Varicose vein care splits into two businesses that look alike from the waiting room. One injects small surface veins with a needle and sells the result cosmetically. The other threads a catheter into a large refluxing vein under ultrasound and closes it with heat, glue or foam, and bills it as a medical procedure when the paperwork supports it.
This guide prices the second one: radiofrequency ablation, endovenous laser, VenaSeal cyanoacrylate closure, Varithena foam, ambulatory phlebectomy and old-style ligation and stripping, plus the duplex ultrasound that has to come first. If what you actually want is spider vein injection, that is a different price list entirely and it lives in our sclerotherapy cost guide at $295 to $950 per session. Figures below are current as of September 2026.
What Does Varicose Vein Treatment Cost Without Insurance?
Medicare rates come from the June 30, 2026 release of the CMS Physician Fee Schedule relative value file (RVU26C), calculated nationally at the 2026 conversion factor of $33.4009 in a non-facility (office) setting. Cash prices are published clinic and marketplace prices read in September 2026.
| Service | Low | Average | High |
|---|---|---|---|
| Radiofrequency ablation, per leg (published clinic prices) | $2,000 | n/a | $5,000 |
| Endovenous laser ablation (EVLT), per leg | $1,500 | n/a | $4,000 |
| VenaSeal cyanoacrylate closure, per leg | $1,500 | n/a | $5,000 |
| Varithena foam, per leg | $1,500 | n/a | $3,000 |
| Ambulatory phlebectomy, per leg | $700 | n/a | $3,000 |
| Bundled endovenous ablation, hospital (MDsave, 59 providers) | $4,526 | n/a | n/a |
| Bundled endovenous ablation, in office (MDsave, 8 providers) | $2,116 | n/a | n/a |
| Bundled varicose vein ligation (MDsave, 4 providers) | $1,150 | n/a | n/a |
| All varicose vein treatment on MDsave | $283 | n/a | $6,988 |
| Duplex ultrasound of leg veins (93971 to 93970, Medicare office) | $116.24 | n/a | $184.04 |
| Duplex ultrasound, average submitted charge, office (93970) | n/a | $516.02 | n/a |
| Medicare 2026 office rate, RFA first vein (36475) | n/a | $1,056.14 | n/a |
| Medicare 2026 office rate, laser first vein (36478) | n/a | $980.32 | n/a |
| Medicare 2026 office rate, adhesive first vein (36482) | n/a | $1,657.35 | n/a |
| Medicare 2026 office rate, each additional vein (36476, 36479) | $278.90 | n/a | $310.29 |
| Medicare 2026 rate, ligation and stripping (37700 to 37722) | $227.79 | n/a | $424.19 |
| Medicare 2026 office rate, stab phlebectomy (37765, 37766) | $414.17 | n/a | $492.66 |
| Compression stockings, one pair | $15 | n/a | $100 |
Published clinic prices disagree, and the disagreement is the useful part. For radiofrequency ablation, Metro Vein Centers posts $2,200 to $2,700, West Medical posts $2,000 to $3,500 per leg, and Inovia Vein posts $3,000 to $5,000 for a ClosureFast procedure. For endovenous laser, the same three sit at $1,900 to $2,200, $2,000 to $4,000 per leg, and (from Comprehensive Vein Care) $1,500 to $3,000 per leg. VenaSeal is the widest split of all: $1,500 to $2,500 at Metro Vein Centers against $3,000 to $5,000 per leg at Comprehensive Vein Care. There is no single national price here, only a band.
MDsave’s bundled marketplace prices show the same split by setting rather than by clinic. Endovenous ablation delivered through its 59 participating hospital providers starts at $4,526, while in-office endovenous ablation from eight providers starts at $2,116. Across every varicose vein service it sells, the range is $283 to $6,988.
Medicare’s numbers explain why the cash band sits where it does. In a physician office, Medicare pays $1,056.14 for the first radiofrequency ablation, $980.32 for the first laser ablation and $1,657.35 for the first cyanoacrylate closure in 2026. Each additional vein in the same leg drops to $278.90 or $310.29. Meanwhile, in CMS’s 2024 national claims data, office providers submitted an average charge of $4,900.24 for radiofrequency ablation against an average allowed amount of $1,040.50, and $5,885.82 for cyanoacrylate against $1,633.96. Providers ask roughly four times what a payer with leverage actually pays.
What Drives the Price
Per leg, per vein, per session
Quotes are almost never all-in, and the unit is the first thing to pin down. The billing codes are built per vein segment: one code for the first vein treated and a much cheaper add-on code for each subsequent vein in the same leg. A patient with reflux in both great saphenous veins is buying two first-vein procedures, not one. Ask whether the quote covers one leg or two, and how many vein segments it includes.
The technology
Heat is cheapest, glue is dearest, and foam sits between them. That ranking holds in both directions of the market: Medicare pays $980 for laser, $1,056 for radiofrequency and $1,657 for adhesive, and clinic cash prices follow the same slope. VenaSeal’s premium is a real material cost, not just markup, but it also usually spares you weeks of compression stockings, which is worth something.
Whether surface veins need removing too
Ablation closes the failing trunk vein. It does not remove the bulging ropes you can see. Those come out by ambulatory phlebectomy through tiny incisions, and that is a separate charge: Metro Vein Centers posts $700 to $1,050 for a microphlebectomy, West Medical $1,000 to $3,000 per leg, and Austin Vein Specialists $1,500 to $2,500 per leg when it is done as cash or cosmetic work. Many treatment plans include both.
Setting
The single biggest lever on this page. The same ablation is dramatically cheaper in a physician office than in a hospital outpatient department, which is exactly what MDsave’s own numbers show: $2,116 in office against $4,526 in a hospital, both bundled. Vein care is one of the procedures most fully migrated to the office setting, so there is usually an office option available.
The workup and the follow-up scans
A duplex ultrasound map is mandatory before anyone touches a vein, and post-procedure scans are common. Medicare pays $184.04 for a complete bilateral extremity venous duplex and $116.24 for a limited study in a 2026 office, while office providers submitted an average charge of $516.02 for the complete study in 2024. Our ultrasound cost guide has the wider self-pay imaging ranges to compare against.
Cash Price vs. Insurance
Varicose vein ablation is one of the few procedures on this site where the covered and cash versions are the identical operation. The only thing separating them is documentation, and that makes the coverage rules worth reading carefully before you pay anything.
Medicare’s LCD L34536, revised effective August 28, 2025 and currently in effect, sets the template that most commercial plans copy. It 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. For ablation specifically it adds anatomic criteria: no aneurysm in the target segment, a maximum vein diameter of 20 mm for radiofrequency or 30 mm for laser, no thrombosis or tortuosity that would block the catheter, and no significant peripheral arterial disease.
Then it says the quiet part out loud. Treatment of asymptomatic varicose veins, or of symptomatic varicose veins without a three-month trial of conservative measures, by any technique, is considered cosmetic and therefore not covered. Spider veins and telangiectasias are cosmetic by any technique unless there is associated bleeding.
Two practical consequences follow. First, the three-month clock is the most valuable thing you can start at your first appointment. A pair of medical-grade compression stockings costs $15 to $40 at Metro Vein Centers and $50 to $100 at Austin Vein Specialists, and three documented months in them is worth more than any discount you will negotiate on a $4,000 quote. Second, the LCD covers exactly one pre-procedure duplex scan, and states that intraoperative ultrasound guidance is not separately payable with ablation. If a self-pay quote itemizes intraoperative guidance as a separate line, that is a fair line to question.
If a procedure was billed to insurance and came back denied or partially paid, the codes make it unusually easy to audit. Our guide to reading an itemized hospital bill covers how to check that a first-vein code was not billed twice where an add-on code belonged.
How to Pay Less
Start the conservative-therapy clock before you shop. If your legs are symptomatic, the cheapest possible path is not a cash discount, it is a documented three-month compression trial followed by a covered ablation. Ask for that documentation to begin at visit one, in writing, even if you are undecided.
Get the office price, not the hospital price. MDsave’s own marketplace shows bundled in-office ablation starting at $2,116 against $4,526 in a hospital setting for the same service. Ask every practice whether the procedure happens in its own office suite or in a hospital outpatient department, because that answer moves the number more than anything else you can negotiate. Check any quote you get against our fair price checker.
Make the quote say how many veins and which leg. Because the second vein in a leg bills at roughly a quarter of the first, a bundled quote for “one leg” can hide a lot of variance. Get the vein count and the leg count in writing, then ask what the price is if the ultrasound finds one more segment on the day.
Price the phlebectomy separately. Ablation and surface vein removal are often quoted together as one number, which makes it impossible to tell whether either half is fair. Published per-leg phlebectomy prices run from $700 to $3,000, a range too wide to accept blind.
Ask what happens to the ultrasound bill. A duplex scan billed by a hospital imaging department and the same scan run in the vein clinic’s own room are not the same price. Austin Vein Specialists notes it performs its ultrasounds in-house for exactly this reason.
Negotiate the cash quote the same way you would a bill. In 2024 Medicare data, office providers submitted an average charge of $4,900.24 for a radiofrequency ablation and were paid $1,040.50. That gap is the room in the number, and the approach in our guide to negotiating medical bills works on a pre-service quote as well as on a bill that already landed. Hospital-based programs may also have financial assistance you can apply for before the procedure, which our guide to hospital price transparency explains how to find.
The Bottom Line
Budget $1,500 to $5,000 per leg for a single varicose vein ablation as of September 2026, plus $116 to $516 for the duplex ultrasound and $700 to $3,000 per leg if bulging surface veins also need to come out. Bundled in-office ablation starting near $2,116 is the realistic low end of the market and a bundled hospital ablation starting near $4,526 is the realistic high end. Anything materially above $6,988, the top of MDsave’s entire varicose vein range, deserves a second quote.
The larger decision is not which catheter. It is whether your legs are symptomatic enough to document, because that single fact is what separates a covered procedure from a cash one. Three months of compression stockings and a clinician’s note are the cheapest medical intervention on this page. If you are also pricing cosmetic vascular work like facial veins or angiomas, our cherry angioma and benign lesion removal guide covers that side of the line.