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Peritoneal Dialysate Concentrate, Powder Additive

Wisconsin rates for HCPCS A4765

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

Rates data updated July 2026.

Facilitymedian $5 · 10th–90th $5$80%50%90th$5Professionalmedian $5 · 10th–90th $5$50%50%$5$1.0$5.0$20.0$100.0

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
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$5.50
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
$2.00
Typical High
$2.19
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$7.59
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$2.34
Typical High
$3.16
Medica
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$8.13
Medica
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$54.95
Typical High
$70.79
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$7.59
Quartz
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Quartz
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.03