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Observation Care Admission, Moderate Complexity

North Carolina 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 physician fee. In North Carolina, July 2026.

Insurers have agreed to pay about $631 for this service. Most negotiated rates run $631 to $631.

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.

How much rates vary

Facilitymedian $468 · 10th to 90th $468 to $468Professionalmedian $631 · 10th to 90th $138 to $631
$100$200$500facility $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
Medcost
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$87.10
Typical High
$281.84
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$467.74
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96

Where North Carolina 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.

North Carolina· 6th 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.