CMS Price Transparency Data

Group therapy session

Facility: HCA Florida Fort Walton-Destin Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $112
Cash Discount Price: $272
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Group therapy session at HCA Florida Fort Walton-Destin Hospital is $112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $272. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 1.08x the Medicare baseline. Located in 1000 Mar-Walt Dr, Fort Walton Beach, FL.

Cash / Self-Pay

$272

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$103.79

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $103.79 (100%)

Cash / Self-Pay: $272 (262%)

Insurance Median: $112 (108%)

Cash: $272 (262% of Medicare)

Ins. Median: $112 (108% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $103.79 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
Corvel Corporation	$30 - $227	29%
Prime Health	$31 - $232	30%
Careworks (Rockport Community)	$32 - $239	31%
Oscar	$35	34%
Simply	$42	40%
Simply Healthcare	$45	43%
Cigna	$47 - $113	45%
Molina Healthcare	$52 - $87	50%
United	$56 - $122	54%
Avmed	$65 - $136	63%
Aetna	$80 - $110	77%
Humana	$103	99%
Plotkin Health	$136	131%
Prime Health Sheriff	$136	131%
Evolutions Healthcare	$176 - $244	170%
Naphcare	$176	170%
Multiplan	$212 - $231	204%
Ppo Next	$231	223%
Novanet	$244	235%

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 $272.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90853.

Insurance In-Network Protection Plan

Contact your insurance company to confirm HCA Florida Fort Walton-Destin Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90853.
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.