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HCPCS A4216

Sterile water, saline and/or dextrose, diluent/flush, 10 ml

Current code18 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

HospitalCommercial insurance rates (lowest – highest)Cash priceList price (before discounts)
Cascade Medical CenterLeavenworth$7.80 – $15.172 plans$16.00 – $19.36$20.00 – $24.20
Cascade Valley HospitalArlington$4.36 – $6088 plans$4.80 – $48.00$6.00 – $60.00
EvergreenHealth Medical CenterKirkland$8.96 – $26.047 plans$22.40$28.00
EvergreenHealth MonroeMonroe$16.38 – $24.1812 plans$20.80$26.00
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01——$1.17
Providence St Peter HospitalOlympiaFile dated 2026-04-01—$39.89$76.71
Seattle Children's HospitalSeattle$2.70 – $4.8098 plans$5.00$5.00
Skagit Valley HospitalMount Vernon$4.78 – $57.007 plans$4.80 – $48.00$6.00 – $60.00
Three Rivers HospitalBrewster—$5.57 – $38.22$5.57 – $38.22

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

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Equipment fee, Washington
$0.54 (fee)