Cosmetic Dermatology Fee Sheet 2018

Cosmetic Dermatology - 2018

Welcome to the Cosmetic Dermatology department at Kaiser Permanente Colorado. Listed below are the cosmetic procedures offered. As discussed during your visit, you are financially responsible for the cost of the procedures to be performed. The procedures are elective and are not covered by your benefits. Prices are subject to change.

Member Name: _____________________________ Date of Visit: _______________ Date of Next Visit: _______________________

Your provider will indicate which service(s) you are recommended to receive in advance of your next appointment from the list below.

Code

Cost

Description

900133 $40

Cosmetic Consultation

Blue Light

900174 $250

Blue Light

900175 $400

Blue Light with Levulan

Chemical Peel

900153 $450

Facial Epidermal Peel TCA, Deep

900154 $300

Facial Epidermal Peel TCA, Medium

900155 $150

Facial Epidermal Peel, Salicylic Acid

900156 $175

Facial Epidermal Peel, Jessner

900791 $400

Chemical Peel, Salicylic package of 4

900797 $300

Microlaser Peels per Site per Session

900087 900088 17110 17111 900856

$250 $300 $132.47 $198.72 $125

Destruction of Lesion Laser Rosacea (face only) Destruction Cutaneous Vascular Proliferative Lesion (e.g. laser technique); 10 - 50 sq. cm Laser Rosacea (face and neck) Destruction Cutaneous Vascular Proliferative Lesion (e.g. laser technique); over 50 sq. cm Destruction Benign Lesion Not Skin Tags, Cutaneous Vascular Proliferative Lesion; up to 14 lesions Destruction Benign Lesion Not Skin Tags, Cutaneous Vascular Proliferative Lesion; 15 or more lesions Laser Rosacea (partial face or neck) Destruction Cutaneous Vascular Proliferative Lesion (e.g. laser technique) < 10 sq. cm

Excision of Benign Lesion

11400 $229.02 Excision Benign Lesion Margin No Skin Tag Trunk Arm/Leg; 0.5 cm/< , [3]

11401 $277.03 Excision Benign Lesion Margin No Skin Tag Trunk Arm/Leg; 0.6-1.0 cm, [3]

11402 $308.45 Excision Benign Lesion Margin No Skin Tag Trunk Arm/Leg; 1.1-2.0 cm, [3]

11403 $357.14 Excision Benign Lesion Margin No Skin Tag Trunk Arm/Leg; 2.1-3.0 cm, [3]

11420 $228.28 Excision Benign Lesion Margin Scalp, Neck, Hand, Foot, Genital; 0.5 cm/ ................
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