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Exhibit B <br /> REF:North Carolina Breast and Cervical Cancer Control Program 2013-4 Fee Schedule <br /> For the Period 7/1/13 through 6130/14 <br /> Revised 3/21/2013 <br /> 13-14 Office Fee <br /> Breast Procedures Code Fee Allowed <br /> Screening <br /> Clinical Breast Examination N/A Yes <br /> Screening Mammogram 77057 $ 77.04 No <br /> 77057TC $ 44.08 <br /> 77057-26 $ 32.96 <br /> Follow-Up <br /> Diagnostic Mammogram-Unilateral 77055 $ 83.98 No <br /> 77055TC $ 51.33 <br /> 77055-26 $ 32.65 <br /> Diagnostic Mammogram-Bilateral 77056 $ 107.97 No <br /> 77056TC $ 67.10 <br /> 77056-26 $ 40.87 <br /> Sterotactic,localization guidance for breast biopsy or 77031 $ 123.40 No <br /> needle placement,each lesion, 77031 T $ 48.18 <br /> 77031-26 $ 75.23 <br /> Mammographic guidance for needle placement, 77032 $ 49.65 No <br /> breast,each lesion 77032TC $ 23.58 <br /> 77032-26 $ 26.07 <br /> Radiological examination,surgical specimen 76098 $ 17.90 No <br /> 76098TC $ 10.33 <br /> 76098-26 $ 7.57 <br /> Screening Mammogram,Digital,Bilateral 60202 $ 130.02 No <br /> G0202TC $ 96.43 <br /> G0202-26 $ 33.59 <br /> Diagnostic Mammogram,Digital,Bilateral G0204 $ 158.44 No <br /> G0204TC $ 116.62 <br /> G0204-26 $ 41.82 <br /> Diagnostic Mammogram,Digital,Unilateral 60206 $ 124.98 No <br /> G0206TC $ 91.39 <br /> G0206-26 $ 33.59 <br /> Ultrasound 76645 $ 85.47 No <br /> 76645TC $ 59.85 <br /> 76645-26 $ 25.63 <br /> Surgical Evaluation/Consultation N/A (2) Yes <br /> Fine Needle Aspiration 10021 $ 144.29 Yes <br /> Fine Needle Aspiration(with imaging guidance) 10022 $ 132.94 Yes <br /> Ultrasonic guidance for needle placement,imaging 76942 $ 194.61 No <br /> supervision and interpretation(performed in 76942-TC $ 162.98 <br /> conjunction with 10022 76942-26 $ 31.63 <br /> Cytopathology,evaluation of fine needle aspirate 88172 $ 52.33 No <br /> 88172TC $ 17.90 <br /> 88172-26 $ 34.44 <br /> Cytopathology,evaluation of fine needle aspirate 88173 $ 142.15 No <br /> >Interpretation and Report 88173TC $ 74.04 <br /> 88173-26 $ 68.11 <br /> Revised: 3/22/12 <br />