Common use of Reasonable and Customary Fee Clause in Contracts

Reasonable and Customary Fee. The term "Reasonable and Customary Fee" means the usual fee which an individual Physician most frequently charges to the majority of his or her patients for a like service or procedure to be determined by the prevailing range of fees in an area charged by most Physicians of similar training and experience for a like service or procedure (including consideration of unusual circumstances or medical complications requiring additional time, skill, or experience). An area may be a municipality or, in the case of a large city, a subdivision thereof, or such greater area as is required to determine prevailing charges. Out-of-network benefit payment is made consistent with the reasonable and customary charge.