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Sugar Separation Test By Chromatography

Ohio 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 $31$930%10%10th90th$52Professionalmedian $28 · 10th–90th $15$720%10%10th90th$28$2.0$5.0$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
$31.62
Median
$70.79
Typical High
$97.72
Aetna
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$33.11
Typical High
$89.13
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$40.74
Typical High
$72.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$19.50
Typical High
$44.67
CareSource
Setting
Facility
Modifier
Global
Typical Low
$23.99
Median
$23.99
Typical High
$44.67
CareSource
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Cigna
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$50.12
Typical High
$158.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$19.05
Typical High
$58.88
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$51.29
Typical High
$158.49
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$18.20
Typical High
$51.29
Molina
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$32.36
Typical High
$47.86
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$40.74
Typical High
$77.62
United
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$38.90
Typical High
$58.88
United
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$16.60
Typical High
$38.90