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Sugar Separation Test By Chromatography

New York 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 $59 · 10th–90th $28$1070%10%10th90th$59Professionalmedian $21 · 10th–90th $14$590%20%40%10th90th$21$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
$27.54
Median
$64.57
Typical High
$107.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$17.78
Typical High
$38.90
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$102.33
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$15.49
Typical High
$60.26
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$23.44
Median
$38.90
Typical High
$38.90
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$38.90
Typical High
$38.90
Cigna
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$83.18
Typical High
$213.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$44.67
Typical High
$186.21
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$38.90
Typical High
$87.10
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$18.20
Median
$23.44
Typical High
$75.86
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$27.54
Median
$27.54
Typical High
$27.54
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$18.20
Median
$32.36
Typical High
$40.74
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$70.79
Typical High
$257.04
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$33.11
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$23.99
Median
$38.90
Typical High
$58.88
United
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$23.44
Typical High
$87.10
Univera
Setting
Facility
Modifier
Global
Typical Low
$27.54
Median
$33.11
Typical High
$47.86
Univera
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$33.11
Typical High
$58.88