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Nursing Facility Evaluation for Acute Change in Condition

Colorado 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 October 2026.

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

$209

Typical negotiated rate. In Colorado, October 2026.

Insurers have agreed to pay about $209 for this service. The price depends on where it is billed: about $240 from a physician practice, and about $166 from a hospital or other facility.

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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$240$166 to $295
FacilityA hospital or hospital-owned outpatient department$166$166 to $234

How much rates vary

Facilitymedian $166 · 10th to 90th $158 to $295Professionalmedian $240 · 10th to 90th $145 to $372
$100$200$500facility $166professional $240

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
Aetna
Setting
Professional
Modifier
None
Typical Low
$165.96
Median
$165.96
Typical High
$194.98
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$83.18
Median
$83.18
Typical High
$97.72
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$33.11
Median
$33.11
Typical High
$38.90
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$24.55
Median
$24.55
Typical High
$29.51
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$16.60
Median
$16.60
Typical High
$19.50
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Denver HMP
Setting
Facility
Modifier
None
Typical Low
$165.96
Median
$177.83
Typical High
$234.42
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$204.17
Typical High
$316.23
Select Health
Setting
Facility
Modifier
None
Typical Low
$158.49
Median
$158.49
Typical High
$331.13
Select Health
Setting
Professional
Modifier
None
Typical Low
$109.65
Median
$109.65
Typical High
$158.49
United
Setting
Professional
Modifier
None
Typical Low
$245.47
Median
$295.12
Typical High
$467.74

Where Colorado sits

The same service costs 4.7 times more in Alaska than in Alabama. 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.

Colorado· 26th of 51

$209

AK $708AL $151

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.