Optional_Optional_Applicable note numbers
OptionaladjudicationAdded items adjudication
OptionalextensionAdditional content defined by implementations
OptionalfactorPrice scaling factor
OptionalidUnique id for inter-element referencing
OptionalmodifierService/Product billing modifiers
OptionalmodifierExtensions that cannot be ignored even if unrecognized
OptionalnetTotal item cost
OptionalnoteApplicable note numbers
Billing, service, product, or drug code
OptionalquantityCount of products or services
OptionalsubInsurer added line items
OptionalunitFee, charge or cost per item
Price scaling factor