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Exhibit B <br /> North Carolina Breast and Cervical Cancer Control Program <br /> 2019 Services Fee Schedule ( 1 ) <br /> For the Period 01 /01 /2019 through 12/31 /2019 <br /> Revised : 1 /23/2019 <br /> 2019 Office Fee <br /> Breast Cancer Screening and Diagnostic Procedures Code Fee Allowed <br /> Screening <br /> Clinical breast examination N/A Yes <br /> Screening digital breast tomosynthesis, bilateral (2) 77063 $ 53 . 24 No <br /> 77063TC $ 23 . 49 <br /> 77063 -26 $ 29 . 76 <br /> Screening mammography, bilateral , includes CAD 77067 $ 130 . 31 No <br /> 77067TC $ 92 . 52 <br /> 77067-26 $ 37 . 79 <br /> Follow-Up <br /> Radiological examination , surgical specimen 76098 $ 16 . 00 No <br /> 76098TC $ T97 <br /> 7609 &26 $ 8 . 03 <br /> Diagnostic mammography, unilateral , includes CAD 77065 $ 128 . 00 No <br /> 77065TC $ 87 . 49 <br /> 77065 -26 $ 40 . 51 <br /> Diagnostic mammography, bilateral , includes CAD 77066 $ 161 . 94 No <br /> 77066TC $ 111 . 98 <br /> 77066-26 $ 49 . 96 <br /> Diagnostic digital breast tomosynthesis, unilateral or bilateral ( 3 ) G0279 $ 53 . 24 No <br /> G0279TC $ 23 . 49 <br /> G0279-26 $ 29 . 76 <br /> Ultrasound, complete examination of breast including axilla , 76641 $ 102 . 72 No <br /> unilateral (4) 76641TC $ 66 . 35 <br /> 76641 -26 $ 36 . 37 <br /> Ultrasound, limited examination of breast including axilla , 76642 $ 84 . 14 No <br /> unilateral (4) 76642TC $ 50 . 24 <br /> 76642-26 $ 33 . 90 <br /> Surgical evaluation/Consultation N/A ( 10) Yes <br /> Fine needle aspiration biopsy without imaging guidance, first lesion 10021 $ 94 . 65 Yes <br /> Each additional lesion 10004 $ 51 . 05 Yes <br /> Fine needle aspiration biopsy including ultrasound guidance, first lesion 10005 $ 122 . 81 Yes <br /> Each additional lesion 10006 $ 59 . 01 Yes <br /> Puncture aspiration of cyst of breast 19000 $ 105 . 84 Yes <br /> Puncture aspiration of cyst of breast, each additional cyst, used with 19000 19001 $ 26 . 45 Yes <br /> Breast biopsy, with placement of localization device and imaging of 19081 $ 623 . 15 Yes <br /> biopsy specimen , percutaneous ; stereotactic guidance; first lesion ( 5 ) <br /> Each additional lesion (5 ) 19082 $ 506 . 86 Yes <br /> Breast biopsy, with placement of localization device and imaging of 19083 $ 610 . 10 Yes <br /> biopsy specimen , percutaneous ; ultrasound guidance ; first lesion ( 5 ) <br /> Each additional lesion ( 5 ) 19084 $ 488 . 67 Yes <br /> Breast biopsy, percutaneous , needle core, not using imaging guidance 19100 $ 145 . 55 Yes <br /> Breast biopsy, open , incisional 19101 $ 325 . 27 Yes <br />