TAX ID1|TAX ID2|CPT|Modifier|Allowable
57-10703496|04-3133400|E0601|RR|131.61
57-10703496|04-3133400|E0601|NU|1124.56
57-10703496|04-3133400|E0562|NU|348.59
57-10703496|04-3133400|E0561|NU|123.82
57-10703496|04-3133400|E0471|RR|743.14
57-10703496|04-3133400|E0471|NU|4803.06
57-10703496|04-3133400|E0470|RR|296.95
57-10703496|04-3133400|E0470|NU|2145.23
57-10703496|04-3133400|A7046|NU|22.57
57-10703496|04-3133400|A7044|NU|139.91
57-10703496|04-3133400|A7039|NU|15.08
57-10703496|04-3133400|A7038|NU|6.19
57-10703496|04-3133400|A7037|NU|46.15
57-10703496|04-3133400|A7036|NU|17.9
57-10703496|04-3133400|A7035|NU|41.76
57-10703496|04-3133400|A7034|NU|136.13
57-10703496|04-3133400|A7033|NU|32.87
57-10703496|04-3133400|A7032|NU|46.9
57-10703496|04-3133400|A7031|NU|80.74
57-10703496|04-3133400|A7030|NU|218.3
57-10703496|04-3133400|A7029|NU|27.17
57-10703496|04-3133400|A7028|NU|66.53
57-10703496|04-3133400|A7027|NU|250.44
57-10703496|04-3133400|A4604|NU|77.31