CPT J0696
The standard charge for Injection, ceftriaxone sodium, per 250 mg is $23.86. 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
$23.86Insurance Discount
-$2.39Price Negotiated by Insurer
$21.47Deductible 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.
CBC WITH DIFF
$72.00INF TX MED 1ST HR
$343.80lactase 3000 units Tab [VDMC]
$1.25Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$60.12VENIPUNCTURE
$18.90This 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
$23.86Insurance Discount
-$2.39Price Negotiated by Insurer
$21.47Deductible 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.
CBC WITH DIFF
$72.00INF TX MED 1ST HR
$343.80lactase 3000 units Tab [VDMC]
$1.25Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$60.12VENIPUNCTURE
$18.90This 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
$23.86Insurance Discount
-$10.26Price Negotiated by Insurer
$13.60Deductible 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.
CBC WITH DIFF
$45.60INF TX MED 1ST HR
$217.74lactase 3000 units Tab [VDMC]
$0.79Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$38.08VENIPUNCTURE
$11.97This 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
$23.86Insurance Discount
-$11.82Price Negotiated by Insurer
$12.04Deductible 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.
CBC WITH DIFF
$40.38INF TX MED 1ST HR
$192.80lactase 3000 units Tab [VDMC]
$0.70Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$33.71VENIPUNCTURE
$10.60This 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
$23.86Insurance Discount
-$11.81Price Negotiated by Insurer
$12.05Deductible 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.
CBC WITH DIFF
$40.40INF TX MED 1ST HR
$192.91lactase 3000 units Tab [VDMC]
$0.70Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$33.73VENIPUNCTURE
$10.60This 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
$23.86Insurance Discount
-$4.77Price Negotiated by Insurer
$19.09Deductible 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.
CBC WITH DIFF
$64.00INF TX MED 1ST HR
$305.60lactase 3000 units Tab [VDMC]
$1.11Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$53.44VENIPUNCTURE
$16.80This 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.
Total estimated charges
$23.86Insurance Discount
-$5.96Price Negotiated by Insurer
$17.90Deductible 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.
CBC WITH DIFF
$60.00INF TX MED 1ST HR
$286.50lactase 3000 units Tab [VDMC]
$1.04Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$50.10VENIPUNCTURE
$15.75This 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
$23.86Insurance Discount
-$11.93Price Negotiated by Insurer
$11.93Deductible 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.
CBC WITH DIFF
$40.00INF TX MED 1ST HR
$191.00lactase 3000 units Tab [VDMC]
$0.70Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$33.40VENIPUNCTURE
$10.50This 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
$23.86Insurance Discount
-$11.93Price Negotiated by Insurer
$11.93Deductible 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.
CBC WITH DIFF
$39.98INF TX MED 1ST HR
$190.92lactase 3000 units Tab [VDMC]
$0.69Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$33.39VENIPUNCTURE
$10.50This 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
$23.86Insurance Discount
-$5.96Price Negotiated by Insurer
$17.90Deductible 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.
CBC WITH DIFF
$60.00INF TX MED 1ST HR
$286.50lactase 3000 units Tab [VDMC]
$1.04Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$50.10VENIPUNCTURE
$15.75This 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
$23.86Insurance Discount
-$11.93Price Negotiated by Insurer
$11.93Deductible 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.
CBC WITH DIFF
$40.00INF TX MED 1ST HR
$191.00lactase 3000 units Tab [VDMC]
$0.70Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$33.40VENIPUNCTURE
$10.50This 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
$23.86Insurance Discount
-$7.16Price Negotiated by Insurer
$16.70Deductible 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.
CBC WITH DIFF
$56.00INF TX MED 1ST HR
$267.40lactase 3000 units Tab [VDMC]
$0.97Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$46.76VENIPUNCTURE
$14.70This 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
$23.86Insurance Discount
-$11.75Price Negotiated by Insurer
$12.11Deductible 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.
CBC WITH DIFF
$40.60INF TX MED 1ST HR
$193.86lactase 3000 units Tab [VDMC]
$0.71Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$33.90VENIPUNCTURE
$10.66This 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
$23.86Insurance Discount
-$11.76Price Negotiated by Insurer
$12.10Deductible 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.
CBC WITH DIFF
$40.58INF TX MED 1ST HR
$193.75lactase 3000 units Tab [VDMC]
$0.71Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$33.88VENIPUNCTURE
$10.65This 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
$23.86Insurance Discount
-$5.96Price Negotiated by Insurer
$17.90Deductible 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.
CBC WITH DIFF
$60.00INF TX MED 1ST HR
$286.50lactase 3000 units Tab [VDMC]
$1.04Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$50.10VENIPUNCTURE
$15.75This 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
$23.86Insurance Discount
-$5.96Price Negotiated by Insurer
$17.90Deductible 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.
CBC WITH DIFF
$60.00INF TX MED 1ST HR
$286.50lactase 3000 units Tab [VDMC]
$1.04Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$50.10VENIPUNCTURE
$15.75This 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
$23.86Insurance Discount
-$2.39Price Negotiated by Insurer
$21.47Deductible 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.
CBC WITH DIFF
$72.00INF TX MED 1ST HR
$343.80lactase 3000 units Tab [VDMC]
$1.25Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$60.12VENIPUNCTURE
$18.90This 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
$23.86Insurance Discount
-$9.78Price Negotiated by Insurer
$14.08Deductible 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.
CBC WITH DIFF
$47.20INF TX MED 1ST HR
$225.38lactase 3000 units Tab [VDMC]
$0.82Sodium Chloride 0.9% IV Sol 50 mL [VDMC]
$39.41VENIPUNCTURE
$12.39This 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.