go back

Ostomy Barrier with Flange, Flat, over 4x4

Montana rates for HCPCS A4415

Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 in, each

Rates data updated July 2026.

Facilitymedian $8 · 10th–90th $5$100%20%40%10th90th$8Professionalmedian $7 · 10th–90th $3$360%10%20%10th90th$7$5.0$10.0$20.0$50.0

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
Professional
Modifier
Global
Typical Low
$2.29
Median
$6.76
Typical High
$36.31
BCBS
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$8.71
Typical High
$8.71
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.27
Median
$8.71
Typical High
$8.71
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$6.46
Median
$8.13
Typical High
$15.85
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$8.13
Typical High
$15.85
Providence
Setting
Facility
Modifier
Global
Typical Low
$4.07
Median
$7.76
Typical High
$10.00
Providence
Setting
Professional
Modifier
Global
Typical Low
$6.17
Median
$8.71
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$2.82
Median
$3.24
Typical High
$3.24
United
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$3.55
Typical High
$4.79