Technology
01Treatment
×Shoulder surgery
02Insurance
×United Healthcare
03Practice
myHealth Urgent Care
=
04Realtime costresolved$7,277.28
insured patient
prices instantly
The problem:
the cost of medical treatment arrives weeks after the treatment is rendered
the journey to a price
- 01Patient sick
- 02Patient visits doctor
- 03Claim generated for treatment
- 04Adjudication
claim recordCLM-2026-04471825 lines
knee, right
knee, right
- 99204Office visit, new patient
- 73721MRI, lower extremity joint
- 29881Knee arthroscopy w/ meniscectomy
- J1885Ketorolac injection, 15 mg
- 01402Anesthesia, knee arthroplasty
01Claim submission
02Clearinghouse processing
03Payer system intake
04Adjudication
05Determination
06Remittance advice (ERA / EDB)
07Payment posting
08Patient billing
claim recordCLM-2026-04471825 lines
knee, right
knee, right
- 99204Office visit, new patient
- 73721MRI, lower extremity joint
- 29881Knee arthroscopy w/ meniscectomy
- J1885Ketorolac injection, 15 mg
- 01402Anesthesia, knee arthroplasty
00Claim submission
claim recordCLM-2026-04471825 lines
knee, right
knee, right
determine treatment rateABE
cross-reference with insuranceAIR
recursively self-improveART
claim
CLM-044claim
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CLM-044ABE uses all historical claims from a practice to map codes to treatments and determine a negotiated rate for each treatment
$1,371.25Endoscopy · Cigna
= 6 CPT line items
= 6 CPT line items
43239EGD with biopsy
$642.00$642.0000731Anesthesia, upper GI endoscopy
$328.50$328.5099152Moderate sedation, initial
$112.75$112.7588305Surgical pathology, level IV
$146.00$29.2088312Special stain
$94.00CoveredJ2250Midazolam injection
$48.00Covered$642.00 deductible
$328.50 deductible
$112.75 deductible
$29.20 20% coinsurance
Fully covered
Fully covered
Patient owes$1,112.45
$1,371.25
Endoscopy · Cigna= 6 CPT line items
43239EGD with biopsy$642.00$642.00DED
00731Anesthesia, upper GI endoscopy$328.50$328.50DED
99152Moderate sedation, initial$112.75$112.75DED
88305Surgical pathology, level IV$146.00$29.20CO-INS
88312Special stain$94.00CoveredCVRD
J2250Midazolam injection$48.00CoveredCVRD
Patient owes$1,112.45
AIR splits each negotiated rate into its component CPT codes, then cross-references every code with the payer to resolve the patient share
AIR outputCigna PPO
43239EGD with biopsyDED$642.00
00731Anesthesia, upper GIDED$328.50
99152Moderate sedationDED$112.75
88305Surgical pathologyCOINS$29.20
88312Special stainCVRDCovered
J2250Midazolam injectionCVRDCovered
Patient owes$1,112.45
claim
CLM-044ART reads every adjudicated claim and maps each pricing discrepancy. 8,700+ weekly appointments generate labeled training examples with unambiguous outcome signals, so the system self-corrects without human annotation or reward model drift.
Pricing infrastructure for US healthcare
Pricing infrastructure for US healthcare
determine treatment rateABE
cross-reference with insuranceAIR
recursively self-improveART
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Superscript
Book a Demodetermine treatment rateABE
cross-reference with insuranceAIR
recursively self-improveART