HCPCS J1572

Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg

Current codeInjection - Immune Globulin33 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.

Prices for HCPCS J1572 by hospital
Hospital	Medicaid managed care rates (lowest – highest)	Cash price	List price (before discounts)
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01	—	$2,312 – $4,624	$3,303 – $6,606
Providence Centralia HospitalCentraliaFile dated 2026-04-01	—	$1,541 – $5,502	$2,964 – $10,580
Providence Regional Medical Center EverettEverettFile dated 2026-04-01	—	$1,175	$2,259
Providence St Peter HospitalOlympiaFile dated 2026-04-01	—	$1,541	$2,964
Virginia Mason Medical CenterSeattle	—	$62.58 – $97.57	$123 – $191

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Hospital outpatient payment (national): $90.74 (APC 0947)
Surgery center payment (national): $90.74