Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Zidovudine, oral, 100 mg
Low
$1
Average
$15
Median
$12
High
$38
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
11 hospitals; the 90th percentile is 9.2× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Filter by billing methodology
Filter by billing class
11 hospital rates
iThe hospitals that file a Medicaid rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Hospital Service District #1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System Houma, LA facility · other · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 2 | Mercy Hospital Fort Smith Smith, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 3 | Mercy Hospital Fort Smith Smith, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 4 | Mercy Hospital Jefferson Imperial, MO facility · percent of total billed charges · outpatientfrom % of charges | 2 | $1 | $1 | $0 | 14% | — | $1 – $2 |
| 5 | Mercy Hospital Rogers dba Mercy Hospital Northwest Arkansas Rogers, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $12 | $12 | $11 | 88% | — | $2 – $23 |
| 6 | Mercy Hospital South Louis, MO facility · percent of total billed charges · outpatientfrom % of charges | 2 | $12 | $14 | $13 | 93% | — | $1 – $31 |
| 7 | Mercy Hospital Springfield Ozark, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $12 | $12 | $11 | 88% | — | $2 – $23 |
| 8 | Mercy Hospital Springfield Springfield, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $12 | $12 | $11 | 88% | — | $2 – $23 |
| 9 | SAN JOAQUIN COMMUNITY HOSPITAL Bakersfield, CA fee schedule · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 10 | Southeast Hospital dba Mercy Hospital Southeast Girardeau, MO facility · percent of total billed charges · outpatientfrom % of charges | 2 | $11 | $11 | $2 | 14% | — | $9 – $13 |
| 11 | WHITE MEMORIAL MEDICAL CENTER MONTEBELLO, CA fee schedule · outpatient | 1 | $38 | $38 | — | — | — | $38 – $38 |
← Payers reporting HCPCS S0104 · Snapshot 20261112T181611Z-3fa9fb76