A piece of anecdata on what happens when it's not as opaque: I took the script for a lumbar MRI to a standalone imaging chain advertising low costs. The phone quote was 1/10th the price quoted by the hospital. What puzzled me was that although the imaging place accepts my insurance it asked for $395 if I wanted payment to apply against my insurance deductible but only $275 if I paid without going through the insurer. Was the delta reflecting the imager's cost to file a claim? They couldn't tell me. I wish there were ombudsmen to turn to.