ISA*00*          *00*          *ZZ*TAIGADEMO      *ZZ*CLINIC         *261007*1200*^*00501*000020499*0*T*:~
GS*HP*TAIGADEMO*CLINIC*20261007*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*142.56*C*CHK************20261007~
TRN*1*UHC-520499*11982744321~
DTM*405*20261007~
N1*PR*UNITEDHEALTHCARE~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-2499*1*240.00*142.56*15.84*12*PCN-CLM-2499*11*1~
CAS*CO*45*81.60~
NM1*QC*1*QUINN*ANTHONY~
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*000020499~