OBJECTIVES: To evaluate costs of initial procedures and during a 6-month follow-up period of women who had hysteroscopic sterilization (HS) vs. laparoscopic bilateral tubal ligation. (LBTL) METHODS: Women (18-49 years) continuously insured with claims for HS and LBTL procedures without a concomitant procedure on the same day were identified from the MarketScan Commercial claims database (1/1/2010-12/31/2012). Women were placed into cohorts based on sterilization procedure received. Demographics, characteristics, procedure setting, initial procedure costs, and 6-month procedural-related costs were compared. Procedure-related costs included diagnoses that could be related to a sterilization procedure (eg pelvic pain, wound infection, allergic reaction), selected from a list of all diagnoses that occurred during the follow-up period. Multivariable regression analyses were used to examine the impact of HS vs. LBTL on initial procedure costs and 6-month procedural-related costs while controlling for key patient characteristics. RESULTS: Among the study population, 12,031 had HS (mean age: 37.0 years) and 7,286 had LBTL (mean age: 35.8 years). The majority (80.9%) of women who had HS received the procedure in a physician's office. Fewer women who had HS vs. LBTL received the procedure in an inpatient setting (0.5% vs. 2.1%), a hospital outpatient setting (13.4% vs. 71.9%), and an ambulatory surgical center setting (5.0% vs. 23.8%). Mean total cost for the initial procedure was lower for HS ($3,964) than for LBTL ($5,163, p<0.001). During the 6-month follow-up period sterilization procedure-related costs were lower for women who had HS vs. LBTL ($4,971 vs. $5,407, p<0.001). After controlling for key patient characteristics, multivariable regression results confirmed that initial procedure costs (-$1,215) and 6-month sterilization procedural-related costs (-$456) were less for women who had HS vs. LBTL. CONCLUSIONS: Among commercially-insured women, HS vs. LBTL is associated with lower costs for the initial procedure and lower procedure-related costs 6 months after the sterilization procedure.