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 | |
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.
These two claims show the contractual allowed amount as a percentage of the CMS 2026 National Medicare rate — making it immediately clear how this insurer’s contract compares to the federal benchmark at each visit level.
| CPT | Modifiers | Description | Billed | Contractual adj. | Allowed |
|---|---|---|---|---|---|
| 99285 | 25 | ED visit, high complexity (Level 5) | $1,600.00 | $1,035.00 | $565.00 |
| Totals | $1,600.00 | $1,035.00 | $565.00 | ||
| CPT | Modifiers | Description | Billed | Contractual adj. | Allowed |
|---|---|---|---|---|---|
| 99284 | 25 | ED visit, moderate complexity (Level 4) | $1,100.00 | $710.00 | $390.00 |
| Totals | $1,100.00 | $710.00 | $390.00 | ||
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.
These two claims — different patients, different procedures, same anesthesiologist group — show an identical conversion factor of $66.00 per unit. That is the contractual rate. Not an estimate. Not a model. The actual rate the insurer pays — confirmed across multiple EOBs and delivered to you as irrefutable evidence.
| CPT | Modifiers | Description | Base units | Time units | Total units | Allowed |
|---|---|---|---|---|---|---|
| 00630 | AAP1 | Anesthesia, lumbar spine | 10 | 14 | 24 | $1,584.00 |
| Totals | 24 | $1,584.00 | ||||
| CPT | Modifiers | Description | Base units | Time units | Total units | Allowed |
|---|---|---|---|---|---|---|
| 00402 | AAP1 | Anesthesia, reconstructive breast | 6 | 20 | 26 | $1,716.00 |
| Totals | 26 | $1,716.00 | ||||