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Nursing Facility Evaluation for Acute Change in Condition

Michigan 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?

$224

Typical negotiated rate. In Michigan, October 2026.

Insurers have agreed to pay about $224 for this service. The price depends on where it is billed: about $219 from a physician practice, and about $479 from a hospital or other facility.

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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$219$195 to $240
FacilityA hospital or hospital-owned outpatient department$479$195 to $575

How much rates vary

Facilitymedian $479 · 10th to 90th $191 to $589Professionalmedian $219 · 10th to 90th $186 to $282
$200$500facility $479professional $219

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
$190.55
Median
$190.55
Typical High
$478.63
Aetna
Setting
Professional
Modifier
None
Typical Low
$169.82
Median
$190.55
Typical High
$190.55
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$85.11
Median
$95.50
Typical High
$95.50
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$34.67
Median
$38.02
Typical High
$38.90
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$25.70
Median
$28.18
Typical High
$28.84
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$17.38
Median
$19.05
Typical High
$19.05
BCBS Michigan
Setting
Facility
Modifier
None
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
BCBS Michigan
Setting
Professional
Modifier
None
Typical Low
$229.09
Median
$239.88
Typical High
$269.15
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$194.98
Median
$537.03
Typical High
$588.84
Health Alliance Plan
Setting
Professional
Modifier
None
Typical Low
$158.49
Median
$199.53
Typical High
$275.42
Health Alliance Plan
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Health Alliance Plan
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$38.90
Median
$38.90
Typical High
$38.90
Health Alliance Plan
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Health Alliance Plan
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$19.50
Median
$19.50
Typical High
$19.50
Priority Health
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
United
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$239.88
Typical High
$302.00

Where Michigan 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.

Michigan· 15th of 51

$224

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.