Every insurance carrier has a payment rate for each test, procedure, and medical service. The rates are what the insurer has decided are appropriate for these services in New York City. Insurers have different ways of deciding what is usual and customary. Memorial Sloan-Kettering's charges may be different from an insurer's rates due to the high level of care we provide to our patients. If you only have out-of-network benefits, you are responsible for paying the difference between Memorial Sloan-Kettering's charges and the carrier's usual and customary rates, in addition to your co-insurance and deductible costs.