INELIG-RX (113)    RATE SCHEDULE (363)

Name Value
NAME INELIG-RX
RATE TYPE INELIGIBLE
BILL TYPE OUTPATIENT
BILLABLE SERVICE OUTPATIENT VISIT
EFFECTIVE DATE 2018-01-01 00:00:00
INACTIVE DATE 2018-12-31 00:00:00
ADJUSTMENT S X=X+16.64
CHARGE SET