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Methodist Hospitals of Dallas · HC Sane Em Lvl 99285 W/O Photo
$69.90
Source file dated 2026-03-21 · both
Source note: OPPS APC; APC Pricing (APC Code: 5025 / Adjusted APC Price: 599.23), and; Pricing Extension - MHS HB PRC CIGNA HEALTHSPRING - Medicare OPPS Outlier; Note: No outlier payment added to this line. Paid as 105% of $599.23 as defined in the pricing extension.; Reimbursement capped so that total reimbursement does not exceed 100% of claim billed.; Estimated Allowed Amount: 233
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