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.
Cosmetic Dermatology - 2014 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 900133
Cost $40
Description Cosmetic Consultation Blue Light
900174
$250
Blue Light
900175
$400 $200
Blue Light with Levulan Additional sticks of Levulan
900___
Chemical Peel 900153 900154 900155
$450 $300 $150
Facial Epidermal Peel TCA, Deep Facial Epidermal Peel TCA, Medium Facial Epidermal Peel, Salicylic Acid
900156 900791 900797
$175 $400 $300
900087
$250
900088
$300
17110
$128.62
17111
$192.93
900856
$125
Facial Epidermal Peel, Jessner Chemical Peel, Salicylic package of 4 Microlaser Peels per Site per Session 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 11401
$229.67 $275.96
11402 11403 11420 11421 11422
$306.55 $352.92 $227.78 $291.24 $323.66
Excision Benign Lesion Margin No Skin Tag Trunk Arm/Leg; 0.5 cm/< , [3] Excision Benign Lesion Margin No Skin Tag Trunk Arm/Leg; 0.6-1.0 cm, [3]
Excision Benign Lesion Margin No Skin Tag Trunk Arm/Leg; 1.1-2.0 cm, [3] Excision Benign Lesion Margin No Skin Tag Trunk Arm/Leg; 2.1-3.0 cm, [3] Excision Benign Lesion Margin Scalp, Neck, Hand, Foot, Genital; 0.5 cm/
