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Peritoneal Dialysate Concentrate, Powder Additive

Montana rates for HCPCS A4765

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

Rates data updated July 2026.

How much rates vary

Facilitymedian $6 · 10th to 90th $5 to $457Professionalmedian $5 · 10th to 90th $5 to $282
$2$10$50$200facility $6professional $5

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$281.84
Providence
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.89
Typical High
$457.09
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$85.11