CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: John Randolph Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $33
Cash Discount Price: $314
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at John Randolph Medical Center is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $314. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.02x the Medicare baseline. Located in 411 West Randolph Road, Hopewell, VA.

Cash / Self-Pay

$314

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

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: $314 (969%)

Insurance Median: $33 (102%)

Cash: $314 (969% of Medicare)

Ins. Median: $33 (102% 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.

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
Triatlantic	$27	83%
Aetna	$29 - $33	90%
Devoted	$29 - $33	90%
Humana	$29 - $33	90%
Sentara Health	$29 - $33	90%
United	$29 - $141	90%
United Behavioral Health	$29 - $33	90%
Blue Cross Blue Shield	$30 - $34	93%
Cigna	$30 - $34	93%
Clear Spring Health Plan	$30 - $35	93%
Davita Village Health	$30 - $34	93%
Evernorth Behavioral Health	$30 - $34	93%
Health Net	$30	93%
Virginia Premier Health	$30 - $34	93%
Align Senior Care	$31 - $35	96%
Pyramid Life	$31 - $35	96%
Johns Hopkins	$32	99%
Naphcare	$39 - $44	120%
Oscar	$53	164%
Lifeworks	$60	185%
Universal Healthcare Group	$69	213%
Virginia Health Network	$110 - $204	340%
Value Options	$188	580%
Corvel	$226	698%
Occunet Workers Comp	$251	775%
4Most Health Nework	$283	873%
Multiplan	$283	873%

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 $314.
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 John Randolph 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.