Test to assess the ability to complete specific functional tasks applicable to environment
Medicare pricing data for 1,072 providers across 47 states
This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Test to assess the ability to complete specific functional tasks applicable to environment (HCPCS code 96125) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $95.13, but hospitals typically charge $230.82 — a 2.4x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $95.13, your out-of-pocket cost would be approximately $19.03. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 2.4x more than what Medicare allows for this procedure. Medicare actually pays $72.72 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| New Hampshire | $110 | $285 | 2 | 12 | +15.4% |
| Massachusetts | $102 | $237 | 16 | 60 | +7.7% |
| New Jersey | $102 | $183 | 54 | 811 | +7.5% |
| New York | $100 | $202 | 37 | 441 | +5.4% |
| Illinois | $100 | $263 | 22 | 64 | +5.3% |
| California | $100 | $273 | 94 | 651 | +4.7% |
| Maryland | $99 | $186 | 31 | 379 | +4.5% |
| Missouri | $98 | $219 | 20 | 173 | +3.1% |
| Virginia | $98 | $172 | 19 | 90 | +2.8% |
| Colorado | $97 | $273 | 48 | 236 | +1.9% |
| Delaware | $97 | $209 | 5 | 18 | +1.8% |
| Mississippi | $96 | $181 | 9 | 46 | +1.1% |
| Iowa | $96 | $217 | 12 | 98 | +1.1% |
| South Dakota | $96 | $216 | 6 | 85 | +1.0% |
| Arizona | $96 | $183 | 30 | 392 | +0.9% |
| Texas | $96 | $185 | 77 | 923 | +0.7% |
| West Virginia | $95 | $187 | 7 | 31 | -0.1% |
| Kansas | $95 | $212 | 13 | 114 | -0.2% |
| Montana | $95 | $293 | 10 | 69 | -0.2% |
| North Dakota | $95 | $246 | 21 | 102 | -0.2% |
| Ohio | $95 | $217 | 11 | 31 | -0.3% |
| Minnesota | $95 | $317 | 50 | 306 | -0.3% |
| Wisconsin | $95 | $703 | 19 | 272 | -0.4% |
| Nevada | $95 | $243 | 7 | 49 | -0.5% |
| Kentucky | $94 | $223 | 9 | 91 | -0.9% |
| Maine | $94 | $183 | 9 | 29 | -1.1% |
| South Carolina | $94 | $185 | 10 | 66 | -1.2% |
| Georgia | $94 | $202 | 33 | 203 | -1.2% |
| Louisiana | $94 | $224 | 14 | 25 | -1.7% |
| Nebraska | $93 | $222 | 9 | 35 | -2.0% |
| Wyoming | $93 | $200 | 7 | 78 | -2.8% |
| Oklahoma | $92 | $237 | 20 | 242 | -3.1% |
| Florida | $92 | $206 | 73 | 602 | -3.3% |
| North Carolina | $92 | $212 | 30 | 75 | -3.5% |
| Utah | $91 | $221 | 19 | 63 | -4.0% |
| Oregon | $91 | $207 | 14 | 86 | -4.1% |
| Alabama | $91 | $148 | 12 | 37 | -4.4% |
| Pennsylvania | $91 | $203 | 46 | 373 | -4.5% |
| Indiana | $91 | $196 | 18 | 36 | -4.7% |
| Tennessee | $91 | $178 | 17 | 62 | -4.8% |
| Michigan | $88 | $225 | 18 | 104 | -7.1% |
| Rhode Island | $87 | $189 | 3 | 17 | -8.1% |
| Idaho | $87 | $275 | 9 | 106 | -8.2% |
| Washington | $87 | $267 | 40 | 264 | -8.5% |
| Arkansas | $83 | $278 | 9 | 36 | -12.4% |
| Connecticut | $75 | $125 | 8 | 52 | -21.2% |
| New Mexico | $55 | $92 | 15 | 109 | -42.2% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber