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Biopsy of a Toe Joint

Maine rates for HCPCS 28054

This procedure opens a joint in a toe, between two of the toe bones, through a small incision to obtain a tissue sample from inside the joint. It is used to investigate unexplained swelling, pain, or a suspected growth in that area when other testing has not been conclusive. The joint is closed afterward and the toe is typically protected while it heals.

Rates data updated July 2026.

How much does Biopsy of a Toe Joint cost?

$372

Typical physician fee. In Maine, July 2026.

Insurers have agreed to pay about $372 for this service. Most negotiated rates run $275 to $479.

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 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $6,761 · 10th to 90th $6,761 to $6,761Professionalmedian $372 · 10th to 90th $245 to $676
$200$500$1K$2K$5Kfacility $6,761professional $372

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$302.00
Typical High
$436.52
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$346.74
Typical High
$512.86
Cigna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$467.74
Typical High
$794.33
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$446.68
Typical High
$794.33
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$302.00
Typical High
$478.63
United
Setting
Facility
Modifier
Global
Typical Low
$6,760.83
Median
$6,760.83
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$416.87
Typical High
$707.95

Where Maine sits

The same service costs 5.9 times more in California than in West Virginia. 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.

Maine· 37th of 51

$372

CA $1,905WV $324

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.