Yeah, actually I can attest that a lot of our hospital clients have no idea what the hospital next door is charging / getting paid by insurance. So, a lot of price setting is guessing. It's often not cost-based. And often, negotiations will arbitrarily shift high prices over to one service type, eg Blue Cross will say: "Fine, if you want to get paid that much for knee replacements, we get a lower rate for bariatric surgery." So you'll find weird price discrepancies within the same provider.