Sometimes it has more to do with your insurance. My insurance company covers WLS but not the initial consultation. They do, however, have some kind of scale of what a reasonable charge for that service should be. I was charged $235 for the initial consultation, then the doctors office submitted the bill to my insurance company. BCBS of TX determined that $180 was the reasonable cost for the service, and that's all they would allow them to charge me, so I had a $55 credit on my account that I applied against what I had to pay to have my EGD done.