Home › Hospitals › Banner Payson Medical Center Posts prices for 37 of the 66 common shoppable procedures we track. Price file retrieved 2026-08-15.
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Procedure Cash price Gross charge × Medicare
CT head/brain without contrast (70450) $488.75
$964
4.4×
MRI brain without contrast (70551) $867
$1,700
3.4×
MRI brain with contrast (70552) $1,083.75
$2,125
2.9×
MRI brain without and with contrast (70553) $1,300.50
$2,550
3.5×
X-ray lower spine, 4+ views (72110) $239.56
$452
2.1×
MRI lumbar spine without contrast (72148) $811.95
$1,637
3.2×
CT pelvis with contrast (72193) $816.68
$1,614
4.4×
MRI lower-extremity joint without contrast (73721) $605.11
$1,071
2.4×
CT abdomen and pelvis with contrast (74177) $1,061.08
$2,097
2.9×
Ultrasound, abdomen complete (76700) $356.66
$579
3.2×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $313.54
$509
2.8×
Ultrasound, transvaginal (76830) $243.32
$395
2.2×
Mammography, one breast (diagnostic) (77065) $99.06
$159
1.1×
Mammography, both breasts (diagnostic) (77066) $149.52
$240
1.4×
Mammography, screening (bilateral) (77067) $165.57
$212
1.8×
Basic metabolic panel (80048) $21.62
$46
2.6×
Comprehensive metabolic panel (80053) $22.56
$48
2.1×
Lipid panel (80061) $24.68
$52.50
1.8×
Renal function panel (80069) $21.62
$46
2.5×
Hepatic function panel (80076) $21.15
$45
2.6×
Urinalysis, non-automated, without microscopy (81002) $5.81
$11
1.7×
PSA, total (84153) $26.32
$56
1.4×
Thyroid stimulating hormone (TSH) (84443) $24.68
$52.50
1.5×
CBC with automated differential (85025) $17.04
$34.50
2.2×
CBC, automated (85027) $9.88
$20
1.5×
Prothrombin time (PT) (85610) $25.19
$51
5.9×
Partial thromboplastin time (PTT) (85730) $9.39
$19
1.6×
Psychotherapy, 30 minutes (90832) $96.35
$222
0.5×
Psychotherapy, 45 minutes (90834) $109.80
$253
0.6×
Psychotherapy, 60 minutes (90837) $124.12
$286
0.7×
Family psychotherapy, with patient (50 min) (90847) $186.68
$330
1.0×
Group psychotherapy (90853) $151.16
$347.50
1.4×
Sleep study (attended polysomnography) (95810) $2,940.74
$5,507
3.2×
Physical therapy, therapeutic exercise (per 15 min) (97110) $9.11
$66
0.3×
Office visit, new patient (low complexity, ~30 min) (99203) $1,122.72
$1,210
7.9×
Office visit, new patient (moderate complexity, ~45 min) (99204) $1,359.30
$1,472.50
9.6×
Office visit, new patient (high complexity, ~60 min) (99205) $1,805.26
$1,942.50
12.7×
As a Critical Access Hospital, Medicare pays this facility about 101% of its own costs. The × Medicare column compares the cash price against that cost-based benchmark, not a standard rate.
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