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Observation Care Admission, Moderate Complexity

Pennsylvania 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?

$105

Typical physician fee. In Pennsylvania, July 2026.

Insurers have agreed to pay about $105 for this service. Most negotiated rates run $100 to $132.

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 $126 · 10th to 90th $126 to $126Professionalmedian $105 · 10th to 90th $100 to $174
$100$200facility $126professional $105

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
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$104.71
Typical High
$173.78
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$128.82
Typical High
$128.82
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$120.23
Typical High
$173.78

Where Pennsylvania 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.

Pennsylvania· 41st of 50

$105

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.