Insurance Circular Letter No. 22 (1988): No-Fault Reimbursement Schedules for Hospital - WITHDRAWN

October 5, 1988

SUBJECT: INSURANCE

Circular Letter No. 22 (1988)

WITHDRAWN

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

RE:

NO-FAULT REIMBURSEMENT SCHEDULES FOR HOSPITAL

(A) INPATIENT SERVICES RENDERED ON & AFTER JANUARY 1, 1986 TO PATIENTS ADMITTED PRIOR TO JANUARY 1, 1988; AND

(B) OUTPATIENT SERVICES RENDERED ON & AFTER JULY 1, 1988.

Pursuant to Regulation No. 83, 11 NYCRR 68.2, the no-fault rate schedules for reimbursing hospital services provided under § 5102(a)(1) of the Insurance Law shall be those established for workers compensation by the Chair of the Workers Compensation Board (WCB), which has now established rates for hospital:

(A). inpatient services, in conformity with Chapter 767 of the Laws of 1977, as amended, and § 2807-a of the Public Health Law, as amended; and

(B) outpatient services, in conformity with Chapter 453 of the Laws of 1984.

Attached are the four rate schedules duly established by the WCB Chair. Thus No-Fault payors shall use:

(a) the first two revised per diem schedules to reimburse hospitals for inpatient services rendered during the past periods:

(1) January 1, 1986 through December 31, 1986; and

(2) January 1, 1987 through December 31, 1987;

(b) the third per diem schedule to reimburse hospitals for inpatient services rendered on and after January 1, 1988 to patients admitted prior to January 1, 1988; and

Please note that the Health Department has determined that inpatient hospital admissions prior to January 1, 1988 shall be reimbursed on a per diem. basis, rather than by the Diagnosis-Related Group (DRG) approach, effective January 1, 1988 for inpatient reimbursement as discussed in Circular Letter Nos. 11 and 18 (1988).

Very truly yours,

[SIGNATURE]

JAMES P. CORCORAN

SUPERINTENDENT OF INSURANCE

REVISED HOSPITAL FEE SCHEDULE

Effective 1/1/86-12/31/86

The inpatient Hospital Fee Schedule was recommended and certified by the State Commissioner of Health. These rates were developed in accordance with amendments to Articles 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 Part 86 of the Commissioner of Health's Administrative Rules and Regulations.

The rates for outpatient services were prepared and established pursuant to Chapter 453 Laws of 1984 and will be filed in the office of the Department of State. This schedule will constitute Sections 329.6 and 329.7 of Title 12 of the Official Compilation of Codes, Rules and Regulations of the State of New York.

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

WORKERS' COMPENSATION

SCHEDULE OF RATES FOR OUTPATIENT HOSPITAL SERVICES

Effective 1/1/87 - 6/30/88

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 indicated in 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 indicated in 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

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

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

Lidocaine 2 percent with/

without Epinephrine

Alcohol 70 percent

Lidocaine 5 percent ointment

Alcohol swabs

Lindane lotion (e.g. Kwell)

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

Lubricating jelly

Aspirin 325 mg. tablet

Magnesium Sulfate

Aromatic Spirits of Ammonia

Meperidine injection (e.g. Demerol)

Atropine 2 percent Ophthalmic

Solution

Merthiolate

Atropine 0.4 mg/ml

Neomycin and Polympcin B Sulfates

Bacitracin ointment

w/Hydrocortisone ophthalmic

suspension

Castor Oil

(e.g. Cortisporin)

Calamine lotion

Nitroglycerin 0.4 mg. s. 1. tablet

Collodion Flexible

Nitroglycerin 0.6 mg. s. 1. tablet

Id Cream

Peppermint Spirit

unitest tablets

Petrolatum

Dibucaine 1 percent ointment

Providone-Iodine solution

(e.g. Nupercainal)

(e.g. Betadine)

Epinephrine Injection

Pralidoxime Chloride (e.g. Protopam)

Ethyl Chloride spray

Silver Nitrate Sticks

Gelfoam

Silver Sulfadiazine cream

(e.g. Savadene)

Glycerin suppository

Sodium Chloride - injection

Hematest tablets

Sodium Chloride for irrigation

Hydrocortisone 1 percent ointment

Sterile Water for irrigation

Hydrogen Peroxide

Talcum powder

Iodine

Tetanus Toxoid

Ipecac Syrup

Tuberculin PPD (1st and 2nd strength)

Lidocaine 2 percent viscous

(e.g. Xylocaine)

Witch Hazel

Lidocaine 1 percent with/

without Epinephrine

Zinc Oxide ointment

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

WESTERN NEW YORK REGION

EFFECTIVE 1/1/86-12/31/86

DAILY

EMERGENCY

RATE

SERVICE

1-1-86

7-1-86

OTHER

EXCLUSIONS:

ROOM

RATE

ALLEGANY

CUBA

MEMORIAL

HOSPITAL

INC

INPATIENT

ACUTE

CARE

$ 389.13

$ 388.95

$ 55.00

MEMORIAL

HOSPITAL

OF WM F

& GERTRUDE

F JONES

A/K/A

JONES

MEMORIAL

INPATIENT

ACUTE

CARE

$ 349.82

$ 35.00

CATTARAUGUS

OLEAN GENERAL

HOSPITAL

INPATIENT

ACUTE CARE

$ 333.46

A.E.R.

$ 45.00

PHYSICIANS,

RADIOLOGYx

PHYSICIANS,

SALAMANCA

HOSPITAL

DISTRICT

AUTHORITY

INPATIENT

ACUTE

CARE

$ 299.77

$ 28.00

REHAB

$ 170.27

ST FRANCIS

HOSPITAL

OF OLEAN

INPATIENT

ACUTE

CARE

$ 328.40

$ 35.00

TRI-COUNTY

MEMORIAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 289.73

A.B.I.L

$ 35.00

CHAUTAUQUA

BROOKS

MEMORIAL

HOSPITAL

INPATIENT

ACUTE CARE

$ 659.29

$ 707.46

A.B

$ 35.00

JAMESTOWN

GENERAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 348.46

A.B.C.D

$ 35.00

LAKE

SHORE

HOSPITAL INC

INPATIENT

ACUTE

CARE

$ 278.34

$ 279.19

A.B.C.D.E

$ 35.00

WESTFIELD

MEMORIAL

HOSPITAL INC

INPATIENT

ACUTE

CARE

$ 336.86

$ 338.48

$ 45.00

WOMANS

CHRISTIAN

ASSOCIATION

INPATIENT

ACUTE

CARE

$ 335.82

A.B

$ 35.00

ERIE

BERTRAND

CHAFFEE

HOSPITAL

INPATIENT

ACUTE

CARE

$ 322.75

$ 333.84

A.C

28.00

BUFFALO

COLUMBUS

HOSPITAL

INPATIENT

ACUTE

CARE

$ 491.64

$ 55.00

BUFFALO

GENERAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 564.46

$ 574.95

A.B.E.G.H.K

$ 55.00

ANGIO. ECHO

CHILDRENS

HOSPITAL

OF BUFFALO

INPATIENT

ACUTE

CARE

$ 439.10

$ 35.00

ERIE

COUNTY

MEDICAL

CENTER

INPATIENT

ACUTE

CARE

$ 518.52

$ 518.84

A.B.C.D

$ 55.00

DETOX

UNIT

$ 315.77

A.B.C.D

KENMORE

MERCY

HOSPITAL

INPATIENT

ACUTE

CARE

$ 275.88

A.E

$ 45.00

LAFAYETTE

GENERAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 292.18

$ 213.02

MERCY

HOSPITAL OF

BUFFALO

INPATIENT

ACUTE

CARE

$ 301.79

A.B

$ 28.00

MILLARD

FILLMORE

HOSPITAL

INPATIENT

ACUTE

CARE

$ 370.41

A.B

$ 45.00

DAILY

EMERGENCY

RATE

SERVICE

1-1-86

7-1-86

OTHER

EXCLUSIONS:

ROOM RATE

ERIE(CONT'D)

OUR LADY

OF VICTORY

HOSPITAL OF

LACKAWANNA

INPATIENT

ACUTE

CARE

$ 300.17

A,B,F,L,

$ 55.00

ENDOSC,

SONO,

ELECTROMY,

ENDOC

ROSWELL

PARK

MEMORIAL

INSTITUTE

INPATIENT

ACUTE

CARE

$ 644.74

NO E.R. SERVICE

SAINT

FRANCIS

HOSPITAL

OF BUFFALO

INPATIENT

ACUTE

CARE

$ 273.34

$ 55.00

SHEEHAN

MEMORIAL

EMERGENCY

HOSPITAL INC

INPATIENT

ACUTE

CARE

$ 445.99

$ 447.29

$ 55.00

SHERIDAN

PARK

HOSPITAL

INC

INPATIENT

ACUTE

CARE

$ 658.55

$ 55.00

SISTERS

OF CHARITY

HOSPITAL

INPATIENT

ACUTE

CARE

$ 307.05

A,B

$ 55.00

ST JOSEPH

INTERCOMMUNITY

HOSPITAL

INPATIENT

ACUTE

CARE

$ 287.75

$ 45.00

GENESEE

MEMORIAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 323.09

A.B

$ 35.00

ST JEROME

HOSPITAL

INPATIENT

ACUTE

CARE

$ 277.61

$ 35.00

NIMARA

OFF

MEMORIAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 343.46

A,B

$ 35.00

INTER-COMMUNITY

MEMORIAL

HOSPITAL AT

NEWFANE INC

INPATIENT

ACUTE

CARE

$ 315.70

$ 35.00

LOCKPORT

MEMORIAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 377.90

A,E,F,G

$ 55.00

MOUNT

ST MARYS

HOSPITAL

OF NIAGARA

FALLS

INPATIENT

ACUTE

CARE

$ 379.65

$ 381.28

$ 45.00

NIAGARA

FALLS

MEMORIAL

MEDICAL

CENTER

INPATIENT

ACUTE

CARE

$ 344.10

$ 342.38

$ 45.00

ORLEANS

ARNOLD

GREGORY

MEMORIAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 352.07

$ 355.94

$ 35.00

MEDINA

MEMORIAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 280.62

$ 281.98

A,B

$ 45.00

WYOMING

COUNTY

COMMUNITY

HOSPITAL

$ 55.00

INPATIENT

ACUTE

CARE

$ 354.90

A,B,E,L

$ 55.00

DAILY

EMERGENCY

RATE

SERVICE

1-1-86

7-1-86

OTHER

EXCLUSIONS:

ROOM RATE

CHEMUNG

ARNOT-OGOEN

MEMORIAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 473.37

$ 477.75

A,B,F

$ 55.00

ST JOSEPHS

HOSPITAL

OF ELMIRA

INPATIENT

ACUTE

CARE

$ 481.37

$ 700.62

A,B

$ 55.00

LIVINGSTON

NICHOLAS H

NOYES

MEMORIAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 327.32

$ 329.36

A,B

$ 55.00

MONROE

GENESEE

HOSPITAL

OF ROCHESTER

INPATIENT

ACUTE

CARE

$ 480.36

$ 484.83

A,B

$ 55.00

HIGHLAND

HOSPITAL

OF ROCHESTER

INPATIENT

ACUTE

CARE

$ 483.44

$ 486.56

A,B

$ 55.00

LAKESIDE

MEMORIAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 459.00

$ 462.92

A,B

$ 45.00

MONROE

COMMUNITY

OSPITAL

INPATIENT

ACUTE

CARE

$ 526.92

PHYSICIANS

E.R.

PARK

RIDGE

HOSPITAL

INPATIENT

ACUTE

CARE

$ 468.63

$ 471.35

A,B,O

$ 55.00

ROCHESTER

GENERAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 472.44

A,B

$ 55.00

ST MARYS

HOSPITAL

OF ROCHESTER

INPATIENT

ACUTE

CARE

$ 624.73

A,B,C,N

$ 55.00

STRONG

MEMORIAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 559.76

$ 559.97

A,B

$ 55.00

ONTARIO

CLIFTON

SPRINGS

HOSPITAL

AND

CLINIC

INPATIENT

ACUTE

CARE

$ 405.60

$ 408.89

A,B,O

55.00

F F

THOMPSON

HOSPITAL

INPATIENT

ACUTE

CARE

$ 277.96

B,G,I

$ 35.00

GENEVA

GENERAL

HOSPITAL

INPATIENT

ACUTE

CARE

$ 378.88

$ 35.00

SCHUYLER

HOSPITAL

INPATIENT

ACUTE

CARE

$ 345.64

$ 346.00

A,B,C

$ 45.00

SENECA

FALLS

HOSPITAL

INPATIENT

ACUTE

CARE

$ 424.49

B,D,E,M

$ 55.00

WATERLOO

MEMORIAL

HOSPITAL

INC D/B/A

TAYLOR-BROWN

MEMORIAL HOSP

INPATIENT

ACUTE

CARE

$ 382.04

$ 385.04

$ 55.00

DAILY

EMERGENCY

RATE

SERVICE

1-1-86

7-1-86

OTHER

EXCLUSIONS:

ROOM

RATE

JBEN

BETHESDA HOSPITAL

INPATIENT ACUTE CARE

$ 291.49

$ 35.00

CORNING HOSPITAL

INPATIENT ACUTE CARE

$ 353.02

A,B

$ 55.00

IRA DAVENPORT

MEMORIAL HOSPITAL INC

INPATIENT ACUTE CARE

$ 317.48

$ 45.00

ST JAMES MERCY HOSPITAL

INPATIENT ACUTE CARE

$ 274.04

A,B,C,D

$ 35.00

WAYNE

MYERS COMMUNITY HOSPITAL

FOUNDATION INC

INPATIENT ACUTE CARE

$ 339.91

$ 340.24

A,B

$ 45.00

NEWARK-WAYNE COMMUNITY

HOSPITAL INC INPATIENT

ACUTE CARE

$ 345.34

$ 347.00

A,B

$ 45.00

YATES

SOLDIERS AND SAILORS

MEMORIAL HOSPITAL OF

YATES COUNTY INC

INPATIENT ACUTE CARE

$ 370.29

$ 372.59

$ 45.00

DAILY

EMERGENCY

RATE

SERVICE

1-1-86

7-1-86

OTHER

EXCLUSIONS:

ROOM

RATE

BROOME

OUR LADY OF LOURDES

MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 369.26

$ 369.64

A,B,G

$ 45.00

UNITED HEALTH SERVICES INC

INPATIENT ACUTE CARE

$ 478.98

A.B.C.

$ 45.00

REHABILITATION

$ 176.10

A,B,C

CAYUGA

AUBURN MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 280.42

A,E

$ 35.00

CHENANGO

INPATIENT ACUTE CARE

$ 415.60

$ 415.98

A,B

$ 45.00

CORTLAND

CORTLAND MEMORIAL HOSPITAL

INC INPATIENT

ACUTE CARE

$ 446.69

$ 476.92

$ 45.00

HERKIMER

LITTLE FALLS HOSPITAL

INPATIENT ACUTE CARE

$ 264.47

A,B

$ 35.00

MOHAWK VALLEY

GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 289.11

A,B

$ 28.00

JEFFERSON

CARTHAGE AREA HOSPITAL INC

INPATIENT ACUTE CARE

$ 310.17

$ 45.00

EDWARD JOHN NOBLE

HOSPITAL OF ALEXANDRIA BAY

INPATIENT ACUTE CARE

$ 259.57

$ 268.23

$ 45.00

HOUSE OF THE GOOD

SAMARITAN

INPATIENT ACUTE CARE

$ 320.19

A,B,C

$ 45.00

MERCY HOSPITAL OF

WATERTOWN

INPATIENT ACUTE CARE

$ 497.66

$ 537.98

A,B

$ 45.00

LEWIS

LEWIS COUNTY GENERAL

HOSPITAL INPATIENT

ACUTE CARE

$ 371.69

$ 386.61

$ 55.00

MADISON

COMMUNITY MEMORIAL

HOSPITAL

INC INPATIENT ACUTE CARE

$ 343.01

347.80*

A,B

$ 45.00

ONEIDA CITY HOSPITAL

INPATIENT ACUTE CARE

$ 296.74

A,B,D,O,

$ 35.00

ONEIDA

CHILDRENS HOSPITAL AND

REHABILITATION CENTER

REHABILITATION

$ 384.62

$ 383.89

NO E.R.

SERVICE

FAXTON HOSPITAL

INPATIENT ACUTE CARE

$ 357.56

A,B,H,I,O

$ 28.00

*EFFECTIVE DATE: 4/1/86

DAILY

EMERGENCY

RATE

SERVICE

1-1-86

7-1-86

OTHER

EXCLUSIONS:

ROOM

RATE

[ILLEGIBLE TEXT]

ROME HOSPITAL AND MURPHY

MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 299.38

$ 299.96

A,B,C,D

$ 35.00

ST ELIZABETH HOSPITAL

INPATIENT ACUTE CARE

$ 491.68

$ 503.63

A,B,C

$ 55.00

FAMILY

PRACTICE

FACILITY

ST LUKES MEMORIAL

HOSPITAL CENTER

INPATIENT. ACUTE CARE

$ 362.06

A,B,C,E

$ 45.00

ONONDAGA

COMMUNITY GENERAL

HOSPITAL OF

GREATER SYRACUSE

INPATIENT ACUTE CARE

$ 382.12

A,B,G

$ 55.00

NON-

INVASIVE

VASCULAR

LAB

CROUSE - IRVING MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 497.06

$ 498.57

A,B,C,D,

$ 55.00

E,G

ST JOSEPHS HOSPITAL

HEALTH CENTER

INPATIENT ACUTE CARE

$ 433.14

$ 418.79

A.B,C

$ 45.00

PERIPHERAL

VASCULAR

LAB, PATH

FROZEN

SECT,

CARDIOVASCULAR

LAB,

PULMONARY

FUNCTION

LAB

[ILLEGIBLE TEXT]

INPATIENT ACUTE CARE

$ 538.74

554.43*

A,B,C,H,

$ 55.00

I,K,0

OSWEGO

ALBERT LINDLEY LEE

MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 378.42

$ 380.21

A,B

$ 28.00

OSWEGO HOSPITAL

INPATIENT ACUTE CARE

$ 267.43

A,B

$ 45.00

ST LAWRENCE

A.BARTON HEPBURN

HOSPITAL

INPATIENT ACUTE CARE

$ 399.22

$ 400.48

A,B,C

$ 45.00

CANTON-POTSDAM

HOSPITAL

INPATIENT ACUTE CARE

$ 397.36

$ 400.14

A,B,C

$ 35.00

CLIFTON-FINE HOSPITAL

INPATIENT ACUTE CARE

$ 352.11

$ 28.00

EDWARD JOHN NOBLE

HOSPITAL OF GOUVERNEUR

INPATIENT ACUTE CARE

$ 330.83

$ 344.42

A,B

$ 35.00

*EFFECTIVE DATE: 3/18/86

DAILY

EMERGENCY

RATE

SERVICE

1-1-86

7-1-86

OTHER

EXCLUSIONS:

ROOM

RATE

ST LAWRENCE

MASSENA MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 420.12

$ 55.00

TIOGA

TIOGA GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 359.21

$ 360.95

A,B,D,N

35.00

TOMPKINS

TOMPKINS COUNTY HOSPITAL

INPATIENT ACUTE CARE

$ 363.36

A,B,C,E,F

$ 45.00

HOSPITAL RATE SCHEDULE

CENTRAL NEW YORK REGION

EFFECTIVE 1/1/86 - 12/31/86

DAILY

EMERGENCY

RATE

SERVICE

1-1-86

7-1-86

OTHER

EXCLUSIONS:

ROOM

RATE

ALBANY

ALBANY MEDICAL CENTER

HOSPITAL

INPATIENT ACUTE CARE

$ 492.79

$ 498.10

A,B,I,K

$ 55.00

CHILDS HOSPITAL

INPATIENT ACUTE CARE

$ 485.09

A,B,C

NO E.R.

SERVICE

COHOES MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 291.61

A,B,C

$ 45.00

MEMORIAL HOSPITAL OF

ALBANY

INPATIENT ACUTE CARE

$ 355.58

$ 356.27

A,B,C,D,

$ 45.00

E,F,I,O,R

ST PETERS HOSPITAL

INPATIENT ACUTE CARE

$ 355.96

A,B,C,F,

$ 55.00

H,I,K,O,R

CARDIO

PULMONARY

CLINTON

CHAMPLAIN VALLEY

PHYSICIANS

HOSPITAL MEDICAL CENTER

INPATIENT ACUTE CARE

$ 266.42

A,B,E

$ 45.00

COLUMBIA

COLUMBIA MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 351.01

$ 45.00

DELAWARE

A LINDSAY 8 OLIVE B

OCONNOR HOSPITAL

INPATIENT ACUTE CARE

$ 320.65

$ 321.25

$ 28.00

COMMUNITY HOSPITAL OF

STAMFORD

INPATIENT ACUTE CARE

$ 365.61

$ 367.86

$ 45.00

VARE VALLEY HOSPITAL INC

INPATIENT ACUTE CARE

$ 423.80

$ 429.04

$ 35.00

MARGARETVILLE MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 425.62

$ 429.44

$ 35.00

THE HOSPITAL

INPATIENT ACUTE CARE

$ 354.83

A, B

$ 45.00

ESSEX

ELIZABETHTOWN COMMUNITY

HOSPITAL

INPATIENT ACUTE CARE

$ 335.35

$ 335.48

$ 55.00

MOSES-LUDINGTON HOSPITAL

INPATIENT ACUTE CARE

$ 457.09

$ 55.00

PLACID MEMORIAL

HOSPITAL INC

INPATIENT ACUTE CARE

$ 353.38

B,D

$ 55.00

FRANKLIN

ALICE HYDE MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 267.01

$ 267.88

$ 35.00

GENERAL HOSPITAL OF

SARANAC LAKE

INPATIENT ACUTE CARE

$ 239.07

A,B,D

$ 35.00

DAILY

RATE

1-1-86

7-1-86

OTHER

FULTON

JOHNSTOWN HOSPITAL

INPATIENT ACUTE CARE

$ 297.95

$ 298.13

NATHAN LITTAUER HOSPITAL

INPATIENT ACUTE CARE

$ 483.06

$ 510.52

GREENE

MEMORIAL HOSPITAL AND NURSING HOME

OF GREENE COUNTY

INPATIENT ACUTE CARE

$ 438.50

$ 439.48

MONTGOMERY

LAMSTERDAM MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 278.16

ST MARYS HOSPITAL AT AMSTERDAM

INPATIENT ACUTE CARE

$ 287.60

OTSEGO

AURELIA OSBORN FOX MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

$ 343.24

MARY IMOGENE BASSM HOSPITAL

INPATIENT ACUTE CARE

$ 531.79

RENSSELAER

LEONARD HOSPITAL

INPATIENT ACUTE CARE

$ 326.15

REHABILITATION

$ 181.76

SAMARITAN HOSPITAL OF TROY

INPATIENT ACUTE CARE

$ 280.80

ST MARYS HOSPITAL OF TROY

INPATIENT ACUTE CARE

$ 299.70

SARATOGA

ADIRONDACK REGIONAL HOSPITAL

INPATIENT ACUTE CARE

$ 404.42

SARATOGA HOSPITAL

INPATIENT ACUTE CARE

$ 342.98

SCHENECTADY

BELLEVUE MATERNITY HOSPITAL INC

INPATIENT ACUTE CARE

$ 425.35

ELLIS HOSPITAL

INPATIENT ACUTE CARE

$ 397.76

EMERGENCY

SERVICE

EXCLUSIONS:

ROOM RATE

FULTON

JOHNSTOWN HOSPITAL

INPATIENT ACUTE CARE

A,C

$ 45.00

NATHAN LITTAUER HOSPITAL

INPATIENT ACUTE CARE

A,B

$ 35.00

GREENE

MEMORIAL HOSPITAL AND NURSING HOME

OF GREENE COUNTY

INPATIENT ACUTE CARE

A,B

$ 45.00

MONTGOMERY

AMSTERDAM MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

A.B,C,D,N

$ 45.00

ST MARYS HOSPITAL AT AMSTERDAM

INPATIENT ACUTE CARE

A,B,C,D

$ 45.00

OTSEGO

AURELIA OSBORN FOX MEMORIAL

HOSPITAL

INPATIENT ACUTE CARE

A,B,F

$ 55.00

MARY IMOGENE BASSM HOSPITAL

INPATIENT ACUTE CARE

A,B,C,D.K

$ 55.00

OPHTHALMOLOGY, GEN.

PRACTITIONER,

SURGERY, OB-GYN,

PEDIATRICS,

OPTOMETRY,

PSYCHIATRY,

OTOLARYNGOLOGY

RENSSELAER

LEONARD HOSPITAL

INPATIENT ACUTE CARE

A,B,C,F

$ 55.00

REHABILITATION

A,B,C,F

SAMARITAN HOSPITAL OF TROY

INPATIENT ACUTE CARE

A,B,C,E,F,G,I,J,M

$ 45.00

ST MARYS HOSPITAL OF TROY

INPATIENT ACUTE CARE

A,B,D,F,L,P

$ 45.00

PULMON. FUNCT.

STUDIES

SARATOGA

ADIRONDACK REGIONAL HOSPITAL

INPATIENT ACUTE CARE

B,D

$ 35.00

SARATOGA HOSPITAL

INPATIENT ACUTE CARE

A,B,D,F.J

$ 45.00

VASCULAR LAB

SCHENECTADY

BELLEVUE MATERNITY HOSPITAL INC

INPATIENT ACUTE CARE

A,B

ALL INCLUSIVE

ELLIS HOSPITAL

INPATIENT ACUTE CARE

A,B,C,D

$ 55.00

DAILY

RATE

1-1-86

7-1-86

OTHER

SCHENECTADY

ST CLARES HOSPITAL OF SCHENECTADY

INPATIENT ACUTE CARE

$ 670.33

$ 723.27

SUNNYVIEW HOSPITAL AND

REHABILITATION

CENTER

INPATIENT ACUTE CARE

$ 267.31

$ 267.90

SCHOHARIE

COMMUNITY HOSPITAL OF SCHOHARIE

COUNTY INC

INPATIENT ACUTE CARE

$ 345.69

WARREN

GLENS FALLS HOSPITAL

INPATIENT ACUTE CARE

$ 332.31

WASHINGTON

EMMA LAING STEVENS HOSPITAL

INPATIENT ACUTE CARE

$ 462.44

$ 480.94

MARY MCCLELLAN HOSPITAL

INPATIENT ACUTE CARE

$ 362.18

EMERGENCY

SERVICE

EXCLUSIONS:

ROOM RATE

SCHENECTADY

ST CLARES HOSPITAL OF SCHENECTADY

INPATIENT ACUTE CARE

A,B,C,D,G

$ 4500

GASTRO, PROCTOLOGY

SUNNYVIEW HOSPITAL AND

REHABILITATION

CENTER

INPATIENT ACUTE CARE

A,B,C,D,J

NO E.R. SERVICE

CYSTOMETRY

SCHOHARIE

COMMUNITY HOSPITAL OF SCHOHARIE

COUNTY INC

INPATIENT ACUTE CARE

$ 55.00

WARREN

GLENS FALLS HOSPITAL

INPATIENT ACUTE CARE

A,B,D,N

$ 35.00

WASHINGTON

EMMA LAING STEVENS HOSPITAL

INPATIENT ACUTE CARE

$ 55.00

MARY MCCLELLAN HOSPITAL

INPATIENT ACUTE CARE

B,0

$ 55.00

DAILY

RATE

1-1-86

7-1-86

OTHER

DUTCHESS

NORTHERN DUTCHESS HOSPITAL

INPATIENT ACUTE CARE

$ 332.90

$ 334.61

ST FRANCIS HOSPITAL OF BEACON

(HIGHLAND)

INPATIENT ACUTE CARE

$ 290.06

ST FRANCIS HOSPITAL OF POUGHKEEPSIE

INPATIENT ACUTE CARE

$ 423.06

$ 422.82

VASSAR BROTHERS HOSPITAL

INPATIENT. ACUTE CARE

$ 390.80

ORANGE

ARDEN HILL HOSPITAL

INPATIENT ACUTE CARE

$ 319.43

CORNWALL HOSPITAL

INPATIENT ACUTE CARE

$ 359.51

E A HORTON MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 360.06

ST ANTHONY COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

$ 410.62

$ 414.90

ST FRANCIS - MERCY

COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

$ 389.72

ST LUKES HOSPITAL OF NEWBURGH

INPATIENT ACUTE CARE

$ 321.97

PUTNAM

JULIA BUTTERFIELD MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 335.57

$ 336.59

PUTNAM COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

$ 367.40

$ 376.12

ROCKLAND

GOOD SAMARITAN HOSPITAL OF SUFFERN

INPATIENT ACUTE CARE

$ 477.50

HELEN HAYES HOSPITAL

INPATIENT ACUTE CARE

$ 557.62

NYACK HOSPITAL

INPATIENT ACUTE CARE

$ 474.05

SUMMIT PARK HOSPITAL-

ROCKLAND COUNTY. INFIRMARY

INPATIENT ACUTE CARE

$ 290.21

PSYCHIATRIC CARE

EMERGENCY

SERVICE

EXCLUSIONS:

ROOM RATE

DUTCHESS

NORTHERN DUTCHESS HOSPITAL

INPATIENT ACUTE CARE

A,D

$ 35.00

ST FRANCIS HOSPITAL OF BEACON

(HIGHLAND)

INPATIENT ACUTE CARE

A,B

$ 55.00

ST FRANCIS HOSPITAL OF POUGHKEEPSIE

INPATIENT ACUTE CARE

A,B

$ 55.00

VASSAR BROTHERS HOSPITAL

INPATIENT. ACUTE CARE

A,B,D

$ 55.00

RADIATION ONCOLOGY

ORANGE

ARDEN HILL HOSPITAL

INPATIENT ACUTE CARE

A,B,D,J

$ 55.00

CORNWALL HOSPITAL

INPATIENT ACUTE CARE

A,B,G,H,I,L

$ 55.00

HOLTER MONITOR

E A HORTON MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

A,B,C,D,E,F

$ 55.00

RENAL,

CARDIOPULMONARY

ST ANTHONY COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

A,B

$ 35.00

ST FRANCIS - MERCY

COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

A,B,D

$ 45.00

ST LUKES HOSPITAL OF NEWBURGH

INPATIENT ACUTE CARE

A,B

$ 35.00

PUTNAM

JULIA BUTTERFIELD MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

A,B,D

$ 45.00

PUTNAM COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

A,B

$ 45.00

ROCKLAND

GOOD SAMARITAN HOSPITAL OF SUFFERN

INPATIENT ACUTE CARE

A,B

$ 55.00

HELEN HAYES HOSPITAL

INPATIENT ACUTE CARE

NO E.R. SERVICE

NYACK HOSPITAL

INPATIENT ACUTE CARE

AB,D

$ 55.00

SUMMIT PARK HOSPITAL-

ROCKLAND COUNTY. INFIRMARY

INPATIENT ACUTE CARE

NO E.R. SERVICE

PSYCHIATRIC CARE

NO E.R. SERVICE

DAILY

RATE

1-1-86

7-1-86

OTHER

SUWAN

COMMUNITY GENERAL HOSPITAL OF

SULLIVAN COUNTY - HARRIS DIV

INPATIENT ACUTE CARE

$ 661.72

$ 729.98

COMMUNITY GENERAL HOSPITAL OF

SULLIVAN COUNTY G HERMAN DIV

INPATIENT ACUTE CARE

$ 335.34

JLSTER

BENEDICTINE HOSPITAL

INPATIENT ACUTE CARE

$ 338.13

ELLENVILLE COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

$ 290.58

$ 293.51

KINGSTON HOSPITAL

INPATIENT ACUTE CARE

$ 322.08

WESTCHESTER

BLYTHEDALE CHILDRENS HOSPITAL

INPATIENT ACUTE CARE

$ 332.07

$ 332.43

BURKE REHABILITATION CENTER

INPATIENT ACUTE CARE

$ 450.19

$ 451.53

DOBBS FERRY HOSPITAL

INPATIENT ACUTE CARE

$ 476.17

$ 482.57

LAWRENCE HOSPITAL

INPATIENT ACUTE CARE

$ 425.77

MMT VERNON HOSPITAL

PATIENT ACUTE CARE

$ 460.95

$ 467.81

IROCHELLE HOSPITAL MEDICAL CENTER

INPATIENT ACUTE CARE

$ 514.02

NEW YORK HOSPITAL-CORNELL MEDICAL CENTER

WESTCHESTER DIVISION

PSYCHIATRIC CARE

$ 386.97

NORTHERN WESTCHESTER HOSPITAL

INPATIENT ACUTE CARE

$ 455.14

$ 459.04

PEEKSKILL HOSPITAL

INPATIENT ACUTE CARE

$ 415.66

$ 438.45

PHELPS MEMORIAL HOSPITAL ASSOCIATION

INPATIENT ACUTE CARE

$ 473.84

$ 483.83

ST AGNES HOSPITAL

INPATIENT ACUTE CARE

$ 422.01

ST JOHNS RIVERSIDE HOSPITAL

INPATIENT ACUTE CARE

$ 560.47

$ 569.04

ST JOSEPHS HOSPITAL YONKERS

INPATIENT ACUTE CARE

$ 453.65

$ 456.94

ST VINCENTS HOSP AND MEDICAL CTR OF NY

WESTCHESTER BRANCH

PSYCHIATRIC CARE

EMERGENCY

SERVICE

EXCLUSIONS:

ROOM RATE

SUWAN

COMMUNITY GENERAL HOSPITAL OF

SULLIVAN COUNTY - HARRIS DIV

INPATIENT ACUTE CARE

A,B

$ 55.00

COMMUNITY GENERAL HOSPITAL OF

SULLIVAN COUNTY G HERMAN DIV

INPATIENT ACUTE CARE

A,B

$ 55.00

JLSTER

BENEDICTINE HOSPITAL

INPATIENT ACUTE CARE

A,B

$ 45.00

ELLENVILLE COMMUNITY HOSPITAL

INPATIENT ACUTE CARE

$ 28.00

KINGSTON HOSPITAL

INPATIENT ACUTE CARE

A,B

$ 35.00

WESTCHESTER

BLYTHEDALE CHILDRENS HOSPITAL

INPATIENT ACUTE CARE

A,D

NO E.R. SERVICE

BURKE REHABILITATION CENTER

INPATIENT ACUTE CARE

NO E.R. SERVICE

DOBBS FERRY HOSPITAL

INPATIENT ACUTE CARE

$ 35.00

LAWRENCE HOSPITAL

INPATIENT ACUTE CARE

$ 55.00

MMT VERNON HOSPITAL

PATIENT ACUTE CARE

A,B

$ 55.00

IROCHELLE HOSPITAL MEDICAL CENTER

INPATIENT ACUTE CARE

A,B,C,D

$ 55.00

NEW YORK HOSPITAL-CORNELL MEDICAL CENTER

WESTCHESTER DIVISION

PSYCHIATRIC CARE

NO E.R. SERVICE

NORTHERN WESTCHESTER HOSPITAL

INPATIENT ACUTE CARE

A,B,H,I,K

$ 55.00

PEEKSKILL HOSPITAL

INPATIENT ACUTE CARE

$ 35.00.

PHELPS MEMORIAL HOSPITAL ASSOCIATION

INPATIENT ACUTE CARE

A,B

$ 55.00

ST AGNES HOSPITAL

INPATIENT ACUTE CARE

A,C,K

$ 55.00

ANATOMICAL

PATHOLOGY

ST JOHNS RIVERSIDE HOSPITAL

INPATIENT ACUTE CARE

A,B,C,J

$ 45.00

ST JOSEPHS HOSPITAL YONKERS

INPATIENT ACUTE CARE

$ 45.00

ST VINCENTS HOSP AND MEDICAL CTR OF NY

WESTCHESTER BRANCH

PSYCHIATRIC CARE

NO E.R. SERVICE

DAILY

RATE

1-1-86

7-1-86

OTHER

ESTCHESTER

UNITED HOSPITAL

INPATIENT ACUTE CARE

$ 461.27

$ 462.01

WESTCHESTER COUNTY MEDICAL CENTER

INPATIENT ACUTE CARE

$ 636.13

WHITE PLAINS HOSPITAL MEDICAL CENTER

INPATIENT ACUTE CARE

$ 416.39

$ 412.27

YONKERS GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 375.34

EFFECTIVE 5-1-86

EMERGENCY

SERVICE

EXCLUSIONS:

ROOM RATE

ESTCHESTER

UNITED HOSPITAL

INPATIENT ACUTE CARE

A,B,D

$ 45.00

WESTCHESTER COUNTY MEDICAL CENTER

INPATIENT ACUTE CARE

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

$ 55.00

CYSTOSCOPY

WHITE PLAINS HOSPITAL MEDICAL CENTER

INPATIENT ACUTE CARE

A,C

$ 55.00

ELECTRO-DIAGNOSTIC

STUDIES

YONKERS GENERAL HOSPITAL

INPATIENT ACUTE CARE

A,K

$ 35.00

EFFECTIVE 5-1-86

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

LONG ISLAND REGION

EFFECTIVE 1/1/86 - 12/31/86

DAILY

RATE

1-1-86

7-1-86

OTHER

NASSAU

CENTRAL GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 392.73

$ 393.28

COMMUNITY HOSPITAL AT GLEN COVE

INPATIENT ACUTE CARE

$ 438.89

$ 448.26

FRANKLIN GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 480.89

$ 617.90

HEMPSTEAD.GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 448.62

LONG BEACH MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 443.12

LONG ISLAND JEWISH -

HILLSIDE MEDICAL CENTER

(MANHASSET DIV.)

INPATIENT ACUTE CARE

$ 675.67

$ 676.26

MASSAPEOUA GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 521.50

MERCY HOSPITAL OF

ROCKVILLE CENTER

INPATIENT ACUTE CARE

$ 469.94

$ 470.05

MID-ISLAND HOSPITAL

INPATIENT ACUTE CARE

$ 462.95

$ 467.07

NASSAU COUNTY MEDICAL

CENTER MEADOW DIV

INPATIENT ACUTE CARE

$ 629.00

NORTH SHORE

UNIVERSITY HOSPITAL

INPATIENT ACUTE CARE

$ 579.09

SOUTH NASSAU

COMMUNITIES HOSPITAL

INPATIENT ACUTE CARE

$ 338.31

ST FRANCIS HOSPITAL

OF ROSLYN

INPATIENT ACUTE CARE

$ 1210.47

$ 1252.48

SYOSSET COMMUNITY HOSPITAL

(HIP HOSPITAL OF L.I.)

INPATIENT ACUTE CARE

$ 625.85

WINTHROP UNIVERSITY HOSPITAL

(NASSAU HOSP)

INPATIENT ACUTE CARE

$ 440.85

EMERGENCY

SERVICE

EXCLUSIONS:

ROOM RATE

NASSAU

CENTRAL GENERAL HOSPITAL

INPATIENT ACUTE CARE

A,B,E,F

$ 55.00

COMMUNITY HOSPITAL AT GLEN COVE

INPATIENT ACUTE CARE

$ 28.00

FRANKLIN GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 55.00

HEMPSTEAD.GENERAL HOSPITAL

INPATIENT ACUTE CARE

A,B,C,D,E,F

$ 55.00

LONG BEACH MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 28.00

LONG ISLAND JEWISH -

HILLSIDE MEDICAL CENTER

(MANHASSET DIV.)

INPATIENT ACUTE CARE

A,B

$ 55.00

CARDIAC

CATHERIZATION

MASSAPEOUA GENERAL HOSPITAL

INPATIENT ACUTE CARE

A,B,E

$ 55.00

MERCY HOSPITAL OF

ROCKVILLE CENTER

INPATIENT ACUTE CARE

$ 55.00

MID-ISLAND HOSPITAL

INPATIENT ACUTE CARE

A,B,C,D,E,F

$ 45.00

NASSAU COUNTY MEDICAL

CENTER MEADOW DIV

INPATIENT ACUTE CARE

$ 55.00

NORTH SHORE

UNIVERSITY HOSPITAL

INPATIENT ACUTE CARE

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

$ 55.00

SPEECH THERAPY

SOUTH NASSAU

COMMUNITIES HOSPITAL

INPATIENT ACUTE CARE

A,L

$ 45.00

ECHOCARDIOGRAM

ST FRANCIS HOSPITAL

OF ROSLYN

INPATIENT ACUTE CARE

$ 55.00

SYOSSET COMMUNITY HOSPITAL

(HIP HOSPITAL OF L.I.)

INPATIENT ACUTE CARE

$ 55.00

WINTHROP UNIVERSITY HOSPITAL

(NASSAU HOSP)

INPATIENT ACUTE CARE

A,B,

$ 45.00

DAILY

RATE

1-1-86

7-1-86

OTHER

SUFFOLK

BROOKHAVEN MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 461.02

BRUNSWICK HOSPITAL CENTER INC

INPATIENT ACUTE CARE

$ 485.42

$ 524.62

REHABILITATION

$ 356.23

CENTRAL SUFFOLK

HOSPITAL ASSOCIATION

INPATIENT ACUTE CARE

$ 806.19

$ 810.50

CHURCH CHARITY FOUNDATION -

SEE ST JOHNS EPISCOPAL

HOSP-SMITHTOWN

COMMUNITY HOSP OF

WESTERN SUFFOLK

(SMITHTOWN GENERAL HOSP)

INPATIENT ACUTE CARE

$ 1214.26

$ 1330.83

EASTERN LONG ISLAND HOSPITAL

INPATIENT ACUTE CARE

$ 423.10

GOOD SAMARITAN HOSPITAL

OF WEST ISLIP.

INPATIENT ACUTE CARE

$ 525.63

$ 563.44

HUNTINGTON HOSPITAL

INPATIENT ACUTE CARE

$ 399.12

JOHN T MATHER MEMORIAL

HOSPITAL OF PORT

JEFFERSON NEW YORK INC

INPATIENT ACUTE CARE

$ 469.86

$ 467.26

SMITHTOWN GENERAL HOSPITAL (SEE

COMM HOSP OF WESTERN SUFFOLK)

SOUTHAMPTON HOSPITAL

INPATIENT ACUTE CARE

$ 416.59

SOUTHSIOE HOSPITAL

INPATIENT ACUTE CARE

$ 402.60

ST CHARLES HOSPITAL

INPATIENT ACUTE CARE

$ 394.37

ST JOHNS EPISCOPAL

HOSPITAL SMITHTOWN

(CHURCH CHARITY FOUNDATION)

INPATIENT ACUTE CARE

$ 524.43

UNIVERSITY HOSPITAL

OF STONY BROOK

INPATIENT ACUTE CARE

$ 775.88

EMERGENCY

SERVICE

EXCLUSIONS:

ROOM RATE

SUFFOLK

BROOKHAVEN MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

A,B

$ 55.00

BRUNSWICK HOSPITAL CENTER INC

INPATIENT ACUTE CARE

A,B,E,F

$ 55.00

REHABILITATION

A,B,E,F

CENTRAL SUFFOLK

HOSPITAL ASSOCIATION

INPATIENT ACUTE CARE

$ 35.00

CHURCH CHARITY FOUNDATION -

SEE ST JOHNS EPISCOPAL

HOSP-SMITHTOWN

COMMUNITY HOSP OF

WESTERN SUFFOLK

(SMITHTOWN GENERAL HOSP)

INPATIENT ACUTE CARE

$ 55.00

EASTERN LONG ISLAND HOSPITAL

INPATIENT ACUTE CARE

A,B

$ 55.00

GOOD SAMARITAN HOSPITAL

OF WEST ISLIP.

INPATIENT ACUTE CARE

A,C

$ 45.00

HUNTINGTON HOSPITAL

INPATIENT ACUTE CARE

A,D,M

$ 45.00

DIALYSIS,

CHEMOTHERAPY

JOHN T MATHER MEMORIAL

HOSPITAL OF PORT

JEFFERSON NEW YORK INC

INPATIENT ACUTE CARE

A,B,E,F

$ 55.00

SMITHTOWN GENERAL HOSPITAL (SEE

COMM HOSP OF WESTERN SUFFOLK)

SOUTHAMPTON HOSPITAL

INPATIENT ACUTE CARE

$ 45.00

SOUTHSIDE HOSPITAL

INPATIENT ACUTE CARE

A,B,C

$ 55.00

ST CHARLES HOSPITAL

INPATIENT ACUTE CARE

$ 45.00

ST JOHNS EPISCOPAL

HOSPITAL SMITHTOWN

(CHURCH CHARITY FOUNDATION)

INPATIENT ACUTE CARE

A,B,C

$ 55.00

UNIVERSITY HOSPITAL

OF STONY BROOK

INPATIENT ACUTE CARE

A,B,C

$ 55.00

WORKERS' COMPENSATION

HOSPITAL RATE SCHEDULE

NEW YORK CITY REGION

EFFECTIVE 1/1/86 - 12/31/86

DAILY

RATE

1-1-86

7-1-86

OTHER

GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 412.30

$ 421.56

BAPTIST MEDICAL CENTER

OF NEW YORK

INPATIENT ACUTE CARE

$ 441.53

$ 440.24

BAYLEY SETON HOSPITAL

INPATIENT ACUTE CARE

$ 595.21

$ 598.61

BETH ISRAEL MEDICAL CENTER

INPATIENT ACUTE CARE

$ 670.07

DETOXIFICATION UNIT

$ 303.61

BOOTH MEMORIAL MEDICAL CENTER

INPATIENT ACUTE CARE

$ 1412.89

$ 1457.19

BRONX-LEBANON HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 702.50

$ 723.09

BROOKDALE HOSPITAL

MEDICAL CENTER

INPATIENT ACUTE CARE

$ 511.96

$ 516.68

BROOKLYN/CALEDONIAN HOSPITAL

INPATIENT ACUTE CARE

$ 524.98

CABRINI HEALTH CARE CTR

INPATIENT ACUTE CARE

$ 508.45

CALVARY HOSPITAL

INPATIENT ACUTE CARE

$ 470.56

MEDICAL CENTER*

INPATIENT ACUTE CARE

$ 585.40

$ 577.12

ST MARYS HOSP -

SEE SEPARATE LISTING

CHURCH CHARITY FOUNDATION -

SEE ST JOHNS

EPISCOPAL HOSPITAL

COMMUNITY HOSPITAL

OF BROOKLYN INC

INPATIENT ACUTE CARE

$ 393.53

DEEPDALE GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 439.15

DOCTORS HOSPITAL INC

INPATIENT ACUTE CARE

$ 594.74

$ 600.27

DOCTORS HOSPITAL

OF STATEN ISLAND

INPATIENT ACUTE CARE

$ 481.68

$ 491.87

FLATBUSH GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 371.02

FLUSHING HOSPITAL

AND MEDICAL CENTER

INPATIENT ACUTE CARE

$ 469.28

$ 468.42

HILLCREST GEN HOSP -

SEE CATHOLIC MEDICAL

CENTER

HOSSPITAL INC (LA GUARDIA)

INPATIENT ACUTE CARE

EMERGENCY

SERVICE

EXCLUSIONS:

ROOM RATE

GENERAL HOSPITAL

INPATIENT ACUTE CARE

A,B,F,G

$ 35.00

BAPTIST MEDICAL CENTER

OF NEW YORK

INPATIENT ACUTE CARE

$ 28.00

BAYLEY SETON HOSPITAL

INPATIENT ACUTE CARE

A,B

$ 55.00

BETH ISRAEL MEDICAL CENTER

INPATIENT ACUTE CARE

A,B

$ 55.00

DETOXIFICATION UNIT

A,B

BOOTH MEMORIAL MEDICAL CENTER

INPATIENT ACUTE CARE

A,B,D,N,P, VASCULAR

$ 55.00

BRONX-LEBANON HOSPITAL CENTER

INPATIENT ACUTE CARE

A,C,E,H,K

$ 45.00

BROOKDALE HOSPITAL

MEDICAL CENTER

INPATIENT ACUTE CARE

A,C,D

$ 55.00

BROOKLYN/CALEDONIAN HOSPITAL

INPATIENT ACUTE CARE

$ 45.00

CABRINI HEALTH CARE CTR

INPATIENT ACUTE CARE

A.B

$ 55.00

CALVARY HOSPITAL

INPATIENT ACUTE CARE

NO E.R. SERVICE

MEDICAL CENTER*

INPATIENT ACUTE CARE

$ 55.00

ST MARYS HOSP -

SEE SEPARATE LISTING

CHURCH CHARITY FOUNDATION -

SEE ST JOHNS

EPISCOPAL HOSPITAL

COMMUNITY HOSPITAL

OF BROOKLYN INC

INPATIENT ACUTE CARE

A.B,C,D

$ 45.00

DEEPDALE GENERAL HOSPITAL

INPATIENT ACUTE CARE

A,B,C,D,E

$ 45.00

DOCTORS HOSPITAL INC

INPATIENT ACUTE CARE

$ 55.00

DOCTORS HOSPITAL

OF STATEN ISLAND

INPATIENT ACUTE CARE

A,B

$ 28.00

FLATBUSH GENERAL HOSPITAL

INPATIENT ACUTE CARE

A,C,F,H,I, ECHO

$ 35.00

FLUSHING HOSPITAL

AND MEDICAL CENTER

INPATIENT ACUTE CARE

A,B

$ 55.00

HILLCREST GEN HOSP -

SEE CATHOLIC MEDICAL

CENTER

HOSSPITAL INC (LA GUARDIA)

INPATIENT ACUTE CARE

$ 55.00

DAILY

RATE

1-1-86

7-1-86

OTHER

HOSPITAL FOR JOINT

DISEASES AND MEDICAL

CENTER ORTHOPEDIC INSTITUTE

INPATIENT ACUTE CARE

$ 912.65

$ 899.86

HOSPITAL FOR SPECIAL SURGERY

INPATIENT ACUTE CARE

$ 686.82

INSTITUTE OF REHAB

MEDICINE NY UNIVERSITY

SEE RUSK INST-NYU

INTERFAITH MEDICAL CENTER

INPATIENT ACUTE CARE

$ 566.47

JAMAICA HOSPITAL

INPATIENT ACUTE CARE

$ 524.16

JOINT DISEASES NORTH

GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 501.79

KINGS HIGHWAY HOSPITAL

INPATIENT ACUTE CARE

$ 371.24

KINGSBROOK JEWISH MEDICAL CENTER

INPATIENT ACUTE CARE

$ 530.22

LAGUARDIA HOSP - SEE HIP. HOSP

LENOX HILL HOSPITAL

INPATIENT ACUTE CARE

$ 628.92

$ 631.99

LONG ISLAND COLLEGE HOSPITAL

INPATIENT ACUTE CARE

$ 644.82

$ 638.43

LONG ISLAND JEWISH-HILLSIDE MED CTR

INPATIENT ACUTE CARE

$ 675.67

$ 676.26

PSYCHIATRIC

$ 339.48

REHABILITATION

$ 930.44

LUTHERAN MEDICAL CENTER

INPATIENT ACUTE CARE

$ 481.78

MAIMONIDES MEDICAL CENTER

INPATIENT ACUTECARE

$ 580.77

MANHATTAN EYE EAR

AND THROAT HOSPITAL

INPATIENT ACUTE CARE

$ 795.77

MEDICAL ARTS CENTER HOSPITAL

INPATIENT ACUTE CARE

$ 454.42

MEMORIAL HOSPITAL FOR

CANCER AND ALLIED

DISEASES

INPATIENT ACUTE CARE

EMERGENCY

SERVICE

EXCLUSIONS:

ROOM RATE

HOSPITAL FOR JOINT

DISEASES AND MEDICAL

CENTER ORTHOPEDIC INSTITUTE

INPATIENT ACUTE CARE

A,B,C,D

NO E.R. SERVICE

HOSPITAL FOR SPECIAL SURGERY

INPATIENT ACUTE CARE

A,B, P

NO E.R. SERVICE

INSTITUTE OF REHAB

MEDICINE NY UNIVERSITY

SEE RUSK INST-NYU

INTERFAITH MEDICAL CENTER

INPATIENT ACUTE CARE

$ 55.00

JAMAICA HOSPITAL

INPATIENT ACUTE CARE

A,B,C,E

$ 55.00

JOINT DISEASES NORTH

GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 55.00

KINGS HIGHWAY HOSPITAL

INPATIENT ACUTE CARE

A,B,E

$ 35.00

KINGSBROOK JEWISH MEDICAL CENTER

INPATIENT ACUTE CARE

A.B.C,E,F,O, AUDIOLOGY

$ 55.00

LAGUARDIA HOSP - SEE HIP. HOSP

LENOX HILL HOSPITAL

INPATIENT ACUTE CARE

A,J

$ 55.00

LONG ISLAND COLLEGE HOSPITAL

INPATIENT ACUTE CARE

A,B

$ 55.00

LONG ISLAND JEWISH-HILLSIDE MED CTR

INPATIENT ACUTE CARE

A,B CARDIAC-

$ 55.00

CATHETERIZATION

PSYCHIATRIC

SAME

REHABILITATION

SAME

LUTHERAN MEDICAL CENTER

INPATIENT ACUTE CARE

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

$ 55.00

ELECTROCARDIOLOGY

MAIMONIDES MEDICAL CENTER

INPATIENT ACUTECARE

A,B,C,D,E,P

$ 55.00

MANHATTAN EYE EAR

AND THROAT HOSPITAL

INPATIENT ACUTE CARE

A,B,C,E

$ 45.00

MEDICAL ARTS CENTER HOSPITAL

INPATIENT ACUTE CARE

B,D

$ 45.00

MEMORIAL HOSPITAL FOR

CANCER AND ALLIED

DISEASES

INPATIENT ACUTE CARE

NO E.R. SERVICE

DAILY

RATE

1-1-86

7-1-86

OTHER

HOSPITAL OF BROOKLYN

INPATIENT ACUTE CARE

$ 598.96

$ 598.10

MISERICORDIA HOSPITAL MEDICAL CENTER -

SEE OUR LADY OF MERCY MED CTR

MONTEFIORE HOSPITAL & MEDICAL CENTER

INPATIENT ACUTE CARE

$ 943.83

$ 960.91

REHABILITATION

$ 204.91

MOUNT SINAI HOSPITAL

INPATIENT ACUTE CARE

$ 766.59

NY EYE AND EAR INFIRMARY

INPATIENT ACUTE CARE

$ 510.97

NEW YORK HOSPITAL AND PAYNE WHITNEY

PSYCHIATRIC CLINIC

INPATIENT ACUTE CARE

$ 745.15

NY INFIRMARY BEEKMAN

DOWNTOWN HOSPITAL

INPATIENT ACUTE CARE

$ 876.20

$ 1132.34

NY UNIVERSITY MEDICAL CENTER

INPATIENT ACUTE CARE

$ 724.00

$ 730.91*

OSTEOPATHIC HOSPITAL AND

CLINIC OF NEW YORK

D/B/A HILLCREST GENERAL HOSPITAL -

SEE CATHOLIC MEDICAL CENTER

OF MERCY MED CTR (MISERICORDIA

HOSP)

INPATIENT ACUTE CARE

$ 582.56

PARKWAY HOSPITAL

INPATIENT ACUTE CARE

$ 427.72

PARSONS HOSPITAL

INPATIENT ACUTE CARE

$ 546.24

PELHAM BAY GENERAL HOSPITAL

INPATIENT ACUTE CARE

$ 407.55

PENINSULA HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 550.57

$ 606.10

PHYSICIANS HOSPITAL

INPATIENT ACUTE CARE

$ 456.90

$ 457.14

PRESBYTERIAN HOSPITAL

IN THE CITY OF NY

INPATIENT ACUTE CARE

$ 615.80

EMERGENCY

SERVICE

EXCLUSIONS:

ROOM RATE

HOSPITAL OF BROOKLYN

INPATIENT ACUTE CARE

MISERICORDIA HOSPITAL MEDICAL CENTER -

SEE OUR LADY OF MERCY MED CTR

MONTEFIORE HOSPITAL & MEDICAL CENTER

INPATIENT ACUTE CARE

A,B,G

$ 55.00

REHABILITATION

MOUNT SINAI HOSPITAL

INPATIENT ACUTE CARE

A,B,E,F,G,J

$ 55.00

NY EYE AND EAR INFIRMARY

INPATIENT ACUTE CARE

$ 28.00

NEW YORK HOSPITAL AND PAYNE WHITNEY

PSYCHIATRIC CLINIC

INPATIENT ACUTE CARE

A,B,D CYTOLOGY

$ 55.00

NY INFIRMARY BEEKMAN

DOWNTOWN HOSPITAL

INPATIENT ACUTE CARE

$ 55.00

NY UNIVERSITY MEDICAL CENTER

INPATIENT ACUTE CARE

A,B,C

$ 55.00

OSTEOPATHIC HOSPITAL AND

CLINIC OF NEW YORK

D/B/A HILLCREST GENERAL HOSPITAL -

SEE CATHOLIC MEDICAL CENTER

OF MERCY MED CTR (MISERICORDIA

HOSP)

INPATIENT ACUTE CARE

A,B.C,E

$ 45.00

PARKWAY HOSPITAL

INPATIENT ACUTE CARE

A,B

$ 55.00

PARSONS HOSPITAL

INPATIENT ACUTE CARE

$ 45.00

PELHAM BAY GENERAL HOSPITAL

INPATIENT ACUTE CARE

A,B

$ 55.00

PENINSULA HOSPITAL CENTER

INPATIENT ACUTE CARE

A,B,G

$ 55.00

PHYSICIANS HOSPITAL

INPATIENT ACUTE CARE

$ 28.00

PRESBYTERIAN HOSPITAL

IN THE CITY OF NY

INPATIENT ACUTE CARE

A,B.D

$ 55.00

DAILY

RATE

1-1-86

7-1-86

OTHER

RICHMOND MEMORIAL

HOSPITAL AND HEALTH

CENTER INPATIENT ACUTE CARE

$ 581.51

$ 577.63

ROCKEFELLER UNIVERSITY HOSPITAL

INPATIENT ACUTE CARE

$ 294.86

RUSK INSTITUTE - NYU

INPATIENT ACUTE CARE

$ 497.98

ST BARNABAS HOSPITAL

INPATIENT ACUTE CARE

$ 492.82

ST CLARES HOSPITAL

AND HEALTH CENTER

INPATIENT ACUTE CARE

$ 471.37

ST JOHNS EPISCOPAL

HOSPITAL (CHURCH CHARITY

FOUNDATION)

INPATIENT ACUTE CARE

$ 524.43

ST JOSEPHS HOSPITAL

SEE CATHOLIC MEDICAL

CENTER

ST LUKES - ROOSEVELT

HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 603.95

$ 602.67

DETOXIFICATION UNIT.

$ 168.82

ST MARYS HOSPITAL OF

BROOKLYN

INPATIENT ACUTE CARE

$ 598.37

$ 598.29

ST VINCENTS HOSPITAL

AND MEDICAL CENTER OF

NY INPATIENT ACUTE CARE

$ 658.35

$ 658.39

ST VINCENTS MEDICAL

CENTER OF RICHMON

INPATIENT ACUTE CARE

$ 498.47

B,E

STATE UNIVERSITY

HOSPITAL DOWNSTATE

MEDICAL CENTER

$ 659.54

$ 665.58

INPATIENT ACUTE CAR

STATEN ISLAND HOSPITAL

INPATIENT ACUTE CARE

$ 520.55

$ 523.53

UNION HOSPITAL OF THE BRONX

INPATIENT ACUTE CARE

$ 435.54

VICTORY MEMORIAL HOSPITAL

$ 380.95

$ 382.65

INPATIENT ACUTE CARE

WESTCHESTER SQUARE HOSPITAL

$ 475.76

$ 491.19

INPATIENT ACUTE CARE

WYCKOFF HEIGHTS HOSPITAL

INPATIENT ACUTE CARE

EMERGENCY

SERVICE

EXCLUSIONS:

ROOM RATE

RICHMOND MEMORIAL

HOSPITAL AND HEALTH

CENTER INPATIENT ACUTE CARE

A,B

$ 55.00

ROCKEFELLER UNIVERSITY HOSPITAL

INPATIENT ACUTE CARE

NO E.R. SERVICE

RUSK INSTITUTE - NYU

INPATIENT ACUTE CARE

A,B,D

NO E.R. SERVICE

ST BARNABAS HOSPITAL

INPATIENT ACUTE CARE

A,B,C.E,H

$ 55.00

ST CLARES HOSPITAL

AND HEALTH CENTER

INPATIENT ACUTE CARE

A,B,C,E,F

$ 55.00

ST JOHNS EPISCOPAL

HOSPITAL (CHURCH CHARITY

FOUNDATION)

INPATIENT ACUTE CARE

A,B,C

$ 55.00

ST JOSEPHS HOSPITAL

SEE CATHOLIC MEDICAL

CENTER

ST LUKES - ROOSEVELT

HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 55.00

DETOXIFICATION UNIT.

ST MARYS HOSPITAL OF

BROOKLYN

INPATIENT ACUTE CARE

$ 55.00

ST VINCENTS HOSPITAL

AND MEDICAL CENTER OF

NY INPATIENT ACUTE CARE

A,I, DIAG. RADIO

OGY $ 55.00

ST VINCENTS MEDICAL

CENTER OF RICHMON

INPATIENT ACUTE CARE

$ 55.00

STATE UNIVERSITY

HOSPITAL DOWNSTATE

MEDICAL CENTER

A,B

NO E.R. SERVICE

INPATIENT ACUTE CAR

STATEN ISLAND HOSPITAL

INPATIENT ACUTE CARE

A,B,C,D,EI,

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

$ 55.00

UNION HOSPITAL OF THE BRONX

A,C

$ 28.00

INPATIENT ACUTE CARE

VICTORY MEMORIAL HOSPITAL

$ 55.00

INPATIENT ACUTE CARE

WESTCHESTER SQUARE HOSPITAL

A,B,C

$ 55.00

INPATIENT ACUTE CARE

WYCKOFF HEIGHTS HOSPITAL

A,C

$ 45.00

INPATIENT ACUTE CARE

DAILY

RATE

1-1-86

7-1-86

OTHER

HEALTH AND HOSPITAL CORPORATION

BELLEVUE HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 628.71

BRONX MUNICIPAL HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 626.28

CITY HOSPITAL CENTER AT ELMHURST

INPATIENT ACUTE CARE

$ 543.19

COLER MEMORIAL HOSPITAL AND HOME

INPATIENT ACUTE CARE

$ 369.72

CONEY ISLAND HOSPITAL

INPATIENT ACUTE CARE

$ 574.55

GOLDWATER MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

$ 294.25

HARLEM HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 659.98

KINGS COUNTY HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 547.09

LINCOLN MEDICAL & MENTAL HEALTH CENTER

INPATIENT ACUTE CARE

$ 665.33

MSM 3LITAN HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 637.47

NORTH CENTRAL BRONX HOSPITAL

INPATIENT ACUTE CARE

$ 839.06

QUEENS HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 648.43

WOODHULL MEDICAL AND MENTAL HEALTH CENTER

INPATIENT ACUTE CARE

EMERGENCY

SERVICE

EXCLUSIONS:

ROOM RATE

HEALTH AND HOSPITAL CORPORATION

BELLEVUE HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 55.00

BRONX MUNICIPAL HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 55.00

CITY HOSPITAL CENTER AT ELMHURST

INPATIENT ACUTE CARE

$ 45.00

COLER MEMORIAL HOSPITAL AND HOME

INPATIENT ACUTE CARE

NO E.R. SERVICE

CONEY ISLAND HOSPITAL

INPATIENT ACUTE CARE

A,B.D,G,H

$ 55.00

GOLDWATER MEMORIAL HOSPITAL

INPATIENT ACUTE CARE

NO E.R. SERVICE

HARLEM HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 55.00

KINGS COUNTY HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 35.00

LINCOLN MEDICAL & MENTAL HEALTH CENTER

INPATIENT ACUTE CARE

$ 55.00

MSM 3LITAN HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 555.00

NORTH CENTRAL BRONX HOSPITAL

INPATIENT ACUTE CARE

$ 55.00

QUEENS HOSPITAL CENTER

INPATIENT ACUTE CARE

$ 55.00

WOODHULL MEDICAL AND MENTAL HEALTH CENTER

INPATIENT ACUTE CARE

$ 55.00

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