Sclerotherapy is the injection of a chemical solution into a vein to make its walls stick together so blood stops pooling there. It is the standard treatment for both cosmetic spider veins and, in a different form, for symptomatic varicose veins. Those two uses look similar from the patient chair and could not be more different at the billing desk.
That split is the whole story of sclerotherapy pricing. Cosmetic spider vein work is a pure cash purchase with a published price list. Symptomatic varicose vein work runs through insurance if, and only if, you clear a documented set of criteria first. This guide prices both, using price lists that clinics actually publish and Medicare’s own 2024 claims data, current as of August 2026.
What Does Sclerotherapy Cost Without Insurance?
Expect $295 to $950 for a single session, with most cosmetic spider vein sessions landing between $350 and $650.
| Service or package | Low | Average | High |
|---|---|---|---|
| One sclerotherapy injection, national average (CareCredit) | $250 | $497 | $825 |
| Spider vein treatment, average fee (ASPS) | n/a | $500 | n/a |
| Per vial of Asclera (polidocanol), published med spa price | n/a | $295 | n/a |
| Single session, published clinic price (Florida Vein Care) | n/a | $425 | n/a |
| Spider veins, 30-minute session (Austin Vein Specialists) | n/a | $650 | n/a |
| Spider plus reticular veins, 30-minute session | n/a | $750 | n/a |
| Varicose veins with ultrasound guidance, one session | n/a | $950 | n/a |
| Two-session package (Florida Vein Care) | n/a | $789 | n/a |
| Three-session package | n/a | $1,147 | n/a |
| Four-session package | n/a | $1,429 | n/a |
| Surface laser or thermolysis for spider veins, per session | n/a | $450 | n/a |
| Ambulatory phlebectomy, cash price per leg | $1,500 | n/a | $2,500 |
| Medicare allowed amount, liquid sclerotherapy, one leg (CPT 36471, office) | n/a | $191 | n/a |
The two national averages agree closely. The American Society of Plastic Surgeons puts the average cost of spider vein treatment at $500, noting that the figure covers the procedure alone and excludes anesthesia, facility fees, and related expenses. CareCredit’s cost research puts the average single sclerotherapy injection at $497 with a range of $250 to $825, and its state table runs from $401 in New York to $609 in New Jersey. When two independent studies land within $3 of each other, that is about as solid as a cosmetic-procedure benchmark gets.
Real clinic price lists spread wider than the averages, because they are pricing different things. Florida Vein Care in Orlando publishes $425 for a single self-pay session, $789 for two, $1,147 for three, and $1,429 for four, with the multi-session packages bundling in compression stockings and supplements. Austin Vein Specialists prices by what is being treated rather than by count: $650 for a 30-minute spider vein session, $750 when reticular veins are also treated, and $950 for a varicose vein session, which includes the ultrasound when guided therapy is required. Express Med Spa prices by product, starting from $295 per vial of Asclera.
The Medicare row is the outlier, and it matters. In 2024 the average Medicare allowed amount for CPT 36471, sclerotherapy of multiple incompetent veins in one leg performed in an office, was $191.30, against an average submitted charge of $590.91. That is the gap between what clinics ask and what a payer with negotiating power actually pays.
What Drives the Price
Which veins you are treating
This is the biggest single factor and the one that decides everything downstream. Spider veins (telangiectasias) are under 1 mm, reticular veins are 1 to 3 mm, and varicose veins bulge and typically exceed 3 mm. Asclera, the most common sclerosant for cosmetic work, is approved for spider and reticular veins and has not been studied in varicose veins over 3 mm. Larger veins need a different sclerosant, often in foam form, and usually a different clinician.
How many veins, injections, or vials
Sclerotherapy is not one shot. Aetna’s medical policy describes 1 to 3 injections to obliterate any given vessel, with 10 to 40 vessels, or a set of up to 20 injections in each leg, treated during a single session. Clinics translate that into either a flat session price or a per-vial price. Those two models are not comparable on their face, which is why a $295 vial price and a $650 session price can describe the same appointment.
Ultrasound guidance and foam
This is where the price steps up sharply. Plain visual sclerotherapy treats what the clinician can see. Ultrasound-guided and foam sclerotherapy treat deeper incompetent veins and are billed under separate codes that bundle the imaging. In 2024 Medicare data the foam-sclerosant-with-ultrasound codes carried average office allowed amounts of $1,260.51 for a single vein and $1,344.51 for multiple veins, against $104.59 and $191.30 for the liquid codes. Cash prices follow the same slope: Austin Vein Specialists charges $950 for the ultrasound-inclusive varicose session versus $650 for the visual spider vein session.
Worth knowing before you accept an ultrasound upcharge on cosmetic work: Aetna’s policy states that ultrasound or radiologically guided techniques are of no proven value when performed solely to guide the needle into the varicose vein, and that guided techniques are considered medically necessary only when initially performed to determine the extent and configuration of the veins. If you are being sold guidance for surface spider veins, ask why.
Number of sessions
CareCredit notes that some veins require two or three treatments, that spider veins generally disappear within three to six weeks, and that varicose veins may take three to four months. Results are considered permanent once treatment is complete, though new veins can develop later in the same area. Two to four sessions is the realistic planning range, which is why clinics sell packages.
Who injects and where
A vascular surgeon running an accredited vein center, a dermatologist, and a nurse injector at a med spa can all perform cosmetic sclerotherapy, and their price lists differ by hundreds of dollars per session. Geography adds another layer: CareCredit’s state data shows a $208 spread between the cheapest and most expensive states for the same single injection.
Cash Price vs. Insurance
For spider veins, there is no insurance angle and there never will be. Medicare’s coverage policy for varicose vein treatment states that treatment of spider veins or superficial telangiectasias by any technique is considered cosmetic and therefore not covered unless there is associated bleeding. Aetna reaches the same conclusion, classifying sclerotherapy for veins under 2.5 mm in diameter as cosmetic on the grounds that such veins do not cause symptoms.
The claims data shows how absolute that is. Across all of Medicare in 2024, CPT 36468, the spider vein sclerotherapy code, was billed in an office setting by just 31 providers for 47 beneficiaries nationwide. By comparison, the foam sclerotherapy code for incompetent veins was billed 100,788 times. Spider vein work is a cash market, full stop.
Symptomatic varicose veins are a different question, and the criteria are strict but achievable. Medicare’s LCD L34536, currently in effect since August 28, 2025, requires a failed three-month trial of conservative therapy (exercise, periodic leg elevation, weight loss, graduated compression therapy, and avoiding prolonged immobility) plus at least one documented symptom: pain, aching, cramping, burning, itching, or swelling severe enough to impair mobility; recurrent superficial phlebitis; non-healing skin ulceration; bleeding from a varicosity; stasis dermatitis; or refractory dependent edema. Aetna layers on a vein diameter of 2.5 mm or greater measured by recent ultrasound. Both require documentation, and the LCD covers one pre-procedure Doppler or duplex ultrasound to map the anatomy.
The practical takeaway is that the three-month clock is the gate. If your legs ache and you have not yet documented three months in medical-grade compression stockings, starting that clock at your first visit is worth more than any discount you can negotiate later. Our guide to reading an itemized hospital bill covers how to check that a covered vein procedure was coded the way it was performed.
How to Pay Less
Get the diagnosis sorted before you shop on price. If your veins are symptomatic and over 2.5 mm, the cheapest path is not a cash med spa session, it is a documented conservative-therapy trial followed by a covered procedure. If they are cosmetic spider veins, no amount of documentation will get them covered and you should shop purely on cash price.
Buy the package, but read the expiration. Florida Vein Care’s four-session package at $1,429 works out to $357 a session against $425 for a single, and it bundles compression stockings and supplements worth part of the difference. The catch is the use-by window: its two-session package must be used within six months and the three and four-session packages within twelve. A package you cannot finish is not a discount. Run any quote through our fair price checker first.
Make quotes comparable before you compare them. Per-vial, per-session, and per-injection prices are three different units. Ask every clinic the same three questions: how many vials or syringes does this price include, what happens if my legs need more in the same appointment, and how many sessions do you project for an area like mine.
Decline ultrasound guidance you do not need. For surface spider veins, guidance is an upcharge that both Aetna and Medicare treat as unproven when used only to place the needle. That is a legitimate line to question on a cash quote.
Ask what happens to the diagnostic ultrasound bill. A duplex scan is a separate charge, and self-pay imaging prices vary wildly between a vein clinic, a hospital outpatient department, and an independent imaging center. Our ultrasound cost guide has the cash-price ranges to compare against.
Negotiate, and skip the deferred-interest card. Vein clinics that push medical credit cards usually have room to move when you decline and pay outright. The approach in our guide to negotiating medical bills works the same way on a cash quote as on a bill that has already landed.
The Bottom Line
Budget $425 to $650 for a typical cosmetic sclerotherapy session and $800 to $2,000 for a full course of two to four sessions as of August 2026. Sessions that include ultrasound guidance or foam for larger veins run closer to $950. If you are being quoted well above $825 for a straightforward spider vein session, you are above the top of CareCredit’s national range and should get a second quote.
The bigger decision is not which clinic, it is which category you are in. Cosmetic spider veins are cash, permanently. Symptomatic varicose veins are potentially covered, and the difference between paying $1,400 out of pocket and paying a copay comes down to whether someone documented three months of compression therapy and a qualifying symptom. That paperwork is worth more than any coupon. If you are also pricing other cash-only cosmetic work, our laser tattoo removal cost guide walks through the same session-count math.