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

Medicaid (state program): Washington Apple Health fee-for-service. Applies only to Medicaid enrollees.

Prices for HCPCS A4216 by hospital
Hospital	Medicaid (state program) rates (lowest – highest)	Cash price	List price (before discounts)
Cascade Medical CenterLeavenworth	$10.68 – $12.931 plan	$16.00 – $19.36	$20.00 – $24.20
Cascade Valley HospitalArlington	—	$4.80 – $48.00	$6.00 – $60.00
EvergreenHealth Medical CenterKirkland	—	$22.40	$28.00
EvergreenHealth MonroeMonroe	—	$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	$1.261 plan	$5.00	$5.00
Skagit Valley HospitalMount Vernon	—	$4.80 – $48.00	$6.00 – $60.00
Three Rivers HospitalBrewster	$3.90 – $26.761 plan	$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)