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Unlisted X-Ray Imaging Study

Pennsylvania rates for HCPCS 76499

Covers a diagnostic imaging study using X-rays that has no standard named entry of its own. It is used when the examination performed does not match any of the established named X-ray studies, so the doctor supplies a written description of exactly what was done and why.

Rates data updated July 2026.

How much does Unlisted X-Ray Imaging Study cost?

$269

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $269 for this service. The price depends on where it is billed: about $724 from a physician practice, and about $107 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$724$724 to $64,565
FacilityA hospital or hospital-owned outpatient department$107$70.79 to $200

How much rates vary

Facilitymedian $107 · 10th to 90th $48 to $257Professionalmedian $724 · 10th to 90th $724 to $64,565
$100$1K$10Kfacility $107professional $724

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$165.96
Typical High
$199.53
Aetna
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$724.44
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$64,565.42
Median
$64,565.42
Typical High
$64,565.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$190.55
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$165.96
Typical High
$199.53
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$724.44
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$60.26
Typical High
$93.33
United
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$208.93
Typical High
$288.40

Where Pennsylvania sits

The same service costs 23.4 times more in Iowa than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 16th of 50

$269

IA $724DE $30.90

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.