go back

Nursing Facility Evaluation for Acute Change in Condition

Idaho 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?

$219

Typical negotiated rate. In Idaho, July 2026.

Insurers have agreed to pay about $219 for this service. The price depends on where it is billed: about $219 from a physician practice, and about $148 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 8 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$219$200 to $245
FacilityA hospital or hospital-owned outpatient department$148$148 to $200

How much rates vary

Facilitymedian $148 · 10th to 90th $148 to $251Professionalmedian $219 · 10th to 90th $148 to $275
$200facility $148professional $219

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. 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
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$218.78
Typical High
$245.47
BCBS
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$208.93
Typical High
$251.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$302.00
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$245.47
Typical High
$354.81
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$275.42
Typical High
$316.23
Molina
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$275.42
Typical High
$302.00
Select Health
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$147.91
Typical High
$389.05
Select Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
United
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$251.19
Typical High
$363.08

Where Idaho 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.

Idaho· 12th of 51

$219

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.