Basic example

<section>
 <div class="d-flex justify-content-between align-items-center mb-5">
 <div class="d-flex flex-row align-items-center">
 <h4 class="text-uppercase mt-1">Eligible</h4>
 <span class="ms-2 me-3">Pay</span>
 </div>
 <a href="#!">Cancel and return to the website</a>
 </div>
 <div class="row">
 <div class="col-md-7 col-lg-7 col-xl-6 mb-4 mb-md-0">
 <h5 class="mb-0 text-success">85ドル.00</h5>
 <h5 class="mb-3">Diabites Pump & Supplies</h5>
 <div>
 <div class="d-flex justify-content-between">
 <div class="d-flex flex-row mt-1">
 <h6>Insurance Responsibility</h6>
 <h6 class="fw-bold text-success ms-1">71ドル.76</h6>
 </div>
 <div class="d-flex flex-row align-items-center text-primary">
 <span class="ms-1">Add Insurer card</span>
 </div>
 </div>
 <p>
 Insurance claim and all neccessary dependencies will be submitted to your
 insurer for the covered portion of this order.
 </p>
 <div
 class="p-2 d-flex justify-content-between align-items-center"
 style="background-color: #eee;"
 >
 <span>Aetna - Open Access</span>
 <span>Aetna - OAP</span>
 </div>
 <hr />
 <div class="d-flex justify-content-between align-items-center">
 <div class="d-flex flex-row mt-1">
 <h6>Patient Balance</h6>
 <h6 class="fw-bold text-success ms-1">13ドル.24</h6>
 </div>
 <div class="d-flex flex-row align-items-center text-primary">
 <span class="ms-1">Add Payment card</span>
 </div>
 </div>
 <p>
 Insurance claim and all neccessary dependencies will be submitted to your
 insurer for the covered portion of this order.
 </p>
 <div class="d-flex flex-column mb-3">
 <div class="btn-group-vertical" role="group" aria-label="Vertical button group">
 <input
 type="radio"
 class="btn-check"
 name="options"
 id="option1"
 autocomplete="off"
 />
 <label class="btn btn-outline-primary btn-lg" for="option1">
 <div class="d-flex justify-content-between">
 <span>VISA </span>
 <span>**** 5436</span>
 </div>
 </label>
 <input
 type="radio"
 class="btn-check"
 name="options"
 id="option2"
 autocomplete="off"
 checked
 />
 <label class="btn btn-outline-primary btn-lg" for="option2">
 <div class="d-flex justify-content-between">
 <span>MASTER CARD </span>
 <span>**** 5038</span>
 </div>
 </label>
 </div>
 </div>
 <div class="btn btn-success btn-lg btn-block">Proceed to payment</div>
 </div>
 </div>
 <div class="col-md-5 col-lg-4 col-xl-4 offset-lg-1 offset-xl-2">
 <div class="p-3" style="background-color: #eee;">
 <span class="fw-bold">Order Recap</span>
 <div class="d-flex justify-content-between mt-2">
 <span>contracted Price</span> <span>186ドル.86</span>
 </div>
 <div class="d-flex justify-content-between mt-2">
 <span>Amount Deductible</span> <span>0ドル.0</span>
 </div>
 <div class="d-flex justify-content-between mt-2">
 <span>Coinsurance(0%)</span> <span>+ 0ドル.0</span>
 </div>
 <div class="d-flex justify-content-between mt-2">
 <span>Copayment </span> <span>+ 40.00</span>
 </div>
 <hr />
 <div class="d-flex justify-content-between mt-2">
 <span class="lh-sm"
 >Total Deductible,<br />
 Coinsurance and copay
 </span>
 <span>40ドル.00</span>
 </div>
 <div class="d-flex justify-content-between mt-2">
 <span class="lh-sm"
 >Maximum out-of-pocket <br />
 on insurance policy</span
 >
 <span>40ドル.00</span>
 </div>
 <hr />
 <div class="d-flex justify-content-between mt-2">
 <span>Insurance Responsibility </span> <span>71ドル.76</span>
 </div>
 <div class="d-flex justify-content-between mt-2">
 <span>Patient Balance </span> <span>13ドル.24</span>
 </div>
 <hr />
 <div class="d-flex justify-content-between mt-2">
 <span>Total </span> <span class="text-success">85ドル.00</span>
 </div>
 </div>
 </div>
 </div>
</section>

.btn-group-vertical>.btn:not(:first-child),
.btn-group-vertical>.btn-group:not(:first-child) {
 margin-top: 0;
 }

How to use?

More examples

More extended Bootstrap documentation