A nuclear stress test, also called myocardial perfusion imaging, is the most expensive of the common non-invasive heart tests. You get an injected radiotracer, images of your heart at rest, a period of exercise or a drug that mimics it, and then a second set of images. Two scans, a tracer, several hours of chair time, and a cardiologist’s read all land on the same bill.
This guide covers real cash prices as of August 2026 for SPECT myocardial perfusion imaging (the standard version) and cardiac PET (the newer, pricier one), what CMS claims data shows providers actually bill, and why identical hospitals publish prices that differ by a factor of seven for the same test.
What Does a Nuclear Stress Test Cost Without Insurance?
The figures below are published cash prices verified in August 2026 plus national average submitted charges from the CMS Medicare Physician & Other Practitioners file (2024 claims). A submitted charge is approximately what a provider bills before any discount, which is the number an uninsured patient sees first.
| Service | Low | Average | High |
|---|---|---|---|
| Nuclear stress test, prepaid cash (MDsave) | $1,043 | $2,231 | $3,398 |
| Myocardial perfusion scan bought in office, prepaid cash (MDsave) | $787 | $1,332 | $3,165 |
| Cardiology-office self-pay rate, pharmacologic version (Tampa Heart) | n/a | $1,000 | n/a |
| Median hospital price, 20 top-ranked US hospitals (JAMA IM) | $463 | n/a | $3,230 |
| CPT 78452 SPECT, multiple studies, average billed charge (CMS 2024) | $377.54 | n/a | $1,218.92 |
| CPT 78452 Medicare allowed amount (CMS 2024) | $73.10 | n/a | $369.92 |
| CPT 78451 SPECT, single study, average billed charge (CMS 2024) | $311.71 | n/a | $788.19 |
| CPT 78431 cardiac PET with CT, average billed charge (CMS 2024) | $402.09 | n/a | $5,038.05 |
| Plain exercise stress test for comparison, prepaid cash (MDsave) | $331 | $491 | $774 |
Sources: prepaid cash ranges and national averages from MDsave’s national listings as of August 2026; the flat self-pay rate from Tampa Heart and Vascular Associates’ published price list; hospital medians from the 2022 JAMA Internal Medicine analysis of the 20 top-ranked US hospitals; billed charges and allowed amounts are national averages in the CMS 2024 physician file (low is the facility-setting figure, high is the office-setting figure).
The facility and office columns in the CMS data look backwards until you know why. In a facility, the physician bills only the interpretation and the hospital bills the imaging separately under its own outpatient rates, so the physician file captures a fraction of the transaction. In an office, one provider bills the whole study, so $1,218.92 for CPT 78452 is closer to the real all-in charge. Take the office figures as your reference point.
The codes on a nuclear stress test bill
- CPT 78452 is the standard study: SPECT myocardial perfusion imaging with multiple studies at rest and with stress. It was billed 664,238 times in office settings and 580,088 times in facility settings in 2024 Medicare claims.
- CPT 78451 is the single-study version, with an average submitted charge of $788.19 in office settings and Medicare allowing $272.01.
- CPT 78431 is cardiac PET perfusion imaging with concurrent CT, the premium option, averaging $5,038.05 in submitted charges in office settings with Medicare allowing $1,989.80.
- CPT 93016, 93017, and 93018 may also appear, because the stress portion is billed with the same supervision, tracing, and interpretation codes as an ordinary stress test.
What Drives the Price
SPECT versus PET
This is the largest single swing in the whole guide. In 2024 CMS data, the office-setting average submitted charge was $1,218.92 for SPECT with multiple studies and $5,038.05 for PET with CT, and Medicare’s allowed amounts follow the same pattern at $369.92 versus $1,989.80. PET is faster and uses a different tracer, but if you are paying cash, ask which technology is being scheduled before anything else.
Where you get it
A freestanding cardiology office bills one global fee. A hospital outpatient department adds a facility charge on top of the professional read. MDsave’s own listings show the effect: a $1,332 national average when the scan is bought as an in-office procedure against $2,231 for the general listing.
The JAMA Internal Medicine analysis shows how wide hospital pricing runs even among peers. Across the 20 highest-ranked hospitals in the country, using their own price transparency filings, the median nuclear stress test price ranged from $463 to $3,230. Same test, seven times the price, depending on the letterhead.
The tracer and the stress agent
Two consumables ride along with this test: the radiotracer that makes the imaging possible and, if you cannot exercise, a pharmacologic stress agent. Either can appear as a separate supply or drug charge. Tampa Heart’s published $1,000 self-pay rate is specifically for the pharmacologic version, which is a useful benchmark for what an all-in office price looks like when the drug is included.
Single study versus multiple studies
CPT 78451 covers a single set of images and 78452 covers rest-and-stress imaging. The office-setting average submitted charge is $788.19 for the single study and $1,218.92 for the multiple study. Most nuclear stress tests are the multiple-study version, but it is worth confirming what was ordered so the bill matches.
Whether the interpretation is separate
As with an EKG or an echo, the read can be billed by a physician who does not work for the imaging facility. That produces a second bill weeks later from a name you do not recognize. Our EKG cost guide explains the same technical-plus-professional split in a cheaper setting where it is easier to see.
Cash Price vs. Insurance
This is a test where a high-deductible plan can leave you paying more than a cash patient. Until the deductible is met you owe the full negotiated rate, and hospital negotiated rates for myocardial perfusion imaging routinely land in the $2,000 to $3,000 range. A prepaid in-office purchase at $1,332 or a published office rate of $1,000 can beat that outright.
Self-pay pricing has to be set up before the service. Once a claim is filed, most providers will not switch you to their cash rate retroactively. Identify yourself as self-pay when you schedule and ask for a single all-in number that names the imaging, the tracer, the stress agent, and the interpretation. If the scheduler cannot give you that, ask for the billing office.
The honest counterweight is that cash payments generally do not count toward your deductible or out-of-pocket maximum, and a nuclear stress test is often ordered in the middle of a larger workup that will hit the deductible anyway. This guide covers pricing, not coverage or medical strategy, so compare the two paths against your own plan.
How to Pay Less
- Ask for a flat, all-in self-pay price before scheduling. Tampa Heart publishes a pharmacologic nuclear stress test at $1,000, well under the $2,231 prepaid national average. Practices that publish a price will honor it if you ask in advance.
- Buy it prepaid. MDsave’s in-office myocardial perfusion scan averages $1,332 and its general listing averages $2,231 against a $4,151 estimated national average. Test any quote against our fair price checker before you agree to it.
- Use a freestanding cardiology or imaging center rather than a hospital outpatient department. The gap between MDsave’s in-office and general national averages is roughly $900 for identical imaging.
- Ask whether SPECT or PET is being ordered. If both are clinically reasonable, that question alone is worth thousands of dollars based on the CMS charge data above.
- Pull the hospital’s posted cash price if a hospital is involved. The 78451 and 78452 codes appear in every hospital’s machine-readable file. Our hospital price transparency guide shows how to find and read them, and how to hold a hospital to its own posted number.
- Challenge the bill if it arrives inflated. Request an itemized hospital bill so you can see the imaging, the tracer, and the interpretation as separate lines, then use our medical bill negotiation guide. For a large hospital balance, run our charity care checker and read our hospital charity care guide. If the balance has already been sold, our guide to medical bills in collections covers your options.
Bottom Line
A nuclear stress test is a four-figure test almost everywhere. The realistic self-pay range is $787 to $3,398, the prepaid in-office national average is $1,332, and published cardiology-office rates reach as low as $1,000 for the pharmacologic version. Hospital pricing is where the number gets away from you, with median prices at top-ranked hospitals spanning $463 to $3,230 for the same study.
Three questions decide most of your bill: SPECT or PET, office or hospital, and what exactly is inside the quoted price. If the answers push the number past $2,500, price the alternatives before you schedule. Our stress test cost guide prices the exercise and stress echo versions, our echocardiogram cost guide prices the ultrasound on its own, and our calcium score test guide covers the low-cost screening scan that sometimes comes first.