Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

⚖️ Compare🖨️ Print Report

OPTUMCARE NEW MEXICO LLC

Family Medicine·ALBUQUERQUE, NM·NPI: 1124053210Share

Compared to Family Medicine Peers

Total spending distribution among 19 providers in this specialty

P25MedianP75P90

This provider's total spending of $23.6M is at the 75th percentile among 19 Family Medicine providers.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$23.6M

$23,640,944

Total Claims

411K

Beneficiaries

396K

1.0 claims/patient

Avg Cost/Claim

$58

Monthly Spending Trend

Yearly Spending

2018
$3.9M
+12%
2019
$4.4M
-41%
2020
$2.6M
+27%
2021
$3.3M
+5%
2022
$3.5M
+5%
2023
$3.7M
-41%
2024
$2.2M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 50 distinct procedure codes. The top code (99214 (Office/outpatient visit, est. patient, mod-high complexity)) accounts for 27% of total spending.

99214Top 25%

Office/outpatient visit, est. patient, mod-high complexity

$6.5M

79K claims · 27.4%

Your Cost: $82.13/claim|Median: $53.41
1.5× median
99213Top 25%

Office/outpatient visit, est. patient, low-mod complexity

$4.0M

58K claims · 17.1%

Your Cost: $69.43/claim|Median: $37.81
1.8× median
90460Top 5%

Immunization administration, first vaccine/toxoid, with counseling

$1.7M

33K claims · 7.3%

Your Cost: $52.01/claim|Median: $17.85
2.9× median
99392Top 10%

Preventive medicine, established patient, age 1-4

$1.5M

13K claims · 6.5%

Your Cost: $114.92/claim|Median: $75.18
1.5× median
90461Top 1%

Immunization admin, additional vaccine, counseling

$1.5M

17K claims · 6.2%

Your Cost: $85.53/claim|Median: $6.93
12.3× median
99393Top 10%

Preventive medicine, established patient, age 5-11

$1.4M

12K claims · 5.9%

Your Cost: $115.61/claim|Median: $74.82
1.5× median
99391Top 10%

Preventive medicine, established patient, infant (under 1)

$1.2M

11K claims · 5.3%

Your Cost: $113.02/claim|Median: $69.35
1.6× median
99394Top 10%

Preventive medicine, established patient, age 12-17

$928K

8,084 claims · 3.9%

Your Cost: $114.76/claim|Median: $80.15
1.4× median
99173Top 1%

$759K

20K claims · 3.2%

Your Cost: $38.38/claim|Median: $2.16
17.8× median
96110Top 25%

Developmental screening, per standardized instrument

$428K

24K claims · 1.8%

Your Cost: $17.48/claim|Median: $9.10
1.9× median
J0129Normal range

Injection, abatacept, ten milligrams intravenous

$269K

149 claims · 1.1%

Your Cost: $1,806.96/claim|Median: $1,286.08
1.4× median
77067Top 25%

Screening mammography, bilateral, including CAD

$205K

2,159 claims · 0.9%

Your Cost: $94.91/claim|Median: $39.33
2.4× median
99215Normal range

Office/outpatient visit, high complexity

$199K

2,170 claims · 0.8%

Your Cost: $91.64/claim|Median: $74.09
1.2× median
J0585Normal range

Injection, onabotulinumtoxinA, 1 unit

$182K

259 claims · 0.8%

Your Cost: $703.89/claim|Median: $470.36
1.5× median
90677Top 1%

$169K

573 claims · 0.7%

Your Cost: $295.78/claim|Median: $12.96
22.8× median
20610Normal range

Arthrocentesis, aspiration/injection, major joint

$136K

3,316 claims · 0.6%

Your Cost: $41.00/claim|Median: $29.03
1.4× median
99203Top 25%

Office/outpatient visit, new patient, low-mod complexity

$119K

1,396 claims · 0.5%

Your Cost: $85.11/claim|Median: $57.85
1.5× median
90471Top 5%

Immunization administration, 1 vaccine, percutaneous/ID/SC/IM

$115K

5,037 claims · 0.5%

Your Cost: $22.81/claim|Median: $9.80
2.3× median
99212Top 25%

Office/outpatient visit, low complexity

$109K

2,399 claims · 0.5%

Your Cost: $45.38/claim|Median: $25.06
1.8× median
62323Normal range

Epidural injection of diagnostic or therapeutic substance, lumbar

$107K

1,026 claims · 0.5%

Your Cost: $104.75/claim|Median: $111.02
0.9× median
99177Top 5%

$106K

3,097 claims · 0.4%

Your Cost: $34.11/claim|Median: $3.74
9.1× median
95913Normal range

$94K

521 claims · 0.4%

Your Cost: $180.66/claim|Median: $166.25
1.1× median
87426Top 5%

SARS-CoV-2 COVID-19 antigen detection, immunoassay

$82K

1,791 claims · 0.3%

Your Cost: $45.94/claim|Median: $30.04
1.5× median
76000Normal range

$79K

2,530 claims · 0.3%

Your Cost: $31.05/claim|Median: $17.70
1.8× median
92014Normal range

Ophthalmological exam, comprehensive, established patient

$69K

1,228 claims · 0.3%

Your Cost: $56.27/claim|Median: $47.08
1.2× median
73721Normal range

MRI joint of lower extremity without contrast

$69K

497 claims · 0.3%

Your Cost: $138.47/claim|Median: $127.34
1.1× median
87880Top 5%

Streptococcus, Group A, rapid antigen detection

$67K

3,838 claims · 0.3%

Your Cost: $17.51/claim|Median: $11.48
1.5× median
99204Top 25%

Office/outpatient visit, new patient, mod-high complexity

$61K

469 claims · 0.3%

Your Cost: $130.29/claim|Median: $84.03
1.6× median
93306Normal range

Echocardiography, transthoracic, complete, with Doppler

$55K

628 claims · 0.2%

Your Cost: $87.27/claim|Median: $54.68
1.6× median
95886Normal range

$53K

545 claims · 0.2%

Your Cost: $97.67/claim|Median: $67.70
1.4× median
77063Normal range

Screening digital breast tomosynthesis, bilateral

$53K

1,855 claims · 0.2%

Your Cost: $28.62/claim|Median: $21.41
1.3× median
92551Top 25%

Screening audiometry, pure tone, air only

$51K

4,295 claims · 0.2%

Your Cost: $11.92/claim|Median: $6.61
1.8× median
J0178Normal range

Injection, aflibercept, 1 mg

$50K

96 claims · 0.2%

Your Cost: $521.86/claim|Median: $730.09
0.7× median
73564Normal range

$48K

2,153 claims · 0.2%

Your Cost: $22.48/claim|Median: $15.00
1.5× median
99188Normal range

$48K

2,541 claims · 0.2%

Your Cost: $18.74/claim|Median: $12.80
1.5× median
72148Normal range

MRI lumbar spine without contrast

$41K

418 claims · 0.2%

Your Cost: $98.84/claim|Median: $101.03
1.0× median
96127Normal range

Brief emotional/behavioral assessment, per standardized instrument

$38K

6,782 claims · 0.2%

Your Cost: $5.63/claim|Median: $3.67
1.5× median
87804Top 25%

Influenza virus detection, rapid test

$38K

1,890 claims · 0.2%

Your Cost: $20.09/claim|Median: $12.59
1.6× median
76856Normal range

Ultrasound, pelvic, complete

$35K

673 claims · 0.2%

Your Cost: $52.72/claim|Median: $47.58
1.1× median
76830Normal range

Ultrasound, transvaginal

$33K

622 claims · 0.1%

Your Cost: $52.66/claim|Median: $57.47
0.9× median
96365Normal range

IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour

$30K

1,110 claims · 0.1%

Your Cost: $27.17/claim|Median: $54.77
0.5× median
90674Top 25%

$26K

1,093 claims · 0.1%

Your Cost: $23.58/claim|Median: $15.16
1.6× median
99381Top 5%

Preventive visit, new patient, infant (<1 yr)

$26K

143 claims · 0.1%

Your Cost: $179.34/claim|Median: $73.46
2.4× median
71046Normal range

Chest X-ray, 2 views

$24K

1,636 claims · 0.1%

Your Cost: $14.54/claim|Median: $8.92
1.6× median
73630Normal range

X-ray, foot, complete, minimum 3 views

$24K

1,267 claims · 0.1%

Your Cost: $18.65/claim|Median: $12.06
1.5× median
67028Normal range

Intravitreal injection of a pharmacologic agent

$23K

615 claims · 0.1%

Your Cost: $37.43/claim|Median: $58.82
0.6× median
76942Normal range

$23K

781 claims · 0.1%

Your Cost: $29.10/claim|Median: $24.73
1.2× median
76700Normal range

Ultrasound, abdominal, complete

$23K

358 claims · 0.1%

Your Cost: $63.10/claim|Median: $50.69
1.2× median
92004Top 25%

Ophthalmological exam, comprehensive, new patient

$23K

216 claims · 0.1%

Your Cost: $104.55/claim|Median: $59.72
1.8× median
73030Normal range

$22K

1,593 claims · 0.1%

Your Cost: $13.98/claim|Median: $10.94
1.3× median

Other Top Providers in New Mexico

View all →

Ambercare Home Health Care Corporation

Home Health

$518.1M

Unm Hospital

General Acute Care Hospital

$463.3M

Presbyterian Healthcare Services

Emergency Medicine

$345.5M

Presbyterian Healthcare Services

Surgery

$240.2M

DHHS PHS Naihs Shiprock Hospital

General Acute Care Hospital

$190.6M

Similar Providers

Other top providers in Family Medicine

Dap Health, Inc.

El Cajon, CA

$270.2M

Adelante Healthcare, Inc.

Phoenix, AZ

$245.9M

Fast Pace Medical Clinic PLLC

Spring Hill, TN

$179.4M

← All providersAll providers in New Mexico →How we detect fraud →