go back

Pennsylvania rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Facilitymedian $3 · 10th–90th $1–$40%20%10th90th$3Professionalmedian $1 · 10th–90th $1–$30%50%90th$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.48 / $3.31 / $4.27
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $3.63
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.29 / $1.51 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.45 / $1.45 / $1.45
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.29 / $4.47 / $4.79
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.29 / $1.29
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.29 / $1.29 / $1.29
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.95 / $2.24 / $2.24
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.00 / $1.95 / $3.72
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.29 / $1.66 / $2.14
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.66 / $2.63
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.38 / $1.38 / $1.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.41 / $1.55 / $2.34