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비급여 항목

금액

분류

코드

명칭

내복약

052400511

메게이트현탁액 10ml4,000
059800011원프렙40,000
648900910챔픽스정0.5mg(바레니클린타르타르산염) 1,300
648900920챔픽스정1mg(바레니클린타르타르산염) 1,300
642401370콜민에이정60
650201670애니탈삼중정350
647802340트레스탄캡슐450
외용약650800260spongostan-standard(스펀지형 지혈제)20,000
642507391주블리아외용액45,000
주사약제655501931가다실9프리필드시린지(인유두종바이러스9가백 190,000
V-02++가다실9프리필드시린지-2회360,000
V-02가다실9프리필드시린지-3회(선납) 540,000
643605311녹십자티디백신프리필드시린지주 0.5mL30,000
670500861보령플루Ⅴ테트라백신주(프리필드시린지)(인플 37,000
650001960부스트릭스프리필드시린지(성인용)50,000
665900180아박심160U성인용주(A형간염백신) 70,000
668902161유박스비프리필드주 1ml 25,000
655500900조스터박스주(대상포진생바이러스백신)150,000
648902270프리베나13주(폐렴구균 씨알엠(CRM197) 단백접 130,000
650001800하브릭스주성인용1440(A형간염백신)(1ml)70,000
643601841-1하이퍼테트주(항파상풍사람면역글로불린)(250i.40,000
V-01대상포진+독감 170,000
V-03폐렴구균+독감 150,000
641100431네비도주사(테스토스테론운데카노에이트)300,000
657807051네큐팜주사액100mg/10mL 35,000
669906641뉴디엔주(폴리데옥시리보뉴클레오티드나트륨)80,000
669906440대한뉴팜멀티비타주50,000
669900560대한뉴팜비타민씨주10g/20ml 30,000
657805981덱스메딘주 2ml50,000
669904730리코리스주10,000
669904600리포라제주(히알우로니다제) 30,000
670602310리포토신주40,000
669906221바이타디주200,000IU(콜레칼시페롤) 40,000
653402050베노스틴주10ml20,000
655501751브리디온주2ml 200,000
669906481비코라민주-단독 5,000
669906481-1비코라민주-영양제 45,000
647801081삼진타우로린주사2%250ml(타우로리딘) 100,000
648502530아노솔주40,000
670607751아모부로펜주4ml 30,000
IBU-A아모부로펜주A 130,000
IBU-C아모부로펜주C 120,000
640007291아세트펜프리믹스주 100ml 40,000
654802210액상하이랙스주 2000IU/1.3ml200,000
645905920에스멀티비타주(N/S 250ml MIX + 일반수액세트)50,000
640006700오마프원페리362ml 100,000
644901752유바솔주30,000
066903401지타코주(은행엽엑스)5ml10,000
622900010카티스템(동종 제대혈유래 중간엽줄기세포)10,000,000
644913140페린젝트주250,000
669904211푸르민주 10ml(염산푸르설티아민) 20,000
668901281히루안주 25mg 30,000
재활및물리치료료MZ001FIMS(Functional Intramuscular Stimulation)1,500,000
MX122도수치료A (30분)70,000
MX122도수치료B (60분)140,000
MX122도수치료C (15분)35,000
MZ007신장분사치료(Cryo)[1부위]20,000
MZ007신장분사치료(Cryo)[2부위]40,000
MY143증식치료(척추부위)-[1부위] 100,000
MY143증식치료(척추부위)-[2부위] 150,000
MY142증식치료A 50,000
MY142증식치료B 80,000
SZ084체외충격파술 (1부위) 70,000
SZ084체외충격파술 (2부위) 140,000
수술료SZ634경피적 경막외강 신경성형술2,000,000
SZ641경피적 풍선확장 경막외강 신경성형3,000,000
SZ083C-IDET: Cervical Nucleoplasty3,200,000
SZ083L-IDET : Lumbar Nucleoplasty 3,200,000
처치재료BM5100RW-1메디큐어롤반창고 10cmx10m - 10cm단위 500
BM5100RW메디큐어롤반창고 15cmx10m - 10cm단위700
BM5114HF에이덤 롤 반창고 10cmx10M - 10cm 단위 1,200
BK7001WT3헤카(HEKAFAST) 3인치 - 10cm단위 2,000
BK7001WT4헤카(HEKAFAST) 4인치 - 10cm단위 2,200
BM5013BL슈퍼크린 4cm*8cm(PAD 16mm*28mm) 1,000
DES드레싱키트1,500
FILTER3필터주사기 3cc1,500
FILTER5필터주사기 5cc1,500
FILTER10필터주사기 10cc 1,500
FILTER20필터주사기 20cc 1,500
BK7101EA코반3,000
IDIS이디스반창고8.6cmX6.5cm4,500
M3060224BACTICOAT FLEX 3 11,580
BK7000MSMS 스타키넷 30,000
BK7000MY스타밴드40,000
BM5001KUPSC(Proster Skin Care) 40,000
BK7100GQSpo band40,000
BM2002XV-1대장내시경 일회용멸균포30,000
BM2000SB더셀스카 - 상처흉터스프레이80,000
KBFORM케이비폼 5*5150,000
BJ7000CHQuikclot Hemostatic Dressing250,000
BM2101QT메디클로-유착방지제300,000
COLAG콜라탬프 G 10*10400,000
수술재료BM5107JNextension 100cm 2,000
BK7000ZCMEDIAS T(마킹펜)10,000
BM2000ASnasal mask10,000
BM5104WIO2 마스크 10,000
BM5100JN석션튜브15,000
BK7001TF토니밴드35,000
BM2002XVProbe Lock (실리콘 롤 테이프) 40,000
BM2000MJ엠픽스실리콘반창고70,000
BK7001KRCLAROFAST-차폐용drap 110,000
BK7000VWRAPBAND 120,000
BJ7000DSINOSTOP-지혈거즈300,000
BM2601MS마이젠 3% 1cc 300,000
BM2601MS-1마이젠 3% 3cc 700,000
BM2601MS-2마이젠 6% 1cc 1,800,000
BM2601MS-3마이젠 6% 3cc 3,000,000
BC0101UHOSG DBM SYRINGE, ACCEL BONE SYRINGE 550,000
BC0103BURafugen Dbm Gel Pro(인체조직유래 2차 가공뼈)550,000
BM5302TJ케어젤(Caregel) 3cc600,000
BF0100AJ커버실-유착방지제 1,000,000
BF0100VDINTERBLOCK-유착방지제1,000,000
BM5304TP-STOP600,000
BJ4803GZEPISOL 1,000,000
BJ4801DUC-FLEXIS 1,000,000
BJ4820RAFORA-B1,300,000
BJ4802DUB-FLEXIS1,300,000
BF0203DAL'DISQ ULTRA2,000,000
BF0202DALDISQ-C 2,000,000
BTS01019MEGADERM2,000,000
BF0202SHYES C DISC2,000,000
BF0201SHYESDISC CATHETER2,000,000
BTS01414벨라셀 에이치디 3,000,000
BTS01131아스로플렉스3,000,000
보조기료B-B1팔걸이5,000
B-B2캐스트슈즈(전규격)8,000
B-B3중지보호대-손가락스프린트25,000
B-B4핑거커버10,000
B-B5벨포밴드15,000
B-B6목발(버튼식)20,000
B-B7립밴드25,000
B-B13토 실리콘 15,000
B-B14숄더풀리30,000
BC1201YU소프트칼라5,000
BC1207WV팔꿈치보호대15,000
BC1204RE발목보호대(발목스프린트)20,000
BC1205RE손목스프린트(DR-W004)(전규격) 20,000
BC1209RE쇄골밴드(팔자)25,000
BC1218RE무릎보호대(U/공용)(Dr-K009)30,000
BC1219RE썸 브레이스 30,000
BC1215RE테니스엘보35,000
BC1213UZ요통대60,000
BC1000TMJoint ICEPACK 70,000
BC1011PRMCL(내측부인대보조기)150,000
뇨검사D5701Urine HCG-요임신반응검사(정성)1,390
TBPE+TBPE-마약류검사(65480)20,000
혈액화학검사D4902020-1비타민-D20,000
면역혈청검사D1710+코로나 항체검사(N)60,000
D1709++코로나 항체검사(S1 RBD)60,000
D6620코로나 항원 간이검사 30,000
D6611인플루엔자 A·B 바이러스항원검사-간이검사 30,000
D6620A해외발급-코로나 항원 간이검사 70,000
병리조직검사BX슬라이드대여(1장당)15,000
골밀도검사HC342-1골밀도검사-DXA (2부위이상) 50,000
기타기능검사EZ776CDITI (전신)200,000
EZ776BDITI (Lower)100,000
EZ776ADITI (Upper)100,000
EZ868동맥경화도검사(맥파전달속도측정)60,000
내시경검사B-SL1진정내시경환자관리료 I 50,000
B-SL2진정내시경환자관리료 II80,000
B-SL3진정내시경환자관리료 III 105,000
초음파검사B-SN01SONO Guide(3) 30,000
B-SN16SONO Guide(5) 50,000
B-SN1SONO-상복부(Upper Abdomen) 100,000
B-SN02SONO-상복부 100,000
B-SN03SONO-복부 120,000
B-SN04SONO-심장 150,000
B-SN05SONO-경동맥 80,000
B-SN06SONO-갑상선 80,000
B-SN07SONO-도플러(편측) 100,000
B-SN08SONO-도플러(양측) 200,000
B-SN09SONO-경부 80,000
B-SN11SONO-하지정맥류 100,000
B-SN12SONO-상지관절 80,000
B-SN13SONO-하지관절 80,000
B-SN14SONO-유방 80,000
B-SN15SONO-전립선 80,000
B-SN17SONO-늑골 80,000
B-SN18SONO-연조직 60,000

자기영상

(MRI)

G000외부병원MRI판독료 40,000
BMREMRI조영제추가(도타렘주프리필드시린지) 100,000
MR121POST OP MRI 150,000
MR120MRI F/U 250,000
MR70Abdomen Double sequence MRI450,000
MR69Abdomen limited MRI450,000
MR46Abdomen MRI 450,000
MR96Ankle Double sequence MRI450,000
MR95Ankle limited MRI 450,000
MR38Ankle MRI 450,000
MR04Brain Diffusion 150,000
MR62Brain Double sequence MRI450,000
MR61Brain limited MRI 450,000
MR01Brain MRI 450,000
MR05Brain MRI+Diffusion600,000
MR03Brain MRI+MRA 600,000
MR10Brain MRI+MRA+Diffusion700,000
MR111Chest MRI 450,000
MR74Coccyx Double sequence MRI 450,000
MR73Coccyx limited MRI450,000
MR49Coccyx MRI450,000
MR64C-Spine Double sequence MRI450,000
MR63C-Spine limited MRI450,000
MR11C-Spine MRI 450,000
MR13C-spine MRI+Foraminal view 550,000
MR21CT-Spine MRI450,000
MR58Diffusion MRI 450,000
MR80Elbow Double sequence MRI450,000
MR79Elbow limited MRI 450,000
MR26Elbow MRI 450,000
MR90Femur Double sequence MRI450,000
MR89Femur limited MRI 450,000
MR57Femur MRI 450,000
MR98Foot Double sequence MRI 450,000
MR97Foot limited MRI450,000
MR40Foot MRI450,000
MR78Forearm Double sequence MRI450,000
MR77Forearm limited MRI450,000
MR55Forearm MRI 450,000
MR84Hand Double sequence MRI 450,000
MR83Hand limited MRI450,000
MR30Hand MRI450,000
MR86HIP Double sequence MRI450,000
MR85HIP limited MRI 450,000
MR32HIP MRI 450,000
MR92Knee Double sequence MRI 450,000
MR91Knee limited MRI450,000
MR36Knee MRI450,000
MR102Lower Extremity Double sequence MRI 450,000
MR101Lower Extremity limited MRI450,000
MR44Lower Extremity MRI450,000
MR68L-Spine Double sequence MRI450,000
MR67L-Spine limited MRI450,000
MR16L-Spine MRI 450,000
MR19L-Spine MRI+Foraminal view 550,000
MR18L-Spine+Pelvis MRI600,000
MR17L-Spine+Whole Spine MRI600,000
MR56Myelogram MRI(척추강)450,000
MR105Neck Double sequence MRI 450,000
MR104Neck limited MRI450,000
MR103Neck MRI(두경부-경부)450,000
MR106Pancreas MRI(췌장)450,000
MR88Pelvis bone or Sacroiliac Double sequence 450,000
MR34Pelvis bone or Sacroiliac Joint MRI 450,000
MR87Pelvis bone or Sacroiliac limited MRI 450,000
MR110Rib MRI 450,000
MR72Sacrum Double sequence MRI 450,000
MR71Sacrum limited MRI450,000
MR47Sacrum MRI450,000
MR60Sellar MRI450,000
MR76Shoulder Double sequence MRI450,000
MR75Shoulder limited MRI 450,000
MR24Shoulder MRI450,000
MR51Shoulder MRI-Arthro450,000
MR94Tibia Double sequence MRI450,000
MR93Tibia limited MRI 450,000
MR53Tibia MRI 450,000
R107TL-spine limited MRI 450,000
MR22TL-spine MRI450,000
MR22TTL-spine MRI(T 추가) 550,000
66T-Spine Double sequence MRI450,000
MR65T-Spine limited MRI450,000
MR15T-Spine MRI 450,000
MR150T-Spine+Whole Spine MRI600,000
MR100Upper Extremity Double sequence MRI 450,000
MR99Upper Extremity limited MRI450,000
MR42Upper Extremity MRI450,000
MR23Whole-Spine MRI(CTL동시촬영)150,000
MR82Wrist Double sequence MRI450,000
MR81Wrist limited MRI 450,000
MR28Wrist MRI 450,000
식대료B-G3공기밥추가1(보) 1,000
B-G5공기밥추가2(보) 2,000
B-G6공기밥추가3(보) 3,000
B-G보호자식(1식당) 5,000
B-G2보호자식(2식당) 10,000
B-G4보호자식(3식당) 15,000
B-BOB일반식대 5,000
B-G1잡곡밥 1,000
증명료B-D31건강진단서10,000
B-D21근로능력 평가용 진단서10,000
B-D17병무용진단서20,000
B-D22보험사용 소견서 50,000
SJ-3산재-요양급여신청서용 진단서(최초/재요양) 17,000
SJ-1산재-요양비청구서확인 4,000
SJ-2산재-장해보상청구용 진단서25,000
B-D24상해진단서(3주미만 재발행)1,000
B-D14상해진단서(3주미만) 100,000
B-D25상해진단서(3주이상 재발행)1,000
B-D15상해진단서(3주이상) 150,000
B-D33소견서(산재보상보험초진소견서) 25,000
SJ-4소견조회 등 회신-산재 10,000
B-D5수술확인서3,000
B-D43수술확인서(재발행)1,000
B-D6시술확인서3,000
B-D44시술확인서(재발행)1,000
B-D30영문진단서20,000
B-D28운전면허 적성검사 5,000
B-D7의무기록사본(1~5매까지) 1,000
B-D8의무기록사본(1장당) 6매이상100
B-D23의사소견서(재발행)1,000
B-D27의사소견서(진찰료포함)10,000
B-D1일반진단서10,000
B-D2일반진단서(재발행)1,000
B-D3입원/퇴원 확인서3,000
B-D4입원/퇴원 확인서(재발행)1,000
G-1001장기요양 의사소견서 발급비용(본인10%) 3,840
G-100장기요양 의사소견서 발급비용(본인100%)39,640
G-1002장기요양 의사소견서 발급비용(본인20%) 7,690
B-D41장애인증명서1,000
B-D16장애진단서(신체적장애)15,000
B-D36제증명 사본 1,000
SJ-5진료계획서(2회째)용 진단서-산재14,000
SJ-6진료계획서(3회째부터)용 진단서-산재10,000
SJ-10진료기록영상(CD)10,000
SJ-13진료기록영상(DVD) 20,000
B-D45진료확인서3,000
B-D37초진기록지1,000
B-D12통원확인서3,000
B-D13통원확인서(재발행)1,000
B-D19향후진료비 추정서(천만원미만)50,000
B-D20향후치료비 추정서(천만원이상)100,000
B-D18후유장애진단서100,000
B-D34후유장애진단서 재발행(장당)1,000
SJ-8휴업급여청구서-산재 2,000
B-PD3환의(상,하의)대여료20,000
B-PD환의(상의)대여료15,000
B-PD2환의(하의)대여료15,000
실료차VA011병실료1인실차액(자보) 92,000
AB9011인실입원료-특실200,000
AB9021인실입원료-A200,000
AB9031인실입원료-B150,000
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