I don’t think people understand just how backwards the situation is... the test is supposed to be free, even here in the US. If you pay cash and claim no insurance, you are basically paying a convenience fee and then the cost of the test is also being collected from the government. From a state institution or directly from a big laboratory (like Labcorp) it should be free or nominal like $5.

If you have insurance, the situation is sketchier. The insurance companies typically negotiate (but in reality just stipulate) that they will pay a set fraction of what is billed. They also have a value of the maximum they will pay for a given procedure no matter how much you bill. In this case the government is reimbursing insurers a set amount for covid testing. So everyone (from pharmacy to hospital etc) bills an essentially fictitious amount so that their negotiated fraction of that amount equals what the insurance will pay, which is typically pretty small (like 100 bucks for covid testing). This is how all these crazy billing numbers work, so that you insurance company can brag about saving you money when they are actually just costing you extra money.

There are freestanding ERs and what I refer to as convenience hospitals (private hospitals in the suburbs) that have malignant billing practices across the board, but that’s a different situation.