Usual and Customary Charge

The lesser of: 1. the actual charge 2. the fee most often charged by the provider for the same service or supply, or 3. the fee most often charged in the same are by providers with similar training and experience for a comparable service or supply. An area is defined as the metropolitan area, a county or a greater area if needed to find a cross-section of providers of a comparable service or supply

See Also: Self-Insured Health Plan; Third-Party Administrator (TPA); Utilization Review (UR);

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