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Levoleucovorin (Khapzory) Injection

South Dakota rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Rates data updated July 2026.

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

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
$1.29
Typical High
$2.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$1.32
Typical High
$1.62
Medica
Setting
Facility
Modifier
Global
Typical Low
$1.58
Median
$1.91
Typical High
$3.09
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.00
Median
$1.26
Typical High
$1.41
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$1.35
Typical High
$1.35
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$1.41
Typical High
$1.41
United
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$1.41
Typical High
$1.62
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.29
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.29