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Levoleucovorin (Khapzory) Injection

Nebraska rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Rates data updated July 2026.

Facilitymedian $2 · 10th–90th $1$30%20%10th90th$2Professionalmedian $1 · 10th–90th $1$40%50%90th$1$1.0$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
Facility
Modifier
Global
Typical Low
$1.29
Median
$2.29
Typical High
$2.95
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$4.27
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.15
Median
$1.41
Typical High
$1.51
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.62
Median
$1.66
Typical High
$1.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.19
Median
$2.19
Typical High
$2.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.32
Typical High
$1.62
Medica
Setting
Facility
Modifier
Global
Typical Low
$1.51
Median
$3.47
Typical High
$85.11
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.17
Typical High
$1.41
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$1.41
Typical High
$1.41
United
Setting
Facility
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$3.39
United
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$1.41
Typical High
$2.69