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GS*HS*60054*60054*260711*1407*1487113239*X*005010X279A1~
ST*270*000049026*005010X279A1~
BHT*0022*13*000049026*2607192*1407~
HL*1**20*1~
NM1*PR*2*AETNA*****PI*60054~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*RZEPKA*JOSEPH****MI*W294982148~
DMG*D8*19650526*M~
DTP*291*RD8*20260711-20261009~
EQ*42~
EQ*30~
SE*14*000049026~
GE*1*49026~
IEA*1*000049026~