Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Test to assess the ability to complete specific functional tasks applicable to environment
Low
$116
Average
$311
Median
$265
High
$913
Each hospital's average Carefirst rate, under the methodology and billing class chosen below.
47 hospitals; the 90th percentile is 4.1× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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55 hospital rates
iThe hospitals that file a Carefirst rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · inpatient | 3 | $119 | $112 | $31 | 28% | — | $74 – $142 |
| 2 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · outpatient | 3 | $132 | $125 | $44 | 35% | — | $74 – $168 |
| 3 | Diley Ridge Medical Center Canal Winchester, OH facility · fee schedule · both | 1 | $129 | $129 | — | — | — | $129 – $129 |
| 4 | Greater Baltimore Medical Center Towson, MD professional · fee schedule · both | 3 | $189 | $163 | $46 | 28% | — | $107 – $205 |
| 5 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · case rate · both | 1 | $309 | $309 | — | — | — | $309 – $309 |
| 6 | Inova Alexandria Hospital Alexandria, VA other · both | 2 | $510 | $510 | $14 | 3% | — | $497 – $524 |
| 7 | Inova Fair Oaks Hospital Fairfax, VA other · both | 2 | $510 | $510 | $14 | 3% | — | $497 – $524 |
| 8 | Inova Fairfax Hospital Falls Church, VA other · both | 2 | $510 | $510 | $14 | 3% | — | $497 – $524 |
| 9 | Inova Loudoun Hospital Leesburg, VA other · both | 2 | $510 | $510 | $14 | 3% | — | $497 – $524 |
| 10 | Inova Mount Vernon Hospital Alexandria, VA other · both | 2 | $510 | $510 | $14 | 3% | — | $497 – $524 |
| 11 | MedStar Franklin Square Medical Center Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 3 | $203 | $203 | — | — | — | $203 – $203 |
| 12 | MedStar Georgetown Hospital Washington, DC facility · fee schedule · outpatient | 1 | $114 | $114 | — | — | — | $114 – $114 |
| 13 | MedStar Georgetown Hospital Washington, DC facility · percent of total billed charges · outpatientfrom % of charges | 2 | $273 | $273 | — | — | — | $273 – $273 |
| 14 | MedStar Good Samaritan Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 3 | $317 | $317 | — | — | — | $317 – $317 |
| 15 | MedStar Harbor Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 3 | $559 | $559 | — | — | — | $559 – $559 |
| 16 | MedStar St. Mary's Hospital Leonardtown, MD percent of total billed charges · outpatientfrom % of charges | 3 | $264 | $264 | — | — | — | $264 – $264 |
| 17 | MedStar Union Memorial Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 3 | $329 | $329 | — | — | — | $329 – $329 |
| 18 | MedStar Washington Hospital Center NW, WA facility · fee schedule · outpatient | 1 | $114 | $114 | — | — | — | $114 – $114 |
| 19 | MedStar Washington Hospital Center NW, WA facility · percent of total billed charges · outpatientfrom % of charges | 2 | $316 | $316 | — | — | — | $316 – $316 |
| 20 | Mercy Fitzgerald Hospital Darby, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $703 | $703 | — | — | — | $703 – $703 |
| 21 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $192 | $192 | — | — | — | $192 – $192 |
| 22 | Mishawaka Medical Center Mishawaka, IN facility · fee schedule · both | 1 | $199 | $199 | — | — | — | $199 – $199 |
| 23 | Mount Carmel East Reynoldsburg, OH facility · fee schedule · both | 1 | $129 | $129 | — | — | — | $129 – $129 |
| 24 | Mount Carmel Grove City Grove City, OH facility · fee schedule · both | 1 | $129 | $129 | — | — | — | $129 – $129 |
| 25 | Mount Carmel New Albany Surgical Hospital New Albany, OH facility · fee schedule · both | 1 | $129 | $129 | — | — | — | $129 – $129 |
← Payers reporting CPT 96125 · Snapshot 20261111T120946Z-9134e7f7