CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Banner Payson Medical Center

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $944
Cash Discount Price: $1,061
vs. Medicare Baseline: 2.65x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Banner Payson Medical Center is $944. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,061. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 2.65x the Medicare baseline. Located in 807 South Ponderosa Drive, Payson, AZ.

Cash / Self-Pay

$1,061

Average discount available for prompt cash payment at this facility.

Insurance Median

$944

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $1,061 (298%)

Insurance Median: $944 (265%)

Cash: $1,061 (298% of Medicare)

Ins. Median: $944 (265% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 265% of the Medicare baseline (a markup of 165%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Arizona Physicians Ipa	$242 - $860	68%
Banner University Health Plan	$242 - $860	68%
Health Choice Arizona, Inc.	$242 - $1,227	68%
Health Net	$242 - $1,272	68%
Mercy Care	$242 - $860	68%
Aetna	$341 - $1,388	96%
Banner Health	$860	241%
Blue Cross Blue Shield	$860 - $1,662	241%
Care 1St	$860	241%
Cigna	$860 - $1,669	241%
Gila River Health Care Corporation	$860	241%
Kaiser Foundation Health Plan	$860	241%
Triwest Healthcare Alliance Corp - Va Ccn	$860	241%
UnitedHealthcare	$860 - $1,405	241%
Upmc Health Plan	$860	241%
Wellpoint	$860	241%
Carelon	$903	253%
Humana	$911	256%
National Healthcare Solutions Inc (Nhsi) And Vip Universal Medical Insurance Group (Vumi)	$944	265%
Plotkin Health	$944	265%
Arizona Priority Care	$946	265%
Devoted Health Services	$946	265%
Gold Kidney Health Plan	$946	265%
Oscar Health Plan	$1,419	398%
Quiktrip Corporation	$1,468	412%
Arizona Medical Network	$1,887	529%
Provider Network Of America	$1,887	529%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,061.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74177.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Banner Payson Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74177.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.