In the United States, estimated total revenue as of 2016 was $75 billion, about 2% of total healthcare spending. In 2016, an estimated 60% of revenue was done by hospital labs, with 25% done by two independent companies (LabCorp and Quest). Hospital labs may also outsource their lab, known as outreach, to run tests; however, health insurers may pay the hospitals more than they would pay a laboratory company for the same test, but as of 2016, the markups were questioned by insurers. Rural hospitals, in particular, can bill for lab outreach under the Medicare's 70/30 shell rule.