← Back to 52-Portal Commercial Payer MRF & NSA IDR Directory
RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
DE
DEDOI-MRF-CPT-45378-342
•
Delaware Department of Insurance (DDOI) & CMS TiC Payer MRF Index
•
New Castle County, DE
•
Filing / IDR Window: 2026-11-20
[DEDOI-MRF-CPT-45378-342] Delaware UHC, Anthem & BCBS-DE Commercial MRF Rate Disparity & NSA IDR Benchmark (CPT 45378 / 45380 GI Endoscopy & Colonoscopy ASC)
Commercial payer Transparency in Coverage (TiC) Machine-Readable File (MRF) negotiated rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for CPT 45378 / 45380 GI Endoscopy & Colonoscopy ASC in Delaware (18 Del. C. § 2304(16) (18% Prompt-Pay)).
Cohort MRF 75th-Pct Value
$1,420,000
Target % of Medicare
237.5% MPFS
Statutory Authority
DE-GPCI-2026 (18 Del. C. § 2304(16) (18% Prompt-Pay))
ERISA / Timely-Filing Window
470 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-45378 | Diagnostic Colonoscopy with Biopsy (ASC Facility + Pro) | CLAIM | 460 | $422.30 | $993.95 | $1,251.45 |
| CPT-43239 | Upper GI Endoscopy (EGD) with Biopsy | CLAIM | 190 | $612.34 | $1,441.23 | $1,814.60 |
| 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)
Delaware Specialty Surgical AssociatesDelaware Ambulatory Surgery Center LLCRegional Medical Group of DelawareDelaware Physician Billing & RCM Partners