Two Kinds of Hospitals

Under the federal Hospital Price Transparency rule, Idaho's hospitals are required to publish a list price, known in the rule as the gross charge, for every item and service they provide. This report measures what they actually publish. The threshold is 260% of Medicare, the line Indiana wrote into law for employer contracts, measured under the Solomon Standard with the same instrument as Reports No. 1 through 9.

Of 90,738 list prices that could be matched to a 2026 Medicare rate, 70,350 sit above the line. That is 77.5%. At 200% of Medicare the share is 87.5%. Move the line up to 300% of Medicare and 73.0% of prices are still above it. Excluding extreme prices leaves the figure at 77.5%; excluding Idaho's one emergency hospital that is not Medicare-certified moves it to 77.4%.

Idaho sits seventh of ten, above New York, Michigan and Maryland. Across the ten states, the series has now measured 1,702,997 benchmarkable list prices. In every one of the ten, most of them sit above the line.

What sets Idaho apart is the size of its hospitals. Twenty-two of the 38 hospital files in this report belong to critical access hospitals, small rural hospitals with 25 or fewer beds. No earlier state had a critical access majority. Those 22 price above the line far less often than the rest of the state. Idaho's 77.5% is the blend of two groups of hospitals: its 22 critical access hospitals, at 66.4%, and its other hospitals, at 85.7%. The state's largest systems sit well above both: St. Luke's, HCA and Portneuf are all above 93%.

Idaho is measured on 38 hospital price files from 10 systems and 20 independent hospitals; see Methodology. Price counts reflect the current measurement table and may differ slightly from counts in earlier reports as hospital files are reloaded. Headline shares are unchanged unless a dated correction note says otherwise.

The 19.3-point difference between these two groups is the reason Idaho sits below the series' larger states. Critical access hospitals carry 42.5% of the prices in this report. Measured on its own, the rest of Idaho would sit at 85.7%, alongside North Carolina.

Both groups are measured in the same manner, by comparing each hospital's list price to the Medicare fee schedule rate for the same service. For critical access hospitals, that rate is a reference point rather than what Medicare actually pays them. Medicare pays these hospitals based on their reported costs, not its fee schedule.

One of the 16 hospitals that are not critical access, St. Joseph Regional Medical Center in Lewiston, publishes no list price at all and contributes no prices; see What the Files Disclose.

The Boise metro area follows the federal definition: Ada, Boise, Canyon, Gem and Owyhee counties. Its seven hospitals are St. Luke's Regional, St. Luke's Nampa, Saint Alphonsus Regional, Saint Alphonsus Nampa, Treasure Valley Hospital, HCA West Valley in Caldwell, and Valor Health in Emmett.

St. Luke's is Idaho's largest system and the largest contributor to this report: 30.6% of every benchmarkable price in the state. Its five hospitals, from Boise to Twin Falls to McCall, publish one price list. A CT scan of the head is $1,361 at each of them. Across that list, 93.5% of prices sit above the line.

Kootenai Health, in the north, sits at 48.6%. Its two rural hospitals, Clearwater Valley in Orofino and St. Mary's in Cottonwood, also share one list, and it is the lowest in the state: 29.9% of prices above the line. St. Luke's list and Kootenai's rural list sit 63.6 points apart. In Idaho, as in Florida, the price moves with the owner.

By hospital, the share above the line runs from 29.9% at Clearwater Valley and St. Mary's to 98.2% at Treasure Valley Hospital in Boise, a physician-owned surgical hospital.

LifePoint Health (St. Joseph Regional Medical Center, Lewiston) publishes no list prices and contributes none; see What the Files Disclose.

In 2026, Medicare pays $106.81 for a CT scan of the head without contrast (CPT 70450). Thirty-six Idaho hospitals publish it. Each hospital's price here is its highest full-service list price for the code:

Idaho's cheapest CT of the head costs about half of Florida's cheapest. Among Medicare-certified hospitals, the state's spread for this scan is 3.9 to 1.

Post Falls ER & Hospital is a five-bed, state-licensed emergency hospital that is not Medicare-certified. Its file prices each CT scan twice by setting: the same head scan is $9,416 in one setting and $1,242.30 as an outpatient service. This exhibit takes every hospital's highest full-service price, so it shows $9,416. It is the highest price in Idaho on every procedure this report examined.

The 36 hospitals publish 29 distinct prices, because four groups share a price list: St. Luke's five hospitals ($1,361), Saint Alphonsus's two ($1,669), Kootenai's Clearwater Valley and St. Mary's ($1,273), and Idaho Falls Community with Mountain View ($737). Each group's price is one decision, not several.

Prices are each hospital's highest full-service list price for the code, excluding component-only lines (professional or technical only) and $1.00 placeholders. In the exhibits, a hospital is named only where it sets the state's floor or ceiling, or where it shares a price list.

For inpatient care, hospitals publish the rates they have negotiated with each insurer for each diagnosis-related group, measured here against each hospital's own wage-adjusted Medicare payment. Fourteen Idaho hospitals are paid by Medicare this way and publish negotiated inpatient rates. Idaho's 22 critical access hospitals are paid by Medicare on cost, not by diagnosis group, so they have no Medicare inpatient rate to measure against and are not included.

At the ceiling, Idaho's hospitals charge some insurer a median of 3.10 times Medicare for an inpatient stay, and 70.4% of those ceiling rates sit above the 260% line. That is below Florida's 4.37x and New Jersey's 3.79x, and just above North Carolina's 3.04x.

In these files, four commercial insurers publish usable inpatient dollar rates at four or more of the 14 inpatient hospitals: SelectHealth (7 hospitals), Regence BlueShield of Idaho (6), PacificSource (5) and Blue Cross of Idaho (4). For plans their files name as commercial, each insurer's median across those hospitals falls between 3.0 and 3.2 times Medicare for an inpatient stay. Six insurers' Medicare Advantage plans, each at seven or more hospitals, have medians between 1.22 and 1.25 times Medicare. Cigna publishes its inpatient contracts labeled commercial (at four hospitals) and labeled PPO (at two more) as a percentage of billed charges rather than a dollar rate, so what it pays at those hospitals depends on each hospital's list price.

At the floor, the lowest negotiated rate per stay has a median of 1.22 times Medicare across eight hospitals, ranging from 1.05 to 1.40, a band that includes SCAN's 1.12. SCAN is the California Medicare Advantage plan used as the control in this series since Report No. 5. Four more hospitals have floors below Medicare, from 0.79 to 0.94 times; as in Florida, they are set aside from the floor figure rather than pooled with it. At the two Saint Alphonsus hospitals, that floor is set by an Oregon Medicaid managed-care plan; at the two HCA hospitals, by plans whose names do not say what they are. Two more hospitals publish a minimum that is not a price: Mountain View lists the same $2,618 for 755 different diagnosis groups, the same amount for a heart failure admission as for a joint replacement, and Northwest Specialty uses two flat amounts. A rate that does not change with the diagnosis is a flat per-case amount, not a negotiated price for the stay, and this report does not cite it. The lowest rate and the highest rate belong to different insurers at the same hospital. Which one a plan pays depends on its contract.

The payer names behind the floor were read from the hospitals' own files and checked against the published minimum on every diagnosis group. At four hospitals, Kootenai Health, St. Joseph Regional, St. Luke's Regional and St. Luke's Nampa, Medicare Advantage or commercial plans set the floor on most diagnosis groups. Elsewhere the floor belongs to someone else. At Madison Memorial it is a workers' compensation plan. At Idaho Falls Community and St. Luke's Magic Valley, Medicare Advantage, Tricare and veterans' plans publish identical amounts.

Limits. The inpatient basis covers 14 of 38 files. The 22 critical access hospitals are outside Medicare's inpatient payment system. Post Falls ER & Hospital has no Medicare provider number. Portneuf Medical Center has a Medicare inpatient rate but publishes no diagnosis-group codes at all. Treasure Valley's floor is included, but its floor payer is not named, because a Medicare Advantage plan and Medicare itself publish identical amounts there.

Every hospital in this report has attested under federal rule that its price file is accurate and complete. The files were read as published.

• A hospital with no list price. St. Joseph Regional Medical Center in Lewiston publishes 12,232 rows. Not one carries a list price or a cash price; every charge in the file states negotiated rates only. 5,235 of its rows carry a code Medicare has a rate for. The hospital published nothing to compare it with, so it contributes no prices to this report.
• No inpatient codes. Twelve of the 38 hospitals publish no MS-DRG prices. One of them, Portneuf Medical Center in Pocatello, is a full acute-care hospital paid by Medicare per diagnosis group, and publishes no diagnosis-group codes of any kind.
• The implant catalogue. St. Luke's five files carry 304,261 rows. 225,761 of them, 74.2%, are device and implant codes, a catalogue repeated in each hospital's file. Medicare's fee schedule has no rate for these codes, so none of them enters this report's measurement. St. Luke's contributes 27,748 benchmarkable prices. The catalogue is in the files; it does not move the number.
• Shared price lists. Four groups of hospitals publish one price list between them: St. Luke's five, Saint Alphonsus's two, Kootenai's Clearwater Valley and St. Mary's, and Idaho Falls Community with Mountain View. They are counted as published, as the series has treated shared price lists since Report No. 7.
• One price, two settings. Post Falls ER & Hospital prices each CT scan twice, by setting, with the higher price several times the lower. Removing the hospital entirely moves the headline from 77.5% to 77.4%.

Idaho's small, rural hospitals are where list prices sit closest to Medicare's fee schedule. The larger systems serving the state's cities are where they sit furthest above it.

For employers, the files show that Idaho's hospitals already accept rates close to Medicare for inpatient care from some payers, for the same stays they price far higher for others. What an employer's plan pays depends on what it negotiates, not on what hospitals can accept.

The question this report cannot answer is why hospitals in the same state, publishing under the same federal rule, price so differently. The files only show that they do.