go back

Nursing Facility Evaluation for Acute Change in Condition

Kentucky 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?

$209

Typical physician fee. In Kentucky, October 2026.

Insurers have agreed to pay about $209 for this service. Most negotiated rates run $162 to $275.

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 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $162 · 10th to 90th $162 to $219Professionalmedian $214 · 10th to 90th $158 to $759
$200$500facility $162professional $214

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
$162.18
Median
$162.18
Typical High
$199.53
Aetna
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$162.18
Typical High
$199.53
Cigna
Setting
Facility
Modifier
None
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$758.58
Typical High
$758.58
United
Setting
Professional
Modifier
None
Typical Low
$169.82
Median
$229.09
Typical High
$309.03

Where Kentucky 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.

Kentucky· 25th of 51

$209

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.