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Sugar Separation Test By Chromatography

Oklahoma 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 $36 · 10th–90th $17$980%20%10th90th$36Professionalmedian $20 · 10th–90th $10$300%20%10th90th$20$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
$28.84
Median
$36.31
Typical High
$97.72
Aetna
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$29.51
BCBS
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$36.31
Typical High
$36.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$11.48
Median
$33.88
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$17.38
Typical High
$44.67
Medica
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$28.18
Typical High
$186.21
Medica
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$16.22
Typical High
$40.74
United
Setting
Facility
Modifier
Global
Typical Low
$11.48
Median
$35.48
Typical High
$46.77
United
Setting
Professional
Modifier
Global
Typical Low
$4.17
Median
$16.22
Typical High
$25.70