Contact investigation is a fundamental component of tuberculosis (TB) programs that drives prompt diagnosis and treatment of Mycobacterium tuberculosis infection among those exposed. Few studies have examined contact investigation costs for TB. We conducted a systematic review of TB contact investigation costs in the United States by searching English-language articles published during January 1990-August 2024 in electronic databases, including MEDLINE, Embase, CINAHL, and Scopus. We identified 2,920 titles and abstracts; 10 studies met our inclusion criteria. We abstracted costs for labor, diagnostic tests, and chest radiographs. Labor cost per contact was estimated at $175.94 (range $79.97-$293.51); total cost, including diagnostic testing and chest radiography, was $228.93 (range $132.95-$346.49).The overall cost of contact investigation in the United States was $9.94 (range $5.77-$15.04) million in 2022; total cost during 2013-2022 was $137.35 million. Contact investigations are essential to prevent TB and avert TB-related labor and diagnostic costs.