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Observation Follow-Up Visit, High Complexity

Wisconsin 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?

$282

Typical physician fee. In Wisconsin, July 2026.

Insurers have agreed to pay about $282 for this service. Most negotiated rates run $204 to $324.

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 $302 · 10th to 90th $234 to $479Professionalmedian $282 · 10th to 90th $79 to $479
$100$200$500facility $302professional $282

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
Cigna
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$302.00
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$281.84
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$58.88
Typical High
$70.79
Quartz
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$234.42
Typical High
$234.42
Quartz
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$478.63
Typical High
$478.63
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$87.10
Typical High
$169.82

Where Wisconsin 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.

Wisconsin· 9th of 49

$282

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.