ISA*00*          *00*          *ZZ*TAIGADEMO      *ZZ*CLINIC         *261023*1200*^*00501*000020926*0*T*:~
GS*HP*TAIGADEMO*CLINIC*20261023*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*136.62*C*CHK************20261023~
TRN*1*UHC-520926*11982744321~
DTM*405*20261023~
N1*PR*UNITEDHEALTHCARE~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-2926*1*230.00*136.62*15.18*12*PCN-CLM-2926*11*1~
CAS*CO*45*78.20~
NM1*QC*1*NGUYEN*CHLOE~
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*000020926~