Sometimes the first price quoted is just a formality. One time my significant other went to an optometrist for a contacts prescription, without optical insurance (long story), and the bill was for $1000. She emailed asking why, and they just replied "here's your updated bill: $250"

I was reminded of this just yesterday by a similarly simple story: https://twitter.com/chrisalbon/status/1172161958759395333

It's sort of like "add to cart to see the real price" but they can't say that. And sometimes hospitals are in a different mode where they fight for it. It's not logical, it's screwed up, but anyway the first bill is usually just fake.