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As opposed to the maximum allowed amount, however, the 90th percentile of the total allowed amounts for an item or service would be more representative of the dollar amount the individual might be responsible for paying, less subject to extreme outliers, and would provide an additional data point to contextualize the dollar value when the payer-specific negotiated charge for an item or service is based on a percentage or algorithm

The LMN helps prove that these items are essential for treating or managing a diagnosed condition

GLP-1 Program: Patients may continue until goal weight is reached or transition to body sculpting once goals are achieved

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Risk of Bias Graph