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Peritoneal Dialysate Concentrate, Powder Additive

Virginia rates for HCPCS A4765

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

Rates data updated July 2026.

Facilitymedian $6 · 10th–90th $5$110%50%10th90th$6Professionalmedian $5 · 10th–90th $1$50%50%10th$5$0.0$0.2$2.0$20.0$200.0$2.0K

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
$5.50
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.68
Median
$0.68
Typical High
$1.12
Medcost
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.75
Typical High
$10.23
Sentara
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$4,073.80
Typical High
$4,073.80
Sentara
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$4,073.80
Typical High
$4,073.80