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GS*HP*TAIGADEMO*CLINIC*20261023*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*142.56*C*CHK************20261023~
TRN*1*UHC-520766*11982744321~
DTM*405*20261023~
N1*PR*UNITEDHEALTHCARE~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-2766*1*240.00*142.56*15.84*12*PCN-CLM-2766*11*1~
CAS*CO*45*81.60~
NM1*QC*1*BOOKER*THEO~
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*000020766~