October 16, 1987

SUBJECT: INSURANCE

Circular Letter No. 18 (1987)

WITHDRAWN

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 11 NYCRR 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 - ULTRASOUND

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

  

 WOMAN'S 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

  

 CHILDREN'S HOSPITAL OF BUFFALO

      

INPATIENT 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,
   

ENDO CARDIOGRAMS

 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 MARY'S 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 JOSEPH'S 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 COMMUNITY 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:
   

RADIOCHEMISTRY
     

 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

    

 CHILDREN'S 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 LUKE'S 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 JOSEPH'S 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 HOSPITAL

      

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

  
       

CHILD'S 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 PETER'S 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 O'CONNOR 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 MARY'S 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 MARY'S 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 CLARE'S HOSPITAL OF SCHENECTADY

  

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

  

INPATIENT ACUTE CARE

$ 576.20

GASTROENTEROLOGY

  
   

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

  
   

CARDIOPULMONARY

  
       

 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 LUKE'S 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 CARE

$ 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 CHILDREN'S 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 JOHN'S RIVERSIDE HOSPITAL

$ 588.52

A,B,C,J

  

INPATIENT ACUTE CARE

      

 ST JOSEPH'S 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 CENTER

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

  
   

CATHETERIZATION

  

 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

      

EAST MEADOW

      

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 JOHN'S 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 JOHN'S 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 JOHN'S

    

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

OSTEOEOPATHIC HOSPITAL AND CLINIC OF NEW YORK

    

HILLCREST GENERAL HOSPITAL -

    

CATHOLIC 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 CLARE'S HOSPITAL AND

    

HEALTH CENTER

    

INPATIENT ACUTE CARE

$ 420.17

A,B,C,E,F

ST JOHN'S EPISCOPAL HOSPITAL

    

(CHURCH CHARITY FOUNDATION)

    

INPATIENT ACUTE CARE

$ 512.77

A,B,C,D,L,N OTHER:
   

HOLTER MONITOR

ST JOSEPH'S HOSPITAL -

    

SEE CATHOLIC MEDICAL CENTER

    

ST LUKE'S - ROOSEVELT

    

HOSPITAL CENTER

    

INPATIENT ACUTE CARE

$ 615.88

  

DETOXIFICATION UNIT

$ 185.22

  

ST MARY'S HOSPITAL OF BROOKLYN

    

INPATIENT ACUTE CARE

$ 623.61

E,F

ST VINCENT'S HOSPITAL AND

    

MEDICAL CENTER OF NY

    

INPATIENT ACUTE CARE

$ 678.28

A,I OTHER:
   

DIAGNOSTIC
   

RADIOLOGY

ST VINCENT'S 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