Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM

Facility

$484.61

Service Code	CPT 11403
Hospital Revenue Code	360
Min. Negotiated Rate	$461.54
Max. Negotiated Rate	$484.61
Rate for Payer: BCBS Complete	$484.61
Rate for Payer: Mclaren Medicaid	$461.54
Rate for Payer: Meridian Medicaid	$484.61
Rate for Payer: Priority Health Choice Medicaid	$461.54

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM

Facility

$1,116.73

Service Code	CPT 11404
Hospital Revenue Code	360
Min. Negotiated Rate	$1,063.55
Max. Negotiated Rate	$1,116.73
Rate for Payer: BCBS Complete	$1,116.73
Rate for Payer: Mclaren Medicaid	$1,063.55
Rate for Payer: Meridian Medicaid	$1,116.73
Rate for Payer: Priority Health Choice Medicaid	$1,063.55

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER OVER 4.0 CM

Facility

$1,116.73

Service Code	CPT 11406
Hospital Revenue Code	360
Min. Negotiated Rate	$1,063.55
Max. Negotiated Rate	$1,116.73
Rate for Payer: BCBS Complete	$1,116.73
Rate for Payer: Mclaren Medicaid	$1,063.55
Rate for Payer: Meridian Medicaid	$1,116.73
Rate for Payer: Priority Health Choice Medicaid	$1,063.55

EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ABDOMEN, INFRAUMBILICAL PANNICULECTOMY

Facility

$4,491.68

Service Code	CPT 15830
Hospital Revenue Code	360
Min. Negotiated Rate	$4,277.79
Max. Negotiated Rate	$4,491.68
Rate for Payer: BCBS Complete	$4,491.68
Rate for Payer: Mclaren Medicaid	$4,277.79
Rate for Payer: Meridian Medicaid	$4,491.68
Rate for Payer: Priority Health Choice Medicaid	$4,277.79

EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM

Facility

$1,116.73

Service Code	CPT 11623
Hospital Revenue Code	360
Min. Negotiated Rate	$1,063.55
Max. Negotiated Rate	$1,116.73
Rate for Payer: BCBS Complete	$1,116.73
Rate for Payer: Mclaren Medicaid	$1,063.55
Rate for Payer: Meridian Medicaid	$1,116.73
Rate for Payer: Priority Health Choice Medicaid	$1,063.55

EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM

Facility

$1,957.20

Service Code	CPT 11626
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$1,957.20
Rate for Payer: BCBS Complete	$1,957.20
Rate for Payer: Mclaren Medicaid	$1,864.00
Rate for Payer: Meridian Medicaid	$1,957.20
Rate for Payer: Priority Health Choice Medicaid	$1,864.00

EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM

Facility

$484.61

Service Code	CPT 11604
Hospital Revenue Code	360
Min. Negotiated Rate	$461.54
Max. Negotiated Rate	$484.61
Rate for Payer: BCBS Complete	$484.61
Rate for Payer: Mclaren Medicaid	$461.54
Rate for Payer: Meridian Medicaid	$484.61
Rate for Payer: Priority Health Choice Medicaid	$461.54

EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN OR MALIGNANT TUMOR, ABERRANT BREAST TISSUE, DUCT LESION, NIPPLE OR AREOLAR LESION (EXCEPT 19300), OPEN, MALE OR FEMALE, 1 OR MORE LESIONS

Facility

$2,625.49

Service Code	CPT 19120
Hospital Revenue Code	360
Min. Negotiated Rate	$559.44
Max. Negotiated Rate	$2,625.49
Rate for Payer: BCBS Complete	$2,625.49
Rate for Payer: BCCCP Commercial	$559.44
Rate for Payer: Mclaren Medicaid	$2,500.47
Rate for Payer: Meridian Medicaid	$2,625.49
Rate for Payer: Priority Health Choice Medicaid	$2,500.47

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

Facility

$1,107.03

Service Code	CPT 25111
Hospital Revenue Code	360
Min. Negotiated Rate	$1,054.31
Max. Negotiated Rate	$1,107.03
Rate for Payer: BCBS Complete	$1,107.03
Rate for Payer: Mclaren Medicaid	$1,054.31
Rate for Payer: Meridian Medicaid	$1,107.03
Rate for Payer: Priority Health Choice Medicaid	$1,054.31

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

Facility

$1,107.03

Service Code	CPT 28090
Hospital Revenue Code	360
Min. Negotiated Rate	$1,054.31
Max. Negotiated Rate	$1,107.03
Rate for Payer: BCBS Complete	$1,107.03
Rate for Payer: Mclaren Medicaid	$1,054.31
Rate for Payer: Meridian Medicaid	$1,107.03
Rate for Payer: Priority Health Choice Medicaid	$1,054.31

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

Facility

$1,107.03

Service Code	CPT 28092
Hospital Revenue Code	360
Min. Negotiated Rate	$1,054.31
Max. Negotiated Rate	$1,107.03
Rate for Payer: BCBS Complete	$1,107.03
Rate for Payer: Mclaren Medicaid	$1,054.31
Rate for Payer: Meridian Medicaid	$1,107.03
Rate for Payer: Priority Health Choice Medicaid	$1,054.31

EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED

Facility

$1,957.20

Service Code	CPT 11772
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$1,957.20
Rate for Payer: BCBS Complete	$1,957.20
Rate for Payer: Mclaren Medicaid	$1,864.00
Rate for Payer: Meridian Medicaid	$1,957.20
Rate for Payer: Priority Health Choice Medicaid	$1,864.00

EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE

Facility

$1,957.20

Service Code	CPT 11771
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$1,957.20
Rate for Payer: BCBS Complete	$1,957.20
Rate for Payer: Mclaren Medicaid	$1,864.00
Rate for Payer: Meridian Medicaid	$1,957.20
Rate for Payer: Priority Health Choice Medicaid	$1,864.00

EXCISION OF SINGLE EXTERNAL PAPILLA OR TAG, ANUS

Facility

$812.82

Service Code	CPT 46220
Hospital Revenue Code	360
Min. Negotiated Rate	$774.12
Max. Negotiated Rate	$812.82
Rate for Payer: BCBS Complete	$812.82
Rate for Payer: Mclaren Medicaid	$774.12
Rate for Payer: Meridian Medicaid	$812.82
Rate for Payer: Priority Health Choice Medicaid	$774.12

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

Facility

$1,957.20

Service Code	CPT 11451
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$1,957.20
Rate for Payer: BCBS Complete	$1,957.20
Rate for Payer: Mclaren Medicaid	$1,864.00
Rate for Payer: Meridian Medicaid	$1,957.20
Rate for Payer: Priority Health Choice Medicaid	$1,864.00

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

Facility

$1,957.20

Service Code	CPT 11450
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$1,957.20
Rate for Payer: BCBS Complete	$1,957.20
Rate for Payer: Mclaren Medicaid	$1,864.00
Rate for Payer: Meridian Medicaid	$1,957.20
Rate for Payer: Priority Health Choice Medicaid	$1,864.00

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

Facility

$1,957.20

Service Code	CPT 11462
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$1,957.20
Rate for Payer: BCBS Complete	$1,957.20
Rate for Payer: Mclaren Medicaid	$1,864.00
Rate for Payer: Meridian Medicaid	$1,957.20
Rate for Payer: Priority Health Choice Medicaid	$1,864.00

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

Facility

$2,229.50

Service Code	CPT 25109
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

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

Facility

$2,229.50

Service Code	CPT 28104
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

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

$484.61

Service Code	CPT 11441
Hospital Revenue Code	360
Min. Negotiated Rate	$461.54
Max. Negotiated Rate	$484.61
Rate for Payer: BCBS Complete	$484.61
Rate for Payer: Mclaren Medicaid	$461.54
Rate for Payer: Meridian Medicaid	$484.61
Rate for Payer: Priority Health Choice Medicaid	$461.54

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

$1,116.73

Service Code	CPT 11443
Hospital Revenue Code	360
Min. Negotiated Rate	$1,063.55
Max. Negotiated Rate	$1,116.73
Rate for Payer: BCBS Complete	$1,116.73
Rate for Payer: Mclaren Medicaid	$1,063.55
Rate for Payer: Meridian Medicaid	$1,116.73
Rate for Payer: Priority Health Choice Medicaid	$1,063.55

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

$1,957.20

Service Code	CPT 11446
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$1,957.20
Rate for Payer: BCBS Complete	$1,957.20
Rate for Payer: Mclaren Medicaid	$1,864.00
Rate for Payer: Meridian Medicaid	$1,957.20
Rate for Payer: Priority Health Choice Medicaid	$1,864.00

EXCISION, PREPATELLAR BURSA

Facility

$2,229.50

Service Code	CPT 27340
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

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

Facility

$1,957.20

Service Code	CPT 22900
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$1,957.20
Rate for Payer: BCBS Complete	$1,957.20
Rate for Payer: Mclaren Medicaid	$1,864.00
Rate for Payer: Meridian Medicaid	$1,957.20
Rate for Payer: Priority Health Choice Medicaid	$1,864.00

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

Facility

$1,116.73

Service Code	CPT 21931
Hospital Revenue Code	360
Min. Negotiated Rate	$1,063.55
Max. Negotiated Rate	$1,116.73
Rate for Payer: BCBS Complete	$1,116.73
Rate for Payer: Mclaren Medicaid	$1,063.55
Rate for Payer: Meridian Medicaid	$1,116.73
Rate for Payer: Priority Health Choice Medicaid	$1,063.55

Know your out-of-pocket cost for care.

All Charges