Gold Valley Advantage EPO 2150/10/20

Deductible (individual / family)

$2,150 / $4,300

Out-of-pocket max (individual / family)

$8,550 / $17,100

Coinsurance

10%

Diagnostic lab services

Paid in full after deductible

Outpatient diagnostic test (X-ray)

10% coinsurance after deductible

Outpatient high tech imaging

25% coinsurance after deductible

Outpatient surgery service

10% coinsurance after deductible

Inpatient hospital admission

10% coinsurance after deductible