Contraceptives and Other Related Services

Guide to inquiring about insurance coverage for contraceptives and other related services.

Please call your insurance company for specific information on your coverage benefits. You can find the customer service number on the back of your insurance card.

Important questions to ask your insurance company:
  • Is contraceptives covered under my medical plan, specifically procedure codes you plan to receive in a clinic setting?
  • Is contraceptives services covered if I have certain diagnosis?
  • If contraceptives are covered, do I have a co-pay or co-insurance?
  • What is my deductible and how much is remaining for this year?
  • Is Winona Health Services an in-network provider?
    • If not, what are my out-of-network benefits?
  • Is a preauthorization by physician required?
    • If yes, please call Winona Health’s business office at 507.457.4579 option 4 to reach our pre-authorization specialist to assist you with this.
  • If your plan does not cover contraceptive service, or you do not meet your plan’s qualifications for coverage, you have the option of paying out of pocket. Out-of-pocket prices are listed on this brochure.

For your benefit, we recommend that you obtain a reference number for your call.

Cost for Contraceptives and Other Related Services

Click on the appropriate topic for pricing information.

IUD

CPT Description Fee
58300 Physician Charges – Insertion $269.00
58301 Physician Charges – Removal $267.00
Total Physician:
$536.00
CPT Description Fee
J7302 Mirena IUD $965.00
J7300 Peragard IUD $1,301.00
J7301 Skyla IUD $975.00

Nexplanon

CPT Description Fee
11975 Physician Charges – Insertion $368.00
58301 Physician Charges – Removal $400.00
Total Physician: $768.00
CPT Description Fee
J7307 Nexplanon $1,909.00

Leep

CPT Description Fee
57461 Physician Charges $1,228.00
88307 Pathology Test & Read $504.00
**88305 Pathology Test & Read $350.00
Total Physician: $2,082.00

 **Occasionally based on results, the provider may request an additional test.

Colposcopy

CPT Description Fee
57452-57454 Physician Charges $346.00-$477.00
57455 Biopsy Cervix with Scope $393.00
**88305 Pathology Test & Read $350.00
Total Physician: $1,089.00-$1,220.00

**This is a per specimen charge. Each additional specimen taken will result in an additional charge.

Tubal Ligation

CPT Description Fee
58600 Physician Charges $1,867.00
Hospital Charges $7,700.00-$8,700.00
Total Physician: $9,567.00-$10,567.00

For coverage and benefit information for these services, please call your insurance provider at the number listed on the back of your insurance card.

For more information

Business Office
Winona Health, clinic 1st floor
855 Mankato Avenue • Winona, MN 55987

877.201.3731 or 507.457.4579
businessoffice@winonahealth.org
8 a.m.–5 p.m. Monday–Friday

Direct mail to:
Business Office
P.O. Box 5600
Winona, MN 55987

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