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Exhibit B <br /> North Carolina Breast and Cervical Cancer Control Program <br /> 2018 Services Fee Schedule (1) <br /> For the Period 0/1012018 through l2/3I2018 <br /> Revised: 1/4/2018 <br /> 2018 Office Fee <br /> Breast Cancer Screening and Diagnostic Procedures Code Fee Allowed <br /> Screening <br /> Clinical breast examination N/A You <br /> Screening digital Invest tomosynthesis, bilateral (2) 77063 S 52.98 No <br /> 77063TC $ 23.80 <br /> 77063-26 $ 29.18 <br /> Screening mammography, bilateral 77067 S 130.82 No <br /> 77067TC $ 94.43 <br /> 77067-26 $ 36.39 <br /> Follow-Up <br /> Radiological examination, surgical specimen 76098 $ 16.17 No <br /> 76098TC $ 8.29 <br /> 76098-26 S 7.88 <br /> Diagnostic mammography, unilateral, includes CAD 77065 $ 127.80 No <br /> 77065fC $ 89.40 <br /> 77065-26 S 38.40 <br /> Diagnostic mammography, bilateral, includes CAD 77066 S 161.86 No <br /> 77066TC $ 114.20 <br /> 77066-26 S 47.66 <br /> Diagnostic digital breast tomosynthesis, bilateral (3) G0279 $ 52.98 No <br /> G0279TC $ 23.80 <br /> G0279-26 $ 29.18 <br /> Ultrasound, complete examination of breast including walla, 76641 $ 103.29 No <br /> unilateral 76641TC $ 64.62 <br /> 76641-26 $ 35.67 <br /> Ultrasound, complete examination of breast including axilla, 76641-50 $ 154.94 No <br /> bilateral 76641-TC-50 $ 101.43 <br /> 76641-26-50 $ 53.51 <br /> Ultrasound, limited examination of breast including axilla, 76642 S 84.78 No <br /> unilateral 76642TC S 51.53 <br /> 76642-26 $ 33.25 <br /> Ultrasound limited examination of breast including axilla, 76642-50 S 127.17 No <br /> bilateral 76642-TC-50 $ 77.30 <br /> 76642-26-50 $ 49.87 <br /> Surgical evaluffiion/Consultation N/A (8) Yes <br /> Fine needle aspiration without imaging guidance 10021 S 116.87 Yes <br /> Fine needle aspiration with imaging guidance 10022 S 134.97 Yes <br /> Puncture aspiration of cyst of breast 19000 $ 107.65 Yes <br /> Puncture aspiration of cyst of breast, each additional cyst, used with 19000 19001 S 26.05 Yes <br /> Breast biopsy, with placement of localization device and imaging of 19081 S 660.06 Yes <br /> biopsy specimen, percutaneous; suncousaic guidance; first lesion (4) <br /> Each additional lesion (4) 19082 $ 544.29 Yes <br /> Breast biopsy, with placement of localization device and imaging of 19083 $ 641.92 Yes <br /> biopsy specimen, percutancous; ultrasound guidance; first lesion (4) <br /> Each additional lesion (4) 19084 $ 522.60 Yes <br /> Breast biopsy, percutmeous, needle core, not using imaging guidance 19100 S 143.33 Yes <br /> Breast biopsy, open, incisional 19101 $ 325.36 Yes <br />