CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Kootenai Health

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $111
Cash Discount Price: $203
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Kootenai Health is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $203. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.94x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.

Cash / Self-Pay

$203

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Cash / Self-Pay: $203 (173%)

Insurance Median: $111 (94%)

Cash: $203 (173% of Medicare)

Ins. Median: $111 (94% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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.

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
Coordinated Care Of Washington	$58	49%
Molina Healthcare Of Idaho	$58 - $113	49%
Molina Healthcare Of Washington	$58	49%
Blue Cross Blue Shield	$68 - $243	58%
Humana	$68 - $110	58%
Pacificsource	$68 - $221	58%
Premera	$68 - $167	58%
Regence Blue Shield Of Idaho	$68 - $148	58%
UnitedHealthcare	$68 - $243	58%
Aetna	$71 - $224	60%
Magellan	$85 - $97	72%
Wellpoint	$85 - $97	72%
Group Health/Kaiser	$99 - $396	84%
Mountain Health Co-Op	$209	178%
Cigna	$221 - $224	188%
First Choice Health (Ameriben)	$230 - $234	196%
Interwest Health	$230	196%

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 $203.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

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 99203.
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.