Tc-99m pentetate dtpa 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

$143.33

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.

$281.60

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.

$35.72 with Health Net vs $253.44 with Provider Network of America — 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 $35.72 ↓ -75%
Health Choice Arizona, Inc. Medicaid $35.72 ↓ -75%
Mercy Care Mercy Medicaid $35.72 ↓ -75%
Banner University Health Plan AZ Medicaid - AHCCCS $35.72 ↓ -75%
Arizona Physicians IPA Medicaid $35.72 ↓ -75%
Care 1st Medicare Advantage $115.46 ↓ -19%
Banner University Health Plan Medicare Advantage $115.46 ↓ -19%
Gila River Health Care Corporation Managed Care Program $115.46 ↓ -19%
United Healthcare UHC Medicare Advantage $115.46 ↓ -19%
UPMC Health Plan Medicare Advantage $115.46 ↓ -19%
Blue Cross Blue Shield of Arizona Medicare Advantage $115.46 ↓ -19%
Mercy Care Mercy Care Advantage $115.46 ↓ -19%
Cigna Healthcare of Arizona, Inc. HMO Medicare Advantage Plan/PPO Medicare Advantage Plan $115.46 ↓ -19%
Aetna Medicare Advantage $115.46 ↓ -19%
Banner Health Medicare Advantage $115.46 ↓ -19%
Health Choice Arizona, Inc. Medicare Advantage $115.46 ↓ -19%
Kaiser Foundation Health Plan Medicare Advantage $115.46 ↓ -19%
TriWest Healthcare Alliance Corp - VA CCN VA Community Care Network $115.46 ↓ -19%
TriWest Healthcare Alliance Corp - VA CCN Tricare $115.46 ↓ -19%
Health Net Medicare $115.46 ↓ -19%
Wellpoint Medicare Advantage HMO $115.46 ↓ -19%
Arizona Physicians IPA Medicare Advantage $115.46 ↓ -19%
Carelon Medicare Advantage $121.23 ↓ -15%
Humana Medicare Advantage $122.38 ↓ -15%
Plotkin Health Plotkin Health $126.72 ↓ -12%
National Healthcare Solutions Inc (NHSI) and VIP Universal Medical Insurance Group (VUMI) NHSI VUMI $126.72 ↓ -12%
Devoted Health Services Medicare Advantage $127.00 ↓ -11%
Arizona Priority Care Medicare Advantage $127.00 ↓ -11%
Gold Kidney Health Plan Medicare Advantage $127.00 ↓ -11%
Aetna Joint Venture $149.25 ↑ +4%
Aetna Aetna Qualified Health Plan $157.13 ↑ +10%
Health Choice Arizona, Inc. ACA Health Plan $164.74 ↑ +15%
Health Net Commerical Exchange Product $170.87 ↑ +19%
Aetna Medical Rental $181.07 ↑ +26%
Aetna Broad Network $186.42 ↑ +30%
United Healthcare UHC Individual Exchange $188.67 ↑ +32%
Oscar Health Plan Commercial $190.50 ↑ +33%
Quiktrip Corporation Commercial $197.12 ↑ +38%
Cigna Healthcare of Arizona, Inc. Commerical/HMO Benefit Plan/Local Flex Plan/Network Benefit Plan/Open Access Plan $224.15 ↑ +56%
Arizona Medical Network Commercial $253.44 ↑ +77%
Provider Network of America Commercial $253.44 ↑ +77%

Visitor-reported prices

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Tc-99m pentetate dtpa at other Arizona hospitals

Hospital City Cash price Negotiated range
Mercy Gilbert Medical Center Gilbert $199.02 $36.61 – $622.93
Banner University Medical Center Phoenix Phoenix $81.62 $35.72 – $171.00
Banner University Medical Center Tucson Tucson $30.75 $24.60 – $98.40
Banner Baywood Medical Center Mesa $40.83 $29.80 – $111.75
Banner Boswell Medical Center Sun City $32.68 $34.40 – $137.60
Banner Casa Grande Medical Center Casa Grande $41.99 $35.72 – $174.00
Banner Del Webb Medical Center Sun City West $25.63 $28.80 – $115.20
Banner Desert Medical Center Mesa $63.74 $35.72 – $186.00

All Arizona hospitals for this procedure →