SUBJECT: INSURANCE
CIRCULAR LETTER NO. 1 (1984)
DATED: January 25, 1984
WITHDRAWN
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' 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"
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