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Rebuilding The Eye Surface With Amniotic Graft

Wisconsin 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 $8,128 · 10th–90th $2,692$13,4900%10%10th90th$8,128Professionalmedian $1,072 · 10th–90th $617$3,4670%5%10%10th90th$1,072$50.0$200.0$1.0K$5.0K

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
$1,000.00
Median
$4,786.30
Typical High
$9,332.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$891.25
Typical High
$3,388.44
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,317.64
Typical High
$14,125.38
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,288.25
Typical High
$3,467.37
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$1,862.09
Typical High
$2,951.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,905.46
Typical High
$2,187.76
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$5,754.40
Typical High
$10,232.93
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,479.11
Typical High
$1,737.80
Medica
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$4,265.80
Typical High
$11,481.54
Medica
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$1,412.54
Typical High
$4,466.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$489.78
Network Health
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$8,511.38
Typical High
$9,120.11
Network Health
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,949.84
Typical High
$3,235.94
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$870.96
Typical High
$1,202.26
Quartz
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$1,230.27
Typical High
$1,819.70
Quartz
Setting
Facility
Modifier
Global
Typical Low
$8,511.38
Median
$12,302.69
Typical High
$12,302.69
Quartz
Setting
Professional
Modifier
Global
Typical Low
$3,630.78
Median
$4,677.35
Typical High
$4,677.35
Security Health
Setting
Professional
Modifier
Global
Typical Low
$3,090.30
Median
$3,090.30
Typical High
$3,090.30
Security Health
Setting
Professional
Modifier
Global
Typical Low
$2,570.40
Median
$5,754.40
Typical High
$5,754.40
United
Setting
Facility
Modifier
Global
Typical Low
$5,128.61
Median
$10,232.93
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,122.02
Typical High
$2,884.03