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Peritoneal Dialysate Concentrate, Powder Additive

New Hampshire rates for HCPCS A4765

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

Rates data updated July 2026.

Professionalmedian $5 · 10th–90th $2$50%50%10th$5$1.0$5.0$20.0$100.0

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
$5.50
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.66
Median
$1.66
Typical High
$1.66