the charge most frequently made to the majority of patients for the same service or procedure. The charge must be within the range of the charges most frequently made in the same or similar medical service area for the service or procedure as billed by the other Physicians.
The amount Medicare determines to be the maximum amount allowable for any given service. There is a 5% differential between the approved charges for services rendered by participating providers and the approved charges for services rendered by nonparticipating providers. The participating approved amount is 5% higher.
The maximum reimbusement allowed for covered services. It can reflect a fee schedule or customary charges determined by WellChoice, WellChoice's agreement with a provider, or by statute or regulation (may be subject to a deductible or coinsurance).