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Nursing Facility Evaluation for Acute Change in Condition

South Dakota 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?

$251

Typical physician fee. In South Dakota, October 2026.

Insurers have agreed to pay about $251 for this service. Most negotiated rates run $214 to $339.

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 7 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $234 · 10th to 90th $200 to $234Professionalmedian $251 · 10th to 90th $174 to $389
$200$500facility $234professional $251

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
$199.53
Median
$199.53
Typical High
$199.53
Aetna
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$169.82
Cigna
Setting
Professional
Modifier
None
Typical Low
$199.53
Median
$199.53
Typical High
$251.19
Medica
Setting
Facility
Modifier
None
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
Medica
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$338.84
Typical High
$398.11
Midlands
Setting
Professional
Modifier
None
Typical Low
$323.59
Median
$323.59
Typical High
$323.59
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$213.80
Median
$295.12
Typical High
$354.81
United
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$363.08
Typical High
$389.05
Wellmark
Setting
Professional
Modifier
None
Typical Low
$234.42
Median
$234.42
Typical High
$234.42

Where South Dakota 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.

South Dakota· 9th of 51

$251

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.