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Sugar Separation Test By Chromatography

Wisconsin 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 $47 · 10th–90th $17$1120%10%10th90th$47Professionalmedian $36 · 10th–90th $15$1230%10%20%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
$46.77
Median
$107.15
Typical High
$107.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$36.31
Typical High
$46.77
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$104.71
Typical High
$107.15
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$15.49
Typical High
$114.82
CareSource
Setting
Facility
Modifier
Global
Typical Low
$23.99
Median
$23.99
Typical High
$23.99
Cigna
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$114.82
Typical High
$181.97
Cigna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$58.88
Typical High
$123.03
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$17.38
Median
$37.15
Typical High
$50.12
Medica
Setting
Facility
Modifier
Global
Typical Low
$17.38
Median
$35.48
Typical High
$186.21
Medica
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$23.44
Typical High
$60.26
Molina
Setting
Professional
Modifier
Global
Typical Low
$7.94
Median
$32.36
Typical High
$64.57
Network Health
Setting
Facility
Modifier
Global
Typical Low
$16.60
Median
$46.77
Typical High
$60.26
Network Health
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$39.81
Typical High
$109.65
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$17.38
Median
$30.90
Typical High
$50.12
Quartz
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$91.20
Typical High
$128.82
Quartz
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$186.21
Quartz
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$18.62
Typical High
$97.72
Security Health
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$83.18
Security Health
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$23.44
Typical High
$213.80
United
Setting
Facility
Modifier
Global
Typical Low
$14.79
Median
$30.90
Typical High
$75.86
United
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$23.44
Typical High
$64.57