Notice of Ambulatory Price Transparency

Effective date of notice: 03/31/21 
NOTICE OF AMBULATORY PRICE TRANSPARENCY 
CLI Surgery Center 
Privacy Officer 
P.O. Box 549 
Wabash, IN 46992 

• Commercial insurers negotiate rates with Ambulatory Surgical Centers on behalf of their members. The rates vary among insurers.

• Several factors can affect the amount a patient owes to an Ambulatory Surgical Center, including the type of plan you have the amount your insurance benefits require you to pay for co-pays, deductibles and co-insurance.

• Generally, the amount you pay will be less if your Ambulatory Surgical Center are in-network with your plan.

• Be sure to review your benefits plan to understand all the factors affecting your financial responsibility.

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