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Nursing Facility Evaluation for Acute Change in Condition

North Carolina 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?

$195

Typical physician fee. In North Carolina, October 2026.

Insurers have agreed to pay about $195 for this service. Most negotiated rates run $191 to $282.

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

Facilitymedian $191 · 10th to 90th $191 to $191Professionalmedian $200 · 10th to 90th $158 to $372
$100$200facility $191professional $200

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
$190.55
Aetna
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$38.90
Median
$38.90
Typical High
$38.90
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$19.05
Median
$19.05
Typical High
$19.05
BCBS North Carolina
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$120.23
Typical High
$346.74
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Medcost
Setting
Facility
Modifier
None
Typical Low
$177.83
Median
$177.83
Typical High
$190.55
Medcost
Setting
Professional
Modifier
None
Typical Low
$199.53
Median
$199.53
Typical High
$199.53
United
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$281.84
Typical High
$416.87

Where North Carolina 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.

North Carolina· 34th of 51

$195

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.