| Name | Value |
|---|---|
| BILL FORM | LEGACY UB-92 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| PAGE OR SEQUENCE | 1 |
| FIRST LINE NUMBER | 14 |
| LOCAL OVERRIDE ALLOWED | YES |
| STARTING COLUMN OR PIECE | 43.9 |
| SHORT DESCRIPTION | VALUE CODE EXTRACT (FL-39:41) |
| CALCULATE ONLY OR OUTPUT | CALCULATE ONLY |