Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY

Facility

$1,215.03

Service Code	CPT 25111
Hospital Revenue Code	360
Min. Negotiated Rate	$1,157.10
Max. Negotiated Rate	$1,215.03
Rate for Payer: BCBS Complete	$1,215.03
Rate for Payer: Mclaren Medicaid	$1,157.10
Rate for Payer: Meridian Medicaid	$1,215.03
Rate for Payer: Priority Health Choice Medicaid	$1,157.10
Rate for Payer: UHCCP Medicaid	$1,157.10

EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (EG, CYST OR GANGLION); FOOT

Facility

$1,215.03

Service Code	CPT 28090
Hospital Revenue Code	360
Min. Negotiated Rate	$1,157.10
Max. Negotiated Rate	$1,215.03
Rate for Payer: BCBS Complete	$1,215.03
Rate for Payer: Mclaren Medicaid	$1,157.10
Rate for Payer: Meridian Medicaid	$1,215.03
Rate for Payer: Priority Health Choice Medicaid	$1,157.10
Rate for Payer: UHCCP Medicaid	$1,157.10

EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (EG, CYST OR GANGLION); TOE(S), EACH

Facility

$1,215.03

Service Code	CPT 28092
Hospital Revenue Code	360
Min. Negotiated Rate	$1,157.10
Max. Negotiated Rate	$1,215.03
Rate for Payer: BCBS Complete	$1,215.03
Rate for Payer: Mclaren Medicaid	$1,157.10
Rate for Payer: Meridian Medicaid	$1,215.03
Rate for Payer: Priority Health Choice Medicaid	$1,157.10
Rate for Payer: UHCCP Medicaid	$1,157.10

EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED

Facility

$2,172.87

Service Code	CPT 11772
Hospital Revenue Code	360
Min. Negotiated Rate	$2,069.26
Max. Negotiated Rate	$2,172.87
Rate for Payer: BCBS Complete	$2,172.87
Rate for Payer: Mclaren Medicaid	$2,069.26
Rate for Payer: Meridian Medicaid	$2,172.87
Rate for Payer: Priority Health Choice Medicaid	$2,069.26
Rate for Payer: UHCCP Medicaid	$2,069.26

EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE

Facility

$2,172.87

Service Code	CPT 11771
Hospital Revenue Code	360
Min. Negotiated Rate	$2,069.26
Max. Negotiated Rate	$2,172.87
Rate for Payer: BCBS Complete	$2,172.87
Rate for Payer: Mclaren Medicaid	$2,069.26
Rate for Payer: Meridian Medicaid	$2,172.87
Rate for Payer: Priority Health Choice Medicaid	$2,069.26
Rate for Payer: UHCCP Medicaid	$2,069.26

EXCISION OF SINGLE EXTERNAL PAPILLA OR TAG, ANUS

Facility

$895.16

Service Code	CPT 46220
Hospital Revenue Code	360
Min. Negotiated Rate	$852.47
Max. Negotiated Rate	$895.16
Rate for Payer: BCBS Complete	$895.16
Rate for Payer: Mclaren Medicaid	$852.47
Rate for Payer: Meridian Medicaid	$895.16
Rate for Payer: Priority Health Choice Medicaid	$852.47
Rate for Payer: UHCCP Medicaid	$852.47

EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH COMPLEX REPAIR

Facility

$2,172.87

Service Code	CPT 11451
Hospital Revenue Code	360
Min. Negotiated Rate	$2,069.26
Max. Negotiated Rate	$2,172.87
Rate for Payer: BCBS Complete	$2,172.87
Rate for Payer: Mclaren Medicaid	$2,069.26
Rate for Payer: Meridian Medicaid	$2,172.87
Rate for Payer: Priority Health Choice Medicaid	$2,069.26
Rate for Payer: UHCCP Medicaid	$2,069.26

EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH SIMPLE OR INTERMEDIATE REPAIR

Facility

$2,172.87

Service Code	CPT 11450
Hospital Revenue Code	360
Min. Negotiated Rate	$2,069.26
Max. Negotiated Rate	$2,172.87
Rate for Payer: BCBS Complete	$2,172.87
Rate for Payer: Mclaren Medicaid	$2,069.26
Rate for Payer: Meridian Medicaid	$2,172.87
Rate for Payer: Priority Health Choice Medicaid	$2,069.26
Rate for Payer: UHCCP Medicaid	$2,069.26

EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH SIMPLE OR INTERMEDIATE REPAIR

Facility

$2,172.87

Service Code	CPT 11462
Hospital Revenue Code	360
Min. Negotiated Rate	$2,069.26
Max. Negotiated Rate	$2,172.87
Rate for Payer: BCBS Complete	$2,172.87
Rate for Payer: Mclaren Medicaid	$2,069.26
Rate for Payer: Meridian Medicaid	$2,172.87
Rate for Payer: Priority Health Choice Medicaid	$2,069.26
Rate for Payer: UHCCP Medicaid	$2,069.26

EXCISION OF TENDON, FOREARM AND/OR WRIST, FLEXOR OR EXTENSOR, EACH

Facility

$2,463.31

Service Code	CPT 25109
Hospital Revenue Code	360
Min. Negotiated Rate	$2,345.85
Max. Negotiated Rate	$2,463.31
Rate for Payer: BCBS Complete	$2,463.31
Rate for Payer: Mclaren Medicaid	$2,345.85
Rate for Payer: Meridian Medicaid	$2,463.31
Rate for Payer: Priority Health Choice Medicaid	$2,345.85
Rate for Payer: UHCCP Medicaid	$2,345.85

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL, EXCEPT TALUS OR CALCANEUS;

Facility

$2,463.31

Service Code	CPT 28104
Hospital Revenue Code	360
Min. Negotiated Rate	$2,345.85
Max. Negotiated Rate	$2,463.31
Rate for Payer: BCBS Complete	$2,463.31
Rate for Payer: Mclaren Medicaid	$2,345.85
Rate for Payer: Meridian Medicaid	$2,463.31
Rate for Payer: Priority Health Choice Medicaid	$2,345.85
Rate for Payer: UHCCP Medicaid	$2,345.85

EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 0.6 TO 1.0 CM

Facility

$534.17

Service Code	CPT 11441
Hospital Revenue Code	360
Min. Negotiated Rate	$508.70
Max. Negotiated Rate	$534.17
Rate for Payer: BCBS Complete	$534.17
Rate for Payer: Mclaren Medicaid	$508.70
Rate for Payer: Meridian Medicaid	$534.17
Rate for Payer: Priority Health Choice Medicaid	$508.70
Rate for Payer: UHCCP Medicaid	$508.70

EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 2.1 TO 3.0 CM

Facility

$1,230.09

Service Code	CPT 11443
Hospital Revenue Code	360
Min. Negotiated Rate	$1,171.43
Max. Negotiated Rate	$1,230.09
Rate for Payer: BCBS Complete	$1,230.09
Rate for Payer: Mclaren Medicaid	$1,171.43
Rate for Payer: Meridian Medicaid	$1,230.09
Rate for Payer: Priority Health Choice Medicaid	$1,171.43
Rate for Payer: UHCCP Medicaid	$1,171.43

EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER OVER 4.0 CM

Facility

$2,172.87

Service Code	CPT 11446
Hospital Revenue Code	360
Min. Negotiated Rate	$2,069.26
Max. Negotiated Rate	$2,172.87
Rate for Payer: BCBS Complete	$2,172.87
Rate for Payer: Mclaren Medicaid	$2,069.26
Rate for Payer: Meridian Medicaid	$2,172.87
Rate for Payer: Priority Health Choice Medicaid	$2,069.26
Rate for Payer: UHCCP Medicaid	$2,069.26

EXCISION, PREPATELLAR BURSA

Facility

$2,463.31

Service Code	CPT 27340
Hospital Revenue Code	360
Min. Negotiated Rate	$2,345.85
Max. Negotiated Rate	$2,463.31
Rate for Payer: BCBS Complete	$2,463.31
Rate for Payer: Mclaren Medicaid	$2,345.85
Rate for Payer: Meridian Medicaid	$2,463.31
Rate for Payer: Priority Health Choice Medicaid	$2,345.85
Rate for Payer: UHCCP Medicaid	$2,345.85

EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM

Facility

$2,172.87

Service Code	CPT 22900
Hospital Revenue Code	360
Min. Negotiated Rate	$2,069.26
Max. Negotiated Rate	$2,172.87
Rate for Payer: BCBS Complete	$2,172.87
Rate for Payer: Mclaren Medicaid	$2,069.26
Rate for Payer: Meridian Medicaid	$2,172.87
Rate for Payer: Priority Health Choice Medicaid	$2,069.26
Rate for Payer: UHCCP Medicaid	$2,069.26

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,230.09

Service Code	CPT 21931
Hospital Revenue Code	360
Min. Negotiated Rate	$1,171.43
Max. Negotiated Rate	$1,230.09
Rate for Payer: BCBS Complete	$1,230.09
Rate for Payer: Mclaren Medicaid	$1,171.43
Rate for Payer: Meridian Medicaid	$1,230.09
Rate for Payer: Priority Health Choice Medicaid	$1,171.43
Rate for Payer: UHCCP Medicaid	$1,171.43

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,230.09

Service Code	CPT 21930
Hospital Revenue Code	360
Min. Negotiated Rate	$1,171.43
Max. Negotiated Rate	$1,230.09
Rate for Payer: BCBS Complete	$1,230.09
Rate for Payer: Mclaren Medicaid	$1,171.43
Rate for Payer: Meridian Medicaid	$1,230.09
Rate for Payer: Priority Health Choice Medicaid	$1,171.43
Rate for Payer: UHCCP Medicaid	$1,171.43

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

Facility

$2,172.87

Service Code	CPT 21933
Hospital Revenue Code	360
Min. Negotiated Rate	$2,069.26
Max. Negotiated Rate	$2,172.87
Rate for Payer: BCBS Complete	$2,172.87
Rate for Payer: Mclaren Medicaid	$2,069.26
Rate for Payer: Meridian Medicaid	$2,172.87
Rate for Payer: Priority Health Choice Medicaid	$2,069.26
Rate for Payer: UHCCP Medicaid	$2,069.26

EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER

Facility

$1,230.09

Service Code	CPT 21012
Hospital Revenue Code	360
Min. Negotiated Rate	$1,171.43
Max. Negotiated Rate	$1,230.09
Rate for Payer: BCBS Complete	$1,230.09
Rate for Payer: Mclaren Medicaid	$1,171.43
Rate for Payer: Meridian Medicaid	$1,230.09
Rate for Payer: Priority Health Choice Medicaid	$1,171.43
Rate for Payer: UHCCP Medicaid	$1,171.43

EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; LESS THAN 1.5 CM

Facility

$1,230.09

Service Code	CPT 28043
Hospital Revenue Code	360
Min. Negotiated Rate	$1,171.43
Max. Negotiated Rate	$1,230.09
Rate for Payer: BCBS Complete	$1,230.09
Rate for Payer: Mclaren Medicaid	$1,171.43
Rate for Payer: Meridian Medicaid	$1,230.09
Rate for Payer: Priority Health Choice Medicaid	$1,171.43
Rate for Payer: UHCCP Medicaid	$1,171.43

EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,230.09

Service Code	CPT 25075
Hospital Revenue Code	360
Min. Negotiated Rate	$1,171.43
Max. Negotiated Rate	$1,230.09
Rate for Payer: BCBS Complete	$1,230.09
Rate for Payer: Mclaren Medicaid	$1,171.43
Rate for Payer: Meridian Medicaid	$1,230.09
Rate for Payer: Priority Health Choice Medicaid	$1,171.43
Rate for Payer: UHCCP Medicaid	$1,171.43

EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$2,172.87

Service Code	CPT 27632
Hospital Revenue Code	360
Min. Negotiated Rate	$2,069.26
Max. Negotiated Rate	$2,172.87
Rate for Payer: BCBS Complete	$2,172.87
Rate for Payer: Mclaren Medicaid	$2,069.26
Rate for Payer: Meridian Medicaid	$2,172.87
Rate for Payer: Priority Health Choice Medicaid	$2,069.26
Rate for Payer: UHCCP Medicaid	$2,069.26

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$2,172.87

Service Code	CPT 21552
Hospital Revenue Code	360
Min. Negotiated Rate	$2,069.26
Max. Negotiated Rate	$2,172.87
Rate for Payer: BCBS Complete	$2,172.87
Rate for Payer: Mclaren Medicaid	$2,069.26
Rate for Payer: Meridian Medicaid	$2,172.87
Rate for Payer: Priority Health Choice Medicaid	$2,069.26
Rate for Payer: UHCCP Medicaid	$2,069.26

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,230.09

Service Code	CPT 21555
Hospital Revenue Code	360
Min. Negotiated Rate	$1,171.43
Max. Negotiated Rate	$1,230.09
Rate for Payer: BCBS Complete	$1,230.09
Rate for Payer: Mclaren Medicaid	$1,171.43
Rate for Payer: Meridian Medicaid	$1,230.09
Rate for Payer: Priority Health Choice Medicaid	$1,171.43
Rate for Payer: UHCCP Medicaid	$1,171.43

Know your out-of-pocket cost for care.

All Charges