HCPCS S0164
Injection, pantoprazole sodium, 40 mg
Retired code8 hospitals with prices
This code is retired. Some hospitals still list it.
What Washington hospitals publish for this code
Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.
| Hospital | Commercial insurance rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Prov Sacred HRT Med Ctr & Childs Hosp. | $4.90 | — | — |
| Providence Holy Family Hospital | $4.90 | — | — |
| Providence Regional Medical Center Everett | $4.90 | — | — |
| Swedish Edmonds Hospital | $4.90 | — | — |
| Swedish Issaquah | $4.90 | — | — |
| Swedish Medical Center | $4.90 | — | — |
| Swedish Medical Center / Cherry Hill | $4.90 | — | — |
Medicare (traditional) reference
CMS publishes no national amount for this code.