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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 October 2026.

How much does Nursing Facility Evaluation for Acute Change in Condition cost?

$269

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $269 for this service. The price depends on where it is billed: about $263 from a physician practice, and about $269 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$263$186 to $309
FacilityA hospital or hospital-owned outpatient department$269$195 to $275

How much rates vary

Facilitymedian $269 · 10th to 90th $155 to $288Professionalmedian $263 · 10th to 90th $79 to $331
$100$200facility $269professional $263

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
$181.97
Median
$181.97
Typical High
$181.97
Cigna
Setting
Facility
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Cigna
Setting
Professional
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$154.88
Median
$269.15
Typical High
$288.40
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$173.78
Typical High
$288.40
Providence
Setting
Facility
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$263.03
Typical High
$309.03
United
Setting
Professional
Modifier
None
Typical Low
$295.12
Median
$331.13
Typical High
$363.08

Where Montana 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.

Montana· 8th of 51

$269

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.