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ApoB test vs coronary calcium (CAC) score: what each shows and what it costs
An ApoB test is a blood test that counts the cholesterol-carrying particles in your blood; a coronary artery calcium (CAC) score is a CT scan that measures calcified plaque already in the heart's arteries. One measures a risk factor, the other measures disease that is already there. Here is how they differ, what guidelines say, and what each costs (ApoB prices checked Oct 23, 2026; scan prices checked Oct 23, 2026).
| ApoB blood test | CAC score (heart scan) | |
|---|---|---|
| What it measures | Apolipoprotein B (ApoB) in blood. | "The amount of calcium in the walls of your coronary arteries" (NHLBI), reported as an Agatston score; "A score of 0 is normal." |
| How it's done | Blood draw at a lab | CT scan without contrast dye, about 10 to 15 minutes (NHLBI) |
| Radiation | None | NHLBI: similar to the natural background radiation of about one year |
| What it can't show | Whether plaque is already present | Soft plaque that has not calcified, or whether an artery is narrowed (RadiologyInfo) |
| Doctor's order | Not needed at most sellers we track | Most providers below require one |
| Prices | $17.20–$89 (9 listings we track) | $87–$150 self-pay at the 9 providers below |
What guidelines say about a CAC score
- 2019 ACC/AHA primary prevention guideline: "In adults at intermediate risk (≥7.5% to <20% 10-year ASCVD risk) or selected adults at borderline risk (5% to <7.5% 10-year ASCVD risk), if risk-based decisions for preventive interventions (e.g., statin therapy) remain uncertain, it is reasonable to measure a coronary artery calcium score to guide clinician–patient risk discussion." It adds that the scan "should be performed in facilities that have current technology and expertise to deliver the lowest radiation possible."
- 2018 AHA/ACC cholesterol guideline: "the predictive significance of a CAC score of zero must be further verified in follow-up studies."
- 2019 ESC/EAS dyslipidaemia guideline: "CAC score assessment with CT should be considered as a risk modifier in the CV risk assessment of asymptomatic individuals at low or moderate risk."
- US Preventive Services Task Force (2018): "the current evidence is insufficient to assess the balance of benefits and harms of adding the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, or coronary artery calcium (CAC) score to traditional risk assessment". It lists "exposure to radiation and incidental findings" as harms. An update focused on CAC scoring is in progress; the 2018 statement is current.
What guidelines say about ApoB
The 2019 ESC/EAS guideline says "ApoB analysis is recommended for risk assessment, particularly in people with high TG, diabetes, obesity or metabolic syndrome, or very low LDL-C", and that it can be used as an alternative to LDL cholesterol. The 2018 AHA/ACC guideline lists ApoB of 130 mg/dL or more as a risk-enhancing factor. See ApoB vs LDL and ApoB vs Lp(a).
Guidelines use the two differently: ApoB is one of the inputs to risk assessment, while the US guideline suggests a CAC score mainly when a risk-based decision remains uncertain, and the ESC/EAS guideline treats it as a risk modifier at low or moderate risk. This page compares published guidance and prices; whether either test fits your situation is a question for a clinician.
What a heart scan costs: examples
We don't track scan prices weekly. These are self-pay prices posted on each provider's own page on Oct 23, 2026; prices and order rules vary by location, and insurance coverage varies (RadiologyInfo notes that not all plans cover it).
| Provider | Location | Self-pay price | Doctor's order |
|---|---|---|---|
| Saint Alphonsus (Trinity Health) | Boise, ID | $149 ($69 scan + $80 reading fee) | Order required |
| OSF St. Joseph Medical Center | Bloomington, IL | $87 (includes cardiologist read) | Order required |
| Memorial Healthcare System | South Florida | $99 | Prescription required |
| CardioVascular Center of Florida | Lake Nona, FL | $99 | No referral required (cardiology practice) |
| Froedtert & the Medical College of Wisconsin | Milwaukee area, WI | $99 | Order required |
| Hackensack Meridian Health | New Jersey | $99 (regular price "$250 or more") | Prescription required |
| Valley Health System | New Jersey | $99 | Prescription required |
| Houston Methodist | Houston, TX | $140 (scan and interpretation) | Not stated on page |
| WakeMed | Raleigh, NC | $150 | Referral required |
Compare prices
Sources
- NHLBI. Heart Tests: coronary calcium scan (last updated March 24, 2022). https://www.nhlbi.nih.gov/health/heart-tests
- RadiologyInfo.org (ACR/RSNA). Cardiac CT for Calcium Scoring (reviewed July 15, 2026). https://www.radiologyinfo.org/en/info/ct_calscoring
- Arnett DK, Blumenthal RS, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary. J Am Coll Cardiol. 2019;74(10):1376-1414. https://pmc.ncbi.nlm.nih.gov/articles/PMC8344373/
- Grundy SM, et al. 2018 AHA/ACC Guideline on the Management of Blood Cholesterol: Executive Summary. Circulation. 2019;139:e1046. https://pmc.ncbi.nlm.nih.gov/articles/PMC7403606/
- Mach F, Baigent C, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2020;41(1):111-188. https://eas-society.org/wp-content/uploads/2022/11/2019_dyslipidaemias_guidelin.pdf
- US Preventive Services Task Force. Cardiovascular Disease: Risk Assessment With Nontraditional Risk Factors (2018). https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cardiovascular-disease-screening-using-nontraditional-risk-assessment
- US Preventive Services Task Force. Update in progress: Cardiovascular Disease: Enhanced Risk Assessment (coronary artery calcium scoring). https://www.uspreventiveservicestaskforce.org/uspstf/draft-update-summary/cardiovascular-disease-enhanced-risk-assessment-non-traditional-risk-factors
Guideline quotes and scan prices checked Oct 23, 2026. ApoB prices update when we re-check sellers.
Informational only, not medical advice. See about & disclaimer.
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