ISA*00*          *00*          *ZZ*TAIGADEMO      *ZZ*CLINIC         *261018*1200*^*00501*000021120*0*T*:~
GS*HP*TAIGADEMO*CLINIC*20261018*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*193.05*C*CHK************20261018~
TRN*1*W-521120*11982744321~
DTM*405*20261018~
N1*PR*AETNA~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-3120*1*650.00*193.05*42.90*12*PCN-CLM-3120*11*1~
CAS*CO*45*221.00~
NM1*QC*1*RUSSELL*HAZEL~
SVC*HC:76700*650.00*193.05**1~
CAS*CO*45*221.00~
CAS*PR*3*42.90~
AMT*B6*429.00~
LQ*HE*N130~
SE*16*0001~
GE*1*1~
IEA*1*000021120~