go back

Nursing Facility Evaluation for Acute Change in Condition

Missouri 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?

$148

Typical negotiated rate. In Missouri, July 2026.

Insurers have agreed to pay about $148 for this service. The price depends on where it is billed: about $148 from a physician practice, and about $162 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 4 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$148$132 to $162
FacilityA hospital or hospital-owned outpatient department$162$132 to $204

How much rates vary

Facilitymedian $162 · 10th to 90th $132 to $372Professionalmedian $148 · 10th to 90th $132 to $200
$200$500$1Kfacility $162professional $148

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. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$162.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$346.74
Typical High
$933.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$239.88
Typical High
$338.84
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$316.23
Typical High
$316.23
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$229.09
Typical High
$331.13

Where Missouri 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.

Missouri· 49th of 51

$148

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.