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Levoleucovorin (Khapzory) Injection

Washington rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Rates data updated July 2026.

Facilitymedian $2 · 10th–90th $1$30%20%10th90th$2Professionalmedian $1 · 10th–90th $1$40%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
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$2.24
Typical High
$2.69
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$1.41
Typical High
$4.27
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$1.29
Median
$2.51
Typical High
$4.90
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.29
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$1.95
Typical High
$2.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.58
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$1.62
Typical High
$2.95
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.70
Median
$1.95
Typical High
$5.13
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.23
Median
$1.70
Typical High
$1.70
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1.70
Median
$2.04
Typical High
$4.90
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.29
United
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$1.41
Typical High
$3.31
United
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$1.41
Typical High
$1.70
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.70