Freestone Medical Center
125 Newman St
Fairfield, TX 75840
Acute Care Hospitals
Overview
- CCN450658
Procedures & prices
- KETOROLAC TROMETHAMINE INJJ1885$11cashGross $150 payers
- PROMETHAZINE HCL INJECTIONJ2550$11cashGross $160 payers
- PHENYTOIN SODIUM INJECTIONJ1165$12cashGross $170 payers
- INJ, ACETAMINOPHEN (NOS)J0131$12cashGross $170 payers
- AMIKACIN SULFATE INJECTIONJ0278$12cashGross $170 payers
- MORPHINE SULFATE INJECTIONJ2270$12cashGross $170 payers
- FENTANYL CITRATE INJECTIONJ3010$12cashGross $180 payers
- HC COLLJ CAPILLARY BLOOD SPEC36416$13cashGross $180 payers
- HC FIBRINOGEN85384$13cashGross $180 payers
- HC SYPHILIS TEST NON-TREP QUANT86593$13cashGross $180 payers
| Procedure | Code | Cash↑ | Gross | Negotiated range | Payers |
|---|---|---|---|---|---|
| KETOROLAC TROMETHAMINE INJ | J1885 | $11 | $15 | — | 0 |
| PROMETHAZINE HCL INJECTION | J2550 | $11 | $16 | — | 0 |
| PHENYTOIN SODIUM INJECTION | J1165 | $12 | $17 | — | 0 |
| INJ, ACETAMINOPHEN (NOS) | J0131 | $12 | $17 | — | 0 |
| AMIKACIN SULFATE INJECTION | J0278 | $12 | $17 | — | 0 |
| MORPHINE SULFATE INJECTION | J2270 | $12 | $17 | — | 0 |
| FENTANYL CITRATE INJECTION | J3010 | $12 | $18 | — | 0 |
| HC COLLJ CAPILLARY BLOOD SPEC | 36416 | $13 | $18 | — | 0 |
| HC FIBRINOGEN | 85384 | $13 | $18 | — | 0 |
| HC SYPHILIS TEST NON-TREP QUANT | 86593 | $13 | $18 | — | 0 |
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