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Peritoneal Dialysate Concentrate, Powder Additive

Wyoming rates for HCPCS A4765

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

Rates data updated October 2026.

How much rates vary

Facilitymedian $5 · 10th to 90th $5 to $5Professionalmedian $76 · 10th to 90th $5 to $76
$10$20$50$100$200facility $5professional $76

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
$5.50
Median
$5.50
Typical High
$5.50
BCBS Wyoming
Setting
Professional
Modifier
None
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
BCBS Wyoming
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$52.48
Median
$52.48
Typical High
$52.48