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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.

Facilitymedian $178 · 10th–90th $151$2820%20%10th90th$178Professionalmedian $162 · 10th–90th $145$2880%20%40%10th90th$162$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

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