CMS Price Transparency Data

Blood test, hemoglobin

Facility: PAM Specialty Hospital of Wilkes-Barre

Billing Code: 85018 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85018
Insurance Median: $148
Cash Discount Price: $198
vs. Medicare Baseline: 62.45x Medicare

The contracted insurance negotiated median rate for a Blood test, hemoglobin at PAM Specialty Hospital of Wilkes-Barre is $148. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $198. Compared to the federal Medicare reimbursement reference rate of $2.37, this hospital’s rate is 62.45x the Medicare baseline. Located in 575 North River St, Wilkes-Barre, PA.

Cash / Self-Pay

$198

Average discount available for prompt cash payment at this facility.

Insurance Median

$148

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$2.37

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $2.37 (100%)

Cash / Self-Pay: $198 (8354%)

Insurance Median: $148 (6245%)

Cash: $198 (8354% of Medicare)

Ins. Median: $148 (6245% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $2.37 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 6245% of the Medicare baseline (a markup of 6145%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
America'S Choice	$138	5823%
Intergroup	$148	6245%
Provider Network Of Amercia	$148	6245%
Quik Trip	$148	6245%
Usa Managed Care Organization	$148	6245%
Velocity Provider Ppo Network	$148	6245%
Devon Health Services	$158	6667%
Multiplan/Phcs	$158	6667%
Prime Health Services	$168	7089%
Medincrease	$178	7511%

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 $198.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85018.

Insurance In-Network Protection Plan

Contact your insurance company to confirm PAM Specialty Hospital of Wilkes-Barre is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85018.
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.