ISA*00*          *00*          *ZZ*TAIGADEMO      *ZZ*CLINIC         *261019*1200*^*00501*000021293*0*T*:~
GS*HP*TAIGADEMO*CLINIC*20261019*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*2851.20*C*CHK************20261019~
TRN*1*UHC-521293*11982744321~
DTM*405*20261019~
N1*PR*UNITEDHEALTHCARE~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-3293*1*4800.00*2851.20*316.80*12*PCN-CLM-3293*11*1~
CAS*CO*45*1632.00~
NM1*QC*1*PATEL*OWEN~
SVC*HC:29881*4800.00*2851.20**1~
CAS*CO*45*1632.00~
CAS*PR*3*316.80~
AMT*B6*3168.00~
SE*15*0001~
GE*1*1~
IEA*1*000021293~