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Levoleucovorin (Khapzory) Injection

Montana rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Rates data updated July 2026.

Facilitymedian $2 · 10th–90th $1$40%20%10th90th$2Professionalmedian $2 · 10th–90th $1$40%20%40%10th90th$2$2.0$5.0$10.0$20.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$1.55
Typical High
$4.27
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.35
Median
$1.35
Typical High
$5.75
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.35
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$1.82
Median
$1.86
Typical High
$3.24
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.86
Typical High
$3.24
Providence
Setting
Facility
Modifier
Global
Typical Low
$1.35
Median
$1.35
Typical High
$5.75
Providence
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.82
Typical High
$85.11
United
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$1.41
Typical High
$1.41