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Sugar Separation Test By Chromatography

Arizona 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 $60 · 10th–90th $26$1700%10%10th90th$60Professionalmedian $31 · 10th–90th $14$2570%20%10th90th$31$2.0$5.0$10.0$20.0$50.0$100.0$200.0

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
$39.81
Median
$60.26
Typical High
$169.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.30
Median
$31.62
Typical High
$257.04
BCBS
Setting
Facility
Modifier
Global
Typical Low
$23.44
Median
$97.72
Typical High
$181.97
BCBS
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$33.11
Typical High
$158.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$32.36
Typical High
$125.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$35.48
Typical High
$58.88
Medica
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$28.84
Typical High
$186.21
Medica
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$16.22
Typical High
$23.44
United
Setting
Facility
Modifier
Global
Typical Low
$14.45
Median
$35.48
Typical High
$46.77
United
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$16.22
Typical High
$27.54