Insurance and Billing
Usual, customary and reasonable (UCR) fee
A UCR fee is the amount an insurer treats as the standard charge for a service in your area. It is used to set what the plan will pay.
UCR stands for usual, customary and reasonable. HealthCare.gov defines it as the amount paid for a service in an area, based on what providers there usually charge for the same or similar service. It is sometimes used to set the plan's allowed amount.
The ADA points out that the three words are not the same idea. The usual fee is set by the dentist. The customary fee is set by the insurer, and it may be lower than what area dentists usually charge. Methods vary a great deal among plans. Patients often do not know their out-of-pocket costs, because insurers generally do not release their customary fee schedules.
If the dentist charges more than the plan's amount, you may owe the difference. See balance billing and indemnity plans.