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COASTAL HEALTH SYSTEMS OF BREVARD, INC. <br />TRANSPORT RATE SCHEDULE <br />AMBULANCE TRANSPORTATION <br />BLS Non -Emergency $225.00 <br />ALS Non -Emergency $275.00 <br />SLS Emergency $330.00 <br />ALS Emergency $390.00 <br />ALS -2 $570.00 <br />ALS -SCT $675.00 <br />All Mileage $9.00 per mile <br />Stand -By or Waiting Time $100.00 per hour <br />or increment thereof <br />In addition to Coastal's primarily non -emergency inter facility services, Coastal routinely renders <br />ambulance services in response to facility requests that fall into the Center for Medicare and <br />Medicaid Services (CMS) guidelines qualifying Coastal fpr reimbursement under the CMS code <br />for ALS or BLS Emergency based on the "immediate response" criteria. 77ie current CMS <br />definition for Emergency is not based on "lights and sirens it is based on "immediate response". <br />Under this contract Coastal will bill the ALS or BLS Emergency rates only when an immediate <br />response is rendered following an inter facility or 911 request and only when all other CMS <br />criteria for this type of transport have been met. <br />SERVICE CHARGES for ADDITIONAL PERSONEIISPECIAL EQUIPMENT <br />Stair Chair Hydraulic Stretcher Use — Lift Assist <br />$ 100 Additional Charge for each service 1 crew 1 equipment. <br />*There is a one-hour minimum charge for all wait time. <br />Note. The above rates are subject to change based on changes made by Medicare or by <br />Coastal's Ambulance Franchise Contract with Brevard County and will be automatically <br />updated in Coastal's billing database on the effective date of each change. <br />�w <br />97 <br />