CMS Price Transparency Data

X-ray, pelvis

Facility: Banner Payson Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72170
  • Insurance Median: $91
  • Cash Discount Price: $107
  • vs. Medicare Baseline: 0.85x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at Banner Payson Medical Center is $91. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $107. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.85x the Medicare baseline. Located in 807 South Ponderosa Drive, Payson, AZ.
Cash / Self-Pay
$107

Average discount available for prompt cash payment at this facility.

Insurance Median
$91

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: $107 (100%)
Insurance Median: $91 (85%)
Cash: $107 (100% of Medicare)
Ins. Median: $91 (85% 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.

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 - $83 74%
Banner University Health Plan $79 - $83 74%
Health Choice Arizona, Inc. $79 - $118 74%
Health Net $79 - $123 74%
Mercy Care $79 - $83 74%
Blue Cross Blue Shield $81 - $108 76%
Aetna $82 - $134 77%
Banner Health $83 78%
Care 1St $83 78%
Cigna $83 - $161 78%
Gila River Health Care Corporation $83 78%
Kaiser Foundation Health Plan $83 78%
Triwest Healthcare Alliance Corp - Va Ccn $83 78%
UnitedHealthcare $83 - $135 78%
Upmc Health Plan $83 78%
Wellpoint $83 78%
Carelon $87 81%
Humana $88 82%
Arizona Priority Care $91 85%
Devoted Health Services $91 85%
Gold Kidney Health Plan $91 85%
National Healthcare Solutions Inc (Nhsi) And Vip Universal Medical Insurance Group (Vumi) $91 85%
Plotkin Health $91 85%
Oscar Health Plan $137 128%
Quiktrip Corporation $141 132%
Arizona Medical Network $182 170%
Provider Network Of America $182 170%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 807 South Ponderosa Drive, Payson, AZ 85541
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Other
  • Hospital Type: Critical Access Hospitals