go back

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 July 2026.

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

$158

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $158 for this service. The price depends on where it is billed: about $158 from a physician practice, and about $158 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 5 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$158$155 to $200
FacilityA hospital or hospital-owned outpatient department$158$158 to $316

How much rates vary

Facilitymedian $158 · 10th to 90th $158 to $347Professionalmedian $158 · 10th to 90th $141 to $245
$200facility $158professional $158

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
$158.49
Median
$158.49
Typical High
$346.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$158.49
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$190.55
Typical High
$288.40
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$234.42
Typical High
$245.47
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$316.23
Typical High
$575.44
United
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$269.15
Typical High
$389.05

Where Illinois 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.

Illinois· 43rd of 51

$158

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.