CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Clay County Hospital

Billing Code: 43239 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$207

about 0.2× the $927 Medicare rate · typically $122–$1,138

modeled estimate · not a bill or quote

What this hospital charges insurers

$134

Below the fair price — a good deal

about $73 under the fair price · 0.1× Medicare

Medicare pays $927 Fair price $207 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.

⚠ 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 $207 (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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna 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

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 2,809), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 43239.

Insurance Before you use insurance

Call your insurance company to confirm Clay County Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 43239.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

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.