On your last comment - no, that's not correct. Providers set rates, negotiate in/out of network rates with insurers, and - sometimes - cut a break to cash money payers (never experienced it, but I know people who swear by it, as a reasonable alternative in a high deductible situation). In any case, the cash cost is not typically above the putative ("rack rate") standard levels they publish). So, yes, if you're not getting the benefit of the rate negotiated by powerful insurers, then sure, the cost to [whomever] is greater than the pre-negotiated reimbursement rate agreed by two companies (or ins co and provider system, whatever) - but you're not penalized on top of that by having to pay more than their rate card specifies.