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 |
|---|---|---|---|---|
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $4,678.82 | $9,265.00 | $39.51 – $149.40 | 27 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $17,697.22 | $35,044.00 | $141.37 – $534.60 | 27 |
| Stent bronch dumon sil 10x40mm HCPCS C1875 | $4,678.82 | $9,265.00 | $336.29 – $1,271.70 | 27 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $190.86 | $295.00 | $70.21 – $265.50 | 27 |
| Stimulants synthetic CPT 80371 | $75.20 | $160.00 | $38.08 – $144.00 | 27 |
| Stomach Emptying Scan (Nuclear Medicine) CPT 78264 | $548.59 | $1,039.00 | $273.41 – $935.10 | 27 |
| Strapping of ankle and/or ft 29540 CPT 29540 | $56.39 | $242.00 | $66.01 – $144.90 | 27 |
| Strapping of chest CPT 29200 | $12.73 | $296.00 | $81.00 – $266.40 | 27 |
| Strapping of elbow or wrist 29260 CPT 29260 | $17.50 | $407.00 | $40.35 – $243.90 | 27 |
| Strapping of hand or finger CPT 29280 | $10.10 | $235.00 | $40.35 – $211.50 | 27 |
| Strapping of knee CPT 29530 | $82.48 | $354.00 | $81.00 – $212.40 | 27 |
| Strapping of toes 29550 CPT 29550 | $91.10 | $391.00 | $40.35 – $351.90 | 27 |
| Strep a ag ia CPT 87430 | $24.12 | $51.00 | $16.81 – $45.90 | 27 |
| Strep b dna amp probe CPT 87653 | $50.14 | $106.00 | $35.09 – $95.40 | 27 |
| Stress test pulmonary CPT 94618 | $134.68 | $260.00 | $65.65 – $234.00 | 27 |
| Str markers specimen anal CPT 81265 | $639.30 | $1,427.00 | $233.07 – $630.00 | 27 |
| Sulfonylurea screen qn-sendout CPT 80377 | $83.66 | $178.00 | $42.36 – $160.20 | 27 |
| Surgical pathology level 1 gross examination only CPT 88300 | $26.55 | $53.00 | $17.89 – $47.70 | 27 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $42.08 | $84.00 | $17.89 – $75.60 | 27 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $57.11 | $114.00 | $36.08 – $102.60 | 27 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $57.11 | $114.00 | $36.08 – $102.60 | 27 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $381.76 | $762.00 | $211.16 – $685.80 | 27 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $857.71 | $1,712.00 | $475.71 – $1,540.80 | 27 |
| Susceptibility agar dilution per agent CPT 87181 | $31.22 | $66.00 | $4.75 – $13.50 | 27 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $26.49 | $56.00 | $4.75 – $50.40 | 27 |
| Susceptibility mic per plate CPT 87186 | $91.60 | $200.00 | $8.65 – $23.40 | 27 |
| Suscept studies macrobroth dilution ea CPT 87188 | $54.39 | $115.00 | $6.64 – $52.20 | 27 |
| Svc venogram s&i CPT 75827 | $1,278.36 | $2,412.00 | $273.38 – $2,170.80 | 27 |
| Swallowing Evaluation (Bedside) CPT 92610 | $162.40 | $251.00 | $59.74 – $225.90 | 27 |
| Swallowing Therapy Session CPT 92526 | $100.45 | $205.00 | $48.79 – $184.50 | 27 |
| Sweat collection by iontophoresis CPT 89230 | $52.21 | $114.00 | $10.20 – $102.60 | 27 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $19.03 | $52.00 | $4.40 – $46.80 | 27 |
| System pacing micra av HCPCS C1786 | $16,926.25 | $35,044.00 | $2,754.85 – $10,417.50 | 27 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $52,890.43 | $109,504.00 | $4,169.76 – $15,768.00 | 27 |
| T3 (triiodothyronine) free CPT 84481 | $33.37 | $71.00 | $16.94 – $48.60 | 27 |
| T3 (triiodothyronine) total CPT 84480 | $20.21 | $43.00 | $14.18 – $38.70 | 27 |
| T4 (thyroxine) free CPT 84439 | $31.02 | $66.00 | $9.02 – $25.20 | 27 |
| T4 (thyroxine) total CPT 84436 | $26.32 | $56.00 | $6.87 – $50.40 | 27 |
| Tacrolimus therapeutic drug level CPT 80197 | $30.08 | $64.00 | $13.73 – $51.30 | 27 |
| Tailbone (Sacrum and Coccyx) X-ray CPT 72220 | $104.94 | $198.00 | $58.65 – $178.20 | 27 |
| Target gsa panel hmtlmph neop CPT 81450 | $1,072.96 | $2,395.00 | $759.53 – $2,051.10 | 27 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $3,924.03 | $8,759.00 | $1,262.17 – $7,883.10 | 27 |
| Target gsa panel organ neop CPT 81445 | $803.71 | $1,794.00 | $597.91 – $1,614.60 | 27 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $109.80 | $300.00 | $100.00 – $270.00 | 27 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $68.08 | $186.00 | $61.98 – $167.40 | 27 |
| Tc-99m labeled rbc HCPCS A9560 | $238.26 | $468.10 | $100.00 – $421.29 | 27 |
| Tc-99m maa HCPCS A9540 | $235.16 | $462.00 | $30.00 – $415.80 | 27 |
| Tc-99m mebrofenin HCPCS A9537 | $1,773.97 | $3,485.20 | $56.50 – $3,136.68 | 27 |
| Tc-99m medronate HCPCS A9503 | $180.34 | $354.30 | $13.00 – $318.87 | 27 |
| Tc-99m mertiatide HCPCS A9562 | $458.35 | $900.50 | $369.20 – $810.45 | 27 |
| Tc-99m pentetate dtpa HCPCS A9539 | $143.33 | $281.60 | $35.72 – $253.44 | 27 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $93.71 | $184.10 | $1.69 – $165.69 | 27 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $250.22 | $491.60 | $64.05 – $442.44 | 27 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $141.45 | $277.90 | $113.94 – $250.11 | 27 |
| Tc-99m sulfur colloid HCPCS A9541 | $221.92 | $436.00 | $178.76 – $392.40 | 27 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $465.99 | $915.50 | $85.27 – $823.95 | 27 |
| Tc-99m tilmanocept diag HCPCS A9520 | $1,221.35 | $2,399.50 | $661.57 – $2,159.55 | 27 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $51.61 | $141.00 | $46.98 – $126.90 | 27 |
| T cells absolute cd 4 count CPT 86361 | $29.65 | $81.00 | $26.78 – $72.90 | 27 |
| T cells total count CPT 86359 | $41.72 | $114.00 | $37.73 – $102.60 | 27 |
| Team conf w/pat by hc prof CPT 99366 | $40.31 | $173.00 | $41.17 – $155.70 | 27 |
| Telehealth original site facility fee HCPCS Q3014 | $23.76 | $42.00 | $6.05 – $37.80 | 27 |
| Tenosynovectomy radic 26145 CPT 26145 | not published | not published | $1,009.45 – $3,860.87 | 6 |
| Tenotomy open tndn flxr toe sgl tndn spx CPT 28232 | not published | not published | $1,009.45 – $3,860.87 | 6 |
| Test stress cardiovascular tracing only CPT 93017 | $466.36 | $929.00 | $191.73 – $836.10 | 27 |
| Theophylline therapeutic drug level CPT 80198 | $20.21 | $43.00 | $14.14 – $38.70 | 27 |
| Therapeutic procd strg endur HCPCS G0237 | $32.05 | $65.00 | $9.37 – $58.50 | 27 |
| Therapy Activity Training (each 15 minutes) CPT 97530 | $15.61 | $67.00 | $15.95 – $60.30 | 27 |
| Therapy Exercise Session (each 15 minutes) CPT 97110 | $15.38 | $66.00 | $15.71 – $59.40 | 27 |
| Ther nma rdctj intus/obstrcj CPT 74283 | $461.63 | $871.00 | $129.45 – $783.90 | 27 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $3.18 | $16.40 | $1.79 – $14.76 | 27 |
| Thigh Bone (Femur) X-ray (both sides) CPT 73552 | $132.50 | $250.00 | $58.65 – $225.00 | 27 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $472.82 | $983.00 | $268.55 – $589.50 | 27 |
| Three-Phase Bone Scan (Nuclear Medicine) CPT 78315 | $706.99 | $1,339.00 | $273.41 – $1,205.10 | 27 |
| Throat x-ray & fluoroscopy CPT 70370 | $178.08 | $336.00 | $58.65 – $302.40 | 27 |
| Thrombin time CPT 85670 | $27.66 | $56.00 | $5.77 – $50.40 | 27 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $50.88 | $103.00 | $6.47 – $92.70 | 27 |
| Thyroglobulin antibody CPT 86800 | $35.14 | $96.00 | $15.91 – $51.30 | 27 |
| Thyroid (TSH) Test CPT 84443 | $25.38 | $54.00 | $16.80 – $45.90 | 27 |
| Thyroid Ultrasound CPT 76536 | $277.82 | $451.00 | $79.00 – $405.90 | 27 |
| Thyroxine binding globulin (tbg) CPT 84442 | $21.15 | $45.00 | $14.78 – $40.50 | 27 |
| Tilt table study CPT 93660 | $665.22 | $1,383.00 | $353.64 – $1,244.70 | 27 |
| Tissue culture placenta CPT 88235 | $225.05 | $451.00 | $150.30 – $405.90 | 27 |
| Tissue culture skin/biopsy CPT 88233 | $211.08 | $423.00 | $140.73 – $380.70 | 27 |
| Tissue culture tumor CPT 88239 | $221.06 | $443.00 | $147.52 – $398.70 | 27 |
| Tissue exam koh skin/hair/nails CPT 87220 | $101.69 | $215.00 | $4.27 – $57.60 | 27 |
| Tissue transglutaminase iga CPT 86364 | $21.59 | $59.00 | $11.53 – $31.50 | 27 |
| Tlh uterus 250 g or less CPT 58570 | not published | not published | $3,860.87 – $6,458.05 | 6 |
| Tlh w/t/o 250 g or less CPT 58571 | not published | not published | $4,368.79 – $6,458.05 | 6 |
| Tlh w/t/o uterus over 250 g CPT 58573 | not published | not published | $5,521.19 – $6,458.05 | 6 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $14.12 | $72.80 | $2.46 – $65.52 | 27 |
| Tobramycin peak therapeutic drug level CPT 80200 | $23.03 | $49.00 | $16.13 – $44.10 | 27 |
| Toe X-ray (both feet) CPT 73660 | $82.68 | $156.00 | $58.65 – $140.40 | 27 |
| Tomosynthesis breast diagnostic left HCPCS G0279 | $34.89 | $56.00 | $13.33 – $50.40 | 27 |
| Tomosynthesis breast screen bilateral CPT 77063 | $53.11 | $68.00 | $16.18 – $61.20 | 26 |
| Total hip arthroplasty CPT 27132 | not published | not published | $8,928.20 – $20,256.15 | 6 |
| Total Hip Replacement CPT 27130 | not published | not published | $8,928.20 – $20,256.15 | 6 |
| Total Knee Replacement CPT 27447 | not published | not published | $8,928.20 – $20,256.15 | 6 |
| Total tau CPT 84394 | $211.97 | $451.00 | $22.21 – $405.90 | 27 |
| Toxoplasma antibody igg CPT 86777 | $23.06 | $63.00 | $14.39 – $39.60 | 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.