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Wisconsin rates for HCPCS J0642

Injection, levoleucovorin (Khapzory), 0.5 mg

Facilitymedian $2 · 10th–90th $1$40%10%20%10th90th$2Professionalmedian $1 · 10th–90th $1$30%20%40%10th90th$1$1.0$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.45 / $2.14 / $4.27
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $2.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.62 / $1.62 / $1.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.29 / $1.62
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.82 / $3.31 / $4.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.78 / $2.63
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.41 / $1.41 / $2.88
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.14 / $2.82 / $2.82
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.12 / $1.12 / $2.14
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.26 / $2.63
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.62 / $1.62 / $1.62
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.48 / $4.37
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.41 / $1.41 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.41 / $1.41 / $1.41
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.74 / $1.74 / $2.14
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
$1.41 / $1.55 / $2.04