Skin Biopsy (Punch) Cost in California
Punch bx skin single lesion
$453Hospital outpatient total2026 Medicare, physician + facility- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
California Medicare physician rate (2026)
+13.4% vs nationalAverage of 29 localities. Office range $129.06–$163.13.
What the whole procedure costs
The rate above is the physician’s fee on its own. The facility bills separately, and for most procedures the facility is the larger half of the bill. These are 2026 national Medicare amounts.
Choosing a surgery centre over a hospital saves about $324 on the Medicare allowed amount for skin biopsy (punch). Ask whether your procedure can be done at an ambulatory surgery centre.
This is Medicare's separate payment to the facility on top of the physician's fee. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Your ZIP in California
A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
What skin biopsy (punch) costs at hospitals near you
Everything above is a national average. The hospital you pick in California moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. In California the office and hospital physician lines for this CPT differ by $98.41.
National vs California
Where California ranks for this CPT
CPT 11104 by California locality
| Locality | Office |
|---|---|
| san jose-sunnyvale-santa clara (san benito cnty) | $163.13 |
| san jose-sunnyvale-santa clara (santa clara cnty) | $162.71 |
| san francisco-oakland-berkeley (marin cnty) | $159.57 |
| san francisco-oakland-berkeley (san francisco/san mateo/alameda/contra costa cnty) | $159.47 |
| napa | $150.47 |
| vallejo | $150.32 |
| santa rosa-petaluma | $141.45 |
| santa cruz-watsonville | $140.02 |
| san diego-chula vista-carlsbad | $138.55 |
| los angeles-long beach-anaheim (los angeles/orange cnty) | $138.03 |
| oxnard-thousand oaks-ventura | $137.47 |
| santa maria-santa barbara | $135.74 |
| sacramento-roseville-folsom | $135.69 |
| salinas | $135.19 |
| san luis obispo-paso robles | $132.99 |
| riverside-san bernardino-ontario | $130.04 |
| bakersfield | $129.34 |
| el centro | $129.08 |
| chico | $129.06 |
| fresno | $129.06 |
| hanford-corcoran | $129.06 |
| madera | $129.06 |
| merced | $129.06 |
| modesto | $129.06 |
| redding | $129.06 |
| stockton | $129.06 |
| visalia | $129.06 |
| yuba city | $129.06 |
| rest of california | $129.06 |
PE GPCI ranges from 1.096 to 1.442 in California. That index is why the same CPT is not one price statewide.
Skin Biopsy (Punch) and how California is priced
California is the most finely divided state in the Medicare fee schedule, with roughly thirty payment localities drawn around metropolitan statistical areas after CMS reformed the state's locality map. The San Francisco Bay Area carries some of the highest geographic adjustments in the nation, with San Francisco, San Jose, and the East Bay each priced separately, while Los Angeles, Orange County, San Diego, and Sacramento have their own localities at somewhat lower levels. Rural and inland counties fall into lower-cost localities, so the same procedure can carry meaningfully different Medicare-approved amounts within a single day's drive. No other state shows this much in-state variation on the fee schedule itself.
California's markets differ sharply: the Bay Area combines high wages with heavily consolidated hospital systems, Los Angeles offers enormous choice across a sprawling region, and the Central Valley and far north face genuine access shortages. Where you are treated within the state matters more here than almost anywhere else in the country. Academic medical centers in the Bay Area, Los Angeles, San Diego, and Sacramento handle much of the complex referral care.
This procedure: A punch biopsy uses a small round cutting tool, usually 2 to 6 millimeters across, to remove a full-thickness core of skin down through the deeper layers. Dermatologists choose it over a shave when they need to see the entire depth of the skin, for example to evaluate a rash, a suspected melanoma, or an inflammatory condition. After a numbing injection, the punch takes under a minute, and the small hole is typically closed with one or two stitches that come out in one to two weeks.
What Is Skin Biopsy (Punch)?
A punch biopsy uses a small round cutting tool, usually 2 to 6 millimeters across, to remove a full-thickness core of skin down through the deeper layers. Dermatologists choose it over a shave when they need to see the entire depth of the skin, for example to evaluate a rash, a suspected melanoma, or an inflammatory condition. After a numbing injection, the punch takes under a minute, and the small hole is typically closed with one or two stitches that come out in one to two weeks.
What Affects the Cost
- –The separate pathology fee for processing and reading the full-thickness specimen is often the largest single charge on the bill.
- –Additional punches at the same visit are billed with add-on code 11105 for each extra lesion.
- –Because punch sites are usually sutured, a suture removal or wound check visit may generate its own charge if done as a distinct appointment.
- –Rash workups sometimes require special immunofluorescence or extra stains at the lab, which increases the pathology bill.
- –A biopsy done in a hospital-based clinic carries a facility fee on top of the physician charge.
Questions to Ask Before Booking
- 1.Why a punch rather than a shave biopsy, and does the choice change the cost?
- 2.Is my suture removal visit included, or billed separately?
- 3.Which lab reads the specimen and is it in network for my plan?
- 4.If special stains are needed for my rash, what extra lab charges should I expect?
- 5.How many sites do you plan to biopsy today, and what is the add-on charge per site?
Other featured procedures in California
Skin Biopsy (Punch) in other states
Skin Biopsy (Punch) in California: questions
The 2026 Medicare physician office rate for CPT 11104 averages $137.55 across 29 California localities, from $129.06 in CHICO to $163.13 in SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY). The hospital physician rate averages $39.14. Enter a ZIP for the exact locality.
Yes. CMS splits California into 29 payment localities. For this CPT the office physician fee spans $34.07 from the lowest to highest locality. A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $28 for the office physician line or $8 for the hospital physician line in California. Medigap may cover that 20%. This is not the hospital facility fee.
No. $137.55 is only the physician's share. Adding Medicare's facility payment brings the total to about $453 in a hospital outpatient department, or about $130 at an ambulatory surgery centre. Anesthesia, pathology and other codes billed the same day are extra. California ranks #49 of 51 states on the physician line (13% above the national office rate of $121.25).