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| Term: Prevailing Charge |
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| Covered Charges which are identified by the Plan Administrator, taking into consideration the charge which the provider most frequently bills the majority of patients for the service or supply, the cost to the provider for providing the service or supply. the usual range of charges billed in the same area by providers of similar training and experience for the service or supply, and/or the Medicare reimbursement rates. Area means, as appropriate, a metropolitan area, county, or such greater area as is necessary to obtain a representative cross-section of providers, persons or organizations rendering such treatment, service. or supply for which a specific charge is made. To be Prevailing, the charge must be in compliance with the Plan Administrator's policies and procedures relating to billing practices for unbundling or multiple procedures. |
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