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 |
|---|---|---|---|---|
| Western blot test CPT 84181 | $81.78 | $174.00 | $17.03 – $93.60 | 27 |
| Whole blood for transfusion HCPCS P9010 | $310.70 | $650.00 | $108.85 – $585.00 | 27 |
| Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit HCPCS P9054 | $425.90 | $891.00 | $225.26 – $801.90 | 27 |
| Whole-Body Bone Scan (Nuclear Medicine) CPT 78306 | $615.12 | $1,165.00 | $273.41 – $1,048.50 | 27 |
| Whole Skeleton X-ray Survey CPT 77075 | $131.44 | $248.00 | $79.00 – $223.20 | 27 |
| Wound Cleaning and Dead Tissue Removal (up to 20 sq cm) CPT 97597 | $64.52 | $113.00 | $45.99 – $101.70 | 27 |
| Wound therapy negative pressure per session <= 50 sq cm CPT 97607 | $210.13 | $368.00 | $149.78 – $331.20 | 27 |
| Wound therapy negative pressure per session > 50 sq cm CPT 97608 | $246.10 | $431.00 | $175.42 – $387.90 | 27 |
| Wound therapy negative pressure per session <= 50 sq cm dme CPT 97605 | $56.53 | $99.00 | $40.29 – $89.10 | 27 |
| Wound therapy negative pressure per session > 50 sq cm dme CPT 97606 | $110.77 | $194.00 | $78.96 – $174.60 | 27 |
| Wrist X-ray CPT 73110 | $114.48 | $216.00 | $58.65 – $194.40 | 27 |
| Wrist X-ray (2 views, both wrists) CPT 73100 | $96.46 | $182.00 | $58.65 – $163.80 | 27 |
| Xcapsl ctrc rmvl cplx wo ecp CPT 66982 | not published | not published | $1,507.39 – $7,096.97 | 6 |
| Xe133 xenon 10mci HCPCS A9558 | $173.52 | $340.90 | $139.77 – $306.81 | 27 |
| X-ray abdomen >=3 views CPT 74021 | $141.51 | $267.00 | $79.00 – $240.30 | 27 |
| X-ray arthrogram shoulder supervision & interpretation (both sides) CPT 73040 | $316.02 | $458.00 | $186.41 – $412.20 | 27 |
| X-ray bone length studies CPT 77073 | $146.28 | $276.00 | $79.00 – $248.40 | 27 |
| X-ray bone survey infant CPT 77076 | $209.88 | $396.00 | $79.00 – $356.40 | 27 |
| X-ray exam entire spi 4/5 vw CPT 72083 | $201.93 | $381.00 | $79.00 – $342.90 | 27 |
| X-ray exam entire spi 6/> vw CPT 72084 | $286.20 | $540.00 | $79.00 – $486.00 | 27 |
| X-ray exam of arm infant CPT 73092 | $112.89 | $213.00 | $79.00 – $191.70 | 27 |
| X-ray exam of femur 1 CPT 73551 | $112.89 | $213.00 | $58.65 – $191.70 | 27 |
| X-ray exam of jaw joint CPT 70328 | $97.52 | $184.00 | $58.65 – $165.60 | 27 |
| X-ray exam of jaw joint CPT 70332 | $429.18 | $622.00 | $166.84 – $559.80 | 27 |
| X-ray exam of mastoids CPT 70120 | $127.73 | $241.00 | $79.00 – $216.90 | 27 |
| X-ray exam of middle ear CPT 70134 | $125.61 | $237.00 | $96.46 – $213.30 | 27 |
| X-ray exam of perineum CPT 74775 | $425.59 | $803.00 | $166.84 – $722.70 | 27 |
| X-ray exam of salivary gland CPT 70380 | $314.29 | $593.00 | $58.65 – $533.70 | 27 |
| X-ray exam of tear duct CPT 70170 | $159.53 | $301.00 | $122.51 – $270.90 | 27 |
| X-ray exam si joints CPT 72200 | $120.31 | $227.00 | $79.00 – $204.30 | 27 |
| X-ray exam thorac spine4/>vw CPT 72074 | $173.84 | $328.00 | $79.00 – $295.20 | 27 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $58.83 | $111.00 | $45.18 – $99.90 | 27 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $138.86 | $262.00 | $79.00 – $235.80 | 27 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $182.85 | $345.00 | $79.00 – $310.50 | 27 |
| X-ray joint survey 1 view CPT 77077 | $80.03 | $151.00 | $61.46 – $135.90 | 27 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $80.56 | $152.00 | $58.65 – $136.80 | 27 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $201.93 | $381.00 | $79.00 – $342.90 | 27 |
| X-ray mandible ltd <4 views CPT 70100 | $93.28 | $176.00 | $58.65 – $158.40 | 27 |
| X-ray nose to rectum for foreign body child CPT 76010 | $59.89 | $113.00 | $45.99 – $101.70 | 27 |
| X-ray of mammary ducts CPT 77054 | $234.26 | $442.00 | $166.84 – $397.80 | 27 |
| X-ray optic foramina CPT 70190 | $121.37 | $229.00 | $58.65 – $206.10 | 27 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $246.98 | $466.00 | $189.66 – $419.40 | 27 |
| X-ray ribs 2 views left CPT 71100 | $126.67 | $239.00 | $58.65 – $215.10 | 27 |
| X-ray sella turcica CPT 70240 | $78.44 | $148.00 | $58.65 – $133.20 | 27 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $182.85 | $345.00 | $140.41 – $310.50 | 27 |
| X-ray slg plne bdy sect without urogr CPT 76100 | $213.59 | $403.00 | $79.00 – $362.70 | 27 |
| X-ray small intestine follow-through study CPT 74248 | $104.41 | $197.00 | $46.89 – $177.30 | 27 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $106.00 | $200.00 | $58.65 – $180.00 | 27 |
| X-ray surgical specimen CPT 76098 | $66.78 | $126.00 | $51.28 – $113.40 | 27 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $87.98 | $166.00 | $58.65 – $149.40 | 27 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | $270.83 | $511.00 | $129.45 – $459.90 | 27 |
| Zika virus dna/rna amp probe CPT 87662 | $94.60 | $200.00 | $51.31 – $180.00 | 27 |
| Zika virus igm antibody CPT 86794 | $118.95 | $325.00 | $16.85 – $292.50 | 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.