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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 October 2026.

How much rates vary

Professionalmedian $79 · 10th to 90th $5 to $79
$10$20$50$100$200professional $79

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$5.50
Median
$5.50
Typical High
$281.84
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$79.43
Typical High
$79.43