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Sugar Separation Test By Chromatography

Hawaii 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 $39 · 10th–90th $32$470%20%40%10th90th$39Professionalmedian $46 · 10th–90th $30$600%10%20%10th90th$46$20.0$50.0

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
$32.36
Median
$38.90
Typical High
$46.77
Cigna
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$15.49
Typical High
$46.77
HMSA
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$48.98
Typical High
$53.70
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$46.77
Typical High
$75.86
United
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$27.54
Typical High
$58.88
University Health Alliance
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$43.65
Typical High
$66.07