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Sugar Separation Test By Chromatography

Utah 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 $14 · 10th–90th $2$780%20%10th90th$14Professionalmedian $31 · 10th–90th $2$450%10%20%10th90th$31$2.0$5.0$10.0$20.0$50.0$100.0

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
$2.04
Median
$10.96
Typical High
$77.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.04
Median
$30.90
Typical High
$44.67
Cigna
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$40.74
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$18.62
Typical High
$56.23
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$44.67
Typical High
$158.49
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$26.30
Median
$33.11
Typical High
$34.67
Select Health
Setting
Facility
Modifier
Global
Typical Low
$27.54
Median
$27.54
Typical High
$27.54
Select Health
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$38.90
Typical High
$51.29
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1.74
Median
$34.67
Typical High
$38.90
United
Setting
Facility
Modifier
Global
Typical Low
$19.50
Median
$25.12
Typical High
$60.26
United
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$16.22
Typical High
$27.54