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Peritoneal Dialysate Concentrate, Powder Additive

North Carolina rates for HCPCS A4765

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

Rates data updated July 2026.

Facilitymedian $5 · 10th–90th $5$110%50%90th$5Professionalmedian $5 · 10th–90th $5$600%50%90th$5$5.0$10.0$20.0$50.0$100.0$200.0$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
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$5.50
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$7.41
BCBS
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$60.26
Typical High
$60.26
Medcost
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$10.23
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$4.68
Typical High
$6.03