PVC got it in one. I looked at the provider forum on the old board. One mentioned and respected member was trashed in his own thread about his business. Rapacious is a term I seem to recall. Don’t get me wrong; I been as guilty or frank about my own thoughts.
Yes, they markup 100% and even more. On the other hand, I saw an article from St. Louis University (Link posted here) that talked about the cost of supporting a single fitter. Shocked me; although, I should have known. When medical is part of the description the cost start to look like a B52 toilet seat.
So they invest substantial cost that some won’t recover. An ongoing nut each month. The result, when you are lucky, is an upper middle class living.