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Sugar Separation Test By Chromatography

Missouri 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 $51 · 10th–90th $33$910%20%10th90th$51Professionalmedian $34 · 10th–90th $15$620%10%10th90th$34$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
$34.67
Median
$66.07
Typical High
$75.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$38.02
Typical High
$66.07
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$138.04
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$27.54
Typical High
$58.88
BCBS
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$38.02
Typical High
$44.67
Cigna
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$75.86
Typical High
$112.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$30.20
Typical High
$60.26
Medica
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$51.29
Typical High
$186.21
Medica
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$19.50
Typical High
$41.69
United
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$38.90
Typical High
$46.77
United
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$19.50
Typical High
$45.71