I wonder if the significant deflation was a feature of this being a medical context, a US medical context in particular. My vague understanding of the subject

I wonder if the significant deflation was a feature of this being a medical context, a US medical context in particular. My vague understanding of the subject is that everyone just pulls giant numbers out of thin air to start the professional haggling conversation with (presumably) the recipient's insurance adjustment team - who will promptly bring things into the realm of reality they work within. IIUC if insurance is held hostage for a full amount (eg, workplace injury) it might end up a lot lower, while if there's an opportunity for recipient copay (eg, elective surgery) the insurer will punt and say "ok we'll just do $X" - even though the recipient may not realize they can adjust the cost down just as easily as the insurer can. (I faintly recall reading about someone getting some random procedure done, getting quoted $10k by a doctor in a medical center, following up and going "?!?!?!" and being told by the receptionist or similar that the procedure was really just $300 or so (or similarly less). Something like that. The doctor simply had no idea so pulled a number out of rand().) I think things started out trying to manage liability and lawsuit funding (and legal can generally be a giant price guide watermark hot air balloon...), but sort of accidentally got permanently associated with "oh that'll be expensive" to the point the whole thing just a self-fulfilling-prophecy-powered perpetual motion machine - and not just that, but one with an ever-widening margin between expectation and reality... that the powers that be are distinctly disincentivized to disentangle in any way shape or form. So being able to assertively question medical fees, and do it Correctly™, is a definitely-useful skill, albeit one that is categorically tricky to learn (caveat emptor :/)...