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Isn’t this kind of like TJ Maxx or Ross labeling clothes at insane “retail” prices so you feel like you got a good deal when you saved 95% but still spent $50?

The entire point of the original sky high price tag is to make your final share seem reasonable.

Also, you still pay hundreds if not thousands per month in premiums.

Why don't insurance companies lead the change towards transparent pricing?

Because their profits are limited as a percentage of revenue (aka "they must spend x% of their revenue on patient care"), and thus there's a huge incentive for prices to go up across the board to increase their dollar amounts that don't have to be spent on patient care.

Not if she gets bankrupted by the $50k that the insurance didn't cover.

Insurance can put whatever number they want to make you feel you got a great deal.

It’s like car sales people showing fake papers about how much the car cost them. “They are selling to you at cost”.

There is absolutely no way a simple hand X-ray costs multiples of thousands of dollars.