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 |
|---|---|---|---|---|
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets CPT 87507 | $591.72 | $1,251.00 | $416.78 – $1,125.90 | 27 |
| Infectious agent nucleic acid quantification bk virus CPT 87799 | $130.07 | $275.00 | $42.84 – $116.10 | 27 |
| Infectious agent nucleic acid quantification hepatitis b CPT 87517 | $61.02 | $129.00 | $42.84 – $116.10 | 27 |
| Infectious agent nucleic acid quantification hepatitis c CPT 87522 | $69.53 | $147.00 | $42.84 – $116.10 | 27 |
| Infectious agent nucleic acid quantification hiv-1 CPT 87536 | $121.09 | $256.00 | $85.10 – $230.40 | 27 |
| Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 | $202.44 | $428.00 | $142.63 – $385.20 | 27 |
| Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis CPT 94642 | $149.87 | $304.00 | $123.73 – $273.60 | 27 |
| Inj cntr knee arthro incl ct/mri CPT 27369 | $99.57 | $207.00 | $32.84 – $124.20 | 27 |
| Inj disk cerv-thor ea lev CPT 62291 | $507.46 | $1,055.00 | $251.09 – $949.50 | 27 |
| Inj dx for sinogram CPT 20501 | $89.47 | $186.00 | $26.80 – $167.40 | 27 |
| Injection arthrography hip without anesthesia (both sides) CPT 27093 | $103.41 | $215.00 | $34.03 – $128.70 | 27 |
| Injection epidural blood patch or clot CPT 62273 | $272.94 | $478.00 | $194.55 – $430.20 | 27 |
| Injection for arthrography wrist (both sides) CPT 25246 | $146.70 | $305.00 | $48.31 – $182.70 | 27 |
| Injection for bladder x-ray CPT 51600 | $117.36 | $244.00 | $58.07 – $219.60 | 27 |
| Injection for hip x-ray CPT 27095 | $124.10 | $258.00 | $40.94 – $154.80 | 27 |
| Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides) CPT 23350 | $152.48 | $317.00 | $50.22 – $189.90 | 27 |
| Injection for ureter x-ray CPT 50684 | $268.40 | $558.00 | $88.54 – $334.80 | 27 |
| Injection into brain canal CPT 61055 | $294.37 | $612.00 | $189.35 – $550.80 | 27 |
| Injection jaw joint x-ray CPT 21116 | $53.39 | $111.00 | $26.42 – $99.90 | 27 |
| Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides) HCPCS G0260 | not published | not published | $460.08 – $2,312.52 | 6 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | not published | not published | $460.08 – $1,176.86 | 6 |
| Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) CPT 64483 | not published | not published | $596.28 – $1,965.63 | 6 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level CPT 64491 | not published | not published | $176.09 – $681.68 | 6 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level CPT 64490 | not published | not published | $596.28 – $1,965.63 | 6 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance CPT 64494 | not published | not published | $176.09 – $681.68 | 6 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 | not published | not published | $596.28 – $1,965.63 | 6 |
| Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance CPT 62321 | not published | not published | $460.08 – $1,002.07 | 6 |
| Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance CPT 62323 | not published | not published | $460.08 – $986.06 | 6 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $87.06 | $181.00 | $74.21 – $162.90 | 27 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $30.96 | $60.00 | $14.28 – $54.00 | 27 |
| Inject sacroiliac joint CPT 27096 | not published | not published | $483.22 – $483.22 | 1 |
| Inj for ext venography CPT 36005 | $122.66 | $255.00 | $40.46 – $153.00 | 27 |
| Inj for mammo ductogram CPT 19030 | $131.31 | $273.00 | $43.32 – $163.80 | 27 |
| Inj, gadopiclenol, 1 ml HCPCS A9573 | $4.60 | $23.70 | $3.41 – $21.33 | 27 |
| Inj/inf neurolyt sbst spinal canal lesion 62282 CPT 62282 | $303.99 | $632.00 | $259.12 – $568.80 | 27 |
| Inj nephrosto/ureterogram w/img exstng access CPT 50431 | $292.45 | $608.00 | $166.05 – $364.50 | 27 |
| Inj proc ankle arthr CPT 27648 | $116.40 | $242.00 | $38.32 – $144.90 | 27 |
| Inj proc elbow arthro CPT 24220 | $146.70 | $305.00 | $48.31 – $182.70 | 27 |
| Inj proc lumbr disk ea lvl CPT 62290 | $661.86 | $1,376.00 | $327.49 – $1,238.40 | 27 |
| Inj proc myelogram lumbar CPT 62284 | $166.91 | $347.00 | $82.59 – $312.30 | 27 |
| Inj proc sialogram CPT 42550 | $88.02 | $183.00 | $43.55 – $164.70 | 27 |
| Inj retacrit esrd on dialysi HCPCS Q5105 | $2.77 | $4.90 | $0.20 – $0.45 | 27 |
| Inj retro urethrocysto CPT 51610 | $119.29 | $248.00 | $59.02 – $223.20 | 27 |
| Inj, rimabotulinumtoxinb HCPCS J0587 | $12.65 | $37.10 | $10.42 – $33.39 | 27 |
| Inj w/fluor eval cv device CPT 36598 | $151.03 | $314.00 | $128.74 – $282.60 | 27 |
| Ins cerv dilator (sep proc) CPT 59200 | $490.73 | $418.00 | $170.13 – $376.20 | 27 |
| Insert cath pleura with image CPT 32557 | $1,122.17 | $2,333.00 | $637.55 – $1,399.50 | 27 |
| Insert intrauterine device iud CPT 58300 | not published | not published | $2,518.60 – $2,518.60 | 1 |
| Insertion catheter bladder non indwelling CPT 51701 | $52.53 | $92.00 | $37.44 – $82.80 | 27 |
| Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance CPT 37191 | $2,144.30 | $4,458.00 | $1,827.78 – $4,012.20 | 27 |
| Insertion nontunneled centrally inserted central venous catheter >= 5 years old CPT 36556 | $440.12 | $915.00 | $375.15 – $823.50 | 27 |
| Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years CPT 36569 | $428.09 | $890.00 | $364.90 – $801.00 | 27 |
| Insertion picc without port or pump with imaging guidance=>5y CPT 36573 | $443.48 | $922.00 | $378.02 – $829.80 | 27 |
| Insertion subcutaneous cardiac rhythm monitor CPT 33285 | not published | not published | $5,910.62 – $10,026.00 | 7 |
| Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides) CPT 36561 | not published | not published | $2,074.70 – $3,860.87 | 6 |
| Insert swan-ganz cath CPT 93503 | $1,256.37 | $2,612.00 | $1,019.45 – $2,350.80 | 27 |
| Insert tunneled cv cath CPT 36563 | not published | not published | $3,458.52 – $3,860.87 | 6 |
| Insitu hybridization auto CPT 88367 | $381.76 | $762.00 | $211.16 – $685.80 | 27 |
| Insitu hybridization (fish) CPT 88366 | $259.02 | $517.00 | $210.42 – $465.30 | 27 |
| Insitu hybridization manual CPT 88368 | $381.76 | $762.00 | $211.16 – $685.80 | 27 |
| In situ hybridization per specimen each additional single probe stain CPT 88364 | $65.13 | $130.00 | $28.56 – $108.00 | 27 |
| In situ hybridization per specimen initial single probe stain CPT 88365 | $182.86 | $365.00 | $108.14 – $328.50 | 27 |
| Ins picc wo subq prt/pmp w image guidnc <5yr CPT 36572 | $432.90 | $900.00 | $369.00 – $810.00 | 27 |
| Ins/rplc spi npg/rcvr pocket CPT 63685 | not published | not published | $3,372.77 – $21,347.28 | 6 |
| Instillation anticarcinogenic agent bladder CPT 51720 | $231.83 | $406.00 | $165.24 – $365.40 | 27 |
| Insulin total CPT 83525 | $26.79 | $57.00 | $11.43 – $51.30 | 27 |
| Intracranial complete study CPT 93886 | $402.47 | $835.00 | $166.84 – $751.50 | 27 |
| Intracranial limited study CPT 93888 | $233.77 | $485.00 | $79.00 – $436.50 | 27 |
| Intrapul surf admin endo tube CPT 94610 | $39.37 | $76.00 | $30.93 – $68.40 | 27 |
| Intrinsic factor antibody CPT 86340 | $21.59 | $59.00 | $15.08 – $53.10 | 27 |
| Intro long gi tube CPT 44500 | $287.64 | $598.00 | $245.18 – $538.20 | 27 |
| Intro long gi tube w/mult fluo CPT 74340 | $136.74 | $258.00 | $61.40 – $232.20 | 27 |
| Intubation endotracheal emergency procedure CPT 31500 | $227.77 | $462.00 | $153.41 – $415.80 | 27 |
| Iron CPT 83540 | $97.76 | $208.00 | $6.47 – $18.00 | 27 |
| Iron binding capacity CPT 83550 | $12.69 | $27.00 | $8.74 – $24.30 | 27 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $68.11 | $132.00 | $40.35 – $118.80 | 27 |
| IV Fluids (each additional hour) CPT 96361 | $28.07 | $58.00 | $23.61 – $52.20 | 27 |
| IV Fluids (first hour) CPT 96360 | $102.12 | $211.00 | $77.79 – $189.90 | 27 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $49.37 | $102.00 | $24.28 – $91.80 | 27 |
| IV Medicine Infusion (additional drug) CPT 96367 | $54.21 | $112.00 | $44.93 – $100.80 | 27 |
| IV Medicine Infusion (each additional hour) CPT 96366 | $31.94 | $66.00 | $26.86 – $59.40 | 27 |
| IV Medicine Infusion (first hour) CPT 96365 | $122.45 | $253.00 | $102.97 – $227.70 | 27 |
| IV Push Injection (each additional drug) CPT 96375 | $38.70 | $75.00 | $29.00 – $67.50 | 27 |
| IV Push Injection (first drug) CPT 96374 | $132.10 | $256.00 | $77.79 – $230.40 | 27 |
| Ivp w/nephrotomography CPT 74415 | $602.61 | $1,137.00 | $129.45 – $1,023.30 | 27 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $341.85 | $645.00 | $129.45 – $580.50 | 27 |
| Jak2 targeted sequence analysis CPT 81279 | $249.09 | $556.00 | $185.20 – $500.40 | 27 |
| Jaw Joint (TMJ) X-ray (both sides, open and closed) CPT 70330 | $175.43 | $331.00 | $58.65 – $297.90 | 27 |
| Jaw (Mandible) X-ray (complete) CPT 70110 | $108.65 | $205.00 | $79.00 – $184.50 | 27 |
| John cunningham antibody CPT 86711 | $529.97 | $1,448.00 | $16.89 – $1,303.20 | 27 |
| Ketamine and metabolite screen - quest CPT 80357 | $68.15 | $145.00 | $34.51 – $130.50 | 27 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $28.67 | $61.00 | $8.17 – $22.50 | 27 |
| Kidney imag w/bld flow multi CPT 78709 | $422.93 | $801.00 | $326.01 – $720.90 | 27 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $267.17 | $506.00 | $205.94 – $455.40 | 27 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $325.86 | $529.00 | $79.00 – $476.10 | 27 |
| Kidney (Retroperitoneal) Ultrasound (limited) CPT 76775 | $170.02 | $276.00 | $79.00 – $248.40 | 27 |
| Kit gene analys d816 variant CPT 81273 | $168.00 | $375.00 | $124.87 – $337.50 | 27 |
| Kit hfx iq ipg bundle HCPCS C1822 | $55,299.52 | $109,504.00 | $1,452.99 – $5,494.50 | 27 |
| Kit lead specify 5-6-5 HCPCS C1778 | $15,485.32 | $30,664.00 | $1,654.10 – $6,255.00 | 27 |
| Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set HCPCS C1878 | $1,360.97 | $2,695.00 | $139.94 – $529.20 | 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.