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Unlisted X-Ray Imaging Study

Utah 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 October 2026.

How much does Unlisted X-Ray Imaging Study cost?

$174

Typical negotiated rate. In Utah, October 2026.

Insurers have agreed to pay about $174 for this service. The price depends on where it is billed: about $44.67 from a physician practice, and about $191 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$44.67$30.20 to $60.26
FacilityA hospital or hospital-owned outpatient department$191$158 to $257

How much rates vary

Facilitymedian $191 · 10th to 90th $145 to $302Professionalmedian $45 · 10th to 90th $30 to $5,012
$50$100$200$500$1K$2K$5Kfacility $191professional $45

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
TC · Technical part
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
Aetna
Setting
Professional
Modifier
TC · Technical part
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
Cigna
Setting
Facility
Modifier
None
Typical Low
$95.50
Median
$158.49
Typical High
$724.44
Molina
Setting
Professional
Modifier
None (both parts)
Typical Low
$30.20
Median
$44.67
Typical High
$60.26
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$190.55
Typical High
$269.15
Select Health
Setting
Facility
Modifier
None
Typical Low
$5,011.87
Median
$5,011.87
Typical High
$5,011.87
Select Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$5,011.87
Median
$5,011.87
Typical High
$7,585.78
U of Utah Health Plan
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$134.90
Typical High
$134.90

Where Utah sits

The same service costs 20.9 times more in New Hampshire 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.

Utah· 27th of 51

$174

NH $646DE $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.