Anal fistula repair Cost by Hospital

Anal fistula repair is a surgical procedure. Prices are from 1520 US hospitals across 52 states, from their machine-readable files.

$2,774median cash price · 1520 hospitals, 52 statestypically $649–$9,430 depending on the hospital
≈ 5.1× Medicare · High vs MedicareFind hospitals near you

Price comparison (median)

Chargemaster (list price)
$4,813
Cash / self-pay
$2,774
Insurer-negotiated
$2,874
Medicare pays
$541
$649$9,430
Median cash $2,774  ·  Medicare $541  ·  bar = typical cash range (10th–90th percentile)
Is this a fair price?
1× Medicarefair ≈2×5×+

Typical cash price here is $2,774 — about 5.1× the Medicare rate ($541). High vs Medicare. A fair cash price is usually within ~2× Medicare ($1,083).

💡 Asking for the cash price instead of the $4,813 list price could save about $2,039 (42%).

Estimate what you’ll pay
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Rough estimate from this procedure’s median insurer-negotiated rate. Your actual cost depends on your plan — confirm with your insurer.

Lowest cash prices

HospitalLocationCashInsurerCMS ratingER waitReadmit
Vanderbilt Bedford Hospital Shelbyville, TN $438 $779 ★ 4/5 123 min 13.6%
Vanderbilt Tullahoma-Harton Hospital Tullahoma, TN $438 $779 ★ 3/5 173 min 15.1%
San Juan Hospital Monticello, UT $440 $488 — 122 min 14.9%
Boulder Community Health Boulder, CO $444 $774 ★ 4/5 133 min 13.6%
Summersville Regional Medical Center Summersville, WV $461 — ★ 2/5 140 min 15.1%
Doctors Memorial Hospital Bonifay, FL $468 $558 ★ 2/5 123 min 15.3%
Jackson General Hospital Ripley, WV $479 — ★ 3/5 133 min 14.8%
Bassett Healthcare Cooperstown, NY $484 $715 ★ 2/5 199 min 15.6%
Hugh Chatham Memorial Hospital Elkin, NC $485 $491 ★ 3/5 171 min 15.1%
Potomac Valley Hospital Keyser, WV $487 — ★ 1/5 118 min 15.5%
Ascension Calumet Hospital Chilton, WI $494 $502 — 83 min —
Braxton County Memorial Hospital, Inc Gassaway, WV $494 — — 102 min 15.0%
St Joseph's Hospital of Buckhannon, Inc Buckhannon, WV $494 — ★ 3/5 142 min 16.4%
Ste Genevieve County Memorial Hospital Sainte Genevieve, MO $495 $407 ★ 4/5 111 min 14.5%
Berkeley Medical Center Martinsburg, WV $497 $2,792 ★ 3/5 160 min 15.1%
Southwest General Health Center Middleburg Heights, OH $516 $434 ★ 4/5 199 min 15.2%
Bertrand Chaffee Hospital Springville, NY $527 $454 — 144 min 15.2%
Harrison Community Hospital Cadiz, OH $533 — — 84 min 15.2%
Barnesville Hospital Association, Inc Barnesville, OH $533 $4,513 — 113 min 15.0%
Page Hospital Page, AZ $534 $722 — 77 min —
Paulding County Hospital Paulding, OH $537 — — 77 min 15.2%
York Hospital York, ME $545 — ★ 4/5 172 min 14.8%
Ozark Health Clinton, AR $552 $430 ★ 4/5 150 min 14.7%
Alice Peck Day Memorial Hospital Lebanon, NH $560 $803 ★ 4/5 120 min 15.3%
Highlands ARH Regional Medical Center Prestonsburg, KY $569 $383 ★ 2/5 193 min 15.1%

CMS rating = overall hospital star rating (1–5); ER wait = median minutes in the emergency department; Readmit = 30-day readmission rate (lower is better) — all from Medicare’s Care Compare; “—” = not reported. Data last updated August 2026. Prices from hospitals’ machine-readable files (45 CFR §180); Medicare benchmark from CMS PFS/CLFS/IPPS. Prices below 15% of the median are excluded as likely partial or mis-coded charges. Estimates — confirm with the hospital. Report an incorrect price.

What insurers pay for Anal fistula repair

Median in-network negotiated rate by insurer, across hospitals that publish it (cheapest first). Your actual rate depends on your specific plan and deductible. Cash / self-pay for comparison: $2,774; Medicare pays $541.

InsurerHospitalsNegotiated median
Medicaid 173
$184
$100 – $1,231
Univera 13
$370
$37 – $586
Medicare 284
$379
$204 – $3,099
Geisinger 39
$490
$308 – $3,209
Tricare / VA 205
$510
$212 – $3,310
Highmark 80
$548
$209 – $6,049
Independent Health 25
$552
$198 – $1,262
MVP Health Care 54
$916
$382 – $5,542
Amerigroup 121
$987
$356 – $2,771
Priority Health 38
$987
$373 – $2,978
AmeriHealth 135
$1,024
$300 – $8,727
Workers' Comp / No-Fault 53
$1,207
$709 – $4,321
Molina Healthcare 408
$1,231
$279 – $3,242
UCare 42
$1,244
$348 – $2,988
Centene / Ambetter 520
$1,321
$230 – $5,360
Sanford Health Plan 32
$1,407
$386 – $4,798
Medica 74
$1,530
$443 – $3,573
Harvard Pilgrim 29
$1,699
$565 – $5,671
Bright Health 38
$1,714
$1,257 – $4,829
Health Net 153
$1,771
$194 – $6,968
HealthPartners 114
$1,806
$330 – $4,503
MultiPlan / PHCS network 271
$1,889
$356 – $6,951
Coventry 57
$2,441
$481 – $5,957
Blue Cross Blue Shield 845
$2,613
$236 – $8,204
UPMC Health Plan 60
$2,626
$390 – $7,074
Anthem 380
$2,675
$270 – $7,972
Devoted Health 106
$2,676
$476 – $3,017
Security Health Plan 29
$2,695
$447 – $7,155
Kaiser Permanente 147
$2,770
$216 – $8,092
Humana 647
$2,776
$394 – $4,690
UnitedHealthcare 968
$3,105
$431 – $8,384
Aetna 869
$3,278
$504 – $8,917
Healthcare Highways 31
$3,650
$3,041 – $5,524
SelectHealth 33
$3,743
$978 – $5,307
Cigna 701
$5,057
$1,080 – $12,508
Oscar Health 134
$5,876
$3,421 – $7,928
EmblemHealth 42
$6,682
$1,877 – $21,898
AvMed 31
$8,168
$588 – $11,304

Negotiated rates are from hospitals’ machine-readable files (45 CFR §180); payer names are normalized to major brands, so a brand may span several plans. Estimates — confirm with your insurer.

Where it’s cheapest

StateMedian cash
Hawaii$587
Vermont$664
New Hampshire$982
Mississippi$1,155
Nebraska$1,208
Iowa$1,230

Prices by city

Chicago, ILAustin, TXFort Worth, TXNew York, NYPittsburgh, PADallas, TXHouston, TXSacramento, CABrooklyn, NYCharlotte, NCCleveland, OHKansas City, MOLos Angeles, CAPhiladelphia, PASan Antonio, TXArlington, TXBronx, NYCincinnati, OHLittle Rock, ARNashville, TNSan Francisco, CAAurora, COColorado Springs, COFrisco, TX

Prices by state

TexasCaliforniaOhioWisconsinFloridaNew YorkPennsylvaniaMinnesotaIllinoisColoradoMichiganLouisianaNorth CarolinaTennesseeMissouriNew JerseyIowaIndianaWashingtonGeorgiaArkansasArizonaMaineKansasMississippiMassachusettsVirginiaSouth CarolinaKentuckyWest VirginiaIdahoNebraskaOklahomaAlabamaUtahConnecticutNew HampshireNew MexicoNevadaOregonWyomingNorth DakotaSouth DakotaMontanaAlaskaMarylandHawaiiVermontDelaware

Does Medicare cover Anal fistula repair?

Yes — Medicare generally covers Anal fistula repair. It is typically an outpatient service under Medicare Part B, with a Medicare-approved amount of about $541. After your annual Part B deductible, you typically owe the 20% coinsurance — roughly $108 — unless a Medicare Advantage or supplemental (Medigap) plan covers it.

General guidance from Medicare’s national rates — your actual coverage and share depend on medical necessity, your plan, and where the service is performed. Confirm with Medicare or your plan.

About these prices

Based on prices published by 1520 US hospitals across 52 states, the typical (median) cash price is $2,774, versus a chargemaster (list) price around $4,813, a median insurer-negotiated rate of $2,874, a Medicare rate of about $541. Most cash prices fall between $649 and $9,430 — a wide spread, which is exactly why comparing hospitals pays off.

How to save

  • Ask each hospital for its cash / self-pay price — for shoppable services it is often far below the list price.
  • Compare several nearby hospitals; prices for the same service can differ severalfold.
  • Request a written estimate and the billing code (CPT/DRG) before scheduling.
  • Use the Medicare benchmark above to judge whether a quote is reasonable.
  • If you are uninsured, ask about financial assistance or prompt-pay discounts.

Frequently asked questions

How much does Anal fistula repair cost without insurance?
The median cash (self-pay) price across 1520 US hospitals is $2,774. Most hospitals fall between $649 and $9,430. Prices vary widely between hospitals, so it pays to compare before you book.
Does Medicare cover Anal fistula repair?
Yes — it is generally covered under Medicare Part B as an outpatient service (Medicare-approved amount about $541). After your Part B deductible you typically owe 20% coinsurance, unless a Medicare Advantage or Medigap plan covers it.
What does Medicare pay for Anal fistula repair?
Medicare pays about $541. We show this as a benchmark — a fair cash price is often within a few multiples of the Medicare rate.
Why do Anal fistula repair prices vary between hospitals?
Hospitals set their own chargemaster and cash prices and negotiate different rates with each insurer, so two hospitals in the same area can charge very differently for the same service.
Is the cash price lower than using insurance?
Sometimes. If you are uninsured or have a high deductible, the cash/self-pay price can be lower than the insurer-negotiated rate — ask the hospital for both.

Related Surgery & Procedures

Abscess incision and drainageAbscess drainage (simple)Abscess drainage (complex or multiple)Foreign body removal (skin)Simple wound stitchesBurn treatmentSimple laceration repair (small, up to 2.5 cm)Burn dressing and debridement (small)

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