Wheelchair for amputee with fixed arms and detachable footrests

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

Wheelchair amputee fixed arm

Payers reporting HCPCS E1200

Payer pricing summary

Low

Average

$406

Median

$225

High

$3.6k

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +6 other terms	247	$122	$191	$217	113%	—	$84 – $954
2	Aetna fee schedule · outpatient · +5 other terms	236	$122	$261	$768	295%	—	$39 – $8.9k
3	UnitedHealthcare fee schedule · outpatient · +8 other terms	232	$120	$224	$241	107%	—	$52 – $1.2k
4	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	178	$126	$261	$508	195%	—	$0 – $4.3k
5	WellCare fee schedule · outpatient · +1 other terms	169	$123	$127	$21	17%	—	$105 – $226
6	Devoted fee schedule · outpatient · +1 other terms	151	$124	$120	$9	8%	—	$101 – $131
7	Cigna Healthspring fee schedule · outpatient	104	$114	$121	$7	5%	—	$105 – $129
8	Molina fee schedule · outpatient · +3 other terms	89	$183	$169	$67	39%	—	$88 – $325
9	Cigna fee schedule · outpatient · +3 other terms	69	$122	$194	$398	205%	—	$101 – $3.1k
10	Superior Healthplan fee schedule · outpatient	39	$130	$130	—	—	—	$130 – $130
11	Anthem fee schedule · outpatient · +5 other terms	34	$105	$112	$18	16%	—	$101 – $202
12	Clover fee schedule · outpatient	32	$113	$116	$8	7%	—	$110 – $130
13	Bcbs Tx fee schedule · outpatient	31	$114	$117	$34	29%	—	$86 – $425
14	Kaiser fee schedule · outpatient · +3 other terms	24	$108	$105	$3	3%	—	$101 – $108
15	Optum fee schedule · outpatient · +1 other terms	24	$124	$137	$65	47%	—	$101 – $310
16	Oscar fee schedule · outpatient	24	$122	$117	$5	5%	—	$111 – $122
17	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$126	$126	$2	2%	—	$122 – $126
18	Caresource fee schedule · outpatient · +3 other terms	15	$105	$105	—	—	—	$105 – $105
19	Medicare fee schedule · outpatient	15	$101	$101	$0	0%	—	$101 – $103
20	Wellmark fee schedule · both · +1 other terms	13	$93	$120	$168	140%	—	$89 – $1.2k
21	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$969	$982	$254	26%	—	$490 – $1.2k
22	Bcbs Nj fee schedule · outpatient	12	$113	$245	$166	68%	—	$113 – $502
23	Highmark fee schedule · outpatient · +3 other terms	10	$307	$310	$362	117%	—	$57 – $1.0k
24	Medica fee schedule · outpatient · +4 other terms	10	$1.6k	$1.5k	$516	34%	—	$195 – $2.1k
25	Medical Mutual fee schedule · outpatient	9	$222	$222	—	—	—	$222 – $222

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