1. Personal Health Record Alerts Print Personal Health Record Out of Pocket Estimator: Step 1 of 4 powered by Plan Information Out of Pocket Estimate for: John Select Miles willing to travel: 100 miles Co-pay: In-Network Deductible: In-Network Co-Insurance In-Network Out of Pocket Max Remaining Deductible: Remaining Co-insurance: Balance in Healthcare Accounts Select procedure MRI Next Select Network In-Network Only 1 2 3 Getting Started None $ 2,000.00 $ 0.00 $ 2,000.00 $ 1,286.00 $ 0.00 $ 1,900.00

2. Personal Health Record Alerts Print Personal Health Record Out of Pocket Estimator: Step 2 of 4 powered by Compare Facilities: Select up to 3 facilities Next FacilitySelect up to 3 facilitiesCost/Quality Score ABC Radiology 123 Easy Street Anytown, US 12345 Cost: High Quality: High ABC Radiology 123 Easy Street Anytown, US 12345 Cost: High Quality: High ABC Radiology 123 Easy Street Anytown, US 12345 Cost: High Quality: High ABC Radiology 123 Easy Street Anytown, US 12345 Cost: High Quality: High ABC Radiology 123 Easy Street Anytown, US 12345 Cost: High Quality: High ABC Radiology 123 Easy Street Anytown, US 12345 Cost: High Quality: High

3. Personal Health Record Alerts Print Personal Health Record Out of Pocket Estimator: Step 3 of 4 powered by ABC Radiology 123 Easy Street Anytown, US 12345 Compare Providers: Select up to 5 providers ABC Radiology 123 Easy Street Anytown, US 12345 Next Dr. John Doe 123 Easy Street Anytown, US 12345 map Facilities 1 Providers Avg. Cost: High Avg. Quality: Medium Dr. John Doe 123 Easy Street Anytown, US 12345 map Avg. Cost: High Avg. Quality: Medium Dr. John Doe 123 Easy Street Anytown, US 12345 map Avg. Cost: High Avg. Quality: Medium Dr. John Doe 123 Easy Street Anytown, US 12345 map Avg. Cost: High Avg. Quality: Medium Dr. John Doe 123 Easy Street Anytown, US 12345 map Avg. Cost: High Avg. Quality: Medium Dr. John Doe 123 Easy Street Anytown, US 12345 map Avg. Cost: High Avg. Quality: Medium Dr. John Doe 123 Easy Street Anytown, US 12345 map Avg. Cost: High Avg. Quality: Medium Dr. John Doe 123 Easy Street Anytown, US 12345 map Avg. Cost: High Avg. Quality: Medium Facilities 3 ABC Radiology 123 Easy Street Anytown, US 12345 Dr. John Doe 123 Easy Street Anytown, US 12345 map Avg. Cost: High Avg. Quality: Medium Dr. John Doe 123 Easy Street Anytown, US 12345 map Avg. Cost: High Avg. Quality: Medium Dr. John Doe 123 Easy Street Anytown, US 12345 map Avg. Cost: High Avg. Quality: Medium Dr. John Doe 123 Easy Street Anytown, US 12345 map Avg. Cost: High Avg. Quality: Medium Facilities 2

4. Out of Pocket Estimator: Step 4 of 4 powered by Comparing Providers Return to Home Provider/ Facility Total Cost Insurance Responsibility Your Responsibility Balance in Accounts Net Out of Pocket Cost/Quality Score Dr. John Doe ABC Radiology $900.00 view details $ 0.00 view details $900.00 view details $1,900.00 view details $ 0.00 view details 4.5 Dr. John Doe ABC Radiology $900.00 view details $ 0.00 view details $900.00 view details $1,900.00 view details $ 0.00 view details 4.5 Dr. John Doe ABC Radiology $900.00 view details $ 0.00 view details $900.00 view details $1,900.00 view details $ 0.00 view details 4.5 Dr. John Doe ABC Radiology $900.00 view details $ 0.00 view details $900.00 view details $1,900.00 view details $ 0.00 view details 4.5 Dr. John Doe ABC Radiology $900.00 view details $ 0.00 view details $900.00 view details $1,900.00 view details $ 0.00 view details 4.5