PREVAILING RATE/MAXIMUM FEE SCHEDULE FOR …

PREVAILING RATE/MAXIMUM FEE SCHEDULE FOR AMBULATORY SURGERY CENTERS

DISCOUNT

FACILITY NAME

RATE

Alabama Digestive Health Endoscopy Center

10%

Alabama Outpatient Surgery Center

15%*

- part of Walker Baptist as 10/6/2011

American Surgery Center (Surgery Center South)

10%

Birmingham Outpatient SC/Outpatient Care Center

15%*

Birmingham Surgery Center, The

15%*

Children's South Outpatient Center

#

# - The lesser of $2,700.00 or 70% of charges

Dale Medical Center ASC

25%

Dauphin West Surgery Center

7%

Decatur Ambulatory Surgery Center

7%

Dothan Surgery Center

15%*

Eye Surgery Center of North Alabama

10%

Gadsden Surgery Center

10%*

Gardendale Surgical Associates, LLC

15%

Gulf Coast Surgical Partners, LLC

15%*

* Formerly d/b/a The Orthopaedic Center at Springhill

Huntsville Endoscopy Center, Inc.

10%

Infirmary Eastern Shore ASC

15%

Jackson Surgery Center

20%

Lamar Healthcare Services (Closed 01/01/2006)

15%*

Madison Surgery Center

10%*

Medplex Outpatient Surgery Center

20%

Mobile Surgery Center

7%*

Montgomery Eye Surgery Center

15%

Montgomery Surgical Center

15%*

North River Surgical Center, Inc.

15%

Northeast Alabama Eye Surgery Center

25%

Outpatient Services East

15%*

St. Vincent's Outpatient Surgery Services, LLC

15%

Shelby Baptist Ambulatory Surgery Center

16%

Shoals Outpatient Surgery

10%*

Sothern Eye Group of AL

10%

Surgery Center of Cullman, The

10%

Surgery Center of Decatur LP

7%

Surgery Center (Oxford), The

15%*

Surgery Center of Huntsville, The

12.5%

Surgicare of Mobile, Ltd.

10%*

Trinity Development, LLC D/B/A

South Alabama Outpatient Services

12%*

Tuscaloosa Endoscopy Center

10%

Tuscaloosa Surgical Center

10%*

U. of Alabama Health Services Foundation

(Kirklin Clinic)-merged with UAB effective 03/01/2014

UAB Medical West ASC, LLC - merged with UAB effective 09/30/2010

EFF. DATE 1/1/2018 5/19/2011

6/15/2017 5/19/2017 1/1/2018 1/1/2018

3/1/2018 6/15/2017 11/1/2017 12/15/2017 5/19/2017 5/19/2017 6/15/2017 11/1/2017

11/1/2017 7/1/2017 2/1/2018 9/1/2005 1/1/2018 1/1/2018 5/19/2017 5/19/2017 1/1/2018 1/1/2018 5/19/2017 7/1/2017 7/1/2017 4/1/2018 5/19/2017 1/1/2018 5/19/2017 11/1/2017 1/1/2018 6/15/2017 5/19/2017

10/1/2017 8/7/2017 5/19/2017

94

Vision Correction Center

10%

9/1/2017

* The identified surgery centers have agreed to a maximum reimbursement of cost plus 10 percent for hardware, implants and prosthesis used in authorized workers' compensation outpatient surgery cases that cost over $200.00. Copies of invoices are to be included with submitted claims.

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