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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 July 2026.

Facilitymedian $200 · 10th–90th $166$2340%20%40%10th90th$200Professionalmedian $174 · 10th–90th $155$2090%50%10th90th$174$50.0$100.0$200.0$500.0

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
$165.96
Median
$199.53
Typical High
$234.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$173.78
Typical High
$208.93
AvMed
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$131.83
Typical High
$165.96
AvMed
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$165.96
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$114.82
Typical High
$151.36
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23
United
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$257.04
Typical High
$416.87
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$199.53