CMS Price Transparency Data

Gallbladder removal (laparoscopic)

Facility: SSM Health St Agnes Hospital-Fond Du Lac

Billing Code: 47562 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 47562
Insurance Median: $7,194
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Gallbladder removal (laparoscopic) at SSM Health St Agnes Hospital-Fond Du Lac is $7,194. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $6,176.47, this hospital’s rate is 1.16x the Medicare baseline. Located in 430 E Division St, Fond Du Lac, WI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,194

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%)

Insurance Median: $7,194 (116%)

Ins. Median: $7,194 (116% 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
Molina	$4,485	73%
Blue Cross Blue Shield	$5,257 - $6,462	85%
Wellcare	$6,099	99%
Faboh	$7,926	128%
Doc	$11,541	187%
Network Health Plan	$17,314	280%
Centivo	$18,364	297%

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 $X.
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 SSM Health St Agnes Hospital-Fond Du Lac 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.