CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Banner Payson Medical Center

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $28
Cash Discount Price: $15
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Banner Payson Medical Center is $28. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 0.83x the Medicare baseline. Located in 807 South Ponderosa Drive, Payson, AZ.

Cash / Self-Pay

$15

Average discount available for prompt cash payment at this facility.

Insurance Median

$28

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$33.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $33.73 (100%)

Cash / Self-Pay: $15 (44%)

Insurance Median: $28 (83%)

Cash: $15 (44% of Medicare)

Ins. Median: $28 (83% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $33.73 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.

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	$15 - $26	44%
Health Net	$15 - $38	44%
Mercy Care	$15 - $26	44%
Aetna	$26 - $81	77%
Banner Health	$26	77%
Banner University Health Plan	$26	77%
Blue Cross Blue Shield	$26 - $201	77%
Care 1St	$26	77%
Cigna	$26 - $50	77%
Gila River Health Care Corporation	$26	77%
Health Choice Arizona, Inc.	$26 - $37	77%
Kaiser Foundation Health Plan	$26	77%
Triwest Healthcare Alliance Corp - Va Ccn	$26	77%
UnitedHealthcare	$26 - $42	77%
Upmc Health Plan	$26	77%
Wellpoint	$26	77%
Carelon	$27	80%
Humana	$27	80%
Arizona Priority Care	$28	83%
Devoted Health Services	$28	83%
Gold Kidney Health Plan	$28	83%
National Healthcare Solutions Inc (Nhsi) And Vip Universal Medical Insurance Group (Vumi)	$28	83%
Plotkin Health	$28	83%
Oscar Health Plan	$43	127%
Quiktrip Corporation	$44	130%
Arizona Medical Network	$57	169%
Provider Network Of America	$57	169%

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 $15.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97750.

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 97750.
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.