go back

Observation Care Admission, Moderate Complexity

New York 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?

$186

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $186 for this service. The price depends on where it is billed: about $174 from a physician practice, and about $186 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 4 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$174$89.13 to $186
FacilityA hospital or hospital-owned outpatient department$186$126 to $513

How much rates vary

Facilitymedian $186 · 10th to 90th $110 to $550Professionalmedian $174 · 10th to 90th $85 to $209
$100$200$500$1K$2Kfacility $186professional $174

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
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$60.26
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$363.08
Typical High
$363.08
United
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$512.86
Typical High
$2,570.40
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$128.82
Typical High
$208.93

Where New York 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.

New York· 26th of 50

$186

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.