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Nursing Facility Evaluation for Acute Change in Condition

New York 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?

$162

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $162 for this service. The price depends on where it is billed: about $162 from a physician practice, and about $178 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 8 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$162$145 to $200
FacilityA hospital or hospital-owned outpatient department$178$155 to $209

How much rates vary

Facilitymedian $178 · 10th to 90th $151 to $282Professionalmedian $162 · 10th to 90th $145 to $288
$200$1K$5K$20Kfacility $178professional $162

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
$144.54
Median
$154.88
Typical High
$218.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$151.36
Typical High
$177.83
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$281.84
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$281.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$758.58
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$213.80
Typical High
$588.84
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$275.42
Typical High
$575.44
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$173.78
Typical High
$173.78
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$177.83
Typical High
$338.84
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$50,118.72
Median
$53,703.18
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$204.17
Typical High
$478.63
United
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$645.65
Typical High
$1,737.80
United
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$245.47
Typical High
$489.78
Univera
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$173.78
Typical High
$208.93
Univera
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$199.53
Typical High
$338.84

Where New York 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 York· 37th of 51

$162

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.