Other · 0552T

Low-Level Laser Therapy

Medicare Payment (avg)
$4.64
What Medicare actually pays
Billed Charge (avg)
$44.43
What providers submit
Markup
9.6x
858% above Medicare rate
348
Total Services
70
Beneficiaries
14
Providers
2
States with Data

Price Range Across States

Lowest State Avg
$4.38
Texas
Highest State Avg
$5.30
California

What You Might Pay

Est. Commercial Insurance
$13.08
Range: $9.15 – $18.31
Est. Cash / Self-Pay
$16.60
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Other procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Prices by State

State Medicare Payment Billed Charge
California $5.30 $97.50
Texas $4.38 $15.00

What the Data Says About Low-Level Laser Therapy

Across 2 states with reporting providers, CPT code 0552T (Low-Level Laser Therapy) shows a national average Medicare payment of $4.64 against an average billed charge of $44.43. That gap — a 9.6x markup, or 858% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Other procedures like this one saw 348 services billed to Medicare in 2023 by 14 distinct providers, serving 70 unique beneficiaries. State-level variation is significant: Texas reports the lowest average payment at $4.38, while California reports the highest at $5.30. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Other category (2.24x), the estimated commercial insurance price lands near $13.08, with self-pay cash discounts commonly bringing the figure closer to $16.60. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Low-Level Laser Therapy cost?

The national average Medicare payment for Low-Level Laser Therapy (CPT 0552T) is $4.64, while providers typically bill $44.43. Prices vary significantly by state, ranging from $4.38 to $5.30.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Low-Level Laser Therapy cost with insurance?

With commercial insurance, Low-Level Laser Therapy costs an estimated $13.08 on average (range: $9.15 – $18.31). Without insurance, the estimated cash price is $16.60. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Low-Level Laser Therapy?

Texas has the lowest average Medicare payment for Low-Level Laser Therapy at $4.38, while California has the highest at $5.30. This $0.92 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Low-Level Laser Therapy?

Nationally, 14 providers billed Medicare for Low-Level Laser Therapy in 2023, performing 348 total services for 70 beneficiaries across 2 states and territories.

What is the billed-to-Medicare markup for Low-Level Laser Therapy?

Providers bill 9.6x what Medicare pays for Low-Level Laser Therapy — a 858% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial