Questions & corrections

Methodist Hospitals of Dallas · Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp

$4,212.98

Source file dated 2026-08-01 · outpatient

Source note: Re-evaluated: HLB.51559641; Using new claim; Scope: All Financial Classes; Cases: 1; OPPS APC; APC Pricing (APC Code: 5491 / Adjusted APC Price: 2,193.42), and; Pricing Extension - MHS HB PRC BCBS MEDICARE - Medicare OPPS Outlier; Note: No outlier payment added to this line. Paid as 105% of $2,193.42 as defined in the pricing extension.