State of Utah Medicaid	10/6/2025
Ambulance Assessment
				R426-8-2(3)(a)	Rate Basis:
SFY 2026	Q1	Q1
Service Dates:	>=7/1/2015	Q2		Amount to fund Enhanced Rate	$       11,020,495.34
SFY Paid Dates in:	Jul-Sep	Q3		Federal Share	$         8,558,759.37
		Q4		State Share	$         2,461,735.97
				Admin Fee (Annual)	$              20,000.00
Calendar Year Transport Data:	2024			Admin Fee (Qtr)	$                 5,000.00
Calendar Year (2024) Transports (all payors)	173,339			Total Assessment Needed	$         2,466,735.97
SFY	2026			Prior Calendar Year Per-Transport Rate	$                      14.23
Provider Name	Provider ID	Vendor #	Ground Transports	% of Ground	Invoice Amount
AMBULANCE SRVCS OF TOOELE	102410300	VC197381	3,682	2.12%	$              52,397.45
AMERICAN FORK AMBULANCE	101056600	VC197382	2,482	1.43%	$              35,320.61
BEAVER AMBULANCE	102211200	VC0000180552	284	0.16%	$                 4,041.52
BLUFFDALE FIRE DEPT	102677900	VC197520	242	0.14%	$                 3,443.83
Box Elder County Ambulance	MedicaidID04	VC206667	8	0.00%	$                    113.85
BRIGHAM CITY CORP AMB	100855200	VC206653	1,595	0.92%	$              22,697.97
Cache County Fire District	404290501	VC251740	561	0.32%	$                 7,983.42
CARBON COUNTY AMBULANCE	101421900	VC197384	1,339	0.77%	$              19,054.91
Cedar Mountain Fire	407174701	VC262525	99	0.06%	$                 1,408.84
CITY OF ENTERPRISE AMBU	101391300	VC197460	155	0.09%	$                 2,205.76
CITY OF SARATOGA SPRINGS	100635900	VC197386	1,461	0.84%	$              20,791.06
CITY OF SOUTH SALT LAKE	101240500	VC197387	2,977	1.72%	$              42,364.81
Clinton City Fire Department	102102700	VC197389	503	0.29%	$                 7,158.04
CURLEW EMERGENCY MED	102709000	VC197463	37	0.02%	$                    526.54
DRAPER CITY AMBULANCE	100225100	VC221541	1,724	0.99%	$              24,533.73
EMERY COUNTY AMBULANCE	100736300	VC197390	603	0.35%	$                 8,581.11
EPHRAIM AMBULANCE ASSOC	102352500	VC197393	300	0.17%	$                 4,269.21
FARMINGTON FIRE DEPT AMB	101880000	VC197522	825	0.48%	$              11,740.33
Fielding Fire Department	MedicaidID01	VC197468	41	0.02%	$                    583.46
FLAMING GORGE FIRE AND EMS DISTRICT	MedicaidID06	VC0000278023	30	0.02%	$                    426.92
GARFIELD COUNTY AMBULANCE	102605500	VC197394	362	0.21%	$                 5,151.51
GOLD CROSS AMBULANCE	102031000	VC197396	59,885	34.55%	$            852,205.70
Grand County Emergency Medical Services Special Se	301114900	VC197397	945	0.55%	$              13,448.02
GUNNISON VALLEY HOSP-AMBUL	102412600	VC197469	438	0.25%	$                 6,233.05
HILDALE FIRE DEPARTMENT	102982100	VC197470	186	0.11%	$                 2,646.91
HURRICANE VALLEY FIRE	102157900	VC197399	3,370	1.94%	$              47,957.47
JUAB COUNTY  AMBULANCE	100854900	VC197403	721	0.42%	$              10,260.34
KANE COUNTY AMBULANCE	102413700	VC197405	784	0.45%	$              11,156.87
KAYSVILLE CITY FIRE DEPT	102214900	VC197406	701	0.40%	$                 9,975.72
LAYTON CITY FIRE DEPT AMB	100700900	VC197407	4,764	2.75%	$              67,795.07
LEHI CITY AMBULANCE	100853400	VC197526	2,253	1.30%	$              32,061.78
Logan City Fire Department	402785601	VC251746	3,544	2.04%	$              50,433.61
LONE PEAK AMBULANCE	103021900	VC197409	418	0.24%	$                 5,948.43
MANTI AMBULANCE ASSOC	101706000	VC197527	185	0.11%	$                 2,632.68
MAPLETON CITY AMBULANCE	101501700	VC197528	362	0.21%	$                 5,151.51
MILFORD MEM HOSP PHYS GRP	101268200	VC197410	140	0.08%	$                 1,992.30
MILLARD COUNTY AMBULANCE	100729700	VC197411	655	0.38%	$                 9,321.11
MORGAN COUNTY AMBULANCE	100499000	VC197473	238	0.14%	$                 3,386.91
MOUNTAIN WEST INC	102930500	VC197474	453	0.26%	$                 6,446.51
MURRAY CITY FIRE DEPT	101592700	VC197412	2,506	1.45%	$              35,662.14
North Davis Fire District	102306300	VC228626	1,629	0.94%	$              23,181.82
North Fork Fire Department	MedicaidID02	VC197476	75	0.04%	$                 1,067.30
NORTH SANPETE AMBULANCE	102040900	VC197529	572	0.33%	$                 8,139.96
North Summit Fire District	426967901	VC0000143807	171	0.10%	$                 2,433.45
NORTH VIEW FIRE AGENCY	102604500	VC197413	1,595	0.92%	$              22,697.97
Ogden City Corporation	102439100	VC197414	9,581	5.53%	$            136,344.37
OREM FIRE DEPARTMENT	102743700	VC197477	3,002	1.73%	$              42,720.57
PARK CITY AMBULANCE	100426200	VC197530	2,564	1.48%	$              36,487.52
PAYSON AMBULANCE	102067600	VC197532	1,294	0.75%	$              18,414.53
PIUTE CO AMBULANCE SRVC	102067700	VC197415	79	0.05%	$                 1,124.23
PLEASANT GROVE AMBULANCE	100695900	VC197417	730	0.42%	$              10,388.41
Plymouth Town Corporation	100454600	VC197418	44	0.03%	$                    626.15
PROVO CITY CORP	100701500	VC197419	2,581	1.49%	$              36,729.45
RICH COUNTY AMBULANCE	101836400	VC197420	91	0.05%	$                 1,294.99
RIVERDALE CITY AMBULANCE	100685500	VC197422	355	0.20%	$                 5,051.90
ROY CITY AMBULANCE	100027300	VC197425	2,303	1.33%	$              32,773.31
SALEM EMERGENCY MED AMB	100332500	VC197479	287	0.17%	$                 4,084.21
SAN JUAN CO EMERGENCY	102743400	VC197427	472	0.27%	$                 6,716.89
SANDY CITY AMBULANCE	101016300	VC197429	3,249	1.87%	$              46,235.56
Santa Clara Ivins Fire and Rescue	301049400	VC225033	500	0.29%	$                 7,115.35
SANTAQUIN AMBULANCE	101120200	VC197533	376	0.22%	$                 5,350.74
Scipio Ambulance	MedicaidID03	VC197534	30	0.02%	$                    426.92
SEVIER COUNTY AMBULANCE	100629600	VC197430	1,676	0.97%	$              23,850.66
Smithfield Fire and EMS	403731502	VC251747	783	0.45%	$              11,142.64
SOUTH DAVIS METRO FIRE	101736400	VC197431	3,580	2.07%	$              50,945.92
SOUTH JORDAN FIRE DEPT	101307900	VC197480	4,010	2.31%	$              57,065.12
SOUTH OGDEN CITY FIRE DEPT	102946200	VC197434	1,253	0.72%	$              17,831.07
SOUTH SUMMIT FIRE PROTECTION DISTRICT	429295301	VC0000277580	257	0.15%	$                 3,657.29
South Weber Fire	405220401	VC251066	139	0.08%	$                 1,978.07
SPANISH FORK AMBULANCE	100629800	VC197435	2,250	1.30%	$              32,019.08
SPRINGVILLE AMBULANCE SRVC	101838700	VC197481	858	0.49%	$              12,209.94
St George Regional Hospital	101078700	VC197464	92	0.05%	$                 1,309.22
SUNNYSIDE AMBULANCE SRVC	100722100	VC240417	149	0.09%	$                 2,120.37
SYRACUSE CITY CORPORATION	100811600	VC197437	704	0.41%	$              10,018.42
TREMONTON CITY CORP	101533100	VC197482	851	0.49%	$              12,110.33
UINTAH BASIN MED CTR	102630600	VC197535	1,059	0.61%	$              15,070.32
UNIFIED FIRE AUTHORITY	100169800	VC197438	11,867	6.85%	$            168,875.76
UTAH NAVAJO HLTH SYST AMB	101786100	VC197439	393	0.23%	$                 5,592.67
UTE TRIBE AMBULANCE	102782700	VC197440	320	0.18%	$                 4,553.83
WASATCH COUNTY FIRE DISTRICT	101707800	VC197441	1,771	1.02%	$              25,202.58
WAYNE COUNTY AMBULANCE	100338200	VC197442	108	0.06%	$                 1,536.92
WEBER FIRE DISTRICT	100344100	VC197518	1,241	0.72%	$              17,660.30
WEST JORDAN FIRE and AMBUL	101278800	VC197443	2,378	1.37%	$              33,840.61
WEST VALLEY CITY FIRE AMB	102824900	VC197458	4,162	2.40%	$              59,228.19
Grand Total			173,339	100.00%	$2,466,735.97