Complex GI Procedures in New Mexico
What 12 hospitals in New Mexico charged and were paid for complex gi procedures (APC 5331), from 2024 Medicare claims.
Average charge
$29,238
Hospital list price billed
Average allowed
$5,146
Medicare's payment + patient's share
Medicare paid
$4,100
Average per service
State rank
#27 of 48
1 = lowest average payment
Hospitals in New Mexico billed an average of $29,238 for complex gi procedures, about 5.7 times the average medicare-allowed amount of $5,146. That payment is 4% below the U.S. average of $5,364.
These are averages for patients with original (fee-for-service) Medicare. Private insurance pays different, negotiated prices, and what you owe depends on your plan's deductible and coinsurance. Use these figures to compare hospitals, not as a quote.
Paid $5,146Billed $29,238
About 18¢ was paid for every $1 hospitals in New Mexico billed for this service.
New Mexico hospitals: complex gi procedures
Every New Mexico hospital that billed Medicare for this service at least 11 times. Click a column to sort.
| Hospital | Services | Avg charge | Avg allowed | Medicare paid |
|---|---|---|---|---|
| UNM HospitalAlbuquerque | 13 | $14,434 | $4,656 | $3,710 |
| St Vincent HospitalSanta Fe | 12 | $59,316 | $5,771 | $4,598 |
| Presbyterian HospitalAlbuquerque | 11 | $13,920 | $5,044 | $4,019 |
| CHRISTUS Southern New MexicoAlamogordo | – | – | – | – |
| San Juan Regional Medical CenterFarmington | – | – | – | – |
| Lovelace Medical CenterAlbuquerque | – | – | – | – |
| Lovelace Women's HospitalAlbuquerque | – | – | – | – |
| Memorial Medical Center INCLas Cruces | – | – | – | – |
| Carlsbad Medical CenterCarlsbad | – | – | – | – |
| Covenant Health Hobbs HospitalHobbs | – | – | – | – |
| Presbyterian Santa Fe Medical CenterSanta Fe | – | – | – | – |
| Three Crosses Regional Hospital LLCLas Cruces | – | – | – | – |
Lowest and highest allowed amounts in New Mexico
Among hospitals with at least 11 Medicare services. Differences reflect local wage costs, teaching status and how sick patients were, as well as price.
Lowest
| UNM HospitalAlbuquerque, NM | $4,656 |
|---|---|
| Presbyterian HospitalAlbuquerque, NM | $5,044 |
| St Vincent HospitalSanta Fe, NM | $5,771 |
Highest
| St Vincent HospitalSanta Fe, NM | $5,771 |
|---|---|
| Presbyterian HospitalAlbuquerque, NM | $5,044 |
| UNM HospitalAlbuquerque, NM | $4,656 |
Complex GI Procedures in other states
Questions
How much does complex gi procedures cost in New Mexico?
In 2024 Medicare data, complex gi procedures (APC 5331) at 12 hospitals in New Mexico was billed at $29,238 on average, while the average medicare-allowed amount was $5,146, of which Medicare paid $4,100. Your own cost depends on your insurance, deductible and the hospital.
Why are hospital charges so much higher than payments?
Charges are a hospital's list prices. Medicare pays fixed rates set in advance, and private insurers negotiate their own discounts, so almost nobody pays the full charge. For this service in New Mexico, average charges were 5.7 times the average payment. Uninsured patients can ask the hospital about its financial assistance (charity care) policy and cash prices.
Source: CMS, Medicare Outpatient Hospitals by Provider and Service, 2024. The allowed amount is Medicare's payment plus the patient's coinsurance. CMS omits hospitals with fewer than 11 services for privacy. About the data.