Objectives: To compare abortion-related morbidities and adverse events and costs from abortions provided at Ambulatory Surgery Centers (ASCs) versus office-based settings. Methods: Retrospective cohort study of 49287 women continuously enrolled in US private health insurance who had 50311 induced abortions in ASCs or office-based settings 2011 – 2014. Outcomes were ascertained during the six weeks subsequent to the abortion using data from a large national private insurance claims database. The primary outcome was any abortion-related morbidity or adverse event; two secondary outcomes were major events and abortion-related infections. For cost analyses, healthcare expenditures were assessed for the abortion and the six- week follow-up period. Costs included all payments to the provider, including insurance and out-of-pocket. Results: 11% of abortions were in ASCs, 89% office-based settings. In adjusted analyses, there was no statistically significant difference in any events [3.25% v. 3.34%], major events [0.26% v. 0.33%], or infections [0.58% v. 0.77%] in ASCs versus office-based settings. Unadjusted mean index abortion costs were higher in ASCs than office-based settings ($2,465 vs. $874; p<0.001). In adjusted analyses, costs of index abortions, total costs during follow-up period, and abortion-related event follow-up costs were all higher in ASCs than office-based settings, although there were no significant differences in likelihood of having follow-up care. Conclusions: Performance of abortions in ASCs versus office-based settings was not associated with a significant difference in abortion-related morbidities and adverse events. Abortions provided at ASCs are more costly than those in office-based settings, with no difference in likelihood of receiving follow-up care.