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Peritoneal Dialysate Concentrate, Powder Additive

Arizona rates for HCPCS A4765

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

Rates data updated July 2026.

Facilitymedian $6 · 10th–90th $4$3160%20%10th90th$6Professionalmedian $5 · 10th–90th $5$2820%50%90th$5$5.0$20.0$100.0$500.0

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
Professional
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$281.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2.40
Median
$3.89
Typical High
$8.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$7.08
Median
$8.91
Typical High
$13.49
Medica
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$100.00
Typical High
$331.13
Medica
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.03