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 |
|---|---|---|---|---|
| Hla i typing complete hr CPT 81379 | $451.14 | $1,007.00 | $335.38 – $906.30 | 27 |
| Hla i typing complete lr CPT 81372 | $542.53 | $1,211.00 | $403.59 – $1,089.90 | 27 |
| Hla i typing high res 1 allele grp ea CPT 81381 | $228.48 | $510.00 | $169.90 – $459.00 | 27 |
| Hla i typing low res one locus ea CPT 81373 | $171.58 | $383.00 | $127.43 – $344.70 | 27 |
| Hla typing dr/dq CPT 86816 | $33.31 | $91.00 | $30.17 – $81.90 | 27 |
| Hla x-math non-cytotoxic CPT 86825 | $120.41 | $329.00 | $109.49 – $296.10 | 27 |
| Homocysteine CPT 83090 | $27.26 | $58.00 | $17.92 – $52.20 | 27 |
| Homogenization tissue CPT 87176 | $8.51 | $18.00 | $5.88 – $16.20 | 27 |
| Homovanillic acid (hva) CPT 83150 | $31.96 | $68.00 | $22.41 – $61.20 | 27 |
| Hpv types 16 & 18 only CPT 87625 | $57.71 | $122.00 | $40.55 – $109.80 | 27 |
| H pylori (c-13) breath CPT 83013 | $95.41 | $203.00 | $67.36 – $182.70 | 27 |
| Human epididymis protein 4 (he4) CPT 86305 | $35.50 | $97.00 | $13.98 – $87.30 | 27 |
| Hydroxyzine hcl 50 mg/ml intramuscular solution HCPCS J3410 | $4.27 | $22.00 | $8.95 – $19.80 | 27 |
| Hysterosalpingography s&i CPT 74740 | $228.96 | $432.00 | $166.84 – $388.80 | 27 |
| Hysteroscopy ablation CPT 58563 | not published | not published | $3,196.92 – $10,128.08 | 6 |
| Hysteroscopy biopsy CPT 58558 | not published | not published | $1,901.83 – $3,860.87 | 6 |
| Hysteroscopy remove fb CPT 58562 | not published | not published | $1,901.83 – $3,860.87 | 6 |
| I-123 sod iodide diag per 100 uci HCPCS A9516 | $400.48 | $786.80 | $106.24 – $708.12 | 27 |
| Iaadi respiratory synctial virus CPT 87280 | $28.38 | $60.00 | $13.42 – $54.00 | 27 |
| Iadna legionella pneumophila amplified probe tq CPT 87541 | $50.14 | $106.00 | $35.09 – $95.40 | 27 |
| Ia nfct ab sarscov2 covid19 CPT 86328 | $49.78 | $136.00 | $45.23 – $122.40 | 27 |
| Icd cobalt xt dr MRI is1 df1 HCPCS C1721 | $63,468.13 | $131,404.00 | $10,424.40 – $39,420.00 | 27 |
| Icd crtd cobalt hf MRI is1 df1 HCPCS C1882 | $61,935.22 | $122,644.00 | $14,594.16 – $55,188.00 | 27 |
| Icd crtp serena MRI HCPCS C2621 | $21,157.33 | $43,804.00 | $1,452.99 – $5,494.50 | 27 |
| Icd reliance df4 ib 64cm HCPCS C1895 | $16,591.27 | $32,854.00 | $641.41 – $2,425.50 | 27 |
| Ifnl3 gene CPT 81283 | $99.01 | $221.00 | $73.37 – $198.90 | 27 |
| Igh gene rearrange amp meth CPT 81261 | $266.11 | $594.00 | $197.99 – $534.60 | 27 |
| Igh@ var region somatic mutation analy CPT 81263 | $396.03 | $884.00 | $294.52 – $795.60 | 27 |
| Igk rearrangeabn clonal pop CPT 81264 | $232.51 | $519.00 | $172.73 – $467.10 | 27 |
| Ihc/icc per specimen each additional single antibody stain CPT 88341 | $78.66 | $157.00 | $19.52 – $73.80 | 27 |
| Ihc/icc per specimen each multiplex antibody stain CPT 88344 | $381.76 | $762.00 | $211.16 – $685.80 | 27 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $182.86 | $365.00 | $108.14 – $328.50 | 27 |
| Immune complex assay CPT 86332 | $27.08 | $74.00 | $24.37 – $66.60 | 27 |
| Immunoassay tumor antigen quantitative ca 125 CPT 86304 | $23.06 | $63.00 | $20.81 – $56.70 | 27 |
| Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 | $23.06 | $63.00 | $20.81 – $56.70 | 27 |
| Immunodiff gel qual ea antigen/ab CPT 86331 | $13.18 | $36.00 | $11.98 – $32.40 | 27 |
| Immunodiffusion nes CPT 86329 | $20.13 | $55.00 | $14.05 – $38.70 | 27 |
| Immunofixation electrophoresis serum CPT 86334 | $51.97 | $142.00 | $22.34 – $61.20 | 27 |
| Immunofluorescence per specimen each additional single antibody stain CPT 88350 | $94.69 | $189.00 | $20.71 – $78.30 | 27 |
| Immunofluorescence per specimen initial single antibody stain CPT 88346 | $182.86 | $365.00 | $148.56 – $328.50 | 27 |
| Immunoglobulin assay CPT 86023 | $86.38 | $236.00 | $12.46 – $212.40 | 27 |
| Implant cartilage 10mm synthetic HCPCS L8699 | $48,663.82 | $96,364.00 | $37.84 – $143.10 | 27 |
| Implant cochlear osia osi300 HCPCS L8690 | $17,697.22 | $35,044.00 | $241.76 – $534.60 | 27 |
| Implant nerve end CPT 64787 | not published | not published | $1,296.71 – $1,688.83 | 6 |
| Implant ureth bulk agent HCPCS L8606 | $1,554.39 | $3,078.00 | $67.56 – $149.40 | 27 |
| Impl neurostim electr perc CPT 63650 | not published | not published | $4,466.49 – $7,526.50 | 6 |
| Implnt spinl canal catheter 62350 CPT 62350 | $1,192.88 | $2,480.00 | $1,016.80 – $2,232.00 | 27 |
| In-111 autol wbc diag per dose HCPCS A9570 | $3,031.60 | $5,956.00 | $2,441.96 – $5,360.40 | 27 |
| In-111 oxyquinolin per 0.5 mci HCPCS A9547 | $1,237.63 | $2,431.50 | $996.91 – $2,188.35 | 27 |
| In-111 pentetate dtpa / 0.5 mci HCPCS A9548 | $975.55 | $1,916.60 | $785.81 – $1,724.94 | 27 |
| In-111 pentetreotide HCPCS A9572 | $2,042.77 | $4,013.30 | $1,645.45 – $3,611.97 | 27 |
| Incision & drainage hematoma/seroma/fluid collection CPT 10140 | $196.99 | $345.00 | $140.41 – $310.50 | 27 |
| Incision of foot fascia CPT 28008 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Incision of heel bone CPT 28300 | not published | not published | $3,372.77 – $4,542.09 | 6 |
| Incision of metatarsal CPT 28306 | not published | not published | $4,542.09 – $4,768.74 | 6 |
| Incision of metatarsal CPT 28308 | not published | not published | $2,052.04 – $3,372.77 | 6 |
| Incision of spinal nerve 64772 CPT 64772 | not published | not published | $1,271.93 – $3,372.77 | 6 |
| Incision of tendon sheath CPT 25000 | not published | not published | $1,009.45 – $3,860.87 | 6 |
| Incision of thigh tendon CPT 27306 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Incision of toe tendons 28011 CPT 28011 | not published | not published | $1,009.45 – $3,860.87 | 6 |
| Incision tendon sheath CPT 26055 | not published | not published | $1,009.45 – $3,372.77 | 6 |
| Infect ag drug suscept pheno predict CPT 87900 | $185.42 | $392.00 | $130.35 – $352.80 | 27 |
| Infect ag genotype na cytomegalovirus CPT 87910 | $365.63 | $773.00 | $257.45 – $695.70 | 27 |
| Infect ag genotype na dna hepatitis b CPT 87912 | $365.63 | $773.00 | $257.45 – $695.70 | 27 |
| Infect ag genotype na hiv-1 other region CPT 87906 | $183.05 | $387.00 | $128.73 – $348.30 | 27 |
| Infect ag genotype na hiv-1 revr trn/prt CPT 87901 | $365.63 | $773.00 | $257.45 – $695.70 | 27 |
| Infect ag ia optc obs influenza CPT 87804 | $23.65 | $50.00 | $16.55 – $45.00 | 27 |
| Infect ag if ea plyvlnt antsrm CPT 87300 | $28.38 | $60.00 | $11.98 – $54.00 | 27 |
| Infect ag if influenza a CPT 87276 | $28.38 | $60.00 | $16.07 – $54.00 | 27 |
| Infect ag if influenza b CPT 87275 | $28.38 | $60.00 | $12.25 – $54.00 | 27 |
| Infect ag if legionella pneumophila CPT 87278 | $22.23 | $47.00 | $15.60 – $42.30 | 27 |
| Infect ag if pneumocystis carinii CPT 87281 | $35.95 | $76.00 | $11.98 – $32.40 | 27 |
| Infect ag if varicella zoster CPT 87290 | $28.38 | $60.00 | $13.42 – $54.00 | 27 |
| Infect ag na hep b amp CPT 87516 | $63.85 | $135.00 | $35.09 – $121.50 | 27 |
| Infect ag na herpes simplex quant CPT 87530 | $61.02 | $129.00 | $42.84 – $116.10 | 27 |
| Infect ag na hpv high-risk types CPT 87624 | $50.14 | $106.00 | $35.09 – $95.40 | 27 |
| Infect ag na influenza r/amp 1st 2 types CPT 87502 | $136.22 | $288.00 | $95.80 – $259.20 | 27 |
| Infect ag na orthopoxvirus amp prb each CPT 87593 | $72.84 | $154.00 | $36.65 – $138.60 | 27 |
| Infect ag na resp virus 12-25 targets CPT 87633 | $591.72 | $1,251.00 | $416.78 – $1,125.90 | 27 |
| Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 | $28.38 | $60.00 | $11.98 – $54.00 | 27 |
| Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 | $31.22 | $66.00 | $11.98 – $32.40 | 27 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | $35.00 | $74.00 | $14.38 – $39.60 | 27 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 | $109.26 | $231.00 | $10.33 – $43.20 | 27 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization CPT 87341 | $40.20 | $85.00 | $10.33 – $53.10 | 27 |
| Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 | $41.15 | $87.00 | $24.08 – $78.30 | 27 |
| Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 | $74.26 | $157.00 | $11.98 – $32.40 | 27 |
| Infectious agent antigen immunoassay ql/sq multi step rotavirus CPT 87425 | $17.03 | $36.00 | $11.98 – $32.40 | 27 |
| Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin CPT 87427 | $30.27 | $64.00 | $11.98 – $57.60 | 27 |
| Infectious agent nucleic acid amplified probe CPT 87798 | $199.13 | $421.00 | $35.09 – $95.40 | 27 |
| Infectious agent nucleic acid amplified probe chlamydia trachomatis CPT 87491 | $54.39 | $115.00 | $35.09 – $95.40 | 27 |
| Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) CPT 87493 | $52.98 | $112.00 | $37.27 – $100.80 | 27 |
| Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets CPT 87483 | $591.72 | $1,251.00 | $416.78 – $1,125.90 | 27 |
| Infectious agent nucleic acid amplified probe hsv-1 CPT 87529 | $50.14 | $106.00 | $35.09 – $95.40 | 27 |
| Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus CPT 87641 | $50.14 | $106.00 | $35.09 – $95.40 | 27 |
| Infectious agent nucleic acid amplified probe mycobacteria tuberculosis CPT 87556 | $59.60 | $126.00 | $41.68 – $113.40 | 27 |
| Infectious agent nucleic acid amplified probe neisseria gonorrhoeae CPT 87591 | $50.14 | $106.00 | $35.09 – $95.40 | 27 |
| Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 CPT 87635 | $72.84 | $154.00 | $51.31 – $138.60 | 27 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b CPT 87636 | $45.41 | $96.00 | $39.07 – $86.40 | 27 |
| Infectious agent nucleic acid amplified probe streptococcus group a CPT 87651 | $50.14 | $106.00 | $35.09 – $95.40 | 27 |
| Infectious agent nucleic acid amplified probe trichomonas vaginalis CPT 87661 | $52.50 | $111.00 | $35.09 – $95.40 | 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.