CT abdomen and pelvis with contrast at UnityPoint Health - Iowa Lutheran Hospital. CPT 74177.
What UnityPoint Health - Iowa Lutheran Hospital publishes for this service, straight from its standard-charges file, last updated January 28, 2026.
Outpatient / ER
$162cash price (self-pay)
$680list price
$79.84–$2,832range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Medicare Advantage | $235 |
| Wellmark Blue Cross and Blue Shield | Medicare Advantage | $240 |
| Molina | Medicare Advantage | $240 |
| Humana | Medicare Advantage | $247 |
| Amerivantage | Medicare Advantage | $247 |
| United Healthcare | Medicare Advantage | $247 |
| United Healthcare | HMO | $340 |
| United Healthcare | PPO | $340 |
| Iowa Total Care | Managed Medicaid | $344 |
| Amerigroup | Managed Medicaid | $344 |
| Wellmark Blue Cross and Blue Shield | HMO | $424 |
| Wellmark UPH Self-Funded | Commercial | $424 |
| Wellmark Blue Cross and Blue Shield | PPO | $499 |
| Health Partners Open Network | Commercial | $509 |
| Cigna/Midlands | Commercial | $510 |
| Aetna | HMO | $621 |
| Aetna | PPO | $723 |
| Medica Exchange Inspire | Commercial | $2,178 |
| Medica Exchange Insure | Commercial | $2,440 |
Inpatient
$5,233cash price (self-pay)
$6,541list price
$2,832–$2,832range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna/Midlands | Commercial | $2,832 |
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All common services at UnityPoint Health - Iowa Lutheran Hospital