State of Utah Medicaid	7/7/2025
Ambulance Assessment
				R426-8-2(3)(a)	Rate Basis:
SFY 2025	Q4	Q1
Service Dates:	>=7/1/2015	Q2		Amount to fund Enhanced Rate	$     10,220,261.78
SFY Paid Dates in:	Apr-Jun	Q3		Federal Share	$       7,906,902.74
		Q4		State Share	$       2,313,359.04
				Admin Fee (Annual)	$            20,000.00
Calendar Year Transport Data:	2023			Admin Fee (Qtr)	$               5,000.00
Calendar Year (2023) Transports (all payors)	172,030			Total Assessment Needed	$       2,318,359.04
SFY	2025			Prior Calendar Year Per-Transport Rate	$                    13.48
Provider Name	Provider ID	Vendor #	Ground Transports	% of Ground	Invoice Amount
AMBULANCE SRVCS OF TOOELE	102410300	VC197381	3,708	2.16%	$            49,970.79
AMERICAN FORK AMBULANCE	101056600	VC197382	2,732	1.59%	$            36,817.75
BEAVER AMBULANCE	102211200	VC0000180552	306	0.18%	$               4,123.80
BLUFFDALE FIRE DEPT	102677900	VC197520	227	0.13%	$               3,059.16
Box Elder County Ambulance	MedicaidID04	VC206667	10	0.01%	$                  134.76
BRIGHAM CITY CORP AMB	100855200	VC206653	2,198	1.28%	$            29,621.31
Cache County Fire District	404290501	VC251740	552	0.32%	$               7,439.02
CARBON COUNTY AMBULANCE	101421900	VC197384	1,386	0.81%	$            18,678.40
Cedar Mountain Fire	407174701	VC262525	120	0.07%	$               1,617.18
CITY OF ENTERPRISE AMBU	101391300	VC197460	138	0.08%	$               1,859.75
CITY OF SARATOGA SPRINGS	100635900	VC197386	816	0.47%	$            10,996.81
CITY OF SOUTH SALT LAKE	101240500	VC197387	2,945	1.71%	$            39,688.24
Clinton City Fire Department	102102700	VC197389	513	0.30%	$               6,913.43
CURLEW EMERGENCY MED	102709000	VC197463	43	0.02%	$                  579.49
DRAPER CITY AMBULANCE	100225100	VC221541	1,565	0.91%	$            21,090.69
EMERY COUNTY AMBULANCE	100736300	VC197390	560	0.33%	$               7,546.83
EPHRAIM AMBULANCE ASSOC	102352500	VC197393	287	0.17%	$               3,867.75
FARMINGTON FIRE DEPT AMB	101880000	VC197522	801	0.47%	$            10,794.66
Fielding Fire Department	MedicaidID01	VC197468	53	0.03%	$                  714.25
FLAMING GORGE FIRE AND EMS DISTRICT	MedicaidID06	VC0000278023	37	0.02%	$                  498.63
GARFIELD COUNTY AMBULANCE	102605500	VC197394	373	0.22%	$               5,026.73
GOLD CROSS AMBULANCE	102031000	VC197396	59,544	34.61%	$          802,443.59
Grand County Emergency Medical Services Special Se	301114900	VC197397	870	0.51%	$            11,724.54
GUNNISON VALLEY HOSP-AMBUL	102412600	VC197469	480	0.28%	$               6,468.71
HILDALE FIRE DEPARTMENT	102982100	VC197470	136	0.08%	$               1,832.80
HURRICANE VALLEY FIRE	102157900	VC197399	2,438	1.42%	$            32,855.66
JUAB COUNTY  AMBULANCE	100854900	VC197403	678	0.39%	$               9,137.05
KANE COUNTY AMBULANCE	102413700	VC197405	746	0.43%	$            10,053.45
KAYSVILLE CITY FIRE DEPT	102214900	VC197406	728	0.42%	$               9,810.88
LAYTON CITY FIRE DEPT AMB	100700900	VC197407	4,588	2.67%	$            61,830.10
LEHI CITY AMBULANCE	100853400	VC197526	2,507	1.46%	$            33,785.54
Logan City Fire Department	402785601	VC251746	3,635	2.11%	$            48,987.01
LONE PEAK AMBULANCE	103021900	VC197409	456	0.27%	$               6,145.28
MANTI AMBULANCE ASSOC	101706000	VC197527	206	0.12%	$               2,776.16
MAPLETON CITY AMBULANCE	101501700	VC197528	364	0.21%	$               4,905.44
MILFORD MEM HOSP PHYS GRP	101268200	VC197410	150	0.09%	$               2,021.47
MILLARD COUNTY AMBULANCE	100729700	VC197411	718	0.42%	$               9,676.11
MORGAN COUNTY AMBULANCE	100499000	VC197473	247	0.14%	$               3,328.69
MOUNTAIN WEST INC	102930500	VC197474	377	0.22%	$               5,080.63
MURRAY CITY FIRE DEPT	101592700	VC197412	2,500	1.45%	$            33,691.20
North Davis Fire District	102306300	VC228626	1,570	0.91%	$            21,158.08
North Fork Fire Department	MedicaidID02	VC197476	83	0.05%	$               1,118.55
NORTH SANPETE AMBULANCE	102040900	VC197529	754	0.44%	$            10,161.27
North Summit Fire District	426967901	VC0000143807	167	0.10%	$               2,250.57
NORTH VIEW FIRE AGENCY	102604500	VC197413	1,564	0.91%	$            21,077.22
Ogden City Corporation	102439100	VC197414	9,764	5.68%	$          131,584.36
OREM FIRE DEPARTMENT	102743700	VC197477	2,844	1.65%	$            38,327.11
PARK CITY AMBULANCE	100426200	VC197530	2,518	1.46%	$            33,933.78
PAYSON AMBULANCE	102067600	VC197532	1,180	0.69%	$            15,902.25
PIUTE CO AMBULANCE SRVC	102067700	VC197415	161	0.09%	$               2,169.71
PLEASANT GROVE AMBULANCE	100695900	VC197417	697	0.41%	$               9,393.11
Plymouth Town Corporation	100454600	VC197418	64	0.04%	$                  862.49
PROVO CITY CORP	100701500	VC197419	2,413	1.40%	$            32,518.75
RICH COUNTY AMBULANCE	101836400	VC197420	90	0.05%	$               1,212.88
RIVERDALE CITY AMBULANCE	100685500	VC197422	457	0.27%	$               6,158.75
ROY CITY AMBULANCE	100027300	VC197425	2,587	1.50%	$            34,863.66
SALEM EMERGENCY MED AMB	100332500	VC197479	246	0.14%	$               3,315.21
SAN JUAN CO EMERGENCY	102743400	VC197427	486	0.28%	$               6,549.57
SANDY CITY AMBULANCE	101016300	VC197429	2,768	1.61%	$            37,302.90
Santa Clara Ivins Fire and Rescue	301049400	VC225033	601	0.35%	$               8,099.37
SANTAQUIN AMBULANCE	101120200	VC197533	270	0.16%	$               3,638.65
Scipio Ambulance	MedicaidID03	VC197534	26	0.02%	$                  350.39
SEVIER COUNTY AMBULANCE	100629600	VC197430	1,542	0.90%	$            20,780.73
Smithfield Fire and EMS	403731502	VC251747	868	0.50%	$            11,697.59
SOUTH DAVIS METRO FIRE	101736400	VC197431	3,589	2.09%	$            48,367.09
SOUTH JORDAN FIRE DEPT	101307900	VC197480	3,992	2.32%	$            53,798.11
SOUTH OGDEN CITY FIRE DEPT	102946200	VC197434	1,237	0.72%	$            16,670.41
SOUTH SUMMIT FIRE PROTECTION DISTRICT	429295301	VC0000277580	232	0.13%	$               3,126.54
South Weber Fire	405220401	VC251066	121	0.07%	$               1,630.65
SPANISH FORK AMBULANCE	100629800	VC197435	2,121	1.23%	$            28,583.62
SPRINGVILLE AMBULANCE SRVC	101838700	VC197481	849	0.49%	$            11,441.53
St George Regional Hospital	101078700	VC197464	93	0.05%	$               1,253.31
SUNNYSIDE AMBULANCE SRVC	100722100	VC240417	187	0.11%	$               2,520.10
SYRACUSE CITY CORPORATION	100811600	VC197437	538	0.31%	$               7,250.35
TREMONTON CITY CORP	101533100	VC197482	894	0.52%	$            12,047.97
UINTAH BASIN MED CTR	102630600	VC197535	1,122	0.65%	$            15,120.61
UNIFIED FIRE AUTHORITY	100169800	VC197438	12,664	7.36%	$          170,666.16
UTAH NAVAJO HLTH SYST AMB	101786100	VC197439	459	0.27%	$               6,185.70
UTE TRIBE AMBULANCE	102782700	VC197440	303	0.18%	$               4,083.37
WASATCH COUNTY FIRE DISTRICT	101707800	VC197441	1,573	0.91%	$            21,198.50
WAYNE COUNTY AMBULANCE	100338200	VC197442	135	0.08%	$               1,819.32
WEBER FIRE DISTRICT	100344100	VC197518	787	0.46%	$            10,605.99
WEST JORDAN FIRE and AMBUL	101278800	VC197443	2,392	1.39%	$            32,235.74
WEST VALLEY CITY FIRE AMB	102824900	VC197458	4,284	2.49%	$            57,733.24
Grand Total			172,030	100.00%	$2,318,359.04