Effective October 16, 2017 we are offering our new tests for Lyme IGXSpot, Lyme Borreliosis, and Tick-borne Relapsing Fever Borreliosis The new ImmunoBlot tests have replaced the original Western Blot tests in most panels. The original Western Blot IgG and IgM will still be offered as individual tests. Prior to selecting your tests/panels, please review the components listed within each panel. Updated Prices for all tests and panels (effective October 16, 2017) are also listed on the new Test Requisition Form. *Tests/Panels are not yet available for New York Residents LYME PANELS (BORRELIA BURGDORFERI) LPA LYME PANEL A $546.00 Lyme Western Blot IgM 86617 Lyme Western Blot IgG 86617 *IB1 LYME IMMUNOBLOT PANEL 1 $490.50 *IB2 LYME IMMUNOBLOT PANEL 2 $686.00 *IB3 LYME IMMUNOBLOT PANEL 3 $752.50 LPCR1 LYME PCR PANEL 1 $371.00 *LU1 LYME URINE PANEL 1 $468.00 Lyme Dot Blot - 3 urine samples 87449 x3 Lyme PCR - 3 urine samples-pooled 87800, 87801 BS-WS-001 REV.004 04-1-2018 *Tests/Panels are not yet available for New York Residents 795 San Antonio Road, Palo Alto, CA 94303-4801 T: (800) 832-3200 F: (650) 424-1196 www.igenex.com Page 1 of 8
LYME INDIVIDUAL TESTS (BORRELIA BURGDORFERI) *300 Lyme IgXSpot 86352 $295.00 *325 86617 $225.00 *335 86617 $225.00 *230 Lyme G/M/A IFA Screen 86618 $ 95.00 183 Lyme Serology IgG/IgM 86618 $ 95.00 170 C6 Peptide B. burgdorferi 86618 $120.00 188 Lyme Western Blot IgM 86617 $125.00 189 Lyme Western Blot IgG 86617 $125.00 *488 31 kda Epitope IgM 86617 $125.00 *489 31 kda Epitope IgG 86617 $125.00 195 Lyme Serology IgM 86618 $ 95.00 *800 Lyme Dot Blot Assay (LDA) 1 sample 87449 $ 85.00 *802 Lyme Dot Blot Assay (LDA) 2 samples 87449 x 2 $170.00 *805 Lyme Dot Blot Assay (LDA) 3 samples 87449 x 3 $255.00 456 Lyme Multiplex PCR Whole Blood 87800, 87801 $265.00 450 Lyme Multiplex PCR Urine 87800, 87801 $265.00 465 Lyme Multiplex PCR Urine, Pooled 87800, 87801 $265.00 453 Lyme Multiplex PCR Serum 87800, 87801 $265.00 *462 Lyme Multiplex PCR Miscellaneous (Tissue, Breast Milk, etc.) 87800, 87801 $295.00 TICK-BORNE RELAPSING FEVER - BORRELIA (TBRF) *TBRF1 TBRF PANEL 1 $686.00 TBRF PCR - Serum 87800, 87801 TBRF PCR - Whole Blood 87800, 87801 *TBRF2 TBRF PANEL 2 $371.00 TBRF PCR - Serum 87800, 87801 TBRF PCR - Whole Blood 87800, 87801 TICK-BORNE RELAPSING FEVER INDIVIDUAL TESTS (TBRF) *585 TBRF Western Blot IgM 86619 $175.00 *595 TBRF Western Blot IgG 86619 $175.00 *345 $225.00 *355 $225.00 Relapsing Fever Borrelia and B. burgdorferi sensu lato real-time PCR *556 Relapsing Fever PCR - Whole Blood 87800, 87801 $265.00 *562 Relapsing Fever PCR - Urine (pooled 3 samples) 87800, 87801 $265.00 *573 Relapsing Fever PCR - Serum 87800, 87801 $265.00 *568 Relapsing Fever PCR - Miscellaneous (Tissue, Breast Milk, etc.) 87800, 87801 $295.00 *559 Relapsing Fever PCR - Urine 87800, 87801 $265.00 795 San Antonio Road, Palo Alto, CA 94303-4801 T: (800) 832-3200 F: (650) 424-1196 www.igenex.com Page 2 of 8
BORRELIOSIS PANELS - COMBINES LYME AND TBRF TESTING *LTP1 LYME/TBRF PANEL 1 $895.50 *LTP2 LYME/TBRF PANEL 2 $991.25 *LTP3 LYME/TBRF PANEL 3 $1335.75 TBRF PCR - Serum 87800, 87801 TBRF PCR - Whole Blood 87800, 87801 CENTRAL NERVOUS SYSTEM PANEL *CSF1 CSF PANEL 1 $500.00 Lyme Dot Blot Assay CSF 87449 Lyme PCR CSF 87800, 87801 TBRF PCR - CSF 87800, 87801 CENTRAL NERVOUS SYSTEM INDIVIDUAL TESTS (CEREBRAL SPINAL FLUID) *810 Lyme Dot Blot Assay CSF 87449 $95.00 281 Bartonella henselae PCR CSF 87471 $265.00 459 Lyme (B. burgdorferi ) PCR CSF 87800, 87801 $265.00 *565 TBRF PCR - CSF 87800, 87801 $265.00 986 Rickettsia PCR Panel CSF (Only R. rickettsii will be reported for NY Resident*) 87797, 87798 x 2 $230.00 795 San Antonio Road, Palo Alto, CA 94303-4801 T: (800) 832-3200 F: (650) 424-1196 www.igenex.com Page 3 of 8
CO-INFECTION PANELS *TBD1 TICK-BORNE DISEASE PANEL $1346.25 *CP1 CO-INFECTION PANEL 1 $816.00 Rickettsia rickettsii IgG IFA 86757 Rickettsia typhi IgG IFA 86757 795 San Antonio Road, Palo Alto, CA 94303-4801 T: (800) 832-3200 F: (650) 424-1196 www.igenex.com Page 4 of 8
*CP2 CO-INFECTION PANEL 2 $816.00 *CP3 CO-INFECTION PANEL 3 $992.00 Bartonella FISH 88365 795 San Antonio Road, Palo Alto, CA 94303-4801 T: (800) 832-3200 F: (650) 424-1196 www.igenex.com Page 5 of 8
CP4 CO-INFECTION PANEL 4 $680.00 Rickettsia ricketsii IgG IFA 86757 Rickettsia typhi IgG IFA 86757 CP5 CO-INFECTION PANEL 5 $816.00 Rickettsia ricketsii IgG IFA 86757 Rickettsia typhi IgG IFA 86757 795 San Antonio Road, Palo Alto, CA 94303-4801 T: (800) 832-3200 F: (650) 424-1196 www.igenex.com Page 6 of 8
BABESIOSIS PANELS BAB1 BABESIA PANEL 1 $518.50 Babesia PCR Panel 87797, 87798 x2 *BAB2 BABESIA PANEL 2 $654.50 Babesia PCR Panel 87797, 87798 x2 BABESIOSIS INDIVIDUAL TESTS 200 B. microti IgG & IgM IFA 86317 x2 $160.00 640 Babesia FISH (RNA) 88365 $220.00 *720 B. duncani IgG & IgM IFA 86317 x2 $160.00 663 Babesia PCR Panel Whole Blood 87797, 87798 x2 $230.00 BARTONELLOSIS PANEL *BART1 BARTONELLA PANEL 1 $518.50 Bartonella PCR Whole Blood 87471 *Bartonella FISH 88365 BARTONELLOSIS INDIVIDUAL TESTS 285 Bartonella henselae IgG & IgM IFA 86611 x2 $160.00 *289 Bartonella FISH 88365 $220.00 280 Bartonella henselae PCR Whole Blood 87471 $230.00 795 San Antonio Road, Palo Alto, CA 94303-4801 T: (800) 832-3200 F: (650) 424-1196 www.igenex.com Page 7 of 8
RICKETTSIOSIS PANEL RP1 RICKETTSIA PANEL 1 $331.50 Rickettsia ricketsii IgG IFA 86757 Rickettsia typhi IgG IFA 86757 Rickettsia PCR Panel (Only R. rickettsii will be reported for NY Resident*) 87797, 87798 x2 RICKETTSIOSIS INDIVIDUAL TESTS (ROCKY MOUNTAINSPOTTED FEVER) 965 Rickettsia rickettsii/typhi IgG IFA 86757 x2 $160.00 998 Rickettsia PCR Whole Blood (Only R. rickettsii will be reported for NYResident*) 87797, 87798 x2 $230.00 EHRLICHIOSIS PANEL EP1 EHRLICHIA PANEL 1 $663.00 Ehrlichia chaffeensis (HME) PCR Whole Blood 87797, 87798 Anaplasma phagocytophilum (HGA) PCR Whole Blood 87797, 87798 EHRLICHIOSIS INDIVIDUAL TESTS 203 Ehrlichia chaffeensis (HME) IgG & IgM IFA 86666 x2 $160.00 206 Anaplasma phagocytophilum (HGA) IgG & IgM IFA 86666 x2 $160.00 770 Ehrlichia chaffeensis (HME) PCR Whole Blood 87797, 87798 $230.00 775 Anaplasma phagocytophilum (HGA) PCR Whole Blood 87797, 87798 $230.00 IMMUNOLOGY *275 CD57 86356 $155.00 *296 Chlamydophila pneumoniae IgA ELISA 86631 $ 85.00 *295 Chlamydophila pneumoniae IgG ELISA 86631 $ 85.00 Test Panels are tailored to meet the needs of the referring healthcare practitioner. Test Panel discounts apply only to tests ordered at the same time. IGeneX, Inc. accepts Personal Checks, Money Orders, Visa, MasterCard, Discover, and American Express. Canadian/International Residents: NO Personal Checks accepted. Visa, MasterCard, Discover, American Express, Money Orders in US Dollars. *Tests/Panels are not yet available for New York Residents Please Note: Only tests that are medically reasonable and necessary for the diagnosis or treatment of a Medicare patient will be reimbursed. The Office of the Inspector General -OIG takes the position that a physician who orders medically unnecessary tests for which Medicare reimbursement is claimed may be subject to civil penalties under the False Claims Act. 795 San Antonio Road, Palo Alto, CA 94303-4801 T: (800) 832-3200 F: (650) 424-1196 www.igenex.com Page 8 of 8