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The bill for an out of network service is 25000 In network deductible 500 In network coinsurance 80% Out of Pocket Maximum 10000 Out of

The bill for an out of network service is 25000

In network deductible 500

In network coinsurance 80%

Out of Pocket Maximum 10000

Out of network deductible 1000

Out of network coinsurance 60%

Out of pocket maximum 20000

UCR 80%

What is the amount the PLAN WILL pay? Enter as whole number with no decimals and no commas.

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