go back

Observation Follow-Up Visit, High Complexity

Pennsylvania 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?

$72.44

Typical physician fee. In Pennsylvania, July 2026.

Insurers have agreed to pay about $72.44 for this service. Most negotiated rates run $72.44 to $85.11.

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 $74 · 10th to 90th $74 to $74Professionalmedian $72 · 10th to 90th $72 to $123
$100$200facility $74professional $72

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
$72.44
Median
$72.44
Typical High
$123.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$81.28
Typical High
$81.28
United
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$87.10
Typical High
$131.83

Where Pennsylvania 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.

Pennsylvania· 47th of 49

$72.44

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.