Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
HC ASSAY OF SELENIUM - SELENIUM SERUM
Elyria, OH
See all hospitals reporting CPT 84255 →Price type
University Hospitals Health System’s median price of $114 is 203% above the median hospital's median price ($38), higher than 86% of the 2,469 hospitals reporting CPT 84255. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 13 payers, 30 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Aetna medicare advantage facility · fee schedule · outpatient | $26 | $26 | — | — | — | $26 – $26 |
| 2 | Anthem medicare advantage facility · fee schedule · outpatient | $26 | $26 | — | — | — | $26 – $26 |
| 3 | Cigna medicare advantage facility · fee schedule · outpatient | $26 | $26 | — | — | — | $26 – $26 |
| 4 | Devoted medicare advantage facility · fee schedule · outpatient | $26 | $26 | — | — | — | $26 – $26 |
| 5 | Humana medicare advantage facility · fee schedule · outpatient | $26 | $26 | — | — | — | $26 – $26 |
| 6 | Medical Mutual medicare advantage facility · fee schedule · outpatient | $26 | $26 | — | — | — | $26 – $26 |
| 7 | Molina medicare advantage facility · fee schedule · outpatient | $26 | $26 | — | — | — | $26 – $26 |
| 8 | UnitedHealthcare medicare advantage facility · fee schedule · outpatient | $26 | $26 | — | — | — | $26 – $26 |
| 9 | WellCare medicare advantage facility · fee schedule · outpatient | $26 | $26 | — | — | — | $26 – $26 |
| 10 | Ambetter commercial facility · fee schedule · outpatient | $46 | $46 | — | — | — | $46 – $46 |
| 11 | Caresource marketplace facility · fee schedule · outpatient | $46 | $46 | — | — | — | $46 – $46 |
| 12 | Aetna commercial facility · fee schedule · outpatient | $61 | $61 | — | — | — | $61 – $61 |
| 13 | Medical Mutual medflex commercial facility · percent of total billed charges · outpatientfrom % of charges | $78 | $78 | — | — | — | $78 – $78 |
| 14 | UnitedHealthcare commercial facility · fee schedule · outpatient | $78 | $78 | — | — | — | $78 – $78 |
| 15 | UnitedHealthcare nexus commercial facility · fee schedule · outpatient | $78 | $78 | — | — | — | $78 – $78 |
| 16 | Medical Mutual northern ohio commercial facility · percent of total billed charges · outpatientfrom % of charges | $84 | $84 | — | — | — | $84 – $84 |
| 17 | Medical Mutual supermed ppo facility · percent of total billed charges · outpatientfrom % of charges | $86 | $86 | — | — | — | $86 – $86 |
| 18 | Medical Mutual supermed hmo facility · percent of total billed charges · outpatientfrom % of charges | $87 | $87 | — | — | — | $87 – $87 |
| 19 | Medical Mutual nas commercial facility · percent of total billed charges · outpatientfrom % of charges | $95 | $95 | — | — | — | $95 – $95 |
| 20 | Anthem commercial facility · percent of total billed charges · outpatientfrom % of charges | $109 | $109 | — | — | — | $109 – $109 |
| 21 | Anthem traditional commercial facility · percent of total billed charges · outpatientfrom % of charges | $109 | $109 | — | — | — | $109 – $109 |
| 22 | Medical Mutual northern ohio commercial facility · percent of total billed charges · inpatientfrom % of charges | $117 | $117 | — | — | — | $117 – $117 |
| 23 | Cigna ppo commercial facility · percent of total billed charges · inpatientfrom % of charges | $131 | $131 | — | — | — | $131 – $131 |
| 24 | Cigna ppo commercial facility · percent of total billed charges · outpatientfrom % of charges | $131 | $131 | — | — | — | $131 – $131 |
| 25 | Medical Mutual hmo facility · percent of total billed charges · inpatientfrom % of charges | $165 | $165 | — | — | — | $165 – $165 |
Last updated: Jul 14, 2026
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