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Observation Follow-Up Visit, High Complexity

Massachusetts 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?

$479

Typical negotiated rate. In Massachusetts, July 2026.

Insurers have agreed to pay about $479 for this service. The price depends on where it is billed: about $479 from a physician practice, and about $234 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 3 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$479$479 to $479
FacilityA hospital or hospital-owned outpatient department$234$200 to $234

How much rates vary

Facilitymedian $234 · 10th to 90th $200 to $1,000Professionalmedian $479 · 10th to 90th $479 to $479
$100$200$500$1Kfacility $234professional $479

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
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
United
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$1,000.00
United
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$93.33

Where Massachusetts 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.

Massachusetts· 5th of 49

$479

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.