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 |
|---|---|---|---|---|
| Kit tissue closure sealant adhesive air leak progel 4 ml pleura HCPCS C2615 | $3,083.02 | $6,105.00 | $641.41 – $2,425.50 | 27 |
| Knee Arthroscopy (Meniscus Trimming) CPT 29881 | not published | not published | $2,052.04 – $4,768.74 | 6 |
| Knee arthroscopy/surgery CPT 29875 | not published | not published | $2,052.04 – $4,768.74 | 6 |
| Knee arthroscopy/surgery CPT 29880 | not published | not published | $2,052.04 – $4,768.74 | 6 |
| Knee arthroscopy/surgery CPT 29882 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Knee arthroscopy/surgery CPT 29888 | not published | not published | $3,860.87 – $4,542.09 | 6 |
| Knee MRI (with and without contrast) CPT 73723 | $907.95 | $1,607.00 | $266.89 – $1,446.30 | 27 |
| Knee MRI (with contrast) CPT 73722 | $756.54 | $1,339.00 | $487.00 – $1,205.10 | 27 |
| Knee MRI (without contrast) CPT 73721 | $605.11 | $1,071.00 | $166.84 – $963.90 | 27 |
| Knee X-ray CPT 73564 | $149.46 | $282.00 | $79.00 – $253.80 | 27 |
| Knee X-ray (1 to 2 views, both knees) CPT 73560 | $118.72 | $224.00 | $58.65 – $201.60 | 27 |
| Knee X-ray (3 views, both knees) CPT 73562 | $135.15 | $255.00 | $58.65 – $229.50 | 27 |
| Knee X-ray (standing, both knees) CPT 73565 | $135.15 | $255.00 | $58.65 – $229.50 | 27 |
| Kras gene addl variants CPT 81276 | $259.84 | $580.00 | $193.25 – $522.00 | 27 |
| Kras gene variants exon 2 CPT 81275 | $259.84 | $580.00 | $193.25 – $522.00 | 27 |
| Lactate dehydrogenase (ldh) CPT 83615 | $26.32 | $56.00 | $6.04 – $17.10 | 27 |
| Lactic acid CPT 83605 | $41.36 | $88.00 | $11.57 – $31.50 | 27 |
| Lactoferrin fecal qualitative CPT 83630 | $46.06 | $98.00 | $19.70 – $65.70 | 27 |
| Lactoferrin fecal quant CPT 83631 | $95.88 | $204.00 | $19.63 – $183.60 | 27 |
| Laparo cholecystectomy/graph CPT 47563 | not published | not published | $3,668.82 – $10,128.08 | 6 |
| Laparo proc abdm/per/oment 49329 CPT 49329 | not published | not published | $3,668.82 – $3,860.87 | 6 |
| Laparoscopy excise lesions CPT 58662 | not published | not published | $3,668.82 – $5,422.79 | 6 |
| Laparoscopy lysis CPT 58660 | not published | not published | $3,668.82 – $5,422.79 | 6 |
| Laparoscopy remove adnexa CPT 58661 | not published | not published | $3,668.82 – $5,422.79 | 6 |
| Laparoscopy surg colpopexy CPT 57425 | not published | not published | $5,422.79 – $6,458.05 | 6 |
| Lap enterolysis CPT 44180 | not published | not published | $3,668.82 – $10,128.08 | 6 |
| Lap ing hernia repair init CPT 49650 | not published | not published | $3,668.82 – $4,768.74 | 6 |
| Lap ing hernia repair recur CPT 49651 | not published | not published | $3,668.82 – $7,526.50 | 6 |
| Large Joint Injection or Fluid Draw (both sides) CPT 20610 | $291.49 | $606.00 | $165.64 – $363.60 | 27 |
| Laser surgery of prostate CPT 52648 | not published | not published | $3,200.08 – $10,128.08 | 6 |
| Lat retinacular release open CPT 27425 | not published | not published | $2,052.04 – $7,526.50 | 6 |
| Lead acuity x4 spiral l 86cm HCPCS C1900 | $15,485.32 | $30,664.00 | $641.41 – $2,425.50 | 27 |
| Lead capillary CPT 83655 | $37.13 | $79.00 | $12.11 – $33.30 | 27 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $15,485.32 | $30,664.00 | $641.41 – $2,425.50 | 27 |
| Lead tachy durata sj4 58cm HCPCS C1777 | $9,955.57 | $19,714.00 | $641.41 – $2,425.50 | 27 |
| Leg Artery Ultrasound (complete, both legs) CPT 93925 | $373.07 | $774.00 | $166.84 – $696.60 | 27 |
| Leg CT Scan (with contrast, both legs) CPT 73701 | $496.89 | $982.00 | $129.45 – $883.80 | 27 |
| Leg CT Scan (without contrast, both legs) CPT 73700 | $397.21 | $785.00 | $79.00 – $706.50 | 27 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $365.36 | $758.00 | $166.84 – $682.20 | 27 |
| Leishmania antibody CPT 86717 | $13.54 | $37.00 | $12.25 – $33.30 | 27 |
| Lens, intraocular (new tech) HCPCS C1780 | $606.18 | $1,413.00 | $336.29 – $1,271.70 | 27 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $2,095.66 | $4,885.00 | $141.37 – $534.60 | 27 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $2,619.04 | $6,105.00 | $141.37 – $534.60 | 27 |
| Lens iol ant chamb 10.5 HCPCS V2630 | $925.35 | $2,157.00 | $141.37 – $534.60 | 27 |
| Levetiracetam therapeutic drug level CPT 80177 | $29.61 | $63.00 | $13.25 – $36.00 | 27 |
| Liberta rc ipg HCPCS C1820 | $44,240.02 | $87,604.00 | $1,162.63 – $4,396.50 | 27 |
| Lidocaine therapeutic drug level CPT 80176 | $21.15 | $45.00 | $14.69 – $40.50 | 27 |
| Lifileucel til/dose 7.5b-72b snij HCPCS J9999 | $2,126,751.41 | $3,759,504.00 | $4.88 – $3,383,553.60 | 27 |
| Lipase CPT 83690 | $27.26 | $58.00 | $6.89 – $18.90 | 27 |
| Lipoprotein blood high res frac & quant CPT 83701 | $47.94 | $102.00 | $33.86 – $91.80 | 27 |
| Lipoprotein blood quant CPT 83704 | $48.41 | $103.00 | $34.19 – $92.70 | 27 |
| Lipoprotein direct measurement hdl CPT 83718 | $21.15 | $45.00 | $8.19 – $22.50 | 27 |
| Lipoprotein direct measurement ldl CPT 83721 | $44.18 | $94.00 | $10.50 – $28.80 | 27 |
| Lipoprtn dir meas sd ldl chl CPT 83722 | $48.41 | $103.00 | $34.19 – $92.70 | 27 |
| Lithium therapeutic drug level CPT 80178 | $24.44 | $52.00 | $6.61 – $46.80 | 27 |
| Liver Function Test CPT 80076 | $21.15 | $45.00 | $8.17 – $40.50 | 27 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $1.27 | $2.24 | $0.92 – $2.02 | 27 |
| Low-Dose Lung Cancer Screening CT Scan CPT 71271 | $177.61 | $351.00 | $79.00 – $315.90 | 27 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $656.79 | $1,298.00 | $129.45 – $1,168.20 | 27 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $547.49 | $1,082.00 | $266.89 – $973.80 | 27 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $437.69 | $865.00 | $79.00 – $778.50 | 27 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $1,218.18 | $2,456.00 | $266.89 – $2,210.40 | 27 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $1,015.31 | $2,047.00 | $266.89 – $1,842.30 | 27 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $811.95 | $1,637.00 | $166.84 – $1,473.30 | 27 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $171.72 | $324.00 | $79.00 – $291.60 | 27 |
| Lower Back (Lumbar Spine) X-ray (4 or more views) CPT 72110 | $239.56 | $452.00 | $79.00 – $406.80 | 27 |
| Lower Back (Lumbar Spine) X-ray (with bending views) CPT 72114 | $271.89 | $513.00 | $79.00 – $461.70 | 27 |
| Lower Leg (Shin) X-ray (both sides) CPT 73590 | $115.54 | $218.00 | $58.65 – $196.20 | 27 |
| Low frequency non-thermal Ultrasound CPT 97610 | $97.07 | $170.00 | $24.50 – $153.00 | 27 |
| Lumbar diskogram s&i CPT 72295 | $928.03 | $1,751.00 | $299.64 – $1,575.90 | 27 |
| Lung Function Test Before and After an Inhaler CPT 94060 | $211.86 | $409.00 | $166.46 – $368.10 | 27 |
| Lung function test (mbc/mvv) CPT 94200 | $49.21 | $95.00 | $38.66 – $85.50 | 27 |
| Lung Function Test (Spirometry) CPT 94010 | $118.62 | $229.00 | $93.20 – $206.10 | 27 |
| Lung perfusion imaging CPT 78580 | $330.00 | $625.00 | $254.38 – $562.50 | 27 |
| Lymphatics/lymph node imaging CPT 78195 | $481.01 | $911.00 | $354.82 – $819.90 | 27 |
| Lymphocyte transformation mitogen CPT 86353 | $54.17 | $148.00 | $49.03 – $133.20 | 27 |
| Macroscopic exam arthropod CPT 87168 | $6.15 | $13.00 | $4.27 – $11.70 | 27 |
| Macroscopic exam parasite CPT 87169 | $27.43 | $58.00 | $4.31 – $52.20 | 27 |
| Magnesium CPT 83735 | $41.36 | $88.00 | $6.70 – $18.90 | 27 |
| Magnetic image bone marrow CPT 77084 | $870.66 | $1,541.00 | $166.84 – $1,386.90 | 27 |
| Mammosite ced HCPCS C1728 | $7,016.98 | $13,895.00 | $336.29 – $1,271.70 | 27 |
| Marker biop eviva buckle ss HCPCS A4648 | $1,694.28 | $3,355.00 | $74.49 – $281.70 | 27 |
| Mastectomy partial CPT 19301 | not published | not published | $2,289.36 – $3,860.87 | 6 |
| Mastoids complete CPT 70130 | $142.04 | $268.00 | $79.00 – $241.20 | 27 |
| Mast simple complete CPT 19303 | not published | not published | $4,012.11 – $4,768.74 | 6 |
| M.avium-intra dna amp prob CPT 87561 | $50.14 | $106.00 | $35.09 – $95.40 | 27 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $29.61 | $63.00 | $14.46 – $56.70 | 27 |
| Mayo aathr protein s free CPT 85306 | $32.60 | $66.00 | $15.32 – $54.00 | 27 |
| Mayo activated protein c resistance assay CPT 85307 | $32.60 | $66.00 | $15.32 – $59.40 | 27 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $141.00 | $300.00 | $38.57 – $270.00 | 27 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $74.26 | $158.00 | $26.18 – $99.00 | 27 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $59.22 | $126.00 | $14.52 – $54.90 | 27 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $26.79 | $57.00 | $14.78 – $51.30 | 27 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $68.62 | $146.00 | $34.75 – $131.40 | 27 |
| Mayo alpha 1 antitrypsin CPT 82103 | $27.73 | $59.00 | $13.44 – $36.90 | 27 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $29.14 | $62.00 | $15.08 – $41.40 | 27 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $73.32 | $156.00 | $13.33 – $50.40 | 27 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $163.52 | $365.00 | $121.63 – $328.50 | 27 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $123.20 | $275.00 | $91.66 – $247.50 | 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.