ISA*00*          *00*          *ZZ*TAIGADEMO      *ZZ*CLINIC         *260802*1200*^*00501*000020930*0*T*:~
GS*HP*TAIGADEMO*CLINIC*20260802*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*1306.80*C*CHK************20260802~
TRN*1*UHC-520930*11982744321~
DTM*405*20260802~
N1*PR*UNITEDHEALTHCARE~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-2930*1*2200.00*1306.80*145.20*12*PCN-CLM-2930*11*1~
CAS*CO*45*748.00~
NM1*QC*1*NGUYEN*CHLOE~
SVC*HC:70551*2200.00*1306.80**1~
CAS*CO*45*748.00~
CAS*PR*3*145.20~
AMT*B6*1452.00~
SE*15*0001~
GE*1*1~
IEA*1*000020930~