Area Specialty Episode Group Description Severity Comorbidity Group TabHouston OB-Gynecology 230 Other Disorders of Female Genital System 1.00 II HOU OBG 230 1.00 IIHouston OB-Gynecology 203 Delivery, Vaginal 1.00 II HOU OBG 203 1.00 IIHouston OB-Gynecology 230 Other Disorders of Female Genital System 1.00 I HOU OBG 230 1.00 IHouston OB-Gynecology 202 Delivery, Cesarean Section 1.02 I HOU OBG 202 1.02 IHouston OB-Gynecology 203 Delivery, Vaginal 1.00 I HOU OBG 203 1.00 I

BlueCross BlueShield of TexasBlueChoice® Solutions Network

Solutions ID UPUE25423 Report Date 10/27/2006Specialty OB-GynecologyMEG # 230MEG DescriptionArea HoustonComorbidity Group II Severity 1.00

Allowed Expected228.43$ 199.00$

SolutionsID / Specialty Comparison

10 3,608

SolutionsID / Specialty Comparison

- 0.08 - 0.17 - 2.00 -$ 4.17$

Allowed Amount per Admit -$ 5,212.50$

SolutionsID / Specialty Comparison

123.26$ 174.06$ 105.17$ 32.10$ 20.00 5.49

100.88$ 160.96$ 140.00 146.54

-$ 1.07$ - 0.30

13.71$ 39.98$ 40.00 173.45

127.55$ 35.82$ 80.00 27.72

Allow Amt Per Epis Ambulatory Care includes all ambulatory facility and ambulatory professional services. Allow Amt Per Epis Ambulatory Professional includes all professional services for all ambulatory locationsAllow Amt Per Epis Ambulatory Facility is limited to allowed amounts for ambulatory facility services only; no office based services.Allow Amt Per Epis Ambulatory Office is limited to services provided in an office setting (place of service = 11).Allow Amt Per 100 Epis Ambulatory ER includes both ER services that resulted in an admission and those that did not.

Amt per Epis

Episode Count

INPATIENT

Admits Per 100 Epis

Allow Amt Per Epis Ambulatory Facility

Allow Amt Per Epis Ambulatory Office

Days Per 100 Epis AdmitAvg Length of StayAllow Amt Per Epis Admit

AMBULATORY SERVICES

Visits Per 100 Epis Amb Fac

Other Disorders of Female Genital System

Svcs Per 100 Epis Ambulatory LabAllow Amt Per Epis Ambulatory RadSvcs Per 100 Epis Ambulatory Rad

Visits Per 100 Epis Ambulatory Office Allow Amt Per Epis Ambulatory ERVisits Per 100 Epis Ambulatory ERAllow Amt Per Epis Ambulatory Lab

Allow Amt Per Epis Ambulatory Professional

Page 2 of 23

BlueCross BlueShield of TexasBlueChoice® Solutions Network

CPT / HCPCS Code Description % of Episodes

Comparison % of

EpisodesRelative Cost

36415 COLLECTION VENOUS BLD VENIPUNCTURE 10.00% 14.05% $57500 BX SINGLE/MX/LOC EXC LES W/WO FULG 10.00% 1.80% $$58100 ENDOMET BX W/WO ENDOCRV BX-SEP PROC 20.00% 3.74% $$76075 DXA BN DNSITY 1/> SITE; AXIAL SKEL 0.00% 2.63% $$$$76830 ULTRASOUND TRANSVAGINAL 20.00% 10.06% $$$76856 US PELVIC B-SCAN W/IMAG DOC; CMPL 20.00% 5.88% $$$80061 LIPID PANEL 0.00% 3.27% $$$$81000 UA DIPSTIK/TABLET; NON-AUTO W/MICRO 0.00% 3.66% $81002 UA DIP STIK/TABLT;WO MICRO NON-AUTO 0.00% 6.82% $81025 URIN PG TST VISUAL COLR COMPAR METH 0.00% 4.41% $$82270 BLD OCCLT PEROX ACTV; QUAL FECES 10.00% 1.47% $82670 ESTRADIOL 0.00% 5.27% $$$$$83001 GONADOTROPIN; FOLLICLE STIM HORMONE 0.00% 8.51% $$$$83002 GONADOTROPIN; LUTEINIZING HORMONE 0.00% 4.05% $$$$84146 PROLACTIN 0.00% 2.44% $$$$84403 TESTOSTERONE; TOTAL 0.00% 3.58% $$$$$84436 THYROXINE; TOTAL 0.00% 2.08% $$$84443 THYROID STIMULATING HORMONE 0.00% 7.68% $$$$85025 BLD CNT;CMPL AUTO&AUTO DIFF WBC CNT 0.00% 5.82% $$$87070 CULT BACT;NO URINE/BLD/STOOL AEROBC 0.00% 2.16% $$$87480 INF AGT-DNA/RNA;CANDIDA SPECIES-DIR 0.00% 2.74% $$$$87491 INF AGT-DNA/RNA; CHLAMYD TRACH-AMP 0.00% 2.66% $$$$$87510 INF AGT-DNA/RNA; GARDNRELLA VAG-DIR 0.00% 2.99% $$$$87591 INF AGT-DNA/RNA; NEISSR GNRRHEA-AMP 0.00% 2.66% $$$$$87797 INF AGT-DNA/RNA NOS; DIR PROBE EA 0.00% 2.25% $$$$88142 CYTPTH CERV/VAG; THIN PREP; MNL SCR 0.00% 5.57% $$$$88164 CYTOPATH CERV/VAG BETHSEDA;MNL PHYS 0.00% 2.38% $$$88305 LEVEL IV - SURG PATH GROSS&MIC EXAM 20.00% 6.40% $$$$$99202 OFC/OUTPT E&M NEW LOW-MOD 20 MIN 10.00% 1.77% $$99203 OFC/OUTPT E&M NEW MOD-SEVER 30 MIN 0.00% 4.10% $$$99205 OFC/OUTPT E&M NEW MOD-HI 60 MIN 0.00% 3.27% $$$$$99212 OFC/OUTPT E&M ESTAB MINOR 10 MIN 20.00% 12.33% $99213 OFC/OUTPT E&M ESTAB LOW-MOD 15 MIN 50.00% 34.56% $99214 OFC/OUTPT E&M ESTAB MOD-HI 25 MIN 0.00% 23.70% $$$99215 OFC/OUTPT E&M ESTAB MOD-HI 40 MIN 0.00% 6.76% $$$$

Page 3 of 23

This chart contains up to TOP 14 CPT codes based on the % of episodes, the comparison % of episodes and their difference.

Percent of Episodes CPT Codes Houston OB-Gynecology

Other Disorders of Female Genital System Severity 1.00 Comorbidity Group II

0% 10% 20% 30% 40% 50% 60%

OFC/OUTPT E&M ESTAB LOW-MOD 15 MIN

OFC/OUTPT E&M ESTAB MINOR 10 MIN

OFC/OUTPT E&M NEW LOW-MOD 20 MIN

LEVEL IV - SURG PATH GROSS&MIC EXAM

BLD OCCLT PEROX ACTV; QUAL FECES

US PELVIC B-SCAN W/IMAG DOC; CMPL

ULTRASOUND TRANSVAGINAL

ENDOMET BX W/WO ENDOCRV BX-SEP PROC

BX SINGLE/MX/LOC EXC LES W/WO FULG

9921

399

212

9920

288

305

8227

076

856

7683

058

100

5750

0

% of Episodes Comparison % of Episodes

BlueCross BlueShield of TexasBlueChoice® Solutions Network

Solutions ID Report Date 10/27/2006Specialty OB-GynecologyMEG # 203MEG DescriptionArea HoustonComorbidity Group II Severity 1.00

Allowed Expected7,364.62$ 6,768.00$

SolutionsID / Specialty Comparison

9 2,089

SolutionsID / Specialty Comparison

100.00 104.88 188.89 220.39

1.89 2.10 6,956.03$ 5,453.00$

Allowed Amount per Admit 6,956.03$ 5,199.28$

SolutionsID / Specialty Comparison

315.10$ 733.28$ 93.49$ 486.30$ 33.33 98.56 54.58$ 548.65$

200.00 571.37 -$ 25.30$ - 8.90

55.80$ 305.52$ 577.78 1,429.49 85.26$ 301.67$ 44.44 205.98

Allow Amt Per Epis Ambulatory Care includes all ambulatory facility and ambulatory professional services. Allow Amt Per Epis Ambulatory Professional includes all professional services for all ambulatory locationsAllow Amt Per Epis Ambulatory Facility is limited to allowed amounts for ambulatory facility services only; no office based services.Allow Amt Per Epis Ambulatory Office is limited to services provided in an office setting (place of service = 11).Allow Amt Per 100 Epis Ambulatory ER includes both ER services that resulted in an admission and those that did not.

Amt per Epis

Episode Count

INPATIENT

Admits Per 100 Epis

Allow Amt Per Epis Ambulatory Facility

Allow Amt Per Epis Ambulatory Office

Days Per 100 Epis AdmitAvg Length of StayAllow Amt Per Epis Admit

AMBULATORY SERVICES

Visits Per 100 Epis Amb Fac

Delivery, Vaginal

Svcs Per 100 Epis Ambulatory LabAllow Amt Per Epis Ambulatory RadSvcs Per 100 Epis Ambulatory Rad

Visits Per 100 Epis Ambulatory Office Allow Amt Per Epis Ambulatory ERVisits Per 100 Epis Ambulatory ERAllow Amt Per Epis Ambulatory Lab

Allow Amt Per Epis Ambulatory Professional

Page 5 of 23

BlueCross BlueShield of TexasBlueChoice® Solutions Network

CPT / HCPCS Code Description % of Episodes

Comparison % of

EpisodesRelative Cost

00851 ANES-INTRAPER W/LAP; TUBAL LIG 0.00% 3.06% na01967 NEURAX LABR ANLG/ANES-PLAN VAG DEL 77.78% 62.33% na01996 DAILY HOS EPIDURL/SUBARACH CONT RX 11.11% 0.24% $$36415 COLLECTION VENOUS BLD VENIPUNCTURE 66.67% 74.05% $58605 LIG FALLOP TUBE ABD/VAG PP-SEP PROC 0.00% 3.35% $$$$59000 AMNIOCENTESIS; DIAGNOSTIC 0.00% 5.31% $$59025 FETAL NON-STRESS TEST 0.00% 15.03% $59400 ROUTINE OB CARE W/VAG DEL & PP CARE 77.78% 92.20% $$$$$59409 VAGINAL DELIVERY ONLY; 11.11% 6.46% $$$$$59410 VAGINAL DEL ONLY; INCL PP CARE 22.22% 6.51% $$$$$59426 ANTEPARTUM CARE ONLY; 7/MORE VISITS 0.00% 2.54% $$$$59430 POSTPARTUM CARE ONLY 0.00% 4.26% $$62319 INJ NOT NEUROLYTIC-EPID; LUMB/SAC 0.00% 4.69% $$$76801 RTU PG UTRUS 1 TRI ABD;1/1 GEST 0.00% 5.31% $$$$76805 RTU UTRUS AFTR 1 TRI ABD; 1/1 GEST 22.22% 33.75% $$$$76811 RTU PG UTRUS FETL ANAT ABD;1/1 GEST 11.11% 19.05% $$$$76815 RTU PG UTRUS LTD 1/MORE FETUSES 0.00% 12.59% $$$76816 RTU PG UTRUS F/U TRANSABD FETUS 0.00% 15.99% $$$76817 RTU PG UTRUS W/IMAG DOC TRANSVAG 0.00% 9.33% $$$76818 FETAL BIOPHYS PROFILE W/NONSTRESS 0.00% 6.32% $$$$76819 FETL BIOPHYS PROFILE; W/O NST 0.00% 8.09% $$$76827 DOPPLR ECHO FETL PULSE&/CONT; CMPL 0.00% 2.68% $$$76830 ULTRASOUND TRANSVAGINAL 0.00% 4.50% $$$76946 US GUID AMNIO IMAG SUPERVIS&INTEPR 0.00% 4.60% $$$80048 BASIC METABOLIC PANEL 0.00% 4.16% $$$80053 COMPREHENSIVE METABOLIC PANEL 0.00% 6.22% $$$80076 HEPATIC FUNCTION PANEL 0.00% 5.31% $$$80101 RX SCRN QUAL; RX CLASS MTHD EA RX 0.00% 2.87% $$$$81000 UA DIPSTIK/TABLET; NON-AUTO W/MICRO 0.00% 8.62% $81001 UA DIP STICK/TABLET; AUTO W/MICRO 44.44% 27.24% $81002 UA DIP STIK/TABLT;WO MICRO NON-AUTO 0.00% 18.48% $81003 UA DIP STIK/TABLET; W/O MICRO AUTO 0.00% 16.90% $81015 URINALYSIS; MICROSCOPIC ONLY 0.00% 2.20% $81025 URIN PG TST VISUAL COLR COMPAR METH 0.00% 6.85% $$82105 ALPHA-FETOPROTEIN; SERUM 22.22% 38.68% $$$$82106 ALPHA-FETOPROTEIN; AMNIOTIC FLUID 0.00% 3.59% $$$$82150 AMYLASE 0.00% 2.11% $$82565 CREATININE; BLOOD 0.00% 4.21% $$82575 CREATININE; CLEARANCE 0.00% 2.25% $$$82677 ESTRIOL 0.00% 36.48% $$$$$82731 FETAL FIBRONECTIN CERV/VAG SECRETNS 0.00% 2.68% $$$$$82803 GASES BLOOD ANY COMBO 0.00% 3.69% $$$$82947 GLUCOSE; QUANTITATIVE BLOOD 0.00% 8.90% $82950 GLUCOSE; POST GLUCOSE DOSE 66.67% 61.80% $$83021 HGB FRACTIONATION&QUAN; CHROMATGRPH 0.00% 5.07% $$$$83036 HEMOGLOBIN; GLYCATED 0.00% 4.02% $$$83615 LACTATE DEHYDROGENASE; 0.00% 2.82% $$83735 MAGNESIUM 0.00% 2.35% $$$83890 MOLECLR DXS; MOLECLR ISOLAT/EXTRAC 0.00% 7.95% $83891 MOLEC DX;ISOLAT/EXTRAC NUCLEIC ACID 0.00% 4.45% $83892 MOLECULAR DXS; ENZYMATIC DIGESTION 0.00% 2.39% $83893 MOLEC DX; DOT/SLOT BLOT PRODUCTION 0.00% 2.44% $83894 MOLECLR DXS; SEP GEL ELEC-PHORE 0.00% 8.04% $83896 MOLECLR DXS; NUCLEIC ACID PROBE EA 0.00% 12.11% $83901 MOLEC DX; AMPL NUCLEIC ACID-MXPLEX 0.00% 9.81% $$$83912 MOLECULAR DXS; INTEPR&REPORT 0.00% 12.21% $

Page 6 of 23

BlueCross BlueShield of TexasBlueChoice® Solutions Network

CPT / HCPCS Code Description % of Episodes

Comparison % of

EpisodesRelative Cost

84144 PROGESTERONE 0.00% 4.07% $$$$84156 PROT TOTAL NO REFRACTOMETRY; URINE 0.00% 2.63% $84436 THYROXINE; TOTAL 0.00% 4.36% $$$84439 THYROXINE; FREE 0.00% 4.50% $$$84443 THYROID STIMULATING HORMONE 0.00% 20.92% $$$$84450 TRANSFERASE; ASPARTATE AMINO 0.00% 5.60% $$84460 TRANSFERASE; ALANINE AMINO 0.00% 5.51% $$84479 THYROID HORMONE UPTAKE/BINDNG RATIO 0.00% 3.93% $$84520 UREA NITROGEN; QUANTITATIVE 0.00% 3.11% $84550 URIC ACID; BLOOD 0.00% 8.43% $84702 GONADOTROPIN CHORIONIC; QUAN 0.00% 40.88% $$$84703 GONADOTROPIN CHORIONIC; QUALITATIVE 0.00% 2.54% $$$85007 BLD CNT; SMER MIC EX MNL DIFF WBC 0.00% 3.73% $85014 BLOOD COUNT; HEMATOCRIT 88.89% 48.25% $85018 BLOOD COUNT; HEMOGLOBIN 33.33% 46.19% $85025 BLD CNT;CMPL AUTO&AUTO DIFF WBC CNT 66.67% 87.60% $$$85027 BLOOD COUNT; COMPLETE AUTOMATIC 33.33% 14.22% $$85362 FIBRN DEGRAD PROD; AGGLUT-SEMIQUAN 0.00% 2.01% $$$85384 FIBRINOGEN; ACTIVITY 0.00% 5.22% $$$85461 HGB/RBC FETAL-HEMORR; ROSETTE 0.00% 4.93% $$85610 PROTHROMBIN TIME; 0.00% 7.37% $85660 SICKLING OF RBC REDUCTION 0.00% 8.14% $$85730 P T T; PLASMA/WHOLE BLOOD 0.00% 7.52% $$86022 ANTIBODY ID; PLATELET ANTIBODIES 0.00% 13.26% $$$86336 INHIBIN A 0.00% 21.78% $$$$86592 SYPHILIS TEST; QUALITATIVE 100.00% 90.76% $86688 ANTIBODY; HTLV-II 0.00% 6.46% $$$86701 ANTIBODY; HIV-1 44.44% 55.67% $$$86703 ANTIBODY; HIV-1&HIV-2 SINGLE ASSAY 100.00% 58.50% $$$$86747 ANTIBODY; PARVOVIRUS 0.00% 2.30% $$$$86781 ANTIB; TREPONEMA PALLIDUM CONFIRM 11.11% 0.38% $$$86803 HEPATITIS C ANTIBODY; 0.00% 5.31% $$$$86850 ANTIBDY SCR RBC EA SERUM TECHNIQUE 88.89% 49.74% $$$86870 ANTIB ID RBC ANTIB EA PANEL EA SERM 0.00% 3.35% $$$86880 ANTIHUMAN GLOB TEST; DIR EA ANTISRM 0.00% 3.26% $$86885 ANTIHUMAN GLOB TEST; INDIR QUAL EA 0.00% 12.83% $$86886 ANTIHUMAN GLOB; INDIRECT TITER EA 0.00% 3.06% $$86900 BLOOD TYPING; ABO 88.89% 77.74% $86901 BLOOD TYPING; RH 88.89% 82.62% $$$87070 CULT BACT;NO URINE/BLD/STOOL AEROBC 0.00% 2.97% $$$87077 CULT BACT; AEROB-ADD-DEFIN ID-EA 22.22% 3.16% $$$87081 CULT PRESUMP PATH ORGNSMS SCR ONLY; 33.33% 52.90% $$87086 CULT BACTERL; QUAN COLONY CNT URINE 44.44% 35.62% $$$87088 CULT BACT; W/ISOLTN & ID ISOL-URINE 33.33% 9.86% $$$87147 CULT TYPE; IMMUNOLOG METHD/ANTISERU 11.11% 5.12% $$87149 CULT TYPING; ID NUCLEIC ACID PROBE 0.00% 19.77% $$$$87184 SUSCEPT-ANTIMICROB; DISK METH-PLATE 0.00% 2.97% $$$87186 SUSCEPT-ANTIMICRB; MICRO/AGAR DILUT 22.22% 2.54% $$$87210 SMEAR-PRIM W/INTERPT; WET MOUNT 0.00% 5.46% $87340 INF AGT-IMMUNOAS; HEP B SURF ANTIG 100.00% 64.19% $$$87490 INF AGT-DNA/RNA; CHLAMYD TRACH-DIR 0.00% 15.70% $$$$87491 INF AGT-DNA/RNA; CHLAMYD TRACH-AMP 0.00% 12.16% $$$$$87590 INF AGT-DNA/RNA; NEISSR GNRRHEA-DIR 0.00% 15.61% $$$$87591 INF AGT-DNA/RNA; NEISSR GNRRHEA-AMP 0.00% 12.21% $$$$$87800 INF AGT-DNA/RNA MX ORG; DIR PROBE 0.00% 3.83% $$$$$87802 INF AGT ANTIG IMMUOAS; STREP GRP B 0.00% 2.92% $$$88141 CYTOPATH CERV/VAG RQR INTEPR PHYS 0.00% 2.78% $$$$

Page 7 of 23

BlueCross BlueShield of TexasBlueChoice® Solutions Network

CPT / HCPCS Code Description % of Episodes

Comparison % of

EpisodesRelative Cost

88142 CYTPTH CERV/VAG; THIN PREP; MNL SCR 0.00% 25.42% $$$$88164 CYTOPATH CERV/VAG BETHSEDA;MNL PHYS 0.00% 3.83% $$$88235 TISS CULT NON-NEOPLAS; AMNIOT FLUID 0.00% 3.97% $$$$$88269 CHROMO ANAL AMNIO FLD CT 6-12 COLNY 0.00% 3.49% $$$$$88280 CHROMOSOME ANALY; ADD KARYOTYPES EA 0.00% 2.44% $$$$$88291 CYTOGEN & MOLEC CYTOGEN INTER & RPT 0.00% 3.54% $$$$$88300 LEVEL I - SURG PATH GROSS EXAM ONLY 0.00% 3.26% $$$$88302 LEVEL II - SURG PATH GROSS&MIC EXAM 0.00% 3.88% $$$$$88307 LEVEL V- SURG PATH GROSS/MICRO EXAM 0.00% 15.17% $$$$$90782 THERAPEUTIC PROPH/DX INJ; SUBQ/IM 0.00% 5.12% $99000 HANDL/CONVEY SPECMN-OFFIC TO LAB 0.00% 7.13% $99140 ANES-COMPLICATED EMERGENCY CONDS 11.11% 7.99% na99203 OFC/OUTPT E&M NEW MOD-SEVER 30 MIN 0.00% 3.21% $$$99204 OFC/OUTPT E&M NEW MOD-HI 45 MIN 0.00% 7.71% $$$$99205 OFC/OUTPT E&M NEW MOD-HI 60 MIN 0.00% 2.49% $$$$$99211 OFC/OUTPT E&M ESTAB 5 MIN 0.00% 3.88% $99212 OFC/OUTPT E&M ESTAB MINOR 10 MIN 0.00% 5.65% $99213 OFC/OUTPT E&M ESTAB LOW-MOD 15 MIN 0.00% 19.44% $99214 OFC/OUTPT E&M ESTAB MOD-HI 25 MIN 0.00% 13.31% $$$99215 OFC/OUTPT E&M ESTAB MOD-HI 40 MIN 0.00% 3.30% $$$$99234 OBSRV/INPT HOSP CARE E&M LOW SEVER 0.00% 2.11% $$$$99238 HOSPITAL D/C DAY MGMT; 30 MIN/LESS 0.00% 3.49% $$99242 OFC CNSLT NEW/EST LOW SEVER 30 MIN 0.00% 2.20% $$$99243 OFFICE CNSLT NEW/ESTAB MOD 40 MIN 0.00% 7.04% $$$$99284 ER VISIT E&M HIGH SEVER URGENT EVAL 0.00% 2.82% $$$A4550 SURGICAL TRAYS 0.00% 3.35% $$J2790 INJECTION, RHO (D) IMMUNE GLOBULIN, HUMAN, ONE DOSE

PACKAGE0.00% 3.83% $$$$$

Page 8 of 23

This chart contains up to TOP 14 CPT codes based on the % of episodes, the comparison % of episodes and their difference.

Percent of Episodes CPT Codes Houston OB-Gynecology

Delivery, Vaginal Severity 1.00 Comorbidity Group II

0% 20% 40% 60% 80% 100% 120%

INF AGT-IMMUNOAS; HEP B SURF ANTIG

SUSCEPT-ANTIMICRB; MICRO/AGAR DILUT

CULT TYPE; IMMUNOLOG METHD/ANTISERU

CULT BACT; W/ISOLTN & ID ISOL-URINE

CULT BACTERL; QUAN COLONY CNT URINE

CULT BACT; AEROB-ADD-DEFIN ID-EA

BLOOD TYPING; RH

ANTIBDY SCR RBC EA SERUM TECHNIQUE

ANTIB; TREPONEMA PALLIDUM CONFIRM

ANTIBODY; HIV-1&HIV-2 SINGLE ASSAY

BLOOD COUNT; COMPLETE AUTOMATIC

VAGINAL DEL ONLY; INCL PP CARE

VAGINAL DELIVERY ONLY;

DAILY HOS EPIDURL/SUBARACH CONT RX

8734

087

186

8714

787

088

8708

687

077

8690

186

850

8678

186

703

8502

759

410

5940

901

996

% of Episodes Comparison % of Episodes

BlueCross BlueShield of TexasBlueChoice® Solutions Network

Solutions ID UPUE25423 Report Date 10/27/2006Specialty OB-GynecologyMEG # 230MEG DescriptionArea HoustonComorbidity Group I Severity 1.00

Allowed Expected505.17$ 170.00$

SolutionsID / Specialty Comparison

9 2,413

SolutionsID / Specialty Comparison

- 0.08 - 0.12 - 1.50 -$ 4.49$

Allowed Amount per Admit -$ 5,612.50$

SolutionsID / Specialty Comparison

184.11$ 164.26$ 321.05$ 20.72$ 44.44 3.73 76.26$ 154.97$

111.11 141.69 -$ 0.42$ - 0.25

89.78$ 34.86$ 111.11 167.55 44.61$ 32.29$ 22.22 26.48

Allow Amt Per Epis Ambulatory Care includes all ambulatory facility and ambulatory professional services. Allow Amt Per Epis Ambulatory Professional includes all professional services for all ambulatory locationsAllow Amt Per Epis Ambulatory Facility is limited to allowed amounts for ambulatory facility services only; no office based services.Allow Amt Per Epis Ambulatory Office is limited to services provided in an office setting (place of service = 11).Allow Amt Per 100 Epis Ambulatory ER includes both ER services that resulted in an admission and those that did not.

Amt per Epis

Episode Count

INPATIENT

Admits Per 100 Epis

Allow Amt Per Epis Ambulatory Facility

Allow Amt Per Epis Ambulatory Office

Days Per 100 Epis AdmitAvg Length of StayAllow Amt Per Epis Admit

AMBULATORY SERVICES

Visits Per 100 Epis Amb Fac

Other Disorders of Female Genital System

Svcs Per 100 Epis Ambulatory LabAllow Amt Per Epis Ambulatory RadSvcs Per 100 Epis Ambulatory Rad

Visits Per 100 Epis Ambulatory Office Allow Amt Per Epis Ambulatory ERVisits Per 100 Epis Ambulatory ERAllow Amt Per Epis Ambulatory Lab

Allow Amt Per Epis Ambulatory Professional

Page 10 of 23

BlueCross BlueShield of TexasBlueChoice® Solutions Network

CPT / HCPCS Code Description % of Episodes

Comparison % of

EpisodesRelative Cost

00952 ANES-VAG;HYSTEROSCOPY&/SALPINGRAPHY 11.11% 0.08% na36415 COLLECTION VENOUS BLD VENIPUNCTURE 11.11% 14.55% $57500 BX SINGLE/MX/LOC EXC LES W/WO FULG 11.11% 1.62% $$58100 ENDOMET BX W/WO ENDOCRV BX-SEP PROC 0.00% 2.74% $$76075 DXA BN DNSITY 1/> SITE; AXIAL SKEL 0.00% 2.15% $$$$76830 ULTRASOUND TRANSVAGINAL 0.00% 10.36% $$$76856 US PELVIC B-SCAN W/IMAG DOC; CMPL 11.11% 6.05% $$$80048 BASIC METABOLIC PANEL 11.11% 0.17% $$$80061 LIPID PANEL 0.00% 3.65% $$$$81000 UA DIPSTIK/TABLET; NON-AUTO W/MICRO 0.00% 3.03% $81002 UA DIP STIK/TABLT;WO MICRO NON-AUTO 0.00% 6.80% $81025 URIN PG TST VISUAL COLR COMPAR METH 0.00% 5.43% $$82670 ESTRADIOL 0.00% 4.10% $$$$$83001 GONADOTROPIN; FOLLICLE STIM HORMONE 0.00% 7.67% $$$$83002 GONADOTROPIN; LUTEINIZING HORMONE 0.00% 3.44% $$$$84146 PROLACTIN 0.00% 3.27% $$$$84403 TESTOSTERONE; TOTAL 0.00% 2.53% $$$$$84436 THYROXINE; TOTAL 0.00% 2.15% $$$84443 THYROID STIMULATING HORMONE 11.11% 8.74% $$$$84479 THYROID HORMONE UPTAKE/BINDNG RATIO 0.00% 2.03% $$84702 GONADOTROPIN CHORIONIC; QUAN 0.00% 2.45% $$$84703 GONADOTROPIN CHORIONIC; QUALITATIVE 11.11% 0.95% $$$85018 BLOOD COUNT; HEMOGLOBIN 11.11% 1.41% $85025 BLD CNT;CMPL AUTO&AUTO DIFF WBC CNT 11.11% 6.34% $$$87210 SMEAR-PRIM W/INTERPT; WET MOUNT 0.00% 8.16% $87480 INF AGT-DNA/RNA;CANDIDA SPECIES-DIR 0.00% 2.86% $$$$87491 INF AGT-DNA/RNA; CHLAMYD TRACH-AMP 0.00% 2.61% $$$$$87510 INF AGT-DNA/RNA; GARDNRELLA VAG-DIR 0.00% 3.07% $$$$87591 INF AGT-DNA/RNA; NEISSR GNRRHEA-AMP 0.00% 2.53% $$$$$87797 INF AGT-DNA/RNA NOS; DIR PROBE EA 0.00% 2.15% $$$$88142 CYTPTH CERV/VAG; THIN PREP; MNL SCR 0.00% 5.97% $$$$88305 LEVEL IV - SURG PATH GROSS&MIC EXAM 11.11% 4.39% $$$$$99203 OFC/OUTPT E&M NEW MOD-SEVER 30 MIN 33.33% 5.35% $$$99204 OFC/OUTPT E&M NEW MOD-HI 45 MIN 0.00% 9.70% $$$$99205 OFC/OUTPT E&M NEW MOD-HI 60 MIN 0.00% 3.94% $$$$$99213 OFC/OUTPT E&M ESTAB LOW-MOD 15 MIN 44.44% 31.62% $99214 OFC/OUTPT E&M ESTAB MOD-HI 25 MIN 0.00% 23.12% $$$99215 OFC/OUTPT E&M ESTAB MOD-HI 40 MIN 0.00% 7.42% $$$$

Page 11 of 23

This chart contains up to TOP 14 CPT codes based on the % of episodes, the comparison % of episodes and their difference.

Percent of Episodes CPT Codes Houston OB-Gynecology

Other Disorders of Female Genital System Severity 1.00 Comorbidity Group I

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

OFC/OUTPT E&M ESTAB LOW-MOD 15 MIN

OFC/OUTPT E&M NEW MOD-SEVER 30 MIN

LEVEL IV - SURG PATH GROSS&MIC EXAM

BLD CNT;CMPL AUTO&AUTO DIFF WBC CNT

BLOOD COUNT; HEMOGLOBIN

GONADOTROPIN CHORIONIC; QUALITATIVE

THYROID STIMULATING HORMONE

BASIC METABOLIC PANEL

US PELVIC B-SCAN W/IMAG DOC; CMPL

BX SINGLE/MX/LOC EXC LES W/WO FULG

ANES-VAG;HYSTEROSCOPY&/SALPINGRAPHY

9921

399

203

8830

585

025

8501

884

703

8444

380

048

7685

657

500

0095

2

% of Episodes Comparison % of Episodes

BlueCross BlueShield of TexasBlueChoice® Solutions Network

Solutions ID UPUE25423 Report Date 10/27/2006Specialty OB-GynecologyMEG # 202MEG DescriptionArea HoustonComorbidity Group I Severity 1.02

Allowed Expected9,927.33$ 9,250.00$

SolutionsID / Specialty Comparison

7 785

SolutionsID / Specialty Comparison

100.00 104.84 242.86 323.18

2.43 3.08 9,488.21$ 8,009.32$

Allowed Amount per Admit 9,488.21$ 7,639.57$

SolutionsID / Specialty Comparison

309.42$ 789.92$ 129.70$ 497.54$ 28.57 111.85

161.12$ 603.14$ 357.14 596.43

-$ 27.60$ - 7.13

100.16$ 308.28$ 757.14 1,385.73 235.94$ 363.59$ 114.29 268.79

Allow Amt Per Epis Ambulatory Care includes all ambulatory facility and ambulatory professional services. Allow Amt Per Epis Ambulatory Professional includes all professional services for all ambulatory locationsAllow Amt Per Epis Ambulatory Facility is limited to allowed amounts for ambulatory facility services only; no office based services.Allow Amt Per Epis Ambulatory Office is limited to services provided in an office setting (place of service = 11).Allow Amt Per 100 Epis Ambulatory ER includes both ER services that resulted in an admission and those that did not.

Amt per Epis

Episode Count

INPATIENT

Admits Per 100 Epis

Allow Amt Per Epis Ambulatory Facility

Allow Amt Per Epis Ambulatory Office

Days Per 100 Epis AdmitAvg Length of StayAllow Amt Per Epis Admit

AMBULATORY SERVICES

Visits Per 100 Epis Amb Fac

Delivery, Cesarean Section

Svcs Per 100 Epis Ambulatory LabAllow Amt Per Epis Ambulatory RadSvcs Per 100 Epis Ambulatory Rad

Visits Per 100 Epis Ambulatory Office Allow Amt Per Epis Ambulatory ERVisits Per 100 Epis Ambulatory ERAllow Amt Per Epis Ambulatory Lab

Allow Amt Per Epis Ambulatory Professional

Page 13 of 23

BlueCross BlueShield of TexasBlueChoice® Solutions Network

CPT / HCPCS Code Description % of Episodes

Comparison % of

EpisodesRelative Cost

01961 ANESTHESIA CESAREAN DELIVERY ONLY 85.71% 67.39% na01968 ANES-CD FLW NEURAX LABR ANALG/ANES 0.00% 11.46% na01996 DAILY HOS EPIDURL/SUBARACH CONT RX 57.14% 35.16% $$36415 COLLECTION VENOUS BLD VENIPUNCTURE 100.00% 68.54% $58611 LIG FALLOP TUBE-C/D/INTRA-ABD SURG 28.57% 17.58% $$59000 AMNIOCENTESIS; DIAGNOSTIC 0.00% 6.75% $$59025 FETAL NON-STRESS TEST 14.29% 20.25% $59400 ROUTINE OB CARE W/VAG DEL & PP CARE 0.00% 2.93% $$$$$59425 ANTEPARTUM CARE ONLY; 4-6 VISITS 0.00% 2.04% $$$$59430 POSTPARTUM CARE ONLY 0.00% 3.31% $$59510 ROUTINE OB CARE W/C-SECT & PP CARE 100.00% 90.83% $$$$$59514 CESAREAN DELIVERY ONLY; 85.71% 58.85% $$$$$59515 C-SECT DELIVERY ONLY; INCL PP CARE 0.00% 7.39% $$$$$76375 CORON SAG OBL RECN CT/MRI/OTH TOMO 0.00% 3.06% $$$$76801 RTU PG UTRUS 1 TRI ABD;1/1 GEST 0.00% 5.35% $$$$76805 RTU UTRUS AFTR 1 TRI ABD; 1/1 GEST 0.00% 34.90% $$$$76811 RTU PG UTRUS FETL ANAT ABD;1/1 GEST 57.14% 22.17% $$$$76815 RTU PG UTRUS LTD 1/MORE FETUSES 28.57% 15.03% $$$76816 RTU PG UTRUS F/U TRANSABD FETUS 0.00% 20.51% $$$76817 RTU PG UTRUS W/IMAG DOC TRANSVAG 0.00% 9.30% $$$76818 FETAL BIOPHYS PROFILE W/NONSTRESS 0.00% 7.77% $$$$76819 FETL BIOPHYS PROFILE; W/O NST 0.00% 13.76% $$$76827 DOPPLR ECHO FETL PULSE&/CONT; CMPL 0.00% 4.20% $$$76830 ULTRASOUND TRANSVAGINAL 0.00% 4.71% $$$76946 US GUID AMNIO IMAG SUPERVIS&INTEPR 0.00% 5.61% $$$80048 BASIC METABOLIC PANEL 0.00% 6.50% $$$80053 COMPREHENSIVE METABOLIC PANEL 0.00% 8.03% $$$80055 OBSTETRIC PANEL 100.00% 42.80% $$$$$80076 HEPATIC FUNCTION PANEL 0.00% 6.88% $$$81000 UA DIPSTIK/TABLET; NON-AUTO W/MICRO 0.00% 7.52% $81001 UA DIP STICK/TABLET; AUTO W/MICRO 71.43% 30.45% $81002 UA DIP STIK/TABLT;WO MICRO NON-AUTO 0.00% 17.32% $81003 UA DIP STIK/TABLET; W/O MICRO AUTO 0.00% 15.80% $81025 URIN PG TST VISUAL COLR COMPAR METH 14.29% 5.10% $$82105 ALPHA-FETOPROTEIN; SERUM 71.43% 32.87% $$$$82106 ALPHA-FETOPROTEIN; AMNIOTIC FLUID 0.00% 3.82% $$$$82247 BILIRUBIN; TOTAL 0.00% 2.80% $$82310 CALCIUM; TOTAL 0.00% 2.04% $$82374 CARBON DIOXIDE 0.00% 3.44% $$82435 CHLORIDE; BLOOD 0.00% 3.57% $82565 CREATININE; BLOOD 0.00% 6.88% $$82575 CREATININE; CLEARANCE 0.00% 4.59% $$$82677 ESTRIOL 28.57% 31.08% $$$$$82731 FETAL FIBRONECTIN CERV/VAG SECRETNS 0.00% 2.17% $$$$$82803 GASES BLOOD ANY COMBO 0.00% 8.79% $$$$82947 GLUCOSE; QUANTITATIVE BLOOD 0.00% 14.01% $82950 GLUCOSE; POST GLUCOSE DOSE 71.43% 54.39% $$82951 GLUCOSE; TOLERANCE TEST 3 SPECIMENS 28.57% 13.50% $$$$82952 GLU; TOLERANCE EA ADD BEYOND 3 SPEC 28.57% 12.10% $83021 HGB FRACTIONATION&QUAN; CHROMATGRPH 0.00% 4.59% $$$$83036 HEMOGLOBIN; GLYCATED 0.00% 5.10% $$$83520 IMMUNOASSAY ANALYTE QUAN; NOS 0.00% 2.29% $$$$83615 LACTATE DEHYDROGENASE; 0.00% 4.08% $$83735 MAGNESIUM 0.00% 3.44% $$$83890 MOLECLR DXS; MOLECLR ISOLAT/EXTRAC 0.00% 6.24% $83891 MOLEC DX;ISOLAT/EXTRAC NUCLEIC ACID 0.00% 4.46% $

Page 14 of 23

BlueCross BlueShield of TexasBlueChoice® Solutions Network

CPT / HCPCS Code Description % of Episodes

Comparison % of

EpisodesRelative Cost

83892 MOLECULAR DXS; ENZYMATIC DIGESTION 0.00% 2.80% $83893 MOLEC DX; DOT/SLOT BLOT PRODUCTION 0.00% 2.29% $83894 MOLECLR DXS; SEP GEL ELEC-PHORE 0.00% 5.61% $83896 MOLECLR DXS; NUCLEIC ACID PROBE EA 0.00% 10.45% $83901 MOLEC DX; AMPL NUCLEIC ACID-MXPLEX 0.00% 7.77% $$$83912 MOLECULAR DXS; INTEPR&REPORT 0.00% 10.45% $84132 POTASSIUM; SERUM 0.00% 7.77% $84144 PROGESTERONE 0.00% 3.95% $$$$84155 PROTEIN TOT NO REFRACTOMETRY; SERUM 0.00% 3.95% $84156 PROT TOTAL NO REFRACTOMETRY; URINE 0.00% 3.57% $84295 SODIUM; SERUM 0.00% 2.80% $$84436 THYROXINE; TOTAL 0.00% 3.06% $$$84439 THYROXINE; FREE 0.00% 5.73% $$$84443 THYROID STIMULATING HORMONE 0.00% 20.13% $$$$84450 TRANSFERASE; ASPARTATE AMINO 0.00% 7.13% $$84460 TRANSFERASE; ALANINE AMINO 0.00% 6.50% $$84520 UREA NITROGEN; QUANTITATIVE 0.00% 5.73% $84550 URIC ACID; BLOOD 0.00% 11.59% $84702 GONADOTROPIN CHORIONIC; QUAN 28.57% 36.31% $$$84703 GONADOTROPIN CHORIONIC; QUALITATIVE 0.00% 2.29% $$$85007 BLD CNT; SMER MIC EX MNL DIFF WBC 42.86% 5.10% $85008 BLD CNT;SMER MIC EX NO MNL DIFF WBC 0.00% 2.55% $85014 BLOOD COUNT; HEMATOCRIT 14.29% 38.22% $85018 BLOOD COUNT; HEMOGLOBIN 0.00% 39.49% $85025 BLD CNT;CMPL AUTO&AUTO DIFF WBC CNT 71.43% 85.86% $$$85027 BLOOD COUNT; COMPLETE AUTOMATIC 42.86% 10.57% $$85362 FIBRN DEGRAD PROD; AGGLUT-SEMIQUAN 0.00% 2.04% $$$85384 FIBRINOGEN; ACTIVITY 0.00% 6.88% $$$85461 HGB/RBC FETAL-HEMORR; ROSETTE 0.00% 4.97% $$85610 PROTHROMBIN TIME; 0.00% 10.83% $85660 SICKLING OF RBC REDUCTION 0.00% 5.48% $$85730 P T T; PLASMA/WHOLE BLOOD 0.00% 10.70% $$86022 ANTIBODY ID; PLATELET ANTIBODIES 0.00% 9.55% $$$86336 INHIBIN A 0.00% 18.73% $$$$86592 SYPHILIS TEST; QUALITATIVE 100.00% 71.97% $86688 ANTIBODY; HTLV-II 0.00% 3.57% $$$86701 ANTIBODY; HIV-1 100.00% 49.81% $$$86703 ANTIBODY; HIV-1&HIV-2 SINGLE ASSAY 100.00% 50.06% $$$$86747 ANTIBODY; PARVOVIRUS 0.00% 2.29% $$$$86762 ANTIBODY; RUBELLA 0.00% 7.26% $$$$86803 HEPATITIS C ANTIBODY; 0.00% 5.73% $$$$86850 ANTIBDY SCR RBC EA SERUM TECHNIQUE 100.00% 50.32% $$$86870 ANTIB ID RBC ANTIB EA PANEL EA SERM 0.00% 3.82% $$$86880 ANTIHUMAN GLOB TEST; DIR EA ANTISRM 14.29% 2.29% $$86885 ANTIHUMAN GLOB TEST; INDIR QUAL EA 0.00% 7.77% $$86886 ANTIHUMAN GLOB; INDIRECT TITER EA 0.00% 4.08% $$86900 BLOOD TYPING; ABO 100.00% 69.04% $86901 BLOOD TYPING; RH 100.00% 71.21% $$$87070 CULT BACT;NO URINE/BLD/STOOL AEROBC 0.00% 3.18% $$$87077 CULT BACT; AEROB-ADD-DEFIN ID-EA 0.00% 3.82% $$$87081 CULT PRESUMP PATH ORGNSMS SCR ONLY; 0.00% 47.52% $$87086 CULT BACTERL; QUAN COLONY CNT URINE 100.00% 33.50% $$$87088 CULT BACT; W/ISOLTN & ID ISOL-URINE 85.71% 10.57% $$$87147 CULT TYPE; IMMUNOLOG METHD/ANTISERU 14.29% 6.50% $$87149 CULT TYPING; ID NUCLEIC ACID PROBE 0.00% 18.73% $$$$87184 SUSCEPT-ANTIMICROB; DISK METH-PLATE 0.00% 2.04% $$$87186 SUSCEPT-ANTIMICRB; MICRO/AGAR DILUT 0.00% 3.31% $$$

Page 15 of 23

BlueCross BlueShield of TexasBlueChoice® Solutions Network

CPT / HCPCS Code Description % of Episodes

Comparison % of

EpisodesRelative Cost

87205 SMEAR-PRIM W/INTERPT; GRAM STAIN 0.00% 2.42% $87210 SMEAR-PRIM W/INTERPT; WET MOUNT 0.00% 3.69% $87340 INF AGT-IMMUNOAS; HEP B SURF ANTIG 100.00% 56.69% $$$87490 INF AGT-DNA/RNA; CHLAMYD TRACH-DIR 0.00% 13.38% $$$$87491 INF AGT-DNA/RNA; CHLAMYD TRACH-AMP 0.00% 10.32% $$$$$87590 INF AGT-DNA/RNA; NEISSR GNRRHEA-DIR 0.00% 13.25% $$$$87591 INF AGT-DNA/RNA; NEISSR GNRRHEA-AMP 0.00% 10.32% $$$$$87621 INF AGT-DNA/RNA; PAPILLOMAVIRUS-AMP 0.00% 2.29% $$$$$87798 INF AGT-DNA/RNA NOS; AMP PROBE EA 0.00% 2.17% $$$$$87800 INF AGT-DNA/RNA MX ORG; DIR PROBE 0.00% 3.31% $$$$$87802 INF AGT ANTIG IMMUOAS; STREP GRP B 0.00% 5.99% $$$88141 CYTOPATH CERV/VAG RQR INTEPR PHYS 0.00% 2.17% $$$$88142 CYTPTH CERV/VAG; THIN PREP; MNL SCR 14.29% 26.11% $$$$88164 CYTOPATH CERV/VAG BETHSEDA;MNL PHYS 0.00% 2.42% $$$88235 TISS CULT NON-NEOPLAS; AMNIOT FLUID 0.00% 4.46% $$$$$88269 CHROMO ANAL AMNIO FLD CT 6-12 COLNY 0.00% 3.82% $$$$$88280 CHROMOSOME ANALY; ADD KARYOTYPES EA 0.00% 2.93% $$$$$88285 CHROMO ANALY; ADD CELLS COUNTED EA 0.00% 2.42% $$$$88291 CYTOGEN & MOLEC CYTOGEN INTER & RPT 0.00% 4.20% $$$$$88300 LEVEL I - SURG PATH GROSS EXAM ONLY 0.00% 3.31% $$$$88302 LEVEL II - SURG PATH GROSS&MIC EXAM 28.57% 17.58% $$$$$88305 LEVEL IV - SURG PATH GROSS&MIC EXAM 0.00% 2.93% $$$$$88307 LEVEL V- SURG PATH GROSS/MICRO EXAM 0.00% 26.88% $$$$$90782 THERAPEUTIC PROPH/DX INJ; SUBQ/IM 0.00% 3.18% $93325 DOPPLR ECHO COLOR FLOW VELOCITY MAP 0.00% 2.93% $$99000 HANDL/CONVEY SPECMN-OFFIC TO LAB 0.00% 7.01% $99140 ANES-COMPLICATED EMERGENCY CONDS 14.29% 23.69% na99203 OFC/OUTPT E&M NEW MOD-SEVER 30 MIN 14.29% 2.04% $$$99204 OFC/OUTPT E&M NEW MOD-HI 45 MIN 0.00% 6.62% $$$$99205 OFC/OUTPT E&M NEW MOD-HI 60 MIN 0.00% 3.18% $$$$$99211 OFC/OUTPT E&M ESTAB 5 MIN 0.00% 4.46% $99212 OFC/OUTPT E&M ESTAB MINOR 10 MIN 0.00% 7.39% $99213 OFC/OUTPT E&M ESTAB LOW-MOD 15 MIN 14.29% 21.27% $99214 OFC/OUTPT E&M ESTAB MOD-HI 25 MIN 0.00% 15.80% $$$99215 OFC/OUTPT E&M ESTAB MOD-HI 40 MIN 0.00% 4.71% $$$$99218 INIT OBSRV CARE-DAY E&M LOW SEVRITY 0.00% 2.04% $$99231 SUBSQT HOSP-DAY E&M STABLE 15 MIN 28.57% 14.39% $99232 SUBSQT HSP-DAY E&M MINR CMPL 25 MIN 0.00% 2.68% $$99234 OBSRV/INPT HOSP CARE E&M LOW SEVER 0.00% 2.42% $$$$99235 OBSRV/INPT HOSP CARE E&M MOD SEVER 14.29% 1.02% $$$$$99238 HOSPITAL D/C DAY MGMT; 30 MIN/LESS 0.00% 4.84% $$99242 OFC CNSLT NEW/EST LOW SEVER 30 MIN 0.00% 3.31% $$$99243 OFFICE CNSLT NEW/ESTAB MOD 40 MIN 0.00% 7.01% $$$$99244 OFC CNSLT NEW/ESTAB MOD-HI 60 MIN 0.00% 2.93% $$$$$99284 ER VISIT E&M HIGH SEVER URGENT EVAL 0.00% 2.17% $$$A4550 SURGICAL TRAYS 0.00% 4.08% $$J2790 INJECTION, RHO (D) IMMUNE GLOBULIN, HUMAN, ONE DOSE

PACKAGE0.00% 3.06% $$$$$

Page 16 of 23

This chart contains up to TOP 14 CPT codes based on the % of episodes, the comparison % of episodes and their difference.

Percent of Episodes CPT Codes Houston OB-Gynecology

Delivery, Cesarean Section Severity 1.02 Comorbidity Group I

0% 20% 40% 60% 80% 100% 120%

OBSRV/INPT HOSP CARE E&M MOD SEVER

LEVEL II - SURG PATH GROSS&MIC EXAM

INF AGT-IMMUNOAS; HEP B SURF ANTIG

CULT BACT; W/ISOLTN & ID ISOL-URINE

CULT BACTERL; QUAN COLONY CNT URINE

ANTIBDY SCR RBC EA SERUM TECHNIQUE

ANTIBODY; HIV-1&HIV-2 SINGLE ASSAY

ANTIBODY; HIV-1

GLUCOSE; TOLERANCE TEST 3 SPECIMENS

ALPHA-FETOPROTEIN; SERUM

OBSTETRIC PANEL

RTU PG UTRUS FETL ANAT ABD;1/1 GEST

CESAREAN DELIVERY ONLY;

ROUTINE OB CARE W/C-SECT & PP CARE

9923

588

302

8734

087

088

8708

686

850

8670

386

701

8295

182

105

8005

576

811

5951

459

510

% of Episodes Comparison % of Episodes

BlueCross BlueShield of TexasBlueChoice® Solutions Network

Solutions ID UPUE25423 Report Date 10/27/2006Specialty OB-GynecologyMEG # 203MEG DescriptionArea HoustonComorbidity Group I Severity 1.00

Allowed Expected7,953.07$ 6,227.00$

SolutionsID / Specialty Comparison

6 689

SolutionsID / Specialty Comparison

100.00 103.63 183.33 214.22

1.83 2.07 7,386.60$ 5,219.68$

Allowed Amount per Admit 7,386.60$ 5,036.84$

SolutionsID / Specialty Comparison

243.84$ 619.29$ 322.63$ 366.21$ 50.00 75.91

134.23$ 486.05$ 250.00 540.78

-$ 19.00$ - 6.82

224.61$ 244.48$ 750.00 1,296.81 276.14$ 244.05$ 116.67 171.12

Allow Amt Per Epis Ambulatory Care includes all ambulatory facility and ambulatory professional services. Allow Amt Per Epis Ambulatory Professional includes all professional services for all ambulatory locationsAllow Amt Per Epis Ambulatory Facility is limited to allowed amounts for ambulatory facility services only; no office based services.Allow Amt Per Epis Ambulatory Office is limited to services provided in an office setting (place of service = 11).Allow Amt Per 100 Epis Ambulatory ER includes both ER services that resulted in an admission and those that did not.

Amt per Epis

Episode Count

INPATIENT

Admits Per 100 Epis

Allow Amt Per Epis Ambulatory Facility

Allow Amt Per Epis Ambulatory Office

Days Per 100 Epis AdmitAvg Length of StayAllow Amt Per Epis Admit

AMBULATORY SERVICES

Visits Per 100 Epis Amb Fac

Delivery, Vaginal

Svcs Per 100 Epis Ambulatory LabAllow Amt Per Epis Ambulatory RadSvcs Per 100 Epis Ambulatory Rad

Visits Per 100 Epis Ambulatory Office Allow Amt Per Epis Ambulatory ERVisits Per 100 Epis Ambulatory ERAllow Amt Per Epis Ambulatory Lab

Allow Amt Per Epis Ambulatory Professional

Page 18 of 23

BlueCross BlueShield of TexasBlueChoice® Solutions Network

CPT / HCPCS Code Description % of Episodes

Comparison % of

EpisodesRelative Cost

00851 ANES-INTRAPER W/LAP; TUBAL LIG 0.00% 2.90% na01967 NEURAX LABR ANLG/ANES-PLAN VAG DEL 83.33% 61.83% na36415 COLLECTION VENOUS BLD VENIPUNCTURE 100.00% 73.58% $59000 AMNIOCENTESIS; DIAGNOSTIC 16.67% 1.89% $$59025 FETAL NON-STRESS TEST 0.00% 14.95% $59400 ROUTINE OB CARE W/VAG DEL & PP CARE 100.00% 91.58% $$$$$59409 VAGINAL DELIVERY ONLY; 0.00% 3.77% $$$$$59410 VAGINAL DEL ONLY; INCL PP CARE 0.00% 6.82% $$$$$59430 POSTPARTUM CARE ONLY 0.00% 4.21% $$62319 INJ NOT NEUROLYTIC-EPID; LUMB/SAC 0.00% 2.32% $$$76801 RTU PG UTRUS 1 TRI ABD;1/1 GEST 0.00% 4.79% $$$$76805 RTU UTRUS AFTR 1 TRI ABD; 1/1 GEST 0.00% 30.48% $$$$76811 RTU PG UTRUS FETL ANAT ABD;1/1 GEST 33.33% 14.22% $$$$76815 RTU PG UTRUS LTD 1/MORE FETUSES 16.67% 11.90% $$$76816 RTU PG UTRUS F/U TRANSABD FETUS 0.00% 12.92% $$$76817 RTU PG UTRUS W/IMAG DOC TRANSVAG 0.00% 8.56% $$$76818 FETAL BIOPHYS PROFILE W/NONSTRESS 0.00% 3.48% $$$$76819 FETL BIOPHYS PROFILE; W/O NST 0.00% 8.56% $$$76830 ULTRASOUND TRANSVAGINAL 0.00% 3.19% $$$80048 BASIC METABOLIC PANEL 0.00% 3.34% $$$80053 COMPREHENSIVE METABOLIC PANEL 0.00% 3.48% $$$80055 OBSTETRIC PANEL 100.00% 43.11% $$$$$80076 HEPATIC FUNCTION PANEL 0.00% 3.92% $$$80100 DRUG SCREEN QUAL; MX DRUG CHROMT EA 0.00% 2.03% $$$80101 RX SCRN QUAL; RX CLASS MTHD EA RX 0.00% 3.19% $$$$81000 UA DIPSTIK/TABLET; NON-AUTO W/MICRO 0.00% 6.24% $81001 UA DIP STICK/TABLET; AUTO W/MICRO 100.00% 21.34% $81002 UA DIP STIK/TABLT;WO MICRO NON-AUTO 0.00% 19.30% $81003 UA DIP STIK/TABLET; W/O MICRO AUTO 0.00% 14.08% $81015 URINALYSIS; MICROSCOPIC ONLY 0.00% 3.19% $81025 URIN PG TST VISUAL COLR COMPAR METH 0.00% 7.84% $$82105 ALPHA-FETOPROTEIN; SERUM 33.33% 38.75% $$$$82677 ESTRIOL 16.67% 37.45% $$$$$82731 FETAL FIBRONECTIN CERV/VAG SECRETNS 0.00% 2.32% $$$$$82947 GLUCOSE; QUANTITATIVE BLOOD 0.00% 6.97% $82951 GLUCOSE; TOLERANCE TEST 3 SPECIMENS 0.00% 12.92% $$$$82952 GLU; TOLERANCE EA ADD BEYOND 3 SPEC 0.00% 12.05% $83021 HGB FRACTIONATION&QUAN; CHROMATGRPH 16.67% 3.63% $$$$83036 HEMOGLOBIN; GLYCATED 0.00% 2.76% $$$83890 MOLECLR DXS; MOLECLR ISOLAT/EXTRAC 0.00% 7.40% $83891 MOLEC DX;ISOLAT/EXTRAC NUCLEIC ACID 0.00% 3.05% $83894 MOLECLR DXS; SEP GEL ELEC-PHORE 0.00% 8.71% $83896 MOLECLR DXS; NUCLEIC ACID PROBE EA 0.00% 10.74% $83901 MOLEC DX; AMPL NUCLEIC ACID-MXPLEX 0.00% 9.58% $$$83912 MOLECULAR DXS; INTEPR&REPORT 0.00% 10.45% $84144 PROGESTERONE 0.00% 3.48% $$$$84436 THYROXINE; TOTAL 0.00% 4.64% $$$84439 THYROXINE; FREE 0.00% 3.92% $$$84443 THYROID STIMULATING HORMONE 0.00% 19.59% $$$$84450 TRANSFERASE; ASPARTATE AMINO 0.00% 2.32% $$84460 TRANSFERASE; ALANINE AMINO 0.00% 2.32% $$84479 THYROID HORMONE UPTAKE/BINDNG RATIO 0.00% 4.21% $$84520 UREA NITROGEN; QUANTITATIVE 0.00% 2.03% $84550 URIC ACID; BLOOD 0.00% 2.18% $84702 GONADOTROPIN CHORIONIC; QUAN 16.67% 40.78% $$$84703 GONADOTROPIN CHORIONIC; QUALITATIVE 0.00% 2.32% $$$

Page 19 of 23

BlueCross BlueShield of TexasBlueChoice® Solutions Network

CPT / HCPCS Code Description % of Episodes

Comparison % of

EpisodesRelative Cost

85007 BLD CNT; SMER MIC EX MNL DIFF WBC 33.33% 3.92% $85014 BLOOD COUNT; HEMATOCRIT 50.00% 45.72% $85018 BLOOD COUNT; HEMOGLOBIN 0.00% 42.96% $85027 BLOOD COUNT; COMPLETE AUTOMATIC 50.00% 14.08% $$85384 FIBRINOGEN; ACTIVITY 0.00% 2.18% $$$85461 HGB/RBC FETAL-HEMORR; ROSETTE 0.00% 2.76% $$85610 PROTHROMBIN TIME; 0.00% 2.76% $85660 SICKLING OF RBC REDUCTION 0.00% 6.82% $$85730 P T T; PLASMA/WHOLE BLOOD 0.00% 2.76% $$86022 ANTIBODY ID; PLATELET ANTIBODIES 0.00% 16.69% $$$86336 INHIBIN A 0.00% 23.37% $$$$86592 SYPHILIS TEST; QUALITATIVE 100.00% 80.55% $86688 ANTIBODY; HTLV-II 0.00% 9.87% $$$86701 ANTIBODY; HIV-1 100.00% 53.27% $$$86703 ANTIBODY; HIV-1&HIV-2 SINGLE ASSAY 100.00% 45.14% $$$$86762 ANTIBODY; RUBELLA 0.00% 12.77% $$$$86777 ANTIBODY; TOXOPLASMA 0.00% 2.90% $$$$86778 ANTIBODY; TOXOPLASMA IGM 0.00% 2.32% $$$$86803 HEPATITIS C ANTIBODY; 0.00% 5.81% $$$$86850 ANTIBDY SCR RBC EA SERUM TECHNIQUE 66.67% 38.32% $$$86870 ANTIB ID RBC ANTIB EA PANEL EA SERM 0.00% 3.05% $$$86880 ANTIHUMAN GLOB TEST; DIR EA ANTISRM 0.00% 3.34% $$86885 ANTIHUMAN GLOB TEST; INDIR QUAL EA 0.00% 12.19% $$86886 ANTIHUMAN GLOB; INDIRECT TITER EA 0.00% 3.63% $$86901 BLOOD TYPING; RH 66.67% 72.71% $$$87070 CULT BACT;NO URINE/BLD/STOOL AEROBC 0.00% 2.47% $$$87077 CULT BACT; AEROB-ADD-DEFIN ID-EA 0.00% 3.92% $$$87081 CULT PRESUMP PATH ORGNSMS SCR ONLY; 0.00% 52.83% $$87086 CULT BACTERL; QUAN COLONY CNT URINE 100.00% 36.43% $$$87088 CULT BACT; W/ISOLTN & ID ISOL-URINE 33.33% 9.58% $$$87147 CULT TYPE; IMMUNOLOG METHD/ANTISERU 0.00% 6.53% $$87149 CULT TYPING; ID NUCLEIC ACID PROBE 0.00% 22.64% $$$$87184 SUSCEPT-ANTIMICROB; DISK METH-PLATE 0.00% 3.05% $$$87186 SUSCEPT-ANTIMICRB; MICRO/AGAR DILUT 0.00% 2.76% $$$87210 SMEAR-PRIM W/INTERPT; WET MOUNT 0.00% 4.93% $87340 INF AGT-IMMUNOAS; HEP B SURF ANTIG 100.00% 51.96% $$$87490 INF AGT-DNA/RNA; CHLAMYD TRACH-DIR 0.00% 18.29% $$$$87491 INF AGT-DNA/RNA; CHLAMYD TRACH-AMP 0.00% 7.40% $$$$$87590 INF AGT-DNA/RNA; NEISSR GNRRHEA-DIR 0.00% 18.29% $$$$87591 INF AGT-DNA/RNA; NEISSR GNRRHEA-AMP 0.00% 7.40% $$$$$87800 INF AGT-DNA/RNA MX ORG; DIR PROBE 0.00% 4.21% $$$$$88142 CYTPTH CERV/VAG; THIN PREP; MNL SCR 16.67% 25.40% $$$$88164 CYTOPATH CERV/VAG BETHSEDA;MNL PHYS 0.00% 4.50% $$$88302 LEVEL II - SURG PATH GROSS&MIC EXAM 0.00% 3.19% $$$$$88307 LEVEL V- SURG PATH GROSS/MICRO EXAM 0.00% 12.92% $$$$$90782 THERAPEUTIC PROPH/DX INJ; SUBQ/IM 0.00% 4.35% $99000 HANDL/CONVEY SPECMN-OFFIC TO LAB 0.00% 6.24% $99050 SRVC REQUEST AFTR HRS ADD TO BASIC 16.67% 0.87% $99140 ANES-COMPLICATED EMERGENCY CONDS 0.00% 7.55% na99203 OFC/OUTPT E&M NEW MOD-SEVER 30 MIN 0.00% 4.06% $$$99204 OFC/OUTPT E&M NEW MOD-HI 45 MIN 16.67% 6.68% $$$$99205 OFC/OUTPT E&M NEW MOD-HI 60 MIN 0.00% 2.32% $$$$$99211 OFC/OUTPT E&M ESTAB 5 MIN 0.00% 4.35% $99212 OFC/OUTPT E&M ESTAB MINOR 10 MIN 0.00% 5.81% $99214 OFC/OUTPT E&M ESTAB MOD-HI 25 MIN 0.00% 11.61% $$$99215 OFC/OUTPT E&M ESTAB MOD-HI 40 MIN 0.00% 4.06% $$$$99243 OFFICE CNSLT NEW/ESTAB MOD 40 MIN 0.00% 4.06% $$$$

Page 20 of 23

BlueCross BlueShield of TexasBlueChoice® Solutions Network

CPT / HCPCS Code Description % of Episodes

Comparison % of

EpisodesRelative Cost

99284 ER VISIT E&M HIGH SEVER URGENT EVAL 0.00% 2.03% $$$J2790 INJECTION, RHO (D) IMMUNE GLOBULIN, HUMAN, ONE DOSE

PACKAGE0.00% 3.19% $$$$$

Page 21 of 23

This chart contains up to TOP 14 CPT codes based on the % of episodes, the comparison % of episodes and their difference.

Percent of Episodes CPT Codes Houston OB-Gynecology

Delivery, Vaginal Severity 1.00 Comorbidity Group I

0% 20% 40% 60% 80% 100% 120%

OFC/OUTPT E&M NEW MOD-HI 45 MIN

INF AGT-IMMUNOAS; HEP B SURF ANTIG

CULT BACT; W/ISOLTN & ID ISOL-URINE

CULT BACTERL; QUAN COLONY CNT URINE

ANTIBDY SCR RBC EA SERUM TECHNIQUE

ANTIBODY; HIV-1&HIV-2 SINGLE ASSAY

ANTIBODY; HIV-1

BLOOD COUNT; COMPLETE AUTOMATIC

HGB FRACTIONATION&QUAN; CHROMATGRPH

OBSTETRIC PANEL

RTU PG UTRUS LTD 1/MORE FETUSES

RTU PG UTRUS FETL ANAT ABD;1/1 GEST

ROUTINE OB CARE W/VAG DEL & PP CARE

AMNIOCENTESIS; DIAGNOSTIC

9920

487

340

8708

887

086

8685

086

703

8670

185

027

8302

180

055

7681

576

811

5940

059

000

% of Episodes Comparison % of Episodes

Solutions ID UPUE25423 Specialty OB-GynecologyArea Houston

How sick are my patients? Lower Comorbidity Index = Healthier; higher comorbidity index = sicker.Are costs for my patients higher or lower? Risk Adjusted Cost Index greater than 1.00 indicates costs

higher than peers for similar cases.

How do my costs compare to peers? Area greater than 0% contribute to a higher RACI.

Were more services used? Which types? Area greater than 0% indicate higher utilization than peers.

0 0.2 0.4 0.6 0.8 1 1.2Bar indicates range of Comorbidity Index for specialty peers in areaRACI Comorbidity Index

Your Cost Compared to Peers

-60% -50% -40% -30% -20% -10% 0% +10% +20% +30% +40%

Cost per admit

Admit cost per episode

Amb care

Amb facility

Amb prof

Office

ER

Lab

Imaging

Your Utilization Compared to Peers

-80% -70% -60% -50% -40% -30% -20% -10% 0% +10%

Admits

Days

ALOS

Office

ER

Lab

Imaging