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Levoleucovorin (Khapzory) Injection

Pennsylvania rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Rates data updated July 2026.

Facilitymedian $2 · 10th–90th $1$40%20%10th90th$2Professionalmedian $1 · 10th–90th $1$20%50%10th90th$1$1.0$10.0$100.0$1.0K$10.0K

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
$1.32
Median
$2.19
Typical High
$3.55
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.32
Typical High
$2.82
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$1.20
Median
$1.41
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$1.35
Typical High
$1.35
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.29
Median
$4.47
Typical High
$4.79
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.29
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.29
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$2.24
Typical High
$2.24
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1.32
Median
$1.95
Typical High
$3.55
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.32
Typical High
$3.31
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$1.48
Median
$1.66
Typical High
$1.82
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1.48
Median
$1.74
Typical High
$1.74
United
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$1.55
Typical High
$2.34