New Image Flat FormaFlex Skin Barrier
HollisterSkin barriers2-pieceFlat
- Brand
- Hollister
- Category
- Skin barriers
- System
- 2-piece
- Pouch type
- Not found in our sources
- Barrier type
- Flat (from product name)
- Opening
- Not found in our sources
- Filter
- Not found in our sources
- Box quantity
- 5
- Flange sizes
- Not found in our sources
- HCPCS code(s)
- A4409 (Hollister product page)
- Lowest cash price seen
- From $37.54 / Box of 5 ($7.51 each)
Vitality Medical, Nov 4, 2026 - Source
- hollister.com · checked Nov 4, 2026
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Sizes, codes and prices
Prices are cash prices one retailer listed on the date shown, per the retailer's unit. Retailer links are marked as sponsored for search engines and may become affiliate links later. We do not take referral fees from suppliers that bill Medicare. The retailer page says the manufacturer labels this item Rx only.
| Code | Description / size | Box | HCPCS | Price seen |
|---|---|---|---|---|
14102 | 1-3/4 Inch Green Code Up to 1-1/4 Inch Description from Vitality Medical listing | Box of 5 | A4409 | $40.40 / Box of 5 Vitality Medical · Nov 4, 2026 |
14103 | 2-1/4 Inch Red Code Up to 1-11/16 Inch Description from Vitality Medical listing | Box of 5 | A4409 | $38.97 / Box of 5 Vitality Medical · Nov 4, 2026 |
14104 | 2-3/4 Inch Blue Code Up to 2-1/4 Inch Description from Vitality Medical listing | Box of 5 | A4409 | $37.54 / Box of 5 Vitality Medical · Nov 4, 2026 |
Medicare usual maximums for these codes
- A4409: Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each. No usual maximum is listed for this code in the LCD table.
From our Medicare guide (LCD L33828). Informational only; coverage depends on your plan and documentation. Confirm with your supplier or plan.
Manufacturer-listed features
- Skin barrier with integrated beige floating flange
- FormaFlex (extended wear) skin barrier, flat
- Shape-to-fit skin barrier with starter hole
- Tape border
- Designed to be used with any New Image drainable, closed, or urostomy pouch with same flange size
As described on the source page.
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