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Peritoneal Dialysate Concentrate, Powder Additive

Ohio rates for HCPCS A4765

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

Rates data updated July 2026.

Facilitymedian $65 · 10th–90th $10$2820%20%40%10th90th$65Professionalmedian $5 · 10th–90th $2$70%20%40%10th90th$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
Facility
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$281.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$281.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.00
Median
$2.29
Typical High
$3.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Molina
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$50.12
Typical High
$60.26
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$60.26
Typical High
$75.86