CMS Price Transparency Data

Gallbladder removal (laparoscopic)

Facility: UPMC Somerset

Billing Code: 47562 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 47562
Insurance Median: $5,441
Cash Discount Price: $2,270
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Gallbladder removal (laparoscopic) at UPMC Somerset is $5,441. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,270. Compared to the federal Medicare reimbursement reference rate of $6,176.47, this hospital’s rate is 0.88x the Medicare baseline. Located in 225 South Center Avenue, Somerset, PA.

Cash / Self-Pay

$2,270

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,441

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$6,176.47

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $6,176.47 (100%)

Cash / Self-Pay: $2,270 (37%)

Insurance Median: $5,441 (88%)

Cash: $2,270 (37% of Medicare)

Ins. Median: $5,441 (88% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $6,176.47 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
Upmc Health Plan	$626 - $5,674	10%
Highmark Wholecare (Prev Gateway)	$676 - $6,007	11%
UnitedHealthcare	$892 - $5,562	14%
Upmc Work Partners	$1,414	23%
Geisinger	$1,490 - $7,599	24%
Aetna	$1,514 - $5,526	25%
Blue Cross Blue Shield	$1,615 - $10,442	26%
Multiplan	$1,892 - $8,980	31%
Galaxy Health Plan	$2,460 - $8,980	40%
Humana	$2,838 - $10,362	46%
Amerihealth Caritas	$5,562	90%

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 $2,270.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 47562.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Somerset is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 47562.
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.