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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
MO
MODOI-MRF-CPT-93458-319
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Missouri Department of Commerce and Insurance (DCI) & CMS TiC Payer MRF Index
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St. Louis County, MO
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Filing / IDR Window: 2026-11-27
[MODOI-MRF-CPT-93458-319] Missouri UHC, Anthem & BCBS-MO 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 Missouri (RSMo § 376.383 (12% Prompt-Pay)).
Cohort MRF 75th-Pct Value
$1,605,000
Target % of Medicare
195.0% MPFS
Statutory Authority
MO-GPCI-2026 (RSMo § 376.383 (12% 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 | $1,144.60 | $2,657.80 | $3,317.40 |
| CPT-93306 | Transthoracic Echocardiography Complete with Doppler | CLAIM | 240 | $1,659.67 | $3,853.81 | $4,810.23 |
| 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)
Missouri Specialty Surgical AssociatesMissouri Ambulatory Surgery Center LLCRegional Medical Group of MissouriMissouri Physician Billing & RCM Partners