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Ostomy Barrier with Flange, Flat, over 4x4

Utah 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 $2 · 10th–90th $2$50%50%90th$2Professionalmedian $6 · 10th–90th $2$360%10%10th90th$6$0.1$0.5$2.0$10.0$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
Facility
Modifier
Global
Typical Low
$2.29
Median
$2.29
Typical High
$2.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.29
Median
$5.37
Typical High
$36.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$5.01
Typical High
$5.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.27
Median
$4.27
Typical High
$5.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$6.17
Typical High
$8.32
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$4.68
Median
$6.03
Typical High
$9.33
Select Health
Setting
Facility
Modifier
Global
Typical Low
$8.51
Median
$8.51
Typical High
$8.51
Select Health
Setting
Professional
Modifier
Global
Typical Low
$4.27
Median
$8.51
Typical High
$8.51
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$8.51
Typical High
$10.23
United
Setting
Facility
Modifier
Global
Typical Low
$2.82
Median
$3.24
Typical High
$4.57
United
Setting
Professional
Modifier
Global
Typical Low
$2.75
Median
$3.55
Typical High
$5.37