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Nursing Facility Evaluation for Acute Change in Condition

Maine 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?

$219

Typical physician fee. In Maine, October 2026.

Insurers have agreed to pay about $219 for this service. Most negotiated rates run $178 to $295.

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 $219 · 10th to 90th $145 to $339
$200professional $219

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
$177.83
Median
$177.83
Typical High
$177.83
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$281.84
Typical High
$371.54
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
United
Setting
Professional
Modifier
None
Typical Low
$263.03
Median
$295.12
Typical High
$371.54

Where Maine 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.

Maine· 21st of 51

$219

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.