CT abdomen and pelvis with contrast at Southeast Iowa Regional Medical Center West Burlington. CPT 74177.
What Southeast Iowa Regional Medical Center West Burlington publishes for this service, straight from its standard-charges file, last updated June 11, 2026.
Outpatient / ER
—cash price (self-pay)
$230list price
$66.44–$3,767range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| American Healthplan of Iowa - Midlevel | MEDICARE ADV. | $66.44 |
| Medicaid - Nurse Practitioner | MANAGED MEDICAID | $69.51 |
| Medicaid - Physician Assistant | MANAGED MEDICAID | $71.00 |
| Humana | MEDICARE ADV. | $83.52 |
| Aetna | FIRST HEALTH | $86.59 |
| American Healthplan of Iowa - MD | MEDICARE ADV. | $87.81 |
| Plain Church | ALL PRODUCTS | $150 |
| Wellmark Blue Cross - Anesthesiology | PPO | $166 |
| Wellmark Blue Cross - Pathologist | PPO | $166 |
| Wellmark Blue Cross - Physician | HMO | $166 |
| Wellmark Blue Cross - Physician Assistant | HMO | $166 |
| Wellmark Blue Cross - Physician Assistant | PPO | $166 |
| United Healthcare | ALL PRODUCTS | $167 |
| Midlands Choice | ALL PRODUCTS | $184 |
| Wellmark Blue Cross - Physician | PPO | $195 |
| Absolute Solutions | ALL PRODUCTS | $207 |
| First Agency | ALL PRODUCTS | $207 |
| Multiplan | ALL PRODUCTS | $207 |
| Henderson County | ALL PRODUCTS | $219 |
| Midlands Choice | All Products | $860 |
| Wellmark Blue Cross | HMO | $880 |
| Wellmark Blue Cross | PPO | $967 |
| Wellpoint (Amerigroup) | Managed Medicaid | $2,268 |
| Immugrun | All Products | $2,552 |
| Brighton Amish Church | All Products | $2,633 |
| Plain Church | All Products | $2,633 |
| 6 Degree | All Products | $3,240 |
| Geha | PPO | $3,767 |
Inpatient
—cash price (self-pay)
$4,050list price
$2,268–$3,767range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Midlands Choice | All Products | $3,645 |
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All common services at Southeast Iowa Regional Medical Center West Burlington