CC-DOD-RX (204)    RATE SCHEDULE (363)

Name Value
NAME CC-DOD-RX
RATE TYPE CC MTF REIMB INS
BILL TYPE OUTPATIENT
EFFECTIVE DATE 2014-01-01 00:00:00
INACTIVE DATE 2014-12-31 00:00:00
DISPENSING FEE 13.07
ADMINISTRATIVE FEE S X=X+13.07
CHARGE SET