CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: John Randolph Medical Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $34
Cash Discount Price: $359
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at John Randolph Medical Center is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $359. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.04x the Medicare baseline. Located in 411 West Randolph Road, Hopewell, VA.

Cash / Self-Pay

$359

Average discount available for prompt cash payment at this facility.

Insurance Median

$34

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $359 (1097%)

Insurance Median: $34 (104%)

Cash: $359 (1097% of Medicare)

Ins. Median: $34 (104% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.73 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	82%
Devoted	$29 - $33	89%
Humana	$29 - $33	89%
Sentara Health	$29 - $33	89%
United	$29 - $162	89%
United Behavioral Health	$29 - $33	89%
Aetna	$30 - $34	92%
Blue Cross Blue Shield	$30 - $34	92%
Cigna	$30 - $35	92%
Davita Village Health	$30 - $35	92%
Evernorth Behavioral Health	$30 - $35	92%
Health Net	$30	92%
Virginia Premier Health	$30 - $34	92%
Align Senior Care	$31 - $36	95%
Clear Spring Health Plan	$31 - $35	95%
Pyramid Life	$31 - $36	95%
Johns Hopkins	$32	98%
Naphcare	$39 - $45	119%
Oscar	$61	186%
Lifeworks	$68	208%
Universal Healthcare Group	$79	241%
Virginia Health Network	$126 - $233	385%
Value Options	$215	657%
Corvel	$258	788%
Occunet Workers Comp	$287	877%
4Most Health Nework	$323	987%
Multiplan	$323	987%

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 $359.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

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 97112.
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.