SUMMIT MEDICAL CENTER
100 SUMMIT BLVD, MT JULIET, TN · Tristarhealth · · NPI 1982650024
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Lidocaine therapeutic drug level CPT 80176 | $176.00 | $176.00 | $6.61 – $44.07 | 23 |
| Lift assist for elbow HCPCS L6635 | not published | not published | $194.07 – $316.98 | 20 |
| Lift heel adj small gl60404sm HCPCS L3332 | not published | not published | $82.03 – $133.98 | 20 |
| Lift heel adjustable med HCPCS L3334 | not published | not published | $42.42 – $69.28 | 20 |
| Lifts elevation metal extens HCPCS L3330 | not published | not published | $629.35 – $1,027.94 | 20 |
| Liletta, 52 mg HCPCS J7297 | not published | not published | $1,122.34 – $3,111.05 | 2 |
| Limb exercise test CPT 95875 | not published | not published | $19.56 – $19.56 | 1 |
| Limited ankle motion ea jnt HCPCS L2200 | not published | not published | $49.17 – $80.31 | 20 |
| Limited autopsy CPT 88036 | not published | not published | $4.10 – $377.84 | 4 |
| Limited autopsy CPT 88037 | not published | not published | $3.64 – $335.84 | 4 |
| Limited motion knee joint HCPCS L2184 | not published | not published | $170.82 – $279.01 | 20 |
| Limited visual field xm CPT 92081 | not published | not published | $7.04 – $7.04 | 1 |
| Lincomycin injection HCPCS J2010 | not published | not published | $7.62 – $14.31 | 3 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $1,759.97 | $1,759.97 | $3.25 – $7.26 | 3 |
| Lipase CPT 83690 | not published | not published | $3.10 – $20.67 | 23 |
| Lipoprotein blood high res frac & quant CPT 83701 | not published | not published | $15.24 – $101.58 | 23 |
| Lipoprotein blood quant CPT 83704 | $70.20 | $70.20 | $15.39 – $102.57 | 23 |
| Lipoprotein direct measurement hdl CPT 83718 | $130.00 | $130.00 | $3.69 – $24.57 | 23 |
| Lipoprotein direct measurement ldl CPT 83721 | not published | not published | $4.73 – $31.50 | 23 |
| Lipoprtn dir meas sd ldl chl CPT 83722 | not published | not published | $15.39 – $102.57 | 23 |
| Lisocabtagene mara car pos t HCPCS Q2054 | not published | not published | $631,423.78 – $1,489,833.29 | 2 |
| Listeria monocytogenes CPT 86723 | not published | not published | $5.94 – $39.57 | 23 |
| Lith ion batt cid, ear level HCPCS L8624 | not published | not published | $179.66 – $293.44 | 20 |
| Lith ion batt cid,non-earlvl HCPCS L8623 | not published | not published | $72.06 – $117.70 | 20 |
| Lithium ion battery charger HCPCS L7368 | not published | not published | $562.35 – $918.50 | 20 |
| Lithium therapeutic drug level CPT 80178 | $130.00 | $130.00 | $2.97 – $19.83 | 23 |
| Liver ds alys 3 bmrk srm alg CPT 81517 | not published | not published | $79.29 – $528.57 | 23 |
| Liver elastography 91200 CPT 91200 | not published | not published | $18.75 – $186.77 | 2 |
| Liver Function Test CPT 80076 | not published | not published | $3.68 – $24.51 | 23 |
| Liver imaging CPT 78201 | $2,811.22 | $2,811.22 | $79.56 – $1,623.62 | 5 |
| Liver imag w/vasclr flow CPT 78202 | not published | not published | $91.72 – $1,623.62 | 5 |
| Liver/spleen imag static only CPT 78215 | $4,375.20 | $4,375.20 | $90.20 – $500.66 | 5 |
| Liver/spleen imag w/vasclr flow CPT 78216 | not published | not published | $85.67 – $471.74 | 5 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | $91.54 – $91.54 | 1 |
| Lockingelbow forearm cntrbal HCPCS L6693 | not published | not published | $3,163.26 – $5,166.65 | 20 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | not published | not published | $1.14 – $2.76 | 3 |
| Lomustine 10 mg HCPCS S0178 | not published | not published | $142.27 – $142.27 | 1 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | not published | not published | $255.95 – $586.23 | 3 |
| Long tongue stirrup HCPCS L2265 | not published | not published | $121.80 – $198.94 | 20 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | not published | not published | $1.63 – $3.74 | 3 |
| Lo rig pos pnl l1-l5 pre ots HCPCS L0641 | not published | not published | $54.49 – $89.01 | 20 |
| Lo sag rig pnl stays pre cst HCPCS L0626 | not published | not published | $86.69 – $141.59 | 20 |
| Loudness balance test CPT 92562 | not published | not published | $19.62 – $19.62 | 1 |
| Low cost skin substitute app HCPCS C5271 | not published | not published | $1,334.44 – $1,334.44 | 1 |
| Low cost skin substitute app HCPCS C5273 | not published | not published | $3,987.72 – $3,987.72 | 1 |
| Low cost skin substitute app HCPCS C5275 | not published | not published | $1,334.44 – $1,334.44 | 1 |
| Low cost skin substitute app HCPCS C5277 | not published | not published | $1,334.44 – $1,334.44 | 1 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | not published | not published | $236.80 – $459.25 | 4 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | not published | not published | $226.72 – $616.10 | 4 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | not published | not published | $154.52 – $459.25 | 4 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $20,105.43 | $20,105.43 | $425.72 – $1,008.04 | 4 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $15,341.70 | $15,341.70 | $331.56 – $756.19 | 4 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $10,093.47 | $10,093.47 | $277.00 – $530.38 | 4 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | not published | not published | $21.62 – $154.52 | 5 |
| Low frequency non-thermal Ultrasound CPT 97610 | not published | not published | $326.12 – $532.67 | 20 |
| Loxapine for inhalation 1 mg HCPCS J2062 | not published | not published | $18.97 – $42.14 | 2 |
| Lso corset front HCPCS L0972 | not published | not published | $120.83 – $197.35 | 20 |
| Lso flex no ri stays pre ots HCPCS L0628 | not published | not published | $58.65 – $95.80 | 20 |
| Lso full corset HCPCS L0976 | not published | not published | $220.49 – $360.14 | 20 |
| Lso r post pnl sj-t9 pre cst HCPCS L0630 | not published | not published | $180.06 – $294.10 | 20 |
| Lso sag-coronal panel custom HCPCS L0638 | not published | not published | $1,466.70 – $2,395.61 | 20 |
| Lso sag-co shell pnl pre ots HCPCS L0651 | not published | not published | $830.48 – $1,356.44 | 20 |
| Lso sag ctr rigi pos pre ots HCPCS L0643 | not published | not published | $113.23 – $184.94 | 20 |
| Lso sagit rigid panel prefab HCPCS L0635 | not published | not published | $1,182.51 – $1,931.43 | 20 |
| Lso sagittal rigid panel cus HCPCS L0636 | not published | not published | $1,744.89 – $2,849.99 | 20 |
| Lso sc r pos/lat pnl pre cst HCPCS L0633 | not published | not published | $318.90 – $520.87 | 20 |
| Lso sc r pos/lat pnl pre ots HCPCS L0649 | not published | not published | $200.49 – $327.47 | 20 |
| Lso s/c shell/panel custom HCPCS L0640 | not published | not published | $1,163.66 – $1,900.65 | 20 |
| Lso s/c shell/panel prefab HCPCS L0639 | not published | not published | $1,513.89 – $2,472.69 | 20 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $9.90 – $65.97 | 23 |
| Lubricant per ounce HCPCS A4402 | not published | not published | $1.74 – $2.84 | 20 |
| Lumbar bolster pad HCPCS L1030 | not published | not published | $87.72 – $143.28 | 20 |
| Lumbar derotation pad HCPCS L1240 | not published | not published | $101.17 – $165.24 | 20 |
| Lumbar diskogram s&i CPT 72295 | $6,053.18 | $6,053.18 | $49.99 – $2,174.18 | 5 |
| Lumbar or lumbar rib pad HCPCS L1040 | not published | not published | $105.59 – $172.46 | 20 |
| Lumbar sling HCPCS L1090 | not published | not published | $94.80 – $154.84 | 20 |
| Lumizyme injection HCPCS J0221 | not published | not published | $246.44 – $549.58 | 3 |
| Lung function test (mbc/mvv) CPT 94200 | $247.10 | $247.10 | $11.69 – $11.69 | 1 |
| Lung Function Test (Spirometry) CPT 94010 | $1,030.08 | $1,030.08 | $19.86 – $19.86 | 1 |
| Lung perfusion imaging CPT 78580 | $4,774.44 | $4,774.44 | $136.04 – $570.00 | 5 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | not published | not published | $250.68 – $558.57 | 3 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | not published | not published | $50.42 – $113.34 | 3 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | not published | not published | $358.85 – $850.04 | 3 |
| Lutetium lu 177 vipivotide HCPCS A9607 | not published | not published | $292.22 – $687.20 | 3 |
| Lvad shower bag heartmate HCPCS Q0501 | not published | not published | $569.02 – $929.41 | 20 |
| Lwr ext dynamic prosth pylon HCPCS L5985 | not published | not published | $314.62 – $513.88 | 20 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $9.02 – $60.15 | 23 |
| Lymphatics/lymph node imaging CPT 78195 | $5,669.64 | $5,669.64 | $164.68 – $837.27 | 5 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $16.45 – $109.68 | 23 |
| Lymphocyte transformation mitogen CPT 86353 | not published | not published | $22.06 – $147.09 | 23 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $71.34 – $568.53 | 23 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $21.42 – $142.77 | 23 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $159.12 – $826.97 | 5 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $193.08 – $1,842.44 | 5 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $150.64 – $3,722.48 | 5 |
| Lymph vessel x-ray trunk CPT 75807 | not published | not published | $205.68 – $3,724.33 | 5 |
| Lyumjev for insulin pump use HCPCS J1813 | not published | not published | $19.26 – $40.02 | 2 |
| Macro exam dissect molec study ea CPT 88387 | not published | not published | $5.66 – $27.84 | 5 |
| Macroscopic exam arthropod CPT 87168 | not published | not published | $1.92 – $12.81 | 23 |
| Macroscopic exam parasite CPT 87169 | $92.13 | $92.13 | $1.94 – $12.93 | 23 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.