ISA*00*          *00*          *ZZ*TAIGADEMO      *ZZ*CLINIC         *261022*1200*^*00501*000020074*0*T*:~
GS*HP*TAIGADEMO*CLINIC*20261022*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*178.20*C*CHK************20261022~
TRN*1*UHC-520074*11982744321~
DTM*405*20261022~
N1*PR*UNITEDHEALTHCARE~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-2074*1*300.00*178.20*19.80*12*PCN-CLM-2074*11*1~
CAS*CO*45*102.00~
NM1*QC*1*QUINN*ZOE~
SVC*HC:99204*300.00*178.20**1~
CAS*CO*45*102.00~
CAS*PR*3*19.80~
AMT*B6*198.00~
SE*15*0001~
GE*1*1~
IEA*1*000020074~