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Sugar Separation Test By Chromatography

South Dakota 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 $76 · 10th–90th $37$760%50%10th$76Professionalmedian $51 · 10th–90th $26$930%10%10th90th$51$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
$27.54
Median
$44.67
Typical High
$44.67
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.30
Median
$30.20
Typical High
$36.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$75.86
Typical High
$93.33
Medica
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$87.10
Medica
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$40.74
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$79.43
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$46.77
United
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$27.54
Typical High
$44.67
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$38.90