HCPCS S0164

Injection, pantoprazole sodium, 40 mg

Retired code13 hospitals with prices

Description from CMS's HCPCS Level II code file.

This code is retired. Some hospitals still list it.

What Washington hospitals publish for this code

Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.

Prices for HCPCS S0164 by hospital
Hospital	Medicare Advantage rates (lowest – highest)	Cash price	List price (before discounts)
Cascade Medical CenterLeavenworth	$11.35 – $16.997 plans	$16.26	$20.32
PeaceHealth Peace Island Medical CenterFriday Harbor	$6,305 – $6,9367 plans	$40.24 – $41.60	$61.91 – $64.00
PeaceHealth Southwest Medical CenteVancouver	—	$40.24 – $41.60	$61.91 – $64.00
PeaceHealth St John Medical CenterLongview	—	$40.24 – $41.60	$61.91 – $64.00
PeaceHealth St Joseph Medical CenterBellingham	—	$40.24 – $41.60	$61.91 – $64.00
PeaceHealth United General Medical CenterSedro Woolley	$3,312 – $3,6437 plans	$40.24 – $41.60	$61.91 – $64.00

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

CMS publishes no national amount for this code.