Comprehensive metabolic panel at SSM Health St. Agnes Hospital - Fond du Lac. CPT 80053.
What SSM Health St. Agnes Hospital - Fond du Lac publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$133cash price (self-pay)
$241list price
$7.92–$21.40range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| MOLINA | Medicare Managed Care Plan | $7.92 |
| BCBS | Anthem Medicare Managed Care Plan | $10.56 |
| UnitedHealthCare | All Commercial Plans | $10.56 |
| Wellcare | Medicare Managed Care Plan | $10.77 |
| Centivo | Broad(WI1) Other Commercial Plan | $13.20 |
| Centivo | Median(WI2) Other Commercial Plan | $13.20 |
| Centivo | Value(WI3) Other Commercial Plan | $13.20 |
| The Alliance | All Commercial Plans | $18.48 |
| DOC | Government | $20.38 |
| BCBS | Blue Preferred / Blue Preferred Plus HMO/POS | $21.40 |
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All common services at SSM Health St. Agnes Hospital - Fond du Lac