Panel & Test Price List Effective Date: October 16, 2017

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1 -New tests now available: Bartonella IGXSpot, Bartonella Western Blot IgG & IgM -Tests Now available for New York residents: Lyme ImmunoBlots IgG & IgM *IGXSP IGXSpot Panel $ Lyme IGXSpot Bartonella IGXSpot LYME PANELS (BORRELIA BURGDORFERI) LPA LYME PANEL A $ Lyme Western Blot IgM Lyme Western Blot IgG Lyme PCR - Whole Blood 87800, IB1 LYME IMMUNOBLOT PANEL 1 $ If ordered for a New York Resident, the IFA Screen will be replaced with Lyme Serology IgG/IgM Test #183 IB2 LYME IMMUNOBLOT PANEL 2 $ Lyme PCR - Whole Blood 87800, IB3 LYME IMMUNOBLOT PANEL 3 $ Lyme PCR - Whole Blood 87800, If ordered for a New York Resident, the IFA Screen will be replaced with Lyme Serology IgG/IgM Test #183 LPCR1 LYME PCR PANEL 1 $ Lyme PCR - Whole Blood 87800, *LU1 LYME URINE PANEL 1 $ Lyme Dot Blot - 3 urine samples x3 Lyme PCR - 3 urine samples-pooled 87800, BS-WS-001 REV *Tests/Panels are not yet available for New York Residents 556 Gibraltar Drive, Milpitas, CA T: (800) F: (650) Page 1 of 9

2 LYME INDIVIDUAL TESTS (BORRELIA BURGDORFERI) *300 Lyme IGXSpot $ C6 Peptide B. burgdorferi $ U,86617, x U,86617, x4 $ Lyme Western Blot IgM $ $ Lyme Western Blot IgG $ *230 Lyme G/M/A IFA Screen $ * kda Epitope IgM $ Lyme Serology IgG/IgM $ * kda Epitope IgG $ Lyme Serology IgM $ *800 Lyme Dot Blot Assay (LDA) 1 sample $ Lyme Multiplex PCR Whole Blood 87800, $ *802 Lyme Dot Blot Assay (LDA) 2 samples x 2 $ Lyme Multiplex PCR Urine 87800, $ *805 Lyme Dot Blot Assay (LDA) 3 samples x 3 $ Lyme Multiplex PCR Urine, Pooled 87800, $ Lyme Multiplex PCR Serum 87800, $ *462 Lyme Multiplex PCR Miscellaneous (Tissue, Breast Milk, etc.) 87800, $ TICK-BORNE RELAPSING FEVER - BORRELIA (TBRF) *TBRF1 TBRF PANEL 1 $ TBRF PCR - Serum TBRF PCR - Whole Blood 0043U, 86619, 86609x3 0044U, 86619, 86609x3 *TBRF2 TBRF PANEL 2 $ TBRF PCR - Serum TBRF PCR - Whole Blood TICK-BORNE RELAPSING FEVER INDIVIDUAL TESTS (TBRF) *585 TBRF Western Blot IgM $ * U, 86619, x3 $ *595 TBRF Western Blot IgG $ * U, 86619, x3 $ Relapsing Fever Borrelia and B. burgdorferi sensu lato real-time PCR *556 TBRF PCR Whole blood $ *562 TBRF PCR Urine (pooled) $ *573 TBRF PCR - Serum $ *568 TBRF PCR Miscellaneous (example: Tissue, Breast milk) $ *559 TBRF PCR - Urine $ Page 2 of 9

3 BORRELIOSIS PANELS - COMBINES LYME AND TBRF TESTING *LTP1 LYME/TBRF PANEL 1 $ U,86619,86609 x3 0044U,86619,86609 x3 *LTP2 LYME/TBRF PANEL 2 $ Lyme PCR - Whole Blood 87800, U,86619,86609 x3 0044U,86619,86609 x3 *LTP3 LYME/TBRF PANEL 3 $ Lyme PCR - Whole Blood TBRF PCR - Serum TBRF PCR - Whole Blood 87800, U,86619,86609 x3 0044U,86619,86609 x3 CENTRAL NERVOUS SYSTEM PANEL *CSF1 CSF PANEL 1 $ Lyme Dot Blot Assay CSF Lyme PCR CSF 87800, TBRF PCR - CSF CENTRAL NERVOUS SYSTEM INDIVIDUAL TESTS (CEREBRAL SPINAL FLUID) *810 Lyme Dot Blot Assay CSF $ Bartonella henselae PCR CSF $ Lyme (B. burgdorferi ) PCR CSF 87800, $ Rickettsia PCR Panel CSF (R rickettsii only for NY residents) *565 TBRF PCR - CSF $ $ Page 3 of 9

4 CO-INFECTION PANELS *TBD1 TICK-BORNE DISEASE PANEL 1 $ U, 86617,86609x4 0042U, 86617, 86609x4 0043U, 86619, 86609x3 0044U, 86619, 86609x3 *TBD1R TICK-BORNE DISEASE PANEL 1 with Rickettsia IFA $ NEW $ U, 86617, x4 0042U, 86617, x4 0043U, 86619, x3 0044U, 86619, x3 Page 4 of 9

5 *TBD2 TICK-BORNE DISEASE PANEL 2 $ U, 86617, x4 0042U, 86617, x4 Lyme Multiplex PCR Serum 87800, Lyme Multiplex PCR Whole Blood 87800, U, 86619, x3 0044U, 86619, x3 *TBD3 TICK-BORNE DISEASE PANEL 3 $ Lyme Multiplex PCR Serum 87800, Lyme Multiplex PCR Whole Blood 87800, TBRF PCR Serum TBRF PCR Whole Blood 0043U,86619,86609 x3 0044U,86619,86609 x3 Bartonella FISH Page 5 of 9

6 *CP1 CO-INFECTION PANEL 1 $ CP5 CO-INFECTION PANEL 5 $ Page 6 of 9

7 *CP6 CO-INFECTION PANEL 6 $ Bartonella FISH BABESIOSIS PANELS BAB1 BABESIA PANEL 1 $ Babesia PCR Panel 87797, x2 *BAB2 BABESIA PANEL 2 $ Babesia PCR Panel 87797, x 2 BABESIOSIS INDIVIDUAL TESTS 200 B. microti IgG & IgM IFA x2 $ Babesia FISH (RNA) $ *720 B. duncani IgG & IgM IFA x2 $ Babesia PCR Panel Whole Blood 87797, x2 $ Page 7 of 9

8 BARTONELLOSIS PANELS *BART1 BARTONELLA PANEL 1 $ Bartonella PCR Whole Blood *Bartonella FISH *BART2 BARTONELLA PANEL 2 $ Bartonella IGXSpot Bartonella Western Blot IgM 86611x2, Bartonella Western Blot IgG 86611x2, *BART3 BARTONELLA PANEL 3 $ Bartonella IGXSpot Bartonella Western Blot IgM 86611x2, Bartonella Western Blot IgM 86611x2, Bartonella PCR Whole Blood Bartonella FISH BARTONELLOSIS INDIVIDUAL TESTS *350 Bartonella IGXSpot $ Bartonella henselae IgG & IgM IFA 86611x2 $ *351 Bartonella Western Blot IgM x 2, $ *289 Bartonella FISH $ *352 Bartonella Western Blot IgG x 2, $ Bartonella PCR $ Page 8 of 9

9 RICKETTSIOSIS PANEL RP1 RICKETTSIA PANEL 1 $ Rickettsia PCR Panel (Only R. rickettsii will be reported for NY Resident) 87797, x2 RICKETTSIOSIS INDIVIDUAL TESTS (ROCKY MOUNTAINSPOTTED FEVER) 965 Rickettsia rickettsii/typhi IgG IFA x2 $ Rickettsia PCR Whole Blood (Only R. rickettsii will be reported for NY Resident*) 87797, x2 $ EHRLICHIOSIS PANEL EP1 EHRLICHIA PANEL 1 $ Ehrlichia chaffeensis (HME) PCR 87797, Anaplasma phagocytophilum (HGA) PCR 87797, EP1 EHRLICHIA PANEL 1 $ EHRLICHIOSIS INDIVIDUAL TESTS 203 Ehrlichia chaffeensis (HME) IgG & IgM IFA x2 $ Anaplasma phagocytophilum IgG & IgM IFA x2 $ Ehrlichia chaffeensis (HME) PCR 87797, $ Anaplasma phagocytophilum PCR 87797, $ IMMUNOLOGY *275 CD $ *296 Chlamydophila pneumoniae IgA ELISA $85.00 *295 Chlamydophila pneumoniae IgG Elisa $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, and Money Orders is U.S. dollars. * Tests/Panels are not available to New York Residence. Please Note: Only Tests that are medically reasonable or 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. Page 9 of 9