­­Public Notice Jay County, Indiana Ordinance # 2013-4 An ordinance setting rates and charges for services and Supplies provided by the Jay County Emergency Medical Services I, be it ordained by the Board of County Commissioners of Jay County, Indiana that the following schedule of charges shall be the amounts charged for the respective services and supplies provided by the Jay County Emergency Medical Service. Fee Schedule BLS Emergency Base Rate: $ 500.00 ALS1 Emergency Base Rate: $ 700.00 ALS2 Emergency Base Rate: $ 900.00 Prescheduled (Nursing Home): $ 75.00 Mileage (per loaded mile): $ 12.00 Treatment no Transport: $ 150.00 No Treatment no Transport: $ 00.00 Paramedic Intercept Rate: $ 125.00 BLS Inter-Hospital: $ 500.00 ALSI Inter-Hospital: $ 700.00 ALS2 Inter-Hospital: $ 900.00 Supply Price List Current Cost Plus 20% Group A EZ 1.0. Needle: Pediatric $125.00 Adult $125.00 Obese $145.00 I.V. Therapy (Additional Bag) $5.00 Chemstrip-Lancet $5.00 I.V. Therapy $65.00 Big I.O. $100.00 Manual I.O. $50.00 Blood Draw $5.00 Current Cost Plus 30% Group B Sterile Water $7.00 5x9 Dressing $1.00 Kling/Kerlex $3.00 Vaseline Gauze $2.00 Evac-u-Splint $25.00 Splints $16.00 Oval Eye Pad $.50 Alcohol Preps $.25 Immobilization Kit $25.00 Bite Stick $2.00 Isolation Kit $10.00 Isolation Gown $2.00 Trauma Dressing $6.00 Triangular Bandage $2.00 4x4 Dressing $.50 Cold/Heat Packs $3.00 Restraints $7.00 Jaw Spreader $5.00 Disposable Blanket $10.00 OB Kit $20.00 Burn Sheet $10.00 Celox: 15g $25.00 35g $35.00 Current Cost Plus 40% Group C Pocket Mask $20.00 K-YJelly $1.00 OralAirway $5.00 ET Tube Holder $5.00 Suction $15.00 BAAM Air Flow Monitor $11.00 Auto vent w/Disposable Circuit $74.00 ET Tube Introducer (Bougie) $12.00 CPAP $70.00 Ammonia Inhalants $1.00 Thermometer $5.00 Emesis Basin(Small) $1.00 Humidifier $5.00 NasalAirway $8.00 Nebulizer $5.00 Oxygen $25.00 Ambu Bay $35.00 Combitube $70.00 ET Tube $65.00 King Air Ways $55.00 Cric Kit $255.00 Res-Q-Pod $115.00 Emesis Basin (Large) $2.00 Convenience Bag $3.00 Current Cost Plus 50% Group D Heart Monitor (12-lead ECG) $130.00 Heart Monitor $65.00 Et Co2 Detector (Monitor) $12.00 Colorimetric EtCo2 Detector $15.00 Insta Glucose Gel $6.00 Heart Monitor (pacing) $130.00 Defibrillation $130.00 Pulse Oximeter $5.00 Pressure Infusion Bag $27.00 Medication Price List Adenocard 6mg $55.00 Albuterol $2.00 Ativan $8.00 Atrovent $2.00 Bacteriostatic Water $2.00 Brethine $36.00 Calcium Gluconate $10.00 Dextrose 50% $8.00 Dopamine (Premix Bag) $24.00 Epi 1:10,000 $9.00 Fentanyl $7.00 Haldol $11.00 Lidocaine $8.00 Mag Sulfate $5.00 Morphine $3.00 Nitro Paste $2.00 Pitressin $10.00 Romazion $76.00 Sodium Chloride (10ml syringe) $2.00 Solu-Medrol $12.00 Vercuronium $19.00 Adenocard 12mg $99.00 Amioidarone $38.00 Atropine $10.00 Baby Aspirin $1.00 Benadryl $5.00 Calcium Chloride $6.00 Cardizem $7.00 Diazepam $12.00 Epi 1:1000 $3.00 Etomidate $38.00 Glucagon $176.00 Lasix $2.00 Lidocaine (Premix Bag) $18.00 Midazolam $4.00 Naloxone $32.00 Nitro-Spray $48.00 Procchlorperazine $22.00 Sodium BiCarbonate $13.00 Solu Cortef $12.00 Succinylcholine $5.00 Zofran $18.00 Adopted this 11th day of March, 2013; and shall be in full force and effect from and after its adoption; and shall supersede and repeal existing policies. Board of Commissioners Jay County. Indiana Milo Miller. Jr. Faron Parr Jim Zimmerman Attest: Nancy Culy, Auditor CR/NS 3-20, 27, 2013