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Sugar Separation Test By Chromatography

Illinois 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 $62 · 10th–90th $32$1100%10%10th90th$62Professionalmedian $34 · 10th–90th $23$790%10%20%10th90th$34$2.0$10.0$50.0$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
$31.62
Median
$61.66
Typical High
$107.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$33.88
Typical High
$79.43
BCBS
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$138.04
Typical High
$489.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$81.28
Typical High
$181.97
Cigna
Setting
Professional
Modifier
Global
Typical Low
$13.49
Median
$41.69
Typical High
$57.54
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$63.10
Typical High
$151.36
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Molina
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$21.38
Typical High
$48.98
United
Setting
Facility
Modifier
Global
Typical Low
$14.45
Median
$38.90
Typical High
$75.86
United
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$16.60
Typical High
$33.88