search again

Nationwide rates for HCPCS 99226

Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit.

Facilitymedian $234 · 10th–90th $100$6760%20%10th90th$234Professionalmedian $151 · 10th–90th $85$3630%10%10th90th$151$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $363.08 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $245.47 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $100.00 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $104.71 / $173.78