CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: John Randolph Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $36
Cash Discount Price: $367
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at John Randolph Medical Center is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $367. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.03x the Medicare baseline. Located in 411 West Randolph Road, Hopewell, VA.

Cash / Self-Pay

$367

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $367 (1046%)

Insurance Median: $36 (103%)

Cash: $367 (1046% of Medicare)

Ins. Median: $36 (103% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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	$29	83%
Devoted	$31 - $36	88%
Humana	$31 - $36	88%
Sentara Health	$31 - $36	88%
United	$31 - $165	88%
United Behavioral Health	$31 - $36	88%
Aetna	$32 - $36	91%
Blue Cross Blue Shield	$32 - $37	91%
Virginia Premier Health	$32 - $36	91%
Cigna	$33 - $37	94%
Clear Spring Health Plan	$33 - $37	94%
Davita Village Health	$33 - $37	94%
Evernorth Behavioral Health	$33 - $37	94%
Health Net	$33	94%
Align Senior Care	$34 - $38	97%
Johns Hopkins	$34	97%
Pyramid Life	$34 - $38	97%
Naphcare	$42 - $48	120%
Oscar	$62	177%
Lifeworks	$70	200%
Universal Healthcare Group	$81	231%
Virginia Health Network	$128 - $239	365%
Value Options	$220	627%
Corvel	$264	753%
Occunet Workers Comp	$294	838%
4Most Health Nework	$330	941%
Multiplan	$330	941%

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 $367.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

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 97530.
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.