Icd reliance df4 ib 64cm at Banner Payson Medical Center

807 South Ponderosa Street, Payson, AZ · Banner Health · · NPI 1063923340

Source: hospital's published price file ↗ · Published Mar 2, 2026 · Ingested Aug 12, 2026

$16,591.27

Cash price

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Discounted cash price

What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge.

Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.

Full explanation →

What you pay up front if you don't use insurance.

$32,854.00

Gross charge

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Gross charge (chargemaster price)

The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this.

Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.

Full explanation →

The hospital's undiscounted list price — almost no one pays this.

$641.41 with Health Net vs $59,588.68 with Blue Cross Blue Shield of Arizona — same scan, same building. Share

Negotiated rates by payer
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Negotiated rate

The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.

Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.

Full explanation →

Payer
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Payer

The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on.

Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509.

Full explanation →
Plan
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Plan

The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates.

Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible.

Full explanation →
Negotiated rate vs. cash
Health Net Medicaid $641.41 ↓ -96%
Mercy Care Mercy Medicaid $641.41 ↓ -96%
Banner University Health Plan AZ Medicaid - AHCCCS $641.41 ↓ -96%
Health Choice Arizona, Inc. Medicaid $641.41 ↓ -96%
Arizona Physicians IPA Medicaid $641.41 ↓ -96%
Aetna Banner Employee Plans $1,096.87 ↓ -93%
Arizona Physicians IPA Medicare Advantage $1,104.95 ↓ -93%
Gila River Health Care Corporation Managed Care Program $1,104.95 ↓ -93%
United Healthcare UHC Medicare Advantage $1,104.95 ↓ -93%
UPMC Health Plan Medicare Advantage $1,104.95 ↓ -93%
Blue Cross Blue Shield of Arizona Medicare Advantage $1,104.95 ↓ -93%
Banner University Health Plan Medicare Advantage $1,104.95 ↓ -93%
Mercy Care Mercy Care Advantage $1,104.95 ↓ -93%
Cigna Healthcare of Arizona, Inc. HMO Medicare Advantage Plan/PPO Medicare Advantage Plan $1,104.95 ↓ -93%
Aetna Medicare Advantage $1,104.95 ↓ -93%
Banner Health Medicare Advantage $1,104.95 ↓ -93%
Health Choice Arizona, Inc. Medicare Advantage $1,104.95 ↓ -93%
Kaiser Foundation Health Plan Medicare Advantage $1,104.95 ↓ -93%
TriWest Healthcare Alliance Corp - VA CCN VA Community Care Network $1,104.95 ↓ -93%
TriWest Healthcare Alliance Corp - VA CCN Tricare $1,104.95 ↓ -93%
Health Net Medicare $1,104.95 ↓ -93%
Wellpoint Medicare Advantage HMO $1,104.95 ↓ -93%
Care 1st Medicare Advantage $1,104.95 ↓ -93%
Carelon Medicare Advantage $1,160.20 ↓ -93%
Humana Medicare Advantage $1,171.25 ↓ -93%
Plotkin Health Plotkin Health $1,212.75 ↓ -93%
National Healthcare Solutions Inc (NHSI) and VIP Universal Medical Insurance Group (VUMI) NHSI VUMI $1,212.75 ↓ -93%
Gold Kidney Health Plan Medicare Advantage $1,215.44 ↓ -93%
Arizona Priority Care Medicare Advantage $1,215.44 ↓ -93%
Devoted Health Services Medicare Advantage $1,215.44 ↓ -93%
Aetna Joint Venture $1,428.35 ↓ -91%
Aetna Aetna Qualified Health Plan $1,503.81 ↓ -91%
Health Choice Arizona, Inc. ACA Health Plan $1,576.58 ↓ -90%
Health Net Commerical Exchange Product $1,635.33 ↓ -90%
Aetna Medical Rental $1,732.88 ↓ -90%
Aetna Broad Network $1,784.09 ↓ -89%
United Healthcare UHC Individual Exchange $1,805.65 ↓ -89%
Oscar Health Plan Commercial $1,823.17 ↓ -89%
Quiktrip Corporation Commercial $1,886.50 ↓ -89%
Cigna Healthcare of Arizona, Inc. Commerical/HMO Benefit Plan/Local Flex Plan/Network Benefit Plan/Open Access Plan $2,145.22 ↓ -87%
Arizona Medical Network Commercial $2,425.50 ↓ -85%
Provider Network of America Commercial $2,425.50 ↓ -85%
Blue Cross Blue Shield of Arizona BXBSAZ Neighborhood $44,691.51 ↑ +169%
Blue Cross Blue Shield of Arizona BCBSAZ Alliance/Blue HPN $47,670.94 ↑ +187%
Blue Cross Blue Shield of Arizona BXBSAZ Alliance CHS $50,054.31 ↑ +202%
Blue Cross Blue Shield of Arizona BCBSAZ Medicare $56,915.06 ↑ +243%
Blue Cross Blue Shield of Arizona Commercial $59,588.68 ↑ +259%
Blue Cross Blue Shield of Arizona BCBSAZ Workers Comp $59,588.68 ↑ +259%

Visitor-reported prices

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Icd reliance df4 ib 64cm at other Arizona hospitals

Hospital City Cash price Negotiated range
Mercy Gilbert Medical Center Gilbert $14,056.20 $799.26 – $5,709.00
Banner University Medical Center Phoenix Phoenix $9,396.24 $539.00 – $16,847.44
Banner University Medical Center Tucson Tucson $9,659.08 $539.00 – $36,945.35
Banner University Medical Center South Tucson $9,264.83 $539.00 – $26,021.98
Banner Baywood Medical Center Mesa $8,936.29 $539.00 – $43,304.34
Banner Boswell Medical Center Sun City $8,082.08 $539.00 – $33,065.86
Banner Casa Grande Medical Center Casa Grande $4,293.38 $539.00 – $25,359.98
Banner Del Webb Medical Center Sun City West $8,542.04 $539.00 – $16,847.44

All Arizona hospitals for this procedure →