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Washington rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Facilitymedian $2 · 10th–90th $1–$30%20%10th90th$2Professionalmedian $1 · 10th–90th $1–$20%50%90th$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
$1.41 / $2.45 / $2.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.86
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.29 / $2.51 / $5.25
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.29 / $1.29
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.41 / $1.95 / $2.51
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.29 / $1.58
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.41 / $1.62 / $2.95
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.70 / $1.95 / $5.13
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.23 / $1.70 / $1.70
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.70 / $2.51 / $5.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.29 / $1.29
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.17 / $1.17 / $2.75
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.17 / $1.41 / $1.48
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.29 / $1.82