Legal · Good Faith Estimate

Good Faith Estimate (No Surprises Act)

Last reviewed: 2026-05-21 · Effective: 2026-05-07

Practiclear is online, no appointment required for most orders, and reviewed by a Virginia nurse practitioner. The review covers eligibility, whether the request fits Practiclear's scope, Labcorp requisition routing when appropriate, result review, signed documentation letters, and limited follow-up or referral guidance.

Practiclear charges one posted direct-pay price for the service. Payment does not guarantee that a lab order or signed documentation letter will be issued. Outside laboratories perform testing; Practiclear does not perform specimen testing or receive referral fees, rebates, commissions, or volume-based compensation from the laboratory.

You may seek testing elsewhere. Practiclear documentation supports school, clinical, employment, or program file requirements based on available information and results, but the receiving institution makes the final acceptance decision. Practiclear may require follow-up or referral when clinically indicated.

Your right to a Good Faith Estimate

Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services.

This right is guaranteed by the federal No Surprises Act (42 USC 300gg-136; 45 CFR 149.610). Practiclear is a direct-pay practice and does not bill insurance, which means every Practiclear patient is entitled to a Good Faith Estimate ("GFE").

How Practiclear delivers your GFE

Practiclear intends to use flat, published pricing before any live checkout opens. The documented launch workflow uses manual Evexia ordering with Labcorp collection after clinician review. Live checkout remains gated until Evexia test-menu pricing, the confirmed $8 Labcorp PSC fee, and possible reflex/cascade billing exposure are reconciled in pricing and disclosures. To make your GFE concrete and individualized, we deliver it in two forms:

Public price posting. Each test's product page lists the patient-facing professional service fee and describes the included review, manual ordering coordination when appropriate, result review, and documentation support once final Evexia/Labcorp pricing is approved.
Itemized GFE document. After order processing, Practiclear sends a written, itemized Good Faith Estimate by encrypted email through Paubox during monitored business operations. The GFE includes your name and date of birth, the service description and codes, the provider's NPI and TIN, the place of service (telehealth + the appropriate lab patient-service center), the total expected charges, and the dispute-resolution language required by federal law.

Standard GFE amounts and codes

Below are the standard direct-pay professional service fees for Practiclear services, with the laboratory test descriptions and CPT codes typically used in the documented manual Evexia/Labcorp workflow. These patient-facing prices must account for Evexia test costs, the confirmed $8 Labcorp PSC fee, Stripe fee, Practiclear service/documentation fee, and refund risk for the listed MVP services before checkout opens. Any additional services, reflex/cascade testing, or follow-up outside this limited scope may require separate review and pricing before it is offered. Place of service is telehealth (POS 02) for the clinician review and independent laboratory (POS 81) for the specimen collection.

Service	CPT	Total
TB Screening Documentation — QuantiFERON-TB Gold Plus IGRA + Practiclear clinician review and signed documentation when appropriate	86480	$129
Core Screening Panel — TB IGRA, MMR (measles / mumps / rubella IgG), Varicella IgG, Hep B Surface Antibody, plus clinician review and combined documentation when appropriate	86480, 86765, 86735, 86762, 86787, 86706	$299
MMR Immunity — measles, mumps, rubella IgG + documentation support when appropriate	86765, 86735, 86762	$79
Varicella Immunity — Varicella-Zoster IgG + documentation support when appropriate	86787	$59
Hep B Immunity — Hepatitis B Surface Antibody (Anti-HBs) + documentation support when appropriate	86706	$59
Screening Documentation Review — deferred records-review workflow requiring a dedicated secure upload path before checkout (no new lab)	—	$49

Clinician review and documentation support are included in the published professional service fee once final pricing is approved; there is no separate Practiclear letter charge. Practiclear must not open live checkout until Evexia test-menu pricing, the Labcorp PSC fee, records-review checkout deferral, and any reflex/cascade exposure are resolved in the posted price and disclosures.

The patient-specific GFE delivered to you after order also includes Practiclear PLLC's federal Tax Identification Number (EIN 42-1960336), the practice's Organization NPI 1972448322, the provider's individual NPI 1104220367, your name and date of birth, and the routing platform used after clinician review (documented launch workflow: Evexia Diagnostics with Labcorp as performing lab / Patient Service Center draw path), as required by 45 CFR 149.610(c)(1)(iii).

What is and is not included

Your Practiclear GFE covers Practiclear-billed services only. The intended MVP lab path is Evexia Diagnostics plus Labcorp. Quest Diagnostics and Fullscript Labs are not part of the MVP workflow.

Things that are not part of your GFE:

Any in-person follow-up care you may need, including but not limited to chest imaging or infectious-disease evaluation if your result requires it. If your provider determines you need follow-up outside Practiclear, we will tell you in writing and refer you appropriately, but we cannot estimate the third party's fees.
Travel, parking, or time off work associated with your Labcorp Patient Service Center visit.
Any services from a primary care provider or local health department to whom we may refer you for follow-up.

Your right to dispute the bill

You have the right to initiate a patient-provider dispute resolution ("PPDR") process if you receive a bill that is at least $400 more than your Good Faith Estimate (45 CFR 149.620). You must start the dispute process within 120 calendar days of the date on the original bill.

To start the process, visit cms.gov/nosurprises/consumers/medical-bill-disputes or call the federal No Surprises Help Desk at 1-800-985-3059.

Because Practiclear's pricing is flat and the GFE matches the posted product price, this $400 threshold is unlikely to be triggered in normal circumstances. We disclose it because federal law requires us to.

Keep a copy

Save a copy of your Good Faith Estimate for your records. You may need it if you decide to dispute a bill later.

Questions

Email andrew@practiclear.com if you would like a Good Faith Estimate before placing an order, if you did not receive one, or if you have any other questions about pricing.

More information about your rights under the No Surprises Act is available at cms.gov/nosurprises.