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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
ND
NDDOI-MRF-CPT-93458-344
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North Dakota Insurance Department (NDID) & CMS TiC Payer MRF Index
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Cass County, ND
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Filing / IDR Window: 2026-11-22
[NDDOI-MRF-CPT-93458-344] North Dakota UHC, Anthem & BCBS-ND 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 North Dakota (N.D.C.C. § 26.1-36-37.2).
Cohort MRF 75th-Pct Value
$1,790,000
Target % of Medicare
254.5% MPFS
Statutory Authority
ND-GPCI-2026 (N.D.C.C. § 26.1-36-37.2)
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 | 540 | $1,286.20 | $2,986.60 | $3,727.80 |
| CPT-93306 | Transthoracic Echocardiography Complete with Doppler | CLAIM | 240 | $1,864.99 | $4,330.57 | $5,405.31 |
| 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)
North Dakota Specialty Surgical AssociatesNorth Dakota Ambulatory Surgery Center LLCRegional Medical Group of North DakotaNorth Dakota Physician Billing & RCM Partners