |
Choose one state to replace the mixed-state examples with payer-specific provider rates for available preview codes.
No trial or data preparation required.Which providers have the highest claim volume in the obstetrics & gynecology market?
Provider organizations with the highest combined 2024 Medicare and Medicaid claim volume in the obstetrics & gynecology market.
- 1TXObstetrix Medical Group Of Texas Billing INCNPI 1568486264Medicare 54,768Medicaid 2,30157,069 total
- 2AZMom Doc LLCNPI 1184780355Medicare 6,181Medicaid 44,69750,878 total
- 3MULTIRegional Womens Health Group LLCNPI 1750880118Medicare 12,584Medicaid 27,27539,859 total
- 4TXNima Goharkhay PLLCNPI 1437501988Medicare 33,132Medicaid 59333,725 total
- 5MULTIUniv Of Penn Medical GroupNPI 1336537448Medicare 413Medicaid 30,24230,655 total
- 6TXMacarthur Medical Center PLLCNPI 1497982268Medicare 20,514Medicaid 5,85326,367 total
- 7MULTISeven Hills OB GYN Associates LLCNPI 1609856525Medicare 21,132Medicaid 3,32124,453 total
- 8CASan Gabriel Valley Perinatal Medical Group INCNPI 1154371623Medicare 20,087Medicaid 1,10521,192 total
- 9MDPediatrix Medical Group Of The Mid-Atlantic PCNPI 1205859691Medicare 16,961Medicaid 3,22920,190 total
- 10DEOB-GYN Associates of Dover P.ANPI 1548291891Medicare 18,286Medicaid 78919,075 total
- 11INUniversity ObstetriciansgynecologistsincNPI 1235177924Medicare 13,562Medicaid 4,20817,770 total
- 12VAJefferson Ob Gyn LtdNPI 1538197454Medicare 17,035Medicaid 817,043 total
- 13MIEdward W Sparrow HospitalNPI 1811943582Medicare 14,997Medicaid 1,81516,812 total
- 14ORWomens Health Center Of Southern Oregon PCNPI 1528175437Medicare 15,999Medicaid 42016,419 total
- 15NJCharles Haddad MDNPI 1952705410Medicare 16,286Medicaid 016,286 total
- 16NYUnion Women Care Obgyn PLLCNPI 1538816186Medicare 15,874Medicaid 23316,107 total
- 17TXAlejandro A Tey MdpaNPI 1700896826Medicare 5,306Medicaid 10,49315,799 total
- 18PATower Health Medical GroupNPI 1861733248Medicare 600Medicaid 14,84715,447 total
- 19TXHoly Cross ObgynNPI 1720581432Medicare 13,510Medicaid 1,86915,379 total
- 20CADr Jamie A Lipeles A Professional Medical CorporationNPI 1760756860Medicare 13,296Medicaid 1,22414,520 total
How reimbursement changes across OB/GYN services
Keep global maternity, delivery-only, ultrasound, office visits, screening, devices, and reproductive services in their appropriate billing context.
| Service line / billing code | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
$ per service · 4 codes | ||||
59400Routine obstetric care with vaginal delivery | $3,269.18 | $3,897.57 | $3,634.12 | $4,411.89 |
59426Antepartum care only, seven or more visits | $1,193.36 | $1,451.34 | $1,560.69 | $1,592.01 |
59510Routine obstetric care with cesarean delivery | $3,461.04 | $4,257.41 | $3,980.52 | $4,692 |
59514Cesarean delivery only | $1,399.98 | $1,624.05 | $1,586.71 | $1,915.10 |
$ per service · 6 codes | ||||
76801First-trimester obstetric ultrasound, single fetus | $167.91 | $204.74 | $196.76 | $246.79 |
76805Obstetric ultrasound at 14 weeks or later, single fetus | $192.87 | $234.22 | $225.61 | $280.95 |
76811Detailed fetal anatomy ultrasound, single fetus | $259.59 | $312.80 | $294.63 | $384.23 |
76816Follow-up obstetric ultrasound, per fetus | $153.04 | $184.79 | $180.78 | $215.12 |
76817Transvaginal obstetric ultrasound | $132.79 | $160.52 | $155.26 | $196.69 |
76819Fetal biophysical profile without non-stress testing | $123.47 | $149.26 | $142.60 | $182.58 |
$ per service · 2 codes | ||||
76830Transvaginal non-obstetric ultrasound | $165.85 | $199.54 | $195.08 | $230.87 |
76856Complete pelvic ultrasound | $150.77 | $182.48 | $177.63 | $217.93 |
$ per visit · 11 codes | ||||
99203New patient office visit, low complexity | $118.97 | $153.52 | $172.67 | $162.71 |
99204New patient office visit, moderate complexity | $185.25 | $237.21 | $262.53 | $249.01 |
99211Established patient office visit, minimal service | $21.30 | $26.25 | $35.86 | $30.49 |
99212Established patient office visit, straightforward complexity | $52.30 | $66.29 | $74.66 | $70.68 |
99213Established patient office visit, low complexity | $88.05 | $112.16 | $122.02 | $116.54 |
99214Established patient office visit, moderate complexity | $128.82 | $164.27 | $176.80 | $165.95 |
99215Established patient office visit, high complexity | $181 | $232.95 | $240.94 | $233.48 |
99385Preventive visit, new patient age 18–39 | $149.32 | $181.49 | $206.16 | $196.40 |
99386Preventive visit, new patient age 40–64 | $175.28 | $213.18 | $238.05 | $228.30 |
99395Preventive visit, established patient age 18–39 | $133.15 | $162.78 | $184.82 | $177.87 |
99396Preventive visit, established patient age 40–64 | $144.05 | $175.35 | $197.18 | $190.30 |
$ per service · 6 codes | ||||
77067Bilateral screening mammography with computer-aided detection | $181.04 | $223.37 | $213.79 | $269.85 |
81001Automated urinalysis with microscopy | $4.05 | $6.34 | $3.21 | $5.13 |
81002Non-automated urinalysis without microscopy | $4.01 | $5.83 | $3.27 | $4.63 |
81025Urine pregnancy test | $9.72 | $13.86 | $8.03 | $10.71 |
J7298Levonorgestrel intrauterine contraceptive system, 52 mg | $1,521.61 | $1,307.22 | $1,420 | $1,408.33 |
S4016Frozen in vitro fertilization cycle, case rate | $3,206.87 | $2,696.62 | $966.35 | $497.46 |
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Book a 20-min scoping call No trial or data preparation required.How to read these obstetrics & gynecology rates
Benchmarks calculated by PayerPrice from health plan price transparency files. CMS price transparency requirements.
- Published rates, not paymentsThese figures summarize negotiated rates reported by health plans. They are not claim payments, patient prices or a provider's verified contract.
- Average vs. medianThe average combines eligible billing-entity rates; the median is the middle rate. A large gap between them can signal that high or low rates are pulling the average.
- What a provider row meansA billing entity may be a clinician, practice, facility or health system. A named row does not always represent one individual provider.
- Compare like for likeMatch the code, billing component, setting, payment unit, network and reporting period. Facility, drug and other service payments may be separate.
Calculation details and specialty-specific notes
Use this methodology to understand what each published rate represents and which billing details must match before comparing OB/GYN services.
- Rate source
- Each value is a negotiated professional OB/GYN rate published in a payer machine-readable file, not a claim, charge, or facility payment.
- Rate calculation
- National figures use eligible published rate records across the country; state views use records tied to the selected state. Averages are not weighted by delivery or procedure volume or by patient mix. The calculation targets the lowest and highest 2% of entity rates for removal, rounded down to whole entities. Tied boundary values stay together, so fewer rates may be removed. A payer, code and geography cohort is published only when at least 10 billing entities remain after trimming. A missing benchmark does not mean the rate is zero.
- Provider entity
- Named examples use payer-file NPI and TIN records. An entity may represent a clinician, group practice, health system, or another billing organization. Each NPI and TIN combination contributes one representative rate: its most frequent normalized value. When multiple values are equally frequent, those values are averaged.
- Comparable rates
- Match the exact service and package scope, billing code, modifier or component, site of service, payment unit, payer product, and network. Facility, drug, and device payments may be separate. Benchmarks keep the payer, service code, geography, reporting period and billing unit separate. Different services or payment units are not blended into one rate.
Compare Obstetrics & Gynecology rates in your market
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Explore obstetrics & gynecology rates by state
Choose a state to compare payer reference averages for common services.
How to interpret OB/GYN rates
How to interpret the selected market and payer-published rates.
Are global maternity and delivery-only rates comparable?
No. Global maternity packages and delivery-only services include different work and should be benchmarked separately.
How should obstetric ultrasound rates be interpreted?
Ultrasound codes differ by gestational timing, anatomy, approach, and follow-up status. Compare the same code and professional billing context.
Are office, surgical, and maternity services pooled?
No. The page keeps these service families separate so their payment structures remain visible.
Which billing details change an OB/GYN rate comparison?
Confirm the exact code, whether maternity care is global, delivery-only, or antepartum-only, the imaging component or modifier, site of service, payer product, and network.
How are named OB/GYN providers selected?
Provider examples are sampled from different points in the selected payer's rate range. An entity may be an individual clinician, group practice, health system, or another billing organization. The national overview includes public provider samples; state provider-level comparisons require a free state preview.