Labor cost
Surgeon and nursing compensation reflects each country's cost of living and purchasing power. Lower local labor costs don't mean lower training standards — Colombian plastic surgeons, for example, complete 5+ years of specialty training after medical school under SCCP standards.
Malpractice insurance
US malpractice premiums, particularly for high-risk specialties, are among the highest in the world and get built directly into procedure pricing. Malpractice insurance costs are structurally lower in most medical tourism destinations.
Facility overhead
US hospital real estate, administrative staffing, and billing-department overhead (a byproduct of the insurance-negotiation system itself) add cost layers that a self-pay clinic abroad simply doesn't carry.
Currency valuation
A strong US dollar against the Colombian peso, Mexican peso, or Indian rupee amplifies the effective savings for American patients paying in USD, on top of the underlying cost differences above.
These same structural factors explain the pricing you'll see on colombiacosmeticsurgery.com and colombiadentist.co as well.
The Takeaway
These factors are structural, not a quality signal in either direction — verify quality independently through accreditation, not through price alone.