Banner Payson Medical Center
807 South Ponderosa Street, Payson, AZ · Banner Health · · NPI 1063923340
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 |
|---|---|---|---|---|
| 11-desoxycortisol - sendout CPT 82634 | $41.36 | $88.00 | $29.28 – $79.20 | 27 |
| 17-hydroxypregnenolone CPT 84143 | $32.43 | $69.00 | $22.81 – $62.10 | 27 |
| 17-ketosteroids CPT 83586 | $37.60 | $80.00 | $12.80 – $72.00 | 27 |
| 3d recon without postprocess indpndt CPT 76376 | $89.94 | $146.00 | $34.75 – $131.40 | 27 |
| 5' nucleotidase - sendout CPT 83915 | $46.53 | $99.00 | $11.15 – $89.10 | 27 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | $25.99 | $71.00 | $12.01 – $63.90 | 27 |
| Abd aorta w/runoff s&i CPT 75630 | $471.23 | $833.00 | $267.67 – $749.70 | 27 |
| Abdominal and Pelvic Blood Vessel Ultrasound (complete) CPT 93975 | $322.46 | $669.00 | $166.84 – $602.10 | 27 |
| Abdominal and Pelvic Blood Vessel Ultrasound (limited) CPT 93976 | $187.98 | $390.00 | $79.00 – $351.00 | 27 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $933.57 | $1,845.00 | $129.45 – $1,660.50 | 27 |
| Abdominal CT scan (with contrast) CPT 74160 | $778.23 | $1,538.00 | $129.45 – $1,384.20 | 27 |
| Abdominal CT scan (without contrast) CPT 74150 | $622.38 | $1,230.00 | $79.00 – $1,107.00 | 27 |
| Abdominal MRI (with and without contrast) CPT 74183 | $983.10 | $1,740.00 | $266.89 – $1,566.00 | 27 |
| Abdominal MRI (with contrast) CPT 74182 | $819.25 | $1,450.00 | $266.89 – $1,305.00 | 27 |
| Abdominal MRI (without contrast) CPT 74181 | $655.40 | $1,160.00 | $166.84 – $1,044.00 | 27 |
| Abdominal paracentesis w/image guidance CPT 49083 | $343.55 | $616.00 | $252.56 – $554.40 | 27 |
| Abdominal Ultrasound (complete) CPT 76700 | $356.66 | $579.00 | $79.00 – $521.10 | 27 |
| Abdominal Ultrasound (limited) CPT 76705 | $266.11 | $432.00 | $79.00 – $388.80 | 27 |
| Abdominal X-ray (2 views) CPT 74019 | $121.37 | $229.00 | $79.00 – $206.10 | 27 |
| Abdominal X-ray Series (acute, with chest view) CPT 74022 | $175.96 | $332.00 | $79.00 – $298.80 | 27 |
| Abdominal X-ray (single view) CPT 74018 | $66.78 | $126.00 | $51.28 – $113.40 | 27 |
| Abd paracentesis/w/o image guide 49082 CPT 49082 | $190.96 | $397.00 | $162.77 – $357.30 | 27 |
| Abl1 gene CPT 81170 | $403.20 | $900.00 | $300.00 – $810.00 | 27 |
| Ablate bone tumor(s) perq CPT 20982 | $3,710.92 | $7,715.00 | $1,170.00 – $6,943.50 | 27 |
| Ablate pulm tumor perq rf CPT 32998 | $4,165.46 | $8,660.00 | $2,366.93 – $5,195.70 | 27 |
| Abscess drain retroperitoneal surg code CPT 49406 | $900.91 | $1,873.00 | $767.93 – $1,685.70 | 27 |
| Acetylcholine receptor modulating antibody CPT 86043 | $28.55 | $78.00 | $12.05 – $70.20 | 27 |
| Acute hepatitis panel CPT 80074 | $56.40 | $120.00 | $47.63 – $108.00 | 27 |
| Acyclovir 400 mg tablet HCPCS J8499 | $0.54 | $4.90 | $0.01 – $0.05 | 27 |
| #acylcarnitineprfl CPT 82017 | $54.05 | $115.00 | $16.87 – $103.50 | 27 |
| Adapter b 8 channel 10cm HCPCS C1883 | $11,061.52 | $21,904.00 | $267.99 – $1,013.40 | 27 |
| Adenovirus antibody,serum - quest CPT 86603 | $22.33 | $61.00 | $12.87 – $54.90 | 27 |
| Adh-sendout CPT 84588 | $47.94 | $102.00 | $33.94 – $91.80 | 27 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $7.07 | $45.00 | $18.32 – $40.50 | 27 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $15.54 | $99.00 | $40.29 – $89.10 | 27 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $31.56 | $201.00 | $81.81 – $180.90 | 27 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $67.61 | $191.00 | $77.74 – $171.90 | 27 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $75.76 | $214.00 | $44.93 – $192.60 | 27 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $195.41 | $552.00 | $44.93 – $496.80 | 27 |
| Administration immunization each additional vaccine CPT 90472 | $10.53 | $30.00 | $12.21 – $27.00 | 27 |
| Administration vaccine hepatitis b HCPCS G0010 | $21.06 | $60.00 | $24.42 – $54.00 | 27 |
| Administration vaccine influenza virus HCPCS G0008 | $21.06 | $60.00 | $24.42 – $54.00 | 27 |
| Administration vaccine pneumococcal HCPCS G0009 | $21.06 | $60.00 | $24.42 – $54.00 | 27 |
| Adrenalin epinephrine inject HCPCS J0171 | $0.01 | $0.04 | $0.01 – $0.04 | 27 |
| Aep hearing status deter i&r CPT 92651 | $107.48 | $190.00 | $77.33 – $171.00 | 27 |
| _afb id by dna probe rflx ast CPT 87149 | $34.53 | $73.00 | $20.05 – $65.70 | 27 |
| #afb mycobacteria suscep. #1 CPT 87190 | $29.80 | $63.00 | $7.31 – $56.70 | 27 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $164.13 | $347.00 | $50.00 – $312.30 | 27 |
| Airway resistance by impulse oscillometry 94728 CPT 94728 | $99.97 | $193.00 | $78.55 – $173.70 | 27 |
| Albumin body fluid quantitative each specimen CPT 82042 | $27.26 | $58.00 | $7.78 – $21.60 | 27 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $56.37 | $165.30 | $42.46 – $148.77 | 27 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $31.96 | $68.00 | $5.78 – $50.40 | 27 |
| Albumin serum plasma or whole blood CPT 82040 | $29.61 | $63.00 | $4.95 – $37.80 | 27 |
| Alkaline phosphatase CPT 84075 | $26.79 | $57.00 | $5.18 – $37.80 | 27 |
| Allergen alpha lactalbumin ige CPT 86008 | $29.28 | $80.00 | $17.93 – $57.60 | 27 |
| Allergen egg white ige CPT 86003 | $20.50 | $56.00 | $5.22 – $49.50 | 27 |
| Allergen specific ige qual multi scrn ea CPT 86005 | $21.59 | $59.00 | $7.97 – $50.40 | 27 |
| Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet HCPCS Q4100 | $424.70 | $841.00 | $121.19 – $756.90 | 27 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $438.09 | $867.50 | $59.53 – $371.79 | 27 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $8,849.62 | $17,524.00 | $641.41 – $2,425.50 | 27 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | $91.18 | $194.00 | $64.41 – $174.60 | 27 |
| Alpha-fetoprotein amniotic CPT 82106 | $23.97 | $51.00 | $17.00 – $45.90 | 27 |
| Alpha-fetoprotein tumor marker CPT 82105 | $23.97 | $51.00 | $16.77 – $45.90 | 27 |
| Alt/sgpt CPT 84460 | $27.73 | $59.00 | $5.30 – $38.70 | 27 |
| Aluminum - quest CPT 82108 | $36.19 | $77.00 | $25.48 – $69.30 | 27 |
| Amantadine (symmetrel)-sendout CPT 80375 | $87.89 | $187.00 | $21.66 – $81.90 | 27 |
| Aminolevulinic acid delta CPT 82135 | $35.25 | $75.00 | $16.45 – $67.50 | 27 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $1.20 | $6.20 | $0.51 – $5.58 | 27 |
| Amitriptyline (elavil) -sendout CPT 80335 | $31.96 | $68.00 | $7.38 – $27.90 | 27 |
| Ammonia CPT 82140 | $54.05 | $115.00 | $14.57 – $39.60 | 27 |
| Amniocentesisdiagnostic 59000 CPT 59000 | $254.45 | $529.00 | $216.89 – $476.10 | 27 |
| Amniocentesis therapeutic CPT 59001 | $561.81 | $1,168.00 | $204.07 – $1,051.20 | 27 |
| Amphetamine confirm urine -sendout CPT 80324 | $73.32 | $156.00 | $13.33 – $50.40 | 27 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $0.16 | $0.83 | $0.34 – $0.75 | 27 |
| Amp metatarsal w/toe single 28810 CPT 28810 | not published | not published | $2,052.04 – $3,372.77 | 6 |
| Amputation leg; tib/fib f/u 27886 CPT 27886 | not published | not published | $4,542.09 – $10,128.08 | 6 |
| Amputation thru metatarsal CPT 28805 | not published | not published | $2,052.04 – $10,128.08 | 6 |
| Amputation toe interphalangeal joint CPT 28825 | not published | not published | $2,052.04 – $3,372.77 | 6 |
| Amputation toe metatarsophalangeal joint CPT 28820 | not published | not published | $2,052.04 – $3,372.77 | 6 |
| Amylase CPT 82150 | $160.27 | $341.00 | $6.48 – $18.00 | 27 |
| Analgesics non-opioid definitive assay 1 or 2 acetaminophen CPT 80329 | $78.02 | $166.00 | $39.51 – $149.40 | 27 |
| Anal pressure record CPT 91122 | $423.20 | $736.00 | $191.73 – $662.40 | 27 |
| Analysis gene f2 20210g>a variant CPT 81240 | $88.70 | $198.00 | $65.69 – $178.20 | 27 |
| Analysis gene f5 leiden variant CPT 81241 | $99.01 | $221.00 | $73.37 – $198.90 | 27 |
| Anca screen with reflex to titer -quest CPT 86021 | $20.13 | $55.00 | $15.05 – $41.40 | 27 |
| An cholangiogram percutaneous compl CPT 47531 | $255.89 | $532.00 | $218.12 – $478.80 | 27 |
| An fluoro guide for cvp CPT 77001 | $206.70 | $390.00 | $92.82 – $351.00 | 27 |
| Angiotensin ii CPT 82163 | $41.83 | $89.00 | $20.52 – $80.10 | 27 |
| Angiotensin ii 0.5 mg/ml soln 1 ml vial HCPCS J3490 | $2,974.73 | $5,258.50 | $0.30 – $1.89 | 27 |
| Ankle arthroscopy/surgery CPT 29891 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Ankle arthroscopy/surgery CPT 29895 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Ankle X-ray CPT 73610 | $102.82 | $194.00 | $58.65 – $174.60 | 27 |
| Ankle X-ray (2 views, both ankles) CPT 73600 | $94.34 | $178.00 | $58.65 – $160.20 | 27 |
| Anoscopy remove fb 46608 CPT 46608 | not published | not published | $575.40 – $2,518.60 | 6 |
| Antibody bacterium, not elsewhere specified CPT 86609 | $56.00 | $153.00 | $12.88 – $137.70 | 27 |
| Antibody elution rbc reference CPT 86860 | $133.59 | $365.00 | $100.01 – $328.50 | 27 |
| Antibody htlv/hiv confirm test CPT 86689 | $184.10 | $503.00 | $19.35 – $424.80 | 27 |
| Antibody htlv-i CPT 86687 | $10.25 | $28.00 | $9.09 – $25.20 | 27 |
| Antibody identification platelet antibodies heparin-pf4 igg CPT 86022 | $87.47 | $239.00 | $18.37 – $50.40 | 27 |
| Antibody id rbc panel CPT 86870 | $349.00 | $762.00 | $100.01 – $685.80 | 27 |
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.