ISA*00*          *00*          *ZZ*TAIGADEMO      *ZZ*CLINIC         *260922*1200*^*00501*000021144*0*T*:~
GS*HP*TAIGADEMO*CLINIC*20260922*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*136.62*C*CHK************20260922~
TRN*1*BCB-521144*11982744321~
DTM*405*20260922~
N1*PR*BLUE CROSS BLUE SHIELD~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-3144*1*230.00*136.62*15.18*12*PCN-CLM-3144*11*1~
CAS*CO*45*78.20~
NM1*QC*1*FROST*ELIJAH~
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*000021144~