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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