It's the reason why healthcare is so expensive in the U.S. because this is not just true for drugs, but for procedures as well.

IIRC. I worked orthogonally to medical billing, but never did billing directly.

Fee schedules don't get published. Because if providers know insurance is willing to pay $125 for a procedure, they're going to charge $125 rather than what it cost to do it. So if they want to know, they have to be deduced by the providers.

So providers charge out the fucking ass for everything. Then submit that charge to the insurance. The insurance will say, "We'll only pay $75 of that $300 bill, the rest is patient responsibility". And often, what will happen is that the doctor will write off some or all of the remaining $225, because they weren't looking for that anyway. The charge is just to make sure they get the maximum from the insurance.

The price is completely divorced from the value of the services provided. It's become this weird game.