New York State seal

January 25, 1984

SUBJECT: INSURANCE

WITHDRAWN

CIRCULAR LETTER NO. 1 (1984)

DATED: January 25, 1984

TO: ALL INSURERS, AND SELF-INSURERS, LICENSED TO WRITE AUTOMOBILE INSURANCE IN NEW YORK STATE

SUBJECT: Reimbursement Rates for Hospital and Health Related Services under No-Fault for treatment rendered on and after September 1, 1983 through December 31, 1983.

Insurance Department Regulation No.83 at Section 68.2(b) provides that on and after January 1, 1978, the schedule of all-inclusive rates payable for hospital services and health-related services, provided pursuant to Section 671(1)(a) of the Insurance Law, shall be the rates approved by the Chairmen of the Workers' Compensation Board in accordance with the provisions of the Laws of 1977, Chapter 767, as amended.

For your information, the attached schedule of Inpatient Rates 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 536 of the Laws of 1982 and Part 86 of the Commissioner of Health Administrative Rules and Regulations. Also attached is a Schedule of Outpatient Rates approved by the Chairman of the Workers' Compensation Board.

Accordingly, for your information the attached schedules of rates are the rates for no-fault cases for payment of hospital outpatient and inpatient services rendered on and after September 1, 1983 through December 31, 1983.

Very truly yours,

[SIGNATURE]

JAMES P. CORCORAN

Superintendent of Insurance

JPC/bmb

Attach.

STATE OF NEW YORK

WORKERS' COMPENSATION BOARD

OFFICE OF THE CHAIRMAN

HOSPITAL FEE SCHEDULE

Effective 9/1/83 - 12/31/83

This revision of the Hospital Fee Schedule Inpatient Rates 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 536 of the Laws of 1982 and Part 86 of the Commissioner of Health Administrative Rules and Regulations, these rates are for the use in payment of claims under the Workers' Compensation Law and the Volunteer Firemen's Benefit Law.

The third column of this schedule applies to emergency service.

[SIGNATURE]

Chairman

WORKERS' COMPENSATION

SCHEDULE OF RATES FOR THE PERIOD

SEPTEMBER 1, 1983 THROUGH DECEMBER 31, 1983

Rates for Outpatient Services

Room other than 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 the fee as appears on Line 90010 of the Schedule of Medical Fees.

For the hospital providing intern or resident staffing or by physician group contractual coverage the total fee is the fee for physician services as appears on Line 90010 of the Schedule of Medical Fees plus the fee for use of the Emergency Service Room as shown in this schedule.

When the care is provided by an attending physician, the hospital fee is the Emergency Service Room fee as shown in this schedule, with the physician billing separately.

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' Com-

pensation 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"

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

Acetaminophen 325 mg. tablet

Alcohol 70 percent

Alcohol swabs

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

Aspirin 325 mg. tablet

Aromatic Spirits of Ammonia

Atropine 2 percent Ophthalmic Solution

Atropine 0.4 mg/ml

Bacitracin ointment

Castor Oil

Calamine lotion

Collodion Flexible

Cold Cream

Clinitest tablets

Dibucaine 1 percent ointment (e.g. Nupercainal)

Epinephrine Injection

Ethyl Chloride spray

Gel foam

Glycerin suppository

Hematest tablets

Hydrocortisone 1 percent ointment

Hydrogen Peroxide

Iodine

Ipecac Syrup

Lidocaine 2 percent viscous (e.g. Xylocaine)

Lidocaine 1 percent with/without Epinephrine

Lidocaine 2 percent with/without Epinephrine

Lidocaine 5 percent ointment

Lindane lotion (e.g. Kwell)

Lubricating jelly

Magnesium Sulfate

Meperidine injection (e.g. Demerol)

Merthiolate

Neomycin and Polymyxin B Sulfates

w/Hydrocortisone ophthalmic suspension

(e.g. Cortisporin)

Nitroglycerin 0.4 mg. s. 1. tablet

Nitroglycerin 0.6 mg. s. 1. tablet

Peppermint Spirit

Petrolatum

Providone-Iodine solution (e.g. Betadine)

Pralidoxime Chloride (e.g. Protopam)

Silver Nitrate Sticks

Silver Sulfadiazine cream (e.g. Silvadene)

Sodium Chloride - injection

Sodium Chloride for irrigation

Sterile Water for irrigation

Talcum powder

Tetanus Toxoid

Tuberculin PPD (1st and 2nd strength)

Witch Hazel

Zinc Oxide ointment

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

WESTERN NEW YORK REGION

EFFECTIVE 09/01/83 - 12/31/83

DAILY

EMERGENCY SERVICE

RATE

EXCLUSIONS:

ROOM RATE

ALLEGANY

CUBA MEMORIAL HOSPITAL INC

$ 253.00

ALL INCLUSIVE

$ 27.00

INPATIENT ACUTE CARE

MEMORIAL HOSPITAL OF WM F

& GERTRUDE F JONES A/K/A

JONES MEMORIAL

INPATIENT ACUTE CARE

$ 251.00

ALL INCLUSIVE

$ 26.00

CATTARAUGUS

OLEAN GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 252.00

A

$ 35.00

SALAMANCA HOSPITAL

DISTRICT AUTHORITY

INPATIENT ACUTE CARE

$ 183.00

ALL INCLUSIVE

$ 27.00

ST FRANCIS HOSPITAL OF

OLEAN

INPATIENT ACUTE CARE

$ 225.00

B, OTHER: ER PHYS

$ 35.00

TRI-COUNTY MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 222.00

A,B

$ 26.00

CHAUTAUQUA

BROOKS MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 311.00

A,B

$ 27.00

JAMESTOWN GENERAL

HOSPITAL

INPATIENT ACUTE CARE

$ 228.00

A, B

$ 26.00

LAKE SHORE HOSPITAL INC

INPATIENT ACUTE CARE

$ 209.00

B, OTHER: EKG

$ 27.00

WESTFIELD MEMORIAL

STRESS TESTING

HOSPITAL INC

INPATIENT ACUTE CARE

$ 239.00

B

$ 35.00

WOMANS CHRISTIAN

ASSOCIATION

INPATIENT ACUTE CARE

$ 237.00

A, B

$ 27.00

ERIE

 BERTRAND CHAFFEE HOSPITAL

INPATIENT ACUTE CARE

$ 224.00

ALL INCLUSIVE

$ 26.00

BUFFALO COLUMBUS HOSPITAL

INPATIENT ACUTE CARE

$ 271.00

ALL INCLUSIVE

$ 26.00

BUFFALO GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 337.00

A

$ 30.00

CHILDRENS HOSPITAL OF

BUFFALO

INPATIENT ACUTE CARE

$ 360.00

A

$ 26.00

ERIE COUNTY MEDICAL

CENTER

INPATIENT ACUTE CARE

$ 366.00

A, B, C, D

$ 35.00

KENMORE MERCY HOSPITAL

INPATIENT ACUTE CARE

$ 232.00

A, OTHER: EKG

$ 27.00

LAFAYETTE GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 180.00

A, B

$ 26.00

MERCY HOSPITAL OF BUFFALO

INPATIENT ACUTE CARE

$ 263.00

A, B

$ 26.00

 MILLARD FILLMORE HOSPITAL

INPATIENT ACUTE CARE

$ 287.00

A

$ 30.00

OUR LADY OF VICTORY

HOSPITAL OF LACKAWANNA

INPATIENT ACUTE CARE

$ 295.00

A, B, OTHER:

$ 30.00

ENDOSCOPY, STRESS

TESTS--SONOGRAMS,

ENDOCARDIOGRAMS,

ELECTROMIOGRAPHS

ERIE

ROSWELL PARK MEMORIAL

INSTITUTE

INPATIENT ACUTE CARE

$ 442.00

ALL INCLUSIVE

NO E.R. SERVICE

SAINT FRANCIS HOSPITAL OF

BUFFALO

INPATIENT ACUTE CARE

$ 183.00

A

$ 27.00

SHEEHAN MEMORIAL EMERGENCY

HOSPITAL INC

INPATIENT ACUTE CARE

$ 257.00

A, B

$ 35.00

SHERIDAN PARK HOSPITAL INC

INPATIENT ACUTE CARE

$ 211.00

A

$ 26.00

SISTERS OF CHARITY

 HOSPITAL

INPATIENT ACUTE CARE

$ 233.00

A

$ 35.00

ST JOSEPH INTERCOMMUNITY

HOSPITAL

INPATIENT ACUTE CARE

$ 206.00

A

$ 27.00

GENESEE

GENESEE MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 208.00

A

$ 27.00

ST JEROME HOSPITAL

INPATIENT ACUTE CARE

$ 210.00

A

$ 30.00

NIAGARA

DEGRAFF MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 273.00

A, B

$ 26.00

INTER-COMMUNITY MEMORIAL

HOSPITAL AT NEWFANE INC

INPATIENT ACUTE CARE

$ 182.00

A

$ 27.00

LOCKPORT MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 207.00

A, B, OTHER: EKG, EEG,

$ 30.00

MOUNT ST MARYS HOSPITAL OF

NUCLEAR MEDICINE

NIAGARA FALLS

INPATIENT ACUTE CARE

$ 254.00

A

$ 26.00

NIAGARA FALLS MEMORIAL

MEDICAL CENTER

INPATIENT ACUTE CARE

$ 231.00

A

$ 35.00

ORLEANS

ARNOLD GREGORY MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 252.00

A

$ 26.00

MEDINA MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 208.00

A, B

$ 27.00

WYOMING

WYOMING COUNTY COMMUNITY

HOSPITAL

INPATIENT ACUTE CARE

$ 272.00

A, B

$ 30.00

A-ANESTHESIOLOGIST, B-RADIOLOGIST,

C-PHYSIOTHERAPIST, D-PATHOLOGIST

WORKER'S COMPENSATION

HOSPITAL RATE SCHEDULE

ROCHESTER NEW YORK REGION

EFFECTIVE 09/01/83 - 12/31/83

DAILY

EMERGENCY SERVICE

RATE

EXCLUSIONS

ROOM RATE

CHEMUNG

ARNOT-OGDEN MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 346.00

A, B*

$ 30.00

ST JOSEPHS HOSPITAL OF

ELMIRA

INPATIENT ACUTE CARE

$ 308.00

A

$ 35.00

LIVINGSTON

NICHOLAS H NOYES MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 393.00

A, B

$ 30.00

MONROE

GENESEE HOSPITAL OF

ROCHESTER

INPATIENT ACUTE CARE

$ 553.00

A, B

$ 35.00

HIGHLAND HOSPITAL OF

ROCHESTER

INPATIENT ACUTE CARE

$ 957.00

A, B

$ 35.00

 LAKESIDE MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 580.00

A, B

$ 30.00

MONROE COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

$ 547.00

ALL INCLUSIVE

NO E.R. SERVICE

PARK RIDGE HOSPITAL

INPATIENT ACUTE CARE

$ 1107.00

A, B, C

$ 35.00

ROCHESTER GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 674.00

A, B

$ 35.00

ST MARYS HOSPITAL OF

ROCHESTER

INPATIENT ACUTE CARE

$ 680.00

A, B, C, OTHER: EKG

$ 35.00

STRONG MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 617.00

ECHOCARDIOGRAMS,

$ 35.00

STRESS TESTING

A, B

ONTARIO

CLIFTON SPRINGS HOSPITAL

AND CLINIC

INPATIENT ACUTE CARE

$ 692.00

B

$ 35.00

F F THOMPSON HOSPITAL

INPATIENT ACUTE CARE

$ 393.00

ALL INCLUSIVE

$ 35.00

GENEVA GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 631.00

A

$ 35.00

SCHUYLER

SCHUYLER HOSPITAL

INPATIENT ACUTE CARE

$ 292.00

A, B

$ 26.00

SENECA

 SENECA FALLS HOSPITAL

INPATIENT ACUTE CARE

$ 206.00

A

$ 35.00

WATERLOO MEMORIAL HOSPITAL

INC D/B/A TAYLOR-BROWN

MEMORIAL HOSP

INPATIENT ACUTE CARE

$ 723.00

A

$ 27.00

STEUBEN

BETHESDA HOSPITAL

INPATIENT ACUTE CARE

$ 190.00

A, B, C

$ 27.00

CORNING HOSPITAL

INPATIENT ACUTE CARE

$ 266.00

A

$ 35.00

IRA DAVENPORT MEMORIAL

HOSPITAL INC

INPATIENT ACUTE CARE

$ 261.00

A, B

$ 35.00

 ST JAMES MERCY HOSPITAL

INPATIENT ACUTE CARE

$ 240.00

A, B

$ 35.00

WAYNE

MYERS COMMUNITY HOSPITAL

FOUNDATION INC

INPATIENT ACUTE CARE

$ 246.00

A

$ 35.00

NEWARK-WAYNE COMMUNITY

HOSPITAL INC

INPATIENT ACUTE CARE

$ 387.00

A

$ 35.00

YATES

SOLDIERS AND SAILORS

MEMORIAL HOSPITAL OF

YATES COUNTY INC

INPATIENT ACUTE CARE

$ 608.00

A

$ 30.00

A-ANESTHESIOLOGIST, B-RADIOLOGIST,

C-PHYSIOTHERAPIST, D-PATHOLOGIST

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

CENTRAL NEW YORK REGION

EFFECTIVE 09/01/83 - 12/31/83

DAILY

EMERGENCY SERVICE

RATE

EXCLUSIONS:

ROOM RATE

BROOME

OUR LADY OF LOURDES

MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 334.00

A, B

$ 27.00

UNITED HEALTH SERVICES

INC

INPATIENT ACUTE CARE

$ 395.00

A, B

$ 30.00

REHABILITATION

$ 155.00

A, B

CAYUGA

AUBURN MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 211.00

A

$ 30.00

CHENANGO

CHENANGO MEMORIAL

HOSPITAL INC

INPATIENT ACUTE CARE

$ 298.00

A

$ 30.00

CORTLAND

CORTLAND MEMORIAL

HOSPITAL INC

INPATIENT ACUTE CARE

$ 236.00

A,B,C

$ 35.00

HERKIMER

HERKIMER MEMORIAL

HOSPITAL INC

INPATIENT ACUTE CARE

$ 195.00

A,B

$ 26.00

LITTLE FALLS HOSPITAL

INPATIENT ACUTE CARE

$ 192.00

A,B,C,

$ 35.00

MOHAWK VALLEY GENERAL

HOSPITAL

INPATIENT ACUTE CARE

$ 255.00

A

$ 26.00

JEFFERSON

CARTHAGE AREA HOSPITAL

INC

INPATIENT ACUTE CARE

$ 230.00

B

$ 30.00

EDWARD JOHN NOBLE

HOSPITAL OF

ALEXANDRIA BAY

INPATIENT ACUTE CARE

$ 258.00

B

$ 27.00

HOUSE OF THE GOOD

SAMARITAN

INPATIENT ACUTE CARE

$ 259.00

A,B

$ 35.00

MERCY HOSPITAL OF

WATERTOWN

INPATIENT ACUTE CARE

$ 274.00

A,B

$ 35.00

LEWIS

LEWIS COUNTY GENERAL

HOSPITAL

INPATIENT ACUTE CARE

$ 316.00

B

$ 35.00

MADISON

COMMUNITY MEMORIAL

$ 200.00

A

$ 27.00

HOSPITAL INC

INPATIENT ACUTE CARE

ONEIDA CITY HOSPITAL

INPATIENT ACUTE CARE

$ 254.00

A, B

$ 27.00

ONEIDA

CHILDRENS HOSPITAL AND

REHABILITATION CENTER

REHABILITATION

$ 233.00

A, C,

NO E.R. SERVICE

OTHER, EMG,

CARDIOLOGY

ONEIDA

FAXTON HOSPITAL

INPATIENT ACUTE CARE

$ 239.00

A, C, OTHER:

$ 27.00

EMG, CARDIOLOGY

ROME HOSPITAL AND MURPHY

MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 226.00

A, C

$ 30.00

ROSE HOSPITAL

INPATIENT ACUTE CARE

$ 246.00

A

$ 27.00

ST ELIZABETH HOSPITAL

INPATIENT ACUTE CARE

$ 382.00

A, B, C

$ 35.00

* ST LUKES MEMORIAL

HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 276.00

A, B, C, OTHER:

$ 30.00

EKG, EEG

ONONDAGA

 COMMUNITY GENERAL

HOSPITAL OF GREATER

SYRACUSE

INPATIENT ACUTE CARE

$ 292.00

A, B, OTHER:

$ 35.00

NUCLEAR MEDICINE,

NON-INVASIVE

VASCULAR LAB

CROUSE - IRVING

MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 380.00

A, B, D, OTHER:

$ 35.00

CARDIOLOGY, NUCLEAR

MEDICINE, PSYCHIATRY,

NEUROLOGY

ST JOSEPHS HOSPITAL

HEALTH CENTER

INPATIENT ACUTE CARE

$ 370.00

A, B, C, OTHER:

$ 27.00

PERIPHERAL VASCULAR LAB,

PULMONARY FUNCTION LAB,

PATHOLOGY, FROZEN

SECTIONS, CARDIO

VASCULAR LAB

STATE UNIVERSITY

HOSPITAL UPSTATE

MEDICAL CENTER

INPATIENT ACUTE CARE

$ 270.00

A, B

$ 35.00

OSWEGO

 ALBERT LINDLEY LEE

MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 280.00

A, B

$ 30.00

OSWEGO HOSPITAL

INPATIENT ACUTE CARE

$ 217.00

A

$ 35.00

ST LAWRENCE

A BARTON HEPBURN

HOSPITAL

INPATIENT ACUTE CARE

$ 286.00

A

$ 27.00

CANTON-POTSDAM HOSPITAL

INPATIENT ACUTE CARE

$ 244.00

A

$ 27.00

CLIFTON-FINE HOSPITAL

INPATIENT ACUTE CARE

$ 343.00

ALL INCLUSIVE

$ 26.00

EDWARD JOHN NOBLE

 HOSPITAL OF GOUVERNEUR

INPATIENT ACUTE CARE

$ 328.00

ALL INCLUSIVE

$ 30.00

MASSENA MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 276.00

A

$ 27.00

TIOGA

TIOGA GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 374.00

A

$ 35.00

TOMPKINS

TOMPKINS COUNTY

HOSPITAL

INPATIENT ACUTE CARE

$ 395.00

A, B

$ 35.00

A-ANESTHESIOLOGIST, B-RADIOLOGIST,

C-PHYSIOTHERAPIST, D-PATHOLOGIST

*9/1/83 rate adjusted to reflect

exclusion of radiologists Eff. 7/1/83

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

NORTHEASTERN NEW YORK REGION

EFFECTIVE 09/01/83 - 12/31/83

DAILY

EMERGENCY SERVICE

RATE

EXCLUSIONS:

ROOM RATE

ALBANY

ALBANY MEDICAL

CENTER HOSPITAL

INPATIENT ACUTE

CARE

$ 449.00

A, B, OTHER:

$ 35.00

CHILDS HOSPITAL

INPATIENT ACUTE

ULTRASOUND

CARE

$ 242.00

A

NO E.R. SERVICE

COHOES MEMORIAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 264.00

A, B, C,

$ 35.00

MEMORIAL HOSPITAL

OF ALBANY

INPATIENT ACUTE

CARE

$ 269.00

A, B, C, OTHER:

$ 35.00

ULTRASOUND, NUCLEAR

MEDICINE

ST PETERS HOSPITAL

INPATIENT ACUTE

CARE

$ 278.00

A, B

$ 35.00

CLINTON

CHAMPLAIN VALLEY

PHYSICIANS HOSPITAL

MEDICAL CTR

INPATIENT ACUTE

CARE

$ 196.00

A, B, OTHER: EKG

$ 27.00

COLUMBIA

COLUMBIA MEMORIAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 294.00

B

$ 30.00

DELAWARE

A LINDSAY & OLIVE B

OCONNOR HOSPITAL

INPATIENT ACUTE

CARE

$ 378.00

A, C

$ 26.00

COMMUNITY HOSPITAL

OF STAMFORD

INPATIENT ACUTE

CARE

$ 236.00

A

$ 26.00

DELAWARE VALLEY

HOSPITAL INC

INPATIENT ACUTE

CARE

$ 319.00

ALL INCLUSIVE

$ 26.00

MARGARETVILLE

MEMORIAL HOSPITAL

INPATIENT ACUTE

CARE

$ 543.00

ALL INCLUSIVE

$ 30.00

HE HOSPITAL

INPATIENT ACUTE

CARE

$ 236.00

A,B, OTHER:

$ 30.00

ULTRASOUND,

ELECTRO-CARDIOLOGY

ESSEX

ELIZABETHTOWN

COMMUNITY HOSPITAL

INPATIENT ACUTE

CARE

$ 232.00

B, OTHER:

$ 30.00

MOSES LUDINGTON

HOSPITAL

ELECTROCARDIOLOGY

INPATIENT ACUTE

CARE

$ 430.00

ALL INCLUSIVE

$ 35.00

PLACID MEMORIAL

HOSPITAL INC

INPATIENT ACUTE

CARE

$ 332.00

B

$ 26.00

FRANKLIN

ALICE HYDE MEMORIAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 176.00

B

$ 26.00

GENERAL HOSPITAL OF

SARANAC LAKE

INPATIENT ACUTE

CARE

$ 200.00

A, B, C

$ 27.00

FULTON

JOHNSTOWN HOSPITAL

INPATIENT ACUTE

CARE

$ 231.00

A, C

$ 35.00

NATHAN LITTAUER

HOSPITAL

INPATIENT ACUTE

CARE

$ 233.00

A, B, C

$ 30.00

GREENE

MEMORIAL HOSPITAL

 AND NURSING HOME

OF GREENE COUNTY

INPATIENT ACUTE

CARE

$ 276.00

B, C

$ 35.00

MONTGOMERY

AMSTERDAM MEMORIAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 240.00

A, C

$ 27.00

ST MARYS HOSPITAL

AT AMSTERDAM

INPATIENT ACUTE

CARE

$ 328.00

A,C

$ 35.00

OTSEGO

AURELIA OSBORN FOX

MEMORIAL HOSPITAL

INPATIENT ACUTE

CARE

$ 264.00

A, B, C

$ 35.00

MARY IMOGENE

BASSETT

HOSPITAL

INPATIENT ACUTE

CARE

$ 435.00

ALL INCLUSIVE

$ 30.00

RENSSELAER

LEONARD HOSPITAL

INPATIENT ACUTE

CARE

$ 235.00

A, B, C

$ 35.00

SAMARITAN HOSPITAL

OF TROY

INPATIENT ACUTE

CARE

$ 230.00

A, B

$ 30.00

ST MARYS HOSPITAL

OF TROY

INPATIENT ACUTE

CARE

$ 178.00

A, B, C

$ 30.00

SARATOGA

ADIRONDACK REGIONAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 238.00

B

$ 26.00

SARATOGA HOSPITAL

INPATIENT ACUTE

CARE

$ 268.00

A, B

$ 35.00

SCHENECTADY

BELLEVUE MATERNITY

HOSPITAL INC

INPATIENT ACUTE

CARE

$ 305.00

A

NO E.R. SERVICE

ELLIS HOSPITAL

INPATIENT ACUTE

CARE

$ 373.00

A, B, C, OTHER:

$ 35.00

NUCLEAR MEDICINE,

SPEC. HEMATOLOGY LAB

ST CLARES HOSPITAL

OF SCHENECTADY

INPATIENT ACUTE

CARE

$ 306.00

A, B, OTHER: NUCLEAR

$ 30.00

MEDICINE,

GASTROENTEROLOGY

PROCTOLOGY

SUNNYVIEW HOSPITAL

AND REHABILITATION

CENTER

INPATIENT ACUTE

CARE

$ 230.00

A, B, C, D

NO E.R. SERVICE

SCHOHARIE

 COMMUNITY HOSPITAL

OF SCHOHARIE COUNTY

INC

INPATIENT ACUTE

CARE

$ 249.00

C

$ 35.00

WARREN

GLENS FALLS

HOSPITAL

INPATIENT ACUTE

CARE

$ 252.00

A, B, OTHER: EMG

$ 27.00

WASHINGTON

EMMA LAING STEVENS

HOSPITAL

INPATIENT ACUTE

CARE

$ 207.00

ALL INCLUSIVE

$ 35.00

MARY MCCLELLAN

HOSPITAL

INPATIENT ACUTE

CARE

$ 276.00

C

$ 35.00

A-ANESTHESIOLOGIST, B-RADIOLOGIST,

C-PHYSIOTHERAPIST, D-PATHOLOGIST

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

NORTHERN METROPOLITAN REGION

EFFECTIVE 09/01/83 - 12/31/83

DAILY

EMERGENCY SERVICE

RATE

EXCLUSIONS:

ROOM RATE

DUTCHESS

 HIGHLAND HOSPITAL OF

BEACON

INPATIENT ACUTE CARE

$ 272.00

A

$ 27.00

NORTHERN DUTCHESS

HOSPITAL

INPATIENT ACUTE CARE

$ 239.00

A

$ 35.00

ST FRANCIS HOSPITAL

OF POUGHKEEPSIE

INPATIENT ACUTE CARE

$ 506.00

A, B

$ 35.00

VASSAR BROTHERS

HOSPITAL

INPATIENT ACUTE CARE

$ 284.00

A, B, OTHER: RADIATION

$ 30.00

THERAPY

ORANGE

ARDEN HILL HOSPITAL

INPATIENT ACUTE CARE

$ 219.00

A, OTHER: EMG

$ 35.00

CORNWALL HOSPITAL

INPATIENT ACUTE CARE

$ 311.00

A,B, OTHER: NUCLEAR

$ 30.00

MEDICINE, ULTRASOUND

DOCTORS SUNNYSIDE

HOSPITAL

INPATIENT ACUTE CARE

$ 231.00

ALL INCLUSIVE

$ 30.00

E A HORTON MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 397.00

A

$ 35.00

ST ANTHONY COMMUNITY

HOSPITAL

INPATIENT ACUTE CARE

$ 317.00

A

$ 35.00

ST FRANCIS HOSPITAL

OF PORT JERVIS NEW

YORK

INPATIENT ACUTE CARE

$ 275.00

A, C

$ 26.00

ST LUKES HOSPITAL

OF NEWBURGH

INPATIENT ACUTE CARE

$ 207.00

A

$ 30.00

TUXEDO MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 226.00

A

$ 35.00

PUTNAM

JULIA BUTTERFIELD

MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 319.00

A, C

$ 35.00

PUTNAM COMMUNITY

HOSPITAL

INPATIENT ACUTE CARE

$ 221.00

A

$ 27.00

ROCKLAND

GOOD SAMARITAN

 HOSPITAL OF SUFFERN

INPATIENT ACUTE CARE

$ 319.00

A, OTHER: EMG

$ 35.00

HELEN HAYES HOSPITAL

INPATIENT ACUTE CARE

$ 779.00

ALL INCLUSIVE

NO E.R. SERVICE

NYACK HOSPITAL

INPATIENT ACUTE CARE

$ 337.00

A, B, OTHER: EMG

$ 27.00

SUMMIT PARK HOSPITAL-

ROCKLAND COUNTY

INFIRMARY

INPATIENT ACUTE CARE

$ 241.00

ALL INCLUSIVE

NO E.R. SERVICE

PSYCHIATRIC CARE

$ 175.00

ALL INCLUSIVE

NO E.R. SERVICE

SULLIVAN

 COMMUNITY GENERAL

HOSPITAL OF SULLIVAN

COUNTY - HARRIS

INPATIENT ACUTE CARE

$ 335.00

A

$ 35.00

COMMUNITY GENERAL

HOSPITAL OF SULLIVAN

COUNTY G HERMAN DIV

INPATIENT ACUTE CARE

$ 276.00

A

$ 35.00

ULSTER

BENEDICTINE HOSPITAL

INPATIENT ACUTE CARE

$ 319.00

A

$ 35.00

ELLENVILLE COMMUNITY

HOSPITAL

INPATIENT ACUTE CARE

$ 253.00

ALL INCLUSIVE

$ 26.00

KINGSTON HOSPITAL

INPATIENT ACUTE CARE

$ 248.00

A

$ 30.00

WESTCHESTER

BLYTHEDALE CHILDRENS

HOSPITAL

INPATIENT ACUTE CARE

$ 306.00

ALL INCLUSIVE

NO E.R. SERVICE

BURKE REHABILITATION

CENTER

INPATIENT ACUTE CARE

$ 378.00

ALL INCLUSIVE

NO E.R. SERVICE

DOBBS FERRY HOSPITAL

INPATIENT ACUTE CARE

$ 474.00

A

$ 26.00

LAWRENCE HOSPITAL

INPATIENT ACUTE CARE

$ 294.00

A

$ 35.00

MOUNT VERNON HOSPITAL

INPATIENT ACUTE CARE

$ 296.00

A

$ 30.00

NEW ROCHELLE HOSPITAL

MEDICAL CENTER

INPATIENT ACUTE CARE

$ 662.00

A, B

$ 35.00

NEW YORK HOSPITAL-

CORNELL MEDICAL

CENTER WESTCHESTER

DIVISION

PSYCHIATRIC CARE

$ 311.00

ALL INCLUSIVE

NO E.R. SERVICE

NORTHERN WESTCHESTER

HOSPITAL

INPATIENT ACUTE CARE

$ 410.00

A,B,C, OTHER:

$ 35.00

ULTRASOUND, CATSCANS,

RADIATION THERAPY

PEEKSKILL HOSPITAL

INPATIENT ACUTE CARE

$ 288.00

A

$ 30.00

PHELPS MEMORIAL

HOSPITAL ASSOCIATION

INPATIENT ACUTE CARE

$ 355.00

A,B,C, OTHER:

$ 35.00

NUCLEAR MEDICINE,

ULTRASOUND RADIOISOTOPES

ST AGNES HOSPITAL

INPATIENT ACUTE CARE

$ 327.00

A, C

$ 35.00

ST JOHNS RIVERSIDE

HOSPITAL

INPATIENT ACUTE CARE

$ 325.00

A, OTHER: EMG

$ 26.00

ST JOSEPHS HOSPITAL

YONKERS

INPATIENT ACUTE CARE

$ 377.00

ALL INCLUSIVE

$ 35.00

ST VINCENTS HOSP AND

MEDICAL CTR OF NY

WESTCHESTER BRANCH

PSYCHIATRIC CARE

$ 265.00

A

NO E.R. SERVICE

UNITED HOSPITAL

INPATIENT ACUTE CARE

$ 419.00

A, B

$ 30.00

WESTCHESTER COUNTY

 MEDICAL CENTER

INPATIENT ACUTE CARE

$ 565.00

A,B,C, OTHER: ALL PROF.

$ 35.00

SERVICES

WHITE PLAINS HOSPITAL

MEDICAL CENTER

INPATIENT ACUTE CARE

$ 343.00

A, OTHER: ELECTRO-

$ 35.00

DIAGNOSTIC STUDIES

 YONKERS GENERAL

HOSPITAL

INPATIENT ACUTE CARE

$ 258.00

A, C

$ 35.00

A-ANESTHESIOLOGIST, B-RADIOLOGIST,

C-PHYSIOTHERAPIST, D-PATHOLOGIST

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

LONG ISLAND REGION

EFFECTIVE 09/01/83 - 12/31/83

DAILY

EMERGENCY SERVICE

RATE

EXCLUSIONS:

ROOM RATE

NASSAU

CENTRAL GENERAL

HOSPITAL

INPATIENT ACUTE CARE

$ 307.00

A, B

$ 35.00

COMMUNITY HOSPITAL

AT GLEN COVE

INPATIENT ACUTE CARE

$ 323.00

A

$ 27.00

FRANKLIN GENERAL

HOSPITAL

INPATIENT ACUTE CARE

$ 300.00

A

$ 30.00

HEMPSTEAD GENERAL

HOSPITAL

INPATIENT ACUTE CARE

$ 326.00

A, B, C

$ 30.00

LONG BEACH MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 330.00

A

$ 30.00

LONG ISLAND JEWISH -

HILLSIDE MEDICAL CENTER

(MANHASSET DIV.)

INPATIENT ACUTE CARE

$ 396.00

A, OTHER: CARDIAC

$ 35.00

CATHERIZATION

LYDIA E HALL HOSPITAL

INPATIENT ACUTE CARE

$ 352.00

A, B, OTHER:

$ 30.00

NUCLEAR MEDICINE

MASSAPEQUA GENERAL

HOSPITAL

INPATIENT ACUTE CARE

$ 404.00

A

$ 30.00

MERCY HOSPITAL OF

ROCKVILLE CENTER

INPATIENT ACUTE CARE

$ 307.00

A

$ 35.00

MID-ISLAND HOSPITAL

INPATIENT ACUTE CARE

$ 311.00

A, C

$ 27.00

NASSAU COUNTY MEDICAL

CENTER EAST MEADOW DIV

INPATIENT ACUTE CARE

$ 508.00

ALL INCLUSIVE

$ 30.00

NASSAU HOSPITAL

INPATIENT ACUTE CARE

$ 308.00

A,B,C

$ 35.00

NORTH SHORE UNIVERSITY

HOSPITAL

INPATIENT ACUTE CARE

$ 455.00

A

$ 35.00

SOUTH NASSAU

COMMUNITIES HOSPITAL

INPATIENT ACUTE CARE

$ 255.00

A

$ 26.00

ST FRANCIS HOSPITAL

OF ROSLYN

INPATIENT ACUTE CARE

$ 453.00

A, C

$ 35.00

SUFFOLK

BROOKHAVEN MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 341.00

A, C

$ 35.00

BRUNSWICK HOSPITAL

CENTER INC

INPATIENT ACUTE CARE

$ 393.00

A, C, OTHER: EKG, EEG,

$ 35.00

NUCLEAR SCANS SONOGRAMS

REHABILITATION

$ 320.00

A, C

CENTRAL SUFFOLK

HOSPITAL ASSOCIATION

INPATIENT ACUTE CARE

$ 255.00

A

$ 27.00

 EASTERN LONG ISLAND

HOSPITAL

INPATIENT ACUTE CARE

$ 367.00

A

$ 35.00

GOOD SAMARITAN HOSPITAL

OF WEST ISLIP

INPATIENT ACUTE CARE

$ 301.00

A

$ 30.00

HUNTINGTON HOSPITAL

INPATIENT ACUTE CARE

$ 293.00

A, OTHER: DIALYSIS,

$ 27.00

CHEMOTHERAPY,

RESPIRATORY THERAPY

SUFFOLK

JOHN T MATHER

MEMORIAL HOSPITAL

OF PORT

JEFFERSON NEW

YORK INC

INPATIENT ACUTE CARE

$ 291.00

A, C

$ 35.00

SMITHTOWN GENERAL

HOSPITAL

INPATIENT ACUTE CARE

$ 304.00

A

$ 27.00

SOUTHAMPTON HOSPITAL

INPATIENT ACUTE CARE

$ 333.00

A

$ 27.00

SOUTHSIDE HOSPITAL

INPATIENT ACUTE CARE

$ 301.00

A, C

$ 30.00

ST CHARLES HOSPITAL

INPATIENT ACUTE CARE

$ 300.00

A

$ 27.00

ST JOHNS EPISCOPAL

HOSPITAL SMITHTOWN

INPATIENT ACUTE CARE

$ 285.00

A,B,C

$ 35.00

UNIVERSITY HOSPITAL

OF STONY BROOK

INPATIENT ACUTE CARE

$ 562.00

A, C

$ 35.00

A-ANESTHESIOLOGIST, B-RADIOLOGIST,

C-PHYSIOTHERAPIST, D-PATHOLOGIST

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

NEW YORK CITY REGION

EFFECTIVE 09/01/83 - 12/31/83

DAILY

EMERGENCY SERVICE

RATE

EXCLUSIONS:

ROOM RATE

ASTORIA GENERAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 301.00

A, OTHER:EEG,

$ 27.00

NUCLEAR MEDICINE

BAPTIST MEDICAL

CENTER OF NEW YORK

INPATIENT ACUTE

CARE

$ 336.00

A

$ 27.00

BAYLEY SETON

HOSPITAL

INPATIENT ACUTE

CARE

$ 712.00

ALL INCLUSIVE

$ 35.00

BETH ISRAEL MEDICAL

CENTER

INPATIENT ACUTE

CARE

$ 326.00

A,OTHER: PHYSICIANS

$ 35.00

SERVICES

BOOTH MEMORIAL

MEDICAL CENTER

INPATIENT ACUTE

CARE

$ 564.00

A, B

$ 35.00

BOULEVARD HOSPITAL

INPATIENT ACUTE

CARE

$ 260.00

A,OTHER: NUCLEAR

$ 26.00

MEDICINE

BRONX-LEBANON

HOSPITAL CENTER

INPATIENT ACUTE

CARE

$ 446.00

A,C

$ 30.00

BROOKDALE HOSPITAL

MEDICAL CENTER

INPATIENT ACUTE

CARE

$ 273.00

A,C

$ 35.00

BROOKLYN/CALEDONIA

HOSPITAL

INPATIENT ACUTE

CARE

$ 580.00

A,OTHER:

$ 27.00

RADIOLOGICAL

SURGICAL

INTERVENTION

PROCEDURES

PHYSIOTHERAPY

CONSULTANTS

CABRINI HEALTH CARE

CTR

INPATIENT ACUTE

CARE

$ 456.00

A,B,C, OTHER:

$ 35.00

EEG, EKG,

RADIOISOTOPES,

ULTRASOUND

CALVARY HOSPITAL

INPATIENT ACUTE

CARE

$ 394.00

ALL INCLUSIVE

NO E.R. SERVICE

CATHOLIC MEDICAL

CENTER

INPATIENT ACUTE

CARE

$ 566.00

ALL INCLUSIVE

$ 27.00

COMMUNITY HOSPITAL

OF BROOKLYN INC.

INPATIENT ACUTE

CARE

$ 377.00

A, OTHER:

$ 26.00

NUCLEAR

MEDICINE,

ULTRASOUND

DEEPDALE GENERAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 306.00

A, B, C

$ 26.00

DOCTORS HOSPITAL

INC

INPATIENT ACUTE

CARE

$ 396.00

A, C

$ 35.00

DOCTORS HOSPITAL

OF STATEN ISLAND

INPATIENT ACUTE

CARE

$ 310.00

A

$ 27.00

FLATBUSH GENERAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 337.00

A, C, OTHER:

$ 26.00

EEG, ULTRA

SOUND, CATSCAN

ECHONCEPHASOGRAPHY*

FLUSHING HOSPITAL

AND MEDICAL CENTER

INPATIENT ACUTE

CARE

$ 363.00

A

$ 30.00

H I P HOSPITAL INC

INPATIENT ACUTE

CARE

$ 395.00

A

$ 35.00

HOSPITAL FOR

JOINT DISEASES

AND MEDICAL

CENTER ORTHOPEDIC

INSTITUTE

INPATIENT ACUTE

CARE

$ 781.00

A, C

NO E.R. SERVICE

HOSPITAL FOR

SPECIAL SURGERY

INPATIENT ACUTE

CARE

$ 492.00

A,B

NO E.R. SERV

INSTITUTE OF

REHAB MEDICINE

NY UNIVERSITY

REHABILITATION

$ 392.00

A, C, D

NO E.R. SERVICE

INTERFAITH MEDICAL

CENTER

INPATIENT ACUTE

CARE

$ 515.00

A, B

$ 35.00

JAMAICA HOSPITAL

INPATIENT ACUTE

CARE

$ 447.00

A, B

$ 27.00

JEWISH MEMORIAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 283.00

A

$ 35.00

JOINT DISEASES

NORTH GENERAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 440.00

ALL INCLUSIVE

$ 35.00

KINGS HIGHWAY

HOSPITAL

INPATIENT ACUTE

CARE

$ 318.00

A,C

$ 27.00

KINGSBROOK JEWISH

MEDICAL CENTER

INPATIENT ACUTE

CARE

$ 435.00

A,B,C

$ 35.00

LENOX HILL

HOSPITAL

INPATIENT ACUTE

CARE

$ 486.00

A, C, OTHER: EMG

$ 35.00

LONG ISLAND

COLLEGE HOSPITAL

INPATIENT ACUTE

CARE

$ 495.00

A,B,C

$ 30.00

LONG ISLAND JEWISH-

HILLSIDE MED CTR

INPATIENT ACUTE

CARE

$ 396.00

A,B,OTHER:

$ 35.00

CARDIAC-

CATHERIZATION

LUTHERAN MEDICAL

CENTER

INPATIENT ACUTE

CARE

$ 354.00

A

$ 30.00

MAIMONIDES MEDICAL

CENTER

INPATIENT ACUTE

CARE

$ 523.00

A, B

$ 35.00

MANHATTAN EYE

EAR AND THROAT

HOSPITAL

INPATIENT ACUTE

CARE

$ 467.00

A,B,C, OTHER: EKG

$ 26.00*

MEDICAL ARTS

CENTER HOSPITAL

INPATIENT ACUTE

CARE

$ 335.00

A

$ 26.00

MEMORIAL HOSPITAL

FOR CANCER AND

ALLIED DISEASES

INPATIENT ACUTE

CARE

$ 732.00

ALL INCLUSIVE

NO E.R. SERVICE

METHODIST

HOSPITAL OF

BROOKLYN

INPATIENT ACUTE

CARE

$ 445.00

A, OTHER: PSYCHIATRY

$ 35.00

MISERICORDIA

HOSPITAL MEDICAL

CENTER

INPATIENT ACUTE

CARE

$ 568.00

A,B,OTHER: CARDIO-

$ 35.00

PULMONARY, RENAL

MONTEFIORE HOSPITAL

& MEDICAL CENTER

INPATIENT ACUTE

CARE

$ 639.00

A,B, OTHER:

$ 35.00

NUCLEAR

MEDICINE

(RADIOISTOPES)

MOUNT SINAI

HOSPITAL

INPATIENT ACUTE

CARE

$ 620.00

A,B, OTHER:

$ 30.00

EKG, NUCLEAR

MEDICINE

NY EYE AND EAR

INFIRMARY

INPATIENT ACUTE

CARE

$ 520.00

A

NO E.R. SERVICE

NEW YORK HOSPITAL

AND PAYNE WHITNEY

PSYCHIATRIC CLINIC

INPATIENT ACUTE

CARE

$ 521.00

A,B, OTHER:

$ 35.00

SURGICAL PATHOLOGY,

CYTOLOGY

NY INFIRMARY

BEEKMAN DOWNTOWN

HOSPITAL

INPATIENT ACUTE

CARE

$ 472.00

ALL INCLUSIVE

$ 35.00

NY UNIVERSITY

MEDICAL CENTER

INPATIENT ACUTE

CARE

$ 760.00

A,B,C

$ 35.00

OSTEOPATHIC

HOSPITAL AND

CLINIC

 OF NEW YORK D/B/A

HILLCREST GENERAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 380.00

A

$ 27.00

PARKWAY HOSPITAL

INPATIENT ACUTE

CARE

$ 319.00

A

$ 27.00

PARSONS HOSPITAL

INPATIENT ACUTE

CARE

$ 296.00

A, C

$ 30.00

PELHAM BAY GENERAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 373.00

A, C

$ 27.00

PENINSULA HOSPITAL

CENTER

INPATIENT ACUTE

CARE

$ 430.00

A, B, C, OTHER:

$ 30.00

NUCLEAR MEDICINE,

ULTRASOUND

RADIATION THERAPY

PHYSICIANS

HOSPITAL

INPATIENT ACUTE

CARE

$ 297.00

A, OTHER: NUCLEAR

$ 26.00

MEDICINE*

PRESBYTERIAN

HOSPITAL IN THE

CITY OF NEW YORK

INPATIENT ACUTE

CARE

$ 612.00

A, B

$ 30.00

PROSPECT HOSPITAL

INPATIENT ACUTE

CARE

$ 223.00

A

$ 26.00

RICHMOND MEMORIAL

HOSPITAL AND

HEALTH CENTER

INPATIENT ACUTE

CARE

$ 224.00

A

$ 35.00

ROCKEFELLER

UNIVERSITY

HOSPITAL

INPATIENT ACUTE

CARE

$ 575.00

ALL INCLUSIVE

NO E.R. SERVICE

ST BARNABAS

HOSPITAL

INPATIENT ACUTE

CARE

$ 525.00

B

$ 35.00

ST CLARES

HOSPITAL AND

HEALTH CENTER

INPATIENT ACUTE

CARE

$ 398.00

A, B, C

$ 30.00

ST JOHNS EPISCOPAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 285.00

A, B, C

$ 35.00

ST LUKES - ROOSEVELT

HOSPITAL CENTER

INPATIENT ACUTE

CARE

$ 473.00

A

$ 30.00

DETOXIFICATION

UNIT

$ 182.00

ST MARYS HOSPITAL

OF BROOKLYN

INPATIENT ACUTE

CARE

$ 525.00

ALL INCLUSIVE

$ 35.00

ST VINCENTS

HOSPITAL AND

MEDICAL CENTER

OF NY

INPATIENT ACUTE

CARE

$ 655.00

A, B

$ 27.00

ST VINCENTS

MEDICAL CENTER

OF RICHMOND

INPATIENT ACUTE

CARE

$ 355.00

B

$ 35.00

STATE UNIVERSITY

HOSPITAL DOWNSTATE

MEDICAL CENTER

INPATIENT ACUTE

CARE

$ 636.00

A, B

NO E.R. SERVICE

STATEN ISLAND

HOSPITAL

INPATIENT ACUTE

CARE

$ 608.00

A, B, OTHER:

$ 35.00

PULMONARY

TERRACE HEIGHTS

HOSPITAL

INPATIENT ACUTE

CARE

$ 275.00

A

$ 27.00

UNION HOSPITAL

OF THE BRONX

INPATIENT ACUTE

CARE

$ 260.00

A, C

$ 26.00

VICTORY MEMORIAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 302.00

A, B, C, OTHER:

$ 26.00

EKG

WESTCHESTER

SQUARE HOSPITAL

INPATIENT ACUTE

CARE

$ 383.00

A

$ 35.00

WYCKOFF HEIGHTS

HOSPITAL

INPATIENT ACUTE

CARE

$ 322.00

A, C, OTHER:

$ 35.00

CARDIOLOGY

HEALTH AND HOSPITAL

CORPORATION

BELLEVUE HOSPITAL

CENTER

INPATIENT ACUTE

CARE

$ 562.00

ALL INCLUSIVE

$ 35.00

EXCLUDING

PHYSICIANS

$ 537.00

BRONX MUNICIPAL

HOSPITAL CENTER

INPATIENT ACUTE

CARE

$ 569.00

ALL INCLUSIVE

$ 30.00

CITY HOSPITAL

CENTER AT

ELMHURST

INPATIENT ACUTE

CARE

$ 496.00

ALL INCLUSIVE

$ 27.00

EXCLUDING

PHYSICIANS

$ 461.00

COLER MEMORIAL

HOSPITAL AND HOME

INPATIENT ACUTE

CARE

$ 266.00

ALL INCLUSIVE

NO E.R. SERVICE

CONEY ISLAND

HOSPITAL

INPATIENT ACUTE

CARE

$ 534.00

A, C

$ 30.00

EXCLUDING

PHYSICIANS

$ 513.00

CUMBERLAND

HOSPITAL

INPATIENT ACUTE

CARE

$ 609.00

ALL INCLUSIVE

$ 26.00

GOLDWATER MEMORIAL

HOSPITAL

INPATIENT ACUTE

CARE

$ 227.00

ALL INCLUSIVE

NO E.R. SERVICE

HARLEM HOSPITAL

CENTER

INPATIENT ACUTE

CARE

$ 708.00

ALL INCLUSIVE

$ 30.00

EXCLUDING

PHYSICIANS

$ 680.00

KINGS COUNTY

HOSPITAL CENTER

INPATIENT ACUTE

CARE

$ 533.00

ALL INCLUSIVE

$ 26.00

LINCOLN MEDICAL &

MENTAL HEALTH

CENTER

INPATIENT ACUTE

CARE

$ 617.00

ALL INCLUSIVE

$ 35.00

METROPOLITAN

HOSPITAL CENTER

INPATIENT ACUTE

CARE

$ 614.00

ALL INCLUSIVE

$ 35.00

EXCLUDING

PHYSICIANS

$ 581.00

NORTH CENTRAL BRONX

HOSPITAL

INPATIENT ACUTE

CARE

$ 629.00

ALL INCLUSIVE

$ 35.00

QUEENS HOSPITAL

CENTER

INPATIENT ACUTE

CARE

$ 634.00

ALL INCLUSIVE

$ 35.00

WOODHULL MEDICAL

AND MENTAL HEALTH

CENTER

INPATIENT ACUTE

CARE

$ 646.00

ALL INCLUSIVE

$ 35.00

*EXCLUSION EFFECTIVE 1/1/83

**EFFECTIVE 1/1/82 - 12/31/83

A-ANESTHESIOLOGIST, B-RADIOLOGIST,

C-PHYSIOTHERAPIST, D-PATHOLOGIST