|
| 1 | 350 | Assigned Identification | Opt | Alphanumeric | 1/20 | 1 |
| 2 | 358 | Quantity Invoiced | Rel | Decimal | 1/10 | 1 |
| 3 | 355 | Unit or Basis for Measurement Code | Rel | ID | 2/2 | 1 |
| 4 | 212 | Unit Price | Rel | Decimal | 1/17 | 1 |
| 5 | 639 | Basis of Unit Price Code | Opt | ID | 2/2 | 1 |
| 6 | 235 | Product/Service ID Qualifier | Rel | ID | 2/2 | 1 |
| 7 | 234 | Product/Service ID | Rel | Alphanumeric | 1/48 | 1 |
| 8 | 235 | Product/Service ID Qualifier | Rel | ID | 2/2 | 1 |
| 9 | 234 | Product/Service ID | Rel | Alphanumeric | 1/48 | 1 |
| 10 | 235 | Product/Service ID Qualifier | Rel | ID | 2/2 | 1 |
| 11 | 234 | Product/Service ID | Rel | Alphanumeric | 1/48 | 1 |
| 12 | 235 | Product/Service ID Qualifier | Rel | ID | 2/2 | 1 |
| 13 | 234 | Product/Service ID | Rel | Alphanumeric | 1/48 | 1 |
| 14 | 235 | Product/Service ID Qualifier | Rel | ID | 2/2 | 1 |
| 15 | 234 | Product/Service ID | Rel | Alphanumeric | 1/48 | 1 |
| 16 | 235 | Product/Service ID Qualifier | Rel | ID | 2/2 | 1 |
| 17 | 234 | Product/Service ID | Rel | Alphanumeric | 1/48 | 1 |
| 18 | 235 | Product/Service ID Qualifier | Rel | ID | 2/2 | 1 |
| 19 | 234 | Product/Service ID | Rel | Alphanumeric | 1/48 | 1 |
| 20 | 235 | Product/Service ID Qualifier | Rel | ID | 2/2 | 1 |
| 21 | 234 | Product/Service ID | Rel | Alphanumeric | 1/48 | 1 |
| 22 | 235 | Product/Service ID Qualifier | Rel | ID | 2/2 | 1 |
| 23 | 234 | Product/Service ID | Rel | Alphanumeric | 1/48 | 1 |
| 24 | 235 | Product/Service ID Qualifier | Rel | ID | 2/2 | 1 |
| 25 | 234 | Product/Service ID | Rel | Alphanumeric | 1/48 | 1 |
