RC 099

CB BLOOD ALCOHOL at Dignity Health

Mt Shasta, CA

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Pricing by billing methodology

Price type

Payers reporting RC 099 at Dignity Health

Negotiated rates from the hospital’s own file: 8 payers, 25 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Aetna medicare\|all plans fee schedule · outpatient	$61	$61	$54	88%	—	$7 – $114
2	Anthem medicare\|all plans fee schedule · outpatient	$61	$61	$54	88%	—	$7 – $114
3	Blue Cross Blue Shield medicare\|all plans fee schedule · outpatient	$61	$61	$54	88%	—	$7 – $114
4	Humana medicare\|all plans fee schedule · outpatient	$61	$61	$54	88%	—	$7 – $114
5	Kaiser medicare\|all plans fee schedule · outpatient	$61	$61	$54	88%	—	$7 – $114
6	UnitedHealthcare medicare\|all plans fee schedule · outpatient	$61	$61	$54	88%	—	$7 – $114
7	Anthem medicaid\|all plans fee schedule · outpatient	$87	$87	—	—	—	$87 – $87
8	Cigna commercial\|all other plans fee schedule · inpatient	$165	$165	$140	85%	—	$25 – $305
9	Cigna commercial\|all other plans fee schedule · outpatient	$165	$165	$140	85%	—	$25 – $305
10	Cigna commercial\|ppo fee schedule · inpatient	$165	$165	$140	85%	—	$25 – $305
11	Cigna commercial\|ppo fee schedule · outpatient	$165	$165	$140	85%	—	$25 – $305
12	UnitedHealthcare commercial\|hmo fee schedule · inpatient	$173	$173	$147	85%	—	$26 – $320
13	UnitedHealthcare commercial\|hmo fee schedule · outpatient	$173	$173	$147	85%	—	$26 – $320
14	Aetna commercial\|all other plans fee schedule · outpatient	$175	$175	$149	85%	—	$26 – $324
15	Aetna commercial\|hmo fee schedule · outpatient	$175	$175	$149	85%	—	$26 – $324
16	Aetna commercial\|ppo fee schedule · outpatient	$175	$175	$149	85%	—	$26 – $324
17	Aetna commercial\|all other plans fee schedule · inpatient	$177	$177	$150	85%	—	$26 – $327
18	Aetna commercial\|hmo fee schedule · inpatient	$177	$177	$150	85%	—	$26 – $327
19	Aetna commercial\|ppo fee schedule · inpatient	$177	$177	$150	85%	—	$26 – $327
20	UnitedHealthcare commercial\|all other plans fee schedule · inpatient	$177	$177	$150	85%	—	$26 – $327
21	UnitedHealthcare commercial\|all other plans fee schedule · outpatient	$177	$177	$150	85%	—	$26 – $327
22	MultiPlan commercial\|all plans fee schedule · inpatient	$197	$197	$168	85%	—	$29 – $365
23	MultiPlan commercial\|all plans fee schedule · outpatient	$197	$197	$168	85%	—	$29 – $365
24	Anthem commercial\|exchange fee schedule · outpatient	$253	$253	—	—	—	$253 – $253
25	Anthem commercial\|all other plans fee schedule · outpatient	$312	$312	—	—	—	$312 – $312

Last updated: Feb 28, 2026

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