Comparison of Costs Between TIHN Referral and Normal Charges

UCLA Medical Center – Inpatient Hospital Charge (Heart Surgery)

Type of Referral	Network	Billed Amount	Allowed Amount	Deductible	Patient Responsibility
TIHN Referral	TIHN	$123,698.83	$44,079.48	None	$100.00
Other Referral	Blue Cross	$123,698.83	$122,398.83	$300.00	$1,300.00

UCLA Medical Center – Outpatient Hospital Charge (Eye Surgery)

Type of Referral	Network	Billed Amount	Allowed Amount	Deductible	Patient Responsibility
TIHN Referral	TIHN	$10,690.28	$6,194.00	None	$100.00
Other Referral	Blue Cross	$10,690.28	$6,194.00	$300.00	$929.10

Cedars Sinai Medical Center – Outpatient Hospital Charge (Hysteroscopy Surgery)

Type of Referral	Network	Billed Amount	Allowed Amount	Deductible	Patient Responsibility
TIHN Referral	TIHN	$34,130.80	$14,334.94	None	$100
Other Referral	Blue Cross	$34,130.80	$14,334.94	$300.00	$1,300.00

C V ENT SURGICAL GROUP – Doctor Charge (Nasal Surgery)

Type of Referral	Network	Billed Amount	Allowed Amount	Deductible	Patient Responsibility
TIHN Referral	TIHN	$41,260.00	$3,450.93	None	$100.00
Other Referral	Blue Cross	$41,260.00	$3,450.93	$300.00	$772.64

UCLA ORTHOPAEDIC SURGERY – Doctor Charge (Office Consultation)

Type of Referral	Network	Billed Amount	Allowed Amount	Deductible	Patient Responsibility
TIHN Referral	TIHN	$945.00	$472.65	None	$10.00
Other Referral	Blue Cross	$945.00	$472.65	$300.00	$325.90

ABEMAYOR, ELLIOTT MD – Doctor Charge (Thyroid Surgery)

Type of Referral	Network	Billed Amount	Allowed Amount	Deductible	Patient Responsibility
TIHN Referral	TIHN	$25,381.25	$7,065.68	None	$100.00
Other Referral	Blue Cross	$25,381.25	$7,065.68	$300.00	$1,300.00

UCLA DEPARTMENT OF PEDIATRICS GROUP PRAC – Doctor Charge (Heart Surgery)

Type of Referral	Network	Billed Amount	Allowed Amount	Deductible	Patient Responsibility
TIHN Referral	TIHN	$20,432.00	$10,850.38	None	$100.00
Other Referral	Blue Cross	$20,432.00	$10,850.38	$300.00	$1,300.00