go back

Levoleucovorin (Khapzory) Injection

Wisconsin rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Rates data updated July 2026.

Facilitymedian $2 · 10th–90th $1$40%10%20%10th90th$2Professionalmedian $1 · 10th–90th $1$30%50%10th90th$1$2.0$5.0$10.0$20.0$50.0

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
$1.32
Median
$2.57
Typical High
$3.89
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.32
Typical High
$3.89
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.62
Median
$1.62
Typical High
$1.62
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.62
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.82
Median
$3.39
Typical High
$5.75
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.91
Typical High
$2.63
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$1.41
Typical High
$2.88
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$2.82
Typical High
$2.82
Medica
Setting
Facility
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$2.14
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.26
Typical High
$2.63
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$64.57
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$1.62
Median
$1.62
Typical High
$1.62
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$1.41
Median
$1.41
Typical High
$2.88
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$2.82
Typical High
$2.82
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.78
Typical High
$4.37
Quartz
Setting
Facility
Modifier
Global
Typical Low
$2.14
Median
$3.89
Typical High
$85.11
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$1.82
Security Health
Setting
Professional
Modifier
Global
Typical Low
$1.78
Median
$1.78
Typical High
$2.14
United
Setting
Facility
Modifier
Global
Typical Low
$1.29
Median
$1.29
Typical High
$3.31
United
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$1.58
Typical High
$2.04