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South Dakota rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Facilitymedian $1 · 10th–90th $1$30%50%10th90th$1Professionalmedian $1 · 10th–90th $1$20%20%40%10th90th$1$1.0$2.0$5.0

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $2.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.45 / $1.45 / $1.78
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.58 / $1.91 / $3.09
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.26 / $1.41
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.35
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.55 / $1.55 / $1.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.41 / $1.62
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.41 / $1.41 / $1.41