CC-RI-RX (190)    RATE SCHEDULE (363)

Name Value
NAME CC-RI-RX
RATE TYPE CC REIMB INS
BILL TYPE OUTPATIENT
EFFECTIVE DATE 2016-01-01 00:00:00
INACTIVE DATE 2016-12-31 00:00:00
DISPENSING FEE 14.29
ADMINISTRATIVE FEE S X=X+14.29
CHARGE SET