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Sugar Separation Test By Chromatography

Pennsylvania 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 $65 · 10th–90th $33$1580%10%10th90th$65Professionalmedian $32 · 10th–90th $17$600%20%40%10th90th$32$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
$33.11
Median
$60.26
Typical High
$147.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$31.62
Typical High
$91.20
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$141.25
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$53.70
Typical High
$114.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$33.88
Typical High
$58.88
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$18.20
Median
$22.91
Typical High
$56.23
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$38.90
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$20.42
Median
$28.84
Typical High
$67.61
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$31.62
Median
$64.57
Typical High
$186.21
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$31.62
Typical High
$114.82
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$95.50
Typical High
$190.55
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$34.67
Typical High
$39.81
United
Setting
Facility
Modifier
Global
Typical Low
$16.60
Median
$38.90
Typical High
$46.77
United
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$23.44
Typical High
$48.98