Observation Care Admission, Straightforward

Nationwide rates for HCPCS 99218

The doctor's first full assessment when you are placed under observation in hospital — kept in a bed for monitoring and testing without being formally admitted. It covers the history, examination and plan on the day observation starts, for a problem that is comparatively uncomplicated.

Rates data updated July 2026.

How much does Observation Care Admission, Straightforward cost?

$191

Typical negotiated rate. Nationwide, July 2026.

Insurers have agreed to pay about $191 for this service. The price depends on where it is billed: about $170 from a physician practice, and about $269 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 27 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed by	Who charges it	Typical	Range
Physician practiceA doctor's office, clinic or independent provider	A doctor's office, clinic or independent provider	$170	$105 to $288
FacilityA hospital or hospital-owned outpatient department	A hospital or hospital-owned outpatient department	$269	$186 to $603

How much rates vary

Facilitymedian $269 · 10th to 90th $98 to $724Professionalmedian $170 · 10th to 90th $87 to $501

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier	Facility/Professional	Modifier	Typical Low	Median	Typical High
BCBS Setting Facility Modifier Global Typical Low $131.83 Median $223.87 Typical High $977.24	Facility	Global	$131.83	$223.87	$977.24
Cigna Setting Facility Modifier Global Typical Low $245.47 Median $323.59 Typical High $912.01	Facility	Global	$245.47	$323.59	$912.01
Cigna Setting Professional Modifier Global Typical Low $169.82 Median $229.09 Typical High $389.05	Professional	Global	$169.82	$229.09	$389.05
United Setting Facility Modifier Global Typical Low $75.86 Median $223.87 Typical High $870.96	Facility	Global	$75.86	$223.87	$870.96
United Setting Professional Modifier Global Typical Low $66.07 Median $89.13 Typical High $147.91	Professional	Global	$66.07	$89.13	$147.91

What it costs in each state

The same service costs 16.6 times more in North Carolina than in South Carolina. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

NC $501SC $30.20

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.