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Peritoneal Dialysate Concentrate, Powder Additive

South Dakota rates for HCPCS A4765

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

Rates data updated October 2026.

How much rates vary

Facilitymedian $479 · 10th to 90th $8 to $479Professionalmedian $282 · 10th to 90th $282 to $282
$10$20$50$100$200$500facility $479professional $282

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$5.50
Median
$5.50
Typical High
$5.50
Aetna
Setting
Professional
Modifier
None
Typical Low
$281.84
Median
$281.84
Typical High
$281.84
Medica
Setting
Facility
Modifier
None
Typical Low
$9.12
Median
$478.63
Typical High
$478.63