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비급여항목

비급여항목

분류코드 수가코드 품목명 보험수가 
12.외용약 BM2600 노시셉톨겔 40ml                                      12,000
12.외용약 BM2601 노시셉톨겔 120ml                                     29,000
12.외용약 BM5001LT 베러덤 Md 크림, Varrerderm Md Cream                  45,000
12.외용약 BM5002QT 비)이지듀Md 보습크림                                 40,000
19.기타주사수기료 PRP 비)PRP(초음파 유도하 자가혈청 주사치료)              300,000
19.기타주사수기료 PRP-1 비)PRP(초음파 유도하 자가혈청 주사치료) + 부위추가   100,000
19.기타주사수기료 MY142-1 prolotheraphy-3 증식치료                             30,000
19.기타주사수기료 MY142C 증식치료-10(초음파비용 미포함)                         100,000
20.주사약제 P006 비)플라센텍스주1vial  대우제약                         80,000
20.주사약제 642301821 반코마이신염산염주500mg 삼성제약                     8,791
20.주사약제 671807061 테로사카트리지주(테리파라타이드)_(0.6mg/2.4ml) 급여   219,550
20.주사약제 V-12 리코발라민(Vit.B12)-비급여                           50,000
20.주사약제 METD1 비)메리트디(vit D)inj (0.5ml) 휴온스제약             50,000
20.주사약제 650902021 카비파라세타몰주(아세트아미노펜) 40,000
23.마취행위료 S-P 수면 MRI                                             50,000
25.재활및물리치료료 MX122A 비)도수치료 [1일당] A                                 60,000
25.재활및물리치료료 MX122B 비)도수치료 [1일당] B                                120,000
25.재활및물리치료료 MX122C 비)도수치료 (1일당) -C                               180,000
37.처치재료 BC1206RL Shoulder Support Cover Fabric, Chinlon               60,000
37.처치재료 BM2601MS 마이젠(Mygen)3% 0.5cc                                200,000
37.처치재료 BM5001BL Superpore (9X6)                                      220
37.처치재료 BM5003BL Superpore (9X12)                                     340
37.처치재료 스타픽스슈즈 Starfix Shoes                                        10,000
37.처치재료 DR-W004 손목 보조기                                          30,000
38.수술재료 M-PIECE MOUTH PIECE                                          15,000
38.수술재료 BM5100JN Fixation suction set 비젼헬스케어브이에스밴드부직반  16,000
38.수술재료 BF0100AJ Artq, Cover Seal Sodium Hyaluronate 등               350,000
38.수술재료 BK7001NA Toni-Fix Viscose, Polyamide, Elastane                35,000
38.수술재료 BK7101HN Wm-Band Cotton 외                                    16,000
50.혈액화학검사 D4902020 위탁)비타민-[정밀면역검사]_25-OH-Vitamin D  Total    50,000
50.혈액화학검사 CZ242 아밀로이드 A                                         70,000
54.병리조직검사 S-D 조직검사 슬라이드                                    5,000
70.방사선단순촬영 B-AGE Boneage(wrist)-골연령검사                            100,000
76.자기영상(MRI) ME73E-L (B)Lt Knee MRI+ACL-E                           750,000
76.자기영상(MRI) MR01 (비)Brain MRI                                        520,000
76.자기영상(MRI) MR20 (비)C-Spine MRI                                      520,000
76.자기영상(MRI) MR20-1 (비)C-Spine MRI(+)                                   600,000
76.자기영상(MRI) MR25-1 (비)C-SPINE MRI (Post OP)                            300,000
76.자기영상(MRI) MR21 (비)C-Spine MRI(E)                                   650,000
76.자기영상(MRI) MR22 (비)T-Spine MRI                                      520,000
76.자기영상(MRI) MR22 (B)T-Spine MRI                                     520,000
76.자기영상(MRI) MR23 (B)T-Spine MRI(E)                                  650,000
76.자기영상(MRI) MR25-2 (비)T-SPINE MRI (POST OP)                            300,000
76.자기영상(MRI) MR556E (비)T-Spine MR arthrogram                          680,000
76.자기영상(MRI) MR24 (비)L-Spine MRI                                      520,000
76.자기영상(MRI) MR25 (비)L-Spine MRI(E)                                   650,000
76.자기영상(MRI) MR25-3 (비)L-SPINE MRI (Post OP)                            300,000
76.자기영상(MRI) MR556D (비)L-Spine  MRI arthrogram                         680,000
76.자기영상(MRI) MR28 (비)T-L-spine MRI(total inclusion,)                  650,000
76.자기영상(MRI) MR28-1 (비)T-L-spine MRI(total inclusion,) (+)              700,000
76.자기영상(MRI) MR26 (B)Sacrum-Coccyx MRI                                 520,000
76.자기영상(MRI) MR27 (B)Sacrum-Coccyx MRI(E)                              650,000
76.자기영상(MRI) MR55-3L 비)Simple Shoulder MRI-Lt                            300,000
76.자기영상(MRI) MR55-2R 비)Simple Shoulder MRI-Rt                            300,000
76.자기영상(MRI) MR55-R (비)Shoulder MRI(Rt)                                 520,000
76.자기영상(MRI) MR55-L (비)Shoulder MRI(Lt)                                 520,000
76.자기영상(MRI) MR55-2 (비)Shoulder MRI(post OP)-Rt                         300,000
76.자기영상(MRI) MR55-3 (비)Shoulder MRI(post OP)-Lt                         300,000
76.자기영상(MRI) MR556-L (비)shoulder MRI athrogram(LT)                       680,000
76.자기영상(MRI) MR556-R (비)shoulder MRI athrogram(RT)                       680,000
76.자기영상(MRI) MR55A-L (비)Shoulder MRI(LT)(+)                              600,000
76.자기영상(MRI) MR55A-R (비)Shoulder MRI(RT)(+)                              600,000
76.자기영상(MRI) MR55E-L (비)Shoulder MRI(LT)-E                               650,000
76.자기영상(MRI) MR55E-R (비)Shoulder MRI(RT)-E                                 650,000
76.자기영상(MRI) MR59 (비)Wrist MRI                                        520,000
76.자기영상(MRI) MR59-2 (비)Wrist MRI(post OP)-Rt                          300,000
76.자기영상(MRI) MR59-3 (비)Wrist MRI(post OP)-Lt                          300,000
76.자기영상(MRI) MR59-L (비)Wrist MRI (LT)                                   520,000
76.자기영상(MRI) MR59-R (비)Wrist MRI (RT)                                   520,000
76.자기영상(MRI) MR596-L (비)Wrist MRI athrogram(LT)                          680,000
76.자기영상(MRI) MR596-R (비)Wrist MRI athrogram(RT)                          680,000
76.자기영상(MRI) MR59A-L (비)Wrist MRI (LT)(+)                                600,000
76.자기영상(MRI) MR59A-R (비)Wrist MRI (RT)(+)                                600,000
76.자기영상(MRI) MR59E-L (비)Wrist MRI (LT)-E                                 600,000
76.자기영상(MRI) MR631 (비)forearm MRI(RT)                                  520,000
76.자기영상(MRI) MR641 (비)forearm MRI(LT)                                  520,000
76.자기영상(MRI) MR601 (비)forearm MRI(RT)-E                                650,000
76.자기영상(MRI) MR621 (비)forearm MRI(LT)-E                                650,000
76.자기영상(MRI) MR63 (비)Elbow MRI (우측)                                 520,000
76.자기영상(MRI) MR63-2 (비)elbow MRI(post OP)-Rt                            300,000
76.자기영상(MRI) MR63-3 (비)elbow MRI(post OP)-Lt                            300,000
76.자기영상(MRI) MR63-2R 비)Simple Elbow MRI(우측)                            300,000
76.자기영상(MRI) MR63-3L 비)Simple Elbow MRI(좌측)                            300,000
76.자기영상(MRI) MR63-L (비)Elbow MRI (LT)                                   520,000
76.자기영상(MRI) MR63-R (비)Elbow MRI (RT)                                   520,000
76.자기영상(MRI) MR636-L (비)elbow MRI athrogram(LT)                          680,000
76.자기영상(MRI) MR636-R (비)elbow MRI athrogram(RT)                          680,000
76.자기영상(MRI) MR63A-L (비)Elbow MRI (LT)(+)                                600,000
76.자기영상(MRI) MR63A-R (비)Elbow MRI (RT)(+)                                600,000
76.자기영상(MRI) MR63E-L (비)Elbow MRI (LT)-E                                 650,000
76.자기영상(MRI) MR63E-R (비)Elbow MRI (RT)-E                                 650,000
76.자기영상(MRI) MR65-2 (비)Hand MRI (Post OP)-Rt                            300,000
76.자기영상(MRI) MR65-3 (비)Hand MRI (Post OP)-Lt                            300,000
76.자기영상(MRI) MR65-L (비)Hand MRI (LT)                                    520,000
76.자기영상(MRI) MR65-L (비)Hand MRI (LT)                                  520,000
76.자기영상(MRI) MR65-R (비)Hand MRI (RT)                                  520,000
76.자기영상(MRI) MR65E-L (비)Hand MRI (LT)-E                                  650,000
76.자기영상(MRI) MR65E-L (비)Hand MRI (LT)-E                                650,000
76.자기영상(MRI) MR65E-R (비)Hand MRI (RT)-E                                  650,000
76.자기영상(MRI) MR65E-R (비)Hand MRI (RT)-E                                 650,000
76.자기영상(MRI) MR67-2 (비)Foot MRI (post OP)-Rt                            300,000
76.자기영상(MRI) MR67-3 (비)Foot MRI (post OP)-Lt                            300,000
76.자기영상(MRI) MR67-R (비)Foot MRI (RT)                                  520,000
76.자기영상(MRI) MR67-L (비)Foot MRI (LT)                                  520,000
76.자기영상(MRI) MR67E-L (비)Foot MRI (LT)-E                                  650,000
76.자기영상(MRI) MR67E-R (비)Foot MRI (RT)-E                                650,000
76.자기영상(MRI) MR76-2 (비)Ankle MRI (post OP)-Rt                         300,000
76.자기영상(MRI) MR76-3 (비)Ankle MRI (post OP)-Lt                           300,000
76.자기영상(MRI) MR76-L (비)Ankle MRI (LT)                                   520,000
76.자기영상(MRI) MR76-R (비)Ankle MRI (RT)                                 520,000
76.자기영상(MRI) MR76A-L (비)Ankle MRI (LT)(+)                                550,000
76.자기영상(MRI) MR76A-R (비)Ankle MRI (RT)(+)                                600,000
76.자기영상(MRI) MR76E-L (비)Ankle MRI (LT)-E                               650,000
76.자기영상(MRI) MR76E-R (비)Ankle MRI (RT)-E                                 650,000
76.자기영상(MRI) MR70 (비)HIP MRI                                          520,000
76.자기영상(MRI) MR70-1 (비)HIP MRI (RT) & L-Spine Sagittal                  750,000
76.자기영상(MRI) MR70-2 (비)HIP MRI (LT) & L-Spine Sagittal                  750,000
76.자기영상(MRI) MR70-3 (비)HIP MRI (LT)-E                                   650,000
76.자기영상(MRI) MR70-4 (비)HIP MRI (RT)-E                                   650,000
76.자기영상(MRI) MR70-E (비)HIP MRI-E                                        650000
76.자기영상(MRI) MR71 (비)Pelvis MRI                                       520,000
76.자기영상(MRI) MR71-1 (비)Pelvis MRI (+)                                   600,000
76.자기영상(MRI) MR556I (비)Pelvis MR artrogram                            680,000
76.자기영상(MRI) MR711 (B)Rt Femur MRI                                    520,000
76.자기영상(MRI) MR712 (B)Lt Femur MRI                                    520,000
76.자기영상(MRI) MR72-2 (비)KNEE MRI(post OP)-Rt                           300,000
76.자기영상(MRI) MR72-2 (비)KNEE MRI(post OP)-Lt                              300,000
76.자기영상(MRI) MR72-2L 비) LT knee cor/sag/ACL (좌측)                       300,000
76.자기영상(MRI) MR72-2R 비) RT knee cor/sag/ACL (우측)                       300,000
76.자기영상(MRI) MR72-3 (비)KNEE MRI(post OP)-Lt                           300,000
76.자기영상(MRI) MR72-3L 비) LT knee cor/sag/ACL/Axial (좌측)                 430,000
76.자기영상(MRI) MR72-3R 비) RT knee cor/sag/ACL/Axial (우측)                 430,000
76.자기영상(MRI) MR72-L (비)Knee MRI(LT)                                     520,000
76.자기영상(MRI) MR72-R (비)KNEE MRI (RT)                                  520,000
76.자기영상(MRI) MR726-L (비)KNEE MRI athrogram(LT)                           680,000
76.자기영상(MRI) MR726-R (비)KNEE MRI athrogram(RT) 680,000
76.자기영상(MRI) MR72A (B)RT Knee MRI+ACL                                   630,000
76.자기영상(MRI) MR72A-1 (B)Lt Knee MRI+ACL                                   630,000
76.자기영상(MRI) MR72A-L (비)KNEE MRI (LT)(+)                                 600,000
76.자기영상(MRI) MR72A-R (비)KNEE MRI (RT)(+)                               600,000
76.자기영상(MRI) MR72E-L (비)KNEE MRI (LT)-E                                  650,000
76.자기영상(MRI) MR72E-R (비)KNEE MRI (RT)-E                                650,000
76.자기영상(MRI) MR73E (B)Knee MRI+ACL(E)                                   750,000
76.자기영상(MRI) MR73E-L (B)Lt Knee MRI+ACL-E                               750,000
76.자기영상(MRI) MR73E-R (B)Rt Knee MRI+ACL-E                                 750,000
76.자기영상(MRI) MR80 (B)Rt Upper Extremity MRI                          520,000
76.자기영상(MRI) MR80-1 (B)Lt Upper Extremity MRI                          520,000
76.자기영상(MRI) MR80-1A (B)Rt Upper Extremity MRI (E)                        650,000
76.자기영상(MRI) MR80-1B (B)Lt Upper Extremity MRI (E)                        650,000
76.자기영상(MRI) MR82 (B)Lower Extremity MRI-E                              600,000
76.자기영상(MRI) MR82E (B)Lower Extremity MRI RT(E)                       600,000
76.자기영상(MRI) MR82-1 (B)Lower Extremity MRI(RT)                         520,000
76.자기영상(MRI) MR82-2 (B)Lower Extremity MRI (LT)                        520,000
76.자기영상(MRI) MR82-3 (B)Rt Lower Leg MRI (E)                            650000
76.자기영상(MRI) MR82-4 (B)Lt Lower Leg MRI (E)                            650,000
76.자기영상(MRI) MR82E (B)Lower Extremity MRI LT-(E)                      650,000
76.자기영상(MRI) MR84 (비)Pelvis MRI(POST OP)                              300,000
76.자기영상(MRI) MR90 (B)MRCP MRI                                          520,000
76.자기영상(MRI) MR711 (비)Femur MRI (Rt)                             520,000
76.자기영상(MRI) MR712 (비)Femur MRI (Lt) 520,000
76.자기영상(MRI) MR93 (B)Rt Femur MRI (E)                                650,000
76.자기영상(MRI) MR93-1 (B)Lt Femur MRI (E)                                  650,000
76.자기영상(MRI) MR98 (B)Tibia MRI (RT)                                    520,000
76.자기영상(MRI) MR98-1 (B)Tibia MRI (LT)                                    520,000
76.자기영상(MRI) MR98A-L (B)Tibia MRI (LT)(+)                                 550,000
76.자기영상(MRI) MR98A-R (B)Tibia MRI (RT)(+)                                 550,000
76.자기영상(MRI) MR98E-L (B)Tibia MRI (LT)-E                                    650,000
76.자기영상(MRI) MR98E-R (B)Tibia MRI (RT)-E                                    650,000
76.자기영상(MRI) MR98AE-L (B)Tibia MRI (LT)-E(+)                                650,000
76.자기영상(MRI) MR98AE-R (B)Tibia MRI (RT)-E(+)                               650,000
76.자기영상(MRI) MR98E (B)(B)CALF MRI(E)(편측당)                              550,000
81.증명료 B-D7 진료기록사본1~5매 1,000 
81.증명료 B-D8 진료기록사본6매이상  1,000 
81.증명료 B-D36 영문진단서 20,000 
81.증명료 B-D49 건강진단서 20,000 
81.증명료 COPY-CD CD복사수수료 10,000 
81.증명료 B-D39 향후진료비추정천만원이하  50,000 
81.증명료 B-391 향후진료비추정천만원이상 100,000 
81.증명료 B-D14 상해진단서3주미만 100,000 
81.증명료 B-D15 상해진단서3주이상 150,000 
81.증명료 B-D45 제증명서사본 1매당 1,000 
81.증명료 B-D12 통원확인서 3,000 
81.증명료 B-D3 입퇴원확인서  3,000 
81.증명료 B-D1 일반진단서  20,000 
81.증명료 B-D21 근로능력평가용진단서  10,000 
81.증명료 AB902 상급병실1인실 180,000 
81.증명료 B-D17 병무용진단서 20,000 
81.증명료 B-D16-1 지체장애용(관절장애)소견서                           10,000
81.증명료 B-D16-2 국민연금(팔, 다리 장애)소견서                        10,000
84.구급차사용료 AY100 일반구급차 이송처치료 기본요금(10km이내)             30,000
84.구급차사용료 AY100020 일반구급차 이송처치료 기본요금(10km이내) 심야(이송)  36,000
84.구급차사용료 AY101 일반구급차 이송처치료 기본요금(10km초과 1km당)       1,000
84.구급차사용료 AY101020 일반구급차 이송처치료 추가요금(10km초과 1km당) 심야 1,200
84.구급차사용료 AY102 일반구급차이송처치료부가요금(의사 간호사 응급구조사  15,000
84.구급차사용료 AY102020 일반구급차이송처치료부가요금(의사 간호사 응급구조사  18,000