Special medical report or insurance form completion

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

SPECIAL REPORTS OR FORMS

Payers reporting CPT 99080

Payer pricing summary

Low

Average

$103

Median

$78

High

$560

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Humana fee schedule · outpatient · +18 other terms	95	$213	$380	$1.1k	288%	—	$0 – $8.3k
2	Aetna fee schedule · outpatient · +23 other terms	56	$18	$490	$1.6k	326%	—	$0 – $8.4k
3	Blue Cross Blue Shield fee schedule · outpatient · +19 other terms	26	$74	$103	$157	152%	—	$0 – $823
4	Anthem fee schedule · both · +15 other terms	17	$10	$10	—	—	—	$10 – $10
5	UnitedHealthcare facility · case rate · outpatient · +24 other terms	17	$365	$326	$178	54%	—	$3 – $635
6	Caresource fee schedule · outpatient · +4 other terms	16	$220	$194	$70	36%	—	$2 – $220
7	Molina facility · case rate · outpatient · +14 other terms	15	$367	$402	$93	23%	—	$257 – $623
8	Cigna professional · fee schedule · both · +20 other terms	14	$18	$11	$9	77%	—	$0 – $18
9	Medcost professional · percent of total billed charges · outpatientfrom % of charges · +6 other terms	14	$107	$156	$177	113%	—	$9 – $884
10	Medical Mutual professional · percent of total billed charges · outpatientfrom % of charges · +5 other terms	13	$107	$224	$242	108%	—	$9 – $902
11	Wellmark fee schedule · both · +4 other terms	13	$29	$29	—	—	—	$29 – $29
12	Bcbs Mn fee schedule · outpatient · +5 other terms	12	$2	$1	$1	56%	—	$1 – $2
13	Medicaid fee schedule · outpatient · +3 other terms	12	$97	$101	$74	73%	—	$29 – $329
14	Optum facility · case rate · outpatient · +8 other terms	11	$346	$380	$85	22%	—	$312 – $564
15	Tricare fee schedule · outpatient · +12 other terms	11	$126	$116	$32	28%	—	$15 – $126
16	Ucare professional · percent of total billed charges · outpatientfrom % of charges · +2 other terms	10	$107	$222	$237	107%	—	$7 – $930
17	WellCare professional · fee schedule · both · +6 other terms	10	$0	$1	$5	565%	—	$0 – $30
18	Aetna Better Health professional · fee schedule · both · +6 other terms	9	$0	$2	$9	359%	—	$0 – $35
19	First Health professional · fee schedule · both · +13 other terms	9	$1	$5	$4	89%	—	$1 – $10
20	Bcbs Pa facility · percent of total billed charges · outpatientfrom % of charges	8	$24	$25	$14	56%	—	$10 – $65
21	Bcbs Il professional · fee schedule · both · +2 other terms	7	$0	$0	—	—	—	$0 – $0
22	MultiPlan fee schedule · outpatient · +12 other terms	7	$0	$22	$39	172%	—	$0 – $107
23	Ambetter fee schedule · both · +8 other terms	5	$0	$1	$4	621%	—	$0 – $27
24	Carefirst case rate · both · +1 other terms	5	$93	$93	$1	1%	—	$92 – $93
25	Healthcare Highways percent of total billed charges · outpatientfrom % of charges · +2 other terms	5	$14	$14	—	—	—	$14 – $14

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