Without insurance, you're screwed

Rico says he (with some trepidation) opened the latest invoice from Jefferson Hospital, of whom he was a guest a couple of years ago (and without whom, along with some serious prodding by the ladyfriend, he'd be dead now).

Summary of charges: $150,910.56
Adjustments (unspecified): $64,891.54
Insurance payment: $85,524.58
Balance due: $494.44

Rico says it sounds like a deal to him...