CMS Price Transparency Data

X-ray, lower back

Facility: Banner Payson Medical Center

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72110
Insurance Median: $196
Cash Discount Price: $240
vs. Medicare Baseline: 1.84x Medicare

The contracted insurance negotiated median rate for a X-ray, lower back at Banner Payson Medical Center is $196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $240. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.84x the Medicare baseline. Located in 807 South Ponderosa Drive, Payson, AZ.

Cash / Self-Pay

$240

Average discount available for prompt cash payment at this facility.

Insurance Median

$196

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $240 (225%)

Insurance Median: $196 (184%)

Cash: $240 (225% of Medicare)

Ins. Median: $196 (184% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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	$79 - $185	74%
Banner University Health Plan	$79 - $185	74%
Health Choice Arizona, Inc.	$79 - $264	74%
Health Net	$79 - $274	74%
Mercy Care	$79 - $185	74%
Blue Cross Blue Shield	$164 - $219	154%
Aetna	$184 - $299	172%
Banner Health	$185	173%
Care 1St	$185	173%
Cigna	$185 - $360	173%
Gila River Health Care Corporation	$185	173%
Kaiser Foundation Health Plan	$185	173%
Triwest Healthcare Alliance Corp - Va Ccn	$185	173%
UnitedHealthcare	$185 - $303	173%
Upmc Health Plan	$185	173%
Wellpoint	$185	173%
Carelon	$195	183%
Humana	$196	184%
National Healthcare Solutions Inc (Nhsi) And Vip Universal Medical Insurance Group (Vumi)	$203	190%
Plotkin Health	$203	190%
Arizona Priority Care	$204	191%
Devoted Health Services	$204	191%
Gold Kidney Health Plan	$204	191%
Oscar Health Plan	$306	286%
Quiktrip Corporation	$316	296%
Arizona Medical Network	$407	381%
Provider Network Of America	$407	381%

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 $240.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72110.

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 72110.
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.