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Nursing Facility Evaluation for Acute Change in Condition

California rates for HCPCS G9685

Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. This service is for a demonstration project

Rates data updated July 2026.

Facilitymedian $209 · 10th–90th $182$1,2020%20%10th90th$209Professionalmedian $182 · 10th–90th $100$3090%10%20%10th90th$182$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$208.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$181.97
Typical High
$218.78
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$190.55
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$177.83
Typical High
$309.03
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,513.56
Typical High
$1,513.56
Providence
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$263.03
Typical High
$371.54
Providence
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$162.18
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$645.65
Typical High
$645.65
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$263.03
Typical High
$724.44