Anal fistula repair Cost by Hospital

Anal fistula repair is a surgical procedure. Prices are from 1537 US hospitals across 52 states, from their machine-readable files.

$2,774median cash price · 1537 hospitals, 52 statestypically $650–$9,430 depending on the hospital
≈ 5.1× Medicare · High vs MedicareFind hospitals near you

Price comparison (median)

Chargemaster (list price)
$4,754
Cash / self-pay
$2,774
Insurer-negotiated
$2,859
Medicare pays
$541
$650$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 $4,754 list price could save about $1,980 (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 ★ 4/5 125 min —
Vanderbilt Tullahoma-Harton Hospital Tullahoma, TN $438 $779 ★ 3/5 168 min —
San Juan Hospital Monticello, UT $440 $488 — 128 min —
Boulder Community Health Boulder, CO $444 $774 ★ 4/5 135 min —
Summersville Regional Medical Center Summersville, WV $461 — ★ 2/5 136 min —
Doctors Memorial Hospital Bonifay, FL $468 $558 ★ 2/5 121 min —
Jackson General Hospital Ripley, WV $479 — ★ 3/5 127 min —
Bassett Healthcare Cooperstown, NY $484 $715 ★ 2/5 199 min —
Hugh Chatham Memorial Hospital Elkin, NC $485 $491 ★ 3/5 168 min —
Potomac Valley Hospital Keyser, WV $487 — ★ 1/5 119 min —
Ascension Calumet Hospital Chilton, WI $494 $502 — 86 min —
Braxton County Memorial Hospital, Inc Gassaway, WV $494 — — 102 min —
St Joseph's Hospital of Buckhannon, Inc Buckhannon, WV $494 — ★ 3/5 141 min —
Ste Genevieve County Memorial Hospital Sainte Genevieve, MO $495 $407 ★ 4/5 103 min —
Berkeley Medical Center Martinsburg, WV $497 $2,792 ★ 3/5 167 min —
Southwest General Health Center Middleburg Heights, OH $516 $434 ★ 4/5 199 min —
Bayside Community Hospital Anahuac, TX $518 $328 — 106 min —
Bertrand Chaffee Hospital Springville, NY $527 $454 — 145 min —
Harrison Community Hospital Cadiz, OH $533 — — 82 min —
Barnesville Hospital Association, Inc Barnesville, OH $533 $4,513 — 115 min —
Page Hospital Page, AZ $534 $722 — 78 min —
Paulding County Hospital Paulding, OH $537 — — 74 min —
York Hospital York, ME $545 — ★ 4/5 166 min —
Ozark Health Clinton, AR $552 $430 ★ 4/5 132 min —
Alice Peck Day Memorial Hospital Lebanon, NH $560 $803 ★ 4/5 118 min —

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 October 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 175
$184
$100 – $1,231
Univera 13
$370
$37 – $586
Medicare 288
$379
$204 – $3,099
Geisinger 41
$490
$308 – $3,215
Tricare / VA 207
$510
$212 – $3,297
Independent Health 25
$552
$198 – $1,262
Highmark 88
$560
$209 – $6,049
MVP Health Care 55
$921
$382 – $5,542
Amerigroup 122
$987
$365 – $2,779
Priority Health 37
$987
$373 – $2,978
AmeriHealth 138
$1,024
$307 – $8,727
Workers' Comp / No-Fault 53
$1,207
$709 – $4,321
Molina Healthcare 410
$1,231
$279 – $3,242
UCare 42
$1,244
$348 – $2,988
Centene / Ambetter 536
$1,321
$235 – $5,360
Sanford Health Plan 32
$1,407
$386 – $4,798
Medica 74
$1,530
$443 – $3,573
Harvard Pilgrim 28
$1,713
$565 – $5,671
Bright Health 38
$1,714
$1,257 – $4,829
Health Net 155
$1,771
$194 – $6,968
HealthPartners 116
$1,806
$330 – $4,503
MultiPlan / PHCS network 274
$1,889
$365 – $6,899
Coventry 60
$2,441
$483 – $5,840
Blue Cross Blue Shield 851
$2,614
$240 – $8,252
UPMC Health Plan 65
$2,626
$392 – $7,352
Anthem 396
$2,649
$276 – $7,972
Security Health Plan 29
$2,695
$447 – $7,155
Devoted Health 110
$2,699
$482 – $3,017
Kaiser Permanente 147
$2,770
$216 – $8,092
Humana 657
$2,776
$394 – $4,690
UnitedHealthcare 989
$3,083
$435 – $8,283
Aetna 891
$3,245
$499 – $8,911
Healthcare Highways 31
$3,650
$3,041 – $5,524
SelectHealth 33
$3,743
$978 – $5,307
Cigna 716
$5,044
$1,052 – $12,562
EmblemHealth 56
$5,384
$1,877 – $21,898
Oscar Health 146
$5,632
$3,272 – $7,927
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$719
Mississippi$900
New Hampshire$982
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

TexasCaliforniaOhioWisconsinPennsylvaniaFloridaNew YorkMinnesotaIllinoisColoradoMichiganLouisianaNorth CarolinaTennesseeNew JerseyMissouriIowaIndianaGeorgiaWashingtonArizonaArkansasMaineKansasMassachusettsVirginiaMississippiSouth CarolinaKentuckyWest VirginiaNebraskaIdahoOklahomaAlabamaUtahConnecticutNew HampshireNevadaNew MexicoOregonWyomingNorth DakotaSouth DakotaMontanaVermontAlaskaMarylandHawaiiDelaware

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 1537 US hospitals across 52 states, the typical (median) cash price is $2,774, versus a chargemaster (list) price around $4,754, a median insurer-negotiated rate of $2,859, a Medicare rate of about $541. Most cash prices fall between $650 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 1537 US hospitals is $2,774. Most hospitals fall between $650 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)Simple wound stitchesForeign body removal (skin)Burn treatmentSimple laceration repair (small, up to 2.5 cm)Burn dressing and debridement (small)

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