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Office Visit Nutrition

DETAIL FOR SERVICES: Facility Fee Physician Services 
2020 CPT/HCPCS Primary Code G0463 Not provided by Hospital (may be billed separately)
Negotiated Private Fee $40.00 Not provided by Hospital (may be billed separately)
Prossam $25.00 Not provided by Hospital (may be billed separately)
Champva Ambulatory Payment classification (APC) Not provided by Hospital (may be billed separately)
First Medical $40.00 Not provided by Hospital (may be billed separately)
First Medical Vital $54.60 Not provided by Hospital (may be billed separately)
Plan de Salud Menonita $30.00 Not provided by Hospital (may be billed separately)
Menonita Vital $54.00 Not provided by Hospital (may be billed separately)
Humana Gold Plus / Gold Choice Ambulatory Payment classification (APC) Not provided by Hospital (may be billed separately)
Humana $25.00 Not provided by Hospital (may be billed separately)
Mapfre $15.00 Not provided by Hospital (may be billed separately)
Mcsclassicare $35.00 Not provided by Hospital (may be billed separately)
MCS Life $35.00 Not provided by Hospital (may be billed separately)
Medicare Ambulatory Payment classification (APC) Not provided by Hospital (may be billed separately)
MMM $25.00 Not provided by Hospital (may be billed separately)
MMM Vital $54.60 Not provided by Hospital (may be billed separately)
Panamerican Life $25.00 Not provided by Hospital (may be billed separately)
PMC $25.00 Not provided by Hospital (may be billed separately)
Tricare Ambulatory Payment classification (APC) Not provided by Hospital (may be billed separately)
Triple S Salud $70.00 Not provided by Hospital (may be billed separately)
Triple S Vital $55.00 Not provided by Hospital (may be billed separately)
Triple S Advantage Ambulatory Payment classification (APC) Not provided by Hospital (may be billed separately)
Negotiated Minimum Charge $15.00 Not provided by Hospital (may be billed separately)
Negotiated Maximum Charge $70.00 Not provided by Hospital (may be billed separately)
Discounted Cash Price $32.00 Not provided by Hospital (may be billed separately)

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