go back

Nursing Facility Evaluation for Acute Change in Condition

Florida 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?

$170

Typical negotiated rate. In Florida, October 2026.

Insurers have agreed to pay about $170 for this service. The price depends on where it is billed: about $170 from a physician practice, and about $138 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$170$145 to $204
FacilityA hospital or hospital-owned outpatient department$138$132 to $166

How much rates vary

Facilitymedian $138 · 10th to 90th $129 to $174Professionalmedian $170 · 10th to 90th $129 to $295
$100$200$500facility $138professional $170

Distribution of negotiated rates across all payers (price axis is log-scale). 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
$169.82
Typical High
$173.78
Aetna
Setting
Professional
Modifier
None
Typical Low
$158.49
Median
$169.82
Typical High
$199.53
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$77.62
Median
$85.11
Typical High
$100.00
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$31.62
Median
$34.67
Typical High
$39.81
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$23.44
Median
$25.70
Typical High
$30.20
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$15.85
Median
$17.38
Typical High
$19.95
AvMed
Setting
Facility
Modifier
None
Typical Low
$128.82
Median
$138.04
Typical High
$173.78
AvMed
Setting
Professional
Modifier
None
Typical Low
$128.82
Median
$158.49
Typical High
$190.55
Cigna
Setting
Facility
Modifier
None
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Florida Blue
Setting
Professional
Modifier
None
Typical Low
$112.20
Median
$114.82
Typical High
$151.36
Molina
Setting
Professional
Modifier
None
Typical Low
$147.91
Median
$199.53
Typical High
$295.12
United
Setting
Professional
Modifier
None
Typical Low
$147.91
Median
$263.03
Typical High
$363.08
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$154.88
Typical High
$199.53

Where Florida 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.

Florida· 45th of 51

$170

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.