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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
MD
MDDOI-MRF-CPT-93458-349
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Maryland Insurance Administration (MIA) & CMS TiC Payer MRF Index
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Baltimore County, MD
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Filing / IDR Window: 2026-11-27
[MDDOI-MRF-CPT-93458-349] Maryland UHC, Anthem & BCBS-MD Commercial MRF Rate Disparity & NSA IDR Benchmark (CPT 93458 / 93306 Cardiology Left Heart Catheterization)
Commercial payer Transparency in Coverage (TiC) Machine-Readable File (MRF) negotiated rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for CPT 93458 / 93306 Cardiology Left Heart Catheterization in Maryland (Md. Code Ins. § 15-1005 (18%–30% Prompt-Pay)).
Cohort MRF 75th-Pct Value
$2,715,000
Target % of Medicare
220.5% MPFS
Statutory Authority
MD-GPCI-2026 (Md. Code Ins. § 15-1005 (18%–30% Prompt-Pay))
ERISA / Timely-Filing Window
560 Days
1. Commercial Payer TiC MRF Allowed-Amount Benchmarks (API #02)
| CPT / DRG Code | Clinical Procedure Description | Unit | Cohort Claims | MRF 25th Pct | MRF Median (QPA) | MRF 75th Pct |
|---|---|---|---|---|---|---|
| CPT-93458 | Left Heart Catheterization with Coronary Angiography | CLAIM | 500 | $1,215.40 | $2,822.20 | $3,522.60 |
| CPT-93306 | Transthoracic Echocardiography Complete with Doppler | CLAIM | 240 | $1,762.33 | $4,092.19 | $5,107.77 |
| CPT-99214-25 | Level 4 Established Patient Outpatient E/M with Separately Identifiable Modifier 25 | CLAIM | 1,200 | $115.00 | $172.00 | $204.00 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Maryland Specialty Surgical AssociatesMaryland Ambulatory Surgery Center LLCRegional Medical Group of MarylandMaryland Physician Billing & RCM Partners