go back

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 October 2026.

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

$186

Typical physician fee. In Maryland, October 2026.

Insurers have agreed to pay about $186 for this service. Most negotiated rates run $170 to $245.

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

Professionalmedian $186 · 10th to 90th $148 to $389
$200$500professional $186

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$169.82
Median
$169.82
Typical High
$173.78
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$85.11
Median
$85.11
Typical High
$87.10
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$33.88
Median
$33.88
Typical High
$35.48
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$25.70
Median
$25.70
Typical High
$26.30
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$16.98
Median
$16.98
Typical High
$17.38
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$186.21
Typical High
$338.84
United
Setting
Professional
Modifier
None
Typical Low
$165.96
Median
$234.42
Typical High
$426.58
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$245.47
Typical High
$245.47

Where Maryland 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.

Maryland· 41st of 51

$186

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.