Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$1,116.73

Service Code	CPT 21930
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, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

Facility

$1,957.20

Service Code	CPT 21933
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, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM

Facility

$1,957.20

Service Code	CPT 21932
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 FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); 2 CM OR GREATER

Facility

$1,957.20

Service Code	CPT 21014
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 FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER

Facility

$1,116.73

Service Code	CPT 21012
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, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; LESS THAN 2 CM

Facility

$1,116.73

Service Code	CPT 21011
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, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; LESS THAN 1.5 CM

Facility

$1,116.73

Service Code	CPT 28043
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, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,116.73

Service Code	CPT 25075
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, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,957.20

Service Code	CPT 27632
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 NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,957.20

Service Code	CPT 21552
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 NECK OR ANTERIOR THORAX, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,116.73

Service Code	CPT 21555
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, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

Facility

$1,957.20

Service Code	CPT 21554
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 NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM

Facility

$1,957.20

Service Code	CPT 21556
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 PELVIS AND HIP AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,957.20

Service Code	CPT 27043
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 SHOULDER AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,116.73

Service Code	CPT 23071
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, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,116.73

Service Code	CPT 23075
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, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,957.20

Service Code	CPT 27337
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 THIGH OR KNEE AREA, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,116.73

Service Code	CPT 27327
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, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

Facility

$1,957.20

Service Code	CPT 27339
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 UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,957.20

Service Code	CPT 24071
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

EYELASH TINTING

Professional

Both

$30.00

Service Code	HCPCS 00176
Hospital Revenue Code	960
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$21.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00

EZETIMIBE 10 MG TABLET

Facility

$76.95

Service Code	NDC 0781-5690-31
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$46.93
Max. Negotiated Rate	$69.26
Rate for Payer: Aetna Commercial	$65.41
Rate for Payer: BCBS Trust/PPO	$59.47
Rate for Payer: BCN Commercial	$59.47
Rate for Payer: Cash Price	$61.56
Rate for Payer: Cofinity Commercial	$66.18
Rate for Payer: Encore Health Key Benefits Commercial	$61.56
Rate for Payer: Healthscope Commercial	$69.26
Rate for Payer: Lakeland Regional Health Systems Commercial	$57.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.41
Rate for Payer: PHP Commercial	$65.41
Rate for Payer: Priority Health Cigna Priority Health	$53.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$66.95
Rate for Payer: Priority Health Narrow/Tiered Network	$46.93
Rate for Payer: UHC All Payor (Choice/PPO)	$67.72
Rate for Payer: UHC Core	$64.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$57.71

EZETIMIBE 10 MG TABLET

Facility

$482.41

Service Code	NDC 0904-7103-04
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$294.22
Max. Negotiated Rate	$434.17
Rate for Payer: Aetna Commercial	$410.05
Rate for Payer: BCBS Trust/PPO	$372.81
Rate for Payer: BCN Commercial	$372.81
Rate for Payer: Cash Price	$385.93
Rate for Payer: Cofinity Commercial	$414.87
Rate for Payer: Encore Health Key Benefits Commercial	$385.93
Rate for Payer: Healthscope Commercial	$434.17
Rate for Payer: Lakeland Regional Health Systems Commercial	$361.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$410.05
Rate for Payer: PHP Commercial	$410.05
Rate for Payer: Priority Health Cigna Priority Health	$337.69
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$419.70
Rate for Payer: Priority Health Narrow/Tiered Network	$294.22
Rate for Payer: UHC All Payor (Choice/PPO)	$424.52
Rate for Payer: UHC Core	$402.81
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$361.81

EZETIMIBE 10 MG TABLET

Facility

$66.27

Service Code	NDC 67877-490-30
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$40.42
Max. Negotiated Rate	$59.64
Rate for Payer: Aetna Commercial	$56.33
Rate for Payer: BCBS Trust/PPO	$51.21
Rate for Payer: BCN Commercial	$51.21
Rate for Payer: Cash Price	$53.02
Rate for Payer: Cofinity Commercial	$56.99
Rate for Payer: Encore Health Key Benefits Commercial	$53.02
Rate for Payer: Healthscope Commercial	$59.64
Rate for Payer: Lakeland Regional Health Systems Commercial	$49.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.33
Rate for Payer: PHP Commercial	$56.33
Rate for Payer: Priority Health Cigna Priority Health	$46.39
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$57.65
Rate for Payer: Priority Health Narrow/Tiered Network	$40.42
Rate for Payer: UHC All Payor (Choice/PPO)	$58.32
Rate for Payer: UHC Core	$55.34
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$49.70

EZETIMIBE 10 MG TABLET

Facility

$1,190.92

Service Code	NDC 66582-414-31
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$726.34
Max. Negotiated Rate	$1,071.83
Rate for Payer: Aetna Commercial	$1,012.28
Rate for Payer: BCBS Trust/PPO	$920.34
Rate for Payer: BCN Commercial	$920.34
Rate for Payer: Cash Price	$952.74
Rate for Payer: Cofinity Commercial	$1,024.19
Rate for Payer: Encore Health Key Benefits Commercial	$952.74
Rate for Payer: Healthscope Commercial	$1,071.83
Rate for Payer: Lakeland Regional Health Systems Commercial	$893.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,012.28
Rate for Payer: PHP Commercial	$1,012.28
Rate for Payer: Priority Health Cigna Priority Health	$833.64
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,036.10
Rate for Payer: Priority Health Narrow/Tiered Network	$726.34
Rate for Payer: UHC All Payor (Choice/PPO)	$1,048.01
Rate for Payer: UHC Core	$994.42
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$893.19

Know your out-of-pocket cost for care.

All Charges