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Nursing Facility Evaluation for Acute Change in Condition

Georgia 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?

$195

Typical physician fee. In Georgia, October 2026.

Insurers have agreed to pay about $195 for this service. Most negotiated rates run $155 to $269.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $155 · 10th to 90th $155 to $166Professionalmedian $204 · 10th to 90th $155 to $363
$200$500facility $155professional $204

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
$154.88
Median
$154.88
Typical High
$165.96
Aetna
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$158.49
Typical High
$169.82
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$77.62
Median
$77.62
Typical High
$85.11
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$31.62
Median
$31.62
Typical High
$33.88
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$23.44
Median
$23.44
Typical High
$25.70
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$15.85
Median
$15.85
Typical High
$16.98
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$158.49
Median
$173.78
Typical High
$173.78
United
Setting
Professional
Modifier
None
Typical Low
$208.93
Median
$269.15
Typical High
$436.52

Where Georgia 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.

Georgia· 33rd of 51

$195

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.