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Ostomy Barrier with Flange, Flat, over 4x4

South Dakota 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 $9 · 10th–90th $5$110%20%10th90th$9Professionalmedian $8 · 10th–90th $5$120%10%10th90th$8$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.37
Median
$5.75
Typical High
$11.48
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$5.01
Typical High
$9.33
Cigna
Setting
Professional
Modifier
Global
Typical Low
$9.77
Median
$9.77
Typical High
$12.30
Medica
Setting
Facility
Modifier
Global
Typical Low
$5.75
Median
$9.12
Typical High
$15.85
Medica
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$5.37
Typical High
$41.69
Midlands
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$9.12
Typical High
$9.12
Midlands
Setting
Facility
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$9.33
Midlands
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$7.59
Typical High
$15.14
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$8.32
Typical High
$10.96
United
Setting
Facility
Modifier
Global
Typical Low
$3.24
Median
$3.98
Typical High
$5.89
United
Setting
Professional
Modifier
Global
Typical Low
$2.75
Median
$5.62
Typical High
$9.77
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$6.92