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Sugar Separation Test By Chromatography

Texas 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 $68 · 10th–90th $26$1860%5%10%10th90th$68Professionalmedian $30 · 10th–90th $16$470%10%10th90th$30$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
$25.70
Median
$63.10
Typical High
$181.97
Aetna
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$29.51
Typical High
$46.77
BCBS
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$109.65
Typical High
$204.17
BCBS
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$47.86
Typical High
$52.48
Christus
Setting
Facility
Modifier
Global
Typical Low
$22.39
Median
$38.90
Typical High
$38.90
Cigna
Setting
Facility
Modifier
Global
Typical Low
$23.99
Median
$70.79
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$19.95
Typical High
$56.23
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$38.90
Typical High
$42.66
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$38.90
Typical High
$38.90
Molina
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$33.11
Typical High
$33.11
Providence
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$38.90
Typical High
$100.00
Providence
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$15.14
Typical High
$43.65
United
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$38.90
Typical High
$46.77
United
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$16.22
Typical High
$27.54
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$26.92
Typical High
$52.48