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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 July 2026.

Facilitymedian $158 · 10th–90th $158$3470%50%90th$158Professionalmedian $158 · 10th–90th $141$2450%20%40%10th90th$158$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

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