As HCCI has previously documented, the price of childbirth in the U.S. is higher than in many other countries. When prices are high, patients with health insurance pay directly through coinsurance (i.e., cost-sharing calculated as a percent of what their insurer pays for the service) and over time, as higher prices charged to insurers are passed along to individuals through higher premiums.

We examined the price of childbirth in the U.S. in 2020 nationally, by state, and in a set of local areas and found that the average price of childbirth was $13,393 in 2020. The average price of a c-section was $17,103 compared to $11,453 for a vaginal delivery.

To examine the price of childbirth, we assessed allowed amounts for deliveries in HCCI's unique commercial claims dataset, which includes claims for over one-third of the population with employer-sponsored insurance in 2020. For people with employer-sponsored health insurance, "allowed amounts," the negotiated amount paid by the insurer to the provider for the service, are the most direct measure of the "price" of a service.

The Price of a Delivery Varied by a Factor of 2.5 Across States

In Mississippi, the average price of a delivery was $7,639 in 2020, the lowest among the states we studied. The price of a delivery in California, in contrast, was $19,230, more than double the price in Mississippi and the highest among the states we studied (Table 1). Even neighboring states had meaningfully different prices. For example, in Michigan, the average price of a childbirth was $10,858 (19% below the national average) while in Wisconsin it was $14,670 (10% above the national average). Figure 1 shows how average price in each state compared to the national average.

We observed similar variation in price across states for both c-sections and vaginal deliveries. The highest average price of a c-section was in Alaska at $27,527; this price was almost three times higher than in Mississippi, the state with the lowest average c-section price ($9,377). Mississippi also had the lowest price for a vaginal delivery ($6,557) compared to a price 2.5 times higher in California ($16,668). The average price difference between a c-section and vaginal birth ranged from $2,820 in Mississippi to $11,773 in Alaska.

Childbirth in the San Francisco-Oakland Metro Area Exceeded $25,000

In addition to the range of prices among states, we found that childbirth prices varied substantially across and even within relatively small geographic areas. Across the 136 metro areas we studied, the price of a delivery ranged from a low of just over $6,000 in the Midland, Texas metro area to a high of nearly $27,000 in the San Francisco-Oakland, California metro area (Table 2).

Even within local metro areas, the price of delivery can vary dramatically, as shown in Figure 2. Comparing the lower and upper percentiles (10^th and 90^th) of delivery prices, we found that in all 136 metro areas, prices at the high end were over double prices at the low end, and in 29 of these areas, the range was over threefold. For example, in the Memphis, Tennessee metro area, the price of a delivery ranged from $4,475 to $17,113. In the San Jose, California metro area, the price of delivery ranged from $11,000 to $38,000. The average dollar difference between the high and low delivery prices within metro was approximately $12,000.

Childbirth is a common and fairly routine hospital admission, with most admissions following a clear set of standard clinical procedures and resulting in largely comparable outcomes (e.g., length of stay). As such, the widely varying prices for childbirth we observe, without accompanying improvements in quality and outcomes such as maternal mortality, unjustifiably affect patients. Efforts to improve the affordability and predictability of paying for the birth of a child depend on lowering these prices.