Ondansetron injection at Good Samaritan Hospital. CPT J2405.
What Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$208cash price (self-pay)
$307list price
$0.09–$407range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Shield | TRICARE | $0.09 |
| Health Net | Tricare | $0.09 |
| Physicians Medical Group | MCD | $0.09 |
| Anthem | Medi-Cal | $0.10 |
| Physician Health Network | MGMCD | $0.10 |
| United | AllPayerAppendix | $0.15 |
| Cigna | LocalPlus | $1.47 |
| Cigna | HMO | $1.56 |
| Cigna | POS | $1.56 |
| Cigna | PPO | $1.56 |
| Aetna | MCRHMO | $46.09 |
| Aetna | MCRPOS | $46.09 |
| Aetna | MCRPPO | $46.09 |
| Imperial Insurance | MCR | $46.09 |
| MedCare Partners | MGMCR | $46.09 |
| Santa Clara Family Health Plan | Medicaid | $58.38 |
| United | OptionsPPO | $78.35 |
| United | GlobalBenefitPlan | $138 |
| Santa Clara IPA COMM | COMM | $154 |
| Santa Clara IPA MCR | MCR | $154 |
| NX Health Network | COMM | $184 |
| Sutter Select | COMM | $184 |
| ChoiceCare Humana | COMM | $215 |
| First Health | COMM | $234 |
| Cigna BH | COMMBH | $246 |
| HealthSmart | WCOMP | $246 |
| Intercontinental Corporation | COMM | $246 |
| MultiPlan | Complementary | $246 |
| PHA Pacific Health Alliance | COMM | $246 |
| PPO Next | COMM | $246 |
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