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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 October 2026.

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

$178

Typical physician fee. In New Jersey, October 2026.

Insurers have agreed to pay about $178 for this service. Most negotiated rates run $151 to $224.

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 $151 to $178Professionalmedian $178 · 10th to 90th $145 to $282
$100$200$500facility $178professional $178

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
$151.36
Median
$177.83
Typical High
$177.83
Aetna
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$177.83
Typical High
$181.97
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$75.86
Median
$89.13
Typical High
$91.20
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$30.20
Median
$35.48
Typical High
$36.31
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$22.91
Median
$26.92
Typical High
$27.54
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$15.14
Median
$17.78
Typical High
$18.20
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Horizon BCBS
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$223.87
Typical High
$309.03
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$186.21
Typical High
$380.19

Where New Jersey 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.

New Jersey· 43rd of 51

$178

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.