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비급여항목

비급여항목

코드명칭 금액 
PRPPRP(elbow)    300,000
프롤로테라피    200,000
증식주사(초음파미포함)    100,000
초음파(증식주사시)    100,000
SZ084Ceswt-5(radial)     50,000
SZ084Beswt-7(focal)     70,000
SZ084Aeswt-15(focal) 1부위    150,000
SZ084eswt-23(focal) 2부위 이상    230,000
초음파    100,000
MX122A도수치료A     50,000
MX122B도수치료B    100,000
MX122C도수치료C    150,000
C-spineMR20(비)C-Spine MRI    470,000
PelvisMR71(비)Pelvis MRI    470,000
T-SpineMR22(비)T-Spine MRI    470,000
L-spineMR24(비)L-Spine MRI    470,000
HipMR70(비)HIP MRI    470,000
ShoulderMR55-R(비)Shoulder MRI(Rt)    470,000
MR55-L(비)Shoulder MRI(Lt)    470,000
ElbowMR63-R(비)Elbow MRI (우측)    470,000
MR63-L(비)Elbow MRI (좌측)    470,000
WristMR59-R(비)Wrist MRI (우측)    470,000
MR59-L(비)Wrist MRI (좌측)    470,000
ForearmMR631(비)forearm MRI(RT)    470,000
MR641(비)forearm MRI(LT)    470,000
HandMR65-R(비)Hand MRI (우측)    470,000
MR65-L(비)Hand MRI (좌측)    470,000
FootMR67-R(비)Foot MRI (우측)    470,000
MR67-L(비)Foot MRI (좌측)    470,000
AnkleMR76-R(비)Ankle MRI (우측)    470,000
MR76-L(비)Ankle MRI (좌측)    470,000
KNEEMR72-R(비)KNEE MRI (우측)    470,000
MR72-L(비)KNEE MRI (좌측)    470,000
MR80(B)Upper Extremity MRI 편측당    470,000
MR26(B)Sacrum-Coccyx MRI    470,000
MR98E(B)(B)CALF MRI(E)(편측당)    550,000
MR91(B)Femur MRI 편측당    470,000
MR82(B)Lower Extremity MRI (편측당)    470,000
MR98(B)Tibia MRI 편측당    470,000
B-D7진료기록사본1~5매       1,000
B-D8진료기록사본6매이상       1,000
B-D36영문진단서     20,000
B-D49건강진단서     20,000
COPY-CDCD복사수수료     10,000
B-D39향후진료비추정천만원이하     50,000
B-391향후진료비추정천만원이상     100,000
B-D14상해진단서3주미만    100,000
B-D15상해진단서3주이상    150,000
B-D45제증명서사본 1매당         1,000
B-D12통원확인서         3,000
B-D3입퇴원확인서         3,000
B-D1일반진단서       20,000
B-D21근로능력평가용진단서       10,000
AB902상급병실1인실     180,000
병무용진단서       20,000
수술재료BM210QT메디클로(유착방지제)    350,000
BM2601OP콜라쉴드(인대강화제)    200,000
BM5300YY쥬벤콜(창상피복제)    260,000
BM5302VT  젠타큐(콜라겐항생제)    300,000
655501751브리디온주    201,600