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Nursing Facility Evaluation for Acute Change in Condition

Ohio 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?

$166

Typical physician fee. In Ohio, October 2026.

Insurers have agreed to pay about $166 for this service. Most negotiated rates run $145 to $234.

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.

How much rates vary

Facilitymedian $145 · 10th to 90th $145 to $501Professionalmedian $166 · 10th to 90th $145 to $417
$200$500facility $145professional $166

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
$144.54
Median
$144.54
Typical High
$501.19
Aetna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$524.81
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$72.44
Median
$72.44
Typical High
$263.03
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$28.84
Median
$28.84
Typical High
$104.71
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$21.88
Median
$21.88
Typical High
$79.43
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$14.45
Median
$14.45
Typical High
$52.48
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Medical Mutual of Ohio
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Molina
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$173.78
Typical High
$208.93
SummaCare
Setting
Professional
Modifier
None
Typical Low
$162.18
Median
$169.82
Typical High
$309.03
United
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$251.19
Typical High
$416.87

Where Ohio 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.

Ohio· 46th of 51

$166

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.