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Nursing Facility Evaluation for Acute Change in Condition

Indiana 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?

$200

Typical negotiated rate. In Indiana, October 2026.

Insurers have agreed to pay about $200 for this service. The price depends on where it is billed: about $195 from a physician practice, and about $479 from a hospital or other facility.

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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$195$145 to $245
FacilityA hospital or hospital-owned outpatient department$479$224 to $955

How much rates vary

Facilitymedian $479 · 10th to 90th $174 to $2,089Professionalmedian $195 · 10th to 90th $135 to $288
$50$100$200$500$1K$2Kfacility $479professional $195

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
$134.90
Median
$134.90
Typical High
$134.90
Aetna
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$134.90
Typical High
$162.18
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$67.61
Median
$67.61
Typical High
$81.28
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$26.92
Median
$26.92
Typical High
$32.36
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$20.42
Median
$20.42
Typical High
$24.55
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$13.49
Median
$13.49
Typical High
$16.22
Cigna
Setting
Facility
Modifier
None
Typical Low
$173.78
Median
$190.55
Typical High
$190.55
Cigna
Setting
Professional
Modifier
None
Typical Low
$26.30
Median
$26.30
Typical High
$144.54
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$223.87
Median
$912.01
Typical High
$2,137.96
United
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$234.42
Typical High
$309.03

Where Indiana 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.

Indiana· 32nd of 51

$200

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.