Two very different days end with the same three letters on a bill. One is a scheduled gynecology procedure to find out why bleeding will not stop, or to remove tissue left behind after a birth. The other follows a miscarriage. Clinically these are handled differently and coded differently, but both get called a D&C, and both are priced by the same rule: the room matters more than the procedure.
That is the whole story of this bill. The instrument, the surgeon’s time and the fifteen minutes involved barely change. What changes is whether the procedure happens in an exam room, an ambulatory surgery center, a hospital outpatient department or an emergency department, and how many separate parties send you a bill afterward. Figures below are current as of September 2026.
What Does a D&C Cost Without Insurance?
Cash and prepaid prices are what providers publish today. Billed-charge figures are national average submitted charges from the CMS Medicare Physician & Other Practitioners file (2024 claims, released 2026), which is a useful ceiling because it shows what gets charged before anyone negotiates.
| Setting / Service | Low | Average | High |
|---|---|---|---|
| Office procedure, provider fee only (ACOG cost case) | n/a | $447 | n/a |
| In-office hysteroscopy, prepaid (MDsave) | $473 | $680 | $1,484 |
| D&C at a cash-price surgery center, all-inclusive | n/a | $2,200 | n/a |
| Hysteroscopy at a cash-price surgery center, all-inclusive | n/a | $2,900 | n/a |
| ASC total: provider + facility + anesthesia (ACOG cost case) | n/a | $3,494 | n/a |
| Hysteroscopy with polyp removal, cash-price surgery center | n/a | $5,180 | n/a |
| D&C prepaid at a hospital or ASC (MDsave) | $3,639 | $5,786 | $8,003 |
| D&C, estimated national average when not shopped (MDsave) | n/a | $11,292 | n/a |
| CPT 58120 D&C, average billed charge (CMS 2024) | $1,072 | n/a | $1,287 |
| CPT 58558 hysteroscopy with D&C, average billed charge | $3,231 | n/a | $3,562 |
| Miscarriage codes 59812 / 59820 / 59821, average billed charge | $1,113 | n/a | $1,520 |
| Anesthesia, CPT 00940, average billed charge | n/a | $1,083 | n/a |
| Pathology, CPT 88305, average billed charge | n/a | $186 | n/a |
Sources: the $447 office fee and the $3,494 ambulatory surgery center total (provider $447, facility $2,582, anesthesia $465) come from ACOG’s CREOG high-value-care case on surgical management of first trimester pregnancy loss, revised May 2025; the $2,200, $2,900 and $5,180 all-inclusive prices are the Surgery Center of Oklahoma’s published gynecology list; prepaid ranges are MDsave’s national listings; billed charges are national averages in the CMS 2024 physician file, shown across office and facility settings.
The gap between $447 and $11,292 for the same fifteen minutes is not a data error. It is the difference between one bill and four.
What Drives the Price
Office versus surgery center versus hospital
This is the single largest factor and it is worth more than every other lever combined. ACOG’s own teaching case prices an office procedure using a manual vacuum aspirator and a paracervical block at the provider fee alone, $447, against $3,494 for the identical clinical problem treated in an ambulatory surgery center. Nothing about the patient changed. The facility fee ($2,582) and the anesthesia fee ($465) appeared because the setting changed.
Not every practice offers the office route, and not every situation is suitable for it. But if it is offered, ask about it explicitly, because many practices default to booking the operating room.
The number of separate bills
A D&C at a facility generates a surgeon bill, a facility bill, an anesthesia bill and often a pathology bill. In 2024 CMS data the anesthesia code for gynecologic procedures (CPT 00940) carried an average submitted charge of $1,083 by itself, and intermediate-complexity pathology (CPT 88305) averaged about $186. Neither is usually mentioned in the estimate you get on the phone.
Facilities that publish an all-inclusive cash price collapse all of this into one number. The Surgery Center of Oklahoma states that its posted prices carry no separate surgeon, facility or anesthesia bill, which is why $2,200 there is directly comparable to a $3,494 itemized total elsewhere.
Hysteroscopy versus a blind D&C
The modern version of this procedure usually includes a hysteroscope, a camera that lets the surgeon see inside the uterus rather than working blind. It is coded as CPT 58558 and it costs more. In 2024 CMS data, CPT 58120 (D&C alone) carried an average submitted charge of $1,072 to $1,287 while CPT 58558 averaged $3,231 to $3,562. On the Surgery Center of Oklahoma’s list the same split is $2,200 versus $2,900, rising to $5,180 if a polyp is removed.
The cheapest form of this whole family of procedures is an in-office hysteroscopy, which prepaid through MDsave runs $473 to $1,484 nationally with an average around $680.
Anesthesia type
A paracervical block costs a fraction of general anesthesia, and it is what makes the office route possible. Once you need an anesthesiologist and a monitored recovery bay, you need a facility, and the facility fee follows.
Whether tissue goes to pathology
Most D&C specimens are sent for pathology review. That is a separate lab bill under CPT 88305. It is small relative to the facility fee but it arrives weeks later, which is when people assume they are being double-billed.
The Miscarriage Situation, Billed Differently
If the procedure follows a pregnancy loss, it is not billed with 58120. It is billed as treatment of an incomplete abortion (CPT 59812) or a missed abortion in the first or second trimester (CPT 59820 and 59821). Those are the clinical billing terms and they appear on paperwork regardless of circumstance.
In 2024 CMS claims data those codes carried average submitted charges of $1,113, $1,520 and $1,385 respectively, all in facility settings. Planned Parenthood of Florida publishes miscarriage management at $700 to $825 as a flat self-pay price, which is one of the few posted numbers in this space.
Two practical points. First, surgical management is one of three accepted approaches, and the other two cost less because they involve no procedure at all, so it is reasonable to ask a clinician what your options are before assuming an operating room is the only path. Second, if a hospital bill does arrive, hospital financial assistance and charity care apply here exactly as they do to any other bill. Nonprofit hospitals maintain written financial assistance policies, and a pregnancy loss is not an exception to them. Our hospital charity care guide and the charity care checker walk through how to apply.
Cash Price vs. Insurance
For a scheduled procedure, cash pricing is unusually competitive here. A $2,200 all-inclusive surgery center price is below what many people with high-deductible plans pay after insurance processes an itemized $3,494 to $8,003 bundle, because the deductible eats the difference anyway. It is worth pricing both ways before you schedule.
The catch is that a cash price paid outside your plan does not count toward your deductible or out-of-pocket maximum. If you have already met your deductible for the year, use the insurance. If you are in January with a $6,000 deductible and no other expected care, the cash route is usually cheaper in total.
If you are uninsured, ask every facility for its self-pay or prompt-pay rate rather than its chargemaster price. Hospitals are required to post cash prices under federal price transparency rules, and our guide to hospital price transparency explains how to find the file and read it.
How to Pay Less
- Ask whether the office setting is an option. This is the biggest single saving available, worth roughly $3,000 in ACOG’s own cost scenarios. The question to ask is “do you offer this as an office procedure with a paracervical block, and what is the total self-pay price?”
- Get a written all-in quote covering four line items. Surgeon, facility, anesthesia, pathology. A quote that covers only the first one is not a quote. Compare whatever you are told against our fair price checker.
- Price a freestanding surgery center against the hospital. Ambulatory surgery centers that publish cash rates routinely beat hospital outpatient departments for the same procedure, and some publish a single all-inclusive number that eliminates the surprise bills entirely.
- Check prepaid marketplaces before you book. MDsave’s national D&C range of $3,639 to $8,003 sits well under its own estimated national average of $11,292, which is what the same procedure costs when nobody shops.
- If a bill has already arrived, work it down. Request an itemized hospital bill so you can see the facility, anesthesia and pathology charges separately, then use our medical bill negotiation guide and negotiation script to get to the posted cash rate. Apply for charity care in parallel, not afterward.
- Do not let it reach collections while you are appealing. If the balance is large and the timing is bad, our guide on medical bills in collections covers what protections exist and what to do first.
The ER Route Costs More
Heavy bleeding sends a lot of people to an emergency department, and sometimes that is exactly right. It is also the most expensive door into this procedure, because you pay a facility fee just for being seen before any treatment is billed.
In a national analysis of hospital price-transparency files published in JAMA Network Open in 2024, the median posted cash price for the emergency facility fee alone was $420 at level 3, $699 at level 4 and $1,059 at level 5, with wide variation between hospitals. Peterson-KFF puts the average total emergency department visit at $2,453, with facility fees accounting for 80% of the cost. That is before the D&C itself, any ultrasound, labs or anesthesia.
This is a cost guide, not medical guidance, and heavy bleeding is a situation where the cost question is secondary. But if you are stable and a clinic or your own OB-GYN can see you, the scheduled route is dramatically cheaper than the emergency room.
Bottom Line
A D&C is a $447 office procedure, a $2,200 all-inclusive surgery center procedure, or an $11,292 hospital event, and the difference is almost entirely about where it is done and how many parties bill you. Ask about the office option first, ask for an all-in written quote second, and price a freestanding surgery center against the hospital third.
If the procedure is related to a pregnancy loss, the same rules apply and so does every financial assistance program. If you are exploring related gynecologic procedures, our guides to colposcopy, LEEP, endometrial ablation and hysterectomy use the same setting-first logic.