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 |
|---|---|---|---|---|
| Polycentric hinge pair HCPCS L6600 | not published | not published | $206.68 – $337.57 | 20 |
| Polysom <6 yrs cpap/bilvl CPT 95783 | not published | not published | $1,180.12 – $1,180.12 | 1 |
| Polysom any age 1-3> param CPT 95808 | not published | not published | $242.50 – $242.50 | 1 |
| Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap CPT 95811 | $12,532.80 | $12,532.80 | $325.44 – $325.44 | 1 |
| Polyvalent mult org ea ag ia CPT 87451 | not published | not published | $4.73 – $31.53 | 23 |
| Porfimer sodium injection HCPCS J9600 | not published | not published | $27,987.60 – $64,205.31 | 3 |
| Portable 02 contents, gas HCPCS E0443 | not published | not published | $55.67 – $90.93 | 20 |
| Portable 02 contents, liquid HCPCS E0444 | not published | not published | $55.67 – $90.93 | 20 |
| Positional nystagmus test CPT 92532 | not published | not published | $25.17 – $25.17 | 1 |
| Post-coital mucous exam HCPCS Q0115 | not published | not published | $11.25 – $75.00 | 22 |
| Postop applicat rigid dsg on HCPCS L6388 | not published | not published | $484.39 – $791.17 | 20 |
| Postop app non-wgt bear dsg HCPCS L5450 | not published | not published | $451.07 – $736.75 | 20 |
| Postop app non-wgt bear dsg HCPCS L5460 | not published | not published | $600.98 – $981.59 | 20 |
| Postop dress & 1 cast chg bk HCPCS L5400 | not published | not published | $1,500.50 – $2,450.81 | 20 |
| Postop dsg & 1 cast chg ak/d HCPCS L5420 | not published | not published | $1,838.81 – $3,003.39 | 20 |
| Postop dsg ak ea add cast ch HCPCS L5430 | not published | not published | $554.46 – $905.62 | 20 |
| Postop dsg bk ea add cast ch HCPCS L5410 | not published | not published | $460.36 – $751.92 | 20 |
| Postop dsg cast chg elb dis/ HCPCS L6382 | not published | not published | $2,024.72 – $3,307.04 | 20 |
| Postop dsg cast chg wrst/elb HCPCS L6380 | not published | not published | $1,345.82 – $2,198.16 | 20 |
| Postop ea cast chg & realign HCPCS L6386 | not published | not published | $442.48 – $722.71 | 20 |
| Post-operative body jacket HCPCS L1310 | not published | not published | $1,777.67 – $2,903.53 | 20 |
| Post-op hip abduct custom fa HCPCS L1685 | not published | not published | $1,535.39 – $2,507.81 | 20 |
| Post op service lvrs min 6 HCPCS G0305 | not published | not published | $1,156.71 – $1,156.71 | 1 |
| Potassium 24 hour urine CPT 84133 | $258.00 | $258.00 | $2.13 – $14.19 | 23 |
| Potassium chloride 10 meq/100ml in sterile water intravenous piggyback HCPCS J3480 | not published | not published | $0.14 – $0.32 | 3 |
| Potassium hydroxide preps HCPCS Q0112 | not published | not published | $2.62 – $17.49 | 22 |
| Potassium serum/plasma/whole blood CPT 84132 | not published | not published | $2.14 – $14.28 | 23 |
| Pouch clsd w barr attached HCPCS A5051 | not published | not published | $2.65 – $4.32 | 20 |
| Pouch drainable w barrier at HCPCS A5061 | not published | not published | $4.54 – $7.41 | 20 |
| Pouch high output 2pc 50mm red HCPCS A4413 | not published | not published | $7.06 – $11.54 | 20 |
| Pouch ostmy flat lk n 2.5in roll premier 1pc trnsp HCPCS A4388 | not published | not published | $5.59 – $9.13 | 20 |
| Pouch ostmy nb pouchkin ctf HCPCS A5062 | not published | not published | $2.81 – $4.59 | 20 |
| Pouch uros new (both sides) 2.75in clr HCPCS A4432 | not published | not published | $4.60 – $7.51 | 20 |
| Powder prem protct 1oz HCPCS A4371 | not published | not published | $4.68 – $7.64 | 20 |
| Ppp2r2b gen detc abnor allel CPT 81343 | not published | not published | $61.65 – $411.00 | 23 |
| Pq biliary strict dil s&i CPT 74363 | not published | not published | $72.20 – $162.80 | 3 |
| Pq dr cath chg w cont s&i CPT 75984 | $3,935.13 | $3,935.13 | $67.34 – $147.24 | 3 |
| Pralatrexate injection HCPCS J9307 | not published | not published | $370.92 – $1,040.71 | 3 |
| Pralidoxime 1 gram solution for injection HCPCS J2730 | $864.31 | $864.31 | $104.04 – $275.71 | 3 |
| Pr application of long arm splint CPT 29105 | not published | not published | $164.26 – $164.26 | 1 |
| Pr application splint static short arm CPT 29125 | not published | not published | $133.09 – $133.09 | 1 |
| Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes CPT 99406 | not published | not published | $18.20 – $18.20 | 1 |
| Pr debridement open wound topical appl/wound asmt per session 20 sq cm/< CPT 97597 | $985.15 | $985.15 | $61.36 – $138.12 | 20 |
| Pr discharge day management hospital ip/obs <=30 min on ecounter date CPT 99238 | not published | not published | $82.44 – $82.44 | 1 |
| Pr discharge day management hospital ip/obs > 30 min on encounter date CPT 99239 | not published | not published | $113.92 – $113.92 | 1 |
| Prealbumin CPT 84134 | $308.00 | $308.00 | $6.57 – $43.77 | 23 |
| Pr ecg 12 lead report only CPT 93010 | not published | not published | $16.34 – $3,807.00 | 2 |
| Pr ecg external < 48 hours continuous recording/storage r&i by a phys/qhp CPT 93227 | not published | not published | $70.39 – $3,807.00 | 2 |
| Prednisolone acetate inj HCPCS J2650 | not published | not published | $0.64 – $0.64 | 1 |
| Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution HCPCS J7510 | $97.16 | $97.16 | $0.30 – $2.44 | 2 |
| Prednisone 1 mg tablet HCPCS J7512 | not published | not published | $0.01 – $0.03 | 2 |
| Prefab glove for term device HCPCS L6890 | not published | not published | $187.41 – $306.10 | 20 |
| Pregabalin - sendout CPT 80366 | not published | not published | $0.01 – $86.44 | 2 |
| Pregnancy associated plasma protein-a CPT 84163 | not published | not published | $6.77 – $45.15 | 23 |
| Pregnancy Ultrasound (complete, after first trimester) CPT 76805 | not published | not published | $85.04 – $277.55 | 5 |
| Pregnancy Ultrasound (first trimester) CPT 76801 | not published | not published | $42.54 – $222.49 | 5 |
| Pr e&m preventive medicine initial comprehensive new patient 12-17 years CPT 99384 | not published | not published | $71.30 – $71.30 | 1 |
| Pre-op service lvrs 10-15dos HCPCS G0303 | not published | not published | $678.85 – $678.85 | 1 |
| Pre-op service lvrs 1-9 dos HCPCS G0304 | not published | not published | $1,156.71 – $1,156.71 | 1 |
| Pre-op service lvrs complete HCPCS G0302 | not published | not published | $1,156.71 – $1,156.71 | 1 |
| Prep ak ischial direct form HCPCS L5570 | not published | not published | $2,226.38 – $3,636.43 | 20 |
| Prep ak ischial laminated HCPCS L5590 | not published | not published | $2,648.71 – $4,326.22 | 20 |
| Prep ak ischial plast molded HCPCS L5560 | not published | not published | $2,141.49 – $3,497.76 | 20 |
| Prep ak ischial thermo mold HCPCS L5580 | not published | not published | $2,599.15 – $4,245.27 | 20 |
| Prepare donor heart CPT 33944 | not published | not published | $428.28 – $428.28 | 1 |
| Prepare embryo for transfer CPT 89255 | not published | not published | $49.76 – $325.87 | 3 |
| Prep bk ptb laminated socket HCPCS L5540 | not published | not published | $1,994.25 – $3,257.27 | 20 |
| Prep bk ptb open end socket HCPCS L5535 | not published | not published | $1,868.48 – $3,051.85 | 20 |
| Prep bk ptb plaster molded HCPCS L5510 | not published | not published | $1,604.11 – $2,620.04 | 20 |
| Prep bk ptb thermopls molded HCPCS L5530 | not published | not published | $1,903.10 – $3,108.40 | 20 |
| Prep skin to 100cm2 other CPT 15004 | not published | not published | $760.34 – $760.34 | 1 |
| Prep skin to 100cm2 trk/ext CPT 15002 | not published | not published | $657.62 – $657.62 | 1 |
| Prep skn trk/ext adl 100cm2 CPT 15003 | not published | not published | $131.80 – $131.80 | 1 |
| Pressure velocity wire add ves CPT 93572 | not published | not published | $225.65 – $225.65 | 1 |
| Pre-tibial shell molded to p HCPCS L2340 | not published | not published | $563.72 – $920.75 | 20 |
| Pretreatment serum by diff red cell adsorption patient rbc/known phenotype each adsorption ref CPT 86977 | $285.00 | $285.00 | $22.20 – $149.16 | 5 |
| Pretreat rbc absorption reference CPT 86978 | $386.00 | $386.00 | $22.20 – $125.96 | 5 |
| Pretreat rbc density gradient separation reference CPT 86972 | $418.00 | $418.00 | $25.74 – $149.16 | 5 |
| Pretreat rbc w chem/drugs reference CPT 86970 | $136.00 | $136.00 | $1.40 – $104.96 | 5 |
| Pretreat rbc w enzyme reference CPT 86971 | $71.00 | $71.00 | $14.80 – $291.26 | 5 |
| Preventive counseling group CPT 99411 | not published | not published | $59.07 – $59.07 | 1 |
| Preventive counseling group CPT 99412 | not published | not published | $49.35 – $49.35 | 1 |
| Prev med cnsl indiv apprx 15 CPT 99401 | not published | not published | $20.97 – $20.97 | 1 |
| Prev med cnsl indiv apprx 30 CPT 99402 | not published | not published | $63.55 – $63.55 | 1 |
| Prev med cnsl indiv apprx 45 CPT 99403 | not published | not published | $102.87 – $102.87 | 1 |
| Prev med cnsl indiv apprx 60 CPT 99404 | not published | not published | $137.78 – $137.78 | 1 |
| Prgrmg dev eval impltbl sys CPT 93260 | not published | not published | $27.13 – $3,807.00 | 2 |
| Prgrmg dev eval pm/ldls pm CPT 93279 | not published | not published | $23.27 – $3,807.00 | 2 |
| Prgrmg dev eval scrms ip CPT 93285 | not published | not published | $21.98 – $3,807.00 | 2 |
| Prgrmg eval implantable dfb CPT 93282 | not published | not published | $28.47 – $3,807.00 | 2 |
| Prgrmg eval implantable dfb CPT 93283 | not published | not published | $32.36 – $3,807.00 | 2 |
| Prgrmg eval implantable dfb CPT 93284 | not published | not published | $36.69 – $3,807.00 | 2 |
| Prgr stim/pace a/iv drug CPT 93623 | $32,633.86 | $32,633.86 | $411.04 – $411.04 | 1 |
| Pr hospital ip/obs care initial high level per day CPT 99223 | not published | not published | $191.12 – $191.12 | 1 |
| Pr hospital ip/obs care initial moderate level per day CPT 99222 | not published | not published | $148.41 – $148.41 | 1 |
| Pr hospital ip/obs care initial straightforward or low level per day CPT 99221 | not published | not published | $89.87 – $89.87 | 1 |
| Pr hospital ip/obs care subsequent high level per day CPT 99233 | not published | not published | $96.02 – $96.02 | 1 |
| Pr hospital ip/obs care subsequent moderate level per day CPT 99232 | not published | not published | $70.03 – $70.03 | 1 |
| Pr hospital ip/obs care subsequent straightforward or low level per day CPT 99231 | not published | not published | $47.31 – $47.31 | 1 |
| Procainamide 100 mg/ml injection (wrapper) HCPCS J2690 | $2,772.00 | $2,772.00 | $347.64 – $913.00 | 3 |
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.