CPT G0463
The standard charge for Hospital outpatient clinic visit for assessment and management of a patient is $200.00. 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
$200.00Insurance Discount
-$20.00Price Negotiated by Insurer
$180.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$2,644.34This 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
$200.00Insurance Discount
-$20.00Price Negotiated by Insurer
$180.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$2,644.34This 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
$200.00Insurance Discount
-$86.00Price Negotiated by Insurer
$114.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$1,674.75This 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
$200.00Insurance Discount
-$99.06Price Negotiated by Insurer
$100.94Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$1,482.89This 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
$200.00Insurance Discount
-$99.00Price Negotiated by Insurer
$101.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$1,483.77This 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
$200.00Insurance Discount
-$40.00Price Negotiated by Insurer
$160.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$2,350.53This 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
$200.00Insurance Discount
-$50.00Price Negotiated by Insurer
$150.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$2,203.62This 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
$200.00Insurance Discount
-$100.00Price Negotiated by Insurer
$100.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$1,469.08This 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
$200.00Insurance Discount
-$100.04Price Negotiated by Insurer
$99.96Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$1,468.49This 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
$200.00Insurance Discount
-$50.00Price Negotiated by Insurer
$150.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$2,203.62This 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
$200.00Insurance Discount
-$100.00Price Negotiated by Insurer
$100.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$1,469.08This 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
$200.00Insurance Discount
-$60.00Price Negotiated by Insurer
$140.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$2,056.71This 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
$200.00Insurance Discount
-$98.50Price Negotiated by Insurer
$101.50Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$1,491.12This 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
$200.00Insurance Discount
-$98.56Price Negotiated by Insurer
$101.44Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$1,490.23This 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
$200.00Insurance Discount
-$50.00Price Negotiated by Insurer
$150.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$2,203.62This 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
$200.00Insurance Discount
-$50.00Price Negotiated by Insurer
$150.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$2,203.62This 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
$200.00Insurance Discount
-$20.00Price Negotiated by Insurer
$180.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$2,644.34This 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
$200.00Insurance Discount
-$82.00Price Negotiated by Insurer
$118.00Deductible 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.
esketamine 56 mg/2 Nasal Spray [VDMC]
$1,733.51This 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.