Example A - KBC vs "in-network" Clinician
Selma gets a 3D Mammogram that is read by KBC and she pays $252 upfront. If she instead goes to an "in-network" Clinician, she would initially pay $0. You can compare the costs going down the page in a similar manner... KBC (green) vs "in-network" Clinician (red).
Unfortunately, Selma has a mass that needs further analysis, so she then gets a Diagnostic Mammogram & Ultrasound which costs:
Selma then needs a Biopsy:
Selma had cancer and then had surgery, but because it was detected early... Selma's issue is resolved. If she is at KBC, after being cleared, she will return to getting Screening Mammogram periodically.
Other facilities that use offsite General Radiologists (also without the best technology or Breast Fellowship-Trained Radiologists) are more likely to request that Selma continues getting the more expensive Diagnostic exams for years beyond what is recommended by the ACR Guidelines.
Total Maximum Costs:
KBC: $2,072 Vs. "in-network": $3,609 to $5,862
A "switching facilities" scenario is explained in Example B.