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Levoleucovorin (Khapzory) Injection

Ohio rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Rates data updated July 2026.

Facilitymedian $3 · 10th–90th $1$40%10%10th90th$3Professionalmedian $1 · 10th–90th $1$30%20%40%10th90th$1$1.0$2.0$5.0$10.0

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
$2.82
Typical High
$3.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.32
Typical High
$2.82
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.38
Median
$2.75
Typical High
$8.32
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.55
Typical High
$2.45
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$1.41
Typical High
$1.41
CareSource
Setting
Professional
Modifier
Global
Typical Low
$1.91
Median
$1.91
Typical High
$1.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$2.57
Typical High
$4.27
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$2.63
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$2.57
Typical High
$3.72
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.29
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.55
Median
$1.78
Typical High
$2.04
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$2.19
Typical High
$3.02
United
Setting
Facility
Modifier
Global
Typical Low
$1.29
Median
$1.58
Typical High
$2.75
United
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$1.58
Typical High
$1.74