Your last comment is the reason for the massive gap between list price versus net price in the US system.
The US has a rule about “usual & customary price”. That’s a legal definition and providers can’t charge any customer more than that.
If you’re looking to price discriminate, you set your U&C price as high as possible, maybe 2-5x what you’d accept. That way if you find a customer willing to pay 4X, you’re not running afoul of the law.
For everyone else, you negotiate a much more reasonable net price, typically through insurance.
The people who get screwed in the end are ones without insurance. They get billed the imaginary number nobody ever intended anyone to pay.
