CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Kootenai Health

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $129
  • Cash Discount Price: $244
  • vs. Medicare Baseline: 0.95x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Kootenai Health is $129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $244. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.95x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.
Cash / Self-Pay
$244

Average discount available for prompt cash payment at this facility.

Insurance Median
$129

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $244 (180%)
Insurance Median: $129 (95%)
Cash: $244 (180% of Medicare)
Ins. Median: $129 (95% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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.

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 $61 45%
Molina Healthcare Of Idaho $61 - $132 45%
Molina Healthcare Of Washington $61 45%
UnitedHealthcare $78 - $292 58%
Blue Cross Blue Shield $81 - $292 60%
Humana $81 - $128 60%
Premera $81 - $201 60%
Regence Blue Shield Of Idaho $81 - $179 60%
Pacificsource $82 - $266 60%
Aetna $85 - $270 63%
Magellan $100 - $113 74%
Wellpoint $100 - $113 74%
Group Health/Kaiser $101 - $460 74%
Mountain Health Co-Op $252 186%
Cigna $266 - $270 196%
Interwest Health $276 204%
First Choice Health (Ameriben) $277 - $281 204%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 2003 Kootenai Health Way, Coeur D'Alene, ID 83814
  • CMS Rating: ★★★★☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals