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 |
|---|---|---|---|---|
| Pt application of modality >=1 area ultrasound each 15 minutes CPT 97035 | $17.01 | $73.00 | $17.37 – $65.70 | 27 |
| Pt application of modality traction mechanical CPT 97012 | $18.17 | $78.00 | $18.56 – $70.20 | 27 |
| Pten gene full sequence CPT 81321 | $806.40 | $1,800.00 | $600.00 – $1,620.00 | 27 |
| Pt repositioning canalith procedure(s) per day CPT 95992 | $38.91 | $167.00 | $39.75 – $150.30 | 27 |
| Pt therapeutic procedure >=1 area massage each 15 minutes CPT 97124 | $15.61 | $67.00 | $15.95 – $60.30 | 27 |
| Pt wheelchair management each 15 minutes CPT 97542 | $16.78 | $72.00 | $17.14 – $64.80 | 27 |
| Punc of shunt for asp or inj CPT 61070 | $190.00 | $395.00 | $161.95 – $355.50 | 27 |
| Puncture arterial withdrawal blood for diagnosis CPT 36600 | $38.93 | $85.00 | $34.59 – $76.50 | 27 |
| Puncture aspiration abscess/hematoma/bulla/cyst CPT 10160 | $114.48 | $238.00 | $97.58 – $214.20 | 27 |
| Puncture spinal lumbar diagnostic CPT 62270 | $287.78 | $504.00 | $205.13 – $453.60 | 27 |
| Pyruvate CPT 84210 | $20.68 | $44.00 | $14.48 – $39.60 | 27 |
| Pyruvate kinase CPT 84220 | $87.89 | $187.00 | $9.44 – $168.30 | 27 |
| Quant diff pulm perf and vent w/imaging CPT 78598 | $393.36 | $745.00 | $303.21 – $670.50 | 27 |
| Quant diff pulm perf w/imaging CPT 78597 | $347.95 | $659.00 | $268.21 – $593.10 | 27 |
| Quest t3 uptake CPT 84479 | $26.32 | $56.00 | $6.47 – $50.40 | 27 |
| Radphm lcl tmr plnr bdy sgl day img CPT 78802 | $351.12 | $665.00 | $270.65 – $598.50 | 27 |
| Radphm lcl tmr plnr bdy two day img CPT 78804 | $578.69 | $1,096.00 | $446.07 – $986.40 | 27 |
| Radphm lcl tmr spect/ct 2+ areas/2+ days CPT 78831 | $553.87 | $1,049.00 | $426.94 – $944.10 | 27 |
| Radphm lcl tomogr sgl area sgl day CPT 78803 | $553.87 | $1,049.00 | $426.94 – $944.10 | 27 |
| Radphm lcl tumor plr sgl day CPT 78800 | $299.38 | $567.00 | $230.77 – $510.30 | 27 |
| Range of motion measurements CPT 95852 | $15.84 | $68.00 | $16.18 – $61.20 | 27 |
| Rapid Strep Test CPT 87880 | $23.65 | $50.00 | $16.53 – $45.00 | 27 |
| Rbc count only automated CPT 85041 | $4.94 | $10.00 | $3.02 – $9.00 | 27 |
| Rbc serum pretx incubj drugs CPT 86975 | $310.37 | $848.00 | $83.37 – $763.20 | 27 |
| Recon, cta for surg plan HCPCS G0288 | $330.38 | $697.00 | $100.44 – $627.30 | 27 |
| Reconstruct finger joint CPT 26548 | not published | not published | $2,052.04 – $4,768.74 | 6 |
| Reconstruct head of radius CPT 24365 | not published | not published | $5,422.79 – $8,928.20 | 6 |
| Reconstruct shoulder joint CPT 23472 | not published | not published | $8,928.20 – $10,640.58 | 6 |
| Red blood cells frozen/deglycerolized/washed leukocytes reduced irradiated each unit HCPCS P9057 | $334.60 | $700.00 | $188.93 – $630.00 | 27 |
| Red blood cells leukocytes reduced each unit HCPCS P9016 | $341.29 | $714.00 | $119.66 – $264.60 | 27 |
| Red blood cells leukocytes reduced irradiated each unit HCPCS P9040 | $167.30 | $350.00 | $142.45 – $315.00 | 27 |
| Red blood cells washed each unit HCPCS P9022 | $237.57 | $497.00 | $179.49 – $396.90 | 27 |
| Refill/maint pump/resvr syst CPT 96522 | $65.02 | $126.00 | $51.28 – $113.40 | 27 |
| Removal biliary drg cath CPT 47537 | $419.43 | $872.00 | $357.52 – $784.80 | 27 |
| Removal central venous catheter tunneled without port/pump CPT 36589 | $153.44 | $319.00 | $130.79 – $287.10 | 27 |
| Removal central venous device tunneled w/port/pump central/peripheral insertion CPT 36590 | not published | not published | $1,019.45 – $2,518.60 | 6 |
| Removal devitalized tissue non-selective debridement without anesthesia per session CPT 97602 | $56.53 | $99.00 | $40.29 – $89.10 | 27 |
| Removal duct glbldr calculi CPT 47544 | $675.32 | $1,404.00 | $334.15 – $1,263.60 | 27 |
| Removal of bone for graft CPT 20902 | not published | not published | $4,542.09 – $4,768.74 | 6 |
| Removal of breast lesion CPT 19120 | not published | not published | $2,289.36 – $3,860.87 | 6 |
| Removal of eye lesion CPT 65420 | not published | not published | $1,451.70 – $3,372.77 | 6 |
| Removal of heel bone CPT 28118 | not published | not published | $2,052.04 – $4,768.74 | 6 |
| Removal of heel spur CPT 28119 | not published | not published | $2,052.04 – $4,768.74 | 6 |
| Removal of hydrocele CPT 55040 | not published | not published | $2,307.97 – $3,860.87 | 6 |
| Removal of implant deep CPT 20680 | not published | not published | $1,718.26 – $3,860.87 | 6 |
| Removal of metatarsal heads CPT 28114 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Removal of sperm cord lesion CPT 55520 | not published | not published | $2,230.35 – $4,768.74 | 6 |
| Removal of tendon lesion CPT 27630 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Removal of toe lesions CPT 28092 | not published | not published | $1,009.45 – $3,860.87 | 6 |
| Removal of toe lesions CPT 28108 | not published | not published | $1,009.45 – $3,372.77 | 6 |
| Removal/replacement ppm generator dual lead system CPT 33228 | not published | not published | $3,860.87 – $7,540.11 | 6 |
| Removal sutr and stapl no anes CPT 15854 | $73.66 | $129.00 | $30.70 – $116.10 | 27 |
| Removal sutr or stapl no anes CPT 15853 | $73.66 | $129.00 | $30.70 – $116.10 | 27 |
| Remove bladder stone CPT 52317 | not published | not published | $2,230.35 – $2,518.60 | 6 |
| Remove bladder stone CPT 52318 | not published | not published | $2,230.35 – $3,372.77 | 6 |
| Remove epididymis lesion CPT 54830 | not published | not published | $2,230.35 – $3,860.87 | 6 |
| Remove epididymis lesion CPT 54840 | not published | not published | $1,299.92 – $4,768.74 | 6 |
| Remove esophagus obstruction CPT 74235 | $114.48 | $216.00 | $51.41 – $194.40 | 27 |
| Remove ext hem groups 2+ CPT 46250 | not published | not published | $1,771.46 – $3,860.87 | 6 |
| Remove in/ex hem groups 2+ CPT 46260 | not published | not published | $1,771.46 – $3,860.87 | 6 |
| Remove int/ext hem 1 group CPT 46255 | not published | not published | $1,771.46 – $3,860.87 | 6 |
| Remove nerve lesion CPT 64784 | not published | not published | $1,271.93 – $3,860.87 | 6 |
| Remove pilonidal cyst exten CPT 11771 | not published | not published | $1,718.26 – $3,860.87 | 6 |
| Remove renal tube w/fluoro CPT 50389 | $292.93 | $609.00 | $166.46 – $365.40 | 27 |
| Remove wrist joint implant CPT 25449 | not published | not published | $4,542.09 – $5,422.79 | 6 |
| Remove wrist tendon lesion CPT 25111 | not published | not published | $1,009.45 – $3,860.87 | 6 |
| Renal function panel CPT 80069 | $21.62 | $46.00 | $8.68 – $41.40 | 27 |
| Repair achilles tendon CPT 27650 | not published | not published | $3,860.87 – $4,542.09 | 6 |
| Repair biceps tendon CPT 23430 | not published | not published | $4,542.09 – $4,768.74 | 6 |
| Repair elbow deb/attch open CPT 24359 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Repair elbow w/deb open CPT 24358 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Repair eyelid defect CPT 67914 | not published | not published | $1,451.70 – $3,860.87 | 6 |
| Repair eyelid defect CPT 67916 | not published | not published | $1,451.70 – $4,768.74 | 6 |
| Repair eyelid defect CPT 67917 | not published | not published | $1,451.70 – $4,768.74 | 6 |
| Repair eyelid defect CPT 67923 | not published | not published | $1,451.70 – $4,768.74 | 6 |
| Repair eyelid defect CPT 67924 | not published | not published | $1,451.70 – $4,768.74 | 6 |
| Repair fibula nonunion CPT 27726 | not published | not published | $4,542.09 – $10,128.08 | 6 |
| Repair finger/hand tendon CPT 26356 | not published | not published | $2,052.04 – $4,768.74 | 6 |
| Repair foot dislocation CPT 28615 | not published | not published | $3,860.87 – $4,542.09 | 6 |
| Repair lower leg tendons CPT 27675 | not published | not published | $2,052.04 – $3,372.77 | 6 |
| Repair of achilles tendon CPT 27654 | not published | not published | $3,860.87 – $4,542.09 | 6 |
| Repair of humerus CPT 24430 | not published | not published | $3,860.87 – $8,928.20 | 6 |
| Repair of leg tendon each CPT 27658 | not published | not published | $2,052.04 – $2,518.60 | 6 |
| Repair of leg tendon each CPT 27665 | not published | not published | $3,372.77 – $4,542.09 | 6 |
| Repair of thigh muscle CPT 27385 | not published | not published | $3,860.87 – $4,542.09 | 6 |
| Repair rpr lip full thickness vermilion only CPT 40650 | not published | not published | $327.96 – $3,860.87 | 6 |
| Repair upper arm/elbow tendon/muscle ea CPT 24341 | not published | not published | $3,860.87 – $4,542.09 | 6 |
| Reptilase test CPT 85635 | $14.82 | $30.00 | $9.85 – $27.00 | 27 |
| Rerepair ing hernia reduce CPT 49520 | not published | not published | $2,307.97 – $7,526.50 | 6 |
| #resp virpnl dfa-adenovirus CPT 87260 | $20.81 | $44.00 | $14.43 – $39.60 | 27 |
| #resp virpnl dfa-parainfluenza CPT 87279 | $23.65 | $50.00 | $16.43 – $45.00 | 27 |
| Resp virus 6-11 targets CPT 87632 | $309.82 | $655.00 | $218.06 – $589.50 | 27 |
| Resuscitation delivery/birthing room CPT 99465 | $290.77 | $514.00 | $209.20 – $462.60 | 27 |
| Reticulated platelet assay CPT 85055 | $53.35 | $108.00 | $35.74 – $97.20 | 27 |
| Reticulocyte direct measurement automated CPT 85046 | $28.16 | $57.00 | $5.57 – $51.30 | 27 |
| Revise eye muscle CPT 67311 | not published | not published | $1,451.70 – $3,860.87 | 6 |
| Revise lower leg tendon CPT 27691 | not published | not published | $4,542.09 – $4,768.74 | 6 |
| Revise/replace knee joint CPT 27486 | not published | not published | $8,928.20 – $10,128.08 | 6 |
| Revise/replace knee joint CPT 27487 | not published | not published | $8,928.20 – $10,128.08 | 6 |
| Revise wrist joint CPT 25332 | not published | not published | $2,052.04 – $5,422.79 | 6 |
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.