CC-NF-RX (165)    RATE SCHEDULE (363)

Name Value
NAME CC-NF-RX
RATE TYPE CC NO-FAULT AUTO
BILL TYPE OUTPATIENT
EFFECTIVE DATE 2015-01-01 00:00:00
INACTIVE DATE 2015-12-31 00:00:00
DISPENSING FEE 13.10
ADMINISTRATIVE FEE S X=X+13.10
CHARGE SET