Definitions for "Reasonable and Customary Charge"
A charge for medical/dental treatment or service customarily performed for the condition treated, which fairly reflects its value.
Insurance companies foster a misconception among the patient population as to how fees are established and what is "usual and customary." Stating that a charge exceeds the "usual and customary" fee leads one to believe that there is actually one standard fee schedule established for a particular geographical area and the clinic/physician is deviating from this schedule. This is certainly not the case. In fact, by law, physician groups are restricted from comparing fee schedules. Even within the insurance company population you will find a wide variance in fee schedule and what they deem "usual and customary" charges.
the fee for a product or service that is usually charged most patients for a similar service performed by similar providers within a geographic area.