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Nursing Facility Evaluation for Acute Change in Condition

Illinois 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?

$186

Typical physician fee. In Illinois, October 2026.

Insurers have agreed to pay about $186 for this service. Most negotiated rates run $158 to $251.

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 $158 · 10th to 90th $100 to $158Professionalmedian $186 · 10th to 90th $145 to $316
$100$200$500facility $158professional $186

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
$131.83
Median
$158.49
Typical High
$158.49
Aetna
Setting
Professional
Modifier
None
Typical Low
$131.83
Median
$158.49
Typical High
$169.82
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$66.07
Median
$79.43
Typical High
$85.11
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$26.30
Median
$31.62
Typical High
$33.88
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$19.95
Median
$23.99
Typical High
$25.70
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$13.18
Median
$15.85
Typical High
$16.98
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Hally Health
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$190.55
Typical High
$269.15
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$234.42
Typical High
$245.47
Molina
Setting
Professional
Modifier
None
Typical Low
$33.11
Median
$33.11
Typical High
$33.11
United
Setting
Professional
Modifier
None
Typical Low
$165.96
Median
$251.19
Typical High
$371.54

Where Illinois 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.

Illinois· 40th of 51

$186

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.