ISA*00*          *00*          *ZZ*TAIGADEMO      *ZZ*CLINIC         *260726*1200*^*00501*000020015*0*T*:~
GS*HP*TAIGADEMO*CLINIC*20260726*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*142.56*C*CHK************20260726~
TRN*1*UHC-520015*11982744321~
DTM*405*20260726~
N1*PR*UNITEDHEALTHCARE~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-2015*1*240.00*142.56*15.84*12*PCN-CLM-2015*11*1~
CAS*CO*45*81.60~
NM1*QC*1*WALLACE*GRACE~
SVC*HC:99395*240.00*142.56**1~
CAS*CO*45*81.60~
CAS*PR*3*15.84~
AMT*B6*158.40~
SE*15*0001~
GE*1*1~
IEA*1*000020015~