Idaho / Kootenai Health

CMS certification 130049 · Coeur D'Alene, ID · 2 entries in CMS's price-transparency list

Kootenai Health: charges and Medicare payments

Kootenai Health reported 3,994 Medicare inpatient stays across 127 DRGs in 2024. Across them it charged 3.52 times what it was paid — among the lower ratios in Idaho, number 12 of 13 hospitals with at least 100 stays (state median 4.16×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 327 stays at an average charge of $46,866, 48% below the national average. It also billed 5,242 outpatient services, charging 5.36 times what Medicare paid.

1Medicare inpatient stays 3,994
2Charge ÷ paid, inpatient 3.52×
3Rank in ID (highest ratio = 1) 12 of 13
4CMS price-transparency actions 2

Average charge per stay at Kootenai Health, its 10 most frequent DRGs, bars to scale. Source: CMS DY2024.

Inpatient stays

For the 127 DRGs that can be compared with the national average, Kootenai Health charged more than the national average in 0 (0%). Payments follow Medicare's rates, so they usually vary far less than charges.

DRG	Stays	Avg charge	vs US	Avg paid
871 Septicemia or Severe Sepsis without MV >96 Hours with MCC	327	$46,866	-48%	$14,770
291 Heart Failure and Shock with MCC	222	$32,983	-41%	$9,759
274 Percutaneous and Other Intracardiac Procedures without MCC	173	$105,597	-33%	$24,545
189 Pulmonary Edema and Respiratory Failure	126	$30,497	-47%	$10,171
177 Respiratory Infections and Inflammations with MCC	119	$41,902	-41%	$11,773
885 Psychoses	98	$40,786	-7%	$11,769
267 Endovascular Cardiac Valve Replacement and Supplement...	76	$146,085	-34%	$37,292
378 Gastrointestinal Hemorrhage with CC	75	$26,980	-44%	$7,614
193 Simple Pneumonia and Pleurisy with MCC	74	$31,662	-47%	$9,666
322 Percutaneous Cardiovascular Procedures with Intraluminal...	73	$74,906	-35%	$15,132
853 Infectious and Parasitic Diseases with O.R. Procedures with...	67	$105,610	-54%	$33,617
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	60	$22,317	-44%	$6,519
683 Renal Failure with CC	60	$21,325	-48%	$7,145
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	56	$29,246	-40%	$7,932
065 Intracranial Hemorrhage or Cerebral Infarction with CC or...	55	$28,057	-50%	$8,048
897 Alcohol, Drug Abuse or Dependence without Rehabilitation...	50	$17,471	-53%	$7,025
321 Percutaneous Cardiovascular Procedures with Intraluminal...	49	$96,523	-41%	$21,937
481 Hip and Femur Procedures except Major Joint with CC	45	$54,599	-46%	$15,204
522 Hip Replacement with Principal Diagnosis of Hip Fracture...	45	$64,525	-37%	$16,875
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	44	$24,183	-35%	$6,362
377 Gastrointestinal Hemorrhage with MCC	43	$47,396	-44%	$14,579
330 Major Small and Large Bowel Procedures with CC	42	$61,369	-48%	$18,282
682 Renal Failure with MCC	42	$28,211	-57%	$10,298
286 Circulatory Disorders except AMI, with Cardiac...	41	$62,838	-44%	$16,467
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	40	$35,651	-41%	$9,745
208 Respiratory System Diagnosis with Ventilator Support <=96...	39	$66,203	-51%	$21,054
308 Cardiac Arrhythmia and Conduction Disorders with MCC	37	$30,747	-46%	$9,699
689 Kidney and Urinary Tract Infections with MCC	37	$27,702	-46%	$8,686
280 Acute Myocardial Infarction, Discharged Alive with MCC	36	$46,210	-39%	$12,376
064 Intracranial Hemorrhage or Cerebral Infarction with MCC	35	$44,767	-55%	$13,804
603 Cellulitis without MCC	35	$19,200	-49%	$6,715
698 Other Kidney and Urinary Tract Diagnoses with MCC	34	$35,140	-52%	$11,235
389 Gastrointestinal Obstruction with CC	33	$16,425	-58%	$6,637
390 Gastrointestinal Obstruction without CC/MCC	32	$15,851	-43%	$4,659
025 Craniotomy and Endovascular Intracranial Procedures with MCC	30	$116,453	-50%	$34,421
175 Pulmonary Embolism with MCC or Acute Cor Pulmonale	30	$32,917	-49%	$10,596
266 Endovascular Cardiac Valve Replacement and Supplement...	30	$168,001	-41%	$46,728
253 Other Vascular Procedures with CC	29	$60,025	-54%	$19,665
329 Major Small and Large Bowel Procedures with MCC	28	$130,423	-39%	$41,225
391 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	28	$33,994	-44%	$10,387
394 Other Digestive System Diagnoses with CC	27	$22,279	-53%	$7,388
039 Extracranial Procedures without CC/MCC	26	$39,158	-39%	$8,928
194 Simple Pneumonia and Pleurisy with CC	26	$23,232	-39%	$6,405
233 Coronary Bypass with Cardiac Catheterization or Open...	26	$278,840	-28%	$69,777
543 Pathological Fractures and Musculoskeletal and Connective...	26	$22,782	-54%	$8,131
690 Kidney and Urinary Tract Infections without MCC	26	$22,477	-41%	$6,278
287 Circulatory Disorders except AMI, with Cardiac...	25	$40,806	-36%	$9,080
236 Coronary Bypass without Cardiac Catheterization without MCC	24	$159,149	-24%	$34,909
252 Other Vascular Procedures with MCC	24	$95,451	-44%	$27,626
418 Laparoscopic Cholecystectomy without C.D.E. with CC	24	$55,291	-41%	$16,276
281 Acute Myocardial Infarction, Discharged Alive with CC	23	$32,250	-36%	$7,299
480 Hip and Femur Procedures except Major Joint with MCC	22	$76,986	-45%	$23,204
190 Chronic Obstructive Pulmonary Disease with MCC	21	$32,977	-35%	$8,509
243 Permanent Cardiac Pacemaker Implant with CC	21	$61,801	-44%	$17,038
314 Other Circulatory System Diagnoses with MCC	21	$46,514	-51%	$14,764
101 Seizures without MCC	20	$22,720	-53%	$7,100
178 Respiratory Infections and Inflammations with CC	20	$22,106	-51%	$7,482
269 Aortic and Heart Assist Procedures except Pulsation Balloon...	20	$118,566	-38%	$31,407
229 Other Cardiothoracic Procedures without MCC	19	$120,663	-27%	$28,901
309 Cardiac Arrhythmia and Conduction Disorders with CC	19	$24,114	-33%	$6,007

Showing the 60 most frequent of 127 DRGs.

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Comprehensive Observation Services	1,028	$14,166	$2,579
Level 2 Excision/ Biopsy/ Incision and Drainage	412	$6,098	$1,523
Level 2 Upper GI Procedures	373	$6,080	$1,765
Level 1 Endovascular Procedures	347	$21,582	$3,065
Level 3 Electrophysiologic Procedures	283	$104,681	$22,438
Level 5 Musculoskeletal Procedures	234	$53,454	$12,164
Level 3 Vascular Procedures	211	$14,739	$2,983
Level 1 Laparoscopy and Related Services	186	$23,649	$5,460
Level 2 Musculoskeletal Procedures	172	$6,862	$1,486
Level 4 Urology and Related Services	171	$13,192	$3,259
Level 5 Urology and Related Services	170	$18,701	$4,849
Level 4 Musculoskeletal Procedures	143	$29,863	$6,761
Level 3 Excision/ Biopsy/ Incision and Drainage	124	$11,634	$2,657
Level 2 Laparoscopy and Related Services	117	$39,701	$9,706
Level 3 Pacemaker and Similar Procedures	108	$39,474	$10,060
Level 3 Endovascular Procedures	104	$52,361	$10,445
Level 3 Musculoskeletal Procedures	93	$14,370	$3,052
Level 2 Pacemaker and Similar Procedures	77	$32,953	$7,990
Level 2 Endovascular Procedures	71	$30,383	$5,432
Level 2 Vascular Procedures	68	$5,675	$1,504
Level 4 Airway Endoscopy	61	$14,757	$3,559
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	52	$14,031	$3,288
Level 4 Pacemaker and Similar Procedures	49	$73,757	$18,475
Level 3 Urology and Related Services	49	$10,545	$1,865
Complex GI Procedures	47	$21,421	$4,979

Against the Idaho average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Kootenai Health charged $46,866 on average, 29% less than the Idaho average of $65,631, and was paid $14,770 against a state average of $16,189. For Heart Failure and Shock with MCC (DRG 291), Kootenai Health charged $32,983 on average, 30% less than the Idaho average of $47,013, and was paid $9,759 against a state average of $10,637. For Percutaneous and Other Intracardiac Procedures without MCC (DRG 274), Kootenai Health charged $105,597 on average, 13% less than the Idaho average of $121,268, and was paid $24,545 against a state average of $24,800. For Pulmonary Edema and Respiratory Failure (DRG 189), Kootenai Health charged $30,497 on average, 30% less than the Idaho average of $43,340, and was paid $10,171 against a state average of $10,491. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $14,166 was 12% below the state average of $16,143. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $6,098 was 26% below the state average of $8,252. For Level 2 Upper GI Procedures (outpatient APC 5302), its average charge of $6,080 was 27% below the state average of $8,277. For Level 1 Endovascular Procedures (outpatient APC 5191), its average charge of $21,582 was 26% below the state average of $29,086.

Price-transparency record

CMS's enforcement list records these actions for a hospital named Kootenai Health in Coeur D'Alene, ID, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:

Warning Notice — 2023-07-24 (CMS case 341)
Closure Notice — 2023-11-02 (CMS case 341)

A warning notice or corrective-action request is not a finding of wrongdoing; "Met Requirements" and closure notices record that CMS's review ended. Matched to this hospital by exact name, city and state.

Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.

Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.