New York State seal

October 16, 1987

SUBJECT: INSURANCE

WITHDRAWN

Circular Letter No. 18 (1987)

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

RE: REIMBURSEMENT FOR OUTPATIENT HOSPITAL SERVICES UNDER NO-FAULT FOR TREATMENT RENDERED ON AND AFTER JANUARY 1, 1987

According to the provisions of 11NYCRR 68.2 (Regulation No. 83), the schedule of rates for hospital outpatient services provided pursuant to section 5102(a)(1) of the Insurance Law shall be the rates approved by the Chairman of the Workers' Compensation Board.

The attached schedule of rates has been established by the Chairman pursuant to Chapter 453 of the Laws of 1984. Accordingly, no-fault insurers shall use the schedule for payment of hospital outpatient services rendered during the period of January 1, 1987 through June, 30, 1988.

Also, enclosed are Amendments to the June 17, 1984 Chiropractic Fee Schedule and Amendments to the September 1986 Medical Fee Schedule. Amendments attached are effective September 1, 1987.

Very truly yours,

JAMES P. CORCORAN

Superintendent of Insurance

HOSPITAL INPATIENT FEE SCHEDULE Effective 1/1/87 - 12/31/87

The inpatient Hospital Fee Schedule was recommended and certified by the State Commissioner of Health and approved by the Chairman of the Workers' Compensation Board. These rates were developed in accordance with amendments to Article 2803 and 2807 of the Public Health Law as set forth in Chapter 807 of the Laws of 1986, as amended by Chapter 906 of the Laws of 1985, Chapters 266, 267 and 268 of the Laws of 1986 and Pan 86 of the Commissioner of Health's Administrative Rules and Regulations.

These charges are for use in payment of claims under the Workers' Compensation Law and the Volunteer Firefighters' Benefit Law.

Chairman

KEY TO EXCLUSIONS

A - ANESTHESIOLOGY

B - RADIOLOGY

C - PHYSICAL THERAPY

D - PATHOLOGY

E - EKG

F - EEG

G - NUCLEAR MEDICINE

H - CAT SCAN

I - ULTRA SOUND

J - EMG

K - THERAPEUTIC RADIOLOGY

L - STRESS TESTS

M - RESPIRATORY THERAPY

N - CARDIOLOGY

O - RADIOISOTOPES

P - NEUROLOGY

Q - PSYCHOLOGY

R - OXYGEN THERAPY

WORKERS' COMPENSATION

HOSPITAL INPATIENT FEE SCHEDULE

WESTERN NEW YORK REGION

EFFECTIVE 1/1/87 - 12/31/87

DAILY

RATE

EXCLUSIONS:

ALLEGANY

 CUBA MEMORIAL HOSPITAL INC

$ 340.62

ALL INCLUSIVE

INPATIENT ACUTE CARE

 MEMORIAL HOSPITAL OF WM F & GERTRUDE

 F JONES A/K/A JONES MEMORIAL

INPATIENT ACUTE CARE

$ 277.90

ALL INCLUSIVE

CATTARAUGUS

 OLEAN GENERAL HOSPITAL

$ 314.16

A,B OTHER: E.R.

INPATIENT ACUTE CARE

PHYSICIANS

 SALAMANCA HOSPITAL DISTRICT AUTHORITY

$ 306.89

B,I

INPATIENT ACUTE CARE

 ST FRANCIS HOSPITAL OF OLEAN

INPATIENT ACUTE CARE

$ 325.32

B

 TRI-COUNTY MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 271.12

A,B,E,I,L

CHAUTAUQUA

 BROOKS MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 556.41

A,B

 JAMESTOWN GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 366.84

A,B,C,D

 LAKE SHORE HOSPITAL INC

INPATIENT ACUTE CARE

$ 267.85

A

 WESTFIELD MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

$ 319.29

B

 WOMANS CHRISTIAN ASSOCIATION

INPATIENT ACUTE CARE

$ 323.46

A,B

ERIE

 BERTRAND CHAFFEE HOSPITAL

$ 268.92

A,C

INPATIENT ACUTE CARE

 BUFFALO COLUMBUS HOSPITAL

$ 414.07

ALL INCLUSIVE

INPATIENT ACUTE CARE

 BUFFALO. GENERAL HOSPITAL

$ 589.28

A,B,C,E,H,K,0

INPATIENT ACUTE CARE

OTHER:

ANGIOLOGY,

ECHO

 CHILDRENS HOSPITAL OF BUFFALO

AINPATIENT ACUTE CARE

$ 477.00

A

 ERIE COUNTY MEDICAL CENTER

INPATIENT ACUTE CARE

$ 488.43

A,B,C,D

DETOX UNIT

$ 317.42

A,B,C,D

 KENMORE MERCY HOSPITAL

INPATIENT ACUTE CARE

$ 274.12

A

 MERCY HOSPITAL OF BUFFALO

INPATIENT ACUTE CARE

$ 295.12

A,B

 MILLARD FILLMORE HOSPITAL

INPATIENT ACUTE CARE

$ 377.39

A,B

DAILY

RATE

EXCLUSIONS

ERIE

 OUR LADY OF VICTORY HOSPITAL OF

 LACKAWANNA

INPATIENT ACUTE CARE

$ 303.71

A,B,F,L,J OTHER

ENDOSCOPY,

SONOGRAMS,

ENDOCARDIOGRAMS

 ROSWELL PARK MEMORIAL INSTITUTE

INPATIENT ACUTE CARE

$ 631.19

ALL INCLUSIVE

 SAINT FRANCIS HOSPITAL OF BUFFALO

INPATIENT ACUTE CARE

$ 285.79

A

 SHEEHAN MEMORIAL EMERGENCY HOSPITAL INC

INPATIENT ACUTE CARE

$ 382.07

B

 SHERIDAN PARK HOSPITAL INC

INPATIENT ACUTE CARE

$ 465.86

ALL INCLUSIVE

 SISTERS OF CHARITY HOSPITAL

INPATIENT ACUTE CARE

$ 288.46

A,B

 ST JOSEPH INTERCOMMUNITY HOSPITAL

INPATIENT ACUTE CARE

$ 271.26

A

GENESEE

 GENESEE MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 328.88

A,B

 ST JEROME HOSPITAL

INPATIENT ACUTE CARE

$ 276.56

B

NIAGARA

 DEGRAFF MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 321.90

A,B

 INTER--COMMUNITY MEMORIAL HOSPITAL AT

 NEWFANE INC

INPATIENT ACUTE CARE

$ 280.68

A,B

 LOCKPORT MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 372.63

A,B

 MOUNT ST MARYS HOSPITAL OF NIAGARA FALLS

INPATIENT ACUTE CARE

$ 350.14

A

 NIAGARA FALLS MEMORIAL MEDICAL CENTER

INPATIENT ACUTE CARE

$ 358.85

A

ORLEANS

 ARNOLD GREGORY MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 278.53

ALL INCLUSIVE

 MEDINA MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 284.80

A,B,C,G,I

WYOMING

 WYOMING COUNTY COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

$ 368.44

A,B,E,L

DAILY

RATE

EXCLUSIONS:

CHEMUNG

 ARNOT-OGDEN MEMORIAL HOSPITAL

$ 455.55

A,B,F

INPATIENT ACUTE CARE

 ST JOSEPHS HOSPITAL OF ELMIRA

$ 481.44

A,B

INPATIENT ACUTE CARE

LIVINGSTON

 NICHOLAS H NOYES MEMORIAL HOSPITAL

$ 337.13

A,B

INPATIENT ACUTE CARE

MONROE

 GENESEE HOSPITAL OF ROCHESTER

$ 488.27

A,B

INPATIENT ACUTE CARE

 HIGHLAND HOSPITAL OF ROCHESTER

$ 499.20

A,B

INPATIENT ACUTE CARE

 LAKESIDE MEMORIAL HOSPITAL

$ 469.04

A,B

INPATIENT ACUTE CARE

 MONROE COMMUNITY HOSPITAL

$ 552.83

A,B,C

INPATIENT ACUTE CARE

 PARK RIDGE HOSPITAL

$ 474.66

A,B,C

INPATIENT ACUTE CARE

 ROCHESTER GENERAL HOSPITAL

$ 495.64

A,B

INPATIENT ACUTE CARE

 ST MARYS. HOSPITAL OF ROCHESTER

$ 655.51

A,B,C,N

INPATIENT ACUTE CARE

 STRONG MEMORIAL HOSPITAL

$ 586.73

A,B

INPATIENT ACUTE CARE

ONTARIO

 CLIFTON SPRINGS HOSPITAL AND CLINIC

$ 291.15

A,B,Q

INPATIENT ACUTE CARE

 F F THOMPSON HOSPITAL

$ 287.69

A,B

INPATIENT ACUTE CARE

 GENEVA GENERAL HOSPITAL

$ 392.14

A

INPATIENT ACUTE CARE

SCHUYLER

 SCHUYLER HOSPITAL

$ 341.45

A,B OTHER, ER

INPATIENT ACUTE CARE

PRIMARY CARE

SENECA

 SENECA FALLS HOSPITAL

$ 436.25

B,D,E,M

INPATIENT ACUTE CARE

 WATERLOO MEMORIAL HOSPITAL INC D/B/A

 TAYLOR-BROWN MEMORIAL HOSP

INPATIENT ACUTE CARE

$ 321.55

A

DAILY

RATE

EXCLUSIONS

STEUBEN

 CORNING HOSPITAL

INPATIENT ACUTE CARE

$ 343.47

A, B

 IRA DAVENPORT MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

$ 303.24

A

 SAINT JAMES MERCY HOSPITAL

INPATIENT ACUTE CARE

$ 277.82

A, B, C, D OTHER:

PULMONARY

WAYNE

 MYERS COMMUNITY HOSPITAL FOUNDATION INC

INPATIENT ACUTE CARE

$ 346.42

A, B

 NEWARK-WAYNE COMMUNITTY HOSPITAL INC

INPATIENT ACUTE CARE

$ 353.84

A, B

YATES

 SOLDIERS AND SAILORS MEMORIAL HOSPITAL OF

 YATES COUNTY INC

INPATIENT ACUTE CARE

$ 373.22

A

DAILY

RATE

EXCLUSIONS:

BROOME

 OUR LADY OF LOURDES MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 371.56

A, B, G, H, I, OTHER:

RADIO CHEMISTRY

 UNITED HEALTH SERVICES INC

INPATIENT ACUTE CARE

$ 488.99

A, B, C

REHABILITATION

$ 170.41

A, B, C

CAYUGA

 AUBURN MEMORIAL HOSPITAL

A, B, E, G, H, I, OTHER:

INPATIENT ACUTE CARE

$ 283.14

PULMONARY

CHENANGO

 CHENANGO MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

$ 433.94

A, B,

CORTLAND

 CORTLAND MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

$ 453.54

A, B, C

HERKIMER

 LITTLE FALLS HOSPITAL

INPATIENT ACUTE CARE

$ 253.33

A, B

 MOHAWK VALLEY GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 225.22

A, B

JEFFERSON

 CARTHAGE AREA HOSPITAL INC

INPATIENT ACUTE CARE

$ 306.16

A, B

 EDWARD JOHN NOBLE HOSPITAL INC

 ALEXANDRIA BAY

INPATIENT ACUTE CARE

$ 275.64

B

 HOUSE OF GOOD SAMARITAN

   INPATIENT ACUTE CARE

$ 320.24

A, B, C

 MERCY HOSPITAL OF WATERTOWN

INPATIENT ACUTE CARE

$ 490.54

A, B

LEWIS

 LEWIS COUNTY GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 292. 67

B

MADISON

 COMMUNITY MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

$ 331.20

A, B

 ONEIDA CITY HOSPITAL

INPATIENT ACUTE CARE

$ 298.57

A, B, D, O

ONEIDA

 CHILDRENS HOSPITAL AND REHABILITATION

 CENTER

REHABILITATION

$ 323.23

B

 FAXTON HOSPITAL

INPATIENT ACUTE CARE

$ 317.54

B

DAILY

RATE

EXCLUSIONS:

ONEIDA

 ROME HOSPITAL AND MURPHY MEMORIAL

 HOSPITAL

INPATIENT ACUTE CARE

$ 288.69

A,B,C,F,G,H,I,O

 ST ELIZABETH HOSPITAL

INPATIENT ACUTE CARE

$ 441.03

A,B,C

 ST LUKES MEMORIAL HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 358.51

A,B,C,E

ONONDAGA

 COMMUNITY GENERAL HOSPITAL OF

 GREATER SYRACUSE

INPATIENT ACUTE CARE

$ 386.09

A,B,G, OTHER:

NON-INVASIVE

VASCULAR LAB

 CROUSE - IRVING MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 502.78

A,B,D,E,G

 ST JOSEPHS HOSPITAL HEALTH CENTER

INPATIENT ACUTE CARE

$ 420.68

A,B,D, OTHER:

VASCULAR LAB,

PULMONARY

FUNCTION LAB,

CARDIO

VASCULAR LAB

 STATE UNIVERSITY HOSPITAL

 STATE MEDICAL CENTER

INPATIENT ACUTE CARE

$ 516.64

A,B,C

OSWEGO

 ALBERT LINDLEY LEE MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 329.59

A,B,D

 OSWEGO HOSPITAL

INPATIENT ACUTE CARE

$ 271.0

A,B,C

ST LAWRENCE

 A BARTON HEPBURN HOSPITAL

INPATIENT ACUTE CARE

$ 432.63

A,B

 CANTON-POTSDAM HOSPITA

INPATIENT ACUTE CARE

$ 377.29

A,B,C

 CLIFTON-FINE HOSPITAL

INPATIENT ACUTE CARE

$ 376.95

 EDWARD JOHN NOBLE HOSPITAL OF

 GOUVERNEUR

$ 299.73

A,B,E

INPATIENT ACUTE CARE

DAILY

RATE

EXCLUSIONS:

ST LAWRENCE

 MASSENA MEMORIAL HOSPITAL

A

INPATIENT ACUTE CARE

$ 363.69

TIOGA

 TIOGA GENERAL HOSPITAL

A,B,C,D,N

INPATIENT ACUTE CARE

$ 384.91

TOMPKINS

 TOMPKINS COUNTY HOSPITAL

$ 344.15

A,B,C,E,F

INPATIENT ACUTE CARE

DAILY

RATE

EXCLUSIONS:

ALBANY

 ALBANY MEDICAL CENTER HOSPITAL

INPATIENT ACUTE CARE

$ 486.64

A,B

CHILDS HOSPITAL

 INPATIENT ACUTE CARE

$ 626.15

A,B,C,D

MEMORIAL HOSPITAL OF ALBANY

 INPATIENT ACUTE CARE

$ 366.36

A,B,C,D,G,H,I

ST PETERS HOSPITAL

 INPATIENT ACUTE CARE

$ 343.80

A,B,C,E,F,H,I,K,O,R

OTHER:

CARDIOPULMONARY

CLINTON

 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL

 MEDICAL CENTER

INPATIENT ACUTE CARE

$ 280.21

A,B,E

COLUMBIA

 COLUMBIA MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 346.48

B

DELAWARE

 A LINDSAY & OLIVE B OCONNOR HOSPITAL

INPATIENT ACUTE CARE

$ 349.47

A

 COMMUNITY HOSPITAL OF STAMFORD

INPATIENT ACUTE CARE

$ 340.35

ALL INCLUSIVE

 WARE VALLEY HOSPITAL INC

 INPATIENT ACUTE CARE

$ 436.92

B

 MARGARETVILLE MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 392.70

B

 THE HOSPITAL

INPATIENT ACUTE CARE

$ 332.41

A,B

ESSEX

 ELIZABETHTOWN COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

$ 316.13

A,B,D,E,F

 MOSES-LUDINGTON HOSPITAL

INPATIENT ACUTE CARE

$ 438.48

B,D

 PLACID MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

$ 375.14

B,D

FRANKLIN

 ALICE HYDE MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 275.40

B

 GENERAL HOSPITAL OF SARANAC LAKE

INPATIENT ACUTE CARE

$ 253.31

A,B,D

DAILY

RATE

EXCLUSIONS:

FULTON

 JOHNSTOWN HOSPITAL

A,C

INPATIENT ACUTE CARE

$ 306.58

 NATHAN LITTAUER HOSPITAL

INPATIENT ACUTE CARE

$ 412.84

A,B

GREENE

 MEMORIAL HOSPITAL AND NURSING HOME

 OF GREENE COUNTY

INPATIENT ACUTE CARE

$ 383.10

A,B

MONTGOMERY

 AMSTERDAM MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 266.97

A,B,C,D,N

 ST MARYS HOSPITAL AT AMSTERDAM

$ 312.50

A,B,C,D,E,F

INPATIENT ACUTE CARE

OTSEGO

 AURELIA OSBORN FOX

 MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 359.23

A,B,F

 MARY IMOGENE BASSETT HOSPITAL

INPATIENT ACUTE CARE

$ 477.62

A,B,D

RENSSELAER

 LEONARD HOSPITAL

INPATIENT ACUTE CARE

$ 329.17

A,B,C,F

REHABILITATION

$ 214.65

A,B,C,F

 SAMARITAN HOSPITAL OF TROY

INPATIENT ACUTE CARE

$ 296.35

A,B,C

 ST MARYS HOSPITAL OF TROY

$ 303.05

A,B,D,F

INPATIENT ACUTE CARE

SARATOGA

 ADIRONDACK REGIONAL HOSPITAL

INPATIENT ACUTE CARE

$ 352.04

B,D,N OTHER:

HOLTER MONITOR

 SARATOGA HOSPITAL

INPATIENT ACUTE CARE

$ 352.94

A,B,D,F,H,J, OTHER:

VASCULAR LAB

SCHENECTADY

 BELLEVUE MATERNITY HOSPITAL INC

INPATIENT ENT ACUTE CARE

$ 418.69

A,B

 ELLIS HOSPITAL

INPATIENT ACUTE CARE

$ 417.51

A,B,C,D

DAILY

RATE

EXCLUSIONS:

SCHENECTADY

 ST CLARES HOSPITAL OF SCHENECTADY

A,B,C,D,G, OTHER:

INPATIENT ACUTE CARE

$ 576.20

GASTROENTEROLOG1

PROCTOLOGY

 SUNNYVIEW HOSPITAL AND

 REHABILITATION CENTER

INPATIENT ACUTE CARE

$ 274.43

CYSTOMETRY

SCHOHARIE

 COMMUNITY HOSPITAL OF SCHOHARIE

 COUNTY INC

INPATIENT ACUTE CARE

$ 327.03

A,C

WARREN

 GLENS FALLS HOSPITAL

INPATIENT ACUTE CARE

$ 327.70

A,B,D,N

WASHINGTON

 EMMA LAING STEVENS HOSPITAL

INPATIENT ACUTE CARE

$ 570.97

B

 MARY MCCLELLAN HOSPITAL

INPATIENT ACUTE CARE

$ 344.88

B,O

DAILY

RATE

EXCLUSIONS:

DUTCHESS

 HIGHLAND HOSPITAL OF BEACON --

 SEE ST FRANCIS HOSPITAL OF BEACON

 NORTHERN DUTCHESS HOSPITAL

INPATIENT ACUTE CARE

$ 336.95

A,B,C,D

 ST FRANCIS HOSPITAL OF BEACON

INPATIENT ACUTE CARE

$ 348.48

A,B,C,E,F,N

 ST FRANCIS HOSPITAL OF POUGHKEEPSIE

INPATIENT ACUTE CARE

$ 411.83

A,B

 VASSAR BROTHERS HOSPITAL

INPATIENT ACUTE CARE

$ 390.99

A,B,D, OTHER:

RADIATION

ONCOLOGY

ORANGE

 ARDEN HILL HOSPITAL

INPATIENT ACUTE CARE

$ 318.38

A,B,D,J

 CORNWALL HOSPITAL

INPATIENT ACUTE CARE

$ 360.76

A,B,G,H,I,L OTHER:

DIAG. RADIOLOGY

HOLTER MONITOR.

 E A HORTON MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 381.99

A,B,C,D,E,F OTHER:

RENAL,

CARDIOPULMRY

 MERCY COMMUNITY HOSPITAL --

 SEE ST FRANCIS-MERCY HOSPITAL

 ST ANTHONY COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

$ 358.20

A,B

 ST FRANCIS-MERCY HOSPITAL

INPATIENT ACUTE CARE

$ 398.17

A,B,D

 ST LUKES HOSPITAL OF NEWBURGH

INPATIENT ACUTE CARE

$ 316.67

A,B

PUTNAM

 JULIA BUTTERFIELD MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 355.26

A,B,D,E

 PUTNAM COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

$ 358.68

A,B,C

ROCKLAND

 GOOD SAMARITAN HOSPITAL OF SUFFERN

INPATIENT ACUTE CARE

$ 526.22

A,B,H,J,N, OTHER:

DIALYSIS

 HELEN HAYES HOSPITAL

INPATIENT ACUTE CARE

$ 550.21

ALL INCLUSIVE

 NYACK HOSPITAL

INPATIENT ACUTE CARE

$ 444.65.

A,B,D

 SUMMIT PARK HOSPITAL --

 ROCKLAND COUNTY INFIRMARY

INPATIENT ACUTE CARE

$ 267.04

ALL INCLUSIVE

PSYCHIATRIC CARE

$ 211.01

ALL INCLUSIVE

DAILY

RATE

EXCLUSIONS:

SULLIVAN

 COMMUNITY GENERAL HOSPITAL OF

 SULLIVAN COUNTY - HARRIS DIV

INPATIENT ACUTE CARE

$ 506.94

A,B

 COMMUNITY GENERAL HOSPITAL OF

 SULLIVAN COUNTY G HERMAN DIV

INPATIENT ACUTE CAR

$ 321.56

A,B

ULSTER

 BENEDICTINE HOSPITAL

INPATIENT ACUTE CARE

$ 340.16

A,B,C

 ELLENVILLE COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

$ 272.86

ALL INCLUSIVE

 KINGSTON HOSPITAL

INPATIENT ACUTE CARE

$ 330.33

ALL INCLUSIVE

WESTCHESTER

 BLYTHEDALE CHILDRENS HOSPITAL

INPATIENT ACUTE CARE

$ 330.96

A,D

 BURKE REHABILITATION CENTER

INPATIENT ACUTE CARE

$ 461.25

ALL INCLUSIVE

 DOBBS FERRY HOSPITAL

INPATIENT ACUTE CARE

$ 545.12

ALL INCLUSIVE

 LAWRENCE HOSPITAL

INPATIENT ACUTE CARE

$ 434.74

ALL INCLUSIVE

 JNT VERNON HOSPITAL

INPATIENT ACUTE CARE

$ 459.77

A,B,C,E,F

 NEW ROCHELLE HOSPITAL MEDICAL CENTER'

INPATIENT ACUTE CARE

$ 513.44

A,B,C

 NEW YORK HOSPITAL-CORNELL MEDICAL

 CENTER WESTCHESTER DIVISION

PSYCHIATRIC CARE

$ 40.1.37

ALL INCLUSIVE

 NORTHERN WESTCHESTER HOSPITAL

INPATIENT ACUTE CARE

$ 485.22

A,B,H,I,K

 PEEKSKILL HOSPITAL

INPATIENT ACUTE CARE

$ 391.32

B

 PHELPS MEMORIAL HOSPITAL ASSOCIATION

INPATIENT ACUTE CARE

$ 456.53

A,B

 ST AGNES HOSPITAL

INPATIENT ACUTE CARE

$ 430.73

A,C,G,K,OTHER:

ANATOMICAL

PATHOLOGY

 ST JOHNS RIVERSIDE HOSPITAL

$ 588.52

A,B,C,J

INPATIENT ACUTE CARE

 ST JOSEPHS HOSPITAL YONKERS

$ 466.91

ALL INCLUSIVE

INPATIENT ACUTE CARE

 ST VINCENTS HOSP AND MEDICAL CTR OF NY

 WESTCHESTER BRANCH

PSYCHIATRIC CARE

$ 331.05

ALL INCLUSIVE

DAILY

RATE

EXCLUSIONS:

WESTCHESTER

 UNITED HOSPITAL

$ 459.21

A,B,D,E

INPATIENT ACUTE CARE

 WESTCHESTER COUNTY MEDICAL CENTER

$ 653.92

A,B,C,D,E,F,G,

INPATIENT ACUTE CARE

OTHER:

CYSTOSCOPY

 WHITE PLAINS HOSPITAL MEDICAL CEN

ER $ 435.23

A,B,C,G,H,I, OTHER:-.

INPATIENT ACUTE CARE

ELECTRO-

DIAGNOSTIC

STUDIES,

PULMONARY

 YONKERS GENERAL HOSPITAL

$ 399.32

A,C,K

INPATIENT ACUTE CARE

DAILY

RATE

EXCLUSIONS:

NASSAU

 CENTRAL GENERAL HOSPITAL

INPATIENT ACUTE CARE.

$ 412.58

A,B,E,F

 COMMUNITY HOSPITAL AT GLEN COVE

INPATIENT ACUTE CARE

$ 441.52

ALL INCLUSIVE

 FRANKLIN GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 571.19

A

 HEMPSTEAD GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 460.39

B,D

 LONG BEACH MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 426.23

A

 LONG ISLAND JEWISH - HILLSIDE

MEDICAL CENTER (MANHASSET DIV.)

INPATIENT ACUTE CARE

$ 745.47

A,B OTHER:

CARDIAC

CATHERIZATION

 MASSAPEQUA GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 494.72

A,B,D,E

 MERCY HOSPITAL OF ROCKVILLE CENTER

INPATIENT ACUTE CARE

$ 452.49

A,E

 MID-ISLAND HOSPITAL

INPATIENT ACUTE CARE

$ 430.61

A,B,C,D,E,F

 NASSAU COUNTY MEDICAL CENTER

FAST MEADOW DIV

INPATIENT ACUTE CARE

$ 653.45

A,B,C,D

 NORTH SHORE UNIVERSITY HOSPITAL

INPATIENT ACUTE CARE

$ 602.09

A,B,C,D,E,F,G,M

OTHER:

SPEECH THERAPY

 SOUTH NASSAU COMMUNITIES HOSPITAL

INPATIENT ACUTE CARE

$ 359.85

A,L OTHER:

ECHOCARDIOGRAM

 ST FRANCIS HOSPITAL OF ROSLYN

INPATIENT ACUTE CARE

$ 1084.75

A

 SYOSSET COMMUNITY HOSPITAL

(HIP HOSPITAL OF L.I.)

INPATIENT ACUTE CARE

$ 637.30

A

 WINTHROP UNIVERSITY HOSPITAL

(NASSAU HOSP)

INPATIENT ACUTE CARE

$ 448.97

A,B,C OTHER:

CARDIOPULMONARY,

ENDOSCOPY,

SONOGRAPHY

DAILY

RATE

EXCLUSIONS:

SUFFOLK

 BROOKHAVEN MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 436.23

A,B

 BRUNSWICK HOSPITAL CENTER INC

INPATIENT ACUTE CARE

$ 482.94

A,B,E,F

REHABILITATION

$ 403.28

A,B,E,F

 CENTRAL SUFFOLK HOSPITAL

ASSOCIATION

INPATIENT ACUTE CARE

$ 456.08

A,B,D,E,F,G,H

OTHER:

RENAL,

PULMONARY,

THAL., CARDIAC

STRESS TESTS

 CHURCH CHARITY FOUNDATION -

SEE ST JOHNS EPISCOPAL

HOSP-SMITHTOWN

 COMMUNITY HOSP OF

WESTERN SUFFOLK

INPATIENT ACUTE CARE

$ 404.31

A,B,D

 EASTERN LONG ISLAND HOSPITAL

INPATIENT ACUTE CARE

$ 456.89

ALL INCLUSIVE

 GOOD SAMARITAN HOSPITAL

OF WEST ISLIP

INPATIENT ACUTE CARE

$ 467.84

A

 HUNTINGTON HOSPITAL

INPATIENT ACUTE CARE

$ 395.62

A,B,M, OTHER:

DIALYSIS,

CHEMOTHERAPY

 JOHN T MATHER MEMORIAL

HOSPITAL OF PORT

JEFFERSON NEW YORK INC

INPATIENT ACUTE CARE

$ 416.47

A,B,E,F,G,H,I

 SMITHTOWN GENERAL HOSPITAL

(SEE COMM HOSP OF

WESTERN SUFFOLK)

 SOUTHAMPTON HOSPITAL

INPATIENT ACUTE CARE

$ 437.01

ALL INCLUSIVE

 SOUTHSIDE HOSPITAL

INPATIENT ACUTE CARE

$ 418.85

A,B,C

 ST CHARLES HOSPITAL

INPATIENT ACUTE CARE

$ 404.28

ALL INCLUSIVE

 ST JOHNS EPISCOPAL

HOSPITAL SMITHTOWN

(CHURCH CHARITY FOUNDATION)

INPATIENT ACUTE CARE

$ 512.77

A,B,C,D,L,N,

OTHER:

HOLTER MONITOR

 UNIVERSITY HOSPITAL

OF STONY BROOK

INPATIENT ACUTE CARE

$ 808.45

A,B,C

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

NEW YORK CITY REGION

EFFECTIVE 1/1/87 - 12/31/87

DAILY

RATE

EXCLUSIONS:

ASTORIA GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 369.67

A,B,F,G

BAPTIST MEDICAL CENTER OF NEW YORK

INPATIENT ACUTE CARE

$ 369.54

A

BAYLEY SETON HOSPITAL

INPATIENT ACUTE CARE

$ 618.00

A,B

BETH ISRAEL MEDICAL CENTER

INPATIENT ACUTE CARE

$ 676.49

A

DETOXIFICATION UNIT

$ 230.74

A

BOOTH MEMORIAL MEDICAL CENTER

A,B,C,D,N,P,

INPATIENT ACUTE CARE

$ 880.68

OTHER: VASCULAR

BRONX-LEBANON HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 591.54

A,C,E,H,K

BROOKDALE HOSPITAL MEDICAL CENTER

INPATIENT ACUTE CARE

$ 521.54

A,C,D

BROOKLYN/CALEDONIAN HOSPITAL

INPATIENT ACUTE CARE

$ 536.66

A,K OTHER:

CARDIAC CATH

CABRINI HEALTH CARE CTR

INPATIENT ACUTE CARE

$ 528.11

A,B,C

CALVARY HOSPITAL

INPATIENT ACUTE CARE

$ 416.35

ALL INCLUSIVE

   DLIC MEDICAL CENTER

INPATIENT ACUTE CARE

$ 633.97

A,E,F

ST MARYS HOSP - SEE SEPARATE LISTING

CHURCH CHARITY FOUNDATION - SEE ST JOHNS

EPISCOPAL HOSPITAL

COMMUNITY HOSPITAL OF BROOKLYN INC

INPATIENT ACUTE CARE

$ 424.19

A,B,C,D

DEEPDALE GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 386.10

A,B,C,D,E

DOCTORS HOSPITAL INC

INPATIENT ACUTE CARE

$ 614.94

A,B,E

DOCTORS HOSPITAL OF STATEN ISLAND

INPATIENT ACUTE CARE

$ 403.07

A,B,D,E,F

FLUSHING HOSPITAL AND MEDICAL CENTER

INPATIENT ACUTE CARE

$ 466.16

A,B,E,N

HILLCREST GEN HOSP -

SEE CATHOLIC MEDICAL

CENTER

HIP HOSPITAL INC (LA GUARDIA)

INPATIENT ACUTE CARE

$ 511.13

A

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

NEW YORK CITY REGION

EFFECTIVE 1/1/87 - 12/31/87

DAILY

RATE

EXCLUSIONS:

HOSPITAL FOR JOINT DISEASES

AND MEDICAL CENTER

ORTHOPEDIC INSTITUTE

INPATIENT ACUTE CARE

$ 944.92

A,B,C,D

HOSPITAL FOR SPECIAL SURGERY

INPATIENT ACUTE CARE

$ 646.82

A,B,P

INSTITUTE OF REHAB

MEDICINE NY UNIVERSITY

SEE RUSK INST-NYU

INTERFAITH MEDICAL CENTER

INPATIENT ACUTE CARE

$ 604.63

ALL INCLUSIVE

JAMAICA HOSPITAL

INPATIENT ACUTE CARE

$ 523.19

A,B,C,E

JOINT DISEASES NORTH

GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 499.30

ALL INCLUSIVE

KINGS HIGHWAY HOSPITAL

INPATIENT ACUTE CARE

$ 375.10

A,B,C,E

KINGSBROOK JEWISH

MEDICAL CENTER

INPATIENT ACUTE CARE

$ 531.90

A,B,C,E,F,C) OTHER:

AUDIOLOGY

LAGUARDIA HOSP - SEE HIP HOSP

LENOX HILL HOSPITAL

INPATIENT ACUTE CARE

$ 644.54

A;J

LONG ISLAND COLLEGE HOSPITAL

INPATIENT ACUTE CARE

$ 697.46

A,B,C,D,N

LONG ISLAND JEWISH-HILLSIDE

MED CTR

INPATIENT ACUTE CARE

$ 745.47

A,B OTHER:

CARDIAC-

CATHETERIZATION

PSYCHIATRIC

$ 346.03

SAME AS ABOVE

REHABILITATION

$ 995.61

SAME AS ABOVE

LUTHERAN MEDICAL CENTER

INPATIENT ACUTE CARE

$ 517.17

A,B,C,E,G,H,I,K

MAIMONIDES MEDICAL CENTER

INPATIENT ACUTE CARE

$ 580.62

A,B,C,D.E,P OTHER:

NEONATAL,

HEMATOLOGY,

ONCOLOGY,

RENAL

MANHATTAN EYE EAR AND

THROAT HOSPITAL

INPATIENT ACUTE CARE

$ 895.97

A,B,C,E

MEDICAL ARTS CENTER HOSPITAL

INPATIENT ACUTE CARE

$ 387.62

B,D

MEMORIAL HOSPITAL FOR

CANCER AND ALLIED

DISEASES

INPATIENT ACUTE CARE

$ 913.97

A,B,K

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

NEW YORK CITY REGION

EFFECTIVE 1/1/87 - 12/31/87

DAILY

RATE

EXCLUSIONS:

METHODIST HOSPITAL OF BROOKLYN

INPATIENT ACUTE CARE

$ 587.63

A,B

MISERICORDIA HOSPITAL

MEDICAL CENTER -

SEE OUR LADY OF MERCY MED CTR

MONTEFIORE HOSPITAL &

MEDICAL CENTER

INPATIENT ACUTE CARE

$ 849.80

A,B,G

MOUNT SINAI HOSPITAL

INPATIENT ACUTE CARE

$ 781.90

A,B,E,F,G,J

NY EYE AND EAR INFIRMARY

INPATIENT ACUTE CARE

$ 520.91

A

NEW YORK HOSPITAL AND PAYNE WHITNEY

PSYCHIATRIC CLINIC

INPATIENT ACUTE CARE

$ 752.33

A,B,D OTHER:

CYTOLOGY

NY INFIRMARY BEEKMAN

DOWNTOWN HOSPITAL

INPATIENT ACUTE CARE

$ 590.23

A,B

NY UNIVERSITY MEDICAL CENTER

INPATIENT ACUTE CARE

$ 749.66

A,B,C,D,N

OEOPATHIC HOSPITAL AND

CLINIC OF NEW YORK

HILLCREST GENERAL HOSPITAL -

ATHOLIC MEDICAL CENTER

OUR LADY OF MERCY MED CTR

(MISERICORDIA HOSP)

INPATIENT ACUTE CARE

$ 540.97

A,B,C,D,E

PARKWAY HOSPITAL

INPATIENT ACUTE CARE

$ 389.99

A

PARSONS HOSPITAL

INPATIENT ACUTE CARE

$ 358.25

A,B,C

PELHAM BAY GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 398.60

A,B,C,D

PENINSULA HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 451.65

A,B,G,I,K

PHYSICIANS HOSPITAL

INPATIENT ACUTE CARE

$ 355.13

ALL INCLUSIVE

PRESBYTERIAN HOSPITAL

IN THE CITY OF NY

INPATIENT ACUTE CARE

$ 639.21

A,B,D

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

NEW YORK CITY REGION

EFFECTIVE 1/1/87 - 12/31/87

DAILY

RATE

EXCLUSIONS:

RICHMOND MEMORIAL HOSPITAL

AND HEALTH

CENTER

INPATIENT ACUTE CARE

$ 449.97

A,B

ROCKEFELLER UNIVERSITY HOSPITAL

INPATIENT ACUTE CARE

$ 295.62

ALL INCLUSIVE

RUSK INSTITUTE - NYU

INPATIENT ACUTE CARE

$ 489.09

A,5,0

ST BARNABAS HOSPITAL

INPATIENT ACUTE CARE

$ 497.80

A,B,C,E,F,H2O

ST GLARES HOSPITAL AND

HEALTH CENTER

INPATIENT ACUTE CARE

$ 420.17

A,B,C,E,F

ST JOHNS EPISCOPAL HOSPITAL

(CHURCH CHARITY FOUNDATION)

INPATIENT ACUTE CARE

$ 512.77

A,B,C,D,L,N OTHER:

HOLTER MONITOR

ST JOSEPHS HOSPITAL -

SEE CATHOLIC MEDICAL

CENTER

ST LUKES - ROOSEVELT

HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 615.88

DETOXIFICATION UNIT

$ 185.22

ST MARYS HOSPITAL OF BROOKLYN

INPATIENT ACUTE CARE

$ 623.61

E,F

ST VINCENTS HOSPITAL AND

MEDICAL CENTER OF NY

INPATIENT ACUTE CARE

$ 678.28

A,I OTHER:

DIAGNOSTIC

RADIOLOGY

ST VINCENTS MEDICAL CENTER

OF RICHMOND

INPATIENT ACUTE CARE

$ 485.52

B,E

STATE UNIVERSITY HOSPITAL

DOWNSTATE MEDICAL

CENTER

INPATIENT ACUTE CARE

$ 638.74

A,B OTHER:

PHYSIATRY

STATEN ISLAND HOSPITAL

$ 531.41

A,B,C,D,E,F,G,H,I,

INPATIENT ACUTE CARE

J,K,L,M,N,O,P,R

UNION HOSPITAL OF THE BRONX

$ 395.33

A,C

INPATIENT ACUTE CARE

VICTORY MEMORIAL HOSPITAL

$ 400.54

A

INPATIENT ACUTE CARE

WESTCHESTER SQUARE HOSPITAL

INPATIENT ACUTE CARE

$ 480.22

A,B,C

WYCKOFF HEIGHTS HOSPITAL

INPATIENT ACUTE CARE

$ 435.33

A,H

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

NEW YORK CITY REGION

EFFECTIVE 1/1/87 - 12/31/87

DAILY

RATE

EXCLUSIONS:

HEALTH AND HOSPITAL CORPORATION

BELLEVUE HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 589.28.

ALL INCLUSIVE

BRONX MUNICIPAL HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 664.61

ALL INCLUSIVE

CITY HOSPITAL CENTER AT ELMHURST

INPATIENT ACUTE CARE

$ 568.23

ALL INCLUSIVE

COLER MEMORIAL HOSPITAL AND HOME

INPATIENT ACUTE CARE

$ 338.03

ALL INCLUSIVE

CONEY ISLAND HOSPITAL

INPATIENT ACUTE CARE

$ 573.77

A,B,D,G,H

GOLDWATER MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 294.38

ALL INCLUSIVE

HARLEM HOSPITAL CENTER

INPATIENT ACUTE CARE.

$ 648.90

ALL INCLUSIVE

KINGS COUNTY HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 540.96

ALL INCLUSIVE

FOLN MEDICAL & MENTAL HEALTH CENTER

INPATIENT ACUTE CARE

$ 680.64

ALL INCLUSIVE

METROPOLITAN HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 672.13

ALL INCLUSIVE

NORTH CENTRAL BRONX HOSPITAL

INPATIENT ACUTE CARE

$ 777.56

ALL INCLUSIVE

QUEENS HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 661.15

ALL INCLUSIVE

WOODHULL MEDICAL AND MENTAL HEALTH CENTER

INPATIENT ACUTE CARE

$ 792.65

ALL INCLUSIVE