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Methodist Hospitals of Dallas · HC CT Head Brain Woc
$1,073.40
Source file dated 2026-03-23 · both
Source note: OPPS APC; APC Pricing (APC Code: 5522 / Adjusted APC Price: 105.02), and; Pricing Extension - MHS HB XR PRC 90 DEGREE - Medicare OPPS Outlier; Note: No outlier payment added to this line. Paid as 165% of $105.02 as defined in the pricing extension.; Estimated Allowed Amount: 173.29
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