They are opportunists. I have two pets 16 years old that can barely eat and are skin and bones. I have decided its time to put them to rest. This vet wants to charge an extra $60 each for an "exam". Then the cost of euthanasia $60 each. I called the NC Vet Board to see if this is a requirement. It isn't. It doesn't take a doctor to know when your pet is at the end of its life.
Some people can't afford $220. This is unethical practice at work.