They only bill that much because they need the average amount of money collected for a procedure to pencil.

They get that cash price amount from a tiny amount of people, 70% of that price from private insurers, 30-60% from Medicare, less from Medicaid. Even then, they have to basically litigate the bills through private insurance appeals.

If they had one payer which had a single reimbursement rate, they wouldn't have to do these shenanigans.