第八十條附件三 特殊材料給付品項暨支付標準表
特材代碼 中英文名稱 支付點數(109年1月)
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)
27.4
ACA0100CDVPW ”PERFECT”I.V LOCK(NEEDLESS SAFETY)”普惠”注射帽 (免針安全型)
27.4
ACA0108008SG IV CAP 注射帽 3
ACA01AB00NPW IV LOCK 3
ACA01C1C02LL INJECTION CUP(IV LOCK) 3
ACA01NF005LL ”怡安” 輸液套留置蓋(安全型)”LILY” INJECTION CAP 38
ACA01NFS00M6 “宇仁”免針型輸液加藥器 ”IMM”NEEDLE FREE SET 27.4
ACC01HSC60H6 PLASTIC CONNECTOR(兩尖型) 17.4
ACC01HSC61H6 PLASTIC CONNECTOR(一尖一平型) 17.4
ACC02VP004LL 3 WAY 7.8
ACM0101285BB ANGIODYN HIGHT PRESSURE MANIFOLDS STOPCOCKS DOUBLE PORTS 500PSI 1000PSI
180
ACM0101286BB ANGIODYN HIGHT PRESSURE MANIFOLDS STOPCOCKS TRIPLE PORTS 500PSI 1000PSI
200
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
ACM012P200NL ”娜維利斯特”娜米克血管造影多路水接頭”NAVILYST”
NAMIC ANGIOGRAPHIC MANIFOLDS(2-PORT)
180
ACM013P700NL ”娜維利斯特”娜米克血管造影多路水接頭”NAVILYST”
NAMIC ANGIOGRAPHIC MANIFOLDS(3-PORT)
200
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
ACM01502RXMR MANIFOLD 2-PORTS 500 PSI 180
ACM01503RXMR MANIFOLD 3-PORTS 500 PSI 200
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
ACM01APMF2H9 ANGIO PACK:MANIFOLDS 2 PORT/500 180
ACM01APMF3H9 ANGIO PACK:MANIFOLDS 3 PORT/500 200
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 通則
1.本表所列屬不分廠牌別編列代碼之特殊材料者，藥物許可證之持有廠商或保險醫事服務機構無須向保 險人建議收載；保險醫事服務機構按其所提供之特殊材料類別，不分廠牌，依本標準所列代碼申報費 用。
2.本表係一百零九年一月份之給付品項及支付點數，依本標準第四條第八項規定，如有異動，以保險人 最新公告為主。
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
”多路引流器
287
ACM01MA2PVGJ ”JSM”MANIFOLDS(2 PORT/500PSI W/PVC 1000PSI)”吉生
”多路引流器
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
”多路引流器
287
ACM01MA3PVGJ ”JSM”MANIFOLDS(3 PORT/500PSI W/PVC 1000PSI)”吉生
”多路引流器
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
”多路引流器
287
ACM01MA4PVGJ ”JSM”MANIFOLDS(4 PORT/500PSI W/PVC 1000PSI)”吉生
”多路引流器
250
ACM01MAN2NBQ ”邦特”多管道引流器 180
ACM01MAN2PGJ MANIFOLDS (2 PORT 500PSI)多路引流器 180
ACM01MAN3NBQ ”邦特”多管道引流器”BIOTEQ”MANIFOLDS 200
ACM01MAN3PGJ MANIFOLDS (3 PORT 500PSI)多路引流器 200
ACM01MAN4NBQ ”邦特”多管道引流器”BIOTEQ”MANIFOLDS 261
ACM01MAN4PGJ MANIFOLDS (4 PORT 500PSI)多路引流器 261
ACM01MFD225S “昕力”一次性使用連通器:2路“SUNMED” MANIFOLD AND STOPCOCKS:2 PORT
180
ACM01MFD325S “昕力”一次性使用連通器:3路“SUNMED” MANIFOLD AND STOPCOCKS:3 PORT
200
ACM01MFD425S “昕力”一次性使用連通器:4路“SUNMED” MANIFOLD AND STOPCOCKS:4 PORT
261
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
ACP01CA123R5 ”索倫”心臟麻痺轉接器(開心用灌流接頭/直型、Y型接 頭)”SORIN” CARDIOPLEGIA ADAPTERS
88 ACP01ECTBSM6 EXTRACORPOREAL TUBING STRAIGHT CONNECTOR 88 ACP01ECTBYM6 EXTRACORPOREAL TUBING Y-CONNECTOR 88
ACP0214003DL MULTIPURPOSE PERFUSION SET※適應症請見備註欄 657 ACPD1C4129BT ”百特”鈦金屬接頭 ”BAXTER” ADAPTER FOR
PERITONEAL DIALYSIS CATHETER
1482
ACPD1MTC01M0 “美康”腹膜透析導管及配件：鈦金屬接頭“MEDCOMP”
PERITONEAL DIALYSIS CATHETER AND ACCESSORIES
1482
ACPTCPFLPW5S ”昕力”一次性使用Y型連接器套件”SUNMED”
HAEMOSTATIC VALVES
931
ACS0109512BB DISCOFIX C-3/-3 MULTIDIRECTIONAL STOPCOCKS”柏朗”
輸液轉換閥
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
ACS01A010VPW ”普惠”三通閥”PERFECT”3-WAY STOPCOCK 7.8
ACS01AM01H3B ”康德萊”旋塞閥”KDL”STOPCOCK(500PSI) 34
ACS01AM01L3B ”康德萊”旋塞閥”KDL”STOPCOCK(45PSI) 7.8
ACS01AM01M3B ”康德萊”旋塞閥”KDL”STOPCOCK(1200PSI) 70
ACS01D010NPW DISPOSABLE INFUSION SET 3 WAY STOPCOCK 7.8 ACS01H3SNCMR MARQUIES SERIES STOPCOCKS 1050PSI 70
ACS01M3SNCMR MARQUIS SERIES STOPCOCK 500PSI 34
ACS01NCN3SNR 3 WAY STOPCOCK 塑膠三極栓 7.8
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
ACS036494CBB “柏朗”輸液轉換活塞 DISCOFIX MULTIDIRECTIONAL STOPCOCKS
25
ACS03SMT01SG 1000PSI HIGH PRESSURE 3 WAY 70
ACVP105103B0 CSF CATHETER CONNECTOR，STRAIGHT 380
ACVP105104B0 CSF CATHETER CONNECTOR，RIGHT ANGLE 660
ACVP123048CM HAKIM STRAIGHT CONNECTOR 380
ACVP145103PM CONNECTOR 380
ACVP145104PM CONNECTOR L型 660
ACVP182150CM ACCU-FLO STRAIGHT CONNECTORS(METAL，PLASTIC) 380 ACVP182151CM ACCU-FLO RIGHT ANGLE CONNECTORS(METAL，PLASTIC) 660
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 931
ACY0103331AB COPILOT BLEEDBACK CONTROL VALVE Y ADAPTOR 931 ACY010KAY2GG ”GOODTEC”Y-CONNECTOR SET ”固德克”Y型連接器套組 931 ACY016248VM4 ADJUSTABLE VALVE W/3-WAY STOPCOCK 931
ACY0191400NL NAMIC MORSE Y-ADAPTOR 931
ACY0191400SB NAMIC MORSE Y ADAPTOR 931 ACY01HV001BQ ”邦特”Y型連接器組”BIOTEQ” Y CONNECTOR SET 931 ACY01HV002BQ ”邦特”Y型連接器組”BIOTEQ” Y CONNECTOR SET 931 ACY01HV003BQ ”邦特”Y型連接器組”BIOTEQ” Y CONNECTOR SET 931 ACY01HVA8FMR “美瑞特”止血閥門配接器“MERIT MEDICAL”
HEMOSTASIS VALVE ADAPTER
931
ACY01KESU1NX ”尼瓦西斯”Y型接頭組:氣球導管或導引管用接頭(單Y型)
”MINVASYS” Y-CONNECTOR
931
ACY01MAP13MR MONIFOLD W/HEMOSTASIS VALVE 200PSI 單Y型 931 ACY01MAP22MR ANGIOPLASTIC PACK & DOUBLE HEMOSTASIS VALVES 950 ACY01MAP32MR HONOR HEMOSTASIS VALVE ANGIOPLASTY PACK 931 ACY01MAP45MR ”MERIT”ANGIOPLASTY PACKS & HEMOSTASIS VALVES”美
瑞特”血管成型術止血閥組
931
ACY01MAP80MR “美瑞特”博士止血閥門“MERIT” PHD HEMOSTASIS VALVE
931
ACY01NYC00GJ ”JSM”Y CONNECTOR KIT ”吉生”Y 型連接器組 931 ACY01NYC10GJ ”JSM”Y CONNECTOR KIT W/INSERTION TOOL”吉生”Y 型
連接器組含導引支撐器
931
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)
931
ACY01YK100GJ ”吉生”Y 型連接器組”JSM”Y CONNECTOR KIT 931
ACY01YK110GJ ”吉生”Y 型連接器組(含導引支撐器)”JSM”Y CONNECTOR KIT(INSERTION TOOL)
931
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)
931
BBB01T060CTM TRANSFER BAG 600ML 60
BBB01T100BTM TRANSFER BAG 1000ML 60
BBB01TEMP001 100CC MEDICATION CASSETTE RESERVOIR※限原發性肺動脈 高血壓症居家靜脈注射FLOLAN者
750
BBF0373006KD KENDALL KANGAROO ENTERAL FEEDING PUMP SETS*”肯特利
”袋鼠灌食機用套組
100
BBF0373622KD ”KENDALL”KANGAROO 924 PUMP SETS”肯特利”袋鼠灌食 機用套組
100
BBF0377508KG “卡比”艾美嘉管灌營養袋餵食管“KABI” AMIKA PUMP SET
100
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
100
BBF0377545KG “卡比”愛普仕管灌餵食管袋組合套“KABI” APPLIX SMART/VISION PUMP SET
100
BBF03830ENBB “柏朗”史倍斯腸道營養輸液套-一千毫升軟袋“B. BRAUN
” INFUSOMAT SPACE LINE TYPE ENTERAL NUTRITION ENFIT-1000ML BAG
100
BBF03831ENBB “柏朗”史倍斯腸道營養輸液套-一千毫升軟袋/轉接器
“B. BRAUN” INFUSOMAT SPACE LINE TYPE ENTERAL NUTRITION ENFIT-1000ML BAG/TRANSITION SETS
100
BBF03E1002M6 宇仁餵食引導器(未滅菌)-餵食袋IMM FEEDING TUBE ACCESSORIES(NON-STERILE)-PUMP SET
100
BBF03E2002M6 宇仁餵食引導器 (未滅菌)-重力式餵食袋IMM FEEDING TUBE ACCESSORIES(NON-STERILE)
72
BBF03F1200SG FEEDING PUMP SET※適應症請見備註欄 100
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
100
BBF03FB120SG “十美牌”餵食引導器 (未滅菌)-重力式餵食袋“SIGMA”
FEED TUBE GUIDE (NON-STERILE)
72
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
30.7
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
30.7
BBP011680NA5 YOUCARE C 14:59MM*限住院患者使用 25.1
BBP0120695F4 ”康威”益舒穩大容量造口袋 (未滅菌)”CONVATEC”
NATURA HIGH OUTPUT POUCH (NON-STERILE)
30.7
BBP0120696F4 ”康威”益舒穩大容量造口袋 (未滅菌)”CONVATEC”
NATURA HIGH OUTPUT POUCH (NON-STERILE)
30.7
BBP0120697F4 ”康威”益舒穩大容量造口袋 (未滅菌)”CONVATEC”
NATURA HIGH OUTPUT POUCH (NON-STERILE)
30.7
BBP0400315DD ONE PIECE SOLO MINI DRAINABLE POUCH 15:50MM(含人工 皮、不織布)※限住院患者申報
49
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
30.7
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
30.7
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
30.7
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
28.3
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
49
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
30.7
BBP0400818DD SOLO DRAINABLE POUCHES(NON-STERILE) 10-40MM*限住院 患者申報
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
30.7
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
28.3
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
30.7
BBP0403223HL ”鶴牌”造口術用袋及其附件 (未滅菌)-卡拉亞開口便袋 (含人工皮)”HOLLISTER”OSTOMY POUCH AND
ACCESSORIES(NON-STERILE)-KARAYA 5 SEAL RING DRAINABLE POUCH (INCLUDING SKIN BARRIER)
37.6
BBP0403250HL ”鶴牌”造口術用袋及其附件 (未滅菌)-開口便袋 (含人 工皮、不織布)”HOLLISTER”OSTOMY POUCH AND
ACCESSORIES (NON-STERILE)-POST OPERATION COMPACT DRAINABLE POUCH (INCLUDING SKIN BARRIER，
NONWOVEN)
49
BBP0403796HL ”鶴牌”造口術用袋及其附件-小兒單片式便袋(含人工 皮、不織布)”HOLLISTER”OSTOMY POUCH AND
ACCESSORIES (NON-STERILE)- POUCHKINS ONE-PIECE DRAINABLE POUCH (INCLUDING SKIN BARRIER， NONWOVEN)
49
BBP0403802HL ”鶴牌”造口術用袋及其附件 (未滅菌)-中央點鎖透明可 引流便袋”HOLLISTER”OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-DRAINABLE POUCH 44MM
30.7
BBP0403806HL ”鶴牌”造口術用袋及其附件 (未滅菌)-中央點鎖透明可 引流便袋”HOLLISTER”OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-DRAINABLE POUCH 102MM
28.3
BBP0403807HL ”鶴牌”造口術用袋及其附件(未滅菌)-中央點鎖便袋”
HOLLISTER”OSTOMY POUCH AND ACCESSORIES (NON-
STERILE)-CENTERPOINTLOCK DRAINABLE POUCH*限住院患者 申報
30.7
BBP0403857HL ”鶴牌”造口術用袋及其附件 (未滅菌)-中央點鎖式兩式 便袋”HOLLISTER”OSTOMY POUCH AND ACCESSORIES (NON- STERILE)-OSTOMY TWO-PIECE WITH TRANSPARENT 57MM
30.7
BBP0405403F4 ”CONVATEC”ESTEEMSYNERGY DRAINABLE POUCH
TRANSPARENT 35/48/61MM雙片式造口袋*限住院患者申報
30.7
BBP0406820CA POST OPEN BAG 100MM*限住院患者申報 28.3
BBP0407650HL ”鶴牌”造口術用袋及其附件 (未滅菌)-單片附人造皮便 袋 (含人工皮)”HOLLISTER”OSTOMY POUCH AND
ACCESSORIES (NON-STERILE)-STONINAL ONE PIECE POUCH 51MM (INCLUDING SKIN BARRIER)
37.6
BBP0408511HL ”鶴牌”造口術用袋及其附件(未滅菌)-單片墊高式便袋 (含人工皮”不織布)”HOLLISTER” OSTOMY POUCH AND ACCESSORIES(NON-STERILE)-PREMIER ONE-PIECE
DRAINABLE OSTOMY(INCLUDING SKIN BARRIER， NONWOVEN)
49
BBP0408531HL 鶴牌造口術用袋及其附件 (未滅菌)-單片黏捲式便袋(含人 工皮、不織布)”HOLLISTER”OSTOMY POUCH AND
ACCESSORIES (NON-STERILE)-PREMIER DRAINABLE POUCH (INCLUDING SKIN BARRIER， NONWOVEN)
49
BBP0408631HL ”鶴牌”造口術用袋及其附件(未滅菌)-單片附紙膠型便袋 (含人工皮”不織布)”HOLLISTER”OSTOMY POUCH AND ACCESSORIES(NON-STERILE)-PREMIER DRAINABLE POUCH (INCLUDING SKIN BARRIER， NONWOVEN)
49
BBP0408651HL ”鶴牌”造口術用袋及其附件 (未滅菌)-單片式透明便袋 (含人工皮、不織布)”HOLLISTER”OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-PREMIER DRAINABLE POUCH (INCLUDING SKIN BARRIER， NONWOVEN)
49
BBP0409243F4 ”CONVATEC”ESTEEMSYNERGY CLOSE POUCH
TRANSPARENT35/48/61MM雙片式造口袋*限住院患者申報
30.7
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
30.7
BBP0410387CA ”康樂保”善舒樂造口術用袋及其附件(未滅菌)”
COLOPLAST” SENSURA OSTOMY POUCH AND ACCESSORIES (NON-STERILE)
30.7
BBP0412131A5 PROCARE-2 DRAINABLE POUCH 30，40，50MM*限住院患者申 報
49
BBP0412134A5 PROCARE-2 DRAINABLE POUCH 70MM*限住院患者申報 30.7 BBP0412501A5 LAPACK SUPER-G 人工肛門袋 G80*限住院患者申報 10.6 BBP0412502A5 LAPACK SUPER-G 人工肛門袋 G100*限住院患者申報 10.6 BBP0412511A5 LAPACK SUPER-C 100 人工肛門封口便袋*限住院患者申報 10.6
BBP0413351A5 POSPACK-B、K 60，70MM*限住院患者申報 49
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。
49
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
30.7
BBP0415021A5 POSPACK B 60MM※限住院患者使用 49
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
49
BBP0415696CA “康樂保”善舒樂造口術用袋及其附件(未滅菌)
“COLOPLAST”SENSURA OSTOMY POUCH AND ACCESSORIES(NON-STERILE)
49
BBP0416623A5 YOUCARE 2 POUCH D 優護二件式開口便袋*限住院患者使用 30.7 BBP041662NA5 YOUCARE 2 POUCH D 優護二件式開口便袋*限住院患者使用 30.7
BBP0416771A5 YOUCARE D 14:59MM*限住院患者使用 49
BBP0416960CA ILEOSTOMY BAG MAXI 40MM，50MM，60MM※限住院患者申報 30.7
BBP041776NA5 ”愛樂康” 造口術用袋及其附件(未滅菌)-優護二件式開 口便袋*限住院患者申報”ALCARE” OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-YOUCARE 2P TDF
30.7
BBP0417820CA ALTERNA CHILDREN 雙片OPEN TRANSPARENT BAG 40MM※限 住院患者申報
44.2
BBP0418006HL ”鶴牌”造口術用袋及其附件 (未滅菌)-新象便袋”
HOLLISTER”OSTOMY POUCH AND ACCESSORIES (NON- STERILE)-NEW IMAGE LOCK’N ROLL DRAINABLE POUCH 102MM
28.3
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 POUCH
30.7
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 DRAINABLE POUCH
28.3
BBP0418102HL ”鶴牌”造口術用袋及其附件 (未滅菌)-新象便袋”
HOLLISTER”OSTOMY POUCH AND ACCESSORIES (NON- STERILE)-NEW IMAGE DRAINABLE POUCH 2 PIECE 44:70MM
30.7
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，
TRANSPARENT WITH FILTER
30.7
BBP041827NA5 ”愛樂康” 造口術用袋及其附件 (未滅菌)-兩件式造口開 口便袋*限住院患者申報”ALCARE” OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-CELLCARE-2 DF(4-49MM)
30.7
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
49
BBP0419052CA ”康樂保”善舒樂造口術用袋及其附件 (未滅菌) ” COLOPLAST” SENSURA OSTOMY POUCH AND ACCESSORIES (NON-STERILE)
30.7
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。
44.2
BBP0421615F4 ”康威” 新優穩舒柔單片墊高式造口袋 (未滅菌)-便袋*
限住院患者申報”CONVATEC” ESTEEM + FLEX CONVEX POUCH (NON-STERILE)-OSTOMY POUCH
49
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。
49
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、不織布)”HOLLISTER” OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-ONE PIECE HIGH OUTPUT WITH FLEXTEND， SKIN BARRIER AND SOFT DRAIN TAP (INCLUDING SKIN BARRIER， NONWOVEN)
49
BBP0456860CA ”康樂保”愛特大造口術用袋及其附件 (未滅菌) _含人工 皮+不織布” COLOPLAST” ALTERNA OSTOMY POUCH AND ACCESSORIES (NON-STERILE)
49
BBP0459850CA ”COLOPLAST”ALTERNA ILEOSTOMY BAGS 10-70MM愛特大迴 腸造口袋*適應症請見備註欄
49
BBP0480020CA ONE PIECE ALTERNA CHILDREN OPEN TRANSPARENT BAG 10:35MM※限住院患者申報
44.2
BBP0488800HL ”鶴牌”造口術用袋及其附件-單片迷你便袋附除臭片(含 人工皮、不織布)”HOLLISTER”OSTOMY POUCH AND
ACCESSORIES (NON-STERILE)- PREMIER MINI DRAINABLE POUCH (INCLUDING SKIN BARRIER， NONWOVEN)
49
BBU0101460HL ”鶴牌”造口術用袋及其附件 (未滅菌)-首選尿袋 (含人 工皮)”HOLLISTER”OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-FIRST CHOICE UROSTOMY POUCH WITH CUT- TO-FIT BARRIER (INCLUDING SKIN BARRIER)
88.5
BBU0101482HL ”鶴牌”造口術用袋及其附件 (未滅菌)-單片式尿袋附墊 高片 (含人工皮)”HOLLISTER”OSTOMY POUCH AND
ACCESSORIES (NON-STERILE)-UROSTOMY POUCHS W CONVEX BARRIERS (INCLUDING SKIN BARRIER)
88.5
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。
56.7
BBU0103907HL ”鶴牌”造口術用袋及其附件 (未滅菌)-中央點鎖式透明 尿袋”HOLLISTER”OSTOMY POUCH AND ACCESSORIES (NON- STERILE)-UROSTOMY POUCH 38MM
56.7
BBU0103944HL ”鶴牌”造口術用袋及其附件 (未滅菌)-中央點鎖式透明 尿袋 (含人工皮)”HOLLISTER”OSTOMY POUCH AND
ACCESSORIES (NON-STERILE)-CENTER POINT LOCK UROSTOMY POUCH (INCLUDING SKIN BARRIER)
88.5
BBU0108432HL ”鶴牌”造口術用袋及其附件 (未滅菌)-單片式尿袋附墊 高片 (含人工皮)”HOLLISTER”OSTOMY POUCH AND
ACCESSORIES (NON-STERILE)-UROSTOMY POUCHS W CONVEX BARRIERS (INCLUDING SKIN BARRIER)
88.5
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(含人工皮)”HOLLISTER”OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-PREMIER UROSTOMY POUCH (INCLUDING SKIN BARRIER)
88.5
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
88.5
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
56.7
BBU0112451A5 BIOURINE-B 50MM*限住院患者申報 88.5
BBU0114201A5 YOUCARE U優護一件式尿袋*限住院患者使用 88.5
BBU011666NA5 YOUCARE 2U優護二件式尿袋*限住院患者使用 56.7
BBU0117570CA COLOPLAST ALTERNA UROSTOMY BAG MAXI375ML※限住院患 者申報
56.7
BBU0117890CA ALTERNA CHILDREN TRANSPARENT URINE BAG※限住院患者 申報
56.7
BBU0118402HL ”鶴牌”造口術用袋及其附件 (未滅菌)-新象尿袋(不含人 工皮)”HOLLISTER”OSTOMY POUCH AND ACCESSORIES (NON-STERILE)-NEW IMAGE UROSTOMY POUCH (NON- INCLUDING SKIN BARRIER) 44:70MM
56.7
BBU0118681A5 ”愛樂康” 造口術用袋及其附件 (未滅菌)-兩件式造口尿 袋*限住院患者申報”ALCARE” OSTOMY POUCH AND
ACCESSORIES (NON-STERILE)-CELLCARE 2 U
56.7
BBU0121623F4 ”康威” 新優穩舒柔單片墊高式造口袋 (未滅菌)-尿袋*
限住院患者申報”CONVATEC” ESTEEM + FLEX CONVEX POUCH (NON-STERILE)-URO POUCH(NON-STERILE)-OSTOMY POUCH
88.5
BBU0155850CA UROSTOMY BAG MAXI 375ML ※限住院患者申報 88.5 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。
88.5
BBU0180090CA ONE PIECE ALTERNA CHILDREN TRANSPARENT URINE BAG 10:35MM(含人工皮)※限住院患者申報
88.5
BBW0104055P2 ”太平洋”引流袋(腎臟造廔引流袋)”PAHSCO” DRAINAGE BAG(P.C.N. BAG)
34
BBW0104200P2 P.C.N. BAG (L) 腎臟造廔引流袋 34
BBW0149620P2 ”太平洋”引流袋(滅菌)(腎臟造廔引流袋)”PAHSCO”
DRAINAGE BAG(STERILE)(P.C.N. BAG)
34
BBW0185000AG ”亞康恩”導入/引流導管附件(滅菌)-造廔口引流袋”
ARGON” INTRODUCER/DRAINAGE CATHETER ACCESSORIES(STERILE)-OSTOMY DRAINAGE BAG
34
BBW01BAG01BQ ”邦特”導入/引流導管附件(滅菌)-引流袋BIOTEQ
INTRODUCER/DRAINAGE CATHETER ACCESSORIES(STERILE)- DRAINAGE BAG
34
BBW01DB7504Q ”康諾”引流袋 (滅菌)-腎臟造廔引流袋”CONOD”
DRAINAGE BAG (STERILE)-PCN BAG
34
CAE0101401BB PERIFIX ONE EPIDURAL
ANAESTHESIA(NEEDLE+CATH+CONNECTOR+FILTER+LOR SYRINGE+SYRINGE)
383
CAE0105400AR ”亞諾”硬脊膜外麻醉導管組(針+導管+過濾器)”ARROW”
EPIDURAL CATHETERIZATION SET
362
CAE0112006BB EPIDURAL ANAESTHESIA SET 16:18G(N+C+F+S)(型號含 04514300，04515-013:021，-200:307，04516-206:303)
383
CAE0112170BB EPIDURAL ANAESTHESIA CATHETER 103
CAE0113010BB EPIDURAL ANAESTHESIA SET(N+C+S) 362
CAE0139101PX ”保德士”硬膜外腔麻醉針組(1)”PORTEX”EPIDURAL MINIPACK SYSTEMS(1)
16;18G(NEEDLE+CATHETER+FILTER+SYRINGE)
383
CAE0139411PX ”保德士”硬膜外腔麻醉針組(4)”PORTEX”EPIDURAL MINIPACK SYSTEMS(4) 16;18G(NEEDLE+CATHETER)
206
CAE014014NBD PERISAFE EPIDURAL ANAESTHESIA KIT NEEDLE 17，18G CATH 19，20G(N+C+FILTER+SYRINGE+GUIDE+CONNECTOR)
383
CAE0151238BB PERICAN EPIDURAL NEEDLE 110
CAE0151300BB PERIFIX EPIDURAL SET 206
CAE0151410BB PERIFIX FOR CONTINUOUS EPIDURAL AND CAUDAL ANAESTHESIA 400 SERIES
383
CAE01ANE153B ”康德萊”一次性使用麻醉針-硬膜外穿刺針”KDL”
DISPOSABLE SPINAL NEEDLE
110
CAE01E5400AR NON-KINGKING EPIDURAL CATHETER 20GA 91.4CM，
19GAX92CM
362
CAE01EC54EAR ”泰利福亞諾”硬脊膜外麻醉導管套組(針+導管+過濾器)
”TELEFLEX ARROW”EPIDURAL CATHETERIZATION
362
CAE01MY150BB “柏朗”背利旺硬脊膜麻醉針組(CATHETER)“B. BRAUN”
PERIFIX SET FOR CONTINUOUS EPIDURAL ANAESTHESIA(CATHETER)
103
CAE01MY300BB “柏朗”背利旺硬脊膜麻醉針組(NEEDLE+CATHETER)“B.
BRAUN” PERIFIX SET FOR CONTINUOUS EPIDURAL ANAESTHESIA(NEEDLE+CATHETER)
206
CAE01MY301BB “柏朗”背利旺硬脊膜麻醉針組(NEEDLE+CATHETER+FILTER 或SYRINGE)“B. BRAUN” PERIFIX SET FOR CONTINUOUS EPIDURAL ANAESTHESIA(NEEDLE+CATHETER+FILTER或 SYRINGE)
362
CAE01MY401BB “柏朗”背利旺硬脊膜麻醉針組
(NEEDLE+CATHETER+FILTER+SYRINGE)“B. BRAUN”
PERIFIX SET FOR CONTINUOUS EPIDURAL
ANAESTHESIA(NEEDLE+CATHETER+FILTER+SYRINGE)
383
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
CAE01SD300BB ”B.BRAUN”PERIFIX CATHETERS FOR EPIDURAL ANAESTHESIA”柏朗”脊椎硬膜麻醉用穿刺套 (NEEDLE+CATHETER)
206
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
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)
383
CBA010502SAR INTRA AORTIC BALLOON CATHETER (型號:IAB-04230U，
04240U，04250U，06830U，06840U，R950U自94.10.01起生 效)
25364
CBA01078007T ”東海”銳思克閉塞球囊導管-臨時封堵大血管或人造內置 血管擴張(含導線GUIDE WIRE)”TMP”RESCUE BALLOON OCCLUSION CATHETER
22007
CBA010AB46M4 ”MEDTRONIC”RELIANT STENT GRAFT BALLOON CATHETER”
美敦力”瑞萊恩球囊導管
22007
CBA011ABA2YQ CORART BP IAB CATHETER A2 7:8FR 22:40CC柯拉特主動脈 內氣球導管
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
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 CBA01B2640GX ”GORE”TRI-LOBE BALLOON CATHETER(AORTIC)三葉球囊導
管
22007
CBA01C0DA1CK ”COOK”CODA BALLOON CATHETER (AORTIC)科達球曩導管 22007
CBA01C0DA2CK ”COOK”CODA BALLOON CATHETER(AORTIC)科達球囊導管 22007 CBA01C0DA3CK ”COOK”CODA 3G OCCLUSION BALLOON CATHETER”曲克”
柯達閉合球囊導管
22007
CBA01S730CAR REDIGUARD IAB CATHETER 7，8，9FR. 30CC，40CC 25364 CBA01ULTRA8S ”英斯卓”主動脈氣球導管”INSIGHTRA”ULTRA IABP 7FR
CATHETER KIT
25364
CBA021ABP2YQ 柯拉特主動脈內感應式氣球導管CORART BP SENSOR BALLOON P2
41110
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
7425
CBB0114508SB XXL BALLOON DILATATION CATHETER 5130 CBB0122064SB ”波士頓科技”艾瑟羅血管氣球擴張導管”BOSTON
SCIENTIFIC”XXL VASCULAR BALLOON DILATATION CATHETER
5130
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
5130
CBB0135HPVM4 ”美敦力”福戰士同軸導線型球囊導管”MEDTRONIC”
FORTREX 0.035” OTW PTA BALLOON CATHETER D:4:12MM;L:20:100MM
5130
CBB0139031SB ”BOSTON SCIENTIFIC”STERLING BALLOON DILATATION CATHETERS D 3:8MM L 10:60MM C USABLE 80;135CM氣球擴 張導管
5130
CBB0139032SB ”BOSTON SCIENTIFIC”STERLING BALLOON DILATATION CATHETERS(OTW)D 4:10MM L 20:100MM C USABLE
L40:135CM氣球擴張導管
5130
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
5130
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
5130
CBB014105NCD POWERFLEX PTA BALLOON CATHTER 5FR 5130
CBB0141500CD POWERFLEX PTA CATHETER 5130
CBB0141550CD POWERFLEX PTA BALLOON 5130
CBB0141570CD POWERFLEX PTA BALLOON 5130
CBB0141590CD POWERFLEX PTA BALLOON 5130
CBB01420XNCD POWER FLEX PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) CATHETER 3MM:12MM 40，80，135CM
5130
CBB01424NWCD ”CORDIS”AVIATOR PLUS PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY(PTA)BALLOON DILATATION CATHETER PTA氣球 擴張導管 4.0MM:6.0MM;7.0MM
5130
CBB0142610CD ”CORDIS”MAXI LD LARGE DIAMETER BALLOON PERCUTANEOUS TRANSLUMINAL
ANGIOPLASTY(PTA)DILATATION CATHETER D:14:25MM L:2:8CM”考迪斯”邁晰大直徑氣球擴張導管
5130
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
5130
CBB0150500SB WANDA PTA BALLOON DILATATION CATHETER 5130 CBB0152111BQ ”BIOTEQ”PTA BALLOON DILATATION CATHETER”邦特”血
管氣球擴張導管
5130
CBB0152115BQ ”BIOTEQ”PTA BALLOON DILATATION CATHETER”邦特”血 管氣球擴張導管
5130
CBB01540757T ”東海”氣球擴張導管”TMP”PTA BALLOON CATHETER(D:3.0MM:6.0MM;L:20MM:40MM)
5130
CBB0161111BQ ”BIOTEQ”PTA BALLOON DILATATION CATHETER”邦特”血 管氣球擴張導管
5130
CBB0161115BQ ”BIOTEQ”PTA BALLOON DILATATION CATHETER”邦特”血 管氣球擴張導管
5130
CBB018040N6K ”博仕美”雅其利周邊血管氣球擴張導管(L:10-100MM)”
BROSMED”ACHILLES NC PTA BALLOON DILATATION CATHETER
8103
CBB018041N6K ”博仕美”雅其利周邊血管氣球擴張導管(L:150MM)”
BROSMED”ACHILLES NC PTA BALLOON DILATATION CATHETER
10660
CBB018160N6K ”博仕美”卡斯特周邊血管氣球擴張導管(L:10:100MM)”
BROSMED”CASTOR NC PTA BALLOON DILATATION CATHETER
8103
CBB018161N6K ”博仕美”卡斯特周邊血管氣球擴張導管(L:150MM)”
BROSMED”CASTOR NC PTA BALLOON DILATATION CATHETER
10660
CBB018200N6K ”博仕美”艾瑪仕周邊血管氣球擴張導管(L:20:100MM)”
BROSMED”HERMES NC PTA BALLOON DILATATION CATHETER
5130
CBB018201N6K ”博仕美”艾瑪仕周邊血管氣球擴張導管(L:150MM)”
BROSMED”HERMES NC PTA BALLOON DILATATION CATHETER
10660
CBB01ADMXTM4 ”美敦力”愛德米羅周邊血管球囊導管”Medtronic”
ADMIRAL XTREME PTA Balloon Catheter D:3MM:12MM L:20MM:300MM
5130
CBB01ARM35AB ”ABBOTT”ARMADA 35/ARMADA 35LL PTA CATHETER”亞培
”阿曼達周邊血管球囊導管
5130
CBB01ARMA8AB ”ABBOTT”ARMADA 18 PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY(PTA)CATHETER”亞培”阿曼達18周邊血管球 囊導管
5130
CBB01AT751BA BARD ATLAS PTA BALLOON DILATATION CATHETER 75CM，
120CM
5130
CBB01AT752BA ”BARD”ATLAS PTA BALLOON DILATATION CATHETER 5130 CBB01ATB01CK ALL-TERRAIN BALLOON PTA DILATATION CATHETERS 5130 CBB01ATG35BA ”巴德”艾特斯格經皮穿刺血管成形術導管”BARD”ATLAS
GOLD PTA DILATATION CATHETER L:20-60MM
5130
CBB01BTM01QC ”CLEARSTREAM”BANTAM PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY(PTA)CATHETER”清流”班特經皮穿刺血管成 形術導管
5130
CBB01BTM02QC ”CLEARSTREAM”BANTAM PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY(PTA)CATHETER L:120MM-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
10660
CBB01BTM03QC ”清流”班特經皮穿刺血管成形術導管”CLEARSTREAM”
BANTAM PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY(PTA)CATHETER 280MM
10660
CBB01CHABCXW ”朗提仕”克納適周邊氣球導管”RONTIS”CRONUS PERIPHERAL BALLOON CATHETER(L:20:120MM)
5130
CBB01CMT285Q ”克雷”特瑟斯周邊血管擴張術氣球導管”CREAGH”
TERSUS PTA BALLOON DILATION CATHETER D:5MM-10MM L:20MM-80MM
5130
CBB01CQ120BA ”BARD”CONQUEST PTA BALLOON DILATATION CATHETER氣 球擴張導管
5130
CBB01CQ40ABA ”巴德”康格斯特40經皮穿刺血管成形術導管”BARD”
CONQUEST 40 PTA DILATATION CATHETER(>=40ATM)
5899
CBB01CQ575BA CONQUEST PTA BALLOON DILATATION CATHETER(型號CQ- 50;75-52;54;58自950401起生效，文號0940040071)
5130
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
5130
CBB01DR035BA ”巴德”杜拉德經皮穿刺血管成形術氣球擴張導管”BARD
”DORADO PTA BALLOON DILATATION CATHETER
5130
CBB01F0XSVAB ”ABBOTT”FOX SV PTA BALLOON CATHETER D 2:6MM L 90 135 150CM周邊血管氣球導管
5130
CBB01FCPTAAB ”ABBOTT”FOXCROSS PTA CATHETER周邊血管氣球導管 5130 CBB01G11XXN5 ”NUMED”GHOST II PTA CATHETER 40CM 75CM 120CM
135CM 150CM
5130
CBB01JK020EQ ”優洛可”優克經皮血管氣球擴張導管(L20:80MM)”
EUROCOR”JOKER 035 OVER THE WIRE (OTW) PTA BALLOON CATHETER
5130
CBB01L2457KE ”KANEKA”PTA BALLOON CATHETER 經皮穿腔成型術氣球導 管
5130
CBB01LYNX18R ”雅瑟斯”林可斯周邊血管氣球導管”ARTHESYS”LYNX PTA CATHETER L:10:200MM
5130
CBB01MG1XXN5 NUMED MINI GHOST DILATATION CATHETER 2MM-6MM 2CM:4CM 40CM:150CM
5130
CBB01NCELAM4 ”美敦力”娜諾可舒球囊擴張導管”MEDTRONIC”
NANOCROSS ELITE 0.014 OVER-THE-WIRE PTA BALLOON DILATATION CATHETER
5130
CBB01PAS35BK ”百多力”帕希爾18周邊血管氣球擴張導管”BIOTRONIK”
PASSEO-18 PTA BALLOON CATHETER 20:80MM
8103
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
10660
CBB01PAS38BK ”百多力”帕希爾35周邊血管氣球擴張導管”BIOTRONIK”
PASSEO-35，PTA BALLOON CATHETER 20:80MM
5130
CBB01PASHPBK ”百多力”帕希爾35高壓周邊血管周邊氣球擴張導管”
BIOTRONIK”PASSEO-35 HP PTA BALLOON DILATATION CATHETER L:20-80MM
5130
CBB01PCECAM4 ”美敦力”派斯飛克普拉斯周邊血管治療導管”MEDTRONIC
”PACIFIC PLUS PTA CATHETER
5130
CBB01PCF18F2 ”INVATEC”PACIFIC XTREME PTA BALLOON CATHETER”英 泰克”派斯飛克血管治療導管
5130
CBB01PTA14Y9 NANOCROSS .014 OTW PTA DILATATION CATHETER D 1.5:4.0MM;L 20:120MM 導管長度90;150CM
5130
CBB01PTA16EY 瑞提快速交換血管擴張氣球導管”EV3”RAPIDCROSS PTA RAPID EXCHANGE BALLOON DILATATION CATHETER
5130
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
5130
CBB01PTA31K7 SD PTA DILATATION CATHETER迅捷血管擴張氣球導管 5130 CBB01PTA35Y8 艾維血管擴張氣球導管EVERCROSS .035 OTW PTA
DILATATION CATHETER D 3.0:12.0MM L 15:120MM 導管長 度40，80，135CM
5130
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 球囊擴張導管80CM 135CM
5130
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
5130
CBB01PW035E7 ”優科德”優科滑經皮球囊擴張導管”EUCATECH”EUCA PW PTA BALLOON CATHETER L20-100MM
5130
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
5130
CBB01RV135BA ”BARD”RIVAL PTA BALLOON DILATATION CATHETER氣球擴 張導管 SHAFT 80&135CM D 4:10MM L 2:15CM
5130
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
5130
CBB01SMTRYSB ”BOSTON SCIENTIFIC”SYMMETRY BALLOON DILATATION CATHETER 1.5MM-6.0MM 2CM-10CM對稱式氣球裝導管
5130
CBB01TER155U ”泰速-35”氣球擴張導管”TERSUS”0.035”PTA BALLOON DILATATION CATHETER
5130
CBB01U3501BA ”巴德”艾特凡斯035氣球擴張導管”BARD”ULTRAVERSE 035 PTA DILATATION CATHETER
5130
CBB01U3502BA ”巴德”艾特凡斯035氣球擴張導管”BARD”ULTRAVERSE 035 PTA DILATATION CATHETER
10660
CBB0221055LW ”LEMAITRE”DISTAL PERFUSION CATHETER”樂脈”遠端灌 流導管
6072
CBB0342510CD ”考迪斯”速立刻擴張導管”CORDIS”SLEEK PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) CATHETER D2:4MM L40:100MM
8103
CBB0342522CD ”考迪斯”速立刻擴張導管”CORDIS”SLEEK PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) CATHETER D2:4MM L120:220MM
10660
CBB0342610CD ”考迪斯”速立刻擴張導管”CORDIS”SLEEK OTW PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) CATHETER L15:100MM
8103
CBB0342628CD ”考迪斯”速立刻擴張導管”CORDIS”SLEEK OTW PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) CATHETER L120:280MM
10660
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
10660
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
8103
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
10660
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
10660
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
10660
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
10660
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
8103
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
8103
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 請見備註欄
10660
CBB03ARMA3AB ”ABBOTT”ARMADA 14 XT PTA CATHETER D:1.2MM-2.0MM L:6MM:20MM”亞培”阿曼達凱蒂周邊血管球囊導管
8103
CBB03BTK225R ”泰速-14”氣球擴張導管(D:2-4MM;L:150-220MM)”
TERSUS-14”BTK PTA BALLOON DILATATION CATHETER
10660
CBB03BTK805R ”泰速-14”氣球擴張導管(D:2-4MM;L:20-100MM)”
TERSUS-14”BTK PTA BALLOON DILATATION CATHETER
8103
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。
8103
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。
10660
CBB03CMT105Q ”克雷”特瑟斯周邊血管擴張術氣球導管(下肢血管)”
CREAGH”TERSUS PTA BALLOON DILATION CATHETER D:2.0MM-8.0MM L:20MM-100MM
8103
CBB03CMT125Q ”克雷”特瑟斯周邊血管擴張術氣球導管(下肢血管)”
CREAGH”TERSUS PTA BALLOON DILATION CATHETER D:2.0MM-8.0MM L:120MM-220MM
10660
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
10660
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
8103
CBB03DR035BA ”巴德”杜拉德經皮穿刺血管成形術氣球擴張導管(下肢血 管)”BARD”DORADO PTA BALLOON DILATATION CATHETER L:120-200MM
10660
CBB03J0K15EQ ”優洛可”優克經皮血管氣球擴張導管(下肢血管)”
EUROCOR”JOKER 014 OVER THE WIRE (OTW) PTA BALLOON CATHETERD:2.0MM:3.5MM L:120MM:150MM
10660
CBB03J0K80EQ ”優洛可”優克經皮血管氣球擴張導管(下肢血管)”
EUROCOR”JOKER 014 OVER THE WIRE (OTW) PTA BALLOON CATHETER D:2.0:4.0MM L:40MM:80MM
8103
CBB03JK100EQ ”優洛可”優克經皮血管氣球擴張導管(L100MM)”EUROCOR
”JOKER 035 OVER THE WIRE (OTW) PTA BALLOON CATHETER
8103
CBB03JK120EQ ”優洛可”優克經皮血管氣球擴張導管(L:120;150MM)”
EUROCOR”JOKER 035 OVER THE WIRE (OTW) PTA BALLOON CATHETER
10660
CBB03LYNX28R ”雅瑟斯”林可斯周邊血管氣球導管(下肢血管)”
ARTHESYS”LYNX PTA CATHETER L:10:100MM
8103
CBB03LYNX38R ”雅瑟斯”林可斯周邊血管氣球導管(下肢血管)”
ARTHESYS”LYNX PTA CATHETER L:120:200MM
10660
CBB03NCELLM4 ”美敦力”娜諾可舒球囊擴張導管”MEDTRONIC”
NANOCROSS ELITE 0.014 OVER-THE-WIRE PTA BALLOON DILATATION CATHETER L:120:210MM
10660
CBB03NCELSM4 ”美敦力”娜諾可舒球囊擴張導管”MEDTRONIC”
NANOCROSS ELITE 0.014 OVER-THE-WIRE PTA BALLOON DILATATION CATHETER L:20:100MM
8103
CBB03PAS13BK ”百多力”帕希爾14周邊氣球擴張導管”BIOTRONIK”
PASSEO-14 PERIPHERAL DILATATION CATHETER 140:220MM
10660
CBB03PAS14BK ”百多力”帕希爾14周邊氣球擴張導管”BIOTRONIK”
PASSEO-14 PERIPHERAL DILATATION CATHETER 20:100MM
8103
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
10660
CBB03PAS35BK ”百多力”帕希爾35周邊血管氣球擴張導管”BIOTRONIK”
PASSEO-35， PTA BALLOON CATHETER L:100MM
8103
CBB03PASHPBK ”百多力”帕希爾35高壓周邊血管周邊氣球擴張導管”
BIOTRONIK”PASSEO-35 HP PTA BALLOON DILATATION CATHETER L:100MM
8103
CBB03PCELLM4 ”美敦力”派斯飛克普拉斯周邊血管治療導管-
L:120:150MM”MEDTRONIC”PACIFIC PLUS PTA CATHETER
10660
CBB03PCESSM4 ”美敦力”派斯飛克普拉斯周邊血管治療導管-L:20:80MM
”MEDTRONIC”PACIFIC PLUS PTA CATHETER
8103
