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Cost Estimator
Mid-Valley Hospital
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Select a service.
You may need to get a specific service code from your provider.
Code
Description
Ambulance Service, Non-emergent Transport (Level 1)
Basic Life Support, Non-Emergent
Ground mileage, Per Mile
M0243 IV Infusion Casirivimab/Imdevimab Adm and Monitoring
M0243 IV Infusion Casirivimab/Imdevimab Adm and Monitoring
M0247: Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
NitroUltrasound Oxide Therapy Initiated
OXYGEN - HOUR
RECOVERY EXTENDED ABOVE 4HRS CHARGE
0001A
ADM Pfizer SARSCOV2 30 MCG/0.3 ML 1ST
0001A
Pfizer vaccine 1st dose: 0001A - 30mcg
0002A
ADM Pfizer SARSCOV2 30 MCG/0.3 ML 2ND
0002A
Pfizer vaccine 2nd dose: 0002A - 30mcg
0003A
ADM Pfizer SARSCOV2 30MCG/0.3ML 3RD
0004A
Pfizer ADM SARSCOV2 30MCG/0.3ML Booster
0011A
ADM Moderna SARSCOV2 100 MCG/0.5 ML 1ST
0011A
Moderna Vaccine 1st Dose: 0011A - 100mcg
0012A
ADM Moderna SARSCOV2 100 MCG/0.5 ML 2ND
0012A
Moderna Vaccine 2nd dose: 0012A - 100mcg
0013A
ADM Moderna SARSCOV2 100MCG/0.5ML3RD
0013A
Moderna Vaccine 3rd Dose: 0013A - 100mcg - Moderna Vaccine Admin Charge
0031A
ADM JANSSEN SARSCOV2 VAC AD26 .5ML.
0031A
Janssen Vaccine 0031A - Janssen Vaccine Admin Charge
0034A
JANSSEN ADM SARSCOV2 VAC AD26 .5ML BOOSTER
0034A
Janssen Vaccine Booster 0034A - Janssen Vaccine Admin Charge
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