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COASTAL HEALTH SYSTEMS OF BREVARD, INC. <br /> TRANSPORT RATE SCHEDULE <br /> AMBULANCE TRANSPORTATION <br /> BLS Non-Emergency $29000 <br /> ALS Non-Emergency $400.00 <br /> BLS Emergency $44000 <br /> ALS Emergency $520.00 <br /> ALS-2 $775.00 <br /> ALS-SCT $890.00 <br /> All Mileage $11.25 per mile <br /> Stand-By or Waiting Time $125.00 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 for reimbursement under the CMS code <br /> for ALS or BLS Emergency based on the "immediate response"criteria. The 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 PERSONEL/SPECIAL EQUIPMENT <br /> Stair Chair-Hydraulic Stretcher Use—Lift Assist <br /> $100 Additional Charge for each service/crew/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 /> 56 <br />