Sole Community Hospital Outpatient Rate Add-Ons
EFFECTIVE 4/1/2025 - 3/31/2026
(Medicaid Managed Care)
- Add-ons also available in Portable Document Format (PDF)
| Sole Community Hospital Rate Add-ons (4/1/2025 - 3/31/2026) | Clinic | Ambulatory Surgery | Emergency Department | |||
|---|---|---|---|---|---|---|
| Operating Certificate | Medicaid ID | NPI | Hospital Name | Add-on Payment Per Visit |
Add-on Payment Per Visit |
Add-on Payment Per Visit |
| 1623001 | 00363213 | 1245446533 | Adirondack Medical Center | $165.00 | $3,029.00 | $236.00 |
| 1623001 | 03002559 | 1699709576 | Adirondack Medical Center | $165.00 | $3,029.00 | $236.00 |
| 1623001 | 03002568 | 1750395562 | Adirondack Medical Center | $165.00 | $3,029.00 | $236.00 |
| 1623001 | 03002577 | 1740317189 | Adirondack Medical Center | $165.00 | $3,029.00 | $236.00 |
| 1623001 | 03002586 | 1831226273 | Adirondack Medical Center | $165.00 | $3,029.00 | $236.00 |
| 1623001 | 03002595 | 1922135367 | Adirondack Medical Center | $165.00 | $3,029.00 | $236.00 |
| 1623001 | 03474128 | 1922135367 | Adirondack Medical Center | $165.00 | $3,029.00 | $236.00 |
| 0501000 | 00347553 | 1093712911 | Auburn Community Hosp | $165.00 | $3,029.00 | $236.00 |
| 0501000 | 03001223 | 1205801362 | Auburn Community Hosp | $165.00 | $3,029.00 | $236.00 |
| 0501000 | 07599580 | 1336855683 | Auburn Community Hosp | $165.00 | $3,029.00 | $236.00 |
| 3801000 | 00279098 | 1114114808 | A.O. Fox Hospital | $165.00 | $3,029.00 | $236.00 |
| 3801000 | 03000415 | 1578529954 | A.O. Fox Hospital | $165.00 | $3,029.00 | $236.00 |
| 0601000 | 00381439 | 1215917224 | Brooks-TLC Hospital System | $165.00 | $3,029.00 | $236.00 |
| 0601000 | 02995848 | 1487738886 | Brooks-TLC Hospital System | $165.00 | $3,029.00 | $236.00 |
| 0601000 | 03002999 | 1609846948 | Brooks-TLC Hospital System | $165.00 | $3,029.00 | $236.00 |
| 0601000 | 03924825 | 1538419502 | Brooks-TLC Hospital System | $165.00 | $3,029.00 | $236.00 |
| 0601000 | 06501284 | 1225654494 | Brooks-TLC Hospital System | $165.00 | $3,029.00 | $236.00 |
| 4429000 | 00354196 | 1568548782 | Canton-Potsdam Hospital | $165.00 | $3,029.00 | $236.00 |
| 4429000 | 03131160 | 1114104445 | Canton-Potsdam Hospital | $165.00 | $3,029.00 | $236.00 |
| 5401001 | 00332729 | 1144397100 | Cayuga Medical Center at Ithaca | $165.00 | $3,029.00 | $236.00 |
| 5401001 | 03001067 | 1164547303 | Cayuga Medical Center at Ithaca | $165.00 | $3,029.00 | $236.00 |
| 5401001 | 03001076 | 1366519795 | Cayuga Medical Center at Ithaca | $165.00 | $3,029.00 | $236.00 |
| 5401001 | 03001085 | 1962422733 | Cayuga Medical Center at Ithaca | $165.00 | $3,029.00 | $236.00 |
| 5401001 | 03001094 | 1982771325 | Cayuga Medical Center at Ithaca | $165.00 | $3,029.00 | $236.00 |
| 0824000 | 00314723 | 1770593956 | Chenango Memorial Hospital | $165.00 | $3,029.00 | $236.00 |
| 5263000 | 02997051 | 1710977012 | Garnet Health Medical Center - Catskills | $165.00 | $3,029.00 | $236.00 |
| 5263000 | 02978536 | 1205096278 | Garnet Health Medical Center - Catskills | $165.00 | $3,029.00 | $236.00 |
| 1101000 | 00279176 | 1033117635 | Guthrie Cortland Medical Center | $165.00 | $3,029.00 | $236.00 |
| 1101000 | 03000424 | 1396743993 | Guthrie Cortland Medical Center | $165.00 | $3,029.00 | $236.00 |
| 1101000 | 03000433 | 1487655056 | Guthrie Cortland Medical Center | $165.00 | $3,029.00 | $236.00 |
| 1101000 | 03000442 | 1740287531 | Guthrie Cortland Medical Center | $165.00 | $3,029.00 | $236.00 |
| 0228000 | 00354403 | 1720030703 | Jones Memorial Hospital | $165.00 | $3,029.00 | $236.00 |
| 0228000 | 06582636 | 1477176667 | Jones Memorial Hospital | $165.00 | $3,029.00 | $236.00 |
| 0228000 | 06582645 | 1376166652 | Jones Memorial Hospital | $165.00 | $3,029.00 | $236.00 |
| 0228000 | 06582654 | 1457974644 | Jones Memorial Hospital | $165.00 | $3,029.00 | $236.00 |
| 0228000 | 06582663 | 1467075622 | Jones Memorial Hospital | $165.00 | $3,029.00 | $236.00 |
| 0228000 | 06582672 | 1376166538 | Jones Memorial Hospital | $165.00 | $3,029.00 | $236.00 |
| 3824000 | 00305000 | 1063572733 | Mary Imogene Bassett Hospital | $165.00 | $3,029.00 | $236.00 |
| 3824000 | 03000584 | 1093897910 | Mary Imogene Bassett Hospital | $165.00 | $3,029.00 | $236.00 |
| 3824000 | 03000593 | 1780600577 | Mary Imogene Bassett Hospital | $165.00 | $3,029.00 | $236.00 |
| 3824000 | 03000608 | 1851452890 | Mary Imogene Bassett Hospital | $165.00 | $3,029.00 | $236.00 |
| 3824000 | 06428528 | 1700198652 | Mary Imogene Bassett Hospital | $165.00 | $3,029.00 | $236.00 |
| 0401001 | 00354632 | 1225083074 | Olean General Hospital | $165.00 | $3,029.00 | $236.00 |
| 0401001 | 03001778 | 1699715904 | Olean General Hospital | $165.00 | $3,029.00 | $236.00 |
| 0401001 | 03001787 | 1700825262 | Olean General Hospital | $165.00 | $3,029.00 | $236.00 |
| 0401001 | 03001796 | 1740333681 | Olean General Hospital | $165.00 | $3,029.00 | $236.00 |
| 3702000 | 02997771 | 1871678458 | Oswego Health | $165.00 | $3,029.00 | $236.00 |
| 2201000 | 00354316 | 1093722068 | Samaritan Medical Center | $165.00 | $3,029.00 | $236.00 |
| 2201000 | 03001594 | 1598713745 | Samaritan Medical Center | $165.00 | $3,029.00 | $236.00 |
| 2201000 | 03001609 | 1801902713 | Samaritan Medical Center | $165.00 | $3,029.00 | $236.00 |
| 5002001 | 00363162 | 1013985399 | St. James Hospital | $165.00 | $3,029.00 | $236.00 |
| 5002001 | 03002531 | 1104893320 | St. James Hospital | $165.00 | $3,029.00 | $236.00 |
| 5002001 | 03002540 | 1699742270 | St. James Hospital | $165.00 | $3,029.00 | $236.00 |
| 0901001 | 00318814 | 1033270699 | Univ of Vt Hlth Network-Champlain Valley Physicians | $165.00 | $3,029.00 | $236.00 |
| 0901001 | 03000873 | 1376607531 | Univ of Vt Hlth Network-Champlain Valley Physicians | $165.00 | $3,029.00 | $236.00 |
| 0901001 | 03000882 | 1487785382 | Univ of Vt Hlth Network-Champlain Valley Physicians | $165.00 | $3,029.00 | $236.00 |
| 0901001 | 03000891 | 1609942739 | Univ of Vt Hlth Network-Champlain Valley Physicians | $165.00 | $3,029.00 | $236.00 |
| 0901001 | 03000906 | 1841344983 | Univ of Vt Hlth Network-Champlain Valley Physicians | $165.00 | $3,029.00 | $236.00 |
