| Name | Description | Type | Additional information |
|---|---|---|---|
| ConfigurationCode | integer |
None. |
|
| ModalityCode | integer |
None. |
|
| InsuranceCoverageCode | integer |
None. |
|
| CoverageCode | integer |
None. |
|
| InsuredAmount | string |
None. |
|
| DeductibleAmount | string |
None. |