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Sugar Separation Test By Chromatography

Oregon 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 $43 · 10th–90th $39$1480%20%40%10th90th$43Professionalmedian $39 · 10th–90th $11$650%20%10th90th$39$2.0$10.0$50.0$200.0$1.0K

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
$51.29
Median
$109.65
Typical High
$173.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.04
Median
$38.02
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$70.79
Typical High
$112.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$13.49
Median
$43.65
Typical High
$69.18
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$87.10
Typical High
$100.00
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$38.90
Typical High
$38.90
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$38.90
Typical High
$52.48
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$77.62
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$48.98
Providence
Setting
Facility
Modifier
Global
Typical Low
$17.78
Median
$53.70
Typical High
$112.20
Providence
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$42.66
Typical High
$79.43
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$114.82
Typical High
$141.25
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$8.91
Median
$30.20
Typical High
$46.77
United
Setting
Facility
Modifier
Global
Typical Low
$12.30
Median
$58.88
Typical High
$58.88
United
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$16.22
Typical High
$46.77