--- title: Lyme Disease Serology with Reflex Test type: test id: lyme-disease url: "https://www.test-well.com/tests/lyme-disease" price_usd: 64.99 lab_fee_usd: 6 all_in_usd: 70.99 cpt: 86618 category: STI & Infectious Disease sample: Blood draw fasting_required: false results_in: "3–7 business days" labs: - Quest orderable: true reviewed_at: 2026-09-14 order_url: "https://www.test-well.com/cart?add=lyme-disease&utm_source=ai_agent&utm_medium=markdown" --- # Lyme Disease Serology with Reflex Test > Lyme Disease Serology with Reflex measures Lyme IgG/IgM Antibody Screen, Western Blot IgG (if reactive) and Western Blot IgM (if reactive) from a standard blood draw. At TestWell it costs $64.99 plus a $6 lab fee, needs no fasting, and results post in 3–7 business days. Physician-authorized with no doctor's visit or insurance needed; draw at Quest. ## Key facts | Fact | Value | | --- | --- | | Price | $64.99 + $6 lab processing fee per order ($70.99 all-in for this test alone) | | CPT code | 86618 | | Sample | Blood draw | | Fasting | Not required | | Results | 3–7 business days | | Labs | Quest Diagnostics | | Biomarkers measured | 3 | | Physician authorization | Included — no doctor's visit, referral or insurance needed | | Payment | Card, HSA or FSA; cash-pay only (no insurance billing) | ## What does the Lyme Disease Serology with Reflex test tell you? Two-tier testing for Lyme disease — screens with ELISA and confirms with Western blot if positive. Lyme disease testing follows the CDC-recommended two-tier approach. The first tier is an ELISA or immunoassay that screens for Lyme antibodies. If the screen is positive or equivocal, a confirmatory Western blot is performed. This reflex approach reduces false positives while maintaining high sensitivity. Testing is most accurate 4–6 weeks after a suspected tick bite. **Clinical use:** Two-tier Lyme serology: ELISA screen followed automatically by a Western blot confirmatory test if positive — the CDC-recommended diagnostic algorithm. ## Who should order it? Anyone with known tick exposure, characteristic erythema migrans (bullseye) rash, or unexplained fevers/joint pains/neuropathy living in or recently visited a Lyme-endemic region (Northeast, mid-Atlantic, upper Midwest, parts of CA/OR). ## Biomarkers measured - Lyme IgG/IgM Antibody Screen - Western Blot IgG (if reactive) - Western Blot IgM (if reactive) ## Price by lab | Lab | Test price | All-in (with $6 fee) | Notes | | --- | --- | --- | --- | | Quest Diagnostics | $64.99 | $70.99 | Choose at checkout; walk-in patient service centers nationwide (not NY/NJ) | Rhode Island is not served. Prices are identical online and in the lab; no draw fee or physician fee is added. ## How much does a Lyme Disease Serology with Reflex test cost? A Lyme Disease Serology with Reflex test costs $64.99 at TestWell — $70.99 all-in when ordered alone, because the $6 lab processing fee is charged once per order, with no draw fee or physician fee added. Ordered directly from the labs' own consumer sites, the closest equivalent lists at $100.00 at Quest Health and $99.00 at Labcorp OnDemand (list prices checked Sep 12, 2026; see the notes on how the products differ). Hospital outpatient labs typically bill around $200.00 self-pay for the same test, and often more. With insurance, what you pay depends on your deductible and your plan's negotiated rate; TestWell's price is fixed before the draw and is HSA/FSA-eligible. | Where you order | Price | One test, all-in | Notes | | --- | --- | --- | --- | | TestWell (drawn at Quest or Labcorp) | $64.99 | $70.99 | Includes the one $6 lab processing fee, charged once per order | | Quest Health (Quest Diagnostics' own site) | $100.00 | $100.00 | Both include reflex confirmation of positive screens · [list price checked 2026-09-12](https://www.questhealth.com/product/lyme-disease-test-with-confirmation/6646M.html) | | Labcorp OnDemand (Labcorp's own site) | $99.00 | $99.00 | Labcorp OnDemand sells the antibody screen alone; TestWell's reflexes to Western blot confirmation · [list price checked 2026-09-12](https://www.ondemand.labcorp.com/lab-tests/lyme-disease-antibody-test) | | Hospital outpatient lab, self-pay (typical) | $200.00 | $200.00 | Reference figure; hospital charges vary widely by facility and are often higher | Lab test codes: Quest test code 6646. ## How do you prepare? No fasting required. Testing is most accurate 4–6 weeks after a suspected tick bite. ## Related conditions - Lyme disease (early) (A69.20) - Lyme arthritis (A69.23) - Neurologic Lyme disease (A69.22) - Lyme carditis (A69.21) ## Is the Lyme Disease Serology with Reflex worth it? > Worth it when the timing is right. This is the CDC-standard two-tier Lyme test (an antibody screen that automatically reflexes to a confirmatory Western blot), which is the correct way to test - but antibodies take 4-6 weeks to build, so testing too soon after a bite gives a false negative. ### Worth it if you… - A known or suspected tick bite 4-6+ weeks ago, especially in a Lyme-endemic area - Lingering fatigue, joint pain, or neurological symptoms after possible tick exposure - Confirming or ruling out Lyme when the classic bull's-eye rash was never seen - Following up an earlier negative test once enough time has passed for antibodies to develop ### You can probably wait if you… - You have a classic expanding bull's-eye (erythema migrans) rash now - that alone justifies treatment, and testing this early is often falsely negative; see a provider promptly - The bite was only a few days ago - wait until at least 4 weeks have passed so antibodies have time to form ### At home or in the lab? At-home collection is available. This is a venous blood draw at Quest or Labcorp (billed under CPT 94322 for the two-tier reflex), or an at-home mobile draw where available - no fasting required. The reflex design means you pay for one order and, if the initial antibody screen is reactive, the confirmatory Western blot runs automatically on the same sample. TestWell's price is $40.99 versus roughly $65 at Quest Direct. ### How do you read the results? | Result | Typical adult range | What an out-of-range value can mean | | --- | --- | --- | | Lyme antibody screen (EIA/ELISA) | Non-reactive = negative | A non-reactive screen 4-6+ weeks after exposure makes Lyme unlikely. A reactive or equivocal screen automatically triggers the confirmatory Western blot - a single reactive screen is not a diagnosis on its own. | | Western blot IgM (reflex) | Reported if screen reactive | IgM turns positive earlier in infection; it is most meaningful in the first ~4-6 weeks and can be a false positive later, so it is interpreted with timing in mind. | | Western blot IgG (reflex) | Reported if screen reactive | IgG develops later and is the more reliable confirmation for infections older than 4-6 weeks. A positive screen plus a positive IgG blot supports a Lyme diagnosis in the right clinical picture. | _This section medically reviewed; last reviewed 2026-07-17._ ## Common questions about the Lyme Disease Serology with Reflex test ### How soon after a tick bite should I test? Antibodies take 2-6 weeks to develop. Testing within the first 2 weeks of a bite often shows false negatives — treat empirically if you have erythema migrans rash without waiting for serology. Retest at 4-6 weeks if early test is negative but symptoms persist. ### How much does a Lyme disease test cost? On TestWell the Lyme Disease Serology with Reflex is $64.99 with no insurance required — vs $100 at Quest, $99 at Labcorp OnDemand (screen only), and $120-$300 at clinics and hospital labs. The reflex Western blot (if your screen is positive) is included in that price, not billed separately. ### What is Quest test code 94322 and how much does it cost? 94322 is Quest's Tick-borne Disease Acute Molecular Panel — a PCR test that looks for tick-borne pathogen DNA (Borrelia, Anaplasma, Babesia, Ehrlichia) in the first ~14 days after a bite, typically $250-$400 cash. It's a different test from this one: our $64.99 two-tier serology is the CDC-recommended standard from 4-6 weeks post-exposure onward, which is when most people test. If you're within 2 weeks of a bite with symptoms, see a clinician promptly rather than waiting on any lab test. ### Which Lyme antibody test is cheaper? Among antibody (serology) options, the two-tier test with reflex is usually the best value because the confirmatory Western blot is bundled: $64.99 all-in on TestWell, vs $100 at Quest and $99 at Labcorp OnDemand for the screen alone. A standalone ELISA can look cheaper up front, but a positive screen then needs a separately billed Western blot ($80-$150 at most labs) — often costing more in total. PCR panels like Quest's 94322 run $250-$400 and answer a different question (acute infection in the first two weeks). For most people testing 4+ weeks after exposure, bundled two-tier serology is both the recommended test and the cheapest complete answer. ### Do I need to fast? No fasting required. ### What's the difference between ELISA and Western blot? ELISA is the screen — fast, sensitive, but with false positives. Western blot is the confirmatory test — specific but slower. CDC's two-tier algorithm: ELISA first, automatic reflex to Western blot if positive. Our 'with Reflex' option does both in one draw. ### What does "Lyme antibody screen with reflex to Western blot" mean on a lab order? It is the CDC two-tier test written as one order line. The lab first runs the antibody screen (an EIA/ELISA for IgG and IgM against Borrelia burgdorferi). If that screen is positive or equivocal, the lab automatically — "reflexively" — runs the confirmatory immunoblot (Western blot) for IgG and IgM on the same blood sample; if the screen is negative, testing stops there and the report shows only the screen. This is exactly what TestWell's Lyme Disease Serology with Reflex ($64.99) is: Quest test code 6646, one draw, and the confirmatory step is included in the price when it is triggered — nothing extra is billed. The CPT codes are 86618 for the screen and 86617 for each confirmatory blot. ### What's the CPT code? 86618 (ELISA), 86617 (Western blot reflex). HSA/FSA eligible. ### Can a positive Lyme test mean past infection? Yes — IgG antibodies persist for years after successful treatment. A positive test with current symptoms warrants treatment evaluation; a positive test years after treatment with no symptoms doesn't. ### How much does a Lyme disease test (CPT 94322) cost? TestWell's two-tier Lyme serology with reflex is $64.99 - the code 94322 refers to the reflex-to-Western-blot design where a reactive screen is automatically confirmed. The same two-tier testing is $100 at Quest, and Labcorp OnDemand charges $99 for the antibody screen alone, with no doctor visit or referral needed and results in 3-7 business days. ### Which Lyme antibody test is cheaper - and is a cheaper one as good? A standalone Lyme antibody screen (ELISA alone) can look cheaper, but on its own it is not diagnostic and a reactive result still needs a confirmatory Western blot - so you often end up paying twice. The two-tier reflex test at $64.99 bundles the screen and the automatic confirmation into one order, which is both the CDC-recommended approach and usually the better value. ### How long after a tick bite should I get tested? Wait at least 4-6 weeks. Lyme testing detects your antibodies, not the bacteria directly, and antibodies take weeks to build - so testing in the first few days after a bite is frequently falsely negative. The exception is a classic bull's-eye rash, which is treated on sight without waiting for a test. ## How to order 1. Add to cart: https://www.test-well.com/cart?add=lyme-disease&utm_source=ai_agent&utm_medium=markdown 2. Create an account or sign in, confirm your state and preferred lab, pay by card, HSA or FSA. 3. A licensed physician authorizes the order (usually within minutes); the requisition arrives by email. 4. Walk into any Quest Diagnostics patient service center — no appointment needed at most sites. 5. Results post to your TestWell portal in 3–7 business days with reference ranges and flags. ## Related - [Lyme Disease Testing Explained: How Two-Tier Testing Works and When to Test After a Tick Bite](https://www.test-well.com/guides/lyme-disease-testing-explained) - [CMV IgG + IgM Antibodies (Cytomegalovirus)](https://www.test-well.com/tests/cmv-igg-igm-antibodies) — $74.99 - [CMV IgG Antibody (Cytomegalovirus)](https://www.test-well.com/tests/cmv-igg-antibody) — $40.99 - [CMV IgM Antibody (Cytomegalovirus)](https://www.test-well.com/tests/cmv-igm-antibody) — $40.99 - [Hepatitis B Test with Confirmation](https://www.test-well.com/tests/hepatitis-b-test) — $59.99 - [Hepatitis C Test with Confirmation](https://www.test-well.com/tests/hepatitis-c-test) — $30.99 - [All STI & Infectious Disease tests](https://www.test-well.com/tests/category/sti-infectious-disease) - [Full test directory](https://www.test-well.com/tests/directory) --- Medically reviewed by Youmna DiStefano, MD (Medical Reviewer, TestWell); last reviewed 2026-09-14. Review policy: https://www.test-well.com/reviewers/youmna-distefano-md Canonical page: https://www.test-well.com/tests/lyme-disease Machine-readable catalog: https://www.test-well.com/api/catalog.json · MCP server: https://www.test-well.com/mcp · Overview for agents: https://www.test-well.com/llms.txt Prices are cash-pay, in USD, and include physician authorization; every order adds one flat $6 lab processing fee. Educational content is not a diagnosis — discuss results with a clinician.