Low
$86
Average
$86
Median
$86
High
$86
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1 hospital rate
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $86 | $86 | — | — | — | $86 – $86 |
← Payers reporting HCPCS G6058 · Snapshot 20261112T181611Z-3fa9fb76