ISA*00*          *00*          *ZZ*TAIGADEMO      *ZZ*CLINIC         *261023*1200*^*00501*000021400*0*T*:~
GS*HP*TAIGADEMO*CLINIC*20261023*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*1425.60*C*CHK************20261023~
TRN*1*CIG-521400*11982744321~
DTM*405*20261023~
N1*PR*CIGNA~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-3400*1*2400.00*1425.60*158.40*12*PCN-CLM-3400*11*1~
CAS*CO*45*816.00~
NM1*QC*1*HUGHES*MATTHEW~
SVC*HC:45378*2400.00*1425.60**1~
CAS*CO*45*816.00~
CAS*PR*3*158.40~
AMT*B6*1584.00~
SE*15*0001~
GE*1*1~
IEA*1*000021400~