The EOBs below are a digital representation for illustration purposes only — created to show exactly what FlexPoint’s data reveals. In practice, FlexPoint delivers scanned copies of the actual underlying patient EOBs, procured directly from patients and stripped of all protected health information (PHI) prior to delivery.
Both claims share the same contracted base rate of $15,750.00, multiplied by the 2026 MS-DRG relative weight for each DRG. Carve-out payments for high-cost drugs (RC 636) and implants (RC 278) are paid in addition to the weighted base — and are only visible in an actual EOB.
| RC | Description | Billed | Contractual adj. | Allowed |
|---|---|---|---|---|
| DRG 251 | Perc cardiovasc proc w DES w/o MCC | $84,200.00 | $60,661.62 | $23,538.38 |
| RC 636 | High-cost drugs — IV heparin & contrast | $4,800.00 | $960.00 | $3,840.00 |
| RC 278 | Implant — drug-eluting coronary stent | $9,500.00 | $1,425.00 | $8,075.00 |
| Totals | $98,500.00 | $63,046.62 | $35,453.38 | |
| RC | Description | Billed | Contractual adj. | Allowed |
|---|---|---|---|---|
| DRG 470 | Major joint replacement w/o MCC | $68,400.00 | $38,019.82 | $30,380.18 |
| RC 636 | High-cost drugs — tranexamic acid & anticoag | $2,200.00 | $440.00 | $1,760.00 |
| RC 278 | Implant — total knee prosthesis system | $18,600.00 | $2,790.00 | $15,810.00 |
| Totals | $89,200.00 | $41,249.82 | $47,950.18 | |