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Pennsylvania rates for HCPCS A4765

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

Facilitymedian $7 · 10th–90th $7–$70%50%$7Professionalmedian $5 · 10th–90th $5–$50%50%90th$5$1.0$5.0$20.0$100.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.92 / $6.92 / $6.92
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $5.01 / $5.01
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $17.78 / $17.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $5.01 / $5.01
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $0.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20