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Observation Care Admission, Moderate Complexity

Massachusetts rates for HCPCS 99219

The doctor's first full assessment when you are placed under observation in hospital for monitoring and testing. It covers a more detailed history and examination and a moderately involved plan, for a problem that is more complicated than a routine one but not immediately dangerous.

Rates data updated July 2026.

How much does Observation Care Admission, Moderate Complexity cost?

$631

Typical negotiated rate. In Massachusetts, July 2026.

Insurers have agreed to pay about $631 for this service. The price depends on where it is billed: about $631 from a physician practice, and about $468 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

Few insurers publish rates for this combination, so treat this figure as a rough guide.

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 3 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$631$631 to $631
FacilityA hospital or hospital-owned outpatient department$468$200 to $468

How much rates vary

Facilitymedian $468 · 10th to 90th $200 to $1,000Professionalmedian $631 · 10th to 90th $631 to $631
$100$200$500$1Kfacility $468professional $631

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$467.74
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$467.74
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
United
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$1,000.00
United
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$134.90
Typical High
$169.82

Where Massachusetts sits

The same service costs 20.9 times more in Massachusetts than in South Carolina. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Massachusetts· 1st of 50

$631

MA $631SC $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.