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Sugar Separation Test By Chromatography

New Hampshire 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 $76 · 10th–90th $55$2190%20%10th90th$76Professionalmedian $29 · 10th–90th $19$870%10%10th90th$29$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
$54.95
Median
$70.79
Typical High
$275.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$22.39
Typical High
$87.10
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$75.86
Typical High
$223.87
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$25.12
Typical High
$74.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$141.25
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$14.13
Median
$32.36
Typical High
$112.20
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$67.61
Typical High
$131.83
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
United
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$23.44
Typical High
$87.10