Ondansetron injection at Samaritan Hospital. CPT J2405.
What Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$2.31cash price (self-pay)
$7.30list price
$0.08–$7.30range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Mvp | Mvp Commercial Products | $0.39 |
| Mvp | Mvp Individual & Student Health Plan | $0.39 |
| Mvp | Mvp Commercial PPO | $0.39 |
| Tufts Health Plan | Cigna | $0.56 |
| Diversified Administrators | Cigna | $0.56 |
| Blue Cross - Ia (Wellmark) | Blue Shield Of Ne New York HMO | $0.79 |
| Blue Cross - Md (Carefirst) | Blue Shield Of Ne New York HMO | $0.79 |
| Blue Cross - Hi | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - Id | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - Mi | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - Mi | Blue Shield Of Ne New York HMO | $0.79 |
| Blue Cross - MA | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - MA | Blue Shield Of Ne New York HMO | $0.79 |
| Blue Cross - Ks | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - La | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - Ms | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Shield - Id (Regence) | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - Nd | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - Mt | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - Ia (Wellmark) | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - Mn | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - Md (Carefirst) | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - Nj (Horizon) | Blue Shield Of Ne New York HMO | $0.79 |
| Blue Cross - Nj (Horizon) | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - IL | Blue Shield Of Ne New York HMO | $0.79 |
| Blue Cross - IL | Blue Shield Of Ne New York PPO | $0.79 |
| Blue Cross - Ne | Blue Shield Of Ne New York PPO | $0.79 |
| Trustmark Small Business Benefits | Aetna | $0.82 |
| United Healthcare | United Healthcare | $2.08 |
| Carelon Health Medicare Advantage | Carelon Mvp Or Emblem Medicare Adv | $3.55 |
Inpatient
$3.00cash price (self-pay)
$3.00list price
$0.32–$3.00range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Union Health Service | Pb Xr 100% Default | $3.00 |
| Commonwealth Care Alliance | Pb Xr 100% Default | $3.00 |
| Rx Allwin | Pb Xr 100% Default | $3.00 |
| Health Choices | Pb Xr 100% Default | $3.00 |
| Pace Of Southwest Michigan | Pb Xr 100% Default | $3.00 |
| Harvard Pilgrim Healthcare | Pb Xr 100% Default | $3.00 |
| The Health Plan | Pb Xr 100% Default | $3.00 |
| Molina Medicare Advantage | Pb Xr 100% Default | $3.00 |
| Dentaquest | Pb Xr 100% Default | $3.00 |
| Everence | Pb Xr 100% Default | $3.00 |
| Individual Assurance Co | Pb Xr 100% Default | $3.00 |
| Humana | Pb Xr 100% Default | $3.00 |
| Healthlink Inc | Pb Xr 100% Default | $3.00 |
| Medica | Pb Xr 100% Default | $3.00 |
| Health Partners | Pb Xr 100% Default | $3.00 |
| America'S Tpa | Pb Xr 100% Default | $3.00 |
| Positive Healthcare Partners Medicare | Pb Xr 100% Default | $3.00 |
| Todays Options | Pb Xr 100% Default | $3.00 |
| Encore Health | Pb Xr 100% Default | $3.00 |
| Sunbelt International | Pb Xr 100% Default | $3.00 |
| Devon Health Services | Pb Xr 100% Default | $3.00 |
| Plain Church Group | Pb Xr 100% Default | $3.00 |
| Bcn Domestic | Pb Xr 100% Default | $3.00 |
| Blue Cross Domestic | Pb Xr 100% Default | $3.00 |
| Sandhills Center Lme | Pb Xr 100% Default | $3.00 |
| Advanced Correctional Healthcare | Pb Xr 100% Default | $3.00 |
| Local - Ct | Pb Xr 100% Default | $3.00 |
| Vaya Health Lme | Pb Xr 100% Default | $3.00 |
| Rx Rx Advance Commercial | Pb Xr 100% Default | $3.00 |
| Admiral Life | Pb Xr 100% Default | $3.00 |
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