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S-SV EMS Agency
Butte, Colusa, Glenn, Nevada, Placer, Shasta, Siskiyou, Sutter, Tehama & Yuba Counties
(916) 625-1702
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Agency Information
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Ground Ambulance Provider Rate Survey
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Provider Organization & Ambulance Rate Setting Information
EMS Provider Organization
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Primary Contact Name
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Primary Contact Telephone Number
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Primary Contact Email
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Date of your last rate adjustment
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How often are your rates adjusted?
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S-SV EMS Region Ground Ambulance Base Rates
Note: Enter your current MAXIMUM base rate for each category charged for transports originating in the S-SV EMS region. If you do not have a base rate for a specific category, enter 'N/A' in that field
BLS Base Rate
*
LALS Base Rate
*
ALS Base Rate
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CCT/SCT Base Rate
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S-SV EMS Region Ground Ambulance Mileage
Note: Enter your current loaded per whole mile rate for each category for transports originating in the S-SV EMS region. If you do not have a rate for a specific category, enter N/A in that field
BLS Mileage
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LALS Mileage
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ALS Mileage
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CCT Mileage
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Do you have a 'Treat/No Transport' (or similar) rate/charge
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Yes
No
Current 'Treat/No Transport' rate/charge
Do you have an oxygen administration rate/charge
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Yes
No
Current oxygen administration rate/charge
Do you have a 'Night Charge'
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Yes
No
Current 'Night Charge' rate/charge
What is your criteria for billing a 'Night Charge'
Do you have an 'Extra Attendant' rate/charge
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Yes
No
Current 'Extra Attendant' rate/charge
What is your criteria for billing an 'Extra Attendant' rate/charge?
Do you have additional itemized rates/charges other than those included on this survey
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Yes
No
Please provide any additional pertinent comments
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