FEE SERV RX3 (138)    IB ACTION CHARGE (350.2)

Name Value
KEY FEE SERV RX3
EFFECTIVE DATE 2014-03-12 00:00:00
IB TRANSACTION TYPE CCN (RX) CANCEL
UNIT CHARGE, FIXED 8
ADDITIONAL AMOUNT 1
COPAYMENT TIER 2
ADDITIONAL AMOUNT LOGIC I $G(DFN)>0,$$PRIORITY^DGENA(DFN)>6