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Peritoneal Dialysate Concentrate, Powder Additive

South 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%20%40%90th$5Professionalmedian $5 · 10th–90th $5$2820%50%90th$5$2.0$10.0$50.0$200.0

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
$281.84
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.00
Median
$2.29
Typical High
$3.55
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Medcost
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$11.48
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20