Is Seattle's market competitive? It is comparing their prices to "ours" . One can go to Seattle or anywhere else and receive comparable care for less, better care, or care that isn't even available here!  but then you're there and not here... which works for single visits. What about follow up visits? what a way to earn frequent flier miles eh! Good luck trying to schedule a follow up visit with a local physician to assess the care of an out of state doctor. 
I'm not trying to debate you specifically Another Commenter!,we're on the sameside  I'm very interested/vested in a reasonable/affordable outcome here! I've been self-employed/self-insured my entire adult life. My blue cross plan that I've had since I was 19 to date has increased over 2600% since my first invoice. My standard of living/ income unfortunately hasn't kept that kind of pace! I've been lucky that I've overall been healthy, but with high deductables, my "healthcare" has been out of pocket, even with 1+K month premiums.