12207038 (OTHER) — raw rate rows

OTHER · raw rates

12207038 — Gammagard (immglob) 30 Gm Sdv

Per-row negotiated rates, exactly as filed by each hospital. Aggregated views below summarize across hospitals; the bottom table shows the underlying rows.

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Typical negotiated price $13,878

Usually $13,878–$13,878 (25th–75th percentile) across 1 hospital · 5 payers.

“Negotiated” is the hospital’s negotiated facility rate for this OTHER 12207038 — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.

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This estimate runs on the hospital’s facility charge only. The surgeon’s and anesthesiologist’s fees are billed separately and aren’t in this number — your EOB shows your complete total.

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Out-of-pocket max (assumed — typical plan) Coinsurance % (after deductible)

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Per-month price trends are temporarily unavailable while we rebuild them on quality-filtered rates. The medians, percentiles, and per-hospital rates on this page are the quality-filtered figures.

Hospital rates (per row)

Showing consumer-grade rates only. Flagged / outlier filings (excluded from the medians above) are hidden — tick “Show flagged / outlier rates” to include them.

Hospital	Payer	Plan	Negotiated rate	Gross	Cash	Observed	Source
SARAH D CULBERTSON MEMORIAL HOSPITAL	Cigna All Plans	—	$9,113.37	$15,420.25	—	2026-05-28	MRF ↗
SARAH D CULBERTSON MEMORIAL HOSPITAL	Aetna All Ppo & Pos Elect Choice Plans	—	$13,878.23	$15,420.25	—	2026-05-28	MRF ↗
SARAH D CULBERTSON MEMORIAL HOSPITAL	Multiplan All Plans	—	$13,878.23	$15,420.25	—	2026-05-28	MRF ↗
SARAH D CULBERTSON MEMORIAL HOSPITAL	Unitedhealthcare All Commercial Ppo & Commerical Hmo Plans	—	$13,878.23	$15,420.25	—	2026-05-28	MRF ↗
SARAH D CULBERTSON MEMORIAL HOSPITAL	Blue Cross Blue Shield Of Illinois Ppo Plans Only	—	$15,420.25	$15,420.25	—	2026-05-28	MRF ↗