What is the top of the local market (P90) for CPT 95811 under Bcbst Tn for Sioux Falls, SD-MN providers?

The P90, the top of the local market and Reddenda's target rate, is $1,428.

Reddenda · Rate Intelligence · Sioux Falls, SD-MN

95811 under Bcbst Tn, for Sioux Falls, SD-MN providers

Name: Bcbst Tn rates for CPT 95811 among Sioux Falls, SD-MN providers
Creator: Reddenda

Local peer median $1,428 · Medium confidence

$1,428 local peer median. Bcbst Tn's published rate file lists a local peer median of $1,428 for CPT 95811 among 916 indexed providers in Sioux Falls, SD-MN. Where a Blue Cross entity’s label carries a state, that state names the file we found the rate in, not the provider’s location. Blue Cross plans file separately per state and do not share rates, even for the same provider. The top of that filed distribution, the P90 target, is $1,428, which is the same as the median here: this payer's filed rates for this code cluster on one number, so the opportunity in this cell is reaching the median rather than exceeding it. A provider billed below this median is being paid less than peers holding the identical Bcbst Tn contract for the identical code. Modeled from published rates, not guaranteed.

Local distribution · 916 providers · 916 rate records

P10

$1,213.80

P25

$1,428

Median

$1,428

P75

$1,428

P90 (target)

$1,428

P10$1,213.80

P25$1,428

Median (P50)$1,428

P75$1,428

P90 target$1,428

Peer basis: local peer distribution: same CPT, same payer file, same metro (CBSA) Benchmark: local peer median; never a national average Range: $603.89 – $1,428

The local peer median for CPT 95811 under Bcbst Tn for Sioux Falls, SD-MN providers is $1,428, drawn from 916 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbst Tn to publish this rate
The bottom of the local market (P10) is $1,213.80 and the top (P90) is $1,428; the median-to-P90 spread is $0.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbst Tn to publish this rate
The lowest published rate in this market is $603.89; the highest is $1,428.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbst Tn to publish this rate
This benchmark is drawn from 916 individual rate records that Bcbst Tn itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbst Tn to publish this rate
77.7% of indexed providers cluster at the single most common rate; the remainder shows a real, scoreable spread across the local market.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbst Tn to publish this rate
A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute over this exact code and payer.Source: 45 CFR §149.510(c)(4)(iii)(B)

916 providers bill this code to this payer in this metro.

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These are the rates Bcbst Tn publishes for CPT 95811 among Sioux Falls, SD-MN providers. Enter your NPI to see your own contracted rate against this peer curve, per payer and per code. Free, about 15 seconds, no card and no PHI.

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Documented reimbursement opportunity, modeled from published rates and never a guaranteed outcome.

Modeled from Bcbst Tn's own published in-network rates, never guaranteed and never a national average. Peer basis: same CPT, same payer file, same metro (CBSA). Federal citation for the underlying obligation: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbst Tn to publish this rate. Page generated 2026-08-23 23:44 UTC; the live index is queried in real time on every request.