Early on, I remember there being a tactic for apps where the owner wants them to be findable in the App Store, but doesn't want any new buyers, they set the price to $10K. But these days, I think the most expensive apps are $1K - app.cash, vueCAD Pro and Cyber Tuner.
I would imagine any medical app/ERP/etc. would have creative ways to get users to not make a one-time purchase via the App Store. Although certain interpretations of the rules might mean they have to offer App Store signup as an option.