US Mobility Private Pay Rate Calculator

Customer Information

Client Full Name *

Phone Number *

Rider / Passenger Name(if different)

Additional Passengers / Companions

Payment Method *

CardCheckCash

Payment is required upfront before transportation services are provided.

Pickup Date

Pickup Time

Pickup / Starting Location *

Destination / Ending Location *

Trip Type *

Ambulatory

Walking passengers

$40 base+$4/mi

Wheelchair

Wheelchair-accessible

$50 base+$5/mi

Add Waiting Fee

Flat $45.00 fee for waiting time

Appointment / Arrival Time

When the patient needs to arrive at destination

Special Instructions

Any notes for the driver

Trip Direction *

One Way

Standard rate

Return Trip

2x the cost

Hospital Discharge Fee

Flat $100.00 fee for hospital discharges

Estimated Pricing

(distance calculated on submit)

Base Rate

$40.00

Per Mile

$4.00

Waiting Fee

—

Formula: $40.00 + ($4 × miles)

No Quote Generated

Fill out the form and click "Generate Quote" to calculate the trip cost.