CC-DOD-RX (208) RATE SCHEDULE (363)
Name
Value
NAME
CC-DOD-RX
RATE TYPE
CC MTF REIMB INS
BILL TYPE
OUTPATIENT
EFFECTIVE DATE
2018-01-01 00:00:00
INACTIVE DATE
2018-12-31 00:00:00
DISPENSING FEE
16.64
ADMINISTRATIVE FEE
S X=X+16.64
CHARGE SET
RX COST
AUTO ADD: YES
