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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 July 2026.

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

$191

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $191 for this service. The price depends on where it is billed: about $191 from a physician practice, and about $191 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 6 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$191$191 to $200
FacilityA hospital or hospital-owned outpatient department$191$191 to $295

How much rates vary

Facilitymedian $191 · 10th to 90th $191 to $295Professionalmedian $191 · 10th to 90th $158 to $295
$100$200$500$1Kfacility $191professional $191

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
$190.55
Median
$190.55
Typical High
$295.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$199.53
BCBS
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$190.55
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Medcost
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$190.55
Typical High
$263.03
United
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$257.04
Typical High
$398.11
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26

Where North Carolina 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.

North Carolina· 22nd of 51

$191

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.