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Sugar Separation Test By Chromatography

Washington 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 $55 · 10th–90th $35$1410%10%20%10th90th$55Professionalmedian $36 · 10th–90th $15$630%20%40%10th90th$36$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
$8.71
Median
$72.44
Typical High
$208.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$36.31
Typical High
$257.04
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$48.98
Typical High
$107.15
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$34.67
Typical High
$38.90
Cigna
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$70.79
Typical High
$100.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$13.49
Median
$38.90
Typical High
$56.23
Molina
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$34.67
Typical High
$64.57
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$77.62
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$63.10
Typical High
$120.23
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$35.48
Typical High
$46.77
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$58.88
Typical High
$104.71
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$34.67
Typical High
$38.90
United
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$46.77
Typical High
$46.77
United
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$16.22
Typical High
$38.90
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$20.42
Typical High
$70.79