CMS Price Transparency Data

Blood test, basic metabolic panel

Facility: Kootenai Health

Billing Code: 80048 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80048
Insurance Median: $18
Cash Discount Price: $127
vs. Medicare Baseline: 2.13x Medicare

The contracted insurance negotiated median rate for a Blood test, basic metabolic panel at Kootenai Health is $18. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $8.46, this hospital’s rate is 2.13x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$18

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$8.46

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $8.46 (100%)

Cash / Self-Pay: $127 (1501%)

Insurance Median: $18 (213%)

Cash: $127 (1501% of Medicare)

Ins. Median: $18 (213% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $8.46 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 213% of the Medicare baseline (a markup of 113%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
UnitedHealthcare	$4 - $152	47%
Magellan	$7 - $9	83%
Wellpoint	$7 - $9	83%
Coordinated Care Of Washington	$8	95%
Humana	$8	95%
Molina Healthcare Of Idaho	$8 - $63	95%
Molina Healthcare Of Washington	$8	95%
Premera	$8 - $104	95%
Regence Blue Shield Of Idaho	$8	95%
Aetna	$9 - $140	106%
Blue Cross Blue Shield	$9 - $152	106%
Pacificsource	$9 - $19	106%
Group Health/Kaiser	$30	355%
Mountain Health Co-Op	$131	1548%
Cigna	$138 - $140	1631%
First Choice Health (Ameriben)	$144 - $146	1702%
Interwest Health	$144	1702%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $127.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80048.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Kootenai Health is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 80048.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.