This is a bill for a recent labor and delivery service in the United States. And it includes a $39.35 charge for holding the baby after delivery. Really.

The image of the bill, now shared widely on Reddit, shows a charge for “skin to skin after c sec.” The Reddit user who posted it explained more in a few comments. He wasn’t exactly mad about the charge — he said the hospital did a great job delivering his son. Instead, it more of spoke to the absurdity of American health care.

During the C-section the nurse asked my wife if she would like to do skin to skin after the baby was born. Which of course anyone would say yes too. We just noticed it in the bill today. The nurse let me hold the baby on my wife's neck/chest. Even borrowed my camera to take a few pictures for us. Everyone involved in the process was great, and we had a positive experience. We just got a chuckle out of seeing that on the bill.

A labor and delivery nurse added a bit of context as to why this charge might show up on a bill — that it requires an additional nurse come in and watch the baby while it’s being held by the mother.

As a labor and delivery nurse, I can kind of explain this. I didn't know that hospitals charged for it, but doing 'skin to skin' in the operating room requires an additional staff member to be present just to watch the baby. We used to take all babies to the nursery once the NICU team made sure everything was okay. "Skin to skin" in the OR is a relatively new thing and requires a second Labor and Delivery RN to come in to the OR and make sure the baby is safe.

Mostly, the bill speaks to how mysterious medical bills can be, even for exceptionally common procedures like delivering a baby. Vox’s Johnny Harris recently did a project where he tried to figure out the cost of his wife’s birth before it happened. It didn’t go well.

He made dozens of phones calls to different billing offices, but couldn’t find anyone who could tell him how much an uncomplicated birth would ultimately cost. Here’s what he wrote about it:

What struck me the most about my quest to learn about hospital prices was the fact that consumers have no way of knowing where a hospital stands on the vast pricing spectrum. Consumers have few options to interact with pricing until after they have received treatment. It's significantly easier to find out how much it costs to park at a hospital than how much it will cost to get treatment. All of this results in a system where consumers are totally divorced from prices. This is dangerous because prices are a key ingredient to a healthy market. We rely on prices in every industry to communicate value and drive competition. A lack of transparency can lead to an artificial inflation of prices, making consumers pay more for treatment that is of no better quality.

You can watch Johnny’s video below to learn more — and see the full Reddit thread here.