|
| I003-1 | 5701 | Product/Service Identification | Mandatory | Alphanumeric | 1/40 | 1 |
| I003-2 | 5703 | Product/Service Qualifier | Rel | Alphanumeric | 1/3 | 1 |
| I003-3 | 7703 | Procedure Modifier, coded | Rel | Alphanumeric | 1/3 | 1 |
| I003-4 | 7703 | Procedure Modifier, coded | Rel | Alphanumeric | 1/3 | 1 |
| I003-5 | 7703 | Procedure Modifier, coded | Rel | Alphanumeric | 1/3 | 1 |
| I003-6 | 7703 | Procedure Modifier, coded | Rel | Alphanumeric | 1/3 | 1 |
