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Observation Care Admission, High Complexity

Nationwide rates for HCPCS 99220

The doctor's first full assessment when you are placed under observation in hospital, for someone who is seriously unwell or unstable. It covers a comprehensive history and examination and complex decision-making, often with several tests and treatments started at the same time.

Rates data updated October 2026.

How much does Observation Care Admission, High Complexity cost?

$851

Typical negotiated rate. Nationwide, October 2026.

Insurers have agreed to pay about $851 for this service. The price depends on where it is billed: about $851 from a physician practice, and about $468 from a hospital or other facility.

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 28 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$851$229 to $851
FacilityA hospital or hospital-owned outpatient department$468$347 to $603

How much rates vary

Facilitymedian $468 · 10th to 90th $251 to $1,072Professionalmedian $851 · 10th to 90th $166 to $851
$50$100$200$500$1K$2Kfacility $468professional $851

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
AllWays Health Partners
Setting
Professional
Modifier
None
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
Asuris Northwest Health
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$134.90
Typical High
$162.18
Asuris Northwest Health
Setting
Professional
Modifier
None
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
AvMed
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$147.91
Typical High
$154.88
AvMed
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$154.88
Typical High
$194.98
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$323.59
Median
$478.63
Typical High
$1,621.81
BCBS Minnesota
Setting
Facility
Modifier
None
Typical Low
$1,071.52
Median
$1,071.52
Typical High
$1,995.26
CDPHP
Setting
Professional
Modifier
None
Typical Low
$257.04
Median
$257.04
Typical High
$257.04
Cigna
Setting
Facility
Modifier
None
Typical Low
$446.68
Median
$524.81
Typical High
$1,412.54
Cigna
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$389.05
Typical High
$616.60
Emblem Health
Setting
Facility
Modifier
None
Typical Low
$95.50
Median
$144.54
Typical High
$144.54
Geisinger
Setting
Professional
Modifier
None
Typical Low
$141.25
Median
$154.88
Typical High
$309.03
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$436.52
Median
$478.63
Typical High
$524.81
Health Alliance Plan
Setting
Professional
Modifier
None
Typical Low
$177.83
Median
$208.93
Typical High
$251.19
Health Partners
Setting
Facility
Modifier
None
Typical Low
$354.81
Median
$562.34
Typical High
$1,318.26
Health Partners
Setting
Professional
Modifier
None
Typical Low
$281.84
Median
$426.58
Typical High
$588.84
Horizon BCBS
Setting
Professional
Modifier
None
Typical Low
$208.93
Median
$263.03
Typical High
$489.78
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$275.42
Median
$309.03
Typical High
$831.76
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$354.81
Typical High
$467.74
Lucent Health
Setting
Professional
Modifier
None
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
MVP Health Care
Setting
Professional
Modifier
None
Typical Low
$501.19
Median
$501.19
Typical High
$501.19
Mass General Brigham
Setting
Professional
Modifier
None
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
Medcost
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$218.78
Typical High
$316.23
Medica
Setting
Facility
Modifier
None
Typical Low
$218.78
Median
$602.56
Typical High
$602.56
Medica
Setting
Professional
Modifier
None
Typical Low
$234.42
Median
$851.14
Typical High
$851.14
Medical Mutual of Ohio
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$208.93
Typical High
$208.93
Midlands
Setting
Professional
Modifier
None
Typical Low
$371.54
Median
$371.54
Typical High
$371.54
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$30.20
Typical High
$147.91
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$251.19
Median
$251.19
Typical High
$257.04
Oscar Health
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$194.98
Typical High
$338.84
Pacific Source
Setting
Facility
Modifier
None
Typical Low
$257.04
Median
$302.00
Typical High
$354.81
Providence
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Sutter Health Plus
Setting
Professional
Modifier
None
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
United
Setting
Professional
Modifier
None
Typical Low
$131.83
Median
$181.97
Typical High
$269.15
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$208.93
Typical High
$213.80
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Emblem Health
Setting
Professional
Modifier
GL · Free upgrade
Typical Low
$128.82
Median
$128.82
Typical High
$141.25

What it costs in each state

The same service costs 28.2 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.

Touch or drag across the chart to see any state's rate.

MA $851SC $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.