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Observation Follow-Up Visit, High Complexity

Washington 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?

$162

Typical negotiated rate. In Washington, July 2026.

Insurers have agreed to pay about $162 for this service. The price depends on where it is billed: about $170 from a physician practice, and about $162 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$170$97.72 to $224
FacilityA hospital or hospital-owned outpatient department$162$97.72 to $214

How much rates vary

Facilitymedian $162 · 10th to 90th $71 to $245Professionalmedian $170 · 10th to 90th $79 to $245
$100$200facility $162professional $170

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
$181.97
Median
$181.97
Typical High
$229.09
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$162.18
Typical High
$257.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$173.78
Typical High
$245.47
Molina
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$194.98
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$85.11
Typical High
$169.82

Where Washington 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.

Washington· 24th of 49

$162

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.