自費骨材與自付差額項目之說明

編號

代碼

品         項

衛署醫器輸字

售價(元)

生效日期

說明書

暨同意書

1

#2FI14

鎖骨鉤桿骨板系統         

Clavicle Hook locking plate

(健保自費碼：FBZ003129013)

003129

(愛派司)

40000

104.05.18

TF-25

2

#2FI0

鎖骨前方上方鎖定型骨板骨釘系統  

LCP SuperiorAnterior Clavicle Plates

(健保自費碼：FBZ020565002)

020565

(信迪思)

50000

101.12.10

TE-45

3

#2FI6

肱骨上端骨板內固定系統(PHILOS)       Proximal humeral internal locking system

(健保自費碼：FBZ019220005)

019220

(信迪思)

65000

101.12.10

4

#2FI29

肱骨下端關節周圍預先造型骨板   

DHP- double locking plate

(健保自費碼：FBZ019220004)

019220

(信迪思)

60000

106.03.07

      5

#2FI10

遠端橈骨鎖定骨板系統  

LCP Distal Radius Plates 2.4

(健保自費碼：FBZ003129012)-愛派司

(健保自費碼：FBZ007815018)-信迪思

003129

(愛派司)

46000

102.07.01

#2FI11

007815

(信迪思)

6

#2FI36

近端橈骨鎖定骨板系統 

LCP Proximal Radius Plates

(健保自費碼：FBZ021824001)

021824

(信迪思)

52000

110.04.29

7

#2FI28

鷹嘴突手部鎖定骨板系統   

LCP Olecranon Plate 3.5mm

(健保自費碼：FBZ019220002)

019220

(信迪思)

60000

105.09.16

8

#2FI22

小骨鈦合金鎖定加壓骨板系統(3.5mm)

Small LCP locking compression plate

(健保自費碼：FBZ007815004)

007815

(信迪思)

35000

105.02.23

9

#2FI23

大骨鈦合金鎖定加壓骨板系統(4.5~5.0mm)

Large LCP locking compression plate

(健保自費碼：FBZ019220001)

019220

(信迪思)

40000

105.03.02

10

#2FI12

遠端脛骨鎖定加壓骨板系統

LCP Metaphyseal Plate for distal medial tibia

(健保自費碼：FBZ023616001)         

023616

(信迪思)

65000

102.07.01

11

#2FI13

近端脛骨鎖定加壓骨板系統(內或外側)

LCP Metaphyseal Plate for proximal tibia

(健保自費碼：FBZ019793003)

19793

(信迪思)

65000

102.07.01

12

#2FI16

遠端腓骨部位鎖定骨板系統

LCP Distal Fibula pate Setting Price List

(健保自費碼：FBZ024782001)

024782

(信迪思)

62000

104.01.20

13

#2FI4

股骨下(或上)端骨折內固定系統 

LISS-DF, PLT(Less Invasive Stabilization System Distal Femur,Proximal Latertal Tibia)

(健保自費碼：FBZ007815001)

007815

(信迪思)

75000

101.12.10

14

#2FI30

手部純鈦迷你鎖定加壓骨板組 

LCP Compact Hand and Foot

(健保自費碼：FBZ018914001)

018914

(信迪思)

40000

108.01.24

15

#2FI52

足部純鈦迷你鎖定加壓骨板組 

LCP Compact Hand and Foot

(健保自費碼：FBZ018914001)

018914

(信迪思)

42000

108.01.24

16

#2FI041

(停用)跟骨VA多角度鎖定加壓(前外側)骨板系統  

VA Locking Anterolateral calcaneal plates2.7

(健保自費碼：FBZ035154001)

035154

(信迪思)

58000

111.09.01

TU-89

17

#2FI042

跟骨VA多角度鎖定加壓後足跟骨板組(章魚型)

VA LCP Midfoot System plates2.7

(健保自費碼：FBZ029705001)

029705

(信迪思)

65000

111.09.01

18

#2FI38

埋頭中空加壓骨釘系統

"Synthes" HCS Headles Compression Screw System

(健保自費碼：FBS0901530S1)

021272

(信迪思)

12000

110.09.21

19

#2FI43

FRN股骨重建髓內釘系統

"Synthes" Femoral Recon Nail

(差額給付碼：FBN05FRN00S1)

033414

(信迪思)

82000

(自費)

111.03.10

62964

(自付

差額)

20

#2FI043

TFNA進階型股骨近端髓內釘系統

"Synthes" TFN-ADVANCED Proximal Femoral

Nailing System

 (差額給付碼：FBNG1LSCTCS1)

028857

(信迪思)

87000

(自費)

111.08.10

TU-91

67964

(自付

差額)

21

#2FI037

縫合錨釘                   

"ARTHREX艾思瑞斯" 4.75-5.5*19.1mm  FiberTape 

(健保自費碼：FBZ023869001)

023869

(艾思瑞斯)

32000

110.04.29

22

#2FI46

#2FI40

泰若普肌腱固定懸吊鈕系統組

"Arthrex" Tight-Rope Syndesmosis Repair System

(健保自費碼：FBZ024051001)-手部

(健保自費碼：FBZ020077001)-足部

024051

020077

(艾思瑞斯)

42000

110.10.25

23

#2FI42

半月軟骨縫合修補器

"Arthrex" Meniscal CinchⅡ

(健保自費碼：FBZ033006001)

033006

(艾思瑞斯)

32000

111.01.25

24

TKR2

人工膝關節超耐磨聚乙烯墊片(脛骨)

Prolong Surface

(健保自費碼：FBZ007513002)

007513

(捷邁)

50000

101.12.10

25

TKR3

(停用)人工膝關節超耐磨聚乙烯墊片

(髕骨)

Highly Cross-linked Patellae and Surface

(健保自費碼：FBZ025742001)

025742

(捷邁)

36000

108.11.12

26

!THR

最新巨頭粉陶瓷人工髖關節系統

(Head & Insert) 

Biolox Delta IT Total Hip System

(差額給付碼：FBHPCCERA3Z1)

022415

(捷邁)

98000

102.07.01

27

#TMSC

（頸椎）多孔鉭金屬椎體替代物

TM-S Cage 

(健保自費碼：FBZ023047001)

023047

(捷邁)

50000

105.08.25

28

#TMSL

（腰椎）多孔鉭金屬椎體替代物

TM-500 Cage 

(健保自費碼：FBZ018297003)

018297

(捷邁)

50000

105.08.25

29

#CAPL

寶楠椎體護架頸椎骨板組

"Paonan"I Type Intervertebral Spacer-Cervical Plate Kit  

(健保特材碼：FBSF2100ZXP)

003630

(寶楠)

42000

106.12.19

30

#SPBON

椎體成型術套組

Kyphoplasty Kit +Bone Cement

(健保自費碼：FBZ005479002)

   005479

(阿凡龍)

92000

106.09.06

31

#BONC

脊固骨水泥 

Spine-Fix Vertebroplasty Bone Cement

(健保自費碼：FBZ021578001)

021578

(泰克美)

20000

106.09.06

32

#2FI9

橈骨頭骨板系統        

 Radius head system

(健保自費碼：FBZ019775001)

019775

(傑奎)

60000

104.01.20

33

#2FI47

#2FI48

“安特福”去礦化異質股補骨材(合成人工代骨)                        

"MTF" Demineralized Bone Matrix:DBX Putty

(健保自費碼：FBZ032745002)-1cc

(健保自費碼：FBZ032745003)-2.5cc

032745

 36000

34

#2FI49

“瑞德”浦登仕人工代                       

"Wright" Pro-Dense Bone Graft

018878

(瑞德)

35

#2FI50

#2FI51

腓骨遠端外側(鉤狀)鎖定骨板系統

LCP Hook Plate System

(健保自費碼：FBZ003129016)

003129

(愛派司)

026602

(信迪思)

36

#2FI53

關節鏡射頻切除系統

"Stryker"  RF Ablation System

(健保自費碼：TKY018487W01)

018487

(Stryker)

37

#2FI54

瑞奇人工骨(5c.c)

RICH Bone Substitute

(健保特材代碼：FBA04TP0054R)

004865

(瑞奇)