CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Pioneer Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $128
Cash Discount Price: $108
vs. Medicare Baseline: 3.95x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Pioneer Medical Center is $128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.95x the Medicare baseline. Located in 301 W 7Th Ave, Big Timber, MT.

Cash / Self-Pay

$108

Average discount available for prompt cash payment at this facility.

Insurance Median

$128

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $108 (333%)

Insurance Median: $128 (395%)

Cash: $108 (333% of Medicare)

Ins. Median: $128 (395% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 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 395% of the Medicare baseline (a markup of 295%). 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
Blue Cross Blue Shield	$61 - $112	188%
Health Info Net Mcr Adv	$61	188%
Healtnet Federal-All Plans	$61	188%
Humana	$61 - $124	188%
Triwest Va Pccc-All Plans	$61	188%
UnitedHealthcare	$61 - $128	188%
Rocky Mountain Health Network-All Plans	$94	290%
Allegiance Provider-All Plans	$115	355%
Mountain Health Co-Op Hpn	$119	367%
6 Degrees Health-All Plans	$128	395%
Americas Choice-All Plans	$128	395%
City Of Billings-All Plans	$128	395%
Community Health Ntwk-All Plans	$128	395%
Ebms Select Care Network-All Plans	$128	395%
Fedmed Network-All Plans	$128	395%
First Choice Big Sky-All Plans	$128	395%
First Health-All Plans	$128	395%
Interwest Ppo	$128	395%
Mountain Health Co-Op-All Other Plans	$128	395%
Pacific Source-All Plans	$128	395%
Pacific Steel & Recycling-All Plans	$128	395%
Three Rivers-All Plans	$128	395%
Health Info Net Peak/Equity	$131	404%
Health Info Net Standard-All Other Plans	$131	404%
Mountain Health Co-Op Ppo/Pos	$132	407%
Interwest Health Traditional-All Other Plans	$135	417%

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 $108.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Pioneer Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
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.