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Nursing Facility Evaluation for Acute Change in Condition

Texas 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 $158 · 10th–90th $155$1,2020%20%40%10th90th$158Professionalmedian $158 · 10th–90th $155$1910%20%40%10th90th$158$50.0$100.0$200.0$500.0$1.0K

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
$154.88
Median
$158.49
Typical High
$162.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$158.49
Typical High
$177.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,513.56
Typical High
$1,513.56
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$162.18
Typical High
$229.09
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
Providence
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$162.18
Typical High
$229.09
Providence
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
United
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$1,258.93
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$229.09
Typical High
$309.03
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$154.88
Typical High
$208.93