ISA*00*          *00*          *ZZ*TAIGADEMO      *ZZ*CLINIC         *261008*1200*^*00501*000020470*0*T*:~
GS*HP*TAIGADEMO*CLINIC*20261008*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*136.62*C*CHK************20261008~
TRN*1*W-520470*11982744321~
DTM*405*20261008~
N1*PR*AETNA~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-2470*1*230.00*136.62*15.18*12*PCN-CLM-2470*11*1~
CAS*CO*45*78.20~
NM1*QC*1*PATEL*NORA~
SVC*HC:99214*230.00*136.62**1~
CAS*CO*45*78.20~
CAS*PR*3*15.18~
AMT*B6*151.80~
SE*15*0001~
GE*1*1~
IEA*1*000020470~