附件三特殊材料給付品項暨支付標準表修正特材代碼中英文名稱 ...

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附件三 特殊材料給付品項暨支付標準表修正 特材代碼 中英文名稱 支付點數-104/01/01 ACA0100ABNPW IV CAP 3 ACA0100CDNPW "普惠"注射帽(免針安全型)※給付規定請見備註欄"PERFECT:IV LOCK(SAFETY) 43.1 ACA0108008SG IV CAP 注射帽 3 ACA011PN01NQ INJECTION CAP 3 ACA0121010TZ IV LOCK 3 ACA01AB00NPW IV LOCK 3 ACA01C1C02LL INJECTION CUP(IV LOCK) 3 ACA01NF005LL INJECTION CAP(安全型)※適應症請見備註欄 43.1 ACC0100360BT PLASTIC CONNECTOR 兩尖型 17.4 ACC0100361BT PLASTIC CONNECTOR 一尖一平塑膠連接頭 17.4 ACC0100362BT PLASTIC CONNECTOR 塑膠連接頭 17.4 ACC0100364BT PLASTIC CONNECTOR 直型塑膠連接頭 17.4 ACC01HSC60H6 PLASTIC CONNECTOR(兩尖型) 17.4 ACC01HSC61H6 PLASTIC CONNECTOR(一尖一平型) 17.4 ACC02VP004LL 3 WAY 7.8 ACM01PT003CK 2-PORTS MANIFOLD 連接頭 250 ACP011000NDL Y TYPE ADAPTOR 329 ACP0146201H9 "華億"體外循環管組"HYM"HEART LUNG PACK-Y & STRAIGHT & REDUCER CONNECTOR(WITH LUER) 88 ACP0147166GJ “吉生”體外循環管組-Y型&直型&漸細連接器(附LUER) ”JSM” HEART LUNG PACK-Y&STRAIGHT&REDUCER CONNECTOR(WITH LUER) 88 ACP01CA123L5 "加州"心臟麻痺轉接器 "CALIFORNIA" CARDIOPLEGIA ADAPTERS 88 ACP01ECTBSM6 EXTRACORPOREAL TUBING STRAIGHT CONNECTOR 88 ACP01ECTBYM6 EXTRACORPOREAL TUBING Y-CONNECTOR 88 ACP0214000DL MULTIPURPOSE PERFUSION SET WITH VENT LINE 889 ACP0214003DL MULTIPURPOSE PERFUSION SET※適應症請見備註欄 657 ACS0109512BB DISCOFIX C-3/-3 MULTIDIRECTIONAL STOPCOCKS"柏朗"輸液轉換 7.8 ACS013CAPSM8 3 WAY STOPCOCK 7.8 ACS0168MPATP PREDURA PRESSURE RESISTAN THREE WAY STOPCOCK 1000PSI 70 ACS0170015NL 3-WAY NAMIC MORSE STOPCOCK (200PSI) 7.8 ACS0170035NL 3-WAY NAMIC MORSE STOPCOCK (400PSI) 34 ACS0170055NL 3-WAY NAMIC MORSE STOPCOCK (1050PSI) 70 ACS01D010NPW DISPOSABLE INFUSION SET 3 WAY STOPCOCK 7.8 ACS01H3FLCMR MANIFOLD HIGH PRESSURE 3 WAY STOPCOCK (1050PSI)(自 92.10.01起廠牌碼由ER改為MR) 70 ACS01H3SNCMR MARQUIES SERIES STOPCOCKS 1050PSI 70 ACS01M3SNCMR MARQUIS SERIES STOPCOCK 500PSI 34 ACS01NCN3SNR 3 WAY STOPCOCK 塑膠三極栓 7.8 ACS01S3SNCMR MANIFOLD 3 WAY STOPCOCK W/LUER LOCK(自92.10.01起廠牌碼由 ER改為MR) 34 ACS01STP34H9 "華億"體外循環管組"HYM"HEART LUNG PACK-3 & 4 WAY STOPCOCKS 7.8 ACS01TS201SG 3 WAY STOPCOCK W/LOCK 7.8 ACS01V68MPTP PREDURA PRESSURE RESISTAN THREE WAY STOPCOCK V-TYPE 1000PSI 70 ACS01VP004LL "LILY"3 WAY STOPCOCK"怡安"輸液三通閥 7.8 ACS03SMT01SG 1000PSI HIGH PRESSURE 3 WAY 70 修正規定 731

Transcript of 附件三特殊材料給付品項暨支付標準表修正特材代碼中英文名稱 ...

附件三 特殊材料給付品項暨支付標準表修正

特材代碼 中英文名稱 支付點數-104/01/01

ACA0100ABNPW IV CAP 3

ACA0100CDNPW "普惠"注射帽(免針安全型)※給付規定請見備註欄"PERFECT:IV

LOCK(SAFETY)

43.1

ACA0108008SG IV CAP 注射帽 3

ACA011PN01NQ INJECTION CAP 3

ACA0121010TZ IV LOCK 3

ACA01AB00NPW IV LOCK 3

ACA01C1C02LL INJECTION CUP(IV LOCK) 3

ACA01NF005LL INJECTION CAP(安全型)※適應症請見備註欄 43.1

ACC0100360BT PLASTIC CONNECTOR 兩尖型 17.4

ACC0100361BT PLASTIC CONNECTOR 一尖一平塑膠連接頭 17.4

ACC0100362BT PLASTIC CONNECTOR 塑膠連接頭 17.4

ACC0100364BT PLASTIC CONNECTOR 直型塑膠連接頭 17.4

ACC01HSC60H6 PLASTIC CONNECTOR(兩尖型) 17.4

ACC01HSC61H6 PLASTIC CONNECTOR(一尖一平型) 17.4

ACC02VP004LL 3 WAY 7.8

ACM01PT003CK 2-PORTS MANIFOLD 連接頭 250

ACP011000NDL Y TYPE ADAPTOR 329

ACP0146201H9 "華億"體外循環管組"HYM"HEART LUNG PACK-Y & STRAIGHT &

REDUCER CONNECTOR(WITH LUER)

88

ACP0147166GJ “吉生”體外循環管組-Y型&直型&漸細連接器(附LUER) ”JSM”

HEART LUNG PACK-Y&STRAIGHT&REDUCER CONNECTOR(WITH LUER)

88

ACP01CA123L5 "加州"心臟麻痺轉接器 "CALIFORNIA" CARDIOPLEGIA ADAPTERS 88

ACP01ECTBSM6 EXTRACORPOREAL TUBING STRAIGHT CONNECTOR 88

ACP01ECTBYM6 EXTRACORPOREAL TUBING Y-CONNECTOR 88

ACP0214000DL MULTIPURPOSE PERFUSION SET WITH VENT LINE 889

ACP0214003DL MULTIPURPOSE PERFUSION SET※適應症請見備註欄 657

ACS0109512BB DISCOFIX C-3/-3 MULTIDIRECTIONAL STOPCOCKS"柏朗"輸液轉換

7.8

ACS013CAPSM8 3 WAY STOPCOCK 7.8

ACS0168MPATP PREDURA PRESSURE RESISTAN THREE WAY STOPCOCK 1000PSI 70

ACS0170015NL 3-WAY NAMIC MORSE STOPCOCK (200PSI) 7.8

ACS0170035NL 3-WAY NAMIC MORSE STOPCOCK (400PSI) 34

ACS0170055NL 3-WAY NAMIC MORSE STOPCOCK (1050PSI) 70

ACS01D010NPW DISPOSABLE INFUSION SET 3 WAY STOPCOCK 7.8

ACS01H3FLCMR MANIFOLD HIGH PRESSURE 3 WAY STOPCOCK (1050PSI)(自

92.10.01起廠牌碼由ER改為MR)

70

ACS01H3SNCMR MARQUIES SERIES STOPCOCKS 1050PSI 70

ACS01M3SNCMR MARQUIS SERIES STOPCOCK 500PSI 34

ACS01NCN3SNR 3 WAY STOPCOCK 塑膠三極栓 7.8

ACS01S3SNCMR MANIFOLD 3 WAY STOPCOCK W/LUER LOCK(自92.10.01起廠牌碼由

ER改為MR)

34

ACS01STP34H9 "華億"體外循環管組"HYM"HEART LUNG PACK-3 & 4 WAY

STOPCOCKS

7.8

ACS01TS201SG 3 WAY STOPCOCK W/LOCK 7.8

ACS01V68MPTP PREDURA PRESSURE RESISTAN THREE WAY STOPCOCK V-TYPE

1000PSI

70

ACS01VP004LL "LILY"3 WAY STOPCOCK"怡安"輸液三通閥 7.8

ACS03SMT01SG 1000PSI HIGH PRESSURE 3 WAY 70

修正規定

731

特材代碼 中英文名稱 支付點數-104/01/01

ACVP205105B0 CSF CATHETER CONNECTOR,3-WAY 1600

ACVP221520CM "美杜思"愛可閥腦水腫引流管系統-3Way連接管"Medos"Accu-Flo

Hydrocephalus Shunt System-3Way connector

1600

ACVP245105PM 3 WAY CONNECTOR 1600

ACY010210NSD PTCA Y CONNECTOR 979

ACY010210XSD MYSHELL LITE Y CONNECTORS 麥雪兒萊Y型接頭 979

ACY0103331AB COPILOT BLEEDBACK CONTROL VALVE Y ADAPTOR 979

ACY010KAY2GG "GOODTEC"Y-CONNECTOR SET "固德克"Y型連接器套組 979

ACY016248VM4 ADJUSTABLE VALVE W/3-WAY STOPCOCK 979

ACY0191400NL NAMIC MORSE Y-ADAPTOR 979

ACY0191400SB NAMIC MORSE Y ADAPTOR 979

ACY01CFM01CK "曲克"闕克芙爾導管轉接頭“COOK”CHECK-FLO PERFORMER

ASSEMBLY

979

ACY01KESU1NX Y-CONNECTOR(PTCA,PTA用) 979

ACY01MAP13MR MONIFOLD W/HEMOSTASIS VALVE 200PSI 單Y型 979

ACY01MAP22MR ANGIOPLASTIC PACK & DOUBLE HEMOSTASIS VALVES 989

ACY01MAP32MR HONOR HEMOSTASIS VALVE ANGIOPLASTY PACK 979

ACY01MAP45MR "MERIT"ANGIOPLASTY PACKS & HEMOSTASIS VALVES"美瑞特"血管

成型術止血閥組

979

ACY01NYC00GJ "JSM"Y CONNECTOR KIT "吉生"Y 型連接器組 979

ACY01NYC10GJ "JSM"Y CONNECTOR KIT W/INSERTION TOOL"吉生"Y 型連接器組含

導引支撐器

979

ACY01NYC11GJ "JSM"Y CONNECTOR KIT W/INSERTION TOOL+TORQUE DEVICE"吉

生"Y型連接器組(含導引支撐器+扭力控制器)

979

ACY01PTBYCCK ADAPTERS PTCA用 979

ACY01YK100GJ "吉生"Y 型連接器組"JSM"Y CONNECTOR KIT 979

ACY01YK110GJ "吉生"Y 型連接器組(含導引支撐器)"JSM"Y CONNECTOR

KIT(INSERTION TOOL)

979

ACY01YK111GJ "吉生"Y 型連接器組(含導引支撐器+扭力控制器)"JSM"Y

CONNECTOR KIT(INSERTION TOOL+TORQUE DEVICE)

979

BBB01T060CTM TRANSFER BAG 600ML 60

BBB01T100BTM TRANSFER BAG 1000ML 60

BBF0320404LL "LILY"FEEDING SET ACCESSORIES雙袋機械(PUMP)式餵食袋*適應

症請見備註欄

110

BBF0320405LL "LILY"FEEDING SET ACCESSORIES雙袋重力式餵食袋*適應症請見

備註欄

72

BBF0373006KD KENDALL KANGAROO ENTERAL FEEDING PUMP SETS*"肯特利"袋鼠灌

食機用套組

110

BBF0373622KD "KENDALL"KANGAROO 924 PUMP SETS"肯特利"袋鼠灌食機用套組 110

BBF0373642SH "KENDALL" KANGAROO ENTERAL FEEDING PUMP SETS"肯特利" 袋鼠

灌食管及袋子

110

BBF0373656KD "KENDALL"KANGAROO EPUMP FEEDING SETS "肯特利"袋鼠電子灌食

機用灌食套組

110

BBF0377512KG APPLIX SMART/VISION PUMP SET BAG愛普仕管灌餵食管袋組合套*

適應症請見備註欄

110

BBF03F1200SG FEEDING PUMP SET※適應症請見備註欄 110

BBF03FB030P2 "PAHSCO"FEEDING BAG雙袋重力式餵食袋*適應症請見備註欄 72

BBF03FB040P2 "PAHSCO"FEEDING BAG雙袋機械式餵食袋*適應症請見備註欄 110

BBF03FB600P2 PAHSC0 FEEDING BAG 重力式 600ML*適應症請見備註欄 72

BBP0100070CA POST OPERATION OPEN TRANSPARENT BAG 康便舒手術後便袋*限住

院患者申報

25.1

BBP0100406F4 "CONVATEC"NATURA POUCH(NON-STERILE)"康威"益舒穩造口袋-雙

片式不透明封口便袋45-57MM(未滅菌)*適應症請見備註欄

37.1

732

特材代碼 中英文名稱 支付點數-104/01/01

BBP0100774F4 "CONVATEC"ESTEEM SYNERGY POUCH(NON-STERILE)"康威"新易優穩

造口袋-雙片式35-61MM(未滅菌)*適應症請見備註欄

37.1

BBP0101522F4 SUR-FIT NATURA POUCH(Non-sterile) 新舒穩雙片式造口袋(未滅

菌)*限住院患者申報

37.1

BBP011680NA5 YOUCARE C 14:59MM*限住院患者使用 25.1

BBP0121132LK “福立克”可樂適造口術用袋及其附件(未滅菌)-雙片式透明封口

便袋32-70MM“FLEXICARE” COLOSET OSTOMY BAG AND

ACCESSORIES (NON-STERILE)- CLOSED BAG,COMFORT BACKING,

37.1

BBP0121232LK “福立克”可樂適造口術用袋及其附件(未滅菌)-雙片式透明封口

便袋32-70MM(不織布) “FLEXICARE” COLOSET OSTOMY BAG AND

ACCESSORIES (NON-STERILE)- CLOS

37.1

BBP0122132LK “福立克”可樂適造口術用袋及其附件(未滅菌)-雙片式不透明封

口便袋32-70MM“FLEXICARE” COLOSET OSTOMY BAG AND

ACCESSORIES (NON-STERILE)- CLOSED BAG,

37.1

BBP0122232LK “福立克”可樂適造口術用袋及其附件(未滅菌)-雙片式不透明封

口便袋32-70MM(不織布) “FLEXICARE” COLOSET OSTOMY BAG

AND ACCESSORIES (NON-STERILE)- CL

37.1

BBP0400315DD ONE PIECE SOLO MINI DRAINABLE POUCH 15:50MM(含人工皮、不

織布)※限住院患者申報

51.5

BBP0400414F4 "CONVATEC"NATURA POUCH(NON-STERILE)"康威"益舒穩造口袋-雙

片式透明開口便袋38-70MM(未滅菌)*適應症請見備註欄

37.1

BBP0400415F4 "CONVATEC"NATURA POUCH(NON-STERILE)"康威"益舒穩造口袋-雙

片式不透明開口便袋38-57MM(未滅菌)*適應症請見備註欄

37.1

BBP0400420F4 "CONVATEC"NATURA POUCH(NON-STERILE)"康威"益舒穩造口袋-雙

片式不透明開口便袋38-57MM(未滅菌)*適應症請見備註欄

37.1

BBP0400472F4 "CONVATEC"NATURA POUCH(NON-STERILE)"康威"益舒穩造口袋-雙

片式透明開口便袋100MM(未滅菌)*適應症請見備註欄

42.3

BBP0400718F4 "CONVATEC"ESTEEM POUCH(NON-STERILE)"康威"新優穩造口袋-單

片(含人工皮、不織布 )(未滅菌)*適應症請見備註欄

51.5

BBP0400795F4 "CONVATEC"ESTEEM SYNERGY POUCH(NON-STERILE)"康威"新易優穩

造口袋-雙片式透明開口35-61MM(未滅菌)*適應症請見備註欄

37.1

BBP0400818DD SOLO DRAINABLE POUCHES(NON-STERILE) 10-40MM*限住院患者申

37.6

BBP0401512F4 "Convatec"SUR-FIT NATURA POUCH(Non-Sterile)"康威"新舒穩雙

片式造口袋(未滅菌)*限住院患者申報

37.1

BBP0401515F4 "Convatec"SUR-FIT NATURA POUCH(Non-Sterile)"康威"新舒穩雙

片式造口袋(未滅菌)*限住院患者申報

42.3

BBP0401927F4 "ConvaTec "Little Ones Pouch(non-sterile)- 2 PIECE

TRANSPARENT DRAINABLE POUCH "康威"幼兒造口袋-雙片式開口便

袋*限住院患者申報

37.1

BBP0403223HL "HOLLISTER"OSTOMY POUCH AND ACCESSORIES(NON-STERILE)-

KARAYA 5 SEAL RING DRAINABLE POUCH造口術用袋及其附件-卡拉

亞開口便袋*給付規定見備註

37.6

BBP0403250HL POST OPERATION COMPACT DRAINABLE POUCH(開口便袋)※限住院

患者申報

51.5

BBP0403802HL DRAINABLE POUCH 44MM *限住院患者申報 37.1

BBP0403806HL DRAINABLE POUCH 102MM *限住院患者申報 42.3

BBP0403857HL OSTOMY TWO-PIECE WITH TRANSPARENT 57MM 中央點鎖式兩式便袋

*限住院患者申報

37.1

BBP0405403F4 "CONVATEC"ESTEEMSYNERGY DRAINABLE POUCH TRANSPARENT

35/48/61MM雙片式造口袋*限住院患者申報

37.1

BBP0405420F4 "CONVATEC"ESTEEMSYNERGY DRAINABLE POUCH OPAQUE 35/48MM雙

片式造口袋*限住院患者申報

37.1

733

特材代碼 中英文名稱 支付點數-104/01/01

BBP0405436F4 "CONVATEC"ESTEEMSYNERGY CLOSE POUCH OPAQUE 35/48/61MM雙片

式造口袋*限住院患者申報

37.1

BBP0405441F4 "CONVATEC"ESTEEMSYNERGY CLOSE POUCH OPAQUE MINI 35/48MM雙

片式造口袋*限住院患者申報

37.1

BBP0406820CA POST OPEN BAG 100MM*限住院患者申報 42.3

BBP0407650HL STONINAL ONE PIECE POUCH 51MM 單片附人造皮便袋*限住院患者

申報

37.6

BBP0408631HL "HOLLISTER"OSTOMY POUCH AND ACCESSORIES(NON-STERILE)"鶴

牌"造口術用袋及其附件(未滅菌)(含人工皮"不織布)*適應症請見

備註欄

51.5

BBP0409243F4 "CONVATEC"ESTEEMSYNERGY CLOSE POUCH TRANSPARENT35/48/61MM

雙片式造口袋*限住院患者申報

37.1

BBP0410384CA "COLOPLAST"OSTOMY POUCH AND ACCESSORIES(NON-STERILE)造口

術用袋及其附件*限住院患者申報40MM:60MM

37.1

BBP0412131A5 PROCARE-2 DRAINABLE POUCH 30,40,50MM*限住院患者申報 51.5

BBP0412134A5 PROCARE-2 DRAINABLE POUCH 70MM*限住院患者申報 37.1

BBP0412501A5 LAPACK SUPER-G 人工肛門袋 G80*限住院患者申報 11

BBP0412502A5 LAPACK SUPER-G 人工肛門袋 G100*限住院患者申報 11

BBP0412511A5 LAPACK SUPER-C 100 人工肛門封口便袋*限住院患者申報 11

BBP0412521A5 LAPACK SUPER F簡易型夾鏈式開口便袋*限住院患者使用 11

BBP0413351A5 POSPACK-B、K 60,70MM*限住院患者申報 51.5

BBP0413860CA "COLOPLAST"ALTERNA OSTOMY POUCH AND ACCESSORIES(NON-

STERILE)"康樂保"愛特大造口術用袋及其附件(未滅菌)*限住院患

者申報。

51.5

BBP0413984CA "COLOPLAST"ALTERNA FREE WITH HIDE-AWAY OUTLET OSTOMY

POUCH 40MM 50MM60MM(TWO-PIECE)崇尚型易關式開口袋*適應證請

見備註欄

37.1

BBP0414212A5 PEDIATRIC PROCARE 1 POST-OP *限住院患者使用 45

BBP0415021A5 POSPACK B 60MM※限住院患者使用 51.5

BBP041503NA5 POSPACK LIGHT 60MM※限住院患者使用 34

BBP0415570CA "COLOPLAST"SENSURA OSTOMY POUCH AND ACCESSORIES(NON-

STERILE)善舒樂造口術用袋及其附件*給付規定請見備註欄

51.5

BBP0416623A5 YOUCARE 2 POUCH D 優護二件式開口便袋*限住院患者使用 37.1

BBP041662NA5 YOUCARE 2 POUCH D 優護二件式開口便袋*限住院患者使用 37.1

BBP0416771A5 YOUCARE D 14:59MM*限住院患者使用 51.5

BBP041678NA5 YOUCARE D 14:59MM*限住院患者使用 51.5

BBP0416960CA ILEOSTOMY BAG MAXI 40MM,50MM,60MM※限住院患者申報 37.1

BBP0417820CA ALTERNA CHILDREN 雙片OPEN TRANSPARENT BAG 40MM※限住院患

者申報

45

BBP0418006HL "HOLLISTER"OSTOMY POUCH AND ACCESSORIES-NEW IMAGE LOCK'N

ROLL DRAINABLE POUCH 新象便袋 102MM *適應症請件備註欄

42.3

BBP0418102HL NEW IMAGE DRAINABLE POUCH 2 PIECE 44:70MM *限住院患者申報 37.1

BBP0419020CA "COLOPLAST"SENSURA OSTOMY POUCH AND ACCESSORIES(NON-

STERILE)1-PIECE (含人工皮、不織布)"康樂保"善舒樂造口術用

袋及其附件*給付規定請見備註欄

51.5

BBP0420922F4 "ConvatecTec "Little Ones Pouch(non-sterile)-ONE PIECE

POUCH WITH SKIN BARRIER "康威"幼兒造口袋-單片式造口袋*限

住院患者申報。

45

BBP0422771F4 "Convatec"ACTIVE LIFE ONE-PIECE DRAINABLE POUCH(Non-

sterile) 19/64MM"康威"愛得富單片式造口袋(未滅菌)*限住院患

者申報。

51.5

734

特材代碼 中英文名稱 支付點數-104/01/01

BBP0431132LK “福立克”可樂適造口術用袋及其附件(未滅菌)-雙片式透明開口

便袋32-70MM“FLEXICARE” COLOSET OSTOMY BAG AND

ACCESSORIES (NON-STERILE)- DRAINABLE BAG

37.1

BBP0431232LK “福立克”可樂適造口術用袋及其附件(未滅菌)-雙片式透明開口

便袋32-70MM(不織布)“FLEXICARE” COLOSET OSTOMY BAG AND

ACCESSORIES (NON-STERILE)- DRAIN

37.1

BBP0432132LK “福立克”可樂適造口術用袋及其附件(未滅菌)-雙片式不透明開

口便袋32-70MM“FLEXICARE” COLOSET OSTOMY BAG AND

ACCESSORIES (NON-STERILE)- DRAINABLE B

37.1

BBP0432232LK “福立克”可樂適造口術用袋及其附件(未滅菌)-雙片式不透明開

口便袋32-70MM(不織布)“FLEXICARE” COLOSET OSTOMY BAG AND

ACCESSORIES (NON-STERILE)- DRA

37.1

BBP0459850CA "COLOPLAST"ALTERNA ILEOSTOMY BAGS 10-70MM愛特大迴腸造口袋

*適應症請見備註欄

51.5

BBP0480020CA ONE PIECE ALTERNA CHILDREN OPEN TRANSPARENT BAG 10:35MM※

限住院患者申報

45

BBU0101460HL FIRST CHOICE UROSTOMY POUCH WITH CUT-TO-FIT BARRIER(含人

工皮)※限住院串者申報

90.1

BBU0101482HL "HOLLISTER"OSTOMY POUCH AND ACCESSORIES(NON-STERILE)-

UROSTOMY POUCHS W CONVEX BARRIERS造口術用袋及其附件單片式

尿袋附墊高片*給付規定見備註

90.1

BBU0101544F4 "Convatec"SUR-FIT NATURA POUCH(Non-Sterile) -UROSTOMY

POUCH "康威"新舒穩雙片式造口袋(未滅菌)-透明尿袋*限住院患

者申報。

77

BBU0103907HL UROSTOMY POUCH 38MM*限住院患者申報 77

BBU0103944HL CENTER POINT LOCK UROSTOMY POUCH※限住院患者申報 90.1

BBU0108432HL "HOLLISTER"OSTOMY POUCH AND ACCESSORIES(NON-STERILE)-

UROSTOMY POUCHS W CONVEX BARRIERS造口術用袋及其附件單片式

尿袋附墊高片*給付規定見備註

90.1

BBU0111803CA "COLOPLAST"SENSURA OSTOMY POUCH AND ACCESSORIES(NON-

STERILE)-UROSTOMY BAGS"康樂保"善舒樂造口術用袋及其附件(未

滅菌)-尿造口袋*給付規定見備註欄

90.1

BBU0111854CA "COLOPLAST"SENSURA OSTOMY POUCH AND ACCESSORIES(NON-

STERILE)40-60MM"康樂保"善舒樂造口術用袋及其附件(未滅菌)※

限住院患者申報

77

BBU0112151A5 PROCARE-2 URINARY POUCH 30,40,50MM*限住院患者申報 77

BBU0112451A5 BIOURINE-B 50MM*限住院患者申報 90.1

BBU0114201A5 YOUCARE U優護一件式尿袋*限住院患者使用 90.1

BBU011666NA5 YOUCARE 2U優護二件式尿袋*限住院患者使用 77

BBU0117570CA COLOPLAST ALTERNA UROSTOMY BAG MAXI375ML※限住院患者申報 77

BBU0117890CA ALTERNA CHILDREN TRANSPARENT URINE BAG※限住院患者申報 77

BBU0118402HL NEW IMAGE UROSTOMY POUCH (不含人工皮) 44:70MM *限住院患者

申報

77

BBU0155850CA UROSTOMY BAG MAXI 375ML ※限住院患者申報 90.1

BBU0164927F4 "CONVATEC"ACTIVE LIFE ONE-PIECE UROSTOMY POUCH (Non-

sterile)19:45MM"康威"愛得富單片式造口袋(未滅菌)單片式尿袋

*限住院患者申報。

90.1

BBU0180090CA ONE PIECE ALTERNA CHILDREN TRANSPARENT URINE BAG

10:35MM(含人工皮)※限住院患者申報

90.1

BBW0104055P2 "太平洋"引流袋"PAHSCO" DRAINAGE BAG 34

BBW0104200P2 P.C.N. BAG (L) 腎臟造廔引流袋 34

BBW0145000TZ PCN BAG 腎臟造口引流袋 34

BBW0185001PB PBN DRAINAGE BAG 34

735

特材代碼 中英文名稱 支付點數-104/01/01

CAE0112170BB EPIDURAL ANAESTHESIA CATHETER 103

CAE0113010BB EPIDURAL ANAESTHESIA SET(N+C+S) 362

CAE0151238BB PERICAN EPIDURAL NEEDLE 110

CAE01E5400AR NON-KINGKING EPIDURAL CATHETER 20GA 91.4CM,19GAX92CM 362

CAE01PC383BB PERICAN NEEDLES FOR EPIDURAL ANAESTHESIA背利安硬脊膜麻醉

穿刺針

110

CAE01SD150BB "B.BRAUN"PERIFIX CATHETERS FOR EPIDURAL

ANAESTHESIA(CATHETER)"柏朗"脊椎硬膜麻醉用穿刺套

103

CAE01SD301BB "B.BRAUN"PERIFIX CATHETERS FOR EPIDURAL ANAESTHESIA:MINI

SETS"柏朗"脊椎硬膜麻醉用穿刺套(NEEDLE+CATHETER+FILTER或

SYRINGE)

362

CBA010502SAR INTRA AORTIC BALLOON CATHETER (型號:IAB-

04230U,04240U,04250U,06830U,06840U,R950U自94.10.01起生效)

25364

CBA010AB46M4 "MEDTRONIC"RELIANT STENT GRAFT BALLOON CATHETER"美敦力"瑞

萊恩球囊導管

22348

CBA0111612QM "MAQUET"PEDIATRIC INTRA AORTIC BALLOON (PUMP)CATHETER

FIDELITY 2.5CC 5CC 7CC 12CC 20CC"邁柯唯"主動脈氣球導管

25364

CBA0142912QM "MAQUET"INTRA AORTIC BALLOON (PUMP) FIDELITY 8FR 25CC"邁

柯唯"主動脈氣球導管

25364

CBA0143001QM "MAQUET"INTRA AORTIC BALLOON PUMP CATHETER 8FR 34CC"邁柯

唯"主動脈氣球導管

25364

CBA014300SLW "樂脈"非氣球型閉塞導管"LEMAITRE"THE UNBALLOON NON-

OCCLUSIVE MODELING CATHETER

22348

CBA0143012QM "MAQUET"INTRA-AORTIC (PUMP)BALLOON 8FR 34CC 40CC"邁柯唯"

主動脈氣球導管

25364

CBA0147982QM "MAQUET"INTRA AORTIC BALLOON(PUMP) CATHETER 7.5FR

25;34;40CC"邁柯唯"主動脈氣球導管

25364

CBA014830UAR NARROWFLEX UNIVERSAL IAB CATHETER 8FR.30CC,40CC 25364

CBA0162080ED "EDWARDS"FOGARTY OCCLUSION CATHETER(AORTIC)堵塞用導管 22348

CBA01B2640GX "GORE"TRI-LOBE BALLOON CATHETER(AORTIC)三葉球囊導管 22348

CBA01C0DA1CK "COOK"CODA BALLOON CATHETER (AORTIC)科達球曩導管 22348

CBA01C0DA2CK "COOK"CODA BALLOON CATHETER(AORTIC)科達球囊導管 22348

CBA01C0DA3CK "COOK"CODA 3G OCCLUSION BALLOON CATHETER"曲克"柯達閉合球

囊導管

22348

CBA01C0DA4CK "COOK"CODA LP BALLOON CATHETER"曲克"科達艾皮球囊導管 22348

CBA01REL46M4 "MEDTRONIC"RELIANT STENT GRAFT BALLOON CATHETER瑞萊恩氣球

導管

22348

CBA01S730CAR REDIGUARD IAB CATHETER 7,8,9FR. 30CC,40CC 25364

CBA02F6830AR "ARROW"FIBER OPTIC INTRA-AORTIC BALLOON CATHETER光纖感應

主動脈弓氣球導管

41110

CBA02SEN7FQM "MAQUET"SENSATION 7FR INTRA-AORTIC BALLOON CATHETER"邁柯

唯"光纖感應主動脈氣球導管*適應症請見備註欄

41110

CBA0321002LW "樂脈"普特主動脈阻斷導管"LEMAITRE"PRUITT AORTIC OCCLUSION

CATHETER*適應症請見備註欄

7623

CBB0106433SB ULTRA-THIN DIAMOND BALLOON DILATATION CATHETER 5398

CBB0112512SB BLUW MAX BALLOON DILATATION CATHETERS 5398

CBB0114508SB XXL BALLOON DILATATION CATHETER 5398

CBB0130240SB "BOSTON SCIENTIFIC"MUSTANG PTA BALLOON DILATATION

CATHETERS D 3:10;12MM; L 20:100MM "波士頓科技"瑪思丹氣球

擴張導管

5398

CBB0131555N5 GHOST II PTA ANGIOPLASTY CATHETER 5FR. 3:10MM *1.5:10CM,

40,75,120,150CM(衛署字號009069)

5398

736

特材代碼 中英文名稱 支付點數-104/01/01

CBB0139031SB "BOSTON SCIENTIFIC"STERLING BALLOON DILATATION CATHETERS

D 3:8MM L 10:60MM C USABLE 80;135CM氣球擴張導管

5398

CBB0139032SB "BOSTON SCIENTIFIC"STERLING BALLOON DILATATION

CATHETERS(OTW)D 4:10MM L 20:100MM C USABLE L40:135CM氣球

擴張導管

5398

CBB0139134SB "BOSTON SCIENTIFIC"STERLING BALLOON DILATATION

CATHETERS(OTW) D 1.5:4MM L 20:40MM C USABLE 142;145CM氣球

擴張導管

5398

CBB0139135SB "BOSTON SCIENTIFIC"STERLING BALLOON DILATATION

CATHETERS(Monorail) D 1.5:4MM L 20:40MM C USABLE

143;146CM氣球擴張導管

5398

CBB014105NCD POWERFLEX PTA BALLOON CATHTER 5FR 5398

CBB0141500CD POWERFLEX PTA CATHETER 5398

CBB0141550CD POWERFLEX PTA BALLOON 5398

CBB0141570CD POWERFLEX PTA BALLOON 5398

CBB0141590CD POWERFLEX PTA BALLOON 5398

CBB01420XNCD POWER FLEX PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA)

CATHETER 3MM:12MM 40,80,135CM

5398

CBB01424NWCD "CORDIS"AVIATOR PLUS PERCUTANEOUS TRANSLUMINAL

ANGIOPLASTY(PTA)BALLOON DILATATION CATHETER PTA氣球擴張導

管 4.0MM:6.0MM;7.0MM

5398

CBB0144028CD "CORDIS"POWERFLEX PRO PERCUTANEOUS TRANSLUMINAL

ANGIOPLASTY CATHETER 2:8CM"考迪斯"保飛力斯博經皮穿腔成型

術導管

5398

CBB0150500SB WANDA PTA BALLOON DILATATION CATHETER 5398

CBB0152111BQ "BIOTEQ"PTA BALLOON DILATATION CATHETER"邦特"血管氣球擴張

導管

5398

CBB0152115BQ "BIOTEQ"PTA BALLOON DILATATION CATHETER"邦特"血管氣球擴張

導管

5398

CBB0161111BQ "BIOTEQ"PTA BALLOON DILATATION CATHETER"邦特"血管氣球擴張

導管

5398

CBB0161115BQ "BIOTEQ"PTA BALLOON DILATATION CATHETER"邦特"血管氣球擴張

導管

5398

CBB01ADM18F2 "INVATEC"ADMIRAL XTREME PTA BALLOON CATHETER愛德米羅週邊

血管氣球導管3MM:12MM 20MM:120MM

5398

CBB01AP128AB FOX PLUS PTA CATHETER 5398

CBB01ARM35AB "ABBOTT"ARMADA 35/ARMADA 35LL PTA CATHETER"亞培"阿曼達周

邊血管球囊導管

5398

CBB01AT751BA BARD ATLAS PTA BALLOON DILATATION CATHETER 75CM,120CM 5398

CBB01AT752BA "BARD"ATLAS PTA BALLOON DILATATION CATHETER 5398

CBB01ATB01CK ALL-TERRAIN BALLOON PTA DILATATION CATHETERS 5398

CBB01ATB02CK "COOK"ALL-TERRAIN BALLOON PTA DILATATION CATHETER經皮穿刺

血管成形術用氣球擴張導管

5398

CBB01BTFLRQC "清流"班特弗洛里安經皮穿刺血管成形術導管 5398

CBB01BTM01QC "CLEARSTREAM"BANTAM PERCUTANEOUS TRANSLUMINAL

ANGIOPLASTY(PTA)CATHETER"清流"班特經皮穿刺血管成形術導管

5398

CBB01BTM02QC "CLEARSTREAM"BANTAM PERCUTANEOUS TRANSLUMINAL

ANGIOPLASTY(PTA)CATHETER 150MM-220MM"清流"班特經皮穿刺血

管成形術導管*給付規定請見備註欄

11140

CBB01CPAC1QC "CLEARSTREAM"CLEARPAC 歐美加 PTA CATHETER"清流"清派歐美

加經皮穿刺血管成形術導管

5398

737

特材代碼 中英文名稱 支付點數-104/01/01

CBB01CPAC2QC "CLEARSTREAM"CLEARPAC 歐美加 PTA CATHETER

120MM;150MM;220MM"清流"清派歐美加經皮穿刺血管成形術導管*

給付規定請見備註欄

11140

CBB01CQ120BA "BARD"CONQUEST PTA BALLOON DILATATION CATHETER氣球擴張導

5398

CBB01CQ575BA CONQUEST PTA BALLOON DILATATION CATHETER(型號CQ-50;75-

52;54;58自950401起生效,文號0940040071)

5398

CBB01CYTESSB "BOSTON SCIENTIFIC"COYOTE ES OTW MONORAIL PTA BALLOON

DILATATION CATHETERS D 1.5:4MM 20:40MM "波士頓科技"凱優帝

氣球擴張導管

5398

CBB01F0XSVAB "ABBOTT"FOX SV PTA BALLOON CATHETER D 2:6MM L 90 135

150CM周邊血管氣球導管

5398

CBB01FCPTAAB "ABBOTT"FOXCROSS PTA CATHETER周邊血管氣球導管 5398

CBB01G11XXN5 "NUMED"GHOST II PTA CATHETER 40CM 75CM 120CM 135CM 150CM 5398

CBB01L2457KE "KANEKA"PTA BALLOON CATHETER 經皮穿腔成型術氣球導管 5398

CBB01MG1XXN5 NUMED MINI GHOST DILATATION CATHETER 2MM-6MM 2CM:4CM

40CM:150CM

5398

CBB01PCF18F2 "INVATEC"PACIFIC XTREME PTA BALLOON CATHETER派斯飛克血管

治療導管

5398

CBB01PTA14Y9 NANOCROSS .014 OTW PTA DILATATION CATHETER D 1.5:3.5MM L

20:120MM 導管長度90;150CM娜諾血管擴張氣球導管

5398

CBB01PTA15Y9 NANOCROSS.014 OTW PTA DILATATION CATHETER D 4.0MM L

20;40;80;120MM 導管長度90;150CM娜諾血管擴張氣球導管

5398

CBB01PTA18Y7 POWERCROSS .018 OTW PTA DILATATION CATHETER包爾血管擴張氣

球導管 導管長度90CM 150CM 球囊直徑2MM:6MM 球囊長度

20MM:200MM

5398

CBB01PTA31K7 SD PTA DILATATION CATHETER迅捷血管擴張氣球導管 5398

CBB01PTA35Y8 EVERCROSS .035 OTW PTA DILATATION CATHETER D 3.0:12.0MM L

15:200MM 導管長度40,80,135CM艾維血管擴張氣球導管

5398

CBB01PTA41CK "COOK"ADVANCED 18LP LOW PROFILE PTA BALLOON DILATATION

CATHETER艾德凡絲小剖面經皮穿刺血管成形術球曩擴張導管80CM

135CM

5398

CBB01PTA51CK "COOK"ADVANCED 35LP LOW PROFILE PTA BALLOON DILATION

CATHETER 5-7 FR 80/135CM艾德凡絲小剖面經皮穿刺血管成形術

球囊

5398

CBB01REU35F2 "INVATEC"REEF HP PTA BALLOON CATHETER D 4.0:8.0MM L

20:80MM USE LENGTH 50 80 120CM週邊血管氣球導管

5398

CBB01RV135BA "BARD"RIVAL PTA BALLOON DILATATION CATHETER氣球擴張導管

SHAFT 80&135CM D 4:10MM L 2:15CM

5398

CBB01SBR18F2 "INVATEC"SUBMARINE RAPIDO PTA BALLOON CATHETER 直徑

2.00MM-7.00MM,長度20MM:40MM,60MM,80MM 。USE

LENGTH:75CM,135CM潛艇周邊血管治療導管

5398

CBB01SMTRYSB "BOSTON SCIENTIFIC"SYMMETRY BALLOON DILATATION CATHETER

1.5MM-6.0MM 2CM-10CM對稱式氣球裝導管

5398

CBB01USSV1SB "BOSTON SCIENTIFIC"ULTRA-SOFT SV BALLOON DILATATION

CATHETER4.0MM:7.0MM 1.5CM:2.0CM 3.1CM/3.1CM:3.4CM/3.1CM

90FR,150FR

5398

CBB0221055LW "LEMAITRE"DISTAL PERFUSION CATHETER"樂脈"遠端灌流導管 6590

CBB0344010CD "CORDIS"POWERFLEX PRO PERCUTANEOUS TRANSLUMINAL

ANGIOPLASTY CATHETER 10CM"考迪斯"保飛力斯博經皮穿腔成型術

導管*給付規定請見備註

8455

738

特材代碼 中英文名稱 支付點數-104/01/01

CBB0344022CD "CORDIS"POWERFLEX PRO PERCUTANEOUS TRANSLUMINAL

ANGIOPLASTY CATHETER 12:22CM"考迪斯"保飛力斯博經皮穿腔成

型術導管*給付規定請見備註

11140

CBB0351240SB "BOSTON SCIENTIFIC"MUSTANG PTA BALLOON DILATATION

CATHETERS D 3:8MM; L 120:200MM "波士頓科技"瑪思丹氣球擴張

導管*適應症請見備註欄

11140

CBB03AB210Y9 NANOCROSS.014 OTW PTA DILATATION CATHETER D:2.0MM:4.0MM

L:150MM,210MM娜諾血管擴張氣球導管(下肢血管)*適應症請見備

註欄

11140

CBB03AMD21F2 "INVATEC"AMPHIRION DEEP PTA BALLOON CATHETER D:2.0:4.00MM

L:120:210MM"英泰克"安菲允血管治療導管*適應症請見備註欄

11140

CBB03AMD80F2 "INVATEC"AMPHIRION DEEP PTA BALLOON CATHETER D:1.5:4.00MM

L:20:80MM"英泰克"安菲允血管治療導管*適應症請見備註欄

8455

CBB03ARMA1AB "ABBOTT"ARMADA 14 PTA CATHETER D:1.5MM-4.0MM L:20MM:80MM"

亞培"阿曼達周邊血管球囊導管*適應症請見備註欄

8455

CBB03ARMA2AB "ABBOTT"ARMADA 14 PTA CATHETER D:1.5MM-4.0MM

L:120MM:200MM"亞培"阿曼達周邊血管球囊導管*適應症請見備註

11140

CBB03BTMA1QC "CLEARSTREAM"BANTAM阿爾發PERCUTANEOUS TRANSLUMINAL

ANGIOPLASTY(PTA) CATHETER 15-100MM"清流"班特阿爾發經皮穿

刺血管成形術導管*給付規定見備註。

8455

CBB03BTMA2QC "CLEARSTREAM"BANTAM阿爾發PERCUTANEOUS TRANSLUMINAL

ANGIOPLASTY CATHETER 120-220MM"清流"班特阿爾發經皮穿刺血

管成形術導管*給付規定見備註。

11140

CBB03CYTLTSB "BOSTON SCIENTIFIC"COYOTE PTA BALLOON DILATATION

CATHETERS D 2.0:4MM;L 120:220MM "波士頓科技"凱優帝氣球擴

張導管*適應症請見備註欄

11140

CBB03CYTSTSB "BOSTON SCIENTIFIC"COYOTE OTW.MONORAIL PTA BALLOON

DILATATION CATHETERS D 1.5:4MM; 40:100MM "波士頓科技"凱優

帝氣球擴張導管*適應症見備註

8455

CBB03PTAX1CK "COOK"ADVANCED 14LP LOW PROFILE PTA BALLOON DILATATION

2:4MM 2:8CM經皮穿刺血管成形術球曩擴張導管*適應症請見備註

8455

CBB03PTAX2CK "COOK"ADVANCED 14LP LOW PROFILE PTA BALLOON DILATATION

2:4MM 12:20CM經皮穿刺血管成形術球曩擴張導管*適應症請見備

註欄

11140

CBB03STSL1SB "BOSTON SCIENTIFIC"STERLING PTA BALLOON DILATATION

CATHETERS L:120:220MM"波士頓科技"施特靈氣球擴張導管

11140

CBB03STSL8SB "BOSTON SCIENTIFIC"STERLING PTA BALLOON DILATATION

CATHETERS D:2.0:4.00MM L:80,100MM"波士頓科技"施特靈氣球

擴張導管*適應症請見備註欄

8455

CBB03SV435CD "CORDIS"SAVVY PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY ( PTA

) CATHETER D:2.0:6.0MM L:20:100MM"考迪斯"沙維 PTA 擴張導

管*給付規定請見備註欄

8455

CBB04JS0S1CK "COOK"SOS BAKRI TAMPONADE BALLOON 500ML(含60ML針筒)"曲克"

貝克利填塞氣球*適應症請見備註欄

7470

CBC0110101AB "ABBOTT"RX ACCULINK CAROTID STENT SYSTEM亞科林頸動脈支架

系統*適應症請見備註欄

28608

CBC01PCRXCCD "CORDIS"PRECISE PRO RX NITINOL STENT SYSTEM普塞斯普羅鎳鈦

支架系統(頸動脈支架)*適應症請見備註欄

28608

739

特材代碼 中英文名稱 支付點數-104/01/01

CBC01PR0TEY7 "EV3"PROTEGE RX CAROTID STENT SYSTEMS STRAIGHT L:20:60MM

D:6:10MM TAPERED L:30;40MM D:8X6;10X7MM波特捷自動擴張式頸

動脈支架系統*適應症見備註

28608

CBC01SCH64SB OTW&MONORAIL CAROTID WALLSTENT D:6:10MM,L:30:50MM*使用規

範請見備註欄

28608

CBC01SCH65SB OTW&MONORAIL CAROTID WALLSTENT*適應症請見備註欄 28608

CBC0210125AB "亞培"全能自擴型血管支架系統"ABBOTT"ABSOLUTE PRO VASCULAR

SELF-EXPANDING STENT SYSTEM

27129

CBC0222820SB "波士頓科技"艾柏克鎳鈦合金血管支架系統"BOSTON

SCIENTIFIC"EPIC NITINOL VASCULAR STENT SYSTEM*給付規定請

見備註欄

27129

CBC0249380SB "BOSTON SCIENTIFIC "EXPRESS LD ILIAC PREMOUNTED STENT

SYSTEM"波士頓科技"極速腸骨支架系統*適應症請見備註欄

27129

CBC0249381SB "BOSTON SCIENTIFIC "EXPRESS LD ILIAC PREMOUNTED STENT

SYSTEM"波士頓科技"極速腸骨支架系統*給付規定請見備註欄

27129

CBC0271200SB BOSTON SCIENTIFIC WALLSTENT ILIAC ENDOPROSTHESIS WITH

UNISTEP PLUS DELIVERY SYSTEM*"波士頓科技"華斯登腸骨支架系

統*適應症請見備註欄

27129

CBC02ASSURM4 "MEDTRONIC"ASSURANT COBALT OVER THE WIRE ILIAC STENT

SYSTEM腸骨血管支架系統*適應症請見備註欄

27129

CBC02C0810CD "CORDIS"S.M.A.R.T.CONTROL NITINOL STENT SYSTEM(ILIAC)"考

迪斯 "史瑪特鎳鈦支架系統(腸骨支架)*適應症請見備註欄

27129

CBC02C0MSEM4 "MEDTRONIC"COMPLETE SE ILIAC STENT SYSTEM D:4.0-10MM

L:20:150MM CATHETER:80-130CM"美敦力"康博立腸骨血管支架系

統*適應症請見備註欄

27129

CBC02GENESCD "CORDIS"PALMAZ GENESIS PERIPHERAL STENT AND DELIVERY

SYSTEM "考迪斯"帕瑪傑耐周邊血管支架及氣球輸送系統(腸骨動

脈支架)*適應症見備註欄

27129

CBC02MP628F2 "INVATEC"MARIS PERIPHERAL SELF-EXPANDING STENT

SYSTEM(ILIAC ARTERY)瑪瑞斯自膨式週邊血管支架系統*適應症請

見備註欄

27129

CBC02SCA35F2 "INVATEC"SCUBA PERIPHERAL STENT SYSTEM 80CM 130CM腸骨血管

支架系統*適應症請見備註欄

27129

CBC02Z1V60CK "COOK"ZILVER VASCULAR STENT SYS(ILIAC ARTERY) "曲克"麗而

服血管支架系統(腸骨動脈)*適應症請見備註欄

27129

CBC02Z1V62CK "COOK"ZILVER SELF EXPANDABLE VASCULAR STENTS(ILIAC

ARTERY)"曲克"麗而服自展性血管支架*適應症請見備註欄

27129

CBC02Z1V63CK "COOK"ZILVER VASCULAR STENTS(ILIAC)6:10MMX20:80MM"曲克"麗

而服血管支架(腸骨血管支架)*適應症請見備註欄

27129

CBC02ZFV61CK "COOK"ZILVER FLEX 35 VASCULAR STENTS(ILIAC ARTERY)直徑

5:10MM 長度20:140MM"曲克"麗而服福雷斯血管支架(腸骨動脈支

架)

27129

CBC02ZVM04AN "ANGIOMED"BARD E.LUMINEXX VASCULAR STENT"安吉美爾德"巴德.

依路明尼斯血管支架(腸骨血管支架)*適應症請見備註欄

27129

CBC02ZVS04AN "ANGIOMED"BARD E.LUMINEXX VASCULAR STENT 巴德依.路明尼斯

血管支架(腸骨血管支架) 直徑4MM:10MM;12MM;14MM 長度

60CM;135CM*適應症請見備註欄

27129

CBC0320714TM "TERUMO"ANACONDA AAA STENT GRAFT SYSTEM"泰爾茂"安康達腹主

動脈人工血管支架系統(主體+分支體*2)*給付規定請見備註欄

427500

CBC0320715TM "TERUMO"ANACONDA AAA STENT GRAFT SYSTEM -AORTIC CUFF腹主

動脈人工血管支架系統-輔助配件*適應症請見備註欄

56686

740

特材代碼 中英文名稱 支付點數-104/01/01

CBC0320716TM "TERUMO"ANACONDA AAA STENT GRAFT SYSTEM-ILIAC LEGS"泰爾

茂"安康達腹主動脈人工血管支架系統-輔助配件*給付規定請見備

註欄

56686

CBC03AAA01CK ZENITH FLEX AAA ENDOVASCULAR GRAFT W/THE H&L-B ONE-SHOT

INTRO SYS腹主動脈瘤支架暨輸送系統(主體+分支體*2)*適應症見

備註

427500

CBC03AAA01M4 "MEDTRONIC"TALENT AAA STENT GRAFT W THE XCELERANT HYDRO

DELIVERY SYS腹主動脈支架系統(主體+分支體)*適應症請見備註

427500

CBC03AAA02CK ZENITH FLEX AAA ENDOVASCULAR GRAFT W/THE H&L-B ONE-SHOT

INTRODUCTION SYS腹主動脈瘤支架暨輸送系統-輔助配件*適應症

見備註

56686

CBC03AAA02M4 "MEDTRONIC"TALENT AAA STENT GRAFT W THE XCELERANT HYDRO

DELIVERY SYS(AORTIC,ILIAC EXT)腹主動脈支架系統(主動脈,

髂動脈延長段)*適應症見備註

56686

CBC03AAA03CK "COOK"ZENITH AAA ENDOVASCULAR GRAFT W/H&L-B ONE-SHOT

INTRO SYS腹主動脈瘤支架暨輸送導引系統(主體+分支體*2)*適應

症見備註

427500

CBC03AAA03M4 "MEDTRONIC"ENDURANT STENT GRAFT SYSTEM"美敦力"茵德倫覆膜

支架系統(主體+分支體)*適應症請見備註欄

427500

CBC03AAA04CK "COOK"ZENITH AAA ENDOVASCULAR GRAFT W/H&L-B ONE-SHOT

INTRO SYS腹主動脈瘤支架暨輸送導引系統-輔助配件*適應症見備

56686

CBC03AAA04M4 "MEDTRONIC"ENDURANT STENT GRAFT SYSTEM"美敦力"茵德倫覆膜

支架系統(輔助配件-主動脈.髂動脈延長段)*適應症請見備註欄

56686

CBC03AAA05M4 "美敦力"茵德倫第二代覆膜支架系統(主體+分支

體)"MEDTRONIC"ENDURANT Ⅱ STENT GRAFT SYSTEM

427500

CBC03AAA06M4 "美敦力"茵德倫第二代覆膜支架系統(AUI主體+分支

體)"MEDTRONIC"ENDURANT Ⅱ STENT GRAFT SYSTEM

427500

CBC03AAA07M4 "美敦力"茵德倫第二代覆膜支架系統(輔助配件-主動脈.髂動脈延

長段)"MEDTRONIC"ENDURANT Ⅱ STENT GRAFT SYSTEM

56686

CBC03AX101CK "COOK"ZENITH RENU AAA ANCILLARY GRAFT W/H&L-B ONE-SHOT

INTRO SYS腹主動脈瘤支架暨輸送導引系統(主體+分支體*2)*適應

症請見備註

427500

CBC03AZT01CK "COOK"ZENITH FLEX AAA ENDOVASCULAR GRAFT /W Z-TRAK INTRO

SYS主動脈瘤支架暨輸送導引系統(主體+分支體*2)*適應症見備註

427500

CBC03LEZT1CK "COOK"ZENITH FLEX AAA ENDOVASCULAR GRAFT W Z-TRAK INTRO

SYS"曲克"蘭尼斯腹主動脈瘤支架暨輸送導引系統-輔助配件(髂動

脈延長段)*適應症見備註欄

56686

CBC03PA23NGX "GORE"EXCLUDER AAA ENDOPROSTHESIS- AORTIC EXTENDER "戈爾"

易時固得腹主動脈瘤支架(腹主動脈瘤主體延伸支架)

56686

CBC03PC12NGX "GORE"EXCLUDER AAA ENDOPROSTHESIS(CONTRALATERAL LEG

ENDOPROSTHESIS)"戈爾"易時固得腹主動脈瘤支架(腹主動脈瘤對

側腳支架)

56686

CBC03PL10NGX "GORE"EXCLUDER AAA ENDOPROSTHESIS(ILIAC EXTENDER

ENDOPROSTHESIS)"戈爾"易時固得腹主動脈瘤支架(髂動脈分支延

伸體)

56686

CBC03PX23NGX "GORE"EXCLUDER AAA ENDOPROSTHESIS"戈爾"易時固得腹主動脈瘤

支架(腹主動脈瘤主體同側腳支架+對側腳支架+股動脈延伸支架)

427500

741

特材代碼 中英文名稱 支付點數-104/01/01

CBC03RX101CK "COOK"ZENITH RENU AAA ANCILLARY GRAFT WITH H&L-B ONE-SHOT

INTRODUCTION SYS腹主動脈瘤支架暨輸送導引系統-輔助配件(延

伸主體)*適應症請見備註欄

56686

CBC03ZFEN1CK "COOK"ZENITH FENESTRATED AAA ENDOVASCULAR GRAFT W/H&L-B

ONE-SHOT INTRO SYS腹主動脈瘤支架暨導引系統(主體+分支體

*2)*適應症見備註

427500

CBC03ZSLE1CK "COOK"ZENITH SPIRAL-Z AAA ILIAC LEG W/THE Z-TRAK

INTRODUCTION SYS腹主動脈瘤支架暨輸送系統-輔助配件*給付規

定見備註

56686

CBC0599999CK "COOK"ZENITH TX2 TAA ENDOVAS GRAFT W THE Z-TRAK PLUS

INTRO SYS胸主動脈支架手術出院後之滲漏特殊個案,得申報需另

修補之輔助配件*給付規定見備註

164666

CBC0599999GX "GORE" TAG THORACIC ENDOPROSTHESIS*胸主動脈支架手術出院後

之滲漏特殊個案,得申報需另修補之輔助配件*給付規定請見備註

164666

CBC0599999L1 "BOLTON"RELAY PLUS THORAC STENT GRAFT W A TRANSPORT

DELIVERY SYS胸主動脈支架手術出院後之滲漏個案,得申報需另

修補之輔助配件*給付規定見備註

164666

CBC0599999M4 "MEDTRONIC"VALIANT THORA STENT GRAFT W CAPTIVIA DELIVERY

SYS胸主動脈支架手術出院後之滲漏特殊個案,得申報需另修補之

輔助配件*給付規定見備註

164666

CBC05RE145L1 "BOLTON"RELAY PLUS THORAC STENT GRAFT W A TRANSPORT

DELIVERY SYS胸主動脈支架暨輸送系統*整組費用含門急診及當次

住院所有置放支架*給付規定見備註

468000

CBC05RELAYL1 "BOLTON"RELAY PLUS THORAC STENT GRAFT W A TRANSPORT

DELIVERY SYS胸主動脈支架暨輸送系統*整組費用含門急診及當次

住院所有置放支架*給付規定見備註

468000

CBC05TAA01CK "COOK"ZENITH TX2 TAA ENDOVASCULAR GRAFT W THE Z-TRAK PLUS

INTRODUCTION SYS胸主動脈支架*整組費用,含門急診及當次住院

所有置放支架*適應症見備註

468000

CBC05TAA02CK "COOK"ZENITH TX2 TAA ENDOVASCULAR GRAFT W PTO-FORM"曲克"

蘭尼思胸主動脈瘤支架*整組費用,含門急診及當次住院所有置放

支架*適應症見備註欄

468000

CBC05TG26NGX "戈爾" 胸主動脈瘤支架暨遞送系統 "GORE" TAG THORACIC

ENDOPROSTHESIS*整組費用,含門急診及當次住院所有置放支架*

給付規定請見備註欄

468000

CBC05TT26NGX "戈爾" 胸主動脈瘤支架暨遞送系統 "GORE" TAG THORACIC

ENDOPROSTHESIS*整組費用,含門急診及當次住院所有置放支架*

給付規定請見備註欄

468000

CBC05TX201CK "COOK"ZENITH TX2 DISSECTION ENDOVAS GRAFT W PTO-

FORM+INTRO SYSTEM"曲克"蘭尼思胸主動脈剝離血管支架及其輸送

系統*整組費用,含門急診及當次住院置放支

468000

CBC05VLCAPM4 "MEDTRONIC"VALIANT THORACIC STENT GRAFT W THE CAPTIVIA

DELIVERY SYS范倫特胸主動脈支架系統。整組含門、急診及當次

住院所有支架*給付規定見備註。

468000

CBC05VLTAAM4 "MEDTRONIC"VALIANT THORACIC STENT GRAFT W THE XCELERANT

DELIVERY SYS胸主動脈支架系統*整組費用,含門急診及當次住院

所有置放支架*適應症見備註

468000

CBP0103012UZ TURQUOISE PTCA BALLOON DILATATION CATHETER D 1.5MM:4.5MM

綠松石冠狀動脈氣球擴張導管

6843

CBP010MEGASB "BOSTON SCIENTIFIC"OMEGA MONORAIL PTCR CORONARY STENT

SYSTEM "波士頓科技"*亞美加單軌冠狀動脈支架系統*適應症請見

備註欄

16293

742

特材代碼 中英文名稱 支付點數-104/01/01

CBP01103TBRB "ORBUSNEICH"SAPPHIRE CORONARY DILATATION CATHETER

1.5MM:4.0MM 10MM:30MM塞費爾冠狀動脈球曩擴張術導管

6843

CBP01104TBRB "ORBUSNEICH"SAPPHIRE NC CORONARY DILATATION CATHETER神飛

冠狀動脈球囊擴張術導管

6843

CBP01105TBRB "ORBUSNEICH"SAPPHIRE II CORONARY DILATATION CATHETER"奧

爾"第二代塞費爾冠狀動脈球曩擴張術導管

6843

CBP01106TBRB "ORBUSNEICH"SAPPHIRE NC CORONARY DILATATION CATHETER"奧

爾"神飛冠狀動脈球囊擴張術導管

6843

CBP0112510UV INVADER CTO CORONARY ANGIOPLASTY BALLOON CATHETER入侵者慢

性全閉塞氣球擴張導管

6843

CBP011NTEGM4 "MEDTRONIC"INTEGRITY RAPID EXCHANGE CORONARY STENT

SYSTEM"美敦力"英泰爾快速交換冠狀動脈血管支架系統*適應症請

見備註欄

16293

CBP0122545SB "BOSTON SCIENTIFIC"OMEGA MONORAIL PTCR CORONARY STENT

SYSTEM"波士頓科技"亞美加單軌冠狀動脈支架系統*給付規定請見

備註欄

16293

CBP012535SHC HELISTENT CORONARY STENT W/DELIVERY SYSTEM *適應症請見備

註欄(原文號910034694)

16293

CBP012540SHC HELISTENT CORONARY STENT W/DELIVERY SYSTEM *適應症請見備

註欄(原文號910034694)

16293

CBP0138938SB LIBERTE MONORAIL CORONARY STENT SYSTEM*適應症請見備註欄 16293

CBP0150200BB COROFLEX CORONARY STENT SYSTEM(W/DELIVERY SYSTEM)*適應症

請見備註欄

16293

CBP0150201BB COROFLEX CORONARY STENT SYSTEM(W/DELIVERY SYSTEM)*適應症

請見備註欄

16293

CBP0150212BB "B.BRAUN"SEQUENT PTCA CATHETER"柏朗"適可穩經皮穿刺汽球擴

張導管

6843

CBP0182926AB ABBOTT FLEXMASTER F1 CORONARY STENT WITH DELIVERY SYSTEM

適應症請見備註欄

16293

CBP01AU729RB "ORBUSNEICH"AZULE CORONARY STENT DELIVERY SYSTEM"奧爾"雅

助冠狀動脈血管支架輸送系統*適應症請見備註欄

16293

CBP01BL729RB "ORBUSNEICH"BLAZER CORONARY STENT DELIVERY SYSTEM布雷冠狀

動脈血管支架輸送系統*適應症請見備註欄

16293

CBP01BLUE1BB "B.BRAUN"COROFLEX BLUE CORONARY STENT SYSTEM普弩冠狀動脈

血管支架系統*適應症請見備註欄

16293

CBP01BLUE2BB "B.BRAUN"COROFLEX BLUE CORONARY STENT SYSTEM普弩冠狀動脈

血管支架系統

16293

CBP01CSUNATM TSUNAMI CORONARY STENT SYSTEM(WITH BALLOON)*適應症請見備

註欄

16293

CBP01CT480Y0 "擴適達"高斯喜通冠狀動脈氣球導管"ACROSTAK"ACROSS CTO PTCA

BALLOON CATHETER

6843

CBP01DFX08JF "DURAFLEX"CORONARY STENT SYSTEM"杜拉佛克斯"冠狀動脈血管支

架系統支架 支架長度8MM:25MM 支架內徑2.5MM:4.0MM*適應症請

見備註欄

16293

CBP01DVW35AS "ASAHI"DOUVAN PTCA DILATATION CATHETER"朝日"朵凡氣球擴張

導管

6843

CBP01FCBRVF2 "INVATEC"FALCON BRAVO PTCA BALLOON CATHETER獵鷹柏拉弗冠狀

動脈氣球導管 直徑1.5:4.0MM BALLOON LENGTH

10,14,20,30,40MM CATHETER LENGTH 145CM

6843

CBP01FF22BF2 "INVATEC"FALCON FORTE PTCA BALLOON CATHETER冠狀動脈氣球導

管直徑2.00MM:4.00MM,4.50MM,5.00MM,長度145CM

6843

CBP01FLC10F2 "INVATEC"FALCON CTO PTCA BALLOON CATHETER冠狀動脈氣球導管 6843

743

特材代碼 中英文名稱 支付點數-104/01/01

CBP01GAZSTBS "BIOSENSORS"GAZELLE CORONARY STENT SYSTEM冠狀動脈內支架系

統*適應症請見備註欄

16293

CBP01KANMETM "TERUMO"KANAME COBALT-CHROMIUM CORONARY STENT SYSTEM"泰爾

茂"凱樂鎂冠狀動脈血管支架系統*適應症請見備註欄

16293

CBP01ML8STAB "ABBOTT"MULTI-LINK 8 CORONARY STENT SYSTEM"亞培"第八代冠

狀動脈支架系統 D 2.25:4.00MM L:8MM:38MM*適應症請見備註欄

16293

CBP01MLVSTAB "ABBOTT"MULTI-LINK VISION RX CORONARY STENT SYSTEM"亞培"

冠狀動脈支架系統*適應症請見備註欄

16293

CBP01PWRLNBS "BIOSENSORS"POWERLINE PTCA CATHETER經皮冠狀動脈成形術球囊

導管

6843

CBP01TRKNCAB "ABBOTT"NC TREK RX CORONARY DILATATION CATHETER"亞培"恩希

快克冠狀動脈氣球擴張導管

6843

CBP01TSUG2TM "TERUMO"TSUNAMI CORONARY STENT SYSTEM冠狀動脈血管支架*適

應症請見備註欄

16293

CBP01TSUG3TM "TERUMO"TSUNAMI CORONARY STENT SYSTEM冠狀動脈血管支架系統

*適應症請見備註欄

16293

CBP01TSUGDTM "TERUMO"TSUNAMI CORONARY STENT SYSTEM冠狀動脈血管支架*適

應症請見備註欄

16293

CBP01TSUNATM TSUNAMI CORONARY STENT SYSTEM(WITH BALLOON)*適應症請見備

註欄

16293

CBP01V1S1NAB "ABBOTT"MULTI-LINK VISION RX CORONARY STENT

SYSTEM2.75MM:4MM 8MM:28MM適見冠狀動脈支架系統*適應症請見

備註欄

16293

CBP01V7844AB "ABBOTT"MULTI-LINK VISION RX CORONARY STENT SYSTEM

2.75:4.00MM 8:28MM"亞培"冠狀動脈支架系統*適應症請見備註欄

16293

CBP01VYGNCAB "ABBOTT"VOYAGER NC CORONARY DILATATION CATHETER航行家恩希

冠狀動脈擴張導管2.00MM:5.00MM 6MM:25MM

6843

CBP01ZETANAB "ABBOTT"MULTI-LINK RX ZETA CORONARY STENT SYSTEM智達冠狀

動脈支架系統*適應症請見備註欄

16293

CBP02NCSP1M4 "MEDTRONIC"NC SPRINTER RAPID EXCHANGE BALLOON DILATATION

CATHETER"美敦力"史賓特高壓快速交換氣球擴張導管

6843

CBP02NCSPRM4 "MEDTRONIC"NC SPRINTER RAPID EXCHANGE BALLOON DILATATION

CATHETER"美敦力"史賓特高壓快速交換氣球擴張導管

6843

CBP02R5A85KE FORTIS II PTCA CATHETER 2.50MM:4.50MM佛緹斯冠狀動脈成型術

導管

6843

CBP02R7R7FKE "KANEKA"IKAZUCHI RAPID EXCHANGE PTCA BALLOON CATHETER雷快

速抽換冠狀動脈氣球導管

6843

CBP02R7REVKE "KANEKA"PTCA CATHETER IKAZUCHI REV "卡內卡"冠狀動脈氣球導

6843

CBP02SPR32M4 MEDTRONIC SPRINTER OVER-THE-WIRE BALLOON DILATATION

CATHETER 1.5MM:4.0MM 6MM:30MM

6843

CBP02SPRL1M4 "MEDTRONIC"SPRINTER LEGEND RAPID EXCHANGE BALLOON

DILATATION CATHETER快速交換氣球擴張導管

6843

CBP02SPRLGM4 "MEDTRONIC"SPRINTER LEGEND RAPID EXCHANGE BALLOON

DILATATION CATHETER (D:1.25MM:4MM,L:6MM:30MM)

6843

CBP02SPRNTM4 SPRINTER RAPID EXCHANGE BALLOON DILATION CATHETER 6843

CBP031016TTM "TERUMO"RYUJIN PLUS PTCA DILATATION CATHETER琉均柏柆思冠

狀動脈氣球擴張導管

6843

CBP031215NTM RYUJIN PTCA DILATATION CATHETER RX-1 6843

CBP0314038TM TERUMO RYUJIN PLUS PTCA DILATATION CATHETER 6843

744

特材代碼 中英文名稱 支付點數-104/01/01

CBP0314039TM TERUMO RYUJIN PLUS PTCA DILATATION CATHETER 6843

CBP0318634TM RYUJIN PLUS OTW PTCA DILATATION CATHETER冠狀動脈氣球擴張

導管

7809

CBP032015NTM RYUJIN PTCA DILATATION CATHETER RX-1 6843

CBP0337910SB "BOSTON SCIENTIFIC"MAVERICK XL MONORAIL PTCA DILATATION

CATHETER 馬文瑞克氣球擴張導管

6843

CBP0338080SB QUANTUM MAVERICK MONORAIL DILATION CATHETER(PTCA BALLOON

CATHETER)

6843

CBP0338081SB "BOSTON SCIENTIFIC"QUANTUM MAVERICK PTCA DILATATION

CATHETER D 2.0:5.0MM L8:30MM冠狀動脈擴張導管

7809

CBP0338928SB MAVERICK 2 MONORAIL BALLOON CATHETER *自92.7.1改按條支付 6843

CBP0338960SB "BOSTON SCIENTIFIC"APEX OTW PTCA DILATATION CATHETER氣球

擴張導管

7809

CBP0338961SB "BOSTON SCIENTIFIC"APEX PTCA DILATATION CATHETER氣球擴張

導管

6843

CBP03389XXSB "BOSTON SCIENTIFIC"APEX MONORAIL PTCA DILATATION CATHETER

D 1.50MM:5.0MM L8MM:40MM艾佩斯單軌氣球擴張導管

6843

CBP0339124SB "BOSTON SCIENTIFIC"NC QUANTUM APEX PTCA DILATATION

CATHETER(MONORAIL)康騰艾佩斯氣球擴張導管2.0:5.0MM 6:30MM

6843

CBP0339125SB "BOSTON SCIENTIFIC"NC QUANTUM APEX PTCA DILATATION

CATHETER(OTW)康騰艾佩斯氣球擴張導管2.0:5.0MM 6:30MM

7809

CBP035265NAB "ABBOTT"CROSSSAIL CORONARY DILATATION CATHETER可思爾冠狀

動脈擴張導管

6843

CBP03701XNCD "CORDIS"DURA STAR RX PTCA DILATATION CATHETER杜芮星冠狀動

脈擴張導管

6843

CBP03801XNCD "CORDIS"FIRE STAR RX PTCA DILATATION CATHETER法爾星冠狀動

脈擴張導管

6843

CBP03ACRHPY0 "ACROSTAK"ACROSS HP PTCA BALLOON CATHETER"擴適達"高斯高壓

冠狀動脈氣球導管

6843

CBP03CT481Y0 "擴適達"高斯喜通冠狀動脈氣球導管"ACROSTAK"ACROSS CTO PTCA

BALLOON CATHETER(OTW)

7809

CBP03DCRK1TM "TERUMO"TAZUNA PTCA DILATATION CATHETER"泰爾茂"鈦速納冠狀

動脈氣球擴張導管

6843

CBP03EMERMSB "BOSTON SCIENTIFIC"EMERGE PTCA DILATATION

CATHETER(MONORAIL) D:1.20MM:4.00MM L:8MM:30MM"波士頓科技"

宜加冠狀動脈擴張導管

6843

CBP03EMERTSB "BOSTONSCIENTIFIC"EMERGEPTCADILATATIONCATHETERD:1.20MM:4.

00MML:8MM:30MM"波士頓科技"宜加同軸冠狀動脈擴張導管

7809

CBP03EP75RCD "CORDIS"EMPIRA NC RX PTCA DILATATION CATHETER"考迪斯"安博

冠狀動脈擴張導管

6843

CBP03EP85RCD "CORDIS"EMPIRA RX PTCA DILATATION CATHETER"考迪斯"安博冠

狀動脈擴張導管

6843

CBP03EPNCRCD "CORDIS"EMPIRA NC RX PTCA DILATATION CATHETER"考迪斯"安博

冠狀動脈擴張導管

7547

CBP03H1RU1TM "TERUMO"HIRYU PTCA DILATATION CATHETER 2.25:5.0MM 6:20MM

冠狀動脈氣球擴張導管

6843

CBP03M3115AB JOCATH MERCURY PTCA CATHETER 6843

CBP03R2A15KE KANEKA RX CATHETER AEROCROSS FIGHTER 1.5MM:4.0MM

15MM:20MM

6843

CBP03R4K15KE KANEKA RX CATHETER OTTIMO 1.5MM:4.0MM 10MM:20MM 6843

CBP03RAF25HC "HEXACATH"RAFALE PTCA DILATATION CATHETER旋風冠狀動脈氣球

擴張導管

6843

745

特材代碼 中英文名稱 支付點數-104/01/01

CBP03SL0TWM4 "MEDTRONIC"SPRINTER LEGEND OVER-THE-WIRE BALLOON

DILATATION CATHETER同軸導線球囊擴張導管

7809

CBP03TREK1AB "ABBOTT"TREK AND MINI TREK RX CORONARY DILATATION

CATHETER"亞培"快克/小快克冠狀動脈擴張導管

6843

CBP03TREK2AB "ABBOTT"TREK AND MINI TREK OTW CORONARY DILATATION

CATHETER"亞培"快克/小快克冠狀動脈氣球擴張導管

7809

CBP03V0TWNAB "ABBOTT"VOYAGER OTW CORONARY DILATATION CATHETER莫雅佳甌

第冠狀動脈擴張導管

7809

CBP03V391NAB "ABBOTT"VOYAGER RX CORONARY DILATATION CATHETER莫雅佳冠狀

動脈擴張導管

6843

CBP0510128AB "亞培"冠狀動脈包覆支架"ABBOTT"GRAFTMASTER RX CORONARY

STENT GRAFT SYSTEM(WITH DELIVERY SYSTEM)*給付規定請見備註

49500

CBP05210CGAB "ABBOTT"JOSTENT GRAFTMASTER CORONARY STENT GRAFT(WITH

DELIVERY SYSTEM)*適應症請見備註欄.

49500

CBP06ELUT1AB "ABBOTT"XIENCE V EVEROLIMUS ELUTING CORONARY STENT SYSTEM

艾諾莉茉斯冠狀動脈塗藥支架,部分給付品項,適應症見備註欄

,並註明其禁忌症勿使用。

16293

CBP06ELUT1BB COROFLEX PLEASE PACLITAXEL-ELUTING CORONARY STENT SYSTEM

部分給付品項紫杉醇釋放型冠狀動脈血管支架*適應症見備註,並

註明其禁忌症勿使用。

16293

CBP06ELUT1BK "BIOTRONIK"ORSIRO SIROLIMUS ELUTING CORONARY STENT

SYSTEM"百多力"歐禧樂西羅莫司冠狀動脈塗藥支架系統(自付差額

品項)

16293

CBP06ELUT1BS "BIOSENSORS"BIOMATRIX DRUG ELUTING CORONARY STENT SYS釋放

型冠狀動脈支架系統部分給付品項*適應症見備註,並註明禁忌症

不可使用。

16293

CBP06ELUT1HC "HEXACATH"PREMOUNTED CORONARY STENT HELISTENT TITAN2"海斯

凱"泰坦2(塗層)冠狀動脈血管支架*部分給付品項,適應症見備註

欄,並註明禁忌症不可用。

16293

CBP06ELUT1RB "ORBUS"GENOUS R STENT傑納斯冠狀動脈血管支架輸送系統

2.5MM:4.0MM 9MM:33MM 部分給付品項.適應症請見備註欄.並註明

其禁忌症不可使用.

16293

CBP06ELUT1TM "TERUMO"NOBORI DRUG STENT SYSTEM 2.5MM:3.5MM 8MM:28MM冠狀

動脈塗藥支架 部分給付品項*適應症請見備註,並註明其禁忌症

不可使用。

16293

CBP06ELUT1YV "CID"JANUS OPTIMA CARBOSTENT W DELIVERY SYS"喜安汀"真神奧

普帝馬塗藥冠狀動脈血管支架,部分給付品項*給付規定見備註欄

,並註明其禁忌症不可使用。

16293

CBP06ELUT2BS "BIOSENSORS"BIOMATRIX FLEX DRUG ELUTING CORONARY STENT

SYS拜美翠弗雷絲藥物釋放冠狀動脈支架,部分給付品項*適應症

見備註,並註明禁忌症不可用。

16293

CBP06ELUT2SB TAXUS LIBERTE MONORAIL PACLITAXEL-ELUTING CORONARY STENT

SYSTEM 2.25:3.5MM 8:32MM.部分給付品項.適應症請見備註欄.並

註明其禁忌症不可使用

16293

CBP06ELUT3AB "ABBOTT"XIENCE PRIME EVEROLIMUS ELUTING CORONARY STENT

SYSTEM冠狀動脈塗藥支架系統部份給付品項*適應症請見備註欄,

並註明其禁忌症不可使用。

16293

CBP06ELUT3M4 ENDEAVOR RESOLUTE ZOTAROLIMUS-ELUTING CORONARY STENT

SYSTEM釋放型冠狀動脈支架系統,部分給付品項,適應症見備註

,並註明其禁忌症不可用。

16293

CBP06ELUT3SB "BOSTON SCIENTIFIC"TAXUS LIBERTE LONG MONORAIL

PACLITAXEL-ELUTING CORONARY STENT SYS紫杉醇釋放型冠狀動脈

支架*適應證見備註

16293

746

特材代碼 中英文名稱 支付點數-104/01/01

CBP06ELUT4AB "ABBOTT"XIENCE XPEDITION EVEROLIMUS ELUTING CORONARY

STENT SYSTEM"亞培"賽恩斯征艾諾莉茉斯冠狀動脈塗藥支架系統

(自付差額品項)

16293

CBP06ELUT4M4 "MEDTRONIC"ENDEAVOR RESOLUTE ZOTAROLIMUS-ELUTING CORONARY

STENT SYS釋放型冠狀動脈支架系統。部分給付品項,適應症見備

註,並註明其禁忌症勿用。

16293

CBP06ELUT4SB "BOSTON SCIENTIFIC"TAXUS ELEMENT PACLITAXEL-ELUTING

CORONARY STENT SYS冠狀動脈塗藥支架系統*部分給付品項,適應

症見備註,並註明禁忌症不可用

16293

CBP06ELUT5M4 "MEDTRONIC"RESOLUTE INTEGRITY ZOTAROLIMUS-ELUTING

CORONARY STENT SYS"美敦力"釋放型冠狀動脈支架*部分給付,給

付規定見備註,並註明禁忌症勿用

16293

CBP06ELUT5SB "BOSTON SCIENTIFIC"PROMUS ELEMENT EVEROLIMUS-ELUTING

CORONARY STENT SYS冠狀動脈塗藥支架系統*部分給付品項,適應

症見備註,並註明禁忌症不可用

16293

CBP06ELUT6SB "波士頓科技"博謨適艾勒門艾諾莉茉斯冠狀動脈塗藥支架系

統"BOSTON SCIENTIFIC"PROMUS ELEMENT PLUS EVEROLIMUS-

ELUTING CORONARY STENT SYSTEM 部分給付品

16293

CBP0750222BB "B.BRAUN"SEQUENT PLEASE PACLITAXEL-RELEASING RAPID

EXCHANGE PTCA BALLOON CATHETER"柏朗"喜寬普利斯紫杉醇釋放

型冠狀動脈氣球導管*適應證見備註

47000

CBS01RASHKM4 "MEDTRONIC"RASHKIND BALLOON SEPTOSTOMY CATHETER"美敦力"球

囊中膈切除術導管

9000

CBS01SPTXXN5 "NUMED"Z-5 ATRIOSEPTOSTOMY CATHETER 9000

CBS029ASDAG6 "AGA"AMPLATZER SEPTAL OCCLUDER 4:20MM,22MM:38MM,40MM"銨積

維"安普拉茲心房關閉器

138000

CBS029ASDNG6 "AGA"AMPLAATZER SEPTAL OCCLUDER WITH DELIVERY SYSTEM"銨積

維"安普拉茲心房關閉器※給付規定請見備註欄

143762

CBS029CR19G6 AMPLATZER CRIBRIFORM OCCLUDER安普拉茲多孔心房中膈關閉器*

給付規定請見備註欄

138000

CBS029DEL5G6 "AGA"AMPLATZER DELIVERY SYSTEM 5-9FR*安普拉茲遞送導管系統

*給付規定請見備註欄(自981001起適應症代碼由A213-4更改為

A213-5)。

12000

CBS029DEL9G6 "AGA"AMPLATZER DELIVERY SYSTEM 9FR,10FR,12FR"銨積維"安普

拉茲遞送導管系統*給付規定請見備註欄

12000

CBS029DELNG6 "AGA"AMPLATZER DELIVERY SYSTEM 6:8FR*"銨積維"安普拉茲遞送

導管系統*給付規定請見備註欄

12000

CBS029DELTG6 "AGA"AMPLATZER DELIVERY SYSTEM"銨積維"安普拉茲遞送導管系

統5F:10F,12:13F*給付規定請見備註欄

12000

CBS029SZB2G6 AMPLATZER SIZING BALLOON II 安普拉茲測量氣球導管*給付規定

請見備註欄

14476

CBS029TVEXG6 "AGA"AMPLATZER TORQ VUE EXCHANGE SYSTEM安普拉茲托克交換導

管系統6F:12F*給付規定請見備註欄

12000

CBS02F2ASDJ7 "奧圖"菲雷心房中隔補綴器"OCCLUTECH"FIGULLA FLEX Ⅱ ASD *

給付規定請見備註欄

138000

CBS02FASDNJ7 "OCCLUTECH"FIGULLA ASD OCCLUDERS"奧圖"心房中隔補綴器*適應

症請見備註欄

138000

CBS02FX2PFJ7 "奧圖"菲雷卵圓孔補綴器"OCCLUTECH"FIGULLA FLEX ⅡPFO 138000

CBS02PFC98G6 "安普拉茲"卵圓孔關閉器"AMPLATZER" PFO OCCLUDER 138000

CBS02PTSXXN5 PTS SIZING CATHETER 20:40MM 3:5CM 80CM 0.035" GUIDE WIRE

※適應症請見備註欄

14476

CBS02TV454G6 AMPLATZER TORQVUE 45X45 DELIVERY SHEATH安普拉茲托菲遞送導

管*給付規定請見備註欄

12000

747

特材代碼 中英文名稱 支付點數-104/01/01

CBS02TVLA1G6 AMPLATZER TORQVUE LA DELIVERY SHEATH安普拉茲托菲樂爾遞送

導管*給付規定請見備註欄

12000

CBS02TVLP4G6 AMPLATZER TORQVUE LP DELIVERY SYSTEM安普拉茲托菲遞送導管

系統*給付規定請見備註欄

12000

CBS02TVLPCG6 AMPLATZER TORQVUE LP CATHETER 安普拉茲特維力普導管*給付規

定請見備註欄

12000

CBS039PDAAG6 "AGA"AMPLATZER DUCT OCCLUDER"銨積維"安普拉茲開放性動脈導

管關閉器*適應症請見備註欄

66941

CBS03AD029G6 安普拉茲開放性動脈導管關閉器第二代 AMPLATZER DUCT

OCCLUDERⅡ

66941

CBS03AD0ASG6 安普拉茲艾絲開放性動脈導管關閉器第二代 AMPLATZER DUCT

OCCLUDER Ⅱ ADDITIONAL SIZES *給付規定請見備註欄

66941

CBS04407XXST "聖猷達" 房中膈穿刺針"SJM" BRK TRANSSEPTAL NEEDLE 6379

CBS059AVP2G6 "AMPLATZER"VASCULAR PLUG II 3MM:22MM"安普拉茲"II型血管塞

(含遞送導管)

24990

CBS059AVP4G6 "AMPLATZER"VASCULAR PLUG&DELIVERY SYSTEM 4MM:16MM血管塞含

遞送導管

22750

CBT020712NAR ARROW BALLOON WEDGE-PRESSURE CATHETERS 4:8FR 60:110CM "亞

諾"肺動脈楔壓導管(順流導管雙腔)

1709

CBT022014LPU PULSIOCATH CONTINUOUS CARDIAC OUTPUT THERMODILUTION

CATHETER

5775

CBT022014NPU PULSIOCATH THERMODILUTION CATHETERS(PICCO2) 普新卡熱稀釋

導管(含CATHETER+NITINOL GUIDE WIRE)

5775

CBT022015LPU "PULSION"PULSIOCATH THERMODILUTION CATHETER 5775

CBT0405000AR "ARROW"BALLOONTHERMODILUTION CATHETERS(HEPARIN-COATED)

FOUR LUMEN"亞諾"熱稀釋順流導管

2143

CBT0405050AR "ARROW"BALLOONTHERMODILUTION CATHETERS(HEPARIN-COATED) 5

LUMEN"亞諾"熱稀釋順流導管

2143

CBT0407044AR "ARROW" THERMODILUTION BALLOON CATHETER(4 LUMEN) 4FR 75CM

"亞諾"熱稀釋順流導管(兒童)

1962

CBT0407055AR "ARROW"BALLOON THERMODILUTION CATHETER 4FRX75CM

5FRX80CM(HEPARIN COATED) 4 LUMENS "亞諾"熱稀釋順流導管

2143

CBT0407365AR "ARROW"BALLOON THERMODILUTION CATHETER 6FRX80CM;110CM

7FRX110CM(HEPARIN COATED) 4 LUMENS "亞諾"熱稀釋順流導管

2143

CBT0407367AR "ARROW" THERMODILUTION BALLOON CATHETER(4 LUMEN) 7FR

110CM "亞諾"熱稀釋順流導管

1610

CBT04131HVED EDWARDS SWAN-GANZ THERMODILUTION CATHETER 4LUMEN

7FR,W/AMC THROMBOSHIELD COATING

2143

CBT04132F5ED "EDWARDS"SWAN-GANZ THERMODILUTION CATHETER 4LUMEN 5FR

75CM(兒童用)史望康熱稀釋導管

1962

CBT041704HBS THERMODILUTION CATHETER 測輸量順流導管(四腔)7fr 110cm 1610

CBT04254NDBS THERMODILUTION CATHETER 5FR 4 LUMEN, 6FR 4 LUMEN ,7FR 4

LUMEN 順流導管(四腔)

1962

CBT0445080AG "ARGON"CRITICATH THERMODILUTION CATHETERS(HEPARIN

COATING) 4 LUMEN 5F 80CM"愛琅"熱稀釋導管

2143

CBT0445110AG "ARGON"CRITICATH THERMODILUTION CATHETERS(HEPARIN

COATING)4 LUMEN 5F 110CM"愛琅"熱稀釋導管

2143

CBT045107SAG "ARGON"CRITICATH THERMODILUTION CATHETERS(HEPARIN

COATING)4 LUMEN 7FR 110CM"愛琅"熱稀釋導管

2143

CBT0493137ED SWAN-GANZ THERMODILUTION CATHETER FOUR LUMEN/AMC

THROMBOSHIELD(HEPARIN)熱稀釋導管

2143

CBT04C144HED "EDWARDS"SWAN-GANZ THERMODILUTION CATHETER 4 LUMEN 7FR

W/AMC THROMBOSHIELD COATING

2143

748

特材代碼 中英文名稱 支付點數-104/01/01

CBT04H5107AG "ARGON"CRITICATH THERMODILUTION CATHETERS(HEPARIN

COATING)4 LUMEN 7FR 110CM"愛琅"熱稀釋導管

2143

CBT05175HDBS THERMODILUTION CATHETER 7.5FR 5 LUMEN 2143

CBT0550324U2 "愛西優"流量導向導管/測血氧"ICU"FLOW-DIRECTED CATHETERS 7148

CBT055507SAG "ARGON"CRITICATH THERMODILUTION CATHETERS(HEPARIN

COATING)5 LUMEN 7.5FR 110CM"愛琅"熱稀釋導管

2143

CBT0574175ED SWAN GANZ OXIMETRY AND VOLUMETRIC CATHETER*適應症請見備註

7148

CBT05831HFED "EDWARDS"SWAN-GANZ THERMODILUTION CATHETERS 5 LUMEN 7FR

W/AMC THROMBOSHIELD COATING史望康熱稀釋管

2143

CBT05831HVED EDWARDS SWAN-GANZ THERMODILUTION CATHETER 5LUMEN

7.5FR,W/AMC THROMBOSHIELD COATING

2143

CBT0617775ED SWAN GANZ CONTINUOUS CARDIAC /END DIASTOLIC VOLUME

THERMODILUTION CATHETER CCO/cEDV*適應症請見備註欄

5756

CBT0652510U2 "愛西優"流量導向導管"ICU"FLOW-DIRECTED CATHETERS OPTI-Q

SVO2/CCO CATHETER

6548

CBT0652515U2 "愛西優"流量導向導管"ICU"FLOW-DIRECTED CATHETERS 5886

CBT06746F8ED SWAN GANZ CONTINUOUS CARDIAC /END DIASTOLIC VOLUME

THERMODILUTION CATHETER CCO/SVO2/VIP*適應症請見備註欄

6548

CBT06757HFED SWAN GANZ CONTINUOUS CARDIAC /END DIASTOLIC VOLUME

THERMODILUTION CATHETER CCO/SVO2/EDV/VIP*適應症請見備註欄

6548

CBT0677475ED "EDWARDS"SWAN GANZ CONTINUOUS CARDIAC OUTPUT/END

DIASTOLIC VOLUME THERMODILUTION CATH CCO/SVO2/CEDV熱稀釋

導管*適應症見備註

6548

CBT06777F8ED SWAN GANZ CONTINUOUS CARDIAC /END DIASTOLIC VOLUME

THERMODILUTION CATHETER CCO/SVO2/CEDV/VIP*適應症請見備註

6548

CBT06831HFED "EDWARDS"SWAN-GANZ THERMODILUTION CATHETERS 6 LUMEN 7FR

W/AMC THROMBOSHIELD COATING史望康熱稀釋管

2924

CBT07MHD68ED FLOTRAC SENSOR KIT W/60" OR 84" PRESSURE TUBING弗羅威克感

應器組

6138

CBT07MHDAZED FLOTRAC SENSOR KIT W/60" PRESSURE TUBING & VAMP ADULT

SYSTEM 弗羅威克感應器組附血液管理保護系統

6138

CBT08VLV8RED "EDWARDS"VOLUME VIEW SET(VOLUME VIEW SENSOR W TUBING

SET+FEMORAL CATH KIT+VENOUS INJECTATE KIT W DPT) "愛德華"

體積監視套組

7068

CBV020MS2NTR PTMC BALLOON CATHETER 33700

CBV02PDCXXN5 PERCUTANEOUS TRANSLUMINAL VALVULOPASTY (PTV)CATHETER

4.0MM:30.0MM,2.0CM:8.0CM

12301

CBV02PDZXXN5 NUMED Z-MED II PERCUTANEOUS TRANSULUMINAL VALVULOPLASTY

(PTV)CATHETER 4:30MM 2:10CM 100CM

12301

CBV02PTVNXN5 "NUMED"NUCLEUS PTV DILATATION CATHETER 二尖瓣及主動脈瓣氣

球擴張導管

33700

CCC030980EHA THERAPEUTIC AND AUTOLOGOUS ERYTHROPHERESIS SET 3014

CCC030981EHA THERAPEUTIC AND AUTOLOGOUS ERYTHROPHERESIS SET 3014

CCC03BT271YT "SAFETRAN"BLOOD COMPONENTS APHERESIS"笙創"血液成份分離器

(離心杯275CC+體外血液迴路管)

3014

CCC03BX051YT "SAFETRAN"BLOOD COMPONENTS APHERESIS"笙創"血液成份分離器

(離心杯50CC+體外血液迴路管)

3014

CCC03BX221YT "SAFETRAN"BLOOD COMPONENTS APHERESIS"笙創"血液成份分離器

(離心杯225CC+體外血液迴路管)

3014

CCC03BX371YT "SAFETRAN"BLOOD COMPONENTS APHERESIS"笙創"血液成份分離器

(離心杯375CC+體外血液迴路管)

3014

749

特材代碼 中英文名稱 支付點數-104/01/01

CCC110971EHA PERIPHERAL BLOOD STEM CELLS SET 3622

CCC1300200HA 自體血液回收系統管套CELL SAVER COLLECTION RESERVOIR ※適

應症請見備註欄

3900

CCC13BT894R5 "SORIN"AUTOTRANSFUSION RESERVOIR SET自動輸血組儲血器*適

應症請見備註欄

3900

CCC1400260HA CELL SAVER 5 FAST PACK 225ML  體血液收集洗滌套※適應症請

見備註欄

7260

CCC1400261HA "漢尼帝克"自體血液回收系統管套" HAEMONETICS " CELL SAVER

SET FOR AUTOTRANSFUSION SYSTEM 70ML BOWL *適應症請見備註

7260

CCC1400265HA "漢尼帝克"自體血液回收系統管套"HAEMONETICS" CELL SAVER

SET FOR AUTOTRANSFUSION SYSTEM-125ML BOWL *給付規定請見備

註欄

7260

CCC1400ATFVB AUTOTRANSFUSION FAST START KIT(AUTOTRANSFUSION

SET+AUTOTRANSFUSION RESERVOIR+ATS SUCTION LINE)*適應症請

見備註欄

7260

CCC1400CSEHA "漢尼帝克"依利特自體輸血系統管套"HAEMONETICS" CELL SAVER

ELITE SYSTEM DISPOSABLE SET-70,125,225ML BOWL *給付規定請

見備註欄

7260

CCC1402001M4 AUTOLOG WASH KIT*適應症請見備註欄 7260

CCC14745E5R5 "SORIN"AUTOTRANSFUSION KITS FOR ELECTA(WASH

SET+AUTOTRANSFUSION RESERVOIR SET+LINE)依雷塔專用自體輸血

組*適應症請見備註欄

7260

CCC1474E55R5 "SORIN"WASH SET血液洗淨組*適應症請見備註欄 3974

CCC1520503AH "ATRIUM"OCEAN WATER SEAL CHEST DRAINS海洋自體血液回收胸腔

引流儲血器(單管回流式)*適應症請見備註欄

3882

CCC1520523AH "ATRIUM"OCEAN WATER SEAL CHEST DRAINS海洋自體血液回收胸腔

引流儲血器(雙管回流式)*適應症請見備註欄

4158

CDCC243418PM C.S.F CARDIAC CATHETER REDUCED TIP BARIUM IMPREGNATED 2418

CDCC2PCS01CK "曲克" 心包引流管組"COOK"PERICARDIOCENTESIS SET 2300

CDCC2PCS02CK "曲克"心包引流管組"COOK" PERICARDIOCENTESIS SET 1652

CDCC2PPD01CK 〝曲克〞費曼胸膜腔/心包積氣引流組"COOK"FUHRMAN

PLEURAL/PNEUMOPERICARDIAL DRAINAGE SET

2000

CDCG20RCA1RC "RANFAC"INTRODUCTION DRAINAGE CATHETER"仁斐"導入及引流導

管(術中膽管攝影導管)

460

CDCS126101CM ACCU-FLO CSF RESERVOIR(含CONNECTOR,CATHETER) 3500

CDD010212NFM SILICONE T DRAINAGE TUBE W/EYES 12:24FR 205

CDD010810NFM SILICONE T-DRAINGE TUBE 8#:24# 205

CDD012014NFM SILICONE Y DRAINAGE TUBE 14:24FR 205

CDD0133008KK SILICON T-TUBE 5M/M:13M/M (TRACHEAL) 2825

CDD0200114FM SILICONE ABDOMINAL SUMP DRAIN 14" 7MMX13MM 273

CDD0200120FM SILICONE ABDOMINAL SUMP DRAIN 20" 7MMX13MM 273

CDD0200804BA "BARD"NONPOWERED WOUND SUCTION DEVICES:SILICONE 3 LUMEN

W/FILTER"巴德"非動力式傷口抽吸器具

1222

CDD0210050M4 "MEDTRONIC"SUCTION TUBES "美敦力"抽吸管 398

CDD0246148H9 INTRACARDIAC SUCKER 398

CDD02SUCKEM6 EXTRACORPOREAL SUCKER 398

CDD0401201ED PERICARDIAL SUMP(1/4") 431

CDD0403300ED SUCTION WAND(9F-22F) 431

CDD0404300SA RIGID I-C SUCKER 431

CDD0404360BA 400CC THREE-SPRING EVACUATOR KIT W/PVC ROUND DRAIN 271

CDD0404366BA 400CC THREE-SPRING EVACUATOR KIT W/SILICONE ROUND DRAIN 455

CDD0406648PC TLS BULB DRAINAGE SYSTEM 100CC 10.5FR(球+管) 455

CDD0408705P2 PVC VAC (球+管) 450CC 1/8",3/16",1/4" 271

750

特材代碼 中英文名稱 支付點數-104/01/01

CDD0408770P2 SILICON VAC (球+管) 100CC,200CC 1/8",3/16",1/4" 455

CDD0408902P2 MINIVAC WOUND DRAINAGE SYSTEM(PVC DRAIN 6FR WITH PVC

RESERVOIR 50ML)

196

CDD0408903P2 MINIVAC WOUND DRAINAGE SYSTEM(PVC DRAIN 6FR WITH PVC

RESERVOIR 20ML)

196

CDD0410440LL WOUND DRAINAGE SYSTEM 400ML真空傷口引流套(PVC引流管+PVC吸

引球+穿刺針)

271

CDD0420131FM ALL SILICONE C.W.V SET(RESERVOIR 100CC+DRAIN 7MM,10MM) 455

CDD0420132FM ALL SILICONE C.W.V SET(RESERVOIR 100CC+DRAIN 13MM) 455

CDD0420133FM ALL SILICONE C.W.V SET(RESERVOIR 150CC+DRAIN 7MM,10MM) 455

CDD0420134FM ALL SILICONE C.W.V SET(RESERVOIR 150CC+DRAIN 13MM) 455

CDD0420135FM ALL SILICONE C.W.V SET(RESERVOIR 400CC+DRAIN 7MM,10MM) 455

CDD0420136FM ALL SILICONE C.W.V SET(RESERVOIR 400CC+DRAIN 13MM) 455

CDD0425001Z1 HEMOVAC 271

CDD042535NZ1 MINI SNYDER HEMOVAC SILICONE DRAIN 3/32 1/8",3/16",1/4"

SILICONE EVACUATOR 100ML(球+管+針)

455

CDD042541NZ1 400ML HEMOVAC COMPACT EVACUATOR KIT SILICONE DRAIN

1/8",3/16",1/4(球+管)

417

CDD042560NZ1 MINI SNYDER HEMOVAC SILICONE DRAIN 7MM,10MM SILICONE

EVACUATOR 100ML(球+管+針)

455

CDD042564NZ1 EVAC KITS 100ML FLAT DRAIN W/O TROCAR 7MM,10MM(球+管) 455

CDD0425904Z1 HEMOVAC 271

CDD0425951Z1 PVC HEMOVAC COMPACT EVACUATOR KIT 3/32",3/16" 7,15FR 271

CDD0430101P2 WOUND DRAINAGE SYSTEM (PAHSCO-VAC)450ML(BAG+TUBE+TROCAR) 271

CDD0450511P2 太平洋密閉式真空傷口引流套(滅菌) "PAHSCO"CLOSED WOUND

DRAINAGE SYSTEM(STERILE) 400ML球PVC、管SILICONE(球+管+針)

417

CDD0453101P2 CLOSED WOUND DRAINAGE SYSTEM 450MLPVC (球+管+針) 271

CDD0454101P2 CLOSED WOUND DRAINAGE SYSTEMPVC WOUND DRAINAGE SYSTEM

20ML (BAG+TUBE+TROCAR)

196

CDD0454302P2 CLOSED WOUND DRAINAGE SYSTEMPVC WOUND DRAINAGE SYSTEM

50ML (BAG+TUBE+TROCAR)

196

CDD0456001P2 CLOSED SYSTEM SUCTION DRAINAGE SET 800ML 1/4〞,1/8〞,3/16

〞(球100CC+管+針)

271

CDD0456025P2 CLOSED WOUND DRAINAGE SYSTEM 400CCPVC (球+管+針) 271

CDD048410NM5 WOUND-EVC ET(EASY TOUCH)(PVC RESERVOIR 400ML,SILICONE

TUBING 1/8",3/16",1/4")

417

CDD04CSB00LL "LILY"WOUND DRAINAGE SYSTEM(SILICONE)"怡安"真空傷口引流套

/套組(矽質引流管+矽質吸引球+穿刺針)

455

CDD04CWBSTSG "SIGMA" INTRODUCTION DRAINAGE CATHETER AND ACCESSORIES

(SILICONE) 100;125;150;400CC+7;10;13MM+TROCAR 十美牌導入

/引流導管及其附件(球+管+針)

455

CDD04CWCV1EF SILICONE C.W.V SET(100CC,150CC,400CC+7MM,10MM,13MM)矽質真

空傷口引流球+引流管

455

CDD04CWVS1SG SIGMA SILICONE C.W.V SET 100;125;150;400CC+7;10;13MM 十美

牌矽質真空引流球+矽質引流管組

455

CDD04HS2XXH0 "HOSMED"CLOSED WOUND VACUUM DRAINAGE SYSTEM:SILICONE CWV

RESERVOIR+DRAIN "世新" 密閉式真空傷口引流系統:矽質引流球+

引流管

455

CDD04MB125SG SILICON MINI VACCUM BLUB 125CC(MB125)+FLAT TUBE OR ROUND

TUBE MD-118 7:9MM(HF107:9)

455

CDD04PP400WN BAROVAC CLOSED WOUND DRAINAGE SYSTEMS (PVC DRAIN

3/32",1/8",3/16",1/4"WITH PVC RESERVOIR 400ML)

271

751

特材代碼 中英文名稱 支付點數-104/01/01

CDD04PT503TM PORTABLE WOUND SUCTION UNIT(球+管) 271

CDD04SS100WN ALL SILICONE CLOSED WOUND DRAINAGE SYSTEMS(SILICONE DRAIN

WITH RESERVOIR 100ML)

455

CDD04SS200WN ALL SILICONE CLOSED WOUND DRAINAGE SYSTEMS 200ML(SILICONE

DRAIN WITH RESERVOIR 200ML)

455

CDD05000SMWN ALL SILICONE WOUND TUBINGW/TROCAR NEEDLE 3.2MM,4.8MM(圓

型)

271

CDD0500SJPWN ALL SILICONE WOUND TUBINGW/TROCAR NEEDLE 4.8MM(扁型) 271

CDD0500SMAWN "世運"傷口引流套(滅菌)"SEWOON"CLOSED WOUND DRAINAGE

SYSTEM(STERILE)-矽膠傷口引流管(不附針)3.2MM:13MM

271

CDD0500SXLWN "世運"傷口引流套(滅菌)"SEWOON"CLOSED WOUND DRAINAGE

SYSTEM(STERILE)-矽膠傷口引流管(附針)6.4MM;13MM

271

CDD0501310C8 JACKSON-PRATT SILICONE DRAINS 7MM, 10MMJACKSON-PRATT矽質

傷口引流管

271

CDD0501310L6 JACKSON-PRATT HUBLESS FLAT SILICONE DRAINS W/O TROCAR 271

CDD0501407FM "FORTUNE"C.W.V DRAIN SYSTEM:SILICON DRAINS TUBE 7MM"富強"

傷口引流系統:矽膠引流管

271

CDD0501410FM "FORTUNE"C.W.V DRAIN SYSTEM:SILICON DRAINS TUBE 10MM"富

強"傷口引流系統:矽膠引流管

271

CDD0501413FM "FORTUNE"C.W.V DRAIN SYSTEM:SILICON DRAINS TUBE 13MM"富

強"傷口引流系統:矽膠引流管

271

CDD0501420FM "FORTUNE"C.W.V DRAIN SYSTEM:SILICON DRAINS TUBE 10:29FR "

富強"傷口引流系統:矽膠引流管

271

CDD050208NFM SILICONE ROUND DRAIN END PERFORATED 8,10,16,20FR 900MM 271

CDD0502099FM "FORTUNE"C.W.V DRAIN SYSTEM:SILICON DRAINS TUBE+TROCAR "

富強"傷口引流系統:矽膠引流管+穿刺針

271

CDD05020XXH0 "HOSMED"CLOSED WOUND VACUUM DRAINAGE SYSTEM:SILICONE CWV

DRAIN "世新" 密閉式真空傷口引流系統:矽質引流管

271

CDD0502185ET "ETHICON"J-VAC CLOSED WOUND DRAINAGE SYSTEM BLAKE SILICON

DRAINS WITH TROCAR捷凡克封閉式引流系統

271

CDD0502187ET "ETHICON"J-VAC CLOSED WOUND DRAINAGE SYSTEM BLAKE SILICON

DRAINS WITH TROCAR捷凡克封閉式引流系統

298

CDD050308NFM SILICONE ROUND DRAIN MIDDLE PERFORATED 8,10,16,20FR

1100MM

271

CDD0503203SM EXTRA STRENGTH FLAT SUCTION DRAIN 7MM 271

CDD0503204SM EXTRA STRENGTH FLAT SUCTION DRAIN 10MM 271

CDD0508711P2 SILICON VAC DRAINAGE & TROCAR 271

CDD0510101P2 CLOSED WOUND DRAINAGE SYSTEMPVC VAC DRAINAGE 125

CDD0513101P2 CLOSED WOUND DRAINAGE SYSTEMSILICONE VAC DRAINAGE 271

CDD052540NZ1 MINI-SNYDER HEMOVAC SILICONE DRAIN 3/32",1/8",3/16",1/4"

7MM,10MM W/TROCAR

271

CDD052542NZ1 DRAIN ROUND W/O TROCAR 3/32",1/8",3/16",1/4 SILICONE(管) 271

CDD052569NZ1 DRAIN FLAT W/O TROCAR 7MM,10MM SILICONE 271

CDD0530502P2 CLOSED WOUND DRAINAGE SYSTEMSILICONE VAC DRAINAGE &TROCAR 271

CDD0566481B0 SILICONE BULB DRAINAGE CATHETER 7MM 真空傷口引流管 271

CDD0566482B0 SILICONE BULB DRAINAGE CATHETER 真空傷口引流管 271

CDD0566483B0 SILICONE BULB RESERVOIR 100CC 真空傷口引流球 210

CDD0566484B0 SILICONE BULB DRAINAGE CATHETER 10MM 真空傷口引流管 271

CDD05CSC00LL LILY WOUND DRAINAGE SYSTEM:SILICON SUCTION DRAINAGE TUBE

怡安真空傷口引流套:矽質傷口引流管

271

CDD05CV110EF SILICONE C.W.V DRAIN 271

CDD05MF104SG SILICONE SUCTION DRAINAGE TUBE(FLAT) 4,7,10MM 271

752

特材代碼 中英文名稱 支付點數-104/01/01

CDD05MFTR1SG "SIGMA" INTRODUCTION DRAINAGE CATHETER AND ACCESSORIES

(SILICONE) 7;10;13MM+TROCAR 十美牌導入/引流導管及其附件

(管+針)

271

CDD0600640FM SILICONE CLOSED WOUND VACUUM RESERVOIR 400CC 210

CDD0601305C8 JACKSON-PRATT SILICONE BULB RESERVOIR 100CC & 400CC矽質真

空傷口引流儲液器

210

CDD0602160JJ J-VAC RESERVOIR SILICON 100CC 210

CDD0602161JJ J-VAC RESERVOIR 150CC,450CC(PVC球) 146

CDD06021XXH0 "HOSMED"CLOSED WOUND VACUUM DRAINAGE SYSTEM:SILICONE CWV

RESERVOIR "世新" 密閉式真空傷口引流系統:矽質引流球

210

CDD0603101SM SUCTION RESERVOIR 242

CDD0608709P2 SILICON VAC RESERVOIR 100CC,200CC 210

CDD060S100WN ALL SILICONE BAROVAC RESERVOIR 100ML 210

CDD060S200WN ALL SILICONE BAROVAC RESERVOIR 200ML 210

CDD060S400WN "世運"傷口引流套(滅菌)"SEWOON"CLOSED WOUND DRAINAGE

SYSTEM(STERILE)-矽膠吸引球 400CC

210

CDD0613150FM "FORTUNE"C.W.V DRAIN SYSTEM:SILICON RESERVOIR 100CC,150CC

"富強"傷口引流系統:矽膠真空吸球

210

CDD0620201P2 太平洋真空傷口引流套(滅菌)PAHSCO WOUND DRAINAGE

SYSTEM(STERILE)-SILICONE EVACUATOR 125ML 、200ML

210

CDD0623009P2 太平洋真空傷口引流套(滅菌)PAHSCO WOUND DRAINAGE

SYSTEM(STERILE)-PVC PAHSCO-VAC 150ML、200ML、250ML、

300ML、450ML

146

CDD0625681Z1 SIKICONE MINI SNYDER HEMOVAC 100ML 210

CDD06CSB00LL LILY WOUND DRAINAGE SYSTEM:SILICON SURGICAL CWV

RESERVOIR 100ML;125ML;150ML;200ML怡安真空傷口引流套:矽質

真空傷口引流蓄液球

210

CDD06CW1S1EF SILICONE C.W.V RESERVOIR 100CC,150CC,400CC 210

CDD06CWVB1SG SIGMA SILICONE MINI BULB 100;125;150;400CC 十美牌矽質真空

引流球

210

CDD06MB125SG MINI BULB 125CC 真空吸引球 210

CDD1012001P2 DIAMOND TIP THROACIC CANNULA 8:16FR 259

CDD1012007P2 DIAMOND TIP THROACIC CANNULA 20:32FR 259

CDD1021110MA "麥林可" 套針導管“MALLINCKRODT” TROCAR CATHETER

10FR,12FR,16FR

259

CDD1021120MA "麥林可" 套針導管“MALLINCKRODT” TROCAR CATHETER

20FR,24FR,28FR,32FR

259

CDD1056080AY "肯麥斯"亞羅套針導管"KENMEX" ARGYLE TROCAR CATHETER-8FR 259

CDD1056101AY "肯麥斯"亞羅套針導管"KENMEX" ARGYLE TROCAR CATHETER-

10:32FR

259

CDD1056702AY INGRAM TROCAR CATHETER 12FR,16FR 膀胱穿刺針組 465

CDD1080116PX " SMITHS"PORTEX CHEST DRAINAGE CATHETER"史密斯"保德士胸腔

引流管

259

CDD10TDC10EE THORACIC DRAINAGE CATHETER W/TROCAR 259

CDD1100001ET TROCAR KIT穿刺套管2-12MM(穿剌針1+外管1+內建可變式轉接頭

1)(511;512HA;NA;DA;355NA;DA;35LNA;LDA;FPK02自980701刪除)

1459

CDD1100001PA 〝安培〞安全穿刺套管系統〝APPLIED〞TROCAR SYSTEM KIT 5-

12MM(穿剌針1+外管1+內建可變式轉接頭1)

1459

CDD1100001U7 SURGICAL TROCAR SYSTEM 5-12MM (穿剌針1+外管1+內建可變式轉

接頭1)

1459

CDD1100002PA 〝安培〞安全穿刺套管系統〝APPLIED〞TROCAR SYSTEM(5-12MM多

孔道平滑拋棄剝離式套管)(穿剌針1+外管1+內建可變式轉接頭1)

1459

753

特材代碼 中英文名稱 支付點數-104/01/01

CDD1100002U7 SURGICAL TROCAR SYSTEM 5-12MM (穿剌針1+外管2+內建可變式轉

接頭2)

1509

CDD1100002ZH DETACHAPORT OBTURATOR AND SEAL SET:TROCAR SLEEVE(1支外管

+1支固定轉接頭)

917

CDD1100003PA TROCAR SYSTEM:SEPARATOR ACCESS SYSTEM11X100MM

12X100MM(穿剌針1+外管1+內建可變式轉接頭1)

1459

CDD1100003ZH DETACHAPORT OBTURATOR AND SEAL SET:TROCAR KIT(1支穿刺針

+2支外管+2支固定轉接頭)

1509

CDD1100004KM "METROMED"TROCAR "益鳴"穿刺套管(穿剌針1+外管1+固定轉接頭

1)

1116

CDD1100004PA SEPARATOR OBTURATOR 內視鏡手術剝離式穿刺針 553

CDD1100005PA CANNULAS WITH DISPOSABLE SEAL內視鏡手術拋棄式套筒組(穿刺

外管+可變式轉接頭)

955

CDD1100005U7 SURGICAL TROCAR SYSTEM 5-12MM (穿剌針1+外管1+內建可變式轉

接頭1)

1459

CDD1100006U7 SURGICAL TROCAR SYSTEM 5-12MM (穿剌針1+外管2+內建可變式轉

接頭2)

1509

CDD1100007PA PREMIUM DISPOSABLE TROCAR SYSTEM W/UNIVERSAL SEAL通用孔道

拋棄式穿刺系統(穿剌針1+外管1+內建可變式轉接頭1)

1459

CDD1100007U7 SURGICAL TROCAR SYSTEM 5MM (穿剌針1+外管1+內建固定式轉接

頭1)

1116

CDD1100008U7 SURGICAL TROCAR SYSTEM 5MM (穿剌針1+外管2+內建固定式轉接

頭2)

1509

CDD1100009U7 SURGICAL TROCAR SYSTEM 5-12MM (穿剌針1+外管1+內建可變式轉

接頭1)

1459

CDD1100010U7 SURGICAL TROCAR SYSTEM 5-12MM (穿剌針1+外管2+內建可變式轉

接頭2)

1509

CDD1100011U7 SURGICAL TROCAR SYSTEM 5MM (穿剌針1+外管1+內建固定式轉接

頭1)

1116

CDD1100012ET TROCAR KIT穿刺套管雙支包裝(穿刺針1+外管2+內建可變式轉接頭

2)

1509

CDD1100012U7 SURGICAL TROCAR SYSTEM 5MM (穿剌針1+外管2+內建固定式轉接

頭2)

1509

CDD1100013U7 SURGICAL TROCAR SYSTEM 5MM (穿剌針1+外管1+內建固定式轉接

頭1)

1116

CDD110005NPA CANNULAS WITH DISPOSABLE SEAL內視鏡手術拋棄式套筒組(穿刺

外管+可變轉接頭)

955

CDD1100066KM "METROMED"TROCAR "益鳴"穿刺套管(穿剌針1+外管2+固定轉接頭

2)

1509

CDD1100K1TPA TROCAR KIT(穿刺針X1+外管X2+可變轉接頭X2) 1509

CDD1105121L7 TROCAR KIT 10-12MM TROCAR AND CANULA 穿刺套管組(防滑套管1

支,穿刺針1支,多功能轉換器1組)

1459

CDD1105122L7 TROCAR KIT 5-12MM TROCAR AND CANULA 穿刺套管組(防滑套管1

支,穿刺針1支,多功能轉換器1組)

1459

CDD1105123L7 TROCAR KIT 5-12MM TROCAR AND CANULA 穿刺套管組(防滑套管2

支,穿刺針1支,多功能轉換器2組)

1509

CDD1105124L7 TROCAR KIT 5-12MM TROCAR AND CANULA穿刺套管組(防滑套管1支

,穿刺針1支,多功能轉換器1組)

1459

CDD1105125L7 TROCAR KIT 5-12MM TROCAR AND CANULA 穿刺套管組(防滑套管2

支,穿刺針1支,多功能轉換器2組)

1509

CDD110612AL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管5-6MM(穿刺套管1支+穿刺

針1支+固定式轉接頭1支)

1116

CDD110612CL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管5-12MM(穿刺套管2支+穿

刺針1支+固定式轉接頭2支)

1509

754

特材代碼 中英文名稱 支付點數-104/01/01

CDD110612DL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管5-6MM(穿刺套管1支+穿刺

針1支+固定式轉接頭1支)

1116

CDD110612EL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管5-6MM(穿刺套管2支+穿刺

針1支+固定式轉接頭2支)

1509

CDD110612FL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管5-6MM(穿刺套管1支+固定

式轉接頭1支)

917

CDD110612HL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管5-12MM(穿刺套管1支+穿

刺針1支+可變式轉接頭1支)

1459

CDD110612JL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管5-12MM(穿刺套管1支+可

變式轉接頭1支)

955

CDD110612LL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管5-12MM(穿刺套管2支+穿

刺針1支+可變式轉接頭2支)

1509

CDD110612NL7 LAGIS TROCAR 大吉士穿刺套管(穿刺套管1支+可變式轉接頭1支+

穿刺針1支)

1459

CDD110612PL7 LAGIS TROCAR 大吉士穿刺套管(穿刺套管2支+可變式轉接頭2支+

穿刺針1支)

1509

CDD110612QL7 LAGIS TROCAR 大吉士穿刺套管(穿刺套管1支+可變式轉接頭1支+

穿刺針1支+套管固定器1組)

2233

CDD11090PF2C "柯惠"可變徑式V型安全穿刺套管 "COVIDIEN" AUTOSUTURE

VERSAPORT PLUS V2 W/FIXATION CANNULA 11-12MM (外管+可變轉

接頭)

955

CDD11095PF2C "柯惠"可變徑式V型安全穿刺套管 "COVIDIEN" AUTOSUTURE

VERSAPORT PLUS V2 W/FIXATION CANNULA 11-12MM (穿刺內管+外

管+可變轉接頭)

1459

CDD11100011T "TOPBOUND"SURGICAL TROCAR SET "仁齊"穿刺器 5MM 鈍頭(穿刺

針1+外管1+固定轉接頭1)

1116

CDD11100021T "TOPBOUND"SURGICAL TROCAR SET "仁齊"穿刺器 5MM 鈍頭(穿刺

針1+外管2+固定轉接頭2)

1509

CDD1110051L9 ENDOSCOPIC INSTRUMENT內視鏡器械(含:穿刺針*1+外管*1+固定

式轉接頭*1)

1116

CDD1110092L9 ENDOSCOPIC INSTRUMENT內視鏡器械(含:穿刺針*1+外管*2+固定

式轉接頭*2)

1509

CDD11101011T "TOPBOUND"SURGICAL TROCAR SET "仁齊"穿刺器 5MM 軟管(穿刺

針1+外管1+固定轉接頭1)

1116

CDD11101021T "TOPBOUND"SURGICAL TROCAR SET "仁齊"穿刺器 5MM 軟管(穿刺

針1+外管2+固定轉接頭2)

1509

CDD11200011T SURGICAL TROCAR SET 5MM(穿刺內管X1+穿刺外管X1+固定式轉接

頭X1)

1116

CDD11200021T "TOPBOUND"SURGICAL TROCAR SET "仁齊"穿刺器 5MM (穿刺針1+

外管2+固定轉接頭2)

1509

CDD11201011T "TOPBOUND"SURGICAL TROCAR SET "仁齊"穿刺器 5MM 尖頭硬管

(穿刺針1+外管1+固定轉接頭1)

1116

CDD11201021T "TOPBOUND"SURGICAL TROCAR SET "仁齊"穿刺器 5MM (穿刺針1+

外管2+固定轉接頭2)

1509

CDD11210011T SURGICAL TROCAR SET 5-10MM(穿刺內管X1+穿刺外管X1+可變式轉

接頭X1)

1459

CDD11210021T "TOPBOUND"SURGICAL TROCAR SET "仁齊"穿刺器 10MM (穿刺針1+

外管2+可變式轉接頭2)

1509

CDD11220011T SURGICAL TROCAR SET 5-12MM(穿刺內管X1+穿刺外管X1+可變式轉

接頭X1)

1459

CDD11220021T "TOPBOUND"SURGICAL TROCAR SET "仁齊"穿刺器 12MM(穿刺針1+

外管2+可變式轉接頭2)

1509

CDD11300031T "TOPBOUND"SURGICAL TROCAR SET "仁齊"穿刺器 5MM (穿刺針1+

外管3+固定式轉接頭3)

2530

755

特材代碼 中英文名稱 支付點數-104/01/01

CDD11310041T "TOPBOUND"SURGICAL TROCAR SET "仁齊"穿刺器 5MM (穿刺針1+

外管4+固定式轉接頭4)

3358

CDD11320031T "TOPBOUND"SURGICAL TROCAR SET "仁齊"穿刺器 (5MM:穿刺針1+

外管3+固定式轉接頭3)+(10MM:穿刺針1+外管1+可變式轉接頭1)

3913

CDD114216K2C "柯惠"可充氣穿刺套管"COVIDIEN" AUTO SUTURE THREADED

TROCAR SLEEVES WITH WOODFORD SPIKE TROCAR AND INSUFFATION

PORT(穿剌針1+外管2+固定轉接頭2)

1509

CDD117092F2C "柯惠"可變徑式V型安全穿刺套管 "COVIDIEN" AUTOSUTURE

VERSAPORT PLUS V2 W/FIXATION CANNULA 5MM (外管+固定轉接

頭)

917

CDD11770922C ”柯惠”安全穿刺套管組 "COVIDIEN" AUTO SUTURE VERSAPORT

PLUS RPF TROCAR SYSTEM 5MM(外管+固定式轉接頭1)

917

CDD11770962C "柯惠"安全穿刺套管組 "COVIDIEN" AUTO SUTURE VERSAPORT

PLUS RPF TROCAR SYSTEM 5/10-12MM (外管1+內建式可變轉接頭

1)

955

CDD1178062US "優施西"可變式穿刺套管組"USSC" VERSAPORT RPF SINGLE USE

RADIOLUCENT TROCAR KIT 5/10MM(穿剌針1+外管2+內建可變式轉

接頭2)

1509

CDD1178064US "優施西"可變式穿刺套管組"USSC" VERSAPORT RPF SINGLE USE

RADIOLUCENT TROCAR KIT 5MM(穿剌針1+外管2+內建固定式轉接頭

2)

1509

CDD1179079US "優施西"腹腔穿刺套管"USSC" AUTO SUTURE SURGISPIKE TROCAR

5MM(穿剌針1+外管1+固定式轉接頭1)

1116

CDD11790932C "柯惠"V型刀片穿刺套管 "COVIDIEN" AUTO SUTURE VERSAPORT V2

SINGLE USE WITH RADIOLUCENT TROCAR SLEEVE(內管+外管+固定

式接頭)

1116

CDD11790952C "柯惠"V型刀片穿刺套管 "COVIDIEN" AUTO SUTURE VERSAPORT V2

SINGLE USE WITH RADIOLUCENT TROCAR SLEEVE(內管+外管+可變

轉接頭)

1459

CDD11793052C "柯惠"胸腔穿刺套管 "COVIDIEN" THORACOPORT TROCAR 1116

CDD11906892C "柯惠"安全穿刺套管組 "COVIDIEN" AUTO SUTURE VERSAPORT

PLUS RPF TROCAR SYSTEM 5MM (穿剌針1+外管1+固定式轉接頭1)

1116

CDD119075P2C "柯惠"開放性腹腔鏡手術用之一次性穿刺器"COVIDIEN"AUTO

SUTURE BLUNTPORT PLUS 5-12MM (穿刺針1+外管1+可變式轉接頭

1+袋口結固定器)

2233

CDD119076P2C "柯惠"安全穿刺套管組 "COVIDIEN" AUTO SUTURE VERSAPORT

PLUS RPF TROCAR SYSTEM 5/10-12MM (穿剌針1+外管1+內建可變

式轉接頭1)

1459

CDD119094F2C "柯惠"可變徑式V型安全穿刺套管 "COVIDIEN" AUTOSUTURE

VERSAPORT PLUS V2 W/FIXATION CANNULA 5MM (穿刺內管+外管+

固定轉接頭)

1116

CDD11976892C "柯惠"穿刺套管 "COVIDIEN" AUTO SUTURE VERSAPORT RT

OBTURATOR 5MM(穿剌針1+外管1+固定式轉接頭1)

744

CDD119776P2C "柯惠"穿刺套管 "COVIDIEN" AUTO SUTURE VERSAPORT RT

OBTURATOR 10-12MM(穿剌針1+外管1+內建可變式轉接頭1)

1010

CDD11BASXCET BASX BLADELESS TROCAR 外套管+可變式轉接頭 955

CDD11BASXTET BASX BLADELESS TROCAR 穿刺器+外套管+可變式轉接頭 1459

CDD11EPATHET "ETHICON"ENDOPATH XCEL TROCAR"愛惜康"安德派思外科穿刺器

(穿刺針+外管+可變式轉接頭)

1459

CDD11K1101PA TROCAR SYSTEM(穿剌針1+外管1+可變式轉接頭1) 1459

CDD11K1102PA 〝APPLIED〞TROCAR SYSTEM〝安培〞安全穿刺套管系統(穿剌針1+

外管1+可變式轉接頭1)

1459

756

特材代碼 中英文名稱 支付點數-104/01/01

CDD11K1103PA TROCAR SYSTEM(穿剌針1+外管1+可變式轉接頭1) 1459

CDD11K1104PA 〝APPLIED〞TROCAR SYSTEM 〝安培〞安全穿刺套管系統(穿剌針

1+外管1+可變式轉接頭1)

1459

CDD11K1105PA 〝APPLIED〞TROCAR SYSTEM〝安培〞安全穿刺套管系統(穿剌針1+

外管2+可變式轉接頭2)

1509

CDD11K1106PA TROCAR SYSTEM(穿剌針1+外管2+可變式轉接頭2) 1509

CDD11K1107PA 〝APPLIED〞TROCAR SYSTEM〝安培〞安全穿刺套管系統(穿剌針1+

外管2+可變式轉接頭2)

1509

CDD11K1108PA 〝APPLIED〞TROCAR SYSTEM〝安培〞安全穿刺套管系統(外管1+可

變式轉接頭1)

955

CDD11K1109PA 〝APPLIED〞TROCAR SYSTEM〝安培〞安全穿刺套管系統(穿剌針1+

外管1+可變式轉接頭1)

1459

CDD11K1110PA "APPLIED" TROCAR SYSTEM(KIIFIOS)"安培"安全穿刺套管系統(含

外管+可變式轉接頭+內管(附充氣功能)

1857

CDD11NB12F2C "柯惠"無刀刃可變式穿刺套管"COVIDIEN"VERSAPORT BLADELESS

AND VERSAPORT PLUS BLADELESS SINGLE USE BLADELESS

TROCAR(內管1+外管1+可變轉接頭1)

1459

CDD11NB5LP2C "柯惠"無刀片薄型穿刺套管含固定套管(穿剌針1+外管1+固定轉接

頭1)"COVIDIEN"VERSAPORT BLADELESS LOW PROFILE TROCAR WITH

FIXATION CANNULA

1116

CDD11NBFCA2C "柯惠"無刀刃可變式穿刺套管"COVIDIEN"VERSAPORT BLADELESS

AND VERSAPORT PLUS BLADELESS SINGLE USE BLADELESS

TROCAR(外管1+固定式轉接頭1)

917

CDD11XCEL2ET ”愛惜康”安德派思外科穿刺器 雙外管"ETHICON"ENDOPATH XCEL

TROCAR

1509

CDD11XCELBET ”愛惜康”安德派思外科穿刺器"ETHICON"ENDOPATH XCEL

TROCAR(BLADELESS)

1459

CDD11XCELLET ”愛惜康”安德派思外科穿刺器 "ETHICON"ENDOPATH XCEL

TROCAR

1459

CDD11XCELSET ”愛惜康”安德派思外科穿刺器-外套管+固定式頭"ETHICON"

TROCAR SLEEVE(BLADELESS)

917

CDD11XCELVET ”愛惜康”安德派思外科穿刺器-外套管+可變式頭"ETHICON"

TROCAR SLEEVE(BLADELESS)

955

CDD12BAL40JU "帕將克"環形球囊套管組"PAJUNK"RING-ANCHOR BALLOON SET 3039

CDD12BAL50JU "帕將克"球囊套管組"PAJUNK" BALLOON SET 2370

CDD12K1109PA TROCAR SYSTEM充氣式(穿剌針1+外管1+可變式轉接頭1) 3039

CDD12MSBT12C "柯惠"腹腔鏡汽球固定式鈍頭穿刺套管組"COVIDIEN" AUTO

SUTURE BLUNT TIP TROCAR AND SYRINGE

3039

CDD12MSXB1US ”優施西”可視式腹腔鏡汽球撐開式套管 2370

CDD12PDBS22C "柯惠"腹腔鏡汽球撐開式套管"COVIDIEN"PDB STERILE BALLOON 2370

CDD13DGC01CK "COOK"JABCZENSKI DUCTOGRAM CANNULA 30 GAGE(乳管攝影導管) 943

CDD13DGK00ZM "MD TECH"ANGIOTECH INTRODUCTION/DRAINAGE CATHETER "美迪

克"安酋導入及引流導管(乳管攝影導管)

943

CDD13G1U30RC INTRODUCTION DRAINAGE CATHETER 導入及引流導管(乳管攝影導

管)

943

CDDF100794SN "史耐輝"負壓傷口治療敷料"SMITH & NEPHEW" RENASYS DRESSING

KIT WITH SOFTPORT

2355

CDDF100795SN "史耐輝"負壓傷口治療敷料"SMITH & NEPHEW" RENASYS DRESSING

KIT WITH SOFTPORT

2603

CDDF100796SN "史耐輝"負壓傷口治療敷料"SMITH & NEPHEW"RENASYS DRESSING

KIT WITH SOFTPORT

2715

CDDF162151LN “美尼克”艾薇斯敷料(滅菌) “MOLNLYCKE”AVANCE DRESSING

KIT (STERILE)-SMALL

2355

757

特材代碼 中英文名稱 支付點數-104/01/01

CDDF162251LN “美尼克”艾薇斯敷料(滅菌) “MOLNLYCKE”AVANCE DRESSING

KIT (STERILE)-MEDIUM

2603

CDDF162351LN “美尼克”艾薇斯敷料(滅菌) “MOLNLYCKE”AVANCE DRESSING

KIT (STERILE)-LARGE

2715

CDLP244513PM C.S.F. LUMBOPERITONEAL RESERVOIR 3305

CDP0104015MV FLEXIMA NASOBILIARY CATH W/GUIDEWIRE(CATH+TRANSFER

TUBE+DRAINAGE CANNECTOR TUBE+GUIDEWIRE)

5198

CDP0104015SB FLEXIMA NASOBILIARY CATHETER (CATH+TRANSFER TUBE+DRAINAGE

CONNECTOR TUBE+GUIDE WIRE)

5198

CDP010A001CK OASIS ONE ACTION STENT INTRODUCER SYSTEM 2000

CDP010ACL1CK OASIS PRE-LOADED STENT INTRODUCTION SYSTEM 4458

CDP010ACL3CK "曲克" 膽道支架暨支架引導系統"COOK" COTTON-LEUNG BILIARY

STENTS AND INTRODUCERS

4458

CDP010ATS1CK 歐爾喜斯一步式支架引導系統膽道支架"COOK"OASIS ONE ACTION

STENT INTRODUCTION SYSTEM WITH ST-2 SOEHENDRA TANNENBAUM

BILIARY STENT

4458

CDP0111270CL P.T.C.D SET 矽質膽道膽囊穿刺套 2649

CDP0111807CL P.T.C.D KIT (ONE STEP) 1720

CDP011STWNCY PERCUTANEOUS DIRECT ACCESS KIT 1720

CDP0120702SB ACCUSTICK II PERCUTANEOUS INTRODUCER

SYSTEM(NEEDLE+INTRODUCER+GUIDEWIRE*2)

2700

CDP0120704SB ACCUSTICK II PERCUTANEOUS INTRODUCER

SYSTEM(NEEDLE+INTRODUCER+GUIDEWIRE*1)

1666

CDP0121333BQ "BIOTEQ"INTRODUCER SET"邦特"穿刺導入系統組(含穿刺針

+INTRODUCER+0.018"GUIDE WIREX1支+0.035"或0.038"GUIDE

WIREX1支)

2700

CDP012633NC3 ULTRASONICALLY GUIDED ONE-STEP DRAINAGE SET 1720

CDP0145550SB MICROVASIVE RAPID EXCHANGE BILIARY STENT SYSTEM(含推進導

管及導引導管)

3929

CDP0165150PB INTRODUCER SET(NEEDLE+INTRODUCER+GUIDE WIREX2) 2700

CDP0175110PB SKATER DRAINAGE CATHETER 6:16FR 25-35CM 1352

CDP0175601PB SKATER ONE STEP DRAINAGE CATHETER 6:16FR 20:25CM 1720

CDP0175651PB SKATER ONE STEP DRAINAGE CATHETER 6:16FR 20:25CM 1720

CDP01ABSDSSB "波士頓"阿德凡斯膽道支架"BOSTON SCIENTIFIC"ADVANIX

BILIARY STENT

2033

CDP01ABSPLSB "波士頓科技"阿德凡斯膽道支架"BOSTON SCIENTIFIC"ADVANIX

BILIARY STENT WITH NAVIFLEX RX DELIVERY SYSTEM

4458

CDP01BCLN1CK "曲克"多功能引流導管組"COOK”MULTIPURPOSE DRAINAGE

CATHETER SET

1720

CDP01BS001SB AMSTERDAM BILIARY STENT KIT

7,8.5,10,11.5FRX5,7,10,12,15CM(含推進導管及導引導管)

4458

CDP01BSK12SB AMSTERDAM BILIARY STENT KIT (含推進導管) 2401

CDP01BSK1TSB AMSTERDAM BILIARY STENT KIT 10,12FRX5,7,10,12,15CM(含推進

導管及導引導管)

4458

CDP01BTPD2BQ PIGTAIL DRAINAGE CATHETER SET (ONE SETP)7:14FR 19:39CM含

導管及穿刺針

1720

CDP01BTPDABQ PIGTAIL DRAINAGE CATHETER SET(ONE STEP TYPE)(含穿刺針組+

引流管)

1720

CDP01BTPDBBQ PIGTAIL DRAINAGE CATHETER SET(ONE STEP TYPE)(含穿刺針組+

引流管)

1720

CDP01BTPDCBQ PIGTAIL DRAINAGE CATHETER SET(ONE STEP)(含引流管及穿刺針

組)

1720

CDP01BTPDDBQ PIGTAIL DRAINAGE CATHETER SET(ONE STEP)(含引流管及穿刺針

組)

1720

758

特材代碼 中英文名稱 支付點數-104/01/01

CDP01BTPDSBQ "邦拓"豬尾巴引流導管組(直接穿刺型)"BIOTEQ"PIGTAIL

DRAINAGE CATHETER SET(ONE STEP TYPE)

1720

CDP01CHB1NCK COTTON HUIBREGTSE BILIARY STENT SET 4458

CDP01CL120CK MAC-LOC BILIARY DRAINAGE CATH 12,14F 1720

CDP01CLB85CK "曲克" 經皮引流導管針組(滅菌) "COOK" DRAINAGE CATHETER

NEEDLE SET(STERILE) 6~16FR

1720

CDP01CLBS2CK "COOK"COTTON-LEUNG BILIARY STENTS AND INTRODUCERS 5:14FR

膽道支架暨支架引導系統

4458

CDP01DTVN1CK ”曲克”經皮引流導管針組(滅菌)”COOK” DRAINAGE CATHETER

NEEDLE SET(STERILE)

1720

CDP01DTVN2CK ”曲克”經皮引流導管針組”COOK” DRAINAGE CATHETER NEEDLE

SET

1720

CDP01DTVN3CK ”曲克”經皮引流導管針組”COOK” DRAINAGE CATHETER NEEDLE

SET

1720

CDP01E001NCK LIGUORY ENDOSCOPIC NASAL BILIARY DRAINAGE SET 5:7FR 5198

CDP01EC01NCK LIGUORY ENDOSCOPIC NASAL BILIARY DRAINAGE CATHETER 2333

CDP01EC02NCK NAGARAJA ENDOSCOPIC NASAL BILIARY DRAINAGE CATHETER 內視

鏡經膽道引流管

730

CDP01ENBD1CK "曲克" 鼻-膽道引流管組"COOK" NASAL BILIARY DRAINAGE SET 5198

CDP01ENBD2CK "曲克" 鼻-膽道引流管"COOK" NASAL BILIARY DRAINAGE

CATHETER

2200

CDP01FSA01CK "曲克" 歐爾西思單動支架置入系統"COOK" OASIS ONE ACTION

STENT INTRODUCTION SYSTEM

2000

CDP01GEPD2CK "曲克"吉南胰管支架組"COOK"GEENEN PANCREATIC STENT SET 4087

CDP01GPL00KQ “優式”導入/引流導管及其附件(滅菌) “URESIL”

INTRODUCTION/DRAINAGE CATHETER AND ACCESSORIES (STERILE)

1720

CDP01GPPS1FG "福萊克斯"支架放置套組"ENDO-FLEX" STENT INTRODUCTION SET

GPPS

4458

CDP01L001NCK COTTON LEUNG BILIARY STENT SET 4458

CDP01MAS18MR "美瑞特" 福祿小血管導引鞘"MERIT" PRELUDE MINI ACCESS

SHEATH INTRODUCERS(7,11CM

SHEATH+SIDEPORT+VALVE+DILATOR+0.018GW+NEEDLE)

1666

CDP01MD102CK ULTRATHANE MULTIPUEPOSE DRAINAGE CATH 12,14F,25CM,18G 1720

CDP01MDC85CK ULTRATHANE MULTIPURPOSE DRAINAGE CATH 8.5,10.2F,25CM,18G 1720

CDP01MP1S1CK "COOK"MICROPUNCTURE INTRODUCER SETS 4F:5F 0.018英吋 21G

微穿刺引導器組

1666

CDP01N0DNNBA OPTI-DRAIN MULTI-USE DRAINAGE CATHETER 8-12FR 1720

CDP01NNUNNBA DRAINAGE CATHETERS AND ACCESSORIES(含穿刺針組+引流管) 1720

CDP01NPAS1CK "COOK"NEFF PERCUTANEOUS ACCESS SETS"曲克"涅夫經皮引導組

6FR 20CM 0.018 60CM

1666

CDP01NPAS2CK "COOK"NEFF PERCUTANEOUS ACCESS SETS"曲克"涅夫經皮引導組

6FR 20CM 0.018 60CM

1666

CDP01NPAS3CK "COOK"NEFF PERCUTANEOUS ACCESS SETS 4.0/7.0 20CM 22/15CM

.018 4.0/6.0 20CM 21/15CM:22/15CM .018

1666

CDP01NPDS1CK NASAL PANCREATIC DRAINAGE SET 5198

CDP01P001NCK "COOK"BILIARY DRAINAGE CATHETER"曲克"膽道引流導管 800

CDP01P008NCK "COOK"BILIARY DRAINAGE CATHETER"曲克"膽道引流導管 832

CDP01PAS30BA NAVARRE PERCUTANEOUS ACCESS SET 1666

CDP01PDD10BQ "邦特" 豬尾巴引流導管組(直接穿刺型) "BIOTEQ" PIGTAIL

DRAINAGE CATHETER SET(ONE STEP TYPE

1720

CDP01PDD2WBQ "邦特" 豬尾巴引流導管組(直接穿刺型) "BIOTEQ" PIGTAIL

DRAINAGE CATHETER SET(ONE STEP TYPE

1720

759

特材代碼 中英文名稱 支付點數-104/01/01

CDP01PDD30BQ "邦特" 豬尾巴引流導管組(直接穿刺型) "BIOTEQ" PIGTAIL

DRAINAGE CATHETER SET(ONE STEP TYPE

1720

CDP01PDD4WBQ "邦特" 豬尾巴引流導管組(直接穿刺型) "BIOTEQ" PIGTAIL

DRAINAGE CATHETER SET(ONE STEP TYPE

1720

CDP01PDS50BQ "邦特" 豬尾巴引流導管組(直接穿刺型) "BIOTEQ" PIGTAIL

DRAINAGE CATHETER SET(ONE STEP TYPE

1720

CDP01PDS6WBQ "邦特" 豬尾巴引流導管組(直接穿刺型) "BIOTEQ" PIGTAIL

DRAINAGE CATHETER SET(ONE STEP TYPE

1720

CDP01PDS70BQ "邦特" 豬尾巴引流導管組(直接穿刺型) "BIOTEQ" PIGTAIL

DRAINAGE CATHETER SET(ONE STEP TYPE

1720

CDP01PDS8WBQ "邦特" 豬尾巴引流導管組(直接穿刺型) "BIOTEQ" PIGTAIL

DRAINAGE CATHETER SET(ONE STEP TYPE

1720

CDP01PV600LY "奧林柏斯"膽道引流管(膽道支架暨支架引導組)"OLYMPUS"

BILIARY DRAINAGE TUBE (BILIARY STENT KIT)

4458

CDP01PV601LY "奧林柏斯"膽道引流管(膽道支架暨支架引導組)"OLYMPUS"

BILIARY DRAINAGE TUBE (BILIARY STENT KIT)

4458

CDP01PV602LY "奧林柏斯"膽道引流管(膽道支架暨支架引導組)"OLYMPUS"

BILIARY DRAINAGE TUBE (BILIARY STENT KIT)

4458

CDP01RLC38MR "MERIT"RESOLVE DRAINAGE CATHETERS(ONE STEP含引流管及穿刺

針組)(STERILE)"美瑞特"通用引流管(滅菌)

1720

CDP01TQT01CK "COOK" THAI-QUICK ABSCESS DRAINAGE CATHETER(STERILE) "曲

克"泰坤膿腫引流管

1720

CDP01U004NCK RING BILIARY DUCT DRAINAGE SET 2649

CDP01UC102CK ULTRATHANE UNIVERSAL CURVED DRAINAGE CATH 10.2F,25CM,18G 1720

CDP01UCD70CK ULTRATHANE UNIVERSAL CURVED DRAINAGE CATH 7,8.5F,25CM,18G 1720

CDP01UL120CK MAC-LOC ULTRATHANE DRAINAGE CATH 10.2,12F,25CM,18G 1720

CDP01UL140CK MAC-LOC MULTIPURPOSE DRAINAGE CATHETER 12,14F 25CM,18G 1720

CDP01ULT01CK "曲克"經皮引流導管針組"COOK" DRAINAGE CATHETER NEEDLE

SET(BILIARY DRAINAGE CATHETERS)

1720

CDP01ULT50CK MAC-LOC ULTRATHANE DRAINAGE CATH 5,6F,25CM,23,20G 1720

CDP01ULT70CK MAC-LOC ULTRATHANE DRAINAGE CATH 1720

CDP01ULT85CK "曲克"經皮引流導管針組"COOK"DRAINAGE CATHETER NEEDLE

SET(STERILE)-MAC-LOC MULTIPURPOSE 8.5,10F-14F,25CM

1720

CDP01ZEBD1CK ZIMMON ENDOSCOPIC BILIARY STENT SET 5:7FR(STENT GUIDEWIRE

INTRODUCER CATHETER)

4458

CDP01ZEBD2CK ”曲克”膽道留置管組”COOK”BILIARY STENT SET 4458

CDP01ZEBD4CK “曲克” 膽道支架暨支架引導系統“COOK” ZIMMON BILIARY

STENTS AND INTRODUCERS

4458

CDP0240110MV FLEXIMA NASOBILIARY CATH(NASOBILIRY CATH+NASAL TRANSFER

TUBE+DRAINAGE CANNECTOR TUBE)

2200

CDP0240110SB FLEXIMA NASOBILIARY CATHETER (CATH+TRANSFER TUBE+DRAINAGE

CONNECTOR TUBE)

2200

CDP0242010CL P.T.C.D. INTERNAL DRAINAGE TUBE (SILICON) 832

CDP02CHB1NCK COTTON HUIBREGTSE BILIARY STENT ONLY 2033

CDP02CLS01CK "COOK"COTTON-LEUNG BILIARY STENTS 5:14FR膽道支架 2033

CDP02LS01NCK COTTON LEUNG BILIANY STENT ONLY 2033

CDP02PADBSSB AMSTERDAM BILIARY STENT 2033

CDP02PEBSTFG "福萊克斯" 膽道引流管 "ENDO-FLEX" BILIARY STENT 2033

CDP02PTFESFG "福萊克斯" 膽道引流管 "ENDO-FLEX" PTFE BILIARY STENT 2033

CDP02SPS12CK "曲克" 西門胰管支架組 "COOK" ZIMMON PANCREATIC STENT SET 2033

760

特材代碼 中英文名稱 支付點數-104/01/01

CDP02TTS02CK “曲克”所亨多坦念包膽道支架“COOK” ST-2 SOEHENDRA

TANNENBAUM BILIARY STENT

2033

CDP02ZS001CK ZIMMON ENDOSCOPIC BILIARY STENT ONLY 5:7FR 4,7,10CM 2033

CDP02ZS003CK “曲克” 膽道支架“COOK” ZIMMON BILIARY STENT 2033

CDPC103105B0 PERITONEAL CATHETER 1897

CDPC121303CM ACCU-FLO BARIUM PISTAL SLIT VALVE PERITONEAL CATHETER 2191

CDPC123045CM HAKIM PERITONEAL CATHETER 1897

CDPC143103PM C.S.F CARDIAC/PERITONEAL CATHETER 1897

CDPC143209M4 CSF FLOW CONTROL SHUNTS AND

ACCESSORIES(CARDIAC/PERITONEAL CATHETERS )

1897

CDPC19007MM4 CSF FLOW CONTROL SHUNTS AND ACCESSORIES CSF CARDIAC

PERITONEAL CATHETER WITH PRESSURE

2191

CDSR104111B0 VENTRICULAR RESERVOIR 4352

CDSR123038M4 "美敦力"腦脊髓液儲液囊"MEDTRONIC" RESERVOIRS 4352

CDSR144111PM VENTRICULAR ACCESS DEVICE BURR HOLE 12MM 4352

CDV0121700CM EXTERNAL DRAINAGE COLLECTION KIT 腦室體外引流組 4850

CDV0121701CM EXTERNAL DRAINAGE SYSTEM(E.D.S.) SET (不含VENTRICULAR

SET)

3220

CDV0121702CM EXTERNAL DRAINAGE SYSTEM(E.D.S.) COLLECTION BAG 539

CDV0121705CM EXTERNAL DRAINAGE SYSTEM(E.D.S.)VENTRICULAR SET (不含

TUBING AND BAG)

1664

CDV0121720CM EXTERNAL DRAINAGE SYSTEM EDSII (VENTRICULAR

CATH+TUBING+BAG)

4850

CDV0121721CM EXTERNAL DRAINAGE SYSTEM EDSII WITHOUT CATH(TUBING+BAG) 3220

CDV0121732CM 柯特曼體外引流集液袋"CODMAN" EDS CSF COLLECTION BAGS 539

CDV0201000TP VENTRICULAR DRAINAGE KIT(VENTRICULAR CATH+TUBING+BAG) 4850

CDV0201101B0 VENTRICULAR CATHETER 1074

CDV0202070TP VENTRICULAR DRAINAGE KIT(VENTRICULAR CATH+TUBING+BAG) 4850

CDV0202204TP VENTRICULAR DRAINAGE SET(TUBING+BAG) 3220

CDV0202207TP VENTRICULAR DRAINAGE BAG 539

CDV0206115B0 EDMS VENTRICULAR CATHETER 20CM W/STYLET 1074

CDV0206124B0 EDMS DRAINAGE BAG 700ML 539

CDV0206126B0 EDMS PATIENT CONNECTION LINE ASSEMBLY 162CM 1167

CDV0206128B0 EXTERNAL DRAINAGE MONITORING SYSTEM 63X11CM 84CM 3220

CDV0221731CM CODMAN EXTERNAL DRAINAGE SYSTEM 3 WITHOUT VENTRICULAR

CATHETER

3220

CDV0246124PM BECKER EDMS DRAINAGE BAG 700ML 539

CDV0246126PM EDMS PATIENT CONNECTION LINE ASSEMBLY 1167

CDV0246128PM I.C.P SHUNT BECKER 3220

CDV0246700M4 EXTERNAL DRAINAGE AND MONITORING SYSTEM 3220

CDV0246710M4 EXACTA DRAINAGE BAG 600ML 539

CDV02ND200TP VENTRICULAR CATH 1074

CDV0506118B0 EDMS VENTRICULAR CATHETER 35CM W/STYLET+TROCAR 型

號:06118S自94年10月1日起生效(文號0940021120)

1664

CDV0523041CM HAKIM VENTRICULAR CATHETER W/INTRODUCER 1664

CDV0527703M4 "美敦力"體外引流及監測用腦室導管"MEDTRONIC" EXTERNAL

DRAINAGE AND MONITORING VENTRICULAR

1664

CDV0546118PM VENTRICULAR CATHETER WITH TROCAR 1664

CDV0619181CM "CODMAN" BACTISEAL EVD CATHETER

SET(CATHETER+STYLET+CLIP+TROCAR) "柯特曼"貝特斯引流管組*

適應症請見備註欄

10000

CDV0621125CM "CODMAN" BACTISEAL EVD CATHETER

SET(CATHETER+STYLET+TROCAR+CLIP) "柯特曼"貝特斯引流管組*

適應症請見備註欄

10000

761

特材代碼 中英文名稱 支付點數-104/01/01

CDVC121201CM ACCU-FLO VENTRICULAR CATHETER 1074

CDVC141101M4 EXTERNAL DRAINAGE AND MONITORING VENTRICULAR CATHETER 1074

CDVC141101PM VENTRICULAR CATHETER 1074

CDVP123011CM HAKIM PRECISION VALVE PRECHAMBER ONLY W/INTRODUCER 5520

CDVP19003AM4 CSF FLOW CONTROL SHUNTS AND ACCESSORIES V-PSHUNT KIT (腦

室引流管+腹腔導管+CTR RESERVOIR+CONX2)

7127

CDVP19003DM4 CSF FLOW CONTROL SHUNTS AND ACCESSORIES V-PSHUNT KIT (腦

室引流管+腹腔導管+CTR RESERVOIR+CONX2)

7127

CDVP19040BPM V-P SHUNT 腦室腹腔分流術導管組 7127

CDVP19040EPM V-P SHUNT 腦室腹腔分流術導管組 7127

CDVP323001CM HYDROCEPHALUS SHUNT SYSTEM 7127

CDVP323016CM VALVE UNIT+PERITONEAL C+VENTRICULAR

C+ADAPTER+CONNECTOR+VALVE INTRODUCER

7127

CDVP323281CM CODMAN HAKIM RIGHT ANGLE VALVES SYSTEM(腦室導管+腹腔導管+

定壓引流閥)

7127

CDVP328501CM UNI-SHUNT WITH ENLARGED DOME RESERVOIR 7127

CDVP346024PM C.S.F UNITIZED SHUNT KIT 7127

CEE010090NPW EXTENSION TUBE 6.3

CEE010150CLL EXTENSION TUBE 90CM,100CM,120CM,150CM 6.3

CEE010150NPW EXTENSION TUBE 6.3

CEE010180NPW EXTENSION TUBE 6.3

CEE0108003P2 EXTENSION TUBE WITH Y 10CM 24.6

CEE0108005P2 EXTENSION TUBE WITH SAMPLING PORT 60CM,70CM 6.3

CEE0108007P2 EXTENSION TUBE WITH SAMPLING PORT 85CM:95CM 6.3

CEE0108100P2 EXTENSION TUBE WITH T 15CM 14

CEE0108300P2 IV EXTENSION TUBE 輸液延長管 45CM 6.3

CEE0108301P2 IV EXTENSION TUBE 輸液延長管 60CM 6.3

CEE0108302P2 EXTENSION TUBE 90CM 6.3

CEE0108303P2 IV EXTENSION TUBE 輸液延長管 120CM 6.3

CEE0108308P2 IV EXTENSION TUBE 輸液延長管 180CM 6.3

CEE010E877SG EXTENSION TUBE MALE-FEMALE LUER LUCK 100CM 6.3

CEE0110655LL "LILY"EXTENSION TUBE 15CM"怡安"輸液延長管 6.3

CEE0110656LL "LILY"EXTENSION TUBE(NEEDLE FREE)"怡安"輸液延長管:免針加

藥座

43.1

CEE012000EJ6 "CAREFUSION"SMARTSITE NEEDLE FREE VALVE EXTENSION SETS

AND COMPONENTS "卡爾費森"無針輸注閥組及配件:無針輸注閥

43.1

CEE0120039J6 "CAREFUSION"SMARTSITE NEEDLE FREE VALVE EXTENSION SETS

AND COMPONENTS "卡爾費森"無針輸注閥組及配件:無針輸注閥延

長管

43.1

CEE0125120M8 EXTENSION TUBE 25:120CM 6.3

CEE0172310CN 2 WAY Y CONNECTOR 24.6

CEE0180015P2 EXTENSION TUBE WITH 3-WAY 15CM 17.3

CEE01A101NPW EXTENSION TUBE 6.3

CEE01A110NPW EXTENSION TUBE WITH T 14

CEE01AS303SG "十美牌"輸液器(免針安全型)"SIGMA"INFUSION SET 43.1

CEE01B430BBQ "BIOTEQ"ANGIOGRAPHIC SYRINGE KIT(LOW PRESSURE TUBE)"邦特"

攝影導管用注射筒套組(螺旋連接管)

40

CEE01BTXDABQ "BIOTEQ"CONTRAST MEDIA DELIVERY SET "邦特"顯影藥物輸液套

組:病人端輸液管(含捲型幫浦輸液管-系統管)

280

CEE01C1000U2 "ICU"CLAVE CONNECTOR AND ACCESSORIES DEVICES:CLAVE

NEEDLELESS CONNECTOR "愛喜優"克萊福無針式接頭 ※適應症請

見備註欄

43.1

CEE01C2000U2 "ICU"CLAVE NEEDLELESS CONNECTOR EXTENSION SET "愛喜優”克

萊福無針式延長管※適應症請見備註欄

43.1

762

特材代碼 中英文名稱 支付點數-104/01/01

CEE01C4200U2 "ICU"CLAVE NEEDLELESS PIGGYBACK EXTENSION SET DUAL PORT "

愛喜優"克萊福無針式雙接頭延長管※適應症請見備註欄

99

CEE01CH100U2 "ICU"CLAVE DRUG PREPARATION SYSTEM:ACCESS DEVICE IV BAG

CLAVE CONNECTOR"愛喜優"克萊福藥物準備系統組件

70

CEE01CH150U2 "ICU"CLAVE DRUG PREPARATION SYSTEM:IV BAG ACCESS SPIKE

CLAVE CHECK VALVE)"愛喜優"克萊福藥物準備系統組件(玻璃瓶

用)

70

CEE01CH303U2 "ICU"CLAVE DRUG PREPARATION SYSTEM:5" (13CM)BAG SPIKE

ADAPTER W/SPIROS NON-DEHP TUBING"愛喜優"克萊福藥物準備系

統組件

134

CEE01DCTPQUL XD2001 CT INJECTOR MISSOURI:PATIENT HOSE AND PUMP HOSE

密蘇里造影劑注射器:病人端輸液管(含捲型幫浦輸液管)

280

CEE01E0085SG EXTENSION TUBE 6.3

CEE01E010NPW "普惠"靜注延長管Y型(免針安全型)給付規定請見備註

欄"PERFECT"EXTENSION TUBE Y TYPE(SAFETY)

43.1

CEE01E030NPW "普惠"輸液套(免針安全型)※給付規定請見備註

欄"PERFECT"DISPOSABLE INFUSION SET(SAFETY)

43.1

CEE01E050NPW "普惠"靜注延長管(免針安全型)給付規定請見備註

欄"PERFECT"EXTENSION TUBE(SAFETY)

43.1

CEE01ENT10SG "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE T-TYPE

EXTENSION TUBE"十美牌"免針輸液接頭T型延長管 ※適應症請見

備註欄

43.1

CEE01ENY10SG "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE Y EXTENSION

TUBE"十美牌"免針輸液接頭Y延長管 ※適應症請見備註欄

51.5

CEE01ENY20SG "十美牌"免針輸液接頭"SIGMA"NEEDLELESS INJECTION ACCESS

DEVICE-Y三路免針輸液接頭 *適應症請見備註欄

99

CEE01ES107SG EXTENSION TUBE 6.3

CEE01ET015SG T-CONNECTOR 14

CEE01ET067BB SAFSITE NEEDLE FREE EXTENSION SET※適應症請見備註欄 43.1

CEE01ET112LL EXTENSION TUBE 6.3

CEE01ET116BB SAFSITE NEEDLE FREE EXTENSION SET※適應症請見備註欄 43.1

CEE01ET12CLL EXTENSION TUBE 6.3

CEE01ET20ULL 2 WAY EXTENSION TUBE 24.6

CEE01ET24ULL 4-WAY EXTENSION TUBE 48.3

CEE01ET33SBB SAFSITE NEEDLE FREE EXTENSION SET(二個NEEDLE FREE)※適應

症請見備註欄

99

CEE01ET60SLL SAFETY EXTENSION TUBE※適應症請見備註欄 23

CEE01ETB05NQ Y-CONNECTOR(Y-IV EXTENSION TUBE) 24.6

CEE01ETC01NQ IV EXTENSION SET 6.3

CEE01ETN10SG "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE SINGLE

EXTENSION TUBE"十美牌"免針輸液接頭延長管 ※適應症請見備註

43.1

CEE01ETN20SG "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE DOUBLE

EXTENSION TUBE"十美牌"免針輸液接頭2路延長管 ※適應症請見

備註欄

99

CEE01ETN51SG EXTENSION TUBE W/FREE SITE 無針式接頭+延長管*適應症請見備

註欄

43.1

CEE01H001NCK CONNECTING TUBE 314

CEE01H003NCK CONNECTING TUBE WITH DRAINAGE BAG CONNECTOR PCN連接管 305

CEE01HPC03CK CONNECTING TUBE BRAIDED POLYETHYLENE 1200PSI 連接管雙層 314

CEE01LP160MH LOW PRESSURE COUNECTOR TUBE 300PSI(螺旋連接管) 40

CEE01LRX50TP EXTENSION TUBE 50CM W/3 WAY STOPCOCK 17.3

763

特材代碼 中英文名稱 支付點數-104/01/01

CEE01N8000SG "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE "十美牌"免針輸

液接頭 ※適應症請見備註欄

43.1

CEE01NFEYSLL "怡安"點滴輸液套(附免針式安全型加藥座)"LILY"INFUSION

SET+NEEDLE FREE

43.1

CEE01P8100SG "SIGMA"NEEDLELESS || INJECTION ACCESS DEVICE "十美牌"免針

||型輸液接頭 ※適應症請見備註欄

43.1

CEE01PET10SG "SIGMA"NEEDLELESS || INJECTION ACCESS DEVICE SINGLE

EXTENSION TUBE "十美牌"免針||型輸液接頭延長管 ※適應症請

見備註欄

43.1

CEE01PET20SG "SIGMA"NEEDLELESS || INJECTION ACCESS DEVICE DOUBLE

EXTENSION TUBE "十美牌"免針||型輸液接頭2路延長管 ※適應症

請見備註欄

99

CEE01PEY10SG "SIGMA"NEEDLELESS || INJECTION ACCESS DEVICE Y EXTENSION

TUBE "十美牌"免針||型輸液接頭Y延長管 ※適應症請見備註欄

51.5

CEE01PTT10SG "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE T-TYPE

EXTENSION TUBE "十美牌"免針||型輸液接頭T延長管 ※適應症請

見備註欄

43.1

CEE01Q5100BD Q-SYTE LUER ACCESS SITE(無針式接頭)※適應症請見備註欄 43.1

CEE01Q5101BD Q-SYTE LUER ACCESS SITE EXTENSION SETS 延長型無針式輸液套

接頭 ※適應症請見備註欄

43.1

CEE01Q5102BD Q-SYTE LUER ACCESS SITE EXTENSION SETS 延長型無針式輸液套

接頭 ※適應症請見備註欄

43.1

CEE01R1000BB SAFSITE VALVES AND ACCESSORIES※適應症請見備註欄 43.1

CEE01T1100U2 "ICU"NON-DEHP MINIBORE EXT SET T-CONNECTOR AND BONDED

CLAVE CONNECTOR"愛喜優”克萊福無針式T延長管※適應症請見備

註欄

43.1

CEE01TC15NLL T-SITE CONNECTOR 14

CEE01TC15SLL "怡安"T型延長管"LILY"T-SITE CONNECTOR:免針式安全型*給付規

定請見備註欄

43.1

CEE01VP003LL EXTENSION TUBE W/3 WAY 17.3

CEP0108314P2 PRESSURE MONITOR LINES 24"-48" 30.7

CEP0108317P2 PRESSURE MONITOR LINES 60"-72" 30.7

CEP010A01NPW EXTENSION TUBE 800PSI高壓延長管 57

CEP0111507BB 1200PSI ANGIODYN HIGH PRESSURE TUBINGS PUR(雙層) 314

CEP011200PTP ANGIOGRAPHIC TUBE 1200PSI 雙層血管造影劑注入延長管 314

CEP012100DCD EXTENSION CATHETER 45CM,65CM,100CM (88/8/1改按條給付) 314

CEP0142373AB ARTERIAL PRESSURE TUBING 30.7

CEP0190701SB PRESSUREE MONITORING LINE 6":96" 30.7

CEP0190702NL PRESSURE MONITORING LINE 6":96" 30.7

CEP0191031NL CONTRAST INJECTION LINES (1200PSI雙層)顯影劑注射導線 314

CEP01A813ABQ 1200PSI HIGH PRESSURE CONNECTING TUBE (雙層) 314

CEP01A841ABQ 900PSI HIGH PRESSURE CONNECTING TUBE(單層) 57

CEP01A851ABQ 1200PSI HIGH PRESSURE CONNECTING TUBE(單層) 57

CEP01AL150SD "SEDAT"ALGAFLEX CONNECTION LINES 1200PSI(HIGH PRESSURE

LINE)"西達"艾加非司壓力連接管

314

CEP01B024NPW HIGH PRESSURE CONNECTING TUBE※限連接測壓導管或檢查導管及

注射造影劑使用

57

CEP01B330BBQ PRESSURE CONNECTING TUBE 500PSI 30.7

CEP01ETP01M6 PRESSURE TUBE 500PSI 30.7

CEP01ETP19M6 PRESSURE TUBE 800-1000PSI 57

CEP01HP20EMR HIGH PRESSURE TUBING 20" 1200PSI(雙層) 314

CEP01HP30EMR HIGH PRESSURE TUBING 30" 1200PSI(雙層) 314

CEP01HP48EMR HIGH PRESSURE TUBING 48" 1200PSI(雙層) 314

764

特材代碼 中英文名稱 支付點數-104/01/01

CEP01HP50EMR HIGH PRESSURE TUBING 500PSI(雙層) 230

CEP01PT006AG "ARGON"DISPOSABLE PRESSURE MONITOR:PRESSURE TUBING"愛琅"

血壓監視組合套:壓力連接管

30.7

CEP01PT012BD ARTERIAL PRESSURE TUBING 30.7

CEP01PT024BD ARTERIAL PRESSURE TUBING 30.7

CEP01PT048AG "ARGON"DISPOSABLE PRESSURE MONITOR:PRESSURE TUBING"愛琅"

血壓監視組合套:壓力連接管

30.7

CEP01PT072BD ARTERIAL PRESSURE TUBING 30.7

CEP01PT483GJ "JSM"PRESSURE TUBING "吉生"壓力連接管(500PSI PVC 每包3條) 92

CEP01PT500GJ PRESSURE TUBING 壓力連接管(500PSI PVC) 30.7

CEP01PT500H9 PRESSURE TUBING 500PSI 壓力連接管 30.7

CEP01PT500SG ARTERIAL PRESSURE TUBING 500PSI 6":72" 30.7

CEP01PT501GJ "JSM"PRESSURE TUBING "吉生"壓力連接管(500PSI/PVC) 30.7

CEP01PTH12SG ARTERIAL PRESSURE TUBING 1200PSI 6":72" 57

CEP01PTHP1GJ "JSM"PRESSURE TUBING:HIGH PRESSURE TUBING"吉生" 壓力連接

管(1200PSI PU 雙層)

314

CEP01PTHPTGJ PRESSURE TUBING:HIGH PRESSURE TUBING 壓力連接管(1200PSI

PU 雙層)

314

CEP01PTHPTH9 PRESSURE TUBING 1200PSI 壓力連接管(雙層) 314

CEP01PTPV1GJ "JSM"PRESSURE TUBING:HIGH PRESSURE TUBING 壓力連接管

(1000PSI/PVC)

57

CEP01PTPVCGJ PRESSURE TUBING:HIGH PRESSURE TUBING 壓力連接管(1000PSI

PVC)

57

CEP01PTPVCH9 HIGH PRESSURE TUBING PVC 1000PSI 高壓力連接管 57

CET0105180BB T-CONNECTOR 15CM 14

CET01B024NPW EXTENSION TUBE 6.3

CET01B032NPW EXTENSION TUBE W/T 14

CEV010KMS1TR PTMV(經皮穿靜脈氣球導管二尖瓣成形術)METAL TUBE 3615

CFD0120936CU CORFLO ENTERAL FEEDING TUBE 36" 6FR;8FR;10FR(含STYLE)※限

G-I手術後併G-I TRACT溢漏或吻合須NPO者

450

CFD0120943CU CORFLO ENTERAL FEEDING TUBE 43" 8FR;10FR;12FR(含STYLE)※

限G-I手術後併G-I TRACT溢漏或吻合須NPO者

450

CFD0120955CU "CORPAK"CORFLO ENTERAL FEEDING TUBES"蔻沛"可福樂管灌餵食

450

CFD0179801FL AG FREKA FEEDING TUBE SET 15FR. 100CM 艾極管灌餵食管袋組

合套 *適應症請見備註欄

450

CFD01BSTPUEE ENTERAL FEEDING TUBE 8,10,12,14,16FGX125CM*適應症請見備註

125

CFD0280845SH KANGAROO ENTERNAL FEEDING TUBE 8,10,12FR 附導線 ※適應症

請見備註欄

450

CFD05BPU08EE PU STOMACH CATHETER 聚胺酯胃管 ※適應症請見備註欄 115

CFD0601006BA "BARD"PONSKY PULL PEG KIT (TUBE+WIRE+S+N+ADAP+BOL)"巴德"

經皮內視鏡胃造口組(半套)※適應症請見備註欄

3634

CFD060644NK4 "KIMBERLY-CLARK"PEG

KIT(TUBE+ADAPTER+RING+NEEDLE+WIRE+CLAMP)〝金百利克拉克〞

經皮內視鏡胃造廔組(半套)※適應症請見備註欄

3634

CFD060644NLZ PEG KIT(半套)經皮內視鏡胃造廔組(PEG

TUBE,ADAPTER,EXTERNAL RETENTION RING,INTRODUCER

NEEDLE,WIRE,TUBING CLAMP)※適應症請見備註欄

3634

CFE02MBL01CK "COOK"4,6,10 SHOOTER SAEED MULTI-BAND LIGATOR "曲克"多發

型結紮器※給付規定請見備註欄

4000

CFE02MBL02CK "COOK"SAEED MULTI-BAND LIGATOR(NON-STERILE)4;6;10 "曲克"

結紮器(未滅菌)※給付規定請見備註欄

4000

765

特材代碼 中英文名稱 支付點數-104/01/01

CFE02SUPERSB 〝BOSTON SCIENTIFIC〞SPEEDBAND SUPERVIEW SUPER7 MULTIPLE

BAND LIGATOR〝波士頓科技〞多發式靜脈瘤結紮環組※適應症請

見備註欄

4000

CGAP1AP212GJ "吉生"心導管包"JSM"ANGIO PACK-基本包(含N+導引鞘組

+GW/0.035"260/300CM+3PORT多路引流器*2+壓力連接管500PSI*4+

壓力連接管1200PSI雙層)

3127.8

CGAP1AP313GJ "吉生"心導管包"JSM"ANGIO PACK-基本包(含N+導引鞘組+GW/不鏽

鋼 0.035"260/300CM+3PORT多路引流器*2+壓力連接管500PSI*4+

壓力連接管1200PSI雙層)

2197.8

CGAP1AP414GJ "吉生"心導管包"JSM"ANGIO PACK-基本包(含N+導引鞘組

+GW/0.035"120~180CM+3PORT多路引流器*2+壓力連接管500PSI*4+

壓力連接管1200PSI雙層)

2507.8

CGAP1AP515GJ "吉生"心導管包"JSM"ANGIO PACK-基本包(含N+導引鞘組+GW/不鏽

鋼 0.035"120~180CM+3PORT多路引流器*2+壓力連接管500PSI*4+

壓力連接管1200PSI雙層)

2087.8

CGAP1AP620GJ "吉生"心導管包"JSM"ANGIO PACK-基本包無導引鞘組(含穿刺針+

導引線/ 0.035"260/300CM+3PORT多路引流器*2+壓力連接管

500PSI*4+壓力連接管1200PSI雙層)

2412.8

CGAP1AP721GJ "吉生"心導管包"JSM"ANGIO PACK-基本包無導引鞘組(N+GW/不鏽

鋼 0.035"260/300CM+3PORT多路引流器*2+壓力連接管500PSI*4+

壓力連接管1200PSI雙層)

1482.8

CGAP1AP822GJ "吉生"心導管包"JSM"ANGIO PACK-基本包無導引鞘組(含

N+GW/0.035"120~180CM+3PORT多路引流器*2+壓力連接管

500PSI*4+壓力連接管1200PSI雙層)

1792.8

CGAP1AP923GJ "吉生"心導管包"JSM"ANGIO PACK-基本包無導引鞘組(N+GW/不鏽

鋼 0.035"120~180CM+3PORT多路引流器*2+壓力連接管500PSI*4+

壓力連接管1200PSI雙層)

1372.8

CGAP1APMAXGJ "吉生"心導管包"JSM"ANGIO PACK-最大包(N*2+導引鞘組

+GW/0.035"260/300CM+4PORT多路引流器*2+壓力連接管500PSI*4+

壓力連接管1200PSI雙層)

3309.8

CGAP1HY100H9 HYM ANGIO PACK 心導管包(GWX1+SHEATHX1+ARTERIAL

NEEDLEX1+MANIFOLDX2+PRESSURE TUBINGX4+HIGHT PRESSURE

TUBINGX1)

2413

CGAP1HY211H9 HYM ANGIO PACK "華億"心導管包(ARTERIAL

NEEDLEX1+MANIFOLDX1+PRESSURE TUBINGX2+HIGH PRESSURE

TUBINGX1)

880

CGBK1AFGV4LY "奧林柏斯"單次用取石網"OLYMPUS"SINGLE USE GRASPING

FORCEPS

12365

CGBK1FSLX1CK "COOK"EXTRACTION BASKETS"曲克"取石網 12365

CGBK1MB501CK "COOK"EXTRACTION BASKETS"曲克"取石網 12365

CGBK1MSB01CK "COOK"EXTRACTION BASKETS"曲克"取石網 12365

CGBK1TRWRBSB "BOSTON SCIENTIFIC"TRAPEZOID RX WIREGUIDED RETRIEVAL

BASKET"波士頓科技"快速交換取石籃

12365

CGDW10113NAN STAINLESS GUIDE WIRE 0.025~0.035" 125~150CM 311

CGDW10117NAN STAINLESS GUIDE WIRE 0.025~0.045" 40~100CM 140

CGDW101228CD MINI GUIDE WIRE 140

CGDW10220NAN GUIDE WIRE 80CM:150CM 0.018":0.038"泌尿科使用 313

CGDW10222NAN STAINLESS PTFE-COATED GUIDE WIRE 0.018~0.038" 80~100CM 277

CGDW10225NAN GUIDE WIRE 200CM:260CM 0.018":0.038"(型號0300,0302-0060)

泌尿科使用

437

CGDW10227NAN STAINLESS GUIDE WIRE PTFE-COATED 0.018~0.038"125CM 313

CGDW10227WAN STAINLESS GUIDE WIRE PTFE-COATED 0.018~0.038"175~200CM 313

CGDW10228NAN STAINLESS GUIDE WIRE PTFE-COATED 0.018~0.038"150CM 313

CGDW10229NAN STAINLESS GUIDE WIRE PTFE-COATED 0.018~0.038" 220CM 437

766

特材代碼 中英文名稱 支付點數-104/01/01

CGDW10233NAN STAINLESS GUIDE WIRE PTFE-COATED 0.018~0.038" 260~500CM 437

CGDW10252NCD EMERALD GUIDE WIRE FIXED-CORE STRAIGHT TIP 0.025" :0.038"

125:175CM

313

CGDW10253NCD EMERALD GUIDE WIRE FIXED-CORE STRAIGHT TIP 0.025":0.038"

125:175CM

313

CGDW10254NCD EMERALD GUIDE WIRE FIXED-CORE STRAIGHT TIP 0.025":0.038"

125:175CM

313

CGDW102555CD EMERALD GUIDE WIRE FIXED-CORE STRAIGHT TIP 0.035" 260CM 437

CGDW102560CD EMERALD GUIDE WIRE FIXED-CORE STRAIGHT TIP 0.035" 150CM 313

CGDW10430NAN STAINLESS GUIDE WIRE PTFE-COATED 0.018~0.038" 150CM 313

CGDW104435AR "ARROW"SPRING GUIDE WIRE 0.035" 60CM"亞諾”導引線 140

CGDW10541NAN NITINOL GUIDE WIRE 0.021~0.035" 145~200CM 751

CGDW10542NAN NITINOL GUIDE WIRE STIFF SHAFF 0.035" 145CM 779

CGDW10620NMV GUIDE WIRE(0.035" 0.038" 150CM) 313

CGDW108005ST "聖猷達"海卓史蒂爾導引線"ST.JUDE"HYDROSTEER GUIDEWIRE

0.035:0.038" 150CM,180CM(鎳合金)

751

CGDW108011ST "聖猷達"海卓史蒂爾導引線"ST.JUDE"HYDROSTEER

GUIDEWIRE0.035:0.038" 260CM(鎳合金)

1359

CGDW111011PB WORKER GUIDE WIRE〈100CM STRAIGHT 277

CGDW111012PB WORKER GUIDE WIRE 100-200CM STRAIGHT(型號

114035120,113935150,112035150自92/7/1生效)

313

CGDW111051PB WORKER GUIDE WIRE〈100CM CURVE 277

CGDW111052PB WORKER GUIDE WIRE 100-200CM CURVE(型號113735,110518-150自

92/7/1生效)

313

CGDW111053PB WORKER GUIDE WIRE 200-300CM CURVE 437

CGDW111080C3 GUIDE WIRE 80CM 277

CGDW111420PB AMPLATZ GUIDE WIRE EXTRA STIFF 0.035" 150CM 779

CGDW112511PB CANALIZER GUIDE WIRE 0.035" 150CM,180CM 751

CGDW112512PB CANALIZER GUIDE WIRE 0.035" 260CM 1359

CGDW112901PB CANALIZER GUIDE WIRE STIFF 0.035" 150CM,180CM 779

CGDW1145FSBA "BARD"UROLOGICAL CATHETER ACCESSORIES:HYDROGLIDE

GUIDEWIRES(STAINLESS STEEL)0.035" 145CM "巴德"泌尿導管附

件:親水性塗層導線

313

CGDW114735AR "ARROW”SPRING WIRE GUIDE 0.035 68CM“亞諾"導引線 140

CGDW116402AR "ARROW" SPRING GUIDE WIRE 0.018" 68CM (DUOFKEX)"亞諾”導

引線

140

CGDW135153WT WATSON GUIDE WIRE STAINLESS WITH PTFE 150CM 0.021:0.038" 313

CGDW135206AG SPRING GUIDE WIRE 0.025",0.035",0.038" 40:65CM FIXED CORE

STRAIGHT

140

CGDW135225AG GUIDE WIRE 0.021,0.025,0.032" 150CM TF/FC/ST 313

CGDW135231AG GUIDE WIRE 0.035" 150CM STRAIGHT 313

CGDW135234AG GUIDE WIRE 0.038" 150CM STRAIGHT 313

CGDW135263WT WATSON GUIDE WIRE STAINLESS WITH PTFE 260CM 0.025:0.038" 437

CGDW135282AG GUIDE WIRE J-TIP 0.035" 150CM 3MM 313

CGDW135284AG SPRINGE GUIDE WIRE 150CM 311

CGDW135368AG GUIDE WIRE 0.032" 260CM 437

CGDW135369AG GUIDE WIRE EXTENSIVE 0.035" 260CM 437

CGDW135415AG SPRING GUIDE WIRE 0.025",0.032",0.035",0.038" 50,65CM

FIXED CORE,3MMJ STRAIGHT

140

CGDW135451AG SPRING GUIDE WIRE 0.018",0.021" 25:80CM FIXED CORE

STRAIGHT

140

767

特材代碼 中英文名稱 支付點數-104/01/01

CGDW135454AG SPRING GUIDE WIRE 0.018",0.021",0.025" 40,50CM FIXED

CORE,3MMJ

140

CGDW135464AG GUIDE WIRE 0.018" 50CM 277

CGDW135470AG GUIDE WIRE 0.018" 150CM TF/FC/1.5MMJ 313

CGDW135522AG GUIDE WIRE 0.018:0.038" 260CM TF/ST 437

CGDW135523AG GUIDE WIRE 0.018:0.038" 125CM,150CM TF/FC/3MMJ 313

CGDW135541AG GUIDE WIRE 0.021" 50CM 277

CGDW135550AG GUIDE WIRE 0.025" 50CM 277

CGDW135585AG GUIDE WIRE 0.025" 260CM 437

CGDW135703AG GUIDE WIRE 0.035" 200CM EXCHANGE TF/ST 437

CGDW135711AG GUIDE WIRE 75CM 140

CGDW135730AG SPRING GUIDE WIRE 0.018",0.021",0.025",50CM FIXED

CORE,6MMJ STRAIGHT

140

CGDW135787AG GUIDE WIRE J-TIP 0.035" 150CM 1.5MM 313

CGDW135798AG SPRING GUIDE WIRE 0.035",0.038" 70,80CM FIXED CORE,3MMJ 140

CGDW135817AG GUIDE WIRE 0.038" 200CM TF/3MMJ 437

CGDW135839AG GUIDE WIRE 0.032,0.035,0.038" 260CM TF/3MMJ 437

CGDW135963AG GUIDE WIRE 0.021" 260CM 437

CGDW135964AG GUIDE WIRE 0.018" 260CM 437

CGDW135968AG SPRING GUIDE WIRE 0.028",0.032",0.035" 40,50CM FIXED

CORE,3MMJ

140

CGDW135989AG GUIDE WIRE 0.028" 50CM 140

CGDW140455ST "聖猶達"蓋瑞特導引線"ST.JUDE " GUIDERIGHT GUIDEWIRE 50CM 277

CGDW14652NMT AMPLATZ SUPER STIFF GUIDE WIRE 779

CGDW14652NSB "波士頓科技"安普拉茲超硬導線"BOSTON SCIENTIFIC"AMPLATZ

SUPER STIFF GUIDEWIRE 0.035/0.038" 145CM,180CM

779

CGDW14656NSB "波士頓科技"安普拉茲超硬導線"BOSTON SCIENTIFIC"AMPLATZ

SUPER STIFF GUIDEWIRE 0.035/0.038" 75CM

779

CGDW1465AMSB "波士頓科技"安普拉茲超硬導線"BOSTON SCIENTIFIC"AMPLATZ

SUPER STIFF GUIDEWIRE 0.035/0.038"X260CM

923

CGDW149101SB STARTER GUIDE WIRE FIXED CORE STR TIP 3.5CM FIEXIBLE TIP

0.032-0.035,100-150CM

313

CGDW149110SB STARTER GUIDE WIRE MOVEABLE CORE STR TIP & J-CURVE TIP

0.035:0.038 150CM

313

CGDW149115SB STARTER GUIDE WIRE FIXED CORE J-CURVE 3.5CM FIEXIBLE TIP

0.025:0.038 120-180CM

313

CGDW14914NSB STARTER GUIDE WIRE NEW BENSON TYPE 0.035 150:180CM 313

CGDW149150SB STARTER GUIDE WIRE NEWTON & NEWTON(LLT)TYPE 0.035 150CM 313

CGDW149155SB STARTER GUIDE WIRE ROSEN HEAVY DUTY TYPE 0.035 180CM 313

CGDW149200LR STARTER GUIDEWIRE 0.018":0.038" 100:180CM(產品型號含

M001492351:81;2501:11)

313

CGDW149200SB STARTER GUIDE WIRE FIXED CORE STR TIP 3.5CM FIEXIBLE TIP

0.018:0.032,100-150CM

313

CGDW149201LR STARTER GUIDEWIRE 0.025":0.035" 40CM,80CM 277

CGDW149201SB STARTER GUIDE WIRE FIXED CORE STR TIP 3.5CM FIEXIBLE TIP

0.025:0.035,40,80CM

277

CGDW149212SB STARTER GUIDE WIRE FIXED CORE STR TIP 3.5CM FIEXIBLE TIP

0.035:0.038,100-180CM

313

CGDW149213LR STARTER GUIDEWIRE 0.035";0.038" 260CM 437

CGDW149213SB STARTER GUIDE WIRE FIXED CORE STR & 3CM J SHAPE 3.5CM

FLEXIBLE TIP 0.035,0.038 260CM

437

CGDW149220SB STARTER GUIDE WIRE DOUBLE END STR TIP& J CURVE TIP 0.035

150CM

313

768

特材代碼 中英文名稱 支付點數-104/01/01

CGDW149221SB STARTER GUIDE WIRE FIXED CORE J-CURVE 3.5CM FIEXIBLE TIP

0.035,0.038 100-180CM

313

CGDW149222SB STARTER GUIDE WIRE FIXED CORE J-CURVE 3.5CM FIEXIBLE TIP

0.035 40,80CM

277

CGDW149250SB STARTER GUIDE WIRE HEAVY DUTY TYPE 0.035 150CM 313

CGDW150270CD GUIDE WIRE TEFLON 0.035" 80CM 277

CGDW15027XCD GUIDE WIRE TEFLON 0.035";0.038" 260CM 437

CGDW15410NAN NITINOL GUIDE WIRE 0.021~0.035" 220~400CM 1359

CGDW15FS38BA "BARD"UROLOGICAL CATHETER ACCESSORIES:HYDROGLIDE

GUIDEWIRES(STAINLESS STEEL)0.038" 145CM "巴德"泌尿導管附

件:親水性塗層導線

313

CGDW163541CK "COOK"URETERAL WIRE GUIDES "曲克"輸尿管導線145CM

0.035;0.038

313

CGDW163845CK AMPLATZ STIFF WIRE GUIDE 145cm 779

CGDW172600PB NITINOL GUIDE WIRE 0.018" 80CM 653

CGDW17900JVQ "VOLCANO"PRIMEWIRE PRESSURE GUIDE WIRE"火山"壓力偵測導線

※給付規定請見備註欄

20000

CGDW18185JVQ "VOLCANO"PRIMEWIRE PRESTIGE PRESSURE GUIDE WIRE"火山"壓力

偵測導線※給付規定請見備註欄

20000

CGDW1960012C "柯惠"肯特利慢性血液透析導管"COVIDIEN"KENDALL CHRONIC

HEMODIALYSIS CATHETERS-GUIDE WIRE 0.035" 0.038" 70CM

140

CGDW1A1340BQ "邦特"血管外引導鋼線"BIOTEQ"GUIDEWIRE PTFE 0.018~0.065"

40~100CM

277

CGDW1A1346BQ "邦特"血管外引導鋼線"BIOTEQ"GUIDEWIRE PTFE 0.018~0.065"

220~500CM

437

CGDW1A1347BQ "邦特"血管外引導鋼線"BIOTEQ"GUIDEWIRE PTFE 0.018~0.065"

120~200CM

313

CGDW1A2131BQ BIOTEQ URETERAL STENT SET DOUBLE J TYPE:GUIDE WIRE

0.028":0.038" 120CM;150CM 邦特輸尿管導管組(雙J型):引導鋼

313

CGDW1A3513TM RADIFOCUS GUIDE WIRE 0.025":0.038" 150CM ANGLED TIP 751

CGDW1A3515TM RADIOFOCUS GUIDE WIRE 0.025",0.035" 150CM (ANGLE) 751

CGDW1A3518TM RADIFOCUS GUIDE WIRE 0.032":0.038" 150CM FLEXIBLE TIP 751

CGDW1A3530TM RADIOFOCUS GUIDE WIRE 0.035" 300CM 1359

CGDW1AER25ST 〝SJM〞PRESSURE WIRE AERIS(FFR)(含0.014"導引線+傳輸器+旋

轉頭)"聖猷達〞壓力感應金屬導引線※給付規定請見備註欄

20000

CGDW1AES01CK "COOK"AMPLATZ EXTRA STIFF FIXED CORE WIRE GUIDE (PTFE

CODE)"曲克"安培茲硬導線0.025";0.035";0.038" 145CM

779

CGDW1ANG11M4 "美敦力"血管診斷攝影用導線"MEDTRONIC"ANGIOGRAPHIC

GUIDEWIRES 0.025~0.038" 120~145CM PTFE

313

CGDW1ANG12M4 "美敦力"血管診斷攝影用導線"MEDTRONIC"ANGIOGRAPHIC

GUIDEWIRES 0.025~0.038" 145~175CM PTFE

313

CGDW1ANG13M4 "美敦力"血管診斷攝影用導線"MEDTRONIC"ANGIOGRAPHIC

GUIDEWIRES 0.035~0.038" 260CM PTFE EXTRA SUPPORT

923

CGDW1ANG14M4 "美敦力"血管診斷攝影用導線"MEDTRONIC"ANGIOGRAPHIC

GUIDEWIRES 0.063" 160CM PTFE EXTRA SUPPORT

779

CGDW1APGW1H9 ANGIO PACK:GUIDE WIRE 0.035" 150CM PTFE 313

CGDW1APGW2H9 ANGIO PACK:GUIDE WIRE 0.035" 260CM PTFE 437

CGDW1AUS21CK "COOK" GUIDE WIRE ULTRA STIFF STAINLESS STEEL TFE COATING

0.035" 0.038" 260CM "曲克"導線

923

CGDW1B1340BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE PTFE 0.018~0.045"

40~100CM

277

CGDW1B1341BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE PTFE 0.018~0.045"

120~200CM

313

769

特材代碼 中英文名稱 支付點數-104/01/01

CGDW1B1346BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE PTFE 0.018~0.045"

220~500CM

437

CGDW1B3450BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE HYDROPHILIC

0.016~0.038" 40~100CM

653

CGDW1B3551BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE HYDROPHILIC

0.025~0.038" 120~200CM

751

CGDW1B3557BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE HYDROPHILIC

0.016~0.018" 120~200CM

751

CGDW1B5250BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE PTFE AMPLATZ

0.025~0.035" 90CM

779

CGDW1B5251BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE PTFE AMPLATZ

0.025~0.035" 145~180CM

779

CGDW1B5252BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE PTFE AMPLATZ

0.025~0.035" 260CM

923

CGDW1B7361BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE PTFE 0.035~0.038"

150CM

313

CGDW1BA340BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE 0.018~0.045"

40~100CM

140

CGDW1BA344BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE 0.018~0.045"

120~200CM

311

CGDW1BC423BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE HYDROPHILIC

0.016~0.038" 400~450CM

1359

CGDW1BC457BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE HYDROPHILIC

0.016~0.038" 120~200CM

751

CGDW1BC521BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE HYDROPHILIC

0.025~0.038" 220~450CM

1359

CGDW1BC552BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE HYDROPHILIC

0.025~0.038" 220~300CM

1359

CGDW1C6121BQ "BIOTEQ"DRAINAGE CATHETER & INTRODUCER SET:NITINOL GUIDE

WIRE 0.018" 80CM "邦特"引流導管及穿刺導入系統:鎳鈦合金引

導鋼線

653

CGDW1CERTUST 〝SJM〞PRESSURE WIRE CERTUS(FFR)(含0.014"導引線+傳輸器+旋

轉頭)"聖猷達〞壓力感應金屬導引線※給付規定請見備註欄

20000

CGDW1EMER1CD "CORDIS"GUIDE WIRE "考迪斯"引導線 PTFE 125;150;175;180CM 313

CGDW1EMER2CD "CORDIS"GUIDE WIRE "考迪斯"引導線 PTFE 220;260CM 437

CGDW1G002ACK GUIDE WIRE STRAIGHT 50CM,80CM 277

CGDW1G002NCK GUIDE WIRE STRAIGHT (100,125,145CM) 313

CGDW1G003ACK GUIDE WIRE AMPLATZ EXTRA-STIFF 145CM,180CM 779

CGDW1G003NCK GUIDE WIRE AMPLATZ EXTRA-STIFF 923

CGDW1G004NCK GUIDE WIRE COONS INTERVENTIONAL 313

CGDW1G005NCK TIP DEFLECTING GUIDE WIRE 822

CGDW1G006ACK GUIDE WIRE CURVED 50CM, 80CM 277

CGDW1G006NCK GUIDE WIRE CURVED 50:145CM(100,125,145CM) 313

CGDW1G007ACK GUIDE WIRE CURVED 180CM 313

CGDW1G007NCK "曲克"導線"COOK"GUIDE WIRE CURVED 180:260CM(260CM) 437

CGDW1G008ACK GUIDE WIRE CURVED 50CM, 80CM 277

CGDW1G008NCK GUIDE WIRE CURVED 50:145CM(100,125,145CM) 313

CGDW1G009ACK GUIDE WIRE CURVED 80CM 277

CGDW1G009NCK GUIDE WIRE CURVED (100,125,145CM) 313

CGDW1G011ACK "曲克"導線"COOK"GUIDE WIRE STRAIGHT 0.018~0.021"

50CM,80CM

277

CGDW1G011NCK "曲克"導線"COOK"GUIDE WIRE STRAIGHT 0.018~0.021"

100,125,145CM

313

770

特材代碼 中英文名稱 支付點數-104/01/01

CGDW1G012NCK "曲克"導線"COOK"GUIDE WIRE STRAIGHT 0.018~0.052" 260CM 437

CGDW1G013NCK SOS INTERVENTIONAL GUIDE WIRE 145CM 952

CGDW1G016ACK "曲克"導線"COOK"GUIDE WIRE STRAIGHT 0.025~0.052"

50CM,80CM

277

CGDW1G016NCK "曲克"導線"COOK"GUIDE WIRE STRAIGHT 0.025~0.052"

100,125,145CM

313

CGDW1G017NCK "COOK"GUIDE WIRE TEFCOR MOVABLE CURVED"曲克"導線 313

CGDW1G018NCK GUIDE WIRE LUNDERQUIST EXCHANGE 120CM 787

CGDW1GAGSNTM RADIFOCUS GUIDEWIRE(SHAPEABLE TYPE

ANGLE,STRAIGHT)0.018":0.038"120:150CM

751

CGDW1GKGLNTM RADIFOCUS GUIDEWIRE(SHAPEABLE TYPE

ANGLE,STRAIGHT)0.018":0.038"120:180CM

751

CGDW1GW001G6 'AGA' AMPLATZER GUIDE WIRE (PDA OCCLUDER 用)※適應症請見

備註欄

1600

CGDW1GW003G6 "銨積維"導引導管"AGA" AMPLATZER GUIDEWIRE (OCCLUDER 用)※

給付規定請見備註欄

1600

CGDW1H1258GJ "JSM"GUIDE WIRE (HYDROPHILIC PVP PRE-COATED)

0.018"~0.038"120;150;180CM "吉生"導引線

751

CGDW1H2630GJ "JSM"GUIDE WIRE (HYDROPHILIC PVP PRE-COATED)

0.018"~0.038" 260;300CM "吉生"導引線

1359

CGDW1HAHSNTM RADIFOCUS GUIDEWIRE HALFSTIFF(SHAPEABLE TYPE

ANGLE,STRAIGHT)0.018":0.038"120:180CM

779

CGDW1HSF01CK LUNDERQUIST RING TORQUE GUIDE WIRE 變換金屬導線 787

CGDW1HW001CK HYDROPHILIC WIRE GUIDES 150CM,180CM 0.025" 0.035" 0.038" 751

CGDW1HW018CK HYDROPHILIC WIRE GUIDES 180CM 0.018" 2781

CGDW1HWA01CK HYDROPHILIC WIRE GUIDES 150CM,180CM 0.025" 0.035" 0.038" 751

CGDW1HWA02CK HYDROPHILIC WIRE GUIDES 260CM 0.025" 0.035" 0.038" 1359

CGDW1HWA18CK HYDROPHILIC WIRE GUIDES 150CM 180CM 0.018" 2781

CGDW1HWA28CK HYDROPHILIC WIRE GUIDES 260CM 0.018" 2800

CGDW1HWAS1CK HYDROPHILIC WIRE GUIDES EXTRA SUPPORT(STIFF SHAFT)150CM

180CM 0.035" 0.038"

779

CGDW1HWAS2CK HYDROPHILIC WIRE GUIDES 260CM 0.035" 0.038" 1359

CGDW1HWS01CK HYDROPHILIC WIRE GUIDES EXTRA SUPPORT(STIFF SHAFT)150CM

180CM 0.035" 0.038"

779

CGDW1LC181TM RADIFOCUS GUIDE WIRE M 0.018"~0.038"120CM,150CM,180CM 751

CGDW1LC182TM RADIFOCUS GUIDE WIRE M STIFF WIRE 0.025"~0.038"

150CM,180CM

779

CGDW1LC183TM RADIFOCUS GUIDE WIRE M STIFF WIRE 0.018" 180CM 779

CGDW1LC18NTM RADIFOCUS GUIDE WIRE M 0.018"~0.038" 120CM,150CM,180CM 751

CGDW1LC301TM RADIFOCUS GUIDE WIRE M STIFF WIRE 0.018"~0.038"

220CM,260CM,300CM

1359

CGDW1LC303TM "泰爾茂"導引導線"TERUMO"RADIFOCUS GUIDE WIRE M STIFF WIRE

0.025",0.035" 260CM,300CM

1359

CGDW1LC30NTM RADIFOCUS GUIDE WIRE M 0.018"~0.038" 220CM,260CM,300CM 1359

CGDW1MSU70MW GUIDE WIRE 股靜脈、鎖骨下靜脈導管 140

CGDW1N405HST GUIDERIGHT GUIDEWIRE HEPARIN COATED FIXED CORE

0.035",0.038" 150CM;180CM

313

CGDW1N4568ST "聖猷達"蓋瑞特導引線"ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 313

CGDW1N4577ST "聖猷達"蓋瑞特導引線"ST.JUDE " GUIDERIGHT GUIDEWIRE 260CM 437

771

特材代碼 中英文名稱 支付點數-104/01/01

CGDW1N458NST GUIDERIGHT GUIDEWIRE SUPER STIFF FIXED CODE 0.032",0.038"

180CM

779

CGDW1N4610ST "聖猷達"蓋瑞特導引線"ST.JUDE"GUIDERIGHT GUIDEWIRE 150CM

180CM

313

CGDW1N4840ST "聖猷達"蓋瑞特導引線"ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 313

CGDW1N4841ST "聖猷達"蓋瑞特導引線"ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 313

CGDW1N4870ST "聖猷達"蓋瑞特導引線"ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 313

CGDW1N4948ST "聖猷達"蓋瑞特導引線"ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 313

CGDW1N4998ST "聖猷達"蓋瑞特導引線"ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 313

CGDW1N5018ST "聖猷達"蓋瑞特導引線"ST.JUDE " GUIDERIGHT GUIDEWIRE 260CM 437

CGDW1PA353TM "泰爾茂"血管攝影用導線"TERUMO"RADIFOCUS GUIDE WIRE M

0.035":0.038" 80:180CM STIFF TYPE

779

CGDW1PMG01CK COPE NITINOL MANDRIL WIRE GUIDE(PLATINUM TIP)0.018" 25-

200CM 加蓋軸心鎳鉻合金導線

1655

CGDW1PTGW1GJ STAINLESS STEEL GUIDE WIRE0.018"~0.038" 50CM;80CM W/PTFE 277

CGDW1PTGW1H9 STAINLESS W/PTFE GUIDE WIRE 0.018":0.038" 50CM:80CM 277

CGDW1PTGW2GJ STAINLESS STEEL GUIDE WIRE0.018"~0.038" 120CM;150CM;180CM

W/PTFE

313

CGDW1PTGW2H9 STAINLESS W/PTFE GUIDE WIRE 0.018":0.038"

120CM;150CM;180CM

313

CGDW1PTGW3GJ STAINLESS STEEL GUIDE WIRE0.018"~0.038" 260CM;300CM

W/PTFE

437

CGDW1PTGW3H9 STAINLESS W/PTFE GUIDE WIRE 0.018":0.038" 260CM;300CM 437

CGDW1PWC28ST "SJM"PRESSUREWIRE(含0.014"導引線+可拆解接線+旋轉頭)"聖猷

達"壓力感應金屬導線

20000

CGDW1R402NST GUIDERIGHT GUIDEWIRE HEPARIN COATED MOVABLE CORE

0.035",0.038" 150CM

313

CGDW1R455NST GUIDERIGHT GUIDEWIRE INTRODUCER

0.021",0.025",0.032",0.035",0.038 50CM,80CM

277

CGDW1R45DDST GUIDERIGHT GUIDEWIRE DOUBLE DISTAL FIXED CORE

0.035",0.038" 150CM,180CM

313

CGDW1R45J2ST GUIDERIGHT GUIDEWIRE J TIP FIXED CORE 0.32",0.35",0.038"

260CM

437

CGDW1R45NNST GUIDERIGHT GUIDEWIRE J TIP FIXED CORE

0.21",0.25",0.30",0.32",0.35",0.038,0.65" 150CM,180CM

313

CGDW1R4876ST GUIDERIGHT GUIDEWIRE SUPER STIFF FIXED CODE 0.038" 260CM 923

CGDW1R48NNST GUIDERIGHT GUIDEWIRE STRAIGHT FIXED CORE

0.021",0.025",0.032",0.035",0.038" 150CM

313

CGDW1R48SFST GUIDERIGHT GUIDEWIRE STRAIGHT FIXED CORE 0.035",0.038"

260CM

437

CGDW1R4946ST GUIDERIGHT GUIDEWIRE J TIP MOVABLE CORE 0.035",0.038"

150CM

313

CGDW1R4950ST GUIDERIGHT GUIDEWIRE STRAIGHT MOVABLE CORE 0.035",0.038"

150CM

313

CGDW1R5018ST GUIDERIGHT GUIDEWIRE HEPARIN COATED FIXATED CORE 0.035"

260CM

437

772

特材代碼 中英文名稱 支付點數-104/01/01

CGDW1RFPC1CK ROADRUNNER GUIDE WIRE 0.035",0.038" 145CM,180CM/TIP 7CM 751

CGDW1RFPC2CK ROADRUNNER GUIDE WIRE 0.035",0.038" 260CM/TIP 7CM 1359

CGDW1RFSP1CK ROADRUNNER WIRE GUIDE 0.035",0.038" 145CM,180CM 751

CGDW1RFSP2CK ROADRUNNER WIRE GUIDE 0.035",0.038" 260CM 1359

CGDW1RLPC1CK ROADRUNNER GUIDE WIRE 0.035",0.038" 145CM,180CM/TIP 16CM 751

CGDW1RLPC2CK ROADRUNNER GUIDE WIRE 0.035",0.038" 260CM/TIP 16CM 1359

CGDW1RPC1XCK ROADRUNNER GUIDE WIRE 0.035",0.038" 145CM,180CM/TIP 8CM 751

CGDW1RPC2XCK ROADRUNNER GUIDE WIRE 0.035",0.038" 260CM/TIP 8CM 1359

CGDW1S3515TM RADIOFOCUS GUIDE WIRE 0.035" 150CM (STRAIGHT) 751

CGDW1S3530TM RADIOFOCUS GUIDE WIRE 0.035" 300CM 1359

CGDW1SFA35C3 GUIDE WIRE 0.035" 150CM 313

CGDW1SPCG1AB "亞培"高鐸格超核心血管導線"ABBOTT"HI-TORQUE SUPRA CORE 35

GUIDE WIRE 0.035" 145CM,190CM

779

CGDW1SPCG3AB "亞培"高鐸格超核心血管導線"ABBOTT"HI-TORQUE SUPRA CORE 35

GUIDE WIRE 0.035" 300CM

923

CGDW1SUPERG6 'AGA' AMPLATZER GUIDE WIRE (ASD OCCLUDER 用)※適應症請見

備註欄

1600

CGDW1THSF1CK GUIDE WIRE STAINLESS STEEL TFE COATING 0.035";0.038"

260CM

437

CGDW1TSF01CK "曲克"導線 "COOK" GUIDE WIRE STAINLESS TEFLON-COATED

0.018~0.038"145;180CM

313

CGDW1TSM01CK MOVABLE CORE STRAIGHT SAFELY GUIDE WIRE 安全導線

100,145CM(90/10/1產品型號 TSM-32:38-80另編代碼)

313

CGDW1TSM0ACK MOVABLE CORE STRAIGHT SAFETY GUIDE WIRE 80CM 277

CGDW1UA35BAS "朝日"優你客血管造影導線"ASAHI" UNIQUAL ANGIOGRAPHIC

GUIDE WIRE 0.035" 50-80CM

653

CGDW1UJAJNAS ASAHI UNIQUAL ANGIOGRAPHIC GUIDE WIRE 0.025":0.038"

150CM:200CM

751

CGDW1UJBESAS ASAHI UNIQUAL ANGIOGRAPHIC GUIDE WIRE 0.025":0.038"

220CM:300CM

1359

CGDW1USAJNAS ASAHI UNIQUAL ANGIOGRAPHIC GUIDE WIRE 0.025":0.038"

150CM:200CM

751

CGDW1USBESAS ASAHI UNIQUAL ANGIOGRAPHIC GUIDE WIRE 0.025":0.038"

220CM:300CM

1359

CGDW1USUJ3AS "朝日"優你客血管造影導線"ASAHI" UNIQUAL ANGIOGRAPHIC

GUIDE WIRE 0.035" 220CM~300CM

1359

CGDW1USUJBAS "朝日"優你客血管造影導線"ASAHI" UNIQUAL ANGIOGRAPHIC

GUIDE WIRE 0..35" 150CM~200CM

751

CGDW1Z1P26SB ZIPWIRE HYDROPHILIC GUIDE WIRE STIFF/STANDARD

0.025",0.035",0.038" 260CM 利博親水性導線

1359

CGDW1ZSD58SB ZIPWIRE HYDROPHILIC GUIDE WIRE 0.025",0.035",0.038"

150CM,180CM 利博親水性導線

751

CGDW1ZSF58SB ZIPWIRE HYDROPHILIC GUIDE WIRE STIFF 0.025",0.035",0.038"

150CM,180CM 利博親水性導線

779

CGDW1ZSF80SB ZIPWIRE HYDROPHILIC GUIDE WIRE STIFF 0.035",0.038" 80CM

利博親水性導線

779

CGPG11001NAC VIKING CORONARY GUIDING CATHETER 6:10FR※自92.7.1改按條支

1744

CGPG11006NAC VIKING CORONARY GUIDING CATHETER*自92.7.1改按條支付 1744

CGPG110264SB MACH 1 PERIPHERAL GUIDING CATHETER 6:8F 55,90CM 1744

CGPG118084ZF "史特勞斯"區克斯極緻/選擇支撐導管(直線

型)"SPECTRANETICS"QUICK-CROSS EXTREME/SELECT SUPPORT

CATHETERS

8715

773

特材代碼 中英文名稱 支付點數-104/01/01

CGPG118085ZF "史特勞斯"區克斯極緻/選擇支撐導管(角度

型)"SPECTRANETICS"QUICK-CROSS EXTREME/SELECT SUPPORT

CATHETERS

8715

CGPG134356SB "波士頓科技"馬克導引導管"BOSTON SCIENTIFIC"MACH 1 GUIDE

CATHETER 6:8FR

1744

CGPG138969SB RUNWAY GUIDE CATHETER 6FR 1744

CGPG151038ZF "史特勞斯"區克斯導管"SPECTRANETICS"QUICK-CROSS SUPPORT2

CATHETERS

8715

CGPG15565FCD VISTABRITETIP GUIDING CATHETERS 5F 0.056(ALL CURVE STYLE)

*自92.7.1改按條支付

1744

CGPG1574XNCD VISTABRITETIP GUIDING CATHETER 7FR 0.074",0.078"※自

92.7.1改按條支付

1744

CGPG1586XNCD "CORDIS"VISTABRITETIP GUIDING CATHETER 8FR 0.086",0.088""

考迪斯"導引導管※自92.7.1改按條支付

1744

CGPG158882CD VISTA BRITE TIP GUIDING CATHETER 8FR 0.088 *自92.7.1改按

條支付(型號5888200:2自92/7/1生效)

1744

CGPG15888FCD PERIPHERAL GUIDING CATHETER 8FR 0.088※自92.7.1改按條支付 1744

CGPG159892CD VISTA BRITE TIP GUIDING CATHETER 9FR 0.098 *自92.7.1改按

條支付(型號5989200:2自92/7/1生效)

1744

CGPG15989FCD PERIPHERAL GUIDING CATHETER 9FR 0.098※自92.7.1改按條支付 1744

CGPG16676FCD VISTABRITEIP GUIDING CATHETER 6FR 0.67(ALL CURVE STYLE)※

自92.7.1改按條支付

1744

CGPG16706FCD "CORDIS"VISTABRITETIP GUIDING CATHETERS 6FR .070"考迪斯"

導引導管※(自92/7/1改按條支付)

1744

CGPG17787FCD VISTABRITETIP GUIDING CATHETERS 7F 0.078(ALL CURVE STYLE)

*自92.7.1改按條支付

1744

CGPG1AB035BQ GUIDING CATHETER 1744

CGPG1AB131BQ GUIDING CATHETER 1744

CGPG1AB234BQ GUIDING CATHETER 1744

CGPG1CA031BQ GUIDING CATHETER 1744

CGPG1CA131BQ GUIDING CATHETER 1744

CGPG1CA214BQ GUIDING CATHETER 1744

CGPG1CAS31BQ GUIDING CATHETER 1744

CGPG1CGC58MR "MERIT" CONCIERGE GUIDING CATHETER(5~8F)"美瑞特"康捷導引

導管

1744

CGPG1CNCRGMR "MERIT" CONCIERGE GUIDING CATHETER(5~8F)"美瑞特"康捷導引

導管

1744

CGPG1CNVEYSB "波士頓科技"康必導引導管"BOSTON SCIENTIFIC"CONVEY GUIDING

CATHETER 5FR

1744

CGPG1CX101CK CXI SUPPORT CATHETER(含4個不透線標記)西斯艾支持導管 8715

CGPG1CX102CK CXI SUPPORT CATHETER(含4個不透射線標記)西斯艾支持導管 8715

CGPG1CXC01CK "COOK" CROSSCATH SUPPORT CATHETER (單腔含3個探

頭)3.0~4.8FR 90~150CM"曲克" 庫斯凱支持導管

8715

CGPG1GCF60TM HEARTRAIL PTCA GUIDING CATHETER 5:8FR 100CM 哈得睿兒導引

導管

1744

CGPG1GCF70TM HEARTRAIL PTCA GUIDING CATHETER 5:8FR 100CM 哈得睿兒導引

導管

1744

CGPG1GCF90TM HEARTRAIL II PTCA GUIDING CATHETER哈得睿兒導引導管第二代 1744

CGPG1GCH60TM "泰爾茂"哈得睿兒導引導管"TERUMO"HEARTRAIL PTCA GUIDING

CATHETER STANDARD TYPE 5:8FR

1744

774

特材代碼 中英文名稱 支付點數-104/01/01

CGPG1JLJRAAS "ASAHI" ZENYTEEX PTCA GUIDING CATHETER "朝日"辛尼堤經皮冠

狀動脈成型術導引導管

1744

CGPG1KMF4AKE CRUSADE CORONARY ANGIOPLASTY CATHETER 2 LUMEN 140CM

3.2FR(冠狀動脈成型術探測導管)

8951

CGPG1LA006M4 "美敦力"浪曲導引導管"MEDTRONIC"LAUNCHER GUIDE CATHETERS

6FR

1744

CGPG1LA501M4 "美敦力"浪曲導引導管"MEDTRONIC"LAUNCHER GUIDE CATHETERS

5FR

1744

CGPG1LA502M4 "美敦力"浪曲導引導管"MEDTRONIC"LAUNCHER GUIDE CATHETERS

5FR

1744

CGPG1LA701M4 "美敦力"浪曲導引導管"MEDTRONIC"LAUNCHER GUIDE CATHETERS

7FR

1744

CGPG1LA702M4 LAUNCHER GUIDE CATHETER 7FR 1744

CGPG1LA801M4 "美敦力"浪曲導引導管"MEDTRONIC"LAUNCHER GUIDE CATHETERS

8FR

1744

CGPG1LA802M4 LAUNCHER GUIDE CATHETER 8FR 1744

CGPG1MSC57VS MINNIE SUPPORT CATHETER(含3個探頭) 8715

CGPG1PBSMPAS "ASAHI" ZENYTEEX PTCA GUIDING CATHETER "朝日"辛尼堤經皮冠

狀動脈成型術導引導管

1744

CGPG1SC014Y7 "伊維三"崔爾巴特支持導管"EV3"TRAILBLAZER SUPPORT CATHETER 8715

CGPG1SCBR1CK SLIP-CATH GUIDING CATHETERS 4.0FR 40:150CM 1744

CGPG1SCBR2CK SLIP-CATH GUIDING CATHETERS 4.5:6.5FR 75:135CM 1744

CGPG1SCBR3CK SLIP-CATH GUIDING CATHETERS 5.0FR 40:125CM 1744

CGPG1SCBR4CK SLIP-CATH GUIDING CATHETERS 5.0FR 65:90CM 1744

CGPG1SELE2M4 "美敦力"艾坦賽勒傳送導管系統"MEDTRONIC"ATTAIN SELECT II

DELIVERY CATHETER SYSTEM

1744

CGPG1SHA01M4 SHERPA NX ACTIVE GUIDE CATHETERS 5:6F 1744

CGPG1SHA02M4 SHERPA NX ACTIVE GUIDE CATHETERS 5:6F 1744

CGPG1SHA03M4 "MEDTRONIC"SHERPA NX ACTIVE GUIDE CATHETERS 5:6F"美敦力"

雪爾帕導引導管

1744

CGPG1SHB01M4 SHERPA NX BALANCED GUIDE CATHETERS 6:8F 1744

CGPG1SHB02M4 SHERPA NX BALANCED GUIDE CATHETERS 6:8F 1744

CGPG1SHB03M4 "MEDTRONIC"SHERPA NX BALANCED GUIDE CATHETERS 6:8F"美敦

力"雪爾帕導引導管

1744

CGPG1SW510VS SKYWAY SUPPORT CATHETER 0.014" 138CM(多功能) 8715

CGPG2CFLNRVS 〝VASCULAR SOLUTIONS〞GUIDELINER CATHETER "法斯樂舒順"冠

連導管※適應症請見備註欄

18617

CGPG2GDLV2VS "法斯樂舒順"第2代冠連導管"VASCULAR SOLUTIONS"GUIDELINER

V2 CATHETER※給付規定請見備註欄

18617

CGPG338942SB "BOSTON SCIENTIFIC"ATLANTIS SR CORONARY IMAGING CATHETER

W/SLED"波士頓"亞蘭提斯冠狀動脈攝影導管-血管內超音波導管及

橇型板※適應症請見備註欄

20480

CGPG385900VQ "VOLCANO"EAGLE EYE F/X 2.9F INTRAVASCULAR ULTRASOUND

IMAGING CATHETER"火山"血管內超音波影像導管(彩色)※給付規

定請見備註欄

20480

CGPG38590PVQ "VOLCANO"EAGLE EYE PLATINUM DIGITAL IVUS CATHETER"火山"數

位式血管內超音波影像導管(彩色)※給付規定請見備註欄

20480

CGPG389000VQ "VOLCANO"REVOLUTION ROTATIONAL IVUS IMAGING CATHETER"火

山"血管內超音波影像導管※給付規定請見備註欄

20480

CGPW10462HAB HI-TORQUE BALANCE HEAVY WEIGHT GUIDE WIRE PTFE SUPPORT

0.014" 190CM

2817

CGPW10463HAB HI-TORQUE BALANCE HEAVY WEIGHT GUIDE WIRE PTFE SUPPORT

0.014" 300CM

2870

775

特材代碼 中英文名稱 支付點數-104/01/01

CGPW108001ST "聖猷達"海卓史蒂爾導引線"ST.JUDE"HYDROSTEER GUIDEWIRE

0.018" 150CM,180CM(鎳合金)

2430

CGPW11048NAB HI-TORQUE PILOT 150 200 GUIDE WIRE 0.014" 300CM 2870

CGPW112154SB CHOICE GUIDE WIRE 0.014" 300CM 2587

CGPW112160SB CHOICE GUIDE WIRE 0.014" 182CM 2353

CGPW112201SB "波士頓科技"凱耐帝斯導引線"BOSTON SCIENTIFIC"KINETIX

GUIDE WIRE PTFE 0.014" 185CM

2430

CGPW112202SB "波士頓科技"凱耐帝斯導引線"BOSTON SCIENTIFIC"KINETIX

GUIDE WIRE PTFE 0.014" 300CM

2587

CGPW114901SB PT GRAPHIX GUIDE WIRE 0.014" 182CM 2353

CGPW114913SB PT GRAPHIX GUIDE WIRE 0.014" 300CM 2587

CGPW11740NAB HI-TORQUE SUPER SUPPORT PTCA GUIDE WIRE 0.014" 190CM 2817

CGPW11741NAB HI-TORQUE ALL STAR PTCA GUIDE WIRE 0.014" 300CM 2870

CGPW11780NAB HI-TORQUE GUIDE WIRE EXTRA SUPPORT 190CM 2817

CGPW11782NAB HI-TORQUE GUIDE WIRE EXTRA SUPPORT 300CM 2870

CGPW11834HAB HI-TORQUE WHISPER EXTRA SUPPORT GUIDE WIRE 190CM 0.014" 2817

CGPW11835HAB HI-TORQUE WHISPER EXTRA SUPPORT GUIDE WIRE 300CM 0.014" 2870

CGPW118688TM RUNTHROUGH NS PTCA GUIDE WIRE W/PTFE 不鏽鋼 0.014" 150CM 2353

CGPW12224NAB HI-TORQUE EXTRE SUPPORT GUIDE WIRE 0.014" 190CM 2817

CGPW12234NAB HI-TORQUE EXTRA SUPPORT GUIDE WIRE 0.014" 300CM 2870

CGPW1223HNAB HI-TORQUE PTCA GUIDE WIRE W/HYDROCOAT 0.014" 190CM 2353

CGPW1223MNAB HI-TORQUE PTCA GUIDE WIRE W/MICROGLIDE COATING 0.014"

190CM

2353

CGPW128000AB HI-TORQUE GUIDE WIRE W/HYDROCOAT 0.014" 190CM EXTRA

SUPPORT

2817

CGPW128001AB HI-TORQUE GUIDE WIRE W/HYDROCOAT 0.014" 300CM EXTRA

SUPPORT

2870

CGPW13309NAB HI-TORQUE CROSS-IT PTCA GUIDE WIRE 0.014" 190CM 2353

CGPW13310NAB HI-TORQUE CROSS-IT PTCA GUIDE WIRE 0.014" 300CM 2587

CGPW1379MNAB HI-TORQUE PTCA GUIDE WIRE W/MICROGLIDE COATING 0.014"

300CM

2587

CGPW138931SB PT2 GUIDEWIRE HYDROPHILIC COATING 0.014" 185CM 2353

CGPW138932SB PT2 GUIDEWIRE HYDROPHILIC COATING 0.014" 300CM 2587

CGPW138950SB IQ GUIDE WIRE 0.014" 185CM 2353

CGPW138951SB IQ GUIDE WIRE 0.014" 300CM 2587

CGPW14181ATM RUNTHROUGH NS PTCA GUIDE WIRE 嵐鍶路導引導線 2353

CGPW1418FATM RUNTHROUGH NS PTCA GUIDE WIRE HYDROPHILLIC COATING 180CM

0.014"

2353

CGPW1418XATM "TERUMO"RUNTHROUGH PTCA GUIDE WIRE(0.014" 180CM

W/COATING)"泰爾茂"嵐鍶路導引導線

2430

CGPW143092AS "朝日"周邊血管導引線"ASAHI"PERIPHERAL GUIDEWIRE

0.014";0.018" 180CM;190CM

2430

CGPW1430RSTM PTCA GUIDE WIRE W/HYDROPHILIC COATING 0.014" 180:300CM 2353

CGPW143392AS "朝日"周邊血管導引線"ASAHI"PERIPHERAL GUIDEWIRE

0.014";0.018" 300CM

2800

CGPW144586AB "亞培"亥托克新輕巧型導管引線"Abbott"HI-TORQUE ADVANCE

LITE GUIDE WIRE W/HYDROCOAT HYDROPHILIC COATING 0.014"

190CM

2353

CGPW144587AB "亞培"亥托克新輕巧型導管引線"Abbott"HI-TORQUE ADVANCE

LITE GUIDE WIRE W/HYDROCOAT HYDROPHILIC COATING 0.014"

300CM

2587

CGPW144588AB HI-TORQUE ADVANCE GUIDE WIRE 190CM 0.014" 2353

CGPW144589AB HI-TORQUE ADVANCE GUIDE WIRE 300CM 0.014" 2587

776

特材代碼 中英文名稱 支付點數-104/01/01

CGPW146850SB V-18 CONTROL WIRE 0.018" 150-200CM W/HYDROPHILIC COATING 2781

CGPW146860SB V-18 CONTROL WIRE 0.018" 300CM W/HYDROPHILIC COATING 2800

CGPW1480P5AB HI-TORQUE PILOT 50 GUIDE WIRE 0.014" 190CM 2353

CGPW1483P5AB HI-TORQUE PILOT 50 GUIDE WIRE 0.014" 300CM 2587

CGPW148P15AB HI-TORQUE PILOT 150 200 GUIDE WIRE 0.014" 190CM 2817

CGPW149283SB THRUWAY GUIDEWIRE 0.018"*300CM 2800

CGPW1492TWSB THRUWAY GUIDEWIRE 0.018"*130,190CM 2781

CGPW15024XCD GUIDE WIRE TEFLON 0.018" 150CM;260CM 2430

CGPW1503XACD 0.018 SMALL VESSAL PERIPHERAL GUIDE WIRE 180CM 2430

CGPW1503XNCD 0.018 SMALL VESSEL PERIPHERAL GUIDE WIRE 300CM(90/10/1型

號503458,558,658,758-G刪除)

2800

CGPW15079ACD STEERABLE GUIDE WIRE 0.014" STRAIGHT TIP 3CM RADIOPAQUE

TIP 180CM

2353

CGPW15357NAB HI-TORQUE WHISPER GUIDE WIRE 0.014" 190CM 2353

CGPW15359NAB HI-TORQUE WHISPER GUIDE WIRE 0.14" 300CM 2587

CGPW1547XACD SHINOBI GUIDE WIRE 0.014" 180CM 2353

CGPW1547XNCD SHINOBI GUIDEWIRE 0.014 300CM (90/10/1原180CM規格另編碼) 2587

CGPW1595M0CD ATW STEERABLE GUIDEWIRE(MARKER WIRE)0.014" 195CM 2353

CGPW1595M1CD ATW STEERABLE GUIDEWIRE(MARKER WIRE)0.014" 300CM 2587

CGPW1595XACD ATW STEERABLE GUIDE WIRE 0.014" 195CM 2353

CGPW1595XNCD ATW STEERABLE GUIDEWIRE 300CM (90/10/1原型號595014,595-

J,X,Y,E-014另編碼)

2587

CGPW19660NAB HI-TORQUE GUIDE WIRE EXTRA SUPPORT 190CM 2817

CGPW19661NAB HI-TORQUE GUIDE WIRE EXTRA SUPPORT 300CM 2870

CGPW196646AB "Abbott"HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL II GUIDE

WIRE W/HYDROCOAT HYDROPHILIC COATING 0.014" 190CM

2353

CGPW196657AB "Abbott"HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL II GUIDE

WIRE W/HYDROCOAT HYDROPHILIC COATING 0.014" 300CM

2587

CGPW1ACUMMSB "波士頓科技"艾裘帝靜脈導線"BOSTON SCIENTIFIC"ACUITY

STRAIT-TRAK AND MAILMAN VENOUS GUIDE WIRES

2353

CGPW1ADDWRLR "大湖區"愛德延伸導線"LAKE REGION"ADDWIRE EXTENSION WIRE

0.014" 145CM

2353

CGPW1AG141AS PTCA GUIDE WIRE PTFE SOFT INTERMEDIATE 0.014 (自971001由

175CM改為180CM)

2353

CGPW1AG143AS PTCA GUIDE WIRE 0.014 STANDARD, STANDARD J,

EXTENSION(AG149000仍為150CM,其他型號自971001由175CM改為

180CM)

2353

CGPW1AG149AS "朝日"冠狀動脈延長導引線"ASAHI"PTCA GUIDE WIRE EXTENSION

PTFE 0.014" 150;165CM

2353

CGPW1AGH14AS NEO'S PTCA GUIDE WIRE EXTRA SUPPORT 0.014" (自971001由

175CM改為180CM)

2817

CGPW1AGH46AS "ASAHI"PTCA GUIDE WIRE EXTRA SUPPORT PTFE 0.014" 180CM "

朝日"冠狀動脈導引線

2817

CGPW1AGH47AS "ASAHI"PTCA GUIDE WIRE PTFE 0.014" 150CM;180CM "朝日"冠狀

動脈導引線

2353

CGPW1AGM46AS "ASAHI"PTCA GUIDE WIRE EXTRA SUPPORT PTFE 0.014" 180CM "

朝日"冠狀動脈導引線

2817

CGPW1AGM47AS "ASAHI"PTCA GUIDE WIRE PTFE 0.014" 150CM;180CM "朝日"冠狀

動脈導引線

2353

CGPW1AGP14AS PTCA GUIDE WIRE 0.014 EXTRA SUPPORT(自971001由175CM改為

180CM)

2817

777

特材代碼 中英文名稱 支付點數-104/01/01

CGPW1AGPFCAS PTCA GUIDE WIRE HYDROPHILIC COATING EXTRA SUPPORT 0.014"

175CM 180CM

2817

CGPW1AHWR3AS "ASAHI"PTCA GUIDE WIRE ASAHI SION 0.014" 300CM(PTFE

COATING EXTRA SUPPORT)"朝日"冠狀動脈導引線紫苑

2587

CGPW1AHWRSAS "ASAHI"PTCA GUIDE WIRE ASAHI SION 0.014" 180CM (PTFE

COATING EXTRA SUPPORT)"朝日"冠狀動脈導引線紫苑

2817

CGPW1B8611BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE PTFE HEAVY DUTY

STIFFNESS TIP 0.014" 180CM

2828

CGPW1B8612BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE PTFE HEAVY DUTY

STIFFNESS TIP 0.014" 300CM

2870

CGPW1BE611BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE PTFE 0.014" 180CM 2587

CGPW1BE612BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE PTFE 0.014" 300CM 2587

CGPW1BMWE3AB "ABBOTT"HI-TORQUE BALANCE MIDDLEWEIGHT ELITE GUIDE WIRE

HYDROPHILIC COATING 0.014" 300CM "亞培"高鐸格寶馬精英導線

2587

CGPW1BMWE9AB "ABBOTT"HI-TORQUE BALANCE MIDDLEWEIGHT ELITE GUIDE WIRE

HYDROPHILIC COATING 0.014" 190CM "亞培"高鐸格寶馬精英導線

2353

CGPW1CMW01CK APPROACH PRO LT MICRO WIRE GUIDE 0.014" 135CM,190CM 2828

CGPW1CMW02CK APPROACH PRO LT MICRO WIRE GUIDE 0.014" 300CM 2870

CGPW1CMW03CK APPROACH PRO LT MICRO WIRE GUIDE 0.018" 135CM;190CM 2828

CGPW1CMW04CK APPROACH PRO LT MICRO WIRE GUIDE 0.018" 300CM 2870

CGPW1CNGW1AB 亞培高鐸格聯康血管導線 ABBOTT HI-TORQUE CONNECT GUIDE

WIRE 0.018" PTFE 145;195CM

2430

CGPW1CNGW3AB 亞培高鐸格聯康血管導線 ABBOTT HI-TORQUE CONNECT GUIDE

WIRE 0.018" PTFE 300CM

2800

CGPW1CT190M4 WIRE WORK GUIDE WIRES 190CM 0.014" NITINOL HYDROPHILLIC

COATING

2587

CGPW1CT300M4 WIRE WORK GUIDE WIRES 300CM 0.014" NITINOL HYDROPHILLIC

TEFLON COATING

2587

CGPW1D0CNNAB "亞培"鐸格延長導線"Abbott"DOC GUIDE WIRE EXTENSION 0.014"

145CM

2353

CGPW1EEL14JV "日本來富恩" 艾斯利特伊爾導引線"JAPAN LIFELINE" ATHLETE

EEL PTCA GUIDE WIRE(冠狀動脈擴張導引線0.014,178CM直型)

2430

CGPW1HMW01CK APPROACH HYDRO ST MICRO WIRE GUIDE W/HYDROPHILIC COATING

親水性塗層微細導線0.014" 300CM

2587

CGPW1HMW02CK APPROACH HYDRO ST MICRO WIRE GUIDE W/HYDROPHILIC COATING

親水性塗層微細導線0.014" 135,190CM

2353

CGPW1HYBGWM4 "美敦力" 艾坦導引導線"MEDTRONIC" ATTAIN HYBRID GUIDE WIRE 2353

CGPW1JUN18SB "BOSTON SCIENTIFIC"JOURNEY GUIDEWIRE(W/HYDROCOAT 0.014"

185CM)"波士頓科技"哲尼導引線

2817

CGPW1JUN30SB "BOSTON SCIENTIFIC"JOURNEY GUIDEWIRE(W/HYDROCOAT 0.014"

300CM)"波士頓科技"哲尼導引線

2587

CGPW1LW26EMR "美瑞特"桂冠親水性導引導線"MERIT"LAUREATE HYDROPHILIC

GUIDE WIRE 0.035" 260CM EXCHANGE

2800

CGPW1LWS35MR "美瑞特"桂冠親水性導引導線"MERIT"LAUREATE HYDROPHILIC

GUIDE WIRE 0.035" 150;180CM

2781

CGPW1N6W19AB “亞培”第六代血栓防護盾系統-過濾輸送金屬絲“ABBOTT”

EMBOSHIELD NAV6 EMBOLIC PROTECTION SYSTEM-BAREWIRE 190CM

2353

CGPW1N6W31AB “亞培”第六代血栓防護盾系統-過濾輸送金屬絲“ABBOTT”

EMBOSHIELD NAV6 EMBOLIC PROTECTION SYSTEM-BAREWIRE 315CM

2587

778

特材代碼 中英文名稱 支付點數-104/01/01

CGPW1PAGH3AS PERIPHERIAL GUIDE WIRE 0.018" 300CM 2800

CGPW1PAGHSAS PERIPHERIAL GUIDE WIRE 0.018" 180CM 2430

CGPW1PAGP3AS PERIPHERIAL GUIDE WIRE 0.014" 300CM 2800

CGPW1PAGPSAS PERIPHERIAL GUIDE WIRE 0.014" 180CM 2430

CGPW1PRGW3AB ABBOTT HI-TORQUE PROGRESS GUIDE WIRE 0.014" 300CM 亞培博

格斯血管導線

2587

CGPW1PRGW9AB ABBOTT HI-TORQUE PROGRESS GUIDE WIRE 0.014" 190CM 亞培博

格斯血管導線

2353

CGPW1PS180M4 WIRE WORK GUIDE WIRE W/COATING HYDRO-TRACK,PRO/PEL 180CM

0.014"沃爾沃克導引導線

2353

CGPW1PS300M4 WIRE WORK GUIDE WIRE W/COATING HYDRO-TRACK,PRO/PEL 300CM

0.014"沃爾沃克導引導線

2587

CGPW1PTGW3AB "ABBOTT"HI-TORQUE POWERTURN GUIDE WIRE HYDROPHILIC

COATING 0.014" 300CM "亞培"高鐸格寶特導線

2587

CGPW1PTGW9AB "ABBOTT"HI-TORQUE POWERTURN GUIDE WIRE HYDROPHILIC

COATING 0.014" 190CM "亞培"高鐸格寶特導線

2353

CGPW1PV1A1M4 "MEDTRONIC"PROVIA/INTUITION GUIDE WIRE W/COATING HYDRO-

TRACK,PRO/PEL 180CM 0.014" "美敦力"波維亞/英特迅導引導線

2353

CGPW1PV1A2M4 "MEDTRONIC"PROVIA/INTUITION GUIDE WIRE W/COATING HYDRO-

TRACK,PRO/PEL 300CM 0.014" "美敦力"波維亞/英特迅導引導線

2587

CGPW1PV1A3M4 "MEDTRONIC"PROVIA/INTUITION GUIDE WIRE W/COATING HYDRO-

TRACK,PRO/PEL EXTRA SUPPORT 180CM 0.014" "美敦力"波維亞/

英特迅導引導線

2817

CGPW1RSTF0CK ROADRUNNER EXTRA-SUPPORT WIRE GUIDES 180,270,300CM 2817

CGPW1SK1P1F2 "INVATEC"SKIPPER DEEP GUIDE WIRE W/COATING

0.014"250CM;300CM"英泰克"賽艇帝普導引導絲

2587

CGPW1SK1P2F2 "INVATEC"SKIPPER DEEP GUIDE WIRE W/COATING 0.014"195CM"英

泰克"賽艇帝普導引導絲

2817

CGPW1SN18JAS "朝日"冠狀動脈導引線紫苑"ASAHI"PTCA GUIDE WIRE ASAHI SION

0.014"180CM HYDROPHILIC EXTRA SUPPORT

2817

CGPW1TH491SB THRUWAY GUIDEWIRE PTFE EXTRA SUPPORT 0.014" 130,190CM 2817

CGPW1TH492SB THRUWAY GUIDEWIRE PTFE 0.014" 300CM 2587

CGPW1THDR1M4 WIRE WORK GUIDE WIRES 190CM 0.014" STAINLESS STEEL

TEFLON(PRO/PEL) COATING EXTRA SUPPORT

2817

CGPW1V1430SB "BOSTON SCIENTIFIC" V14 CONTROLWIRE GUIDEWIRE 0.014"

300CM "波士頓科技"康卓導引線

2870

CGPW1V1482SB "BOSTON SCIENTIFIC" V14 CONTROLWIRE GUIDEWIRE 0.014"

182CM "波士頓科技"康卓導引線

2817

CGPW1VGW19SB "波士頓科技"勝利導線"BOSTON SCIENTIFIC"VICTORY

GUIDEWIRE(PERIPHERAL) PTFE 0.014";0.018" 195CM

2430

CGPW1VGW30SB "波士頓科技"勝利導線"BOSTON SCIENTIFIC"VICTORY

GUIDEWIRE(PERIPHERAL) PTFE 0.014";0.018" 300CM

2800

CGPW1WNGW3AB "亞培"高鐸格威恩血管導線"ABBOTT"HI-TORQUE WINN GUIDE WIRE

0.014" 300CM

2587

CGPW1WNGW9AB "亞培"高鐸格威恩血管導線"ABBOTT"HI-TORQUE WINN GUIDE WIRE

0.014" 190CM

2353

CGPW1ZH180M4 WIRE WORK GUIDE WIRES 180CM 0.014" STAINLESS STEEL

HYDROPHILLIC COATING

2353

CGPW1ZH300M4 WIRE WORK GUIDE WIRES 300CM 0.014" STAINLESS STEEL

HYDROPHILLIC COATING

2587

CGS0100011VE PERCUTANEOUS CATHETER INTRODUCERS W/DILATOR,GUIDEWIRE

11CM 5:9FR

583

779

特材代碼 中英文名稱 支付點數-104/01/01

CGS0100023VE PERCUTANEOUS CATHETER INTRODUCERS W/DILATOR 23CM 6:9FR 887

CGS0100412K0 ANGIOGATE HV INTRODUCER KIT 12CM (S+D+GW+3WAY+SI) 583

CGS0101200AR HI-FLOW TRUAMA SET 700

CGS010511MCD "考迪斯"皮膜鞘導引器"CORDIS"BRITE TIP INTERVENTIONAL

SHEATH 5.5;

11CM(DILATOR+SIDEARM+VALVE+GUIDEWIRE+3WAY+RADIOPAQUE

BRITETIP)

820

CGS010512TK0 ANGIOGATE TRANSRADIAL INTRODUCER KIT 12CM

(S+D+N+GW+3WAY+SI)

715

CGS010519TK0 ANGIOGATE TRANSRADIAL INTRODUCER KIT 19CM,24CM

(S+D+N+GW+3WAY+SI)

1067

CGS010601NBA "BARD"PTFE PEEL-APART PERCUTANEOUS INTRODUCER KITS"巴德"

剝撕式經皮導引套組

864

CGS010610NST "聖猷達"費思凱斯導管導引器"SJM"FAST-CATH HEMOSTASIS

INTRODUCER 12CM(S+D+SV+GW+SY+N+保護套)

875

CGS0106249ST "聖猷達"麥克斯導管導引器"SJM"MAXIMUM HEMOSTASIS

INTRODUCER 12CM 4:9FR 0.025:0.038"(W/S+D+V+G.W+SI)

583

CGS0106255ST "聖猷達"麥克斯導管導引器"SJM"MAXIMUM HEMOSTASIS

INTRODUCER 8.5CM 4:7FR

0.021:0.025"(W/SHEATH+DILATOR+VALVE+G.W+SIDEPORT)

583

CGS0106351ST "聖猷達"麥克斯導管導引器"SJM"MAXIMUM HEMOSTASIS

INTRODUCER 5CM 4:6FR

0.021"(W/SHEATH+DILATOR+VALVE+G.W+SIDEPORT)

583

CGS010658NBA "BARD"PTFE PEEL-APART PERCUTANEOUS INTRODUCER

KITS"(MICROINTRODUCER)巴德"剝撕式經皮導引套組

864

CGS0106660ST "聖猷達"麥克斯導管導引器"SJM"MAXIMUM HEMOSTASIS

INTRODUCER 23CM 5:8FR 0.038"(W/S+D+G.W+SI+V+N)

1067

CGS0106667ST "聖猷達"麥克斯導管導引器"SJM"MAXIMUM HEMOSTASIS

INTRODUCER 12CM

715

CGS0106668ST "聖猷達"麥克斯導管導引器"SJM"MAXIMUM HEMOSTASIS

INTRODUCER 23CM

1067

CGS010674NST "聖猷達"費思凱斯導管導引器"SJM"FAST-CATH HEMOSTASIS

INTRODUCERS 45CM 30度(S+D+SV+3WAY)

1400

CGS0107688ST "聖猷達"雅帝明導管導引器"SJM"ULTIMUM INTRODUCER WITH

HEMOSTASIS VALVE( 35CM 16FR 0.035"

W/SHEATH+DILATOR+GW+SIDEPORT+VALVE)

977

CGS010768NST "聖猷達"雅帝明導管導引器"SJM"ULTIMUM INTRODUCER WITH

HEMOSTASIS VALVE( 30CM 14:20FR 0.035"

W/SHEATH+DILATOR+GW+SIDEPORT+VALVE)

977

CGS0107691ST "聖猷達"雅帝明導管導引器"SJM"ULTIMUM INTRODUCER WITH

HEMOSTASIS VALVE(25CM 22FR 0.035" W/SHEATH+

DILATOR+GW+SIDEPORT+VALVE)

977

CGS0107830ST "聖猷達"雅帝明導管導引器"SJM"ULTIMUM INTRODUCER SET

(S+H+V+G+SIDEPORT)

583

CGS0107835ST "聖猷達"雅帝明導管導引器"SJM"ULTIMUM INTRODUCER SET 8.5CM

W/HEMOSTASIS VALVE(S+H+V+G+SIDEPORT)

583

CGS0107840ST "聖猷達"雅帝明導管導引器"SJM"ULTIMUM INTRODUCER

SETW/HEMOSTASIS VALVE 12CM (S+H+V+G+SIDEPORT)

583

CGS0107851ST "聖猷達"雅帝明導管導引器"SJM"ULTIMUM INTRODUCER SET

W/HEMOSTASIS VALVE 23CM (S+H+V+G+SIDEPORT)

977

CGS0108403AR "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM 4FR X 7.5CM

(S+D+GW+SV+3WAY+N)“亞諾”經皮導引鞘組

790

780

特材代碼 中英文名稱 支付點數-104/01/01

CGS0108503AR "ARROW"PERCUTANEOUS SHEATH WITH SPRING WIRE GUIDE(

S+D+G+SV+3 WAY)4:6FR 7.5CM;5:9FR 11CM"亞諾"經皮導引鞘組

583

CGS0108530VE MULLINS TRANSSEPTAL INTRODUCER SET PRDIATRIC 44CM 6:8FR 1400

CGS0108550VE MULLINS TRANSSEPTAL INTRODUCER SET AUDLT 59CM 6:8FR 1400

CGS0109600AR PERCUTANEOUS INTRODUCER SYSTEM KIT 6FR 11CM 875

CGS0109803AR PERCUTANEOUS INTRODUCER SYSTEM KIT

8FR(SHE+DIL+SIDEPORT+G.W+NE+一般空針)

715

CGS0109808AR PERCUTANEOUS INTRODUCER SYSTEM KIT 8FR 11CM 875

CGS0109870AR PERCUTANEOUS SHEATH INTRODUCER SET 8.5FR 875

CGS011101AVE PERCUTANEOUS CATHETER INTRODUCERS 11CM(5F:9F),WITH

DILATOR, GUIDE WIRE

583

CGS0111A00BQ "邦特"導引鞘"BIOTEQ" SHEATH INTRODUCER KIT 5:14CM 4:9FR

WITHOUT GUIDEWIRE

470

CGS0111A10BQ "邦特"導引鞘"BIOTEQ" SHEATH INTRODUCER KIT 5:14CM 4:9FR

(S+D+GW+V+SIDEPORT+3WAY)

583

CGS0111A13BQ "邦特"導引鞘"BIOTEQ" SHEATH INTRODUCER KIT 5:14CM 4:9FR

(S+D+GW+V+SIDEPORT+3WAY+N+SYRINGE)

790

CGS0111A16BQ "邦特"導引鞘"BIOTEQ" SHEATH INTRODUCER KIT 5:14CM 4:9FR

(S+D+GW+V+SIDEPORT+3WAY+N)

715

CGS0111B00BQ "邦特"導引鞘"BIOTEQ" SHEATH INTRODUCER KIT 16:35CM 4:9FR

(S+D+V+SIDEPORT+3WAY)

887

CGS0111B10BQ "邦特"導引鞘"BIOTEQ" SHEATH INTRODUCER KIT 16:35CM 4:9FR

(S+D+V+GW+SIDEPORT+3WAY)

977

CGS0111B16BQ "邦特"導引鞘"BIOTEQ" SHEATH INTRODUCER KIT 16:35CM 4:9FR

(S+D+V+GW+SIDEPORT+3WAY+N)

1067

CGS0113059ED INTRO-FLEX PERCUTANEOUS SHEATH INTRODUCER SET 10CM(S+SV+4

WAY+D+GW+N+保護套)

875

CGS011389HED INTRO-FLEX PERCUTANEOUS SHEATH INTRODUCER SET 10CM

W/COATING(S+SV+4 WAY+D+GW+N+保護套)

875

CGS01200392C "柯惠"植入型注射系統"COVIDIEN"AUTO SUTURE CHEMOSITE

IMPLANTABLE DRUG DELIVERY SYSTEM-9 FR PEEL-AWAY SHEATH

INTRODUCER KIT

864

CGS01200892C "柯惠"植入型注射系統"COVIDIEN"AUTO SUTURE CHEMOSITE

IMPLANTABLE DRUG DELIVERY SYSTEM -7 FR PEEL-AWAY SHEATH

INTRODUCER KIT

864

CGS0121322ST FAST-CATH HEMOSTASIS INTRODUCER 費思凱絲止血導管導引器 583

CGS012335MCD "考迪斯"皮膜鞘導引器"CORDIS"BRITE TIP INTERVENTIONAL

SHEATH 23;35CM(DILATOR+SIDEARM+VALVE+3WAY+RADIOPAQUE

BRITETIP)

887

CGS0130085ED INTRO-FLEX PERCUTANEOUS SHEATH INTRODUCER SET 8.5FR

10CM(S+D+SI+V+GW+N+保護套+SY)

875

CGS0130185ED INTRO-FLEX PERCUTANEOUS SHEATH INTRODUCER SET AMC COATED

8.5FR 10CM(S+D+SI+V+GW+N+保護套)

875

CGS0130484BB INTRODUCER KIT,7F,9F,11F *適應症請見備註欄 864

CGS0135023BK "百多力"思考導線引入裝置系統"BIOTRONIK"SCOUTPRO CORONARY

SINUS LEAD DELIVERY SYSTEM*適應症請見備註欄

6528

CGS0140009AG P.T.C.A LONG SHEATH 23CM 887

CGS01402ANCD AVANTI PLUS SHEATH INTRODUCER 11CM(4:11FR WITHOUT

GUIDEWIRE)

470

CGS01402RNCD AVANTI PLUS SHEATH INTRODUCER 5CM(4:8FR WITHOUT

GUIDEWIRE)

470

CGS014065NST "聖猷達"麥克斯導管導引器"SJM" MAXIMUM HEMOSTASIS

INTRODUCER

835

781

特材代碼 中英文名稱 支付點數-104/01/01

CGS0140764ST ULTIMUM INTRODUCER WITH HEMOSTASIS VALVE) SHEATH;

DILATOR;HEMOSTASIS VALVE;GUIDEWIRE; SIDEPORT ( 3WAY)

12CM 0.035"

583

CGS0140765ST ULTIMUM INTRODUCER WITH HEMOSTASIS VALVE) SHEATH;

DILATOR;HEMOSTASIS VALVE;GUIDEWIRE; SIDEPORT ( 3WAY)

23CM 0.035"

977

CGS014076NST ULTIMUM INTRODUCER WITH HEMOSTASIS VALVE) SHEATH;

DILATOR;HEMOSTASIS VALVE;GUIDEWIRE; SIDEPORT ( 3WAY)

5CM 0.035"

583

CGS0141040K0 "KIMAL"ANGIOGATE INTRODUCER KIT(0.018"NITINOL

GUIDEWIRE+4FR 5FR+21G NEEDLE)"期茂"導引鞘組:微型導引器組

1661

CGS0141060K0 "KIMAL"ANGIOGATE INTRODUCER KIT(0.018"NITINOL

GUIDEWIRE+4FR 5FR+21G NEEDLE)"期茂"導引鞘組:微型導引器組

1661

CGS01440042C "柯惠"肯特利慢性血液透析導管"COVIDIEN"KENDALL CHRONIC

HEMODIALYSIS CATHETERS-PULL-APART INTRODUCER

SET(10,12,14,16FR)(C+D+GW+N+SY)

864

CGS01440132C "柯惠"肯特利慢性血液透析導管"COVIDIEN"KENDALL CHRONIC

HEMODIALYSIS CATHETERS-OVAL PULL-APART INTRODUCER

SET(PEEL-AWAY)(SH+DIL+GW+SYR+NE)

864

CGS014555MCD "考迪斯"皮膜鞘導引器"CORDIS"BRITE TIP INTERVENTIONAL

SHEATH 45;55CM(DILATOR+SIDEARM+VALVE+3WAY+RADIOPAQUE

BRITETIP)

1400

CGS0146005AG SHEATH INTRODUCER 5:9FR 583

CGS0146064AG PEDIATRIC INTRODUCER KIT(SHEATH+DILATOR+GUIDE WIRE) 583

CGS0146070AG SHEATH INTRODUCER 583

CGS0146131AG ONE PIECE TUOHY-BORST INTRODUCER 5:9FR(INTRODUCER+GUIDE

WIRE+DILATOR)

583

CGS0146132AG INTRODUCER KIT 583

CGS0146133AG SHEATH INTRODUCER 7FR 583

CGS0146134AG SHEATH INTRODUCER 8FR 583

CGS0146151AG INTRODUCER KIT(SHEATH,DILATOR,SIDE PORT,3 WAY,GUIDE WIRE) 583

CGS0150461CD AVANTI PLUS CATHETER SHEATH INTRODUCER TRANSRADIAL KIT

11CM

835

CGS0150462CD AVANTI PLUS CATHETER SHEATH INTRODUCER TRANSRADIAL KIT

23CM

1262

CGS01504PNCD AVANTI PLUS SHEATH INTRODUCER 5CM(4:8FR WITH

GUIDEWIRE,DILATOR)

583

CGS01504TNCD AVANTI PLUS SHEATH INTRODUCER 23CM(4:11FR WITHOUT

GUIDEWIRE)

887

CGS01504XNCD AVANTI PLUS SHEATH INTRODUCER 11CM(4:11FR WITH

GUIDEWIRE,DILATOR)

583

CGS0150562CD "考迪斯"雷帝索經橈骨皮膜鞘導引器"CORDIS" RADIALSOURCE

TRANSRADIAL ACCESS KIT 4~6FR 20CM

1363

CGS015056XCD "考迪斯"雷帝索經橈骨皮膜鞘導引器"CORDIS" RADIALSOURCE

TRANSRADIAL ACCESS KIT 4~6FR 6.5;10CM

902

CGS0158F38MR "美瑞特"動脈導引鞘"MERIT"PRELUDE SHEATH INTRODUCER 583

CGS016014NDV HICKMAN INTRODUCER 864

CGS016031NBA INTRO-EZE PERCUTANEOUS INTRODUCER KIT 5:15FR

10:16CM(SH+DI+GW+SY+N)

864

CGS016207DM4 DUAL CHAMBER PERCUTANEOUS LEAD INTRODUCER

60CM(2SH+2D+2GW+N+SY)

1198

782

特材代碼 中英文名稱 支付點數-104/01/01

CGS016207NM4 PERCUTANEOUS LEAD INTRODUCER 60CM(SH+D+GW+N+SY) 864

CGS016207SM4 PERCUTANEOUS LEAD INTRODUCER 60CM(SH+D+GW+N+SY) 864

CGS0162BTKM4 PERCUTANEOUS LEAD INTRODUCER 60CM(SH+D+GW+N+SY) 864

CGS0167090GQ "葛貝可"可剝式導入管工具組"GREATBATCH" PTFE PEELABLE

INTRODUCER KIT(S+D+SY+N+G.W)

864

CGS016890MCD "考迪斯"皮膜鞘導引器"CORDIS"BRITE TIP INTERVENTIONAL

SHEATH 90CM(DILATOR+SIDEARM+VALVE+3WAY+RADIOPAQUE

BRITETIP)

2850

CGS0190703M0 "MEDCOMP"CENTRAL VENOUS CATHETERS AND

ACCESSORIES(PEELABLE INTRODUCER)(S+D+GW+N)"美德康"中央靜

脈導管與配件(剝式導管導引器)

864

CGS0193001GQ "葛貝可"帶閥撕裂式導引器"GREATBATCH" OPTISEAL VALVED PTFE

PEELABLE INTRODUCER (S+D+SY+N+G.W)

864

CGS01A1MDSST "SJM" CPS AIM SL SLITTABLE INNER CATHETER(CATHETER+SIDE

PORT+TOOL)"聖猷達"縱裂式內導管

1810

CGS01A1MWSST "SJM" CPS AIM SL SLITTABLE INNER CATHETER(

CATHETER+TOOL)"聖猷達"縱裂式內導管

1810

CGS01A40GNTM RADIOFOCUS INTRODUCER II 16CM 4:6FR WITH 0.025" GUIDE

WIRE

1262

CGS01A40K1TM RADIFOCUS INTRODUCER II 4FR

10CM(W/SHEATH,DILATOR,GUIDEWIRE,NEEDLE)

835

CGS01A40K2TM RADIFOCUS INTRODUCER II 4:11FR

25CM(W/SHEATH,DILATOR,GUIDEWIRE,NEEDLE)

1262

CGS01ACUBASB "波士頓科技"艾裘帝突破導線導管"BOSTON SCIENTIFIC"ACUITY

BREAK-AWAY GUIDE CATHETER(CATHETER+CUTTER+GW

INTRODUCER+TORQUE DEVICE+FINISH WIRE)

6528

CGS01AL191TM "泰爾茂"攝影引導管"TERUMO" RADIFOCUS INTRODUCER II 4-

11FR,16;25CM

1262

CGS01APASDKH "奧斯卡"導管導引器"OSCOR"ADELANTE PEEL AWAY INTRODUCER

SET(SHEATH+DILATOR)

864

CGS01APK1TKH "奧斯卡"導管導引器"OSCOR"ADELANTE PEEL AWAY INTRODUCER

SET(SHEATH+DILATOR+GW+NEEDLE+SYRINGE)

864

CGS01APSHKH9 ANGIO PACK INTRODUCER SHEATH KIT(W/SH+GW+SI+N+V) 715

CGS01AS035TM "泰爾茂"攝影引導套(附針,針筒)"TERUMO"RADIFOCUS INTRODUCER

II(WITH NEEDLE/SYRINGE)

835

CGS01AS073TM "泰爾茂"血管攝影引導管"TERUMO" RADIFOCUS INTRODUCER II 4-

11FR 7CM,10CM

835

CGS01AS091TM "泰爾茂"攝影引導管"TERUMO" RADIFOCUS INTRODUCER II 4-

11FR,5-10CM

835

CGS01ATTANM4 “美敦力” 安坦左心室傳送系統“MEDTRONIC IRELAND” ATTAIN

LEFT-HEART DELIVERY SYSTEM*適應症請見備註欄

6528

CGS01ATTCSM4 "美敦力"艾坦左心室傳送系統"MEDTRONIC" ATTAIN COMMAND LEFT

HEART DELIVERY SYSTEM *適應症請見備註欄

6528

CGS01AVK11TM "TERUMO"RADIFOCUS INTRODUCER II(4-11FR 30-100MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線+針筒+導入針、SIDEARM、

W/VALVE)

835

CGS01AVK12TM "TERUMO"RADIFOCUS INTRODUCER II(4-11FR 30-100MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線+針筒+導入針、SIDEARM、

W/VALVE)

835

CGS01AVK13TM "TERUMO"RADIFOCUS INTRODUCER II(4-11FR 30-100MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線+針筒+導入針、SIDEARM、

W/VALVE)

835

783

特材代碼 中英文名稱 支付點數-104/01/01

CGS01AVK14TM "TERUMO"RADIFOCUS INTRODUCER II(4-11FR 30-100MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線+針筒+導入針、SIDEARM、

W/VALVE)

835

CGS01AVK21TM "TERUMO"RADIFOCUS INTRODUCER II(4-10FR 160-250MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線+針筒+導入針、SIDEARM、

W/VALVE)

1262

CGS01AVK22TM "TERUMO"RADIFOCUS INTRODUCER II(4-10FR 160-250MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線+針筒+導入針、SIDEARM、

W/VALVE)

1262

CGS01B11MQTM RADIFOCUS INTRODUCER II 11FR 0.035"(GW+SH+SD)不含NEEDLE 820

CGS01B40G7TM RADIFOCUS INTRODUCER II 7CM 4:5FR 835

CGS01B50N1TM RADIFOCUS INTRODUCER II AND WIRE 10CM 5:11FR 835

CGS01B50N2TM RADIFOCUS INTRODUCER II 25CM 5:11FR AND WIRE 1098

CGS01BL073TM "泰爾茂"血管攝影引導管"TERUMO" RADIFOCUS INTRODUCER II 4-

11FR 7CM,10CM

820

CGS01BL191TM "泰爾茂"攝影引導管"TERUMO" RADIFOCUS INTRODUCER II 4-

11FR,25,40CM

1098

CGS01BL192TM "泰爾茂"攝影引導管"TERUMO" RADIFOCUS INTRODUCER II 4-

11FR,16,25CM

1262

CGS01BS073TM "泰爾茂"血管攝影引導管"TERUMO" RADIFOCUS INTRODUCER II 4-

11FR 25CM,40CM

1098

CGS01BS091TM "泰爾茂"攝影引導管"TERUMO" RADIFOCUS INTRODUCER II 4-

11FR,7;10CM

820

CGS01BS092TM "泰爾茂"攝影引導管"TERUMO" RADIFOCUS INTRODUCER II 4-

11FR,7;10CM

835

CGS01BVK11TM "TERUMO"RADIFOCUS INTRODUCER II(4-11FR 70-100MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線SIDEARM、W/VALVE)

820

CGS01BVK12TM "TERUMO"RADIFOCUS INTRODUCER II(4-11FR 70-100MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線SIDEARM、W/VALVE)

820

CGS01BVK13TM "TERUMO"RADIFOCUS INTRODUCER II(4-11FR 70-100MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線SIDEARM、W/VALVE)

820

CGS01BVK14TM "TERUMO"RADIFOCUS INTRODUCER II(4-11FR 70-100MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線SIDEARM、W/VALVE)

820

CGS01BVK21TM "TERUMO"RADIFOCUS INTRODUCER II(4-11FR 160-250MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線SIDEARM、W/VALVE)

1098

CGS01BVK22TM "TERUMO"RADIFOCUS INTRODUCER II(4-11FR 160-250MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線SIDEARM、W/VALVE)

1098

CGS01BVK23TM "TERUMO"RADIFOCUS INTRODUCER II(4-11FR 160-250MM)"泰爾茂"

血管攝影引導套(鞘+擴張器+導線SIDEARM、W/VALVE)

1098

CGS01BVK31TM "TERUMO"RADIFOCUS INTRODUCER II(7FR 450MM)"泰爾茂"血管攝

影引導套(鞘+擴張器+導線SIDEARM、W/VALVE)

1400

CGS01C407NST ULTIMUM INTRODUCER WITH HEMOSTASIS VALVE(SHEATH;

DILATOR;HEMOSTASIS VALVE;GUIDEWIRE;NEEDLE)12CM

TRANSRADIAL KITS

835

CGS01C4852ST "SJM"ENGAGE ENGAGE TR INTRODUCER (FEMORAL)25CM

0.035"0.038"(SH+DIL+VALVE+GUIDE WIRE+SIDEPORT 3WAY)"聖猷

達"茵給桔導管導引器

977

CGS01C485NST "SJM"ENGAGE ENGAGE TR INTRODUCER (FEMORAL)12CM

0.035"0.038"(SH+DIL+VALVE+GUIDE WIRE+SIDEPORT 3WAY)"聖猷

達"茵給桔導管導引器

583

CGS01CL711AR "亞諾"經皮導引鞘組(可彎折式)"ARROW"PERCUTANEOUS SHEATH

INTRODUCER SYSTEM(SUPER ARROW KINK-RESISTANT)5:10FR

11CM(S+D+SIDEARM+V+3WAY)

966

784

特材代碼 中英文名稱 支付點數-104/01/01

CGS01CL724AR "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM (SUPER

ARROW-FLEX NON-KINKING)5:10FR 24CM“亞諾”經皮導引鞘組(可

彎折式)

1470

CGS01CL735AR "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM (SUPER

FLEX)35CM(S+D+SV+3 AWY)“亞諾”經皮導引鞘組(可彎折式)

1470

CGS01CL745AR "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM (SUPER

ARROW-FLEX NON-KINKING)5:8FR,10FR 45CM“亞諾”經皮導引鞘

組(可彎折式)

2780

CGS01CL765AR "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM (SUPER

ARROW-FLEX NON-KINKING) 6,7,9,10FR 65CM“亞諾”經皮導引鞘

組(可彎折式)

3000

CGS01CL775AR "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM(SUPER FLEX)

65:100CM(S+D+SV+3 AWY)“亞諾”經皮導引鞘組(可彎折式)

3000

CGS01CP711AR "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM(SUPER ARROW-

FLEX NON-KINKING)5:10FR 11CM“亞諾”經皮導引鞘組(可彎折

式)

1094

CGS01CPSAMST "聖猷達"內導管"SJM" CPS AIM INNER CATHETER 1810

CGS01CPSDSST "SJM"CPS DIRECT SL II SLITTABLE OUTER GUIDE CATHETER "聖

猷達"縱裂式外導引導管(導管+擴張器+縱裂器(含導引絲)+止血閥

旁縱裂器)※適應症請見備註欄

6528

CGS01CPSPLST 縱裂式外導引導管 CPS DIRECT PL PEELABLE OUTER CATHETER(導

管+擴張器+止血閥接合器(含導引絲)+止血閥旁縱裂器)※適應症

請見備註欄

6528

CGS01CPSSLST 縱裂式外導引導管 CPS DIRECT SL OUTER CATHETER(導管+擴張器

+止血閥接合器(含導引絲)+止血閥旁縱裂器)※適應症請見備註欄

6528

CGS01CS11NYZ SUPERSHEATH INTRODUCER SET 11CM(SH+DI+GW+N+SI+V) 715

CGS01CS25NYZ SUPERSHEATH INTRODUCER SET 25CM(SH+DI+GW+N+SI+V) 1067

CGS01CW08NAR "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM WITH CATH-

GARD 5:9FRX7.5,11CM (S+D+SV+GW+N+SY+3 WAY)“亞諾”經皮導

引鞘組

790

CGS01DUH25SB SUPER SHEATH INTRODUCER SHEATH 25CM 5-9FR 0.035",0.038"

(SHEATH+DILATOR+SIDEARM+VALVE,GUIDEWIRE)

977

CGS01EX124AG "愛琅"前引導組 "ARGON"PERCUTANEOUS SHEATH INTRODUCER KIT-

TRAY KITS 6:9FR(W/DILATOR,GUIDE WIRE,NEEDLE,保護套)

875

CGS01EX132AG "愛琅"前引導組 "ARGON"PERCUTANEOUS SHEATH INTRODUCER KIT-

LINK KITS 6:9FR(W/DILATOR,GUIDE WIRE,NEEDLE)

715

CGS01EX134AG "愛琅"前引導組 "ARGON"PERCUTANEOUS SHEATH INTRODUCER KIT-

POPULAR KITS 6:9FR(W/DILATOR,GUIDE WIRE,NEEDLE)

715

CGS01KCFN1CK "曲克"福來瑟橈動脈導入鞘組"COOK"FLEXOR RADIAL INTRODUCER

SHEATH SET 0.018" 5~7FR 7;13CM

902

CGS01KCFN2CK "曲克"福來瑟橈動脈導入鞘組"COOK"FLEXOR RADIAL INTRODUCER

SHEATH SET 0.018" 5~7FR 23CM

1363

CGS01KCFN3CK "曲克"引導器"COOK"FLEXOR INTRODUCER-FLEXOR CHECK FLO

MICROPUNCTURE INTRODUCER SETS 0.018" 6~7FR 7;13CM

902

CGS01KCFN4CK "曲克"引導器"COOK"FLEXOR INTRODUCER-FLEXOR CHECK FLO

MICROPUNCTURE INTRODUCER SETS 0.018" 6~7FR 23CM

1363

CGS01MASNTMR "MERIT" PRELUDE MINI ACCESS SHEATH

INTRODUCERS(SHEATH+SIDEPORT+DILATOR+NITINOL GW+21G

NEEDLE) "美瑞特"福祿小血管導引鞘

1661

CGS01MPS01CK "COOK"MICROPUNCTURE INTRODUCER SETS(W0.018 NITINOL GUIDE

WIRE+4-5FR CATHETER+21G NEEDLE)"曲克"微穿刺引導器組

1661

785

特材代碼 中英文名稱 支付點數-104/01/01

CGS01MPS02CK "COOK"MICROPUNCTURE INTRODUCER SETS(W0.018 NITINOL GUIDE

WIRE+4-5FR CATHETER+21G NEEDLE)"曲克"微穿刺引導器組

1661

CGS01MPS03CK "COOK"MICROPUNCTURE INTRODUCER SETS(W0.018 NITINOL GUIDE

WIRE+4-5FR CATHETER+21G NEEDLE)"曲克"微穿刺引導器組

1661

CGS01N6100ST "聖猷達"費思凱絲導管導引器"SJM" FAST-CATH HEMOSTASIS

INTRODUCERS WITH HEMOSTASIS VALVE 12CM SHEATH

583

CGS01N6123ST "聖猷達"費思凱絲導管導引器"SJM" FAST-CATH HEMOSTASIS

INTRODUCERS WITH HEMOSTASIS VALVE 12CM SHEATH

583

CGS01N6138ST "聖猷達"費思凱絲導管導引器"SJM" FAST-CATH HEMOSTASIS

INTRODUCERS WITH HEMOSTASIS VALVE 23CM SHEATH

977

CGS01N6151ST "聖猷達"費思凱絲導管導引器"SJM" FAST-CATH HEMOSTASIS

INTRODUCERS WITH HEMOSTASIS VALVE 12CM SHEATH

583

CGS01N6159ST "聖猷達"費思凱絲導管導引器"SJM" FAST-CATH HEMOSTASIS

INTRODUCERS WITH HEMOSTASIS VALVE 5CM SHEATH

583

CGS01N6160ST "聖猷達"費思凱絲導管導引器"SJM" FAST-CATH HEMOSTASIS

INTRODUCERS WITH HEMOSTASIS VALVE 5CM SHEATH

583

CGS01N6560ST "聖猷達"費思凱絲導管導引器"SJM" FAST-CATH HEMOSTASIS

INTRODUCERS WITH HEMOSTASIS VALVE 70CM SHEATH

2850

CGS01N6656ST "聖猷達"麥克斯導管導引器"SJM" MAXIMUM HEMOSTASIS

INTRODUCER

1262

CGS01N6700ST "聖猷達"費思凱絲導管導引器"SJM" FAST-CATH HEMOSTASIS

INTRODUCERS WITH HEMOSTASIS VALVE 12CM SHEATH

583

CGS01N6773ST "聖猷達"費思凱絲導管導引器"SJM" FAST-CATH HEMOSTASIS

INTRODUCERS WITH HEMOSTASIS VALVE 98CM SHEATH

2850

CGS01N6784ST "聖猷達"費思凱絲導管導引器"SJM" FAST-CATH HEMOSTASIS

INTRODUCERS WITH HEMOSTASIS VALVE 40CM SHEATH

1400

CGS01PA140ST "SJM"PEEL-AWAY INTRODUCERS 14CM 5:16FR(SHEATH+DILATOR)"聖

猷達"剝式導管導引器

864

CGS01PA14NST "SJM"PEEL-AWAY INTRODUCERS 14CM

5:16FR(SHEATH+DILATOR+SYRINGE+NEEDLE+GUIDE WIRE)"聖猷達"

剝式導管導引器

864

CGS01PA230ST "SJM"PEEL-AWAY INTRODUCERS 23CM

7:14FR(SHEATH+DILATOR+SYRINGE+NEEDLE+GUIDE WIRE)"聖猷達"

剝式導管導引器

864

CGS01PA6CMST "SJM"PEEL-AWAY INTRODUCERS 6CM 4;5;6FR(SHEATH+NEEDLE)"聖

猷達"剝式導管導引器

864

CGS01PLD11MR PRELUDE SHEATH INTRODUCER 11CM

(W/SHEATH+SIDEPORT+VALVE+DILATOR+G.W)

583

CGS01PLD23MR PRELUDE SHEATH INTRODUCER 23CM

(W/SHEATH+SIDEPORT+VALVE+DILATOR+G.W)

977

CGS01PS11GMR PRELUDE SHEATH INTRODUCER 11CM

(W/SHEATH+SIDEPORT+VALVE+DILATOR+G.W+NEEDLE)

715

CGS01PS18TMR "MERIT"PRELUDE SHORT SHEATH INTRODUCER(DILATOR+MARKER TIP

SHEATH+STOPCOCK+0.018"GUIDE WIRE) "美瑞特"福祿動靜脈廔管

用導引鞘

1308

CGS01PSSMTMR "MERIT"PRELUDE SHORT SHEATH INTRODUCER(DILATOR+MARKER TIP

SHEATH+STOPCOCK) "美瑞特"福祿動靜脈廔管用導引鞘

1024

CGS01RCF01CK CHECK-FLO PERFORMER INTRODUCER SETS 25CM(SH+DI+SI+V+GW) 977

CGS01RCF02CK CHECK-FLO PERFORMER INTRODUCER SETS 30CM

W/RADIOLOGY(SH+DI+SI+V+GW)

1262

CGS01RCF03CK CHECK-FLO PERFORMER INTRODUCER SETS 45CM

W/RADIOLOGY(SH+DI+SI+V+GW)

1262

786

特材代碼 中英文名稱 支付點數-104/01/01

CGS01RCF04CK CHECK-FLO PERFORMER INTRODUCER SETS

5:13CM(S+D+GW+N+SV+SY+3WAY)0.021",0.035",0.038"

835

CGS01RCFN1CK "COOK"CHECK-FLO PERFORMER INTRODUCER SETS 4.0:9.0 FR.

5.5:13 CM(SHEATH,DILATOR,SIDE+V,RADIOLOGY GW,NEEDLE)"曲

克"闕克芙爾引導器組

835

CGS01RCFN2CK "COOK"CHECK-FLO PERFORMER INTRODUCER SETS 4.0:9.0 FR.

23CM(SHEATH,DILATOR,SIDE+V,RADIOLOGY GW,NEEDLE)"曲克"闕克

芙爾引導器組

1262

CGS01RPDCAGU 雷必多可切開式導管組合系統 RAPIDO CUT-AWAY GUIDING

CATHETER SYSTEM(CATHETER+FINISH WIRE+CUTTER+RHV+BCV)※適

應症請見備註欄

6528

CGS01SC001CK SCHWARZ CATHETER INTRODUCTION SET 2200

CGS01SEA14ST "SJM"PEEL-AWAY INTRODUCERS 14CM

7:12FR(SHEATH+VALVE+DILATOR+SYRINGE+NEEDLE+GUIDE WIRE)"聖

猷達"剝式導管導引器

864

CGS01SHK1TGJ "JSM"SHEATH KIT "吉生"導引鞘組

(SH+SIDEPORT+VALVE+DIL+G.W+N+IV CATHETER+SYN)

715

CGS01SHKLAGJ "JSM"SHEATH KIT "吉生"導引鞘組

(SH+SIDEPORT+VALVE+DIL+G.W+N+IV CATHETER+SYN+保護套)

875

CGS01SHSH7SB SUPER SHEATH INTRODUCER SHEATH 4-9FR 7CM 0.035",0.308"

(SHEATH+DILATOR+SIDEARM+VALVE,GUIDEWIRE)

583

CGS01SPTSWYZ 玫締特導引鞘組MEDIKIT INSERT SUPER SHEATH SET 3~9FR,

5:7:11CM(SH+DI+GW+SI+V+N)

715

CGS01SUH11SB SUPER SHEATH INTRODUCER SHEATH 11CM 4-9FR 0.035",0.038"

(SHEATH+DILATOR+SIDEARM+VALVE,GUIDEWIRE)

583

CGS01SUM11SB SUPER SHEATH INTRODUCER SHEATH 4-9FR 11CM 0.035",0.038"

(SHEATH+DILATOR+SIDEARM+VALVE,GUIDEWIRE)

583

CGS01SUM25SB SUPER SHEATH INTRODUCER SHEATH 5-9FR 25CM 0.038"

(SHEATH+DILATOR+SIDEARM+VALVE,GUIDEWIRE)

977

CGS01TR482ST "SJM"ENGAGE ENGAGE TR INTRODUCER(RADIA INTRODUCER)12CM

0.025"(SH+DIL+VALVE GUIDE WIRE+SIDEPORT 3WAY+NEEDLE)"聖猷

達"茵給桔導管導引器

835

CGS01TR485ST "SJM"ENGAGE ENGAGE TR INTRODUCER(RADIA INTRODUCER)25CM

0.025"(SH+DIL+VALVE GUIDE WIRE+SIDEPORT 3WAY+NEEDLE)"聖猷

達"茵給桔導管導引器

1262

CGS01TR487ST "SJM"ENGAGE ENGAGE TR INTRODUCER(RADIA INTRODUCER)7CM

0.025"(SH+DIL+VALVE GUIDE WIRE+SIDEPORT 3WAY+NEEDLE)"聖猷

達"茵給桔導管導引器

835

CGS01TS20NGX "GORE"INTRODUCER SHEATH WITH SILICONE PINCH

VALVE(W/DILATOR)30CM 20:24FR帶矽膠夾管閥導鞘

887

CGS0209880AR PERCUTANEOUS SHEATH 875

CGS0306018M9 DILATOR(FACIAL)6:18FR 23CM 153

CGS0311110BQ "BIOTEQ"INTRODUCER SET:DILATOR 4:16FR 5:30CM"邦特"穿刺導

入系統組:引流用擴張管

153

CGS0360508PB DILATOR 5:8FR 20CM 153

CGS0361040PB DILATOR 4:8FR 0.035:0.038" 20:35CM 153

CGS0361090PB DILATOR 9:18FR 0.038:0.052" 25CM 153

CGS03J001NCK "曲克"擴張器"COOK"DILATORS 153

CGS03JCD03CK DILATOR 擴張器(JCD20:24-45:52-20自86.10.27生效) 449

CGS04C304SM4 "美敦力"賽勒克可調彎導管系統 "MEDTRONIC"SELECTSITE

DEFLECTABLE CATHETER SYSTEM*適應症請見備註欄

2257

CGVD10DMS1TR PTMV(經皮穿靜脈氣球導管二尖瓣成形術)DILATOR 3615

CGVW10GMS1TR PTMV(經皮穿靜脈氣球導管二尖瓣成形術)GUIDE WIRE 3615

CGVW20SMS1TR PTMV(經皮穿靜脈氣球導管二尖瓣成形術)STYLET 3615

787

特材代碼 中英文名稱 支付點數-104/01/01

CHA0106642TM AORTIC ARCH CANNULA 6.5MM 20FR 565

CHA0106672TM AORTIC ARCH CANNULA 8MM 24FR 565

CHA0159100AY "肯特利"亞羅主動脈灌流導管 "Kendall" Argyle Thi Aortic

Perfusion Cannula

565

CHA0165264TM AORTIC ARCH CANNULA 8MM 24FR 790

CHA0175324DL PEDIATRIC STRAIGHT ARTERIAL CANNULA 18FR:24FR 565

CHA0188020DL ARTERIAL CANNULA 20:24FR 565

CHA01A085BED AORTIC PERFUSION CANNULAE(8-16F) 565

CHA01AS202ED AORTIC PERFUSION CANNULA 790

CHA0305761TM SOFT-FLOW AORTIC ARCHCANNULAE W/WIRE REINFORCED 7MM,8MM

21FR,24FR

790

CHA0305779TM SOFT-FLOW AORTIC ARCH CANNULA 7MM,8MM 21FR,24FR 565

CHA0306395TM SOFT-FLOW AORTIC ARCH CANNULAE WITH WIRE REINFORCED 790

CHA0306397TM SOFT-FLOW AORTIC ARCH CANNULAE WITHOUT REINFORCED 515

CHA031137CL5 AORTIC ARCH CANNULAE WIRE-REINFORCED 6,7,8MM/18,21,24FR 790

CHA031206CL5 AORTIC ARCH CANNULA W/WIRE REINFORCED 6:24FR 790

CHA0312305TM HIGH FLOW AORTIC ARCH CANNULA 565

CHA0313010TM FLEXIBLE ARTERIAL CANNULA 20:24FR 565

CHA0320STAED "愛德華" 動脈灌注導管"EDWARDS" AORTIC PERFUSION CANNULAE 790

CHA0387020M4 DLP ARTERIAL CANNULAE WIREWOUND BODY 20FR,22FR,24FR 790

CHA03NA120L5 AORTIC ARCH CANNULAE 565

CHA03NA343L5 AORTIC ARCH CANNULAE FLEXIBLE STRAIGHT TIP WITH MOVABLE

SUTURE RING NON-REINFORCED 6,7,8MM/18,21,24FR

565

CHA03RA213L5 AORTIC ARCH CANNULAE STRAIGHT TIP WIRE-REINFORCED

6,7,8MM/18,21,24FR

790

CHAT100009ED CARDIOPLEGIA DELIVERY SETS(9F) 135

CHAT110016S6 AORTA/VEIN PUNCH 4:6MM 918

CHAT131001DL IMA CANNULA 內乳動脈導管 530

CHAT131002DL ARTERIOTOMY CANNULA 2:3MM 1 1/4 ,2 1/4 295

CHAT131003M4 ARTERIOTOMY CANNULAE 295

CHAT180271A9 "奧圖"旋轉式主動脈打孔器"ALTO" A/E ROTATING AORTIC PUNCH 918

CHAT1PUNCHGJ "吉生"主動脈打孔器(滅菌)"JSM"AORTIC PUNCH(STERILE) 918

CHAT1PUNCHQT “科斯特”主動脈打孔器(滅菌) “QUEST” AORTIC PUNCH

(STERILE)

918

CHAT1VCANNL5 "加州" 血管套管"CALIFORNIA" VESSEL CANNULAE 135

CHC0100200ED CARDIOPLEGIA DELIVERY SETS(2 LINES) 329

CHC0100400ED CARDIOPLEGIA DELIVERY SETS(3 LINES) 657

CHC0110001M4 ADAPTERS 轉接器 (結合心肺繞道手術使用) 329

CHC0113000M4 "美敦力"順行/逆行性結合選擇開關"MEDTRONIC" ARISS

ANTEGRADE/RETROGRADE INTEGRAL SELECTOR SWITCH

1035

CHC0114006M4 "美敦力"多重灌流組"MEDTRONIC" DLP MULTIPLE PERFUSION SETS 990

CHC0130010DL CORONARY CANNULA 10:14FR 611

CHC01CA123L5 "加州"心臟麻痺轉接器"CALIFORNIA" CARDIOPLEGIA ADAPTERS 329

CHC01CA410L5 MULTIPLE PERFUSION ADAPTER 657

CHC01CA420L5 MULTIPLE PERFUSION ADAPTER WITH VENT LINE 15 INCH※適應症

請見備註欄

889

CHC01CA430L5 MULTIPLE PERFUSION ADAPTER WITH VESSEL CANNULA三條(VC-

11000,VC-11010)

990

CHC01CA810L5 CARDIOPLEGIA PERFUSION ADAPTERS WITH MONITORING SET*適應

症請見備註欄

1035

CHC01CP110L5 CORONARY ARTERY PERFUSION CANNULAE 611

788

特材代碼 中英文名稱 支付點數-104/01/01

CHC01CP212L5 CORONARY ARTERY PERFUSION CANNULAE WITH BALLOON 611

CHC01MS001ED CARDIOPLEGIA DELIVERY SETS(MONITORING SET) 1035

CHF0696345M4 BIO-MEDICUS CANNULA套管及導管(ADULT)23:29FR*使用參考請見

備註欄

16771

CHF0696570M4 BIO-MEDICUS CANNULA套管及導管(ADULT)15:21FR*使用參考請見

備註欄

16771

CHF0696825M4 BIO-MEDICUS CANNULA套管及導管(PEDIATRIC)8:14FR*使用參考請

見備註欄

16771

CHF06CAVALM4 "MEDTRONIC"CARPENTIER BI-CAVAL FEMORAL CANNULA

24/29FR;30/33FR 75CM"美敦力"雙腔式股靜脈套管

16771

CHF06CB965M4 "美敦力"皮下套管組-動脈"MEDTRONIC"BIO-MEDICUS ONE-PC

FEMORAL CANNULA KIT-ARTERIAL W/INTRODUCER SET

18230

CHF06CB966M4 "美敦力"皮下套管組-靜脈"MEDTRONIC"BIO-MEDICUS ONE-PC

FEMORAL CANNULA KIT-VENOUS W/INTRODUCER SET

18230

CHF06D008VED FEM-FLEX II DURAFLO HEPARIN TREATED FEMORAL CANNULAE SET

W/INTRODUCER 芬弗列克肝素塗層股靜脈導管及導引組 ※使用參

考請見備註欄

18230

CHF06EBSAXTM "泰爾茂"人工心肺新式導管套"TERUMO" CAPIOX EBS CANNULA KIT

WITH X COATING(ARTERIAL CANNULATION KIT W/INTRODUCER)*適

應症請見備註欄

18230

CHF06EBSCATM ARTRIAL CAPIOX EBS CANNULATION KIT W/INTRODUCER SET

13.5,15,16.5FR※使用參考請見備註欄

18230

CHF06EBSCVTM VENOUS CAPIOX EBS CANNULATION KIT W/INTRODUCER SET

18,19.5,21FR※使用參考請見備註欄

18230

CHF06EBSVXTM "泰爾茂"人工心肺新式導管套"TERUMO" CAPIOX EBS CANNULA KIT

WITH X COATING(VENOUS CANNULATION KIT W/INTRODUCER)*適應

症請見備註欄

18230

CHF06ELS88QM ELS CANNULA 雙腔靜脈引流灌注導管(含PU導管+血管擴張器+導線

+穿刺針) ※適應症請見備註欄

18230

CHF06EZFACE8 "艾斯泰格"動脈導管"ESTECH"EASYFLOW AORTIC CANNULA 11572

CHF06FEM08ED FEM-FLEX II FEMORAL ACCESS CANNULAE SET W/INTRODUCER 股動

/靜脈導管及導引管組(無肝素塗層) ※使用參考請見備註欄

12404

CHF06FEM14ED FEM-FLEX II DURAFLO HEPARIN TREATED FEMORAL CANNULAE SET

W/INTRODUCER 芬弗列克肝素塗層股動脈導管及導引組 ※使用參

考請見備註欄

18230

CHF06HLSCAQM "邁柯唯"動靜脈導管-股動脈導管 "MAQUET" HLS CANNULAE

/BIOLINE COATING/含INTRODUCER SET

18230

CHF06HLSCVQM "邁柯唯"動靜脈導管-股靜脈導管 "MAQUET" HLS CANNULAE

/BIOLINE COATING/含INTRODUCER SET

18230

CHF06MED1CM4 "MEDTRONIC"BIO-MEDICUS FEMORAL ARTERIAL/VENOUS CANNULA

8:29FR"美敦力"股動/靜脈套管*適應症請見備註欄

16771

CHF06MEFKAML FEMORAL CANNULAE 股動靜脈導管※適應症請見備註欄 16771

CHF06RAPFVE8 "艾斯泰格"雷卜股靜脈導管"ESTECH"RAP FEMORAL VENOUS

CANNULA

11572

CHF06VFEM1ED FEM-FLEX II FEMORAL ACCESS CANNULAE SET W/INTRODUCER 股動

/靜脈導管及導引管組(無肝素塗層) ※使用參考請見備註欄

12404

CHG0204427TM RETROGRADE CARDIOPLEGIA CANNULAE MANUAL INFLATE 13FR,17FR 3129

CHG0204429TM RETROGRADE CARDIOPLEGIA CANNULA 3129

CHG0294006M4 DLP RETROGRADE CORONARY SINUS PERFUSION CANNULA 3129

CHG02RCM14L5 RETROGRADE CARDIOPLEGIA CANNULAE 6,10,13,15FR 3129

CHG02RCS14L5 RETROGRADE CARDIOPLEGIA CANNULAE 13,14,15FR 3129

CHG02RCS35L5 RETROGRADE CARDIOPLEGIA CANNULAE 13FR,14FR,15FR 逆向心臟

麻痺液灌注套管

3129

789

特材代碼 中英文名稱 支付點數-104/01/01

CHG02SGK14QM RETROGRADE CARDIOPLEGIA CANNULA 3129

CHH0112001DL LEFT HEART VENT CATHETER 13FR 568

CHH0112002DL VENT CATHETER 645

CHH0112008M4 DLP LEFT HEART VENT CATHETER 568

CHH01EE061ED "EDWARDS"LEFT VENTRICULAR VENT CATHETER左心室用導管 568

CHH01PE062ED LEFT VENTRICULAR VENT CATHETER 645

CHH01VT573L5 “加州”心肺手術用引流導管“CALIFORNIA VENT CATHETERS 568

CHH025902MAY “肯特利”左心室導管 "Kendall" Argyle Left Ventricular

Sump Vent Catheters

568

CHR0100011RM AORTIC ROOT CANNULA 616

CHR010014VED AORTIC PERFUSION CANNULAE(14G) 797

CHR0110009DL AORTIC ROOT CANNULA 9FR:18FR 616

CHR0110012DL AORTIC CANNULA 12:18G 410

CHR0116094TM AORTIC CANNULA 24FR 加強型動脈導管 797

CHR01AR012ED AORTIC ROOT CANNULA主動脈根部套管 616

CHR01AR109L5 AORTIC ROOT CANNULAE 9:18GA 410

CHR01AR112L5 AORTIC ROOT CANNULAE 12:16GA 410

CHR01AR212L5 AORTIC ROOT CANNULAE WITH VENT LINE 12:16G 616

CHR01CA16VQM ANTEGRADE CARDIOPLEGIA CANNULAE W/VENT 順行性心臟麻醉導管 616

CHR01CAS16QM ANTEGRADE CARDIOPLEGIA CANNULAE 順行性心臟麻醉導管 410

CHR0220009M4 AORTIC ROOT CANNULAE WITH VENT LINE 616

CHR0220014DL AORTIC ROOT CANNULA WITH VENT LINE 616

CHR0300014ED RETROGRADE CARDIOPLEGIA CANNULAE(14F) 3129

CHR03RC014ED RETROGRADE CARDIOPLEGIA CANNULAE 3129

CHR03RC301ED RETROGRADE CARDIOPLEGIA CANNULAE 3129

CHSU116022AY “肯特利”亞羅臍脈導管 "Kendall" Argyle Umbilical Vessel

Catheter

170

CHSU116035KD "柯惠"肯特利亞羅臍脈導管"COVIDIEN"KENDALL ARGYLE

UMBILICAL VESSEL CATHETER

170

CHT0104413TM CONDUCER CARDIOPLEGIA SET W/MP-4 1:1,4:1,8:1 3173

CHT0106375TM CONDUCER CARDIOPLEGIA SSET W/MP-4 AND BRIDGE 4:1 3173

CHT0109457TM CONDUCER CARDIOPLEGIA SET 4:1,2:1 BLOOD MIXING 2884

CHT0109499TM CONDUCER CARDIOPLEGIA SET(含DOMEXI,ARTERIAL PRESSURE

TUBINGX3,3-WAY STOPCOCKX1)

3173

CHT0132301GJ “吉生”體外循環管組(ORGANIZER+PRE-BYPASS FILTER+SUCKER X

2+ARTERIAL FILTER+ISOLATOR+TUBING+PRIMING LINE)”JSM”

HEART LUNG PACK

7315

CHT0132501GJ “吉生”體外循環管組(含PRE-BYPASS FILTER)”JSM” HEART

LUNG PACK

4137

CHT0132701GJ “吉生”體外循環管組(含TUBING+ORGANIZER+PRE-BYPASS

FILTER)”JSM” HEART LUNG PACK

4770

CHT0179003DL PEDIATRIC TOURNIQUET KIT 255

CHT01A32NSH9 HEART LUNG PACK:A32 CUSTOMER PACK(TUBING+ORGANIZER+PRE-

BYPASS FILTER)

4770

CHT01CH207H9 HEART LUNG PACK(含PRE-BYPASS FILTER) 4137

CHT01CHX30QM PLEGIOX CARDIOPLEGIA HEAT EXCHANGER(含DIA-CONN,PVC-

75SH,PUMP CONN,SILICONE,PVC-70SH,Y-CONN,ONE WAY

VALVE,DIA-CONN/BL)

3173

CHT01CPSETGJ “吉生”麻痺液輸送管路組“JSM”CARDIOPLEGIA SET 3173

CHT01CSS01TV "康翠特"灌流管組"CONTRACT"CSS PERFUSION TUBING SET (含

TUBING+PRE-BYPASS FILTER+ORGANIZER+SUCKER X 2)

5218

CHT01CSS02TV CSS PERFUSION TUBING SET (含TUBING+PRE-BYPASS

FILTER+SUCKER X 2)

4996

790

特材代碼 中英文名稱 支付點數-104/01/01

CHT01CSS03TV CSS PERFUSION TUBING SET (含TUBING+PRE-BYPASS FILTER) 4137

CHT01CSS04TV CSS PERFUSION TUBING SET (只含TUBING) 3748

CHT01ECTB1M6 EXTRACORPOREAL TUBING PACK(含PRE-BYPASS

FILTER+SUCKERX2+ORGANIZER)

5218

CHT01ECTBSM6 EXTRACORPOREAL TUBING PACK(含PRE-BYPASS FILTER) 4137

CHT01HL106H9 "華億" 體外循環管組"HYM" HEART LUNGPACK(含ORGANIZER+PRE-

BYPASS FILTER+SUCKER*2)

5218

CHT01HS101H9 HEART LUNG PACK(含ORGANIZER+PRE-BYPASS FILTER+SUCKERX2) 5218

CHT01HTA12H9 HEART LUNG PACK HSIN TUNG A12 ADULT(含ORGANIZER+PRE-

BYPASS FILTER+SUCKER X2+ARTERIAL FILTER)

7315

CHT01MY100M4 MYOTHERMXP CARDIOPLEGIA DELIVERY SYSTEM(BLOOD

MIXING+CONDUCER+COIL TUBING+MP4)

3173

CHT01P0201QM BLOOD CARDIOPLEGIA SET W/PLEGIOX 具自動熱交換功能(含DIA-

CONN,PVC-75SH,PUMP CONN,SILICONE,PVC-70SH,Y-CONN,ONE WAY

VALVE,DIA-CONN/BL)

3173

CHT01TS100L5 TOURNIQUET KIT WITH SNARE 255

CHT01TS130L5 TOURNIQUET KIT 255

CHT01VBC4CGH VISION BLOOD CARDIOPLEGIA(BLOOD MIXING+CONDUCER+COIL

TUBING+MP4)具熱交換功能

3173

CHT01VBCBRGH VISION BLOOD CARDIOPLEGIA SYSTEM(BLOOD

MIXING+CONDUCER+COIL TUBING)

2884

CHT0332401GJ “吉生”體外循環管組-預充管路組”JSM” HEART LUNG PACK-

PRIMING LINE

276

CHT03A25PLH9 HEART LUNG PACK:A25 PRIME LINE(TUBING 49"+ Y CONNECTOR) 276

CHT03CB993M4 "美敦力"血液套裝組-有塗層"MEDTRONIC"BLOOD TUBING PACK-

WITH COATING(TUBING ONLY)

3829

CHT0546202H9 HEART LUNG PACK:FLOW PROBE CONNECTOR 914

CHT0546203GJ “吉生”體外循環管組-動脈&靜脈氧分壓接頭”JSM” HEART

LUNG PACK-PO2 ARTERIAL & VENOUS CONNECTOR

914

CHT0546203H9 HEART LUNG PACK:STATSAT CONNECTOR 1/4;3/8;1/2氧分壓測定接

頭*適應症請見備註欄

914

CHT0546212GJ “吉生”體外循環管組-流量測定接頭”JSM” HEART LUNG PACK-

FLOW PROBE CONNECTOR

914

CHT0569120TM CDI HEMATOCRIT SATURATION CUVETTE 血氧感知器 914

CHT05TMC25M4 TMC TRI-OPTIC MEASUREMENT CELL 914

CHV0100012ED SINGLE STAGE VENOUS RETURN CANNULAE(12:40FR/直) 771

CHV0100028ED SINGLE STAGE VENOUS RETURN CANNULAE 771

CHV0100040ED SINGLE STAGE VENOUS RETURN CANNULAE(12:40FR/彎) 771

CHV0104882TM MALLEABLE VENOUS RETURN CATHETER REINFORCED 24FR 977

CHV0166112M4 SINGLE STAGE VENOUS CANNULA 771

CHV0167312DL VENOUS CANNULAR 12,16,20,31FR (PEDIATRIC) 1002

CHV0168112M4 "MEDTRONIC"SINGLE STAGE VENOUS CANNULA"美敦力"單孔型靜脈

套管12:40FR

977

CHV0169312DL VENOUS CANNULAR 12:31FR (HIGH FLOW) 1002

CHV0169424DL VENOUS CANNULAR 12:31FR (ADULT) 1002

CHV0191228M4 TWO STAGE VENOUS CANNULA 803

CHV01LRD41L5 "CALIFORNIA" DUAL STAGEVENOUS RETURN CANNULAE(WIRE-

REINFORCED)"加州"二階靜脈引流導管

803

CHV01RV110L5 WIRE REINFORCED VENOUS RETURN CANNULAE24,28,32,34,36,40 771

CHV01RV224L5 "CALIFORNIA"VENOUS RETURN CANNULAE(WIRE-REINFORCED)"加州"

靜脈回流導管

771

CHV01TF008ED SINGLE STAGE VENOUS RETURN CANNULAE 靜脈引流導管 771

CHV01XRDS2L5 DUAL STAGE VENOUS RETURN CANNULAE 32:36FR 803

791

特材代碼 中英文名稱 支付點數-104/01/01

CHV0329370ED DUAL STAGE VENOUS RETURN CANNULAE(29/37F) 1002

CHV0336460ED DUAL STAGE VENOUS RETURN CANNULAE(36/46F) 1002

CHV03TF334ED "愛德華" 二階靜脈引流導管"EDWARDS" DUAL STAGE VENOUS

RETURN CANNULAE

1002

CHV03TR283ED DUAL STAGE VENOUS RETURN CANNULA 803

CHV03TRF29ED DUAL STAGE VENOUS CANNULAE 1002

CKB0144002BB CYSTOFIX 10:15FR 8:12CM 542

CKB0144205BB CYSTOFIX 10:15FR 8:12CM 542

CKB0144212BB CYSTOFIX 10:15FR 8:12CM 542

CKB0144215BB CYSTOFIX 10:15FR 8:12CM 542

CKB0156116BA SUPRAPUBIC CATHETERISATION KIT 膀胱穿刺針組 16CH 590

CKB0160600AN VESICO SET 膀胱穿刺引流組 542

CKD0100950CK DOUBLE PIGTAIL(J)STENT SET 4.7:8.2FR(stent+guide

wire+pusher)

1132

CKD01BTDJ2BQ DOUBLE J URETERAL STENT SET(STENT+GUIDE+PUSHER) 1117

CKD01US101CK "COOK"UNIVERSA FIRM AND SOFT URETERAL STENT SET(雙

JSTENT+GUIDE WIRE+PUSHER)"曲克"由尼維莎結實型和柔軟型輸尿

管內置支架組

1132

CKD01US102CK "COOK"UNIVERSA FIRM AND SOFT URETERAL STENT SET(雙

JSTENT+GUIDE WIRE+PUSHER)"曲克"由尼維莎結實型和柔軟型輸尿

管內置支架組

1132

CKD030472NAN DOUBLE J-STENT 4,7FR 24CM:7FR 32CM 1132

CKD035550NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1132

CKD035572NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1132

CKD035591NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1132

CKD035610NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1132

CKD035704NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1132

CKD035723NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1132

CKD035921NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1132

CKD0380155MV CONTOUR SOFT PERCUFLEX STENTS W/HYDROPLUS

COATING+GUIDEWIRE+PUSHER+CLAMP

1416

CKD0380220MV CONTOUR SOFT PERCUFLEX STENTS W/HYDROPLUS

COATING+GUIDEWIRE+PUSHER+CLAMP

1416

CKD0380244MV CONTOUR SOFT PERCUFLEX STENTS W/HYDROPLUS

COATING+GUIDEWIRE+PUSHER+CLAMP

1416

CKD0380801MV CONTOUR SOFT PERCUFLEX STENTS W/HYDROPLUS

COATING+GUIDEWIRE+PUSHER+CLAMP

1416

CKD03STRVLSB "BOSTON SCIENTIFIC" STRETCH VL STENT WITH HYDROPLUS "波士

頓科技"伸展輸尿管支架

1416

CKD0512135BQ "BIOTEQ"URETERAL STENT SET(DOUBLE J TYPE)( W/HYDROPHILIC

COATING+GUIDE WIRE+PUSHER+CLIP)"邦特"輸尿管導管組(雙J型)

1416

CKD0542135BQ "BIOTEQ"URETERAL STENT SET(DOUBLE J TYPE)( W/HYDROPHILIC

COATING+GUIDE WIRE+PUSHER+CLIP)"邦特"輸尿管導管組(雙J型)

1416

CKD057774NBA URETERAL STENT WITH HYDROPLUS COATING+GUIDE

WIRE+PUSHER+CLAMP

1416

CKD0577848BA "BARD"INLAY URETERAL STENT( WITH HYDROPLUS

COATING)+PUSHER+CLAMP"巴德"輸尿管導管組

1348

CKD05BTDJ3BQ URETERAL STENT(DOUBLE J TYPE)(STENT WITH HYDROPHILIC

COATING+GUIDE WIRE+PUSHER+CLIP)

1416

CKD05DSHFNGT DOUBLE PIGTAIL URETERAL STENT SET(stent with

hydromer+guide wire+pusher)

1416

792

特材代碼 中英文名稱 支付點數-104/01/01

CKD05DUSPNGT DOUBLE PIGTAIL URETERAL STENT SET(stent with

hydromer+guide wire+pusher)

1416

CKD05DUTWNGT DOUBLE PIGTAIL URETERAL STENT SET(stent with

hydromer+guide wire+pusher)

1416

CKD05J3114BQ "BIOTEQ"URETERAL STENT SET(LONG-TERM TYPE) (STENT WITH

HYDROPHILIC+GUIDE WIRE+PUSHER)"邦特"輸尿管導管組(長效型)

1416

CKD05J3125BQ "BIOTEQ"URETERAL STENT SET(LONG-TERM TYPE) (STENT WITH

HYDROPHILIC+GUIDE WIRE+PUSHER)"邦特"輸尿管導管組(長效型)

1416

CKD05K3114BQ "BIOTEQ"URETERAL STENT SET(LONG-TERM TYPE) (STENT WITH

HYDROPHILIC+GUIDE WIRE+PUSHER)"邦特"輸尿管導管組(長效型)

1416

CKD05K3125BQ "BIOTEQ"URETERAL STENT SET(LONG-TERM TYPE) (STENT WITH

HYDROPHILIC+GUIDE WIRE+PUSHER)"邦特"輸尿管導管組(長效型)

1416

CKD05R3214BQ "BIOTEQ"URETERAL STENT SET(LONG-TERM TYPE) (STENT WITH

HYDROPHILIC+GUIDE WIRE+PUSHER)"邦特"輸尿管導管組(長效型)

1416

CKD05R3225BQ "BIOTEQ"URETERAL STENT SET(LONG-TERM TYPE) (STENT WITH

HYDROPHILIC+GUIDE WIRE+PUSHER)"邦特"輸尿管導管組(長效型)

1416

CKD05S3214BQ "BIOTEQ"URETERAL STENT SET(LONG-TERM TYPE) (STENT WITH

HYDROPHILIC+GUIDE WIRE+PUSHER)"邦特"輸尿管導管組(長效型)

1416

CKD05S3225BQ "BIOTEQ"URETERAL STENT SET(LONG-TERM TYPE) (STENT WITH

HYDROPHILIC+GUIDE WIRE+PUSHER)"邦特"輸尿管導管組(長效型)

1416

CKD05T3114BQ "BIOTEQ"URETERAL STENT SET(W HYDROPHILIC)(LONG-TERM

TYPE)(+PUSHER+CLAMP)"邦特"輸尿管導管組

1348

CKD05T3125BQ "BIOTEQ"URETERAL STENT SET(W HYDROPHILIC)(LONG-TERM

TYPE)(+PUSHER+CLAMP)"邦特"輸尿管導管組

1348

CKD05U3214BQ "BIOTEQ"URETERAL STENT SET(W HYDROPHILIC)(LONG-TERM

TYPE)(+PUSHER+CLAMP)"邦特"輸尿管導管組

1348

CKD05U3225BQ "BIOTEQ"URETERAL STENT SET(W HYDROPHILIC)(LONG-TERM

TYPE)(+PUSHER+CLAMP)"邦特"輸尿管導管組

1348

CKD05USH01CK "COOK"UNIVERSA STENT FIRM AQ AND SOFT AQ SET (STENT-WITH

HYDROPHILIC COATING+GUIDE WIRE+PUSHER)由尼維莎輸尿管內置

支架組

1416

CKD0706016BA SILICON FLOURO-4 URETERAL STENT(stent+introducer kit) 1972

CKDD20450NBA HICKMAN HEMODIALYSIS CATHETER KIT(CATH+INTRODUCER KIT)永

植型

3509

CKDD20452NBA HICKMAN HEMODIALYSIS CATHETER KIT(CATH+INTRODUCER KIT)永

植型

3509

CKDD214554NL "NAVILYST"VAXCEL PLUS CHRONIC DIALYSIS CATHETERS

KIT(CATHETER+INTRODUCER KIT)"娜維利斯特"斐克希長期透析用

導管

3509

CKDD2330742C "柯惠"肯特利慢性血液透析導管"COVIDIEN"KENDALL CHRONIC

HEMODIALYSIS CATHETERS-MAHURKAR 13.5FR CUFFED CATHETER

KIT

3509

CKDD2450142C "COVIDIEN"KENDALL PALINDROME CATHETER KIT AND

SPORTPACK(CATH+INTRODUCER KIT)"柯惠"肯特利沛霖卓導管組(永

植型)

3509

793

特材代碼 中英文名稱 支付點數-104/01/01

CKDD2480012C "柯惠"肯特利慢性血液透析導管"COVIDIEN"KENDALL CHRONIC

HEMODIALYSIS CATHETERS-PERMCATH CATHETER KIT

36~45CM(CATH+INTRODUCER KIT)

3509

CKDD256631BA HEMOGLIDE HEMODIALYSIS CATHETER KIT(CATH+INTRODUCER KIT)

永植型

3509

CKDD257331BA "BARD"HEMOSPLIT HEMODIALYSIS CATHETER(CATH+INTRODUCER

KIT)"巴德"思伯利特血液透析導管.永植型

3509

CKDD25833NBA "BARD"HemoStar HEMODIALYSIS CATHETER KITS(CATH+INTRODUCER

KIT)永植型

3509

CKDD266606BA HICKMAN HEMODIALYSIS CATHETER KIT(CATH+INTRODUCER KIT)永

植型

3509

CKDD2690012C "柯惠"肯特利慢性血液透析導管"COVIDIEN"KENDALL CHRONIC

HEMODIALYSIS CATHETERS-PERMCATH CATHETER KIT

28CM(CATH+INTRODUCER KIT)

3509

CKDD2881452C "柯惠"肯特利慢性血液透析導管"COVIDIEN"KENDALL CHRONIC

HEMODIALYSIS CATHETERS-MAHURKAR MAXID 14.5FR.雙腔導管

(CATH+INTRODUCER KIT)

3509

CKDD2SL12PM0 "MEDCOMP"SILICONE DOUBLE LUMEN CATHETERS AND

ACCESSORIES(CATHETER+NEEDLE+GUIDE WIRE+DILATOR)"美德康"矽

質血液透析導管與配件

3509

CKDD2SL18PM0 "MEDCOMP"HEMO-CATH LONG TERM DIALYSIS CATHETERS (DOUBLE

LUMEN )AND ACCESSORIES(CATHETER+INTRODUCER KIT)"美德康"長

期矽質血液透析導管與配件

3509

CKDD312123AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION

SETS(CATH+NEEDLE+GUIDEWIRE+DILATOR)"亞諾"多重輸液導管套

1738

CKDD323334BQ "BIOTEQ"HEMODIALYSIS CATHETER KIT(3 LUMEN

CATHETER+NEEDLE+GUIDE WIRE+DILATOR)血液透析導管組

1738

CKDD325123AR "ARROW"ARROWGARD CATHETERS

SETS(CATH+NEEDLE+GUIDEWIRE+DILATOR+SHEATH) 3 LUMEN "亞諾"

抗感染安全尖端導管

1738

CKDD3456032C "柯惠"肯特利急性血液透析導管"COVIDIEN"KENDALL ACUTE

HEMODIALYSIS CATHETERS-三腔透析導管(C+N+G+D)

1738

CKF0201237BA "BARD"75CC BARDEX LUBRICATH LATEX FOLEY CATHETER,2 WAY"巴

德"導尿管*給付規定請見備註欄

106

CKF0222630BA "BARD"BARDEX PEDIATRIC FOLEY CATHETER,LUBRICIOUS COATED,2

WAY 3CC導尿管*適應症請見備註欄

106

CKF0222656BA "BARD"FOLEY CATHETER二叉滑潤長期導尿管5CC,30CC*適應症請

見備註欄

106

CKF025118NUW "UNOMEDICAL"FOLEY CATHETERS(HYDROPHILIC 2-WAY)3CC-30CC"巫

諾"導尿管*適應症請見備註欄

106

CKF02H2265BA BIOCATH HYDROGEL COATING 2 WAY FOLED 8:24FR 5CC,30CC ※適

應症請見備註欄

106

CKF02L0165BA LUBRICATH 2 WAY FOLED 8:26FR 3CC,5CC ※適應症請見備註欄 106

CKF02M5118UM "UNOMEDICAL"FOLEY CATHETERS(HYDROPHILIC 2-WAY)3CC-30CC"巫

諾"親水性雙叉導尿管*適應性請見備註欄

106

CKF0300006FM 2 WAY SILICONE FOLEY BALLOON CATH 1.5CC 6FR,3CC 8:10FR※

適應症請見備註欄

93.1

CKF030012NFM 2 WAY SILICONE FOLEY BALLOON CATHETER 5CC,30CC 12:26FR※

適應症請見備註欄

93.1

CKF0300142R4 2 WAY ALL SILICONE FOLEY BALLOON CATHETER 5CC 12:24FR※適

應症請見備註欄

93.1

CKF0300212YN 2 WAY ALL SILICONE FOLEY BALLOON CATH 12:26FR 5CC※適應症

請見備註欄

93.1

794

特材代碼 中英文名稱 支付點數-104/01/01

CKF0300242R4 2 WAY ALL SILICONE FOLEY BALLOON CATHETER 30CC 16:26FR※

適應症請見備註欄

93.1

CKF0300506FM "富強"導尿管(二叉矽質)"FORTUNE"UROLOGICAL CATHETER(ALL

SILICON 2-WAY)

93.1

CKF0301641W6 ALL SILICONE 2 WAY FOLEY CATHETER 6FR:26FR*適應症請見備註

93.1

CKF0303201EW E-UP SILICONE FOLEY CATHETER FOR SINGLE USE(2 WAY 1-3ML)

毅升一次性使用純矽膠球囊導尿管*給付規定請見備註欄。

93.1

CKF0303203EW E-UP SILICONE FOLEY CATHETER FOR SINGLE USE(2 WAY 5-10ML)

毅升一次性使用純矽膠球囊導尿管*給付規定請見備註欄。

93.1

CKF0303205EW E-UP SILICONE FOLEY CATHETER FOR SINGLE USE(2 WAY 5-15ML)

毅升一次性使用純矽膠球囊導尿管*給付規定請見備註欄。

93.1

CKF0303207EW E-UP SILICONE FOLEY CATHETER FOR SINGLE USE(2 WAY 30ML)毅

升一次性使用純矽膠球囊導尿管*給付規定請見備註欄。

93.1

CKF0303308P2 SILICON 2 WAY FOLEY CATHETER*適應症請見備註欄 93.1

CKF030512NFM 2 WAY SILICONE FOLEY BALLOON CATH W/X-RAY5CC,30CC 12:26FR

※適應症請見備註欄

93.1

CKF030513NCL SILICONE 2-WAY FOLEY CATHE 6:26FR ※適應症請見備註欄 93.1

CKF0312352BA "BARD"BARDIA 2-WAY FOLEY CATHETER(5;30CC/12:30FR)"巴德"巴

迪亞二叉導尿管※適應症請見備註欄

93.1

CKF0376SF6MU MODERN ALL SILICONE FOLEY CATHETER導尿管*適應症請見備註欄 93.1

CKF03F0101SG SILICONE 2 WAY FOLEY CATHETER*適應症請見備註欄 93.1

CKF03FC001SG SILICON FOLEY BALLOON CATHETER*適應症請見備註欄 93.1

CKF03S2100WN SILICONE 2WAY FOLEY CATHE 3:50ML ※適應症請見備註欄 93.1

CKF0404303EW E-UP SILICONE FOLEY CATHETER FOR SINGLE USE(3 WAY 5-10ML)

毅升一次性使用純矽膠球囊導尿管*給付規定請見備註欄。

170

CKF0404305EW E-UP SILICONE FOLEY CATHETER FOR SINGLE USE(3 WAY 5-15ML)

毅升一次性使用純矽膠球囊導尿管*給付規定請見備註欄。

170

CKF0404307EW E-UP SILICONE FOLEY CATHETER FOR SINGLE USE(3 WAY 30ML)毅

升一次性使用純矽膠球囊導尿管*給付規定請見備註欄。

170

CKF040514NFM 3 WAY SILICONE FOLEY BALLOON CATHETER W/X-RAY 30CC

14:26FR※適應症請見備註欄

170

CKF0412343BA "BARD"BARDIA 3-WAY FOLEY CATHETER(30CC/16:26FR)"巴德"巴迪

亞三叉導尿管※適應症請見備註欄

164

CKF041426NFM SILICONE 3 WAY FOLEY CATHETER 14:26FR ※適應症請見備註欄 170

CKF042103NWN SILICONE 3 WAY FOLEY CATHETER 5CC,30CC 16:26FR ※適應症請

見備註欄

170

CKF045518NUW "UNOMEDICAL"FOLEY CATHETERS(HYDROPHILIC 3-WAY)5CC-30CC"巫

諾"導尿管*適應症請見備註欄

164

CKF04H1875BA LUBRICATH 3 WAY FOLEY CATHETER 75CC 18:24FR ※適應症請見

備註欄

278

CKF04H2267BA BIOCATH 3 WAY FOLEY CATHETER 30:50CC 18:24FR ※適應症請見

備註欄

164

CKF04L1630BA HYDROGEL 3 WAY FOLEY CATHETER 30CC 16:26FR ※適應症請見備

註欄

164

CKF04M5118UM "UNOMEDICAL"FOLEY CATHETERS(HYDROPHILIC 3-WAY)5CC-30CC"巫

諾"親水性三叉導尿管*適應性請見備註欄

164

CKF04Y0630GC 三叉矽質導尿管*適應症請見備註欄 170

795

特材代碼 中英文名稱 支付點數-104/01/01

CKN0108000CK PERCUTANEOUS PIGTAIL NEPHROSTOMY SETS 6.0:10FR 15:30CM(標

準型)

2640

CKN0111245BQ "BIOTEQ"DRAINAGE CATHETERAND INTRODUCER SET/KIT(C+N+G+D+

引流管袋+固定貼布)導管5-16FR 20-50CM

2580

CKN0113113BQ "BIOTEQ"DRAINAGE CATHETER&INTRODUCER

SET/KIT(HYDROPHILIC)5-16FR 20-50CM(NEEDLE+GUIDE

WIRE+DILATOR+引流管袋+固定貼布)引流導管及穿刺導入系統

2580

CKN011450NC3 PERCUTANEOUS NEPHROSTOMY SET PIGTAIL TYPE(chiba N+initial

N+D+G+C)

2640

CKN011460NC3 PERCUTANEOUS NEPHROSTOMY SET PIGTAIL TYPE(chiba N+initial

N+D+G+C)

2640

CKN011470NC3 PERCUTANEOUS NEPHROSTOMY SET PIGTAIL TYPE(chiba N+initial

N+D+G+C)

2640

CKN011897SAN "ANGIOMED"INTRODUCTION/DRAINAGE CATHETER AND

ACCESSORIES(STERILE)SOFT-DRAIN DIRECT PUNCTURE SET(ONE-

STEP)"安吉美爾德"導入/引流導管及其附件

1720

CKN0120111MV PCN NEPHROSTOMY SET 8FR 30CM(C+N+D+G+cannecting tube) 2651

CKN0120111SB PERCUTANEOUS NEPHROSTOMY SET-PIGTAIL DESIGN(C+N+D+G) 2640

CKN0141010CL PCN NEPHROSTOMY KIT WITH SILICON WALECOT 10FR:14FR(C+穿刺

N+顯影N+G+D+引流管)

3120

CKN015500PAN "ANGIOMED"INTRODUCTION/DRAINAGE CATHETER AND

ACCESSORIES:PERCUT NEPHROSTOMY SET(C+CHIBA N+INITIAL

N+D+G+固定盤)導入/引流導管及附件

2511

CKN015520PAN "ANGIOMED"INTRODUCTION/DRAINAGE CATH AND

ACCESSORIES:NEPHROPUR NEPHROSTOMY SET(C+CHIBA N+INITIAL

N+D+G+引流管袋+固定盤)導入/引流導管及附件

2640

CKN015521LAN "ANGIOMED"INTRODUCTION/DRAINAGE CATH AND

ACCESSORIES:NEPHROPUR NEPHROSTOMY SET(C+CHIBA N+INITIAL

N+D+G+引流管袋+固定盤)導入/引流導管及附件

2640

CKN015522SAN "ANGIOMED"INTRODUCTION/DRAINAGE CATHETER AND

ACCESSORIES:NEPHROSTOMY SET(C+INITIAL N+D+G+引流管袋)"安

吉美爾德"導入/引流導管及附件

2651

CKN0178000PB PIGTAIL NEPHROSTOMY SET(自950401起增加型號780016030.文號

0940041345)

2767

CKN0178050PB PIGTAIL NEPHROSTOMY SET W/SAFETY STRING LOCK SYSTEM(自

950401起增加型號780516030.文號0940041345)導管

(HYDROFEEL)+STIFFENER+GX2+D+固定貼布

2746

CKN01PNS01CK SAFE-T-J CURVED WIRE GUIDE 277

CKN01RLCTRMR "MERIT"RESOLVE LOCKING DRAINAGE CATHETERS(HYDROPHILIC)

SET(引流管+NX2+G+D+引流管袋)(STERILE)"美瑞特"通用引流管

(滅菌)

2797

CKN0218522FM SILICONE 2WAY NEPHROSTOMY BALLOON CATHETER X-RAY OPEN TIP

8:24FR

331

CKN0218523FM SILICONE 3WAY NEPHROSTOMY BALLOON CATHETER X-RAY OPEN TIP

14:24FR

349

CKN0218562FM SILICONE 2WAY NEPHROSTOMY BALLOON CATHETER TIEMANN TIP 331

CKN0218563FM SILICONE 3WAY NEPHROSTOMY BALLOON CATHETER TIEMANN TIP 349

CKN0251608CL SILICON NEPHROSTOMY BALLOON CATHETER 8:10FR 球型腎臟造廔

331

CKN0251612CL SILICON NEPHROSTOMY BALLOON CATHETER 12:24FR 球型腎臟造廔

331

CKN0252116CL SILICON 3 WAY FOLEY CATHETER 16:26FR ※適應症請見備註欄 170

CKN02N2108YN ALL SILICONE NEPHROSTOMY BALLOON CATHETER 8:24FR1.5:5CC 331

CKN02NS001SG SIGMA NEPHROSTOMY CATHETER(SILICON)*適應症請見備註欄 331

796

特材代碼 中英文名稱 支付點數-104/01/01

CKN02S0101SG SILICONE 2 WAY NEPHROSTOMY CATHETER 331

CKN0318552FM SILICONE NEPHROSTOMY CATHETER WITH DETACHABLE FUNNEL

14:24FR

331

CKN0351912CL SILICON NEPHROSTOMY BALLOON CATHETER W/REMOVABLE 12:24FR

可分離式腎臟造廔管

530

CKN0410111MV PERCUTANEOUS NEPHROSTOMY CATHETER WITH LOOP LOCKING

RETENSION 豬尾巴導管

829

CKN0418572FM SILICONE NEPHROSTOMY PIGTAIL PATTERN CATHETER 12FR 331

CKN045522SAN "ANGIOMED"INTRODUCTION/DRAINAGE CATHETER AND

ACCESSORIES:NEPHROSTOMY SLIM SET "安吉美爾德"導入/引流導

管及附件

524

CKN04BTPDSBQ NEPHROSTOMY CATHETER(WITH STYLET&FLEXIBLE CANNULA) 829

CKN0508240CK MALECOT CATHETER 885

CKN051111NWN MALECOT CATHETER 4 WING 12:40FR 273

CKN0514010CL SILICON 4 WING MALECOT 10:26FR 梅花型腎臟造廔管 885

CKN051840NFM "FORTUNE"SILICONE MALECOT CATHETER 14:36FR矽質梅花型引流

885

CKN0583808CK "COOK"SILICONE MALECOT CATHETERS 8:24FR"曲克"矽膠蕈狀導管 885

CKN0586010BA MALECOT NEPHROSTOMY TUBE 16:36FR 273

CKN0718512FM SILICONE 2WAY NEPHROSTOMY CATHETER X-RAY OPAQUE TIP

8:24FR

331

CKN0718513FM SILICONE 3WAY NEPHROSTOMY CATHETER X-RAY OPAQUE TIP

14:24FR

349

CKP0413836FA "FRESENIUS"PD ACCESSORIES SLEEP.SAFE SET/SET PLUS"費森尤

斯"自動腹膜透析管組

232

CKS016020NAN "ANGIOMED"URETERAL STENTS(STENT+GUIDE+PUSHER) 1117

CKS0257071CK "COOK"URETERAL AND URETHRAL STENTS(URETERAL STENT+GUIDE

WIRE+SHEATH+PUSHER)"曲克"輸尿管及尿道內置管祖

1257

CKU0303903P2 URETERAL CATHETER STRAIGHT TIP 3:7FR 75CM 153

CKU0324103CK "COOK"URETERAL CATHETER輸尿管導管 153

CKU0336504BA URETERAL CATHETER (OLIVE TIP) 4:6FR 153

CKU0337504BA URETERAL CATHETER (SPIRAL) 4:6FR 153

CKU0338008BA URETERAL CATHETER (CONE TIP) 8:12FR 153

CKU0362400AN URETERAL CATHETER 153

CKU0362433AN URETERAL CATHETER 153

CKU036243NAN URETERAL CATHETER 153

CKU0362453AN URETERAL CATHETER 153

CKU036245NAN URETERAL CATHETER 153

CKU0362500AN URETERAL CATHETER 153

CKU036251NAN URETERAL CATHETER CYLINDERAL 4:8CH 70CM 斑馬線導管 153

CKU0362930AN URETERAL CATHETER 153

CKU036313NAN URETERAL CATHETER 153

CKUB101000CK URETeRAL BALLOON dilator CATHETER 65CM 5FR,7FR 4032

CKUB101415CK BALLOON URETERAL(UREThERAL自980401起改為URETERAL) DILATOR

SETS 5:7FR 65CM(CATH+GUIDE WIRE)

5068

CKUB107835CK "COOK"URETEROSCOPY BALLOON CATHETER(CATHETER+GUIDE WIRE)

輸尿管氣球導管

5068

CKUB121810SB "BOSTON SCIENTIFIC"PASSPORT UROLOGICAL BALLOON DILATATION

CATHETER WITH HYDRO PLUS BONDED HYDROGEL COATING"波士頓科

技"帕斯泌尿科氣球擴張導管

5068

CKUB122510MV UROMAX ULTRA HIGH PRESSURE URETERAL CATHETER W/SHEATH 5068

CKUB128005CK "COOK" UPJ OCCLUSION BALLOON CATHETER SETS(CATH+GUIDE

WIRE)"曲克"優皮傑閉合氣球導管組

5068

797

特材代碼 中英文名稱 支付點數-104/01/01

CKUB18884NBA UROFORCE BALLOON DILATION CATHETER 4032

CKUB1AUBS1CK COOK ASCEND AQ URETERAL DILATION BALLOON CATHETER

4CM:10CM

4032

CKUB2UNB01CK "COOK"ULTRAXX NEPHROSTOMY BALLOON AND SETS(WITH SHEATH)"

曲克"奧創腎造口術氣球套組

5068

CKUB2XFN30BA “巴德” 艾克-佛斯腎造口手術氣球擴張導管 “BARD”X-FORCE

NEPHROSTOMY BALLOON DILATION CATHETER (WITH SHEATH)

5068

CKUD126100SB BOSTON SCIENTIFIC AMPLATZ TYPE GRADUATED RENAL DILATOR

SET

953

CKUD126120SB "BOSTON SCIENTIFIC"AMPLATZ TYPE GRADUATED RENAL

STYLET/SHEATH

695

CKUD1261XXSB "BOSTON SCIENTIFIC" AMPLATZ TYPE GRADUATED RENAL DILATOR

SET(INDIVIDUAL) "波士頓科技"安普拉斯腎臟擴張導管組(單支)

953

CKUD160300AN RENAL DILATOR W/SHEATH 695

CKUD200040AN PTFE DILATOR 4:9FR 110

CKUD200120AN PTFE DILATOR 12:14FR 154

CKUD20012DAN "ANGIOMED"DILATATION SET 12FR擴張器組 154

CKUD200160AN PTFE DILATOR 16FR 220

CKUS22614NSB AMPLATZ TYPE RENAL SHEATH SET 818

CKUS26015NSB "BOSTON SCIENTIFIC"AMPLATZ TYPE RENAL SHEATH

SET/INDIVIDUAL SHEATHS

818

CKUS2AMPV1CK TFE SHEATHS FOR AMPLATZRENAL DILATORS 10:36FR,16:40CM 818

CLPA102001HJ "史密斯"內植用輸液管/用於靜脈*給付規定請見備註

欗"SMITHS"IMPLANTABLE ACCESS SYSTEM

7539

CLPA102002HJ "史密斯"內植用輸液管/用於動脈*給付規定請見備註

欗"SMITHS"IMPLANTABLEACCESSSYSTEM/ARTERIAL

10137

CLPA105041AR 1 LUMEN PICC RADIOLOGY SELDINGER ACCESS

SET(CATHETER+NEEDLE+DILATOR+GUIDE WIRE)※適應症請見備註欄

2884

CLPA105052AR DUAL LUMEN PICC RADIOLOGY SELDINGER ACCESS SET(C+G+I+T-

PORT)※適應症請見備註欄

3335

CLPA10604NBA MRI SINGLE LUMEN IMPLANTED PORTS(PORT+C+N)*適應症請見備註

7539

CLPA10615NBA MRI DUAL-LUMEN IMPLANTED PORTS(PORT+C+N)*適應症請見備註欄 7804

CLPA107500BA X-PORT ISP IMPLANTED PORT (P+C+N)*適應症請見備註欄 7539

CLPA107530BA X-PORT ISP IMPLANTED PORT (P+C+N+I)*適應症請見備註欄 7712

CLPA11019NYP "PEROUSE"POLYSITE IMPLANTABLE PORT(PORT+CATHETER)"普羅斯"

植入式動脈血管輸注器

9285

CLPA119S20M0 "MEDCOMP"VASCU-PICC PERIPHERALLY INSERTED CENTRAL VEIN

ACCESS CATHETER(1 LUMEN)(C+N+G+D)"美德康"週邊置入中央靜脈

導管組*給付規定請見備註欄

2884

CLPA11PS0TCK VITAL-PORT VASCULAR ACCESS SYSTEMS(P+C+N+I+GW)※適應症請

見備註欄

7712

CLPA1200202C "柯惠"植入型注射系統"COVIDIEN"AUTO SUTURE CHEMOSITE

IMPLANTABLE DRUG DELIVERY SYSTEM(PORT+CATH+NEEDLE)※適應

症請見備註欄

7539

CLPA1200212C "柯惠"植入型注射系統"COVIDIEN"AUTO SUTURE CHEMOSITE

IMPLANTABLE DRUG DELIVERY SYSTEM(P+C+N+I)※適應症請見備註

7712

798

特材代碼 中英文名稱 支付點數-104/01/01

CLPA1200222C "柯惠"植入型注射系統"COVIDIEN"AUTO SUTURE CHEMOSITE

IMPLANTABLE DRUG DELIVERY SYSTEM(PORT+CATH+NEEDLE)※適應

症請見備註欄

7539

CLPA1200232C "柯惠"植入型注射系統"COVIDIEN"AUTO SUTURE CHEMOSITE

IMPLANTABLE DRUG DELIVERY SYSTEM(PORT+CATH+NEEDLE)※適應

症請見備註欄

7539

CLPA1200242C "柯惠"植入型注射系統"COVIDIEN"AUTO SUTURE CHEMOSITE

IMPLANTABLE DRUG DELIVERY SYSTEM(P+C+N)※適應症請見備註欄

7539

CLPA1200262C "柯惠"植入型注射系統"COVIDIEN"AUTO SUTURE CHEMOSITE

IMPLANTABLE DRUG DELIVERY SYSTEM(PORT+CATH+NEEDLE)※適應

症請見備註欄

7539

CLPA1200272C "柯惠"植入型注射系統"COVIDIEN"AUTO SUTURE CHEMOSITE

IMPLANTABLE DRUG DELIVERY SYSTEM(PORT+CATH+NEEDLE)※適應

症請見備註欄

7539

CLPA1200442C "柯惠"植入型注射系統"COVIDIEN"AUTO SUTURE CHEMOSITE

IMPLANTABLE DRUG DELIVERY SYSTEM(PORT+CATH+NEEDLE)※適應

症請見備註欄

7539

CLPA1200452C "柯惠"植入型注射系統"COVIDIEN"AUTO SUTURE CHEMOSITE

IMPLANTABLE DRUG DELIVERY SYSTEM(P+C+N+I)※適應症請見備註

7712

CLPA1200852C "柯惠"植入型注射系統"COVIDIEN"AUTO SUTURE CHEMOSITE

IMPLANTABLE DRUG DELIVERY SYSTEM(PORT+CATH+NEEDLE)※適應

症請見備註欄

7539

CLPA12023A2C "柯惠"輕薄型植入式釋藥系統"COVIDIEN"CHEMOSITE IMPLANTABLE

DRUG DELIVERY SYSTEM/AUTO SUTURE

CHEMOSITE(PORT+CATH+NEEDLE)※給附規定請見備註欄

7539

CLPA130000BB SINGLE TITANIUM MBS CELSITE PORT(PORT+CATH+NEEDLE)※適應

症請見備註欄

7539

CLPA13007NYP "PEROUSE"POLYSITE IMPLANTABLE PORT(P+C+N+I)全套式植入式血

管輸注器

7712

CLPA130085BB SINGLE TITANIUM EPOXY CELSITE PORT(PORT+CATH+NEEDLE)※適

應症請見備註欄

7539

CLPA13008NYP "PEROUSE"POLYSITE IMPLANTABLE PORT(PORT+CATH)植入式血管輸

注器*適應症請見備註欄

7470

CLPA130395BB CELSITE IMPLANTABLE PORT ,STANDARD (P+C+N+I)*適應症請見備

註欄

7712

CLPA130893BB CELSITE IMPLANTABLE PORT ,SMALL (P+C+N+I)*適應症請見備註

欄(型號04436962文號:920036552)(型號04436806自940701起刪

除)

7712

CLPA132045BB SINGLE TITANIUM MBS CELSITE

PORT(PORT+CATH+NEEDLE+INTRODUCER)※適應症請見備註欄

7712

CLPA14025NHJ TITANIUM PORT-A-CATH (P+C+N+I) ※適應症請見備註欄 7712

CLPA14072NHJ "SMITHS"IMPLANTABLE ACCESS SYSTEM內植用輸液管

(P+C+N+I+GRIPPER NEEDLE)*適應症請見備註欄

7712

CLPA14130NBA SINGLE LUMEN PER-Q-CATHETER WITH GUIDWIRE 2.0:5.0FR※適應

症請見備註欄

2798

CLPA145213NL "NAVILYST"VAXCEL IMPLANTABLE PORTS/W PASV TECHNOLOGY (1

LUMEN)(P+C+N+I)斐克希植入式輸液座*適應症請見備註欄

7712

CLPA145455NL VAXCEL PERIPHERALLY INSERTED CENTRAL CATHETER(PICC)(1

LUMEN)/W PASV VALVE TECHNOLOGY週邊導入中央靜脈導管*適應症

見備註

2798

799

特材代碼 中英文名稱 支付點數-104/01/01

CLPA145458NL "NAVILYST"VAXCEL PERIPHERALLY INSERTED CENTRAL

CATHE(PICC)W PASV VALVE TECHNOLOGY(1 LUMEN)(C+N+D+G)週邊

導入中央靜脈導管*適應症見備註

2884

CLPA145470NL VAXCEL PERIPHERALLY INSERTED CENTRAL CATHETER(PICC)(2

LUMEN)/W PASV VALVE TECHNOLOGY週邊導入中央靜脈導管*適應症

見備註

2858

CLPA145478NL "NAVILYST"VAXCEL PERIPHERALLY INSERTED CENTRAL

CATHE(PICC)W PASV VALVE TECHNOLOGY(2 LUMEN)(C+N+D+G)週邊

導入中央靜脈導管*適應症見備註

3335

CLPA1501112A "迪特適"內植輸液導管座及其附件"DISTRICATH" IMPLANTABLE

CATHETER PORTS AND ACCESSORIES

7712

CLPA1501122A "迪特適"內植輸液導管座及其附件"DISTRICATH" IMPLANTABLE

CATHETER PORTS AND ACCESSORIES

7712

CLPA1501132A "迪特適"內植輸液導管座及其附件"DISTRICATH" IMPLANTABLE

CATHETER PORTS AND ACCESSORIES

7712

CLPA1501142A "迪特適"內植輸液導管座及其附件"DISTRICATH" IMPLANTABLE

CATHETER PORTS AND ACCESSORIES

7712

CLPA1501152A "迪特適"內植輸液導管座及其附件"DISTRICATH" IMPLANTABLE

CATHETER PORTS AND ACCESSORIES

7712

CLPA1501162A "迪特適"內植輸液導管座及其附件"DISTRICATH" IMPLANTABLE

CATHETER PORTS AND ACCESSORIES

7712

CLPA150120FM "FORTUNE"IMPLANTABLE VASCULAR ACCESS

PORT(PORT+CATH+NEEDLE+INTRODUCER)"富強"植入型血管輸液系統

*適應症請見備註欄

7712

CLPA15105KHZ "HORIZEN"VORTEX VTX TITANIUM VASCULAR ACCESS

PORTS(P+C+N+I)*給付規定請見備註欄

8196

CLPA160260DV SINGLE PLASTIC HICKMAN PORT(PORT+CATH+NEEDLE) ※適應症請

見備註欄

7539

CLPA160284BA SINGLE MRI PLASTIC PORT W/GROSHONG 3-WAY(P+C+N) (型號

0604510自91/07/01生效)※適應症請見備註欄

7539

CLPA161635PF ARTERIAL PORT CATH組(PORT+CATH+NEEDLE+INTRODUCER)※給付規

定請見備註欄

10370

CLPA161636PF SINGLE LUMEN PFM VASCULAR ACCESS SYSTEM JET

(C+G+N+I+GRIPPER NEEDLE)*適應症請見備註欄

7712

CLPA165750BA X-PORT ISP IMPLANTED PORT WITH MICROINTRODUCER

KIT(P+C+N+I)*適應正請見備註欄

7712

CLPA166041M0 "MEDCOMP"LOW PROFILE SHAPED CT PORTS AND

ACCESSORIES(P+C+N+I)薄型植入式輸液座與導管組*適應症請見備

註欄

7712

CLPA166801M0 "MEDCOMP"MID-SIZE SHAPED CT PORTS AND

ACCESSORIES(P+C+N+I) 中型植入式輸液座與導管組*適應症請見

備註欄

7712

CLPA170754BA X-PORT ISP IMPLANTED PORT WITH INTERMEDIATE KIT(P+C+N+I)*

適應正請見備註欄

7712

CLPA17505NBA "BARD"GROSHONG PERIPHERALLY INSERTED CENTRAL VENOUS DUAL-

LUMEN W/INTRODUCER KIT*適應症請見備註欄

3335

CLPA176174BA "BARD"GROSHONG NXT CLEAR VUE 4FR.SINGLE LUMEN(PICC)葛羅祥

刻立回中央靜脈導管*適應症請見備註欄

2798

CLPA17715NBA SINGLE LUMEN GROSHONG PERIPHERALLY INSERT CENTRAL VENOUS

CATH 3,4FR※適應症請見備註欄

2798

CLPA196001M0 "MEDCOMP"PRO-FUSE AND ACCESSORIES(P+C+N+I)普羅福斯植入式

輸液座與導管組*適應症請見備註欄

7712

800

特材代碼 中英文名稱 支付點數-104/01/01

CLPA1ABRM1CK "COOK"SPECTRUM TURBO-JECT PICC SETS 4-5FR

60CM(CATH+INTRODUCER) "曲克"史派純特波傑特周邊血管導入套

組(單腔)

3900

CLPA1ABRM2CK "COOK"SPECTRUM TURBO-JECT PICC SETS 4-5FR 50CM

(CATH+INTRODUCER)"曲克"史派純特波傑特周邊血管導入套組(雙

腔)

4100

CLPA1P0R45SB "BOSTON SCIENTIFIC"VAXCEL IMPLANTABLE PORTS WITH PASV

TECHNOLOGY (SINGLE LUMEN)(P+C+NX2+I)斐克希植入式輸液座*適

應症請見備註欄

7712

CLPA1P1CC1CK TURBO-FLO PERIPHERALLY INSERTED CENTRAL VENOUS

CATHETER(PICC) SET-ONE LUMEN (C+D+G+N)*適應請見備註欄

2884

CLPA1P1CC2CK TURBO-FLO PERIPHERALLY INSERTED CENTRAL VENOUS

CATHETER(PICC) SET-ONE LUMEN (C+D+G+N)*適應請見備註欄

2884

CLPA1P1CC3CK TURBO-FLO PERIPHERALLY INSERTED CENTRAL VENOUS

CATHETER(PICC) SET-TWOLUMEN (C+D+G+N)*適應請見備註欄

3335

CLPA1P1CC4CK TURBO-FLO PERIPHERALLY INSERTED CENTRAL VENOUS

CATHETER(PICC) SET-TWOLUMEN (C+D+G+N)*適應請見備註欄

3335

CLPA1P1CC5CK TURBO-FLO OVER THE WIRE PERIPHERALLY INSERTED CENTRAL

VENOUS CATHETER(PICC)SET(SINGLE LUMEN C+I+G)*適應症請見備

註欄

2884

CLPA1P1CC6CK TURBO-FLO OVER THE WIRE PERIPHERALLY INSERTED CENTRAL

VENOUS CATHETER(PICC)SET(DOUBLE LUMEN C+I+G)*適應症請見備

註欄

3335

CLPA1P1CC7CK "COOK"TURBO-JECT PICC SET(CATH+INTRODUCER)週邊導入中央靜

脈導管組(單腔)*適應症請見備註欄

2884

CLPA1P1CC8CK "COOK"TURBO-JECT PICC SET(CATH+INTRODUCER)週邊導入中央靜

脈導管組(雙腔)*適應症請見備註欄

3335

CLPA1V1TA1CK "COOK"VITAL-PORT VASCULAR ACCESS SYSTEM注射口組(P+C+N+I)

適應症請見備註欄

7712

CLPA1VRXTRRH “瑞塔”植入型注射系統 “RITA” VORTEX TR PORT SYSTEM 8196

CLS040114NPW INFUSION SET W/BURETTE W/VALVE 100CC 41

CLS0404965HR "赫士睿"微量輸液套"Hospira"SOLUSET 100X60 PRECISION

VOLUME IV SET W/100ML BURETTE AND MICRODRIP DRIP CHAMBER

※適應症請見備註欄

94.5

CLS040520VBB DOSIFIX VOLUME CONTROL ADMMINISTRATION SET 120ML WITH

VALVE

41

CLS040708NPW PERFECT DISPOSABLE INFUSION SET(W/BURETTE W/VALVE) 41

CLS041VC02TZ "善德"定量型輸液套"SUNDER" VOLUME CONTROL I.V.

ADMINISTRATION SET

41

CLS041VPB3JS JMS INFUSION SET WITH BURET 100CC 41

CLS046369NPW INFUSION SET W/BURETTE W/VALVE 150CC,200CC 41

CLS04BR150SG VOLUME METERIC ADMINISTRATION SET W/FILTER 41

CLS04BS120SG VOLUME METERIC ADMISTRATION SET W/VALVE W/FILTER 41

CLS04BS150SG VOLUME METERIC ADMINISTRATION SET W/VALUE W/FILTER 41

CLS04BT100SG VOLUMEMETRIC ADMINSTRATION SET 41

CLS04BT120SG VOLUME METERIC ADMISTRATION SET W/FILTER 41

CLS04BT163BQ Infusion set 100ml with valve &filter 41

CLS04BT164BQ Infusion set 150ml with valve &filter 41

CLS04BV100SG VOLUMEMMETRIC ADMINSTRATION SET 100ML WITH VALVE 41

CLS04BV150SG VOLUMEMMETRIC ADMINSTRATION SET 150ML WITH VALVE 41

CLS04C1BESLL "怡安"精密輸液套"LILY"VOLUME METRIC ADMINISTRATION SET 41

CLS04CSBACLL "LILY"VOLUME METERIC ADMINISTRATION SET W/VALVE精密輸液套 41

CLS04CSBESLL "LILY"VOLUME METERIC ADMINISTRATION SET(W/VALVE)* 41

801

特材代碼 中英文名稱 支付點數-104/01/01

CLS04CSBVFLL VOLUME METERIC ADMINISTRATION SET 100ML 120ML 150ML附過濾

41

CLS04CSBVSLL VOLUME METERIC ADMINISTRATION SET 100ML 120ML 150ML

W/VALVE附止水閥、附過濾網

41

CLS04IVPBFJS INFUSION SET PEDIATRIC 100ML BURET W/FLOAT VALVE 41

CLS04M270LTM TERUFUSION VOLUMETRIC SOLUTION ADMINISTRAION SET WITH

VALVE

41

CLS04SBAFHLL VOLUME METERIC ADMINISTRATION SET 150CC W/VALVE 41

CLS0501648HR PLUMSET I.V PUMP SET*適應症請見備註欄 152

CLS0501756HR PRIMARY IV PUMP SET*適應症請見備註欄 152

CLS0502210ZL "CARDINAL" ADMINSTRATION SET※適應症請見備註欄 152

CLS0502230ZL "CARDINAL" ADMINSTRATION SET(0.2MICRO FILTER) 261

CLS0502260ZL "CARDINAL" ADMINISTRATION SET 230

CLS0502280ZL "CARDINAL" ADMINSTRATION SET※適應症請見備註欄 152

CLS05036SPBB "B.BRAUN"INFUSOMAT SPACE LINE柏朗史倍司輸液套*適應症請見

備註欄

152

CLS050800BTM "TERUMO"TERUFUSION SOLUTION ADMINISTRATION SET FOR

INFUSION PUMP(IV PUMP SET)"泰爾茂"輸液套*給付規定請見備註

75

CLS05095SPBB 柏朗史倍司輸液套 INFUSOMAT SPACE LINE INFUSION PUMP

ADMINISSTRATION SETS

261

CLS0511943HR “Hospira” Lifeshield Plum Pump Sets “赫士睿”浦朗幫浦

輸液套(附無針式接頭1個)

195

CLS0511948HR "HOSPIRA"LIFESHIELD PLUM PUMP SETS W/BURETTE"赫士睿"浦朗

幫浦輸液套(BURETTE幫浦輸液套附無針式接頭3個)※給付規定請

見備註欄

326

CLS0512030HR “Hospira” Lifeshield Plum Pump Sets “赫士睿”浦朗幫浦

輸液套(附無針式接頭2個)

238

CLS05130PUSG "SIGMA"INFUSION PUMP SET 幫浦輸液套*適應症請見備註欄 152

CLS052027HM8 "MEDITOP"INFUSION SET FOR INFUSION PUMP輸液套(輸液幫浦用) 75

CLS0541950KG "KABI"VOLUMAT LINE INFUSION SETS- STANDARD PUMP SET FOR

INFUSION "卡比"路美輸液組合套-一般幫浦輸液套*給付規定請見

備註欄

152

CLS0543150KG "KABI"VOLUMAT LINE INFUSION SETS- PUMP DUAL SET FOR

TRANSFUSION AND INFUSION "卡比"路美輸液組合套-幫浦用Y型輸

血套

230

CLS0543650KG "KABI"VOLUMAT LINE INFUSION SETS- PVC-FREE SET FOR

INFUSION OF NTG AND DRUGS INCOMPATIBLE WITH PVC "卡比"路

美輸液組合套-NTG幫浦輸液套

230

CLS0544950KG "KABI"VOLUMAT LINE INFUSION SETS- PVC-FREE PUMP SET FOR

INFUSION OF LIGHT SENSITIVE DRUGS "卡比"路美輸液組合套-幫

浦用避光輸液套

188

CLS0545250KG "KABI"VOLUMAT LINE INFUSION SETS- INFUSION PUMP SET WITH

150ML GRADUATED BURETTE "卡比"路美輸液組合套-幫浦用精密

輸液套*給付規定請見備註欄

197

CLS0560103J6 "卡爾費森"輸液套(含量筒附無針式接頭二個)“CAREFUSION”

ALARIS GP INFUSION SETS(WITH BURETTE, 2*NEEDLE-FREE VALVE

PORT)

283

CLS0563200J6 "卡爾費森"輸液套"CAREFUSION"ALARIS GP INFUSION SETS 152

CLS0563401J6 "卡爾費森"輸液套(含無針式接頭一個)“CAREFUSION” ALARIS

GP INFUSION SETS(WITH 1*NEEDLE-FREE VALVE PORT)

195

CLS0563420J6 "卡爾費森"輸液套(含無針式接頭二個)“CAREFUSION” ALARIS

GP INFUSION SETS(WITH 2*NEEDLE-FREE VALVE PORT)

238

802

特材代碼 中英文名稱 支付點數-104/01/01

CLS05A200LTM TERUFUSION IV PUMP SET WITHOUT BAG※適應症請見備註欄 75

CLS05T037HTP INFUSION PUMP SET※適應症請見備註欄 75

CLS0602241ZL "CARDINAL" ADMINSTRATION SET※適應症請見備註欄 197

CLS0602427HR PUMP SET(NITROGLYCERIN) 230

CLS06080PUSG "SIGMA"INFUSION PUMP SET WITH BURETTE幫浦輸液套*適應症請

見備註欄

197

CLS060L218HR NTG PUMP SET WITH LIGHT PROTECTIVE POLYETHYLENE TUBINGING 188

CLS0611706HR BURETTE PUMP SET*適應症請見備註欄 197

CLS0611879HR "赫士睿"浦朗幫浦靜脈輸液套"Hospira"PLUMSET IV PUMP SET

W/FILTER

261

CLS06120PUSG "SIGMA"INFUSION PUMP SET LIGHT-RESISTANT 幫浦輸液套(不透

光型)

188

CLS0612339HR “Hospira” Lifeshield Plum Pump Sets W/Light-resistance

“赫士睿”浦朗幫浦輸液套(避光幫浦輸套附無針式接頭1個)

231

CLS06125SPBB INFUSOMAT SPACE LINE UV-PROTECT史倍司輸液套(不透光型) 188

CLS06294SPBB "B.BRAUN"INFUSOMAT SPACE LINE WITH BURETTE+NEEDLE-FREE

ACCESS PORT 柏朗史倍司輸液套(含儲藥筒)*適應症請見備註欄

197

CLS06731SPBB INFUSOMAT SPACE LINE PVC-FREE SET FOR THE ADMINISTRATION

OF CYTOTOXIC AGENTS史倍司輸液套

188

CLS06C7553BT (NON-)VENTED PACLITAXEL SET W/0.22MICRON FILTER 261

CLS06C9644BT LIGHT SENSITIVE CLEARLINK SET無針系統含過濾器避光輸液套※

適應症請見備註欄

265

CLS06C9651BT BURETROL PUMP SET W/BURETTE※適應症請見備註欄 197

CLS06M270LTM TERUFUSION IV PUMP SET WITH BAG 100CC※適應症請見備註欄 122.6

CLS06V9607BT "BAXTER"LIGHT SENSITIVE DRUGS SET避光靜脈輸液管組 188

CLS070800BTM "TERUMO"TERUFUSION PLATELET ADMINISTRATION SET"泰爾茂"血

小板輸液套

17

CLS071724NPW TRANSFUSION SET 17

CLS07A130NPW PERFECT DISPOSABLE TRANSFUSION (L TYPE ) 17

CLS07BT110SG 十美牌輸血套-單腔型DEHP SIGMA BLOOD TRANSFUSION SET–

SINGLE TYPE DEHP

17

CLS07BT120SG 十美牌輸血套-單腔型DEHP FREE SIGMA BLOOD TRANSFUSION SET

–SINGLE TYPE DEHP FREE

17

CLS07BT350JS BLOOD TRANSFUSION SET 17

CLS08066SPBB INFUSOMAT SPACE LINE TRANSFUSION WITH 200UM BLOOD FILTER

史倍司輸血套

230

CLS0808949HR Y-TYPE BLOOD SET WITH PUMP 230

CLS0811664HR "赫士睿"Y型輸血用幫浦套"Hospira"Y-TYPE BLOOD PLUMSET 230

CLS0812259HR “Hospira” Lifeshield Plum Pump Sets W/Y Pump Set “赫士

睿”浦朗幫浦輸液套(附無針式接頭2個)

316

CLS08140PUSG "SIGMA"INFUSION PUMP SET BLOOD FILTER 幫浦輸血輸液套 230

CLS08150PUSG "SIGMA"INFUSION PUMP SET Y-SITE BLOOD FILTER Y 型幫浦輸血

輸液套

230

CLS0900BTYJS Y TYPE BLOOD TRANSFUSION SET 22

CLS0902004TM Y TYPE ADMINISTRATION SET 22

CLS0902005TM Y TYPE ADMINISTRATION SET 22

CLS09A140NPW PERFECT DISPOSABLE TRANSFUSION (Y TYPE ) 22

CLS09B140NPW Y TYPE BLOOD TRANSFUSION SET 22

CLS09BT210SG 十美牌輸血套-雙腔Y型DEHP SIGMA BLOOD TRANSFUSION SET–

DOUBLE Y TYPE DEHP

22

CLS09BT220SG 十美牌輸血套-雙腔Y型DEHP SIGMA BLOOD TRANSFUSION SET–

DOUBLE Y TYPE DEHP FREE

22

803

特材代碼 中英文名稱 支付點數-104/01/01

CLS1202427HR PUMP SET(NITROGLYCERIN) 230

CLS1400737BX "BAXA"EXACTA-MIX EVA CONTAINER 250ML"柏瑟"靜脈營養術灌注

101

CLS1400738BX "BAXA"EXACTA-MIX EVA CONTAINER 500ML"柏瑟"靜脈營養術灌注

101

CLS1400739BX "BAXA"EXACTA-MIX EVA CONTAINER 1000ML"柏瑟"靜脈營養術灌注

127

CLS14B8084CT VIAFLEX TPN BAG 1000C.C. 125

CLS14B8112CT ALL-IN-ONE BAG 1000CC 127

CLS14B8152CT ALL-IN-ONE BAG 500 CC 101

CME01MABDLBL MAGIC CATHETER WITH BALLOON EMBOLIZATION

SET(BALLOON+MICRO CATH+MANDRIA)※適應症請見備註欄

36019

CME01MABDXBL MAGIC CATHETER WITH BALLOON EMBOLIZATION

SET(BALLOON+MICRO CATH+MANDRIA)※適應症請見備註欄

36019

CME02BC04XMS “麥新”史凱特閉塞球囊導管組(含“麥新”翠克絲微導線)

“MICROVENTION”SCEPTER OCCLUSION BALLOON CATHETER

(INCLUDE “MICROVENTION” TRAXCESS GUIDEWI

33164

CME02BCXXXMS “麥新”史凱特閉塞球囊導管“MICROVENTION”SCEPTER

OCCLUSION BALLOON CATHETER*給付規定請見備註欄

29261

CME02GL1DEV9 "MTI"OCCLUSION BALLOON SYSTEM(HYPERGLIDE)(含GUIDE WIRE及

卡式注射器)"恩提愛"閉塞球囊系統*適應症請見備註欄

33164

CME02HYPERV9 "MTI"OCCLUSION BALLOON SYSTEM(HYPERFORM)(含GUIDE WIRE及卡

式注射器)"恩提愛"閉塞球囊系統

35267

CMV0107056UF "PENUMBRA"NEURON INTRACRANIAL ACCESS SYSTEM"彼娜波"紐諾顱

內導入系統(NEURON傳送導管)

12000

CMV0118298SB RENEGADE HI-FLO MICROCATHETER KIT(MICROCATH+G

WIRE+HEMASTATIC)*適應症請見備註欄

13810

CMV0149152SB SPINNAKER ELITE FLOW DIRECTED INFUSION CATHETER

SET(INFUSION CATH+MICRO GUIDEWIRE+HEMASTATIC )*適應症請見

備註欄

13810

CMV0149152TA SPINNAKER INFUSION CATHTER(CATH+GUIDEWIRE+HEMASTATIC)※適

應症請見備註欄

13810

CMV0149181SB EXCELSIOR MICROCATHETER LENGTH 150/6 TIP CONFIGURATION

1,2 MARKER *適應症請見備註欄

7440

CMV0149189SB EXCELSIOR PRE-SHAPED MICROCATHETER*適應症請見備註欄 7440

CMV0150103SB FAS TRACKER INFUSON CATHETER KIT(CATH+GUIDE

WIRE+HEMASTATIC)*適應症請見備註欄

13810

CMV016060NCM "CODMAN"PROWLER INFUSION CATHETER"科特曼"保勒注射導管※適

應症請見備註欄

7440

CMV016061NCM "CODMAN"PROWLER INFUSION CATHETER"科特曼"保勒注射導管※適

應症請見備註欄

7440

CMV01606S1CM "CODMAN"PROWLER LP&LP-ES INFUSION CATHETER"科特曼"保勒注

射導管※適應症請見備註欄

7440

CMV01606S2CM "CODMAN"PROWLER PLUS INFUSION CATHETER"科特曼"保勒注射導

管※適應症請見備註欄

7440

CMV01606XNCM "CODMAN"PROWLER INFUSION CATHETER"科特曼"保勒注射導管※適

應症請見備註欄

7440

CMV016251NCM "CODMAN"PROWLER INFUSION CATHETER"科特曼"保勒注射導管※適

應症請見備註欄

7440

CMV018F088UF "彼娜波"紐諾邁克斯系統-8F傳送導管(NEURON傳送導

管)"PENUMBRA"NEURON MAX SYSTEM-8F DELIVERY CATHETER

12000

CMV01E2710TM PROGREAT CATHETER(MICRO CATH+INTRODUCER

WIRE+COATING+HEMASTATIC)※適應症請見備註欄

13810

804

特材代碼 中英文名稱 支付點數-104/01/01

CMV01ECHL0V9 "MTI"ECHELON MICRO CATHETERS "恩提愛"微導管(CATH+MICRO

GUIDE WIRE+HEMASTATIC)*適應症請見備註欄

13810

CMV01FS135MR "MERIT"FOUNTAIN INFUSION SYSTEM(CATH+GUIDE

WIRE+HEMASTATIC)芳登灌輸系統*適應症請見備註欄

13810

CMV01HEADWMS "MICROVENTION"HEADWAY MICROCATHETER(導管+止血閥+導引器)"

麥新"前進微導管*給付規定請見備註欄

13810

CMV01MC1S2CK "COOK"MULTI-SIDEPORT CATHETER INFUSION SET多側孔注射導管

組*適應症請見備註欄

7440

CMV01MF251CK "COOK"MIRA-FLEX 18 MICROCATHETER*適應症請見備註欄 7440

CMV01MF252CK "COOK"CANTATA 2.5 AND CANTATA 2.8 MICROCATHETER"曲克"坎塔

塔微導管*適應症請見備註欄

7440

CMV01MFNT1CK "COOK"MIRAFLEX MICROCATHETER麥拉菲微導管*適應症請見備註欄 7440

CMV01MFNT2CK "COOK"MIRAFLEX MICROCATHETER 2.5FR 100:150CM麥拉菲微導管*

適應症請見備註欄

7440

CMV01MFS01CK MICROFERRET-21 HIGH FLOW INFUSION CATH

SET(C+G+CONNE.+TOR.DEVICE)※適應症請見備註欄

13810

CMV01MFS11CK COOK MICROFERRET-18 INFUSION CATHETER SET(CATH+GUIDE

WIRE+HEMASTATIC)*適應症請見備註欄

13810

CMV01MFS15CK COOK MICROFERRET-18 INFUSION CATHETER SET(CATH+GUIDE

WIRE+HEMASTATIC)*適應症請見備註欄

13810

CMV01P2710TM PROGREAT CATHETER(MICRO CATH+INTERODUCER

WIRE+COATING+HEMASTATIC)※適應症請見備註欄

13810

CMV01PC241TM PROGREAT CATHETER(MICRO CATH+INTRODUCER

WIRE+COATING+HEMASTATIC)※適應症請見備註欄

13810

CMV01PX400UF "PENUMBRA"MICROCATHETER(導管+止血閥+導引器)"彼娜波"*微導

管*給付規定請見備註欄

13810

CMV01REBARV9 MTI REBAR MICRO CATHETER SET(MICRO CATH+GUIDE

WIRE+HEMASTATIC)恩提愛瑞霸微導管*適應症請見備註欄

13810

CMV01RENFASB "BOSTON SCIENTIFIC"RENEGADE HI-FLO FATHOM KIT (CATH+GUIDE

WIRE+HEMASTATIC)AND SYSTEM "波士頓科技"瑞能蓋高流動探測組

*適應症請見備註欄

13810

CMV01SCR3NCK "COOK"MULTI-SIDEPORT CATHETER INFUSION SET 多側孔注射導管

組*適應症請見備註欄

7440

CMV01SCWHVMR "MERIT"FOUNTAIN INFUSION SYSTEM(CATH+GUIDE

WIRE+HEMASTATIC)芳登灌輸系統*適應症請見備註欄

13810

CMV01SMAGXBL BALT MAGIC CATHETER SET ※適應症請見備註欄 18227

CMV01SQ135MR "MERIT"FOUNTAIN INFUSION SYSTEM(CATH+GUIDE

WIRE+HEMASTATIC)芳登灌輸系統*適應症請見備註欄

13810

CMV020402XGT "GOODTEC"BALLOON CATHETER-ARTERIAL EMBOLECTOMY CATHETER"

固特克"球型導管

995

CMV0205102SB FAS TRACKER INFUSON CATHETER*適應症請見備註欄 7440

CMV020F20LQM "MAQUET"AXIUS CORONARY SHUNT"邁柯唯"艾齊克氏冠狀動脈分流

管*適應症請見備註欄

2696

CMV0210042SB "BOSTON SCIENTIFIC"GUIDER SOFTIP XF GUIDING CATHETER*適應

症請見備註欄

6535

CMV0210062SB "BOSTON SCIENTIFIC"GUIDER SOFTIP XF GUIDING CATHETER*適應

症請見備註欄

6535

CMV02120FFED EDWARDS FOGARTY ARTERIAL EMBOLECTOMY CATHETER 995

CMV02120XNED FORGATY ARTERIAL EMBOLECTOMY CATHETER 2:7FR 40:80MM 995

CMV021240NBT FORGATY EMBOLECTOMY CATHETER 995

CMV021280NBT FORGATY EMBOLECTOMY CATHETER 995

CMV0212TLWED FOGARTY THRU-LUMEN EMBOLECTOMY CATHETER(2 LUMEN CATH) 1895

CMV0214270SB TRACKER EXCEL-14 MICROCATHETER*適應症請見備註欄 7440

805

特材代碼 中英文名稱 支付點數-104/01/01

CMV0214270TA TARGET THERAPEUTICS TRACKER EXCEL-14 MICROCATHETER*適應症

請見備註欄

7440

CMV02142NNTA TARGET THERAPEUTICS TRACKER EXCEL-14 MICROCATHETER*適應症

請見備註欄

7440

CMV021601SLW "LEMAITRE"EMBOLECTOMY CATHETERS單腔式動脈血栓清除導管 995

CMV0216510LW "LEMAITRE"EMBOLECTOMY CATHETERS導引線式動脈血栓清除導管

(雙腔)

1895

CMV0218251SB RENEGADE MICROCATHETER*適應症請見備註欄 7440

CMV0218251TA RENAGADE FIBER BRAIDED MICRO CATH PROXIMAL/DISTAL 3F/2.5F

130,150CM※適應症請見備註欄

7440

CMV0218282SB RENEGADE HI-FLO MICROCATHETER OD=3.0F/2.8F ID=0.027/0.027

L80/150CM *適應症請見備註欄

7440

CMV0218284SB RENEGADE HI-FLO MICROCATHETER O.D 3.0,2.8F I.D 0.027 L

80,150CM *適應症請見備註欄

7440

CMV021CXXXMS "MICROVENTION"CHAPERON GUIDING CATHETER SYSTEM"麥新"護航

導引導管系統*給付規定請見備註欄

6535

CMV021VS12ED ANASTA FLO INTRAVASCULAR SHUNT*適應症請見備註欄 2696

CMV0231100M4 CLEARVIEW INTRACORONARY SHUNT*適應症請見備註欄 2696

CMV0232080ED FORGATY VENOUS THROMBECTOMY CATHETER 995

CMV02403VBCD "CORDIS"VISTA BRITE TIP INTRODUCER GUIDING "考迪斯"導引導

管*適應症請見備註欄

6535

CMV02600XNCM "CODMAN"TRANSIT INFUSION CATHETER"科特曼"微細血管注射導管

*適應症請見備註欄

7440

CMV02A4400A4 SYNTEL ARTERIAL EMBOLECTOMY CATHETER 3:7FR/40,50,80CM 995

CMV02A4E09A4 PYTHON DUAL LUMEN EMBOLECTOMY CATHETER(CATH+GUIDE

WIRE+INTRODUCER)

2556

CMV02A4F00A4 SYNTEL ARTERIAL EMBOLECTOMY CATHETER 2:7FR 40,60,80CM 995

CMV02C1254B2 FLORESTER CORONARY ARTERY OCCLUDER 冠狀動脈血管阻塞棒 2591

CMV02C5015S7 "SYNOVIS"FLO-RESTER VESSEL OCCLUDERS血管閉塞器 2591

CMV02EL134BS ARTERIAL EMBOLECTOMY CATHETER"拜爾生"血栓清除導管 995

CMV02EL326BS EMBOLECTOMY CATHETER 995

CMV02FT012B2 FLO-THRU INTRALUMINAL SHUNT 血管通路器 *適應症請見備註欄 2696

CMV02FT012S7 FLO-THRU INTRALUMINAL SHUNT 血管通路器*適應症請見備註欄 2696

CMV02GCXXXMS "MICROVENTION"CHAPERON GUIDING CATHETER SYSTEM"麥新"護航

導引導管系統*給付規定請見備註欄

6535

CMV02GNDRAVS "VASCULAR SOLUTIONS"GANDRAS INTRAVASCULAR

CATHETER(INFUSION)"法斯樂舒順"恩德拉血管內導管*適應症請見

備註欄

7440

CMV02GSFK1TM "TERUMO"DESTINATION GUIDING SHEATH"泰爾茂"諦思迪迅導引套*

給付規定請見備註欄

6535

CMV02KCFW1CK "COOK"FLEXOR GUIDING CATHETERS 福雷色引導導管*適應症請見

備註欄

6535

CMV02KCFW2CK "COOK"FLEXOR GUIDING CATHETERS "曲克"服來瑟引導導管

4.0~12.0FR,30~110CM

6535

CMV02KCFW3CK "COOK"FLEXOR GUIDING CATHETERS "曲克"服來瑟引導導管

5.0~10.0FR,55~90CM

6535

CMV02KCFW4CK "COOK"FLEXOR GUIDING CATHETERS "曲克"福雷色引導導管

4.0~12.0FR,40~110CM

6535

CMV02KSAW1CK "COOK "FLEXOR GUIDING CATHETERS "曲克"服來瑟引導導管*適應

症請見備註欄

6535

CMV02KSAW2CK COOK FLEXOR GUIDING CATHETERS 0.038" 70:90CM*適應症請見備

註欄

6535

806

特材代碼 中英文名稱 支付點數-104/01/01

CMV02KSAW3CK "COOK"FLEXOR GUIDING CATHETERS 5.0FR:8.0FR

0.018/0.038:0.038 40CM:90CM

6535

CMV02KSAW4CK "COOK"FLEXOR GUIDING CATHETERS弗萊色引導導管*適應症請見備

註欄

6535

CMV02KSAW5CK "COOK"FLEXOR GUIDING CATHETERS弗萊色引導導管*適應症請見備

註欄

6535

CMV02KSAW6CK "COOK"FLEXOR GUIDING CATHETERS5-8FR 55:110MM服來瑟引導導

管*適應症請見備註欄

6535

CMV02LMGN1CK "COOK"NORTHSTAR LUMAX FLEX GUIDING CATHETERS諾斯達盧馬福

雷司導引導管*適應症請見備註欄

6535

CMV02LMGN2CK "COOK"WHITE LUMAX GUIDING CATHETERS懷特盧馬導引導管*適應

症請見備註欄

6535

CMV02MC172MS "MICROVENTION"HEADWAY MICROCATHETER前進微導管*給付規定請

見備註欄

7440

CMV02MF001CK MICROFERRET-18 INFUSION CATHETER SET 3FR *適應症請見備註

7440

CMV02PNS13UF "PENUMBRA"NEURON INTRACRANIAL ACCESS SYSTEM-SELECT

CATHETER顱內導入系統導管*適應症請見備註欄

7440

CMV02V3064B2 FLORESTER VASCULAR OCCLUDER 週邊動脈血管阻塞棒 2591

CMV0346802SB TRANSEND GUIDE WIRE *適應症請見備註欄 4650

CMV0361414CM "CODMAN"AGILITY STEERABLE GUIDEWIRE"科特曼"愛捷第導引線※

適應症請見備註欄

4650

CMV03614XNCM "CODMAN"AGILITY STEERABLE GUIDEWIRE"科特曼"愛捷第導引線※

適應症請見備註欄

4650

CMV03FA509SB "BOSTON SCIENTIFIC"FATHOM-16 STEERABLE GUIDEWIRE菲森可控

式導線*適應症請見備註欄

4650

CMV03FWR45MR "MERIT"FOUNTAIN INFUSION SYSTEM(GUIDE WIRE+TORQUE)芳登灌

輸系統*適應症請見備註欄

4650

CMV03GW14XMS "MICROVENTION"TRAXCESS GUIDE WIRE"麥新"翠克絲微導線*適應

症請見備註欄

4650

CMV03MT1GWV9 "MTI"GUIDEWIRE導引線(親水性導入線+扭轉器+導入線導入鞘)*適

應症請見備註欄

4650

CMV03S0RXXBL "BALT"SORCERER GUIDEWIRE魔術師導線*適應症請見備註欄 4650

CMV03STM48AS ASAHI MICRO GUIDEWIRE 0.014" 0.018"*適應症請見備註欄 4650

CMV03STMGWAS "ASAHI"STREAMING MICRO GUIDEWIRE 0.014" 0.018"朝日"微導引

線*給付規定請見備註欄

4650

CMV03TPMG1CK MICRO GUIDE WIRE 0.14INCH *適應症請見備註欄 4650

CMV03TPMG2CK "COOK"MICRO WIRE GUIDE 導線*適應症請見備註欄 4650

CMV03XCEGWV9 "MTI"X-CELERATOR GUIDEWIRE 0.010",0.014"300CM "恩提愛"愛

克西亞導引線(親水性導引線+扭轉器+導入線導入鞘)

4650

CMV0403010TA FIBERED PLATINUM COIL※適應症請見備註欄 2971

CMV0403120TA FIBERED PLATINUM COIL2:30MMX2:100MM※適應症請見備註欄 2971

CMV0436010SB GDC-SYNERG OCCLUSION COIL*適應症請見備註欄(型號:347204-SR

自951001起生效)

16876

CMV0436018SB GDC-SYNERG OCCLUSION COIL*適應症請見備註欄 16876

CMV0437204TA VASCULAR PLATINUM COIL※適應症請見備註欄 2971

CMV0437230SB FIBERED PLATINUM COILS*適應症請見備註欄 2971

CMV04AX1UMV9 "MTI"AXIUM DETACHABLE COILS SYSTEM西恩分離式閉塞捲

1.5MM:25MM,1CM:50CM*適應症請見備註欄

15780

CMV04C0SM0MS "MICROVENTION"MICROPLEX COIL SYSTEM COSMOS COMPLEX

COILS(10,18 SYSTEM)"麥新"微導線圈栓塞系統*適應症請見備註

16876

CMV04DCS01CK DETACHABLE EMBOLIZATION COIL(機械式旋轉方式解離)*適應症請

見備註欄

13696

807

特材代碼 中英文名稱 支付點數-104/01/01

CMV04DCS01CM "CODMAN"TRUFILL DCS DETACHABLE COIL SYSTEM"柯特曼"楚菲爾

分離式白金纖維環系統*適應症請見備註欄

16876

CMV04DCS02CM "CODMAN"TRUFILL DCS DETACHABLE COIL SYSTEM"柯特曼"楚菲爾

分離式白金纖維環系統*適應症請見備註欄

16876

CMV04DCS03CM "CODMAN"TRUFILL DCS DETACHABLE COIL SYSTEM"柯特曼"楚菲爾

分離式白金纖維環系統*適應症請見備註欄

16876

CMV04DPLBP2E "麥克思"微白金纖維環輸送系統“MICRUS” MICROCOIL DELIVERY

SYSTEM

16876

CMV04DPQBP2E "麥克思"微白金纖維環輸送系統“MICRUS” MICROCOIL DELIVERY

SYSTEM

16876

CMV04GDC10SB "BOSTON SCIENTIFIC"GDC DETACHABLE COIL 2,2.5,3,4,5,6,7MM

古利艾美分離式閉塞捲*適應症請見備註欄

16876

CMV04GDC10TA GDC OCCLUSION COILS(OD 2:20MM 1:30CM) 適應症見備註(355-

8254,10:20-34 92.7.1生效920009154)

16876

CMV04GDC11SB GDC DETACHALE COIL*適應症請見備註欄 16876

CMV04GDC12SB GDC DETACHALE COIL*適應症請見備註欄 16876

CMV04GDC18SB GDC DETACHALE COIL*適應症請見備註欄 16876

CMV04GDC19SB GDC DETACHALE COIL*適應症請見備註欄 16876

CMV04H2HSVMS "MICROVENTION"HYDROCOIL(HYDROSOFT HELICAL) EMBOLIC

SYSTEM(10 COIL SIZE)1.5MM:10MM 2CM:30CM親水性線圈栓塞系統

*適應症請見備註欄

18302

CMV04HCSVXMS "MICROVENTION"MICROPLEX COIL SYSTEM微導線圈栓塞系統*適應

症請見備註欄

16876

CMV04HESVXMS HYDROCOIL EMBOLIC SYSTEM (HES)親水性線圈栓塞系統*適應症請

見備註欄

18302

CMV04HFLLVMS "麥新"親水性線圈栓塞系統"MICROVENTION"HYDROCOIL EMBOLIC

SYSTEM (HYDROFILL)D:2MM:24MM L:2CM:50CM *適應症請見備註欄

18302

CMV04HFRMVMS "MICROVENTION"HYDROCOIL EMBOLIC SYSTEM(HES) D:3MM:8MM

L:6CM:33CM;" D:6MM:20MM L:19CM:48CM麥新"親水性線圈栓塞系

統*適應症請見備註欄

18302

CMV04M000TCK TORNADO EMBOLIZATION MICROCOIL 0.018,2:14CM 2:10MM※適應

症請見備註欄

2971

CMV04M001NCK "COOK"EMBOLIZATION COILS"曲克:栓塞環*適應症請見備註欄 1862

CMV04M002NCK "COOK"EMBOLIZATION COILS"曲克:栓塞環*適應症請見備註欄 1862

CMV04M003NCK TORNADO EMBOLIZATION MICROCOIL 0.035,0.038,3:14CM,3:10MM

※適應症請見備註欄

2971

CMV04M005NCK "曲克"犀厲彈簧栓塞"COOK" HILAL EMBOLIZATION MICROCOILS 2971

CMV04M006NCK EMBOLIZATION COILS *適應症請見備註欄 1862

CMV04M007NCK COOK NESTER EMBOLIZATION COILS*適應症請見備註欄 2971

CMV04M008NCK COOK MREYE EMBOLIZATION COILS AND DETACHABLE COILS 0.025

英吋.1:5公分 0.035英吋.1:20公分 0.038英吋.1:20公分*適應請

見備註欄

2971

CMV04MAX05SB MATRIX2 DETA.COIL D:2-24MM L:2-40CM 360度COMP SHAPE-360度

FIRM.360度STANDARD SR.360度SOFT SR.HELICAL SHAPE-HELICAL

ULTRA SOFT SR*適應症見備註

18302

CMV04MAX06SB MATRIX COIL D:2-20MM L:4:30CM 3D OMEGA SHAPE-3D OMEGA

FIRM;STANDARD HELICAL SHAPE-2DFIRM;STANDARD SR;SOFT

SR;HELICAL SOFT SR*適應症見備註

18302

CMV04MCSVXMS "MICROVENTION"MICROPLEX COIL SYSTEM微導線圈栓塞系統*適應

症請見備註欄

16876

CMV04MWCE1CK "COOK"MREYE EMBOLIZATION COILS密絲特艾栓塞線圈,伸展之栓

塞長度1:20公分,線圈狀栓塞直徑2:25公厘*適應症請見備註欄

2971

808

特材代碼 中英文名稱 支付點數-104/01/01

CMV04NEST2CK "COOK"NESTER EMBOLIZATION COILS(PLATINUM)"曲克"奈斯特彈簧

栓塞*適應症請見備註欄

2971

CMV04NEXUSV9 "MTI"NEXUS DETACHABLE COILS SYSTEM 雷瑟斯分離式閉塞捲 *適

應症請見備註欄

18302

CMV04NYL0NV9 "MTI"AXIUM NYLON DETACHABLE COILS SYSTEM"恩提愛"艾司恩分

離式閉塞捲,D 1.5MM-10MM,L 1CM-30CM*適應症請見備註欄

18302

CMV04PC400UF "PENUMBRA"PENUMBRA COIL SYSTEM"彼娜波"栓塞環系統*給付規定

請見備註欄

16876

CMV04PGLACV9 "MTI"AXIUM PGLA DETACHABLE COILS SYSTEM"恩提愛"艾恩斯分離

式閉塞捲,直徑1.5MM-10MM,長度1CM-30CM*適應症請見備註欄

18302

CMV04SPHBP2E "麥克思"微白金纖維環輸送系統“MICRUS” MICROCOIL DELIVERY

SYSTEM

16876

CMV04SRCBP2E "麥克思"微白金纖維環輸送系統“MICRUS” MICROCOIL DELIVERY

SYSTEM

16876

CMV04SSRXL2E "麥克思"微白金纖維環輸送系統“MICRUS” MICROCOIL DELIVERY

SYSTEM

16876

CMV04TARGTSB "BOSTON SCIENTIFIC"TARGET DETACHABLE COIL "波士頓科技"塔

吉特分離線圈*適應症請見備註欄

16876

CMV0621029LW "LEMAITRE"PRUITT IRRIGATION OCCLUSION CATHETER普特灌沖血

管閉塞導管

2396

CMV0621036LW "LEMAITRE"PRUITT OCCLUSION CATHETER普特血管閉塞導管 2466

CMV070NYXXV9 "MTI"ONYX LIQUID EMBOLIC SYSTEM歐尼斯液態栓塞系統 57467

CMV0755055V9 "MTI"MARATHON FLOW DIRECTED MICRO CATHETERS梅洛森微導管 11600

CMV0755105V9 “恩提愛”馬克司孟導管 “MTI”MARKSMAN CATHETER 11600

CPC0101406M0 SINGLE LUMEN INFUSION CATHETER SET(C+D+GW+N) 439

CPC0102005M0 SINGLE LUMEN INFUSION CATHETER SET 20G;24G(C+D+GW+N) 679

CPC0104706AR "ARROW"CENTRAL VEIN CATHETERIZATION SET I

LUMEN(CATH+NEEDLE+DILATOR+GUIDE WIRE+SYRING)"亞諾"中央靜

脈導管組

439

CPC01114G53D "福尼亞"中心靜脈導管/單腔"FORNIA"DISPOSABLE CENTRAL

VENOUS CATHETER KITS/1LUMEN

439

CPC01116G53D "福尼亞"中心靜脈導管/小兒用單腔"FORNIA"DISPOSABLE CENTRAL

VENOUS CATHETER KITS/PEDIATRIC 1LUMEN

679

CPC0141320BA SILICONE PER-Q CATHETER(PICC)(CATH W/STYLET,INTRODUCER

NEEDLE)2,3FR 28CM,60CM

1043

CPC014132NBA SINGLE LUMEN SILICONE PER-Q CATHETER BASIC TRAY 2FR 1043

CPC0147630AG CVP KIT MINI (含GUIDE WIRE, CATHETER, NEEDLE) 16FR 439

CPC0147631AG CVP KIT MINI (含GUIDE WIRE, CATHETER, NEEDLE) 16FR 439

CPC0160004DV SINGLE LUMEN BROVIAC CATHETER 布羅斐式導管(用於化療患者)

2.7FR 90CM

2412

CPC016816NAG "愛琅"中央靜脈導管組"ARGON"CENTRAL VENOUS CATHETERS-1

LUMEN 5:7FR (C+N+D+G+S)

439

CPC01A4301AR "ARROW"ARROWGARD CATHETERS:ANTISEPTIC SINGLE LUMEN CVP

CATHETER 16GX20CM (C+N+D+G+S)"亞諾"抗感染安全尖端導管※適

應症請見備註欄

548

CPC01A4650AR "ARROW"CENTRAL VEIN CATHETERIZATION SET I

LUMEN(PEDIATRIC)(CATH+NEEDLE+DILATOR+GUIDE WIRE+SYRING)"

亞諾"中央靜脈導管組

679

CPC01B1161AG "ARGON"HYDROCATH ASSURE HYDROPHILIC ANTI-MICROBIAL

CENTRAL VENOUS CATHETER:1 LUMEN(C+N+D+G+S)"愛琅"抑菌中心

靜脈導管:單腔※適應症請見備註欄

548

CPC01BCV11EE 1 LUMEN CVP CATHETER(CATHETER+GW+DILATOR+SYRINGE) 439

809

特材代碼 中英文名稱 支付點數-104/01/01

CPC01C4400AR "ARROW"CENTRAL VEIN CATHETERIZATION SET I

LUMEN(CATH+NEEDLE+DILATOR+GUIDE WIRE+SYRING)"亞諾"中央靜

脈導管組

439

CPC01E4301AR "ARROW"CENTRAL VEIN CATHETERIZATION SET I

LUMEN(CATH+NEEDLE+DILATOR+GUIDE WIRE+SYRING)"亞諾"中央靜

脈導管組

439

CPC01E4700AR "ARROW"CENTRAL VEIN CATHETERIZATION SET(1

LUMEN)(CATHETER+NEEDLE+DILATOR+GUIDE WIRE+SYRINGE)"亞諾"

中央靜脈導管組

439

CPC01ECL11BB CERTOFIX CENTRAL VENOUS CATHETER (1

LUMEN)(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE)舒鈦單腔

中心靜脈導管組

439

CPC01H1056AG "愛琅"中央靜脈導管組"ARGON"CENTRAL VENOUS CATHETERS-1

LUMEN 5:7FR(C+N+D+G+S)

439

CPC01M1142ED 1 LUMEN MULTI-MED CENTRAL CATHETER SET W/AMC

THROMBOSHIELD※適應症請見備註欄

548

CPC01M1162ED 1 LUMEN MULTI-MED CENTRAL CATHETER SET(C+N+GW+DIL+SY) 439

CPC01M1201ED 1 LUMEN CVP CATHETER W/AMC THROMBOSHIELD

COATING(C+N+D+GW+S)※適應症請見備註欄

548

CPC01P1051AG "愛琅"中央靜脈導管組"ARGON"CENTRAL VENOUS CATHETERS-1

LUMEN 2.5:4FR(PEDIATRIC)(C+N+D+G+S)

679

CPC01PED01BB CERTOFIX CENTRAL VENOUS CATHETER(PEDIATRIC 1

LUMEN)(CATHETER+GUIDEWIRE+NEEDLE+SCALPEL+3 WAY)舒鈦單腔

小兒用中心靜脈導管組

679

CPC01PMS01CK "COOK" FEMORAL DISTAL AORTIC PRESSURE MONITORING SET

2.5:5.0 FR. "曲克"動脈壓力監測組

(CATHETER+WIRE+NEEDLE+SYRINGE)※適應症請見備註欄

1490

CPC01PMS02CK "COOK" FEMORAL DISTAL AORTIC PRESSURE MONITORING SET

2.5:5.0 FR. "曲克"動脈壓力監測組

(CATHETER+WIRE+NEEDLE+SYRINGE)※適應症請見備註欄

1490

CPC01PMS03CK "COOK" FEMORAL DISTAL AORTIC PRESSURE MONITORING SET

2.5:5.0 FR. "曲克"動脈壓力監測組

(CATHETER+WIRE+NEEDLE+SYRINGE)※適應症請見備註欄

1490

CPC01PTT11BB CERTOFIX CENTRAL VENOUS CATHETER(PROTECT 1 LUMEN)

(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE)舒鈦抗感染單腔

中心靜脈導管組

548

CPC01R4020AR "ARROW"ARTERIAL CATHETERIZATION SET(RA-

04220,04122,FA04018,04016自91/07/01生

效))(SAC00324;524;01616;02316自100年4月1日刪除)動脈測壓導

381

CPC01STD11BB CERTOFIX CENTRAL VENOUS CATHETER(1

LUMEN)(CATHETER+DILATOR+GUIDEWIRE +NEEDLE+SYRINGE)舒鈦單

腔中心靜脈導管組

439

CPC01SWL12W8 SINGLE LUMEN PEDIATRIC CENTRAL VENOUS CATHETER SET

5FR(C+N+S+GW+D+ INJECTION CAP)

679

CPC01SWL13W8 SINGLE LUMEN CENTRAL VENOUS CATHETER SET

6FR(C+N+S+GW+D+INJECTION CAP)

439

CPC01SWL21W8 DOUBLE LUMEN INFANT CENTRAL VENOUS CATHETER SET

4FR(C+N+S+GW+D+ INJECTION CAP)

1568

CPC01SWL22W8 DOUBLE LUMEN PEDIATRIC CENTRAL VENOUS CATHETER SET

5FR(C+N+S+GW+D+ INJECTION CAP)

1568

CPC01SWL23W8 DOUBLE LUMEN CENTRAL VENOUS CATHETER SET

7FR(C+N+S+GW+D+INJECTION CAP)

951

810

特材代碼 中英文名稱 支付點數-104/01/01

CPC01SWL33W8 TRIPLE LUMEN CENTRAL VENOUS CATHETER SET

7FR(C+N+S+GW+D+INJECTION CAP)

1118

CPC0214402AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS:2

LUMEN (早產兒) 4FR 13CM" 亞諾"多重輸液導管

1568

CPC0217702AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS:2

LUMEN(C+N+GW+SY+D)" 亞諾"多重輸液導管

951

CPC0222502AR "ARROW"ARROWGARD CATHETERS:ANTISEPTIC PEDIATRIC DOUBLE

LUMEN (C+N+D+G+S)"亞諾"抗感染安全尖端導管※適應症請見備註

1835

CPC02245F53D "福尼亞"中心靜脈導管/小兒用雙腔"FORNIA"DISPOSABLE CENTRAL

VENOUS CATHETER KITS/PEDIATRIC 2LUMEN

1568

CPC02278F53D "福尼亞"中心靜脈導管/雙腔"FORNIA"DISPOSABLE CENTRAL

VENOUS CATHETER KITS/2LUMEN

951

CPC022L715M0 DOUBLE LUMEN INFUSION CATHETER SET (C+D+GW+N+SY) 951

CPC022LP35M0 DOUBLE LUMEN INFUSION CATHETER SET 4FR,5FR(C+D+GW+N+SY) 1568

CPC0260048DV DUAL LUMEN HICKMAN CATHETER"巴德"希克曼血液透析導管 2743

CPC026817NAG "愛琅"中央靜脈導管組"ARGON"CENTRAL VENOUS CATHETERS-2

LUMEN 7FR(C+N+D+G+S)

951

CPC02A7702AR "ARROW"ARROWGARD CATHETER (DOUBLE LUMEN )14FR X

15CM(C+N+D+G+S)"亞諾"抗感染安全尖端導管(大管徑)※適應症請

見備註欄

1428

CPC02B1150AG "ARGON"HYDROCATH ASSURE HYDROPHILIC ANTI-MICROBIAL

CENTRAL VENOUS CATHETER:2 LUMEN(C+N+D+G)"愛琅"抑菌中心靜

脈導管:2腔※適應症請見備註欄

1141

CPC02B1152AG "愛琅"抑菌中心靜脈導管(2腔)"ARGON"HYDROCATH ASSURE

HYDROPHILIC ANTI-MICROBIAL CENTRAL VENOUS

CATHETER(2LUMEN)

1428

CPC02BCV22EE 2 LUMEN CVP CATHETER/SET 二腔中央靜脈導管組

(CATH+NEEDLE+DILATOR+GUIDEWIRE+SYRINGE)

951

CPC02CUDLMCK 2 LUMEN SPECTRUM AND SPECTRUM GLIDE CENTRAL VENOUS

CATHETERS AND SETS(C+N+D+GW+SY)※適應症請見備註欄

1428

CPC02CV782BS "BIOSENSORS"CENTRAL VENOUS CATHETER KIT

2LUMEN(CATH+NEEDLE+DILATOR+GUIDEWIRE+SYRINGE)"拜爾生"中央

靜脈導管組

951

CPC02ECL12BB CERTOFIX CENTRAL VENOUS CATHETER (2 LUMEN)

(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+ SYRINGE)舒鈦雙腔中心

靜脈導管組

951

CPC02M2716ED 2 LUMEN CVP CATHETER W/AMC THROMBOSHIELD

COATING(C+N+D+GW+S)※適應症請見備註欄

1428

CPC02M271SED 2 LUMEN MULTI-MED CENTRAL CATHETER SET(C+N+GW+DIL+SY) 951

CPC02M27S1ED 2 LUMEN CVP CATHETER W/AMC THROMBOSHIELD

COATING(C+N+D+GW+S)※適應症請見備註欄

1428

CPC02N7702AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS:2

LUMEN(C+N+GW+SY+D)" 亞諾"多重輸液導管

951

CPC02P1065AG "愛琅"中央靜脈導管組"ARGON"CENTRAL VENOUS CATHETERS-2

LUMEN 4:5FR(PEDIATRIC)(C+N+D+G+S)

1568

CPC02PED02BB CERTOFIX CENTRAL VENOUS CATHETER (PEDIATRIC 2

LUMEN)(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE)舒鈦雙腔

小兒用中心靜脈導管組

1568

CPC02PEDSUCK SPECTRUM PEDIATRIC 2 LUMEN CVP CATHETER

4FR,5FR(C+D+GW+N+S)※適應症請見備註欄

1835

CPC02PEDUDCK 2 LUMEN SPECTRUM GLIDE CENTRAL VENOUS CATHETERS AND SETS

4.0-5.0FR 8CM 小兒用(C+N+D+G+S)抗感染導管※適應症請見備註

1835

811

特材代碼 中英文名稱 支付點數-104/01/01

CPC02PEUD1CK SPECTRUM AND SPECTRUM PEDIATRIC 2 LUMEN CVP CATHETER

4.0~5.0FR(C+N+D+G+S)※適應症請見備註欄

1835

CPC02PTT12BB CERTOFIX CENTRAL VENOUS CATHETER (PROTECT 2 LUMEN)

(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE)舒鈦抗感染雙腔

中心靜脈導管組

1428

CPC02SDLM1CK SPECTRUM PEDIATRIC 2 LUMEN CVP CATHETER 4.0FR(C+N+D+G+S)

※適應症請見備註欄

1835

CPC02STD12BB CERTOFIX CENTRAL VENOUS CATHETER(2

LUMEN)(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE)舒鈦雙腔

中心靜脈導管組

951

CPC02SUDLMCK SPECTRUM 2 LUMEN CVP CATHETER(C+D+GW+N+S)※適應症請見備註

1428

CPC02SWL24W8 DOUBLE LUMEN CENTRAL VENOUS CATHETERIZATION

SET(C+N+GW+S+D)

951

CPC02UDL81CK 2 LUMEN SPECTRUM GLIDE CENTRAL VENOUS CATHETERS AND SETS

8.0FR 15CM (C+N+D+G+S)抗感染導管※適應症請見備註欄

1428

CPC02UDLM2CK SPECTRUM AND SPECTRUM 2 LUMEN CVP CATHETER 7.5-

8.0FR(C+N+D+G+S)※適應症請見備註欄

1428

CPC02UDLM3CK 2 LUMEN SPECTRUM CENTERAL VENOUS CATHETER 抗感染導管※適

應症請見備註欄

1428

CPC0312123AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION

SETS:LARGE BORE 3 LUMEN CVP CATHETER 12FR(C+N+D+G+S)"亞

諾"多重輸液導管套(大管徑)

1664

CPC0314553AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION

SETS:PEDATRIC 3 LUMEN CVP SET 5.5FR 30CM(C+N+GW+SY+D)" 亞

諾"多重輸液導管

2050

CPC0314703AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION

SETS:TRIPLE-LUMEN C+N+GW+SY+D)" 亞諾"多重輸液導管

1118

CPC0315703AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION

SETS:TRIPLE-LUMEN (CATH+NEEDLE+DILATOR+GW+SYRING)"亞諾"多

重輸液導管

1118

CPC0316553AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION

SETS:TRIPLE-LUMEN (CATH+NEEDLE+DILATOR+GW+SYRING)5.5FR

13CM"亞諾"多重輸液導管

2050

CPC03345F53D "福尼亞"中心靜脈導管/小兒用三腔"FORNIA"DISPOSABLE CENTRAL

VENOUS CATHETER KITS/PEDIATRIC 3LUMEN

2050

CPC03378F53D "福尼亞"中心靜脈導管/三腔"FORNIA"DISPOSABLE CENTRAL

VENOUS CATHETER KITS/3LUMEN

1118

CPC033L715M0 TRIPLE LUMEN INFUSION CATHETER SET (C+D+GW+N+SY) 1118

CPC033LP58M0 TRIPLE LUMEN INFUSION CATHETER SET 5.5FR(C+D+GW+N+SY) 2050

CPC0368172AG "愛琅"中央靜脈導管組"ARGON"CENTRAL VENOUS CATHETERS-3

LUMEN 7FR(C+N+D+G+S)

1118

CPC03A4703AR "ARROW"ARROWGARD CATHETERS:ANTISEPTIC TRIPLE-LUMEN

(C+N+D+G+S)"亞諾"抗感染安全尖端導管※適應症請見備註欄

1905

CPC03A5123AR "ARROW"ARROWGARD CATHETERS:ANTISEPTIC LARGE BORE TRIPLE-

LUMEN (C+N+D+G+S)"亞諾"抗感染安全尖端導管※適應症請見備註

1905

CPC03B1158AG "愛琅"抑菌中心靜脈導管(3腔)"ARGON"HYDROCATH ASSURE

HYDROPHILIC ANTI-MICROBIAL CENTRAL VENOUS CATHETER(3LUMEN

1905

CPC03BCV31EE 3 LUMEN CVP CATHETER 三腔中央靜脈導管組

(CATHETER+GW+DILATOR+SYRINGE+NEEDLE)

1118

CPC03CUTLMCK 3 LUMEN SPECTRUM AND SPECTRUM GLIDE CENTRAL VENOUS

CATHETERS AND SETS(C+N+D+GW+SY)※適應症請見備註欄

1905

812

特材代碼 中英文名稱 支付點數-104/01/01

CPC03CV783BS "BIOSENSORS"CENTRAL VENOUS CATHETER KIT

3LUMEN(CATH+NEEDLE+DILATOR+GUIDEWIRE+SYRINGE)"拜爾生"中央

靜脈導管組

1118

CPC03ECL13BB CERTOFIX CENTRAL VENOUS CATHETER (3 LUMEN)

(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE)舒鈦三腔中心靜

脈導管組

1118

CPC03HFL13BB CERTOFIX CENTRAL VENOUS CATHETER(3

LUMEN)(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE)舒鈦三腔

中心靜脈導管組

1664

CPC03M3716ED 3 LUMEN CVP CATHETER W/AMC THROMBOSHIELD

COATING(C+N+D+GW+S)※適應症請見備註欄

1905

CPC03M371SED 3 LUMEN MULTI-MED CENTRAL CATHETER SET(C+N+GW+DIL+SY) 1118

CPC03M37S1ED 3 LUMEN CVP CATHETER W/AMC THROMBOSHIELD

COATING(C+N+D+GW+S)※適應症請見備註欄

1905

CPC03P1139AG "愛琅"中央靜脈導管組"ARGON"CENTRAL VENOUS CATHETERS-3

LUMEN 5FR(PEDIATRIC)(C+N+D+G+S)

2050

CPC03PED03BB CERTOFIX CENTRAL VENOUS CATHETER (PEDIATRIC 3

LUMEN)(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE)舒鈦三腔

小兒用中心靜脈導管組

2050

CPC03PEDUTCK SPECTRUM PEDIATRIC 3 LUMEN CVP CATHETER 5FR(C+D+GW+N+S)※

適應症請見備註欄

2200

CPC03PTT13BB CERTOFIX CENTRAL VENOUS CATHETER(PROTECT 3 LUMEN)

(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE)舒鈦抗感染三腔

中心靜脈導管組

1905

CPC03STD13BB CERTOFIX CENTRAL VENOUS CATHETER(3

LUMEN)(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE)舒鈦三腔

中心靜脈導管組

1118

CPC03SWL34W8 TRIPLE LUMEN CENTRAL VENOUS CATHETERIZATION

SET(C+N+GW+S+D)

1118

CPC03UTLM1CK SPECTRUM AND SPECTRUM 3 LUMEN CVP CATHETER 7.0-

9.0FR(C+N+D+G+S)※適應症請見備註欄

1905

CPC03UTLM3CK 3 LUMEN SPECTRUM CENTERAL VENOUS CATHETER 抗感染導管※適

應症請見備註欄

1905

CPC03UTLMACK "COOK"SPECTRUM AND SPECTRUM GLIDE 3 LUMEN CVP CATHETER

5FR,7FR(C+D+GW+N+S)"曲克"史派純和史派純革來得中央靜脈導管

組※適應症請見備註欄

1905

CPC03UTPE2CK SPECTRUM GLIDE CENTRAL VENOUS CATHETERS AND SETS 3 LUMEN

5FR(C+D+GW+N+S)※適應症請見備註欄

2200

CPC03UTPEDCK SPECTRUM AND SPECTRUM PEDIATRIC 3 LUMEN CVP CATHETER

5FR(C+N+D+G+S)※適應症請見備註欄

2200

CPC05S1000AG "愛琅"中央靜脈導管組"ARGON"CENTRAL VENOUS CATHETERS-CVP

CATHETER 14G:18G 90MM:160MM

210

CPC0885HS1ED AVA ADVANCED VENOUS ACCESS DEVICES(AVA 3XI)(CVP KIT+保護

套+SHEATH+SIDE ARM)*適應症請見備註欄

2734

CPC089FHS1ED AVA ADVANCED VENOUS ACCESS DEVICES(AVA HF)(CVP KIT+保護套

+SHEATH)*適應症請見備註欄

2600

CPC0902022PU CEVOX CENTRAL VENOUS OXYGEN SATURATION MONITORING

SYSTEM:FIBROPTIC PROBE CATHETER 中央靜脈血氧飽和度:光纖

探針導管※適應症請見備註欄

5500

CPC0977475ED 3 LUMEN PRESEP CENTRAL VENOUS OXIMETRY CATHETER

SET(CVPC+PROBE+N+GW+D+SY)※適應症請見備註欄

7300

CPC09X3820ED PRESEP OXIMETRY CATHETER 3LUMEN (PROBE+3 LUMEN CVP

KIT(CATHETER+DILATOR+GUIDE WIRE+NEEDLE+SYRINGE)裴瑟週邊血

氧濃度導管

7300

813

特材代碼 中英文名稱 支付點數-104/01/01

CPD011010DBD PRESSURE MONITOR DOME 154

CPD011011DBD DOME 154

CPD01BTR00GJ "JSM"PRESSURE MONITORING KIT: BIOTRANS DOME "吉生"血壓監

視組合套:DOME

154

CPD01BTR01BS PRESSURE MONITOR DOME 154

CPD01BTR01H9 BIOTRANS DOME 154

CPM01SC441SG CVP SCALE SYSTEM+3 WAY 114

CPM01VP001LL CVP SCALE SYSTEM(MONITOR+3 WAY) 114

CPM020460TBD 1DOME PRESSURE MONITORING KIT 310

CPM021560TBD 1 DOME PRESSURE MONITORING KIT 310

CPM028603NSG PRESSURE MONITORING KIT 1DOME 310

CPM02BT481GJ "JSM"PRESSURE MONITORING KIT: 1 DOME PRESSURE MONITORING

KIT(DOME+FD+TUBING+3 WAYX2) "吉生"血壓監視組合套:1 DOME

KIT

310

CPM02BT482GJ "JSM"PRESSURE MONITORING KIT :2 DOME 3WAY PRESSURE

MONITORING KIT 2X(DOME+FD+3WAYX2+TUBING)"吉生"血壓監視組

合套:2 DOME KIT

664

CPM02BT483GJ "JSM"PRESSURE MONITORING KIT :3 DOME 3WAY PRESSURE

MONITORING KIT 3X(DOME+FD+3WAYX2+TUBING)"吉生"血壓監視組

合套:3 DOME KIT

978

CPM02BTR24BS 2 DOME 3WAY PRESSURE MONITORING KIT

2X(DOME+FLUSH+TUBING+3WAYX2)

664

CPM02BTR24H9 2 DOME 3WAY PRESSURE MONITORING KIT

2X(DOME+DEVICE+TUBING+3 WAYX2)

664

CPM02BTR33BS 3 DOME 3WAY PRESSURE MONITORING KIT

3X(DOME+FLUSH+TUBING+3WAYX2)

978

CPM02BTR48BS 1DOME 3WAY PRESSURE MONITORING

KIT(DOME+DEVICE+TUBING+3WAYX2)

310

CPM02BTR48H9 1 DOME 3WAY PRESSURE MONITORING KIT(DOME+DEVICE+TUBING+3

WAYX2)

310

CPM02BTRDLGJ "JSM"PRESSURE MONITORING KIT :1 DOME 3WAY PRESSURE

MONITORING KIT 1X(DOME+FDX2+3WAYX4+TUBINGX2)"吉生"血壓監

視組合套:1 DOME 2WAY KIT

369

CPM02DL418BS 1DOME 2WAY PRESSURE MONITORING KIT

1X(DOME+FLUSH+TUBINGX2+3WAYX4)

369

CPM02DL418H9 1 DOME 2WAY PRESSURE MONITORING KIT

1X(DOME+DEVICE+TUBINGX2+3 WAYX4)

369

CPM02HP60RBD PRESSURE MONITORING KIT 1DOME 310

CPM030TNFRAG "ARGON"DISPOSABLE PRESSURE MONITOR:TRANSDUCER "愛琅"血壓

監視組合套:壓力轉換器

369

CPM0342584HR TRANSPAC IV MONITORING KIT(TRAN+FLUSH+TUBING+3WAYX2) 369

CPM0342584U2 "ICU"TRANSPAC IV MONITORING

KIT(TRAN+FLUSH+TUBING+3WAYX2)"愛西優"壓力監測套

369

CPM0342591HR TRIFURCATED KITS WITH 3 DISPOSABLE TRANSDUCER 1105

CPM0342591U2 "ICU"3 TRANSPAC IV MONITORING KIT

3X(TRAN+FLUSH+TUBING+3WAYX2)"愛西優"壓力監測套

1105

CPM0342597HR TRANSPAC IV MONITORING KIT WITH 2 DISPOSABLE TRANSDUCER 915

CPM0342652HR TRANSPAC IV MONITORING KIT WITH 2 DISPOSABLE TRANSDUCER 915

CPM0342652U2 "ICU"2 TRANSPAC IV MONITORING KIT

2X(TRAN+FLUSH+TUBING+3WAYX2)"愛西優"壓力監測套

915

CPM034812DAG "ARGON"DISPOSABLE PRESSURE MONITOR KIT:2 TRANSDUCER

(TR+FL+TU+3WAYX4)"愛琅"血壓監視組合套

915

CPM034812TAG "ARGON"DISPOSABLE PRESSURE MONITOR KIT:3 TRANSDUCER

(TR+FL+TU+3WAYX6)"愛琅"血壓監視組合套

1105

814

特材代碼 中英文名稱 支付點數-104/01/01

CPM0352026BB COMBITRANS MONITORING SETS(FD+TR+3WAYX2+TUBING) 康比得壓

力監測組

369

CPM0352036BB COMBITRANS MONITORING SETS: DISPOSABLE TRANSDUCER 康比得

壓力監測組:壓力轉換器

369

CPM038603ASG DISPOSABLE PRESSURE MONITOR KIT 1 DOME

W/TRANSDUCER(TR+FLU+TUB+3WAYX2)

369

CPM038603BSG DISPOSABLE PRESSURE MONITOR KIT 2 DOME W/TRANSDUCER

2(TR+FLU+TUB+3WAYX2)

915

CPM038603CSG DISPOSABLE PRESSURE MONITOR KIT 3 DOME W/TRANSDUCER

3(TR+FLU+TUB+3WAYX2)

1105

CPM038603TSG PRESSURE MONITOR KIT 1 DOME WITH TRANSDUCER 369

CPM03ADP00GJ "JSM"PRESSURE MONITORING KIT(TRANSDUCER)"吉生"血壓監視組

合套

369

CPM03ADP3WGJ "JSM"PRESSURE MONITORING KIT(TRANSDUCER+3WAY)"吉生"血壓監

視組合套

369

CPM03ADPT1GJ "JSM"PRESSURE MONITORING KIT :TRANSDUCER PRESSURE

MONITORING KIT(TR+FD+3WAYX2+TUBING)"吉生"血壓監視組合

套:1TR

369

CPM03ADPT2GJ "JSM"PRESSURE MONITORING KIT: 2 TRANSDUCER PRESSURE

MONITORING KIT 2X(TR+FD+3WAYX2+TUBING)"吉生"血壓監視組合

套:2TR

915

CPM03ADPT3GJ "JSM"PRESSURE MONITORING KIT: 3 TRANSDUCER PRESSURE

MONITORING KIT 3X(TR+FD+3WAYX2+TUBING)"吉生"血壓監視組合

套:3TR

1105

CPM03ADPTDGJ "JSM"PRESSURE MONITORING KIT: TRANSDUCER PRESSURE

MONITORING 2 WAY KIT (TR+FDX2+3WAYX4+TUBINGX2)"吉生"血壓

監視組合套:1TR 2WAY

644

CPM03AT148H9 PRESSURE MONITORING KIT(TR+FD+3 WAYX2+TUBING) 369

CPM03D2020AG "ARGON"DISPOSABLE PRESSURE MONITOR:TRANSDUCER W/FLUSH"愛

琅"血壓監視組合套:壓力轉換器

369

CPM03D4812AG "ARGON"DISPOSABLE PRESSURE MONITOR KIT:1 TRANSDUCER "愛

琅"血壓監視組合套

369

CPM03D4812HM DISPOSABLE PRESSURE MONITORING KIT WITH TRANSDUCER 369

CPM03DDL60AG "ARGON"DISPOSABLE PRESSURE MONITOR KIT:1 TRANSDUCER

2WAY(1TR+2(FL+TU+3WAYX2)"愛琅"血壓監視組合套

644

CPM03DNN12AG "ARGON"DISPOSABLE PRESSURE MONITOR KIT:1 TRANSDUCER

(TR+FL+TU+3WAYX2)"愛琅"血壓監視組合套

734

CPM03DP240H9 2 TRANSDUCER PRESSURE MONITORING KIT 2X(TR+FD+3

WAYX2+TUBING)

915

CPM03DP340H9 3 TRANSDUCER PRESSURE MONITORING KIT 3X(TR+FD+3

WAYX2+TUBING)

1105

CPM03DPT24H9 TREANSDUCER PRESSURE MONITORING KIT(TR+FD+3 WAYX2+TUBING) 369

CPM03PV800PU PCCO MONITORING KIT 30CM,100CM,150CM(TX1+FX1+TX2+3-

WAYX2)(含溫度感應器,與CBT022014LPU及CBT022015LPU搭配使

用)

650

CPM03PX12NED "EDWARDS"TRUWAVE NEONATAL PEDIATRIC DISPOSABLE PRESSURE

TRANSDUCER (1 TR) ( TR+FD+TUBING+3WAYX2)"愛德華"凸威壓力

傳導器:1TR 小兒

734

CPM03PX1X0ED "EDWARDS"TRUWAVE DISPOSABLE PRESSURE TRANSDUCER (1 TR

2WAY) 2X( TR+FD+TUBING+3WAYX2)"愛德華"凸威壓力傳導器:1TR

2WAY

644

CPM03PX260ED "EDWARDS"TRUWAVE DISPOSABLE PRESSURE TRANSDUCER (1 DOME)(

TR+FD+TUBING+3WAY)"愛德華"凸威壓力傳導器:1TR

369

815

特材代碼 中英文名稱 支付點數-104/01/01

CPM03PX2X2ED "EDWARDS"TRUWAVE DISPOSABLE PRESSURE TRANSDUCER (2 TR)

2X( TR+FD+TUBING+3WAY)"愛德華"凸威壓力傳導器:2TR

915

CPM03PX3X7ED "EDWARDS"TRUWAVE DISPOSABLE PRESSURE TRANSDUCER (3 TR)

3X( TR+FD+TUBING+3WAYX2)"愛德華"凸威壓力傳導器:3TR

1105

CPM03PX604ED "EDWARDS"TRUWAVE DISPOSABLE PRESSURE TRANSDUCER(FLUSH

DEVICE X1+ STOPCOCK 1)"愛德華"凸威壓力傳導器:1TR

369

CPM04ABV30WP "沃夫德李"艾比凡瑟腹內壓力監測組"WOLFE TORY"ABVISER

INTRA-ABDOMINAL PRESSURE MONITORING KIT

2100

CRB01000282C "柯惠"麥林可雙腔支氣管內管"COVIDIEN" MALLINCKRODT

BRONCHO-CATH ENDOBROCHIAL TUBE

1490

CRB0224390FJ “富士”塞爾布朗支氣管閉鎖導管-雙腔左彎/右彎“FUJI”

SILBRONCHO ENDOTRACHEAL TUBE

1490

CRB0303104FJ "富世"支氣管內管阻隔器(小兒用)"FUJI" UNIBLOCKER AND

FUGGIANO BLOCKER

4000

CRB0324477FJ "富世"支氣管閉鎖導管"FUJI"UNIVENT TUBE(TCB TYPE) 3675

CRB0324480FJ "富世"支氣管內管阻隔器"FUJI" UNIBLOCKER AND FUGGIANO

BLOCKER

3675

CRB03AEBS1CK ARNDT ENDOBRONCHIAL BLOCKER SET 9.0FR. 78CM *給付規定請

見備註欄

3675

CRB03AEBS2CK ”曲克”支氣管內管阻隔管組ARNDT ENDOBRONCHIAL BLOCKER SET

7.0FR. 65CM *給付規定請見備註欄

3675

CRB03AEBS3CK ”曲克”支氣管內管阻隔管組ARNDT ENDOBRONCHIAL BLOCKER SET

5.0FR. 50CM,65CM *給付規定請見備註欄

4000

CRB03BBTAEDZ ”大研”支氣管閉鎖導管”DAIKEN” COOPDECH ENDOBRONCHIAL

BLOCKER TUBE給付規定請見備註欄

3675

CRE01C00402C "柯惠"麥林可顯微喉手術氣管插管 "COVIDIEN" MALLINCKRODT

MLT MICROLARYNGEAL TUBE

159

CRE01C4060EU NON-KINKING ENDOTRACHEAL TUBE ARMOURED CUFF 6.0:8.5MM ※

處置使用可申報手術使用不另給付。

300

CRE01C6121UW "巫諾" 氣管內管"UNOMEDICAL" ENDOTRACHEAL TUBES(增強型

CUFF,ID5:9MM)*處置使用可申報,手術使用不另給付。

300

CRE01U0030EU NON-KINKING ENDOTRACHEAL TUBE ARMOURED UNCUFF 3.0:5.5MM

※處置使用可申報手術使用不另給付。

328

CRE01U6113UW "巫諾" 氣管內管"UNOMEDICAL" ENDOTRACHEAL TUBES(增強型

UNCUFFED,ID2.5:9MM)*處置使用可申報,手術使用不另給付。

328

CRE03118302C "柯惠"麥林可加強型氣管內管"COVIDIEN" MALLINCKRODT SAFETY-

FLEX REINFORCED TRACHEAL TUBE*處置使用可申報,手術使用不另

給付

300

CRE03C055NFM SILICONE ENDOTRACHEAL TUBE W/CUFF 5.5:10.0MM※處置使用可

申報手術使用不另給付

300

CRE03U025NFM SILICONE ENDOTRACHEAL TUBE W/WIRE WITHOUT CUFF 2.5:5.0MM

※處置使用可申報手術使用不另給付

328

CRE04C00402C "柯惠"麥林可彎型氣管內管"COVIDIEN" MALLINCKRODT RAE ORAL

AND NASAL TRACHEAL TUBE- 鼻彎有氣囊

202

CRE04C0060PP NASAL CURVED W/CUFF ENDOTRACHEAL TUBE 6:8MM ※處置使用可

申報,手術使用不另給付

202

CRE04C0060UW "巫諾" 氣管內管"UNOMEDICAL" ENDOTRACHEAL TUBES(鼻彎低壓氣

囊) *處置使用可申報,手術使用不另給付

202

CRE04C6131UW "巫諾" 氣管內管"UNOMEDICAL" ENDOTRACHEAL TUBES(鼻彎型CUFF

ID6:8MM)*處置使用可申報,手術使用不另給付。

202

CRE04U030N2C "柯惠"麥林可彎型氣管內管"COVIDIEN" MALLINCKRODT RAE ORAL

AND NASAL TRACHEAL TUBES- 鼻彎無氣囊

188

CRE04U3030UW "巫諾" 氣管內管"UNOMEDICAL" ENDOTRACHEAL TUBES(鼻彎型

UNCUFFED,ID3:7MM)*處置使用可申報,手術使用不另給付。

188

816

特材代碼 中英文名稱 支付點數-104/01/01

CRE04U6133UW "巫諾"氣管內管"UNOMEDICAL" ENDOTRACHEAL TUBES(鼻彎型氣管

內管-無閥)*處置使用可申報,手術使用不另給付。

188

CRE06C00402C "柯惠"麥林可彎型氣管內管"COVIDIEN" MALLINCKRODT RAE ORAL

AND NASAL TRACHEAL TUBES-口彎有氣囊

201

CRE06C0040UW "巫諾" 氣管內管"UNOMEDICAL" ENDOTRACHEAL TUBES(口彎低壓氣

囊) *處置使用可申報,手術使用不另給付

201

CRE06C0050MU MODERN ENDOTRACHEAL TUBE(CUFFED)華新氣管內管*處置使用可申

報、手術使用不另申報。

201

CRE06C0453W6 ENDOTRACHEAL TUBE (WITH/CUFF)*處置使用可申報,手術使用不另

給付.

201

CRE06C3060UW "巫諾" 氣管內管"UNOMEDICAL" ENDOTRACHEAL TUBES(口彎型

CUFF,ID4:9MM)*處置使用可申報,手術使用不另給付。

201

CRE06U0030UW "巫諾" 氣管內管"UNOMEDICAL" ENDOTRACHEAL TUBES處置使用可

申報,手術使用不另給付

143

CRE06U0304W6 ENDOTRACHEAL TUBE (WITHOUT/CUFF)處置使用可申報,手術使用不

另給付.

143

CRE06U045N2C "柯惠"麥林可彎型氣管內管"COVIDIEN" MALLINCKRODT RAE ORAL

AND NASAL TRACHEAL TUBES-口彎無氣囊

143

CRE06U6123UW "巫諾" 氣管內管"UNOMEDICAL" ENDOTRACHEAL TUBES(口彎型

UNCUFFED,ID3:9MM)*處置使用可申報,手術使用不另給付。

143

CRE07C00452C "柯惠" 麥林可鐳射氣管內管 “COVIDIEN” MALLINCKRODT

LASER-FLEX TRACHEAL TUBES

2451

CRG0100BN1QD “崇仁”嬰兒持續正壓鼻部給氧管路組及配件“GALEMED”NCPAP

NASAL KIT AND ACCESSORY*給付規定請見備註欄

1120

CRG010168NHU "哈德森" 嬰兒型連續正壓氣道給氧管路-全套"HUDSON" INFANT

CPAP CANNULAS(SYSTEM) NO.0:N0.5 ※適應症請見備註欄

1120

CRG010169NHU "哈德森" 嬰兒型連續正壓氣道給氧管路-半套"HUDSON" INFANT

CPAP CANNULAS(SET) NO.0:N0.5 ※適應症請見備註欄

654

CRG01407NNW7 "嬰克"嬰兒經鼻式氧氣鼻套管"INCA" INFANT NASAL OXYGEN CPAP

CANNULA*適應症請見備註欄

654

CRG01427NNW7 "嬰克"嬰兒經鼻式氧氣鼻套管"INCA" INFANT NASAL OXYGEN CPAP

CANNULA*適應症請見備註欄

1120

CRG0212520KV "費雪派克" 正壓呼吸輔助系統-半套"FISHER & PAYKEL" BUBBLE

CPAP SYSTEM*給付規定請見備註欄

1216

CRG02BC161KV "費雪派克" 正壓呼吸輔助系統-全套"FISHER & PAYKEL" BUBBLE

CPAP SYSTEM*給付規定請見備註欄

3049

CRN0185067NU NASAL NASOPHARYNX APPLICATION 後荷式咽插管 2960

CRT0155050VK “旭邦”柔得多內管型氣切管“VITALTEC”ROTA-TRACH INNER

CANNULA TRACHEOSTOMY TUBE

865

CRT01TTLPCS5 雪莉氣切套管及其附件 SHILEY TRACHEOSTOMY CANNULAE AND

ACCESSORIES—有氣囊、無開窗/LONG TERM CARE使用)

865

CRT01U0025ZG "富齡"氣切管"ALLY" TRACHEOSTOMY TUBE(UNCUFF, ID 2.5-

5.5MM)

328

CRT01U0060WN TEFLON TRACHEOSTOMY TUBE(DOUBLE TUBE)6:12MM外徑 525

CRT0236368KK "高研"氣管套管"KOKEN" TRACHEAL CANNULA 525

CRT0252608KK "高研"比比氣管套管"KOKEN" TRACHEAL CANNULA PP 493

CRT0253065VK “旭邦”柔得多標準型氣切管(一次使用型)-有氣囊/有孔

“VITALTEC”ROTA-TRACH STANDARD TRACHEOSTOMY TUBE

(DISPOSABLE)

332

CRT0254060VK “旭邦”柔得多標準型氣切管(一次使用型)-無氣囊/有孔

“VITALTEC”ROTA-TRACH STANDARD TRACHEOSTOMY TUBE

(DISPOSABLE)

328

CRT02673502C "柯惠" 麥林可恰可舒氣切管”COVIDIEN” MALLINCKRODT

TRACHESOFT TRACHEOSTOMY CANNULAE-標準型無氣囊

328

817

特材代碼 中英文名稱 支付點數-104/01/01

CRT02673752C "柯惠" 麥林可恰可舒氣切管"COVIDIEN" MALLINCKRODT

TRACHESOFT TRACHEOSTOMY CANNULAE

328

CRT02C0030UW "花瑪"氣切套管 PHARMA TRACHEOSTOMY TUBE UNCUFF 3:10MM 328

CRT02C00502C "柯惠" 麥林可恰可舒氣切管”COVIDIEN” MALLINCKRODT

TRACHESOFT TRACHEOSTOMY CANNULAE-可調整型

332

CRT02C0050SG TRACHEOSTOMY TUBE W/CUFF 5.0:9.0MM 332

CRT02C0050TP SILICONE TRACHEOSTOMY TUBE 5.0MM:9.5MM 577

CRT02C0050WN ALL SILICONE TRACHEOSTOMY TUBE WITH CUFF 22:42FR 5.0:10MM

內徑產品型號2217-035:100自93.1.1生效

577

CRT02C0060UW TRACHEOSTOMY TUBE,REGULAR HVLP CUFF,ID 6:10MM氣切套管(有

閥)

332

CRT02C0060ZG "富齡"氣切管"ALLY" TRACHEOSTOMY TUBE(W/CUFF, ID 6.0-

9.0MM)

332

CRT02C0062UW "花瑪"氣切套管 PHARMA TRACHEOSTOMY TUBE W/CUFF 6:10MM 332

CRT02C0065MU 華新氣切套管 MODERN TRACHEOSTOMY TUBE 332

CRT02C0065UW "巫諾" 氣管切開套管 "UNOMEDICAL" TRACHEOSTOMY TUBE 332

CRT02C00802C "柯惠" 麥林可恰可舒氣切管”COVIDIEN” MALLINCKRODT

TRACHESOFT TRACHEOSTOMY CANNULAE-標準型

332

CRT02C0793W6 TRACHEOSTOMY TUBE (WITH/CUFF) 332

CRT02C1560FM 氣切套管FORTUNE TRACHEOSTOMY TUBE ID2.0MM:12.0MM(普通球) 577

CRT02C1565FM 氣切套管FORTUNE TRACHEOSTOMY TUBE ID2.0MM:12.0MM(低壓球) 577

CRT02C5060UW “巫諾”氣管切開套管-有閥“UNOMEDICAL” TRACHEOSTOMY

TUBE-HIGH VOLUME LOW PRESSURE CUFF (HVLP CUFF),ID 6:10MM

332

CRT02C595NFM SILICONE TRACHEOSTOMY TUBE W/CUFF 5.5:9.5MM 577

CRT02C6262UW “巫諾”氣管切開套管-可調式(有閥)“UNOMEDICAL”

TRACHEOSTOMY TUBE-WITH ADJUSTABLE FLANGE (TTAF) WITH HVLP

CUFF, ID 6:11MM

332

CRT02CP050YN ALL SILICONE TRACHEOSTOMY TUBE W/CUFF 5.0:10.0MM(PRE-

FORMED TYPE)

577

CRT02TT016SG SIGMA TRACHEOSTOMY TUBE 332

CRT02TT046SG SIGMA TRACHEOSTOMY TUBE(SILICON) 577

CRT02U0025WN ALL SILICONE TRACHEOSTOMY TUBE WITHOUT CUFF 12:42FR

2.5:10.0MM內徑

460

CRT02U0030UW TRACHEOSTOMY TUBE,PLAIN,UNCUFF,ID 3:10MM氣切套管(無閥) 328

CRT02U0030YN ALL SILICONE TRACHEOSTOMY TUBE UNCUFF 3.0:10.0MM(PLAIN

TYPE)

460

CRT02U0045S5 雪莉氣切套管SHILEY TRACHEOSTOMY CANNULAE—小兒用( WITH

OBTURATION)

893

CRT02U0062UW "巫諾" 氣管切開套管"UNOMEDICAL" TRACHEOSTOMY TUBE 328

CRT02U0065MU 華新氣切套管MODERN TRACHEOSTOMY TUBE 332

CRT02U1561FM 氣切套管FORTUNE TRACHEOSTOMY TUBE ID2.0MM:12.0MM(無球型) 460

CRT02U5060UW “巫諾”氣管切開套管-無閥“UNOMEDICAL” TRACHEOSTOMY

TUBE-PLAIN (WITHOUT CUFF), ID 3:10MM

328

CRT04C678MHJ "史密斯"百弗納氣切套管與配件"SMITHS" BIVONA TRACHEOSTOMY

TUBE AND ACCESSORIES*使用規定請見備註欄

3800

CRT04C750MHJ "史密斯"百弗納氣切套管與配件"SMITHS" BIVONA TRACHEOSTOMY

TUBE AND ACCESSORIES*使用規定請見備註欄

3800

CRT04C850MHJ "史密斯"百弗納氣切套管與配件"SMITHS" BIVONA TRACHEOSTOMY

TUBE AND ACCESSORIES*使用規定請見備註欄

3800

818

特材代碼 中英文名稱 支付點數-104/01/01

CRT0552518KK "高研"比比氣切套管-無氣囊、開窗/LONG TERM CARE使

用"KOKEN"TRACHEAL CANNULA PP

850

CRT0555150VK “旭邦”柔得多內管型氣切管“VITALTEC”ROTA-TRACH INNER

CANNULA TRACHEOSTOMY TUBE

865

CRT0556150VK “旭邦”柔得多內管型氣切管“VITALTEC”ROTA-TRACH INNER

CANNULA TRACHEOSTOMY TUBE

850

CRT05C0050S5 雪莉氣切套管及其附件 SHILEY TRACHEOSTOMY CANNULAE AND

ACCESSORIES—有氣囊、開窗/LONG TERM CARE使用

865

CRT05C7271UW “巫諾”氣管切開套管-雙管型(有閥)“UNOMEDICAL”

TRACHEOSTOMY TUBE-TTIC WITH HVLP CUFF, FENESTRATED ID

6:10MM*LONG TERM CARE使用

865

CRT05C7272UW “巫諾”氣管切開套管-雙管型(有閥)“UNOMEDICAL”

TRACHEOSTOMY TUBE-TTIC WITH HVLP CUFF, ID 6:10MM*LONG

TERM CARE使用

865

CRT05U0050S5 雪莉氣切套管SHILEY TRACHEOSTOMY CANNULAE—無氣囊、開窗

/LONG TERM CARE使用

850

CRT05U7273UW “巫諾”氣管切開套管-雙管型(無閥)“UNOMEDICAL”

TRACHEOSTOMY TUBE- TTIC PLAIN (WITHOUT CUFF), FENESTRATED

ID 6:10MM*LONG TERM CARE使用

493

CRT09C6262UW “巫諾”氣管切開套管-可調式增強型(有閥)“UNOMEDICAL”

TRACHEOSTOMY TUBE-ADJUSTABLE FLANGE(TTAF)WITH HVLP

CUFF,REINFORCED(ID6:11MM)

450

CRT09U6264UW “巫諾”氣管切開套管-可調式增強型(無閥)“UNOMEDICAL”

TRACHEOSTOMY TUBE-ADJUSTABLE FLANGE(TTAF)WITH HVLP

WITHOUT CUFF,REINFORCED(ID6:11MM)

450

CRT1000543PX "史密斯"保德士經皮式氣切套管組"SMITHS" PORTEX

PERCUTANEOUS TRACHEOSTOMY KIT*適應症請見備註欄

1951

CRT10PTS01CK 〝曲克〞藍犀牛氣管引導器組〝COOK〞CIAGLIA BLUE RHINO

PERCUTANEOUS TRACHEOSTOMY INTRODUCER SET*適應症請見備註欄

4500

CRT10PTS02CK 〝曲克〞藍犀牛氣管引導器組〝COOK〞CIAGLIA BLUE RHINO

PERCUTANEOUS TRACHEOSTOMY INTRODUCER SET*適應症請見備註欄

4500

CRT10PTS03CK "曲克"藍犀牛氣管引導器組*給付規定請見備註欄"COOK"CIAGLIA

BLUE RHINO PERCUTANEOUS TRACHEOSTOMY INTRODUCER SET

5365

CVA0100490M4 PROFLO ANGIOGRAPHIC CATHETER 6F,7F*100,110,125CM (衛署字

號009770)

594

CVA0107130AR "ARROW"BERMAN ANGIOGRAPHIC CATHETER(PEDIATRIC) 4:8FR

50:110CM “亞諾”帕曼心臟血管攝影用導管

1750

CVA011MG31SB IMAGER11 ANGIOGRAPHIC CATH(4-

5FRX40,65,90,100CM)0.035,0.038(型號M001316021:M001316911

自92/7/1生效)

594

CVA01451XNCD "CORDIS"TEMPO ANGIOGRAPHIC CATHETER TEMPO4,TEMPO5田布血管

造影導管

594

CVA014A00NM4 SITESEER CARDIOVASCULAR ANGIOGRAPHIC CATHETER 4FR 594

CVA01512HNMR IMPRESS ANGIOGRAPHIC CATHETERS 0.035",0.038" 100,125CM 映

象血管攝影導管

594

CVA01565CBMR IMPRESS ANGIOGRAPHIC CATHETERS 0.035",0.038" 65CM,100CM

映象血管攝影導管

594

CVA01565REMR IMPRESS ANGIOGRAPHIC CATHETERS 0.035",0.038"

40CM,65,80,100CM 映象血管攝影導管

594

CVA01565SMMR IMPRESS ANGIOGRAPHIC CATHETERS 0.035",0.038" 65CM,100CM

映象血管攝影導管

594

819

特材代碼 中英文名稱 支付點數-104/01/01

CVA01565VEMR IMPRESS ANGIOGRAPHIC CATHETERS 0.035",0.038"

65CM,100,125CM 映象血管攝影導管

594

CVA015A00NM4 SITESEER CARDIOVASCULAR ANGIOGRAPHIC CATHETER 5FR 594

CVA016A00NM4 SITESEER CARDIOVASCULAR ANGIOGRAPHIC CATHETER 6FR 594

CVA017779AMR PERFORMA DIAGNOSTIC RADIOLOGY CATHETERS 594

CVA01A80CMTM "TERUMO"RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 4FR

80CM 歐帝克血管攝影導管

594

CVA01B001NCK CEREBRAL CATHETER 594

CVA01H001NCK ANGIO CATHETER CEREBRAL CATHETER 594

CVA01H1234BQ ANGIOGRAPHIC CATHETER 4:5FR 100CM(腦部血管用) 594

CVA01HN001CK ROYAL FLUSH PLUS HIGH FLOW ANGIOGRAPHIC FLUSH CATHETER

0.035,0.038 4:6FR 70:110CM

594

CVA01HNB01CK TORCON NB ANGIOGRAPHIC CATHETER 4.1FR 50:125CM(CEREBRAL

PULMONARY MUTIPURPOSE VISCERAL CATH)

594

CVA01HNB02CK TORCON NB ANGIOGRAPHIC CATHETER 5.0,6.0FR

50:125CM(CEREBRAL PULMONARY MUTIPURPOSE VISCERAL CATH)

594

CVA01HNB03CK TORCON NB ANGIOGRAPHIC CATHETER 4.1,5.0,6.0FR 70:110CM(

CORONARY CATH)

594

CVA01HNBR1CK ANGIOGRAPHIC CATHETER W/RADIOPAQUE TIPS 4.1FR 50:125CM 594

CVA01HNBR2CK ANGIOGRAPHIC CATHETER W/RADIOPAQUE TIPS 5.0FR 50:125CM 594

CVA01HNBR3CK ANGIOGRAPHIC CATHETER W/RADIOPAQUE TIPS 4.1FR,5.0FR

70:110CM CORONARY CATH

594

CVA01HNBR4CK TORCON NB ANGIOGRAPHIC CATHETER 594

CVA01HNBR5CK TORCON NB ANGIOGRAPHIC CATHETER 594

CVA01HNBR6CK "COOK" BEACON TIP TORCON NB ADVANTAGE CATHETER 4.0

FR,40~100 CM "曲克" 遠端導引託鏗增益導管

594

CVA01HNBR7CK "COOK" BEACON TIP TORCON NB ADVANTAGE CATHETER 4.0

FR,65~125CM "曲克" 遠端導引託鏗增益導管

594

CVA01HNBR8CK "COOK" BEACON TIP TORCON NB ADVANTAGE CATHETER 4.0

FR,80CM "曲克" 遠端導引託鏗增益導管

594

CVA01HNR01CK ROYAL FLUSH PLUS ANGIOGRAPHIC CATHETER 0.35" 65-110CM 594

CVA01HNR02CK ROYAL FLUSH PLUS ANGIOGRAPHIC CATHETER 0.035" 0.038" 65-

110CM

594

CVA01N001NCK ANGIO CATHETER VISCERAL CATHETER 65:100CM 594

CVA01NP4RCGT "GOODTEC"ANGIOGRAPHY CATHETER "固特克"血管攝影導管 594

CVA01P027NCK ANGIO CATHETER 50:110CM 594

CVA01RC123BQ ANGIOGRAPHIC CATHETER 4:5FR 65~80CM(周邊血管用) 594

CVA020TL0KTM "泰爾茂"歐路克血管造影導管"TERUMO" OUTLOOK ANGIOGRAPHIC

CATHER

594

CVA024SP68TM "TERUMO"RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER

PIGTAIL"泰爾茂"歐帝克血管攝影導管

594

CVA0295007TM "TERUMO"RADIOFOCUS YASHIRD ANGIOGRAPHIC CATHETER"泰爾茂"

血管攝影導管

594

CVA02AB441TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR COBRA 594

CVA02ABCDGTM "TERUMO"RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 4-5FR

65-80CM"泰爾茂"歐帝克血管攝影導管

594

CVA02AC341TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR SHEPHERD

HOOK

594

CVA02AD441TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR J CURVE 594

CVA02AE441TM "TERUMO"RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER"泰爾

茂"歐帝克血管攝影導管

594

CVA02AG341TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4FR RH 594

CVA02AG941TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR YASHIRO 594

820

特材代碼 中英文名稱 支付點數-104/01/01

CVA02APLPRTM "TERUMO"RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 4-6FR

80-100CM"泰爾茂"歐帝克血管攝影導管

594

CVA02APRHLTM "TERUMO"RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 4-6FR

100-110CM"泰爾茂"歐帝克血管攝影導管

594

CVA02BABCHTM "TERUMO"RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 4-5FR

65-100CM"泰爾茂"歐帝克血管攝影導管

594

CVA02BB141TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR HEADHUNTER 594

CVA02BC141TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR NEWTON 594

CVA02BE141TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR BENTSON 594

CVA02CLRJRTM "TERUMO"RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 4-6FR

80-110CM"泰爾茂"歐帝克血管攝影導管

594

CVA02CRFJRTM "TERUMO"RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 4-6FR

80-100CM"泰爾茂"歐帝克血管攝影導管

594

CVA02DADBETM "TERUMO"RADIFOCUS ANGIOGRAPHIC CATHETER 5FR/65,80CM"泰爾

茂"血管攝影導管

594

CVA02DB450TM RADIFOCUS COBRA ANGIOGRAPHIC CATHETER 5:6FR 65:100CM 594

CVA02DCDEGTM "TERUMO"RADIFOCUS ANGIOGRAPHIC CATHETER 5FR/65,80CM"泰爾

茂"血管攝影導管

594

CVA02DD450TM RADIFOCUS J CURVE ANGIOGRAPHIC CATHETER 5:7FR 65CM 594

CVA02DG350TM "TERUMO"RADIFOCUS RH ANGIOGRAPHIC CATHETER 5FR 65CM"泰爾

茂"血管攝影導管

594

CVA02DG450TM RADIFOCUS RS ANGIOGRAPHIC CATHETER 5FR 65CM 594

CVA02DGEA9TM "TERUMO"RADIFOCUS ANGIOGRAPHIC CATHETER 5FR 65,80;100CM"

泰爾茂"血管攝影導管

594

CVA02EA150TM RADIFOCUS SIMMONS ANGIOGRAPHIC CATHETER 5:6FR 100CM 594

CVA02EB150TM RADIFOCUS HEADHUNTER ANGIOGRAPHIC CATHETER 5:7FR 100CM 594

CVA02EBCGJTM "TERUMO"RADIFOCUS ANGIOGRAPHIC CATHETER 5FR 100CM"泰爾茂"

血管攝影導管

594

CVA02EE150TM RADIFOCUS BENTSON ANGIOGRAPHIC CATHETER 5FR 100CM 594

CVA02FGFKLTM "TERUMO"RADIFOCUS ANGIOGRAPHIC CATHETER 5FR 6FR

65,80;100;110CM"泰爾茂"血管攝影導管

594

CVA02RDTR9TM "TERUMO"RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 5-6FR

80-110CM"泰爾茂"歐帝克血管攝影導管

594

CVA02RQ4FNTM OUTLOOK ANGIOGRAPHIC CATHETER 4FR 60CM:110CM ANY CURVE

(衛署字號9685)

594

CVA02RQ5FNTM OUTLOOK ANGIOGRAPHIC CATHETER 5FR 60CM:110CM ANY CURVE

(衛署字號9685)

594

CVC0132400CD VISCERAL COBRA FEMORAL CATHETER 594

CVC0132412CD ANGIO CATHETER FEMORAL AORTIC FLUSH (PIGTAIL) 594

CVC013241NCD ANGIO CATHETER FEMORAL VISCERAL (SIDEWINDER) 594

CVC0132420CD ANGIO CATHETER FEMORAL AORTIC FLUSH (STRAIGH) 594

CVC013243NCD ANGIO CATHETER FEMORAL VISCERAL (BENTSON) 594

CVC013244NCD ANGIO CATHETER FEMORAL VISCERAL J CURVE (SHEPHERD HOOK) 594

CVC0132461CD ANGIO CATHETER FEMORAL VISCERAL (HEADUNTER) 594

CVC0132474CD ANGIO CATHETER FEMORAL VISCERAL (SHEPHERD HOOK) 594

CVC0132545CD NIH CATHETER 5:8FR 80:100CM 594

CVC0134610UV ALVISION CARDIOVASCULAR ANGIOGRAPHIC CATHETER 艾微視心血

管攝影導管

594

CVC014505NCD INFINITI DIAGNOSTIC CARDIOLOGY CATHETER 5FR 594

CVC015325NCD PIGTAIL CATHETER 5:8FR 594

CVC015334NCD CARDIOLOGY ANGIOGRAPHIC CATHETER 4.1FR 65:100CM 594

CVC015335NCD CARDIOLOGY ANGIOGRAPHIC CATHETER 5.2FR 65:125CM 594

CVC015336NCD CARDIOLOGY ANGIOGRAPHIC CATHETER 6FR 80:100CM 594

CVC015346NCD INFINITI DIAGNOSTIC CARDIOLOGY CATHETER 6FR 594

821

特材代碼 中英文名稱 支付點數-104/01/01

CVC015384XCD INFINITI DIAGNOSTIC CARDIOLOGY CATHETER 4FR 594

CVC01752F1MR ANGIO CATHETER 594

CVC018526NSB EXPO ANGIOGRAPHIC CATHETER 100:125CM 5F:7F 594

CVC01AMK4JK0 CARDIAC CATHETER(AMPLATZ)4-6FR 100CM 594

CVC01CAPGTMR ANGIOGRAPHIC CATHETERS PIGTAIL CATHETER 594

CVC01HF456BK HYPERFLOW DIAGNOSTIC CATHETER 594

CVC01JKK4JK0 CARDIAC CATHETER(JUDKINS)4-6FR 100CM 594

CVC01JL235BQ ANGIOGRAPHIC CATHETER JL4,JL3.5 594

CVC01JR235BQ ANGIOGRAPHIC CATHETER JR4,JR3.5 594

CVC01MLK4JK0 CARDIAC CATHETER(MULTIPURPOSE)4-6FR 100CM 594

CVC01N001NCK ANGIO CATHETER CORONARY CATHETER 110:150CM 594

CVC01P1451BQ ANGIOGRAPHIC CATHETER 4:6FR 100~110CM(冠狀動脈用) 594

CVC01P1K4JK0 CARDIAC CATHETER(PIGTAIL)4-6FR 110-130CM 594

CVC01PG155BQ ANGIOGRAPHIC CATHETER P155,P1G 594

CVC01RAK4JK0 CARDIAC CATHETER(INTERNAL MAMMARY, CORONARY BYPASS,

RADIAL)4-6FR 100CM

594

CVC01RH001TM TERUMO RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 泰爾茂

歐帝克血管攝影導管

594

CVC01RH002TM TERUMO RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 泰爾茂

歐帝克血管攝影導管

594

CVC01RHAL1TM OPTITORQUE ANGIOGRAPHIC CATHETER AMPLATZ LEFT 1:3,5:6FR

100CM

594

CVC01RHAR1TM OPTITORQUE ANGIOGRAPHIC CATHETER AMPLATZ RIGHT 1-3 5:6FR

100CM

594

CVC01RHJL4TM OPTITORQUE ANGIOGRAPHIC CATHETER JUDKINS LEFT 3.5:5.0MM

4:6FR 100CM

594

CVC01RHJR4TM OPTITORQUE ANGIOGRAPHIC CATHETER JUDKINS RIGHT 3.5:5.0CM

4:6FR 100CM

594

CVC01RHSP6TM OPTITORQUE ANGIOGRAPHIC CATHETER STRAIGHT PIGTAIL 4:6FR

110CM

594

CXE0100624BA "巴德"歐文四極診斷電極導管"BARD"WOVEN DIAGNOSTIC

ELECTRODE CATHETER

7191

CXE0102943BA QUADPOLAR ELECTRODE 6FR 110CM 1CM 7191

CXE0104019BA WOVEN TRIPOLAR ELECTRODE CATHETER 7191

CXE0107150BA NBIH BIPOLAR PACING ELECTRODE 5:7FR 100:125CM 5905

CXE0108567BA QUADPOLAR ELECTRODE 6FR 120CM 7191

CXE0120011BA "巴德"歐文診斷電極導管"BARD" WOVEN DIAGNOSTIC ELECTRODE

CATHETERS四極

7191

CXE0120015BA WOVEN QUADPOLAR ELECTRODE

CATH200150:3,200055P,56,56E,57P,58,58E,59P,60,60E,61P,62E

,63P,64P

7191

CXE0120016BA WOVEN QUADPOLAR ELECTRODE

CATHETER201400,200066:69,202,203,472,473,574,578,582:586,

7191

CXE0120035BA WOVEN DECAPOLAR ELECTRODE CATHETER 9882

CXE0120061BA "巴德"歐文診斷電極導管"BARD" WOVEN DIAGNOSTIC ELECTRODE

CATHETERS十極

9882

CXE0120076BA OPEN-LUMEN QUADPOLAR ELECTRODE 6FR 110CM 1CM 6889

CXE0120077BA OPEN-LUMEN QUADPOLAR ELECTRODE 6FR 110CM 5MM 6889

CXE0120140BA WOVEN PENTAPOLAR ELECTRODE CATHETER 7191

CXE0140003BA VIKING DECAPOLAR ELECTRODE

CATHETER400030:36,400070:71,400074:75

9882

CXE014000NBA VIKING QUADPOLAR ELECTRODE

CATHETER400001:12,400041:48,400050:51,400091P,

7191

822

特材代碼 中英文名稱 支付點數-104/01/01

CXE0140010BA "巴德"維克診斷電極導管"BARD" VIKING DIAGNOSTIC ELECTRODE

CATHETER十極

9882

CXE0140012BA "巴德"維克診斷電極導管-四極"BARD" VIKING DIAGNOSTIC

ELECTRODE CATHETER

7191

CXE0140050BA VIKING SOFT TIP QUADPOLAR ELECTRODE CATHETER

400501:512,400541:542

7191

CXE0140053BA VIKING SOFT TIP DECAPOLAR ELECTRODE

CATHETER400530:536,400570:571

9882

CXE0140054BA "巴德"探戈診斷電極導管-四,五極"BARD" TANGO DIAGNOSTIC

ELECTRODE CATHETERS

7191

CXE0140057BA "巴德"探戈診斷電極導管"BARD" TANGO DIAGNOSTIC ELECTRODE

CATHETERS十極

9882

CXE01CDFNNYB "爾灣"電生理診斷導管"IBI"ELECTROPHYSIOLOGY DIAGNOSTIC

CATHETER-INQUIRY FIXED SOFT TIP DIAGNOSTIC CATH.-

DECAPOLAR

9882

CXE01EPEXDSB "波士頓科技"診斷電極導管"BOSTON SCIENTIFIC" EXPLORER

FIXED CURVE DIAGNOSTIC CATHETER 十極

9882

CXE01EPEXQSB "波士頓科技"診斷電極導管"BOSTON SCIENTIFIC" EXPLORER

FIXED CURVE DIAGNOSTIC CATHETER 四極

7191

CXE01EPF10JV "日本來富恩" 菲克斯固定彎電極導管"JAPAN LIFELINE" EPSTAR

FIX ELECTROPHYSIOLOGY CATHETER(4FR./10電極)

9882

CXE01F0400CV ELECTRODE CATH.4極,型號F4:6,65-QA,D,E,F,H,K,L-2,5,10,252-

RT;F5,6-

7191

CXE01F1000CV ELECTRODE CATH.DECAPOLAR,型號F5A-DP-282,P10-RT;F6-DA,

F,G,P-

9882

CXE01F1001CV ELECTRODE CATH.DECAPOLAR,型號F6A-DP-282-RT;F7LA-DP-P10-

RT

9882

CXE01F5120JV "日本來富恩" 菲克斯固定彎電極導管"JAPAN LIFELINE" EPSTAR

FIX ELECTROPHYSIOLOGY CATHETER(4,5FR./5電極)

7191

CXE01LUMENST 雷斯龐生理電極導管RESPONSE ELECTROPHYSIOLOGY CATHETERS 11060

CXE01Q0405YB "爾灣"電生理診斷導管"IBI"ELECTROPHYSIOLOGY DIAGNOSTIC

CATHETER-INQUIRY 4F FIXED DIAGNOSTIC CATH.-QUADRAPOLAR

7191

CXE01RDECAST 雷斯龐生理電極導管RESPONSE ELECTROPHYSIOLOGY CATHETERS

6F,7F,DECAPOLAR

9882

CXE01RQUADST 雷斯龐生理電極導管RESPONSE ELECTROPHYSIOLOGY CATHETERS

5F,6F,QUADRIPOLAR

7191

CXE01SDECAST 「“聖猷達”史普力米生理電極導管”SJM”SUPREME

ELECTROPHYSIOLOGY CATHETER」十極

9882

CXE01SQUADST 「“聖猷達”史普力米生理電極導管”SJM”SUPREME

ELECTROPHYSIOLOGY CATHETER」-四極

7191

CXE0201101BA DYNAMIC XT STEERABLE DECAPOLAR ELECTRODE CATHETER 14154

CXE0201103BA DYNAMIC XT STEERABLE QUADPOLAR ELECTRODE CATHETER 12284

CXE0210MCSJV "日本來富恩" 意皮斯塔單向電極導管"JAPAN LIFELINE"

STEERABLE ELECTROPHYSIOLOGY CATHETER(可控式5FR./10電極)

14154

CXE022005NBA EP.XT STEERABLE QUADPOLAR ELECTRODE CATH.200525:527:

735:737:741:769:770:898

12284

CXE0223076BA 巴德”雷迪雅斯特操控式電極導管-四極“BARD”RADIA XT

STEERABLE ELECTRODE CATHETER(6F;110CM;QUADPOLAR)

12284

CXE0223077BA 巴德”雷迪雅斯特操控式電極導管-六極“BARD”RADIA XT

STEERABLE ELECTRODE CATHETER(6F;110CM;HEXAPOLAR)

12255

CXE0223079BA 巴德”雷迪雅斯特操控式電極導管-八極“BARD”RADIA XT

STEERABLE ELECTRODE CATHETER(6F;110CM;OCTAPOLAR)

12255

CXE0223107BA 巴德”雷迪雅斯特操控式電極導管-十極“BARD”RADIA XT

STEERABLE ELECTRODE CATHETER(6F;110CM;DECAPOLAR)

14154

823

特材代碼 中英文名稱 支付點數-104/01/01

CXE0255120JV "日本來富恩" 意皮斯塔單向電極導管"JAPAN LIFELINE"

STEERABLE ELECTROPHYSIOLOGY CATHETER(可控式5FR./5電極)

12284

CXE02557XSSB "波士頓科技" 診斷用導管"BOSTON SCIENTIFIC" POLARIS DX

STEERABLE DIAGNOSTIC CATHETER

12284

CXE02567STYB "爾灣"電生理診斷導管"IBI"ELECTROPHYSIOLOGY DIAGNOSTIC

CATHETER-INQUIRY SOFT TIP STEERABLE DIAGNOSTIC CATH.-

DECAPOLAR

14154

CXE0281504YB "爾灣"電生理診斷導管 "IBI" ELECTROPHYSIOLOGY DIAGNOSTIC

CATHETER(十極)

14154

CXE0281920YB "爾灣" 電生理診斷導管-十極"IBI" ELECTROPHYSIOLOGY

DIAGNOSTIC CATHETER

14154

CXE028478NYB "爾灣"電生理診斷導管 "IBI" ELECTROPHYSIOLOGY DIAGNOSTIC

CATHETER-QUADRIPOLAR STEERABLE 5F

12284

CXE02848STYB "爾灣"電生理診斷導管 "IBI" ELECTROPHYSIOLOGY DIAGNOSTIC

CATHETER(四極)

12284

CXE02849STYB "爾灣"電生理診斷導管 "IBI" ELECTROPHYSIOLOGY DIAGNOSTIC

CATHETER(四極)

12284

CXE02D0400CV ELECTRODE CATH.可彎式四極,型號D5S-270L-B2-RT;D5S-AL-

252-RT;D5S-270L-

12284

CXE02D0401CV ELECTRODE CATH.四極可彎,型號D6,7-DR-5,10,252-RT;D6,7-

AGALBGBLCGCLDGDL

12284

CXE02D1000CV "百歐森偉伯司特" 電極導管-可彎十極"BIOSENSE WEBSTER"

ELECTROPHYSIOLOGY CATHETERS,6,7-10DR,FR-2,5,P10,

252-RT;

14154

CXE02D6DR2CV SMALL DOME DEFLECTABLE QUADRAPOLAR EP CATHETER (可彎式四

極)

12284

CXE02LVW04ST “聖猷達”可控式生理電極導管”SJM”LIVEWIRE STEERABLE

ELECTROPHYSIOLOGY CATHETER-4極

12284

CXE02LVW10ST “聖猷達”可控式生理電極導管”SJM”LIVEWIRE STEERABLE

ELECTROPHYSIOLOGY CATHETER-10極

14154

CXE02QSNSTYB "爾灣"電生理診斷導管"IBI"ELECTROPHYSIOLOGY DIAGNOSTIC

CATHETER-INQUIRY SOFT TIP STEERABLE DIAGNOSTIC CATH.-

QUADRAPOLAR

12284

CXE0321000BA "巴德"史汀格除顫電極導管"BARD"STINGER ABLATION CATHETERS 21479

CXE0331000BA "巴德"天蠍電燒電極導管"BARD"SCORPION ABLATION CATHETER 21479

CXE033100TBA "巴德"天蠍電燒電極導管"BARD" SCORPION ABLATION CATHETER 21479

CXE034500TSB "波士頓科技"布雷瑟心臟除顫系統"BOSTON SCIENTIFIC" BLAZER

II XP CARDIAC ABLATION SYSTEM

21479

CXE035086TSB "波士頓科技" 布雷瑟除顫電極導管"BOSTON SCIENTIFIC" BLAZER

II/BLAZER II HTD ABLATION CATHETER

21479

CXE0360811M4 CARDIOBLATE SURGICAL ABLATION SYSTEM心臟電燒系統 *適應症

請見備註欄(產品型號60813,60814自94年10月1日生效)

40854

CXE038336NYB "爾灣"除顫電極導管"IBI"ABLATION ELECTROPHYSIOLOGY

CATHETER

21479

CXE038337NYB "爾灣"瑟爾皮除顫電極導管"IBI"THERAPY DUAL-8 ABLATION

CATHETER

21479

CXE038344NYB "爾灣"瑟爾皮熱阻電燒導管"IBI" THERAPY 8MM TIP THERMISTOR

ABLATION CATHETER

21479

CXE038372NYB "爾灣"除顫電極導管"IBI" ABLATION ELECTROPHYSIOLOGY

CATHETER

21479

CXE03ASU23FW "艾科" 電刀設備及其附件"ATRICURE" ABLATION AND SENSING

UNIT AND ACCESSORIES*適應症請見備註欄

40854

824

特材代碼 中英文名稱 支付點數-104/01/01

CXE03BD74LWE “百歐森偉伯斯特”易擊史遞兒雙向可彎式診斷/電燒導管

“BIOSENSE WEBSTER”EZ STEER BI-DIRECTIONAL

DIAGNOSTIC/ABLATION DEFLECTABLE TIP CATHETER

21479

CXE03BD78LWE “百歐森偉伯斯特”易擊史遞兒雙向可彎式診斷/電燒導管

BIOSENSE WEBSTER EZ STEER DS BI-DIRECTIONAL

DIAGNOSTIC/ABLATION DEFLECTABLE TIP CATHETER

21479

CXE03BPLARE8 "艾斯泰格"康柏拉電雙極套"ESTECH"COBRA BIPOLAR INSERTS**限

心臟外科手術時使用並附AF心電圖報告術前術中或術後

40854

CXE03CBBRAE8 "艾斯泰格"康柏拉電雙極套"ESTECH"COBRA BIPOLAR INSERTS**限

心臟外科手術時使用並附AF心電圖報告術前術中或術後

40854

CXE03CRY02FW "艾科"冷凍治療系統-探針"ATRICURE" CRYO MODULE SYSTEM-

ABLATION PROBE*使用規定請見備註欄

40210

CXE03CRYCSFW "艾科"冷凍治療儀專用探針"ATRICURE" CRYO1 CRYO-ABLATION

PROBE*使用規定請見備註欄

40210

CXE03CS007E8 "艾斯泰格"康柏拉電刀用內建導線電極"ESTECH"COBRA SURGICAL

PROBE WITH INTEGRATED CABLE**限心臟外科手術時使用並附AF心

電圖報告術前術中或術後

40854

CXE03CS927E8 "ESTECH"COBRA SURGICAL PROBE "艾斯泰格"康柏拉電刀用電極*

限心臟外科手術時使用並附AF心電圖報告術前術中或術後

40854

CXE03EMR23FW "艾科" 外科手術剝離夾鉗 "ATRICURE" ISOLATOR SURGICAL

ABLATION CLAMPS*適應症請見備註欄

40811

CXE03EP920CV 電生理導管(四極可控式溫控導管)(型號

含:D7TAG;TCAGFL252RT;TPSL252RT,D8BTBL;BTCBL:FG252RT,

D8BTCCG;BTCL:F5L252RT)

21479

CXE03EP920WE "百歐森偉伯司特"電生理導管(四極可控式溫控導管) "BIOSENSE

WEBSTER"ELECTROPHYSIOLOGY CATHETER

21479

CXE03LVWTCST "聖猷達" 除顫電燒導管"SJM" LIVEWIRE TC ABLATION CATHETER 21479

CXE03MARNXM4 美敦力瑪林射頻電燒導管MEDTRONIC MARINR STEERABLE ABLATION

CATHETER

21479

CXE03P4500SB "波士頓科技" 布雷瑟除顫電極導管"BOSTON SCIENTIFIC" BLAZER

PRIME TEMPERATURE ABLATION CATHETER

21479

CXE03P5031SB "波士頓科技" 布雷瑟除顫電極導管"BOSTON SCIENTIFIC" BLAZER

PRIME TEMPERATURE ABLATION CATHETER

21479

CXE03SAFFRST "聖猷達" 雙向電燒導管"SJM" SAFIRE BI-DIRECTIONAL ABLATION

CATHETER

21479

CXE03WAUW2ER "愛匹克"心臟燒灼系統"EPICOR"CARDIAC ABLATION SYSTEM限心臟

外科手術時使用並附AF心電圖報告術前術中或術後

40854

CXE03WULP2ER "愛匹克" 心臟燒灼系統 "EPICOR" CARDIAC ABLATION SYSTEM*適

應症請見備註欄

40854

CXE04EACECST "聖猷達" 恩賽導管"SJM" ENSITE ARRAY CATHETER*適應症請見備

註欄

48097

CXE04NS7TCWE 〝百歐森偉伯司特〞藍星導管"BIOSENSE WEBSTER" NAVI-STAR

CATHETER*適應症請見備註欄

48097

FAD01000S2ZJ AHMED GLAUCOMA VALVE壓滅青光眼用舒壓導流瓣膜*適應症請見備

註欄

19900

FAD0150200UX "OPTONOL"EX-PRESS MINIATURE GLAUCOMA SHUNT AND

ACCESSORIES(EDS)"歐能"伊倍視小型眼房水調整閥及其配件*適應

症請見備註欄

19900

FAD0150201UX EX-PRESS GLAUCOMA FILTRATION DEVICE伊倍視青光眼房水調整裝

置*給付規定請見備註欄

19900

FALSM95UVNSZ PMMA I.O.L. 1555

FALSMAAB00A2 "AMO"SENSAR I-PIECE ACRYLIC IOL"眼力健"勝視明單片型摺疊式

人工水晶體

2744

825

特材代碼 中英文名稱 支付點數-104/01/01

FALSMACRA11X "CROMA"ACRYLIC INTRAOCULAR LENS"克洛瑪"人工水晶體 2744

FALSMAR40NA2 "AMO" SENSAR ACRYLIC POSTERIOR CHAMBER INTRAOCULAR LENS "

艾米歐"勝色人工水晶體眼球

2744

FALSMCR5BUA1 PMMA I.O.L 1555

FALSMCSFLXRY "RAYNER"INJECTABLE IOL SYSTEM PACK(HYDROPHILIC ACRYLIC)"

銳能"推注式人工水晶體系統包

2744

FALSMDL52NA2 DURALENS II IOL 1555

FALSMHAKR0ZX AKREOS FOLDABLE INTRAOCULAR LENSES(ACRYLIC W/UV FILTER) 2744

FALSMHBEC11B OII HYDROPHOBIC ACRYLIC POSTERIOR CHAMBER INTRAOCULAR

LENS W/U.V. ABSORBER 艾絲抗紫外線疏水性丙烯酸脂後房人工水

晶體

2744

FALSMHBEC11E "AAREN"HYDROPHOBIC ACRYLIC POSTERIOR CHAMBER INTRAOCULAR

LENS W/U.V. ABSORBER "愛銳"抗紫外線疏水性丙烯酸脂後房人工

水晶體

2744

FALSMHBEC21E "AAREN"SINGLE-PIECE HYDROPHOBIC ACRYLIC POSTERIOR CHAMBAR

IOL W/U.V ABS0RBER"愛銳"單片型抗紫外線疏水性丙烯酸脂後房

人工水晶體

2744

FALSMLS100LS INTRAOCULAR LENS 1555

FALSMMA30BA1 ACRYSOF INTRAOCULAR LENSES 2744

FALSMMC71CA1 PMMA I.O.L. UV,UV+LASER 1555

FALSMMZ30BA1 "ALCON" CILCO INTRAOCULAR LENSES(PMMA)"愛爾康"視而卡人工

水晶體

1555

FALSMNEFL1RQ NEO EYE FOLDABLE INTRAOCULAR LENS新視軟式人工水晶體 2744

FALSMNERP1RQ "ROHTO"NEO EYE INTRAOCULAR LENS RP-11;RP12 "樂敦"新視人工

水晶體

1555

FALSMSA30AA1 ACRYSOF SINGLE-PIECE FOLDABLE ACRYLIC POSTERIOR CHAMBER

INTRAOCULAR LENSES

2744

FALSMSA60AA1 ACRYSOF SINGLE PIECE INTRAOCULAR LENS"愛爾康愛爾蘭廠"可舒

單片型軟式人工水晶體

2744

FALSMSFLEXB9 SILICONE SOFLEX(SOFLEX SE) INTRAOCULAR LENS(可折疊式矽膠) 2744

FALSMSTEC1LS ACRYLIC INTRAOCULAR LENS 2744

FALSNCRYA0B9 "BAUSCH&LOMB"CRYSTALENS ASPHERIC OPTIC ACCOMMODATING

INTRAOCULAR LENS"博士倫”晶鑽非球面調節式人工水晶體※按一

般功能給付,超過部分病患自付

2744

FALSNCRYHDB9 "BAUSCH&LOMB"CRYSTALENS ACCOMMODATING INTRAOCULAR LENS "

博士倫"晶鑽調節式人工水晶體,按一般功能人工水晶體價格給付

,超過部分由病患自付

2744

FALSNMULT1A2 REZOOM ACRYLIC MULTIFOCAL IOL多焦點軟式人工水晶體,按一般

功能人工水晶體價格給付,超過部分由病患自付

2744

FALSNMULT1LS TETRAFLEX INTRAOCULAR LENS 多焦點軟式人工水晶體,按一般功

能人工水晶體價格給付,超過部分由病患自付

2744

FALSNMULT1RY M-FLEX MULTIFOCAL INJECTABLE ACRYLIC LENS INJECTION

SYSTEM 敏視多焦點推注式人工水晶體系統,按一般功能人工水晶

體價格給付,超過部分由病患自付

2744

FALSNMULT2A1 ACRYSOF IQ RESTOR MULTI FOCAL INTRAOCULAR LENS 可舒銳視妥

智慧型非球面多焦點軟式人工水晶體(可濾部分藍光),部分給付

品項,差額由病患自付。

2744

FALSNMULT2RY "RAYNER"SULCOFLEX HYDROPHILIC INTRAOCULAR LENSES"銳能"視

飛克斯人工水晶體(多焦點型)按一般功能人工水晶體價格給付,

超過部分由病患自付

2744

FALSNMULT3A2 "眼力健"添視明單片型多焦點人工水晶體:多焦點軟式人工水晶體

※自付差額品項,超過部分由病患自付"AMO"TECNIS MULTIFOCAL

1-PIECE INTRAOCULAR

2744

826

特材代碼 中英文名稱 支付點數-104/01/01

FALSNMULT3RY "RAYNER"M-FLEX TORIC HYDROPHILIC INTRAOCULAR LENSES"銳能"

多焦點散光推注式人工水晶體※按一般功能人工水晶體價格給付

,超過部分由病患自付

2744

FALSNMULT4A2 "眼力健"添視明多焦點散光矯正單片型人工水晶體(自付差額品

項)"AMO"TECNIS TORIC MULTIFOCAL 1-PIECE SOFT ACRYLIC LENS

2744

FALSNMULT4RY "銳能"視飛克斯人工水晶體:多焦點散光型(自付差額品

項)"RAYNER"SULCOFLEX HYDROPHILIC INTRAOCULAR LENSES

2744

FALSNMULTTA1 ACRYSOF IQ RESTOR MULITFOCAL TORIC IOL"愛爾康"可舒視爾特

智慧型非球面多焦點散光矯正單片軟式人工水晶體(可過濾部分藍

光)※部分給付項目

2744

FALSNNATU1A1 ACRYSOF NATURAL STERILE UV-ABSORBING ACRYLIC FOLDABLE

SINGLE PIECE IOL 黃色軟式人工水晶體,按一般功能人工水晶體

價格給付,超過部分由病患自付

2744

FALSNNATU2A1 ACRYSOF NATURAL SINGLE PIECE IOL "愛爾康愛爾蘭廠"可舒視然

單片型軟式人工水晶體(可過濾部分藍光),按一般功能人工水晶

體給付,超過部分由病患自付

2744

FALSNT0RC1A1 ACRYSOF TORIC SINGLE PIECE NATURAL IOL 散光功能軟式人工水

晶體,按一般功能人工水晶體價格給付,超過部分由病患自付

2744

FALSNT0RC1A2 "AMO"TECNIS TORIC I-PIECE SOFT ACRYLIC LENS"眼力健"添視明

散光矯正單片型折疊式人工水晶體,按一般功能人工水晶體價格

給付,超過部分由病患自付

2744

FALSNT0RC1RY T-FLEX TORIC INJECTABLE ACRYLIC LENS INJECTION SYSTEM 散

光功能軟式人工水晶體,按一般功能人工水晶體價格給付,超過

部分由病患自付

2744

FALSNT0RC2A1 ACRYSOF IQ TORIC SINGLE PIECE NATURAL IOL "愛爾康"可舒智

慧型妥瑞明非球面散光矯正軟式人工水晶體,按一般功能人工水

晶體給付,超過部分由病患自付

2744

FALSNT0RC2RY "RAYNER"SULCOFLEX HYDROPHILIC INTRAOCULAR LENSES"銳能"視

飛克斯人工水晶體(散光型)按一般功能人工水晶體價格給付,超

過部分由病患自付

2744

FALSNT0RCARY "RAYNER"T-FLEX ASPHERIC HYDROPHILIC INTRAOCULAR LENSES"銳

能"散光非球面人工晶體,按一般功能人工水晶體價格給付,超過

部分由病患自付

2744

FALSNT0RTU1D "DR.SCHMIDT"SILICONE INTRAOCULAR LENS MICROSIL TORIC"史密

舒"散光人工水晶體,按一般功能人工水晶體價格給付,超過部分

由病患自付

2744

FALSNT0RTY1D "DR.SCHMIDT"SILICONE INTRAOCULAR LENS MICROSIL TORIC"史密

舒"散光人工水晶體,按一般功能人工水晶體價格給付,超過部分

由病患自付

2744

FALSNWAVE11D "DR.SCHMIDT"ACRYLIC INTRAOCULAR LENS MICROCRYL "史密舒"單

片型軟式人工水晶體體(非球面),按一般功能人工水晶體價格給

付,超過部分由病患自付

2744

FALSNWAVE11E "AAREN"HYDROPHILIC ACRYLIC INTRAOCULAR LENS W/U.V

ABSORBER(ASPHERIC)"愛銳"抗紫外線人工水晶體(非球面),按一

般功能水晶體給付,超過部分民眾自付

2744

FALSNWAVE11K "XCELENS"IDEA INTRAOCULAR LENS(ASPHERIC)"愛瑟樂視"人工水

晶體※非球面軟式人工水晶體,按一般功能人工水晶體價格給付

,超過部分由病患自付

2744

FALSNWAVE11X "CROMA"PRELOADED ACRYLIC INTRAOCULAR LENS "克洛瑪"植入器

預載式人工水晶體(非球面),按一般功能水晶體給付,超過部分

由民眾自付

2744

827

特材代碼 中英文名稱 支付點數-104/01/01

FALSNWAVE1A1 ACRYSOF ASPHERIC NATURAL IQ SINGLE PIECE IOL 非球面軟式人

工水晶體,按一般功能人工水晶體價格給付,超過部分由病患自

2744

FALSNWAVE1B9 SOFPORT ADVANCED OPTICS ASPHERIC LENS 非球面軟式人工水晶

體,按一般功能人工水晶體價格給付,超過部分由病患自付

2744

FALSNWAVE1HY "HOYA"HOYA-PS AF-I(UY)INTRAOCULAR LENS"豪雅"植入器預載式

人工水晶體※非球面過瀘藍光人工水晶體,超過部分由病患自付

2744

FALSNWAVE1LS ASPHERIC IOL 非球面人工水晶體,按一般功能人工水晶體價格給

付,超過部分由病患自付

2744

FALSNWAVE1RY ASPHERIC INJECTABLE ACRYLIC LENS INJECTION SYSTEM 非球面

推注式人工水晶體,按一般功能人工水晶體價格給付,超過部分

由病患自付

2744

FALSNWAVE21D "DR.SCHMIDT"ACRYLIC INTRAOCULAR LENS MICROCRYL "史密舒"單

片型軟式人工水晶體(非球面藍光防護),按一般功能人工水晶體

給付,超過部分由病患自付

2744

FALSNWAVE21E "AAREN"SINGLE-PIECE HYDROPHILIC ACRYLIC POSTERIOR CHAMBER

IOL W/U.V ABSORBER(ASPHERIC)"愛銳"單片型抗紫外線人工水晶

體(非球面),部分給付項目

2744

FALSNWAVE21X "CROMA"BARRETT ACRYLIC INTRAOCULAR LENS ASPHERIC"克洛瑪"

植入器預載式非球面人工水晶體,按一般功能水晶體給付,超過

部分由民眾自付

2744

FALSNWAVE2A1 ACRYSOF RESTOR APODIZED DIFFRACTIVE ASPHERIC IOL 非球面軟

式人工水晶體(含多焦點及可過濾藍光)按一般功能人工水晶體價

格給付,超過部分由病患自付

2744

FALSNWAVE2A2 TECNIS FOLDABLE ACRYLIC IOL 非球面軟式人工水晶體,按一般

功能人工水晶體價格給付,超過部分由病患自付

2744

FALSNWAVE2HY "豪雅"植入器預載單片式非球面黃色人工水晶體(自付差額品

項)"HOYA"ISERT PRELOADED IOL

2744

FALSNWAVE2LS "蘭斯特克"人工水晶體(非球面,自付差額品

項)"LENSTEC"INTRAOCULAR LENS:BI-ASPHERIC IOL

2744

FALSNWAVE2RY "RAYNER"SULCOFLEX HYDROPHILIC INTRAOCULAR LENSES"銳能"視

飛克斯人工水晶體(非球面型)按一般功能人工水晶體價格給付,

超過部分由病患自付

2744

FALSNWAVE3A1 ACRYSOF IQ ASPHERIC NATURAL SINGLE PIECE IOL 可舒愛視明智

慧型非球面單片型軟式人工水晶體(可濾部分藍光),按一般功能

給付,超過部分由病患自付

2744

FALSNWAVE4A2 TECNIS 1 PIECE ACRYLIC INTRAOCULAR LENS 非球面,按一般功

能人工水晶體價格給付,超過部分由病患自付

2744

FALSNWAVE4B9 AKREOS AO MICRO INCISION LENS 非球面軟式人工水晶體,按一

般功能人工水晶體價格給付,超過部分由病患自付

2744

FALSNWAVE5B9 "BAUSCH&LOMB"AKREOS INTRAOCULAR LENS "博士倫〞優視非球面

人工水晶體,按一般功能人工水晶體價格給付,超過部分由病患

自付

2744

FALSNWAVE6B9 "BAUSCH&LOMB"AKREOS AO MICRO INCISION LENS"博士倫”優視微

切口人工水晶體※非球面人工水晶體,按一般功能人工水晶體給

付,超過部分由病患自付

2744

FALSNWAVE7B9 "博士倫"恩視非球面人工水晶體(自付差額品

項)"BAUSCH&LOMB"ENVISTA HYDROPHOBIC ACRYLIC INTRAOCULAR

LENS

2744

FAV01AP050B9 "博士倫"安視平人工玻璃體0.5ML"BAUSCH&LOMB"AMVISC PLUS

VISCOELASTIC

1564

FAV01AP080B9 "博士倫"安視平人工玻璃體0.8ML"BAUSCH&LOMB"AMVISC PLUS

VISCOELASTIC

1785

828

特材代碼 中英文名稱 支付點數-104/01/01

FAV01AV050B9 "博士倫"安視可人工玻璃體0.5ML"BAUSCH&LOMB"AMVISC

VISCOELASTIC

1564

FAV01AV080B9 "博士倫"安視可人工玻璃體0.8ML"BAUSCH&LOMB"AMVISC

VISCOELASTIC

1785

FAV01B0050A1 0.5ML VISCOAT STERILE OCULAR VISCOELASTIC SOLUTION 玻離體

替代物

1564

FAV01B0075A1 0.75CC VISCOAT-STERILE OCULAR VISCOELASTIC SOLUTION 1785

FAV01BC1001X CROMA-PHARMA"BIOCORNEAL II 1CC"克洛法瑪"拜耳克尼人工玻璃

1785

FAV01C0100R9 MEGACROM 1.8% 1CC 明佳人工玻璃體 1785

FAV01C0150R9 VISICROM 2% 1.5ML 2.5ML人工玻璃體 2021

FAV01C0200R9 "CROMA"EYEFILL HD VISCOELASTIC SOLUTION 2.5ML;1.5ML "寇

瑪"艾飛爾人工玻璃體

2021

FAV01C0300R9 "CROMA"EYEFILL M.B VISCOELASTIC SOLUTION 1.8% 0.55ML+1.4%

0.8ML "寇瑪"艾飛雙劑人工玻璃體

2021

FAV01C0400R9 "CROMA"EYEFILL S.C. VISCOELASTIC SOLUTION 0.9ML"寇瑪"艾飛

人工玻璃體

1785

FAV01D0100A1 DISCOVISC OPHTHALMIC VISCOSURGICAL DEVICE 1CC(人工玻璃體) 1785

FAV01D3540A1 0.75ML DUOVISC VISCOELASTIC SYSTEM 1785

FAV01H0055A2 HEALON 0.55ML 1564

FAV01H0506A2 HEALON 5 0.6ML 1564

FAV01HGV55A2 HEALON GV 0.55ML 1564

FAV01HGV85A2 HEALON GV 0.85ML 1785

FAV01P0040A1 0.4ML PROVISC 玻離體替代物 1415

FAV01P0055A1 0.55ML PROVISC 玻離體替代物 1564

FAV01P0085A1 0.85CC PROVISC 玻離體替代物 1785

FAV01RN085RY RAYVISC OPHTHALMIC VISCOELASTIC 0.85ML 人工玻璃體 1785

FAV01VA08CLB VISCAID 0.8ML 1785

FAV01VA10CLB "MBI"VISCAID OPHTHALMIC VISCOELASTIC(1.0CC)"和康"維視愛眼

科黏彈劑

1785

FAV01VA204LB VISCAID OPHTHALMIC VISCOELASTIC 維視愛眼科黏彈劑(0.4CC

1.5% SODIUM HYALURONATE)

1415

FAV01VA205LB VISCAID OPHTHALMIC VISCOELASTIC 維視愛眼科黏彈劑(0.55CC

1.5% SODIUM HYALURONATE)

1564

FAV01VA208LB VISCAID OPHTHALMIC VISCOELASTIC 維視愛眼科黏彈劑(0.8CC

1.5% SODIUM HYALURONATE)

1785

FAV01VA210LB VISCAID OPHTHALMIC VISCOELASTIC 維視愛眼科黏彈劑(1.0CC

1.5% SODIUM HYALURONATE)

1785

FBA0228607SN KRACKOW HTO BLADE STAPLES (鈷鉻鉬) 2473

FBA022860NSN KRACKOW HTO BLADE STAPLE (鈷鉻鉬) 2473

FBA0228673SN OSTEOTOMY FIXATION STAPLES(鈷鉻鉬) 1637

FBA022867NSN OSTEOTOMY STAPLE(鈷鉻鉬) 1637

FBA022868NSN TABLE FIXATION STAPLE(鈷鉻鉬) 2005

FBA0228690SN REGULAR FIXATION STAPLES(鈷鉻鉬) 978

FBA0228698SN TABLE FIXATION STAPLES(鈷鉻鉬) 2005

FBA022869NSN BONE STAPLE(ㄇ型)(鈷鉻鉬) 978

FBA0228720SN SHORT LEG FIXATION STAPLES(鈷鉻鉬) 978

FBA022872NSN BONE STAPLE IRREGULAR/SHORT FIXATION STAPLE(ㄇ型)(鈷鉻

鉬)

978

FBA040053NZ0 TRIOSITE BONE SUBSTITUTES 5CC *適應症請見備註欄 4197

FBA0401202XR "歐斯金"泰普人工代用骨"ORTHOGEM"TRIPORE HA SYNTHETIC BONE

GRAFT 2CC

3150

829

特材代碼 中英文名稱 支付點數-104/01/01

FBA0401210XR "歐斯金"泰普人工代用骨"ORTHOGEM"TRIPORE HA SYNTHETIC BONE

GRAFT 1CC

1923

FBA0402405XR "歐斯金"泰普人工代用骨"ORTHOGEM"TRIPORE HA SYNTHETIC BONE

GRAFT 5CC

4197

FBA0402410XR "歐斯金"泰普人工代用骨"ORTHOGEM"TRIPORE HA SYNTHETIC BONE

GRAFT 10CC

8457

FBA0402420XR "歐斯金"泰普人工代用骨"ORTHOGEM"TRIPORE HA SYNTHETIC BONE

GRAFT 20CC

12062

FBA0403G05BC "BIOMATLANTE"MBCP BONE SUBSTITUTE GRANULES 2-3MM 5CC"瑪蘭

尼"博萌得多孔雙相人工替代物*適應症請建備註欄

4197

FBA040C02BWG "WILTROM"OSTEOCERA BONE GRAFT SUBSTITUTE塊材(2.0CM3)"台微

醫"康骨益人工骨替代物*適應症請見備註欄

3150

FBA040C05BFQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE塊材(5.0CM3)紐創康骨

益人工骨替代物*適應症請見備註欄

4197

FBA040C05BWG "WILTROM"OSTEOCERA BONE GRAFT SUBSTITUTE塊材(5.0CM3)"台微

醫"康骨益人工骨替代物*適應症請見備註欄

4197

FBA040C05GWG "WILTROM"OSTEOCERA BONE GRAFT SUBSTITUTE顆粒(5.0CM3)"台微

醫"康骨益人工骨替代物*適應症請見備註欄

4197

FBA040C07BFQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE塊材(7.0CM3)紐創康骨

益人工骨替代物*適應症請見備註欄

4197

FBA040C07BWG "WILTROM"OSTEOCERA BONE GRAFT SUBSTITUTE塊材(7.0CM3)"台微

醫"康骨益人工骨替代物*適應症請見備註欄

4197

FBA040C07GFQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE顆粒(7.0CM3)紐創康骨

益人工骨替代物*適應症請見備註欄

4197

FBA040C07GWG "WILTROM"OSTEOCERA BONE GRAFT SUBSTITUTE顆粒(7.0CM3)"台微

醫"康骨益人工骨替代物*適應症請見備註欄

4197

FBA040C10BFQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE塊材(10.0CM3)紐創康骨

益人工骨替代物*適應症請見備註欄

8457

FBA040C10BWG "WILTROM"OSTEOCERA BONE GRAFT SUBSTITUTE塊材(10.0CM3)"台

微醫"康骨益人工骨替代物*適應症請見備註欄

8457

FBA040C10GFQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE顆粒(10.0CM3)紐創康骨

益人工骨替代物*適應症請見備註欄

8457

FBA040C10GWG "WILTROM"OSTEOCERA BONE GRAFT SUBSTITUTE顆粒(10.0CM3)"台

微醫"康骨益人工骨替代物*適應症請見備註欄

8457

FBA040CB01FQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE STICK 5X5X20MM(2CM3)

人工骨替代物*適應症請見備註欄

3150

FBA040CB02FQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE STICK 5X5X10MM(2CM3)

人工骨替代物*適應症請見備註欄

3150

FBA040CG01FQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE GRANULE 2-3MM(5CM3)

人工骨替代物*適應症請見備註欄

4197

FBA040CG02FQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE GRANULE 1-2MM(5CM3)

人工骨替代物*適應症請見備註欄

4197

FBA040CG03FQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE GRANULE 0.5-

1MM(5CM3)人工骨替代物*適應症請見備註欄

4197

FBA041000NS1 CHRON OS GRANULE,60%POROSITY,1.0CC *適應症請見備註欄 1923

FBA041001NS1 CHRON OS GRANULE,60%POROSITY,5.0CC*適應症請見備註欄 4197

FBA041002NS1 CHRON OS GANULE,60%POROSITY,10CC*適應症請見備註欄 8457

FBA0410045S1 CHRON OSTM BLOCK,70%POROSITY,12.5X12.5X10MM*適應症請見備

註欄

3150

FBA0410047S1 CHRON OS BLOCK,70%POROSITY,20X20X10MM*適應症請見備註欄 3150

FBA0410101FV BONAGRAFT SYNTHETIC BONE SUBSTITUTE 1GM(1CC)博納骨人工骨

替代物*適應症請見備註欄

1923

FBA0410102FV BONAGRAFT SYNTHETIC BONE SUBSTITUTE 2.5GM(2.5CC)博納骨人

工骨替代物*適應症請見備註欄

3150

830

特材代碼 中英文名稱 支付點數-104/01/01

FBA0410103FV BONAGRAFT SYNTHETIC BONE SUBSTITUTE 5GM(5CC)博納骨人工骨

替代物*適應症請見備註欄

4197

FBA0410500M4 "MEDTRONIC"MASTERGRAFT RESORBABLE CERAMIC GRANULES"美敦

力"瑪斯特可吸收性骨填充物5CC

4197

FBA0411000M4 "MEDTRONIC"MASTERGRAFT RESORBABLE CERAMIC GRANULES"美敦

力"瑪斯特可吸收性骨填充物10CC

8457

FBA041142NZ0 TRIOSITE BONE SUBSTITUTES 2CC適應症請見備註欄 3150

FBA0411500M4 "MEDTRONIC"MASTERGRAFT RESORBABLE CERAMIC GRANULES"美敦

力"瑪斯特可吸收性骨填充物15CC

10236

FBA041151NZ0 BIOMATLANTE TRIOSITE BONE SUBSTITUTES 10CC*適應症請見備註

8457

FBA0413000M4 "MEDTRONIC"MASTERGRAFT RESORBABLE CERAMIC GRANULES"美敦

力"瑪斯特可吸收性骨填充物30CC

16100

FBA041300NZ0 TRIOSITE BONE SUBSTITUTES 2CC適應症請見備註欄 3150

FBA044020RW2 OSTEOSET BONE VOID FILLER 4.8MM 20 PELLETS(2CC) ※適應症

請見備註欄

3150

FBA044050RW2 OSTEOSET BONE VOID FILLER 4.8MM 50 PELLETS(5CC) ※適應症

請見備註欄

4197

FBA044050TW2 OSTEOSET T BONE VOID FILLER W/TOBRAMYCIN 4.8MM 50顆 5CC※

限骨感染需補骨時使用,適應症見備註欄

10246

FBA0463005Z8 STIMULAN CALCIUM SULPHATEBONE GRAFT 3.0MM 5CC*適應症請見

備註欄

4197

FBA0463010Z8 STIMULAN CALCIUM SULPHATEBONE GRAFT 3.0MM 10CC*適應症請見

備註欄

8457

FBA0464010Z8 STIMULAN CALCIUM SULPHATEBONE GRAFT 4.8MM 10CC*適應症請見

備註欄

8457

FBA0464020Z8 STIMULAN CALCIUM SULPHATEBONE GRAFT 4.8MM 20CC*適應症請見

備註欄

12062

FBA0480005Z8 ALLOGRAN-R BONE VOID FILLER 5CC *適應症請見備註欄 4197

FBA0490G10BC MSCP BONE SUBSTITUTE 10CC*適應症請見備註欄 8457

FBA0499205DP CONDUIT TCP(TRICALCIUM PHOSPHATE)GRANULES 5CC※適應症請見

備註欄

4197

FBA0499210DP CONDUIT TCP(TRICALCIUM PHOSPHATE)GRANULES 10CC※適應症請

見備註欄

8457

FBA0499215DP CONDUIT TCP(TRICALCIUM PHOSPHATE)GRANULES 15CC※適應症請

見備註欄

10236

FBA0499230DP CONDUIT TCP(TRICALCIUM PHOSPHATE)GRANULES 30CC(2X15CC)※

適應症請見備註欄

16100

FBA04A2Q05RJ "GRAFTYS"RESORBABLE BONE VOID FILLER 5CC可吸收性骨填充物*

適應症請見備註欄

4197

FBA04A2Q10RJ "GRAFTYS"RESORBABLE BONE VOID FILLER 10CC可吸收性骨填充物

*適應症請見備註欄

8457

FBA04A3Q10RJ "GRAFTYS"RESORBABLE BONE VOID FILLER 10CC可吸收性骨填充物

*適應症請見備註欄

8457

FBA04AG01RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID

FILLER)1ML"台塑生醫"人工代用骨(再吸收骨填充物)*適應症請見

備註欄

1923

FBA04AG03RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER)

3 ML人工代用骨(再吸收骨填充物)*適應症請見備註欄

3150

FBA04AG05RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER)

5 ML人工代用骨(再吸收骨填充物)*適應症請見備註欄

4197

FBA04AG10RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID

FILLER)10ML"台塑生醫"人工代用骨(再吸收骨填充物)*適應症請

見備註欄

8457

831

特材代碼 中英文名稱 支付點數-104/01/01

FBA04AG15RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID

FILLER)15ML"台塑生醫"人工代用骨(再吸收骨填充物)*適應症請

見備註欄

10236

FBA04AG20RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID

FILLER)20ML"台塑生醫"人工代用骨(再吸收骨填充物)*適應症請

見備註欄

12062

FBA04AX0A1HY 艾沛瓷骨移植替代物:塊狀:APACERAM BONE GRAFT SUBSTITUTE-

TYPE AX BLOCK

1923

FBA04AX0A2HY 艾沛瓷骨移植替代物:塊狀:APACERAM BONE GRAFT SUBSTITUTE-

TYPE AX BLOCK

3150

FBA04AX0A3HY 艾沛瓷骨移植替代物:塊狀:APACERAM BONE GRAFT SUBSTITUTE-

TYPE AX BLOCK

4197

FBA04B01141U 尼諾斯人工替代骨(滅菌)NUROS BONE GRAFT

SUBSTITUTE(STERILE)-1CC *適應症請見備註欄

1923

FBA04B02151U 尼諾斯人工替代骨(滅菌)NUROS BONE GRAFT

SUBSTITUTE(STERILE)-2.5CC *適應症請見備註欄

3150

FBA04B03161U 尼諾斯人工替代骨(滅菌)NUROS BONE GRAFT

SUBSTITUTE(STERILE)-5CC *適應症請見備註欄

4197

FBA04B04171U 尼諾斯人工替代骨(滅菌)NUROS BONE GRAFT

SUBSTITUTE(STERILE)-10CC *適應症請見備註欄

8457

FBA04B05181U 尼諾斯人工替代骨(滅菌)NUROS BONE GRAFT

SUBSTITUTE(STERILE)-20CC *適應症請見備註欄

12062

FBA04B06191U 尼諾斯人工替代骨(滅菌)NUROS BONE GRAFT

SUBSTITUTE(STERILE)-30CC *適應症請見備註欄

16100

FBA04BC02BWG "WILTROM"BICERA BONE GRAFT SUBSTITUTE塊材(2.0CM3)"台微醫"

喜瑞骨人工骨替代物*適應症請見備註欄

3150

FBA04BC05BFQ NANO BICERA BONE GRAFT SUBSTITUTE塊狀(5.0CM3)紐創喜瑞骨人

工骨替代物*適應症請見備註欄

4197

FBA04BC05BWG "WILTROM"BICERA BONE GRAFT SUBSTITUTE塊材(5.0CM3)"台微醫"

喜瑞骨人工骨替代物*適應症請見備註欄

4197

FBA04BC05GWG "WILTROM"BICERA BONE GRAFT SUBSTITUTE顆粒(5.0CM3)"台微醫"

喜瑞骨人工骨替代物*適應症請見備註欄

4197

FBA04BC07BFQ NANO BICERA BONE GRAFT SUBSTITUTE塊狀(7.0CM3)紐創喜瑞骨人

工骨替代物*適應症請見備註欄

4197

FBA04BC07BWG "WILTROM"BICERA BONE GRAFT SUBSTITUTE塊材(7.0CM3)"台微醫"

喜瑞骨人工骨替代物*適應症請見備註欄

4197

FBA04BC07GFQ NANO BICERA BONE GRAFT SUBSTITUTE顆粒(7.0CM3)紐創喜瑞骨人

工骨替代物*適應症請見備註欄

4197

FBA04BC07GWG "WILTROM"BICERA BONE GRAFT SUBSTITUTE顆粒(7.0CM3)"台微醫"

喜瑞骨人工骨替代物*適應症請見備註欄

4197

FBA04BC10BFQ NANO BICERA BONE GRAFT SUBSTITUTE塊狀(10.0CM3)紐創喜瑞骨

人工骨替代物*適應症請見備註欄

8457

FBA04BC10BWG "WILTROM"BICERA BONE GRAFT SUBSTITUTE塊材(10.0CM3)"台微

醫"喜瑞骨人工骨替代物*適應症請見備註欄

8457

FBA04BC10GFQ NANO BICERA BONE GRAFT SUBSTITUTE顆粒(10.0CM3)紐創喜瑞骨

人工骨替代物*適應症請見備註欄

8457

FBA04BC10GWG "WILTROM"BICERA BONE GRAFT SUBSTITUTE顆粒(10.0CM3)"台微

醫"喜瑞骨人工骨替代物*適應症請見備註欄

8457

FBA04BCB01FQ NANO BICERA BONE GRAFT SUBSTITUTE GRANULE 5X5X20MM(2 CM3)

人工骨替代物*適應症請見備註欄

3150

FBA04BCB02FQ NANO BICERA BONE GRAFT SUBSTITUTE GRANULE 5X5X10MM(2 CM3)

人工骨替代物*適應症請見備註欄

3150

FBA04BCG01FQ NANO BICERA BONE GRAFT SUBSTITUTE GRANULE2-3MM(5.0 CM3)人

工骨替代物*適應症請見備註欄

4197

832

特材代碼 中英文名稱 支付點數-104/01/01

FBA04BCG02FQ NANO BICERA BONE GRAFT SUBSTITUTE GRANULE 1-2MM(5.0 CM3)

人工骨替代物*適應症請見備註欄

4197

FBA04BCG03FQ NANO BICERA BONE GRAFT SUBSTITUTE GRANULE 0.5-1MM(5.0

CM3)人工骨替代物*適應症請見備註欄

4197

FBA04CA01RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID

FILLER)1ML"台塑生醫"人工代用骨(再吸收骨填充物)*適應症請見

備註欄

1923

FBA04CA03RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER)

3 ML人工代用骨(再吸收骨填充物)*適應症請見備註欄

3150

FBA04CA05RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER)

5 ML人工代用骨(再吸收骨填充物)*適應症請見備註欄

4197

FBA04CA10RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER)

10 ML人工代用骨(再吸收骨填充物)*適應症請見備註欄

8457

FBA04CA15RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER)

15 ML人工代用骨(再吸收骨填充物)*適應症請見備註欄

10236

FBA04CA20RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER)

20 ML人工代用骨(再吸收骨填充物)*適應症請見備註欄

12062

FBA04CS005Z6 UNI-OSTEO 5CC*適應症請見備註欄 4197

FBA04CS010Z6 UNI-OSTEO 10CC*適應症請見備註欄 8457

FBA04CS102Z6 "MERRIES"UNI-OSTEO "美瑞世"人工骨2GM(2CC)*適應症請見備註

3150

FBA04CS105Z6 "MERRIES"UNI-OSTEO "美瑞世"人工骨5GM(5CC)*適應症請見備註

4197

FBA04CS110Z6 "MERRIES"UNI-OSTEO "美瑞世"人工骨10GM(10CC)*適應症請見備

註欄

8457

FBA04CS120Z6 "MERRIES"UNI-OSTEO "美瑞世"人工骨20GM(20CC)*適應症請見備

註欄

12062

FBA04FM01GLB 富瑞密骨骼填補顆粒FORAMIC BONE SUBSTITUTE GRANULES

1CC(0.25CC*4VIALS/BOX;0.5CC*2VIALS/BOX;1CC*1VIAL/BOX) ※

給付規定請見備註欄

1923

FBA04FM02CLB 富瑞密骨骼填補顆粒FORAMIC BONE SUBSTITUTE GRANULES 2CC ※

給付規定請見備註欄

3150

FBA04FM05CLB FORAMIC BONE GRAFT SUBSTITUTE 5CC*適應症請見備註欄 4197

FBA04FM10CLB FORAMIC BONE GRAFT SUBSTITUTE 10CC*適應症請見備註欄 8457

FBA04FM20CLB FORAMIC BONE GRAFT SUBSTITUTE 20CC*適應症請見備註欄 12062

FBA04HS001Z6 "MERRIES" K-PHATE BONE SUBSTITUTE 1CC/TUBE"美瑞世"凱飛人

工骨

1923

FBA04HS205Z6 MERRIES K-PHATE BONE SUBSTITUTE 5CC*適應症請見備註欄 4197

FBA04HT020PQ "PURZER"SINBONEHT BONE REPLACEMENT (7立方公分)生骨替代物

二代*適應症請見備註欄

4197

FBA04HT021PQ "PURZER"SINBONEHT BONE REPLACEMENT(1立方公分)*適應症請見

備註欄

1923

FBA04HT022PQ "PURZER"SINBONEHT BONE REPLACEMENT(2立方公分)*適應症請見

備註欄

3150

FBA04HT023PQ "PURZER"SINBONEHT BONE REPLACEMENT(5立方公分)*適應症請見

備註欄

4197

FBA04HT024PQ "PURZER"SINBONEHT BONE REPLACEMENT (10立方公分)生骨替代物

二代*適應症請見備註欄

8457

FBA04HT040PQ "PURZER"SINBONEHT BONE REPLACEMENT (7立方公分)生骨替代物

二代*適應症請見備註欄

4197

833

特材代碼 中英文名稱 支付點數-104/01/01

FBA04HT041PQ "PURZER"SINBONEHT BONE REPLACEMENT(1立方公分)*適應症請見

備註欄

1923

FBA04HT042PQ "PURZER"SINBONEHT BONE REPLACEMENT(2立方公分)*適應症請見

備註欄

3150

FBA04HT043PQ "PURZER"SINBONEHT BONE REPLACEMENT(5立方公分)*適應症請見

備註欄

4197

FBA04HT050PQ "PURZER"SINBONEHT BONE REPLACEMENT (7立方公分)生骨替代物

二代*適應症請見備註欄

4197

FBA04HT051PQ "PURZER"SINBONEHT BONE REPLACEMENT (1立方公分)生骨替代物

二代*適應症請見備註欄

1923

FBA04HT052PQ "PURZER"SINBONEHT BONE REPLACEMENT (2立方公分)生骨替代物

二代*適應症請見備註欄

3150

FBA04HT053PQ "PURZER"SINBONEHT BONE REPLACEMENT (5立方公分)生骨替代物

二代*適應症請見備註欄

4197

FBA04HT054PQ "PURZER"SINBONEHT BONE REPLACEMENT (10立方公分)生骨替代物

二代*適應症請見備註欄

8457

FBA04HT091PQ "PURZER"SINBONEHT BONE REPLACEMENT(1立方公分)*適應症請見

備註欄

1923

FBA04HT092PQ "PURZER"SINBONEHT BONE REPLACEMENT(2立方公分)*適應症請見

備註欄

3150

FBA04HT093PQ "PURZER"SINBONEHT BONE REPLACEMENT(5立方公分)*適應症請見

備註欄

4197

FBA04MA001HY 艾沛瓷骨移植替代物:顆粒:APACERAM BONE GRAFT

SUBSTITUTE,TYPE AX GRANULE

1923

FBA04MA002HY 艾沛瓷骨移植替代物:顆粒:APACERAM BONE GRAFT

SUBSTITUTE,TYPE AX GRANULE

3150

FBA04MA005HY 艾沛瓷骨移植替代物:顆粒:APACERAM BONE GRAFT

SUBSTITUTE,TYPE AX GRANULE

4197

FBA04MA010HY 艾沛瓷骨移植替代物:顆粒:APACERAM BONE GRAFT

SUBSTITUTE,TYPE AX GRANULE

8457

FBA04P6922BZ SBM BIOSORB BONE SUBSTITUTES 2CC*適應症請見備註欄 3150

FBA04P6944BZ SBM BIOSORB BONE SUBSTITUTES 5CC*適應症請見備註欄 4197

FBA04P6946BZ SBM BIOSORB BONE SUBSTITUTES 15CC*適應症請見備註欄(產品型

號:P822893229自940701起生效)

10236

FBA04PB005YG OSTEO-G BONE VOID FILLER DEVICE 6G 奧斯吉骨填充裝置*適應

症請見備註欄

4197

FBA04PB103YG OSTEO-G BONE VOID FILLER DEVICE 3 CC奧斯吉骨填充裝置*適應

症請見備註欄

3150

FBA04PB106YG OSTEO-G BONE VOID FILLER DEVICE 6 CC奧斯吉骨填充裝置*適應

症請見備註欄

4197

FBA04PSB01PQ 瑞安保立堅骨替代物 PURZER BIPOLYSORB BONE REPLACEMENT 3CC

*給付規定請見備註欄

3150

FBA04SB050PQ "PURZER"SINBONE BONE REPLACEMENT 7.0CM3"瑞安"生骨替代物 3416

FBA04SB054PQ "PURZER"SINBONE BONE REPLACEMENT 10CM3"瑞安"生骨替代物 5492

FBA04SB0X0PQ SINBONE BONE REPLACEMENT (SB020:5MM*5MM*5MM 7.0 CM3)

(SB010自970701起將5MM*5MM*40MM 7.0 CM3變更為5MM*5MM*20MM

7.0 CM3)*適應症請見備註欄

3416

FBA070942NH1 X-CHANGE MESH 5250

FBA1422321Z1 CABLE-READY COBALT CHROME CABLE+SLEEVE※適應症請見備註欄 3546

FBA1422322Z1 STAINLESS CABLE-READY PLATE 6:8HOLE ※適應症請見備註欄 7384

FBA1422323Z1 TITANIUM CABLE-READY GRIP(SHORT)※適應症請見備註欄 4975

FBA142232NZ1 STAINLESS CABLE-READY+SLEEVE 1.3MM,1.8MM ※適應症請見備註

3341

834

特材代碼 中英文名稱 支付點數-104/01/01

FBA143704NH1 DALL-MILES STAINLESS CABLE BONE PLATE ※適應症請見備註欄 7384

FBD00001NNY2 DCS PLATE 6:22HOLE 6748

FBD00001XNY2 DHS PLATE 135:150度 2:12HOLE(產品型號

281420:410,281540:560)

6796

FBD000095NZ1 VERSA-FX SUPRACONDYLAR FIXATION SYSTEM 6748

FBD000135NZ1 VERSA-FX FEMORAL FIXATION SYSTEM 6796

FBD0011931Z1 VERSA-FX II SUPRACONDYLAR FIXATION SYSTEM 90,95度

(PLATEX1+LAG SCREWX1+COMP SCREWX1)

6748

FBD001193NZ1 VERSA-FX II FEMORAL FIXATION SYSTEM 130,135度(PLATEX1+LAG

SCREWX1+COMP SCREWX1)

6796

FBD002412NSN COMPRESSION HIP SCREW SYSTEM (DHS) 6796

FBD0028110WG 威創骨釘骨板植入物(骨釘+骨板)WILTROM BONE SCREW&BONE

PLATE IMPLANT

6796

FBD0028190WG 威創骨釘骨板植入物(骨釘+骨板)WILTROM BONE SCREW&BONE

PLATE IMPLANT

6748

FBD00281CNS1 "SYNTHES"BONE PLATE IMPLANT:COMPRESSION HIP

SYSTEM(DHS)130-150度"信迪思"骨板植入物:動力髖螺釘骨板

6796

FBD00281NNS1 DCS PLATE SYSTEM 95度 6748

FBD003281NZ6 STAINLESS COMPRESSION HIP SCREW SYSTEM 95:140度(PX1+COM

SCREWX1+LAG SCREWX1)

6796

FBD00401NNY2 TITANIUM DCS PLATE 6:22HOLE 7287

FBD00401XNY2 TITANIUM DHS PLATE 135:150度 2:10HOLE 7339

FBD004819N2W "MICROWARE"BONE PLATE:DYNAMIC CONDYLAR SCREW PLATE

SET(PLATE+SCREWX3)"全微"動態膝部骨板骨釘組(骨板+動態拉力

骨釘+壓迫螺絲)

6748

FBD0048NNN2W "MICROWARE"BONE PLATE:DYNAMIC HIP SCREW PLATE

SET(PLATE+SCREWX3)"全微"動態髖部骨板骨釘組(骨板+動態拉力

骨釘+壓迫螺絲)

6796

FBD005963NS9 OMEGA II LOW PROFILE:CHS SYSTEM 135-150度(PLATEX1+LAG

SCREWX1+COMPRESSION SCREWX1)

6796

FBD005966NS9 OMEGA II SYSTEM:SUPRACONDYLAR PLATE 95度(PLATE+LAG

SCREW+COMPRESSION SCREW)

6748

FBD005970NS9 "STRYKER"OMEGA3 HIP PLATE CHS SYSTEM "史賽克"歐米加三固定

系統(PLATEX1+LAG SCREW+COMP SCREW)

6796

FBD005973NS9 OMEGA3 HIP PLATE SYSTEM 歐米加三固定系統(PLATEX1+LAG

SCREW+COMP SCREW)

6748

FBD00K004NAE COMPRESSION HIP SCREW(DHS) 6796

FBD01244XNSN DCS COMPRESSION TUBE PLATE SYSTEM(PLATE+LAG

SCREW+COMPRESSING SCREW)

6748

FBEF100002RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-UNI-LENGTHENING

瑞寶億骨外固定系統-單邊延長組 (PIN CLAMPX2+DISTR&COMP

RODX1) ※適應症請見備註欄

12155

FBEF100003RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-PELVIC FRAME瑞寶

億骨外固定系統-骨盆架框組(PINCLAMPX2+SMOOTH RODX3+ROD

CONNECTORX2)※適應症請見備註欄

21000

FBEF110001D1 TRAUMA-FIX EXTERNAL FIXTOR:FEMORAL BASIC FRAME 股骨基本組

※適應症請見備註欄

18900

FBEF110002D1 TRAUMA-FIX EXTERNAL FIXTOR:FEMORAL LENGTHENING FRAME 股骨

延長組 ※適應症請見備註欄

25722

FBEF110003D1 TRAUMA-FIX EXTERNAL FIXTOR:FEMORAL BONE TRANSPORT FRAM 股

骨移位組 ※適應症請見備註欄

18900

FBEF127500R1 ILIZAROV External Fixator System :FEMORAL BASIC SET 股骨

基本組 ※適應症請見備註欄

18900

835

特材代碼 中英文名稱 支付點數-104/01/01

FBEF135000R1 ILIZAROV External Fixator System :FEMORAL LENGTHENING SET

股骨延長組 ※適應症請見備註欄

25722

FBEF141800R1 ILIZAROV External Fixator System :FEMORAL DOUBLE

LENGTHENING SET股骨雙層延長組※適應症請見備註欄

35112

FBEF1D0001RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-FEMORAL BASIC

FRAME瑞寶億骨外固定系統-股骨基本組(全環+半環+連結桿+螺栓+

鉸+螺帽+桿座)*適應症見備註欄

18900

FBEF1D0002RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM 瑞寶億骨外固定系

統-股骨延長組(全環+半環+連結桿+螺栓+鉸+延長桿+桿座)*適應

症見備註欄

25722

FBEF1D0003RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-FEMORALBONE

TRANSPORT瑞寶億骨外固定系統-股骨移位組(全環+半環+連結桿+

螺栓+螺帽+溝槽墊片)*適應症見備註

18900

FBEF200004RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-UNI-BASIC FRAME瑞

寶億骨外固定系統:單一基本架框組(PIN CLAMPX2+RODX1) ※適應

症請見備註欄

8755

FBEF2199XNS1 DISPOFIX SYSTEM(EXTERNAL

FIXATOR)(SELDRILLX4+CLAMPX4+RODX1+BARX1)※適應症請見備註

8755

FBEF220001D1 TRAUMA-FIX EXTERNAL FIXTOR:TIBIAL BASIC FRAME 脛骨基本組

※適應症請見備註欄

16500

FBEF220002D1 TRAUMA-FIX EXTERNAL FIXTOR:TIBIAL BONE TRANSPORT FRAM 脛

骨移位組 ※適應症請見備註欄

20625

FBEF220003D1 TRAUMA-FIX EXTERNAL FIXTOR:SINGLE LEVEL TIBIAL

LENGTHENING FRAM ※適應症請見備註欄

23100

FBEF220004D1 TRAUMA-FIX EXTERNAL FIXTOR:DOUBLE LEVEL TIBIAL

LENGTHENING FRAM ※適應症請見備註欄

33948

FBEF220005D1 TRAUMA-FIX EXTERNAL FIXTOR:TIBIAL DEFORMITY FRAM ※適應症

請見備註欄

18040

FBEF22010NZ6 HUMERUS FRAME SET(美瑞世肱骨外固定器組)一支連接桿+二支多

向球)※適應症請見備註欄

8755

FBEF223000R1 ILIZAROV External Fixator System :TIBIAL BASIC SET 脛骨基

本組 ※適應症請見備註欄

16500

FBEF228750R1 ILIZAROV External Fixator System :TIBIAL BONE TRANSPORT

SET 脛骨移位組 ※適應症請見備註欄

20625

FBEF231900R1 ILIZAROV External Fixator System :TIBIAL LENGTHENING SET

脛骨延長組 ※適應症請見備註欄

23100

FBEF241400R1 ILIZAROV External Fixator System :TIBIAL DOUBLE

LENGTHENING SET 脛骨雙層延長組 ※適應症請見備註欄

33948

FBEF2D0004RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM 瑞寶億骨外固定系

統-脛骨基本組(全環+半環+連結桿+螺栓+螺帽+溝槽墊片+桿座)*

適應症見備註欄

16500

FBEF2D0005RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-TIBIAL BONE

TRANSPORT瑞寶億骨外固定系統-脛骨移位組(全環+半環+連結桿+

螺栓+溝槽墊片)*適應症見備註欄

20625

FBEF2D0006RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM 瑞寶億骨外固定系

統-脛骨延長組(全環+半環+連結桿+螺栓+延長桿+溝槽墊片+桿

座)*適應症見備註欄

23100

FBEF2D0007RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM 瑞寶億骨外固定系

統-脛骨雙層延長組(全環+半環+連結桿+螺栓+螺帽+延長桿+溝槽

墊片+桿座)*適應症見備註欄

33948

FBEF2D0008RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-TIBIAL DEFORMITY

瑞寶億骨外固定系統-脛骨變形組(全環+半環+連結桿+螺栓+鏈+鉸

+螺帽+桿座)*適應症見備註欄

18040

836

特材代碼 中英文名稱 支付點數-104/01/01

FBEF32180NR1 ILIZAROV External Fixator System:ANKLE BASIC SET 踝骨基本

組 ※適應症請見備註欄

20866

FBEF330001D1 TRAUMA-FIX EXTERNAL FIXTOR:ANKLE BASIC SET 踝骨基本組 ※

適應症請見備註欄

20866

FBEF3D0009RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-ANKLE BASIC瑞寶億

骨外固定系統-踝骨基本組(全環+半環+連結桿+螺栓+鏈+螺帽+溝

槽墊片+桿座)*適應症見備註欄

20866

FBEF421800R1 ILIZAROV External Fixator System :HUMERAL BASIC SET 肱骨

基本組 ※適應症請見備註欄

17500

FBEF440001D1 TRAUMA-FIX EXTERNAL FIXTOR:HUMERAL BASIC SET 肱骨基本組

※適應症請見備註欄

17500

FBEF440002D1 TRAUMA-FIX EXTERNAL FIXTOR:HUMERAL TRANSPORT FRAME 肱骨移

位組 ※適應症請見備註欄

17500

FBEF4D0010RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-HUMERAL BASIC SET

瑞寶億骨外固定系統-肱骨基本組(全環+半環+螺帽+溝槽墊片+桿

座)*適應症見備註欄

17500

FBEF4D0011RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-HUMERAL TRANSPORT

FRAME 瑞寶億骨外固定系統-肱骨移位組(全環+半環+螺帽+溝槽墊

片)*適應症見備註欄

17500

FBEF500017D1 TELES CONNECTING ROD 341

FBEF50019ND1 EXTERNAL FIXATOR SYSTEM:ADJUSTABLE TELESCOPICCONNECTING

ROD調整桿

1692

FBEF50019NRK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-ADJUSTABLE

TELESCOPIC CONNECTING ROD 瑞寶億骨外固定系統-調整桿 ※適

應症請見備註欄

1692

FBEF5U1U2ND1 EXTERNAL FIXATOR SYSTEM:PIN CLAMP針夾(DIA.15:20MM) 3767

FBEF5U1U2NRK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-PIN CLAMP 瑞寶億

骨外固定系統-針夾 ※適應症請見備註欄

3767

FBEF5U3U4ND1 EXTERNAL FIXATOR SYSTEM:SMOOTH ROD 連結桿

(DIA.20MM*L200:300MM)

866

FBEF5U3U4NRK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-CONNECTING ROD 瑞

寶億骨外固定系統-連結桿 ※適應症請見備註欄

866

FBEF5U6U7ND1 EXTERNAL FIXATOR SYSTEM:ROD CONNECTOR桿連結器

(DIA.8:20MM*DIA.20MM)

3971

FBEF5U6U7NRK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-ROD CONNECTOR 瑞

寶億骨外固定系統-桿連結器 ※適應症請見備註欄

3971

FBEFP02106SN ILIZAROV WIRE 1.5MM (WITH STOPPER) ※適應症請見備註欄 1337

FBEFP02107SN ILIZAROV WIRE 1.8MM(WITH STOPPER) ※適應症請見備註欄 1337

FBEFP0640ND1 EXTERNAL FIXATION SYSTEM:WIRE WTITH OLIVE 1.5MM:2.0MM

300:400MM ※適應症請見備註欄

1337

FBEFP294XNY2 SKELETAL TRACTION PIN 319

FBEFP295XNY2 HALF PIN 319

FBEFP296XNY2 TRANSFIXING PIN 319

FBEFPW0002RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-OLIVE WIRE 瑞寶億

骨外固定系統-橄欖針 *適應症見備註欄

1337

FBFW14885NW2 SWANSON WRIST JOINT IMPLANT 11052

FBHCM1100NU0 CUSTOM MADE FEMORAL PROXIMAL TUMOR PROTHSIS

SYSTEM(H+I+C+S)※申報費用時應檢附發票備查

144250

FBHCM2475NH1 "HOWMEDICA"MODULAR REPLACEMENT SYSTEM -HIP※申報時應檢附

該被保險人之發票備查

187000

FBHCM6485NH1 "HOWMEDICA"MODULAR REPLACEMENT SYSTEM -HIP ※申報費用應檢

附發票備查

187000

FBHCMXXXXNW2 CUSTOM MADE HIP SYSTEM(HEAD+INSERT+CUP+FEMORAL STEM)※申

報費用時應檢附該被保險人之發票備查

187000

837

特材代碼 中英文名稱 支付點數-104/01/01

FBHS32000NW2 PERFECTA REVISION HIP STEM(NECK+BODY+STEM)※適應症請見備

註欄

56371

FBHS51108NU0 G.T.F HIP STEM大粗隆股骨柄※適應症請見備註欄 24750

FBHU1113NNDP GLOBAL HUMERAL HEAD 11557

FBHU143001Z1 BIGLIANI/FLATOW HEMI SHOULDER(STEM+HEAD) 38489

FBHU143002Z1 BIGLIANI/FLATOW MONOBLOCK SHOULDER(STEM+HEAD) 38489

FBHU14300NZ1 BIGLIANI/FLATOW HUMERAL STEMS 26932

FBHU14301NZ1 BIGLIANI/FLATOW MODULAR HEAD 11557

FBHU15301NS2 SHOULDER SYSTEM(HEAD+STEM) 38489

FBHU15350NS2 SHOULDER HUMERAL HEAD(鈷鉻) 11557

FBHU15351NS2 SHOULDER HUMERAL STEM(TITANIUM) 26932

FBKCM1101NU0 CUSTOM MADE KNEE JOINT TUMOR PROSTHESIS※申報費用時應檢附

該被保險人之發票備查

177137

FBKCM2475NH1 "HOWMEDICA"GLOBAL MODULAR REPLACEMENT SYSTEM -KNEE※適應

症請見備註欄,申報費用時應附發票備查

187962

FBKCM6485NH1 "HOWMEDICA"GLOBAL MODULAR REPLACEMENT SYSTEM -KNEE※申報

費用應檢附發票備查

187962

FBKCMXXXXNW2 CUSTOM-MADE TOTAL KNEE PROTHESIS ※適應症請見備註欄,申報

費用檢附發票

187962

FBKF22105NU0 FEMUR COMPONENT 訂製型股骨植入物※適應症請見備註欄 89000

FBKF25393NH1 ROTATINGE HINGE TOTAL KNEE SYSTEM:FEMORAL COMPONENT※適應

症請見備註欄

41032

FBKF25880TZ1 NEXGEN ROTATING HINGE KNEE FEMORAL COMPONENT※適應症請見

備註欄

80658

FBKF25926TZ1 "ZIMMER"GENDER SOLUTION PATELLOFEMORAL JOINT

SYSTEM:FEMORAL COMPONENT "捷邁"皮富捷髕骨股骨人工關節:髕

股骨關節股骨組件※適應症請見備註欄

40550

FBKF26430NH1 "HOWMEDICA"AVON PATELLO-FEMORAL JOINT PROSTHESIS-FEMORAL

COMPONENT"好美得卡"阿文股骨膝蓋人工關節-股骨組件

40550

FBKFA5000TZ1 "ZIMMER"GENDER SOLUTION PATELLOFEMORAL JOINT SYSTEM "捷

邁"皮富捷髕骨股骨人工關節※適應症請見備註欄

46894

FBKFA6430NH1 "HOWMEDICA"AVON PATELLO-FEMORAL JOINT PROSTHESIS"好美得

卡"阿文股骨膝蓋人工關節

46894

FBKL25880NZ1 NEXGEN ROTATING HINGE KNEE ARTICULAR SURFACE※適應症請見

備註欄

11684

FBKP21190NH1 ROTATINGE HINGE TOTAL KNEE SYSTEM :DOME PATELLAR (型號

6485-19,39,59-15自93/4/1生效)※適應症請見備註欄

11672

FBKRA6475NH1 ROTATING HINGE TOTAL KNEE SYSTEM (FE+TI PLUG+PA+

BEARING+AXLE+BUMPER+BUSHINGX2)※適應症請見備註欄

117924

FBKS129051U0 SEGMENT PART 訂製型脛骨中段延伸件※適應症請見備註欄 23000

FBKS12905NU0 STEM 訂製型脛骨下段延伸件※適應症請見備註欄 25000

FBKT21872NW2 TIBIAL BASE WITH WEDGE ※限人工膝關節再置換時使用 16704

FBKT222059U0 TIBIAL BEARING COMPONENT 訂製型脛骨連接件※適應症請見備註

18000

FBKT22205NU0 TIBIAL COMPONENT 訂製型脛骨植入物※適應症請見備註欄 33000

FBKT253933H1 ROTATINGE HINGE TOTAL KNEE SYSTEM:TIBIAL BEARING

COMPONENT(型號6485-8435自93/4/1生效※適應症請見備註欄

23335

FBKT253940H1 ROTATINGE HINGE TOTAL KNEE SYSTEM:AXLE ※適應症請見備註欄 8370

FBKT253942H1 ROTATINGE HINGE TOTAL KNEE SYSTEM:BUMPER COMPONENT(型號

6485-4100自93/4/1生效※適應症請見備註欄

5205

FBKT253944H1 ROTATINGE HINGE TOTAL KNEE SYSTEM:BUSHING (型號6485-2460

自93/4/1生效 )※適應症請見備註欄

2344

838

特材代碼 中英文名稱 支付點數-104/01/01

FBKT25394NH1 ROTATINGE HINGE TOTAL KNEE SYSTEM:TIBIAL PLUG (型號6485-

2008:2421自93/4/1生效※適應症請見備註欄

23622

FBKT25880NZ1 NEXGEN ROTATING HINGE KNEE TIBIAL PLATE※適應症請見備註欄 17992

FBN0212206SN R-T RECONSTRUCTION NAIL ※限股骨粗隆下骨折及股骨粗隆複合

骨折患者申報

6933

FBN04102XNU0 HUMERAL LOCKING SCREW※適應症請見備註欄 899

FBN0412223SN R-T PROXIMAL SCREW ※適應症請見備註欄 899

FBN0412226SN FEMORAL LOCKING SCREW ※適應症請見備註欄 899

FBN04303XNU0 FEMORAL&TIBIAL LOCKING SCREW W/SET SCREW※適應症請見備註

899

FBN04403SSY2 STAINLESS INTERLOCKING SCREW 骨髓內固定螺絲 ※適應症請見

備註欄

899

FBN04403STY2 TITANIUM KING BO INTERLOCKING SCREW 鈦合金骨髓內固定螺絲

※適應症請見備註欄

970

FBN04520XNU0 NAIL LOCKING SCREW※適應症請見備註欄 899

FBN05002XNY2 HUMERAL NAIL 7.0:9.0X210:280※適應症請見備註欄 7890

FBN05003XNY2 FEMORAL NAIL 10:17,18,19,300:480,400:180※適應症請見備註

7890

FBN05004XNY2 TIBIAL NAIL 9:13 255:420(產品型號

251280:420,252280:420,253280:420)※適應症請見備註欄

7890

FBN0512202R1 FEMORAL NAIL SYSTEM※適應症請見備註欄 7890

FBN0512202SN FEMORAL NAIL SYSTEM(含NAIL+SCREW)※適應症請見備註欄 7890

FBN0512217R1 TIBIAL NAIL SYSTEM※適應症請見備註欄 7890

FBN0512217SN TIBIAL NAIL SYSTEM(含NAIL+SCREW)※適應症請見備註欄 7890

FBN051722NS9 S2 NAIL SYSTEM:TIBIAL(NX1+SX3)※適應症請見備註欄 7890

FBN051732NS9 S2 NAIL SYSTEM:FEMORAL(NX1+SX3)※適應症請見備註欄 7890

FBN05251XNS1 TIBIAL NAIL SYSTEM※適應症請見備註欄 7890

FBN05274XNS1 FEMORAL NAIL SYSTEM※適應症請見備註欄 7890

FBN05301XNU0 HUMERAL NAIL SYSTEM(NAILX1+SCREWX3)※適應症請見備註欄 7890

FBN05402XNY2 TITANIUM UNREAMED HUMERAL NAIL(NAILX1+LOCKING BOLTX4)※適

應症請見備註欄

7879

FBN05403FSY2 STAINLESS FEMUR INTERLOCKING NAIL(NAILX1+SCREWX3)股骨髓內

釘組※適應症請見備註欄

7890

FBN05403FTY2 TITANIUM KING BO FEMUR INTERLOCKING NAIL

SYSTEM(NAILX1+LOCKING BOLTX3)鈦合金股骨髓內釘組 ※適應症

請見備註欄

7879

FBN05403HSY2 STAINLESS HUMERAL INTERLOCKING NAIL(NAILX1+SCREWX3)肱骨髓

內釘組※適應症請見備註欄

7890

FBN05403HTY2 TITANIUM KING BO HUMERAL INTERLOCKING NAIL

SYSTEM(NAILX1+LOCKING BOLTX3)※適應症請見備註欄

7879

FBN05403TSY2 STAINLESS TIBIA INTERLOCKING NAIL(NAILX1+SCREWX3)脛骨髓內

釘組※適應症請見備註欄

7890

FBN05403TTY2 TITANIUM TIBIA INTERLOCKING NAIL SYSTEM(NAILX1+LOCKING

BOLTX3) 脛骨髓內釘組※適應症請見備註欄

7879

FBN05403XNY2 TITANIUM UNREAMED FEMORAL NAIL(NAILX1+LOCKING BOLTX4)※適

應症請見備註欄

7879

FBN05404XNY2 TITANIUM UNREAMED TIBIAL NAIL(NAILX1+LOCKING BOLTX4)※適

應症請見備註欄

7879

FBN05601XNU0 FEMORAL&TIBIAL NAIL SYSTEM(NX1+SX3)(或SCREW型號5201-

1085:1105)※適應症請見備註欄

7890

FBN05KA36NAE FEMORAL NAIL SYSTEM※適應症請見備註欄 7890

FBN05KC35NAE TIBIAL NAIL SYSTEM※適應症請見備註欄 7890

FBN070301YM1 INTRAMEDULLARY NAIL(KUNTSCHER NAIL)骨髓內釘 1534

839

特材代碼 中英文名稱 支付點數-104/01/01

FBN07KA12NAE KIRSCHNER I.M. PIN FEMUR 1534

FBN07KC11NAE KIRSCHNER I.M.PIN HUMERUS/TIBIAL 1534

FBN080481YM1 INTRAMEDULLARY TIBIA (KUNTSCHER)下腿用骨髓內釘 1534

FBN084041NZ1 KUNTSCHER NAIL 14:15MM 1534

FBNG1273XNS1 PROXIMAL FEMORAL NAILS STAINLESS

STEEL(273.125:137+080:120+234.075:120+259.260:960) ※適應

症請見備註欄

16675

FBNG13120NS9 GAMMMA3 TI SYSTEM 鈦合金股骨固定系統(NX1+SX3) 19440

FBNG14003NS9 GAMMA3 SYSTEM STAINLESS STEEL 脛股骨固定系統

(NAILX1+SCREWX3)※適應症請見備註欄

16675

FBNG1403GSY2 STAINLESS GAMMA INTERLOCKING NAIL SYSTEM

(NAILX1+LOCKINGX3)伽瑪釘單孔(骨髓內釘組)※適應症請見備註

16675

FBNG1403GTY2 TITANIUM KING BO GAMMA LOCKING NAIL SYSTEM(NAILX1+LOCKING

BOLTX3)※適應症請見備註欄

19440

FBNG1473XNS1 TI PROXIMAL FEMORAL NAIL※適應症請見備註欄 18302

FBNG2148GSY2 "SYNTEC"KING BO HUMERAL INTERLOCKING NAILS SYSTEM:GAMMA

SYSTEM:NAIL "亞太醫療"金寶骨髓內釘系統:股骨頸髓內釘※適應

症請見備註欄

10190

FBNG24060NS9 GAMMA3 SYSTEM:NAIL ※適應症請見備註欄 10190

FBNG3161GSY2 "SYNTEC"KING BO HUMERAL INTERLOCKING NAILS SYSTEM:GAMMA

SYSTEM:SET SCREW "亞太醫療"金寶骨髓內釘系統:固定釘※適應

症請見備註欄

865

FBNG3162GSY2 "SYNTEC"KING BO HUMERAL INTERLOCKING NAILS SYSTEM:GAMMA

SYSTEM:LAG SCREW "亞太醫療"金寶骨髓內釘系統:空心鎖釘※適

應症請見備註欄

1997

FBNG34003NS9 GAMMA3 SYSTEM:SET SCREW ※適應症請見備註欄 865

FBNG34004NS9 GAMMA3 SYSTEM:LAG SCREW ※適應症請見備註欄 1997

FBP01007XNY2 4.5 SEMI-TUBULAR PLATE 2:12HOLE 500

FBP01008XNY2 3.5 1/3 TUBULAR PLATE 2:12HOLE 441

FBP01009XNY2 2.7 1/4 TUBULAR PLATE 2:8HOLE 380

FBP011403NSN ONE-THIRD TUBULAR PLATE 2:8HOLE,9:12HOLE 441

FBP011413NSN SEMI-TUBULAR PLATE 2:7HOLE,8:12HOLE 500

FBP011480NSN QUARTER TUBULAR PLATE 3:8HOLE 380

FBP01222NNS1 SEMI-TUBULAR PLATE 2:12 HOLE 39:199MM 500

FBP012413NS1 "SYNTHES"ONE-THIRD TUBULAR PLATE 2:12HOLE 28:148MM"信迪

思"三分之一管狀骨板

441

FBP012420NS1 QUARTER TUBULAR PLATE 3:8 HOLE 380

FBP013020NS9 ONE THIRD TUBULAR PLATE 2:14HOLE 441

FBP01407XNY2 TITANIUM SEMI-TUBULAR PLATE 4.5MM 2:12HOLE 539

FBP01408XNY2 TITANIUM ONE-THIRD TUBULAR PLATE 3.5MM 2:12HOLE 441

FBP01409XNY2 TITANIUM QUARTER TUBULAR PLATE 2.7MM 2:8HOLE 409

FBP01422NN2W "MICROWARE"BONE PLATE:SEMI-TUBULAR PLATE 4.5MM, 2:12

HOLE"全微"骨板:半管型骨板

500

FBP01427NN2W "MICROWARE"BONE PLATE:LENGTHENING PLATE 4.5MM,8:10 HOLE,

BROAD,135:249MM"全微"骨板:寬加長型骨板

1849

FBP01441NN2W "MICROWARE"BONE PLATE:ONE-THIRD TUBULAR PLATE 3.5MM, 2:12

HOLE"全微"骨板:管型骨板

441

FBP014420N2W "MICROWARE"BONE PLATE:QUARTER TUBULAR PLATE 2.7MM,3:8

HOLE"全微"骨板:管型骨板

380

FBP0149274Z1 ONE-QUARTER TUBULAR PLATE 3:8HOLE 380

FBP0149351Z1 ONE-THIRD TUBULAR PLATE 2:12HOLE 441

FBP0149452Z1 SEMI-TUBULAR PLATE 2:12HOLE 500

FBP01LM30NAE 1/3 TUBULAR PLATE 3.5MM 441

840

特材代碼 中英文名稱 支付點數-104/01/01

FBP01LM32NAE SEMI-TUBLUAR PLATE 4.5 MM 500

FBP01LN25NAE QUARTER TUBULAR PLATE 2.7 MM 380

FBP01LN2SNAE SMALL FRAGMENT PLATE 2.7MM 230

FBP02010XNY2 4.5 BROAD DYNAMIC COMPRESSION PLATE 6:18HOLE 1782

FBP02011XNY2 4.5 BROAD LENGTHENING PLATE 8:10HOLE 1849

FBP02012XNY2 4.5 NARROW DYNAMIC COMPRESSION PLATE 2:17HOLE 1228

FBP02013XNY2 4.5 NARROW LENGTHENING PLATE 30:80MM 1849

FBP02015XNY2 2.0,2.7,3.5 DYNAMIC COMPRESSION PLATE 2:12HOLE(產品型號

243540:580)

1782

FBP020559NS9 FEMORAL PLATE DISTAL 6-10HOLE(配合4.5MM,6.5MM SCREW用) 3157

FBP021045NS9 L-BUTTRESS PLATE 67:339MM 3:20HOLE 2130

FBP021402NSN 3.5MM SMALL PLATE 2:12HOLE 952

FBP021412NSN 4.5MM BROAD PLATE 6:18HOLE 1782

FBP021414NSN 4.5MM NARROW PLATE 2:16HOLE,18:24HOLE 1228

FBP021460NSN 2.0MM STRAIGHT PLATE3:6HOLE 230

FBP022235NS1 LC-DCP 3.5 PLATE 4:12HOLE 977

FBP022245NS1 LC-DCP 4.5 NARROW PLATE 2:16HOLE 1228

FBP02224NNS1 NARROW DYNAMIC COMPRESSION PLATE DCP 2:18 HOLE 1228

FBP022265NS1 LC-DCP 4.5 BROAD PLATE 6:18HOLE 1782

FBP02226NNS1 BROAD DYNAMIC COMPRESSION PLATE DCP 6:18 HOLE 103:295MM 1782

FBP022278NS1 BROAD LENGTHENING PLATE 8 HOLE 135:165MM 1849

FBP02228NNS1 NARROW LENGTHENING PLATE 8 HOLE 135:185MM 1787

FBP022431NS1 MINI STRAIGHT PLATE 3:6 HOLE 17:35MM 230

FBP022435NS1 MINI DYNAMIC COMPRESSION PLATE DCP 4:8 HOLE 22:42MM 1173

FBP022440NS1 MINI DYNAMIC COMPRESSION PLATE 2:12 HOLE 20:100MM 1173

FBP022480NS1 DYNAMIC COMPRESSION PLATE DCP 2:12 HOLE 26:146MM 977

FBP023002NS9 SMALL COMPRESSION BONE PLATE ACP 2:30HOLE 1782

FBP023102NS9 SMALL T BONE PLATE ACP 3:4HOLE 952

FBP023205NS9 NARROW BONE PLATE 38:542MM 2:30HOLE 1228

FBP023215NS9 WIDE BONE PLATE ACP 4:30HOLE 1782

FBP02410XNY2 TITANIUM BROAD DYNAMIC COMPRESSION PLATE 4.5MM 6:18HOLE 1296

FBP02412XNY2 TITANIUM NARROW DYNAMIC COMPRESSION PLATE 4.5MM 2:16HOLE 924

FBP02415XNY2 TITANIUM DYNAMIC COMPRESSION PLATE 2.0MM:3.5MM 2:12HOLE 761

FBP02424NN2W "MICROWARE"BONE PLATE:DYNAMIC COMPRESSION PLATE 4.5MM,

NARROW,2:17 HOLE"全微"骨板:窄動態加壓骨板

1228

FBP02426NN2W "MICROWARE"BONE PLATE:DYNAMIC COMPRESSION PLATE 4.5MM,

BROAD,6:22 HOLE"全微"骨板:寬動態加壓骨板

1782

FBP024288N2W "MICROWARE"BONE PLATE:LENGTHENING PLATE 4.5MM,8

HOLES,NARROW, 135:185MM"全微"骨板:窄加長型骨板

1787

FBP02448NN2W "MICROWARE"BONE PLATE:DYNAMIC COMPRESSION PLATE 2.0MM,

2.7MM, 3.5MM, 2:12 HOLEMM"全微"骨板:動態加壓骨板

977

FBP0249202Z1 2.0MM MINI COMPRESSION PLATE 4:12HOLE 1173

FBP0249203Z1 2.0MM STRAIGHT PLATE 3:6HOLE 17:35MM 230

FBP0249272Z1 2.7MM MINI COMPRESSION PLATE 2:12HOLE 977

FBP024935NZ1 3.5MM COMPRESSION PLATE 2:22HOLE 977

FBP0249451Z1 4.5MM BVROAD COMPRESSION PLATE 5:26HOLE 1782

FBP024945NZ1 4.5MM NARROW COMPRESSION PLATE 2:24HOLE 1228

FBP026028NSN MINI STRAIGHT PLATE 20 HOLE 2.0MM 2686

FBP02LM26NAE NARROW LENGTHING PLATE 4.5 MM 1787

FBP02LM28NAE BROAD LENGTHING PLATE 4.5 MM 1849

FBP02LM40NAE NARROW BONE PLATE 4.5 MM 1228

FBP02LM42NAE BROAD BONE PLATE 4.5 MM 1782

FBP02LN027AE MULTIPLE FRAGMENT PLATE 230

841

特材代碼 中英文名稱 支付點數-104/01/01

FBP02LN28NAE DCP 2.0MM SMALL PLATE 1173

FBP03016XNY2 4.5 T-PLATE HOLE 2130

FBP03017NNY2 L-TIBIAL BUTTRESS PLATE 5:13HOLE 2130

FBP03017XNY2 4.5 L/T-BUTTRESS PLATE 3:6HOLE 2130

FBP03018XNY2 4.5 SPOON PLATE 5:6HOLE 1762

FBP03019XNY2 4.5 COBRA HEAD PLATE 8:11HOLE 3892

FBP03021XNY2 4.5 CONDYLAR BUTTRESS PLATE 7:15HOLE 3493

FBP03022XNY2 SMALL T-PLATE 3:6HOLE 952

FBP03023XNY2 CLOCERLEAF PLATE 3:6HOLE,CALCANEAL PLATE 60:70MM 1603

FBP03024XNY2 1.5/2.0 MINI T-PLATE 3:4HOLE,2.0/2.7 L-PLATE 336

FBP03025XNY2 1.5/2.0/2.7 MINI CONDYLAR PLATE 2829

FBP03026XNY2 MINI PLATE STRAIGHT 3:6HOLE 230

FBP03027XNY2 MINI PLATE(H PLATE 4HOLE,STR 100MM,ADAPTATION PLATE

100MM)

2686

FBP03028XNY2 "SYNTEC"SMALL PLATE:RECONSTRUCTION PLATE 5:22HOLE"亞太醫

療"小型骨板:重建骨板(4HOLE自100.10.01生效)

3487

FBP031005NSN STAINLESS LATERAL TIBIAL HEAD BUTTRESS PLATE 5:13HOLE

118:246MM

3157

FBP031179NZ1 RECONSTRUCTION PLATE 3487

FBP031400NSN 4.5MM RECONTRACTION PLATE 3:16HOLE 3487

FBP031406NSN CLOVERLEAF PLATE 3:6HOLE 1603

FBP031407NSN T-BUTTRESS PLATE 4:6HOLE,L-BUTTRESS PLATE TIBIAL 2130

FBP031415NSN SPOON PLATE 5:6HOLE 1762

FBP031416NSN T-PLATE 3:8HOLE 2130

FBP03229NNS1 PELVIC RECONSTRUCTION PLATE 3:16 HOLE 45:253MM 3487

FBP03229XNY2 STRAIGHT RECONSTRUCTION PLATE 4.5 3:16HOLE 3487

FBP032400NS1 SPOON PLATE 5:6:12 HOLE 100:120MM 1762

FBP032401NS1 T PLATE 3:12 HOLE 2130

FBP032403NS1 SUPPORTING T PLATE 4:6 HOLE 81:112MM 2130

FBP032404NS1 SUPPORTING PLATE(L-BUTTRESS PLATE) 3:6 HOLE 2130

FBP032405NS1 LATERAL TIBIAL BUTTRESS PLATE 5:13HOLE 3157

FBP032407NS1 DISTAL FEMUR PLATE 7:15 HOLE (CONDYLAR BUTTRESS PLATE) 3493

FBP0324080S1 HOOK PLATE 128MM 3151

FBP0324080Y2 HOOK PLATE 4.5 123MM 3151

FBP032409NS1 COBRA HEAD PLATE 8:11 HOLE 3892

FBP032411NS1 SMALL T PLATE RIGHT ANGLE 3/3:6/4 HOLE 50:78MM 952

FBP032412NS1 SMALL T PLATE OLIQUE ANGLE 3/3:5/3 HOLE 52:74MM 952

FBP032416NS1 CALCANEAL PLATE 3.5 3104

FBP032418NS1 CLOVERLEAF PLATE 3:6 HOLE 1603

FBP032423NS1 MINI L FINGER JOINT-HEAD PLATE 336

FBP0324241S1 MINI T FINGER JOINT-HEAD PLATE 336

FBP0324319S1 MINI PLATE 1.5:2.0 2686

FBP032433NS1 MINI L FINGER JOINT HEAD PLATE 336

FBP0324341S1 MINI T FINGER JOINT HEAD PLATE 336

FBP0324348S1 MINI PLATE 1.5:2.0 2686

FBP032451NS1 RECONSTRUCTION PLATE STRAIGHT 5:22 HOLE 58:262MM 3487

FBP032453NS1 RECONSTRUCTION PLATE BENT 6:18 HOLE 70:214MM 3487

FBP03245XNY2 PELVIC RECONSTRUCTION PLATE 3.5 6:18HOLE 3487

FBP03246NNS1 MINI T-PLATE 1.5,2.0 9HOLE 2686

FBP033100NS9 OBLIQUE PLATE 3:8HOLE 952

FBP033104NS9 CLOVERLEAF PLATE 4/6 5/6HOLE 3:10HOLE 1603

FBP033110NS9 CALCANEAL PLATE 14HOLE 3104

FBP033220NS9 RECONSTRUCTION 4.5MM PLATE 3:30HOLE(型號430104:430122自

93/1/1生效)

3487

842

特材代碼 中英文名稱 支付點數-104/01/01

FBP033310NS9 V-PLATE T-PLATE 63:335MM 3:20HOLE 2130

FBP033315NS9 T-PLATE 65:337MM 3:20HOLAE 3157

FBP03401XNSN 3.5MM RECONTRACTION PLATE 4:22HOLE,CURVED RECONTRACTION

PLATE 6:18HOLE

3487

FBP03404XNSN SMALL T-PLATE PT ANGLE 3:6HOLE 952

FBP03405XNSN SMALL T-PLATE OBLIQUE 3:5HOLE 952

FBP03416XNY2 TITANIUM T-PLATE 4.5MM 3:8HOLE 1637

FBP03417XNY2 TITANIUM L/T BUTTRESS PLATE 4.5MM 3:6HOLE,L TIBIAL

BUTTRESS PLATE 5:13HOLE

2288

FBP03418XNY2 TITANIUM SPOON PLATE 4.5MM 5:6HOLE 1358

FBP03421XNY2 TITANIUM CONDYLAR BUTTRESS PLATE 4.5MM 7:15HOLE 2901

FBP03422XNY2 TITANIUM SMALL T-PLATE 3.5MM,4.0MM 710

FBP03423XNY2 TITANIUM CLOVERLEAF PLATE 3.5MM,4.0MM,CALCANEAL PLATE

60:70MM

1221

FBP03424XNY2 TITANIUM MINI T-PLATE 1.5MM:2.0MM 3:4HOLE,MINI L-PLATE

2.0MM,2.7MM

240

FBP034256NS9 PELVIS AND ACETABULUM PLATES 2:30HOLE(型號 425654:425772

自93/1/1生效)

3487

FBP03425XNY2 TITANIUM MINI CONDYLAR PLATE 1.5,2.0,2.7MM 2059

FBP03427NNY2 TITANIUM STRAIGHT MINI H-PLATE 1.5,2.0MM 20HOLE 2059

FBP03427XNY2 TITANIUM MINI H-PLATE 1.5,2.0MM 4HOLE 2059

FBP03428XNY2 TITANIUM RECONSTRUCTION PLATE 3.5MM 5:22HOLE 3463

FBP034293N2W "MICROWARE"BONE PLATE:RECONSTRUCTION PLATE 4.5MM,

STRAIGHT,3:16 HOLE"全微"直線型重建骨板

3487

FBP034301NS9 RECONSTRUCTION 4.5MM PLATE 2:30 HOLES 3487

FBP034400N2W "MICROWARE"BONE PLATE:SPOON PLATE 4.5MM, 5:6 HOLE"全微"匙

型骨板

1762

FBP034403N2W "MICROWARE"BONE PLATE:T-BUTTRESS PLATE 4.5MM,4:6 HOLE"全

微"T型支撐骨板

2130

FBP03440502W "MICROWARE"BONE PLATE:L-BUTTRESS PLATE 4.5MM, LEFT/

RIGHT, 3:6 HOLE"全微"左/右邊型L型支撐骨板

2130

FBP03440552W "MICROWARE"BONE PLATE:LATERAL TIBIAL HEAD PLATE

4.5MM,LEFT / RIGHT LEG 5:13 HOLE"全微"左/右邊型側邊脛骨骨

3157

FBP03440902W "MICROWARE"BONE PLATE:CONDYLAR BUTTRESS PLATE 4.5MM,

LEFT/RIGHT,7:15 HOLE"全微"右邊型骨踝支撐骨板

3493

FBP034409N2W "MICROWARE"BONE PLATE:COBRA HEAD PLATE 4.5MM 8:11 HOLE"全

微"眼鏡蛇骨板

3892

FBP03440NN2W "MICROWARE"BONE PLATE:T-PLATE 4.5MM, 3:12 HOLE"全微"骨

板:4.5MM T型骨板

2130

FBP03440XNSN CALCANEAL Y-PLATE 9HOLE 3104

FBP034411N2W "MICROWARE"BONE PLATE:SMALL T-PLATE 3.5MM, RIGHT

ANGLED,3:8 HOLE "全微" 3.5MM 右角T型骨板

952

FBP034412N2W "MICROWARE"BONE PLATE:SMALL T-PLATE 3.5MM, OBLIQUE

ANGLED, 3:5 HOLE"全微" 3.5MM 斜角T型骨板

952

FBP034416N2W "MICROWARE"BONE PLATE:CALCANEAL PLATE 3.5MMT,60:70MM"全

微"跟骨骨板

3104

FBP034418N2W "MICROWARE"BONE PLATE:CLOVERLEAF PLATE 3.5MM, 3:9 HOLE"全

微"葉型骨板

1603

FBP03443312W "MICROWARE"BONE PLATE:MINI L-PLATE 2.0MM, 2.7MM,

LEFT/RIGHT"全微"L型骨板

336

FBP03443332W "MICROWARE"BONE PLATE:MINI L-PLATE 2.0MM,

2.7MM,LEFT/RIGHT,OBLIQUE"全微"L型骨板

336

843

特材代碼 中英文名稱 支付點數-104/01/01

FBP034433N2W "MICROWARE"BONE PLATE:MINI T-PLATE 2.0MM, 2.7MM"全微" T型

骨板

336

FBP034450N2W "MICROWARE"BONE PLATE:RECONSTRUCTION PLATE 3.5MM,

STRAIGHT,5:22 HOLE"全微"直線型重建骨板

3487

FBP034453N2W "MICROWARE"BONE PLATE:RECONSTRUCTION PLATE 3.5MM, CURVED,

6:18 HOLE"全微"弧線型重建骨板

3487

FBP03446192W "MICROWARE"BONE PLATE:MINI STRAIGHT PLATE 20 HOLE 1.5MM,

2.0MM"全微"直線骨板

2686

FBP034462N2W "MICROWARE"BONE PLATE:MINI T-PLATE 1.5MM,2.0MM,3:4 HOLE"

全微"T型骨板 長軸9孔,3:4孔

2686

FBP034464N2W "MICROWARE"BONE PLATE:MINI H-PLATE 1.5MM, 2.0MM "全微" H

型骨板

336

FBP034466N2W "MICROWARE"BONE PLATE:CONDYLAR PLATE 1.5MM,2.0MM,2.7MM

LEFT/ RIGHT"全微"左/右邊型骨踝骨板

2829

FBP03460XNSN 2.0MM T-PLATE,L-PLATE,H-PLATE(型號7114-6030,032,048自

93/1/1起刪除)

336

FBP0349151Z1 1.5MM,2.0MM MINI STRAIGHT PLATE 20HOLE 2686

FBP034915NZ1 1.5MM,2.0MM MINI H-PLATE 4HOLE 2686

FBP0349201Z1 2.0MM MINI L-PLATE 4HOLE 336

FBP0349271Z1 2.7MM MINI L-PLATE 5HOLE 336

FBP0349273Z1 2.7MM MULTIPLE FRAGMENT PLATE 7HOLE 230

FBP034927NZ1 2.7MM MINI T-PLATE 5HOLE 336

FBP0349352Z1 3.5MM T-PLATE 3:4+3:8HOLE 952

FBP0349353Z1 3.5MM OBLIQUE T-PLATE 3+3:5HOLE 952

FBP0349354Z1 3.5MM CLOVERLEAF PLATE 3:10HOLE 1603

FBP0349355Z1 3.5MM CALCANEAL PLATE 60:70MM 3104

FBP0349356Z1 3.5MM CALCANEAL Y-PLATE 3104

FBP0349453Z1 4.5MM T-PLATE 3:8HOLE 2130

FBP0349454Z1 4.5MM T-BUTTRESS PLATE 4:6HOLE 2130

FBP0349455Z1 4.5MM L-BUTTRESS PLATE 4HOLE 2130

FBP0349456Z1 4.5MM SPOON PLATE 5:6HOLE 1762

FBP0349457Z1 4.5MM COBRA HEAD PLATE 8:11HOLE 3892

FBP0349XXNZ1 1.5MM,2.0MM T-PLATE (3:4+9HOLE) 2686

FBP035020NSN STAINLESS MINI STRAIGHT PLATE 20HOLE 1.5MM 2686

FBP035030NSN 1.5MM H-PLATE 4HOLE 2686

FBP036030NSN 2.0MM T-PLATE 9HOLE 2686

FBP037012NSN MULTI FRAGMENT PLATE 7HOLE 230

FBP0371147SN L-PLATE,T-PLATE 2.7MM 3HOLE 336

FBP03LM16NAE CLOVERLEAF PLATE 4.5 MM 3,4 HOLE 1603

FBP03LM17NAE L/T PLATE 4.5 MM 2130

FBP03LM18NAE T-BUTTRESS PLATE 4.5 MM 4,5,6 HOLE 2130

FBP03LM19NAE L-BUTTRESS PLATE 4.5 MM L/R 4 HOLE 2130

FBP03LM50NAE COBRA HEAD PLATE 3892

FBP03LM95NAE SPOON PLATE 4.5MM 5,6 HOLE 1762

FBP03LN02NAE L-PLATE 2.7 MM 336

FBP03LN15NAE RECONSTRUCTION PLATE 3.5 MM 3487

FBP03LN16NAE RECONSTRUCTION PLATE 2.7MM 3487

FBP03LN190AE Y-PLATE 3104

FBP03LN20NAE STRAIGHT/L PLATE 2.0 MM 230

FBP03LN225AE T-MINI FINGER PLATE 336

FBP03LN22NAE L-MINI PLATE 2.0MM 336

FBP03LN26NAE DCP 2.7 MM SMALL PLATE 1173

FBP03LN278AE MAXILLO-RECOSTRUCTION PLATE 2.0MM 3487

FBP03LN29NAE DCP PLATE 2.7MM 1173

844

特材代碼 中英文名稱 支付點數-104/01/01

FBP03LN31NAE MAXILLA PLATE 2.7MM 463

FBP03LN32NAE T-PLATE 3.5 MM 952

FBP03LN33NAE SMALL T-PLATE 3.5MM 952

FBP03LN34NAE PCP PLATE 3.5 MM 952

FBP04142XNSN CONDYLAR PLATE 7:15HOLE LT,RT 3941

FBP042351NS1 HIP DCP PLATE CHILD 2315

FBP042351NY2 ANGLED BLADE PLATES FOR INTERTROCHANTERIC FEMORAL

OSTEOTOMIES IN CHILDREN

2315

FBP042356NS1 TEENAGER HIP PLATE 2315

FBP04236NNY2 ANGLED BLADE PLATES FOR INTERTROCHANTERIC FEMORAL

OSTEOTOMIES IN SMALL ADULTS

2315

FBP04236XNS1 BABY HIP PLATE 2315

FBP04236XNY2 ANGLED BLADE PLATES 90度 FOR INTERTROCHANTERIC FEMORAL

OSTEOTOMIES IN INFANT

2315

FBP042372NS1 CONDYLAR PLATE 95度 12 HOLE 50:80MM 3941

FBP042372NY2 CONDYLAR PLATE 95度 FOR ADULTS AND 5:18HOLE 3941

FBP042375NS1 CONDYLAR PLATE 95度 5 HOLE 50:80MM 3941

FBP042377NS1 CONDYLAR PLATE 95度 7 HOLE 50:80MM 3941

FBP042379NS1 CONDYLAR PLATE 95度 9 HOLE 50:80MM 3941

FBP04238NNS1 ANGLED BLADE PLATE 130度 4:12 HOLE 50:110MM 2927

FBP04238NNY2 ANGLED BLADE PLATES 130度4:12HOLE 50:110MM 2927

FBP042392NS1 HIP PLATE 90:130度 2927

FBP042392NY2 ANGLED BLADE PLATES FOR INTERTROCHANTERIC FEMORAL

OSTEOTOMIES IN ADULTS

2927

FBP042436NS1 MINI CONDYLAR PLATE 2.0:2.7 2829

FBP042466NS1 MINI CONDYLAR PLATE 2829

FBP04254XNSN ADULT CONDYLAR PLATE 95度 5:16HOLE 3941

FBP04282XNS1 CONDYLAR PLATE 2927

FBP04282XNY2 CONDYLAR PLATE 95度 FOR SMALL ADULTS AND ADOLESCENTS 2927

FBP04283XNS1 ANGLED BLADE PLATE 130度 4:9HOLE 2927

FBP04283XNY2 ANGLED BLADE PLATES 130度 FOR SMALL STATURED ADULTS AND

ADOLESCENTS 4:9HOLE

2927

FBP0449XXNZ1 1.5MM,2.0MM,2.7MM MINI CONDYLAR PLATE 7HOLE 2829

FBP045026NSN CONDYLAR PLATE 7HOLE 1.5MM RT,LT 2829

FBP046040NSN CONDYLAR PLATE 7HOLE 2.0MM RT,LT 2829

FBP04K012NAE CONDYLAR PLATE 95度 4.5MM 3941

FBP04K021NAE ANGLED PLATE 90:130度 4.5MM 2927

FBP04LM15NAE CONDYLAR BUTTRESS PLATE 4.5 MM 3493

FBP094102NU0 STAINLESS ANATOMIC FEMUR PLATE 4:8HOLE※限EPIPHYSIS、

METAPHYSIS骨折使用

8744

FBP09510SNY2 STAINLESS ANATOMICAL PLATE (TIBIAL,FEMUR,FIBULAR) ※適應

症請見備註欄

8744

FBPN10579NM1 STEINMANN PIN 180:230MM 184

FBPN12910NY2 STEINMANN PINS(SHANK)2.0MM:4.8MM *9"(230MM) 184

FBPN12915NY2 STEINMANN PINS(THREADED)2.0MM:4.8MM *9"(230MM) 279

FBPN12920NY2 STEINMANN PINS(SHANK)0.8MM:3.0MM *70MM 184

FBPN129210V2 STEINMANN PINS(SHANK) 0.8MM:5.0MM 184

FBPN12921NY2 STEINMANN PINS(SHANK)0.8MM:3.0MM *150MM 184

FBPN12922NY2 STEINMANN PINS(SHANK)0.8MM:3.0MM *280MM 184

FBPN12923NY2 STEINMANN PINS(SHANK)0.8MM:3.0MM *400MM 184

FBPN1292XNY2 STEINMANN PIN 70MM 150MM 184

FBPN12936NS1 STEINMANN PIN WITH THREAD 279

FBPN12936NY2 STEINMANN PIN W/MIDDLE THREADED 279

FBPN1293NNS1 STEINMANN PIN 184

845

特材代碼 中英文名稱 支付點數-104/01/01

FBPN1293NNY2 STEINMANN PIN W/TROCAR TIP 184

FBPN1KX10NAE STEINMANN PIN 184

FBPN1KX30NAE STEINMANN PIN WITH THREAD 279

FBPN20750NM1 KNOWLES PIN 65MM:120MM 879

FBPN22811NZ1 KNOWLES PIN 2.5":4" 879

FBPN22815NZ1 KNOWLES PIN 5 1/4":6" 879

FBPN22818NZ1 KNOWLES PIN 4 1/4":5" 879

FBPN2282XNSN KNOWLES PIN 879

FBPN2283XNSN KNOWLES PIN 879

FBPN22991NY2 KNOWLES PINS(HEX.DRIVE)4.0/4.8MM *2.5":6"(63.5MM:152.4MM) 879

FBPN22993NY2 KNOWLES PINS(SQUARE DRIVE)4.0/4.8MM

*2.5":6"(63.5MM:152.4MM)

879

FBPN30531YM1 MR-500型髓內釘(RUSH PIN) 722

FBPN3KJ10NAE RUSH PIN 722

FBPS1000XNX0 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNX1 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNX2 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNX4 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNX5 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNX6 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNX7 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNX8 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNX9 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNXB PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNXC PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNXD PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNXE PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNXF PARTIAL FOOT PROSTHESIS 健保給寸部分足義肢 ※適應症請見備

註欄.

19000

FBPS1000XNXG PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNXH PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNXJ PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNXK PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNXN PARTIAL FOOT PROSTHESIS 健保給付部分足義肢 ※適應症請見備

註欄

19000

846

特材代碼 中英文名稱 支付點數-104/01/01

FBPS1000XNXS PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNXV PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄.

19000

FBPS1000XNXY PARTIAL FOOT PROSTHESIS 健保給付部分足義肢※適應症請見備

註欄

19000

FBPS1001XNX0 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNX1 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNX2 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNX4 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNX5 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNX6 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNX7 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNX8 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNX9 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNXB SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNXC SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNXD SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNXE SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNXF SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNXG SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNXH SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNXJ SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNXK SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNXN SYME"S PROSTHESIS 珊姆式小腿義肢(踝關節離斷) ※適應症請見

備註欄

24000

FBPS1001XNXS SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNXV SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄.

24000

FBPS1001XNXY SYME"S PROSTHESIS 健保給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄

24000

FBPS1002XNX0 K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNX1 K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

847

特材代碼 中英文名稱 支付點數-104/01/01

FBPS1002XNX2 K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNX4 K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNX5 K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNX6 K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNX7 K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNX8 K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNX9 K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNXB K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNXC K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNXD K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNXE K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNXF K/D PROSTHESIS 健保給付膝關節離斷義肢 ※適應症請見備註欄. 48000

FBPS1002XNXG K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNXH K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNXJ K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNXK K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNXN K/D PROSTHESIS 膝關節離斷義肢 ※適應症請見備註欄 48000

FBPS1002XNXS K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNXV K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄. 48000

FBPS1002XNXY K/D PROSTHESIS 健保給付膝關節離斷義肢※適應症請見備註欄 48000

FBPS1003XNX0 A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNX1 A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNX2 A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNX3 A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNX4 A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNX5 A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNX6 A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNX7 A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNX8 A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNX9 A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNXB A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNXC A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNXD A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNXE A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNXF A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNXG A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

848

特材代碼 中英文名稱 支付點數-104/01/01

FBPS1003XNXH A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNXJ A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNXK A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNXN A/K PROSTHESIS 膝上義肢 ※適應症請見備註欄 48000

FBPS1003XNXS A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNXV A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄. 48000

FBPS1003XNXY A/K PROSTHESIS 健保給付膝上義肢 ※適應症請見備註欄 48000

FBPS1004XNX0 B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNX1 B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNX2 B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNX3 B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNX4 B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNX5 B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNX6 B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNX7 B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNX8 B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNX9 B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNXB B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNXC B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNXD B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNXE B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNXF B/K PROSTHESIS 健保給付膝下義肢 ※適應症請見備註欄. 34000

FBPS1004XNXG B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNXH B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNXJ B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNXK B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNXN B/K PROSTHESIS 膝下義肢 ※適應症請見備註欄 34000

FBPS1004XNXS B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNXV B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄. 34000

FBPS1004XNXY B/K PROSTHESIS 健保給付膝下義肢※適應症請見備註欄 34000

FBPS1005XNX0 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNX1 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNX2 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNX4 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNX5 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNX6 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNX7 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNX8 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNX9 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNXB H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNXC H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNXD H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

849

特材代碼 中英文名稱 支付點數-104/01/01

FBPS1005XNXE H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNXF H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNXG H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNXH H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNXJ H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNXK H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNXN H/D&H/P PROSTHESIS 髖關節離斷義肢 ※適應症請見備註欄 68000

FBPS1005XNXS H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNXV H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄.

68000

FBPS1005XNXY H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢 ※適應症請見備

註欄

68000

FBPS1006XNX0 W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNX1 W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNX2 W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNX4 W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNX5 W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNX6 W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNX7 W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNX9 W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNXB W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNXC W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNXD W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNXE W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNXF W/D PROSTHESIS 健保給付腕關節離斷義肢 ※適應症請見備註欄. 42000

FBPS1006XNXG W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNXH W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄 42000

FBPS1006XNXJ W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNXK W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNXS W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

850

特材代碼 中英文名稱 支付點數-104/01/01

FBPS1006XNXV W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄. 42000

FBPS1006XNXY W/D PROSTHESIS 健保給付腕關節離斷義肢※適應症請見備註欄 42000

FBPS1007XNX0 E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNX1 E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNX2 E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNX4 E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNX5 E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNX6 E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNX7 E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNX9 E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNXB E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNXC E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNXD E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNXE E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNXF E/D PROSTHESIS 健保給付肘關節離斷義肢 ※適應症請見備註欄. 62000

FBPS1007XNXG E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNXH E/D PROSTHESIS健保給付肘關節離斷義肢※適應症請見備註欄 62000

FBPS1007XNXJ E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNXK E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNXS E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNXV E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄. 62000

FBPS1007XNXY E/D PROSTHESIS 健保給付肘關節離斷義肢※適應症請見備註欄 62000

FBPS1008XNX0 A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNX1 A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNX2 A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNX4 A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNX5 A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNX6 A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNX7 A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNX9 A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNXB A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNXC A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNXD A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNXE A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNXF A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

851

特材代碼 中英文名稱 支付點數-104/01/01

FBPS1008XNXG A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNXH A/E PROSTHESIS 健保給付肘關節以上截肢義肢※適應症請見備註

65000

FBPS1008XNXJ A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNXK A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNXS A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNXV A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄. 65000

FBPS1008XNXY A/E PROSTHESIS 健保給付肘上義肢※適應症請見備註欄 65000

FBPS1009XNX0 B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNX1 B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNX2 B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNX4 B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNX5 B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNX6 B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNX7 B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNX9 B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNXB B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNXC B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNXD B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNXE B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNXF B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNXG B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNXH B/E PROSTHESIS 健保給付肘下功能性義肢※適應症請見備註欄 42000

FBPS1009XNXJ B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNXK B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNXS B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNXV B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄. 42000

FBPS1009XNXY B/E PROSTHESIS 健保給付肘下義肢 ※適應症請見備註欄 42000

FBPS1010XNX0 S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNX1 S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNX2 S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNX4 S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNX5 S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNX6 S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNX7 S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNX9 S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNXB S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNXC S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNXD S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNXE S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNXF S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

852

特材代碼 中英文名稱 支付點數-104/01/01

FBPS1010XNXG S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNXH S/D PROSTHESIS 健保給付功能性肩關節離斷義肢※適應症請見備

註欄

65000

FBPS1010XNXJ S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNXK S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNXS S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNXV S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1010XNXY S/D PROSTHESIS 健保給付肩關節離斷義肢 ※適應症請見備註欄. 65000

FBPS1011XNX0 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNX1 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNX2 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNX4 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNX5 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNX6 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNX7 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNX9 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNXB FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNXC FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNXD FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNXE FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNXF FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNXG FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNXH FOREQUATER PROSTHESIS 健保給付肩胛截除義肢※適應症請見備

註欄

65000

FBPS1011XNXJ FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNXK FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNXS FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNXV FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄.

65000

FBPS1011XNXY FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 ※適應症請見備

註欄

65000

853

特材代碼 中英文名稱 支付點數-104/01/01

FBPS1012XNX0 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNX1 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNX2 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNX4 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNX5 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNX6 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNX7 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNX9 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNXB A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNXC A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNXD A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNXE A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNXF A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNXG A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNXH A/E COSMETIC PROSTHESIS 健保給付美觀性肘關節以上截肢義肢

※適應症請見備註欄

23000

FBPS1012XNXJ A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNXK A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNXN A/E COSMETIC PROSTHESIS 肘上美觀義肢 ※適應症請見備註欄 23000

FBPS1012XNXS A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNXV A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄.

23000

FBPS1012XNXY A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢 ※適應症請見

備註欄

23000

FBPS1013XNX0 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNX1 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNX2 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNX4 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNX5 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNX6 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

854

特材代碼 中英文名稱 支付點數-104/01/01

FBPS1013XNX7 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNX9 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNXB B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNXC B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNXD B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNXE B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNXF B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNXG B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNXH B/E COSMETIC PROSTHESIS健保給付肘關節以下美觀義肢※適應症

請見備註欄

14000

FBPS1013XNXJ B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNXK B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNXN B/E COSMETIC PROSTHESIS 肘下美觀義肢 ※適應症請見備註欄 14000

FBPS1013XNXS B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNXV B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄.

14000

FBPS1013XNXY B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢※適應症請見

備註欄

14000

FBPS1014XNX0 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNX1 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNX2 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNX4 S/D COSMETIC PROSTHESIS健保給付肩關節離斷美觀義肢 ※適應

症請見備註欄.

32300

FBPS1014XNX5 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNX6 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNX7 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNX9 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNXB 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNXC 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNXD 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNXE 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNXF 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNXG 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNXH S/D COSMETIC PROSTHESIS 健保給付美觀性肩關節離斷義肢※適

應症請見備註欄

32300

FBPS1014XNXJ 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNXK 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNXS 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNXV 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄. 32300

FBPS1014XNXY 健保給付肩關節離斷美觀義肢 ※適應症請見備註欄 32300

FBPS1015XNX0 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNX1 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNX2 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

855

特材代碼 中英文名稱 支付點數-104/01/01

FBPS1015XNX4 TRANS-CARPAL COSMETIC PROSTHESIS健保給付橫掌截肢美觀義肢

※適應症請見備註欄.

7300

FBPS1015XNX5 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNX6 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNX7 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNX9 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNXB 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNXC 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNXD 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNXE 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNXF 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNXG 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNXH TRANS-CARPAL COSMETIC PROSTHESIS 健保給付橫掌截肢義肢※適

應症請見備註欄

7300

FBPS1015XNXJ 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNXK 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNXS 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNXV 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄. 7300

FBPS1015XNXY 健保給付橫掌截肢美觀義肢 ※適應症請見備註欄 7300

FBPS1016XNX0 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNX1 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNX2 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNX4 PARTIAL FINGER COSMETIC PROSTHESIS健保給付手指截肢美觀義

肢 ※適應症請見備註欄.

4800

FBPS1016XNX5 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNX6 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNX7 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNX9 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNXB 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNXC 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNXD 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNXE 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNXF 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNXG 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNXH PARTIAL FINGER COSMETIC PROSTHESIS 健保給付手指截肢義肢※

適應症請見備註欄

4800

FBPS1016XNXJ 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNXK 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNXS 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNXV 健保給付手指截肢美觀義肢 ※適應症請見備註欄. 4800

FBPS1016XNXY 健保給付手指截肢美觀義肢 ※適應症請見備註欄 4800

FBPS2000XNX0 PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNX1 PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNX2 PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNX4 PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNX5 PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNX6 PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

856

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2000XNX7 PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNX8 PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNX9 PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNXB PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNXC PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNXD PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNXE PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNXF PARTIAL FOOT PROSTHESIS 部分給寸部分足義肢 ※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNXG PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNXH PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNXJ PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNXK PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNXN PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNXS PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2000XNXV PARTIAL FOOT PROSTHESIS 部分給付部分足義肢※適應症請見備

註欄,按健保給付之部分足義肢給付,超過部分由病患自付.

19000

FBPS2001XNX0 SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNX1 SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNX2 SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNX4 SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNX5 SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNX6 SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNX7 SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNX8 SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

857

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2001XNX9 SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNXB SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNXC SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNXD SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNXE SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNXF SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNXG SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNXH SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNXJ SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNXK SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNXN SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNXS SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2001XNXV SYME"S PROSTHESIS 部分給付珊姆式小腿義肢(踝關節離斷)※適

應症請見備註欄,按健保給付之珊姆式小腿義肢(踝關節離斷)給

付,超過部分由病患自付.

24000

FBPS2002XNX0 K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNX1 K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNX2 K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNX4 K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNX5 K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNX6 K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNX7 K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

858

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2002XNX8 K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNX9 K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNXB K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNXC K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNXD K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNXE K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNXF K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNXG K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNXH K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNXJ K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNXK K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNXN K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNXS K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2002XNXV K/D PROSTHESIS 部分給付膝關節離斷義肢※適應症請見備註欄,

按健保給付之膝關節離斷義肢給付,超過部分由病患自付.

48000

FBPS2003XNX0 A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNX1 A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNX2 A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNX3 A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNX4 A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNX5 A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNX6 A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNX7 A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNX8 A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNX9 A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNXB A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNXC A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNXD A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

859

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2003XNXE A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNXF A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNXG A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNXH A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNXJ A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNXK A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNXN A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNXS A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2003XNXV A/K PROSTHESIS 部分給付膝上義肢 ※適應症請見備註欄,按健

保給付膝上義肢給付,超過部分由病患自付.

48000

FBPS2004XNX0 B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNX1 B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNX2 B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNX3 B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNX4 B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNX5 B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNX6 B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNX7 B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNX8 B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNX9 B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNXB B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNXC B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNXD B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNXE B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNXF B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNXG B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNXH B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNXJ B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

860

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2004XNXK B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNXN B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNXS B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2004XNXV B/K PROSTHESIS 部分給付膝下義肢※適應症請見備註欄,按健保

給付之膝下義肢給付,超過部分由病患自付.

34000

FBPS2005XNX0 H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNX1 H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNX2 H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNX4 H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNX5 H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNX6 H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNX7 H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNX8 H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNX9 H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNXB H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNXC H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNXD H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNXE H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNXF H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNXG H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

861

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2005XNXH H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNXJ H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNXK H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNXN H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNXS H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2005XNXV H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢 ※適應症請見備

註欄,按健保給付之髖關節離斷義肢給付,超過部分由病患自付.

68000

FBPS2006XNX0 W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNX1 W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNX2 W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNX4 W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNX5 W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNX6 W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNX7 W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNX9 W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNXB W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNXC W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNXD W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNXE W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNXF W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNXG W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNXH W/D PROSTHESIS部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNXJ W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNXK W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNXN W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

862

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2006XNXS W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2006XNXV W/D PROSTHESIS 部分給付腕關節離斷義肢※適應症請見備註欄,

按健保給付之腕關節離斷義肢給付,超過部分由病患自付.

42000

FBPS2007XNX0 E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNX1 E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNX2 E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNX4 E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNX5 E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNX6 E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNX7 E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNX9 E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNXB E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNXC E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNXD E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNXE E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNXF E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNXG E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNXH E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNXJ E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNXK E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNXN E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNXS E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2007XNXV E/D PROSTHESIS 部分給付肘關節離斷義肢※適應症請見備註欄,

按健保給付之肘關節離斷義肢給付,超過部分由病患自付.

62000

FBPS2008XNX0 A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNX1 A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNX2 A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNX4 A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNX5 A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

863

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2008XNX6 A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNX7 A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNX9 A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNXB A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNXC A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNXD A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNXE A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNXF A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNXG A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNXH A/E PROSTHESIS部分給付肘關節以上截肢義肢※適應症請見備註

欄,按健保給付之肘關節以上截肢義肢給付,超過部分由病患自

付.

65000

FBPS2008XNXJ A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNXK A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNXN A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNXS A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2008XNXV A/E PROSTHESIS 部分給付肘上義肢※適應症請見備註欄,按健保

給付之肘上義肢給付,超過部分由病患自付.

65000

FBPS2009XNX0 B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNX1 B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNX2 B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNX4 B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNX5 B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNX6 B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNX7 B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNX9 B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNXB B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNXC B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNXD B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

864

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2009XNXE B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNXF B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNXG B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNXH B/E PROSTHESIS部分給付肘下功能性義肢※適應症請見備註欄,

按健保給付之肘下功能性義肢給付,超過部分由病患自付.

42000

FBPS2009XNXJ B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNXK B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNXN B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNXS B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2009XNXV B/E PROSTHESIS 部分給付肘下義肢 ※適應症請見備註欄,按健

保給付之肘下義肢給付,超過部分由病患自付.

42000

FBPS2010XNX0 S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNX1 S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNX2 S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNX4 S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNX5 S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNX6 S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNX7 S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNX9 S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNXB S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNXC S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNXD S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNXE S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNXF S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNXG S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNXH S/D PROSTHESIS部分給付功能性肩關節離斷義肢※適應症請見備

註欄,按健保給付之功能性肩關節離斷義肢給付,超過部分由病患

自付.

65000

FBPS2010XNXJ S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNXK S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

865

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2010XNXN S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNXS S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2010XNXV S/D PROSTHESIS 部分給付肩關節離斷義肢 ※適應症請見備註欄

,按健保給付之肩關節離斷義肢給付,超過部分由病患自付.

65000

FBPS2011XNX0 FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNX1 FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNX2 FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNX4 FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNX5 FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNX6 FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNX7 FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNX9 FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNXB FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNXC FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNXD FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNXE FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNXF FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNXG FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNXH FOREQUATER PROSTHESIS 部分給付肩胛截除義肢※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNXJ FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

866

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2011XNXK FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNXN FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNXS FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2011XNXV FOREQUATER PROSTHESIS 部分給付肩胛截除義肢 ※適應症請見備

註欄,按健保給付之肩胛截除義肢給付,超過部分由病患自付.

65000

FBPS2012XNX0 A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNX1 A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNX2 A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNX4 A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNX5 A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNX6 A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNX7 A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNX9 A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNXB A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNXC A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNXD A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNXE A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNXF A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNXG A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

867

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2012XNXH A/E COSMETIC PROSTHESIS 部分給付美觀性肘關節以上截肢義肢

※適應症請見備註欄,按健保給付之美觀性肘關節以上截肢義肢

給付,超過部分由病患自付.

23000

FBPS2012XNXJ A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNXK A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNXN A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNXS A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2012XNXV A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢 ※適應症請見

備註欄,按健保給付之肘上美觀義肢給付,超過部分由病患自付.

23000

FBPS2013XNX0 B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNX1 B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNX2 B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNX4 B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNX5 B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNX6 B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNX7 B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNX9 B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNXB B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNXC B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNXD B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNXE B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

868

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2013XNXF B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNXG B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNXH B/E COSMETIC PROSTHESIS部分給付肘關節以下美觀義肢※適應症

請見備註欄,按健保給付之肘關節以下美觀義肢給付,超過部分由

病患自付.

14000

FBPS2013XNXJ B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNXK B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNXN B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNXS B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2013XNXV B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢※適應症請見

備註欄,按健保給付之肘下美觀義肢給付,超過部分由病患自付.

14000

FBPS2014XNX0 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNX1 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNX2 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNX4 S/D COSMETIC PROSTHESIS部分給付肩關節離斷美觀義肢 ※適應

症請見備註欄,按健保給付之肩關節離斷美觀義肢給付,超過部分

由病患自付.

32300

FBPS2014XNX5 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNX6 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNX7 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNX9 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNXB 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNXC 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNXD 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNXE 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNXF 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNXG 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

869

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2014XNXH S/D COSMETIC PROSTHESIS部分給付美觀性肩關節離斷義肢※適應

症請見備註欄,按健保給付之美觀性肩關節離斷義肢給付,超過部

分由病患自付

32300

FBPS2014XNXJ 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNXK 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNXS 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2014XNXV 部分給付肩關節離斷美觀義肢 ※適應症請見備註欄,按健保給付

之肩關節離斷美觀義肢給付,超過部分由病患自付.

32300

FBPS2015XNX0 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNX1 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNX2 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNX4 TRANS-CARPAL COSMETIC PROSTHESIS部分給付橫掌截肢美觀義肢

※適應症請見備註欄,按健保給付之橫掌截肢美觀義肢給付,超過

部分由病患自付.

7300

FBPS2015XNX5 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNX6 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNX7 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNX9 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNXB 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNXC 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNXD 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNXE 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNXF 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNXG 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNXH TRANS-CARPAL COSMETIC PROSTHESIS部分給付橫掌截肢義肢※適

應症請見備註欄,按健保給付之橫掌截肢義肢給付,超過部分由病

患自付.

7300

FBPS2015XNXJ 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNXK 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNXN 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNXS 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

FBPS2015XNXV 部分給付橫掌截肢美觀義肢 ※適應症請見備註欄,按健保給付之

橫掌截肢美觀義肢給付,超過部分由病患自付.

7300

870

特材代碼 中英文名稱 支付點數-104/01/01

FBPS2016XNX0 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNX1 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNX2 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNX4 PARTIAL FINGER COSMETIC PROSTHESIS部分給付手指截肢美觀義

肢 ※適應症請見備註欄,按健保給付之手指截肢美觀義肢給付,

超過部分由病患自付.

4800

FBPS2016XNX5 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNX6 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNX7 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNX9 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNXB 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNXC 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNXD 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNXE 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNXF 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNXG 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNXH PARTIAL FINGER COSMETIC PROSTHESIS部分給付手指截肢義肢※

適應症請見備註欄,按健保給付之手指截肢義肢給付,超過部分由

病患自付.

4800

FBPS2016XNXJ 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNXK 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNXN 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNXS 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBPS2016XNXV 部分給付手指截肢美觀義肢 ※適應症請見備註欄,按健保給付之

手指截肢美觀義肢給付,超過部分由病患自付.

4800

FBS01037XNY2 1.5,2.0,2.7,3.5 CORTEX SCREW(產品型號

202006:040,204010:110)

145

FBS01038XNY2 4.5 CORTEX SCREW(產品型號214228:250) 161

FBS010701NH1 CORTEX SMALL SCREW 3.5MM,4.5MM DIA 161

FBS011622NSN 1.5,2.0,2.7,3.5MM CORTEX SCREW (產品型號71162-

008:020,022:032,7122006:024,26:40,10:50,55:115)

145

FBS012042N2W "MICROWARE"BONE SCREW:SHAFT SCREW 3.5MM, 4.5MM, 12:115MM"

全微"骨釘:軸骨釘

145

FBS012100N2W "MICROWARE"BONE SCREW:CORTEX SCREW 1.5MM, 2.0MM, 2.7MM,

3.5MM, 6:110MM"全微"骨釘:皮質骨釘

145

FBS01210NNY2 STAINLESS CORTEX SCREW 1.5:3.5X6:110MM 145

FBS01211NNS1 CORTEX SCREW 1.5:4.0MM 145

871

特材代碼 中英文名稱 支付點數-104/01/01

FBS01214NN2W "MICROWARE"BONE SCREW:CORTEX SCREW 4.5MM, 12:140MM"全微"

骨釘:皮質骨釘

161

FBS01214NNS1 CORTEX SCREW 4.5MM 161

FBS01225XNSN 4.5MM CORTEX SCREW 14:70MM,72:145MM 161

FBS01270XNSN CORTEX BONE SCREW 161

FBS013861NS9 SMALL CORTEX SCREW 2.0/2.7/3.5MM 145

FBS014000NS3 CORTEX SCREW 1.5:3.5MM 6:9MM 145

FBS014000NS9 "STRYKER"BONE SCREW 1.5:3.5MM 6:9MM"史賽克"骨釘(原代碼

FBS014000NS3)

145

FBS014001NS3 CORTEX BONE SCREW 161

FBS014061NS9 CORTEX SCREW 4.5MM 14:150MM 161

FBS01410NNY2 TITANIUM CORTEX SCREW 1.5:3.5X6:110MM 183

FBS014148NY2 TITANIUM CORTEX SCREW 3.0:4.0X8:50MM 201

FBS01437XNY2 TITANIUM CORTEX SCREW 1.5MM:3.5MM (型號

402006:040,404010:110,404212:250)

183

FBS01438XNY2 TITANIUM CORTEX SCREW 4.5MM 201

FBS014800NZ1 1.5:3.5MM CORTICAL SCREW(型號482006:50-

01,02,03,482706:70-01,483510:150-01,-40:130-07,-16:50-04)

145

FBS014845NZ1 4.5MM CORTICAL SCREW 161

FBS01LA11NAE CORTEX SCREW 4.5MM 161

FBS01LB02NAE CORTEX SCREW 2.0MM 145

FBS01LB06NAE CORTEX SCREW 1.5MM 6:20MM 145

FBS01LB12NAE CORTEX SCREW 2.7MM 145

FBS01LB18NAE CORTEX SCREW 145

FBS02039XNY2 4.0 CANCELLOUS SCREW 144

FBS02040XNY2 6.5 CANCELLOUS SCREW(產品型號217045:150) 281

FBS022060N2W "MICROWARE"BONE SCREW:CANCELLOUS SCREW 4.0MM, 10:60MM"全

微"骨釘:海綿骨釘

144

FBS02207NNS1 CANCELLOUS BONE SCREW 3.5:4.0MM 144

FBS02218NN2W "MICROWARE"BONE SCREW:CANCELLOUS SCREW 6.5MM, 20:130MM"全

微"骨釘:海綿骨釘

281

FBS02218NNS1 CANCELLOUS BONE SCREW 6.5MM 281

FBS02223XNSN 4.0MM FULL,PART TH CANC SCREW 10:100,10:50,55:100MM 144

FBS02229XNSN 6.5MM CANC SCREW 16,32MM,FULL TH 25:150MM(產品型號7122-

8045:8110,8115:8150,9025:9110,9115:9150)

281

FBS022331NZ1 LONG CANCELLOUS SCREW FULLY THREAD 6.5MM 281

FBS024102NS3 CANCELLOUS BONE SCREW 281

FBS024103NS9 CANCELLOUS BONE SCREW 6.5MM(1/3) 115:150MM 281

FBS024203NS3 CANCELLOUS BONE SCREW 281

FBS024204NS9 CANCELLOUS BONE SCREW 6.5MM(2/3) 105:200M 281

FBS024302NS9 CANCELLOUS BONE SCREW 6.5MM 105:150M 281

FBS024303NS3 CANCELLOUS BONE SCREW 281

FBS02439XNY2 TITANIUM CANCELLOUS SCREW 4.0MM 144

FBS024402NU0 STAINLESS SELF-LOCKING SCREW 4.5MM 35:75MM 144

FBS02440XNY2 TITANIUM CANCELLOUS SCREW 6.5MM(型號417045:150) 259

FBS024541NS3 CANCELLOUS BONE SCREW (SMALL) 144

FBS024541NS9 SMALL CANCELLOUS BONE SCREW 4MM 144

FBS024551NS3 CANCELLOUS BONE SCREW (SMALL) 144

FBS024551NS9 SMALL CANCELLOUS BONE SCREW 4MM (1/2) 144

FBS024840NZ1 4.0MM CANCELLOUS SCREW 144

FBS024865NZ1 6.5MM CANCELLOUS SCREW 281

FBS02LA33NAE THREAD CANCELLOUS SCREW 6.5MM 281

FBS02LB35NAE CANCELLOUS SCREW 4.0MM 144

872

特材代碼 中英文名稱 支付點數-104/01/01

FBS03041XNY2 4.5 MALLEOLAR SCREW 269

FBS030811NH1 MALLEOLAR SCREW 踝質釘 269

FBS032150N2W "MICROWARE"BONE SCREW:MALLEOLAR SCREW 4.5MM, 25:70MM"全

微"骨釘:踝骨釘

269

FBS03215NNS1 MALLEOLAR SCREW (ANY SIZE) 269

FBS032252NSN 4.5MM MALLEOLAR SCREW 25:70MM 269

FBS034402NS3 MALLEOLAR SCREW 269

FBS034402NS9 MALLEOLAR SCREWS 4.5MM(原代碼FBS034402NS3) 269

FBS0348451Z1 4.5MM MALLEOLAR SCREW 269

FBS03LA22NAE MALLEOLAR SCREW 20:110MM 269

FBS04042XNY2 3.5,4.5 CANNULATED SCREW(產品型號214420:472,214620:672) 1544

FBS04043XNY2 6.5 CANNULATED SCREW(產品型號208620:730) 1544

FBS04044XNY2 7.0,7.3 CANNULATED SCREW(產品型號

209420:530,208830:950,209850:930)

1544

FBS041142NZ1 MINI MAGNA-FX CANNULATED SCREW 4.0MM,5.0MM 1544

FBS041146NZ1 MAGNA-FX CANNULATED SCREW 16MM,32MM 1544

FBS041155NZ1 HERBERT CANNULATED BONE SCREW 25:100MM 1544

FBS04202NNS1 3.0 CANNULATED SCREW 1544

FBS04202NNY2 STAINLESS CANNULATED SCREW 3.4:4.0X8:50MM 1544

FBS0420500WG WILTROM BONE SCREW AND BONE PLATE IMPLANT:CANNULATED

SCREW 3.5,4.0,4.5威創骨釘骨板植入物:中空骨釘

1544

FBS04205NN2W "MICROWARE"BONE SCREW:CANNULATED SCREW 3.5MM, 4.0MM,

4.5MM, 10:72MM"全微"骨釘:中空骨釘

1544

FBS04205NNS1 3.5 CANNULATED SCREW 1544

FBS04207NNS1 4.0 CANNULATED SCREW 1544

FBS0420800WG WILTROM BONE SCREW AND BONE PLATE IMPLANT:CANNULATED

SCREW 7.0,7.3威創骨釘骨板植入物:中空骨釘

1544

FBS0420840WG WILTROM BONE SCREW AND BONE PLATE IMPLANT:CANNULATED

SCREW 6.5威創骨釘骨板植入物:中空骨釘

1544

FBS04208NN2W "MICROWARE"BONE SCREW:CANNULATED SCREW 7.3MM, 7.0MM,

20:150MM"全微"骨釘:中空骨釘

1544

FBS04208NNS1 "信迪思"骨螺釘植入物-中空螺釘(7.0MM及7.3MM)"SYNTHES"BONE

SCREW IMPLANT-CANNULATED SCREW

1544

FBS04209NNS1 CANNULATED SCREW 7.0MM 32MM L45:130MM 1544

FBS0421180WG WILTROM BONE SCREW AND BONE PLATE IMPLANT:CANNULATED

SCREW 2.4,3.0威創骨釘骨板植入物:中空骨釘

1544

FBS04214NNS1 4.5 CANNULATED SCREW 1544

FBS0421654SN CANNULATED HIP PIN SYSTEM(STAINLESS STEEL) 1544

FBS04216XNSN CANNULATED HIP PIN 1544

FBS042170NSN CANNULATED SCREW D 8,6.5,4MM(產品型號

71100045:71100130,222820:870)

1544

FBS0421810SN CANNULATED SCREW(STAINLESS STEEL) 1544

FBS04218NNY2 STAINLESS CANNULATED SCREW 7.0:7.3X30:150MM 1544

FBS04286NN2W "MICROWARE"BONE SCREW:CANNULATED SCREW 6.5MM, 20:150MM"全

微"骨釘:中空骨釘

1544

FBS04402NNS1 TITANIUM 3.0 CANNULATED SCREW 1984

FBS04402NNY2 TITANIUM CANNULATED SCREW 3.0:4.0X8:50MM 1984

FBS0440500WG WILTROM BONE SCREW AND BONE PLATE IMPLANT:TITANIUM

CANNULATED SCREW 3.5,4.0,4.5威創骨釘骨板植入物:鈦合金中空

骨釘

1984

FBS04407NNS1 TITANIUM 4.0 CANNULATED SCREW 1984

FBS0440800WG WILTROM BONE SCREW AND BONE PLATE IMPLANT:TITANIUM

CANNULATED SCREW 7.0,7.3威創骨釘骨板植入物:鈦合金中空骨釘

1984

873

特材代碼 中英文名稱 支付點數-104/01/01

FBS0440840WG WILTROM BONE SCREW AND BONE PLATE IMPLANT:TITANIUM

CANNULATED SCREW 6.5威創骨釘骨板植入物:鈦合金中空骨釘

1984

FBS04408NNS1 TITANIUM 7.3 CANNULATED SCREW 1984

FBS04408XNY2 TITANIUM CANNULATED SCREW 7.0X30:130MM 1984

FBS0441180WG WILTROM BONE SCREW AND BONE PLATE IMPLANT:TITANIUM

CANNULATED SCREW 2.4,3.0威創骨釘骨板植入物:鈦合金中空骨釘

1984

FBS044144NY2 TITANIUM CANNULATED SCREW 4.5X20:72MM 1984

FBS04414NNS1 TITANIUM 4.5 CANNULATED SCREW 1984

FBS04418NNY2 TITANIUM CANNULATED SCREW 7.0:7.3X30:150MM 1984

FBS04442XNY2 TITANIUM CANNULATE SCREW 7.3MM 1984

FBS0461040SN CANNULATED SCREW(TITANIUM) 1984

FBS051150NZ1 HERBERT MINI BONE SCREW 10:24MM 1544

FBS051151NZ1 HERBERT SCREW 16:30MM 1544

FBS051152NZ1 HERBERT WHIPPLE BONE SCREW 12:30MM 1544

FBS051154NZ1 HERBERT BONE SCREW 12:30MM 1544

FBS05602XNS3 TITANIUM CANNULATED SCREW(604610:604670自88/09/01起生效) 1984

FBS05602XNS9 TITANIUM CANNULATED SCREW(原代碼FBS05602XNS3) 1984

FBS0649001Z1 CORTICAL NUT 48

FBS07044XNY2 4.5,7.0,7.3 WASHER 66

FBS071430NSN WASHER 10,7,13MM OD 66

FBS072199NS1 WASHER 66

FBS07219XNS1 WASHER/NUT 48

FBS072971N2W "MICROWARE"BONE PLATE:ROUND WASHER, 13.0, 7.0, 4.5, 10.0,

6.5MM"全微"圓滑司

66

FBS074199NS1 WASHER FOR TITANIUM CANNULATE SCREW 84

FBS07444XNY2 TITANIUM WASHER 84

FBS074900NZ1 1.5MM:4.5MM WASHER 66

FBS076199NS3 WASHER FOR TCS SCREWS(619905自88/09/01起生效) 84

FBS076199NS9 WASHER(原代碼FBS076199NS3) 84

FBS079001NS9 WASHER 66

FBS07LA196AE WASHER 4.5MM 66

FBS07LA198AE WASHER 1.3MM 66

FBS0801768SN "SMITH&NEPHEW"BIOSURE HA INTERFERENCE SCREW "史耐輝"可吸

收性固定螺絲※限十字韌帶重建手術使用

4234

FBS0804101NF BIODEGRADABLE MINI PLATING SYSTEM:ACL/PCL SCREW※限實施

十字韌帶重建手術患者使用

4234

FBS081322SAW FASTAK SUTURE ANCHOR 2.4MM縫合錨釘※限肩關節韌帶手術患者

使用

3268

FBS081370BAW BIO-INTERFERENCE SCREW※限實施十字韌帶重建手術患者使用 4234

FBS081370TAW CANNULATED INTERFERENCE SCREW ※限實施十字韌帶重手術使用 4113

FBS081915SAW SUTURE ANCHOR※限肩關節韌帶手術患者使用 3268

FBS082123NT1 MITEK ROTATOR CUFF ANCHOR ※限肩關節韌帶手術患者使用 3268

FBS082165NT1 SOFT TISSUE ANCHOR(G II SNAP-PAK MINI QUICK ANCHER)※限肩

關節韌帶手術患者使用

3268

FBS082545NT1 ABSOLUTE ABSORBABLE INTERFERENCE SCREW※限實施十字韌帶重

建手術患者使用

4234

FBS082870BKL MEGAFIX BIOABSORBABLE INTERFERENCE SCREW 可吸收性韌帶螺釘

※限用於十字韌帶重建手術者

4234

FBS082870TKL MEGAFIX-T INTERFERENCE SCREW ※限實施十字韌帶重手術使用 4113

FBS083512NLA LIGAMENT CANULATED SCREW※限十字韌帶重建手術使用 4113

874

特材代碼 中英文名稱 支付點數-104/01/01

FBS085015TLV "CONMED LINVATEC"MATRYX INTERFERENCE SCREW "康美靈威特"固

定螺釘(可吸收)※限十字韌帶重建手術使用

4234

FBS086101HLV "LINVATEC"REVO SOFT TISSUE ANCHOR"靈威特"軟組織固定錨釘※

限肩關節韌帶手術患者使用

3268

FBS086101NLV REVO SUTURE ANCHOR(CANCELLOUS SCREW)2.7,4MM (C6140,C6141

自91/10/01生效)※限肩關節韌帶手術患者使用

3268

FBS086140HLV "LINVATEC"SUPER REVO-FT SUTURE ANCHOR "靈威特"軟組織縫合

錨釘(肩關節)

3268

FBS08623MS2R "ORTHOMED"MISBIO BIOABSORBABLE INTERFERENCE SCREWS"奧圖

曼"可吸收介面骨釘※給付規定請見備註欄

4234

FBS08718HE2R "ORTHOMED"INTERFERENCE SCREWS"奧圖曼"介面螺釘※給付規定請

見備註欄

4113

FBS0872070SN SOFTSILK TM SCREW SYSTEM(型號含7207256:7207264)※限實施十

字韌帶重建手術使

4113

FBS0872075SN BIORCI SCREW SYSTEM RCI可吸收性介面固定螺絲※限十字韌帶重

建手術使用

4234

FBS087207NSN TITANIUM RCI SCREW 固定螺釘※限實施十字韌帶重建手術使用。 4113

FBS0872091SN TWINFIX SUTURE ANCHOR(TI)軟組織錨釘 ※限肩關節韌帶手術患

者使用

3268

FBS0872200SN TWINFIX SUTURE ANCHORS AND ACCESSORIES 3268

FBS088059NLV "LINVATEC"ENDOPEARL BIOABSORBABLE SOFT TISSUE FIXATION

DEVICE "靈威特"恩皮爾軟組織固定器

4100

FBS088320NLV LINVATEC CANNULATED INTEREFERENCE SCREW ※限實施十字韌帶

重建術患者使用

4113

FBS08ARWSFAW SUTURE ANCHOR W/FIBER WIRE 縫合錨釘含高鋼性縫線※限肩關節

韌帶手術患者使用

3918

FBS08C8000LV LINVATEC ABSORBABLE INTERFERENCE SCREW (型號C8030:39自

92/7/1生效)※限實施十字韌帶重建手術患者使用

4234

FBS08C8027LV LINVATEC BIOSCREW XTRALOK 9:11MMX35:40MM(加長型可吸收性固

定螺絲)※限用於十字韌帶重建手術者

4234

FBS08CPV10BC "BIOMATLANTE"OSTEOTWIN RESORBABLE COMPOSITE INTERFERENCE

SCREW"瑪蘭尼"使得挺吸收性複合式螺絲 7:10MM/25;30MM

4234

FBSCM1103NU0 CUSTOM MADE HUMERAL TUMOR PROSTHESIS ※申報費用時應檢附該

被保險人之發票備查

197000

FBSCM6487NH1 CASTOM MADE HUMERAL PROTHESIS※申報費用應檢附發票備查 197000

FBSF1000F21A "SPINEWAY" MONT BLANC SPINE SYSTEM (SX4+RX2)"施百威”脊椎

固定系統二節(免事前審查)

13816

FBSF1000F31A "SPINEWAY" MONT BLANC SPINE SYSTEM (SX6+RX2)"施百威”脊椎

固定系統三節(免事前審查)

20044

FBSF101640B0 TITANIUM LUMBAR SPINAL SYSTEM二節(PX2+SX4) 13816

FBSF101641B0 TITANIUM LUMBAR SPINAL SYSTEM三節(PX2+SX6) 20044

FBSF101642B0 TITANIUM LUMBAR SYSTEM二節(SX4+RX2)免事前審查 13816

FBSF101643B0 TITANIUM LUMBAR SYSTEM三節(SX6+RX2)免事前審查 20044

FBSF13800NS9 TITANIUM XIA SPINAL SCREW(免事審查) 3114

FBSF13802NS9 TITANIUM XIA SPINAL SYSTEM(二節SX4+RX2)(免事審查) 13816

FBSF13803NS9 TITANIUM XIA SPINAL SYSTEM(三節SX6+RX2)(免事審查) 20044

FBSF14994NS1 TITANIUM SPINAL SYSTEM 三節(SX6+RX2)免事前審查 20044

FBSF14995NS1 TITANIUM SPINAL SYSTEM 二節(SX4+RX2)免事前審查 13816

FBSF16201NS9 TITANIUM SPINAL IMPLANT (DIAPASON)(SX4+RX2)脊椎人工置換

組:二節(免事前審查)

13816

FBSF162200S9 TITANIUM ROD PLATE SPINE SYSTEM二節(RX2+SX4+BLOCKERX4) 13816

FBSF162300S9 TITANIUM ROD PLATE SPINE SYSTEM三節(RX2+SX6+BLOCKERX6) 20044

875

特材代碼 中英文名稱 支付點數-104/01/01

FBSF16301NS9 TITANIUM SPINAL IMPLANT (DIAPASON)(SX6+RX2)脊椎人工置換

組:三節(免事前審查)

20044

FBSF176902Y2 TITANIUM POSTERIOR SPINAL FIXATION SYSTEM二節(RX2+SX4)(原

產品型號769130:855+765905:930)

13816

FBSF176903Y2 TITANIUM POSTERIOR SPINAL FIXATION SYSTEM三節(RX2+SX6)(原

產品型號769130:855+765905:930)

20044

FBSF177002Y2 TITANIUM C TYPE SPINAL FIXATION SYSTEM二節 (RX2+SX4)(免術

前審查)

13816

FBSF177003Y2 TITANIUM C TYPE SPINAL FIXATION SYSTEM三節 (RX2+SX6)(免術

前審查)

20044

FBSF181NP2Y2 BRIDGE SPINAL FIXATION SYSTEM 二節(RX2+SX4) 免事前審查 13816

FBSF181NP3Y2 BRIDGE SPINAL FIXATION SYSTEM 三節(RX2+SX6) 免事前審查 20044

FBSF183NP2Y2 "SYNTEC" AREIKEN SPINAL FIXATION SYSTEM(RX2+SX4)"亞太醫

療"亞力健脊椎固定系統(二節)免事前審查

13816

FBSF183NP3Y2 "SYNTEC" AREIKEN SPINAL FIXATION SYSTEM(RX2+SX6)"亞太醫

療"亞力健脊椎固定系統(三節)免事前審查

20044

FBSF186001RK TITANIUM SPINAL SYSTEM (SX4 + RX2) 二節 免事前審查 13816

FBSF186002RK TITANIUM SPINAL SYSTEM (SX6+RX2) 三節 免事前審查 20044

FBSF1865N2M4 BASIS SPINAL SYSTEM TITANIUM二節 (SX4+RX2)(免事前審查) 13816

FBSF1865N3M4 BASIS SPINAL SYSTEM TITANIUM 三節(SX6+RX2)(免事前審查) 20044

FBSF188NP2Y2 "SYNTEC" COLISEUM SPINAL FIXATION SYSTEM "亞太醫療"高立捷

脊椎固定系統二節(RX2+SX4)

13816

FBSF188NP3Y2 "SYNTEC" COLISEUM SPINAL FIXATION SYSTEM "亞太醫療"高立捷

脊椎固定系統三節(RX2+SX6)

20044

FBSF1AS001AQ TITANIUM SPINAL OC-FIX SCREW SYSTEM二節(RX2+SX4)免術前審

13816

FBSF1AS002AQ TITANIUM SPINAL OC-FIX SCREW SYSTEM三節(RX2+SX6)免術前審

20044

FBSF1AS003AQ TITANIUM SPINAL FIXATION SYSTEM (SX4+RX2)二節 免事前審查 13816

FBSF1AS004AQ TITANIUM SPINAL FIXATION SYSTEM (SX6+RX2)三節 免事前審查 20044

FBSF1ASN01AQ TITANIUM SMARTLOC SPINAL SYSTEM(SX4+RX2)免事前審前 13816

FBSF1ASN02AQ TITANIUM SMARTLOC SPINAL SYSTEM(SX6+RX2)免事前審前 20044

FBSF1AYS2NXA Y TYPE POSTERIOR TITANIUM SPINAL SYSTEM二節(RX2+SX4)(免事

前審查)

13816

FBSF1AYS8NXA Y TYPE POSTERIOR TITANIUM SPINAL SYSTEM 三節(RX2+SX6)(免

事前審查)

20044

FBSF1CD2S2M4 TITANIUM CD SPINAL SYSTEM 二節(SX4+RX2)(免術前審查) 13816

FBSF1CD2S3M4 TITANIUM CD SPINAL SYSTEM 三節(SX6+RX2)(免術前審查) 20044

FBSF1LCLR2GZ SPINAL SYSTEM (RX2+SX4)脊椎系統二節 免事前審查 13816

FBSF1LCLR3GZ SPINAL SYSTEM (RX2+SX6)脊椎系統三節 免事前審查 20044

FBSF1M2SP2Z6 TITANIUM SPINAL SYSTEM二節(PX2+SX4或RX2+SX4) 13816

FBSF1M2SP3Z6 M2 SPINAL POSTERIOR SYSTEM 三節(ROD×2+SCREW×6或PLATE×

2+SCREW×6)M2脊椎後方固定系統 免事前審查

20044

FBSF1PCS01V2 "INTAI"SPINAL FIXATION SYSTEM(RX2+SX4)"鐿鈦"脊椎固定系統:

二節(免事前審查)

13816

FBSF1PCS01WG "WILTROM"SPINAL FIXATION SYSTEM(RX2+SX4)"威創"脊椎固定系

統二節(免事前審查)

13816

FBSF1PCS02V2 "INTAI"SPINAL FIXATION SYSTEM(RX2+SX6)"鐿鈦"脊椎固定系統:

三節(免事前審查)

20044

FBSF1PCS02WG "WILTROM"SPINAL FIXATION SYSTEM(RX2+SX6)"威創"脊椎固定系

統三節(免事前審查)

20044

FBSF1RF002RX RF SPINAL SYSTEM二節(SX4+RX2)(免事前審查) 13816

876

特材代碼 中英文名稱 支付點數-104/01/01

FBSF1RF003RX RF SPINAL SYSTEM三節(SX6+RX2)(免事前審查) 20044

FBSF1SX002AE TITANIUM SPINE SYSTEM EVOLUTION二節(SCREWX4+LODX2)(96年10

月1日起免事前審查)

13816

FBSF1SX003AE TITANIUM SPINE SYSTEM EVOLUTION三節(SCREWX6+LODX2)(96年10

月1日起免事前審查)

20044

FBSF1TS002JA TITANIUM SPINAL SYSTEM 二節(RX2+SX4)(免事前審查) 13816

FBSF1TS003JA TITANIUM SPINAL SYSTEM 三節(RX2+SX6)(免事前審查) 20044

FBSF2000F21A "SPINEWAY" MONT BLANC SPINE SYSTEM:ROD 40:64MM"施百威”脊

椎固定系統:固定桿(免事前審查)

679

FBSF21502NS1 TITANIUM UNIVERSAL SPINAL ROD 免事前審查 679

FBSF22040NS9 XIA TITANIUM SPINAL ROD 40:60MM(免事前審查) 679

FBSF265041S9 TITANIUM SPINAL IMPLANT (DIAPASON):ROD 40:60MM 脊椎人工

置換組:固定桿(免事審查)

679

FBSF277004Y2 TITANIUM SPINAL ROD 6X50:100MM 短節(免術前審查) 679

FBSF277104Y2 STAINLESS SPINAL ROD 4:10CM短節(免術前審查) 558

FBSF277111Y2 STAINLESS SPINAL ROD 11:30CM長節(免術前審查) 558

FBSF2820NSY2 TITANIUM SPINAL ROD 2:11CM 短節 免事前審查 679

FBSF2839NSY2 "SYNTEC" AREIKEN SPINAL FIXATION SYSTEM:ROD "亞太醫療"亞

力健脊椎固定系統:連結棒(短節)2~11CM,免事前審查

679

FBSF2860NSY2 ROD 連結棒-短節 679

FBSF286540M4 BASIS SPINAL TITANIUM ROD 51CM(免事前審查) 679

FBSF2911NSY2 "SYNTEC"COLISEUM SPINAL FIXATION SYSTEM:ROD 40:100MM"亞太

醫療"高立捷脊椎固定系統:連接桿(短節)免事前審查

679

FBSF2AS001AQ TITANIUM SPINAL ROD 5:10CM免術前審查 679

FBSF2ASNR1AQ TITANIUM SMARTLOC SPINAL ROD 40:100MM免事前審前 679

FBSF2B0001RK TITANIUM SPINAL ROD 40:100 MM(短節) 免事前審查 679

FBSF2LR001GZ SPINAL ROD 脊椎固定桿短節 免事前審查 679

FBSF2M2PLTZ6 M2 SPINAL POSTERIOR SYSTEM:PLATE M2脊椎後方固定系統:骨

板 免事前審查

679

FBSF2M2SRNZ6 TITANIUM SPINAL ROD 4.5:10.5CM 679

FBSF2PR040B0 TITANIUM SPINAL ROD 40MM:100MM免事前審查 679

FBSF2RD01TV2 "INTAI"SPINAL FIXATION SYSTEM:ROD 25:100MM"鐿鈦"脊椎固定

系統:連接桿(免事前審查)

679

FBSF2RD01TWG "WILTROM"SPINAL FIXATION SYSTEM:TITANIUM SPINAL ROD

50:100MM"威創"脊椎固定系統:連接桿50:100MM(免事前審查)

679

FBSF2RF00SRX RF SPINAL ROD 40:100MM(免事前審查) 679

FBSF2RY63NXA Y TYPE POSTERIOR TITANIUM SPINAL ROD 5:10CM(免事前審查) 679

FBSF2TS01TJA TITANIUM SPINAL ROD 30:100MM(免事前審查) 679

FBSF36132NY2 TITANIUM CERVICAL CLAMP(配合FBSF46132NY2使用) 4110

FBSF4000F41A "SPINEWAY" MONT BLANC SPINE SYSTEM:SCREW "施百威”脊椎固

定系統:固定釘(免事前審查)

3114

FBSF44002TWG "WILTROM"SPINAL FIXATION SYSTEM:PEDICLE SCREW U TYPE"威

創"脊椎固定系統:脊椎骨釘U型(免事前審查)

3114

FBSF44004TWG "WILTROM"SPINAL FIXATION SYSTEM:PEDICLE SCREW REDUCTION U

TYPE"威創"脊椎固定系統:脊椎骨釘U型折斷(免事前審查)

3114

FBSF44006TV2 "INTAI"SPINAL FIXATION SYSTEM:PEDICLE SCREW POLY AXIAL U

TYPE"鐿鈦"脊椎固定系統:脊椎骨釘-U型多軸向(免事前審查)

3114

FBSF44006TWG "WILTROM"SPINAL FIXATION SYSTEM:PEDICLE SCREW AXIAL U

TYPE"威創"脊椎固定系統:脊椎骨釘U型多軸向(免事前審查)

3114

FBSF44007TWG "WILTROM"SPINAL FIXATION SYSTEM:PEDICLE SCREW POLY-AXIAL

REDUCTION U TYPE"威創"脊椎固定系統:脊椎骨釘U型多軸向折斷

(免事前審查)

3114

FBSF44995NS1 TITANIUM CLICK'X PEDICLE SCREW (免事前審查) 3114

FBSF455030B0 TITANIUM SPINAL SCREW(免事前審查) 3114

877

特材代碼 中英文名稱 支付點數-104/01/01

FBSF464001S9 TITANIUM SPINAL (DIAPASON)SCREW脊椎人工置換組:骨釘(免事

前審查)

3114

FBSF4769NNY2 TITANIUM SPINAL PEDICLE SCREW 4.5:8,30:55MM 3114

FBSF4770NNY2 TITANIUM SPINAL PEDICLE SCREW(免術前審查) 3114

FBSF477253Y2 TITANIUM SPINAL OSTEOPOROTIC SCREW(免術前審查) 3114

FBSF4780NNY2 ARTEST SPINAL FIXATION SYSTEM:TITANIUM SPINAL PEDICLE

SCREW(免事前審查)

3114

FBSF4781NNY2 ARTEST SPINAL FIXATION SYSTEM:TITANIUM SPINAL POLYAXIAL

PEDICLE SCREW(免事前審查)

3114

FBSF4782NNY2 PEDICLE SCREW(免事前審查) 3114

FBSF4790NNY2 ARTEST SPINAL FIXATION SYSTEM:TITANIUM SPINAL CANNULATED

PEDICLE SCREW(免事前審查)

3114

FBSF4791NNY2 ARTEST SPINAL FIXATION SYSTEM:TITANIUM SPINAL CANNULATED

POLYAXIAL PEDICLE SCREW(免事前審查)

3114

FBSF4816NNY2 REDUCTION PEDICLE SCREW 免事前審查 3114

FBSF4818NNY2 POLYAXIAL PEDICLE SCREW 免事前審查 3114

FBSF4832NNY2 "SYNTEC" AREIKEN SPINAL FIXATION SYSTEM:MONOAXIAL SCREW"

亞太醫療"亞力健脊椎固定系統單軸骨釘,免事前審查

3114

FBSF4865MNM4 BASIS SPINAL TITANIUM SCREW(免事前審查) 3114

FBSF4886NNY2 MONOAXIAL SCREW 單軸骨釘 3114

FBSF4895NNY2 MONOAXIAL SCREW 單軸骨釘 3114

FBSF4AS001AQ TITANIUM SPINAL SCREW免術前審查 3114

FBSF4AS002AQ TITANIUM SPINAL FIXATION SYSTEM:SCREW 免事前審查 3114

FBSF4ASNS1AQ TITANIUM SMARTLOC SPINAL SCREW免事前審查 3114

FBSF4B0001RK TITANIUM SPINAL SCREW免事前審查 3114

FBSF4B0009RK "REBORN ESSENCE"LUMBAR FIXATION SYSTEM:MULTI SCREW"瑞寶

億"腰椎內固定系統:萬向螺釘(免事前審查)

3114

FBSF4LC004GZ "際仁"脊椎固定系統:固定釘(免事前審查)GEZEN SPINAL

FIXATION:SPINAL SCREW

3114

FBSF4M2PCNZ6 M2 SPINAL POSTERIOR SYSTEM:SCREW M2脊椎後方固定系統:骨

釘 免事前審查

3114

FBSF4M2PWNZ6 TITANIUM SPINAL SCREW 3114

FBSF4RF001RX RF SPINAL SCREW(免事前審查) 3114

FBSF4S8655M4 TITANIUM CD TULIP SCREW(免術前審查) 3114

FBSF4S9603M4 TITANIUM CD REDUCTION SCREW(免術前審查) 3114

FBSF4SX07NAE TITANIUM SPINE SCREW (96年10月1日起免事前審查) 3114

FBSF4TS01TJA TITANIUM SPINAL PEDICLE SCREW(免事前審查) 3114

FBSF4YP04NXA Y TYPE POSTERIOR TITANIUM SPINAL PEDICLE SCREW(免事前審

查)

3114

FBSFA000011A "SPINEWAY" TWIN PEAKS LUMBAR CAGES "施百威”腰椎椎間融合

器(後開型)※適應症請見備註欄

21971

FBSFA00001RK TITANIUM INTERVERTEBRAL CAGE 椎間融合器※適應症請見備註欄 13116

FBSFA00002RK TITANIUM INTERVERTEBRAL CAGE 椎間融合器※適應症請見備註欄 13116

FBSFA00003RK PEEK LUMBAR INTERVERTEBRAL CAGE 高分子材料腰椎椎間融合器

(後開型)※適應症請見備註欄

21971

FBSFA0001NS1 TRAVIOS IMPLANTS PEEK TLIF"信迪思"腰椎椎間支架(側開型每節

椎體限置放1個)※給付規定請見備註欄

43943

FBSFA01718DP "帝富脊椎"椎體置換系統:碳纖複合(每節限置放1個)※給付規定

請見備註欄"DEPUY SPINE"VBR SPINAL SYSTEM (TLIF)

45000

FBSFA0LY011S OLYS TRANSFORMINAL CAGE PEEK(側開型每節椎體限置放1個)※適

應症請見備註欄

43943

878

特材代碼 中英文名稱 支付點數-104/01/01

FBSFA1000NZ1 ZIMMER SPINE FIDJI LUMBAR CAGES( PLIF PEEK) "捷邁"斐濟腰

椎椎間融合器 ※適應症請見備註欄

21971

FBSFA10410DP "帝富脊椎"頸椎護架:碳纖複合※給付規定請見備註欄"DEPUY

SPINE"CERVICAL I/F CAGE

22500

FBSFA173NNDP "帝富脊椎"I/F 腰椎椎間骨融合器:碳纖複合※給付規定請見備註

欄"DEPUY SPINE"LUMBAR I/F CAGE(PLIF)

22500

FBSFA21001XP I-TYPE INTERVERTEBRAL SPACER PEEK CAGE 馬蹄式椎間填充塊

(頸椎)※適應症請見備註欄

21971

FBSFA22001XP II-TYPE INTERVERTEBRAL SPACER PEEK CAGE 錐頭式椎間填充塊

(後開型)※適應症請見備註欄

21971

FBSFA22002XP "寶楠"錐頭式椎間填充塊(聚醚醚酮)(側開型每節椎體限置放1

個)"PAONAN"II-TYPE INTERVERTEBRAL SPACER(PEEK)

43943

FBSFA2740LB0 TITANIUM LUMBAR SPINAL CAGE 腰椎椎間融合器 ※適應症請見備

註欄

13116

FBSFA29906M4 CAPSTONE SPINAL SYSTEM:TLIF PEEK SPACER(側開型每節椎體限

置放1個)※適應症請見備註欄

43943

FBSFA3000NS1 SYNCAGE IMPLANTS 辛凱吉椎間支架植入物(SYNCAGE-C TITANIUM

CERVICAL)※適應症請見備註欄

12110

FBSFA3605LU0 "UNITED"EXPRESS LUMBAR CAGE SYSTEM(PLIF PEEK)"聯合"快捷腰

椎融合器系統(後開型)※適應症請見備註欄

21971

FBSFA420MNM4 TELAMON FUSION DEVICE PEEK CAGE 泰拉蒙融合器(後開型)※適

應症請見備註欄

21971

FBSFA6000NDP "帝富脊椎"I/F 腰椎椎間骨融合器:碳纖複合※給付規定請見備註

欄"DEPUY SPINE"LUMBAR I/F CAGE(PLIF)

22500

FBSFA6284NM4 "美敦力"科能脊椎系統裝置(頸椎)※給付規定請見備註

欄"MEDTRONIC"CORNERSTONE PSR CERVICAL FUSION SYSTEM

CERVICAL INTERBODY FUSION DEVICE(PEEK)

21971

FBSFA6730NS9 OIC CAGE SYSTEM-PEEK IMPLANTS 椎體護架系統(後開型)※適應

症請見備註欄

21971

FBSFA6731NS9 "STRYKER" OGIVAL INTERBODY CAGE(TLIF) "史賽克" 腰椎間融合

器(側開型每個椎體限置放1個)※適應症請見備註欄

43943

FBSFA6741NS9 SOLIS CERVICAL CAGE SYSTEM 梭利斯椎頸護架系統(頸椎PEEK

CAGE)※適應症請見備註欄

21971

FBSFA6742NS9 "STRYKER" SOLIS AS PEEK SPACER "史賽克"椎間融合器(頸椎)※

適應症請見備註欄

21971

FBSFA6760NS9 OIC PL PEEK SPACER 椎間融合器(後開型)※適應症請見備註欄 21971

FBSFA706NNY2 TITANIUM VETEBRAL INTERBODY CAGE 高9:14MM長20:24※適應症

請見備註欄

13116

FBSFA7074NY2 TITANIUM VETEBRAE INTERBODY CAGE:ANTERIOR CERVICAL

INTERBODY CAGE 鈦合金椎籠:前方頸椎間融合器※適應症請見備

註欄

12110

FBSFA7091NY2 TITANIUM VETEBRAE INTERBODY CAGE 9:14MMX20:24MM※適應症請

見備註欄

13116

FBSFA7092NY2 TITANIUM VETEBRAE INTERBODY CAGE 9:14MMX20:24MM※適應症請

見備註欄

13116

FBSFA82501Y2 "SYNTEC"PEEK VERTEBRAE INTERBODY CAGE"亞太醫療"春菊聚醚醚

酮椎籠(腰椎後開型)※適應症請見備註欄

21971

FBSFA82526Y2 "SYNTEC"BARNANA PEEK TLIF VERTEBRA INTERBODY CAGE"亞太醫

療"巴拿馬腰椎椎間融合器(側開型每節椎體限置放1個)※適應症

請見備註欄

43943

FBSFA8380NS9 AVS TL PEEK SPACER SYSTEM(側開型每節椎體限置放1個)※適應

症請見備註欄

43943

FBSFA8984NS1 PLIVIOS IMPLANTS PEEK CAGE 腰椎椎間融合器(後開型)※適應症

請見備註欄

21971

879

特材代碼 中英文名稱 支付點數-104/01/01

FBSFA8992NS1 CERVIOS IMPLANTS WEDGE-SHAPED PEEK CAGE 頸椎椎間融合器※

適應症請見備註欄

21971

FBSFA8993NS1 CERVIOS IMPLANTS CURVED PEEK CAGE 頸椎椎間融合器※適應症

請見備註欄

21971

FBSFA908MNM4 TELAMON FUSION DEVICE※適應症請見備註欄 13116

FBSFA939MNM4 "MEDTRONIC"CRESCENT SPINAL SYSTEM:SPACER(PEEK)"美敦力"克

里森脊椎系統:椎體護架(側開型每個椎體限置放1個)※適應症請

見備註欄

43943

FBSFA9501NS1 TITANIUM CONTACT FUSION CAGE 9:15MM X8:11MM※適應症請見備

註欄

13116

FBSFAALS01AQ TITANIUM LUMBAR DISC SPACER ※適應症請見備註欄 13116

FBSFAALS01TT TITANIUM LUMBAR DISC SPACER※適應症請見備註欄 13116

FBSFAALS02AQ TITANIUM VIGOR CERVICAL DISC SPACER ※適應症請見備註欄 12110

FBSFAAP002AQ "A-SPINE"POLYMER LUMBAR DISC SPACER(PEEK)"冠亞"高分子複合

材料腰椎椎間融合器(後開型)*適應症請見備註欄

21971

FBSFAAP003AQ "A-SPINE"VIGOR PEEK CERVICAL DISC SPACER"冠亞"偉戈高分子

複合材料頸椎椎間融合器*適應症請見備註欄

21971

FBSFAAR004AQ X'PLO POLYMER LUMBAR CAGE (PEEK TLIF)"艾斯普"高分子複合材

料腰椎融合器(側開型,每節椎體限置放1個)※適應症請見備註欄

43943

FBSFAC000NZ1 "ZIMMER SPINE"FIDJI CERVICAL CAGES (PEEK)"捷邁"頸椎椎間融

合器 ※給付規定請見備註欄

21971

FBSFAC001NZ1 "ZIMMER SPINAL"FIDJI CERVICAL CAGES(PEEK)"捷邁"頸椎椎間融

合器※適應症請見備註欄

21971

FBSFAC0CCK1S SCIENT X LUMBAR CAGE(PEEK) 賽恩司腰椎融合器(後開型) ※適

應症請見備註欄

21971

FBSFAC2331DP "帝富脊椎"康赫脊椎護架系統:碳纖複合(每節限置放1個)※給付

規定請見備註欄"DEPUY SPINE"CONCORDE BULLET SPINAL SYSTEM

CARBON FIBER COMPOSITE(TLIF)

45000

FBSFACA11NXA TITANIUM VERTEBRAL FUSION CAGE 20:24MMX8:15MM※適應症請見

備註欄

13116

FBSFACC11NXA PEEK LUMBAR INTERBODY SPACER(側開型每節椎體限置放1個)※適

應症請見備註欄

43943

FBSFACCAGE1A "SPINEWAY" AYERS ROCK CERVICAL CAGES"(PEEK) 施百威"頸椎融

合器 ※適應症請見備註欄

21971

FBSFACD11NXA PEEK LUMBAR CAGE 聚醚醚酮腰椎椎間融合器(後開型)※適應症請

見備註欄

21971

FBSFACE11NXA CERVICAL CAGE 頸椎椎間融合器(頸椎PEEK CAGE)※適應症請見備

註欄

21971

FBSFACG11NXA TITANIUM CERVICAL CAGE 鈦合金頸椎椎間融合器※適應症請見備

註欄

12110

FBSFACG15NZ6 TITANIUM SPINAL SPACER 5:11MMX7:13MM※適應症請見備註欄 13116

FBSFACH11NXA TITANIUM CERVICAL CAGE 鈦合金頸椎椎間融合器※適應症請見備

註欄

12110

FBSFACR11NXA "全合"聚醚醚酮椎間支架系統:椎間支架(側開型每節椎體限置放1

個)“Aaxter”PEEK Lumbar Spacer System:PEEK Cage TLIF

43943

FBSFAF0001RK PEEK LUMBAR INTERVERTEBRAL CAGE 高分子材料腰椎椎間融合器

(側開型,每節椎體置放1個)※適應症請見備註欄

43943

FBSFAF0002RK REBORN ESSENCE PEEK LUMBAR INTERVERTEBRAL CAGE 瑞寶億高分

子材料腰椎椎間融合器(後開型) ※適應症請見備註欄

21971

FBSFAF0003RK REBORN ESSENCE PEEK CERVICAL INTERVERTEBRAL CAGE瑞寶億高

分子材料頸椎椎間融合器※適應症請見備註欄

21971

880

特材代碼 中英文名稱 支付點數-104/01/01

FBSFAFJ00CAE AESCULAP CESPACE PEEK CERVICAL FUSION SPACER 雅氏樹脂頸

椎融合植入物※適應症請見備註欄

21971

FBSFAFJ00NAE "AESCULAP"TSPACE PEEK TLIF SYSTEM "雅氏"樹脂椎間盤支撐架

植入物(側開型,每節椎體置放1個)※適應症請見備註欄

43943

FBSFAGCP012G 群力頸椎椎間融合器※給付規定請見備註欄"GIB"CERVICAL

SPINAL CAGE(PEEK)

21971

FBSFAJUL0L1C "SPINEART"JULIET OL LUMBAR CAGE(PEEK)"司佰特"茱麗葉腰椎融

合器(側開型每節椎體限置放1個)

43943

FBSFAJULPL1C SPINEART JULIET LUMBAR CAGE(PLIF)"司佰特"腰椎融合器※適應

症請見備註欄

21971

FBSFAJULTL1C SPINEART JULIET LUMBAR CAGE(TLIF)"司佰特"腰椎融合器(側開

型,每節椎體置放1個)※適應症請見備註欄

43943

FBSFAN0VSDL2 "ALPHATEC"NOVEL SPINAL SPACER SYSTEM-PEEK TLIF"佳鴻"諾歐

椎間融合器(側開型每節椎體限置放1個)

43943

FBSFAN0VTLL2 "ALPHATEC"NOVEL TL SPINAL SPACER SYSTEM-PEEK TLIF"佳鴻"諾

歐椎間融合器(側開型每節椎體限置放1個)

43943

FBSFAPCCNNJZ JO PEEK CERVICAL CAGE 傑奎高分子頸椎椎間融合器※適應症請

見備註欄

21971

FBSFAPCG01V2 "INTAI"INTERBODY FUSION SYSTEM(CERVICAL PEEK CAGE)"鐿鈦"

高分子複合椎間融合器(頸椎椎籠)※適應症請見備註欄

21971

FBSFAPCG01WG "WILTROM"INTERBODY FUSION SYSTEM:CERVICAL PEEK CAGE"威創"

高分子複合椎間融合器系統:頸椎椎籠※適應症請見備註欄

21971

FBSFAPLC30JZ "JO"PEEK LUMBAR CAGE(TLIF)"傑奎"高分子腰椎椎間融合器(側開

型每節椎體限置放1個)※給付規定請見備註欄

43943

FBSFAPLCNNJZ "JO"PEEK LUMBAR CAGE "傑奎"高分子腰椎椎間融合器(後開型)※

適應症請見備註欄

21971

FBSFAPPG01WG "WILTROM"INTERBODY FUSION SYSTEM:PLIF PEEK CAGE"威創"高分

子複合椎間融合器系統:胸腰椎椎籠※適應症請見備註欄

21971

FBSFAPR001AQ RAINBOO PEEK LUMBAR CAGE(側開型每節椎體限置放1個)※適應症

請見備註欄

43943

FBSFAPTG01WG "WILTROM"INTERBODY FUSION SYSTEM:TLIF PEEK CAGE"威創"高分

子複合椎間融合器系統(側開型腰椎椎籠,每節椎體限置放1個)※

給付規定請見備註欄

43943

FBSFARD1SNZ1 "ZIMMER"SPINE ARDIS INTERBODY SYSTEM(PEEK)"捷邁"亞帝斯脊

椎椎間穩定系統(側開型每節椎體限置放1個)※給付規定請見備註

43943

FBSFASAMRY1S "SCIENT'X"ANTERIOR CAGE SAMARYS(PEEK) "賽恩司"莎美莉前路

頸椎融合器 ※適應症請見備註欄

21971

FBSFASJ00NAE AESCULAP PROSPACE PEEK POSTERIOR LUMBAR AND THORACIC

SPINE FUSION SYSTEM 雅氏後方樹脂胸腰椎融合植入物※適應症

請見備註欄

21971

FBSFASN00PAE "AESCULAP"PROSPACE PEEK"雅氏"博斯貝椎融間融合植入物※給付

規定請見備註欄

21971

FBSFATPG00V2 "INTAI"INTERBODY FUSION SYSTEM(TLIF PEEK)"鐿鈦"高分子複合

椎間融合系統(側開型每節椎體置放1個)※適應症請見備註欄

43943

FBSFATPG04V2 "INTAI"INTERBODY FUSION SYSTEM(TLIF PEEK)"鐿鈦"高分子複合

椎間融合系統(側開型每節椎體置放1個)※適應症請見備註欄

43943

FBSFATPG08V2 "INTAI"INTERBODY FUSION SYSTEM(TLIF PEEK)"鐿鈦"高分子複合

椎間融合系統(側開型每節椎體置放1個)※適應症請見備註欄

43943

FBSFATRYKC1C SPINEART CERVICAL IMPLANTS(PEEK) 司佰特頸椎椎間植入物 ※

適應症請見備註欄

21971

FBSFAWS141B0 LUMBAR SPINAL PEEK CAGE(側開型每節椎體限置放1個)※適應症

請見備註欄

43943

FBSFAWS16CB0 CERVICAL CAGE(PEEK)頸椎椎間融合器※適應症請見備註欄 21971

881

特材代碼 中英文名稱 支付點數-104/01/01

FBSFAWS41LB0 LUMBAR SPINAL CAGE PEEK CAGE 腰椎椎間融合器(後開型)※適應

症請見備註欄

21971

FBSFR6411LS1 "SYNTHES"VEPTR II RIB TO LUMBAR LAMINA"信迪思"第二代延展

式肋骨支撐架:肋骨至板狀腰椎組合

326712

FBSFR6412LS1 "SYNTHES"VEPTR II:RIB TO ILIUM"信迪思"第二代延展式肋骨支

撐架:肋骨至髂骨組合

300221

FBSFR6413LS1 "SYNTHES"VEPTR II:RIB TO RIB"信迪思"第二代延展式肋骨支撐

架:肋骨至肋骨組合

290247

FBSFR9701LS1 "SYNTHES"VEPTR RIB TO LUMBAR

LAMINA(CRS*1+L*3+EB*1+ER*1+H*1+FR*1)"信迪思"延展式肋骨支

撐架:肋骨至板狀腰椎組合※適應症請見備註欄

326712

FBSFR9702LS1 "SYNTHES"VEPTR:RIB TO

ILIUM(CRS*1+CHR*1+DL*3+EB*1+LER*1+AH*1+EC*1+FR*1)"信迪思"

延展式肋骨支撐架:肋骨至髂骨組合※適應症請見備註欄

300221

FBSFR9703LS1 "SYNTHES"VEPTR:RIB TO

RIB(CRS*1+CRS*1+CHR*2+DL*4+EB*1+FR*1)"信迪思"延展式肋骨支

撐架:肋骨至肋骨組合※適應症請見備註欄

290247

FBSFR9704LS1 "SYNTHES"VEPTR:DISTRACTION LOCKS"信迪思"延展式肋骨支撐架:

延展用鎖※適應症請見備註欄(整組使用者不得申報,只適用於組

件單獨使用者申報)

6584

FBSFR97057S1 "SYNTHES"VEPTR:CRANIAL RIB SUPPORT "信迪思"延展式助骨支撐

架(頭位肋骨支架)※適應症請見備註欄(整組使用者不得申報,只

適用於組件單獨使用者申報)

63303

FBSFR97065S1 "SYNTHES"VEPTR:CAUDAL RIB SUPPORT"信迪思"延展式助骨支撐

架:尾位直式肋骨支架※適應症請見備註欄(整組使用者不得申報

,只適用於組件單獨使用者申報)

84148

FBSFR97103S1 "SYNTHES"VEPTR:EXTENSION BAR"信迪思"延展橫槓※適應症請見

備註欄(整組使用者不得申報,只適用於組件單獨使用者申報)

71155

FBSFR97126S1 "SYNTHES"VEPTR:CLOSING HALF-RING FOR RIB SUPPORT"信迪思"

閉鎖半圓環※適應症請見備註欄(整組使用者不得申報,只適用於

組件單獨使用者申報)

19989

FBSFR97127S1 "SYNTHES"VEPTR:ROD"信迪思"橫槓※適應症請見備註欄(整組使用

者不得申報,只適用於組件單獨使用者申報)

14161

FBSFR97131S1 "SYNTHES"VEPTR:LUMBAR EXTENSION ROD"信迪思"板狀腰椎延展橫

槓※適應症請見備註欄(整組使用者不得申報,只適用於組件單獨

使用者申報)

80838

FBSFR97167S1 "SYNTHES"VEPTR:EXTENSION CONNECTOR"信迪思"延展連接器※適

應症請見備註欄(整組使用者不得申報,只適用於組件單獨使用者

申報)

14824

FBSFR97257S1 "SYNTHES"VEPTR:ALA HOOK "信迪思"薦骨翼鉤※適應症請見備註

欄(整組使用者不得申報,只適用於組件單獨使用者申報)

25033

FBSFR97261S1 "SYNTHES"VEPTR:LAMINIA HOOK "信迪思"板狀椎弓鉤※適應症請

見備註欄(整組使用者不得申報,只適用於組件單獨使用者申報)

66348

FBSFR98910S1 "SYNTHES"VEPTR:FIXATION RING FOR RODS"信迪思"橫槓固定環※

適應症請見備註欄(整組使用者不得申報,只適用於組件單獨使用

者申報)

5327

FBTCM1102NU0 CUSTOMER MADE TIBIAL TUMOR PROSTHESIS ※適應症請見備註欄

,申報費用應檢附發票備查

160000

FBTCM6495NH1 "HOWMEDICA" GLOBAL MODULAR REPLACEMENT SYSTEM(PROXIMAL

TIBIA)"好美得卡"整體人工替換物組合系統※適應症請見備註欄

,申報費用應檢附發票備查

160000

FBW0106321M1 KIRSCHNER WIRE (K-PIN) 1.0:1.2MM 300MM 72

882

特材代碼 中英文名稱 支付點數-104/01/01

FBW0106324M1 KIRSCHNER WIRE (K-PIN) 1.5:1.8MM 300MM 72

FBW0106325M1 KIRSCHNER WIRE (K-PIN) 2.0MM 300MM 72

FBW0106326M1 KIRSCHNER WIRE (K-PIN) 2.4MM 300MM 72

FBW0106327M1 KIRSCHNER WIRE (K-PIN) 3.0MM 300MM 72

FBW011610NSN K-WIRE 0.6:1.6MM,2.0MM 72

FBW012900NY2 KIRSCHNER WIRES(SHANK)0.7MM,0.9MM,1.1MM,1.6MM

*4"(101.6MM)

72

FBW0129101Y2 KIRSCHNER WIRE 72

FBW012910NY2 KIRSCHNER WIRES(SHANK)0.7MM,0.9MM,1.1MM,1.6MM *9"(230MM) 72

FBW012911NY2 KIRSCHNER WIRES(SHANK)0.7MM,0.9MM,1.1MM,1.6MM *12"(300MM) 72

FBW012915NY2 KIRSCHNER WIRES(THREADED)0.9MM,1.1MM,1.6MM *9"(230MM) 255

FBW012926NY2 KIRSCHNER WIRE W/THREADED 255

FBW012927NS1 K-PIN,GUIDEWIRE WITH THREAD 255

FBW01292NNS1 KIRSCHNER WIRE (K-PIN)0.6:3.0MM 72

FBW01294XNY2 KIRSCHNER WIRE WITH THREADED TIP 255

FBW01LX08NAE K-WIRE 0.8MM ,1.0MMX310MM 72

FBW01LX08SAE KIRSCHNER WIRE (K-PIN)0.8MMx150MM 72

FBW01LX105AE K-WIRE 2.5MMx70MM 72

FBW01LX10SAE KIRSCHNER WIRE (K-PIN)1.0MMx150MM 72

FBW01LX12NAE K-WIRE 310MM,1.2:1.7MM 72

FBW01LX12SAE KIRSCHNER WIRE (K-PIN)1.2MMx150MM 72

FBW01LX14SAE KIRSCHNER WIRE (K-PIN)1.4MMx150MM 72

FBW01LX15SAE KIRSCHNER WIRE (K-PIN)1.5MMx150MM 72

FBW01LX16SAE KIRSCHNER WIRE (K-PIN)1.6MMx150MM 72

FBW01LX17SAE K-WIRE 150MM 1.7MM 72

FBW01LX18NAE K-WIRE 310MM,1.8MM 72

FBW01LX18SAE KIRSCHNER WIRE (K-PIN)1.8MMx150MM 72

FBW01LX20NAE K-WIRE 310MM,2.0MM 72

FBW01LX20SAE KIRSCHNER WIRE (K-PIN)2.0MMx150MM 72

FBW01LX22NAE K-WIRE 310MM,2.2MM 72

FBW01LX22SAE KIRSCHNER WIRE (K-PIN)2.2MMx150MM 72

FBW01LX25NAE K-WIRE 310MM,2.5MM 72

FBW01LX25SAE KIRSCHNER WIRE (K-PIN)2.5MMx150MM 72

FBW01LX28SAE KIRSCHNER WIRE (K-PIN)0.8MMx150MM 72

FBW01LX30NAE K-WIRE 210MM,1.0MM(102.01.01更改為1.0X310MM) 72

FBW01LX30SAE KIRSCHNER WIRE (K-PIN)1.0MMx150MM 72

FBW01LX32NAE K-WIRE 310MM,1.2:1.6MM 72

FBW01LX32SAE KIRSCHNER WIRE (K-PIN)1.2MMx150MM 72

FBW01LX34SAE KIRSCHNER WIRE (K-PIN)1.4MMx150MM 72

FBW01LX35SAE KIRSCHNER WIRE (K-PIN)1.5MMx150MM 72

FBW01LX36SAE KIRSCHNER WIRE (K-PIN)1.6MMx150MM 72

FBW01LX37SAE KIRSCHNER WIRE 1.7MMx150MM 72

FBW01LX38NAE K-WIRE 310MM,1.8MM 72

FBW01LX38SAE KIRSCHNER WIRE (K-PIN)1.8MMx150MM 72

FBW01LX40NAE K-WIRE 310MM,2.0MM 72

FBW01LX40SAE KIRSCHNER WIRE (K-PIN)2.0MMx150MM 72

FBW01LX42NAE K-WIRE 310MM,2.2MM 72

FBW01LX42SAE KIRSCHNER WIRE (K-PIN)2.2MMx150MM 72

FBW01LX45NAE K-WIRE 310MM,2.5MM 72

FBW01LX45SAE KIRSCHNER WIRE (K-PIN)2.5MMx150MM 72

FBW01LX46SAE KIRSCHNER WIRE (K-PIN)3.0MMx150MM 72

FBW01LX47SAE KIRSCHNER WIRE 雅式鋼針 72

883

特材代碼 中英文名稱 支付點數-104/01/01

FBW01LX90NAE KIRSCHNER WIRE 雅式鋼針 72

FBW01LX915AE KIRSCHNER WIRE 雅式鋼針 72

FBW01LX91NAE KIRSCHNER WIRE 雅式鋼針 72

FBW01LX925AE KIRSCHNER WIRE 雅式鋼針 72

FBW01LX92NAE KIRSCHNER WIRE 雅式鋼針 72

FBW01LX955AE KIRSCHNER WIRE 雅式鋼針 72

FBW01LX95NAE KIRSCHNER WIRE 雅式鋼針 72

FBW01LX98SAE K-WIRE 0.8MM,1.0MMX70MM 72

FBW03C018NM1 KIRSCHNER WIRE(田島 PIN) 0.7:1.5MM 100:120MM 72

FEP0256234XT WIRE PISTON 2811

FEP0256235XT WIRE PISTON 2811

FEP0356324XT FISCH TEF-WIRE PISTON 1365

FEP0456210XT MCGEE MODIFIED LOOP PISTON 1250

FEP0456211XT MCGEE MODIFIED LOOP PISTON 1250

FEP0456212XT MCGEE MODIFIED LOOP PISTON 1250

FES0256362XT AUSTIN MODIFIED PARTIAL OSSICULAR REPLACEMENT 3500

FES0256363XT AUSTIN MODIFIED PARTIAL OSSICULAR REPLACEMENT 3500

FES0270141GS MICRON ALL TITANIUM PORP 全鈦部分人工聽小骨置換物 3500

FHFCD01701GU "佳騰"康達克艾維塔心臟再同步治療用去顫器"GUIDANT" CONTAK

RENEWALL 4 AVT CARDIAC RESYNCHRONIZATION THERAPY

DEFIBRILLATOR *適應症請見備註欄

500106

FHFCD07298M4 "美敦力"因信可植入式去纖維顫動器*適應症請見備註欄 500106

FHFCD32374ST "聖猷達"波默克卓植入式心律去顫器”SJM”PROMOTE QUADRA

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*使用規定請見備註欄

609212

FHFCD32454ST “聖猷達”優你法克卓植入式心律去顫器“SJM”UNIFY QUADRA

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*給付規定請見備註欄

609212

FHFCD354TMM4 "MEDTRONIC"PROTECTA XT CRT-D IMPLANTABLE CARDIOVERTER

DEFIBRILLATOR"美敦力"博特多艾緹植入式心臟去顫器*適應症請

見備註欄

591468

FHFCDAHF37ST "聖猷達"波默植入式心律去顫器"SJM"PROMOTE IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR(CRT-D) *適應症請見備註欄

500106

FHFCDC174AM4 "美敦力"康妥植入式心臟去顫器CONCERTO IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR*適應症請見備註欄

565882

FHFCDCD321ST "聖猷達" 波默艾塞爾植入式心律去顫器"SJM" PROMOTE ACCEL

CRT-D CARDIOVERTER/DEFIBRILLATOR*適應症請見備註欄

565882

FHFCDCD323ST "聖猷達" 植入式心律去顫器"SJM" UNIFY IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR(CRT-D)*適應症請見備註欄

565882

FHFCDCD40QST "聖猷達" 植入式心律去顫器"SJM" UNIFY IMPLANTABLE

CARDIOVERTER/DEFIBRILLATOR(CRT-D)*適應症請見備註欄

565882

FHFCDCDPLSST “聖猷達”波默普拉斯植入式心律去顫器“SJM”PROMOTE+

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR(CRT)*使用規定請見

備註欄

500106

FHFCDCRT19GU "佳騰"康達克心臟再同步治療用去顫器"GUIDANT"CONTAK RENEWAL

4&4 HE CARDIAC RESYNCHRONIZATION THERAPY*適應症請見備註欄

500106

FHFCDD214MM4 "美敦力"康賽特植入式心臟去顫器“MEDTRONIC”CONSULTA CRT-D

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR *適應症請見備註欄

565882

FHFCDD234TM4 "美敦力"康賽特植入式心臟去顫器“MEDTRONIC”CONSULTA CRT-D

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR *適應症請見備註欄

565882

884

特材代碼 中英文名稱 支付點數-104/01/01

FHFCDD284TM4 "美敦力"麥思蒙植入式心臟去顫器"MEDTRONIC" MAXIMO II CRT-D

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請見備註欄

500106

FHFCDD354TM4 "美敦力"博特多艾緹植入式心臟去顫器"MEDTRONIC" PROTECTA XT

CRT-D IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請見備

註欄

591468

FHFCDD364TM4 "美敦力"博特多植入式心臟去顫器"MEDTRONIC" PROTECTA CRT-D

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請見備註欄

500106

FHFCDDRF32ST "聖猷達" 波默植入式心律去顫器 "SJM" PROMOTE IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR(CRT-D)*適應症請見備註欄

500106

FHFCDP1068SB "波士頓科技" 康格斯心臟再同步治療用去顫器"BOSTON

SCIENTIFIC" COGNIS 100 HE CRT-D*適應症請見備註欄

500106

FHFCDQ3267ST “聖猷達”克卓亞速拉植入式心律去顫器-四極*給付規定請見備

註欄“SJM” QUADRA ASSURA IMPLANTABLE CARDIOVERTER

DEFIBRILLATOR

609212

FHFCDQMP32ST “聖猷達”克卓亞速拉多點式植入式心律去顫器“SJM”QUADRA

ASSURA MP IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

609212

FHFCDSYN72M4 因信可植入式去纖維顫動器“MEDTRONIC” INSYNC ICD *適應症

請見備註欄

500106

FHFCDTBAD1M4 "美敦力"長青植入式心臟去顫器"MEDTRONIC"VIVA XT/S CRT-D

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

591468

FHFCDTBAD4M4 "美敦力"長青植入式心臟去顫器""MEDTRONIC"VIVA XT/S CRT-D

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

591468

FHFCDTBAQQM4 "美敦力"長青植入式心臟去顫器"MEDTRONIC"VIVA QUAD CRT-D

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

591468

FHFCDUA326ST “聖猷達”優你法亞速拉植入式心律去顫器*給付規定請見備註欄

“SJM” UNIFY ASSURA IMPLANTABLE CARDIOVERTER

DEFIBRILLATOR-CRT-D

565882

FHG103010NGX 戈爾特賜內植人工血管-小兒用薄壁伸展性"GORE" GORE-TEX

VASCULAR GRAFTS-10CM

4289

FHG110304NGX STRAIGHT VASCULAR PROSTHESIS 3MM,4MM,5MM,6MM,7MM,8MM,10MM

40CM

10795

FHG110307NGX STRAIGHT VASCULAR PROSTHESIS 3MM,4MM,5MM,6MM,7MM,8MM,10MM

70CM

16800

FHG1104010MP STRAIGHT GRAFT 4MM 10CM 3363

FHG110401CMP CARBOFLO GRAFT,STRAIGHT,10CM 卡邦人工血管 3363

FHG1104040MP STRAIGHT GRAFT 4MM 40CM 10795

FHG110404CMP CARBOFLO GRAFT,STRAIGHT,40CM 卡邦人工血管 10795

FHG110405CMP CARBOFLO GRAFT,STRAIGHT,50CM 卡邦人工血管 12610

FHG1105040MP STRAIGHT GRAFT 5MM 40CM 10795

FHG1106020MP STRAIGHT GRAFT 6,8MM 20CM 6279

FHG1106020QM "邁柯唯"人工血管"MAQUET"EXXCEL SOFT EPTFE VASCULAR

GRAFT(STANDARD WALL STRAIGHT4-8MM*20CM

6279

FHG110602CMP CARBOFLO GRAFT,STRAIGHT,20CM 卡邦人工血管 6279

FHG110603CMP CARBOFLO GRAFT,STRAIGHT,30CM 卡邦人工血管 8714

FHG1106040MP STRAIGHT GRAFT 6MM 40CM 10795

FHG1106040QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

4-6MM*40CM

10795

FHG1106040SB EXXCEL SOFT EPTFE VASCULAR STANDARD WALL GRAFT 4:8MMX40CM

型號381046,47,48自92.10.1生效

10795

FHG1106050MP STRAIGHT GRAFT 6MM 50CM 12610

FHG1106050QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

6MM*50CM

12610

885

特材代碼 中英文名稱 支付點數-104/01/01

FHG1106050SB EXXCEL SOFT EPTFE VASCULAR STANDARD WALL GRAFT 4:8MMX50CM

型號381056,57,58自92.10.1生效

12610

FHG1106060QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL STRAIGHT 6MM*60CM

14780

FHG1106070MP STRAIGHT GRAFT 6MM 70CM 16800

FHG1106070QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL STRAIGHT 4-8MM*70CM

16800

FHG110607CMP CARBOFLO GRAFT,STRAIGHT,70CM 卡邦人工血管 16800

FHG1106080QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL STRAIGHT 4-8MM*80CM

17465

FHG110608CMP CARBOFLO GRAFT,STRAIGHT,80CM 卡邦人工血管 17465

FHG1106S10TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES STRAIGHT GRAFT 10CM*6,7,8,10MM

3363

FHG1106S20TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES STRAIGHT GRAFT 20CM*6,7,8,10MM

6279

FHG1106S30TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES STRAIGHT GRAFT 30CM*6,7,8,10MM

8714

FHG1106S40TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES STRAIGHT GRAFT 40CM*6,7,8,10MM

10795

FHG1106S50TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES STRAIGHT GRAFT 50CM*6,7,8,10MM

12610

FHG1106S60TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES STRAIGHT GRAFT 60CM*6,7,8,10MM

14780

FHG1106S70TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES STRAIGHT GRAFT 70CM*6,7,8,10MM

16800

FHG1106S80TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES STRAIGHT GRAFT 80CM*6,7,8,10MM

17465

FHG1107040MP STRAIGHT GRAFT 7MM 40CM 10795

FHG1116040QM "邁柯唯"人工血管"MAQUET" EXXCEL SOFT EPTFE VASCULAR GRAFT

5-8MM*40CM

10795

FHG1116050QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL STRAIGHT 5-8MM*50CM

12610

FHG1121000AH "亞翠恩" 艾德凡達聚四氟乙烯人工血管"ATRIUM" ADVANTA PTFE

VASCULAR GRAFTS STANDARD WALL-STRAIGHT,6MM 10CM

3363

FHG1130S06BA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR

GRAFT(STRAIGHT 6MM*30CM)

8714

FHG1140S08BA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR

GRAFT(STRAIGHT 3.5,8,10MM*40CM)

10795

FHG11D5008BA "巴德"迪斯塔人工血管"BARD"DISTAFLO BYPASS GRAFTS 50CM 12610

FHG11D500CBA "巴德"迪斯塔人工血管"BARD" DISTAFLO BYPASS GRAFTS 12610

FHG11D6008BA "巴德"迪斯塔人工血管"BARD"DISTAFLO BYPASS GRAFTS 60CM 14780

FHG11D600CBA "巴德"迪斯塔人工血管"BARD" DISTAFLO BYPASS GRAFTS 60CM 14780

FHG11D7008BA "巴德"迪斯塔人工血管"BARD"DISTAFLO BYPASS GRAFTS 70CM 16800

FHG11D700CBA "巴德"迪斯塔人工血管"BARD" DISTAFLO BYPASS GRAFTS 70CM 16800

FHG11D8008BA "巴德"迪斯塔人工血管"BARD"DISTAFLO BYPASS GRAFTS 80CM 17465

FHG11D800CBA "巴德"迪斯塔人工血管"BARD" DISTAFLO BYPASS GRAFTS 80CM 17465

FHG11V106CMP VENAFLO GRAFT,STRAIGHT,10CM維那人工血管 3363

FHG11V206CMP VENAFLO GRAFT,STRAIGHT,20CM維那人工血管 6279

FHG11V306CMP VENAFLO GRAFT,STRAIGHT,30CM維那人工血管 8714

FHG11V406CMP VENAFLO GRAFT,STRAIGHT,40CM維那人工血管 10795

FHG11V506CMP VENAFLO GRAFT,STRAIGHT,50CM維那人工血管 12610

FHG11VL100MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS-STRAIGHT

GRAFT(6,7MM,10CM)維那人工血管直式

3363

886

特材代碼 中英文名稱 支付點數-104/01/01

FHG11VL200MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS-STRAIGHT

GRAFT(6,7MM,20CM)維那人工血管直式

6279

FHG11VL300MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS-STRAIGHT

GRAFT(6,7MM,30CM)維那人工血管直式

8714

FHG11VL400MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS-STRAIGHT

GRAFT(6,7MM,40CM)維那人工血管直式

10795

FHG11VL500MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS-STRAIGHT

GRAFT(6,7MM,50CM)維那人工血管直式

12610

FHG120304NGX THIN WALLED VASCULAR GRAFT 3MM,4MM,5MM,6MM,7MM,8MM,10MM

40CM

10795

FHG120307NGX THIN WALLED VASCULAR GRAFT 3MM,4MM,5MM,6MM,7MM,8MM,10MM

70CM

16800

FHG120401TMP CARBOFLO GRAFT,STRAIGHT THINWALL,10CM 卡邦人工血管 3363

FHG120405TMP CARBOFLO GRAFT,STRAIGHT THINWALL,50CM 卡邦人工血管 12610

FHG120407TMP CARBOFLO GRAFT,STRAIGHT THINWALL,70CM 卡邦人工血管 16800

FHG120508TMP CARBOFLO GRAFT,STRAIGHT THINWALL,80CM 卡邦人工血管 17465

FHG1206020QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT 6-8MM*20CM

6279

FHG120602TMP CARBOFLO GRAFT,STRAIGHT THINWALL,20CM 卡邦人工血管 6279

FHG120603TMP CARBOFLO GRAFT,STRAIGHT THINWALL,30CM 卡邦人工血管 8714

FHG1206040QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT 6-10MM*40CM

10795

FHG120604TMP CARBOFLO GRAFT,STRAIGHT THINWALL,40CM 卡邦人工血管 10795

FHG1206050QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT 6-10MM*50CM

12610

FHG1206060QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT 6MM*60CM

14780

FHG1206070QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT 5-10MM*70CM

16800

FHG1206075TM "TERUMO"GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELSOFT PLUS EXTERNALLY REINFORCED STRAIGHT

GRAFTS6:10MM 75CM

19012

FHG1206076TM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELSEAL EXTERNALLY REINFORCEED STRAIGHT 6:10MM

75CM

19012

FHG1206080QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT 5-10MM*80CM

17465

FHG1221185AH "亞翠恩" 艾德凡達聚四氟乙烯人工血管"ATRIUM" ADVANTA PTFE

VASCULAR GRAFTS THIN WALL-STRAIGHT,6MM 7MM 8MM *70CM

16800

FHG1230STWBA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR

GRAFT(STRAIGHT THINWALL 6MM*30CM)

8714

FHG1240STWBA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR

GRAFT(STRAIGHT THINWALL 3,6,8MM*40CM)

10795

FHG12F0650MP FLEX GRAFT 6:10MM 50CM 16948

FHG12F0660MP FLEX GRAFT 6:10MM 60CM 20625

FHG12F0680MP FLEX GRAFT 6:10MM 80CM 25266

FHG130504NGX STANDARD STREATCH GRAFT 5MM,6MM,7MM,8MM,10MM 40CM 12721

FHG130507NGX STANDARD STRETCH GRAFT 5MM,6MM,7MM,8MM 70CM 18620

FHG1321010AH "亞翠恩"艾德凡達聚四氟乙烯人工血管"ATRIUM" ADVANTA PTFE

VASCULAR GRAFTS(STANDARD 4MM,6-8MM,40CM)

10795

FHG1321015AH "亞翠恩"艾德凡達聚四氟乙烯人工血管"ATRIUM" ADVANTA PTFE

VASCULAR GRAFTS(STANDARD 4-8MM;10MM*50CM)

12610

887

特材代碼 中英文名稱 支付點數-104/01/01

FHG1321024AH "亞翠恩"艾德凡達聚四氟乙烯人工血管"ATRIUM" ADVANTA PTFE

VASCULAR GRAFTS(STANDARD 4:8MM,10MM 70CM)

16800

FHG1321179AH "亞翠恩"艾德凡達聚四氟乙烯人工血管"ATRIUM" ADVANTA PTFE

VASCULAR GRAFTS(STANDARD 6MM*60CM)

14780

FHG1406070QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL STRAIGHT EXTERNALLY SUPPORTED 6-

8MM*70CM*20-50CM

21700

FHG1406080QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL STRAIGHT EXTERNALLY SUPPORTED 6-

8MM*80CM*20-50CM

22488

FHG1406545GX RINGED GRAFT 5CM 6MM 45CM 13639

FHG140657NGX RINGED GRAFT 50CM 6MM,8MM 70CM 21700

FHG1406C40QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

6MM*45CM

13639

FHG1406C40SB EXXCEL SOFT EPTFE GRAFT STRAIGHT CENTRALLY SUPPORTED

6MM/40CM,45CM/5CM

13639

FHG1406C50QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL STRAIGHT CENTRALLY SUPPORTED

6MM*50CM*5CM

16948

FHG1408030QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL STRAIGHT EXTERNALLY SUPPORTED

8MM*30CM*12CM

11447

FHG1416C40QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL STRAIGHT CENTRALLY SUPPORTED

6MM*40CM*5CM

13639

FHG1421092AH "亞翠恩" 艾德凡達聚四氟乙烯人工血管"ATRIUM" ADVANTA PTFE

VASCULAR GRAFTS STANDARD WALL-CENTER HELIX,6MM* 45CM

13639

FHG1506040QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6-

8MM*40CM*20-30CM

13639

FHG1506070QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

5MM*70CM

21700

FHG1506080QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6-

8MM*80CM*30-70CM

22488

FHG1506440QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED

6MM*40CM*40CM

13639

FHG1506550QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

6MM*50CM

16948

FHG1506550SB EXXCEL SOFT EPTFE VASCULAR THIN WALL GRAFT WITH

EXTERNALLY RING SUPPORTED 6MM,10MMX50CM/RING50CM

16948

FHG150657NGX RINGED THIN WALLED GRAFT 50CM 6MM,8MM,10MM 70CM 21700

FHG1506660QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

6MM*60CM

20625

FHG1506660SB EXXCEL SOFT EPTFE GRAFT THIN WALL STRAIGHT EXTERNALLY

SUPPORTED 6MM/60CM/60CM

20625

FHG1506770QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

6-8MM*70CM

22555

FHG1506770SB EXXCEL SOFT EPTFE GRAFT THIN WALL STRAIGHT EXTERNALLY

SUPPORTED 6MM,8MM,10MM/70CM/70CM

22555

FHG1506880QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

8MM*80CM

25266

888

特材代碼 中英文名稱 支付點數-104/01/01

FHG1506880SB EXXCEL SOFT EPTFE GRAFT THIN WALL STRAIGHT EXTERNALLY

SUPPORTED 6MM,8MM/80CM/80CM

25266

FHG1508030QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED

8MM*30CM*12CM

11447

FHG1516070QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6-

8MM*70CM*20-30CM

21700

FHG1516550QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED

10MM*50CM*50CM

16948

FHG1516880QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED

6MM*80CM*80CM

25266

FHG15F30TWBA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR GRAFT(FLEX

THINWALL 6MM*30CM)

11615

FHG15F4007BA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR GRAFT(FLEX

THINWALL 6,8MM*40CM)

14920

FHG15F408SBA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR GRAFT(FLEX

SMALL BEADING 8MM*40CM)

14920

FHG160577NGX REMOVABLE RINGED THIN WALLED GRAFT 70CM 5MM,6MM,8MM 70CM 22555

FHG160634NGX REMOVABLE RINGED THIN WALLED GRAFT 8MM 40CM 16306

FHG1606550QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL STRAIGHT EXTERNALLY SUPPORTED 6-

8MM*50CM*50CM

16948

FHG1606660QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

5MM*70CM

20625

FHG1606670GX REMOVABLE RINGED THIN WALLED GRAFT 60CM 6MM 70CM 22555

FHG1606770QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

6MM*70CM

22555

FHG1606880QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

6-8MM*80CM

25266

FHG1606880SB EXXCEL SOFT EPTFE GRAFT STRAIGHT EXTERNALLY SUPPORTED

6MM,8MM/80CM/80CM

25266

FHG1606C40TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES CENTRAL SUPPORT STRAIGHT GRAFT 40CM*6,7,8,10MM

14920

FHG1606C50TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES CENTRAL SUPPORT STRAIGHT GRAFT 50CM*6,7,8,10MM

16948

FHG1606E50TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES END SUPPORT STRAIGHT GRAFT 50CM*6,7,8,10MM

16948

FHG1606S10TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES FULL SUPPORT STRAIGHT GRAFT 10CM*6,7,8,10MM

4289

FHG1606S20TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES FULL SUPPORT STRAIGHT GRAFT 20CM*6,7,8,10MM

8114

FHG1606S30TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES FULL SUPPORT STRAIGHT GRAFT 30CM*6,7,8,10MM

11615

FHG1606S40TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES FULL SUPPORT STRAIGHT GRAFT 40CM*6,7,8,10MM

14920

FHG1606S50TM "泰爾茂"緻密人工血管"TERUMO" SEALPTFE GELATIN SEALED

EPTFE VASCULAR PROSTHESES-PTFE FULL SUPPORT STRAIGHT

GRAFT 50CM*6,7,8,10MM

16948

889

特材代碼 中英文名稱 支付點數-104/01/01

FHG1606S60TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES FULL SUPPORT STRAIGHT GRAFT 60CM*6,7,8,10MM

20625

FHG1606S70TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES FULL SUPPORT STRAIGHT GRAFT 70CM*6,7,8,10MM

22555

FHG1606S80TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR

PROSTHESES FULL SUPPORT STRAIGHT GRAFT 80CM*6,7,8,10MM

25266

FHG16CF604MP CARBOFLO GRAFT,CENTERFLEX,40CM 卡邦人工血管 13639

FHG16CF605MP CARBOFLO GRAFT,CENTERFLEX,50CM 卡邦人工血管 16948

FHG16CV604MP VENAFLO GRAFT,CENTERFLEX,40CM維那人工血管 13639

FHG16CV605MP VENAFLO GRAFT,CENTERFLEX,50CM維那人工血管 16948

FHG16CVL40MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS CENTERFLEX(6-

7MM,40CM)印帕維那人工血管中間螺旋式

13639

FHG16CVL50MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS CENTERFLEX(6MM,50CM)

印帕維那人工血管中間螺旋式

16948

FHG16DF508BA "巴德"迪斯塔人工血管"BARD"DISTAFLO BYPASS GRAFTS WITH

FLEX SMALL BEADING 50CM

16948

FHG16DF5SCBA "巴德"迪斯塔人工血管"BARD" DISTAFLO BYPASS GRAFTS WITH

FLEX SMALL BEADING 50CM

16948

FHG16DF600BA "巴德"迪斯塔人工血管"BARD"DISTAFLO BYPASS GRAFTS WITH

FLEX SMALL BEADING 60CM

20625

FHG16DF6SCBA "巴德"迪斯塔人工血管"BARD" DISTAFLO BYPASS GRAFTS WITH

FLEX SMALL BEADING 60CM

20625

FHG16DF700BA "巴德"迪斯塔人工血管"BARD"DISTAFLO BYPASS GRAFTS WITH

FLEX SMALL BEADING 70CM

22555

FHG16DF7SCBA "巴德"迪斯塔人工血管"BARD" DISTAFLO BYPASS GRAFTS WITH

FLEX SMALL BEADING 70CM

22555

FHG16DF800BA "巴德"迪斯塔人工血管"BARD"DISTAFLO BYPASS GRAFTS WITH

FLEX SMALL BEADING 80CM

25266

FHG16DF8SCBA "巴德"迪斯塔人工血管"BARD" DISTAFLO BYPASS GRAFTS WITH

FLEX SMALL BEADING 80CM

25266

FHG16F0640MP FLEX GRAFT 6,7,8,10MM 40CM 14920

FHG16F3006BA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR GRAFT(FLEX

6MM*30CM)

11615

FHG16F4007BA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR GRAFT(FLEX

7;8;10MM*40CM)

14920

FHG16F401TMP CARBOFLO GRAFT,FLEX THINWALL SMALL BEADING,10CM 卡邦人工

血管

4289

FHG16F507TMP CARBOFLO GRAFT,FLEX THINWALL SMALL BEADING,70CM 卡邦人工

血管

22555

FHG16F601CMP CARBOFLO GRAFT,STRAIGHT FLEX,10CM 卡邦人工血管 4289

FHG16F603TMP CARBOFLO GRAFT,FLEX THINWALL SMALL BEADING,30CM 卡邦人工

血管

11615

FHG16F604CMP CARBOFLO GRAFT,STRAIGHT FLEX,40CM 卡邦人工血管 14920

FHG16F605CMP CARBOFLO GRAFT,STRAIGHT FLEX,50CM 卡邦人工血管 16948

FHG16F605TMP CARBOFLO GRAFT,FLEX THINWALL SMALL BEADING,50CM 卡邦人工

血管

16948

FHG16F606CMP CARBOFLO GRAFT,STRAIGHT FLEX,60CM 卡邦人工血管 20625

FHG16F606TMP CARBOFLO GRAFT,FLEX THINWALL SMALL BEADING,60CM 卡邦人工

血管

20625

FHG16F607CMP CARBOFLO GRAFT,STRAIGHT FLEX,70CM 卡邦人工血管 22555

FHG16F608CMP CARBOFLO GRAFT,STRAIGHT FLEX,80CM 卡邦人工血管 25266

FHG16F608TMP CARBOFLO GRAFT,FLEX THINWALL SMALL BEADING,80CM 卡邦人工

血管

25266

890

特材代碼 中英文名稱 支付點數-104/01/01

FHG16VXT80AH "亞翠恩"艾德凡達聚四氟乙烯人工血管"ATRIUM"ADVANTA PTFE

VASCULAR GRAFTS(STANDARD WALL RINGED 5-10MM 80CM)

22488

FHG1721068AH "亞翠恩"艾德凡達聚四氟乙烯人工血管"ATRIUM" ADVANTA PTFE

VASCULAR GRAFTS(STANDARD WALL-HELIX SUPPORTED 4:8MM,70CM)

22555

FHG1721220AH "亞翠恩" 艾德凡達聚四氟乙烯人工血管"ATRIUM" ADVANTA PTFE

VASCULAR GRAFTS THIN WALL-HELIX SUPPORTED,6MM 7MM 8MM*

70CM

22555

FHG1722063AH "亞翠恩"艾德凡達聚四氟乙烯人工血管"ATRIUM" ADVANTA PTFE

VASCULAR GRAFTS(WALL-HELIX SUPPORTED STANDARD

5MM:8MM*50CM)

16948

FHG1806040GX "戈爾"戈爾特賜內植人工血管(內環伸展性人工血管)"GORE"

GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)6MM X 40CM

14915

FHG180604NGX "戈爾"戈爾特賜內植人工血管(內環伸展性薄壁人工血管)"GORE"

GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)6MM,7MM,8MM X

40CM

17990

FHG180606NGX "戈爾"戈爾特賜內植人工血管(內環伸展性薄壁人工血管)"GORE"

GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)6MM,7MM,8MM X

60CM

26400

FHG180608NGX "戈爾"戈爾特賜內植人工血管(內環伸展性薄壁人工血管)"GORE"

GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)6MM,7MM,8MM X

80CM

28330

FHG1825525AH "ATRIUM" FLIXENE VASCULAR GRAFTS"亞翠恩" 福立心人工血管 21170

FHG1861020GX "戈爾"戈爾特賜內植人工血管(內環伸展性人工血管)"GORE"

GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)6MM X 10CM X 20CM

8926

FHG2106030TM "TERUMO"GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELSEAL STRAIGHT GRAFTS6:10MM 30CM

8169

FHG2106031TM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELSEAL TRIAXIAL,GELSOFT STRAIGHT 6:10MM 30CM

8169

FHG2106060TM "TERUMO"GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELSEAL STRAIGHT GRAFTS6:10MM 60CM

13580

FHG2106061TM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELSEAL TRIAXIAL,GELSOFT STRAIGHT 6:10MM 60CM

13580

FHG2112025TM "TERUMO"GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELSEAL STRAIGHT GRAFTS12:18MM 25,30CM

7888

FHG211203NGX "戈爾" 戈爾特賜內植人工血管-伸展性直型人工血管"GORE"

GORE-TEX VASCULAR GRAFTS-STRETCH VASCULAR GRAFT STRAIGHT

12:18MM*30CM

9563

FHG2112050TM "TERUMO"GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELSEAL STRAIGHT GRAFTS12:18MM 60CM

9836

FHG2112051TM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELSEAL TRIAXIAL,GELSOFT STRAIGHT 12:18MM

50,60CM

10234

FHG2120020TM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELSEAL TRIAXIAL,GELSOFT STRAIGHT 20:38MM

20,25CM

9140

FHG2120025TM "泰爾茂"傑斯弗特加強型人工血管"TERUMO" GELSOFT PLUS

GELATIN SEALED POLYESTER VASCULAR PROSTHESES-GELSEAL

STRAIGHT GRAFTS,20:24MM,25CM

9140

891

特材代碼 中英文名稱 支付點數-104/01/01

FHG212003NGX "戈爾" 戈爾特賜內植人工血管-伸展性直型人工血管"GORE"

GORE-TEX VASCULAR GRAFTS-STRETCH VASCULAR GRAFT STRAIGHT

20:24MM*30CM

11592

FHG2143108TM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR

PROSTHESES SPECIAL FOUR BRANCH(PLEXUS)40CM*4@15CM*適應症

請見備註欄

56028

FHG2173108TM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR

PROSTHESES SPECIAL FOUR BRANCH(PLEXUS)40CM*4@15CM *適應症

請見備註欄

56028

FHG21GK020V8 MAQUET INTERGARD KNITTED VASCULAR GRAFTS邁柯唯英特佳針織

系列人工血管6-10MM,20CM

5723

FHG21GK021V8 MAQUET INTERGARD KNITTED VASCULAR GRAFTS邁柯唯英特佳針織

系列人工血管12-24MM,20CM

7888

FHG21GK040V8 MAQUET INTERGARD KNITTED VASCULAR GRAFTS邁柯唯英特佳針織

系列人工血管6-10MM,40CM

9312

FHG21GK041V8 MAQUET INTERGARD KNITTED VASCULAR GRAFTS邁柯唯英特佳針織

系列人工血管12-24MM,40CM

10234

FHG21GK070V8 MAQUET INTERGARD KNITTED VASCULAR GRAFTS邁柯唯英特佳針織

系列人工血管6-10MM,70CM

13580

FHG21GK100V8 MAQUET INTERGARD KNITTED VASCULAR GRAFTS邁柯唯英特佳針織

系列人工血管8MM,100CM

18818

FHG21GK12SQM 邁柯唯英特佳塗銀人工血管和補片MAQUET INTERGARD SILVER

VASCULAR GRAFT AND PATCH(雙叉型)50CM 雙叉人工血管12-

24MM,50CM

15287

FHG21GK20SQM 邁柯唯英特佳塗銀人工血管和補片MAQUET INTERGARD SILVER

VASCULAR GRAFT AND PATCH 12-24MM,20CM

7888

FHG21GK40SQM 邁柯唯英特佳塗銀人工血管和補片MAQUET INTERGARD SILVER

VASCULAR GRAFT AND PATCH 12-24MM,40CM

10234

FHG21GK61SQM 邁柯唯英特佳塗銀人工血管和補片MAQUET INTERGARD SILVER

VASCULAR GRAFT AND PATCH 6-10MM,70CM

13580

FHG21GK67HQM 邁柯唯英特佳肝素膠原塗層人工血管MAQUET INTERGARD HEPARIN

VASCULAR GRAFT 6-10MM*70CM

16800

FHG21GK67SQM 邁柯唯英特佳塗銀人工血管和補片MAQUET INTERGARD SILVER

VASCULAR GRAFT AND PATCH 6-10MM,40CM

9312

FHG21GK68SQM 邁柯唯英特佳塗銀人工血管和補片MAQUET INTERGARD SILVER

VASCULAR GRAFT AND PATCH 6-8MM*20CM

5723

FHG21GKRS1QM 邁柯唯英特佳塗銀人工血管和補片MAQUET INTERGARD SILVER

VASCULAR GRAFT AND PATCH(徑向支撐型)6-8MM*70CM

21700

FHG21GKRS1V8 邁柯唯英特佳針織系列人工血管MAQUET INTERGARD KNITTED

VASCULAR GRAFTS RADIALLY SUPPORTED 6-8MM,70CM,R15-30CM

19012

FHG21GKRS2QM 邁柯唯英特佳塗銀人工血管和補片MAQUET INTERGARD SILVER

VASCULAR GRAFT AND PATCH(徑向支撐型)6-8MM*80CM

22488

FHG21GKRS2V8 邁柯唯英特佳針織系列人工血管MAQUET INTERGARD KNITTED

VASCULAR GRAFTS RADIALLY SUPPORTED ULTRA THIN

6MM,85CM,R45CM

20399

FHG21GKRS3QM 邁柯唯英特佳塗銀人工血管和補片MAQUET INTERGARD SILVER

VASCULAR GRAFT AND PATCH(徑向支撐型)8MM*100CM

25266

FHG21GKUT1V8 邁柯唯英特佳針織系列人工血管MAQUET INTERGARD KNITTED

VASCULAR GRAFTS ULTRA THIN 5-8MM,70CM

13580

FHG21GKUT2V8 邁柯唯英特佳針織系列人工血管MAQUET INTERGARD KNITTED

VASCULAR GRAFTS ULTRA THIN 5-8MM,40CM

9312

FHG21GKUT3V8 "英特維"英特佳"INTERVASCULAR" INTERGARD KNITTED VASCULAR

GRAFTS ULTRA THIN 6-8MM,20CM

5723

892

特材代碼 中英文名稱 支付點數-104/01/01

FHG21GKUT8QM 邁柯唯英特佳塗銀人工血管和補片MAQUET INTERGARD SILVER

VASCULAR GRAFT AND PATCH(超薄/非超薄徑向支撐型)8MM,40CM

13639

FHG21GKUTSQM 邁柯唯英特佳塗銀人工血管和補片MAQUET INTERGARD SILVER

VASCULAR GRAFT AND PATCH(超薄徑向支撐型)6-8MM,70CM

21700

FHG21HEWAAV8 MAQUET INTERGARD WOVEN VASCULAR GRAFTS邁柯唯英特佳編織系

列人工血管-四分叉主動脈弓人工血管20-34MM*8-10MM,50CM

56028

FHG21K1206V8 "INTERVASCULAR"INTERGARD KNITTED VASCULAR GRAFTS"英特維"

英特佳針織系列雙叉人工血管12-24MM,50CM

15287

FHG21KUT4HQM 邁柯唯英特佳肝素膠原塗層人工血管MAQUET INTERGARD HEPARIN

VASCULAR GRAFT 6-8MM*40CM

10795

FHG21KUT7HQM 邁柯唯英特佳肝素膠原塗層人工血管MAQUET INTERGARD HEPARIN

VASCULAR GRAFT 6-8MM*70CM

16800

FHG21W0630TM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELWEAVE STRAIGHT VASCULAR GRAFTS

30CM*6,8,10MM

8169

FHG21W0660TM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELWEAVE STRAIGHT VASCULAR GRAFTS 60CM*6-10MM

13580

FHG21W1230TM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELWEAVE STRAIGHT VASCULAR GRAFTS 30CM*12-18MM

9849

FHG21W1260TM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELWEAVE STRAIGHT VASCULAR GRAFTS 60CM*12-18MM

9836

FHG21W1407V8 MAQUET INTERGARD WOVEN VASCULAR GRAFTS邁柯唯英特佳編織系

列人工血管14-24MM,50CM

15287

FHG21W2030TM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELWEAVE STRAIGHT VASCULAR GRAFTS 30CM*20-38MM

11630

FHG21W2050TM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR

PROSTHESES GELWEAVE STRAIGHT VASCULAR GRAFTS 50CM*20-34MM

12416

FHG21WK015V8 MAQUET INTERGARD WOVEN VASCULAR GRAFTS邁柯唯英特佳編織系

列人工血管12-24MM,15CM

4608

FHG21WK016V8 MAQUET INTERGARD WOVEN VASCULAR GRAFTS邁柯唯英特佳編織系

列人工血管26-36MM,15CM

5587

FHG21WK030V8 MAQUET INTERGARD WOVEN VASCULAR GRAFTS邁柯唯英特佳編織系

列人工血管6-10MM,30CM

8169

FHG21WK031V8 MAQUET INTERGARD WOVEN VASCULAR GRAFTS邁柯唯英特佳編織系

列人工血管12-18MM,30CM

9849

FHG21WK032V8 MAQUET INTERGARD WOVEN VASCULAR GRAFTS邁柯唯英特佳編織系

列人工血管20-38MM,30CM

11630

FHG21WK060V8 MAQUET INTERGARD WOVEN VASCULAR GRAFTS邁柯唯英特佳編織系

列人工血管22-32MM,60CM

14899

FHG3140A64BA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR

GRAFT(SHORT TAPERED 6,7-4MM*40CM)

12527

FHG3146040QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL SHORT TAPER 4-7MM*40-45CM

12527

FHG3146040TM "泰爾茂"特普弗人工血管"TERUMO" TAPERFLO GELATIN SEALED

EPTFE VASCULAR PROSTHESES SHORT TAPER GRAFT40,45CM 4-6,4-

7MM

12527

FHG3146041TM "泰爾茂"麥斯弗人工血管"TERUMO" MAXIFLO EXPANDED EPTFE

VASCULAR PROSTHESES(SHORT TAPER GRAFT40,50CM*4-6:4-7MM)

12527

893

特材代碼 中英文名稱 支付點數-104/01/01

FHG3146045QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

4-7MM*45CM

12527

FHG3146045SB EXXCEL SOFT EPTFE VASCULAR STANDARD WALL GRAFT(STEP)4-

6MM,4-7MMX45CM型號382456,57自92.10.1生效

12527

FHG3146050QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL SHORT TAPER 4-7MM*50CM

14973

FHG3146S30TM "泰爾茂"特普弗人工血管 TAPERFLO GELATIN SEALED EPTFE

VASCULAR PROSTHESES GELATIN SEALED STEPPED TAPER GRAFT

30,35CM 4-6:5-8MM

9040

FHG3146S40TM "泰爾茂"特普弗人工血管 TAPERFLO GELATIN SEALED EPTFE

VASCULAR PROSTHESES GELATIN SEALED STEPPED TAPER GRAFT

40,45CM 4-6:5-8MM

12527

FHG3146S41TM "泰爾茂"麥斯弗人工血管"TERUMO" MAXIFLO EXPANDED EPTFE

VASCULAR PROSTHESES(STEPPED TAPER GRAFT40,45CM*4-6:5-

8MM)

12527

FHG3146S45TM "泰爾茂"特普弗人工血管"TERUMO" TAPERFLO GELATIN SEALED

EPTFE VASCULAR PROSTHESES STEPPED TAPER CENTRAL SUPPORT

GRAFT 40,45CM 4-7,5-8MM

15800

FHG3146S46TM "泰爾茂"麥斯弗人工血管"TERUMO" MAXIFLO EXPANDED EPTFE

VASCULAR PROSTHESES(SHORT TAPER WITH CENTRAL

REINFORCEMENT40,45CM*4-7:5-8MM)

15800

FHG3146S50TM "泰爾茂"特普弗人工血管 TAPERFLO GELATIN SEALED EPTFE

VASCULAR PROSTHESES GELATIN SEALED STEPPED TAPER CENTRAL

SUPPORT GRAFT 50CM 4-7MM

14973

FHG3146W40TM “泰爾茂”特普弗人工血管“TERUMO” TAPERFLO GELATIN

SEALED EPTFE VASCULAR PROSTHESES EPTFE STEPPED TAPER

GRAFT40,45CM*4-6,5-8MM

12527

FHG3146W41TM “泰爾茂”特普弗人工血管“TERUMO”TAPERFLO GELATIN SEALED

EPTFE VASCULAR PROSTHESES EPTFE STEPPED TAPER

GRAFT40,50CM*4-6,4-7MM

12527

FHG3146W45TM “泰爾茂”特普弗人工血管"TERUMO”TAPERFLO GELATIN SEALED

EPTFE VASCULAR PROSTHESES STEPPED TAPER CENTRAL SUPPORT

GRAFT 40,45CM*4-7,5-8MM

15800

FHG3147030TM "泰爾茂"特普弗人工血管"TERUMO" TAPERFLO GELATIN SEALED

EPTFE VASCULAR PROSTHESES SHORT TAPER GRAFT 30CM 4-7MM

9040

FHG3147040GX TAPERED GRAFT 4-7MM 40CM 12527

FHG3147S45MP STEPPED GRAFT 4-7MM 45CM 12527

FHG3148045QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL STEP 4-6MM*45CM

12527

FHG3164A40MP CARBOFLO GRAFT,SHORT TAPERED,40CM 卡邦人工血管 12527

FHG316CF50MP CENTER FLEX 6:8MM 50CM 16948

FHG31T4645MP CARBOFLO GRAFT,STEPPED,45CM 卡邦人工血管 12527

FHG31T4750MP CARBOFLO GRAFT,STEPPED,50CM 卡邦人工血管 14973

FHG31VLT20MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS STEPPED GRAFT(4-6,4-

7MM,20CM,25CM)印帕維那人工血管階級式

6762

FHG31VLT30MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS STEPPED GRAFT(4-6,4-

7MM,30CM,35CM)印帕維那人工血管階級式

9040

FHG31VLT40MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS STEPPED GRAFT(4-6,4-

7MM,40CM,45CM)印帕維那人工血管階級式

12527

FHG31VT246MP VENAFLO GRAFT,STEPPED,20/25CM維那人工血管 6762

FHG31VT346MP VENAFLO GRAFT,STEPPED,30CM維那人工血管 9040

FHG3274070MP CARBOFLO GRAFT,TAPERED THINWALL,70CM 卡邦人工血管 18528

894

特材代碼 中英文名稱 支付點數-104/01/01

FHG3322114AH "亞翠恩"艾德凡達聚四氟乙烯人工血管"ATRIUM" ADVANTA PTFE

VASCULAR GRAFTS(SHORT TAPER STANDARD WALL 4-6MM,4-

7MM*40CM,45CM)

12527

FHG3347040GX TAPERED STRETCH VASCULAR GRAFT 4:7MMX40CM 14640

FHG336CF40MP CENTER FLEX GRAFT 6:10MM 40CM 13639

FHG3447940QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR

GRAFT(STANDARD WALL SHORT TAPER CENTRALLY SUPPORTED 4-

7MM*40-45CM*5-10CM

14400

FHG3447C40QM "邁柯唯"人工血管"MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT

4-7MM*45CM

14400

FHG3447C40SB EXXCEL SOFT EPTFE GRAFT SHORT TAPER ,STEP CENTRALLY

SUPPORTED 4-7MM/40CM,45CM/5-15CM

14400

FHG3447S45MP CENTERFLEX STEPPED GRAFT 4-7MM,5-8MM 45CM 14400

FHG34CF40ABA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR

GRAFT(SHORT TAPERED CENTERFLEX 6,7-4MM*40CM)

14400

FHG34CFT40BA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR

GRAFT(STEPPED CENTERFLEX 4-7MM*40CM)

14400

FHG3622125AH "亞翠恩"艾德凡達聚四氟乙烯人工血管"ATRIUM" ADVANTA PTFE

VASCULAR GRAFTS(SHORT TAPER CENTER HELIX STANDARD 4-

7MM*45CM)

15800

FHG3630A74BA "印帕"聚四氟乙烯人工血管"IMPRA" EPTFE VASCULAR

GRAFT(SHORT TAPERED 7-4MM*30CM)

9040

FHG3647145GX TAPERED GRAFT WITH REMOVAL RINGED 15800

FHG3674A40MP CARBOFLO GRAFT,SHORT TAPERED CENTERFLEX,40CM 卡邦人工血管 15800

FHG36CVLT4MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS STEPPED CENTERFLEX(4-

7MM,45CM)印帕維那人工血管階級中間螺旋式

14400

FHG36F7407MP CARBOFLO GRAFT,FLEX THINWALL TAPERED SMALL BEADING,70CM

卡邦人工血管

22179

FHG36T4740MP CARBOFLO GRAFT,STEPPED CENTERFLEX,40/45CM 卡邦人工血管 15800

FHG36T4750MP CARBOFLO GRAFT,STEPPED CENTERFLEX,50CM 卡邦人工血管 16374

FHG36VT454MP VENAFLO GRAFT,STEPPED CENTERFLEX,45CM維那人工血管 15800

FHG3847045GX 戈爾特賜內植人工血管(錐狀內環伸展性人工血管)GORE-TEX

VASCULAR GRAFTS(INTERING GRAFT)4-7MM X 45CM

17380

FHG4312645TM "TERUMO"GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR

PROSTHESES BIFURCATION WOVEN GRAFTS12:24*6:12MM 45CM

15287

FHG4312646TM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR

PROSTHESES BIFURCATION WOVEN GRAFT 12:24*6:12MM 45CM

15287

FHG431401NGX "戈爾" 戈爾特賜內植人工血管-伸展性Y型人工血管"GORE" GORE-

TEX VASCULAR GRAFTS-STRETCH VASCULAR GRAFT BIFURCATED

14:24MM*7:12MM*40CM

15456

FHG43W1245TM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR

PROSTHESES BIFURCATION WOVEN GRAFT 12:24*6:12MM 45CM

15287

FHP0112400PR REGENCY SR+SSIR PULSE GENERATOR W/AUTOCAPTURE※須檢附心電

圖報告專案報備使用

64214

FHP0112402PR REGENCY SC+SSIC PULSE GENERATOR W/AUTOCAPTURE※須檢附心電

圖報告專案報備使用

61910

FHP0112525PR REGENCY/MICRONY SSIR PULSE GENERATOR須附心電圖報告專案報

備使用(不須事前審查)

64214

FHP011NGSRSB "波士頓科技"迎吉心臟節律器(單腔)"BOSTON

SCIENTIFIC"INGENIO PACEMAKER (SR)

64214

FHP011NGVRSB "波士頓科技"迎吉心臟節律器 (雙腔)"BOSTON

SCIENTIFIC"INGENIO PACEMAKER (VDDR)

93833

895

特材代碼 中英文名稱 支付點數-104/01/01

FHP012404NPR REGENCY SR SSIR PULSE GENERATOR WITHOUT LEAD※須檢附心電

圖報告專案報備使用

64214

FHP012406NPR REGENCY SC/SCX SSI PULSE GENERATOR WITHOUT LEAD※須檢附心

電圖報告專案報備使用

56540

FHP01ACCPMST "聖猷達"艾森心臟節律器(ACCENT IMPLANTABLE CARDIAC PULSE

GENERATOR) *適應症請見備註欄

64214

FHP01ACCRMST "聖猷達"艾森心臟節律器((ACCENT IMPLANTABLE CARDIAC PULSE

GENERATOR) *適應症請見備註欄

64214

FHP01ACCV2ST "聖猷達" 艾森艾斯特心臟節律器(單腔)"SJM" ACCENT ST PULSE

GENERATOR*適應症請見備註欄

64214

FHP01ACCVRST "聖猷達" 艾森艾斯特心臟節律器(單腔)"SJM" ACCENT ST PULSE

GENERATOR*適應症請見備註欄

64214

FHP01ADAPSM4 "MEDTRONIC" ADAPTA PACING SYSTEM"美敦力"黛拉心臟節律系統*

適應症請見備註欄

64214

FHP01ADD1SM4 "美敦力" 黛拉心臟節律器"MEDTRONIC" ADAPTA PACEMAKER-DDD*

使用規定請見備註欄

93833

FHP01ADSRSM4 "美敦力" 黛拉心臟節律器"MEDTRONIC" ADAPTA PACEMAKER-

AAI/VVI*使用規定請見備註欄

64214

FHP01ADVDSM4 "美敦力" 黛拉心臟節律器"MEDTRONIC" ADAPTA PACEMAKER-VDD*

使用規定請見備註欄

93833

FHP01ADVSRSB “波士頓科技”艾凡緹心臟節律器“BOSTON SCIENTIFIC”

ADVANTIO PACEMAKER

64214

FHP01AVTSRGU "佳騰"因施尼亞內植用雅密特心臟整律器"GUIDANT"INSIGNIA I

AVT PULSE GENERATOR SSIR*須檢附心電圖報告專案報備適用

64214

FHP01AVTSSGU "佳騰"因施尼亞內植用雅密特心臟整律器"GUIDANT"INSIGNIA I

AVT PULSE GENERATOR*須檢附心電圖報告專案報備適用

61910

FHP01DDD20SB "波士頓科技" 歐超心臟整律器"BOSTON SCIENTIFIC" ALTRUA 20

PACEMAKER *適應症見備註欄。

93833

FHP01EFTDDBK “百多力”艾飛塔植入式心律調節器(包含配件)*給付規定請見備

註欄“BIOTRONIK”EFFECTA IMPLANTABLE CARDIAC PACEMAKERS

INCL. ACCESSORIES-EFFECTA DDD

93833

FHP01EFTDRBK "百多力"艾飛塔植入式心律調節器(包含配件)(雙腔自付差

額)"BIOTRONIK"EFFECTA IMPLANTABLE CARDIAC PACEMAKERS

INCL. ACCESSORIES-EFFECTA DDDR

93833

FHP01EFTSRBK “百多力”艾飛塔植入式心律調節器(包含配件)*給付規定請見備

註欄“BIOTRONIK”EFFECTA IMPLANTABLE CARDIAC PACEMAKERS

INCL. ACCESSORIES-EFFECTA SR

64214

FHP01EFTSSBK “百多力”艾飛塔植入式心律調節器(包含配件)*給付規定請見備

註欄“BIOTRONIK”EFFECTA IMPLANTABLE CARDIAC PACEMAKERS

INCL. ACCESSORIES-EFFECTA S

61910

FHP01ESS1RM4 ENPULSE PACING GENERATOR須檢附心電圖報告專案報備使用 64214

FHP01EVASRBK "百多力" 艾維亞植入式心律調節器"BIOTRONIK" EVIA

IMPLANTABLE CARDIAC PACEMAKER*需檢附心電圖報告專案報備使

64214

FHP01MR224ST "聖猷達"艾森核磁共振心臟節律器"SJM"ACCENT MRI PULSE

GENERATOR

81477

FHP01PM134ST “聖猷達”薩斯坦植入式心臟節律器“SJM”SUSTAIN XL

IMPLANTABLE CARDIAC PULSE GENERATOR-SSI*需檢附心電圖報告

專案報備

61910

FHP01PM136ST “聖猷達”薩斯坦植入式心臟節律器“SJM”SUSTAIN XL

IMPLANTABLE CARDIAC PULSE GENERATOR-SSIR*需檢附心電圖報告

專案報備

64214

FHP01SD01SM4 "美敦力" 賽亞心臟節律器"MEDTRONIC" SENSIA PACEMAKER(DDD)*

需檢附心電圖報告專案報備使用

93833

896

特材代碼 中英文名稱 支付點數-104/01/01

FHP01SENAAM4 "美敦力"賽亞心臟節律系統"MEDTRONIC" SENSIA PACING SYSTEM

VVI/AAI*需檢附心電圖報告專案報備使用

61910

FHP01SENARM4 "美敦力"賽亞心臟節律系統"MEDTRONIC" SENSIA PACING SYSTEM

VVIR/AAIR*需檢附心電圖報告專案報備使用

64214

FHP01SR01SM4 "美敦力" 賽亞心臟節律器"MEDTRONIC" SENSIA

PACEMAKER(VVIR/AAIR)*需檢附心電圖報告專案報備使用

64214

FHP01SS01SM4 "美敦力" 賽亞心臟節律器"MEDTRONIC" SENSIA

PACEMAKER(VVI/AAI)*需檢附心電圖報告專案報備使用

61910

FHP01SSR20SB "波士頓科技" 歐超心臟整律器"BOSTON SCIENTIFIC" ALTRUA 20

PACEMAKER *適應症見備註欄。

64214

FHP01SSR40SB "波士頓科技" 歐超心臟整律器"BOSTON SCIENTIFIC" ALTRUA 40

PACEMAKER *適應症見備註欄

64214

FHP01SSR50SB "波士頓科技" 歐超心臟整律器"BOSTON SCIENTIFIC" ALTRUA 50

PACEMAKER *需檢附心電圖報告專案報備使用

64214

FHP01SSR60SB "波士頓科技" 歐超心臟整律器"BOSTON SCIENTIFIC" ALTRUA 60

PACEMAKER *需檢附心電圖報告專案報備使用

64214

FHP01SSS20SB "波士頓科技" 歐超心臟整律器"BOSTON SCIENTIFIC" ALTRUA 20

PACEMAKER *適應症見備註欄。

56540

FHP01UTASRGU "佳騰"因施尼亞內植用雅密特心臟整律器"GUIDANT"INSIGNIA I

ULTRA PULSE GENERATOR SSIR*須檢附心電圖報告專案報備適用

64214

FHP01V56SRST "聖猷達"維奇植入式心臟節律器"SJM" VICTORY IMPLANTABLE

CARDIAC PULSE GENERATOR * 須檢附心電圖報告專案報備使用

64214

FHP01VDSS5SB "波士頓科技" 歐超心臟整律器"BOSTON SCIENTIFIC" ALTRUA 50

PACEMAKER *適應症見備註欄

61910

FHP01VEESRST IMPLANTABLE CARDIAC PULSE GENERATOR單腔型植入式心臟節律器

*須檢附心電圖報告專案報備使用

64214

FHP01VERSCST 植入式心臟節律器IMPLANTABLE CARDIAC PULSE GENERATOR 61910

FHP01VERSRST 植入式心臟節律器IMPLANTABLE CARDIAC PULSE GENERATOR#須檢

附心電圖報告專案報備使用

64214

FHP01ZESR6ST "聖猷達"神風植入式心臟節律器"SJM" ZEPHYR IMPLANTABLE

CARDIAC PULSE GENERATOR *適應症請見備註欄

64214

FHP021A5DRM4 美敦力艾維莎植入式心臟節律器ADVISA DR IMPLANTABLE

PACEMAKERM*適應症請見備註欄,按同類近似特材支付點數支付,

超過部分由病患自付。

93833

FHP02A3DR1M4 "美敦力"艾維莎核磁共振植入式心臟節律器"MEDTRONIC"ADVISA

DR MRI SURESCAN IMPLANTABLE PACEMAKER*按近似特材102500點

支付,超過部分由病患自付。

93833

FHP02ACCDRST "聖猷達" 艾森艾斯特心臟節律器(雙腔)"SJM" ACCENT ST PULSE

GENERATOR*適應症請見備註欄,按同類近似特材支付點數支付,

超過部分由病患自付

93833

FHP02ACSDRST "聖猷達" 艾森艾斯特心臟節律器(雙腔)"SJM" ACCENT ST PULSE

GENERATOR*適應症請見備註欄,按同類近似特材支付點數支付,

超過部分由病患自付

93833

FHP02ACTDRST "聖猷達"艾森心臟節律器(IMPLANTABLE CARDIAC PULSE

GENERATOR雙腔型) *適應症請見備註欄,按同類近似特材支付點數

支付,超過部分由病患自付。

93833

FHP02ADDRSM4 "美敦力" 黛拉心臟節律器"MEDTRONIC" ADAPTA PACEMAKER-DDDR*

使用規定請見備註欄,,按同類近似特材支付點數支付,超過部分

由病患自付。

93833

FHP02ARFDRST "聖猷達"艾森心臟節律器(IMPLANTABLE CARDIAC PULSE

GENERATOR雙腔型) *適應症請見備註欄,按同類近似特材支付點數

支付,超過部分由病患自付。

93833

FHP02DDD2SST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄

93833

897

特材代碼 中英文名稱 支付點數-104/01/01

FHP02DDD2UST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄

93833

FHP02DDD32GU 內植用雅密特心臟整律器GUIDANT INSIGNIA I AVT PULSE

GENERATOR*適應症請見備註欄

93833

FHP02DDD50SB "波士頓科技" 歐超心臟整律器"BOSTON SCIENTIFIC" ALTRUA 50

PACEMAKER *需檢附心電圖報告專案報備使用

93833

FHP02DDD6SST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄

93833

FHP02DDD6UST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄

93833

FHP02DDDADM4 美敦力黛拉心臟節律器MEDTRONIC ADAPTA PACING GENERATOR*適

應症請見備註欄

93833

FHP02DDDSEM4 美敦力賽亞心臟節律器MEDTRONIC SENSIA PACING GENERATOR*適

應症請見備註欄

93833

FHP02DDR20SB "波士頓科技" 歐超心臟整律器"BOSTON SCIENTIFIC" ALTRUA 20

PACEMAKER *適應症見備註欄,按同類近似特材支付點數支付,超

過部分由病患自付。

93833

FHP02DDR31GU 內植用雅密特心臟整律器GUIDANT INSIGNIA I AVT PULSE

GENERATOR*適應症請見備註欄,按同類近似特材支付點數支付,超

過部分由病患自付。

93833

FHP02DDR3SST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄,按同類近似特材支付點數支付,超過部分由

病患自付。

93833

FHP02DDR3UST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄,按同類近似特材支付點數支付,超過部分由

病患自付。

93833

FHP02DDR40SB "波士頓科技" 歐超心臟整律器"BOSTON SCIENTIFIC" ALTRUA 40

PACEMAKER *適應症見備註欄,按同類近似特材支付點數支付,超

過部分由病患自付。

93833

FHP02DDR41GU 因施尼亞心臟整律器GUIDANT INSIGNIA I ULTRA PULSE

GENERATOR*適應症請見備註欄,按同類近似特材支付點數支付,超

過部分由病患自付。

93833

FHP02DDR50SB "波士頓科技" 歐超心臟整律器"BOSTON SCIENTIFIC" ALTRUA 50

PACEMAKER *適應症見備註欄,按同類近似特材支付點數支付,超

過部分由病患自付。

93833

FHP02DDR5SST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄,按同類近似特材支付點數支付,超過部分由

病患自付。

93833

FHP02DDR5UST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄,按同類近似特材支付點數支付,超過部分由

病患自付。

93833

FHP02DDR60SB "波士頓科技" 歐超心臟整律器"BOSTON SCIENTIFIC" ALTRUA 60

PACEMAKER *適應症見備註欄,按同類近似特材支付點數支付,超

過部分由病患自付。

93833

FHP02DDR7UST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄,按同類近似特材支付點數支付,超過部分由

病患自付。

93833

FHP02DDR8SST 維奇植入式心臟節律器"SJM"VICTORY IMPLANTABLE CARDIAC

PULSE GENERATOR適應症請見備註欄,按同類近似特材支付點數

102500點支付,超過部分由病患自付

93833

FHP02DDR8UST 雙腔型心臟節律器"SJM" VICTORY IMPLANTABLE CARDIAC PULSE

GENERATOR *適應症請見備註欄,按同類近似特材支付點數支付,

超過部分由病患自付。

93833

898

特材代碼 中英文名稱 支付點數-104/01/01

FHP02DDRADM4 美敦力黛拉心臟節律器MEDTRONIC ADAPTA PACING GENERATOR*適

應症請見備註欄,按同類近似特材支付點數支付,超過部分由病

患自付。

93833

FHP02DDRSEM4 美敦力賽亞心臟節律器MEDTRONIC SENSIA PACING GENERATOR*適

應症請見備註欄,按同類近似特材支付點數支付,超過部分由病

患自付。

93833

FHP02DDRTHM4 植入式心臟節律系統ENRHYTHM IMPLANTABLE PACEMAKER SYSTEMS*

適應症請見備註欄,按同類近似特材支付點數支付,超過部分由

病患自付。

93833

FHP02DDRVEM4 美敦力維莎心臟節律器MEDTRONIC VERSA PACING GENERATOR*適應

症請見備註欄,按同類近似特材支付點數支付,超過部分由病患

自付。

93833

FHP02EMRDRBK "百多力"艾維亞植入式心律調節器(雙腔自付差

額)"BIOTRONIK"EVIA IMPLANTABLE CARDIAC PACEMAKERS(DR

PROMRI)

93833

FHP02EMRDTBK "百多力"艾維亞植入式心律調節器(雙腔自付差

額)"BIOTRONIK"EVIA IMPLANTABLE CARDIAC PACEMAKERS(DR-T

PROMRI)

93833

FHP02EN1DRM4 "美敦力"安信諾核磁共振植入式心臟節律器(雙腔自付差

額)"MEDTRONIC"ENSURA DR MRI SURESCAN IMPLANTABLE

PACEMAKER

93833

FHP02EVADRBK "百多力"艾維亞植入式心律調節器"BIOTRONIK" EVIA

IMPLANTABLE CARDIAC PACEMAKER(DDDR)*適應症見備註欄按近似

特材支付,超過部分由病患自付。

93833

FHP02MR224ST “聖猷達”艾森核磁共振心臟節律器-雙腔“SJM”ACCENT MRI

PULSE GENERATOR給付規定請見備註欄,按同類近似特材點數支付

,超過部分由病患自付

93833

FHP02MR226ST 聖猷達艾森艾斯特核磁共振心臟節律器-雙腔“SJM”ACCENT ST

MRI PULSE GENERATOR給付規定請見備註,按同類近似特材支付,

超過部分由病患自付

93833

FHP02PM234ST "聖猷達" 薩斯坦植入式心臟節律器"SJM" SUSTAIN XL

IMPLANTABLE CARDIAC PULSE GENERATOR(DDD)*需檢附心電圖報告

專案報備使用

93833

FHP02PM236ST 薩斯坦植入式心臟節律器"SJM"SUSTAIN XL IMPLANTABLE CARDIAC

PULSE GENERATOR-DDDR適應症見備註欄,按同類近似特材支付,

超過部分由病患支付

93833

FHP02SDR1SM4 "美敦力" 賽亞心臟節律器"MEDTRONIC" SENSIA

PACEMAKER(DDDR)*適應症請見備註欄,按同類近似特材支付點數

102500點支付,超過部分由病患自付。

93833

FHP02VDDADM4 美敦力黛拉心臟節律器MEDTRONIC ADAPTA PACING GENERATOR*適

應症請見備註欄

93833

FHP02VDR1SST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄

93833

FHP02VDR1UST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄

93833

FHP02VDR4SST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄

93833

FHP02VDR4UST 雙腔型心臟節律器"SJM" IMPLANTABLE CARDIAC PULSE GENERATOR

*適應症請見備註欄

93833

FHP02ZEDRSST 神風植入式心臟節律器"SJM"ZEPHYR IMPLANTABLE CARDIAC PULSE

GENERATOR適應症請見備註欄,按同類近似特材支付點數支付,超

過部分由病患自付。

93833

899

特材代碼 中英文名稱 支付點數-104/01/01

FHP02ZEDRUST 神風植入式心臟節律器"SJM"ZEPHYR IMPLANTABLE CARDIAC PULSE

GENERATOR適應症請見備註欄,按同類近似特材支付點數支付,超

過部分由病患自付。

93833

FHP1104700ED CVS DIVISION PERICARDIAL PATCH 10X15CM 7838

FHP1106120GX "戈爾"普瑞得福心包膜代用膜"GORE" PRECLUDE PRECARDIAL

MEMBRANE 6*12CM

4310

FHP1112120GX "戈爾"普瑞得福心包膜代用膜"GORE" PRECLUDE PRECARDIAL

MEMBRANE 12*12CM

8322

FHP1115200GX "戈爾"普瑞得福心包膜代用膜"GORE" PRECLUDE PRECARDIAL

MEMBRANE 15*20CM

14500

FHP11XA400ED EQUINE PERICARDIAL PATCH 10*10 CM 7838

FHP41V1017VW "維喜"人工血管接環"VASORING" VASCULAR RING CONNECTOR 35000

FHP5600782BA "巴德"心血管補片"BARD"CARDIOVASCULAR PATCH-CARDIOVASCULAR

FABRICS(15.2*15.2CM)

4935

FHP5600790BA "巴德"心血管補片"BARD"CARDIOVASCULAR PATCH-CARDIOVASCULAR

FABRICS(1.0*15.2CM)(2.1*5.1CM)

281

FHP5600793BA "巴德"心血管補片"BARD"CARDIOVASCULAR PATCH-CARDIOVASCULAR

FABRICS(2.5CM*10.2CM)

563

FHP5600794BA "巴德"心血管補片"BARD"CARDIOVASCULAR PATCH-CARDIOVASCULAR

FABRICS(5.1*10.2CM)

1697

FHP5600795BA "巴德"心血管補片"BARD"CARDIOVASCULAR PATCH-CARDIOVASCULAR

FABRICS(10.2*10.2CM)

2319

FHP5607018BA "巴德"心血管補片"BARD" CARDIOVASCULAR PATCH-SURGICAL

FELTS 2.5*2.5CM,0.6*5.1CM,1.3*10.2CM,2.5*2.5CM,1.0*15.2CM

281

FHP5607836BA "巴德"心血管補片"BARD" CARDIOVASCULAR PATCH-SURGICAL

FELTS 10.2*10.2CM

2319

FHP5607837BA "巴德"心血管補片"BARD" CARDIOVASCULAR PATCH-SURGICAL

FELTS 15.2*15.2CM

4935

FHP5607963BA "巴德"心血管補片"BARD" CARDIOVASCULAR PATCH-PTFE FELT

PLEDGETS 矩形4.86*6MM,9.5*4.8MM,7.9*7.9MM,6*6MM;橢圓形

4.8*6MM;圓形4.8MM,6MM

41

FHP5607968BA "巴德"心血管補片"BARD" CARDIOVASCULAR PATCH-SURGICAL

FELTS 2.5*10.2CM,5.1*5.1CM

563

FHP5607976BA "巴德"心血管補片"BARD" CARDIOVASCULAR PATCH-SURGICAL

FELTS 2.5*15.2CM

832

FHP5611073AE "雅氏" 人工血管補片"AESCULAP" VASCULAR

PATCH(2*9CM,1*7CM,3*4CM)

281

FHPCD1870VGU GUIDANT VITALITY AICD維達自動植入型心律去顫器*適應症請見

備註欄

315795

FHPCD1871DGU GUIDANT VITALITY AICD維達自動植入型心律去顫器*適應症請見

備註欄

383267

FHPCD214DMM4 "美敦力" 思格拉植入式心臟去顫器(雙腔)"MEDTRONIC" SECURA

DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*使用規定請見備

註欄

443350

FHPCD214VMM4 "美敦力" 思格拉植入式心臟去顫器(單腔)"MEDTRONIC" SECURA

VR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*使用規定請見備

註欄

330345

FHPCD354DMM4 "MEDTRONIC"PROTECTA XT DR IMPLANTABLE CARDIOVERTER

DEFIBRILLATOR"美敦力"博特多艾緹植入式心臟去顫器*適應症請

見備註欄

483701

FHPCD354VMM4 "MEDTRONIC"PROTECTA XT VR IMPLANTABLE CARDIOVERTER

DEFIBRILLATOR"美敦力"博特多艾緹植入式心臟去顫器*適應症請

見備註欄

342335

900

特材代碼 中英文名稱 支付點數-104/01/01

FHPCDA155DGU "佳騰"維達艾維塔植入型心律去顫器"GUIDANT" VITALITY AVT

ICD*適應症請見備註欄

383267

FHPCDC164AM4 "美敦力"維多植入式心臟去顫器"MEDTRONIC" VIRTUOSO

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請見備註欄

443350

FHPCDD164VM4 "美敦力"維多植入式心臟去顫器"MEDTRONIC" VIRTUOSO

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請見備註欄

315795

FHPCDD234DM4 "美敦力"思格拉植入式心臟去顫器“MEDTRONIC”SECURA DR

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR *適應症請見備註欄

443350

FHPCDD234VM4 "美敦力"思格拉植入式心臟去顫器“MEDTRONIC”SECURA VR

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR *適應症請見備註欄

330345

FHPCDD284DM4 "美敦力"麥思蒙植入式心臟去顫器(雙腔)"MEDTRONIC" MAXIMO II

DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請見備註

383267

FHPCDD284VM4 "美敦力"麥思蒙植入式心臟去顫器(單腔)"MEDTRONIC" MAXIMO II

VR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請見備註

315795

FHPCDD354DM4 "MEDTRONIC"PROTECTA XT DR IMPLANTABLE CARDIOVERTER

DEFIBRILLATOR"美敦力"博特多艾緹植入式心臟去顫器*適應症請

見備註欄

483701

FHPCDD354VM4 "MEDTRONIC"PROTECTA XT VR IMPLANTABLE CARDIOVERTER

DEFIBRILLATOR"美敦力"博特多艾緹植入式心臟去顫器*適應症請

見備註欄

342335

FHPCDD364DM4 "美敦力"博特多植入式心臟去顫器"MEDTRONIC" PROTECTA DR

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請見備註欄

383267

FHPCDD364VM4 "美敦力"博特多植入式心臟去顫器"MEDTRONIC" PROTECTA VR

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請見備註欄

315795

FHPCDDR259ST “聖猷達”弗帝法亞速拉植入式心律去顫器(射頻雙腔型)*給付規

定請見備註欄“SJM” FORTIFY ASSURA IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR

443350

FHPCDDR279ST “聖猷達”依利普植入式心律去顫器(射頻雙腔型)*給付規定請見

備註欄“SJM” ELLIPSE IMPLANTABLE CARDIOVERTER

DEFIBRILLATOR

483701

FHPCDDR36QST "聖猷達" 植入式心律去顫器"SJM" CURRENT ACCEL IMPLANTABLE

CARDIOVERTER/DEFIBRILLATOR(DR)*適應症請見備註欄

443350

FHPCDDRCD2ST "SJM" CURRENT ACCEL IMPLANTABLE

CARDIOVERTER/DEFIBRILLATOR"聖猷達"植入式心律去顫器*適應症

請見備註欄

443350

FHPCDDRF22ST "聖猷達" 弗帝法艾斯特植入式心律去顫器"SJM" FORTIFY ST

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請見備註欄

443350

FHPCDDRF23ST "聖猷達" 植入式心律去顫器"SJM" FORTIFY IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR(雙腔)*適應症請見備註欄

443350

FHPCDDRPLSST “聖猷達”克侖特普拉斯植入式心律去顫器-雙腔SJM”CURRENT+

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*使用規定請見備註欄

383267

FHPCDF102DSB "波士頓科技" 泰利均植入型心律去顫器 "BOSTON SCIENTIFIC"

TELIGEN 100 HE ICD*適應症請見備註欄

315795

FHPCDF110DSB "波士頓科技" 泰利均植入型心律去顫器 "BOSTON SCIENTIFIC"

TELIGEN 100 HE ICD*適應症請見備註欄

383267

FHPCDP0230ST PHOTON DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請

見備註欄

337982

901

特材代碼 中英文名稱 支付點數-104/01/01

FHPCDPD232ST PHOTON DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請

見備註欄

337982

FHPCDPD240ST PHOTON DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR※適應症

請見備註欄

337982

FHPCDPD243ST PHONTON DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR植入式雙

腔型心臟去顫器*適應症請見備註欄

383267

FHPCDPD26NST "聖猷達"植入式雙腔型心臟去顫器"SJM"PHONTON DR IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR*適應症請見備註欄

383267

FHPCDPD27NST "聖猷達"克侖特植入式心律去顫器"SJM"CURRENT IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR(雙腔) *適應症請見備註欄

383267

FHPCDPS168ST "聖猷達"植入式心律去顫器"SJM"IMPLANTABLE CARDIOVERTER

DEFIBRILLATORS*適應症請見備註欄

315795

FHPCDPS193ST 植入性心律去顫器IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適

應症請見備註欄

315795

FHPCDPS199ST IMPLANTABLE CARDIOVERTER DEFIBRILLATOR※適應症請見備註欄 285381

FHPCDPVRC7ST "聖猷達"克侖特植入式心律去顫器"SJM"CURRENT IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR(單腔) *適應症請見備註欄

315795

FHPCDRFD22ST "聖猷達" 克侖特植入式心律去顫器 "SJM" CURRENT IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR*適應症請見備註欄

383267

FHPCDRFVD2ST "聖猷達" 克侖特植入式心律去顫器 "SJM" CURRENT IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR*適應症請見備註欄

315795

FHPCDT167DGU "佳騰"維達第2代自動植入型心律去顫器"GUIDANT" VITALITY 2EL

ICD (雙腔)*適應症請見備註欄

383267

FHPCDT177DGU "佳騰"維達第2代自動植入型心律去顫器"GUIDANT" VITALITY 2EL

ICD (單腔)*適應症請見備註欄

315795

FHPCDVR259ST “聖猷達”弗帝法亞速拉植入式心律去顫器(射頻單腔型)*給付規

定請見備註欄“SJM” FORTIFY ASSURA IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR

330345

FHPCDVR279ST “聖猷達”依利普植入式心律去顫器(射頻單腔型)*給付規定請見

備註欄“SJM” ELLIPSE IMPLANTABLE CARDIOVERTER

DEFIBRILLATOR

342335

FHPCDVR36QST "聖猷達" 植入式心律去顫器"SJM" CURRENT ACCEL IMPLANTABLE

CARDIOVERTER/DEFIBRILLATOR*適應症請見備註欄

330345

FHPCDVRCD2ST "聖猷達" 植入式心律去顫器"SJM" CURRENT ACCEL IMPLANTABLE

CARDIOVERTER/DEFIBRILLATOR*適應症請見備註欄

330345

FHPCDVRF23ST "聖猷達" 植入式心律去顫器"SJM" FORTIFY IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR(單腔)*適應症請見備註欄

330345

FHPCDVRF35ST "聖猷達" 弗帝法艾斯特植入式心律去顫器(單腔)"SJM" FORTIFY

ST IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*適應症請見備註

330345

FHPCDVRPLSST “聖猷達”克侖特普拉斯植入式心律去顫器-單腔SJM”CURRENT+

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR*使用規定請見備註欄

315795

FHPCL06935M4 "美敦力"史賓特導管"MEDTRONIC" SPRINT QUATTRO SECURE S

LEAD*適應症請見備註欄

76664

FHPCL06944M4 SPRINT LEAD(ICD)*適應症請見備註欄 75682

FHPCL06947M4 史賓特導線SPRINT LEAD 58,65,75,100CM *適應症請見備註欄 76664

FHPCL6935MM4 “美敦力”史賓特植入式導線“MEDTRONIC”SPRINT QUATTRO

SECURE IMPLANTABLE LEAD

76664

FHPCL6947MM4 “美敦力”史賓特植入式導線 “MEDTRONIC”SPRINT QUATTRO

SECURE IMPLANTABLE LEAD*給付規定請見備註欄

76664

FHPCLAF157GU 安達植入式去顫器電極導線ENDOTAK RELIANCE IMPLANTABLE

LEAD*適應症請見備註欄

76664

902

特材代碼 中英文名稱 支付點數-104/01/01

FHPCLB0147GU "佳騰"安達植入式去顫器電極導線"GUIDANT" ENDOTAK RELIANCE

IMPLANTABLE LEAD*適應症請見備註欄

75682

FHPCLB0157GU "佳騰"安達植入式電極導線"GUIDANT" ENDOTAK RELIANCE

IMPLANTABLE LEAD*適應症請見備註欄

76664

FHPCLB0170GU "GUIDANT"ENDOTAK RELIANCE SG IMPLANTABLE LEAD*適應症請見

備註欄

75682

FHPCLB0174GU "佳騰"安達集植入式電極導線"GUIDANT" ENDOTAK RELIANCE G

IMPLANTABLE LEAD*適應症請見備註欄

75682

FHPCLB0184GU "佳騰"安達集植入式電極導線"GUIDANT" ENDOTAK RELIANCE G

IMPLANTABLE LEAD*適應症請見備註欄

76664

FHPCLD712QST "聖猷達" 德拉多心臟導線"SJM" DURATA LEAD(FOR ICD)*適應症

請見備註欄

76664

FHPCLD717QST "聖猷達" 德拉多心臟導線"SJM" DURATA LEAD(FOR ICD)*適應症

請見備註欄

75682

FHPCLDU723ST "聖猷達"德拉多心臟導線"SJM" DURATA LEAD 76664

FHPCLDU7SWST "聖猷達" 德拉多心臟導線 "SJM" DURATA LEAD *適應症請見備註

76664

FHPCLE0147GU 安達植入式去顫器電極導線ENDOTAK RELIANCE IMPLANTABLE

LEAD*適應症請見備註欄

75682

FHPCLLS359BK “百多力”霖納思(四極)心內除顫器被動導線“BIOTRONIK”

LINOX SMART TD IMPLANTABLE DEFIBRILLATOR LEADS INCL.

ACCESSORIES (包括附件)

75682

FHPCLR1ATAST TRANSVENOUS TACHYARRHYTHMIA LEAD※適應症請見備註欄(產品型

號RIATA1560:1562,1590:1592自94.4.1生效使用)

75682

FHPCLR700NST "聖猷達"經靜脈心搏過速導線"SJM" TRANSVENOUS

TACHYARRHYTHMIA LEAD*適應症請見備註欄

76664

FHPCLR704NST "聖猷達"經靜脈心搏過速導線※適應症見備"SJM”TRANSVENOUS

TACHYARRHYTHMIA LEAD

75682

FHPHF04193M4 ATTAIN OTW LEAD艾坦插入式導線※適應症請見備註欄 19845

FHPHF04194M4 "美敦力"艾坦插入式導線"MEDTRONIC"ATTAIN OTW LEAD*適應症請

見備註欄

19845

FHPHF04195M4 "美敦力"艾坦史塔菲導線"MEDTRONIC" ATTAIN STARFIX LEAD*適

應症請見備註欄

22655

FHPHF04196M4 "美敦力"艾坦艾比利導線"MEDTRONIC" ATTAIN ABILITY LEAD*適

應症請見備註欄

19952

FHPHF04591SB "波士頓"艾裘帝螺旋植入式電極導線"BOSTON SCIENTIFIC"

ACUITY SPIRAL IMPLANTABLE LEAD※適應症請見備註欄

19845

FHPHF08042M4 INSYNC III ATRIAL SYNCHRONOUS PACING DEVICE※適應症請見備

註欄

180228

FHPHF0C2TRM4 "美敦力"信可心臟再同步節律器"MEDTRONIC"SYNCRA CRT-P

CARDIAC RESYNCHRONIZATION THERAPY PACEMAKER*適應症請見備

註欄

180228

FHPHF1056NST 〝SJM〞LEFT VENTRICULAR LEAD〝聖猷達〞左心室心臟節律器導

線*適應症請見備註欄(產品型號QUICKSITE 1056T自95.1.1生效)

19845

FHPHF1058NST "聖猷達"左心室心臟節律器導線"SJM" LEFT VENTRICULAR LEAD*

適應症請見備註欄

19845

FHPHF11568ST "聖猷達" 左心導線 "SJM" QUICKFLEX LEAD*適應症請見備註欄 19845

FHPHF1258TST "聖猷達"快克弗里斯麥可左心導線"SJM" QUICKFLEX u LEAD*適應

症請見備註欄

19952

FHPHF32374ST "聖猷達"夸特左心導線“SJM”QUARTET LEFT HEART LEAD*使用規

定請見備註欄

22311

FHPHF96CRTST 〝SJM〞BIVENTRICULAR STIMULATION DEVICE〝聖猷達〞雙心室心

臟節律器*適應症請見備註欄

180228

903

特材代碼 中英文名稱 支付點數-104/01/01

FHPHFACUTYGU "佳騰"雅各易導型電極導管"GUIDANT"ACUITY STEERABLE LEAD*適

應症請見備註欄

19845

FHPHFEASY2GU "佳騰"易導型第二代雙電極導管"GUIDANT"EASYTRAK 2 IS-1

PACING LEAD*適應症請見備註欄

19845

FHPHFEASY3GU "佳騰"易導型第3代冠狀靜脈電極導線"GUIDANT"EASYTRAK 3

CORONARY VENOUS LEAD*適應症請見備註欄

19845

FHPHFEASYTGU ”佳騰”易導型電極導線”GUIDANT”EASYTRAK 2 PACING LEAD*

適應症請見備註欄

19845

FHPHFH1401GU "佳騰"控達刻脈搏產生器"GUIDANT" CONTAK RENEWAL CRT-P

PULSE GENERATOR*適應症請見備註欄

180228

FHPHFKX346BK "百多力"可洛植入式心導線"BIOTRONIK"COROX OTW LEAD*適應症

請見備註欄

19845

FHPHFPM2RTST "聖猷達"安勝心臟節律器"SJM" ANTHEM IMPLANTABLE CARDIAC

PULSE GENERATOR(CRT-P)*適應症請見備註欄

180228

FHPHFPM3RTST "聖猷達"安勝心臟節律器"SJM" ANTHEM IMPLANTABLE CARDIAC

PULSE GENERATOR(CRT-P)*適應症請見備註欄

180228

FHPHFW172ESB “波士頓科技”迎福心臟再同步治療用起搏器“BOSTON

SCIENTIFIC”INVIVE CRT-P

180228

FHPL104067M4 CAPSURE FIX LEAD *須檢附心電圖報告專案報備使用 7479

FHPL104073M4 CAPSURE SENSE LEAD蓋普夏導線※須附心電圖報告專案報備使用 7434

FHPL104074M4 "MEDTRONIC" CAPSURE SENSE LEAD "美敦力"蓋普夏導線*需檢附

心電圖報告專案報備使用

7434

FHPL104088GU "佳騰" 伸縮性雙極之心內膜心房電極導線 "GUIDANT" FLEXTEND

PACING LEAD*須檢附心電圖報告專案報備使用

7479

FHPL104965M4 CAPSURE EPICARDIA LEAD STEROID ELUTING ※須檢附心電圖專案

報備使用

7924

FHPL104968M4 CAPSURE EPICARDIAL LEAD *須檢附心電圖報告專案報備使用 7924

FHPL105054M4 CAPSURE Z PACING LEADS *須檢附心電圖報告專案報備使用 7592

FHPL105071M4 PACEMAKER LEAD (EPICARDIAL)※須檢附心電圖報告專案報備使用 7306

FHPL105076M4 CAPSURE FIX NOVUS LEAD *須檢附心電圖報告專案報備使用(型號

4076自94年7月1日生效)

7479

FHPL105594M4 CAPSURE SP NOVUS ENDOCARDIAL LEAD,STEROID ELUTING*須附心

電圖報告專案報備使用

7434

FHPL11368NST IMPLANTABLE CARDIAC VDD PACING LEAD 52CM,58CM,65CM *須檢

附心電圖報告專案報備使用

7434

FHPL11388NST PACESETTER TENDRIL IMPLANTABLE CARDIAC PACING LEAD※須檢

附心電圖報告專案報備使用

7479

FHPL11488NST PACESETTER TENDRIL IMPLANTABLE CARDIAC PACING LEDA *須檢

附心電圖報告專案報備使用

7479

FHPL11646TST IMPLANTABLE CARDIAC PACING LEAD※須檢附心電圖報告專案報備

使用1646T,1642T

7479

FHPL11646UST “聖猷達”心臟節律器導線“SJM”ISOFLEX S LEAD*需檢附心電

圖報告專案報備使用

7434

FHPL11688NST IMPLANTABLE CARDIAC PACING LEADS※須附心電圖報告專案報備

使用

7479

FHPL117882ST "聖猷達"心臟節律器導線"SJM" IMPLANTABLE CARDIAC PACING

LEADS*須附心電圖報告專案報備使用

7479

FHPL11888NST "聖猷達"心臟節律器導線"SJM" IMPLANTABLE CARDIAC PACING

LEADS*適應症請見備註欄

7479

FHPL11888UST “聖猷達”佩斯賽得心臟節律器導線"SJM"PACESETTER TENDRIL

IMPLANTABLE CARDIAC PACING LEAD*需檢附心電圖報告專案報備

使用

7479

904

特材代碼 中英文名稱 支付點數-104/01/01

FHPL140335GU GUIDANT SELUTE PICOTIP PACING 沖提心內膜心房電極導線*適應

症請見備註欄

7592

FHPL140535GU GUIDANT SWEET PICOTIP RX STEROID ELUTING POSITIVE-

FIXATION POROUS TIP PACING LEAD史威類固醇沖提正極固定多孔

尖端電極導線*適應症請見備註欄

7699

FHPL151121GQ "格列巴齊" 心臟節律器導線"GREATBATCH" MYOPORE BIPOLAR

SUTURELESS MYOCARDIAL LEAD*需檢附心電圖報告專案報備使用

7306

FHPL19288NST "聖猷達" 心臟節律器導線"SJM"IMPLANTABLE CARDIAC PACING

LEADS*須附心電圖報告專案報備使用。

7479

FHPL19288UST “聖猷達”佩斯賽得心臟節律器導線"SJM"PACESETTER TENDRIL

IMPLANTABLE CARDIAC PACING LEAD*需檢附心電圖報告專案報備

7479

FHPL1B4456GU "佳騰"纖幼植入式起搏電極導線"GUIDANT" FINELINE II PACING

LEAD*適應症請見備註欄

7434

FHPL1PPT99ST "聖猷達" 亞提仙司心臟導線"SJM" OPTISENSE LEAD *應檢附心電

圖報告專案報備使用

7479

FHPL1S9F4NST ”聖猷達”心臟節律器導線”SJM” IMPLANTABLE CARDIAC

PACING LEAD※須檢附心電圖報告專案報備使用

7434

FHPL1S9F4UST "聖猷達" 心臟節律器導線 "SJM" IMPLANTABLE CARDIAC PACING

LEADS ※須檢附心電圖報告專案報備使用

7434

FHPL1SE362BK "百多力"喜羅植入式心律調節器電極導線"BIOTRONIK"SIELLO

JT/T IMPLANTABLE ENDOCARDIAL LEADS INCL. ACCESSORIES*給付

規定請見備註欄

7434

FHPL1SR346BK "百多力"植入式心律調節器電極導線"BIOTRONIK" SELOX

ST/SELOX JT ENDOCARDIAL LEAD(SELOX ST 60,53; JT 53,45)*需

檢附心電圖報告專案報備使用

7434

FHPL1SS350BK "百多力"喜特植入式電極導線"BIOTRONIK" SETROX S

IMPLANTABLE ENDOCARDIAL LEADS*須檢附心電圖報告專案報備使

7479

FHPL1SS362BK "百多力"喜羅植入式電極導線(包括配件)"BIOTRONIK"SIELLO S

IMPLANTABLE ENDOCARDIAL LEADS INCL. ACCESSORIES*給付規定

見備註欄

7479

FHPL1VDD43GU "佳騰"類固醇(VDD型)心內膜心房電極導線"GUIDANT"SELUTE

PICOTIP VDD PACING LEADS*應檢附心電圖報告專案報備使用

7434

FHPL203830M4 "美敦力"賽西兒導線 "MEDTRONIC"SELECTSURE LEAD*適應症請見

備註欄

17197

FHPL205038M4 〝美敦力〞蓋普夏整律導管"METRONIC" CAPSURE VDD-2 LEAD*適

應症請見備註欄

14140

FHPL21368NST "聖猷達"植入式心臟節律器電刺激導線 "SJM" IMPLANTABLE

CARDIAC PACING LEAD*適應症請見備註欄

14140

FHPL2SLX65BK "百多力"世樂植入式電極導線 "BIOTRONIK" SOLOX IMPLANTABLE

ENDOCARDIAL LEAD*適應症請見備註欄

14140

FHV010019AST AORTIC VALVE 40196

FHV010025MST "聖猷達"人工機械瓣膜"ST.JUDE" MECHANICAL HEART VALVE 40196

FHV0117AHPST AORTIC VALVE 40196

FHV01A1927ST REGENT MECHANICAL HEART VALVE瑞珍機械性心臟瓣膜 50503

FHV01A1929F6 "翁克斯" 人工心瓣膜 "ON-X" PROSTHETIC HEART VALVE 19:29MM 40196

FHV01AMHPJST MECHANICAL HEART VALVE人工機械瓣膜 40196

FHV01APAVGM4 “美敦力”主動脈人工血管瓣膜 “MEDTRONIC”AORTIC VALVED

GRAFT*給付規定請見備註欄

60955

FHV01CAVGJST 馬斯特機械性人工心臟瓣膜MASTERS MECHANICAL HEART VALVE*適

應症請見備註欄

60955

FHV01CNNFVF6 "翁克斯"人工心瓣膜"ON-X" PROSTHETIC HEART VALVE 50503

905

特材代碼 中英文名稱 支付點數-104/01/01

FHV01DPMHVM4 “美敦力”心臟瓣膜“MEDTRONIC”OPEN PIVOT HEART VALVE 50503

FHV01M2333F6 "翁克斯" 人工心瓣膜 "ON-X" PROSTHETIC HEART VALVE 23:33MM 40196

FHV01VAVGJST "聖猷達"馬斯特機械性人工心臟瓣膜 "SJM" MASTERS MECHANICAL

HEART VALVE*適應症請見備註欄

85000

FHV0200995M4 FREESTYLE AORTIC ROOT BIOPROSTHESIS(19MM:27MM)※適應症請

見備註欄

63000

FHV02A2650ED "愛德華"卡本特愛德華人工心臟瓣膜"EDWARDS"CARPENTIER-

EDWADRS S.A.V. BIOPROSTHESIS

43613

FHV02B10AMST PORCIN HEART VALVE (AORTIC 21MM:29MM,MITRAL 25MM:35MM) 43613

FHV02B2933ST "聖猷達"豬組織瓣膜"SJM"PORCINE VALVE 43613

FHV02ELEAMST 〝SJM〞EPIC VALVE AORTIC-21A-31A MITRAL-25M-35M 43613

FHV02EPSAMST "聖猷達"豬組織瓣膜"SJM" EPIC VALVE 43613

FHV02T505TM4 HANCOCK II BIOPROSTHETIC HEART VALVE(AORTIC

21:29MM,MITRAL 25:33MM)

43613

FHVR104100ED 卡本特-麥卡錫亞當二尖瓣修補環"EDWARDS"CARPENTIER-

MCCARTHY-ADMA IMR ETLOGIX ANNULOPLASTY RING24MM:34MM

20100

FHVR104450ED C/E PHYSIO ANNULOPLASTY RING(24:40MM) 20100

FHVR104600ED COSGROVE-EDWARDS ANNULOPLASTY SYSTEM(26:38MM) 20100

FHVR1AFR23ST "聖猷達" 愛調環狀成形術環"SJM" ATTUNE FLEXIBLE ADJUSTABLE

ANNULOPLASTY RING

20100

FHVR1M4900ED "愛德華"三尖瓣環成形術系統"EDWARDS"MC3 TRICUSPID

ANNULOPLASTY SYSTEM

20100

FHVR1RSARNST "聖猷達"環狀成形術環"SJM" RIGID SADDLE RING 15700

FHVR1SARNNST 環狀成形術環 SEGUIN ANNULOPLASTY RING 20100

FHVR1SARPNST 環狀成形術環 SEGUIN ANNULOPLASTY RING 20100

FHVR1T4528ED CARPENTIER-EDWARDS CLASSIC ANNULOPLASTY RING(26:36MM) 15700

FHVR1TARNNST SJM TAILOR ANNULOPLASTY RING(25MM:35MM) 20100

FHVR1TARPNST TAILOR ANNULOPLASTY RING泰勒環狀成形術環 20100

FHX0229400M4 OCTOPUS 4 TISSUE STABILIZER SYSTEM (產品型號29403自94年10

月1日生效)29700&29800自95年9月1日刪除給付

44002

FHX02AM100QM “邁柯唯”阿克貝埃心臟不停跳穩定器系統 "MAQUET”ACROBAT I

OFF-PUMP SYSTEM -含ACCESSRAIL PLATFORM(BLADES)+SUCTION

TUBING PACK+STABLILIZER

44002

FHX02CB100QM "邁柯唯"噴射灌洗器(滅菌)"MAQUET" JET LAVAGE(STERILE)*適應

症請見備註欄

2178

FHX02E4012E8 SYNERGY ATTACHMENT *心臟不停跳冠狀動脈繞道手術用吸引式穩

定器

34805

FHX02E401SE8 CORONARY ARTERY STABILIZER *心臟不停跳冠狀動脈繞道手術用

穩定器

34805

FHX02E4031E8 “艾斯泰格”穩定器與定位器-心臟不停跳冠狀動脈繞道手術用穩

定器“ESTECH”STABILIZER AND POSITIONER-TITAN STABILIZER*

給付規定請見備註欄

34805

FHX02E4210E8 “艾斯泰格”穩定器與定位器-噴射灌洗器 (滅菌) “ESTECH”

STABILIZER AND POSITIONER-BLOW MISTER (STERILE)

2178

FHX02FX15RTM "泰爾茂"菲斯膜型人工心肺"TERUMO"CAPIOX FX(OXYGENATOR

WITHOUT RESERVOIR WITH HYDROPHILIC POLYMER COATED AND

ARTERIAL FILTER*適應症請見備註欄

20703

FHX02HMM50QM "邁柯唯"微孔膜氧合器"MAQUET" QUADROX-I SMALL ADULT

MICROPOROUS MEMBRANE OXGENATOR*適應症請見備註欄

12913

FHX02HMS70QM "邁柯唯"微孔膜氧合器"MAQUET" OXYGENATOR QUADROX-I WITH

SOFTLINE COATING *適應症請見備註欄

12913

FHX02LAVAGGJ "吉生"噴射灌洗器(滅菌)"JSM" JET LAVAGE(STERILE)*適應症請

見備註欄

2178

906

特材代碼 中英文名稱 支付點數-104/01/01

FHX02MBSTRM4 "美敦力"噴射灌洗器"MEDTRONIC" BLOWER/MISTER(WITH TUBING

SET)

2178

FHX02ME258ML “美德思”氧合器與硬殼靜脈儲血槽-中空纖維氧合器“MEDOS”

OXYGENATOR AND VENOUS HARDSHELL RESERVOIR-HOLLOW FIBER

OXYGENATOR

10073

FHX02MSSMVKZ "吉尼士" 心臟血管外科器械 (滅菌)-心外膜穩定器 "GENESEE"

CARDIOVASCULAR SURGICAL INSTRUMENTS (STERILE)-EPICARDIAL

STABILIZER FEET

34805

FHX02MT222L5 ”加州”灌洗器”CALIFORNIA” BLOWER/MISTER(WITH TUBING

SET) *適應症請見備註欄

2178

FHX02RX050TM CAPIOX RX HOLLOW FIBER OXYGENATOR WITHOUT RESERVOIR BY X-

COATING

10073

FHX02RX150TM ”泰爾茂”膜型人工心肺RX”TERUMO”CAPIOX RX

OXYGENATOR(WITHOUT RESERVOIR)*適應症請見備註欄

12913

FHX02RX250TM CAPIOX RX OXYGENATOR WITHOUT/RESERVOIR W/HYDROPHILIC

POLYMER COATED※適應症請見備註欄(二)(產品型號

CX*RX25W,CX*RX25E自94年10月1日生效)

12913

FHX02SCTSPM4 "美敦力"穩定器"MEDTRONIC" CARDIOVASCULAR SURGICAL

INSTRUMENTS(STERILE)-OCTOPUS TISSUE STABILIZER心臟不停跳

冠狀動脈繞道手術用穩定器

44002

FHX02STB70CX "雀斯"緯博心臟血管外科器械(滅菌) "CHASE" VIPER II

CARDIOVASCULAR SURGICAL INSTRUMENTS (STERILE)-"CHASE"

VIPER II VACUUM STABILIZER

44002

FHX02UM900QM ACROBAT VACUUM OFF PUMP SYSTEM(ACCESS RAIL

PLATFORM+STABILIZER+VACCUM TUBING SET)

44002

FHX02VF200ED "愛德華"噴射灌洗器(滅菌)"EDWARDS" VISUFLO ⅡSURGICAL SITE

VISUALIZATION WAND(STERILE) *適應症請見備註欄

2178

FHX0303301M4 MINIMAX PLUS OXYGENATOR WITH RESERVOIR 12124

FHX0305306R5 "索倫"亞文成人氧合器"SORIN" D903 DIDECO AVANT ADULT

OXYGENATOR

12124

FHX0307850TM 丟棄式離心幫浦"TERUMO" DISPOSABLE CENTRIFUGUAL PUMP適應症

請見備註欄

9062

FHX030BP80M4 BIO-PUMP ※適應症請見備註欄 9062

FHX030DP38M4 BIO-PROBE INSERT ※適應症請見備註欄 914

FHX0350515R5 "索倫" 康倍佛進化成人氧合器"SORIN" DIDECO COMPACTFLO

EVOLUTION ADULT OXYGENATOR(WITH HARDSHELL VENOUS

RESERVOIR)

12124

FHX0350516R5 "索倫" 康倍佛進化成人氧合器(具塗層)"SORIN" DIDECO

COMPACTFLO EVOLUTION ADULT OXYGENATOR(WITH HARDSHELL

VENOUS RESERVOIR/WITH PHISIO COATED)

14409

FHX0350531R5 "索倫"滴得可新生兒氧合器附靜脈儲血槽(具PHISIO塗層)"SORIN"

DIDECO KIDS-NEWBORN OXYGENATOR(WITH VENOUS HARDSHELL

RESERVOIR)PHISIO COATED適應症

22284

FHX0350534R5 "索倫" 滴得可-新生兒氧合器(具PHISIO塗層)"SORIN" DIDECO

KIDS-NEWBORN OXYGENATOR-PHISIO COATED*適應症請見備註欄

18688

FHX0350540R5 "索倫"滴得可嬰兒氧合器附靜脈儲血槽"SORIN" DIDECO KIDS-

INFANT OXYGENATOR(WITH VENOUS HARDSHELL RESERVOIR)PHISIO

COATED*給付規定見備註欄

22284

FHX0350543R5 "索倫" 滴得可-嬰兒氧合器(具PHISIO塗層)"SORIN" DIDECO

KIDS-INFANT OXYGENATOR-PHISIO COATED*適應症請見備註欄

18688

FHX03541TTM4 AFFINITY NT HOLLOW FIBER OXYGENATOR WITH TRILLIUM

BIOPASSIVE SURFACE AND INTEGRATED CVR NT 含心臟切開術靜脈

貯槽之人工心肺*適應症請見備註欄

14409

907

特材代碼 中英文名稱 支付點數-104/01/01

FHX03A5410M4 AFFINITY NT HOLLOW FIBER OXYGENATOR WITH TRILLIUM

BIOPASSIVE SURFACE AND INTEGRATED CVR NT

12124

FHX03A541TM4 AFFINITY NT HOLLOW FIBER OXYGENATOR W/RESERVOIR (TRILLIUM

COATED)※適應症請見備註欄

12368

FHX03BEHLSQM "邁柯唯"體外循環管路組及動靜脈導管"MAQUET"HLS SET WITH

BIOLINE COATING & HLS CANNULAE SET(認證可用30天)*給付規定

請見備註欄

428468

FHX03BPX80M4 BIO-PUMP PLUS CENTRIFUGAL BLOOD PUMP *適應症請見備註欄 9062

FHX03CB511M4 AFFINITY HOLLOW FIBER OXYGENATOR BIOACTIVE SURFACE※適應

症請見備註欄

12913

FHX03FC038TM ”泰爾茂” 血液幫浦-流量接頭”TERUMO”CAPIOX SP PUMP-FLOW

CONNECTOR*適應症請見備註欄

914

FHX03FS038TM CAPIOX SP BLOOD FLOW SENSOR ※適應症請見備註欄 914

FHX03FX15RTM "泰爾茂"菲斯膜型人工心肺"TERUMO"CAPIOX FX(OXYGENATOR WITH

RESERVOIR WITH HYDROPHILIC POLYMER COATED AND ARTERIAL

FILTER*適應症請見備註欄

24000

FHX03HMM51QM "邁柯唯"微孔膜氧合器"MAQUET" OXYGENATOR QUADROX-I WITH

SOFTLINE COATING*適應症請見備註欄

15046

FHX03HMM71QM "邁柯唯"微孔膜氧合器"MAQUET" QUADROX-I ADULT MICROPOROUS

MEMBRANE OXYGENATOR*適應症請見備註欄

15046

FHX03ME002ML HOLLOW FIBER OXYGENATOR WITH RESERVOIR,RHEOPARIN

COATED(HILITE 7000ADULT/HILITE 2800PEDIATRIC/HILITE

1000INFANT)適應症請見備註欄

12368

FHX03ME062ML HOLLOW FIBER OXYGENATOR WITH RESERVOIR,(HILITE

7000ADULT/HILITE 2800PEDIATRIC/HILITE 1000INFANT)

12124

FHX03ME622ML “美德思”氧合器與硬殼靜脈儲血槽"MEDOS” OXYGENATOR AND

VENOUS HARDSHELL RESERVOIR

12124

FHX03ME658ML "美德思"氧合器與硬殼靜脈儲血槽RHEOPARIN塗層(小孩,嬰兒)(氧

合器有COATING,儲血槽無COATING)"MEDOS"OXYGENATOR AND

VENOUS HARDSHELL RESERVOIR,RHEOPARIN

21985

FHX03MEC62ML “美德思”氧合器與硬殼靜脈儲血槽"MEDOS” OXYGENATOR AND

VENOUS HARDSHELL RESERVOIR-OXYGENATOR COATING

12368

FHX03MECL6ML "美德思"人工心肺"MEDOS"OXYGENATOR*適應症請見備註欄 22548

FHX03MECLRML “美德思”氧合器與硬殼靜脈儲血槽-中空纖維氧合器RHEOPARIN

塗層(ECMO使用長效型)"MEDOS" OXYGENATOR AND VENOUS

HARDSHELL RESERVOIR-OXYGENATOR(LONG TE

22548

FHX03MEDP2ML "美德思"血液幫浦系統"MEDOS"DELTASTREAM BLOOD PUMP SYSTEM*

適應症請見備註欄

9062

FHX03PHEADH9 "華億"體外循環管組"HYM" HEART LUNG PACK(PUMP HEAD)*適應症

請見備註欄

9062

FHX03PMAG1T8 “索羅格”善翠美血液幫浦“THORATEC”CENTRIMAG BLOOD PUMP*

適應症請見備註欄

350000

FHX03PMAG2T8 "索羅格"小兒血液幫浦"THORATEC" PEDIVAS BLOOD PUMP 350000

FHX03RRF32QM "邁柯唯" 離心幫浦(未含肝素塗層) "MAQUET" CENTRIFUGAL PUMP

ROTAFLOW WITHOUT BIOLINE COATING*適應症請見備註欄

9062

FHX03RX15RTM ”泰爾茂”膜型人工心肺RX”TERUMO”CAPIOX RX OXYGENATOR*適

應症請見備註欄

14409

FHX03RX25RTM CAPIOX RX OXYGENATOR W/RESERVOIR W/HYDROPHILIC COATED※適

應症請見備註欄(二)(產品型號CX*RX25RW,CX*RX25RE於941001生

效)

14409

FHX03SP045TM CAPIOX SP PUMP HEAD ※適應症請見備註欄 9062

FHX03SX10RTM CAPIOX SX MEMBRANE OXYGENATOR WITH HARD-SHELL RESERVOIR

(PEDIATRIC)

12124

908

特材代碼 中英文名稱 支付點數-104/01/01

FHX03SX18RTM CAPIOX SX MEMBRANE OXYGENATOR WITH HARD-SHELL RESERVOIR

(ADULT)

12124

FHX03VKM10QM 邁柯唯”嬰幼兒微孔膜氧合器附靜脈硬殼式儲血槽OXYGENATOR

QUADROX-I NEONATAL WITH SOFTLINE COATING WITH VENOUS

HARDSHELL RESERVOIR

22284

FHX03VKM11QM 嬰幼兒微孔膜氧合器附靜脈硬殼式儲血槽OXYGENATOR QUADROX-I

NEONATAL WITH SOFTLINE COATING WITH VENOUS HARDSHELL

RESERVOIR ARTERIAL FILTER

24000

FHX03VKM30QM “邁柯唯”幼兒微孔膜氧合器附靜脈硬殼式儲血槽“MAQUET”

OXYGENATOR QUADROX-I PEDIATRIC WITH SOFTLINE COATING WITH

VENOUS HARDSHELL RESERVOIR

22284

FHX03VKM31QM 邁柯唯幼兒微孔膜氧合器附靜脈硬殼式儲血槽OXYGENATOR

QUADROX-I PEDIATRIC WITH SOFTLINE COATING WITH VENOUS

HARDSHELL RESERVOIR ARTERIAL FILTER

24000

FHX03VKM51QM "邁柯唯"微孔膜氧合器附靜脈硬殼式儲血槽OXYGENATOR QUADROX-

I WITH SOFTLINE COATING WITH VENOUS HARDSHELL

RESERVOIR+FILTER*適應症見備註欄

16730

FHX03VKM55QM "邁柯唯"微孔膜氧合器附靜脈硬殼式儲血槽OXYGENATOR QUADROX-

I WITH SOFTLINE COATING WITH VENOUS HARDSHELL RESERVOIR

ARTERIAL*適應症備註欄

14409

FHX03VKM71QM "邁柯唯"微孔膜氧合器附靜脈硬殼式儲血槽OXYGENATOR QUADROX-

I WITH SOFTLINE COATING WITH VENOUS HARDSHELL

RESERVOIR+FILTER*適應症見備註欄

16730

FHX03VKM77QM "邁柯唯" 微孔膜氧合器附靜脈硬殼式儲血槽"MAQUET"OXYGENATOR

QUADROX-I WITH VENOUS HARDSHELL RESERVOIR WITH SOFTLINE

COATING適應症請見備註欄

14409

FHX0432201GJ “吉生”體外循環管組(PVC TUBING(WITH PHISIO

COATING)+OXYGENATOR+BIOLINE CENTRIFUGAL PUMP+ARTERIAL

FILTER WITH PHISIO COATING+AIR FILTER)”JSM” H

28984

FHX0432801GJ “吉生”體外循環管組(OXYGENATOR+PUMP HEAD+TUBING

SET+TRANSDUCER+CUVETTE)”JSM” HEART LUNG PACK

51883

FHX0432802GJ “吉生”體外循環管組(OXYGENATOR+TUBING

SET+TRANSDUCER+CUVETTE)”JSM” HEART LUNG PACK

42355

FHX04A20E1H9 "HYM" HEART LUNG PACK(W/OXYGENATOR+PUMP HEAD+FLOW

PROBE+TUBING SET等)適應症請見備註欄

44306

FHX04A21E1H9 "HYM" HEART LUNG PACK(W/OXYGENATOR+FLOW PROBE+TUBING SET

等)適應症請見備註欄

32432

FHX04A2729H9 "華億" 體外循環管組"HYM" HEART LUNGPACK給付規定請見備註欄

TUBING SET+PRE BYPASS FILTER+ORGANIZER+SUCKER*2+ARTERIAL

FILTER

8500

FHX04A2730H9 "華億" 體外循環管組"HYM" HEART LUNGPACK給付規定請見備註欄

TUBING SET+ORGANIZER+SUCKER*2+ARTERIAL FILTER

6270

FHX04A31CPH9 HEART LUNG PACK適應症備註PRE BYPASS

FILTER+ORGANIZER+SUCKER*2+ARTERIAL

FILTER+TRANSDUCER+PROBE CONNECTOR+SATURATION CUVETTE+PUMP

HEAD

19124

FHX04CB1V9M4 BLOOD TUBING PACK血液套裝組(OXYGENATOR+BIO-PUMP+TUBING

SET+DISPOSABLE PROBE)型號CB1Q91R4,CB2503R1自940701生效

44306

FHX04CB4P7M4 "美敦力"血液套裝組”MEDTRONIC”BLOOD TUBING PACK(WITHOUT

OXYGENATOR)*適應症請見備註欄

28028

FHX04CBCCSM4 ECMO CLOSE CHEST SUPPORT CIRCUIT W/OXYGENATOR+BIO-

PUMP+TUBING SET使用參考見備註欄CB2506於920401擴增

44306

FHX04CXESLTM CAPIOX EBS OXYGENATOR KIT(HP)人工心肺套 /OXYGENATOR+SP-

PUMP+TUBING SET※使用參考請見備註欄

44306

909

特材代碼 中英文名稱 支付點數-104/01/01

FHX04CXXSATM "泰爾茂"易倍適聚合物塗層人工心肺套CAPIOX EBS CIRCUIT WITH

X COATING/OXYGENATOR+SP-PUMP+FLOW SENSOR+COATING TUBING

SET※使用參考請見備註欄

44306

FHX04ME620ML ECMO LT SYSTEM(OXGENATOR+TUBING,A-V

LOOP,ADAPTOR,ACCESSORY+PUMP HEAD)適應症請見備註欄

44306

FHX04ME623ML ECMO LT SYSTEM WITHOUT PUMPHEAD適應症請見備註欄 32432

FHX04METUBML "美德思" 管路組"MEDOS" TUBING SETS(ECMO)*適應症請見備註欄 15437

FHX04XYPUMML "美德思" 管路組"MEDOS" TUBING SETS(ECMO長效型人工心肺組)

組件含OXYGENATOR+PUMP HEAD+TUBING SET*適應症請見備註欄

44419

FHX04XYTFLML "美德思" 管路組"MEDOS" TUBING SETS(ECMO長效型人工心肺組)

組件含OXYGENATOR+DISPOSABLE PROBE+TUBING SET*適應症請見備

註欄

37375

FHX04XYTUBML "美德思" 管路組"MEDOS" TUBING SETS(ECMO長效型人工心肺組)

組件含OXYGENATOR+TUBING SET*適應症請見備註欄

35346

FHXR20CR40TM CARDIOTOMY RESERVOIR 4000CC 3297

FHXR2EL400M4 CARDIOTOMY RESERVOIR*適應症請見備註欄 3420

FHXR2ME210ML “美德思”氧合器與硬殼靜脈儲血槽-儲血槽(小孩,嬰兒)"MEDOS

” OXYGENATOR AND VENOUS HARDSHELL RESERVOIR-VENOUS

HARDSHELL RESERVOIR (PEDIATRIC, INFA

3297

FHXR2MEMVCML “美德思”氧合器與硬殼靜脈儲血槽-儲血槽(大人)"MEDOS”

OXYGENATOR AND VENOUS HARDSHELL RESERVOIR-VENOUS

HARDSHELL RESERVOIR (ADULT)

3297

FHXR2VHK11QM "邁柯唯" 靜脈硬殼式儲血槽"MAQUET" VENOUS HARDSHELL

CARDIOTOMY RESERVOIR※適應症請見備註欄

3420

FHXR2VHK20QM "邁柯唯"開心術靜脈硬殼式儲血槽"MAQUET" VENOUS HARDSHELL

CARDIOTOMY RESERVOIR

3297

FNP9106010GX DURA SUBSTITUTE 6CMX10CM(代用人工腦膜) 11296

FNP910610XGX DURA SUBSTITUTE 6CMX10CM 11296

FPP0014202XU "合碩"顱顏骨固定系統:L形骨板4洞;5洞;8洞"CUSMED"CMF

FIXATION SYSTEM: MINI BONE PLATE TITANIUM L-TYPE

4HOLE;5HOLE;8HOLE

1380

FPP0074402XU "合碩"顱顏骨固定系統:T形骨板,6:7洞"CUSMED"CMF FIXATION

SYSTEM: MICRO T-TYPE BONE PLATE,PURE TITANIUM 6:7HOLE

4430

FPP0105152LE “史賽克 雷賓格爾”下頷骨系統;骨板Y型5-8孔1.7MM

““STRYKER LEIBINGER” UNIVERSAL MANDIBLE SYSTEM 1.7MM

LOCKING Y PLATE 5-8 HOLES

1743

FPP0105188LE STRYKER LEIBINGER UNIVERSAL MANDIBLE SYSTEM:1.7MM MID-

FACE CURVED PLATE 4-10 HOLES ※適應症請見備註欄

1562

FPP0105742LE STRYKER LEIBINGER UNIVERSAL MANDIBLE SYSTEM:1.7MM MID-

FACE SET LOCKING DOUBLE Y PLATE 7 HOLES※適應症請見備註欄

2469

FPP010574NLE MINI DOUBLE Y PLATE 7 HOLE※適應症請見備註欄 2469

FPP010575NLE MINI Y PLATE W/BAR 5 HOLE※適應症請見備註欄 1743

FPP010576NLE MINI LOCKING PLATE W/BAR 5-6 HOLE ※適應症請見備註欄 1380

FPP0106002M3 2HOLE MINI LOW PROFILE PLATE※適應症請見備註欄 975

FPP0106106LE 0.6,1.0MM MINI BONE PLATE 5,6HOLE REGULAR STR ※適應症請

見備註欄

975

FPP0106109LE 0.6,1.0MM MINI BONE PLATE 8HOLE REGULAR STR※適應症請見備

註欄

1134

FPP0106112LE 0.6,1.0MM MINI BONE PLATE 4 HOLE REGULAR STR ※適應症請見

備註欄

975

910

特材代碼 中英文名稱 支付點數-104/01/01

FPP0106120LE 0.6,1.0MM MINI L-PLATE REGULAR RIGHT 4HOLE ※適應症請見備

註欄

1380

FPP0106121LE L-PLATE LEFT 0.6MM ※適應症請見備註欄 1380

FPP0106122LE 0.6,1.0MM MINI L-PLATE LONG RIGHT 4HOLE ※適應症請見備註

1380

FPP0106123LE 0.6,1.0MM MINI L-PLATE LONG LEFT 4HOLE ※適應症請見備註欄 1380

FPP0106124LE 0.6,1.0MM MINI L-PLATE REGULAR LEFT 4HOLE ※適應症請見備

註欄

1380

FPP0106140LE 0.6,1.0MM MINI T-PLATE REGULAR 90度 6HOLE ※適應症請見備

註欄

1885

FPP0106141LE 0.6,1.0MM MINI T-PLATE LONG 90度 5HOLE ※適應症請見備註欄 1885

FPP0106142LE 0.6,1.0MM MINI T-PLATE LONG 80度 RIGHT 5HOLE ※適應症請

見備註欄

1885

FPP0106143LE 0.6,1.0MM MINI T-PLATE LONG 80度 LEFT 5HOLE ※適應症請見

備註欄

1885

FPP0106144LE 0.6,1.0MM MINI DOUBLE T PLATE REGULAR 6HOLE ※適應症請見

備註欄

2270

FPP0106145LE 0.6,1.0MM MINI DOUBLE T LONG 90度 4HOLE ※適應症請見備註

2270

FPP0106160LE 0.6,1.0MM MINI Y PLATE(REGULAR LONG)5HOLE ※適應症請見備

註欄

1743

FPP0106162LE 0.6,1.0MM MINI DOUBLE Y PLATE LONG 6HOLE ※適應症請見備註

2469

FPP0106164LE 0.6,1.0MM MINI DOUBLE Y PLATE LONG EXTENDED 8HOLE ※適應

症請見備註欄

2469

FPP0106181LE LOW PROFILE ORBITA PLATE CURVE 6,8 HOLE 0.6MM REGULAR ※

適應症請見備註欄

1562

FPP0106214M3 TITANIUM 0.6MM MINI PLATE L SHAPE ※適應症請見備註欄 1380

FPP0106760LE 1.7 MID-FACE L-PLATE 5-6 HOLES ※適應症請見備註欄 1380

FPP0106763M3 0.6MM,1.0MM TIANIUM LOW PROFILE MINI PLATE DOUBLE Y 6HOLE

※適應症請見備註欄

2469

FPP010677NLE MINI T PLATE 5 HOLE※適應症請見備註欄 1885

FPP0106906M3 TITANIUM 0.6MM LOW PROFILE MINI PLATE ORBITA SHAPE 6,8

HOLES ※適應症請見備註欄

1562

FPP0108203LE 2.0 MINI PLATE BAR 4-6 HOLES※適應症請見備註欄 975

FPP0108216LE 1.0MM MINI BONE PLATE 16HOLE REGULAR STR ※適應症請見備註

1565

FPP010821NLE 2.0 MINI PLATE BAR 16 HOLES※適應症請見備註欄 1565

FPP0108230LE 2.0 MINI PLATE L-PLATE 4-9 HOLES※適應症請見備註欄 1380

FPP0108240LE 2.0 MINI PLATE T-PLATE 6-8 HOLES※適應症請見備註欄 1885

FPP0108250LE 2.0 MINI PLATE Y-PLATE 5-8 HOLES※適應症請見備註欄 1743

FPP0108260LE 1.0MM MINI DOUBLE Y PLATE REGULAR 6HOLE ※適應症請見備註

2469

FPP010826NLE 2.0 MINI PLATE DOUBLE Y-PLATE ※適應症請見備註欄 2469

FPP0108586LE 2.0 MINI PLATE CURVED PLATE 12 HOLES ※適應症請見備註欄 1562

FPP0110001EJ 2.0 MM MINI "L" PLATE 4 HOLE ※適應症請見備註欄 1380

FPP0110021EJ 2.0 MM MINI L PLATE 4 HOLE ※適應症請見備註欄 1380

FPP0110023EJ 2.0 MM MINI Y PLATE 7 HOLE ※適應症請見備註欄 1743

FPP0110030EJ 2.0 MM MINI STRAIGHT PLATE 4 HOLE ※適應症請見備註欄 975

FPP0110032EJ 2.0 MM MINI STRAIGHT PLATE 10 HOLE ※適應症請見備註欄 1134

FPP0110039EJ 2.0 MM MINI LARGE BUR HOLE PLATE 6 HOLE ※適應症請見備註

5873

911

特材代碼 中英文名稱 支付點數-104/01/01

FPP0110052EJ 2.0 MM MINI X PLATE 4 HOLE ※適應症請見備註欄 2469

FPP0110103LE 1.0MM MINI BONE PLATE 4HOLE LONG STR ※適應症請見備註欄 975

FPP0110106LE 0.6,1.0MM MINI BONE PLATE 6HOLE LONG STR ※適應症請見備

註欄

1134

FPP0110230EJ 2.0 MM MINI STRAIGHT PLATE 4 HOLE ※適應症請見備註欄 975

FPP011051NLE MINI PLATE 16 HOLE※適應症請見備註欄 1565

FPP011054NLE “史賽克 雷賓格爾”下頷骨系統迷你骨板4孔“STRYKER

LEIBINGER” UNIVERSAL MANDIBLE SYSTEM MINI PLATE 4 HOLE

975

FPP011056NLE "史賽克雷賓格爾"下頷骨系統迷你骨板 6孔"STRYKER LEIBINGER"

UNIVERSAL MANDIBLE SYSTEM MINI PLATE 6 HOLE

1134

FPP011057NLE MINI STRAIGHT PLATE 8 HOLE ※適應症請見備註欄 1134

FPP01105NNLE MINI LOCKING STRAIGHT PLATE 16 HOLES ※適應症請見備註欄 1565

FPP011067NLE MINI PLATE 4 HOLE W/BAR ※適應症請見備註欄 975

FPP0111031EJ 2.0 MM MINI STRAIGHT PLATE 6 HOLE ※適應症請見備註欄 1134

FPP0111032EJ 2.0 MM MINI STRAIGHT PLATE 8 HOLE ※適應症請見備註欄 1134

FPP0114008EJ 2.0 MM MINI TR BSSO PLATE 4 HOLE ※適應症請見備註欄 2270

FPP0120211Y2 MINI PLATE 1.0MM 4HOLE STR※適應症請見備註欄 975

FPP0120213Y2 MINI PLATE 1.0MM 8HOLE STR※適應症請見備註欄 1134

FPP0120216Y2 MINI PLATE 1.0MM 16HOLE STR※適應症請見備註欄 1565

FPP0120221Y2 MINI PLATE 1.0MM 4HOLE L-SHAPE※適應症請見備註欄 1380

FPP0120231Y2 MINI PLATE 1.0MM 5HOLE T-SHAPE 80,90度※適應症請見備註欄 1885

FPP0120241Y2 MINI PLATE 1.0MM 5HOLE DOUBLE T-SHAPE ※適應症請見備註欄 2270

FPP0120246Y2 MINI PLATE 1.0MM 6HOLE Y-SHAPE ※適應症請見備註欄 1743

FPP0120251Y2 MINI PLATE 1.0MM 6HOLE DOUBLE Y-SHAPE ※適應症請見備註欄 2469

FPP0120256Y2 MINI NASAL BONE PLATE 1.0MM※適應症請見備註欄 4479

FPP0141122XU "合碩"顱顏骨固定系統:直行骨板4洞"CUSMED"CMF FIXATION

SYSTEM: COMBINE MINI BONE PLATE TITANIUM STR 4HOLE

975

FPP0141126XU "合碩"顱顏骨固定系統:直行骨板6洞;8洞"CUSMED"CMF FIXATION

SYSTEM:MINI BONE PLATE TITANIUM STR 6HOLE;8HOLE

1134

FPP0141329XU "合碩"顱顏骨固定系統:連接形骨板12洞;16洞;24洞"CUSMED"CMF

FIXATION SYSTEM:MINI BONE PLATE TITANIUM ADAPTION

12HOLE;16HOLE;24HOLE

1565

FPP0142123XU "合碩"顱顏骨固定系統:L形骨板4洞;5洞;8洞"CUSMED"CMF

FIXATION SYSTEM: MINI BONE PLATE TITANIUM L-TYPE

4HOLE;5HOLE;8HOLE

1380

FPP0142224XU "合碩"顱顏骨固定系統:L中長形骨板4:5洞"CUSMED"CMF FIXATION

SYSTEM: MINI BONE PLATE TITANIUM L-TYPE 4:5HOLE

1380

FPP0142324XU "合碩"顱顏骨固定系統:L中長形骨板4:5洞"CUSMED"CMF FIXATION

SYSTEM: MINI BONE PLATE TITANIUM L-TYPE 4:5HOLE

1380

FPP0142424XU "合碩"顱顏骨固定系統;斜L形骨板,4:5洞"CUSMED"CMF FIXATION

SYSTEM:MINI BONE PLATE,PURE TITANIUM L-TYPE 4:5HOLE

1380

FPP0142524XU "合碩"顱顏骨固定系統;斜L形骨板,4:5洞"CUSMED"CMF FIXATION

SYSTEM:MINI BONE PLATE,PURE TITANIUM L-TYPE 4:5HOLE

1380

FPP0143022XU "合碩"顱顏骨固定系統:眼框形骨板,6洞,8洞"CUSMED"CMF

FIXATION SYSTEM: MINI BONE PLATE,PURE

TITANIUM,ORBITAL,6HOLE,8HOLE

1562

912

特材代碼 中英文名稱 支付點數-104/01/01

FPP0144022XU "合碩"顱顏骨固定系統:T形骨板,6:7洞"CUSMED"CMF FIXATION

SYSTEM: MINI T-TYPE BONE PLATE,PURE TITANIUM 6:7HOLE

1885

FPP0144121XU "合碩"顱顏骨固定系統:T形骨板,5洞"CUSMED"CMF FIXATION

SYSTEM: MINI T-TYPE BONE PLATE,PURE TITANIUM 5HOLE

1885

FPP0144221XU "合碩"顱顏骨固定系統:斜T形骨板,5洞"CUSMED"CMF FIXATION

SYSTEM: MINI T-TYPE ANGLED BONE PLATE,PURE TITANIUM 5HOLE

1885

FPP0145021XU "合碩"顱顏骨固定系統:雙T形骨板,4洞,6洞"CUSMED"CMF

FIXATION SYSTEM: MINI BONE PLATE,PURE TITANIUM,DOUBLE T-

TYPE 4HOLE,6HOLE

2207

FPP0146022XU "合碩"顱顏骨固定系統:Y形骨板,5:6洞"CUSMED"CMF FIXATION

SYSTEM: MINI BONE PLATE,PURE TITANIUM,Y-TYPE LONG 5:6HOLE

1743

FPP0147004S1 MINI PLATE 1.5/2.0 2:4HOLE 16:28MM ※適應症請見備註欄 975

FPP0147016S1 MINI PLATE 2.0 6HOLE 35:40MM ※適應症請見備註欄 1134

FPP0147018S1 2.0MM MANDIBLE MINI PLATE 6HOLE,70D(轉70度) TWISTED 40MM

※適應症請見備註欄

2001

FPP0147021XU "合碩"顱顏骨固定系統:雙Y形骨板,6洞,8洞"CUSMED"CMF

FIXATION SYSTEM: MINI BONE PLATE,PURE TITANIUM,DOUBLE Y-

TYPE 6HOLE,8HOLE

2469

FPP0147100S1 ADAPTION MINI PLATE 1.5,2.0 20HOLE STR ※適應症請見備註欄 1565

FPP0147220S1 ORBITAL RIM PLATE 1.5,2.0 CURVED 8:12 HOLES ※適應症請見

備註欄

1562

FPP01475NNS1 L- PLATE 1.5,2.0 5:10 HOLES ※適應症請見備註欄 1380

FPP0147620S1 Y- PLATE 1.5,2.0 5:8 HOLES ※適應症請見備註欄 1743

FPP0147680S1 DOUBLE Y-PLATE 2.0 8HOLE ※適應症請見備註欄 2469

FPP0147810S1 X-PLATE 1.5,2.0 4 HOLES ※適應症請見備註欄 2469

FPP0147850S1 MINI H-PLATE 2.0 8:9 HOLES ※適應症請見備註欄 4479

FPP0147910S1 MINI BURR HOLE COVER 1.5,2.0 6 HOLES ※適應症請見備註欄 5873

FPP0149024XU "合碩"顱顏骨固定系統:鑽孔蓋型骨板,6洞"CUSMED" CMF

FIXATION SYSTEM:COMBINE CMF MINI BONE PLATE,PURE

TITANIUM,BURR HOLE COVER ,6HOLE

5873

FPP0149124XU "合碩"顱顏骨固定系統:引流鑽孔蓋,骨板,5洞"CUSMED"

CMFFIXATION SYSTEM:COMBINE CMF MINI BONE PLATE,PURE

TITANIUM,BURR HOLE COVER FOR SHUNT OR DRAIN

5873

FPP0151004M3 TITANIUM 0.6MM,1.0MM MINI PLATE 4 HOLES STR ※適應症請見

備註欄

975

FPP0151006M3 TITANIUM 0.6MM,1.0MM MINIP LATE 6 HOLES STR ※適應症請見

備註欄

1134

FPP0151008M3 TITANIUM 0.6MM,1.0MM MINIP LATE 8HOLE STR ※適應症請見備

註欄

1134

FPP0151016M3 TITANIUM 0.6MM,1.0MM MINI PLATE 16 HOLE STR ※適應症請見

備註欄

1565

FPP0152014M3 TITANIUM 1.0MM MINI PLATE L SHAPE 4 HOLE ※適應症請見備註

1380

FPP0152414M3 TITANIUM 0.6MM,1.0MM MINI PLATE L SHAPE 4HOLE ※適應症請

見備註欄

1380

FPP0152520M3 TITANIUM0.6MM,1.0MM MINI PLATE 110度 4HOLE ※適應症請見

備註欄

1380

FPP0154015M3 TITANIUM 0.6MM,1.0MM MIN IPLATE T SHAPE 90度 4HOLE ※適應

症請見備註欄

1885

FPP0154315M3 TITANIUM 0.6MM,1.0MM MINI PLATE T SHAPE 80度 4HOLE ※適應

症請見備註欄

1885

913

特材代碼 中英文名稱 支付點數-104/01/01

FPP0154816M3 TITANIUM 0.6MM,1.0MM MINI PLATE DOUBLE T SHAPE 90 度

4,6HOLE※適應症請見備註欄

2270

FPP0155015M3 TITANIUM0.6MM,1.0MM MINI PLATE Y SHAPE 5HOLE ※適應症請

見備註欄

1743

FPP0156016M3 TITANIUM 0.6MM,1.0MM MINI PLATE DOUBLE Y SHAPE 6HOLE ※

適應症請見備註欄

2469

FPP0156217M3 TITANIUM 0.6MM,1.0MM MINI PLATE DOUBLE Y SHAPE 7HOLE ※適

應症請見備註欄

2469

FPP0157012M3 TITANIUM 0.6MM,1.0MM MINI PLATE H SHAPE 12HOLE ※適應症請

見備註欄

4479

FPP0187004MC TITANIUM 1MM MINI PLATE 4HOLE STR ※適應症請見備註欄 975

FPP0187005MC TITANIUM 1MM MINI PLATE 5HOLE STR※適應症請見備註欄 975

FPP0187006MC TITANIUM 1MM MINI PLATE 6 HOLE STR ※適應症請見備註欄 1134

FPP0187008MC TITANIUM 1MM MINI PLATE 8 HOLE STR ※適應症請見備註欄 1134

FPP0187014MC TITANIUM 1MM MINI PLATE 4 HOLE 9MM STR ※適應症請見備註欄 975

FPP0187024MC TITANIUM 1MM MINI PLATE 4 HOLE 12MM STR ※適應症請見備註

975

FPP0187030MC "MEDICON"TITANIUM 1MM MINI L-PLATE LEFT 9MM 4 HOLE 鈦金屬

顏面骨板系統:迷你骨板 ※適應症請見備註欄

1380

FPP0187031MC TITANIUM 1MM MINI L-PLATE RIGHT 9MM 4 HOLE※適應症請見備

註欄

1380

FPP0187032MC TITANIUM 1MM MINI L-PLATE LEFT 9MM 4 HOLE ※適應症請見備

註欄

1380

FPP0187033MC TITANIUM 1MM MINI L-PLATE R 9MM 4 HOLE ※適應症請見備註欄 1380

FPP0187034MC TITANIUM 1MM MINI L-PLATE LEFT 12MM 4 HOLE ※適應症請見備

註欄

1380

FPP0187053MC TITANIUM 1MM MINI Y PLATE 9MM 4 HOLE ※適應症請見備註欄 1743

FPP0187054MC TITANIUM 1MM MINI Y PLATE 12MM 4HOLE※適應症請見備註欄 1743

FPP0187055MC TITANIUM 1MM MINI DOUBLE Y PLATE 9MM 6HOLE ※適應症請見備

註欄

2469

FPP0187077MC TITANIUM 1MM MANDIBULAR ANGLE PLATE 4HOLE LEFT ※適應症請

見備註欄

1626

FPP0187078MC TITANIUM 1MM MINI MANDIBULAR ANGLE PLATE 4HOLE RIGHT ※適

應症請見備註欄

1626

FPP0187079MC TITANIUM 1MM MINI MANDIBULAR ANGLE PLATE 6HOLE LEFT ※適

應症請見備註欄

1836

FPP0187080MC TITANIUM 1MM MINI MANDIBULAR ANGLE PLATE 6HOLE RIGHT ※適

應症請見備註欄

1836

FPP0187085MC 1MM MINI TI-ORBITA PLATE 12MM 4HOLE※適應症請見備註欄 1562

FPP0189501MC TITANIUM MANDIBULAR RECONSTRUCTION PLATE STRAIGHT 100MM

2MM ※適應症請見備註欄

4230

FPP0189512MC TITANIUM MANDIBULAR RECONSTRUCTION PLATE ANGLE 105MM 2MM

14HOLE R/L※適應症請見備註欄

6720

FPP0208734LE BRIDGING PLATE STR 11:17 H

(5620011:7,8003:11,3,9012:6,5415070,5633034:139 92/1/1生

效)※適應症見備註

4230

FPP0208743LE BRIDGING PLATE ANGLE LEFT 11HOLE(4+3+4HOLE)2.8MM (型號

5415076自92/1/1/生效)※適應症請見備註欄

6720

FPP0208745LE BRIDGING PLATE L-ANGLE 12:21H(型號

5620048:59,8025:87,9038:76自92/1/1生效) ※適應症請見備註

6720

914

特材代碼 中英文名稱 支付點數-104/01/01

FPP0208747LE BRIDGING PLATE ANGLE LEFT 15HOLE(4+7+4HOLE)2.8MM ※適應症

請見備註欄

6720

FPP0208755LE BRIDGING PLATE ANGLE RIGHT 13HOLE(4+5+4HOLE)2.8MM ※適應

症請見備註欄

6720

FPP0208757LE BRIDGING PLATE ANGLE RIGHT 15HOLE(4+7+4HOLE)2.8MM ※適應

症請見備註欄

6720

FPP0208770LE CONDYLAR IMPLANT LEFT 14MM ※適應症請見備註欄 6874

FPP0208771LE CONDYLAR IMPLANT RIGHT 14MM※適應症請見備註欄 6874

FPP0214201EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION

SYSTEM:RECONSTRUCTION PLATE 4+12 HOLE"歐美特"下頷骨折重建

系統,重建骨板單邊4+12洞

6720

FPP0214203EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION

SYSTEM:RECONSTRUCTION PLATE 5+16 HOLE"歐美特"下頷骨折重建

系統,重建骨板單邊5+16洞

6720

FPP0214205EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION

SYSTEM:RECONSTRUCTION PLATE FULL 5+20+5 5+16+5 HOLE"歐美

特"下頷骨折重建系統,重建骨板雙邊

14495

FPP0214207EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION

SYSTEM:RECONSTRUCTION PLATE 14HOLE"歐美特"下頷骨折重建系

統,重建直型骨板14洞

4230

FPP0214208EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION

SYSTEM:RECONSTRUCTION PLATE 18HOLE"歐美特"下頷骨折重建系

統,重建直型骨板18洞

4230

FPP021552NLE ANGLE PLATE 6-10 HOLE※適應症請見備註欄 5573

FPP021591NLE “史賽克 雷賓格爾”下頷骨系統重建型骨板11-30孔“STRYKER

LEIBINGER” UNIVERSAL MANDIBLE SYSTEM RECON PLATE 11-30

HOLE

4230

FPP021592NLE “史賽克 雷賓格爾”下頷骨系統重建骨板全/半型“STRYKER

LEIBINGER” UNIVERSAL MANDIBLE SYSTEM RECON PLATE HEMI /

FULL

6874

FPP0220511Y2 COMPRESSION PLATE 1.6MM 4,8HOLE STR※適應症請見備註欄 2722

FPP0220518Y2 COMPRESSION PLATE 1.6MM 16HOLE STR※適應症請見備註欄 4230

FPP0220521Y2 COMPRESSION PLATE 1.6MM 4HOLE STR/斜孔※適應症請見備註欄 2722

FPP0220610Y2 TOTAL MANDIBULAR BRIDGING STR PLATE 3.0MM(4+9+4) HOLE※

適應症請見備註欄

14495

FPP0220611Y2 MANDIBULAR BRIDGING STR PLATE 3.0MM(4+2+4) HOLE※適應症

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2722

FPP0220612Y2 MANDIBULAR BRIDGING STR PLATE 3.0MM(4+3,4,5,6,7+4)HOLE※

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4230

FPP0220621Y2 MANDIBULAR BRIDGING STR PLATE 3.0MM(4+3,5,7,9+4)HOLE※適

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6720

FPP0240008M3 TITANIUM RECONSTRUCTION PLATE 8HOLE STR※適應症請見備註欄 2722

FPP0240010M3 TITANIUM RECONSTRUCTION PLATE 10:14HOLE STR※適應症請見備

註欄

4230

FPP0240016M3 TITANIUM RECONSTRUCTION PLATE 16,18HOLE STR※適應症請見備

註欄

4230

FPP0240028M3 TITANIUM RECONSTRUCTION PLATE 5+8HOLE ANG※適應症請見備註

6720

FPP0240032M3 TITANIUM RECONSTRUCTION PLATE 5+12HOLE ANG※適應症請見備

註欄

6720

FPP0240036M3 TITANIUM RECONSTRUCTION PLATE 5+16HOLE,5+20HOLE ANG※適應

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6720

915

特材代碼 中英文名稱 支付點數-104/01/01

FPP0240080M3 TITANIUM RECONSTRUCTION PLATE 5+20+5HOLE COMPLETE

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14495

FPP024009KM3 TITANIUM CONDYLAR PROTHESIS W/2 FIXATION HOLES※適應症請

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6874

FPP0241220XU "合碩"顱顏骨固定系統:下顎直行骨板8洞"CUSMED"CMF FIXATION

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2722

FPP0241221XU "合碩"顱顏骨固定系統:直行下顎骨板10洞;12洞;14洞;16洞;18

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4230

FPP0241509LE COMPRESSION PLATE ANGLE 4HOLE※適應症請見備註欄 5573

FPP0242620XU "合碩"顱顏骨固定系統:斜角下顎骨板,13:25洞"CUSMED"CMF

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6720

FPP0242720XU "合碩"顱顏骨固定系統:斜角下顎骨板,13:25洞"CUSMED"CMF

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6720

FPP0243520XU "合碩"顱顏骨固定系統:下顎雙斜角骨板,30洞"CUSMED"CMF

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14495

FPP0245037S1 "SYNTHES"MATRIX MANDIBLE SYSTEM:20 HOLES STRAIGHT "信迪

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4230

FPP0249630S1 2.4MM RECONSTRUCTION PLATE STRAIGHT 12HOLE 95MM ※適應症

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4230

FPP0249720S1 2.4MM RECONSTRUCTION PLATE STRAIGHT 20:24HOLE 159MM ※適

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4230

FPP024988NS1 2.4MM RECONSTRUCTION PLATE ANGLED 18:27HOLE 146MM ※適應

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6720

FPP0269502MC TITANIUM MANDIBULAR RECONSTRACTION PLATE 14HOLE※適應症請

見備註欄

4230

FPP0269510MC TITANIUM MANDIBULAR RECONSTRACTION PLATE ANGLE 12HOLE※適

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6720

FPP027051NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:ADAPTION PLATES PURE

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4230

FPP027171NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:PLATES PURE TITANIUMM 12

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4230

FPP0308640LE FRACTURE PLATE 4:8HOLE 35MM 1.8MM(型號5415-

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2722

FPP0308642LE FRACTURE PLATE 4 HOLE 40MM 1.8MM ※適應症請見備註欄 2722

FPP0308644LE FRACTURE PLATE 4 HOLE 50MM 1.8MM ※適應症請見備註欄 2722

FPP0308650LE FRACTURE PLATE 8 HOLE 60MM 1.8MM ※適應症請見備註欄 2722

FPP0308652LE FRACTURE PLATE 8 HOLE 70MM 1.8MM ※適應症請見備註欄 2722

FPP0308660LE MAND ANGLE PLATE 60 R "TS 1.8MM ※適應症請見備註欄 3519

FPP0308670LE FRACTURE PLATE 4H 35MM 1.8MM STR ※適應症請見備註欄 2722

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FPP0314080EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:BSSO

PLATE 4+6 HOLE"歐美特"下頷骨折重建系統,直型骨板4+6洞

2722

FPP0314210EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION

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2722

FPP0314219EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION

SYSTEM:ANGLED FRACTION PLATE 2X2 3X3 HOLE"歐美特"下頷骨折

重建系統,成角骨折骨板4;6洞

5573

916

特材代碼 中英文名稱 支付點數-104/01/01

FPP0314222EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:RIGID

COMMINUTED FRACTURE PLATE 15HOLE"歐美特"下頷骨折重建系統,

硬式粉碎骨折骨板15洞

4230

FPP0314311EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.4

LOCKING FRACTURE PLATE 4;6 HOLE"歐美特"下頷骨折重建系

統,2.4鎖定骨折骨板4;6洞

2722

FPP0314400EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.0

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統,2.0鎖定骨折骨板4;6洞

2722

FPP0314403EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.0

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統,2.0鎖定粉碎骨板15洞

4230

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FPP0315070LE MANDIBULAR COMPRESSION PLATE 14HOLE ※適應症請見備註欄 4230

FPP0315131M3 MRS FRACTURE BONE PLATE 4:8HOLE STR ※適應症請見備註欄 2722

FPP0315170M3 MRS FRACTURE BONE PLATE 14HOLE STR ※適應症請見備註欄 4230

FPP031550NLE “史賽克 雷賓格爾”下頷骨系統加壓骨板2-10孔“STRYKER

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2-10 HOLE

2722

FPP0320526Y2 COMPRESSION PLATE 1.6MM 4HOLE STR/60度※適應症請見備註欄 3519

FPP03434NNS1 2.0MM ZYGOMATIC DCP 4:6HOLE STR ※適應症請見備註欄 2722

FPP034503NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:RCCONSTRUCTION PLATE

7+23HOLES "信迪思"下顎固定系統:重建骨板※給付規定請見備

註欄

6720

FPP0349110S1 TENSION BAND PLATE 2.0,2.4 4:6HOLE STR 22:35MM ※適應症請

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2722

FPP0349160S1 2.4MM LC-DCP STRAIGHT 4:6HOLE 36:52MM ※適應症請見備註欄 2722

FPP0349236S1 2.4MM LIMITED CONTACT-DCP ECCENTRIC 4:6HOLE 36:52MM ※適

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3519

FPP0349260S1 2.4MM LC-DCP CURVED 4:6HOLE 35:50MM ※適應症請見備註欄 3519

FPP0349380S1 UNIVERSAL FRACTURE PLATE 2.4 STRAIGHT 8 HOLES ※適應症請

見備註欄

2722

FPP0349400S1 UNIVERSAL FRACTURE PLATE 2.4 STRAIGHT 10 HOLES ※適應症請

見備註欄

2722

FPP0349424S1 UNIVERSAL FRACTURE PLATE 2.4 STRAIGHT 24 HOLES (447.021自

90/10/01生效)※適應症請見備註欄

4230

FPP034944NS1 UNIVERSAL FRACTURE PLATE 2.4 ANGLED 20:27 HOLES ※適應症

請見備註欄

6720

FPP034984NS1 UNIVERSAL FRACTURE PLATE 2.4 ANGLED 6:10 HOLES ※適應症請

見備註欄

5573

FPP035415NLE MANDIBULAR COMPRESSION PLATE 4:6HOLE ※適應症請見備註欄 2722

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FPP037011NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:MINI TENSION BAND PLATES

1.0MM PURE TITANIUMM 4HOLE;6HOLE"信迪思"下顎固定系統:迷你

張力骨板

2722

FPP037101NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:DCP PLATES PURE TITANIUM

2+2 OR 3+3 HOLES"信迪思"下顎固定系統:動態加壓骨板

3519

FPP037111NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:PLATE(2+2HOLE)"信迪思"下

顎固定系統:下顎骨板※給付規定請見備註欄

2722

917

特材代碼 中英文名稱 支付點數-104/01/01

FPP037131NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:DCP PLATES PURE TITANIUMM

3+3 HOLES CRESCENT OR ANGLED"信迪思"下顎固定系統:動態加壓

新月型或曲型骨板

5573

FPP037151NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:PLATE(3+3HOLE)"信迪思"下

顎固定系統:下顎骨板※給付規定請見備註欄

2722

FPP037211NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:DCP PLATES PURE TITANIUMM

3+3 HOLES, CRESCENT OR ANGLED"信迪思"下顎固定系統:新月型

或曲型骨板

5573

FPP060573NLE “史賽克 雷賓格爾”下頷骨系統3D鎖定骨板6X2孔“STRYKER

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LOCKING 3-D PLATE 6X2 HOLES

10711

FPP0606310LE TITAN MINI 3-D BONE PLATE 2X2 HOLES SQUARE 0.6MM ※適應症

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3867

FPP0606312LE TITAN MINI 3-D BONE PLATE 2X2 HOLES RECTANGULAR SEGMENT

0.6MM ※適應症請見備註欄

3867

FPP060631NLE 2.0 MINI PLATE 3-D 2X2 HOLES 0.6MM※適應症請見備註欄 3867

FPP0606320LE TITAN MINI 3-D BONE PLATE 3X2 HOLES SQUARE SEGMENT 0.6MM

※適應症請見備註欄

4767

FPP0606322LE TITAN MINI 3-D BONE PLATE 3X2 HOLES RECTANGULAR SEGMENT

0.6MM ※適應症請見備註欄

4767

FPP060632NLE 2.0 MINI PLATE 3-D 3X2 HOLES 0.6MM※適應症請見備註欄 4767

FPP0606332LE TITAN 3-D BONE PLATE 4X2 HOLES RECTANGULAR SEGMENT 0.6MM

※適應症請見備註欄

5211

FPP0606731LE STRYKER LEIBINGER UNIVERSAL MANDIBLE SYSTEM:1.7MM MID-

FACE 3D PLATE 2X2 HOLES ※適應症請見備註欄

3867

FPP0610054EJ 2.0 MM MINI SQUARE PLATE 4 HOLE ※適應症請見備註欄 3867

FPP0610310LE TITAN MINI 3-D BONE PLATE 2X2 HOLES SQUARE SEGMENT 1.0MM

※適應症請見備註欄

3867

FPP0610312LE TITAN MINI 3-D BONE PLATE 2X2 HOLES RECTANGULAR SEGMENT

1.0MM ※適應症請見備註欄

3867

FPP0610322LE TITAN MINI 3-D BONE PLATE 3X2 HOLES RECTANGULAR SEGMENT

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4767

FPP0610330LE TITAN MINI 3-D BONE PLATE 4X2 HOLES SQUARE SEGMENT 1.0MM

※適應症請見備註欄

5211

FPP0610332LE TITAN MINI 3-D BONE PLATE 4X2 HOLES RECTANGULAR SEGMENT

1.0MM ※適應症請見備註欄

5211

FPP0610501EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:MINI

LOCKING STRUT PLATE CURVED 2X4HOLE"歐美特"下頷骨折重建系

統,迷你鎖定矩陣型骨板弧狀

5211

FPP0610502EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:MINI

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統,迷你鎖定矩陣型骨板弧狀

10711

FPP0610503EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:MINI

LOCKING STRUT PLATE CURVED 2X8 HOLE"歐美特"下頷骨折重建系

統,迷你鎖定矩陣型骨板弧狀

10711

FPP0610532LE 3 D PLATE 3X2 HOLE※適應症請見備註欄 4767

FPP0610542LE 3 D PLATE 4X2 HOLE※適應症請見備註欄 5211

FPP0610562LE 3 D PLATE 6X2 HOLE※適應症請見備註欄 10711

FPP0620261Y2 MINI H-SHAPE(3-D)PLATE 2X2 HOLE※適應症請見備註欄 3867

FPP0620262Y2 MINI 1.0MM H-SHAPE(3-D)PLATE 3X2 HOLE※適應症請見備註欄 4767

FPP0620263Y2 MINI 1.0MM H-SHAPE(3-D)PLATE 4X2 HOLE※適應症請見備註欄 5211

FPP0620266Y2 MINI 1.0MM H-SHAPE(3-D)PLATE 2X2 HOLE※適應症請見備註欄 3867

FPP0620267Y2 MINI 1.0MM H-SHAPE(3-D)PLATE 3X2 HOLE※適應症請見備註欄 4767

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918

特材代碼 中英文名稱 支付點數-104/01/01

FPP0648025XU "合碩"顱顏骨固定系統:正方型骨板,2*2洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MINI BONE PLATE,PURE

TITANIUM,SQUARE,2*2HOLE

3867

FPP0648026XU "合碩"顱顏骨固定系統:正方型骨板,3*2洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MINI BONE PLATE,PURE

TITANIUM,SQUARE,3*2HOLE

4767

FPP0648027XU "合碩"顱顏骨固定系統:正方型骨板,4*2洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MINI BONE PLATE,PURE

TITANIUM,SQUARE,4*2HOLE

5211

FPP0648028XU "合碩"顱顏骨固定系統:正方型骨板,4*4洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MINI BONE PLATE,PURE

TITANIUM,SQUARE,4*2HOLE

10383

FPP0648029XU "合碩"顱顏骨固定系統:正方型骨板,6*4洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MINI BONE PLATE,PURE

TITANIUM,SQUARE,6*2HOLE

10711

FPP0648125XU "合碩"顱顏骨固定系統:矩形骨板,2*2洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MINI BONE PLATE,PURE

TITANIUM,RECTANGULAR,2*2HOLE

3867

FPP0648126XU "合碩"顱顏骨固定系統:矩形骨板,3*2洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MINI BONE PLATE,PURE

TITANIUM,RECTANGULAR,3*2HOLE

4767

FPP0648127XU "合碩"顱顏骨固定系統:矩形骨板,4*2洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MINI BONE PLATE,PURE

TITANIUM,RECTANGULAR,4*2HOLE

5211

FPP0648128XU "合碩"顱顏骨固定系統:矩形骨板,4*4洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MINI BONE PLATE,PURE

TITANIUM,RECTANGULAR,4*4HOLE

10383

FPP0648129XU "合碩"顱顏骨固定系統:矩形骨板,6*4洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MINI BONE PLATE,PURE

TITANIUM,RECTANGULAR,6*4HOLE

10711

FPP0657710M3 MINI 2000 CAD 4 HOLE PLATE SQUARE ,RECTANGULAR

0.6MM,1.0MM※適應症請見備註欄

3867

FPP0657720M3 MINI 2000 CAD 6 HOLE PLATE SQUARE ,RECTANGULAR

0.6MM,1.0MM※適應症請見備註欄

4767

FPP0657730M3 MINI 2000 CAD 8 HOLE PLATE SQUARE ,RECTANGULAR

0.6MM,1.0MM※適應症請見備註欄

5211

FPP069001NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:PREFORMED RECONSTRUCTION

PLATE"信迪思"下顎固定系統:立體重建骨板

10711

FPP0706104M3 MONDEAL TITANIUM 0.6MM MICRO 1200 PLATE 4HOLE STR ※限顏

面骨折患者使用

2498

FPP0706106M3 MONDEAL TITANIUM 0.6MM MICRO 1200 PLATE 6HOLE STR ※適應

症請見備註欄

2672

FPP0706107M3 MICRO 1200 TITANIUM STR PLATE 6HOLE 7.5MM※適應症請見備註

2672

FPP0706108M3 MONDEAL TITANIUM 0.6MM MICRO 1200 8HOLE PLATE STR ※適應

症請見備註欄

2672

FPP0706114M3 MICRO 1200 TITANIUM STR PLATE 4HOLE 6MM:9MM※適應症請見備

註欄

2498

FPP0706116M3 MONDEAL TITANIUM 0.6MM MICRO 1200 16HOLE PLATE STR※適應

症請見備註欄

4246

FPP0706120M3 MONDEAL TITANIUM 0.6MM MICRO 1200 L PLATE 5,8HOLE ※適應

症請見備註欄

4085

FPP0706124M3 MONDEAL TITANIUM 0.6MM MICRO 1200 L PLATE 4HOLE ※適應症

請見備註欄

4085

919

特材代碼 中英文名稱 支付點數-104/01/01

FPP0706126M3 MONDEAL TITANIUM 0.6MM MICRO 1200 L PLATE 5HOLE ※適應症

請見備註欄

4085

FPP0706141M3 MONDEAL TITANIUM 0.6MM MICRO 1200 T PLATE 7 HOLE ※限顏面

骨折患者使用

4430

FPP0706142M3 MONDEAL TITANIUM 0.6MM MICRO 1200 T PLATE 4 HOLE ※適應症

請見備註欄

4430

FPP0706144M3 MONDEAL TITANIUM 0.6MM MICRO 1200 H PLATE 9,14HOLE ※限顏

面骨折患者使用

4633

FPP0706160M3 MONDEAL TITANIUM 0.6MM MICRO 1200 Y PLATE 6 HOLE※適應症

請見備註欄

4997

FPP0706162M3 MONDEAL TITANIUM 0.6MM MICRO 1200 X PLATE 6,7 HOLE※適應

症請見備註欄

5560

FPP0706174M3 MONDEAL TITANIUM 0.6MM MICRO 1200 Y PLATE 4 HOLE ※適應症

請見備註欄

4997

FPP0706182M3 MONDEAL TITANIUM 0.6MM MICRO 1200 ORBITAL 8HOLE※適應症請

見備註欄

3883

FPP0706204LE MICROPLUS BONE PLATE 0.55MM 4 HOLE STR ※適應症請見備註欄 2498

FPP0706206LE MICROPLUS BONE PLATE 0.55MM 6 HOLE STR ※適應症請見備註欄 2672

FPP0706208LE MICROPLUS BONE PLATE 0.55MM 8 HOLE STR ※適應症請見備註欄 2672

FPP0706209LE MICROPLUS BONE PLATE 0.55MM 12 HOLE STR ※適應症請見備註

4246

FPP0706210LE MICROPLUS BONE PLATE 0.55MM 16HOLE STR ※適應症請見備註欄 4246

FPP0706211LE MICROPLUS BONE PLATE 0.55MM 24 HOLE STR ※適應症請見備註

4246

FPP0706220LE MICROPLUS BONE PLATE 0.55MM L SHAPE 5 HOLE ※適應症請見備

註欄

4085

FPP0706222LE MICROPLUS BONE PLATE 0.55 MM L SHAPE 8 HOLE ※適應症請見

備註欄

4085

FPP070622NLE “史賽克 雷賓格爾”下頷骨系統直型骨板18-24孔“STRYKER

LEIBINGER” UNIVERSAL MANDIBLE SYSTEM MICRO STRAIGHT

PLATE 18-24 HOLE

4246

FPP070623NLE “史賽克 雷賓格爾”下頷骨系統3D骨板2X2孔“STRYKER

LEIBINGER” UNIVERSAL MANDIBLE SYSTEM MICRO 3D PLATE 2X2

HOLE

3867

FPP0706240LE MICROPLUS BONE PLATE 0.55MM T SHAPE 5 HOLE 90 DE ※適應症

請見備註欄

4430

FPP0706241LE MICROPLUS BONE PLATE 0.55MM T SHSPE 7 HOLE 90 DE ※適應症

請見備註欄

4430

FPP0706244LE MICROPLUS BONE PLATE 0.55MM DOUBLE T SHAPE 9 HOLE ※適應

症請見備註欄

4633

FPP0706246LE MICROPLUS BONE PLATE 0.55MM DOUBLE T SHAPE 14 HOLE ※適應

症請見備註欄

4633

FPP0706249LE MICROPLUS BONE PLATE 0.55MM DOUBLE T SHAPE 7 HOLE ※適應

症請見備註欄

4633

FPP070624NLE “史賽克 雷賓格爾”下頷骨系統雙Y微型骨板7孔“STRYKER

LEIBINGER” UNIVERSAL MANDIBLE SYSTEM MICRO DOUBLE Y

PLATE 7 HOLE

5560

FPP070625NLE “史賽克 雷賓格爾”下頷骨系統微型眼眶骨板4孔;10孔

“STRYKER LEIBINGER” UNIVERSAL MANDIBLE SYSTEM MICRO

ORBITA PLATE 4HOLE;10 HOLE

3883

920

特材代碼 中英文名稱 支付點數-104/01/01

FPP0706260LE MICROPLUS BONE PLATE 0.55MM Y SHAPE 6 HOLE ※適應症請見備

註欄

4997

FPP0706262LE MICROPLUS BONE PLATE 0.55MM DOUBLE Y SHAPE 6 HOLE ※適應

症請見備註欄

5560

FPP0706263LE MICROPLUS BONE PLATE 0.55MM DOUBLE Y SHAPE 7 HOLE ※適應

症請見備註欄

5560

FPP070626NLE “史賽克 雷賓格爾”下頷骨系統L骨板4-8孔“STRYKER

LEIBINGER” UNIVERSAL MANDIBLE SYSTEM MICRO L PLATE 4-8

HOLE

4085

FPP0706270LE MICROPLUS BURR 0.55MM H COVERING & BONE FLAP FIXATION

PLATE 7,10,14MM※適應症請見備註欄

5873

FPP070627NLE MICRO T PLATE 7HOLE ※適應症請見備註欄 4430

FPP0706282LE MICROPLUS BONE PLATE 0.55MM ORBITA PLATE 8 HOLE CURVED※

適應症請見備註欄

3883

FPP0706303M3 MONDEAL TITANIUM 0.6MM MICRO 1200 CAD PLATE 3 HOLE,4HOLE

SQUARE ※適應症請見備註欄

3867

FPP0706325M3 MONDEAL TITANIUM 0.6MM MICRO 1200 CAD PLATE 6HOLE ※適應

症請見備註欄

5679

FPP0706335M3 MONDEAL TITANIUM 0.6MM MICRO 1200 CAD PLATE 8HOLE ※適應

症請見備註欄

6805

FPP070633NLE “史賽克 雷賓格爾”下頷骨系統3D微骨板6X2孔“STRYKER

LEIBINGER” UNIVERSAL MANDIBLE SYSTEM MICRO 3D PLATE 6X2

HOLE

10383

FPP070637NLE ““史賽克 雷賓格爾”下頷骨系統微型鑽孔覆蓋骨板7-14MM

“STRYKER LEIBINGER” UNIVERSAL MANDIBLE SYSTEM MICRO

MALLEABLE BURR HOLE COVER PLATE 7-14MM

5873

FPP0706415LE MICROPLUS BONE PLATE 0.55MM 4(2X2)HOLE SQUARE

SEGMENTS,REGANG ULAR SEGMENT ※適應症請見備註欄

3867

FPP0706425LE MICROPLUS BONE PLATE 0.55MM 6(3X2)HOLE SQUARE ,RECTANG

ULAR SEAGMENT ※適應症請見備註欄

5679

FPP0706435LE MICROPLUS BONE PLATE 0.55MM 8(4X2)HOLE SQUARE ,REGANG

ULAR SEGMENT ※適應症請見備註欄

6805

FPP0706445LE MICROPLUS BONE PLATE 0.55MM 16(4X4)HOLE SQUARE SEGMENTS

※適應症請見備註欄

10383

FPP0706467LE TITANIUM MICRO 3-D PLATE 0.55MM 6X4HOLE※適應症請見備註欄 11325

FPP0707007M3 MICRO BURR HOLE COVER PLATE 7:14MM ※適應症請見備註欄 5873

FPP0710220XU "合碩"顱顏骨固定系統:顱骨固定夾"CUSMED"CMF FIXATION

SYSTEM:FLAP FIXATOR

4000

FPP0710250XU "合碩"顱顏骨固定系統:顱骨固定夾"CUSMED"CMF FIXATION

SYSTEM:FLAP FIXATOR

4000

FPP0712001EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.2MM

12 HOLE CURVED PLAT※適應症請見備註欄

3883

FPP0712002EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.2MM 5

HOLE STRAIGHT PLATE ※適應症請見備註欄

2498

FPP0712003EJ M4 RIGID FIXATION SYSTEM 7, 11 HOLE Y PLATE, 0.5MM ※適應

症請見備註欄

4997

FPP0712004EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.2MM

18 HOLE STRAIGHT PLATE ※適應症請見備註欄

4246

FPP0712006EJ M4 RIGID FIXATION SYSTEM 6 HOLE LARGE, SMALL BUR HOLE

PLATE, 0.5MM※適應症請見備註欄

5873

FPP0712013EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.2MM 2

HOLE STRAIGHT PLATE:MEDIUM,LONG ※適應症請見備註欄

2498

921

特材代碼 中英文名稱 支付點數-104/01/01

FPP0712036EJ M4 RIGID FIXATION SYSTEM 12 HOLE CURVED PLATE, 0.55MM※適

應症請見備註欄

3883

FPP0712040EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.2MM

2X4 HOLE QUAD PLATE※適應症請見備註欄

6805

FPP0712045EJ M4 RIGID FIXATION SYSTEM 4 HOLE 13, 16 MM LEFT, RIGHT L

PLATE, 0.5MM※適應症請見備註欄

4085

FPP0712046EJ M4 RIGID FIXATION SYSTEM 2X4 HOLE QUAD PLATE, 0.5MM※適應

症請見備註欄

6805

FPP0712068EJ M4 RIGID FIXATION SYSTEM 5 HOLE X PLATE, 0.5MM ※適應症請

見備註欄

5560

FPP0712086EJ M4 RIGID FIXATION SYSTEM ORBITAL FLOOR PLATE

0.35MM;0.25MM※適應症請見備註欄

10437

FPP0712104EJ M4 RIGID FIXATION SYSTEM MICRO 6 HOLE DOUBLE Y PLATE,

0.5MM※適應症請見備註欄

5560

FPP0712130EJ M4 RIGID FIXATION SYSTEM MICRO 4 HOLE STRAIGHT PLATE,

0.5MM※適應症請見備註欄

2498

FPP0712134EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.2MM

SQUARE PLATE ※適應症請見備註欄

3867

FPP0712136EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.2MM

EXTENDED X PLATE ※適應症請見備註欄

5560

FPP0712138EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.2MM

DOUBLE Y PLATE※適應症請見備註欄

5560

FPP0712140EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.2MM

BUR HOLE PLATE SMALL LARGE X-LARGE※適應症請見備註欄

5873

FPP0712146EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.2MM

MESH PLATE 40X40MM 90X90MM※適應症請見備註欄

10992

FPP0712312EJ M4 RIGID FIXATION SYSTEM MICRO 6, 8 HOLE STRAIGHT PLATE,

0.5MM※適應症請見備註欄

2672

FPP0718001EJ "OSTEO MED"NEURO FIXATION SYSTEM 0.48MM(2HOLE PLATE

X3+SCREW*6) "歐特美"顱顏骨固定系統:含2 HOLE PLATE

X3+SCREWX6※適應症請見備註欄

15882

FPP0718002EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.6MM 5

HOLE STRAIGHT PLATE ※適應症請見備註欄

2498

FPP0718003EJ "OSTEOMED" FAST-FLAP NEURO FIXATION SYSTEM(3X2HOLE) "歐特

美"速固硬式固定系統※給付規定請見備註欄

5679

FPP0718004EJ "OSTEO MED"NEURO FIXATION SYSTEM0.48MM "歐特美"顱顏骨固定

系統:含2 HOLE PLATE X2+SCREWX4※適應症請見備註欄

10587

FPP0718005EJ "OSTEO MED"NEURO FIXATION SYSTEM 0.48MM "歐特美"顱顏骨固

定系統:含 BURR HOLE X1+SCREWX6※適應症請見備註欄

14133

FPP0718020EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.6MM

SQUARE PLATE 9MM ※適應症請見備註欄

3867

FPP0718022EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.6MM 2

HOLE STRAIGHT PLATE:MEDIUM,LONG,SHORT※適應症請見備註欄

2498

FPP0718028EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.6MM

DOUBLE Y PLATE※適應症請見備註欄

5560

FPP0718032EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.6MM

BUR HOLE PLATE SMALL LARGE X-LARGE※適應症請見備註欄

5873

FPP0718038EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.6MM

10 HOLE STRAIGHT PLATE ※適應症請見備註欄

2672

FPP0718059EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.6MM

2X3 HOLE QUAD PLATE※適應症請見備註欄

5679

FPP0718060EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.6MM

2X4 HOLE QUAD PLATE※適應症請見備註欄

6805

922

特材代碼 中英文名稱 支付點數-104/01/01

FPP0720010S1 MICRO STRUT PLATE 16:22HOLE(網狀) ※適應症請見備註欄 10383

FPP0720100S1 MICRO 0.5MM ADAPTION PLATE 24HOLES(型號420.100另編代碼

FPP072010N)適應症請見備註欄

4246

FPP072010NS1 MICRO 0.5MM ADAPTION PLATE 34HOLE ※適應症請見備註欄 4246

FPP0720111Y2 MICRO PLATE 0.6MM 4HOLE STR※適應症請見備註欄 2498

FPP0720112Y2 MICRO PLATE 0.6MM 6,8HOLE STR※適應症請見備註欄 2672

FPP0720114Y2 MICRO PLATE 0.6MM 12,16,24HOLE STR※適應症請見備註欄 4246

FPP0720121Y2 MICRO PLATE 0.6MM 5,8HOLE L-SHAPE※適應症請見備註欄 4085

FPP0720131Y2 MICRO PLATE 0.6MM 5,7HOLE T-SHAPE※適應症請見備註欄 4430

FPP0720135Y2 MICRO PLATE 0.6MM 6HOLE Y-SHAPE※適應症請見備註欄 4997

FPP0720136Y2 MICRO PLATE 0.6MM 6,7HOLE DOUBLE Y-SHAPE※適應症請見備註

5560

FPP0720141Y2 MICRO ORBITA PLATE 0.6MM 8HOLE※適應症請見備註欄 3883

FPP0720150Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 2X2 HOLE※適應症請見備註欄 3867

FPP0720151Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 3X2 HOLE※適應症請見備註欄 5679

FPP0720152Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 4X2 HOLE※適應症請見備註欄 6805

FPP0720153Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 4X4 HOLE※適應症請見備註欄 10383

FPP0720154Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 6X4 HOLE※適應症請見備註欄 11325

FPP0720155Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 2X2 HOLE※適應症請見備註欄 3867

FPP0720156Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 3X2 HOLE※適應症請見備註欄 5679

FPP0720157Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 4X2 HOLE※適應症請見備註欄 6805

FPP0720158Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 4X4 HOLE※適應症請見備註欄 10383

FPP0720159Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 6X4 HOLE※適應症請見備註欄 11325

FPP072016NY2 MICRO BURR HOLES PLATE 0.6MM 7:14MM※適應症請見備註欄 5873

FPP0720210S1 MICRO 0.5MM ORBITAL RIM PLATE CURVED 8:12HOLE ※適應症請

見備註欄

3883

FPP07204NNS1 MICRO ORBITAL FLOOR PLATE UNIVERSAL/L/R (421.040,044,045

自89/10/1生效)※適應症請見備註欄

10437

FPP07205NNS1 MICRO 0.5MM L-PLATE 5:9HOLE ※適應症請見備註欄 4085

FPP0720620S1 MICRO 0.5MM Y-PLATE 5:13HOLE ※適應症請見備註欄 4997

FPP0720680S1 MICRO 0.5MM DOUBLE Y-PLATE 6HOLE(型號421.068,069自89/10/1

生效)※適應症請見備註欄

5560

FPP0720710S1 MICRO 0.5MM T-PLATE 7:12HOLE ※適應症請見備註欄 4430

FPP0720810S1 MICRO 0.5MM X-PLATE 4HOLE ※適應症請見備註欄 5560

FPP0720850S1 MICRO 0.5MM H-PLATE 6:11HOLE ※適應症請見備註欄 4633

FPP0720910S1 TITANIUM MICRO BURR HOLE COVER※適應症請見備註欄 5873

FPP0721024S1 MICRO 0.5MM PLATE 2:4HOLE STR ※適應症請見備註欄 2498

FPP0721096S1 MICRO BOX PLATE 4 HOLES ※適應症請見備註欄 3867

FPP0741020XU "合碩"顱顏骨固定系統:直行骨板 2洞"CUSMED"CMF FIXATION

SYSTEM:MICRO BONE PLATE TITANIUM STR 2HOLE

2498

FPP074102YXU "合碩"顱顏骨固定系統:2洞骨板*3,骨釘*6"CUSMED"CMF FIXATION

SYSTEM:CONDUCT.COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,2 HOLE PLATE*3 ,SCREW*6

15882

923

特材代碼 中英文名稱 支付點數-104/01/01

FPP074102ZXU "合碩"顱顏骨固定系統:2洞骨板,4個骨釘"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE TITANIUM,2 HOLE

PLATE ,SCREW*4

10587

FPP0741120XU "合碩"顱顏骨固定系統:直行骨板4洞"CUSMED"CMF FIXATION

SYSTEM: COMBINE MICRO BONE PLATE TITANIUM STR 4HOLE

2498

FPP0741121XU "合碩"顱顏骨固定系統:直行骨板6洞;8洞"CUSMED"CMF FIXATION

SYSTEM:MICRO BONE PLATE TITANIUM STR 6HOLE;8HOLE

2672

FPP0741323XU "合碩"顱顏骨固定系統:連接形骨板12洞;16洞;24洞"CUSMED"CMF

FIXATION SYSTEM:MICRO BONE PLATE TITANIUM ADAPTION

12HOLE;16HOLE;24HOLE

4246

FPP0742020XU "合碩"顱顏骨固定系統:L形骨板4洞;5洞;8洞"CUSMED"CMF

FIXATION SYSTEM: MICRO BONE PLATE TITANIUM L-TYPE

4HOLE;5HOLE;8HOLE

4085

FPP0742025Y2 "SYNTEC"TITANIUM MESH PLATE"亞太醫療"鈦合金網眼骨板※給付

規定請見備註欄

10437

FPP074202HY2 "SYNTEC"TITANIUM MESH PLATE:STRAIGHT 2HOLE "亞太醫療"鈦合

金網眼骨板:直型骨板※給付規定請見備註欄

2498

FPP0742051Y2 "SYNTEC"TITANIUM MESH PLATE"亞太醫療"鈦合金網眼骨板※給付

規定請見備註欄

10437

FPP0742120XU "合碩"顱顏骨固定系統:L形骨板4洞;5洞;8洞"CUSMED"CMF

FIXATION SYSTEM: MICRO BONE PLATE TITANIUM L-TYPE

4HOLE;5HOLE;8HOLE

4085

FPP07421FFY2 "SYNTEC"FLAPFIX SYSTEM"亞太醫療"顱骨固定系統※適應症請見

備註欄

4000

FPP0742220XU "合碩"顱顏骨固定系統:L形中長骨板左4:5洞"CUSMED"CMF

FIXATION SYSTEM: MICRO BONE PLATE TITANIUM L-TYPE

LONG,LEFT, 4:5HOLE

4085

FPP0742320XU "合碩"顱顏骨固定系統:L中長形骨板,右4:5洞"CUSMED"CMF

FIXATION SYSTEM: MICRO BONE PLATE TITANIUM L-TYPE,RIGHT,

4:5HOLE

4085

FPP0742420XU "合碩"顱顏骨固定系統:斜L形骨板4:5洞"CUSMED"CMF FIXATION

SYSTEM: MICRO BONE PLATE TITANIUM L-TYPE 4:5HOLE

4085

FPP0742520XU "合碩"顱顏骨固定系統;斜L形骨板,4:5洞"CUSMED"CMF FIXATION

SYSTEM:MICRO BONE PLATE,PURE TITANIUM L-TYPE 4:5HOLE

4085

FPP0743020XU "合碩"顱顏骨固定系統:眼框形骨板,6洞,8洞"CUSMED"CMF

FIXATION SYSTEM: MICRO BONE PLATE,PURE

TITANIUM,ORBITAL,6HOLE,8HOLE

3883

FPP0744120XU "合碩"顱顏骨固定系統:T形骨板,5洞"CUSMED"CMF FIXATION

SYSTEM: MICRO T-TYPE BONE PLATE,PURE TITANIUM 5HOLE

4430

FPP0744220XU "合碩"顱顏骨固定系統:斜T形骨板,5洞"CUSMED"CMF FIXATION

SYSTEM: MICRO T-TYPE ANGLED BONE PLATE,PURE TITANIUM

5HOLE

4430

FPP0745020XU "合碩"顱顏骨固定系統:雙T形骨板,4洞,6洞"CUSMED"CMF

FIXATION SYSTEM: MICRO BONE PLATE,PURE TITANIUM,DOUBLE T-

TYPE 4HOLE,6HOLE

4430

FPP0746020XU "合碩"顱顏骨固定系統:Y形骨板,5:6洞"CUSMED"CMF FIXATION

SYSTEM: MICRO BONE PLATE,PURE TITANIUM,Y-TYPE LONG

5:6HOLE

4997

FPP0747020XU "合碩"顱顏骨固定系統:雙Y形骨板,6洞,8洞"CUSMED"CMF

FIXATION SYSTEM: MICRO BONE PLATE,PURE TITANIUM,DOUBLE Y-

TYPE 6HOLE,8HOLE

5560

924

特材代碼 中英文名稱 支付點數-104/01/01

FPP0748020XU "合碩"顱顏骨固定系統:正方型骨板2*2洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,SQUARE,2*2HOLE

3867

FPP0748021XU "合碩"顱顏骨固定系統:正方型骨板,3*2洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,SQUARE,3*2HOLE

5679

FPP0748022XU "合碩"顱顏骨固定系統:正方型骨板,4*2洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,SQUARE,4*2HOLE

6805

FPP0748023XU "合碩"顱顏骨固定系統:正方型骨板,4*4洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,SQUARE,4*2HOLE

10383

FPP0748024XU "合碩"顱顏骨固定系統:正方型骨板,6*4洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,SQUARE,6*4HOLE

11325

FPP0748120XU "合碩"顱顏骨固定系統:矩形骨板,2*2洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,RECTANGULAR,2*2HOLE

3867

FPP0748121XU "合碩"顱顏骨固定系統:矩形骨板3*2洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,RECTANGULAR,3*2HOLE

5679

FPP0748122XU "合碩"顱顏骨固定系統:矩形骨板4*2洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,RECTANGULAR,4*2HOLE

6805

FPP0748123XU "合碩"顱顏骨固定系統:矩形骨板4*4洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,RECTANGULAR,4*4HOLE

10383

FPP0748124XU "合碩"顱顏骨固定系統:矩形骨板6*4洞"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,RECTANGULAR,6*4HOLE

11325

FPP0749020XU "合碩"顱顏骨固定系統:鑽孔蓋型骨板,6洞"CUSMED" CMF

FIXATION SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,BURR HOLE COVER ,6HOLE

5873

FPP074902ZXU "合碩"顱顏骨固定系統:骨板+骨釘BURR HOLE"CUSMED"CMF

FIXATION SYSTEM:CONDUCT.COMBINE CMF BONE PLATE,PURE

TITANIUM,BURR HOLE,SCREW*6

14133

FPP0749120XU "合碩"顱顏骨固定系統:引流鑽孔蓋,骨板,5洞"CUSMED" CMF

FIXATION SYSTEM:COMBINE CMF MICRO BONE PLATE,PURE

TITANIUM,BURR HOLE COVER FOR SHUNT OR DR

5873

FPP0750121XU "合碩"顱顏骨固定系統:骨網圓孔形,骨板"CUSMED"CMF FIXATION

SYSTEM:COMBINE CMF MESH, MICRO BONE PLATE,PURE

TITANIUM,ROUND HOLE

10992

FPP0750221XU "合碩"顱顏骨固定系統:MESH圓形孔"CUSMED"CMF FIXATION

SYSTEM:CONTOUR CMF MESH, PURE TITANIUM,MULTI-ROUND HOLE

10992

FPP0750306S1 CRANIAL PLATE 2:4HOLE ※適應症請見備註欄 2498

FPP075030NS1 MICRO T PLATE 3+4HOLE 0.5:0.8MM※適應症請見備註欄 4430

FPP075031NS1 ORBITAL RIM PLATE 12HOLE 0.4:0.7MM※適應症請見備註欄 3883

FPP0750321XU "合碩"顱顏骨固定系統:MESH菱形孔形"CUSMED"CMF FIXATION

SYSTEM:CONTOUR CMF MESH, PURE TITANIUM,RHOMBUS HOLE

10992

FPP075032NS1 MICRO ADAPTION PLATE 20HOLE 0.4:0.8MM※適應症請見備註欄 4246

FPP075033NS1 MICRO Y PLATE (3+2HOLE) 0.4:0.7MM※適應症請見備註欄 4997

FPP075034NS1 MICRO DOUBLE Y PLATE 6HOLE 0.4:0.7MM※適應症請見備註欄 5560

FPP075035NS1 MICRO BOX PLATE 4HOLE 0.4:0.7MM※適應症請見備註欄 3867

FPP075036NS1 MICRO X PLATE 4HOLE 0.4:0.7MM※適應症請見備註欄 5560

925

特材代碼 中英文名稱 支付點數-104/01/01

FPP075037NS1 MICRO STRUT PLATE 18HOLE 0.4:0.7MM※適應症請見備註欄 10383

FPP075038NS1 MICRO L PLATE 3+2HOLE 0.5:0.8MM※適應症請見備註欄 4085

FPP075039NS1 MICRO L PLATE 3+4HOLE;4+6HOLE 0.5:0.8MM※適應症請見備註欄 4085

FPP07503FNS1 ORBITAL FLOOR MESH PLATE 0.2:0.4MM※適應症請見備註欄 10437

FPP07503HNS1 MICRO H PLATE 11HOLE 0.5:0.8MM※適應症請見備註欄 4633

FPP07503NNS1 ANATOMICAL ORBITAL FLOOR PLATE ※適應症請見備註欄 10437

FPP07503XNS1 UNIVERSAL ORBITAL FLOOR PLATE 0.4:0.5MM※適應症請見備註欄 10437

FPP0750421XU "合碩"顱顏骨固定系統:MESH人孔形"CUSMED" CMF FIXATION

SYSTEM:CONTOUR CMF MESH, PURE TITANIUM,FLEXIBLE

10992

FPP0750521XU "合碩"顱顏骨固定系統:骨網網柵田孔形"CUSMED"CMF FIXATION

SYSTEM:CONTOUR CMF MESH, PURE TITANIUM,GRIDE

10992

FPP0750621XU "合碩"顱顏骨固定系統:MESH等線孔形"CUSMED"CMF FIXATION

SYSTEM:CONTOUR CMF MESH, PURE TITANIUM,ISOGRID

10992

FPP075403NLE ORBITAL FLOOR PLATE※適應症請見備註欄 10437

FPP0760101M4 "MEDTRONIC"INVISX CRANIAL FIXATION SYSTEM"美敦力"茵薇斯顱

骨固定系統※給付規定請見備註欄

4000

FPP077071NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:STRUT PLATES PURE

TITANIUMM 4 HOLES STRAIGHT"信迪思"下顎固定系統:網狀

3867

FPP077081NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:STRUT PLATES PURE

TITANIUM 8 HOLES"信迪思"下顎固定系統:網狀

6805

FPP07801FNS1 PREFORMED ORBITAL PLATE 0.4MM※適應症請見備註欄 10437

FPP0782146EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統:1.6MM

MESH PLATE 40X40MM 90X90MM 36X50MM 74X50MM 111X191MM※適

應症請見備註欄

10992

FPP0788704MC MICRO PLATE 4 HOLE 6.0,4.5MM 0.6MM STR ※適應症請見備註欄 2498

FPP0788706MC MICRO PLATE 6 HOLE 0.6MM STR ※適應症請見備註欄 2672

FPP0788708MC MICRO PLATE 8 HOLE 0.6MM STR ※適應症請見備註欄 2672

FPP0788734MC MICRO PLATE 4HOLE 7.5,9MM 0.6MM STR ※適應症請見備註欄 2498

FPP0788745MC MICRO PLATE 4HOLE 12MM 0.6MM STR ※適應症請見備註欄 2498

FPP0788747MC MICRO PLATE 6HOLE 7.5MM 0.6MM STR ※適應症請見備註欄 2672

FPP0788748MC MICRO PLATE 6HOLE 12MM 0.6MM STR ※適應症請見備註欄 2672

FPP0788750MC MICRO L-PLATE 4HOLE 7.5,9MM 0.6MM LEFT,RIGHT ※適應症請見

備註欄

4085

FPP0788754MC MICRO L-PLATE 6HOLE 12MM 0.6MM LEFT,RIGHT ※適應症請見備

註欄

4085

FPP0788760MC MICRO T-PLATE 4HOLE 7.5,9MM 0.6MM ※適應症請見備註欄 4430

FPP0788764MC MICRO T-PLATE 5HOLE 12MM 0.6MM※適應症請見備註欄 4430

FPP0788765MC TITANIUM MICRO 0.6MM H-PLATE 9HOLE※限顏面骨折患者使用 4633

FPP0788770MC TITANIUM 0.6MM MICRO Y-PLATE 4HOLE 8,12,15MM ※適應症請

見備註欄

4997

FPP0788774MC TITANIUM 0.6MM MICRO DOUBLE Y-PLATE 6,7HOLE ※適應症請見

備註欄

5560

FPP0788780MC TITANIUM MICRO 0.6MM ORBITAL PLATE 6,7HOLE 8,12,15MM※適

應症請見備註欄

3883

FPP0789050MC 0.4MM TITANIUM BURR HOLES PLATE 6:13MM ※適應症請見備註欄 5873

FPP07ASF01AQ A-FLAP CRANIAL FIXATION SYSTEM 艾弗勒顱骨固定系統 ※給付

規定請見備註欄

4000

FPP07FF460S1 "SYNTHES"FLAPFIX SYSTEM:FLAPFIX(PURE TITANIUM)"信迪思"顱

骨固定系統:皮瓣固定夾※給付規定請見備註欄

4000

926

特材代碼 中英文名稱 支付點數-104/01/01

FPP07FF490AE "AESCULAP"CRANIOFIX 2 TITANIUM CLAMP "雅氏"第二代鈦合金頭

骨固定夾※適應症請見備註欄

4000

FPP07FM960AE 0.6MM MICRO PLATE STRAIGHT 2HOLE,4 HOLE※適應症請見備註欄 2498

FPP07FM964AE 0.6MM MICRO Y PLATE 5 HOLE※適應症請見備註欄 4997

FPP07FM965AE 0.6MM MICRO PLATE STRAIGHT 16 HOLE※適應症請見備註欄 4246

FPP07FM966AE 0.6MM MICRO DOUBLE Y PLATE 6 HOLE※適應症請見備註欄 5560

FPP07FM968AE MICRO BOX CAR PLATE 4 HOLE※適應症請見備註欄 3867

FPP07FM969AE 0.6MM MICRO BOX CAR PLATE 6 HOLE※適應症請見備註欄 5679

FPP07FM970AE 0.6MM MICRO BOX CAR PLATE 8 HOLE※適應症請見備註欄 6805

FPP07FM971AE 0.6MM MICRO BURR HOLE COVER PLATE※適應症請見備註欄 5873

FPP07FM973AE "AESCULAP"CRANIOPLATE SYSTEM:0.6MM MICRO MESH,MINIFEN

PLATE"雅氏"顱顏骨釘骨板系統※適應症請見備註欄

10992

FPP07FM990AE "雅氏"顱顏骨釘骨板系統:雙孔骨板3個+骨釘6

個"AESCULAP"CRANIOPLATE SYSTEM(MICRO):2HOLEX3+SCREWX6

15882

FPP07FM991AE "雅氏"顱顏骨釘骨板系統:4孔骨板3個+骨釘12

個"AESCULAP"CRANIOPLATE SYSTEM(MICRO):4HOLEX3+SCREWX12

23826

FPP07FM992AE "雅氏"顱顏骨釘骨板系統:BURR HOLE 1個+雙孔骨板2個+骨釘10

個"AESCULAP"CRANIOPLATE SYSTEM(MICRO):BURR

HOLEX1+2HOLEX2+SCREWX10

24479

FPP07RFS75WR "BIOMET MICROFIXATION"RAPIDFLAP SPIN DOWN SYSTEM "生邁"顱

骨固定夾※給付規定請見備註欄

4000

FPP07SF12FJL 〝JEIL〞SPEEDY FLAP CRANIOPLASTY PLATE 〝偕猷〞顱骨板固定

系統 ※適應症請見備註欄

4000

FPP0903104LE TITANIUM LIGATURE WIRE 0.4MM 30CM ※適應症請見備註欄 120

FPP0903105LE TITANIUM LIGATURE WIRE 0.5MM 30CM ※適應症請見備註欄 120

FPP0903106LE TITANIUM LIGATURE WIRE 0.6MM 30CM ※適應症請見備註欄 120

FPP0909104LE "史賽克雷賓格爾"下頷骨系統迷你骨板6孔;4-12MM;“STRYKER

LEIBINGER” UNIVERSAL MANDIBLE SYSTEM 2.0 MINI CHIN PLATE

6 HOLE 4-12MM

2700

FPP0913511LE CHIN PLATE 4MM ※適應症請見備註欄 2700

FPP0913512LE CHIN PLATE 6MM ※適應症請見備註欄 2700

FPP0913513LE CHIN PLATE 8MM ※適應症請見備註欄 2700

FPP0913514LE CHIN PLATE 10MM ※適應症請見備註欄 2700

FPP0913515LE CHIN PLATE 12MM ※適應症請見備註欄 2700

FPP0913516LE CHIN PLATE 14MM ※適應症請見備註欄 2700

FPP0920185Y2 SKULL TITANIUM WIRE 0.4:0.6MM※適應症請見備註欄 120

FPP094707NS1 TITANIUM MINI CHIN PLATE 2.0 DOUBLE BEND 5 HOLE ※適應症

請見備註欄

2700

FPP0957504M3 TIANIUM CHINPLATE 4HOLE 4:12MM※適應症請見備註欄 2700

FPP1042736W2 TENDON SPACER 3:6MM 2500

FPP1101501FV BONAMATES BIOFIXATION SYSTEM:STR 4 HOLE

1.0X1.5MM,1.2X2.0MM,1.5X2.5MM ※適應症請見備註欄

2498

FPP1101502FV BONAMATES BIOFIXATION SYSTEM:STR 6 HOLE

1.0X1.5MM,1.2X2.0MM,1.5X2.5MM ※適應症請見備註欄

2672

FPP1101503FV BONAMATES BIOFIXATION SYSTEM:C 型 7 HOLE

1.0X1.5MM,1.2X2.0MM ※適應症請見備註欄

3883

FPP1101504FV BONAMATES BIOFIXATION SYSTEM:Y 型 8 HOLE

1.0X1.5MM,1.2X2.0MM ,1.5X2.5MM ※適應症請見備註欄

4997

FPP1101505FV BONAMATES BIOFIXATION SYSTEM:L 型 8/10 HOLE

1.0X1.5MM,1.2X2.0MM ,1.5X2.5MM ※適應症請見備註欄

4085

FPP1101507FV BONAMATES BIOFIXATION SYSTEM:X 型 10 HOLE

1.0X1.5MM,1.2X2.0MM ,1.5X2.5MM ※適應症請見備註欄

5560

927

特材代碼 中英文名稱 支付點數-104/01/01

FPP1101508FV BONAMATES BIOFIXATION SYSTEM:STR 8 HOLE 1.5X2.5MM ※適應

症請見備註欄

2672

FPS0100001EJ "OSTEOMED"FAST-FLAP NEURO FIXATION SYSTEM:1.2MM AUTO-

DRIVE SCREW"歐特美"速固硬式固定系統自攻螺絲※適應症請見備

註欄

1361

FPS0100002EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.3MM

SAFETY SCREW "歐美特"下頷骨折重建系統,2.3MM 安全骨釘

579

FPS0100003EJ "OSTEOMED"FAST-FLAP NEURO FIXATION SYSTEM:1.5MM SAFETY

SCREW"歐特美"速固硬式固定系統安全螺絲※適應症請見備註欄

1361

FPS0100004EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.7MM

SCREW "歐美特"下頷骨折重建系統,2.7MM 骨釘

579

FPS0100005EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.4MM

SCREW "歐美特"下頷骨折重建系統,2.4MM 骨釘

579

FPS0100006EJ "OSTEOMED"FAST-FLAP NEURO FIXATION SYSTEM:1.6MM AUTO-

DRIVE SCREW"歐特美"速固硬式固定系統自攻螺絲※適應症請見備

註欄

1361

FPS0100007EJ "OSTEOMED"FAST-FLAP NEURO FIXATION SYSTEM:1.9MM SAFETY

SCREW"歐特美"速固硬式固定系統安全螺絲※適應症請見備註欄

1361

FPS010000NEJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.0MM

SCREW "歐美特"下頷骨折重建系統,2.0MM 骨釘

298

FPS010071NS1 1.5 MM CORTEX SCREW SELF-TAPPING 4:18 MM ※適應症請見備

註欄

298

FPS0100NNNS1 1.0:1.3 MM MICRO,1.2:1.7 MM EMERGENCY SCREW 2:8MM ※適應

症請見備註欄

1361

FPS010151NS1 2.4 MM,2.0MM CORTEX SCREW SELF-TAPPING 8:18 MM ※適應症

請見備註欄

579

FPS010156NS1 2.7MM EMERGENCY SCREW 8:18MM※適應症請見備註欄 579

FPS0108405LE MINI BONE SCREW 2.0X5MM(型號52-17012:52-82308自 90/07/01

生效)※適應症請見備註欄

298

FPS0108407LE MINI BONE SCREW 2.0x7MM ※適應症請見備註欄 298

FPS0108409LE MINI BONE SCREW 2.0x8MM/9MM ※適應症請見備註欄 298

FPS0108411LE MINI BONE SCREW 2.0x10MM/11MM ※適應症請見備註欄 298

FPS0108413LE MINI BONE SCREW 2.0x12MM/13MM ※適應症請見備註欄 298

FPS0108415LE MINI BONE SCREW 2.0x14MM/15MM ※適應症請見備註欄 298

FPS0108417LE MINI 2.0MM BONE SCREW 17MM ※適應症請見備註欄 298

FPS0108459LE MINI 2.3MM EMERGENCY BONE SCREW 9MM ※適應症請見備註欄 298

FPS0108780LE BRIFGING BONE SCREW 3.5X10MM※適應症請見備註欄 579

FPS0108786LE BRIDGING BONE SCREW (型號5227-375:822,5230-

008:135,5108:5130自92/1/1生效)※適應症請見備註欄

579

FPS0109650LE COMPREDSSION BONE SCREW SELF-TAPPING 2.7x10MM ※適應症請

見備註欄

579

FPS0109652LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x12MM ※適應症請見

備註欄

579

FPS0109654LE BONE SCREW SELF-TAPPING 2.7x14MM ※適應症請見備註欄 579

FPS0109656LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x16MM ※適應症請見

備註欄

579

FPS0109658LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x18MM ※適應症請見

備註欄

579

FPS0109660LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x20MM ※適應症請見

備註欄

579

FPS0109662LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x22MM ※適應症請見

備註欄

579

928

特材代碼 中英文名稱 支付點數-104/01/01

FPS0109664LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x24MM ※適應症請見

備註欄

579

FPS0109666LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x26MM ※適應症請見

備註欄

579

FPS0109668LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x28MM ※適應症請見

備註欄

579

FPS0109670LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x30MM ※適應症請見

備註欄

579

FPS0109674LE COMPRESSION EMERGENCY BONE SCREW 3.2x12MM ※適應症請見備

註欄

579

FPS0109676LE EMERGENCY BONE SCREW 3.2x16MM ※適應症請見備註欄 579

FPS0109678LE COMPRESSION EMERGENCY BONE SCREW 3.2x20MM ※適應症請見備

註欄

579

FPS0109680LE COMPRESSION EMERGENCY BONE SCREW 3.2x24MM ※適應症請見備

註欄

579

FPS01119NNS1 2MM MINI CORTEX 2.4MM,EMERGENCY SCREW SELF-TAPPING ※適應

症請見備註欄

298

FPS0112102LE MICROPLUS BONE SCREW SELF-TAPPING(型號52-10002:81409,59-

14105:14111自90/07/01生效)※適應症請見備註欄

1361

FPS0112104LE MICROPLUS BONE SCREW SELF-TAPPING 1.2x4MM,1.2x5MM ※適應

症請見備註欄

1361

FPS0112106LE MICROPLUS BONE SCREW SELF-TSPPING 1.2x6MM:1.2x12MM ※適應

症請見備註欄

1361

FPS011210NLE “史賽克 雷賓格爾”下頷骨系統骨釘;1.2MM/1.4MM“STRYKER

LEIBINGER” UNIVERSAL MANDIBLE SYSTEM MICRO BONE

SCREW1.2MM/1.4MM

1361

FPS0114103LE MICROPLUS EMERGENCY BONE SCREW SELF-TAPPING 1.4x3MM ※適

應症請見備註欄

1361

FPS0115104LE BONE SCREW 1.5x4MM ※適應症請見備註欄 298

FPS0115105LE LOW PROFILE BONE SCREW 1.5x5MM ※適應症請見備註欄 298

FPS0115106LE LOE PROFILE BONE SCREW 1.5x6MM ※適應症請見備註欄 298

FPS0115107LE LOW PROFILE BONE SCREW 1.5x7MM ※適應症請見備註欄 298

FPS0115108LE LOW PROFILE BONE SCREW 1.5x8MM ※適應症請見備註欄 298

FPS0115109LE LOW PROFILE BONE SCREW 1.5x9MM ※適應症請見備註欄 298

FPS0115110LE LOW PROFILE BONE SCREW 1.5x10MM ※適應症請見備註欄 298

FPS0115111LE BONE SCREW 1.5x11MM ※適應症請見備註欄 298

FPS0115112LE BONE SCREW 1.5x12MM ※適應症請見備註欄 298

FPS0115113LE BONE SCREW 1.5x13MM ※適應症請見備註欄 298

FPS011700NLE MINI BONE SCREW 1.7MM,1.9MM ※適應症請見備註欄 298

FPS0120013M3 TITANIUM LOCK-DRIVE TRANSPLANT SCREW 2.0X7:17MM SELF-

CUTTING※適應症請見備註欄

579

FPS012009NLE TITANIUM FASTENING SCREW FOR TEMPORARY CONDYLAR

PROSTHESES※適應症請見備註欄

579

FPS012017NY2 MICRO BONE SCREW 1.2MM 2:12MM※適應症請見備註欄 1361

FPS0120220EJ M4 RIGID FIXATION SYSTEM 2.0MM SCREW ※適應症請見備註欄 298

FPS012028NY2 MINI BONE SCREW 2.0MM 5:19MM※適應症請見備註欄 298

FPS0120412EJ M4 RIGID FIXATION SYSTEM MICRO SCREW 1.2MM(SCREW 1.2 X 2,

3, 4, 6, 8, 10, 12, 14MM)※適應症請見備註欄

1361

FPS0120415EJ M4 RIGID FIXATION SYSTEM MICRO SAFETY SCREW 1.5MM※適應症

請見備註欄

1361

FPS012042NLE MINI SCREW 2.0:2.7MM※適應症請見備註欄 579

FPS012053NY2 COMPRESSION BONE SCREW 2.7,3.2MM※適應症請見備註欄 579

929

特材代碼 中英文名稱 支付點數-104/01/01

FPS0120624EJ M4 RIGID FIXATION SYSTEM 2.4MM MAXI FRACTURE SCREW ※適應

症請見備註欄

579

FPS0120641Y2 MANDIBULAR BONE SCREW 3.5MM 10:20MM※適應症請見備註欄 579

FPS0120704LE “史賽克 雷賓格爾”下頷骨系統骨釘 2.0MM“STRYKER

LEIBINGER” UNIVERSAL MANDIBLE SYSTEM 2.0 MM BONE SCREW

298

FPS0121112EJ M4 RIGID FIXATION SYSTEM:AUTO-DRIVE SCREW※適應症請見備

註欄

1361

FPS0121120EJ M4 RIGID FIXATION SYSTEM 2.0 MM SCREW ※適應症請見備註欄 298

FPS01291BSY2 "SYNTEC"TITANIUM MESH PLATE:SCREW "亞太醫療"鈦合金網眼骨

板:骨釘※給付規定請見備註欄

1361

FPS013015AXU "合碩"顱顏骨固定系統:骨釘,自鑽"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF,BONE SCREW,SELF-DRILLING, TITANIUM

ALLOY

1361

FPS013015FXU "合碩"顱顏骨固定系統:骨釘,自鑽"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF,BONE SCREW,SELF-DRILLING, TITANIUM

ALLOY

1361

FPS013015LXU "合碩"顱顏骨固定系統:骨釘,自鑽"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF MINI BONE SCREW,SELF-DRILLING,

TITANIUM ALLOY

298

FPS013015TXU "合碩"顱顏骨固定系統:骨釘,自鑽"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF BONE SCREW,SELF-DRILLING, TITANIUM

ALLOY

579

FPS01301BSY2 "SYNTEC"TITANIUM MESH PLATE:SCREW "亞太醫療"鈦合金網眼骨

板:骨釘※給付規定請見備註欄

1361

FPS013025CXU "合碩"顱顏骨固定系統:骨釘,應急自鑽"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF BONE SCREW,EMERGENCY,SELF-DRILLING,

TITANIUM ALLOY

1361

FPS013025EXU "合碩"顱顏骨固定系統:骨釘,應急自鑽"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF MICRO BONE SCREW,EMERGENCY,SELF-

DRILLING, TITANIUM ALLOY

1361

FPS013025PXU "合碩"顱顏骨固定系統:骨釘,應急自鑽"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF MICRO BONE SCREW,EMERGENCY,SELF-

DRILLING, TITANIUM ALLOY

298

FPS013025WXU "合碩"顱顏骨固定系統:骨釘,應急自鑽"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF BONE SCREW,EMERGENCY,SELF-DRILLING,

TITANIUM ALLOY

579

FPS013115AXU "合碩"顱顏骨固定系統:骨釘,自攻"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF,BONE SCREW,SELF-TAPPING, TITANIUM

ALLOY

1361

FPS013115CXU "合碩"顱顏骨固定系統:骨釘,應急自攻"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF,BONE SCREW,EMERGENCY SELF-TAPPING,

TITANIUM ALLOY

1361

FPS013115FXU "合碩"顱顏骨固定系統:骨釘,自攻"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF,BONE SCREW,SELF-TAPPING, TITANIUM

ALLOY

1361

FPS013115LXU "合碩"顱顏骨固定系統:骨釘,自攻"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF,BONE SCREW,SELF-TAPPING, TITANIUM

ALLOY

298

FPS013115TXU "合碩"顱顏骨固定系統:骨釘,自攻"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF,BONE SCREW,SELF-TAPPING, TITANIUM

ALLOY

579

FPS01311STY2 "SYNTEC"TITANIUM MESH PLATE:SCREW "亞太醫療"鈦合金網眼骨

板:骨釘※給付規定請見備註欄

1361

930

特材代碼 中英文名稱 支付點數-104/01/01

FPS013125EXU "合碩"顱顏骨固定系統:骨釘,應急自攻"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF,BONE SCREW,EMERGENCY,SELF-TAPPING,

TITANIUM ALLOY

1361

FPS013125PXU "合碩"顱顏骨固定系統:骨釘,應急自攻"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF,BONE SCREW,EMERGENCY,SELF-TAPPING,

TITANIUM ALLOY

298

FPS013125WXU "合碩"顱顏骨固定系統:骨釘,應急自攻"CUSMED"CMF FIXATION

SYSTEM:CONDUCT CMF,BONE SCREW,EMERGENCY,SELF-TAPPING,

TITANIUM ALLOY

579

FPS014009SM3 TITANIUM CONDYLAR PROTHESIS FIXATION SCREW※適應症請見備

註欄

579

FPS014051NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:SCREWS,SELF-TAPPING SCREW

2.0-2.4MM 5-18MM"信迪思"下顎固定系統:骨釘

579

FPS014651NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:EMERGENCY SELF-TAPPING

SCREW 2.7, 5-18MM"信迪思"下顎固定系統:骨釘

579

FPS014668NS1 2.4MM UNILOCK SCREW 自攻牙鎖定骨釘※適應症請見備註欄 579

FPS01503CNS1 "SYNTHES"MATRIX MIDFACE SYSTEM:1.5MM SELF-TAPPING MICRO

SCREW 3:12MM"信迪思"中顏面固定系統:固定螺釘 ※適應症請見

備註欄

1361

FPS01503DNS1 "SYNTHES"MATRIX MIDFACE SYSTEM:1.5MM SELF-DRILLING MICRO

SCREW 3:8MM "信迪思"中顏面固定系統:固定螺釘※適應症請見備

註欄

1361

FPS01503ENS1 "SYNTHES"MATRIX MIDFACE SYSTEM:1.8MM EMERGENCY MICRO

SCREW 3:12MM"信迪思"中顏面固定系統:固定螺釘 ※適應症請見

備註欄

1361

FPS015223NLE MANDIBULAR SCREW 2.3MM 6:22MM※適應症請見備註欄 579

FPS015227NLE MANDIBULAR SCREW 2.7MM 6:22MM※適應症請見備註欄 579

FPS0152306M3 MRS TITANIUM SCREW※適應症請見備註欄 579

FPS016051NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:LOCK SCREWS SELF-TAPPING

2.0-2.4MM"信迪思"下顎固定系統:骨釘

579

FPS016681NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:LOCK SCREWS SELF-TAPPING

2.9 MM"信迪思"下顎固定系統:骨釘

579

FPS017020NM3 MONDEAL TITANIUM 1.2MM MICRO LOCK DRIVE SCREW

2:8MM,1.5MMX4:6MM※適應症請見備註欄

1361

FPS01702NNM3 TITANIUM 1.2MM MICRO LOCK DRIVE SCREW ※適應症請見備註欄 1361

FPS0172005M3 TITANIUM 2.0MM MINI STANDARD SCREW 5MM:19MM ※適應症請見

備註欄

298

FPS0172007M3 TITANIUM 2.0MM MINI LOCK-DRIVE SCREW 5MM:19MM ※適應症請

見備註欄

298

FPS0172305M3 TITANIUM 2.3MM MINI EMERGENCY SCREW 5MM:9MM ※適應症請見

備註欄

298

FPS0172307M3 TITANIUM 2.3MM MINI EMERGENCY LOCK-DRIVE SCREW 5MM:9MM ※

適應症請見備註欄

298

FPS018020NM3 MONDEAL TITANIUM 1.2MM MICRO CROSS FIT SCREW

2:8MM,1.5X4:6MM※適應症請見備註欄

1361

FPS0182004M3 CROSS-FIT,LOCK-DRIVE SCREW 2.0 4MM ※適應症請見備註欄 298

FPS0182005M3 TITANIUM 2.0MM MINI CROSS-FIT SCREW 5MM:19MM ※適應症請見

備註欄

298

FPS0182305M3 TITANIUM 2.3MM MINI EMERGENCY CROSS-FIT SCREW 5MM:9MM ※

適應症請見備註欄

298

FPS0182716M3 TITANIUM LOCK-DRIVE SCREW 2.7X8:22MM SELF-CUTTING※適應症

請見備註欄

579

931

特材代碼 中英文名稱 支付點數-104/01/01

FPS0183012M3 TITANIUM LOCK-DRIVE EMERGENCY SCREW 3.0X8:14MM SELF-

CUTTING※適應症請見備註欄

579

FPS0187505MC TITANIUM 2MM MINI SCREW 5.5MM ※適應症請見備註欄 298

FPS0187507MC TITANIUM 2MM MINI SCREW 7MM ※適應症請見備註欄 298

FPS0187509MC TITANIUM 2MM MINI SCREW 9MM ※適應症請見備註欄 298

FPS0187511MC TITANIUM 2MM MINI SCREW 11MM ※適應症請見備註欄 298

FPS0187513MC "MEDICON"TITANIUM 2MM MINI SCREW 13MM 鈦金屬顏面骨板系統:

迷你骨釘 ※適應症請見備註欄

298

FPS0188303MC MICRO SCREW 3.5X1.5MM ※適應症請見備註欄 1361

FPS0188305MC MICRO SCREW 5X1.5MM ※適應症請見備註欄 1361

FPS0188307MC MICRO SCREW 7X1.5MM ※適應症請見備註欄 1361

FPS0188309MC MICRO SCREW 9X1.5MM ※適應症請見備註欄 1361

FPS0188311MC MICRO SCREW 11X1.5MM ※適應症請見備註欄 1361

FPS0188313MC TITANIUM 1.5MM MICRO SCREW 13,15,16,17MM※適應症請見備註

1361

FPS0188334MC MICRO EMERGENCY SCREW 4X1.9MM ※適應症請見備註欄 1361

FPS0188339MC MICRO EMERGENCY SCREW 9X1.9MM ※適應症請見備註欄 1361

FPS0189520MC "MEDICON"TITANIUM MANDIBULAR RECONSTRUCTION SCREWS

2.7X7MM 鈦金屬顏面骨板系統:下顎骨釘※適應症請見備註欄

579

FPS0189521MC TITANIUM SCREWS 2.7X9MM ※適應症請見備註欄 579

FPS0189522MC TITANIUM SCREWS 2.7X11MM ※適應症請見備註欄 579

FPS0189523MC TITANIUM SCREWS 2.7X13MM ※適應症請見備註欄 579

FPS0189524MC TITANIUM SCREWS 2.7X15MM ※適應症請見備註欄 579

FPS0189525MC TITANIUM SCREWS 2.7X17MM ※適應症請見備註欄 579

FPS0189527MC TITANIUM SCREWS 2.7X21MM ※適應症請見備註欄 579

FPS0189531MC TITANIUM EMERGENCY SCREWS 3.2X9MM ※適應症請見備註欄 579

FPS0192004M3 NEWS S-DRIVE SELF-DRILLING SCREW(MINI 2000)※適應症請見備

註欄

298

FPS01FM940AE "AESCULAP"CRANIO PLATE SYSTEM:MICRO SCREW"雅式"顱顏骨釘骨

板系統:骨釘※適應症請見備註欄

1361

FPS0201N2NS1 2.0,2.4,2.7MM CORTEX SCREW 20:28MM ※適應症請見備註欄 749

FPS0201N3NS1 2.0,2.4,2.7MM CORTEX SCREW 30:40MM ※適應症請見備註欄 749

FPS1150400FV BONAMATES BIOFIXATION SYSTEM:SCREW 1.5X4.0~2.5X25MM(單支

包裝) ※適應症請見備註欄

1361

FPS1150401FV BONAMATES BIOFIXATION SYSTEM:SCREW 1.5X4.0~2.5X25MM(2支/

包) ※適應症請見備註欄

2722

FPS1150402FV BONAMATES BIOFIXATION SYSTEM:SCREW 1.5X4.0~2.5X25MM(4支/

包) ※適應症請見備註欄

5444

FPT0120789L0 "SILIMED"TISSUE EXPANDER "賜妳媚"組織擴張器※給付規定請見

備註欄

11500

FPT0135054NW "MENTOR"TISSUE EXPANDER"曼陀"組織擴張器 11500

FPT01SC088A2 "ALLERGAN" TISSUE EXPANDERS"愛力根"組織擴張器※適應症請見

備註欄

11500

FSAE171000SB TRACHEOBRONCHIAL WALLSTENT UNISTEP DELIVERY SYS. STENT5:

24*20:90MM適應症見備註M001711-000:390

32122

FSAE1GTBXXQS "博娜" 氣管及支氣管支架"BONASTENT" TRACHEAL/BRONCHIAL

STENT*適應症請見備註欄

32122

FSAE1GTBXXSB "BOSTON SCIENTIFIC"ULTRAFLEX TRACHEOBRONCHIAL STENT

SYSTEM歐超福雷斯氣管和支氣管支架系統*適應症請見備註欄

32122

FSAE1TBRXXWH "TAEWOONG"NITI-S TRACHEOBRONCHIAL STENT"泰悟"氣管支氣管支

架(含支架系統)*給付規定請見備註欄

32122

FSP6201127DV "DAVOL"BARD MESH PERFIX PLUG"德柏"巴德修補網:珀菲斯塞子

(高/直徑1"/1.35"、1.3"/1.55"、1.6"/1.9"、1.6"/2.0")

3800

932

特材代碼 中英文名稱 支付點數-104/01/01

FSP62P3DPAET "ETHICON"PROLENE(POLYPROPYLENE)3D PATCH"愛惜康"伯羅倫3D修

補網

3800

FSP62TECRTZQ "SOFRADIM"PARIETEX MESHES-PLUGS"舒法定"帕瑞得人工編網-立

體錐形塞編網

3800

FSP7103657AM "AMS"SPARC SLING SYSTEM懸吊手術系統(兩支不銹鋼彎曲弓狀穿

引針(不需再使用INTRODUCER)+一條聚丙烯懸帶)

13680

FSP7103831AM "AMS"MONARC SUBFACIAL HAMMOCK懸吊手術系統(兩支不銹鋼彎曲

弓狀穿引針(不需再使用INTRODUCER)+一條聚丙烯懸帶)

13680

FSP710BTRXSB "BOSTON SCIENTIFIC"OBTRYX SYSTEM"波士頓科技"歐碧翠系統(2

個輸送裝置+1個網狀結構)

13680

FSP7181004ET "ETHICON"TENSION-FREE VAGINAL TAPE(TVT)DEVICE 含

INTRODUCER 及RIGID CATHETER GUIDE

13680

FSP71ADVANSB "波士頓科技"艾凡極網片系統(1個輸送裝置+1個網狀結

構)"BOSTON SCIENTIFIC"ADVANTAGE SYSTEM

13680

FSP71BRD16BA "BARD"ALIGN URETHRAL SUPPORT SYSTEM(含INTRODUCER+MESH

ASSEMBLY)艾萊尿道支撐系統

13680

FSP71TVT0MYM GYNECARE TVT ABBREVO CONTINENCE SYSTEM蓋那客尿失禁手術用

懸吊帶愛不漏系統(含放置環、螺旋型導針、無創帶翼導引器)

13680

FSP71TVTRLYM "GYNECARE"TVTEXACT CONTINENCE SYSTEM"蓋那客"尿失禁手術用

懸吊帶依捷特系統(含放置環、螺旋型導針、無創帶翼導引器)

13680

FUK02CA101NV EXTRACORPOREAL TUBING SET(CAVH TUBING SET) 730

FUK02TS013FN 英弗梅體外血液迴路管-連續性動靜脈血液濾過套組 INFOMED

EXTRACORPOREAL BLOOD CIRCUIT-CONTINUOUS ARTERIO-VENOUS

HEMOFILTRATION,CAVH

730

FUK030300CGA ADSORBA 300GM 9982

FUK03300KTGA "GAMBRO"PRISMAFLEX ADSORBA 300KIT "衛寶"吸附器套組(灌注器

+體外血液迴路管)

11342

FUK03TS205FN INFOMED EXTRACORPOREAL BLOOD CIRCUITS-HEMOPERFUSION英弗梅

體外血液迴路管-血液灌流

1274

FUK03TS206FN INFOMED EXTRACORPOREAL BLOOD CIRCUITS-PEDIATRIC

HEMOPERFUSION英弗梅體外血液迴路管-小兒血液灌流

1274

FUK03TS407FN INFOMED EXTRACORPOREAL BLOOD CIRCUITS-HEMOPERFUSION英弗梅

體外血液迴路管-血液灌流

1274

FUK03TS408FN INFOMED EXTRACORPOREAL BLOOD CIRCUITS-PEDIATRIC

HEMOPERFUSION英弗梅體外血液迴路管-小兒血液灌流

1274

FUK0500M60GA PRISMA SET(CVVH TUBING+HEMOFILTER)膜面積0.6M平方,連續式血

液透析器及迴路套管*適應症請見備註欄

4579

FUK0501000GA PRISMAFLEX SET(CVVH TUBING+HEMOFILTER)膜面積1.1M平方*適應

症請見備註欄

5102

FUK0501400GA PRISMAFLEX SET(CVVH TUBING+HEMOFILTER)膜面積1.4M平方*適應

症請見備註欄

5102

FUK050M100GA PRISMA SET(CVVH TUBING+HEMOFILTER)膜面積0.9M平方,連續式血

液透析器及迴路套管*適應症請見備註欄

5102

FUK05DF080FN "INFOMED"CVVH HEMOFILTER 0.8M平方血液過濾器*適應症請見備

註欄

3596

FUK05DF140FN "INFOMED"CVVH HEMOFILTER 1.4M平方血液過濾器*適應症請見備

註欄

4002

FUK05DF190FN "INFOMED"CVVH HEMOFILTER 1.9M平方血液過濾器*適應症請見備

註欄

4002

FUK05F0M60GA PRISMAFLEX SET(CVVH TUBING+HEMOFILTER)0.6M平方*適應症請見

備註欄

4579

933

特材代碼 中英文名稱 支付點數-104/01/01

FUK05FM100GA PRISMAFLEX SET(CVVH TUBING+HEMOFILTER)0.9M平方*適應症請見

備註欄

5102

FUK05FM150GA "GAMBRO"PRISMAFLEX SET(CVVH TUBING+HEMOFILTER膜面積1.5M平

方)普利司馬弗列克斯套組*適應症請見備註欄

5102

FUK05HD200E9 CVVH HEMOFILTER*適應症請見備註欄 3596

FUK05HD300E9 CVVH HEMOFILTER*適應症請見備註欄 4002

FUK05PF150GA "GAMBRO"PRISMAFLEX SET*適應症請見備註欄 5102

FUK05PFXSTGA "GAMBRO"PRISMAFLEX SET(CVVH TUBING+HEMOFILTER)膜面積1M平

方*適應症請見備註欄.

5102

FUK05PR100GA "GAMBRO"PRISMA SET (CVVH TUBING+HEMOFILTER)1.15M平方*適應

症請見備註欄

5102

FUK05PST60GA "GAMBRO"PRISMAFLEX SET(CVVH TUBING+HEMOFILTER)膜面積0.6M

平方*適應症請見備註欄.

4579

FUK05RHF6SGA "GAMBRO"CVVH HEMOFILTER(0.6M平方)血液過濾器*適應症請見備

註欄

3596

FUK05ST100GA "GAMBRO"PRISMA SET(CVVH TUBING+HEMOFILTER)膜面積1.0M平方

連續式血液透析器及迴路管套*適應症請見備註欄

5102

FUK05ST60PGA "GAMBRO"PRISMA SET連續式血液透析器及迴路管套*適應症請見備

註欄

4579

FUK05TS200FN INFOMED EXTRACORPOREAL BLOOD CIRCUITS FOR CF200- CVVH英弗

梅體外血液迴路管*適應症請見備註欄

1393

FUK05TS201K5 HEMOSCIEN EXTRACORPOREAL BLOOD CIRCUITS-CVVH英禾美體外血

液迴路管-血液濾過

1393

FUK05TS400FN INFOMED EXTRACORPOREAL BLOOD CIRCUITS-CVVH英弗梅體外血液

迴路管*適應症請見備註欄

1393

FUK05TS403K5 HEMOSCIEN EXTRACORPOREAL BLOOD CIRCUIT-CONTINUOUS VENO-

VENOUS HEMOFILTRATION (CVVH)HF400/HF440用英禾美體外血液迴

路管-血液濾過

1393

FUK05U1000FA "FRESENIUS"POLYSULFONE HAEMOFILTERS(CVVH FILTER 1.8M平方

)人工合成膜血液過濾器*適應症請見備註欄

4002

FUK05U400SFA "FRESENIUS"POLYSULFONE HAEMOFILTERS(CVVH FILTER 0.7M平方)

人工合成膜血液過濾器*適應症請見備註欄

3596

FUK05U600SFA "FRESENIUS"POLYSULFONE HAEMOFILTERS(CVVH FILTER 1.4M平方)

人工合成膜血液過濾器*適應症請見備註欄

4002

FUS0100411AM "AMS"800 URINARY CONTROL SYSTEM(CONTROL PUMP+PRESSURE-

REGULATING BALLOON+BELT CUFFS+800 ACCESSORY KIT)"艾梅斯"

尿控系統*給付規定請見備註欄

155000

HEF0146092H9 "華億"體外循環管組"HYM"HEART LUNG PACK-ARTERIAL FILTER

3/8" ADULT 20 MICRO

1573

HEF0146093H9 HEART LUNG PACK:ARTERIAL FILTER WITH HEPARIN

COATING(ADULT;PEDIATRIC;INFANT)*體外循環120分以上用

1716

HEF0146163GJ “吉生”體外循環管組-動脈過濾器”JSM” HEART LUNG PACK-

ARTERIAL FILTER

1573

HEF0146247GJ “吉生”體外循環管組-PHISIO塗層動脈過濾器”JSM” HEART

LUNG PACK-ARTERIAL FILTER WITH PHISIO COATING

1716

HEF01ARF40H9 "華億" 體外循環管組-動脈過濾器"HYM" HEART LUNGPACK-

ARTERIAL FILTER 40MICRO

1573

HEF02A3510M4 AFFINITY ARTERIAL FILTER 1573

HEF02AF001TM ARTERY FILTER ADULT 1573

HEF02AF002TM ARTERY FILTER PEDIATRIC 1573

HEF02AF125TM CAPIOX ARTERIAL FILTER 1573

HEF02E3840P3 EXTRA CORTOREAL FILTER 體外循環血液過濾器(開心用) 1573

HEF02HBF14QM "邁柯唯"動脈過濾器"MAQUET" QUART ARTERIAL FILTER 1573

934

特材代碼 中英文名稱 支付點數-104/01/01

HEF02S4104M4 "美敦力" 艾芬你堤兒童動脈過濾器 "MEDTRONIC"AFFINITY

PEDIATRIC ARTERIAL FILTER

1573

HEF030P005AS "旭"血漿分離器"ASAHI"PLASMAFLO 4296

HEF030P008AS "旭"血漿分離器"ASAHI"PLASMAFLO(PLASMA FILTER) 4296

HEF032011NF5 MJ BLOOD LINE SET FOR BLOOD PURIFICATION邁捷血液淨化迴路

導管

1358

HEF03EC030AS "旭" 血漿成分分離器"ASAHI" CASCADEFLO EC PLASMA COMPONENT

SEPARATOR

4296

HEF03EVACLKA "川澄化工"膜型血漿分離器"KAWASUMI LABORATORIES" PLASMA

SEPARATOR EVACLIO

4296

HEF03EVAFLKA EVAFLUX 血液成份分離器加血液迴路管組 6000

HEF03EVAFXKA "川澄化工" 血漿成分分離器"KAWASUMI LABORATORIES" PLASMA

FRACTIONATOR EVAFLUX

4296

HEF03HD400E9 雙重濾過血液濾過器HEMOFILTER 6000

HEF03HD500E9 雙重濾過血液濾過器HEMOFILTER 6000

HEF03KPE88KA "KAWASUMI LABORATORIES" BLOOD TUBING LINE FOR PLASMA

EXCHANGE "川澄化工"血漿交換用血液迴路導管

1430

HEF03LF030FN "英弗梅"血漿過濾器"INFOMED"PLASMAFILTER 4296

HEF03LF050FN "英弗梅"血漿過濾器"INFOMED"PLASMAFILTER 4296

HEF03LF070FN "英弗梅"血漿過濾器"INFOMED"PLASMAFILTER 4296

HEF03P1DRYFA "費森尤斯"血漿過濾器"FRESENIUS" PLASMAFILTER 4296

HEF03PLA20E9 MEDICA PLASMAFILTERS 0.15平方公尺 4296

HEF03PLA40E9 MEDICA PLASMAFILTERS 0.35平方公尺 4296

HEF03PLA60E9 MEDICA PLASMAFILTERS 0.55平方公尺 4296

HEF03PRFPEGA "GAMBRO"PRISMAFLEX SET血漿透析器及血液迴路管 6000

HEF03PRLPEGA "GAMBRO"PRISMAFLEX SET 血液透析器及迴路管套 6000

HEF03PRTPEGA "GAMBRO"PRISMA SET 連續式血液透析器及迴路管套 6000

HEF03PS08SKA 川澄化工血漿分離器KAWASUMI LABORATORIES PLASMACURE PE

PLASMA SEPARATOR

4296

HEF03TS203FN 英弗梅體外血液迴路管INFOMED EXTRACORPOREAL BLOOD

CIRCUITS(FOR CF200 PLASMA EXCHANGE)

1430

HEF03TS203K5 HEMOSCIEN EXTRACORPOREAL BLOOD CIRCUIT FOR CF200-PLASMA

EXCHANGE 英禾美CF200用體外血液迴路管-血漿置換

1430

HEF03TS204FN 英弗梅體外血液迴路管INFOMED EXTRACORPOREAL BLOOD

CIRCUITS(FOR CF200-PEDIATRIC PLASMA EXCHANGE)

1430

HEF03TS204K5 HEMOSCIEN EXTRACORPOREAL BLOOD CIRCUIT FOR CF200-

PEDIATRIC PLASMA EXCHANGE 英禾美CF200用體外血液迴路管-小

兒血漿置換

1430

HEF03TS401FN 英弗梅體外血液迴路管INFOMED EXTRACORPOREAL BLOOD CIRCUITS 1358

HEF03TS401K5 HEMOSCIEN EXTRACORPOREAL BLOOD CIRCUIT-DOUBLE FILTRATION

HF400/HF440用英禾美體外血液迴路管-雙重濾過

1358

HEF03TS402K5 HEMOSCIEN EXTRACORPOREAL BLOOD CIRCUIT-PLASMA EXCHANGE體

外血液迴路管-血漿置換

1430

HEF03TS406K5 HEMOSCIEN EXTRACORPOREAL BLOOD CIRCUIT-PEDIATRIC PLASMA

EXCHANGE英禾美體外血液迴路管-小兒血漿置換

1430

HEF03TSP02FN 英弗梅體外血液迴路管INFOMED EXTRACORPOREAL BLOOD

CIRCUITS(FOR PLASMA EXCHANGE)

1430

HEF03TSP06FN 英弗梅體外血液迴路管INFOMED EXTRACORPOREAL BLOOD

CIRCUITS(PEDIATRIC PLASMA EXCHANGE)

1430

HEF05CPS02P3 PALL EXTRACORPOREAL CIRCUIT FILTER*適應症請見備註欄 722

HEF05VBT16QM "邁柯唯" 氣泡過濾器 "MAQUET" VENOUS BUBBLE TRAP 722

HEF060BC1BP3 PALL EXTRACORPOREAL CIRCUIT FILTER ※限開心手術使用於

BLOOD CARDIOPIEGIA SOLUTION 時申報

2735

935

特材代碼 中英文名稱 支付點數-104/01/01

HEH01511SLTM HEMOCONCENTRATOR W/HEMODIALYSIS OR HEMOCARE TUBING SET※

適應症請見備註欄

4118

HEH01HF53TFA "比孚"血液濃縮器"B.V."HEMOCONCENTRATORS(WITH TUBING)*適應

症請見備註欄

4118

HEH01HPHJUMY “美狄菲特”血液濃縮器“MEDIVATORS”Hemocor

Hemoconcentrator(小兒使用)*適應症請見備註欄

3300

HEH01HPHTSMY “美狄菲特”血液濃縮器“MEDIVATORS”Hemocor

Hemoconcentrator*適應症請見備註欄

4118

HFF0209930BB STERIFIX INFUSION FILTER 00.2UM(T.P.N) 68.3

HFF02C8363BT TPN 0.22 MICRO FILTER 68.3

HFF02E25YFLL TPN FILTER W/EXTENSION TUBE 68.3

HFF02EF010SG TPN FILTER SET 0.22UM 68.3

HFF02EF15YSG TPN FILTER SET 0.22UM 68.3

HHF01H4R70KW “芬沃”白血球過濾器“FENWAL”SEPACELL PLATELET AND

PLASMA COLLECTOR*給付規定請見備註欄

1162

HHF01P1ASDTM LEUKOCYTE REMOVAL FILTER IMUGARD III-PL*適應症請見備註欄 1162

HHF01P214YTM LEUKOCYTE REMOVAL FILTER IMUGARD III-PL 12UNIT Y TYPE※適

應症請見備註欄

1162

HHF01PL110WX "雙威" 單次使用濾除白血球過濾器(血小板用)"SHUANGWEI"

LEUKOCYTE REDUCTION FILTER FOR BLOOD

1162

HHF01PL210WX "雙威" 單次使用濾除白血球過濾器(血小板用)"SHUANGWEI"

LEUKOCYTE REDUCTION FILTER FOR BLOOD

1162

HHF01PL310WX "雙威" 單次使用濾除白血球過濾器(血小板用)"SHUANGWEI"

LEUKOCYTE REDUCTION FILTER FOR BLOOD

1162

HHF01PPBBFFA LENKOCYTE REMOVAL FILTER FOR PLATELET CONCENTRATES*適應症

請見備註欄

1162

HHF01PPBSFFA LENKOCYTE REMOVAL FILTER FOR PLATELET CONCENTRATES*適應症

請見備註欄

1162

HHF01PXL8YP3 LEUKOCYTE REMOVAL FILTER FOR PLATELATE ※適應症請見備註欄 1162

HHF01R0250JH 笙創白血球過濾器SAFETRAN LEUKOCYTE REDUCTION FILTER/紅血

球濃厚液 1UNIT*給付規定請見備註欄

487

HHF02H4RBCKW “芬沃”白血球過濾器“FENWAL”SEPACELL LEUKOCYTE

REDUCTION SET(2UNIT RED BLOOD CELL)*給付規定請見備註欄

778

HHF02R0500JH 笙創白血球過濾器SAFETRAN LEUKOCYTE REDUCTION FILTER/紅血

球濃厚液 2UNIT*給付規定請見備註欄

778

HHF02R204YTM LEUKOCYTE REMOVAL FILTER IMUGARD III-RC 500CC Y TYPE※適

應症請見備註欄

487

HHF02R602ETM IMUGARD III-RC LEUKOCYTE REMOVAL FILTER*適應症請見備註欄 487

HHF02RC101WX "雙威" 單次使用濾除白血球過濾器(全血及紅血球

用)"SHUANGWEI" LEUKOCYTE REDUCTION FILTER FOR

BLOOD(500CC)

487

HHF02RC102WX "雙威" 單次使用濾除白血球過濾器(全血及紅血球

用)"SHUANGWEI" LEUKOCYTE REDUCTION FILTER FOR

BLOOD(1000CC)

778

HHF02RC201WX "雙威" 單次使用濾除白血球過濾器(全血及紅血球

用)"SHUANGWEI" LEUKOCYTE REDUCTION FILTER FOR

BLOOD(500CC)

487

HHF02RC202WX "雙威" 單次使用濾除白血球過濾器(全血及紅血球

用)"SHUANGWEI" LEUKOCYTE REDUCTION FILTER FOR

BLOOD(1000CC)

778

HHF02RCL1YP3 LEUKOCYTE REMOVAL FILTER FOR RBC ※適應症請見備註欄 487

936

特材代碼 中英文名稱 支付點數-104/01/01

HHF02RPBBFFA LENKOCYTE REMOVAL FILTER FOR RED CELL CONCENTRATES*適應症

請見備註欄

487

HHF02RPBSFFA LENKOCYTE REMOVAL FILTER FOR RED CELL CONCENTRATES*適應症

請見備註欄

487

HHF02T1000JH 笙創白血球過濾器SAFETRAN LEUKOCYTE REDUCTION FILTER/血小

板用12U*給付規定請見備註欄

1162

HHM010040SP3 BLOOD TRANSFUSION FILTER 40UM 1500CC 305

HHM0103048WU “優樂”高佳輸血過濾器“EUROSETS” GOCCIA BLOOD FILTER 305

HHM0104435BB "柏朗"永久性腔靜脈過濾器"B.BRAUN" VENATECH LP PERMANENT

VENA CAVA FILTER(含PUNCTURE KIT,GUIDE WIRE,FILTER

INTRODUCER,DILATOR,FILTER,SHEATH)

33528

HHM0110940MH “美樂得”第二代快取血栓清除導管“MEDRAD”FETCH 2

ASPIRATION CATHETER*給付規定請見備註欄

14123

HHM0111649AB "亞培"阿克奈防血塊栓塞保護系統"ABBOTT" RX ACCUNET EMBOLIC

PROTECTION SYSTEM*適應症請見備註欄

33371

HHM012120FN6 "奈堤諾" 希門氏血栓過濾器組"NMT"SIMON NITINOL FILTER SET

含INTRODUCER CATH. WITH FILTER、GUIDEWIRE、ENTRY NEEDLE

33528

HHM01445TWSB FILTER WIRE EX SYETEM L 190CM,300CM*適應症請見備註欄 33371

HHM01466F2CD “考迪斯” 歐特易可回收血栓過濾網“CORDIS” OPTEASE

RETRIEVABLE VENA CAVA FILTER

33528

HHM01466XNCD TRAPEASE PERMANENT VENA CAVA FILTER AND INTRODUCTION KIT 33528

HHM01500TWSB GREENFIELD VENA CAVA FILTER

SET(INTRODUCER+FILTER+SHEATH/DILATOR+ADAPTER)

33528

HHM0150300SB GREENFIELD VENA CAVA FILTER

SYSTEM(INTRODUCER+FILTER+SHEATH/DILATOR+ADAPTER)

33528

HHM0150301SB GREENFIELD VENA CAVA FILTER

SYSTEM(INTRODUCER+FILTER+SHEATH/DILATOR+ADAPTER)

33528

HHM0181550VS “法斯樂舒順”普倫特血栓清除導管“VASCULAR SOLUTIONS”

PRONTO V3 EXTRACTION CATHETER*給付規定請見備註欄

14123

HHM0192010SB FILTERWIRE EMBOLIC PROTECTION SYSTEM L190CM,300CM*適應症

請見備註欄

33371

HHM01AEGSYJQ "先健" 腔靜脈過濾器 "LIFETECH" AEGISY VENA CAVA FILTER

SYSTEM(INTRODUCER CATH WITH FILTER,SHEATH/DILATOR)

33528

HHM01ANGRXCD "考迪斯"安琪歐卡爾德栓塞捕捉導引線系統"CORDIS"ANGIOGUARD

RX EMBOLIC CAPTURE GUIDEWIRE SYSTEM*適應症請見備註欄

33371

HHM01CELE1CK "曲克" 色列克特腔靜脈濾器組"COOK" CELECT VENA CAVA FILTER

SET

33528

HHM01CELECCK "曲克"色列克特腔靜脈濾器"COOK" CELECT VENA CAVA FILTER 33528

HHM01DVMAXF2 "英泰克" 戴芙血栓清除導管加大型"INVATEC" DIVER CE MAX

CLOT EXTRACTIOM CATHETER

14123

HHM01ELNATTM “泰爾茂”艾密麗血栓清除導管“TERUMO” ELIMINATE

ASPIRATION CATHETER*適應症請見備註欄

14123

HHM01ENAV6AB "亞培" 第六代血栓防護盾系統 "ABBOTT" EMBOSHIELD NAV6

EMBOLIC PROTECTION SYSTEM(FILTRATION SYSTEM & RX

RETRIEVAL CATH. PACK)*適應症請見備註欄

33371

HHM01EXPAPM4 美敦力”吸除導管"MEDTRONIC" EXPORT AP ASPIRATION

CATHETER*適應症請見備註欄

14123

HHM01EXPRTM4 美敦力”吸除導管"MEDTRONIC" EXPORT XT ASPIRATION

CATHETER*適應症請見備註欄

14123

HHM01FETCHF3 "普希士"快取血栓清除導管 "POSSIS" FETCH ASPIRATION

CATHETER*適應症請見備註欄

14123

937

特材代碼 中英文名稱 支付點數-104/01/01

HHM01G1462M4 "美敦力"保護導線加上暫時阻斷吸除系統GUARDWIRE PLUS

TEMPORARY OCCLUSION AND ASPIRATION SYSTEM(EXPORT XT

ASPIRATION CATHETER)*適應症請見備註欄

14123

HHM01G146SM4 GUARDWIRE PLUS TEMPORARY OCCLUSION AND ASPIRATION SYSTEM*

適應症請見備註欄

35000

HHM01M13A1F2 "英泰克" 莫瑪腦血管保護裝置"INVATEC" MO MA CEREBRAL

PROTECTION DEVICE*適應症請見備註欄

33371

HHM01P5010VS "法斯樂舒順"普倫特羅賓血栓清除導管"VASCULAR SOLUTIONS"

PRONTO LP EXTRACTION CATHETER*適應症請見備註欄

14123

HHM01Q5070VS "法斯樂舒順"快特血栓清除導管"VASCULAR SOLUTIONS" QXT

EXTRACTION CATHETER*適應症請見備註欄

14123

HHM01RF400BA "巴德"腔靜脈過濾器"BARD"G2 X VENA CAVA FILTER

(FILTER+INTRO+DILA+DELIVERY KIT+ADAPTER)

33528

HHM01SPDEREY 史派德栓塞防護系統"EV3"SPIDER FX EMBOLIC PROTECTION

DEVICE*適應症請見備註欄

33371

HHM01T2R9SKE ”卡內卡”史隆巴斯特血栓抽吸導管"KANEKA" THROMBUSTER II*

適應症請見備註欄

14123

HHM01TUL1PCK COOK GUNTHER TULIP VENA CAVA MREYE FILTER

SET(INTRODUCER+FILTER+SHEATH/DILATOR+ADAPTER)

33528

HHM01TULIPCK COOK GUNTHER TULIP VENA CAVA MREYE FILTER

SET(INTRODUCER+FILTER+SHEATH/DILATOR+ADAPTER)

33528

HHM01TULP1CK "曲克" 剛特圖利浦腔靜脈濾器"COOK" GUNTHER TULIP VENA CAVA

FILTER

33528

HHM02040SNP3 BLOOD TRANSFUSION FILTER 40UM 移除微血栓輸血過濾器(小兒科

專用)

305

LEE0106500M4 TEMPORARY MYOCARDIAL PACING LEAD 1036

LEE0107154AR "亞諾" 心律調整導管"ARROW" PACING CATHETERS 2846

LEE011210H2C "柯惠"羅勒電極貼片"COVIDIEN" LUDLOW MEDI-TRACE

DEFIBRILLATION ELECTRODES

652

LEE011410Z2C "柯惠"羅勒電極貼片"COVIDIEN" LUDLOW MEDI-TRACE

DEFIBRILLATION ELECTRODES

652

LEE012255R2C "柯惠"肯特利柯登斯去顫器電極貼片 "COVIDIEN" KENDALL MEDI-

TRACE CADENCE ELECTRODES

652

LEE012266P2C "柯惠"肯特利柯登斯去顫器電極貼片 "COVIDIEN" KENDALL MEDI-

TRACE CADENCE ELECTRODES (小兒用)

1050

LEE0125202A9 "奧圖"心肌導線"ALTO" Myo/Wire Temporary Cardiac Pacing

Wire

420

LEE0140176ST "聖猷達" 電極導線 "SJM" PACEL BIPOLAR PACING CATHETERS-

BALLOON CATH.

2846

LEE014017AST "聖猷達" 電極導線 "SJM" PACEL BIPOLAR PACING CATHETERS 2249

LEE014017VST "聖猷達" 電極導線 "SJM" PACEL BIPOLAR PACING CATHETERS 2249

LEE0160250JE "宜喜美"暫時性節律導線-雙極”ECM”TEMPORARY PACING WIRES-

BIPOLAR

2076

LEE016025SJE "宜喜美"暫時性節律導線"ECM"TEMPORARY PACING WIRES 1036

LEE0160BWQJE “宜喜美”暫時性節律導線-四極“ECM” TEMPORARY PACING

WIRES-QUADOPOLAR

3737

LEE016173PBA "巴德"暫時性電極導管"BARD"TEMPORARY BALLOON PACING

ELECTRODE CATHETER

2846

LEE016221PBA "巴德"暫時性電極導管"BARD"SEMI-FLOATING BIPOLAR PACING

ELECTRODE CATHETER

2249

LEE018153PBA "巴德"暫時性電極導管"BARD"SPECIAL CARE BIPOLAR PACING

ELECTRODE CATHETER

2249

LEE0197125ED "愛德華"史望康雙極心律導管組”EDWARDS”SWAN-GANZ BIPOLAR

CATHETER KIT

2846

938

特材代碼 中英文名稱 支付點數-104/01/01

LEE01AP518G2 PEDIATRIC DEFIB ELECTRODES體外心律調節器貼片 1050

LEE01AP919G2 MARGUETTE DEFIBRILLATION PACING MONITORING PADS 652

LEE01BP250BS BIPOLAR PACING CATHETER 5F,110CM(BALLOON

CATHETER,ADAPTOR,PEEL-AWAY SHEATH)

2846

LEE01BPX25BS BIPOLAR PACING CATHETER 5F,110CM 2249

LEE01KL180JC "耐倫科技" 哈特普拉斯自動體外心臟去顫電擊器-電極

片"NANOOMTECH" HEARTPLUS AUTOMATED EXTERNAL

DEFIBRILLATORS-ELECTRODE PAD

652

LEE01M1749HP DEFIB PACING PADS ADULT (2EA/SET) 652

LEE01M3501HP MULTIFUNCTION ADULT DEFIB ELECTRODES 652

LEE01M3504HP MULTIFUNCTION PEDIATRIC DEFIB ELECTRODES 1050

LEE01M3713HP MULTIFUNCTION ADULT PLUS PADS多功能電擊貼片 652

LEE01M3716HP MULTIFUNCTION ADULT RADIOLUCENT PADS多功能電擊貼片X光可穿

透型

652

LEE01M3717HP MULTIFUNCTION PEDIATRIC PLUS PADS多功能兒童用電擊貼片 1050

LEE01M3870HP INFANT/CHILD PADS多功能嬰幼兒用電擊貼片 1050

LEE01N1749HP DEFIB PACING PADS CHILD (2 EA/SET) 1050

LEE01P0510KT "日本光電" 心臟電極蘇復器-體外電極貼片"NIHON KOHDEN"

DEFIBRILLATOR-EXTERNAL PACING ELECTRODES

652

LEE01P0512KT "日本光電" 心臟電極蘇復器-體外電極貼片"NIHON KOHDEN"

DEFIBRILLATOR-EXTERNAL PACING ELECTRODES(CHILD)

1050

LEE01PADSTZ2 "佐爾" 電擊去顫器-電擊貼片"ZOLL" DEFIBRILLATOR-ADULT

MULTI-FUNCTION PACING/DEFIBRILLATION STAT PADZ

652

LEE01TBJFSKH “奧斯卡”暫時型心律調節器導線“OSCOR”TB TEMPORARY

BIPOLAR PACING LEAD

2249

LEE01TBVRHKH "奧斯卡"暫時型心律調節器導線"OSCOR" TB TEMPORARY BIPOLAR

PACING LEAD

2249

MA12345678NH 特殊材料管理費用 1500

NAN011430NBB "B.BRAUN"STERICAN SINGLE USE HYPODERMIC NEEDLE "必勃朗"注

射針

0.5

NAN011627NBB NEEDLE 0.5

NAN011826NV4 DISPOSABLE NEEDLE 18G:26G 0.5

NAN011827N3B "康德萊"一次性使用無菌注射針"KDL"DISPOSABLE NEEDLE 0.5

NAN011827NBD NEEDLE 0.5

NAN011827NNR NEEDLE 0.5

NAN011827NTM NEEDLE 0.5

NAN011827NTP NEEDLE 0.5

NAN011827NUY NEEDLE 0.5

NAN011830NTM "泰爾茂"亞加尼針頭"TERUMO"AGANI NEEDLE 0.5

NAN020030BFB FEEL-FINE INSULIN PEN NEEDLES桂台胰島素注射筆專用針頭 3.2

NAN020031N3B "康德萊"胰島素筆配套用針"KDL"INSULIN PEN NEEDLE 3.2

NAN020031NBD "BD"PEN NEEDLE"必帝"注射筆專用針(胰島素筆型針頭) 3.2

NAN020050NNR NOVOFINE NEEDLE 30G 胰島素筆型注射器針頭 3.2

NAN020632GNR NIPRO NOVOFINE NEEDLE 32G 尼普爾諾和筆注射針 3.2

NAN0291676BB OMNICAN FINE NEEDLES 29:31G 胰島素注射筆專用針頭 3.2

NAN041823NNR IC NEEDLE心肌長針 4.9

NAN061822NHK P.T.C.D NEEDLE 150:200MM 102

NAN061822NTP P.T.C.D NEEDLE 102

NAN061823MTP P.T.C.D NEEDLE MS TYPE 18G:23G 102

NAN0620200TP P.T.C.D NEEDLE 102

NAN0621150TP P.T.C.D NDDELE 102

NAN0622150TP P.T.C.D NEEDLE 102

NAN0623150TP P.T.C.D NEEDLE 23GX150MM 102

NAN1118275AG AMC/4 ARTERIAL NEEDLE 18Gx23/4"(7.0CM) 導線導引針 105

939

特材代碼 中英文名稱 支付點數-104/01/01

NAN1121200AG AMC/4 ARTERIAL NEEDLE 21Gx2"(5.1CM)導線導引針 105

NAN11A1820GJ "JSM"INTRODUCER NEEDLE"吉生"穿刺針 60

NAN11AP1NEH9 ANGIO PACK :INTRODUCER NEEDLE(單針) 60

NAN141822NCK DISPOSABLE ONE PART NEEDLE 導線導引針 105

NAN1418275AG AMC/4 ARTERIAL NEEDLE WITH FIXED WINGS 18Gx23/4"(7.0CM)

導線導引針

105

NAN1421100AG AMC/3 ARTERIAL NEEDLE 21Gx1"(2.5CM)導線導引針 105

NAN145312NAG AMC/3 ARTERIAL NEEDLE 18GX7CM,3.8CM 19GX3.8CM 105

NAN1521500C3 DISPOSABLE SELDING NEEDLE 18G 7.5CM 128

NAN1550400PB PUNCTURE NEEDLE W/STYLET雙針(外套管+內針) 128

NAN155324NAG PERCUTANEOUS ENTRY NEEDLE

16GX7.3CM,18GX7.3CM,19GX3.8,7.3CM,21GX3.8CM

128

NAN155324NAR "ARROW"MULTI-LUMEN CENTRAL VENOUS

CATHETERIZATION:INTRODUCER NEEDLE (外套管+內針)

128

NAN15ADVANMR ADVANCE ANGIOGRAPHIC NEEDLES 高昇血管攝影穿刺針(外管+內

針)

128

NAN15AN72SMR MAJESTIK SERIES ANGIOGRAPHY NEEDLES 16-21G(雙針) 128

NAN15DCM18CK "曲克"拋棄式經皮穿刺針"COOK"DISPOSABLE PERCUTANEOUS ENTRY

NEEDLES 18:22G 2.5:9.0CM

128

NAN165341NAG ARTERIAL CATHETER NEEDLE 16GX6.4CM,18GX6.4CM,20GX3.8CM 203

NAN16AN18TMR MAJESTIK SERIES ANGIOGRAPHY NEEDLES 18G 7CM(3-PART)(外管+

內針+填充器)

203

NBS010001NBD 1CC SYRINGE WITHOUT NEEDLE 1.9

NBS010001NSP 1CC SYRINGE WITHOUT NEEDLE 1.9

NBS010001NV4 1 CC SYRINGE WITHOUT NEEDLE 1.9

NBS010001PTM 1CC SYRINGE WITHOUT/NEEDLE 1.9

NBS010001SB8 "普康"注射筒 1CC 不附針頭"BU KWANG"DISPOSABLE SYRINGE

WITHOUT NEEDLE

1.9

NBS010001VPW 1CC SYRINGE WITHOUT NEEDLE 1.9

NBS010002NSP 2-3CC SYRINGE WITHOUT NEEDLE 1

NBS010003NBD 3CC SYRINGE WITHOUT NEEDLE 1

NBS010003NPW 3CC SYRINGE WITHOUT NEEDLE 1

NBS010003NV4 2 CC,3CC SYRINGE WITHOUT NEEDLE 1

NBS010003PTM 3CC SYRINGE WITHOUT/NEEDLE 1

NBS010003SB8 "普康"注射筒 3CC 不附針頭"BU KWANG"DISPOSABLE SYRINGE

WITHOUT NEEDLE

1

NBS010003VPW 3CC SYRINGE WITHOUT NEEDLE 1

NBS010005NBD 5CC SYRINGE WITHOUT NEEDLE 1.4

NBS010005NFR "FAIRY"SYRINGE 5CC WITHOUT NEEDLE"樺萊"塑膠注射筒(不附針) 1.4

NBS010005NSP 5CC SYRINGE WITHOUT NEEDLE 1.4

NBS010005NV4 5 CC SYRINGE WITHOUT NEEDLE 1.4

NBS010005PTM 5CC SYRINGE WITHOUT/NEEDLE 1.4

NBS010005SB8 "普康"注射筒 5CC 不附針頭"BU KWANG"DISPOSABLE SYRINGE

WITHOUT NEEDLE

1.4

NBS010005VPW 5CC SYRINGE WITHOUT NEEDLE 1.4

NBS010010NBD 10CC SYRINGE WITHOUT NEEDLE 2.4

NBS010010NFR 10 CC SYRINGE WITHOUT NEEDLE 2.4

NBS010010NPW 10CC SYRINGE WITHOUT NEEDLE 2.4

NBS010010NSP 10CC SYRINGE WITHOUT NEEDLE 2.4

NBS010010NUY 10CC SYRINGE WITHOUT/NEEDLE 2.4

NBS010010NV4 10 CC SYRINGE WITHOUT NEEDLE 2.4

NBS010010PTM 10CC SYRINGE WITHOUT/NEEDLE 2.4

940

特材代碼 中英文名稱 支付點數-104/01/01

NBS010010SB8 "普康"注射筒 10CC 不附針頭"BU KWANG"DISPOSABLE SYRINGE

WITHOUT NEEDLE

2.4

NBS010010VPW 10CC SYRINGE WITHOUT NEEDLE 2.4

NBS010020NBD 20 CC SYRINGE WITHOUT NEEDLE 2.9

NBS010020NFR 20 CC SYRINGE WITHOUT NEEDLE 2.9

NBS010020NNR 20 CC SYRINGE WITHOUT NEEDLE 2.9

NBS010020NPD 20CC SYRINGE WITHOUT NEEDLE 2.9

NBS010020NPW 20 CC SYRINGE WITHOUT NEEDLE 2.9

NBS010020NSP 20CC SYRINGE WITHOUT NEEDLE 2.9

NBS010020NTM 20 CC SYRINGE WITHOUT NEEDLE 2.9

NBS010020NTP 20 CC SYRINGE WITHOUT NEEDLE 2.9

NBS010020NUY 20CC SYRINGE WITHOUT/NEEDLE 2.9

NBS010020NV4 20CC SYRINGE WITHOUT NEEDLE 2.9

NBS010020NYF 20 CC SYRINGE WITHOUT NEEDLE 2.9

NBS010020PTM 20CC SYRINGE WITHOUT/NEEDLE 2.9

NBS010020SB8 "普康"注射筒 20CC 不附針頭"BU KWANG"DISPOSABLE SYRINGE

WITHOUT NEEDLE

2.9

NBS010020VPW 20CC SYRINGE WITHOUT NEEDLE 2.9

NBS010025NPW 25CC SYRINGE WITHOUT NEEDLE 2.9

NBS010030NBD 30 CC SYRINGE WITHOUT NEEDLE 6.6

NBS010030NFR 30 CC SYRINGE WITHOUT NEEDLE 6.6

NBS010030NNR 30 CC SYRINGE WITHOUT NEEDLE 6.6

NBS010030NPW 30 CC SYRINGE WITHOUT NEEDLE 6.6

NBS010030NSP 30CC SYRINGE WITHOUT NEEDLE 6.6

NBS010030NTM 30 CC SYRINGE WITHOUT NEEDLE 6.6

NBS010030NTP 30 CC SYRINGE WITHOUT NEEDLE 6.6

NBS010030NUY 30CC SYRINGE WITHOUT/NEEDLE 6.6

NBS010030NV4 30CC SYRINGE WITHOUT NEEDLE 6.6

NBS010030SB8 "普康"注射筒 30CC 不附針頭"BU KWANG"DISPOSABLE SYRINGE

WITHOUT NEEDLE

6.6

NBS010030TTM "TERUMO"DISPOSABLE SYRINGE:30CC WITHOUT NEEDLE"泰爾茂"注

射針筒:30CC不附針

6.6

NBS010030VPW 30CC SYRINGE WITHOUT NEEDLE 6.6

NBS010050NBD 50 CC SYRINGE WITHOUT NEEDLE 9.5

NBS010050NFR 50CC SYRINGE WITHOUT NEEDLE 9.5

NBS010050NNR 50 CC SYRINGE WITHOUT NEEDLE 9.5

NBS010050NPW 50 CC SYRINGE WITHOUT NEEDLE 9.5

NBS010050NSP 50CC,60CC SYRINGE WITHOUT NEEDLE 9.5

NBS010050NTM 50 CC SYRINGE WITHOUT NEEDLE 9.5

NBS010050NTP 50 CC SYRINGE WITHOUT NEEDLE 9.5

NBS010050NUY 60CC SYRINGE WITHOUT/NEEDLE 9.5

NBS010050NV4 50CC SYRINGE WITHOUT NEEDLE 9.5

NBS010050SB8 "普康"注射筒 50CC 不附針頭"BU KWANG"DISPOSABLE SYRINGE

WITHOUT NEEDLE

9.5

NBS010050VPW 50CC SYRINGE WITHOUT NEEDLE 9.5

NBS010060NPW 60CC SYRINGE WITHOUT NEEDLE 9.5

NBS010060TTM "TERUMO"DISPOSABLE SYRINGE:60CC WITHOUT NEEDLE"泰爾茂"注

射針筒:60CC不附針

9.5

NBS0100N20BD PLASTIPAK SYRINGE 20CC WITHOUT NEEDLE 2.9

NBS0100N30BD PLASTIPAK SYRINGE 30CC WITHOUT NEEDLE 6.6

NBS0100N50BD PLASTIPAK SYRINGE 50CC WITHOUT NEEDLE 9.5

NBS010301SSG SIGMA SYRINGE WITHOUT NEEDLE 3CC 十美牌注射筒不附針3CC 1

NBS010303SSG SIGMA SYRINGE WITHOUT NEEDLE 3CC SAFETY 十美牌注射筒不附

針安全型3CC※適應症請見備註欄

1.8

941

特材代碼 中英文名稱 支付點數-104/01/01

NBS010501SSG SIGMA SYRINGE WITHOUT NEEDLE 5CC 十美牌注射筒不附針5CC 1.4

NBS010503SSG SIGMA SYRINGE WITHOUT NEEDLE SAFETY 5CC 十美牌注射筒不附

針安全型5CC※適應症請見備註欄

2.6

NBS011001SSG SIGMA SYRINGE WITHOUT NEEDLE 10CC 十美牌注射筒不附針10CC 2.4

NBS011003SSG SIGMA SYRINGE WITHOUT NEEDLE SAFETY 10CC 十美牌注射筒不附

針安全型10CC※適應症請見備註欄

4

NBS012001SSG SIGMA SYRINGE WITHOUT NEEDLE 20CC 十美牌注射筒不附針20CC 2.9

NBS012003SSG SIGMA SYRINGE WITHOUT NEEDLE SAFETY 20CC 十美牌注射筒不附

針安全型20CC※適應症請見備註欄

6.6

NBS0120CC1BD "必帝"塑膠注射筒(不附針):20CC"BD"DISPOSABLE

SYRINGE(WITHOUT NEEDLE):20CC

2.9

NBS0216154NN NOVOPEN 4 WITHOUT NEEDLE(筆型胰島素注射筒)※每支以使用三

年以上為原則

900

NBS0216158NN "NOVOPEN ECHO"諾和筆易兒樂(筆型胰島素注射筒)※每支以使用

三年以上為原則

900

NBS02M9662HQ INSULIN DELIVERY DEVICE 胰島素注射筆,每支以使用三年以上為

原則※適應症請見備註欄

900

NBS02M9673HQ HUMAPEN LUXURA HD INSULIN DELIVERY DEVICE 胰島素注射筆,每

支以使用三年以上為原則※適應症請見備註欄

900

NBS0700096LF OPTIVANTAGE DUAL-HEAD INJECTOR 200CC SYRINGE (注射筒X1+吸

管X1)

222

NBS0700099LF OPTIVANTAGE DUAL-HEAD INJECTOR 200CC SYRINGE (注射筒X1+吸

管X1+螺旋管X1)

313

NBS0700150MH CONTRAST MEDIUM INJECTION SYRINGE 130,150CC(型號DSK130自

91/4/1生效)

222

NBS0700172LF "LF"DISPOSABLE SYRINGE FOR DIGITAL INJECTION 130CC W/H-

FIL"理博"高壓注射器用拋棄式針筒

222

NBS0700200MH CONTRAST MEDIUM INJECTION SYRINGE 200CC顯影劑注射筒 222

NBS0701021N8 MRI SYRINGE SET 顯影劑注射筒(60CC SYRINGEX1+25CC

SYRINGEX1+SPIKEX2+Y型螺旋管X1)

435

NBS070150QMH DISPOSABLE SYRINGE 150CC W/FILL TUBE顯影劑注射筒 222

NBS0701800N8 MRI SYRINGE SET 顯影劑注射筒(60CC SYRINGEX2+SPIKEX2+Y型螺

旋管X1)

435

NBS0701801N8 MRI SYRINGE W/SPIKE 顯影劑注射筒 60CC 222

NBS070200FMH CONTRAST MEDIUM INJECTION SYRINGE 200CC 222

NBS070200QMH CONTRAST MEDIUM INJECTION SYRINGE 200ML W/FILL TUBE顯影劑

注射筒

222

NBS07065VSMH DISPOSABLE SYRINGE KIT 顯影劑注射筒(注射筒2+剌針2+低壓螺

旋管與T型連接管1)

435

NBS071010TTY OPTIRAY 350 造影劑注射筒 222

NBS07115VSMH DISPOSABLE SYRINGE KIT 顯影劑注射筒(注射筒2+剌針2+低壓螺

旋管與T型連接管1)

435

NBS07137NESD ANGIOGRAPHIC POWER SYRINGE 150ML W/J-CURVED FILL TUBE 222

NBS0714158MR "MERIT"MEDALLION SERIES SYRINGES"美瑞特"馬德廉注射筒

1CC;3CC;6CC

174

NBS07150AQMH DISPOSABLE SYRINGE 150CC W/FILL TUBE顯影劑注射筒 222

NBS07150EQ2M "IMAXEON"SYRINGE AND QUICK FILL TUBE"愛美聖"注射筒及填充

222

NBS07200FCMH DISPOSABLE SYRINGE KIT 200ML(注射筒+吸管+螺旋連接管) 313

NBS07200FQMH DISPOSABLE SYRINGE 200CC W/FILL TUBE顯影劑注射筒 222

NBS0730210N8 DISPOSABLE SYRINGE SYSTEM WITH ACCESSORIES(注射筒+吸管) 222

942

特材代碼 中英文名稱 支付點數-104/01/01

NBS0732377MA OPTIRAY 320 IOVERSOL INJECTION SYRINGE 125ML歐得利320造影

劑注射筒

222

NBS0744020LF OPTIVANTAGE DUAL-HEAD INJECTOR(注射筒X1+吸管X1+Y型螺旋接

管X1)

313

NBS0744022LF OPTIVANTAGE DUAL-HEAD INJECTOR(注射筒X2+吸管X2+Y型螺旋接

管X1)

435

NBS0760269N8 DISPOSABLE SYRINGE SYSTEM WITH ACCESSORIES(注射筒+吸管+螺

旋低壓連接管)

313

NBS07700SRMH "MEDRAD"DISPOSABLE SYRINGE KIT"美樂得"注射筒組套:拋棄式注

射筒及填充管

222

NBS0784402LF "LF"OPTIVANTAGE DUAL-HEAD INJECTOR"理博"雙驅動自動注射系

統 (注射筒X2+吸管X2+Y型螺旋接管X1)

455

NBS0785003NL NAMIC ANGIOGRAPHIC CONTROL SYRINGES (8:20ML)血管造影控制

注射系統

174

NBS0790103N8 DISPOSABLE SYRINGE SYSTEM 150CC W/HANDI FIL LINDEN LUER

注射筒+吸管

222

NBS07AG115BQ ANGIOGRAPHIC SYRINGE (注射筒X1+抽藥管X1) 222

NBS07AG215BQ ANGIOGRAPHIC SYRINGE (注射筒X1+抽藥管X1) 222

NBS07CCS60MR CORONARY CONTROL SYRINGE 6CC 10CC 12CC 174

NBS07CT119BQ ANGIOGRAPHIC SYRINGE KIT (注射筒X1+抽藥管X1+螺旋管X1) 313

NBS07CT129BQ ANGIOGRAPHIC SYRINGE KIT (注射筒X2+抽藥管X2+螺旋管X1) 435

NBS07CT219BQ ANGIOGRAPHIC SYRINGE KIT (注射筒X1+抽藥管X1+螺旋管X1) 313

NBS07CT229BQ ANGIOGRAPHIC SYRINGE KIT (注射筒X2+抽藥管X2+螺旋管X1) 435

NBS07DCTPQMH DISPOSABLE 200 CC SYRINGE 二支 KIT(注射筒X2+吸管+連接管

+PRIME TUBE)

455

NBS07DCTPSMH DISPOSABLE 200 CC SYRINGE 二支 KIT(注射筒X2+SPIKE+連接管

+PRIME TUBE)

435

NBS07MR123BQ ANGIOGRAPHIC SYRINGE KIT (60CC注射筒X2+抽藥管X1+Y螺旋管

X1)

435

NBS07MR214BQ ANGIOGRAPHIC SYRINGE KIT (65CC注射筒X2+抽藥管X1+Y螺旋管

X1)

435

NBS07SCTPQMH DISPOSABLE 200 CC SYRINGE KIT(含吸管+連接管+PRIME TUBE) 313

NBS07SSQFTMH DISPOSABLE 200 CC SYRINGE KIT(含吸管) 222

NBS07ZY3202M "IMAXEON"SALIENT SYRINGE KIT W/QUICK FILL TUBE"愛美聖"注

射筒套組(含填充管1支)

222

NBS07ZY3212M "IMAXEON"SALIENT SYRINGE KIT W/SPIKE"愛美聖"注射筒套組(含

刺針)

222

NCS010001N3B "康德萊"一次性使用無菌注射器附針1ML"KDL"FOR SINGLE USE

STERILE SYRINGE W/NEEDLE

2

NCS010001NBD 1 CC SYRINGE 2

NCS010001NDD 1CC SYRINGE 2

NCS010001NFR 1 CC SYRINGE 2

NCS010001NNR 1 CC SYRINGE 2

NCS010001NPD 1CC SYRINGE W/NEEDLE 2

NCS010001NPW 1 CC SYRINGE 2

NCS010001NSH 1 CC SYRINGE 2

NCS010001NSP 1CC SYRINGE W/NEEDLE 2

NCS010001NTM 1 CC SYRINGE 2

NCS010001NTP 1 CC SYRINGE 2

NCS010001NUY 1 CC SYRINGE W/NEEDLE 2

NCS010001NV4 1CC SYRINGE W/NEEDLE 2

NCS010001PTM 1CC SYRINGE W/NEEDLE 2

NCS010001SB8 "普康"注射筒 1CC 附針頭"BU KWANG"DISPOSABLE SYRINGE WITH

NEEDLE

2

943

特材代碼 中英文名稱 支付點數-104/01/01

NCS010001VPW 1CC SYRINGE W/NEEDLE 2

NCS010002N3B "康德萊"一次性使用無菌注射器附針2ML;2.5ML "KDL"FOR SINGLE

USE STERILE SYRINGE W/NEEDLE

1.4

NCS010002NPW 2 CC SYRINGE 1.4

NCS010002NSP 2-3CC SYRINGE W/NEEDLE 1.4

NCS010003N3B "康德萊"一次性使用無菌注射器附針3ML"KDL"FOR SINGLE USE

STERILE SYRINGE W/NEEDLE

1.4

NCS010003NBD 3 CC SYRINGE 1.4

NCS010003NDD 3CC SYRINGE 1.4

NCS010003NFR 3CC SYRINGE W/NEEDLE 1.4

NCS010003NNR 3 CC SYRINGE 1.4

NCS010003NPD 3CC SYRINGE W/NEEDLE 1.4

NCS010003NPW 3 CC SYRINGE 1.4

NCS010003NSH 3 CC SYRINGE 1.4

NCS010003NTM 3 CC SYRINGE 1.4

NCS010003NTP 3 CC SYRINGE 1.4

NCS010003NUY 3 CC SYRINGE W/NEEDLE 1.4

NCS010003NV4 2CC,3CC SYRINGE W/NEEDLE 1.4

NCS010003NYF 3 CC SYRINGE 1.4

NCS010003PTM 3CC SYRINGE W/NEEDLE 1.4

NCS010003SB8 "普康"注射筒 3CC 附針頭"BU KWANG"DISPOSABLE SYRINGE WITH

NEEDLE

1.4

NCS010003VPW 3CC SYRINGE W/NEEDLE 1.4

NCS010005N3B "康德萊"一次性使用無菌注射器附針5ML"KDL"FOR SINGLE USE

STERILE SYRINGE W/NEEDLE

1.8

NCS010005NBD 5 CC SYRINGE 1.8

NCS010005NDD 5CC SYRINGE 1.8

NCS010005NFR 5CC SYRINGE W/NEEDLE 1.8

NCS010005NNR 5 CC SYRINGE 1.8

NCS010005NPD 5CC SYRINGE W/NEEDLE 1.8

NCS010005NPW 5 CC SYRINGE 1.8

NCS010005NSP 5CC SYRINGE W/NEEDLE 1.8

NCS010005NTM 5 CC SYRINGE 1.8

NCS010005NTP 5 CC SYRINGE 1.8

NCS010005NUY 5CC SYRINGE W/NEEDLE 1.8

NCS010005NV4 5CC SYRINGE W/NEEDLE 1.8

NCS010005NYF 5 CC SYRINGE 1.8

NCS010005PTM 5CC SYRINGE W/NEEDLE 1.8

NCS010005SB8 "普康"注射筒 5CC 附針頭"BU KWANG"DISPOSABLE SYRINGE WITH

NEEDLE

1.8

NCS010005VPW 5CC SYRINGE W/NEEDLE 1.8

NCS010010N3B "康德萊"一次性使用無菌注射器附針10ML"KDL"FOR SINGLE USE

STERILE SYRINGE W/NEEDLE

2.5

NCS010010NBD 10 CC SYRINGE 2.5

NCS010010NDD 10CC SYRINGE 2.5

NCS010010NFR 10CC SYRINGE W/NEEDLE 2.5

NCS010010NNR 10 CC SYRINGE 2.5

NCS010010NPD 10CC SYRINGE W/NEEDLE 2.5

NCS010010NPW 10 CC SYRINGE 2.5

NCS010010NSP 10CC SYRINGE W/NEEDLE 2.5

NCS010010NTM 10 CC SYRINGE 2.5

NCS010010NTP 10 CC SYRINGE 2.5

NCS010010NUY 10CC SYRINGE W/NEEDLE 2.5

NCS010010NV4 10CC SYRINGE W/NEEDLE 2.5

944

特材代碼 中英文名稱 支付點數-104/01/01

NCS010010NYF 10 CC SYRINGE 2.5

NCS010010PTM 10CC SYRINGE W/NEEDLE 2.5

NCS010010SB8 "普康"注射筒 10CC 附針頭"BU KWANG"DISPOSABLE SYRINGE WITH

NEEDLE

2.5

NCS010010VPW 10CC SYRINGE W/NEEDLE 2.5

NCS01001HZ2P 嘉鎂一次性使用無菌自毀式注射器1ML附針"EWNL"AUTO DISABLE

SYRINGE W/NEEDLE

2

NCS010020N3B "康德萊"一次性使用無菌注射器附針20ML"KDL"FOR SINGLE USE

STERILE SYRINGE W/NEEDLE

3.1

NCS010020NBD 20 CC SYRINGE (附針) 3.1

NCS010020NDD 20CC SYRINGE 3.1

NCS010020NFR 20CC SYRINGE W/NEEDLE 3.1

NCS010020NNR 20 CC SYRINGE(附針) 3.1

NCS010020NPD 20CC SYRINGE W/NEEDLE 3.1

NCS010020NPW 20CC SYRINGE W/NEEDLE 3.1

NCS010020NSP 20CC SYRINGE W/NEEDLE 3.1

NCS010020NTM 20 CC SYRINGE (附針) 3.1

NCS010020NTP 20CC SYRINGE W/NEEDLE 3.1

NCS010020NUY 20CC SYRINGE W/NEEDLE 3.1

NCS010020NV4 20CC SYRINGE W/NEEDLE 3.1

NCS010020NYF 20 CC SYRINGE (附針) 3.1

NCS010020SB8 "普康"注射筒 20CC 附針頭"BU KWANG"DISPOSABLE SYRINGE WITH

NEEDLE

3.1

NCS010020VPW 20CC SYRINGE W/NEEDLE 3.1

NCS01002HZ2P 嘉鎂一次性使用無菌自毀式注射器2ML附針"EWNL"AUTO DISABLE

SYRINGE W/NEEDLE

1.4

NCS010030N3B "康德萊"一次性使用無菌注射器附針30ML"KDL"FOR SINGLE USE

STERILE SYRINGE W/NEEDLE

5.2

NCS010030NFR 30CC SYRINGE W/NEEDLE 5.2

NCS010030NPD 30CC SYRINGE W/NEEDLE 5.2

NCS010030NPW 30CC SYRINGE W/NEEDLE 5.2

NCS010030NSP 30CC SYRINGE W/NEEDLE 5.2

NCS010030NUY 30CC SYRINGE W/NEEDLE 5.2

NCS010030NV4 30CC SYRINGE W/NEEDLE 5.2

NCS010030SB8 "普康"注射筒 30CC 附針頭"BU KWANG"DISPOSABLE SYRINGE WITH

NEEDLE

5.2

NCS010030VPW 30CC SYRINGE W/NEEDLE 5.2

NCS01003HZ2P 嘉鎂一次性使用無菌自毀式注射器3ML附針"EWNL"AUTO DISABLE

SYRINGE W/NEEDLE

1.4

NCS010050N3B "康德萊"一次性使用無菌注射器附針50ML"KDL"FOR SINGLE USE

STERILE SYRINGE W/NEEDLE

8.5

NCS010050NFR 50CC SYRINGE W/NEEDLE 8.5

NCS010050NPD 50CC SYRINGE W/NEEDLE 8.5

NCS010050NPW 50CC SYRINGE W/NEEDLE 8.5

NCS010050NSP 50CC,60CC SYRINGE W/NEEDLE 8.5

NCS010050NTM "TERUMO"DISPOSABLE SYRINGE W/NEEDLE 50CC"泰爾茂"注射針筒

含針頭

8.5

NCS010050NUY 60CC SYRINGE W/NEEDLE 8.5

NCS010050NV4 50CC SYRINGE W/NEEDLE 8.5

NCS010050SB8 "普康"注射筒 50CC 附針頭"BU KWANG"DISPOSABLE SYRINGE WITH

NEEDLE

8.5

NCS010050VPW 50CC SYRINGE W/NEEDLE 8.5

NCS01005HZ2P 嘉鎂一次性使用無菌自毀式注射器5ML附針"EWNL"AUTO DISABLE

SYRINGE W/NEEDLE

1.8

945

特材代碼 中英文名稱 支付點數-104/01/01

NCS010060NTM "TERUMO"DISPOSABLE SYRINGE W/NEEDLE 60CC"泰爾茂"注射針筒

含針頭

8.5

NCS010102SSG SIGMA SYRINGE WITH NEEDLE 1CC 十美牌注射筒附針1CC 2

NCS01010HZ2P 嘉鎂一次性使用無菌自毀式注射器10ML附針"EWNL"AUTO DISABLE

SYRINGE W/NEEDLE

2.5

NCS010302SSG SIGMA SYRINGE WITH NEEDLE 3CC 十美牌注射筒附針3CC 1.4

NCS010502SSG SIGMA SYRINGE WITH NEEDLE 5CC 十美牌注射筒附針5CC 1.8

NCS011002SSG SIGMA SYRINGE WITH NEEDLE 10CC 十美牌注射筒附針10CC 2.5

NCS030000NUU RETRACTABLE SAFETY INSULIN SYRINGE W/NEEDLE※適應症請見備

註欄

6

NCS0300100NR INSULIN SYRINGE 1CC 3.7

NCS030310N3B "康德萊"一次性使用無菌胰島素注射器"KDL"DISPOSABLE INSULIN

SYRINGE

3.7

NCS030310NSP INSULIN SYRINGE W/NEEDLE 3.7

NCS030510NBD BD胰島素專用塑膠注射筒附針BD DISPOSABLE INSULIN SYRINGE

W/NEEDLE

3.7

NCS030510NMJ INSULIN SYRINGE 3.7

NCS030510NNR INSULIN SYRINGE 1 CC 3.7

NCS030510NPW INSULIN SYRINGE W/NEEDLE 3.7

NCS030510NTM INSULIN SYRINGE 0.3,0.5,1CC(0.3CC自87/12/19收錄)(型號

SS30M;05M3009(A)自911001生效)

3.7

NCS030510S3C "千禧光"附針安全注射器:胰島素注射器"SOL-CARE"SAFETYE

W/FIXED NEEDLE:INSULIN SYRINGE

6

NCS0330593BD BD SAFETYGLIDE INSULIN SYRINGE W/NEEDLE BD滑蓋式胰島素安

全注射筒附針※給付規定請見備註欄

6

NCS0388816KD INSULINE SYRINGE W/NEEDLE(8881-

600137,145,350,368,1358,1366,600700,800,601600)

3.7

NCS0391511BB OMNICAN INSULIN SYRINGES W/NEEDLE 0.5/1.0ML 3.7

NDD04N8008SG INJECTION CAP W/FREE SITE 無針式接頭*適應症請見備註欄 43.1

NDN0100022GW SCALP VEIN SET 22:25G 3.9

NDN01023XNPW SCALP NEEDLE 3.9

NDN011825NV4 SCALP SET 18G:25G 3.9

NDN011827NFR SCALP NEEDLE 3.9

NDN011827NJS SCALP NEEDLE 3.9

NDN011827NM8 "MEDITOP"TOP SCALP VEIN SET"邁迪特浦"特浦翼狀針 3.9

NDN011827NNR SCALP NEEDLE 3.9

NDN011827NTP SCALP NEEDLE 3.9

NDN011925NLL SCALP頭皮針 3.9

NDN011925NTM SCALP NEEDLE 3.9

NDN01A010NPW SCALP VEIN SET 16:27G 3.9

NDN020112NBA "BARD"HUBER PLUS NON-CORING NEEDLE SAFETY INFUSION SET

W/TUBING "巴德"賀伯氏安全性無心彎針附蝴蝶翼輸液套組※適應

症請見備註欄

91.5

NDN020119YBA "BARD"HUBER PLUS NON-CORING NEEDLE SAFETY INFUSION SET

W/Y-INJECTION SITE AND NEEDLESS INJECTION CAP"巴德"賀伯氏

安全性無心彎針附蝴蝶翼輸液套組※

91.5

NDN0202006HJ PORT-A-CATH NEEDLE※適應症請見備註欄 64

NDN02027NNHJ PORT-A-CATH GRIPPER NEEDLE W/EXTENSION TUBING※適應症請見

備註欄

64

NDN0206023BA STRAIGHT AND RIGHT-ANGLE NON-CORING NEEDLE 直式或直角無心

彎針 ※適應症請見備註欄

64

NDN0206025BA PORT-A NON-CORING NEEDLE ※限癌症化學治療及癌症未期之疼痛

治療使用

64

NDN0206033BA WINGED INFUSION SET 蝴蝶彎針注射套組 ※適應症請見備註欄 64

946

特材代碼 中英文名稱 支付點數-104/01/01

NDN0222052BA 蝴蝶彎針WINGED INFUSION SET※適應症請見備註欄 64

NDN0227600HJ "SMITHS"GRIPPER PLUS NEEDLE (SAFETY ) "史密斯"新式內植用

輸液管灌注針(安全型)※給付規定請見備註欄

91.5

NDN0227601HJ "SMITHS"GRIPPER PLUS NEEDLE (SAFETY ) "史密斯"新式內植用

輸液管灌注針(安全型)※給付規定請見備註欄

91.5

NDN0229490YP "普羅斯"植入式輸液座專用安全灌注針"POLYPERF SAFE 91.5

NDN0239759BB CYTOCAN NEEDLES FOR ACCESS PORT W/EXTENSION TUBING※適應

症請見備註欄

64

NDN0239953BB SURECAN NON-CORING NEEDLE FOR PORT A※適應症請見備註欄 64

NDN0248430BB SURECAN NON-CORING NEEDLE W/EXTENSION TUBE FOR ACCESS

PORTS※適應症請見備註欄

64

NDN02A180NPW WINGED CORE RESISTANT NEEDLE SETS※適應症請見備註欄 64

NDN02A190NPW WINGED NEEDLE SET(含輸液管)※適應症請見備註欄 64

NDN02LH29NBA "巴德"安全性賀伯注射針組"BARD"SAFESTEP HUBER NEEDLE SET

W/EXTENSION TUBE

91.5

NDN02LH29YBA "巴德"安全性賀伯注射針組"BARD"SAFESTEP HUBER NEEDLE SET

W/Y INJECTION SITE

91.5

NDN02PN001SG PORT ACCESS INFUSION SET※適應症請見備註欄 64

NDN04000011N "BIOCIV"I.V. CATHETER(TPU)"百仕韋"靜脈留置針 10.5

NDN040024CBB INTROCAN CERTO-IV CATHETER 24G(PU) 10.5

NDN0404000HJ "SMITHS"JELCO IV CATHETER TEFLON 14:24G "史密斯"杰可靜脈

留置針

9.5

NDN0405000HJ "SMITHS" OPTIVA IV CATHETER PU 14:24G "史密斯"奧迪發靜脈

留置針

10.5

NDN041214NAY IV CATHETER(TEFLON) 9.5

NDN041422CBB INTROCAN CERTO-IV CATHETER 14:22G (PU)(產品型號0405-

5756,64,72,6272,99)

10.5

NDN041422NBB IV CATHETER(TEFLON) 9.5

NDN041424NBD IV CATHETER(TEFLON) 9.5

NDN041424NTM IV CATHETER(TEFLON) 9.5

NDN041424P3B "康德萊"一次性使用留置針PU"KDL"IV CATHETER 10.5

NDN041424STM SURFLO IV CATHETER 14G:24G(ETFE) 9.5

NDN041622NBD IV CATHETER(TEFLON) 9.5

NDN041622NNR IV CATHETER(TEFLON) 9.5

NDN041622NTM IV CATHETER(TEFLON) 9.5

NDN041627NTM IV CATHETER 16:27G (PU) 10.5

NDN041824ATM SURSHIELD SURFLO II安全靜脈留置針※適應症請見備註欄 27.5

NDN041824NTP IV CATHETER MN(TEFLON) 9.5

NDN042400NBB IV CATHETER(TEFLON) 9.5

NDN042400NNR IV CATHETER(TEFLON) 9.5

NDN043818ABD INSYTE AUTOGUARD SHIELDED IV CATHETER 回縮式安全靜脈導管

※適應症請見備註欄

27.5

NDN0442603BB VASOFIX SAFETY I.V. CANNULAE 菲適免針加藥安全靜脈留置針※

適應症請見備註欄

33.8

NDN0442689BB VASOFIX I.V. CANNULAE 菲適免針加藥靜脈留置針 16.8

NDN0442CWSBB INTROCAN CERTO SAFETY PU 18:24G安全靜脈留置針※適應症請見

備註欄

27.5

NDN04FEP03BB INTROCAN SAFETY IVC CANNULAE ※適應症請見備註欄 27.5

NDN04PUR03BB INTROCAN SAFETY IVC CANNULAE ※適應症請見備註欄 27.5

NDN04S1424BD INSYTE IV CATHETER(VIALON) 10.5

NDN04SR01NTM SURFLO I.V CATHETER 14G:24G 9.5

NDN050024WBB INTROCAN CERTO IV CATHETER W/WING 24G(PU) 10.5

NDN050024WBD IV CATHETER 24G(TEFLON) 9.5

947

特材代碼 中英文名稱 支付點數-104/01/01

NDN051422WBB INTROCAN CERTO IV CATHETER W/WING (PU) 14:22G(產品型號

0405-6280,5780,5799,6264,7802)

10.5

NDN051622WBD IV CATHETER 16:22G(TEFLON) 9.5

NES010201NBA MAX-CORE DISPOSABLE BIOPSY INSTRUMENT 14:20G(自動式) 633

NES010804TZM "MD TECH"T-LOK BONE MARROW BIOPSY NEEDLES迪洛骨髓活體組織

切片針

598

NES0115011ZM BONE MARROW ASPIRATION NEEDLE 529

NES0118015ZM PEDIATRIC BONE MARROW NEEDLE 598

NES0182000ZM MD TECH SNARELOK BONE MARROW BIOPSY TRAY AND ACCESSORIES 598

NES01AM18NGP BONE MARROW ASPIRATION NEEDLE 529

NES01BM00XGP "GALLINI"BIOMID DISPOSABLE BONE MARROW ASPIRATION BIOPSY

NEEDLE"格利尼"可丟棄式骨髓吸取針

623

NES01BM13NGP BONE MARROW BIOPSY NEEDLE 598

NES01BMHN1ZM BONE MARROW HARVEST NEEDLE WITH SIDE HOLE 529

NES01BN160ZM OSTY CORE BONE BIOPSY NEEDLE 598

NES01MN120BA MAGNUM BIOPSY NEEDLE 633

NES01ST00NJ6 "CAREFUSION"STERNUM TEMNO DEVICE"卡弗迅"骨髓抽吸針 623

NES01TC00XC8 T-HANDLE JAMSHIDI BONE MARROW BIOPSY /ASPIRATION NEEDLES 623

NES01TC00XJ6 "CAREFUSION"T-HANDLE JAMSHIDI BONE MARROW

BIOPSY/ASPIRATION NEEDLES"卡弗迅"介入體骨髓切片/組織抽取

623

NES01TN00XC8 ILLINOIS STERNAL/ILIAC BONE MARROW ASPIRATION NEEDLES 529

NES01TN00XJ6 "CAREFUSION"ILLINOIS STERNAL/ILIAC BONE MARROW ASPIRATION

NEEDLES"卡弗迅"伊利諾胸骨/腸骨骨髓抽取針

529

NES0310800ZM "MD TECH"BIOPINCE FULL CORE BIOPSY INSTRUMENT 10CM"美迪

克"拜爾賓全組織切片器

633

NES0312182BA "BARD"MONOPTY BIOPSY INSTRUMENT組織取樣針 633

NES031406NJ6 "CAREFUSION"TEMNO BIOPSY NEEDLES "卡弗迅"生檢針 611

NES0315800ZM BIOPINCE FULL CORE BIOPSY INSTRUMENT 15CM"美迪克"拜爾賓全

組織切片器

633

NES0320800ZM BIOPINCE FULL CORE BIOPSY INSTRUMENT 20CM"美迪克"拜爾賓全

組織切片器

633

NES03315SDJU "PAJUNK"DELTA CUT BIOPSY SYSTEM生檢穿刺套管組14:20G 611

NES0370111ZM SUPER-CORE II ADJUSTABLE BIOPSY INSTRUMENT 彈簧組織切片針 611

NES0376260ZN ULTRA CORE BIOPSY NEEDLE FOR USE WITH BARD MAGNUM BIOPSY

INSTRUMENT(AUTOMATIC)

633

NES0376311ZR TRU-CORE II AUTOMATIC DISPOSABLE BIOPSY DEVICE 633

NES0376501ZM PRO-MAG AUTOMATIC BIOPSY NEEDLE 633

NES0376502ZM PRO-MAG AUTOMATIC BIOPSY NEEDLE 633

NES0376511ZM PRO-MAG AUTOMATIC BIOPSY NEEDLE 633

NES03TM14NGP SPRING LOADED BIOPSY NEEDLE(自動彈簧切片針) 611

NES03TM16NGP SPRING LOADED BIOPSY NEEDLE(自動彈簧切片針) 611

NES03TZ14NGP SPRING LOADED BIOPSY NEEDLE(自動彈簧切片針) 611

NES041218ABA "BARD"MONOPTY DISPOSABLE BIOPSY INSTRUMENT+TRUGUIDE

COAXIAL BIOPSY NEEDLE組織取樣針+同軸導引針

1380

NES041356NJ6 "CAREFUSION"UNIVERSAL COAXIAL INTRODUCER NEEDLE(STERILE)"

卡弗迅"同軸導引針(滅菌)*給付規定請見備註欄

889

NES041MBS9ZM "MD TECH"SUPER-CORE II ADJUSTABLE BIOPSY INSTRUMENT+MD

TECH CO-AXIAL INTRODUCER NEEDLE切片針+同軸導引針*適應症請

見備註欄

1380

948

特材代碼 中英文名稱 支付點數-104/01/01

NES04415SDJU “帕將克”生檢器+同軸導引針“PAJUNK”DELTACUT BIOPSY

SYSTEM + UNIVERSAL COAXIAL SLEEVE NEEDLE SET

1380

NES04ACNMFG5 "ANGIOTECH"ACN BIOPSY NEEDLES WITH CO-AXIAL NEEDLE愛仕恩

切片針(同軸庫針組)14-20G*適應症請見備註欄

1380

NES04C12ABBA "BARD"BIOPSY NEEDLE SYSTEM-TRUGUIDE COAXIAL BIOPSY

NEEDLE"巴德"組織取樣針-同軸組織取樣針*適應證請見備註欄

889

NES04CT14NJ6 "CAREFUSION"TEMNO BIOPSY NEEDLE + UNIVERSAL COAXIAL

INTRODUCER NEEDLE"卡弗迅"生檢針+同軸導引針*適應症請見備註

1380

NES04MCTGABA "BARD"MAX-CORE DISPOSABLE BIOPSY INSTRUMENT+TRUGUIDE

COAXIAL BIOPSY NEEDLE組織取樣針+同軸導引針

1380

NES04MCXS0ZM "MD TECH"CO-AXIAL INTRODUCER NEEDLE"美迪克"同軸導引針*適

應症請見備註欄

889

NES04MCXS1ZM "MD TECH"CO-AXIAL INTRODUCER NEEDLE"美迪克"同軸導引針*適

應症請見備註欄

889

NES04QCS01CK "COOK"COAXIAL QUICK-CORE BIOPSY SETS"曲克"拋棄式取樣針

(組)(同軸庫)*適應症請見備註欄

1380

RRB0117301TX 泰利福”誘發性肺量計“TELEFLEX” INCENTIVE SPIROMETERS-

TRIFLO*給付規定請見備註欄

177

RRB0219009TX 泰利福”誘發性肺量計“TELEFLEX” INCENTIVE SPIROMETERS-

VOLDYNE5000*給付規定請見備註欄

140

RRB0219025TX 泰利福”誘發性肺量計“TELEFLEX” INCENTIVE SPIROMETERS-

VOLDYNE2500*給付規定請見備註欄

140

RRB024301NGF GALEMED SPIROMETER AND ACCESSORY*適應症請見備註欄 140

RRB024311NGF ”崇仁”三球式呼吸訓練器"及配件GALEMED"TRI-BALLS

INCENTIVE SPIROMETER AND ACCESSORY*適應症請見備註欄

177

RRB0293100EF "貝斯美德" 誘發型肺量計"BESMED" INCENTIVE SPIROMETER 177

SAS026025S2C "柯惠"GIA自動手術縫合器 "COVIDIEN"AUTO SUTURE MULTIFIRE

GIA DISPOSABLE SURGICAL STAPLER *適應症請見備註欄

2459

SAS02MLC60J8 "南京邁迪欣" 一次性使用直線型切割吻和器和釘倉"NANJING

MAIDIXIN" DISPOSABLE LINEAR CUTTER AND CARTRIDGE*適應症請

見備註欄

2403

SAS02MLC80J8 "南京邁迪欣" 一次性使用直線型切割吻和器和釘倉"NANJING

MAIDIXIN" DISPOSABLE LINEAR CUTTER AND CARTRIDGE*適應症請

見備註欄

2459

SAS02NTLC5ET "愛惜康"直線形切割縫合器和可調節釘匣"ETHICON ENDO-

SURGERY"LINEAR CUTTER 55MM AND SELECTABLE

CARTRIDGE/RELOADS(55MM)

2403

SAS02NTLC7ET "愛惜康"直線形切割縫合器和可調節釘匣"ETHICON ENDO-

SURGERY"LINEAR CUTTER 75MM AND SELECTABLE

CARTRIDGE/RELOADS(75MM)

2459

SAS02TCT55JJ LINEAR CUTTER SAFETY LOCKOUT 55MM 腸胃自動縫合器 ※適應症

請見備註欄

2403

SAS02TLC55JJ TITANIUM LINEAR CUTTER 55MM 腸胃自動縫合器 55MM ※適應症

請見備註欄

2403

SAS02TLC75JJ LINEAR CUTTER SAFETY LOCKOUT 75MM 腸胃自動縫合器 ※適應症

請見備註欄

2459

SAS02TLHNNJJ TITANIUM LINEAR STAPLE 30,60,90MM (自動縫合器+釘)※適應症

請見備註欄

2300

SAS03CDHXAET 愛惜康彎型管腔吻合器ETHICON ENDO-SURGERY CURVED

INTRALUMINAL STAPLERS(ILS)21,25,29,33MM

5196

SAS03CDHXXET "愛惜康"普克美釘合器"ETHICON"PROXIMATE ILS INTRALUMINAL

STAPLER*適應症請見備註欄

5196

949

特材代碼 中英文名稱 支付點數-104/01/01

SAS03EEA252C "柯惠"一次性彎形端對端縫合器 "COVIDIEN" AUTO SUTURE CEEA

SINGLE USE STAPLERS *適應症請見備註欄

5196

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5196

SAS03PCEAT2C "柯惠"自動手術縫合器及縫合釘 "COVIDIEN" PREMIUM PLUS CEEA

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5196

SAS03PCEEA2C "柯惠"自動手術縫合器及縫合釘“COVIDIEN” AUTO SUTURE EEA

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5196

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5196

SAS03SDHXAET 愛惜康直線型管腔吻合器ETHICON ENDO-SURGERY STRAIGHT

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5196

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2293

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2153

SAU01154272C "柯惠"TA自動手術縫合器及縫合釘 "COVIDIEN" AUTO SUTURE TA

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2293

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2293

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2153

SAU01MLSA3J8 "南京邁迪欣" 一次性使用直線型吻和器和釘倉"NANJING

MAIDIXIN" DISPOSABLE LINEAR STAPLER AND CARTRIDGE 30*適應

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2293

SAU01MLSA9J8 "南京邁迪欣" 一次性使用直線型吻和器和釘倉"NANJING

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2153

SAU01MLSC3J8 "南京邁迪欣" 一次性使用直線型吻和器和釘倉"NANJING

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2293

SAU01MLSC9J8 "南京邁迪欣" 一次性使用直線型吻和器和釘倉"NANJING

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2153

SAU01TA30L2C "柯惠" TA自動手術縫合器及縫合釘 "COVIDIEN" TA STAPLERS

AND LOADING UNITS

2293

SAU01TA90L2C "柯惠" TA自動手術縫合器及縫合釘 "COVIDIEN" TA STAPLERS

AND LOADING UNITS

2153

SAU01TRH90JJ "ETHICON"DISPOSABLE STAPLER-PROXIMATE LINEAR RELOADING

UNIT( TITANIUM)90MM ※適應症請見備註欄

2153

SAU01XR30BJJ PROXIMATE RELOADABLE LINEAR STAPLER 30MM 3.5LEG,4.8LEG ※

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2293

SAU026025L2C "柯惠"GIA自動手術縫合器 "COVIDIEN"AUTO SUTURE MULTIFIRE

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2239

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3900

950

特材代碼 中英文名稱 支付點數-104/01/01

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2239

SAU02TRT75JJ RELOAD LINEAR CUTTER 75MM 腸胃自動縫合釘 ※適應症請見備註

2239

SAU03102142C "柯惠"自動手術縫合器及縫合釘"COVIDIEN" AUTO SUTURE EEA

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5087

SAU07304122C "柯惠" GIA自動手術縫合器-縫合釘匣"Covidien" AUTO

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5956

SAU07304162C "柯惠" GIA自動手術縫合器-縫合釘匣"Covidien" AUTO

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4000

SAU07304262C "柯惠" GIA自動手術縫合器-縫合釘匣"Covidien" AUTO

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4900

SAU07304502C "柯惠"GIA自動手術縫合器-旋轉式釘匣(30MM)"Covidien" AUTO

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4000

SAU07304532C "柯惠"GIA自動手術縫合器-旋轉式釘匣(45MM)"COVIDIEN" AUTO

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4900

SAU07304562C "柯惠"GIA自動手術縫合器-旋轉式釘匣(60MM)"COVIDIEN" AUTO

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5956

SAU07CEC30J8 "南京邁迪欣"一次性使用旋轉切割吻合器-30MM縫合釘匣"Nanjing

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STAPLE

4000

SAU07CEC45J8 " 南京邁迪欣" 一次性使用旋轉切割吻合器-45MM縫合釘匣"

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Use-45MM STAPLE

4900

SAU07CEC60J8 " 南京邁迪欣" 一次性使用旋轉切割吻合器-60MM縫合釘匣"

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5956

SAU07CFC30J8 "南京邁迪欣"一次性使用旋轉切割吻合器-30MM縫合釘匣"Nanjing

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STAPLE

4000

SAU07CFC45J8 " 南京邁迪欣" 一次性使用旋轉切割吻合器-45MM縫合釘匣"

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4900

SAU07CFC60J8 "南京邁迪欣"一次性使用旋轉切割吻合器-60MM縫合釘匣"Nanjing

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5956

SAU07ECR45ET "愛惜康"愛喜龍45安德派思縫合釘" Ethicon" ECHELON 45

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4802

SAU07ECR60ET "愛惜康"愛喜龍安德派思縫合釘"ETHICON" ECHELON 60 ENDOPATH

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5756

SAU07TR45BET "愛惜康"安德派思切割縫合釘"ETHICON" ENDOPATH ENDOSCOPIC

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4802

SCV010412LV7 "維達力克" 鈦金屬血管夾系統(大)"VITALITEC" SLS-CLIP

TITANIUM HEMOSTATIC CLIP SYSTEM

35

SCV0104200TX "TELEFLEX" HORIZON METAL LIGATING CLIPS "泰利芙斯"金屬血

管夾(大) 6;24 CLIPS/排(L)

35

SCV010912LV7 "維達力克" 鈦金屬血管夾(大)"VITALITEC" NINE CLIP TITANIUM

HEMOSTATIC CLIP SYSTEM(LARGE)

35

951

特材代碼 中英文名稱 支付點數-104/01/01

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SCV029400NM1 SUGITA ANEURYSM CLIP (STANDARD TYPE) 2256

SCV029401NM1 SUGITA ANEURYSM CLIP (LARGE TYPE) 2801

SCV029402NM1 SUGITA ANEURYSM CLIP (LARGE TYPE) 2801

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SCV029406SM1 SUGITA ANEURYSM CLIP (LARGE TYPE) 2801

SCV0294073M1 SURGITA ANEURYSM CLIPS LARGE TYPE N0.73 2801

SCV029407NM1 SUGITA ANEURYSM CLIP (LARGE TYPE) 2801

SCV02FE60NAE ANEURYSM CLIP 2602

SCV0300005ET LIGACLIP MULTIPLE CLIP APPLIER多釘縫合釘 175

SCV031112CRG 內視鏡多發式可重複使用血管夾"MICROLINE"M/L-10 ENDOSCOPIC

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175

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175

SCV03530MLCH "康美"拋棄式血管夾 "CONMED" DISPOSABLE CLIP APPLIER 175

SCV03615ML2C ”柯惠”內視鏡自動血管夾 "COVIDIEN" ENDO CLIP SINGLE USE

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175

SCV03625LL2C ”柯惠”內視鏡自動血管夾 "COVIDIEN" ENDO CLIP SINGLE USE

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200

SCV03EL5MLET "愛惜康"5毫米腹腔鏡多釘縫合器"ETHICON"LIGAMAX5 5MM

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200

TBCT10023TVR "EAGLE LABS"MANUAL OPHTHALMIC SURGICAL INSTRUMENT-

LACRIMAL INTUBATION SET"老鷹"手動式眼科手術器械-鼻淚管通

1773

TBCT10027TVR "EAGLE LABS"MANUAL OPHTHALMIC SURGICAL INSTRUMENT-

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1773

TBCT102836HV "艾伯特海斯"手動式眼科手術器械-鼻淚管通條"ALBERT

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1773

TBCT109600W5 CRAWFORD LARCRIMAL INTUBATION SET鼻淚管通條 1773

TBCT1L1S27QT "QUEST"MANUAL OPHTHALMIC SURGICAL INSTRUMENT:LACRIMAL

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1773

TBS01510101Z FCI SCLERAL BUCKLING IMPLANTS-BAND "佛朗惜眼"鞏膜環扣物 463

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TKP0113509WF EHL 9FR 電擊線 3477

TKP0113713WF EHL 3.5FR 電擊線 3477

TKP0113715WF EHL 5FR 電擊線 3477

TKP012280NWF LITHOTRIPTER:RIWOLITH PROBES 2280.XXX 3477

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TKP0425000ZM 〝MD TECH〞BREAST LOCALIZATION NEEDLE(NEEDLE+HOOK WIRE)〝

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984

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984

TKP0460100XL "首馬特"乳房定位針"SOMATEX"BREAST LOCALIZATION

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1287

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984

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984

952

特材代碼 中英文名稱 支付點數-104/01/01

TKP04BREASBA "BARD"BREAST LOCALIZATION NEEDLE(NEEDLE+WIRE)"巴德"乳房定

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984

TKP04DKBL1CK "COOK" DISPOSABLE (KOPANS)BREAST LESION LOCALIZATION

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984

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1287

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1287

TKP04EZN2X1G "E-Z-EM"PERCUGUIDE LESION MARKING SYSTEM(NEEDLE+HOOK

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984

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1287

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1123

TKVC10506NQQ "麥可威視"手動式眼科手術器械:玻璃體切除探頭(自103.08.01

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TKVC105124QQ "麥可威視"手動式眼科手術器械:玻璃體切除探頭(自103.08.01

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TKVC107402A1 STANDALONE ACCURUS PROBE(自103.08.01起支付標準醫令代碼

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TKVC12405CZS "米睿"玻璃體切割系統配件(切除刀)(自103.08.01起支付標準醫

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TKVC1267012D "竇可"歐索德晶體乳化切割儀:高速晶體切除器(自103.08.01起支

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TKVC201006A1 ANTERIOR ADVANCE TECHNOLOGY IRRIGATION OCUTOME PROBE

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TKVC208012A1 ANTERIOR VITRECTOMY PROBE(自103.08.01起支付標準醫令代碼

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TKVC244006B9 "博士倫"曙光超音波乳化儀:前房玻璃體切除刀(自103.08.01起支

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18

WBB0406050TW ELASTIC BANDAGE*適應症請見備註欄 18

WBB0406050UQ "U.A.TOP"ELASTIC BANDAGE(NON-STERILE)6"X5Y"優亞特"彈性繃

帶(未滅菌*適應症請見備註欄)

18

WBB0406050YS ELASTIC BANDAGE 6"x5Y※適應症請見備註欄 18

WBB0406050ZB ELASTIC BANDAGE*適應症請見備註欄 18

WBB0702050AZ PLASTER OF PARIS BANDAGE 2"x5Y 22.7

WBB0703030A5 CAST BANDAGE 22.7

WBB0703030AZ "M&A"POP PLASTER OF PARIS BANDAGE EXTRA FAST SETTING

3"X3Y石膏繃帶

22.7

954

特材代碼 中英文名稱 支付點數-104/01/01

WBB0703030C7 "CSD"PLASTER OF PAIRS BANDAGE (non-sterile)3"X3Y"中衛"石

膏繃帶(未滅菌)

22.7

WBB0703030NJ PLASTER BANDAGE 3"X3Y 22.7

WBB0703030QP "POP"PLASTER OF PARIS BANDAGE(NON-STERILE)3"X3Y"披歐披"石

膏繃帶(未滅菌)

22.7

WBB0703030U6 PLASTER OF PARIS BANDAGE 3"X3Y 22.7

WBB0703030ZD DUK-IN PLASTER BANDAGE 22.7

WBB0703031NS NOK-SAN CAST PLASTER BANDAGE石膏繃帶3"X3Y 22.7

WBB0703050AZ PLASTER OF PARIS BANDAGE 3"X5Y 30.9

WBB0703050C7 CAST BANDAGE 30.9

WBB0703050JX "ANJI JIXIANG"PLASTER OF PARIS BANDAGES(NON-STERILE)"安吉

吉祥"石膏繃帶(未滅菌)3"X5Y

30.9

WBB0703050QP "POP"PLASTER OF PARIS BANDAGE(NON-STERILE)3"X5Y"披歐披"石

膏繃帶(未滅菌)

30.9

WBB0703050U6 PLASTER OF PARIS BANDAGE 3"X5Y 30.9

WBB0704030U6 PLASTER OF PARIS BANDAGE 4"X3Y 24.4

WBB0704040U6 PLASTER OF PARIS BANDAGE 4"X4Y 34.1

WBB0704040ZD DUK-IN PLASTER BANDAGE 34.1

WBB0704050A5 CAST BANDAGE 38.1

WBB0704050AZ PLASTER OF PARIS BANDAGE 4"X5Y 38.1

WBB0704050C7 "CSD"PLASTER OF PAIRS BANDAGE (non-sterile)4"X5Y"中衛"石

膏繃帶(未滅菌)

38.1

WBB0704050JX "ANJI JIXIANG"PLASTER OF PARIS BANDAGES(NON-STERILE)"安吉

吉祥"石膏繃帶(未滅菌)4"X5Y

38.1

WBB0704050NJ PLASTER BANDAGE 4"X5Y 38.1

WBB0704050NS NOK-SAN CAST PLASTER BANDAGE 10CMX4.5M(4"X5Y) 38.1

WBB0704050QP "POP"PLASTER OF PARIS BANDAGE(NON-STERILE)4"X5Y"披歐披"石

膏繃帶(未滅菌)

38.1

WBB0704050U6 PLASTER OF PARIS BANDAGE 4"X5Y 38.1

WBB0704051A5 "ALCARE"P&O PLASTER OF PARIS BANDAGE 4"X5Y(10CMX4.5M)"愛

樂康"石膏繃帶

38.1

WBB0705050AZ "M&A"POP PLASTER OF PARIS BANDAGE EXTRA FAST SETTING

5"X5Y石膏繃帶

48.8

WBB0705050NJ PLASTER BANDAGE 5"X5Y 48.8

WBB0705050QP "POP"PLASTER OF PARIS BANDAGE(NON-STERILE)5"X5Y"披歐披"石

膏繃帶(未滅菌)

48.8

WBB0705050U6 PLASTER OF PARIS BANDAGE 5"X5Y 48.8

WBB0706030U6 PLASTER OF PARIS BANDAGE 6"X3Y 38

WBB0706040U6 PLASTER OF PARIS BANDAGE 6"X4Y 47

WBB0706040ZD DUK-IN PLASTER BANDAGE 47

WBB0706050A5 "Alcare"casting 6"x5y 50.1

WBB0706050AZ PLASTER OF PARIS BANDAGE 6"X5Y 50.1

WBB0706050C7 "CSD"PLASTER OF PAIRS BANDAGE (non-sterile)6"X5Y"中衛"石

膏繃帶(未滅菌)

50.1

WBB0706050JX "ANJI JIXIANG"PLASTER OF PARIS BANDAGES(NON-STERILE)"安吉

吉祥"石膏繃帶(未滅菌)6"X5Y

50.1

WBB0706050NJ PLASTER BANDAGE 6"X5Y 50.1

WBB0706050NS NOK-SAN CAST PLASTER BANDAGE 15CMX4.5M(6"X5Y) 50.1

WBB0706050QP "POP"PLASTER OF PARIS BANDAGE(NON-STERILE)6"X5Y"披歐披"石

膏繃帶(未滅菌)

50.1

WBB0706050U6 PLASTER OF PARIS BANDAGE 6"X5Y 50.1

WBB0706051A5 "ALCARE"P&O PLASTER OF PARIS BANDAGE 6"X5Y(15CMX4.5M)"愛

樂康"石膏繃帶

50.1

955

特材代碼 中英文名稱 支付點數-104/01/01

WBB0801020KB "KOB"KOBRA CAST 易速石膏繃帶(聚脂石膏繃帶)1吋X2碼*適應症

請見備註欄

85

WBB08020402B "瑪迪安納"樹脂石膏繃帶(未滅菌)"MEDIANA" CASTING TAPE

(NON-STERILE)

120

WBB08020403M SCOTCHCAST PLUS CASTING TAPE玻璃纖維石膏繃帶2吋X4碼*適應

症請見備註欄

120

WBB0802040HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE)樹脂石膏繃帶

(聚脂纖維)2吋X4.4碼*適應症請見備註欄

120

WBB0802040K3 "KANGDA"ORTHOPEDIC CASTING TAPE樹脂石膏繃帶(玻璃纖維)2吋4

碼*適應症請見備註欄

120

WBB0802040KB "KOB"KOBRA CAST 易速石膏繃帶(聚脂石膏繃帶)2吋X4碼*適應症

請見備註欄

196

WBB0802040Q3 "DONG HAE"ORTHOPEDIC CASTING TAPE輕石膏(玻璃纖維)2吋X4碼*

適應症請見備註欄

120

WBB0802040Q5 "S&F"ROBO CASTING TAPE若玻樹脂石膏繃帶(聚脂纖維)2吋X4碼*

適應症請見備註欄

120

WBB0802040Q6 NEMOA CAST ORTHOPAEDIC CASTING TAPE(POLYESTER)米尼亞聚脂

繃帶2吋X4碼*使用規範請見備註欄

120

WBB0802040Q7 "KJC"PP-BAND CASTING TAPE必庇綁樹脂石膏(聚脂纖維)2吋X4碼*

適應症請見備註欄

120

WBB0802040Q8 "OPTIMA CAST"ORTHOPAEDIC CASTING TAPE(NON-STERILE)樹脂石

膏繃帶(玻璃纖維)2吋X4碼*適應症請見備註欄

120

WBB0802040Q9 "TOMATO"ORTHOPAEDIC CASTING TAPE(NON-STERILE)玻璃纖維石膏

繃帶2吋X4碼*適應症請見備註欄

120

WBB0802040YK "CONNECT"ORTHOPEDIC CASTING TAPE 2"X4Y(5.0CMX360CM)(NON-

STERILE)"可耐特"樹脂石膏繃帶(未滅菌)*適應症請見備註欄

120

WBB08020413M SCOTCHCAST PREMIUM CASTING TAPE玻璃纖維石膏繃帶2吋X4碼*適

應症請見備註欄

120

WBB0802041HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NEAL CAST FIBERGLASS

ALPHA TYPE)樹脂石膏繃帶(玻璃纖維)2吋X4.4碼*適應症請見備註

120

WBB0802041NJ POLYESTER CAST TAPE聚脂纖維石膏繃帶2吋X4Y*使用規範請見備

註欄

120

WBB08030402B "瑪迪安納"樹脂石膏繃帶(未滅菌) "MEDIANA" CASTING TAPE

(NON-STERILE)

140

WBB08030403M SCOTCHCAST PLUS CASTING TAPE玻璃纖維石膏繃帶3吋X4碼*適應

症請見備註欄

140

WBB0803040HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE)樹脂石膏繃帶

(聚脂纖維)3吋X4.4碼*適應症請見備註欄

140

WBB0803040K3 "KANGDA"ORTHOPEDIC CASTING TAPE樹脂石膏繃帶(玻璃纖維)3吋4

碼*適應症請見備註欄

140

WBB0803040KB "KOB"KOBRA CAST 易速石膏繃帶(聚脂石膏繃帶)3吋X4碼*適應症

請見備註欄

230

WBB0803040NJ FIBERGLASS CAST TAPE玻璃纖維石膏繃帶3吋X4Y*使用規範請見備

註欄

140

WBB0803040Q3 "DONG HAE"ORTHOPEDIC CASTING TAPE輕石膏(玻璃纖維)3吋X4碼*

適應症請見備註欄

140

WBB0803040Q5 "S&F"ROBO CASTING TAPE若玻樹脂石膏繃帶(聚脂纖維)3吋X4碼*

適應症請見備註欄

140

WBB0803040Q6 NEMOA CAST ORTHOPAEDIC CASTING TAPE(POLYESTER)米尼亞聚脂

繃帶3吋X4碼*使用規範請見備註欄

140

WBB0803040Q7 "KJC"PP-BAND CASTING TAPE必庇綁樹脂石膏(聚脂纖維)3吋X4碼*

適應症請見備註欄

140

956

特材代碼 中英文名稱 支付點數-104/01/01

WBB0803040Q8 "OPTIMA CAST"ORTHOPAEDIC CASTING TAPE(NON-STERILE)樹脂石

膏繃帶(玻璃纖維)3吋X4碼*適應症請見備註欄

140

WBB0803040Q9 "TOMATO"ORTHOPAEDIC CASTING TAPE(NON-STERILE)玻璃纖維石膏

繃帶3吋X4碼*適應症請見備註欄

140

WBB0803040YK "CONNECT"ORTHOPEDIC CASTING TAPE 3"X4Y(7.5CMX360CM)(NON-

STERILE)"可耐特"樹脂石膏繃帶(未滅菌)*適應症請見備註欄

140

WBB08030413M SCOTCHCAST PREMIUM CASTING TAPE玻璃纖維石膏繃帶3吋X4碼*適

應症請見備註欄

140

WBB0803041HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NEAL CAST FIBERGLASS

ALPHA TYPE)樹脂石膏繃帶(玻璃纖維)3吋X4.4碼*適應症請見備註

140

WBB0803041NJ POLYESTER CAST TAPE聚脂纖維石膏繃帶3吋X4Y*使用規範請見備

註欄

140

WBB08040402B "瑪迪安納"樹脂石膏繃帶(未滅菌)"MEDIANA" CASTING TAPE

(NON-STERILE)

160

WBB08040403M SCOTCHCAST PLUS CASTING TAPE玻璃纖維石膏繃帶4吋X4碼*適應

症請見備註欄

160

WBB0804040HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE)樹脂石膏繃帶

(聚脂纖維)4吋X4.4碼*適應症請見備註欄

160

WBB0804040K3 "KANGDA"ORTHOPEDIC CASTING TAPE樹脂石膏繃帶(玻璃纖維)4吋4

碼*適應症請見備註欄

160

WBB0804040KB "KOB"KOBRA CAST 易速石膏繃帶(聚脂石膏繃帶)4吋X4碼*適應症

請見備註欄

265

WBB0804040NJ FIBERGLASS CAST TAPE玻璃纖維石膏繃帶4吋X4Y*使用規範請見備

註欄

160

WBB0804040Q3 "DONG HAE"ORTHOPEDIC CASTING TAPE輕石膏(玻璃纖維)4吋X4碼*

適應症請見備註欄

160

WBB0804040Q5 "S&F"ROBO CASTING TAPE若玻樹脂石膏繃帶(聚脂纖維)4吋X4碼*

適應症請見備註欄

160

WBB0804040Q6 NEMOA CAST ORTHOPAEDIC CASTING TAPE(POLYESTER)米尼亞聚脂

繃帶4吋X4碼*使用規範請見備註欄

160

WBB0804040Q7 "KJC"PP-BAND CASTING TAPE必庇綁樹脂石膏(聚脂纖維)4吋X4碼*

適應症請見備註欄

160

WBB0804040Q8 "OPTIMA CAST"ORTHOPAEDIC CASTING TAPE(NON-STERILE)樹脂石

膏繃帶(玻璃纖維)4吋X4碼*適應症請見備註欄

160

WBB0804040Q9 "TOMATO"ORTHOPAEDIC CASTING TAPE(NON-STERILE)玻璃纖維石膏

繃帶4吋X4碼*適應症請見備註欄

160

WBB0804040YK "CONNECT"ORTHOPEDIC CASTING TAPE 4"X4Y(10.0CMX360CM)(NON-

STERILE)"可耐特"樹脂石膏繃帶(未滅菌)*適應症請見備註欄

160

WBB08040413M SCOTCHCAST PREMIUM CASTING TAPE玻璃纖維石膏繃帶4吋X4碼*適

應症請見備註欄

160

WBB0804041HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NEAL CAST FIBERGLASS

ALPHA TYPE)樹脂石膏繃帶(玻璃纖維)4吋X4.4碼*適應症請見備註

160

WBB0804041NJ POLYESTER CAST TAPE聚脂纖維石膏繃帶4吋X4Y*使用規範請見備

註欄

160

WBB08050402B "瑪迪安納"樹脂石膏繃帶(未滅菌)"MEDIANA" CASTING TAPE

(NON-STERILE)

180

WBB08050403M SCOTCHCAST PLUS CASTING TAPE玻璃纖維石膏繃帶5吋X4碼*適應

症請見備註欄

180

WBB0805040HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE)樹脂石膏繃帶

(聚脂纖維)5吋X4.4碼*適應症請見備註欄

180

957

特材代碼 中英文名稱 支付點數-104/01/01

WBB0805040K3 "KANGDA"ORTHOPEDIC CASTING TAPE樹脂石膏繃帶(玻璃纖維)5吋4

碼*適應症請見備註欄

180

WBB0805040KB "KOB"KOBRA CAST 易速石膏繃帶(聚脂石膏繃帶)5吋X4碼*適應症

請見備註欄

334

WBB0805040NJ FIBERGLASS CAST TAPE玻璃纖維石膏繃帶5吋X4Y*使用規範請見備

註欄

180

WBB0805040Q3 "DONG HAE"ORTHOPEDIC CASTING TAPE輕石膏(玻璃纖維)5吋X4碼*

適應症請見備註欄

180

WBB0805040Q5 "S&F"ROBO CASTING TAPE若玻樹脂石膏繃帶(聚脂纖維)5吋X4碼*

適應症請見備註欄

180

WBB0805040Q6 NEMOA CAST ORTHOPAEDIC CASTING TAPE(POLYESTER)米尼亞聚脂

繃帶5吋X4碼*使用規範請見備註欄

180

WBB0805040Q7 "KJC"PP-BAND CASTING TAPE必庇綁樹脂石膏(聚脂纖維)5吋X4碼*

適應症請見備註欄

180

WBB0805040Q8 "OPTIMA CAST"ORTHOPAEDIC CASTING TAPE(NON-STERILE)樹脂石

膏繃帶(玻璃纖維)5吋X4碼*適應症請見備註欄

180

WBB0805040Q9 "TOMATO"ORTHOPAEDIC CASTING TAPE(NON-STERILE)玻璃纖維石膏

繃帶5吋X4碼*適應症請見備註欄

180

WBB0805040YK "CONNECT"ORTHOPEDIC CASTING TAPE 5"X4Y(12.5CMX360CM)(NON-

STERILE)"可耐特"樹脂石膏繃帶(未滅菌)*適應症請見備註欄

180

WBB08050413M SCOTCHCAST PREMIUM CASTING TAPE玻璃纖維石膏繃帶5吋X4碼*適

應症請見備註欄

180

WBB0805041HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NEAL CAST FIBERGLASS

ALPHA TYPE)樹脂石膏繃帶(玻璃纖維)5吋X4.4碼*適應症請見備註

180

WBB0805041NJ POLYESTER CAST TAPE聚脂纖維石膏繃帶5吋X4Y*使用規範請見備

註欄

180

WBB0806040K3 "KANGDA"ORTHOPEDIC CASTING TAPE樹脂石膏繃帶(玻璃纖維)6吋4

碼*適應症請見備註欄

200

WBB0806040Q3 "DONG HAE"ORTHOPEDIC CASTING TAPE輕石膏(玻璃纖維)6吋X4碼*

適應症請見備註欄

200

WBB0806040Q5 "S&F"ROBO CASTING TAPE若玻樹脂石膏繃帶(聚脂纖維)6吋X4碼*

適應症請見備註欄

207

WBB0806040Q6 NEMOA CAST ORTHOPAEDIC CASTING TAPE(POLYESTER)米尼亞聚脂

繃帶6吋X4碼*使用規範請見備註欄

207

WBB0806040YK "CONNECT"ORTHOPEDIC CASTING TAPE6"X4Y(15.0CMX360CM)(NON-

STERILE)"可耐特"樹脂石膏繃帶(未滅菌)*適應症請見備註欄

207

WBB0815382A5 玻璃纖維石膏繃帶3吋X4碼*使用規範請見備註欄 140

WBB0815383A5 玻璃纖維石膏繃帶4吋X4碼*使用規範請見備註欄 160

WBB0817942A5 聚脂纖維石膏繃帶3吋X4碼*使用規範請見備註欄 140

WBB0817943A5 聚脂纖維石膏繃帶4吋X4碼*使用規範請見備註欄 160

WBB0817944A5 聚脂纖維石膏繃帶5吋X4碼*使用規範請見備註欄 180

WBB0820400HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE)樹脂石膏繃帶

(玻璃纖維)2吋X4.4碼*適應症請見備註欄

120

WBB0820400Q5 "S&F"ROBO CASTING TAPE若玻樹脂石膏繃帶(玻璃纖維)2吋X4碼*

適應症請見備註欄

120

WBB0830400HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE)樹脂石膏繃帶

(玻璃纖維)3吋X4.4碼*適應症請見備註欄

140

WBB0840400HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE)樹脂石膏繃帶

(玻璃纖維)4吋X4.4碼*適應症請見備註欄

160

WBB0850400HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE)樹脂石膏繃帶

(玻璃纖維)5吋X4.4碼*適應症請見備註欄

180

958

特材代碼 中英文名稱 支付點數-104/01/01

WBB0850400Q5 "S&F"ROBO CASTING TAPE若玻樹脂石膏繃帶(玻璃纖維)5吋X4碼*

適應症請見備註欄

180

WBP0102030YK "CONNECT"CAST COTTON PADDING(NON-

STERILE)2"X3Y(5CMX270CM)"可耐特"石膏棉捲(未滅菌)

8

WBP0102040GM "卓和"繃帶(棉捲繃帶)"GMTH" BANDAGE(COTTON BANDAGES) 11

WBP0102040JN OPTIMA PAD石膏棉捲 11

WBP0102040QB "CHUAN SHUN"COTTON BANDAGES(NON-STERILE) 2"X4Y"銓順"石膏

棉捲(未滅菌)

11

WBP0103030C7 CSD ORTHOPAEDIC CAST COTTON PADDING 13

WBP0103030DQ SABHARWAL'S BANDAGE ORTHOPAEDIC CAST PADDING 13

WBP0103030YK "CONNECT"CAST COTTON PADDING(NON-

STERILE)3"X3Y(7.5CMX270CM)"可耐特"石膏棉捲(未滅菌)

13

WBP0103040C7 CSD ORTHOPAEDIC CAST COTTON PADDING 12.8

WBP0103040FC ORTHOPEDIC COTTON BANDAGE 12.8

WBP0103040GM "卓和"繃帶(棉捲繃帶)"GMTH" BANDAGE(COTTON BANDAGES) 12.8

WBP0103040JN OPTIMA PAD石膏棉捲 12.8

WBP0103040JX "ANJI JIXIANG"UNDERCAST PADDING BANDAGE(NON-STERILE)

3"X4Y"安吉吉祥"棉捲(未滅菌)

12.8

WBP0103040KF ORTHOPEDIC COTTON BANDAGE 12.8

WBP0103040QB "CHUAN SHUN"COTTON BANDAGES(NON-STERILE) 3"X4Y"銓順"石膏

棉捲(未滅菌)

12.8

WBP0104030C7 CSD ORTHOPAEDIC CAST COTTON PADDING 12.8

WBP0104030YK "CONNECT"CAST COTTON PADDING(NON-

STERILE)4"X3Y(10CMX270CM)"可耐特"石膏棉捲(未滅菌)

12.8

WBP0104033DQ ORTHOPAEDIC CAST PADDING 12.8

WBP0104040BP B.P.I UNDER CAST PADDING BANDAGE COTTON 17.3

WBP0104040C7 CSD ORTHOPAEDIC CAST COTTON PADDING 17.3

WBP0104040FC ORTHOPEDIC COTTON BANDAGE 17.3

WBP0104040GM "卓和"繃帶(棉捲繃帶)"GMTH" BANDAGE(COTTON BANDAGES) 17.3

WBP0104040JN OPTIMA PAD石膏棉捲 17.3

WBP0104040JX "ANJI JIXIANG"UNDERCAST PADDING BANDAGE(NON-STERILE)

4"X4Y"安吉吉祥"棉捲(未滅菌)

17.3

WBP0104040KF ORTHOPEDIC COTTON BANDAGE 17.3

WBP0104040NJ ORTHOPEDIC COTTON BANDAGE 17.3

WBP0104040QB "CHUAN SHUN"COTTON BANDAGES(NON-STERILE) 4"X4Y"銓順"石膏

棉捲(未滅菌)

17.3

WBP0104050C7 CSD ORTHOPAEDIC CAST COTTON PADDING 22.9

WBP0105040C7 CSD ORTHOPAEDIC CAST COTTON PADDING 22.9

WBP0106030C7 CSD ORTHOPAEDIC CAST COTTON PADDING 24

WBP0106030YK "CONNECT"CAST COTTON PADDING(NON-

STERILE)6"X3Y(15CMX270CM)"可耐特"石膏棉捲(未滅菌)

24

WBP0106033DQ ORTHOPAEDIC CAST PADDING 24

WBP0106040BP B.P.I UNDER CAST PADDING BANDAGE COTTON 25.6

WBP0106040C7 CSD ORTHOPAEDIC CAST COTTON PADDING 25.6

WBP0106040FC ORTHOPEDIC COTTON BANDAGE 25.6

WBP0106040GM "卓和"繃帶(棉捲繃帶)"GMTH" BANDAGE(COTTON BANDAGES) 25.6

WBP0106040JN OPTIMA PAD石膏棉捲 25.6

WBP0106040JX "ANJI JIXIANG"UNDERCAST PADDING BANDAGE(NON-STERILE)

6"X4Y"安吉吉祥"棉捲(未滅菌)

25.6

WBP0106040KF ORTHOPEDIC COTTON BANDAGE 25.6

WBP0106040NJ ORTHOPEDIC COTTON BANDAGE 25.6

WBP0106040QB "CHUAN SHUN"COTTON BANDAGES(NON-STERILE) 6"X4Y"銓順"石膏

棉捲(未滅菌)

25.6

WBP0106050A5 ORTHOPEDIC COTTON BANDAGE 31.5

959

特材代碼 中英文名稱 支付點數-104/01/01

WBP0106050C7 CSD ORTHOPAEDIC CAST COTTON PADDING 31.5

WBP0108030YK "CONNECT"CAST COTTON PADDING(NON-

STERILE)8"X3Y(20CMX270CM)"可耐特"石膏棉捲(未滅菌)

25.6

WDD0800008SN INTRASITE GEL 8GM *適應症請見備註欄 83.9

WDD08000153M 3M TEGADERM HYDROGEL WOUND FILLER(STERILE) 15GM水解凝膠*

適應症請見備註欄

140

WDD0800015SN INTRASITE GEL 15GM *適應症請見備註欄 140

WDD08000253M 3M TEGADERM HYDROGEL WOUND FILLER(STERILE)25GM水解凝膠*適

應症請見備註欄

276

WDD0800025SN INTRASITE GEL 25GM *適應症請見備註欄 276

WDD0800043SN "SMITH&NEPHEW"ALLEVYN ADHESIVE

DRESSING(STERILE)7.5CMX7.5CM"史耐輝"愛力膚親水性自黏敷料

(滅菌)*適應症請見備註欄

73

WDD0800044SN "SMITH&NEPHEW"ALLEVYN ADHESIVE

DRESSING(STERILE)12.5CMX12.5CM"史耐輝"愛力膚親水性自黏敷

料(滅菌)*適應症請見備註欄

177

WDD0800045SN "SMITH&NEPHEW"ALLEVYN ADHESIVE

DRESSING(STERILE)17.5CMX17.5CM"史耐輝"愛力膚親水性自黏敷

料(滅菌)*適應症請見備註欄

327

WDD0800046SN "SMITH&NEPHEW"ALLEVYN ADHESIVE

DRESSING(STERILE)22.5CMX22.5CM"史耐輝"愛力膚親水性自黏敷

料(滅菌)*適應症請見備註欄

395

WDD0800073SN "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL

DRESSING 7.5CMX7.5CM"史耐輝"愛力膚銀親水性抗菌敷料*適應症

請見備註欄

198

WDD0800078SN "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL

DRESSING 12.5CMX12.5CM"史耐輝"愛力膚銀親水性抗菌敷料*適應

症請見備註欄

320

WDD0800081SN "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL

DRESSING 17.5CMX17.5CM"史耐輝"愛力膚銀親水性抗菌敷料*適應

症請見備註欄

459

WDD0800083SN "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL

DRESSING 5CMX5CM"史耐輝"愛力膚銀親水性抗菌敷料*適應症請見

備註欄

56.4

WDD0800086SN "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL

DRESSING 10CMX10CM"史耐輝"愛力膚銀親水性抗菌敷料*適應症請

見備註欄

224

WDD0800089SN "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL

DRESSING 15CMX15CM"史耐輝"愛力膚銀親水性抗菌敷料*適應症請

見備註欄

406

WDD0800091SN "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL

DRESSING 20CMX20CM"史耐輝"愛力膚銀親水性抗菌敷料*適應症請

見備註欄

612

WDD0800248SN "SMITH&NEPHEW"ALLEVYN GENTLE SOFT GEL ADHESIVE

HYDROCELLULAR DRESSING 10CMX10CM"史耐輝"柔膠愛力膚敷料(滅

菌)*適應症請見備註欄

119

WDD0800249SN "SMITH&NEPHEW"ALLEVYN GENTLE SOFT GEL ADHESIVE

HYDROCELLULAR DRESSING 10CMX20CM"史耐輝"柔膠愛力膚敷料(滅

菌)*適應症請見備註欄

225

WDD0800250SN "SMITH&NEPHEW"ALLEVYN GENTLE SOFT GEL ADHESIVE

HYDROCELLULAR DRESSING 15CMX15CM"史耐輝"柔膠愛力膚敷料(滅

菌)*適應症請見備註欄

243

960

特材代碼 中英文名稱 支付點數-104/01/01

WDD0800251SN "SMITH&NEPHEW"ALLEVYN GENTLE SOFT GEL ADHESIVE

HYDROCELLULAR DRESSING 20CMX20CM"史耐輝"柔膠愛力膚敷料(滅

菌)*適應症請見備註欄

364

WDD0800270SN "SMITH & NEPHEW"ALLEVYN GENTLE BORDER

DRESSING(STERILE)10X10CM"史耐輝"矽膠愛力膚敷料(滅菌)*適應

症請見備註欄

119

WDD0800272SN "SMITH & NEPHEW"ALLEVYN GENTLE BORDER

DRESSING(STERILE)12.5X12.5CM"史耐輝"矽膠愛力膚敷料(滅菌)*

適應症請見備註欄

225

WDD0800273SN "SMITH & NEPHEW"ALLEVYN GENTLE BORDER

DRESSING(STERILE)17.5X17.5CM"史耐輝"矽膠愛力膚敷料(滅菌)*

適應症請見備註欄

364

WDD0800434SN "SMITH&NEPHEW"REPLICARE ULTRA HYDROCOLLOID WOUND

DRESSING(STERILE)10CMX10CM"史耐輝"力普佳敷料(滅菌)*給付規

定請見備註欄

53.2

WDD0800435SN "SMITH&NEPHEW"REPLICARE ULTRA HYDROCOLLOID WOUND

DRESSING(STERILE)15CMX15CM"史耐輝"力普佳敷料(滅菌)*給付規

定請見備註欄

116

WDD0800436SN "SMITH&NEPHEW"REPLICARE ULTRA HYDROCOLLOID WOUND

DRESSING(STERILE)20CMX20CM"史耐輝"力普佳敷料(滅菌)*給付規

定請見備註欄

192

WDD0800451SN "SMITH&NEPHEW"ALLEVYN DRESSING(SACRUM)22CMX22CM愛力膚親水

性的聚乙烯膚料*適應症請見備註欄

395

WDD0800505YY "CORELEADER" COLLA-ALGI FIBER WOUND DRESSING (STERILE) "

康力得"膠原藻酸纖維敷料(滅菌)※適應症請見備註欄

20.4

WDD0800510F4 DUODERM EXTRA THIN CGF DRESSING(2"x4") 5X10CM超薄型多愛膚

滅菌親水性敷料*給付規定請見備註欄。

41.1

WDD0800520F4 DUODERM EXTRA THIN CGF DRESSING (2"X8")5X20CM超薄型多愛膚

滅菌親水性敷料*適應症請見備註欄

53.2

WDD0800700SN "SMITH&NEPHEW"ALLEVYN DRESSING(SACRUM)17CMX17CM愛力膚親水

性的聚乙烯膚料*適應症請見備註欄

327

WDD0800707SN HYDROCELLULAR ADHESIVE DRESSING 7.5X7.5CM※適應症請見備註

73

WDD0801008J9 "TRONJEN"HYDROCOLLOID DRESSING(STERILE)10CMX10CM"中鎮"親

水性敷料(滅菌)*適應症請見備註欄

119

WDD0801010F4 DUODERM EXTRA THIN CGF DRESSING (4"X4")10X10CM超薄型多愛

膚滅菌親水性敷料*給付規定請見備註欄。

53.2

WDD0801010HZ "和豐"保立美傷口敷料(滅菌)"HORIZON"POLYMEM WOUND PAD

DRESSING (STERILE)4"X4"(10CMX10CM)

119

WDD0801010J9 "TRONJEN"HYDROCOLLOID DRESSING(STERILE)10X10CM "中鎮"親水

性敷料(滅菌)(超薄)*適應症請見備註欄

53.2

WDD0801010SN HYDROPHILIC POLYURETHANE DRESSING 10X10CM※適應症請見備註

119

WDD0801010YY "CORELEADER" COLLA-ALGI FIBER WOUND DRESSING (STERILE) "

康力得"膠原藻酸纖維敷料(滅菌)※適應症請見備註欄

112

WDD0801020SN HYDROPHILIC POLYURETHANE DRESSING 10X20CM※適應症請見備註

245

WDD0801020YY "CORELEADER" COLLA-ALGI FIBER WOUND DRESSING (STERILE) "

康力得"膠原藻酸纖維敷料(滅菌)※適應症請見備註欄

125

WDD0801212SN HYDROCELLULAR ADHESIVE DRESSING 12.5X12.5CM※適應症請見備

註欄

177

WDD0801419BB "B.BRAUN"ASKINA GEL,15G 雅膚清創凝膠*適應症請見備註欄 140

WDD0801515F4 DUODERM EXTRA THIN CGF DRESSING (6"X6")15X15CM超薄型多愛

膚滅菌親水性敷料*給付規定請見備註欄。

116

961

特材代碼 中英文名稱 支付點數-104/01/01

WDD0801717SN HYDROCELLULAR ADHESIVE DRESSING 17.5X17.5CM※適應症請見備

註欄

327

WDD0802020SN HYDROPHILIC POLYURETHANE DRESSING 20X20CM※適應症請見備註

395

WDD0802222SN HYDROCELLULAR ADHESIVE DRESSING 22.5X22.5CM※適應症請見備

註欄

395

WDD0803410CA "COLOPLAST" BIATAIN FOAM DRESSING(STERILE)-NON-ADHESIVE "

康樂保"平而坦泡綿敷料(滅菌)-非黏性※適應症請見備註欄

119

WDD0803413CA "COLOPLAST" BIATAIN FOAM DRESSING(STERILE)-NON-ADHESIVE "

康樂保"平而坦泡綿敷料(滅菌)-非黏性※適應症請見備註欄

245

WDD0803416CA "COLOPLAST" BIATAIN FOAM DRESSING(STERILE)-NON-ADHESIVE "

康樂保"平而坦泡綿敷料(滅菌)-非黏性※適應症請見備註欄

395

WDD0803420CA "COLOPLAST" BIATAIN FOAM DRESSING(STERILE)-ADHESIVE "康樂

保"平而坦泡綿敷料(滅菌)-黏性※適應症請見備註欄

177

WDD0803423CA "COLOPLAST" BIATAIN FOAM DRESSING(STERILE)-ADHESIVE "康樂

保"平而坦泡綿敷料(滅菌)-黏性※適應症請見備註欄

327

WDD0803470CA "COLOPLAST" BIATAIN FOAM DRESSING(STERILE)-SOFT-HOLD "康

樂保"平而坦泡綿敷料(滅菌)-自黏※適應症請見備註欄

119

WDD0803472CA "COLOPLAST" BIATAIN FOAM DRESSING(STERILE)-SOFT-HOLD "康

樂保"平而坦泡綿敷料(滅菌)-自黏※適應症請見備註欄

245

WDD0803475CA "COLOPLAST" BIATAIN FOAM DRESSING(STERILE)-SOFT-HOLD "康

樂保"平而坦泡綿敷料(滅菌)-自黏※適應症請見備註欄

245

WDD0803708F4 "CONVATEC"AQUACEL AG HYDROFIBER DRESSING 10X10CM(4"X4") "

康威"愛康膚-銀親水性纖維敷料*給付規定請見備註欄。

224

WDD0803710F4 "CONVATEC"AQUACEL AG HYDROFIBER DRESSING 15X15CM(6"X6")

"康威"愛康膚-銀親水性纖維敷料*給付規定請見備註欄。

406

WDD0803711F4 "CONVATEC"AQUACEL AG HYDROFIBER DRESSING 20X30CM (8"X12")

"康威"愛康膚-銀親水性纖維敷料*給付規定請見備註欄。

920

WDD0803712F4 "CONVATEC"AQUACEL AG HYDROFIBER DRESSING 2X45CM *適應症請

見備註欄

198

WDD0803760CA COLOPLAST SEASORB AG DRESSING 康樂保藻膠銀離子敷料

10CMX10CM*適應症請見備註欄

224

WDD0803771F4 "CONVATEC"AQUACEL AG HYDROFIBER DRESSING 2X45CM

(0.75"X18") "康威"愛康膚-銀親水性纖維敷料*給付規定請見備

註欄。

198

WDD0803780CA COLOPLAST SEASORB AG DRESSING 康樂保藻膠銀離子敷料

3CMX44CM*適應症請見備註欄

224

WDD080451CSN "SMITH&NEPHEW"ALLEVYN SACRUM DRESSING(STERILE)22CMX22CM"

史耐輝"愛力膚親水性自黏敷料(滅菌)*給付規定請見備註欄

395

WDD080505AVH "HOBE" HYDROPHILIC WOUND DRESSING-

ALGINATE(STERILE)5CMX5CM"梓源"親水性傷口敷料*給付規定請見

備註欄

20.4

WDD0805101YY "CORELEADER"HYDROCOLLOID DRESSING(STERILE)"康力得"親水性

敷料(滅菌)5CMX10CM*適應症請見備註欄

41.1

WDD0805201YY "CORELEADER"HYDROCOLLOID DRESSING(STERILE)"康力得"親水性

敷料(滅菌)5CMX20CM*適應症請見備註欄

53.2

WDD080700CSN "SMITH&NEPHEW"ALLEVYN SACRUM DRESSING(STERILE)17CMX17CM"

史耐輝"愛力膚親水性自黏敷料(滅菌)*給付規定請見備註欄

327

WDD08090023M 3MTEGASORB HYDROCOLLOID DRESSING親水性敷料 10CMX10CM*適應

症請見備註欄

119

962

特材代碼 中英文名稱 支付點數-104/01/01

WDD08090053M 3MTEGASORB HYDROCOLLOID DRESSING親水性敷料 15CMX15CM*適應

症請見備註欄

245

WDD0809238KD CURASORB CALCUIUM ALIGINATE DRESSINGS 20.32X10.16CM ※給

付規定請見備註欄

125

WDD0809622CA "COLOPLAST"BIATAIN AG FOAM DRESSING "康樂保"平而坦銀離子

泡綿敷料10CMX10CM*適應症請見備註欄

224

WDD0809625CA "COLOPLAST"BIATAIN AG FOAM DRESSING "康樂保"平而坦銀離子

泡綿敷料15CMX15CM*適應症請見備註欄

406

WDD0809801KD ULTEC PRO ALGINATE HYDROCOLLOID DRESSING

4X4(10.16X10.16CM)※給付規定請見備註欄

112

WDD0809802KD ULTEC PRO ALGINATE HYDROCOLLOID DRESSING

6X6(15.24X15.24CM)※給付規定請見備註欄

167

WDD0809804KD ULTEC PRO ALGINATE HYDROCOLLOID DRESSING

8X8(20.32X20.32CM)※給付規定請見備註欄

227

WDD0809921HL RESTORE EXTRA THIN 10CMMX10CM※適應症請見備註欄 53.2

WDD0809923HL RESTORE EXTRA THIN 15.2CMMX20.3CM※適應症請見備註欄 145

WDD0809937HL RESTORE CALCICARE WOUND CARE DRESSING STERILE 10X10CM ※

適應症請見備註欄

112

WDD0809938HL RESTORE CALCICARE WOUND CARE DRESSING STERILE 5X5CM ※適

應症請見備註欄

20.4

WDD0809939HL RESTORE CALCICARE WOUND CARE DRESSING STERILE 10X20CM ※

適應症請見備註欄

125

WDD0809955HL RESTORE PLUS WOUND CARE DRESSING STERILE 20X20CM※適應症

請見備註欄

395

WDD0809956HL RESTORE PLUS TAPERED EDGE WOUND CARE DRESSING STERILE

10X10CM※適應症請見備註欄

119

WDD0810100YY "CORELEADER"ALGINATE FIBER WOUND

DRESSING(STERILE)10CMX10CM"康力得"藻酸鹽纖維傷口敷料(滅

菌)*適應症請見備註欄

112

WDD0810101YY "CORELEADER"HYDROCOLLOID DRESSING(STERILE)"康力得"親水性

敷料(滅菌)10CMX10CM*適應症請見備註欄

53.2

WDD081010AVH "HOBE" HYDROPHILIC WOUND DRESSING-

ALGINATE(STERILE)10CMX10CM"梓源"親水性傷口敷料*給付規定請

見備註欄

112

WDD081010TSN REPLICARE ULTRA 10X10CM※適應症請見備註欄 53.2

WDD0810200YY "CORELEADER"ALGINATE FIBER WOUND

DRESSING(STERILE)10CMX20CM"康力得"藻酸鹽纖維傷口敷料(滅

菌)*適應症請見備註欄

125

WDD0810607F4 "ConvaTec"VERSIVA XC DRESSING(STERILE)-Non Adhesive

11CMX11CM"康威"威吸寶敷料(滅菌)-非粘性*給付規定請見備註

欄。

143

WDD0810608F4 "ConvaTec"VERSIVA XC DRESSING(STERILE)-Non Adhesive

15CMX15CM"康威"威吸寶敷料(滅菌)-非粘性*給付規定請見備註

欄。

243

WDD0810609F4 "ConvaTec"VERSIVA XC DRESSING(STERILE)-Adhesive

10CMX10CM"康威"威吸寶敷料(滅菌)-自粘性*給付規定請見備註

欄。

119

WDD0810610F4 "ConvaTec"VERSIVA XC DRESSING(STERILE)-Adhesive

14CMX14CM"康威"威吸寶敷料(滅菌)-自粘性*給付規定請見備註

欄。

225

WDD0810611F4 "ConvaTec"VERSIVA XC DRESSING(STERILE)-Adhesive

22CMX22CM"康威"威吸寶敷料(滅菌)-自粘性*給付規定請見備註

欄。

409

963

特材代碼 中英文名稱 支付點數-104/01/01

WDD0810612F4 "ConvaTec"VERSIVA XC DRESSING(STERILE)-Adhesive

18.5CMX20.5CM"康威"威吸寶敷料(滅菌)-自粘性*給付規定請見備

註欄。

364

WDD0810613F4 "ConvaTec"VERSIVA XC DRESSING(STERILE)-Adhesive

21CMX25CM"康威"威吸寶敷料(滅菌)-自粘性*給付規定請見備註

欄。

507

WDD0810614F4 "ConvaTec"VERSIVA XC DRESSING(STERILE)-Non Adhesive

20CMX20CM"康威"威吸寶敷料(滅菌)-非自粘性*給付規定請見備註

欄。

364

WDD0810615F4 "ConvaTec"VERSIVA XC DRESSING(STERILE)-Adhesive

19CMX19CM"康威"威吸寶敷料(滅菌)-自粘性*給付規定請見備註

欄。

364

WDD0811010F4 "CONVATEC"DUO DERM CGF CONTROL GEL FORMULA DRESSING

10X10CM親水性CGF敷料*適應症請見備註欄

119

WDD0812009F4 "CONVATEC" AQUACEL AG SURGICAL COVER DRESSING (STERILE) "

康威"愛康膚-銀手術覆蓋敷料(滅菌)

198

WDD0812010F4 "CONVATEC" AQUACEL AG SURGICAL COVER DRESSING (STERILE) "

康威"愛康膚-銀手術覆蓋敷料(滅菌)

224

WDD0812011F4 "CONVATEC" AQUACEL AG SURGICAL COVER DRESSING (STERILE) "

康威"愛康膚-銀手術覆蓋敷料(滅菌)

406

WDD0812012F4 "CONVATEC" AQUACEL AG SURGICAL COVER DRESSING (STERILE) "

康威"愛康膚-銀手術覆蓋敷料(滅菌)

459

WDD0812020F4 "CONVATEC"DUO DERM CGF CONTROL GEL FORMULA DRESSING

20X20CM親水性CGF敷料*適應症請見備註欄

395

WDD0812030F4 "CONVATEC"DUO DERM CGF CONTROL GEL FORMULA DRESSING

20X30CM親水性CGF敷料*適應症請見備註欄

689

WDD0815150YY "CORELEADER"ALGINATE FIBER WOUND

DRESSING(STERILE)15CMX15CM"康力得"藻酸鹽纖維傷口敷料(滅

菌)*適應症請見備註欄

167

WDD0815151YY "CORELEADER"HYDROCOLLOID DRESSING(STERILE)"康力得"親水性

敷料(滅菌)15CMX15CM*適應症請見備註欄

116

WDD081515TSN REPLICARE ULTRA 15X15CM※適應症請見備註欄 116

WDD0815183A5 KARAYAHESIVE HYDROCOLLOID WOUND DRESSING 113CM2,親水性敷

料*適應症請見備註欄

53.2

WDD081518TSN REPLICARE ULTRA 15X18CM※適應症請見備註欄 116

WDD0815192A5 KARAYAHESIVE HYDROCOLLOID WOUND DRESSING 100CM2,親水性敷

料*適應症請見備註欄

53.2

WDD081520AVH "HOBE" HYDROPHILIC WOUND DRESSING-

ALGINATE(STERILE)15CMX20CM"梓源"親水性傷口敷料*給付規定請

見備註欄

177

WDD0818752A5 "ALCARE"SI-AID SILICONE-FACED DRESSING(STERILE)10CMX10CM"

愛樂康"矽膠泡棉敷料(滅菌)親水性創傷覆蓋材

119

WDD0818753A5 "ALCARE"SI-AID SILICONE-FACED DRESSING(STERILE)10CMX20CM"

愛樂康"矽膠泡棉敷料(滅菌)親水性創傷覆蓋材

245

WDD082020TSN REPLICARE ULTRA 20X20CM※適應症請見備註欄 192

WDD0820619F4 “康威”愛康膚泡棉敷料 (滅菌):可黏性"CONVATEC" AQUACEL

FOAM HYDROFIBER DRESSING (STERILE)12.5 X 12.5cm

225

WDD0820621F4 "康威"愛康膚泡棉敷料(滅菌)可黏性"CONVATEC” AQUACEL FOAM

HYDROFIBER DRESSING (STERILE)17.5 X 17.5cm

364

WDD0820623F4 “康威”愛康膚泡棉敷料 (滅菌):可黏性“CONVATEC” AQUACEL

FOAM HYDROFIBER DRESSING (STERILE)21 X 21cm

409

964

特材代碼 中英文名稱 支付點數-104/01/01

WDD0820633F4 “康威”愛康膚泡棉敷料 (滅菌):非黏性“CONVATEC” AQUACEL

FOAM HYDROFIBER DRESSING (STERILE)10 X 10cm

119

WDD0820635F4 “康威”愛康膚泡棉敷料 (滅菌):非黏性“CONVATEC” AQUACEL

FOAM HYDROFIBER DRESSING (STERILE)15 X 15cm

243

WDD0820636F4 “康威”愛康膚泡棉敷料 (滅菌):非黏性“CONVATEC” AQUACEL

FOAM HYDROFIBER DRESSING (STERILE)20 X 20cm

364

WDD0820637F4 “康威”愛康膚泡棉敷料 (滅菌):非黏性“CONVATEC” AQUACEL

FOAM HYDROFIBER DRESSING (STERILE)15 X 20cm

326

WDD082100SBB "B.BRAUN"ASKINA SORB CALCIUM ALGINATE DRESSING(STERILE)

6CMX6CM雅膚藻酸鈣敷料*適應症請見備註欄

20.4

WDD082101SBB "B.BRAUN"ASKINA SORB CALCIUM ALGINATE DRESSING(STERILE)

10CMX10CM雅膚藻酸鈣敷料*適應症請見備註欄

112

WDD082102SBB "B.BRAUN"ASKINA SORB CALCIUM ALGINATE DRESSING(STERILE)

15CMX15CM雅膚藻酸鈣敷料*適應症請見備註欄

167

WDD082105SBB "B.BRAUN"ASKINA SORB CALCIUM ALGINATE DRESSING(STERILE)

2.7CMX34CM雅膚藻酸鈣敷料*適應症請見備註欄

61.7

WDD0831100CA COMFEEL PLUS ULCER DRESSING 10X10CM※適應症請見備註欄 119

WDD0831150CA COMFEEL PLUS ULCER DRESSING 15X15CM※適應症請見備註欄 245

WDD0831200CA COMFEEL PLUS ULCER DRESSING 20X20CM ※適應症請見備註欄 395

WDD0831460CA COMFEEL PLUS ULCER DRESSING 4X6CM※適應症請見備註欄 29.3

WDD0834210CA "COLOPLAST" BIATAIN FOAM DRESSING(STERILE)-ADHESIVE "康樂

保"平而坦泡綿敷料(滅菌)-黏性※適應症請見備註欄

243

WDD083488AYD "BCT"ANTIMICROBIAL DRESSING(STERILE)5CMX5CM"科云"抗菌敷料

(滅菌)*給付規定請見備註欄

56.4

WDD083488BYD "BCT"ANTIMICROBIAL DRESSING(STERILE)10CMX10CM"科云"抗菌敷

料(滅菌)*給付規定請見備註欄

224

WDD083488CYD "BCT"ANTIMICROBIAL DRESSING(STERILE)2.5CMX10CM"科云"抗菌

敷料(滅菌)*給付規定請見備註欄

56.4

WDD083488DYD "BCT"ANTIMICROBIAL DRESSING(STERILE)2.5CMX20CM"科云"抗菌

敷料(滅菌)*給付規定請見備註欄

198

WDD083488EYD "BCT"ANTIMICROBIAL DRESSING(STERILE)5CMX20CM"科云"抗菌敷

料(滅菌)*給付規定請見備註欄

224

WDD083488FYD "BCT"ANTIMICROBIAL DRESSING(STERILE)20CMX20CM"科云"抗菌敷

料(滅菌)*給付規定請見備註欄

612

WDD0835300CA COMFEEL PLUS TRANSPARENT DRESSING 5X7CM※適應症請見備註欄 26

WDD0835330CA COMFEEL PLUS TRANSPARENT DRESSING 10X10CM※適應症請見備註

53.2

WDD0835361CA "COLOPLAST"COMFEEL PLUS DRESSINGS(STERILE)9CMX14CM"康樂

保"康惠爾親水性敷料(滅菌)*給付規定請見備註欄

55

WDD0835390CA COMFEEL PLUS TRANSPARENT DRESSING 15X15CM※適應症請見備註

116

WDD0835421CA "COLOPLAST"COMFEEL PLUS DRESSINGS(STERILE)15CMX20CM"康樂

保"康惠爾親水性敷料(滅菌)*給付規定請見備註欄

145

WDD0835450CA COMFEEL PLUS TRANSPARENT DRESSING 20X20CM※適應症請見備註

192

WDD0835481CA "COLOPLAST"COMFEEL PLUS DRESSINGS(STERILE)5CMX25CM"康樂

保"康惠爾親水性敷料(滅菌)*給付規定請見備註欄

55

WDD0837100CA "Coloplast" Biatain Alginate Dressing (Sterile)"康樂保"藻

膠敷料(滅菌) 10X10CM

119

WDD0837150CA "Coloplast" Biatain Alginate Dressing (Sterile)"康樂保"藻

膠敷料(滅菌) 15X15CM

245

WDD083736AYD "BCT"CALCIUM ALGINATE DRESSING(STERILE) 10CMX10CM"科云"藻

酸鈣敷料(滅菌)*給付規定請見備註欄

112

965

特材代碼 中英文名稱 支付點數-104/01/01

WDD0837400CA "Coloplast" Biatain Alginate Dressing (Sterile)"康樂保"藻

膠敷料(滅菌)3CMX44CM

118

WDD0839000CA COMFEEL PURILON GEL 15GM*適應症請見備註欄 140

WDD0839030CA COMFEEL PURILON GEL 25GM*適應症請見備註欄 276

WDD0841010BB "B.BRAUN"ASKINA FOAM WOUND DRESSING(STERILE)10CMX10CM雅膚

泡棉敷料*適應症請見備註欄

119

WDD0841210BB "B.BRAUN"ASKINA FOAM WOUND DRESSING(STERILE)0CMX20CM雅膚

泡棉敷料*適應症請見備註欄

245

WDD0842005BB "B.BRAUN"ASKINA FOAM WOUND DRESSING(STERILE)20CMX20CM雅

膚泡棉敷料*適應症請見備註欄

395

WDD0850557BB ASKINA THINSITE 5CMX20CM*適應症請見備註欄 53.2

WDD0856100LN MOLNLYCKE MELGISORB AG ANTIMICROBIAL ALGINATE DRESSING美

尼克美極收銀抗菌海藻鹽敷料10CMX10CM*適應症請見備註欄

224

WDD0856150LN MOLNLYCKE MELGISORB AG ANTIMICROBIAL ALGINATE DRESSING美

尼克美極收銀抗菌海藻鹽敷料15CMX15CM*適應症請見備註欄

406

WDD0856600LN MOLNLYCKE MELGISORB AG ANTIMICROBIAL ALGINATE DRESSING美

尼克美極收銀抗菌海藻鹽敷料3CMX44CM*適應症請見備註欄

224

WDD0860923P8 TENDERWET 7.5X7.5CM※適應症請見備註欄 73

WDD0860924P8 TENDERWET 10X10CM※適應症請見備註欄 119

WDD0862110BB "B.BRAUN"ASKINA CALGITROL AG"柏朗"雅膚凱奇樂藻酸銀敷料

10CMX10CM*適應症請見備註欄

224

WDD0862115BB "B.BRAUN"ASKINA CALGITROL AG雅膚凱奇樂藻酸銀敷料

15CMX15CM*適應症請見備註欄

406

WDD0862120BB "B.BRAUN"ASKINA CALGITROL AG"柏朗"雅膚凱奇樂藻酸銀敷料

20CMX20CM*適應症請見備註欄

612

WDD0868210F4 "ConvaTec"KALTOSTAT ALGINATE WOUND DRESSING(Sterile)

5X5CM"康威"藻酸鈣鈉鹽傷口敷料(滅菌)*給付規定請見備註欄。

20.4

WDD0868212F4 "ConvaTec"KALTOSTAT ALGINATE WOUND DRESSING(Sterile)

7.5X12CM"康威"藻酸鈣鈉鹽傷口敷料(滅菌)*給付規定請見備註

欄。

61.7

WDD0868214F4 "ConvaTec"KALTOSTAT ALGINATE WOUND DRESSING(Sterile)

10X20CM"康威"藻酸鈣鈉鹽傷口敷料(滅菌)*給付規定請見備註

欄。

125

WDD0868215F4 "ConvaTec"KALTOSTAT ALGINATE WOUND DRESSING(Sterile)

15X25CM"康威"藻酸鈣鈉鹽傷口敷料(滅菌)*給付規定請見備註

欄。

227

WDD0871500LN NORMLGEL 15GM*適應症請見備註欄 140

WDD0872041BB "B.BRAUN"ASKINA HYDRO 10CMX10CM雅膚親水膠敷料*適應症請見

備註欄

119

WDD0872045BB "B.BRAUN"ASKINA HYDRO 15CMX15CM雅膚親水膠敷料*適應症請見

備註欄

245

WDD0872047BB "B.BRAUN"ASKINA HYDRO 20CMX20CM雅膚親水膠敷料*適應症請見

備註欄

395

WDD0872050BB ASKINA BS,BP,BT 10X10CM,5X20CM ※適應症請見備註欄 119

WDD0872051BB ASKINA BS,BP,BT 15X15CM ※適應症請見備註欄 型號F72051、

F72015自93.1.1刪除

245

WDD0872052BB ASKINA BS,BT 20X20CM ※適應症請見備註欄 395

WDD0872789BB "B.BRAUN"ASKINA TRANSORBENT "柏朗"雅膚多聚泡棉敷料10X10CM

※適應症請見備註欄

119

WDD0872790BB "B.BRAUN"ASKINA TRANSORBENT"柏朗雅膚多聚泡綿敷料" 15X15CM

※適應症請見備註欄

245

WDD0872791BB ASKINA TRANSORBENT 20X20CM 柏朗雅膚多聚泡綿敷料※適應症請

見備註欄

395

966

特材代碼 中英文名稱 支付點數-104/01/01

WDD0877901F4 "ConvaTec"AQUACEL HYDROFIBER DRESSING(sterile)5cmx5cm"康

威"愛康膚親水性纖維敷料(滅菌)*給付規定請見備註欄。

29.3

WDD0877902F4 "ConvaTec"AQUACEL HYDROFIBER DRESSING(sterile)10cmx10cm"

康威"愛康膚親水性纖維敷料(滅菌)*給付規定請見備註欄。

119

WDD0877903F4 "ConvaTec"AQUACEL HYDROFIBER DRESSING(sterile)15cmx15cm"

康威"愛康膚親水性纖維敷料(滅菌)*給付規定請見備註欄。

245

WDD0884300LN "MOLNLYCKE"MEPILEX LITE SAFETAC ABSORBENT SOFT SILICONE

DRESSING 15X15CM "美尼克"美皮蕾薄型吸收軟性矽膠敷料 ※適

應症請見備註欄

243

WDD0887987F4 "CONVATEC"DUODERM HYDROACTIVE GEL(sterile) 30GM "康威"多

愛膚親水性凝膠(滅菌)*給付規定請見備註欄。

276

WDD0887990F4 "CONVATEC"DUODERM HYDROACTIVE GEL(sterile) 15GM "康威"多

愛膚親水性凝膠(滅菌)*給付規定請見備註欄。

140

WDD08900203M TEGASORB THIN HYDROCOLLOID DRESSING 5CMX10CM*適應症請見備

註欄

41.1

WDD08900223M HYDROCOLLOID DRESSING 10X10CM(薄) ※適應症請見備註欄 53.2

WDD08900273M 3M TEGASORB THIN HYDROCOLLOID DRESSING 15CMX15CM親水性敷

料*適應症請見備註欄

116

WDD08900283M 3M TEGASORB THIN HYDROCOLLOID DRESSING 20CMX20CM親水性敷

料*適應症請見備註欄

192

WDD08900333M TEGASORB THIN HYDROCOLLOID DRESSING 10CMX10CM *適應症請見

備註欄

53.2

WDD08900523M 3M TEGASORB THIN HYDROCOLLOID DRESSING 5CMX20CM*適應症請

見備註欄

53.2

WDD08901123M 3M TEGADERM HIGH INTEGRITY ALGINATE DRESSING(STERILE)海藻

酸鹽敷料10CMX10CM*適應症請見備註欄

112

WDD08902123M 3M TEGADERM HIGH GELLING ALGINATE DRESSING(STERILE)海藻酸

鹽敷料10CMX10CM*適應症請見備註欄

112

WDD0890510LN Mepitel 5cm x 7.5cm *適應症請見備註欄 65.9

WDD08906003M 3M HYDROPHILIC WOUND DRESSING親水性創傷覆蓋材(TEGADERM

FOAM 5CMX5CM)*適應症請見備註欄

29.3

WDD08906013M 3M HYDROPHILIC WOUND DRESSING親水性創傷覆蓋材(TEGADERM

FOAM 10CMX10CM)*適應症請見備註欄

119

WDD08906023M 3M HYDROPHILIC WOUND DRESSING親水性創傷覆蓋材(TEGADERM

FOAM 10CMX20CM)*適應症請見備註欄

245

WDD08906033M 3M HYDROPHILIC WOUND DRESSING親水性創傷覆蓋材(TEGADERM

FOAM 20CMX20CM)*適應症請見備註欄

395

WDD0890670P8 HYDROCOLL 10X10CM※適應症請見備註欄 119

WDD0890672P8 HYDROCOLL 15X15CM※適應症請見備註欄 245

WDD0890674P8 HYDROCOLL 20X20CM※適應症請見備註欄 395

WDD0890685P8 HYDROCOLL TRANSPARENT 10X10CM(薄)※適應症請見備註欄 53.2

WDD0890710LN Mepitel 7.5cm x10cm*適應症請見備註欄 98

WDD0891010LN MEPITEL 10cm x18cm*適應症請見備註欄(型號更正為291010) 185

WDD0892005LN Mepitel 20cm x30cm*適應症請見備註欄 619

WDD0894100LN MEPILEX STERILE 10CMX10CM※適應症請見備註欄 119

WDD0894200LN MEPILEX STERILE 10CMX20CM※適應症請見備註欄 225

WDD0894300LN MEPILEX STERILE 15CMX15CM※適應症請見備註欄 243

WDD0894400LN MEPILEX STERILE 20CMX20CM※適應症請見備註欄 364

WDD0895200LN MEPILEX BORDER SAFETAC SILICON FOAM DRESSING 7.5X7.5CM*適

應症請見備註欄

68

WDD0895300LN MEPILEX BORDER SAFETAC SILICON FOAM DRESSING 10X10CM*適應

症請見備註欄

119

967

特材代碼 中英文名稱 支付點數-104/01/01

WDD0895400LN MEPILEX BORDER SAFETAC SILICON FOAM DRESSING 15X15CM*適應

症請見備註欄

243

WDD0895600LN MEPILEX BORDER SAFETAC SELF-ADHERENT SOFT SILICONE FOAM

DRESSING 15CMX20CM*適應症請見備註欄

326

WDD0897121LN "MOLNLYCKE"MEPILEX AG ANTIMICROBIAL SOFT SILICONE FOAM

DRESSING美皮蕾銀抗菌軟性矽膠泡棉敷料12.5CM*12.5CM*適應症

請見備註欄

317

WDD0897321LN "MOLNLYCKE"MEPILEX AG ANTIMICROBIAL SOFT SILICONE FOAM

DRESSING美皮蕾銀抗菌軟性矽膠泡棉敷料17.5CM*17.5CM*適應症

請見備註欄

559

WDD0897510LN "MOLNLYCKE"MEPILEX AG ANTIMICROBIAL SOFT SILICONE FOAM

DRESSING美皮蕾銀抗菌軟性矽膠泡棉敷料20CM*50CM*適應症請見

備註欄

1040

WDD0899570HN "HARTMANN"ATRAUMAN AG SILVER DRESSING(5X5CM)含銀軟膏膚料*

適應證請見備註欄

56.4

WDD0899571HN "HARTMANN"ATRAUMAN AG SILVER DRESSING(10X10CM)含銀軟膏膚

料*適應證請見備註欄

224

WDD0899572HN "HARTMANN"ATRAUMAN AG SILVER DRESSING(10X20CM)含銀軟膏膚

料*適應證請見備註欄

406

WDD0899581P8 "HARTMANN"HYDROPHILIC WOUND

DRESSING(THIN)(STERILE)HYDROTUL 5X5CM親水性創傷覆蓋材*適

應症請見備註欄

26

WDD0899583P8 "HARTMANN"HYDROPHILIC WOUND

DRESSING(THIN)(STERILE)HYDROTUL 10X12CM親水性創傷覆蓋材*

適應症請見備註欄

53.2

WDD0899584P8 "HARTMANN"HYDROPHILIC WOUND

DRESSING(THIN)(STERILE)HYDROTUL 15X20CM親水性創傷覆蓋材*

適應症請見備註欄

145

WDD0899595P8 SORBALGON 10X10CM※適應症請見備註欄 119

WDD0899598P8 SORBALGON 5X5CM※適應症請見備註欄 29.3

WDD08A0112ZW SAVDERM ALGINATE DRESSING 舒膚貼藻酸鈣鹽敷料(5.5CMX8.5CM) 41.8

WDD08A0202ZW SAVDERM ALGINATE DRESSING 舒膚貼藻酸鈣鹽敷料(10CMX10CM) 112

WDD08A0520SN "SMITH&NEPHEW"ALGISITE M CALCIUM ALGINATE DRESSING"史耐

輝"海藻酸鈣敷料10X10CM*適應症請見備註欄

112

WDD08A0521SN "SMITH&NEPHEW"ALGISITE M CALCIUM ALGINATE DRESSING"史耐

輝"海藻酸鈣敷料15X20CM*適應症請見備註欄

177

WDD08A0522SN "SMITH&NEPHEW"ALGISITE M CALCIUM ALGINATE DRESSING"史耐

輝"海藻酸鈣敷料2X30CM*適應症請見備註欄

41.8

WDD08A1111QY "SYSTAGENIX"ACTISORB PLUS 25 ACTIVATED CHARCOAL DRESSING

WITH SILVER(STERILE)10.5CMX10.5CM"新世捷"愛克臭活性碳銀敷

料*給付規定請見備註。

224

WDD08A1911QY "SYSTAGENIX"ACTISORB PLUS 25 ACTIVATED CHARCOAL DRESSING

WITH SILVER(STERILE)19CMX10.5CM"新世捷"愛克臭活性碳銀敷料

*給付規定請見備註。

320

WDD08A6595QY "SYSTAGENIX"ACTISORB PLUS 25 ACTIVATED CHARCOAL DRESSING

WITH SILVER(STERILE)6.5CMX9.5CM"新世捷"愛克臭活性碳銀敷料

(滅菌)*給付規定請見備註。

198

WDD08B0110ZW "SAVDERM"BIOCELLULOSE FILM (6CMX6CM)"舒膚貼"生物合成纖維

膜*適應症請見備註欄

108

WDD08B0211ZW "SAVDERM"BIOCELLULOSE FILM (10CMX8CM) "舒膚貼"生物合成纖

維膜 *適應症請見備註欄

275

WDD08B0308ZW "SAVDERM"BIOCELLULOSE FILM (16CMX10CM)"舒膚貼" 生物合成纖

維膜 *適應症請見備註欄

438

968

特材代碼 中英文名稱 支付點數-104/01/01

WDD08B0409ZW "SAVDERM"BIOCELLULOSE FILM (21CMX16CM)"舒膚貼"生物合成纖

維膜*適應症請見備註欄

791

WDD08C0113ZW SAVDERM HYDROGEL(STERILE)30G 舒膚貼清創修護凝膠(滅菌)*適

應症請見備註欄

276

WDD08C0220ZW SAVDERM HYDROGEL(STERILE)25GM舒膚貼清創修護凝膠(滅菌)*適

應症請見備註欄

276

WDD08C0502ZW 舒膚貼抗菌親水性敷料(滅菌)SAVDERM ANTISEPTIC

HYDROCOLLOIDS THIN DRESSING (STERILE)10CMX10CM*給付規定請

見備註欄

224

WDD08C0506SN "SMITH&NEPHEW"CUTINOVA HYDRO DRESSING新世代人工皮膚

5CMX6CM*適應症請見備註欄

29.3

WDD08C1010QA SIFOTEC HYDROCOLLOID DRESSING (STERILE) "和豐"親水性敷料

(滅菌) 10CMX10CM

53.2

WDD08C1010SN "SMITH&NEPHEW"CUTINOVA HYDRO DRESSING 10X10CM*適應症請見

備註欄

119

WDD08C1515QA SIFOTEC HYDROCOLLOID DRESSING (STERILE) "和豐"親水性敷料

(滅菌) 15CMX15CM

116

WDD08C1520SN "SMITH&NEPHEW"CUTINOVA HYDRO DRESSING 15X20CM*適應症請見

備註欄

327

WDD08D0245SN "SMITH&NEPHEW"DURAFIBER GELLING FIBER

DRESSING(STERILE)2CMX45CM"史耐輝"愛爾膚纖維敷料(滅菌)*給

付規定請見備註欄

119

WDD08D0410SN "SMITH&NEPHEW"DURAFIBER GELLING FIBER

DRESSING(STERILE)4CMX10CM"史耐輝"愛爾膚纖維敷料(滅菌)*給

付規定請見備註欄

73

WDD08D0420SN "SMITH&NEPHEW"DURAFIBER GELLING FIBER

DRESSING(STERILE)4CMX20CM"史耐輝"愛爾膚纖維敷料(滅菌)*給

付規定請見備註欄

83.8

WDD08D0430SN "SMITH&NEPHEW"DURAFIBER GELLING FIBER

DRESSING(STERILE)4CMX30CM"史耐輝"愛爾膚纖維敷料(滅菌)*給

付規定請見備註欄

143

WDD08D0505SN "SMITH&NEPHEW"DURAFIBER GELLING FIBER

DRESSING(STERILE)5CMX5CM"史耐輝"愛爾膚纖維敷料(滅菌)*給付

規定請見備註欄

29.3

WDD08D1010SN "SMITH&NEPHEW"DURAFIBER GELLING FIBER

DRESSING(STERILE)10CMX10CM"史耐輝"愛爾膚纖維敷料(滅菌)*給

付規定請見備註欄

119

WDD08D1515SN "SMITH&NEPHEW"DURAFIBER GELLING FIBER

DRESSING(STERILE)15CMX15CM"史耐輝"愛爾膚纖維敷料(滅菌)*給

付規定請見備註欄

245

WDD08E1405K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND

DRESSING(STERILE)(STANDARD)10X10CM"優而美"舒肌親水性傷口

敷料*適應症請健備註欄

119

WDD08E1407K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND

DRESSING(STERILE)(STANDARD)20X20CM"優而美"舒肌親水性傷口

敷料*適應症請健備註欄

395

WDD08E1416K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND

DRESSING(STERILE)(STANDARD)15X15CM"優而美"舒肌親水性傷口

敷料*適應症請健備註欄

245

WDD08E2405K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND

DRESSING(STERILE)(BORDER)10X10CM"優而美"舒肌親水性傷口敷

料*適應症請健備註欄

119

969

特材代碼 中英文名稱 支付點數-104/01/01

WDD08E2407K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND

DRESSING(STERILE)(BORDER)20X20CM"優而美"舒肌親水性傷口敷

料*適應症請健備註欄

395

WDD08E2412K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND

DRESSING(STERILE)(BORDER-SACRAL)15X18CM"優而美"舒肌親水性

傷口敷料*適應症請健備註欄

327

WDD08E2416K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND

DRESSING(STERILE)(BORDER)15X15CM"優而美"舒肌親水性傷口敷

料*適應症請健備註欄

245

WDD08E2432K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND

DRESSING(STERILE)(BORDER-SACRAL LARGE BUTTERFLY)15X18CM"

優而美"舒肌親水性傷口敷料*適應症請健備註欄

327

WDD08E3205K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND

DRESSING(STERILE)(THIN)10X10CM"優而美"舒肌親水性傷口敷料*

適應症請健備註欄

53.2

WDD08E3216K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND

DRESSING(STERILE)(THIN)15X15CM"優而美"舒肌親水性傷口敷料*

適應症請健備註欄

116

WDD08E3515K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND

DRESSING(STERILE)(THIN)5X15CM"優而美"舒肌親水性傷口敷料*

適應症請健備註欄

41.1

WDD08F0102ZW "SAVDERM"FOAM DRESSING (STERILE)10X10CM泡棉敷料*適應症請

見備註欄

119

WDD08F0203ZW "SAVDERM"FOAM DRESSING(STERILE)10CM*20CM泡棉敷料(滅菌)*適

應症請見備註欄

245

WDD08F0301ZW "SAVDERM"FOAM DRESSING(STERILE)(5CMX5CM)泡棉敷料(滅菌)*適

應症請見備註欄

29.3

WDD08G0101ZW SAVDERM ANTISEPTIC AG FOAM DRESSING 5X5CM 舒膚貼抗菌含銀

泡棉敷料 *適應症請見備註欄

55.3

WDD08G0202ZW SAVDERM ANTISEPTIC AG FOAM DRESSING 10X10CM 舒膚貼抗菌含

銀泡棉敷料 *適應症請見備註欄

184

WDD08H0102ZW SAVDERM HYDROCOLLOIDS THIN DRESSING(STERILE)10X10CM親水性

敷料(滅菌)*適應症請見備註欄

53.2

WDD08H0206ZW SAVDERM HYDROCOLLOIDS THIN DRESSING(STERILE)15X15CM親水性

敷料(滅菌)*適應症請見備註欄

116

WDD08H0307ZW SAVDERM HYDROCOLLOIDS THIN DRESSING(STERILE)5X20CM親水性

敷料(滅菌)*適應症請見備註欄

53.2

WDD08HDGE12H 赫麗敷清創凝膠(滅菌) HERADERM GEL (STERILE)40GM 276

WDD08NG415QY "SYSTAGENIX"NU-GEL HYDROGEL WITH ALGINATE(STERILE)15G"新

世捷"紐潔海藻水凝膠*給付規定請見備註。

140

WDD08NG425QY "SYSTAGENIX"NU-GEL HYDROGEL WITH ALGINATE(STERILE)25G"新

世捷"紐潔海藻水凝膠*給付規定請見備註。

276

WDD08P9595QY "SYSTAGENIX"TIELLE PACKING HYDROPOLYMER DRESSING

(STERILE)9.5CMX9.5CM"新世捷"德力填塞型親水性敷料*給付規定

請見備註。

119

WDD08S2405K6 "EUROMED INC"SURESKIN SLIVER HYDROCOLLOID DRESSING

10CMX10CM(BORDER)"優而美"舒肌親水性含銀離子傷口敷料(滅

菌)(固定型)*適應症請見備註欄

224

WDD08S2407K6 "EUROMED INC"SURESKIN SLIVER HYDROCOLLOID DRESSING

20CMX20CM(BORDER)"優而美"舒肌親水性含銀離子傷口敷料(滅

菌)(固定型)*適應症請見備註欄

612

970

特材代碼 中英文名稱 支付點數-104/01/01

WDD08S2416K6 "EUROMED INC"SURESKIN SLIVER HYDROCOLLOID DRESSING

15CMX15CM(BORDER)"優而美"舒肌親水性含銀離子傷口敷料(滅

菌)(固定型)*適應症請見備註欄

406

WDD08T0510RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創

傷敷料(滅菌)5X10CM*(薄型)*適應症請見備註欄

41.1

WDD08T0520RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創

傷敷料(滅菌)5X20CM*(薄型)*適應症請見備註欄

53.2

WDD08T0709QY "SYSTAGENIX"TIELLE HYDROPOLYMER ADHESIVE DRESSING

(STERILE)7CMX9CM"新世捷"德力自黏親水性敷料*給付規定請見備

註。

73

WDD08T1010RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創

傷敷料(滅菌)10X10CM*(薄型)*適應症請見備註欄

53.2

WDD08T1111QY "SYSTAGENIX"TIELLE HYDROPOLYMER ADHESIVE DRESSING

(STERILE)11CMX11CM"新世捷"德力自黏親水性敷料*給付規定請見

備註。

143

WDD08T1515QY "SYSTAGENIX"TIELLE HYDROPOLYMER ADHESIVE DRESSING

(STERILE)15CMX15CM"新世捷"德力自黏親水性敷料*給付規定請見

備註。

245

WDD08T1515RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創

傷敷料(滅菌)15X15CM*(薄型)*適應症請見備註欄

116

WDD08T1520QY "SYSTAGENIX"TIELLE HYDROPOLYMER ADHESIVE DRESSING

(STERILE)15CMX20CM"新世捷"德力自黏親水性敷料*給付規定請見

備註。

327

WDD08T2020RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創

傷敷料(滅菌)20X20CM*(薄型)*適應症請見備註欄

192

WDD08W0505RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創

傷敷料(滅菌)5X5CM*適應症請見備註欄

29.3

WDD08W1010RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創

傷敷料(滅菌)10X10CM*適應症請見備註欄

119

WDD08W1020RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創

傷敷料(滅菌)10X20CM*適應症請見備註欄

245

WDD08W2020RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創

傷敷料(滅菌)20X20CM*適應症請見備註欄

395

WDD08X1111QY "SYSTAGENIX"TIELLE XTRA NON-ADHESIVE HYDROPOLYMER

DRESSING (STERILE)11CMX11CM"新世捷"德力裁剪型不自黏親水性

敷料*給付規定請見備註。

143

WDD08X1515QY "SYSTAGENIX"TIELLE XTRA NON-ADHESIVE HYDROPOLYMER

DRESSING (STERILE)15CMX15CM"新世捷"德力裁剪型不自黏親水性

敷料*給付規定請見備註。

245

WDD08X1520SY "SYSTAGENIX" TIELLE XTRA NON-ADHESIVE HYDROPOLYMER

DRESSING (STERILE) 15X20CM "新世捷"德力裁剪型不自粘親水性

敷料 ※適應症請見備註欄

327

WDD08Y0101ZW SAVDERM AQUAFABRIC DRESSING(STERILE)5X5公分舒膚貼親水性纖

維敷料(滅菌)*給付規定請見備註欄。

29.3

WDD08Y0202ZW SAVDERM AQUAFABRIC DRESSING(STERILE)10X10公分舒膚貼親水性

纖維敷料(滅菌)*給付規定請見備註欄。

119

WDD08Y0362ZW SAVDERM AQUAFABRIC DRESSING(STERILE)15X15公分舒膚貼親水性

纖維敷料(滅菌)*給付規定請見備註欄。

245

WDD08Y0463ZW SAVDERM AQUAFABRIC DRESSING(STERILE)2X45公分舒膚貼親水性

纖維敷料(滅菌)*給付規定請見備註欄。

119

ACM012P200NL "娜維利斯特"娜米克血管造影多路水接頭"NAVILYST"NAMIC

ANGIOGRAPHIC MANIFOLDS(2-PORT)

184

ACM014P200NL "娜維利斯特"娜米克血管造影多路水接頭"NAVILYST"NAMIC

ANGIOGRAPHIC MANIFOLDS(4-PORT)

261

971

特材代碼 中英文名稱 支付點數-104/01/01

ACM01MAN2NBQ "邦特"多管道引流器 184

ACM01MAN3NBQ "邦特"多管道引流器"BIOTEQ"MANIFOLDS 211

ACM01MAN4NBQ "邦特"多管道引流器"BIOTEQ"MANIFOLDS 261

BBF03E1002M6 宇仁餵食引導器 (未滅菌)-PUMP SET 餵食袋IMM FEEDING TUBE

ACCESSORIES(NON-STERILE)

110

BBP0408531HL "鶴牌"造口術用袋及其附件 (未滅菌)-單片黏捲式便

袋"HOLLISTER"OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-

PREMIER DRAINABLE POUCH

51.5

BBP0411210LK 福立克”可樂適造口術用袋及其附件(未滅菌)-單片式便袋13-

64MM(含人工皮、不織布)“FLEXICARE”COLOSET OSTOMY BAG AND

ACCESSORIES (NON-STERILE) –1 PCS

51.5

BBP0418012HL "鶴牌"造口術用袋及其附件 (未滅菌)-新象高流量便

袋"HOLLISTER" OSTOMY POUCH AND ACCESSORIES(NON-STERILE)-

NEW IMAGE HIGH OUTPUT ULTRA CLEAR DRAINABLE

37.1

BBP0418016HL "鶴牌"造口術用袋及其附件 (未滅菌)-新象高流量便

袋"HOLLISTER" OSTOMY POUCH AND ACCESSORIES (NON-STERILE)

-NEW IMAGE HIGH OUTPUT ULTRA CLEAR DRAINAB

42.3

BBP0418192HL "鶴牌"造口術用袋及其附件 (未滅菌)-新象便袋附除臭

片"HOLLISTER" OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-

NEW IMAGE LOCK’N ROLL DRAINABLE POUCH,

37.1

BBP0426064HL "鶴牌"造口術用袋及其附件 (未滅菌)-單片式便袋附除臭片(含人

工皮) "HOLLISTER" OSTOMY POUCH AND ACCESSORIES (NON-

STERILE)-ONE PIECE HIGH OUTPUT WITH

51.5

BBP042D7382Q 威樂造口術用袋及其附件(未滅菌)-穩立優雙片式便袋

38/45/60/70MM "WELLAND" OSTOMY POUCH AND ACCESSORIES

(NON-STERILE)-VALORE

37.1

BBP04TD7132Q 威樂造口術用袋及其附件(未滅菌)-穩立優便袋13-70MM

"WELLAND" OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-

VALORE DRAINABLE POUCH 13-70MM

51.5

BBU0108460HL "鶴牌"造口術用袋及其附件 (未滅菌)-單片人工皮附紙膠型尿

袋"HOLLISTER"OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-

PREMIER UROSTOMY POUCH

90.1

BBU012U7382Q 威樂造口術用袋及其附件(未滅菌)-穩立優雙片式尿造口袋

38/45/60/70MM "WELLAND" OSTOMY POUCH AND ACCESSORIES

(NON-STERILE)-VALORE UROSTOMY 2-PIECE POU

77

BBU01TU7132Q 威樂造口術用袋及其附件(未滅菌)-穩立優尿造口袋13-70MM

"WELLAND" OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-

VALORE UROSTOMY POUCH 13-70MM

90.1

BBW01LU500BQ "邦特"導入/引流導管附件(滅菌):引流袋 BIOTEQ

INTRODUCER/DRAINAGE CATHETER ACCESSORIES : DRAINAGE BAG

34

BBW01LU800BQ "邦特"導入/引流導管附件(滅菌):腎臟造口引流袋 BIOTEQ

INTRODUCER/DRAINAGE CATHETER ACCESSORIES(STERILE): PCN

DRAINAGE BAG

34

BBW01UB121BQ "邦特"導入/引流導管附件(滅菌):引流袋 BIOTEQ

INTRODUCER/DRAINAGE CATHETER ACCESSORIES : DRAINAGE BAG

34

BBW01UB201BQ "邦特"導入/引流導管附件(滅菌):引流袋 BIOTEQ

INTRODUCER/DRAINAGE CATHETER ACCESSORIES : DRAINAGE BAG

34

CAE01ANE153B "康德萊"一次性使用麻醉針-硬膜外穿刺針"KDL"DISPOSABLE

SPINAL NEEDLE

110

CBB0122064SB "波士頓科技"艾瑟羅血管氣球擴張導管"BOSTON SCIENTIFIC"XXL

VASCULAR BALLOON DILATATION CATHETER

5398

CBB01BTM03QC "清流"班特經皮穿刺血管成形術導管"CLEARSTREAM"BANTAM

PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY(PTA)CATHETER 280MM

11140

972

特材代碼 中英文名稱 支付點數-104/01/01

CBB01CH458XW "朗迪"可樂士高壓氣球導管"RONTIS"CRONUS HP PTA BALLOON

CATHETER

5398

CBB01PAS35BK "百多力"帕希爾18周邊血管氣球擴張導管"BIOTRONIK"PASSEO-18

PTA BALLOON CATHETER

5398

CBB01PAS36BK "百多力"帕希爾18周邊血管氣球擴張導管"BIOTRONIK"PASSEO-18

PTA BALLOON CATHETER 120:200MM

11140

CBB01PAS38BK "百多力"帕希爾35周邊血管氣球擴張導管"BIOTRONIK"PASSEO-

35,PTA BALLOON CATHETER

5398

CBB01PTA16EY 瑞提快速交換血管擴張氣球導管"EV3"RAPIDCROSS PTA RAPID

EXCHANGE BALLOON DILATATION CATHETER

5398

CBB01RFLX1QC "清流"銳弗斯經皮穿刺血管成形術導管"CLEARSTREAM"REEFLEX

PTA CATHETER L40:80MM

5398

CBB01RKRS1QC "CLEARSTREAM"REEKROSS PERCUTANEOUS TRANSLUMINAL

ANGIOPLASTY(PTA)CATHETER"清流"銳克斯經皮穿刺血管成形術導

5398

CBB01VTR14AB "亞培"懷維克周邊血管擴張導管"ABBOTT"VIATRAC 14 PLUS

PERIPHERAL DILATATION CATHETER

5398

CBB0342510CD "考迪斯"速立刻擴張導管"CORDIS"SLEEK PERCUTANEOUS

TRANSLUMINAL ANGIOPLASTY (PTA) CATHETER D2:4MM L40:100MM

8455

CBB0342522CD "考迪斯"速立刻擴張導管"CORDIS"SLEEK PERCUTANEOUS

TRANSLUMINAL ANGIOPLASTY (PTA) CATHETER D2:4MM L120:220MM

11140

CBB0342610CD "考迪斯"速立刻擴張導管"CORDIS"SLEEK OTW PERCUTANEOUS

TRANSLUMINAL ANGIOPLASTY (PTA) CATHETER L15:100MM

8455

CBB0342628CD "考迪斯"速立刻擴張導管"CORDIS"SLEEK OTW PERCUTANEOUS

TRANSLUMINAL ANGIOPLASTY (PTA) CATHETER L120:280MM

11140

CBB0343622CD "考迪斯"沙維長型PTA擴張導管"CORDIS"SAVVY LONG

PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) CATHETER

D2:6MM L120:220MM

11140

CBB03LPAC1QC "清流"萊特派經皮穿刺血管成形術導管"CLEARSTREAM"LITEPAC

PTA CATHETER L15-100MM

8455

CBB03LPAC2QC "清流"萊特派經皮穿刺血管成形術導管"CLEARSTREAM"LITEPAC

PTA CATHETER L120-220MM

11140

CBB03PAS23BK "百多力"帕希爾35周邊血管氣球擴張導管"BIOTRONIK"PASSEO-

35,PTA BALLOON CATHETER 120:200MM

11140

CBB03PTA16EY 瑞提快速交換血管擴張氣球導管"EV3"RAPIDCROSS PTA RAPID

EXCHANGE BALLOON DILATATION CATHETER 氣球長度150:210MM

11140

CBB03PTA31CK "曲克"艾德凡絲麥可小剖面經皮穿刺血管成形術球曩擴張導

管"COOK"ADVANCED MICRO 14 ULTRA LOW PROFILE PTA BALLOON

CATHETER 2:10CM

8455

CBB03PTA32CK "曲克"艾德凡絲麥可小剖面經皮穿刺血管成形術球曩擴張導

管"COOK"ADVANCED MICRO 14 ULTRA LOW PROFILE PTA BALLOON

CATHETER 12CM

11140

CBB03RFLX2QC "清流"銳弗斯經皮穿刺血管成形術導管"CLEARSTREAM"REEFLEX

PTA CATHETER L120:220MM

11140

CBB03RKRS2QC "CLEARSTREAM"REEKROSS PERCUTANEOUS TRANSLUMINAL

ANGIOPLASTY(PTA)CATHETER L:40:80MM"清流"銳克斯經皮穿刺血

管成形術導管

8455

CBB03RKRS3QC "CLEARSTREAM"REEKROSS PERCUTANEOUS TRANSLUMINAL

ANGIOPLASTY(PTA)CATHETER L:120:220MM"清流"銳克斯經皮穿刺

血管成形術導管

11140

CBB03SAB02CD "考迪斯"沙博擴張導管"CORDIS"SABER OTW PERCUTANEOUS

TRANSLUMINAL ANGIOPLASTY(PTA)DILATATION CATHETER 2:10CM

8455

973

特材代碼 中英文名稱 支付點數-104/01/01

CBB03SAB15CD "考迪斯"沙博擴張導管"CORDIS"SABER OTW PERCUTANEOUS

TRANSLUMINAL ANGIOPLASTY(PTA)DILATATION CATHETER 15:30CM

11140

CBC01XACTCAB "亞培"確位頸動脈支架系統"ABBOTT"XACT CAROTID STENT SYSTEM 28608

CBC0210126AB "亞培"歐密林精英球囊擴張血管支架"ABBOTT"OMNILINK ELITE

VASCULAR BALLOON-EXPANDABLE STENT SYSTEM

27129

CBC021L1ACM4 "美敦力"康博立血管自膨式支架系統(腸股動脈血管支

架)"MEDTRONIC"COMPLETE SE VASCULAR STENT SYSTEM

27129

CBC02V1EL6AN "ANGIOMED"BARD LIFESTAR VASCULAR STENT SYSTEM"安吉美爾德"

巴德萊弗使達血管支架系統(腸骨血管支架)-輸送系統長135CM

27129

CBC02V1ES6AN "ANGIOMED"BARD LIFESTAR VASCULAR STENT SYSTEM"安吉美爾德"

巴德萊弗使達血管支架系統(腸骨血管支架)-輸送系統長80CM

27129

CBC04APL12AB "亞培"雅速博長型周邊血管自張支架系統(淺股動脈血管支

架)"ABBOTT"ABSOLUTE PRO LL PERIPHERAL SELF-EXPANDING

STENT SYSTEM L120MM

28773

CBC04APL15AB "亞培"雅速博長型周邊血管自張支架系統(淺股動脈血管支

架)"ABBOTT"ABSOLUTE PRO LL PERIPHERAL SELF-EXPANDING

STENT SYSTEM L150MM

44293

CBC04M1SG1TM "泰爾茂"彌薩爾周邊血管支架(淺股動脈血管支

架)"TERUMO"MISAGO SELF-EXPANDING PERIPHERAL STENT

L40:120MM

28773

CBC04M1SG2TM "泰爾茂"彌薩爾周邊血管支架(淺股動脈血管支

架)"TERUMO"MISAGO SELF-EXPANDING PERIPHERAL STENT L150MM

44293

CBC04PR200EY 愛爾飛絲自動擴張周邊血管支架系統"EV3"EVERFLEX SELF-

EXPANDING PERIPHERAL STENT SYSTEM 150:200MM

44293

CBC04PRB20EY 愛爾飛絲自動擴張周邊血管支架系統"EV3"EVERFLEX SELF-

EXPANDING PERIPHERAL STENT SYSTEM 20:120MM

28773

CBC04SFALLM4 "MEDTRONIC"COMPLETE SE VASCULAR STENT SYSTEM"美敦力"康博

立血管自膨式支架系統(淺股動脈血管支架)L150MM

44293

CBC04SFASLM4 "MEDTRONIC"COMPLETE SE VASCULAR STENT SYSTEM"美敦力"康博

立血管自膨式支架系統(淺股動脈血管支架)L20:120MM

28773

CBC06PBLUECD "考迪斯"帕瑪藍周邊血管支架系統(腎動脈支架及輸送系

統)"CORDIS"PALMAZ BLUE .014 PERIPHERAL STENT SYSTEM

31063

CBP01HPERBYC "樂普"琥珀經皮穿刺冠狀動脈球囊導管"LEPU"HOPER PTCA

BALLOON DILATATION CATHETER

6843

CBP01MZXXXQR "渼瑞爾"莫利克冠狀動脈氣球擴張導管"MERIL"MOZEC RX PTCA

BALLOON DILATATION CATHETER

6843

CBP03ERUNCXW "朗迪"優霸恩喜冠狀動脈氣球導管"RONTIS"EUROPA ULTRA NC

PTCA BALLOON CATHETER

7547

CBP06ELUT1QR "MERIL"BIOMIME SIROLIMUS ELUTING CORONARY STENT SYSTEM"渼

瑞爾"拜歐邁冠狀動脈塗藥支架系統(自付差額品項)

16293

CBP06ELUT5AB "ABBOTT"XIENCE XPEDITION 48 EVEROLIMUS ELUTING CORONARY

STENT SYSTEM"亞培"賽恩斯征長型艾諾莉茉斯冠狀動脈塗藥支架

系統(自付差額品項)

16293

CBP06ELUT7SB "波士頓科技"博謨適帕米爾艾諾莉茉斯冠狀動脈塗藥支架系統 ※

自付差額品項,超過部分由病患自付"BOSTON SCIENTIFIC"PROMUS

PREMIER EVEROLIMUS-ELUTING COR

16293

CBP07D1DEBEQ "優洛可"笛沃心臟經皮冠狀動脈氣球擴張導管"EUROCOR"DIOR

PACLITAXEL ELUTING PTCA BALLOON CATHETER

47000

974

特材代碼 中英文名稱 支付點數-104/01/01

CBS04D1400WE "百歐森偉伯司特" 摩比卡斯心房中膈穿刺針"BIOSENSE WEBSTER"

MOBICATH TRANSSEPTAL NEEDLE

6379

CBS06MUSP1G6 "銨積維"安普拉茲梗塞後肌肉性心室中膈缺損關閉器"AGA"

AMPLATZER MUSCULAR VSD PI OCCLUDER 16:24MM

121679

CCC1304260R5 "索倫"卓越自體輸血套組(含儲血槽+血液收集套組)"SORIN"XTRA

AUTOTRANSFUSION DISPOSABLE SET

3900

CCC1404250R5 "索倫"卓越自體輸血套組(含離心缽+血液回輸袋+廢液袋及預接管

路)"SORIN"XTRA AUTOTRANSFUSION DISPOSABLE SET 55:225ML

BOWL

7260

CDD0246398GJ "吉生"體外循環管組-心臟內抽吸器"JSM"HEART LUNG PACK-

INTRACARDIAC SUCKER

398

CDD110506AL7 "大吉士"穿刺套管"LAGIS" TROCAR(內管*1+外管*1+轉接頭*1) 1459

CDD110506BL7 "大吉士"穿刺套管"LAGIS" TROCAR(內管*1+外管*1+轉接頭*1) 1459

CDD110506CL7 "大吉士"穿刺套管"LAGIS" TROCAR(內管*1+外管*2+轉接頭*2) 1509

CDD110506DL7 "大吉士"穿刺套管"LAGIS" TROCAR(內管*1+外管*2+轉接頭*2) 1509

CDD110506EL7 "大吉士"穿刺套管"LAGIS" TROCAR(內管*1+外管*1+轉接頭*1) 1459

CDD110506FL7 "大吉士"穿刺套管"LAGIS" TROCAR(內管*1+外管*1+轉接頭*1) 1459

CDD110506GL7 "大吉士"穿刺套管"LAGIS" TROCAR(內管*1+外管*2+轉接頭*2) 1509

CDD110506HL7 "大吉士"穿刺套管"LAGIS" TROCAR(內管*1+外管*2+轉接頭*2) 1509

CDD11091PF2C "柯惠"可變徑式V型安全穿刺套管 "COVIDIEN" VERSAPORT PLUS

AUTOSUTURE V2 W/FIXATION CANNULA 5-11~12MM (外管+可變轉接

頭)

955

CDD11096PF2C "柯惠"可變徑式V型安全穿刺套管 "COVIDIEN"VERSAPORT PLUS

AUTOSUTURE V2 W/FIXATION CANNULA 5-12MM (穿刺內管+外管+可

變轉接頭)

1459

CDD111112AL7 "大吉士"穿刺套管"LAGIS" TROCAR(內管*1+外管*1+轉接頭*1) 1459

CDD111112BL7 "大吉士"穿刺套管"LAGIS" TROCAR(內管*1+外管*2+轉接頭*2) 1509

CDD114216U2C "柯惠"可充氣穿刺套管"COVIDIEN" AUTO SUTURE THREADED

TROCAR SLEEVES WITH WOODFORD SPIKE TROCAR AND INSUFFATION

PORT(穿剌針1+外管2+固定轉接頭2)

1509

CDD116626P2C "柯惠"開放性腹腔鏡手術用之一次性穿刺器"COVIDIEN"BLUNTPORT

PLUS AUTO SUTURE 5-12MM (穿刺針1+外管1+可變式轉接頭1+袋口

結固定器+螺紋固定器)

2233

CDD117092D2C ”柯惠”安全穿刺套管組 "COVIDIEN" AUTO SUTURE VERSAPORT

PLUS RPF TROCAR SYSTEM 5MM(外管+固定式轉接頭1)

917

CDD117093F2C "柯惠"可變徑式V型安全穿刺套管 "COVIDIEN" VERSAPORT PLUS

AUTOSUTURE V2 W/FIXATION CANNULA 5MM (外管+固定轉接頭)

917

CDD11770902C "柯惠"安全穿刺套管組 "COVIDIEN" AUTO SUTURE VERSAPORT

PLUS RPF TROCAR SYSTEM 5/11-12MM (外管1+可變轉接頭1)

955

CDD11790942C "柯惠"V型刀片穿刺套管 "COVIDIEN"VERSAPORT AUTO SUTURE

PLUS V2/V2 BLADED TROCAR (內管+外管+固定式接頭)

1116

CDD11790962C "柯惠"V型刀片穿刺套管 "COVIDIEN"VERSAPORT AUTO SUTURE

PLUS V2/V2 BLADED TROCAR(內管+外管+可變轉接頭)

1459

CDD119076D2C ”柯惠”安全穿刺套管組 "COVIDIEN" AUTO SUTURE VERSAPORT

PLUS RPF TROCAR SYSTEM 5-10MM(穿刺針1+外管1+可變式轉接頭

1)

1459

CDD119093F2C "柯惠"可變徑式V型安全穿刺套管 "COVIDIEN"VERSAPORT PLUS

AUTOSUTURE V2 W/FIXATION CANNULA 5MM (穿刺內管+外管+固定

轉接頭)

1116

CDD11FPK03ET "愛惜康"外科套管針"ETHICON" FLEXIPATH SURGICAL TROCAR(穿

剌針1+外管3+內建固定轉接頭3)

2530

CDD11GT100QW "台灣先進"拋棄式穿刺套管"TAIWAN SURGICAL"DISPOSABLE

TROCAR 5-10/12MM (穿剌針1+外管1+內建可變式轉接頭1)

1459

975

特材代碼 中英文名稱 支付點數-104/01/01

CDD11GT500QW "TAIWAN SURGICAL"DISPOSABLE TROCAR "台灣先進"拋棄式穿刺套

管(穿剌針1+外管1+調節旋塞1)

1116

CDD11GT501QW "台灣先進"拋棄式穿刺套管"TAIWAN SURGICAL"DISPOSABLE

TROCAR 5MM (穿剌針1+外管1+內建固定式轉接頭1)

1116

CDD11GTCS1QW "台灣先進"拋棄式穿刺套管"TAIWAN SURGICAL"DISPOSABLE

TROCAR 5MM (外管1+內建固定式轉接頭1)

917

CDD11GTCS2QW "台灣先進"拋棄式穿刺套管"TAIWAN SURGICAL"DISPOSABLE

TROCAR 5-10/12MM (外管1+內建可變式轉接頭1)

955

CDD11NB12S2C "柯惠"無刀刃可變式穿刺套管"COVIDIEN"VERSAPORT BLADELESS

AND VERSAPORT PLUS BLADELESS SINGLE USE BLADELESS

TROCAR(內管1+外管1+可變轉接頭1)

1459

CDD11NBFCS2C "柯惠"無刀刃可變式穿刺套管"COVIDIEN"VERSAPORT BLADELESS

AND VERSAPORT PLUS BLADELESS SINGLE USE BLADELESS

TROCAR(外管1+固定式轉接頭1)

917

CDD11TT012ET "愛惜康"外科套管針"ETHICON" FLEXIPATH SURGICAL TROCAR(穿

剌針1+外管1+內建固定轉接頭1)

1116

CDDF1D5051KC "凱西爾"負壓輔助癒合敷料"KCI" V.A.C. GRANUFOAM DRESSING 2355

CDDF1D5052KC "凱西爾"負壓輔助癒合敷料"KCI" V.A.C. GRANUFOAM DRESSING 2603

CDDF1D5053KC "凱西爾"負壓輔助癒合敷料"KCI" V.A.C. GRANUFOAM DRESSING 2715

CDDF1H11011V "雃博"立補負壓傷口治療系統_立補泡棉敷料(大)"APEX" ZIP

NEGATIVE PRESSURE WOUND THERAPY SYSTEM_ZIP FOAM

DRESSING(LARGE)

2715

CDDF1H11021V "雃博"立補負壓傷口治療系統_立補泡棉敷料(中)"APEX" ZIP

Negative Pressure Wound Therapy System_ZIP FOAM

DRESSING(MIDDLE)

2603

CDDF1H11031V "雃博"立補負壓傷口治療系統_立補泡棉敷料(小)"APEX" ZIP

NEGATIVE PRESSURE WOUND THERAPY SYSTEM_ZIP FOAM

DRESSING(SMALL)

2355

CDP0143110BQ "邦特"引流導管及穿刺導入系統"BIOTEQ"DRAINAGE

CATHETER&INTRODUCER SET/KIT(含導管及穿刺針)

1720

CDP0175110AG "亞康恩"導入引流導管及其附件(滅

菌)"ARGON"INTRODUCTION/DRAINAGE CATHETER AND

ACCESSORIES(STERILE)

1720

CDP0175530AG "亞康恩"導入/引流導管及其附件(滅

菌)"ARGON"INTRODUCTION/DRAINAGE CATHETER AND

ACCESSORIES(STERILE)

1720

CDP01MAKSSMR "美瑞特"馬克迷你血管導引套組"MERIT"MAK-MINI ACCESS KIT 1666

CDPN1CASP1CK "曲克"胸腔吸引導管組(滅菌)"COOK"SIMPLE PNEUMOTHORAX

ASPIRATION ACCESSORY SET(STERILE)

1281

CEE010544A3N "根本"高壓延長管-螺旋管"NEMOTO"PRESSURE TUBE300PSI 40

CEE01B060NPW "普惠"輸液套-Y管免針安全型"PERFECT" DISPOSABLE INFUSION

SET-SAFETY

43.1

CEE01C3300U2 "ICU"MICROCLAVE CONNECTOR AND ACCESSORIES DEVICES "愛西

優"可來福接頭及組件-無針式接頭

43.1

CEE01C3322U2 "ICU"MICROCLAVE CONNECTOR AND ACCESSORIES DEVICES "愛西

優"可來福接頭及組件-無針式雙接頭延長管

99

CEE01CH140U2 "ICU"CLAVE DRUG PREPARATION SYSTEM"愛喜優"克萊福藥物準備

系統-克萊福接頭+輸液袋接頭

70

CEE01CH318U2 "ICU"CLAVE DRUG PREPARATION SYSTEM"愛喜優"克萊福藥物準備

系統-輸液管含SPIROS注射調節接頭

134

CEE01CNE02Q4 "尼得立斯"免針輸液接頭-藥物準備系統組件/輸液

管"NEEDLELESS"NEEDLELESS INJECTION ACCESS DEVICE/TUBING

134

CEE01E005NPW "普惠"免針安全型T型輸液延長管"PERFECT"SAFETY EXTENSION

TUBE WITH T NEEDLE FREE

43.1

976

特材代碼 中英文名稱 支付點數-104/01/01

CEE01E020NPW "普惠"靜注延長管T型(免針安全型)"PERFECT"EXTENSION TUBE T

TYPE(SAFETY)

43.1

CEE01ETAT1NQ "宇仁"延長管-T型"INNOVATIVE"EXTENSION SET/T-CONNECTOR 14

CEE01ETNE1Q4 "尼得立斯"免針輸液接頭-延長管"NEEDLELESS"NEEDLELESS

INJECTION ACCESS DEVICE/EXTENSION TUBE

43.1

CEE01ETNE2Q4 "尼得立斯"免針輸液接頭-二路延長管"NEEDLELESS"NEEDLELESS

INJECTION ACCESS DEVICE/2-WAY EXTENSION TUBE

99

CEE01ETNE3Q4 "尼得立斯"免針輸液接頭-三路延長管"NEEDLELESS"NEEDLELESS

INJECTION ACCESS DEVICE/3-WAY EXTENSION TUBE

99

CEE01NE810Q4 "尼得立斯"免針輸液接頭-無針式接頭"NEEDLELESS"NEEDLELESS

INJECTION ACCESS DEVICE

43.1

CEE01NFA012U "佳承"輸液點滴套-無針式接頭"CHIA

CHERNE"I.V.ADMINISTRATION SET/NEEDLELESS FEMALE ADAPTOR

43.1

CEE01NFS012U "佳承"輸液點滴套-藥物準備系統組件/插入針"CHIA

CHERNE"I.V.ADMINISTRATION SET/NEEDLELESS FEMALE ADAPTOR

SPIKE(NON AIRVENTED)

70

CEE01NFS022U "佳承"輸液點滴套-藥物準備系統組件/插入針(玻璃瓶用)"CHIA

CHERNE"I.V.ADMINISTRATION SET/NEEDLELESS FEMALE ADAPTOR

SPIKE(AIRVENTED)

70

CEE01NMT012U "佳承"輸液點滴套-藥物準備系統組件/輸液管"CHIA

CHERNE"I.V.ADMINISTRATION SET/NEEDLELESS MALE ADAPTOR

TUBING

134

CEE01NSE01Q4 "尼得立斯"免針輸液接頭-藥物準備系統組件/插入

針"NEEDLELESS"NEEDLELESS INJECTION ACCESS DEVICE/SPIKE

70

CEE01NTE10Q4 "尼得立斯"免針輸液接頭-T型延長管"NEEDLELESS"NEEDLELESS

INJECTION ACCESS DEVICE/T-TYPE EXTENSION TUBE

43.1

CEE01NYE10Q4 "尼得立斯"免針輸液接頭-Y型延長管"NEEDLELESS"NEEDLELESS

INJECTION ACCESS DEVICE/Y-TYPE EXTENSION TUBE

51.5

CEE01SCE01Q4 "尼得立斯"免針輸液接頭-藥物準備系統組件/插入針(玻璃瓶

用)"NEEDLELESS"NEEDLELESS INJECTION ACCESS DEVICE/SPIKE

FOR GLASS BOTTLE

70

CEE01SEE02Q4 尼得立斯免針輸液接頭(藥物準備系統組件玻璃瓶

用)NEEDLELESS"NEEDLELESS INJECTION ACCESS DEVICE

70

CEP010544B3N "根本"高壓延長管-直型管"NEMOTO"PRESSURE TUBE300PSI 30.7

CGBK1BML20LY "奧林柏斯"機械式碎石器(碎石加取石網)"OLYMPUS"MECHANICAL

LITHOTRIPTOR

12365

CGBK1BML23LY "奧林柏斯"單次使用機械碎石器及附件(碎石加取石

網)"OLYMPUS"SINGLE USE MECHANICAL LITHOTRIPTOR AND

ACCESSORIES

12365

CGBK1BML43LY "奧林柏斯"單次使用機械碎石器(碎石加取石網)"OLYMPUS"SINGLE

USE MECHANICAL LITHOTRIPTOR

12365

CGDW1A8263TM "泰爾茂"導引導線"TERUMO"RADIFOCUS GUIDE WIRE M

STIFF/HALF-STIFF 0.018":0.038" 220;260CM

1359

CGDW1B3422BQ "邦特"血管內引導鋼線"BIOTEQ"GUIDEWIRE HYDROPHILIC

0.016~0.018" 220~300CM

1359

CGDW1G012ACK "曲克"導線"COOK"GUIDE WIRE 0.018~0.052" 180CM 313

CGDW1GA083TM "泰爾茂"導引導線"TERUMO"RADIFOCUS GUIDE WIRE M

0.018":0.038" 80CM

653

CGDW1GA153TM "泰爾茂"導引導線"TERUMO"RADIFOCUS GUIDE WIRE M

0.018":0.038" 120~180CM

751

CGDW1GW004G6 "銨積維"導引導管"AGA" AMPLATZER GUIDEWIRE (VSD OCCLUDER

用)

1600

CGDW1HPW01CK "曲克"路德朗優尼格親水性導線"COOK"ROADRUNNER UNIGLIDE

HYDROPHILIC WIRE GUIDE 0.018"~0.038" 150CM;180CM

751

977

特材代碼 中英文名稱 支付點數-104/01/01

CGDW1HPW02CK "曲克"路德朗優尼格親水性導線"COOK"ROADRUNNER UNIGLIDE

HYDROPHILIC WIRE GUIDE(STIFF SHAFT) 0.025"~0.038"

150CM;180CM

779

CGDW1HPW03CK "曲克"路德朗優尼格親水性導線"COOK"ROADRUNNER UNIGLIDE

HYDROPHILIC WIRE GUIDE 0.018"~0.038" 260CM

1359

CGDW1PA183TM "泰爾茂"導引導線"TERUMO"RADIFOCUS GUIDE WIRE M

STIFF/HALF-STIFF 0.020":0.038" 150:180CM

779

CGPG101827AS "朝日"瑪仕特微導管系列ASAHI MASTERS PARKWAY MICROCATHETER 8715

CGPG126046SB "波士頓科技"盧碧肯支撐導管"BOSTON SCIENTIFIC"RUBICON

SUPPORT CATHETERS

8715

CGPG12X400BB 柏朗導引導管B.BRAUN SERPIA HYDROPHILIC GUIDING CATHETER 1744

CGPG156FXBCM "柯特曼"導引導管"CODMAN"ENVOY GUIDING CATHETER 1744

CGPG1672ADCD "考迪斯"安卓特導引導管"CORDIS"ADROIT GUIDING CATHETERS

6FR

1744

CGPG1STD74AS "朝日"斯卓德微導管"ASAHI"STRIDE MICROCATHETER 2.2FR 8715

CGPG2GDLV3VS "法斯樂舒順"第3代冠連導管"VASCULAR SOLUTIONS"GUIDELINER

V3 CATHETER

18617

CGPG2GUDEASB "波士頓科技"蓋茲導引延長導管"BOSTON SCIENTIFIC"GUIDEZILLA

GUIDE EXTENSION CATHETER

18617

CGPG3137513L "萊特萊柏"光學同調斷層掃描影像系統-飛龍影像導管〝LIGHTLAB

〞OPTICAL COHERENT TOMOGRAPHY IMAGING SYSTEM

26009

CGPG3CA8643L "萊特萊柏"飛龍德爾影像導管〝LIGHTLAB〞DRAGONFLY DUO IMAGE

CATHETER

26009

CGPG3PTCRSSB "BOSTON SCIENTIFIC"OPTICROSS CORONARY IMAGING CATHETER

W/SLED"波士頓科技"艾地可冠狀動脈攝影導管-血管內超音波導管

及橇型板

20480

CGPW1165CMAS "朝日"冠狀動脈延長導引線"ASAHI"EXTENSION WIRE PTFE 0.014"

150;165CM

2353

CGPW1B1258GJ "吉生"周邊血管導引線"JSM"PERIPHERAL GUIDE WIRE

0.014~0.038" 120~180CM

2781

CGPW1B2630GJ "吉生"周邊血管導引線"JSM"PERIPHERAL GUIDE WIRE

0.014~0.038" 260~300CM

2800

CGPW1CMGW1AB "亞培"高鐸格康曼血管導線"ABBOTT" HI-TORQUE COMMAND GUIDE

WIRE 0.014" 190CM

2430

CGPW1CMGW3AB "亞培"高鐸格康曼血管導線"ABBOTT" HI-TORQUE COMMAND GUIDE

WIRE 0.014" 250~300CM

2800

CGPW1W1GG3AB "ABBOTT"HI-TORQUE WIGGLE GUIDE WIRE HYDROPHILIC COATING

0.014" 300CM "亞培"高鐸格偉格導線

2587

CGPW1W1GG9AB "ABBOTT"HI-TORQUE WIGGLE GUIDE WIRE HYDROPHILIC COATING

0.014" 190CM "亞培"高鐸格偉格導線

2353

CGPW1WZA01JV "日本來富恩"艾斯利特威札導引線"JAPAN LIFELINE" ATHLETE

WIZARD PTCA GUIDE WIRE 0.010-0.014";0.0078-0.010-0.014"

190CM

3324

CGS0119042M0 "美德康"微穿刺導引器組與配件"MEDCOMP"MICRO-STICK

INTRODUCER SET AND ACCESSORIES(4-5FR SHEATH+0.018 NITINOL

GUIDEWIRE+21G NEEDLE)

1661

CGS01ATT62M4 "美敦力"艾坦確保閥左心傳送系統"MEDTRONIC" ATTAIN

COMMAND+SUREVALVE LEFT-HEART DELIVERY SYSTEM

6528

CGS01MP1S1CK "曲克"微穿刺組"COOK"MICROPUNCTURE PEDAL ACCESS SET(0.018"

NITINOL GUIDE WIRE+4-5FR CATHETER+21G NEEDLE+轉接組)

2640

978

特材代碼 中英文名稱 支付點數-104/01/01

CGS01MRK23MR "MERIT"PRELUDE MARKER TIP SHEATH INTRODUCERS (4-8FR

23CM)"美瑞特"福祿可顯影導引鞘(鞘W/MARKER TIP+擴張器+導

線、SIDEARM、W/VALVE)

1098

CGS01MRKTPMR "MERIT"PRELUDE MARKER TIP SHEATH INTRODUCERS (4-8FR

11CM)"美瑞特"福祿可顯影導引鞘(鞘W/MARKER TIP+擴張器+導

線、SIDEARM、W/VALVE)

820

CGS01PMA25MR "美瑞特"福祿小血管導引鞘"MERIT"PRELUDE MINI ACCESS SHEATH

INTRODUCERS(SHEATH+DILATOR+SIDEARM+V+GW+NEEDLE) 7;11CM

835

CGS01PSS35MR "MERIT"PRELUDE SHORT SHEATH INTRODUCER(DILATOR+4CM MARKER

TIP SHEATH+STOPCOCK+0.035~0.038"GUIDE WIRE) "美瑞特"福祿

動靜脈廔管用導引鞘

1308

CGS01QG110TA "天地合"鞘管組"TARGET"DISPOSABLE INTRODUCER KIT 4:11FR

11CM(W/SHEATH,DILATOR,GUIDEWIRE,NEEDLE)

835

CGS01QG160TA "天地合"鞘管組"TARGET"DISPOSABLE INTRODUCER KIT 4:11FR

16;24CM(W/SHEATH,DILATOR,GUIDEWIRE,NEEDLE)

1262

CGS01SV12NGX "戈爾"密封閥導鞘"GORE"DRYSEAL SHEATH

28CM(DILATOR+SIDEARM+VALVE+2WAY活栓*2+RADIOPAQUE MARKER)

887

CHF06PT16AED "愛德華"動脈灌注導管(含導引管組)"EDWARDS"OPTISITE

ARTERIAL PERFUSION CANNULA W/INTRODUCER

12404

CHT0131601GJ "吉生"體外循環管組"JSM"HEART LUNG

PACK(TUBING+ORGANIZER+PRE-BYPASS FILTER+SUCKER*2)

5218

CKD03PERCPSB "波士頓科技"全立體彎曲輸尿管支架"BOSTON SCIENTIFIC"

PERCUFLEX PLUS URETERAL STENT

1416

CKD03STRV6SB "波士頓科技"伸展輸尿管支架"BOSTON SCIENTIFIC" STRETCH VL

STENT WITH HYDROPLUS

1416

CKDD269033BA "巴德"伊奎斯長期性血液透析導管"BARD" EQUISTREAM LONG-TERM

HEMODIALYSIS CATHETER

3509

CKF0304822FM "富強" 導尿管"FORTUNE" UROLOGICAL CATHETER 93.1

CKF03060312X "百合"矽質導尿管(雙叉)"BAIHE" DISPOSABLE SILICONE FOLEY

CATHETER(2 WAY)

93.1

CKF03060322X "百合"矽質導尿管(三叉)"BAIHE" DISPOSABLE SILICONE FOLEY

CATHETER(3 WAY)

170

CKF03FL000EF "貝斯美德"矽質導尿管(二叉)6FR:26FR "BESMED" SILICONE

FOLEY CATHETER(2 WAY)6FR:26FR

93.1

CKN0143115BQ "邦特"引流導管及穿刺導入系統"BIOTEQ"DRAINAGE CATHETER &

INTRODUCER SET

2580

CKN0143116BQ "邦特"引流導管及穿刺導入系統"BIOTEQ" DRAINAGE CATHETER &

INTRODUCER SET

2580

CKUD1VTD01CK "曲克"安培茲腎臟擴張器組(單支)"COOK" AMPLATZ RENAL

DILATOR SET AND DILATORS(INDIVIDUAL)

953

CLS041015B3B "康德萊"滴定管式輸液器"KDL" INFUSION SETS WITH BURETTE 41

CLS04MS1502U "佳承"輸液點滴套"CHIA CHERNE"I.V. ADMINISTRATION SET 63.4

CLS04MV1502U "佳承"輸液點滴套"CHIA CHERNE"I.V. ADMINISTRATION SET 41

CLS05087SPBB "柏朗"史倍司輸液套INFUSOMAT SPACE LINE INFUSION PUMP

ADMINISTRATION SETS

152

CLS06C5088U2 "愛西優"可來福接頭及組件-無針接頭含過濾器避光輸液套"ICU"

MICROCLAVE CONNECTOR AND ACCESSORIES DEVICES

265

CLS0863477J6 "卡爾費森"輸液套(輸血套組, 附無針式接頭1個)"CAREFUSION"

ALARIS GP INFUSION SETS(BLOOD SET, LSS VLV)

273

CMV0101437CM "柯特曼"安德普血管重建裝置及傳導系統"CODMAN" ENTERPRISE

VASCULAR RECONSTRUCTION DEVICE AND DELIVERY SYSTEM

94000

979

特材代碼 中英文名稱 支付點數-104/01/01

CMV0110527AS "朝日"瑪仕特微導管系列ASAHI MASTERS PARKWAY MICROCATHETER 13810

CMV0114300AS "朝日"神經血管導引線"ASAHI" NEUROVASCULAR GUIDE WIRE 4650

CMV013XT27S9 "史賽克"微導管"STRYKER"EXCELSIOR XT-27 MICROCATHETER 7440

CMV0149181S9 "史賽克" 超微細導管"STRYKER" EXCELSIOR MICROCATHETER 7440

CMV016FMLSUF "彼娜波"紐諾邁克斯系統"PENUMBRA" NEURON MAX SYSTEM 12000

CMV01C44562E "麥克思"中介導管"MICRUS" REVIVE INTERMEDIATE CATHETER 12000

CMV01STD22AS “朝日”斯卓德微導管“ASAHI”STRIDE MICROCATHETER 7440

CMV0205102S9 "史賽克"菲絲雀克灌注導管"STRYKER" FASTRACKER INFUSION

CATHETER

7440

CMV02DEF68TM "泰爾茂"諦思迪迅導引套"TERUMO" DESTINATION GUIDING SHEATH 6535

CMV03AMW01CK "曲克"萊特超選擇微導線"COOK" ALIGHT SUPERSELECTIVE

MICROWIRE GUIDES

4650

CMV04MAX05S9 "史賽克"瑪琪斯分離式閉塞捲"STRYKER " MATRIX2 DETACHABLE

COILS

18302

CMV04MAX06S9 "史賽克"瑪琪斯分離式閉塞捲"STRYKER " MATRIX2 DETACHABLE

COILS

18302

CMV04PR1MEV9 "恩提愛"艾欣波萊分離式閉塞捲"MTI" AXIUM PRIME DETACHABLE

COIL

15780

CMV04TARGTS9 "史賽克"塔吉特分離線圈"STRYKER" TARGET DETACHABLE COIL 16876

CMV04VFCVXMS "麥新"微導線圈栓塞系統"MICROVENTION"MICROPLEX COIL

SYSTEM(VFC)

16876

CPC01S14163G "以仁"中央靜脈導管組-成人單腔"ELINE"CENTRAL VENOUS

CATHETER SET-SINGLE LUMEN(C+N+D+G+S)

439

CPC01S20123G "以仁"中央靜脈導管組-嬰兒單腔"ELINE"CENTRAL VENOUS

CATHETER SET-SINGLE LUMEN(C+N+D+G+S)

679

CPC02D40053G "以仁"中央靜脈導管組-小兒雙腔"ELINE" CENTRAL VENOUS

CATHETER SET-DOUBLE LUMEN(C+N+D+G+S)

1568

CPC02D70163G "以仁"中央靜脈導管組-成人雙腔"ELINE"CENTRAL VENOUS

CATHETER SET-DOUBLE LUMEN(C+N+D+G+S)

951

CPC03T55083G "以仁"中央靜脈導管組-小兒三腔"ELINE"CENTRAL VENOUS

CATHETER SET-TRIPLE LUMEN(C+N+D+G+S)

2050

CPC03T70203G "以仁"中央靜脈導管組-成人三腔"ELINE"CENTRAL VENOUS

CATHETER SET-TRIPLE LUMEN(C+N+D+G+S)

1118

CRB0116100RU "路希"支氣管內管及配件"RUSCH" BRONCHIAL TUBES AND

ACCESSORIES

1490

CRB03AEBS4CK "曲克"支氣管內管阻隔管組"COOK"ENDOBRONCHIAL BLOCKER SET 3675

CRB03AEBS5CK "曲克"支氣管內管阻隔管組"COOK" ENDOBRONCHIAL BLOCKER SET 4000

CRE0400181RU "路希"氣管內管"RUSCH"ENDOTRACHEAL TUBE 188

CRE0411781RU "路希"氣管內管"RUSCH"ENDOTRACHEAL TUBE 202

CRE04ETPNC3G "以仁"氣管內管(朝北型/有氣囊)"ELINE" ENDOTRACHEAL

TUBE(NORTH POLAR PREFORMED)

202

CRE04ETPNU3G "以仁"氣管內管(朝北型/無氣囊)"ELINE" ENDOTRACHEAL

TUBE(NORTH POLAR PREFORMED)

188

CRE0600180RU "路希"氣管內管"RUSCH" ENDOTRACHEAL TUBE 143

CRE0611780RU "路希" 氣管內管"RUSCH" ENDOTRACHEAL TUBE 201

CRE06CPW033P "全安"氣管內管(口彎型且有氣囊)"PURECATH" PUREWAY TRACHEAL

TUBES

201

CRE06ETPSC3G "以仁"氣管內管(朝南型/有氣囊)"ELINE" ENDOTRACHEAL

TUBE(SOUTH POLAR PREFORMED)

201

CRE06ETPSU3G "以仁"氣管內管(朝南型/無氣囊)"ELINE" ENDOTRACHEAL

TUBE(SOUTH POLAR PREFORMED)

143

980

特材代碼 中英文名稱 支付點數-104/01/01

CRE06UPW033P "全安"氣管內管(口彎型且無氣囊)"PURECATH" PUREWAY TRACHEAL

TUBES

143

CRE0702004RU "路希"喉部雷射手術用氣管內管"RUSCH" LASER TRACHEAL TUBE 2451

CRG0212521KV "費雪派克"正壓呼吸輔助系統-半套"FISHER & PAYKEL" BUBBLE

CPAP SYSTEM

1216

CRG02BC151KV "費雪派克"正壓呼吸輔助系統-全套"FISHER & PAYKEL" BUBBLE

CPAP SYSTEM

3049

CRT02PW04T3P "全安"氣切套管(單管有氣囊)"PURECATH" PUREWAY TRACHEOSTOMY

TUBES

332

CRT02TS03U3G "以仁"氣切套管(標準型/無氣囊)"ELINE" TRACHEOSTOMY TUBE 328

CRT02TS05C3G "以仁"氣切套管(標準型/有氣囊)"ELINE" TRACHEOSTOMY TUBE 332

CRT02TS0U13G "以仁"氣切套管(標準型/無氣囊/有內管)"ELINE" TRACHEOSTOMY

TUBE

525

CRT05PW04S3P "全安"氣切套管(含抽痰管有氣囊)"PURECATH" PUREWAY

TRACHEOSTOMY TUBES

865

CRT05TSFC13G "以仁"氣切套管(發聲型/有氣囊/有內管)"ELINE" TRACHEOSTOMY

TUBE

865

CRT05TSFU13G "以仁"氣切套管(發聲型/無氣囊/有內管)"ELINE" TRACHEOSTOMY

TUBE

850

CRT05TSSC13G "以仁"氣切套管(抽痰型/有氣囊/有內管)"ELINE" TRACHEOSTOMY

TUBE

865

CRT1021549TX "泰利福" 快速經皮氣切組及配件"TELEFLEX" PERCUQUICK SET 5365

CVA0135125MR "美瑞特"迎晰血管攝影導管"MERIT"IMPRESS ANGIOGRAPHIC

CATHETERS(4-5FR,0.035"80:125CM)

594

CVA0135465MR "美瑞特"迎晰血管攝影導管"MERIT"IMPRESS ANGIOGRAPHIC

CATHETERS(4-5FR,0.035"40:65CM)

594

CVA0138125MR "美瑞特"迎晰血管攝影導管"MERIT"IMPRESS ANGIOGRAPHIC

CATHETERS(4-5FR,0.038"100:125CM)

594

CVA0138468MR "美瑞特"迎晰血管攝影導管"MERIT"IMPRESS ANGIOGRAPHIC

CATHETERS(4-5FR,0.038"40:80CM)

594

CVA014FLNBMR "美瑞特"迎晰血管攝影導管"MERIT"IMPRESS ANGIOGRAPHIC

CATHETERS(4FR,65:110CM;NON-BRAIDED)

594

CVA015FLNBMR "美瑞特"迎晰血管攝影導管"MERIT"IMPRESS ANGIOGRAPHIC

CATHETERS(5FR,65:110CM;NON-BRAIDED)

594

CVA01RFGC4TM "泰爾茂"葛來血管攝影導管"TERUMO" REDIFOCUS GLIDECATH 594

CVA0250115BB 柏朗血管造影導管(4-6FRENCH)B.BRAUN ANGIODYN ANGIOGRAPHIC

CATHETER

594

CVC01532XNCD "考迪斯"血管造影導管"CORDIS"SUPER TORQUE ANGIOGRAPHIC

CATHETER

594

CVC01CRDPGMR "美瑞特"普瑪豬尾巴導管"MERIT PERFORMA CARDIAC PIGTAIL

CATHETERS

594

CXE0132003BA "巴德"歐比特診斷電極導管-十極"BARD" ORBITER ST DIAGNOSTIC

ELECTRODE CATHETERS

9882

CXE02DP853YB "爾灣"電生理診斷導管-十極"IBI"ELECTROPHYSIOLOGY

DIAGNOSTIC CATHETER

14154

CXE02QP854YB "爾灣"電生理診斷導管-四極"IBI"ELECTROPHYSIOLOGY

DIAGNOSTIC CATHETER

12284

CXE0332214JV "日本來富恩"方騰斯塔溫控雙向電燒導管(4MM)"JLL"FANTASISTA

ABLATION CATHETER(4MM)

21479

CXE0332215JV "日本來富恩"方騰斯塔溫控雙向電燒導管(5MM)"JLL"FANTASISTA

ABLATION CATHETER(5MM)

21479

CXE0332218JV "日本來富恩"方騰斯塔溫控雙向電燒導管(6MM、

8MM)"JLL"FANTASISTA ABLATION CATHETER(6MM、8MM)

21479

981

特材代碼 中英文名稱 支付點數-104/01/01

CXE0344500SB "波士頓科技"布雷瑟心臟除顫電極導管(7F/8MM;10MM)"BOSTON

SCIENTIFIC" BLAZER II XP TEMPERATURE ABLATION

CATHETERS(7F/8MM;10MM)

21479

CXE0383351YB "爾灣"除顫電極導管"IBI" THERAPY ABLATION CATHETERS 21479

CXE03EPT45SB "波士頓科技"布雷瑟心臟除顫電極導管(8F/8MM:10MM)"BOSTON

SCIENTIFIC" BLAZER II XP TEMPERATURE ABLATION

CATHETERS(8F/8MM;10MM)

21479

CXE03LVW40ST "聖猷達"除顫電燒導管"SJM"LIVEWIRE TC ABLATION CATHETER 21479

CXE0570454ST "聖猷達"瑟爾皮庫爾帕斯杜爾心臟電燒導管"SJM" THERAPY COOL

PATH DUO SP ABLATION CATHETERS

74100

CXE05CFLEXST "聖猷達"瑟爾皮庫爾菲斯心臟電燒導管"SJM"THERAPY COOL FLEX

ABLATION CATHETERS

74100

CXE05CH1L2SB "波士頓科技"奇利液體冷卻除顫導管"BOSTON SCIENTIFIC"

CHILLI II COOLED ABLATION CATHETER

74100

CXE05D1316WE "百歐森偉伯司特"灌注冷卻式斯芙溫控單向導管"BIOSENSE

WEBSTER" THERMOCOOL SF UNI-DIRECTIONAL CATHETER

74100

CXE05D131FWE "百歐森偉伯司特"灌注冷卻式斯芙溫控導航單向導管"BIOSENSE

WEBSTER" THERMOCOOL SF NAV UNI-DIRECTIONAL CATHETER

74100

CXE05EBD75WE "百歐森偉伯司特"易擊灌注冷卻式溫控可彎式診斷/電燒導

管"BIOSENSE WEBSTER"EZ STEER THERMOCOOL

DIAGNOSTIC/ABLATION DEFLECTABLE TIP CATHETER

74100

CXE05EBN75WE "百歐森偉伯司特"易擊灌注冷卻式溫控導航可彎式診斷/電燒導

管"BIOSENSE WEBSTER"EZ STEER THERMOCOOL NAV

DIAGNOSTIC/ABLATION DEFLECTABLE TIP CATHETER

74100

CXE05EECATM4 "美敦力"心臟冷凍消融導管"MEDTRONIC" FREEZOR CARDIAC

CRYOABLATION CATHETER

74100

CXE05SBD35WE "百歐森偉伯司特"灌注冷卻式斯芙溫控雙向診斷/電燒可彎式導

管"Biosense Webster" ThermoCool SF Bi-Directional

Diagnostic/Ablation Deflectable Tip Cath

74100

CXE05SBN35WE "百歐森偉伯司特"灌注冷卻式斯芙溫控導航雙向診斷/電燒可彎式

導管"Biosense Webster" ThermoCool SF NAV Bi-directional

Diagnostic/Ablation Deflectable

74100

FALSNMULT0A1 "愛爾康"可舒銳視妥智慧型非球面多焦點軟式人工水晶體※自付

差額品項,超過部分由病患自付"ALCON"ACRYSOF IQ RESTOR

MULTIFOCAL INTRAOCULAR LENS

2744

FALSNMULT2LS "蘭斯特克"福來視人工水晶體:多焦點+非球面人工水晶體(自付差

額品項)"LENSTEC"TETRAFLEX INTRAOCULAR LENS

2744

FALSNMULTVA1 "愛爾康"可舒視爾特智慧型非球面多焦點散光矯正單片型軟式人

工水晶體※自付差額品項,超過部分由病患自付"ALCON"ACRYSOF

IQ RESTOR MULTIFOCAL TORIC INTRA

2744

FALSNWAVE11W 千禧力視單片軟式人工水晶體(非球面)(自付差額品項)MBI

PRECISAL ONE PIECE SOFT HYDROPHOBIC ACRYLIC INTRAOCULAR

LENS

2744

FALSNWAVE13Q "麥德仁"眉特視人工水晶體:非球面變色(自付差額品

項)"MEDENNIUM" MATRIX ACRYLIC (AURIUM) INTRAOCULAR LENS

2744

FALSNWAVE1RQ "樂敦"新視非球面人工水晶體:非球面軟式人工水晶體※自付差額

品項,超過部分由病患自付"ROHTO"NEO EYE ASPHERIC FOLDABLE

LENS

2744

FALSNWAVE3LS "蘭斯特克"後房型人工水晶體:雙非球面(自付差額品

項)"LENSTEC" POSTERIOR CHAMBER INTRAOCULAR LENS

2744

FALSNWAVE3RY "銳能"進階推注式非球面人工水晶體系統(自付差額品

項)"RAYNER"ADVANCE PRELOADED HYDROPHILIC ACRYLIC IOL

INJECTION SYSTEM

2744

982

特材代碼 中英文名稱 支付點數-104/01/01

FALSNWAVE4LS "蘭斯特克"雙非球面人工水晶體(自付差額品項)"LENSTEC" BI-

ASPHERIC INTRAOCULAR LENS

2744

FAV01E01003H "艾肯"明妥見人工玻璃體"EYEKON"EYE COAT SH SODIUM

HYALURONATE VISCOELASTIC

1785

FAV01PA001LB 護視安玻璃體替代物:0.55ML PREVISCAID OPHTHALMIC

VISCOELASTIC:0.55ML

1564

FAV01PA002LB 護視安玻璃體替代物:0.75ML PREVISCAID OPHTHALMIC

VISCOELASTIC:0.75ML

1785

FAV01PA003LB 護視安玻璃體替代物:1.0ML PREVISCAID OPHTHALMIC

VISCOELASTIC:1.0ML

1785

FAV01VT585A2 "眼力健"喜隆安多玻璃體替代物0.85ML"AMO"HEALON ENDOCOAT

OPHTHALMIC VISCOSURGICAL DEVICE(OVD)0.85ML

1785

FBA011200S2Z "泰瑞斯"低黏性骨水泥"TECRES"CEMEX XL 839

FBA0428022AE "雅氏"歐斯特福膠原骨彌補物

(1.5*1.5*0.5CM)"AESCULAP"OSTEOVIT

2563

FBA0428030AE "雅氏"歐斯特福膠原骨彌補物(2*2*1CM)"AESCULAP"OSTEOVIT 2563

FBA103005M5B 威力骨可吸收性磷酸鈣陶瓷MAXIBONE CALCIUM PHOSPHATE

CERAMIC(1.0-3.0MM GRANULES/5ML)

4197

FBD1028110V2 "鐿鈦"骨釘骨板植入物-股骨壓迫性骨板系統(壓迫性骨板,拉力骨

釘壓迫骨釘)"INTAI" BONE SCREW AND BONE PLATE IMPLANT-DHS

PLATE SYSTEM(DYNAMIC HIP PLATE,

6796

FBHBCCERA7U0 "聯合"雙極半髖人工髖關節:搭配襯套式陶瓷股小

球"UNITED"BIPOLAR SYSTEM:BIOLOX OPTION CERAMIC FRMORAL

HEAD(自付差額品項)

35195

FBHHCCERA7U0 "聯合"襯套式陶瓷股小球"UNITED"BIOLOX OPTION CERAMIC

FRMORAL HEAD(自付差額品項)

4352

FBHL16201NS2 "好美得卡奧斯得寧"采登特髖臼內墊系統(超耐磨髖臼內

墊)"HOWMEDICA OSTEONICS"TRIDENT ACETABULAR COMPONENT

SYSTEM(UHMWPE)

4018

FBHMCPCEA3S2 "史賽克"采登特MOORE人工髖關節系統(陶瓷HEAD)※自付差額品項

,超過部分由病患自付"STRYKER"TRIDENT MOORE HIP

SYSTEM(CERAMIC HEAD)

7733

FBHMCRCEA3S2 "史賽克"采登特MOORE人工髖關節再置換系統(陶瓷HEAD)※自付差

額品項,超過部分由病患自付"STRYKER"TRIDENT MOORE REVISION

HIP SYSTEM(CERAMIC HEAD)

7733

FBHPCCERA3S2 "史賽克"采登特髖關節系統(陶瓷HEAD)※自付差額品項,超過部

分由病患自付"STRYKER"TRIDENT HIP SYSTEM(CERAMIC HEAD)

39396

FBHRC6200NU0 "聯合"優磨二代重建型全人工髖關節:搭配襯套式陶瓷股小球及陶

瓷內襯"UNITED"U-MOTION II REVISION HIP SYSTEM:BIOLOX

OPTION CERAMIC FRMORAL HEAD TO DELT

52796

FBHRCCERA3S2 "史賽克"采登特髖關節再置換系統(陶瓷HEAD)※自付差額品項,

超過部分由病患自付"STRYKER"TRIDENT REVISION HIP

SYSTEM(CERAMIC HEAD)

52796

FBHRCCERA7U0 "聯合"重建型全人工髖關節:搭配襯套式陶瓷股小

球"UNITED"REVISION HIP SYSTEM:BIOLOX OPTION CERAMIC

FRMORAL HEAD(自付差額品項)

52796

FBKL12303TU0 "聯合"康膝人工膝關節:脛骨關節面襯墊"UNITED"U2 TOTAL KNEE

SYSTEM:TIBIAL INSERT

13109

FBKPA7000NU0 "聯合"康膝人工膝關節:模組式(高彎曲度155度)"UNITED"U2

TOTAL KNEE SYSTEM

51297

FBKT12203TU0 "聯合"康膝人工膝關節:脛骨基座模組式"UNITED"U2 TOTAL KNEE

SYSTEM:TIBIAL BASEPLATE CMA

14031

FBN05403S1Y2 "亞太醫療"金寶骨髓內釘系統-股骨髓內釘組"SYNTEC"KING BO

HUMERAL INTERLOCKING NAILS SYSTEM-FEMORAL

7890

983

特材代碼 中英文名稱 支付點數-104/01/01

FBN05403S2Y2 "亞太醫療"金寶骨髓內釘系統-脛骨髓內釘組"SYNTEC"KING BO

HUMERAL INTERLOCKING NAILS SYSTEM-TIBIA

7890

FBN07321004P "沛佳"法斯樂-杜瓦伸縮式髓內釘系統"PEGA"FASSIER-DUVAL

TELESCOPIC IM SYSTEM

140000

FBP0122201V2 "鐿鈦"骨釘骨板植入物(管型骨板4.5MM)"INTAI"BONE SCREW AND

BONE PLATE IMPLANT(TUBULAR PLATE4.5MM)

500

FBP0124131V2 "鐿鈦"骨釘骨板植入物(管型骨板3.5MM)"INTAI"BONE SCREW AND

BONE PLATE IMPLANT(TUBULAR PLATE3.5MM)

441

FBP0124201V2 "鐿鈦"骨釘骨板植入物(管型骨板2.7MM)"INTAI"BONE SCREW AND

BONE PLATE IMPLANT(TUBULAR PLATE 2.7MM)

380

FBP0222400V2 "鐿鈦"骨釘骨板植入物(窄動力加壓骨板4.5MM)"INTAI"BONE

SCREW AND BONE PLATE IMPLANT(NARROW DYNAMIC COMPRESSION

PLATE4.5MM)

1228

FBP0222600V2 "鐿鈦"骨釘骨板植入物(寬動力加壓骨板4.5MM)"INTAI"BONE

SCREW AND BONE PLATE IMPLANT(BROAD DYNAMIC COMPRESSION

PLATE4.5MM)

1782

FBP0222781V2 "鐿鈦"骨釘骨板植入物(加長型骨板4.5MM)"INTAI"BONE SCREW

AND BONE PLATE IMPLANT(LENGTHENING PLATE4.5MM)

1787

FBP0224311V2 "鐿鈦"骨釘骨板植入物(直型骨板2.0MM)"INTAI"BONE SCREW AND

BONE PLATE IMPLANT(MINI STRAIGHT PLATE)

230

FBP0224350V2 "鐿鈦"骨釘骨板植入物(動力加壓骨板3.5MM)"INTAI"BONE SCREW

AND BONE PLATE IMPLANT(DYNAMIC COMPRESSION PLATE)

977

FBP0324001V2 "鐿鈦"骨釘骨板植入物(匙型骨板4.5MM)"INTAI"BONE SCREW AND

BONE PLATE IMPLANT(SPOON PLATE 4.5MM)

1762

FBP0324031V2 "鐿鈦"骨釘骨板植入物(支撐骨板4.5MM)"INTAI"BONE SCREW AND

BONE PLATE IMPLANT(BUTTRESS PLATE4.5MM)

2130

FBP0324071V2 "鐿鈦"骨釘骨板植入物(脛骨支撐骨板4.5MM)"INTAI"BONE SCREW

AND BONE PLATE IMPLANT(BUTTRESS PLATE4.5MM)

3157

FBP0324091V2 "鐿鈦"骨釘骨板植入物(眼鏡蛇骨板4.5MM)"INTAI"BONE SCREW

AND BONE PLATE IMPLANT(COBRA HEAD PLATE4.5MM)

3892

FBP0324123V2 "鐿鈦"骨釘骨板植入物(T型骨板3.5MM)"INTAI"BONE SCREW AND

BONE PLATE IMPLANT(T-PLATE)

952

FBP0324167V2 "鐿鈦"骨釘骨板植入物(跟骨骨板3.5MM)"INTAI"BONE SCREW AND

BONE PLATE IMPLANT(CALCANEAL PLATE3.5MM)

3104

FBP0324181V2 "鐿鈦"骨釘骨板植入物(葉形骨板3.5MM)"INTAI"BONE SCREW AND

BONE PLATE IMPLANT(CLOVERLEAF PLATE3.5MM)

1603

FBP0324302V2 "鐿鈦"骨釘骨板植入物(重建骨板)"INTAI"BONE SCREW AND BONE

PLATE IMPLANT(RECONSTRUCTION PLATE)

3487

FBP0324331V2 "鐿鈦"骨釘骨板植入物(L型迷你型骨板)"INTAI"BONE SCREW AND

BONE PLATE IMPLANT(MINI L-PLATE)

336

FBP0324605V2 "鐿鈦"骨釘骨板植入物(H型迷你骨板1.5MM,2.0MM)"INTAI"BONE

SCREW AND BONE PLATE IMPLANT(H PLATE1.5MM,2.0MM)

336

FBP0324612V2 "鐿鈦"骨釘骨板植入物(直型骨板20洞2.0MM)"INTAI"BONE SCREW

AND BONE PLATE IMPLANT(STRAIGHT PLATE,2.0MM,20HOLE)

2686

FBP0324623V2 "鐿鈦"骨釘骨板植入物(T型迷你型骨板1.5MM,2.0MM)"INTAI"BONE

SCREW AND BONE PLATE IMPLANT(MINI T-PLATE,1.5MM,2.0MM)

336

FBP0324807V2 "鐿鈦"骨釘骨板植入物(骨踝支撐骨板4.5MM)"INTAI"BONE SCREW

AND BONE PLATE IMPLANT(CONDYLAR BUTTRESS PLATE4.5MM)

3493

FBS0120068V2 "鐿鈦"骨釘骨板植入物-皮質骨釘1.3/1.5/2.0/2.7/3.5MM"INTAI"

BONE SCREW AND BONE PLATE IMPLANT-CORTEX SCREW

145

984

特材代碼 中英文名稱 支付點數-104/01/01

FBS01445024C 華骨-髖骨板系統:皮質骨螺釘(4.5MM)ORDC-DYNAMIC HIP SCREW

SYSTEM:CORTEX SCREW(4.5MM)

161

FBS0221500V2 "鐿鈦"骨釘骨板植入物-海綿骨釘-4.5MM"INTAI" BONE SCREW AND

BONE PLATE IMPLANT-CANCELLOUS SCREW-4.5MM

144

FBS0221600V2 "鐿鈦"骨釘骨板植入物-海綿骨釘-6.5MM"INTAI" BONE SCREW AND

BONE PLATE IMPLANT-CANCELLOUS SCREW-6.5MM

281

FBS0800234S2 "史賽克"前十字韌帶界面固定螺釘"STRYKER"ACL INTERFERENCE

SCREW

4113

FBS081120MLV "靈威特"傑耐斯可吸收性螺釘"LINVATEC"GENESYS MATRYX

INTERFERENCE SCREW

4234

FBS08222FNT1 "邁特"軟組織固定錨"MITEK"ANCHOR SYSTEM-FOR SOFT TISSUE

REATTACHMENT

3268

FBS085020MLV "靈威特"傑耐斯可吸收性螺釘"LINVATEC"GENESYS MATRYX

INTERFERENCE SCREW

4234

FBS088020MLV "靈威特"傑耐斯可吸收性螺釘"LINVATEC"GENESYS MATRYX

INTERFERENCE SCREW

4234

FBS1121400V2 "鐿鈦"骨釘骨板植入物-皮質骨釘4.5MM"INTAI" BONE SCREW AND

BONE PLATE IMPLANT-CORTEX SCREW

161

FBS1220600V2 "鐿鈦"骨釘骨板植入物-海綿骨釘-4.0MM"INTAI" BONE SCREW AND

BONE PLATE IMPLANT-CANCELLOUS SCREW-4.0MM

144

FBSF11004LXP "寶楠"阿姆斯壯脊椎後路固定系統:二節(免事前審

查)"PAONAN"ARMSTRONG POSTERIOR SPINAL FIXATION

SYSTEM(S*4+R*2)

13816

FBSF11005LXP "寶楠"阿姆斯壯脊椎後路固定系統:三節(免事前審

查)"PAONAN"ARMSTRONG POSTERIOR SPINAL FIXATION

SYSTEM(S*6+R*2)

20044

FBSF11006LXP "寶楠"阿姆斯壯脊椎後路固定系統:二節"PAONAN"ARMSTRONG

POSTERIOR SPINAL FIXATION SYSTEM(S*4+R*2)

23358

FBSF11007LXP "寶楠"阿姆斯壯脊椎後路固定系統:三節"PAONAN"ARMSTRONG

POSTERIOR SPINAL FIXATION SYSTEM(S*6+R*2)

34118

FBSF1689D2S1 "信迪思"廣用型脊椎系統:2節(含萬用復位椎弓根螺釘系統:萬向

螺釘+固定桿)"SYNTHES"UNIVERSAL SPINE SYSTEM:2

LEVEL(RX2+SX4)

23358

FBSF1689D3S1 "信迪思"廣用型脊椎系統:3節(含萬用復位椎弓根螺釘系統:萬向

螺釘+固定桿)"SYNTHES"UNIVERSAL SPINE SYSTEM:3

LEVEL(RX2+SX6)

34118

FBSF1800023F "泰德"腰椎內固定系統:三節TEND LUMBAR FIXATION SYSTEM:3

LEVEL(SX6+RX2)

34118

FBSF1860013F "泰德"腰椎內固定系統:二節(免事前審查)TEND LUMBAR FIXATION

SYSTEM:2 LEVEL(SX4+RX2)

13816

FBSF1860023F "泰德"腰椎內固定系統:三節(免事前審查)TEND LUMBAR FIXATION

SYSTEM:3 LEVEL(SX6+RX2)

20044

FBSF1880013F "泰德"腰椎內固定系統:二節TEND LUMBAR FIXATION SYSTEM:2

LEVEL(SX4+RX2)

23358

FBSF188002RK 瑞寶億腰椎內固定系統:二節REBORN ESSENCE LUMBAR FIXATION

SYSTEM:2 LEVEL(SX4+RX2)

23358

FBSF188003RK 瑞寶億腰椎內固定系統:三節REBORN ESSENCE LUMBAR FIXATION

SYSTEM:3 LEVEL(SX6+RX2)

34118

FBSF1880043F "泰德"腰椎內固定系統:三節TEND LUMBAR FIXATION SYSTEM:3

LEVEL(SX6+RX2)

34118

FBSF1880053F "泰德"腰椎內固定系統:二節TEND LUMBAR FIXATION SYSTEM:2

LEVEL(SX4+RX2)

23358

985

特材代碼 中英文名稱 支付點數-104/01/01

FBSF216001XP "寶楠"阿姆斯壯脊椎後路固定系統:平滑桿(短)(免事前審

查)"PAONAN"ARMSTRONG POSTERIOR SPINAL FIXATION SYSTEM:ROD

30:100MM

679

FBSF216002XP "寶楠"阿姆斯壯脊椎後路固定系統:平滑桿(長)(免事前審

查)"PAONAN"ARMSTRONG POSTERIOR SPINAL FIXATION SYSTEM:ROD

130:500MM

1419

FBSF216003XP "寶楠"阿姆斯壯脊椎後路固定系統:平滑桿

(短)"PAONAN"ARMSTRONG POSTERIOR SPINAL FIXATION

SYSTEM:ROD 40:100MM

919

FBSF216004XP "寶楠"阿姆斯壯脊椎後路固定系統:平滑桿

(長)"PAONAN"ARMSTRONG POSTERIOR SPINAL FIXATION

SYSTEM:ROD 130:500MM

2662

FBSF2B00013F "泰德"腰椎內固定系統:固定桿(標準桿)(免事前審查)TEND

LUMBAR FIXATION SYSTEM:STANDARD ROD

679

FBSF2B00023F "泰德"腰椎內固定系統:固定桿(標準桿)(長節,免事前審查)TEND

LUMBAR FIXATION SYSTEM:STANDARD ROD

1419

FBSF2BA0013F "泰德"腰椎內固定系統:固定桿(標準桿)TEND LUMBAR FIXATION

SYSTEM:STANDARD ROD

919

FBSF2BA0023F "泰德"腰椎內固定系統:固定桿(平滑桿)(長節)TEND LUMBAR

FIXATION SYSTEM:SMOOTH ROD

2662

FBSF314001XP "寶楠"阿姆斯壯脊椎後路固定系統:固定鉤"PAONAN"ARMSTRONG

POSTERIOR SPINAL FIXATION SYSTEM:HOOK

3311

FBSF411061XP "寶楠"阿姆斯壯脊椎後路固定系統:螺釘(免事前審

查)"PAONAN"ARMSTRONG POSTERIOR SPINAL FIXATION

SYSTEM:SCREW

3114

FBSF411062XP "寶楠"阿姆斯壯脊椎後路固定系統:螺釘(免事前審

查)"PAONAN"ARMSTRONG POSTERIOR SPINAL FIXATION

SYSTEM:SCREW

3114

FBSF411063XP "寶楠"阿姆斯壯脊椎後路固定系統:螺釘"PAONAN"ARMSTRONG

POSTERIOR SPINAL FIXATION SYSTEM:SCREW

5380

FBSF411064XP "寶楠"阿姆斯壯脊椎後路固定系統:螺釘"PAONAN"ARMSTRONG

POSTERIOR SPINAL FIXATION SYSTEM:SCREW

5380

FBSF411751XP "寶楠"阿姆斯壯脊椎後路固定系統:骨水泥釘"PAONAN"ARMSTRONG

POSTERIOR SPINAL FIXATION SYSTEM:CEMENT SCREW

12960

FBSF411761XP "寶楠"阿姆斯壯脊椎後路固定系統:骨水泥釘"PAONAN"ARMSTRONG

POSTERIOR SPINAL FIXATION SYSTEM:CEMENT SCREW

12960

FBSF468959S1 "信迪思"萬用復位椎弓根螺釘系統:萬向螺釘"SYNTHES"UNIVERSAL

REDUCTION PEDICLE PEDICLE SCREW SYSTEM:UNIVERSAL DEGEN

SCREWS

5380

FBSF4ASYS8AQ 史麥特歐美加脊椎固定系統:多角度中空螺釘SMARTLOC OMEGA

SPINAL FIXATION SYSTEM:POLYAXIAL CANNULATED SCREW

12960

FBSF4ASYS9AQ SMARTLOC EVOLUTION SYSTEM:POLYAXIAL SCREW 史麥特艾爾脊椎

固定系統:多角度螺釘

5380

FBSF4B00013F "泰德"腰椎內固定系統:脊椎螺釘(免事前審查)TEND LUMBAR

FIXATION SYSTEM:SPINAL SCREW

3114

FBSF4BA0013F "泰德"腰椎內固定系統:脊椎螺釘TEND LUMBAR FIXATION

SYSTEM:SPINAL SCREW

5380

FBSF4BA0073F "泰德"腰椎內固定系統:中空萬向螺釘TEND LUMBAR FIXATION

SYSTEM:CANNULATED POLY AXIAL SCREW

5380

FBSF4BA0123F "泰德"腰椎內固定系統:中空萬向螺釘TEND LUMBAR FIXATION

SYSTEM:CANNULATED POLY AXIAL SCREW

12960

986

特材代碼 中英文名稱 支付點數-104/01/01

FBSF4P2GCPZ6 “美瑞世”普生二代後方脊椎固定器:固定釘"MERRIES”PROT II

POSTERIOR SPINE SYSTEM:POLY CANNULATED SCREW

5380

FBSF517021XP "寶楠"阿姆斯壯脊椎後路固定系統"橫向連結器(免事前審

查)"PAONAN"ARMSTRONG POSTERIOR SPINAL FIXATION

SYSTEM:CROSS LINK

2661

FBSF517022XP "寶楠"阿姆斯壯脊椎後路固定系統:橫向連結

器"PAONAN"ARMSTRONG POSTERIOR SPINAL FIXATION

SYSTEM:CROSS LINK

6108

FBSF5B00013F "泰德"腰椎內固定系統:橫向連結器(免事前審查)TEND LUMBAR

FIXATION SYSTEM:TRANSVERSE LINK

2661

FBSF5BA0013F "泰德"腰椎內固定系統:橫向連結器TEND LUMBAR FIXATION

SYSTEM:TRANSVERSE LINK

6108

FBSFA000021A “施百威”腰椎融合器(TLIF,每節椎體限置放1個)"SPINEWAY”

TWIN PEAKS OBLIQUE LUMBAR CAGE

43943

FBSFA000033F "泰德"高分子腰椎椎間融合器:後開型TEND PEEK LUMBAR

INTERBODY FUSION CAGE

21971

FBSFA22003XP "寶楠"錐頭式椎間填充塊(聚醚醚酮)(側開型每節椎體限置放1

個)"PAONAN"II-TYPE INTERVERTEBRAL SPACER(PEEK)

43943

FBSFA22004XP "寶楠"錐頭式椎間填充塊(側開型每節椎體限置放1

個)"PAONAN"II-TYPE INTERVERTEBRAL SPACER

43943

FBSFA6730SS9 "STRYKER"OIC PEEK CAGE(STERILE)"史賽克"後開腰椎護架系統

(滅菌)

21971

FBSFA6731SS9 "STRYKER"OGIVAL INTERBODY CAGE-PEEK(STERILE)"史賽克"側開

腰椎間融合器(每節椎體置放1個)(滅菌)

43943

FBSFA6741SS9 "STRYKER"SOLIS CERVICAL CAGE SYSTEM(STERILE)(PEEK)"史賽

克"梭利斯椎頸護架系統(滅菌)

21971

FBSFA6742SS9 "STRYKER"SOLIS AS PEEK SPACER(STERILE)"史賽克"椎間融合器

(滅菌)

21971

FBSFA6760SS9 "STRYKER"OIC PEEK CAGE(STERILE)"史賽克"後開腰椎護架系統

(滅菌)

21971

FBSFA8380SS9 "STRYKER"AVS TL PEEK SPACER(STERILE)"史賽克"脊椎襯墊系統

(側開型每節椎體置放1個)((滅菌)

43943

FBSFA919PRM4 "美敦力"克里森椎體填充器(側開型每個椎體限置放1

個)"MEDTRONIC"VERTE-STACK CRESCENT VERTEBRAL BODY SPACER

43943

FBSFACPLCNJZ "傑奎"碳纖維高分子複材腰椎融合器(碳纖維聚醚醚酮)(側開型每

節椎體限置放1個)"JO"CFR PEEK LUMBAR CAGE

43943

FBSFAF00013F "泰德"高分子腰椎椎間融合器:側開型(每椎節限制放1個)TEND

PEEK LUMBAR INTERBODY FUSION CAGE

43943

FBSFAF00023F "泰德"高分子腰椎椎間融合器:後開型TEND PEEK LUMBAR

INTERBODY FUSION CAGE

21971

FBSFAF00033F "泰德"高分子頸椎椎間融合器TEND PEEK CERVICAL INTERBODY

FUSION CAGE

21971

FBSFAPPG03V2 "鐿鈦"高分子複合材料椎間融合系統:胸腰椎椎籠(聚醚醚

酮)24;26MM "INTAI"INTERBODY FUSION SYSTEM:PLIF LUMBAR

CAGE(PEEK)

21971

FBSFAPTG02WG "威創"高分子複合/鈦合金材料椎間融合系統:聚醚醚酮(側開型每

節椎體限置放1個)"WILTROM"INTERBODY FUSION SYSTEM:PEEK

43943

FBSFAPTG03V2 "鐿鈦"高分子複合材料椎間融合系統:胸腰椎椎籠(聚醚醚

酮)28:36MM(脊椎側開型,每節椎體置放一個)"INTAI"INTERBODY

FUSION SYSTEM:LUMBAR CAGE(PEEK)

43943

FBSFAPTG03WG "威創"高分子複合椎間融合系統(飛梭胸腰椎椎籠,側開型每節椎

體限置放一個)32:36MM "WILTROM" INTERBODY FUSION

SYSTEM(PEEK)

43943

987

特材代碼 中英文名稱 支付點數-104/01/01

FBSFAWS419B0 "長安"腰椎椎間融合器(側開型每節椎體限置放1個)"BMI"LUMBAR

SPINAL CAGE(PEEK)

43943

FBSFC2LEVEM4 "美敦力"亞特蘭提斯前方頸椎骨板系統(二節)"MEDTRONIC”

ATLANTIS ANTERIOR CERVICAL PLATE SYSTEM(PX1+SX4)

18623

FBSFC312XXM4 "美敦力"亞特蘭提斯前方頸椎骨板系統-骨釘"MEDTRONIC”

ATLANTIS ANTERIOR CERVICAL PLATE SYSTEM-SCREW

984

FBSFC3LEVEM4 "美敦力"亞特蘭提斯前方頸椎骨板系統(三節)"MEDTRONIC”

ATLANTIS ANTERIOR CERVICAL PLATE SYSTEM(PX1+SX6)

20591

FBSFC4801NS9 "史賽克"頸椎後側固定系統-骨釘"STRYKER" OASYS SYSTEM-SCREW 8260

FBSFC4802NS9 "史賽克"頸椎後側固定系統-二節"STRYKER" OASYS SYSTEM-TWO

LEVEL(SCREWX4+RODX2或PLATEX2)

36940

FBSFC4803NS9 "史賽克"頸椎後側固定系統-三節"STRYKER" OASYS SYSTEM-

THREE LEVEL(SCREWX6+RODX2或PLATEX2)

53460

FBSFC4804NS9 "史賽克"頸椎後側固定系統-短骨板"STRYKER" OASYS SYSTEM-

PLATE

1950

FBSFC4805NS9 "史賽克"頸椎後側固定系統-短固定桿"STRYKER" OASYS SYSTEM-

ROD

1950

FBSFC4806NS9 "史賽克"頸椎後側固定系統-橫連結器組"STRYKER" OASYS

SYSTEM-CONNECTOR

7208

FBSFC4807NS9 "史賽克"頸椎後側固定系統-骨鉤"STRYKER" OASYS SYSTEM-HOOK 5375

FBSFC4808NS9 "史賽克"頸椎後側固定系統-長骨板"STRYKER" OASYS SYSTEM-

PLATE

3700

FBSFC4809NS9 "史賽克"頸椎後側固定系統-長固定桿"STRYKER" OASYS SYSTEM-

ROD

3700

FBSFCASC05AQ 穩特頸椎前路骨板系統:二節WINLOC ANTERIOR CERVICAL PLATE

SYSTEM(PX1+SX4)

18623

FBSFCASC06AQ 穩特頸椎前路骨板系統:三節WINLOC ANTERIOR CERVICAL PLATE

SYSTEM(PX1+SX6)

20591

FBSFCASC07AQ 偉歐頸椎鋼板固定系統:二節VELO CERVICAL PLATE SYSTEM:2

LEVEL(PX1+SX2)

18623

FBSFCASC08AQ 偉歐頸椎鋼板固定系統:三節VELO CERVICAL PLATE SYSTEM:3

LEVEL(PX1+SX3)

20591

FBSFCASCS3AQ 穩特頸椎前路骨板系統:螺釘WINLOC ANTERIOR CERVICAL PLATE

SYSTEM:SCREW

984

FBSFCASCS4AQ 偉歐頸椎鋼板固定系統:螺釘VELO CERVICAL PLATE SYSTEM:SCREW 984

FBSFCGPT012G 脊力頸椎骨板系統:二節GIB CERVICAL PLATE SYSTEM:TWO

LEVEL(PX1+SX4)

18623

FBSFCGPT022G 脊力頸椎骨板系統:三節GIB CERVICAL PLATE SYSTEM:THREE

LEVEL(PX1+SX6)

20591

FBSFCGPT032G 脊力頸椎骨板系統:螺釘GIB CERVICAL PLATE SYSTEM:SCREW 984

FBSFR64101S1 "信迪思"第二代延展式肋骨支撐架-肋骨翼金勾蓋"SYNTHES"VEPTR

VERTICAL EXPANDABLE PROSTHETIC TITANIUM RIB II-HOOK

CAP(整組使用者不得申報,只適用於組件

31000

FBSFR64102S1 "信迪思"第二代延展式肋骨支撐架-肋骨翼金勾"SYNTHES"VEPTR

VERTICAL EXPANDABLE PROSTHETIC TITANIUM RIB II-HOOK(整組

使用者不得申報,只適用於組件單獨使

40100

FBSFR64103S1 "信迪思"第二代延展式肋骨支撐架-近端延展桿"SYNTHES"VEPTR

VERTICAL EXPANDABLE PROSTHETIC TITANIUM RIB II-PROXIMAL

EXTENSION(220MM)(整組使用者不得申

64148

988

特材代碼 中英文名稱 支付點數-104/01/01

FBSFR64104S1 "信迪思"第二代延展式肋骨支撐架-遠端延展桿"SYNTHES"VEPTR

VERTICAL EXPANDABLE PROSTHETIC TITANIUM RIB II-DISTAL

EXTENSION(220MM)(整組使用者不得申報

64147

FBSFR64105S1 "信迪思"第二代延展式肋骨支撐架-近端延展桿"SYNTHES"VEPTR

VERTICAL EXPANDABLE PROSTHETIC TITANIUM RIB II-PROXIMAL

EXTENSION(500MM)(整組使用者不得申

88048

FBSFR64106S1 "信迪思"第二代延展式肋骨支撐架-遠端延展桿"SYNTHES"VEPTR

VERTICAL EXPANDABLE PROSTHETIC TITANIUM RIB II-DISTAL

EXTENSION(500MM)(整組使用者不得申報

88048

FBT01020MS4M 速普新關節內注射劑SUPLASYN STERILE SODIUM HYALURONATE

SOLUTION(2ML/注射筒裝)

709

FHFCD32354ST "聖猷達"優你法植入式心律去顫器"SJM" UNIFY IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR

565882

FHFCDLUXHFBK "拜耳德尼克"路麥斯核磁共振植入式心臟去顫器(HF-

T)"BIOTRONIK" LUMAX IMPLANTABLE DEFIBRILLATOR SYSTEMS

WITH A CONDITIONAL INTENDED USE IN A MRI ENVI

591468

FHFCDUA32MST "聖猷達"優你法亞速拉植入式心律去顫器"SJM" UNIFY ASSURA

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

565882

FHFCDUA33MST "聖猷達"優你法亞速拉植入式心律去顫器"SJM"UNIFY ASSURA

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

565882

FHG1825130AH "亞翠恩"福立心人工血管"ATRIUM" FLIXENE VASCULAR GRAFTS

30CM

14629

FHG1825140AH "亞翠恩"福立心人工血管"ATRIUM" FLIXENE VASCULAR GRAFTS

40CM

18122

FHG1825180AH "亞翠恩"福立心人工血管"ATRIUM" FLIXENE VASCULAR GRAFTS

80CM

29320

FHG2112026TM "泰爾茂"傑斯弗特加強型人工血管"TERUMO"GELSOFT PLUS

GELATIN SEALED POLYESTER VASCULAR PROSTHESES 12:16MM 30CM

9849

FHG3425145AH "亞翠恩"福立心人工血管"ATRIUM"FLIXENE VASCULAR GRAFTS 三

層錐型 4-6:5-8X45CM

18630

FHP011NGMRSB "波士頓科技"迎吉心臟節律器"BOSTON SCIENTIFIC"INGENIO MRI

PACEMAKER

81477

FHP01ACSRMST "聖猷達"愛森心臟節律器(單腔)"SJM"ACCENT PULSE

GENERATOR(SR)

64214

FHP01ADVMRSB "波士頓科技"艾凡緹心臟節律器"BOSTON SCIENTIFIC"ADVANTIO

MRI PACEMAKER

81477

FHP01EMRSRBK "百多力"艾維亞植入式心律調節器(單腔)"BIOTRONIK" EVIA

IMPLANTABLE CARDIAC PACEMAKERS(SR)

81477

FHP01EVASTBK "百多力"艾維亞植入式心律調節器"BIOTRONIK"EVIA IMPLANTABLE

CARDIAC PACEMAKERS

64214

FHP01VSR1UST "聖猶達"植入式心臟節律器(單腔)"SJM"IMPLANTABLE CARDIAC

PULSE GENERATOR(SR)

64214

FHP01ZESRMST "聖猷達"神風植入式心臟節律器(單腔)"SJM"ZEPHYR IMPLANTABLE

CARDIAC PULSE GENERATOR(SR)

64214

FHP021NGDRSB "波士頓科技"迎吉心臟節律器(雙腔自付差額)"BOSTON

SCIENTIFIC"INGENIO PACEMAKER(DDDR)

93833

FHP022A2ADSB "波士頓科技"艾凡緹心臟節律器(雙腔自付差額)"BOSTON

SCIENTIFIC"ADVANTIO MRI PACEMAKER(DDDR)

93833

FHP02A21DRSB "波士頓科技"迎吉心臟節律器(雙腔自付差額)"BOSTON

SCIENTIFIC"INGENIO MRI PACEMAKER(DDDR)

93833

FHP02ACDRMST "聖猷達"愛森心臟節律器(雙腔自付差額)"SJM" ACCENT PULSE

GENERATOR(DDDR)

93833

989

特材代碼 中英文名稱 支付點數-104/01/01

FHP02ADVDRSB "波士頓科技"艾凡緹心臟節律器(雙腔自付差額)"BOSTON

SCIENTIFIC"ADVANTIO PACEMAKER(DDDR)

93833

FHP02EVADTBK "百多力"艾維亞植入式心律調節器(雙腔自付差額)"BIOTRONIK"

EVIA IMPLANTABLE CARDIAC PACEMAKER(DDDR)

93833

FHPCDDD1S1M4 "美敦力"艾維拉植入式心臟去顫器(DR 34CM3)"MEDTRONIC"EVERA

XT/S IMPLANTABLE CARDIOVERTER DEFIBRILLATOR(DR 34CM3)

483701

FHPCDDDDF1M4 "美敦力"艾維拉植入式心臟去顫器(DR 33CM3)"MEDTRONIC"EVERA

XT/S IMPLANTABLE CARDIOVERTER DEFIBRILLATOR(DR 33CM3)

483701

FHPCDDR59MST "聖猷達"幅地法亞速拉植入式心律去顫器(雙腔)"SJM" FORTIFY

ASSURA IMPLANTABLE CARDIOVERTER DEFIBRILLATOR(DR)

443350

FHPCDDRF2MST "聖猷達"植入式心律去顫器-雙腔"SJM" FORTIFY IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR

443350

FHPCDDRFSMST "聖猷達" 幅地法艾斯特植入式心律去顫器-雙腔"SJM" FORTIFY

ST IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

443350

FHPCDDVDF1M4 "美敦力"艾維拉植入式心臟去顫器(VR 33CM3)"MEDTRONIC"EVERA

XT/S IMPLANTABLE CARDIOVERTER DEFIBRILLATOR(VR 33CM3)

342335

FHPCDDVDF4M4 "美敦力"艾維拉植入式心臟去顫器(VR 34CM3)"MEDTRONIC"EVERA

XT/S IMPLANTABLE CARDIOVERTER DEFIBRILLATOR(VR 34CM3)

342335

FHPCDLUXDRBK "拜耳德尼克"路麥斯核磁共振植入式心臟去顫器(DR-

T)"BIOTRONIK" LUMAX IMPLANTABLE DEFIBRILLATOR SYSTEMS

WITH A CONDITIONAL INTENDED USE IN A MRI ENVI

483701

FHPCDLUXVDBK "拜耳德尼克"路麥斯核磁共振植入式心臟去顫器(VR-T

DX)"BIOTRONIK" LUMAX IMPLANTABLE DEFIBRILLATOR SYSTEMS

WITH A CONDITIONAL INTENDED USE IN A MRI E

342335

FHPCDLUXVRBK "拜耳德尼克" 路麥斯核磁共振植入式心臟去顫器(VR-

T)"BIOTRONIK" LUMAX IMPLANTABLE DEFIBRILLATOR SYSTEMS

WITH A CONDITIONAL INTENDED USE IN A MRI ENV

342335

FHPCDVR59MST "聖猷達"幅地法亞速拉植入式心律去顫器(單腔)"SJM" FORTIFY

ASSURA IMPLANTABLE CARDIOVERTER DEFIBRILLATOR(SR)

330345

FHPCDVRF1MST "聖猷達"植入式心律去顫器-單腔"SJM" FORTIFY IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR

330345

FHPCDVRFSMST "聖猷達" 幅地法艾斯特植入式心律去顫器-單腔"SJM" FORTIFY

ST IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

330345

FHPCL1S377BK "百多力"霖納思進化版(五極單環)心內除顫器植入式主動導線(包

括附件)"BIOTRONIK"LINOX SMART PROMRI S DX IMPLANTABLE

DEFIBRILLATOR LEADS INCL. ACCESSOR

76664

FHPCL1SSDPBK "百多力"霖納思進化版(四極)心內除顫器植入式主動導線(包括附

件)"BIOTRONIK"LINOX SMART PROMRI SD IMPLANTABLE

DEFIBRILLATOR LEADS INCL. ACCESSORIES

76664

FHPCL37716BK "百多力"霖納思進化版(三極)心內除顫器 植入式主動導線(包括

附件)"BIOTRONIK"LINOX SMART PROMRI S IMPLANTABLE

DEFIBRILLATOR LEADS INCL. ACCESSORIES

76664

FHPCL6946MM4 "美敦力"史賓特植入式導線"MEDTRONIC"SPRINT QUATTRO SECURE

IMPLANTABLE LEAD

76664

FHPCL6996SM4 "美敦力"皮下導線系統"MEDTRONIC" SUBCUTANEOUS LEAD SYSTEM 87034

FHPCLRE4ACSB "波士頓科技"芮萊安植入式電極導線(主動式固定)"BOSTON

SCIENTIFIC" RELIANCE 4-FRONT IMPLANTABLE LEAD(ACTIVE)

76664

FHPCLRE4PSSB "波士頓科技"芮萊安植入式電極導線(被動式固定)"BOSTON

SCIENTIFIC"RELIANCE 4-FRONT IMPLANTABLE LEAD(PASSIVE)

75682

990

特材代碼 中英文名稱 支付點數-104/01/01

FHPCLSD399BK "百多力"保心護心內除顫器植入式主動導線(包括附

件)"BIOTRONIK" PROTEGO PROMRI SD IMPLANTABLE

DEFIBRILLATOR LEADS INCL. ACCESSORIES

76664

FHPHF04X98M4 "美敦力"艾坦卓越電極導線"MEDTRONIC"ATTAIN PERFORMA LEAD 22311

FHPHF38153BK "百多力"艾維亞進化版植入式心律調節器"BIOTRONIK"EVIA HF-T

PROMRI IMPLANTABLE CARDIAC PACEMAKERS INCL. ACCESSORIES

180228

FHPHFCRXBPBK "百多力"可洛進化版植入式心導線(包括配件)"BIOTRONIK"COROX

PROMRI OTW IMPLANTABLE CORONARY SINUS LEADS INCL.

ACCESSORIES

19845

FHPL1SLS37BK "百多力"梭利亞雙極植入式導線(包括附件)"BIOTRONIK"SOLIA S

IMPLANTABLE ENDOCARDIAL LEADS INCL. ACCESSORIES

7479

FHPL1SLT37BK "百多力"梭利亞雙極節律器導線(包括附件)"BIOTRONIK"SOLIA T

IMPLANTABLE ENDOCARDIAL LEADS INCL. ACCESSORIES

7434

FHV01BMVALR5 "索倫"機械式心臟瓣膜"SORIN" BICARBON MECHANICAL HEART

VALVES

50503

FHV01CARBMR5 "索林"康保人工心臟瓣膜"SORIN" CARBOMEDICS PROSTHETIC

HEART VALVE

50503

FHV01VAA21R5 "索林"康保升主動脈人工瓣膜"SORIN" CARBOMEDICS CARBOSEAL

ASCENDING AORTIC PROSTHESIS

60955

FHV01VAC21R5 "索林"康保升主動脈人工瓣膜(VALSALVA)"SORIN" CARBOMEDICS

CARBOSEAL ASCENDING AORTIC PROSTHESIS(VALSALVA)

85000

FHVD128TFXED "愛德華"卡本特-愛德華沛旅旺心包生物瓣膜(PERIMOUNT主動脈

瓣,型號2800TFX)(自付差額)"EDWARDS" CARPENTIER-EDWARDS

PERIMOUNT PERICARDIAL BIOPROSTHESIS(

43613

FHVD13000TED "愛德華"卡本特-愛德華沛旅旺人工心瓣膜-MAGNA(自付差

額)"EDWARDS" CARPENTIER-EDWARDS PERIMOUNT PERICARDIAL

BIOPROSTHESIS-MAGNA

43613

FHVD169PTFED "愛德華"卡本特-愛德華沛旅旺人工心瓣膜(PERIMOUNT二尖瓣,型

號6900PTFX)(自付差額)"EDWARDS" CARPENTIER-EDWARDS

PERIMOUNT PERICARDIAL BIOPROSTHESIS(PER

43613

FHVD173TFXED "愛德華"卡本特-愛德華沛旅旺人工心瓣膜-MAGNA EASE(自付差

額)"EDWARDS" CARPENTIER-EDWARDS PERIMOUNT PERICARDIAL

BIOPROSTHESIS-MAGNA EASE

43613

FHVD1BRASLST "聖猷達"翠翡塔組織瓣膜(自付差額)"SJM"TRIFECTA VALVE 43613

FHVD1CSTRCST "聖猷達"翠翡塔組織瓣膜(自付差額)"SJM"TRIFECTA VALVE 43613

FHVD1MAPH1R5 "索林"脈長流主動脈人工心瓣膜(LX型)(自付差額)"SORIN"

MITROFLOW AORTIC PERICARDIAL HEART VALVE

43613

FHVD1MAPH2R5 "索林"脈長流主動脈人工心瓣膜(DL型)(自付差額)"SORIN"

MITROFLOW AORTIC PERICARDIAL HEART VALVE

43613

FHVD1MSPB3M4 "美敦力" 莫克人工豬心瓣膜-第三代(自付差額)"MEDTRONIC"

MOSAIC PORCINE BIOPROSTHESIS

43613

FHVD1USAWRST "聖猷達"翠翡塔組織瓣膜(自付差額)"SJM"TRIFECTA VALVE 43613

FHVR1A2636R5 "索林"康保瓣膜成形術環"SORIN"CARBOMEDICS ANNULOPLASTY

RING

20100

FHVR1SRBRMR5 "索倫"環狀成形術環"SORIN"SOVERING ANNULOPLASTY DEVICES 20100

FHVR1SRM3DR5 "索倫"環狀成形術環"SORIN" MEMO 3D ANNULOPLASTY RING 20100

FHX0250700R5 "索倫"英派爾氧合器(氧合器)"SORIN" INSPIRE

OXYGENATORS(OXYGENATOR)

12913

FHX02TS250M4 "美敦力"心臟血管外科器械(滅菌)-穩定器"MEDTRONIC"

CARDIOVASCULAR SURGICAL INSTRUMENTS (STERILE)-STABILIZER

44002

991

特材代碼 中英文名稱 支付點數-104/01/01

FHX032CL62ML "美德思"氧合器與硬殼靜脈儲血槽-中空纖維氧合器RHEOPARIN塗

層+硬殼靜脈儲血槽"MEDOS"OXYGENATOR AND VENOUS HARDSHELL

RESERVOIR

25845

FHX0350511R5 "索倫"立利普氧合器"SORIN"DIDECO D902 LILLIPUT 2

OXYGENATOR

22548

FHX0350521R5 "索倫"伊歐斯兒童-小成人氧合器以及迷你繞道手術系

統"SORIN"DIDECO D905 EOS PEDIATRIC-SMALL ADULT OXYGENATOR

AND MINI BYPASS SYSTEM

22548

FHX0350702R5 "索倫"英派爾氧合器(氧合器及動脈過濾器)"SORIN" INSPIRE

OXYGENATORS(OXYGENATOR AND ARTERIAL FILTER)

15046

FHX0350713R5 "索倫"英派爾氧合器(氧合器及硬式儲血槽)"SORIN" INSPIRE

OXYGENATORS(OXYGENATOR AND HARD SHELL VENOUS RESERVOIR)

14409

FHX0350715R5 "索倫"英派爾氧合器(氧合器、動脈過濾器及硬式儲血槽)"SORIN"

INSPIRE OXYGENATORS(OXYGENATOR AND ARTERIAL FILTER AND

HARD SHELL VENOUS RESERVOIR)

16730

FHX03AF811M4 "美敦力"艾芬你堤富生氧合處理系統-氧合器及動脈過濾

器"MEDTRONIC" AFFINITY FUSION OXYGENATION SYSTEM-

OXYGENATOR AND ARTERIAL FILTER

15046

FHX03AF841M4 "美敦力"艾芬你堤富生氧合處理系統-氧合器、動脈過濾器及儲血

槽"MEDTRONIC" AFFINITY FUSION OXYGENATION SYSTEM-

OXYGENATOR、ARTERIAL FILTER AND RESERVO

16542

FHX03BERASQM "邁柯唯"離心幫浦套管組(含BIOLINE)"MAQUET"ROTASSIST SET

WITH BIOLINE COATING

350000

FHX03BP211M4 "美敦力"艾芬你堤皮克斯氧合處理系統(OXYGENATOR WITH

COATING-小兒用)"MEDTRONIC" AFFINITY PIXIE OXYGENATION

SYSTEM(OXYGENATOR WITH COATING)

18688

FHX03BP241M4 "美敦力"艾芬你堤皮克斯氧合處理系統(OXYGENATOR WITH

COATING AND RESERVOIR WITH COATING-小兒用)"MEDTRONIC"

AFFINITY PIXIE OXYGENATION SYSTEM(OXYGEN

22284

FHX04BEPLSQM "邁柯唯"體外循環管路組(含BIOLINE塗層)"MAQUET" PERMANENT

LIFE SUPPORT-SET WITH BIOLINE COATING

98010

FHX04C3464ML "美德思"管路組(ECMO長效型人工心肺組-組件包括

OXYGENATOR+PUMP HEAD+TUBING SET)"MEDOS" TUBING SETS

44419

FHXR250704R5 "索倫"英派爾氧合器(硬式儲血槽)"SORIN" INSPIRE

OXYGENATORS(HARD SHELL VENOUS RESERVOIR)

3297

FHXR250705R5 "索倫"英派爾氧合器(硬式儲血槽具自體血液回收過濾器)"SORIN"

INSPIRE OXYGENATORS(DUAL HARD SHELL VENOUS RESERVOIR)

3420

FND01SC376M4 "美敦力"艾提神經刺激器-SC(單側)"MEDTRONIC" ACTIVA

NEUROSTIMULATOR-SC

231000

FND02PC376M4 "美敦力"艾提神經刺激器-PC(雙側)"MEDTRONIC" ACTIVA

NEUROSTIMULATOR-PC

462000

FPP0141021XU "合碩"顱顏骨固定系統-直行骨板2洞"CUSMED"CMF FIXATION

SYSTEM:MINI BONE PLATE TITANIUM STR 2HOLE

975

FPP0204449S1 "信迪思"髁頭重建系統(下顎髁頭固定器+固定骨

板)"SYNTHES"CONDYLAR HEAD ADD-ON SYSTEM(CONDYLAR HEAD

ADD-ON AND FIXATION PLATE)

6874

FPP0701526M4 "美敦力"顱骨固定系統:BURR HOLE*1;骨釘*6"MEDTRONIC"TIMESH

CRANIAL FIXATION SYSTEM:BURR HOLE*1;SCREW*6

14133

FPP0707014M3 "蒙締邇"顱骨口腔頷骨顏面骨接合系統-鈦質顯微網

片"MONDEAL"PLATING SYSTEMS FOR CRANIO ORAL AND

MAXILLOFACIAL OSTEOSYNTHESIS-TITANIUM MICROMESH

10992

992

特材代碼 中英文名稱 支付點數-104/01/01

FPP074112ZXU "合碩"顱顏骨固定系統(+骨板4洞*3+骨釘*12)"CUSMED"CMF

FIXATION SYSTEM(MICRO-4HOLE PLATE*3+SCREW*12)

23826

FPP074902XXU "合碩"顱顏骨固定系統(BURR HOLE*1+骨板2洞*2+骨釘

*10)"CUSMED"CMF FIXATION SYSTEM(MICRO-BURR HOLE*1+2 HOLE

PLATE*2+SCREW*10)

24479

FPP074902YXU "合碩"顱顏骨固定系統(BURR HOLE*1+骨釘*6)"CUSMED"CMF

FIXATION SYSTEM(MICRO-BURR HOLE*1+SCREW*6)

14133

FPS0104497S1 "信迪思"髁頭重建系統_下顎固定螺釘"SYNTHES"CONDYLAR HEAD

ADD-ON SYSTEM_SET SCREW

579

FPS012340NLE "史賽克雷賓格爾"下頷骨系統-骨釘(2.3及2.7MM)"STRYKER

LEIBINGER"UNIVERSAL MANDIBLE SYSTEM-BONE SCREW

579

FSP71SAF01QN "博美敦"蘇菲可調式懸吊帶系統(懸吊帶+置入

針)"PROMEDON"SAFYRE

13680

FUK02TS014FN 英弗梅體外血液迴路管-小兒連續性動靜脈血液濾過套組 INFOMED

EXTRACORPOREAL BLOOD CIRCUIT-CONTINUOUS ARTERIO-VENOUS

HEMOFILTRATION,CAVH-PED

839

FUK05TS404FN 英弗梅體外血液迴路管-連續靜靜脈血液透析INFOMED

EXTRACORPOREAL BLOOD CIRCUITS -CVVHD

1393

FUT01CYST12L "邁蘭"喜仕膀胱灌注液"MYLAN" CYSTISTAT STERILE SODIUM

HYALURONATE SOLUTION

4819

HEF01B4014M4 "美敦力"艾芬你堤皮克斯兒童動脈過濾器"MEDTRONIC"AFFINITY

PIXIE PEDIATRIC ARTERIAL FILTER

1716

HHF01PXL8HHA "漢尼帝克"血小板專用高效率去除白血球血液過濾

器"HAEMONETICS"LEUKOCYTE REDUCTION FILTER FOR PLATELETS

1162

HHF020NE01HA "漢尼帝克"紅血球專用去除白血球血液過濾器(嬰幼兒專

用)"HAEMONETICS" NEO NEONATAL HIGH EFFICIENCY LEUKOCYTE

REDUCTION FILTER FOR RED BLOOD CELLS

487

HHF020RCEZHA "漢尼帝克"去除白血球過濾器"HAEMONETICS"(EZ-PRIME) SELF-

PRIMING HIGH EFFICIENCY LEUKOCYTE REDUCTION FILTER SET

FOR SINGLE UNIT BLOOD TRANSFUSION

487

HHM010VX6HQL "克力玫"抽吸導管"QUALIMED"EMAX ASPIRATION CATHETER 14123

HHM01DL950BA "巴德"迪耐立腔靜脈過濾器"BARD" DENALI VENA CAVA FILTER 33528

HHM01M13X1F2 "英泰克"莫瑪極致腦血管保護裝置"INVATEC" MO.MA ULTRA

CEREBRAL PROTECTION DEVICE

33371

HHM01SCACTNX "尼瓦西斯"血栓吸除導管"MINVASYS"STEMICATH

THROMBOASPIRATION CATHETER

14123

HHM01SQ40SHA "漢尼帝克"篩選微集合體之輸血過濾器"HAEMONETICS" BLOOD

TRANSFUSION FILTER

305

LEE0111996PY "菲康"來沛去顫器/監視器及附件-EDGE SYSTEM電擊片(成人

用)"PHYSIO-CONTROL"LIFEPAK 20E DEFIBRILLATOR/MONITOR AND

ACCESSORIES-EDGE SYSTEM ELECTRODES

652

LEE01B1P0BQM "邁柯唯"暫時性電極導線-雙極"MAQUET" TEMPORARY PACING

ELECTRODE-BIPOLAR

2076

LEE01B1P0HQM "邁柯唯"暫時性電極導線-雙極且配有心肌穿刺針和電極護

套"MAQUET" TEMPORARY PACING ELECTRODE-BIPOLAR WITH

MYOCARDIAL NEEDLE AND ELECTRODE JACKET

2076

LEE01DBP0LQM "邁柯唯"暫時性電極導線-兩條雙極"MAQUET" TEMPORARY PACING

ELECTRODE-DOUBLE BIPOLAR

3737

LEE01M10061Q "施肯貼克"去顫器用電擊貼片(兒童型)"SKINTACT"

MULTIFUNCTION DEFIBRILLATION ELECTRODE

1050

LEE01M15101Q "施肯貼克"去顫器用電擊貼片(成人型)"SKINTACT"

MULTIFUNCTION DEFIBRILLATION ELECTRODE

652

993

特材代碼 中英文名稱 支付點數-104/01/01

LEE01P1199PY "菲康"來沛去顫器/監視器及附件-兒科EDGE SYSTEM RTS電擊片

(小兒用)"PHYSIO-CONTROL"LIFEPAK 20E DEFIBRILLATOR/MONITOR

AND ACCESSORIES-PEDIATRIC EDGE S

1050

LEE01QUAP0QM "邁柯唯"暫時性電極導線-四極"MAQUET" TEMPORARY PACING

ELECTRODE-QUADRIPOLAR

3737

LEE01UN1P0QM "邁柯唯"暫時性電極導線-單極"MAQUET" TEMPORARY PACING

ELECTRODE-UNIPOLAR

1036

NAN011830N3B "千禧光"安全注射針SOL-CARE SAFETY NEEDLE 1

NAN011830NBD BD塑膠注射針"B-D" DISPOSABLE NEEDLE 0.5

NAN020032NBD BD注射筆專用針:31~32G,4~8MM BD MICRO-FINE PEN

NEEDLE:31~32G,4~8MM

3.2

NAN0601823TP "特浦"造影針"TOP"P.T.C. NEEDLE 102

NBS010003S3C “千禧光”安全注射器3CC(不附針)SOL-CARE LUER LOCK SAFETY

SYRINGE 3CC(WITHOUT NEEDLE)

1.8

NBS010005S3C “千禧光”安全注射器5CC(不附針)SOL-CARE LUER LOCK SAFETY

SYRINGE 5CC (WITHOUT NEEDLE)

2.6

NBS010010NRW "勤達"一次性使用無菌注射器10CC無針"TEAM POWER"DISPOSABLE

SYRINGE 10CC WITHOUT NEEDLE

2.4

NBS010010S3C “千禧光”安全注射器10CC(不附針)SOL-CARE LUER LOCK SAFETY

SYRINGE 10CC (WITHOUT NEEDLE)

4

NBS010020NRW "勤達"一次性使用無菌注射器20CC無針"TEAM POWER"DISPOSABLE

SYRINGE 20CC WITHOUT NEEDLE

2.9

NBS010020S3C “千禧光”安全注射器20CC(不附針)SOL-CARE LUER LOCK SAFETY

SYRINGE 20CC (WITHOUT NEEDLE)

6.6

NBS010050NRW "勤達"一次性使用無菌注射器50CC無針"TEAM POWER"DISPOSABLE

SYRINGE 50CC WITHOUT NEEDLE

9.5

NBS01A003NPW "普惠"塑膠注射筒不附針(安全型)3CC"PERFECT" DISPOSABLE

SYRINGE WITHOUT NEEDLE(SAFETY)

1.8

NBS01A003VPW "普惠"塑膠注射筒不附針:3CC(安全型)"PERFECT" DISPOSABLE

SYRINGE WITHOUT NEEDLE:(SAFETY)

1.8

NBS01A005NPW "普惠"塑膠注射筒不附針(安全型)5CC"PERFECT" DISPOSABLE

SYRINGE WITHOUT NEEDLE(SAFETY)

2.6

NBS01A005VPW "普惠"塑膠注射筒不附針:5CC(安全型)"PERFECT" DISPOSABLE

SYRINGE WITHOUT NEEDLE:(SAFETY)

2.6

NBS01A010NPW "普惠"塑膠注射筒不附針(安全型)10CC"PERFECT" DISPOSABLE

SYRINGE WITHOUT NEEDLE(SAFETY)

4

NBS01A010VPW "普惠"塑膠注射筒不附針:10CC(安全型)"PERFECT" DISPOSABLE

SYRINGE WITHOUT NEEDLE:(SAFETY)

4

NBS01A020NPW "普惠"塑膠注射筒不附針(安全型)20CC"PERFECT"DISPOSABLE

SYRINGE WITHOUT NEEDLE(SAFETY)

6.6

NBS01A020VPW "普惠"塑膠注射筒不附針:20CC(安全型)"PERFECT"DISPOSABLE

SYRINGE WITHOUT NEEDLE:(SAFETY)

6.6

NBS01EME05BD BD注射筒(不含注射針)5CC BD EMERALD SYRINGE WITHOUT NEEDLE 1.4

NBS01EME10BD BD注射筒(不含注射針)10CC BD EMERALD SYRINGE WITHOUT

NEEDLE

2.4

NBS01EME20BD BD注射筒(不含注射針)20CC BD EMERALD SYRINGE WITHOUT

NEEDLE

2.9

NBS01EME23BD BD注射筒(不含注射針)2CC;3CC BD EMERALD SYRINGE WITHOUT

NEEDLE

1

NBS07390033N "根本"顯影注射筒 200ML"NEMOTO"DISPOSABLE SYRINGE 222

NBS07390083N "根本"顯影注射筒100ML "NEMOTO"DISPOSABLE SYRINGE 222

NBS073900A3N "根本"顯影注射筒附填充管200ML"NEMOTO"DISPOSABLE SYRINGE

WITH FILL TUBE(J TUBE)

222

994

特材代碼 中英文名稱 支付點數-104/01/01

NBS07390103N "根本"顯影注射筒 150ML附填充管"NEMOTO” DISPOSABLE

SYRINGE W/J TUBE

222

NBS07390153N "根本"顯影注射筒 50ML“NEMOTO” DISPOSABLE SYRINGE 222

NBS0739B0A3N "根本"顯影注射筒 150ML“NEMOTO” DISPOSABLE SYRINGE 222

NBS07AE100KZ "康康"一次性使用高壓造影注射筒及配件(注射筒*1+抽藥管*1+螺

旋管*1)"KK"SINGLE USE HIGH PRESSURE ANGIOGRAPHIC SYRINGES

AND ACCESSORIES

313

NBS07AE200KZ "康康"一次性使用高壓造影注射筒及配件:針筒+盤旋管+穿刺吸藥

器"KK" SINGLE-USE HIGH PRESSURE ANGIOGRAPHIC SYRINGES AND

ACCESSORIES:SYRINGE+COILED TUB

313

NBS07AG100KZ "康康"一次性使用高壓造影注射筒及配件(注射筒*2+SPIKE*2+Y型

螺旋管*1)"KK"SINGLE USE HIGH PRESSURE ANGIOGRAPHIC

SYRINGES AND ACCESSORIES

435

NBS07AG200KZ "康康"一次性使用高壓造影注射筒及配件:針筒X2+單向閥盤旋T管

+穿刺器"KK" SINGLE-USE HIGH PRESSURE ANGIOGRAPHIC

SYRINGES AND ACCESSORIES:2X SYRINGES+C

435

NCS010001N3C "千禧光"附針安全注射器:1.0ML附針SOL-CARE SAFETY SYRINGE

WITH FIXED NEEDLE:1.0ML

4.9

NCS010001NRW "勤達"一次性使用無菌注射器帶針1CC"TEAM POWER"DISPOSABLE

SYRINGE 1CC

2

NCS010001S1M "濟翔"自動回縮式安全針筒:1CC附針MYSAFETY SYRINGE:1CC WITH

NEEDLE

4.9

NCS010003N3C "千禧光"安全注射器:3CC附針SOL-CARE LUER LOCK SAFETY

SYRINGE:3CC WITH NEEDLE

4.9

NCS010003NRW "勤達"一次性使用無菌注射器帶針3CC"TEAM POWER"DISPOSABLE

SYRINGE 3CC W/NEEDLE

1.4

NCS010005N3C "千禧光"安全注射器:5CC附針SOL-CARE LUER LOCK SAFETY

SYRINGE:5CC WITH NEEDLE

4.9

NCS010005NRW "勤達"一次性使用無菌注射器帶針5CC"TEAM POWER"DISPOSABLE

SYRINGE 5CC W/NEEDLE

1.8

NCS010010N3C “千禧光”安全注射器10CC(附針)SOL-CARE LUER LOCK SAFETY

SYRINGE 10CC (WITH NEEDLE)

4.9

NCS010010NRW "勤達"一次性使用無菌注射器帶針10CC"TEAM POWER"DISPOSABLE

SYRINGE 10CC W/NEEDLE

2.5

NCS01001BR3E "博瑞司"自動回收式安全注射器(附

針)1CC"BRILLIAX"AUTOMATICALLY RETRACTABLE SAFETY SYRINGE

1CC W/NEEDLE

4.9

NCS010020N3C "千禧光"安全注射器:20ML附針SOL-CARE LUER LOCK SAFETY

SYRINGE:20ML WITH NEEDLE

7.1

NCS010020NRW "勤達"一次性使用無菌注射器帶針20CC"TEAM POWER"DISPOSABLE

SYRINGE 20CC W/NEEDLE

3.1

NCS01003BR3E "博瑞司"自動回收式安全注射器(附

針)3CC"BRILLIAX"AUTOMATICALLY RETRACTABLE SAFETY SYRINGE

3CC W/NEEDLE

4.9

NCS01005BR3E "博瑞司"自動回收式安全注射器(附

針)5CC"BRILLIAX"AUTOMATICALLY RETRACTABLE SAFETY SYRINGE

5CC W/NEEDLE

4.9

NCS01010BR3E "博瑞司"自動回收式安全注射器(附

針)10CC"BRILLIAX"AUTOMATICALLY RETRACTABLE SAFETY SYRINGE

10CC W/NEEDLE

4.9

NCS01020SS2P 嘉鎂一次性使用無菌回縮型自毀式注射器(安全型附針

20CC)"EWNL"SAFETY SYRINGE 20CC WITH NEEDLE

7.1

NCS01A003VPW "普惠"塑膠注射筒附針3CC(安全型)"PERFECT"DISPOSABLE

SYRINGE 3CC/NEEDLE(SAFETY)

4.9

995

特材代碼 中英文名稱 支付點數-104/01/01

NCS01A005VPW "普惠"塑膠注射筒附針5CC(安全型)"PERFECT"DISPOSABLE

SYRINGE 5CC/NEEDLE(SAFETY)

4.9

NCS01A010NPW "PERFECT"10CC DISPOSABLE SYRINGE(SAFETY) W/NEEDLE"普惠"塑

膠注射筒附針(安全型)

4.9

NCS01A010VPW "普惠"塑膠注射筒附針10CC(安全型)"PERFECT"DISPOSABLE

SYRINGE 10CC/NEEDLE(SAFETY)

4.9

NCS01A020NPW "PERFECT"20CC DISPOSABLE SYRINGE(SAFETY) W/NEEDLE"普惠"塑

膠注射筒附針(安全型)

7.1

NCS01A020VPW "普惠"塑膠注射筒附針20CC(安全型)"PERFECT"DISPOSABLE

SYRINGE 20CC/NEEDLE(SAFETY)

7.1

NCS01B030NPW "普惠"塑膠注射筒:安全型附針1CC"PERFECT"DISPOSABLE

SYRINGE:SAFETY WITH NEEDLE 1CC

4.9

NCS01C001NPW "普惠"塑膠注射筒:安全型附針1CC"PERFECT" DISPOSABLE

SYRINGE:SAFETY WITH NEEDLE 1CC

4.9

NCS01ECL01BD BD安全遮蔽防護式注射針(含1CC注射筒)BD ECLIPSE NEEDLE

W/SYRINGE 1CC

4.9

NCS01ECL02BD BD安全遮蔽防護式注射針(含3CC注射筒)BD ECLIPSE NEEDLE

W/SYRINGE 3CC

4.9

NCS01ECL03BD BD安全遮蔽防護式注射針(含5CC注射筒)BD ECLIPSE NEEDLE

W/SYRINGE 5CC

4.9

NCS01ECL04BD BD安全遮蔽防護式注射針(含10CC注射筒)BD ECLIPSE NEEDLE

W/SYRINGE 10CC

4.9

NCS01EME05BD BD注射筒(含注射針)5CC BD EMERALD SYRINGE W/NEEDLE 1.8

NCS01EME10BD BD注射筒(含注射針)10CC BD EMERALD SYRINGE W/NEEDLE 2.5

NCS01EME20BD BD注射筒(含注射針)20CC BD EMERALD SYRINGE W/NEEDLE 3.1

NCS01EME23BD BD注射筒(含注射針)2CC;3CC BD EMERALD SYRINGE W/NEEDLE 1.4

NCS01S001NTM “泰爾茂”確保安全針筒附針(1CC)“TERUMO” SURGUARD2

HYPODERMIC SYRINGE WITH SAFETY NEEDLE

4.9

NCS01S003NTM “泰爾茂”確保安全針筒附針(3CC)“TERUMO” SURGUARD2

HYPODERMIC SYRINGE WITH SAFETY NEEDLE

4.9

NCS01S005NTM “泰爾茂”確保安全針筒附針(5CC)“TERUMO” SURGUARD2

HYPODERMIC SYRINGE WITH SAFETY NEEDLE

4.9

NCS01S010NTM “泰爾茂”確保安全針筒附針(10CC)“TERUMO” SURGUARD2

HYPODERMIC SYRINGE WITH SAFETY NEEDLE

4.9

NCS03001DB2P 嘉鎂一次性使用無菌回縮型自毀式注射器(安全型胰島素注射筒附

針)"EWNL"SAFETY SYRINGE WITH NEEDLE(INSULIN SYRINGE)

6

NCS030310NFB "桂台"胰島素注射筒附針"FEELJECT"DISPOSABLE INSULIN

SYRINGES WITH NEEDLE

3.7

NCS030510VPW "普惠"塑膠注射筒:胰島素空針"PERFECT"DISPOSABLE

SYRINGE:INSULIN SYRINGE

3.7

NDN011828N3B "康德萊"頭皮針"KDL" SCALP VEIN SET 3.9

NDN02A430NPW "PERFECT"WINGED CORE RESISTANT NEEDLE SETS(SAFETY)"普惠"

蝴蝶彎針(安全型)

91.5

NDN041624N2F "美德芙"靜脈留置針"MEDIFIRST"CATH PRO I.V CATHETER(PU) 10.5

NDN041824N2F "美德芙"靜脈留置針"MEDIFIRST"CATH PRO I.V CATHETER(PU) 10.5

NDN0442511BB "柏朗"第三代安全靜脈留置針"B.BRAUN" INTROCAN SAFETY 3

CLOSED I.V. CATHETER

27.5

NDN0451SNW2K "欣意"安全靜脈留置針"MASTER&FRANK"SAFETY IV CATHETER 27.5

NDN04BC001BD BD INSYTE AUTOGUARD BC SHIELD IV CATHETER 16:24G BD 安全

性靜脈留置針-血液控制

27.5

NDN04SC5J1YZ “美迪克”安全性靜脈留置針"MEDIKIT” SUPERCATH 5 SAFETY

I.V.CATHETER

27.5

NDN04SC5V1YZ "美迪克"安全性靜脈留置針"MEDIKIT" SUPERCATH 5 SAFETY I.V.

CATHETER

27.5

996

特材代碼 中英文名稱 支付點數-104/01/01

NES0376330ZM "楚克"切片針"TRU-CORE" I BIOPSY NEEDLES 633

RRB01TB000EF "貝斯美德"誘發型肺量計"BESMED" INCENTIVE SPIROMETER 140

SAS06548872C "柯惠"可拆除式皮膚縫合釘(滅菌) "COVIDIEN" REMOVABLE SKIN

STAPLE (STERILE))

210

SAS06803522C "柯惠"可拆除式皮膚縫合釘(滅菌) "COVIDIEN" REMOVABLE SKIN

STAPLE (STERILE)

173

SAS06TS35RQW "台灣先進"可拆除式皮膚縫合釘(滅菌) "TAIWAN SURGICAL"

REMOVABLE SKIN STAPLE (STERILE)

173

SAS06TS35WQW "台灣先進"可拆除式皮膚縫合釘(滅菌) "TAIWAN SURGICAL"

REMOVABLE SKIN STAPLE (STERILE)

210

SAU01P130L2C "柯惠" 胸腹自動縫合器及縫合釘-縫合釘"COVIDIEN" AUTO

SUTURE PI DISPOSABLE STAPLER AND LOADING UNIT-SINGLE USE

LOADING UNIT

2293

SAU07304512C "柯惠"旋轉式內視鏡胃腸自動吻合釘匣"COVIDIEN"AUTO SUTURE

ENDO GIA UNIVERSAL ROTICULATOR SINGLE USE LOADING UNIT

4000

SAU07308052C "柯惠" 內視鏡GIA自動手術縫合器及縫合釘-縫合釘

匣"COVIDIEN" AUTO SUTURE MULTIFIRE ENDO GIA DISPOSABLE

SURGICAL STAPLER AND DISPOSABLE LOADING UN

4000

SCV01FD100TX "泰利芙斯"血管夾"Teleflex Medical" Hemoclip (M) 每盒10排

,每排25CLIP

15

SCV01FD135TX "泰利芙斯"血管夾"Teleflex Medical" Hemoclip(S) 每盒12排,

每排25CLIP

12.5

SCV01FD160TX "泰利芙斯"血管夾"Teleflex Medical" Hemoclip(M.L) 每盒20排

,每排10CLIP

18.6

SCV01FD170TX "泰利芙斯"血管夾"Teleflex Medical" Hemoclip(L) 每盒10排,

每排15CLIP

29.4

SCV01FD300TX "泰利芙斯"血管夾"Teleflex Medical" Hemoclip(M) 每盒20排,

每排10CLIP

15

SCV01FD335TX "泰利芙斯"血管夾"Teleflex Medical" Hemoclip(S) 每盒24排,

每排10CLIP

12.5

SCV01FD360TX "泰利芙斯"血管夾"Teleflex Medical" Hemoclip (ML) 每盒16排

,每排10CLIP

18.6

SCV01FD370TX "泰利芙斯"血管夾"Teleflex Medical" Hemoclip(L) 每盒12排,

每排10CLIP

29.4

SCV01FD800TX "泰利芙斯"血管夾"Teleflex Medical" Hemoclip-TITANIUM

(MEDIUM)

17.9

SCV01FD835TX "泰利芙斯"血管夾"Teleflex Medical" Hemoclip-TITANIUM

(SMALL)

15

SCV01FD860TX "泰利芙斯"血管夾"Teleflex Medical" Hemoclip-

TITANIUM(MEDIUM-LARGE)

20.2

SCV01FD870TX "泰利芙斯"血管夾"Teleflex Medical" Hemoclip-

TITANIUM(LARGE)

35

SCV029380NM1 "瑞穗"腦動脈瘤夾"MIZUHO"SUGITA ANEURYSM CLIP 2897

SCV0294050M1 "瑞穗"腦動脈瘤夾"MIZUHO"SUGITA ANEURYSM CLIP 2801

SCV0294069M1 "瑞穗"腦動脈瘤夾"MIZUHO"SUGITA ANEURYSM CLIP 2256

SCV2023703TX "泰利芙斯"希瑪克力普血管夾"Teleflex Medical" Hemoclip

Automatic Clip Applier With Clips-M20

98.7

TKP03700UB3R "安吉優戴爾美德"射頻燒灼手術系統及其配件(優你布

蕾)"ANGIODYNAMICS"RFA SURGICAL SYSTEM AND

ACCESSORIES:UNIBLATE

18800

TKP0427160XL "首馬特"乳房定位針"SOMATEX"BREAST LOCALIZATION NEEDLE 984

TKP04CHESBBA "巴德"乳房定位針(滅菌):切絲柏乳房定位導線"BARD" BREAST

LOCALIZATION NEEDLE (STERILE):CHESBROUGH BREAST

LOCALIZATION WIRES(NEEDLE+WIRE)

984

997

特材代碼 中英文名稱 支付點數-104/01/01

TSS0100003LQ "長庚"血糖檢測系統血糖試片(側吸式)(25*2瓶/組)"CHANG

GUNG"BLOOD GLUCOSE MONITORING SYSTEM BLOOD GLUCOSE TEST

STRIP(SIDE TYPE)(25*2 BOTTLES/SET)

8.1

TSS0100005LQ "長庚"血糖檢測系統血糖試片鋁箔包裝(側吸式)(單片鋁箔包50片

裝)"CHANG GUNG"BLOOD GLUCOSE MONITORING SYSTEM BLOOD

GLUCOSE TEST STRIP PACKAGE OF ALUMI

8.1

TSS0100008G8 測利得血糖檢測系統-測利得血糖試片(罐裝25片,50片,及鋁箔包

10片,25片,50片,100片)GLUCOLEADER BLOOD GLUCOSE MONITORING

SYSTEM-GLUCOLEADER BLOOD GLUCOS

8.1

TSS01101011Y 紅電血糖監測系統-紅電血糖測試片(25、40、50片盒裝)MEDACCU

BLOOD GLUCOSE MONITORING SYSTEM-MEDACCU BLOOD GLUCOSE

TEST STRIP(25、40、50 PCS)

8.1

TSS0125693AB 亞培輔理善越佳型醫院用血糖試紙(50片/盒)ABBOTT FREESTYLE

OPTIUM H BLOOD GLUCOSE TEST STRIPS

8.1

TSS0125879AB 亞培輔理善越佳型血糖試紙(10片,25片,50片/盒)ABBOTT

FREESTYLE OPTIUM BLOOD GLUCOSE TEST STRIP

8.1

TSS014132AK9 福爾愛立測血糖測試系統血糖試片(25片/罐,2罐/盒)FORA

IDIAMOND BLOOD GLUCOSE MONITORING SYSTEM BLOOD GLUCOSE

TEST STRIP

8.1

TSS0171191AB 亞培輔理善越巧型血糖試紙(50片/罐)ABBOTT FREESTYLE LITE

BLOOD GLUCOSE TEST STRIPS

8.1

TSS01AS0012J 捷兌佳攜帶型血糖測試系統-捷兌佳攜帶型血糖試片(25、2*25、

50片/罐)ALCOSE POCKET BLOOD GLUCOSE MONITORING SYSTEM-

ALCOSE BLOOD GLUCOSE STRIPS(25、2*2

8.1

TSS01EN003FY "愛科來"SIGMA血糖試紙(25片/盒,50片/盒)"ARKRAY"GLUCOCARD

SIGMA TEST STRIPS

8.1

TSS01GM250FS 瑞特血糖監測系統GM250-瑞特血糖測試片(10片/盒、25片/盒、50

片/盒、75片/盒、100片/盒、200片/盒)RIGHTEST BLOOD GLUCOSE

MONITORING SYSTEM GM250-BLOOD

8.1

TSS01GM260FS 瑞特血糖監測系統GM260-瑞特血糖測試片(10片/盒、25片/盒、50

片/盒、75片/盒、100片/盒、200片/盒RIGHTEST BLOOD GLUCOSE

MONITORING SYSTEM GM260-BLOOD G

8.1

TSS01GM720FS 瑞特血糖監測系統GM720-瑞特血糖監測試片(10片/罐,25片/罐,25

片/罐*2,25片/罐*3,25片/罐*4,25片/罐*8)RIGHTEST BLOOD

GLUCOSE MONITORING SYSTEM GM720-BLO

8.1

TSS01HL5221J 帝寶血糖試紙(25片/盒、50片/盒)TIPOCARE BLOOD GLUCOSE TEST

STRIP

8.1

TSS01NS0012Y 史丹斯翠血糖測定儀-血糖試片(50片/罐)STATSTRIP GLUCOSE

HOSPITAL METER-BLOOD GLUCOSE TEST STRIPS

8.1

TSS01TB001NR 測寶穩血糖試紙條(10片,50片,25片,25片*2瓶/盒)TRUEBALANCE

BLOOD GLUCOSE TEST STRIPS

8.1

TSS01VBM1A2V 美高安易型血糖監測系統-血糖試片(10片,25片,50片/盒)VERI-Q

BALANCE BLOOD GLUCOSE MONITORING SYSTEM-BLOOD GLUCOSE

TEST STRIPS

8.1

WBB0703035NJ "必史恩"義肢及裝具用附件-石膏繃帶 3"×3YDS "BSN"

PROSTHETIC AND ORTHOTIC ACCESSORY-PLASTER BANDAGE

22.7

WBB0704030C7 "中衛"石膏繃帶(未滅菌)"CSD"PLASTER OF PAIRS BANDAGE (NON-

STERILE)

24.4

WBB0704055NJ "必史恩"義肢及裝具用附件-石膏繃帶 4"×5YDS "BSN"

PROSTHETIC AND ORTHOTIC ACCESSORY-PLASTER BANDAGE

38.1

WBB0705055NJ "必史恩"義肢及裝具用附件-石膏繃帶 5"×5YDS

"BSN"PROSTHETIC AND ORTHOTIC ACCESSORY-PLASTER BANDAGE

48.8

WBB0706055NJ "必史恩"義肢及裝具用附件-石膏繃帶 6"×5YDS "BSN"

PROSTHETIC AND ORTHOTIC ACCESSORY-PLASTER BANDAGE

50.1

998

特材代碼 中英文名稱 支付點數-104/01/01

WBB0802040C7 "中衛"樹脂石膏繃帶 (未滅菌)"CSD" ORTHOPEDIC CASTING TAPE

(NON-STERILE)

120

WBB0803040C7 "中衛"樹脂石膏繃帶 (未滅菌)"CSD" ORTHOPEDIC CASTING TAPE

(NON-STERILE)

140

WBB0804040C7 "中衛"樹脂石膏繃帶 (未滅菌)"CSD" ORTHOPEDIC CASTING TAPE

(NON-STERILE)

160

WBB0805040C7 "中衛"樹脂石膏繃帶 (未滅菌)"CSD" ORTHOPEDIC CASTING TAPE

(NON-STERILE)

180

WBB0806040C7 "中衛"樹脂石膏繃帶 (未滅菌)"CSD" ORTHOPEDIC CASTING TAPE

(NON-STERILE)

207

WDD0809940HL "鶴牌"親水性創傷覆蓋材(滅菌)-無菌傷口滲出液貼

布"HOLLISTER"HYDROPHILIC WOUND DRESSING (STERILE)-RESTORE

CALCICARE WOUND CARE DRESSING STERILE

119

WDD0820671F4 〝康威〞愛康膚 強化吸收親水性纖維敷料 (滅菌)〝CONVATEC〞

AQUACEL EXTRA HYDROFIBER DRESSING (STERILE)5*5cm

29.3

WDD0820672F4 〝康威〞愛康膚 強化吸收親水性纖維敷料 (滅菌)〝CONVATEC〞

AQUACEL EXTRA HYDROFIBER DRESSING (STERILE)10*10cm

119

WDD0820673F4 〝康威〞愛康膚 強化吸收親水性纖維敷料 (滅菌)〝CONVATEC〞

AQUACEL EXTRA HYDROFIBER DRESSING (STERILE)15*15cm

245

WDD0820674F4 〝康威〞愛康膚 強化吸收親水性纖維敷料 (滅菌) 〝CONVATEC〞

AQUACEL EXTRA HYDROFIBER DRESSING (STERILE)10*12cm

143

WDD0839530LN "美尼克"美皮蕾防水型銀自黏抗菌軟性矽膠泡棉敷料"MOLNLYCKE"

MEPILEX BORDER AG SELF-ADHERENT ANTIMICROBIAL SOFT

SILICONE FOAM DRESSING

184

WDD0839570LN "美尼克"美皮蕾防水型銀自黏抗菌軟性矽膠泡棉敷料"MOLNLYCKE"

MEPILEX BORDER AG SELF-ADHERENT ANTIMICROBIAL SOFT

SILICONE FOAM DRESSING

460

WDD0839580LN "美尼克"美皮蕾防水型銀自黏抗菌軟性矽膠泡棉敷料"MOLNLYCKE"

MEPILEX BORDER AG SELF-ADHERENT ANTIMICROBIAL SOFT

SILICONE FOAM DRESSING

368

WDD0839590LN "美尼克"美皮蕾防水型銀自黏抗菌軟性矽膠泡棉敷料"MOLNLYCKE"

MEPILEX BORDER AG SELF-ADHERENT ANTIMICROBIAL SOFT

SILICONE FOAM DRESSING

559

WDD08C0501ZW 舒膚貼抗菌親水性敷料(滅菌)SAVDERM ANTISEPTIC

HYDROCOLLOIDS THIN DRESSING (STERILE)5×5cm

56.4

WDD08C0512ZW 舒膚貼抗菌親水性敷料(滅菌)5.5*8.5cm 56.4

WDD08C0563ZW 舒膚貼抗菌親水性敷料(滅菌)SAVDERM ANTISEPTIC

HYDROCOLLOIDS THIN DRESSING (STERILE)

224

WDD08C1001ZW 舒膚貼抗菌親水性敷料(滅菌)SAVDERM ANTISEPTIC

HYDROCOLLOIDS DRESSING (STERILE)5x5cm

56.4

WDD08C1002ZW 舒膚貼抗菌親水性敷料(滅菌)SAVDERM ANTISEPTIC

HYDROCOLLOIDS DRESSING (STERILE)10x10cm

224

WDD08C1004ZW 舒膚貼抗菌親水性敷料(滅菌)SAVDERM ANTISEPTIC

HYDROCOLLOIDS DRESSING (STERILE)20x20cm

612

WDD08C1006ZW 舒膚貼抗菌親水性敷料(滅菌)SAVDERM ANTISEPTIC

HYDROCOLLOIDS DRESSING (STERILE)15x15cm

406

WDD08C1012ZW 舒膚貼抗菌親水性敷料(滅菌)SAVDERM ANTISEPTIC

HYDROCOLLOIDS DRESSING (STERILE)

56.4

WDD08C1063ZW 舒膚貼抗菌親水性敷料(滅菌)SAVDERM ANTISEPTIC

HYDROCOLLOIDS DRESSING (STERILE)5x20cm

224

WDD08X1520QY "SYSTAGENIX" TIELLE XTRA NON-ADHESIVE HYDROPOLYMER

DRESSING (STERILE)"新世捷"德力裁剪型不自粘親水性敷料

327

ACM0101278BB HIGH PRESSURE MANIFOLDS DOUBLE W/ROTABLE ADAPTER 70 BAR 184

ACM0101280BB HIGH PRESSURE MANIFOLDS TRIPLE 35 BAR 211

999

特材代碼 中英文名稱 支付點數-104/01/01

ACM0101281BB HIGH PRESSURE MANIFOLDS TRIPLE W/ROTABLE ADAPTER 35 BAR 211

ACM0101284BB HIGH PRESSURE MANIFOLDS TRIPLE W/ROTABLE ADAPTER 70 BAR 211

ACM0101285BB ANGIODYN HIGHT PRESSURE MANIFOLDS STOPCOCKS DOUBLE PORTS

500PSI 1000PSI

184

ACM0101286BB ANGIODYN HIGHT PRESSURE MANIFOLDS STOPCOCKS TRIPLE PORTS

500PSI 1000PSI

211

ACM01202HFMR MANIFOLD 2-V 200PSI 184

ACM01253RXMR MANIFOLD 3 PORTS 200PSI;500PSI WITH HIGH PRESSURE TUBING

雙層 (可達1200PSI)

287

ACM012HFRXMR MANIFOLD 2-PORTS W/ HIGH PRESSURE TUBING(雙層可達1200PSI) 287

ACM013P700NL "娜維利斯特"娜米克血管造影多路水接頭"NAVILYST"NAMIC

ANGIOGRAPHIC MANIFOLDS(3-PORT)

211

ACM01502RXMR MANIFOLD 2-PORTS 500 PSI 184

ACM01503RXMR MANIFOLD 3-PORTS 500 PSI 211

ACM01504RXMR MANIFOLD 4 PORTS 200PSI;500PSI WITH HIGH PRESSURE TUBING

雙層 (可達1200PSI)

287

ACM0154PRTMR "MERIT"MANIFOLD:4 PORTS 200PSI;500PSI"美瑞特"多路水接頭:4

連接頭

261

ACM019310NAG MANIFOLDS 2 PORTS 184

ACM01APMF2H9 ANGIO PACK:MANIFOLDS 2 PORT/500 184

ACM01APMF3H9 ANGIO PACK:MANIFOLDS 3 PORT/500 211

ACM01M2P2HGJ "JSM" 2-PORTS MANIFOLDS (500PSI)+2條PRESSURE TUBING (PVC

可達500PSI)+1條HIGH PRESSURE TUBING (雙層PU可達1200PSI)"

吉生"多路引流器

464

ACM01M3P2HGJ "JSM" 3-PORTS MANIFOLDS (500PSI)+2條PRESSURE TUBING (PVC

可達500PSI)+1條HIGH PRESSURE TUBING (雙層PU可達1200PSI)"

吉生"多路引流器

478

ACM01M3P4HGJ "JSM" 2個3-PORTS MANIFOLDS (500PSI)+4條PRESSURE TUBING

(PVC可達500PSI)+1條HIGH PRESSURE TUBING (雙層PU可達

1200PSI)"吉生"多路引流器

721

ACM01M4P2HGJ "JSM" 4-PORTS MANIFOLDS (500PSI)+2條PRESSURE TUBING (PVC

可達500PSI)+1條HIGH PRESSURE TUBING (雙層PU可達1200PSI)"

吉生"多路引流器

523

ACM01MA2PTGJ MANIFOLDS (2 PORT 500PSI W/PVC PT)多路引流器(含PVC壓力連

接管)

188

ACM01MA2PUGJ "JSM"MANIFOLDS(2 PORT/500PSI W/PU 1200PSI)"吉生"多路引流

287

ACM01MA2PVGJ "JSM"MANIFOLDS(2 PORT/500PSI W/PVC 1000PSI)"吉生"多路引流

250

ACM01MA3PTGJ MANIFOLDS (3 PORT 500PSI W/PVC PT)多路引流器(含PVC壓力連

接管)

218

ACM01MA3PUGJ "JSM"MANIFOLDS(3 PORT/500PSI W/PU 1200PSI)"吉生"多路引流

287

ACM01MA3PVGJ "JSM"MANIFOLDS(3 PORT/500PSI W/PVC 1000PSI)"吉生"多路引流

250

ACM01MA4PTGJ MANIFOLDS (4 PORT 500PSI W/PVC PT)多路引流器(含PVC壓力連

接管)

278

ACM01MA4PUGJ "JSM"MANIFOLDS(4 PORT/500PSI W/PU 1200PSI)"吉生"多路引流

287

ACM01MA4PVGJ "JSM"MANIFOLDS(4 PORT/500PSI W/PVC 1000PSI)"吉生"多路引流

250

ACM01MAN2PGJ MANIFOLDS (2 PORT 500PSI)多路引流器 184

ACM01MAN3PGJ MANIFOLDS (3 PORT 500PSI)多路引流器 211

1000

特材代碼 中英文名稱 支付點數-104/01/01

ACM01MAN4PGJ MANIFOLDS (4 PORT 500PSI)多路引流器 261

ACM01TS520SG MANIFOLD 2 PORTS 184

ACM01TS530SG MANIFOLD 3 PORTS 211

ACM01TS540SG MANIFOLD 4 PORTS 261

ACPD1C4129BT "百特"鈦金屬接頭 "BAXTER" ADAPTER FOR PERITONEAL DIALYSIS

CATHETER

1482

ACVP105103B0 CSF CATHETER CONNECTOR,STRAIGHT 380

ACVP105104B0 CSF CATHETER CONNECTOR,RIGHT ANGLE 719

ACVP123048CM HAKIM STRAIGHT CONNECTOR 380

ACVP145103PM CONNECTOR 380

ACVP145104PM CONNECTOR L型 719

ACVP182150CM ACCU-FLO STRAIGHT CONNECTORS(METAL,PLASTIC) 380

ACVP182151CM ACCU-FLO RIGHT ANGLE CONNECTORS(METAL,PLASTIC) 719

CAE0101401BB PERIFIX ONE EPIDURAL

ANAESTHESIA(NEEDLE+CATH+CONNECTOR+FILTER+LOR

SYRINGE+SYRINGE)

389

CAE0112006BB EPIDURAL ANAESTHESIA SET 16:18G(N+C+F+S)(型號含

04514300,04515-013:021,-200:307,04516-206:303)

389

CAE0139101PX "保德士"硬膜外腔麻醉針組(1)"PORTEX"EPIDURAL MINIPACK

SYSTEMS(1) 16;18G(NEEDLE+CATHETER+FILTER+SYRINGE)

389

CAE0139411PX "保德士"硬膜外腔麻醉針組(4)"PORTEX"EPIDURAL MINIPACK

SYSTEMS(4) 16;18G(NEEDLE+CATHETER)

208

CAE014014NBD PERISAFE EPIDURAL ANAESTHESIA KIT NEEDLE 17,18G CATH

19,20G(N+C+FILTER+SYRINGE+GUIDE+CONNECTOR)

389

CAE0151300BB PERIFIX EPIDURAL SET 208

CAE0151410BB PERIFIX FOR CONTINUOUS EPIDURAL AND CAUDAL ANAESTHESIA

400 SERIES

389

CAE01SD300BB "B.BRAUN"PERIFIX CATHETERS FOR EPIDURAL ANAESTHESIA"柏朗"

脊椎硬膜麻醉用穿刺套(NEEDLE+CATHETER)

208

CAE01SD401BB "B.BRAUN"PERIFIX CATHETERS FOR EPIDURAL

ANAESTHESIA:FILTER SETS"柏朗"脊椎硬膜麻醉用穿刺套

(NEEDLE+CATHETER+FILTER+SYRINGE)

389

CBC04EX06CAN "ANGIOMED"BARD LIFESTENT VASCULAR STENT(DELIVERY

SYS+STENT)"安吉美爾德" 巴德萊弗丹血管支架,支架長20:120MM

28773

CBC04EX12LAN "ANGIOMED"BARD LIFESTENT SOLO VASCULAR STENT

SYSTEM(DELIVERY SYS+STENT)"安吉美爾德" 巴德萊弗丹舒樂血管

支架系統,支架長20:120MM

28773

CBC04EX15CAN "ANGIOMED"BARD LIFESTENT VASCULAR STENT(DELIVERY

SYS+STENT)"安吉美爾德" 巴德萊弗丹血管支架,支架長150:170MM

44293

CBC04EX20LAN "ANGIOMED"BARD LIFESTENT SOLO VASCULAR STENT

SYSTEM(DELIVERY SYS+STENT)"安吉美爾德" 巴德萊弗丹舒樂血管

支架系統,支架長150:200MM

44293

CBC04MAR1SF2 "INVATEC"MARIS PERIPHERAL SELF-EXPANDING STENT SYSTEM"英

泰克"瑪瑞斯自膨式周邊血管支架系統(淺股動脈血管支

架)L20:120MM D6:12MM*適應症請見備註

28773

CBC04NSFALSB "波士頓科技"宜諾自膨式支架系統(淺股動脈支架)"BOSTON

SCIENTIFIC"INNOVA SELF-EXPANDING STENT SYSTEM(DELIVERY

SYS+STENT)L150:201MM

44293

CBC04NSFASSB "波士頓科技"宜諾自膨式支架系統(淺股動脈支架)"BOSTON

SCIENTIFIC"INNOVA SELF-EXPANDING STENT SYSTEM(DELIVERY

SYS+STENT)L20:120MM

28773

1001

特材代碼 中英文名稱 支付點數-104/01/01

CBC04PR120EY "EV3"PROTEGE EVERFLEX SELF-EXPANDING BILIARY STENT SYS

20:120MM 5:8MM波特捷自動擴張式膽道支架系統-淺股動脈*適應

症請見備註欄

28773

CBC04PR150EY "EV3"PROTEGE EVERFLEX SELF-EXPANDING BILIARY STENT SYSTEM

150MM 6:8MM波特捷自動擴張式膽道支架系統-淺股動脈用

44293

CBC04SC210CD "CORDIS"S.M.A.R.T.CONTROL NITINOL STENT SYSTEM"考迪斯"史

瑪特鎳鈦支架系統(淺股動脈血管支架)D20:100MM L6:14MM

28773

CBC04SN120CD "CORDIS"S.M.A.R.T.NITINOL STENT SYSTEM"考迪斯"史瑪特鎳鈦

支架系統(淺股動脈血管支架)D 6:8MM L 120MM*給付規定請見備

註欄

28773

CBC04SN150CD "CORDIS"S.M.A.R.T.NITINOL STENT SYSTEM"考迪斯"史瑪特鎳鈦

支架系統(淺股動脈血管支架)D 6:8MM L 150MM*給付規定請見備

註欄

44293

CBC04ZFV61CK "COOK"ZILVER FLEX 35 VASCULAR STENTS"曲克"麗而服福雷斯血

管支架(淺股動脈血管支架)20:140MM 5:10MM*適應症請見備註欄

28773

CBC04ZFV62CK "COOK"ZILVER FLEX 35 VASCULAR STENTS"曲克"麗而服福雷斯血

管支架(淺股動脈血管支架)170:200MM 5-8MM

44293

CBC06F0RX1CK "COOK"FORMULA 414 RENAL STENT SYSTEM 支架5-7MMX12-24MM"曲

克"佛摩拉414腎臟血管支架系統*適應症請見備註欄

31063

CBC06H1PP0F2 "INVATEC"HIPPOCAMPUS RENAL STENT SYSTEM :D:4-7MM L:10-

24MM"英泰克"海馬腎動脈支架系統*給付規定請見備註欄

31063

CBC06H7493SB "BOSTON SCIENTIFIC"EXPRESS RENAL/BILIARY SD PREMOUNTED

STENT SYS"波士頓科技"極速腎臟/膽道用支架系統(腎臟支架系

統)*適應証見備註欄

31063

CBC06HLELTAB "ABBOTT"RX HERCULINK ELITE PERIPHERAL STENT SYSTEM"亞培"

赫可林精英周邊血管支架系統(腎動脈支架及輸送系統)*給付規定

請見備註欄

31063

CBC07VB10NGX "GORE"VIABAHN ENDOPROTHESIS D5:13MM.L10CM"戈爾"威爾棒周邊

血管支架(含傳輸裝置)*給付規定請見備註欄

76050

CBC07VB15NGX "GORE"VIABAHN ENDOPROTHESIS D5:10MM.L15CM"戈爾"威爾棒周邊

血管支架(含傳輸裝置)*給付規定請見備註欄

91800

CBC07VBC5NGX "GORE"VIABAHN ENDOPROTHESIS D5:8MM.L2.5CM,D5:13MM.L5CM"

戈爾"威爾棒周邊血管支架(含傳輸裝置)*給付規定請見備註欄

62370

CBS069MVSDG6 "銨積維"安普拉茲肌肉性心室中膈缺損關閉器"AGA" AMPLATZER

MUSCULAR VSD OCCLUDER 4:18MM

121679

CDF0121000M4 CSF FLOW CONTROL SHUNTS AND ACCESSORIES V-P-SHUNT

RESERVOIR

2653

CDF0121401CM ACCU-FLO SINGLE LUMEN RESERVOIR 2653

CDF0221411CM ACCU-FLO SINGLE LUMEN RESERVOIR 2653

CDF0242104PM C.S.F. FLOW CONTROL VALVE STANDARD 5568

CDF0302512B0 CSF VALVE BURR HOLE 5568

CDF0302812B0 CSF VALVE BURR HOLE 5568

CDF0342324PM C.S.F. FLOW CONTROL VALVE CONTOURED 5568

CDF0342544PM C.S.F. FLOW CONTROL VALVE BURR HOLE 5568

CDLP106418B0 "長安"腦脊髓分引流系統"BMI"CSF Shunting System 6599

CDLP144410PM "美敦力"腦脊髓液腰椎腹膜分流系

統"MEDTRONIC"LUMBOPERITONEAL SHUNT SYSTEM

6599

CDLP146418M4 "美敦力"體外腰椎引流監測系統"MEDTRONIC"EDM LUMBER

CATHETER 24CM;80CM

1903

1002

特材代碼 中英文名稱 支付點數-104/01/01

CDPN1UTPT1CK "COOK"WAYNE PNEUMOTHORAX SET(含單向引流閥+豬尾導管+0.035

導線+擴張器+3WAY+連接管+穿刺針*2)"曲克"威恩氣胸引流組

2908

CDPN2TQTS1CK "COOK"THAL-QUICK CHEST TUBE SET 8~36FR 18~41CM(穿刺針+擴

張器*3+導線+胸管插入器+胸管)"曲克"胸腔引流管組

1948

CFD0202308P2 "太平洋"胃管"PAHSCO"STOMACH TUBE SILICON*適應症請見備註欄 65.6

CFD0216120W6 SILICONE STOMACH TUBE 6FR:18FR*適應症請見備註欄 65.6

CFD022020NFM ALL SILICONE STOMACH(GASTRIC)TUBE 4:20FR ※適應症請見備註

65.6

CFD0222070WN ALL SILICON LEVIN TUBE W/TAPER FUNNEL 2EYES※適應症請見備

註欄

65.6

CFD0222073WN "世運"矽質胃管附蓋子"SEWOON"GASTROINTESTINAL TUBE AND

CATHETER(SILICONE)

65.6

CFD0222074WN ALL SILICON LEVIN TUBE W/TAPER FUNNEL 4EYES※適應症請見備

註欄

65.6

CFD022207NWN Silicon Levin Tube W/Taper Funnel 8:22FR※適應症請見備註

65.6

CFD0276ST6MU ALL SILICONE STOMACH TUBE※適應症請見備註欄 65.6

CFD02G0101SG SILICONE GASTRIC TUBE*適應症請見備註欄 65.6

CFD02GT001SG SIGMA GASTRIC TUBE(SILICON)*適應症請見備註欄 65.6

CFD02GT301EW E-UP STOMACH TUBE(SILICON) 毅升一次性使用胃管 65.6

CFD02GT501EW E-UP GASTRIC DUODENAL LEVIN TUBE (SILICON) 08~18FR 毅升胃

65.6

CFD02ST000EF BESMED SILICONE STOMACH TUBING*適應症請見備註欄 65.6

CFD04CNJFTCK 〝COOK〞TIGER TUBE FRICTIONAL NASAL JEJUNAL FEEDING

TUBE9(含導管、餵食管接頭)〝曲克〞泰格管菲宣那鼻空腸餵食管

※給付規定請見備註欄

4157

CFD04NJFT1CK "COOK"NASAL JEJUNAL FEEDING TUBE(含導線、餵食管、鼻引導

管、餵食管接頭)"曲克"經鼻腔空腸餵食管※適應症請見備註欄

2700

CFD0600026BA "BARD" BUTTON REPLACEMENT GASTROSTOMY DEVICE

(BUTTON+OBTURATOR+BOLUS AND F-TUBES+DECOMP TUBE+SY)"巴德"

鈕扣式置換胃造口組※適應症請見備註欄

4243

CFD0600031BA "BARD"DUAL PORT FEEDING ADAPTOR 經皮內視鏡胃造口組:雙座餵

食管接頭※適應症請見備註欄

204

CFD0600627BA "BARD"PONSKY PULL PEG DELUXE KIT

(TUBE+WIRE+S+N+ADAP+BOL+SNARE+SCISSOR)"巴德"經皮內視鏡胃

造口組(全套)※適應症請見備註欄

4610

CFD060640NK4 "KIMBERLY-CLARK"PEG

KIT(TUBE+SNARE+ADAPTER+RING+NEEDLE+WIRE+CLAMP)〝金百利克

拉克〞經皮內視鏡胃造廔組(全套)※適應症請見備註欄

4610

CFD060640NLZ PEG KIT(全套)經皮內視鏡胃造廔組(PEG TUBE,RETRIEVAL

SNARE,ADAPTER,RING,INTRODUCER NEEDLE,WIRE,TUBING CLAMP)※

適應症請見備註欄

4610

CFD0612LVNK4 "KIMBERLY-CLARK"GASTROSTOMY TUBE(SILICONE BALLOON TYPE)〝

金百利克拉克〞胃造廔管※適應症請見備註欄

1541

CFD0612LVNLZ GASTROSTOMY TUBE BALLOON FEEDING TUBE 胃造口術器材配件

/BALLOON型替換管※適應症請見備註欄

1541

CFD062019NFM "富強"胃造廔管 "FORTUNE" GASTROSTOMY CATHETERX *給付規定

請見備註欄

1541

CFD0630652CU "蔻沛"可福樂經皮內視鏡胃造口組"CORPAK"CORFLO-MAX

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE KIT(PEG管+外固定

器*2+穿刺針+導線+Y型連接器+管線夾)

4610

1003

特材代碼 中英文名稱 支付點數-104/01/01

CFD0632000CU "蔻沛"可福樂胃造口管組"CORPAK"CORFLO GASTROSTOMY TUBE

KIT(CORFLO-DUAL GT) 12~24FR

1541

CFD0633000CU "蔻沛"可福樂胃造口管組"CORPAK"CORFLO GASTROSTOMY TUBE

KIT(CORFLO-TRIPLE GT) 16~24FR

1541

CFD0635000CU "蔻沛"可福樂低板胃造口替換組套"CORPAK"CORFLO-CUBBY LOW

PROFILE GASTROSTOMY DEVICE KIT

4243

CFD0679010FL PEG KIT(全套,含所材料在內)經皮內視鏡胃造廔組(PEG

TUBE,ADAPTER,RING,INTRODUCER NEEDLE,WIRE,TUBING CLAMP)※

適應症請見備註欄

4610

CFD0679010VZ FREKA PEG-SET GASTRIC(全套,含所有材料在內)福胃可胃造口術

胃管套組(PEG TUBE,ADAPTER,RING,INTRODUCER NEEDLE,TUBING

CLAMP)※適應症請見備註欄

4610

CFD0679819VZ FREKA PEG-SET GASTRIC福胃可胃造口術胃管套組:餵食管接頭※

適應症請見備註欄

204

CFD068000NCL GASTROSTOMY TUBE BALLOON FEEDING TUBE 胃造口術器材配件

/BALLOON型替換管※適應症請見備註欄

1541

CFD06BFA01CK PERCUTANEOUS ENDOSCOPIC GASTROSTOMY SYSTEM—ADAPTER 餵食

管接頭(TWO WAY OR ONE WAY)※適應症請見備註欄

204

CFD06BRT01CK "COOK"GASTROSTOMY DEVICES/ACCESSORIES BALLOON FEEDING

TUBE "曲克"胃造口術器材配件/BALLOON型替換管※適應症請見備

註欄

1541

CFD06FLW01CK PERCUTANEOUS ENDOSCOPIC GASTROSTOMY SYSTEM 經皮內視鏡胃造

口術系統(含FEEDING TUBE+鬱金香形頭+藍色導線+(A+N+D)※適應

症請見備註欄

4610

CFD06PASS1CK GASTROSTOMY DEVICES/ACCESSORIES LOW PROFILE FEEDING TUBE

胃造口術器材配件/低板胃造口術替換套組(鈕釦型替換管)※適應

症請見備註欄

4243

CFD06PCK01CK GASTROSTOMY DEVICES/ACCESSORIES PATIENT CARE KIT 護理套

組※適應症請見備註欄

1506

CFD06PEG01CK PERCUTANEOUS ENDOSCOPIC GASTROSTOMY SYSTEM 胃造口術裝置組

(含FEEDING TUBE+鬱金香形頭+藍色導線+(ADAPTER+

NEEDLE+DILATOR)※適應症請見備註欄

4610

CFD06PEGJ1CK "COOK"GASTROSTOMY DEVICES/ACCESSORIES JEJUNAL FEEDING

TUBE "曲克"胃造口術器材配件/空腸餵食管※適應症請見備註欄

3277

CFD07WGS01CK "COOK"WILLS-OGLESBY PERCUTANEOUS GASTROSTOMY CATHETER(餵

食管、矯直器通管針、接合器、連接管蓋)"曲克"威爾歐葛拜經皮

胃造廔導管

2472

CKDD112122AR LARGE-BORE MULTILUMEN HEMODIALYSIS CATHETER 1388

CKDD1135132C "COVIDIEN"KENDALL ACUTE HEMODIALYSIS CATHETERS(DUAL

LUMEN) KIT(C+N+G+D)"柯惠"肯特利急性血液透析導管

1388

CKDD115122AR ARROW-HOWES LARGE-BORE MULTI-LUMEN HEMODIALYSIS CATHETER

雙腔輸液導管組

724

CKDD1170052C "柯惠"肯特利急性血液透析導管"COVIDIEN"KENDALL ACUTE

HEMODIALYSIS CATHETERS-MAHURKAR KIT(C+N+G+D)

1388

CKDD1170092C "柯惠"肯特利急性血液透析導管"COVIDIEN"KENDALL ACUTE

HEMODIALYSIS CATHETERS-MAHURKAR KIT,CURVED EXT.(C+N+G+D)

1388

CKDD122122AR "ARROW"ARROWGARD CATHETERS

SETS(CATH+NEEDLE+GUIDEWIRE+DILATOR+SHEATH) 2 LUMEN "亞諾"

抗感染安全尖端導管

1388

CKDD122334BQ "BIOTEQ"HEMODIALYSIS CATHETER KIT(2 LUMEN

CATHETER+NEEDLE+GUIDE WIRE+DILATOR)血液透析導管組

1388

1004

特材代碼 中英文名稱 支付點數-104/01/01

CKDD123122AR "ARROW"ARROWGARD CATHETERS

SETS(CATH+NEEDLE+GUIDEWIRE+DILATOR+SHEATH)2LUMEN"亞諾"抗

感染安全尖端導管

1388

CKDD124334BQ "BIOTEQ"2 LUMEN HEMODIALYSIS CATHETER KIT(C+N+G+D)血液透

析導管組

1388

CKDD1390032C "柯惠"肯特利急性血液透析導管"COVIDIEN"KENDALL ACUTE

HEMODIALYSIS CATHETERS-MAHURKAR DUAL LUMEN KIT(C+N+G+D)

1388

CKDD154334BQ "BIOTEQ"HEMODIALYSIS CATHETER KIT"邦特"血液透析導管組(雙

腔)

724

CKDD15553NBA DUAL-LUMEN NIAGARA SLIM CATH DIALYSIS CATH KIT(C+N+G+D) 1388

CKDD15554NBA DUAL-LUMEN NIAGARA SLIM CATH DIALYSIS CATH KIT(C+N+G+D) 1388

CKDD1881CK2C "柯惠"肯特利急性血液透析導管"COVIDIEN"KENDALL ACUTE

HEMODIALYSIS CATHETERS-MAHURKAR KIT,CURVED EXT.(C+N+G+D)

1388

CKDD1881SK2C "柯惠"肯特利急性血液透析導管"COVIDIEN"KENDALL ACUTE

HEMODIALYSIS CATHETERS-MAHURKAR KIT(C+N+G+D)

1388

CKDD1883CK2C "柯惠"肯特利急性血液透析導管"COVIDIEN"KENDALL ACUTE

HEMODIALYSIS CATHETERS-MAHURKAR KIT,CURVED EXT.(C+N+G+D)

1388

CKDD1883SK2C "柯惠"肯特利急性血液透析導管"COVIDIEN"KENDALL ACUTE

HEMODIALYSIS CATHETERS-MAHURKAR KIT(C+N+G+D)

1388

CKDD1K3500VC DIALYSIS CATHETERS KIT(CATH+DILATOR+GUIDE

WIRE+NEEDLE)12.5CM:24CM(自950401起型號更改為

5678125.5678150.5678240.文號0940040227

1388

CKDD1K4065VC 雙頭管路DIALYSIS CATHTER KIT(C+N+G+D)(自950401起型號更改

為5576100.5576125.5576150.文號0940040227)

1388

CKDD2140012C "柯惠"肯特利急性血液透析導管"COVIDIEN"KENDALL ACUTE

HEMODIALYSIS CATHETERS-MAHURKAR CATHETER

724

CKDD2140022C "柯惠"肯特利急性血液透析導管"COVIDIEN"KENDALL ACUTE

HEMODIALYSIS CATHETERS-MAHURKAR CATHETER,CURVED EXT.

724

CKDD2420052C "柯惠"肯特利急性血液透析導管"COVIDIEN"KENDALL ACUTE

HEMODIALYSIS CATHETERS-MAHURKAR CATHETER

724

CKDD2450072C "柯惠"肯特利急性血液透析導管"COVIDIEN"KENDALL ACUTE

HEMODIALYSIS CATHETERS-MAHURKAR CATHETER,CURVED EXT.

724

CKDD260049BA HICKMAN HEMODIALYSIS CATHETER永植型 2603

CKDD2D3500BA DOUBLE LUMEN SUBCLAVIAN CANNULA 12.5CM(C+N+G+D)(自950401

起型號更改為5577165文號0940040227

1388

CKDD2D4000BA DOUBLE LUMEN SUBCLAVIAN CANNULA 15CM(C+N+G+D)((自950401起

型號更改為5577170文號0940040227)

1388

CKDD2D4400BA DOUBLE LUMEN SUBCLAVIAN CANNULA 20CM(C+N+G+D)((自950401起

型號更改為5577175文號0940040227)

1388

CKDD2J0KADJ0 DOUBLE LUMEN CATHETERS 724

CKDD2K4400BA DOUBLE LUMEN SUBCLAVIAN CANNULA 20(C+N+G+D)(CM(自950401起

型號更改為5678200文號0940040227)

1388

CKDD2L4424VC 雙頭管路 DIALYSIS CATHETER(自950401起型號更改為5577180文

號0940040227)

724

CKN0175030PB DRAINAGE SET AND ACCESSORIES導管(HYDROFEEL)+N+G+D+固定貼

2580

CKP010T2022C "COVIDIEN"KENDALL PERITONEAL DIALYSIS CATHETERS(TENCKHOFF

CATH T202)"柯惠"肯特利腹膜液透析導管

1488

CKP0119671FA PD CATHETER 1488

CKP018812N2C "COVIDIEN"KENDALL PERITONEAL DIALYSIS CATHETER"柯惠"肯特

利腹膜液透析導管系列

1488

1005

特材代碼 中英文名稱 支付點數-104/01/01

CKP018814N2C "COVIDIEN"KENDALL PERITONEAL DIALYSIS CATHETER"柯惠"肯特

利腹膜液透析導管系列

1488

CKP018817N2C "COVIDIEN"KENDALL PERITONEAL DIALYSIS CATHETER"柯惠"肯特

利腹膜液透析導管系列

1488

CKP018880N2C "COVIDIEN"KENDALL PERITONEAL DIALYSIS CATHETER"柯惠"肯特

利腹膜液透析導管系列

1488

CKP018884N2C "COVIDIEN"KENDALL PERITONEAL DIALYSIS CATHETERS(TENCKHOFF

PEDIATRIC)"柯惠"肯特利腹膜液透析導管

1488

CKP018888N2C "COVIDIEN"KENDALL PERITONEAL DIALYSIS CATHETERS(TENCKHOFF

CATH)"柯惠"肯特利腹膜液透析導管

1488

CKP018890N2C "COVIDIEN"KENDALL PERITONEAL DIALYSIS CATHETER"柯惠"肯特

利腹膜液透析導管系列

1488

CKP04C4479BT HOMECHOICE AUTOMATED PD SET全自動腹膜透析導管組 224

CKP04C8303BT "Baxter"HOMECHOICE PEDIATRIC /LOW RECIRCULATION VOLUME

APD SET WITH CASSETTE小兒全自動腹膜透析導管組

224

CLPA1P1CC1VY "VYGON" PERIPHERALLY INSERTED CENTRAL VENOUS

CATHETERS(P.I.C.C.)-PREMICATH "斐貢"周邊導入中央靜脈導管-

超低體重新生兒導管組※適應症請見備註欄

3316

CLPA1P1CC2VY "VYGON" PERIPHERALLY INSERTED CENTRAL VENOUS

CATHETERS(P.I.C.C.)-PREMICATH WITH STYLET"斐貢"周邊導入中

央靜脈導管-超低體重新生兒導管組附通條

4485

CLPA1P1CC3VY "VYGON" PERIPHERALLY INSERTED CENTRAL VENOUS

CATHETERS(P.I.C.C.)-EPICUTANEO-CAVA-CATHETER "斐貢"周邊導

入中央靜脈導管-經皮腔靜脈導管組※適應症請見

3316

CLPA1P1CC4VY "VYGON" PERIPHERALLY INSERTED CENTRAL VENOUS

CATHETERS(P.I.C.C.)- EPICUTANEO 2 "斐貢"周邊導入中央靜脈

導管-二代經皮腔靜脈導管組

4485

CLPA1P1CC5VY "VYGON" PERIPHERALLY INSERTED CENTRAL VENOUS

CATHETERS(P.I.C.C.)-NUTRILINE "斐貢"周邊導入中央靜脈導管-

新生兒導管組

3316

CLPA1P1CC6VY "VYGON" PERIPHERALLY INSERTED CENTRAL VENOUS

CATHETERS(P.I.C.C.)- NUTRILINE TWINFLO "斐貢"周邊導入中央

靜脈導管-新生兒雙腔導管組

4715

CLPA202701WY ACCUFUSER DISPOSABLE SILICONE BALLOON INFUSER-CONTI

TYPE(275ML-10ML;550ML-20ML;250ML-10ML/HR)輸液器-連續(1日

型))(雙層含外殼)*適應症請見備註

920

CLPA202702WY ACCUFUSER DISPOSABLE SILICONE BALLOON INFUSER-CONTI

TYPE(275ML-5.0ML;550ML-10.0ML;250ML-5.0ML/HR)輸液器-連續

(2日型)(雙層含外殼)*適應症見備註

920

CLPA205275SG "SIGMA"BALLOON PUMP INFUSION SET(275ML-5ML/HR)"十美牌"球

泵型微量輸液器(2日型)(雙層含外殼)*適應症請見備註欄

920

CLPA21009KBT 2日型 INFUSOR 輸液器(雙層含外殼)※適應症請見備註欄 920

CLPA210275SG "SIGMA"BALLOON PUMP INFUSION SET(275ML-10ML/HR)"十美牌"球

泵型微量輸液器(1日型)(雙層含外殼)*適應症請見備註欄

920

CLPA21063KBT 1日型 INFUSOR 輸液器(雙層含外殼)※適應症請見備註欄 920

CLS0405759BB DOSIFIX W/SAFESITE NEEDLE-FREE SYSTEM W/VALVE 120ML(自

92.03.01更改功能類別)*適應症請見備註欄

63.4

CLS04A260NPW "普惠"輸液套-計量點滴器附活塞免針安全型"PERFECT"

DISPOSABLE INFUSION SET- INFUSIOSON SET W/BURETTE W/VALVE

W/SAFESITE NEEDLE-FREE SYSTEM

63.4

CLS04C1BSSLL "怡安"精密輸液套-免針式安全型"LILY"VOLUME METRIC

ADMINISTRATION SET WITH VALVE-NEEDLE FREE

63.4

1006

特材代碼 中英文名稱 支付點數-104/01/01

CLS04E010NPW INFUSION SET W/BURETTE W/VALVE W/SAFESITE NEEDLE-FREE

SYSTEM*適應症請見備註欄

63.4

CLS04NB150SG SIGMA VOLUME METERIC ADMINISTRATION SET*適應症請見備註欄 63.4

CLS04NS120SG VOLUME METERIC ADMINISTRATION SET W/FREE SITE *適應症請見

備註欄

63.4

CLS04SBASSLL VOLUME METERIC ADMINISTRATIONN SET (安全型免針加

藥)W/VALVE*適應症請見備註欄

63.4

CLS1400740BX "BAXA"EXACTA-MIX EVA CONTAINER 2000ML"柏瑟"靜脈營養術灌注

149

CLS1400741BX "BAXA"EXACTA-MIX EVA CONTAINER 3000ML"柏瑟"靜脈營養術灌注

149

CLS1402000BB NUTRIENT MIXING BAG-NUTRIMIX 149

CLS1403000BB TPN BAG 3000CC 149

CLS14B8082CT VIAFLEX TPN BAG 250C.C. 93.2

CLS14B8083CT VIAFLEX TPN BAG 500C.C. 93.2

CLS14B8122CT ALL-IN-ONE BAG 2000C.C. 149

CLS14B8132CT ALL-IN-ONE BAG 3000C.C. 149

CRE03U00502C "柯惠"麥林可加強型氣管內管"COVIDIEN" MALLINCKRODT SAFETY-

FLEX REINFORCED TRACHEAL TUBE

300

CXE01EPF13JV “日本來富恩”菲克斯固定彎電極導管“JAPAN LIFELINE”

EPSTAR FIX ELECTROPHYSIOLOGY CATHETER

16180

CXE05BLZ01SB “波士頓科技”布雷瑟開放式灌注除顫導管“BOSTON SCIENTIFIC

”BLAZER OPEN-IRRIGATED ABLATION CATHETER

74100

CXE05D17LRWE 藍星攝氏灌注冷卻式溫控電生理導管BIOSENSE WEBSTER NAVI-

STAR/CELCIUS THERMOCOOL DIAGNOSTIC/ABLATION DEFLECTABLE

TIP CATHETER適應症見備註欄

74100

CXE05NN75TWE 藍星攝氏灌注冷卻式溫控電生理導管BIOSENSE WEBSTER NAVI-

STAR/CELCIUS THERMOCOOL DIAGNOSTIC/ABLATION DEFLECTABLE

TIP CATHETER適應症見備註欄

74100

CXE05SAFBDST "聖猷達" 薩爾普雙向電燒導管"SJM" SAFIRE BLU BI-

DIRECTIONAL ABLATION CATHETERS*適應症請見備註欄

74100

CXE05TCPACYB "爾灣" 瑟爾皮庫爾帕斯心臟電燒導管"IBI" THERAPY COOL PATH

ABLATION CATHETER*適應症請見備註欄

74100

CXE05TCPBDST 聖猷達瑟爾皮庫爾帕斯雙向心臟電燒導管 SJM THERAPY COOL

PATH BI-DIRECTIONAL ABLATION CATHETERS*適應症請見備註欄

74100

FBA0110001H1 BONE CEMENT40GM 839

FBA011101NZ1 OSTEOBOND COPOLYMER BONE CEMENT 40G/20ML 839

FBA011102NZ1 DOUGH TYPE BONE CEMENT 40GM 839

FBA011112NZ1 L.V.C BONE CEMENT 1285

FBA011200A2Z "泰瑞斯"低黏性骨水泥CEMEX RX 40GM 839

FBA0131050CM CRANIOPLASTY BONE CEMENT (2PKG/BOX)頭顱整形術專用 3622

FBA0131280DP CRANIOPLASTIC (POWDER 30G+LIQUID 16.17G/20分鐘)頭顱整形泥 7181

FBA0133CMWDP CMW BONE CEMENT 40GM(粉末+液體) 839

FBA100900NH1 HIP STEM PLUG 8:14MM 1019

FBA101905NU0 U2 HIP STEM PLUG 7:16 1019

FBA102002NW2 CEMENT CENTRALIZER 9:21MM 1019

FBA142300NH1 DALL-MILES STAINLESS CABLE ※適應症請見備註欄 1230

FBA142301NH1 DALL-MILES STAINLESS CABLE GRIP ※適應症請見備註欄 4528

FBA142305NH1 DALL-MILES STAINLESS CABLE SLEEVE(纜線套) ※適應症請見備

註欄

1707

FBA1428100S1 WIRE MOUNT骨板固定鈕※適應症請見備註欄 1707

1007

特材代碼 中英文名稱 支付點數-104/01/01

FBEF500001RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-PIN HOLDER CLAMP

瑞寶億骨外固定系統-針夾 ※適應症請見備註欄

627

FBEF500018D1 CONNECTING ROD 97.9

FBEF50001ND1 UNIVERSAL BALL JOINT 688

FBEF50001NRK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-ARTICULATION

COUPLING 瑞寶億骨外固定系統-結合器 ※適應症請見備註欄

274

FBEF50001NZ6 5HOLE UNIVERSAL BALL JOINT(美瑞世五洞外固定器) 688

FBEF50001XD1 EXTERNAL FIXATOR SYSTEM:PIN HOLDER CLAMP(WITH ONE:TWO

DIA.8MM ROD , WITH ONE:TWO DIA.5MM ROD)針夾

627

FBEF50008ND1 EXTERNAL FIXATOR SYSTEM:ARTICULATION

COUPLING(DIA.5:8MM*DIA.3:8MM)結合器

274

FBEF50013ND1 ARTICULING COUPING 274

FBEF50014NZ6 ARTICULATION COUPLING 8X3,8X4,8X5MM(美瑞世多向外固定

器)(990701規格8*3更正為8*8MM)

274

FBEF50018ND1 EXTERNAL FIXATOR SYSTEM:CONNECTING ROD連結桿 97.9

FBEF50018NRK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-CONNECTING ROD 瑞

寶億骨外固定系統-連結桿 ※適應症請見備註欄

97.9

FBEF50018NZ6 CONNECTING ROD 200,250,300MM(美瑞世骨外連接管) 97.9

FBEF50020NZ6 COLLES FRAME SET(美瑞世一支連接桿+二支多向球)※限橈骨和尺

骨雙骨折使用

3829

FBEF500S2ND1 EXTERNAL FIXATOR SYSTEM:COLLES-FOREARM FRAME 手腕組

(L170MM)

3829

FBEF55150NZ6 STAINLESS HALP PIN 5MM 796

FBEF5S0001RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-COLLES FOREARM

FRAME 瑞寶億骨外固定系統-手腕組 ※限橈骨和尺骨雙骨折使用

3829

FBEF5U5LEND1 EXTERNAL FIXATOR SYSTEM:DISTRACTION&COMPRESSION ROD伸縮

桿(250+50MM)

2643

FBEF5U5LENRK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-

DISTRACTION&COMPRESSION ROD 瑞寶億骨外固定系統-伸縮桿 ※

適應症請見備註欄

2643

FBEFP02101SN ILIZAROV WIRE 1.5MM ※適應症請見備註欄 466

FBEFP02102SN ILIZAROV WIRE 1.8MM※適應症請見備註欄 466

FBEFP0666ND1 EXTERNAL FIXATION SYSTEM:WIRE 1.5MM 2.0MM 300:400MM ※適

應症請見備註欄

466

FBEFP0M30NRT EXTERNAL FIXATOR CORTICAL SCREW 1423

FBEFP1010NRT EXTERNAL FIXATOR CORTICAL SCREW 1423

FBEFP1012NRT CANCELLOUS SCREW(10.130:4,10.180:4自90/04/01起刪除) 1423

FBEFP2482NSN SKELETAL TRACTION HALF PIN 3MM (COVE POINT PIN) 519

FBEFP24831SN HALF PIN 4MM 519

FBEFP2483NSN SKELETAL TRACTION HALF PIN 5MM (COVE POINT PIN) 796

FBEFP248XNSN SKELETAL TRACTION FULL PIN ALL SIZE (COVE POINT PIN) 1114

FBEFP294NNS1 SCHANZ SCREW (FOR EXTERNAL FIXATION ) 410

FBEFP29771S1 "MATHYS" SCHANZ SCREW (SELDRILL) 4.0/3.0MM 837

FBEFP29774S1 "MATHYS" SCHANZ SCREW(SELDRILL) DIA 3.5-4.0MM 837

FBEFP29782S1 "MATHYS" SCHANZ SCREW(SELDRILL) DIA 4.4- 5.0MM 1023

FBEFP29792S1 SELDRILL 6.0MM 1050

FBEFP297XNY2 SCHANZ SCREW(型號294400,294520:70,294620:40)(90/04/01起型

號294300刪除,新增294960)

410

FBEFP3059NZ6 STAINLESS FULL PIN 4-5MM(兩截全針) 1114

FBEFP3070NZ6 TITANIUM HALF PIN 2.5-3MM,3-4MM(兩截半針) 1337

FBEFP3090NZ6 STAINLESS HALF PIN 4-5MM,5-6MM(兩截半針) 1023

FBEFP3109NZ6 TITANIUM HALF PIN 3MM 541

FBEFP4031NZ6 TITANIUM HALF PIN 4MM 612

1008

特材代碼 中英文名稱 支付點數-104/01/01

FBEFPA4001RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-HALF PIN DIA.3MM

瑞寶億骨外固定系統-半骨針 ※適應症請見備註欄

519

FBEFPA5002RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-HALF PIN DIA.4MM

瑞寶億骨外固定系統-半骨針 ※適應症請見備註欄

519

FBEFPA6005RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-HALF PIN DIA.4-

5MM 瑞寶億骨外固定系統-半骨針(雙直徑) ※適應症請見備註欄

1023

FBEFPA9003RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-HALF PIN DIA.5MM

瑞寶億骨外固定系統-半骨針 ※適應症請見備註欄

796

FBEFPAB004RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-HALF PIN DIA.2-

3MM;3-4MM 瑞寶億骨外固定系統-半骨針(雙直徑) ※適應症請見

備註欄

837

FBEFPAC006RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-FULL PIN DIA.4-

5MM 瑞寶億骨外固定系統-全骨針 ※適應症請見備註欄

1114

FBEFPFUP1ND1 EXTERNAL FIXATOR SYSTEM:FULL PIN 全針(DIA

3:6MM*L200:300MM)

1114

FBEFPHAP1ND1 EXTERNAL FIXATOR SYSTEM:HALF PIN 半針(DIA.2:3MM*L45:90MM) 444

FBEFPKX36NAE SCHANZ SCREW 410

FBEFPLX34NAE "SCHANZ" SCREW SCHRAUBEN HALF PIN 796

FBEFPLX74NAE SMALL EF SCHANZE SCREW AND PIN 943

FBEFPP1N56D1 EXTERNAL FIXATOR SYSTEM: HALF PIN 半針(DIA.5-

6MM*L150:180MM)

643

FBEFPPN040D1 EXTERNAL FIXATOR SYSTEM: HALF PIN 半針

(DIA.4MM*L150:180MM)

519

FBEFPPN234D1 EXTERNAL FIXATOR SYSTEM:HALF PIN 半針(DIA2:4MM*L70:150MM) 837

FBEFPPN456D1 EXTERNAL FIXATOR SYSTEM:HALF PIN 半針

(DIA.4:6MM*L150:180MM)

1023

FBEFPW0001RK REBORN ESSENCE EXTERNAL FIXATION SYSTEM-WIRE 瑞寶億骨外固

定系統-針 *適應症見備註欄

466

FBEH15000NS2 TOTAL ELBOW SYSTEM※適應症請見備註欄 60206

FBEH15005NS2 TOTAL ELBOW:HUMERAL COMPONENT※適應症請見備註欄 35692

FBEH18006NZ1 TOTAL ELBOW SYSTEM(HUMERAL+ULNAR) ※適應症請見備註欄 60206

FBEH181051Z1 COONRAD/MORREY HUMERAL COMPONENT(型號32-8105-025-04:036-

08自90/07/01生效)※適應症請見備註欄

35692

FBEH18105NZ1 "ZIMMER"COONRAD/MORREY TOTAL ELBOW SYSTEM(HUMERAL+ULNAR)"

捷邁"人工肘關節組 ※適應症請見備註欄

60206

FBEU15005NS2 TOTAL ELBOW:ULNA COMPONENT※適應症請見備註欄 24514

FBEU181052Z1 COONRAD/MORREY ULNAR COMPONENT(型號32-8105-053-01:093-02

自90/07/01生效)※適應症請見備註欄

24514

FBEU181053Z1 "ZIMMER"COONRAD/MORREY TOTAL ELBOW SYSTEM:ULNAR"捷邁"人工

肘關節組:尺骨件 ※適應症請見備註欄

24514

FBFJ11234NDP NEUFLEX FINGER IMPLANTS(SILICON) 3619

FBFJ1G470NW2 SWANSON FINGER JOINT(含鈦合金指套) 14144

FBHB1103XNDP CUP ※適應症請見備註欄 10334

FBHB11503NU0 "UNITED"HIP SYSTEM-U2 BIPOLAR IMPLANT:CUP+LINER "聯合"雙

極半髖人工髖關節:髖臼杯+內襯※適應症請見備註欄

10334

FBHB11700NW2 BIPOLAR CUP※適應症請見備註欄 7080

FBHB13110NW2 BIOPOLAR CUP&CUP INSERT※適應症請見備註欄 10334

FBHB1501XNU0 UNITED BIPOLAR CUP 聯髖半髖外帽 ※適應症請見備註欄 7080

FBHB15984NZ1 BIPOLAR CUP※適應症請見備註欄 10334

FBHB1NK04NAE BICONTACT BIPOLAR CUP※適應症請見備註欄 10334

1009

特材代碼 中英文名稱 支付點數-104/01/01

FBHB1UH10NS2 "HOWMEDICA-OSTEONICS" OMNIFIT HIP SYSTEM:CUP"好美得卡-奧

斯得寧"人工髖關節系統:髖臼杯※適應症請見備註欄

10334

FBHB21700NW2 BIPOLAR INSERT※適應症請見備註欄 3071

FBHB2601XNU0 UNITED BIPOLAR CUP LINER 聯髖半髖內襯 ※適應症請見備註欄 3071

FBHBA1000NAE BICONTACT BIPOLAR HIP SYSTEM ※適應症請見備註欄 35195

FBHBA1000NDP "DEPUY"BIPOLAR HIP SYSTEM"帝富"雙極式人工髖關節組※適應症

請見備註欄

35195

FBHBA1000NU0 UNITED BIPOLAR SYSTEM※適應症請見備註欄 35195

FBHBA1000NW2 BIOPOLAR HIP SYSTEM※適應症請見備註欄 35195

FBHBA1000TZ1 BIPOLAR HIP SYSTEM ※適應症請見備註欄 35195

FBHBA1100NDP "DEPUY"CORAIL BIPOLAR HIP SYSTEM"帝富:可瑞雙極式人工髖關

節組 ※適應症請見備註欄

35195

FBHBA2000NS2 "HOWMEDICA-OSTEONICS" OMNIFIT HIP SYSTEM:HA BIPOLAR

SYSTEM"好美得卡-奧斯得寧"人工雙極式髖關節系統 ※適應症請

見備註欄

35195

FBHBA2000NU0 UNITED U2 BIPOLAR SYSTEM※適應症請見備註欄 35195

FBHBA3000NU0 "UNITED"HIP SYSTEM-U2 BIPOLAR IMPLANT "聯合"雙極半髖人工

髖關節※適應症請見備註欄

35195

FBHBA3000TZ1 VERSYS BIPOLAR SYSTEM※適應症請見備註欄 35195

FBHBA5000NS2 "HOWMEDICA-OSTEONICS" OMNIFIT HIP SYSTEM:BIPOLAR SYSTEM"

好美得卡-奧斯得寧"人工雙極式髖關節系統※適應症請見備註欄

35195

FBHBA5500NS2 ACCOLADE BIPOLAR HIP SYSTEM(STEM+CUP+HEAD)※適應症請見備

註欄

35195

FBHBA6000NZ1 CLS BIOPOLAR SYSTEM(STEM+HEAD+CUP)※適應症請見備註欄 35195

FBHBA8000TZ1 BIPOLAR HIP SYSTEM(CUP+HEAD+STEM)※適應症請見備註欄 35195

FBHBAKTV1TZ1 "ZIMMER"KINECTIV M/L TAPER BIPOLAR HIP PROSTHESIS SYSTEM"

西美"組合式股骨柄可旋式雙極式全人工股骨修補系統※適應症請

見備註欄

45118

FBHBAPRFMRW2 "WRIGHT" BIPOLAR HIP SYSTEM(搭配組合式股骨柄) "瑞德"雙極

式人工髖關節系統※適應症請見備註欄

45118

FBHBAUTF1NU0 "聯合"雙極式人工髖關節系統(楔形骨柄)"UNITED”HIP BIPOLAR

SYSTEM(UTF STEM)

35195

FBHBCCERA1AE CERAMIC BIPOLAR HIP SYSTEM※符合傳統雙極式髖關節組適應症

者,如自願選用陶瓷雙極式人工髖關節組,則按傳統雙極式髖關

節組給付,超過部分由病患自付

35195

FBHBCCERA1DP CERAMIC BIPOLAR HIP SYSTEM※符合傳統雙極式髖關節組適應症

者,如自願選用陶瓷雙極式人工髖關節組,則按傳統雙極式髖關

節組給付,超過部分由病患自付

35195

FBHBCCERA1S2 CERAMIC BIPOLAR HIP SYSTEM※符合傳統雙極式髖關節組適應症

者,如自願選用陶瓷雙極式人工髖關節組,則按傳統雙極式髖關

節組給付,超過部分由病患自付

35195

FBHBCCERA1U0 CERAMIC BIPOLAR SYSTEM※符合傳統雙極式髖關節組適應症者,

如自願選用陶瓷雙極式人工髖關節組,則按傳統雙極式髖關節組

給付,超過部分由病患自付

35195

FBHBCCERA1W2 CERAMIC BIPOLAR HIP SYSTEM※符合傳統雙極式髖關節組適應症

者,如自願選用陶瓷雙極式人工髖關節組,則按傳統雙極式髖關

節組給付,超過部分由病患自付

35195

FBHBCCERA1Z1 BIPOLAR CERAMIC SYSTEM※符合傳統雙極式髖關節組適應症者,

如自願選用陶瓷雙極式人工髖關節組,則按傳統雙極式髖關節組

給付,超過部分由病患自付。

35195

1010

特材代碼 中英文名稱 支付點數-104/01/01

FBHBCCERA2AE CERAMIC BIPOLAR HIP SYSTEM※符合傳統雙極式髖關節組適應症

者,如自願選用陶瓷雙極式人工髖關節組,則按傳統雙極式髖關

節組給付,超過部分由病患自付

35195

FBHBCCERA2S2 "STRYKER"CERAMIC BIPOLAR SYSTEM※符合傳統雙極式髖關節適應

症,自願選用陶瓷HEAD,則按傳統雙極式髖關節組給付,超過部

分由病患自付

35195

FBHBCCERA2Z1 "ZIMMER"KINECTIV M/L TAPER CERAMIC BIPOLAR HIP PROSTHESIS

SYSTEM"西美"組合式股骨柄可旋式雙極式陶瓷人工股骨系統(部分

給付)

45118

FBHBCCERA3Z1 "ZIMMER"BIPOLAR BIOLOX DELTA HIP SYSTEM(CERAMIC)※符合傳

統雙極式適應症者,如自願選用陶瓷雙極式,按傳統髖關節組給

付,超過部分由病患自付

35195

FBHBCCERA4Z1 "ZIMMER"M/L TAPER BIPOLAR HIP PROSTHESIS W/KINECTIV

TECHNOLOGY"捷邁"康內特人工髖關節(雙極式陶瓷組合式股骨柄,

部分給付)※適應症請見備註欄

45118

FBHBCCERA5U0 "UNITED"CERAMIC BIPOLAR SYSTEM※符合傳統雙極式髖關節組適

應症者,如自願選用陶瓷雙極式人工髖關節組,則按健保局給付

,超過部分由病患自付

35195

FBHBCCERAZW2 "WRIGHT" CERAMIC BIPOLAR HIP SYSTEM(搭配組合式股骨柄) "瑞

德"陶瓷雙極式人工髖關節系統(部分給付項目,超過部分由病患自

付)※適應症請見備註欄

45118

FBHBCCERR5Z1 “捷邁”百優陶瓷半人工髖關節組“ZIMMER” BIOLOX OPTION

BIPOLAR HIP SYSTEM

35195

FBHBCUTF1TU0 "聯合"DELTA陶瓷球頭雙極式人工髖關節系統(楔形骨柄)(自付差

額品項)"UNITED”BIPOLAR SYSTEM (UTF STEM)-DELTA CERAMIC

HEAD

35195

FBHC11246NDP AML CUP+AML INSERT ※適應症請見備註欄 10334

FBHC1124XNDP AML CUP(型號96-23-23:80,24-09:10,50,51,53-22-040:153自

92/4/1生效)※適應症請見備註欄

10334

FBHC11455NDP DURALOC HIP IMPLANT:ACETABULAR CUP※適應症請見備註欄 10334

FBHC12540NS2 "HOWMEDICA-OSTEONICS" OMNIFIT HIP SYSTEM: HA ACETABULUM

CUP "好美得卡-奧斯得寧"人工髖關節系統:髖臼杯※適應症請見

備註欄

10334

FBHC12541NS2 "HOWMEDICA-OSTEONICS" SECUR-FIT HA HIP SYSTEM:HA SELL "好

美得卡-奧斯得寧"髖關節系統:髖臼杯(原健保碼為FBHC12540NS2)

※適應症請見備註欄

10334

FBHC1301XNU0 UNITED ACETABULAR CUP(型號1303-5044:5062自92/4/1生效) ※

適應症請見備註欄

10334

FBHC1302XNU0 TOTAL HIP CUP+LINER※適應症請見備註欄 10334

FBHC1303XNU0 TITANIUM U2 ACETABULAR CUP※適應症請見備註欄 10334

FBHC1306XNU0 "聯合"優磨二代全髖臼植入物:全髖臼外帽"UNITED”HIP

SYSTEM:U-MOTION II CUP

10334

FBHC13671NW2 HIP CUP (1808,3000,398-XXXX自88/10/1生效,3631,41,51-

39:57-0040:80自93/1/1生效)※適應症請見備註欄

10334

FBHC14262NZ1 ALLOFIT CUP SYSTEM※適應症請見備註欄 10334

FBHC15000NZ1 MULTIPOLAR BIPOLAR CUP 雙極式人工半髖臼杯 (型號5001自

92/1/1生效)※適應症請見備註欄

10334

FBHC154NXNS2 ACETABULUM CUP※適應症請見備欄 10334

FBHC16200NZ1 "捷邁"人工髖關節臼杯"ZIMMER"TRILOGY ACETABULAR

CUP(40:80MM)

10334

FBHC18005NZ1 ZCA ALL-POLY ACETABULAR CUP+INSERT ※適應症請見備註欄 14352

FBHC18753NZ1 "ZIMMER" TRILOGY IT ACETABULAR SYSTEM:SHELL"捷邁"崔勒艾提

髖臼杯系統 ※適應症請見備註欄

10334

1011

特材代碼 中英文名稱 支付點數-104/01/01

FBHC1DYNA2W2 "WRIGHT"DYNASTY ACETABULAR CUP SYSTEM:CUP"瑞德"戴內斯帝髖

臼杯系統※適應症請見備註欄

10334

FBHC1NA64NAE BICONTACT CUP 44:64MM(型號NH044T:068T自92/4/1生效) ※適應

症請見備註欄

10334

FBHC1NK810AE PE-ACETABULAR CUP+INSERT※適應症請見備註欄 10334

FBHC1P1CUPDP "DEPUY"PINNACLE HIP SYSTEM:CUP"帝富"必耐久人工髖臼系統:髖

臼杯※適應症請見備註欄

10334

FBHC1P1NNADP PINNACLE ACETABULAR CUP全人工髖關節髖臼杯 10334

FBHH101432DP "DEPUY"AML TOTAL HIP SYSTEM:FEMORAL HEAD"帝富"全人工髖關

節系統:股骨頭)※適應症請見備註欄

4352

FBHH1101XNDP AML FEMORAL HEAD(87/7/7 15190-51:60,136501:03,11:

15,21:25,29:30,43:48,9113112:13※適應症見備註

4352

FBHH11260NS2 "HOWMEDICA-OSTEONICS" OMNIFIT HIP SYSTEM: HA FEMORAL HEAD

"好美得卡-奧斯得寧"人工髖關節系統:股骨頭※適應症請見備註

4352

FBHH11261NS2 "HOWMEDICA-OSTEONICS" OMNIFIT HIP SYSTEM: HA FEMORAL HEAD

"好美得卡-奧斯得寧"人工髖關節系統:股骨頭(原健保碼為

FBHH11260NS2)※適應症請見備註欄

4352

FBHH11262NS2 "BG" EXETER TOTAL HIP SYSTEM: HA FEMORAL HEAD "必吉"愛克

斯特人工髖關節: 人工股骨頭(原健保碼為FBHH11260NS2)※適應

症請見備註欄

4352

FBHH11840NDP CORAIL FEMORAL HEAD ※適應症請見備註欄 4352

FBHH1201XNU0 UNITED FEMORAL HEAD (BIPOLAR) ※適應症請見備註欄 4352

FBHH13611NW2 FEMORAL HEAD※適應症請見備註欄 4352

FBHH14003NH1 P.C.A.FEMORAL HEAD ※適應症請見備註欄 4352

FBHH16260NH1 V40/PCA FEMORAL HEAD※適應症請見備註欄 4352

FBHH16260NS2 HA FEMORAL HEAD ※適應症請見備註欄 4352

FBHH18018NZ1 FEMORAL HEAD※適應症請見備註欄(00-8018-036-01:05自981001

刪除)

4352

FBHH1ARTHDDP "DEPUY"ARTICUL/EZE HEADS "帝富"股骨頭系統※適應症請見備註

4352

FBHH1NK33NAE FEMORAL HEAD※適應症請見備註欄 4352

FBHH1NK46NAE BICONTACT FEMORAL HEAD 28,32MM(NK330K:533K,NJ111K-134K自

92/4/1生效) ※適應症請見備註欄

4352

FBHHCCERA1AE CERAMIC HIP SYSTEM:HEAD※凡只更換股骨頭者,如自願選用陶瓷

股骨頭時,則按傳統股骨頭給付,超過部分由病患自付。

4352

FBHHCCERA1DP CERAMIC HIP SYSTEM:HEAD※凡只更換股骨頭者,如自願選用陶

瓷股骨頭時,則按傳統股骨頭給付,超過部分由病患自付。

4352

FBHHCCERA1S2 CERAMIC HIP SYSTEM:HEAD※凡只更換股骨頭者,如自願選用陶

瓷股骨頭時,則按傳統股骨頭給付,超過部分由病患自付。

4352

FBHHCCERA1U0 CERAMIC FEMORAL HEAD※凡只更換股骨頭者,如自願選用陶瓷股

骨頭時,則按傳統股骨頭給付,超過部分由病患自付。

4352

FBHHCCERA1W2 CERAMIC HIP SYSTEM:HEAD ※凡只更換股骨頭者,如自願選用陶

瓷股骨頭時,則按傳統股骨頭給付,超過部分由病患自付。

4352

FBHHCCERA1Z1 CERAMIC HIP SYSTEM:HEAD※凡只更換股骨頭者,如自願選用陶

瓷股骨頭時,則按傳統股骨頭給付,超過部分由病患自付。

4352

FBHHCCERA2AE CERAMIC HIP SYSTEM:HEAD※凡只更換股骨頭者,如自願選用陶瓷

股骨頭時,則按傳統股骨頭給付,超過部分由病患自付。

4352

FBHHCCERA2S2 "STRYKER"TRIDENT POLY ACETABULAR SYSTEM:CERAMIC HEAD※凡

只更換股骨頭者,如自願選用陶瓷股骨頭時,則按傳統股骨頭給

付,超過部分由病患自付。

4352

FBHHCCERA2W2 "WRIGHT"DYNASTY ACETABULAR CUP SYSTEM:CERAMIC HEAD 陶瓷股

骨頭※凡只更換股骨頭者,則按傳統股骨頭給付,超過部份由病

患自付。

4352

1012

特材代碼 中英文名稱 支付點數-104/01/01

FBHHCCERA2Z1 "ZIMMER"BIOLOX DELTA TAPER HEAD(CERAMIC)※符合傳統髖關節

股骨頭適應症者,如自願選用陶瓷股骨頭,按傳統髖關節組給付

,超過部分由病患自付

4352

FBHHCCERA3W2 "WRIGHT"DYNASTY ACETABULAR CUP SYSTEM:CERAMIC HEAD "瑞德"

戴內斯帝髖臼杯系統:陶瓷股骨頭(自付差額品項)。

4352

FBHHCCERA5U0 "UNITED"CERAMIC FEMORAL HEAD DELTA※凡只更換股骨頭者,如

自願選用陶瓷股骨頭時,則按健保局核價部份給付,超過部分由

病患自付。

4352

FBHHCCERR3Z1 “捷邁”百優陶瓷人工股骨頭(自付差額品項)“ZIMMER” BIOLOX

CERAMIC FEMORAL HEAD ─ BIOLOX OPTION HEAD

4352

FBHHMBFH01W2 "瑞德”康適服人工髖關節系統:金屬股骨頭※部分給付項目,超

過部分由病患自付"WRIGHT”CONSERVE HIP SYSTEM:METAL

FEMORAL HEAD

4352

FBHHMBFH02W2 "歐受曼"博飛達人工髖關節系統:金屬股骨頭※部分給付項目,超

過部分由病患自付"ORTHOMET”PERFECTA TOTAL HIP

SYSTEM:METAL FEMORAL HEAD

4352

FBHL11236NS2 "好美得卡奧斯得寧"雙動式人體結構型/組配型髖關節重建組件:

髖臼內墊(超高分子聚乙烯)"HOWMEDICA OSTEONICS"RESTORATION

ADM AND MDM HIP COMPONENT:INSERT

4018

FBHL11241NDP DURALOC HIP IMPLANT:ENDURON LINER※適應症請見備註欄 4018

FBHL11260NS2 HA HIP INSERT(型號2041C-26XX,28XX自91/01/01生效)※適應症

請見備註欄

4018

FBHL1241XNDP AML HIP INSERT(87/7/7新增產品型號1251-08:24,48:64) ※適應

症請見備註欄

4018

FBHL13820NW2 HIP CUP INSERT (3X15,5X00,5X15-XXXX自88/10/1生效,3641:47-

2200:4006自93/1/1生效)※適應症請見備註欄

4018

FBHL13830NW2 "WRIGHT"LINEAGE INTERSEAL HIP SYSTEM:A-CLASS ACETABLAR

LINER"瑞德"尼盈聚髖關節系統:髖白杯內櫬※適應症請見備註欄

4018

FBHL1401XNU0 UNITED ACETABULAR CUP LINER(型號1403-5044:5062自92/4/1生

效)※適應症請見備註欄

4018

FBHL1403XNU0 U2 ACETABULAR LINER※適應症請見備註欄 4018

FBHL1406XNU0 "聯合"優磨二代全髖臼植入物:高耐磨聚乙烯全髖臼內襯"UNITED

”HIP SYSTEM:U-MOTION II XPE LINER

4018

FBHL16200NS2 INSERT CUP※適應症請見備註欄 4018

FBHL16305NZ1 "捷邁"人工髖關節臼杯內襯"ZIMMER”LONGEVITY ACETABULAR CUP

LINER

4018

FBHL18751NZ1 “捷邁”隆傑艾提髖臼杯墊片※給付規定請見備註欄“ZIMMER”

LONGEVITY IT HIGHLY CROSSLINKED POLYETHYLENE LINERS

4018

FBHL1DYNA1W2 “瑞德”戴內斯帝髖臼杯系統:高耐磨襯墊※給付規定請見備註

欄"WRIGHT"DYNASTY ACETABULAR CUP SYSTEM:POLY LINER

4018

FBHL1NK17NAE BICONTACT INSERT 28,30MM(型號NA278:NA291自92/1/1生

效,NH171:476自92/4/1生效)※適應症請見備註欄

4018

FBHL1P1NPLDP "DEPUY"PINNACLE HIP SYSTEM:LINER "帝富"必耐久人工髖臼系

統:襯墊

4018

FBHL1PNNPEDP "DEPUY" PINNACLE ACETABULAR SYSTEM "帝富"可耐髖人工髖臼杯

系統(型號1218-22-138:146;26-144:146;1218:19-446自

102/08/01刪除)

4018

FBHLC406XNU0 "聯合"優磨二代全髖臼植入物:陶瓷全髖臼內襯(自付差額品

項)"UNITED”HIP SYSTEM:U-MOTION II DELTA CERAMIC LINER

4018

FBHLCCERA1AE CERAMIC TOTAL HIP SYSTEM:INSERT※凡只更換髖臼杯內襯者,如

自願選用陶瓷髖臼杯內襯時,則按傳統髖臼杯內襯給付,超過部

分由病患自付。

4018

1013

特材代碼 中英文名稱 支付點數-104/01/01

FBHLCCERA1S2 CERAMIC HIP SYSTEM:INSERT※凡只更換髖臼杯內襯者,如自願

選用陶瓷髖臼杯內襯時,則按傳統髖臼杯內襯給付,超過部分由

病患自付。

4018

FBHLCCERA1U0 CERAMIC FEMORAL INSERT※凡只更換髖臼杯內襯者,如自願選用

陶瓷髖臼杯內襯時,則按傳統髖臼杯內襯給付,超過部份由病患

自付

4018

FBHLCCERA1W2 CERAMIC HIP SYSTEM:INSERT ※凡只更換髖臼杯內襯者,如自願

選用陶瓷髖臼杯內襯時,則按傳統髖臼杯內襯給付,超過部分由

病患自付。

4018

FBHLCCERA1Z1 CERAMIC HIP SYSTEM:LINER※凡只更換髖臼杯內襯者,如自願選

用陶瓷髖臼杯內襯時,則按傳統髖臼杯內襯給付,超過部分由病

患自付。

4018

FBHLCCERA2Z1 "ZIMMER"BIOLOX DELTA TAPER LINER(CERAMIC)※符合傳統髖關節

髖臼內杯適應症者,如自願選用陶瓷髖臼內杯,按傳統髖關節組

給付,超過部分由病患自付

4018

FBHLMDYNA1W2 "瑞德"戴內斯帝髖臼杯系統:金屬髖臼內杯※部分給付項目,超過

部分由病患自付"WRIGHT"DYNASTY ACETABULAR CUP SYSTEM:METAL

LINER

4018

FBHMCBCER1AE CERAMIC BIPOLAR HIP SYSTEM※凡符合使用MOORE規定者,如自願

選用陶瓷雙極式人工髖關節組,則按MOORE人工髖關節給付,超過

部分由病患自付。

7733

FBHMCBCER1DP CERAMIC BIPOLAR HIP SYSTEM※凡符合使用MOORE規定者,如自願

選用陶瓷雙極式人工髖關節組,則按MOORE人工髖關節給付,超過

部分由病患自付。

7733

FBHMCBCER1S2 CERAMIC BIPOLAR HIP SYSTEM※凡符合使用MOORE規定者,如自願

選用陶瓷雙極式人工髖關節組,則按MOORE人工髖關節給付,超過

部分由病患自付。

7733

FBHMCBCER1U0 CERAMIC BIPOLAR SYSTEM ※凡符合使用MOORE規定者,如自願選

用陶瓷雙極式人工髖關節組,則按MOORE人工髖關節給付,超過部

分由病患自付。

7733

FBHMCBCER1W2 CERAMIC BIPOLAR HIP SYSTEM ※凡符合使用MOORE規定者,如自

願選用陶瓷雙極式人工髖關節組,則按MOORE人工髖關節給付,超

過部分由病患自付。

7733

FBHMCBCER1Z1 CERAMIC BIPOLAR HIP SYSTEM※凡符合使用MOORE規定者,如自願

選用陶瓷雙極式人工髖關節組,則按MOORE人工髖關節給付,超過

部分由病患自付。

7733

FBHMCBCER2AE CERAMIC BIPOLAR HIP SYSTEM※凡符合使用MOORE規定者,如自願

選用陶瓷雙極式人工髖關節組,則按MOORE人工髖關節給付,超過

部分由病患自付。

7733

FBHMCBCER2S2 "STRYKER"CERAMIC BIPOLAR HIP SYSTEM※符合使用MOORE規定者

,如使用雙極式人工髖關節組,部分給付品項)

7733

FBHMCBCER3Z1 "ZIMMER"BIPOLAR BIOLOX DELTA HIP SYSTEM(CERAMIC)※符合

MOORE規定者,如自願選用陶瓷雙極式,按傳統髖關節組給付,超

過部分由病患自付

7733

FBHMCBCER4Z1 “捷邁”百優陶瓷半人工髖關節組 (符合使用MOORE規定者)

“ZIMMER” BIOLOX OPTION BIPOLAR HIP SYSTEM

7733

FBHMCBCER5U0 "UNITED"CERAMIC BIPOLAR SYSTEM ※凡符合使用MOORE規定者,

如自願選用本陶瓷單極式人工髖關節組,則按健保局核價部份給

付,超過部分由病患自付。

7733

FBHMCPCEE4Z1 “捷邁”百優陶瓷全人工髖關節組(符合使用MOORE規定者)※

“ZIMMER” BIOLOX OPTION TOTAL HIP SYSTEM

7733

FBHMCPCEE5Z1 “捷邁”百優組合式陶瓷全人工髖關節組(符合使用MOORE規定者)

“ZIMMER” BIOLOX OPTION TOTAL HIP SYSTEM (KINECTIV)

7733

1014

特材代碼 中英文名稱 支付點數-104/01/01

FBHMCPCER1AE CERAMIC TOTAL HIP SYSTEM※凡符合使用MOORE規定者,如自願選

用陶瓷人工髖關節組,則按MOORE人工髖關節給付,超過部分由病

患自付。

7733

FBHMCPCER1DP CERAMIC TOTAL HIP SYSTEM※凡符合使用MOORE規定者,如自願選

用陶瓷人工髖關節組,則按MOORE人工髖關節給付,超過部分由病

患自付。

7733

FBHMCPCER1S2 CERAMIC HIP SYSTEM※凡符合使用MOORE者,自願選用陶瓷人工髖

關節組,按MOORE給付,超過部分由病患自付

7733

FBHMCPCER1U0 CERAMIC HIP SYSTEM※凡符合使用MOORE規定者,如自願選用陶瓷

人工髖關節組,則按MOORE人工髖關節給付,超過部分由病患自

付。

7733

FBHMCPCER1W2 CERAMIC TOTAL HIP SYSTEM ※凡符合使用MOORE規定者,如自願

選用陶瓷人工髖關節組,則按MOORE人工髖關節給付,超過部分由

病患自付。

7733

FBHMCPCER1Z1 CERAMIC TOTAL HIP SYSTEM※凡符合使用MOORE規定者,如自願選

用陶瓷人工髖關節組(自付差額品項,超過部分由病患自付)

7733

FBHMCPCER2AE CERAMIC TOTAL HIP SYSTEM※凡符合使用MOORE規定者,如自願選

用陶瓷人工髖關節組,則按MOORE人工髖關節給付,超過部分由病

患自付。

7733

FBHMCPCER2S2 "STRYKER"CERAMIC TOTAL HIP SYSTEM※符合使用MOORE規定者,

使用陶瓷全髖關節組,部分給付,超過部分由病患自付。

7733

FBHMCPCER3Z1 "ZIMMER"BIOLOX DELTA TOTAL HIP SYSTEM(CERAMIC)※符合MOORE

規定者,如自願選用陶瓷全人工髖關節組,按MOORE給付,超過部

分由病患自付

7733

FBHMCPCER4Z1 “捷邁”百優陶瓷全人工髖關節組(符合使用MOORE規定者)

“ZIMMER” BIOLOX OPTION TOTAL HIP SYSTEM

7733

FBHMCPCER5U0 "UNITED"CERAMIC HIP SYSTEM※凡符合使用MOORE規定者,如自願

選用本陶瓷雙極式人工髖關節組,則按健保局核價部份給付,超

過部分由病患自付。

7733

FBHMCPCER5Z1 "ZIMMER"BIOLOX DELTA CERAMIC TOTAL HIP SYSTEM※符合使用

MOORE規定者,如自願選用陶瓷HEAD,則按MOORE給付,超過部分

由病患自付。

7733

FBHMCPCER6Z1 "ZIMMER"BIOLOX DELTA CERAMIC TOTAL HIP SYSTEM※符合使用

MOORE規定者,如自願選用陶瓷HEAD(組合式股骨柄),則按MOORE

給付,超過部分由病患自付。

7733

FBHMCPCER7Z1 “捷邁”百優組合式陶瓷全人工髖關節組(符合使用MOORE規定者)

“ZIMMER” BIOLOX OPTION TOTAL HIP SYSTEM(KINECTIV)

7733

FBHMCRCEE5Z1 “捷邁”重建型百優陶瓷全人工髖關節組(符合使用MOORE規定者)

“ZIMMER” BIOLOX OPTION REVISION TOTAL HIP SYSTEM

7733

FBHMCRCEE6Z1 “捷邁”重建型百優組合式陶瓷全人工髖關節組(符合使用MOORE

規定者)“ZIMMER”BIOLOX OPTION REVISION TOTAL HIP

SYSTEM(ZMR)

7733

FBHMCRCER1AE CERAMIC REVISION HIP SYSTEM※凡符合使用MOORE規定者,如自

願選用陶瓷重建型人工髖關節組,則按MOORE人工髖關節給付,超

過部分由病患自付。

7733

FBHMCRCER1DP CERAMIC REVISION HIP SYSTEM※凡符合使用MOORE規定者,如自

願選用陶瓷重建型人工髖關節組,則按MOORE人工髖關節給付,超

過部分由病患自付。

7733

FBHMCRCER1S2 CERAMIC REVISION HIP SYSTEM※凡符合使用MOORE規定者,如自

願選用陶瓷重建型人工髖關節組,則按MOORE人工髖關節給付,超

過部分由病患自付。

7733

FBHMCRCER1U0 CERAMIC REVISION HIP SYSTEM※凡符合使用MOORE規定者,如自

願選用陶瓷重建型人工髖關節組,則按MOORE人工髖關節給付,超

過部分由病患自付。

7733

1015

特材代碼 中英文名稱 支付點數-104/01/01

FBHMCRCER1W2 CERAMIC REVISION HIP SYSTEM ※凡符合使用MOORE規定者,如自

願選用陶瓷重建型人工髖關節組,則按MOORE人工髖關節給付,超

過部分由病患自付。

7733

FBHMCRCER1Z1 CERAMIC REVISION HIP SYSTEM凡符合使用MOORE規定者,如選用

陶瓷重建型人工髖關節組(付差額品項,超過部分由病患自付)

7733

FBHMCRCER2AE CERAMIC REVISION HIP SYSTEM※凡符合使用MOORE規定者,如自

願選用陶瓷重建型人工髖關節組,則按MOORE人工髖關節給付,超

過部分由病患自付。

7733

FBHMCRCER2S2 "STRYKER"CERAMIC REVISION HIP SYSTEM※符合使用MOORE規定,

使用陶瓷重建型,部分給付)

7733

FBHMCRCER2Z1 "ZIMMER"BIOLOX DELTA CERAMIC REVISION HIP SYSTEM※符合使

用MOORE規定者,如自願選用陶瓷HEAD,則按MOORE給付,超過部

分由病患自付。

7733

FBHMCRCER3Z1 "ZIMMER"REVISION BIOLOX DELTA HIP SYSTEM(CERAMIC)※符合

MOORE規定者,如自願選用陶瓷重建型人工髖關節組,按MOORE給

付,超過部分由病患自付

7733

FBHMCRCER4Z1 "ZIMMER"BIOLOX DELTA CERAMIC REVISION HIP SYSTEM※符合使

用MOORE規定者,如自願選用陶瓷HEAD(骨缺損2度以上),則按

MOORE給付,超過部分病患自付。

7733

FBHMCRCER5U0 "UNITED"CERAMIC REVISION HIP SYSTEM ※凡符合使用MOORE規定

者,如自願選用本重建型人工髖關節組,則按健保局核價部份給

付,超過部分由病患自付。

7733

FBHMCRCER5Z1 “捷邁”重建型百優陶瓷全人工髖關節組(符合使用MOORE規定者)

“ZIMMER” BIOLOX OPTION REVISION TOTAL HIP SYSTEM

7733

FBHMCRCER6Z1 “捷邁”重建型百優組合式陶瓷全人工髖關節組(符合使用MOORE

規定者)“ZIMMER”BIOLOX OPTION REVISION TOTAL HIP

SYSTEM(ZMR)

7733

FBHMMLDH01W2 BIG FEMORAL HEAD TOTAL HIP SYSTEM(含固定樁) ※符合使用

MOORE規定者,如自願選用BFH人工髖關節組,按MOORE給付,超過

部分由病患自付

7733

FBHMMLDH01Z1 LDH TOTAL HIP SYSTEM ※符合使用MOORE規定者,如使用LDH人工

髖關節組,按MOORE給付,超過部分由病患自付

7733

FBHMMLDH02W2 BIG FEMORAL HEAD TOTAL HIP SYSTEM(不含固定樁) ※符合使用

MOORE規定者,如自願選用BFH人工髖關節組,按MOORE給付,超過

部分由病患自付

7733

FBHMMLDH02Z1 MMC CUP NON-HA VERSION (LDH TOTAL HIP SYSTEM)※符合使用

MOORE規定者,如使用LDH人工髖關節組,按MOORE給付,超過部分

由病患自付

7733

FBHMMMETA1DP PINNACLE METAL ON METAL TOTAL HIP SYSTEM金屬對金屬人工髖

關節組

7733

FBHMMMETA1Z1 METAL ON METAL TOTAL HIP SYSTEM ※符合使用MOORE規定者,如

使用METAL ON METAL人工髖關節組,按MOORE給付,超過部分由病

患自付

7733

FBHMMMETA2Z1 "ZIMMER" METAL ON METAL TOTAL HIP SYSTEM ※符合使用MOORE

規定者,如使用METAL ON METAL人工髖關節組,按MOORE給付,超

過部分由病患自付

7733

FBHPA1000NAE BICONTACT TOTAL HIP SYSTEM ※適應症請見備註欄 39396

FBHPA1000NDP AML TOTAL HIP SYSTEM ※適應症請見備註欄 39396

FBHPA1000NS2 "好美得卡奧斯得寧"全人工髖關節系統 "HOWMEDICA

OSTEONICS"OMNIFIT HIP SYSTEM※適應症請見備註欄

39396

FBHPA1000NU0 UNITED TOTAL HIP SYSTEM 聯髖人工髖關節 ※適應症請見備註欄 39396

FBHPA1000NW2 TOTAL HIP SYSTEM※適應症請見備註欄 39396

FBHPA1100NDP CORAIL TOTAL HIP SYSTEM ※適應症請見備註欄 39396

1016

特材代碼 中英文名稱 支付點數-104/01/01

FBHPA2000NS2 TOTAL HIP SYSTEM(STEM+CUP+INSERT+HEAD)※適應症請見備註欄 39396

FBHPA2000NU0 UNITED U2 TOTAL HIP SYSTEM※適應症請見備註欄 39396

FBHPA2000TZ1 HA/TCP TOTAL HIP SYSTEM ※適應症請見備註欄 39396

FBHPA3000NU0 TOTAL HIP SYSTEM (型號

13021044:62+11045034:67+12011126:1726)※適應症請見備註欄

39396

FBHPA4000NS2 "HOWMEDICA-OSTEONICS" OMNIFIT HIP SYSTEM "好美得卡-奧斯得

寧"全人工髖關節系統 ※適應症請見備註欄

39396

FBHPA4000TZ1 VERSYS TOTAL HIP SYSTEM※適應症請見備註欄 39396

FBHPA5500NS2 ACCOLADE TOTAL HIP SYSTEM(STEM+CUP+INSERT+HEAD)※適應症請

見備註欄

39396

FBHPA6000NZ1 CLS SPOTORNO SYSTEM(STEM+LINER+HEAD+ACETABULAR CUP)※適應

症請見備註欄

39396

FBHPA7000NU0 "聯合"優磨二代全髖關節組"UNITED”U-MOTION II TOTAL HIP

SYSTEM

39396

FBHPA8000TZ1 TOTAL HIP SYSTEM(CUP+LINER+HEAD+STEM)※適應症請見備註欄 39396

FBHPA9000TZ1 "捷邁"隆傑艾提全人工髖關節組"ZIMMER"LONGEVITY IT TOTAL

HIP SYSTEM

39396

FBHPA9979NDP SUMMIT TOTAL HIP SYSTEM(STEM+HEAD+CUP+INSERT)※適應症請見

備註欄

39396

FBHPAKTV1TZ1 "ZIMMER"KINECTIV M/L TAPER TOTAL HIP PROSTHESIS SYSTEM"西

美"組合式股骨柄可旋式全人工股骨修補系統※適應症請見備註欄

49319

FBHPAKTV2TZ1 "捷邁"隆傑艾提全人工髖關節組(搭配組合式股骨

柄)"ZIMMER"LONGEVITY IT TOTAL HIP SYSTEM (WITH KINECTIV)

49319

FBHPAPMAMLDP "DEPUY"PINNACLE HIP SYSTEM"帝富"必耐久人工髖臼系統※適應

症請見備註欄

39396

FBHPAPMARADP "DEPUY"TOTAL HIP SYSTEM"帝富"全人工髖關節組※適應症請見備

註欄

39396

FBHPAPRFMRW2 "WRIGHT"TOTAL HIP SYSTEM (搭配組合式股骨柄)"瑞德"全人工髖

關節系統※適應症請見備註欄

49319

FBHPAUTF1NU0 "聯合"全人工髖關節系統(楔形骨柄)"UNITED”TOTAL HIP

SYSTEM(UTF STEM)

39396

FBHPC7000NU0 "聯合"優磨二代全人工髖關節(陶瓷巨頭對高耐磨聚乙烯襯墊)(自

付差額品項)"UNITED”U-MOTION II TOTAL HIP SYSTEM:DELTA

CERAMIC HEAD

39396

FBHPC7100NU0 "聯合"優磨二代全人工髖關節(陶瓷巨頭對陶瓷襯墊)(自付差額品

項)"UNITED”U-MOTION II TOTAL HIP SYSTEM:DELTA CERAMIC

HEAD TO CERAMIC LINER

39396

FBHPCCERA1AE CERAMIC TOTAL HIP SYSTEM※凡符合傳統人工髖關節組之適應症

者,如自願選用陶瓷人工髖關節組時,則按傳統人工髖關節組給

付,超過部分由病患自付。

39396

FBHPCCERA1DP CERAMIC TOTAL HIP SYSTEM※凡符合傳統人工髖關節組之適應症

者,如自願選用陶瓷人工髖關節組時,則按傳統人工髖關節組給

付,超過部分由病患自付。

39396

FBHPCCERA1S2 CERAMIC TOTAL HIP SYSTEM※凡符合傳統髖關節組者,自願選用

陶瓷髖關節組,則按傳統髖關節組給付,超過部分由病患自付

39396

FBHPCCERA1U0 CERAMIC TOTAL HIP SYSTEM※凡符合傳統人工髖關節組之適應症

者,如自願選用陶瓷人工髖關節組時,則按傳統人工髖關節組給

付,超過部分由病患自付。

39396

1017

特材代碼 中英文名稱 支付點數-104/01/01

FBHPCCERA1W2 CERAMIC TOTAL HIP SYSTEM ※凡符合人工髖關節組者,如自願選

用陶瓷人工髖關節時(自付差額品項,超過部分由病患自付)。

39396

FBHPCCERA1Z1 CERAMIC TOTAL HIP SYSTEM※凡符合傳統人工髖關節組之適應症

者,如自願選用陶瓷人工髖關節組時,則按傳統人工髖關節組給

付,超過部分由病患自付。

39396

FBHPCCERA2AE CERAMIC TOTAL HIP SYSTEM※凡符合傳統人工髖關節組之適應症

者,如自願選用陶瓷人工髖關節組時,則按傳統人工髖關節組給

付,超過部分由病患自付。

39396

FBHPCCERA2S2 "STRYKER"CERAMIC TOTAL HIP SYSTEM※符合傳統人工髖關節適應

症者,自願選用陶瓷HEAD,則按傳統人工髖關節組給付,超過部

分由病患自付。

39396

FBHPCCERA2W2 CERAMIC TOTAL HIP SYSTEM ※凡符合傳統人工髖關節組之適應症

者,如自願選用陶瓷人工髖關節時,則按傳統人工髖關節組給付

,超過部分由病患自付。

39396

FBHPCCERA2Z1 "ZIMMER"KINECTIV M/L TAPER CERAMIC TOTAL HIP PROSTHESIS

SYSTEM"西美"組合式股骨柄可旋式陶瓷全人工股骨修補系統(部分

給付項目)※適應症請見備註欄

49319

FBHPCCERA3Z1 "ZIMMER"BIOLOX TOTAL HIP SYSTEM(CERAMIC)※符合傳統髖關節

組適應症者,如自願選用陶瓷全人工髖關節組,按傳統髖關節組

給付,超過部分由病患自付

39396

FBHPCCERA4W2 "WRIGHT" CERAMIC TOTAL HIP SYSTEM(搭配組合式股骨柄) "瑞

德"陶瓷全人工髖關節系統(部分給付項目,超過部分由病患自付)

※適應症請見備註欄

49319

FBHPCCERA4Z1 "ZIMMER"M/L TAPER HIP PROSTHESIS W/KINECTIV TECHNOLOGY"捷

邁"康內特人工髖關節(陶瓷,組合式股骨柄,部分給付項目,超過

部分自付

49319

FBHPCCERA5U0 "UNITED"CERAMIC TOTAL HIP SYSTEM ※凡符合傳統人工髖關節組

之適應症者,如自願選用陶瓷人工髖關節組,則按健保給付,超

過部分由病患自付。

39396

FBHPCCERA5W2 "WRIGHT" CERAMIC TOTAL HIP SYSTEM(搭配組合式股骨柄) "瑞

德"陶瓷全人工髖關節系統(部分給付項目,超過部分由病患自付)

※適應症請見備註欄

49319

FBHPCCERA5Z1 "ZIMMER"BIOLOX DELTA CERAMIC TOTAL HIP SYSTEM※符合傳統人

工髖關節適應症者,自願選用陶瓷HEAD,則按傳統人工髖關節組

給付,超過部分由病患自付。

39396

FBHPCCERA6W2 “瑞德”戴內斯帝陶瓷全人工髖關節系統(自付差額品

項)。"WRIGHT”DYNASTY CERAMIC TOTAL HIP SYSTEM

39396

FBHPCCERA6Z1 "ZIMMER"BIOLOX DELTA CERAMIC TOTAL HIP SYSTEM※符合傳統人

工髖關節適應症,選用陶瓷HEAD,則按傳統人工髖關節組給付(組

合式STEM),超過病患自付。

49319

FBHPCCERA7W2 “瑞德”戴內斯帝陶瓷全人工髖關節系統(搭配組合式股骨柄,自

付差額品項)"WRIGHT”DYNASTY CERAMIC TOTAL HIP SYSTEM

49319

FBHPCCERE7Z1 “捷邁”百優陶瓷全人工髖關節組“ZIMMER” BIOLOX OPTION

TOTAL HIP SYSTEM

39396

FBHPCCERE8Z1 “捷邁”百優陶瓷全人工髖關節組“ZIMMER” BIOLOX OPTION

TOTAL HIP SYSTEM(KINECTIV)

49319

FBHPCCERR7Z1 “捷邁”百優陶瓷全人工髖關節組“ZIMMER” BIOLOX OPTION

TOTAL HIP SYSTEM

39396

FBHPCCERR8Z1 “捷邁”百優陶瓷全人工髖關節組“ZIMMER” BIOLOX OPTION

TOTAL HIP SYSTEM(KINECTIV)

49319

FBHPCUTF1TU0 "聯合"全人工髖關節系統(楔形骨柄):DELTA巨頭陶瓷對陶瓷櫬墊

(自付差額品項)"UNITED”TOTAL HIP SYSTEM (UTF STEM)-DELTA

CERAMIC HEAD TO CERAMIC LINER

39396

1018

特材代碼 中英文名稱 支付點數-104/01/01

FBHPCUTF1XU0 "聯合"DELTA陶瓷球頭全人工髖關節系統(楔形骨柄)(自付差額品

項)"UNITED”TOTAL HIP SYSTEM(UTF STEM)(DELTA CERAMIC

HEAD)

39396

FBHPMLDH01W2 BIG FEMORAL HEAD TOTAL HIP SYSTEM (含固定樁)※符合傳統髖

關節組適應症者,如自願選用BFH人工髖關節組,按傳統髖關節組

給付,超過部分由病患自付

39396

FBHPMLDH01Z1 LARGE DIAMETER HEAD (LDH))TOTAL HIP SYSTEM※符合傳統髖關

節組適應症者,如自願選用LDH人工髖關節組,按傳統髖關節組給

付,超過部分由病患自付

39396

FBHPMLDH02W2 BIG FEMORAL HEAD TOTAL HIP SYSTEM(不含固定樁) ※符合傳統

髖關節組適應症者,如自願選用BFH人工髖關節組,按傳統髖關節

組給付,超過部分由病患自付

39396

FBHPMLDH02Z1 MMC CUP NON-HA VERSION (LDH TOTAL HIP SYSTEM)※符合傳統髖

關節組適應症者,如自願選用LDH人工髖關節組,按傳統髖關節組

給付,超過部分由病患自付

39396

FBHPMLDH03W2 "WRIGHT" BIG FEMORAL HEAD TOTAL HIP SYSTEM(含固定樁) (搭

配組合式股骨柄) "瑞德"巨頭全人工髖關節系統(部分給付項目)

※適應症請見備註欄

49319

FBHPMLDH03Z1 "ZIMMER"KINECTIV M/L TAPER LDH TOTAL HIP PROSTHESIS

SYSTEM"西美"組合式股骨柄可旋式巨頭全人工股骨修補系統(部分

給付項目)※適應症請見備註欄

49319

FBHPMLDH04W2 "WRIGHT" BIG FEMORAL HEAD TOTAL HIP SYSTEM (不含固定樁)

(搭配組合式股骨柄) "瑞德"巨頭全人工髖關節系統(部分給付項

目)※適應症請見備註欄

49319

FBHPMMETA1DP PINNACLE METAL ON METAL TOTAL HIP SYSTEM※符合傳統髖關節

組適應症者,如自願選用金屬人工髖關節組,按傳統髖關節組給

付,超過部分由病患自付

39396

FBHPMMETA1Z1 METASUL METAL ON METAL TOTAL HIP SYSTEM※符合傳統髖關節組

適應症者,如自願選用金屬人工髖關節組,按傳統髖關節組給付

,超過部分由病患自付

39396

FBHPMMETA2DP "DEPUY"PINNACLE METAL ON METAL TOTAL HIP SYSTEM※符合傳統

髖關節適應症者,如自願選用PINNACLE,按傳統髖關節組給付,

超過部分由病患自付

39396

FBHPMMETA2Z1 "ZIMMER"KINECTIV M/L TAPER METASUL TOTAL HIP PROSTHESIS

SYSTEM"西美"組合式股骨柄可旋式金屬對金屬(部分給付項目)※

適應症請見備註欄

49319

FBHPMMETA3W2 "瑞德"金屬對金屬全人工髖關節系統"WRIGHT"TOTAL HIP

SYSTEM(METAL ON METAL)※部分給付項目,超過部分由病患自付

39396

FBHPMMETA3Z1 "ZIMMER" METAL ON METAL TOTAL HIP SYSTEM ※符合傳統髖關節

組適應症者,如自願選用金屬人工髖關節組,按傳統髖關節組給

付,超過部分由病患自付

39396

FBHPMMETA4W2 "WRIGHT" METAL ON METAL TOTAL HIP SYSTEM (搭配組合式股骨

柄)"瑞德"金屬對金屬全人工髖關節系統※部分給付項目,超過部

分由病患自付

49319

FBHPMMETA4Z1 "ZIMMER"M/L TAPER HIP PROSTHESIS W/KINECTIV TECHNOLOGY"捷

邁"康內特人工髖關節組(金屬對金屬,組合式股骨柄,部分給付項

目)※適應症請見備註欄

49319

FBHRA1000NDP AML REVISION TOTAL HIP SYSTEM ※適應症請見備註欄 52796

FBHRA1000NW2 REVISION TOTAL HIP SYSTEM※適應症請見備註欄 52796

FBHRA1000TZ1 REVISION TOTAL HIP SYSTEM ※適應症請見備註欄 52796

FBHRA2000NW2 PERFECTA REVISION TOTAL HIP

SYSTEM(NECK+BODY+STEM+HEAD+CUP+INSERT)※適應症請見備註欄

70099

1019

特材代碼 中英文名稱 支付點數-104/01/01

FBHRA2000TZ1 VERSYS REVISION TOTAL HIP SYSTEM※適應症請見備註欄 52796

FBHRA3000NS2 "HOWMEDICA-OSTEONICS" RESTORATION HA HIP SYSTEM:REVISION

SYSTEM "好美得卡 奧斯得寧"再置換人工髖關節系統 ※適應症請

見備註欄

52796

FBHRA3000TZ1 VERSYS CEMENTED REVISION/CALCAR TOTAL HIP SYSTEM※適應症

請見備註欄

52796

FBHRA4000TZ1 ZMR REVISION HIP SYSTEM(BODY+STEM+HEAD+CUP+INSERT)※適應

症請見備註欄

70099

FBHRA5000NU0 U2 REVISION HIP SYSTEM※適應症請見備註欄 52796

FBHRA5000TZ1 CPT REVISION HIP SYSTEM(CUP+LINER+HEAD+STEM)捷奔特髖關節

組※適應症請見備註欄

52796

FBHRA6000NU0 "聯合"優磨二代重建型全髖關節組"UNITED”U-MOTION II

REVISION TOTAL HIP SYSTEM

52796

FBHRA6000TZ1 "ZIMMER"WAGNER SL REVISION HIP SYSTEM"捷邁"衛格能重建型髖

關節組※適應症請見備註欄

52796

FBHRA6260NH1 RESTORATION REVISION HIP SYSTEM※適應症請見備註欄 52796

FBHRA8000TZ1 "捷邁"隆傑艾提重建型人工髖關節組"ZIMMER"LONGEVITY IT

REVISION TOTAL HIP SYSTEM

52796

FBHRA9000TZ1 "捷邁"重建型人工髖關節組(隆傑艾提搭配組合式股骨

柄)"ZIMMER"LONGEVITY IT REVISION TOTAL HIP SYSTEM(WITH

ZMR)

70099

FBHRANK20NAE BICONTACY REVISION HIP SYSTEM(STEM+HEAD+CUP+INSERT)※適應

症請見備註欄

52796

FBHRAP1REVDP "DEPUY"PINNACLE HIP SYSTEM:REVISION"帝富"必耐久人工髖臼系

統:重建式※適應症請見備註欄

52796

FBHRC6000NU0 "聯合"優磨二代重建型全人工髖關節組(陶瓷巨頭對高耐磨聚乙烯

襯墊)(自付差額品項)"UNITED”U-MOTION II REVISION HIP

SYSTEM(DELTA CERAMIC HEAD TO XPE LI

52796

FBHRC6100NU0 "聯合"優磨二代重建型全人工髖關節組(陶瓷巨頭對陶瓷襯墊)(自

付差額品項)"UNITED”U-MOTION II REVISION HIP SYSTEM(DELTA

CERAMIC HEAD TO CERAMIC LINER

52796

FBHRCCERA1AE CERAMIC REVISION HIP SYSTEM※符合傳統重建型髖關節組適應症

者,如自願選用陶瓷重建型人工髖關節組,按傳統重建型髖關節

組給付,超過部分由病患自付

52796

FBHRCCERA1DP CERAMIC REVISION HIP SYSTEM※符合傳統重建型髖關節組適應症

者,如自願選用陶瓷重建型人工髖關節組,按傳統重建型髖關節

組給付,超過部分由病患自付

52796

FBHRCCERA1S2 CERAMIC REVISION HIP SYSTEM※符合傳統重建型髖關節組者,自

願選用陶瓷重建型髖關節組,按傳統重建型髖關節組給付,超過

部分由病患自付

52796

FBHRCCERA1U0 CERAMIC REVISION HIP SYSTEM※符合傳統重建型髖關節組適應症

者,如自願選用陶瓷重建型人工髖關節組,按傳統重建型髖關節

組給付,超過部分由病患自付

52796

FBHRCCERA1W2 CERAMIC REVISION HIP SYSTEM符合重建型髖關節組者,如自願選

用陶瓷重建型人工髖關節組(自付差額品項,超過部分由病患自

付)

52796

FBHRCCERA1Z1 REVISION CERAMIC HIP SYSTEM※符合傳統重建型髖關節組適應症

者,如自願選用陶瓷重建型人工髖關節組,按傳統重建型髖關節

組給付,超過部分由病患自付

52796

FBHRCCERA2AE CERAMIC REVISION HIP SYSTEM※符合傳統重建型髖關節組適應症

者,如自願選用陶瓷重建型人工髖關節組,按傳統重建型髖關節

組給付,超過部分由病患自付

52796

FBHRCCERA2S2 "史賽克"全人工陶瓷髖關節再置換系統(自付差額品

項)"STRYKER"CERAMIC REVISION HIP SYSTEM

52796

1020

特材代碼 中英文名稱 支付點數-104/01/01

FBHRCCERA2W2 CERAMIC REVISION HIP SYSTEM※符合傳統重建型(且骨頭缺損達

第二度以上者)者,自願選用陶瓷重建型髖關節組,超過部分由病

患自付

70099

FBHRCCERA2Z1 "ZIMMER"BIOLOX DELTA CERAMIC REVISION HIP SYSTEM※符合傳

統重建型髖關節適應症,選用陶瓷HEAD,則按傳統重建型髖關節

組給付,超過病患自付。

52796

FBHRCCERA3W2 “瑞德”戴內斯帝重建型陶瓷全人工髖關節系統(自付差額品

項)。"WRIGHT”DYNASTY REVISION CERAMIC TOTAL HIP SYSTEM

52796

FBHRCCERA3Z1 "ZIMMER"REVISION BIOLOX DELTA HIP SYSTEM(CERAMIC)※符合傳

統重建型適應症者,如自願選用陶瓷重建型,按傳統髖關節組給

付,超過部分由病患自付

52796

FBHRCCERA4W2 “瑞德”戴內斯帝重建型陶瓷全人工髖關節系統(搭配組合式股骨

柄,自付差額品項)"WRIGHT”DYNASTY REVISION CERAMIC TOTAL

HIP SYSTEM

70099

FBHRCCERA4Z1 "ZIMMER"BIOLOX DELTA CERAMIC REVISION HIP SYSTEM※符合重

建型(骨缺損2度以上)髖關節適應症,選用陶瓷HEAD,按傳統重建

髖關節給付,超過病患自付。

70099

FBHRCCERA5U0 "UNITED"CERAMIC REVISION HIP SYSTEM※符合傳統重建型髖關節

組適應症者,如自願選用陶瓷重建型人工髖關節組,則按健保局

給付,超過部分由病患自付

52796

FBHRCCERE5Z1 “捷邁”重建型百優陶瓷全人工髖關節組“ZIMMER” BIOLOX

OPTION REVISION TOTAL HIP SYSTEM

52796

FBHRCCERE6Z1 “捷邁”重建型百優組合式陶瓷全人工髖關節組“ZIMMER”

BIOLOX OPTION REVISION TOTAL HIP SYSTEM(ZMR)

70099

FBHRCCERR5Z1 “捷邁”重建型百優陶瓷全人工髖關節組“ZIMMER” BIOLOX

OPTION REVISION TOTAL HIP SYSTEM

52796

FBHRCCERR6Z1 “捷邁”重建型百優組合式陶瓷全人工髖關節組“ZIMMER”

BIOLOX OPTION REVISION TOTAL HIP SYSTEM(ZMR)

70099

FBHS1101XNU0 UNITED PRIMARY HIP STEM (BIPOLAR STEM) ※適應症請見備註欄 20692

FBHS11104NU0 UNITED U2 HIP STEM"聯合"U2人工髖關節股骨柄※適應症請見備

註欄

20692

FBHS11104RU0 U2 REVISION HIP SYSTEM:STEM※適應症請見備註欄 34092

FBHS1110XNU0 TOTAL HIP STEM(CEMENT STEM)※適應症請見備註欄 20692

FBHS11170NS2 HA PRIMARY STEM ※適應症請見備註欄 20692

FBHS11300NS2 ACCOLADE PRIMARY STEM ※適應症請見備註欄 20692

FBHS1135XNDP AML STEM(87/7/7新增1554,1557-02:08,42:48,1345-20:27)※適

應症請見備註欄

20692

FBHS115570DP "帝富"髖關節系統:股骨柄"DEPUY"AML TOTAL HIP

SYSTEM:FEMORAL STEM

20692

FBHS12900NZ1 CLS SPOTORNO STEM※適應症請見備註欄 20692

FBHS13708NW2 FEMORAL STEM (378X-XXXX自88/09/01起生效,385X,3793-XXXX自

88/10/1生效)※適應症請見備註欄

20692

FBHS16070NS2 "HOWMEDICA-OSTEONICS" OMNIFIT HIP SYSTEM: PRIMARY FEMORAL

STEM "好美得卡-奧斯得寧"人工髖關節系統:股骨柄※適應症請見

備註欄

20692

FBHS16260NH1 RESTORATION P/S LONG STEM※適應症請見備註欄 34092

FBHS16578NZ1 VERSYS HA/TCP FIBER METAL TAPER STEM※適應症請見備註欄 20692

FBHS17711NZ1 M/L TAPER HIP PROSTHESIS(STEM)※適應症請見備註欄 20692

FBHS17841NZ1 VERSYS FIBER METAL MIDCOAT HIP STEM(COLLARED)※適應症請見

備註欄

20692

FBHS17850NZ1 VERSYS ADVOCATE CEMENTED STEM※適應症請見備註欄 20692

FBHS17853NZ1 VERSYS CEMENTED TOTAL HIP STEM(7853-11:17-01:21自89/04/01

起生效)※適應症請見備註欄

20692

1021

特材代碼 中英文名稱 支付點數-104/01/01

FBHS17854NZ1 VERSYS CEMENTED HIP CT STEM※適應症請見備註欄 20692

FBHS17857NZ1 VERSYS HERITAGE CDH:FEMORAL STEM※適應症請見備註欄 20692

FBHS17862NZ1 VERSYS FIBER METAL TAPER HIP STEM※適應症請見備註欄 20692

FBHS1925XNDP CORAIL FEMORAL STEM ※適應症請見備註欄 20692

FBHS19979NDP SUMMIT HIP STEM※適應症請見備註欄 20692

FBHS1KTV1NZ1 "ZIMMER"KINECTIV M/L TAPER HIP PROSTHESIS SYSTEM:STEM"西

美"可旋式人工股骨修補系統:組合式股骨柄※適應症請見備註欄

30615

FBHS1L0820DP "帝富"可瑞髖關節系統:股骨柄"DEPUY"CORAIL HIP SYSTEM:STEM

※給付規定請見備註欄

20692

FBHS1L1020DP "帝富"可瑞髖關節系統:再置換式股骨柄"DEPUY"CORAIL HIP

SYSTEM:REVISION STEM※給付規定請見備註欄

34092

FBHS1NK62NAE BICONTACT PRIMARY STEM 10:21MM(型號NK010K-

18K,NJ009T:16T,NJ028-34K自92/4/1生效)※適應症請見備註欄

20692

FBHS1PRFMRW2 "WRIGHT"PROFEMUR HIP SYSTEM:MODULAR STEM"瑞德"博菲莫人工

髖關節系統:組合式股骨柄※適應症請見備註欄

30615

FBHS1UTF1NU0 "聯合"楔形骨柄"UNITED”HIP SYSTEM:UTF STEM 20692

FBHS2130LNS2 "HOWMEDICA-OSTEONICS"OMNIFIT HIP SYSTEM:OMNIFIT CEMENTED

LONG STEM"好美得卡-奧斯得寧"人工髖關節系統:股骨柄※適應症

請見備註欄

34092

FBHS23730NW2 REVISION HIP LONG STEM※適應症請見備註欄(型號3783-

XXXX,3784-XXXX自89/10/1生效)

34092

FBHS2601XNS2 "HOWMEDICA-OSTEONICS" RESTORATION HA HIP STEM好美得卡 奧

斯得寧"人工髖關節股骨柄:長股骨柄※適應症請見備註欄

34092

FBHS30102NZ1 "ZIMMER"WAGNER SL REVISION HIP SYSTEM:STEM"捷邁"衛格能重

建型髖關節組:股骨柄※適應症請見備註欄

34092

FBHS3354XNDP AML LONG STEM(87/11/2起1571-02-000:90-000,1573-03-000:19-

000)※適應症請見備註欄

34092

FBHS37846NZ1 "西美"威士人工髖關節:股骨柄(重建型)"ZIMMER"VERSYS HIP

SYSTEM:VERSYS BEADED FULLCOAT PLUS(REVISION)

34092

FBHS37855NZ1 VERSYS CEMENTED REVISION STEM 200:260MM※適應症請見備註欄 34092

FBHS37871NZ1 VERSYS CEMENTED REVISION/CALCAR STEM※適應症請見備註欄 34092

FBHS38114NZ1 CPT REVISION HIP SYSTEM:STEM 捷奔特髖關節系統(股骨柄)※

適應症請見備註欄

34092

FBHS39980NZ1 ZMR REVISION HIP STEM※適應症請見備註欄 13096

FBHS39990NZ1 ZMR REVISION HIP STEM BODY※適應症請見備註欄 38299

FBHS3NK21NAE REVISION HIP STEM※適應症請見備註欄 34092

FBHU143000Z1 BIGLIANI/FLATOW TOTAL SHOULDER(STEM+HEAD+CUP) 52893

FBHU14302NZ1 BIGLIANI/FLATOW GLENOID(PU CUP) 14404

FBHU15300NS2 TOTAL SHOULDER SYSTEM(GLENOID+HEAD+STEM) 52893

FBHU15362NS2 SOLAR TOTAL SHOULDER SYSTEM:SHOULDER GLENOID

COMP(PLASTIC)

14404

FBKA21872NW2 FEMORAL BUILD(WEDGE)※限用於人工膝關節再置換時使用 2989

FBKA22600NU0 FEMORAL AUGMENT SET(後端遠側-整塊)※適應症請見備註欄 5750

FBKA22603NU0 "聯合"康膝人工膝關節:股骨填補塊"UNITED"U2 TOTAL KNEE

SYSTEM:FEMORAL AUGMENT

2989

FBKA22803NU0 "聯合"康膝人工膝關節:脛骨填補塊"UNITED"U2 TOTAL KNEE

SYSTEM:TIBIAL AUGMENT

2989

FBKA23000NW2 REVISION FEMORAL WEDGE※限用於人工膝關節再置換時使用 2989

FBKA23001NW2 REVISION TIBIAL WEDGE※限用於人工膝關節再置換時使用 2989

FBKA25988NZ1 TIBIAL WEDGE※須事前審查限用於膝關節再置換時使用 2989

FBKA25990TZ1 FEMORAL AUGMENTATION ※須事前審查限用於膝關節再置換時使用 2989

1022

特材代碼 中英文名稱 支付點數-104/01/01

FBKA27510NS2 "HOWMEDICA OSTEONICS" SCORPIO TOTAL KNEE SYSTEM:FEMORAL

AUGMENTATION"斯高比歐膝關節股骨墊片※限用於人工膝關節再置

換時使用

2989

FBKA296080JJ TC3 PFC REVISION FEMORAL AUGMENTATION ※限用於人工膝關節

再置換時使用

2989

FBKB21759NW2 WHITESIDE ORTHOLOC REVISION TIBIAL STEM 5CM,6.25CM※適應

症請見備註欄

1179

FBKB21870NW2 REVISION TIBIAL LONG STEM 7.5CM,15CM ※限用於人工膝關節再

置換時使用

5682

FBKE21859NW2 WHITESIDE ORTHOLOC REVISION FEMORAL STEM 5CM ※適應症請見

備註欄

1289

FBKE21890NW2 REVISION FEMORAL LONG STEM 10CM,15CM ※限用於人工膝關節再

置換時使用

5682

FBKE22700NU0 CURVED EXTENSION STEM(型號2703-

5031:38;041:48;5132:38;42:48;5231:37;41:47自981001生效)

※適應症請見備註欄

5682

FBKE23000NW2 EXTENSION FEMORAL TIBIAL STEM※限用於人工膝關節再置換時使

5682

FBKE25988NZ1 STEM EXTENSION ※須事前審查限用於膝關節再置換時使用 5682

FBKE26478NS2 EXTENSION STEM 80MM:155MM※限用於人工膝關節再置換時使用 5682

FBKE286960JJ REVISION STEM EXTENSION(96-07,17-20,21,31,32自89/04/01生

效)※限用於人工膝關節再置換時使用

5682

FBKF10011NH1 FEMORAL COMPONENT EXTRA EXTRA-SMALL:LARGE ※適應症請見備

註欄

18197

FBKF10096PSN GENESIS II TOTAL KNEE SYSTEM(PS):FEMORAL COMPONENTS※適

應症請見備註欄

18197

FBKF10410NJJ PFC FEMORAL※適應症請見備註欄 18197

FBKF111027DP "帝富"全人工膝關節系統:股骨※給付規定請見備註欄"DEPUY:PFC

SIGMA RPF TOTAL KNEE SYSTEM:FEMORAL

18197

FBKF11880NW2 WHITESIDE ORTHOLOC FEMORAL COMPONENT(1840-

10XX;1870;75;80;85-00XX)(KFTC-XXXX自91/01/01生效) "瑞德"

人工膝關節系統:股骨※適應症請見備註欄

18197

FBKF11890NW2 "WRIGHT"ADVANCE TOTAL KNEE SYSTEM FEMORAL "瑞德"艾德凡斯

人工膝關節系統:股骨※適應症請見備註欄

18197

FBKF12000NW2 PSL FEMORAL COMPONENT ※適應症請見備註欄 18197

FBKF12101NU0 FEMORAL COMPONENT(PS)※適應症請見備註欄 18197

FBKF12103MU0 U2 TOTAL KNEE SYSTEM:FEMORAL※適應症請見備註欄 18197

FBKF12103NU0 U2 TOTAL KNEE SYSTEM:FEMORAL CRUCIATE RETAINING※適應症

請見備註欄

18197

FBKF1210XNU0 UNITED FEMORAL COMPONENT※適應症請見備註欄 18197

FBKF15500NH1 TRIATHLON FEMORAL COMPONENT ※適應症見備註欄 18197

FBKF15950TZ1 "西美"人工膝關節股骨組件"ZIMMER"NEXGEN CR-FLEX FEMORAL

COMPONENT ※適應症請見備註欄

18197

FBKF15964TZ1 "西美"人工膝關節股骨組件(LPS-FLEX)“ZIMMER” NEXGEN LPS-

FLEX FEMORAL COMPLETE※適應症請見備註欄(00-5964-012:018-

01:02;00-5964-011:018-51:52)

18197

FBKF15970NZ1 "西美"人工膝關節股骨組件(CR)“ZIMMER” NEXGEN FEMORAL

COMPONENT※適應症請見備註欄

18197

FBKF15996TZ1 "西美"人工膝關節股骨組件(LPS)"ZIMMER"NEXGEN FEMORAL

COMPONENT(LPS)※適應症請見備註欄

18197

FBKF17030NS2 "HOWMEDICA OSTEONICS" SCORPIO TOTAL KNEE SYSTEM: CR

FEMORAL COPMONENT "好美得卡-奧斯得寧"斯高比歐人工膝關節系

統:股骨※適應症請見備註欄

18197

1023

特材代碼 中英文名稱 支付點數-104/01/01

FBKF17130NS2 "HOWMEDICA OSTEONICS" SCORPIO TOTAL KNEE SYSTEM: FEMORAL

COPMONENT"好美得卡-奧斯得寧"斯高比歐人工膝關節系統:股骨※

適應症請見備註欄

18197

FBKF18000NS2 "HOWMEDICA OSTEONICS" SCORPIO NRG TOTAL KNEE SYSTEM:

FEMORAL COMPONENT"好美得卡-奧斯得寧"斯高比歐人工膝關節系

統:股骨※適應症請見備註欄

18197

FBKF19600NDP PFC SIGMA CRUCIATE RETAINING FEMORAL COMPONENT ※適應症請

見備註欄

18197

FBKF19600NJJ PFC E CURCIATE RETAINING FEMORAL ※適應症請見備註欄(96-

0042:58自89/7/1收,93/1/1由FBKF296008JJ調來)

18197

FBKF1N050NAE E.MOTION FEMORAL COMPONENT※適應症請見備註欄 18197

FBKF1S1G1RDP "DEPUY" SIGMA PS FEMORAL COMPONENTS"帝富"膝格瑪股骨組件※

適應症請見備註欄

18197

FBKF1S1GUSDP "DEPUY"SIGMA PS FEMORAL KNEE SYSTEM:FEMORAL"帝富"膝格瑪人

工股骨膝關節系統:股骨 ※適應症請見備註欄

18197

FBKF2179NNDP LCS REVISION FEMORAL COMPONENT※適應症請見備註欄 18197

FBKF21850NW2 WHITESIDE ORTHOLOC REVISION FEMORAL COMPONENT ※適應症請

見備註欄

17201

FBKF21857NW2 WHITESIDE ORTHOLOC P.S.L REVISION FEMORAL COMPONENT※適應

症請見備註欄

17201

FBKF22103NU0 FEMORAL COMPONENT PSA TYPE※適應症請見備註欄 18197

FBKF23000NW2 ADVANCE REVISION FEMORAL COMPONENT※適應症請見備註欄 18197

FBKF25976NZ1 NEXGEN FEMORAL COMPONENT(CRA)※適應症請見備註欄 18197

FBKF25994TZ1 NEXGEN FEMORAL COMPONENT(LCCK)※適應症請見備註欄 18197

FBKF26000NS2 “HOWMEDICA OSTEONICS" SCORPIO TOTAL KNEE SYSTEM: FEMORAL

COPMONENT"好美得卡-奧斯得寧"斯高比歐人工膝關節系統:股骨※

適應症請見備註欄

18197

FBKF26001NJJ PFC REVISION FEMORAL※適應症請見備註欄 18197

FBKF296008JJ TC3 PFC REVISION FEMORAL COMPONENTS (96-0042:96-0058自

93/01/01轉至FBKF19600NJJ)※適應症請見備註欄

18197

FBKL10460NDP PFC INSERT ※適應症請見備註欄 5348

FBKL10460NJJ PFC INSERT (96-0410:96-0467自89/07/01生效)※適應症請見備

註欄

5348

FBKL10802PSN GENESIS II TOTAL KNEE SYSTEM(PS):TIBIAL ARTICULAR

COMPONENTS※適應症請見備註欄

5348

FBKL11030NS2 OMNIFIT TIBIAL INSERT※適應症請見備註欄 5348

FBKL11501PSN PS HIGH FLEXION ARTICULAR INSERT ※適應症請見備註欄 13109

FBKL11770NW2 WHITESIDE ORTHOLOC TIBIAL INSERT(型號KITC,KIMP-XXXX自

91/01/01生效) ※適應症請見備註欄

5348

FBKL12000NW2 PSL TIBIAL INSERT ※適應症請見備註欄 5348

FBKL12301NU0 TIBIAL INSERT(PS)※適應症請見備註欄 5348

FBKL123033U0 U2 TOTAL KNEE SYSTEM:TIBIAL INSERT※適應症請見備註欄 5348

FBKL12303NU0 U2 TOTAL KNEE SYSTEM:TIBIAL INSERT CRUCIATE RETAINING※

適應症請見備註欄

5348

FBKL1230XNU0 UNITED TIBIAL INSERT PLAINED※適應症請見備註欄 5348

FBKL13000NW2 "WRIGHT"ADVANCE TOTAL KNEE SYSTEM:INSERT(DOUBLE HIGH)"瑞

德"艾德凡斯人工膝關節系統:脛骨襯墊※適應症請見備註欄

13109

FBKL15500NH1 TRIATHLON TIBIA INSERT ※適應症見備註欄 13109

FBKL15960NZ1 NEXGEN LPS-FLEX TIBIAL ARTICULAR SURFACE ※適應症請見備

註欄

13109

FBKL15971NZ1 ARTICULAR SURFACE※適應症請見備註欄 5348

FBKL15981NZ1 ARTICULAR SURFACE※適應症請見備註欄 5348

FBKL15996NZ1 NEXGEN TIBIAL ARTICULAR SURFACE※適應症請見備註欄 5348

FBKL17220NS2 SCORPIO CR INSERT COMPONENT※適應症請見備註欄 5348

1024

特材代碼 中英文名稱 支付點數-104/01/01

FBKL17230NS2 TIBIAL INSERT※適應症請見備註欄 5348

FBKL17250NS2 SCORPIO SUPERFLEX PS TIBIAL INSERT※適應症請見備註欄 13109

FBKL18200NS2 SCORPIO NRG TIBIAL INSERT※適應症請見備註欄 13109

FBKL19059NZ1 NEXGEN CR-FLEX TIBIAL ARTICULAR SURFACE ※適應症請見備註

13109

FBKL19602NDP PFC E CURCIATE RETAINING TIBIAL INSERT ※適應症請見備註欄 5348

FBKL19602NJJ PFC E CURCIATE RETAINING TIBIAL INSERT ※適應症請見備註欄 5348

FBKL1962RPJJ PFC SIGMA RP KNEE SYSTEM ROTATING PLATFORM INSERT※適應症

請見備註欄

13109

FBKL1N064NAE E.MOTION TIBIA INSERT※適應症請見備註欄 13109

FBKL21658NW2 P.S.L REVISION TIBIAL INSERT(型號KIPS-0114:2625,KIRV-

110S,M:630S,M自93/1/1生效)※適應症請見備註欄

25015

FBKL22303NU0 TIBIAL INSERT PSA TYPE※適應症請見備註欄 25015

FBKL25970NZ1 NEXGEN TIBIAL ARTICULAR SURFACE(CRA) ※適應症請見備註欄 25015

FBKL25994NZ1 NEXGEN TIBIAL ARTICULAR SURFACE(型號5994-022:042-10:33自

92/10/01生效) ※適應症請見備註欄

25015

FBKL26000NS2 TIBIAL BEARING COMPONENT※適應症請見備註欄 25015

FBKL26040NJJ PFC REVISION INSERT※適應症請見備註欄 25015

FBKL27493NS2 SERIES 7000 TIBIAL INSERT※適應症請見備註欄 25015

FBKL296050JJ TC3 PFC REVISION TIBIAL INSERT※適應症請見備註欄 25015

FBKP10417NDP PFC PATELLA ※適應症請見備註欄 5961

FBKP10417NJJ PFC PATELLA ※適應症請見備註欄 5961

FBKP10566NSN GENESIS II TOTAL KNEE SYSTEM:PARELLAR COMPONENTS※適應症

請見備註欄

5961

FBKP11670NW2 WHITESIDE ORTHOLOC PATELLA(型號KPRC,KPON-XXXX自91/01/01生

效)※適應症請見備註欄

5961

FBKP12401NU0 TOTAL KNEE PATELLA 26:44MM※適應症請見備註欄 5961

FBKP12403NU0 UKNEE TOTAL KNEE SYSTEM:PATELLA※適應症請見備註欄 5961

FBKP1240XNU0 "UNITED"UKNEE TOTAL KNEE SYSTEM:PATELLA"聯合"聯膝人工膝關

節:髕骨植入物

5961

FBKP13420NS2 OMNIFIT PATELLA COMPONENT※適應症請見備註欄 5961

FBKP15500NH1 TRIATHLON PATELLA※適應症見備註欄 5961

FBKP15973NZ1 PATELLA COMPONENT※適應症請見備註欄 5961

FBKP16430NH1 "HOWMEDICA"AVON PATELLO-FEMORAL JOINT PROSTHESIS-PATELLA

COMPONENT"好美得卡"阿文股骨膝蓋人工關節-臏骨組件

5961

FBKP17331NS2 SCORPIO CR PATELLA※適應症請見備註欄 5961

FBKP19601NDP PFC SIGMA CRUCIATE RETAINING OVAL-DOME PATELLA ※適應症請

見備註欄

5961

FBKP19601NJJ PFC SIGMA CURCIATE RETAINING OVAL-DOME PATELLA (型號96-

0120:0122自90/10/01生效)※適應症請見備註欄

5961

FBKP1N048NAE E.MOTION PATELLA※適應症請見備註欄 5961

FBKP26035NJJ PFC REVISION PATELLA※適應症請見備註欄 5961

FBKPA1000NJJ PFC TOTAL KNEE SYSTEM ※適應症請見備註欄 43537

FBKPA1000NU0 UNITED TOTAL KNEE SYSTEM ※適應症請見備註欄 43537

FBKPA1000NW2 WHITESIDE ORTHOLOC TOTAL KNEE SYSTEM 瑞德人工膝關節系統

※適應症請見備註欄

43537

FBKPA1000PSN GENESIS II TOTAL KNEE SYSTEM(PS)※適應症請見備註欄 43537

FBKPA1100NDP "DEPUY"PFC SIGMA TOTAL KNEE

SYSTEM(TIBIAL+INSERT+PATELLA+FEMORAL)"帝富"全人工膝關節組

※適應症請見備註欄

43537

FBKPA1100NJJ PFC E KNEE SYSTEM※適應症請見備註欄 43537

1025

特材代碼 中英文名稱 支付點數-104/01/01

FBKPA129RPJJ PFC SIGMA RP KNEE SYSTEMW/ROTATING PLATFORM※適應症請見備

註欄

51297

FBKPA2000NU0 TOTAL KNEE SYSTEM(PS)※適應症請見備註欄 43537

FBKPA2000NW2 PSL TOTAL KNEE SYSTEM ※適應症請見備註欄 43537

FBKPA2000PSN GENESIS II TOTAL KNEE SYSTEM(PS-FLEX) 高彎曲度全人工膝關

節系統※適應症請見備註欄

51297

FBKPA3000NW2 "WRIGHT"ADVANCE TOTAL KNEE SYSTEM(DOUBLE HIGH) "瑞德"艾德

凡斯人工膝關節系統(高彎曲度)※適應症請見備註欄

51297

FBKPA5000NU0 U2 TOTAL KNEE SYSTEM-CRUCIATE RETAINING※適應症請見備註欄 43537

FBKPA5000TZ1 NEXGEN COMPLETE KNEE (CR)SYSTEM ※適應症請見備註欄 43537

FBKPA5100TZ1 NEXGEN MIS COMPLETE KNEE SOLUTION (CR)微創全人工膝關節組

※適應症請見備註欄

43537

FBKPA5500NH1 TRIATHLON TOTAL KNEE SYSTEM(含TIBIA INSERT+FEMORAL+TIBIA

TRAY+PATELLA) ※適應症見備註欄

51297

FBKPA6000NU0 U2 TOTAL KNEE SYSTEM-POSTERIOR STABILIZED※適應症請見備註

43537

FBKPA6000TZ1 NEXGEN COMPLETE KNEE (PS)SYSTEM ※適應症請見備註欄 43537

FBKPA7000TZ1 NEXGEN COMPLETE KNEE SOLUTION (LPS)※適應症請見備註欄 43537

FBKPA7100NS2 SCORPIO TOTAL KNEE SYSTEM(PS)※適應症請見備註欄 43537

FBKPA7100TZ1 NEXGEN MIS COMPLETE KNEE SOLUTION (LPS)微創全人工膝關節組

※適應症請見備註欄

43537

FBKPA7200NS2 “HOWMEDICA OSTEONICS" SCORPIO TOTAL KNEE SYSTEM: CR

TOTAL KNEE SYSTEM"好美得卡-奧斯得寧"斯高比歐人工膝關節系

統※適應症請見備註欄

43537

FBKPA7300NS2 SCORPIO TOTAL KNEE SYSTEM※適應症請見備註欄 51297

FBKPA7800NS2 "HOWMEDICA"SCORPIO MOBILE BEARING KNEE SYSTEM"好美得卡-奧

斯得寧"人工膝關節系統※適應症請見備註欄

51297

FBKPA8000TZ1 NEXGEN LPS-FLEX COMPLETE KNEE SYSTEM ※適應症請見備註欄 51297

FBKPA8100NS2 SCORPIO NRG TOTAL KNEE SYSTEM※適應症請見備註欄 51297

FBKPA8100TZ1 NEXGEN MIS COMPLETE KNEE SOLUTION (LPS-FLEX)微創全人工膝

關節組 ※適應症請見備註欄

51297

FBKPA9000TZ1 NEXGEN CR-FLEX COMPLETE KNEE SOLUTION※適應症請見備註欄 51297

FBKPA9100TZ1 NEXGEN MIS COMPLETE KNEE SOLUTION (CR-FLEX)微創全人工膝關

節組※適應症請見備註欄

51297

FBKPAN000NAE E.MOTION KNEE SYSTEM FOLATING KNEE※適應症請見備註欄 51297

FBKRA1000NJJ PFC REVISION KNEE SYSTEM ※適應症請見備註欄 63204

FBKRA1000NW2 WHITESIDE ORTHOLOC LONG STEM REVISION TOTAL KNEE SYSTEM

※適應症請見備註欄

63204

FBKRA1000TZ1 M/G REVISION KNEE SYSTEM ※適應症請見備註欄 63204

FBKRA1001NW2 REVISION TOTAL KNEE SYSTEM W/TIBIA WEDGE ※適應症請見備註

欄,限需使用墊片者申報

67349

FBKRA11000JJ TC3 PFC REVISION KNEE SYSTEM※適應症請見備註欄 63204

FBKRA1100NU0 U2 REVISION TOTAL KNEE

SYSTEM(FEMORAL+TIBIAL+INSERT+PATELLA)※適應症請見備註欄

63204

FBKRA2000NW2 WHITESIDE ORTHOLOC P.S.L.TOTAL KNEE SYSTEM ※適應症請見備

註欄

63204

FBKRA3000NW2 ADVANCE REVISION TOTAL KNEE SYSTEM※適應症請見備註欄 63204

FBKRA3000TZ1 NEXGEN COMPLETE KNEE SOLUTION(LCCK)※適應症請見備註欄 63204

FBKRA4000TZ1 NEXGEN COMPLETE KNEE SOLUTION(CRA)※適應症請見備註欄 63204

FBKRA5000TZ1 NEXGEN ROTATING HINGE KNEE SYSTEM※適應症請見備註欄 116295

FBKRA6000NS2 “HOWMEDICA OSTEONICS" SCORPIO TOTAL KNEE SYSTEM:REVISION

SYSTEM”好美得卡-奧斯得寧"斯高比歐人工膝關節系統:再置換※

適應症請見備註欄

63204

1026

特材代碼 中英文名稱 支付點數-104/01/01

FBKS12703NU0 EXTENSION STRAIGHT STEM PSA TYPE※適應症請見備註欄 5682

FBKT10160NSN GENESIS II TOTAL KNEE SYSTEM:TIBIAL COMPONENTS※適應症請

見備註欄

14031

FBKT10411NDP PFC TIBIAL(PRIMARY或REVISION) ※適應症請見備註欄 14031

FBKT10411NJJ PFC TIBIAL(PRIMARY或REVISION)(型號86-4177:9自89/1/1生效)

※適應症請見備註欄

14031

FBKT11581NDP "DEPUY"SIGMA CO-CR TIBIAL TRAYS"帝富"人工膝關節脛骨盤※適

應症請見備註欄

14031

FBKT11870NW2 WHITESIDE ORTHOLOC TIBIAL BASE 脛骨基座 ※適應症請見備註

12559

FBKT11871NW2 TIBIAL BASE※適應症請見備註欄 12559

FBKT11885NW2 CF TIBIAL STEM+TIBIAL BASE(型號KTCO,KTCC,KTTI-XXXX自

91/01/01生效) ※適應症請見備註欄

14031

FBKT12203NU0 U2 TOTAL KNEE SYSTEM:TIBIAL BASEPLATE※適應症請見備註欄 14031

FBKT1220XNU0 UNITED TIBIAL BASEPLATE WITH STEM(型號2201-3010:3060自

89/10/1生效)※適應症請見備註欄

14031

FBKT1432RPJJ PFC SIGMA RP KNEE SYSTEM MOBILE BEARING TIBIA BASEPLATE※

適應症請見備註欄

14031

FBKT15500NH1 TRIATHLON TIBIA TRAY※適應症見備註欄 14031

FBKT15950NZ1 NEXGEN MIS TIBIAL PLATE微創人工莖骨板 ※適應症請見備註欄 14031

FBKT15972NZ1 TIBIAL PLATE※適應症請見備註欄 14031

FBKT15982NZ1 TIBIAL PLATE※適應症請見備註欄 14031

FBKT17151NS2 "HOWMEDICA" SCORPIO MOBILE BEARING KNEE SYSTEM: TIBIAL

COMPONENT "好美得卡"人工膝關節系統:脛骨盤(原健保碼為

FBKT1715LNS2)※適應症請見備註欄

14031

FBKT1715LNS2 "HOWMEDICA-OSTEONICS" SERIES 7000 TOTAL KNEE SYSTEM:

TIBIAL COMPONENT "好美得卡-奧斯得寧" 7000系列全人工膝關節

系統:脛骨盤※適應症請見備註欄

14031

FBKT1AP0LYDP PFC SIGMA KNEE SYSTEM:ALL POLYETHYLENE TIBIAL+INSERT ※

適應症請見備註欄

14031

FBKT1N062NAE E.MOTION TIBIA FOLATING PLATE※適應症請見備註欄 14031

FBKT2179NNDP LCS REVISION ROTATING TIBIAL PLATEAU ※適應症請見備註欄 14031

FBKT22203NU0 TIBIAL BASEPLATE PSA TYPE※適應症請見備註欄 14031

FBKT26000NS2 “HOWMEDICA OSTEONICS" SCORPIO TOTAL KNEE SYSTEM:TIBIAL

TRAY”好美得卡-奧斯得寧"斯高比歐人工膝關節系統:脛骨盤※適

應症請見備註欄

14031

FBKT286000JJ TC3 PFC REVISION TIBIAL TRAY※適應症請見備註欄 14031

FBKUA1000TW2 UNICOMPARTMENTAL KNEE SYSTEM(FEMORAL+TIBIAL+INSERT)※適應

症請見備註欄

44983

FBKUA1000USN GENESIS UNICOMPARMENTAL KNEE SYSTEM※適應症請見備註欄 44983

FBKUA2000TZ1 "ZIMMER"UNICOMPARTMENTAL HIGH-FLEX SYSTEM 155度

(FEMORAL+TIBIAL +SURFACE)※適應症請見備註欄

44983

FBKUA9600NJJ PFC SIGMA UNICOMPARTMENTAL KNEE SYSTEM 人工半膝關節組※適

應症請見備註欄

44983

FBKW2280XNU0 TIBIAL WEDGE※限用於人工膝關節再置換時使用 2989

FBKW25220NZ1 TIBIAL WEDGE ※限用於人工膝關節再置換時使用 2989

FBKW286010JJ TC3 PFC REVISION TIBIAL WEDGE ※限用於人工膝關節再置換時

使用

2989

FBM011109NU0 MOORE HIP SYSTEM 7732

FBM01203XNSN MOORE PROSTHESES 7732

FBM014006NZ1 "ZIMMER"MOORE HIP PROSTHESIS "西美"莫爾人工髖關節 7732

FBM019138NH1 AUSTIN MOORE 7732

1027

特材代碼 中英文名稱 支付點數-104/01/01

FBSF1000021A MONT BLANC SPINAL SYSTEM二節(RX2+SX4)※適應症請見備註欄 23358

FBSF1000031A MONT BLANC SPINAL SYSTEM 三節(RX2+SX6)※適應症請見備註欄 34118

FBSF101626B0 TITANIUM SPINAL SYSTEM(RX2+SX4)※適應症請見備註欄 23358

FBSF101635B0 TITANIUM SPINAL SYSTEM(RX2+SX6或RX2+SX4+HX2)※適應症請見

備註欄

34118

FBSF110002U0 "UNITED"CENTURY SPINAL SYSTEM (S*4+R*2) "聯合"世紀脊椎固

定系統 二節※適應症請見備註欄

23358

FBSF110003U0 "UNITED"CENTURY SPINAL SYSTEM (S*6+R*2) "聯合"世紀脊椎固

定系統(三節)※適應症請見備註欄

34118

FBSF11002LTD TITANIUM TREND SPINAL SYSTEM二節(SX4+RX2)※適應症請見備註

23358

FBSF11003LTD TITANIUM TREND SPINAL SYSTEM三節(SX6+RX2)※適應症請見備註

34118

FBSF11302NB0 TITANIUM SPINAL FIXATION SYSTEM 脊椎固定系統二節(SX4+RX2)

※適應症請見備註欄

23358

FBSF11303NB0 TITANIUM SPINAL FIXATION SYSTEM 脊椎固定系統三節(SX6+RX2)

※適應症請見備註欄

34118

FBSF13820NS9 TITANIUM XIA SPINAL SYSTEM 二節前置脊椎固定(SX4+RX2)※適

應症請見備註欄

23886

FBSF140001RK TITANIUM ANTERIOR SPINAL SYSTEM(PX1+SX4)※適應症請見備註

23886

FBSF148144S9 XIA 4.5 TITANIUM SPINAL IMPLANTS (SX4+RX2)二節(適用於兒童

或體型嬌小者)

24210

FBSF148145S9 XIA 4.5 TITANIUM SPINAL IMPLANTS (SX6+RX2)三節(適用於兒童

或體型嬌小者)

35358

FBSF148232S9 "STRYKER" XIA 3 SPINAL SYSTEM TWO LEVEL(SX4+RX2)"史賽克"

喜爾三脊椎系統二節 ※適應症請見備註欄

23358

FBSF148233S9 "STRYKER" XIA 3 SPINAL SYSTEM THERE LEVEL(SX6+RX2)"史賽

克"喜爾三脊椎系統三節 ※適應症請見備註欄

34118

FBSF1495XNS1 TITANIUM CLICK'X SPINAL SYSTEM上開式三節(SX6+RX2) ※適應

症請見備註欄

34118

FBSF14981NS1 TITANIUM UNIVERSAL SPINAL SYSTEM (二節 SCREWX4+RODX2)※適

應症請見備註欄,須事前審查

23358

FBSF14982NS1 VENTROFIX ANTERIOR SPINAL SYSTEM(RODX2+或X1+SCREWX4)※適

應症請見備註欄

23886

FBSF14985NS1 TITANIUM CLICK'X SPINAL SYSTEM上開式二節(SX4+RX2) ※適應

症請見備註欄

23358

FBSF1498XNS1 TITANIUM UNIVERSAL SPINAL SYSTEM (三節 SCREWX6+RODX2)※適

應症請見備註欄,須事前審查

34118

FBSF16200NDX TITANIUM SPINAL IMPLANT(RX2+SX4)二節 型號48485030:9060,XL

自90/07/01生效※適應症請見備註欄

23358

FBSF16200NS9 TITANIUM SPINAL IMPLANT(DIAPASON)(RX2+SX4)脊椎人工置換

組:二節 ※適應症請見備註欄

23358

FBSF16202NS1 TITANIUM PANGEA SPINAL SYSTEM(SX4+RX2) ※適應症請見備註欄 23358

FBSF16203NS1 TITANIUM PANGEA SPINAL SYSTEM(SX6+RX2) ※適應症請見備註欄 34118

FBSF162722DP DEPUY SPINE(DEPUY SPINE SARL)MOSS MIAMI SPINE

SYSTEM(RX2+SX4) 帝富脊椎莫斯(士)邁阿密脊椎系統(二節)※適

應症請見備註欄

23358

FBSF162723DP DEPUY SPINE(DEPUY SPINE SARL)MOSS MIAMI SPINE

SYSTEM(RX2+SX6) 帝富脊椎莫斯(士)邁阿密脊椎系統(三節)※適

應症請見備註欄

34118

1028

特材代碼 中英文名稱 支付點數-104/01/01

FBSF16300NDX TITANIUM SPINAL IMPLANT 三節(SX6+RX2)型號48485030:9060,XL

自90/07/01生效※適應症請見備註欄

34118

FBSF16300NS9 TITANIUM SPINAL IMPLANT(DIAPASON)(RX2+SX6)脊椎人工置換

組:三節 ※適應症請見備註欄

34118

FBSF1765P2Y2 TITANIUM SPINAL SYSTEM二節(RX2+SX4)※適應症請見備註欄 23358

FBSF1765P3Y2 TITANIUM SPINAL SYSTEM三節(RX2+SX6)※適應症請見備註欄 34118

FBSF177202Y2 TITANIUM SPINAL SYSTEM(RX2+SX4)二節※適應症請見備註欄 23358

FBSF177203Y2 TITANIUM SPINAL SYSTEM(RX2+SX6)三節※適應症請見備註欄 34118

FBSF177402Y2 TITANIUM O TYPE SPINAL SYSTEM 二節(RX2+SX4)※適應症請見備

註欄

23358

FBSF177403Y2 TITANIUM O TYPE SPINAL SYSTEM 三節(RX2+SX6)※適應症請見備

註欄

34118

FBSF180001RK TITANIUM SPINAL SYSTEM (SX4+RX2)二節※適應症請見備註欄 23358

FBSF180002RK TITANIUM SPINAL SYSTEM (SX6+RX2)三節 ※適應症請見備註欄 34118

FBSF180003RK TITANIUM SPINAL SYSTEM 二節(SX4+RX2) ※適應症請見備註欄 23358

FBSF180004RK TITANIUM SPINAL SYSTEM 三節(SX6+RX2) ※適應症請見備註欄 34118

FBSF180005RK TITANIUM SPINAL SYSTEM 二節(SX4+RX2) ※適應症請見備註欄 23358

FBSF180006RK TITANIUM SPINAL SYSTEM 三節(SX6+RX2) ※適應症請見備註欄 34118

FBSF180NP2Y2 ARTEST SPINAL FIXATION SYSTEM(SX4+RX2)二節 亞力士脊椎固定

系統※適應症請見備註欄

23358

FBSF180NP3Y2 ARTEST SPINAL FIXATION SYSTEM(SX6+RX2)三節 亞力士脊椎固定

系統 ※適應症請見備註欄

34118

FBSF1821XNDA TITANIUM ZPLATE ANTERIOR SPINAL SYSTEM (PLATEX1+SCREWX4)

※適應症請見備註欄,須事前審查

23886

FBSF1822MNM4 ZPLATE II ANTERIOR FIXATION SYSTEM(PX1+SX4)二節※適應症請

見備註欄

23886

FBSF1865P2M4 BASIS SPINAL SYSTEM 二節(ATL PLATE SYSTEM)(PX1+SX4)※適應

症請見備註欄

23358

FBSF188CP2Y2 "SYNTEC" COLISEUM SPINAL FIXATION SYSTEM "亞太醫療"高立捷

脊椎固定系統二節(RX2+SX4) ※適應症請見備註欄

23358

FBSF188CP3Y2 "SYNTEC" COLISEUM SPINAL FIXATION SYSTEM "亞太醫療"高立捷

脊椎固定系統三節 ※適應症請見備註欄

34118

FBSF1A3N2NXA A3 POSTERIOR TITANIUM SPINAL SYSTEM 二節(RX2+SX4)※適應症

請見備註欄

23358

FBSF1A3N3NXA A3 POSTERIOR TITANIUM SPINAL SYSTEM 三節(RX2+SX6)※適應症

請見備註欄

34118

FBSF1AAS2NXA TITANIUM SPINAL SYSTEM二節(RX2+SX4)※適應症請見備註欄 23358

FBSF1AAS8NXA TITANIUM SPINAL SYSTEM三節(RX2+SX6)※適應症請見備註欄 34118

FBSF1ASAT1AQ TITANIUM ANTERIOR SPINAL SYSTEM(PX1+SX4)※適應症請見備註

23886

FBSF1ASPL1AQ TITANIUM SPINAL SYSTEM二節(RX2+SX4)※適應症請見備註欄 23358

FBSF1ASPL2AQ TITANIUM SPINAL SYSTEM二節(PX2+SX4)※適應症請見備註欄 23358

FBSF1ASPL3AQ TITANIUM SPINAL SYSTEM三節(RX2+SX6)※適應症請見備註欄 34118

FBSF1ASPL4AQ TITANIUM SPINAL SYSTEM三節(PX2+SX6)※適應症請見備註欄 34118

FBSF1ASY01AQ TITANIUM SMARTLOC SPINAL SYSTEM二節(SX4+RX2)※適應症請見

備註欄

23358

FBSF1ASY02AQ TITANIUM SMARTLOC SPINAL SYSTEM三節(SX6+RX2)※適應症請見

備註欄

34118

FBSF1ASY05AQ SMARTLOC EVOLUTION SPINAL SYSTEM (SX4+RX2)史麥特艾爾脊椎

固定系統:二節 ※適應症請見備註欄

23358

FBSF1ASY06AQ TITANIUM SMARTLOC EVOLUTION SPINAL SYSTEM(SX6+RX2)史麥特

艾爾脊椎固定系統:三節 ※適應症請見備註欄

34118

1029

特材代碼 中英文名稱 支付點數-104/01/01

FBSF1BAR121S "SCIENT'X"ISOBAR TTL VERTEBRAL CONNECTION SYSTEM "賽恩司"

脊椎連接系統:二節(SX4+RX2)※給付規定請見備註欄

23358

FBSF1BAR131S "SCIENT'X"ISOBAR TTL VERTEBRAL CONNECTION SYSTEM "賽恩司"

脊椎連接系統:三節(SX6+RX2)※給付規定請見備註欄

34118

FBSF1CDH2TDA TITANIUM CD HORIZON SPINAL SYSTEM二節(SCREWX4+RODX2)※適

應症請見備註欄

23886

FBSF1CDH3TDA TITANIUM CD HORIZON SPINAL SYSTEM三節(SCREWX6+RODX2)※適

應症請見備註欄

34118

FBSF1GS12NG0 GSS TITANIUM SPINAL SYSTEM 二節(RX2+SX4) ※適應症請見備註

23358

FBSF1GS13NG0 GSS TITANIUM SPINAL SYSTEM 三節(RX2+SX6) ※適應症請見備註

34118

FBSF1HUTR2GZ GEZEN SPINAL FIXATION SYSTEM(RX2+SX4)際仁脊椎固定系統(二

節)※適應症請見備註欄

23358

FBSF1HUTR3GZ GEZEN SPINAL FIXATION SYSTEM(RX2+SX6)際仁脊椎固定系統(三

節)※適應症請見備註欄

34118

FBSF1JAVA2JA TITANIUM SPINAL SYSTEM 二節(RX2+SX4)※適應症請見備註欄 23358

FBSF1JAVA3JA TITANIUM SPINAL SYSTEM 三節(RX2+SX6)※適應症請見備註欄 34118

FBSF1LERS2M4 "MEDTRONIC" CD HORIZON LEGACY SPINAL SYSTEM(RX2+SX4) "美

敦力"雷格斯脊椎矯正系統二節※適應症請見備註欄

23358

FBSF1LERS3M4 "MEDTRONIC" CD HORIZON LEGACY SPINAL SYSTEM(RX2+SX6) "美

敦力"雷格斯脊椎矯正系統三節※適應症請見備註欄

34118

FBSF1LSTR2GZ GEZEN SPINAL FIXATION SYSTEM(RX2+SX4)際仁脊椎固定系統(二

節)※適應症請見備註欄

23358

FBSF1LSTR3GZ GEZEN SPINAL FIXATION SYSTEM(RX2+SX6)際仁脊椎固定系統(三

節)※適應症請見備註欄

34118

FBSF1LUTR2GZ GEZEN SPINAL FIXATION SYSTEM(RX2+SX4)際仁脊椎固定系統二節

※適應症請見備註欄

23358

FBSF1LUTR3GZ GEZEN SPINAL FIXATION SYSTEM(RX2+SX6)際仁脊椎固定系統三節

※適應症請見備註欄

34118

FBSF1M3SP3Z6 TITANIUM M3 SPINAL POSTERIOR SYSTEM 三節(RX2+SX6)※適應症

請見備註欄

34118

FBSF1M8RS2M4 "美敦力"思迪M8脊椎固定系統-2節"MEDIRONIC"CD HORIZON M8

SPINAL SYSTEM

13816

FBSF1M8RS3M4 "美敦力"思迪M8脊椎固定系統-3節"MEDIRONIC"CD HORIZON M8

SPINAL SYSTEM

20044

FBSF1MES2NZ6 TITANIUM SPINAL SYSTEM二節(RODX2或PLATEX2+SCREWX4)※適應

症請見備註欄

23358

FBSF1MES3NZ6 TITANIUM SPINAL SYSTEM三節(RODX2或PLATEX2+SCREWX6)※適應

症請見備註欄

34118

FBSF1P2SP2Z6 "MERRIES"PROT II POSTERIOR SPINE SYSTEM(RX2+SX4) "美瑞世"

普生二代後方脊椎固定器二節※適應症請見備註欄

23358

FBSF1P2SP3Z6 "MERRIES"PROT II POSTERIOR SPINE SYSTEM (RX2+SX6) "美瑞

世"普生二代後方脊椎固定器三節※適應症請見備註欄

34118

FBSF1PCS03V2 "INTAI"SPINAL FIXATION SYSTEM(RX2+SX4)"鐿鈦"脊椎固定系統:

二節※給付規定請見備註欄

23358

FBSF1PCS03WG WILTROM SPINAL FIXATON SYSTEM (RX2+SX4) 威創脊椎固定系

統:二節※適應症請見備註欄

23358

FBSF1PCS04V2 "INTAI"SPINAL FIXATION SYSTEM(RX2+SX6)"鐿鈦"脊椎固定系統:

三節※給付規定請見備註欄

34118

FBSF1PCS04WG WILTROM SPINAL FIXATON SYSTEM (RX2+SX6) 威創脊椎固定系

統:三節※適應症請見備註欄

34118

FBSF1PCS05WG "WILTROM"SPINAL FIXATION SYSTEM(RX2+SX4)"威創"脊椎固定系

統:二節※給付規定請見備註欄

23358

1030

特材代碼 中英文名稱 支付點數-104/01/01

FBSF1PCS06WG "WILTROM"SPINAL FIXATION SYSTEM(RX2+SX6)"威創"脊椎固定系

統:三節※給付規定請見備註欄

34118

FBSF1R200NS9 XIA REDUCTION IMPLANTS 二節(RX2+SX4)※適應症請見備註欄 23358

FBSF1R300NS9 XIA REDUCTION IMPLANTS 三節(RX2+SX6)※適應症請見備註欄 34118

FBSF1SA1T2Y2 TITANIUM UNIVERSAL ANTERIOR SPINAL FIXATION

SYSTEM(SX4+PX1)※適應症請見備註欄

23886

FBSF1SA2T2Y2 TITANIUM UNIVERSAL ANTERIOR SPINAL FIXATION

SYSTEM(SX4+BLOCKX2+RODX2)※適應症請見備註欄

23886

FBSF1SW200AE "AESCULAP"TITANIUM S4 SPINAL SYSTEM二節(SX4+RX2)"雅氏"雅

士弗脊椎固定系統※適應症請見備註欄

23358

FBSF1SW300AE "AESCULAP"TITANIUM S4 SPINAL SYSTEM三節(SX6+RX2)"雅氏"雅

士弗脊椎固定系統※適應症請見備註欄

34118

FBSF1T2552DP M-M TITANIUM SPINAL SYSTEM(二節) ※適應症請見備註欄 23358

FBSF1T3553DP M-M TITANIUM SPINAL SYSTEM(三節) ※適應症請見備註欄 34118

FBSF1X200NS9 XIA TITANIUM SPINAL IMPLANTS 二節

(SX4+RX2)(03820425:860,03821425:760自92/4/1生效)※適應症

請見備註欄

23358

FBSF1X300NS9 XIA TITANIUM SPINAL IMPLANTS 三節

(SX6+RX2)(03820425:860,03821425:760自92/4/1生效)※適應症

請見備註欄

34118

FBSF2000021A MONT BLANC SPINAL ROD 短※適應症請見備註欄 919

FBSF2000041A MONT BLANC SPINAL ROD 長※適應症請見備註欄 2662

FBSF2000F41A "SPINEWAY" MONT BLANC SPINE SYSTEM:ROD 132:158MM"施百威”

脊椎固定系統:固定桿(免事前審查)

1419

FBSF20572NDP M-M TITANIUM ROD 30CM,48CM※適應症請見備註欄 2662

FBSF20574NDP M-M TITANIUM ROD 12CM※適應症請見備註欄 919

FBSF210002TT TITANIUM SPINAL ROD 110MM:450MM(免事前審查) 1419

FBSF210B2NZ6 TITANIUM SPINAL ROD 4.5:10.5CM※適應症請見備註欄 919

FBSF210B5NZ6 TITANIUM SPINAL ROD 12.5:20CM※適應症請見備註欄 2662

FBSF21534NS1 TITANIUM UNIVERSAL SPINAL ROD LONG 免事前審查 1419

FBSF21600LTD TITANIUM TREND SPINAL ROD 110:300MM※適應症請見備註欄 2662

FBSF21600STD TITANIUM TREND SPINAL ROD※適應症請見備註欄 919

FBSF22110NS9 XIA TITANIUM SPINAL ROD 110:350MM(免事前審查) 1419

FBSF248147S9 XIA TITANIUM SPINAL ROD 40:100MM(短節)(適用於兒童或體型嬌

小者)

957

FBSF248148S9 XIA TITANIUM SPINAL ROD 110:600MM (長節)(適用於兒童或體型

嬌小者)

2662

FBSF248232S9 "STRYKER" XIA 3 SPINAL SYSTEM:ROD 30:100MM "史賽克"喜爾三

脊椎系統:固定桿短節 ※適應症請見備註欄

919

FBSF248233S9 "STRYKER" XIA 3 SPINAL SYSTEM:ROD 11:600MM "史賽克"喜爾三

脊椎系統:固定桿長節 ※適應症請見備註欄

2662

FBSF24981NS1 TITANIUM UNIVERSAL SPINAL ROD ※適應症請見備註欄 919

FBSF24985NS1 TITANIUM PANGEA ROD 35:85MM ※適應症請見備註欄 919

FBSF2498XNS1 TITANIUM UNIVERSAL SPINAL ROD LONG ※適應症請見備註欄,應

事前審查

2662

FBSF254040B0 TITANIUM SPINAL ROD 40MM:110MM(短節)※適應症請見備註欄 919

FBSF254047B0 TITANIUM SPINAL ROD 120MM:200MM(長節)※適應症請見備註欄 2662

FBSF26202NS1 TITANIUM PANGEA ROD 200-500MM ※適應症請見備註欄 2662

FBSF26504NDX TITANIUM DIAPASON SPINAL ROD 40:100MM ※適應症請見備註欄

,須事前審查

919

FBSF26504NS9 TITANIUM SPINAL IMPLANT(DIAPASON):ROD 70:100MM 脊椎人工

置換組:固定桿※適應症請見備註欄

919

FBSF265111S9 TITANIUM SPINAL IMPLANT(DIAPASON):ROD 110:250MM脊椎人工

置換組:固定桿(免事前審查)

1419

1031

特材代碼 中英文名稱 支付點數-104/01/01

FBSF26511NDX TITANIUM DIAPASON SPINAL ROD 11:40CM ※適應症請見備註欄,

須事前審查

2662

FBSF26511NS9 TITANIUM SPINAL (DIAPASON)ROD 26:40CM脊椎人工置換組:固定

桿※適應症請見備註欄

2662

FBSF276590Y2 TITANIUM SPINAL ROD 5:10CM※適應症請見備註欄 919

FBSF27659NY2 TITANIUM SPINAL ROD 12:30CM※適應症請見備註欄 2662

FBSF277006Y2 TITANIUM SPINAL ROD短節※適應症請見備註欄 919

FBSF277011Y2 TITANIUM SPINAL ROD 6X110:300MM 長節固定四節以上(免術前審

查)

1419

FBSF277071Y2 TITANIUM SPINAL FIXATION PLATE 45:80MM※適應症請見備註欄 919

FBSF2785NLY2 ARTEST SPINAL FIXATION SYSTEM:ROD 115:450MM 亞力士脊椎固

定系統長節連接管※適應症請見備註欄

2662

FBSF2785NSY2 ARTEST SPINAL FIXATION SYSTEM:ROD 20:110MM 亞力士脊椎固

定系統短節連接管※適應症請見備註欄

919

FBSF2820NLY2 TITANIUM SPINAL ROD 11.5:45CM 長節 免事前審查 1419

FBSF2839NLY2 "SYNTEC" AREIKEN SPINAL FIXATION SYSTEM:ROD "亞太醫療"亞

力健脊椎固定系統:連結棒(長節)11.5~45CM,免事前審查

1419

FBSF2855LTDA TITANIUM CD HORIZON SPINAL ROD(長節) ※適應症請見備註欄 2662

FBSF2855STDA TITANIUM CD HORIZON SPINAL ROD(短節) ※適應症請見備註欄 919

FBSF2886NLY2 ROD 連結棒-長節 1419

FBSF2887CLY2 ROD 連結棒-長節 ※適應症請見備註欄 2662

FBSF2887CSY2 ROD 連結棒-短節 ※適應症請見備註欄 919

FBSF2911NLY2 "SYNTEC"COLISEUM SPINAL FIXATION SYSTEM:ROD 120:450MM"亞

太醫療"高立捷脊椎固定系統:連接桿(長節)免事前審查

1419

FBSF2913CLY2 "SYNTEC"COLISEUM SPINAL FIXATION SYSTEM:ROD 120:450MM"亞

太醫療"高立捷脊椎固定系統:連接桿(長節)※適應症請見備註欄

2662

FBSF2913CSY2 "SYNTEC"COLISEUM SPINAL FIXATION SYSTEM:ROD 40:100MM"亞太

醫療"高立捷脊椎固定系統:連接桿(短節)※適應症請見備註欄

919

FBSF2A3R1NXA A3 POSTERIOR TITANIUM SPINAL ROD 4:10CM※適應症請見備註欄 919

FBSF2A3R2NXA A3 POSTERIOR TITANIUM SPINAL ROD 11:50CM ※適應症請見備註

2662

FBSF2ASLP1AQ TITANIUM SPINAL PLATE※適應症請見備註欄 919

FBSF2ASLR1AQ TITANIUM SPINAL ROD 20:90MM※適應症請見備註欄 919

FBSF2ASLR2AQ TITANIUM SPINAL ROD 110:450MM※適應症請見備註欄 2662

FBSF2ASNR2AQ TITANIUM SMARTLOC SPINAL ROD 110:450MM免事前審前 1419

FBSF2ASYR1AQ TITANIUM SMARTLOC SPINAL ROD 40:100MM※適應症請見備註欄 919

FBSF2ASYR2AQ TITANIUM SMARTLOC SPINAL ROD 110:480MM※適應症請見備註欄 2662

FBSF2ASYR3AQ TITANIUM SMARTLOC EVOLUTION SPINAL ROD 40MM:100MM ※適應

症請見備註欄

919

FBSF2ASYR4AQ TITANIUM SMARTLOC EVOLUTION SPINAL ROD 110:600MM ※適應症

請見備註欄

2662

FBSF2B0002RK TITANIUM SPINAL ROD 110:480MM(長節)免事前審查 1419

FBSF2BA001RK TITANIUM SPINAL ROD 40:100MM(短節)※適應症請見備註 919

FBSF2BA002RK TITANIUM SPINAL ROD 110:450MM(長節)※適應症請見備註欄 2662

FBSF2BA003RK TITANIUM SPINAL PLATE※適應症請見備註欄 919

FBSF2BAR2L1S "SCIENT'X"ISOBAR TTL VERTEBRAL CONNECTION SYSTEM:ROD

110~400MM"賽恩司"脊椎連接系統:固定桿(長節)※給付規定請見

備註欄

2662

1032

特材代碼 中英文名稱 支付點數-104/01/01

FBSF2BAR2S1S "SCIENT'X"ISOBAR TTL VERTEBRAL CONNECTION SYSTEM:ROD

45~95MM"賽恩司"脊椎連接系統:固定桿(短節)※給付規定請見備

註欄

919

FBSF2GS21NG0 GSS TITANIUM SPINAL ROD 40-100MM※適應症請見備註欄 919

FBSF2GS22NG0 GSS TITANIUM SPINAL ROD 110-600MM※適應症請見備註欄 2662

FBSF2L3401U0 "UNITED"CENTURY SPINAL SYSTEM:ROD 11:51CM "聯合"世紀脊椎

固定系統固定桿(長節)※適應症請見備註欄

2662

FBSF2LR002GZ GEZEN SPINAL FIXATION SYSTEM:ROD際仁脊椎固定系統:脊椎固定

桿長節 免事前審查

1419

FBSF2M3LRDZ6 TITANIUM M3 SPINAL POSTERIOR ROD 125:300MM※適應症請見備

註欄

2662

FBSF2P2LRDZ6 “美瑞世”普生二代後方脊椎固定器:固定桿"MERRIES”PROT II

POSTERIOR SPINE SYSTEM:ROD ※給付規定請見備註欄

2662

FBSF2P2SRDZ6 PROT II POSTERIOR SPINE ROD 4.5:10.5CM※適應症請見備註欄 919

FBSF2PR041B0 TITANIUM SPINAL ROD 110MM:450MM免事前審查 1419

FBSF2R063NXA TITANIUM SPINAL ROD 4:11CM※適應症請見備註欄 919

FBSF2R068NXA TITANIUM SPINAL ROD 13:40CM※適應症請見備註欄 2662

FBSF2R1797DP DEPUY SPINE MOSS MIAMI SPINE SYSTEM:ROD 帝富脊椎莫斯邁阿

密脊椎系統:固定桿※適應症請見備註欄

919

FBSF2R3401U0 "UNITED"CENTURY SPINAL SYSTEM:ROD 3:10CM "聯合"世紀脊椎固

定系統固定桿(短節)※適應症請見備註欄

919

FBSF2R482NS9 XIA REDUCTION ROD 30:90MM※適應症請見備註欄 919

FBSF2R8550M4 TITANIUM CD HORIZON M8 SPINAL ROD 20"(免術前審查) 1419

FBSF2R855LM4 TITANIUM CD HORIZON M8 SPINAL ROD長節 50.4CM※適應症請見

備註欄

2662

FBSF2R869SM4 "美敦力"思迪M8脊椎固定系統-短節固定桿"MEDTRONIC"CD

HORIZON M8 SPINAL SYSTEM:ROD 3CM,8CM

679

FBSF2RD02TV2 "INTAI"SPINAL FIXATION SYSTEM:ROD 110:500MM"鐿鈦"脊椎固定

系統:長節連接桿(免事前審查)

1419

FBSF2RD02TWG "WILTROM"SPINAL FIXATION SYSTEM:TITANIUM SPINAL ROD

125:500MM"威創"脊椎固定系統:連接桿125:500MM(免事前審查)

1419

FBSF2RD03TV2 "INTAI"SPINAL FIXATION SYSTEM:TITANIUM ROD 25:100MM"鐿鈦"

脊椎固定系統:連接桿※給付規定請見備註欄

919

FBSF2RD03TWG "WILTROM"SPINAL FIXATON SYSTEM:TITANIUM ROD 25:100MM "威

創"脊椎固定系統:連接桿

919

FBSF2RD04TV2 "INTAI"SPINAL FIXATION SYSTEM:TITANIUM ROD 110:500MM"鐿

鈦"脊椎固定系統:長節連接桿※給付規定請見備註欄

2662

FBSF2RD04TWG "WILTROM"SPINAL FIXATON SYSTEM:TITANIUM ROD 125:500MM "威

創"脊椎固定系統:連接桿

2662

FBSF2RF00LRX RF SPINAL ROD 110:150MM(免事前審查) 1419

FBSF2RL869M4 "MEDTRONIC" CD HORIZON LEGACY SPINAL SYSTEM:ROD 500MM "美

敦力"雷格斯脊椎矯正系統:固定桿長節※適應症請見備註欄

2662

FBSF2RS869M4 "MEDTRONIC" CD HORIZON LEGACY SPINAL SYSTEM:ROD 30-120MM

"美敦力"雷格斯脊椎矯正系統:固定桿短節※適應症請見備註欄

919

FBSF2RY68NXA Y TYPE POSTERIOR TITANIUM SPINAL ROD 12:40CM(免事前審查) 1419

FBSF2SR125Z6 TITANIUM SPINAL ROD 125MM:200MM(免事前審查) 1419

FBSF2SW35NAE "AESCULAP"TITANIUM S4 SPINAL SYSTEM:ROD 35MM:120MM"雅氏"

雅士弗脊椎固定系統:支撐桿※適應症請見備註欄

919

FBSF2SW50NAE "AESCULAP"TITANIUM S4 SPINAL SYSTEM:ROD 150MM:500MM"雅

氏"雅士弗脊椎固定系統:支撐桿※適應症請見備註欄

2662

FBSF2SX12NAE TITANIUM SPINE ROD 250-500MM (96年10月1日起免事前審查) 1419

1033

特材代碼 中英文名稱 支付點數-104/01/01

FBSF2T1FRMCM TI-FRAME TITANIUM(後頸椎固定架)※適應症請見備註欄 6656

FBSF2TL01TJA TITANIUM SPINAL ROD 30:100MM※適應症請見備註欄 919

FBSF2TL02TJA TITANIUM SPINAL ROD 120:800MM※適應症請見備註欄 2662

FBSF2TR001GZ GEZEN SPINAL FIXATION SYSTEM:ROD 40:105 MM 際仁脊椎固定系

統:固定桿(短)※適應症請見備註欄

919

FBSF2TR002GZ GEZEN SPINAL FIXATION SYSTEM:ROD 110-500 MM 際仁脊椎固定

系統:固定桿(長)※適應症請見備註欄

2662

FBSF2TS02TJA TITANIUM SPINAL ROD 120-200MM(免事前審查) 1419

FBSF2X204NS9 XIA TITANIUM SPINAL ROD 70:100MM※適應症請見備註欄 919

FBSF2X211NS9 XIA TITANIUM SPINAL ROD 360:600MM※適應症請見備註欄 2662

FBSF3000031A MONT BLANC SPINAL HOOK※適應症請見備註欄 3311

FBSF30559NDP M-M TITANIUM HOOK※適應症請見備註欄 3311

FBSF3140XNTD TITANIUM TREND SPINAL HOOK※適應症請見備註欄 3311

FBSF340051WG "WILTROM"SPINAL FIXATION SYSTEM:HOOK"威創"脊椎固定系統:椎

弓鉤※適應症請見備註欄

3311

FBSF348150S9 XIA TITANIUM SPINAL HOOK(適用於兒童或體型嬌小者) 4997

FBSF348232S9 "STRYKER" XIA 3 SPINAL SYSTEM:HOOK"史賽克"喜爾三脊椎系統:

骨鉤※適應症請見備註欄

3311

FBSF34983NS1 TITANIUM UNIVERSAL SPINAL HOOK ※適應症請見備註欄,須事前

審查

3311

FBSF36201NS1 TITANIUM PANGEA SPINAL HOOK※適應症請見備註欄 3311

FBSF375504Y2 STAINLESS SPINAL HOOK※適應症請見備註欄 2725

FBSF376504Y2 TITANIUM SPINAL HOOK※適應症請見備註欄 3311

FBSF377041Y2 TITANIUM SPINAL HOOK(免術前審查) 1490

FBSF3961TMDA TITANIUM CD HORIZON SPINAL HOOK ※適應症請見備註欄 3311

FBSF3ASLH1AQ TITANIUM SPINAL HOOK※適應症請見備註欄 3311

FBSF3ASYH1AQ TITANIUM SMARTLOC SPINAL HOOK※適應症請見備註欄 3311

FBSF3ASYH2AQ SMARTLOC EVOLUTION SYSTEM:HOOK 史麥特艾爾脊椎固定系統:固

定鉤※適應症請見備註欄

3311

FBSF3BA001RK TITANIUM SPINAL HOOK ※適應症請見備註欄 3311

FBSF3H212NXA TITANIUM SPINAL PEDICLE HOOK※適應症請見備註欄 3311

FBSF3H754PM4 "MEDTRONIC" CD HORIZON LEGACY SPINAL SYSTEM:HOOK "美敦力"

雷格斯脊椎矯正系統:骨鉤※適應症請見備註欄

3311

FBSF3H8415M4 TITANIUM CD REDUCTION SCREW CONNECTOR HOOK(免術前審查) 1490

FBSF3H859PM4 TITANIUM CDH M8 PEDIATRIC HOOK※適應症請見備註欄 3311

FBSF3H859SM4 TITANIUM CD HORIZON M8 SPINAL HOOK※適應症請見備註欄 3311

FBSF3H869RM4 TITANIUM CDH M8 REDUCTION SPINAL HOOK※適應症請見備註欄 3311

FBSF3LK003GZ GEZEN SPINAL FIXATION SYSTEM:HOOK 際仁脊椎固定系統:固定鉤

※適應症請見備註欄

3311

FBSF3R382NS9 XIA REDUCTION HOOK※適應症請見備註欄 3311

FBSF3X600NS9 XIA TITANIUM SPINAL HOOK※適應症請見備註欄

(03820200:20215;03820220;20221;20230;20231自980401生效)

3311

FBSF3XPDHTDP "DEPUY SPINE"EXPEDIUM SPINE SYSTEM:HOOK "帝富脊椎"易配置

脊椎系統:固定鉤※給付規定請見備註欄

3311

FBSF4000041A MONT BLANC SPINAL SCREW※適應症請見備註欄 5380

FBSF4010RNZ6 TITANIUM SPINAL SCREW※適應症請見備註欄 5380

FBSF40536NDP M-M TITANIUM SCREW MONO(型號1755-29125:29155自92/1/1生效)

※適應症請見備註欄

5380

FBSF40543NDP M-M TITANIUM SCREW POLY(型號1755-37125:37155自92/1/1生效)

※適應症請見備註欄

5380

FBSF409099DP TITANIUM MOSS MIAMI SPINAL SCREW※適應症請見備註欄 5380

FBSF4110XNTD TITANIUM TREND SPINAL SCREW※適應症請見備註欄 5380

FBSF41300NB0 TITANIUM SPINAL FIXATION SYSTEM:SCREW 脊椎固定螺絲 ※適

應症請見備註欄

5380

1034

特材代碼 中英文名稱 支付點數-104/01/01

FBSF41600NB0 "BMI"SPINAL FIXATION SYSTEM:OPS TITANIUM SPINAL SCREW "長

安"脊頸椎內固定系統:脊椎骨質疏鬆內固定釘※適應症請見備註

12960

FBSF41797CDP DEPUY SPINE SARL MOSS MIAMI SPINE SYSTEM:SCREW 帝富脊椎莫

士邁阿密脊椎系統:固定釘※適應症請見備註欄

5380

FBSF41797UDP DEPUY SPINE MOSS MIAMI SPINE SYSTEM:SCREW 帝富脊椎莫斯邁

阿密脊椎系統:固定釘※適應症請見備註欄

5380

FBSF44005TWG "WILTROM"SPINAL FIXATION SYSTEM:CANNULATED REDUCTION

PEDICLE SCREW U TYPE"威創"脊椎固定系統:脊椎骨釘中空折斷U

型※適應症請見備註欄

5380

FBSF44008TWG "WILTROM"SPINAL FIXATION SYSTEM:CANNULATED PEDICLE SCREW

POLY-AXIAL U TYPE"威創"脊椎固定系統:脊椎骨釘中空U型多軸向

※適應症請見備註欄

5380

FBSF44009TWG "WILTROM"SPINAL FIXATION SYSTEM:CANNULATED PEDICLE SCREW

POLY-AXIAL REDUCTION U TYPE"威創"脊椎骨釘中空U型多軸向折

斷※適應症請見備註欄

5380

FBSF44010TWG "WILTROM"SPINAL FIXATION SYSTEM:CANNULATED PEDICLE SCREW

U TYPE"威創"脊椎固定系統:脊椎骨釘中空U型※適應症請見備註

5380

FBSF44011TV2 "INTAI"SPINAL FIXATION SYSTEM:PEDICLE SCREW POLY-AXIAL U

TYPE"鐿鈦"脊椎固定系統:脊椎骨釘-U型多軸向※給付規定請見備

註欄

5380

FBSF44011TWG "WILTROM"SPINAL FIXATION SYSTEM:PEDICLE SCREW POLY-AXIAL

U TYPE"威創"脊椎固定系統:脊椎骨釘U型多軸向※給付規定請見

備註欄

5380

FBSF44012TV2 "INTAI"SPINAL FIXATION SYSTEM:CANNULATED PEDICLE SCREW

POLY-AXIAL U TYPE"鐿鈦"脊椎固定系統:脊椎骨釘-中空U型多向

12960

FBSF44012TWG "WILTROM"SPINAL FIXATION SYSTEM:CANNULATE PEDICLE SCREW

POLY-AXIAL U TYPE"威創"脊椎固定系統:脊椎骨釘中空U型多軸向

※給付規定請見備註欄

12960

FBSF448146S9 XIA 4.5 TITANIUM SPINAL SCREW(適用於兒童或體型嬌小者) 5574

FBSF448231S9 "STRYKER"XIA SPINAL SYSTEM:TITANIUM CANNULATED SCREW"史賽

克"喜爾脊椎系統:中空螺釘※給付規定請見備註欄

12960

FBSF448232S9 "STRYKER" XIA 3 SPINAL SYSTEM:SCREW"史賽克"喜爾三脊椎系

統:骨釘 ※適應症請見備註欄

5380

FBSF448233S9 "STRYKER" XIA 3 SPINAL SYSTEM:SCREW"史賽克"喜爾三脊椎系

統:骨釘 ※適應症請見備註欄

5380

FBSF44985NS1 TITANIUM UNIVERSAL SPINAL SCREW ※適應症請見備註欄 5380

FBSF44988NS1 TITANIUM CLICK'X SPINAL SCREW※適應症請見備註欄 5380

FBSF44989NS1 TITANIUM CLICK'X SPINAL SCREW ※適應症請見備註欄

(499.500V:507V;520V:527V自981001刪除)

5380

FBSF46121NY2 STAINLESS CERVICAL SCREW 17:24MM 164

FBSF461221Y2 STAINLESS SPINAL RESCUABLE SCREW(FBSF46121NY2失敗時用,配

合FBSF661202Y2用)

164

FBSF461321Y2 TITANIUM SPINAL RESCUABLE SCREW(FBSF66131NY2失敗時用,配合

FBSF661302Y2用)

180

FBSF46132NY2 TITANIUM CERVICAL SCREW(配合FBSF36132NY2使用) 2100

FBSF46201NS1 TITANIUM PANGEA PEDICLE SCREW※適應症請見備註欄 5380

FBSF46400NDX TITANIUM DIAPASON SPINAL SCREW型號48485030:9060,XL自

90/07/01生效 ※適應症請見備註欄

5380

FBSF46400NS9 TITANIUM SPINAL(DIAPASON)SCREW 脊椎人工置換組:骨釘※適應

症請見備註欄

5380

1035

特材代碼 中英文名稱 支付點數-104/01/01

FBSF471545B0 TITANIUM SPINAL SCREW(型號含120-6035:45)※適應症請見備註

5380

FBSF4765NNY2 TITANIUM SPINAL SCREW※適應症請見備註欄 5380

FBSF4772NNY2 TITANIUM SPINAL SCREW ※適應症請見備註欄 5380

FBSF4774NNY2 TITANIUM O TYPE SPINAL FIXATION SCREW※適應症請見備註欄 5380

FBSF48010TY2 "SYNTEC"ARTEST SPINAL FIXATION SYSTEM:POLYAXIAL PEDICLE

SCREW"亞太醫療"亞力士脊椎固定系統:圓形中空外孔多軸向椎弓

足骨釘※給付規定請見備註欄

12960

FBSF48022TY2 "亞太醫療"亞力士脊椎固定系統:中空外孔復位椎弓骨釘※給付規

定請見備註欄"SYNTEC” ARTEST SPINAL FIXATION

SYSTEM:CANNULATED REDUCTION PEDICLE SCREW

12960

FBSF4803NNY2 ARTEST SPINAL FIXATION SYSTEM:PEDICLE SCREW 亞力士脊椎固

定系統:骨釘※適應症請見備註欄

5380

FBSF4804NNY2 ARTEST SPINAL FIXATION SYSTEM:CANNULATED PEDICLE SCREW

亞力士脊椎固定系統:骨釘※適應症請見備註欄

5380

FBSF4806NNY2 ARTEST SPINAL FIXATION SYSTEM:POLYAXIAL PEDICLE SCREW 亞

力士脊椎固定系統:骨釘※適應症請見備註欄

5380

FBSF4807NNY2 ARTEST SPINAL FIXATION SYSTEM:CANNULATED POLYAXIAL

PEDICLE SCREW 亞力士脊椎固定系統骨釘※適應症請見備註欄

5380

FBSF4807TMDA TITANIUM CD HORIZON SPINAL SCREW ※適應症請見備註欄 5380

FBSF481405Y2 "SYNTEC"LATILS FIXATION SPINAL SYSTEM:MONOAXIAL

CANNULATED SCREW"亞太醫療"拉提士脊椎固定系統:單軸中空骨鬆

骨釘※給付規定請見備註欄

12960

FBSF481507Y2 "SYNTEC"LATILS FIXATION SPINAL SYSTEM:POLYAXIAL

CANNULATED SCREW"亞太醫療"拉提士脊椎固定系統:多軸中空骨鬆

骨釘※給付規定請見備註欄

12960

FBSF4884CHY2 POLYAXIAL SCREW 多軸骨釘 ※適應症請見備註欄 5380

FBSF4896CHY2 POLYAXIAL SCREW 多軸骨釘 ※適應症請見備註欄 5380

FBSF4A3S1NXA A3 POSTERIOR TITANIUM SPINAL SCREW ※適應症請見備註欄 5380

FBSF4ASLS1AQ TITANIUM SPINAL SCREW※適應症請見備註欄 5380

FBSF4ASYS1AQ TITANIUM SMARTLOC SPINAL SCREW※適應症請見備註欄 5380

FBSF4ASYS3AQ TITANIUM SMARTLOC EVOLUTION SPINAL SCREW ※適應症請見備註

5380

FBSF4ASYS6AQ SMARTLOC EVOLUTION SYSTEM:CANNULATED SCREW 史麥特艾爾脊椎

固定系統:中空螺釘※適應症請見備註欄

12960

FBSF4ASYS7AQ SMARTLOC EVOLUTION SYSTEM: SPINAL SCREW 史麥特艾爾脊椎固

定系統:骨釘※適應症請見備註欄

5380

FBSF4BA001RK TITANIUM SPINAL SCREW※適應症請見備註欄 5380

FBSF4BA002RK TITANIUM SPINAL SCREW※適應症請見備註欄 5380

FBSF4BA005RK TITANIUM SPINAL SCREW ※適應症請見備註欄 5380

FBSF4BA006RK TITANIUM SPINAL SCREW ※適應症請見備註欄 5380

FBSF4BA007RK TITANIUM SPINAL SCREW ※適應症請見備註欄 5380

FBSF4BA008RK "REBORN ESSENCE"LUMBAR FIXATION SYSTEM:PEDICLE LONG

SCREW"瑞寶億"腰椎內固定系統:椎弓根螺釘※適應症請見備註欄

5380

FBSF4BA011RK "REBORN ESSENCE"LUMBAR FIXATION SYSTEM:POLY AXIAL SCREW"

瑞寶億"腰椎內固定系統:萬向螺釘※適應症請見備註欄

5380

FBSF4BA012RK "REBORN ESSENCE"LUMBAR FIXATION SYSTEM:CANNULATED POLY

AXIAL SCREW"瑞寶億"腰椎內固定系統:中空萬向螺釘※給付規定

請見備註欄

12960

FBSF4BAR4S1S "SCIENT'X"ISOBAR TTL VERTEBRAL CONNECTION SYSTEM:SCREW"賽

恩司"脊椎連接系統:螺釘※給付規定請見備註欄

5380

FBSF4CSSCWZ6 "MERRIES"CANNULATED SPINAL SYSTEM:CANNULATED PEDICLE

SCREW "美瑞世"中空螺釘脊椎固定系統

12960

1036

特材代碼 中英文名稱 支付點數-104/01/01

FBSF4CU004GZ GEZEN SPINAL FIXATION SYSTEM:POLY AXIAL CANCELLOUS BONE

SCREW 際仁脊椎固定系統:多軸向鬆質骨骨釘※適應症請見備註欄

12960

FBSF4CV004GZ 際仁脊椎固定系統:鬆質骨骨釘※給付規定請備註欄GEZEN SPINAL

FIXATION SYSTEM:CANCELLOUS BONE SCREW

12960

FBSF4GS41NG0 GSS TITANIUM SPINAL PEDICLE SCREW※適應症請見備註欄 5380

FBSF4HU004GZ GEZEN SPINAL FIXATION SYSTEM:SCREW 際仁脊椎固定系統:骨釘

※適應症請見備註欄

5380

FBSF4LB05NAE STANLESS SPONGIOSA CERVICAL CASPAR SCREW 3.5MM WIDE

THREAD 10MM:19MM

164

FBSF4LB06NAE STANLESS SPONGIOSA CERVICAL CASPAR SCREW 3.5MM WIDE

THREAD 20MM 以上

164

FBSF4LS004GZ GEZEN SPINAL FIXATION SYSTEM:SCREW 際仁脊椎固定系統:骨釘

※適應症請見備註欄

5380

FBSF4LU004GZ GEZEN SPINAL FIXATION SYSTEM:SCREW 際仁脊椎固定系統:固定

釘※適應症請見備註欄

5380

FBSF4M3SSEZ6 TITANIUM M3 SPINAL POSTERIOR SCREW※適應症請見備註欄 5380

FBSF4MPS1NXA "AAXTER" MISS POSTERIOR SPINAL SYSTEM:CANNULATED SCREW "

全合"定位型脊椎後方固定器:中空螺釘※給付規定請見備註欄

12960

FBSF4P2PSPZ6 "MERRIES"PROT II POSTERIOR SPINE SYSTEM:SCREW "美瑞世"普

生二代後方脊椎固定器"固定釘※適應症請見備註欄

5380

FBSF4P2SCWZ6 PROT II POSTERIOR SPINE SCREW※適應症請見備註欄 5380

FBSF4R382NS9 XIA REDUCTION SCREW※適應症請見備註欄 5380

FBSF4S3101U0 "UNITED"CENTURY SPINAL SYSTEM:SCREW "聯合"世紀脊椎固定系

統骨螺絲※適應症請見備註欄

5380

FBSF4S754MM4 "MEDTRONIC" CD HORIZON LEGACY SPINAL SYSTEM:SCREW "美敦

力"雷格斯脊椎矯正系統:骨釘※適應症請見備註欄

5380

FBSF4S859FM4 "美敦力"思迪M8脊椎固定系統:固定角度骨釘"MEDIRONIC"CD

HORIZON M8 SPINAL SYSTEM:TITANIUM FIXED ANGLE SCREW

3114

FBSF4S869MM4 "美敦力"思迪M8脊椎固定系統-多角度骨釘"MEDIRONIC" CD

HORIZON M8 SPINAL SYSTEM:TITANIUM MULTI AXIAL SCREW

3114

FBSF4SW70NAE "AESCULAP"TITANIUM S4 SPINAL SYSTEM:TRANSPEDICULAR BONE

SCREW"雅氏"雅士弗脊椎固定系統:螺釘※適應症請見備註欄

5380

FBSF4TL01TJA TITANIUM SPINAL PEDICLE SCREW※適應症請見備註欄 5380

FBSF4UP04NXA TITANIUM SPINAL SCREW※適應症請見備註欄 5380

FBSF4X380NS9 "史賽克"喜爾脊椎系統-骨固定釘"STRYKER"XIA TITANIUM SPINAL

SCREW※給付規定請見備註欄

5380

FBSF5000051A MONT BLANC SPINAL TRANSVERSE CONNECTOR※適應症請見備註欄 6108

FBSF50001TV2 "INTAI"SPINAL FIXATION SYSTEM:CROSS LINK HOOK"鐿鈦"脊椎固

定系統:橫向連接鉤組合(免事前審查)

2661

FBSF50001TWG "WILTROM"SPINAL FIXATION SYSTEM:CROSS LINK"威創"脊椎固定

系統:橫向連接鉤(免事前審查)

2661

FBSF5000251A MONT BLANC SPINAL TRANSVERSE LINK 免事前審查 2661

FBSF50002TV2 "INTAI"SPINAL FIXATION SYSTEM:CROSS-LINK HOOK"鐿鈦"脊椎固

定系統:橫向連接鉤組合※給付規定請見備註欄

6108

FBSF50002TWG WILTROM SPINAL FIXATION SYSTEM:CROSS-LINK HOOK威創脊椎固

定系統:橫向連接鉤組合※給付規定請見備註欄

6108

FBSF50055TJA TITANIUM SPINAL TRANSVERSE CONNECTOR※適應症請見備註欄 6108

FBSF5010TNZ6 TITANIUM SPINAL TRANSVERSE LINK※適應症請見備註欄 6108

FBSF50380NS9 XIA SPINAL SYSTEM:CROSS LINK (免事前審查) 2661

FBSF50382NS9 XIA TITANIUM CROSS CONNECTOR ※適應症請見備註欄 6108

FBSF50565NDP M-M TITANIUM TRANSVERSE CONNECTOR ※適應症請見備註欄 6108

1037

特材代碼 中英文名稱 支付點數-104/01/01

FBSF5170XNTD TITANIUM TREND TRANSVERSE LINK※適應症請見備註欄 6108

FBSF518010B0 TITANIUM TRANSVERSE LINK※適應症請見備註欄 6108

FBSF518012B0 TITANIUM TRANSVERSE LINK(免事前審查) 2661

FBSF54107NS9 MAC TATINIUM TRANSVERSE LINK※適應症請見備註欄 6108

FBSF548149S9 XIA 4.5 TITANIUM SPINAL CROSSLINK (適用於兒童或體型嬌小

者)

6467

FBSF548232S9 "STRYKER" XIA 3 SPINAL SYSTEM:MONOBLOCK CONNECTOR "史賽

克"喜爾三脊椎系統:結合器組※適應症請見備註欄

6108

FBSF548233S9 "STRYKER" XIA 3 SPINAL SYSTEM:CROSS CONNECTOR "史賽克"喜

爾三脊椎系統:結合器組※適應症請見備註欄

6108

FBSF54977NS1 TITANIUM TRANSVERSE CONNECTORS 免事前審查 2661

FBSF54981NS1 TITANIUM UNIVERSAL SPINAL CROSS LINK ※適應症請見備註欄,

須事前審查

6108

FBSF56201NS1 TITANIUM TRANSVERSE CONNECTORS ※適應症請見備註欄 6108

FBSF56452NDX TITANIUM DIAPASON TRANSVERSE LINK※適應症請見備註欄

(730000+720040:100自86/11/17生效)

6108

FBSF57200NS9 TITANIUM TRANSVERSE LINKS(免事審查) 2661

FBSF57651NY2 TITANIUM SPINAL CROSS-LINK※適應症請見備註欄 6108

FBSF577003Y2 TITANIUM SPINAL TRANSVERSE LINK(免術前審查) 2661

FBSF5811XNDA TATINIUM TSRH LOW PROFILE CROSSLINK PLATE ※適應症請見備

註欄

6108

FBSF5821NHY2 BRIDGE TRANSVERSE LINK 免事前審查 2661

FBSF5821NTY2 "SYNTEC" AREIKEN SPINAL FIXATION SYSTEM:TRANSVERSE LINK "

亞太醫療"亞力健脊椎固定系統:橫向連結器,免事前審查

2661

FBSF5886CCY2 "SYNTEC" TRANSVERSE LINK "亞太醫療"高立捷橫向連結器 ※適

應症請見備註欄

6108

FBSF5886NCY2 "SYNTEC" TRANSVERSE LINK "亞太醫療"高立捷橫向連結器 2661

FBSF5A3C1NXA A3 POSTERIOR TITANIUM SPINAL CROSSLINK HOOK ※適應症請見

備註欄

6108

FBSF5AS001AQ TITANIUM SPINAL LINK免術前審查 2661

FBSF5ASLL1AQ TITANIUM SPINAL LINK※適應症請見備註欄 6108

FBSF5ASNL1AQ TITANIUM SMARTLOC TRANSVERSE LINK免事前審前 2661

FBSF5ASYL1AQ TITANIUM SMARTLOC TRANSVERSE LINK※適應症請見備註欄 6108

FBSF5ASYL2AQ TITANIUM SMARTLOC EVOLUTION TRANSVERSE LINK※適應症請見備

註欄

6108

FBSF5ASYL3AQ SMARTLOC EVOLUTION SYSTEM:TRANSVERSE LINK 史麥特艾爾脊椎

固定系統:橫向連接器※適應症請見備註欄

6108

FBSF5B0001RK TITANIUM SPINAL LINK 免事前審查 2661

FBSF5BA001RK TITANIUM SPINAL TRANSVERSE LINK ※適應症請見備註欄 6108

FBSF5BT001GZ GEZEN SPINAL FIXATION SYSTEM:TRANSVERSE LINK 際仁脊椎固定

系統:橫向連結組※適應症請見備註欄

6108

FBSF5C111NXA TITANIUM SPINAL CROSS LINK ※適應症請見備註欄 6108

FBSF5C3201U0 "UNITED"CENTURY SPINAL SYSTEM:CROSSLINK "聯合"世紀脊椎固

定系統交叉連桿※適應症請見備註欄

6108

FBSF5CY11NXA Y TYPE POSTERIOR TITANIUM SPINAL LINK(免事前審查) 2661

FBSF5DTT4TDA TITANIUM CD HORIZON SPINAL D.T.T#4(橫向固定桿) ※適應症請

見備註欄

6108

FBSF5GS51NG0 GSS TITANIUM SPINAL TRANSVERSE LINK※適應症請見備註欄 6108

FBSF5L8414M4 TITANIUM CD DTT #4 TRANSVERSE LINK(免術前審查) 2661

FBSF5LT001GZ GEZEN SPINAL FIXATION SYSTEM:TRANSVERSE LINK 際仁脊椎固定

系統:橫向連結器 ※適應症請見備註欄

6108

FBSF5LT005GZ GEZEN SPINAL FIXATION SYSTEM:TRANSVERSE LINK 際仁脊椎固定

系統:脊椎橫向連結器 免事前審查

2661

FBSF5M2TKNZ6 TITANIUM SPINAL TRANSVERSE LINK 2661

1038

特材代碼 中英文名稱 支付點數-104/01/01

FBSF5M3SLKZ6 TITANIUM M3 SPINAL POSTERIOR TRANSVERSE LINK※適應症請見

備註欄

6108

FBSF5P2CLKZ6 PROT II POSTERIOR SPINE CROSS LINK※適應症請見備註欄 6108

FBSF5P2CNTZ6 PROT II POSTERIOR SPINE ROD CONNECTOR※適應症請見備註欄 6108

FBSF5P2TLKZ6 PROT II POSTERIOR SPINE TRANSVERSE LINK※適應症請見備註欄 6108

FBSF5R382NS9 XIA REDUCTION CROSS LINK※適應症請見備註欄 6108

FBSF5RF001RX RF SPINAL LINK(免事前審查) 2661

FBSF5SW69NAE AESCULAP"TITANIUM S4 SPINAL SYSTEM:CROSS CONNECTOR"雅氏"

雅士弗脊椎固定系統:連接器※適應症請見備註欄

6108

FBSF5SX17NAE TITANIUM SPINE CROSSLINK (96年10月1日起免事前審查) 2661

FBSF5TS55TJA TITANIUM SPINAL TRANSVERSE CONNECTOR(免事前審查) 2661

FBSF5X380NS9 XIA TITANIUM SPINAL CROSS LINK※適應症請見備註欄 6108

FBSF610001TT TITANIUM CERVICAL PLATE(免術前審查) 3588

FBSF610002TT TITANIUM CERVICAL SCREW(免術前審查) 180

FBSF661202Y2 STAINLESS CERVICAL PLATE 28:72CM 3588

FBSF661302Y2 TITANIUM CERVICAL PLATE 28:72MM 3588

FBSF66131NY2 TITANIUM CERVICAL SCREW 17:24MM 180

FBSF6613NNY2 TITANIUM DYNAMIC CERVICAL FIXATION SYSTEM 180

FBSF6CPU16XA TITANIUM CERVICAL PLATE (免術前審查) 3588

FBSF6CSA35XA TITANIUM CERVICAL SCREW (免術前審查) 180

FBSF6FF930AE STANLESS CASPAR OSTEOSYNTH CERVICAL PLATE 28:33MM LONG 3588

FBSF6FF934AE STANLESS CASPAR OSTEOSYNTH CERVICAL PLATE 37:46MM LONG 3588

FBSF6FF947AE STANLESS CASPAR OSTEOSYNTH CERVICAL PLATE 72MM LONG 3588

FBSF7000271A MONT BLANC SPINAL HOOK SCREW SYSTEM(SX2+HX2+RX2)免事前審

23228

FBSF7295NNS1 STANLESS STEEL HOOK SCREW

SYSTEM(SCREWX2+HOOKX2+NUTX4+SPRINGX2)

21471

FBSF7804NHY2 BRIDGE SPINAL HOOK SCREW SYSTEM(HX2+SX4+NX2)免事前審查 23228

FBSF7SX25NAE TITANIUM SPINE EVOLUTION HOOK

SYSTEM(SCREWX2+HOOKX2+NUTX2)

23228

FBSF8T1SFWCM TITANIUM CABLE SOFWIRE(後頸椎固定軟鋼絲索) ※適應症請見備

註欄

7494

FBSFC014XNS1 "SYNTHES"VECTRA SYSTEM(P*1+S*4)"信迪思"頸椎固定系統(二節)

※適應症請見備註欄

18623

FBSFC10002U0 "UNITED"SLIMFIT ANTERIOR CERVICAL PLATE SYSTEM (P*1+S*4)"

聯合"史令飛頸前路骨板系統二節※適應症請見備註欄

18623

FBSFC10003U0 "UNITED"SLIMFIT ANTERIOR CERVICAL PLATE SYSTEM (P*1+S*6)"

聯合"史令飛頸前路骨板系統三節※適應症請見備註欄

20591

FBSFC10030AD TITANIUM PEAK ANTERIOR CERVICAL SCREW(型號含1749-

02019:13026)※適應症請見備註欄

984

FBSFC10108AD TITANIUM SLIM-LOC ANTERIOR CERVICAL SCREW※適應症請見備註

984

FBSFC128XNS1 "SYNTHES"VECTRA SYSTEM(P*1+S*6)"信迪思"頸椎固定系統(三節)

※適應症請見備註欄

20591

FBSFC1742SDP TITANIUM PEAK ANTERIOR CERVICAL PLATE 二節※適應症請見備

註欄

18623

FBSFC1743SDP TITANIUM PEAK ANTERIOR CERVICAL PLATE 三節※適應症請見備

註欄

20591

FBSFC1792SDP TITANIUM SLIM-LOC ANTERIOR CERVICAL PLATE 二節※適應症請

見備註欄

18623

1039

特材代碼 中英文名稱 支付點數-104/01/01

FBSFC1793SDP TITANIUM SLIM-LOC ANTERIOR CERVICAL PLATE 三節※適應症請

見備註欄

20591

FBSFC20002U0 "UNITED"BOOSTER ANTERIOR CERVICAL PLATE SYSTEM (P*1+S*4)

"聯合"普斯特頸前路骨板系統二節※適應症請見備註欄

18623

FBSFC20003U0 "UNITED"BOOSTER ANTERIOR CERVICAL PLATE SYSTEM (P*1+S*6)

"聯合"普斯特頸前路骨板系統三節※適應症請見備註欄

20591

FBSFC2485NS9 REFLEX HYBRID ANTERIOR CERVICAL PLATE SYSTEM(PX1+SX4)二節

芮菲斯前置頸椎固定系統 ※適應症請見備註欄

18623

FBSFC27551B0 "長安"脊頸椎內固定系統:頸椎固定二節"BMI"SPINAL FIXATION

SYSTEM:TITANIUM CERVICAL SPINAL SYSTEM(PX1+SX4)

18623

FBSFC27553B0 "長安"脊頸椎內固定系統:頸椎固定三節"BMI"SPINAL FIXATION

SYSTEM:TITANIUM CERVICAL SPINAL SYSTEM(PX1+SX6)

20591

FBSFC27555B0 "長安"脊頸椎內固定系統:骨釘"BMI"SPINAL FIXATION

SYSTEM:TITANIUM CERVICAL SCREW

984

FBSFC27556B0 TITANIUM CERVICAL PLATE 24:90MM(免術前審查) 3588

FBSFC27557B0 TITANIUM CERVICAL SCREW(免術前審查) 180

FBSFC2869NS9 "STRYKER"REFLEX HYBRID ANTERIOR CERVICAL

PLATE:SYSTEM(PX1+SX4) "史賽克" 芮菲斯前置頸椎骨板系統:二

節※適應症請見備註欄

18623

FBSFC2Z86NS9 REFLEX ZERO PROFILE ANTERIOR CERVICAL PLATING SYSTEM 二節

(PLATE X1+SCREW X 4)※適應症請見備註欄

18623

FBSFC3400NZ1 TRINICA AND TRINICA SELECT ANTERIOR CERVICAL PLATE SYSTEM

二節(PX1+SX4)※適應症請見備註欄

18623

FBSFC3401NZ1 TRINICA AND TRINICA SELECT ANTERIOR CERVICAL PLATE SYSTEM

三節(PX1+SX6)※適應症請見備註欄

20591

FBSFC3485NS9 REFLEX HYBRID ANTERIOR CERVICAL PLATE SYSTEM(PX1+SX6)三節

芮菲斯前置頸椎固定系統 ※適應症請見備註欄

20591

FBSFC3869NS9 "STRYKER"REFLEX HYBRID ANTERIOR CERVICAL

PLATE:SYSTEM(PX1+SX6) "史賽克" 芮菲斯前置頸椎骨板系統:三

節※適應症請見備註欄

20591

FBSFC3Z86NS9 REFLEX ZERO PROFILE ANTERIOR CERVICAL PLATING SYSTEM 三節

(PLATE X1+SCREW X 6)※適應症請見備註欄

20591

FBSFC4020NS9 REFLEX HYBRID ANTERIOR CERVICAL SCREW 芮菲斯前置頸椎骨釘

※適應症請見備註欄

984

FBSFC4030NS9 RELFEX ZERO PROFILE ANTERIOR CERVICAL SCREW※適應症請見備

註欄

984

FBSFC450XNS1 CERVICAL SPINE SOLID EXPANSION HEAD SCREW 4.0/4.35MM 擴張

頭實心骨釘※適應症請見備註欄

984

FBSFC4869NS9 "STRYKER"REFLEX HYBRID ANTERIOR CERVICAL PLATE:SCREW "史

賽克" 芮菲斯前置頸椎骨板系統:骨釘※適應症請見備註欄

984

FBSFC4871NS1 TITANIUM CERVICAL SPINE LOCKING PLATE SYSTEM 二節※適應症

請見備註欄

18623

FBSFC487XNS1 TITANIUM CERVICAL SPINE LOCKING PLATE SYSTEM 三節※適應症

請見備註欄

20591

FBSFC6113NY2 TITANIUM CERVICAL SPINE SCREW※適應症請見備註欄 984

FBSFC612XNS1 "SYNTHES"VECTRA SYSTEM:CERVICAL SPINE SCREW"信迪思"頸椎固

定系統:多角度動態自攻牙頸椎骨螺釘※適應症請見備註欄

984

FBSFC8340NY2 TITANIUM CERVICAL PLATE FIXATION SYSTEM 三節(PX1+SX6) ※

適應症請見備註欄

20591

FBSFC834NNY2 TITANIUM CERVICAL PLATE FIXATION SYSTEM 二節(PX1+SX4) ※

適應症請見備註欄

18623

FBSFC835NNY2 TITANIUM CERVICAL BONE LOCKING SCREW ※適應症請見備註欄 984

1040

特材代碼 中英文名稱 支付點數-104/01/01

FBSFC8792NM4 ZEPHIR ANTERIOR CERVICAL SCREW ※適應症請見備註欄 984

FBSFC879N2M4 ZEPHIR ANTERIOR CERVICAL SYSTEM 二節(SX4+PX1) ※適應症請

見備註欄

18623

FBSFC879N3M4 ZEPHIR ANTERIOR CERVICAL SYSTEM 三節(SX6+PX1) ※適應症請

見備註欄

20591

FBSFCASC01AQ TITANIUM CERVICAL PLATE SYSTEM二節(PX1+SX4)※適應症請見備

註欄

18623

FBSFCASC02AQ TITANIUM CERVICAL PLATE SYSTEM三節(PX1+SX6)※適應症請見備

註欄

20591

FBSFCASC03AQ TITANIUM WINLOC CERVICAL PLATE SYSTEM 二節(PX1+SX4)※適應

症請見備註欄

18623

FBSFCASC04AQ TITANIUM WINLOC CERVICAL PLATE SYSTEM 三節(PX1+SX6)※適應

症請見備註欄

20591

FBSFCASCS1AQ TITANIUM CERVICAL SCREW※適應症請見備註欄 984

FBSFCASCS2AQ TITANIUM CERVICAL SCREW※適應症請見備註欄 984

FBSFCASP01AQ TITANIUM CERVICAL PLATE (免事前審查) 3588

FBSFCASS02AQ TITANIUM CERVICAL SCREW(免事前審查) 180

FBSFCB0003RK TITANIUM CERVICAL SCREW 免事前審查 180

FBSFCB0004RK TITANIUM CERVICAL PLATE 免事前審查 3588

FBSFCBA001RK TITANIUM CERVICAL PLATE SYSTEM (PX1+SX4) 二節 ※適應症請

見備註欄

18623

FBSFCBA002RK TITANIUM CERVICAL PLATE SYSTEM (PX1+SX6)三節 ※適應症請見

備註欄

20591

FBSFCBA003RK TITANIUM CERVICAL SCREW ※適應症請見備註欄 984

FBSFCCPCN2XA TITANIUM CERVICAL PLATE SYSTEM(PX1+SX4)二節 ※適應症請見

備註欄

18623

FBSFCCPCN3XA TITANIUM CERVICAL PLATE SYSTEM(PX1+SX6)三節 ※適應症請見

備註欄

20591

FBSFCCSC35XA TITANIUM CERVICAL SCREW ※適應症請見備註欄 984

FBSFCCSD35XA TITANIUM CERVICAL SCREW ※適應症請見備註欄 984

FBSFCCSF12Y2 TITANIUM CERVICAL SPINE FIXATION SYSTEM 二節(PX1+SX4)※適

應症請見備註欄

18623

FBSFCCSF13Y2 TITANIUM CERVICAL SPINEFIXATION SYSTEM 三節(PX1+SX6) ※適

應症請見備註欄

20591

FBSFCDC613Y2 "SYNTEC"DYNAMIC CERVICAL FIXATION STSTEM:DYNAMIC CERVICAL

PLATE"亞太醫療"微動頸椎固定系統:微動頸椎骨板(免事前審查)

3588

FBSFCFJ700AE TITANIUM ABC ANTERIOR CERVICAL PLATING SYSTEM(PX1+SX4)※

適應症請見備註欄

18623

FBSFCFJ710AE "AESCULAP" ABC CERVICAL PLATE AND SCRE 二節(PX1+SX4)W"雅

氏"前方頸椎骨釘骨板系統※適應症請見備註欄

18623

FBSFCFJ790AE ABC TITANIUM CERVICAL SCREW※適應症請見備註欄 984

FBSFCFJ800AE TITANIUM ABC ANTERIOR CERVICAL PLATING SYSTEM(PX1+SX6)※

適應症請見備註欄

20591

FBSFCFJ810AE "AESCULAP" ABC CERVICAL PLATE AND SCRE 三節(PX1+SX6)W"雅

氏"前方頸椎骨釘骨板系統※適應症請見備註欄

20591

FBSFCFJ900AE "AESCULAP" ABC CERVICAL SCREW"雅氏"前方頸椎骨釘※適應症請

見備註欄

984

FBSFCPLAT21A SPINE WAY BLUE MOUNTAIN CERVICAL SYSTEM 二節(PX1+SX4)施百

威藍山頸椎固定系統※適應症請見備註欄

18623

FBSFCPLAT31A SPINE WAY BLUE MOUNTAIN CERVICAL SYSTEM三節(PX1+SX5)施百

威藍山頸椎固定系統※適應症請見備註欄

19607

FBSFCS3102U0 "UNITED"SLIMFIT ANTERIOR CERVICAL PLATE SYSTEM:SCREW "聯

合"史令飛頸前路骨板系統:自攻螺絲 ※適應症請見備註欄

984

1041

特材代碼 中英文名稱 支付點數-104/01/01

FBSFCS3104U0 "UNITED"BOOSTER ANTERIOR CERVICAL PLATE SYSTEM:SCREW "聯

合"普斯特頸前路骨板系統:骨螺絲※適應症請見備註欄

984

FBSFCSCREW1A SPINE WAY BLUE MOUNTAIN CERVICAL SYSTEM:SCREW施百威藍山頸

椎固定系統※適應症請見備註欄

984

FBSFCTRYC21C SPINEART CERVICAL IMPLANTS 二節(PX1+SX4)司佰特頸椎間植入

物※適應症請見備註欄

18623

FBSFCTRYC31C SPINEART CERVICAL IMPLANTS 三節(PX1+SX6)司佰特頸椎間植入

物※適應症請見備註欄

20591

FBSFCTRYCS1C SPINEART CERVICAL IMPLANTS:SCREW司佰特頸椎間植入物:骨釘※

適應症請見備註欄

984

FBT01020MLHE SUPLASYN STERILE SODIUM HYALURONATE SOLUTION(2ML/瓶裝)每

次療程注射三次※適應症請見備註欄

705

FBT01025MLH8 HIKAMILON DISPO 1% 2.5ML/SYRINGE 25MG關節內注射劑(每次療

程注射五次)※適應症請見備註欄

425

FBT01025MLN0 "NISSIN"LUMISTERON DISPO (2.5ML/SYRINGE)"日新"倍利骨關節

腔注射劑(每次療程注射五次)※適應症請見備註欄

425

FBT01025MLR7 雅節關節內注射劑(每次療程注射三次)ARTZ/ARTZ DISPO 709

FBT01025MLU5 UNIHYLON DISPO 2.5ML W/SYRINGE(每次療程注射五次)※適應症

請見備註欄

425

FBT010HH253A 高海晶關節內注射劑HIGH HYAL 425

FBT01A25ML1F HYALUTOWA INJ"東和"關健關節注射劑(安瓿型,不含空針)(每次療

程注射5次)※適應症請見備註欄

421

FBT01AA25CLB ARTIAID INTRA-ARTICULAR INJECTION(每次療程注射5次)※適應

症請見備註欄

425

FBT01AAP20LB 優節益關節內注射劑ARTIAID PLUS INTRA-ARTICULAR

INJECTION2.0CC 1.5% SODIUM HYALURONATE

709

FBT01D25ML1F HUSREN DISPO"東和"關健關節內注射劑(每次療程注射5次)※適應

症請見備註欄

425

FBT01HJ001V0 HYA-JOINT SYNOVIAL FLUID SUPPLEMENT(2.5ML/支)每次療程注射

三次※適應症請見備註欄

709

FBT01HY001FD HYALGAN INTRA-ARTICULAR INJECTOR W/SYRINGE(自97年4月1日起

改每次療程注射3次)※適應症請見備註欄

709

FBT01HYRANLJ HYRUAN PLUS INJ.瀚樂骨關節腔注射液,每次療程注射三次※適應

症請見備註欄

709

FBT01N25MLR7 ARTZ/ARTZDISPO 2.5ML 25MG WITHOUT SYRINGE(每次療程注射五

次)※適應症請見備註欄

421

FBT01SA25CLB SYNOAID INTRA-ARTICULAR INJECTION欣節益關節內注射劑※適應

症請見備註欄

425

FBUF11001NW2 UNICOMPARTMENTAL KNEE FEMORAL COMPONENT※適應症請見備註欄 23268

FBUF15842NZ1 "ZIMMER"UNICOMPARTMENTAL HIGH-FLEX FEMORAL COMPONENT※適

應症請見備註欄

23268

FBUF172500SN UNICOMPARMENTAL KNEE FEMORAL※適應症請見備註欄 23268

FBUF19671NJJ PFC SIGMA UNICOMPARTMENTAL FEMORAL COMPONENT人工半膝關節

股骨元件※適應症請見備註欄

23268

FBUL15842NZ1 "ZIMMER"UNICOMPARTMENTAL HIGH-FLEX ARTICULAR SURFACE※適

應症請見備註欄

6980

FBUL171248SN UNICOMPARMENTAL KNEE TIBIAL INSERT※適應症請見備註欄 6980

FBUL19672NJJ PFC SIGMA(PFC)UNICOMPARTMENTAL TIBIAL INSERT COMPONENT 半

膝關節襯墊※適應症請見備註欄

6980

FBUT11002NW2 UNICOMPARTMENTAL KNEE TIBIAL+INSERT COMPONENT※適應症請見

備註欄

21709

FBUT15842NZ1 "ZIMMER"UNICOMPARTMENTAL HIGH-FLEX PRECOAT TIBIAL PLATE※

適應症請見備註欄

14735

1042

特材代碼 中英文名稱 支付點數-104/01/01

FBUT172610SN UNICOMPARMENTAL KNEE TIBIAL BASES※適應症請見備註欄 14735

FBUT19670NJJ PFC SIGMA(PFC)UNICOMPARTMENTAL TIBIAL TRAY COMPONENT 半膝

關節脛骨元件※適應症請見備註欄

14735

FBUT25842NZ1 "ZIMMER"UNICOMPARTMENTAL HIGH-FLEX ALL POLYETHYLENE

TIBIAL BASEPLATE(TIBIAL+SURFACE)※適應症請見備註欄

21709

FES0156295XT FISCH SPANDER II TOTAL WITH FOOTPLATE SHOE全聽 2599

FES0170142GS MICRON ALL TITANIUM TORP 全鈦全人工聽小骨置換物 2599

FHFCDLUMHFBK "百多力"路麥斯植入式心臟除顫器-心房同步雙心室“"百多力"路

麥斯植入式心臟除顫器(心房同步雙心室)"BIOTRONIK"LUMAX

TACHYARRHYTHMIA THERAPY IMPLANTABLE

591468

FHPCDLUMDRBK "百多力"路麥斯植入式心臟除顫器(雙腔)"BIOTRONIK"LUMAX

TACHYARRHYTHMIA THERAPY IMPLANTABLE DEFIBRILLATORS(DR-T)*

給付規定請見備註欄

483701

FHPCDLUMDXBK "百多力"路麥斯植入式心臟除顫器(單腔)"BIOTRONIK"LUMAX

TACHYARRHYTHMIA THERAPY IMPLANTABLE DEFIBRILLATORS(VR-T

DX)*給付規定請見備註欄

342335

FHPCDLUMVRBK "百多力"路麥斯植入式心臟除顫器(單腔)"BIOTRONIK"LUMAX

TACHYARRHYTHMIA THERAPY IMPLANTABLE DEFIBRILLATORS(VR-T)*

給付規定請見備註欄

342335

FHX03RX05RTM CAPIOX RX HOLLOW FIBER OXYGENATOR WITH RESERVOIR BY X-

COATING

22284

FNP9101473CM "柯特曼"人工腦膜 "CODMAN"DURAFORM DURAL GRAFT

IMPLANT(2.5CM*7.5CM)

3213

FNP9101475CM "柯特曼"人工腦膜 "CODMAN"DURAFORM DURAL GRAFT

IMPLANT(5CM*5CM)

4061

FNP9101477CM "柯特曼"人工腦膜 "CODMAN"DURAFORM DURAL GRAFT

IMPLANT(7.5CM*7.5CM)

10110

FNP9101480CM "柯特曼"人工腦膜 "CODMAN"DURAFORM DURAL GRAFT

IMPLANT(10CM*12.5CM)

21448

FNP9102010BB NEURO PATCH 2X10CM 3171

FNP9102010GX DURA SUBSTITUTE 2CMX10CM(代用人工腦膜) 3171

FNP910205XGX DURA SUBSTITUTE 2CMX5CM 1862

FNP910210XGX DURA SUBSTITUTE 2CMX10CM 3171

FNP9102575N7 DURAGEN DURAL GRAFT MATRIX 2.5CMX7.5CM 3213

FNP9104005BB NEURO PATCH 4X5CM 3171

FNP9104010BB NEURO PATCH 4X10CM 6033

FNP910404XGX DURA SUBSTITUTE 4CMX4CM 2773

FNP9105006GX DURA SUBSTITUTE 5CMX6CM(代用人工腦膜) 5865

FNP910506XGX DURA SUBSTITUTE 5CMX6CM 5865

FNP9106008BB NEURO PATCH 6X8CM 7588

FNP9106008S7 "司諾維思"腦膜補片"SYNOVIS"DURA-GUARD DURAL REPAIR PATCH

WITH APEX PROCESSING 6CM*8CM

9211

FNP9106014BB NEURO PATCH 6X14CM 14460

FNP9107575N7 DURAGEN DURAL GRAFT MATRIX 7.5CMX7.5CM 10110

FNP9108014S7 "司諾維思"腦膜補片"SYNOVIS"DURA-GUARD DURAL REPAIR PATCH

WITH APEX PROCESSING8CM*14CM

19427

FNP9110016S7 "司諾維思"腦膜補片"SYNOVIS"DURA-GUARD DURAL REPAIR PATCH

WITH APEX PROCESSING 10CM*16CM

22394

FNP9110125N7 DURAGEN DURAL GRAFT MATRIX 10CMX12.5CM 21448

FNP911012XGX DURA SUBSTITUTE 10CMX12CM 21389

FNP9112014BB "B.BRAUN"NEURO-PATCH 12CMX14CM 23897

FNP9115003BB NEURO PATCH 1.5X3CM 657

FNP9140380T0 WIRE MESH 10X10CM 248

FNP9166021AE "雅氏" 雷歐普代用腦膜 "AESCULAP" LYOPLANT 6CM*14CM 15842

1043

特材代碼 中英文名稱 支付點數-104/01/01

FNP9166048AE "雅氏" 雷歐普代用腦膜 "AESCULAP" LYOPLANT 4CM*10CM 7544

FNP9166064AE "雅氏" 雷歐普代用腦膜 "AESCULAP" LYOPLANT 4CM*5CM 3772

FNP9166080AE "雅氏" 雷歐普代用腦膜 "AESCULAP" LYOPLANT 2CM*10CM 3772

FNP9166102AE "雅氏" 雷歐普代用腦膜 "AESCULAP" LYOPLANT 1.5CM*3CM 848

FNP9166242AE "雅氏" 雷歐普代用腦膜 "AESCULAP" LYOPLANT 6CM*8CM 9211

FNP91CDUR1CK "COOK"DURASIS DURAL SUBSTITUTE"曲克"硬腦膜替代物 2CM*3CM 1039

FNP91CDUR2CK "COOK"DURASIS DURAL SUBSTITUTE"曲克"硬腦膜替代物 4CM*7CM 4183

FNP91DUR01CK "曲克"硬腦膜替代物"COOK" DURASIS DURAL SUBSTITUTE 7CM×

10CM

13404

FNP91DUR02CK "曲克"硬腦膜替代物"COOK" DURASIS DURAL SUBSTITUTE 7CM×

20CM

21749

FPM0119604HH MICROGRAFT GAUZE WITH CORKPLATE 1:4※適應症請見備註欄 1663

FPM0119606HH MICROGRAFT GAUZE WITH CORKPLATE 1:6※適應症請見備註欄 1663

FPM0119609HH MICROGRAFT GAUZE WITH CORKPLATE 1:9※適應症請見備註欄 1663

FSP6100611ZQ "SOFRADIM"PARIETENE POLYPROPYLENE MESHES"舒法定"帕瑞挺人

工聚丙烯編網06X11CM

922

FSP6101170BA "BARD"SOFT MESH柔軟修補網7.5CMX15CM 10CMX15CM (15CMX15CM

自970401起刪除)

1541

FSP6101171BA "BARD"SOFT MESH柔軟修補網5CMX10CM 4.5CMX10CM 6CMX13.7CM 922

FSP6101177BA "BARD"SOFT MESH"巴德" 柔軟修補網15CMX15CM 1603

FSP6101510ZQ "SOFRADIM"PARIETENE POLYPROPYLENE MESHES"舒法定"帕瑞挺人

工聚丙烯編網15X10CM

1541

FSP6101515ZQ "SOFRADIM"PARIETENE POLYPROPYLENE MESHES 15X15CM"舒法定"

帕瑞挺人工聚丙烯編網

1603

FSP6103030ZQ "SOFRADIM"PARIETENE POLYPROPYLENE MESHES 30X30CM"舒法定"

帕瑞挺人工聚丙烯編網

2848

FSP6105010BB PREMILENE MESH 2.5X10CM,5X10CM 922

FSP6106011ET "ETHICON"PROLENE POLYPROPYLENE MESH"愛惜康"伯羅林不可吸收

網6X11CM

922

FSP6106011JJ PROLENE POLYPROPYLENE MESH PMS,6*11CM 922

FSP6110611ZQ "SOFRADIM"PARIETENE POLYPROPYLENE MESHES 6X11CM"舒法定"帕

瑞挺人工聚丙烯編網

922

FSP6110650BB "B.BRAUN"OPTILENE MESH 歐特靈網片5CMX10CM 4.5CMX10CM

6CMX14CM

922

FSP6110651BB "B.BRAUN"OPTILENE MESH 歐特靈網片7.5CMX15CM 10CMX15CM 1541

FSP6110652BB "B.BRAUN"OPTILENE MESH 歐特靈網片15CMX15CM 1603

FSP6110653BB "B.BRAUN"OPTILENE MESH 歐特靈網片26CMX36CM 30CMX30CM 2848

FSP6111264DV MARLEX MESH 1"X4"X0.6MM(自980401起改為BARD MESH FLAT

SHEET1"X4")

922

FSP6111266DV MARLEX MESH 10"X14"(自980401起改為BARD MESH FLAT

SHEET10"X14")

2848

FSP6111267DV MARLEX MESH 2"X12"(自980401起改為BARD MESH FLAT

SHEET2"X12")

1541

FSP6111268DV MARLEX MESH 3"X6" (2PCS/BOX)(自980401起改為BARD MESH FLAT

SHEET3"X6")

1541

FSP6111510ZQ "SOFRADIM"PARIETENE POLYPROPYLENE MESHES 15X10CM"舒法定"

帕瑞挺人工聚丙烯編網

1541

FSP6115015BB PREMILENE MESH 7.5X15CM,15X15CM,5X30CM,10X15CM 1541

FSP6115015ET "ETHICON"PROLENE POLYPROPYLENE MESH"愛惜康"伯羅林不可吸收

網15CMX15CM

1603

FSP6115015JJ PROLENE POLYPROPYLENE MESH PMM,15*15CM 1603

FSP6130030BB PREMILENE MESH 30X30CM,26X36CM 2848

1044

特材代碼 中英文名稱 支付點數-104/01/01

FSP6130030ET "ETHICON"PROLENE POLYPROPYLENE MESH"愛惜康"伯羅林不可吸收

網30CMX30CM

2848

FSP6130030JJ PROLENE POLYPROPYLENE MESH PML,30*30CM 2848

FSP6130711AH "ATRIUM"PROLITE P0LYPROPYLENE MESH普來聚丙烯網片

(2.5CMX10CM,5CMX10CM)

922

FSP6130714AH "ATRIUM"PROLITE P0LYPROPYLENE MESH普來聚丙烯網片

(7.5CMX15CM,10CMX15CM)

1541

FSP6130717AH "ATRIUM"PROLITE P0LYPROPYLENE MESH普來聚丙烯網片

(15CMX15CM)

1603

FSP6130718AH "ATRIUM"PROLITE POLYPROPYLENE MESH PROLITE

ULTRA(20X25.4CM)普來聚丙烯網片

2702

FSP6130719AH "ATRIUM"PROLITE POLYPROPYLENE MESH PROLITE

ULTRA(25.4X25.4CM)普來聚丙烯網片

2702

FSP6130720AH "ATRIUM"PROLITE P0LYPROPYLENE MESH普來聚丙烯網片

(25.4CMX35.5CM,30CMX30CM)

2848

FSP61PL212AH "ATRIUM"PROLITE P0LYPROPYLENE MESH普來聚丙烯網片

(5CMX30CM)

1541

FSP61PL609AH "ATRIUM"PROLITE POLYPROPYLENE MESH PROLITE(15X23CM)普來聚

丙烯網片

2019

FSP61S00352C "COVIDIEN"SYNETURE SURGIPRO MESH 3"X5" "柯惠"舒耐久聚丙烯

編網

922

FSP61S01492C "COVIDIEN"SYNETURE SURGIPRO MESH 14"X9" "柯惠"舒耐久聚丙

烯編網

2848

FSP63CHM01CK "COOK"BIODESIGN SURGISIS INGUINAL HERNIA GRAFT"曲克"拜爾

迪賽瑟集喜司腹股溝疝氣支撐物10CMX15CM.6CMX13CM.8CMX15CM.*

適應症請見備註欄

8621

FUK02HEF2XGA "衛寶"血液濾過器(小兒用)"GAMBRO" HEMOFILTER 2305

FUK05DF030FN "英弗梅"血液過濾器(小兒用)"INFOMED"HEMOFILTER(CVVH) 4095

FUK05FHF20GA "衛寶"普利司馬弗列克斯套組(小兒用)"GAMBRO" PRISMAFLEX SET

(CVVH)

5286

FUK05HD150E9 "美蒂佳" 血液濾過器(小兒用)"MEDICA" HEMOFILTERS(CVVH) 4095

FUK05TS002FN 英弗梅體外血液迴路管(CF200-小兒血液濾過)INFOMED

EXTRACORPOREAL BLOOD CIRCUIT FOR CF200-PEDIATRIC

CONTINUOUS VENO-VENOUS HEMOFILTRATION(CVVH)

1500

FUK05TS202K5 英禾美體外血液迴路管(CF200-小兒血液濾過)HEMOSCIEN

EXTRACORPOREAL BLOOD CIRCUIT FOR CF200-PEDIATRIC

CONTINUOUS VENO-VENOUS HEMOFILTRATION(CVVH)

1500

FUK05TS405K5 英禾美體外血液迴路管(HF400/HF440-小兒血液濾過)HEMOSCIEN

EXTRACORPOREAL BLOOD CIRCUIT-PEDIATRIC CONTINUOUS VENO-

VENOUS HEMOFILTRATION(CVVH)

1500

FUK05TS504FN 英弗梅體外血液迴路管(HF400/HF440-小兒血液濾過)INFOMED

EXTRACORPOREAL BLOOD CIRCUIT–PEDIATRIC CONTINUOUS VENO-

VENOUS HEMOFILTRATION(CVVH)

1500

NCS010001NUU 1CC RETRACTABLE SAFETY SYRINGE W/NEEDLE※適應症請見備註欄 4.9

NCS010003NUU 3CC RETRACTABLE SAFETY SYRINGE W/NEEDLE※適應症請見備註欄 4.9

NCS010003S1M "MEDICAL CHAIN"MY SAFETY SYRINGE 3CC "濟翔"自動回縮式安全

針筒※適應症請見備註欄

4.9

NCS010003SYF 3CC DISPOSABLE SYRINGE W/NEEDLE (SAFETY) ※適應症請見備註

4.9

NCS010005NUU 5CC RETRACTABLE SAFETY SYRINGE W/NEEDLE※適應症請見備註欄 4.9

1045

特材代碼 中英文名稱 支付點數-104/01/01

NCS010005SYF 5CC DISPOSABLE SYRINGE W/NEEDLE (SAFETY) ※適應症請見備註

4.9

NCS01001SS2P 嘉鎂一次性使用無菌回縮型自毀式注射器(附針)"EWNL"SAFETY

SYRINGE W/NEEDLE 1CC

4.9

NCS01002SS2P 嘉鎂一次性使用無菌回縮型自毀式注射器(附針)"EWNL"SAFETY

SYRINGE W/NEEDLE 2CC

4.9

NCS01003SS2P 嘉鎂一次性使用無菌回縮型自毀式注射器(附針)"EWNL"SAFETY

SYRINGE W/NEEDLE 3CC

4.9

NCS01005SS2P 嘉鎂一次性使用無菌回縮型自毀式注射器(附針)"EWNL"SAFETY

SYRINGE W/NEEDLE 5CC

4.9

NCS010104SSG SIGMA SYRINGE WITH NEEDLE 1CC SAFETY 十美牌注射筒附針安全

型1CC※適應症請見備註欄

4.9

NCS01010SS2P 嘉鎂一次性使用無菌回縮型自毀式注射器(附針)"EWNL"SAFETY

SYRINGE W/NEEDLE 10CC

4.9

NCS010304SSG SIGMA SYRINGE WITH NEEDLE SAFETY 3CC 十美牌注射筒附針安全

型3CC※適應症請見備註欄

4.9

NCS010504SSG SIGMA SYRINGE WITH NEEDLE SAFETY 5CC 十美牌注射筒附針安全

型5CC※適應症請見備註欄

4.9

NCS011004SSG SIGMA SYRINGE WITH NEEDLE SAFETY 10CC 十美牌注射筒附針安

全型10CC※適應症請見備註欄

4.9

NCS0152612TZ 5CC SAFETY SYRINGE ※適應症請見備註欄 4.9

NCS01A003NPW 3CC SYRINGE W/NEEDLE(附安全護套)※適應症請見備註欄 4.9

NCS01A005NPW "PERFECT"5CC DISPOSABLE SYRINGE(SAFETY) W/NEEDLE"普惠"塑

膠注射筒附針(安全型)※給付規定請見備註欄

4.9

NES0102300CD BIOPSY FORCEPS(88/08/1再生效,300L,302L自88/08/01起生效) 6402

NES0114070HK SONO GUIDE BIOPSY NEEDLE 14G 16G 70CM ,170CM 358

NES0117070HK SONO GUIDE BIOPSY NEEDLE 17G 18G 70CM ,170CM 358

NES01174LNAN UNI-CUT NEEDLES 16G:18G 200MM 358

NES01174NNAN UNI-CUT NEEDLES 14G:18G 75:150MM 358

NES011762LAN VACU-CUT BIOPSY NEEDLES 18G:19.5G 200MM 618

NES011762NAN VACU-CUT BIOPSY NEEDLES 18G:19.5G 100:150MM 618

NES01176LNAN VACU-CUT BIOPSY NEEDLES 21G,22G 200MM 618

NES01176NNAN VACU-CUT BIOPSY NEEDLES 21G,22G 100:150MM 618

NES011815NHK "HAKKO"PTC CHIBA NEEDLE肝膽穿刺針150MM:250MM 358

NES015043NCD BIOPSY FORCEPS FOR ENDOMYOCADIAL BIOPSIES 6402

NES01CHN01CK "曲克"拋棄式取樣針(組)"COOK" DISPOSABLE BIOPSY NEEDLES

AND SETS-DISPOSABLE CHIBA BIOPSY NEEDLES 18~25GAGE /

5,10,15,20CM

358

NES01M1806ZM SOFT TISSUE BIOPSY NEEDLE 18G,9:15CM 358

NES01M1808ZM SOFT TISSUE BIOPSY NEEDLE 18G,20CM 358

NES01M2006ZM SOFT TISSUE BIOPSY NEEDLE 19:22G,9:15CM 358

NES01M2008ZM SOFT TISSUE BIOPSY NEEDLE 19:22G,20CM 358

NES0218150TP "TOP"ASPIRATION BIOPSY NEEDLE (18GX150MM)吸引生檢針 618

NES0218200TP "TOP"ASPIRATION BIOPSY NEEDLE (18GX200MM)吸引生檢針 618

NES0221150TP ASPIRATION BIOPSY NEEDLE (MAJIMA NEEDLE) 150MM 618

NES0221200TP "TOP"ASPIRATION BIOPSY NEEDLE (21GX200MM)吸引生檢針 618

SAS0652813TX "泰利芙斯"維瑟斯特可拆除式皮膚縫合釘"TELEFLEX

MEDICAL"VISISTAT REMOVABLE SKIN STAPLE(35 REGULAR)*適應症

請見備註欄

173

SAS0652823TX "泰利芙斯"維瑟斯特可拆除式皮膚縫合釘"TELEFLEX

MEDICAL"VISISTAT REMOVABLE SKIN STAPLE(35 WIDE)*適應症請

見備註欄

210

SAS06548732C "柯惠"可拆除式皮膚縫合釘及縫合器(滅菌)"COVIDIEN"

DISPOSABLE SKIN STAPLER AND LOADING UNITS(STERILE)

210

1046

特材代碼 中英文名稱 支付點數-104/01/01

SAS0680341TY 〝泰科〞拋棄式自動縫合鬆開皮膚縫合器(滅菌)"TYCO" APPOSE

DISPOSABLE SKIN STAPLER(STERILE) 25R※適應症請見備註欄

376

SAS0680351TY 〝泰科〞拋棄式自動縫合鬆開皮膚縫合器(滅菌)"TYCO" APPOSE

DISPOSABLE SKIN STAPLER(STERILE)35R*適應症請見備註欄

173

SAS0680361TY 〝泰科〞拋棄式自動縫合鬆開皮膚縫合器(滅菌)"TYCO" APPOSE

DISPOSABLE SKIN STAPLER(STERILE) 25W※適應症請見備註欄

376

SAS0680371TY 〝泰科〞拋棄式自動縫合鬆開皮膚縫合器(滅菌)"TYCO" APPOSE

DISPOSABLE SKIN STAPLER(STERILE) 35W※適應症請見備註欄

210

SAS06PMR35JJ REGULAR 35R MULTI-DIRECTION SKIN STAPLER※適應症請見備註

173

SAS06PMW35JJ WIDE 35W MULTI-DIRECTION SKIN STAPLER※適應症請見備註欄 210

SAS06SK25RKX "凱棣"可拆除式皮膚縫合釘(滅菌) "KAYDEE" REMOVABLE SKIN

STAPLE (STERILE)-25窄針

376

SAS06SK25WKX "凱棣"可拆除式皮膚縫合釘(滅菌) "KAYDEE" REMOVABLE SKIN

STAPLE (STERILE)-25寬針

376

SAS06SK35RKX "凱棣"可拆除式皮膚縫合釘(滅菌) "KAYDEE" REMOVABLE SKIN

STAPLE (STERILE)-35窄針

173

SAS06SK35WKX "凱棣"可拆除式皮膚縫合釘(滅菌) "KAYDEE" REMOVABLE SKIN

STAPLE (STERILE)-35寬針

210

SAS06TS35RTS "台灣先進"可拆除式皮膚縫合釘(滅菌) "TAIWAN SURGICAL"

REMOVABLE SKIN STAPLE (STERILE)

173

SAS06TS35WTS "台灣先進"可拆除式皮膚縫合釘(滅菌) "TAIWAN SURGICAL"

REMOVABLE SKIN STAPLE (STERILE)

210

SAU01103182C "柯惠"TA自動手術縫合器及縫合釘 "COVIDIEN" AUTO SUTURE TA

DISPOSABLE SURGICAL STAPLER AND LOADING UNIT ※適應症請見

備註欄

2036

SAU01154412C "柯惠"TA自動手術縫合器及縫合釘 "COVIDIEN" AUTO SUTURE TA

DISPOSABLE SURGICAL STAPLER AND LOADING UNIT ※適應症請見

備註欄

2041

SAU01154512C "柯惠"TA自動手術縫合器及縫合釘 "COVIDIEN" AUTO SUTURE TA

DISPOSABLE SURGICAL STAPLER AND LOADING UNIT ※適應症請見

備註欄

2036

SAU01154582C "柯惠"TA自動手術縫合器及縫合釘 "COVIDIEN" AUTO SUTURE TA

DISPOSABLE SURGICAL STAPLER AND LOADING UNIT ※適應症請見

備註欄

2036

SAU01MLSA6J8 "南京邁迪欣" 一次性使用直線型吻和器和釘倉"NANJING

MAIDIXIN" DISPOSABLE LINEAR STAPLER AND CARTRIDGE 60*適應

症請見備註欄

2036

SAU01MLSC6J8 "南京邁迪欣" 一次性使用直線型吻和器和釘倉"NANJING

MAIDIXIN" DISPOSABLE LINEAR STAPLER AND CARTRIDGE 60*適應

症請見備註欄

2036

SAU01TA45L2C "柯惠" TA自動手術縫合器及縫合釘 "COVIDIEN" TA STAPLERS

AND LOADING UNITS

2036

SAU01TA60L2C "柯惠" TA自動手術縫合器及縫合釘 "COVIDIEN" TA STAPLERS

AND LOADING UNITS

2036

SAU01XR30RJJ PROXIMATE RELOADABLE LINEAR STAPLER 30MM VASCULAR ※適應

症請見備註欄

2041

SAU01XR30VET "愛惜康"普克美縫合釘"ETHICON" PROXIMATE LINEAR CUTTERS &

RELOAD UNITS(RELOADABLE LINEAR STAPLER)*適應症請見備註欄

2041

1047

特材代碼 中英文名稱 支付點數-104/01/01

SAU01XR60BJJ PROXIMATE RELOADABLE LINEAR STAPLER 60MM 3.5LEG,4.8LEG ※

適應症請見備註欄

2036

SAU02304242C "柯惠"GIA自動手術縫合器 "COVIDIEN"AUTO SUTURE MULTIFIRE

GIA DISPOSABLE SURGICAL STAPLER-LOADING UNIT *適應症請見

備註欄

2244

SAU02MLCCCJ8 "南京邁迪欣" 一次性使用直線型切割吻和器和釘倉"NANJING

MAIDIXIN" DISPOSABLE LINEAR CUTTER AND CARTRIDGE*適應症請

見備註欄

2244

SAU02SSR55ET "愛惜康"直線形切割縫合器和可調節釘匣-可調節釘匣"ETHICON

ENDO-SURGERY"LINEAR CUTTER 55/75MM AND SELECTABLE

CARTRIDGE/RELOADS(55MM)

2244

SAU02TCRNNJJ RELOAD LINEAR CUTTER 55MM,75MM 腸胃自動縫合釘 ※適應症請

見備註欄

2244

SAU02TRT55JJ RELOAD LINEAR CUTTER 55MM 腸胃自動縫合釘 ※適應症請見備註

2244

SCS0101037CM RANEY SCALP CLIP 頭皮夾 20排/盒 10支/排 9.3

SCS0103100P2 "太平洋"頭皮夾"PAHSCO" SCALP CLIP 9.3

SCS01FF15PAE RANEY SCALP CLIPS 9.3

SCV0101200TX "TELEFLEX" HORIZON METAL LIGATING CLIPS "泰利芙斯"金屬血

管夾(小) 6;24 CLIPS/排(S)

15

SCV0102200TX "TELEFLEX" HORIZON METAL LIGATING CLIPS "泰利芙斯"金屬血

管夾(中) 6;24 CLIPS/排(M)

17.9

SCV0103200TX "TELEFLEX" HORIZON METAL LIGATING CLIPS "泰利芙斯"金屬血

管夾(中-大) 6;24 CLIPS/排(M-L)

20.2

SCV01B218MV7 "維達力克" 鈦金屬血管夾系統(中)"VITALITEC" SLS-CLIP

TITANIUM HEMOSTATIC CLIP SYSTEM(MEDIUM)

17.9

SCV01B918MV7 "維達力克" 鈦金屬血管夾(小)"VITALITEC" NINE CLIP TITANIUM

HEMOSTATIC CLIP SYSTEM(MEDIUM)

17.9

SCV01J118SV7 "維達力克" 鈦金屬血管夾系統(小)"VITALITEC" SLS-CLIP

TITANIUM HEMOSTATIC CLIP SYSTEM(SMALL)

15

SCV01J918SV7 "維達力克" 鈦金屬血管夾(小)"VITALITEC" NINE CLIP TITANIUM

HEMOSTATIC CLIP SYSTEM(SMALL)

15

SCV01LT100JJ TITANIUM LIGA CLIP (S) 6 CLIP/排 15

SCV01LT200JJ TITANIUM LIGA CLIP (M) 6 CLIP/排 17.9

SCV01LT300JJ TITANIUM LIGA CLIP (M-L) 6 CLIP/排 20.2

SCV01V312MV7 "維達力克" 鈦金屬血管夾系統(中-大)"VITALITEC" SLS-CLIP

TITANIUM HEMOSTATIC CLIP SYSTEM(MEDIUM/LARGE)

20.2

SCV01V912MV7 "維達力克" 鈦金屬血管夾(中大)"VITALITEC" NINE CLIP

TITANIUM HEMOSTATIC CLIP SYSTEM(MEDIUM/LARGE)

20.2

SCV029404NM1 SUGITA ANEURYSM CLIP (FENESTRATED LARGE TYPE) 2897

SCV029405NM1 SUGITA ANEURYSM CLIP (TEMPORARY TYPE) 2778

SCV029407SM1 SUGITA ANEURYSM CLIP (FENESTRATED LARGE TYPE) 2897

SCV029408SM1 SUGITA ANEURYSM CLIP (MINI TYPE) 2908

SCV2032091US SURGI-CLIP M-11 (每支20 CLIP) 98.7

SCV20340312C "柯惠"拋棄式自動血管夾 "COVIDIEN" AUTO SUTURE DISPOSABLE

AUTOMATIC CLIP APPLIER

98.7

SCV20340442C "柯惠"拋棄式自動血管夾 "COVIDIEN" AUTO SUTURE DISPOSABLE

AUTOMATIC CLIP APPLIER

98.7

SCV20340462C "柯惠"拋棄式自動血管夾(每支20 CLIP) "COVIDIEN" AUTO

SUTURE DISPOSABLE AUTOMATIC CLIP APPLIER(每支20 CLIP)

96.7

SCV20340482C "柯惠"拋棄式自動血管夾 "COVIDIEN" AUTO SUTURE DISPOSABLE

AUTOMATIC CLIP APPLIER

113

SCV20340512C "柯惠"自動連發式血管夾 "COVIDIEN" AUTO SUTURE PREMIUM

SURGICLIP APPLIER WITH CLIPS

98.7

1048

特材代碼 中英文名稱 支付點數-104/01/01

SCV20340532C "柯惠"自動連發式血管夾 "COVIDIEN" AUTO SUTURE PREMIUM

SURGICLIP APPLIER WITH CLIPS

98.7

SCV20MCL20JJ MULTIPLE CLIPS APPLIER (20 CLIP/PC) 113

SCV20MCM20JJ MULTIPLE CLIP APPLIER (20 CLIP/PC) 98.7

SCV20MCM30JJ MULTIPLE CLIP APPLIER (30 CLIP/PC) 98.7

SCV20MCS20JJ MULTIPLE CLIP APPLIER (20 CLIP/PC) 96.7

TKF0108120A1 LIGHT GUIDE 20G(自103.08.01起支付標準醫令代碼86207B、

86409B、86410B及86411B使用者已內含不得另外申報)

1435

TKF01269012D "竇可"歐索德晶體乳化切割儀:透照配件(自103.08.01起支付標準

醫令代碼86207B、86409B、86410B及86411B使用者已內含不得另

外申報)

1435

TKF0192801ZT 後房手術用光纖(自103.08.01起支付標準醫令代碼86207B、

86409B、86410B及86411B使用者已內含不得另外申報)

1435

TKF01B5X20B9 "博士倫"曙光進階超音波乳化系統手術包及配件(自103.08.01起

支付標準醫令代碼86207B、86409B、86410B及86411B使用者已內

含不得另外申報)

1435

TKF01C9606B9 "博士倫"眼科手術儀用光纖導管"BAUSCH&LOMB"ILLUMINATORS(自

103.08.01起支付標準醫令代碼86207B、86409B、86410B及86411B

使用者已內含不得另外申報)

1435

TKF01DP602B9 ILLUMINATORS 眼科手術儀用光纖導管(自103年8月1日起支付標準

醫令代碼86207B、86409B、86410B及86411B使用者已內含不得另

外申報

1435

TKF01MVS01B9 ILLUMINATORS 眼科手術儀用光纖導管(自103.08.01起支付標準醫

令代碼86207B、86409B、86410B及86411B使用者已內含不得另外

申報)

1435

TKP03ACT102C "柯惠"威利雷柏酷迪波無線電頻率電刀系統-冷循環式射頻燒灼電

極針組"COVIDIEN" VALLEYLAB COOL-TIP RF SYSTEM-RF

ELECTRODE KIT*給付規定請見備註欄

18800

TKP03LEVEESB LEVEEN COACCESS ELECTRODES SYSTEM AND LEVEEN NEEDLE

ELECTRODES勒鈖共進電極系統與勒鈖針狀電極探頭 ※適應症請見

備註欄

18800

TKP03RFA01XM "STARMED"ELECTROSURGICAL SYSTEM AND ACCESSORIES:RF

COAGULATION ELECTRODES"史達美克"電燒系統及附件:凝血電極針

(冷卻式)※適應症請見備註欄

18800

TKP03RFA20RX "RF"RADIOFREQUENCY ELECTROSURGICAL CAUTERY APPARATUS AND

ACCESSORIES"愛爾發"電子燒灼機及其附件:凝血電極針(水冷式)

18800

TKP03RFATA1H "MEDSPHERE"ELECTROSURGICAL RF ELECTRODES "邁德斯菲爾"電外

科電極 ※適應症請見備註欄

18800

TKP03STAR2XM "STARMED"STAR RF ELECTRODE-FIXED"史達美克"史達射頻電極-固

定式※給付規定請見備註欄

18800

TKP03STAR3XM "史達美克"史達射頻電極(單面)※給付規定請見備註

欄"STARMED"STAR RF ELECTRODE(UNI-FACED)

18800

TKVC1CX408B9 高速玻璃體切割頭(自103.08.01起支付標準醫令代碼86207B、

86409B、86410B及86411B使用者已內含不得另外申報)

4165

TKVS1D4801B9 "博士倫"玻璃體抽吸及切割器械包(含盒子)(自103.08.01起支付

標準醫令代碼86207B、86409B、86410B及86411B使用者已內含不

得另外申報)

4165

TKVS1D4801SZ BASIC POSTERIOR VITRECTOMY PACK(自103.08.01起支付標準醫令

代碼86207B、86409B、86410B及86411B使用者已內含不得另外申

報)

4165

1049

特材代碼 中英文名稱 支付點數-104/01/01

TKVS1D4803B9 "博士倫"玻璃體抽吸及切割器械包(不含盒子)(自103.08.01起支

付標準醫令代碼86207B、86409B、86410B及86411B使用者已內含

不得另外申報)

4165

TKVS1D4803SZ "博士倫"玻璃體抽吸及切割器械包(不含盒子)(自103.08.01起支

付標準醫令代碼86207B、86409B、86410B及86411B使用者已內含

不得另外申報)

4165

TSS01000011R 羅氏優勝血糖機組-羅氏優勝血糖試紙ACCU-CHEK PERFORMA TEST

STRIPS(10片,25片,50片,MIC50片/罐)*使用規定請見備註欄

8.1

TSS0100001G8 測利得超值型血糖檢測系統-血糖試片(25片、50片/盒)*使用規定

請見備註欄

8.1

TSS0100001J1 暐世血糖測試儀套組-血糖試紙*使用規定請見備註欄(25片,50片

/罐)

8.1

TSS0100001LQ “長庚”血糖檢測系統-血糖試紙“CHANG GUNG”BLOOD GLUCOSE

MONITORING SYSTEM-TEST STRIP

8.1

TSS01000021R 羅氏優勢血糖機組-羅氏優勢血糖試紙ACCU-CHEK ADVANTAGE TEST

STRIPS((10片,25片,50片/罐)*使用規定請見備註欄

8.1

TSS0100002G8 測利得超優型血糖檢測系統-血糖試片(25片、50片/盒)*使用規定

請見備註欄

8.1

TSS0100002J1 暐世新型血糖測試儀套組-血糖試紙*使用規定請見備註欄(50片,

25片/罐)

8.1

TSS0100002LQ “長庚”血糖檢測系統-血糖試紙“CHANG GUNG”BLOOD GLUCOSE

MONITORING SYSTEM-TEST STRIP

8.1

TSS01000031R 羅氏活力血糖機組-羅氏活力血糖試紙(10片,25片,50片/罐)*使用

規定請見備註欄

8.1

TSS0100003G8 好輕鬆血糖檢測系統-血糖試片(25片、50片/盒)*使用規定請見備

註欄

8.1

TSS0100003J1 暐世攜帶型血糖測試儀套組-血糖試紙*使用規定請見備註欄(10片

,15片/罐)

8.1

TSS01000041R 羅氏GO讚血糖機組-羅氏GO讚血糖試紙ACCU-CHEK GO TEST

STRIPS((10片,50片/罐)*使用規定請見備註欄

8.1

TSS0100004G8 日安血糖檢測系統-血糖試片(50片/盒)*使用規定請見備註欄 8.1

TSS0100004J1 暐世語音血糖測試儀套組-暐世語音血糖測片(10片,25片,50片/

罐) EBCHEK BLOOD GLUCOSE MONITORING SYSTEM-EBCHEK BLOOD

GLUCOSE TEST STRIPS(10PCS,25PCS,50

8.1

TSS01000051R 羅氏整合型血糖機組-羅氏整合型血糖試紙ACCU-CHEK INTEGRA

TEST STRIPS((17片/捲,3捲/盒)*使用規定請見備註欄

8.1

TSS0100005G8 好贊血糖試紙SO EASY BLOOD GLUCOSE TEST STRIP(25片、50片、

單片鋁箔包50片/盒)*使用規定請見備註欄

8.1

TSS0100005GV 樂適康血糖監測系統之血糖試紙GLUCO PLUS GLUCOSE MONITORING

SYSTEM'S BLOOD TEST STRIP(25片或50片/盒)*使用規定請見備註

8.1

TSS0100006G8 測利得血糖檢測系統-測利得血糖試片 BLOOD GLUCOSE TEST

STRIP(25、50片/盒,10、25、50、100片/單片包)*使用規定見備

8.1

TSS0100006QG 好生活血糖檢測系統-血糖試片GL GOODLIFE SERIES BLOOD

GLUCOSE TEST STRIP 25片、50片/罐,單片鋁箔包25、50、100片

/盒,袋裝單片10*給付規定見備註

8.1

TSS0100007G8 好贊血糖檢測系統-好贊血糖試片 BLOOD GLUCOSE TEST

STRIP(25、50片/盒,10、25、50、100片/單片包)*使用規定見備

8.1

TSS01000USYJ 優速測血糖測試系統-血糖試片(10片/罐,50片/盒)*使用規定請

見備註欄

8.1

1050

特材代碼 中英文名稱 支付點數-104/01/01

TSS01001ESYE 優速安血糖測試系統-血糖試片(10片/罐,50片/盒)*使用規定請

見備註欄

8.1

TSS01002EKUE 優克糖血糖測試系統-血糖試片(10片/罐,50片/盒)*使用規定請

見備註欄

8.1

TSS0106301AB "亞培"信妥血糖試紙(50片,100片/罐)PRECISION PCX PLUS BLOOD

GLUCOSE TEST STRIPS*使用規定請見備註欄

8.1

TSS0111435AB "亞培"第二代醫療專用血糖試紙OPTIUM POINT OF CARE TEST

STRIPS(25片,50片,100片/罐)*使用規定請見備註欄

8.1

TSS0117311G7 龍易血糖測試系統-血糖試紙(50片/盒)*使用規定請見備註欄 8.1

TSS0119611AB "亞培" 歐騰血糖試紙 "ABBOTT" OPTIUM BLOOD GLUCOSE TEST

STRIPS(25片,50片/盒)*給付規定請見備註欄

8.1

TSS0122528AB "亞培" 利舒坦優血糖試紙"ABBOTT" FREESTYLE LITE BLOOD

GLUCOSE TEST STRIPS(50片,100片/罐)*使用規定請見備註欄

8.1

TSS013250BF9 福爾2合1血糖機之血糖試紙*使用規定請見備註欄(25片,50片/

盒)

8.1

TSS013252AK9 福爾舒康第二代2合1血糖血壓測試儀系統-血糖試片(25片、50片/

盒)*使用規定請見備註欄

8.1

TSS013261AK9 福爾益康語音型2合1血糖血壓測試系統-血糖試片(25片、50片/

盒)*使用規定請見備註欄

8.1

TSS014227AF9 福爾語音型血糖機之血糖試紙*使用規定請見備註欄(25片,50片/

盒)

8.1

TSS014230DF9 福爾舒康血糖測試系統之血糖試紙*使用規定請見備註欄(25片,

50片/盒)

8.1

TSS014231AF9 福爾易退片血糖機之血糖試紙*使用規定請見備註欄(25片,50片/

盒)

8.1

TSS014241AF9 福爾益康血糖機之血糖試紙*使用規定請見備註欄(25片,50片/

盒)

8.1

TSS014242AK9 福爾益康語音型血糖機-血糖試片(25片、50片/盒)*使用規定請見

備註欄

8.1

TSS014251AF9 福爾易退片血糖機之血糖試紙*使用規定請見備註欄(25片,50片/

盒)

8.1

TSS014256AK9 福爾益康背光型血糖機-血糖試片(25片、50片/盒)*使用規定請見

備註欄

8.1

TSS014272AK9 福爾倍康血糖機-血糖試片(25片、50片/盒)*使用規定請見備註欄 8.1

TSS014274AK9 福爾巧易測血糖機-血糖試片(25片、50片/盒)*使用規定請見備註

8.1

TSS0145656GK 歐克葡萄糖試驗系統-歐克血糖試片(25片,50片/盒)*使用規定請

見備註欄

8.1

TSS0145657GK 歐克語音血糖監測系統-歐克語音血糖測試片(25片,50片/盒)*使

用規定請見備註欄

8.1

TSS0145658GK 歐克免設碼血糖監測系統-歐克免設碼血糖試片(25片,50片/盒)*

使用規定請見備註欄

8.1

TSS0145659GK 慧昇克立測血糖監測系統-慧昇克立測血糖試片(50片/盒)*使用規

定請見備註欄

8.1

TSS01505C2J3 "愛森斯" 快速測血糖試紙"I-SENS"CARESENS II BLOOD GLUCOSE

TEST STRIPS(10片,50片/罐)*適應症請見備註欄

8.1

TSS0193327BB “柏朗”貝優血糖測試系統-血糖試紙“B. BRAUN” OMNITEST 3

GLUCOSE MONITORING SYSTEM-BLOOD GLUCOSE TEST STRIPS(25片/

罐)給付規定請見備註欄

8.1

TSS01ACCP1FH 艾康血糖測試系統-血糖試紙ACON ON CALL PLUS BLOOD GLUCOSE

TEST STRIPS(50片/盒,25片(單片鋁箔包)/盒,1片(單片鋁箔包))*

使用規定請見備註欄

8.1

1051

特材代碼 中英文名稱 支付點數-104/01/01

TSS01AD0505A 欣瑞血糖測試系統-欣瑞血糖測試片(25片,50片/罐)*使用規定請

見備註欄

8.1

TSS01AP100FT 愛彼德血糖測試系統-血糖試紙(10片,25片/罐)*使用規定請見備

註欄

8.1

TSS01APPLUFT 愛彼德進階血糖測試系統-血糖測試片(10片,25片/罐)*適應症請

見備註欄

8.1

TSS01APVCCFT 愛彼德語音血糖測試系統-血糖測試片 AP VOICE BLOOD GLUCOSE

MONITORING SYSTEM-BLOOD GLUCOSE TEST STRIPS(10片,25片/

盒)*使用規定請見備註欄

8.1

TSS01B2001WB "拜安捷"血糖測試試紙ASCENSIA BREEZE 2 BLOOD GLUCOSE TEST

STRIPS(10片/DISC,5*10 STRIPS)*使用規定請見備註欄

8.1

TSS01BKG13GB 百捷瑞血糖檢驗系統-百捷瑞血糖試片(50、25片/盒)BENECHECK

IDEAL GLUCOSE MONITORING SYSTEM-BENECHECK IDEAL GLUCOSE

TEST STRIP

8.1

TSS01BKGS1GB 百捷血糖檢測系統-百捷血糖試片(25片,50片/盒)*使用規定請見

備註欄 BENECHECK BLOOD GLUCOSE MONITORING SYSTEM

8.1

TSS01BKPGSGB 百捷益血糖檢測系統-百捷益血糖試片(25片,50片/盒)*使用規定

請見備註欄

8.1

TSS01BKSG1GB 百捷優血糖檢驗系統-百捷優血糖試片(10片,25片,50片/盒)

BENECHECK PREMIUM GLU MONITORING SYSTEM-BENECHECK PREMIUM

GLU TEST STRIP(10 PCS,25PCS,50PCS/

8.1

TSS01CTS01WB "拜耳"拜安康血糖測試試紙"BAYER"CONTOUR TS BLOOD GLUCOSE

TEST STRIPS(50片/盒,2*25 STRIPS)*使用規定請見備註欄

8.1

TSS01DG050FK 糖易測血糖監測系統-血糖試紙*使用規定請見備註欄(10片,25

片,50片,75片,100片/罐)

8.1

TSS01DSACHJ5 優潔血糖監測系統-血糖試紙10片/25片/50片*使用規定請見備註

8.1

TSS01EL001WB "拜耳"易理測血糖測試試紙ASCENSIA ELITE BLOOD GLUCOSE TEST

STRIPS(50片/盒)*使用規定請見備註欄

8.1

TSS01EN001FY "愛科來"葡萄糖檢測試紙II(50片/盒) *使用規定請見備註欄 8.1

TSS01EN002FY "愛科來"X-血糖檢測試紙 10片,50片/盒*適應症請見備註欄 8.1

TSS01EPSEZFU 勁速康血糖量測系統-血糖試紙(10片,25片,50片/盒)*使用規定請

見備註欄

8.1

TSS01EPSMTJG 邁士達血糖量測系統-血糖試片 25片/罐(2罐/盒)*使用規定請見

備註欄

8.1

TSS01G421SVL 愛奧樂血糖測試儀專用試紙*使用規定請見備註欄 8.1

TSS01G423SVL 愛奧樂血糖測試系統專用試紙*使用規定請見備註欄 8.1

TSS01GC2255A 欣云血糖測試片(10片/罐、25片/罐、30片/罐、25片/2罐、50片/

罐)GLUCOCLOUD BLOOD GLUCOSE TEST STRIP

8.1

TSS01GE100JW GE血糖監測系統-血糖測試片 GE BLOOD GLUCOSE MONITORING

SYSTEM-GE100 BLOOD GLUCOSE TEST STRIP(10片/罐,25片/罐)*

給付規定請見備註欄

8.1

TSS01GE200JW GE血糖監測系統-GE200血糖測試片(10片/罐、25片/罐)GE BLOOD

GLUCOSE MONITORING SYSTEM-GE200 BLOOD GLUCOSE TEST STRIP

8.1

TSS01GM100FS 瑞特血糖監測系統GM100-瑞特血糖測試片*(10片,25片,50片,100

片,200片/盒)*使用規定請見備註欄

8.1

TSS01GM210FS 瑞特血糖監測系統GM210-瑞特血糖測試片(10片,25片,50片,100

片,200片/盒)*使用規定請見備註欄

8.1

TSS01GM300FS 瑞特血糖監測系統GM300-瑞特血糖測試片*(10片,25片,50片,100

片/盒)*使用規定請見備註欄

8.1

TSS01GM550FS 瑞特血糖監測系統GM550-瑞特血糖測試片(10片,25片,50片,100

片,200片/盒)*使用規定請見備註欄

8.1

1052

特材代碼 中英文名稱 支付點數-104/01/01

TSS01GM700FS 瑞特血糖監測系統-血糖測試片RIGHTEST BLOOD GLUCOSE

MONITORING SYSTEM-BLOOD GLUCOSE TEST

STRIP(10,25,50,75,100,200片/盒)給付規定請見備註欄

8.1

TSS01GPLUSBB 柏朗貝佳血糖機-血糖試紙 OMNITEST PLUS GLUCOSE MONITORING

SYSTEM-TEST STRIPS(10片,25片,50片/罐)*使用規定請見備註欄

8.1

TSS01HE232JY 歐姆龍血糖監測系統-達安型-血糖試片OMRON BLOOD GLUCOSE

MONITORING SYSTEM HEA-232-BLOOD GLUCOSE STRIP(10,25,50/

罐)給付規定請見備註

8.1

TSS01HHRRZFZ 隨手測血糖試紙"ONETOUCH"HORIZON TM TEST STRIPS(25片/盒)*

使用規定請見備註欄

8.1

TSS01HL5888H 瑞康588自我血糖監控系統-瑞康血糖試紙(10片,25片,50片/盒)*

使用規定請見備註欄

8.1

TSS01LT2255A 欣巧血糖測試片GLUCOSURE LIGHT BLOOD GLUCOSE TEST STRIP 25

片1罐/盒,30片1罐/盒,25片2罐/盒,50片1罐/盒

8.1

TSS01MAJHRFT 茂晶血糖測試系統-血糖試紙(10片,25片/罐)*使用規定請見備註

8.1

TSS01MAJJRFT 茂晶血糖測試系統-血糖試紙(10片,25片/罐)*使用規定請見備註

8.1

TSS01NM001JY 歐姆龍血糖監測系統-達健型-血糖試片OMRON BLOOD GLUCOSE

MONITORING SYSTEM-HEA-230(25片/1罐)*給付規定請見備註欄

8.1

TSS01PGS01GB 百捷益血糖試片(10片,25片,50片,56片,100片/盒) BENECHECK

PLUS BLOOD GLUCOSE TEST STRIP

8.1

TSS01QS2255A 佳盛時血糖測試片QISSENSE BLOOD GLUCOSE TEST STRIP 25片1罐

/盒,30片1罐/盒,25片2罐/盒,50片1罐/盒

8.1

TSS01RMCB1RP 優盛血糖測試套組-血糖試紙(10片,25片,50片/罐,25片*2罐)*使

用規定請見備註欄

8.1

TSS01SC001KJ 掌上靈血糖測試系統-血糖測試片PALMLAB BLOOD GLUCOSE

MONITORING SYSTEM-BLOOD GLUCOSE TEST STRIP(25片/罐)*給付

規定請見備註欄

8.1

TSS01SE0505A 欣速血糖測試系統-欣速血糖測試片SENSOREX G TEST STRIPS(50

片/罐)*使用規定請見備註欄

8.1

TSS01SELECFZ 穩擇血糖試紙ONETOUCH SELECT TEST STRIPS(25片/瓶,50片/2

瓶)*給付規定請見備註欄

8.1

TSS01SG103FX 易立測血糖試紙(10片,25片,50片/盒)*使用規定請見備註欄 8.1

TSS01SG105J4 易美測I血糖試紙(25片/盒)*適應症請見備註欄 8.1

TSS01SG106FX 易立測II血糖試紙(10片,25片,50片/盒)*使用規定請見備註欄 8.1

TSS01SG203FX 易立測血糖試紙(25片*2盒)*使用規定請見備註欄 8.1

TSS01SG205J4 易美測I血糖試紙(25片*2盒)*適應症請見備註欄 8.1

TSS01SG206FX 易立測II血糖試紙(25片*2盒)*使用規定請見備註欄 8.1

TSS01SMC00FT 適美捷血糖測試系統-血糖試紙(10片,25片/罐)*使用規定請見備

註欄

8.1

TSS01STP1AJY 歐姆龍血糖試片二代(10片/罐、25片/罐、50片/罐、25片/2罐、

25片/盒)OMRON BLOOD GLUCOSE TEST STRIP

8.1

TSS01STP30JY 歐姆龍血糖試片(10片,25片,50片/罐,25片/2罐)*給付規定請見

備註欄OMRON BLOOD GLUCOSE TEST STRIP

8.1

TSS01T10255A 必立康GC血糖/膽固醇雙功能測試系統-虹吸2血糖測試片(25片,50

片/罐)*使用規定請見備註欄

8.1

TSS01T10505A 必立康血糖/尿酸雙功能測試系統-虹吸2血糖測試片(25片,50片/

罐)*使用規定請見備註欄

8.1

TSS01T12255A 速利測血糖測試系統-虹吸2血糖測試片(25片,50片/罐)*使用規定

請見備註欄

8.1

TSS01TB001F7 易速得-168血糖測試套組-易速得-168血糖測試片(10片,25片,50

片/罐;25片*2罐)*使用規定請見備註欄

8.1

1053

特材代碼 中英文名稱 支付點數-104/01/01

TSS01TB002F7 易速得-606血糖測試套組-易速得-606血糖測試片(10片,25片,50

片/罐;25片*2罐)*使用規定請見備註欄

8.1

TSS01TB003F7 易速得-608血糖測試套組-易速得-608血糖測試片(10片,25片,50

片/罐;25片*2罐)*使用規定請見備註欄

8.1

TSS01TB004F7 舒適測血糖測試套組-舒適測血糖測試片(10片,25片,50片/罐;25

片*2罐)*使用規定請見備註欄

8.1

TSS01TB005F7 特立捷血糖測試套組-特立捷血糖測試片(10片,25片,50片/罐;25

片*2罐)*使用規定請見備註欄

8.1

TSS01TB006F7 易速得血糖測試片10片,25片,50片/罐*使用規定請見備註欄 8.1

TSS01TB007F7 台欣TB100血糖測試片10片,25片,50片/罐*使用規定請見備註欄 8.1

TSS01TB008F7 台欣血糖測試套組-血糖測試片TYSONBIO AC200 BLOOD GLUCOSE

MONITORING SYSTEM-TEST STRIPS-10片,25片,50片/罐,25片*2罐*

給付規定請見備註

8.1

TSS01ULTRAFZ 穩豪血糖試紙"ONETOUCH" ULTRA TEST STRIPS(25片/罐,2罐/

盒;25片/盒100.1.1生效)*使用規定請見備註欄

8.1

TSS01VE2255A 欣聲血糖檢測試片(25片,30片,50片/罐)*使用規定請見備註欄 8.1

TSS01VV2255A 欣活血糖測試片GLUCOSURE VIVO BLOOD GLUCOSE TEST STRIPS 25

片1罐/盒,30片1罐/盒,25片2罐/盒,50片1罐/盒

8.1

1054