HCPCS J3430 at Three Rivers Hospital

Injection, phytonadione (vitamin k), per 1 mg

Three Rivers Hospital, Brewster

Description from CMS's HCPCS Level II code file.

What Three Rivers Hospital publishes for this code: as an outpatient

Three Rivers Hospital’s prices for HCPCS J3430, as an outpatient
Who pays	Hospital’s fee (lowest – highest)	Doctor’s fee the hospital lists
Medicaid managed careInsurer rates	$125 – $1481 plan	—
Medicaid (state program)Insurer rates	$125 – $1481 plan	—
Medicare (traditional)Insurer rates	$3.49 – $1432 plans	—
UnknownInsurer rates	$120 – $1742 plans	—
Cash pricePaying yourself, without insurance	$178 – $212	—
List priceBefore any discount; few people pay it	$178 – $212	—

Lowest and highest amounts Three Rivers Hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. This is one line of a bill; most care brings several.

Bills to expect

The hospital’s fee is the price above. Doctors usually send their own bills. Their amounts here are what original Medicare allows in the rest of Washington for 2026, and a private-plan estimate of 118% to 179% of that (the range found across studies of what insurers pay doctors). Those are estimates, not quotes.

Bills to expect for HCPCS J3430 at Three Rivers Hospital
Bill	What it’s for	Original Medicare allows	Private plan estimate
Hospital's feeThe hospital	The drug, per billing unit	—	The price above

Drug prices are per billing unit (the unit is in the code's name, such as "per 10 mg"). Your dose decides how many units you're billed, so the total depends on your prescription, and giving the drug may be billed separately.

Original Medicare amounts are only for people on original Medicare. Your share depends on your plan’s deductible, copay and coinsurance.

Compare HCPCS J3430 at every Washington hospital, with Medicare’s reference amounts.