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<p>The $35,000 is probably the provider’s list price which is mainly used as a starting point in negotiation with the insurance companies. Then it is discounted to the negotiated rate with whatever insurance company you have, then the insurance company pays some, leaving you the deductible to pay. There is plenty of negotiation room for a self-pay patient or for the deductible if large, but it means that pricing is very opaque if a self-pay patient attempts to find out the pricing up front for non-emergency non-urgent care. In other words, “shopping around” can be hard to do, which means that there is little pricing pressure from the users (even those few who care about costs) to keep medical costs reasonable.</p>