Orange County NC Website
Browse       Search
Exhibit B <br /> North Carolina Breast and Cervical Cancer Control Program <br /> 2016-2017 Services Fee Schedule(1) <br /> For the Period 07/01/2016 through 06/30/2017 <br /> Revised: 06/08/2016 <br /> 16-17 Office Fee <br /> Breast Procedures Code Fee Allowed <br /> Screening <br /> Clinical Breast Examination N/A Yes <br /> Screening Mammogram 77057 $ 78.38 No <br /> 77057TC S 43.56 <br /> 77057-26 $ 34.82 <br /> Follow-Up <br /> Diagnostic Mammogram-Unilateral 77055 $ 85.38 No <br /> 77055TC S 50.55 <br /> 77055-26 $ 34.82 <br /> Diagnostic Mammogram-Bilateral 77056 $ 109.73 No <br /> 77056TC $ 66.54 <br /> 77056-26 $ 43.18 <br /> Radiological examination,surgical specimen 76098 $ 15.94 No <br /> 76098TC $ 7.93 <br /> 76098-26 $ 8.00 <br /> Screening Mammogram,Digital,Bilateral 60202 $ 127.00 No <br /> G0202TC $ 92.51 <br /> G0202-26 S 34.49 <br /> Diagnostic Mammogram,Digital,Bilateral 60204 $ 155.34 No <br /> G0204TC $ 112.16 <br /> G0204-26 $ 43.18 <br /> Diagnostic Mammogram,Digital,Unilateral 60206 $ 122.00 No <br /> G0206TC $ 87.52 <br /> G0206-26 $ 34.49 <br /> Ultrasound,complete examination of breast including axilla, 76641 $ 102.77 No <br /> unilateral 76641TC $ 66.54 <br /> 76641-26 $ 36.23 <br /> Ultrasound,complete examination of breast including axilla, 76641-50 $ 154.16 No <br /> bilateral 76641-TC-50 $ 99.81 <br /> 76641-26-50 $ 54.35 <br /> Ultrasound,limited examination of breast including axilla, 76642 $ 84.66 No <br /> unilateral 76642TC $ 50.89 <br /> 76642-26 $ 33.77 <br /> Ultrasound,limited examination of breast including axilla, 76642-50 $ 126.99 No <br /> bilateral 76642-TC-50 $ 76.34 <br /> 76642-26-50 $ 50.66 <br /> Surgical Evaluation/Consultation N/A (2) Yes <br /> Fine Needle Aspiration 10021 $ 118.41 Yes <br /> Fine Needle Aspiration(with imaging guidance) 10022 $ 135.62 Yes <br /> Ultrasonic guidance for needle placement,imaging 76942 S 58.66 No <br /> supervision and interpretation(performed in 76942-TC $ 25.58 <br /> conjunction with 10022 76942-26 $ 33.08 <br />