go back

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.

How much does Nursing Facility Evaluation for Acute Change in Condition cost?

$182

Typical negotiated rate. In California, July 2026.

Insurers have agreed to pay about $182 for this service. The price depends on where it is billed: about $182 from a physician practice, and about $209 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 9 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$182$158 to $209
FacilityA hospital or hospital-owned outpatient department$209$182 to $1,202

How much rates vary

Facilitymedian $209 · 10th to 90th $182 to $1,202Professionalmedian $182 · 10th to 90th $100 to $309
$100$200$500$1Kfacility $209professional $182

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
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

Where California sits

The same service costs 3.5 times more in Alaska than in Indiana. 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.

California· 24th of 51

$182

AK $468IN $135

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.