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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.

Facilitymedian $170 · 10th–90th $170$1700%50%100%$170Professionalmedian $174 · 10th–90th $170$2570%50%10th90th$174$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

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