A hitch nowadays, as it perhaps always has been, cannot be bundled with anything else. Yet the price tag is six or so times what an outside shop would charge for installing a hitch.
That's not true on many vehicles. Take the Chevy Blazer. You don't buy a factory hitch, you buy the trailering equipment group. This includes a heavy-duty cooling system on the V6 engine, hitch guidance and hitch view (shows a top-down of the hitch on the backup camera and a line to help align the trailer), trailer sway control (allows the stability control system to detect and counter trailer sway oscillations), and a 7-pin trailer connector (which may require a converter/relay to interface with vehicle lights).
Other vehicles may include a higher powered alternator to allow for higher lighting loads and camper battery recharging, bigger towing mirrors, improved brakes, transmission coolers, an integrated trailer brake control (or wiring provisions for one), trailer tire pressure monitoring, provisions for a trailer-mounted rear camera, automatic trailer backing steering, blind-spot radars to cover the trailer, trailer lane change guidance, jackknife detection, among others.
A hitch adds weight and lowers fuel economy, and so can features like improved cooling and larger mirrors. If a vehicle is sold new with a hitch or trailer package, the carmaker will take a hit on its CAFE mileage. Some of the cost is to compensate for this.
A very important part in anything a carmaker sells is safety. The carmaker will have conducted tests, such as rear-end crash tests to ensure the hitch does not puncture the gas tank.
For a factory accessory hitch, some of these features may be provided. In most cars, a trailer wiring harness is provided, with vehicle-specific interfaces. Additionally, the vehicle's software may be updated; for example if you have rear automatic braking or a kick-to-open tailgate, those features may need to be adjusted.