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Nursing Facility Evaluation for Acute Change in Condition

Iowa 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?

$166

Typical negotiated rate. In Iowa, July 2026.

Insurers have agreed to pay about $166 for this service. The price depends on where it is billed: about $166 from a physician practice, and about $347 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 7 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$166$151 to $174
FacilityA hospital or hospital-owned outpatient department$347$166 to $347

How much rates vary

Facilitymedian $347 · 10th to 90th $155 to $933Professionalmedian $166 · 10th to 90th $151 to $229
$2$10$50$200$1Kfacility $347professional $166

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
$165.96
Median
$165.96
Typical High
$346.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$154.88
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$251.19
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$169.82
Typical High
$309.03
Medica
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$346.74
Typical High
$933.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$281.84
Typical High
$457.09
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1.23
Median
$436.52
Typical High
$436.52
United
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23
United
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$245.47
Typical High
$457.09
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80

Where Iowa 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.

Iowa· 36th of 51

$166

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.