Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Connecticut for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Connecticut only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Connecticut (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Sema4 Opco, Inc (NPI 1518415991)

Sema4 Opco, Inc is a clinical medical laboratory provider located in Branford, Connecticut. This profile covers 0 Medicare and 80 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Sema4 Opco, Inc
Address	1 Commercial St
City	Branford
State	CT
ZIP	06405
Taxonomy	Clinical Medical Laboratory
NPI Enumerated	September 14, 2016

Payer Source	Total Paid
Medicaid	$10.8M
Medicare	$0

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

80 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	9,410	$290	$2.8M
81220	The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR…	11,680	$180	$2.1M
81408	The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 9 molecular pathology code.	10,770	$100	$1.1M
81407	The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 8 molecular pathology code.	9,700	$50	$446.4K
81329	The lab analyst performs the technical lab test to detect deletions in the survival of motor neuron 1 (SMN1), telomeric, gene and may also analyze the survival of motor neuron 2 (SMN2), centromeric,…	9,550	$40	$353.2K
81406	The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 7 molecular pathology code.	11,610	$30	$348.2K
81422	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell–free fetal DNA in maternal blood for chromosomal microdeletion(s) associated with conditions such as DiGeorge…	2,900	$110	$324.4K
81162	The lab analyst performs the technical lab test to analyze the entire gene sequence for the BRCA1, DNA repair–associated gene, also called BRCA1; and BRCA2, DNA repair–associated gene, also called…	900	$260	$235.7K
81404	The lab analyst performs the technical lab tests to complete one of the specific genetic analyses listed in this Tier 2, Level 5 molecular pathology code.	11,350	$20	$215.7K
81405	The lab analyst performs the technical lab tests to complete one of the specific genetic analyses listed in this Tier 2, Level 6 molecular pathology code.	11,100	$20	$210.8K

Showing 1–10 of 80

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Connecticut providers billing the same CPT/HCPCS codes.

Claims Volume vs. Connecticut Distribution

Sema4 Opco, Inc — 15 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

80 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	2	10	4,900	$390	$2.2M
81479	Use 81479 to report a molecular pathology procedure that does not have a specific code.	3	10	830	$850	$620.4K
U0004	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by…	3	30	5,480	$60	$581.1K
81408	The lab analyst performs the technical lab test to complete one of the specific genetic analyses listed in this Tier 2, Level 9 molecular pathology code.	1	10	230	$100	$378.4K
81220	The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR…	1	10	620	$200	$374.6K
U0005	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc,…	7	50	4,960	$20	$273.9K
81162	The lab analyst performs the technical lab test to analyze the entire gene sequence for the BRCA1, DNA repair–associated gene, also called BRCA1; and BRCA2, DNA repair–associated gene, also called…	1	10	900	$260	$236.1K
81251	The lab analyst performs the technical lab test to detect the presence of specific changes in the gene for glucosidase, beta, acid, also known as GBA.	1	10	9,250	$20	$175.3K
83080	The lab analyst measures the amount of the beta–hexosaminidase A or B that is present, typically in a serum specimen. These two enzymes are deficient in conditions such as Tay–Sachs disease or…	1	10	9,750	$20	$167.1K
81422	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell–free fetal DNA in maternal blood for chromosomal microdeletion(s) associated with conditions such as DiGeorge…	1	10	1,470	$110	$162.8K

Showing 1–10 of 80

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hhc Physician Services, PLLC	CT	Internal Medicine Physician	$0	$7.7M
Physicians Alliance Of Connecticut, LLC	CT	Internal Medicine Physician	$0	$6.3M
Genco Lab LLC	CT	Clinical Medical Laboratory	$648.4K	$2.6M
Branford Pediatrics & Allergy, P.C.	CT	Allergy Physician	$0	$3.1M
Town Of Branford	CT	Land Ambulance	$542.1K	$1.7M
Prime Dental LLC	CT	General Practice Dentistry	$0	$1.7M
Town Of Branford	CT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$1.7M
Back To Health Of Branford, LLC	CT	Internal Medicine Physician	$0	$1.6M
New Horizon Healthcare, LLC	CT	Physician Assistant	$0	$1.4M
Stony Creek Urgent Care Center, LLC	CT	General Practice Physician	$0	$1.2M

Sema4 Opco, Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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References