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 10 MG/ML ORAL SYRUP
Smith, AR
See all hospitals reporting HCPCS S0104 →Price type
Mercy Hospital Fort Smith’s median price of $70 is 3120% above the median hospital's median price ($2), higher than 98% of the 842 hospitals reporting HCPCS S0104. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 11 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Medicaid hb ftsm mo medicaid facility · percent of total billed charges · outpatientfrom % of charges | $23 | $23 | — | — | — | $23 – $23 |
| 2 | Aetna hb ftsm ok managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $29 | $29 | — | — | — | $29 – $29 |
| 3 | Humana hb ftsm ok managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $29 | $29 | — | — | — | $29 – $29 |
| 4 | Anthem hb ftsm blue cross facility · fee schedule · outpatient | $40 | $40 | — | — | — | $40 – $40 |
| 5 | Blue Cross Blue Shield hb ftsm bcbs exchange facility · fee schedule · outpatient | $40 | $40 | — | — | — | $40 – $40 |
| 6 | Blue Cross Blue Shield hb ftsm blue cross facility · fee schedule · outpatient | $40 | $40 | — | — | — | $40 – $40 |
| 7 | Cigna hb ftsm cigna facility · percent of total billed charges · outpatientfrom % of charges | $59 | $59 | — | — | — | $59 – $59 |
| 8 | Humana hb ftsm humana facility · percent of total billed charges · outpatientfrom % of charges | $88 | $88 | — | — | — | $88 – $88 |
| 9 | MultiPlan hb ftsm,wldar,ozkar,prsar multi plan facility · percent of total billed charges · outpatientfrom % of charges | $99 | $99 | — | — | — | $99 – $99 |
| 10 | Aetna hb ftsm coventry/aetna facility · fee schedule · outpatient | $103 | $103 | — | — | — | $103 – $103 |
| 11 | First Health hb ftsm first health_ccn facility · fee schedule · outpatient | $118 | $118 | — | — | — | $118 – $118 |
Last updated: Jun 8, 2026
See Zidovudine 100 mg oral tablet pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.