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Ostomy Barrier with Flange, Flat, over 4x4

Washington 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$160%20%10th90th$8Professionalmedian $7 · 10th–90th $4$140%10%10th90th$7$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
$4.79
Median
$4.79
Typical High
$11.22
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$4.79
Typical High
$36.31
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$7.24
Median
$7.24
Typical High
$7.24
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$7.24
Median
$7.24
Typical High
$9.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$5.37
Typical High
$5.37
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.27
Median
$4.27
Typical High
$5.01
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$9.33
Typical High
$17.78
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$10.47
Typical High
$17.38
Molina
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$6.46
Typical High
$64.57
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$8.13
Typical High
$8.32
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$7.24
Median
$8.32
Typical High
$8.32
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$6.92
Median
$7.41
Typical High
$13.49
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.13
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$7.24
Typical High
$9.33
United
Setting
Facility
Modifier
Global
Typical Low
$3.24
Median
$3.55
Typical High
$4.79
United
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$3.80
Typical High
$6.92
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$4.07
Median
$7.24
Typical High
$12.88