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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.

Facilitymedian $339 · 10th–90th $158$8130%20%10th90th$339Professionalmedian $275 · 10th–90th $158$5370%20%10th90th$275$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

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