HCPCS J0642
Injection, levoleucovorin (khapzory), 0.5 mg
Current code27 hospitals with prices
What Washington hospitals publish for this code
Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.
| Hospital | Commercial insurance rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $1.53 – $8.28 | — | — |
| Deaconess Medical Center | $2.45 – $4.73 | — | — |
| Harborview Medical Center | $1.15 | — | — |
| Island Hospital | $1.41 | — | — |
| Kadlec Regional Medical Center | $1.53 – $5.13 | — | — |
| Legacy Salmon Creek Medical Center | $2.24 – $3.41 | — | — |
| Mary Bridge Children's Hospital | $2.45 – $1,323 | — | — |
| MultiCare Auburn Medical Center | $2.04 – $8.28 | — | — |
| MultiCare Covington Medical Center | $2.04 – $8.28 | — | — |
| MultiCare Good Samaritan Hospital | $2.45 – $8.28 | — | — |
| MultiCare Valley Hospital | $2.45 – $4.72 | — | — |
| Olympic Medical Center | — | — | — |
| Overlake Hospital Medical Center & Clinics | $2.51 – $12.42 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $1.19 – $4.60 | — | — |
| Providence Centralia Hospital | $1.70 – $8.63 | — | — |
| Providence Holy Family Hospital | $1.53 – $2.98 | — | — |
| Providence Regional Medical Center Everett | $1.30 – $4.70 | — | — |
| Providence St Mary Medical Center | $1.70 – $11.99 | — | — |
| Providence St Peter Hospital | $1.53 – $6.20 | — | — |
| Swedish Edmonds Hospital | $1.63 – $4.58 | — | — |
| Swedish Issaquah | $1.63 – $6.00 | — | — |
| Swedish Medical Center | $1.63 – $6.00 | — | — |
| Swedish Medical Center / Cherry Hill | $1.63 – $6.00 | — | — |
| Tacoma General Allenmore Hospital | $2.04 – $6.12 | — | — |
| University of Washington Medical Ctr | $1.15 – $3.32 | — | — |
| Virginia Mason Medical Center | $1.38 – $3.74 | — | — |
| Yakima Valley Memorial | $3.11 – $6.46 | — | — |
Medicare (traditional) reference
CMS publishes no national amount for this code.