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CMS Price Transparency Data Hospital file updated: 2026-05-07

Upper endoscopy with biopsy

Facility: Clay County Hospital

Billing Code: 43239 (CPT)

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Good Deal · Below Fair Market
$201Fair BaseRate (0.67× Market)
Position vs. 1.00× Fair Price33% Below Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

This hospital's typical commercial price is $134 compared to the $201 fair price benchmark.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Quality Benchmark
CMS Star Rating3/5 StarsOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score60/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

3-Star CMS clinical quality rating paired with 0.67× fair market pricing.

The BaseRate · fair price low confidence
A fair price for this
$201
about 0.2× the $927 Medicare rate · typically $122–$1,018
modeled estimate · not a bill or quote
What this hospital charges insurers
$134
Below the fair price — a good deal
about $67 under the fair price · 0.1× Medicare
Medicare pays $927 Fair price $201 This hospital $134 Cash price $2,809 Hospital's list price $2,809

How we calculate the fair BaseRate →

How this hospital compares to other IL hospitals

A typical price — 4 charge more and 4 charge less, among the 9 IL hospitals compared.

Cheapest $82 Priciest $151

Black dot = this hospital, among the 9 IL hospitals with a price for this procedure. Full list below.

Note: The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Upper endoscopy with biopsy is about $201 (about 0.2× the $927 Medicare rate). Clay County Hospital charges insurers about $134, or about $2,809 in cash — below the fair price — a good deal. Located in Flora, IL.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

UnitedHealthcareBlue Cross Blue ShieldAetnaCigna HumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company Price range vs. Medicare
UnitedHealthcaremajor $125 - $362 13%
Blue Cross Blue Shieldmajor $134 - $618 14%
Aetnamajor $125 - $160 13%
Cignamajor $2,247 242%
Ambetter (Centene) $125 13%
HealthLink $1,826 - $2,247 197%
Medica $125 - $157 13%
Meridian $125 - $134 13%
Molina $134 14%
WellCare $125 13%
+ 1 smaller / regional plan $2,669

Self-Pay How to get the cash price

Insurance Before you use insurance

Estimate your out-of-pocket cost

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Facility Profile & Credentials

  • Address: 911 Stacy Burk Dr, Flora, IL 62839
  • CMS Rating: 3 / 5 Stars
  • Ownership Type: Government - Local
  • Hospital Type: Critical Access Hospitals

Other Procedures at Clay County Hospital

Compare: Upper endoscopy with biopsy at other IL hospitals

Insurance negotiated median for the same procedure, sorted lowest first.

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at Clay County Hospital (Zero PHI Required)

CMS CCN: 141351
CPT 43239
Fair BaseRate™ $201
Medicare Rate $927
Self-Pay Cash $2,809
Insurer Median $134
Pre-filled with Clay County Hospital’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $1,020 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $1,020

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $1,020).

Step 2 · Cash vs. Insurance Arbitrage Published Cash: $2,809

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Clay County Hospital's published 45 CFR § 180 self-pay cash rate is $2,809 (vs. $134 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$2,608 Above Fair BaseRate

Negotiate Toward $201 Fair BaseRate ($927 Medicare)

Your bill ($2,809) is $2,608 above the denoised Fair BaseRate ($201) and 3.0× the $927 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall3/5 Stars (3/5)

Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

45 CFR § 180 Primary-Source Lineage & Federal Verification Verified CMS CCN 141351

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 141351) ↗ CMS HCRIS Cost Reports ↗
Published MRF File376000605_county-of-clay_standardcharges.csv
Publication / Vintage2026-05-07 · 46.04 MB
Validated Rate Rows473,983 (CMS v3.0.0)
File Integrity Digestdc2fd789458947df05c7…

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy