How Much Does a Skin Biopsy (Punch) Cost in Pennsylvania?
Punch bx skin single lesion
$119.82In-office total2026 Medicare, Pennsylvania averageUnder 2026 Medicare rates, a skin biopsy (punch) in a doctor's office costs about $120 in Pennsylvania, from $114 in Rest of Pennsylvania to $126 in Metropolitan Philadelphia, with no separate facility fee. In a facility the national total is about $453 at a hospital outpatient department or about $130 at an ambulatory surgery center, because the facility is paid its own rate on top of the physician.
- ✓Your ZIP's wage-adjusted hospital and surgery center 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
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- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
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- ✓Printable PDF download
Pennsylvania Medicare physician rate (2026)
-1.2% vs nationalAverage of 2 localities. Office range $113.60–$126.05.
What it costs in a hospital or surgery center
In a doctor’s office, the office rate above is the whole Medicare payment. When the same procedure is done in a hospital or surgery center, the facility bills its own fee on top of the physician, which is what these totals show. They are 2026 national Medicare amounts.
Choosing a surgery center 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 center.
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 Pennsylvania
Look up your ZIP to see whether metro Philadelphia or rest-of-state pricing applies, from Philadelphia and its collar counties to Pittsburgh, Harrisburg, Allentown, Scranton, Erie, and the rural center.
What skin biopsy (punch) costs at hospitals near you
Everything above is a national average. The hospital you pick in Pennsylvania 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.
For example 15001.
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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 center 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 Pennsylvania the office and hospital physician lines for this CPT differ by $81.46.
National vs Pennsylvania
Where Pennsylvania ranks for this CPT
CPT 11104 by Pennsylvania locality
| Locality | Office |
|---|---|
| metropolitan philadelphia | $126.05 |
| rest of pennsylvania | $113.60 |
PE GPCI ranges from 0.918 to 1.041 in Pennsylvania. That index is why the same CPT is not one price statewide.
Skin Biopsy (Punch) and how Pennsylvania is priced
Pennsylvania's fee schedule separates metro Philadelphia from the rest of the state, giving the southeast its own higher-cost locality while Pittsburgh, Harrisburg, Allentown, Erie, and rural Pennsylvania share rest-of-state adjustments. That means the state's second-largest medical market, Pittsburgh, is priced with rural counties rather than with Philadelphia. The Philadelphia locality's premium reflects the metro's wage and rent levels, which lead the state by a wide margin. For patients, the key locality question in Pennsylvania is simply whether care happens in the Philadelphia area.
Philadelphia is one of America's historic centers of academic medicine, dense with teaching hospitals, while Pittsburgh is dominated by a pair of large integrated systems whose rivalry has defined that market for years. The rural middle of the state, sometimes called the T, has far fewer options, and hospital closures there have drawn statewide attention. Residents near the edges use New York, Baltimore, or Ohio providers when convenient.
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 Pennsylvania
Skin Biopsy (Punch) in other states
Skin Biopsy (Punch) in Pennsylvania: questions
Under 2026 Medicare rates, a skin biopsy (punch) in a doctor's office costs about $120 in Pennsylvania, from $114 in Rest of Pennsylvania to $126 in Metropolitan Philadelphia, with no separate facility fee. In a facility the national total is about $453 at a hospital outpatient department or about $130 at an ambulatory surgery center, because the facility is paid its own rate on top of the physician. Enter a ZIP for the exact Pennsylvania locality.
Yes. CMS splits Pennsylvania into 2 payment localities. For this CPT the office physician fee spans $12.45 from the lowest to highest locality. Look up your ZIP to see whether metro Philadelphia or rest-of-state pricing applies, from Philadelphia and its collar counties to Pittsburgh, Harrisburg, Allentown, Scranton, Erie, and the rural center.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $24 for the office physician line or $8 for the hospital physician line in Pennsylvania. Medigap may cover that 20%. This is not the hospital facility fee.
In a doctor's office, $119.82 is Medicare's whole payment in Pennsylvania: it covers the physician, the room and the supplies, with no separate facility fee. If it is done in a hospital outpatient department instead, the physician is paid about $38.36 and the hospital adds its own facility payment, bringing the national total to about $453. Services billed under other codes, such as lab work, are extra. Pennsylvania ranks #30 of 51 states on the office rate (within 2% of the national office rate of $121.25).