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Nursing Facility Evaluation for Acute Change in Condition

Maryland 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?

$174

Typical physician fee. In Maryland, July 2026.

Insurers have agreed to pay about $174 for this service. Most negotiated rates run $170 to $174.

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 $170 · 10th to 90th $170 to $170Professionalmedian $174 · 10th to 90th $170 to $257
$200$500facility $170professional $174

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$173.78
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$186.21
Typical High
$338.84
United
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$245.47
Typical High
$398.11
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$186.21
Typical High
$245.47

Where Maryland 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.

Maryland· 30th of 51

$174

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.