go back

Nursing Facility Evaluation for Acute Change in Condition

New Jersey 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?

$178

Typical physician fee. In New Jersey, July 2026.

Insurers have agreed to pay about $178 for this service. Most negotiated rates run $151 to $191.

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.

How much rates vary

Facilitymedian $178 · 10th to 90th $178 to $178Professionalmedian $178 · 10th to 90th $145 to $224
$200facility $178professional $178

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. 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
Global
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$154.88
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$218.78
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$177.83
Typical High
$346.74

Where New Jersey 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.

New Jersey· 27th of 51

$178

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.