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비급여고시목록

비급여고시목록 보기펼치기

 

 

비급여고시목록

처방코드      

처방명칭      

금액    

X01일반진단서20,000
X02일반진단서사본(1매당)1,000
X03영문진단서20,000
X03-1영문진단서사본(1매당)1,000
Z03-2기타영문확인서3,000
X06병사용진단서20,000
X07병사용진단서사본1,000
X08사망진단서10,000
X09사망진단서사본(1매당)1,000
X10장애진단서(동사무소제출)15,000
X11장애진단서(국민연금제출용)15,000
X12상해진단서(3주미만)100,000
X13상해진단서(3주미만)사본1,000
X14상해진단서(3주이상)150,000
X15상해진단서(3주이상)사본1,000
X16건강진단서20,000
X16-1건강진단서(조리사/미용)40,000
X17입퇴원확인서(본인)3,000
X18-1

입퇴원확인서(본인)

- 재발행(1매당)

1,000
X19통원확인서3,000
X20통원확인서사본(1매당)1,000
X21수술확인서2,000
X21-1수술확인서사본(1매당)1,000
X22

의무기록지사본

(보험회사-1장~5장)

5,000
X22-1

의무기록지사본(보험회사

-6장이상시 1매당)

500
X24

향후치료비추정서

(1000만원미만)

50,000
X25

향후치료비추정서

(1000만원이상)

100,000
X26진료의뢰서
X27채용신체검사서(일반)30,000
X27-1채용신체검사서 사본(1매당)1,000
X28

채용신체검사서

(경찰/공무원)

40,000
X29사채검안서50,000
X29-1사채검안서 사본(1매당)1,000
X30

노인장기요양의사소견서

(본인전액부담)

37,590
X30-1

노인장기요양의사소견서

(본인부담20%)

7,510
X30-2

노인장기요양의사소견서

(본인부담10%)

3,750
X30-3

노인장기요양의사소견서

(본인부담면제)

X57-3치매진단의사소견서

(본인부담면제)

 
X57

치매진단의사소견서

(본인전액부담)

51,350
X57-1

치매진단의사소견서

(본인부담20%)

10,270
X57-2

치매진단의사소견서

(본인부담10%)

5,130 
X31근로능력평가용진단서10,000
X32후유장애진단서100,000
X32-1후유장애진단서사본1,000
X34뇌병변장애소견서10,000
X36상급병실확인서
X47기숙사용진단서30,000
X48국민연금장애진단서15,000
X49

제1형 당뇨병환자

소모성재료 처방전

 
PDZ110004CD copy10,000
2
비급여고시목록

BJ4801DA

BALLOW CATH1,000,000
M30305가네파솔주 250ml (영양제)-550,000
M30307진카로솔주 250ml (영양제)-330,000
M30234라이넥주(1AMP-SC) -태반주사1회30,000
M30333비치라이트주(NS100포함)-(미백)(글루타티온환원형)-4                                                                      40,000
M30225삼진타우로린주사2%250밀리리터(타우로리딘)100,000
M30280A

마시주사10% 5ML-단독처방(비급여)

10,000
M30045메리트씨주사 10g-단독처방 (비급여)                 10,000
M30303메리트디주(콜레칼시페롤-vitamin A및 D제)-5

50,000

M30264A하이코민주사(단독주사)-비급여12,000
M30295B하이알라제주(히알우로니다제 1500 I.U)60,000
M30301네포펜주(네포팜염산염)          10,000
M30319프로파인퓨전주100ML(아세트아미노펜)-550,000
M30308진코발주(은행엽엑스) 5ml10,000
M30320셀레나제 100mg 프로주사(아셀렌산나트륨오수화물)                               30,000
M30334제일에이티피주 2mL25,000
TM30214E 

플라센텍스주 단독 -7

70,000
TMY142C증식치료1.5(Prolotherapy)15,000
TMY142B

증식치료3.5(Prolotherapy)

35,000
TMY142J증식치료(사지관절부위)330,000
TMY142증식치료5(Prolotherapy)50,000
TMY142I

증식치료10 (Prolotherapy)(리쥬비넥스)

100,000
TMY142G증식치료20 (Prolotherapy)(리젠씰1CC+하이알라제주)200,000
TMY142H증식치료60 (Prolotherapy)(리젠씰3CC+하이알라제주)600,000
 TMY142K 증식치료(사지관절부위)+PDRN -10100,000 
 XTMY143 수술용 증식치료-50 (Prolotherapy) 500,000
 XTMY143A 수술용 증식치료-100 (Prolotherapy) 1,000,000
 XTMY143B 수술용 증식치료-150 (Prolotherapy) 1,500,000
 TZM007 PPMP-10100,000 
 TZM007A PPMP-20200,000 
 G4040 마이젠 301 (1cc)200,000 
 G4040A 마이젠 303 (3cc)400,000
 G4041 마이젠 601 (1cc) 700,000
 G4041A 마이젠 603 (3cc)2,500,000
 G4044 QUIKCLOT(퀵클랏)30,000 
 LC3520A B-HCG (혈액 임신반응검사) 25,000 
TOZ005F (ESWT)체외충격파치료

     60,000~100,000

TSZ083 추간판내 고주파 열치료술(IDET)1,300,000
 TSZ631 내시경적 경막외강 신경근성형술1,500,000 
TSZ634PEN-경피적 경막외강 신경성형술700,000
TSZ641 경피적 풍선확장 경막외장 신경성형1,200,000
 G9032 IDOLPHIN-S BJ4801YB1,980,0000 

G0314

ORTHOBLAST ∥ PASTE (DBM) -1cc1,000,000
G0393

ORTHOBLAST II PASTE (DBM)-0.5cc

500,000
G0363SUREFUSE-TM (DBM 0.5CC)500,000
G0384ALLOCOVER HAD                 2,200,000
G0255 REGENSEAL 1CC 단독 (리젠씰)                               250,000
G0256REGENSEAL 3CC 단독 (리젠씰)450,000
TMZ001 FIMS-10100,000
TMZ001AFIMS-30300,000
TMZ001B

FIMS-50

500,000
TMZ001CPIMS-30 (Prolotherapy+FIMS)300,000
TMZ001DPIMS-50 (Prolotherapy+FIMS)500,000
TMZ001EPIMS-100 (Prolotherapy+FIMS)1,000,000
 G4039 X - STIK (DBM) 1cc1,000,000 
 G4045  TEMPUS 2,100,000
 G4046 TEMPUS-KIT 700,000
TZM0003  마이어스칵테일-660,000
TM0001 통증 회복 주사- 660,000
TZM0002

통증 면역 영양주사-3

30,000

TZM0004

해독 면역 주사-6

60,000
TZM0005스트레스 회복 주사-660,000
 G4014 카티스템 (동종 제대혈유래 중간엽줄기세포) 8,000,000 
 M30370 타이유프로게스테론주(1cc)

10,000 

 M30370A 타이유프로게스테론주(2cc) 20,000 
 M30370B 타이유프로게스테론주(3cc) 30,000 
 M30363 페라미플루주(ns100포함)-성인 100,000 
 M30363A 페라미플루주(ns100포함)-소아 50,000  
 M30127 가다실주 4가156,000 
 M30127E 가다실주 9가 210,000 
 XTM30127 가다실주9가(3회접종시)590,000
 OZ005A  도수치료 770,000
 OZ005A 도수치료 10100,000
 OZ005D 도수치료 15 150,000
TR4271-3 자궁내장치삽입술(+카퍼티) 90,000
   
DZA1 공기밥추가 1개1,000
DZA2 공기밥추가 2개2,000
DZA3 공기밥추가 3개3,000
DZA4 보호자식추가 1상 5,000
DZA5 보호자식추가 2상10,000
DZA6 보호자식추가 + 공기밥 1개6,000
DZA7 보호자식추가 + 공기밥 2개7,000
DA8 잡곡밥500
   
 TZ001 수면관리료-위60,000
 TZ002 수면관리료-대장80,000
 TZ003 수면관리료-위/대장100,000
 TB4151A CLO Test (비급여-검진)30,000
 TEZ868 동맥경화검사50,000
 RHC343B 골밀도검사 (검진) 50,000
 LB0260 (비급여)요임신반응검사(정성) 10,000
 TEZ886 자궁경부확대촬영검사 25,000 
 LZ040인플루엔자 A·B 바이러스항원검사 [현장검사] (Rapid  Test /Kit )  25,000
 LCZ432 Anti CCP Ab[IgG]-RA검사55,000
 TZ007 체성분검사10,000
 LCZ437 모발미네랄검사130,000
 LCZ439 마약선별검사 4종(코카인,필로폰,대마,아편)90,000
LD659203C HPV 검사60,000 
 LCZ214 AMH(anti Mullerian Hormone)70,000 
 LCZ440HLA B51 Typing (Behet's disease) 75,000 
 LC3420A성장호르몬(GH)검진시 15,000 
 LD3440013A성장호르몬(somatomedin-c) 20,000 
 LD3440023A성장호르몬IGFBP-3 20,000 
 LD7631003NK 세포활성도검사(검진시) 70,000 
 LCZ397 Malaria(Rapid)50,000 
 LCZ202성호르몬결합글로불린 113,100 
 LCZ114 ECP(Eosinophil Cationic Protein)102,570 
   
 G0127 목발(한쌍)20,000
 G0128 8자붕대10,000
 G0130 소프트컬러10,000
 G0131 팔걸이

5,000

 G0230 석고 신발(1짝) 12,000
 G0126 벨포밴드100,000
 G0135 3M COBAN 1" (1인치당)500
 G0139 3M COBAN 2" (1인치당) 500
 G0141 픽싱롤 6" (10cm당) 500
 G0142 픽싱롤 4" (10cm당) 300
 G0224 픽싱롤 3" (10cm당) 100
 G0160 손목스트린트보호대(BC1201WU)15,000
 G0163A (DR-E005) 팔꿈치브레이스(전규격) 25,000
 G0175 thumb brace (비급여재료대)35,000
 G0176 finger brace (비급여재료대)35,000
 G0226 SUPPERPORE(슈퍼포아 )6*9 (1매당) 1,500
 G0227 SUPPERPORE(슈퍼포아)9*12 (1매당)2,000
 G0258 목뼈보조기-필라델피아70,000
 G0317 Knee Ice Pack80,000
 G0318 Shoulder Ice Pack80,000
 G0345 SAFE FUSION FILTER8,000
 G0373 OPSITE POST-OP (6.5cm*5cm)

2,400

 G0398 냉압박붕대 20,000
 G0147 Alumi splint (frog)10,000
 G0148 멀티핑거스프린트(1호~5호)      20,000
 G0149 요통대 12"(BC1202WU)40,000
 G0150 요통대 9"(BC1213UZ)30,000
 G0174 Multi-sling(전규격)30,000
 G0195손목스프린트보호대 (DR-W012)    50,000
 G4015 PAD BAND55,000
 G4017 Drain Clip20,000
 G4018 Tissue Aid132,000
 G4019 무릎보호대120,000
 G4023 LDISQ 1,200,000
 G4024 ST REED PLUS  500,000
 G4027 울트라슬링80,000 
 G4030 Dressing kit 2,300 
 TZM006 PPFT(prolotherapy+FIMS)-10100,000 
 TZM006A PPFT(prolotherapy+FIMS)-20200,000 
 TR4271 자궁내장치삽입술(+미레나)290,000 
 TR4271-2 임플라논340,000 
 TR4271-1 자궁내장치삽입술(+카일리나)310,000 
 LCZ212 PAPP-A   29,100 
LC580312C   Fragile X syndrome80,000 
 Z37 이송처치료일반구급차기본요금(10km이내)

30,000 

 Z37-1 이송처치료일반구급차(응급구조사,의사 또는 간호사 동승시) 10km이내

15,000 

 Z38 이송처치료일반구급차10km초과시 (1km당 800원추가)1,000 
   
 
 M30088 프리베나주13주(폐렴) 120,000
 M30309 하브릭스주1440 1ml( 성인A형간염백신)-880,000
M30283A 유박스비주1ml (B형간염)30,000
 M30108 SK티디백신주 0.5ml-성인 35,000
 M30335 부스트릭스프리필드시린지-Tdap50,000
 M30127 가다실주프리필드시린지156,000 
 M30167V 4가성인독감(SK) 35,000
 M30210 스카이조스터주(대상포진생바이러스백신)-50세이상 성인 140,000
 M30318 이모젭주[일본뇌염 생바이러스 백신]70000 
   
 M11477 베아제정(원내) 210
 M10073 삐콤정 18
 M10103 액티피드정 40
 M10163 트레스탄캅셀 500
 M20005A 마데카솔분말(10g) 8,200
 M20028 후시딘연고 (10g)6000 
 M20015 알보칠콘센트레이트액(1ml당)500 
 RS01 SONO - Abdomen100,000 
RS02 SONO Echocardiography180,000
 RS12-1 SONO -근골격계 Guide bx70,000 
 RS03 SONO - Carotid100,000 
 RS04 SONO -Brest  Guide (Aspiration Biopsy)70,000 
 RS05 SONO - Thyroid80,000 
 RS05A SONO-Neck(thyroid 제외)

80,000 

 RS06 SONO - Breast100,000 
 RS08 SONO -Liver80,000 
 RS28SONO-Prostate(경복부로 실시)

40,000

 RS11 SONO -근골격계6(편측)60,000 
 RS12 SONO -근골격계7(편측)70,000 
 RS15 SONO -Thyroid  Guide70,000 
 RS20 상지혈관(동맥)-편측80,000 
 RS21 상지혈관(정맥)-편측 80,000 
 RS20-1 상지혈관(동맥)-양측120,000 
 RS21-1 상지혈관(정맥)-양측120,000 
 RS22 하지혈관(동맥)-편측80,000 
 RS23 하지혈관(정맥)-편측      80,000 
 RS22-1 하지혈관(동맥)-양측120,000 
 RS23-1 하지혈관(정맥)-양측120,000 
 RS24 SONO - 하지정맥류 편측100,000 
 RS24-1 SONO - 하지정맥류 양측150,000 
 RS27 SONO-상지혈관[편측]-동맥, 정맥 동시140,000 
 RS26 하지혈관(편측) - 정·동맥동시 140,000 
 RS26-1 하지혈관(양측) - 정·동맥동시220,000 
 REB452 복부-남성생식기 초음파-전립선.정낭(경복부로 실시)40,000 
 RS29 SONO-TVS-3535,000 
 RS29-1 SONO-TVS-3030,000 
 RS29-2 SONO-TVS-25 25,000

접기

 

MRI부위당 가격

MRI부위당 가격펼치기

부위금액
Brain MRI400,000
Brain MRI(contrast)500,000
Face MRI400,000
Face MRI(contrast)500,000
PNS MRI400,000
PNS MRI(contrast)500,000
Orbit MRI400,000
 Orbit MRI(contrast)500,000
 Temporal bone MRI400,000
 Temporal bone MRI(contrast)500,000
 TM joint MRI400,000
 TM joint MRI(contrast) 500,000 
Neck MRI  400,000
Neck MRI(Contrast)  500,000
Brain MRA + Diffusion  600,000
 Brain MRA + Diffusion (contrast) 700,000
 Brain MRI+Brain MRA  700,000
 Brain MRI+Brain MRA(contrast)  800,000
 Brain MRI+MRA +Diffusion  850,000
 Brain MRI+ MRA + Diffusion (contrast)  950,000
Diffusion(단독)   250,000
 C-spine MRI 400,000
 C-spine MRI(contrast) 500,000
 T-spine MRI 400,000
 T-spine MRI(contrast)

500,000

L-spine MRI  400,000
 L-spine MRI(contrast) 500,000
 C-T spine MRI 600,000
 T-L spine MRI 600,000
 C-T-L spine MRI 900,000
 Myelogram MRI 400,000
 Myelogram MRI(contrast) 500,000
Upper extremity MRI(RT) 400,000
 Upper extremity MRI RT(contrast) 500,000
 Upper extremity MRI(LT) 400,000
 Upper extremity MRI LT (contrast) 500,000
 RT Shoulder MRI 400,000
RT Shoulder MRI(contrast)  500,000
 LT Shoulder MRI 400,000
 LT shoulder MRI(contrast)500,000
 RT Elbow MRI 400,000
RT Elbow MRI(contrast) 500,000
LT Elbow MRI  400,000
 LT Elbow MRI(contrast) 500,000
 RT Wrist MRI400,000
 RT Wrist MRI(contrast) 500,000
 LT Wrist MRI 400,000
 LT Wrist MRI(contrast) 500,000
 RT hand MRI 400,000
 RT.hand MRI(contrast) 500,000
 LT hand MRI 400,000 
 LT.hand MRI(contrast) 500,000
Lower Extremity MRI[RT]  400,000
 Lower Extremity MRI RT (contrast) 500,000
 Lower Extremity MRI[LT]400,000
Lower Extremity MRI LT(contrast)  500,000
 BOTH Hip MRI 400,000
BOTH Hip MRI(contrast)  500,000 
 RT Hip MRI 400,000
 BOTH Hip MRI(contrast) 500,000
 RT Hip MRI 400,000
 RT Hip MRI(contrast) 500,000
 LT Hip MRI 400,000
 LT Hip MRI(contrast) 500,000
 RT Femur MRI 400,000
 RT Femur MRI(contrast) 500,000
 LT femur MRI 400,000
 LT Femur MRI(contrast) 500,000
 RT Tibia MRI 400,000
 RT Tibia MRI(contrast) 500,000
 LT Tibia MRI 400,000
 LT Tibia MRI(contrast) 500,000
 RT Knee MRI 400,000
 RT Knee MRI(contrast) 500,000
 LT Knee MRI 400,000
 LT Knee MRI(contrast) 500,000
 RT Ankle MRI 400,000
 RT Ankle MRI(contrast) 500,000
 LT Ankle MRI 400,000
 LT Ankle MRI(contrast) 500,000
 RT Foot MRI 400,000
 RT Foot MRI(contrast) 500,000
 LT Foot MRI

 400,000

 LT Foot MRI(contrast) 500,000
 Pelvis MRI 400,000
 Pelvis MRI(contrast) 500,000
 Sacroiliac MRI400,000
 Sacroiliac MRI(contrast) 500,000
 Liver MRI400,000
 Liver MRI(contrast) 500,000
 Liver MRI(3차원/dynamic) 400,000
Liver MRI(3차원/dynamic)(contrast)  650,000
Brain MRA  450,000
 Brain MRA(contrast) 550,000
 Neck MRA 400,000
 Neck MRA(contrast) 500,000
Chest MRA  400,000
 Chesrt MRA(With contrast) 500,000
Extremity MRA 400,000
Extremity MRA(with contrast)  500,000
 Post op Knee MRI 200,000
 RT  Shoulder MRI (post op) 200,000
 Lt  Shoulder MRI (post op)200,000
 C-spine MRI(부분촬영-비급여) 200,000

 Cardiovascular MRA       

  400,000 

Abdominal MRA          

  400,000 

    Prostate MRI                   

  400,000 

Cholangiogram MRI       

 400,000

Penile & Scrotum MRI     

  400,000

 Kindney and Adrenal MRI  

  400,000

Pancreas MRI           

  400,000

Abdominal MRI          

  400,000

 Breast MRI                 400,000
 Chest MRI                 400,000
 Heart MRI                 400,000
Shoulder MRI(Arthrography)  600,000
 Whole Body MRI 1,200,000 

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