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Sugar Separation Test By Chromatography

Iowa 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 $60 · 10th–90th $30$1120%10%20%10th90th$60Professionalmedian $31 · 10th–90th $23$2570%10%20%10th90th$31$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
$30.20
Median
$91.20
Typical High
$112.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$30.20
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$75.86
Typical High
$93.33
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$58.88
Typical High
$85.11
Medica
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$46.77
Typical High
$100.00
Medica
Setting
Professional
Modifier
Global
Typical Low
$16.60
Median
$35.48
Typical High
$85.11
Midlands
Setting
Professional
Modifier
Global
Typical Low
$23.99
Median
$47.86
Typical High
$51.29
Midlands
Setting
Facility
Modifier
Global
Typical Low
$23.99
Median
$23.99
Typical High
$23.99
United
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$87.10
United
Setting
Professional
Modifier
Global
Typical Low
$16.60
Median
$23.44
Typical High
$83.18
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$38.90
Typical High
$38.90