Men are often discouraged by society from seeking first aid or admitting any sort of ailment or weakness.

Plus Emergency Rooms are known for very long wait times, especially if you are otherwise looking in good health. (triage favors the folks bleeding out).

If you are presented a bill, it's not just an ER charge but a charge from the ER, from the doctor, the anesthetist, and seemingly everyone staffing the ER seems to have their own bill and billing agency.

That's above and beyond the high cost of ER care.