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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 October 2026.

How much does Peritoneal Dialysate Concentrate, Powder Additive cost?

$282

Typical negotiated rate. In Wisconsin, October 2026.

Insurers have agreed to pay about $282 for this service. The price depends on where it is billed: about $282 from a physician practice, and about $282 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$282$5.50 to $282
FacilityA hospital or hospital-owned outpatient department$282$89.13 to $282

How much rates vary

Facilitymedian $282 · 10th to 90th $5 to $282Professionalmedian $282 · 10th to 90th $3 to $282
$2$5$10$20$50$100$200facility $282professional $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
$281.84
Median
$281.84
Typical High
$281.84
Aetna
Setting
Professional
Modifier
None
Typical Low
$5.50
Median
$281.84
Typical High
$281.84
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.81
Median
$42.66
Typical High
$42.66
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.55
Median
$28.18
Typical High
$28.18
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$2.95
Median
$2.95
Typical High
$2.95
DeanCare
Setting
Facility
Modifier
None
Typical Low
$5.50
Median
$5.50
Typical High
$5.50
DeanCare
Setting
Professional
Modifier
None
Typical Low
$2.14
Median
$2.34
Typical High
$2.51
Medica
Setting
Facility
Modifier
None
Typical Low
$5.50
Median
$89.13
Typical High
$89.13
Medica
Setting
Professional
Modifier
None
Typical Low
$6.03
Median
$6.03
Typical High
$6.03
Prevea360
Setting
Facility
Modifier
None
Typical Low
$5.50
Median
$5.50
Typical High
$5.50

Where Wisconsin sits

The same service costs 416.9 times more in Iowa than in Connecticut. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Wisconsin· 5th of 51

$282

IA $282CT $0.68

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.