§ 35. Ambulance fees and charges.

Code	Charge Description	Price	Medicare
1 Base Rate
1	ALS, Emer., all incl.	360.00	A0370
2	ALS, Non-emer., suppl. bill	275.00	A0366
3	ALS, Return, all incl.	275.00	A0222
4	ALS, Return, suppl. bill	275.00	A0366
5	BLS, Emergency	360.00	A0362
6	BLS, Non-emergency	275.00	A0384
7	BLS, Return	275.00	A0222
8	Treatment/other transport	175.00	A0220
9	Treatment no transport	100.00	A0220
10	AMBU, Neonatal transport	300.00
96	Medicaid	0.00
97	BLS, Emer. transfer	300.00	A0010
98	BLS, Non-emer., transfer	275.00	A0150
102	TWCC-Treatment no transport	110.00	99082
103	TWCC, Ambulance transport	360.00	99082
243	ALS, Membership transport	150.00	A0220
244	BLS, Membership transport	137.50	A0150
245	BLS, Return member trip	150.00	A0222
255	ALS, Emer., specialized ser	360.00	A0370
256	ALS, Non-emer., spec. serv.	360.00	A0366
266	BLS, Emer. transfer	300.00	A0362
267	BLS, Non-emer. transfer	275.00	A0360
2 Mileage
11	BLS, Per mile	8.00	A0380
12	ALS, Per mile	8.00	A0390
99	BLS, Mileage	8.00	A0020
104	TWCC, Per mile	8.00	99082
246	ALS, Membership mileage	4.00	A0221
257	BLS, Membership mileage	4.00	A0020
257	ALS, Emer. mileage	8.00	A0390
258	ALS, Non-emer., mileage	8.00	A0390
268	BLS, Emer. mileage	8.00	A0380
269	BLS, Non-emer. mileage	8.00	A0380
3 Oxygen
19	Oxygen incl. supplies	30.00	A0422
264	Oxygen and supplies	30.00	A0422
272	Oxygen and supplies	30.00	A0422
4 Disposables
18	Suction catheter	5.00	A4624
21	IV admin set, cont. flow	25.50	A4305
22	Gauze, elastic, all types	1.50	A0398
24	Burn sheets	10.00	A0999
25	Nebulizer, hand held	7.50	A0999
26	Bite stick	1.00	A0999
29	Tracheal suction catheter	2.31	A4624
30	Endotracheal tubes	7.50	A0999
31	Airway/et tube holder	5.00	A0999
32	Angiocath	3.50	A0999
33	Defibrillator pads	10.00	A0999
35	Butterfly needles	2.50	A0999
36	Syringe w/needle, 1cc-5cc	0.26	A4206
37	Syringe w/needle, 20cc+	0.44	A4209
38	Pacer pads	50.00	A4556
39	EKG pads	10.66	A4556
40	Betadine or iodine	6.49	A4247
41	Laryngectomy tube	49.21	A4622
42	IV admin set, mini drip	7.59	A4202
43	Esophagel obturator air	60.00	A0999
44	D-stick	0.20	A4772
46	Triangular bandages	5.00	A0999
47	Gauze sponges	1.50	A4202
48	Defibrillation	55.00	A0999
95	Gloves	0.25	A0999
105	*IV administration set	25.50	99070
107	*Mask/cannual	10.00	99070
108	*Gauze sponges	3.00	99070
110	*Suction catheters	2.50	99070
111	*Cold packs	3.50	99070
112	*Endotracheal tubes	7.50	99070
113	*Airway/et tube holder	5.00	99070
114	*Angiocath	3.50	99070
115	*Defibrillatoro pads	10.00	99070
116	*EKG pads	10.66	99070
119	*IV prep kit	13.00	99070
120	*Triangular bandages	5.00	99070
153	*Gloves	0.25	99070
154	*Intubation supplies	25.50	99070
155	*Defibrillation supplies	55.00	99070
167	Oxygen incl. supplies	30.00	A0422
168	EKG, Monitoring	35.00	93005
170	Gauze, elastic, all types	3.50	A0999
171	Cold packs	3.50	A0999
174	Bite stick	12.50	A0999
177	Tracheal suction catheter	2.31	A4624
178	Endothracheal tubes	7.50	A0999
179	Airway/et tube holder	5.00	A0999
180	Angiocath	3.50	A0999
181	Defibrillator pads	10.00	A0999
182	Body bag	50.00	A0999
183	Butterfly needles	2.50	A0999
184	Syringe w/needle, 1cc-5cc	0.26	A4206
185	Syringe w/needle, 20cc+	0.44	A4209
186	EKG pads	10.66	A09999
187	Betadine or iodine	6.49	A0999
188	IV prep kit	13.00	A0999
189	D-stick	12.50	A0999
190	Triangular bandages	5.00	A0999
191	Gauze sponges	3.00	A0999
200	Sodium bicarbonate 5% dex	16.50	J3490
259	ALS, Disposable supplies	0.00	A0398
260	ALS, Defib supplies	55.00	A0392
261	ALS, IV therapy supplies	25.50	A0394
262	ALS, Intubation supplies	25.50	A0396
270	BLS, Disposable supplies	0.00	A0382
271	BLS, Defib supplies	55.00	A0384
5 Medications
16	Sodium bicarbonate 50mg	4.27	J3490
45	Esophageal G-tube airway	15.00	A0999
50	Aminophylline 250mg/10ml	1.30	J0280
51	Atropine sulfate. UP-0.3mg	1.09	J0460
52	Adenocard, 6mg	23.40	J0150
53	Epinephrine 1:1,000 1mg	1.45	J0170
54	Epinephrine 1:10,000 1mg	1.45	J0170
55	Decadron 4mg/ml	5.58	J1100
56	Lanoxin 0.5mg	2.07	J1160
57	Benadryl 50 mg	1.52	J1200
58	Dimenhydrinate 50 mg	1.01	J1240
59	Propranolol 1mg	4.31	J1800
60	Lasix 20mg	1.66	J1940
61	Lidocaine 100mg	3.28	J2000
62	Lidocaine 2gm (Drip)	3.50	J2000
63	Demerol HCL	1.00	J2175
64	Morphine sulfate 10mg	1.09	J2270
65	Phenergan 50mg	2.93	J2550
68	Procainamide 1gm	5.06	J2690
70	Valium 10mg	2.51	J3360
71	Proventil	10.00	J3490
72	Normal saline solution	10.93	J7030
73	Normal saline, sterile	5.42	J7040
74	Dextrose/normal sal 500ml	10.93	J7042
75	Normal saline 250cc	2.71	J7050
76	Sterile water 5 CC	1.00	J7051
77	Dextrose/water 500ml	32.78	J7060
78	D5W, 1,000cc	11.02	J7070
79	Ringers lactate 1,000cc	10.93	J7120
80	Isoproterenol hydr. 5%ml	2.21	J7660
81	Isoproterenol 1ml	2.23	J7665
82	Proventil	10.00	J3490
83	Apresoline	10.00	J3490
84	Mivicron	15.00	J3490
85	Neosporin	10.00	J3490
86	Glucagon 1mg	20.00	J3490
87	Procardia	10.00	J3490
88	Albuterol	10.00	J3490
89	Nitroglycerine	2.00	J3490
90	Dopamine drip	10.00	J3490
91	Narcan	3.35	J3490
92	Thiamine 100mg	10.00	J3490
93	Nitrous oxide	10.00	J3490
94	Bretylium 1500mg	10.00	J3490
106	*Oxygen	20.00	99070
118	*Dextrostix	12.50	99070
121	*Aminophylline 250mg/10mi	30.00	99070
122	*Atropine 9.5mg/5ml	7.50	99070
123	*Benadryl 500mg	16.50	99070
124	*Calcium chloride 1000mg/	15.50	99070
125	*D5W 100cc	10.00	99070
126	*D5W 500cc	12.50	99070
127	*Sodium bicarbonate 5%	16.50	99070
128	*D50 25gm (dextrose)	16.50	99070
129	*Epinephrine 1mg/1ml	8.50	99070
130	*Epinephrine 1mg/10ml	20.50	99070
131	*Lasix	15.00	99070
132	*Isuprel 1mg/5ml	10.00	99070
133	*Lidocaine 50mg/5ml	10.00	99070
134	*Lidocaine 100mg/10ml	15.00	99070
135	*Morphine sulphate	17.50	99070
136	*Narcan	17.50	99070
137	*Nitroglycerine	2.00	99070
138	*Normal saline	12.50	99070
139	*Nubain	15.00	99070
140	*Ringers lactate	12.50	99070
141	*Thiamine	7.50	99070
142	*Valium 5mg	20.50	99070
143	*Valium 10mg	20.50	99070
144	*Albuterol	10.00	99070
145	*Adenocard	10.00	99070
146	*Proventil	10.00	99070
147	*Apresoline	10.00	99070
148	*Mivicron	15.00	99070
149	*Neosporin	10.00	99070
150	Nitrous oxide	10.00	99070
151	*Procardia	10.00	99070
152	*Glucagon 1mg	20.00	99070
193	Aminophylline 250mg/10ml	30.00	J3490
194	Atrophine 0.5mg/5ml	7.50	J3490
195	Bebadryl 50mg	7.50	J3490
196	Bretylium 500mg	10.50	J3490
199	D5W	12.50	J3490
201	D50 25 gm	16.50	J7042
203	Diphenydramine HCL 50mg	1.01	J3490
204	Propranolol 1mg	4.31	J3490
205	Lasix 20mg	1.66	J1940
206	Lidocaine HCL, 50cc	3.50	J2000
209	Morphine sulfate 10mg	1.00	J3490
210	Phenergan 50mg	10.00	J3490
211	Phenobabital 120mg	10.00	J3490
213	Procainamide 1 gm	10.00	J3490
215	Valium 10 mg	10.00	J3490
216	Proventil	10.00	J3490
217	Normal saline solution	12.50	J3490
218	Normal saline sterile	12.50	J3490
219	Dextrose 500ml	10.13	J3490
220	Normal saline 250 cc	2.71	J3490
221	Sterile water 5cc	12.00	J3490
222	Dextrose, 500 ml	16.50	J3490
223	D5W, 1,000 cc	12.50	J3490
224	Ringers lactate 1,000cc	14.05	J3490
225	Iosproterenol hydr. 5%ml	2.21	J3490
226	Isoproternol 1ml	2.23	J3490
227	Proventil	10.00	J3490
228	Apresoline	10.00	J3490
229	Mivicron	15.00	J3490
230	Neosporin	10.00	J3490
231	Glucagon 1 mg	20.00	J3490
232	Procardia	10.00	J3490
233	Thiamine	7.50	J3490
234	Narcan	10.50	J3490
235	Nitroglycerin	2.00	J3490
238	Instant glucose 25g	1.85	J3490
6 Other charges
17	Ambu waiting time ½ hr	10.00	A0420
20	EKG, Monitoring	35.00	93005
23	Cold packs	3.50	A4202
34	Body bag	50.00	A09999
101	Workers compensation code	0.00	99070
109	*EKG, Monitoring	35.00	93005
117	*Betadine ointment	2.00	99070
263	EKG, Monitoring	35.00	93005
7 Misc.
13	Add'l attendant-CPR	15.00	A0424
14	Add'l attendant-300 + lbs	15.00	A0424
15	Add'l attendant-stairs	15.00	A0424
49	Drug list	0.00
259	65-over, indiv. membership	30.00
250	65-over membership coup	40.00
251	Individual membership	40.00
252	Family membership fee	60.00

 

(Ord. No. 1752, 9-6-94; Ord. No. 1798, Art. I, 10-17-95)