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Methodist Hospitals of Dallas · HC Sane Em Lvl 99283 W/O Photo
$69.90
Source file dated 2026-03-23 · both
Source note: OPPS; APC Pricing (APC Code: 05023 / Adjusted APC Price: 266.29), and; Pricing Extension - HB XR PRC - Tricare OPPS Outlier; Note: No outlier payment added to this line.; Estimated Allowed Amount: 266.29
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