go back

Nursing Facility Evaluation for Acute Change in Condition

Tennessee 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?

$191

Typical physician fee. In Tennessee, October 2026.

Insurers have agreed to pay about $191 for this service. Most negotiated rates run $151 to $240.

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 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $151 · 10th to 90th $151 to $151Professionalmedian $191 · 10th to 90th $145 to $324
$200$500facility $151professional $191

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
$151.36
Median
$151.36
Typical High
$151.36
Aetna
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$158.49
Typical High
$194.98
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$75.86
Median
$79.43
Typical High
$97.72
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$30.20
Median
$31.62
Typical High
$39.81
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$22.91
Median
$23.99
Typical High
$29.51
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$15.14
Median
$15.85
Typical High
$19.50
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
United
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$257.04
Typical High
$398.11

Where Tennessee 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.

Tennessee· 36th of 51

$191

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.