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Sugar Separation Test By Chromatography

California 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 $95 · 10th–90th $30$2240%10%10th90th$95Professionalmedian $26 · 10th–90th $15$1170%10%20%10th90th$26$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$33.88
Median
$91.20
Typical High
$229.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$27.54
Typical High
$257.04
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$18.20
Median
$100.00
Typical High
$194.98
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$23.99
Typical High
$72.44
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$117.49
Typical High
$275.42
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$22.39
Typical High
$66.07
Cigna
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$69.18
Typical High
$131.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$25.70
Typical High
$69.18
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$38.90
Typical High
$63.10
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$38.90
Typical High
$89.13
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Molina
Setting
Professional
Modifier
Global
Typical Low
$19.50
Median
$19.50
Typical High
$38.90
Providence
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$38.90
Typical High
$97.72
Providence
Setting
Professional
Modifier
Global
Typical Low
$13.49
Median
$22.91
Typical High
$77.62
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$38.90
Typical High
$64.57
United
Setting
Facility
Modifier
Global
Typical Low
$14.79
Median
$38.90
Typical High
$60.26
United
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$17.38
Typical High
$74.13