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Rebuilding The Eye Surface With Amniotic Graft

New Hampshire rates for HCPCS 65780

Repairs a badly damaged surface of the eye using amniotic membrane, a thin sheet of tissue from the lining of the placenta that is donated, screened and preserved for surgical use. The membrane is laid over the injured area and held in place so healing tissue can grow underneath it. It is used for chemical burns, deep scarring and surface defects that will not close on their own.

Rates data updated October 2026.

How much does Rebuilding The Eye Surface With Amniotic Graft cost?

$4,678

Typical total for the visit. In New Hampshire, October 2026.

Insurers have agreed to pay about $4,678 for this procedure. That total is two separate charges: $1,047 to the doctor who performs it, and $3,631 to the hospital or surgery center where it takes place. Done somewhere without a facility charge, you pay only the first.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$1,047$813 to $1,349
Facility feeThe hospital or surgery center$3,631$2,399 to $5,754

How much rates vary

Facilitymedian $3,631 · 10th to 90th $2,188 to $6,607Professionalmedian $1,047 · 10th to 90th $676 to $1,995
$1K$2K$5K$10Kfacility $3,631professional $1,047

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$2,398.83
Median
$3,890.45
Typical High
$15,848.93
Aetna
Setting
Professional
Modifier
None
Typical Low
$891.25
Median
$891.25
Typical High
$1,023.29
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$3,467.37
Median
$4,677.35
Typical High
$6,309.57
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$562.34
Median
$1,047.13
Typical High
$2,238.72
Anthem BCBS
Setting
Professional
Modifier
50 · Both sides
Typical Low
$891.25
Median
$1,584.89
Typical High
$3,019.95
Anthem BCBS
Setting
Professional
Modifier
62 · Two surgeons
Typical Low
$371.54
Median
$660.69
Typical High
$1,258.93
Harvard Pilgrim
Setting
Facility
Modifier
None
Typical Low
$2,187.76
Median
$3,162.28
Typical High
$6,606.93
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$676.08
Median
$1,096.48
Typical High
$2,089.30
United
Setting
Facility
Modifier
None
Typical Low
$2,187.76
Median
$3,235.94
Typical High
$6,606.93
United
Setting
Professional
Modifier
None
Typical Low
$851.14
Median
$1,096.48
Typical High
$1,995.26
Well Sense
Setting
Facility
Modifier
None
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,148.15

Where New Hampshire sits

The same service costs 5.3 times more in Wisconsin than in Montana. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Physician feeFacility fee

New Hampshire· 20th of 51

$4,678

$1,047 physician + $3,631 facility

WI $9,724MT $1,825

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.