Chronic conditions

Heartworm treatment cost

Treating heartworm takes months and costs far more than a year of prevention.

Updated October 15, 2026 · US prices · 2 sources · see sources

Typical US prices
Item	Typical US price	Src
Dog Heartworm Treatment: typical owner bill	$750–$2,200 total	[1]
Flea & Tick Prevention: typical owner bill	$120–$360 total	[2]
On the bill: Heartworm test	$35–$75	[1]
On the bill: Chest X-rays	$125–$250	[1]
On the bill: Blood work	$75–$200	[1]
On the bill: Antibiotic, 30-day course	$30–$150	[1]
On the bill: Monthly heartworm preventive (Given during treatment)	$6–$18 a dose	[1]
On the bill: Treatment injections, three (Priced by your dog’s weight)	$500–$1,500	[1]
On the bill: Anti-inflammatory medication (On injection days)	$10–$30	[1]
On the bill: Follow-up heartworm test (6 months later)	$35–$75	[1]
On the bill: Heart ultrasound (In severe cases)	$300–$800	[1]

Ranges come from the sources below, and each one measures something slightly different (published prices, owner invoices or planning budgets). Your vet's estimate is what counts. Older figures, like the ASPCA's 2021 table, are probably lower than today's prices.

What affects the cost

Your dog’s size The injections are priced by weight. [1]
How advanced it is Severe cases add a hospital stay at $200–$500 a day. Surgery to remove the worms is $3,000–$6,000. [1]
The kind of practice Teaching hospitals and rescue-linked clinics often charge much less. [1]
Complications Emergency care adds $500–$2,000. [1]
The kind of product Chews are $18–$30 a month, spot-on treatments $10–$18 a month, and a collar $55–$70. [2]
Your pet’s size Bigger dogs cost more per dose. [2]
Where you buy it The clinic usually charges the most and online pharmacies less. [2]

📍 Regional note

Where you live Prices tend to be lower in Southern states, where heartworm is common. [1]

Ways to save

Ask about a veterinary teaching hospital They often treat heartworm for well below private practice prices. [1]
Ask local humane societies and rescues Many run subsidized heartworm programs at $225–$600 for owners who qualify. [1]
Ask for a written prescription for the antibiotic It is also a human medicine and usually costs far less at a regular pharmacy. [1]
Ask for the price of the whole course in writing Tests, medication, all three injections and the follow-up test, so nothing is a surprise. [1]
Ask about a 6 or 12 month prevention injection It costs $50–$150 a dose. Ask your vet whether it suits your dog once treatment is finished. [1]
If your dog is insured, check before you start Plans cover heartworm only when the first positive test came after you enrolled. [1]
Ask for a written prescription Chewy and 1-800-PetMeds usually charge less than the clinic for Nexgard, Simparica and Bravecto. Your vet can send the prescription. [2]
Look for a maker’s rebate Nexgard, Simparica and Bravecto often have $15–$50 rebates on 6- and 12-month supplies. [2]

Questions to ask your vet

Print this or bring it on your phone.

Ask about a veterinary teaching hospital
Ask local humane societies and rescues
Ask for a written prescription for the antibiotic
Ask for the price of the whole course in writing
Ask about a 6 or 12 month prevention injection
Ask for a written prescription

Common questions

How much does heartworm treatment cost for a dog?

The full heartworm protocol typically adds up to $750–$2,200, spread over several visits. The standard protocol includes diagnostic testing ($35–$75), chest X-rays ($125–$250), 30 days of doxycycline ($30–$150), a series of melarsomine (Immiticide) injections ($500–$1,500), and follow-up testing. Small dogs land lower; large dogs pay more due to weight-based medication dosing. Severe cases needing hospitalization or oxygen therapy can reach $3,000–$6,000. (Source: VetReceipt)

What does the heartworm treatment protocol include?

The American Heartworm Society protocol typically spans 3–4 months: (1) Diagnostic workup — heartworm antigen test, confirmatory microfilaria test, chest X-rays, and blood work ($200–$500). (2) Pre-treatment — 30 days of doxycycline ($30–$150) plus monthly heartworm preventive ($6–$18/dose). (3) Melarsomine injections — one injection, then two more 24 hours apart one month later ($500–$1,500 for all three). (4) Strict exercise restriction for 6–8 weeks post-injections. (5) Follow-up heartworm test at 6 months ($35–$75). (Source: VetReceipt)

How much do the melarsomine (Immiticide) injections cost?

The melarsomine injections alone cost $500–$1,500 for the standard three-injection series. The drug is injected deep into the lumbar muscles and requires veterinary monitoring. Pricing varies by dog weight (larger dogs need higher doses), geographic location, and whether your vet keeps the drug in stock — supply shortages have historically caused price spikes. Some clinics charge a flat fee for the full injection series; others charge per injection. (Source: VetReceipt)

How much does flea and tick prevention cost?

Based on 10 real line items, flea and tick prevention at the vet costs between $10 and $25 per purchase. Monthly chewables (Nexgard, Simparica): $18–$25/month at the vet, $14–$20 online. 3-month chewable (Bravecto): $50–$70 per dose. Topicals (Frontline, Advantix): $10–$20/month. Annual cost: $120–$360 depending on product and where you buy. (Source: VetReceipt)

How much does each flea/tick product cost?

Dog products: Nexgard ($18–$25/month), Simparica Trio ($22–$30/month, includes heartworm), Bravecto ($50–$70/3 months), Frontline Plus ($12–$18/month), Seresto collar ($55–$70/8 months). Cat products: Revolution Plus ($20–$28/month, combo), Bravecto Plus ($25–$35/2 months), Frontline ($10–$15/month). Online prices are 15–30% cheaper than vet clinic pricing. (Source: VetReceipt)

Where is the cheapest place to buy flea and tick prevention?

Online pet pharmacies are consistently cheapest: Chewy (15–25% less than vet), 1-800-PetMeds (similar), Amazon (select products). Prescription products (Nexgard, Simparica, Bravecto) need a vet prescription — ask your vet to call it in to an online pharmacy. OTC products (Frontline, Seresto collar) are available anywhere without a prescription. Manufacturer rebates ($15–$50 back on 6–12 month supplies) stack with online discounts. (Source: VetReceipt)

Sources

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