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Observation Follow-Up Visit, High Complexity

California rates for HCPCS 99226

A follow-up visit by the doctor to a patient under observation in hospital whose condition is unstable or has worsened. It covers a detailed reassessment, a full review of new findings, and complex decisions about changing treatment or moving to a full admission.

Rates data updated July 2026.

How much does Observation Follow-Up Visit, High Complexity cost?

$234

Typical physician fee. In California, July 2026.

Insurers have agreed to pay about $234 for this service. Most negotiated rates run $112 to $479.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $234 · 10th to 90th $234 to $234Professionalmedian $269 · 10th to 90th $85 to $479
$100$200$500$1Kfacility $234professional $269

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. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Cigna
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$407.38
Typical High
$489.78
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$1,698.24
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$269.15
Typical High
$269.15
United
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$100.00
Typical High
$158.49

Where California sits

The same service costs 15.8 times more in Texas than in Idaho. 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.

California· 11th of 49

$234

TX $479ID $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.