Replacement foam-filled tire for power wheelchair drive wheel

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

Foam filled drive wheel tire

Payers reporting HCPCS E2386

Payer pricing summary

Low

Average

$134

Median

$123

High

$430

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +6 other terms	267	$128	$116	$51	44%	—	$9 – $529
2	Aetna fee schedule · outpatient · +5 other terms	259	$132	$149	$117	79%	—	$7 – $1.0k
3	UnitedHealthcare fee schedule · outpatient · +8 other terms	256	$129	$107	$56	52%	—	$6 – $198
4	WellCare fee schedule · outpatient · +2 other terms	185	$133	$136	$21	15%	—	$113 – $226
5	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	181	$139	$174	$83	48%	—	$0 – $594
6	Devoted fee schedule · outpatient · +1 other terms	165	$130	$125	$30	24%	—	$12 – $182
7	Cigna Healthspring fee schedule · outpatient	111	$137	$130	$11	8%	—	$124 – $174
8	Molina fee schedule · outpatient · +3 other terms	96	$169	$149	$83	56%	—	$11 – $422
9	Cigna fee schedule · outpatient · +3 other terms	77	$136	$130	$87	67%	—	$12 – $371
10	Superior Healthplan fee schedule · outpatient	40	$130	$131	$7	5%	—	$130 – $169
11	Anthem fee schedule · outpatient · +5 other terms	38	$130	$102	$56	55%	—	$12 – $181
12	Clover fee schedule · outpatient	34	$130	$128	$16	13%	—	$113 – $169
13	Bcbs Tx fee schedule · outpatient	31	$160	$168	$53	32%	—	$121 – $633
14	Optum fee schedule · outpatient · +2 other terms	28	$132	$111	$69	62%	—	$12 – $309
15	Kaiser fee schedule · outpatient · +2 other terms	27	$131	$101	$57	57%	—	$12 – $181
16	Oscar fee schedule · outpatient	24	$121	$129	$9	7%	—	$121 – $139
17	Medicare fee schedule · outpatient	18	$93	$94	$61	65%	—	$12 – $181
18	Amerihealth Caritas fee schedule · outpatient · +1 other terms	17	$159	$161	$10	6%	—	$151 – $193
19	Caresource fee schedule · outpatient · +3 other terms	15	$132	$132	—	—	—	$132 – $132
20	Wellmark fee schedule · both · +1 other terms	13	$77	$76	$63	82%	—	$9 – $140
21	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$139	$144	$39	27%	—	$70 – $181
22	Bcbs Nj fee schedule · outpatient	12	$113	$244	$166	68%	—	$113 – $501
23	MultiPlan facility · fee schedule · outpatient · +2 other terms	11	$47	$84	$117	139%	—	$47 – $453
24	Highmark fee schedule · outpatient · +3 other terms	10	$96	$99	$83	84%	—	$5 – $434
25	Medica fee schedule · outpatient · +4 other terms	10	$246	$235	$80	34%	—	$19 – $317

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