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Sugar Separation Test By Chromatography

Louisiana 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 $52 · 10th–90th $39$1320%10%10th90th$52Professionalmedian $44 · 10th–90th $17$540%10%20%10th90th$44$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
$41.69
Median
$52.48
Typical High
$141.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$46.77
Typical High
$79.43
BCBS
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$63.10
Typical High
$95.50
BCBS
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$42.66
Typical High
$42.66
Christus
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$22.91
Median
$95.50
Typical High
$181.97
Cigna
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$17.38
Typical High
$44.67
United
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$35.48
Typical High
$38.90
United
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$16.22
Typical High
$30.90