This is typically a result of the odd ways in which healthcare
facilities negotiate with insurers. The insurers agree to pay only a
fraction of whatever charge the facility claims for something (like a
visit for a TB test).

You may be able to negotiate with the healthcare facility. Ask if they
will let you pay whatever they normally receive from insurers for the
same type of visit/procedure.

avoid the pharma boys http://www.whale.to/a/hoaxmed.html

And this is an example of why the current system of insurance
companies paying for the majority of medical care is so screwed up.

Imagine if you ran a small grocery store, but in the town you live in,
a law was passed that declared food is a right, not a privilege, and
the government further decreed that all employers should pay premiums
to a food insurance company for its employees, and the food insurance
companies should buy food for its insureds. Representatives from a
food insurance company come in one day and tell you that they have
signed up 90% of the people in your town, so they will start paying
your grocery bills on their behalf. However, you must agree to accept
just 50% of what you currently charge, and the customers will have to
pay a $5 copay. If you don't agree to this, they will list you as a
"non-preferred" grocery store and their customers would have to pay
75% of your charges instead of $5, so, naturally, they wouldn't come
to your store.

You think about it, crunch some numbers, and decide you'd better sign
the contract or you'll surely be out of business. You do your best to
make things more efficient and stock more attractive merchandise.
Customers come in and load up their carts with the best products they
can find, because, naturally, people are always quite generous when
they are spending someone else's money, but then they still complain
to you about having to pay $5 for a cartload of groceries. After a few
weeks, you realize, despite brisk business, that you are in the red
given the discounted payments you were forced to accept, so the only
thing you can do to avoid bankruptcy is to raise your prices for
uninsured customers, since your contract with the food insurance
company is not up for renewal. Your uninsured customers are then
shocked that a banana costs $8, but, since all the other grocery
stores have had to make similar price hikes, they have no choice but
to pay it.

PF

<snippity>

Just a quick followup - I spoke to the medical group and they knocked down
the fee quite a bit, so there's hope yet.  Thanks folks.