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 |
|---|---|---|---|---|
| Revision of bladder neck CPT 52500 | not published | not published | $2,230.35 – $3,860.87 | 6 |
| Revision of calf tendon CPT 27687 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Revision of knee joint CPT 27446 | not published | not published | $8,928.20 – $10,738.20 | 6 |
| Revis reconst shoulder joint CPT 23473 | not published | not published | $5,422.79 – $8,928.20 | 6 |
| Rf abltj nrv nrvtg si jt CPT 64625 | not published | not published | $890.29 – $1,271.93 | 6 |
| Rheumatoid factor qualitative CPT 86430 | $25.62 | $70.00 | $6.14 – $63.00 | 27 |
| Rheumatoid factor quantitative CPT 86431 | $20.13 | $55.00 | $5.67 – $16.20 | 27 |
| Rib and Chest X-ray (3 views, left side) CPT 71101 | $143.63 | $271.00 | $79.00 – $243.90 | 27 |
| Rib and Chest X-ray (4 or more views, both sides) CPT 71111 | $177.02 | $334.00 | $79.00 – $300.60 | 27 |
| Rib X-ray (3 views, both sides) CPT 71110 | $149.99 | $283.00 | $79.00 – $254.70 | 27 |
| Rmvl fecal impaction/fb spx under anes CPT 45915 | not published | not published | $751.80 – $2,518.60 | 6 |
| Rp loclzj tum spect w/ct 1 CPT 78830 | $504.24 | $955.00 | $388.69 – $859.50 | 27 |
| Rp loclzj tum spect w/ct 2 CPT 78832 | $616.18 | $1,167.00 | $474.97 – $1,050.30 | 27 |
| Rpl picc wo subq port/pump incl image guidnc w/s&i CPT 36584 | $588.26 | $1,223.00 | $501.43 – $1,100.70 | 27 |
| Rpl tun-cvad w subq port CPT 36582 | not published | not published | $2,074.70 – $3,860.87 | 6 |
| Rpr aa hrn 1st > 10 rdc CPT 49595 | not published | not published | $2,307.97 – $4,768.74 | 6 |
| Rpr aa hrn 1st 3-10 ncr/strn CPT 49594 | not published | not published | $3,668.82 – $10,128.08 | 6 |
| Rpr aa hrn 1st 3-10 rdc CPT 49593 | not published | not published | $2,307.97 – $4,768.74 | 6 |
| Rpr aa hrn 1st < 3 cm rdc CPT 49591 | not published | not published | $2,307.97 – $4,768.74 | 6 |
| Rpr aa hrn 1st < 3 ncr/strn CPT 49592 | not published | not published | $3,668.82 – $10,128.08 | 6 |
| Rpr aa hrn rcr > 10 ncr/strn CPT 49618 | not published | not published | $10,128.08 – $10,128.08 | 1 |
| Rpr aa hrn rcr < 3 ncr/strn CPT 49614 | not published | not published | $3,668.82 – $10,128.08 | 6 |
| Rpr aa hrn rcr < 3 rdc CPT 49613 | not published | not published | $2,307.97 – $4,768.74 | 6 |
| Rpr fem hernia init blocked CPT 49553 | not published | not published | $2,307.97 – $10,128.08 | 6 |
| Rpr rem hernia init reduce CPT 49550 | not published | not published | $2,307.97 – $5,422.79 | 6 |
| Rpr xtnsr tndn leg prim without grft ea tndn CPT 27664 | not published | not published | $3,372.77 – $4,542.09 | 6 |
| Rsv assay w/optic CPT 87807 | $18.92 | $40.00 | $13.10 – $36.00 | 27 |
| Rubella antibody igg CPT 86762 | $20.50 | $56.00 | $14.39 – $39.60 | 27 |
| Rubeola antibody igg CPT 86765 | $21.96 | $60.00 | $12.88 – $35.10 | 27 |
| Russell viper venom diluted CPT 85613 | $29.64 | $60.00 | $9.58 – $54.00 | 27 |
| Rx metab gen seq alys pnl 6 CPT 81418 | $1,232.90 | $2,752.00 | $396.56 – $2,476.80 | 27 |
| Sacroiliac Joint X-ray (3 or more views) CPT 72202 | $135.15 | $255.00 | $79.00 – $229.50 | 27 |
| Salmonella antibody CPT 86768 | $26.72 | $73.00 | $13.19 – $65.70 | 27 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $219.31 | $455.00 | $166.84 – $409.50 | 27 |
| Scan duplex aorta/ivc/iliac unilateral/limited CPT 93979 | $139.30 | $289.00 | $79.00 – $260.10 | 27 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $253.53 | $526.00 | $79.00 – $473.40 | 27 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $317.64 | $659.00 | $79.00 – $593.10 | 27 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $230.88 | $479.00 | $79.00 – $431.10 | 27 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $256.91 | $533.00 | $79.00 – $479.70 | 27 |
| Screening Colonoscopy (average risk) HCPCS G0121 | not published | not published | $575.40 – $3,372.77 | 6 |
| Screening Colonoscopy (high risk) HCPCS G0105 | not published | not published | $575.40 – $3,372.77 | 6 |
| Screening Mammogram CPT 77067 | $165.57 | $212.00 | $50.46 – $190.80 | 26 |
| Screw cortex 2.0 x 10mm HCPCS C1713 | $66,359.02 | $131,404.00 | $16.66 – $63.00 | 27 |
| Scrotal (Testicle) Ultrasound CPT 76870 | $292.60 | $475.00 | $79.00 – $427.50 | 27 |
| Sedimentation rate erythrocyte automated CPT 85652 | $4.45 | $9.00 | $2.70 – $8.10 | 27 |
| Self-Care and Home Skills Training (each 15 minutes) CPT 97535 | $19.34 | $83.00 | $19.75 – $74.70 | 27 |
| Semen analysis presence/motility CPT 89321 | $16.95 | $37.00 | $12.05 – $33.30 | 27 |
| Semen analysis w/count CPT 89310 | $11.91 | $26.00 | $3.75 – $23.40 | 27 |
| Serpina1 gene CPT 81332 | $155.01 | $346.00 | $43.65 – $311.40 | 27 |
| Sgmdsc w/band ligation CPT 45350 | not published | not published | $751.80 – $2,518.60 | 6 |
| Sheath gldlight lasr 12fx50cm HCPCS C2629 | $5,460.74 | $13,895.00 | $74.49 – $281.70 | 27 |
| Sho arthrs srg lmtd dbrdmt CPT 29822 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Shot (Injection into Muscle or Under the Skin) CPT 96372 | $38.70 | $75.00 | $30.52 – $67.50 | 27 |
| Shoulder AC Joint X-ray (both sides) CPT 73050 | $103.35 | $195.00 | $58.65 – $175.50 | 27 |
| Shoulder Arthroscopy (Rotator Cuff Repair) CPT 29827 | not published | not published | $4,542.09 – $5,422.79 | 6 |
| Shoulder Blade (Scapula) X-ray (both sides) CPT 73010 | $116.07 | $219.00 | $63.36 – $197.10 | 27 |
| Shoulder MRI (with and without contrast) CPT 73223 | $896.65 | $1,587.00 | $266.89 – $1,428.30 | 27 |
| Shoulder MRI (with contrast) CPT 73222 | $747.49 | $1,323.00 | $518.51 – $1,190.70 | 27 |
| Shoulder MRI (without contrast) CPT 73221 | $597.77 | $1,058.00 | $166.84 – $952.20 | 27 |
| Shoulder X-ray CPT 73030 | $131.44 | $248.00 | $58.65 – $223.20 | 27 |
| Shoulder X-ray (single view, both shoulders) CPT 73020 | $94.87 | $179.00 | $58.65 – $161.10 | 27 |
| Shunt glaucoma baerveldt 350mm HCPCS C1783 | $2,466.93 | $4,885.00 | $39.51 – $149.40 | 27 |
| Shuntogram nonvascular supervision & interpretation CPT 75809 | $180.73 | $341.00 | $79.00 – $306.90 | 27 |
| Sialography s&i CPT 70390 | $262.88 | $496.00 | $166.84 – $446.40 | 27 |
| Sickling rbc CPT 85660 | $27.66 | $56.00 | $5.51 – $50.40 | 27 |
| Sigmoidoscopy and biopsy CPT 45331 | not published | not published | $575.40 – $2,518.60 | 6 |
| Sigmoidoscopy w/tumr remove CPT 45338 | not published | not published | $751.80 – $2,518.60 | 6 |
| Sigmoid/rmv tumor/polyp/hot bx for 45333 CPT 45333 | not published | not published | $575.40 – $2,518.60 | 6 |
| Sinus CT scan (with and without contrast) CPT 70488 | $658.09 | $1,298.00 | $129.45 – $1,168.20 | 27 |
| Sinus CT scan (with contrast) CPT 70487 | $548.57 | $1,082.00 | $129.45 – $973.80 | 27 |
| Sinus CT scan (without contrast) CPT 70486 | $438.56 | $865.00 | $79.00 – $778.50 | 27 |
| Sinus X-ray (complete) CPT 70220 | $121.37 | $229.00 | $58.65 – $206.10 | 27 |
| Sinus X-ray (limited) CPT 70210 | $98.58 | $186.00 | $58.65 – $167.40 | 27 |
| Skeletal muscle relaxant 1/2 CPT 80369 | $72.38 | $154.00 | $36.65 – $138.60 | 27 |
| Skin Biopsy CPT 11102 | $103.92 | $182.00 | $74.07 – $163.80 | 27 |
| Skull X-ray (1 to 3 views) CPT 70250 | $105.47 | $199.00 | $79.00 – $179.10 | 27 |
| Skull X-ray (complete) CPT 70260 | $120.84 | $228.00 | $79.00 – $205.20 | 27 |
| Slco1b1 gene com variants CPT 81328 | $235.20 | $525.00 | $174.81 – $472.50 | 27 |
| Sleep study attended CPT 95807 | $1,448.21 | $2,712.00 | $353.64 – $1,952.10 | 27 |
| Sleep Study (Polysomnography) CPT 95810 | $3,267.55 | $6,119.00 | $663.00 – $4,405.50 | 27 |
| Sleep study unattended CPT 95806 | $578.69 | $727.00 | $101.17 – $522.90 | 27 |
| Sling suprapubic suburetheral HCPCS C1771 | $13,273.42 | $26,284.00 | $640.22 – $2,421.00 | 27 |
| Small Bowel Barium X-ray (Follow-Through) CPT 74250 | $144.69 | $273.00 | $111.11 – $245.70 | 27 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $32.16 | $68.00 | $5.39 – $51.30 | 27 |
| Smear gram stain CPT 87205 | $41.68 | $91.00 | $4.27 – $11.70 | 27 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $30.27 | $64.00 | $5.99 – $16.20 | 27 |
| Smear wet mount CPT 87210 | $25.07 | $53.00 | $5.82 – $16.20 | 27 |
| Snrpn/ube3a gene CPT 81331 | $130.82 | $292.00 | $51.07 – $262.80 | 27 |
| Sodium 24 hour urine CPT 84300 | $33.84 | $72.00 | $5.06 – $14.40 | 27 |
| Sodium serum/plasma/whole blood CPT 84295 | $19.74 | $42.00 | $4.81 – $13.50 | 27 |
| Specific gravity body fluid CPT 84315 | $4.70 | $10.00 | $3.28 – $9.00 | 27 |
| Specimen fat stain CPT 89125 | $8.24 | $18.00 | $5.88 – $16.20 | 27 |
| Speech and Language Evaluation (comprehensive) CPT 92523 | $181.30 | $370.00 | $81.00 – $333.00 | 27 |
| Speech evaluation complex CPT 70371 | $328.60 | $620.00 | $166.84 – $558.00 | 27 |
| Speech Therapy Session (one-on-one) CPT 92507 | $90.65 | $185.00 | $44.03 – $166.50 | 27 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $441.08 | $917.00 | $375.97 – $825.30 | 27 |
| Spine X-ray (single view, one level) CPT 72020 | $85.33 | $161.00 | $58.65 – $144.90 | 27 |
| Split blood or products CPT 86985 | $167.17 | $365.00 | $70.04 – $328.50 | 27 |
| Sputum specimen collection CPT 89220 | $167.17 | $365.00 | $66.63 – $328.50 | 27 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $26,544.82 | $52,564.00 | $141.37 – $534.60 | 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.