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Sugar Separation Test By Chromatography

Massachusetts 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 $74 · 10th–90th $28$1230%10%10th90th$74Professionalmedian $39 · 10th–90th $18$870%20%40%10th90th$39$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$18.62
Median
$56.23
Typical High
$123.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$17.78
Median
$18.62
Typical High
$87.10
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$44.67
Typical High
$186.21
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$34.67
Typical High
$95.50
BCBS
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$77.62
Typical High
$112.20
BCBS
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$36.31
Typical High
$36.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$38.90
Typical High
$75.86
Cigna
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$41.69
Typical High
$102.33
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$22.39
Median
$154.88
Typical High
$7,079.46
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$56.23
Typical High
$66.07
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$83.18
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$44.67
Typical High
$186.21
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$34.67
Typical High
$95.50
United
Setting
Facility
Modifier
Global
Typical Low
$16.60
Median
$33.11
Typical High
$44.67
United
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$29.51
Typical High
$83.18