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Peritoneal Dialysate Concentrate, Powder Additive

Tennessee rates for HCPCS A4765

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

Rates data updated July 2026.

Facilitymedian $100 · 10th–90th $100$1000%50%100%$100Professionalmedian $5 · 10th–90th $5$60%50%90th$5$5.0$10.0$20.0$50.0$100.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$5.50
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.03