ISA*00*          *00*          *ZZ*TAIGADEMO      *ZZ*CLINIC         *260825*1200*^*00501*000021483*0*T*:~
GS*HP*TAIGADEMO*CLINIC*20260825*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*130.68*C*CHK************20260825~
TRN*1*BCB-521483*11982744321~
DTM*405*20260825~
N1*PR*BLUE CROSS BLUE SHIELD~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-3483*1*220.00*130.68*14.52*12*PCN-CLM-3483*11*1~
CAS*CO*45*74.80~
NM1*QC*1*PATEL*AVA~
SVC*HC:71046*220.00*130.68**1~
CAS*CO*45*74.80~
CAS*PR*3*14.52~
AMT*B6*145.20~
SE*15*0001~
GE*1*1~
IEA*1*000021483~