Ondansetron injection at WellSpan Good Samaritan Hospital. CPT J2405.
What WellSpan Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$19.40cash price (self-pay)
$59.12list price
$0.10–$522range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue_Cross | Capital_Blue_Performance_PPO | $0.10 |
| Blue_Cross | Capital_Cares_4_kids | $1.54 |
| Blue_Cross | Capital_Blue_Cross_Healthy_Benefits_PPO | $1.76 |
| Amerihealth_Caritas_Medicaid | All_Plans | $2.00 |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $2.00 |
| Geisinger_Medicaid | All_Plans | $2.00 |
| Health_Partners_Medicaid | All_Other_Plans | $2.00 |
| Blue_Cross | All_Other_Plans | $2.20 |
| UPMC_Medicaid | All_Plans | $2.20 |
| Aetna | All_Plans | $6.09 |
| United_Healthcare | All_Plans | $6.33 |
| First_Health_Network | All_Plans | $6.70 |
| WellSpan_Capital_Blue_Cross | All_Plans | $35.48 |
| Geisinger | All_Plans | $35.48 |
| UPMC | UPMC_For_Kids | $35.48 |
| UPMC | Employees_And_Dependents | $35.48 |
| PHC | All_Plans | $47.30 |
| Cigna | All_Plans | $59.29 |
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