The list price will nearly always be a multiple of your cost with insurance. The issue here is that insurers have provisions in their network contracts that prevent providers from publically advertising lower prices than what's charged to the insurer, which mandates discounting. In many other industries, these most favored nation arrangements are considered anti-competitive and, thus, illegal.

Large hospital systems totally separate business and care, so it can be difficult to negotiate a discount. Smaller and independent providers are often more accommodating. However, you need to ask for a discount, you can't simply offer to pay cash (i.e. "If I pay cash, can I get 40% off"). The providers can counter your offer, but can't discount you off the bat or else they invite legal action from insurers.

Good to know! Dang 40% is a lot but I believe it hah!