If your healthcare provider is in New York State and requires you to use laboratory services for testing, the In-Network Laboratory to use is Quest Diagnostics. If your provider is in New Jersey and requires you to use laboratory services for testing, the In-Network Laboratory to use is Lab Corp of America. Remember – the Laboratory to use is based on where your healthcare provider is located. (When Medicare is primary, you do not need to choose In-Network or Out-of-Network facilities. Always be sure the facility is a Medicare provider.)

To search for an in-network laboratory in your area, go to www.bcbs.com.

Examples below. For additional information, see the Plan Document.

	In-Network Provider	Out-of-Network Provider
Diagnostic Testing(out-patient hospital)	$35 co-pay per day	$70 co-pay per day, and 20% co-insurance
Imaging (CT/PET scans, MRIs)(out-patient hospital)	$50 co-pay per day	$85 co-pay per day, and 20% co-insurance
Chemotherapy(physician’s office)	$25 co-pay per visit	$25 co-pay per visit, plus deductible and 20% & co-insurance
Hemodialysis(out-patient hospital)	No co-pay	$0 co-pay per day, and no co-insurance
Hemodialysis(physician’s office)	$25 co-pay per visit	$25 co-pay per visit, plus deductible and 20% co-insurance
Radiation Therapy(out-patient hospital)	$0 co-pay per day	100% of u&c (no co-pay)
Radiation Therapy(physician’s office)	$25 co-pay per day	$25 co-pay per visit, plus deductible and 20% co-insurance
Mammography(out-patient hospital or physician’s office)	Paid in full. One baseline – women age 35- 39. Annual – Women age 40 and over. High risk, any age.	100% of U&COne baseline – women age 35- 39. Annual – Women age 40 and over. High risk, any age.
Lab & X-rays (out-patient facility)	$50 co-pay per visit	$85 co-pay per visit, plus deductible and 20% co-insurance
Lab & X-rays (physician’s office)	$25 co-pay per visit	$25 co-pay per visit, plus deductible and 20% co-insurance
Lab-Quest Labs	$5 co-pay per visit	N/A