New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Appendices › Appendix C-6

Current through Register Vol. 46, No. 28, July 10, 2024
STATE OF NEW YORK
WORKERS' COMPENSATION BOARD OFFICE OF THE
				CHAIRMAN
OUTPATIENT HOSPITAL RATE SCHEDULE Effective
				7/1/95-6/30/96
The proposed Outpatient Hospital Fee Schedule was 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, the Volunteer Firefighters' Benefit Law and the
				Volunteer Ambulance Workers' Benefit Law.
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Chairman
WORKERS' COMPENSATION SCHEDULE OF RATES FOR OUTPATIENT HOSPITAL
				SERVICES
Effective 7/1/95 - 6/30/96
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
						  Chair, 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
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
Gelfoam
Glycerine 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 OUTPATIENT HOSPITAL RATE SCHEDULE
				WESTERN NEW YORK REGION EFFECTIVE 7/1/95 - 6/30/96
EMERGENCY SERVICE ROOM
							 RATE
ALLEGANY
CUBA MEMORIAL HOSPITAL INC .......
$97.50
MEMORIAL HOSPITAL OF WM F & GERTRUDE F JONES A/K/A
						  JONES MEMORIAL .......
$101.00
CATTARAUGUS
OLEAN GENERAL HOSPITAL (ALL DIVISIONS) .......
$101.00
ST FRANCIS HOSPITAL OF OLEAN - (SEE OLEAN GENERAL
						  HOSPITAL) .......
TRI-COUNTY MEMORIAL HOSPITAL .......
$101.00
CHAUTAUQUA
BROOKS MEMORIAL HOSPITAL .......
$101.00
LAKE SHORE HEALTH CARE CENTER .......
$101.00
WESTFIELD MEMORIAL HOSPITAL INC .......
$101.00
WOMANS CHRISTIAN ASSOCIATION (ALL DIVISIONS) .......
$65.00
ERIE
BERTRAND CHAFFEE HOSPITAL .......
$101.00
BUFFALO COLUMBUS HOSPITAL .......
$101.00
BUFFALO GENERAL HOSPITAL .......
$101.00
CHILDRENS HOSPITAL OF BUFFALO .......
$73.00
ERIE COUNTY MEDICAL CENTER .......
$101.00
KENMORE MERCY HOSPITAL .......
$73.00
MERCY HOSPITAL (BUFFALO) .......
$72.00
MILLARD FILLMORE HOSPITAL (ALL DIVISIONS) .......
$101.00
OUR LADY OF VICTORY HOSPITAL (LACKAWANNA) .......
$101.00
ROSWELL PARK MEMORIAL INSTITUTE .......
NO E.R. SERVICE
SHEEHAN MEMORIAL HOSPITAL .......
$101.00
SISTERS OF CHARITY HOSPITAL (BUFFALO) .......
$101.00
ST JOSEPH HOSPITAL (CHEEKTOWAGA) .......
$101.00
GENESEE
GENESEE MEMORIAL HOSPITAL (BATAVIA) .......
$101.00
ST JEROME HOSPITAL .......
$101.00
NIAGARA
DEGRAFF MEMORIAL HOSPITAL .......
$90.00
INTER-COMMUNITY MEMORIAL HOSPITAL (NEWFANE) .......
$101.00
LOCKPORT MEMORIAL HOSPITAL .......
$101.00
MOUNT ST MARYS HOSPITAL OF NIAGARA FALLS .......
$84.00
NIAGARA FALLS MEMORIAL MEDICAL CENTER .......
$88.00
ORLEANS
MEDINA MEMORIAL HOSPITAL .......
$101.00
WYOMING
WYOMING COUNTY COMMUNITY HOSPITAL .......
$101.00
WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE
				ROCHESTER NEW YORK REGION EFFECTIVE 7/1/95-6/30/96
EMERGENCY SERVICE ROOM
							 RATE
CHEMUNG
ARNOT OGDEN MEDICAL CENTER .......
$101.00
ST JOSEPHS HOSPITAL (ELMIRA) .......
$101.00
LIVINGSTON
NICHOLAS H NOYES MEMORIAL HOSPITAL .......
$101.00
MONROE
GENESEE HOSPITAL (ROCHESTER) .......
$101.00
HIGHLAND HOSPITAL (ROCHESTER) .......
$101.00
LAKESIDE MEMORIAL HOSPITAL .......
$101.00
MONROE COMMUNITY HOSPITAL .......
NO E.R. SERVICE
PARK RIDGE HOSPITAL .......
$101.00
ROCHESTER GENERAL HOSPITAL .......
$101.00
ST MARYS HOSPITAL (ROCHESTER) .......
$101.00
STRONG MEMORIAL HOSPITAL .......
$101.00
ONTARIO
CLIFTON SPRINGS HOSPITAL AND CLINIC .......
$101.00
F F THOMPSON HOSPITAL .......
$101.00
GENEVA REGIONAL HEALTH SYSTEM (GENEVA GEN DIVISION)
						  .......
$97.50
SCHUYLER
SCHUYLER HOSPITAL .......
$101.00
SENECA
WATERLOO MEMORIAL HOSPITAL INC D/B/A TAYLOR BROWN - (NO
						  LONGER ACUTE CARE - SEE GENEVA GENERAL)
STEUBEN
CORNING HOSPITAL .......
$101.00
IRA DAVENPORT MEMORIAL HOSPITAL .......
$101.00
ST JAMES MERCY HOSPITAL .......
$101.00
WAYNE
MYERS COMMUNITY HOSPITAL .......
$101.00
NEWARK-WAYNE COMMUNITY HOSPITAL .......
$101.00
YATES
SOLDIERS AND SAILORS MEMORIAL HOSPITAL OF YATES COUNTY
						  .......
$101.00
WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE
				CENTRAL NEW YORK REGION EFFECTIVE 7/1/95-6/30/96
EMERGENCY SERVICE ROOM
							 RATE
BROOME
OUR LADY OF LOURDES MEMORIAL HOSPITAL .......
$97.00
UNITED HEALTH SERVICES (ALL DIVISIONS) .......
$101.00
CAYUGA
AUBURN MEMORIAL HOSPITAL .......
$101.00
CHENANGO
UNITED HEALTH SERVICES/CHENANGO MEMORIAL HOSPITAL
$92.00
CORTLAND
CORTLAND MEMORIAL HOSPITAL .......
$101.00
HERKIMER
LITTLE FALLS HOSPITAL .......
$101.00
MOHAWK VALLEY GENERAL HOSPITAL (SEE ST LUKES MEMORIAL
						  HOSPITAL CENTER - ONEIDA COUNTY)
JEFFERSON
CARTHAGE AREA HOSPITAL .......
$101.00
EDWARD JOHN NOBLE HOSPITAL SAMARITAN (ALEXANDRIA BAY)
						  .......
$101.00
SAMARITAN MEDICAL CENTER (WATERTOWN) .......
$101.00
LEWIS
LEWIS COUNTY GENERAL HOSPITAL .......
$98.00
MADISON
COMMUNITY MEMORIAL HOSPITAL (HAMILTON) .......
$101.00
ONEIDA CITY HOSPITAL .......
$101.00
ONEIDA
CHILDRENS HOSPITAL AND REHABILITATION CENTER .......
NO E.R. SERVICE
FAXTON HOSPITAL (ALL DIVISIONS) .......
$79.00
ROME HOSPITAL AND MURPHY MEMORIAL HOSPITAL .......
$85.00
ST ELIZABETH HOSPITAL (UTICA) .......
$101.00
ST LUKES MEMORIAL HOSPITAL CENTER (ALL DIVISIONS) .......
$87.00
ONONDAGA
COMMUNITY GENERAL HOSPITAL OF GREATER SYRACUSE .......
$101.00
CROUSE-IRVING MEMORIAL HOSPITAL .......
$101.00
ST JOSEPHS HOSPITAL HEALTH CENTER (SYRACUSE) .......
$101.00
STATE UNIVERSITY OF NY HEALTH SCIENCE CENTER (SYRACUSE)
						  .......
$101.00
OSWEGO
ALBERT LINDLEY LEE MEMORIAL HOSPITAL .......
$101.00
OSWEGO HOSPITAL (ALL DIVISIONS) .......
$101.00
ST LAWRENCE
A BARTON HEPBURN HOSPITAL .......
$101.00
CANTON-POTSDAM HOSPITAL .......
$101.00
CLIFTON-FINE HOSPITAL .......
$69.00
EDWARD JOHN NOBLE HOSPITAL OF GOUVERNEUR .......
$88.00
MASSENA MEMORIAL HOSPITAL .......
$101.00
TOMPKINS
TOMPKINS COUNTY HOSPITAL .......
$97.00
WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE
				NORTHEASTERN NEW YORK REGION EFFECTIVE 7/1/95-6/30/96
EMERGENCY SERVICE ROOM
							 RATE
ALBANY
ALBANY MEDICAL CENTER HOSPITAL .......
$101.00
ALBANY MEMORIAL HOSPITAL .......
$97.00
CHILDS HOSPITAL .......
NO E.R. SERVICE
ST PETERS HOSPITAL .......
$101.00
CLINTON
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CTR .......
$101.00
COLUMBIA
COLUMBIA-GREENE MEDICAL CENTER (ALL DIVISIONS) .......
$101.00
DELAWARE
A LINDSAY & OLIVE B OCONNOR HOSPITAL (SEE BASSET
						  HEALTH CARE/MIB HOSPITAL - OTSEGO COUNTY)
DELAWARE VALLEY HOSPITAL .......
$98.00
MARGARETVILLE MEMORIAL HOSPITAL .......
$98.00
THE HOSPITAL (SIDNEY) .......
$101.00
ESSEX
ELIZABETHTOWN COMMUNITY HOSPITAL .......
$101.00
MOSES-LUDINGTON HOSPITAL .......
$100.00
PLACID MEMORIAL HOSPITAL INC (SEE ADIRONDACK MEDICAL
						  CENTER - FRANKLIN COUNTY)
FRANKLIN
ADIRONDACK MEDICAL CENTER (ALL DIVISIONS) .......
$101.00
ALICE HYDE HOSPITAL ASSOCIATION .......
$101.00
FULTON
NATHAN LITTAUER HOSPITAL AND NURSING HOME .......
$93.00
GREENE
MEMORIAL HOSPITAL AND NURSING HOME OF GREENE COUNTY (SEE
						  COLUMBIA-GREENE MEDICAL CENTER)
MONTGOMERY
AMSTERDAM MEMORIAL HOSPITAL .......
$101.00
ST MARYS HOSPITAL AT AMSTERDAM .......
$101.00
OTSEGO
AURELIA OSBORN FOX MEMORIAL HOSPITAL .......
$101.00
BASSETT HEALTH CARE/MIB HOSPITAL (ALL DIVISIONS) .......
$101.00
RENSSELAER
SETON HEALTH SYSTEM-LEONARD CAMPUS .......
$101.00
SETON HEALTH SYSTEM-ST MARYS CAMPUS (TROY) .......
$101.00
SAMARITAN HOSPITAL (TROY) .......
$101.00
SARATOGA
ADIRONDACK REGIONAL HOSPITAL (SEE LEONARD HOSPITAL)
						  .......
NO E.R. SERVICE
SARATOGA HOSPITAL AND NURSING HOME .......
$94.00
SCHENECTADY
BELLEVUE-THE WOMANS HOSPITAL .......
NO E.R. SERVICE
ELLIS HOSPITAL .......
$101.00
ST CLARES HOSPITAL (SCHENECTADY) .......
$101.00
SUNNYVIEW HOSPITAL AND REHABILITATION CENTER .......
NO E.R. SERVICE
SCHOHARIE
BASSETT HEALTH CARE/BASSETT HOSP OF SCHOHARIE COUNTY
						  .......
$98.00
WARREN
GLENS FALLS HOSPITAL .......
$101.00
WASHINGTON
MARY MCCLELLAN HOSPITAL .......
$101.00
WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE
				NORTHERN METROPOLITAN REGIO EFFECTIVE 7/1/95-6/30/96
EMERGENCY SERVICE ROOM
							 RATE
DUTCHESS
NORTHERN DUTCHESS HOSPITAL .......
$ 101.00
ST FRANCIS HOSPITAL - POUGHKEEPSIE (BEACON DIVISION)
						  .......
$ 101.00
ST FRANCIS HOSPITAL-POUGHKEEPSIE (POUGHKEEPSIE DIVISION)
						  .......
$ 101.00
VASSAR BROTHERS HOSPITAL .......
$ 97.50
ORANGE
ARDEN HILL HOSPITAL .......
$ 80.00
CORNWALL HOSPITAL .......
$ 101.00
HORTON MEMORIAL HOSPITAL .......
$ 101.00
MERCY COMMUNITY HOSPITAL (PORT JERVIS) .......
$ 101.00
ST ANTHONY COMMUNITY HOSPITAL .......
$ 101.00
ST LUKES HOSPITAL (NEWBURGH) .......
$ 91.00
PUTNAM
JULIA L BUTTERFIELD MEMORIAL HOSPITAL .......
$ 101.00
PUTNAM HOSPITAL CENTER .......
$ 101.00
ROCKLAND
GOOD SAMARITAN HOSPITAL (SUFFERN) .......
$ 101.00
HELEN HAYES HOSPITAL .......
NO E.R. SERVICE
NYACK HOSPITAL .......
$ 101.00
SUMMIT PARK HOSPITAL-ROCKLAND COUNTY INFIRMARY .......
NO E.R. SERVICE
SULLIVAN
COMMUNITY GENERAL HOSPITAL OF SULLIVAN COUNTY (HARRIS
						  DIVISION) .......
$ 101.00
COMMUNITY GENERAL HOSPITAL OF SULLIVAN COUNTY (HERMAN
						  DIVISION) .......
$ 101.00
ULSTER
BENEDICTINE HOSPITAL (KINGSTON) .......
$ 101.00
ELLENVILLE COMMUNITY HOSPITAL .......
$ 101.00
KINGSTON HOSPITAL .......
$ 101.00
WESTCHESTER
BLYTHEDALE CHILDRENS HOSPITAL .......
NO. E.R. SERVICE
COMMUNITY HOSPITAL AT DOBBS FERRY .......
$ 101.00
HUDSON VALLEY HOSPITAL CENTER (PEEKSKILL-CORTLAND)
						  .......
$ 101.00
LAWRENCE HOSPITAL .......
$ 101.00
MOUNT VERNON HOSPITAL .......
$ 101.00
NEW ROCHELLE HOSPITAL MEDICAL CENTER .......
$ 101.00
NEW YORK HOSPITAL-CORNELL MEDICAL CENTER WESTCHESTER
						  DIVISION .......
NO E.R. SERVICE
NORTHERN WESTCHESTER HOSPITAL CENTER .......
$ 101.00
PHELPS MEMORIAL HOSPITAL .......
$ 101.00
ST AGNES HOSPITAL .......
$ 101.00
ST JOHNS RIVERSIDE HOSPITAL .......
$ 101.00
ST JOSEPHS HOSPITAL (YONKERS) .......
$ 101.00
ST VINCENTS HOSP AND MEDICAL CTR OF NY WESTCHESTER
						  DIVISION .......
NO E.R. SERVICE
UNITED HOSPITAL MEDICAL CENTER .......
$ 101.00
WESTCHESTER COUNTY MEDICAL CENTER (ALL DIVISIONS) .......
$ 101.00
WHITE PLAINS HOSPITAL CENTER .......
$ 101.00
WINIFRED MASTERSON BURKE REHABILITATION HOSPITAL .......
NO E.R. SERVICE
YONKERS GENERAL HOSPITAL .......
$ 101.00
WORKERS' COMPENSATIO OUTPATIENT HOSPITAL RATE SCHEDULE
				LONG ISLAND REGION EFFECTIVE 7/1/95-6/30/96
EMERGENCY SERVICE ROOM
							 RATE
NASSAU
CENTRAL GENERAL HOSPITAL .......
$101.00
COMMUNITY HOSPITAL AT GLEN COVE (SEE NORTH SHORE UNIV. AT
						  GLEN COVE)
FRANKLIN HOSPITAL MEDICAL CENTER .......
$101.00
HEMPSTEAD GENERAL HOSPITAL .......
$101.00
LA GUARDIA-SYOSSET/SYOSSET COMMUNITY HOSPITAL .......
$101.00
LONG BEACH MEMORIAL HOSPITAL .......
$101.00
LONG ISLAND JEWISH-HILLSIDE MEDICAL CENTER (MANHASSET
						  DIV) .......
$101.00
MASSAPEQUA GENERAL HOSPITAL .......
$101.00
MERCY MEDICAL CENTER (ROCKVILLE CENTRE) .......
$101.00
MID-ISLAND HOSPITAL .......
$101.00
NASSAU COUNTY MEDICAL CENTER .......
$101.00
NORTH SHORE UNIVERSITY HOSPITAL (GLEN COVE DIVISION)
						  .......
$101.00
NORTH SHORE UNIVERSITY HOSPITAL (MANHASSET DIVISION)
$101.00
SOUTH NASSAU COMMUNITIES HOSPITAL .......
$101.00
ST FRANCIS HOSPITAL (ROSLYN) .......
$101.00
WINTHROP-UNIVERSITY HOSPITAL .......
$101.00
SUFFOLK
BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER .......
$101.00
BRUNSWICK HOSPITAL CENTER .......
$101.00
CENTRAL SUFFOLK HOSPITAL .......
$101.00
COMMUNITY HOSPITAL OF SMITHTOWN (WESTERN SUFFOLK)
$101.00
EASTERN LONG ISLAND HOSPITAL .......
$101.00
GOOD SAMARITAN HOSPITAL MEDICAL CENTER (WEST ISLIP)
$101.00
HUNTINGTON HOSPITAL .......
$101.00
JOHN T MATHER MEMORIAL HOSPITAL .......
$101.00
SOUTHAMPTON HOSPITAL .......
$101.00
SOUTHSIDE HOSPITAL .......
$101.00
ST CHARLES HOSPITAL .......
$101.00
ST JOHNS EPISCOPAL HEALTH SERVICES .......
$101.00
ST JOHNS EPISCOPAL HOSPITAL SMITHTOWN (SEE ST JOHNS
						  EPISCOPAL HEALTH SERVICES)
UNIVERSITY HOSPITAL (STONY BROOK) .......
$101.00
WORKERS' COMPENSATION OUTPATIENT HOSPITAL RATE SCHEDULE
				NEW YORK CITY REGION EFFECTIVE 7/1/95-6/30/96
EMERGENCY SERVICE ROOM
							 RATE
BETH ISRAEL MEDICAL CENTER (BETH ISRAEL DIVISION) .......
$101.00
BETH ISRAEL MEDICAL CENTER (NORTH/DOCTORS HOSP DIVISION)
						  .......
$101.00
BRONX-LEBANON HOSPITAL CENTER (ALL DIVISIONS) .......
$101.00
BROOKDALE HOSPITAL MEDICAL CENTER .......
$101.00
BROOKLYN HOSPITAL CENTER (ALL DIVISIONS) .......
$101.00
CABRINI HEALTH CARE CTR .......
$101.00
CALVARY HOSPITAL .......
NO E.R. SERVICE
CATHOLIC MEDICAL CENTER (ALL DIVISIONS) .......
$101.00
CATHOLIC MEDICAL CENTER/ST MARYS OF BROOKLYN DIVISION
						  (SEE CATHOLIC MEDICAL CENTER
DOCTORS HOSPITAL INC (SEE BETH ISRAEL HOSPITAL
						  NORTH)
DOCTORS HOSPITAL OF STATEN ISLAND .......
$101.00
LA GUARDIA-SYOSSET/LA GUARDIA HOSPITAL .......
$101.00
HOSPITAL FOR JOINT DISEASES ORTHOPEDIC INSTITUTE .......
NO E.R. SERVICE
HOSPITAL FOR SPECIAL SURGERY .......
NO E.R. SERVICE
INTERFAITH MEDICAL CENTER (ALL DIVISIONS) .......
$101.00
JAMAICA HOSPITAL .......
$101.00
KINGSBROOK JEWISH MEDICAL CENTER .......
$101.00
KINGS HIGHWAY HOSPITAL .......
$101.00
LENOX HILL HOSPITAL .......
$101.00
LONG ISLAND COLLEGE HOSPITAL .......
$101.00
LONG ISLAND JEWISH-HILLSIDE MED CTR .......
$101.00
LUTHERAN MEDICAL CENTER .......
$101.00
MAIMONIDES MEDICAL CENTER .......
$101.00
MANHATTAN EYE EAR AND THROAT HOSPITAL .......
$82.00
MEDICAL ARTS CENTER HOSPITAL .......
$98.00
MEMORIAL SLOAN-KETTERING CANCER CENTER .......
$101.00
MONTEFIORE MEDICAL CENTER (ALL DIVISIONS) .......
$101.00
MOUNT SINAI HOSPITAL .......
$101.00
NEW YORK COMMUNITY HOSPITAL OF BROOKLYN .......
$101.00
NEW YORK DOWNTOWN HOSPITAL .......
$101.00
NEW YORK EYE AND EAR INFIRMARY .......
$49.00
NEW YORK HOSPITAL (ALL DIVISIONS) .......
$101.00
NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS (BOOTH)
						  .......
$101.00
NEW YORK METHODIST HOSPITAL (BROOKLYN) .......
$101.00
NEW YORK UNIVERSITY MEDICAL CENTER (RUSK REHAB DIVISION)
						  .......
NO E.R. SERVICE
NEW YORK UNIVERSITY MEDICAL CENTER (TISCH HOSPITAL
						  DIVISION) .......
$101.00
NORTH GENERAL HOSPITAL .......
$101.00
OUR LADY OF MERCY MEDICAL CENTER (ALL DIVISIONS .......
$101.00
PARKWAY HOSPITAL .......
$101.00
PELHAM BAY GENERAL HOSPITAL .......
NO E.R. SERVICE
PENINSULA HOSPITAL CENTER .......
$101.00
PREFERRED HEALTH/FLUSHING HOSPITAL MEDICAL CENTER-MAIN
						  .......
$101.00
PREFERRED HEALTH/LITTLE NECK COMMUNITY HOSPITAL
						  (DEEPDALE) .......
$97.50
PREFERRED HEALTH/WYCKOFF MED CTR (JACKSON HEIGHTS DIV)
						  .......
$101.00
PREFERRED HEALTH/WYCKOFF MED CTR (WYCKOFF HEIGHTS DIV)
						  .......
$101.00
PRESBYTERIAN HOSPITAL IN NEW YORK (ALL DIVISIONS) .......
$101.00
RICHMOND MEMORIAL HOSPITAL AND HEALTH CENTER (SEE STATEN
						  ISLAND UNIVERSITY HOSPITAL) .......
ROCKEFELLER UNIVERSITY HOSPITAL .......
NO E.R. SERVICE
SISTERS OF CHARITY HEALTH CARE SYSTEM (BAYLEY SETON DIV)
						  .......
$101.00
SISTERS OF CHARITY HEALTH CARE SYSTEM (ST VINCENTS
						  DIV)
$101.00
ST BARNABAS HOSPITAL .......
$101.00
ST CLARES HOSPITAL AND HEALTH CENTER (NEW YORK) .......
$101.00
ST JOHNS EPISCOPAL HEALTH SERVICES .......
$101.00
ST JOHNS EPISCOPAL HOSPITAL (SEE ST JOHNS EPISCOPAL
						  HEALTH SERVICES)
ST LUKES - ROOSEVELT HOSPITAL (ALL DIVISIONS) .......
$101.00
ST VINCENTS HOSPITAL AND MEDICAL CENTER OF NY (NEW YORK
						  DIV) .......
$101.00
STATEN ISLAND UNIVERSITY HOSPITAL (ALL DIVISIONS) .......
$101.00
UNION HOSPITAL OF THE BRONX .......
$101.00
UNIVERSITY HOSPITAL OF BROOKLYN .......
NO E.R. SERVICE
WESTCHESTER SQUARE MEDICAL CENTER .......
$101.00
WESTERN QUEENS COMMUNITY HOSPITAL (ASTORIA) .......
$101.00
VICTORY MEMORIAL HOSPITAL .......
$101.00
HEALTH AND HOSPITAL CORPORATION
BELLEVUE HOSPITAL CENTER .......
$101.00
BRONX MUNICIPAL HOSPITAL CENTER .......
$101.00
COLER MEMORIAL HOSPITAL .......
NO E.R. SERVICE
CONEY ISLAND HOSPITAL .......
$101.00
ELMHURST HOSPITAL CENTER .......
$101.00
GOLDWATER MEMORIAL .......
NO E.R. SERVICE
HARLEM HOSPITAL CENTER .......
$101.00
KINGS COUNTY HOSPITAL CENTER .......
$101.00
LINCOLN MEDICAL AND MENTAL HEALTH CENTER .......
$101.00
METROPOLITAN HOSPITAL CENTER .......
$101.00
NORTH CENTRAL BRONX HOSPITAL .......
$101.00
QUEENS HOSPITAL CENTER .......
$101.00
WOODHULL MEDICAL AND MENTAL HEALTH CENTER .......
$101.00