Now thanks to the Internet it's way harder for hotel clerks to claim prices are different, which used to be exactly what they'd do, consequently it's improved dramatically on that front. I still remember the face of an Ottawa guy decades ago confronted with a european smartphone shoved in his face to show he was lying through his teeth. He clearly wasn't ready for the whole concept.
For instance, I once needed $600 of tests at the ER. The hospital billed $80K. The insurance company paid $7K. I paid $100.
Sure, the $600 does not include the ER overhead, but the $7K was still insanely inflated. The important thing is that the money ultimately came from insurance premiums, so every middleman was able to reliably extort all patients.
The other bit of the story was "we realised you might not be American from your face when we showed you the price list". (They told me Americans would have seen the same list and thought the prices were reasonable). I'm guessing you are American?
You need to understand how utterly insane this sounds if you are used to European systems.
And don't get me started on the fact Canadian healthcare doesn't actually transfer between provinces.