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Sugar Separation Test By Chromatography

Alaska rates for HCPCS 84375

Separates the different sugars present in a sample so that each can be identified on its own, using a technique that spreads them out across a plate or paper according to how they travel. It is used when a person may not be digesting or handling particular sugars normally, including in the investigation of inherited disorders of sugar metabolism.

Rates data updated July 2026.

Facilitymedian $28 · 10th–90th $28$1700%50%90th$28Professionalmedian $117 · 10th–90th $39$1550%20%10th90th$117$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$281.84
Typical High
$457.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$131.83
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$44.67
Typical High
$56.23
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$38.90
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$125.89
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$144.54
Typical High
$154.88
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$87.10
Typical High
$87.10
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$28.18
Providence
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$35.48
Typical High
$38.90
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
United
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$27.54
Typical High
$117.49