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 |
|---|---|---|---|---|
| Delivery of placenta 59414 CPT 59414 | $1,579.03 | $1,345.00 | $547.41 – $1,210.50 | 27 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $55.71 | $113.00 | $45.99 – $101.70 | 27 |
| Desoxycorticosterone CPT 82633 | $43.71 | $93.00 | $30.98 – $83.70 | 27 |
| Destroy cervthor facet jnt 64633 CPT 64633 | not published | not published | $1,271.93 – $2,140.81 | 6 |
| Destroy cth facet jnt addl 64634 CPT 64634 | not published | not published | $176.09 – $681.68 | 6 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | not published | not published | $1,271.93 – $2,140.81 | 6 |
| Destruction laser surgery anal lesions 46917 CPT 46917 | not published | not published | $1,771.46 – $2,518.60 | 6 |
| Device ablt adv novasure HCPCS C1886 | $4,550.94 | $11,580.00 | $1,452.99 – $5,494.50 | 27 |
| Device sut capio slim opn HCPCS C2631 | $5,847.90 | $11,580.00 | $576.20 – $2,178.90 | 27 |
| Device tiss remov myosure reach HCPCS C1782 | $5,460.74 | $13,895.00 | $640.22 – $2,421.00 | 27 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $121.37 | $229.00 | $58.65 – $206.10 | 27 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $31.49 | $67.00 | $22.23 – $60.30 | 27 |
| Diabetes (HbA1c) Test CPT 83036 | $14.10 | $30.00 | $9.71 – $27.00 | 27 |
| Diab manage trn ind/group HCPCS G0109 | $15.84 | $28.00 | $11.40 – $25.20 | 27 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | $3,668.82 – $3,860.87 | 6 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $215.01 | $447.00 | $119.18 – $402.30 | 27 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $149.52 | $240.00 | $57.12 – $216.00 | 27 |
| Diagnostic Mammogram (one breast) CPT 77065 | $99.06 | $159.00 | $37.84 – $143.10 | 27 |
| Diffusing capacity CPT 94729 | $142.97 | $276.00 | $60.63 – $248.40 | 27 |
| Digoxin total therapeutic drug level CPT 80162 | $24.91 | $53.00 | $13.28 – $47.70 | 27 |
| Dilator fascial 10fx20cm HCPCS C2627 | $847.70 | $2,157.00 | $59.74 – $225.90 | 27 |
| Disability dlco CPT 94727 | $106.19 | $205.00 | $83.44 – $184.50 | 27 |
| Disaccharidases CPT 82657 | $170.14 | $362.00 | $22.17 – $60.30 | 27 |
| Discography cerv/thor spine CPT 72285 | $758.43 | $1,431.00 | $319.02 – $1,287.90 | 27 |
| Dna antibody native/double stranded CPT 86225 | $22.69 | $62.00 | $13.74 – $37.80 | 27 |
| Dna gardnerella CPT 87510 | $28.85 | $61.00 | $20.05 – $54.90 | 27 |
| Dna trichomonas CPT 87660 | $28.85 | $61.00 | $20.05 – $54.90 | 27 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $1.98 | $10.20 | $0.66 – $9.18 | 27 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $161.95 | $336.00 | $81.16 – $302.40 | 27 |
| Dornhoffer fixed part w/window HCPCS L8614 | $110,597.02 | $219,004.00 | $15,261.64 – $45,333.00 | 27 |
| Dpyd gene common variants CPT 81232 | $235.20 | $525.00 | $174.81 – $472.50 | 27 |
| Drainage lymph node lesion 38300 CPT 38300 | $1,041.37 | $2,165.00 | $887.65 – $1,948.50 | 27 |
| Drainage of kidney lesion CPT 50390 | $1,087.54 | $2,261.00 | $450.93 – $1,356.30 | 27 |
| Drain bladder by trocar/cath CPT 51101 | $3,387.68 | $7,043.00 | $336.45 – $6,338.70 | 27 |
| Drain cath image guided visceral pq CPT 49405 | $895.14 | $1,861.00 | $763.01 – $1,674.90 | 27 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $53.67 | $94.00 | $38.26 – $84.60 | 27 |
| Drain shoulder bursa 23031 CPT 23031 | $1,028.38 | $2,138.00 | $876.58 – $1,924.20 | 27 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $110.20 | $193.00 | $78.55 – $173.70 | 27 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $53.67 | $94.00 | $38.26 – $84.60 | 27 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $4,678.82 | $9,265.00 | $202.30 – $765.00 | 27 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | $213.11 | $422.00 | $38.22 – $84.51 | 27 |
| Drug assay caffeine CPT 80155 | $54.52 | $116.00 | $38.57 – $104.40 | 27 |
| Drug assay posaconazole CPT 80187 | $55.46 | $118.00 | $27.11 – $106.20 | 27 |
| Drug assay voriconazole CPT 80285 | $59.69 | $127.00 | $27.11 – $114.30 | 27 |
| Drug asy hydroxychloroquine CPT 80220 | $136.77 | $291.00 | $18.64 – $261.90 | 27 |
| Drug of abuse screen urine CPT 80305 | $30.08 | $64.00 | $12.60 – $57.60 | 27 |
| Drug screening tapentadol CPT 80372 | $26.32 | $56.00 | $13.33 – $50.40 | 27 |
| Drug test prsmv instrmnt CPT 80306 | $24.44 | $52.00 | $17.14 – $46.80 | 27 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $211.03 | $449.00 | $62.14 – $168.30 | 27 |
| Ductogram sgl duct CPT 77053 | $178.61 | $337.00 | $137.16 – $303.30 | 27 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $294.02 | $610.00 | $79.00 – $549.00 | 27 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $205.33 | $426.00 | $173.38 – $383.40 | 27 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $391.38 | $812.00 | $166.84 – $730.80 | 27 |
| Ecg/1-3 leads/tracing only 93041 CPT 93041 | $55.66 | $110.00 | $35.73 – $99.00 | 27 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $652.70 | $1,248.00 | $350.10 – $1,123.20 | 27 |
| Echocardiogram (Limited Follow-Up Heart Ultrasound) CPT 93308 | $292.36 | $559.00 | $166.84 – $503.10 | 27 |
| Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 | $815.88 | $1,560.00 | $518.51 – $1,404.00 | 27 |
| Echo exam of fetal heart CPT 76825 | $317.86 | $516.00 | $210.01 – $464.40 | 27 |
| Echo exam of fetal heart CPT 76826 | $168.17 | $273.00 | $111.11 – $245.70 | 27 |
| Echo exam of fetal heart CPT 76827 | $202.66 | $329.00 | $79.00 – $296.10 | 27 |
| Echo exam of fetal heart CPT 76828 | $182.95 | $297.00 | $79.00 – $267.30 | 27 |
| Echo exam uterus 76831- CPT 76831 | $313.54 | $509.00 | $166.84 – $458.10 | 27 |
| Echograp trans r pros study CPT 76873 | $335.72 | $545.00 | $79.00 – $490.50 | 27 |
| Echo guidance radiotherapy CPT 76965 | $363.44 | $590.00 | $114.51 – $531.00 | 27 |
| Echo guide for amniocentesis CPT 76946 | $252.56 | $410.00 | $63.36 – $369.00 | 27 |
| Echo guide for artery repair CPT 76936 | $753.98 | $1,224.00 | $191.73 – $1,101.60 | 27 |
| Echo guide for heart biopsy CPT 76932 | $396.70 | $644.00 | $99.18 – $579.60 | 27 |
| Echo guide for transfusion CPT 76941 | $251.33 | $408.00 | $97.10 – $367.20 | 27 |
| Echo guide ova aspiration CPT 76948 | $107.18 | $174.00 | $25.07 – $156.60 | 27 |
| Echo stress CPT 93350 | $557.00 | $1,065.00 | $350.10 – $958.50 | 27 |
| Echo tee probe placement image acquisition interpretation & report CPT 93312 | $758.87 | $1,451.00 | $350.10 – $1,305.90 | 27 |
| Echo transesophageal CPT 93315 | $834.71 | $1,596.00 | $350.10 – $1,436.40 | 27 |
| Echo transesophageal intraop CPT 93318 | $1,276.64 | $2,441.00 | $350.10 – $2,196.90 | 27 |
| Eeg monitor/record/awake/drowsy 95816 CPT 95816 | $197.58 | $370.00 | $150.59 – $333.00 | 27 |
| Eeg recording awake and asleep CPT 95819 | $231.22 | $433.00 | $176.23 – $389.70 | 27 |
| E equine encephalitis igg CPT 86652 | $23.79 | $65.00 | $13.19 – $58.50 | 27 |
| Egd control bleeding any CPT 43255 | not published | not published | $1,178.14 – $3,372.77 | 6 |
| Egd dilate stricture CPT 43245 | not published | not published | $1,178.14 – $3,372.77 | 6 |
| Egd guide wire insertion CPT 43248 | not published | not published | $586.96 – $3,372.77 | 6 |
| Egd remove foreign body CPT 43247 | not published | not published | $586.96 – $3,372.77 | 6 |
| Egd remove lesion snare CPT 43251 | not published | not published | $1,178.14 – $3,372.77 | 6 |
| Egd/remov tum/polyp/hot bx forcep 43250 CPT 43250 | not published | not published | $1,178.14 – $3,372.77 | 6 |
| Egfr gene com variants CPT 81235 | $436.35 | $974.00 | $324.58 – $876.60 | 27 |
| EKG (Tracing Only) CPT 93005 | $117.39 | $232.00 | $25.99 – $208.80 | 27 |
| Elbow X-ray (2 views, both sides) CPT 73070 | $97.52 | $184.00 | $58.65 – $165.60 | 27 |
| Elbow X-ray (3 or more views, both sides) CPT 73080 | $120.31 | $227.00 | $58.65 – $204.30 | 27 |
| Electrd sq emblem s-icd HCPCS C1896 | $9,955.57 | $19,714.00 | $641.41 – $2,425.50 | 27 |
| Electrical Stimulation Therapy (each 15 minutes) CPT 97032 | $15.84 | $68.00 | $16.18 – $61.20 | 27 |
| Electrical stimulation/unattended 97014 CPT 97014 | $14.91 | $64.00 | $15.23 – $57.60 | 27 |
| Electroconvulsive therapy 90870 CPT 90870 | $445.21 | $787.00 | $322.67 – $708.30 | 26 |
| Electrolyte panel CPT 80051 | $21.15 | $45.00 | $7.01 – $40.50 | 27 |
| Electron microscopy diagnostic CPT 88348 | $857.71 | $1,712.00 | $475.71 – $1,540.80 | 27 |
| Encephalitis, california igg/igm CPT 86651 | $23.79 | $65.00 | $13.19 – $58.50 | 27 |
| Encephalitis, st louis igg/igm CPT 86653 | $23.79 | $65.00 | $13.19 – $58.50 | 27 |
| Encephalitis, western equine igg/igm CPT 86654 | $23.79 | $65.00 | $13.19 – $58.50 | 27 |
| Endo cath bile duct s&i CPT 74328 | $359.87 | $679.00 | $64.09 – $611.10 | 27 |
| Endo cath panc duct s&i CPT 74329 | $356.16 | $672.00 | $65.06 – $604.80 | 27 |
| Enzyme histochemistry CPT 88319 | $857.71 | $1,712.00 | $259.33 – $1,540.80 | 27 |
| Epidural/lumbar/sacral/ea add level64484 CPT 64484 | not published | not published | $281.32 – $983.28 | 6 |
| Epoetin alfa, 100 units esrd HCPCS Q4081 | $15.05 | $26.60 | $0.34 – $0.76 | 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.