RC 402
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
HC ULT/GUIDE,INTRAUT FETAL TRS/CO
Grapevine, TX
See all hospitals reporting RC 402 →Price type
Baylor Scott & White Medical Center - Grapevine’s median price of $349 is 16% above the median hospital's median price ($300), higher than 58% of the 1,982 hospitals reporting RC 402. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 40 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 | Superior Healthplan medicaid facility · fee schedule · outpatient | $96.28 | $103.79 | $30.35 – $446.27 |
| 2 | Aetna medicaid facility · fee schedule · outpatient | $98.21 | $105.87 | $30.96 – $455.20 |
| 3 | UnitedHealthcare medicaid/chip facility · fee schedule · outpatient | $103.02 | $111.06 | $32.47 – $477.51 |
| 4 | Superior Healthplan medicaid facility · percent of total billed charges · outpatientfrom % of charges | $139.53 | $127.91 | $29.44 – $253.11 |
| 5 | Aetna medicaid facility · percent of total billed charges · outpatientfrom % of charges | $142.32 | $130.46 | $30.03 – $258.17 |
| 6 | UnitedHealthcare medicaid/chip facility · percent of total billed charges · outpatientfrom % of charges | $149.29 | $136.86 | $31.50 – $270.83 |
| 7 | Baylor Scott White Health Plan medicare advantage facility · fee schedule · outpatient | $99.94 | $159.98 | $27.64 – $1,505 |
| 8 | Aetna medicare advantage facility · fee schedule · outpatient | $105.20 | $168.41 | $29.10 – $1,584 |
| 9 | Humana medicare facility · fee schedule · outpatient | $105.20 | $168.41 | $29.10 – $1,584 |
| 10 | Blue Cross Blue Shield medicare advantage facility · fee schedule · outpatient | $110.46 | $176.83 | $30.55 – $1,663 |
| 11 | Superior Healthplan medicare facility · fee schedule · outpatient | $110.46 | $176.83 | $30.55 – $1,663 |
| 12 | Blue Cross Blue Shield blue advantage facility · fee schedule · outpatient | $212.47 | $183.64 | $26.66 – $466.08 |
| 13 | UnitedHealthcare medicare advantage facility · fee schedule · outpatient | $117.82 | $188.61 | $32.59 – $1,774 |
| 14 | Baylor Scott White Health Plan bsw premier - small group facility · fee schedule · outpatient | $126.24 | $202.09 | $34.92 – $1,901 |
| 15 | Baylor Scott White Health Plan bsw premier - individual facility · fee schedule · outpatient | $132.03 | $211.35 | $36.52 – $1,988 |
| 16 | Blue Cross Blue Shield blue premier/high performance network/my bluehealth facility · fee schedule · outpatient | $300.65 | $263.89 | $37.72 – $849.47 |
| 17 | Baylor Scott White Health Plan bsw plus - small group facility · fee schedule · outpatient | $173.58 | $277.87 | $48.02 – $2,613 |
| 18 | Blue Cross Blue Shield city of dallas facility · fee schedule · outpatient | $403.69 | $348.91 | $50.65 – $885.55 |
| 19 | Ambetter ambetter exchange facility · fee schedule · outpatient | $226.18 | $362.07 | $62.56 – $3,405 |
| 20 | Blue Cross Blue Shield blue essentials (hmo) facility · fee schedule · outpatient | $426.01 | $368.21 | $53.45 – $934.49 |
| 21 | Blue Cross Blue Shield bluechoice (ppo) facility · fee schedule · outpatient | $448.31 | $387.48 | $56.25 – $983.43 |
| 22 | Baylor Scott White Health Plan bsw premier - large group/bsw premier direct to employer (rate 1)/bswh employee facility · percent of total billed charges · outpatientfrom % of charges | $377.14 | $464.40 | $96.77 – $2,598 |
| 23 | Cigna local plus facility · percent of total billed charges · outpatientfrom % of charges | $377.14 | $464.40 | $96.77 – $2,598 |
| 24 | Aetna medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $442.26 | $465.68 | $121.28 – $909.17 |
| 25 | Ambetter ambetter exchange facility · percent of total billed charges · outpatientfrom % of charges | $479.12 | $504.49 | $131.39 – $984.94 |
Last updated: Jun 29, 2026
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