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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 July 2026.

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

$234

Typical physician fee. In South Dakota, July 2026.

Insurers have agreed to pay about $234 for this service. Most negotiated rates run $174 to $295.

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 $195 to $372Professionalmedian $229 · 10th to 90th $138 to $355
$200$500facility $234professional $229

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. 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
Global
Typical Low
$199.53
Median
$199.53
Typical High
$199.53
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$251.19
Medica
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$234.42
Typical High
$371.54
Medica
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$257.04
Typical High
$416.87
Midlands
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$323.59
Typical High
$323.59
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$309.03
Typical High
$354.81
United
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$338.84
Typical High
$501.19
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42

Where South Dakota 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.

South Dakota· 9th of 51

$234

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.