The payment rate established by an insurance company, based on its knowledge of the regional charges for a service, is called:

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Usual and customary fees are the payment rates established by an insurance company based on its knowledge of the charges for a particular service in a specific region. These fees may differ from the actual fee charged by a provider, but they are used by insurance companies to determine how much they will reimburse for that service. Discounted fee for service refers to a reduced fee that a provider may offer to an insurance company or patient. Fee for service is a payment model in which providers are reimbursed for each service they provide. Capitation is a payment model in which providers are paid a fixed amount per patient, regardless of the number of services they provide.

The Payment Rate Established by an Insurance Company, Based on Its