Ondansetron injection at Intermountain Health Good Samaritan Medical Center. CPT J2405.
What Intermountain Health Good Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
$13.01list price
$0.20–$136range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $2.41 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $2.99 |
| Kaiser Perm HMO | Kaiser Out Of State | $2.99 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $2.99 |
| Cigna | Cigna Co Public Option | $3.23 |
| Cigna | Cigna Connect Exchange | $3.23 |
| Cigna | Cigna Surefit | $3.23 |
| Allegiance | Cigna Sclhs Employees | $3.25 |
| Cigna Scl Employees | Cigna Sclhs Cdhp | $3.25 |
| Aetna | Aetna Colorado Preferred | $4.84 |
| BCBS/Anthem | BCBS Co Federal | $5.06 |
| BCBS/Anthem | BCBS Co HMO | $5.06 |
| BCBS/Anthem | BCBS Co PPO | $5.06 |
| Aetna | Aetna HMO/EPO | $5.07 |
| Aetna | Aetna Indemnity | $5.07 |
| Aetna | Aetna Other | $5.07 |
| Aetna | Aetna POS/Qpos | $5.07 |
| Aetna | Aetna PPO | $5.07 |
| Aetna | Aetna Src | $5.07 |
| Geha | Geha-Asa | $5.07 |
| Preferred One | Preferred One | $5.07 |
| Choicecare Humana | Choicecare Humana HMO EPO | $5.46 |
| Choicecare Humana | Choicecare Humana PPO | $5.46 |
| Cigna | Cigna HMO | $7.28 |
| Cigna | Cigna Indemnity | $7.28 |
| Cigna | Cigna Local Plus | $7.28 |
| Cigna | Cigna Other | $7.28 |
| Cigna | Cigna POS/Qpos | $7.28 |
| Cigna | Cigna PPO | $7.28 |
| Cigna | Eighth Dist Elect Ben Pln | $7.28 |
Inpatient
—cash price (self-pay)
$13.01list price
$2.01–$151range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $3.83 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $5.47 |
| Kaiser Perm HMO | Kaiser Out Of State | $5.47 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $5.47 |
| Kaiser Self Funded | Kaiser Self Funded | $5.47 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $5.64 |
| Private Hlthcare Sys | Phcs Other | $9.75 |
| Private Hlthcare Sys | Phcs PPO | $9.75 |
| BCBS/Anthem | BCBS Co Indemnity | $10.95 |
| Multiplan Inc | Multiplan Inc Other | $11.05 |
| Multiplan Inc | Multiplan Inc PPO | $11.05 |
| Aetna | Aetna Nap | $11.66 |
| Cigna | Cigna HMO | $13.01 |
| Cigna | Cigna Indemnity | $13.01 |
| Cigna | Cigna Local Plus | $13.01 |
| Cigna | Cigna Other | $13.01 |
| Cigna | Cigna POS/Qpos | $13.01 |
| Cigna | Cigna PPO | $13.01 |
| Cigna | Eighth Dist Elect Ben Pln | $13.01 |
| Cigna | Health-Partners | $13.01 |
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All common services at Intermountain Health Good Samaritan Medical Center