They did. It is a myth that you can negotiate a cheaper rate for cash. If you have or know someone who has it was an exception.
We used this service, https://www.newchoicehealth.com/ to find the lowest cost hernia surgery for my husband.
It cost us 3500 at a surgery center outside of Seattle. Even with travel costs it was 1/3 the 12-15,000 quoted by the 3 local hospitals.
I was very pleased by the entire process and transaction. The surgery center was very upscale, clean and modern.
In my experience, it was routine process in the hospital accounting department to give a 60% discount for full cash payment on major surgery and specialty appointments. You had to ask for it in order to get it. No negotiation beyond that.
Of course they never expected very many people to take them up on that offer. I was fortunate enough that I could do so.
The net savings was way more than several years of insurance payments.