Daily Reminder:
Hospital Bills are set at insane rates not because that's what they hope to collect, but because 1) that's what they want to bill insurance and 2) when they charge you $50,000 and you negotiate it down to $5,000, that is $45,000 the hospital can write down on the books to keep them at zero profit.
Assuming the headline is true and not clickbait, the Hospital may be trying to extort insurance companies (this is my only healthcare and you have to pay their insane rates reeeee) and/or state bailout money for low income people who can't pay bills. Remember this hospital is not only in commiefornia, but in Sanctuary City San Fransisco. Its probably easier to bill $20K and then collect a portition from the state than is it to try to send collections after an undocumented Salvadorian.
All that said: there is also a very real possibility that's just what it costs to hire and retain medical staff in a place where they want to make minimum wage $15/hr and
this is sort of house you can buy with $500,000.