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Sugar Separation Test By Chromatography

Maine 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 $63 · 10th–90th $39$1820%20%10th90th$63Professionalmedian $32 · 10th–90th $16$470%20%10th90th$32$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
$38.90
Median
$38.90
Typical High
$173.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$31.62
Typical High
$38.90
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$181.97
Typical High
$199.53
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$22.39
Typical High
$26.92
Cigna
Setting
Facility
Modifier
Global
Typical Low
$22.91
Median
$27.54
Typical High
$89.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$35.48
Typical High
$44.67
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$38.90
Typical High
$46.77
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$173.78
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$38.90
Typical High
$95.50
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
United
Setting
Professional
Modifier
Global
Typical Low
$15.85
Median
$37.15
Typical High
$60.26