New York State seal

September 29, 1980

SUBJECT: INSURANCE

WITHDRAWN

Circular Letter No. 14 (1980)

September 29, 1980

TO: All Insurers Licensed to Write Automobile Insurance in New York State

SUBJECT: Reimbursement Rates for Hospital and Health Related Services Under No-Fault

Pursuant to the provisions of 11 NYCRR 63.2 (Regulation 83), on and after January 1, 1978, the schedule of all inclusive rates for hospital services and health related services, including home health services, provided pursuant to Section 671(1)(a) of the Insurance Law shall be the rates approved by the Chairman of the Workers' Compensation Board in accordance with the provisions of Chapter 767 of the Laws of 1977.

Pursuant to the provisions of Regulation 83 and effective with services rendered on and after July 1, 1980 through December 31, 1980, the attached schedule shall be utilized by no-fault insurers for payment of hospital in-patient services. The rates appearing in the attached schedule have been developed in accordance with Chapter 767 of the Laws of 1977 as amended by Chapter 213 of the Laws of 1978 and Chapter 271 of the Laws of 1979 and have been approved by the Chairman of the Workers' Compensation Board.

Also attached is a notice of the merger of Baptist Hospital of New York and Interboro Hospital into a single entity under the name of Baptist Medical Center of New York. It should be noted that the interim rate contained therein, approved by the Chairman of the Workers' Compensation Board, has been revised effective July 1, 1980. Pursuant to the provisions of Regulation 83 these rates shall be utilized by no-fault insurers for payment of hospital in-patient services for the effective periods set forth in the notice and revised hospital schedule.

Very truly yours,

[SIGNATURE]

ALBERT B. LEWIS

Superintendent of Insurance

Attach.

STATE OF NEW YORK

WORKERS' COMPENSATION BOARD

OFFICE OF THE CHAIRMAN

HOSPITAL FEE SCHEDULE

Effective January 1, 1980

Revision No. 1

September 9, 1980

This revision of the Hospital Fee Schedule was recommended and certified by the State Commissioner of Health and approved by the Chairman of the Workers' Compensation Board. Pursuant to Chapter 767, Laws of 1977, as amended by Chapter 213, Laws of 1978 and Chapter 271, Laws of 1979, these rates are for use in payment of claims under the Workers' Compensation Law and the Volunteer Firemen's Benefit Law.

Except as otherwise noted, these revisions are effective July 1, 1980 - December 31, 1980.

[SIGNATURE]

Chairman

WORKERS' COMPENSATION

SCHEDULE OF RATES FOR THE PERIOD

JANUARY 1, 1980 THROUGH DECEMBER 31, 1980

Rates for Outpatient Services

Room other than operating room or operating room when used for minor surgery or emergency treatment:

For the medical service provided whether by employed staff, attending staff or by contractual arrangement with the physician groups the fee for this service is limited to the first visit fee of as appears on line 90010 of the Schedule of Medical Fees.

$ 13.00

For the hospital providing intern or resident staffing or by physician group contractual coverage the total fee is

$ 36.00

When the care is provided by an attending, the hospital fee is with the physician billing separately.

$ 23.00

Note: These fees include common or ordinary medications.

Crutches, mechanical splints and appliances

Rental or Sale at Cost

Plaster Cast and/or Splint

Cost of Plaster

Radium and deep therapy

A & A*

E.K.G., E.E.G., X-ray, P.T., and Laboratory Charges

Rates in Schedule of Medical Fees Promulgated by the Chairman, Workers' Compensation Board

Materials supplied by the Emergency Room (i.e. sterile trays, medications, etc.) over and above those usually included with the Emergency Room visit may be charged for separately. Itemize these on the bill submitted.

* "Authorization and Arrangement"

(Revised 9/9/80)

COMMON OR ORDINARY DRUGS COVERED BY THE EMERGENCY ROOM HOSPITAL RATES

A study was undertaken to determine the low-cost drugs which a large number of hospitals in New York State regard as fairly common or ordinary and for which no charges are made apart from the inclusive Emergency Room rates. A partial list of such drugs is furnished below. It is expected that the list will be enlarged or augmented from time to time. In the meanwhile, the drugs shown below or on any future similar list or heretofore regarded as common or ordinary or any additional drugs so regarded should be considered as covered by the applicable Emergency Room rate. No charge should be made for any drugs, whether or not listed hereunder, in connection with hospitalized patients.

Current List of "No Charge" Drugs and Pharmaceutical Supplies

Alcohol 70%

Alcohol swabs

Antacid (e.g. Mylanta, Maalox, etc.)

Acetaminophen 325 mg. tablet (e.g. Tylenol-Topar Empracet)

Aspirin 325 mg. tablet (e.g. Bayer)

Aromatic Sp. Ammonia

Atropine 2% O.S.

Atropine .4mg/ml

Bacitracin Ointment

Castor Oil

Calamine lotion

Collodian Flexible

Cold Cream

Clinitest tablets

Cortisporin ophthalmic solution

Dibucaine 1% ointment (e.g. Nupercaine)

Ethyl Chloride spray

Gamma Benzene Lotion (e.g. Kwell)

Gelfoam

Glycerin suppository

Hematest tablets

Hydrocortisone 1% ointment

Hydrogen peroxide

Iodine

Ipecac

Lidocaine 2% viscous (e.g. Xylocaine)

Lidocaine 1% w/or without epinephrine (e.g. Xylocaine)

Lidocaine 2% w/or without epinephrine (e.g. Xylocaine)

Lidocaine 5% ointment (e.g. Xylocaine)

Lubricating Jelly

Magnesium sulfate (e.g. Epsom salts)

Meperidine injection (e.g. Demerol)

Merthiolate

Nitroglycerin s.1 .4 mg

Nitroglycerin s.1 .6 mg

Peppermint spirit

Petrolatum

Povidone-Iodine solution (e.g. Betadine)

Pralidoxine (e.g. Protopam - Ayerst)

Silver nitrate sticks

Silver sulfadiazine (e.g. Silvadene - Marion)

Sodium chloride - injection

Sodium chloride for irrigation

Sterile water for irrigation

Talcum powder

Tetanus Toxoid

Tuberculin PPD (1st & 2nd strength)

Witch hazel

Zinc oxide ointment

WORKERS' COMPENSATION
HOSPITAL RATE SCHEDULE
WESTERN NEW YORK REGION
EFFECTIVE 07/01/80 - 12/31/80

  DAILY RATE EXCLUSIONS:

ALLEGANY

CUBA MEMORIAL HOSPITAL INC

* $ 189.00

ALL INCLUSIVE

INPATIENT ACUTE CARE

MEMORIAL HOSPITAL OF WM F &

GERTRUDE F JONES A/K/A

JONES MEMORIAL

INPATIENT ACUTE CARE

* $ 170.00

ALL INCLUSIVE

CATTARAUGUS

OLEAN GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 167.00

A

SALAMANCA HOSPITAL DISTRICT AUTHORITY

INPATIENT ACUTE CARE

* $ 137.00

C

ST FRANCIS HOSPITAL

INPATIENT ACUTE CARE

* $ 161.00

B

TRI-COUNTY MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 133.00

A,B

CHAUTAUQUA

BROOKS MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 140.00

A,B

JAMESTOWN GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 151.00

A,B,C

LAKE SHORE HOSPITAL INC

INPATIENT ACUTE CARE

* $ 147.00

A,B

WESTFIELD MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

* $ 178.00

B

WOMANS CHRISTIAN ASSOCIATION

INPATIENT ACUTE CARE

* $ 159.00

A,B

ERIE

BERTRAND CHAFFEE HOSPITAL

INPATIENT ACUTE CARE

* $ 167.00

ALL INCLUSIVE

BRY-LIN HOSPITAL

PSYCHIATRIC CARE

* $ 142.00

A,B

BUFFALO COLUMBUS HOSPITAL

INPATIENT ACUTE CARE

* $ 110.00

C

BUFFALO GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 192.00

A

CHILDRENS HOSPITAL

INPATIENT ACUTE CARE

* $ 289.00

A

ERIE COUNTY MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 205.00

ALL INCLUSIVE

KENMORE MERCY HOSPITAL

INPATIENT ACUTE CARE

* $ 164.00

A, OTHER: EKG

LAFAYETTE GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 132.00

A

MERCY HOSPITAL OF BUFFALO

INPATIENT ACUTE CARE

* $ 157.00

A, OTHER:

ECHOCARDIOGRAMS

MILLARD FILLMORE HOSPITAL

INPATIENT ACUTE CARE

* $ 194.00

A

OUR LADY OF VICTORY HOSPITAL OF LACKAWANNA

INPATIENT ACUTE CARE

* $ 162.00

A,B, OTHER:

ENDOSCOPY,

STRESS TESTS --

SONOGRAMS,

ECHOCARDIOGRAMS

ERIE

ROSWELL PARK MEMORIAL INSTITUTE

INPATIENT ACUTE CARE

* $ 257.00

ALL INCLUSIVE

SAINT FRANCIS HOSPITAL OF BUFFALO

INPATIENT ACUTE CARE

* $ 143.00

A

SHEEHAN MEMORIAL EMERGENCY HOSPITAL INC

INPATIENT ACUTE CARE

* $ 160.00

A,B

SHERIDAN PARK HOSPITAL INC

INPATIENT ACUTE CARE

* $ 147.00

A

SISTERS OF CHARITY HOSPITAL

INPATIENT ACUTE CARE

* $ 164.00

A

ST JOSEPH INTERCOMMUNITY HOSPITAL

INPATIENT ACUTE CARE

* $ 132.00

A

GENESEE

GENESEE MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 161.00

A

ST JEROME HOSPITAL

INPATIENT ACUTE CARE

* $ 170.00

A

NIAGARA

DEGRAFF MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 153.00

A

INTER-COMMUNITY MEMORIAL HOSPITAL AT NEWFANE INC

INPATIENT ACUTE CARE

* $ 144.00

A

LOCKPORT MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 159.00

A,B

MOUNT ST MARYS HOSPITAL OF NIAGARA FALLS

INPATIENT ACUTE CARE

* $ 162.00

A

NIAGARA FALLS MEMORIAL MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 180.00

A

ORLEANS

ARNOLD GREGORY MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 162.00

A

MEDINA MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 149.00

A,B

WYOMING

WYOMING COUNTY COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

* $ 175.00

A

A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST

* Revised Rate and Exclusions effective 7/1/80 thru 12/31/80

 

WORKERS' COMPENSATION
HOSPITAL RATE SCHEDULE
ROCHESTER NEW YORK REGION
EFFECTIVE 07/01/80 - 12/31/80

DAILY RATE EXCLUSIONS:

CHEMUNG

ARNOT-OGDEN MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 184.00

A

ST JOSEPHS HOSPITAL OF ELMIRA

INPATIENT ACUTE CARE

* $ 153.00

A

LIVINGSTON

NICHOLAS H NOYES MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 178.00

A

MONROE

GENESEE HOSPITAL

INPATIENT ACUTE CARE

* $ 272.00

A

HIGHLAND HOSPITAL

INPATIENT ACUTE CARE

* $ 235.00

A,B

LAKESIDE MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 182.00

A

MONROE COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

* $ 298.00

ALL INCLUSIVE

PARK RIDGE HOSPITAL

INPATIENT ACUTE CARE

* $ 214.00

A,B

ROCHESTER GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 268.00

A

ST MARYS HOSPITAL OF ROCHESTER

INPATIENT ACUTE CARE

* $ 214.00

A,C

STRONG MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 307.00

A,D, OTHER:

DIAGNOSTIC

RADIOLOGY

ONTARIO

CLIFTON SPRINGS HOSPITAL AND CLINIC

INPATIENT ACUTE CARE

* $ 166.00

A

F F THOMPSON HOSPITAL

INPATIENT ACUTE CARE

* $ 147.00

A

GENEVA GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 193.00

A

SCHUYLER

SCHUYLER HOSPITAL

INPATIENT ACUTE CARE

* $ 184.00

A

SENECA

SENECA FALLS HOSPITAL

INPATIENT ACUTE CARE

* $ 177.00

A

WATERLOO MEMORIAL HOSPITAL INC. D/B/A

TAYLOR-BROWN MEMORIAL HOSP

INPATIENT ACUTE CARE

* $ 153.00

A

STEUBEN

BETHESDA HOSPITAL

INPATIENT ACUTE CARE

* $ 168.00

A,B

CORNING HOSPITAL

INPATIENT ACUTE CARE

* $ 170.00

A

IRA DAVENPORT MEMORIAL HOSPITAL INC.

INPATIENT ACTUE CARE

* $ 155.00

A,C

ST JAMES MERCY HOSPITAL

INPATIENT ACUTE CARE

* $ 145.00

A,B

WAYNE

MYERS COMMUNITY HOSPITAL FOUNDATION INC

INPATIENT ACUTE CARE

* $ 159.00

A

NEWARK-WAYNE COMMUNITY HOSPITAL INC

INPATIENT ACUTE CARE

* $ 180.00

A

YATES

SOLDIERS AND SAILORS MEMORIAL HOSPITAL OF YATES COUNTY INC

INPATIENT ACUTE CARE

* $ 171.00

A

A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST

* Revised Rate and Exclusions effective 7/1/80 thru 12/31/80

WORKERS' COMPENSATION
HOSPITAL RATE SCHEDULE
CENTRAL NEW YORK REGION
EFFECTIVE 07/01/80 - 12/31/80

DAILY RATE

EXCLUSIONS:

BROOME

BINGHAMTON GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 182.00

A,B,C

CHARLES S WILSON MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 217.00

A

IDEAL HOSPITAL OF ENDICOTT

INPATIENT ACUTE CARE

* $ 188.00

A

OUR LADY OF LOURDES MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 175.00

A, OTHER:

DIAGNOSTIC

RADIOLOGY

ULTRASOUND

CAYUGA

AUBURN MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 170.00

A

CHENANGO

CHENANGO MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

* $ 215.00

A

CORTLAND

CORTLAND MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

* $ 206.00

A,B

HERKIMER

HERKIMER MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

* $ 176.00

A

LITTLE FALLS HOSPITAL

INPATIENT ACUTE CARE

* $ 150.00

A

MOHAWK VALLEY GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 156.00

A

JEFFERSON

CARTHAGE AREA HOSPITAL INC

INPATIENT ACUTE CARE

* $ 165.00

B

EDWARD JOHN NOBLE HOSPITAL OF ALEXANDRIA BAY

INPATIENT ACUTE CARE

* $ 184.00

ALL INCLUSIVE

HOUSE OF THE GOOD SAMARITAN

INPATIENT ACUTE CARE

* $ 174.00

A,B,C

MERCY HOSPITAL OF WATERTOWN

INPATIENT ACUTE CARE

* $ 190.00

A,B

LEWIS

LEWIS COUNTY GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 196.00

B

MADISON

COMMUNITY MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

* $ 191.00

A

ONEIDA CITY HOSPITAL

INPATIENT ACUTE CARE

* $ 160.00

A,D

ONEIDA

CHILDRENS HOSPITAL AND REHABILITATION CENTER

REHABILITATION

* $ 182.00

A,C, OTHER: EMG

ONEIDA

FAXTON HOSPITAL

INPATIENT ACUTE CARE

* $ 205.00

A,C, OTHER: EMG

ROME HOSPITAL AND MURPHY MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 158.00

A,C

ROSE HOSPITAL

INPATIENT ACUTE CARE

* $ 150.00

A,C

ST ELIZABETH HOSPITAL

INPATIENT ACUTE CARE

* $ 206.00

A,C

ST LUKES MEMORIAL HOSPITAL CENTER

INPATIENT ACUTE CARE

* $ 194.00

A,C, OTHER: EMG

ONONDAGA

BENJAMIN RUSH CENTER

PSYCHIATRIC CARE

* $ 125.00

ALL INCLUSIVE

COMMUNITY-GENERAL HOSPITAL OF GREATER SYRACUSE

INPATIENT ACUTE CARE

* $ 238.00

A

CROUSE-IRVING MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 277.00

A,B,D, OTHERS:

NUCLEAR

MEDICINE,

EEG, EKG

ST JOSEPHS HOSPITAL HEALTH CENTER

INPATIENT ACUTE CARE

* $ 232.00

A,B,C

STATE UNIVERSITY HOSPITAL UPSTATE MEDICAL

CENTER

INPATIENT ACUTE CARE

* $ 253.00

A

OSWEGO

ALBERT LINDLEY LEE MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 179.00

A

OSWEGO HOSPITAL

INPATIENT ACUTE CARE

* $ 172.00

A

ST. LAWRENCE

A BARTON HEPBURN HOSPITAL

INPATIENT ACUTE CARE

* $ 203.00

A

CENTRAL ST LAWRENCE HLTH SERVICES OF POTSDAM

HOSP

INPATIENT ACUTE CARE

* $ 186.00

A, OTHER: EKG, PFT

CLIFTON-FINE HOSPITAL

INPATIENT ACUTE CARE

* $ 189.00

ALL INCLUSIVE

EDWARD JOHN NOBLE HOSPITAL OF GOUVERNEUR

INPATIENT ACUTE CARE

* $ 134.00

ALL INCLUSIVE

MASSENA MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 184.00

A

TIOGA

TIOGA GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 169.00

A

TOMPKINS

TOMPKINS COUNTY HOSPITAL

INPATIENT ACUTE CARE

* $ 220.00

A,B

A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST

* Revised Rate and Exclusions effective 7/1/80 thru 12/31/80

WORKERS' COMPENSATION
HOSPITAL RATE SCHEDULE
NORTHEASTERN NEW YORK REGION
EFFECTIVE 07/01/80 - 12/31/80

DAILY RATE

EXCLUSIONS:

ALBANY

ALBANY MEDICAL CENTER HOSPITAL

INPATIENT ACUTE CARE

* $ 210.00

A,B

CHILDS HOSPITAL

INPATIENT ACUTE CARE

* $ 170.00

A

COHOES MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 154.00

A,B

MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 203.00

A

ST PETERS HOSPITAL

INPATIENT ACUTE CARE

* $ 207.00

A,B

CLINTON

CHAMPLAIN VALLEY PHYSICIANS HOSPITAL

MEDICAL CTR INPATIENT ACUTE CARE

* $ 142.00

A,B, OTHER: EKG

COLUMBIA

COLUMBIA MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 174.00

B

DELAWARE

A LINDSAY & OLIVE B OCONNOR HOSPITAL

INPATIENT ACUTE CARE

* $ 175.00

ALL INCLUSIVE

COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

* $ 183.00

ALL INCLUSIVE

DELAWARE VALLEY HOSPITAL INC

INPATIENT ACUTE CARE

* $ 209.00

ALL INCLUSIVE

MARGARETVILLE MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 201.00

ALL INCLUSIVE

READ MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 177.00

A,B

THE HOSPITAL

INPATIENT ACUTE CARE

* $ 160.00

A,B, OTHER:

ULTRASOUND,

ELECTRO-

CARDIOLOGY

ESSEX

ELIZABETHTOWN COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

* $ 169.00

B

MOSES-LUDINGTON HOSPITAL

INPATIENT ACUTE CARE

* $ 168.00

B,C

PLACID MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

* $ 159.00

A,B

FRANKLIN

ALICE HYDE MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 148.00

B

GENERAL HOSPITAL OF SARANAC LAKE

INPATIENT ACUTE CARE

* $ 161.00

A,B,C

MERCY GENERAL HOSPITAL OF TUPPER LAKE

INPATIENT ACUTE CARE

* $ 162.00

B

FULTON

JOHNSTOWN HOSPITAL

INPATIENT ACUTE CARE

* $ 168.00

A

NATHAN LITTAUER HOSPITAL

INPATIENT ACUTE CARE

* $ 161.00

A

GREENE

MEMORIAL HOSPITAL OF GREENE COUNTY

INPATIENT ACUTE CARE

* $ 183.00

ALL INCLUSIVE

MONTGOMERY

AMSTERDAM MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 165.00

A,C

ST MARYS HOSPITAL AT AMSTERDAM

INPATIENT ACUTE CARE

* $ 157.00

A,C

OTSEGO

AURELIA OSBORN FOX MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 202.00

A

MARY IMOGENE BASSETT HOSPITAL

INPATIENT ACUTE CARE

* $ 191.00

ALL INCLUSIVE

RENSSELAER

LEONARD HOSPITAL

INPATIENT ACUTE CARE

* $ 168.00

B,C

SAMARITAN HOSPITAL OF TROY

INPATIENT ACUTE CARE

* $ 175.00

A

ST MARYS HOSPITAL OF TROY

INPATIENT ACUTE CARE

* $ 175.00

A,B

SARATOGA

ADIRONDACK REGIONAL HOSPITAL

INPATIENT ACUTE CARE

* $ 128.00

ALL INCLUSIVE

BENEDICT MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 73.00

A,C

SARATOGA HOSPITAL

INPATIENT ACUTE CARE

* $ 177.00

A,B

SCHENECTADY

BELLEVUE MATERNITY HOSPITAL INC

INPATIENT ACUTE CARE

* $ 276.00

A

ELLIS HOSPITAL

INPATIENT ACUTE CARE

* $ 189.00

A,B,C, OTHER:

NUCLEAR MEDICINE

ST CLARES HOSPITAL OF SCHENECTADY

INPATIENT ACUTE CARE

* $ 183.00

A,B

SUNNYVIEW HOSPITAL AND REHABILITATION CENTER

INPATIENT ACUTE CARE

* $ 166.00

A,C

SCHOHARIE

COMMUNITY HOSPITAL OF SCHOHARIE COUNTY INC

INPATIENT ACUTE CARE

* $ 155.00

ALL INCLUSIVE

WARREN

GLENS FALLS HOSPITAL

INPATIENT ACUTE CARE

* $ 182.00

A,B,C

WASHINGTON

EMMA LAING STEVENS HOSPITAL

INPATIENT ACUTE CARE

* $ 149.00

ALL INCLUSIVE

MARY MCCLELLAN HOSPITAL

INPATIENT ACUTE CARE

* $ 158.00

A

A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST

* Revised Rate and Exclusions effective 7/1/80 thru 12/31/80

 

WORKERS' COMPENSATION
HOSPITAL RATE SCHEDULE
NORTHERN METROPOLITAN REGION
EFFECTIVE 07/01/80 - 12/31/80

DAILY RATE

EXCLUSIONS:

DUTCHESS

HIGHLAND HOSPITAL OF BEACON

INPATIENT ACUTE CARE

* $ 159.00

A

NORTHERN DUTCHESS HOSPITAL

INPATIENT ACUTE CARE

* $ 170.00

A

ST FRANCIS HOSPITAL OF POUGHKEEPSIE

INPATIENT ACUTE CARE

* $ 208.00

A

VASSAR BROTHERS HOSPITAL

INPATIENT ACUTE CARE

* $ 199.00

A,B,C

ORANGE

ARDEN HILL HOSPITAL

INPATIENT ACUTE CARE

* $ 231.00

A,C

CORNWALL HOSPITAL

INPATIENT ACUTE CARE

* $ 174.00

A

DOCTORS SUNNYSIDE HOSPITAL

INPATIENT ACUTE CARE

* $ 171.00

ALL INCLUSIVE

E A HORTON MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 191.00

A

FALKIRK HOSPITAL

PSYCHIATRIC CARE

* $ 131.00

ALL INCLUSIVE

ST ANTHONY COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

* $ 212.00

ALL INCLUSIVE

ST FRANCIS HOSPITAL OF PORT JERVIS NEW YORK

INPATIENT ACUTE CARE

* $ 191.00

A,C

ST LUKES HOSPITAL OF NEWBURGH

INPATIENT ACUTE CARE

* $ 213.00

A

TUXEDO MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 148.00

ALL INCLUSIVE

PUTNAM

JULIA L BUTTERFIELD MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 245.00

A

PUTNAM COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

* $ 222.00

A

ROCKLAND

COMMUNITY HOSPITAL OF ROCKLAND COUNTY

INPATIENT ACUTE CARE

* $ 135.00

A

GOOD SAMARITAN HOSPITAL OF SUFFERN

INPATIENT ACUTE CARE

* $ 258.00

A, OTHER: EMG

HELEN HAYES HOSPITAL

INPATIENT ACUTE CARE

* $ 260.00

ALL INCLUSIVE

NYACK HOSPITAL

INPATIENT ACUTE CARE

* $ 237.00

A,B

SUMMIT PARK HOSPITAL-ROCKLAND COUNTY INFIRMARY

INPATIENT ACUTE CARE

* $ 123.00

ALL INCLUSIVE

PSYCHIATRIC CARE

* $ 215.00

ALL INCLUSIVE

SULLIVAN

COMMUNITY GENERAL HOSPITAL OF SULLIVAN COUNTY

INPATIENT ACUTE CARE

* $ 272.00

A

COMMUNITY GENERAL HOSPITAL OF SULLIVAN COUNTY G

HERMAN DIV

INPATIENT ACUTE CARE

* $ 154.00

A

HAMILTON AVENUE HOSPITAL

INPATIENT ACUTE CARE

* $ 144.00

ALL INCLUSIVE

ULSTER

BENEDICTINE HOSPITAL

INPATIENT ACUTE CARE

* $ 166.00

ALL INCLUSIVE

ELLENVILLE COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

* $ 175.00

ALL INCLUSIVE

KINGSTON HOSPITAL

INPATIENT ACUTE CARE

* $ 176.00

A

WESTCHESTER

BLYTHEDALE CHILDRENS HOSPITAL

INPATIENT ACUTE CARE

* $ 197.00

ALL INCLUSIVE

BURKE REHABILITATION CENTER

INPATIENT ACUTE CARE

* $ 274.00

A

DOBBS FERRY HOSPITAL

INPATIENT ACUTE CARE

* $ 159.00

A

FOUR WINDS HOSPITAL

PSYCHIATRIC CARE

* $ 176.00

A,B,C,D

LAWRENCE HOSPITAL

INPATIENT ACUTE CARE

* $ 227.00

A

MENTAL RETARDATION INSTITUTE NY FLOWER &

FIFTH AV HOSP MEDICAL

MENTAL RETARDATION ACUTE CARE

$ 209.00

ALL INCLUSIVE

MOUNT VERNON HOSPITAL

INPATIENT ACUTE CARE

* $ 233.00

A

NEW ROCHELLE HOSPITAL MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 263.00

A

NEW YORK HOSPITAL-CORNELL MEDICAL CENTER

WESTCHESTER DIVISION

PSYCHIATRIC CARE

* $ 259.00

ALL INCLUSIVE

NORTHERN WESTCHESTER HOSPITAL

INPATIENT ACUTE CARE

* $ 290.00

A,C

PEEKSKILL HOSPITAL

INPATIENT ACUTE CARE

* $ 230.00

A,C

PHELPS MEMORIAL HOSPITAL ASSOCIATION

INPATIENT ACUTE CARE

* $ 276.00

A

ST AGNES HOSPITAL

INPATIENT ACUTE CARE

* $ 268.00

A

ST JOHNS RIVERSIDE HOSPITAL

INPATIENT ACUTE CARE

* $ 264.00

A

ST JOSEPHS HOSPITAL YONKERS

INPATIENT ACUTE CARE

* $ 298.00

A, OTHER: EMG

ST VINCENTS HOSP AND MEDICAL CTR OF NY

WESTCHESTER BRANCH

PSYCHIATRIC CARE

* $ 217.00

A

UNITED HOSPITAL

INPATIENT ACUTE CARE

* $ 247.00

A

WESTCHESTER COUNTY MEDICAL CENTER

INPATIENT ACUTE CARE

$ 297.00

A,C

WHITE PLAINS HOSPITAL MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 262.00

A

YONKERS GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 244.00

A,C

YONKERS PROFESSIONAL HOSPITAL

INPATIENT ACUTE CARE

* $ 177.00

A

A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST

* Revised Rate and Exclusions effective 7/1/80 thru 12/31/80

 

WORKERS' COMPENSATION


HOSPITAL RATE SCHEDULE
LONG ISLAND REGION
EFFECTIVE 07/01/80 - 12/31/80

DAILY RATE

EXCLUSIONS:

NASSAU

CENTRAL GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 247.00

A

COMMUNITY HOSPITAL AT GLEN COVE

INPATIENT ACUTE CARE

* $ 258.00

A

FRANKLIN GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 238.00

A

FREEPORT HOSPITAL

PSYCHIATRIC CARE

* $ 135.00

ALL INCLUSIVE

HEMPSTEAD GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 273.00

A,C

LONG BEACH MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 207.00

A

LYDIA E HALL HOSPITAL

INPATIENT ACUTE CARE

* $ 265.00

A, OTHER:

NUCLEAR MEDICINE

MANHASSET MEDICAL CENTER HOSPITAL

INPATIENT ACUTE CARE

* $ 199.00

A

MASSAPEQUA GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 278.00

A,C

MERCY HOSPITAL OF ROCKVILLE CENTER

INPATIENT ACUTE CARE

* $ 235.00

A

MID-ISLAND HOSPITAL

INPATIENT ACUTE CARE

* $ 254.00

A,C

NASSAU COUNTY MEDICAL

CENTER EAST MEADOW DIV

INPATIENT ACUTE CARE

* $ 401.00

ALL INCLUSIVE

NASSAU HOSPITAL

INPATIENT ACUTE CARE

* $ 251.00

A,C

NORTH SHORE UNIVERSITY HOSPITAL

INPATIENT ACUTE CARE

* $ 342.00

A

SOUTH NASSAU COMMUNITIES HOSPITAL

INPATIENT ACUTE CARE

* $ 207.00

A

ST FRANCIS HOSPITAL OF ROSLYN

INPATIENT ACUTE CARE

* $ 419.00

A,C

SYOSSET HOSPITAL

INPATIENT ACUTE CARE

* $ 242.00

A, OTHER:

NUCLEAR MEDICINE

SUFFOLK

BROOKHAVEN MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 257.00

A,C

BRUNSWICK HOSPITAL CENTER INC

INPATIENT ACUTE CARE

* $ 269.00

A,C, OTHER: EKG, EEG,

ELECTROMYOGRAPHY,

NUCLEAR SCANS

PSYCHIATRIC CARE

* $ 170.00

A,C

REHABILITATION

* $ 276.00

A,C

CENTRAL SUFFOLK HOSPITAL ASSOCIATION

INPATIENT ACUTE CARE

* $ 216.00

A

EASTERN LONG ISLAND HOSPITAL

INPATIENT ACUTE CARE

* $ 252.00

A

GOOD SAMARITAN HOSPITAL OF WEST ISLIP

INPATIENT ACUTE CARE

* $ 221.00

A

HUNTINGTON HOSPITAL

INPATIENT ACUTE CARE

* $ 214.00

A, OTHER: RENAL

DIALYSIS,

CHEMOTHERAPY,

RESPIRATORY

THERAPY

SUFFOLK

JOHN T MATHER MEMORIAL HOSPITAL OF PORT

JEFFERSON NEW YORK INC

INPATIENT ACUTE CARE

* $ 219.00

C

SMITHTOWN GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 210.00

A

SOUTH OAKS HOSPITAL

PSYCHIATRIC CARE

* $ 178.00

A,C

SOUTHAMPTON HOSPITAL

INPATIENT ACUTE CARE

* $ 253.00

A

SOUTHSIDE HOSPITAL

INPATIENT ACUTE CARE

* $ 274.00

A

ST CHARLES HOSPITAL

INPATIENT ACUTE CARE

* $ 250.00

A

ST JOHNS EPISCOPAL HOSPITAL SMITHTOWN

INPATIENT ACUTE CARE

* $ 271.00

A

UNIVERSITY HOSPITAL OF STONY BROOK

INPATIENT ACUTE CARE

** $ 456.00

ALL INCLUSIVE

Effective

1/1/80 - 12/31/80

A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST

* Revised Rate and Exclusions effective 7/1/80 thru 12/31/80

** Rate and Exclusions effective 1/1/80 thru 12/31/80

 

WORKERS' COMPENSATION
HOSPITAL RATE SCHEDULE
NEW YORK CITY REGION
EFFECTIVE 07/01/80 - 12/31/80

DAILY RATE

EXCLUSIONS:

ASTORIA GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 207.00

A, OTHER: EEG,

NUCLEAR MEDICINE

BAPTIST HOSPITAL OF NEW YORK

INPATIENT ACUTE CARE

* $ 233.00

A

BETH ISRAEL MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 395.00

A

BOOTH MEMORIAL MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 309.00

A

BOULEVARD HOSPITAL

INPATIENT ACUTE CARE

* $ 190.00

A

BRONX-LEBANON HOSPITAL CENTER - FULTON

DIVISION

INPATIENT ACUTE CARE

* $ 381.00

A,C

BROOKDALE HOSPITAL MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 375.00

A,C

BROOKLYN HOSPITAL

INPATIENT ACUTE CARE

$ 286.00

A

CABRINI HEALTH CARE CTR

INPATIENT ACUTE CARE

* $ 317.00

A,C, OTHER: EEG,

EKG, SONOGRAPHY

CALEDONIAN HOSPITAL OF THE CITY OF NY

INPATIENT ACUTE CARE

* $ 217.00

A

CALVARY HOSPITAL

INPATIENT ACUTE CARE

* $ 332.00

ALL INCLUSIVE

CATHOLIC MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 356.00

ALL INCLUSIVE

CMC ST JOHN'S QUEENS DIV

INPATIENT ACUTE CARE

* $ 356.00

A

COMMUNITY HOSPITAL OF BROOKLYN INC.

INPATIENT ACUTE CARE

* $ 180.00

A, NUCLEAR

MEDICINE,

ULTRASOUND

DEEPDALE GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 212.00

A,C

DOCTORS HOSPITAL INC

INPATIENT ACUTE CARE

* $ 235.00

A,C

DOCTORS HOSPITAL OF STATEN ISLAND

INPATIENT ACUTE CARE

* $ 214.00

A

FLATBUSH GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 208.00

A

FLUSHING HOSPITAL AND MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 267.00

A

GRACIE SQUARE GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 229.00

ALL INCLUSIVE

PSYCHIATRIC CARE

* $ 157.00

ALL INCLUSIVE

H I P HOSPITAL INC.

INPATIENT ACUTE CARE

$ 257.00

A

HILLCREST GENERAL HOSPITAL - GHI

INPATIENT ACUTE CARE

$ 245.00

A

HOSPITAL FOR JOINT DISEASES AND MEDICAL

CENTER ORTHOPEDIC INSTI

INPATIENT ACUTE CARE

* $ 497.00

A,C

HOSPITAL FOR SPECIAL SURGERY

RATE

EXCLUSIONS:

INPATIENT ACUTE CARE

* $ 366.00

A

INSTITUTE OF REHAB MEDICINE NY UNIVERSITY

REHABILITATION

* $ 307.00

A,C,D

JAMAICA HOSPITAL

INPATIENT ACUTE CARE

* $ 273.00

A

JEWISH HOSPITAL AND MEDICAL CENTER OF

BROOKLYN

INPATIENT ACUTE CARE

* $ 311.00

A

JEWISH MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

* $ 235.00

A

JOINT DISEASES NORTH GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 239.00

A

KINGS HIGHWAY HOSPITAL

INPATIENT ACUTE CARE

* $ 215.00

A,C, OTHER:

CARDIOLOGY,

SONOGRAPHY

KINGSBROOK JEWISH MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 304.00

A

LENOX HILL HOSPITAL

INPATIENT ACUTE CARE

* $ 336.00

A

LEROY HOSPITAL

INPATIENT ACUTE CARE

* $ 222.00

A

LONG ISLAND COLLEGE HOSPITAL

INPATIENT ACUTE CARE

$ 319.00

A

LONG ISLAND JEWISH-HILLSIDE MED CTR

INPATIENT ACUTE CARE

* $ 404.00

A

LUTHERAN MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 350.00

A

MAIMONIDES MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 320.00

A

MANHATTAN EYE EAR AND THROAT HOSPITAL

INPATIENT ACUTE CARE

* $ 325.00

A

MEDICAL ARTS CENTER HOSPITAL

INPATIENT ACUTE CARE

* $ 212.00

A,C

MEMORIAL HOSPITAL FOR CANCER AND ALLIED

DISEASES

INPATIENT ACUTE CARE

* $ 564.00

ALL INCLUSIVE

METHODIST HOSPITAL OF BROOKLYN

INPATIENT ACUTE CARE

* $ 296.00

A, OTHER: PHYSIATRY

MISERICORDIA HOSPITAL MEDICAL CENTER

INPATIENT ACUTE CARE

$ 230.00

A,D, OTHER:

AMBULANCE

MONTEFIORE HOSPITAL & MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 431.00

A

MOUNT SINAI HOSPITAL

INPATIENT ACUTE CARE

* $ 404.00

A,C

NY EYE AND EAR INFIRMARY

INPATIENT ACUTE CARE

* $ 275.00

A

NEW YORK HOSPITAL AND PAYNE WHITNEY

PSYCHIATRIC CLINIC

INPATIENT ACUTE CARE

* $ 399.00

A

NY INFIRMARY BEEKMAN DOWNTOWN HOSPITAL

INPATIENT ACUTE CARE

* $ 313.00

A

NY UNIVERSITY MEDICAL CENTER

INPATIENT ACUTE CARE

* $ 350.00

A,C

OSTEOPATHIC HOSPITAL AND CLINIC

INPATIENT ACUTE CARE

$ 245.00

A

PARKWAY HOSPITAL

INPATIENT ACUTE CARE

* $ 233.00

A,C

PARSONS HOSPITAL

INPATIENT ACUTE CARE

* $ 183.00

A,C

PELHAM BAY GENERAL HOSPITAL

INPATIENT ACUTE CARE

* $ 199.00

A,B,C, OTHER: EKG,

EEG

PENINSULA HOSPITAL CENTER

INPATIENT ACUTE CARE

* $ 229.00

A,B

PHYSICIANS HOSPITAL

INPATIENT ACUTE CARE

* $ 221.00

A

PRESBYTERIAN HOSPITAL IN THE CITY OF NEW YORK

INPATIENT ACUTE CARE

* $ 414.00

A,B

PROSPECT HOSPITAL

INPATIENT ACUTE CARE

* $ 180.00

A

RICHMOND MEMORIAL HOSPITAL AND HEALTH CENTER

INPATIENT ACUTE CARE

* $ 267.00

A

ROCKEFELLER UNIVERSITY HOSPITAL

INPATIENT ACUTE CARE

$ .00

ALL INCLUSIVE

ST BARNABAS HOSPITAL

INPATIENT ACUTE CARE

* $ 288.00

ALL INCLUSIVE

ST CLARES HOSPITAL AND HEALTH CENTER

INPATIENT ACUTE CARE

$ 246.00

A

ST ELIZABETHS DIVISION OF ST CLARES HOSPITAL

AND HEALTH CENTER

INPATIENT ACUTE CARE

$ 246.00

A

ST JOHNS EPISCOPAL HOSPITAL

INPATIENT ACUTE CARE

* $ 271.00

A

ST JOHNS EPISCOPAL HOSPITAL - SO SHORE DIV

INPATIENT ACUTE CARE

* $ 271.00

A

ST LUKES - ROOSEVELT HOSPITAL CENTER

INPATIENT ACUTE CARE

* $ 410.00

A

DETOXIFICATION UNIT

* $ 91.00

A

ST MARYS HOSPITAL OF BROOKLYN

INPATIENT ACUTE CARE

* $ 354.00

ALL INCLUSIVE

ST VINCENTS HOSPITAL AND MEDICAL CENTER OF NY

INPATIENT ACUTE CARE

$ 315.00

A

ST VINCENTS MEDICAL CENTER OF RICHMOND

INPATIENT ACUTE CARE

* $ 298.00

ALL INCLUSIVE

STATE UNIVERSITY HOSPITAL DOWNSTATE MEDICAL

CENTER

INPATIENT ACUTE CARE

* $ 287.00

A

STATEN ISLAND HOSPITAL

INPATIENT ACUTE CARE

* $ 305.00

A

TERRACE HEIGHTS HOSPITAL

INPATIENT ACUTE CARE

* $ 213.00

A

UNION HOSPITAL OF THE BRONX

INPATIENT ACUTE CARE

* $ 180.00

A,C

VICTORY MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 192.00

A

WESTCHESTER SQUARE HOSPITAL

INPATIENT ACUTE CARE

* $ 178.00

A,C, OTHER:

NUCLEAR MEDICINE

WYCKOFF HEIGHTS HOSPITAL

INPATIENT ACUTE CARE

* $ 240.00

A,C, OTHER: PFT,

EKG, EEG

HEALTH AND HOSPITAL CORPORATION

BELLEVUE HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 298.00

ALL INCLUSIVE

EXCLUDING PHYSICIANS

$ 288.00

BIRD S COLER MEMORIAL HOSPITAL AND HOME

INPATIENT ACUTE CARE

$ 229.00

ALL INCLUSIVE

BRONX MUNICIPAL HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 311.00

ALL INCLUSIVE

CITY HOSPITAL CENTER AT ELMHURST

INPATIENT ACUTE CARE

$ 289.00

ALL INCLUSIVE

CONEY ISLAND HOSPITAL

INPATIENT ACUTE CARE

$ 309.00

ALL INCLUSIVE

EXCLUDING PHYSICIANS

301.00

CUMBERLAND HOSPITAL

INPATIENT ACUTE CARE

$ 336.00

ALL INCLUSIVE

GOLDWATER MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 184.00

ALL INCLUSIVE

GREENPOINT HOSPITAL

INPATIENT ACUTE CARE

$ 323.00

ALL INCLUSIVE

HARLEM HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 288.00

ALL INCLUSIVE

EXCLUDING PHYSICIANS

272.00

KINGS COUNTY HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 292.00

ALL INCLUSIVE

LINCOLN MEDICAL & MENTAL HEALTH CENTER

INPATIENT ACUTE CARE

$ 382.00

ALL INCLUSIVE

METROPOLITAN HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 374.00

ALL INCLUSIVE

EXCLUDING PHYSICIANS

358.00

NORTH CENTRAL BRONX HOSPITAL

INPATIENT ACUTE CARE

$ 417.00

ALL INCLUSIVE

QUEENS HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 290.00

ALL INCLUSIVE

SYDENHAM HOSPITAL

INPATIENT ACUTE CARE

$ 250.00

ALL INCLUSIVE

A-ANESTHESIOLOGIST, B-RADIOLOGIST, C-PHYSIOTHERAPIST, D-PATHOLOGIST

* Revised Rate and Exclusions effective 7/1/80 thru 12/31/80

 

State of New York, Workers' Compensation Board, Office of the Chairman

TO: Insurance Carriers and Self-Insurers Providing Benefits Under the Workers' Compensation Law and Volunteer Firemen's Benefit Law

Subject: Workers' Compensation Hospital Fee Schedule Effective January 1, 1980 - Baptist Medical Center of New York (formerly Interboro Hospital)

Baptist Hospital of New York and Interboro Hospital have merged into a single entity under the name of Baptist Medical Center of New York, which is located at the Interboro site.

For the period 2/1/80 - 12/31/80, the Workers' Compensation rate of $ 221.00, promulgated for Interboro Hospital, should be used as an interim rate of reimbursement for the Baptist Medical Center.

[SIGNATURE]

Chairman