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Nursing Facility Evaluation for Acute Change in Condition

Wisconsin 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?

$288

Typical negotiated rate. In Wisconsin, July 2026.

Insurers have agreed to pay about $288 for this service. The price depends on where it is billed: about $275 from a physician practice, and about $339 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 9 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$275$166 to $407
FacilityA hospital or hospital-owned outpatient department$339$170 to $562

How much rates vary

Facilitymedian $339 · 10th to 90th $158 to $813Professionalmedian $275 · 10th to 90th $158 to $537
$50$100$200$500$1Kfacility $339professional $275

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
$158.49
Median
$158.49
Typical High
$158.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$165.96
Typical High
$169.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$562.34
Typical High
$912.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$309.03
Typical High
$346.74
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$204.17
Typical High
$371.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$204.17
Typical High
$371.54
Medica
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$354.81
Typical High
$549.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$64.57
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$204.17
Typical High
$371.54
Quartz
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$371.54
Typical High
$512.86
Quartz
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$1,202.26
Quartz
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$1,202.26
Security Health
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Security Health
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$776.25
United
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$338.84
Typical High
$575.44

Where Wisconsin 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.

Wisconsin· 6th of 51

$288

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.