Usual and Customary Charge definition

Usual and Customary Charge means the average amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided.

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Usual and Customary Charge means the amount that the provider charges for the service or procedure in the majority of non-Medicaid cases. If the provider varies the charges so that no one amount is charged in the majority of cases, “usual and customary charge” means the median charge. Token charges for charity patients and other exceptional charges shall be excluded when calculating the usual and customary charge; and

Usual and Customary Charge means an amount which we determine represents a customary charge for services in the geographical area in which the service is rendered. We shall determine this customary charge through the use of independent sources of our choice.

Examples of Usual and Customary Charge in a sentence

The Co-payment amount or Co-insurance percentage you pay for a Prescription Drug Product will not exceed the Usual and Customary Charge of the Prescription Drug Product.
For Prescription Drugs purchased at a retail or mail order Network Pharmacy, You are responsible for paying the lower of: • The applicable Cost-Sharing; or • The Network Pharmacy’s Usual and Customary Charge (which includes a dispensing fee and sales tax) for the Prescription Drug.
We will pay up to 80% of the Usual and Customary Charge for each covered Accident or Illness up to the applicable maximum benefit per Incident for Claims resulting from charges incurred for covered veterinary services for the Pet(s) that first occur and are treated by a licensed veterinarian during the Policy Term.
Unless otherwise stated in Exhibit C-1, et seq., or unless otherwise agreed upon by the Parties, Administrator shall charge United for the provision of Covered Prescription Services the lesser of (i) the Usual and Customary Charge; or (ii) the Prescription Drug Compensation.
The “Prescription Drug Compensation” shall equal the following (i) the lesser of (a) the Usual and Customary Charge or (b) the Prescription Drug Contracted Rate; minus (ii) any applicable Cost-Sharing Amount.

More Definitions of Usual and Customary Charge

Usual and Customary Charge means the amount charged to other persons for the same service.

Usual and Customary Charge means the amount we determine represents a customary charge for medical services in the geograhic area in which the service is rendered. We shall determine the usual and customary charge through the use of independent sources of our choice.

Usual and Customary Charge means the fees, costs or charges we determine that represents a common and typical charge for services in the geographical area in which the service is rendered. We may determine the usual and customary charge by using independent sources of our choice.

Usual and Customary Charge means the amount a provider offers to charge the general public for a service or supply, including applicable offered discounts. General public does not include individuals who are enrolled in or a member of an insurance plan that covers the services or supplies in question, or receive a discount of the services or supplies through a program with selective criteria that disqualify certain individuals from eligibility in the program.

Usual and Customary Charge means the provider’s charge for providing the same service to persons not entitled to MA benefits.

Usual and Customary Charge means the average amount charged by most providers for treatment, service or

Usual and Customary Charge means those charges for necessary treatment and services that are reasonable for the treatment of cases of comparable severity and nature. This will be derived from the mean charge based on the experience in a related area of the service delivered and the MDR (Medical Data Research) schedule of fees valued at the 90th percentile.