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ORTHOPANTOGRAM"",""Revenue Code"":""320"",""Hospital Charge"":""721.7"",""Minimum Rate"":""18.05"",""Maximum Rate"":""479.93"",""Self-Pay Rate"":""197.02"",""Aetna Rate"":""445.07"",""Anthem HMO Rate"":""18.05"",""Anthem PPO Rate"":""479.93"",""CIGNA Rate"":""63.44"",""ConnectiCare Commercial Rate"":""78.51"",""ConnectiCare Exchange Rate"":""73.33"",""UnitedHealthcare\/Oxford Rate"":""218.05""},{""CPT-4"":""70371"",""DESC"":""XR SPEECH EVAL COMPLEX W-CINE"",""Revenue Code"":""320"",""Hospital Charge"":""1375.33"",""Minimum Rate"":""95.71"",""Maximum Rate"":""914.59"",""Self-Pay Rate"":""375.47"",""Aetna Rate"":""848.17"",""Anthem HMO Rate"":""95.71"",""Anthem PPO Rate"":""914.59"",""CIGNA Rate"":""316.43"",""ConnectiCare Commercial Rate"":""595.94"",""ConnectiCare Exchange Rate"":""556.61"",""UnitedHealthcare\/Oxford Rate"":""806.96""},{""CPT-4"":""71015"",""DESC"":""XR CHEST STEREO"",""Revenue Code"":""324"",""Hospital Charge"":""721.7"",""Minimum Rate"":""120.80"",""Maximum 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