SGMC BERRIEN CAMPUS — Hospital Ledger

45 CFR § 180 compliance

B · 85

This hospital published most of what § 180 requires.

●Machine-readable file published

●Gross / standard charges

●Discounted cash price

●Payer-specific negotiated rates

○Min / max negotiated charges

●Free, public, no login required

Procedures listed

165

Insurances with rates

CPT / HCPCS codes

144

Source MRF

xlsx ↗

Most expensive procedures (gross)

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
0152U	HC NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ "THE KARIUS TEST"	$3,790	$2,843	—	—	16
G0121	Hc Colon Ca Scrn Low G0121	$2,870	$2,153	—	—	16
G0105	Hc Colon Ca Scrn Hi G0105	$2,866	$2,150	—	—	16
Hc Perq Drainage Pleura Insert Cath W/ Imaging	Hc Perq Drainage Pleura Insert Cath W/ Imaging	$2,485	$1,864	—	—	16
Hc Egd W Orbera Placement	Hc Egd W Orbera Placement	$1,910	$1,433	—	—	16
Hc Egd W Orbera Removal	Hc Egd W Orbera Removal	$1,910	$1,433	—	—	16
G0104	Hc Flx Sig Cancer Scr G0104	$1,570	$1,178	—	—	16
J7298	Pr Levonorgesterl-releasing Intrauterine Contraceptive System (mirena)	$1,204	$903	—	—	16
Pr Veeg>36<60 Hr (2 Day)	Pr Veeg>36<60 Hr (2 Day)	$639	$479	—	—	16
J0588	Incobotulinumtoxin a	$583	$438	—	—	16
J1670	TETANUS IMMUNE GLOBULIN INJ	$560	$420	—	—	16
G0438	PPPS, initial visit	$430	$323	—	—	16
J0561	Penicillin g benzathine inj	$397	$298	—	—	16
Q4004	CAST SUP SHOULDER CAST FBRGL	$335	$251	—	—	16
G0402	Initial preventive exam	$328	$246	—	—	16
Q4026	CAST SUP HIP SPICA FIBERGLAS	$325	$244	—	—	16
J2785	Regadenoson injection	$305	$229	—	—	16
G0439	PPPS, subseq visit	$290	$218	—	—	16
A9500	Tc99m sestamibi	$263	$197	—	—	16
Q4030	CAST SUP LONG LEG FIBERGLASS	$210	$158	—	—	16
J9030	BCG LIVE INTRAVESICAL VAC	$208	$156	—	—	16
Q4034	CAST SUP LNG LEG CYLINDER FB	$185	$139	—	—	16
G0455	Fecal microbiota prep instil	$183	$137	—	—	16
G0108	Hc Dsme-ind-30 Minutes	$181	$136	—	—	16
Q4028	CAST SUP HIP SPICA PED FBRGL	$164	$123	—	—	16
J1610	GLUCAGON HYDROCHLORIDE/1 MG	$138	$104	—	—	16
A9300	EXERCISE EQUIPMENT	$135	$101	—	—	16
G0180	MD CERTIFICATION HHA PATIENT	$134	$101	—	—	16
Q4038	CAST SUP SHRT LEG FIBERGLASS	$114	$85.5	—	—	16
J1050	Medroxyprogesterone acetate	$106	$79.5	—	—	16
Hc Diabete Ed 30m-mcare Only	Hc Diabete Ed 30m-mcare Only	$105	$78.75	—	—	16
Q4032	CAST SUP LNG LEG PED FBRGLS	$105	$78.75	—	—	16
J2997	ALTEPLASE RECOMBINANT	$104	$78	—	—	16
Q4025	CAST SUP HIP SPICA PLASTER	$104	$78	—	—	16
G0179	MD RECERTIFICATION HHA PT	$102	$76.5	—	—	16
Q4003	CAST SUP SHOULDER CAST PLSTR	$97	$72.75	—	—	16
J2790	RHO D IMMUNE GLOBULIN INJ	$94.37	$70.78	—	—	16
Q4042	CAST SUP LNG LEG SPLNT FBRGL	$94	$70.5	—	—	16
Hc Mac Anesth Add 15 Min	Hc Mac Anesth Add 15 Min	$93	$69.75	—	—	16
Hc General Anesth Add 15 Min	Hc General Anesth Add 15 Min	$93	$69.75	—	—	16
Q4036	CAST SUP LNGLEG CYLNDR PED F	$93	$69.75	—	—	16
A9505	TL201 thallium	$92	$69	—	—	16
G0168	Hc Wound Closure By Adh G0168	$90	$67.5	—	—	16
G0463	Hospital outpt clinic visit	$90	$67.5	—	—	16
J1956	LEVOFLOXACIN INJECTION	$87	$65.25	—	—	16
J3030	SUMATRIPTAN SUCCINATE / 6 MG	$87	$65.25	—	—	16
Q4006	CAST SUP LONG ARM ADULT FBRG	$81	$60.75	—	—	16
Q4029	CAST SUP LONG LEG PLASTER	$80	$60	—	—	16
Hc Block Monitor Add 15 Min	Hc Block Monitor Add 15 Min	$78	$58.5	—	—	16
Q4014	CAST SUP GAUNTLET FIBERGLASS	$75	$56.25	—	—	16

Showing top 50 of 165 priced procedures, sorted by gross charge.

Data straight from this hospital's federally-mandated machine-readable file (45 CFR § 180). The compliance grade reflects how completely the hospital published the six required data elements, not the quality of care.