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
$55
Average
$270
Median
$239
High
$913
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
95 hospitals; the 90th percentile is 3.4× 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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148 hospital rates
iThe hospitals that file a Wellmark 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 | Avera Holy Family Hospital Estherville, IA case rate · outpatient | 2 | $132 | $132 | — | — | 2–20 | $132 – $132 |
| 2 | Lakes Regional Hospital Spirit Lake, IA case rate · outpatient | 2 | $95 | $95 | — | — | 2–20 | $95 – $95 |
| 3 | Monument Health Network Inc Custer, SD percent of total billed charges · outpatientfrom % of charges | 2 | $221 | $221 | $123 | 56% | 2–20 | $98 – $344 |
| 4 | Regional Health Services of Howard County Cresco, IA case rate · outpatient | 2 | $388 | $388 | — | — | 2–20 | $388 – $388 |
| 5 | Avera Sacred Heart Hospital Yankton, SD outpatient | 1 | $326 | $326 | — | — | 1–10 | $326 – $326 |
| 6 | Avera Sacred Heart Hospital Yankton, SD percent of total billed charges · outpatientfrom % of charges | 1 | $345 | $345 | — | — | 1–10 | $345 – $345 |
| 7 | Community Memorial Hospital Redfield, SD outpatient | 1 | $234 | $234 | — | — | 1–10 | $234 – $234 |
| 8 | Community Memorial Hospital Redfield, SD percent of total billed charges · outpatientfrom % of charges | 1 | $241 | $241 | — | — | 1–10 | $241 – $241 |
| 9 | Freeman Regional Health Svcs. Freeman, SD outpatient | 1 | $258 | $258 | — | — | 1–10 | $258 – $258 |
| 10 | Freeman Regional Health Svcs. Freeman, SD percent of total billed charges · outpatientfrom % of charges | 1 | $271 | $271 | — | — | 1–10 | $271 – $271 |
| 11 | ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · inpatient | 2 | $412 | $412 | $311 | 75% | — | $101 – $722 |
| 12 | ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · inpatient | 2 | $391 | $391 | $295 | 75% | — | $96 – $686 |
| 13 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $97 | $97 | — | — | — | $97 – $97 |
| 14 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 4 | $168 | $157 | $37 | 23% | — | $97 – $197 |
| 15 | Avera Creighton Hospital Creighton, NE percent of total billed charges · inpatientfrom % of charges | 1 | $459 | $459 | — | — | — | $459 – $459 |
| 16 | Avera Creighton Hospital Creighton, NE percent of total billed charges · outpatientfrom % of charges | 1 | $459 | $459 | — | — | — | $459 – $459 |
| 17 | Avera DeSmet De Smet, SD percent of total billed charges · inpatientfrom % of charges | 1 | $353 | $353 | — | — | — | $353 – $353 |
| 18 | Avera DeSmet De Smet, SD percent of total billed charges · outpatientfrom % of charges | 1 | $353 | $353 | — | — | — | $353 – $353 |
| 19 | Avera Gregory Hospital Gregory, SD percent of total billed charges · inpatientfrom % of charges | 1 | $345 | $345 | — | — | — | $345 – $345 |
| 20 | Avera Gregory Hospital Gregory, SD percent of total billed charges · outpatientfrom % of charges | 1 | $345 | $345 | — | — | — | $345 – $345 |
| 21 | Avera Hand County Hospital Miller, SD percent of total billed charges · inpatientfrom % of charges | 1 | $310 | $310 | — | — | — | $310 – $310 |
| 22 | Avera Hand County Hospital Miller, SD percent of total billed charges · outpatientfrom % of charges | 1 | $310 | $310 | — | — | — | $310 – $310 |
| 23 | Avera Holy Family Hospital Estherville, IA percent of total billed charges · inpatientfrom % of charges | 2 | $78 | $78 | — | — | — | $78 – $78 |
| 24 | Avera Merrill Pioneer Rock Rapids, IA percent of total billed charges · inpatientfrom % of charges | 2 | $88 | $88 | — | — | — | $88 – $88 |
| 25 | Avera Sacred Heart Hospital Yankton, SD percent of total billed charges · inpatientfrom % of charges | 1 | $345 | $345 | — | — | — | $345 – $345 |
← Payers reporting CPT 96125 · Snapshot 20261111T120946Z-9134e7f7