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Customary and Reasonable Charges
 Pinnacle
develops customary and reasonable (C&R) charges
using historical claims data, prevailing fees, and
comparisons with outside sources including
McGraw Hill,
Yale
Wasserman, and
Anthem Blue Cross of California, to determine allowable
amounts on non-participating charges.
Procedures included cover the spectrum of medical,
surgical, laboratory, radiology, anesthesiology,
maternity and dental services. There are 11 separate
geographic designations and data is broken down into
different percentiles including the 50th, 75th, 80th
and 90th percentile. Each client may specify the
percentile point at which they would like their
customary and reasonable allowances set. Pinnacle
currently uses the 80th percentile to determine C&R
amounts for each procedure.
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