Pap smears — the pre-cancer-screening that most women get annually when they visit a gynecologist — should only cost about $20 or $30, writes Dr. Cheryl Bettigole in The New England Journal of Medicine. So, why then, are more women (and/or their insurance companies) paying much, much more — sometimes upwards of $1000? A big part of the problem is add-on tests — extra screenings that haven’t been shown to make women healthier, but do add a lot to the cost of an annual exam. Turns out, medical laboratories have started marketing these pap+ tests, using some of the same techniques pharmaceutical companies have long used to sell more expensive treatments to doctors.