CMS Price Transparency Data

Diagnostic procedure preparation

Facility: Kootenai Health

Billing Code: G0279 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0279
Insurance Median: $38
Cash Discount Price: $62
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Diagnostic procedure preparation at Kootenai Health is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 0.94x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$38

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$40.41

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $40.41 (100%)

Cash / Self-Pay: $62 (153%)

Insurance Median: $38 (94%)

Cash: $62 (153% of Medicare)

Ins. Median: $38 (94% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $40.41 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
Regence Blue Shield of Idaho	$12 - $38	30%
Pacificsource	$12 - $83	30%
Premera	$12 - $84	30%
Blue Cross Blue Shield	$12 - $86	30%
UnitedHealthcare	$12 - $74	30%
Humana	$12 - $38	30%
Aetna	$12 - $68	30%
Molina Healthcare of Idaho	$17 - $39	42%
Coordinated Care of Washington	$17 - $32	42%
Molina Healthcare of Washington	$17 - $32	42%
Wellpoint	$35 - $47	87%
Magellan	$35 - $47	87%
Mountain Health Co-Op	$64	158%
Cigna	$67 - $68	166%
Interwest Health	$70	173%
First Choice Health (Ameriben)	$70 - $71	173%
Group Health/Kaiser	$138	341%

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 $62.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0279.

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 HCPCS code G0279.
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.