Attachment 1
-1-
CITY OF MOUNTAIN VIEW
RESOLUTION NO.
SERIES 2025
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF MOUNTAIN VIEW
TO ADOPT AMBULANCE BILLING AND USER FEES TO BE USED BY
THE MOUNTAIN VIEW FIRE DEPARTMENT FOR ADVANCED LIFE SUPPORT
EMERGENCY AMBULANCE TRANSPORTATION SERVICES
WHEREAS, the Mountain View Fire Department intends to provide Advanced Life Support (ALS) Emergency Ambulance Transportation Services; and
WHEREAS, proposed ambulance billing and user fees in Table 1 and Table 2 of Exhibit A are in accordance with the Emergency Medical Services Agreement between Rura l/Metro of California, Inc., and County of Santa Clara, Exhibit M, Tables 1 and 2, revised April 16, 2024; and WHEREAS, proposed ambulance billing and user fees include a price list of user fees per service level, along with fees for any Equipment/Supplies used and/or medications administered; now, therefore, be it
RESOLVED: that the City Council of the City of Mountain View hereby approves and adopts Ambulance Billing and User Fees; and be it
F
URTHER RESOLVED: that this Resolution shall be effective upon the date of its adoption. – – – – – – – – – – –
AS/
4/RESO
141-02-25-25r
E
xhibit: A. Ambulance Billing and User Fees
Exhibit A
AS/4/RESO Exhibit A
141-02-25-25r—Exh A 1 of 3
AMBULANCE BILLING AND USER FEES
Table 1: User Fees
Service Levels Price
ALS-1 $3,314.54
ALS-2 $3,314.54
BLS $2,651.64
Mileage $112.54
Hourly Ambulance Standby $390.19
Hourly Paramedic—Individual $195.09
Hourly EMT—Individual $130.06
AS/4/RESO Exhibit A
141-02-25-25r—Exh A 2 of 3
Table 2: User Fee Schedule for Disposable Supplies and Medications
Equipment/Supplies
AIRWAY/NASAL $59.95
AIRWAY/ORAL $32.70
BAG VALVE MASK $198.93
BANDAGE, ELASTIC $16.07
BANDAGES, TRIANGULAR $27.25
BED PAN $27.25
BLANKET, DISPOSABLE $65.40
BLOOD GLUCOSE TEST $54.50
BURN SHEET $100.83
CERVICAL COLLAR $196.21
COLD/HOT PACK $40.88
CPAP PROCEDURE $844.79
DEFIB PADS $119.91
DRESSING—MAJOR $27.25
DRESSING—MINOR $27.25
EKG ELECTRODES $51.78
EKG MONITOR, 12 LEAD $258.89
EMESIS BASIN/BAG $21.24
ENDOTRACHEAL TUBE INTRODUCER/GUM ELASTIC BOUGIE $182.04 HEADBED IMMOBILIZER $46.33
HEPA MASK $68.13
HOOD, SPIT SOCK $44.87
INTRAVENOUS SALINE LOCK $143.48
INTRAVENOUS INFUSION SET $242.53
INTRAVENOUS START KIT $108.92
INTUBATION SUPPLIES $122.63
IO SUPPLIES $812.09
KING VISION VIDEO LARYNOSCOPE CHANNEL BLADE $45.07
LMA SUPREME - SUPRAGLOTTIC AIRWAY $54.09
MECONIUM ASPIRATOR $24.23
NEBULIZER $128.09
NON-REBREATHER MASK $29.98
O2 CANNULA WITH END-TIDAL $92.57
O2 MASK/CANNULA $62.68
OB PACK $218.01
PATIENT MOVER $87.46
PLUERAL DECOMPRESSION $185.43
PULSE OXIMETRY $114.46
AS/4/RESO Exhibit A
141-02-25-25r—Exh A 3 of 3
RAZOR, DISPOSABLE $2.27
SPLINT ARM $40.88
SPLINT LEG $40.88
SPLINTING (EXTREMITY) $196.21
STRAP, 5’ IMMOBIZATION $30.16
SUCTION TUBE $84.48
SUCTIONING $171.68
TEMPERATURE MEASUREMENT $46.00
TOURNIQUET, COMBAT $163.85
UNIVERSAL PRECAUTIONS $76.30
URINAL $27.25
Medications
ACETAMINOPHEN $329.94
ACTIVATED CHARCOAL $55.37
ADENOSINE $158.06
ALBUTEROL $65.40
AMIODARONE $105.12
ASPIRIN $16.35
ATROPHINE $46.33
ATROPHINE, HIGH DOSE $218.54
BENADRYL $46.33
CALCIUM CHLORIDE $46.33
DEXTROSE 10% 25G IN 250ML BAG $66.05
DOPAMINE DRIP $147.16
DUODOTE AUTOINJECTOR $136.94
EPI 1:1,000 1MG/1CC $76.30
EPI 1:10,000 $76.30
GLUCAGON $776.66
GLUCOSE PASTE $23.74
LIDOCAINE 2% $59.95
MIDAZOLEM $4.33
MORPHINE $46.33
NARCAN $87.20
NITROGLYCERIN TABLET $2.33
NITROPASTE $21.23
NORMAL SALINE FLUSH PLS 10cc $40.74
NORMAL SALINE 1,000cc $264.34
ONDANSETRON INJECTABLE $94.83
ONDANSETRON ORAL DISSOLVING TABLET $78.32
SODIUM BICARB $81.75
STERILE WATER $65.40
TRANEXAMIC ACID 1,000MG $15.55