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Rebuilding The Eye Surface With Amniotic Graft

Pennsylvania 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 July 2026.

Facilitymedian $6,026 · 10th–90th $1,148$8,7100%10%10th90th$6,026Professionalmedian $794 · 10th–90th $589$1,0960%10%20%10th90th$794$500.0$1.0K$2.0K$5.0K$10.0K$20.0K$50.0K

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
$1,148.15
Median
$6,025.60
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$812.83
Typical High
$1,047.13
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$489.78
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$9,549.93
Median
$10,000.00
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$602.56
Typical High
$1,202.26
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$870.96
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$812.83
Typical High
$1,348.96
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,248.07
Median
$5,248.07
Typical High
$5,248.07
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$812.83
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$5,248.07
Typical High
$9,549.93
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$851.14
Typical High
$2,630.27
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$3,019.95
Median
$3,019.95
Typical High
$5,754.40
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$977.24
Typical High
$1,230.27
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$2,041.74
Typical High
$3,548.13
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$645.65
Typical High
$758.58
United
Setting
Facility
Modifier
Global
Typical Low
$2,238.72
Median
$5,011.87
Typical High
$11,481.54
United
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$758.58
Typical High
$1,288.25