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Sugar Separation Test By Chromatography

Montana 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 $35$1170%10%20%10th90th$52Professionalmedian $49 · 10th–90th $16$2570%20%10th90th$49$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
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$66.07
Typical High
$223.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$13.49
Median
$44.67
Typical High
$56.23
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$48.98
Typical High
$117.49
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$48.98
Typical High
$117.49
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$75.86
Typical High
$223.87
Providence
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$35.48
Typical High
$56.23
United
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$38.90
United
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$16.22
Typical High
$27.54