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Nursing Facility Evaluation for Acute Change in Condition

Montana 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?

$316

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $316 for this service. The price depends on where it is billed: about $316 from a physician practice, and about $324 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 5 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$316$182 to $331
FacilityA hospital or hospital-owned outpatient department$324$316 to $339

How much rates vary

Facilitymedian $324 · 10th to 90th $316 to $355Professionalmedian $316 · 10th to 90th $182 to $355
$100$200facility $324professional $316

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
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$181.97
Cigna
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$323.59
Typical High
$354.81
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$323.59
Typical High
$354.81
Providence
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$186.21
Typical High
$354.81
United
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$331.13
Typical High
$363.08

Where Montana 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.

Montana· 3rd of 51

$316

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.