N.Y. Comp. Codes R. & Regs. tit. 12, Appendices, app C-6
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.
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 |
N.Y. Comp. Codes R. & Regs. tit. 12, Appendices, app C-6