CPT J0696
The standard charge for Injection, ceftriaxone sodium, per 250 mg is $22.02. However, the price you pay depends on the rate negotiated by your insurance plan and what portion your insurance plan requires you to contribute towards that amount. Enter your info below to start your estimate.
To calculate an estimate of your cost, you will need two things:
LOCATION
2350 Hospital Drive, Webster City, IA, 50595CONTACT
(515) 832-9400 Visit WebsiteVan Diest Medical Center is committed to empowering our patients to make informed decisions about their healthcare. This includes helping patients understand the cost of care and the availability of financial assistance.
In compliance with federal law, Van Diest Medical Center provides a list of standard charges. These are reviewed on an annual basis. Charges for hospital services are not equivalent to the actual amount paid by insurance companies or patients. The amount paid for services is based on many factors, including health insurance benefit plans, applicable discounts, and services provided based on each patient’s unique needs.
I understand that the list of standard charges includes only hospital services and does not contain professional fees for non-Van Diest Medical Center physicians or advanced practice providers. It does not contain professional fees for anesthesia, physicians or advanced practice providers.
I understand that a single line item charge may not represent a complete medical service. In general, multiple charge line items are necessary to represent all components of a service (e.g. procedures, supplies, and drugs).
I understand that the list of standard charges is not intended for media use.
I understand prices are the list price of all hospital charges and not necessarily what my insurance company will pay or what I will owe to the hospital. My actual bill may include one or more of list price charges.
The hospital typically accepts a rate that is less than the list charges. Your insurer will determine what you will owe after they have paid their agreed upon amount.
We know that the billing and payment processes may seem overwhelming at times. Please contact our team at 515-832-9400.
Choose a plan to view the insurance rate estimate.
Total estimated charges
$22.02Insurance Discount
-$2.21Price Negotiated by Insurer
$19.81Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$18.90CBC WITH DIFF
$72.00INF TX MED SCHED 1ST HR
$343.80Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$60.12zonisamide 50 mg Cap [VDMC]
$1.30This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$2.21Price Negotiated by Insurer
$19.81Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$18.90CBC WITH DIFF
$72.00INF TX MED SCHED 1ST HR
$343.80Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$60.12zonisamide 50 mg Cap [VDMC]
$1.30This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$9.47Price Negotiated by Insurer
$12.55Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$11.97CBC WITH DIFF
$45.60INF TX MED SCHED 1ST HR
$217.74Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$38.07zonisamide 50 mg Cap [VDMC]
$0.83This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$9.32Price Negotiated by Insurer
$12.70Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$12.11CBC WITH DIFF
$46.14INF TX MED SCHED 1ST HR
$220.34Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$38.53zonisamide 50 mg Cap [VDMC]
$0.84This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$12.01Price Negotiated by Insurer
$10.01Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$9.54CBC WITH DIFF
$36.36INF TX MED SCHED 1ST HR
$173.62Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$30.36zonisamide 50 mg Cap [VDMC]
$0.66This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$4.41Price Negotiated by Insurer
$17.61Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$16.80CBC WITH DIFF
$64.00INF TX MED SCHED 1ST HR
$305.60Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$53.44zonisamide 50 mg Cap [VDMC]
$1.16This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$5.51Price Negotiated by Insurer
$16.51Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$15.75CBC WITH DIFF
$60.00INF TX MED SCHED 1ST HR
$286.50Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$50.10zonisamide 50 mg Cap [VDMC]
$1.09This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$12.11Price Negotiated by Insurer
$9.91Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$9.45CBC WITH DIFF
$36.00INF TX MED SCHED 1ST HR
$171.90Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$30.06zonisamide 50 mg Cap [VDMC]
$0.65This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$9.44Price Negotiated by Insurer
$12.58Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$12.00CBC WITH DIFF
$45.70INF TX MED SCHED 1ST HR
$218.20Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$38.15zonisamide 50 mg Cap [VDMC]
$0.83This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$5.51Price Negotiated by Insurer
$16.51Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$15.75CBC WITH DIFF
$60.00INF TX MED SCHED 1ST HR
$286.50Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$50.10zonisamide 50 mg Cap [VDMC]
$1.09This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$12.11Price Negotiated by Insurer
$9.91Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$9.45CBC WITH DIFF
$36.00INF TX MED SCHED 1ST HR
$171.90Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$30.06zonisamide 50 mg Cap [VDMC]
$0.65This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$6.61Price Negotiated by Insurer
$15.41Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$14.70CBC WITH DIFF
$56.00INF TX MED SCHED 1ST HR
$267.40Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$46.76zonisamide 50 mg Cap [VDMC]
$1.02This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$9.26Price Negotiated by Insurer
$12.76Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$12.17CBC WITH DIFF
$46.37INF TX MED SCHED 1ST HR
$221.41Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$38.71zonisamide 50 mg Cap [VDMC]
$0.84This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$10.63Price Negotiated by Insurer
$11.39Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$10.87CBC WITH DIFF
$41.40INF TX MED SCHED 1ST HR
$197.68Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$34.57zonisamide 50 mg Cap [VDMC]
$0.75This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$2.21Price Negotiated by Insurer
$19.81Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$18.90CBC WITH DIFF
$72.00INF TX MED SCHED 1ST HR
$343.80Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$60.12zonisamide 50 mg Cap [VDMC]
$1.30This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Insurance Discount
-$9.03Price Negotiated by Insurer
$12.99Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$12.39CBC WITH DIFF
$47.20INF TX MED SCHED 1ST HR
$225.38Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$39.41zonisamide 50 mg Cap [VDMC]
$0.86This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Price Negotiated by Insurer
$201.36Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$12.05CBC WITH DIFF
$29.07INF TX MED SCHED 1ST HR
$543.09Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$201.36This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.
Total estimated charges
$22.02Price Negotiated by Insurer
$221.80Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
Bill Venipuncture
$13.28CBC WITH DIFF
$32.02INF TX MED SCHED 1ST HR
$598.25Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$221.80This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Van Diest Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Van Diest Medical Center directly.