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Unlisted X-Ray Imaging Study

Wisconsin 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?

$263

Typical negotiated rate. In Wisconsin, July 2026.

Insurers have agreed to pay about $263 for this service. The price depends on where it is billed: about $209 from a physician practice, and about $288 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 7 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$209$50.12 to $263
FacilityA hospital or hospital-owned outpatient department$288$182 to $324

How much rates vary

Facilitymedian $288 · 10th to 90th $52 to $372Professionalmedian $209 · 10th to 90th $32 to $646
$50$100$200$500$1Kfacility $288professional $209

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. 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
Global
Typical Low
$323.59
Median
$323.59
Typical High
$1,071.52
Aetna
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$263.03
Typical High
$645.65
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$257.04
Typical High
$338.84
Medica
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$70.79
Typical High
$223.87
Medica
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$489.78
Typical High
$1,621.81
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$70.79
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$52.48
Typical High
$89.13
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1,659.59
Median
$1,659.59
Typical High
$1,659.59
United
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$104.71
Typical High
$229.09

Where Wisconsin 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.

Wisconsin· 18th of 50

$263

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.