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 |
|---|---|---|---|---|
| Epstein barr early antigen antibody CPT 86663 | $20.13 | $55.00 | $13.12 – $49.50 | 27 |
| Epstein barr nuclear antigen antibody CPT 86664 | $19.76 | $54.00 | $15.29 – $41.40 | 27 |
| Epstein barr viral capsid antigen antibody igm CPT 86665 | $22.69 | $62.00 | $18.14 – $49.50 | 27 |
| Ercp biliary & pancreas CPT 74330 | $359.87 | $679.00 | $75.31 – $611.10 | 27 |
| ER Visit (level 1, minor) CPT 99281 | $197.65 | $255.00 | $104.55 – $229.50 | 27 |
| ER Visit (level 2) CPT 99282 | $252.10 | $315.00 | $129.15 – $283.50 | 27 |
| ER Visit (level 3) CPT 99283 | $496.79 | $445.00 | $182.45 – $400.50 | 27 |
| ER Visit (level 4) CPT 99284 | $1,191.40 | $565.00 | $231.65 – $508.50 | 27 |
| ER Visit (level 5, high severity) CPT 99285 | $1,496.11 | $775.00 | $317.75 – $697.50 | 27 |
| Esophageal dilat s&i CPT 74360 | $326.48 | $616.00 | $75.07 – $554.40 | 27 |
| Esophagoscopy flex biopsy CPT 43202 | not published | not published | $1,178.14 – $2,518.60 | 6 |
| Esophagus motility study CPT 91010 | $427.22 | $743.00 | $304.63 – $668.70 | 27 |
| Esoph egd dilation <30 mm CPT 43249 | not published | not published | $1,178.14 – $3,372.77 | 6 |
| Established Patient Office Visit (level 1) CPT 99211 | $281.01 | $290.00 | $32.80 – $72.00 | 27 |
| Established Patient Office Visit (level 2) CPT 99212 | $712.22 | $735.00 | $54.54 – $130.50 | 27 |
| Established Patient Office Visit (level 3) CPT 99213 | $1,429.27 | $1,475.00 | $54.54 – $166.50 | 27 |
| Established Patient Office Visit (level 4) CPT 99214 | $2,204.48 | $2,275.00 | $54.54 – $225.00 | 27 |
| Established Patient Office Visit (level 5) CPT 99215 | $3,105.64 | $3,205.00 | $54.54 – $261.00 | 27 |
| Estradiol total CPT 82670 | $39.48 | $84.00 | $27.94 – $75.60 | 27 |
| Estrogens total-sendout CPT 82672 | $31.02 | $66.00 | $21.70 – $59.40 | 27 |
| Ethylene glycol -sendout CPT 82693 | $38.07 | $81.00 | $14.90 – $72.90 | 27 |
| Euglobulin lysis CPT 85360 | $12.84 | $26.00 | $8.41 – $23.40 | 27 |
| Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen CPT 84112 | $138.65 | $295.00 | $98.11 – $265.50 | 27 |
| Evaluation psychiatric diagnostic CPT 90791 | $179.33 | $317.00 | $96.88 – $285.30 | 27 |
| Evoked potentials auditory screening automated analysis CPT 92650 | $107.48 | $190.00 | $45.22 – $171.00 | 27 |
| Exam plvc w/anes othr thn lcl CPT 57410 | not published | not published | $1,901.83 – $3,372.77 | 6 |
| Ex arm/elbow tum deep 5 cm/> CPT 24073 | not published | not published | $1,718.26 – $3,372.77 | 6 |
| Exc back les sbq <3 cm 21930 CPT 21930 | not published | not published | $1,020.08 – $3,372.77 | 6 |
| Exc back tum deep 5 cm/> CPT 21933 | not published | not published | $1,718.26 – $3,372.77 | 6 |
| Exc bartholins gland/cyst CPT 56740 | not published | not published | $1,901.83 – $3,860.87 | 6 |
| Exc benign tal 0.5 < cm 11400 CPT 11400 | not published | not published | $450.93 – $2,518.60 | 6 |
| Exc ben+marg excep skin tag snhfg 2.1-3cm 11423 CPT 11423 | not published | not published | $1,020.08 – $2,518.60 | 6 |
| Exc/crtg b1 cst/b9 tum rds CPT 24120 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Exc foot/toe tum dep 1.5cm/> CPT 28041 | not published | not published | $1,718.26 – $3,860.87 | 6 |
| Exc forearm les sc 3 cm/> CPT 25071 | not published | not published | $1,020.08 – $3,372.77 | 6 |
| Exchange biliary drg cath CPT 47536 | $573.35 | $1,192.00 | $488.72 – $1,072.80 | 27 |
| Exchange drainage catheter CPT 49423 | $235.69 | $490.00 | $200.90 – $441.00 | 27 |
| Exchange nephrostomy cath CPT 50435 | $1,225.11 | $2,547.00 | $696.18 – $1,528.20 | 27 |
| Exc im tumor/foot/toe < 1.5 cm 28045 CPT 28045 | not published | not published | $1,718.26 – $3,860.87 | 6 |
| Excision benign lesion trunk/arms/legs > 4.0 cm CPT 11406 | not published | not published | $1,020.08 – $3,372.77 | 6 |
| Excision of anal lesion(s) CPT 46922 | not published | not published | $1,771.46 – $2,518.60 | 6 |
| Excision of neck cyst confined 42810 CPT 42810 | not published | not published | $1,983.88 – $3,860.87 | 6 |
| Excision olecranon bursa CPT 24105 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Excision tumor soft tissue back/flank subcutaneous >= 3 cm CPT 21931 | not published | not published | $1,020.08 – $3,372.77 | 6 |
| Exc neck tum deep 5 cm/> CPT 21554 | not published | not published | $1,718.26 – $3,372.77 | 6 |
| Exc prtl bn phlnx toe CPT 28124 | not published | not published | $2,052.04 – $3,860.87 | 6 |
| Exc sq tum/leg or ankle area <3 cm 27618 CPT 27618 | not published | not published | $1,020.08 – $3,372.77 | 6 |
| Exc sq tumor/foot or toe < 1.5 cm 28039 CPT 28039 | not published | not published | $1,718.26 – $3,372.77 | 6 |
| Exc sq tumor/shoulder area 3cm/> 23071 CPT 23071 | not published | not published | $1,020.08 – $3,372.77 | 6 |
| Exc sq tumor/thigh/knee area 3cm/> 27337 CPT 27337 | not published | not published | $1,718.26 – $3,372.77 | 6 |
| Exc sq tum/vasc malform/hand/fngr 26111 CPT 26111 | not published | not published | $1,020.08 – $3,372.77 | 6 |
| Exc thigh/knee tum deep <5cm CPT 27328 | not published | not published | $1,718.26 – $3,860.87 | 6 |
| Expander tiss 133s-mv-12-t 300ml natrelle smth HCPCS C1789 | $4,678.82 | $9,265.00 | $641.41 – $2,425.50 | 27 |
| External chromosome analysis 20-25 cells CPT 88264 | $216.57 | $434.00 | $144.61 – $390.60 | 27 |
| External newborn metabolic screening panel HCPCS S3620 | $111.75 | $244.00 | $58.07 – $219.60 | 27 |
| External pretreatment of serum for use in antibody identification by dilution CPT 86976 | $19.40 | $53.00 | $17.89 – $47.70 | 27 |
| External tissue culture neoplastic disorders bone marrow/blood cells CPT 88237 | $215.57 | $432.00 | $143.75 – $388.80 | 27 |
| Extractable nuclear antigen/antibody any method each antibody centromere CPT 86235 | $47.58 | $130.00 | $17.93 – $48.60 | 27 |
| Eye Socket (Orbit) X-ray CPT 70200 | $146.28 | $276.00 | $79.00 – $248.40 | 27 |
| Eye Socket, Pituitary or Ear CT Scan (with and without contrast) CPT 70482 | $785.85 | $1,550.00 | $129.45 – $1,395.00 | 27 |
| Eye Socket, Pituitary or Ear CT Scan (with contrast) CPT 70481 | $655.04 | $1,292.00 | $129.45 – $1,162.80 | 27 |
| Eye Socket, Pituitary or Ear CT Scan (without contrast) CPT 70480 | $523.73 | $1,033.00 | $79.00 – $929.70 | 27 |
| F-18 fdg pet diag HCPCS A9552 | $1,760.48 | $3,458.70 | $359.05 – $3,112.83 | 27 |
| Face, Eye Socket and Neck MRI (with and without contrast) CPT 70543 | $726.24 | $1,424.00 | $266.89 – $1,281.60 | 27 |
| Face, Eye Socket and Neck MRI (without contrast) CPT 70540 | $483.99 | $949.00 | $166.84 – $854.10 | 27 |
| Facial Bones X-ray (1 to 2 views) CPT 70140 | $85.33 | $161.00 | $58.65 – $144.90 | 27 |
| Facial Bones X-ray (complete) CPT 70150 | $122.96 | $232.00 | $79.00 – $208.80 | 27 |
| Factor ix CPT 85250 | $39.03 | $79.00 | $19.04 – $67.50 | 27 |
| Factor viii CPT 85240 | $32.60 | $66.00 | $17.90 – $59.40 | 27 |
| Family therapy with patient 50 min 90847 CPT 90847 | $186.68 | $330.00 | $96.88 – $297.00 | 26 |
| Fat/lipids feces qualitative CPT 82705 | $31.96 | $68.00 | $5.10 – $61.20 | 27 |
| Fatty acids nonesterified CPT 82725 | $32.43 | $69.00 | $18.77 – $62.10 | 27 |
| #fecal-sodium CPT 84302 | $27.26 | $58.00 | $4.86 – $13.50 | 27 |
| Feeding tube reposition CPT 74355 | $430.36 | $812.00 | $100.79 – $730.80 | 27 |
| Felbamate (felbatol(r)) - sendout CPT 80167 | $34.78 | $74.00 | $18.64 – $66.60 | 27 |
| Fern test HCPCS Q0114 | $31.02 | $66.00 | $9.74 – $59.40 | 27 |
| Ferritin CPT 82728 | $28.20 | $60.00 | $13.63 – $54.00 | 27 |
| Fetal biophys profile w/nst 76818 CPT 76818 | $297.53 | $483.00 | $79.00 – $434.70 | 27 |
| Fetal contract stress test 59020 - 26 CPT 59020 | $370.94 | $466.00 | $123.48 – $419.40 | 27 |
| Fetal fibronectin CPT 82731 | $91.18 | $194.00 | $64.41 – $174.60 | 27 |
| Fetal hemoglobin (kleihauer betke) CPT 85460 | $29.15 | $59.00 | $7.73 – $53.10 | 27 |
| Fetal hemoglobin rosette CPT 85461 | $14.33 | $29.00 | $9.36 – $26.10 | 27 |
| Fetal non stress test CPT 59025 | $254.72 | $320.00 | $123.48 – $288.00 | 27 |
| #_fet/norfentcnfrmur CPT 80354 | $31.49 | $67.00 | $13.33 – $50.40 | 27 |
| Fibrin degradation d dimer quantitative CPT 85379 | $15.31 | $31.00 | $10.18 – $27.90 | 27 |
| Fibrin degradation products CPT 85362 | $39.52 | $80.00 | $6.89 – $18.90 | 27 |
| Fibrinogen activity CPT 85384 | $14.82 | $30.00 | $9.72 – $27.00 | 27 |
| Fibrinolytic antiplasmin CPT 85410 | $11.86 | $24.00 | $7.71 – $21.60 | 27 |
| Fibrinolytic plasminogen CPT 85415 | $41.50 | $84.00 | $17.19 – $75.60 | 27 |
| Fibrinolytic plasminogen CPT 85421 | $15.31 | $31.00 | $10.18 – $27.90 | 27 |
| Fibrinolytic plasminogen xcpt antgnc asa CPT 85420 | $35.07 | $71.00 | $6.53 – $51.30 | 27 |
| Filter spider fx 3mmx320cm HCPCS C1884 | $11,061.52 | $21,904.00 | $1,394.92 – $5,274.90 | 27 |
| Filter vena cava fem denali HCPCS C1880 | $4,678.82 | $9,265.00 | $334.87 – $1,266.30 | 27 |
| Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007 CPT 10007 | $78.88 | $164.00 | $67.24 – $147.60 | 27 |
| Fine needle aspiration biopsy w/fluor gdn; ea addtl 10008 CPT 10008 | $50.99 | $106.00 | $25.23 – $95.40 | 27 |
| Fine needle aspiration biopsy w/us gdn; ea addtl 10006 CPT 10006 | $283.31 | $589.00 | $140.18 – $530.10 | 27 |
| Fine needle asp without image guide 10021 CPT 10021 | $124.10 | $258.00 | $105.78 – $232.20 | 27 |
| Finger X-ray (both hands) CPT 73140 | $84.27 | $159.00 | $58.65 – $143.10 | 27 |
| Fixation of knee joint CPT 27570 | not published | not published | $1,009.45 – $2,518.60 | 6 |
| Flecainide (tambocor)-sendout CPT 80181 | $31.96 | $68.00 | $18.64 – $61.20 | 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.