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Peritoneal Dialysate Concentrate, Powder Additive

Nationwide rates for HCPCS A4765

Dialysate concentrate, powder, additive for peritoneal dialysis, per packet

Rates data updated July 2026.

Facilitymedian $6 · 10th–90th $5$123,0270%50%10th90th$6Professionalmedian $5 · 10th–90th $5$100%50%90th$5$0.0$0.5$10.0$200.0$5.0K$100.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$281.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$7.24
BCBS
Setting
Facility
Modifier
Global
Typical Low
$114,815.36
Median
$138,038.43
Typical High
$588,843.66
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.68
Median
$1.91
Typical High
$2.75
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$4.37
Typical High
$4.37
United
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$44.67
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$38,018.94