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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 October 2026.

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

$251

Typical physician fee. In Iowa, October 2026.

Insurers have agreed to pay about $251 for this service. Most negotiated rates run $200 to $407.

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.

How much rates vary

Facilitymedian $437 · 10th to 90th $166 to $933Professionalmedian $234 · 10th to 90th $166 to $468
$200$500$1Kfacility $437professional $234

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
$165.96
Typical High
$165.96
Aetna
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$165.96
Typical High
$169.82
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$75.86
Median
$83.18
Typical High
$85.11
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$30.20
Median
$33.11
Typical High
$33.88
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$22.91
Median
$24.55
Typical High
$25.70
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$15.14
Median
$16.60
Typical High
$16.98
Cigna
Setting
Professional
Modifier
None
Typical Low
$199.53
Median
$234.42
Typical High
$251.19
Hally Health
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$177.83
Typical High
$309.03
Medica
Setting
Facility
Modifier
None
Typical Low
$165.96
Median
$933.25
Typical High
$933.25
Medica
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$323.59
Typical High
$524.81
Midlands
Setting
Professional
Modifier
None
Typical Low
$234.42
Median
$380.19
Typical High
$380.19
United
Setting
Professional
Modifier
None
Typical Low
$213.80
Median
$288.40
Typical High
$467.74
Wellmark
Setting
Professional
Modifier
None
Typical Low
$213.80
Median
$213.80
Typical High
$213.80

Where Iowa 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.

Iowa· 10th of 51

$251

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.