Replacement foam drive wheel tire for power wheelchair

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 drive wheel tire

Payers reporting HCPCS E2388

Payer pricing summary

Low

Average

$58

Median

$52

High

$200

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +6 other terms	267	$59	$51	$22	43%	—	$5 – $238
2	Aetna fee schedule · outpatient · +5 other terms	259	$60	$62	$45	72%	—	$2 – $397
3	UnitedHealthcare fee schedule · outpatient · +8 other terms	256	$60	$44	$22	50%	—	$3 – $75
4	WellCare fee schedule · outpatient · +2 other terms	185	$61	$64	$10	16%	—	$58 – $115
5	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	181	$61	$67	$28	42%	—	$0 – $199
6	Devoted fee schedule · outpatient · +1 other terms	165	$60	$56	$12	22%	—	$6 – $69
7	Cigna Healthspring fee schedule · outpatient	111	$62	$61	$2	3%	—	$60 – $66
8	Molina fee schedule · outpatient · +3 other terms	96	$74	$65	$37	57%	—	$5 – $159
9	Cigna fee schedule · outpatient · +3 other terms	77	$61	$52	$33	64%	—	$6 – $172
10	Superior Healthplan fee schedule · outpatient	40	$63	$63	$0	0%	—	$63 – $64
11	Anthem fee schedule · outpatient · +5 other terms	38	$60	$42	$22	53%	—	$6 – $63
12	Clover fee schedule · outpatient	34	$62	$61	$2	4%	—	$58 – $64
13	Bcbs Tx fee schedule · outpatient	31	$58	$60	$18	29%	—	$44 – $219
14	Optum fee schedule · outpatient · +2 other terms	28	$60	$45	$30	66%	—	$6 – $149
15	Kaiser fee schedule · outpatient · +2 other terms	27	$60	$40	$22	56%	—	$6 – $64
16	Oscar fee schedule · outpatient	24	$58	$60	$2	3%	—	$58 – $63
17	Medicare fee schedule · outpatient	18	$36	$36	$22	62%	—	$6 – $64
18	Amerihealth Caritas fee schedule · outpatient · +1 other terms	17	$71	$71	$1	2%	—	$68 – $73
19	Caresource fee schedule · outpatient · +3 other terms	15	$60	$60	—	—	—	$60 – $60
20	Wellmark fee schedule · both · +1 other terms	13	$29	$29	$24	82%	—	$4 – $53
21	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$52	$54	$14	26%	—	$26 – $64
22	Bcbs Nj fee schedule · outpatient	12	$58	$125	$85	68%	—	$58 – $256
23	MultiPlan facility · fee schedule · outpatient · +2 other terms	11	$18	$30	$38	128%	—	$18 – $152
24	Highmark fee schedule · outpatient · +3 other terms	10	$37	$38	$31	82%	—	$3 – $153
25	Medica fee schedule · outpatient · +4 other terms	10	$114	$109	$37	34%	—	$9 – $147

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