I actually had this experience for an MRI, I called billing at the hospital at which my doctor was affiliated/recommended I take my MRI - I was floored to learn that if I paid cash, it was ~$1k and if I ran it through insurance it was $1.5k
I actually ended up running it through insurance as I wanted the amount to be applied to my deductible…
When I asked the (very nice) woman in billing how this made any sense - she told me (paraphrasing) that it’s basically a super complex optimization problem where several thousand products/services are being simultaneously negotiated, such that the hospital can maximize its gross margin, and the insurer can minimize its payments under insurance.
I actually ended up running it through insurance as I wanted the amount to be applied to my deductible…
When I asked the (very nice) woman in billing how this made any sense - she told me (paraphrasing) that it’s basically a super complex optimization problem where several thousand products/services are being simultaneously negotiated, such that the hospital can maximize its gross margin, and the insurer can minimize its payments under insurance.