特材代碼中英文品名支付點數 ACY01PTBYCCK ADAPTERS PTCA 用 1065 BBF LL "LILY"FEEDING SET ACCESSORIES 雙袋機械 (PUMP) 式餵食袋 * 127 BBF LL "LILY"FEEDING SET ACCES

特材代碼中英文品名支付點數 ACM012P700NL ANGIOGRAPHIC MANIFOLDS 2 PORTS 221 ACM013P700NL ANGIOGRAPHIC MANIFOLDS 3 PORTS 263 ACM014P700NL ANGIOGRAPHIC MANIFOLDS 4 PORTS 324 ACM0154PRTMR "MERIT"MANIFOLD:4 PORTS 200PSI;500PSI" 美瑞特 " 多路水接頭 :4 連接頭 324 ACM01MA2PTGJ MANIFOLDS (2 PORT 500PSI W/PVC PT) 多路引流器 ( 含 PVC 壓力連接管 ) 251 ACM01MA2PTH9 MANIFOLDS 2 PORTS W/ PVC TUBING 500PSI 251 ACM01MA3PTGJ MANIFOLDS (3 PORT 500PSI W/PVC PT) 多路引流器 ( 含 PVC 壓力連接管 ) 291 ACM01MA3PTH9 MANIFOLDS 3 PORTS W/ PVC TUBING 500PSI 291 ACM01MA4PTGJ MANIFOLDS (4 PORT 500PSI W/PVC PT) 多路引流器 ( 含 PVC 壓力連接管 ) 372 ACM01MA4PTH9 MANIFOLDS 4 PORTS W/ PVC TUBING 500PSI 372 ACM01MAN12H9 MANIFOLDS 2PORTS 500PSI 221 ACM01MAN13H9 MANIFOLDS 3PORTS 500PSI 263 ACM01MAN14H9 MANIFOLDS 4PORTS 500PSI 324 ACM01MAN2PGJ MANIFOLDS (2 PORT 500PSI) 多路引流器 221 ACM01MAN3PGJ MANIFOLDS (3 PORT 500PSI) 多路引流器 263 ACM01MAN4PGJ MANIFOLDS (4 PORT 500PSI) 多路引流器 324 ACM01TS520SG MANIFOLD 2 PORTS 221 ACM01TS530SG MANIFOLD 3 PORTS 263 ACM01TS540SG MANIFOLD 4 PORTS 324 ACS0170015NL 3-WAY NAMIC MORSE STOPCOCK (200PSI) 12 ACS0170035NL 3-WAY NAMIC MORSE STOPCOCK (400PSI) 20 ACS0170055NL 3-WAY NAMIC MORSE STOPCOCK (1050PSI) 70 ACS01H3SNCMR MARQUIES SERIES STOPCOCKS 1050PSI 70 ACY010210XSD MYSHELL LITE Y CONNECTORS 麥雪兒萊 Y 型接頭 1065 ACY0191400NL NAMIC MORSE Y-ADAPTOR 1065 ACY01MAP32MR HONOR HEMOSTASIS VALVE ANGIOPLASTY PACK 1065 1

特材代碼中英文品名支付點數 ACY01PTBYCCK ADAPTERS PTCA 用 1065 BBF0320404LL "LILY"FEEDING SET ACCESSORIES 雙袋機械 (PUMP) 式餵食袋 * 127 BBF0320405LL "LILY"FEEDING SET ACCESSORIES 雙袋重力式餵食袋 * 72 BBP0101522F4 SUR-FIT NATURA POUCH 45/57MM 雙片式封口除臭便袋 * 限住院患者申報 43 BBP0401512F4 SUR-FIT NATURA DRAINABLE POUCH 38:70MM 雙片式造口袋 * 限住院患者申報 43 BBP0401515F4 SUR-FIT NATURA DRAINABLE POUCH 100MM 雙片式造口袋 * 限住院患者申報 74 BBP0401927F4 BBP0405403F4 BBP0405420F4 "CONVATEC"LITTLE ONES 2 PIECE TRANSPARENT DRAINABLE POUCH 32/45MM 雙片式開口便袋 * 限住院患者申報 "CONVATEC"ESTEEMSYNERGY DRAINABLE POUCH TRANSPARENT 35/48/61MM 雙片式造口袋 * 限住院患者申報 "CONVATEC"ESTEEMSYNERGY DRAINABLE POUCH OPAQUE 35/48MM 雙片式造口袋 * 限住院患者申報 43 43 43 BBP0405436F4 "CONVATEC"ESTEEMSYNERGY CLOSE POUCH OPAQUE 35/48/61MM 雙片式造口袋 * 限住院患者申報 43 BBP0405441F4 BBP0409243F4 BBP0410384CA "CONVATEC"ESTEEMSYNERGY CLOSE POUCH OPAQUE MINI 35/48MM 雙片式造口袋 * 限住院患者申報 "CONVATEC"ESTEEMSYNERGY CLOSE POUCH TRANSPARENT35/48/61MM 雙片式造口袋 * 限住院患者申報 "COLOPLAST"OSTOMY POUCH AND ACCESSORIES(NON-STERILE) 造口術用袋及其附件 * 限住院患者申報 40MM:60MM 43 43 43 BBP0420922F4 ACTIVE LIFE ONE-PIECE POUCH WITH SKIN BARRIER 50MM 雙片式造口袋 * 限住院患者申報 45 BBP0422771F4 ACTIVE LIFE ONE-PIECE DRAINABLE POUCH 19/64MM 單片式造口袋 * 限住院患者申報 55 BBU0101544F4 SUR-FIT NATURA UROSTOMY POUCH 38:70MM 透明尿袋 * 限住院患者申報 77 BBU0164927F4 "CONVATEC"ACTIVE LIFE ONE-PIECE UROSTOMY POUCH 19:45MM 單片式尿袋 * 限住院患者申報 91 CAE01PC383BB PERICAN NEEDLES FOR EPIDURAL ANAESTHESIA 背利安硬脊膜麻醉穿刺針 110 CAE01SD150BB CAE01SD300BB CAE01SD301BB CAE01SD401BB CBA0111612QM "B.BRAUN"PERIFIX CATHETERS FOR EPIDURAL ANAESTHESIA(CATHETER)" 柏朗 " 脊椎硬膜麻醉用穿刺套 "B.BRAUN"PERIFIX CATHETERS FOR EPIDURAL ANAESTHESIA" 柏朗 " 脊椎硬膜麻醉用穿刺套 (NEEDLE+CATHETER) "B.BRAUN"PERIFIX CATHETERS FOR EPIDURAL ANAESTHESIA:MINI SETS" 柏朗 " 脊椎硬膜麻醉用穿刺套 (NEEDLE+CATHETER+FILTER 或 SYRINGE) "B.BRAUN"PERIFIX CATHETERS FOR EPIDURAL ANAESTHESIA:FILTER SETS" 柏朗 " 脊椎硬膜麻醉用穿刺套 (NEEDLE+CATHETER+FILTER+SYRINGE) "MAQUET"PEDIATRIC INTRA AORTIC BALLOON (PUMP)CATHETER FIDELITY 2.5CC 5CC 7CC 12CC 20CC" 邁柯唯 " 主動脈氣球導管 103 241 362 427 26302 CBA0142912QM "MAQUET"INTRA AORTIC BALLOON (PUMP) FIDELITY 8FR 25CC" 邁柯唯 " 主動脈氣球導管 26302 CBA0143001QM "MAQUET"INTRA AORTIC BALLOON PUMP CATHETER 8FR 34CC" 邁柯唯 " 主動脈氣球導管 26302 CBA0143012QM "MAQUET"INTRA-AORTIC (PUMP)BALLOON 8FR 34CC 40CC" 邁柯唯 " 主動脈氣球導管 26302 2

CBA0147982QM "MAQUET"INTRA AORTIC BALLOON(PUMP) CATHETER 7.5FR 25;34;40CC" 邁柯唯 " 主動脈氣球導管 26302 CBA0162080ED "EDWARDS"FOGARTY OCCLUSION CATHETER(AORTIC) 堵塞用導管 25916 CBA01B2640GX "GORE"TRI-LOBE BALLOON CATHETER(AORTIC) 三葉球囊導管 25916 CBA01C0DA2CK "COOK"CODA BALLOON CATHETER(AORTIC) 科達球囊導管 25916 CBA01REL46M4 "MEDTRONIC"RELIANT STENT GRAFT BALLOON CATHETER 瑞萊恩氣球導管 25916 CBA02F6830AR "ARROW"FIBER OPTIC INTRA-AORTIC BALLOON CATHETER 光纖感應主動脈弓氣球導管 41110 CBA02SEN7FQM "MAQUET"SENSATION 7FR INTRA-AORTIC BALLOON CATHETER" 邁柯唯 " 光纖感應主動脈氣球導管 * 41110 CBA0321002LW " 樂脈 " 普特主動脈阻斷導管 "LEMAITRE"PRUITT AORTIC OCCLUSION CATHETER* 7638 CBB0139031SB CBB0139032SB CBB0139134SB CBB0139135SB "BOSTON SCIENTIFIC"STERLING BALLOON DILATATION CATHETERS D 3:8MM L 10:60MM C USABLE 80;135CM 氣球擴張導管 "BOSTON SCIENTIFIC"STERLING BALLOON DILATATION CATHETERS(OTW)D 4:10MM L 20:100MM C USABLE L40:135CM 氣球擴張導管 "BOSTON SCIENTIFIC"STERLING BALLOON DILATATION CATHETERS(OTW) D 1.5:4MM L 20:40MM C USABLE 142;145CM 氣球擴張導管 "BOSTON SCIENTIFIC"STERLING BALLOON DILATATION CATHETERS(OTW) D 1.5:4MM L 20:40MM C USABLE 143;146CM 氣球擴張導管 5822 5822 5822 5822 CBB0152111BQ "BIOTEQ"PTA BALLOON DILATATION CATHETER" 邦特 " 血管氣球擴張導管 5822 CBB0152115BQ "BIOTEQ"PTA BALLOON DILATATION CATHETER" 邦特 " 血管氣球擴張導管 5822 CBB0161111BQ "BIOTEQ"PTA BALLOON DILATATION CATHETER" 邦特 " 血管氣球擴張導管 5822 CBB0161115BQ "BIOTEQ"PTA BALLOON DILATATION CATHETER" 邦特 " 血管氣球擴張導管 5822 CBB01CQ120BA "BARD"CONQUEST PTA BALLOON DILATATION CATHETER 氣球擴張導管 5822 CBB01F0XSVAB "ABBOTT"FOX SV PTA BALLOON CATHETER D 2:6MM L 90,135,150CM 周邊血管氣球導管 5822 CBB01FCPTAAB "ABBOTT"FOXCROSS PTA CATHETER 周邊血管氣球導管 5822 CBB01PTA14Y9 NANOCROSS.014 OTW PTA DILATATION CATHETER D 1.5:3.5MM L 20:120MM 導管長度 150CM 娜諾血管擴張氣球導管 CBB01PTA35Y8 EVERCROSS.035 OTW PTA DILATATION CATHETER D 3.0:12.0MM L 15:120MM 導管長度 40,80, 135CM 艾維血管擴張氣球導管 CBB01PTA51CK CBB01PTAX1CK CBB01REU35F2 CBB01RV135BA CBB01SMTRYSB "COOK"ADVANCED 35LP LOW PROFILE PTA BALLOON DILATION CATHETER 5-7 FR 80/135CM 艾德凡絲小剖面經皮穿刺血管成形術球囊 "COOK"ADVANCED 14LP LOW PROFILE PTA BALLOON DILATATION CATH 經皮穿刺血管成形術球囊擴張導管直徑 2-4MM 長度 2-20CM 導管長度 170CM "INVATEC"REEF HP PTA BALLOON CATHETER D 4.0:8.0MM L 20:80MM USE LENGTH 50,80,120CM 週邊血管氣球導管 "BARD"RIVAL PTA BALLOON DILATATION CATHETER 氣球擴張導管 SHAFT 80&135CM D 4:10MM L 2:15CM "BOSTON SCIENTIFIC"SYMMETRY BALLOON DILATATION CATHETER 1.5MM-6.0MM 2CM-10CM 對稱式氣球裝導管 5822 5822 5822 5822 5822 5822 5822 3

CBC01PCRXCCD "CORDIS"PRECISE PRO RX NITINOL STENT SYSTEM 普塞斯普羅鎳鈦支架系統 ( 頸動脈支架 )* 28608 CBC01PR0TEY7 "EV3"PROTEGE RX CAROTID STENT SYSTEMS STRAIGHT L:20:60MM D:6:10MM TAPERED L:30;40MM D:8X6;10X7MM 波特捷自動擴張式頸動脈支架系統 * 適應症見備註 28608 CBC01XRXSTAB "ABBOTT"XACT CAROTID STENT SYSTEM 頸動脈支架系統 * 28608 CBC0222262PF EVO TARGET NITINOL STENT IMPLANTATION SYSTEM FOR VASCULAR(A.ILIAC) 腸骨支架植入系統 * 30076 CBC0244318BB "B.BRAUN"VASCUL FLEX SE SELF-EXPANDING PERIPHERAL STENT(ILIAC) 脈舒萊週邊血管支架 * 30076 CBC02ASSURM4 "MEDTRONIC"ASSURANT COBALT OVER THE WIRE ILIAC STENT SYSTEM 腸骨血管支架系統 * 30076 CBC02C0MSEM4 "MEDTRONIC"COMPLETE SE ILIAC STENT SYSTEM D:4.0-10MM L:20:150MM CATHETER:80-130CM" 美敦力 " 康博立腸骨血管支架系統 * 適應正請見備註欄 30076 CBC02SCA35F2 "INVATEC"SCUBA PERIPHERAL STENT SYSTEM 80CM 130CM 腸骨血管支架系統 * 30076 CBC02Z1V63CK "COOK"ZILVER VASCULAR STENTS(ILIAC)6:10MMX20:80MM 腸骨血管支架 * 30076 CBC02ZVM04AN "ANGIOMED"BARD E.LUMINEXX VASCULAR STENT 腸骨血管支架 * 30076 CBC0320714TM "TERUMO"ANACONDA AAA STENT GRAFT SYSTEM 腹主動脈人工血管支架系統 ( 主體 + 分支體 *2)* 427500 CBC0320715TM CBC03AAA01CK CBC03AAA01M4 CBC03AAA02CK CBC03AAA02M4 CBC03AAA03CK "TERUMO"ANACONDA AAA STENT GRAFT SYSTEM -AORTIC CUFF 腹主動脈人工血管支架系統 - 輔助配件 * ZENITH FLEX AAA ENDOVASCULAR GRAFT W/THE H&L-B ONE-SHOT INTRO SYS 腹主動脈瘤支架暨輸送系統 ( 主體 + 分支體 *2)* 適應症見備註 "MEDTRONIC"TALENT AAA STENT GRAFT W THE XCELERANT HYDRO DELIVERY SYS 腹主動脈支架系統 ( 主體 + 分支體 )* ZENITH FLEX AAA ENDOVASCULAR GRAFT W/THE H&L-B ONE-SHOT INTRODUCTION SYS 腹主動脈瘤支架暨輸送系統 - 輔助配件 * 適應症見備註 "MEDTRONIC"TALENT AAA STENT GRAFT W THE XCELERANT HYDRO DELIVERY SYS(AORTIC, ILIAC EXT) 腹主動脈支架系統 ( 主動脈, 髂動脈延長段 )* 適應症見備註 "COOK"ZENITH AAA ENDOVASCULAR GRAFT W/H&L-B ONE-SHOT INTRO SYS 腹主動脈瘤支架暨輸送導引系統 ( 主體 + 分支體 *2)* 適應症見備註 72000 427500 427500 72000 72000 427500 CBC03AAA03M4 "MEDTRONIC"ENDURANT STENT GRAFT SYSTEM" 美敦力 " 茵德倫覆膜支架系統 ( 主體 + 分支體 )* 427500 CBC03AAA04CK CBC03AAA04M4 CBC03AZT01CK CBC03LEZT1CK CBC03PA23NGX CBC03PC12NGX CBC03PL10NGX CBC03PX23NGX "COOK"ZENITH AAA ENDOVASCULAR GRAFT W/H&L-B ONE-SHOT INTRO SYS 腹主動脈瘤支架暨輸送導引系統 - 輔助配件 * 適應症見備註 "MEDTRONIC"ENDURANT STENT GRAFT SYSTEM" 美敦力 " 茵德倫覆膜支架系統 ( 輔助配件 - 主動脈. 髂動脈延長段 )* "COOK"ZENITH FLEX AAA ENDOVASCULAR GRAFT /W Z-TRAK INTRO SYS 主動脈瘤支架暨輸送導引系統 ( 主體 + 分支體 *2)* 適應症見備註 "COOK"ZENITH FLEX AAA ENDOVASCULAR GRAFT W Z-TRAK INTRO SYS" 曲克 " 蘭尼斯腹主動脈瘤支架暨輸送導引系統 - 輔助配件 ( 髂動脈延長段 )* 適應症見備註欄 "GORE"EXCLUDER AAA ENDOPROSTHESIS- AORTIC EXTENDER 易時固得腹主動脈瘤支架 ( 腹主動脈瘤主體延伸支架 )* "GORE"EXCLUDER AAA ENDOPROSTHESIS(CONTRALATERAL LEG ENDOPROSTHESIS) 腹主動脈瘤支架輔助系統 ( 腹主動脈瘤對側腳支架 )* "GORE"EXCLUDER AAA ENDOPROSTHESIS(ILIAC EXTENDER ENDOPROSTHESIS) 腹主動脈瘤支架輔助系統 ( 髂動脈分支延伸體 )* "GORE"EXCLUDER AAA ENDOPROSTHESIS 易時固得腹主動脈支架 ( 腹主動脈瘤主體同測腳支架 + 對測腳支架 + 股動脈延伸支架 )* 72000 72000 427500 72000 72000 72000 72000 427500 4

CBC03ZFEN1CK "COOK"ZENITH FENESTRATED AAA ENDOVASCULAR GRAFT W/H&L-B ONE-SHOT INTRO SYS 腹主 427500 動脈瘤支架暨導引系統 ( 主體 + 分支體 *2)* 適應症見備註 CBC04EX06CAN CBC04EX15CAN CBC04ZFV61CK CBC04ZFV62CK "ANGIOMED"BARD LIFESTENT VASCULAR STENT(DELIVERY SYS+STENT)" 安吉美爾德 " 巴德萊弗丹血管支架, 支架長 20:120MM* "ANGIOMED"BARD LIFESTENT VASCULAR STENT(DELIVERY SYS+STENT)" 安吉美爾德 " 巴德萊弗丹血管支架, 支架長 150:170MM* "COOK"ZILVER FLEX 35 VASCULAR STENTS" 曲克 " 麗而服福雷斯血管支架 ( 淺骨動脈血管支架 )20:140MM 5:10MM "COOK"ZILVER FLEX 35 VASCULAR STENTS" 曲克 " 麗而服福雷斯血管支架 ( 淺骨動脈血管支架 )170:200MM 5-8MM 35000 49625 35000 49625 CBP01104TBRB "ORBUSNEICH"SAPPHIRE NC CORONARY DILATATION CATHETER 神飛冠狀動脈球囊擴張術導管 8340 CBP01BLUE1BB "B.BRAUN"COROFLEX BLUE CORONARY STENT SYSTEM 普弩冠狀動脈血管支架系統 * 19940 CBP01BLUE2BB "B.BRAUN"COROFLEX BLUE CORONARY STENT SYSTEM 普弩冠狀動脈血管支架系統 * 19940 CBP01GAZSTBS "BIOSENSORS"GAZELLE CORONARY STENT SYSTEM 冠狀動脈內支架系統 * 19940 CBP01PWRLNBS "BIOSENSORS"POWERLINE PTCA CATHETER 經皮冠狀動脈成形術球囊導管 8340 CBP01TSUG2TM "TERUMO"TSUNAMI CORONARY STENT SYSTEM 冠狀動脈血管支架 * 19940 CBP01TSUG3TM "TERUMO"TSUNAMI CORONARY STENT SYSTEM 冠狀動脈血管支架系統 * 19940 CBP01TSUGDTM "TERUMO"TSUNAMI CORONARY STENT SYSTEM 冠狀動脈血管支架 * 19940 CBP02NCSP1M4 "MEDTRONIC"NC SPRINTER RAPID EXCHANGE BALLOON DILATATION CATHETER 快速交換氣球擴張導管 8340 CBP02R7R7FKE "KANEKA"IKAZUCHI RAPID EXCHANGE PTCA BALLOON CATHETER 雷快速抽換冠狀動脈氣球導管 8340 CBP02SPRL1M4 CBP0337910SB CBP0338081SB "MEDTRONIC"SPRINTER LEGEND RAPID EXCHANGE BALLOON DILATATION CATHETER 快速交換氣球擴張導管 "BOSTON SCIENTIFIC"MAVERICK XL MONORAIL PTCA DILATATION CATHETER 馬文瑞克氣球擴張導管 "BOSTON SCIENTIFIC"QUANTUM MAVERICK PTCA DILATATION CATHETER D 2.0:5.0MM L8:30MM 冠狀動脈擴張導管 8340 8340 8340 CBP0338960SB "BOSTON SCIENTIFIC"APEX OTW PTCA DILATATION CATHETER 氣球擴張導管 8340 CBP0338961SB "BOSTON SCIENTIFIC"APEX PTCA DILATATION CATHETER 氣球擴張導管 8340 CBP0339124SB CBP0339125SB "BOSTON SCIENTIFIC"NC QUANTUM APEX PTCA DILATATION CATHETER(MONORAIL) 康騰艾佩斯氣球擴張導管 2.0:5.0MM 6:30MM "BOSTON SCIENTIFIC"NC QUANTUM APEX PTCA DILATATION CATHETER(OTW) 康騰艾佩斯氣球擴張導管 2.0:5.0MM 6:30MM 8340 8340 CBP03DCRK1TM "TERUMO"TAZUNA PTCA DILATATION CATHETER" 泰爾茂 " 鈦速納冠狀動脈氣球擴張導管 8340 CBP03SL0TWM4 CBP06ELUT1BS CBP06ELUT1TM "MEDTRONIC"SPRINTER LEGEND OVER-THE-WIRE BALLOON DILATATION CATHETER 同軸導線球囊擴張導管 "BIOSENSORS"BIOMATRIX DRUG ELUTING CORONARY STENT SYS 釋放型冠狀動脈支架系統部分給付品項 * 適應症見備註, 並註明禁忌症不可使用 "TERUMO"NOBORI DRUG STENT SYSTEM 2.5MM:3.5MM 8MM:28MM 冠狀動脈塗藥支架部分給付品項 * 適應症請見備註, 並註明其禁忌症不可使用 8340 19940 19940 5

CBP06ELUT3AB "ABBOTT"XIENCE PRIME EVEROLIMUS ELUTING CORONARY STENT SYSTEM 冠狀動脈塗藥支架系 19940 統部份給付品項 *, 並註明其禁忌症不可使用 CBP06ELUT3SB CBP06ELUT4M4 CBP06ELUT4SB CBP06ELUT5SB "BOSTON SCIENTIFIC"TAXUS LIBERTE LONG MONORAIL PACLITAXEL-ELUTING CORONARY STENT SYS 紫杉醇釋放型冠狀動脈支架 * 適應證見備註 "MEDTRONIC"ENDEAVOR RESOLUTE ZOTAROLIMUS-ELUTING CORONARY STENT SYS 釋放型冠狀動脈支架系統部分給付品項, 適應症見備註, 並註明其禁忌症勿用 "BOSTON SCIENTIFIC"TAXUS ELEMENT PACLITAXEL-ELUTING CORONARY STENT SYS 冠狀動脈塗藥支架系統 * 部分給付品項, 適應症見備註, 並註明禁忌症不可用 "BOSTON SCIENTIFIC"PROMUS ELEMENT EVEROLIMUS-ELUTING CORONARY STENT SYS 冠狀動脈塗藥支架系統 * 部分給付品項, 適應症見備註, 並註明禁忌症不可用 19940 19940 19940 19940 CBS029CR19G6 AMPLATZER CRIBRIFORM OCCLUDER 安普拉茲多孔心房中膈關閉器 * 138000 CBS029DELTG6 "AGA"AMPLATZER DELIVERY SYSTEM 安普拉茲遞送導管系統 5F:10F,12F* 12000 CBS04407XXST " 聖猷達 " 房中膈穿刺針 "SJM" BRK TRANSSEPTAL NEEDLE 7230 CBS059AVP4G6 "AMPLATZER"VASCULAR PLUG&DELIVERY SYSTEM 4MM:8MM 血管塞含遞送導管 21700 CBS059AVP9G6 "AMPLATZER"VASCULAR PLUG&DELIVERY SYSTEM 10MM:16MM 血管塞含遞送導管 23800 CBT022014NPU PULSIOCATH THERMODILUTION CATHETERS(PICCO2) 普新卡熱稀釋導管 ( 含 CATHETER+NITINOL GUIDE WIRE) 5775 CBT0407055AR "ARROW"BALLOON THERMODILUTION CATHETER 4FRX75CM 5FRX80CM(HEPARIN COATED) 4 LUMENS " 亞諾 " 熱稀釋順流導管 2710 CBT0407367AR "ARROW" THERMODILUTION BALLOON CATHETER(4 LUMEN) 7FR 110CM " 亞諾 " 熱稀釋順流導管 1842 CBT04132F5ED "EDWARDS"SWAN-GANZ THERMODILUTION CATHETER 4LUMEN 5FR 75CM( 兒童用 ) 史望康熱稀釋導管 2162 CBT0445080BD "B-D"CRITICATH THERMODILUTION CATHETERS 4 LUMEN 5F 80CM 熱稀釋導管 2162 CBT0445110BD "B-D"CRITICATH THERMODILUTION CATHETERS 4 LUMEN 5F 110CM 熱稀釋導管 2162 CBT05831HFED CBT06831HFED "EDWARDS"SWAN-GANZ THERMODILUTION CATHETERS 5 LUMEN 7FR W/AMC THROMBOSHIELD COATING 史望康熱稀釋管 "EDWARDS"SWAN-GANZ THERMODILUTION CATHETERS 6 LUMEN 7FR W/AMC THROMBOSHIELD COATING 史望康熱稀釋管 2867 3150 CCC13BT894R5 "SORIN"AUTOTRANSFUSION RESERVOIR SET 自動輸血組儲血器 * 3900 CCC14745E5R5 "SORIN"AUTOTRANSFUSION KITS FOR ELECTA(WASH SET+AUTOTRANSFUSION RESERVOIR SET+LINE) 依雷塔專用自體輸血組 * 7307 CCC1474E55R5 "SORIN"WASH SET 血液洗淨組 * 4000 CCC1520503AH "ATRIUM"OCEAN WATER SEAL CHEST DRAINS 海洋自體血液回收胸腔引流儲血器 ( 單管回流式 )* 4000 CCC1520523AH "ATRIUM"OCEAN WATER SEAL CHEST DRAINS 海洋自體血液回收胸腔引流儲血器 ( 雙管回流式 )* 4467 CDCC2PCS01CK " 曲克 " 心包引流管組 "COOK"PERICARDIOCENTESIS SET 2300 CDCC2PPD01CK 曲克費曼胸膜腔 / 心包積氣引流組 "COOK"FUHRMAN PLEURAL/PNEUMOPERICARDIAL DRAINAGE SET 2000 CDCG20RCA1RC "RANFAC"INTRODUCTION DRAINAGE CATHETER" 仁斐 " 導入及引流導管 ( 術中膽管攝影導管 ) 475 6

CDD0410440LL WOUND DRAINAGE SYSTEM 400ML 真空傷口引流套 (PVC 引流管 +PVC 吸引球 + 穿刺針 ) 500 CDD04CSB00LL "LILY"WOUND DRAINAGE SYSTEM(SILICONE)" 怡安 " 真空傷口引流套 / 套組 ( 矽質引流管 + 矽質吸引球 + 穿刺針 ) 670 CDD05CSC00LL CDD06CSB00LL LILY WOUND DRAINAGE SYSTEM:SILICON SUCTION DRAINAGE TUBE 怡安真空傷口引流套 : 矽質傷口引流管 LILY WOUND DRAINAGE SYSTEM:SILICON SURGICAL CWV RESERVOIR 100ML;125ML;150ML;200ML 怡安真空傷口引流套 : 矽質真空傷口引流蓄液球 340 300 CDD1100002KM TROCAR KITS 內視鏡可轉換式安全穿刺套管組 5/10MM,5/12MM ( 穿剌針 1+ 外管 1+ 可變式轉接頭 1) 1595 CDD1100003KM TROCAR KITS 內視鏡鈍型可轉換式安全穿刺套管組 5-10MM/5-12MM( 穿剌針 1+ 外管 1+ 可變式轉接頭 1+ 外管固定器 1) 2233 CDD1100004KM "METROMED"TROCAR " 益鳴 " 穿刺套管 ( 穿剌針 1+ 外管 1+ 固定轉接頭 1) 1329 CDD1100005KM TROCAR KITS 內視鏡固定式安全穿刺套管組 5MM( 穿剌針 1+ 外管 1+ 固定式轉接頭 1) 1329 CDD1100005U7 SURGICAL TROCAR SYSTEM 5-12MM ( 穿剌針 1+ 外管 1+ 內建可變式轉接頭 1) 1595 CDD1100006KM TROCAR KITS 內視鏡可充氣式安全穿刺套管組 5MM ( 穿剌針 1+ 外管 2+ 固定式轉接頭 2) 1963 CDD1100006U7 SURGICAL TROCAR SYSTEM 5-12MM ( 穿剌針 1+ 外管 2+ 內建可變式轉接頭 2) 2658 CDD1100007KM TROCAR KITS 內視鏡可充氣式安全穿刺套管組 5MM( 穿剌針 1+ 外管 1+ 固定式轉接頭 1) 1329 CDD1100007U7 SURGICAL TROCAR SYSTEM 5MM ( 穿剌針 1+ 外管 1+ 內建固定式轉接頭 1) 1329 CDD1100008U7 SURGICAL TROCAR SYSTEM 5MM ( 穿剌針 1+ 外管 2+ 內建固定式轉接頭 2) 1963 CDD1100009KM TROCAR KITS 內視鏡可轉換式安全穿刺套管組 5/10MM,5/12MM ( 穿剌針 1+ 外管 2+ 可變式轉接頭 2) 2658 CDD1100009U7 SURGICAL TROCAR SYSTEM 5-12MM ( 穿剌針 1+ 外管 1+ 內建可變式轉接頭 1) 1595 CDD1100010U7 SURGICAL TROCAR SYSTEM 5-12MM ( 穿剌針 1+ 外管 2+ 內建可變式轉接頭 2) 2658 CDD1100011U7 SURGICAL TROCAR SYSTEM 5MM ( 穿剌針 1+ 外管 1+ 內建固定式轉接頭 1) 1329 CDD1100012U7 SURGICAL TROCAR SYSTEM 5MM ( 穿剌針 1+ 外管 2+ 內建固定式轉接頭 2) 1963 CDD1100013U7 SURGICAL TROCAR SYSTEM 5MM ( 穿剌針 1+ 外管 1+ 內建固定式轉接頭 1) 1329 CDD1100022KM GYNECOLOGIC LAPAROSCOPE ACCESSORIES:TROCAR (1 支外管 +1 支固定轉接頭 ) 955 CDD1100066KM "METROMED"TROCAR " 益鳴 " 穿刺套管 ( 穿剌針 1+ 外管 2+ 固定轉接頭 2) 1963 CDD1100099KM TROCAR KITS 內視鏡固定式安全穿刺套管組 5MM ( 穿剌針 1+ 外管 2+ 固定式轉接頭 2) 1963 CDD11200011T SURGICAL TROCAR SET 5MM( 穿刺內管 X1+ 穿刺外管 X1+ 固定式轉接頭 X1) 1329 CDD11210011T SURGICAL TROCAR SET 5-10MM( 穿刺內管 X1+ 穿刺外管 X1+ 可變式轉接頭 X1) 1595 CDD11220011T SURGICAL TROCAR SET 5-12MM( 穿刺內管 X1+ 穿刺外管 X1+ 可變式轉接頭 X1) 1595 7

CDD1179093US AUTO SUTURE VERSAPORT V2 SINGLE USE W/RADIOLUCENT TROCAR SLEEVE ( 內管 + 外管 + 固定式 1329 接頭 ) CDD1179095US AUTO SUTURE VERSAPORT V2 SINGLE USE W/RADIOLUCENT TROCAR SLEEVE ( 內管 + 外管 + 可變轉接頭 ) 1595 CDD11K1101PA TROCAR SYSTEM( 穿剌針 1+ 外管 1+ 可變式轉接頭 1) 1595 CDD11K1102PA TROCAR SYSTEM( 穿剌針 1+ 外管 1+ 可變式轉接頭 1) 1595 CDD11K1103PA TROCAR SYSTEM( 穿剌針 1+ 外管 1+ 可變式轉接頭 1) 1595 CDD11K1104PA TROCAR SYSTEM( 穿剌針 1+ 外管 1+ 可變式轉接頭 1) 1595 CDD11K1105PA TROCAR SYSTEM( 穿剌針 1+ 外管 2+ 可變式轉接頭 2) 2658 CDD11K1106PA TROCAR SYSTEM( 穿剌針 1+ 外管 2+ 可變式轉接頭 2) 2658 CDD11K1107PA TROCAR SYSTEM( 穿剌針 1+ 外管 2+ 可變式轉接頭 2) 2658 CDD11K1108PA TROCAR SYSTEM( 外管 1+ 可變式轉接頭 1) 955 CDD11NB12FUS CDD11NBFCAUS " 優施西 " 無刀刃可變式穿刺套管 USS VERSAPORT BLADELESS AND VERSAPORT PLUS BLADELESS TROCAR( 穿刺內管 X1 穿刺外管 X1 可變轉接頭 X1) " 優施西 " 無刀刃可變式穿刺套管 "USS" VERSAPORT PLUS BLADELESS SINGLE USE FIXATION CANNULA( 外管 TROCAR SLEEVE 1 支 + 固定式轉接頭 1 支 ) 1595 955 CDD12K1109PA TROCAR SYSTEM 充氣式 ( 穿剌針 1+ 外管 1+ 可變式轉接頭 1) 3091 CDD13DGC01CK "COOK"JABCZENSKI DUCTOGRAM CANNULA 30 GAGE( 乳管攝影導管 ) 960 CDD13G1U30RC INTRODUCTION DRAINAGE CATHETER 導入及引流導管 ( 乳管攝影導管 ) 960 CDP010ACL2CK " 曲克 " 膽道支架暨支架引導組 "COOK"COTTON-LEUNG BILIARY STENT AND INTRODUCER SET 4500 CDP010ATS1CK CDP0121333BQ 歐爾喜斯一步式支架引導系統膽道支架 "COOK"OASIS ONE ACTION STENT INTRODUCTION SYSTEM WITH ST-2 SOEHENDRA TANNENBAUM BILIARY STENT "BIOTEQ"INTRODUCER SET" 邦特 " 穿刺導入系統組 ( 含穿刺針 +INTRODUCER+0.018"GUIDE WIREX1 支 +0.035" 或 0.038"GUIDE WIREX1 支 ) 4500 2700 CDP01CLBS2CK "COOK"COTTON-LEUNG BILIARY STENTS AND INTRODUCERS 5:14FR 膽道支架暨支架引導系統 4500 CDP01GEPD2CK " 曲克 " 吉南胰管支架組 "COOK"GEENEN PANCREATIC STENT SET 4200 CDP01PDD10BQ CDP01PDD2WBQ CDP01PDD30BQ CDP01PDD4WBQ CDP01PDS50BQ CDP01PDS6WBQ " 邦特 " 豬尾巴引流導管組 ( 直接穿刺型 ) "BIOTEQ" PIGTAIL DRAINAGE CATHETER SET(ONE STEP TYPE) " 邦特 " 豬尾巴引流導管組 ( 直接穿刺型 ) "BIOTEQ" PIGTAIL DRAINAGE CATHETER SET(ONE STEP TYPE) " 邦特 " 豬尾巴引流導管組 ( 直接穿刺型 ) "BIOTEQ" PIGTAIL DRAINAGE CATHETER SET(ONE STEP TYPE) " 邦特 " 豬尾巴引流導管組 ( 直接穿刺型 ) "BIOTEQ" PIGTAIL DRAINAGE CATHETER SET(ONE STEP TYPE) " 邦特 " 豬尾巴引流導管組 ( 直接穿刺型 ) "BIOTEQ" PIGTAIL DRAINAGE CATHETER SET(ONE STEP TYPE) " 邦特 " 豬尾巴引流導管組 ( 直接穿刺型 ) "BIOTEQ" PIGTAIL DRAINAGE CATHETER SET(ONE STEP TYPE) 2000 2000 2000 2000 2000 2000 8

CDP01PDS70BQ " 邦特 " 豬尾巴引流導管組 ( 直接穿刺型 ) "BIOTEQ" PIGTAIL DRAINAGE CATHETER SET(ONE STEP 2000 TYPE) CDP01PDS8WBQ " 邦特 " 豬尾巴引流導管組 ( 直接穿刺型 ) "BIOTEQ" PIGTAIL DRAINAGE CATHETER SET(ONE STEP TYPE) 2000 CDP01ZEBD3CK 曲克膽道支架暨支架引導系統 COOK ZIMMON BILIARY STENTS AND SET 4500 CDP01ZEBD4CK 曲克膽道支架暨支架引導系統 COOK ZIMMON BILIARY STENTS AND INTRODUCERS 4500 CDP02CLS01CK "COOK"COTTON-LEUNG BILIARY STENTS 5:14FR 膽道支架 2200 CDP02SPS12CK " 曲克 " 西門胰管支架組 "COOK" ZIMMON PANCREATIC STENT SET 2200 CDP02ZS003CK 曲克膽道支架 COOK ZIMMON BILIARY STENT 2200 CDPN1UTPT1CK "COOK"WAYNE PNEUMOTHORAX SET( 含單向引流閥 + 豬尾導管 +0.035 導線 + 擴張器 +3WAY+ 連接管 + 穿刺針 *2)" 曲克 " 威恩氣胸引流組 3100 CEE0110655LL "LILY"EXTENSION TUBE 15CM" 怡安 " 輸液延長管 11.7 CEE0110656LL "LILY"EXTENSION TUBE 15CM (NEEDLE FREE)" 怡安 " 輸液延長管 : 免針加藥座 70 CEE01B430BBQ "BIOTEQ"ANGIOGRAPHIC SYRINGE KIT(LOW PRESSURE TUBE)" 邦特 " 攝影導管用注射筒套組 ( 螺旋連接管 ) 40 CEE01CH100U2 "ICU"CLAVE DRUG PREPARATION SYSTEM:ACCESS DEVICE IV BAG CLAVE CONNECTOR" 愛喜優 " 克萊福藥物準備系統組件 70 CEE01CH150U2 CEE01CH303U2 CEE01ENT10SG CEE01ENY10SG CEE01ETN10SG CEE01ETN20SG "ICU"CLAVE DRUG PREPARATION SYSTEM:IV BAG ACCESS SPIKE CLAVE CHECK VALVE)" 愛喜優 " 克萊福藥物準備系統組件 ( 玻璃瓶用 ) "ICU"CLAVE DRUG PREPARATION SYSTEM:5" (13CM)BAG SPIKE ADAPTER W/SPIROS NON-DEHP TUBING" 愛喜優 " 克萊福藥物準備系統組件 "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE T-TYPE EXTENSION TUBE" 十美牌 " 免針輸液接頭 T 型延長管 "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE Y EXTENSION TUBE" 十美牌 " 免針輸液接頭 Y 延長管 "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE SINGLE EXTENSION TUBE" 十美牌 " 免針輸液接頭延長管 "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE DOUBLE EXTENSION TUBE" 十美牌 " 免針輸液接頭 2 路延長管 70 134 70 70 70 134 CEE01N8000SG "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE " 十美牌 " 免針輸液接頭 50 CEE01P8100SG "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE " 十美牌 " 免針型輸液接頭 50 CEE01PET10SG CEE01PET20SG CEE01PEY10SG CEE01PTT10SG "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE SINGLE EXTENSION TUBE " 十美牌 " 免針型輸液接頭延長管 "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE DOUBLE EXTENSION TUBE " 十美牌 " 免針型輸液接頭 2 路延長管 "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE Y EXTENSION TUBE " 十美牌 " 免針型輸液接頭 Y 延長管 "SIGMA"NEEDLELESS INJECTION ACCESS DEVICE T-TYPE EXTENSION TUBE " 十美牌 " 免針型輸液接頭 T 延長管 70 134 70 70 CEP0190702NL PRESSURE MONITORING LINE 6":96" 60 CEP0191031NL CONTRAST INJECTION LINES (1200PSI 雙層 ) 顯影劑注射導線 479 9

CEP01A813ABQ 1200PSI HIGH PRESSURE CONNECTING TUBE ( 雙層 ) 479 CEP01A841ABQ 900PSI HIGH PRESSURE CONNECTING TUBE( 單層 ) 114 CEP01A851ABQ 1200PSI HIGH PRESSURE CONNECTING TUBE( 單層 ) 114 CEP01B330BBQ PRESSURE CONNECTING TUBE 500PSI 60 CEP01PT483GJ PRESSURE TUBING 壓力連接管 (500PSI PVC 每包 3 條 ) 180 CEP01PT500GJ PRESSURE TUBING 壓力連接管 (500PSI PVC) 60 CEP01PTHPTGJ PRESSURE TUBING:HIGH PRESSURE TUBING 壓力連接管 (1200PSI PU 雙層 ) 479 CEP01PTPVCGJ PRESSURE TUBING:HIGH PRESSURE TUBING 壓力連接管 (1000PSI PVC) 114 CFD02GT301EW E-UP STOMACH TUBE(SILICON) 毅升一次性使用胃管 86 CFD0600026BA "BARD" BUTTON REPLACEMENT GASTROSTOMY DEVICE (BUTTON+OBTURATOR+BOLUS AND F- TUBES+DECOMP TUBE+SY)" 巴德 " 鈕扣式置換胃造口組 4950 CFD0600031BA "BARD"DUAL PORT FEEDING ADAPTOR 經皮內視鏡胃造口組 : 雙座餵食管接頭 212 CFD0600627BA "BARD"PONSKY PULL PEG DELUXE KIT (TUBE+WIRE+S+N+ADAP+BOL+SNARE+SCISSOR)" 巴德 " 經皮內視鏡胃造口組 ( 全套 ) 5600 CFD0601006BA "BARD"PONSKY PULL PEG KIT (TUBE+WIRE+S+N+ADAP+BOL)" 巴德 " 經皮內視鏡胃造口組 ( 半套 ) 4200 CFD0679010FL CFD06BFA01CK CFD06BRT01CK CFD06FLW01CK CFD06PEG01CK PEG KIT( 全套, 含所材料在內 ) 經皮內視鏡胃造廔組 (PEG TUBE,ADAPTER,RING,INTRODUCER NEEDLE,WIRE,TUBING CLAMP) PERCUTANEOUS ENDOSCOPIC GASTROSTOMY SYSTEM ADAPTER 餵食管接頭 (TWO WAY OR ONE WAY) "COOK"GASTROSTOMY DEVICES/ACCESSORIES BALLOON FEEDING TUBE " 曲克 " 胃造口術器材配件 /BALLOON 型替換管 PERCUTANEOUS ENDOSCOPIC GASTROSTOMY SYSTEM 經皮內視鏡胃造口術系統 ( 含 FEEDING TUBE+ 鬱金香形頭 + 藍色導線 )+(A+N+D) PERCUTANEOUS ENDOSCOPIC GASTROSTOMY SYSTEM 胃造口術裝置組 ( 含 FEEDING TUBE+ 鬱金香形頭 + 藍色導線 )+(ADAPTER+ NEEDLE+DILATOR) CFD06PEGJ1CK "COOK"GASTROSTOMY DEVICES/ACCESSORIES JEJUNAL FEEDING TUBE " 曲克 " 胃造口術器材配件 / 空腸餵食管 CGDW1A2131BQ CGDW1C6121BQ BIOTEQ URETERAL STENT SET DOUBLE J TYPE:GUIDE WIRE 0.028":0.038" 120CM;150CM 邦特輸尿管導管組 ( 雙 J 型 ): 引導鋼線 "BIOTEQ"DRAINAGE CATHETER & INTRODUCER SET:NITINOL GUIDE WIRE 0.018" 80CM " 邦特 " 引流導管及穿刺導入系統 : 鎳鈦合金引導鋼線 5600 212 1620 5600 5600 3840 350 710 CGDW1PTGW1GJ STAINLESS STEEL GUIDE WIRE0.018"~0.038" 50CM;80CM W/PTFE 320 CGDW1PTGW1H9 STAINLESS W/PTFE GUIDE WIRE 0.018":0.038" 50CM:80CM 320 CGDW1PTGW2GJ STAINLESS STEEL GUIDE WIRE0.018"~0.038" 120CM;150CM;180CM W/PTFE 350 CGDW1PTGW2H9 STAINLESS W/PTFE GUIDE WIRE 0.018":0.038" 120CM;150CM;180CM 350 CGDW1PTGW3GJ STAINLESS STEEL GUIDE WIRE0.018"~0.038" 260CM;300CM W/PTFE 460 10

CGDW1PTGW3H9 STAINLESS W/PTFE GUIDE WIRE 0.018":0.038" 260CM;300CM 460 CGPG1AB035BQ GUIDING CATHETER 2048 CGPG1AB131BQ GUIDING CATHETER 2048 CGPG1AB234BQ GUIDING CATHETER 2048 CGPG1CA031BQ GUIDING CATHETER 2048 CGPG1CA131BQ GUIDING CATHETER 2048 CGPG1CA214BQ GUIDING CATHETER 2048 CGPG1CAS31BQ GUIDING CATHETER 2048 CGPG1CGC58MR "MERIT" CONCIERGE GUIDING CATHETER(5~8F)" 美瑞特 " 康捷導引導管 2048 CGPG1CNCRGMR "MERIT" CONCIERGE GUIDING CATHETER(5~8F)" 美瑞特 " 康捷導引導管 2048 CGPG1CX101CK CXI SUPPORT CATHETER( 含 4 個不透線標記 ) 西斯艾支持導管 9165 CGPG1CX102CK CXI SUPPORT CATHETER( 含 4 個不透射線標記 ) 西斯艾支持導管 9165 CGPG1SCBR1CK SLIP-CATH GUIDING CATHETERS 4.0FR 40:150CM 2048 CGPG1SCBR2CK SLIP-CATH GUIDING CATHETERS 4.5:6.5FR 75:135CM 2048 CGPG1SCBR3CK SLIP-CATH GUIDING CATHETERS 5.0FR 40:125CM 2048 CGPG1SCBR4CK SLIP-CATH GUIDING CATHETERS 5.0FR 65:90CM 2048 CGPW112201SB STAINLESS STEEL GUIDE WIRE W/PTFE 0.014" 185CM 2870 CGPW112202SB STAINLESS STEEL GUIDE WIRE W/PTFE 0.014" 300CM 3430 CGPW118688TM RUNTHROUGH NS PTCA GUIDE WIRE W/PTFE 不鏽鋼 0.014" 150CM 2870 CGPW1418XATM "TERUMO"RUNTHROUGH PTCA GUIDE WIRE(0.014" 180CM W/COATING)" 泰爾茂 " 嵐鍶路導引導線 2870 CGPW1AHWR3AS CGPW1AHWRSAS "ASAHI"PTCA GUIDE WIRE ASAHI SION 0.014" 300CM(PTFE COATING EXTRA SUPPORT)" 朝日 " 冠狀動脈導引線紫苑 "ASAHI"PTCA GUIDE WIRE ASAHI SION 0.014" 180CM (PTFE COATING EXTRA SUPPORT)"" 朝日 " 冠狀動脈導引線紫苑 3430 3200 CGPW1CMW01CK APPROACH PRO LT MICRO WIRE GUIDE 0.014" 135CM,190CM 3000 CGPW1CMW02CK APPROACH PRO LT MICRO WIRE GUIDE 0.014" 300CM 3000 CGPW1CMW03CK APPROACH PRO LT MICRO WIRE GUIDE 0.018" 135CM;190CM 3000 CGPW1CMW04CK APPROACH PRO LT MICRO WIRE GUIDE 0.018" 300CM 3000 11

CGPW1HMW01CK APPROACH HYDRO ST MICRO WIRE GUIDE W/HYDROPHILIC COATING 親水性塗層微細導線 0.014" 3430 300CM CGPW1HMW02CK APPROACH HYDRO ST MICRO WIRE GUIDE W/HYDROPHILIC COATING 親水性塗層微細導線 0.014" 135,190CM 2870 CGPW1HYBGWM4 " 美敦力 " 艾坦導引導線 "MEDTRONIC" ATTAIN HYBRID GUIDE WIRE 2870 CGPW1PAGH3AS PERIPHERIAL GUIDE WIRE 0.018" 300CM 3000 CGPW1PAGHSAS PERIPHERIAL GUIDE WIRE 0.018" 180CM 2870 CGPW1PAGP3AS PERIPHERIAL GUIDE WIRE 0.014" 300CM 3000 CGPW1PAGPSAS PERIPHERIAL GUIDE WIRE 0.014" 180CM 2870 CGPW1PRGW3AB ABBOTT HI-TORQUE PROGRESS GUIDE WIRE 0.014" 300CM 亞培博格斯血管導線 3430 CGPW1PRGW9AB ABBOTT HI-TORQUE PROGRESS GUIDE WIRE 0.014" 190CM 亞培博格斯血管導線 2870 CGPW1RSTF0CK ROADRUNNER EXTRA-SUPPORT WIRE GUIDES 180,270,300CM 3200 CGS0100412K0 ANGIOGATE HV INTRODUCER KIT 12CM (S+D+GW+3WAY+SI) 650 CGS010512TK0 ANGIOGATE TRANSRADIAL INTRODUCER KIT 12CM (S+D+N+GW+3WAY+SI) 750 CGS010519TK0 ANGIOGATE TRANSRADIAL INTRODUCER KIT 19CM,24CM (S+D+N+GW+3WAY+SI) 1170 CGS0121322ST FAST-CATH HEMOSTASIS INTRODUCER 費思凱絲止血導管導引器 650 CGS0190703M0 "MEDCOMP"CENTRAL VENOUS CATHETERS AND ACCESSORIES(PEELABLE INTRODUCER)(S+D+GW+N)" 美德康 " 中央靜脈導管與配件 ( 剝式導管導引器 ) 1000 CGS01ATTCSM4 " 美敦力 " 艾坦左心室傳送系統 "MEDTRONIC" ATTAIN COMMAND LEFT HEART DELIVERY SYSTEM * 8000 CGS01C4852ST CGS01C485NST CGS01MPS01CK CGS01MPS02CK CGS01MPS03CK "SJM"ENGAGE ENGAGE TR INTRODUCER (FEMORAL)25CM 0.035"0.038"(SH+DIL+VALVE+GUIDE WIRE+SIDEPORT 3WAY)" 聖猷達 " 茵給桔導管導引器 "SJM"ENGAGE ENGAGE TR INTRODUCER (FEMORAL)12CM 0.035"0.038"(SH+DIL+VALVE+GUIDE WIRE+SIDEPORT 3WAY)" 聖猷達 " 茵給桔導管導引器 "COOK"MICROPUNCTURE INTRODUCER SETS(W0.018 NITINOL GUIDE WIRE+4-5FR CATHETER+21G NEEDLE)" 曲克 " 微穿刺引導器組 "COOK"MICROPUNCTURE INTRODUCER SETS(W0.018 NITINOL GUIDE WIRE+4-5FR CATHETER+21G NEEDLE)" 曲克 " 微穿刺引導器組 "COOK"MICROPUNCTURE INTRODUCER SETS(W0.018 NITINOL GUIDE WIRE+4-5FR CATHETER+21G NEEDLE)" 曲克 " 微穿刺引導器組 1040 650 2350 2350 2350 CGS01PA140ST "SJM"PEEL-AWAY INTRODUCERS 14CM 5:16FR(SHEATH+DILATOR)" 聖猷達 " 剝式導管導引器 1000 CGS01PA14NST CGS01PA230ST "SJM"PEEL-AWAY INTRODUCERS 14CM 5:16FR(SHEATH+DILATOR+SYRINGE+NEEDLE+GUIDE WIRE)" 聖猷達 " 剝式導管導引器 "SJM"PEEL-AWAY INTRODUCERS 23CM 7:14FR(SHEATH+DILATOR+SYRINGE+NEEDLE+GUIDE WIRE)" 聖猷達 " 剝式導管導引器 1000 1000 CGS01PA6CMST "SJM"PEEL-AWAY INTRODUCERS 6CM 4;5;6FR(SHEATH+NEEDLE)" 聖猷達 " 剝式導管導引器 1000 CGS01PLD11MR PRELUDE SHEATH INTRODUCER 11CM (W/SHEATH+SIDEPORT+VALVE+DILATOR+G.W) 650 12

CGS01PLD23MR PRELUDE SHEATH INTRODUCER 23CM (W/SHEATH+SIDEPORT+VALVE+DILATOR+G.W) 1040 CGS01PS11GMR PRELUDE SHEATH INTRODUCER 11CM (W/SHEATH+SIDEPORT+VALVE+DILATOR+G.W+NEEDLE) 750 CGS01PS18TMR CGS01PSSMTMR "MERIT"PRELUDE SHORT SHEATH INTRODUCER(DILATOR+MARKER TIP SHEATH+STOPCOCK+0.018"GUIDE WIRE) " 美瑞特 " 福祿動靜脈廔管用導引鞘 "MERIT"PRELUDE SHORT SHEATH INTRODUCER(DILATOR+MARKER TIP SHEATH+STOPCOCK) " 美瑞特 " 福祿動靜脈廔管用導引鞘 CGS01RCFN1CK "COOK"CHECK-FLO PERFORMER INTRODUCER SETS 4.0:9.0 FR. 5.5:13 CM(SHEATH,DILATOR,SIDE+V,RADIOLOGY GW,NEEDLE)" 曲克 " 闕克芙爾引導器組 CGS01RCFN2CK CGS01SEA14ST CGS01TR482ST CGS01TR485ST CGS01TR487ST CGS01TS20NGX "COOK"CHECK-FLO PERFORMER INTRODUCER SETS 4.0:9.0 FR. 23CM(SHEATH,DILATOR,SIDE+V,RADIOLOGY GW,NEEDLE)" 曲克 " 闕克芙爾引導器組 "SJM"PEEL-AWAY INTRODUCERS 14CM 7:12FR(SHEATH+VALVE+DILATOR+SYRINGE+NEEDLE+GUIDE WIRE)" 聖猷達 " 剝式導管導引器 "SJM"ENGAGE ENGAGE TR INTRODUCER(RADIA INTRODUCER)12CM 0.025"(SH+DIL+VALVE GUIDE WIRE+SIDEPORT 3WAY+NEEDLE)" 聖猷達 " 茵給桔導管導引器 "SJM"ENGAGE ENGAGE TR INTRODUCER(RADIA INTRODUCER)25CM 0.025"(SH+DIL+VALVE GUIDE WIRE+SIDEPORT 3WAY+NEEDLE)" 聖猷達 " 茵給桔導管導引器 "SJM"ENGAGE ENGAGE TR INTRODUCER(RADIA INTRODUCER)7CM 0.025"(SH+DIL+VALVE GUIDE WIRE+SIDEPORT 3WAY+NEEDLE)" 聖猷達 " 茵給桔導管導引器 "GORE"INTRODUCER SHEATH WITH SILICONE PINCH VALVE(W/DILATOR)30CM 20:24FR 帶矽膞夾管閥導鞘 1400 1050 950 1350 1000 950 1350 950 910 CGS0311110BQ "BIOTEQ"INTRODUCER SET:DILATOR 4:16FR 5:30CM" 邦特 " 穿刺導入系統組 : 引流用擴張管 185 CHA01AS202ED AORTIC PERFUSION CANNULA 790 CHAT180271A9 " 奧圖 " 旋轉式主動脈打孔器 "ALTO" A/E ROTATING AORTIC PUNCH 918 CHAT1VCANNL5 " 加州 " 血管套管 "CALIFORNIA" VESSEL CANNULAE 135 CHC0110001M4 ADAPTERS 轉接器 ( 結合心肺繞道手術使用 ) 346 CHF06EBSAXTM CHF06EBSVXTM " 泰爾茂 " 人工心肺新式導管套 "TERUMO" CAPIOX EBS CANNULA KIT WITH X COATING(ARTERIAL CANNULATION KIT W/INTRODUCER)* " 泰爾茂 " 人工心肺新式導管套 "TERUMO" CAPIOX EBS CANNULA KIT WITH X COATING(VENOUS CANNULATION KIT W/INTRODUCER)* 18241 18241 CHF06ELS88QM ELS CANNULA 雙腔靜脈引流灌注導管 ( 含 PU 導管 + 血管擴張器 + 導線 + 穿刺針 ) 18241 CHG02SGK14QM RETROGRADE CARDIOPLEGIA CANNULA 3184 CHH01EE061ED "EDWARDS"LEFT VENTRICULAR VENT CATHETER 左心室用導管 568 CHH01PE062ED LEFT VENTRICULAR VENT CATHETER 685 CHR01CA16VQM ANTEGRADE CARDIOPLEGIA CANNULAE W/VENT 順行性心臟麻醉導管 635 CHR01CAS16QM ANTEGRADE CARDIOPLEGIA CANNULAE 順行性心臟麻醉導管 410 CHT01CHX30QM CHT01P0201QM PLEGIOX CARDIOPLEGIA HEAT EXCHANGER( 含 DIA-CONN,PVC-75SH,PUMP CONN,SILICONE,PVC- 70SH,Y-CONN,ONE WAY VALVE,DIA-CONN/BL) BLOOD CARDIOPLEGIA SET W/PLEGIOX 具自動熱交換功能 ( 含 DIA-CONN,PVC-75SH,PUMP CONN,SILICONE,PVC-70SH,Y-CONN,ONE WAY VALVE,DIA-CONN/BL) 3173 3462 13

CHT01VBC4CGH VISION BLOOD CARDIOPLEGIA(BLOOD MIXING+CONDUCER+COIL TUBING+MP4) 具熱交換功能 3173 CKD01US101CK "COOK"UNIVERSA FIRM AND SOFT URETERAL STENT SET( 雙 JSTENT+GUIDE WIRE+PUSHER)" 曲克 " 由尼維莎結實型和柔軟型輸尿管內置支架組 CKD01US102CK "COOK"UNIVERSA FIRM AND SOFT URETERAL STENT SET( 雙 JSTENT+GUIDE WIRE+PUSHER)" 曲克 " 由尼維莎結實型和柔軟型輸尿管內置支架組 1570 1570 CKD0300951CK CKD0300952CK CKDD122334BQ "COOK"DOUBLE PIGTAIL STENT SET(URETERAL STENT/(SILICONE POLYURETHANE)+GUIDE WIRE+PUSHER) 雙豬尾型輸尿管內置導管組 4.7-8FR 22-32CM "COOK"DOUBLE PIGTAIL STENT SET(URETERAL STENT/(SILICONE POLYURETHANE)+GUIDE WIRE+PUSHER) 雙豬尾型輸尿管內置導管組 4.7-8FR 12-30CM "BIOTEQ"HEMODIALYSIS CATHETER KIT(2 LUMEN CATHETER+NEEDLE+GUIDE WIRE+DILATOR) 血液透析導管組 1570 1570 1392 CKDD124334BQ "BIOTEQ"2 LUMEN HEMODIALYSIS CATHETER KIT(C+N+G+D) 血液透析導管組 1392 CKDD2SL12PM0 CKDD323334BQ "MEDCOMP"SILICONE DOUBLE LUMEN CATHETERS AND ACCESSORIES(CATHETER+NEEDLE+GUIDE WIRE+DILATOR)" 美德康 " 矽質血液透析導管與配件 "BIOTEQ"HEMODIALYSIS CATHETER KIT(3 LUMEN CATHETER+NEEDLE+GUIDE WIRE+DILATOR) 血液透析導管組 CKN0111245BQ "BIOTEQ"DRAINAGE CATHETERAND INTRODUCER SET/KIT(C+N+G+D+ 引流管袋 + 固定貼布 ) 導管 5-16FR 20-50CM CKN0113113BQ "BIOTEQ"DRAINAGE CATHETER&INTRODUCER SET/KIT(HYDROPHILIC)5-16FR 20-50CM(NEEDLE+GUIDE WIRE+DILATOR+ 引流管袋 + 固定貼布 ) 引流導管及穿刺導入系統 3509 1738 2975 2975 CLPA13007NYP "PEROUSE'POLYSITE IMPLANTABLE PORT(P+C+N+I) 全套式植入式血管輸注器 * 10370 CLPA145213NL "NAVILYST"VAXCEL IMPLANTABLE PORTS/W PASV TECHNOLOGY (1 LUMEN)(P+C+N+I)* 10370 CLPA145455NL CLPA145458NL CLPA145470NL CLPA145478NL CLPA166041M0 CLPA166801M0 VAXCEL PERIPHERALLY INSERTED CENTRAL CATHETER(PICC)(1 LUMEN)/W PASV VALVE TECHNOLOGY 週邊導入中央靜脈導管 * 適應症見備註 "NAVILYST"VAXCEL PERIPHERALLY INSERTED CENTRAL CATHE(PICC)W PASV VALVE TECHNOLOGY(1 LUMEN)(C+N+D+G) 週邊導入中央靜脈導管 * 適應症見備註 VAXCEL PERIPHERALLY INSERTED CENTRAL CATHETER(PICC)(2 LUMEN)/W PASV VALVE TECHNOLOGY 週邊導入中央靜脈導管 * 適應症見備註 "NAVILYST"VAXCEL PERIPHERALLY INSERTED CENTRAL CATHE(PICC)W PASV VALVE TECHNOLOGY(2 LUMEN)(C+N+D+G) 週邊導入中央靜脈導管 * 適應症見備註 "MEDCOMP"LOW PROFILE SHAPED CT PORTS AND ACCESSORIES(P+C+N+I) 薄型植入式輸液座與導管組 * "MEDCOMP"MID-SIZE SHAPED CT PORTS AND ACCESSORIES(P+C+N+I) 中型植入式輸液座與導管組 * 2960 3050 3000 3500 10370 10370 CLPA196001M0 "MEDCOMP"PRO-FUSE AND ACCESSORIES(P+C+N+I) 普羅福斯植入式輸液座與導管組 * 10370 CLPA1V1TA1CK "COOK"VITAL-PORT VASCULAR ACCESS SYSTEM 注射口組 (P+C+N+I) 10370 CLPA202701WY CLPA202702WY ACCUFUSER DISPOSABLE SILICONE BALLOON INFUSER-CONTI TYPE(275ML-10ML/HR)(550ML- 20ML/HR) 輸液器 - 連續型 (1 日型 ))( 雙層含外殼 )* ACCUFUSER DISPOSABLE SILICONE BALLOON INFUSER-CONTI TYPE(275ML-5.0ML/HR)(550ML- 10.0ML/HR) 輸液器 - 連續型 (2 日型 )( 雙層含外殼 )* 適應症見備註欄 1000 1100 CLPA205240W9 ACCUFLO ELASTOMERIC INFUSION DEVICE 安可復攜帶式微量輸液器 (2 日型 )( 雙層含外殼 )* 1100 CLPA21009KBT 2 日型 INFUSOR 輸液器 ( 雙層含外殼 ) 1100 CLPA210240W9 ACCUFLO ELASTOMERIC INFUSION DEVICE 安可復攜帶式微量輸液器 (1 日型 )( 雙層含外殼 )* 1000 14

特材代碼中英文品名支付點數 CLPA21063KBT 1 日型 INFUSOR 輸液器 ( 雙層含外殼 ) 1000 CLS05130PUSG "SIGMA"INFUSION PUMP SET 幫浦輸液套 * 180 CLS06080PUSG "SIGMA"INFUSION PUMP SET WITH BURETTE 幫浦輸液套 * 237 CLS06120PUSG "SIGMA"INFUSION PUMP SET LIGHT-RESISTANT 幫浦輸液套 ( 不透光型 ) 220 CLS06V9607BT "BAXTER"LIGHT SENSITIVE DRUGS SET 避光靜脈輸液管組 220 CLS08140PUSG "SIGMA"INFUSION PUMP SET BLOOD FILTER 幫浦輸血輸液套 230 CLS08150PUSG "SIGMA"INFUSION PUMP SET Y-SITE BLOOD FILTER Y 型幫浦輸血輸液套 230 CMV01MFNT2CK "COOK"MIRAFLEX MICROCATHETER 2.5FR 100:150CM 麥拉菲微導管 * 7440 CMV020F150QM AXIUS CORONARY SHUNT* 2771 CMV0210042SB "BOSTON SCIENTIFIC"GUIDER SOFTIP XF GUIDING CATHETER* 6923 CMV02C5015S7 "SYNOVIS"FLO-RESTER VESSEL OCCLUDERS 血管閉塞器 2591 CMV02GNDRAVS "VASCULAR SOLUTIONS"GANDRAS INTRAVASCULAR CATHETER(INFUSION)" 法斯樂舒順 " 恩德拉血管內導管 * 7440 CMV02KSAW6CK "COOK"FLEXOR GUIDING CATHETERS5-8FR 55:110MM 服來瑟引導導管 * 6923 CMV02MC172MS "MICROVENTION"HEADWAY MICROCATHETER 前進微導管 * 7440 CMV02PNS13UF "PENUMBRA"NEURON INTRACRANIAL ACCESS SYSTEM-SELECT CATHETER 顱內導入系統導管 * 7440 CMV03S0RXXBL "BALT"SORCERER GUIDEWIRE 魔術師導線 * 4650 CMV03XCEGWV9 CMV04C0SM0MS CMV04H2HSVMS "MTI"X-CELERATOR GUIDEWIRE 0.010",0.014"300CM " 恩提愛 " 愛克西亞導引線 ( 親水性導引線 + 扭轉器 + 導入線導入鞘 ) "MICROVENTION"MICROPLEX COIL SYSTEM COSMOS COMPLEX COILS(10,18 SYSTEM)" 麥新 " 微導線圈栓塞系統 * "MICROVENTION"HYDROCOIL(HYDROSOFT HELICAL) EMBOLIC SYSTEM(10 COIL SIZE)1.5MM:10MM 2CM:30CM 親水性線圈栓塞系統 * 4650 17119 19085 CMV04NEST2CK "COOK"NESTER EMBOLIZATION COILS(PLATINUM)" 曲克 " 奈斯特彈簧栓塞 * 3122 CMV070NYXXV9 "MTI"ONYX LIQUID EMBOLIC SYSTEM 歐尼斯液態栓塞系統 71000 CMV0755055V9 "MTI"MARATHON FLOW DIRECTED MICRO CATHETERS 梅洛森微導管 12550 CPC0101406M0 SINGLE LUMEN INFUSION CATHETER SET(C+D+GW+N) 520 CPC0102005M0 SINGLE LUMEN INFUSION CATHETER SET 20G;24G(C+D+GW+N) 740 CPC01ECL11BB CERTOFIX CENTRAL VENOUS CATHETER (1 LUMEN)(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE) 舒鈦單腔中心靜脈導管組 CPC01PED01BB CERTOFIX CENTRAL VENOUS CATHETER(PEDIATRIC 1 LUMEN)(CATHETER+GUIDEWIRE+NEEDLE+SCALPEL+3 WAY) 舒鈦單腔小兒用中心靜脈導管組 520 740 15

CPC01PTT11BB CERTOFIX CENTRAL VENOUS CATHETER(PROTECT 1 LUMEN) 560 (CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE) 舒鈦抗感染單腔中心靜脈導管組 CPC01STD11BB CERTOFIX CENTRAL VENOUS CATHETER(1 LUMEN)(CATHETER+DILATOR+GUIDEWIRE +NEEDLE+SYRINGE) 舒鈦單腔中心靜脈導管組 520 CPC022L715M0 DOUBLE LUMEN INFUSION CATHETER SET (C+D+GW+N+SY) 1500 CPC022LP35M0 DOUBLE LUMEN INFUSION CATHETER SET 4FR,5FR(C+D+GW+N+SY) 1700 CPC02ECL12BB CERTOFIX CENTRAL VENOUS CATHETER (2 LUMEN) (CATHETER+DILATOR+GUIDEWIRE+NEEDLE+ SYRINGE) 舒鈦雙腔中心靜脈導管組 1500 CPC02PED02BB CERTOFIX CENTRAL VENOUS CATHETER (PEDIATRIC 2 LUMEN)(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE) 舒鈦雙腔小兒用中心靜脈導管組 1700 CPC02PEUD1CK SPECTRUM AND SPECTRUM PEDIATRIC 2 LUMEN CVP CATHETER 4.0~5.0FR(C+N+D+G+S) 1835 CPC02PTT12BB CERTOFIX CENTRAL VENOUS CATHETER (PROTECT 2 LUMEN) (CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE) 舒鈦抗感染雙腔中心靜脈導管組 1620 CPC02SDLM1CK SPECTRUM PEDIATRIC 2 LUMEN CVP CATHETER 4.0FR(C+N+D+G+S) 1835 CPC02STD12BB CERTOFIX CENTRAL VENOUS CATHETER(2 LUMEN)(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE) 舒鈦雙腔中心靜脈導管組 1500 CPC02UDLM2CK SPECTRUM AND SPECTRUM 2 LUMEN CVP CATHETER 7.5-8.0FR(C+N+D+G+S) 1620 CPC02UDLM3CK 2 LUMEN SPECTRUM CENTERAL VENOUS CATHETER 抗感染導管 1620 CPC033L715M0 TRIPLE LUMEN INFUSION CATHETER SET (C+D+GW+N+SY) 1800 CPC033LP58M0 TRIPLE LUMEN INFUSION CATHETER SET 5.5FR(C+D+GW+N+SY) 2050 CPC03ECL13BB CERTOFIX CENTRAL VENOUS CATHETER (3 LUMEN) (CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE) 舒鈦三腔中心靜脈導管組 1800 CPC03PED03BB CERTOFIX CENTRAL VENOUS CATHETER (PEDIATRIC 3 LUMEN)(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE) 舒鈦三腔小兒用中心靜脈導管組 2050 CPC03PTT13BB CPC03STD13BB CERTOFIX CENTRAL VENOUS CATHETER(PROTECT 3 LUMEN) (CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE) 舒鈦抗感染三腔中心靜脈導管組 CERTOFIX CENTRAL VENOUS CATHETER(3 LUMEN)(CATHETER+DILATOR+GUIDEWIRE+NEEDLE+SYRINGE) 舒鈦三腔中心靜脈導管組 1950 1800 CPC03UTLM1CK SPECTRUM AND SPECTRUM 3 LUMEN CVP CATHETER 7.0-9.0FR(C+N+D+G+S) 1950 CPC03UTLM3CK 3 LUMEN SPECTRUM CENTERAL VENOUS CATHETER 抗感染導管 1950 CPC03UTPEDCK SPECTRUM AND SPECTRUM PEDIATRIC 3 LUMEN CVP CATHETER 5FR(C+N+D+G+S) 2200 CPC09X3820ED PRESEP OXIMETRY CATHETER 3LUMEN (PROBE+3 LUMEN CVP KIT(CATHETER+DILATOR+GUIDE WIRE+NEEDLE+SYRINGE) 裴瑟週邊血氧濃度導管 7300 CPM0352026BB COMBITRANS MONITORING SETS(FD+TR+3WAYX2+TUBING) 康比得壓力監測組 650 CPM0352036BB COMBITRANS MONITORING SETS: DISPOSABLE TRANSDUCER 康比得壓力監測組 : 壓力轉換器 554 CPM03PX12NED "EDWARDS"TRUWAVE NEONATAL PEDIATRIC DISPOSABLE PRESSURE TRANSDUCER (1 TR) ( TR+FD+TUBING+3WAYX2)" 愛德華 " 凸威壓力傳導器 :1TR 小兒 CPM03PX1X0ED "EDWARDS"TRUWAVE DISPOSABLE PRESSURE TRANSDUCER (1 TR 2WAY) 2X( TR+FD+TUBING+3WAYX2)" 愛德華 " 凸威壓力傳導器 :1TR 2WAY 734 930 16

CPM03PX260ED "EDWARDS"TRUWAVE DISPOSABLE PRESSURE TRANSDUCER (1 DOME)( TR+FD+TUBING+3WAY)" 650 愛德華 " 凸威壓力傳導器 :1TR CPM03PX2X2ED "EDWARDS"TRUWAVE DISPOSABLE PRESSURE TRANSDUCER (2 TR) 2X( TR+FD+TUBING+3WAY)" 愛德華 " 凸威壓力傳導器 :2TR 1050 CPM03PX3X7ED "EDWARDS"TRUWAVE DISPOSABLE PRESSURE TRANSDUCER (3 TR) 3X( TR+FD+TUBING+3WAYX2)" 愛德華 " 凸威壓力傳導器 :3TR 1300 CPM03PX604ED CRE04C0060UW CRE06C0040UW CRT0253065VK "EDWARDS"TRUWAVE DISPOSABLE PRESSURE TRANSDUCER(FLUSH DEVICE X1+ STOPCOCK 1)" 愛德華 " 凸威壓力傳導器 :1TR " 巫諾 " 氣管內管 "UNOMEDICAL" ENDOTRACHEAL TUBES( 鼻彎低壓氣囊 ) * 處置使用可申報, 手術使用不另給付 " 巫諾 " 氣管內管 "UNOMEDICAL" ENDOTRACHEAL TUBES( 口彎低壓氣囊 ) * 處置使用可申報, 手術使用不另給付 " 旭邦 " 柔得多標準型氣切管 ( 一次使用型 )"VITALTEC" ROTA-TRACH STANDARD TRACHEOSTOMY TUBE 554 245 227 332 CRT02C0065MU 華新氣切套管 MODERN TRACHEOSTOMY TUBE 332 CRT02U0065MU 華新氣切套管 MODERN TRACHEOSTOMY TUBE 332 CRT10PTS01CK CRT10PTS02CK 曲克藍犀牛氣管引導器組 COOK CIAGLIA BLUE RHINO PERCUTANEOUS TRACHEOSTOMY INTRODUCER SET* 曲克藍犀牛氣管引導器組 COOK CIAGLIA BLUE RHINO PERCUTANEOUS TRACHEOSTOMY INTRODUCER SET* 4500 4500 CVC01AMK4JK0 CARDIAC CATHETER(AMPLATZ)4-6FR 100CM 700 CVC01CAPGTMR ANGIOGRAPHIC CATHETERS PIGTAIL CATHETER 700 CVC01JKK4JK0 CARDIAC CATHETER(JUDKINS)4-6FR 100CM 700 CVC01MLK4JK0 CARDIAC CATHETER(MULTIPURPOSE)4-6FR 100CM 700 CVC01P1K4JK0 CARDIAC CATHETER(PIGTAIL)4-6FR 110-130CM 700 CVC01RAK4JK0 CARDIAC CATHETER(INTERNAL MAMMARY, CORONARY BYPASS, RADIAL)4-6FR 100CM 700 CVC01RH001TM TERUMO RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 泰爾茂歐帝克血管攝影導管 700 CVC01RH002TM TERUMO RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 泰爾茂歐帝克血管攝影導管 700 CXE01SDECAST 聖猷達史普力米生理電極導管 SJM SUPREME ELECTROPHYSIOLOGY CATHETER 十極 11080 CXE01SQUADST 聖猷達史普力米生理電極導管 SJM SUPREME ELECTROPHYSIOLOGY CATHETER - 四極 8090 CXE0281504YB " 爾灣 " 電生理診斷導管 "IBI" ELECTROPHYSIOLOGY DIAGNOSTIC CATHETER( 十極 ) 16370 CXE028478NYB " 爾灣 " 電生理診斷導管 "IBI" ELECTROPHYSIOLOGY DIAGNOSTIC CATHETER-QUADRIPOLAR STEERABLE 5F 14090 CXE02848STYB " 爾灣 " 電生理診斷導管 "IBI" ELECTROPHYSIOLOGY DIAGNOSTIC CATHETER( 四極 ) 14090 CXE02849STYB " 爾灣 " 電生理診斷導管 "IBI" ELECTROPHYSIOLOGY DIAGNOSTIC CATHETER( 四極 ) 14090 CXE02D4028ST " 聖猷達 " 可控式螺旋頭導管 "SJM" REFLEXION SPIRAL VARIABLE RADIUS CATHETER 16370 17

CXE02LVW04ST 聖猷達可控式生理電極導管 SJM LIVEWIRE STEERABLE ELECTROPHYSIOLOGY CATHETER- 14090 4 極 CXE02LVW10ST 聖猷達可控式生理電極導管 SJM LIVEWIRE STEERABLE ELECTROPHYSIOLOGY CATHETER- 10 極 16370 CXE033100TBA " 巴德 " 天蠍電燒電極導管 "BARD" SCORPION ABLATION CATHETER 24285 CXE03ASU23FW " 艾科 " 電刀設備及其附件 "ATRICURE" ABLATION AND SENSING UNIT AND ACCESSORIES* 40854 CXE03BD74LWE CXE03BD78LWE 百歐森偉伯斯特易擊史遞兒雙向可彎式診斷 / 電燒導管 BIOSENSE WEBSTER EZ STEER BI- DIRECTIONAL DIAGNOSTIC/ABLATION DEFLECTABLE TIP CATHETER 百歐森偉伯斯特易擊史遞兒雙向可彎式診斷 / 電燒導管 BIOSENSE WEBSTER EZ STEER DS BI- DIRECTIONAL DIAGNOSTIC/ABLATION DEFLECTABLE TIP CATHETER 24285 24285 CXE03SAFFRST " 聖猷達 " 雙向電燒導管 "SJM" SAFIRE BI-DIRECTIONAL ABLATION CATHETER 24285 CXE04EACECST " 聖猷達 " 恩賽導管 "SJM" ENSITE ARRAY CATHETER* 53000 CXE05NN75TWE 藍星攝氏灌注冷卻式溫控電生理導管 BIOSENSE WEBSTER NAVI-STAR/CELCIUS THERMOCOOL DIAGNOSTIC/ABLATION DEFLECTABLE TIP CATHETER 適應症見備註欄 78000 CXE05TCPACYB " 爾灣 " 瑟爾皮庫爾帕斯心臟電燒導管 "IBI" THERAPY COOL PATH ABLATION CATHETER* 78000 FALSMHBEC11B FALSNMULT2A1 FALSNMULT3A2 FALSNT0RC2A1 FALSNT0RCARY FALSNWAVE1HY OII HYDROPHOBIC ACRYLIC POSTERIOR CHAMBER INTRAOCULAR LENS W/U.V. ABSORBER 艾絲抗紫外線疏水性丙烯酸脂後房人工水晶體 ACRYSOF IQ RESTOR MULTI FOCAL INTRAOCULAR LENS 可舒銳視妥智慧型非球面多焦點軟式人工水晶體 ( 可濾部分藍光 ), 部分給付品項, 差額由病患自付 TECNIS MULTIFOCAL IOL 多焦點人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 ACRYSOF IQ TORIC SINGLE PIECE NATURAL IOL 散光矯正軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 "RAYNER"T-FLEX ASPHERIC HYDROPHILIC INTRAOCULAR LENSES" 銳能 " 散光非球面人工晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 "HOYA"HOYA-PS AF-I(UY)INTRAOCULAR LENS" 豪雅 " 植入器預載式人工水晶體非球面過瀘藍光人工水晶體, 超過部分由病患自付 2843 2843 2843 2843 2843 2843 FAV01VA10CLB "MBI"VISCAID OPHTHALMIC VISCOELASTIC(1.0CC)" 和康 " 維視愛眼科黏彈劑 2204 FBA0131280DP CRANIOPLASTIC (POWDER 30G+LIQUID 16.17G/20 分鐘 ) 頭顱整形泥 8000 FBA0217XXNLV TITANIUM STAPLIZER POWERED METAPHYSEAL STAPLE 546 FBA0228607SN KRACKOW HTO BLADE STAPLES ( 鈷鉻鉬 ) 3190 FBA0228673SN OSTEOTOMY FIXATION STAPLES( 鈷鉻鉬 ) 1750 FBA0228690SN REGULAR FIXATION STAPLES( 鈷鉻鉬 ) 978 FBA0228698SN TABLE FIXATION STAPLES( 鈷鉻鉬 ) 2153 FBA022869NSN BONE STAPLE( ㄇ型 )( 鈷鉻鉬 ) 978 FBA0228720SN SHORT LEG FIXATION STAPLES( 鈷鉻鉬 ) 978 FBA022872NSN BONE STAPLE IRREGULAR/SHORT FIXATION STAPLE( ㄇ型 )( 鈷鉻鉬 ) 978 18

FBA040CB01FQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE STICK 5X5X20MM(2CM3) 人工骨替代物 * 4179 FBA040CB02FQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE STICK 5X5X10MM(2CM3) 人工骨替代物 * 4179 FBA040CG01FQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE GRANULE 2-3MM(5CM3) 人工骨替代物 * 5467 FBA040CG02FQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE GRANULE 1-2MM(5CM3) 人工骨替代物 * 5467 FBA040CG03FQ NANO OSTEOCERA BONE GRAFT SUBSTITUTE GRANULE 0.5-1MM(5CM3) 人工骨替代物 * 5467 FBA04AG01RF8 FBA04AG03RF8 FBA04AG05RF8 FBA04AG10RF8 FBA04AG15RF8 FBA04AG20RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER)1ML" 台塑生醫 " 人工代用骨 ( 再吸收骨填充物 )* "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER) 3 ML 人工代用骨 ( 再吸收骨填充物 )* "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER) 5 ML 人工代用骨 ( 再吸收骨填充物 )* "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER)10ML" 台塑生醫 " 人工代用骨 ( 再吸收骨填充物 )* "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER)15ML" 台塑生醫 " 人工代用骨 ( 再吸收骨填充物 )* "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER)20ML" 台塑生醫 " 人工代用骨 ( 再吸收骨填充物 )* 2565 4179 5467 8791 10525 12062 FBA04BCB01FQ NANO BICERA BONE GRAFT SUBSTITUTE GRANULE 5X5X20MM(2 CM3) 人工骨替代物 * 4179 FBA04BCB02FQ NANO BICERA BONE GRAFT SUBSTITUTE GRANULE 5X5X10MM(2 CM3) 人工骨替代物 * 4179 FBA04BCG01FQ NANO BICERA BONE GRAFT SUBSTITUTE GRANULE2-3MM(5.0 CM3) 人工骨替代物 * 5467 FBA04BCG02FQ NANO BICERA BONE GRAFT SUBSTITUTE GRANULE 1-2MM(5.0 CM3) 人工骨替代物 * 5467 FBA04BCG03FQ NANO BICERA BONE GRAFT SUBSTITUTE GRANULE 0.5-1MM(5.0 CM3) 人工骨替代物 * 5467 FBA04CA01RF8 FBA04CA03RF8 FBA04CA05RF8 FBA04CA10RF8 FBA04CA15RF8 FBA04CA20RF8 "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER)1ML" 台塑生醫 " 人工代用骨 ( 再吸收骨填充物 )* "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER) 3 ML 人工代用骨 ( 再吸收骨填充物 )* "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER) 5 ML 人工代用骨 ( 再吸收骨填充物 )* "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER) 10 ML 人工代用骨 ( 再吸收骨填充物 )* "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER) 15 ML 人工代用骨 ( 再吸收骨填充物 )* "FORMOSA"BONE GRAFT-CALTRIX(RESORBABLE BONE VOID FILLER) 20 ML 人工代用骨 ( 再吸收骨填充物 )* 2565 4179 5467 8791 10525 12062 FBA04PB005YG OSTEO-G BONE VOID FILLER DEVICE 5G 奧斯吉骨填充裝置 * 適應症請件備註欄 5467 FBA04PB103YG OSTEO-G BONE VOID FILLER DEVICE 3 CC 奧斯吉骨填充裝置 * 適應症請件備註欄 4179 FBA04PB106YG OSTEO-G BONE VOID FILLER DEVICE 6 CC 奧斯吉骨填充裝置 * 適應症請件備註欄 5467 FBD005970NS9 OMEGA3 HIP PLATE CHS SYSTEM 歐米加三固定系統 (PLATEX1+LAG SCREW+COMP SCREW) 8497 19

FBD005973NS9 OMEGA3 HIP PLATE SYSTEM 歐米加三固定系統 (PLATEX1+LAG SCREW+COMP SCREW) 8500 FBEFP02101SN ILIZAROV WIRE 1.5MM 475 FBEFP02102SN ILIZAROV WIRE 1.8MM 475 FBEFP02106SN ILIZAROV WIRE 1.5MM (WITH STOPPER) 1337 FBEFP02107SN ILIZAROV WIRE 1.8MM(WITH STOPPER) 1337 FBEFP24831SN HALF PIN 4MM 615 FBEFP248XNSN SKELETAL TRACTION FULL PIN ALL SIZE (COVE POINT PIN) 1191 FBHB11503NU0 "UNITED"HIP SYSTEM-U2 BIPOLAR IMPLANT:CUP+LINER " 聯合 " 雙極半髖人工髖關節 : 髖臼杯 + 內襯 11152 FBHBA3000NU0 "UNITED"HIP SYSTEM-U2 BIPOLAR IMPLANT " 聯合 " 雙極半髖人工髖關節 38177 FBHC14930NH1 ACETABULAUM CUP 11152 FBHH16260NS2 HA FEMORAL HEAD 4696 FBHHC6565NH1 FBHHCCERA2W2 CERAMIC HEAD 凡只更換股骨頭者, 如自願選用陶瓷股骨頭時, 則按傳統股骨頭給付, 超過部分由病患自付 "WRIGHT"DYNASTY ACETABULAR CUP SYSTEM:CERAMIC HEAD 陶瓷股骨頭凡只更換股骨頭者, 則按傳統股骨頭給付, 超過部份由病患自付 4696 4696 FBHL1PNNPEDP "DEPUY" PINNACLE ACETABULAR SYSTEM " 帝富 " 可耐髖人工髖臼杯系統 4336 FBHLC4936NH1 CERAMIC INSERT 凡只更換髖臼杯內襯者, 如自願選用陶瓷髖臼杯內襯時, 則按傳統髖臼杯內襯給付, 超過部分由病患自付 4336 FBHPA2000NS2 TOTAL HIP SYSTEM(STEM+CUP+INSERT+HEAD) 42513 FBHPA4845NH1 ABG TOTAL HIP SYSTEM (STEM+CUP+HEAD+INSERT) 愛必吉全人工髖關節組 42513 FBHPC4845NH1 ABG CERAMIC TOTAL HIP SYSTEM 凡符合傳統人工髖關節組之適應症者, 如自願選用陶瓷人工髖關節組時, 按傳統人工髖關節組給付, 超過部分由病患自付 42513 FBHRA5000TZ1 CPT REVISION HIP SYSTEM(CUP+LINER+HEAD+STEM) 捷奔特髖關節組 55313 FBHS14845NH1 ABG TOTAL HIP SYSTEM:STEM 股骨柄 22329 FBHS1PRFMNW2 PROFEMUR HIP SYSTEM:FEMORAL STEM ( 含 NECK) 22329 FBHS38114NZ1 CPT REVISION HIP SYSTEM:STEM 捷奔特髖關節系統 ( 股骨柄 ) 35129 FBKA22600NU0 FEMORAL AUGMENT SET( 後端遠側 - 整塊 ) 6510 FBKA22603NU0 FEMORAL AUGMENT SET 3006 FBKA22803NU0 TIBIAL AUGMENT SET 3006 FBKE22700NU0 CURVED EXTENSION STEM 5710 20

FBKF11890NW2 "WRIGHT"ADVANCE TOTAL KNEE SYSTEM FEMORAL " 瑞德 " 艾德凡斯人工膝關節系統 : 股骨 19367 FBKF22103NU0 FEMORAL COMPONENT PSA TYPE 19367 FBKF26000NS2 FEMORAL COMPONENT 19367 FBKL10460NDP PFC INSERT 8309 FBKL13000NW2 "WRIGHT"ADVANCE TOTAL KNEE SYSTEM:INSERT(DOUBLE HIGH)" 瑞德 " 艾德凡斯人工膝關節系統 : 脛骨襯墊 13953 FBKL19602NDP PFC E CURCIATE RETAINING TIBIAL INSERT 8309 FBKL22303NU0 TIBIAL INSERT PSA TYPE 25559 FBKP10417NDP PFC PATELLA 6344 FBKPA3000NW2 "WRIGHT"ADVANCE TOTAL KNEE SYSTEM(DOUBLE HIGH) " 瑞德 " 艾德凡斯人工膝關節系統高彎曲度 54597 FBKRA1100NU0 U2 REVISION TOTAL KNEE SYSTEM(FEMORAL+TIBIAL+INSERT+PATELLA) 66203 FBKRA6000NS2 SCORPIO TOTAL KNEE REVISION SYSTEM 66203 FBKS12703NU0 EXTENSION STRAIGHT STEM PSA TYPE 5710 FBKT10411NDP PFC TIBIAL(PRIMARY 或 REVISION) 14933 FBKT22203NU0 TIBIAL BASEPLATE PSA TYPE 14933 FBKT26000NS2 TIBIAL TRAY 14933 FBM01203XNSN MOORE PROSTHESES 8493 FBN04403SSY2 STAINLESS INTERLOCKING SCREW 骨髓內固定螺絲 1350 FBN04403STY2 TITANIUM KING BO INTERLOCKING SCREW 鈦合金骨髓內固定螺絲 1458 FBN05403FSY2 STAINLESS FEMUR INTERLOCKING NAIL(NAILX1+SCREWX3) 股骨髓內釘組 9472 FBN05403FTY2 TITANIUM KING BO FEMUR INTERLOCKING NAIL SYSTEM(NAILX1+LOCKING BOLTX3) 鈦合金股骨髓內釘組 10229 FBN05403HSY2 STAINLESS HUMERAL INTERLOCKING NAIL(NAILX1+SCREWX3) 肱骨髓內釘組 9472 FBN05403HTY2 TITANIUM KING BO HUMERAL INTERLOCKING NAIL SYSTEM(NAILX1+LOCKING BOLTX3) 10229 FBN05403TSY2 STAINLESS TIBIA INTERLOCKING NAIL(NAILX1+SCREWX3) 脛骨髓內釘組 9472 FBN05403TTY2 TITANIUM TIBIA INTERLOCKING NAIL SYSTEM(NAILX1+LOCKING BOLTX3) 脛骨髓內釘組 10229 FBNG13120NS9 GAMMMA3 TI SYSTEM 鈦合金股骨固定系統 (NX1+SX3) 19440 FBNG1403GSY2 STAINLESS GAMMA INTERLOCKING NAIL SYSTEM (NAILX1+LOCKINGX3) 伽瑪釘單孔 ( 骨髓內釘組 ) 18000 21

FBNG1403GTY2 TITANIUM KING BO GAMMA LOCKING NAIL SYSTEM(NAILX1+LOCKING BOLTX3) 19440 FBPS1006XNXH W/D PROSTHESIS 健保給付腕關節離斷義肢 42000 FBPS1007XNXH E/D PROSTHESIS 健保給付肘關節離斷義肢 62000 FBPS1008XNXH A/E PROSTHESIS 健保給付肘關節以上截肢義肢 65000 FBPS1009XNXH B/E PROSTHESIS 健保給付肘下功能性義肢 42000 FBPS1010XNXH S/D PROSTHESIS 健保給付功能性肩關節離斷義肢 65000 FBPS1011XNXH FOREQUATER PROSTHESIS 健保給付肩胛截除義肢 65000 FBPS1012XNXH A/E COSMETIC PROSTHESIS 健保給付美觀性肘關節以上截肢義肢 23000 FBPS1013XNXH B/E COSMETIC PROSTHESIS 健保給付肘關節以下美觀義肢 14000 FBPS1014XNXH S/D COSMETIC PROSTHESIS 健保給付美觀性肩關節離斷義肢 32300 FBPS1015XNXH TRANS-CARPAL COSMETIC PROSTHESIS 健保給付橫掌截肢義肢 7300 FBPS1016XNXH PARTIAL FINGER COSMETIC PROSTHESIS 健保給付手指截肢義肢 4800 FBPS2006XNXH FBPS2007XNXH FBPS2008XNXH W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. A/E PROSTHESIS 部分給付肘關節以上截肢義肢, 按健保給付之肘關節以上截肢義肢給付, 超過部分由病患自付. 42000 62000 65000 FBPS2009XNXH B/E PROSTHESIS 部分給付肘下功能性義肢, 按健保給付之肘下功能性義肢給付, 超過部分由病患自付. 42000 FBPS2010XNXH FBPS2011XNXH FBPS2012XNXH S/D PROSTHESIS 部分給付功能性肩關節離斷義肢, 按健保給付之功能性肩關節離斷義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付美觀性肘關節以上截肢義肢, 按健保給付之美觀性肘關節以上截肢義肢給付, 超過部分由病患自付. FBPS2013XNXH B/E COSMETIC PROSTHESIS 部分給付肘關節以下美觀義肢, 按健保給付之肘關節以下美觀義肢給付, 超過部分由病患自付. FBPS2014XNXH S/D COSMETIC PROSTHESIS 部分給付美觀性肩關節離斷義肢, 按健保給付之美觀性肩關節離斷義肢給付, 超過部分由病患自付 FBPS2015XNXH TRANS-CARPAL COSMETIC PROSTHESIS 部分給付橫掌截肢義肢, 按健保給付之橫掌截肢義肢給付, 超過部分由病患自付. FBPS2016XNXH PARTIAL FINGER COSMETIC PROSTHESIS 部分給付手指截肢義肢, 按健保給付之手指截肢義肢給付, 超過部分由病患自付. 65000 65000 23000 14000 32300 7300 4800 FBS0421654SN CANNULATED HIP PIN SYSTEM(STAINLESS STEEL) 2000 FBS0421810SN CANNULATED SCREW(STAINLESS STEEL) 2000 FBS0461040SN CANNULATED SCREW(TITANIUM) 2160 22

FBS082870BKL MEGAFIX BIOABSORBABLE INTERFERENCE SCREW 可吸收性韌帶螺釘限用於十字韌帶重建手術 5000 者 FBS082870TKL MEGAFIX-T INTERFERENCE SCREW 限實施十字韌帶重手術使用 4500 FBSF1000021A MONT BLANC SPINAL SYSTEM 二節 (RX2+SX4) 27702 FBSF1000031A MONT BLANC SPINAL SYSTEM 三節 (RX2+SX6) 40464 FBSF110002U0 "UNITED"CENTURY SPINAL SYSTEM (S*4+R*2) " 聯合 " 世紀脊椎固定系統二節 27702 FBSF110003U0 "UNITED"CENTURY SPINAL SYSTEM (S*6+R*2) " 聯合 " 世紀脊椎固定系統 ( 三節 ) 40464 FBSF16200NS9 TITANIUM SPINAL IMPLANT(DIAPASON)(RX2+SX4) 脊椎人工置換組 : 二節 27702 FBSF16201NS9 TITANIUM SPINAL IMPLANT (DIAPASON)(SX4+RX2) 脊椎人工置換組 : 二節 ( 免事前審查 ) 13816 FBSF16300NS9 TITANIUM SPINAL IMPLANT(DIAPASON)(RX2+SX6) 脊椎人工置換組 : 三節 40464 FBSF16301NS9 TITANIUM SPINAL IMPLANT (DIAPASON)(SX6+RX2) 脊椎人工置換組 : 三節 ( 免事前審查 ) 20044 FBSF180003RK TITANIUM SPINAL SYSTEM 二節 (SX4+RX2) 27702 FBSF180004RK TITANIUM SPINAL SYSTEM 三節 (SX6+RX2) 40464 FBSF180005RK TITANIUM SPINAL SYSTEM 二節 (SX4+RX2) 27702 FBSF180006RK TITANIUM SPINAL SYSTEM 三節 (SX6+RX2) 40464 FBSF183NP2Y2 FBSF183NP3Y2 "SYNTEC" AREIKEN SPINAL FIXATION SYSTEM(RX2+SX4)" 亞太醫療 " 亞力健脊椎固定系統 ( 二節 ) 免事前審查 "SYNTEC" AREIKEN SPINAL FIXATION SYSTEM(RX2+SX6)" 亞太醫療 " 亞力健脊椎固定系統 ( 三節 ) 免事前審查 13816 20044 FBSF188CP2Y2 "SYNTEC" COLISEUM SPINAL FIXATION SYSTEM " 亞太醫療 " 高立捷脊椎固定系統二節 (RX2+SX4) 27702 FBSF188CP3Y2 "SYNTEC" COLISEUM SPINAL FIXATION SYSTEM " 亞太醫療 " 高立捷脊椎固定系統三節 40464 FBSF188NP2Y2 "SYNTEC" COLISEUM SPINAL FIXATION SYSTEM " 亞太醫療 " 高立捷脊椎固定系統二節 (RX2+SX4) 13816 FBSF188NP3Y2 "SYNTEC" COLISEUM SPINAL FIXATION SYSTEM " 亞太醫療 " 高立捷脊椎固定系統三節 (RX2+SX6) 20044 FBSF1ASY05AQ TITANIUM SMARTLOC EVOLUTION SPINAL SYSTEM 二節 (SX4+RX2) 27702 FBSF1ASY06AQ TITANIUM SMARTLOC EVOLUTION SPINAL SYSTEM 三節 (SX6+RX2) 40464 FBSF1LCLR2GZ SPINAL SYSTEM (RX2+SX4) 脊椎系統二節免事前審查 13816 FBSF1LCLR3GZ SPINAL SYSTEM (RX2+SX6) 脊椎系統三節免事前審查 20044 FBSF1PCS01WG "WILTROM"SPINAL FIXATION SYSTEM(RX2+SX4)" 威創 " 脊椎固定系統二節 ( 免事前審查 ) 13816 FBSF1PCS02WG "WILTROM"SPINAL FIXATION SYSTEM(RX2+SX6)" 威創 " 脊椎固定系統三節 ( 免事前審查 ) 20044 23

特材代碼中英文品名支付點數 FBSF2000021A MONT BLANC SPINAL ROD 短 1089 FBSF2000041A MONT BLANC SPINAL ROD 長 3218 FBSF265041S9 TITANIUM SPINAL IMPLANT (DIAPASON):ROD 40:60MM 脊椎人工置換組 : 固定桿 ( 免事審查 ) 679 FBSF26504NS9 TITANIUM SPINAL IMPLANT(DIAPASON):ROD 70:100MM 脊椎人工置換組 : 固定桿 1089 FBSF265111S9 TITANIUM SPINAL IMPLANT(DIAPASON):ROD 110:250MM 脊椎人工置換組 : 固定桿 ( 免事前審查 ) 1851 FBSF26511NS9 TITANIUM SPINAL (DIAPASON)ROD 26:40CM 脊椎人工置換組 : 固定桿 3218 FBSF2839NLY2 FBSF2839NSY2 "SYNTEC" AREIKEN SPINAL FIXATION SYSTEM:ROD " 亞太醫療 " 亞力健脊椎固定系統 : 連結棒 ( 長節 )11.5~45CM, 免事前審查 "SYNTEC" AREIKEN SPINAL FIXATION SYSTEM:ROD " 亞太醫療 " 亞力健脊椎固定系統 : 連結棒 ( 短節 )2~11CM, 免事前審查 1851 679 FBSF2860NSY2 ROD 連結棒 - 短節 679 FBSF2886NLY2 ROD 連結棒 - 長節 1851 FBSF2887CLY2 ROD 連結棒 - 長節 3218 FBSF2887CSY2 ROD 連結棒 - 短節 1089 FBSF2ASYR3AQ TITANIUM SMARTLOC EVOLUTION SPINAL ROD 40MM:100MM 1089 FBSF2ASYR4AQ TITANIUM SMARTLOC EVOLUTION SPINAL ROD 110:600MM 3218 FBSF2L3401U0 "UNITED"CENTURY SPINAL SYSTEM:ROD 11:51CM " 聯合 " 世紀脊椎固定系統固定桿 ( 長節 ) 3218 FBSF2LR001GZ SPINAL ROD 脊椎固定桿短節免事前審查 679 FBSF2LR002GZ SPINAL ROD 脊椎固定桿長節免事前審查 1851 FBSF2M2PLTZ6 M2 SPINAL POSTERIOR SYSTEM:PLATE M2 脊椎後方固定系統 : 骨板免事前審查 679 FBSF2R3401U0 "UNITED"CENTURY SPINAL SYSTEM:ROD 3:10CM " 聯合 " 世紀脊椎固定系統固定桿 ( 短節 ) 1089 FBSF2RD01TWG FBSF2RD02TWG "WILTROM"SPINAL FIXATION SYSTEM:TITANIUM SPINAL ROD 50:100MM" 威創 " 脊椎固定系統 : 連接桿 50:100MM( 免事前審查 ) "WILTROM"SPINAL FIXATION SYSTEM:TITANIUM SPINAL ROD 125:500MM" 威創 " 脊椎固定系統 : 連接桿 125:500MM( 免事前審查 ) 679 1851 FBSF3000031A MONT BLANC SPINAL HOOK 5375 FBSF340051WG "WILTROM"SPINAL FIXATION SYSTEM:HOOK" 威創 " 脊椎固定系統 : 椎弓鉤 5375 FBSF4000041A MONT BLANC SPINAL SCREW 6381 FBSF41600NB0 OPS TITANIUM SPINAL SCREW 脊椎骨質疏鬆內固定釘 14400 FBSF44002TWG "WILTROM"SPINAL FIXATION SYSTEM:PEDICLE SCREW U TYPE" 威創 " 脊椎固定系統 : 脊椎骨釘 U 型 ( 免事前審查 ) 3114 24

FBSF44004TWG "WILTROM"SPINAL FIXATION SYSTEM:PEDICLE SCREW REDUCTION U TYPE" 威創 " 脊椎固定系統 : 脊 3114 椎骨釘 U 型折斷 ( 免事前審查 ) FBSF44005TWG "WILTROM"SPINAL FIXATION SYSTEM:CANNULATED REDUCTION PEDICLE SCREW U TYPE" 威創 " 脊椎固定系統 : 脊椎骨釘中空折斷 U 型 6381 FBSF44006TWG FBSF44007TWG "WILTROM"SPINAL FIXATION SYSTEM:PEDICLE SCREW AXIAL U TYPE" 威創 " 脊椎固定系統 : 脊椎骨釘 U 型多軸向 ( 免事前審查 ) "WILTROM"SPINAL FIXATION SYSTEM:PEDICLE SCREW POLY-AXIAL REDUCTION U TYPE" 威創 " 脊椎固定系統 : 脊椎骨釘 U 型多軸向折斷 ( 免事前審查 ) 3114 3114 FBSF44008TWG "WILTROM"SPINAL FIXATION SYSTEM:CANNULATED PEDICLE SCREW POLY-AXIAL U TYPE" 威創 " 脊椎固定系統 : 脊椎骨釘中空 U 型多軸向 6381 FBSF44009TWG "WILTROM"SPINAL FIXATION SYSTEM:CANNULATED PEDICLE SCREW POLY-AXIAL REDUCTION U TYPE" 威創 " 脊椎骨釘中空 U 型多軸向折斷 6381 FBSF44010TWG "WILTROM"SPINAL FIXATION SYSTEM:CANNULATED PEDICLE SCREW U TYPE" 威創 " 脊椎固定系統 : 脊椎骨釘中空 U 型 6381 FBSF44995NS1 TITANIUM CLICK'X PEDICLE SCREW ( 免事前審查 ) 3114 FBSF464001S9 TITANIUM SPINAL (DIAPASON)SCREW 脊椎人工置換組 : 骨釘 ( 免事前審查 ) 3114 FBSF46400NS9 TITANIUM SPINAL(DIAPASON)SCREW 脊椎人工置換組 : 骨釘 6381 FBSF4832NNY2 "SYNTEC" AREIKEN SPINAL FIXATION SYSTEM:MONOAXIAL SCREW" 亞太醫療 " 亞力健脊椎固定系統單軸骨釘, 免事前審查 3114 FBSF4884CHY2 POLYAXIAL SCREW 多軸骨釘 6381 FBSF4886NNY2 MONOAXIAL SCREW 單軸骨釘 3114 FBSF4895NNY2 MONOAXIAL SCREW 單軸骨釘 3114 FBSF4896CHY2 POLYAXIAL SCREW 多軸骨釘 6381 FBSF4ASYS3AQ TITANIUM SMARTLOC EVOLUTION SPINAL SCREW 6381 FBSF4BA005RK TITANIUM SPINAL SCREW 6381 FBSF4BA006RK TITANIUM SPINAL SCREW 6381 FBSF4BA007RK TITANIUM SPINAL SCREW 6381 FBSF4LC004GZ SPINAL SCREW 脊椎固定釘免事前審查 3114 FBSF4M2PCNZ6 M2 SPINAL POSTERIOR SYSTEM:SCREW M2 脊椎後方固定系統 : 骨釘免事前審查 3114 FBSF4S3101U0 "UNITED"CENTURY SPINAL SYSTEM:SCREW " 聯合 " 世紀脊椎固定系統骨螺絲 6381 FBSF5000051A MONT BLANC SPINAL TRANSVERSE CONNECTOR 7208 FBSF50001TWG "WILTROM"SPINAL FIXATION SYSTEM:CROSS LINK" 威創 " 脊椎固定系統 : 橫向連接鉤 ( 免事前審查 ) 3331 FBSF5000251A MONT BLANC SPINAL TRANSVERSE LINK 免事前審查 3331 FBSF54977NS1 TITANIUM TRANSVERSE CONNECTORS 免事前審查 3331 25

特材代碼中英文品名支付點數 FBSF56201NS1 TITANIUM TRANSVERSE CONNECTORS 7208 FBSF5821NTY2 "SYNTEC" AREIKEN SPINAL FIXATION SYSTEM:TRANSVERSE LINK " 亞太醫療 " 亞力健脊椎固定系統 : 橫向連結器, 免事前審查 3331 FBSF5886CCY2 "SYNTEC" TRANSVERSE LINK " 亞太醫療 " 高立捷橫向連結器 7208 FBSF5886NCY2 "SYNTEC" TRANSVERSE LINK " 亞太醫療 " 高立捷橫向連結器 3331 FBSF5ASYL2AQ TITANIUM SMARTLOC EVOLUTION TRANSVERSE LINK 7208 FBSF5C3201U0 "UNITED"CENTURY SPINAL SYSTEM:CROSSLINK " 聯合 " 世紀脊椎固定系統交叉連桿 7208 FBSF5LT005GZ SPINAL LINK 脊椎橫向連結器免事前審查 3331 FBSF7000271A MONT BLANC SPINAL HOOK SCREW SYSTEM(SX2+HX2+RX2) 免事前審查 23306 FBSFA000011A "SPINEWAY" TWIN PEAKS LUMBAR CAGES " 施百威腰椎椎間融合器 ( 後開型 ) 25000 FBSFA00002RK TITANIUM INTERVERTEBRAL CAGE 椎間融合器 17550 FBSFA00003RK PEEK LUMBAR INTERVERTEBRAL CAGE 高分子材料腰椎椎間融合器 ( 後開型 ) 25000 FBSFA0001NS1 TRAVIOS IMPLANTS PEEK( 側開型每節椎體限置放 1 個 ) 50000 FBSFA0LY011S OLYS TRANSFORMINAL CAGE PEEK( 側開型每節椎體限置放 1 個 ) 50000 FBSFA1000NZ1 ZIMMER SPINE FIDJI LUMBAR CAGES(PEEK) " 捷邁 " 斐濟腰椎椎間融合器 25000 FBSFA21001XP I-TYPE INTERVERTEBRAL SPACER PEEK CAGE 馬蹄式椎間填充塊 ( 頸椎 ) 25000 FBSFA22001XP II-TYPE INTERVERTEBRAL SPACER PEEK CAGE 錐頭式椎間填充塊 ( 後開型 ) 25000 FBSFA22002XP II-TYPE INTERVERTEBRAL SPACER PEEK( 側開型每節椎體限置放 1 個 ) 50000 FBSFA29906M4 CAPSTONE SPINAL SYSTEM:TLIF PEEK SPACER( 側開型每節椎體限置放 1 個 ) 50000 FBSFA3000NS1 SYNCAGE IMPLANTS 辛凱吉椎間支架植入物 (SYNCAGE-C TITANIUM CERVICAL) 17550 FBSFA3605LU0 "UNITED"EXPRESS LUMBAR CAGE SYSTEM(PLIF PEEK)" 聯合 " 快捷腰椎融合器系統 ( 後開型 ) 25000 FBSFA420MNM4 TELAMON FUSION DEVICE PEEK CAGE 泰拉蒙融合器 ( 後開型 ) 25000 FBSFA6730NS9 OIC CAGE SYSTEM-PEEK IMPLANTS 椎體護架系統 ( 後開型 ) 25000 FBSFA6741NS9 SOLIS CERVICAL CAGE SYSTEM 梭利斯椎頸護架系統 ( 頸椎 PEEK CAGE) 25000 FBSFA6742NS9 "STRYKER" SOLIS AS PEEK SPACER " 史賽克 " 椎間融合器 ( 頸椎 ) 25000 FBSFA6760NS9 OIC PL PEEK SPACER 椎間融合器 ( 後開型 ) 25000 FBSFA7074NY2 TITANIUM VETEBRAE INTERBODY CAGE:ANTERIOR CERVICAL INTERBODY CAGE 鈦合金椎籠 : 前方頸椎間融合器 17550 26

FBSFA82501Y2 "SYNTEC"PEEK VERTEBRAE INTERBODY CAGE" 亞太醫療 " 春菊聚醚醚酮椎籠 ( 腰椎後開型 ) 25000 FBSFA8380NS9 AVS TL PEEK SPACER SYSTEM( 側開型每節椎體限置放 1 個 ) 50000 FBSFA8984NS1 PLIVIOS IMPLANTS PEEK CAGE 腰椎椎間融合器 ( 後開型 ) 25000 FBSFA8992NS1 CERVIOS IMPLANTS WEDGE-SHAPED PEEK CAGE 頸椎椎間融合器 25000 FBSFA8993NS1 CERVIOS IMPLANTS CURVED PEEK CAGE 頸椎椎間融合器 25000 FBSFA919MNM4 VERTE-STACK CRESCENT VERTEBRAL BODY SPACER:TLIF PEEK SPACER( 側開型每節椎體限置放 1 個 ) 50000 FBSFAALS02AQ TITANIUM VIGOR CERVICAL DISC SPACER 17550 FBSFAAP002AQ "A-SPINE"POLYMER LUMBAR DISC SPACER(PEEK)" 冠亞 " 高分子複合材料腰椎椎間融合器 ( 後開型 )* 25000 FBSFAAP003AQ "A-SPINE"VIGOR PEEK CERVICAL DISC SPACER" 冠亞 " 偉戈高分子複合材料頸椎椎間融合器 * 25000 FBSFAC000NZ1 FIDJI CERVICAL CAGES PEEK 頸椎椎間融合器 25000 FBSFAC0CCK1S SCIENT X LUMBAR CAGE(PEEK) 賽恩司腰椎融合器 ( 後開型 ) 25000 FBSFACC11NXA PEEK LUMBAR INTERBODY SPACER( 側開型每節椎體限置放 1 個 ) 50000 FBSFACCAGE1A "SPINEWAY" AYERS ROCK CERVICAL CAGES"(PEEK) 施百威 " 頸椎融合器 25000 FBSFACD11NXA PEEK LUMBAR CAGE 聚醚醚酮腰椎椎間融合器 ( 後開型 ) 25000 FBSFACE11NXA CERVICAL CAGE 頸椎椎間融合器 ( 頸椎 PEEK CAGE) 25000 FBSFACG11NXA TITANIUM CERVICAL CAGE 鈦合金頸椎椎間融合器 17550 FBSFACH11NXA TITANIUM CERVICAL CAGE 鈦合金頸椎椎間融合器 17550 FBSFAF0001RK PEEK LUMBAR INTERVERTEBRAL CAGE 高分子材料腰椎椎間融合器 ( 側開型, 每節椎體置放 1 個 ) 50000 FBSFAF0002RK REBORN ESSENCE PEEK LUMBAR INTERVERTEBRAL CAGE 瑞寶億高分子材料腰椎椎間融合器 ( 後開型 ) 25000 FBSFAF0003RK REBORN ESSENCE PEEK CERVICAL INTERVERTEBRAL CAGE 瑞寶億高分子材料頸椎椎間融合器 25000 FBSFAFJ00CAE AESCULAP CESPACE PEEK CERVICAL FUSION SPACER 雅氏樹脂頸椎融合植入物 25000 FBSFAJULPL1C SPINEART JULIET LUMBAR CAGE(PLIF)" 司佰特 " 腰椎融合器 25000 FBSFAJULTL1C SPINEART JULIET LUMBAR CAGE(TLIF)" 司佰特 " 腰椎融合器 ( 側開型, 每節椎體置放 1 個 ) 50000 FBSFAPCAGEZV VITAL PEEK LUMBAR INTERVERTEBRAL CAGE 威拓高分子材料腰椎椎間融合器 ( 後開型 ) 25000 FBSFAPR001AQ RAINBOO PEEK LUMBAR CAGE( 側開型每節椎體限置放 1 個 ) 50000 FBSFASAMRY1S ANTERIOR CAGE SAMARYS(PEEK) 莎美莉前路頸椎融合器 25000 27

FBSFASJ00NAE AESCULAP PROSPACE PEEK POSTERIOR LUMBAR AND THORACIC SPINE FUSION SYSTEM 雅氏後 25000 方樹脂胸腰椎融合植入物 FBSFATCAGEZV VITAL PEEK LUMBAR INTERVERTEBRAL CAGE( 側開型每節椎體限置放 1 個 ) 50000 FBSFATRYKC1C SPINEART CERVICAL IMPLANTS(PEEK) 司佰特頸椎椎間植入物 25000 FBSFAWS141B0 LUMBAR SPINAL PEEK CAGE( 側開型每節椎體限置放 1 個 ) 50000 FBSFAWS16CB0 CERVICAL CAGE(PEEK) 頸椎椎間融合器 25000 FBSFAWS41LB0 LUMBAR SPINAL CAGE PEEK CAGE 腰椎椎間融合器 ( 後開型 ) 25000 FBSFC10002U0 FBSFC10003U0 FBSFC20002U0 FBSFC20003U0 "UNITED"SLIMFIT ANTERIOR CERVICAL PLATE SYSTEM (P*1+S*4)" 聯合 " 史令飛頸前路骨板系統二節 "UNITED"SLIMFIT ANTERIOR CERVICAL PLATE SYSTEM (P*1+S*6)" 聯合 " 史令飛頸前路骨板系統三節 "UNITED"BOOSTER ANTERIOR CERVICAL PLATE SYSTEM (P*1+S*4) " 聯合 " 普斯特頸前路骨板系統二節 "UNITED"BOOSTER ANTERIOR CERVICAL PLATE SYSTEM (P*1+S*6) " 聯合 " 普斯特頸前路骨板系統三節 22426 23285 22426 23285 FBSFC2Z86NS9 REFLEX ZERO PROFILE ANTERIOR CERVICAL PLATING SYSTEM 二節 (PLATE X1+SCREW X 4) 22426 FBSFC3Z86NS9 REFLEX ZERO PROFILE ANTERIOR CERVICAL PLATING SYSTEM 三節 (PLATE X1+SCREW X 6) 23285 FBSFC4030NS9 RELFEX ZERO PROFILE ANTERIOR CERVICAL SCREW 1125 FBSFC8340NY2 TITANIUM CERVICAL PLATE FIXATION SYSTEM 三節 (PX1+SX6) 23285 FBSFC834NNY2 TITANIUM CERVICAL PLATE FIXATION SYSTEM 二節 (PX1+SX4) 22426 FBSFC835NNY2 TITANIUM CERVICAL BONE LOCKING SCREW 1125 FBSFCASC03AQ TITANIUM WINLOC CERVICAL PLATE SYSTEM 二節 (PX1+SX4) 22426 FBSFCASC04AQ TITANIUM WINLOC CERVICAL PLATE SYSTEM 三節 (PX1+SX6) 23285 FBSFCASCS2AQ TITANIUM CERVICAL SCREW 1125 FBSFCB0003RK TITANIUM CERVICAL SCREW 免事前審查 194 FBSFCB0004RK TITANIUM CERVICAL PLATE 免事前審查 4046 FBSFCBA003RK TITANIUM CERVICAL SCREW 1125 FBSFCS3102U0 FBSFCS3104U0 "UNITED"SLIMFIT ANTERIOR CERVICAL PLATE SYSTEM:SCREW " 聯合 " 史令飛頸前路骨板系統 : 自攻螺絲 "UNITED"BOOSTER ANTERIOR CERVICAL PLATE SYSTEM:SCREW " 聯合 " 普斯特頸前路骨板系統 : 骨螺絲 1125 1125 FBSFCTRYC21C SPINEART CERVICAL IMPLANTS 二節 (PX1+SX4) 司佰特頸椎間植入物 22426 FBSFCTRYC31C SPINEART CERVICAL IMPLANTS 三節 (PX1+SX6) 司佰特頸椎間植入物 23285 28

FBSFCTRYCS1C SPINEART CERVICAL IMPLANTS:SCREW 司佰特頸椎間植入物 : 骨釘 1125 FBSFR9701LS1 FBSFR9702LS1 "SYNTHES"VEPTR RIB TO LUMBAR LAMINA(CRS*1+L*3+EB*1+ER*1+H*1+FR*1)" 信迪思 " 延展式肋骨支撐架 : 肋骨至板狀腰椎組合 "SYNTHES"VEPTR:RIB TO ILIUM(CRS*1+CHR*1+L*3+EB*1+LER*1+AH*1+EC*1+FR*1)" 信迪思 " 延展式肋骨支撐架 : 肋骨至髂骨組合 FBSFR9703LS1 "SYNTHES"VEPTR:RIB TO RIB(CRS*1+CRS*1+CHR*2+DL*4+EB*1+FR*1)" 信迪思 " 延展式肋骨支撐架 : 肋骨至肋骨組合 326712 300221 290247 FBSFR9704LS1 "SYNTHES"VEPTR:DISTRACTION LOCKS" 信迪思 " 延展式肋骨支撐架 : 延展用鎖 6584 FBT01HYRANLJ HYRUAN PLUS INJ. 瀚樂骨關節腔注射液, 每次療程注射三次 1099 FHFCDAHF37ST FHFCDD284TM4 FHFCDDRF32ST " 聖猷達 " 波默植入式心律去顫器 "SJM"PROMOTE IMPLANTABLE CARDIOVERTER DEFIBRILLATOR(CRT-D) * " 美敦力 " 麥思蒙植入式心臟去顫器 "MEDTRONIC" MAXIMO II CRT-D IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* " 聖猷達 " 波默植入式心律去顫器 "SJM" PROMOTE IMPLANTABLE CARDIOVERTER DEFIBRILLATOR(CRT-D)* 556104 556104 556104 FHFCDP1068SB " 波士頓科技 " 康格斯心臟再同步治療用去顫器 "BOSTON SCIENTIFIC" COGNIS 100 HE CRT-D* 556104 FHG211203NGX FHG212003NGX FHG3146W40TM FHG3146W41TM FHG3146W45TM FHG431401NGX " 戈爾 " 戈爾特賜內植人工血管 - 伸展性直型人工血管 "GORE" GORE-TEX VASCULAR GRAFTS- STRETCH VASCULAR GRAFT STRAIGHT 12:18MM*30CM " 戈爾 " 戈爾特賜內植人工血管 - 伸展性直型人工血管 "GORE" GORE-TEX VASCULAR GRAFTS- STRETCH VASCULAR GRAFT STRAIGHT 20:24MM*30CM 泰爾茂特普弗人工血管 TERUMO TAPERFLO GELATIN SEALED EPTFE VASCULAR PROSTHESES EPTFE STEPPED TAPER GRAFT40,45CM*4-6,5-8MM 泰爾茂特普弗人工血管 TERUMO TAPERFLO GELATIN SEALED EPTFE VASCULAR PROSTHESES EPTFE STEPPED TAPER GRAFT40,50CM*4-6,4-7MM 泰爾茂特普弗人工血管 "TERUMO TAPERFLO GELATIN SEALED EPTFE VASCULAR PROSTHESES STEPPED TAPER CENTRAL SUPPORT GRAFT 40,45CM*4-7,5-8MM " 戈爾 " 戈爾特賜內植人工血管 - 伸展性 Y 型人工血管 "GORE" GORE-TEX VASCULAR GRAFTS-STRETCH VASCULAR GRAFT BIFURCATED 14:24MM*7:12MM*40CM 9900 12000 13200 13200 15800 16000 FHP01ACCPMST " 聖猷達 " 艾森心臟節律器 (ACCENT IMPLANTABLE CARDIAC PULSE GENERATOR) * 74070 FHP01ACCRMST " 聖猷達 " 艾森心臟節律器 ((ACCENT IMPLANTABLE CARDIAC PULSE GENERATOR) * 74070 FHP01ADAPSM4 "MEDTRONIC" ADAPTA PACING SYSTEM" 美敦力 " 黛拉心臟節律系統 * 74070 FHP01TA245BK FHP01TA248BK FHP01TA250BK FHP01TA252BK FHP01TA254BK FHP02ACTDRST FHP02ARFDRST 拜耳德尼克塔洛斯心搏徐緩治療節律裝置 BIOTRONIK TALOS BRADYCARDIA THERAPY PACEMAKER(DDD)* 頇檢附心電圖報告專案報備使用拜耳德尼克塔洛斯心搏徐緩治療節律裝置 BIOTRONIK TALOS PACEMAKER(DDDR)* 按同類近似特材支付點數 102500 點支付超過部分由病人支付拜耳德尼克塔洛斯心搏徐緩治療節律裝置 BIOTRONIK TALOS PACEMAKER(VVI/AAI)* 頇檢附心電圖報告專案報備使用拜耳德尼克塔洛斯心搏徐緩治療節律裝置 BIOTRONIK TALOS BRADYCARDIA THERAPY PACEMAKER(VDDR)* 頇檢附心電圖報告專案報備使用拜耳德尼克塔洛斯心搏徐緩治療節律裝置 BIOTRONIK TALOS BRADYCARDIA THERAPY PACEMAKER(VVIR/AAIR)* 頇檢附心電圖報告專案報備使用 " 聖猷達 " 艾森心臟節律器 (IMPLANTABLE CARDIAC PULSE GENERATOR 雙腔型 ) *, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付 " 聖猷達 " 艾森心臟節律器 (IMPLANTABLE CARDIAC PULSE GENERATOR 雙腔型 ) *, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付 102500 102500 62260 102500 74070 102500 102500 29

FHP5611073AE " 雅氏 " 人工血管補片 "AESCULAP" VASCULAR PATCH(2*9CM,1*7CM,3*4CM) 281 FHPCDD284DM4 FHPCDD284VM4 " 美敦力 " 麥思蒙植入式心臟去顫器 ( 雙腔 )"MEDTRONIC" MAXIMO II DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* " 美敦力 " 麥思蒙植入式心臟去顫器 ( 單腔 )"MEDTRONIC" MAXIMO II VR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* 426702 362292 FHPCDF102DSB " 波士頓科技 " 泰利均植入型心律去顫器 "BOSTON SCIENTIFIC" TELIGEN 100 HE ICD* 362292 FHPCDF110DSB " 波士頓科技 " 泰利均植入型心律去顫器 "BOSTON SCIENTIFIC" TELIGEN 100 HE ICD* 426702 FHPCDPD27NST FHPCDPVRC7ST FHPCDRFD22ST FHPCDRFVD2ST " 聖猷達 " 克侖特植入式心律去顫器 "SJM"CURRENT IMPLANTABLE CARDIOVERTER DEFIBRILLATOR( 雙腔 ) * " 聖猷達 " 克侖特植入式心律去顫器 "SJM"CURRENT IMPLANTABLE CARDIOVERTER DEFIBRILLATOR( 單腔 ) * " 聖猷達 " 克侖特植入式心律去顫器 "SJM" CURRENT IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* " 聖猷達 " 克侖特植入式心律去顫器 "SJM" CURRENT IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* 426702 362292 426702 362292 FHPCL06935M4 " 美敦力 " 史賓特導管 "MEDTRONIC" SPRINT QUATTRO SECURE S LEAD* 82010 FHPCLDU723ST " 聖猷達 " 德拉多心臟導線 "SJM" DURATA LEAD 82010 FHPHF04195M4 " 美敦力 " 艾坦史塔菲導線 "MEDTRONIC" ATTAIN STARFIX LEAD* 27500 FHPHF04196M4 " 美敦力 " 艾坦艾比利導線 "MEDTRONIC" ATTAIN ABILITY LEAD* 22953 FHPHF04591SB " 波士頓 " 艾裘帝螺旋植入式電極導線 "BOSTON SCIENTIFIC" ACUITY SPIRAL IMPLANTABLE LEAD 21860 FHPHF0C2TRM4 " 美敦力 " 信可心臟再同步節律器 "MEDTRONIC"SYNCRA CRT-P CARDIAC RESYNCHRONIZATION THERAPY PACEMAKER* 190843 FHPHF11568ST " 聖猷達 " 左心導線 "SJM" QUICKFLEX LEAD* 21860 FHPHF14001BK " 拜耳德尼克 " 可洛植入式雙極心導線 "BIOTRONIK" COROX OTW ENDOCARDIAL LEAD* 21860 FHPHF14002BK " 拜耳德尼克 " 可洛植入式心導線 "BIOTRONIK" COROX OTW LEAD* 21860 FHPHFEASY3GU " 佳騰 " 易導型第 3 代冠狀靜脈電極導線 "GUIDANT"EASYTRAK 3 CORONARY VENOUS LEAD* 21860 FHPHFH1401GU " 佳騰 " 控達刻脈搏產生器 "GUIDANT" CONTAK RENEWAL CRT-P PULSE GENERATOR* 190843 FHPHFPM2RTST " 聖猷達 " 安勝心臟節律器 "SJM" ANTHEM IMPLANTABLE CARDIAC PULSE GENERATOR(CRT-P)* 190843 FHPHFPM3RTST " 聖猷達 " 安勝心臟節律器 "SJM" ANTHEM IMPLANTABLE CARDIAC PULSE GENERATOR(CRT-P)* 190843 FHPL104088GU " 佳騰 " 伸縮性雙極之心內膜心房電極導線 "GUIDANT" FLEXTEND PACING LEAD* 頇檢附心電圖報告專案報備使用 7951 FHPL1PPT99ST " 聖猷達 " 亞提以司心臟導線 "SJM" OPTISENSE LEAD * 應檢附心電圖報告專案報備使用 7951 FHPL1S9F4UST " 聖猷達 " 心臟節律器導線 "SJM" IMPLANTABLE CARDIAC PACING LEADS 頇檢附心電圖報告專案報備使用 7610 FHPL2SLX65BK " 拜耳德尼克 " 世樂植入式電極導線 "BIOTRONIK" SOLOX IMPLANTABLE ENDOCARDIAL LEAD* 18500 30

FHV01A1929F6 " 翁克斯 " 人工心瓣膜 "ON-X" PROSTHETIC HEART VALVE 19:29MM 40212 FHV01ART19R5 " 索林 " 百康保雙葉式人工心臟瓣膜 "SORIN" BICARBON ARTIFICIAL HEART VALVE 50503 FHV01CNNFVF6 " 翁克斯 " 人工心瓣膜 "ON-X" PROSTHETIC HEART VALVE 50503 FHV01M2333F6 " 翁克斯 " 人工心瓣膜 "ON-X" PROSTHETIC HEART VALVE 23:33MM 40212 FHV01MTR19R5 " 索林 " 百康保雙葉式人工心臟瓣膜 "SORIN" BICARBON ARTIFICIAL HEART VALVE 50503 FHV02B2933ST " 聖猶達 " 豬組織瓣膜 "SJM"PORCINE VALVE 44149 FHV02EPSAMST " 聖猶達 " 豬組織瓣膜 "SJM" EPIC VALVE 44149 FHVR1AFR23ST " 聖猷達 " 愛調環狀成形術環 "SJM" ATTUNE FLEXIBLE ADJUSTABLE ANNULOPLASTY RING 20100 FHX02CB100QM " 邁柯唯 " 噴射灌洗器 ( 滅菌 )"MAQUET" JET LAVAGE(STERILE)* 2425 FHX02FX15RTM FHX02HMM50QM " 泰爾茂 " 菲斯膜型人工心肺 "TERUMO"CAPIOX FX(OXYGENATOR WITHOUT RESERVOIR WITH HYDROPHILIC POLYMER COATED AND ARTERIAL FILTER* " 邁柯唯 " 微孔膜氧合器 "MAQUET" QUADROX-I SMALL ADULT MICROPOROUS MEMBRANE OXGENATOR* 20703 13998 FHX02HMS70QM " 邁柯唯 " 微孔膜氧合器 "MAQUET" OXYGENATOR QUADROX-I WITH SOFTLINE COATING * 13998 FHX02LAVAGGJ " 吉生 " 噴射灌洗器 ( 滅菌 )"JSM" JET LAVAGE(STERILE)* 2425 FHX02MT222L5 加州灌洗器 CALIFORNIA BLOWER/MISTER(WITH TUBING SET) * 2425 FHX03FX15RTM " 泰爾茂 " 菲斯膜型人工心肺 "TERUMO"CAPIOX FX(OXYGENATOR WITH RESERVOIR WITH HYDROPHILIC POLYMER COATED AND ARTERIAL FILTER* 24000 FHX03HMM51QM " 邁柯唯 " 微孔膜氧合器 "MAQUET" OXYGENATOR QUADROX-I WITH SOFTLINE COATING* 15627 FHX03HMM71QM " 邁柯唯 " 微孔膜氧合器 "MAQUET" QUADROX-I ADULT MICROPOROUS MEMBRANE OXYGENATOR* 15627 FHX03VKM55QM FHX03VKM71QM FHX03VKM77QM FHX04CXXSATM " 邁柯唯 " 微孔膜氧合器附靜脈硬殼式儲血槽 OXYGENATOR QUADROX-I WITH SOFTLINE COATING WITH VENOUS HARDSHELL RESERVOIR ARTERIAL* 適應症備註欄 " 邁柯唯 " 微孔膜氧合器附靜脈硬殼式儲血槽 OXYGENATOR QUADROX-I WITH SOFTLINE COATING WITH VENOUS HARDSHELL RESERVOIR+FILTER* 適應症見備註欄 " 邁柯唯 " 微孔膜氧合器附靜脈硬殼式儲血槽 "MAQUET"OXYGENATOR QUADROX-I WITH VENOUS HARDSHELL RESERVOIR WITH SOFTLINE COATING " 泰爾茂 " 易倍適聚合物塗層人工心肺套 CAPIOX EBS CIRCUIT WITH X COATING/OXYGENATOR+SP- PUMP+FLOW SENSOR+COATING TUBING SET 使用參考請見備註欄 14558 18500 14558 44695 FHXR2VHK11QM " 邁柯唯 " 靜脈硬殼式儲血槽 "MAQUET" VENOUS HARDSHELL CARDIOTOMY RESERVOIR 3596 FHXR2VHK20QM " 邁柯唯 " 開心術靜脈硬殼式儲血槽 "MAQUET" VENOUS HARDSHELL CARDIOTOMY RESERVOIR 3297 FNP9106008S7 FNP9108014S7 FNP9110016S7 " 司諾維思 " 腦膜補片 "SYNOVIS"DURA-GUARD DURAL REPAIR PATCH WITH APEX PROCESSING 6CM*8CM " 司諾維思 " 腦膜補片 "SYNOVIS"DURA-GUARD DURAL REPAIR PATCH WITH APEX PROCESSING8CM*14CM " 司諾維思 " 腦膜補片 "SYNOVIS"DURA-GUARD DURAL REPAIR PATCH WITH APEX PROCESSING 10CM*16CM 9725 20557 24310 31

FPP0105152LE STRYKER LEIBINGER UNIVERSAL MANDIBLE SYSTEM:1.7MM MID-FACE Y-PLATE 5 HOLES 2022 FPP0105188LE STRYKER LEIBINGER UNIVERSAL MANDIBLE SYSTEM:1.7MM MID-FACE CURVED PLATE 4-10 HOLES 2222 FPP0105742LE STRYKER LEIBINGER UNIVERSAL MANDIBLE SYSTEM:1.7MM MID-FACE SET LOCKING DOUBLE Y PLATE 7 HOLES 2469 FPP0106760LE 1.7 MID-FACE L-PLATE 5-6 HOLES 1923 FPP0108203LE 2.0 MINI PLATE BAR 4-6 HOLES 1207 FPP010821NLE 2.0 MINI PLATE BAR 16 HOLES 2038 FPP0108230LE 2.0 MINI PLATE L-PLATE 4-9 HOLES 1923 FPP0108240LE 2.0 MINI PLATE T-PLATE 6-8 HOLES 2076 FPP0108250LE 2.0 MINI PLATE Y-PLATE 5-8 HOLES 2022 FPP010826NLE 2.0 MINI PLATE DOUBLE Y-PLATE 2469 FPP0108586LE 2.0 MINI PLATE CURVED PLATE 12 HOLES 2222 FPP0214201EJ FPP0214203EJ FPP0214205EJ FPP0214207EJ FPP0214208EJ "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:RECONSTRUCTION PLATE 4+12 HOLE" 歐美特 " 下頷骨折重建系統, 重建骨板單邊 4+12 洞 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:RECONSTRUCTION PLATE 5+16 HOLE" 歐美特 " 下頷骨折重建系統, 重建骨板單邊 5+16 洞 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:RECONSTRUCTION PLATE FULL 5+20+5 5+16+5 HOLE" 歐美特 " 下頷骨折重建系統, 重建骨板雙邊 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:RECONSTRUCTION PLATE 14HOLE" 歐美特 " 下頷骨折重建系統, 重建直型骨板 14 洞 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:RECONSTRUCTION PLATE 18HOLE" 歐美特 " 下頷骨折重建系統, 重建直型骨板 18 洞 FPP027051NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:ADAPTION PLATES PURE TITANIUMM 12 HOLES " 信迪思 " 下顎固定系統 : 連結骨板 FPP027171NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:PLATES PURE TITANIUMM 12 HOLES STRAIGHT " 信迪思 " 下顎固定系統 : 直骨板 FPP0314080EJ FPP0314210EJ FPP0314219EJ FPP0314222EJ FPP0314311EJ FPP0314400EJ FPP0314403EJ FPP037011NS1 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:BSSO PLATE 4+6 HOLE" 歐美特 " 下頷骨折重建系統, 直型骨板 4+6 洞 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:FRACTURE PLATE 4:8 HOLE" 歐美特 " 下頷骨折重建系統, 骨折骨板 4;8 洞 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:ANGLED FRACTION PLATE 2X2 3X3 HOLE" 歐美特 " 下頷骨折重建系統, 成角骨折骨板 4;6 洞 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:RIGID COMMINUTED FRACTURE PLATE 15HOLE" 歐美特 " 下頷骨折重建系統, 硬式粉碎骨折骨板 15 洞 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.4 LOCKING FRACTURE PLATE 4;6 HOLE" 歐美特 " 下頷骨折重建系統,2.4 鎖定骨折骨板 4;6 洞 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.0 LOCKING FRACTURE PLATE 4;6 HOLE" 歐美特 " 下頷骨折重建系統,2.0 鎖定骨折骨板 4;6 洞 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.0 LOCKING COMMINUTION PLATE 15HOLE" 歐美特 " 下頷骨折重建系統,2.0 鎖定粉碎骨板 15 洞 "SYNTHES"MATRIX MANDIBLE SYSTEM:MINI TENSION BAND PLATES 1.0MM PURE TITANIUMM 4HOLE;6HOLE" 信迪思 " 下顎固定系統 : 迷你張力骨板 7920 7920 19060 4900 4900 4900 4900 3918 3918 7920 4900 3918 3918 4900 3918 32

FPP037101NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:DCP PLATES PURE TITANIUM 2+2 OR 3+3 HOLES" 信迪思 " 4560 下顎固定系統 : 動態加壓骨板 FPP037131NS1 FPP037211NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:DCP PLATES PURE TITANIUMM 3+3 HOLES CRESCENT OR ANGLED" 信迪思 " 下顎固定系統 : 動態加壓新月型或曲型骨板 "SYNTHES"MATRIX MANDIBLE SYSTEM:DCP PLATES PURE TITANIUMM 3+3 HOLES, CRESCENT OR ANGLED" 信迪思 " 下顎固定系統 : 新月型或曲型骨板 7920 7920 FPP060573NLE STRYKER LEIBINGER UNIVERSAL MANDIBLE SYSTEM:1.7MM MID-FACE SET LOCKING 3-D PLATE 6X2 HOLES 12480 FPP060631NLE 2.0 MINI PLATE 3-D 2X2 HOLES 0.6MM 4053 FPP060632NLE 2.0 MINI PLATE 3-D 3X2 HOLES 0.6MM 6240 FPP0606731LE STRYKER LEIBINGER UNIVERSAL MANDIBLE SYSTEM:1.7MM MID-FACE 3D PLATE 2X2 HOLES 4053 FPP0610501EJ FPP0610502EJ FPP0610503EJ FPP069001NS1 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:MINI LOCKING STRUT PLATE CURVED 2X4HOLE" 歐美特 " 下頷骨折重建系統, 迷你鎖定矩陣型骨板弧狀 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:MINI LOCKING STRUT PLATE CURVED 2X6 HOLE" 歐美特 " 下頷骨折重建系統, 迷你鎖定矩陣型骨板弧狀 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:MINI LOCKING STRUT PLATE CURVED 2X8 HOLE" 歐美特 " 下頷骨折重建系統, 迷你鎖定矩陣型骨板弧狀 "SYNTHES"MATRIX MANDIBLE SYSTEM:PREFORMED RECONSTRUCTION PLATE" 信迪思 " 下顎固定系統 : 立體重建骨板 8220 12480 12480 12480 FPP0712001EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.2MM 12 HOLE CURVED PLAT 4970 FPP0712002EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.2MM 5 HOLE STRAIGHT PLATE 2830 FPP0712004EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.2MM 18 HOLE STRAIGHT PLATE 5170 FPP0712013EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.2MM 2 HOLE STRAIGHT PLATE:MEDIUM,LONG 2830 FPP0712040EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.2MM 2X4 HOLE QUAD PLATE 8654 FPP0712134EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.2MM SQUARE PLATE 4053 FPP0712136EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.2MM EXTENDED X PLATE 6040 FPP0712138EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.2MM DOUBLE Y PLATE 6040 FPP0712140EJ FPP0712146EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.2MM BUR HOLE PLATE SMALL LARGE X-LARGE FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.2MM MESH PLATE 40X40MM 90X90MM 6616 14160 FPP0718002EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.6MM 5 HOLE STRAIGHT PLATE 2830 FPP0718020EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.6MM SQUARE PLATE 9MM 4053 FPP0718022EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.6MM 2 HOLE STRAIGHT PLATE:MEDIUM,LONG,SHORT 2830 FPP0718028EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.6MM DOUBLE Y PLATE 6040 FPP0718032EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.6MM BUR HOLE PLATE SMALL LARGE X-LARGE 6616 33

FPP0718038EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.6MM 10 HOLE STRAIGHT PLATE 2993 FPP0718059EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.6MM 2X3 HOLE QUAD PLATE 6942 FPP0718060EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.6MM 2X4 HOLE QUAD PLATE 8654 FPP077071NS1 FPP077081NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:STRUT PLATES PURE TITANIUMM 4 HOLES STRAIGHT" 信迪思 " 下顎固定系統 : 網狀 "SYNTHES"MATRIX MANDIBLE SYSTEM:STRUT PLATES PURE TITANIUM 8 HOLES" 信迪思 " 下顎固定系統 : 網狀 4053 8654 FPP07801FNS1 PREFORMED ORBITAL PLATE 0.4MM 14160 FPP0782146EJ FAST-FLAP NEURO FIXATION SYSTEM 速固硬式固定系統 :1.6MM MESH PLATE 40X40MM 90X90MM 36X50MM 74X50MM 111X191MM 14160 FPP07FM960AE 0.6MM MICRO PLATE STRAIGHT 2HOLE,4 HOLE 2830 FPP07FM964AE 0.6MM MICRO Y PLATE 5 HOLE 5308 FPP07FM965AE 0.6MM MICRO PLATE STRAIGHT 16 HOLE 5170 FPP07FM966AE 0.6MM MICRO DOUBLE Y PLATE 6 HOLE 6040 FPP07FM968AE MICRO BOX CAR PLATE 4 HOLE 4053 FPP07FM969AE 0.6MM MICRO BOX CAR PLATE 6 HOLE 6942 FPP07FM970AE 0.6MM MICRO BOX CAR PLATE 8 HOLE 8654 FPP07FM971AE 0.6MM MICRO BURR HOLE COVER PLATE 6616 FPP07FM973AE 0.6MM MICRO MESH,MINIFEN PLATE 14160 FPP0909104LE 2.0 MINI CHIN PLATE BAR 6 HOLES 4-10MM 3000 FPS0100001EJ FPS0100002EJ FPS0100003EJ FPS0100004EJ FPS0100005EJ FPS010000NEJ "OSTEOMED"FAST-FLAP NEURO FIXATION SYSTEM:1.2MM AUTO-DRIVE SCREW" 歐特美 " 速固硬式固定系統自攻螺絲 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.3MM SAFETY SCREW " 歐美特 " 下頷骨折重建系統,2.3MM 安全骨釘 "OSTEOMED"FAST-FLAP NEURO FIXATION SYSTEM:1.5MM SAFETY SCREW" 歐特美 " 速固硬式固定系統安全螺絲 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.7MM SCREW " 歐美特 " 下頷骨折重建系統,2.7MM 骨釘 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.4MM SCREW " 歐美特 " 下頷骨折重建系統,2.4MM 骨釘 "OSTEOMED"MANDIBULAR FRACTURE RECONSTRUCTION SYSTEM:2.0MM SCREW " 歐美特 " 下頷骨折重建系統,2.0MM 骨釘 1470 710 1470 710 710 390 FPS0120704LE 2.0 MINI BONE SCREW 390 FPS014051NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:SCREWS,SELF-TAPPING SCREW 2.0-2.4MM 5-18MM" 信迪思 " 下顎固定系統 : 骨釘 FPS014651NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:EMERGENCY SELF-TAPPING SCREW 2.7, 5-18MM" 信迪思 " 下顎固定系統 : 骨釘 710 710 34

特材代碼中英文品名支付點數 FPS014668NS1 2.4MM UNILOCK SCREW 自攻牙鎖定骨釘 710 FPS016051NS1 FPS016681NS1 "SYNTHES"MATRIX MANDIBLE SYSTEM:LOCK SCREWS SELF-TAPPING 2.0-2.4MM" 信迪思 " 下顎固定系統 : 骨釘 "SYNTHES"MATRIX MANDIBLE SYSTEM:LOCK SCREWS SELF-TAPPING 2.9 MM" 信迪思 " 下顎固定系統 : 骨釘 710 710 FPS01FM940AE MICRO SCREW,CROSS HEAD,CENTRE,LENGTH 3:5MM 1470 FSP6100611ZQ "SOFRADIM"PARIETENE POLYPROPYLENE MESHES 帕瑞挺人工聚丙烯編網 06X11CM 1072 FSP6101177BA "BARD"SOFT MESH" 巴德 " 柔軟修補網 15CMX15CM 1710 FSP6101510ZQ "SOFRADIM"PARIETENE POLYPROPYLENE MESHES 帕瑞挺人工聚丙烯編網 15X10CM 1672 FSP6110611ZQ "SOFRADIM"PARIETENE POLYPROPYLENE MESHES 6X11CM 帕瑞挺人工聚丙烯編網 1072 FSP6111264DV MARLEX MESH 1"X4"X0.6MM( 自 980401 起改為 BARD MESH FLAT SHEET1"X4") 1072 FSP6111266DV MARLEX MESH 10"X14"( 自 980401 起改為 BARD MESH FLAT SHEET10"X14") 3108 FSP6111267DV MARLEX MESH 2"X12"( 自 980401 起改為 BARD MESH FLAT SHEET2"X12") 1672 FSP6111268DV MARLEX MESH 3"X6" (2PCS/BOX)( 自 980401 起改為 BARD MESH FLAT SHEET3"X6") 1672 FSP6111510ZQ "SOFRADIM"PARIETENE POLYPROPYLENE MESHES 15X10CM 帕瑞挺人工聚丙烯編網 1672 FSP6119910QM "MAQUET"MESH 內植用網 2.5CMX10.2CM 1072 FSP6119930QM "MAQUET"MESH 內植用網 5.1CMX30.5CM,7.6CMX15.2CM 1672 FSP6119940QM "MAQUET"MESH 內植用網 25.4CMX35.6CM 3108 FSP6119960QM "MAQUET"MESH 內植用網 15.2CMX15.2CM 1710 FSP6130711AH "ATRIUM"PROLITE P0LYPROPYLENE MESH 普來聚丙烯網片 (2.5CMX10CM,5CMX10CM) 1072 FSP6130714AH "ATRIUM"PROLITE P0LYPROPYLENE MESH 普來聚丙烯網片 (7.5CMX15CM,10CMX15CM) 1672 FSP6130717AH "ATRIUM"PROLITE P0LYPROPYLENE MESH 普來聚丙烯網片 (15CMX15CM) 1710 FSP6130718AH "ATRIUM"PROLITE POLYPROPYLENE MESH PROLITE ULTRA(20X25.4CM) 普來聚丙烯網片 2966 FSP6130719AH "ATRIUM"PROLITE POLYPROPYLENE MESH PROLITE ULTRA(25.4X25.4CM) 普來聚丙烯網片 2966 FSP6130720AH "ATRIUM"PROLITE P0LYPROPYLENE MESH 普來聚丙烯網片 (25.4CMX35.5CM,30CMX30CM) 3108 FSP61PL212AH "ATRIUM"PROLITE P0LYPROPYLENE MESH 普來聚丙烯網片 (5CMX30CM) 1672 FSP61PL609AH "ATRIUM"PROLITE POLYPROPYLENE MESH PROLITE(15X23CM) 普來聚丙烯網片 2217 FSP7103831AM "AMS"MONARC SUBFACIAL HAMMOCK 懸吊手術系統 ( 兩支不銹鋼彎曲弓狀穿引針 ( 不需再使用 INTRODUCER)+ 一條聚丙烯懸帶 ) 13680 35

FUK05DF030FN "INFOMED"CVVH HEMOFILTER 0.3M 平方新生兒血液過濾器 * 3645 FUK05DF080FN "INFOMED"CVVH HEMOFILTER 0.8M 平方血液過濾器 * 3645 FUK05DF140FN "INFOMED"CVVH HEMOFILTER 1.4M 平方血液過濾器 * 4095 FUK05DF190FN "INFOMED"CVVH HEMOFILTER 1.9M 平方血液過濾器 * 4095 FUK05FHF20GA "GAMBRO"PRISMAFLEX SET(CVVH TUBING+HEMOFILTER)0.2M 平方普利司馬弗列克斯套組 * 4847 FUK05RHF6SGA "GAMBRO"CVVH HEMOFILTER(0.6M 平方 ) 血液過濾器 * 3645 FUK05TS002FN INFOMED EXTRACORPOREAL BLOOD CIRCUITS FOR CF200-PEDIATRIC CVVH 英弗梅體外血液迴路管 * 1393 FUK05TS200FN INFOMED EXTRACORPOREAL BLOOD CIRCUITS FOR CF200- CVVH 英弗梅體外血液迴路管 * 1393 FUK05TS400FN INFOMED EXTRACORPOREAL BLOOD CIRCUITS-CVVH 英弗梅體外血液迴路管 * 1393 FUK05TS504FN INFOMED EXTRACORPOREAL BLOOD CIRCUITS-PEDIATRIC CVVH 英弗梅體外血液迴路管 * 1393 FUS0100411AM "AMS"800 URINARY CONTROL SYSTEM(CONTROL PUMP+PRESSURE-REGULATING BALLOON+BELT CUFFS+800 ACCESSORY KIT )" 艾梅斯 " 尿控系統 * 155000 HEF02HBF14QM " 邁柯唯 " 動脈過濾器 "MAQUET" QUART ARTERIAL FILTER 1629 HEF02S4104M4 " 美敦力 " 艾芬你堤兒童動脈過濾器 "MEDTRONIC"AFFINITY PEDIATRIC ARTERIAL FILTER 1629 HEF03TS203FN HEF03TS204FN 英弗梅體外血液迴路管 INFOMED EXTRACORPOREAL BLOOD CIRCUITS(FOR CF200 PLASMA EXCHANGE) 英弗梅體外血液迴路管 INFOMED EXTRACORPOREAL BLOOD CIRCUITS(FOR CF200-PEDIATRIC PLASMA EXCHANGE) 1500 1500 HEF03TS401FN 英弗梅體外血液迴路管 INFOMED EXTRACORPOREAL BLOOD CIRCUITS 1500 HEF03TSP02FN 英弗梅體外血液迴路管 INFOMED EXTRACORPOREAL BLOOD CIRCUITS(FOR PLASMA EXCHANGE) 1500 HEF03TSP06FN 英弗梅體外血液迴路管 INFOMED EXTRACORPOREAL BLOOD CIRCUITS(PEDIATRIC PLASMA EXCHANGE) 1500 HEH01HPHJUMY " 米得克 " 血液濃縮器 "MINNTECH" HEMOCOR HEMOCONCENTRATOR( 小兒使用 )* 3300 HEH01HPHTSMY " 米得克 " 血液濃縮器 "MINNTECH" HEMOCOR HEMOCONCENTRATOR* 4600 HHF01PL110WX HHF01PL210WX HHF01PL310WX HHF02RC101WX HHF02RC102WX HHF02RC201WX " 雙威 " 單次使用濾除白血球過濾器 ( 血小板用 )"SHUANGWEI" LEUKOCYTE REDUCTION FILTER FOR BLOOD " 雙威 " 單次使用濾除白血球過濾器 ( 血小板用 )"SHUANGWEI" LEUKOCYTE REDUCTION FILTER FOR BLOOD " 雙威 " 單次使用濾除白血球過濾器 ( 血小板用 )"SHUANGWEI" LEUKOCYTE REDUCTION FILTER FOR BLOOD " 雙威 " 單次使用濾除白血球過濾器 ( 全血及紅血球用 )"SHUANGWEI" LEUKOCYTE REDUCTION FILTER FOR BLOOD(500CC) " 雙威 " 單次使用濾除白血球過濾器 ( 全血及紅血球用 )"SHUANGWEI" LEUKOCYTE REDUCTION FILTER FOR BLOOD(1000CC) " 雙威 " 單次使用濾除白血球過濾器 ( 全血及紅血球用 )"SHUANGWEI" LEUKOCYTE REDUCTION FILTER FOR BLOOD(500CC) 1400 1400 1400 615 820 615 36

HHF02RC202WX " 雙威 " 單次使用濾除白血球過濾器 ( 全血及紅血球用 )"SHUANGWEI" LEUKOCYTE REDUCTION 820 FILTER FOR BLOOD(1000CC) HHM01EXPAPM4 美敦力吸除導管 "MEDTRONIC" EXPORT AP ASPIRATION CATHETER* 15000 HHM01RF400BA " 巴德 " 腔靜脈過濾器 "BARD"G2 X VENA CAVA FILTER (FILTER+INTRO+DILA+DELIVERY KIT+ADAPTER) 35000 LEE0111996M4 " 美敦力 " 電極片 "MEDTRONIC" ELECTRODES 652 LEE016025SJE " 宜喜美 " 暫時性節律導線 "ECM"TEMPORARY PACING WIRES 1038 LEE01P1199M4 " 美敦力 " 電極片 "MEDTRONIC" ELECTRODES 490 NAN020632GNR NIPRO NOVOFINE NEEDLE 32G 尼普爾諾和筆注射針 3.2 NBS010001KBD 1CC SAFTI DISPOSABLE SYRINGE WITHOUT/NEEDLE 1CC 注射筒不附針 1.9 NBS010003KBD 3CC SAFTI DISPOSABLE SYRINGE WITHOUT/NEEDLE 3CC 注射筒不附針 1 NBS010005KBD 5CC SAFTI DISPOSABLE SYRINGE WITHOUT/NEEDLE 5CC 注射筒不附針 1.4 NBS010010KBD 10CC SAFTI DISPOSABLE SYRINGE WITHOUT/NEEDLE 10CC 注射筒不附針 2.7 NBS010020KBD 20CC SAFTI DISPOSABLE SYRINGE WITHOUT/NEEDLE 20CC 注射筒不附針 3.5 NBS010030KBD 30CC SAFTI DISPOSABLE SYRINGE WITHOUT/NEEDLE 30CC 注射筒不附針 6.8 NBS010050KBD 50CC SAFTI DISPOSABLE SYRINGE WITHOUT/NEEDLE 50CC 注射筒不附針 12.1 NBS0216154NN NOVOPEN 4 WITHOUT NEEDLE( 筆型胰島素注射筒 ) 每支以使用三年以上為原則 900 NBS0701021N8 MRI SYRINGE SET 顯影劑注射筒 (60CC SYRINGEX1+25CC SYRINGEX1+SPIKEX2+Y 型螺旋管 X1) 455 NBS0701800N8 MRI SYRINGE SET 顯影劑注射筒 (60CC SYRINGEX2+SPIKEX2+Y 型螺旋管 X1) 455 NBS0701801N8 MRI SYRINGE W/SPIKE 顯影劑注射筒 60CC 237 NBS07065VSMH DISPOSABLE SYRINGE KIT 顯影劑注射筒 ( 注射筒 2+ 剌針 2+ 低壓螺旋管與 T 型連接管 1) 455 NBS07115VSMH DISPOSABLE SYRINGE KIT 顯影劑注射筒 ( 注射筒 2+ 剌針 2+ 低壓螺旋管與 T 型連接管 1) 455 NBS0785003NL NAMIC ANGIOGRAPHIC CONTROL SYRINGES (8:20ML) 血管造影控制注射系統 177 NBS07AG115BQ ANGIOGRAPHIC SYRINGE ( 注射筒 X1+ 抽藥管 X1) 240 NBS07AG215BQ ANGIOGRAPHIC SYRINGE ( 注射筒 X1+ 抽藥管 X1) 240 NBS07CT119BQ ANGIOGRAPHIC SYRINGE KIT ( 注射筒 X1+ 抽藥管 X1+ 螺旋管 X1) 315 NBS07CT129BQ ANGIOGRAPHIC SYRINGE KIT ( 注射筒 X2+ 抽藥管 X2+ 螺旋管 X1) 455 NBS07CT219BQ ANGIOGRAPHIC SYRINGE KIT ( 注射筒 X1+ 抽藥管 X1+ 螺旋管 X1) 315 37

NBS07CT229BQ ANGIOGRAPHIC SYRINGE KIT ( 注射筒 X2+ 抽藥管 X2+ 螺旋管 X1) 455 NBS07MR123BQ ANGIOGRAPHIC SYRINGE KIT (60CC 注射筒 X2+ 抽藥管 X1+Y 螺旋管 X1) 455 NBS07MR214BQ ANGIOGRAPHIC SYRINGE KIT (65CC 注射筒 X2+ 抽藥管 X1+Y 螺旋管 X1) 455 NCS010001KBD 1CC SAFTI DISPOSABLE SYRINGE W/NEEDLE 1CC 注射筒附針 2.7 NCS010001NUU 1CC RETRACTABLE SAFETY SYRINGE W/NEEDLE 3.9 NCS010003KBD 3CC SAFTI DISPOSABLE SYRINGE W/NEEDLE 3CC 注射筒附針 1.6 NCS010003NUU 3CC RETRACTABLE SAFETY SYRINGE W/NEEDLE 2.8 NCS010003SYF 3CC DISPOSABLE SYRINGE W/NEEDLE (SAFETY) 2.8 NCS010005KBD 5CC SAFTI DISPOSABLE SYRINGE W/NEEDLE 5CC 注射筒附針 2.2 NCS010005NUU 5CC RETRACTABLE SAFETY SYRINGE W/NEEDLE 3.9 NCS010005SYF 5CC DISPOSABLE SYRINGE W/NEEDLE (SAFETY) 3.9 NCS010010KBD 10CC SAFTI DISPOSABLE SYRINGE W/NEEDLE 10CC 注射筒附針 3.2 NCS010020KBD 20CC SAFTI DISPOSABLE SYRINGE W/NEEDLE 20CC 注射筒附針 4 NCS010030KBD 30CC SAFTI DISPOSABLE SYRINGE W/NEEDLE 30CC 注射筒附針 7.3 NCS010050KBD 50CC SAFTI DISPOSABLE SYRINGE W/NEEDLE 50CC 注射筒附針 12.6 NCS030000NUU RETRACTABLE SAFETY INSULIN SYRINGE W/NEEDLE 7 NDN041824ATM SURSHIELD SURFLO II 安全靜脈留置針 32.4 NDN043818ABD INSYTE AUTOGUARD SHIELDED IV CATHETER 回縮式安全靜脈導管 32.4 NDN04FEP03BB INTROCAN SAFETY IVC CANNULAE 32.4 NDN04PUR03BB INTROCAN SAFETY IVC CANNULAE 32.4 NDN04S1424BD INSYTE IV CATHETER(VIALON) 14.5 NES011815NHK "HAKKO"PTC CHIBA NEEDLE 肝膽穿刺針 150MM:250MM 400 NES01BM00XGP "GALLINI"BIOMID DISPOSABLE BONE MARROW ASPIRATION BIOPSY NEEDLE" 格利尼 " 可丟棄式骨髓吸取針 623 NES0218150TP "TOP"ASPIRATION BIOPSY NEEDLE (18GX150MM) 吸引生檢針 663 NES0218200TP "TOP"ASPIRATION BIOPSY NEEDLE (18GX200MM) 吸引生檢針 663 NES0221200TP "TOP"ASPIRATION BIOPSY NEEDLE (21GX200MM) 吸引生檢針 663 38

NES03315SDJU "PAJUNK"DELTA CUT BIOPSY SYSTEM 生檢穿刺套管組 14:20G 611 NES041218ABA NES041MBS9ZM "BARD"MONOPTY DISPOSABLE BIOPSY INSTRUMENT+TRUGUIDE COAXIAL BIOPSY NEEDLE 組織取樣針 + 同軸導引針 "MD TECH"SUPER-CORE II ADJUSTABLE BIOPSY INSTRUMENT+MD TECH CO-AXIAL INTRODUCER NEEDLE 切片針 + 同軸導引針 * 1500 1500 NES04ACNMFG5 "ANGIOTECH"ACN BIOPSY NEEDLES WITH CO-AXIAL NEEDLE 愛仕恩切片針 ( 同軸庫針組 )14-20G* 1500 NES04CT14NC8 NES04MCTGABA "CARDINAL"BIOPSY NEEDLES 14G:22G+UNIVERSAL COAXIAL INTRODUCER NEEDLE 生檢針 + 同軸導引針 * "BARD"MAX-CORE DISPOSABLE BIOPSY INSTRUMENT+TRUGUIDE COAXIAL BIOPSY NEEDLE 組織取樣針 + 同軸導引針 1500 1500 SAU01TA30LUS " 優施西 " TA 自動手術縫合釘 "USSC" TA LOADING UNITS 30MM 2293 SAU01TA45LUS " 優施西 " TA 自動手術縫合釘 "USSC" TA LOADING UNITS 45MM 2063 SAU01TA60LUS " 優施西 " TA 自動手術縫合釘 "USSC" TA LOADING UNITS 60MM 2063 SAU01TA90LUS " 優施西 " TA 自動手術縫合釘 "USSC" TA LOADING UNITS 90MM 2153 TBCT10023TVR TBCT10027TVR TBCT102836HV TKP03LEVEESB "EAGLE LABS"MANUAL OPHTHALMIC SURGICAL INSTRUMENT-LACRIMAL INTUBATION SET" 老鷹 " 手動式眼科手術器械 - 鼻淚管通條 "EAGLE LABS"MANUAL OPHTHALMIC SURGICAL INSTRUMENT-LACRIMAL INTUBATION SET" 老鷹 " 手動式眼科手術器械 - 鼻淚管通條 " 艾伯特海斯 " 手動式眼科手術器械 - 鼻淚管通條 "ALBERT HEISS"MANUAL OPHTHALMIC SURGICAL INSTRUMENT-LACHRYMAL INTUBATION SET LEVEEN COACCESS ELECTRODES SYSTEM AND LEVEEN NEEDLE ELECTRODES 勒鈖共進電極系統與勒鈖針狀電極探頭 1773 1773 1773 22215 TKP04REL01RC "RANFAC"BREAST MARKING SYSTEM:NEEDLE+HOOK WIRE( 乳房定位器材組 ) 990 TKP04SBS01RC "RANFAC"BREAST MARKING SYSTEM:NEEDLE+HOOK WIRE+STIFFENING CANNULA( 乳房定位器材組 ) 1170 TKVC105064QQ POSTERIOR VITRECTOMY CUTTERS 30PSI 20GA( 後房玻璃體切除刀 ) 4409 TKVC10506NQQ TKVC105100MV TKVC105124QQ "MICRO VISION"MANUAL OPHTHALMIC SURGICAL INSTRUMENT:ACCURUS VITRECTOMY PROBE" 麥可威視 " 手動式眼科手術器械 : 玻璃體切除探頭 MICROVISION OPTHALMIC SURGICAL INSTRUMENT:POSTERIOR VITRECTOMY CUTTERS 微視手動式眼科器械 : 玻璃體切除探頭 "MICRO VISION"MANUAL OPHTHALMIC SURGICAL INSTRUMENT:ACCURUS VITRECTOMY PROBE 2500 切 " 麥可威視 " 手動式眼科手術器械 : 玻璃體切除探頭 TSS01000011R 羅氏優勝血糖機組 - 羅氏優勝血糖試紙 ACCU-CHEK PERFORMA TEST STRIPS(10 片,25 片,50 片,MIC50 片 / 罐 )* 使用規定請見備註欄 4409 4409 4950 13 TSS0100001G8 測利得超值型血糖檢測系統 - 血糖試片 (25 片 50 片 / 盒 )* 使用規定請見備註欄 13 TSS0100001J1 暐世血糖測試儀套組 - 血糖試紙 * 使用規定請見備註欄 (25 片,50 片 / 罐 ) 13 TSS0100001XX 安倍賜血糖測試儀 - 安倍賜血糖試片 (25 片,50 片 / 盒 )* 使用規定請見備註欄 13 TSS01000021R 羅氏優勢血糖機組 - 羅氏優勢血糖試紙 ACCU-CHEK ADVANTAGE TEST STRIPS((10 片,25 片,50 片 / 罐 )* 使用規定請見備註欄 13 TSS0100002G8 測利得超優型血糖檢測系統 - 血糖試片 (25 片 50 片 / 盒 )* 使用規定請見備註欄 13 39

TSS0100002J1 暐世新型血糖測試儀套組 - 血糖試紙 * 使用規定請見備註欄 (50 片,25 片 / 罐 ) 13 TSS01000031R 羅氏活力血糖機組 - 羅氏活力血糖試紙 (10 片,25 片,50 片 / 罐 )* 使用規定請見備註欄 13 TSS0100003G8 好輕鬆血糖檢測系統 - 血糖試片 (25 片 50 片 / 盒 )* 使用規定請見備註欄 13 TSS0100003J1 暐世攜帶型血糖測試儀套組 - 血糖試紙 * 使用規定請見備註欄 (10 片,15 片 / 罐 ) 13 TSS01000041R 羅氏 GO 讚血糖機組 - 羅氏 GO 讚血糖試紙 ACCU-CHEK GO TEST STRIPS((10 片,50 片 / 罐 )* 使用規定請見備註欄 13 TSS0100004G8 日安血糖檢測系統 - 血糖試片 (50 片 / 盒 )* 使用規定請見備註欄 13 TSS01000051R TSS0100005GV 羅氏整合型血糖機組 - 羅氏整合型血糖試紙 ACCU-CHEK INTEGRA TEST STRIPS((17 片 / 捲,3 捲 / 盒 )* 使用規定請見備註欄樂適康血糖監測系統之血糖試紙 GLUCO PLUS GLUCOSE MONITORING SYSTEM'S BLOOD TEST STRIP(25 片或 50 片 / 盒 )* 使用規定請見備註欄 13 13 TSS01000EKUE 優克糖血糖監測系統 - 血糖試紙 (25 片 / 罐 )* 使用規定請見備註欄 13 TSS0106301AB TSS0111401AB TSS0111435AB " 亞培 " 信妥血糖試紙 (50 片,100 片 / 罐 )PRECISION PCX PLUS BLOOD GLUCOSE TEST STRIPS* 使用規定請見備註欄 " 亞培 " 歐騰智慧型多功能血糖血酮監測系統 - 歐騰智慧型多功能血糖試紙 OPTIUM POINT OF CARE TEST STRIPS(25 片,50 片,100 片 / 罐 )* 使用規定請見備註欄 " 亞培 " 第二代醫療專用血糖試紙 OPTIUM POINT OF CARE TEST STRIPS(25 片,50 片,100 片 / 罐 )* 使用規定請見備註欄 13 13 13 TSS0117311G7 龍易血糖測試系統 - 血糖試紙 (50 片 / 盒 )* 使用規定請見備註欄 13 TSS013250BF9 福爾 2 合 1 血糖機之血糖試紙 * 使用規定請見備註欄 (25 片,50 片 / 盒 ) 13 TSS014227AF9 福爾語音型血糖機之血糖試紙 * 使用規定請見備註欄 (25 片,50 片 / 盒 ) 13 TSS014230DF9 福爾舒康血糖測試系統之血糖試紙 * 使用規定請見備註欄 (25 片,50 片 / 盒 ) 13 TSS014231AF9 福爾易退片血糖機之血糖試紙 * 使用規定請見備註欄 (25 片,50 片 / 盒 ) 13 TSS0142401AB " 亞培 " 利舒坦血糖檢測系統 - 利舒坦血糖試紙 FREESTYLE TEST STRIPS(10 片,25 片,50 片,100 片 / 罐 )* 使用規定請見備註欄 13 TSS014241AF9 福爾益康血糖機之血糖試紙 * 使用規定請見備註欄 (25 片,50 片 / 盒 ) 13 TSS014251AF9 福爾易退片血糖機之血糖試紙 * 使用規定請見備註欄 (25 片,50 片 / 盒 ) 13 TSS0145656GK 歐克葡萄糖試驗系統 - 歐克血糖試片 (25 片,50 片 / 盒 )* 使用規定請見備註欄 13 TSS0145657GK 歐克語音血糖監測系統 - 歐克語音血糖測試片 (25 片,50 片 / 盒 )* 使用規定請見備註欄 13 TSS0145658GK 歐克免設碼血糖監測系統 - 歐克免設碼血糖試片 (25 片,50 片 / 盒 )* 使用規定請見備註欄 13 TSS0145659GK 慧昇克立測血糖監測系統 - 慧昇克立測血糖試片 (50 片 / 盒 )* 使用規定請見備註欄 13 TSS01505C2J3 " 愛森斯 " 快速測血糖試紙 "I-SENS"CARESENS II BLOOD GLUCOSE TEST STRIPS(10 片,50 片 / 罐 )* 13 TSS01ACCP1FH 艾康血糖測試系統 - 血糖試紙 ACON ON CALL PLUS BLOOD GLUCOSE TEST STRIPS(50 片 / 盒,25 片 ( 單片鋁箔包 )/ 盒,1 片 ( 單片鋁箔包 ))* 使用規定請見備註欄 13 40

TSS01AD0505A 欣瑞血糖測試系統 - 欣瑞血糖測試片 (25 片,50 片 / 罐 )* 使用規定請見備註欄 13 TSS01AP100FT 愛彼德血糖測試系統 - 血糖試紙 (10 片,25 片 / 罐 )* 使用規定請見備註欄 13 TSS01APPLUFT 愛彼德進階血糖測試系統 - 血糖測試片 (10 片,25 片 / 罐 )* 13 TSS01B2001WB " 拜安捷 " 血糖測試試紙 ASCENSIA BREEZE 2 BLOOD GLUCOSE TEST STRIPS(10 片 /DISC,5*10 STRIPS)* 使用規定請見備註欄 13 TSS01BKGS1GB 百捷血糖檢測系統 - 百捷血糖試片 (25 片,50 片 / 盒 )* 使用規定請見備註欄 13 TSS01BKPGSGB 百捷益血糖檢測系統 - 百捷益血糖試片 (25 片,50 片 / 盒 )* 使用規定請見備註欄 13 TSS01CTS01WB " 拜耳 " 拜安康血糖測試試紙 "BAYER"CONTOUR TS BLOOD GLUCOSE TEST STRIPS(50 片 / 盒,2*25 STRIPS)* 使用規定請見備註欄 13 TSS01DG050FK 糖易測血糖監測系統 - 血糖試紙 * 使用規定請見備註欄 (10 片,25 片,50 片,75 片,100 片 / 罐 ) 13 TSS01EL001WB " 拜耳 " 易理測血糖測試試紙 ASCENSIA ELITE BLOOD GLUCOSE TEST STRIPS(50 片 / 盒 )* 使用規定請見備註欄 13 TSS01EN001FY " 愛科來 " 葡萄糖檢測試紙 II(50 片 / 盒 ) * 使用規定請見備註欄 13 TSS01EN002FY " 愛科來 "X- 血糖檢測試紙 10 片,50 片 / 盒 * 13 TSS01EPSEZFU 勁速康血糖量測系統 - 血糖試紙 (10 片,25 片,50 片 / 盒 )* 使用規定請見備註欄 13 TSS01G421SVL 愛奧樂血糖測試儀專用試紙 * 使用規定請見備註欄 13 TSS01G423SVL 愛奧樂血糖測試系統專用試紙 * 使用規定請見備註欄 13 TSS01GM100FS 瑞特血糖監測系統 GM100- 瑞特血糖測試片 *(10 片,25 片,50 片,100 片,200 片 / 盒 )* 使用規定請見備註欄 13 TSS01GM210FS 瑞特血糖監測系統 GM210- 瑞特血糖測試片 (10 片,25 片,50 片,100 片,200 片 / 盒 )* 使用規定請見備註欄 13 TSS01GM300FS 瑞特血糖監測系統 GM300- 瑞特血糖測試片 *(10 片,25 片,50 片,100 片 / 盒 )* 使用規定請見備註欄 13 TSS01GM550FS 瑞特血糖監測系統 GM550- 瑞特血糖測試片 (10 片,25 片,50 片,100 片,200 片 / 盒 )* 使用規定請見備註欄 13 TSS01GPLUSBB 柏朗貝佳血糖機 - 血糖試紙 OMNITEST PLUS GLUCOSE MONITORING SYSTEM-TEST STRIPS(10 片,25 片,50 片 / 罐 )* 使用規定請見備註欄 13 TSS01HHRRZFZ 隨手測血糖試紙 "ONETOUCH"HORIZON TM TEST STRIPS(25 片 / 盒 )* 使用規定請見備註欄 13 TSS01HL5888H 瑞康 588 自我血糖監控系統 - 瑞康血糖試紙 (10 片,25 片,50 片 / 盒 )* 使用規定請見備註欄 13 TSS01MAJHRFT 茂晶血糖測試系統 - 血糖試紙 (10 片,25 片 / 罐 )* 使用規定請見備註欄 13 TSS01MAJJRFT 茂晶血糖測試系統 - 血糖試紙 (10 片,25 片 / 罐 )* 使用規定請見備註欄 13 TSS01RMCB1RP 優盛血糖測試套組 - 血糖試紙 (10 片,25 片,50 片 / 罐,25 片 *2 罐 )* 使用規定請見備註欄 13 TSS01SE0505A 欣速血糖測試系統 - 欣速血糖測試片 SENSOREX G TEST STRIPS(50 片 / 罐 )* 使用規定請見備註欄 13 TSS01SG103FX 易立測血糖試紙 (10 片,25 片,50 片 / 盒 )* 使用規定請見備註欄 13 41

特材代碼中英文品名支付點數 TSS01SG105J4 易美測 I 血糖試紙 (25 片 / 盒 )* 13 TSS01SG106FX 易立測 II 血糖試紙 (10 片,25 片,50 片 / 盒 )* 使用規定請見備註欄 13 TSS01SG203FX 易立測血糖試紙 (25 片 *2 盒 )* 使用規定請見備註欄 13 TSS01SG205J4 易美測 I 血糖試紙 (25 片 *2 盒 )* 13 TSS01SG206FX 易立測 II 血糖試紙 (25 片 *2 盒 )* 使用規定請見備註欄 13 TSS01SMC00FT 適美捷血糖測試系統 - 血糖試紙 (10 片,25 片 / 罐 )* 使用規定請見備註欄 13 TSS01T10255A 必立康 GC 血糖 / 膽固醇雙功能測試系統 - 虹吸 2 血糖測試片 (25 片,50 片 / 罐 )* 使用規定請見備註欄 13 TSS01T10505A 必立康血糖 / 尿酸雙功能測試系統 - 虹吸 2 血糖測試片 (25 片,50 片 / 罐 )* 使用規定請見備註欄 13 TSS01T12255A 速利測血糖測試系統 - 虹吸 2 血糖測試片 (25 片,50 片 / 罐 )* 使用規定請見備註欄 13 TSS01TB001F7 易速得 -168 血糖測試套組 - 易速得 -168 血糖測試片 (10 片,25 片,50 片 / 罐 ;25 片 *2 罐 )* 使用規定請見備註欄 13 TSS01TB002F7 易速得 -606 血糖測試套組 - 易速得 -606 血糖測試片 (10 片,25 片,50 片 / 罐 ;25 片 *2 罐 )* 使用規定請見備註欄 13 TSS01TB003F7 易速得 -608 血糖測試套組 - 易速得 -608 血糖測試片 (10 片,25 片,50 片 / 罐 ;25 片 *2 罐 )* 使用規定請見備註欄 13 TSS01TB004F7 舒適測血糖測試套組 - 舒適測血糖測試片 (10 片,25 片,50 片 / 罐 ;25 片 *2 罐 )* 使用規定請見備註欄 13 TSS01TB005F7 特立捷血糖測試套組 - 特立捷血糖測試片 (10 片,25 片,50 片 / 罐 ;25 片 *2 罐 )* 使用規定請見備註欄 13 TSS01TB006F7 易速得血糖測試片 10 片,25 片,50 片 / 罐 * 使用規定請見備註欄 13 TSS01TB007F7 台欣 TB100 血糖測試片 10 片,25 片,50 片 / 罐 * 使用規定請見備註欄 13 TSS01ULTRAFZ 穩豪血糖試紙 "ONETOUCH" ULTRA TEST STRIPS(25 片 / 罐,2 罐 / 盒 ;25 片 / 盒 100.1.1 生效 )* 使用規定請見備註欄 13 TSS01VE2255A 欣聲血糖檢測試片 (25 片,30 片,50 片 / 罐 )* 使用規定請見備註欄 13 WBB0402050RL "RE-ORDER"ELASTIC BANDAGE(NON-STERILE)2 吋 X5 碼彈性繃帶 * 10.6 WBB0403050RL "RE-ORDER"ELASTIC BANDAGE(NON-STERILE)3 吋 X5 碼彈性繃帶 * 15.2 WBB0404050RL "RE-ORDER"ELASTIC BANDAGE(NON-STERILE)4 吋 X5 碼彈性繃帶 * 19.3 WBB0406050RL "RE-ORDER"ELASTIC BANDAGE(NON-STERILE)6 吋 X5 碼彈性繃帶 * 25.5 WBB0703031NS NOK-SAN CAST PLASTER BANDAGE 石膏繃帶 3"X3Y 23 WBB0802040HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE) 樹脂石膏繃帶 ( 聚脂纖維 )2 吋 X4.4 碼 * 240 WBB0802040K3 "KANGDA"ORTHOPEDIC CASTING TAPE 樹脂石膏繃帶 ( 玻璃纖維 )2 吋 4 碼 * 240 WBB0802041HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NEAL CAST FIBERGLASS ALPHA TYPE) 樹脂石膏繃帶 ( 玻璃纖維 )2 吋 X4.4 碼 * 240 42

WBB0803040HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE) 樹脂石膏繃帶 ( 聚脂纖維 )3 吋 X4.4 碼 * 280 WBB0803040K3 "KANGDA"ORTHOPEDIC CASTING TAPE 樹脂石膏繃帶 ( 玻璃纖維 )3 吋 4 碼 * 280 WBB0803041HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NEAL CAST FIBERGLASS ALPHA TYPE) 樹脂石膏繃帶 ( 玻璃纖維 )3 吋 X4.4 碼 * 280 WBB0804040HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE) 樹脂石膏繃帶 ( 聚脂纖維 )4 吋 X4.4 碼 * 320 WBB0804040K3 "KANGDA"ORTHOPEDIC CASTING TAPE 樹脂石膏繃帶 ( 玻璃纖維 )4 吋 4 碼 * 320 WBB0804041HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NEAL CAST FIBERGLASS ALPHA TYPE) 樹脂石膏繃帶 ( 玻璃纖維 )4 吋 X4.4 碼 * 320 WBB0805040HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE) 樹脂石膏繃帶 ( 聚脂纖維 )5 吋 X4.4 碼 * 360 WBB0805040K3 "KANGDA"ORTHOPEDIC CASTING TAPE 樹脂石膏繃帶 ( 玻璃纖維 )5 吋 4 碼 * 360 WBB0805041HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NEAL CAST FIBERGLASS ALPHA TYPE) 樹脂石膏繃帶 ( 玻璃纖維 )5 吋 X4.4 碼 * 360 WBB0806040K3 "KANGDA"ORTHOPEDIC CASTING TAPE 樹脂石膏繃帶 ( 玻璃纖維 )6 吋 4 碼 * 400 WBB0820400HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE) 樹脂石膏繃帶 ( 玻璃纖維 )2 吋 X4.4 碼 * 240 WBB0830400HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE) 樹脂石膏繃帶 ( 玻璃纖維 )3 吋 X4.4 碼 * 280 WBB0840400HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE) 樹脂石膏繃帶 ( 玻璃纖維 )4 吋 X4.4 碼 * 320 WBB0850400HZ "HORIZON"ORTHOPEDIC CASTING TAPE(NON-STERILE) 樹脂石膏繃帶 ( 玻璃纖維 )5 吋 X4.4 碼 * 360 WDD08000153M 3M TEGADERM HYDROGEL WOUND FILLER(STERILE) 15GM 水解凝膞 * 162 WDD08000253M 3M TEGADERM HYDROGEL WOUND FILLER(STERILE)25GM 水解凝膞 * 276 WDD0800073SN WDD0800078SN WDD0800081SN "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL DRESSING 7.5CMX7.5CM" 史耐輝 " 愛力膟銀親水性抗菌敷料 * "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL DRESSING 12.5CMX12.5CM" 史耐輝 " 愛力膟銀親水性抗菌敷料 * "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL DRESSING 17.5CMX17.5CM" 史耐輝 " 愛力膟銀親水性抗菌敷料 * WDD0800083SN "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL DRESSING 5CMX5CM" 史耐輝 " 愛力膟銀親水性抗菌敷料 * WDD0800086SN WDD0800089SN WDD0800091SN WDD0800248SN WDD0800249SN WDD0800250SN "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL DRESSING 10CMX10CM" 史耐輝 " 愛力膟銀親水性抗菌敷料 * "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL DRESSING 15CMX15CM" 史耐輝 " 愛力膟銀親水性抗菌敷料 * "SMITH&NEPHEW"ALLEVYN AG HYDROCELLULAR ANTIMICROBIAL DRESSING 20CMX20CM" 史耐輝 " 愛力膟銀親水性抗菌敷料 * "SMITH&NEPHEW"ALLEVYN GENTLE SOFT GEL ADHESIVE HYDROCELLULAR DRESSING 10CMX10CM" 史耐輝 " 柔膞愛力膟敷料 ( 滅菌 )* "SMITH&NEPHEW"ALLEVYN GENTLE SOFT GEL ADHESIVE HYDROCELLULAR DRESSING 10CMX20CM" 史耐輝 " 柔膞愛力膟敷料 ( 滅菌 )* "SMITH&NEPHEW"ALLEVYN GENTLE SOFT GEL ADHESIVE HYDROCELLULAR DRESSING 15CMX15CM" 史耐輝 " 柔膞愛力膟敷料 ( 滅菌 )* 198 320 459 57 228 413 612 119 225 250 43

WDD0800251SN "SMITH&NEPHEW"ALLEVYN GENTLE SOFT GEL ADHESIVE HYDROCELLULAR DRESSING 364 20CMX20CM" 史耐輝 " 柔膞愛力膟敷料 ( 滅菌 )* WDD0800510F4 DUODERM EXTRA THIN CGF DRESSING 5X10CM 超薄型親水性敷料 * 43 WDD0800520F4 DUODERM EXTRA THIN CGF DRESSING 5X20CM 超薄型親水性敷料 * 55 WDD0800691SN "SMITH&NEPHEW"ALLEVYN DRESSING 愛力膟親水性的聚乙烯敷料 (LITE 10CMX10CM)* 123 WDD0800692SN "SMITH&NEPHEW"ALLEVYN DRESSING 愛力膟親水性的聚乙烯敷料 (LITE 10CMX20CM)* 255 WDD0801010F4 DUODERM EXTRA THIN CGF DRESSING 10X10CM 超薄型親水性敷料 * 55 WDD0801212UG "URGO"ALGOPLAQUE HYDROCOLLOID DRESSING(STERILE)10CMX10CM 悠可平親水性敷料 * 123 WDD0801214UG "URGO"ALGOPLAQUE HYDROCOLLOID DRESSING(STERILE)15CMX15CM 悠可平親水性敷料 * 255 WDD0801216UG "URGO"ALGOPLAQUE HYDROCOLLOID DRESSING(STERILE)20CMX20CM 悠可平親水性敷料 * 400 WDD0801221UG WDD0801222UG WDD0801224UG WDD0801226UG WDD0801228UG WDD0801249UG WDD0801250UG WDD0801251UG WDD0801252UG "URGO"ALGOPLAQUE FILM/THIN HYDROCOLLOID DRESSING(STERILE)5CMX10CM 悠可平薄型親水性敷料 * "URGO"ALGOPLAQUE FILM/THIN HYDROCOLLOID DRESSING(STERILE)5CMX20CM 悠可平薄型親水性敷料 * "URGO"ALGOPLAQUE FILM/THIN HYDROCOLLOID DRESSING(STERILE)10CMX10CM 悠可平薄型親水性敷料 * "URGO"ALGOPLAQUE FILM/THIN HYDROCOLLOID DRESSING(STERILE)15CMX15CM 悠可平薄型親水性敷料 * "URGO"ALGOPLAQUE FILM/THIN HYDROCOLLOID DRESSING(STERILE)20CMX20CM 悠可平薄型親水性敷料 * "URGO"URGOSORB ALGINATE HYDROCOLLOID ABSORBENT DRESSING(STERILE)5CMX30CM 悠可吸藻酸鹽親水性敷料 * "URGO"URGOSORB ALGINATE HYDROCOLLOID ABSORBENT DRESSING(STERILE)5CMX5CM 悠可吸藻酸鹽親水性敷料 * "URGO"URGOSORB ALGINATE HYDROCOLLOID ABSORBENT DRESSING(STERILE)10CMX10CM 悠可吸藻酸鹽親水性敷料 * "URGO"URGOSORB ALGINATE HYDROCOLLOID ABSORBENT DRESSING(STERILE)10CMX20CM 悠可吸藻酸鹽親水性敷料 * 43 55 55 121 196 130 23 121 139 WDD0801515F4 DUODERM EXTRA THIN CGF DRESSING 15X15CM 超薄型親水性敷料 * 121 WDD0801701UG "URGO"HYDROGEL(STERILE)15G/TUBE 水性凝膞 * 162 WDD0803708F4 "CONVATEC"AQUACEL AG HYDROFIBER DRESSING 10X10CM * 228 WDD0803710F4 "CONVATEC"AQUACEL AG HYDROFIBER DRESSING 15X15CM * 413 WDD0803711F4 "CONVATEC"AQUACEL AG HYDROFIBER DRESSING 20X30CM * 920 WDD0803712F4 "CONVATEC"AQUACEL AG HYDROFIBER DRESSING 2X45CM * 198 WDD0803771F4 "CONVATEC"AQUACEL AG HYDROFIBER DRESSING 2X45CM * 198 WDD0807630SN "SMITH&NEPHEW"ALLEVYN DRESSING 愛力膟親水性的聚乙烯敷料 (HEEL 10.5CMX13.5CM)* 177 44

WDD0807640SN "SMITH&NEPHEW"ALLEVYN DRESSING 愛力膟親水性的聚乙烯敷料 (TRACHE0STOMY 9CMX9CM)* 86 WDD08090023M 3MTEGASORB HYDROCOLLOID DRESSING 親水性敷料 10CMX10CM* 123 WDD08090053M 3MTEGASORB HYDROCOLLOID DRESSING 親水性敷料 15CMX15CM* 255 WDD0810607F4 "CONVATEC"VERSIVA XC DRESSING(STERILE)11CMX11CM 威吸寶敷料 * 143 WDD0810608F4 "CONVATEC"VERSIVA XC DRESSING(STERILE)15CMX15CM 威吸寶敷料 * 250 WDD0810609F4 "CONVATEC"VERSIVA XC DRESSING(STERILE)10CMX10CM 威吸寶敷料 * 119 WDD0810610F4 "CONVATEC"VERSIVA XC DRESSING(STERILE)14CMX14CM 威吸寶敷料 * 225 WDD0810611F4 "CONVATEC"VERSIVA XC DRESSING(STERILE)22CMX22CM 威吸寶敷料 * 419 WDD0810612F4 "CONVATEC"VERSIVA XC DRESSING(STERILE)18.5CMX20.5CM 威吸寶敷料 * 364 WDD0810613F4 "CONVATEC"VERSIVA XC DRESSING(STERILE)21CMX25CM 威吸寶敷料 * 512 WDD0810614F4 "CONVATEC"VERSIVA XC DRESSING(STERILE)20CMX20CM 威吸寶敷料 * 364 WDD0810615F4 "CONVATEC"VERSIVA XC DRESSING(STERILE)19CMX19CM 威吸寶敷料 * 364 WDD0811010F4 "CONVATEC"DUO DERM CGF CONTROL GEL FORMULA DRESSING 10X10CM 親水性 CGF 敷料 * 123 WDD0812020F4 "CONVATEC"DUO DERM CGF CONTROL GEL FORMULA DRESSING 20X20CM 親水性 CGF 敷料 * 400 WDD0812030F4 "CONVATEC"DUO DERM CGF CONTROL GEL FORMULA DRESSING 20X30CM 親水性 CGF 敷料 * 689 WDD0837400CA "COLOPLAST"SEASORB SOFT DRESSING(ALGINATE)(FILLER)3CMX44CM 軟性敷料 * 130 WDD0847578SN "SMITH&NEPHEW"ALLEVYN DRESSING 愛力膟親水性的聚乙烯敷料 (THIN 10CMX10CM)* 55 WDD0847579SN "SMITH&NEPHEW"ALLEVYN DRESSING 愛力膟親水性的聚乙烯敷料 (THIN 15CMX20CM)* 145 WDD0856100LN WDD0856150LN WDD0856600LN MOLNLYCKE MELGISORB AG ANTIMICROBIAL ALGINATE DRESSING 美尼克美極收銀抗菌海藻鹽敷料 10CMX10CM* MOLNLYCKE MELGISORB AG ANTIMICROBIAL ALGINATE DRESSING 美尼克美極收銀抗菌海藻鹽敷料 15CMX15CM* MOLNLYCKE MELGISORB AG ANTIMICROBIAL ALGINATE DRESSING 美尼克美極收銀抗菌海藻鹽敷料 3CMX44CM* 228 413 228 WDD0862110BB "B.BRAUN"ASKINA CALGITROL AG 雅膟凱奇樂藻酸銀敷料 10CMX10CM* 228 WDD0862115BB "B.BRAUN"ASKINA CALGITROL AG 雅膟凱奇樂藻酸銀敷料 15CMX15CM* 413 WDD0868210F4 KALTOSTAT ALGINATE WOUND DRESSING 5X5CM 藻酸鈣鈉鹽傷口敷料 * 23 WDD0868212F4 KALTOSTAT ALGINATE WOUND DRESSING 7.5X12CM 藻酸鈣鈉鹽傷口敷料 * 72 WDD0868214F4 KALTOSTAT ALGINATE WOUND DRESSING 10X20CM 藻酸鈣鈉鹽傷口敷料 * 139 45

WDD0868215F4 KALTOSTAT ALGINATE WOUND DRESSING 15X25CM 藻酸鈣鈉鹽傷口敷料 * 269 WDD0877901F4 AQUACEL HYDROFIBER DRESSING5CMX5CM* 30 WDD0877902F4 AQUACEL HYDROFIBER DRESSING 10CMX10CM* 123 WDD0877903F4 AQUACEL HYDROFIBER DRESSING 15CMX15CM* 255 WDD0887121LN WDD0887321LN MEPILEX AG ANTIMICROBIAL SOFT SILICONE FOAM DRESSING 美皮蕾銀抗菌軟性矽膞泡棉敷料 12.5CM*12.5CM* MEPILEX AG ANTIMICROBIAL SOFT SILICONE FOAM DRESSING 美皮蕾銀抗菌軟性矽膞泡棉敷料 17.5CM*17.5CM* 327 576 WDD0887987F4 "CONVATEC"DUODERM HYDROACTIVE GEL 30GM 多愛膟親水性凝膞 * 276 WDD0887990F4 "CONVATEC"DUODERM HYDROACTIVE GEL 15GM 多愛膟親水性凝膞 * 162 WDD08906003M 3M HYDROPHILIC WOUND DRESSING 親水性創傷覆蓋材 (TEGADERM FOAM 5CMX5CM)* 30 WDD08906013M 3M HYDROPHILIC WOUND DRESSING 親水性創傷覆蓋材 (TEGADERM FOAM 10CMX10CM)* 123 WDD08906023M 3M HYDROPHILIC WOUND DRESSING 親水性創傷覆蓋材 (TEGADERM FOAM 10CMX20CM)* 255 WDD08906033M 3M HYDROPHILIC WOUND DRESSING 親水性創傷覆蓋材 (TEGADERM FOAM 20CMX20CM)* 400 WDD0899570HN "HARTMANN"ATRAUMAN AG SILVER DRESSING(5X5CM) 含銀軟膏膟料 * 適應證請見備註欄 57 WDD0899571HN "HARTMANN"ATRAUMAN AG SILVER DRESSING(10X10CM) 含銀軟膏膟料 * 適應證請見備註欄 228 WDD0899572HN "HARTMANN"ATRAUMAN AG SILVER DRESSING(10X20CM) 含銀軟膏膟料 * 適應證請見備註欄 413 WDD08A0520SN "SMITH&NEPHEW"ALGISITE M CALCIUM ALGINATE DRESSING" 史耐輝 " 海藻酸鈣敷料 10X10CM* 121 WDD08A0521SN "SMITH&NEPHEW"ALGISITE M CALCIUM ALGINATE DRESSING" 史耐輝 " 海藻酸鈣敷料 15X20CM* 200 WDD08A0522SN "SMITH&NEPHEW"ALGISITE M CALCIUM ALGINATE DRESSING" 史耐輝 " 海藻酸鈣敷料 2X30CM* 47 WDD08E1405K6 WDD08E1407K6 WDD08E1416K6 WDD08E2405K6 WDD08E2407K6 WDD08E2412K6 WDD08E2416K6 WDD08E2432K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND DRESSING(STERILE)(STANDARD)10X10CM" 優而美 " 舒肌親水性傷口敷料 * 適應症請健備註欄 "EUROMED"SURESKIN HYDROCOLLOID WOUND DRESSING(STERILE)(STANDARD)20X20CM" 優而美 " 舒肌親水性傷口敷料 * 適應症請健備註欄 "EUROMED"SURESKIN HYDROCOLLOID WOUND DRESSING(STERILE)(STANDARD)15X15CM" 優而美 " 舒肌親水性傷口敷料 * 適應症請健備註欄 "EUROMED"SURESKIN HYDROCOLLOID WOUND DRESSING(STERILE)(BORDER)10X10CM" 優而美 " 舒肌親水性傷口敷料 * 適應症請健備註欄 "EUROMED"SURESKIN HYDROCOLLOID WOUND DRESSING(STERILE)(BORDER)20X20CM" 優而美 " 舒肌親水性傷口敷料 * 適應症請健備註欄 "EUROMED"SURESKIN HYDROCOLLOID WOUND DRESSING(STERILE)(BORDER-SACRAL)15X18CM" 優而美 " 舒肌親水性傷口敷料 * 適應症請健備註欄 "EUROMED"SURESKIN HYDROCOLLOID WOUND DRESSING(STERILE)(BORDER)15X15CM" 優而美 " 舒肌親水性傷口敷料 * 適應症請健備註欄 "EUROMED"SURESKIN HYDROCOLLOID WOUND DRESSING(STERILE)(BORDER-SACRAL LARGE BUTTERFLY)15X18CM" 優而美 " 舒肌親水性傷口敷料 * 適應症請健備註欄 123 400 255 123 400 327 255 327 46

WDD08E3205K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND DRESSING(STERILE)(THIN)10X10CM" 優而美 " 舒肌 55 親水性傷口敷料 * 適應症請健備註欄 WDD08E3216K6 WDD08E3515K6 "EUROMED"SURESKIN HYDROCOLLOID WOUND DRESSING(STERILE)(THIN)15X15CM" 優而美 " 舒肌親水性傷口敷料 * 適應症請健備註欄 "EUROMED"SURESKIN HYDROCOLLOID WOUND DRESSING(STERILE)(THIN)5X15CM" 優而美 " 舒肌親水性傷口敷料 * 適應症請健備註欄 121 43 WDD08F0203ZW "SAVDERM"FOAM DRESSING(STERILE)10CM*20CM 泡棉敷料 ( 滅菌 )* 255 WDD08F0301ZW "SAVDERM"FOAM DRESSING(STERILE)(5CMX5CM) 泡棉敷料 ( 滅菌 )* 30 WDD08F0404ZW "SAVDERM"FOAM DRESSING(STERILE)(20CMX20CM) 泡棉敷料 ( 滅菌 )* 400 WDD08H0102ZW SAVDERM HYDROCOLLOIDS THIN DRESSING(STERILE)10X10CM 親水性敷料 ( 滅菌 )* 55 WDD08H0206ZW SAVDERM HYDROCOLLOIDS THIN DRESSING(STERILE)15X15CM 親水性敷料 ( 滅菌 )* 121 WDD08H0307ZW SAVDERM HYDROCOLLOIDS THIN DRESSING(STERILE)5X20CM 親水性敷料 ( 滅菌 )* 55 ACM0100254BS MANIFOLDS 4 PORTS 500PSI 324 ACM0100297BS MANIFOLDS 2 PORTS 200PSI,500PSI,1000PSI 221 ACM0100298BS MANIFOLDS 3 PORTS 200PSI,500PSI,1000PSI 263 ACM0101274BB HIGH PRESSURE MANIFOLDS DOUBLE 35 BAR 221 ACM0101275BB HIGH PRESSURE MANIFOLDS DOUBLE W/ROTABLE ADAPTER 35 BAR 221 ACM0101277BB HIGH PRESSURE MANIFOLDS DOUBLE 70 BAR 221 ACM0101278BB HIGH PRESSURE MANIFOLDS DOUBLE W/ROTABLE ADAPTER 70 BAR 221 ACM0101280BB HIGH PRESSURE MANIFOLDS TRIPLE 35 BAR 263 ACM0101281BB HIGH PRESSURE MANIFOLDS TRIPLE W/ROTABLE ADAPTER 35 BAR 263 ACM0101283BB HIGH PRESSURE MANIFOLDS TRIPLE 70 BAR 263 ACM0101284BB HIGH PRESSURE MANIFOLDS TRIPLE W/ROTABLE ADAPTER 70 BAR 263 ACM0101285BB ANGIODYN HIGHT PRESSURE MANIFOLDS STOPCOCKS DOUBLE PORTS 500PSI 1000PSI 221 ACM0101286BB ANGIODYN HIGHT PRESSURE MANIFOLDS STOPCOCKS TRIPLE PORTS 500PSI 1000PSI 263 ACM01202HFMR MANIFOLD 2-V 200PSI 221 ACM01253RXMR MANIFOLD 3 PORTS 200PSI;500PSI WITH HIGH PRESSURE TUBING 雙層 ( 可達 1200PSI) 384 ACM012P640SB ANGIOGRAPHIC MANIFOLDS 2-PORTS 221 ACM013P640SB ANGIOGRAPHIC MANIFOLDS 3-PORTS 263 47

ACM0142311AB HIGH PRESSURE STOPCOCK MANIFOLD FIVE-STATION 600PSI 430 ACM0142314AB HIGH PRESSURE STOPCOCK MANIFOLD TWO-STATION 600PSI 221 ACM0142317AB HIGH PRESSURE STOPCOCK MANIFOLD THREE-STATION 600PSI 263 ACM0142320AB HIGH PRESSURE STOPCOCK MANIFOLD FOUR-STATION 600PSI 324 ACM01502RXMR MANIFOLD 2-PORTS 500 PSI 221 ACM01503RXMR MANIFOLD 3-PORTS 500 PSI 263 ACM01504RXMR MANIFOLD 4 PORTS 200PSI;500PSI WITH HIGH PRESSURE TUBING 雙層 ( 可達 1200PSI) 384 ACM019310NAG MANIFOLDS 2 PORTS 221 ACM01APMF2H9 ANGIO PACK:MANIFOLDS 2 PORT/500 221 ACM01APMF3H9 ANGIO PACK:MANIFOLDS 3 PORT/500 263 ACP011000NDL Y TYPE ADAPTOR 346 ACP0146201H9 " 華億 " 體外循環管組 "HYM"HEART LUNG PACK-Y & STRAIGHT & REDUCER CONNECTOR(WITH LUER) 88 ACP01CA123L5 " 加州 " 心臟麻痺轉接器 "CALIFORNIA" CARDIOPLEGIA ADAPTERS 88 ACP01EC210GH EXTRACORPOREAL TUBING Y CONNECTOR 88 ACP01EC212GH EXTRACORPOREAL TUBING STRAIGHT CONNECTOR 88 ACP01EC214GH EXTRACORPOREAL TUBING CONNECTORS REDUCER REDUCER /LUER SPECIALTY 88 ACP01ECTBSM6 EXTRACORPOREAL TUBING STRAIGHT CONNECTOR 88 ACP01ECTBYM6 EXTRACORPOREAL TUBING Y-CONNECTOR 88 ACP0214000DL MULTIPURPOSE PERFUSION SET WITH VENT LINE 889 ACP0214003DL MULTIPURPOSE PERFUSION SET 657 ACPD1C4129BT " 百特 " 鈦金屬接頭 "BAXTER" ADAPTER FOR PERITONEAL DIALYSIS CATHETER 1514 ACY010210NSD PTCA Y CONNECTOR 1065 ACY0103331AB COPILOT BLEEDBACK CONTROL VALVE Y ADAPTOR 1065 ACY016248VM4 ADJUSTABLE VALVE W/3-WAY STOPCOCK 1065 ACY0191400SB NAMIC MORSE Y ADAPTOR 1065 ACY01KESU1NX Y-CONNECTOR(PTCA,PTA 用 ) 1065 48

ACY01MAP13MR MONIFOLD W/HEMOSTASIS VALVE 200PSI 單 Y 型 1065 ACY01MAP22MR ANGIOPLASTIC PACK & DOUBLE HEMOSTASIS VALVES 1155 ACY01MAP45MR ANGIOPLASTIC PACK & HEMOSTASIS VALVES 1065 BBB01T060CTM TRANSFER BAG 600ML 60 BBB01T100BTM TRANSFER BAG 1000ML 60 BBP0100070CA POST OPERATION OPEN TRANSPARENT BAG 康便舒手術後便袋 * 限住院患者申報 51 BBP0103144HL CLOSED MINI POUCH 51MM 單片式封口便袋 * 限住院患者申報 11 BBP0112441A5 NEW BIOCLOSE-AF 50MM* 限住院患者申報 51 BBP011680NA5 YOUCARE C 14:59MM* 限住院患者使用 51 BBP0400315DD ONE PIECE SOLO MINI DRAINABLE POUCH 15:50MM( 含人工皮不織布 ) 限住院患者申報 55 BBP0400818DD SOLO DRAINABLE POUCHES(NON-STERILE) 10-40MM* 限住院患者申報 43 BBP0401240PH DISPOSABLE COLOSTOMY BAG* 限住院患者申報 11 BBP0403250HL POST OPERATION COMPACT DRAINABLE POUCH( 開口便袋 ) 限住院患者申報 55 BBP0403802HL DRAINABLE POUCH 44MM * 限住院患者申報 43 BBP0403806HL DRAINABLE POUCH 102MM * 限住院患者申報 74 BBP0403807HL DRAINABLE POUCH 38MM * 限住院患者申報 43 BBP0403857HL OSTOMY TWO-PIECE WITH TRANSPARENT 57MM 中央點鎖式兩式便袋 * 限住院患者申報 43 BBP0406820CA POST OPEN BAG 100MM* 限住院患者申報 74 BBP0407600HL ONE-PIECE POUCH 51MM* 限住院患者申報 11 BBP0407650HL STONINAL ONE PIECE POUCH 51MM 單片附人造皮便袋 * 限住院患者申報 43 BBP0412131A5 PROCARE-2 DRAINABLE POUCH 30,40,50MM* 限住院患者申報 55 BBP0412134A5 PROCARE-2 DRAINABLE POUCH 70MM* 限住院患者申報 43 BBP0412501A5 LAPACK SUPER-G 人工肛門袋 G80* 限住院患者申報 11 BBP0412502A5 LAPACK SUPER-G 人工肛門袋 G100* 限住院患者申報 11 BBP0412503A5 LAPACK SUPER-G 人工肛門袋 G125* 限住院患者申報 11 BBP0412511A5 LAPACK SUPER-C 100 人工肛門封口便袋 * 限住院患者申報 11 49

BBP0412521A5 LAPACK SUPER F 簡易型夾鏈式開口便袋 * 限住院患者使用 11 BBP0413984CA "COLOPLAST"ALTERNA FREE WITH HIDE-AWAY OUTLET OSTOMY POUCH 40MM,50MM,60MM(TWO-PIECE) 崇尚型易關式開口袋 * 適應證請見備註欄 43 BBP041418NA5 YOUCARE D 14:50MM* 限住院患者使用 55 BBP0414344CA "COLOPLAST"EASIFLEX OSTOMY POUCH (NON-STERILE) 易利膟造口術用袋 * 43 BBP041501KA5 "ALCARE"OSTOMY POUCH POSPACK-K 0-70MM( 含人工皮. 不織布 ) 造口術用袋 * 限住院患者申報 55 BBP0415021A5 POSPACK B 60MM 限住院患者使用 55 BBP0416611A5 YOUCARE 2 POUCH DF 優護二件式開口便袋 * 限住院患者使用 43 BBP0416612A5 YOUCARE 2 POUCH DF 優護二件式開口便袋 * 限住院患者使用 43 BBP0416613A5 YOUCARE 2 POUCH DF 優護二件式開口便袋 * 限住院患者使用 43 BBP0416623A5 YOUCARE 2 POUCH D 優護二件式開口便袋 * 限住院患者使用 43 BBP041662NA5 YOUCARE 2 POUCH D 優護二件式開口便袋 * 限住院患者使用 43 BBP0416771A5 YOUCARE D 14:59MM* 限住院患者使用 55 BBP041678NA5 YOUCARE D 14:59MM* 限住院患者使用 55 BBP0416960CA ILEOSTOMY BAG MAXI 40MM,50MM,60MM 限住院患者申報 43 BBP0417820CA ALTERNA CHILDREN 雙片 OPEN TRANSPARENT BAG 40MM 限住院患者申報 45 BBP0418102HL NEW IMAGE DRAINABLE POUCH 2 PIECE 44:70MM * 限住院患者申報 43 BBP0459850CA "COLOPLAST"ALTERNA ILEOSTOMY BAGS 10-70MM 愛特大迴腸造口袋 * 55 BBU0101460HL FIRST CHOICE UROSTOMY POUCH WITH CUT-TO-FIT BARRIER( 含人工皮 ) 限住院串者申報 91 BBU0103907HL UROSTOMY POUCH 38MM* 限住院患者申報 77 BBU0103944HL CENTER POINT LOCK UROSTOMY POUCH 限住院患者申報 91 BBU0105451SQ URO,ACCUL,TRANSPARENT POUCH 尿袋 35/48/61MM* 限住院患者申報 77 BBU0112151A5 PROCARE-2 URINARY POUCH 30,40,50MM* 限住院患者申報 77 BBU0112451A5 BIOURINE-B 50MM* 限住院患者申報 91 BBU0114201A5 YOUCARE U 優護一件式尿袋 * 限住院患者使用 91 BBU011536NA5 YOUCARE U 優護一件式尿袋 * 限住院患者使用 91 BBU011666NA5 YOUCARE 2U 優護二件式尿袋 * 限住院患者使用 77 50

BBU0117570CA COLOPLAST ALTERNA UROSTOMY BAG MAXI375ML 限住院患者申報 77 BBU0117890CA ALTERNA CHILDREN TRANSPARENT URINE BAG 限住院患者申報 77 BBU0118402HL NEW IMAGE UROSTOMY POUCH ( 不含人工皮 ) 44:70MM * 限住院患者申報 77 BBU0155850CA UROSTOMY BAG MAXI 375ML 限住院患者申報 91 BBU0180090CA ONE PIECE ALTERNA CHILDREN TRANSPARENT URINE BAG 10:35MM( 含人工皮 ) 限住院患者申報 91 BBW0104055P2 P.C.N. BAG (S) 腎臟造廔引流袋 34 BBW0104075PP PCN BAG 750CC( 腎臟造廔引流袋 ) 34 BBW0104200P2 P.C.N. BAG (L) 腎臟造廔引流袋 34 BBW0104200PP PCN BAG 2000CC( 腎臟造廔引流袋 ) 34 BBW0145000TZ PCN BAG 腎臟造口引流袋 34 BBW0145001TZ PCN BAG 500ML 34 BBW0156054P2 WOUND DRAINAGE SYSTEM BAG( 接真空傷口引流袋 ) 34 BBW0185001PB PBN DRAINAGE BAG 34 CBA010502SAR INTRA AORTIC BALLOON CATHETER ( 型號 :IAB-04230U,04240U,04250U,06830U,06840U,R950U 自 94.10.01 起生效 ) 26302 CBA014830UAR NARROWFLEX UNIVERSAL IAB CATHETER 8FR.30CC,40CC 26302 CBA01C0DA1CK "COOK"CODA BALLOON CATHETER (AORTIC) 科達球曩導管 25916 CBA01S730CAR REDIGUARD IAB CATHETER 7,8,9FR. 30CC,40CC 26302 CBC0110101AB "ABBOTT"RX ACCULINK CAROTID STENT SYSTEM 亞科林頸動脈支架系統 * 28608 CBC01EXP0NM4 EXPONENT RX SELF EXPANDING STENT SYSTEM* 28608 CBC01SCH64SB OTW&MONORAIL CAROTID WALLSTENT D:6:10MM,L:30:50MM* 28608 CBC01SCH65SB OTW&MONORAIL CAROTID WALLSTENT* 28608 CBC0271200SB BOSTON SCIENTIFIC WALLSTENT ILIAC ENDOPROSTHESIS WITH UNISTEP PLUS DELIVERY SYSTEM* 30076 CBC02LUDUEAN ANGIOMED LUMINEXX VASCULAR STENT 直徑 4MM:9MM 10MM;12MM;14MM 長度 20MM:120MM 30076 CBC02MP628F2 "INVATEC"MARIS PERIPHERAL SELF-EXPANDING STENT SYSTEM(ILIAC ARTERY) 瑪瑞斯自膨式週邊血管支架系統 * 30076 CBC02P208MCD PALMAZ BALLOON-EXPANDABLE STENT FOR THE ILIAC ARTERIES 3.5MMX30MM 30076 CBC02Z1V60CK "COOK"ZILVER VASCULAR STENT(ILIAC ARTERY) W/ 運送系統 * 30076 51

CBC02Z1V61CK "COOK"ZILVER VASCULAR STENT(ILIAC ARTERY) 麗而服血管支架 * 30076 CBC02Z1V62CK "COOK"ZILVER SELF EXPANDABLE VASCULAR STENTS(ILIAC ARTERY) 麗而服自展性血管支架 * 30076 CBC02ZVS04AN "ANGIOMED"BARD E.LUMINEXX VASCULAR STENT 巴德依. 路明尼斯血管支架 ( 腸骨血管支架 ) 直徑 4MM:10MM;12MM;14MM 長度 60CM;135CM* 30076 CBS029ASDNG6 AMPLAATZER SEPTAL OCCLUDER WITH DELIVERY SYSTEM 143762 CBS029SZB2G6 AMPLATZER SIZING BALLOON II 安普拉茲測量氣球導管 * 14476 CBS029SZBNG6 AMPLATZER SIZING BALLOON 24MM,34MM* 14476 CBS02PTSXXN5 PTS SIZING CATHETER 20:40MM 3:5CM 80CM 0.035" GUIDE WIRE 14476 CBS039PDAAG6 "AGA"AMPLATZER DUCT OCCLUDER 開放性動脈導管關閉器 * 66941 CBT0405000AR CBT0405050AR CBT0407044AR CBT0407365AR CBT04131HVED "ARROW"BALLOONTHERMODILUTION CATHETERS(HEPARIN-COATED) FOUR LUMEN" 亞諾 " 熱稀釋順流導管 "ARROW"BALLOONTHERMODILUTION CATHETERS(HEPARIN-COATED) 5 LUMEN" 亞諾 " 熱稀釋順流導管 "ARROW" THERMODILUTION BALLOON CATHETER(4 LUMEN) 4FR 75CM " 亞諾 " 熱稀釋順流導管 ( 兒童 ) "ARROW"BALLOON THERMODILUTION CATHETER 6FRX80CM;110CM 7FRX110CM(HEPARIN COATED) 4 LUMENS " 亞諾 " 熱稀釋順流導管 EDWARDS SWAN-GANZ THERMODILUTION CATHETER 4LUMEN 7FR,W/AMC THROMBOSHIELD COATING 2710 2867 2162 2710 2710 CBT041704HBS THERMODILUTION CATHETER 測輸量順流導管 ( 四腔 )7fr 110cm 1842 CBT04254NDBS THERMODILUTION CATHETER 5FR 4 LUMEN, 6FR 4 LUMEN,7FR 4 LUMEN 順流導管 ( 四腔 ) 2162 CBT045107SBD THERMODILUTION CATHETER FOUR LUMEN 7FR 110CM 1842 CBT0493137ED CBT04C144HED SWAN-GANZ THERMODILUTION CATHETER FOUR LUMEN/AMC THROMBOSHIELD(HEPARIN) 熱稀釋導管 "EDWARDS"SWAN-GANZ THERMODILUTION CATHETER 4 LUMEN 7FR W/AMC THROMBOSHIELD COATING 2710 2710 CBT04H5107BD THERMODILUTION CATHETER FOUR LUMEN 7FR 110CM 1842 CBT05175HDBS THERMODILUTION CATHETER 7.5FR 5 LUMEN 2867 CBT0550324HR FLOW-DIRECTED CATHETERS/ 測血氧 * 7148 CBT055507SBD THERMODILUTION CATHETER FIVE LUMEN 7.5FR 110CM 1341 CBT0574175ED SWAN GANZ OXIMETRY AND VOLUMETRIC CATHETER* 7148 CBT05831H7ED SWAN-GANZ 5 LUMEN THERMODILUTION CATHETER 1341 CBT05831HVED EDWARDS SWAN-GANZ THERMODILUTION CATHETER 5LUMEN 7.5FR,W/AMC THROMBOSHIELD COATING 2867 CBT05834H7ED SWAN-GANZ 5 LUMEN THERMODILUTION CATHETER 1341 52

CBT0593631E6 OXIMETRY SVO2 CATHETER 5LUMEN(PA,CVP,T,POTICAL,CONNECT,BALLOON INF)* 適應症見備註 7148 CBT0652510HR OPTI-Q SVO2/CCO CATHETRER* 7052 CBT0652515HR TDQ CCO CATHETRER* 6022 CBT0674475ED CONTINUOUS CARDIAC OUTPUT THERMODILUTION CATHETER 7.5FR 7052 CBT06746F8ED CBT06757HFED CBT0677475ED CBT06777F8ED SWAN GANZ CONTINUOUS CARDIAC /END DIASTOLIC VOLUME THERMODILUTION CATHETER CCO/SVO2/VIP* SWAN GANZ CONTINUOUS CARDIAC /END DIASTOLIC VOLUME THERMODILUTION CATHETER CCO/SVO2/EDV/VIP* SWAN GANZ CONTINUOUS CARDIAC /END DIASTOLIC VOLUME THERMODILUTION CATHETER CCO/SVO2/CEDV* SWAN GANZ CONTINUOUS CARDIAC /END DIASTOLIC VOLUME THERMODILUTION CATHETER CCO/SVO2/CEDV/VIP* 7052 7052 7052 7052 CBT07MHD68ED FLOTRAC SENSOR KIT W/60" OR 84" PRESSURE TUBING 弗羅威克感應器組 6138 CBT07MHDAZED FLOTRAC SENSOR KIT W/60" PRESSURE TUBING & VAMP ADULT SYSTEM 弗羅威克感應器組附血液管理保護系統 6138 CBV02PDCXXN5 PERCUTANEOUS TRANSLUMINAL VALVULOPASTY (PTV)CATHETER 4.0MM:30.0MM,2.0CM:8.0CM 12789 CBV02PDZXXN5 NUMED Z-MED II PERCUTANEOUS TRANSULUMINAL VALVULOPLASTY (PTV)CATHETER 4:30MM 2:10CM 100CM 12789 CBV02PTVNXN5 "NUMED"NUCLEUS PTV DILATATION CATHETER 二尖瓣及主動脈瓣氣球擴張導管 33700 CCC022180TBT CLOSED SYSTEM APHERESIS KIT 4336 CCC110971EHA PERIPHERAL BLOOD STEM CELLS SET 4336 CCC1400260HA CELL SAVER 5 FAST PACK 225ML 體血液收集洗滌套 7307 CCC1400ATFVB AUTOTRANSFUSION FAST START KIT(AUTOTRANSFUSION SET+AUTOTRANSFUSION RESERVOIR+ATS SUCTION LINE)* 7307 CCC1402001M4 AUTOLOG WASH KIT* 7307 CCC1471240CB BAYLOR RAPID AUTOLOGOUS TRANSFUSION SETS BRAT 2 PROCEDURE SET 7307 CCC14EC243M4 ONE SOURCE PACK 自體輸血系統套裝組含 EL240 BP721 BT133 BTC93 型號 :EC2S24 含 EL240 BP722 BT133 BTC93 自 94.01.01 生效 7307 CCC1552300AH ATRIUM CHEST DRAINAGE WITH AUTOTRANSFUSION SET( 雙管回流式 ) 4467 CDCC243418PM C.S.F CARDIAC CATHETER REDUCED TIP BARIUM IMPREGNATED 2558 CDD0246148H9 INTRACARDIAC SUCKER 398 CDD02SUCKEM6 EXTRACORPOREAL SUCKER 398 CDDC1M008CKC CANISTER W/ GEL 真空罐含接頭及引管 1829 CDDF1M001SKC DRESSING PU FOAM 100X75X32MM (S SIZE) 2355 53

CDDF1M002MKC DRESSING PU FOAM 180X125X32MM (M SIZE) 2603 CDDF1M003LKC DRESSING PU FOAM 256X150X32MM (L SIZE) 2715 CFD0150124AB FLEXIFLO ENTERAL FEEDING TUBE 12F,16F(WITHOUT STYLET) 125 CFD01BSTPUEE ENTERAL FEEDING TUBE 8,10,12,14,16FGX125CM* 125 CFD0202308P2 ALL SILICON STOMACH TUBE* 86 CFD0216120W6 SILICONE STOMACH TUBE 6FR:18FR* 86 CFD022020NFM ALL SILICONE STOMACH(GASTRIC)TUBE 4:20FR 4 86 CFD0222070WN ALL SILICON LEVIN TUBE W/TAPER FUNNEL 2EYES 86 CFD0222074WN ALL SILICON LEVIN TUBE W/TAPER FUNNEL 4EYES 86 CFD022207NWN Silicon Levin Tube W/Taper Funnel 8:22FR 86 CFD0276ST6MU ALL SILICONE STOMACH TUBE 86 CFD028000NCL ALL SILICONE STOMACH TUBE* 86 CFD02G0101SG SILICONE GASTRIC TUBE* 86 CFD02GT001SG SIGMA GASTRIC TUBE(SILICON)* 86 CFD02GT101EW SILICONE GASTRIC DUODENAL LEVIN TUBE 86 CFD02ST000EF BESMED SILICONE STOMACH TUBING* 86 CFD05BPU08EE PU STOMACH CATHETER 聚胺酯胃管 115 CFE0130414RU E-B TUBE 14FR 1475 CFE0130416RU E-B TUBE 3WAY 食道球 1475 CFE0130418RU E-B TUBE 3WAY 食道球 1475 CFE0140418RU E-B TUBE 4WAY 食道球 1475 CFE017115NP0 E-B TUBE 食道球 3-WAY 1475 CFE019160NRU S-B ESOPHAGEAL VARICES TUBE 4-WAY 1475 CFE01B7118P0 E-B TUBE 3 WAY 1475 CGAP1HY100H9 HYM ANGIO PACK 心導管包 (GWX1+SHEATHX1+ARTERIAL NEEDLEX1+MANIFOLDX2+PRESSURE TUBINGX4+HIGHT PRESSURE TUBINGX1) 2413 CHA0106642TM AORTIC ARCH CANNULA 6.5MM 20FR 585 54

特材代碼中英文品名支付點數 CHA0106672TM AORTIC ARCH CANNULA 8MM 24FR 585 CHA0159100AY AORTIC PERFUSION CANNULA 10:24FR 585 CHA0165264TM AORTIC ARCH CANNULA 8MM 24FR 790 CHA0175324DL PEDIATRIC STRAIGHT ARTERIAL CANNULA 18FR:24FR 585 CHA0188020DL ARTERIAL CANNULA 20:24FR 585 CHA01A085BED AORTIC PERFUSION CANNULAE(8-16F) 585 CHA0305761TM SOFT-FLOW AORTIC ARCHCANNULAE W/WIRE REINFORCED 7MM,8MM 21FR,24FR 790 CHA0305779TM SOFT-FLOW AORTIC ARCH CANNULA 7MM,8MM 21FR,24FR 585 CHA0306395TM SOFT-FLOW AORTIC ARCH CANNULAE WITH WIRE REINFORCED 790 CHA031137CL5 AORTIC ARCH CANNULAE WIRE-REINFORCED 6,7,8MM/18,21,24FR 790 CHA031206CL5 AORTIC ARCH CANNULA W/WIRE REINFORCED 6:24FR 790 CHA0312305TM HIGH FLOW AORTIC ARCH CANNULA 585 CHA0313010TM FLEXIBLE ARTERIAL CANNULA 20:24FR 585 CHA0320STAED AORTIC PERFUSION CANNULAE(20-24F) 790 CHA0387020M4 DLP ARTERIAL CANNULAE WIREWOUND BODY 20FR,22FR,24FR 790 CHA03NA120L5 AORTIC ARCH CANNULAE 585 CHA03NA343L5 AORTIC ARCH CANNULAE FLEXIBLE STRAIGHT TIP WITH MOVABLE SUTURE RING NON- REINFORCED 6,7,8MM/18,21,24FR 585 CHA03RA213L5 AORTIC ARCH CANNULAE STRAIGHT TIP WIRE-REINFORCED 6,7,8MM/18,21,24FR 790 CHAT100009ED CARDIOPLEGIA DELIVERY SETS(9F) 135 CHAT110016S6 AORTA/VEIN PUNCH 4:6MM 918 CHAT131001DL IMA CANNULA 內乳動脈導管 567 CHAT1AP425M4 AORTIC PUNCH 918 CHAT1AP525M4 AORTIC PUNCH 918 CHAT1DP48KTX " 特立菲斯 " 主動脈打孔器 "TELEFLEX"AORTIC PUNCH 918 CHAT1MDP48TX THE DIAMOND EDGE AORTIC PUNCH 918 CHC0100200ED CARDIOPLEGIA DELIVERY SETS(2 LINES) 346 55

特材代碼中英文品名支付點數 CHC0100400ED CARDIOPLEGIA DELIVERY SETS(3 LINES) 657 CHC0130010DL CORONARY CANNULA 10:14FR 611 CHC0130055DL CORONARY SOFT TIP 611 CHC01CA123L5 " 加州 " 心臟麻痺轉接器 CALIFORNIA CARDIOPLEGIA ADAPTERS 346 CHC01CA410L5 MULTIPLE PERFUSION ADAPTER 657 CHC01CA420L5 MULTIPLE PERFUSION ADAPTER WITH VENT LINE 15 INCH 889 CHC01CA430L5 MULTIPLE PERFUSION ADAPTER WITH VESSEL CANNULA 三條 (VC-11000,VC-11010) 990 CHC01CA810L5 CARDIOPLEGIA PERFUSION ADAPTERS WITH MONITORING SET* 1088 CHC01CP110L5 CORONARY ARTERY PERFUSION CANNULAE 611 CHC01CP212L5 CORONARY ARTERY PERFUSION CANNULAE WITH BALLOON 611 CHC01MS001ED CARDIOPLEGIA DELIVERY SETS(MONITORING SET) 1088 CHF06CB965M4 ARTERIAL PERCUTANEOUS CANNULA KIT W/INTRODUCER SET 使用參考請見備註欄 ( 型號 :CB96540-023,CB96605-023 自 94.07.01 生效, 文號 :W0940013331) 18241 CHF06CB966M4 VENOUS PERCUTANEOUS CANNULA KIT W/INTRODUCER SET 使用參考請見備註欄 18241 CHF06D008VED CHF06EBSCATM FEM-FLEX II DURAFLO HEPARIN TREATED FEMORAL CANNULAE SET W/INTRODUCER 芬弗列克肝素塗層股靜脈導管及導引組使用參考請見備註欄 ARTRIAL CAPIOX EBS CANNULATION KIT W/INTRODUCER SET 13.5,15,16.5FR 使用參考請見備註欄 18241 18241 CHF06EBSCVTM VENOUS CAPIOX EBS CANNULATION KIT W/INTRODUCER SET 18,19.5,21FR 使用參考請見備註欄 18241 CHF06FEM08ED CHF06FEM14ED CHF06VFEM1ED FEM-FLEX II FEMORAL ACCESS CANNULAE SET W/INTRODUCER 股動 / 靜脈導管及導引管組 ( 無肝素塗層 ) 使用參考請見備註欄 FEM-FLEX II DURAFLO HEPARIN TREATED FEMORAL CANNULAE SET W/INTRODUCER 芬弗列克肝素塗層股動脈導管及導引組使用參考請見備註欄 FEM-FLEX II FEMORAL ACCESS CANNULAE SET W/INTRODUCER 股動 / 靜脈導管及導引管組 ( 無肝素塗層 ) 使用參考請見備註欄 12404 18241 12404 CHG0204427TM RETROGRADE CARDIOPLEGIA CANNULAE MANUAL INFLATE 13FR,17FR 3184 CHG0204429TM RETROGRADE CARDIOPLEGIA CANNULA 3184 CHG0294006M4 DLP RETROGRADE CORONARY SINUS PERFUSION CANNULA 3184 CHG0294010M4 RETROGRADE CORONARY SINUS PERFUSION CANNULA WITH MANUAL INFLATING CUFF AND SILICONE BODY 3147 CHG02RCM14L5 RETROGRADE CARDIOPLEGIA CANNULAE 6,10,13,15FR 3184 CHG02RCS14L5 RETROGRADE CARDIOPLEGIA CANNULAE 13,14,15FR 3184 CHG02RCS35L5 RETROGRADE CARDIOPLEGIA CANNULAE 13FR,14FR,15FR 逆向心臟麻痺液灌注套管 3184 56

特材代碼中英文品名支付點數 CHH0112001DL LEFT HEART VENT CATHETER 13FR 568 CHH0112002DL VENT CATHETER 685 CHH0112008M4 DLP LEFT HEART VENT CATHETER 568 CHH0112345TM LEFT HEAT VENT CATHETER 20FR 685 CHH0118124TM VENT CATHETER 18FR 685 CHH0163218L4 MALLEABLE VENT CATHETER 18FR 568 CHH01VT218L4 MALLEABLE VENT CATHETER 12FR,18FR 568 CHH025902MAY LEFT VENTRICULAR SUMP VENT CATHETER 14,18,20F 568 CHR0100011RM AORTIC ROOT CANNULA 635 CHR010014VED AORTIC PERFUSION CANNULAE(14G) 797 CHR0110009DL AORTIC ROOT CANNULA 9FR:18FR 635 CHR0116094TM AORTIC CANNULA 24FR 加強型動脈導管 797 CHR01AR012ED AORTIC ROOT CANNULA 主動脈根部套管 635 CHR01AR209L5 AORTIC ROOT CANNULAE WITH VENT LINE 9:18G 635 CHR01AR212L5 AORTIC ROOT CANNULAE WITH VENT LINE 12:16G 635 CHR0220009M4 AORTIC ROOT CANNULAE WITH VENT LINE 635 CHR0220014DL AORTIC ROOT CANNULA WITH VENT LINE 635 CHR0300014ED RETROGRADE CARDIOPLEGIA CANNULAE(14F) 3184 CHR03RC014ED RETROGRADE CARDIOPLEGIA CANNULAE 3184 CHR03RC301ED RETROGRADE CARDIOPLEGIA CANNULAE 3184 CHSU116035KD ARGYLE UMBILICAL VESSEL CATHETER 2.5:8FR 170 CHT0104413TM CONDUCER CARDIOPLEGIA SET W/MP-4 1:1,4:1,8:1 3173 CHT0105476DE SIDUS CARDIOPLEGIA DELIVERY SET (1:1,4:1,8:1)(BLOOD MIXING+CONDUCER+COIL TUBING+MP4 ) 3173 CHT0106375TM CONDUCER CARDIOPLEGIA SSET W/MP-4 AND BRIDGE 4:1 3173 CHT0109457TM CONDUCER CARDIOPLEGIA SET 4:1,2:1 BLOOD MIXING 2884 CHT0109499TM CONDUCER CARDIOPLEGIA SET( 含 DOMEXI,ARTERIAL PRESSURE TUBINGX3,3-WAY STOPCOCKX1) 3173 57

特材代碼中英文品名支付點數 CHT0179003DL PEDIATRIC TOURNIQUET KIT 258 CHT017903SCX TOURNIQUE KIT WITH SNARE(PEDIATRIC) 258 CHT017903SU8 TOURNIQUET KIT WITH SNARE(1 紅 2 藍 3 白 ) 導管綁帶組附鐵線 258 CHT01A32NSH9 HEART LUNG PACK:A32 CUSTOMER PACK(TUBING+ORGANIZER+PRE-BYPASS FILTER) 4873 CHT01CH207H9 HEART LUNG PACK( 含 PRE-BYPASS FILTER) 4137 CHT01CSS01TV CSS PERFUSION TUBING SET ( 含 TUBING+PRE-BYPASS FILTER +ORGANIZER+SUCKER X 2) 5500 CHT01CSS02TV CSS PERFUSION TUBING SET ( 含 TUBING+PRE-BYPASS FILTER+SUCKER X 2) 5252 CHT01CSS03TV CSS PERFUSION TUBING SET ( 含 TUBING+PRE-BYPASS FILTER) 4137 CHT01CSS04TV CSS PERFUSION TUBING SET ( 只含 TUBING) 3829 CHT01ECTB1M6 EXTRACORPOREAL TUBING PACK( 含 PRE-BYPASS FILTER+SUCKERX2+ORGANIZER) 5500 CHT01ECTBSM6 EXTRACORPOREAL TUBING PACK( 含 PRE-BYPASS FILTER) 4137 CHT01HS101H9 HEART LUNG PACK( 含 ORGANIZER+PRE-BYPASS FILTER+SUCKERX2) 5500 CHT01HTA12H9 CHT01MY100M4 HEART LUNG PACK HSIN TUNG A12 ADULT( 含 ORGANIZER+PRE-BYPASS FILTER+SUCKER X2+ARTERIAL FILTER) MYOTHERMXP CARDIOPLEGIA DELIVERY SYSTEM(BLOOD MIXING+CONDUCER+COIL TUBING+MP4) 7315 3173 CHT01TS100L5 TOURNIQUET KIT WITH SNARE 258 CHT01TS130L5 TOURNIQUET KIT 258 CHT01VBCBRGH VISION BLOOD CARDIOPLEGIA SYSTEM(BLOOD MIXING+CONDUCER+COIL TUBING) 2884 CHT03A25PLH9 HEART LUNG PACK:A25 PRIME LINE(TUBING 49"+ Y CONNECTOR) 291 CHV0100012ED SINGLE STAGE VENOUS RETURN CANNULAE(12:40FR/ 直 ) 771 CHV0100028ED SINGLE STAGE VENOUS RETURN CANNULAE 771 CHV0100040ED SINGLE STAGE VENOUS RETURN CANNULAE(12:40FR/ 彎 ) 771 CHV0104882TM MALLEABLE VENOUS RETURN CATHETER REINFORCED 24FR 1029 CHV0114032TM 2 STAGE VENOUS RETURN CANNULA 803 CHV0116471TM VENOUS RETURN CAHTTER W/WIRE REINFORCED 803 CHV0166112M4 SINGLE STAGE VENOUS CANNULA 771 CHV0167312DL VENOUS CANNULAR 12,16,20,31FR (PEDIATRIC) 1034 58

特材代碼中英文品名支付點數 CHV0169312DL VENOUS CANNULAR 12:31FR (HIGH FLOW) 1034 CHV0169424DL VENOUS CANNULAR 12:31FR (ADULT) 1034 CHV0191228M4 TWO STAGE VENOUS CANNULA 803 CHV01LRD32L5 DUAL STAGE VENOUS RETURN CANNULAE 32FR 803 CHV01LRD41L5 "CALIFORNIA" DUAL STAGEVENOUS RETURN CANNULAE 803 CHV01RV110L5 WIRE REINFORCED VENOUS RETURN CANNULAE24,28,32,34,36,40 771 CHV01RV222L5 WIRE REINFORCED VENOUS RETURN CANNULAE(STREIGHT)20:40FR 771 CHV01RV224L5 VENOUS RETURN CANNULAE(WIRE-REINFORCED) 靜脈回流導管 771 CHV01TF008ED SINGLE STAGE VENOUS RETURN CANNULAE 靜脈引流導管 771 CHV01XRDS2L5 DUAL STAGE VENOUS RETURN CANNULAE 32:36FR 803 CHV0329370ED DUAL STAGE VENOUS RETURN CANNULAE(29/37F) 1034 CHV0336460ED DUAL STAGE VENOUS RETURN CANNULAE(36/46F) 1034 CHV0395051DL SINGLE 2 STAGE VENOUS CANNULA 803 CHV03TF334ED " 愛德華 " 二階靜脈引流導管 "EDWARDS" DUAL STAGE VENOUS RETURN CANNULAE 1034 CHV03TR283ED DUAL STAGE VENOUS RETURN CANNULA 803 CHV03TRF29ED DUAL STAGE VENOUS CANNULAE 1034 CKDD112122AR LARGE-BORE MULTILUMEN HEMODIALYSIS CATHETER 1392 CKDD117005KD "KENDALL"DUAL LUMEN HEMODIALYSIS CATHETER KIT(C+N+G+D) 雙腔透析導管 1392 CKDD117009KD "KENDALL"DUAL LUMEN HEMODIALYSIS CATHETER KIT(C+N+G+D) 雙腔透析導管 1392 CKDD122122AR "ARROW"ARROWGARD CATHETERS SETS(CATH+NEEDLE+GUIDEWIRE+DILATOR+SHEATH) 2 LUMEN " 亞諾 " 抗感染安全尖端導管 CKDD123122AR "ARROW"ARROWGARD CATHETERS SETS(CATH+NEEDLE+GUIDEWIRE+DILATOR+SHEATH) 2 LUMEN " 亞諾 " 抗感染安全尖端導管 1392 1392 CKDD139003KD "KENDALL"DUAL LUMEN HEMODIALYSIS CATHETER KIT(C+N+G+D) 雙腔透析導管 1392 CKDD15553NBA DUAL-LUMEN NIAGARA SLIM CATH DIALYSIS CATH KIT(C+N+G+D) 1392 CKDD15554NBA DUAL-LUMEN NIAGARA SLIM CATH DIALYSIS CATH KIT(C+N+G+D) 1392 CKDD1881CKKD DUAL LUMEN HEMODIALYSIS CATHETER KIT CURVE(C+N+G+D) 1392 CKDD1881SKKD DUAL LUMEN HEMODIALYSIS CATHETER KIT STR(C+N+G+D) 1392 59

CKDD1883CKKD DUAL LUMEN HEMODIALYSIS CATHETER KIT CURVE(C+N+G+D) 1392 CKDD1883SKKD DUAL LUMEN HEMODIALYSIS CATHETER KIT STRAIGHT(C+N+G+D) 1392 CKDD193009KD CURVED AND STRAIGHT DUAL LUMEN CATHETER KITS(C+N+G+D) 1392 CKDD1K3500VC CKDD1K4065VC DIALYSIS CATHETERS KIT(CATH+DILATOR+GUIDE WIRE+NEEDLE)12.5CM:24CM( 自 950401 起型號更改為 5678125.5678150.5678240. 文號 0940040227) 雙頭管路 DIALYSIS CATHTER KIT(C+N+G+D)( 自 950401 起型號更改為 5576100.5576125.5576150. 文號 0940040227) 1392 1392 CKDD1KDLS4VC 雙頭管路 DIALYSIS CATHETER KIT(C+N+G+D) 1392 CKDD20450NBA HICKMAN HEMODIALYSIS CATHETER KIT(CATH+INTRODUCER KIT) 永植型 3509 CKDD20452NBA HICKMAN HEMODIALYSIS CATHETER KIT(CATH+INTRODUCER KIT) 永植型 3509 CKDD233074KD Hemodialysis catheter(c+n+g+d) 3509 CKDD248001KD PERMCATH DUAL LUMEN CATHETER KITS(CATH+INTRODUCER KIT) 永植型 3509 CKDD256631BA HEMOGLIDE HEMODIALYSIS CATHETER KIT(CATH+INTRODUCER KIT) 永植型 3509 CKDD25833NBA "BARD"HemoStar HEMODIALYSIS CATHETER KITS(CATH+INTRODUCER KIT) 永植型 3509 CKDD260049BA HICKMAN HEMODIALYSIS CATHETER 永植型 2623 CKDD266606BA HICKMAN HEMODIALYSIS CATHETER KIT(CATH+INTRODUCER KIT) 永植型 3509 CKDD269001KD CKDD288145KD CKDD2D3500BA CKDD2D4000BA CKDD2D4400BA CKDD2K4400BA "KENDALL"CHRONIC HEMODIALYSIS CATHETERS(DUAL LUMEN CATHETER+INTRODUCER KIT) 永植型慢性血液透析導管 "KENDALL"CHRONIC HEMODIALYSIS CATHETER KITS(DUAL LUMEN CATH+INTRODUCER KIT) 永植型 DOUBLE LUMEN SUBCLAVIAN CANNULA 12.5CM(C+N+G+D)( 自 950401 起型號更改為 5577165 文號 0940040227) DOUBLE LUMEN SUBCLAVIAN CANNULA 15CM(C+N+G+D)(( 自 950401 起型號更改為 5577170 文號 0940040227) DOUBLE LUMEN SUBCLAVIAN CANNULA 20CM(C+N+G+D)(( 自 950401 起型號更改為 5577175 文號 0940040227) DOUBLE LUMEN SUBCLAVIAN CANNULA 20(C+N+G+D)(CM( 自 950401 起型號更改為 5678200 文號 0940040227) 3509 3509 1392 1392 1392 1392 CKP010T202KD PERITONEAL DIALYSIS CATHETER(TENCKHOFF 2 CUFF)T202 1505 CKP0119671FA PD CATHETER 1505 CKP018812NKD PERITONEAL DIALYSIS CATHETER 1505 CKP018814NKD PERITONEAL DIALYSIS CATHETER 1505 CKP018817NKD PERITONEAL DIALYSIS CATHETER 1505 CKP018880NKD PERITONEAL DIALYSIS CATHETER 1505 60

特材代碼中英文品名支付點數 CKP018884NKD PERITONEAL DIALYSIS CATHETER 1505 CKP018888NKD PERITONEAL DIALYSIS CATHETER 1505 CKP018890NKD PERITONEAL DIALYSIS CATHETER 1505 CKP0413836FA PD ACCESSORIES SLEEP.SAFE SET/SET PLUS 自動腹膜透析管組 232 CKP04C4407BT BAXTER CYCLER SET 腹膜透析用輸液套 ( 限自動腹膜透析 APD 使用 ) 232 CKP04C4479BT HOMECHOICE AUTOMATED PD SET 全自動腹膜透析導管組 232 CKP04C8303BT HOMECHOICE PEDIATRIC /LOW RECIRCULATION VOLUME A PD SET 小兒全自動腹膜透析導管組 232 CLS0405759BB DOSIFIX W/SAFESITE NEEDLE-FREE SYSTEM W/VALVE 120ML( 自 92.03.01 更改功能類別 )* 74 CLS0405760BB DOSIFIX W/SAFESITE NEEDLE-FREE SYSTEM W/VALVE 150ML( 自 92.03.01 起更改功能類別 )* 74 CLS04A260NPW PERFECT DISPOSABLE INFUSION SET(W/BURETTE W/VALVE W/SAFESITE NEEDLE SYSTEM )* 74 CLS04E010NPW INFUSION SET W/BURETTE W/VALVE W/SAFESITE NEEDLE-FREE SYSTEM* 74 CLS04NB150SG SIGMA VOLUME METERIC ADMINISTRATION SET* 74 CLS04NS120SG VOLUME METERIC ADMINISTRATION SET W/FREE SITE * 74 CLS04SBASSLL VOLUME METERIC ADMINISTRATIONN SET ( 安全型免針加藥 )W/VALVE* 74 CLS04VBNAPBB "B.BRAUN"IV-FIX BURETTE INFUSION SET( 免針加藥 )* 74 CLS1400137BX Exacta-Mix EVA Container TPN Bag 250ML 101 CLS1400138BX Exacta-Mix EVA Container TPN Bag 500ML 101 CLS1400139BX Exacta-Mix EVA Container TPN Bag 1000ML 127 CLS1400140BX Exacta-Mix EVA Container TPN Bag 2000ML 156 CLS1400141BX Exacta-Mix EVA Container TPN Bag 3000ML 156 CLS1402000BB NUTRIENT MIXING BAG-NUTRIMIX 156 CLS1403000BB TPN BAG 3000CC 156 CLS14B8082CT VIAFLEX TPN BAG 250C.C. 96 CLS14B8086BT EMPTY VIAFLEX CONTAINER WITH CONNECTOR 2000ML 156 CLS14B8087BT EMPTY VIAFLEX CONTAINER WITH CONNECTOR 3000ML 156 CLS14B8112CT ALL-IN-ONE BAG 1000CC 127 61

特材代碼中英文品名支付點數 CLS14B8122CT ALL-IN-ONE BAG 2000C.C. 156 CLS14B8132CT ALL-IN-ONE BAG 3000C.C. 156 CLS14B8152CT ALL-IN-ONE BAG 500 CC 101 CME011032NNY GOLDVALVE DETACHABLE BALLOON 16753 CME0180351SB SENTRY BALLOON CATHETER 150CM W/GUIDING CATH 雙導管式 36019 CME01GVBNNN9 GOLDVALVE EMBOLIZATION BALLOONS* 16753 CME01MABDLBL MAGIC CATHETER WITH BALLOON EMBOLIZATION SET(BALLOON+MICRO CATH+MANDRIA) 36019 CME01MABDXBL MAGIC CATHETER WITH BALLOON EMBOLIZATION SET(BALLOON+MICRO CATH+MANDRIA) 36019 CMV01C1FNNN9 MINITORQUER CIFN HYPERSELECTIVE MICROCATHETER FOR DETACHABLE BALLOONS(MICRO CATHETER( 同軸心雙導管 )+MANDREL+HEMASTATIC)* 18864 CMV01CC0LNNY COAXIAL HYDROPHILIC MICRO-CATHETER 2F/3F(2FR 內導管 +3FR 外導管 +MANDREL) 18864 CMV020402XCY CIC BALLOON CATHETER FOR EMBOLECTOMY CATHETER 2:8FR 1071 CMV02120FFED EDWARDS FOGARTY ARTERIAL EMBOLECTOMY CATHETER 1071 CMV02120XNED FORGATY ARTERIAL EMBOLECTOMY CATHETER 2:7FR 40:80MM 1071 CMV021240NBT FORGATY EMBOLECTOMY CATHETER 1071 CMV021280NBT FORGATY EMBOLECTOMY CATHETER 1071 CMV0212TLWED FOGARTY THRU-LUMEN EMBOLECTOMY CATHETER(2 LUMEN CATH) 1895 CMV021601SLW "LEMAITRE"EMBOLECTOMY CATHETERS 單腔式動脈血栓清除導管 1071 CMV0216510LW "LEMAITRE"EMBOLECTOMY CATHETERS 導引線式動脈血栓清除導管 ( 雙腔 ) 1895 CMV021801LLW "LEMAITRE"EMBOLECTOMY CATHETERS 單腔式動脈血栓清除導管 1071 CMV021VS12ED ANASTA FLO INTRAVASCULAR SHUNT* 2771 CMV0231100M4 CLEARVIEW INTRACORONARY SHUNT* 2771 CMV0232080ED FORGATY VENOUS THROMBECTOMY CATHETER 1071 CMV02A4400A4 SYNTEL ARTERIAL EMBOLECTOMY CATHETER 3:7FR/40,50,80CM 1071 CMV02A4E01BS PYTHON ANGIOGRAPHY EMBOLECTOMY CATHETER 3:7FR(CATH+GUIDEWIRE+INTRODUCER) 2565 CMV02A4E09A4 PYTHON DUAL LUMEN EMBOLECTOMY CATHETER(CATH+GUIDE WIRE+INTRODUCER) 2565 CMV02A4F00A4 SYNTEL ARTERIAL EMBOLECTOMY CATHETER 2:7FR 40,60,80CM 1071 62

CMV02C1254B2 FLORESTER CORONARY ARTERY OCCLUDER 冠狀動脈血管阻塞棒 2591 CMV02EL134BS ARTERIAL EMBOLECTOMY CATHETER 1071 CMV02EL326BS EMBOLECTOMY CATHETER 1071 CMV02FT012B2 FLO-THRU INTRALUMINAL SHUNT 血管通路器 * 2771 CMV02FT012S7 FLO-THRU INTRALUMINAL SHUNT 血管通路器 * 2771 CMV02RFGC4TM RADIFOCUS GLIDECATH 4FR 65:100CM ALL CURVE 1071 CMV02V3064B2 FLORESTER VASCULAR OCCLUDER 週邊動脈血管阻塞棒 2591 CVA0107035AR "ARROW"BERMAN ANGIOGRAPHIC BALLOON CATHETERS(REVERSE)5FR 80CM;7FR 110CM" 亞諾 " 帕曼心臟血管攝影用導管 ( 反逆流式 ) 1750 CXE0321000BA " 巴德 " 史汀格除顫電極導管 "BARD"STINGER ABLATION CATHETERS 24285 CXE0331000BA " 巴德 " 天蠍電燒電極導管 "BARD"SCORPION ABLATION CATHETER 24285 CXE03402XXST CXE034500TSB "SJM"STEERABLE ELECTROPHYSIOLOGY CATHETER " 聖猷達 " 可控式生理電極導管 ( 雙溫控可控式燒灼導管 LIVEWIRE TC ABLATION CATHETER) " 波士頓科技 " 布雷瑟心臟除顫系統 "BOSTON SCIENTIFIC" BLAZER II XP CARDIAC ABLATION SYSTEM 24285 24285 CXE035031TSB " 波士頓科技 " 布雷瑟除顫電極導管 "BOSTON SCIENTIFIC" BLAZER ABLATION CATHETER 24285 CXE0360811M4 CARDIOBLATE SURGICAL ABLATION SYSTEM 心臟電燒系統 *( 產品型號 60813,60814 自 94 年 10 月 1 日生效 ) 40854 CXE038336NYB " 爾灣 " 除顫電極導管 "IBI"ABLATION ELECTROPHYSIOLOGY CATHETER 24285 CXE038337NYB " 爾灣 " 瑟爾皮除顫電極導管 "IBI"THERAPY DUAL-8 ABLATION CATHETER 24285 CXE038344NYB " 爾灣 " 瑟爾皮熱阻電燒導管 "IBI" THERAPY 8MM TIP THERMISTOR ABLATION CATHETER 24285 CXE038372NYB " 爾灣 " 除顫電極導管 "IBI" ABLATION ELECTROPHYSIOLOGY CATHETER 24285 CXE03CBBRAE8 CXE03CMBRASB CXE03CS927E8 CXE03EP920CV CXE03EP920WE " 艾斯泰格 " 康柏拉電雙極套 "ESTECH"COBRA BIPOLAR INSERTS** 限心臟外科手術時使用並附 AF 心電圖報告術前術中或術後康柏拉電刀用電極 BOSTON SCIENTIFIC 廠牌 COBRA SURGICAL PROBE 限心臟外科手術時使用並附 AF 心電圖報告術前術中或術後 "ESTECH"COBRA SURGICAL PROBE " 艾斯泰格 " 康柏拉電刀用電極 * 限心臟外科手術時使用並附 AF 心電圖報告術前術中或術後電生理導管 ( 四極可控式溫控導管 )( 型號含 :D7TAG;TCAGFL252RT;TPSL252RT, D8BTBL;BTCBL:FG252RT,D8BTCCG;BTCL:F5L252RT) " 百歐森偉伯司特 " 電生理導管 ( 四極可控式溫控導管 ) "BIOSENSE WEBSTER"ELECTROPHYSIOLOGY CATHETER 40854 40854 40854 24285 24285 CXE03MARNXM4 美敦力瑪林射頻電燒導管 MEDTRONIC MARINR STEERABLE ABLATION CATHETER 24285 CXE03SA402ST " 聖猷達 " 雙向電燒導管 "SJM"BI-DIRECTIONAL ABLATION CATHETER 24285 CXE03WAUW2ER " 愛匹克 " 心臟燒灼系統 "EPICOR"CARDIAC ABLATION SYSTEM 限心臟外科手術時使用並附 AF 心電圖報告術前術中或術後 40854 63

CXE03WULP2ER " 愛匹克 " 心臟燒灼系統 "EPICOR" CARDIAC ABLATION SYSTEM* 40854 FBA0110001H1 BONE CEMENT40GM 906 FBA011101NZ1 OSTEOBOND COPOLYMER BONE CEMENT 40G/20ML 906 FBA011102NZ1 DOUGH TYPE BONE CEMENT 40GM 906 FBA011112NZ1 L.V.C BONE CEMENT 1429 FBA0131050CM CRANIOPLASTY BONE CEMENT (2PKG/BOX) 頭顱整形術專用 3903 FBA0133CMWDP CMW BONE CEMENT 40GM( 粉末 + 液體 ) 906 FBA01CM123C6 BONE CEMENT C.M.W.40GM 906 FBA01ER307DP ENDURANCE BONE CEMENT 40GM WITH 18.88 LIQUID 906 FBA022291NZ1 BONE STAPLE 368 FBA024060NZ1 EPIPHYSEAL STAPLE 978 FBA024061NZ1 FRACTURE STAPLE 978 FBA024064NZ1 STAPLE 978 FBA100900NH1 HIP STEM PLUG 8:14MM 1041 FBA101109NZ1 POLY PLUG INTRAMEDULLARY PLUGS 1041 FBA101905NU0 U2 HIP STEM PLUG 7:16 1041 FBA102002NW2 CEMENT CENTRALIZER 9:21MM 1041 FBA105460RDP C-STEM CEMENT RESTRICTOR 1041 FBA1422321Z1 CABLE-READY COBALT CHROME CABLE+SLEEVE 3546 FBA1422322Z1 STAINLESS CABLE-READY PLATE 6:8HOLE 7384 FBA1422323Z1 TITANIUM CABLE-READY GRIP(SHORT) 4975 FBA142232NZ1 STAINLESS CABLE-READY+SLEEVE 1.3MM,1.8MM 3341 FBA142300NH1 DALL-MILES STAINLESS CABLE 1287 FBA142301NH1 DALL-MILES STAINLESS CABLE GRIP 4586 FBA142305NH1 DALL-MILES STAINLESS CABLE SLEEVE 1784 FBA1428100S1 WIRE MOUNT 骨板固定鈕 1784 64

FBA143704NH1 DALL-MILES STAINLESS CABLE BONE PLATE 7384 FBEF110001D1 TRAUMA-FIX EXTERNAL FIXTOR:FEMORAL BASIC FRAME 股骨基本組 18900 FBEF110002D1 TRAUMA-FIX EXTERNAL FIXTOR:FEMORAL LENGTHENING FRAME 股骨延長組 25722 FBEF110003D1 TRAUMA-FIX EXTERNAL FIXTOR:FEMORAL BONE TRANSPORT FRAM 股骨移位組 18900 FBEF127500R1 ILIZAROV External Fixator System :FEMORAL BASIC SET 股骨基本組 18900 FBEF135000R1 ILIZAROV External Fixator System :FEMORAL LENGTHENING SET 股骨延長組 25722 FBEF141800R1 ILIZAROV External Fixator System :FEMORAL DOUBLE LENGTHENING SET 股骨雙層延長組 35112 FBEF1S0C01ZA LIMB LENGTHENER+COMPRESSION-DISTRACTION UNIT 延長外固定器 12155 FBEF1ULENGTD UNI-LENGTHENING FRAME(U1+U2 CLAMPX1+DISTR&COMP RODX1) 不含 PIN( 單側 ) 12155 FBEF2199XNS1 DISPOFIX SYSTEM(EXTERNAL FIXATOR)(SELDRILLX4+CLAMPX4+RODX1+BARX1) 8755 FBEF220001D1 TRAUMA-FIX EXTERNAL FIXTOR:TIBIAL BASIC FRAME 脛骨基本組 16500 FBEF220002D1 TRAUMA-FIX EXTERNAL FIXTOR:TIBIAL BONE TRANSPORT FRAM 脛骨移位組 20625 FBEF220003D1 TRAUMA-FIX EXTERNAL FIXTOR:SINGLE LEVEL TIBIAL LENGTHENING FRAM 23100 FBEF220004D1 TRAUMA-FIX EXTERNAL FIXTOR:DOUBLE LEVEL TIBIAL LENGTHENING FRAM 33948 FBEF220005D1 TRAUMA-FIX EXTERNAL FIXTOR:TIBIAL DEFORMITY FRAM 18040 FBEF22010NZ6 HUMERUS FRAME SET( 美瑞世肱骨外固定器組 ) 一支連接桿 + 二支多向球 ) 8755 FBEF223000R1 ILIZAROV External Fixator System :TIBIAL BASIC SET 脛骨基本組 16500 FBEF228750R1 ILIZAROV External Fixator System :TIBIAL BONE TRANSPORT SET 脛骨移位組 20625 FBEF231900R1 ILIZAROV External Fixator System :TIBIAL LENGTHENING SET 脛骨延長組 23100 FBEF241400R1 ILIZAROV External Fixator System :TIBIAL DOUBLE LENGTHENING SET 脛骨雙層延長組 33948 FBEF2S0C05ZA CLAMPX2+CONTROL ROD+COMP-DIST UNIT 四肢外固定器 8755 FBEF2UBAS1TD UNI-BASIC FRAME(U1 CLAMPX1+U2 CLAMPX1+RODX1) 不含 PIN( 單側 ) 8755 FBEF32180NR1 ILIZAROV External Fixator System:ANKLE BASIC SET 踝骨基本組 20866 FBEF330001D1 TRAUMA-FIX EXTERNAL FIXTOR:ANKLE BASIC SET 踝骨基本組 20866 FBEF421800R1 ILIZAROV External Fixator System :HUMERAL BASIC SET 肱骨基本組 17500 FBEF500017D1 TELES CONNECTING ROD 341 65

特材代碼中英文品名支付點數 FBEF500018D1 CONNECTING ROD 106 FBEF50001ND1 UNIVERSAL BALL JOINT 714 FBEF50001NTD PIN HOLDER CLAMP 704 FBEF50001NZ6 5HOLE UNIVERSAL BALL JOINT( 美瑞世五洞外固定器 ) 714 FBEF50001XD1 EXTERNAL FIXATOR SYSTEM:PIN HOLDER CLAMP(WITH ONE:TWO DIA.8MM ROD, WITH ONE:TWO DIA.5MM ROD) 針夾 704 FBEF50008ND1 EXTERNAL FIXATOR SYSTEM:ARTICULATION COUPLING(DIA.5:8MM*DIA.3:8MM) 結合器 301 FBEF50008NTD ARTICULATION COUPLING 301 FBEF50013ND1 ARTICULING COUPING 301 FBEF50014NZ6 ARTICULATION COUPLING 8X3,8X4,8X5MM( 美瑞世多向外固定器 )(990701 規格 8*3 更正為 8*8MM) 301 FBEF50018ND1 EXTERNAL FIXATOR SYSTEM:CONNECTING ROD 連結桿 106 FBEF50018NTD CONNECTION ROD 106 FBEF50018NZ6 CONNECTING ROD 200,250,300MM( 美瑞世骨外連接管 ) 106 FBEF50019ND1 EXTERNAL FIXATOR SYSTEM:ADJUSTABLE TELESCOPICCONNECTING ROD 調整桿 1692 FBEF50019NTD ADJUSTABLE TELESCOPIC CONNECTING ROD 1692 FBEF50020NZ6 COLLES FRAME SET( 美瑞世一支連接桿 + 二支多向球 ) 限橈骨和尺骨雙骨折使用 4201 FBEF500D2NTD WRIST FRAME 手腕外固定器限撓骨和尺骨雙骨折使用 4201 FBEF500S2ND1 EXTERNAL FIXATOR SYSTEM:COLLES-FOREARM FRAME 手腕組 (L170MM) 4201 FBEF500S2NTD COLLES FOREARM FRAM 限橈骨和尺骨雙骨折使用 4201 FBEF54601NU0 UNITED EXTERNAL FIXATOR WITHOUT PIN( 手腕骨外固定器組 ) 限撓骨和尺骨雙骨折使用 4201 FBEF5S0C04ZA WRIST FIXATOR 手腕外固定器限撓骨和尺骨雙骨折使用 4201 FBEF5U1U2ND1 EXTERNAL FIXATOR SYSTEM:PIN CLAMP 針夾 (DIA.15:20MM) 3767 FBEF5U1U2NTD PIN CLAMP 組合式外固定針夾 3767 FBEF5U3U4ND1 EXTERNAL FIXATOR SYSTEM:SMOOTH ROD 連結桿 (DIA.20MM*L200:300MM) 866 FBEF5U3U4NTD SMOOTH ROD 外固定平滑桿 866 FBEF5U5LEND1 EXTERNAL FIXATOR SYSTEM:DISTRACTION&COMPRESSION ROD 伸縮桿 (250+50MM) 3192 FBEF5U5LENTD DISTRACTION&COMPRESSION ROD 外固定伸縮延長桿 3192 66

FBEF5U6U7ND1 EXTERNAL FIXATOR SYSTEM:ROD CONNECTOR 桿連結器 (DIA.8:20MM*DIA.20MM) 3971 FBEF5U6U7NTD ROD CONNECTOR 外固定雙孔耦合器 3971 FBEFP0640ND1 EXTERNAL FIXATION SYSTEM:WIRE WTITH OLIVE 1.5MM:2.0MM 300:400MM 1337 FBEFP0666ND1 EXTERNAL FIXATION SYSTEM:WIRE 1.5MM 2.0MM 300:400MM 475 FBEFP0M30NRT EXTERNAL FIXATOR CORTICAL SCREW 1520 FBEFP1010NRT EXTERNAL FIXATOR CORTICAL SCREW 1520 FBEFP1012NRT CANCELLOUS SCREW(10.130:4,10.180:4 自 90/04/01 起刪除 ) 1520 FBEFP294NNS1 SCHANZ SCREW (FOR EXTERNAL FIXATION ) 459 FBEFP294XNY2 SKELETAL TRACTION PIN 319 FBEFP295XNY2 HALF PIN 319 FBEFP296XNY2 TRANSFIXING PIN 319 FBEFP29771S1 "MATHYS" SCHANZ SCREW (SELDRILL) 4.0/3.0MM(HALF PIN) 1039 FBEFP29774S1 "MATHYS" SCHANZ SCREW(SELDRILL) DIA 3.5-4.0MM(HALF PIN) 1039 FBEFP29782S1 "MATHYS" SCHANZ SCREW(SELDRILL) DIA 4.4-5.0MM(HALF PIN) 1102 FBEFP29792S1 SELDRILL 6.0MM(HALP PIN) 1146 FBEFP297XNY2 SCHANZ SCREW( 型號 294400,294520:70,294620:40)(90/04/01 起型號 294300 刪除, 新增 294960) 459 FBEFP3059NZ6 STAINLESS FULL PIN 4-5MM( 兩截全針 ) 1191 FBEFP3070NZ6 TITANIUM HALF PIN 2.5-3MM,3-4MM( 兩截半針 ) 1424 FBEFP3070SZ6 STAINLESS HALF PIN 2.5-3,3-4MM 80:150CM( 粗細兩截 ) 1039 FBEFP3090NZ6 STAINLESS HALF PIN 4-5MM,5-6MM( 兩截半針 ) 1102 FBEFP3109NZ6 TITANIUM HALF PIN 3MM 554 FBEFP4031NZ6 TITANIUM HALF PIN 4MM 622 FBEFP4031SZ6 STAINLESS HALF PIN 4MM 120:180CM 615 FBEFPFUP1ND1 EXTERNAL FIXATOR SYSTEM:FULL PIN 全針 (DIA 3:6MM*L200:300MM) 1191 FBEFPFUP1NTD FULL PIN DIA 3-4MM,5-6MM 1191 FBEFPHAP1ND1 EXTERNAL FIXATOR SYSTEM:HALF PIN 半針 (DIA.2:3MM*L45:90MM) 507 67

特材代碼中英文品名支付點數 FBEFPHAP1NTD HALF PIN DIA 2.0MM,3.0MM 507 FBEFPKX36NAE SCHANZ SCREW 459 FBEFPLX34NAE SCHANZ" SCREW SCHRAUBEN HALF PIN 798 FBEFPLX74NAE SMALL EF SCHANZE SCREW AND PIN 1056 FBEFPP1N56D1 EXTERNAL FIXATOR SYSTEM: HALF PIN 半針 (DIA.5-6MM*L150:180MM) 702 FBEFPP1N56TD HALF PIN DIA 5.0MM,6.0MM 702 FBEFPPN040D1 EXTERNAL FIXATOR SYSTEM: HALF PIN 半針 (DIA.4MM*L150:180MM) 615 FBEFPPN040TD HALF PIN DIA 4.0MM 615 FBEFPPN234D1 EXTERNAL FIXATOR SYSTEM:HALF PIN 半針 (DIA2:4MM*L70:150MM) 1039 FBEFPPN234TD HALF PIN 2MM:4MM 外固定骨半針 1039 FBEFPPN456D1 EXTERNAL FIXATOR SYSTEM:HALF PIN 半針 (DIA.4:6MM*L150:180MM) 1102 FBEFPPN456TD HALF PIN DIA 4-5MM,5-6MM 1102 FBEH14111NH1 TOTAL ELBOW :HUMERAL 41339 FBEH15000NS2 TOTAL ELBOW SYSTEM 69732 FBEH15005NS2 TOTAL ELBOW:HUMERAL COMPONENT 41339 FBEH18006NZ1 TOTAL ELBOW SYSTEM(HUMERAL+ULNAR) 69732 FBEH181051Z1 COONRAD/MORREY HUMERAL COMPONENT( 型號 32-8105-025-04:036-08 自 90/07/01 生效 ) 41339 FBEH18105NZ1 COONRAD/MORREY TOTAL ELBOW SYSTEM(HUMERAL+ULNAR) 69732 FBEU14112NH1 TOTAL ELB0W :ULNAR 28393 FBEU15005NS2 TOTAL ELBOW:ULNA COMPONENT 28393 FBEU181052Z1 COONRAD/MORREY ULNAR COMPONENT( 型號 32-8105-053-01:093-02 自 90/07/01 生效 ) 28393 FBFJ1G470NW2 SWANSON FINGER JOINT( 含鈦合金指套 ) 14500 FBHB1103XNDP CUP 11152 FBHB1126XNSN SYNERGY CONVENE BIPOLAR CUP SHELL 7680 FBHB11700NW2 BIPOLAR CUP 7680 FBHB13110NW2 BIOPOLAR CUP&CUP INSERT 11152 68

特材代碼中英文品名支付點數 FBHB1501XNU0 UNITED BIPOLAR CUP 聯髖半髖外帽 7680 FBHB15264NH1 P.C.A. CUP 11152 FBHB15984NZ1 BIPOLAR CUP 11152 FBHB1NK04NAE BICONTACT BIPOLAR CUP 11152 FBHB21700NW2 BIPOLAR INSERT 3472 FBHB2601XNU0 UNITED BIPOLAR CUP LINER 聯髖半髖內襯 3472 FBHB27139NSN SYNERGY CONVENE BIPOLAR CUP LINER 3472 FBHBA0580NH1 EXTER BIPOLAR SYSTEM 38177 FBHBA1000NAE BICONTACT BIPOLAR HIP SYSTEM 38177 FBHBA1000NDP BIPOLAR HIP SYSTEM 38177 FBHBA1000NSN SYNERGY CONVENE BIPOLAR SYSTEM 38177 FBHBA1000NU0 UNITED BIPOLAR SYSTEM 38177 FBHBA1000NW2 BIOPOLAR HIP SYSTEM 38177 FBHBA1000TZ1 BIPOLAR HIP SYSTEM 38177 FBHBA1100NDP CORAIL BIPOLAR HIP SYSTEM 38177 FBHBA2000NU0 UNITED U2 BIPOLAR SYSTEM 38177 FBHBA3000TZ1 VERSYS BIPOLAR SYSTEM 38177 FBHBA4120NH1 ABG HA BIPOLAR SYSTEM 38177 FBHBA5000TZ1 MAYO BIPOLAR SYSTEM 38177 FBHBA5500NS2 ACCOLADE BIPOLAR HIP SYSTEM(STEM+CUP+HEAD) 38177 FBHBA6000NS2 BIPOLAR HIP SYSTEM 38177 FBHBA6000NZ1 CLS BIOPOLAR SYSTEM(STEM+HEAD+CUP) 38177 FBHBA8000TZ1 BIPOLAR HIP SYSTEM(CUP+HEAD+STEM) 38177 FBHBA9101NH1 P.C.A. BIPOLAR HIP SYSTEM 38177 FBHBA9610NDP C-STEM BIPOLAR HIP SYSTEM 38177 FBHBA9979NDP SUMMIT BIPOLAR HIP STEM(STEM+CUP+HEAD) 38177 69

FBHBCCERA1AE CERAMIC BIPOLAR HIP SYSTEM 符合傳統雙極式髖關節組適應症者, 如自願選用陶瓷雙極式人工 38177 髖關節組, 則按傳統雙極式髖關節組給付, 超過部分由病患自付 FBHBCCERA1DP FBHBCCERA1S2 FBHBCCERA1U0 FBHBCCERA1W2 FBHBCCERA1Z1 FBHBCCERA2AE CERAMIC BIPOLAR HIP SYSTEM 符合傳統雙極式髖關節組適應症者, 如自願選用陶瓷雙極式人工髖關節組, 則按傳統雙極式髖關節組給付, 超過部分由病患自付 CERAMIC BIPOLAR HIP SYSTEM 符合傳統雙極式髖關節組適應症者, 如自願選用陶瓷雙極式人工髖關節組, 則按傳統雙極式髖關節組給付, 超過部分由病患自付 CERAMIC BIPOLAR SYSTEM 符合傳統雙極式髖關節組適應症者, 如自願選用陶瓷雙極式人工髖關節組, 則按傳統雙極式髖關節組給付, 超過部分由病患自付 CERAMIC BIPOLAR HIP SYSTEM 符合傳統雙極式髖關節組適應症者, 如自願選用陶瓷雙極式人工髖關節組, 則按傳統雙極式髖關節組給付, 超過部分由病患自付 BIPOLAR CERAMIC SYSTEM 符合傳統雙極式髖關節組適應症者, 如自願選用陶瓷雙極式人工髖關節組, 則按傳統雙極式髖關節組給付, 超過部分由病患自付 CERAMIC BIPOLAR HIP SYSTEM 符合傳統雙極式髖關節組適應症者, 如自願選用陶瓷雙極式人工髖關節組, 則按傳統雙極式髖關節組給付, 超過部分由病患自付 38177 38177 38177 38177 38177 38177 FBHC10581NH1 ACETABULAR CUPS 11152 FBHC11246NDP AML CUP+AML INSERT 11152 FBHC1124XNDP AML CUP( 型號 96-23-23:80,24-09:10,50,51,53-22-040:153 自 92/4/1 生效 ) 11152 FBHC11455NDP DURALOC HIP IMPLANT:ACETABULAR CUP 11152 FBHC11599NDP DURALOC ACETABULAR CUP SYSTEM 11152 FBHC1301XNU0 UNITED ACETABULAR CUP( 型號 1303-5044:5062 自 92/4/1 生效 ) 11152 FBHC1302XNU0 TOTAL HIP CUP+LINER 11152 FBHC1303XNU0 TITANIUM U2 ACETABULAR CUP 11152 FBHC13671NW2 HIP CUP (1808,3000,398-XXXX 自 88/10/1 生效,3631,41,51-39:57-0040:80 自 93/1/1 生效 ) 11152 FBHC14000NH1 ABG HA OUTERSHELL 42:74MM 11152 FBHC14262NZ1 ALLOFIT CUP SYSTEM 11152 FBHC15000NZ1 MULTIPOLAR BIPOLAR CUP 雙極式人工半髖臼杯 ( 型號 5001 自 92/1/1 生效 ) 11152 FBHC154NXNS2 ACETABULUM CUP 適應症請見備欄 11152 FBHC16200NZ1 TRILOGY ACETABULAR CUP(40:80MM) 11152 FBHC16302NH1 VITALOCK ACETABULAR SHELL 11152 FBHC16304NS2 ACETABULUM CUP(CUP+INSERT 一體成型 ) 11152 FBHC16528NZ1 CUP WITH LINER 11152 FBHC16532NZ1 HARRIS GALANTE CUP WITH LINER 11152 FBHC17133NSN SYNERGY TOTAL HIP REFLECTION SHELL 11152 70

特材代碼中英文品名支付點數 FBHC17504NH1 P.C.A.DEEP SOCKET SHELL 11152 FBHC18005NZ1 ZCA ALL-POLY ACETABULAR CUP+INSERT 15488 FBHC1NA64NAE BICONTACT CUP 44:64MM( 型號 NH044T:068T 自 92/4/1 生效 ) 11152 FBHC1NK810AE PE-ACETABULAR CUP+INSERT 11152 FBHC1P1NNADP PINNACLE ACETABULAR CUP 11152 FBHC26728NZ1 LINER 4336 FBHC27504NH1 P.C.A. UNIVERSAL CUP(SHELL) 11152 FBHCM1100NU0 CUSTOM MADE FEMORAL PROXIMAL TUMOR PROTHSIS SYSTEM(H+I+C+S) 申報費用時應檢附發票備查 144250 FBHCM2475NH1 "HOWMEDICA"MODULAR REPLACEMENT SYSTEM -HIP 申報時應檢附該被保險人之發票備查 187000 FBHCM6485NH1 "HOWMEDICA"MODULAR REPLACEMENT SYSTEM -HIP 申報費用應檢附發票備查 187000 FBHCMXXXXNW2 CUSTOM MADE HIP SYSTEM(HEAD+INSERT+CUP+FEMORAL STEM) 申報費用時應檢附該被保險人之發票備查 187000 FBHH10586NH1 FEMORAL HEAD 4696 FBHH1101XNDP AML FEMORAL HEAD(87/7/7 15190-51:60,136501:03,11: 15,21:25,29:30,43:48,9113112:13 適應症見備註 4696 FBHH11840NDP CORAIL FEMORAL HEAD 4696 FBHH1201XNU0 UNITED FEMORAL HEAD (BIPOLAR)( 型號 1201-1322:1828 自 92//4/1 生效 ) 4696 FBHH13611NW2 FEMORAL HEAD (2601-XXXX 自 88/10/1 生效 ) 4696 FBHH14003NH1 P.C.A.FEMORAL HEAD 4696 FBHH15220RDP S-ROM FEMORAL HEAD 4696 FBHH16260NH1 V40/PCA FEMORAL HEAD 4696 FBHH16530NH1 ABG HA FEMORAL HEAD 22.22:32MM(TOTAL AND BIPOLAR) 4696 FBHH17130NSN SYNERGY TOTAL HIP FEMORAL HEAD 4696 FBHH18018NZ1 FEMORAL HEAD(00-8018-036-01:05 自 981001 刪除 ) 4696 FBHH19262NZ1 FEMORAL HEAD 4696 FBHH1962XNDP C-STEM HIP HEAD 4696 FBHH1NK33NAE FEMORAL HEAD 4696 FBHH1NK46NAE BICONTACT FEMORAL HEAD 28,32MM(NK330K:533K,NJ111K-134K 自 92/4/1 生效 ) 4696 71

FBHHCCERA1AE CERAMIC HIP SYSTEM:HEAD 凡只更換股骨頭者, 如自願選用陶瓷股骨頭時, 則按傳統股骨頭給付 4696, 超過部分由病患自付 FBHHCCERA1DP FBHHCCERA1S2 CERAMIC HIP SYSTEM:HEAD 凡只更換股骨頭者, 如自願選用陶瓷股骨頭時, 則按傳統股骨頭給付, 超過部分由病患自付 CERAMIC HIP SYSTEM:HEAD 凡只更換股骨頭者, 如自願選用陶瓷股骨頭時, 則按傳統股骨頭給付, 超過部分由病患自付 4696 4696 FBHHCCERA1U0 CERAMIC FEMORAL HEAD 凡只更換股骨頭者, 如自願選用陶瓷股骨頭時, 則按傳統股骨頭給付, 超過部分由病患自付 4696 FBHHCCERA1W2 FBHHCCERA1Z1 FBHHCCERA2AE CERAMIC HIP SYSTEM:HEAD 凡只更換股骨頭者, 如自願選用陶瓷股骨頭時, 則按傳統股骨頭給付, 超過部分由病患自付 CERAMIC HIP SYSTEM:HEAD 凡只更換股骨頭者, 如自願選用陶瓷股骨頭時, 則按傳統股骨頭給付, 超過部分由病患自付 CERAMIC HIP SYSTEM:HEAD 凡只更換股骨頭者, 如自願選用陶瓷股骨頭時, 則按傳統股骨頭給付, 超過部分由病患自付 4696 4696 4696 FBHL11241NDP DURALOC HIP IMPLANT:ENDURON LINER 4336 FBHL11260NS2 HA HIP INSERT( 型號 2041C-26XX,28XX 自 91/01/01 生效 ) 4336 FBHL11284NH1 ABG HA INSERT 42:74MM 4336 FBHL1241XNDP AML HIP INSERT(87/7/7 新增產品型號 1251-08:24,48:64) 4336 FBHL13646NH1 P.C.A.HIP INSERT 4336 FBHL13820NW2 HIP CUP INSERT (3X15,5X00,5X15-XXXX 自 88/10/1 生效,3641:47-2200:4006 自 93/1/1 生效 ) 4336 FBHL1401XNU0 UNITED ACETABULAR CUP LINER( 型號 1403-5044:5062 自 92/4/1 生效 ) 4336 FBHL1403XNU0 U2 ACETABULAR LINER 4336 FBHL16161NZ1 ACETABULAR CUP LINER(40:80MM) 4336 FBHL16200NS2 INSERT CUP 4336 FBHL16305NZ1 LONGEVITY ACETABULAR CUP LINER 4336 FBHL16352NH1 SYSTEM 12 ACETABULAR INSERT 4336 FBHL16567NZ1 ACETABULAR CUP LINER 42:70MM 4336 FBHL1717XNSN SYNERGY TOTAL HIP ACETABULAR LINER 4336 FBHL1NK17NAE BICONTACT INSERT 28,30MM( 型號 NA278:NA291 自 92/1/1 生效,NH171:476 自 92/4/1 生效 ) 4336 FBHLCCERA1AE FBHLCCERA1DP FBHLCCERA1S2 FBHLCCERA1U0 CERAMIC TOTAL HIP SYSTEM:INSERT 凡只更換髖臼杯內襯者, 如自願選用陶瓷髖臼杯內襯時, 則按傳統髖臼杯內襯給付, 超過部分由病患自付 CERAMIC HIP SYSTEM:INSERT 凡只更換髖臼杯內襯者, 如自願選用陶瓷髖臼杯內襯時, 則按傳統髖臼杯內襯給付, 超過部分由病患自付 CERAMIC HIP SYSTEM:INSERT 凡只更換髖臼杯內襯者, 如自願選用陶瓷髖臼杯內襯時, 則按傳統髖臼杯內襯給付, 超過部分由病患自付 CERAMIC FEMORAL INSERT 凡只更換髖臼杯內襯者, 如自願選用陶瓷髖臼杯內襯時, 則按傳統髖臼杯內襯給付, 超過部份由病患自付 4336 4336 4336 4336 72

FBHLCCERA1W2 CERAMIC HIP SYSTEM:INSERT 凡只更換髖臼杯內襯者, 如自願選用陶瓷髖臼杯內襯時, 則按傳統 4336 髖臼杯內襯給付, 超過部分由病患自付 FBHLCCERA1Z1 FBHMCBCER1AE FBHMCBCER1DP FBHMCBCER1S2 CERAMIC HIP SYSTEM:LINER 凡只更換髖臼杯內襯者, 如自願選用陶瓷髖臼杯內襯時, 則按傳統髖臼杯內襯給付, 超過部分由病患自付 CERAMIC BIPOLAR HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷雙極式人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC BIPOLAR HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷雙極式人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC BIPOLAR HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷雙極式人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 4336 8493 8493 8493 FBHMCBCER1U0 CERAMIC BIPOLAR SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷雙極式人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 8493 FBHMCBCER1W2 FBHMCBCER1Z1 FBHMCBCER2AE FBHMCPCER1AE FBHMCPCER1DP FBHMCPCER1S2 FBHMCPCER1U0 FBHMCPCER1W2 FBHMCPCER1Z1 FBHMCPCER2AE FBHMCRCER1AE FBHMCRCER1DP FBHMCRCER1S2 FBHMCRCER1U0 FBHMCRCER1W2 FBHMCRCER1Z1 FBHMCRCER2AE FBHMMLDH01W2 FBHMMLDH01Z1 FBHMMLDH02W2 CERAMIC BIPOLAR HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷雙極式人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC BIPOLAR HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷雙極式人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC BIPOLAR HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷雙極式人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC TOTAL HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC TOTAL HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC HIP SYSTEM 凡符合使用 MOORE 者, 自願選用陶瓷人工髖關節組, 按 MOORE 給付, 超過部分由病患自付 CERAMIC HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC TOTAL HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC TOTAL HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC TOTAL HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC REVISION HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷重建型人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC REVISION HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷重建型人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC REVISION HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷重建型人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC REVISION HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷重建型人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC REVISION HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷重建型人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC REVISION HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷重建型人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 CERAMIC REVISION HIP SYSTEM 凡符合使用 MOORE 規定者, 如自願選用陶瓷重建型人工髖關節組, 則按 MOORE 人工髖關節給付, 超過部分由病患自付 BIG FEMORAL HEAD TOTAL HIP SYSTEM( 含固定樁 ) 符合使用 MOORE 規定者, 如自願選用 BFH 人工髖關節組, 按 MOORE 給付, 超過部分由病患自付 LDH TOTAL HIP SYSTEM 符合使用 MOORE 規定者, 如使用 LDH 人工髖關節組, 按 MOORE 給付, 超過部分由病患自付 BIG FEMORAL HEAD TOTAL HIP SYSTEM( 不含固定樁 ) 符合使用 MOORE 規定者, 如自願選用 BFH 人工髖關節組, 按 MOORE 給付, 超過部分由病患自付 8493 8493 8493 8493 8493 8493 8493 8493 8493 8493 8493 8493 8493 8493 8493 8493 8493 8493 8493 8493 73

FBHMMMETA1DP PINNACLE METAL ON METAL TOTAL HIP SYSTEM 符合 MOORE 者, 如自願選用金屬人工髖關節組 8493, 按 MOORE 髖關節組給付, 超過部分由病患自付 FBHMMMETA1Z1 METAL ON METAL TOTAL HIP SYSTEM 符合使用 MOORE 規定者, 如使用 METAL ON METAL 人工髖關節組, 按 MOORE 給付, 超過部分由病患自付 8493 FBHPA0580NH1 EXETER TOTAL HIP SYSTEM 42513 FBHPA1000NAE BICONTACT TOTAL HIP SYSTEM 42513 FBHPA1000NDP AML TOTAL HIP SYSTEM 42513 FBHPA1000NS2 HA TOTAL HIP SYSTEM 42513 FBHPA1000NU0 UNITED TOTAL HIP SYSTEM 聯髖人工髖關節 42513 FBHPA1000NW2 TOTAL HIP SYSTEM 42513 FBHPA1000TZ1 HARRIS GALANTE TOTAL HIP SYSTEM 42513 FBHPA1100NDP CORAIL TOTAL HIP SYSTEM 42513 FBHPA2000NU0 UNITED U2 TOTAL HIP SYSTEM 42513 FBHPA2000TZ1 HA/TCP TOTAL HIP SYSTEM 42513 FBHPA3000NU0 TOTAL HIP SYSTEM ( 型號 13021044:62+11045034:67+12011126:1726) 42513 FBHPA4000TZ1 VERSYS TOTAL HIP SYSTEM 42513 FBHPA4120NH1 ABG HA TOTAL HIP SYSTEM 42513 FBHPA5000NS2 TOTAL HIP SYSTEM(STEM+CUP+HEAD+INSERT) 42513 FBHPA5000TZ1 MAYO TOTAL HIP SYSTEM 42513 FBHPA5500NS2 ACCOLADE TOTAL HIP SYSTEM(STEM+CUP+INSERT+HEAD) 42513 FBHPA6000NZ1 CLS SPOTORNO SYSTEM(STEM+LINER+HEAD+ACETABULAR CUP) 42513 FBHPA7000NSN SYNERGY TOTAL HIP SYSTEM 42513 FBHPA8000TZ1 TOTAL HIP SYSTEM(CUP+LINER+HEAD+STEM) 42513 FBHPA9101NH1 P.C.A.TOTAL HIP SYSTEM 42513 FBHPA9610NDP C-STEM TOTAL HIP SYSTEM 42513 FBHPA9979NDP SUMMIT TOTAL HIP SYSTEM(STEM+HEAD+CUP+INSERT) 42513 FBHPCCERA1AE FBHPCCERA1DP CERAMIC TOTAL HIP SYSTEM 凡符合傳統人工髖關節組之適應症者, 如自願選用陶瓷人工髖關節組時, 則按傳統人工髖關節組給付, 超過部分由病患自付 CERAMIC TOTAL HIP SYSTEM 凡符合傳統人工髖關節組之適應症者, 如自願選用陶瓷人工髖關節組時, 則按傳統人工髖關節組給付, 超過部分由病患自付 42513 42513 74

FBHPCCERA1S2 CERAMIC TOTAL HIP SYSTEM 凡符合傳統髖關節組者, 自願選用陶瓷髖關節組, 則按傳統髖關節 42513 組給付, 超過部分由病患自付 FBHPCCERA1U0 FBHPCCERA1W2 FBHPCCERA1Z1 FBHPCCERA2AE FBHPMLDH01W2 FBHPMLDH01Z1 FBHPMLDH02W2 FBHPMMETA1DP FBHPMMETA1Z1 CERAMIC TOTAL HIP SYSTEM 凡符合傳統人工髖關節組之適應症者, 如自願選用陶瓷人工髖關節組時, 則按傳統人工髖關節組給付, 超過部分由病患自付 CERAMIC TOTAL HIP SYSTEM 凡符合傳統人工髖關節組之適應症者, 如自願選用陶瓷人工髖關節時, 則按傳統人工髖關節組給付, 超過部分由病患自付 CERAMIC TOTAL HIP SYSTEM 凡符合傳統人工髖關節組之適應症者, 如自願選用陶瓷人工髖關節組時, 則按傳統人工髖關節組給付, 超過部分由病患自付 CERAMIC TOTAL HIP SYSTEM 凡符合傳統人工髖關節組之適應症者, 如自願選用陶瓷人工髖關節組時, 則按傳統人工髖關節組給付, 超過部分由病患自付 BIG FEMORAL HEAD TOTAL HIP SYSTEM ( 含固定樁 ) 符合傳統髖關節組適應症者, 如自願選用 BFH 人工髖關節組, 按傳統髖關節組給付, 超過部分由病患自付 LARGE DIAMETER HEAD (LDH))TOTAL HIP SYSTEM 符合傳統髖關節組適應症者, 如自願選用 LDH 人工髖關節組, 按傳統髖關節組給付, 超過部分由病患自付 BIG FEMORAL HEAD TOTAL HIP SYSTEM( 不含固定樁 ) 符合傳統髖關節組適應症者, 如自願選用 BFH 人工髖關節組, 按傳統髖關節組給付, 超過部分由病患自付 PINNACLE METAL ON METAL TOTAL HIP SYSTEM 符合傳統髖關節組適應症者, 如自願選用金屬人工髖關節組, 按傳統髖關節組給付, 超過部分由病患自付 METASUL METAL ON METAL TOTAL HIP SYSTEM 符合傳統髖關節組適應症者, 如自願選用金屬人工髖關節組, 按傳統髖關節組給付, 超過部分由病患自付 42513 42513 42513 42513 42513 42513 42513 42513 42513 FBHRA0580NH1 EXTER REVISION TOTAL HIP SYSTEM 55313 FBHRA1000NDP AML REVISION TOTAL HIP SYSTEM 55313 FBHRA1000NW2 REVISION TOTAL HIP SYSTEM 55313 FBHRA1000TZ1 REVISION TOTAL HIP SYSTEM 55313 FBHRA10099DP C-STEM REVISION TOTAL HIP SYSTEM 55313 FBHRA1100NH1 P.C.A.REVISION TOTAL HIP SYSTEM 55313 FBHRA2000NW2 PERFECTA REVISION TOTAL HIP SYSTEM(NECK+BODY+STEM+HEAD+CUP+INSERT) 76555 FBHRA2000TZ1 VERSYS REVISION TOTAL HIP SYSTEM 55313 FBHRA3000NS2 HA REVISION TOTAL HIP SYSTEM 55313 FBHRA3000TZ1 VERSYS CEMENTED REVISION/CALCAR TOTAL HIP SYSTEM 55313 FBHRA4000TZ1 ZMR REVISION HIP SYSTEM(BODY+STEM+HEAD+CUP+INSERT) 76555 FBHRA5000NS2 TOTAL HIP REVISION SYSTEM(STEM+CUP+INSERT+HEAD) 55313 FBHRA5000NU0 U2 REVISION HIP SYSTEM 55313 FBHRA5200RDP S-ROM TOTAL HIP SYSTEM(STEM+SLEEVES+HEAD+CUP+INSERT) 76555 FBHRA6260NH1 RESTORATION REVISION HIP SYSTEM 55313 FBHRANK20NAE BICONTACY REVISION HIP SYSTEM(STEM+HEAD+CUP+INSERT) 55313 75

FBHRCCERA1AE CERAMIC REVISION HIP SYSTEM 符合傳統重建型髖關節組適應症者, 如自願選用陶瓷重建型人工 55313 髖關節組, 按傳統重建型髖關節組給付, 超過部分由病患自付 FBHRCCERA1DP FBHRCCERA1S2 FBHRCCERA1U0 FBHRCCERA1W2 FBHRCCERA1Z1 FBHRCCERA2AE FBHRCCERA2W2 CERAMIC REVISION HIP SYSTEM 符合傳統重建型髖關節組適應症者, 如自願選用陶瓷重建型人工髖關節組, 按傳統重建型髖關節組給付, 超過部分由病患自付 CERAMIC REVISION HIP SYSTEM 符合傳統重建型髖關節組者, 自願選用陶瓷重建型髖關節組, 按傳統重建型髖關節組給付, 超過部分由病患自付 CERAMIC REVISION HIP SYSTEM 符合傳統重建型髖關節組適應症者, 如自願選用陶瓷重建型人工髖關節組, 按傳統重建型髖關節組給付, 超過部分由病患自付 CERAMIC REVISION HIP SYSTEM 符合傳統重建型髖關節組適應症者, 如自願選用陶瓷重建型人工髖關節組, 按傳統重建型髖關節組給付, 超過部分由病患自付 REVISION CERAMIC HIP SYSTEM 符合傳統重建型髖關節組適應症者, 如自願選用陶瓷重建型人工髖關節組, 按傳統重建型髖關節組給付, 超過部分由病患自付 CERAMIC REVISION HIP SYSTEM 符合傳統重建型髖關節組適應症者, 如自願選用陶瓷重建型人工髖關節組, 按傳統重建型髖關節組給付, 超過部分由病患自付 CERAMIC REVISION HIP SYSTEM 符合傳統重建型 ( 且骨頭缺損達第二度以上者 ) 者, 自願選用陶瓷重建型髖關節組, 超過部分由病患自付 55313 55313 55313 55313 55313 55313 76555 FBHS10580NH1 FEMORAL STEM 22329 FBHS1101XNU0 UNITED PRIMARY HIP STEM (BIPOLAR STEM) 22329 FBHS11104NU0 UNITED U2 HIP STEM 22329 FBHS11104RU0 U2 REVISION HIP SYSTEM:STEM 35129 FBHS1110XNU0 TOTAL HIP STEM(CEMENT STEM) 22329 FBHS11170NS2 HA PRIMARY STEM 22329 FBHS11200NS2 EXETER PRIMARY STEM 22329 FBHS11300NS2 ACCOLADE PRIMARY STEM 22329 FBHS1135XNDP AML STEM(87/7/7 新增 1554,1557-02:08,42:48,1345-20:27) 22329 FBHS12900NZ1 CLS SPOTORNO STEM 22329 FBHS13708NW2 FEMORAL STEM (378X-XXXX 自 88/09/01 起生效,385X,3793-XXXX 自 88/10/1 生效 ) 22329 FBHS14120NH1 ABG HA FEMORAL STEM 1#:9# (TOTAL AND BIPOLAR) 22329 FBHS16260NH1 RESTORATION P/S LONG STEM 35129 FBHS16521NZ1 HARRIS GALANTE PRIMARY STEM 22329 FBHS16578NZ1 VERSYS HA/TCP FIBER METAL TAPER STEM 22329 FBHS1713XNSN SYNERGY TOTAL HIP STEM (7130-6109:7130-6418 自 88/10/1 生效 ) 22329 FBHS17711NZ1 M/L TAPER HIP PROSTHESIS(STEM) 22329 FBHS17841NZ1 VERSYS FIBER METAL MIDCOAT HIP STEM(COLLARED) 22329 76

特材代碼中英文品名支付點數 FBHS17850NZ1 VERSYS ADVOCATE CEMENTED STEM 22329 FBHS17853NZ1 VERSYS CEMENTED TOTAL HIP STEM(7853-11:17-01:21 自 89/04/01 起生效 ) 22329 FBHS17854NZ1 VERSYS CEMENTED HIP CT STEM 22329 FBHS17857NZ1 VERSYS HERITAGE CDH:FEMORAL STEM 22329 FBHS17862NZ1 VERSYS FIBER METAL TAPER HIP STEM 22329 FBHS18026NZ1 MAYO CONSERVATIVE STEM 22329 FBHS19101NH1 P.C.A. PRIMARY STEM 22329 FBHS1925XNDP CORAIL FEMORAL STEM 22329 FBHS1961XNDP C-STEM HIP STEM(9613-15000 自 92/7/1 生效 ) (9611-00500,01500,02500 自 92/10/1 生效 ) 22329 FBHS19979NDP SUMMIT HIP STEM 22329 FBHS1NK62NAE BICONTACT PRIMARY STEM 10:21MM( 型號 NK010K-18K,NJ009T:16T,NJ028-34K 自 92/4/1 生效 ) 22329 FBHS2130LNS2 "HOWMEDICA-OSTEONICS"OMNIFIT HIP SYSTEM:OMNIFIT CEMENTED LONG STEM" 好美得卡 - 奧斯得寧 " 人工髖關節系統 : 股骨柄 35129 FBHS21445NS2 EXETER HIP LONG STEM 35129 FBHS23730NW2 REVISION HIP LONG STEM( 型號 3783-XXXX,3784-XXXX 自 89/10/1 生效 ) 35129 FBHS2601XNS2 RESTORATION HA HIP STEM 35129 FBHS30580NH1 FEMORAL LONG STEM 35129 FBHS310099DP C-STEM REVISION HIP STEM 35129 FBHS31100NH1 P.C.A. LONG STEM 35129 FBHS32000NW2 PERFECTA REVISION HIP STEM(NECK+BODY+STEM) 56371 FBHS3354XNDP AML LONG STEM(87/11/2 起 1571-02-000:90-000,1573-03-000:19-000) 35129 FBHS35500RDP S-ROM ZTT SLEEVES( 近端套筒 ) 14545 FBHS35600RDP S-ROM FEMORAL STEM( 型號含 526092L:424R,526514L:684) 41826 FBHS37846NZ1 VERSYS BEADED FULLCOAT PLUS REVISION STEM 200MM(7843-11:20-08 自 89/04/01 起生效 ) 35129 FBHS37855NZ1 VERSYS CEMENTED REVISION STEM 200:260MM 35129 FBHS37871NZ1 VERSYS CEMENTED REVISION/CALCAR STEM 35129 FBHS39980NZ1 ZMR REVISION HIP STEM 14545 77

特材代碼中英文品名支付點數 FBHS39990NZ1 ZMR REVISION HIP STEM BODY 41826 FBHS3NK21NAE REVISION HIP STEM 35129 FBHU111281DP GLOBAL SHOULDER IMPLANTS STEM 12MM 26932 FBHU111340DP HUMERAL ASSEMBLY STEM 26932 FBHU111344DP HUMERAL HEAD 11557 FBHU111348DP FINNED GLENDOID HYLAMER POLLYMER PEGGED GLENOID 14526 FBHU11134NDP GLOBAL HUMERAL STEM 26932 FBHU111378DP GLOBAL PEGGED GLENOID 14526 FBHU1113NNDP GLOBAL HUMERAL HEAD 11557 FBHU143000Z1 BIGLIANI/FLATOW TOTAL SHOULDER(STEM+HEAD+CUP) 53015 FBHU143001Z1 BIGLIANI/FLATOW HEMI SHOULDER(STEM+HEAD) 38489 FBHU143002Z1 BIGLIANI/FLATOW MONOBLOCK SHOULDER(STEM+HEAD) 38489 FBHU14300NZ1 BIGLIANI/FLATOW HUMERAL STEMS 26932 FBHU14301NZ1 BIGLIANI/FLATOW MODULAR HEAD 11557 FBHU14302NZ1 BIGLIANI/FLATOW GLENOID(PU CUP) 14526 FBHU15300NS2 TOTAL SHOULDER SYSTEM(GLENOID+HEAD+STEM) 53015 FBHU15301NS2 SHOULDER SYSTEM(HEAD+STEM) 38489 FBHU15350NS2 SHOULDER HUMERAL HEAD( 鈷鉻 ) 11557 FBHU15351NS2 SHOULDER HUMERAL STEM(TITANIUM) 26932 FBHU15362NS2 SOLAR TOTAL SHOULDER SYSTEM:SHOULDER GLENOID COMP(PLASTIC) 14526 FBKA20610NH1 DURACON TOTAL KNEE TIBIAL WEDGE 限用於人工膝關節再置換時使用 3006 FBKA21872NW2 FEMORAL BUILD(WEDGE) 限用於人工膝關節再置換時使用 3006 FBKA22510NH1 DURACON TOTAL KNEE FEMORAL SPACER DISTAL 限用於人工膝關節再置換時使用 3006 FBKA23000NW2 REVISION FEMORAL WEDGE 限用於人工膝關節再置換時使用 3006 FBKA23001NW2 REVISION TIBIAL WEDGE 限用於人工膝關節再置換時使用 3006 FBKA25988NZ1 TIBIAL WEDGE 頇事前審查限用於膝關節再置換時使用 3006 78

FBKA25990TZ1 FEMORAL AUGMENTATION 頇事前審查限用於膝關節再置換時使用 3006 FBKA27510NS2 FEMORAL /TIBIAL AUGMENTATION 限用於人工膝關節再置換時使用 3006 FBKA296080JJ TC3 PFC REVISION FEMORAL AUGMENTATION 限用於人工膝關節再置換時使用 3006 FBKB21870NW2 REVISION TIBIAL LONG STEM 7.5CM,15CM 限用於人工膝關節再置換時使用 5710 FBKCM1101NU0 CUSTOM MADE KNEE JOINT TUMOR PROSTHESIS 申報費用時應檢附該被保險人之發票備查 177137 FBKCM2475NH1 "HOWMEDICA"GLOBAL MODULAR REPLACEMENT SYSTEM -KNEE, 申報費用時應附發票備查 187962 FBKCM6485NH1 "HOWMEDICA"GLOBAL MODULAR REPLACEMENT SYSTEM -KNEE 申報費用應檢附發票備查 187962 FBKCMXXXXNW2 CUSTOM-MADE TOTAL KNEE PROTHESIS, 申報費用檢附發票 187962 FBKE21890NW2 REVISION FEMORAL LONG STEM 10CM,15CM 限用於人工膝關節再置換時使用 5710 FBKE23000NW2 EXTENSION FEMORAL TIBIAL STEM 限用於人工膝關節再置換時使用 5710 FBKE25988NZ1 STEM EXTENSION 頇事前審查限用於膝關節再置換時使用 5710 FBKE26478NS2 EXTENSION STEM 80MM:155MM 限用於人工膝關節再置換時使用 5710 FBKE28640NH1 DURACON TIBIAL FEMORAL EXTENSION STEM (6476-8-260 自 91/10/1 生效 ) 限用於人工膝關節再置換時使用 5710 FBKE286960JJ REVISION STEM EXTENSION(96-07,17-20,21,31,32 自 89/04/01 生效 ) 限用於人工膝關節再置換時使用 5710 FBKF10000CSN GENESIS II TOTAL KNEE SYSTEM:FEMORAL COMPONENTS 19367 FBKF10011NH1 FEMORAL COMPONENT EXTRA EXTRA-SMALL:LARGE 19367 FBKF10096PSN GENESIS II TOTAL KNEE SYSTEM(PS):FEMORAL COMPONENTS 19367 FBKF10208NH1 DURACON PS FEMORAL COMPONENT 19367 FBKF10410NJJ PFC FEMORAL 19367 FBKF1179NNDP LCS FEMORAL COMPONENT( 型號 1180-03 自 90/01/01 生效 ) 19367 FBKF11880NW2 WHITESIDE ORTHOLOC FEMORAL COMPONENT( 型號 KFTC-XXXX 自 91/01/01 生效 ) 19367 FBKF12000NW2 PSL FEMORAL COMPONENT 19367 FBKF12101NU0 FEMORAL COMPONENT(PS) 19367 FBKF12103MU0 U2 TOTAL KNEE SYSTEM:FEMORAL 19367 FBKF12103NU0 U2 TOTAL KNEE SYSTEM:FEMORAL CRUCIATE RETAINING 19367 FBKF1210XNU0 UNITED FEMORAL COMPONENT 19367 79

FBKF15500NH1 TRIATHLON FEMORAL COMPONENT 適應症見備註欄 19367 FBKF15950TZ1 NEXGEN CR-FLEX FEMORAL COMPONENT 19367 FBKF15964TZ1 NEXGEN LPS-FLEX FEMORAL COMPLETE 19367 FBKF15970NZ1 FEMORAL COMPONENT 19367 FBKF15996TZ1 NEXGEN FEMORAL COMPONENT(LPS) 19367 FBKF16630NH1 DURACON TOTAL KNEE FEMORAL 19367 FBKF17030NS2 SCORPIO CR FEMORAL COPMONENT 19367 FBKF17130NS2 SCORPIO FEMORAL COPMONENT( 型號 71-4503:4513R/L 自 90/01/01 生效 ) 19367 FBKF18000NS2 SCORPIO FEMORAL COMPONENT 19367 FBKF18110NH1 PCA FEMORAL 19367 FBKF19600NDP PFC SIGMA CRUCIATE RETAINING FEMORAL COMPONENT 19367 FBKF19600NJJ PFC E CURCIATE RETAINING FEMORAL (96-0042:58 自 89/7/1 收,93/1/1 由 FBKF296008JJ 調來 ) 19367 FBKF1N050NAE E.MOTION FEMORAL COMPONENT 19367 FBKF2179NNDP LCS REVISION FEMORAL COMPONENT 19367 FBKF21850NW2 WHITESIDE ORTHOLOC REVISION FEMORAL COMPONENT 18017 FBKF21857NW2 WHITESIDE ORTHOLOC P.S.L REVISION FEMORAL COMPONENT 18017 FBKF22026NH1 DURACON REVISION FEMORAL COMPONENT 19367 FBKF23000NW2 ADVANCE REVISION FEMORAL COMPONENT 19367 FBKF25880TZ1 NEXGEN ROTATING HINGEKNEE FEMORAL COMPONENT 80658 FBKF25976NZ1 NEXGEN FEMORAL COMPONENT(CRA) 19367 FBKF25994TZ1 NEXGEN FEMORAL COMPONENT(LCCK)( 型號 5994-013:017-91:92 自 92/10/01 生效 ) 19367 FBKF26001NJJ PFC REVISION FEMORAL 19367 FBKF296008JJ TC3 PFC REVISION FEMORAL COMPONENTS (96-0042:96-0058 自 93/01/01 轉至 FBKF19600NJJ) 19367 FBKL10100NH1 TIBIAL INSERT EXTRA-SMALL:LARGE 9MM:16MM(6642-1009:7125 自 89/4/1 生效 ) 8309 FBKL10460NJJ PFC INSERT (96-0410:96-0467 自 89/07/01 生效 ) 8309 FBKL10480CSN GENESIS II TOTAL KNEE SYSTEM:TIBIAL ARTICULAR COMPONENTS 8309 80

FBKL10802PSN GENESIS II TOTAL KNEE SYSTEM(PS):TIBIAL ARTICULAR COMPONENTS 8309 FBKL11030NS2 OMNIFIT TIBIAL INSERT 8309 FBKL11501PSN PS HIGH FLEXION ARTICULAR INSERT 13953 FBKL11531CSN CR DEEP FLEXION ARTICULAR INSERT 13953 FBKL11770NW2 WHITESIDE ORTHOLOC TIBIAL INSERT( 型號 KITC,KIMP-XXXX 自 91/01/01 生效 ) 8309 FBKL1178NNDP LCS MENISCAL BEARINGS INSERT( 型號 1778-29-025:1778-84-025 自 90/01/01 生效 ) 8309 FBKL12000NW2 PSL TIBIAL INSERT 8309 FBKL12301NU0 TIBIAL INSERT(PS) 8309 FBKL123033U0 U2 TOTAL KNEE SYSTEM:TIBIAL INSERT 8309 FBKL12303NU0 U2 TOTAL KNEE SYSTEM:TIBIAL INSERT CRUCIATE RETAINING 8309 FBKL1230XNU0 UNITED TIBIAL INSERT PLAINED 8309 FBKL15500NH1 TRIATHLON TIBIA INSERT 適應症見備註欄 13953 FBKL15960NZ1 NEXGEN LPS-FLEX TIBIAL ARTICULAR SURFACE 13953 FBKL15971NZ1 ARTICULAR SURFACE 8309 FBKL15981NZ1 ARTICULAR SURFACE 8309 FBKL15996NZ1 NEXGEN TIBIAL ARTICULAR SURFACE 8309 FBKL16644NH1 DURACON TOTAL KNEE TIBIAL 8309 FBKL17109NH1 DURACON TIBIAL PS INSERT(6742-1-009:425 自 91/10/1 生效 ) 8309 FBKL17220NS2 SCORPIO CR INSERT COMPONENT 8309 FBKL17230NS2 TIBIAL INSERT 8309 FBKL17250NS2 SCORPIO SUPERFLEX PS TIBIAL INSERT 13953 FBKL18130NH1 PCA TIBIAL INSERT 8309 FBKL18200NS2 SCORPIO NRG TIBIAL INSERT 13953 FBKL19059NZ1 NEXGEN CR-FLEX TIBIAL ARTICULAR SURFACE 13953 FBKL19602NJJ PFC E CURCIATE RETAINING TIBIAL INSERT 8309 FBKL1962RPJJ PFC SIGMA RP KNEE SYSTEM ROTATING PLATFORM INSERT 13953 81

特材代碼中英文品名支付點數 FBKL1N064NAE E.MOTION TIBIA INSERT 13953 FBKL21658NW2 P.S.L REVISION TIBIAL INSERT( 型號 KIPS-0114:2625,KIRV-110S,M:630S,M 自 93/1/1 生效 ) 25559 FBKL22410NH1 DURACON REVISION TIBIAL INSERT 25559 FBKL25880NZ1 NEXGEN ROTATING HINGEKNEE ARTICULAR SURFACE 11684 FBKL25970NZ1 NEXGEN TIBIAL ARTICULAR SURFACE(CRA) 25559 FBKL25994NZ1 NEXGEN TIBIAL ARTICULAR SURFACE( 型號 5994-022:042-10:33 自 92/10/01 生效 ) 25559 FBKL26000NS2 TIBIAL BEARING COMPONENT 25559 FBKL26040NJJ PFC REVISION INSERT 25559 FBKL27493NS2 SERIES 7000 TIBIAL INSERT 25559 FBKL296050JJ TC3 PFC REVISION TIBIAL INSERT 25559 FBKP10205NH1 PATELLA COMPONENT METAL BACK,ALL PLASTIC(6642-2040:2645 自 89/04/01 生效 ) 6344 FBKP10417NJJ PFC PATELLA 6344 FBKP10566NSN GENESIS II TOTAL KNEE SYSTEM:PARELLAR COMPONENTS 6344 FBKP11670NW2 WHITESIDE ORTHOLOC PATELLA( 型號 KPRC,KPON-XXXX 自 91/01/01 生效 ) 6344 FBKP1179NNDP LCS PATELLAR COMPONENT( 型號 1779-71:86,1497-71:76-025 自 90/01/01 生效 ) 6344 FBKP12401NU0 TOTAL KNEE PATELLA 26:44MM 6344 FBKP12403NU0 UKNEE TOTAL KNEE SYSTEM:PATELLA 6344 FBKP1240XNU0 UNITED PATELLA 6344 FBKP13420NS2 OMNIFIT PATELLA COMPONENT 6344 FBKP15500NH1 TRIATHLON PATELLA 適應症見備註欄 6344 FBKP15973NZ1 PATELLA COMPONENT 6344 FBKP17331NS2 SCORPIO CR PATELLA 6344 FBKP19601NDP PFC SIGMA CRUCIATE RETAINING OVAL-DOME PATELLA 6344 FBKP19601NJJ PFC SIGMA CURCIATE RETAINING OVAL-DOME PATELLA ( 型號 96-0120:0122 自 90/10/01 生效 ) 6344 FBKP1G442NSN GENESIS PATELLA COMPONENT 6344 FBKP1N048NAE E.MOTION PATELLA 6344 82

特材代碼中英文品名支付點數 FBKP26035NJJ PFC REVISION PATELLA 6344 FBKPA0012NH1 DURACON TOTAL KNEE SYSTEM 48953 FBKPA0208NH1 DURACON PS TOTAL KNEE SYSTEM 48953 FBKPA1000CSN GENESIS II TOTAL KNEE SYSTEM(CR) 48953 FBKPA1000NDP LCS TOTAL KNEE SYSTEM 48953 FBKPA1000NJJ PFC TOTAL KNEE SYSTEM 48953 FBKPA1000NU0 UNITED TOTAL KNEE SYSTEM 48953 FBKPA1000NW2 WHITESIDE ORTHOLOC TOTAL KNEE SYSTEM 48953 FBKPA1000PSN GENESIS II TOTAL KNEE SYSTEM(PS) 48953 FBKPA1100NDP PFC SIGMA TOTAL KNEE SYSTEM(TIBIAL+INSERT+PATELLA+FEMORAL) 48953 FBKPA1100NJJ PFC E KNEE SYSTEM 48953 FBKPA129RPJJ PFC SIGMA RP KNEE SYSTEMW/ROTATING PLATFORM 54597 FBKPA2000CSN GENESIS II TOTAL KNEE SYSTEM(CR-FLEX) 高彎曲度全人工膝關節系統 54597 FBKPA2000NU0 TOTAL KNEE SYSTEM(PS) 48953 FBKPA2000NW2 PSL TOTAL KNEE SYSTEM 48953 FBKPA2000PSN GENESIS II TOTAL KNEE SYSTEM(PS-FLEX) 高彎曲度全人工膝關節系統 54597 FBKPA5000NU0 U2 TOTAL KNEE SYSTEM-CRUCIATE RETAINING 48953 FBKPA5000TZ1 NEXGEN COMPLETE KNEE (CR)SYSTEM 48953 FBKPA5100TZ1 NEXGEN MIS COMPLETE KNEE SOLUTION (CR) 微創全人工膝關節組 48953 FBKPA5500NH1 TRIATHLON TOTAL KNEE SYSTEM( 含 TIBIA INSERT+FEMORAL+TIBIA TRAY+PATELLA) 適應症見備註欄 54597 FBKPA6000NU0 U2 TOTAL KNEE SYSTEM-POSTERIOR STABILIZED 48953 FBKPA6000TZ1 NEXGEN COMPLETE KNEE (PS)SYSTEM 48953 FBKPA7000TZ1 NEXGEN COMPLETE KNEE SOLUTION (LPS) 48953 FBKPA7100NS2 SCORPIO TOTAL KNEE SYSTEM(PS) 48953 FBKPA7100TZ1 NEXGEN MIS COMPLETE KNEE SOLUTION (LPS) 微創全人工膝關節組 48953 FBKPA7200NS2 SCORPIO CR TOTAL KNEE SYSTEM 48953 83

特材代碼中英文品名支付點數 FBKPA7300NS2 SCORPIO TOTAL KNEE SYSTEM 54597 FBKPA7800NS2 SCORPIO MOBILE BEARING KNEE SYSTEM 54597 FBKPA8000TZ1 NEXGEN LPS-FLEX COMPLETE KNEE SYSTEM 54597 FBKPA8100NS2 SCORPIO NRG TOTAL KNEE SYSTEM 54597 FBKPA8100TZ1 NEXGEN MIS COMPLETE KNEE SOLUTION (LPS-FLEX) 微創全人工膝關節組 54597 FBKPA9000TZ1 NEXGEN CR-FLEX COMPLETE KNEE SOLUTION 54597 FBKPA9100TZ1 NEXGEN MIS COMPLETE KNEE SOLUTION (CR-FLEX) 微創全人工膝關節組 54597 FBKPAG1000SN GENESIS TOTAL KNEE SYSTEM 48953 FBKPAN000NAE E.MOTION KNEE SYSTEM FOLATING KNEE 54597 FBKRA1000NJJ PFC REVISION KNEE SYSTEM 66203 FBKRA1000NW2 WHITESIDE ORTHOLOC LONG STEM REVISION TOTAL KNEE SYSTEM 66203 FBKRA1000TZ1 M/G REVISION KNEE SYSTEM 66203 FBKRA1001NW2 REVISION TOTAL KNEE SYSTEM W/TIBIA WEDGE, 限需使用墊片者申報 69209 FBKRA11000JJ TC3 PFC REVISION KNEE SYSTEM 66203 FBKRA2000NDP LCS REVISION TOTAL KNEE SYSTEM 66203 FBKRA2000NW2 WHITESIDE ORTHOLOC P.S.L.TOTAL KNEE SYSTEM 66203 FBKRA2026NH1 DURACON REVISION KNEE SYSTEM 66203 FBKRA3000NW2 ADVANCE REVISION TOTAL KNEE SYSTEM 66203 FBKRA3000TZ1 NEXGEN COMPLETE KNEE SOLUTION(LCCK) 66203 FBKRA4000TZ1 NEXGEN COMPLETE KNEE SOLUTION(CRA) 66203 FBKRA5000TZ1 NEXGEN ROTATING HINGEKNEE SYSTEM 116678 FBKRAG1000SN GENESIS REVISION TOTAL KNEE SYSTEM 66203 FBKT10160NSN GENESIS II TOTAL KNEE SYSTEM:TIBIAL COMPONENTS 14933 FBKT10224CSN GENESIS II TOTAL KNEE SYSTEM:TIBIAL+CRTICULAR COMPONENTS 14933 FBKT10411NJJ PFC TIBIAL(PRIMARY 或 REVISION)( 型號 86-4177:9 自 89/1/1 生效 ) 14933 FBKT1179NNDP LCS TIBIAL 14933 84

FBKT11870NW2 WHITESIDE ORTHOLOC TIBIAL BASE 脛骨基座 13698 FBKT11871NW2 TIBIAL BASE 13698 FBKT11885NW2 CF TIBIAL STEM+TIBIAL BASE( 型號 KTCO,KTCC,KTTI-XXXX 自 91/01/01 生效 ) 14933 FBKT12203NU0 U2 TOTAL KNEE SYSTEM:TIBIAL BASEPLATE 14933 FBKT1220XNU0 UNITED TIBIAL BASEPLATE WITH STEM( 型號 2201-3010:3060 自 89/10/1 生效 ) 14933 FBKT12330NH1 TIBIAL BASEPLATE CURCIFORM S1:L2,SCREW FIX S1:L2 14933 FBKT1432RPJJ PFC SIGMA RP KNEE SYSTEM MOBILE BEARING TIBIA BASEPLATE 14933 FBKT15125NZ1 M/G Ⅱ TIBIAL FIXATION 14933 FBKT15500NH1 TRIATHLON TIBIA TRAY 適應症見備註欄 14933 FBKT15950NZ1 NEXGEN MIS TIBIAL PLATE 微創人工莖骨板 14933 FBKT15972NZ1 TIBIAL PLATE 14933 FBKT15982NZ1 TIBIAL PLATE 14933 FBKT1AP0LYDP PFC SIGMA KNEE SYSTEM:ALL POLYETHYLENE TIBIAL+INSERT 14933 FBKT1N062NAE E.MOTION TIBIA FOLATING PLATE 14933 FBKT2179NNDP LCS REVISION ROTATING TIBIAL PLATEAU 14933 FBKT21872NW2 TIBIAL BASE WITH WEDGE 限人工膝關節再置換時使用 16704 FBKT22360NH1 DURACON REVISION TIBIAL BASEPLATE 14933 FBKT25880NZ1 NEXGEN ROTATING HINGEKNEE TIBIAL PLATE 17992 FBKT286000JJ TC3 PFC REVISION TIBIAL TRAY 14933 FBKW2280XNU0 TIBIAL WEDGE 限用於人工膝關節再置換時使用 3006 FBKW25220NZ1 TIBIAL WEDGE 限用於人工膝關節再置換時使用 3006 FBKW286010JJ TC3 PFC REVISION TIBIAL WEDGE 限用於人工膝關節再置換時使用 3006 FBM011109NU0 MOORE HIP SYSTEM 8493 FBM01203XNR1 MOORE PROSTHESIS (41:52MM,HEAD) 8493 FBM014006NZ1 MOORE HIP PROSTHESIS 1 1/2:1 15/16 8493 FBM019138NH1 AUSTIN MOORE 8493 85

FBUF11001NW2 UNICOMPARTMENTAL KNEE FEMORAL COMPONENT 24256 FBUF110277DP PRESERVATION UNICOMPARTMENTAL KNEE FEMORAL COMPONENT 24256 FBUF15842NZ1 UNICOMPARTMENTAL HIGH-FLEX FEMORAL COMPONENT 24256 FBUF16636NH1 UNICOMPARTMENTAL KNEE FEMORAL 24256 FBUF172500SN UNICOMPARMENTAL KNEE FEMORAL 24256 FBUF19671NJJ PFC SIGMA UNICOMPARTMENTAL FEMORAL COMPONENT 人工半膝關節股骨元件 24256 FBUL15842NZ1 UNICOMPARTMENTAL HIGH-FLEX ARTICULAR SURFACE 7277 FBUL171248SN UNICOMPARMENTAL KNEE TIBIAL INSERT 7277 FBUL19672NJJ PFC SIGMA(PFC)UNICOMPARTMENTAL TIBIAL INSERT COMPONENT 半膝關節襯墊 7277 FBUT11002NW2 UNICOMPARTMENTAL KNEE TIBIAL+INSERT COMPONENT 22638 FBUT110277DP PRESERVATION UNICOMPARTMENTAL KNEE TIBIAL+INSERT COMPONENT 22638 FBUT15842NZ1 UNICOMPARTMENTAL HIGH-FLEX PRECOAT TIBIAL PLATE 15361 FBUT16636NH1 UNICOMPARTMENTAL KNEE TIBIAL+INSERT 22638 FBUT171242SN UNICOMPARMENTAL KNEE ALL-POLY TIBIAL+INSERT 22638 FBUT172610SN UNICOMPARMENTAL KNEE TIBIAL BASES 15361 FBUT19670NJJ PFC SIGMA(PFC)UNICOMPARTMENTAL TIBIAL TRAY COMPONENT 半膝關節脛骨元件 15361 FBUT25842NZ1 UNICOMPARTMENTAL HIGH-FLEX ALL POLYETHYLENE TIBIAL BASEPLATE(TIBIAL+SURFACE) 22638 FEP0256234XT WIRE PISTON 2811 FEP0256235XT WIRE PISTON 2811 FES0156295XT FISCH SPANDER II TOTAL WITH FOOTPLATE SHOE 全聽 2742 FES0156305XT AUSTIN MODIFIED TOTAL OSSICULAR REPLACEMENT 2742 FES0170142GS MICRON ALL TITANIUM TORP 全鈦全人工聽小骨置換物 2742 FHFCD01701GU FHFCD01901GU " 佳騰 " 康達克艾維塔心臟再同步治療用去顫器 "GUIDANT" CONTAK RENEWALL 4 AVT CARDIAC RESYNCHRONIZATION THERAPY DEFIBRILLATOR * " 吉時利 " 康德雙腔同步整律 / 去顫器 "GUIDANT"CONTAK RENEWAL 4/4HE CARDIAL RESYNCHRONIZATION THERAPY DEFIBRILLATOR* 556104 556104 FHFCD07298M4 " 美敦力 " 因信可植入式去纖維顫動器 * 556104 FHFCDAHF34ST " 聖猷達 " 爾德樂雙腔型植入式去纖維顫動器 "SJM"ATLAS IMPLANTABLE CARDIOVERTER/ DEFIBRILLATORS* 556104 86

FHFCDAHF43ST " 聖猷達 " 雙腔型植入式去纖維顫動器 ("SJM"IMPLANTABLE CARDIOVERTER/DEFIBRILLATORS)* 556104 FHFCDAHF65ST " 聖猷達 " 雙腔型植入式去纖維顫動器 ( 心臟再同步治療去顫器 CRT-D)"SJM"IMPLANTABLE CARDIOVERTER/ DEFIBRILLATORS* 556104 FHFCDAHF66ST " 聖猷達 " 雙腔型植入式去纖維顫動器 "SJM" IMPLANTABLE CARDIOVERTER/DEFIBRILLATORS* 556104 FHFCDC174AM4 " 美敦力 " 康妥植入式心臟去顫器 CONCERTO IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* 613118 FHFCDCRT19GU FHFCDD234TM4 " 佳騰 " 康達克心臟再同步治療用去顫器 "GUIDANT"CONTAK RENEWAL 4&4 HE CARDIAC RESYNCHRONIZATION THERAPY* " 美敦力 " 康賽特植入式心臟去顫器 MEDTRONIC CONSULTA CRT-D IMPLANTABLE CARDIOVERTER DEFIBRILLATOR * 556104 613118 FHFCDSYN72M4 因信可植入式去纖維顫動器 MEDTRONIC INSYNC ICD * 556104 FHP1104700ED CVS DIVISION PERICARDIAL PATCH 10X15CM 7838 FHP1112120GX " 戈爾 " 普瑞得福心包膜代用膜 "GORE" PRECLUDE PRECARDIAL MEMBRANE 12*12CM 8322 FHP11XA400ED EQUINE PERICARDIAL PATCH 10*10 CM 7838 FHP5600782BA " 巴德 " 心血管補片 "BARD"CARDIOVASCULAR PATCH-CARDIOVASCULAR FABRICS(15.2*15.2CM) 4935 FHP5600790BA " 巴德 " 心血管補片 "BARD"CARDIOVASCULAR PATCH-CARDIOVASCULAR FABRICS(1.0*15.2CM)(2.1*5.1CM) 281 FHP5600793BA " 巴德 " 心血管補片 "BARD"CARDIOVASCULAR PATCH-CARDIOVASCULAR FABRICS(2.5CM*10.2CM) 563 FHP5600794BA " 巴德 " 心血管補片 "BARD"CARDIOVASCULAR PATCH-CARDIOVASCULAR FABRICS(5.1*10.2CM) 1697 FHP5600795BA " 巴德 " 心血管補片 "BARD"CARDIOVASCULAR PATCH-CARDIOVASCULAR FABRICS(10.2*10.2CM) 2319 FHP5607018BA " 巴德 " 心血管補片 "BARD" CARDIOVASCULAR PATCH-SURGICAL FELTS 2.5*2.5CM,0.6*5.1CM,1.3*10.2CM,2.5*2.5CM,1.0*15.2CM 281 FHP5607836BA " 巴德 " 心血管補片 "BARD" CARDIOVASCULAR PATCH-SURGICAL FELTS 10.2*10.2CM 2319 FHP5607837BA " 巴德 " 心血管補片 "BARD" CARDIOVASCULAR PATCH-SURGICAL FELTS 15.2*15.2CM 4935 FHP5607963BA " 巴德 " 心血管補片 "BARD" CARDIOVASCULAR PATCH-PTFE FELT PLEDGETS 矩形 4.86*6MM,9.5*4.8MM,7.9*7.9MM,6*6MM; 橢圓形 4.8*6MM; 圓形 4.8MM,6MM 41 FHP5607968BA " 巴德 " 心血管補片 "BARD" CARDIOVASCULAR PATCH-SURGICAL FELTS 2.5*10.2CM,5.1*5.1CM 563 FHP5607976BA " 巴德 " 心血管補片 "BARD" CARDIOVASCULAR PATCH-SURGICAL FELTS 2.5*15.2CM 832 FHP5619121SB FHP5619145SB FHP5619237SB FHPCD07232M4 FHPCD07278M4 " 波士頓科技 " 美洛思心臟血管移植彌補片及止血帶 "BOSTON SCIENTIFIC"MEADOX CARDIOVASCULAR FABRICS & TAPES 5.1CM*10.2CM " 波士頓科技 " 美洛思心臟血管移植彌補片及止血帶 "BOSTON SCIENTIFIC"MEADOX CARDIOVASCULAR FABRICS & TAPES 10.2CM*10.2CM " 波士頓科技 " 美洛思心臟血管移植彌補片及止血帶 "BOSTON SCIENTIFIC"MEADOX CARDIOVASCULAR FABRICS & TAPES 15.2CM*15.2CM 美敦力麥思蒙植入式去纖維顫動系統 MEDTRONIC MAXIMO IMPLANTABLE DEFIBRILLATOR SYSTEM* 美敦力麥思蒙植入式去纖維顫動系統 MEDTRONIC MAXIMO IMPLANTABLE DEFIBRILLATOR SYSTEM* 1697 2319 4935 362292 426702 87

FHPCD07287M4 美敦力茵萃斯植入式去纖維顫動系統 MEDTRONIC INTRINSIC IMPLANTABLE 426702 DEFIBRILLATOR SYSTEM* FHPCD15VRCM4 " 美敦力 " 恩特植入式心臟纖維去顫動系統 "MEDTRONIC"ENTRUST IMPLANTABLE DEFIBRILLATOR SYSTEM* 362292 FHPCD1870VGU GUIDANT VITALITY AICD 維達自動植入型心律去顫器 * 362292 FHPCD1871DGU GUIDANT VITALITY AICD 維達自動植入型心律去顫器 * 426702 FHPCD46998BK FHPCD47000BK FHPCD47002BK " 拜耳德尼克 " 植入式心內除顫器 "BIOTRONIK" IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR LEXOS LEXOS VR * " 拜耳德尼克 " 植入式心內除顫器 "BIOTRONIK" IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR LEXOS DR* " 拜耳德尼克 " 植入式心內除顫器 "BIOTRONIK" IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR LEXOS A+ * 362292 426702 426702 FHPCDA155DGU " 佳騰 " 維達艾維塔植入型心律去顫器 "GUIDANT" VITALITY AVT ICD* 426702 FHPCDC164AM4 FHPCDD1534M4 FHPCDD164VM4 FHPCDD234DM4 FHPCDD234VM4 " 美敦力 " 維多植入式心臟去顫器 "MEDTRONIC" VIRTUOSO IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* " 美敦力 " 恩特植入式心臟纖維去顫動系統 "MEDTRONIC"ENTRUST IMPLANTABLE DEFIBRILLATOR SYSTEM* " 美敦力 " 維多植入式心臟去顫器 "MEDTRONIC" VIRTUOSO IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* " 美敦力 " 思格拉植入式心臟去顫器 MEDTRONIC SECURA DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR * " 美敦力 " 思格拉植入式心臟去顫器 MEDTRONIC SECURA VR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR * 483701 483701 362292 483701 365310 FHPCDP0230ST PHOTON DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* 369969 FHPCDPD232ST PHOTON DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* 369969 FHPCDPD236ST EPIC PLUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR 426702 FHPCDPD240ST PHOTON DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR 369969 FHPCDPD243ST PHONTON DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR 植入式雙腔型心臟去顫器 * 426702 FHPCDPD255ST FHPCDPD258ST FHPCDPD26NST FHPCDPS158ST " 聖猶達 " 艾匹克雙腔型植入式去纖維顫動器 "SJM" EPIC PLUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* " 聖猶達 " 艾匹克雙腔型植入式去纖維顫動器 "SJM" EPIC PLUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* " 聖猶達 " 植入式雙腔型心臟去顫器 "SJM"PHONTON DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* " 聖猷達 " 艾匹克單腔型植入式去纖維顫動器 "SJM" EPIC PLUS VR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* 426702 426702 426702 362292 FHPCDPS168ST " 聖猶達 " 植入式心律去顫器 "SJM"IMPLANTABLE CARDIOVERTER DEFIBRILLATORS* 362292 FHPCDPS193ST 植入性心律去顫器 IMPLANTABLE CARDIOVERTER DEFIBRILLATOR* 362292 FHPCDPS196ST EPIC PLUS VR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR 362292 FHPCDPS199ST IMPLANTABLE CARDIOVERTER DEFIBRILLATOR 312390 88

FHPCDT167DGU " 佳騰 " 維達第 2 代自動植入型心律去顫器 "GUIDANT" VITALITY 2EL ICD ( 雙腔 )* 426702 FHPCDT177DGU " 佳騰 " 維達第 2 代自動植入型心律去顫器 "GUIDANT" VITALITY 2EL ICD ( 單腔 )* 362292 FHPCL06944M4 SPRINT LEAD(ICD)* 82010 FHPCL06947M4 史賓特導線 SPRINT LEAD 58,65,75,100CM * 82010 FHPCLAF157GU 安達植入式去顫器電極導線 ENDOTAK RELIANCE IMPLANTABLE LEAD* 82010 FHPCLB0147GU " 佳騰 " 安達植入式去顫器電極導線 "GUIDANT" ENDOTAK RELIANCE IMPLANTABLE LEAD* 82010 FHPCLB0157GU " 佳騰 " 安達植入式電極導線 "GUIDANT" ENDOTAK RELIANCE IMPLANTABLE LEAD* 82010 FHPCLB0170GU "GUIDANT"ENDOTAK RELIANCE SG IMPLANTABLE LEAD* 82010 FHPCLB0174GU " 佳騰 " 安達集植入式電極導線 "GUIDANT" ENDOTAK RELIANCE G IMPLANTABLE LEAD* 82010 FHPCLB0184GU " 佳騰 " 安達集植入式電極導線 "GUIDANT" ENDOTAK RELIANCE G IMPLANTABLE LEAD* 82010 FHPCLDU7SWST " 聖猷達 " 德拉多心臟導線 "SJM" DURATA LEAD * 82010 FHPCLE0147GU 安達植入式去顫器電極導線 ENDOTAK RELIANCE IMPLANTABLE LEAD* 82010 FHPCLKX341BK " 拜耳德尼克 " 植入式心內除顫器導線 "BIOTRONIK" ICD LEAD* 82010 FHPCLKX345BK FHPCLKX348BK " 拜耳德尼克 " 植入式心內除顫器導線 "BIOTRONIK" ICD LEAD(KENTROX RV-S65,SL-S65/16,SL-S65/18- STEROID)* " 拜耳德尼克 " 植入式心內除顫器導線 "BIOTRONIK" ICD LEAD(KENTROX RV65;75,SL65/16;18,SL75/16;18,SL100/16;18-STEROID)* 82010 82010 FHPCLKX633BK " 拜耳德尼克 " 肯特心內除顫器導線 "BIOTRONIK" KENTROX A+ ICD LEADS* 82010 FHPCLLN337BK " 拜耳德尼克 " 霖納思植入式心內除顫器導線 BIOTRONIK LINOX TD ICD LEADS* 82010 FHPCLLN350BK " 拜耳德尼克 " 霖納思植入式心內除顫器導線 BIOTRONIK LINOX SD IMPLANTABLE DEFIBRILLATOR LEADS* 82010 FHPCLLN351BK " 拜耳德尼克 " 霖納思植入式心內除顫器導線 BIOTRONIK LINOX S ICD LEADS* 82010 FHPCLLN352BK " 拜耳德尼克 " 霖納思植入式心內除顫器導線 BIOTRONIK LINOX T IMPLANTABLE DEFIBRILLATOR LEADS* 82010 FHPCLR1ATAST TRANSVENOUS TACHYARRHYTHMIA LEAD( 產品型號 RIATA1560:1562,1590:1592 自 94.4.1 生效使用 ) 82010 FHPCLR700NST " 聖猷達 " 經靜脈心搏過速導線 "SJM" TRANSVENOUS TACHYARRHYTHMIA LEAD* 82010 FHPCLR704NST 聖猷達經靜脈心搏過速導線 SJM TRANSVENOUS TACHYARRHYTHMIA LEAD* 82010 FHPHF04193M4 ATTAIN OTW LEAD 艾坦插入式導線 21860 FHPHF04194M4 " 美敦力 " 艾坦插入式導線 "MEDTRONIC"ATTAIN OTW LEAD* 21860 FHPHF08042M4 INSYNC III ATRIAL SYNCHRONOUS PACING DEVICE 190843 89

FHPHF1056NST SJM LEFT VENTRICULAR LEAD 聖猶達左心室心臟節律器導線 *( 產品型號 QUICKSITE 1056T 21860 自 95.1.1 生效 ) FHPHF1058NST " 聖猶達 " 左心室心臟節律器導線 "SJM" LEFT VENTRICULAR LEAD* 21860 FHPHF33820BK FHPHF55CRTST " 拜耳德尼克 " 璽特司植入式心臟同步治療心律調節器 "BIOTRONIK"STRATOS IMPLANTABLE CARDIAC PACEMAKER* " 聖猶達 " 植入式心臟節律器 "SJM"IMPLANTABLE CARDIAC PULSE GENERATOR(BIVENTRICULAR STIMULATION DEVICE)* 190843 190843 FHPHF86CRTST " 聖猶達 " 植入式心臟節律器 "SJM"IMPLANTABLE CARDIAC PULSE GENERATORS* 190843 FHPHF96CRTST SJM BIVENTRICULAR STIMULATION DEVICE 聖猶達雙心室心臟節律器 * 190843 FHPHFACUTYGU " 佳騰 " 雅各易導型電極導管 "GUIDANT"ACUITY STEERABLE LEAD* 21860 FHPHFEASY2GU " 佳騰 " 易導型第二代雙電極導管 "GUIDANT"EASYTRAK 2 IS-1 PACING LEAD* 21860 FHPHFEASYTGU 佳騰易導型電極導線 GUIDANT EASYTRAK 2 PACING LEAD* 21860 FHPHFKX346BK " 拜耳德尼克 " 可洛植入式心導線 "BIOTRONIK"COROX OTW LEAD* 21860 FHPL104067M4 CAPSURE FIX LEAD * 頇檢附心電圖報告專案報備使用 7951 FHPL104073M4 CAPSURE SENSE LEAD 蓋普夏導線頇附心電圖報告專案報備使用 7610 FHPL104086GU " 凱登 " 飛力得類固醇洗脫可伸展 / 可縮回螺旋線圈節律 / 感應導線 "GUIDANT"FLEXTEND STEROID ELUTING EXTENDABLE RETRACTABLE HELIX PACE/SENSE LEAD 7610 FHPL104965M4 CAPSURE EPICARDIA LEAD STEROID ELUTING 頇檢附心電圖專案報備使用 7924 FHPL104968M4 CAPSURE EPICARDIAL LEAD * 頇檢附心電圖報告專案報備使用 7924 FHPL105038M4 CAPSURE VDD LEAD * 頇檢附心電圖報告專案報備使用 7610 FHPL105054M4 CAPSURE Z PACING LEADS * 頇檢附心電圖報告專案報備使用 7592 FHPL105071M4 PACEMAKER LEAD (EPICARDIAL) 頇檢附心電圖報告專案報備使用 7924 FHPL105076M4 CAPSURE FIX NOVUS LEAD * 頇檢附心電圖報告專案報備使用 ( 型號 4076 自 94 年 7 月 1 日生效 ) 7951 FHPL105594M4 CAPSURE SP NOVUS ENDOCARDIAL LEAD,STEROID ELUTING* 頇附心電圖報告專案報備使用 7610 FHPL11368NST IMPLANTABLE CARDIAC VDD PACING LEAD 52CM,58CM,65CM * 頇檢附心電圖報告專案報備使用 7610 FHPL11388NST PACESETTER TENDRIL IMPLANTABLE CARDIAC PACING LEAD 頇檢附心電圖報告專案報備使用 7951 FHPL11488NST PACESETTER TENDRIL IMPLANTABLE CARDIAC PACING LEDA * 頇檢附心電圖報告專案報備使用 7951 FHPL11646TST IMPLANTABLE CARDIAC PACING LEAD 頇檢附心電圖報告專案報備使用 1646T,1642T 7951 FHPL11688NST IMPLANTABLE CARDIAC PACING LEADS 頇附心電圖報告專案報備使用 7951 FHPL117882ST " 聖猷達 " 心臟節律器導線 "SJM" IMPLANTABLE CARDIAC PACING LEADS* 頇附心電圖報告專案報備使用 7951 90

FHPL11888NST " 聖猷達 " 心臟節律器導線 "SJM" IMPLANTABLE CARDIAC PACING LEADS* 7951 FHPL140335GU GUIDANT SELUTE PICOTIP PACING 沖提心內膜心房電極導線 7592 FHPL140535GU GUIDANT SWEET PICOTIP RX STEROID ELUTING POSITIVE-FIXATION POROUS TIP PACING LEAD 史威類固醇沖提正極固定多孔尖端電極導線 7951 FHPL140634GU SELUTE ATRIAL-J PICOTIP PACING LEAD 頇檢附心電圖報告專案報備使用 7610 FHPL1B4456GU " 佳騰 " 纖幼植入式起搏電極導線 "GUIDANT" FINELINE II PACING LEAD* 7610 FHPL1S9F4NST FHPL1SR343BK FHPL1SR346BK FHPL1SS350BK FHPL1VDD43GU 聖猷達心臟節律器導線 SJM IMPLANTABLE CARDIAC PACING LEAD 頇檢附心電圖報告專案報備使用 " 拜耳德尼克 " 喜樂植入式心律調節器電極導線 "BIOTRONIK" SELOX SR IMPLANTABLE ENDOCARDIAL LEAD* 需檢附心電圖報告專案報備使用 " 拜耳德尼克 " 植入式心律調節器電極導線 "BIOTRONIK" SELOX ST/SELOX JT ENDOCARDIAL LEAD(SELOX ST 60,53; JT 53,45)* 需檢附心電圖報告專案報備使用 " 拜耳德尼克 " 喜特植入式電極導線 "BIOTRONIK" SETROX S IMPLANTABLE ENDOCARDIAL LEADS* 頇檢附心電圖報告專案報備使用 " 佳騰 " 類固醇 (VDD 型 ) 心內膜心房電極導線 "GUIDANT"SELUTE PICOTIP VDD PACING LEADS* 應檢附心電圖報告專案報備使用 7610 7951 7610 7951 7610 FHV010019AST AORTIC VALVE 40212 FHV010025MST " 聖猶達 " 人工機械瓣膜 "ST.JUDE" MECHANICAL HEART VALVE 40212 FHV0117AHPST AORTIC VALVE 40212 FHV01A1927ST REGENT MECHANICAL HEART VALVE 瑞珍機械性心臟瓣膜 50503 FHV01A19LNR5 SORIN BICARBON ARTIFICIAL AORTIC HEART VALVE 17:31MM 40212 FHV01AMHPJST MECHANICAL HEART VALVE 人工機械瓣膜 40212 FHV01CAVGJST 馬斯特機械性人工心臟瓣膜 MASTERS MECHANICAL HEART VALVE* 60955 FHV01M19LSR5 SORIN BICARBON ARTIFICIAL MITRAL HEART VALVE 19:33MM 40212 FHV02A2650ED " 愛德華 " 卡本特愛德華人工心臟瓣膜 "EDWARDS"CARPENTIER-EDWADRS S.A.V. BIOPROSTHESIS 44149 FHV02B10AMST PORCIN HEART VALVE (AORTIC 21MM:29MM,MITRAL 25MM:35MM) 44149 FHV02ELEAMST SJM EPIC VALVE AORTIC-21A-31A MITRAL-25M-35M 44149 FHV02T505TM4 HANCOCK II BIOPROSTHETIC HEART VALVE(AORTIC 21:29MM,MITRAL 25:33MM) 44149 FNP9101473CM " 柯特曼 " 人工腦膜 "CODMAN"DURAFORM DURAL GRAFT IMPLANT(2.5CM*7.5CM) 3443 FNP9101475CM " 柯特曼 " 人工腦膜 "CODMAN"DURAFORM DURAL GRAFT IMPLANT(5CM*5CM) 4403 FNP9101477CM " 柯特曼 " 人工腦膜 "CODMAN"DURAFORM DURAL GRAFT IMPLANT(7.5CM*7.5CM) 10495 FNP9101480CM " 柯特曼 " 人工腦膜 "CODMAN"DURAFORM DURAL GRAFT IMPLANT(10CM*12.5CM) 22710 91

特材代碼中英文品名支付點數 FNP9102010BB NEURO PATCH 2X10CM 3486 FNP9102010GX DURA SUBSTITUTE 2CMX10CM( 代用人工腦膜 ) 3486 FNP910205XGX DURA SUBSTITUTE 2CMX5CM 2000 FNP910210XGX DURA SUBSTITUTE 2CMX10CM 3486 FNP9102575N7 DURAGEN DURAL GRAFT MATRIX 2.5CMX7.5CM 3443 FNP9104005BB NEURO PATCH 4X5CM 3486 FNP9104010BB NEURO PATCH 4X10CM 6797 FNP910404XGX DURA SUBSTITUTE 4CMX4CM 2979 FNP9105006GX DURA SUBSTITUTE 5CMX6CM( 代用人工腦膜 ) 6011 FNP910506XGX DURA SUBSTITUTE 5CMX6CM 6011 FNP9106008BB NEURO PATCH 6X8CM 7819 FNP9106010GX DURA SUBSTITUTE 6CMX10CM( 代用人工腦膜 ) 11296 FNP9106014BB NEURO PATCH 6X14CM 15197 FNP910610XGX DURA SUBSTITUTE 6CMX10CM 11296 FNP9107575N7 DURAGEN DURAL GRAFT MATRIX 7.5CMX7.5CM 10495 FNP9110012GX DURA SUBSTITUTE 10CMX12CM( 代用人工腦膜 ) 22975 FNP9110125N7 DURAGEN DURAL GRAFT MATRIX 10CMX12.5CM 22710 FNP911012XGX DURA SUBSTITUTE 10CMX12CM 22975 FNP9112014BB "B.BRAUN"NEURO-PATCH 12CMX14CM 25444 FNP9115003BB NEURO PATCH 1.5X3CM 750 FNP9130406Q2 " 庫欣 " 神經硬膜補片 "COUSIN"NEUROLOGICAL PATCHES BIOMESH 4*6CM 4276 FNP9130610Q2 " 庫欣 " 神經硬膜補片 "COUSIN"NEUROLOGICAL PATCHES BIOMESH 6*10CM 11296 FNP9130614Q2 " 庫欣 " 神經硬膜補片 "COUSIN"NEUROLOGICAL PATCHES BIOMESH 6*14CM 15197 FNP913L406Q2 " 庫欣 " 神經硬膜補片 "COUSIN"NEUROLOGICAL PATCHES BIOMESH 4*6CM 4276 FNP913L610Q2 " 庫欣 " 神經硬膜補片 "COUSIN"NEUROLOGICAL PATCHES BIOMESH 6*10CM 11296 FNP913L614Q2 " 庫欣 " 神經硬膜補片 "COUSIN"NEUROLOGICAL PATCHES BIOMESH 6*14CM 15197 92

FNP91CDUR1CK "COOK"DURASIS DURAL SUBSTITUTE" 曲克 " 硬腦膜替代物 2CM*3CM 1102 FNP91CDUR2CK "COOK"DURASIS DURAL SUBSTITUTE" 曲克 " 硬腦膜替代物 4CM*7CM 4403 FSAE171000SB TRACHEOBRONCHIAL WALLSTENT UNISTEP DELIVERY SYS. STENT5:24*20:90MM 適應症見備註 M001711-000:390 32122 FSAE1TBXXXSB ULTRAFLEX TRACHEOBRONCHIAL STENT SYSTEM 適應症見備註 32122 FSP6101170BA "BARD"SOFT MESH 柔軟修補網 7.5CMX15CM 10CMX15CM (15CMX15CM 自 970401 起刪除 ) 1672 FSP6101171BA "BARD"SOFT MESH 柔軟修補網 5CMX10CM 4.5CMX10CM 6CMX13.7CM 1072 FSP6101515ZQ "SOFRADIM"PARIETENE POLYPROPYLENE MESHES 15X15CM 帕瑞挺人工聚丙烯編網 1710 FSP6103030ZQ "SOFRADIM"PARIETENE POLYPROPYLENE MESHES 30X30CM 帕瑞挺人工聚丙烯編網 3108 FSP6105010BB PREMILENE MESH 2.5X10CM,5X10CM 1072 FSP610510MGX GORE-TEX MYCROMESH 5CMX10CM 1072 FSP610515MGX GORE-TEX MYCROMESH 5CMX15CM 1072 FSP6106011JJ PROLENE POLYPROPYLENE MESH PMS,6*11CM 1072 FSP611015MGX GORE-TEX MYCROMESH 10CMX15CM 1672 FSP6110650BB "B.BRAUN"OPTILENE MESH 歐特靈網片 5CMX10CM 4.5CMX10CM 6CMX14CM 1072 FSP6110651BB "B.BRAUN"OPTILENE MESH 歐特靈網片 7.5CMX15CM 10CMX15CM 1672 FSP6110652BB "B.BRAUN"OPTILENE MESH 歐特靈網片 15CMX15CM 1710 FSP6110653BB "B.BRAUN"OPTILENE MESH 歐特靈網片 26CMX36CM 30CMX30CM 3108 FSP6115015BB PREMILENE MESH 7.5X15CM,15X15CM,5X30CM,10X15CM 1672 FSP6115015JJ PROLENE POLYPROPYLENE MESH PMM,15*15CM 1710 FSP6119910SB MESH 內植用網 2.5CMX10.2CM 1072 FSP6119930SB MESH 內植用網 5.1CMX30.5CM 1672 FSP6119940SB MESH 內植用網 25.4CMX35.6CM 3108 FSP6119960SB MESH 內植用網 15.2CMX15.2CM 1710 FSP6130030BB PREMILENE MESH 30X30CM,26X36CM 3108 FSP6130030JJ PROLENE POLYPROPYLENE MESH PML,30*30CM 3108 FSP61S0035US SURGIPRO MESH 3"X5" 網狀人工腹膜 1072 93

特材代碼中英文品名支付點數 FSP61S0149US SURGIPRO MESH 14"X9" 3108 FUK02CA101NV EXTRACORPOREAL TUBING SET(CAVH TUBING SET) 730 FUK02HEF2XGA GAMBRO HEMOFILTER 2252 FUK02PAN06AS CAVH HEMOFILTER( 產品型號 PAN-03,PAN-10 自 94 年 10 月 1 日起生效, 文號 0940019644) 2252 FUK0300HP1KU HEMOPERFUSION CARTRIDGE 10224 FUK030300CGA ADSORBA 300GM 10224 FUK04AV60SGA GAMBRO KIT FOR CAVH&CAVHD 4221 FUK04PAN10AS HEMOFILTER 2252 FUK0500M60GA PRISMA SET(CVVH TUBING+HEMOFILTER) 膜面積 0.6M 平方, 連續式血液透析器及迴路套管 * 4847 FUK05F0M60GA PRISMAFLEX SET(CVVH TUBING+HEMOFILTER)0.6M 平方 * 4847 FUK05PST60GA "GAMBRO"PRISMAFLEX SET(CVVH TUBING+HEMOFILTER) 膜面積 0.6M 平方 *. 4847 FUK05ST60PGA "GAMBRO"PRISMA SET 連續式血液透析器及迴路管套 * 4847 FUK05TS403FN FUK05TS405FN INFOMED EXTRACORPOREAL BLOOD CIRCUITS TUBING SET FOR HF400- HEMOFILTRATION(CVVH)* INFOMED EXTRACORPOREAL BLOOD CIRCUITS TUBING SET FOR HF400-PEDIATRIC HEMOFILTRATION(CVVH)* 1393 1393 FUT01CYST1ZP "BIONICHE"CYSTISTAT STERILE SODIUM HYALURONATE SOLUTION 喜仕膀胱灌注液 * 4819 HEF0146092H9 " 華億 " 體外循環管組 "HYM"HEART LUNG PACK-ARTERIAL FILTER 3/8" ADULT 20 MICRO 1629 HEF0146093H9 HEART LUNG PACK:ARTERIAL FILTER WITH HEPARIN COATING(ADULT;PEDIATRIC;INFANT)* 體外循環 120 分以上用 1716 HEF01AFS40GH BLOOD ARTERIAL FILTER 40 MICRO WITH INTEGRATED BYPSS WITH INLET TUBING ATTACHED* 1629 HEF01AFS48GH HEF01GAF25GH ARTERIAL FILTER 40MICR W/INTEGRATED BYPASS INLET TUBING* 體外循環 120 分以上用 (92.4.1 生效 ) HEPARIN COATED 25 MICRON WITH INTEGRATED BYPASS AND INLET TUBING ATTACHED* 限體外循環超過 120 分鐘患者使用 1716 1716 HEF01GAF2BGH 25 MICRON WITHOUT INTEGRATED BYPASS AND INLET TUBING ATTACHED 1629 HEF01GAF40GH ARTERIAL FILTER 40 MICRO W/INTEGRATED BYPASS,INLET TUBING* 體外循環 120 分以上用 (92.4.1 生效 ) 1716 HEF0201338M4 PEDIATRIC ARTERY FILTER 1629 HEF02A3510M4 AFFINITY ARTERIAL FILTER 1629 HEF02AF001TM ARTERY FILTER ADULT 1629 HEF02AF002TM ARTERY FILTER PEDIATRIC 1629 94

特材代碼中英文品名支付點數 HEF02AF125TM CAPIOX ARTERIAL FILTER 1629 HEF02E3840P3 EXTRA CORTOREAL FILTER 體外循環血液過濾器 ( 開心用 ) 1629 LEE0106500M4 TEMPORARY MYOCARDIAL PACING LEAD 1038 LEE011210HG1 MEDI-TRACE DEFIBRILLATION ELECTRODES 652 LEE011410ZG1 MEDI-TRACE DEFIBRILLATION ELECTRODES 2EA/SET 652 LEE012255RKD 肯特利柯登斯去顫器電極貼片 KENDALL MEDI-TRACE CADENCE ELECTRODES 652 LEE0125202A9 TEMPORARY CARDIAC PACING WIRE 420 LEE014016NST " 聖猷達 " 電極導線 "SJM" PACEL BIPOLAR PACING CATHETERS 110CM 2902 LEE014018NST " 聖猷達 " 電極導線 "SJM" PACEL BIPOLAR PACING CATHETERS 110CM 2291 LEE0144626ST " 聖猷達 " 電極導線 "SJM" PACEL BIPOLAR PACING CATHETERS 110CM 2291 LEE016173PBA " 巴德 " 暫時性電極導管 "BARD"TEMPORARY BALLOON PACING ELECTRODE CATHETER 2902 LEE016221PBA " 巴德 " 暫時性電極導管 "BARD"SEMI-FLOATING BIPOLAR PACING ELECTRODE CATHETER 2291 LEE018153PBA " 巴德 " 暫時性電極導管 "BARD"SPECIAL CARE BIPOLAR PACING ELECTRODE CATHETER 2291 LEE0197125ED " 愛德華 " 史望康雙極心律導管組 EDWARDS SWAN-GANZ BIPOLAR CATHETER KIT 2902 LEE01AP913G4 DEFIBRILLATOR/ADULT,PRE-GELLED,SELF-ADHESIVE DISPOSABLE DEFIBRILLATION ELECTRODES 可拋棄式去顫電極片 652 LEE01AP919G2 MARGUETTE DEFIBRILLATION PACING MONITORING PADS 652 LEE01BP250BS BIPOLAR PACING CATHETER 5F,110CM(BALLOON CATHETER,ADAPTOR,PEEL-AWAY SHEATH) 2902 LEE01BPX25BS BIPOLAR PACING CATHETER 5F,110CM 2291 LEE01M1749HP DEFIB PACING PADS ADULT (2EA/SET) 652 LEE01M3501HP MULTIFUNCTION ADULT DEFIB ELECTRODES 652 LEE01M3713HP MULTIFUNCTION ADULT PLUS PADS 多功能電擊貼片 652 LEE01M3716HP MULTIFUNCTION ADULT RADIOLUCENT PADS 多功能電擊貼片 X 光可穿透型 652 LEE01STPADZ2 " 瑞爾 " 電極貼片 "ZOLL"ELECTRODES 652 NBS010003NHG RETRACTABLE SAFETY SYRINGE 3CC WITHOUT NEEDLE 1.8 NBS01003SSFE 3CC RETRACTABLE SAFETY SYRINGE WITHOUT NEEDLE 1.8 NCS010001NCG 1CC RETRACTABLE SAFETY SYRINGE W/NEEDLE 克銳回拉式安全注射器附針 3.9 95

NCS010003NCG 3CC RETRACTABLE SAFETY SYRINGE W/NEEDLE 2.8 NCS010003NHG RETRACTABLE SAFETY SYRINGE 3CC W/NEEDLE 2.8 NCS010005NCG 5CC RETRACTABLE SAFETY SYRINGE W/NEEDLE 3.9 NCS010005NHG RETRACTABLE SAFETY SYRINGE 5CC W/NEEDLE 3.9 NCS010010NCG 10CC RETRACTABLE SAFETY SYRINGE W/NEEDLE 4.2 NCS01001SAFE 1CC RETRACTABLE SAFETY SYRINGE W/NEEDLE FOR ALLERGY 3.9 NCS01001SSFE 1 CC SYRINGE W/NEEDLE( 附安全護套 ) 3.9 NCS01003SSFE 3CC SYRINGE W/NEEDLE( 附安全護套 ) 2.8 NCS0100526TZ ROTATABLE RETRACTABLE SAFETY SYRINGE 3CC 2.8 NCS01005SSFE 5CC SYRINGE W/NEEDLE( 附安全護套 ) 3.9 NCS01010SSFE 10CC RETRACTABLE SAFETY SYRINGE W/NEEDLE 4.2 NCS010110NHG DUOPROSS RETRACTABLE SAFETY SYRINGE W/NEEDLE 0.1CC,0.3CC,0.5CC,1CC 3.9 NCS0101ASAWD ANTI-STICK SAFETY SYRINGE W/NEEDLE 1CC 3.9 NCS0103ASAWD ANTI-STICK SAFETY SYRINGE W/NEEDLE 3CC 2.8 NCS0105ASAWD ANTI-STICK SAFETY SYRINGE W/NEEDLE 5CC 3.9 NCS0110ASAWD ANTI-STICK SAFETY SYRINGE W/NEEDLE 10CC 4.2 NCS0152610TZ 1CC SAFETY SYRINGE 3.9 NCS0152611TZ 3CC SAFETY SYRINGE 2.8 NCS0152612TZ 5CC SAFETY SYRINGE 3.9 NCS0152613TZ 10CC SAFETY SYRINGE 4.2 NCS01A003NPW 3CC SYRINGE W/NEEDLE( 附安全護套 ) 2.8 NES010201NBA MAX-CORE DISPOSABLE BIOPSY INSTRUMENT 14:20G( 自動式 ) 633 NES0102300CD BIOPSY FORCEPS(88/08/1 再生效,300L,302L 自 88/08/01 起生效 ) 6474 NES010804TZM "MD TECH"T-LOK BONE MARROW BIOPSY NEEDLES 迪洛骨髓活體組織切片針 598 NES0114070HK SONO GUIDE BIOPSY NEEDLE 14G 16G 70CM,170CM 400 NES0115011ZM BONE MARROW ASPIRATION NEEDLE 529 96

NES0117070HK SONO GUIDE BIOPSY NEEDLE 17G 18G 70CM,170CM 400 NES01174LNAN UNI-CUT NEEDLES 16G:18G 200MM 400 NES01174NNAN UNI-CUT NEEDLES 14G:18G 75:150MM 400 NES011762LAN VACU-CUT BIOPSY NEEDLES 18G:19.5G 200MM 663 NES011762NAN VACU-CUT BIOPSY NEEDLES 18G:19.5G 100:150MM 663 NES01176LNAN VACU-CUT BIOPSY NEEDLES 21G,22G 200MM 663 NES01176NNAN VACU-CUT BIOPSY NEEDLES 21G,22G 100:150MM 663 NES0118015ZM PEDIATRIC BONE MARROW NEEDLE 598 NES015043NCD BIOPSY FORCEPS FOR ENDOMYOCADIAL BIOPSIES 6474 NES0182000ZM MD TECH SNARELOK BONE MARROW BIOPSY TRAY AND ACCESSORIES 598 NES01AM18NGP BONE MARROW ASPIRATION NEEDLE 529 NES01AM18NHK QUICUT BONE MARROW ASPIRATION NEEDLE 15:18G 45:60MM 八光快切骨髓抽吸生檢針 529 NES01BM13NGP BONE MARROW BIOPSY NEEDLE 598 NES01BM13NHK QUICKCUT BIOPSY FOR BONE MARROW 7:13G,10CM:15CM 598 NES01BMHN1ZM BONE MARROW HARVEST NEEDLE WITH SIDE HOLE 529 NES01BN160ZM OSTY CORE BONE BIOPSY NEEDLE 598 NES01BV00NC8 BONE BEVEL BIOPSY NEEDLE(BV SERIES) 骨髓切片或抽吸針 623 NES01M1806ZM SOFT TISSUE BIOPSY NEEDLE 18G,9:15CM 400 NES01M1808ZM SOFT TISSUE BIOPSY NEEDLE 18G,20CM 400 NES01M2006ZM SOFT TISSUE BIOPSY NEEDLE 19:22G,9:15CM 400 NES01M2008ZM SOFT TISSUE BIOPSY NEEDLE 19:22G,20CM 400 NES01MN120BA MAGNUM BIOPSY NEEDLE 633 NES01ST00NC8 STERNUM TEMNO DEVICE 骨髓抽吸針 623 NES01TC00XC8 T-HANDLE JAMSHIDI BONE MARROW BIOPSY /ASPIRATION NEEDLES 623 NES01TN00XC8 ILLINOIS STERNAL/ILIAC BONE MARROW ASPIRATION NEEDLES 529 NES0221150TP ASPIRATION BIOPSY NEEDLE (MAJIMA NEEDLE) 150MM 663 97

NES02B152NHK BIOPSY NEEDLE QUICKCUT 1B15G:18G 200MM:470MM 400 NES02B154NHK BIOPSY NEEDLE QUICKCUT 1B15G:18G 40MM:150MM 400 NES02B192NHK BIOPSY NEEDLE QUICKCUT 1B19G:22G 200MM:470MM 663 NES02B194NHK BIOPSY NEEDLE QUICKCUT 1B19G:22G 40MM:150MM 663 NES02B234NHK BIOPSY NEEDLE QUICKCUT 1B23G 40MM:470MM 663 NES0310800ZM "MD TECH"BIOPINCE FULL CORE BIOPSY INSTRUMENT 10CM" 美迪克 " 拜爾賓全組織切片器 633 NES0312182BA "BARD"MONOPTY BIOPSY INSTRUMENT 組織取樣針 633 NES0314060C8 JAMSHIDI MENGHINI BIOPSY NEEDLES 自動組織切片針 611 NES031406NC8 CARDINAL TEMNO BIOPSY NEEDLES 14G:16G;18G:20G;22G 611 NES0315800ZM BIOPINCE FULL CORE BIOPSY INSTRUMENT 15CM" 美迪克 " 拜爾賓全組織切片器 633 NES0320800ZM BIOPINCE FULL CORE BIOPSY INSTRUMENT 20CM" 美迪克 " 拜爾賓全組織切片器 633 NES0343453SB BOSTON SCIENTIFIC EASY CORE BIOPSY SYSTEM AND KIT 611 NES0370111ZM SUPER-CORE II ADJUSTABLE BIOPSY INSTRUMENT 彈簧組織切片針 611 NES0376260ZN ULTRA CORE BIOPSY NEEDLE FOR USE WITH BARD MAGNUM BIOPSY INSTRUMENT(AUTOMATIC) 633 NES0376311ZR TRU-CORE II AUTOMATIC DISPOSABLE BIOPSY DEVICE 633 NES0376501ZM PRO-MAG AUTOMATIC BIOPSY NEEDLE 633 NES0376502ZM PRO-MAG AUTOMATIC BIOPSY NEEDLE 633 NES0376511ZM PRO-MAG AUTOMATIC BIOPSY NEEDLE 633 NES03TM14NGP SPRING LOADED BIOPSY NEEDLE( 自動彈簧切片針 ) 611 NES03TM16NGP SPRING LOADED BIOPSY NEEDLE( 自動彈簧切片針 ) 611 NES03TZ14NGP SPRING LOADED BIOPSY NEEDLE( 自動彈簧切片針 ) 611 NES03TZ16NGP SPRING LOADED BIOPSY NEEDLE( 自動彈簧切片針 ) 611 RRB0117301HU HUDSON INCENTIVE SPIROMETER TRIFLO II INSPIRATORY EXERCISER* 190 RRB024311NGF 崇仁三球式呼吸訓練器 " 及配件 GALEMED"TRI-BALLS INCENTIVE SPIROMETER AND ACCESSORY* 190 SAS02TCT55JJ LINEAR CUTTER SAFETY LOCKOUT 55MM 腸胃自動縫合器 2403 SAS02TLC55JJ TITANIUM LINEAR CUTTER 55MM 腸胃自動縫合器 55MM 2403 98

SAS0603036CH " 康美 " 可拆式皮膟縫合釘 "CONMED"REFLEX SKIN STAPLER* 231 SAS0608035RA REFLEX SKIN STAPLE (REGULAR SIZE)(35) 183 SAS0608535RA REFLEX SKIN STAPLE (WIDE SIZE)(35) 231 SAS0628235WK VISITAT SKIN STAPLER 35W * 231 SAS0654873US DISPOSIBLE ROYAL SKIN STAPLE 35W 231 SAS0680351TY 皮膟縫合釘 APPOSE ULC DISPOSABLE SKIN STAPLER* 231 SAS0680371DG SKIN STAPLE 35W 35R 231 SAS06FJ135WK VISISTAT SKIN STAPLE 35R 183 SAS06PMR35JJ REGULAR 35R MULTI-DIRECTION SKIN STAPLER 183 SAS06PMW35JJ WIDE 35W MULTI-DIRECTION SKIN STAPLER 231 SAU010TR30JJ "ETHICON"DISPOSABLE STAPLER-PROXIMATE LINEAR RELOADING UNIT( TITANIUM)30MM 2293 SAU010TR60JJ "ETHICON"DISPOSABLE STAPLER-PROXIMATE LINEAR RELOADING UNIT( TITANIUM)60MM 2063 SAU0110312US PERMIUM MULTIFIRE TA DLU 30 2293 SAU0110318US PERMIUM MULTIFIRE TA DLLU 60 2063 SAU0110322US PERMIUM MULTIFIRE TA DLU 90 2153 SAU0115427US TA 30 P-3.5 DLU 胸腹器吻合釘 TA30 3.5MM 2293 SAU0115433US TA 30 P-4.8 DLU 胸腹器吻合釘 TA30 4.8MM 2293 SAU0115451US TA 55 P-3.5 DLU 胸腹器吻合釘 TA55P 3.5MM 2063 SAU0115458US TA 55 P-4.8 DLU 胸腹器吻合釘 TA55P 4.8MM 2063 SAU0115485US TA 90 P-3.5,4.8 DLU 胸腹器吻合釘 TA90P 3.5MM,4.8MM 2153 SAU01TRH90JJ "ETHICON"DISPOSABLE STAPLER-PROXIMATE LINEAR RELOADING UNIT( TITANIUM)90MM 2153 SAU01XR30BJJ PROXIMATE RELOADABLE LINEAR STAPLER 30MM 3.5LEG,4.8LEG 2293 SAU01XR60BJJ PROXIMATE RELOADABLE LINEAR STAPLER 60MM 3.5LEG,4.8LEG 2063 SAU0230252US AUTO SUTURE MULTIFIRE GIA DISPOSABLE SURGICAL STAPLERS 60-2.5 2272 SAU0230424US GIA 50P DLU 腸胃吻合釘 2272 SAU0230678US AUTO SUTURE MULTIFIRE GIA DISPOSABLE SURGICAL STAPLERS 60-3.8 2272 99

SAU0231739US AUTO SUTURE MULTIFIRE GIA DISPOSABLE SURGICAL STAPLERS 80-3.8 2239 SAU0231749US AUTO SUTURE MULTIFIRE GIA DISPOSABLE SURGICAL STAPLERS 80-4.8 2239 SAU026025LUS " 優施西 "GIA 自動手術縫合器 "USSC"AUTO SUTURE MULTIFIRE GIA DISPOSABLE SURGICAL STAPLER* 2239 SAU02TCRNNJJ RELOAD LINEAR CUTTER 55MM,75MM 腸胃自動縫合釘 2272 SAU02TRD75ET " 愛惜康 " 普克美縫合釘 "ETHICON" PROXIMATE LINEAR CUTTERS & RELOAD UNITS * 2239 SAU02TRT55JJ RELOAD LINEAR CUTTER 55MM 腸胃自動縫合釘 2272 SAU02TRT75JJ RELOAD LINEAR CUTTER 75MM 腸胃自動縫合釘 2239 SAU0310214US EEA 25,28,31 DLU 腸道食道縫合釘 25,28,31MM 5087 SAU0730412US 優施西 GIA 自動手術縫合器 60MM 5956 SAU07ECR45ET " 愛惜康 " 愛喜龍 45 安德派思縫合釘 "ETHICON" ECHELON 45 ENDOPATH ENDOSCOPIC LINER CUTTERS AND RELOADS 4802 SAU07ECR60ET " 愛惜康 " 愛喜龍安德派思縫合釘 "ETHICON" ECHELON 60 ENDOPATH STAPLER CARTRIDGE 5756 SAU07TR45BET SAU07TR60BET " 愛惜康 " 安德派思切割縫合釘 "ETHICON" ENDOPATH ENDOSCOPIC LINEAR CUTTER RELOADING UNIT " 愛惜康 " 安德派思切割縫合釘 "ETHICON" ENDOPATH ENDOSCOPIC LINEAR CUTTER RELOADING UNIT 60MM 4802 5756 SCV0101204WK " 偉克 " 哈瑞隆血管夾 "WECK" HORIZON LIGATING CLIPS- 小型 24 針 / 匣 17 SCV0102204WK " 偉克 " 哈瑞隆血管夾 "WECK" HORIZON LIGATING CLIPS- 中型 24 針 / 匣 19 SCV011150NS6 MINI ANGLE CLIP 192 SCV01B2180V7 " 威坦鐵克 " 鈦金屬血管夾 "VITALITEC" SLS-CLIP TITANIUM HEMOSTATIC CLIP 中型 19 SCV01FD100WK HEMO CLIP (M) 每盒 10 排, 每排 25CLIP 15 SCV01FD135WK HEMO CLIP (S) 每盒 12 排, 每排 25CLIP 13 SCV01FD160WK HEMO CLIP (M.L) 每盒 20 排, 每排 10CLIP 19 SCV01FD170WK HEMO CLIP (L) 每盒 10 排, 每排 15CLIP 30 SCV01FD300WK HEMO CLIP (M) 每盒 20 排, 每排 10CLIP 15 SCV01FD335WK HEMO CLIP (S) 每盒 24 排, 每排 10CLIP 13 SCV01FD360WK HEMO CLIP (ML) 每盒 16 排, 每排 10CLIP 19 SCV01FD370WK HEMO CLIP (L) 每盒 12 排, 每排 10CLIP 30 SCV01FD800WK TITANIUM HEMOCLIP(MEDIUM) 19 100

特材代碼中英文品名支付點數 SCV01FD835WK TITANIUM HEMOCLIP(SMALL) 17 SCV01FD860WK TITANIUM HEMOCLIP(MEDIUM-LARGE) 22 SCV01J1180V7 " 威坦鐵克 " 鈦金屬血管夾 "VITALITEC" SLS-CLIP TITANIUM HEMOSTATIC CLIP 小型 17 SCV01LT100JJ TITANIUM LIGA CLIP (S) 6 CLIP/ 排 17 SCV01LT200JJ TITANIUM LIGA CLIP (M) 6 CLIP/ 排 19 SCV01LT300JJ TITANIUM LIGA CLIP (M-L) 6 CLIP/ 排 22 SCV01V3120V7 " 威坦鐵克 " 鈦金屬血管夾 "VITALITEC" SLS-CLIP TITANIUM HEMOSTATIC CLIP 中型 / 大型 22 SCV029400NM1 SUGITA ANEURYSM CLIP (STANDARD TYPE) 2256 SCV029401NM1 SUGITA ANEURYSM CLIP (LARGE TYPE) 2801 SCV029402NM1 SUGITA ANEURYSM CLIP (LARGE TYPE) 2801 SCV029404SM1 SUGITA ANEURYSM CLIP (LARGE TYPE) 2801 SCV0294050M1 SURGITA ANEURYSM CLIPS LARGE TYPE N0.50 2801 SCV0294069M1 SURGITA ANEURYSM CLIPS STANDARD TYPE N0.69 2256 SCV029406NM1 SUGITA ANEURYSM CLIP (STANDARD TYPE) 2256 SCV029406SM1 SUGITA ANEURYSM CLIP (LARGE TYPE) 2801 SCV0294073M1 SURGITA ANEURYSM CLIPS LARGE TYPE N0.73 2801 SCV029407NM1 SUGITA ANEURYSM CLIP (LARGE TYPE) 2801 SCV02FE60NAE ANEURYSM CLIP 2602 TBCT109600W5 CRAWFORD LARCRIMAL INTUBATION SET 鼻淚管通條 1773 TBCT10P918C8 "CARDINAL"MANUAL OPHTHALMIC SURGICAL INSTRUMENT-LACRIMAL INTUBATION SET" 卡迪諾 " 手動式眼科手術器械 - 鼻淚管通條 1773 TBS0100040MZ SCLERAL BUCKLING COMPONENTS:SILICON BAND 463 TBS0100042MZ SCLERAL BUCKLING COMPONENTS:SILICON BAND 463 TBS0100240MZ SCLERAL BUCKLING COMPONENTS:SILICON BAND 463 TBS0100276MZ SCLERAL BUCKLING COMPONENTS:SILICON TIRE 661 TBS0100277MZ SCLERAL BUCKLING COMPONENTS:SILICON TIRE 661 TBS0100279MZ SCLERAL BUCKLING COMPONENTS:SILICON TIRE 661 101

TBS0200503MZ SCLERAL BUCKLING COMPONENTS:SILICON SPONGE 1378 TBS0200504MZ SCLERAL BUCKLING COMPONENTS:SILICON SPONGE 1378 TBS0200505MZ SCLERAL BUCKLING COMPONENTS:SILICON SPONGE 1378 TBS0200506MZ SCLERAL BUCKLING COMPONENTS:SILICON SPONGE 1378 TBS0200507MZ SCLERAL BUCKLING COMPONENTS:SILICON SPONGE 1378 TKVC107402A1 STANDALONE ACCURUS PROBE 4497 TKVC12405CZS VITREOUS CUTTER W/TUBING SET 玻璃體切除刀 4409 TKVC141018A1 ACCURUS 2500 VITRECTOMY PROBE 玻璃體切除探頭 4950 TKVC201006A1 ANTERIOR ADVANCE TECHNOLOGY IRRIGATION OCUTOME PROBE (ATOP) 4497 TKVC208012A1 ANTERIOR VITRECTOMY PROBE 4497 WDD0800008SN INTRASITE GEL 8GM * 87 WDD0800015SN INTRASITE GEL 15GM * 162 WDD0800683P8 HYDROCOLL CONCAVE 6X14CM 86 WDD0800700SN "SMITH&NEPHEW"ALLEVYN DRESSING(SACRUM)17CMX17CM 愛力膟親水性的聚乙烯膟料 * 327 WDD0801020SN HYDROPHILIC POLYURETHANE DRESSING 10X20CM 255 WDD0801212SN HYDROCELLULAR ADHESIVE DRESSING 12.5X12.5CM 177 WDD0801419BB "B.BRAUN"ASKINA GEL,15G 雅膟清創凝膞 * 162 WDD0801717SN HYDROCELLULAR ADHESIVE DRESSING 17.5X17.5CM 327 WDD0801810ZK OMIDERM WOUND DRESSING (STERILE)18X10CM* 255 WDD0802131ZK OMIDERM WOUND DRESSING (STERILE)21X31CM* 689 WDD080810MZK OMIDERM WOUND DRESSING (STERILE)8X10CM* 86 WDD0808600TB ELASTO-GEL 15X20 CM 327 WDD0809232KD CURASORB CALCUIUM ALIGINATE DRESSINGS 5.08X5.08CM 23 WDD0809233KD CURASORB CALCUIUM ALIGINATE DRESSINGS 10.16X10.16CM 121 WDD0809238KD CURASORB CALCUIUM ALIGINATE DRESSINGS 20.32X10.16CM 139 WDD0809239KD CURASORB CALCUIUM ALIGINATE DRESSINGS 15.24X25.4CM 269 102

WDD0809240KD CURASORB CALCUIUM ALIGINATE DRESSINGS 10.16X13.97CM 130 WDD0809242KD CURASORB CALCUIUM ALIGINATE DRESSINGS 30.48X60.96CM 1425 WDD0809354KD CURASORB CALCUIUM ZINC ALIGINATE DRESSINGS 5.08X5.08CM 23 WDD0809355KD CURASORB CALCUIUM ZINC ALIGINATE DRESSINGS 10.16X10.16CM 121 WDD0809356KD CURASORB CALCUIUM ZINC ALIGINATE DRESSINGS 10.16X20.32CM 139 WDD0809801KD ULTEC PRO ALGINATE HYDROCOLLOID DRESSING 4X4(10.16X10.16CM) 121 WDD0809802KD ULTEC PRO ALGINATE HYDROCOLLOID DRESSING 6X6(15.24X15.24CM) 188 WDD0809804KD ULTEC PRO ALGINATE HYDROCOLLOID DRESSING 8X8(20.32X20.32CM) 269 WDD0809923HL RESTORE EXTRA THIN 15.2CMMX20.3CM 145 WDD0809937HL RESTORE CALCICARE WOUND CARE DRESSING STERILE 10X10CM 121 WDD0809938HL RESTORE CALCICARE WOUND CARE DRESSING STERILE 5X5CM 23 WDD0809939HL RESTORE CALCICARE WOUND CARE DRESSING STERILE 10X20CM 139 WDD081515TSN REPLICARE ULTRA 15X15CM 121 WDD0815182A5 KARAYAHESIVE HYDROCOLLOID WOUND DRESSING 75CM2, 親水性敷料 * 43 WDD0815184A5 KARAYAHESIVE HYDROCOLLOID WOUND DRESSING 150CM2, 親水性敷料 * 55 WDD081518TSN REPLICARE ULTRA 15X18CM 121 WDD081810MZK OMIDERM WOUND DRESSING (STERILE)18X10CM* 255 WDD082020TSN REPLICARE ULTRA 20X20CM 196 WDD082100SBB "B.BRAUN"ASKINA SORB CALCIUM ALGINATE DRESSING(STERILE) 6CMX6CM 雅膟藻酸鈣敷料 * 23 WDD082101SBB "B.BRAUN"ASKINA SORB CALCIUM ALGINATE DRESSING(STERILE) 10CMX10CM 雅膟藻酸鈣敷料 * 121 WDD082102SBB "B.BRAUN"ASKINA SORB CALCIUM ALGINATE DRESSING(STERILE) 15CMX15CM 雅膟藻酸鈣敷料 * 188 WDD082105SBB "B.BRAUN"ASKINA SORB CALCIUM ALGINATE DRESSING(STERILE) 2.7CMX34CM 雅膟藻酸鈣敷料 * 72 WDD082131MZK OMIDERM WOUND DRESSING (STERILE)21X31CM* 689 WDD0825060LN MELGISORB ABSORBENT CALCIUM SODIUM ALGINATE DRESSING(5CMX5CM)* 23 WDD0825110LN MELGISORB ABSORBENT CALCIUM SODIUM ALGINATE DRESSING(10CMX10CM)* 121 WDD0825150LN MELGISORB ABSORBENT CALCIUM SODIUM ALGINATE DRESSING(10CMX20CM)* 139 103

WDD0825300LN MELGISORB ABSORBENT CALCIUM SODIUM ALGINATE DRESSING(32CMX2.2CM)* 72 WDD0831150CA COMFEEL PLUS ULCER DRESSING 15X15CM 255 WDD0834130CA "COLOPLAST"BIATAIN NON-ADHESIVE DRESSING 15X15CM 平而坦非黏性泡綿敷料 * 255 WDD0834200CA "COLOPLAST"BIATAIN ADHESIVE DRESSING 12X12CM 平而坦黏性泡綿敷料 * 177 WDD0834230CA "COLOPLAST"BIATAIN ADHESIVE DRESSING 18X18CM 平而坦黏性泡綿敷料 * 327 WDD0834720CA "COLOPLAST"BIATAIN DRESSING SOFT-HOLD 10CMX20CM 平而坦傷口敷料 * 255 WDD0834750CA "COLOPLAST"BIATAIN DRESSING SOFT-HOLD 15CMX15CM 平而坦傷口敷料 * 255 WDD0835390CA COMFEEL PLUS TRANSPARENT DRESSING 15X15CM 121 WDD0835450CA COMFEEL PLUS TRANSPARENT DRESSING 20X20CM 196 WDD0835520CA "COLOPLAST"BIATAIN AG NON-ADHESIVE FOAM DRESSING 15X15CM 平而坦銀離子非黏性泡綿敷料 * 413 WDD0835620CA "COLOPLAST"BIATAIN AG ADHESIVE FOAM DRESSING 15X15CM 平而坦銀離子黏性泡綿敷料 * 413 WDD0837150CA COMFEEL SEASORB DRESSING 15X15CM 255 WDD0839000CA COMFEEL PURILON GEL 15GM* 162 WDD0841210BB "B.BRAUN"ASKINA FOAM WOUND DRESSING(STERILE)0CMX20CM 雅膟泡棉敷料 * 255 WDD0850555BB ASKINA THINSITE 15CMX15CM* 121 WDD0850556BB ASKINA THINSITE 20CMX20CM* 196 WDD0860923P8 TENDERWET 7.5X7.5CM 73 WDD0861500LN MOLNLYCKE HYPERGEL 15GM* 162 WDD0871500LN NORMLGEL 15GM* 162 WDD0872045BB "B.BRAUN"ASKINA HYDRO 15CMX15CM 雅膟親水膞敷料 * 255 WDD0872050BB ASKINA BS,BP,BT 10X10CM,5X20CM 123 WDD0872051BB ASKINA BS,BP,BT 15X15CM 型號 F72051 F72015 自 93.1.1 刪除 255 WDD0872052BB ASKINA BS,BT 20X20CM 400 WDD0872789BB ASKINA TRANSORBENT 10X10CM 123 WDD0872790BB ASKINA TRANSORBENT 15X15CM 255 WDD0872791BB ASKINA TRANSORBENT 20X20CM 400 104

WDD0875400SH ULTEC HYDROCOLLOID DRESSING 10X10CM 123 WDD0875602SH ULTEC HYDROCOLLOID DRESSING 15X15CM 255 WDD0875800SH ULTEC HYDROCOLLOID DRESSING 15X20CM 327 WDD0875826SH ULTEC HYDROCOLLOID DRESSING 20X20CM 400 WDD08900203M TEGASORB THIN HYDROCOLLOID DRESSING 5CMX10CM* 43 WDD08900273M 3M TEGASORB THIN HYDROCOLLOID DRESSING 15CMX15CM 親水性敷料 * 121 WDD08900283M 3M TEGASORB THIN HYDROCOLLOID DRESSING 20CMX20CM 親水性敷料 * 196 WDD08901123M 3M TEGADERM HIGH INTEGRITY ALGINATE DRESSING(STERILE) 海藻酸鹽敷料 10CMX10CM* 121 WDD08902123M 3M TEGADERM HIGH GELLING ALGINATE DRESSING(STERILE) 海藻酸鹽敷料 10CMX10CM* 121 WDD0890510LN Mepitel 5cm x 7.5cm * 66 WDD0890672P8 HYDROCOLL 15X15CM 255 WDD0890680P8 HYDROCOLL SACRAL 15X18CM 327 WDD0890686P8 HYDROCOLL TRANSPARENT 15X15CM( 薄 ) 121 WDD0890710LN Mepitel 7.5cm x10cm* 98 WDD0891010LN MEPITEL 10cm x18cm*( 型號更正為 291010) 207 WDD0892005LN Mepitel 20cm x30cm* 674 WDD0894100LN MEPILEX STERILE 10CMX10CM 119 WDD0894200LN MEPILEX STERILE 10CMX20CM 225 WDD0894400LN MEPILEX STERILE 20CMX20CM 364 WDD0895200LN MEPILEX BORDER SAFETAC SILICON FOAM DRESSING 7.5X7.5CM* 68 WDD0895300LN MEPILEX BORDER SAFETAC SILICON FOAM DRESSING 10X10CM* 119 WDD0895600LN MEPILEX BORDER SAFETAC SELF-ADHERENT SOFT SILICONE FOAM DRESSING 15CMX20CM* 326 WDD0899583P8 WDD0899584P8 "HARTMANN"HYDROPHILIC WOUND DRESSING(THIN)(STERILE)HYDROTUL 10X12CM 親水性創傷覆蓋材 * "HARTMANN"HYDROPHILIC WOUND DRESSING(THIN)(STERILE)HYDROTUL 15X20CM 親水性創傷覆蓋材 * 55 145 WDD0899589P8 SORBALGON 10X20CM 255 WDD08C1520SN "SMITH&NEPHEW"CUTINOVA HYDRO DRESSING 15X20CM* 327 105

WDD08S0303ZW "SAVDERM"SELF-ADHESIVE FOAM DRESSING(STERILE) 自黏性泡棉敷料 10X20CM* 255 WDD08T0510RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創傷敷料 ( 滅菌 )5X10CM*( 薄型 )* 43 WDD08T1515RW WDD08T2020RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創傷敷料 ( 滅菌 )15X15CM*( 薄型 )* "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創傷敷料 ( 滅菌 )20X20CM*( 薄型 )* 121 196 WDD08W1020RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創傷敷料 ( 滅菌 )10X20CM* 255 ACA0100ABNPW IV CAP 6 ACA0108008SG IV CAP 注射帽 6 ACA011PN01NQ INJECTION CAP 6 ACA011VCAPTP INJECTION CAP 6 ACA0121010TZ IV LOCK 6 ACA012VCAPTP INJECTION CAP 6 ACA01AB00NPW IV LOCK 6 ACA01B1596BN INJECTION PORT CAP(IV LOCK) 6 ACA01C1C02LL INJECTION CUP(IV LOCK) 6 ACA01NF005LL INJECTION CAP( 安全型 ) 50 ACA01SR1PNTM IV LOCK 6 ACC0100360BT PLASTIC CONNECTOR 兩尖型 18 ACC0100361BT PLASTIC CONNECTOR 一尖一平塑膞連接頭 18 ACC0100362BT PLASTIC CONNECTOR 塑膞連接頭 18 ACC0100364BT PLASTIC CONNECTOR 直型塑膞連接頭 18 ACC01HSC60H6 PLASTIC CONNECTOR( 兩尖型 ) 18 ACC01HSC61H6 PLASTIC CONNECTOR( 一尖一平型 ) 18 ACC02VP004LL 3 WAY 12 ACM012HFRXMR MANIFOLD 2-PORTS W/ HIGH PRESSURE TUBING( 可達 1200PSI) 384 ACM01PT003CK 2-PORTS MANIFOLD 連接頭 250 ACS0107401BT 3-WAY STOPCOCK W/LUER LOCK 12 106

特材代碼中英文品名支付點數 ACS0109511BB 3 WAY STOPCOCK 12 ACS0129010TZ THREE WAY STOPCOCK SYSTEM 12 ACS0134MPATP PREDURA PRESSURE RESISTAN THREE WAY STOPCOCK 3.4MPA 360 度 500PSI 20 ACS013CAPSM8 3 WAY STOPCOCK 12 ACS0152001TP 3 WAY STOPCOCK 12 ACS0168MPATP PREDURA PRESSURE RESISTAN THREE WAY STOPCOCK 1000PSI 70 ACS01B1702BD STOPCOCKS W/LUER-LOCK 12 ACS01D010NPW DISPOSABLE INFUSION SET 3 WAY STOPCOCK 12 ACS01H3FLCMR MANIFOLD HIGH PRESSURE 3 WAY STOPCOCK (1050PSI)( 自 92.10.01 起廠牌碼由 ER 改為 MR) 70 ACS01M3SNCMR MARQUIS SERIES STOPCOCK 500PSI 34 ACS01NCN3SNR 3 WAY STOPCOCK 塑膞三極栓 12 ACS01S3SNCMR MANIFOLD 3 WAY STOPCOCK W/LUER LOCK( 自 92.10.01 起廠牌碼由 ER 改為 MR) 20 ACS01STP34EM 3 WAY AND 4 WAY STOPCOCK 12 ACS01STP34H9 " 華億 " 體外循環管組 "HYM"HEART LUNG PACK-3 & 4 WAY STOPCOCKS 12 ACS01STPHPEM HIGH PRESSURE 1 & 3 WAY STOPCOCK(1050PSI) 70 ACS01TS201SG 3 WAY STOPCOCK W/LOCK 12 ACS01V68MPTP PREDURA PRESSURE RESISTAN THREE WAY STOPCOCK V-TYPE 1000PSI 70 ACS03SMT01SG 1000PSI HIGH PRESSURE 3 WAY 70 ACVP101900NZ PUDENZ CONNECTOR STR 400 ACVP101902NZ PUDENZ RIGHT ANGLE CONNECTOR 845 ACVP105103B0 CSF CATHETER CONNECTOR,STRAIGHT 400 ACVP105104B0 CSF CATHETER CONNECTOR,RIGHT ANGLE 845 ACVP123048CM HAKIM STRAIGHT CONNECTOR 400 ACVP145103PM CONNECTOR 400 ACVP145104PM CONNECTOR L 型 845 ACVP182150CM ACCU-FLO STRAIGHT CONNECTORS(METAL,PLASTIC) 400 107

ACVP182151CM ACCU-FLO RIGHT ANGLE CONNECTORS(METAL,PLASTIC) 845 ACVP201908NZ PUDENZ THREE WAY CONNECTOR 1600 ACVP205105B0 CSF CATHETER CONNECTOR,3-WAY 1600 ACVP221520CM 3 WAY CONNECTOR 1600 ACVP245105PM 3 WAY CONNECTOR 1600 BBF0300059KG KABI APPLIX TUBING SET BAG* 72 BBF0307020P2 FEEDING BAG 72 BBF0307030P2 FEEDING BAG DOUBLE BAG 1200CC 72 BBF0307040P2 FEEDING BAG DOUBLE BAG WITH PUMP 1200CC 127 BBF0322361AB PATROL TOP FILL BAG & PUMP SET 127 BBF03223XXAB "ABBOTT"FLEXIFLOW PATROL 1 LITER TOP FILL BAG WITH STOPCOCK AND UNIVERSAL ADAPTER 巡弋管灌餵食幫浦套管含餵食袋 * 127 BBF0350010TZ FEEDING BAG 1200CC( 動力式 )* 72 BBF0373006KD KENDALL KANGAROO ENTERAL FEEDING PUMP SETS* 127 BBF0373642SH EASY CAP BAG 1000ML AND PUMP SET WITH FLUSH BAG 127 BBF0373656KD "KENDALL"KANGAROO EPUMP FEEDING SETS 袋鼠電子灌食機用灌食套組 * 127 BBF0373659SH EASY CAP BAG 1000ML AND PUMP SET WITH ONE WAY VALVE 127 BBF0377360SH KANGAROO FEEDING PUMP SET 127 BBF0377517KG KABI APPLIX SMART/VISION PUMP SET BAG* 127 BBF03F1200SG FEEDING PUMP SET 127 BBF03FB030P2 "PAHSCO"FEEDING BAG 雙袋重力式餵食袋 * 72 BBF03FB040P2 "PAHSCO"FEEDING BAG 雙袋機械式餵食袋 * 127 BBF03FB600P2 PAHSC0 FEEDING BAG 重力式 600ML* 72 BBP011497NA5 YOUCARE CLOSE POUCH 60MM 限住院患者使用 34 BBP0409766HL ONE PIECE PEDIATRIC DRAINABLE POUCH( 附人造皮 ) 限住院患者申報 45 BBP0413351A5 POSPACK-B K 60,70MM* 限住院患者申報 55 BBP0414212A5 PEDIATRIC PROCARE 1 POST-OP * 限住院患者使用 45 108

特材代碼中英文品名支付點數 BBP041503NA5 POSPACK LIGHT 60MM 限住院患者使用 34 BBP0480020CA ONE PIECE ALTERNA CHILDREN OPEN TRANSPARENT BAG 10:35MM 限住院患者申報 45 CAE0101401BB PERIFIX ONE EPIDURAL ANAESTHESIA(NEEDLE+CATH+CONNECTOR+FILTER+LOR SYRINGE+SYRINGE) 427 CAE0110118H0 EPIDURAL ANESTHESIS SET 硬腦膜外醉套 362 CAE0110318H0 EPIDURAL ANESTHESIS SET 硬腦膜外醉套 362 CAE0111000BB EPIDURAL ANAESTHESIA SET(N+C)( 型號包含 04505080,04055098) 241 CAE0112006BB EPIDURAL ANAESTHESIA SET 16:18G(N+C+F+S)( 型號含 04514300,04515-013:021,-200:307,04516-206:303) 427 CAE0112170BB EPIDURAL ANAESTHESIA CATHETER 103 CAE0113010BB EPIDURAL ANAESTHESIA SET(N+C+S) 362 CAE0115005BB EPIDURAL ANAESTHESIA SET(N+C+F) 362 CAE0139116PX EPIDURAL MINIPACK SYSTEM 1 16G 80MM 427 CAE0139118PX EPIDURAL MINIPACK SYSTEM 1 18G 80MM 427 CAE0139416PX EPIDURAL MINIPACK SYSTEM 4 16G 80MM 241 CAE0139418PX EPIDURAL MINIPACK SYSTEM 4 18G 80MM 241 CAE014014NBD PERISAFE EPIDURAL ANAESTHESIA KIT NEEDLE 17,18G CATH 19,20G(N+C+FILTER+SYRINGE+GUIDE+CONNECTOR) 427 CAE0151238BB PERICAN EPIDURAL NEEDLE 110 CAE0151300BB PERIFIX EPIDURAL SET 241 CAE0151310BB PERIFIX EPIDURAL SET 241 CAE0151410BB PERIFIX FOR CONTINUOUS EPIDURAL AND CAUDAL ANAESTHESIA 400 SERIES 427 CAE0191019PX EPIDURAL MINIPACK SYSTEM 19G 硬脊膜穿刺麻醉針組 427 CAE01C1695TM CONNECTING EPIDURAL CATHETER 95CM 103 CAE01C1795TM CONNECTING EPIDURAL CATHETER 95CM 103 CAE01C1895TM CONNECTING EPIDURAL CATHETER 95CM 103 CAE01E5400AR NON-KINGKING EPIDURAL CATHETER 20GA 91.4CM,19GAX92CM 362 CAE01ENC16TM EPIDURAL NEEDLE 16G 110 CAE01ENC17TM EPIDURAL NEEDLE 17G 110 109

特材代碼中英文品名支付點數 CAE01ENC18TM EPIDURAL NEEDLE 18G 110 CAE0200695HK EPIDURAL CATHETER 硬膜外針導管 103 CAE0201095HK EPIDURAL CATHETER 硬膜外針導管 103 CAE0238216PX EPIDURAL ANAESTHESIA CONDUCTION SET:EPIDURAL CATHETER 103 CAE0295440HK EPIDURAL CATHETER 22G 103 CBA02SEN7FD5 "DATASCOPE"SENSATION 7FR INTRA-AORTIC BALLOON CATHETER 光纖感應主動脈氣球導管 * 41110 CBB0106433SB ULTRA-THIN DIAMOND BALLOON DILATATION CATHETER 5822 CBB01115GASB GAZELLE BALLOON DILATATION CATHETER 5822 CBB0112512SB BLUW MAX BALLOON DILATATION CATHETERS 5822 CBB0114508SB XXL BALLOON DILATATION CATHETER 5822 CBB0125400L1 PTA BALLOON CATHETER 5822 CBB0131555N5 GHOST II PTA ANGIOPLASTY CATHETER 5FR. 3:10MM *1.5:10CM, 40,75,120,150CM( 衛署字號 009069) 5822 CBB014020NCD POWER FLEX PTA CATHETER 5822 CBB014105NCD POWERFLEX PTA BALLOON CATHTER 5FR 5822 CBB014122NCD POWER FLEX PTA CATHETER 5FR 5822 CBB0141500CD POWERFLEX PTA CATHETER 5822 CBB0141550CD POWERFLEX PTA BALLOON 5822 CBB0141570CD POWERFLEX PTA BALLOON 5822 CBB014157XJD FOX PTA CATHETER 135CM 5822 CBB0141590CD POWERFLEX PTA BALLOON 5822 CBB01420XNCD CBB01423SWCD CBB01424NWCD POWER FLEX PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) CATHETER 3MM:12MM 40,80,135CM CORDIS AMIIA.014 PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY(PTA) DILATATION CATHETER 4.0:7.0MM,80,142CM "CORDIS"AVIATOR PLUS PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY(PTA)BALLOON DILATATION CATHETER PTA 氣球擴張導管 4.0MM:6.0MM;7.0MM 5822 5822 5822 CBB014352XCD SAVVY PTA CATHETER 5FR 5822 CBB014353XCD SAVVY PTA CATHETER 5FR 5822 CBB014354XCD SAVVY PTA CATHETER 5FR 5822 110

特材代碼中英文品名支付點數 CBB014355XCD SAVVY PTA CATHETER 5822 CBB014356XCD SAVVY PTA CATHETER 5822 CBB014357XCD SAVVY PTA CATHETER 5FR 5822 CBB014358XCD SAVVY PTA CATHETER 5FR 5822 CBB014359XCD SAVVY PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY(PTA)CATHETER 5822 CBB01435XXCD CORDIS SAVVY PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY(PTA) CATHETER 80;120;135;150CM 5822 CBB0150300SB SMASH BALLOON DILATATION CATHETER 5822 CBB0150300SC SMASH PTA BALLOON DILATION CATHETER 5FR 3.0:10MM 5822 CBB0150500SB WANDA PTA BALLOON DILATATION CATHETER 5822 CBB0154002N5 HIGH FIVE PTA ULTRA HIGH PRESSURE CATHETER 5FR BALLOON DIA 3:10MM LENGTH 2:10CM 5822 CBB0182454AB "ABBOTT"FOX SV PTA CATHETER 福斯深層周邊血管氣球導管 135CM 2.0MM:5.0MM 5822 CBB0182954AB "ABBOTT"FOX SV PTA CATHETER 福斯深層周邊血管氣球導管 90CM 2.0MM:5.0MM 5822 CBB01ADM18F2 "INVATEC"ADMIRAL XTREME PTA BALLOON CATHETER 愛德米羅週邊血管氣球導管 3MM:12MM 20MM:120MM 5822 CBB01AP128AB FOX PLUS PTA CATHETER 5822 CBB01AT751BA BARD ATLAS PTA BALLOON DILATATION CATHETER 75CM,120CM 5822 CBB01AT752BA "BARD"ATLAS PTA BALLOON DILATATION CATHETER 5822 CBB01ATB01CK ALL-TERRAIN BALLOON PTA DILATATION CATHETERS 5822 CBB01ATB02CK "COOK"ALL-TERRAIN BALLOON PTA DILATATION CATHETER 經皮穿刺血管成形術用氣球擴張導管 5822 CBB01CQ575BA CONQUEST PTA BALLOON DILATATION CATHETER( 型號 CQ-50;75-52;54;58 自 950401 起生效, 文號 0940040071) 5822 CBB01G11XXN5 "NUMED"GHOST II PTA CATHETER 40CM 75CM 120CM 135CM 150CM 5822 CBB01L2457KE "KANEKA"PTA BALLOON CATHETER 經皮穿腔成型術氣球導管 5822 CBB01L4575KE KANEKA PTA CATHETER 5822 CBB01MG1XXN5 NUMED MINI GHOST DILATATION CATHETER 2MM-6MM 2CM:4CM 40CM:150CM 5822 CBB01P5052VC OPTI-PLAST BALLOON DILATATION CATHETER 5.5FR 5822 CBB01PCF18F2 "INVATEC"PACIFIC XTREME PTA BALLOON CATHETER 派斯飛克血管治療導管 5822 CBB01PTA41CK "COOK"ADVANCED 18LP LOW PROFILE PTA BALLOON DILATATION CATHETER 艾德凡絲小剖面經皮穿刺血管成形術球曩擴張導管 80CM 135CM 5822 111

CBB01SBR18F2 "INVATEC"SUBMARINE RAPIDO PTA BALLOON CATHETER 直徑 2.00MM-7.00MM, 長度 20MM:40MM 5822,60MM,80MM USE LENGTH:75CM,135CM 潛艇周邊血管治療導管 CBB01SF475KE "KANEKA"PTA CATHETER 血管擴張氣球導管 5822 CBB01SUP18F2 "INVATEC"SUBMARINE PLUS PTA CATHETER 潛艇週邊血管治療導管直徑 2.0MM:7.0MM 長度 20MM:120MM 5822 CBB01U7522VC ULTRAVERSE SMALL VESSEL BALLOON DILATATION CATHETER 3.5FR 5822 CBB01USSV1SB "BOSTON SCIENTIFIC"ULTRA-SOFT SV BALLOON DILATATION CATHETER4.0MM:7.0MM 1.5CM:2.0CM 3.1CM/3.1CM:3.4CM/3.1CM 90FR,150FR 5822 CBB01X5052VC OPTI-PLAST XT BALLOON DILATATION CATHETER 5.0FR 5822 CBP01101TBRB BRAVO PTCA DILATATION CATHETER 8340 CBP01103TBRB "ORBUSNEICH"SAPPHIRE CORONARY DILATATION CATHETER 1.5MM:4.0MM 10MM:30MM 塞費爾冠狀動脈球曩擴張術導管 8340 CBP01206FNJD JOSTENT FLEXMASTER(CORONARY STENT) W/DELIVERY SYSTEM 19940 CBP01210FMAB JOSTENT FLEXMASTER WITH DELIVERY SYSTEM * 19940 CBP01210FNJD JOSTENT FLEXMASTER(CORONARY STENT) W/DELIVERY SYSTEM 19940 CBP01211FMAB ABBOTT JOSTENT FLEXMASTER WITH DELIVERY SYSTEM * 19940 CBP012535SHC HELISTENT CORONARY STENT W/DELIVERY SYSTEM *( 原文號 910034694) 19940 CBP012540SHC HELISTENT CORONARY STENT W/DELIVERY SYSTEM *( 原文號 910034694) 19940 CBP0135040SB EXPRESS MONORAIL CORONARY STENT WITH DELIVERY SYSTEM * 19940 CBP0138938SB LIBERTE MONORAIL CORONARY STENT SYSTEM* 19940 CBP0150200BB COROFLEX CORONARY STENT SYSTEM(W/DELIVERY SYSTEM)* 19940 CBP0150201BB COROFLEX CORONARY STENT SYSTEM(W/DELIVERY SYSTEM)* 19940 CBP0150212BB "B.BRAUN"SEQUENT PTCA CATHETER 適可穩經皮穿刺汽球擴張導管 8340 CBP0150281BB COROFLEX CORONARY STENT SYSTEM(W/DELIVERY SYSTEM)* 19940 CBP0150282BB COROFLEX CORONARY STENT SYSTEM(W/DELIVERY SYSTEM)* 19940 CBP01563XNCD NINJA PTCA DILATATION CATHETER 1.5:4.0MM 10:40MM( 自 92.7.1 改按條支付 ) 8340 CBP0174935SB EXPRESS MONORAIL CORONARY STENT DELIVERY SYSTEM * 19940 CBP0182926AB ABBOTT FLEXMASTER F1 CORONARY STENT WITH DELIVERY SYSTEM 19940 CBP01ARAR2AS MASLA JUST RAPID EXCHANGE PTCA DILATATION CATHETER 8340 CBP01BL729RB "ORBUSNEICH"BLAZER CORONARY STENT DELIVERY SYSTEM 布雷冠狀動脈血管支架輸送系統 * 19940 112

CBP01CSUNATM TSUNAMI CORONARY STENT SYSTEM(WITH BALLOON)* 19940 CBP01DRVNXM4 DRIVER RAPID EXCHANGE CORONARY STENT SYSTEM* 19940 CBP01FF22BF2 "INVATEC"FALCON FORTE PTCA BALLOON CATHETER 冠狀動脈氣球導管直徑 2.00MM:4.00MM, 4.50MM,5.00MM, 長度 145CM 8340 CBP01FLC10F2 "INVATEC"FALCON CTO PTCA BALLOON CATHETER 冠狀動脈氣球導管 8340 CBP01FLCBVF2 CBP01GAZ22BS "INVATEC"FALCON BRAVO PTCA BALLOON CATHETER 獵鷹柏拉弗冠狀動脈氣球導管直徑 2.0:4.0MM BALLOON LENGTH 10,14,20,30,40MM CATHETER LENGTH 145CM "BIOSENSORS"GAZELLE RAPID EXCHANGE CORONARY STENT SYSTEM 格希爾快速抽換冠狀動脈支架系統 * 8340 19940 CBP01GENXXBU GENIC EASYWAY CORONARY STENT AND DELIVERY SYSTEM* 19940 CBP01MLVSTAB "ABBOTT"MULTI-LINK VISION RX CORONARY STENT SYSTEM 冠狀動脈支架系統 * 19940 CBP01PN341BK "BIOTRONIK"PLEON PTCA CATHETER 8340 CBP01PR008CD BX SONIC BALLOON EXPANDABLE STENT SYSTEM 19940 CBP01PR023CD BX SONIC BALLOON EXPANDABLE STENT SYSTEM 19940 CBP01PWR25BS "BIOSENSORS"POWERLINE PTCA CATHETER 動源線冠狀動脈氣球擴張導管 8340 CBP01R2252RB R-STENT EVOLUTION 2 CORONARY DELIVERY SYSTEM* 19940 CBP01S103NAC MULTI-LINK CORONARY STENT WITH STEP BALLOON DELIVERY SYSTEM * 19940 CBP01S108NAC MULTI-LINK DUET CORONARY STENT W/RX ROCKET BALLOON DELIVERY SYSTEM 19940 CBP01S115NAC MULTI-LINK CORONARY STENT WITH RX DELIVERY SYSTEM 3.0:4.0MMX15:35MM 19940 CBP01S563NAB "ABBOTT"VASCULAR MULTI-LINK PIXEL CORONARY STENT SYSTEM 披索冠狀動脈擴張支架系統 * 19940 CBP01S600NAC MULTI-LINK STENT&BALLOON DELIVERY SYSTEM 3.0:3.75MM 19940 CBP01S6275VE S-SERIES CORONARY STENT DELIVERY SYSTEM * 19940 CBP01S660DVE S-SERIES CORONARY STENT W/DELIVERY SYSTEM 19940 CBP01S670DVE S-SERIES CORONARY STENT DELIVERY SYSTEM 19940 CBP01S7353VE S-SERIES CORONARY STENT W/DELIVERY SYSTEM 19940 CBP01S915NAC MULTI-LINK HP CORONARY STENT/W HIGH PRESSURE BALL.DELI.SYS.3:4MMX15MM 19940 CBP01S983NAB "ABBOTT"MULTI-LINK CORONARY STENT SYSTEM 冠狀動脈擴張支架系統 * 19940 CBP01STSRXBS S-STENT DELIVERY SYSTEM* 19940 CBP01TSUNATM TSUNAMI CORONARY STENT SYSTEM(WITH BALLOON)* 19940 113

特材代碼中英文品名支付點數 CBP01V1G0RW4 VIGOR PTCA BALLOON CATHETER 8340 CBP01V1S1NAB "ABBOTT"MULTI-LINK VISION RX CORONARY STENT SYSTEM2.75MM:4MM 8MM:28MM 適見冠狀動脈支架系統 * 19940 CBP01V2G0RW4 VIGOR 2 PTCA BALLOON CATHETER 8340 CBP01V7844AB "ABBOTT"MULTI-LINK VISION RX CORONARY STENT SYSTEM 2.75:4.00MM 8:28MM 冠狀動脈支架系統 * 19940 CBP01VFP01CK CORONARY STENT W/BALLOON DELIVERY SYSTEM 19940 CBP01VYGNCAB "ABBOTT"VOYAGER NC CORONARY DILATATION CATHETER 航行家恩希冠狀動脈擴張導管 2.00MM:5.00MM 6MM:25MM 8340 CBP01ZETANAB "ABBOTT"MULTI-LINK RX ZETA CORONARY STENT SYSTEM 智達冠狀動脈支架系統 * 19940 CBP02NCSPRM4 "MEDTRONIC"NC SPRINTER RAPID EXCHANGE BALLOON DILATATION CATHETER" 美敦力 " 史賓特高壓快速交換氣球擴張導管 8340 CBP02R5825KE "KANEKA"FORTIS PTCA CATHETER 2.50MM:4.50MM 8MM:18MM 8340 CBP02R5A85KE FORTIS II PTCA CATHETER 2.50MM:4.50MM 佛緹斯冠狀動脈成型術導管 8340 CBP02SPR32M4 CBP02SPRLGM4 MEDTRONIC SPRINTER OVER-THE-WIRE BALLOON DILATATION CATHETER 1.5MM:4.0MM 6MM:30MM "MEDTRONIC"SPRINTER LEGEND RAPID EXCHANGE BALLOON DILATATION CATHETER (D:1.25MM:4MM,L:6MM:30MM) 8340 8340 CBP02SPRNTM4 SPRINTER RAPID EXCHANGE BALLOON DILATION CATHETER 8340 CBP02X2LNNVE EXTENSOR RAPID EXCHANGE BALLOON DILATATION CATHETER* 自 92.7.1 改按條支付 8340 CBP02XW151BU BLUE MEDICAL XTRM-WAY PTCA DILATATION CATHETER 8340 CBP031016TTM "TERUMO"RYUJIN PLUS PTCA DILATATION CATHETER 琉均柏柆思冠狀動脈氣球擴張導管 8340 CBP031215NTM RYUJIN PTCA DILATATION CATHETER RX-1 8340 CBP0314038TM TERUMO RYUJIN PLUS PTCA DILATATION CATHETER 8340 CBP0314039TM TERUMO RYUJIN PLUS PTCA DILATATION CATHETER 8340 CBP0318634TM RYUJIN PLUS OTW PTCA DILATATION CATHETER 冠狀動脈氣球擴張導管 8340 CBP032015NTM RYUJIN PTCA DILATATION CATHETER RX-1 8340 CBP0338080SB QUANTUM MAVERICK MONORAIL DILATION CATHETER(PTCA BALLOON CATHETER) 8340 CBP0338928SB MAVERICK 2 MONORAIL BALLOON CATHETER * 自 92.7.1 改按條支付 8340 CBP03389XXSB "BOSTON SCIENTIFIC"APEX MONORAIL PTCA DILATATION CATHETER D 1.50MM:5.0MM L8MM:40MM 艾佩斯單軌氣球擴張導管 8340 CBP035265NAB "ABBOTT"CROSSSAIL CORONARY DILATATION CATHETER 可思爾冠狀動脈擴張導管 8340 CBP0356F1XCD NINJA PTCA DILATATION CATHETER 10MM( 衛署字號 9349) 自 92.7.1 改按條支付 8340 114

CBP0356F2XCD NINJA PTCA DILATATION CATHETER 15MM( 衛署字號 9349) 自 92.7.1 改按條支付 8340 CBP0356F3XCD NINJA PTCA DILATATION CATHETER 18MM( 衛署字號 9349) 自 92.7.1 改按條支付 8340 CBP0356F5XCD NINJA PTCA DILATATION CATHETER 20MM( 衛署字號 9349) 自 92.7.1 改按條支付 8340 CBP0356F6XCD NINJA PTCA DILATATION CATHETER 25MM( 衛署字號 9349) 自 92.7.1 改按條支付 8340 CBP0356F7XCD NINJA PTCA DILATATION CATHETER 30MM( 衛署字號 9349) 自 92.7.1 改按條支付 8340 CBP035718NAB "ABBOTT"CORONARY DILATATION CATHETER 冠狀動脈擴張術氣球導管 8340 CBP03701XNCD "CORDIS"DURA STAR RX PTCA DILATATION CATHETER 杜芮星冠狀動脈擴張導管 8340 CBP03801XNCD "CORDIS"FIRE STAR RX PTCA DILATATION CATHETER 法爾星冠狀動脈擴張導管 8340 CBP0382123AB NC MERCURY PTCA CATHETER 8146 CBP03A1540EQ EUROCOR AMADEUS SUPERCROSS RX-CORONARY BALLOON DILATATION CATHETER 1.5MM:4.0MM 10MM:40MM 8340 CBP03DCPANTM GALE PTCA DILATION CATHETER 1.5:4.0MM *20MM 自 92.7.1 改按條支付 ( 衛署字號 9430) 8340 CBP03H1RU1TM "TERUMO"HIRYU PTCA DILATATION CATHETER 2.25:5.0MM 6:20MM 冠狀動脈氣球擴張導管 8340 CBP03M1115JD PTCA BALLOON CATHETER 自 92.7.1 改按條支付 8340 CBP03M2950AB JOCATH MAESTRO PTCA CATHETER( 原核文號 0940006268) 8340 CBP03M3115AB JOCATH MERCURY PTCA CATHETER 8340 CBP03NCMERAB "ABBOTT"NC MERCURY PTCA CATHETER 馬克林冠狀動脈擴張導管 8340 CBP03R2A15KE KANEKA RX CATHETER AEROCROSS FIGHTER 1.5MM:4.0MM 15MM:20MM 8340 CBP03R4K15KE KANEKA RX CATHETER OTTIMO 1.5MM:4.0MM 10MM:20MM 8340 CBP03RAF25HC "HEXACATH"RAFALE PTCA DILATATION CATHETER 旋風冠狀動脈氣球擴張導管 8340 CBP03V0TWNAB "ABBOTT"VOYAGER OTW CORONARY DILATATION CATHETER 莫雅佳甌第冠狀動脈擴張導管 8340 CBP03V391NAB "ABBOTT"VOYAGER RX CORONARY DILATATION CATHETER 莫雅佳冠狀動脈擴張導管 8340 CBP03V400NAB "ABBOTT"VOYAGER RX CORONARY DILATATION CATHETER 茉亞嘉冠狀動脈擴張導管 8340 CBP05210CGAB "ABBOTT"JOSTENT GRAFTMASTER CORONARY STENT GRAFT(WITH DELIVERY SYSTEM)*. 49500 CBP05JCSG1JD CORONARY STENT GRAFT WITH DELIVERY SYSTEM * 49500 CBP06ELUT1AB CBP06ELUT1BB "ABBOTT"XIENCE V EVEROLIMUS ELUTING CORONARY STENT SYSTEM 艾諾莉茉斯冠狀動脈塗藥支架, 部分給付品項, 適應症見備註欄, 並註明其禁忌症勿使用 COROFLEX PLEASE PACLITAXEL-ELUTING CORONARY STENT SYSTEM 部分給付品項紫杉醇釋放型冠狀動脈血管支架 * 適應症見備註, 並註明其禁忌症勿使用 19940 19940 115

CBP06ELUT1M4 MEDTRONIC ENDEAVOR ELUTING CORONARY STENT SYSTEM 2.25MM:4.0MM 8MM:30MM 部分給付 19940 品項 *. 並註明其禁忌症不可使用. CBP06ELUT1RB CBP06ELUT1SB CBP06ELUT2AB CBP06ELUT2CD CBP06ELUT2M4 CBP06ELUT2SB CBP06ELUT3M4 "ORBUS"GENOUS R STENT 傑納斯冠狀動脈血管支架輸送系統 2.5MM:4.0MM 9MM:33MM 部分給付品項.. 並註明其禁忌症不可使用. TAXUS EXPRESS PACLITAXEL-ELUTING CORONARY STENT SYSTEM 2.25:5.00MM 8:32MM. 部分給付品項 *. 並註明其禁忌症不可使用 "ABBOTT"PROMUS EVEROLIMUS ELUTING CORONARY STENT SYSTEM 冠狀動脈塗藥支架系統, 部分給付品項,, 並註明其禁忌症不可使用 "CORDIS"CYPHER SELECT+SIROLIMUS-ELUTING CORONARY STENT 2.25:3.50MM 8:33MM 部分給付品項 *. 並註明其禁忌症不可使用. "MEDTRONIC"ENDEAVOR SPRINT ZOTAROLIMUS ELUTING CORONARY STENT SYSTEM 釋放型冠狀動脈支架, 部分給付品項 * 適應症見備註, 並註明其禁忌症不可使用 TAXUS LIBERTE MONORAIL PACLITAXEL-ELUTING CORONARY STENT SYSTEM 2.25:3.5MM 8:32MM. 部分給付品項.. 並註明其禁忌症不可使用 ENDEAVOR RESOLUTE ZOTAROLIMUS-ELUTING CORONARY STENT SYSTEM 釋放型冠狀動脈支架系統, 部分給付品項, 適應症見備註, 並註明其禁忌症不可用 19940 19940 19940 19940 19940 19940 19940 CBS01SPTXXN5 "NUMED"Z-5 ATRIOSEPTOSTOMY CATHETER 9000 CBS029ASDAG6 AMPLATZER SEPTAL OCCLUDER 4:20MM,22MM:38MM 138000 CBS029DEL5G6 "AGA"AMPLATZER DELIVERY SYSTEM 5-9FR*( 自 981001 起適應症代碼由 A213-4 更改為 A213-5) 12000 CBS029DEL9G6 AMPLATZER DELIVERY SYSTEM 9FR,10FR,12FR* 12000 CBS029DELNG6 AMPLATZER DELIVERY SYSTEM 6:8FR* 12000 CBS044A72FST BRK TRANSSEPTAL NEEDLE/STYLET 房中膈穿刺針 7230 CBT020712NAR ARROW BALLOON WEDGE-PRESSURE CATHETERS 4:8FR 60:110CM " 亞諾 " 肺動脈楔壓導管 ( 順流導管雙腔 ) 1750 CBT022014LPU PULSIOCATH CONTINUOUS CARDIAC OUTPUT THERMODILUTION CATHETER 5775 CBT022015LPU "PULSION"PULSIOCATH THERMODILUTION CATHETER 5775 CBT0613975ED CONTINUOUS CARDIAC OUTPUT THERMODILUTION CATHETER 6 LUMEN 7.5FR 6200 CBT0617775ED SWAN GANZ CONTINUOUS CARDIAC /END DIASTOLIC VOLUME THERMODILUTION CATHETER CCO/cEDV* 6200 CBV020MS2NTR PTMC BALLOON CATHETER 33700 CCC0300AT1VB AUTOTRANSFUSION SET 3160 CCC030980EHA THERAPEUTIC AND AUTOLOGOUS ERYTHROPHERESIS SET 3160 CCC030981EHA THERAPEUTIC AND AUTOLOGOUS ERYTHROPHERESIS SET 3160 CCC1300200HA CELL SAVER COLLECTION RESERVOIR 3900 CCC1300ATRVB AUTOTRANSFUSION RESERVOIR* 3900 CCC1301005M4 AUTOLOG RESERVOIR HOLDING BAG* 3900 116

CCC140156NHA CELL SAVER SET ( 術後自體血液回收單管回流式 ) 4000 CDCA105060NZ SUNDT INTERNAL W/NON-REINFORCED SEGMENT 3375 CDCA105065NZ CAROTID ENDARTERECTOMY SHUNT,SUNDT INTERNAL 3375 CDCA105070NZ CAROTID ENDARTERECTOMY SHUNT,SUNDT EXTERNAL 3375 CDCA105076NZ SUNDT EXTERNAL W/NON-REINFORCED SEGMENT 3375 CDCA171014NZ CAROTID ENDARTERECTOMY SHUNTS 3375 CDCS126101CM ACCU-FLO CSF RESERVOIR( 含 CONNECTOR,CATHETER) 3500 CDD010212NFM SILICONE T DRAINAGE TUBE W/EYES 12:24FR 205 CDD0104103CL RC-T TUBE 3FR:10FR 468 CDD010810NFM SILICONE T-DRAINGE TUBE 8#:24# 205 CDD0108510P2 SILICON T DRAINGE TUBE 10FR:24FR 3MM:8MM 205 CDD012014NFM SILICONE Y DRAINAGE TUBE 14:24FR 205 CDD0133008KK SILICON T-TUBE 5M/M:13M/M (TRACHEAL) 2825 CDD0162110CL SILICON T-DRAIN TUBE 9FR:24FR 205 CDD0200114FM SILICONE ABDOMINAL SUMP DRAIN 14" 7MMX13MM 390 CDD0200120FM SILICONE ABDOMINAL SUMP DRAIN 20" 7MMX13MM 390 CDD0208040DV SILICON TRIPLE LUMEN SUMP DRAIN 1.5CMx38CM 1222 CDD0208042DV SILICON TRIPLE LUMEN SUMP DRAIN 1.0CMx38CM 1222 CDD0208045DV SILICON TRIPLE LUMEN SUMP DRAIN 1.7CMx38CM 1222 CDD0401201ED PERICARDIAL SUMP(1/4") 431 CDD0401348C8 JACKSON-PRATT SILICONE BULB RESERVOIR WITH TUBE KITS 100CC,400CC, 7MM/10MM/10FR/15FR/19FR 矽質真空傷口引流套 ( 儲液器 + 引流管 ) 670 CDD0403300ED SUCTION WAND(9F-22F) 431 CDD0404300SA RIGID I-C SUCKER 431 CDD0404360BA 400CC THREE-SPRING EVACUATOR KIT W/PVC ROUND DRAIN 500 CDD0404366BA 400CC THREE-SPRING EVACUATOR KIT W/SILICONE ROUND DRAIN 670 CDD0406648PC TLS BULB DRAINAGE SYSTEM 100CC 10.5FR( 球 + 管 ) 670 117

特材代碼中英文品名支付點數 CDD0408705P2 PVC VAC ( 球 + 管 ) 450CC 1/8",3/16",1/4" 500 CDD0408770P2 SILICON VAC ( 球 + 管 ) 100CC,200CC 1/8",3/16",1/4" 670 CDD0408902P2 MINIVAC WOUND DRAINAGE SYSTEM(PVC DRAIN 6FR WITH PVC RESERVOIR 50ML) 270 CDD0408903P2 MINIVAC WOUND DRAINAGE SYSTEM(PVC DRAIN 6FR WITH PVC RESERVOIR 20ML) 220 CDD0420131FM ALL SILICONE C.W.V SET(RESERVOIR 100CC+DRAIN 7MM,10MM) 670 CDD0420132FM ALL SILICONE C.W.V SET(RESERVOIR 100CC+DRAIN 13MM) 670 CDD0420133FM ALL SILICONE C.W.V SET(RESERVOIR 150CC+DRAIN 7MM,10MM) 670 CDD0420134FM ALL SILICONE C.W.V SET(RESERVOIR 150CC+DRAIN 13MM) 670 CDD0420135FM ALL SILICONE C.W.V SET(RESERVOIR 400CC+DRAIN 7MM,10MM) 670 CDD0420136FM ALL SILICONE C.W.V SET(RESERVOIR 400CC+DRAIN 13MM) 670 CDD0425001Z1 HEMOVAC 500 CDD042535NZ1 MINI SNYDER HEMOVAC SILICONE DRAIN 3/32 1/8",3/16",1/4" SILICONE EVACUATOR 100ML( 球 + 管 + 針 ) 670 CDD042541NZ1 400ML HEMOVAC COMPACT EVACUATOR KIT SILICONE DRAIN 1/8",3/16",1/4( 球 + 管 ) 620 CDD042560NZ1 MINI SNYDER HEMOVAC SILICONE DRAIN 7MM,10MM SILICONE EVACUATOR 100ML( 球 + 管 + 針 ) 670 CDD042564NZ1 EVAC KITS 100ML FLAT DRAIN W/O TROCAR 7MM,10MM( 球 + 管 ) 670 CDD0425904Z1 HEMOVAC 500 CDD0425951Z1 PVC HEMOVAC COMPACT EVACUATOR KIT 3/32",3/16" 7,15FR 500 CDD0430101P2 WOUND DRAINAGE SYSTEM (PAHSCO-VAC)450ML(BAG+TUBE+TROCAR) 500 CDD0430104P2 WOUND DRAINAGE SYSTEM (PRE-EVACUATOR)600ML,450ML(BAG+TUBE+TROCAR) 500 CDD0433223DV CWS 400CC ( 球 + 管 ) 500 CDD0441000TZ VACUUM WOUND DRAINAGE SYSTEM(PVC 引流管 + 吸引球 ) 500 CDD0441001S4 MINI-RADOVAC 20CC 222 CDD0445003S4 MINI-RADOVAC 50CC 290 CDD0450101P2 CLOSED WOUND DRAINAGE SYSTEM 125 200ML 球 PVC 管 SILICONE ( 球 + 管 + 針 ) 620 CDD0450201P2 CLOSED WOUND DRAINAGE SYSTEM 100 125 200ML 球 + 管 SILICONE ( 球 + 管 + 針 ) 670 CDD0450510P2 CLOSED WOUND DRAINAGE SYSTEM 400ML 球 PVC 管 SILICONE ( 球 + 管 + 針 ) 620 118

CDD0453101P2 CLOSED WOUND DRAINAGE SYSTEM 450MLPVC ( 球 + 管 + 針 ) 500 CDD0453144P2 CLOSED WOUND DRAINAGE SYSTEM 250ML PVC ( 球 + 管 + 針 ) 500 CDD045330NP2 CLOSED WOUND DRAINAGE SYSTEM 400ML PVC ( 球 + 管 + 針 ) 500 CDD0454101P2 CLOSED WOUND DRAINAGE SYSTEMPVC WOUND DRAINAGE SYSTEM 20ML (BAG+TUBE+TROCAR) 220 CDD0454201P2 PVC WOUND DRAINAGE SYSTEM 30ML(BAG+TUBE+NEEDLE) 220 CDD0454302P2 CLOSED WOUND DRAINAGE SYSTEMPVC WOUND DRAINAGE SYSTEM 50ML (BAG+TUBE+TROCAR) 220 CDD0455101P2 PVC WOUND DRAINAGES SYSTEM 600CC(BAG+CATH+TROCAR) 真空傷口引俵套 500 CDD0455606P2 PVC WOUND DRAINAGES SYSTEM 450CC(BAG+CATH+TROCAR) 真空傷口引俵套 500 CDD0455730P2 CLOSED WOUND DRAINAGE SYSTEM 200ML ( 罐 + 管 + 針 ) 500 CDD0456001P2 CLOSED SYSTEM SUCTION DRAINAGE SET 800ML 1/4,1/8,3/16 ( 球 100CC+ 管 + 針 ) 500 CDD0456025P2 CLOSED WOUND DRAINAGE SYSTEM 400CCPVC ( 球 + 管 + 針 ) 500 CDD0456051P2 CLOSED SYSTEM SUCTION DRAINAGE SET ( 球 100CC+ 管 + 針 ) 500 CDD0457001P2 CLOSED WOUND DRAINAGE SYSTEM 150MLPVC (BAG+ 管 + 針 ) 500 CDD0457004P2 CLOSED WOUND DRAINAGE SYSTEM 150MLBAG PVC 管 SILICONE (BAG+ 管 + 針 ) 620 CDD0457050P2 CLOSED WOUND DRAINAGE SYSTEM 300MLPVC (BAG+ 管 + 針 ) 500 CDD0457053P2 CLOSED WOUND DRAINAGE SYSTEM 300MLBAG PVC 管 SILICONE (BAG+ 管 + 針 ) 620 CDD0457100P2 CLOSED WOUND DRAINAGE SYSTEM 450MLPVC (BAG+ 管 + 針 ) 500 CDD0457103P2 CLOSED WOUND DRAINAGE SYSTEM 450MLBAG PVC 管 SILICONE (BAG+ 管 + 針 ) 620 CDD048410NM5 WOUND-EVC ET(EASY TOUCH)(PVC RESERVOIR 400ML,SILICONE TUBING 1/8",3/16",1/4") 620 CDD04CWCV1EF SILICONE C.W.V SET(100CC,150CC,400CC+7MM,10MM,13MM) 矽質真空傷口引流球 + 引流管 670 CDD04MB125SG SILICON MINI VACCUM BLUB 125CC(MB125)+FLAT TUBE OR ROUND TUBE MD-118 7:9MM(HF107:9) 670 CDD04PP400WN BAROVAC CLOSED WOUND DRAINAGE SYSTEMS (PVC DRAIN 3/32",1/8",3/16",1/4"WITH PVC RESERVOIR 400ML) 500 CDD04PT503TM PORTABLE WOUND SUCTION UNIT( 球 + 管 ) 500 CDD04SS100WN ALL SILICONE CLOSED WOUND DRAINAGE SYSTEMS(SILICONE DRAIN WITH RESERVOIR 100ML) 670 CDD04SS200WN ALL SILICONE CLOSED WOUND DRAINAGE SYSTEMS 200ML(SILICONE DRAIN WITH RESERVOIR 200ML) 670 CDD04SU130C8 JACKSON PRATT WOUND DRAINAGE SYSTEM PVC 引流管 + 穿刺針 +PVC 吸引球 500 119

CDD0500070L6 JACKSON-PRATT HEMADUCT SILICONE FLAT DRAINS W/O TROCAR 370 CDD0500071L6 JACKSON-PRATT HEMADUCT SILICONE FLAT DRAINS W/TROCAR 370 CDD05000SMWN ALL SILICONE WOUND TUBINGW/TROCAR NEEDLE 3.2MM,4.8MM( 圓型 ) 370 CDD0500100L6 JACKSON-PRATT HEMADUCT SILICONE ROUND DRAINS W/O TROCAR 370 CDD0500101L6 JACKSON-PRATT HEMADUCT SILICONE ROUND DRAINS W/TROCAR 370 CDD0500SJPWN ALL SILICONE WOUND TUBINGW/TROCAR NEEDLE 4.8MM( 扁型 ) 370 CDD0501002SM EXTRA STRENGTH ROUND SUCTION DRAIN WITH TROCAR 10FR 370 CDD0501012SM EXTRA STRENGTH ROUND SUCTION DRAIN 10FR 370 CDD0501310C8 JACKSON-PRATT SILICONE DRAINS 7MM, 10MMJACKSON-PRATT 矽質傷口引流管 340 CDD0501310L6 JACKSON-PRATT HUBLESS FLAT SILICONE DRAINS W/O TROCAR 370 CDD0501316L6 JACKSON-PRATT GOLD FLAT SILICONE DRAINS W/O TROCAR 370 CDD050132NL6 JACKSON-PRATT SILICONE ROUND DRAINS W/O TROCAR 370 CDD0501330L6 JACKSON-PRATT GOLD SILICONE ROUND DRAINS W/O TROCAR 370 CDD0501416L6 JACKSON-PRATT GOLD FLAT SILICONE DRAINS W/TROCAR 370 CDD0502007H0 SURGICAL CWV DRAIN 7MM 370 CDD0502010H0 SURGICAL CWV DRAIN 10MM 370 CDD0502013H0 SURGICAL CWV DRAIN 13MM 370 CDD050208NFM SILICONE ROUND DRAIN END PERFORATED 8,10,16,20FR 900MM 370 CDD0502185ET CDD0502187ET "ETHICON"J-VAC CLOSED WOUND DRAINAGE SYSTEM BLAKE SILICON DRAINS WITH TROCAR 捷凡克封閉式引流系統 "ETHICON"J-VAC CLOSED WOUND DRAINAGE SYSTEM BLAKE SILICON DRAINS WITH TROCAR 捷凡克封閉式引流系統 370 425 CDD050308NFM SILICONE ROUND DRAIN MIDDLE PERFORATED 8,10,16,20FR 1100MM 370 CDD0503203SM EXTRA STRENGTH FLAT SUCTION DRAIN 7MM 370 CDD0503204SM EXTRA STRENGTH FLAT SUCTION DRAIN 10MM 370 CDD0508711P2 SILICON VAC DRAINAGE & TROCAR 370 CDD0510101P2 CLOSED WOUND DRAINAGE SYSTEMPVC VAC DRAINAGE 250 CDD0513101P2 CLOSED WOUND DRAINAGE SYSTEMSILICONE VAC DRAINAGE 340 120

CDD052540NZ1 MINI-SNYDER HEMOVAC SILICONE DRAIN 3/32",1/8",3/16",1/4" 7MM,10MM W/TROCAR 370 CDD052542NZ1 DRAIN ROUND W/O TROCAR 3/32",1/8",3/16",1/4 SILICONE( 管 ) 370 CDD052569NZ1 DRAIN FLAT W/O TROCAR 7MM,10MM SILICONE 370 CDD0530101P2 CLOSED WOUND DRAINAGE SYSTEMPVC VAC DRAINAGE &TROCAR 250 CDD0530502P2 CLOSED WOUND DRAINAGE SYSTEMSILICONE VAC DRAINAGE &TROCAR 340 CDD0566481B0 SILICONE BULB DRAINAGE CATHETER 7MM 真空傷口引俵管 340 CDD0566482B0 SILICONE BULB DRAINAGE CATHETER 真空傷口引俵管 340 CDD0566483B0 SILICONE BULB RESERVOIR 100CC 真空傷口引俵球 300 CDD0566484B0 SILICONE BULB DRAINAGE CATHETER 10MM 真空傷口引俵管 340 CDD0566485B0 SILICONE BULB DRAINAGE CATHETER W/TROCAR 340 CDD0566486B0 SILICONE BULB DRAINAGE CATHETER W/TROCAR (ROUND) 340 CDD0566487B0 SILICONE BULBRESERVOIR 100CC W/CLIPS 300 CDD0566488B0 SILICONE BULB DRAINAGE CATHETER W/TROCAR (FLAT) 340 CDD05CV007FM SILICON CWV DRAINS TUBE 7MM 370 CDD05CV010FM SILICON CWV DRAINS TUBE 10MM 370 CDD05CV013FM SILICON CWV DRAINS TUBE 13MM 370 CDD05CV110EF SILICONE C.W.V DRAIN 340 CDD05HRU86C8 JACKSON-PRATT HEMADUCT & HEMADUCT GOLD WOUND DRAINS 10FR,15FR,19FRHEMADUCT 矽質傷口引流管 340 CDD05MF104SG SILICONE SUCTION DRAINAGE TUBE(FLAT) 4,7,10MM 370 CDD0600640FM SILICONE CLOSED WOUND VACUUM RESERVOIR 400CC 300 CDD0601305C8 JACKSON-PRATT SILICONE BULB RESERVOIR 100CC & 400CC 矽質真空傷口引流儲液器 300 CDD0602150H0 SURGICAL CWV RESERVOIR 150CC 345 CDD0602160JJ J-VAC RESERVOIR SILICON 100CC 300 CDD0602161JJ J-VAC RESERVOIR 150CC,450CC(PVC 球 ) 250 CDD0603101SM SUCTION RESERVOIR 345 CDD0608709P2 SILICON VAC RESERVOIR 100CC,200CC 300 121

CDD060S100WN ALL SILICONE BAROVAC RESERVOIR 100ML 300 CDD060S200WN ALL SILICONE BAROVAC RESERVOIR 200ML 300 CDD0620201P2 CLOSED WOUND DRAINAGE SYSTEMSILICONE VAC RESERVOIR125ML 200ML 300 CDD0623009P2 CLOSED WOUND DRAINAGE SYSTEMPVC VAC RESERVOIR 150ML 250ML 300ML 450ML 250 CDD0625681Z1 SIKICONE MINI SNYDER HEMOVAC 100ML 300 CDD06CV150FM SILICONE CWV RESERVOIR 100CC,150CC 球 300 CDD06CW1S1EF SILICONE C.W.V RESERVOIR 100CC,150CC,400CC 300 CDD06MB125SG MINI BULB 125CC 真空吸引球 300 CDD1012001P2 DIAMOND TIP THROACIC CANNULA 8:16FR 259 CDD1012007P2 DIAMOND TIP THROACIC CANNULA 20:32FR 259 CDD1021110MA TROCAR CATHETER 10FR,12FR,16FR 259 CDD1021120MA TROCAR CATHETER 20FR,24FR,28FR,30FR,32FR 型號 211-30 自 93.1.1 刪除 259 CDD1056080AY TROCAR CATHETER WITH NEEDLE 259 CDD1056101AY TROCAR CATHETER WITH NEEDLE 259 CDD1056701AY INGRAM TROCAR CATHETER 12FR,16FR 465 CDD1056702AY INGRAM TROCAR CATHETER 12FR,16FR 膀胱穿刺針組 465 CDD10TDC10EE THORACIC DRAINAGE CATHETER W/TROCAR 259 CDD1100001ET CDD1100001PA TROCAR KIT 穿刺套管 2-12MM( 穿剌針 1+ 外管 1+ 內建可變式轉接頭 1)(511;512HA;NA;DA;355NA;DA;35LNA;LDA;FPK02 自 980701 刪除 ) 安培安全穿刺套管系統 APPLIED TROCAR SYSTEM KIT 5-12MM( 穿剌針 1+ 外管 1+ 內建可變式轉接頭 1) 1595 1595 CDD1100001U7 SURGICAL TROCAR SYSTEM 5-12MM ( 穿剌針 1+ 外管 1+ 內建可變式轉接頭 1) 1595 CDD1100001ZH TROCAR KIT (5-12MM 穿刺針 X1+ 外管 X1+ 固定轉接頭 X1) 1329 CDD1100002PA 安培安全穿刺套管系統 APPLIED TROCAR SYSTEM(5-12MM 多孔道平滑拋棄剝離式套管 )( 穿剌針 1+ 外管 1+ 內建可變式轉接頭 1) 1595 CDD1100002U7 SURGICAL TROCAR SYSTEM 5-12MM ( 穿剌針 1+ 外管 2+ 內建可變式轉接頭 2) 2658 CDD1100002ZH DETACHAPORT OBTURATOR AND SEAL SET:TROCAR SLEEVE(1 支外管 +1 支固定轉接頭 ) 955 CDD1100003PA TROCAR SYSTEM:SEPARATOR ACCESS SYSTEM11X100MM 12X100MM( 穿剌針 1+ 外管 1+ 內建可變式轉接頭 1) 1595 CDD1100003ZH DETACHAPORT OBTURATOR AND SEAL SET:TROCAR KIT(1 支穿刺針 +2 支外管 +2 支固定轉接頭 ) 1963 122

CDD1100004PA SEPARATOR OBTURATOR 內視鏡手術剝離式穿刺針 638 CDD1100005PA CANNULAS WITH DISPOSABLE SEAL 內視鏡手術拋棄式套筒組 ( 穿刺外管 + 可變式轉接頭 ) 955 CDD1100006PA CDD1100007PA DISPOSABLE TROCAR W/SHIELDED FLAT BLADE OBTURATOR 穿刺套管組 ( 穿剌針 1+ 外管 1+ 可變式轉接頭 1) PREMIUM DISPOSABLE TROCAR SYSTEM W/UNIVERSAL SEAL 通用孔道拋棄式穿刺系統 ( 穿剌針 1+ 外管 1+ 內建可變式轉接頭 1) 1595 1595 CDD1100008PA CANNULAS WITH DISPOSABLE SEAL 內視鏡手術拋棄式套筒組 ( 穿剌針 ) 638 CDD1100012ET TROCAR KIT 穿刺套管雙支包裝 ( 穿刺針 1+ 外管 2+ 內建可變式轉接頭 2) 2658 CDD110005NPA CANNULAS WITH DISPOSABLE SEAL 內視鏡手術拋棄式套筒組 ( 穿刺外管 + 可變轉接頭 ) 955 CDD110007NPA CANNULAS WITH DISPOSABLE SEAL 內視鏡手術拋棄式套筒組 ( 穿剌針 + 穿刺外管 + 可變轉接頭 ) 1595 CDD1100K1TPA TROCAR KIT( 穿刺針 X1+ 外管 X2+ 可變轉接頭 X2) 2658 CDD1105121L7 CDD1105122L7 CDD1105123L7 CDD1105124L7 CDD1105125L7 TROCAR KIT 10-12MM TROCAR AND CANULA 穿刺套管組 ( 防滑套管 1 支, 穿刺針 1 支, 多功能轉換器 1 組 ) TROCAR KIT 5-12MM TROCAR AND CANULA 穿刺套管組 ( 防滑套管 1 支, 穿刺針 1 支, 多功能轉換器 1 組 ) TROCAR KIT 5-12MM TROCAR AND CANULA 穿刺套管組 ( 防滑套管 2 支, 穿刺針 1 支, 多功能轉換器 2 組 ) TROCAR KIT 5-12MM TROCAR AND CANULA 穿刺套管組 ( 防滑套管 1 支, 穿刺針 1 支, 多功能轉換器 1 組 ) TROCAR KIT 5-12MM TROCAR AND CANULA 穿刺套管組 ( 防滑套管 2 支, 穿刺針 1 支, 多功能轉換器 2 組 ) 1595 1595 2658 1595 2658 CDD110612AL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管 5-6MM( 穿刺套管 1 支 + 穿刺針 1 支 + 固定式轉接頭 1 支 ) 1329 CDD110612BL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管 5-12MM( 穿刺套管 1 支 + 穿刺針 1 支 + 可變式轉接頭 1 支 ) 1595 CDD110612CL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管 5-12MM( 穿刺套管 2 支 + 穿刺針 1 支 + 固定式轉接頭 2 支 ) 1963 CDD110612DL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管 5-6MM( 穿刺套管 1 支 + 穿刺針 1 支 + 固定式轉接頭 1 支 ) 1329 CDD110612EL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管 5-6MM( 穿刺套管 2 支 + 穿刺針 1 支 + 固定式轉接頭 2 支 ) 1963 CDD110612FL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管 5-6MM( 穿刺套管 1 支 + 固定式轉接頭 1 支 ) 955 CDD110612GL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管 5-12MM( 穿刺套管 2 支 + 穿刺針 1 支 + 可變式轉接頭 2 支 ) 2658 CDD110612HL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管 5-12MM( 穿刺套管 1 支 + 穿刺針 1 支 + 可變式轉接頭 1 支 ) 1595 CDD110612JL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管 5-12MM( 穿刺套管 1 支 + 可變式轉接頭 1 支 ) 955 CDD110612KL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管 5-6MM( 穿刺套管 3 支 + 穿刺針 1 支 + 固定式轉接頭 3 支 ) 2918 CDD110612LL7 LAGIS TROCAR KIT 內視鏡安全穿刺套管 5-12MM( 穿刺套管 2 支 + 穿刺針 1 支 + 可變式轉接頭 2 支 ) 2658 CDD11090PFUS AUTO SUTURE VERSAPORT PLUS V2 W/FIXATION CANNULA 11-12MM ( 外管 + 可變轉接頭 ) 955 123

CDD11095PFUS AUTO SUTURE VERSAPORT PLUS V2 W/FIXATION CANNULA 11-12MM ( 穿刺內管 + 外管 + 可變轉接頭 ) 1595 CDD1110051L9 ENDOSCOPIC INSTRUMENT 內視鏡器械 ( 含 : 穿刺針 *1+ 外管 *1+ 固定式轉接頭 *1) 1329 CDD1110092L9 ENDOSCOPIC INSTRUMENT 內視鏡器械 ( 含 : 穿刺針 *1+ 外管 *2+ 固定式轉接頭 *2) 1963 CDD114016SUS 可充氣安全穿刺套管 WOODFORD SPIKE TROCAR AND CANNULA WITH GAS PORT 5MM( 穿剌針 1+ 外管 1+ 固定式轉接頭 1) CDD114216KUS 可充氣安全穿刺套管組 WOODFORD SPIKE TROCAR AND CANNULA WITH GAS PORT KIT( 穿剌針 1+ 外管 2+ 內建固定式轉接頭 2) 1329 1963 CDD117092FUS AUTO SUTURE VERSAPORT PLUS V2 W/FIXATION CANNULA 5MM ( 外管 + 固定轉接頭 ) 955 CDD1177092US VERSAPORT PLUS RPF SINGLE USE RADIOLUCENT TROCAR SLEEVE 5MM( 外管 + 固定式轉接頭 1) 955 CDD1177096US CDD1178062US CDD1178064US CDD1179079US VERSAPORT PLUS RPF SINGLE USE RADIOLUCENT TROCAR SLEEVE5/10-12MM ( 外管 1+ 內建式可變轉接頭 1) VERSAPORT PLUS RPF SINGLE USE RADIOLUCENT TROCAR KITS 5/10MM 可變式安全穿刺套管組 ( 穿剌針 1+ 外管 2+ 內建可變式轉接頭 2) VERSAPORT PLUS RPF SINGLE USE RADIOLUCENT TROCAR KITS5 MM 可變式安全穿刺套管組 ( 穿剌針 1+ 外管 2+ 內建固定式轉接頭 2) 腹腔鏡穿刺套管 SURGISPIKE SINGLE USE 5MM RADIOLUCENT TROCAR( 穿剌針 1+ 外管 1+ 固定式轉接頭 1) 955 2658 1963 1329 CDD1179305US 優施西胸腔穿刺套管 1329 CDD1190689US CDD119075PUS CDD119076PUS VERSAPORT PLUS RPF SINGLE USE RADIOLUCENT TROCAR 5MM 可變式安全穿刺套管 ( 穿剌針 1+ 外管 1+ 固定式轉接頭 1) CONVERTERLESS 5-12MM TROCAR 可變式鈍頭安全穿刺套管 ( 穿刺針 1+ 外管 1+ 可變式轉接頭 1+ 袋口結固定器 ) VERSAPORT PLUS RPF SINGLE USE RADIOLUCENT TROCAR5/10-12MM 可變式安全穿刺套管 ( 穿剌針 1+ 外管 1+ 內建可變式轉接頭 1) 1329 2233 1595 CDD119094FUS AUTO SUTURE VERSAPORT PLUS V2 W/FIXATION CANNULA 5MM ( 穿刺內管 + 外管 + 固定轉接頭 ) 1329 CDD1197689US CDD119776PUS VERSAPORT PLUS RT SINGLE USE OBTURATORS(TROCAR) FOR USE WITH VERSAPORT RT REUSABLE CANNULAE 5MM( 穿剌針 1+ 外管 1+ 固定式轉接頭 1) VERSAPORT PLUS RT SINGLE USE OBTURATORS(TROCAR) FOR USE W/VERSAPORT RT REUSABLE CANNULAE 10-12MM( 穿剌針 1+ 外管 1+ 內建可變式轉接頭 1) 744 1010 CDD11BASXCET BASX BLADELESS TROCAR 外套管 + 可變式轉接頭 955 CDD11BASXTET BASX BLADELESS TROCAR 穿刺器 + 外套管 + 可變式轉接頭 1595 CDD11XCEL2ET 愛惜康安德派思外科穿刺器雙外管 "ETHICON"ENDOPATH XCEL TROCAR 2658 CDD11XCELBET 愛惜康安德派思外科穿刺器 "ETHICON"ENDOPATH XCEL TROCAR(BLADELESS) 1595 CDD11XCELLET 愛惜康安德派思外科穿刺器 "ETHICON"ENDOPATH XCEL TROCAR 1595 CDD11XCELSET 愛惜康安德派思外科穿刺器 - 外套管 + 固定式頭 "ETHICON" TROCAR SLEEVE(BLADELESS) 955 CDD11XCELVET 愛惜康安德派思外科穿刺器 - 外套管 + 可變式頭 "ETHICON" TROCAR SLEEVE(BLADELESS) 955 CDD12MSBT1US 優施西腹腔鏡汽球固定式鈍頭穿刺套管組 3091 124

特材代碼中英文品名支付點數 CDD12MSXB1US 優施西可視式腹腔鏡汽球撐開式套管 2370 CDD12PDBS2US " 優施西 " 腹腔鏡汽球撐開式套管 2370 CDF0101230NZ PUDENZ FLUSHING VALVE 6100 CDF0121000M4 CSF FLOW CONTROL SHUNTS AND ACCESSORIES V-P-SHUNT RESERVOIR 2870 CDF0121401CM ACCU-FLO SINGLE LUMEN RESERVOIR 2870 CDF01T4004BD DISPOSABLE FLOW/FLUSH DEVICE 140 CDF0200125NZ ON-OFF FLUSHING VALVE 3350 CDF0200301NZ MISHLER DUAL CHAMBER FLUSHING VALVE WITH INTEGRAL CONNECTORS 3350 CDF0201100NZ ULTRA VS VALVE SMALL 2870 CDF0201109NZ ULTRA VS VALVE STANDARD 2870 CDF0201126NZ ULTRA VS-NEONATE VALVE SYSTEM 2870 CDF0201195NZ FOLTZ CSF RESERVOIR 2870 CDF0201270NZ OMMAYA CSF RESERVOIR WITH INTEGRAL CONNECTORS 2870 CDF0201410NZ PUDENZ FLUSHING VALVE WITH ANTI-SIPHON DEVICE 6500 CDF0209010NZ NOVUS VALVE STANDARD 2870 CDF0209810NZ LOW PROFILE VALVE II 2870 CDF0221411CM ACCU-FLO SINGLE LUMEN RESERVOIR 2870 CDF0242104PM C.S.F. FLOW CONTROL VALVE STANDARD 6100 CDF0283026NZ MINI-OMMAYA CSF RESERVOIR 2870 CDF0301192NZ BRADEN CSF RESERVOIR 3350 CDF0302512B0 CSF VALVE BURR HOLE 6100 CDF0302812B0 CSF VALVE BURR HOLE 6100 CDF0321422CM ACCU-FLO DOUBLE LUMEN RESERVOIR(91/10/01 再重新生效,82-1422 刪除 ) 3350 CDF0325491CM CODMAN HAKIM RIGHT ANGLE VALVES 6100 CDF0342324PM C.S.F. FLOW CONTROL VALVE CONTOURED 6100 CDF0342544PM C.S.F. FLOW CONTROL VALVE BURR HOLE 6100 125

CDF0400200NZ ON-OFF FLUSHING VALVE ANTI-SIPHON DEVICE (WITH 2 PUDENZ STRAIGHT CONNECTORS) 6500 CDLP106418B0 LUMBAR CATHETER SET( 腦室導管 + 貯水閥 +CONNECTOR+ 腹腔導管 ) 8120 CDLP107210NZ SPETZLER LUMBAR PERITONEAL SHUNT 8120 CDLP107420NZ SPETZLER LUMBAR PERITONEAL IN-LINE VALVE 8120 CDLP144410PM C.S.F. LUMBOPERITONEAL CATHETER SYSTEM 8120 CDLP146418M4 EDM LUMBER CATHETER 24CM 2100 CDLP207460NZ SPETZLER L-P LARGE,SMALL FLUSHING RESERVOIR 3305 CDLP244513PM C.S.F. LUMBOPERITONEAL RESERVOIR 3305 CDP0104015MV CDP0104015SB FLEXIMA NASOBILIARY CATH W/GUIDEWIRE(CATH+TRANSFER TUBE+DRAINAGE CANNECTOR TUBE+GUIDEWIRE) FLEXIMA NASOBILIARY CATHETER (CATH+TRANSFER TUBE+DRAINAGE CONNECTOR TUBE+GUIDE WIRE) 5400 5400 CDP010A001CK OASIS ONE ACTION STENT INTRODUCER SYSTEM 2000 CDP010ACL1CK OASIS PRE-LOADED STENT INTRODUCTION SYSTEM 4500 CDP0111270CL P.T.C.D SET 矽質膽道膽囊穿刺套 3000 CDP0111807CL P.T.C.D KIT (ONE STEP) 2000 CDP011STWNCY PERCUTANEOUS DIRECT ACCESS KIT 2000 CDP0120702SB ACCUSTICK II PERCUTANEOUS INTRODUCER SYSTEM(NEEDLE+INTRODUCER+GUIDEWIRE*2) 2700 CDP0120704SB ACCUSTICK II PERCUTANEOUS INTRODUCER SYSTEM(NEEDLE+INTRODUCER+GUIDEWIRE*1) 1750 CDP012633NC3 ULTRASONICALLY GUIDED ONE-STEP DRAINAGE SET 2000 CDP0127260SB FLEXIMA BILIARY RO DRAINAGE CATHETERES(ONE STEP)( 含穿刺針組 + 引流管 ) 2000 CDP0129128MT FLEXIMA HYDROPHILIC ALL PURPOSE DRAINAGE CATHETER W/TROCAR(ONE STEP) 6:14FR 20:25CM 2000 CDP0129128SB FLEXIMA DRAINAGE CATHETERS SET W/TROCAR(ONE STEP) 2000 CDP0129133MT FLEXIMA HYDROPHILIC ALL PURPOSE DRAINAGE CATHETER W/TROCAR AND LOCKING LOOP(ONE STEP) 6:14FR 25CM 2000 CDP0129133SB FLEXIMA DRAINAGE CATHETERS SET W/STIFFING CANNULA.LUER CAP 1400 CDP0138408AN PIGTAIL CATHETER KIT(CATH+STIFFENING CANNULA+DILATOR+STOPCOCK) 1400 CDP0145550SB MICROVASIVE RAPID EXCHANGE BILIARY STENT SYSTEM( 含推進導管及導引導管 ) 4500 CDP0165150PB INTRODUCER SET(NEEDLE+INTRODUCER+GUIDE WIREX2) 2700 126

CDP0175110PB SKATER DRAINAGE CATHETER 6:16FR 25-35CM 1400 CDP0175601PB SKATER ONE STEP DRAINAGE CATHETER 6:16FR 20:25CM 2000 CDP0175651PB SKATER ONE STEP DRAINAGE CATHETER 6:16FR 20:25CM 2000 CDP01BS001SB AMSTERDAM BILIARY STENT KIT 7,8.5,10,11.5FRX5,7,10,12,15CM( 含推進導管及導引導管 ) 4500 CDP01BSK12SB AMSTERDAM BILIARY STENT KIT ( 含推進導管 ) 2750 CDP01BSK1TSB AMSTERDAM BILIARY STENT KIT 10,12FRX5,7,10,12,15CM( 含推進導管及導引導管 ) 4500 CDP01BTPD2BQ PIGTAIL DRAINAGE CATHETER SET (ONE SETP)7:14FR 19:39CM 含導管及穿刺針 2000 CDP01BTPDABQ PIGTAIL DRAINAGE CATHETER SET(ONE STEP TYPE)( 含穿刺針組 + 引流管 ) 2000 CDP01BTPDBBQ PIGTAIL DRAINAGE CATHETER SET(ONE STEP TYPE)( 含穿刺針組 + 引流管 ) 2000 CDP01BTPDCBQ PIGTAIL DRAINAGE CATHETER SET(ONE STEP)( 含引流管及穿刺針組 ) 2000 CDP01BTPDDBQ PIGTAIL DRAINAGE CATHETER SET(ONE STEP)( 含引流管及穿刺針組 ) 2000 CDP01BTPDSBQ " 邦拓 " 豬尾巴引流導管組 ( 直接穿刺型 )"BIOTEQ"PIGTAIL DRAINAGE CATHETER SET(ONE STEP TYPE) 2000 CDP01CHB1NCK COTTON HUIBREGTSE BILIARY STENT SET 4950 CDP01CL120CK MAC-LOC BILIARY DRAINAGE CATH 12,14F 2000 CDP01CLB85CK " 曲克 " 經皮引流導管針組 "COOK" DRAINAGE CATHETER NEEDLE SET 6~16FR 2000 CDP01CLBS1CK 曲克膽道支架暨支架引導組 COOK COTTON-LEUNG BILIARY STENT AND INTRODUCER SET 4500 CDP01DTVN1CK 曲克經皮引流導管針組 COOK DRAINAGE CATHETER NEEDLE SET 2000 CDP01DTVN2CK 曲克經皮引流導管針組 COOK DRAINAGE CATHETER NEEDLE SET 2000 CDP01DTVN3CK 曲克經皮引流導管針組 COOK DRAINAGE CATHETER NEEDLE SET 2000 CDP01E001NCK LIGUORY ENDOSCOPIC NASAL BILIARY DRAINAGE SET 5:7FR 5400 CDP01EC01NCK LIGUORY ENDOSCOPIC NASAL BILIARY DRAINAGE CATHETER 2500 CDP01EC02NCK NAGARAJA ENDOSCOPIC NASAL BILIARY DRAINAGE CATHETER 內視鏡經膽道引流管 730 CDP01GEPD1CK PANCREATIC STENT SET( 含導入導引組 + 支架 ) 4950 CDP01GPPS1FG " 福萊克斯 " 支架放置套組 "ENDO-FLEX" STENT INTRODUCTION SET GPPS 4500 CDP01K3076TP P.T.C.D SET 經皮穿肝膽道引流針組 1470 CDP01L001NCK COTTON LEUNG BILIARY STENT SET 4950 127

CDP01MD102CK ULTRATHANE MULTIPUEPOSE DRAINAGE CATH 12,14F,25CM,18G 2000 CDP01MDC85CK ULTRATHANE MULTIPURPOSE DRAINAGE CATH 8.5,10.2F,25CM,18G 2000 CDP01MP1S1CK "COOK"MICROPUNCTURE INTRODUCER SETS 4F:5F 0.018 英吋 21G 微穿刺引導器組 1750 CDP01N0DNNBA OPTI-DRAIN MULTI-USE DRAINAGE CATHETER 8-12FR 2000 CDP01NETWNGT GOODTEC DRAINAGE CATHETER 固特克引流管 530 CDP01NNUNNBA DRAINAGE CATHETERS AND ACCESSORIES( 含穿刺針組 + 引流管 ) 2000 CDP01NPAS1CK NEFF PERCUTANEOUS ACCESS SETS 6FR 20CM 0.018 60CM 1750 CDP01NPAS2CK NEFF PERCUTANEOUS ACCESS SETS 6FR 20CM 0.018 60CM 1750 CDP01NPAS3CK "COOK"NEFF PERCUTANEOUS ACCESS SETS 4.0/7.0 20CM 22/15CM.018 4.0/6.0 20CM 21/15CM:22/15CM.018 1750 CDP01NPDS1CK NASAL PANCREATIC DRAINAGE SET 5400 CDP01P001NCK RING BILIARY DULT DRAINAGE CATHETER 800 CDP01P008NCK P.T.C.D DRANIGE CATHETER 990 CDP01PAS30BA NAVARRE PERCUTANEOUS ACCESS SET 1750 CDP01U004NCK RING BILIARY DUCT DRAINAGE SET 4200 CDP01UC102CK ULTRATHANE UNIVERSAL CURVED DRAINAGE CATH 10.2F,25CM,18G 2000 CDP01UCD70CK ULTRATHANE UNIVERSAL CURVED DRAINAGE CATH 7,8.5F,25CM,18G 2000 CDP01UL120CK MAC-LOC ULTRATHANE DRAINAGE CATH 10.2,12F,25CM,18G 2000 CDP01UL140CK MAC-LOC MULTIPURPOSE DRAINAGE CATHETER 12,14F 25CM,18G 2000 CDP01ULT01CK " 曲克 " 經皮引流導管針組 "COOK" DRAINAGE CATHETER NEEDLE SET(BILIARY DRAINAGE CATHETERS) 2000 CDP01ULT50CK MAC-LOC ULTRATHANE DRAINAGE CATH 5,6F,25CM,23,20G 2000 CDP01ULT70CK MAC-LOC ULTRATHANE DRAINAGE CATH 2000 CDP01ULT85CK MAC-LOC MULTIPURPOSE DRAINAGE CATH 8.5,10F,25CM,18G 2000 CDP01ZEBD1CK ZIMMON ENDOSCOPIC BILIARY STENT SET 5:7FR(STENT GUIDEWIRE INTRODUCER CATHETER) 4500 CDP01ZEBD2CK 曲克膽道留置管組 COOK BILIARY STENT SET 4500 CDP0240110MV FLEXIMA NASOBILIARY CATH(NASOBILIRY CATH+NASAL TRANSFER TUBE+DRAINAGE CANNECTOR TUBE) 2200 CDP0240110SB FLEXIMA NASOBILIARY CATHETER (CATH+TRANSFER TUBE+DRAINAGE CONNECTOR TUBE) 2200 128

CDP0242010CL P.T.C.D. INTERNAL DRAINAGE TUBE (SILICON) 980 CDP02A1D16BL BILIARY DRAINAGE CATHETER 45CM 12FR,16FR 900 CDP02CHB1NCK COTTON HUIBREGTSE BILIARY STENT ONLY 2280 CDP02LS01NCK COTTON LEUNG BILIANY STENT ONLY 2280 CDP02PADBSMV PERCUFLEX AMSTERDAM BILIARY STENTS 7:12FR 5:15CM 2200 CDP02PADBSSB AMSTERDAM BILIARY STENT 2200 CDP02PEBSTFG " 福萊克斯 " 膽道引流管 "ENDO-FLEX" BILIARY STENT 2200 CDP02PTFESFG " 福萊克斯 " 膽道引流管 "ENDO-FLEX" PTFE BILIARY STENT 2200 CDP02SPS11CK " 曲克 " 胰管支架及引導器 "COOK" PANCREATIC STENTS AND INTRODUCERS(STENT ONLY) 2200 CDP02TTS01CK ST-2 S0EHENDRA TANNENBAUM BILIARY STENT 8.5,10,11.5FR 5:12CM,15CM 2200 CDP02ZS001CK ZIMMON ENDOSCOPIC BILIARY STENT ONLY 5:7FR 4,7,10CM 2200 CDP02ZS002CK 曲克膽道支架暨支架引導系統 COOK ZIMMON BILIARY STENTS AND SET(STENT ONLY) 2200 CDPC101200NZ PUDENZ CARDIAC CATHETER 2320 CDPC101248NZ RAIMONDI SPRING PERITONEAL CATHETER 2320 CDPC101375NZ REFLUX CONTROL PERITONEAL CATHETER 2320 CDPC101390NZ PUDENZ PERITONEAL CATHETER 2320 CDPC103105B0 PERITONEAL CATHETER 2075 CDPC121303CM ACCU-FLO BARIUM PISTAL SLIT VALVE PERITONEAL CATHETER 2320 CDPC123045CM HAKIM PERITONEAL CATHETER 2075 CDPC143103PM C.S.F CARDIAC/PERITONEAL CATHETER 2075 CDPC143209M4 CSF FLOW CONTROL SHUNTS AND ACCESSORIES(CARDIAC/PERITONEAL CATHETERS ) 2075 CDPC19007MM4 CSF FLOW CONTROL SHUNTS AND ACCESSORIES CSF CARDIAC PERITONEAL CATHETER WITH PRESSURE 2320 CDSR104111B0 VENTRICULAR RESERVOIR 4710 CDSR123038M4 " 美敦力 " 腦脊髓液儲液囊 "MEDTRONIC" RESERVOIRS 4710 CDSR144102PM VENTRICULAR ACCESS DEVICE 18MM,28MM 4710 CDSR144111PM VENTRICULAR ACCESS DEVICE BURR HOLE 12MM 4710 129

CDSR244108M4 " 美敦力 " 腦脊髓液儲液囊 "MEDTRONIC"RESERVOIRS(CSF VENTRICULAR RESERVOIR 流液量 2.4ML) 4710 CDV0121700CM EXTERNAL DRAINAGE COLLECTION KIT 腦室體外引流組 4850 CDV0121701CM EXTERNAL DRAINAGE SYSTEM(E.D.S.) SET ( 不含 VENTRICULAR SET) 4080 CDV0121702CM EXTERNAL DRAINAGE SYSTEM(E.D.S.) COLLECTION BAG 600 CDV0121705CM EXTERNAL DRAINAGE SYSTEM(E.D.S.)VENTRICULAR SET ( 不含 TUBING AND BAG) 2090 CDV0121720CM EXTERNAL DRAINAGE SYSTEM EDSII (VENTRICULAR CATH+TUBING+BAG) 4850 CDV0121721CM EXTERNAL DRAINAGE SYSTEM EDSII WITHOUT CATH(TUBING+BAG) 4080 CDV0121732CM 柯特曼體外引流集液袋 "CODMAN" EDS CSF COLLECTION BAGS 600 CDV0200FVSPH STANDARD FIFTH VENTRICULAR DRAINAGE SYSTEM 4080 CDV0201000TP VENTRICULAR DRAINAGE KIT(VENTRICULAR CATH+TUBING+BAG) 4850 CDV0201101B0 VENTRICULAR CATHETER 1200 CDV0201228NZ PUDENZ VENTRICULAR CATHETER 1200 CDV0201229NZ PORTNOY FLANGED VENTRICULAR CATHETER 1200 CDV0201328NZ NEUROVIEW ENDOSCOPIC VENTRICULAR CATHETER 1200 CDV0202070TP VENTRICULAR DRAINAGE KIT(VENTRICULAR CATH+TUBING+BAG) 4850 CDV0202204TP VENTRICULAR DRAINAGE SET(TUBING+BAG) 4080 CDV0202207TP VENTRICULAR DRAINAGE BAG 600 CDV0206115B0 EDMS VENTRICULAR CATHETER 20CM W/STYLET 1200 CDV0206124B0 EDMS DRAINAGE BAG 700ML 600 CDV0206126B0 EDMS PATIENT CONNECTION LINE ASSEMBLY 162CM 1275 CDV0206128B0 EXTERNAL DRAINAGE MONITORING SYSTEM 63X11CM 84CM 4080 CDV0208120HS HERMETIC VENTRICULAR CATHETER WITH TROCAR 2090 CDV0208220HS HERMETIC VENTRICULAR CATHETER SET 2090 CDV0208300HS HERMETIC EXTERNAL C.S.F DRAINAGE SYSTEM(VENTRICULAR CATHETER 除外 ) 4080 CDV0208305HS REPLACEMENT COLLECTION BAG 600 CDV0208400HS EXTERNAL CSF DRAINAGE SYSTEM 4080 130

特材代碼中英文品名支付點數 CDV0208560HS REPLACEMENT PATIENT LINE ASSEMBLY 1275 CDV0208600HS HERMETIC EXTERNAL CSF DRAINAGE SYSTEM 4080 CDV020FVRSPH CSF DRAINAGE BAG 600 CDV020FVTSPH PATIENT LINE TUBING SET 1275 CDV0221731CM CODMAN EXTERNAL DRAINAGE SYSTEM 3 WITHOUT VENTRICULAR CATHETER 4080 CDV0227579M4 EXACTA WITH PATIENT LINE(TUBING+Y-PORT+ANTI-REFLUX VALVE) 1275 CDV0246124PM BECKER EDMS DRAINAGE BAG 700ML 600 CDV0246126PM EDMS PATIENT CONNECTION LINE ASSEMBLY 1275 CDV0246128PM I.C.P SHUNT BECKER 4080 CDV0246700M4 EXTERNAL DRAINAGE AND MONITORING SYSTEM 4080 CDV0246710M4 EXACTA DRAINAGE BAG 600ML 600 CDV02FVSC1PH VENTRICULAR CATHETER WITH TROCAR 2090 CDV02ND200TP VENTRICULAR CATH 1200 CDV030PFV1PH STANDARD FIFTH VENTRICLE SYSTEM ( 含 CATHETER) 腦室引流器 4850 CDV030SFV1PH STANDARD FIFTH VENTRICULAR SYSTEM KIT(WITH CATHTER) 4850 CDV0506118B0 EDMS VENTRICULAR CATHETER 35CM W/STYLET+TROCAR 型號 :06118S 自 94 年 10 月 1 日起生效 ( 文號 0940021120) 2090 CDV0523041CM HAKIM VENTRICULAR CATHETER W/INTRODUCER 2090 CDV0527703M4 " 美敦力 " 體外引流及監測用腦室導管 "MEDTRONIC" EXTERNAL DRAINAGE AND MONITORING VENTRICULAR 2090 CDV0546118PM VENTRICULAR CATHETER WITH TROCAR 2090 CDVC121201CM ACCU-FLO VENTRICULAR CATHETER 1200 CDVC141101M4 EXTERNAL DRAINAGE AND MONITORING VENTRICULAR CATHETER 1200 CDVC141101PM VENTRICULAR CATHETER 1200 CDVP101103NZ N-LINE VALVE WITH RESERVOIR&CATHETER 9120 CDVP101113NZ ULTRA VS STANDARD KIT WITH RESERVOIR&CATHETER 9120 CDVP106101NZ ONE PIECE SHUNT WITH RESERVOIR 9120 CDVP106401NZ ONE PIECE SHUNTS WITH RESERVOIR 9120 131

CDVP109610NZ NOVUS STANDARD AND PEDIATRIC SHUNTS 9120 CDVP109840NZ LPV II SHUNT KIT ( 含 PUDENZ VENTRICULAR CATHETER) 9120 CDVP123011CM HAKIM PRECISION VALVE PRECHAMBER ONLY W/INTRODUCER 6100 CDVP128503CM UNI-SHUNT WITH RESERVOIR (CATHETER ONLY) 5100 CDVP128504CM UNI-SHUNT WITH RESERVOIR (CATHETER ONLY) 5100 CDVP128513CM UNI-SHUNT WITH RESERVOIR (CATHETER ONLY) 5100 CDVP128514CM UNI-SHUNT WITH RESERVOIR (CATHETER ONLY) 5100 CDVP128523CM UNI-SHUNT WITH RESERVOIR (CATHETER ONLY) 5100 CDVP128524CM UNI-SHUNT WITH RESERVOIR (CATHETER ONLY) 5100 CDVP128545CM UNI-SHUNT WITH RESERVOIR (CATHETER ONLY) 5100 CDVP19003AM4 CDVP19003DM4 CSF FLOW CONTROL SHUNTS AND ACCESSORIES V-PSHUNT KIT ( 腦室引流管 + 腹腔導管 +CTR RESERVOIR+CONX2) CSF FLOW CONTROL SHUNTS AND ACCESSORIES V-PSHUNT KIT ( 腦室引流管 + 腹腔導管 +CTR RESERVOIR+CONX2) 9120 9120 CDVP19040BPM V-P SHUNT 腦室腹腔分流術導管組 9120 CDVP19040EPM V-P SHUNT 腦室腹腔分流術導管組 9120 CDVP323001CM HYDROCEPHALUS SHUNT SYSTEM 9120 CDVP323006CM VALVE UNIT+PERITONEAL C+VENTRICULAR C+ADAPTER+CONNECTOR+VALVE INTRODUCER 9120 CDVP323016CM VALVE UNIT+PERITONEAL C+VENTRICULAR C+ADAPTER+CONNECTOR+VALVE INTRODUCER 9120 CDVP323281CM CODMAN HAKIM RIGHT ANGLE VALVES SYSTEM( 腦室導管 + 腹腔導管 + 定壓引流閥 ) 9120 CDVP328501CM UNI-SHUNT WITH ENLARGED DOME RESERVOIR 9120 CDVP346024PM C.S.F UNITIZED SHUNT KIT 9120 CEE010090NPW EXTENSION TUBE 11.7 CEE0101040TP ANGIOGRAPHIC TUBE 142PSI 血管造影劑注入延長管 11.7 CEE010150CLL EXTENSION TUBE 90CM,100CM,120CM,150CM 11.7 CEE010150NPW EXTENSION TUBE 11.7 CEE010180NPW EXTENSION TUBE 11.7 CEE0107100TP ANGIOGRAPHIC TUBE W/3 WAY 142PSI 血管造影劑注入延長管含三路活栓 34.5 132

特材代碼中英文品名支付點數 CEE0108003P2 EXTENSION TUBE WITH Y 10CM 38 CEE0108005P2 EXTENSION TUBE WITH SAMPLING PORT 60CM,70CM 11.7 CEE0108007P2 EXTENSION TUBE WITH SAMPLING PORT 85CM:95CM 11.7 CEE0108100P2 EXTENSION TUBE WITH T 15CM 28 CEE0108300P2 IV EXTENSION TUBE 輸液延長管 45CM 11.7 CEE0108301P2 IV EXTENSION TUBE 輸液延長管 60CM 11.7 CEE0108302P2 EXTENSION TUBE 90CM 11.7 CEE0108303P2 IV EXTENSION TUBE 輸液延長管 120CM 11.7 CEE0108308P2 IV EXTENSION TUBE 輸液延長管 180CM 11.7 CEE01090ASLL EXTENSION TUBE (W/DOUBLE NEEDLE FREE) 輸液延長管 ( 安全型 ) 134 CEE010E877SG EXTENSION TUBE MALE-FEMALE LUER LUCK 100CM 11.7 CEE0125120M8 EXTENSION TUBE 25:120CM 11.7 CEE0160102BD POSIFLOW LUER LOK 6" EXTENSION SET( 無針式接頭 + 延長管 ) 70 CEE0172310CN 2 WAY Y CONNECTOR 38 CEE0180015P2 EXTENSION TUBE WITH 3-WAY 15CM 34.5 CEE0180019P2 EXTENSION TUBE WITH 3-WAY 192CM 34.5 CEE01A101NPW EXTENSION TUBE 11.7 CEE01A110NPW EXTENSION TUBE WITH T 26 CEE01C1000U2 CLAVE NEEDLELESS CONNECTOR 無針式接頭 60 CEE01C2000U2 CLAVE NEEDLELESS CONNECTOR EXTENSION SET 無針式延長管 70 CEE01C4200U2 CLAVE NEEDLELESS PIGGYBACK EXTENSION SET DUAL PORT 無針式雙接頭延長管 134 CEE01C9190BT CATHETER EXTENSION SET 無針系統導管延長組 70 CEE01DCTPQUL XD2001 CT INJECTOR MISSOURI:PATIENT HOSE AND PUMP HOSE 密蘇里造影劑注射器 : 病人端輸液管 ( 含捲型幫浦輸液管 ) 280 CEE01E0085SG EXTENSION TUBE 11.7 CEE01ES107SG EXTENSION TUBE 11.7 CEE01ET015SG T-CONNECTOR 28 133

特材代碼中英文品名支付點數 CEE01ET067BB SAFSITE NEEDLE FREE EXTENSION SET 70 CEE01ET112LL EXTENSION TUBE 11.7 CEE01ET116BB SAFSITE NEEDLE FREE EXTENSION SET 70 CEE01ET12CLL EXTENSION TUBE 11.7 CEE01ET20ULL 2 WAY EXTENSION TUBE 38 CEE01ET24ULL 4-WAY EXTENSION TUBE 60 CEE01ET33SBB SAFSITE NEEDLE FREE EXTENSION SET( 二個 NEEDLE FREE) 134 CEE01ET60SLL SAFETY EXTENSION TUBE 23 CEE01ETA01NQ T-CONNECTOR(T-IV EXTENSION TUBE) 26 CEE01ETA03NQ IV EXTENSION TUBE+3 WAY 34.5 CEE01ETB05NQ Y-CONNECTOR(Y-IV EXTENSION TUBE) 38 CEE01ETC01NQ IV EXTENSION SET 11.7 CEE01ETN51SG EXTENSION TUBE W/FREE SITE 無針式接頭 + 延長管 * 70 CEE01H001NCK CONNECTING TUBE 479 CEE01H003NCK CONNECTING TUBE WITH DRAINAGE BAG CONNECTOR PCN 連接管 305 CEE01HPC03CK CONNECTING TUBE BRAIDED POLYETHYLENE 1200PSI 連接管雙層 479 CEE01LP160MH LOW PRESSURE COUNECTOR TUBE 300PSI( 螺旋連接管 ) 40 CEE01LRX50TP EXTENSION TUBE 50CM W/3 WAY STOPCOCK 34.5 CEE01LX1FLTP EXTENSION TUBE INJECTOR TYPE 213PSI 50CM,100CM 造影用延長管 11.7 CEE01NFEYSLL INFUSION SET+NEEDLE FREE 70 CEE01P5300BD POSIFLOW IV ACCESS VALVE( 無針式接頭 ) 60 CEE01Q5100BD Q-SYTE LUER ACCESS SITE( 無針式接頭 ) 50 CEE01Q5101BD Q-SYTE LUER ACCESS SITE EXTENSION SETS 延長型無針式輸液套接頭 70 CEE01Q5102BD Q-SYTE LUER ACCESS SITE EXTENSION SETS 延長型無針式輸液套接頭 70 CEE01R1000BB SAFSITE VALVES AND ACCESSORIES 60 CEE01SF877SG EXTENSION TUBE SAFETY 15CM:50CM 23 134

CEE01T1100U2 CLAVE CONNECTOR AND ACCESSORIES DEVICES:NON-DEHP MINIBORE EXT SET T-CONNECTOR 70 AND BONDED CLAVE CONNECTOR 無針式 T 延長管 CEE01TC15NLL T-SITE CONNECTOR 26 CEE01VP003LL EXTENSION TUBE W/3 WAY 34.5 CEE01VP005LL "LILY"CVP-SACLE SYSTEM:3 WAY W/EXTENSION TUBE 34.5 CEE01Y0306BD POSIFLOW DUAL Y 34" EXTENSION SET 無針式雙接頭延長管 134 CEE01Y0506BD POSIFLOW LUER LOK Y EXTENSION SET( 無針式接頭 +Y 型延長管 ) 70 CEP0106015BS ARTERIAL PRESSURE TUBING 15CM,30CM,60CM 60 CEP0108314P2 PRESSURE MONITOR LINES 24"-48" 60 CEP0108317P2 PRESSURE MONITOR LINES 60"-72" 60 CEP010A01NPW EXTENSION TUBE 800PSI 高壓延長管 114 CEP011000PTP ANGIOGRAPHIC TUBE W/3 WAY 1000PSI 雙層血管造影劑注入延長管含三路活栓 549 CEP0111507BB 1200PSI ANGIODYN HIGH PRESSURE TUBINGS PUR( 雙層 ) 479 CEP0111949BB 1000PSI ANGIODYN HIGH PRESSURE TUBINGS PVC 114 CEP011200PTP ANGIOGRAPHIC TUBE 1200PSI 雙層血管造影劑注入延長管 479 CEP0118188BB 1000PSI ANGIODYN HIGH PRESSURE TUBINGS PVC 114 CEP012100DCD EXTENSION CATHETER 45CM,65CM,100CM (88/8/1 改按條給付 ) 479 CEP0125701UM HIGH PRESSURE CATHETER CONNECTOR WITH METER FITTING 479 CEP0136090BS ARTERIAL PRESSURE TUBING 90CM 60 CEP0142373AB ARTERIAL PRESSURE TUBING 60 CEP0148120BS ARTERIAL PRESSURE TUBING 120CM 60 CEP0160150BS ARTERIAL PRESSURE TUBING 150CM 60 CEP0172180BS ARTERIAL PRESSURE TUBING 180CM 60 CEP01800PSTP ANGIOGRAPHIC TUBE 800PSI 雙層血管造影劑注入延長管 479 CEP0184210BS ARTERIAL PRESSURE TUBING 210CM 60 CEP0190701SB PRESSUREE MONITORING LINE 6":96" 60 CEP01AL150SD ALGAFLEX CONNECTION LINES 1200PSI(HIGH PRESSURE LINE) 479 135

CEP01B024NPW HIGH PRESSURE CONNECTING TUBE 限連接測壓導管或檢查導管及注射造影劑使用 114 CEP01ETP01M6 PRESSURE TUBE 500PSI 60 CEP01ETP19M6 PRESSURE TUBE 800-1000PSI 114 CEP01HP20EMR HIGH PRESSURE TUBING 20" 1200PSI( 雙層 ) 479 CEP01HP30EMR HIGH PRESSURE TUBING 30" 1200PSI( 雙層 ) 479 CEP01HP48EMR HIGH PRESSURE TUBING 48" 1200PSI( 雙層 ) 479 CEP01HP50EMR HIGH PRESSURE TUBING 500PSI( 雙層 ) 252 CEP01HPT72BS HIGH PRESSURE TUBING 1000PSI( 雙層 ) 479 CEP01PT006BD ARTERIAL PRESSURE TUBING 60 CEP01PT012BD ARTERIAL PRESSURE TUBING 60 CEP01PT024BD ARTERIAL PRESSURE TUBING 60 CEP01PT036BD ARTERIAL PRESSURE TUBING 60 CEP01PT048BD ARTERIAL PRESSURE TUBING( 型號 PT84,PT12M:84M 自 89/04/01 起生效 ) 60 CEP01PT060BD ARTERIAL PRESSURE TUBING 60 CEP01PT072BD ARTERIAL PRESSURE TUBING 60 CEP01PT500H9 PRESSURE TUBING 500PSI 壓力連接管 60 CEP01PT500SG ARTERIAL PRESSURE TUBING 500PSI 6":72" 60 CEP01PTH12SG ARTERIAL PRESSURE TUBING 1200PSI 6":72" 114 CEP01PTHPTH9 PRESSURE TUBING 1200PSI 壓力連接管 ( 雙層 ) 479 CEP01PTPVCH9 HIGH PRESSURE TUBING PVC 1000PSI 高壓力連接管 114 CEP01SHPCTCK HIGH PRESSURE POLYURETHANE CONNECTING TUBE(SHPCT)75:125CM 1200PSI PU 雙層 479 CET0105180BB T-CONNECTOR 15CM 28 CET01B024NPW EXTENSION TUBE 11.7 CET01B032NPW EXTENSION TUBE W/T 28 CEV010KMS1TR PTMV( 經皮穿靜脈氣球導管二尖瓣成形術 )METAL TUBE 3615 CFD0100471AB FLEXIFLO ENTERAL FEEDING TUBE 8F( 含 STYLE 金屬頭 ) 限 G-I 手術後併 G-I TRACT 溢漏或吻合頇 NPO 者 450 136

CFD0100475AB FLEXIFLO ENTERAL FEEDING TUBE 10FR,12FR 450 CFD0120936CU CFD0120943CU CORFLO ENTERAL FEEDING TUBE 36" 6FR;8FR;10FR( 含 STYLE) 限 G-I 手術後併 G-I TRACT 溢漏或吻合頇 NPO 者 CORFLO ENTERAL FEEDING TUBE 43" 8FR;10FR;12FR( 含 STYLE) 限 G-I 手術後併 G-I TRACT 溢漏或吻合頇 NPO 者 450 450 CFD0280845SH KANGAROO ENTERNAL FEEDING TUBE 8,10,12FR 附導線 450 CFD060640NLZ CFD060644NLZ PEG KIT( 全套 ) 經皮內視鏡胃造廔組 (PEG TUBE,RETRIEVAL SNARE,ADAPTER,RING,INTRODUCER NEEDLE,WIRE,TUBING CLAMP) PEG KIT( 半套 ) 經皮內視鏡胃造廔組 (PEG TUBE,ADAPTER,EXTERNAL RETENTION RING,INTRODUCER NEEDLE,WIRE,TUBING CLAMP) 5600 4200 CFD0612LVNLZ GASTROSTOMY TUBE BALLOON FEEDING TUBE 胃造口術器材配件 /BALLOON 型替換管 1620 CFD068000NCL GASTROSTOMY TUBE BALLOON FEEDING TUBE 胃造口術器材配件 /BALLOON 型替換管 1620 CFD06PASS1CK GASTROSTOMY DEVICES/ACCESSORIES LOW PROFILE FEEDING TUBE 胃造口術器材配件 / 低板胃造口術替換套組 ( 鈕釦型替換管 ) 4950 CFD06PCK01CK GASTROSTOMY DEVICES/ACCESSORIES PATIENT CARE KIT 護理套組 1632 CGDW10113NAN STAINLESS GUIDE WIRE 0.025~0.035" 125~150CM 360 CGDW10117NAN STAINLESS GUIDE WIRE 0.025~0.045" 40~100CM 140 CGDW101228CD MINI GUIDE WIRE 140 CGDW10220NAN GUIDE WIRE 80CM:150CM 0.018":0.038" 泌尿科使用 350 CGDW10222NAN STAINLESS PTFE-COATED GUIDE WIRE 0.018~0.038" 80~100CM 320 CGDW10225NAN GUIDE WIRE 200CM:260CM 0.018":0.038"( 型號 0300,0302-0060) 泌尿科使用 460 CGDW10227NAN STAINLESS GUIDE WIRE PTFE-COATED 0.018~0.038"125CM 350 CGDW10227WAN STAINLESS GUIDE WIRE PTFE-COATED 0.018~0.038"175~200CM 350 CGDW10228NAN STAINLESS GUIDE WIRE PTFE-COATED 0.018~0.038"150CM 350 CGDW10229NAN STAINLESS GUIDE WIRE PTFE-COATED 0.018~0.038" 220CM 460 CGDW10233NAN STAINLESS GUIDE WIRE PTFE-COATED 0.018~0.038" 260~500CM 460 CGDW10252NCD EMERALD GUIDE WIRE FIXED-CORE STRAIGHT TIP 0.025" :0.038" 125:175CM 350 CGDW10253NCD EMERALD GUIDE WIRE FIXED-CORE STRAIGHT TIP 0.025":0.038" 125:175CM 350 CGDW10254NCD EMERALD GUIDE WIRE FIXED-CORE STRAIGHT TIP 0.025":0.038" 125:175CM 350 CGDW102555CD EMERALD GUIDE WIRE FIXED-CORE STRAIGHT TIP 0.035" 260CM 460 CGDW102560CD EMERALD GUIDE WIRE FIXED-CORE STRAIGHT TIP 0.035" 150CM 350 137

CGDW102561CD EMERALD GUIDE WIRE FIXED-CORE STRAIGHT TIP 0.038" 150CM 350 CGDW102571CD EMRALD GUIDE WIRE MOVABLE-CORE J CURVE 0.035" 150CM 350 CGDW102580CD EMERALD GUIDE WIRE MOVABLE-CORE STRAIGHT TIP 0.038" 150CM 350 CGDW102586CD EMERALD GUIDE WIRE FIXED-CORE J CURVE 0.038" 150CM 350 CGDW102587CD EMERALD GUIDE WIRE FIXED-CORE J CURVE 0.035" 150CM 350 CGDW10430NAN STAINLESS GUIDE WIRE PTFE-COATED 0.018~0.038" 150CM 350 CGDW104435AR "ARROW"SPRING GUIDE WIRE 0.035" 60CM" 亞諾導引線 140 CGDW10541NAN NITINOL GUIDE WIRE 0.021~0.035" 145~200CM 770 CGDW10542NAN NITINOL GUIDE WIRE STIFF SHAFF 0.035" 145CM 820 CGDW10620NMV GUIDE WIRE(0.035" 0.038" 150CM) 350 CGDW108005ST " 聖猷達 " 海卓史蒂爾導引線 "ST.JUDE"HYDROSTEER GUIDEWIRE 0.035:0.038" 150CM,180CM( 鎳合金 ) 770 CGDW108011ST " 聖猷達 " 海卓史蒂爾導引線 "ST.JUDE"HYDROSTEER GUIDEWIRE0.035:0.038" 260CM( 鎳合金 ) 1390 CGDW10PNGWMW GUIDE WIRE 140 CGDW111011PB WORKER GUIDE WIRE 100CM STRAIGHT 320 CGDW111012PB WORKER GUIDE WIRE 100-200CM STRAIGHT( 型號 114035120,113935150,112035150 自 92/7/1 生效 ) 350 CGDW111013PB WORKER GUIDE WIRE 200-300CM STRAIGHT( 型號 112035260 自 92/7/1 生效 ) 460 CGDW111051PB WORKER GUIDE WIRE 100CM CURVE 320 CGDW111052PB WORKER GUIDE WIRE 100-200CM CURVE( 型號 113735,110518-150 自 92/7/1 生效 ) 350 CGDW111053PB WORKER GUIDE WIRE 200-300CM CURVE 460 CGDW111080C3 GUIDE WIRE 80CM 320 CGDW111400PB AMPLATZ GUIDE WIRE EXTRA STIFF 0.035" 90CM 830 CGDW111420PB AMPLATZ GUIDE WIRE EXTRA STIFF 0.035" 150CM 890 CGDW112511PB CANALIZER GUIDE WIRE 0.035" 150CM,180CM 770 CGDW112512PB CANALIZER GUIDE WIRE 0.035" 260CM 1390 CGDW112901PB CANALIZER GUIDE WIRE STIFF 0.035" 150CM,180CM 820 CGDW112902PB CANALIZER GUIDE WIRE STIFF 0.035" 260CM 1390 138

CGDW114735AR "ARROW SPRING WIRE GUIDE 0.035 X 68CM 亞諾導引線 140 CGDW116402AR "ARROW" SPRING GUIDE WIRE 0.018" 68CM (DUOFKEX)" 亞諾導引線 140 CGDW135153WT WATSON GUIDE WIRE STAINLESS WITH PTFE 150CM 0.021:0.038" 350 CGDW135206AG SPRING GUIDE WIRE 0.025",0.035",0.038" 40:65CM FIXED CORE STRAIGHT 140 CGDW135225AG GUIDE WIRE 0.021,0.025,0.032" 150CM TF/FC/ST 350 CGDW135231AG GUIDE WIRE 0.035" 150CM STRAIGHT 350 CGDW135234AG GUIDE WIRE 0.038" 150CM STRAIGHT 350 CGDW135263WT WATSON GUIDE WIRE STAINLESS WITH PTFE 260CM 0.025:0.038" 460 CGDW135282AG GUIDE WIRE J-TIP 0.035" 150CM 3MM 350 CGDW135284AG SPRINGE GUIDE WIRE 150CM 360 CGDW135368AG GUIDE WIRE 0.032" 260CM 460 CGDW135369AG GUIDE WIRE EXTENSIVE 0.035" 260CM 460 CGDW135415AG SPRING GUIDE WIRE 0.025",0.032",0.035",0.038" 50,65CM FIXED CORE,3MMJ STRAIGHT 140 CGDW135451AG SPRING GUIDE WIRE 0.018",0.021" 25:80CM FIXED CORE STRAIGHT 140 CGDW135454AG SPRING GUIDE WIRE 0.018",0.021",0.025" 40,50CM FIXED CORE,3MMJ 140 CGDW135464AG GUIDE WIRE 0.018" 50CM 320 CGDW135470AG GUIDE WIRE 0.018" 150CM TF/FC/1.5MMJ 350 CGDW135522AG GUIDE WIRE 0.018:0.038" 260CM TF/ST 460 CGDW135523AG GUIDE WIRE 0.018:0.038" 125CM,150CM TF/FC/3MMJ 350 CGDW135541AG GUIDE WIRE 0.021" 50CM 320 CGDW135550AG GUIDE WIRE 0.025" 50CM 320 CGDW135585AG GUIDE WIRE 0.025" 260CM 460 CGDW135703AG GUIDE WIRE 0.035" 200CM EXCHANGE TF/ST 460 CGDW135711AG GUIDE WIRE 75CM 140 CGDW135730AG SPRING GUIDE WIRE 0.018",0.021",0.025",50CM FIXED CORE,6MMJ STRAIGHT 140 CGDW135787AG GUIDE WIRE J-TIP 0.035" 150CM 1.5MM 350 139

CGDW135798AG SPRING GUIDE WIRE 0.035",0.038" 70,80CM FIXED CORE,3MMJ 140 CGDW135817AG GUIDE WIRE 0.038" 200CM TF/3MMJ 460 CGDW135839AG GUIDE WIRE 0.032,0.035,0.038" 260CM TF/3MMJ 460 CGDW135963AG GUIDE WIRE 0.021" 260CM 460 CGDW135964AG GUIDE WIRE 0.018" 260CM 460 CGDW135968AG SPRING GUIDE WIRE 0.028",0.032",0.035" 40,50CM FIXED CORE,3MMJ 140 CGDW135989AG GUIDE WIRE 0.028" 50CM 140 CGDW14652NMT AMPLATZ SUPER STIFF GUIDE WIRE 890 CGDW14652NSB AMPLATZ SUPER STIFF GUIDEWIRE 145CM,180CM 890 CGDW14656NSB AMPLATZ SUPER STIFF GUIDEWIRE 75CM 830 CGDW1465AMSB AMPLATZ SUPER STIFF GUIDEWIRE 0.035/0.038X260CM 950 CGDW147382BS TEFLON GUIDEWIRE 0.035" 260CM 460 CGDW149101SB STARTER GUIDE WIRE FIXED CORE STR TIP 3.5CM FIEXIBLE TIP 0.032-0.035,100-150CM 350 CGDW149110SB STARTER GUIDE WIRE MOVEABLE CORE STR TIP & J-CURVE TIP 0.035:0.038 150CM 350 CGDW149115SB STARTER GUIDE WIRE FIXED CORE J-CURVE 3.5CM FIEXIBLE TIP 0.025:0.038 120-180CM 350 CGDW14914NSB STARTER GUIDE WIRE NEW BENSON TYPE 0.035 150:180CM 350 CGDW149150SB STARTER GUIDE WIRE NEWTON & NEWTON(LLT)TYPE 0.035 150CM 350 CGDW149155SB STARTER GUIDE WIRE ROSEN HEAVY DUTY TYPE 0.035 180CM 350 CGDW149200LR STARTER GUIDEWIRE 0.018":0.038" 100:180CM( 產品型號含 M001492351:81;2501:11) 350 CGDW149200SB STARTER GUIDE WIRE FIXED CORE STR TIP 3.5CM FIEXIBLE TIP 0.018:0.032,100-150CM 350 CGDW149201LR STARTER GUIDEWIRE 0.025":0.035" 40CM,80CM 320 CGDW149201SB STARTER GUIDE WIRE FIXED CORE STR TIP 3.5CM FIEXIBLE TIP 0.025:0.035,40,80CM 320 CGDW149212SB STARTER GUIDE WIRE FIXED CORE STR TIP 3.5CM FIEXIBLE TIP 0.035:0.038,100-180CM 350 CGDW149213LR STARTER GUIDEWIRE 0.035";0.038" 260CM 460 CGDW149213SB STARTER GUIDE WIRE FIXED CORE STR & 3CM J SHAPE 3.5CM FLEXIBLE TIP 0.035,0.038 260CM 460 CGDW149220SB STARTER GUIDE WIRE DOUBLE END STR TIP& J CURVE TIP 0.035 150CM 350 140

CGDW149221SB STARTER GUIDE WIRE FIXED CORE J-CURVE 3.5CM FIEXIBLE TIP 0.035,0.038 100-180CM 350 CGDW149222SB STARTER GUIDE WIRE FIXED CORE J-CURVE 3.5CM FIEXIBLE TIP 0.035 40,80CM 320 CGDW149250SB STARTER GUIDE WIRE HEAVY DUTY TYPE 0.035 150CM 350 CGDW15024NCD GUIDE WIRE TEFLON 0.035";0.038" 260CM 460 CGDW15025NCD GUIDE WIRE TEFLON 0.021";0.038" 150CM;175CM 350 CGDW150270CD GUIDE WIRE TEFLON 0.035" 80CM 320 CGDW15027NCD GUIDE WIRE TEFLON 0.035";0.038" 150;180CM 350 CGDW15027XCD GUIDE WIRE TEFLON 0.035";0.038" 260CM 460 CGDW154001KD GUIDEWIRE STAINLESS STEEL STRAIGHT 0.038" 70CM 140 CGDW15410NAN NITINOL GUIDE WIRE 0.021~0.035" 220~400CM 1390 CGDW163541CK TEFLON WIRE GUIDE STRAIGHT 60:145CM 0.028:0.038 350 CGDW163845CK AMPLATZ STIFF WIRE GUIDE 145cm 890 CGDW172600PB NITINOL GUIDE WIRE 0.018" 80CM 710 CGDW196001KD J/STRAIGHT STAINLESS STEEL GUIDE WIRE 0.035" 0.038" 70CM 140 CGDW1A3513TM RADIFOCUS GUIDE WIRE 0.025":0.038" 150CM ANGLED TIP 770 CGDW1A3515TM RADIOFOCUS GUIDE WIRE 0.025",0.035" 150CM (ANGLE) 770 CGDW1A3518TM RADIFOCUS GUIDE WIRE 0.032":0.038" 150CM FLEXIBLE TIP 770 CGDW1A3530TM RADIOFOCUS GUIDE WIRE 0.035" 300CM 1390 CGDW1AMP15BS AMPLATZ EXTRA STIFF GUIDE WIRE 0.035"X150CM 890 CGDW1AMP26BS AMPLATZ EXTRA STIFF GUIDE WIRE 0.035"X260CM 950 CGDW1APGW1H9 ANGIO PACK:GUIDE WIRE 0.035" 150CM PTFE 350 CGDW1APGW2H9 ANGIO PACK:GUIDE WIRE 0.035" 260CM PTFE 460 CGDW1F3J10AS TEFLON GUIDE WIRE 0.018:0.038" 120CM:150CM 350 CGDW1F3J80AS TEFLON GUIDE WIRE 0.018:0.038" 80CM 320 CGDW1FS3JFAS TEFLON GUIDE WIRE 0.018:0.038" 260:300CM 460 CGDW1G002ACK GUIDE WIRE STRAIGHT 50CM,80CM 320 141

特材代碼中英文品名支付點數 CGDW1G002NCK GUIDE WIRE STRAIGHT (100,125,145CM) 350 CGDW1G003ACK GUIDE WIRE AMPLATZ EXTRA-STIFF 145CM,180CM 890 CGDW1G003NCK GUIDE WIRE AMPLATZ EXTRA-STIFF 950 CGDW1G004NCK GUIDE WIRE COONS INTERVENTIONAL 350 CGDW1G005NCK TIP DEFLECTING GUIDE WIRE 950 CGDW1G006ACK GUIDE WIRE CURVED 50CM, 80CM 320 CGDW1G006NCK GUIDE WIRE CURVED 50:145CM(100,125,145CM) 350 CGDW1G007ACK GUIDE WIRE CURVED 180CM 350 CGDW1G007NCK GUIDE WIRE CURVED 180:260CM(260CM) 460 CGDW1G008ACK GUIDE WIRE CURVED 50CM, 80CM 320 CGDW1G008NCK GUIDE WIRE CURVED 50:145CM(100,125,145CM) 350 CGDW1G009ACK GUIDE WIRE CURVED 80CM 320 CGDW1G009NCK GUIDE WIRE CURVED (100,125,145CM) 350 CGDW1G011ACK TSF GUIDE WIRE STRAIGHT 50CM, 80CM 320 CGDW1G011NCK TSF GUIDE WIRE STRAIGHT 50:145CM(100,125,145CM) 350 CGDW1G012NCK GUIDE WIRE STRAIGHT 260CM 460 CGDW1G013NCK SOS INTERVENTIONAL GUIDE WIRE 145CM 1100 CGDW1G016ACK GUIDE WIRE STRAIGHT 50CM,80CM 320 CGDW1G016NCK GUIDE WIRE STRAIGHT 50:145CM(100,125,145CM) 350 CGDW1G017NCK GUIDE WIRE TEFCOR MOVABLE CURVED 350 CGDW1G018NCK GUIDE WIRE LUNDERQUIST EXCHANGE 120CM 910 CGDW1GAGSNTM RADIFOCUS GUIDEWIRE(SHAPEABLE TYPE ANGLE,STRAIGHT)0.018":0.038"120:150CM 770 CGDW1GKGLNTM RADIFOCUS GUIDEWIRE(SHAPEABLE TYPE ANGLE,STRAIGHT)0.018":0.038"120:180CM 770 CGDW1GW001G6 AGA' AMPLATZER GUIDE WIRE (PDA OCCLUDER 用 ) 1600 CGDW1HAHSNTM RADIFOCUS GUIDEWIRE HALFSTIFF(SHAPEABLE TYPE ANGLE,STRAIGHT)0.018":0.038"120:180CM 820 CGDW1HS1N2BS TEFLON GUIDE WIRE 0.028:0.038"120CM,150CM 350 142

CGDW1HS1N3BS TEFLON GUIDE WIRE 0.018:0.025" 50CM,80CM 320 CGDW1HS1N4BS TEFLON GUIDE WIRE 0.028:0.032" 260CM 460 CGDW1HSF01CK LUNDERQUIST RING TORQUE GUIDE WIRE 變換金屬導線 910 CGDW1HW001CK HYDROPHILIC WIRE GUIDES 150CM,180CM 0.025" 0.035" 0.038" 770 CGDW1HW018CK HYDROPHILIC WIRE GUIDES 180CM 0.018" 3000 CGDW1HWA01CK HYDROPHILIC WIRE GUIDES 150CM,180CM 0.025" 0.035" 0.038" 770 CGDW1HWA02CK HYDROPHILIC WIRE GUIDES 260CM 0.025" 0.035" 0.038" 1390 CGDW1HWA18CK HYDROPHILIC WIRE GUIDES 150CM 180CM 0.018" 3000 CGDW1HWA28CK HYDROPHILIC WIRE GUIDES 260CM 0.018" 3000 CGDW1HWAS1CK HYDROPHILIC WIRE GUIDES EXTRA SUPPORT(STIFF SHAFT)150CM 180CM 0.035" 0.038" 820 CGDW1HWAS2CK HYDROPHILIC WIRE GUIDES 260CM 0.035" 0.038" 1390 CGDW1HWS01CK HYDROPHILIC WIRE GUIDES EXTRA SUPPORT(STIFF SHAFT)150CM 180CM 0.035" 0.038" 820 CGDW1LC181TM RADIFOCUS GUIDE WIRE M 0.018"~0.038"120CM,150CM,180CM 770 CGDW1LC182TM RADIFOCUS GUIDE WIRE M STIFF WIRE 0.025"~0.038" 150CM,180CM 820 CGDW1LC183TM RADIFOCUS GUIDE WIRE M STIFF WIRE 0.018" 180CM 820 CGDW1LC18NTM RADIFOCUS GUIDE WIRE M 0.018"~0.038" 120CM,150CM,180CM 770 CGDW1LC301TM RADIFOCUS GUIDE WIRE M STIFF WIRE 0.018"~0.038" 220CM,260CM,300CM 1390 CGDW1LC303TM RADIFOCUS GUIDE WIRE M STIFF WIRE 0.025",0.035" 260CM,300CM 1390 CGDW1LC30NTM RADIFOCUS GUIDE WIRE M 0.018"~0.038" 220CM,260CM,300CM 1390 CGDW1LUN15BS LUNDER GUIDE WIRE 0.035"X150CM 910 CGDW1MSU70MW GUIDE WIRE 股靜脈鎖骨下靜脈導管 140 CGDW1N405HST GUIDERIGHT GUIDEWIRE HEPARIN COATED FIXED CORE 0.035",0.038" 150CM;180CM 350 CGDW1N4568ST " 聖猶達 " 蓋瑞特導引線 "ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 350 CGDW1N4577ST " 聖猶達 " 蓋瑞特導引線 "ST.JUDE " GUIDERIGHT GUIDEWIRE 260CM 460 CGDW1N458NST GUIDERIGHT GUIDEWIRE SUPER STIFF FIXED CODE 0.032",0.038" 180CM 890 CGDW1N4610ST " 聖猶達 " 蓋瑞特導引線 "ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 180CM 350 143

CGDW1N4840ST " 聖猶達 " 蓋瑞特導引線 "ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 350 CGDW1N4841ST " 聖猶達 " 蓋瑞特導引線 "ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 350 CGDW1N4870ST " 聖猶達 " 蓋瑞特導引線 "ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 350 CGDW1N4948ST " 聖猶達 " 蓋瑞特導引線 "ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 350 CGDW1N4998ST " 聖猶達 " 蓋瑞特導引線 "ST.JUDE " GUIDERIGHT GUIDEWIRE 150CM 350 CGDW1N5018ST " 聖猶達 " 蓋瑞特導引線 "ST.JUDE " GUIDERIGHT GUIDEWIRE 260CM 460 CGDW1NT015BS GUIDE WIRE 0.038"X150CM(NITINOL) 770 CGDW1NT026BS GUIDE WIRE 0.038"X260CM(NITINOL) 1390 CGDW1PA353TM RADIFOCUS GUIDE WIRE 0.035":0.038" 150CM ANGLED TIP STIFF TYPE 820 CGDW1PMG01CK COPE NITINOL MANDRIL WIRE GUIDE(PLATINUM TIP)0.018" 25-200CM 加蓋軸心鎳鉻合金導線 1800 CGDW1R402NST GUIDERIGHT GUIDEWIRE HEPARIN COATED MOVABLE CORE 0.035",0.038" 150CM 350 CGDW1R455NST GUIDERIGHT GUIDEWIRE INTRODUCER 0.021",0.025",0.032",0.035",0.038 50CM,80CM 320 CGDW1R45DDST GUIDERIGHT GUIDEWIRE DOUBLE DISTAL FIXED CORE 0.035",0.038" 150CM,180CM 350 CGDW1R45J2ST GUIDERIGHT GUIDEWIRE J TIP FIXED CORE 0.32",0.35",0.038" 260CM 460 CGDW1R45NNST GUIDERIGHT GUIDEWIRE J TIP FIXED CORE 0.21",0.25",0.30",0.32",0.35",0.038,0.65" 150CM,180CM 350 CGDW1R4876ST GUIDERIGHT GUIDEWIRE SUPER STIFF FIXED CODE 0.038" 260CM 950 CGDW1R48NNST GUIDERIGHT GUIDEWIRE STRAIGHT FIXED CORE 0.021",0.025",0.032",0.035",0.038" 150CM 350 CGDW1R48SFST GUIDERIGHT GUIDEWIRE STRAIGHT FIXED CORE 0.035",0.038" 260CM 460 CGDW1R4946ST GUIDERIGHT GUIDEWIRE J TIP MOVABLE CORE 0.035",0.038" 150CM 350 CGDW1R4950ST GUIDERIGHT GUIDEWIRE STRAIGHT MOVABLE CORE 0.035",0.038" 150CM 350 CGDW1R5018ST GUIDERIGHT GUIDEWIRE HEPARIN COATED FIXATED CORE 0.035" 260CM 460 CGDW1RFPC1CK ROADRUNNER GUIDE WIRE 0.035",0.038" 145CM,180CM/TIP 7CM 770 CGDW1RFPC2CK ROADRUNNER GUIDE WIRE 0.035",0.038" 260CM/TIP 7CM 1390 CGDW1RFSP1CK ROADRUNNER WIRE GUIDE 0.035",0.038" 145CM,180CM 770 CGDW1RFSP2CK ROADRUNNER WIRE GUIDE 0.035",0.038" 260CM 1390 CGDW1RLPC1CK ROADRUNNER GUIDE WIRE 0.035",0.038" 145CM,180CM/TIP 16CM 770 144

CGDW1RLPC2CK ROADRUNNER GUIDE WIRE 0.035",0.038" 260CM/TIP 16CM 1390 CGDW1RPC1XCK ROADRUNNER GUIDE WIRE 0.035",0.038" 145CM,180CM/TIP 8CM 770 CGDW1RPC2XCK ROADRUNNER GUIDE WIRE 0.035",0.038" 260CM/TIP 8CM 1390 CGDW1S3515TM RADIOFOCUS GUIDE WIRE 0.035" 150CM (STRAIGHT) 770 CGDW1S3530TM RADIOFOCUS GUIDE WIRE 0.035" 300CM 1390 CGDW1SFA35C3 GUIDE WIRE 0.035" 150CM 350 CGDW1SFA38C3 GUIDE WIRE 0.038" 150CM 350 CGDW1SUPERG6 AGA' AMPLATZER GUIDE WIRE (ASD OCCLUDER 用 ) 1600 CGDW1THSF1CK GUIDE WIRE STAINLESS STEEL TFE COATING 0.035";0.038" 260CM 460 CGDW1TSM01CK MOVABLE CORE STRAIGHT SAFELY GUIDE WIRE 安全導線 100,145CM(90/10/1 產品型號 TSM-32:38-80 另編代碼 ) 350 CGDW1TSM0ACK MOVABLE CORE STRAIGHT SAFETY GUIDE WIRE 80CM 320 CGDW1UJAJNAS ASAHI UNIQUAL ANGIOGRAPHIC GUIDE WIRE 0.025":0.038" 150CM:200CM 770 CGDW1UJBESAS ASAHI UNIQUAL ANGIOGRAPHIC GUIDE WIRE 0.025":0.038" 220CM:300CM 1390 CGDW1USAJNAS ASAHI UNIQUAL ANGIOGRAPHIC GUIDE WIRE 0.025":0.038" 150CM:200CM 770 CGDW1USBESAS ASAHI UNIQUAL ANGIOGRAPHIC GUIDE WIRE 0.025":0.038" 220CM:300CM 1390 CGDW1Z1P26SB ZIPWIRE HYDROPHILIC GUIDE WIRE STIFF/STANDARD 0.025",0.035",0.038" 260CM 利博親水性導線 1390 CGDW1ZSD58SB ZIPWIRE HYDROPHILIC GUIDE WIRE 0.025",0.035",0.038" 150CM,180CM 利博親水性導線 770 CGDW1ZSF58SB ZIPWIRE HYDROPHILIC GUIDE WIRE STIFF 0.025",0.035",0.038" 150CM,180CM 利博親水性導線 820 CGDW1ZSF80SB ZIPWIRE HYDROPHILIC GUIDE WIRE STIFF 0.035",0.038" 80CM 利博親水性導線 820 CGPG11001NAC VIKING CORONARY GUIDING CATHETER 6:10FR 自 92.7.1 改按條支付 2048 CGPG11006NAC VIKING CORONARY GUIDING CATHETER* 自 92.7.1 改按條支付 2048 CGPG110264SB MACH 1 PERIPHERAL GUIDING CATHETER 6:8F 55,90CM 2048 CGPG134356SB MACH 1 GUIDE CATHETER 5:8FR 100CM ( 型號 H74935845-010:6970) 自 92.7.1 改按條支付 2048 CGPG138969SB RUNWAY GUIDE CATHETER 6FR 2048 CGPG1416TBRB LUMINA GUIDING CATHETER 2048 CGPG1417TBRB LUMINA GUIDING CATHETER 2048 145

特材代碼中英文品名支付點數 CGPG1418TBRB LUMINA GUIDING CATHETER 2048 CGPG1419TBRB LUMINA GUIDING CATHETER 2048 CGPG151038ZF QUICK-CROSS SUPPORT2 CATHETERS ( 含 3 個探頭 )0.014" 135CM 150MM 0.018" 90CM 0.035"150CM 65MM 3FR 3.4FR 4.8FR 9165 CGPG15565FCD VISTABRITETIP GUIDING CATHETERS 5F 0.056(ALL CURVE STYLE)* 自 92.7.1 改按條支付 2048 CGPG1564XNCD VISTABRITETIP GUIDING CATHETER 6FR 0.064" 自 92.7.1 改按條支付 2048 CGPG1574XNCD VISTABRITETIP GUIDING CATHETER 7FR 0.074",0.078" 自 92.7.1 改按條支付 2048 CGPG1586XNCD VISTABRITETIP GUIDING CATHETER 8FR 0.086",0.088" 自 92.7.1 改按條支付 2048 CGPG158882CD VISTA BRITE TIP GUIDING CATHETER 8FR 0.088 * 自 92.7.1 改按條支付 ( 型號 5888200:2 自 92/7/1 生效 ) 2048 CGPG15888FCD PERIPHERAL GUIDING CATHETER 8FR 0.088 自 92.7.1 改按條支付 2048 CGPG159892CD VISTA BRITE TIP GUIDING CATHETER 9FR 0.098 * 自 92.7.1 改按條支付 ( 型號 5989200:2 自 92/7/1 生效 ) 2048 CGPG15989FCD PERIPHERAL GUIDING CATHETER 9FR 0.098 自 92.7.1 改按條支付 2048 CGPG16206NCD ENVOY GUIDING CATHETER 6FR 0.062" 90CM,100CM 自 92.7.1 改按條支付 2048 CGPG16676FCD VISTABRITEIP GUIDING CATHETER 6FR 0.67(ALL CURVE STYLE) 自 92.7.1 改按條支付 2048 CGPG16706FCD VISTA BRITE TIP GUIDING CATHETER 6FR 0.70 ( 自 92/7/1 改按條支付 ) 2048 CGPG17787FCD VISTABRITETIP GUIDING CATHETERS 7F 0.078(ALL CURVE STYLE)* 自 92.7.1 改按條支付 2048 CGPG1EGA8NCY GUIDING CATHETER 8FR 100CM TYPE:JR,JL,AR,AL,HS,SC 自 92.7.1 改按條支付 2048 CGPG1GC406RB SAFFRON 6FR GUIDING CATHETER 2048 CGPG1GC407RB SAFFRON 7FR GUIDING CATHETER 2048 CGPG1GC408RB SAFFRON 8FR GUIDING CATHETER 2048 CGPG1GCF60TM HEARTRAIL PTCA GUIDING CATHETER 5:8FR 100CM 哈得睿兒導引導管 2048 CGPG1GCF70TM HEARTRAIL PTCA GUIDING CATHETER 5:8FR 100CM 哈得睿兒導引導管 2048 CGPG1GCF90TM HEARTRAIL II PTCA GUIDING CATHETER 哈得睿兒導引導管第二代 2048 CGPG1GCH60TM HEARTRAIL PTCA GUIDING CATHETER STANDARD TYPE 5:8FR 2048 CGPG1JLRAPAS G-STAGE PTCA GUIDING CATHETER 2048 CGPG1KMF4AKE CRUSADE CORONARY ANGIOPLASTY CATHETER 2 LUMEN 140CM 3.2FR( 冠狀動脈成型術探測導管 ) 9165 CGPG1LA006M4 LAUNCHER GUIDE CATHETER 6FR 2048 146

特材代碼中英文品名支付點數 CGPG1LA501M4 LAUNCHER GUIDE CATHETER 5FR 2048 CGPG1LA502M4 LAUNCHER GUIDE CATHETER 5FR 2048 CGPG1LA701M4 LAUNCHER GUIDE CATHETER 7FR 2048 CGPG1LA702M4 LAUNCHER GUIDE CATHETER 7FR 2048 CGPG1LA801M4 LAUNCHER GUIDE CATHETER 8FR 2048 CGPG1LA802M4 LAUNCHER GUIDE CATHETER 8FR 2048 CGPG1MSC57VS MINNIE SUPPORT CATHETER( 含 3 個探頭 ) 9165 CGPG1PBSACAS G-STAGE PTCA GUIDING CATHETER 2048 CGPG1SELE2M4 " 美敦力 " 艾坦賽勒傳送導管系統 "MEDTRONIC"ATTAIN SELECT II DELIVERY CATHETER SYSTEM 2048 CGPG1SHA01M4 SHERPA NX ACTIVE GUIDE CATHETERS 5:6F 2048 CGPG1SHA02M4 SHERPA NX ACTIVE GUIDE CATHETERS 5:6F 2048 CGPG1SHA03M4 SHERPA NX ACTIVE GUIDE CATHETERS 5:6F 2048 CGPG1SHB01M4 SHERPA NX BALANCED GUIDE CATHETERS 6:8F 2048 CGPG1SHB02M4 SHERPA NX BALANCED GUIDE CATHETERS 6:8F 2048 CGPG1SHB03M4 SHERPA NX BALANCED GUIDE CATHETERS 6:8F 2048 CGPG1SW510VS SKYWAY SUPPORT CATHETER 0.014" 138CM( 多功能 ) 9165 CGPG1Z2007M4 Z2 CORONARY GUIDING CATHETER 7FR,8FR 自 92.7.1 改按條支付 2048 CGPG1Z27PUM4 Z2 GUIDING CATHETER 2048 CGPG1Z28PUM4 Z2 GUIDING CATHETER 2048 CGPW10462HAB HI-TORQUE BALANCE HEAVY WEIGHT GUIDE WIRE PTFE SUPPORT 0.014" 190CM 3200 CGPW10463HAB HI-TORQUE BALANCE HEAVY WEIGHT GUIDE WIRE PTFE SUPPORT 0.014" 300CM 3000 CGPW108001ST " 聖猷達 " 海卓史蒂爾導引線 "ST.JUDE"HYDROSTEER GUIDEWIRE 0.018" 150CM,180CM( 鎳合金 ) 2870 CGPW10S0L1RS REGATTA STEERABLE GUIDEWIRE 0.014" 195CM(COATING MICRO RIDGE) 3200 CGPW11048NAB HI-TORQUE PILOT 150 200 GUIDE WIRE 0.014" 300CM 3000 CGPW112154SB CHOICE GUIDE WIRE 0.014" 300CM 3430 CGPW112160SB CHOICE GUIDE WIRE 0.014" 182CM 2870 147

特材代碼中英文品名支付點數 CGPW114901SB PT GRAPHIX GUIDE WIRE 0.014" 182CM 2870 CGPW114913SB PT GRAPHIX GUIDE WIRE 0.014" 300CM 3430 CGPW11740NAB HI-TORQUE SUPER SUPPORT PTCA GUIDE WIRE 0.014" 190CM 3200 CGPW11741NAB HI-TORQUE ALL STAR PTCA GUIDE WIRE 0.014" 300CM 3000 CGPW11780NAB HI-TORQUE GUIDE WIRE EXTRA SUPPORT 190CM 3200 CGPW11782NAB HI-TORQUE GUIDE WIRE EXTRA SUPPORT 300CM 3000 CGPW11834HAB HI-TORQUE WHISPER EXTRA SUPPORT GUIDE WIRE 190CM 0.014" 3200 CGPW11835HAB HI-TORQUE WHISPER EXTRA SUPPORT GUIDE WIRE 300CM 0.014" 3000 CGPW11S0L1RS REGATTA STEERABLE GUIDEWIRE 0.014" 300CM(COATING MICRO RIDGE) 3000 CGPW12224NAB HI-TORQUE EXTRE SUPPORT GUIDE WIRE 0.014" 190CM 3200 CGPW12234NAB HI-TORQUE EXTRA SUPPORT GUIDE WIRE 0.014" 300CM 3000 CGPW1223HNAB HI-TORQUE PTCA GUIDE WIRE W/HYDROCOAT 0.014" 190CM 2870 CGPW1223MNAB HI-TORQUE PTCA GUIDE WIRE W/MICROGLIDE COATING 0.014" 190CM 2870 CGPW12560NAB HI-TORQUE P.T.C.A GUIDE WIRE 0.010" 190CM 2870 CGPW128000AB HI-TORQUE GUIDE WIRE W/HYDROCOAT 0.014" 190CM EXTRA SUPPORT 3200 CGPW128001AB HI-TORQUE GUIDE WIRE W/HYDROCOAT 0.014" 300CM EXTRA SUPPORT 3000 CGPW13309NAB HI-TORQUE CROSS-IT PTCA GUIDE WIRE 0.014" 190CM 2870 CGPW13310NAB HI-TORQUE CROSS-IT PTCA GUIDE WIRE 0.014" 300CM 3430 CGPW1379MNAB HI-TORQUE PTCA GUIDE WIRE W/MICROGLIDE COATING 0.014" 300CM 3430 CGPW138931SB PT2 GUIDEWIRE HYDROPHILIC COATING 0.014" 185CM 2870 CGPW138932SB PT2 GUIDEWIRE HYDROPHILIC COATING 0.014" 300CM 3430 CGPW138950SB IQ GUIDE WIRE 0.014" 185CM 2870 CGPW138951SB IQ GUIDE WIRE 0.014" 300CM 3430 CGPW14181ATM RUNTHROUGH NS PTCA GUIDE WIRE 嵐鍶路導引導線 2870 CGPW1418FATM RUNTHROUGH NS PTCA GUIDE WIRE HYDROPHILLIC COATING 180CM 0.014" 2870 CGPW1430RSTM PTCA GUIDE WIRE W/HYDROPHILIC COATING 0.014" 180:300CM 2870 148

CGPW144586AB HI-TORQUE ADVANCE LITE GUIDE WIRE W/HYDROCOAT HYDROPHILIC COATING 0.014" 190CM 2870 CGPW144587AB HI-TORQUE ADVANCE LITE GUIDE WIRE W/HYDROCOAT HYDROPHILIC COATING 0.014" 300CM 3430 CGPW144588AB HI-TORQUE ADVANCE GUIDE WIRE 190CM 0.014" 2870 CGPW144589AB HI-TORQUE ADVANCE GUIDE WIRE 300CM 0.014" 3430 CGPW146850SB V-18 CONTROL WIRE 0.018" 150-200CM W/HYDROPHILIC COATING 3000 CGPW146860SB V-18 CONTROL WIRE 0.018" 300CM W/HYDROPHILIC COATING 3000 CGPW1480P5AB HI-TORQUE PILOT 50 GUIDE WIRE 0.014" 190CM 2870 CGPW1483P5AB HI-TORQUE PILOT 50 GUIDE WIRE 0.014" 300CM 3430 CGPW148P15AB HI-TORQUE PILOT 150 200 GUIDE WIRE 0.014" 190CM 3200 CGPW149283SB THRUWAY GUIDEWIRE 0.018"*300CM 3000 CGPW1492TWSB THRUWAY GUIDEWIRE 0.018"*130,190CM 3000 CGPW15024XCD GUIDE WIRE TEFLON 0.018" 150CM;260CM 2870 CGPW1503XACD 0.018 SMALL VESSAL PERIPHERAL GUIDE WIRE 180CM 3000 CGPW1503XNCD 0.018 SMALL VESSEL PERIPHERAL GUIDE WIRE 300CM(90/10/1 型號 503458,558,658,758-G 刪除 ) 3000 CGPW15072ACD STEERABLE GUIDE WIRE 0.014" STRAIGHT TIP 180CM 2870 CGPW15072NCD STABILIZER STEERABLE GUIDEWIRE 0.014" 180CM,300CM STRAIGHT TIP 加強型 (90/10/1 原 180CM 規格另編碼 ) 3430 CGPW15079ACD STEERABLE GUIDE WIRE 0.014" STRAIGHT TIP 3CM RADIOPAQUE TIP 180CM 2870 CGPW15079NCD STABILIZER STEERABLE GUIDEWIRE 0.014" 300CM STRAIGHT TIP (90/10/1 原 180CM 另編碼 ) 3430 CGPW15121ACD WIRE 0.014" 180CM STRAIGHT TIP 180CM 2870 CGPW15121NCD WIZDOM GUIDEWIRE 0.014",300CM STRAIGHT TIP (90/10/1 原 180CM 規格另編碼 ) 3430 CGPW15132ACD GUIDE WIRE 0.014" 180CM STRAIGHT TIP MARKER WIRE 2870 CGPW15132NCD WIZDOM GUIDEWIRE 0.014" 300CM STRAIGHT TIP MARKER WIRE (90/10/1 原 180CM 規格另編碼 ) 3430 CGPW15179ACD STEERABLE GUIDE WIRE 0.014" 180CM STRAIGHT TIP MAKER WIRE 2870 CGPW15179NCD STABILIZER STEERABLE GUIDEWIRE 0.014" 300CM STRAIGHT TIP MARKER WIRE(90/10/1 原 180CM 另編碼 ) 3430 CGPW15279ACD STEERABLE GUIDE WIRE 0.014" 180CM STRAIGHT TIP EXTRA SUPPORT 3200 CGPW15357NAB HI-TORQUE WHISPER GUIDE WIRE 0.014" 190CM 2870 149

CGPW15359NAB HI-TORQUE WHISPER GUIDE WIRE 0.14" 300CM 3430 CGPW1547XACD SHINOBI GUIDE WIRE 0.014" 180CM 2870 CGPW1547XNCD SHINOBI GUIDEWIRE 0.014 300CM (90/10/1 原 180CM 規格另編碼 ) 3430 CGPW1595M0CD ATW STEERABLE GUIDEWIRE(MARKER WIRE)0.014" 195CM 2870 CGPW1595M1CD ATW STEERABLE GUIDEWIRE(MARKER WIRE)0.014" 300CM 3430 CGPW1595XACD ATW STEERABLE GUIDE WIRE 0.014" 195CM 2870 CGPW1595XNCD ATW STEERABLE GUIDEWIRE 300CM (90/10/1 原型號 595014,595-J,X,Y,E-014 另編碼 ) 3430 CGPW15970ACD STEERABLE GUIDE WIRE 0.014" 180CM STRAIGHT TIP 25CM RADIOPAQUE TIP 2870 CGPW15970NCD STABILIZER STEERABLE GUIDEWIRE 0.014" 300CM STRAIGHT TIP (90/10/1 原 180CM 規格另編碼 ) 3430 CGPW19660NAB HI-TORQUE GUIDE WIRE EXTRA SUPPORT 190CM 3200 CGPW19661NAB HI-TORQUE GUIDE WIRE EXTRA SUPPORT 300CM 3000 CGPW196646AB CGPW196657AB HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL II GUIDE WIRE W/HYDROCOAT HYDROPHILIC COATING 0.014" 190CM HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL II GUIDE WIRE W/HYDROCOAT HYDROPHILIC COATING 0.014" 300CM 2870 3430 CGPW1AG141AS PTCA GUIDE WIRE PTFE SOFT INTERMEDIATE 0.014 ( 自 971001 由 175CM 改為 180CM) 2870 CGPW1AG143AS PTCA GUIDE WIRE 0.014 STANDARD, STANDARD J, EXTENSION(AG149000 仍為 150CM, 其他型號自 971001 由 175CM 改為 180CM) 2870 CGPW1AG14MBS MIRACLE SERIES PTCA GUIDE WIRE 0.014 175CM EXTRA SUPPORT 3200 CGPW1AGH14AS NEO'S PTCA GUIDE WIRE EXTRA SUPPORT 0.014" ( 自 971001 由 175CM 改為 180CM) 3200 CGPW1AGP14AS PTCA GUIDE WIRE 0.014 EXTRA SUPPORT( 自 971001 由 175CM 改為 180CM) 3200 CGPW1AGPFCAS PTCA GUIDE WIRE HYDROPHILIC COATING EXTRA SUPPORT 0.014" 175CM 180CM 3200 CGPW1CT190M4 WIRE WORK GUIDE WIRES 190CM 0.014" NITINOL HYDROPHILLIC COATING 3000 CGPW1CT300M4 WIRE WORK GUIDE WIRES 300CM 0.014" NITINOL HYDROPHILLIC TEFLON COATING 3000 CGPW1D0CNNAB ACS DOC GUIDE WIRE EXTENSION 0.014" 145CM 2870 CGPW1LJ180M4 GT-SERIES GUIDEWIRE 0.014 180CM 2870 CGPW1LJ300M4 GT-SERIES GUIDEWIRE 0.014 300CM 3430 CGPW1LS180M4 GT-SERIES GUIDEWIRE 0.014 180CM 2870 CGPW1LS300M4 GT-SERIES GUIDEWIRE 0.014 300CM 3430 150

特材代碼中英文品名支付點數 CGPW1LSPH1M4 GT-SERIES GUIDE WIRE 0.014" 180CM 2870 CGPW1LSPH2M4 GT-SERIES GUIDE WIRE 0.014" 300CM 3430 CGPW1MS180M4 GT-SERIES GUIDE WIRE 0.014" 180CM EXTRA-SUPPORT 3200 CGPW1MS300M4 GT-SERIES GUIDE WIRE 0.014"300CM EXTRA-SUPPORT 3000 CGPW1NT180M4 GT-SERIES GUIDE WIRE 0.014" 180CM 3000 CGPW1NT300M4 GT-SERIES GUIDE WIRE 0.014" 300CM 3000 CGPW1PS180M4 WIRE WORK GUIDE WIRE W/COATING HYDRO-TRACK,PRO/PEL 180CM 0.014" 沃爾沃克導引導線 2870 CGPW1PS300M4 WIRE WORK GUIDE WIRE W/COATING HYDRO-TRACK,PRO/PEL 300CM 0.014" 沃爾沃克導引導線 3430 CGPW1SK195F2 SKIPPER & SKIPPER RACE GUIDEWIRES PTFE 0.014" 175CM;195CM 2870 CGPW1SK300F2 SKIPPER & SKIPPER RACE GUIDEWIRES PTFE 0.014" 300CM 3430 CGPW1STRG1CK STRATEGY CORONARY WIRE GUIDES 0.014" 180CM 2870 CGPW1STRG2CK STRATEGY CORONARY WIRE GUIDES 0.014" 300CM 3430 CGPW1TH491SB THRUWAY GUIDEWIRE PTFE EXTRA SUPPORT 0.014" 130,190CM 3200 CGPW1TH492SB THRUWAY GUIDEWIRE PTFE 0.014" 300CM 3430 CGPW1THDR1M4 CGPW1THDR2M4 WIRE WORK GUIDE WIRES 190CM 0.014" STAINLESS STEEL TEFLON(PRO/PEL) COATING EXTRA SUPPORT WIRE WORK GUIDE WIRES 300CM 0.014" STAINLESS STEEL TEFLON(PRO/PEL) COATING EXTRA SUPPORT 3200 3000 CGPW1TR1ESW4 TRANSITO STEERABLE GUIDE WIRE 0.014 190CM EXTRA SUPPORT 3200 CGPW1TR1FMW4 TRANSITO STEERABLE GUIDE WIRE 0.014 190CM 2870 CGPW1ZH180M4 WIRE WORK GUIDE WIRES 180CM 0.014" STAINLESS STEEL HYDROPHILLIC COATING 2870 CGPW1ZH300M4 WIRE WORK GUIDE WIRES 300CM 0.014" STAINLESS STEEL HYDROPHILLIC COATING 3430 CGS0100011VE PERCUTANEOUS CATHETER INTRODUCERS W/DILATOR,GUIDEWIRE 11CM 5:9FR 650 CGS0100023VE PERCUTANEOUS CATHETER INTRODUCERS W/DILATOR 23CM 6:9FR 910 CGS010037AVE PERCUTANEOUS CATHETER INTRODUCERS 23CM(6F:9F), WITH DILATOR,GUIDE WIRE 1040 CGS0101200AR HI-FLOW TRUAMA SET 700 CGS0105100ST " 聖猷達 " 剝式導管導引器 "SJM"PEEL-AWAY INTRODUCER 14CM 5:16FR(S+D+SY+N+G.W) 1000 CGS0105154ST " 聖猷達 " 剝式導管導引器 "SJM" PEEL-AWAY INTRODUCER 1000 151

CGS0105254ST " 聖猷達 " 剝式導管導引器 "SJM"PEEL-AWAY INTRODUCER 23CM 9:14FR(S+D+G.W) 1000 CGS0105300ST " 聖猷達 " 剝式導管導引器 "SJM"PEEL-AWAY INTRODUCER 6CM 4:6FR(SHEATH+NEEDLE) 1000 CGS0105400ST " 聖猷達 " 剝式導管導引器 "SJM"PEEL-AWAY INTRODUCER 14CM 5:16FR(SHEATH+DILATOR) 1000 CGS010601NBA "BARD"PTFE PEEL-APART PERCUTANEOUS INTRODUCER KITS" 巴德 " 剝撕式經皮導引套組 1000 CGS010610NST CGS0106249ST CGS0106255ST CGS0106351ST CGS010658NBA CGS0106660ST " 聖猷達 " 費思凱斯導管導引器 "SJM"FAST-CATH HEMOSTASIS INTRODUCER 12CM(S+D+SV+GW+SY+N+ 保護套 ) " 聖猷達 " 麥克斯導管導引器 "SJM"MAXIMUM HEMOSTASIS INTRODUCER 12CM 4:9FR 0.025:0.038"(W/S+D+V+G.W+SI) " 聖猷達 " 麥克斯導管導引器 "SJM"MAXIMUM HEMOSTASIS INTRODUCER 8.5CM 4:7FR 0.021:0.025"(W/SHEATH+DILATOR+VALVE+G.W+SIDEPORT) " 聖猷達 " 麥克斯導管導引器 "SJM"MAXIMUM HEMOSTASIS INTRODUCER 5CM 4:6FR 0.021"(W/SHEATH+DILATOR+VALVE+G.W+SIDEPORT) "BARD"PTFE PEEL-APART PERCUTANEOUS INTRODUCER KITS"(MICROINTRODUCER) 巴德 " 剝撕式經皮導引套組 " 聖猷達 " 麥克斯導管導引器 "SJM"MAXIMUM HEMOSTASIS INTRODUCER 23CM 5:8FR 0.038"(W/S+D+G.W+SI+V+N) 940 650 650 650 1000 1170 CGS0106667ST " 聖猷達 " 麥克斯導管導引器 "SJM"MAXIMUM HEMOSTASIS INTRODUCER 12CM 750 CGS0106668ST " 聖猷達 " 麥克斯導管導引器 "SJM"MAXIMUM HEMOSTASIS INTRODUCER 23CM 1170 CGS010674NST " 聖猷達 " 費思凱斯導管導引器 "SJM"FAST-CATH HEMOSTASIS INTRODUCERS 45CM 30 度 (S+D+SV+3WAY) 1400 CGS0107500ST " 聖猷達 " 剝式導管導引器 "SJM"PEEL-AWAY INTRODUCER 14CM 7:12FR(S+D+SY+N+G.W+V) 1000 CGS0107688ST CGS010768NST CGS0107691ST " 聖猷達 " 雅帝明導管導引器 "SJM"ULTIMUM INTRODUCER WITH HEMOSTASIS VALVE( 35CM 16FR 0.035" W/SHEATH+DILATOR+GW+SIDEPORT+VALVE) " 聖猷達 " 雅帝明導管導引器 "SJM"ULTIMUM INTRODUCER WITH HEMOSTASIS VALVE( 30CM 14:20FR 0.035" W/SHEATH+DILATOR+GW+SIDEPORT+VALVE) " 聖猷達 " 雅帝明導管導引器 "SJM"ULTIMUM INTRODUCER WITH HEMOSTASIS VALVE(25CM 22FR 0.035" W/SHEATH+ DILATOR+GW+SIDEPORT+VALVE) 1040 1040 1040 CGS0107830ST " 聖猷達 " 雅帝明導管導引器 "SJM"ULTIMUM INTRODUCER SET (S+H+V+G+SIDEPORT) 650 CGS0107835ST CGS0107840ST CGS0107851ST CGS0108403AR CGS0108503AR " 聖猷達 " 雅帝明導管導引器 "SJM"ULTIMUM INTRODUCER SET 8.5CM W/HEMOSTASIS VALVE(S+H+V+G+SIDEPORT) " 聖猷達 " 雅帝明導管導引器 "SJM"ULTIMUM INTRODUCER SETW/HEMOSTASIS VALVE 12CM (S+H+V+G+SIDEPORT) " 聖猷達 " 雅帝明導管導引器 "SJM"ULTIMUM INTRODUCER SET W/HEMOSTASIS VALVE 23CM (S+H+V+G+SIDEPORT) "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM 4FR X 7.5CM(S+D+GW+SV+3WAY+N) 亞諾經皮導引鞘組 "ARROW"PERCUTANEOUS SHEATH WITH SPRING WIRE GUIDE(S+D+G+SV+3 WAY)4:6FR 7.5CM;5:9FR 11CM" 亞諾 " 經皮導引鞘組 650 650 1040 790 650 CGS0108530VE MULLINS TRANSSEPTAL INTRODUCER SET PRDIATRIC 44CM 6:8FR 1400 CGS0108550VE MULLINS TRANSSEPTAL INTRODUCER SET AUDLT 59CM 6:8FR 1400 CGS0108703AR "ARROW"PERCUTANEOUS SHEATH INTRODUCER SET 7:8FR 11CM(S+D+SV+GW+N+SY+3WAY)" 亞諾 " 經皮導引鞘組 790 152

CGS0109600AR PERCUTANEOUS INTRODUCER SYSTEM KIT 6FR 11CM 940 CGS0109803AR PERCUTANEOUS INTRODUCER SYSTEM KIT 8FR(SHE+DIL+SIDEPORT+G.W+NE+ 一般空針 ) 770 CGS0109808AR PERCUTANEOUS INTRODUCER SYSTEM KIT 8FR 11CM 940 CGS0109870AR PERCUTANEOUS SHEATH INTRODUCER SET 8.5FR 940 CGS011101AVE PERCUTANEOUS CATHETER INTRODUCERS 11CM(5F:9F),WITH DILATOR, GUIDE WIRE 650 CGS0113059ED INTRO-FLEX PERCUTANEOUS SHEATH INTRODUCER SET 10CM(S+SV+4 WAY+D+GW+N+ 保護套 ) 940 CGS011389HED INTRO-FLEX PERCUTANEOUS SHEATH INTRODUCER SET 10CM W/COATING(S+SV+4 WAY+D+GW+N+ 保護套 ) 940 CGS0117TPSYZ 玫締特導引鞘組 MEDIKIT INSERT SUPER SHEATH SET 1170 CGS0120010RB ADVANCE CATHETER SHEATH INTRODUCER SYSTEM 10CM(S+D+GW+N) 640 CGS0120016RB ADVANCE CATHETER SHEATH INTRODUCER SYSTEM 16CM(S+D+GW+N) 1040 CGS0120023RB ADVANCE CATHETER SHEATH INTRODUCER SYSTEM 23CM(S+D+GW+N) 1040 CGS0120039US CHEMOSITE 9 FR PEEL-AWAY SHEATH INTRODUCER KIT 1000 CGS0120089US CHEMOSITE 7 FR PEEL-AWAY SHEATH INTRODUCER KIT 1000 CGS0120110RB ADVANCE CATHETER SHEATH INTRODUCER SYSTEM 10CM(S+D+GW) 510 CGS0120123RB ADVANCE CATHETER SHEATH INTRODUCER SYSTEM 23CM(S+D+GW) 910 CGS0125TSWYZ INSERT SUPER SHEATH SET 3~9FR,25CM (SH+DI+GW+SI+V+N) 1170 CGS0130085ED CGS0130185ED INTRO-FLEX PERCUTANEOUS SHEATH INTRODUCER SET 8.5FR 10CM(S+D+SI+V+GW+N+ 保護套 +SY) INTRO-FLEX PERCUTANEOUS SHEATH INTRODUCER SET AMC COATED 8.5FR 10CM(S+D+SI+V+GW+N+ 保護套 ) 940 940 CGS0130484BB INTRODUCER KIT,7F,9F,11F * 1000 CGS0135023BK " 拜耳德尼克 " 思考導線引入裝置系統 "BIOTRONIK"SCOUTPRO CORONARY SINUS LEAD DELIVERY SYSTEM* 8000 CGS0140009AG P.T.C.A LONG SHEATH 23CM 910 CGS01402ANCD AVANTI PLUS SHEATH INTRODUCER 11CM(4:11FR WITHOUT GUIDEWIRE) 500 CGS01402RNCD AVANTI PLUS SHEATH INTRODUCER 5CM(4:8FR WITHOUT GUIDEWIRE) 500 CGS014065NST " 聖猷達 " 麥克斯導管導引器 "SJM" MAXIMUM HEMOSTASIS INTRODUCER 950 CGS0140764ST CGS0140765ST ULTIMUM INTRODUCER WITH HEMOSTASIS VALVE) SHEATH; DILATOR;HEMOSTASIS VALVE; GUIDEWIRE; SIDEPORT ( 3WAY) 12CM 0.035" ULTIMUM INTRODUCER WITH HEMOSTASIS VALVE) SHEATH; DILATOR;HEMOSTASIS VALVE; GUIDEWIRE; SIDEPORT ( 3WAY) 23CM 0.035" 650 1040 153

CGS014076NST ULTIMUM INTRODUCER WITH HEMOSTASIS VALVE) SHEATH; DILATOR;HEMOSTASIS VALVE; 650 GUIDEWIRE; SIDEPORT ( 3WAY) 5CM 0.035" CGS0144004KD QUINTON PULL-APART INTRODUCER SET(7,10,12,14,16FR)( 含 C+D+GW+N+SY) 1000 CGS0144013KD OVAL PULL-APART INTRODUCER SET(PEEL-AWAY)(SH+DIL+GW+SYR+NE) 1000 CGS0146005AG SHEATH INTRODUCER 5:9FR 650 CGS0146064AG PEDIATRIC INTRODUCER KIT(SHEATH+DILATOR+GUIDE WIRE) 650 CGS0146070AG SHEATH INTRODUCER 650 CGS0146131AG ONE PIECE TUOHY-BORST INTRODUCER 5:9FR(INTRODUCER+GUIDE WIRE+DILATOR) 650 CGS0146132AG INTRODUCER KIT 650 CGS0146133AG SHEATH INTRODUCER 7FR 650 CGS0146134AG SHEATH INTRODUCER 8FR 650 CGS0146151AG INTRODUCER KIT(SHEATH,DILATOR,SIDE PORT,3 WAY,GUIDE WIRE) 650 CGS0147025BS LONG SHEATH INTRODUCER 5,6FR 25CM W/DILATOR+SIDEPORT+GW/NEEDLE) 1350 CGS0147912BS INTRODUCER SHEATH 12CM 6:8FR(S+D+GW+SIDEPORT) 650 CGS0150461CD AVANTI PLUS CATHETER SHEATH INTRODUCER TRANSRADIAL KIT 11CM 950 CGS0150462CD AVANTI PLUS CATHETER SHEATH INTRODUCER TRANSRADIAL KIT 23CM 1350 CGS01504PNCD AVANTI PLUS SHEATH INTRODUCER 5CM(4:8FR WITH GUIDEWIRE,DILATOR) 650 CGS01504TNCD AVANTI PLUS SHEATH INTRODUCER 23CM(4:11FR WITHOUT GUIDEWIRE) 910 CGS01504XNCD AVANTI PLUS SHEATH INTRODUCER 11CM(4:11FR WITH GUIDEWIRE,DILATOR) 650 CGS0158F38MR " 美瑞特 " 動脈導引鞘 "MERIT"PRELUDE SHEATH INTRODUCER 650 CGS016014NDV HICKMAN INTRODUCER 1000 CGS016031NBA INTRO-EZE PERCUTANEOUS INTRODUCER KIT 5:15FR 10:16CM(SH+DI+GW+SY+N) 1000 CGS016207DM4 DUAL CHAMBER PERCUTANEOUS LEAD INTRODUCER 60CM(2SH+2D+2GW+N+SY) 1560 CGS016207NM4 PERCUTANEOUS LEAD INTRODUCER 60CM(SH+D+GW+N+SY) 1000 CGS016207SM4 PERCUTANEOUS LEAD INTRODUCER 60CM(SH+D+GW+N+SY) 1000 CGS016226DM4 " 美敦力 " 艾坦導管輸送系統 "MEDTRONIC" ATTAIN TM DEFLECTABLE CATHETER DELIVERY SYSTEM* 8000 CGS0162BTKM4 PERCUTANEOUS LEAD INTRODUCER 60CM(SH+D+GW+N+SY) 1000 154

CGS01A40GNTM RADIOFOCUS INTRODUCER II 16CM 4:6FR WITH 0.025" GUIDE WIRE 1350 CGS01A40K1TM RADIFOCUS INTRODUCER II 4FR 10CM(W/SHEATH,DILATOR,GUIDEWIRE,NEEDLE) 950 CGS01A40K2TM RADIFOCUS INTRODUCER II 4:11FR 25CM(W/SHEATH,DILATOR,GUIDEWIRE,NEEDLE) 1350 CGS01AL191TM " 泰爾茂 " 攝影引導管 "TERUMO" RADIFOCUS INTRODUCER II 4-11FR,16;25CM 1350 CGS01APSHKH9 ANGIO PACK INTRODUCER SHEATH KIT(W/SH+GW+SI+N+V) 770 CGS01AS035TM " 泰爾茂 " 攝影引導套 ( 附針, 針筒 )"TERUMO"RADIFOCUS INTRODUCER II(WITH NEEDLE/SYRINGE) 950 CGS01AS073TM " 泰爾茂 " 血管攝影引導管 "TERUMO" RADIFOCUS INTRODUCER II 4-11FR 7CM,10CM 950 CGS01AS091TM " 泰爾茂 " 攝影引導管 "TERUMO" RADIFOCUS INTRODUCER II 4-11FR,5-10CM 950 CGS01ATTANM4 美敦力安坦左心室傳送系統 MEDTRONIC IRELAND ATTAIN LEFT-HEART DELIVERY SYSTEM* 8000 CGS01B11MQTM RADIFOCUS INTRODUCER II 11FR 0.035"(GW+SH+SD) 不含 NEEDLE 820 CGS01B40G7TM RADIFOCUS INTRODUCER II 7CM 4:5FR 950 CGS01B50N1TM RADIFOCUS INTRODUCER II AND WIRE 10CM 5:11FR 950 CGS01B50N2TM RADIFOCUS INTRODUCER II 25CM 5:11FR AND WIRE 1220 CGS01BL073TM " 泰爾茂 " 血管攝影引導管 "TERUMO" RADIFOCUS INTRODUCER II 4-11FR 7CM,10CM 820 CGS01BL191TM " 泰爾茂 " 攝影引導管 "TERUMO" RADIFOCUS INTRODUCER II 4-11FR,25,40CM 1220 CGS01BL192TM " 泰爾茂 " 攝影引導管 "TERUMO" RADIFOCUS INTRODUCER II 4-11FR,16,25CM 1350 CGS01BS073TM " 泰爾茂 " 血管攝影引導管 "TERUMO" RADIFOCUS INTRODUCER II 4-11FR 25CM,40CM 1220 CGS01BS091TM " 泰爾茂 " 攝影引導管 "TERUMO" RADIFOCUS INTRODUCER II 4-11FR,7;10CM 820 CGS01BS092TM " 泰爾茂 " 攝影引導管 "TERUMO" RADIFOCUS INTRODUCER II 4-11FR,7;10CM 950 CGS01C407NST CGS01CL724AR CGS01CL735AR CGS01CL745AR CGS01CL765AR CGS01CL775AR CGS01CP711AR ULTIMUM INTRODUCER WITH HEMOSTASIS VALVE(SHEATH;DILATOR;HEMOSTASIS VALVE; GUIDEWIRE;NEEDLE)12CM TRANSRADIAL KITS "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM (SUPER ARROW-FLEX NON- KINKING)5:10FR 24CM 亞諾經皮導引鞘組 ( 可彎折式 ) "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM (SUPER FLEX)35CM(S+D+SV+3 AWY) 亞諾經皮導引鞘組 ( 可彎折式 ) "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM (SUPER ARROW-FLEX NON- KINKING)5:8FR,10FR 45CM 亞諾經皮導引鞘組 ( 可彎折式 ) "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM (SUPER ARROW-FLEX NON-KINKING) 6,7,9,10FR 65CM 亞諾經皮導引鞘組 ( 可彎折式 ) "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM(SUPER FLEX) 65:100CM(S+D+SV+3 AWY) 亞諾經皮導引鞘組 ( 可彎折式 ) "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM(SUPER ARROW-FLEX NON- KINKING)5:10FR 11CM 亞諾經皮導引鞘組 ( 可彎折式 ) 950 1470 1470 2780 3000 3000 1150 155

CGS01CPK85BS INTRODUCER SHEATH 6:8.5FR.12CM/WITH DILATOR, GUIDEWIRE, NEEDLE, 保護套 940 CGS01CPSAMST " 聖猷達 " 內導管 "SJM" CPS AIM INNER CATHETER 1810 CGS01CPSPLST CGS01CPSSLST 縱裂式外導引導管 CPS DIRECT PL PEELABLE OUTER CATHETER( 導管 + 擴張器 + 止血閥接合器 ( 含導引絲 )+ 止血閥旁縱裂器 ) 縱裂式外導引導管 CPS DIRECT SL OUTER CATHETER( 導管 + 擴張器 + 止血閥接合器 ( 含導引絲 )+ 止血閥旁縱裂器 ) 8000 8000 CGS01CS11NYZ SUPERSHEATH INTRODUCER SET 11CM(SH+DI+GW+N+SI+V) 770 CGS01CS25NYZ SUPERSHEATH INTRODUCER SET 25CM(SH+DI+GW+N+SI+V) 1170 CGS01CW08NAR "ARROW"PERCUTANEOUS SHEATH INTRODUCER SYSTEM 5,7,9FRX7.5,11CM (S+D+SV+W+N+SY+3 WAY) 亞諾經皮導引鞘組 CGS01DUH25SB SUPER SHEATH INTRODUCER SHEATH 25CM 5-9FR 0.035",0.038" (SHEATH+DILATOR+SIDEARM+VALVE,GUIDEWIRE) 790 1040 CGS01EX124BD PERCUTANEOUS SHEATH INTRODUCER KIT 6:9FR(W/DILATOR,GUIDE WIRE,NEEDLE, 保護套 ) 940 CGS01EX132BD PERCUTANEOUS SHEATH INTRODUCER KIT 6:9FR(W/DILATOR,GUIDE WIRE,NEEDLE) 770 CGS01EX134BD PERCUTANEOUS SHEATH INTRODUCER KIT 6:9FR(W/DILATOR,GUIDE WIRE,NEEDLE) 770 CGS01MPCN4M0 " 美德康 " 微穿刺引導器組 "MEDCOMP" MICRO-STICK INTRODUCER SET 1000 CGS01N6100ST CGS01N6123ST CGS01N6138ST CGS01N6151ST CGS01N6159ST CGS01N6160ST CGS01N6560ST " 聖猷達 " 費思凱絲導管導引器 "SJM" FAST-CATH HEMOSTASIS INTRODUCERS WITH HEMOSTASIS VALVE 12CM SHEATH " 聖猷達 " 費思凱絲導管導引器 "SJM" FAST-CATH HEMOSTASIS INTRODUCERS WITH HEMOSTASIS VALVE 12CM SHEATH " 聖猷達 " 費思凱絲導管導引器 "SJM" FAST-CATH HEMOSTASIS INTRODUCERS WITH HEMOSTASIS VALVE 23CM SHEATH " 聖猷達 " 費思凱絲導管導引器 "SJM" FAST-CATH HEMOSTASIS INTRODUCERS WITH HEMOSTASIS VALVE 12CM SHEATH " 聖猷達 " 費思凱絲導管導引器 "SJM" FAST-CATH HEMOSTASIS INTRODUCERS WITH HEMOSTASIS VALVE 5CM SHEATH " 聖猷達 " 費思凱絲導管導引器 "SJM" FAST-CATH HEMOSTASIS INTRODUCERS WITH HEMOSTASIS VALVE 5CM SHEATH " 聖猷達 " 費思凱絲導管導引器 "SJM" FAST-CATH HEMOSTASIS INTRODUCERS WITH HEMOSTASIS VALVE 70CM SHEATH 650 650 1040 650 650 650 2850 CGS01N6656ST " 聖猷達 " 麥克斯導管導引器 "SJM" MAXIMUM HEMOSTASIS INTRODUCER 1350 CGS01N6700ST CGS01N6773ST CGS01N6784ST " 聖猷達 " 費思凱絲導管導引器 "SJM" FAST-CATH HEMOSTASIS INTRODUCERS WITH HEMOSTASIS VALVE 12CM SHEATH " 聖猷達 " 費思凱絲導管導引器 "SJM" FAST-CATH HEMOSTASIS INTRODUCERS WITH HEMOSTASIS VALVE 98CM SHEATH " 聖猷達 " 費思凱絲導管導引器 "SJM" FAST-CATH HEMOSTASIS INTRODUCERS WITH HEMOSTASIS VALVE 40CM SHEATH 650 2850 1400 CGS01P7983ST " 聖猷達 " 導管傳送系統 "SJM"APEEL CS PLUS CATHETER DELIVERY SYSTEM* 8000 CGS01RCF01CK CHECK-FLO PERFORMER INTRODUCER SETS 25CM(SH+DI+SI+V+GW) 1040 CGS01RCF02CK CHECK-FLO PERFORMER INTRODUCER SETS 30CM W/RADIOLOGY(SH+DI+SI+V+GW) 1350 156

CGS01RCF03CK CHECK-FLO PERFORMER INTRODUCER SETS 45CM W/RADIOLOGY(SH+DI+SI+V+GW) 1350 CGS01RCF04CK CHECK-FLO PERFORMER INTRODUCER SETS 5:13CM(S+D+GW+N+SV+SY+3WAY)0.021",0.035",0.038" 950 CGS01RPDCAGU 雷必多可切開式導管組合系統 RAPIDO CUT-AWAY GUIDING CATHETER SYSTEM(CATHETER+FINISH WIRE+CUTTER+RHV+BCV) 8000 CGS01SC001CK SCHWARZ CATHETER INTRODUCTION SET 2200 CGS01SHSH7SB SUPER SHEATH INTRODUCER SHEATH 4-9FR 7CM 0.035",0.308" (SHEATH+DILATOR+SIDEARM+VALVE,GUIDEWIRE) 650 CGS01SPTSWYZ INSERT SUPER SHEATH SET 3~9FR, 5:7:11CM(SH+DI+GW+SI+V+N) 770 CGS01SUH11SB SUPER SHEATH INTRODUCER SHEATH 11CM 4-9FR 0.035",0.038" (SHEATH+DILATOR+SIDEARM+VALVE,GUIDEWIRE) CGS01SUM11SB SUPER SHEATH INTRODUCER SHEATH 4-9FR 11CM 0.035",0.038" (SHEATH+DILATOR+SIDEARM+VALVE,GUIDEWIRE) CGS01SUM25SB SUPER SHEATH INTRODUCER SHEATH 5-9FR 25CM 0.038" (SHEATH+DILATOR+SIDEARM+VALVE,GUIDEWIRE) 650 650 1040 CGS0209880AR PERCUTANEOUS SHEATH 940 CGS030050NC3 VESSEL DILATOR 5FR:7FR 185 CGS030080NC3 VESSEL DILATOR 8FR:12FR 185 CGS030140NC3 VESSEL DILATOR 14FR:16FR 185 CGS0306018M9 DILATOR(FACIAL)6:18FR 23CM 185 CGS0360508PB DILATOR 5:8FR 20CM 185 CGS0361040PB DILATOR 4:8FR 0.035:0.038" 20:35CM 185 CGS0361090PB DILATOR 9:18FR 0.038:0.052" 25CM 185 CGS03J001NCK VESSEL/FASCIAL DILATOR 擴張器 185 CGS03JCD01CK DILATOR 185 CGS03JCD03CK DILATOR 擴張器 (JCD20:24-45:52-20 自 86.10.27 生效 ) 500 CGS04C304SM4 " 美敦力 " 賽勒克可調彎導管系統 "MEDTRONIC"SELECTSITE DEFLECTABLE CATHETER SYSTEM* 3000 CGVD10DMS1TR PTMV( 經皮穿靜脈氣球導管二尖瓣成形術 )DILATOR 3615 CGVW10GMS1TR PTMV( 經皮穿靜脈氣球導管二尖瓣成形術 )GUIDE WIRE 3615 CGVW20SMS1TR PTMV( 經皮穿靜脈氣球導管二尖瓣成形術 )STYLET 3615 CHA0306397TM SOFT-FLOW AORTIC ARCH CANNULAE WITHOUT REINFORCED 515 CHAT131002DL ARTERIOTOMY CANNULA 2:3MM 1 1/4,2 1/4 295 157

特材代碼中英文品名支付點數 CHAT131003M4 ARTERIOTOMY CANNULAE 295 CHF0696345M4 BIO-MEDICUS CANNULA 套管及導管 (ADULT)23:29FR* 使用參考請見備註欄 17010 CHF0696570M4 BIO-MEDICUS CANNULA 套管及導管 (ADULT)15:21FR* 使用參考請見備註欄 17010 CHF0696825M4 BIO-MEDICUS CANNULA 套管及導管 (PEDIATRIC)8:14FR* 使用參考請見備註欄 17010 CHF06MEFKAML FEMORAL CANNULAE 股動靜脈導管 17010 CHR0110012DL AORTIC CANNULA 12:18G 410 CHR01AR109L5 AORTIC ROOT CANNULAE 9:18GA 410 CHR01AR112L5 AORTIC ROOT CANNULAE 12:16GA 410 CHSU116022AY UMBILICAL VESSEL CATHETER 3.5FR:8FR 170 CHT01CAP40GH POSTOPERATIVE CONVERSION PACKS For Cardiotomy /Autotransfusion /Pleural Drainage Reservoir cap35 1528 CHT0546202H9 HEART LUNG PACK:FLOW PROBE CONNECTOR 914 CHT0546203H9 HEART LUNG PACK:STATSAT CONNECTOR 1/4;3/8;1/2 氧分壓測定接頭 * 914 CHT0569120TM CDI HEMATOCRIT SATURATION CUVETTE 血氧感知器 914 CHT05TMC25M4 TMC TRI-OPTIC MEASUREMENT CELL 914 CHV0312340TM 2 STAGE VENOUS CANNULA 32FR 550 CKB0144002BB CYSTOFIX 10:15FR 8:12CM 542 CKB0144205BB CYSTOFIX 10:15FR 8:12CM 542 CKB0144212BB CYSTOFIX 10:15FR 8:12CM 542 CKB0144215BB CYSTOFIX 10:15FR 8:12CM 542 CKB0156116BA SUPRAPUBIC CATHETERISATION KIT 膀胱穿刺針組 16CH 590 CKB0160600AN VESICO SET 膀胱穿刺引流組 542 CKD0100950CK DOUBLE PIGTAIL(J)STENT SET 4.7:8.2FR(stent+guide wire+pusher) 1570 CKD01BTDJ2BQ DOUBLE J URETERAL STENT SET(STENT+GUIDE+PUSHER) 1117 CKD030472NAN DOUBLE J-STENT 4,7FR 24CM:7FR 32CM 1570 CKD030512NCY ALL SILICONE DOUBLE PIGTAIL URETERAL STENT SET 5:8.5FR(STENT+GUIDEWIRE+PUSHER) 1570 CKD0308518CL SILICON DOUBLE J CATHETER 1570 158

CKD035550NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1570 CKD035572NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1570 CKD035591NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1570 CKD035610NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1570 CKD035704NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1570 CKD035723NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1570 CKD035921NAN URETERAL STENTS(STENT+GUIDE WIRE+PUSHER) 1570 CKD0380155MV CONTOUR SOFT PERCUFLEX STENTS W/HYDROPLUS COATING+GUIDEWIRE+PUSHER+CLAMP 1698 CKD0380220MV CONTOUR SOFT PERCUFLEX STENTS W/HYDROPLUS COATING+GUIDEWIRE+PUSHER+CLAMP 1698 CKD0380244MV CONTOUR SOFT PERCUFLEX STENTS W/HYDROPLUS COATING+GUIDEWIRE+PUSHER+CLAMP 1698 CKD0380801MV CONTOUR SOFT PERCUFLEX STENTS W/HYDROPLUS COATING+GUIDEWIRE+PUSHER+CLAMP 1698 CKD057774NBA URETERAL STENT WITH HYDROPLUS COATING+GUIDE WIRE+PUSHER+CLAMP 1698 CKD05BTDJ3BQ URETERAL STENT(DOUBLE J TYPE)(STENT WITH HYDROPHILIC COATING+GUIDE WIRE+PUSHER+CLIP) 1698 CKD05DSHFNGT DOUBLE PIGTAIL URETERAL STENT SET(stent with hydromer+guide wire+pusher) 1698 CKD05DUSPNGT DOUBLE PIGTAIL URETERAL STENT SET(stent with hydromer+guide wire+pusher) 1698 CKD05DUTWNGT DOUBLE PIGTAIL URETERAL STENT SET(stent with hydromer+guide wire+pusher) 1698 CKD05PSHFNGT DOUBLE PIGTAIL URETERAL STENT SET(stent with hydromer+guide wire+pusher) 1698 CKD05USH01CK "COOK"UNIVERSA STENT FIRM AQ AND SOFT AQ SET (STENT-WITH HYDROPHILIC COATING+GUIDE WIRE+PUSHER) 由尼維莎輸尿管內置支架組 1698 CKD0706016BA SILICON FLOURO-4 URETERAL STENT(stent+introducer kit) 2325 CKDD115122AR ARROW-HOWES LARGE-BORE MULTI-LUMEN HEMODIALYSIS CATHETER 雙腔輸液導管組 900 CKDD214001KD DUAL LUMEN CATHETER 雙頭血液透析管路 900 CKDD214002KD DUAL LUMEN CATHETER 雙頭血液透析管路 900 CKDD242005KD DUAL LUMEN CATHETER 雙頭血液透析管路 900 CKDD245007KD DUAL LUMEN CATHETER 雙頭血液透析管路 900 CKDD288155KD DUAL LUMEN CATHETER 直式雙頭血液透析管路 900 CKDD294009KD CURVED EXTENSION DUAL LUMEN CATHETER 900 159

特材代碼中英文品名支付點數 CKDD2J0KADJ0 DOUBLE LUMEN CATHETERS 900 CKDD2L4424VC 雙頭管路 DIALYSIS CATHETER( 自 950401 起型號更改為 5577180 文號 0940040227) 900 CKDD312123AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS(CATH+NEEDLE+GUIDEWIRE+DILATOR)" 亞諾 " 多重輸液導管套 CKDD325123AR "ARROW"ARROWGARD CATHETERS SETS(CATH+NEEDLE+GUIDEWIRE+DILATOR+SHEATH) 3 LUMEN " 亞諾 " 抗感染安全尖端導管 1738 1738 CKDD345603KD "KENDALL"TRIPLE LUMEN HEMODIALYSIS CATHETERS(C+N+G+D) 三腔透析導管 1738 CKF021800NRU "RUSCH"SYMPACATH BALLOON CATHETERS,COATED WITH HYDROGEL 雙叉親水性留置導尿管 * 115 CKF0222630BA "BARD"BARDEX PEDIATRIC FOLEY CATHETER,LUBRICIOUS COATED,2 WAY 3CC 導尿管 * 115 CKF0222656BA "BARD"FOLEY CATHETER 二叉滑潤長期導尿管 5CC,30CC* 115 CKF02H2265BA BIOCATH HYDROGEL COATING 2 WAY FOLED 8:24FR 5CC,30CC 115 CKF02L0165BA LUBRICATH 2 WAY FOLED 8:26FR 3CC,5CC 115 CKF0300006FM 2 WAY SILICONE FOLEY BALLOON CATH 1.5CC 6FR,3CC 8:10FR 117 CKF030012NFM 2 WAY SILICONE FOLEY BALLOON CATHETER 5CC,30CC 12:26FR 117 CKF0300142R4 2 WAY ALL SILICONE FOLEY BALLOON CATHETER 5CC 12:24FR 117 CKF0300212YN 2 WAY ALL SILICONE FOLEY BALLOON CATH 12:26FR 5CC 117 CKF0300242R4 2 WAY ALL SILICONE FOLEY BALLOON CATHETER 30CC 16:26FR 117 CKF0301641W6 ALL SILICONE 2 WAY FOLEY CATHETER 6FR:26FR* 117 CKF0303308P2 SILICON 2 WAY FOLEY CATHETER* 117 CKF030512NFM 2 WAY SILICONE FOLEY BALLOON CATH W/X-RAY5CC,30CC 12:26FR 117 CKF030513NCL SILICONE 2-WAY FOLEY CATHE 6:26FR 117 CKF0317060RU SILICONE 2 WAY FOLEY CATHETER 6:26FR* 117 CKF0317063RU SILICONE 2 WAY FOLEY CATHETER 16:26FR* 117 CKF034170NES SILICONE 2 WAY FOLEY CATHETER 10CC BALLOON 12FR:26FR 117 CKF036112NP0 2 WAY SILICONE FOLEY CATH 15CC BALLOON 12FR:24FR 117 CKF0376SF6MU MODERN ALL SILICONE FOLEY CATHETER 導尿管 * 117 CKF03AA6CNP0 2WAY SILICON FOLEY 30CC BALLOON* 117 CKF03F0101SG SILICONE 2 WAY FOLEY CATHETER* 117 160

特材代碼中英文品名支付點數 CKF03FC001SG SILICON FOLEY BALLOON CATHETER* 117 CKF03S2100WN SILICONE 2WAY FOLEY CATHE 3:50ML 117 CKF03S6030AY ALL SILICONE 2WAY FOLEY CATHE 3:15ML 8:26FR 117 CKF03S6301AY ALL SILICONE 2WAY FOLEY CATHE 30:45ML 16:26FR 117 CKF0400340R4 3 WAY ALL SILICONE FOLEY BALLOON CATHETER 5CC,30CC 18:26FR 170 CKF040514NFM 3 WAY SILICONE FOLEY BALLOON CATHETER W/X-RAY 30CC 14:26FR 170 CKF041426NFM SILICONE 3 WAY FOLEY CATHETER 14:26FR 170 CKF0417343RU 3 WAY SILICONE FOLEY CATHETER 18:24FR* 170 CKF041831NRU "RUSCH"SYMPACATH BALLOON CATHETERS,COATED WITH HYDROGEL 三叉親水性留置導尿管 * 170 CKF042103NWN SILICONE 3 WAY FOLEY CATHETER 5CC,30CC 16:26FR 170 CKF04H1875BA LUBRICATH 3 WAY FOLEY CATHETER 75CC 18:24FR 283 CKF04H2267BA BIOCATH 3 WAY FOLEY CATHETER 30:50CC 18:24FR 170 CKF04L1630BA HYDROGEL 3 WAY FOLEY CATHETER 30CC 16:26FR 170 CKF04S1830AY SILICON 3 WAY FOLEY CATHETER 18:24FR 170 CKF04Y0630GC 三叉矽質導尿管 * 170 CKN0108000CK PERCUTANEOUS PIGTAIL NEPHROSTOMY SETS 6.0:10FR 15:30CM( 標準型 ) 2716 CKN011450NC3 PERCUTANEOUS NEPHROSTOMY SET PIGTAIL TYPE(chiba N+initial N+D+G+C) 2716 CKN011460NC3 PERCUTANEOUS NEPHROSTOMY SET PIGTAIL TYPE(chiba N+initial N+D+G+C) 2716 CKN011470NC3 PERCUTANEOUS NEPHROSTOMY SET PIGTAIL TYPE(chiba N+initial N+D+G+C) 2716 CKN011897NAN SOFT DRAIN DIRECT PUNCTURE SET(N+C) 2000 CKN0120111MV PCN NEPHROSTOMY SET 8FR 30CM(C+N+D+G+cannecting tube) 2651 CKN0120111SB PERCUTANEOUS NEPHROSTOMY SET-PIGTAIL DESIGN(C+N+D+G) 2716 CKN013873NAN SOFT DRAIN DRAINAGE SET( 針 + 雙腔引流管 +3way+ 固定盤 + 細菌過濾網 + 尖刀 ) 2970 CKN0141010CL PCN NEPHROSTOMY KIT WITH SILICON WALECOT 10FR:14FR(C+ 穿刺 N+ 顯影 N+G+D+ 引流管 ) 3312 CKN015500NAN PERCUTANEOUS NEPHROSTOMY SET: 豬尾巴導管 +chiba N+intial N+G+D+ 引流管袋 + 固定盤 2671 CKN015520NAN NEPHROPUR NEPHROSTOMY SET( 豬尾巴導管 +chiba N+intial N+G+D+ 引流管袋 + 固定盤 ) 2716 161

CKN015521NAN NEPHROPUR NEPHROSTOMY SET( 豬尾巴導管 +chiba N+intial N+G+D+ 引流管袋 + 固定盤 ) 2716 CKN015522NAN SOFT-DRAIN NEPHROSTOMY SET( 豬尾巴導管 +intial N+D+G+ 引流管袋 ) 2651 CKN015526NAN SOFT-DRAIN NEPHROSTOMY SET( 豬尾巴導管 +intial N+D+G+ 引流管袋 ) 2651 CKN0170000PB DRAINAGE SET AND ACCESSORIES 導管 (HYDROFEEL)+N+GX2+D+CO-AXIAL D) 2930 CKN0171000PB DRAINAGE SET AND ACCESSORIES 導管 (HYDROFEEL)+N+G+D+ 引流管袋 + 固定貼布 2975 CKN0175030PB DRAINAGE SET AND ACCESSORIES 導管 (HYDROFEEL)+N+G+D+ 固定貼布 2930 CKN0175730PB DRAINAGE SET AND ACCESSORIES 導管 (HYDROFEEL)+CHIBA N+N+G+D+ 引流管袋 2975 CKN0178000PB PIGTAIL NEPHROSTOMY SET( 自 950401 起增加型號 780016030. 文號 0940041345) 2939 CKN0178050PB PIGTAIL NEPHROSTOMY SET W/SAFETY STRING LOCK SYSTEM( 自 950401 起增加型號 780516030. 文號 0940041345) 導管 (HYDROFEEL)+STIFFENER+GX2+D+ 固定貼布 2930 CKN01PNPDLCY PIGTAIL NEPHROSTOMY SET 6:10FR 40CM 2651 CKN01PNS01CK SAFE-T-J CURVED WIRE GUIDE 320 CKN0218522FM SILICONE 2WAY NEPHROSTOMY BALLOON CATHETER X-RAY OPEN TIP 8:24FR 338 CKN0218523FM SILICONE 3WAY NEPHROSTOMY BALLOON CATHETER X-RAY OPEN TIP 14:24FR 357 CKN0218562FM SILICONE 2WAY NEPHROSTOMY BALLOON CATHETER TIEMANN TIP 338 CKN0218563FM SILICONE 3WAY NEPHROSTOMY BALLOON CATHETER TIEMANN TIP 357 CKN0251608CL SILICON NEPHROSTOMY BALLOON CATHETER 8:10FR 球型腎臟造廔管 338 CKN0251612CL SILICON NEPHROSTOMY BALLOON CATHETER 12:24FR 球型腎臟造廔管 338 CKN0252116CL SILICON 3 WAY FOLEY CATHETER 16:26FR 170 CKN02N2108YN ALL SILICONE NEPHROSTOMY BALLOON CATHETER 8:24FR1.5:5CC 338 CKN02NS001SG SIGMA NEPHROSTOMY CATHETER(SILICON)* 338 CKN02S0101SG SILICONE 2 WAY NEPHROSTOMY CATHETER 338 CKN0318552FM SILICONE NEPHROSTOMY CATHETER WITH DETACHABLE FUNNEL 14:24FR 338 CKN0351912CL SILICON NEPHROSTOMY BALLOON CATHETER W/REMOVABLE 12:24FR 可分離式腎臟造廔管 530 CKN0410111MV PERCUTANEOUS NEPHROSTOMY CATHETER WITH LOOP LOCKING RETENSION 豬尾巴導管 829 CKN0418572FM SILICONE NEPHROSTOMY PIGTAIL PATTERN CATHETER 12FR 338 CKN045524NAN SOFT DRAIN PIGTAIL DRAINAGE CATHETER WITH 2 WAY STOPCOCK 530 162

CKN04BTPDSBQ NEPHROSTOMY CATHETER(WITH STYLET&FLEXIBLE CANNULA) 829 CKN0508240CK MALECOT CATHETER 885 CKN051111NWN MALECOT CATHETER 4 WING 12:40FR 273 CKN0514010CL SILICON 4 WING MALECOT 10:26FR 梅花型腎臟造廔管 885 CKN051840NFM "FORTUNE"SILICONE MALECOT CATHETER 14:36FR 矽質梅花型引流管 885 CKN0586010BA MALECOT NEPHROSTOMY TUBE 16:36FR 273 CKN059106NRU MALECOT CATHETER 4 WING CH10:40 273 CKN0718512FM SILICONE 2WAY NEPHROSTOMY CATHETER X-RAY OPAQUE TIP 8:24FR 338 CKN0718513FM SILICONE 3WAY NEPHROSTOMY CATHETER X-RAY OPAQUE TIP 14:24FR 357 CKS016020NAN "ANGIOMED"URETERAL STENTS(STENT+GUIDE+PUSHER) 1117 CKS022916XCL CLINY SILICONE SINGLE PIGTAIL URETERAL STENT 6:8.5FR(stent+Guide wire+ Pusher) 1570 CKS0275290PB URETERAL PIGTAIL STENT SET HYDROFEEL STEERABLE(STENT+G+SHEATH+CLIP) 1570 CKS0276040PB URETERAL PIGTAIL STENT SET HYDROFEEL STANDARD(STENT+G+SHEATH+CLIP) 1698 CKS0276290PB URETERAL PIGTAIL STENT SET HYDROFEEL STANDARD(STENT+G+SHEATH+CLIP) 1698 CKS0276300PB URETERAL PIGTAIL STENT SET HYDROFEEL PEDIATRIC(STENT+G+SHEATH+CLIP) 1698 CKS0276320PB URETERAL PIGTAIL STENT SET HYDROFEEL STEEERABLE(STENT+G+SHEATH+CLIP) 1698 CKS0276340PB URETERAL PIGTAIL STENT SET HYDROFEEL STEEERABLE(STENT+G+SHEATH+CLIP) 1698 CKU0303903P2 URETERAL CATHETER STRAIGHT TIP 3:7FR 75CM 166 CKU03051XNP0 URETERAL CATHETER STRAIGHT OLIVE TIP 3FR:12FR NYLON STYLET 166 CKU03054XNP0 URETERIC CATHETER STRAIGHT OLIVE TIP 3FR:12FR 166 CKU0324103CK "COOK"URETERAL CATHETER 輸尿管導管 166 CKU033316XH0 URETERAL CATHETER OLIVE TIP 166 CKU0336504BA URETERAL CATHETER (OLIVE TIP) 4:6FR 166 CKU0337504BA URETERAL CATHETER (SPIRAL) 4:6FR 166 CKU0338008BA URETERAL CATHETER (CONE TIP) 8:12FR 166 CKU0362400AN URETERAL CATHETER 166 163

特材代碼中英文品名支付點數 CKU0362433AN URETERAL CATHETER 166 CKU036243NAN URETERAL CATHETER 166 CKU0362453AN URETERAL CATHETER 166 CKU036245NAN URETERAL CATHETER 166 CKU0362500AN URETERAL CATHETER 166 CKU036251NAN URETERAL CATHETER CYLINDERAL 4:8CH 70CM 斑馬線導管 166 CKU0362930AN URETERAL CATHETER 166 CKU036313NAN URETERAL CATHETER 166 CKUB101000CK URETeRAL BALLOON dilator CATHETER 65CM 5FR,7FR 4032 CKUB101415CK BALLOON URETERAL(UREThERAL 自 980401 起改為 URETERAL) DILATOR SETS 5:7FR 65CM(CATH+GUIDE WIRE) 5068 CKUB107835CK "COOK"URETEROSCOPY BALLOON CATHETER(CATHETER+GUIDE WIRE) 輸尿管氣球導管 5068 CKUB121810SB PASSPORT urological BALLOON dilatation catheter with hydro plus bonded hydrogel coating 5068 CKUB122510MV UROMAX ULTRA HIGH PRESSURE URETERAL CATHETER W/SHEATH 5068 CKUB128005CK COOK UPJ OCCLUSION BALLOON CATHETER SETS(CATH+GUIDE WIRE) 5068 CKUB18884NBA UROFORCE BALLOON DILATION CATHETER 4032 CKUB1AUBS1CK COOK ASCEND AQ URETERAL DILATION BALLOON CATHETER 4CM:10CM 4032 CKUB1TB221SB TRILOGY LOW PROFILE URETERAL BALLOON CATHETER 4032 CKUD126100SB BOSTON SCIENTIFIC AMPLATZ TYPE GRADUATED RENAL DILATOR SET 953 CKUD126120SB "BOSTON SCIENTIFIC"AMPLATZ TYPE GRADUATED RENAL STYLET/SHEATH 695 CKUD160300AN RENAL DILATOR W/SHEATH 695 CKUD200008CL SILICON NEPHROSTOMY DILATOR 腎擴張造廔導管 117 CKUD200012CL SILICON NEPHROSTOMY DILATOR 腎擴張造廔導管 164 CKUD200016CL SILICON NEPHROSTOMY DILATOR 腎擴張造廔導管 234 CKUD200040AN PTFE DILATOR 4:9FR 117 CKUD200120AN PTFE DILATOR 12:14FR 164 CKUD20012DAN "ANGIOMED"DILATATION SET 12FR 擴張器組 164 164

特材代碼中英文品名支付點數 CKUD200160AN PTFE DILATOR 16FR 234 CKUS163206CL SILICON CHOLANGICAL BALLOON CATHETER 6:8FR 612 CKUS22614NSB AMPLATZ TYPE RENAL SHEATH SET 820 CKUS26015NSB "BOSTON SCIENTIFIC"AMPLATZ TYPE RENAL SHEATH SET/INDIVIDUAL SHEATHS 820 CKUS2AMPV1CK TFE SHEATHS FOR AMPLATZRENAL DILATORS 10:36FR,16:40CM 820 CLPA102000E5 SINGLE TITANIUM EPOXY PERITONEAL PORT(P+C+N) 限化學治療及癌症未期之疼痛治療使用 9370 CLPA102000HJ PERITONEAL SYSTEM PORT-A-CATH (P+C+N)( 含動脈, 腹膜及靜脈系統 ) 9370 CLPA104150HJ PROPORT IMPLANTABLE VENOUS ACCESS SYSTEMS(P+C+N) 9370 CLPA104151HJ PROPORT IMPLANTABLE VENOUS ACCESS SYSTEMS(P+C+N+I+GW+GRIPPER NEEDLE) 10464 CLPA105041AR 1 LUMEN PICC RADIOLOGY SELDINGER ACCESS SET(CATHETER+NEEDLE+DILATOR+GUIDE WIRE) 3050 CLPA105052AR DUAL LUMEN PICC RADIOLOGY SELDINGER ACCESS SET(C+G+I+T-PORT) 3500 CLPA10604NBA MRI SINGLE LUMEN IMPLANTED PORTS(PORT+C+N)* 9370 CLPA10615NBA MRI DUAL-LUMEN IMPLANTED PORTS(PORT+C+N)* 9700 CLPA107500BA X-PORT ISP IMPLANTED PORT (P+C+N)* 9370 CLPA107530BA X-PORT ISP IMPLANTED PORT (P+C+N+I)* 10370 CLPA108050E5 TI DUAL PORT (P+C+N) 型號 21-8065,67 自 90/10/1 生效限癌症化療及癌症未期之疼痛治療使用 9700 CLPA108050HJ DUAL LUMEN TITANIUM PORT (P+C+N) 9500 CLPA108052E5 DUAL LUMEN TITANIUM PORT (P+C+N+I) 限化學治療及癌症未期之疼痛治療使用 10700 CLPA108052HJ DUAL LUMEN TITANIUM PORT (P+C+N+I) 10700 CLPA108066E5 TITANIUM DUAL LUMEN PORT-A SYSTEM(C+G+N+I+GRIPPER NEEDLE) 10794 CLPA108066HJ DUAL LUMEN TITANIUM PORT (P+C+N+I+GRIPPER NEEDLE) 10794 CLPA115103CL SINGLE TITANIUM SUBCUTANEOUSLY IMPLANTED PORT(PORT+CATH+NEEDLE) 9370 CLPA11PS0TCK VITAL-PORT VASCULAR ACCESS SYSTEMS(P+C+N+I+GW) 10370 CLPA120011US SINGLE TITANIUM CHEMOSITE LOW PROFILE PORT 7FR (P+C+N+I) 10370 CLPA120020US SINGLE TITANIUM CHEMOSITE VENOUS PORT(PORT+CATH+NEEDLE) 9370 CLPA120021US SINGLE TITANIUM CHEMOSITE LOW PROFILE PORT 9FR(P+C+N+I) 10370 165

CLPA120022US SINGLE TITANIUM CHEMOSITE LOW PROFILE PORT(PORT+CATH+NEEDLE) 9370 CLPA120023US SINGLE TITANIUM CHEMOSITE LOW PROFILE PORT(PORT+CATH+NEEDLE) 9370 CLPA120024US SINGLE TITANIUM CHEMOSITE LOW-PROFILE PORT(P+C+N) 9370 CLPA120025US SINGLE TITANIUM CHEMOSITE LOWPROFILE VENOUS PORT 9FR(P+C+N+I) 10370 CLPA120026US SINGLE TITANIUM CHEMOSITE LOW-PROFILE PORT(PORT+CATH+NEEDLE) 9370 CLPA120027US SINGLE TITANIUM CHEMOSITE LOW-PROFILE PORT(PORT+CATH+NEEDLE) 9370 CLPA120044US SINGLE TITANIUM CHEMOSITE PORT(PORT+CATH+NEEDLE) 9370 CLPA120045US SINGLE TITANIUM CHEMOSITE PORT 9FR(P+C+N+I) 10370 CLPA120066US SINGLE LUMEN TITANIUM CHEMOSITE VENOUS PORT 9FR(P+C+N+I) 10370 CLPA120067US SINGLE TITANIUM CHEMOSITE ARTERIAL PORT(PORT+CATH+NEEDLE) 9370 CLPA120085US SINGLE TITANIUM CHEMOSITE VENOUS PORT(PORT+CATH+NEEDLE) 9370 CLPA120092US SINGLE TITANIUM CHEMOSITE VENOUS PORT 7FR(P+C+N+I) 10370 CLPA120115US SINGLE TITANIUM CHEMOSITE LOW-PROFILE ARTERIAL PORT(P+C+N) 9370 CLPA12130NE5 SINGLE TITANIUM PORT-A CATHETER(P+C+N) 9370 CLPA130000BB SINGLE TITANIUM MBS CELSITE PORT(PORT+CATH+NEEDLE) 9370 CLPA130026BB SINGLE TITANIUM EPOXY CELSITE PORT(PORT+CATH+NEEDLE), 型號 :04430379 自 940701 起刪除 9370 CLPA130050BB SINGLE TITANIUM EPOXY CELSITE ARTERIAL PORT(P+C+N) 9370 CLPA130069BB SINGLE TITANIUM EPOXY CELSITE PERITONEAL PORT(P+C+N) 9370 CLPA130085BB SINGLE TITANIUM EPOXY CELSITE PORT(PORT+CATH+NEEDLE) 9370 CLPA13008NYP "PEROUSE"POLYSITE IMPLANTABLE PORT(PORT+CATH) 植入式血管輸注器 * 9285 CLPA130092BB CLPA130100BB "B.BRAUN"CELSITE IMPLANTABLE PORTS (PORT+CATH+NEEDLE+INTRODUCER) 舒載皮下植入式注射座組 *, "B.BRAUN "CELSITE IMPLANTABLE DOUBLE PORTS (P+C+N+I+GRIPPER NEEDLE) 舒載皮下植入式雙槽注射座 * 10370 10794 CLPA130166HD HDC V-CATH SINGLE LUMEN PICC SET (C+N+D+G) 3050 CLPA130395BB CELSITE IMPLANTABLE PORT,STANDARD (P+C+N+I)* 10370 CLPA130893BB CELSITE IMPLANTABLE PORT,SMALL (P+C+N+I)*( 型號 04436962 文號 :920036552)( 型號 04436806 自 940701 起刪除 ) 10370 CLPA132045BB SINGLE TITANIUM MBS CELSITE PORT(PORT+CATH+NEEDLE+INTRODUCER) 10370 166

CLPA133718BB CELSITE IMPLANTABLE PORT,STANDARD (P+C+N+I)*, 型號 :4433718 自 940701 起刪除 10370 CLPA135000HD HDC V-CATH SINGLE LUMEN PICC SET (C+N+D+G) 3050 CLPA135575HD HDC V-CATH SINGLE LUMEN PICC SET(C+N+D+G) 3050 CLPA136008HD HDC V-CATH SINGLE LUMEN PICC SET(C+N+D+G) 3050 CLPA138008HD HDC V-CATH SINGLE LUMEN PICC SET(C+N+D+G) 3050 CLPA139008HD HDC V-CATH DUAL LUMEN PICC SET(C+N+D+G) 3500 CLPA139266HD HDC V-CATH DUAL LUMEN PICC SET(C+N+D+G) 3500 CLPA139450HD HDC V-CATH DUAL LUMEN PICC SET(C+N+D+G) 3500 CLPA139550HD HDC V-CATH DUAL LUMEN PICC SET(C+N+D+G) 3500 CLPA140040HD HDC V-CATH SINGLE LUMEN PICC SET(C+N+D+G) 3050 CLPA14009NE5 SINGLE TITANIUM PORT-A CATHETER(PORT+C+N+I+GRIPPER NEEDLE) 10464 CLPA14024NE5 TI SINGLE PORT-A(P+C+N) 型號 21-4022,64,70,72,84 自 90/10/1 生效限癌症化療及癌症未期之疼痛治療使用 9370 CLPA14025NE5 SINGLE PORT-A CATH(P+C+N+I) ( 型號 21-4023,63,65,85,3020 自 90/10/01 生效 ) 10370 CLPA14025NHJ TITANIUM PORT-A-CATH (P+C+N+I) 10370 CLPA14071NE5 TITANIUM SINGLE LUMEN PORT-A SYSTEM(C+G+N+I+GRIPPER NEEDLE) 10464 CLPA14072NHJ "SMITHS"IMPLANTABLE ACCESS SYSTEM 內植用輸液管 (P+C+N+I+GRIPPER NEEDLE)* 10464 CLPA14130NBA SINGLE LUMEN PER-Q-CATHETER WITH GUIDWIRE 2.0:5.0FR 2960 CLPA145458SB CLPA145468SB VAXCEL PERIPHERALLY INSERTED CENTRAL CATHETER(PICC) WITH PASV VALVE TECHNOLOGY(SINGLE LUMEN,3:5FR,60CM )(C+N+D+G)* VAXCEL PERIPHERALLY INSERTED CENTRAL CATHETER(PICC) WITH PASV VALVE TECHNOLOGY(DUAL LUMEN,4:6FR,60CM )(C+N+D+G)* 3050 3500 CLPA150276HD HDC V-CATH DUAL LUMEN PICC SET(C+N+D+G) 3500 CLPA15105KHZ VORTEX VTX TITANIUM VASCULAR ACCESS PORTS(P+C+N+I)* 10370 CLPA160260DV SINGLE PLASTIC HICKMAN PORT(PORT+CATH+NEEDLE) 9370 CLPA160284BA SINGLE MRI PLASTIC PORT W/GROSHONG 3-WAY(P+C+N) ( 型號 0604510 自 91/07/01 生效 ) 9370 CLPA161548BA MRI DUAL PORT W/GROSHONG CATHETER(PORT+CATH+NEEDLE) 9700 CLPA161635PF ARTERIAL PORT-CATH(PORT+CATH+NEEDLE+INTRODUCER) 10370 CLPA161636PF SINGLE LUMEN PFM VASCULAR ACCESS SYSTEM JET (C+G+N+I+GRIPPER NEEDLE)* 10464 167

CLPA165750BA X-PORT ISP IMPLANTED PORT WITH MICROINTRODUCER KIT(P+C+N+I)* 適應正請見備註欄 10370 CLPA170754BA X-PORT ISP IMPLANTED PORT WITH INTERMEDIATE KIT(P+C+N+I)* 適應正請見備註欄 10370 CLPA17505NBA "BARD"GROSHONG PERIPHERALLY INSERTED CENTRAL VENOUS DUAL-LUMEN W/INTRODUCER KIT* 3500 CLPA176174BA "BARD"GROSHONG NXT CLEAR VUE 4FR.SINGLE LUMEN(PICC) 葛羅祥刻立回中央靜脈導管 * 2960 CLPA17715NBA SINGLE LUMEN GROSHONG PERIPHERALLY INSERT CENTRAL VENOUS CATH 3,4FR 2960 CLPA177255BA DUAL LUMEN GROSHONG PERIPHERALLY INSERT CENTRAL VENOUS CATH 3000 CLPA1MS41NBD CLPA1P0R45SB CLPA1P1CC1CK CLPA1P1CC2CK CLPA1P1CC3CK CLPA1P1CC4CK CLPA1P1CC5CK CLPA1P1CC6CK 1 LUMEN FIST PICC PROCEDURE KIT 3:5FRX65CM (C+G+I+T-PORT) 限癌症化療及癌症末期之疼痛治療使用 "BOSTON SCIENTIFIC"VAXCEL IMPLANTABLE PORTS WITH PASV TECHNOLOGY (SINGLE LUMEN)(P+C+NX2+I)* TURBO-FLO PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER(PICC) SET-ONE LUMEN (C+D+G+N)* 適應請見備註欄 TURBO-FLO PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER(PICC) SET-ONE LUMEN (C+D+G+N)* 適應請見備註欄 TURBO-FLO PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER(PICC) SET-TWOLUMEN (C+D+G+N)* 適應請見備註欄 TURBO-FLO PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER(PICC) SET-TWOLUMEN (C+D+G+N)* 適應請見備註欄 TURBO-FLO OVER THE WIRE PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER(PICC)SET(SINGLE LUMEN C+I+G)* TURBO-FLO OVER THE WIRE PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER(PICC)SET(DOUBLE LUMEN C+I+G)* 3050 10370 3050 3050 3500 3500 3050 3500 CLPA1P1CC7CK "COOK"TURBO-JECT PICC SET(CATH+INTRODUCER) 週邊導入中央靜脈導管組 ( 單腔 )* 3050 CLPA1P1CC8CK "COOK"TURBO-JECT PICC SET(CATH+INTRODUCER) 週邊導入中央靜脈導管組 ( 雙腔 )* 3500 CLPA1PD41NBD CLPA1PP1C1M0 CLPA1PP1C2M0 CLPA1PS41NBD 2 LUMEN FIST PICC PROCEDURE KIT 65CM (C+G+I+T-PORT) 限癌症化療及癌症末期之疼痛治療使用 "MEDCOMP"PRO-PICC PERIPHERALLY INSERTED CENTRAL VEIN CATHETER SET(SINGLE LUMEN C+N+G+D) 普羅匹克週邊導入中央靜脈導管組 * "MEDCOMP"PRO-PICC PERIPHERALLY INSERTED CENTRAL VEIN CATHETER SET(DOUBLE LUMEN C+N+G+D) 普羅匹克週邊導入中央靜脈導管組 * 1 LUMEN FIST PICC PROCEDURE KIT 1.9:5FRX65CM (C+G+I+T-PORT) 限癌症化療及癌症末期之疼痛治療使用 3500 3050 3500 3050 CLPA1VP100GH SINGLE PLASTIC VAS PORT (PORT+CATH+NEEDLE+INTRODUCER) 10370 CLPA1VP150GH SINGLE PLASTIC VASPORT SYSTEM(PORT+CATH+NEEDLE+INTRODUCER)* 10370 CLPA1VTXTRRH "RITA"VORTEX TR PORT SYSTEM(P+C+N+I) 植入型注射系統 * 10370 CLS040114NPW INFUSION SET W/BURETTE W/VALVE 100CC 68 CLS0404965HR SOLUSET 100X60 PRECISION VOLUME IV SET W/100ML BURETTE AND MICRODRIP CHAMBER 94.5 CLS040520VBB DOSIFIX VOLUME CONTROL ADMMINISTRATION SET 120ML WITH VALVE 68 168

CLS040708NPW PERFECT DISPOSABLE INFUSION SET(W/BURETTE W/VALVE) 68 CLS041VC01TZ VOLUME CONTROL I.V ADMINISTRATION SET 60 CLS041VPB3JS JMS INFUSION SET WITH BURET 100CC 63 CLS046369NPW INFUSION SET W/BURETTE W/VALVE 150CC,200CC 68 CLS04BR150SG VOLUME METERIC ADMINISTRATION SET W/FILTER 63 CLS04BRM08LL INFUSION SET WITH BURETTE 100CC 63 CLS04BS120SG VOLUME METERIC ADMISTRATION SET W/VALVE W/FILTER 68 CLS04BS150SG VOLUME METERIC ADMINISTRATION SET W/VALUE W/FILTER 68 CLS04BT100SG VOLUMEMETRIC ADMINSTRATION SET 63 CLS04BT120SG VOLUME METERIC ADMISTRATION SET W/FILTER 63 CLS04BT163BQ Infusion set 100ml with valve &filter 68 CLS04BT164BQ Infusion set 150ml with valve &filter 68 CLS04BUM08LL INFUSION SET WITH BURETTE( 雙路式 ) 63 CLS04BV100SG VOLUMEMMETRIC ADMINSTRATION SET 100ML WITH VALVE 68 CLS04BV150SG VOLUMEMMETRIC ADMINSTRATION SET 150ML WITH VALVE 68 CLS04C5894BT BURETROL IV SOLUTION ADMINISTRATION SET W/ VALVE 68 CLS04CSBACLL "LILY"VOLUME METERIC ADMINISTRATION SET W/VALVE 精密輸液套 68 CLS04CSBESLL "LILY"VOLUME METERIC ADMINISTRATION SET(W/VALVE)* 68 CLS04CSBRBLL VOLUME METERIC ADMINISTRATION SET 100ML 120ML 150ML 附過濾網 60 CLS04CSBVFLL VOLUME METERIC ADMINISTRATION SET 100ML 120ML 150ML 附過濾網 60 CLS04CSBVSLL VOLUME METERIC ADMINISTRATION SET 100ML 120ML 150ML W/VALVE 附止水閥附過濾網 68 CLS04IVC01TZ VOLUME CONTROL I.V ADMINISTRATION SET 60 CLS04IVPBFJS INFUSION SET PEDIATRIC 100ML BURET W/FLOAT VALVE 68 CLS04M270LTM TERUFUSION VOLUMETRIC SOLUTION ADMINISTRAION SET WITH VALVE 68 CLS04SBAFHLL VOLUME METERIC ADMINISTRATION SET 150CC W/VALVE 68 CLS04VB10LFP "MEDPRO"INFUSION SET 輸液套 60 169

特材代碼中英文品名支付點數 CLS04VB10SFP "MEDPRO"INFUSION SET 輸液套 60 CLS04VB10YFP "MEDPRO"INFUSION SET WITH VALVE 輸液套 68 CLS04VB12CBB B.BRAUN IV-FIX BURETTE INFUSION SET WITH VALVE 68 CLS0501648HR PLUMSET I.V PUMP SET* 192 CLS0501756HR PRIMARY IV PUMP SET* 192 CLS0502210ZL "CARDINAL" ADMINSTRATION SET 192 CLS0502230ZL "CARDINAL" ADMINSTRATION SET(0.2MICRO FILTER) 307 CLS0502260ZL "CARDINAL" ADMINISTRATION SET 283 CLS0502280ZL "CARDINAL" ADMINSTRATION SET 192 CLS05036EHM8 MEDITOP INFUSION SET FOR INFUSION PUMP (IV PUMP SET)* 73.6 CLS05036SPBB "B.BRAUN"INFUSOMAT SPACE LINE 史倍司輸液套 * 73.6 CLS0503704HR IV PUMP SET* 192 CLS05037EHM8 MEDITOP INFUSION SET FOR INFUSION PUMP (IV PUMP SET)* 73.6 CLS050F825HR IV PUMP SET* 180 CLS051117ABT VOLUMETERIC PUMP SET( 型號 FNC1117B 自 090/07/01 起生效 ) 192 CLS052027HM8 "MEDITOP"INFUSION SET FOR INFUSION PUMP 輸液套 ( 輸液幫浦用 ) 73.6 CLS0526WEHM8 MEDITOP INFUSION SET FOR INFUSION PUMP (IV PUMP SET)* 73.6 CLS05668SPBB INFUSOMAT SPACE LINE 史倍司輸液套 * 73.6 CLS05A200LTM TERUFUSION IV PUMP SET WITHOUT BAG 73.6 CLS05C0169BT COLLEAGUE PUMP SYRINGE ADAPTER SET * 60 CLS05C7542BT BURETROL PUMP SET WITH 3-INJ SITE 237 CLS05C9604BT CONTINU-FLO PLUS SOLUTION ADMINISTRATION PUMP SET* 180 CLS05T037HTP INFUSION PUMP SET 92 CLS0601753HR SOLUSET 150ML BURETTE IV PUMP SET* 237 CLS0601772HR HOSPIRA SPECIALTY PUMP SET(VENTED NITROGLYCERINE I V SET) 283 CLS0602241ZL "CARDINAL" ADMINSTRATION SET 237 170

特材代碼中英文品名支付點數 CLS0602427HR PUMP SET(NITROGLYCERIN) 283 CLS060E798HR HOSPIRA IV PUMP SETS* 237 CLS060F821HR NTG PUMP SET-STERILE WITH LIGHT PROTECTIVE POLYETHYLENE TUBING 220 CLS060F826HR SOLUSET 150X60 PUMP SET BURETTE I V ADMINSTRATION SET* 180 CLS060L217HR IV PUMP SET 220 CLS060L218HR NTG PUMP SET WITH LIGHT PROTECTIVE POLYETHYLENE TUBINGING 220 CLS0611706HR BURETTE PUMP SET* 237 CLS0611879HR PLUMSET IV PUMP SET W/FILTER 307 CLS06125SPBB INFUSOMAT SPACE LINE UV-PROTECT 史倍司輸液套 ( 不透光型 ) 220 CLS06731SPBB INFUSOMAT SPACE LINE PVC-FREE SET FOR THE ADMINISTRATION OF CYTOTOXIC AGENTS 史倍司輸液套 220 CLS06C7544BT BURETROL SOLUTION PUMP SET * 237 CLS06C7552BT VENTED NITROGLYCERIN PUMP SET 283 CLS06C7553BT (NON-)VENTED PACLITAXEL SET W/0.22MICRON FILTER 290 CLS06C9644BT LIGHT SENSITIVE CLEARLINK SET 無針系統含過濾器避光輸液套 307 CLS06C9651BT BURETROL PUMP SET W/BURETTE 237 CLS06M270LTM TERUFUSION IV PUMP SET WITH BAG 100CC 122.6 CLS071724NPW TRANSFUSION SET 20 CLS07A130NPW PERFECT DISPOSABLE TRANSFUSION (L TYPE ) 20 CLS07A200BTM BLOOD ADMINISTRATION SET 20 CLS07A200LTM BLOOD ADMINISTRATION SET 20 CLS07BT350JS BLOOD TRANSFUSION SET 20 CLS07C5896BT BLOOD ADMINISTRATION SET 20 CLS08066SPBB INFUSOMAT SPACE LINE TRANSFUSION WITH 200UM BLOOD FILTER 史倍司輸血套 230 CLS0808949HR Y-TYPE BLOOD SET WITH PUMP 230 CLS0811664HR Y-TYPE BLOOD PLUMSET 230 CLS0900BTYJS Y TYPE BLOOD TRANSFUSION SET 22 171

特材代碼中英文品名支付點數 CLS0902004TM Y TYPE ADMINISTRATION SET 22 CLS0902005TM Y TYPE ADMINISTRATION SET 22 CLS09A140NPW PERFECT DISPOSABLE TRANSFUSION (Y TYPE ) 22 CLS09B140NPW Y TYPE BLOOD TRANSFUSION SET 22 CLS1202427HR PUMP SET(NITROGLYCERIN) 283 CLS14B8083CT VIAFLEX TPN BAG 500C.C. 96 CLS14B8084CT VIAFLEX TPN BAG 1000C.C. 125 CME04CYNACNG NBCA 栓塞球固定液 0.5CC 腦血管栓塞導管栓塞劑 1905 CMV0118298SB RENEGADE HI-FLO MICROCATHETER KIT(MICROCATH+G WIRE+HEMASTATIC)* 14963 CMV0149152SB SPINNAKER ELITE FLOW DIRECTED INFUSION CATHETER SET(INFUSION CATH+MICRO GUIDEWIRE+HEMASTATIC )* 14963 CMV0149152TA SPINNAKER INFUSION CATHTER(CATH+GUIDEWIRE+HEMASTATIC) 14963 CMV0149181SB EXCELSIOR MICROCATHETER LENGTH 150/6 TIP CONFIGURATION 1,2 MARKER * 7440 CMV0149189SB EXCELSIOR PRE-SHAPED MICROCATHETER* 7440 CMV0150103SB FAS TRACKER INFUSON CATHETER KIT(CATH+GUIDE WIRE+HEMASTATIC)* 14963 CMV016060NCD PROWLER INFUSION CATHETER 7440 CMV016061NCD PROWLER INFUSION CATHETER 7440 CMV01606S1CD "CORDIS"PROWLER SELECT LP&LP-ES INFUSION CATHETER 保勒注射導管 * 7440 CMV01606S2CD "CORDIS"PROWLER SELECT PLUS INFUSION CATHETER 保勒注射導管 * 7440 CMV01606XNCD PROWLER INFUSION CATHETER * 7440 CMV016251NCD PROWLER INFUSION CATHETER 7440 CMV018819XNY NYCOMED STARFAST-18 HYDROPHILIC MICRO CATHETER 適應症請見備註 14963 CMV01E2710TM PROGREAT CATHETER(MICRO CATH+INTRODUCER WIRE+COATING+HEMASTATIC) 14963 CMV01ECHL0V9 "MTI"ECHELON MICRO CATHETERS 微導管 (CATH+MICRO GUIDE WIRE+HEMASTATIC)* 14963 CMV01FS135MR "MERIT"FOUNTAIN INFUSION SYSTEM(CATH+GUIDE WIRE+HEMASTATIC) 芳登灌輸系統 * 14963 CMV01MC11XCY COSMO MICRO CATHETER KIT(CATH+GUIDEWIRE+Y CONNECTOR+TORQUE DEVICE) 14963 CMV01MC1S2CK "COOK"MULTI-SIDEPORT CATHETER INFUSION SET 多側孔注射導管組 * 7440 172

特材代碼中英文品名支付點數 CMV01MF251CK "COOK"MIRA-FLEX 18 MICROCATHETER* 7440 CMV01MFNT1CK "COOK"MIRAFLEX MICROCATHETER 麥拉菲微導管 * 7440 CMV01MFS01CK MICROFERRET-21 HIGH FLOW INFUSION CATH SET(C+G+CONNE.+TOR.DEVICE) 14963 CMV01MFS11CK COOK MICROFERRET-18 INFUSION CATHETER SET(CATH+GUIDE WIRE+HEMASTATIC)* 14963 CMV01MFS15CK COOK MICROFERRET-18 INFUSION CATHETER SET(CATH+GUIDE WIRE+HEMASTATIC)* 14963 CMV01P2710TM PROGREAT CATHETER(MICRO CATH+INTERODUCER WIRE+COATING+HEMASTATIC) 14963 CMV01PC241TM PROGREAT CATHETER(MICRO CATH+INTRODUCER WIRE+COATING+HEMASTATIC) 14963 CMV01REBARV9 MTI REBAR MICRO CATHETER SET(MICRO CATH+GUIDE WIRE+HEMASTATIC) 恩提愛瑞霸微導管 * 14963 CMV01SCR3NCK "COOK"MULTI-SIDEPORT CATHETER INFUSION SET 多側孔注射導管組 * 7440 CMV01SCWHVMR "MERIT"FOUNTAIN INFUSION SYSTEM(CATH+GUIDE WIRE+HEMASTATIC) 芳登灌輸系統 * 14963 CMV01SMAGXBL BALT MAGIC CATHETER SET 18227 CMV01SQ135MR "MERIT"FOUNTAIN INFUSION SYSTEM(CATH+GUIDE WIRE+HEMASTATIC) 芳登灌輸系統 * 14963 CMV01STDATAS ASAHI MICRO CATHETER * 7440 CMV0205102SB FAS TRACKER INFUSON CATHETER* 7440 CMV0205102TA TARGET FASTRACKER INFUSION CATHETER 7440 CMV0210062SB "BOSTON SCIENTIFIC"GUIDER SOFTIP XF GUIDING CATHETER* 6923 CMV0210062TA GUIDER SOFTIP GUIDING CATHETER 5FR 90,100CM * 6923 CMV0214270SB TRACKER EXCEL-14 MICROCATHETER* 7440 CMV0214270TA TARGET THERAPEUTICS TRACKER EXCEL-14 MICROCATHETER* 7440 CMV02142NNTA TARGET THERAPEUTICS TRACKER EXCEL-14 MICROCATHETER* 7440 CMV0218251SB RENEGADE MICROCATHETER* 7440 CMV0218251TA RENAGADE FIBER BRAIDED MICRO CATH PROXIMAL/DISTAL 3F/2.5F 130,150CM 7440 CMV0218282SB RENEGADE HI-FLO MICROCATHETER OD=3.0F/2.8F ID=0.027/0.027 L80/150CM * 7440 CMV0218284SB RENEGADE HI-FLO MICROCATHETER O.D 3.0,2.8F I.D 0.027 L 80,150CM * 7440 CMV02600XNCD TRANSIT INFUSION CATHETER 3FR/2.5FR 75,90,105,140,155,175CM 7440 CMV02FT10XCY INTRACEREBRAL BRAIDED GUIDING CATHETER HYDROPHILIC 5FR,6FR 100CM 6923 173

CMV02KCFW1CK "COOK"FLEXOR GUIDING CATHETERS 福雷色引導導管 * 6923 CMV02KSAW1CK COOK FLEXOR GUIDING CATHETERS 5:8FR 90CM* 6923 CMV02KSAW2CK COOK FLEXOR GUIDING CATHETERS 0.038" 70:90CM* 6923 CMV02KSAW3CK "COOK"FLEXOR GUIDING CATHETERS 5.0FR:8.0FR 0.018/0.038:0.038 40CM:90CM 6923 CMV02KSAW4CK "COOK"FLEXOR GUIDING CATHETERS 弗萊色引導導管 * 6923 CMV02KSAW5CK "COOK"FLEXOR GUIDING CATHETERS 弗萊色引導導管 * 6923 CMV02LMGN1CK "COOK"NORTHSTAR LUMAX FLEX GUIDING CATHETERS 諾斯達盧馬福雷司導引導管 * 6923 CMV02LMGN2CK "COOK"WHITE LUMAX GUIDING CATHETERS 懷特盧馬導引導管 * 6923 CMV02MF001CK MICROFERRET-18 INFUSION CATHETER SET 3FR * 7440 CMV0306510SB DASHER STEERABLE GUIDEWIRE* 4650 CMV0306510TA TARGET THERAPECUTICS DASHER STEERABLE GUIDE WIRE WITH PERMAGLIDE COATING 4650 CMV0346802SB TRANSEND GUIDE WIRE * 4650 CMV0361414CD AGILITY STEERABLE GUIDEWIRE 0.014" 165,205,350CM 4650 CMV0361416CD AGILITY STEERABLE GUIDEWIRE 0.016" 145,175CM 4650 CMV03614XNCD AGILITY STEERABLE GUIDEWIRE 0.010 195CM( 型號 614-179 自 91/07/01 生效 ) 4650 CMV03FA509SB "BOSTON SCIENTIFIC"FATHOM-16 STEERABLE GUIDEWIRE 菲森可控式導線 * 4650 CMV03FWR45MR "MERIT"FOUNTAIN INFUSION SYSTEM(GUIDE WIRE+TORQUE) 芳登灌輸系統 * 4650 CMV03MT1GWV9 "MTI"GUIDEWIRE 導引線 ( 親水性導入線 + 扭轉器 + 導入線導入鞘 )* 4650 CMV03STM48AS ASAHI MICRO GUIDEWIRE 0.014" 0.018"* 4650 CMV03TPMG1CK MICRO GUIDE WIRE 0.14INCH * 4650 CMV03TPMG2CK "COOK"MICRO WIRE GUIDE 導線 * 4650 CMV0403010TA FIBERED PLATINUM COIL 3122 CMV0403120TA FIBERED PLATINUM COIL2:30MMX2:100MM 3122 CMV0436010SB GDC-SYNERG OCCLUSION COIL*( 型號 :347204-SR 自 951001 起生效 ) 17119 CMV0436018SB GDC-SYNERG OCCLUSION COIL* 17119 CMV0437204TA VASCULAR PLATINUM COIL 3122 174

特材代碼中英文品名支付點數 CMV0437230SB FIBERED PLATINUM COILS* 3122 CMV04AX1UMV9 "MTI"AXIUM DETACHABLE COILS SYSTEM 西恩分離式閉塞捲 1.5MM:25MM,1CM:50CM* 17119 CMV04DCS01CD TRUFILL DCS DETACHABLE CIOL SYSTEM * 17119 CMV04DCS01CK DETACHABLE EMBOLIZATION COIL( 機械式旋轉方式解離 )* 14174 CMV04DCS02CD TRUFILL DCS DETACHABLE COIL * 17119 CMV04DCS03CD "CORDIS"TRUFILL DCS DETACHABLE COIL SYSTEM 楚菲爾分離式白金纖維環系統 * 17119 CMV04GDC04TA GDC-SYNER G OCCLUSION COILS( 產品型號包括 341201SR4:344715SR4) 17119 CMV04GDC10SB "BOSTON SCIENTIFIC"GDC DETACHABLE COIL 2,2.5,3,4,5,6,7MM 古利艾美分離式閉塞捲 * 17119 CMV04GDC10TA GDC OCCLUSION COILS(OD 2:20MM 1:30CM) 適應症見備註 (355-8254,10:20-34 92.7.1 生效 920009154) 17119 CMV04GDC11SB GDC DETACHALE COIL* 17119 CMV04GDC12SB GDC DETACHALE COIL* 17119 CMV04GDC18SB GDC DETACHALE COIL* 17119 CMV04GDC19SB GDC DETACHALE COIL* 17119 CMV04HCSVXMS "MICROVENTION"MICROPLEX COIL SYSTEM 微導線圈栓塞系統 * 17119 CMV04HESRNMS MICROVENTION HYDROCOIL EMBOLIC SYSTEM(HES)* 19085 CMV04HESVXMS HYDROCOIL EMBOLIC SYSTEM (HES) 親水性線圈栓塞系統 * 19085 CMV04M000TCK TORNADO EMBOLIZATION MICROCOIL 0.018,2:14CM 2:10MM 3122 CMV04M001NCK EMBOLIZATION COILS* 2019 CMV04M002NCK EMBOLIZATION COILS* 2019 CMV04M003NCK TORNADO EMBOLIZATION MICROCOIL 0.035,0.038,3:14CM,3:10MM 3122 CMV04M005NCK HILAL EMBOLIZATION MICROCOILS* 3122 CMV04M006NCK EMBOLIZATION COILS * 2019 CMV04M007NCK COOK NESTER EMBOLIZATION COILS* 3122 CMV04M008NCK CMV04MAX05SB CMV04MAX06SB COOK MREYE EMBOLIZATION COILS AND DETACHABLE COILS 0.025 英吋.1:5 公分 0.035 英吋.1:20 公分 0.038 英吋.1:20 公分 * 適應請見備註欄 MATRIX2 DETA.COIL D:2-24MM L:2-40CM 360 度 COMP SHAPE-360 度 FIRM.360 度 STANDARD SR.360 度 SOFT SR.HELICAL SHAPE-HELICAL ULTRA SOFT SR* 適應症見備註 MATRIX COIL D:2-20MM L:4:30CM 3D OMEGA SHAPE-3D OMEGA FIRM;STANDARD HELICAL SHAPE-2DFIRM;STANDARD SR;SOFT SR;HELICAL SOFT SR* 適應症見備註 3122 19085 19085 175

CMV04MCSVXMS "MICROVENTION"MICROPLEX COIL SYSTEM 微導線圈栓塞系統 * 17119 CMV04MWCE1CK "COOK"MREYE EMBOLIZATION COILS 密絲特艾栓塞線圈, 伸展之栓塞長度 1:20 公分, 線圈狀栓塞直徑 2:25 公厘 * 3122 CMV04NEXUSV9 "MTI"NEXUS DETACHABLE COILS SYSTEM 雷瑟斯分離式閉塞捲 * 19085 CMV0621029LW "LEMAITRE"PRUITT IRRIGATION OCCLUSION CATHETER 普特灌沖血管閉塞導管 2466 CMV0621036LW "LEMAITRE"PRUITT OCCLUSION CATHETER 普特血管閉塞導管 2466 CPC0100001BB 1 LUMEN PEDIATRIC CVP CATHETER(C+N+D+G+S) 740 CPC0100011BB 1 LUMEN CVP CATHETER(C+N+D+G+S) 520 CPC0104706AR "ARROW"CENTRAL VEIN CATHETERIZATION SET I LUMEN(CATH+NEEDLE+DILATOR+GUIDE WIRE+SYRING)" 亞諾 " 中央靜脈導管組 520 CPC0124301AR SINGLE LUMEN CANTRAL VENOUS CATHETER ( 特材代碼 89/03/01 改為 CPC01A4301AR) 520 CPC0141320BA SILICONE PER-Q CATHETER(PICC)(CATH W/STYLET,INTRODUCER NEEDLE)2,3FR 28CM,60CM 1100 CPC014132NBA SINGLE LUMEN SILICONE PER-Q CATHETER BASIC TRAY 2FR 1100 CPC0147630AG CVP KIT MINI ( 含 GUIDE WIRE, CATHETER, NEEDLE) 16FR 520 CPC0147631AG CVP KIT MINI ( 含 GUIDE WIRE, CATHETER, NEEDLE) 16FR 520 CPC0160004DV SINGLE LUMEN BROVIAC CATHETER 布羅斐式導管 2.7FR 90CM 2500 CPC016816NBD SINGLE LUMEN CVP CATHETER(CATH+N+DIL+GW+SYR) 520 CPC01A4301AR CPC01A4650AR "ARROW"ARROWGARD CATHETERS:ANTISEPTIC SINGLE LUMEN CVP CATHETER 16GX20CM (C+N+D+G+S)" 亞諾 " 抗感染安全尖端導管 "ARROW"CENTRAL VEIN CATHETERIZATION SET I LUMEN(PEDIATRIC)(CATH+NEEDLE+DILATOR+GUIDE WIRE+SYRING)" 亞諾 " 中央靜脈導管組 560 740 CPC01B1161BD ANTIMICROBIAL SINGLE LUMEN CVP CATHETER(C+N+D+G+S) 560 CPC01BCV11EE 1 LUMEN CVP CATHETER(CATHETER+GW+DILATOR+SYRINGE) 520 CPC01C4400AR "ARROW"CENTRAL VEIN CATHETERIZATION SET I LUMEN(CATH+NEEDLE+DILATOR+GUIDE WIRE+SYRING)" 亞諾 " 中央靜脈導管組 520 CPC01CA301AR ARROWGARD CATHETER SINGLE LUMEN (C+N+D+G+S) 抗感染安全尖端導管 560 CPC01E4301AR CPC01E4700AR "ARROW"CENTRAL VEIN CATHETERIZATION SET I LUMEN(CATH+NEEDLE+DILATOR+GUIDE WIRE+SYRING)" 亞諾 " 中央靜脈導管組 "ARROW"CENTRAL VEIN CATHETERIZATION SET(1 LUMEN)(CATHETER+NEEDLE+DILATOR+GUIDE WIRE+SYRINGE)" 亞諾 " 中央靜脈導管組 520 520 CPC01H1056BD SINGLE LUMEN CVP CATHETER SET(CATH+NEEDLE+DILATOR+G.WIRE+SYRINGE) 520 CPC01M1142ED 1 LUMEN MULTI-MED CENTRAL CATHETER SET W/AMC THROMBOSHIELD 560 CPC01M1162ED 1 LUMEN MULTI-MED CENTRAL CATHETER SET(C+N+GW+DIL+SY) 520 176

CPC01M1201ED 1 LUMEN CVP CATHETER W/AMC THROMBOSHIELD COATING(C+N+D+GW+S) 560 CPC01P1051BD 1 LUMEN CVP CATH SET 18G,20G,22G(PEDIATRIC)(C+N+D+G+S) 740 CPC01R4020AR CPC01SWL11W8 CPC01SWL12W8 "ARROW"ARTERIAL CATHETERIZATION SET(RA-04220,04122,FA04018,04016 自 91/07/01 生效 ))(SAC00324;524;01616;02316 自 100 年 4 月 1 日刪除 ) 動脈測壓導管 SINGLE LUMEN PEDIATRIC CENTRAL VENOUS CATHETER SET 4FR(C+N+S+GW+D+ INJECTION CAP) SINGLE LUMEN PEDIATRIC CENTRAL VENOUS CATHETER SET 5FR(C+N+S+GW+D+ INJECTION CAP) 400 740 740 CPC01SWL13W8 SINGLE LUMEN CENTRAL VENOUS CATHETER SET 6FR(C+N+S+GW+D+INJECTION CAP) 520 CPC01SWL14W8 SINGLE LUMEN CENTRAL VENOUS CATHETER SET 7FR(C+N+S+GW+D+INJECTION CAP) 520 CPC01SWL21W8 DOUBLE LUMEN INFANT CENTRAL VENOUS CATHETER SET 4FR(C+N+S+GW+D+ INJECTION CAP) 1700 CPC01SWL22W8 DOUBLE LUMEN PEDIATRIC CENTRAL VENOUS CATHETER SET 5FR(C+N+S+GW+D+ INJECTION CAP) 1700 CPC01SWL23W8 DOUBLE LUMEN CENTRAL VENOUS CATHETER SET 7FR(C+N+S+GW+D+INJECTION CAP) 1500 CPC01SWL33W8 TRIPLE LUMEN CENTRAL VENOUS CATHETER SET 7FR(C+N+S+GW+D+INJECTION CAP) 1800 CPC0200002BB 2 LUMEN PEDIATRIC CVP CATHETER(C+N+D+G+S) 1700 CPC0200012BB 2 LUMEN CVP CATHETER(C+N+D+G+S)( 型號包括 0702-9601:9685) 1500 CPC0214402AR CPC0217702AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS:2 LUMEN ( 早產兒 ) 4FR 13CM" 亞諾 " 多重輸液導管 "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS:2 LUMEN(C+N+GW+SY+D)" 亞諾 " 多重輸液導管 CPC0222502AR "ARROW"ARROWGARD CATHETERS:ANTISEPTIC PEDIATRIC DOUBLE LUMEN (C+N+D+G+S)" 亞諾 " 抗感染安全尖端導管 1700 1500 1835 CPC0260048DV DUAL LUMEN HICKMAN CATHETER 3000 CPC026817NBD 2 LUMEN CVP CATHETER(CATH+N+DIL+GW+SYR) 1500 CPC02A7702AR "ARROW"ARROWGARD CATHETER (DOUBLE LUMEN )14FR X 15CM(C+N+D+G+S)" 亞諾 " 抗感染安全尖端導管 ( 大管徑 ) 1620 CPC02B1152BD ANTIMICROBIAL 2 LUMEN CVP CATHETER(C+N+D+G+S) 1620 CPC02BCV22EE 2 LUMEN CVP CATHETER/SET 二腔中央靜脈導管組 (CATH+NEEDLE+DILATOR+GUIDEWIRE+SYRINGE) 1500 CPC02CA702AR ARROWGARD CATHETER TWO LUMEN (C+N+D+G+S) 抗感染安全尖端導管 1620 CPC02CUDLMCK 2 LUMEN SPECTRUM AND SPECTRUM GLIDE CENTRAL VENOUS CATHETERS AND SETS(C+N+D+GW+SY) 1620 CPC02M2716ED 2 LUMEN CVP CATHETER W/AMC THROMBOSHIELD COATING(C+N+D+GW+S) 1620 CPC02M271SED 2 LUMEN MULTI-MED CENTRAL CATHETER SET(C+N+GW+DIL+SY) 1500 CPC02M27S1ED 2 LUMEN CVP CATHETER W/AMC THROMBOSHIELD COATING(C+N+D+GW+S) 1620 177

CPC02N7702AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS:2 LUMEN(C+N+GW+SY+D)" 1500 亞諾 " 多重輸液導管 CPC02P1065BD 2 LUMEN CVP CATH SET 4,5FR(PEDIATRIC)(C+N+D+G+S) 1700 CPC02PEDSUCK SPECTRUM PEDIATRIC 2 LUMEN CVP CATHETER 4FR,5FR(C+D+GW+N+S) 1835 CPC02PEDUDCK 2 LUMEN SPECTRUM GLIDE CENTRAL VENOUS CATHETERS AND SETS 4.0-5.0FR 8CM 小兒用 (C+N+D+G+S) 抗感染導管 1835 CPC02SUDLMCK SPECTRUM 2 LUMEN CVP CATHETER(C+D+GW+N+S) 1620 CPC02SWL24W8 DOUBLE LUMEN CENTRAL VENOUS CATHETERIZATION SET(C+N+GW+S+D) 1500 CPC02UDL81CK 2 LUMEN SPECTRUM GLIDE CENTRAL VENOUS CATHETERS AND SETS 8.0FR 15CM (C+N+D+G+S) 抗感染導管 1620 CPC0300003BB 3 LUMEN PEDIATRIC CVP CATHETER(C+N+D+G+S) 2050 CPC0300013BB 3 LUMEN CVP CATHETER(C+N+D+G+S) 1800 CPC0312123AR CPC0314553AR CPC0314703AR CPC0315703AR CPC0316553AR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS:LARGE BORE 3 LUMEN CVP CATHETER 12FR(C+N+D+G+S)" 亞諾 " 多重輸液導管套 ( 大管徑 ) "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS:PEDATRIC 3 LUMEN CVP SET 5.5FR 30CM(C+N+GW+SY+D)" 亞諾 " 多重輸液導管 "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS:TRIPLE-LUMEN C+N+GW+SY+D)" 亞諾 " 多重輸液導管 "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS:TRIPLE-LUMEN (CATH+NEEDLE+DILATOR+GW+SYRING)" 亞諾 " 多重輸液導管 "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS:TRIPLE-LUMEN (CATH+NEEDLE+DILATOR+GW+SYRING)5.5FR 13CM" 亞諾 " 多重輸液導管 1800 2050 1800 1800 2050 CPC0355702TZ 3 LUMEN CENTRAL VENOUS CATHETER(CATH+NEE+DILA+GW+SY) 1800 CPC0368172BD 3 LUMEN CVP CATHETER(CATH+N+DIL+GW+SYR) 1800 CPC03A4703AR "ARROW"ARROWGARD CATHETERS:ANTISEPTIC TRIPLE-LUMEN (C+N+D+G+S)" 亞諾 " 抗感染安全尖端導管 1950 CPC03A5123AR "ARROW"ARROWGARD CATHETERS:ANTISEPTIC LARGE BORE TRIPLE-LUMEN (C+N+D+G+S)" 亞諾 " 抗感染安全尖端導管 1950 CPC03B1158BD ANTIMICROBIAL 3 LUMEN CVP CATHETER(C+N+D+G+S) 1950 CPC03BCV31EE 3 LUMEN CVP CATHETER 三腔中央靜脈導管組 (CATHETER+GW+DILATOR+SYRINGE+NEEDLE) 1800 CPC03CA703AR ARROWGARD CATHETER TRIPLE LUMEN (C+N+D+G+S) 抗感染安全尖端導管 1950 CPC03CUTLMCK 3 LUMEN SPECTRUM AND SPECTRUM GLIDE CENTRAL VENOUS CATHETERS AND SETS(C+N+D+GW+SY) 1950 CPC03M3716ED 3 LUMEN CVP CATHETER W/AMC THROMBOSHIELD COATING(C+N+D+GW+S) 1950 CPC03M371SED 3 LUMEN MULTI-MED CENTRAL CATHETER SET(C+N+GW+DIL+SY) 1800 CPC03M37S1ED 3 LUMEN CVP CATHETER W/AMC THROMBOSHIELD COATING(C+N+D+GW+S) 1950 CPC03P1139BD 3 LUMEN CVP CATH SET 5FR(PEDIATRIC)(C+N+D+G+S) 2050 178

CPC03PEDUTCK SPECTRUM PEDIATRIC 3 LUMEN CVP CATHETER 5FR(C+D+GW+N+S) 2200 CPC03SWL34W8 TRIPLE LUMEN CENTRAL VENOUS CATHETERIZATION SET(C+N+GW+S+D) 1800 CPC03UTLMACK SPECTRUM 3 LUMEN CVP CATHETER 5FR,7FR(C+D+GW+N+S) 1950 CPC03UTPE2CK SPECTRUM GLIDE CENTRAL VENOUS CATHETERS AND SETS 3 LUMEN 5FR(C+D+GW+N+S) 2200 CPC05S1000BD CVP CATHETER 14G:18G 90MM:160MM 210 CPC0885HS1ED AVA ADVANCED VENOUS ACCESS DEVICES(AVA 3XI)(CVP KIT+ 保護套 +SHEATH+SIDE ARM)* 2890 CPC089FHS1ED AVA ADVANCED VENOUS ACCESS DEVICES(AVA HF)(CVP KIT+ 保護套 +SHEATH)* 2750 CPC0902022PU CEVOX CENTRAL VENOUS OXYGEN SATURATION MONITORING SYSTEM:FIBROPTIC PROBE CATHETER 中央靜脈血氧飽和度 : 光纖探針導管 5500 CPC0977475ED 3 LUMEN PRESEP CENTRAL VENOUS OXIMETRY CATHETER SET(CVPC+PROBE+N+GW+D+SY) 7300 CPD011010DBD PRESSURE MONITOR DOME 200 CPD011010DHM DOME 200 CPD011011DBD DOME 200 CPD01BTR01BS PRESSURE MONITOR DOME 200 CPD01BTR01H9 BIOTRANS DOME 200 CPM0103417BB CVP MONITOR+3 WAY 150 CPM01SC441SG CVP SCALE SYSTEM+3 WAY 150 CPM01VP001LL CVP SCALE SYSTEM(MONITOR+3 WAY) 150 CPM020460TBD 1DOME PRESSURE MONITORING KIT 480 CPM021560TBD 1 DOME PRESSURE MONITORING KIT 480 CPM0217120BD PRESSURE MONITORING KIT 1 DOME 480 CPM0217120HM 1DOME PRESSURE MONITORING KIT 480 CPM021712BBD 1 DOME PRESSURE MONITORING KIT 480 CPM021712SBD PRESSURE MONITORING KIT 1 DOME 480 CPM021712SHM 1 DOME PRESSURE MONITORING KIT 480 CPM0220707BB 1 DOME COMBIDYN PRESSURE MONITORING SETS 480 CPM028603NSG PRESSURE MONITORING KIT 1DOME 480 179

CPM02BTR24BS 2 DOME 3WAY PRESSURE MONITORING KIT 2X(DOME+FLUSH+TUBING+3WAYX2) 850 CPM02BTR24H9 2 DOME 3WAY PRESSURE MONITORING KIT 2X(DOME+DEVICE+TUBING+3 WAYX2) 850 CPM02BTR33BS 3 DOME 3WAY PRESSURE MONITORING KIT 3X(DOME+FLUSH+TUBING+3WAYX2) 1100 CPM02BTR33H9 3 DOME 3WAY PRESSURE MONITORING KIT 3X(DOME+DEVICE+TUBING+3 WAYX2) 1100 CPM02BTR48BS 1DOME 3WAY PRESSURE MONITORING KIT(DOME+DEVICE+TUBING+3WAYX2) 480 CPM02BTR48H9 1 DOME 3WAY PRESSURE MONITORING KIT(DOME+DEVICE+TUBING+3 WAYX2) 480 CPM02DL418BS 1DOME 2WAY PRESSURE MONITORING KIT 1X(DOME+FLUSH+TUBINGX2+3WAYX4) 650 CPM02DL418H9 1 DOME 2WAY PRESSURE MONITORING KIT 1X(DOME+DEVICE+TUBINGX2+3 WAYX4) 650 CPM02HP60RBD PRESSURE MONITORING KIT 1DOME 480 CPM02VGH2QBD PRESSURE MONITORING KIT 2 DOME 850 CPM02VGH2QHM PRESSURE MONITORING KIT (2 DOME) 850 CPM02VGH3QBD PRESSURE MONITORING KIT 3 DOME 1100 CPM02VGH3QHM PRESSURE MONITORING KIT (3 DOME) 1100 CPM030TNFRBD PRESSURE MONITOR TRANSDUCER 554 CPM0342584HR TRANSPAC IV MONITORING KIT(TRAN+FLUSH+TUBING+3WAYX2) 650 CPM0342591HR TRIFURCATED KITS WITH 3 DISPOSABLE TRANSDUCER 1300 CPM0342597HR TRANSPAC IV MONITORING KIT WITH 2 DISPOSABLE TRANSDUCER 1050 CPM0342615HR TRANSPAC IV MONITORING KIT WITH 1 DISPOSABLE TRANSDUCER 930 CPM0342632HR TRANSPAC IV MONITORING KIT 650 CPM0342652HR TRANSPAC IV MONITORING KIT WITH 2 DISPOSABLE TRANSDUCER 1050 CPM0348123BS 1 TRANSDUCER DISPOSABLLE PRESSURE MONITORING KIT(TR+FD+3WAYX2+TUBING) 650 CPM034812DBD 2 TRANSDUCER DISPOSABLE PRESSURE MONITOR KIT(TR+FL+TU+3WAYX4) 1050 CPM034812TBD 3 TRANSDUCER DISPOSABLE PRESSURE MONITOR KIT(TR+FL+TU+3WAYX6) 1300 CPM038603ASG DISPOSABLE PRESSURE MONITOR KIT 1 DOME W/TRANSDUCER(TR+FLU+TUB+3WAYX2) 650 CPM038603BSG DISPOSABLE PRESSURE MONITOR KIT 2 DOME W/TRANSDUCER 2(TR+FLU+TUB+3WAYX2) 1050 CPM038603CSG DISPOSABLE PRESSURE MONITOR KIT 3 DOME W/TRANSDUCER 3(TR+FLU+TUB+3WAYX2) 1300 180

CPM038603TSG PRESSURE MONITOR KIT 1 DOME WITH TRANSDUCER 650 CPM03AT148H9 PRESSURE MONITORING KIT(TR+FD+3 WAYX2+TUBING) 650 CPM03AT1DLH9 PRESSURE MONITORING KIT (TR+FDX2+3 WAYX2+TUBINGX2) 930 CPM03AT248H9 PRESSURE MONITORING KIT 2X(TR+FD+3 WAYX2+TUBING) 1050 CPM03AT348H9 PRESSURE MONITORING KIT 3X(TR+FD+3 WAYX2+TUBING) 1300 CPM03ATF30H9 PRESSURE MONITORING KIT(TR+FD+3 WAYX2+TUBING) 650 CPM03D2020BD TRANSDUCER W/FLUSH 554 CPM03D4812BD DISPOSABLE PRESSURE MONITORING KIT W/1 TRANSDUCER 650 CPM03D4812HM DISPOSABLE PRESSURE MONITORING KIT WITH TRANSDUCER 650 CPM03DDL60BD DISPOSABLE PRESSURE MONITORING 1 TRANSDUCER(2 WAY) 930 CPM03DNN12BD PEDIATRIC 1 TRANSDUCER DISPOSABLE PRESSURE MONITORING KIT 734 CPM03DP240H9 2 TRANSDUCER PRESSURE MONITORING KIT 2X(TR+FD+3 WAYX2+TUBING) 1050 CPM03DP340H9 3 TRANSDUCER PRESSURE MONITORING KIT 3X(TR+FD+3 WAYX2+TUBING) 1300 CPM03DPT24H9 TREANSDUCER PRESSURE MONITORING KIT(TR+FD+3 WAYX2+TUBING) 650 CPM03DPT30H9 PRESSURE MONITORING KIT(TR+FD+3 WAYX2+TUBING) 650 CPM03DPTDLH9 TRANSDUCER PRESSURE MONITORING 2WAY KIT (TR+FD+3 WAYX2+TUBINGX2) 930 CPM03DTL60BD DISPOSABLE PRESSURE MONITORING 3 WAY KIT(2 TRANSDUCER) 1180 CPM03MER12MR MERITRANS DISPOSABLE PRESSURE MONITORING TRANSDUCER W/3WAY 電子式壓力轉換器 554 CPM03PV800PU PCCO MONITORING KIT 30CM,100CM,150CM(TX1+FX1+TX2+3-WAYX2) 650 CRB0100028MA 2 LUMEN BRONCO-CATHETER LEFT/RIGHT 28:39FR 1490 CRB03AEBS1CK ARNDT ENDOBRONCHIAL BLOCKER SET 9.0FR. 78CM * 限肺葉切除或食道手術使用 3675 CRB03AEBS2CK CRB03AEBS3CK 曲克支氣管內管阻隔管組 ARNDT ENDOBRONCHIAL BLOCKER SET 7.0FR. 65CM * 限肺葉切除或食道手術使用曲克支氣管內管阻隔管組 ARNDT ENDOBRONCHIAL BLOCKER SET 5.0FR. 50CM,65CM * 限肺葉切除或食道手術使用 3675 4000 CRB03BBTAEDZ 大研支氣管閉鎖導管 DAIKEN COOPDECH ENDOBRONCHIAL BLOCKER TUBE* 3675 CRE01C0040MA ENDOTRACHEAL TUBE MLT 4:6FR 處置使用可申報, 手術使用不另給付型號 121-40 自 93.1.1 刪除 159 CRE01C0065RU EDGAR TUBE WITH CUFF 6.5MM:10.0MM TWO LUMEN 限處置使用可申報, 手術使用不另給付 440 181

CRE01C4050UW " 花瑪 " 氣管內管 PHARMA ENDOTRACHEAL TUBES CUFF 5:8.5MM * 處置使用可申報, 手術使用不另給 300 付. CRE01C4060EU CRE01U0030EU CRE0311830MA NON-KINKING ENDOTRACHEAL TUBE ARMOURED CUFF 6.0:8.5MM 處置使用可申報手術使用不另給付 NON-KINKING ENDOTRACHEAL TUBE ARMOURED UNCUFF 3.0:5.5MM 處置使用可申報手術使用不另給付 REINFORCED ENDOTRACHEAL TUBE NON-KINKING 加強型氣管內管 * 處置使用可申報, 手術使用不另給付 300 328 300 CRE03C055NFM SILICONE ENDOTRACHEAL TUBE W/CUFF 5.5:10.0MM 處置使用可申報手術使用不另給付 300 CRE03U0050MA REINFORCED ENDOTRACHEAL TUBE (NON-KINKING) 處置使用可申報, 手術使用不另給付 328 CRE03U025NFM CRE04C0035RU SILICONE ENDOTRACHEAL TUBE W/WIRE WITHOUT CUFF 2.5:5.0MM 處置使用可申報手術使用不另給付 AGT-TUBE,NASAL TRACHEAL TUBE W/LOW-PRESSURE CUFF,ID 3.5:8.0MM 處置使用可申報, 手術使用不另給付 328 245 CRE04C0040MA RAE NASAL TRACHEAL TUBE W/CUFF 4.5:8MM 鼻彎處置使用可申報手術用不另給付 245 CRE04C0060PP NASAL CURVED W/CUFF ENDOTRACHEAL TUBE 6:8MM 處置使用可申報, 手術使用不另給付 245 CRE04U0030RU CRE04U030NMA CRE06C0035RU AGT-TUBE, NASAL TRACHEAL TUBE WITHOUT CUFF,ID 3.0:7.0MM 處置使用可申報, 手術使用不另給付 RAE PREFORMED ENDOTRACHEAL TUBE (NASAL TYPE) 氣管內管 ( 處置使用可申報手術使用不另給付 ) AGT-TUBE, ORAL TRACHEAL TUBE W/LOW-PRESSURE CUFF, ID 3.5:9.0MM 處置使用可申報, 手術使用不另給付 203 203 227 CRE06C0040MA RAE ORAL TRACHEAL TUBES(W/CUFF)* 處置使用可申報, 手術使用不另給付 227 CRE06C0050MU MODERN ENDOTRACHEAL TUBE(CUFFED) 華新氣管內管 * 處置使用可申報手術使用不另申報 227 CRE06C0453W6 ENDOTRACHEAL TUBE (WITH/CUFF)* 處置使用可申報, 手術使用不另給付. 227 CRE06U0030RU AGT-TUBE, ORAL TRACHEAL TUBE WITHOUT CUFF,ID 3.0:7.0MM 處置使用可申報, 手術使用不另給付 143 CRE06U0304W6 ENDOTRACHEAL TUBE (WITHOUT/CUFF) 處置使用可申報, 手術使用不另給付. 143 CRE06U045NMA RAE PREFORMED ENDOTRACHEAL TUBE WITHOUT CUFF 口彎型處置使用可申報, 手術使用不另給付 143 CRE07C0040RU LASERTUBS LASER-RESISTANT TRACHEAL TUBE(DOUBLE CUFF TYPE)4.0:8.0MM 2451 CRE07C0045MA " 麥林可 " 鐳射氣管內管 "MALLINCKRODT"LASER-FLEX TRACHEAL TUBE 2451 CRG010168NHU NASAL CPAP SYSTEM NO.0:N0.5 1120 CRG010169NHU NASAL CPAP CANNULA NO.0:NO.5 654 CRG011630NAY ARGYLE CPAP NASAL CANNULA KIT ARGYLE 小兒專用連續正壓鼻導管組 654 CRG01407NNW7 " 嬰克 " 嬰兒經鼻式氧氣鼻套管 "INCA" INFANT NASAL OXYGEN CPAP CANNULA* 654 CRG01427NNW7 " 嬰克 " 嬰兒經鼻式氧氣鼻套管 "INCA" INFANT NASAL OXYGEN CPAP CANNULA* 1120 182

CRN0185067NU NASAL NASOPHARYNX APPLICATION 後荷式咽插管 2960 CRT01TTLPCS5 雪莉氣切套管及其附件 SHILEY TRACHEOSTOMY CANNULAE AND ACCESSORIES 865 CRT01U0025ZG " 富齡 " 氣切管 "ALLY" TRACHEOSTOMY TUBE(UNCUFF, ID 2.5-5.5MM) 361 CRT01U0060WN TEFLON TRACHEOSTOMY TUBE(DOUBLE TUBE)6:12MM 外徑 525 CRT0236368KK " 高研 " 氣管套管 "KOKEN" TRACHEAL CANNULA 525 CRT0252608KK " 高研 " 比比氣管套管 "KOKEN" TRACHEAL CANNULA PP 493 CRT0267350MA 麥林可恰可舒氣切管 "MALLINCKRODT"TRACHESOFT TRACHEOSTOMY CANNULAE 361 CRT02C0030UW " 花瑪 " 氣切套管 PHARMA TRACHEOSTOMY TUBE UNCUFF 3:10MM 361 CRT02C0050MA TRACHEOSTOMY TUBE CUFF 332 CRT02C0050SG TRACHEOSTOMY TUBE W/CUFF 5.0:9.0MM 332 CRT02C0050TP SILICONE TRACHEOSTOMY TUBE 5.0MM:9.5MM 577 CRT02C0050WN ALL SILICONE TRACHEOSTOMY TUBE WITH CUFF 22:42FR 5.0:10MM 內徑產品型號 2217-035:100 自 93.1.1 生效 577 CRT02C0060UW TRACHEOSTOMY TUBE,REGULAR HVLP CUFF,ID 6:10MM 氣切套管 ( 有閥 ) 332 CRT02C0060ZG " 富齡 " 氣切管 "ALLY" TRACHEOSTOMY TUBE(W/CUFF, ID 6.0-9.0MM) 332 CRT02C0062UW " 花瑪 " 氣切套管 PHARMA TRACHEOSTOMY TUBE W/CUFF 6:10MM 332 CRT02C0080MA STANDARD TRACHEOSTOMY CANNULAE TRACHEOSTOMY TUBE CUFF 332 CRT02C0793W6 TRACHEOSTOMY TUBE (WITH/CUFF) 332 CRT02C1560FM 氣切套管 FORTUNE TRACHEOSTOMY TUBE ID2.0MM:12.0MM( 普通球 ) 577 CRT02C1565FM 氣切套管 FORTUNE TRACHEOSTOMY TUBE ID2.0MM:12.0MM( 低壓球 ) 577 CRT02C595NFM SILICONE TRACHEOSTOMY TUBE W/CUFF 5.5:9.5MM 577 CRT02CP050YN ALL SILICONE TRACHEOSTOMY TUBE W/CUFF 5.0:10.0MM(PRE-FORMED TYPE) 577 CRT02TT016SG SIGMA TRACHEOSTOMY TUBE 332 CRT02TT046SG SIGMA TRACHEOSTOMY TUBE(SILICON) 577 CRT02U0025WN ALL SILICONE TRACHEOSTOMY TUBE WITHOUT CUFF 12:42FR 2.5:10.0MM 內徑 460 CRT02U0030UW TRACHEOSTOMY TUBE,PLAIN,UNCUFF,ID 3:10MM 氣切套管 ( 無閥 ) 361 CRT02U0030YN ALL SILICONE TRACHEOSTOMY TUBE UNCUFF 3.0:10.0MM(PLAIN TYPE) 460 183

CRT02U0045S5 雪莉氣切套管 SHILEY TRACHEOSTOMY CANNULAE (PEDIATRIC TRACHEOSTOMY TUBE WITH 893 OBTURATION) CRT02U1561FM 氣切套管 FORTUNE TRACHEOSTOMY TUBE ID2.0MM:12.0MM( 無球型 ) 460 CRT04C678MHJ CRT04C750MHJ CRT04C850MHJ " 史密斯 " 百弗納氣切套管與配件 "SMITHS" BIVONA TRACHEOSTOMY TUBE AND ACCESSORIES* 使用規定請見備註欄 " 史密斯 " 百弗納氣切套管與配件 "SMITHS" BIVONA TRACHEOSTOMY TUBE AND ACCESSORIES* 使用規定請見備註欄 " 史密斯 " 百弗納氣切套管與配件 "SMITHS" BIVONA TRACHEOSTOMY TUBE AND ACCESSORIES* 使用規定請見備註欄 3800 3800 3800 CRT05C0050S5 TRACHEOSTOMY TUBES LOW PRESSURE CUFFED 5.0MM:9.0MM/LONG TERM CARE 使用 865 CRT05U0050S5 TRACHEOSTOMY TUBE 850 CVA0100490M4 PROFLO ANGIOGRAPHIC CATHETER 6F,7F*100,110,125CM ( 衛署字號 009770) 700 CVA0107130AR CVA011MG31SB "ARROW"BERMAN ANGIOGRAPHIC CATHETER(PEDIATRIC) 4:8FR 50:110CM 亞諾帕曼心臟血管攝影用導管 IMAGER11 ANGIOGRAPHIC CATH(4-5FRX40,65,90,100CM)0.035,0.038( 型號 M001316021:M001316911 自 92/7/1 生效 ) 1750 700 CVA014034FST " 聖猷達 " 血管攝影導管 "SJM"SPYGLASS ANGIOGRAPHIC CATHETERS 700 CVA01451XNCD "CORDIS"TEMPO ANGIOGRAPHIC CATHETER TEMPO4,TEMPO5 田布血管造影導管 700 CVA014567XZ9 MAXITORQUE PLUS ANGIOGRAPHIC CATHETER 700 CVA014A00NM4 SITESEER CARDIOVASCULAR ANGIOGRAPHIC CATHETER 4FR 700 CVA01512HNMR IMPRESS ANGIOGRAPHIC CATHETERS 0.035",0.038" 100,125CM 映象血管攝影導管 700 CVA01565CBMR IMPRESS ANGIOGRAPHIC CATHETERS 0.035",0.038" 65CM,100CM 映象血管攝影導管 700 CVA01565REMR IMPRESS ANGIOGRAPHIC CATHETERS 0.035",0.038" 40CM,65,80,100CM 映象血管攝影導管 700 CVA01565SMMR IMPRESS ANGIOGRAPHIC CATHETERS 0.035",0.038" 65CM,100CM 映象血管攝影導管 700 CVA01565VEMR IMPRESS ANGIOGRAPHIC CATHETERS 0.035",0.038" 65CM,100,125CM 映象血管攝影導管 700 CVA015A00NM4 SITESEER CARDIOVASCULAR ANGIOGRAPHIC CATHETER 5FR 700 CVA016A00NM4 SITESEER CARDIOVASCULAR ANGIOGRAPHIC CATHETER 6FR 700 CVA017779AMR PERFORMA DIAGNOSTIC RADIOLOGY CATHETERS 700 CVA01A42ALAS ANGIOGRAPHIC CATHETER 4:7FR 700 CVA01A80CMTM "TERUMO"RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATHETER 4FR 80CM 歐帝克血管攝影導管 700 CVA01B001NCK CEREBRAL CATHETER 720 CVA01H001NCK ANGIO CATHETER CEREBRAL CATHETER 720 184

CVA01H1234BQ ANGIOGRAPHIC CATHETER 4:5FR 100CM( 腦部血管用 ) 700 CVA01HN001CK ROYAL FLUSH PLUS HIGH FLOW ANGIOGRAPHIC FLUSH CATHETER 0.035,0.038 4:6FR 70:110CM 700 CVA01HNB01CK CVA01HNB02CK TORCON NB ANGIOGRAPHIC CATHETER 4.1FR 50:125CM(CEREBRAL PULMONARY MUTIPURPOSE VISCERAL CATH) TORCON NB ANGIOGRAPHIC CATHETER 5.0,6.0FR 50:125CM(CEREBRAL PULMONARY MUTIPURPOSE VISCERAL CATH) 700 700 CVA01HNB03CK TORCON NB ANGIOGRAPHIC CATHETER 4.1,5.0,6.0FR 70:110CM( CORONARY CATH) 700 CVA01HNBR1CK ANGIOGRAPHIC CATHETER W/RADIOPAQUE TIPS 4.1FR 50:125CM 700 CVA01HNBR2CK ANGIOGRAPHIC CATHETER W/RADIOPAQUE TIPS 5.0FR 50:125CM 700 CVA01HNBR3CK ANGIOGRAPHIC CATHETER W/RADIOPAQUE TIPS 4.1FR,5.0FR 70:110CM CORONARY CATH 700 CVA01HNBR4CK TORCON NB ANGIOGRAPHIC CATHETER 700 CVA01HNBR5CK TORCON NB ANGIOGRAPHIC CATHETER 700 CVA01HNR01CK ROYAL FLUSH PLUS ANGIOGRAPHIC CATHETER 0.35" 65-110CM 700 CVA01HNR02CK ROYAL FLUSH PLUS ANGIOGRAPHIC CATHETER 0.035" 0.038" 65-110CM 700 CVA01N001NCK ANGIO CATHETER VISCERAL CATHETER 65:100CM 710 CVA01NP4RCCY ANGIOGRAPHY CATHETER TYPE RC COBRA RH RLG SH HEAD-HUNTER PIGTTAIL 4.2FR,5FR 65:100CM 700 CVA01P027NCK ANGIO CATHETER 50:110CM 700 CVA01RC123BQ ANGIOGRAPHIC CATHETER 4:5FR 65~80CM( 周邊血管用 ) 700 CVA01SCB01CK SLIP-CATH SELECTIVE ANGIOGRAPHIC CATHETER 5F 40CM:100CM 700 CVA024SP68TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR PIGTAIL 720 CVA0295007TM RADIOFOCUS YASHIRD ANGIOGRAPHIC CATHETER 720 CVA02AB441TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR COBRA 720 CVA02AC341TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR SHEPHERD HOOK 720 CVA02AD441TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR J CURVE 720 CVA02AE441TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR SIDE WINDER 720 CVA02AG341TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4FR RH 720 CVA02AG941TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR YASHIRO 720 CVA02BB141TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR HEADHUNTER 720 185

CVA02BC141TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR NEWTON 720 CVA02BE141TM RADIFOCUS OPTITORQUE ANGIOGRAPHIC CATH 4:5FR BENTSON 720 CVA02DB450TM RADIFOCUS COBRA ANGIOGRAPHIC CATHETER 5:6FR 65:100CM 720 CVA02DD450TM RADIFOCUS J CURVE ANGIOGRAPHIC CATHETER 5:7FR 65CM 720 CVA02DG350TM RADIFOCUS RH ANGIOGRAPHIC CATHETER 5FR 65CM 720 CVA02DG450TM RADIFOCUS RS ANGIOGRAPHIC CATHETER 5FR 65CM 720 CVA02EA150TM RADIFOCUS SIMMONS ANGIOGRAPHIC CATHETER 5:6FR 100CM 720 CVA02EB150TM RADIFOCUS HEADHUNTER ANGIOGRAPHIC CATHETER 5:7FR 100CM 720 CVA02EE150TM RADIFOCUS BENTSON ANGIOGRAPHIC CATHETER 5FR 100CM 720 CVA02RQ4FNTM OUTLOOK ANGIOGRAPHIC CATHETER 4FR 60CM:110CM ANY CURVE ( 衛署字號 9685) 700 CVA02RQ5FNTM OUTLOOK ANGIOGRAPHIC CATHETER 5FR 60CM:110CM ANY CURVE ( 衛署字號 9685) 700 CVC0102049AB JOGRAPHY ANGIOGRAPHIC CATHETER 700 CVC0132400CD VISCERAL COBRA FEMORAL CATHETER 720 CVC0132412CD ANGIO CATHETER FEMORAL AORTIC FLUSH (PIGTAIL) 720 CVC013241NCD ANGIO CATHETER FEMORAL VISCERAL (SIDEWINDER) 720 CVC0132420CD ANGIO CATHETER FEMORAL AORTIC FLUSH (STRAIGH) 720 CVC013243NCD ANGIO CATHETER FEMORAL VISCERAL (BENTSON) 720 CVC013244NCD ANGIO CATHETER FEMORAL VISCERAL J CURVE (SHEPHERD HOOK) 720 CVC0132461CD ANGIO CATHETER FEMORAL VISCERAL (HEADUNTER) 720 CVC0132474CD ANGIO CATHETER FEMORAL VISCERAL (SHEPHERD HOOK) 720 CVC0132545CD NIH CATHETER 5:8FR 80:100CM 720 CVC01430NNST " 聖猷達 " 血管攝影導管 "SJM"SPYGLASS ANGIOGRAPHIC CATHETERS 700 CVC014505NCD INFINITI DIAGNOSTIC CARDIOLOGY CATHETER 5FR 700 CVC015237NCD AMPLANTZ CATHETER LEFT/RIGHT 720 CVC01527XNCD AMPLANTZ TECH LEFT OR RIGHT CORONARY CATHETER 720 CVC015325NCD PIGTAIL CATHETER 5:8FR 720 186

CVC015334NCD CARDIOLOGY ANGIOGRAPHIC CATHETER 4.1FR 65:100CM 720 CVC015335NCD CARDIOLOGY ANGIOGRAPHIC CATHETER 5.2FR 65:125CM 720 CVC015336NCD CARDIOLOGY ANGIOGRAPHIC CATHETER 6FR 80:100CM 720 CVC015346NCD INFINITI DIAGNOSTIC CARDIOLOGY CATHETER 6FR 700 CVC015384XCD INFINITI DIAGNOSTIC CARDIOLOGY CATHETER 4FR 700 CVC01752F1MR ANGIO CATHETER 700 CVC018526NSB EXPO ANGIOGRAPHIC CATHETER 100:125CM 5F:7F 700 CVC01HF456BK HYPERFLOW DIAGNOSTIC CATHETER 700 CVC01JL235BQ ANGIOGRAPHIC CATHETER JL4,JL3.5 700 CVC01JR235BQ ANGIOGRAPHIC CATHETER JR4,JR3.5 700 CVC01N001NCK ANGIO CATHETER CORONARY CATHETER 110:150CM 720 CVC01N3145ST " 聖猷達 " 血管攝影導管 "SJM"SPYGLASS ANGIOGRAPHIC CATHETERS 700 CVC01P1451BQ ANGIOGRAPHIC CATHETER 4:6FR 100~110CM( 冠狀動脈用 ) 700 CVC01PG155BQ ANGIOGRAPHIC CATHETER P155,P1G 700 CVC01RHAL1TM OPTITORQUE ANGIOGRAPHIC CATHETER AMPLATZ LEFT 1:3,5:6FR 100CM 720 CVC01RHAR1TM OPTITORQUE ANGIOGRAPHIC CATHETER AMPLATZ RIGHT 1-3 5:6FR 100CM 720 CVC01RHJL4TM OPTITORQUE ANGIOGRAPHIC CATHETER JUDKINS LEFT 3.5:5.0MM 4:6FR 100CM 720 CVC01RHJR4TM OPTITORQUE ANGIOGRAPHIC CATHETER JUDKINS RIGHT 3.5:5.0CM 4:6FR 100CM 720 CVC01RHSP6TM OPTITORQUE ANGIOGRAPHIC CATHETER STRAIGHT PIGTAIL 4:6FR 110CM 720 CXE0100624BA " 巴德 " 歐文四極診斷電極導管 "BARD"WOVEN DIAGNOSTIC ELECTRODE CATHETER 8090 CXE0101458ST CXE0101893ST CXE010189NST "SJM"SUPREME ELECTROPHYSIOLOGY CATHETER-5F,6F QUADRIPOLAR FIXED CURVE CATHETER" 聖猷達 " 史普力米生理電極導管 "SJM"SUPREME ELECTROPHYSIOLOGY CATHETER-4F DECAPOLAR CSL CATHETER" 聖猷達 " 史普力米生理電極導管 "SJM"SUPREME ELECTROPHYSIOLOGY CATHETER-4F QUADRIPOLAR FIXED CURVE CATHETER" 聖猷達 " 史普力米生理電極導管 8090 11080 8090 CXE0102853BA TRIPOLAR ELECTRODE 6:7FR 125CM 8060 CXE0102943BA QUADPOLAR ELECTRODE 6FR 110CM 1CM 8090 CXE0104019BA WOVEN TRIPOLAR ELECTRODE CATHETER 8060 187

CXE0107150BA NBIH BIPOLAR PACING ELECTRODE 5:7FR 100:125CM 6600 CXE0108567BA QUADPOLAR ELECTRODE 6FR 120CM 8090 CXE0120011BA " 巴德 " 歐文診斷電極導管 "BARD" WOVEN DIAGNOSTIC ELECTRODE CATHETERS 四極 8090 CXE0120015BA WOVEN QUADPOLAR ELECTRODE CATH200150:3,200055P,56,56E,57P,58,58E,59P,60,60E,61P,62E,63P,64P 8090 CXE0120016BA WOVEN QUADPOLAR ELECTRODE CATHETER201400,200066:69,202,203,472,473,574,578,582:586, 8090 CXE0120035BA WOVEN DECAPOLAR ELECTRODE CATHETER 11080 CXE0120061BA " 巴德 " 歐文診斷電極導管 "BARD" WOVEN DIAGNOSTIC ELECTRODE CATHETERS 十極 11080 CXE0120076BA OPEN-LUMEN QUADPOLAR ELECTRODE 6FR 110CM 1CM 7700 CXE0120077BA OPEN-LUMEN QUADPOLAR ELECTRODE 6FR 110CM 5MM 7700 CXE0120079BA QUADPOLAR OPEN LUMEN ELECTRODE 7FR 0.038" 120CM 1CM 7700 CXE0120140BA WOVEN PENTAPOLAR ELECTRODE CATHETER 8090 CXE01272NNST "SJM"EVALUATOR ELECTROPHYSIOLOGY CATHETER" 聖猷達 " 生理電極導管 8090 CXE0140003BA VIKING DECAPOLAR ELECTRODE CATHETER400030:36,400070:71,400074:75 11080 CXE014000NBA VIKING QUADPOLAR ELECTRODE CATHETER400001:12,400041:48,400050:51,400091P, 8090 CXE0140010BA " 巴德 " 維克診斷電極導管 "BARD" VIKING DIAGNOSTIC ELECTRODE CATHETER 十極 11080 CXE0140012BA " 巴德 " 維克診斷電極導管 "BARD" VIKING DIAGNOSTIC ELECTRODE CATHETER 四極 8090 CXE0140050BA VIKING SOFT TIP QUADPOLAR ELECTRODE CATHETER 400501:512,400541:542 8090 CXE0140053BA VIKING SOFT TIP DECAPOLAR ELECTRODE CATHETER400530:536,400570:571 11080 CXE0140054BA " 巴德 " 探戈診斷電極導管 "BARD" TANGO DIAGNOSTIC ELECTRODE CATHETERS 四, 五極 8090 CXE0140057BA " 巴德 " 探戈診斷電極導管 "BARD" TANGO DIAGNOSTIC ELECTRODE CATHETERS 十極 11080 CXE0140123ST CXE01CDFNNYB CXE01EPEXDSB CXE01EPEXQSB " 聖猷達 " 雷斯龐生理電極導線 "SJM" RESPONSE ELECTROPHYSIOLOGY CATHETERS 5F,6F QUADRIPOLAR " 爾灣 " 電生理診斷導管 "IBI"ELECTROPHYSIOLOGY DIAGNOSTIC CATHETER-INQUIRY FIXED SOFT TIP DIAGNOSTIC CATH.-DECAPOLAR " 波士頓科技 " 診斷電極導管 "BOSTON SCIENTIFIC" EXPLORER FIXED CURVE DIAGNOSTIC CATHETER 十極 " 波士頓科技 " 診斷電極導管 "BOSTON SCIENTIFIC" EXPLORER FIXED CURVE DIAGNOSTIC CATHETER 四極 8090 11080 11080 8090 CXE01F0400CV ELECTRODE CATH.4 極, 型號 F4:6,65-QA,D,E,F,H,K,L-2,5,10,252-RT;F5,6-8090 CXE01F0401CV ELECTRODE CATH.QUADPOLAR, 型號 F5,6-ST,C,S-QF,A,D- 8090 188

CXE01F1000CV ELECTRODE CATH.DECAPOLAR, 型號 F5A-DP-282,P10-RT;F6-DA,F,G,P- 11080 CXE01F1001CV ELECTRODE CATH.DECAPOLAR, 型號 F6A-DP-282-RT;F7LA-DP-P10-RT 11080 CXE01F7LDGCV ELECTROPHYSIOLOGY CATHETER FIXED CURVE LUMEN CATHETER(DECAPOLAR 固定式十極 ) 11080 CXE01N1130ST " 聖猷達 " 雷斯龐生理電極導線 "SJM" RESPONSE ELECTROPHYSIOLOGY CATHETERS 7F,DECAPOLAR 11880 CXE01N1381ST " 聖猷達 " 雷斯龐生理電極導線 "SJM" RESPONSE ELECTROPHYSIOLOGY CATHETERS 6F,DECAPOLAR 11080 CXE01N1863ST " 聖猷達 " 史普力米生理電極導管 "SJM" SUPREME ELECTROPHYSIOLOGY CATHETER 5F,DECAPOLAR 11080 CXE01Q0405YB " 爾灣 " 電生理診斷導管 "IBI"ELECTROPHYSIOLOGY DIAGNOSTIC CATHETER-INQUIRY 4F FIXED DIAGNOSTIC CATH.-QUADRAPOLAR 8090 CXE0201101BA DYNAMIC XT STEERABLE DECAPOLAR ELECTRODE CATHETER 16370 CXE0201103BA DYNAMIC XT STEERABLE QUADPOLAR ELECTRODE CATHETER 14090 CXE02019NNST "SJM"STEERABLE ELECTROPHYSIOLOGY CATHETER " 聖猷達 " 可控式生理電極導管 ( 十極 ) 16370 CXE022005NBA EP.XT STEERABLE QUADPOLAR ELECTRODE CATH.200525:527: 735:737:741:769:770:898 14090 CXE02567STYB " 爾灣 " 電生理診斷導管 "IBI"ELECTROPHYSIOLOGY DIAGNOSTIC CATHETER-INQUIRY SOFT TIP STEERABLE DIAGNOSTIC CATH.-DECAPOLAR 16370 CXE02D0400CV ELECTRODE CATH. 可彎式四極, 型號 D5S-270L-B2-RT;D5S-AL-252-RT;D5S-270L- 14090 CXE02D0401CV ELECTRODE CATH. 四極可彎, 型號 D6,7-DR-5,10,252-RT;D6,7-AGALBGBLCGCLDGDL 14090 CXE02D1000CV ELECTRODE CATH. 可彎十極,6,7-10DR,FR-2,5,P10,252-RT; 16370 CXE02D6DR2CV SMALL DOME DEFLECTABLE QUADRAPOLAR EP CATHETER ( 可彎式四極 ) 14090 CXE02N1575ST " 聖猷達 " 可控式生理電極導管 "SJM" STEERABLE ELECTROPHYSIOLOGY CATHETER 6F,DECAPOLAR 16370 CXE02N15NNST CXE02N1600ST CXE02N1601ST CXE02QSNSTYB " 聖猷達 " 可控式生理電極導管 "SJM" STEERABLE ELECTROPHYSIOLOGY CATHETER 7F,QUADRIPOLAR " 聖猷達 " 可控式生理電極導管 "SJM" STEERABLE ELECTROPHYSIOLOGY CATHETER 6F,QUADRIPOLAR " 聖猷達 " 可控式生理電極導管 "SJM" STEERABLE ELECTROPHYSIOLOGY CATHETER 6F,QUADRIPOLAR " 爾灣 " 電生理診斷導管 "IBI"ELECTROPHYSIOLOGY DIAGNOSTIC CATHETER-INQUIRY SOFT TIP STEERABLE DIAGNOSTIC CATH.-QUADRAPOLAR 14090 14090 14090 14090 CXE04NS7TCWE 百歐森偉伯司特藍星導管 "BIOSENSE WEBSTER" NAVI-STAR CATHETER* 53000 FAD01000S2ZJ AHMED GLAUCOMA VALVE 壓滅青光眼用舒壓導流瓣膜 * 19900 FALSM3LENSHB FOLDABLE INTRAOCULAR LENS(HYDROPHILLIC ACRYLIC) 摺疊式人工水晶體 2843 FALSM95UVNSZ PMMA I.O.L. 2343 FALSMAR40NA2 ACRYLIC ALLERGAN AMO SENSAR IOL 2843 189

特材代碼中英文品名支付點數 FALSMCLRFLA2 CLARIFLEX SILICONE IOL 2762 FALSMCR5BUA1 PMMA I.O.L 2343 FALSMDL52NA2 DURALENS II IOL 2343 FALSMEX802E2 PMMA INTRAOCULAR LENS 2343 FALSMH60MMB9 HYDROVIEW INTRAOCULAR LENS 2843 FALSMHAKR0ZX AKREOS FOLDABLE INTRAOCULAR LENSES(ACRYLIC W/UV FILTER) 2843 FALSML2B72E2 SILICONE POSTERIOR CHAMBER INTRAOCULAR LENS( 可摺疊式矽膞 ) 2762 FALSMLS100LS INTRAOCULAR LENS 2343 FALSMMA30BA1 ACRYSOF INTRAOCULAR LENSES 2843 FALSMMC71CA1 PMMA I.O.L. UV,UV+LASER 2343 FALSMMZ30BA1 PMMA ALCON CILCO INTRAOCULAR LENSES 2343 FALSMNEFL1RQ NEO EYE FOLDABLE INTRAOCULAR LENS 新視軟式人工水晶體 2843 FALSMSA30AA1 ACRYSOF SINGLE-PIECE FOLDABLE ACRYLIC POSTERIOR CHAMBER INTRAOCULAR LENSES 2843 FALSMSFLEXB9 SILICONE SOFLEX(SOFLEX SE) INTRAOCULAR LENS( 可折疊式矽膞 ) 2762 FALSMSTEC1LS ACRYLIC INTRAOCULAR LENS 2843 FALSNMULT1A1 FALSNMULT1A2 FALSNMULT1LS FALSNMULT1RY FALSNMULT2A2 FALSNNATU1A1 FALSNT0RC1A1 FALSNT0RC1RY FALSNWAVE1A1 FALSNWAVE1B9 ACRYSOF RESTOR NATURAL SINGLE PIECE IOL 多焦點軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 REZOOM ACRYLIC MULTIFOCAL IOL 多焦點軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 TETRAFLEX INTRAOCULAR LENS 多焦點軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 M-FLEX MULTIFOCAL INJECTABLE ACRYLIC LENS INJECTION SYSTEM 敏視多焦點推注式人工水晶體系統, 按一般功能人工水晶體價格給付, 超過部分由病患自付 TECNIS MULTIFOCAL IOL 多焦點軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 ACRYSOF NATURAL STERILE UV-ABSORBING ACRYLIC FOLDABLE SINGLE PIECE IOL 黃色軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 ACRYSOF TORIC SINGLE PIECE NATURAL IOL 散光功能軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 T-FLEX TORIC INJECTABLE ACRYLIC LENS INJECTION SYSTEM 散光功能軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 ACRYSOF ASPHERIC NATURAL IQ SINGLE PIECE IOL 非球面軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 SOFPORT ADVANCED OPTICS ASPHERIC LENS 非球面軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 2843 2843 2843 2843 2843 2843 2843 2843 2843 2843 FALSNWAVE1LS ASPHERIC IOL 非球面人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 2843 190

FALSNWAVE1RY ASPHERIC INJECTABLE ACRYLIC LENS INJECTION SYSTEM 非球面推注式人工水晶體, 按一般功能 2843 人工水晶體價格給付, 超過部分由病患自付 FALSNWAVE2A1 FALSNWAVE2A2 FALSNWAVE2B9 FALSNWAVE3A2 FALSNWAVE3B9 FALSNWAVE4A2 FALSNWAVE4B9 ACRYSOF RESTOR APODIZED DIFFRACTIVE ASPHERIC IOL 非球面軟式人工水晶體 ( 含多焦點及可過濾藍光 ) 按一般功能人工水晶體價格給付, 超過部分由病患自付 TECNIS FOLDABLE ACRYLIC IOL 非球面軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 AKREOS ADVANCED OPTICS ASPHERIC INTRAOCULAR LENS 非球面軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 TECNIS CL FOLDABLE INTRAOCULAR LENS 非球面軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 SOF PORT AO W/VIOLET SHIELD ADVANCED OPTICS LENS 非球面軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 TECNIS 1 PIECE ACRYLIC INTRAOCULAR LENS 非球面, 按一般功能人工水晶體價格給付, 超過部分由病患自付 AKREOS AO MICRO INCISION LENS 非球面軟式人工水晶體, 按一般功能人工水晶體價格給付, 超過部分由病患自付 2843 2843 2843 2843 2843 2843 2843 FAV01100CCSZ OCUCOAT 1CC 玻璃體替代物 2204 FAV01B0050A1 0.5ML VISCOAT STERILE OCULAR VISCOELASTIC SOLUTION 玻離體替代物 1753 FAV01B0075A1 0.75CC VISCOAT-STERILE OCULAR VISCOELASTIC SOLUTION 2204 FAV01C0090R9 OCULOCROM 2% 0.9CC 歐奇樂人工玻璃體 2204 FAV01C0100A1 1CC Cellugel Ophthalmic Viscosurgical Device 玻璃體替代物 2204 FAV01C0100R9 MEGACROM 1.8% 1CC 明佳人工玻璃體 2204 FAV01C0150R9 VISICROM 2% 1.5ML 2.5ML 人工玻璃體 2500 FAV01D0100A1 DISCOVISC OPHTHALMIC VISCOSURGICAL DEVICE 1CC( 人工玻璃體 ) 2204 FAV01D3540A1 0.75ML DUOVISC VISCOELASTIC SYSTEM 2204 FAV01H0055A2 HEALON 0.55ML 1753 FAV01H0506A2 HEALON 5 0.6ML 1753 FAV01HGV55A2 HEALON GV 0.55ML 1753 FAV01HGV85A2 HEALON GV 0.85ML 2204 FAV01P0040A1 0.4ML PROVISC 玻離體替代物 1665 FAV01P0055A1 0.55ML PROVISC 玻離體替代物 1753 FAV01P0085A1 0.85CC PROVISC 玻離體替代物 2204 FAV01RN085RY RAYVISC OPHTHALMIC VISCOELASTIC 0.85ML 人工玻璃體 2204 FAV01VA04CLB VISCAID 0.4ML 1665 191

特材代碼中英文品名支付點數 FAV01VA05CLB VISCAID 0.55ML 1753 FAV01VA08CLB VISCAID 0.8ML 2204 FAV01VSC10V3 I-VISC 1.0ML 玻離體替代物 2204 FAV01VSC55V3 I-VISC 0.55ML 玻璃體替代物 1753 FAV01VSC85V3 I-VISC 0.85ML 玻璃體替代物 2204 FBA022860NSN KRACKOW HTO BLADE STAPLE ( 鈷鉻鉬 ) 3190 FBA022867NSN OSTEOTOMY STAPLE( 鈷鉻鉬 ) 1750 FBA022868NSN TABLE FIXATION STAPLE( 鈷鉻鉬 ) 2153 FBA040053NZ0 TRIOSITE BONE SUBSTITUTES 5CC * 5467 FBA0402B04BC MBCP BONE SUBSTITUTE 2CC * 4179 FBA041000NS1 CHRON OS GRANULE,60%POROSITY,1.0CC * 2565 FBA041001NS1 CHRON OS GRANULE,60%POROSITY,5.0CC* 5467 FBA041002NS1 CHRON OS GANULE,60%POROSITY,10CC* 8791 FBA0410045S1 CHRON OSTM BLOCK,70%POROSITY,12.5X12.5X10MM* 3922 FBA0410047S1 CHRON OS BLOCK,70%POROSITY,20X20X10MM* 5142 FBA0410101FV BONAGRAFT SYNTHETIC BONE SUBSTITUTE 1GM(1CC) 博納骨人工骨替代物 * 2565 FBA0410102FV BONAGRAFT SYNTHETIC BONE SUBSTITUTE 2.5GM(2.5CC) 博納骨人工骨替代物 * 4179 FBA0410103FV BONAGRAFT SYNTHETIC BONE SUBSTITUTE 5GM(5CC) 博納骨人工骨替代物 * 5467 FBA041142NZ0 TRIOSITE BONE SUBSTITUTES 2CC 4179 FBA041151NZ0 BIOMATLANTE TRIOSITE BONE SUBSTITUTES 10CC* 8791 FBA041300NZ0 TRIOSITE BONE SUBSTITUTES 2CC 4179 FBA044020RW2 OSTEOSET BONE VOID FILLER 4.8MM 20 PELLETS(2CC) 4179 FBA044050RW2 OSTEOSET BONE VOID FILLER 4.8MM 50 PELLETS(5CC) 5467 FBA044050TW2 OSTEOSET T BONE VOID FILLER W/TOBRAMYCIN 4.8MM 50 顆 5CC 限骨感染需補骨時使用, 適應症見備註欄 10785 FBA046184NH1 BONESAVE SYNTHETIC BONE SUBSTITUTE(20CC)* 12062 FBA0463005Z8 STIMULAN CALCIUM SULPHATEBONE GRAFT 3.0MM 5CC* 5467 192

FBA0463010Z8 STIMULAN CALCIUM SULPHATEBONE GRAFT 3.0MM 10CC* 8791 FBA0463020Z8 STIMULAN CALCIUM SULPHATEBONE GRAFT 3.0MM 20CC* 12062 FBA0464010Z8 STIMULAN CALCIUM SULPHATEBONE GRAFT 4.8MM 10CC* 8791 FBA0464020Z8 STIMULAN CALCIUM SULPHATEBONE GRAFT 4.8MM 20CC* 12062 FBA0470010Z8 ALLOGRAN-N BONE GRAFT SUBSTITUTE 10CC * 8791 FBA0470035Z8 ALLOGRAN-N BONE GRAFT SUBSTITUTE 35CC * 17092 FBA0480005Z8 ALLOGRAN-R BONE VOID FILLER 5CC * 5467 FBA0480010Z8 ALLOGRAN-R BONE VOID FILLER 10CC * 8791 FBA0480020Z8 ALLOGRAN-R BONE VOID FILLER 20CC * 12062 FBA048110JSN JAX BONE VOID FILLER 10CC * 8791 FBA0490G01BC MBCP BONE SUBSTITUTE 1CC* 2565 FBA0490G02BC MBCP BONE SUBSTITUTE 2CC* 4179 FBA0490G10BC MSCP BONE SUBSTITUTE 10CC* 8791 FBA0490G16BC MSCP BONE SUBSTITUTE 16CC* 10525 FBA049512JSN JAX BONE VOID FILLER 2CC * 4179 FBA049513JSN JAX BONE VOID FILLER 5CC * 5467 FBA0499205DP CONDUIT TCP(TRICALCIUM PHOSPHATE)GRANULES 5CC 5467 FBA0499210DP CONDUIT TCP(TRICALCIUM PHOSPHATE)GRANULES 10CC 8791 FBA0499215DP CONDUIT TCP(TRICALCIUM PHOSPHATE)GRANULES 15CC 10525 FBA0499230DP CONDUIT TCP(TRICALCIUM PHOSPHATE)GRANULES 30CC(2X15CC) 17092 FBA04A2Q05RJ "GRAFTYS"RESORBABLE BONE VOID FILLER 5CC 可吸收性骨填充物 * 5467 FBA04A2Q10RJ "GRAFTYS"RESORBABLE BONE VOID FILLER 10CC 可吸收性骨填充物 * 8791 FBA04A3Q10RJ "GRAFTYS"RESORBABLE BONE VOID FILLER 10CC 可吸收性骨填充物 * 8791 FBA04BB02GK8 BI-OSTETIC BONE VOID FILLER(2.5CC)* 4179 FBA04BB05GK8 BI-OSTETIC BONE VOID FILLER(5CC)* 5467 FBA04BB10GK8 BI-OSTETIC BONE VOID FILLER(10CC)* 8791 193

特材代碼中英文品名支付點數 FBA04BB15GK8 BI-OSTETIC BONE VOID FILLER(15CC)* 10525 FBA04BB30GK8 BI-OSTETIC BONE VOID FILLER(30CC)* 17092 FBA04CEM02K8 CEM-OSTETIC BONE VOID FILLER(2.5CC)* 4179 FBA04CS001Z6 UNI-OSTEO 1CC* 適應症請鍵備註欄 2565 FBA04CS002Z6 UNI-OSTEO 2CC* 適應症請鍵備註欄 4179 FBA04CS003Z6 UNI-OSTEO 3CC* 適應症請鍵備註欄 5142 FBA04CS005Z6 UNI-OSTEO 5CC* 適應症請鍵備註欄 5467 FBA04CS010Z6 UNI-OSTEO 10CC* 適應症請鍵備註欄 8791 FBA04CS020Z6 UNI-OSTEO 20CC* 適應症請鍵備註欄 12062 FBA04FM01CLB 1CC BONE SUBSTITUTE GRANULES 骨胳填補顆粒 2565 FBA04FM02CLB 2CC BONE SUBSTITUTE GRANULES 骨胳填補顆粒 4179 FBA04FM05CLB FORAMIC BONE GRAFT SUBSTITUTE 5CC* 5467 FBA04FM10CLB FORAMIC BONE GRAFT SUBSTITUTE 10CC* 8791 FBA04FM20CLB FORAMIC BONE GRAFT SUBSTITUTE 20CC* 12062 FBA04HS114Z6 MERRIES K-PHATE BONE SUBSTITUTE BLOCK(5X5X10MM),4 塊 / 包,1CC/ 包 * 2565 FBA04HS122Z6 MERRIES K-PHATE BONE SUBSTITUTE BLOCK(5X5X20MM),2 塊 / 包,1CC/ 包 * 2565 FBA04HS124Z6 MERRIES K-PHATE BONE SUBSTITUTE BLOCK(5X5X20MM),4 塊 / 包,2CC/ 包 * 4179 FBA04HS201Z6 K-PHATE BONE SUBSTITUTE 1CC 2565 FBA04HS202Z6 K-PHATE BONE SUBSTITUTE 2CC 4179 FBA04HS205Z6 MERRIES K-PHATE BONE SUBSTITUTE 5CC* 5467 FBA04HS208Z6 MERRIES K-PHATE BONE SUBSTITUTE 8CC* 5467 FBA04HS210Z6 K-PHATE BONE SUBSTITUTE 10CC 8791 FBA04HS220Z6 K-PHATE BONE SUBSTITUTE 20CC 12062 FBA04HT020PQ "PURZER"SINBONEHT BONE REPLACEMENT (7 立方公分 ) 生骨替代物二代 * 5467 FBA04HT021PQ "PURZER"SINBONEHT BONE REPLACEMENT(1 立方公分 )* 2565 FBA04HT022PQ "PURZER"SINBONEHT BONE REPLACEMENT(2 立方公分 )* 4179 194

FBA04HT023PQ "PURZER"SINBONEHT BONE REPLACEMENT(5 立方公分 )* 5467 FBA04HT024PQ "PURZER"SINBONEHT BONE REPLACEMENT (10 立方公分 ) 生骨替代物二代 * 8791 FBA04HT040PQ "PURZER"SINBONEHT BONE REPLACEMENT (7 立方公分 ) 生骨替代物二代 * 5467 FBA04HT041PQ "PURZER"SINBONEHT BONE REPLACEMENT(1 立方公分 )* 2565 FBA04HT042PQ "PURZER"SINBONEHT BONE REPLACEMENT(2 立方公分 )* 4179 FBA04HT043PQ "PURZER"SINBONEHT BONE REPLACEMENT(5 立方公分 )* 5467 FBA04HT050PQ "PURZER"SINBONEHT BONE REPLACEMENT (7 立方公分 ) 生骨替代物二代 * 5467 FBA04HT051PQ "PURZER"SINBONEHT BONE REPLACEMENT (1 立方公分 ) 生骨替代物二代 * 2565 FBA04HT052PQ "PURZER"SINBONEHT BONE REPLACEMENT (2 立方公分 ) 生骨替代物二代 * 4179 FBA04HT053PQ "PURZER"SINBONEHT BONE REPLACEMENT (5 立方公分 ) 生骨替代物二代 * 5467 FBA04HT054PQ "PURZER"SINBONEHT BONE REPLACEMENT (10 立方公分 ) 生骨替代物二代 * 8791 FBA04HT091PQ "PURZER"SINBONEHT BONE REPLACEMENT(1 立方公分 )* 2565 FBA04HT092PQ "PURZER"SINBONEHT BONE REPLACEMENT(2 立方公分 )* 4179 FBA04HT093PQ "PURZER"SINBONEHT BONE REPLACEMENT(5 立方公分 )* 5467 FBA04P6922BZ SBM BIOSORB BONE SUBSTITUTES 2CC* 4179 FBA04P6944BZ SBM BIOSORB BONE SUBSTITUTES 5CC* 5467 FBA04P6946BZ SBM BIOSORB BONE SUBSTITUTES 15CC*( 產品型號 :P822893229 自 940701 起生效 ) 10525 FBA04SB050PQ SINBONE BONE REPLACEMENT 7.0CM3* 5467 FBA04SB054PQ SINBONE BONE REPLACEMENT 10CM3* 8791 FBA04SB0X0PQ SINBONE BONE REPLACEMENT (SB020:5MM*5MM*5MM 7.0 CM3) (SB010 自 970701 起將 5MM*5MM*40MM 7.0 CM3 變更為 5MM*5MM*20MM 7.0 CM3)* 3416 FBA070942NH1 X-CHANGE MESH 5250 FBD00001NNY2 DCS PLATE 6:22HOLE 8500 FBD00001XNY2 DHS PLATE 135:150 度 2:12HOLE( 產品型號 281420:410,281540:560) 8497 FBD000095NZ1 VERSA-FX SUPRACONDYLAR FIXATION SYSTEM 8500 FBD000135NZ1 VERSA-FX FEMORAL FIXATION SYSTEM 8497 FBD0011931Z1 VERSA-FX II SUPRACONDYLAR FIXATION SYSTEM 90,95 度 (PLATEX1+LAG SCREWX1+COMP SCREWX1) 8500 195

FBD001193NZ1 VERSA-FX II FEMORAL FIXATION SYSTEM 130,135 度 (PLATEX1+LAG SCREWX1+COMP SCREWX1) 8497 FBD001199NZ1 COMPRESSION HIP SCREW(DHS) 8497 FBD002412NSN COMPRESSION HIP SCREW SYSTEM (DHS) 8497 FBD0028110V2 DHS PLATE SYSTEM (PLATE+SCREW)130~150 度 8497 FBD0028190V2 DCS PLATE SYSTEM (PLATE+SCREW) 95 度 8500 FBD00281CNS1 COMPRESSION HIP SYSTEM(DHS)130-150 度 8497 FBD00281NNS1 DCS PLATE SYSTEM 95 度 8500 FBD003281NZ6 STAINLESS COMPRESSION HIP SCREW SYSTEM 95:140 度 (PX1+COM SCREWX1+LAG SCREWX1) 8497 FBD00401NNY2 TITANIUM DCS PLATE 6:22HOLE 9180 FBD00401XNY2 TITANIUM DHS PLATE 135:150 度 2:10HOLE 9176 FBD005963NS9 OMEGA II LOW PROFILE:CHS SYSTEM 135-150 度 (PLATEX1+LAG SCREWX1+COMPRESSION SCREWX1) 8497 FBD005966NS9 OMEGA II SYSTEM:SUPRACONDYLAR PLATE 95 度 (PLATE+LAG SCREW+COMPRESSION SCREW) 8500 FBD009501NS3 OHS SYSTEM (COMPRESSION HIP SCREW) 8497 FBD009501NS9 OHS SYSTEM 135-150 度 (COMPRESSION HIP SCREW)( 原代碼 FBD009501NS3) 8497 FBD0095606S3 COMPRESSION TUBE PLATE OCS 8500 FBD0095606S9 COMPRESSION TUBE PLATE HIP SYSTEM OCS 95 度 ( 原代碼 FBD0095606S3) 8500 FBD00DG135E3 DYNAMIC HIP SCREW SYSTEM(PLATE+CONDYLAR SCREW+COMPRESSION SCREW) 8497 FBD00K004NAE COMPRESSION HIP SCREW(DHS) 8497 FBD01244XNSN DCS COMPRESSION TUBE PLATE SYSTEM(PLATE+LEG SCREW+CORTICAL SCREW) 8500 FBEF1UPELVTD PELVIC FRAME(U1 CLAMPX2+SMOOTH RODX3+ROD CONNECTORX2) 不含 PIN 21000 FBEF440001D1 TRAUMA-FIX EXTERNAL FIXTOR:HUMERAL BASIC SET 肱骨基本組 17500 FBEF440002D1 TRAUMA-FIX EXTERNAL FIXTOR:HUMERAL TRANSPORT FRAME 肱骨移位組 17500 FBEF55150NZ6 STAINLESS HALP PIN 5MM 798 FBEFP2482NSN SKELETAL TRACTION HALF PIN 3MM (COVE POINT PIN) 599 FBEFP2483NSN SKELETAL TRACTION HALF PIN 5MM (COVE POINT PIN) 798 FBEFP3109SZ6 STAINLESS HALF PIN 3MM 80:110CM 599 196

特材代碼中英文品名支付點數 FBEFP4021NU0 HALF PIN 3,4MM 599 FBFJ11234NDP NEUFLEX FINGER IMPLANTS(SILICON) 3712 FBFW14885NW2 SWANSON WRIST JOINT IMPLANT 11052 FBHS51108NU0 G.T.F HIP STEM 大粗隆股骨柄 24750 FBKB21759NW2 WHITESIDE ORTHOLOC REVISION TIBIAL STEM 5CM,6.25CM 1235 FBKE21859NW2 WHITESIDE ORTHOLOC REVISION FEMORAL STEM 5CM 1350 FBKF22105NU0 FEMUR COMPONENT 訂製型股骨植入物 89000 FBKF25393NH1 ROTATINGE HINGE TOTAL KNEE SYSTEM:FEMORAL COMPONENT 41032 FBKP21190NH1 ROTATINGE HINGE TOTAL KNEE SYSTEM :DOME PATELLAR ( 型號 6485-19,39,59-15 自 93/4/1 生效 ) 11672 FBKRA6475NH1 ROTATING HINGE TOTAL KNEE SYSTEM (FE+TI PLUG+PA+ BEARING+AXLE+BUMPER+BUSHINGX2) 117924 FBKS129051U0 SEGMENT PART 訂製型脛骨中段延伸件 23000 FBKS12905NU0 STEM 訂製型脛骨下段延伸件 25000 FBKT222059U0 TIBIAL BEARING COMPONENT 訂製型脛骨連接件 18000 FBKT22205NU0 TIBIAL COMPONENT 訂製型脛骨植入物 33000 FBKT253933H1 ROTATINGE HINGE TOTAL KNEE SYSTEM:TIBIAL BEARING COMPONENT( 型號 6485-8435 自 93/4/1 生效 23335 FBKT253940H1 ROTATINGE HINGE TOTAL KNEE SYSTEM:AXLE 8370 FBKT253942H1 ROTATINGE HINGE TOTAL KNEE SYSTEM:BUMPER COMPONENT( 型號 6485-4100 自 93/4/1 生效 5205 FBKT253944H1 ROTATINGE HINGE TOTAL KNEE SYSTEM:BUSHING ( 型號 6485-2460 自 93/4/1 生效 ) 2344 FBKT25394NH1 ROTATINGE HINGE TOTAL KNEE SYSTEM:TIBIAL PLUG ( 型號 6485-2008:2421 自 93/4/1 生效 ) 23622 FBKUA1000NAE SEARCH UNICOMPARTMENTAL KNEE SYSTEM(FEMORAL+TIBIA+INSERT) 46894 FBKUA1000TH1 EIUS UNICOMPARTMENTAL KNEE SYSTEM( 含 FEMORAL+TIBIAL+INSERT) 46894 FBKUA1000TW2 UNICOMPARTMENTAL KNEE SYSTEM(FEMORAL+TIBIAL+INSERT) 46894 FBKUA1000USN GENESIS UNICOMPARMENTAL KNEE SYSTEM 46894 FBKUA10277DP PRESERVATION UNICOMPARTMENTAL KNEE SYSTEM(FEMORAL+TIBIAL+INSERT) 46894 FBKUA2000TZ1 UNICOMPARTMENTAL HIGH-FLEX SYSTEM 155 度 (FEMORAL+TIBIAL +SURFACE) 46894 FBKUA9600NJJ PFC SIGMA UNICOMPARTMENTAL KNEE SYSTEM 人工半膝關節組 46894 197

FBN0212206SN R-T RECONSTRUCTION NAIL 限股骨粗隆下骨折及股骨粗隆複合骨折患者申報 9000 FBN04102XNU0 HUMERAL LOCKING SCREW 1350 FBN0412223SN R-T PROXIMAL SCREW 1350 FBN0412226SN FEMORAL LOCKING SCREW 1350 FBN042252SZ1 M/DN RECONSTRUCTION SCREW 1350 FBN042253SZ1 M/DN CORTICAL SCREW 1350 FBN04303XNU0 FEMORAL&TIBIAL LOCKING SCREW W/SET SCREW 1350 FBN04520XNU0 NAIL LOCKING SCREW 1350 FBN05002XNY2 HUMERAL NAIL 7.0:9.0X210:280 9472 FBN05003XNY2 FEMORAL NAIL 10:17,18,19,300:480,400:180 9472 FBN05004XNY2 TIBIAL NAIL 9:13 255:420( 產品型號 251280:420,252280:420,253280:420) 9472 FBN0512202R1 FEMORAL NAIL SYSTEM 9472 FBN0512202SN FEMORAL NAIL SYSTEM( 含 NAIL+SCREW) 9472 FBN0512217R1 TIBIAL NAIL SYSTEM 9472 FBN0512217SN TIBIAL NAIL SYSTEM( 含 NAIL+SCREW) 9472 FBN051722NS9 S2 NAIL SYSTEM:TIBIAL(NX1+SX3) 9472 FBN051732NS9 S2 NAIL SYSTEM:FEMORAL(NX1+SX3) 9472 FBN052240SZ1 M/DN RETROGRADE FEMORAL NAIL( 反向股骨固定釘 ) 9000 FBN052252SZ1 M/DN FEMORAL NAIL SYSTEM(NAIL+CORTICAL SCREW) 9472 FBN052253SZ1 M/DN TIBIAL NAIL SYSTEM(NAIL+CORTICAL SCREW) 9472 FBN052254SZ1 M/DN HUMERAL NAIL SYSTEM(NAIL+CORTICAL SCREW) 9472 FBN052450NSN HUMERAL NAIL SYSTEM(NAIL+SCREW) 9472 FBN05251XNS1 TIBIAL NAIL SYSTEM(NAIL 型號 255.927:936,256.027:238 自 89/10/1 生效 ) 9472 FBN05274XNS1 FEMORAL NAIL SYSTEM( 型號 271.934:946,272.034:246 自 89/10/1 生效 ) 9472 FBN05301XNU0 HUMERAL NAIL SYSTEM(NAILX1+SCREWX3) 9472 FBN053603NS3 FEMORAL NAIL SYSTEM 9472 198

FBN053603NS9 FEMORAL NAIL SYSTEM ( 原代碼 FBN053603NS3) 9472 FBN053792NS3 TIBIAL NAIL SYSTEM 9472 FBN053792NS9 TIBIAL NAIL SYSTEM( 原代碼 FBN053792NS3) 9472 FBN05402XNY2 TITANIUM UNREAMED HUMERAL NAIL(NAILX1+LOCKING BOLTX4) 10229 FBN05403XNY2 TITANIUM UNREAMED FEMORAL NAIL(NAILX1+LOCKING BOLTX4) 10229 FBN05404XNY2 TITANIUM UNREAMED TIBIAL NAIL(NAILX1+LOCKING BOLTX4) 10229 FBN054102NH1 FEMORAL NAIL SYSTEM 9472 FBN05601XNU0 FEMORAL&TIBIAL NAIL SYSTEM(NX1+SX3)( 或 SCREW 型號 5201-1085:1105) 9472 FBN056091NH1 HUMERAL NAIL SYSTEM 9472 FBN056092NH1 TIBIAL NAIL SYSTEM 9472 FBN05KA36NAE FEMORAL NAIL SYSTEM 9472 FBN05KC35NAE TIBIAL NAIL SYSTEM 9472 FBN070301YM1 INTRAMEDULLARY NAIL(KUNTSCHER NAIL) 骨髓內釘 1810 FBN07KA12NAE KIRSCHNER I.M. PIN FEMUR 1810 FBN07KC11NAE KIRSCHNER I.M.PIN HUMERUS/TIBIAL 1810 FBN080481YM1 INTRAMEDULLARY TIBIA (KUNTSCHER) 下腿用骨髓內釘 1810 FBN084041NZ1 KUNTSCHER NAIL 14:15MM 1810 FBNG1273XNS1 PROXIMAL FEMORAL NAILS STAINLESS STEEL(273.125:137+080:120+234.075:120+259.260:960) 18000 FBNG14003NS9 GAMMA3 SYSTEM STAINLESS STEEL 脛股骨固定系統 (NAILX1+SCREWX3) 18000 FBNG1473XNS1 TI PROXIMAL FEMORAL NAIL 19440 FBNG1511XNH1 GAMA LOCKING NAIL SYSTEM( 型號 1204-1125:35,1107-4050 自 90/04/01 生效 ) 18000 FBNG22252SZ1 M/DN RECONTRUCTION NAIL 9000 FBNG24060NS9 GAMMA3 SYSTEM:NAIL 11000 FBNG25113NH1 GAMA LOCKING NAIL :GAMA NAIL 11000 FBNG34003NS9 GAMMA3 SYSTEM:SET SCREW 1300 FBNG34004NS9 GAMMA3 SYSTEM:LAG SCREW 3000 199

特材代碼中英文品名支付點數 FBNG360822H1 GAMA LOCKING NAIL :SET SCREW 1300 FBNG37120NH1 GAMA LOCKING NAIL :LAG SCREW 3000 FBP01007XNY2 4.5 SEMI-TUBULAR PLATE 2:12HOLE 627 FBP01008XNY2 3.5 1/3 TUBULAR PLATE 2:12HOLE 595 FBP01009XNY2 2.7 1/4 TUBULAR PLATE 2:8HOLE 459 FBP011403NSN ONE-THIRD TUBULAR PLATE 2:8HOLE,9:12HOLE 595 FBP011413NSN SEMI-TUBULAR PLATE 2:7HOLE,8:12HOLE 627 FBP011480NSN QUARTER TUBULAR PLATE 3:8HOLE 459 FBP0122200V2 TUBULAR PLATE SEMI 2:12HOLE 627 FBP01222NNS1 SEMI-TUBULAR PLATE 2:12 HOLE 39:199MM 627 FBP012360NZ1 1/3 TUBULAR PLATE 2:8HOLE 595 FBP012367NZ1 SEMI-TUBULAR PLATE 4:7HOLE(2364-03 自 88/1/12 生效 ) 627 FBP0124130V2 TUBULAR PLATE 1/3 3.5MM 2:12H 595 FBP012413NS1 ONE-THIRD TUBULAR PLATE 2:8 HOLE 28:148MM 595 FBP0124200V2 QUARTER TUBULAR PLATE 2.7 MM 3:8HOLE 459 FBP012420NS1 QUARTER TUBULAR PLATE 3:8 HOLE 459 FBP012460NZ1 QUARTER TUBULAR PLATE 3:8HOLE 459 FBP013020NS9 ONE THIRD TUBULAR PLATE 2:14HOLE 595 FBP014050NS9 SEMI-TUBULAR PLATE 2:10 HOLE 39:167MM( 原代碼 FBP014050NS3) 627 FBP014071NS9 ONE THIRD TUBULAR PLATE 2:8 HOLE 25:97MM( 原代碼 FBP014071NS3) 595 FBP01407XNY2 TITANIUM SEMI-TUBULAR PLATE 4.5MM 2:12HOLE 677 FBP01408XNY2 TITANIUM ONE-THIRD TUBULAR PLATE 3.5MM 2:12HOLE 642 FBP01409XNY2 TITANIUM QUARTER TUBULAR PLATE 2.7MM 2:8HOLE 495 FBP0149274Z1 ONE-QUARTER TUBULAR PLATE 3:8HOLE 459 FBP0149351Z1 ONE-THIRD TUBULAR PLATE 2:12HOLE 595 FBP0149452Z1 SEMI-TUBULAR PLATE 2:12HOLE 627 200

特材代碼中英文品名支付點數 FBP01LM30NAE 1/3 TUBULAR PLATE 3.5MM 595 FBP01LM32NAE SEMI-TUBLUAR PLATE 4.5 MM 627 FBP01LN25NAE QUARTER TUBULAR PLATE 2.7 MM 459 FBP01LN2SNAE SMALL FRAGMENT PLATE 2.7MM 438 FBP02010XNY2 4.5 BROAD DYNAMIC COMPRESSION PLATE 6:18HOLE 2180 FBP02011XNY2 4.5 BROAD LENGTHENING PLATE 8:10HOLE 2263 FBP02012XNY2 4.5 NARROW DYNAMIC COMPRESSION PLATE 2:17HOLE 1555 FBP02013XNY2 4.5 NARROW LENGTHENING PLATE 30:80MM 2263 FBP02015XNY2 2.0,2.7,3.5 DYNAMIC COMPRESSION PLATE 2:12HOLE( 產品型號 243540:580) 2180 FBP020559NS9 FEMORAL PLATE DISTAL 6-10HOLE( 配合 4.5MM,6.5MM SCREW 用 ) 3500 FBP021010NS9 SMALL BONE PLATES4:10 HOLES; 52:120MM(ULNA AND RADIUS)( 原代碼 FBP021010NS3) 2180 FBP021024NS3 SMALL BONE PLATE 1207 FBP021024NS9 SMALL BONE PLATE ACP 4-8 HOLE( 原代碼 FBP021024NS3) 1207 FBP021044NS9 L-PLATES R/L3/2:6/2 HOLES; 68:116MM TIBIA( 原代碼 FBP021044NS3) 3890 FBP021045NS9 L-BUTTRESS PLATE 67:339MM 3:20HOLE 2783 FBP021046NS3 SMALL BONE PLATE 3.5 SCREW 1207 FBP021402NSN 3.5MM SMALL PLATE 2:12HOLE 1207 FBP021412NSN 4.5MM BROAD PLATE 6:18HOLE 2180 FBP021414NSN 4.5MM NARROW PLATE 2:16HOLE,18:24HOLE 1555 FBP021460NSN 2.0MM STRAIGHT PLATE3:6HOLE 438 FBP022235NS1 LC-DCP 3.5 PLATE 4:12HOLE 1280 FBP022245NS1 LC-DCP 4.5 NARROW PLATE 2:16HOLE 1555 FBP02224NNS1 NARROW DYNAMIC COMPRESSION PLATE DCP 2:18 HOLE 39:295MM 1555 FBP022265NS1 LC-DCP 4.5 BROAD PLATE 6:18HOLE 2180 FBP02226NNS1 BROAD DYNAMIC COMPRESSION PLATE DCP 6:18 HOLE 103:295MM 2180 FBP022278NS1 BROAD LENGTHENING PLATE 8 HOLE 135:165MM 2263 201

FBP02228NNS1 NARROW LENGTHENING PLATE 8 HOLE 135:185MM 2263 FBP022420NZ1 STRAIGHT MINI PLATE 438 FBP022429NZ1 FOREARM PLATE 5:12HOLE( 型號 2429-05 自 91/10/01 生效 ) 1207 FBP022431NS1 MINI STRAIGHT PLATE 3:6 HOLE 17:35MM 438 FBP022435NS1 MINI DYNAMIC COMPRESSION PLATE DCP 4:8 HOLE 22:42MM 1605 FBP022440NS1 MINI DYNAMIC COMPRESSION PLATE 2:12 HOLE 20:100MM 1605 FBP022463NZ1 BROAD SELF COMPRESSION PLATE 5:14HOLE(SCP) 2180 FBP022470NZ1 NARROW SELF COMPRESSION PLATE 12HOLE(SCP)(2462-03:11 自 88/1/11 生效 ) 1555 FBP022480NS1 DYNAMIC COMPRESSION PLATE DCP 2:12 HOLE 26:146MM 1280 FBP023000NS9 NARROW BONE PLATES4:15 HOLES; 72.5:277MM TIBIA AND ULNA( 原代碼 FBP023000NS3) 1555 FBP023002NS9 SMALL COMPRESSION BONE PLATE ACP 2:30HOLE 2180 FBP023100NS9 WIDE BONE PLATES6:16 HOLES; 105:296MM HUMERUS AND TIBIA( 原代碼 FBP023100NS3) 2180 FBP023102NS9 SMALL T BONE PLATE ACP 3:4HOLE 1207 FBP023205NS9 NARROW BONE PLATE 38:542MM 2:30HOLE 1555 FBP023215NS9 WIDE BONE PLATE ACP 4:30HOLE 2180 FBP023300NS3 Y-FORK PLATE ACP L/R 3752 FBP023300NS9 Y-FORK PLATE ACP L/R 3:5 HOLE( 原代碼 FBP023300NS3) 3752 FBP023500NS3 T PLATE FEMORAL L/R 3890 FBP023500NS9 HUMERAL PLATE ACP L/R 3-6 HOLE( 原代碼 FBP023500NS3) 3890 FBP02410XNY2 TITANIUM BROAD DYNAMIC COMPRESSION PLATE 4.5MM 6:18HOLE 2354 FBP02412XNY2 TITANIUM NARROW DYNAMIC COMPRESSION PLATE 4.5MM 2:16HOLE 1679 FBP02415XNY2 TITANIUM DYNAMIC COMPRESSION PLATE 2.0MM:3.5MM 2:12HOLE 1382 FBP0249202Z1 2.0MM MINI COMPRESSION PLATE 4:12HOLE 1605 FBP0249203Z1 2.0MM STRAIGHT PLATE 3:6HOLE 17:35MM 438 FBP0249272Z1 2.7MM MINI COMPRESSION PLATE 2:12HOLE 1605 FBP024935NZ1 3.5MM COMPRESSION PLATE 2:22HOLE 1280 202

FBP0249451Z1 4.5MM BVROAD COMPRESSION PLATE 5:26HOLE 2180 FBP024945NZ1 4.5MM NARROW COMPRESSION PLATE 2:24HOLE 1555 FBP025055NS9 PLATE FOR CONDYLAR-FRAGMENT R/L 7/6:9/6 HOLES 172:210MM( 原代碼 FBP020559NS3) 3500 FBP025062NS3 SMALL BONE PLATE ACP 4:6 HOLE 27:40MM 438 FBP025062NS9 SMALL BONE PLATE ACP 4-6 HOLE( 原代碼 FBP025062NS3) 438 FBP025103NS3 SMALL BONE PLATE ACP 4:10HOLE 35:95MM 1280 FBP025103NS9 SMALL BONE PLATE ACP L/R 4:10 HOLE( 原代碼 FBP025103NS3) 1280 FBP02510XNS9 SMALL BONE PLATE ACP 3-5 HOLE( 原代碼 FBP02510XNS3) 438 FBP025804NS3 CONDYLAR PLATE ACP 90 (ANGLED) 5355 FBP025804NS9 ADUL OSTEOTOMY PLATE ACP 90( 原代碼 FBP025804NS3) 5355 FBP026028NSN MINI STRAIGHT PLATE 20 HOLE 2.0MM 3500 FBP027005NS3 CONDYLAR PLATE ACP 95 5355 FBP027005NS9 CONDYLAR PLATE ACP 95 6/8/10 HOLE( 原代碼 FBP027005NS3) 5355 FBP028003NS3 CONDYLAR PLATE ACP 90 (ANGLED) 5355 FBP028003NS9 CHILDREN OSTEOTOM PLATES ACP 90 4 HOLE( 原代碼 FBP028003NS3) 5355 FBP028192NH1 STRAIGHT WIDE PLATE 2180 FBP02LM26NAE NARROW LENGTHING PLATE 4.5 MM 2263 FBP02LM28NAE BROAD LENGTHING PLATE 4.5 MM 2263 FBP02LM40NAE NARROW BONE PLATE 4.5 MM 1555 FBP02LM42NAE BROAD BONE PLATE 4.5 MM 2180 FBP02LN027AE MULTIPLE FRAGMENT PLATE 438 FBP02LN28NAE DCP 2.0MM SMALL PLATE 1605 FBP03016XNY2 4.5 T-PLATE HOLE 2783 FBP03017NNY2 L-TIBIAL BUTTRESS PLATE 5:13HOLE 2783 FBP03017XNY2 4.5 L/T-BUTTRESS PLATE 3:6HOLE 2783 FBP03018XNY2 4.5 SPOON PLATE 5:6HOLE 2310 203

特材代碼中英文品名支付點數 FBP03019XNY2 4.5 COBRA HEAD PLATE 8:11HOLE 4910 FBP03021XNY2 4.5 CONDYLAR BUTTRESS PLATE 7:15HOLE 4930 FBP03022XNY2 SMALL T-PLATE 3:6HOLE 1207 FBP03023XNY2 CLOCERLEAF PLATE 3:6HOLE,CALCANEAL PLATE 60:70MM 2184 FBP03024XNY2 1.5/2.0 MINI T-PLATE 3:4HOLE,2.0/2.7 L-PLATE 410 FBP03025XNY2 1.5/2.0/2.7 MINI CONDYLAR PLATE 3500 FBP03026XNY2 MINI PLATE STRAIGHT 3:6HOLE 438 FBP03027XNY2 MINI PLATE(H PLATE 4HOLE,STR 100MM,ADAPTATION PLATE 100MM) 3500 FBP03028XNY2 RECONSTRUCTION PLATE 5:22HOLE 4462 FBP031005NSN STAINLESS LATERAL TIBIAL HEAD BUTTRESS PLATE 5:13HOLE 118:246MM 3890 FBP031013NS3 V.T.L.PLATE 2783 FBP031034NS3 T PLATE 3890 FBP031179NZ1 RECONSTRUCTION PLATE 4462 FBP031400NSN 4.5MM RECONTRACTION PLATE 3:16HOLE 4462 FBP031406NSN CLOVERLEAF PLATE 3:6HOLE 2184 FBP031407NSN T-BUTTRESS PLATE 4:6HOLE,L-BUTTRESS PLATE TIBIAL 2783 FBP031415NSN SPOON PLATE 5:6HOLE 2310 FBP031416NSN T-PLATE 3:8HOLE 2783 FBP031418NSN COBRA HEAD PLATE 8:11HOLE 4910 FBP031432NS3 T PLATE 3890 FBP031432NS9 FORMA PLATE L/R 4/3,6/3,8/3 HOLE( 原代碼 FBP031432NS3) 3890 FBP031704NSN HOOK PLATE 4HOLE 4570 FBP0322400V2 DCP 4.5 NARROW DYNAMIC COMPRESSION PLATE 2:18HOLE 1555 FBP0322600V2 DCP 4.5 BROAD DYNAMIC COMPRESSION PLATE 6:22HOLE 2180 FBP0322930V2 RECONSTRUCTION PLATE 4.5MM 3:16HOLE 4462 FBP03229NNS1 PELVIC RECONSTRUCTION PLATE 3:16 HOLE 45:253MM 4462 204

FBP03229XNY2 STRAIGHT RECONSTRUCTION PLATE 4.5 3:16HOLE 4462 FBP0324000V2 SPOON PLATE 4.5 5:6HOLE 2310 FBP032400NS1 SPOON PLATE 5:6:12 HOLE 100:120MM 2310 FBP0324010V2 T PLATES 4.5MM 3:12HOLE 2783 FBP032401NS1 T PLATE 3:8:12 HOLE 68:148MM 2783 FBP0324020V2 LATERAL TIBIAL HEAD PLATE-L/R 5:13HOLE 3500 FBP0324030V2 T-BUTTRESS PLATE 4:6HOLE 2783 FBP032403NS1 SUPPORTING T PLATE 4:6 HOLE 81:112MM 2783 FBP0324040V2 L-BUTTRESS PLATE 4.5 MM L/R 3:6HOLE 2783 FBP032404NS1 SUPPORTING PLATE(L-BUTTRESS PLATE) 3:6 HOLE 69:107MM 2783 FBP032405NS1 LATERAL TIBIAL BUTTRESS PLATE 5:13HOLE 3890 FBP0324070V2 CONDYLAR BUTTRESS PLATE L/R 4.5 MM 7:15H 4930 FBP032407NS1 DISTAL FEMUR PLATE 7:15 HOLE (CONDYLAR BUTTRESS PLATE) 4930 FBP0324080S1 HOOK PLATE 128MM 4570 FBP0324080Y2 HOOK PLATE 4.5 123MM 4570 FBP0324090V2 COBRA HEAD PLATE 4.5 8:11HOLE 4910 FBP032409NS1 COBRA HEAD PLATE 8:11 HOLE 202:218MM 4910 FBP0324110V2 SMALL T-PLATE 3.5MM (3+3:4+8HOLE) 1207 FBP032411NS1 SMALL T PLATE RIGHT ANGLE 3/3:6/4 HOLE 50:78MM 1207 FBP0324120V2 T PLATE OLIQUE 3.5MM (3+3;3+4;3+5HOLE) 1207 FBP032412NS1 SMALL T PLATE OLIQUE ANGLE 3/3:5/3 HOLE 52:74MM 1207 FBP0324140V2 MULTIPLE FRAGMENT MINI PLATE (W-PLATE) 7HOLE 410 FBP0324160V2 CALCANEAL Y-PLATE 3.5MM 3752 FBP0324164S1 Y PLATE 3752 FBP032416NS1 CALCANEAL PLATE 3.5 3752 FBP0324180V2 CLOVERLEAF PLATE 3.5MM 3:9HOLE 2184 205

特材代碼中英文品名支付點數 FBP032418NS1 CLOVERLEAF PLATE 3:4 HOLE 88:104MM 2184 FBP0324191Z1 MINI EPIPHYSIS PLATE T L/R 410 FBP032419NZ1 MINI EPIPHYSIS PLATE OBLIQUE L/R 410 FBP0324230V2 MINI L OBLIQUE PLATE L/R 2.7MM 410 FBP032423NS1 MINI L FINGER JOINT-HEAD PLATE 410 FBP0324240V2 MINI T PLATE 2.0,2.7MM 410 FBP0324241S1 MINI T FINGER JOINT-HEAD PLATE 410 FBP0324300V2 ADAPTATION PLATE 100MM 20HOLE 3500 FBP0324310V2 STRAIGHT MINI PLATE 3:6HOLE 438 FBP0324319S1 MINI PLATE 1.5 3500 FBP0324330V2 MINI L PLATE L/R 2.0,2.7MM 410 FBP032433NS1 MINI L FINGER JOINT HEAD PLATE 410 FBP0324341S1 MINI T FINGER JOINT HEAD PLATE 410 FBP0324348S1 MINI PLATE 1.5 3500 FBP0324350V2 DCP 2.0 2.7 3.5MM 2:12HOLE(DYNAMIC,COMPRESSION PLATE) 1280 FBP0324491Z1 L-BUTTRESS PLATE 4 HOLE 2783 FBP0324495Z1 T-BUTTRESS PLATE 5:6 HOLE 2783 FBP03244XNZ1 CONDYLAR BUTTRESS PLATES 7HOLE,9HOLE 157CM,189CM 4930 FBP0324500V2 RECONSTRUCTION PLATE 3.5MM 5:22HOLE 4462 FBP0324509Z1 SPOON PLATE 5HOLE 2310 FBP032451NS1 RECONSTRUCTION PLATE STRAIGHT 5:22 HOLE 58:262MM 4462 FBP032451NZ1 T-PLATE 4:8HOLE 2783 FBP0324523Z1 CLOVERLEAF PLATE 3HOLE 2184 FBP0324530V2 RECONSTRUCTION PLATE CURVED 3.5MM 6:18H 4462 FBP032453NS1 RECONSTRUCTION PLATE BENT 6:18 HOLE 70:214MM 4462 FBP032454NZ1 SMALL T-PLATE 3:5HOLE 1207 206

特材代碼中英文品名支付點數 FBP032455NZ1 SMALL STRAIGHT PLATE 3:8HOLE 1207 FBP032456NZ1 MULTIPLE FRAGMENT PLATE 438 FBP032458NZ1 PLATE 1605 FBP032459NZ1 EPIPHYSIS PLATE 1605 FBP03245XNY2 PELVIC RECONSTRUCTION PLATE 3.5 6:18HOLE 4462 FBP03245XNZ1 T-PLATES 3HOLE 67CM 2783 FBP0324610V2 STRAIGHT PLATE 1.5MM,2.0MM 20H 3500 FBP0324640V2 H PLATE STRIGHT PLATE 1.5,2.0 4HOLE 410 FBP03246NNS1 MINI T-PLATE 1.5,2.0 9HOLE 3500 FBP033100NS9 OBLIQUE PLATE 3:8HOLE 1207 FBP033104NS9 CLOVERLEAF PLATE 4/6 5/6HOLE 3:10HOLE 2184 FBP033110NS9 CALCANEAL PLATE 14HOLE 3752 FBP033220NS9 RECONSTRUCTION 4.5MM PLATE 3:30HOLE( 型號 430104:430122 自 93/1/1 生效 ) 4462 FBP033310NS9 V-PLATE T-PLATE 63:335MM 3:20HOLE 2783 FBP033315NS9 T-PLATE 65:337MM 3:20HOLAE 3890 FBP03401XNSN 3.5MM RECONTRACTION PLATE 4:22HOLE,CURVED RECONTRACTION PLATE 6:18HOLE 4462 FBP03404XNSN SMALL T-PLATE PT ANGLE 3:6HOLE 1207 FBP03405XNSN SMALL T-PLATE OBLIQUE 3:5HOLE 1207 FBP034102NS3 CLOVER LEAF PLATE 4/6:5/6 HOLE 88:104MM 2184 FBP03416XNY2 TITANIUM T-PLATE 4.5MM 3:8HOLE 3005 FBP03417XNY2 TITANIUM L/T BUTTRESS PLATE 4.5MM 3:6HOLE,L TIBIAL BUTTRESS PLATE 5:13HOLE 4200 FBP03418XNY2 TITANIUM SPOON PLATE 4.5MM 5:6HOLE 2494 FBP03421XNY2 TITANIUM CONDYLAR BUTTRESS PLATE 4.5MM 7:15HOLE 5324 FBP03422XNY2 TITANIUM SMALL T-PLATE 3.5MM,4.0MM 1303 FBP03423XNY2 TITANIUM CLOVERLEAF PLATE 3.5MM,4.0MM,CALCANEAL PLATE 60:70MM 2358 FBP03424XNY2 TITANIUM MINI T-PLATE 1.5MM:2.0MM 3:4HOLE,MINI L-PLATE 2.0MM,2.7MM 442 207

FBP034250NS9 PELVIS AND ACETABULUM PLATES4:12 HOLES; 65:184MM( 原代碼 FBP034250NS3) 4462 FBP034256NS9 PELVIS AND ACETABULUM PLATES 2:30HOLE( 型號 425654:425772 自 93/1/1 生效 ) 4462 FBP03425XNY2 TITANIUM MINI CONDYLAR PLATE 1.5,2.0,2.7MM 3780 FBP03427NNY2 TITANIUM STRAIGHT MINI H-PLATE 1.5,2.0MM 20HOLE 3780 FBP03427XNY2 TITANIUM MINI H-PLATE 1.5,2.0MM 4HOLE 3780 FBP03428XNY2 TITANIUM RECONSTRUCTION PLATE 3.5MM 5:22HOLE 4818 FBP034301NS9 RECONSTRUCTION 4.5MM PLATE 2:30 HOLES 4462 FBP03440XNSN CALCANEAL Y-PLATE 9HOLE 3752 FBP03460XNSN 2.0MM T-PLATE,L-PLATE,H-PLATE( 型號 7114-6030,032,048 自 93/1/1 起刪除 ) 410 FBP0349151Z1 1.5MM,2.0MM MINI STRAIGHT PLATE 20HOLE 3500 FBP034915NZ1 1.5MM,2.0MM MINI H-PLATE 4HOLE 3500 FBP0349201Z1 2.0MM MINI L-PLATE 4HOLE 410 FBP034920NZ1 2.0MM MINI T-PLATE 4HOLE 410 FBP0349271Z1 2.7MM MINI L-PLATE 5HOLE 410 FBP0349273Z1 2.7MM MULTIPLE FRAGMENT PLATE 7HOLE 438 FBP034927NZ1 2.7MM MINI T-PLATE 5HOLE 410 FBP0349352Z1 3.5MM T-PLATE 3:4+3:8HOLE 1207 FBP0349353Z1 3.5MM OBLIQUE T-PLATE 3+3:5HOLE 1207 FBP0349354Z1 3.5MM CLOVERLEAF PLATE 3:10HOLE 2184 FBP0349355Z1 3.5MM CALCANEAL PLATE 60:70MM 3752 FBP0349356Z1 3.5MM CALCANEAL Y-PLATE 3752 FBP0349453Z1 4.5MM T-PLATE 3:8HOLE 2783 FBP0349454Z1 4.5MM T-BUTTRESS PLATE 4:6HOLE 2783 FBP0349455Z1 4.5MM L-BUTTRESS PLATE 4HOLE 2783 FBP0349456Z1 4.5MM SPOON PLATE 5:6HOLE 2310 FBP0349457Z1 4.5MM COBRA HEAD PLATE 8:11HOLE 4910 208

特材代碼中英文品名支付點數 FBP0349XXNZ1 1.5MM,2.0MM T-PLATE (3:4+9HOLE) 3500 FBP035020NSN STAINLESS MINI STRAIGHT PLATE 20HOLE 1.5MM 3500 FBP035030NSN 1.5MM H-PLATE 4HOLE 3500 FBP035600NH1 PROXIMAL TIBIAL PLATE 3:7 HOLE 3890 FBP036030NSN 2.0MM T-PLATE 9HOLE 3500 FBP036048NSN 2.0MM H-PLATE 4HOLE 3500 FBP037012NSN MULTI FRAGMENT PLATE 7HOLE 438 FBP0371147SN L-PLATE,T-PLATE 2.7MM 3HOLE 410 FBP038300NH1 STRAIGHT PLATE FOR SMALL FRAGMENT 438 FBP038310NH1 PLATE FOR MULTIPLE FRAGMENT 7 HOLE 438 FBP038350NH1 MINI STRAIGHT PLATE 438 FBP038360NH1 MINI EPIPHYSEAL PLATE 410 FBP03LM16NAE CLOVERLEAF PLATE 4.5 MM 3,4 HOLE 2184 FBP03LM17NAE L/T PLATE 4.5 MM 2783 FBP03LM18NAE T-BUTTRESS PLATE 4.5 MM 4,5,6 HOLE 2783 FBP03LM19NAE L-BUTTRESS PLATE 4.5 MM L/R 4 HOLE 2783 FBP03LM50NAE COBRA HEAD PLATE 4910 FBP03LM95NAE SPOON PLATE 4.5MM 5,6 HOLE 2310 FBP03LN02NAE L-PLATE 2.7 MM 410 FBP03LN15NAE RECONSTRUCTION PLATE 3.5 MM 4462 FBP03LN16NAE RECONSTRUCTION PLATE 2.7MM 4462 FBP03LN190AE Y-PLATE 3752 FBP03LN20NAE STRAIGHT/L PLATE 2.0 MM 438 FBP03LN225AE T-MINI FINGER PLATE 410 FBP03LN22NAE L-MINI PLATE 2.0MM 410 FBP03LN26NAE DCP 2.7 MM SMALL PLATE 1605 209

特材代碼中英文品名支付點數 FBP03LN278AE MAXILLO-RECOSTRUCTION PLATE 2.0MM 4500 FBP03LN29NAE DCP PLATE 2.7MM 1605 FBP03LN31NAE MAXILLA PLATE 2.7MM 560 FBP03LN32NAE T-PLATE 3.5 MM 1207 FBP03LN33NAE SMALL T-PLATE 3.5MM 1207 FBP03LN34NAE PCP PLATE 3.5 MM 1207 FBP04142XNSN CONDYLAR PLATE 7:15HOLE LT,RT 5355 FBP042351NS1 HIP DCP PLATE CHILD 2315 FBP042351NY2 ANGLED BLADE PLATES FOR INTERTROCHANTERIC FEMORAL OSTEOTOMIES IN CHILDREN 2315 FBP042356NS1 TEENAGER HIP PLATE 2315 FBP04236NNY2 ANGLED BLADE PLATES FOR INTERTROCHANTERIC FEMORAL OSTEOTOMIES IN SMALL ADULTS 2315 FBP04236XNS1 BABY HIP PLATE 2315 FBP04236XNY2 ANGLED BLADE PLATES 90 度 FOR INTERTROCHANTERIC FEMORAL OSTEOTOMIES IN INFANT 2315 FBP042372NS1 CONDYLAR PLATE 95 度 12 HOLE 50:80MM 5355 FBP042372NY2 CONDYLAR PLATE 95 度 FOR ADULTS AND 5:18HOLE 5355 FBP042375NS1 CONDYLAR PLATE 95 度 5 HOLE 50:80MM 5355 FBP042377NS1 CONDYLAR PLATE 95 度 7 HOLE 50:80MM 5355 FBP042379NS1 CONDYLAR PLATE 95 度 9 HOLE 50:80MM 5355 FBP04238NNS1 ANGLED BLADE PLATE 130 度 4:12 HOLE 50:110MM 3510 FBP04238NNY2 ANGLED BLADE PLATES 130 度 4:12HOLE 50:110MM 3510 FBP042392NS1 HIP PLATE 90:130 度 3510 FBP042392NY2 ANGLED BLADE PLATES FOR INTERTROCHANTERIC FEMORAL OSTEOTOMIES IN ADULTS 3510 FBP042436NS1 MINI CONDYLAR PLATE 2.0 3500 FBP042466NS1 MINI CONDYLAR PLATE 3500 FBP04254XNSN ADULT CONDYLAR PLATE 95 度 5:16HOLE 5355 FBP04282XNS1 CONDYLAR PLATE 3510 210

FBP04282XNY2 CONDYLAR PLATE 95 度 FOR SMALL ADULTS AND ADOLESCENTS 3510 FBP04283XNS1 ANGLED BLADE PLATE 130 度 4:9HOLE 3510 FBP04283XNY2 ANGLED BLADE PLATES 130 度 FOR SMALL STATURED ADULTS AND ADOLESCENTS 4:9HOLE 3510 FBP0449XXNZ1 1.5MM,2.0MM,2.7MM MINI CONDYLAR PLATE 7HOLE 3500 FBP045026NSN CONDYLAR PLATE 7HOLE 1.5MM RT,LT 3500 FBP046040NSN CONDYLAR PLATE 7HOLE 2.0MM RT,LT 3500 FBP048202NH1 CONDYLAR PLATE ANGLE 95 度 (312) 5355 FBP04K012NAE CONDYLAR PLATE 95 度 4.5MM 5355 FBP04K021NAE ANGLED PLATE 90:130 度 4.5MM 3510 FBP04LM15NAE CONDYLAR BUTTRESS PLATE 4.5 MM 4930 FBP094102NU0 STAINLESS ANATOMIC FEMUR PLATE 4:8HOLE 限 EPIPHYSIS METAPHYSIS 骨折使用 8744 FBP09510SNY2 STAINLESS ANATOMICAL PLATE (TIBIAL,FEMUR,FIBULAR) 8744 FBP096450NWL ANATOMIC BONE PLATE(TIBIA,FEMUR,FIBULAR)122:230MM 7:13H 限 EPIPHYSIS METAPHYSIS 骨折使用 8744 FBPN10579NM1 STEINMANN PIN 180:230MM 221 FBPN12620NZ1 KIRSCHNER WIRE (K-PIN) WITH THREAD 2.5MM 305 FBPN12910NY2 STEINMANN PINS(SHANK)2.0MM:4.8MM *9"(230MM) 221 FBPN12915NY2 STEINMANN PINS(THREADED)2.0MM:4.8MM *9"(230MM) 356 FBPN12920NY2 STEINMANN PINS(SHANK)0.8MM:3.0MM *70MM 221 FBPN129210V2 STEINMANN PINS(SHANK) 0.8MM:5.0MM 221 FBPN12921NY2 STEINMANN PINS(SHANK)0.8MM:3.0MM *150MM 221 FBPN12922NY2 STEINMANN PINS(SHANK)0.8MM:3.0MM *280MM 221 FBPN12923NY2 STEINMANN PINS(SHANK)0.8MM:3.0MM *400MM 221 FBPN1292XNY2 STEINMANN PIN 70MM 150MM 221 FBPN129360V2 STEINMANN PIN WITH THREAD 356 FBPN12936NS1 STEINMANN PIN WITH THREAD 356 FBPN12936NY2 STEINMANN PIN W/MIDDLE THREADED 356 211

特材代碼中英文品名支付點數 FBPN1293NNS1 STEINMANN PIN 221 FBPN1293NNY2 STEINMANN PIN W/TROCAR TIP 221 FBPN17011NZ1 STEINMANN PIN 1.8MM 221 FBPN17012NZ1 STEINMANN PIN 2.0MM,2.4MM 221 FBPN17013NZ1 STEINMANN PIN 2.8MM,3.2MM 221 FBPN17015NZ1 STEINMANN PIN 3.6MM,4.0MM 221 FBPN17017NZ1 STEINMANN PIN 4.8MM 221 FBPN1KX10NAE STEINMANN PIN 221 FBPN1KX30NAE STEINMANN PIN WITH THREAD 356 FBPN1LK30NXA STEINMANN PIN(THREADED)3.0;3.5;4.0;4.5;5.0;6.0MM 356 FBPN1MK30NXA STEINMANN PIN(NON-THREADED)3.0;3.5;4.0;4.5;5.0;6.0MM 221 FBPN1NK30NXA STEINMANN PIN(WITH TROCAR TIP)3.0;3.5;4.0;4.5;5.0;6.0MM 221 FBPN20750NM1 KNOWLES PIN 65MM:120MM 930 FBPN22811NZ1 KNOWLES PIN 2.5":4" 930 FBPN22815NZ1 KNOWLES PIN 5 1/4":6" 930 FBPN22818NZ1 KNOWLES PIN 4 1/4":5" 930 FBPN2282XNSN KNOWLES PIN 930 FBPN2283XNSN KNOWLES PIN 930 FBPN22991NY2 KNOWLES PINS(HEX.DRIVE)4.0/4.8MM *2.5":6"(63.5MM:152.4MM) 930 FBPN22993NY2 KNOWLES PINS(SQUARE DRIVE)4.0/4.8MM *2.5":6"(63.5MM:152.4MM) 930 FBPN2KK28NXA KNOWLES PIN 2.8;3.2;4.0;4.8MM 930 FBPN30531YM1 MR-500 型髓內釘 (RUSH PIN) 771 FBPN31860NZ1 KIRSCHNER PIN 1.0MM:1.8MM 80 FBPN38111NZ1 RUSH MEDULLARY PIN 1/4" 771 FBPN38211NZ1 RUSH MEDULLARY PIN 3/16" 771 FBPN38310NZ1 RUSH MEDULLARY PIN 1/8" 771 212

特材代碼中英文品名支付點數 FBPN38610NZ1 RUSH MEDULLARY PIN 3/32" 771 FBPN3KJ10NAE RUSH PIN 771 FBPS1000XNX0 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNX1 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNX2 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNX4 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNX5 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNX6 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNX7 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNX8 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNX9 PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNXB PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNXC PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNXD PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNXE PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNXF PARTIAL FOOT PROSTHESIS 健保給寸部分足義肢. 19000 FBPS1000XNXG PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNXH PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNXJ PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNXK PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNXN PARTIAL FOOT PROSTHESIS 健保給付部分足義肢 19000 FBPS1000XNXS PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1000XNXV PARTIAL FOOT PROSTHESIS 健保給付部分足義肢. 19000 FBPS1001XNX0 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNX1 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNX2 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 213

FBPS1001XNX4 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNX5 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNX6 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNX7 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNX8 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNX9 SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNXB SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNXC SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNXD SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNXE SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNXF SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNXG SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNXH SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNXJ SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNXK SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNXN SYME"S PROSTHESIS 珊姆式小腿義肢 ( 踝關節離斷 ) 24000 FBPS1001XNXS SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1001XNXV SYME"S PROSTHESIS 健保給付珊姆式小腿義肢 ( 踝關節離斷 ). 24000 FBPS1002XNX0 K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNX1 K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNX2 K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNX4 K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNX5 K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNX6 K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNX7 K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNX8 K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 214

特材代碼中英文品名支付點數 FBPS1002XNX9 K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNXB K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNXC K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNXD K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNXE K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNXF K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNXG K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNXH K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNXJ K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNXK K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNXN K/D PROSTHESIS 膝關節離斷義肢 48000 FBPS1002XNXS K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1002XNXV K/D PROSTHESIS 健保給付膝關節離斷義肢. 48000 FBPS1003XNX0 A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNX1 A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNX2 A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNX3 A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNX4 A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNX5 A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNX6 A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNX7 A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNX8 A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNX9 A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNXB A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNXC A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNXD A/K PROSTHESIS 健保給付膝上義肢. 48000 215

特材代碼中英文品名支付點數 FBPS1003XNXE A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNXF A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNXG A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNXH A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNXJ A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNXK A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNXN A/K PROSTHESIS 膝上義肢 48000 FBPS1003XNXS A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1003XNXV A/K PROSTHESIS 健保給付膝上義肢. 48000 FBPS1004XNX0 B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNX1 B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNX2 B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNX3 B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNX4 B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNX5 B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNX6 B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNX7 B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNX8 B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNX9 B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNXB B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNXC B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNXD B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNXE B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNXF B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNXG B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNXH B/K PROSTHESIS 健保給付膝下義肢. 34000 216

特材代碼中英文品名支付點數 FBPS1004XNXJ B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNXK B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNXN B/K PROSTHESIS 膝下義肢 34000 FBPS1004XNXS B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1004XNXV B/K PROSTHESIS 健保給付膝下義肢. 34000 FBPS1005XNX0 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNX1 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNX2 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNX4 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNX5 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNX6 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNX7 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNX8 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNX9 H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNXB H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNXC H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNXD H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNXE H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNXF H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNXG H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNXH H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNXJ H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNXK H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNXN H/D&H/P PROSTHESIS 髖關節離斷義肢 68000 FBPS1005XNXS H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 FBPS1005XNXV H/D&H/P PROSTHESIS 健保給付髖關節離斷義肢. 68000 217

特材代碼中英文品名支付點數 FBPS1006XNX0 W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNX1 W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNX2 W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNX4 W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNX5 W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNX6 W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNX7 W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNX9 W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNXB W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNXC W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNXD W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNXE W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNXF W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNXG W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNXJ W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNXK W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNXS W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1006XNXV W/D PROSTHESIS 健保給付腕關節離斷義肢. 42000 FBPS1007XNX0 E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNX1 E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNX2 E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNX4 E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNX5 E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNX6 E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNX7 E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNX9 E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 218

特材代碼中英文品名支付點數 FBPS1007XNXB E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNXC E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNXD E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNXE E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNXF E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNXG E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNXJ E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNXK E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNXS E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1007XNXV E/D PROSTHESIS 健保給付肘關節離斷義肢. 62000 FBPS1008XNX0 A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNX1 A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNX2 A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNX4 A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNX5 A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNX6 A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNX7 A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNX9 A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNXB A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNXC A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNXD A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNXE A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNXF A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNXG A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNXJ A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNXK A/E PROSTHESIS 健保給付肘上義肢. 65000 219

特材代碼中英文品名支付點數 FBPS1008XNXS A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1008XNXV A/E PROSTHESIS 健保給付肘上義肢. 65000 FBPS1009XNX0 B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNX1 B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNX2 B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNX4 B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNX5 B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNX6 B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNX7 B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNX9 B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNXB B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNXC B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNXD B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNXE B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNXF B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNXG B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNXJ B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNXK B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNXS B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1009XNXV B/E PROSTHESIS 健保給付肘下義肢. 42000 FBPS1010XNX0 S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNX1 S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNX2 S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNX4 S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNX5 S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNX6 S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 220

特材代碼中英文品名支付點數 FBPS1010XNX7 S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNX9 S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNXB S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNXC S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNXD S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNXE S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNXF S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNXG S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNXJ S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNXK S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNXS S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1010XNXV S/D PROSTHESIS 健保給付肩關節離斷義肢. 65000 FBPS1011XNX0 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNX1 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNX2 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNX4 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNX5 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNX6 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNX7 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNX9 FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNXB FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNXC FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNXD FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNXE FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNXF FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNXG FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 221

FBPS1011XNXJ FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNXK FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNXS FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1011XNXV FOREQUATER PROSTHESIS 健保給付肩胛截除義肢. 65000 FBPS1012XNX0 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNX1 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNX2 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNX4 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNX5 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNX6 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNX7 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNX9 A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNXB A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNXC A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNXD A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNXE A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNXF A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNXG A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNXJ A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNXK A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNXN A/E COSMETIC PROSTHESIS 肘上美觀義肢 23000 FBPS1012XNXS A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1012XNXV A/E COSMETIC PROSTHESIS 健保給付肘上美觀義肢. 23000 FBPS1013XNX0 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNX1 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNX2 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 222

FBPS1013XNX4 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNX5 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNX6 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNX7 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNX9 B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNXB B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNXC B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNXD B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNXE B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNXF B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNXG B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNXJ B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNXK B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNXN B/E COSMETIC PROSTHESIS 肘下美觀義肢 14000 FBPS1013XNXS B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1013XNXV B/E COSMETIC PROSTHESIS 健保給付肘下美觀義肢. 14000 FBPS1014XNX0 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNX1 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNX2 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNX4 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNX5 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNX6 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNX7 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNX9 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNXB 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNXC 健保給付肩關節離斷美觀義肢. 32300 223

特材代碼中英文品名支付點數 FBPS1014XNXD 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNXE 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNXF 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNXG 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNXJ 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNXK 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNXS 健保給付肩關節離斷美觀義肢. 32300 FBPS1014XNXV 健保給付肩關節離斷美觀義肢. 32300 FBPS1015XNX0 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNX1 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNX2 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNX4 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNX5 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNX6 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNX7 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNX9 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNXB 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNXC 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNXD 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNXE 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNXF 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNXG 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNXJ 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNXK 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNXS 健保給付橫掌截肢美觀義肢. 7300 FBPS1015XNXV 健保給付橫掌截肢美觀義肢. 7300 224

特材代碼中英文品名支付點數 FBPS1016XNX0 健保給付手指截肢美觀義肢. 4800 FBPS1016XNX1 健保給付手指截肢美觀義肢. 4800 FBPS1016XNX2 健保給付手指截肢美觀義肢. 4800 FBPS1016XNX4 健保給付手指截肢美觀義肢. 4800 FBPS1016XNX5 健保給付手指截肢美觀義肢. 4800 FBPS1016XNX6 健保給付手指截肢美觀義肢. 4800 FBPS1016XNX7 健保給付手指截肢美觀義肢. 4800 FBPS1016XNX9 健保給付手指截肢美觀義肢. 4800 FBPS1016XNXB 健保給付手指截肢美觀義肢. 4800 FBPS1016XNXC 健保給付手指截肢美觀義肢. 4800 FBPS1016XNXD 健保給付手指截肢美觀義肢. 4800 FBPS1016XNXE 健保給付手指截肢美觀義肢. 4800 FBPS1016XNXF 健保給付手指截肢美觀義肢. 4800 FBPS1016XNXG 健保給付手指截肢美觀義肢. 4800 FBPS1016XNXJ 健保給付手指截肢美觀義肢. 4800 FBPS1016XNXK 健保給付手指截肢美觀義肢. 4800 FBPS1016XNXS 健保給付手指截肢美觀義肢. 4800 FBPS1016XNXV 健保給付手指截肢美觀義肢. 4800 FBPS2000XNX0 FBPS2000XNX1 FBPS2000XNX2 FBPS2000XNX4 FBPS2000XNX5 FBPS2000XNX6 FBPS2000XNX7 FBPS2000XNX8 PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. 19000 19000 19000 19000 19000 19000 19000 19000 225

FBPS2000XNX9 PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患 19000 自付. FBPS2000XNXB FBPS2000XNXC FBPS2000XNXD FBPS2000XNXE FBPS2000XNXF FBPS2000XNXG FBPS2000XNXH FBPS2000XNXJ FBPS2000XNXK FBPS2000XNXN FBPS2000XNXS FBPS2000XNXV FBPS2001XNX0 FBPS2001XNX1 FBPS2001XNX2 FBPS2001XNX4 FBPS2001XNX5 FBPS2001XNX6 FBPS2001XNX7 FBPS2001XNX8 FBPS2001XNX9 FBPS2001XNXB FBPS2001XNXC FBPS2001XNXD FBPS2001XNXE PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給寸部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. PARTIAL FOOT PROSTHESIS 部分給付部分足義肢, 按健保給付之部分足義肢給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. 19000 19000 19000 19000 19000 19000 19000 19000 19000 19000 19000 19000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 24000 226

FBPS2001XNXF SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節 24000 離斷 ) 給付, 超過部分由病患自付. FBPS2001XNXG FBPS2001XNXH FBPS2001XNXJ FBPS2001XNXK FBPS2001XNXN FBPS2001XNXS FBPS2001XNXV FBPS2002XNX0 FBPS2002XNX1 FBPS2002XNX2 FBPS2002XNX4 FBPS2002XNX5 FBPS2002XNX6 FBPS2002XNX7 FBPS2002XNX8 FBPS2002XNX9 FBPS2002XNXB FBPS2002XNXC FBPS2002XNXD FBPS2002XNXE FBPS2002XNXF FBPS2002XNXG FBPS2002XNXH FBPS2002XNXJ FBPS2002XNXK SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. SYME"S PROSTHESIS 部分給付珊姆式小腿義肢 ( 踝關節離斷 ), 按健保給付之珊姆式小腿義肢 ( 踝關節離斷 ) 給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. 24000 24000 24000 24000 24000 24000 24000 48000 48000 48000 48000 48000 48000 48000 48000 48000 48000 48000 48000 48000 48000 48000 48000 48000 48000 227

FBPS2002XNXN K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自 48000 付. FBPS2002XNXS FBPS2002XNXV K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. K/D PROSTHESIS 部分給付膝關節離斷義肢, 按健保給付之膝關節離斷義肢給付, 超過部分由病患自付. 48000 48000 FBPS2003XNX0 A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNX1 A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNX2 A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNX3 A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNX4 A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNX5 A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNX6 A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNX7 A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNX8 A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNX9 A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNXB A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNXC A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNXD A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNXE A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNXF A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNXG A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNXH A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNXJ A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNXK A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNXN A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNXS A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2003XNXV A/K PROSTHESIS 部分給付膝上義肢, 按健保給付膝上義肢給付, 超過部分由病患自付. 48000 FBPS2004XNX0 B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 228

FBPS2004XNX1 B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNX2 B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNX3 B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNX4 B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNX5 B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNX6 B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNX7 B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNX8 B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNX9 B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNXB B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNXC B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNXD B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNXE B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNXF B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNXG B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNXH B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNXJ B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNXK B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNXN B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNXS B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2004XNXV B/K PROSTHESIS 部分給付膝下義肢, 按健保給付之膝下義肢給付, 超過部分由病患自付. 34000 FBPS2005XNX0 FBPS2005XNX1 FBPS2005XNX2 FBPS2005XNX4 FBPS2005XNX5 H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. 68000 68000 68000 68000 68000 229

FBPS2005XNX6 H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病 68000 患自付. FBPS2005XNX7 FBPS2005XNX8 FBPS2005XNX9 FBPS2005XNXB FBPS2005XNXC FBPS2005XNXD FBPS2005XNXE FBPS2005XNXF FBPS2005XNXG FBPS2005XNXH FBPS2005XNXJ FBPS2005XNXK FBPS2005XNXN FBPS2005XNXS FBPS2005XNXV FBPS2006XNX0 FBPS2006XNX1 FBPS2006XNX2 FBPS2006XNX4 FBPS2006XNX5 FBPS2006XNX6 FBPS2006XNX7 FBPS2006XNX9 FBPS2006XNXB FBPS2006XNXC H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. H/D&H/P PROSTHESIS 部分給付髖關節離斷義肢, 按健保給付之髖關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. 68000 68000 68000 68000 68000 68000 68000 68000 68000 68000 68000 68000 68000 68000 68000 42000 42000 42000 42000 42000 42000 42000 42000 42000 42000 230

FBPS2006XNXD W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自 42000 付. FBPS2006XNXE FBPS2006XNXF FBPS2006XNXG FBPS2006XNXJ FBPS2006XNXK FBPS2006XNXN FBPS2006XNXS FBPS2006XNXV FBPS2007XNX0 FBPS2007XNX1 FBPS2007XNX2 FBPS2007XNX4 FBPS2007XNX5 FBPS2007XNX6 FBPS2007XNX7 FBPS2007XNX9 FBPS2007XNXB FBPS2007XNXC FBPS2007XNXD FBPS2007XNXE FBPS2007XNXF FBPS2007XNXG FBPS2007XNXJ FBPS2007XNXK FBPS2007XNXN W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. W/D PROSTHESIS 部分給付腕關節離斷義肢, 按健保給付之腕關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. 42000 42000 42000 42000 42000 42000 42000 42000 62000 62000 62000 62000 62000 62000 62000 62000 62000 62000 62000 62000 62000 62000 62000 62000 62000 231

FBPS2007XNXS E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自 62000 付. FBPS2007XNXV E/D PROSTHESIS 部分給付肘關節離斷義肢, 按健保給付之肘關節離斷義肢給付, 超過部分由病患自付. 62000 FBPS2008XNX0 A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNX1 A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNX2 A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNX4 A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNX5 A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNX6 A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNX7 A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNX9 A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNXB A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNXC A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNXD A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNXE A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNXF A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNXG A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNXJ A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNXK A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNXN A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNXS A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2008XNXV A/E PROSTHESIS 部分給付肘上義肢, 按健保給付之肘上義肢給付, 超過部分由病患自付. 65000 FBPS2009XNX0 B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNX1 B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNX2 B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNX4 B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNX5 B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 232

FBPS2009XNX6 B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNX7 B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNX9 B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNXB B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNXC B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNXD B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNXE B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNXF B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNXG B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNXJ B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNXK B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNXN B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNXS B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2009XNXV B/E PROSTHESIS 部分給付肘下義肢, 按健保給付之肘下義肢給付, 超過部分由病患自付. 42000 FBPS2010XNX0 FBPS2010XNX1 FBPS2010XNX2 FBPS2010XNX4 FBPS2010XNX5 FBPS2010XNX6 FBPS2010XNX7 FBPS2010XNX9 FBPS2010XNXB FBPS2010XNXC FBPS2010XNXD FBPS2010XNXE S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 233

FBPS2010XNXF S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自 65000 付. FBPS2010XNXG FBPS2010XNXJ FBPS2010XNXK FBPS2010XNXN FBPS2010XNXS FBPS2010XNXV FBPS2011XNX0 FBPS2011XNX1 FBPS2011XNX2 FBPS2011XNX4 FBPS2011XNX5 FBPS2011XNX6 FBPS2011XNX7 FBPS2011XNX9 FBPS2011XNXB FBPS2011XNXC FBPS2011XNXD FBPS2011XNXE FBPS2011XNXF FBPS2011XNXG FBPS2011XNXJ FBPS2011XNXK FBPS2011XNXN FBPS2011XNXS FBPS2011XNXV S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. S/D PROSTHESIS 部分給付肩關節離斷義肢, 按健保給付之肩關節離斷義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. FOREQUATER PROSTHESIS 部分給付肩胛截除義肢, 按健保給付之肩胛截除義肢給付, 超過部分由病患自付. 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 65000 234

FBPS2012XNX0 A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由 23000 病患自付. FBPS2012XNX1 FBPS2012XNX2 FBPS2012XNX4 FBPS2012XNX5 FBPS2012XNX6 FBPS2012XNX7 FBPS2012XNX9 FBPS2012XNXB FBPS2012XNXC FBPS2012XNXD FBPS2012XNXE FBPS2012XNXF FBPS2012XNXG FBPS2012XNXJ FBPS2012XNXK FBPS2012XNXN FBPS2012XNXS FBPS2012XNXV FBPS2013XNX0 FBPS2013XNX1 FBPS2013XNX2 FBPS2013XNX4 FBPS2013XNX5 FBPS2013XNX6 FBPS2013XNX7 A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. A/E COSMETIC PROSTHESIS 部分給付肘上美觀義肢, 按健保給付之肘上美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. 23000 23000 23000 23000 23000 23000 23000 23000 23000 23000 23000 23000 23000 23000 23000 23000 23000 23000 14000 14000 14000 14000 14000 14000 14000 235

FBPS2013XNX9 B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病 14000 患自付. FBPS2013XNXB FBPS2013XNXC FBPS2013XNXD FBPS2013XNXE FBPS2013XNXF FBPS2013XNXG FBPS2013XNXJ FBPS2013XNXK FBPS2013XNXN FBPS2013XNXS FBPS2013XNXV B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. B/E COSMETIC PROSTHESIS 部分給付肘下美觀義肢, 按健保給付之肘下美觀義肢給付, 超過部分由病患自付. 14000 14000 14000 14000 14000 14000 14000 14000 14000 14000 14000 FBPS2014XNX0 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNX1 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNX2 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNX4 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNX5 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNX6 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNX7 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNX9 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNXB 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNXC 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNXD 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNXE 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNXF 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNXG 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 236

FBPS2014XNXJ 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNXK 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNXS 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2014XNXV 部分給付肩關節離斷美觀義肢, 按健保給付之肩關節離斷美觀義肢給付, 超過部分由病患自付. 32300 FBPS2015XNX0 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNX1 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNX2 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNX4 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNX5 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNX6 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNX7 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNX9 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNXB 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNXC 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNXD 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNXE 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNXF 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNXG 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNXJ 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNXK 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNXN 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNXS 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2015XNXV 部分給付橫掌截肢美觀義肢, 按健保給付之橫掌截肢美觀義肢給付, 超過部分由病患自付. 7300 FBPS2016XNX0 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNX1 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNX2 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 237

FBPS2016XNX4 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNX5 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNX6 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNX7 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNX9 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNXB 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNXC 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNXD 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNXE 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNXF 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNXG 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNXJ 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNXK 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNXN 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNXS 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBPS2016XNXV 部分給付手指截肢美觀義肢, 按健保給付之手指截肢美觀義肢給付, 超過部分由病患自付. 4800 FBS01037XNY2 1.5,2.0,2.7,3.5 CORTEX SCREW( 產品型號 202006:040,204010:110) 190 FBS01038XNY2 4.5 CORTEX SCREW( 產品型號 214228:250) 210 FBS010701NH1 CORTEX SMALL SCREW 3.5MM,4.5MM DIA 210 FBS011622NSN 1.5,2.0,2.7,3.5MM CORTEX SCREW ( 產品型號 71162-008:020,022:032,7122006:024,26:40,10:50,55:115) 190 FBS0120000V2 CORTEX SCREW 1.5,2.0,2.7,3.5 190 FBS0120420V2 CORTEX SCREW 3.5,4.5MM PART THREAD(SHATF SCREW) 190 FBS01210NNY2 STAINLESS CORTEX SCREW 1.5:3.5X6:110MM 190 FBS01211NNS1 CORTEX SCREW 1.5:4.0MM 190 FBS0121400V2 CORTEX SCREW 4.5MM 210 FBS01214NNS1 CORTEX SCREW 4.5MM 210 238

特材代碼中英文品名支付點數 FBS01225XNSN 4.5MM CORTEX SCREW 14:70MM,72:145MM 210 FBS012306NZ1 CORTICAL SCREW 4.5MM 210 FBS012320NZ1 CORTICAL SCREW 2.0MM 190 FBS012324NZ1 2.7MM CORTICAL SCREW 6:24MM 190 FBS0123501Z1 3.5MM CORTICAL SCREW 10:50MM 190 FBS012350NZ1 1.5MM CORTICAL SCREW 6:16MM 190 FBS01270XNSN CORTEX BONE SCREW 210 FBS013861NS9 SMALL CORTEX SCREW 2.0/2.7/3.5MM 190 FBS014000NS3 CORTEX SCREW 1.5:3.5MM 6:9MM 190 FBS014000NS9 CORTEX SCREW 1.5:3.5MM 6:9MM( 原代碼 FBS014000NS3) 190 FBS014001NS3 CORTEX BONE SCREW 210 FBS014061NS9 CORTEX SCREW 4.5MM 14:150MM 210 FBS01410NNY2 TITANIUM CORTEX SCREW 1.5:3.5X6:110MM 205 FBS014148NY2 TITANIUM CORTEX SCREW 3.0:4.0X8:50MM 226 FBS01437XNY2 TITANIUM CORTEX SCREW 1.5MM:3.5MM ( 型號 402006:040,404010:110,404212:250) 205 FBS01438XNY2 TITANIUM CORTEX SCREW 4.5MM 226 FBS014800NZ1 1.5:3.5MM CORTICAL SCREW( 型號 482006:50-01,02,03,482706:70-01,483510:150-01,-40:130-07,-16:50-04) 190 FBS014845NZ1 4.5MM CORTICAL SCREW 210 FBS01CAN65E3 6.5MM CANCELLOUS BONE SCREW 361 FBS01COR45E3 4.5MM CORTICAL BONE SCREW 210 FBS01LA11NAE CORTEX SCREW 4.5MM 210 FBS01LB02NAE CORTEX SCREW 2.0MM 190 FBS01LB06NAE CORTEX SCREW 1.5MM 6:20MM 190 FBS01LB12NAE CORTEX SCREW 2.7MM 190 FBS01LB18NAE CORTEX SCREW 190 FBS02039XNY2 4.0 CANCELLOUS SCREW 200 239

FBS02040XNY2 6.5 CANCELLOUS SCREW( 產品型號 217045:150) 361 FBS0220600V2 CANCELLOUS SCREW 4.0MM FULL,PART THREAD 200 FBS02207NNS1 CANCELLOUS BONE SCREW 3.5:4.0MM 200 FBS0221800V2 CANCELLOUS SCREW 6.5MM 16,24,32MM,FULL THREAD 361 FBS02218NNS1 CANCELLOUS BONE SCREW 6.5MM 361 FBS02223XNSN 4.0MM FULL,PART TH CANC SCREW 10:100,10:50,55:100MM 200 FBS02229XNSN 6.5MM CANC SCREW 16,32MM,FULL TH 25:150MM( 產品型號 7122-8045:8110,8115:8150,9025:9110,9115:9150) 361 FBS022322NZ1 4.0MM CANCELLOUS SCREW PARTIAL THREAD 10:50MM 200 FBS022330NZ1 CANCELLOUS SCREW 361 FBS022331NZ1 LONG CANCELLOUS SCREW FULLY THREAD 6.5MM 361 FBS0223321Z1 6.5MM CANCELLOUS SCREW FULLY THREADED 25:40MM 361 FBS022332NZ1 CANCELLOUS SCREW 361 FBS022333NZ1 CANCELLOUS BONE SCREW 32MM 6.5MM 361 FBS022335NZ1 CANCELLOUS SCREW 361 FBS022340NZ1 4.0MM CANCELLOUS SCREW FULLY THREADED 14:60MM 200 FBS024102NS3 CANCELLOUS BONE SCREW 361 FBS024103NS9 CANCELLOUS BONE SCREW 6.5MM(1/3) 115:150MM 361 FBS024203NS3 CANCELLOUS BONE SCREW 361 FBS024204NS9 CANCELLOUS BONE SCREW 6.5MM(2/3) 105:200M 361 FBS024302NS9 CANCELLOUS BONE SCREW 6.5MM 105:150M 361 FBS024303NS3 CANCELLOUS BONE SCREW 361 FBS02439XNY2 TITANIUM CANCELLOUS SCREW 4.0MM 216 FBS024402NU0 STAINLESS SELF-LOCKING SCREW 4.5MM 35:75MM 200 FBS02440XNY2 TITANIUM CANCELLOUS SCREW 6.5MM( 型號 417045:150) 389 FBS024541NS3 CANCELLOUS BONE SCREW (SMALL) 200 FBS024541NS9 SMALL CANCELLOUS BONE SCREW 4MM 200 240

特材代碼中英文品名支付點數 FBS024551NS3 CANCELLOUS BONE SCREW (SMALL) 200 FBS024551NS9 SMALL CANCELLOUS BONE SCREW 4MM (1/2) 200 FBS024840NZ1 4.0MM CANCELLOUS SCREW 200 FBS024865NZ1 6.5MM CANCELLOUS SCREW 361 FBS028080NH1 CANCELLOUS BONE SCREW 4.0MM 200 FBS028120NH1 CANCELLOUS BONE SCREW 6.5MM DIA 361 FBS02LA33NAE THREAD CANCELLOUS SCREW 6.5MM 361 FBS02LB35NAE CANCELLOUS SCREW 4.0MM 200 FBS03041XNY2 4.5 MALLEOLAR SCREW 326 FBS030811NH1 MALLEOLAR SCREW 踝質釘 326 FBS0321500V2 MALLEOLAR SCREW 4.5MM 326 FBS03215NNS1 MALLEOLAR SCREW (ANY SIZE) 326 FBS032252NSN 4.5MM MALLEOLAR SCREW 25:70MM 326 FBS032323NZ1 MALLEOLAR SCREW 326 FBS032334NZ1 MALLEOLAR SCREW 326 FBS034402NS3 MALLEOLAR SCREW 326 FBS034402NS9 MALLEOLAR SCREWS 4.5MM( 原代碼 FBS034402NS3) 326 FBS0348451Z1 4.5MM MALLEOLAR SCREW 326 FBS03LA22NAE MALLEOLAR SCREW 20:110MM 326 FBS04042XNY2 3.5,4.5 CANNULATED SCREW( 產品型號 214420:472,214620:672) 2000 FBS04043XNY2 6.5 CANNULATED SCREW( 產品型號 208620:730) 2000 FBS04044XNY2 7.0,7.3 CANNULATED SCREW( 產品型號 209420:530,208830:950,209850:930) 2000 FBS041142NZ1 MINI MAGNA-FX CANNULATED SCREW 4.0MM,5.0MM 2000 FBS041146NZ1 MAGNA-FX CANNULATED SCREW 16MM,32MM 2000 FBS041155NZ1 HERBERT CANNULATED BONE SCREW 25:100MM 2000 FBS0420260V2 CANNULATED SCREW 3.5,4.0,4.5 2000 241

特材代碼中英文品名支付點數 FBS04202NNS1 3.0 CANNULATED SCREW 2000 FBS04202NNY2 STAINLESS CANNULATED SCREW 3.4:4.0X8:50MM 2000 FBS04205NNS1 3.5 CANNULATED SCREW 2000 FBS04207NNS1 4.0 CANNULATED SCREW 2000 FBS0420800V2 CANNULATED SCREW 7.0,7.3 2000 FBS0420840V2 CANNULATED SCREW 6.5 2000 FBS04208NNS1 CANNULATED SCREW 7.0MM,7.3MM 2000 FBS04209NNS1 CANNULATED SCREW 7.0MM 32MM L45:130MM 2000 FBS0421180V2 CANNULATED SCREW 2.4,3.0 2000 FBS04214NNS1 4.5 CANNULATED SCREW 2000 FBS04216XNSN CANNULATED HIP PIN 2000 FBS042170NSN CANNULATED SCREW D 8,6.5,4MM( 產品型號 71100045:71100130,222820:870) 2000 FBS04218NNY2 STAINLESS CANNULATED SCREW 7.0:7.3X30:150MM 2000 FBS04402NNS1 TITANIUM 3.0 CANNULATED SCREW 2160 FBS04402NNY2 TITANIUM CANNULATED SCREW 3.0:4.0X8:50MM 2160 FBS04407NNS1 TITANIUM 4.0 CANNULATED SCREW 2160 FBS04408NNS1 TITANIUM 7.3 CANNULATED SCREW 2160 FBS04408XNY2 TITANIUM CANNULATED SCREW 7.0X30:130MM 2160 FBS044144NY2 TITANIUM CANNULATED SCREW 4.5X20:72MM 2160 FBS04414NNS1 TITANIUM 4.5 CANNULATED SCREW 2160 FBS04418NNY2 TITANIUM CANNULATED SCREW 7.0:7.3X30:150MM 2160 FBS04442XNY2 TITANIUM CANNULATE SCREW 7.3MM 2160 FBS051150NZ1 HERBERT MINI BONE SCREW 10:24MM 2000 FBS051151NZ1 HERBERT SCREW 16:30MM 2000 FBS051152NZ1 HERBERT WHIPPLE BONE SCREW 12:30MM 2000 FBS051154NZ1 HERBERT BONE SCREW 12:30MM 2000 242

FBS05602XNS3 TITANIUM CANNULATED SCREW(604610:604670 自 88/09/01 起生效 ) 2160 FBS05602XNS9 TITANIUM CANNULATED SCREW( 原代碼 FBS05602XNS3) 2160 FBS064304NSN NUT FOR 4.5MM CORTEX SCREW 84 FBS0649001Z1 CORTICAL NUT 84 FBS07044XNY2 4.5,7.0,7.3 WASHER 85 FBS071430NSN WASHER 10,7,13MM OD 85 FBS0721990V2 WASHER 4.5MM 7.0MM 13.0MM 85 FBS072199NS1 WASHER 85 FBS07219XNS1 WASHER/NUT 84 FBS072344NZ1 WASHERS 85 FBS074199NS1 WASHER FOR TITANIUM CANNULATE SCREW 92 FBS07444XNY2 TITANIUM WASHER 92 FBS074900NZ1 1.5MM:4.5MM WASHER 85 FBS076199NS3 WASHER FOR TCS SCREWS(619905 自 88/09/01 起生效 ) 92 FBS076199NS9 WASHER( 原代碼 FBS076199NS3) 92 FBS079001NS9 WASHER 85 FBS07LA196AE WASHER 4.5MM 85 FBS07LA198AE WASHER 1.3MM 85 FBS0804101NF BIODEGRADABLE MINI PLATING SYSTEM:ACL/PCL SCREW 限實施十字韌帶重建手術患者使用 5000 FBS081322SAW FASTAK SUTURE ANCHOR 2.4MM 縫合錨釘限肩關節韌帶手術患者使用 3400 FBS081370BAW BIO-INTERFERENCE SCREW 限實施十字韌帶重建手術患者使用 5000 FBS081370TAW CANNULATED INTERFERENCE SCREW 限實施十字韌帶重手術使用 4500 FBS081915SAW SUTURE ANCHOR 限肩關節韌帶手術患者使用 3400 FBS082123NT1 MITEK ROTATOR CUFF ANCHOR 限肩關節韌帶手術患者使用 3400 FBS082165NT1 SOFT TISSUE ANCHOR(G II SNAP-PAK MINI QUICK ANCHER) 限肩關節韌帶手術患者使用 3400 FBS082221NT1 FASTIN SOFT TISSUE ANCHOR 限肩關節韌帶手術患者使用 3400 243

FBS082225NT1 FASTIN ANCHOR 限肩關節韌帶手術患者使用 3400 FBS082545NT1 ABSOLUTE ABSORBABLE INTERFERENCE SCREW 限實施十字韌帶重建手術患者使用 5000 FBS083512NLA LIGAMENT CANULATED SCREW 限十字韌帶重建手術使用 4500 FBS086101NLV REVO SUTURE ANCHOR(CANCELLOUS SCREW)2.7,4MM (C6140,C6141 自 91/10/01 生效 ) 限肩關節韌帶手術患者使用 3400 FBS0872070SN SOFTSILK TM SCREW SYSTEM( 型號含 7207256:7207264) 限實施十字韌帶重建手術使 4500 FBS0872075SN BIORCI SCREW SYSTEM RCI 可吸收性介面固定螺絲限十字韌帶重建手術使用 5000 FBS087207NSN TITANIUM RCI SCREW 固定螺釘限實施十字韌帶重建手術使用 4500 FBS0872091SN TWINFIX SUTURE ANCHOR(TI) 軟組織錨釘限肩關節韌帶手術患者使用 3400 FBS0872200SN TWINFIX SUTURE ANCHORS AND ACCESSORIES 3400 FBS088320NLV LINVATEC CANNULATED INTEREFERENCE SCREW 限實施十字韌帶重建術患者使用 4500 FBS088321NLV LINVATEC PROPEL CANNULATED INTERFERENCE SCREW 限實施十字韌帶重建術患者使用 4500 FBS08ARWSFAW SUTURE ANCHOR W/FIBER WIRE 縫合錨釘含高鋼性縫線限肩關節韌帶手術患者使用 4100 FBS08C8000LV FBS08C8027LV LINVATEC ABSORBABLE INTERFERENCE SCREW ( 型號 C8030:39 自 92/7/1 生效 ) 限實施十字韌帶重建手術患者使用 LINVATEC BIOSCREW XTRALOK 9:11MMX35:40MM( 加長型可吸收性固定螺絲 ) 限用於十字韌帶重建手術者 5000 5000 FBSCM1103NU0 CUSTOM MADE HUMERAL TUMOR PROSTHESIS 申報費用時應檢附該被保險人之發票備查 197000 FBSCM6487NH1 CASTOM MADE HUMERAL PROTHESIS 申報費用應檢附發票備查 197000 FBSF100002ZV VIMAX SPINAL SYSTEM 二節 (SX4+RX2) 27702 FBSF100003ZV VIMAX SPINAL SYSTEM 三節 (SX6+RX2) 40464 FBSF100012ZV VIM SPINAL SYSTEM 二節 (SX4+RX2 或 SX4+PX2) 27702 FBSF100013ZV VIM SPINAL SYSTEM 三節 (SX6+RX2) 40464 FBSF100022ZV VIMAX SPINAL SYSTEM 二節 (SX4+RX2) 免事前審查 13816 FBSF100023ZV VIMAX SPINAL SYSTEM 三節 (SX6+RX2) 免事前審查 20044 FBSF10002TDP TITANIUM ISOLA SPINAL SYSTEM 二節 27702 FBSF10003TDP TITANIUM ISOLA SPINAL SYSTEM 三節 40464 FBSF101625B0 TITANIUM SPINAL SYSTEM(PX2+SX4) 27702 FBSF101626B0 TITANIUM SPINAL SYSTEM(RX2+SX4) 27702 244

FBSF101635B0 TITANIUM SPINAL SYSTEM(RX2+SX6 或 RX2+SX4+HX2) 40464 FBSF101640B0 TITANIUM LUMBAR SPINAL SYSTEM 二節 (PX2+SX4) 13816 FBSF101641B0 TITANIUM LUMBAR SPINAL SYSTEM 三節 (PX2+SX6) 20044 FBSF101642B0 TITANIUM LUMBAR SYSTEM 二節 (SX4+RX2) 免事前審查 13816 FBSF101643B0 TITANIUM LUMBAR SYSTEM 三節 (SX6+RX2) 免事前審查 20044 FBSF1082TMDA TITANIUM TSRH SPINAL SYSTEM( 二節 ) 27702 FBSF1083TMDA TITANIUM TSRH SPINAL SYSTEM( 三節 ) 40464 FBSF110001TT TITANIUM SPINAL SYSTEM 二節 (RX2+SX4)( 免事前審查 ) 13816 FBSF110002TT TITANIUM SPINAL SYSTEM 三節 (RX2+SX6)( 免事前審查 ) 20044 FBSF11002LTD TITANIUM TREND SPINAL SYSTEM 二節 (SX4+RX2) 27702 FBSF11003LTD TITANIUM TREND SPINAL SYSTEM 三節 (SX6+RX2) 40464 FBSF11302NB0 TITANIUM SPINAL FIXATION SYSTEM 脊椎固定系統二節 (SX4+RX2) 27702 FBSF11303NB0 TITANIUM SPINAL FIXATION SYSTEM 脊椎固定系統三節 (SX6+RX2) 40464 FBSF12400NDX TITANIUM ALPHA STRYKER CERVICAL IMPLANT( 二節 ) 22426 FBSF13400NDX TITANIUM ALPHA STRYKER CERVICAL IMPLANT( 三節 ) 23285 FBSF13800NS9 TITANIUM XIA SPINAL SCREW( 免事審查 ) 3114 FBSF13802NS9 TITANIUM XIA SPINAL SYSTEM( 二節 SX4+RX2)( 免事審查 ) 13816 FBSF13803NS9 TITANIUM XIA SPINAL SYSTEM( 三節 SX6+RX2)( 免事審查 ) 20044 FBSF13820NS9 TITANIUM XIA SPINAL SYSTEM 二節前置脊椎固定 (SX4+RX2) 27702 FBSF140001RK TITANIUM ANTERIOR SPINAL SYSTEM(PX1+SX4) 27702 FBSF148144S9 XIA 4.5 TITANIUM SPINAL IMPLANTS (SX4+RX2) 二節 27702 FBSF148145S9 XIA 4.5 TITANIUM SPINAL IMPLANTS (SX6+RX2) 三節 40464 FBSF1495XNS1 TITANIUM CLICK'X SPINAL SYSTEM 上開式三節 (SX6+RX2) 40464 FBSF14981NS1 TITANIUM UNIVERSAL SPINAL SYSTEM ( 二節 SCREWX4+RODX2), 頇事前審查 27702 FBSF14982NS1 VENTROFIX ANTERIOR SPINAL SYSTEM(RODX2+ 或 X1+SCREWX4) 27702 FBSF14985NS1 TITANIUM CLICK'X SPINAL SYSTEM 上開式二節 (SX4+RX2) 27702 245

FBSF1498XNS1 TITANIUM UNIVERSAL SPINAL SYSTEM ( 三節 SCREWX6+RODX2), 頇事前審查 40464 FBSF14994NS1 TITANIUM SPINAL SYSTEM 三節 (SX6+RX2) 免事前審查 20044 FBSF14995NS1 TITANIUM SPINAL SYSTEM 二節 (SX4+RX2) 免事前審查 13816 FBSF16200NDX TITANIUM SPINAL IMPLANT(RX2+SX4) 二節型號 48485030:9060,XL 自 90/07/01 生效 27702 FBSF16202NS1 TITANIUM PANGEA SPINAL SYSTEM(SX4+RX2) 27702 FBSF16203NS1 TITANIUM PANGEA SPINAL SYSTEM(SX6+RX2) 40464 FBSF162200S9 TITANIUM ROD PLATE SPINE SYSTEM 二節 (RX2+SX4+BLOCKERX4) 13816 FBSF162300S9 TITANIUM ROD PLATE SPINE SYSTEM 三節 (RX2+SX6+BLOCKERX6) 20044 FBSF16300NDX TITANIUM SPINAL IMPLANT 三節 (SX6+RX2) 型號 48485030:9060,XL 自 90/07/01 生效 40464 FBSF16720NS9 TITANIUM OPUS SPINAL FIXATION 二節 (SX4+RX2) 13816 FBSF16730NS9 TITANIUM OPUS SPINAL FIXATION 三節 (SX6+RX2) 20044 FBSF17200NDX OPUS SPINAL FIXATION 二節 (SCREWX4+RODX2) 27702 FBSF172201Z1 SILHOUETTE SPINAL FIXATION SYSTEM(R*2+S*6) 三節 40464 FBSF17220NZ1 SILHOUETTE SPINAL FIXATION SYSTEM(R*2+S*4) 二節 27702 FBSF172211Z1 SILHOUETTE SPINAL FIXATION SYSTEM-(R*2+S*6) 免事前審查 20044 FBSF17221NZ1 SILHOUETTE SPINAL FIXATION SYSTEM-(R*2+S*4) 免事前審查 13816 FBSF17300NDX OPUS SPINAL FIXATION 三節 (SCREWX6+RODX2) 40464 FBSF1765P2Y2 TITANIUM SPINAL SYSTEM 二節 (RX2+SX4) 27702 FBSF1765P3Y2 TITANIUM SPINAL SYSTEM 三節 (RX2+SX6) 40464 FBSF176902Y2 TITANIUM POSTERIOR SPINAL FIXATION SYSTEM 二節 (RX2+SX4)( 原產品型號 769130:855+765905:930) 13816 FBSF176903Y2 TITANIUM POSTERIOR SPINAL FIXATION SYSTEM 三節 (RX2+SX6)( 原產品型號 769130:855+765905:930) 20044 FBSF177002Y2 TITANIUM C TYPE SPINAL FIXATION SYSTEM 二節 (RX2+SX4)( 免術前審查 ) 13816 FBSF177003Y2 TITANIUM C TYPE SPINAL FIXATION SYSTEM 三節 (RX2+SX6)( 免術前審查 ) 20044 FBSF177202Y2 TITANIUM SPINAL SYSTEM(RX2+SX4) 二節 27702 FBSF177203Y2 TITANIUM SPINAL SYSTEM(RX2+SX6) 三節 40464 FBSF177402Y2 TITANIUM O TYPE SPINAL SYSTEM 二節 (RX2+SX4) 27702 246

FBSF177403Y2 TITANIUM O TYPE SPINAL SYSTEM 三節 (RX2+SX6) 40464 FBSF180001RK TITANIUM SPINAL SYSTEM (SX4+RX2) 二節 27702 FBSF180002RK TITANIUM SPINAL SYSTEM (SX6+RX2) 三節 40464 FBSF180NP2Y2 ARTEST SPINAL FIXATION SYSTEM(SX4+RX2) 二節亞力士脊椎固定系統 27702 FBSF180NP3Y2 ARTEST SPINAL FIXATION SYSTEM(SX6+RX2) 三節亞力士脊椎固定系統 40464 FBSF181NP2Y2 BRIDGE SPINAL FIXATION SYSTEM 二節 (RX2+SX4) 免事前審查 13816 FBSF181NP3Y2 BRIDGE SPINAL FIXATION SYSTEM 三節 (RX2+SX6) 免事前審查 20044 FBSF1821XNDA TITANIUM ZPLATE ANTERIOR SPINAL SYSTEM (PLATEX1+SCREWX4), 頇事前審查 27702 FBSF1822MNM4 ZPLATE II ANTERIOR FIXATION SYSTEM(PX1+SX4) 二節 27702 FBSF186001RK TITANIUM SPINAL SYSTEM (SX4 + RX2) 二節免事前審查 13816 FBSF186002RK TITANIUM SPINAL SYSTEM (SX6+RX2) 三節免事前審查 20044 FBSF1865N2M4 BASIS SPINAL SYSTEM TITANIUM 二節 (SX4+RX2)( 免事前審查 ) 13816 FBSF1865N3M4 BASIS SPINAL SYSTEM TITANIUM 三節 (SX6+RX2)( 免事前審查 ) 20044 FBSF1865P2M4 BASIS SPINAL SYSTEM 二節 (ATL PLATE SYSTEM)(PX1+SX4) 27702 FBSF1A3EHNXA A3 POSTERIOR TITANIUM SPINAL EVOLUTION HOOK(SCREWX2+HOOKX2+NUTX2) 23306 FBSF1A3N2NXA A3 POSTERIOR TITANIUM SPINAL SYSTEM 二節 (RX2+SX4) 27702 FBSF1A3N3NXA A3 POSTERIOR TITANIUM SPINAL SYSTEM 三節 (RX2+SX6) 40464 FBSF1AAS2NXA TITANIUM SPINAL SYSTEM 二節 (RX2+SX4) 27702 FBSF1AAS8NXA TITANIUM SPINAL SYSTEM 三節 (RX2+SX6) 40464 FBSF1AS001AQ TITANIUM SPINAL OC-FIX SCREW SYSTEM 二節 (RX2+SX4) 免術前審查 13816 FBSF1AS002AQ TITANIUM SPINAL OC-FIX SCREW SYSTEM 三節 (RX2+SX6) 免術前審查 20044 FBSF1AS003AQ TITANIUM SPINAL FIXATION SYSTEM (SX4+RX2) 二節免事前審查 13816 FBSF1AS004AQ TITANIUM SPINAL FIXATION SYSTEM (SX6+RX2) 三節免事前審查 20044 FBSF1ASAT1AQ TITANIUM ANTERIOR SPINAL SYSTEM(PX1+SX4) 27702 FBSF1ASN01AQ TITANIUM SMARTLOC SPINAL SYSTEM(SX4+RX2) 免事前審前 13816 FBSF1ASN02AQ TITANIUM SMARTLOC SPINAL SYSTEM(SX6+RX2) 免事前審前 20044 247

特材代碼中英文品名支付點數 FBSF1ASPL1AQ TITANIUM SPINAL SYSTEM 二節 (RX2+SX4) 27702 FBSF1ASPL2AQ TITANIUM SPINAL SYSTEM 二節 (PX2+SX4) 27702 FBSF1ASPL3AQ TITANIUM SPINAL SYSTEM 三節 (RX2+SX6) 40464 FBSF1ASPL4AQ TITANIUM SPINAL SYSTEM 三節 (PX2+SX6) 40464 FBSF1ASY01AQ TITANIUM SMARTLOC SPINAL SYSTEM 二節 (SX4+RX2) 27702 FBSF1ASY02AQ TITANIUM SMARTLOC SPINAL SYSTEM 三節 (SX6+RX2) 40464 FBSF1ASY03AQ SMARTLOC SPINAL SYSTEM 二節 (RX2+SX4) 27702 FBSF1ASY04AQ SMARTLOC SPINAL SYSTEM 三節 (RX2+SX6) 40464 FBSF1AYS2NXA Y TYPE POSTERIOR TITANIUM SPINAL SYSTEM 二節 (RX2+SX4)( 免事前審查 ) 13816 FBSF1AYS8NXA Y TYPE POSTERIOR TITANIUM SPINAL SYSTEM 三節 (RX2+SX6)( 免事前審查 ) 20044 FBSF1CD2S2M4 TITANIUM CD SPINAL SYSTEM 二節 (SX4+RX2)( 免術前審查 ) 13816 FBSF1CD2S3M4 TITANIUM CD SPINAL SYSTEM 三節 (SX6+RX2)( 免術前審查 ) 20044 FBSF1CDH2TDA TITANIUM CD HORIZON SPINAL SYSTEM 二節 (SCREWX4+RODX2) 27702 FBSF1CDH3TDA TITANIUM CD HORIZON SPINAL SYSTEM 三節 (SCREWX6+RODX2) 40464 FBSF1CENTAS9 TITANIUM CENTAUR ANTERIOR SYSTEM( 二節 1P+4S 或 2L+4S) 27702 FBSF1GS12NG0 GSS TITANIUM SPINAL SYSTEM 二節 (RX2+SX4) 27702 FBSF1GS13NG0 GSS TITANIUM SPINAL SYSTEM 三節 (RX2+SX6) 40464 FBSF1JAVA2JA TITANIUM SPINAL SYSTEM 二節 (RX2+SX4) 27702 FBSF1JAVA2SJ TITANIUM SHIRAZ JAVA SYSTEM( 二節 )(RX2+SX4) 27702 FBSF1JAVA3JA TITANIUM SPINAL SYSTEM 三節 (RX2+SX6) 40464 FBSF1JAVA3SJ TITANIUM SHIRAZ JAVA SYSTEM( 三節 )(RX2+SX6) 40464 FBSF1KASRNAD TITANIUM KANEDA SR ANTERIOR SPINAL SYSTEM(SX4+RX2) 27702 FBSF1KAT12DP KANEDA SR-ANTERIOR TITANIUM SPINAL SYSTEM 二節 13816 FBSF1KAT13DP KANEDA SR-ANTERIOR TITANIUM SPINAL SYSTEM 三節 20044 FBSF1M2SP2Z6 TITANIUM SPINAL SYSTEM 二節 (PX2+SX4 或 RX2+SX4) 13816 FBSF1M2SP3Z6 M2 SPINAL POSTERIOR SYSTEM 三節 (ROD 2+SCREW 6 或 PLATE 2+SCREW 6)M2 脊椎後方固定系統免事前審查 20044 248

FBSF1M3SP2Z6 TITANIUM M3 SPINAL POSTERIOR SYSTEM 二節 (RX2+SX4) 27702 FBSF1M3SP3Z6 TITANIUM M3 SPINAL POSTERIOR SYSTEM 三節 (RX2+SX6) 40464 FBSF1M8RS2M4 TITANIUM CD HORIZON M8 SPINAL SYSTEM(RX2+SX4) 二節 27702 FBSF1M8RS3M4 TITANIUM CD HORIZON M8 SPINAL SYSTEM(RX2+SX6) 三節 40464 FBSF1MES2NZ6 TITANIUM SPINAL SYSTEM 二節 (RODX2 或 PLATEX2+SCREWX4) 27702 FBSF1MES3NZ6 TITANIUM SPINAL SYSTEM 三節 (RODX2 或 PLATEX2+SCREWX6) 40464 FBSF1P2SP2Z6 PROT II POSTERIOR SPINE SYSTEM 二節 (RX2+SX4) 27702 FBSF1P2SP3Z6 PROT II POSTERIOR SPINE SYSTEM 三節 (RX2+SX6) 40464 FBSF1R200NS9 XIA REDUCTION IMPLANTS 二節 (RX2+SX4) 27702 FBSF1R300NS9 XIA REDUCTION IMPLANTS 三節 (RX2+SX6) 40464 FBSF1RF002RX RF SPINAL SYSTEM 二節 (SX4+RX2)( 免事前審查 ) 13816 FBSF1RF003RX RF SPINAL SYSTEM 三節 (SX6+RX2)( 免事前審查 ) 20044 FBSF1S200NS9 SR90D RODDING SYSTEM 二節 (RODX2+SCREWX4) 27702 FBSF1S300NS9 SR90D RODDING SYSTEM 三節 (RODX2+SCREWX6) 40464 FBSF1SA1T2Y2 TITANIUM UNIVERSAL ANTERIOR SPINAL FIXATION SYSTEM(SX4+PX1) 27702 FBSF1SA2T2Y2 TITANIUM UNIVERSAL ANTERIOR SPINAL FIXATION SYSTEM(SX4+BLOCKX2+RODX2) 27702 FBSF1SW200AE TITANIUM S4 SPINE SYSTEM 二節 (SX4+RX2) 27702 FBSF1SW300AE TITANIUM S4 SPINE SYSTEM 三節 (SX6+RX2) 40464 FBSF1SX002AE TITANIUM SPINE SYSTEM EVOLUTION 二節 (SCREWX4+LODX2)(96 年 10 月 1 日起免事前審查 ) 13816 FBSF1SX003AE TITANIUM SPINE SYSTEM EVOLUTION 三節 (SCREWX6+LODX2)(96 年 10 月 1 日起免事前審查 ) 20044 FBSF1T2552DP M-M TITANIUM SPINAL SYSTEM( 二節 ) 27702 FBSF1T3553DP M-M TITANIUM SPINAL SYSTEM( 三節 ) 40464 FBSF1TS002JA TITANIUM SPINAL SYSTEM 二節 (RX2+SX4)( 免事前審查 ) 13816 FBSF1TS002SJ TITANIUM SHIRAZ JAVA SYSTEM ( 免事前審查 ) 二節 13816 FBSF1TS003JA TITANIUM SPINAL SYSTEM 三節 (RX2+SX6)( 免事前審查 ) 20044 FBSF1TS003SJ TITANIUM SHIRAZ JAVA SYSTEM( 免事前審查 ) 三節 20044 249

特材代碼中英文品名支付點數 FBSF1VSP2TDP TITANIUM VSP SPINAL SYSTEM 二節 27702 FBSF1VSP3TDP TITANIUM VSP SPINAL SYSTEM 三節 40464 FBSF1X200NS9 XIA TITANIUM SPINAL IMPLANTS 二節 (SX4+RX2)(03820425:860,03821425:760 自 92/4/1 生效 ) 27702 FBSF1X300NS9 XIA TITANIUM SPINAL IMPLANTS 三節 (SX6+RX2)(03820425:860,03821425:760 自 92/4/1 生效 ) 40464 FBSF200002ZV VIMAX SPINAL ROD 40:100MM 1089 FBSF200004ZV VIMAX SPINAL ROD 110:450MM 3218 FBSF200012ZV VIM SPINAL ROD PLATE 40:100MM 35MM 1089 FBSF200014ZV VIM SPINAL ROD 110:300MM 3218 FBSF200022ZV VIMAX SPINAL ROD 40:100MM 免事前審查 679 FBSF200024ZV VIMAX SPINAL ROD 110:150MM 免事前審查 1851 FBSF20572NDP M-M TITANIUM ROD 30CM,48CM 3218 FBSF20574NDP M-M TITANIUM ROD 12CM 1089 FBSF2080TMDA TITANIUM TSRH SPINAL ROD( 短節 ) 1089 FBSF2081TMDA TITANIUM TSRH SPINAL ROD( 長節 ) 3218 FBSF210001TT TITANIUM SPINAL ROD 50:100MM( 免事前審查 ) 679 FBSF210002TT TITANIUM SPINAL ROD 110MM:450MM( 免事前審查 ) 1851 FBSF210B2NZ6 TITANIUM SPINAL ROD 4.5:10.5CM 1089 FBSF210B5NZ6 TITANIUM SPINAL ROD 12.5:20CM 3218 FBSF21502NS1 TITANIUM UNIVERSAL SPINAL ROD 免事前審查 679 FBSF21534NS1 TITANIUM UNIVERSAL SPINAL ROD LONG 免事前審查 1851 FBSF21600LTD TITANIUM TREND SPINAL ROD 110:300MM 3218 FBSF21600STD TITANIUM TREND SPINAL ROD 1089 FBSF22040NS9 XIA TITANIUM SPINAL ROD 40:60MM( 免事前審查 ) 679 FBSF22110NS9 XIA TITANIUM SPINAL ROD 110:350MM( 免事前審查 ) 1851 FBSF232102DP KANEDA SR-ANTERIOR TITANIUM SPINAL ROD 679 FBSF248147S9 XIA TITANIUM SPINAL ROD 40:100MM( 短節 ) 1089 250

FBSF248148S9 XIA TITANIUM SPINAL ROD 110:600MM ( 長節 ) 3218 FBSF24981NS1 TITANIUM UNIVERSAL SPINAL ROD 1089 FBSF24985NS1 TITANIUM PANGEA ROD 35:85MM 1089 FBSF2498XNS1 TITANIUM UNIVERSAL SPINAL ROD LONG, 應事前審查 3218 FBSF250001DP STAINLESS ANTERIOR ISOLA SPINAL ROD 558 FBSF254040B0 TITANIUM SPINAL ROD 40MM:110MM( 短節 ) 1089 FBSF254047B0 TITANIUM SPINAL ROD 120MM:200MM( 長節 ) 3218 FBSF26051NB0 TITANIUM SPINAL PLATE 1089 FBSF26202NS1 TITANIUM PANGEA ROD 200-500MM 3218 FBSF26504NDX TITANIUM DIAPASON SPINAL ROD 40:100MM, 頇事前審查 1089 FBSF26511NDX TITANIUM DIAPASON SPINAL ROD 11:40CM, 頇事前審查 3218 FBSF26702NDX OPUS SPINAL FIXATION PLATE 1089 FBSF26710NDX OPUS SPINAL FIXATION ROD 40:100MM 1089 FBSF26711NDX OPUS SPINAL FIXATION ROD 110:400MM 3218 FBSF26714NS9 TITANIUM OPUS SPINAL FIXATION ROD( 免事前審查 ) 1851 FBSF275001Z1 SILHOUETTE SPINAL FIXATION SYSTEM-ROD 20,47CM 3218 FBSF27500NZ1 SILHOUETTE SPINAL FIXATION SYSTEM-ROD 10CM 1089 FBSF275011Z1 SILHOUETTE SPINAL FIXATION SYSTEM-ROD 20,47,50CM 免事前審查 1851 FBSF27501NZ1 SILHOUETTE SPINAL FIXATION SYSTEM-ROD 10CM 免事前審查 679 FBSF276590Y2 TITANIUM SPINAL ROD 5:10CM 1089 FBSF27659NY2 TITANIUM SPINAL ROD 12:30CM 3218 FBSF277004Y2 TITANIUM SPINAL ROD 6X50:100MM 短節 ( 免術前審查 ) 679 FBSF277006Y2 TITANIUM SPINAL ROD 短節 1089 FBSF277011Y2 TITANIUM SPINAL ROD 6X110:300MM 長節固定四節以上 ( 免術前審查 ) 1851 FBSF277071Y2 TITANIUM SPINAL FIXATION PLATE 45:80MM 1089 FBSF277104Y2 STAINLESS SPINAL ROD 4:10CM 短節 ( 免術前審查 ) 558 251

FBSF277111Y2 STAINLESS SPINAL ROD 11:30CM 長節 ( 免術前審查 ) 558 FBSF2785NLY2 ARTEST SPINAL FIXATION SYSTEM:ROD 115:450MM 亞力士脊椎固定系統長節連接管 3218 FBSF2785NSY2 ARTEST SPINAL FIXATION SYSTEM:ROD 20:110MM 亞力士脊椎固定系統短節連接管 1089 FBSF2820NLY2 TITANIUM SPINAL ROD 11.5:45CM 長節免事前審查 1851 FBSF2820NSY2 TITANIUM SPINAL ROD 2:11CM 短節免事前審查 679 FBSF28280NM4 TITANIUM SPINAL ROD 51CM 3218 FBSF2855LTDA TITANIUM CD HORIZON SPINAL ROD( 長節 ) 3218 FBSF2855STDA TITANIUM CD HORIZON SPINAL ROD( 短節 ) 1089 FBSF286540M4 BASIS SPINAL TITANIUM ROD 51CM( 免事前審查 ) 679 FBSF2A3R1NXA A3 POSTERIOR TITANIUM SPINAL ROD 4:10CM 1089 FBSF2A3R2NXA A3 POSTERIOR TITANIUM SPINAL ROD 11:50CM 3218 FBSF2AS001AQ TITANIUM SPINAL ROD 5:10CM 免術前審查 679 FBSF2ASLP1AQ TITANIUM SPINAL PLATE 1089 FBSF2ASLR1AQ TITANIUM SPINAL ROD 20:90MM 1089 FBSF2ASLR2AQ TITANIUM SPINAL ROD 110:450MM 3218 FBSF2ASNR1AQ TITANIUM SMARTLOC SPINAL ROD 40:100MM 免事前審前 679 FBSF2ASNR2AQ TITANIUM SMARTLOC SPINAL ROD 110:450MM 免事前審前 1851 FBSF2ASYR1AQ TITANIUM SMARTLOC SPINAL ROOD 40:100MM 1089 FBSF2ASYR2AQ TITANIUM SMARTLOC SPINAL ROOD 110:480MM 3218 FBSF2B0001RK TITANIUM SPINAL ROD 40:100 MM( 短節 ) 免事前審查 679 FBSF2B0002RK TITANIUM SPINAL ROD 110:480MM( 長節 ) 免事前審查 1851 FBSF2BA001RK TITANIUM SPINAL ROD 40:100MM( 短節 ) 適應症請見備註 1089 FBSF2BA002RK TITANIUM SPINAL ROD 110:450MM( 長節 ) 3218 FBSF2BA003RK TITANIUM SPINAL PLATE 1089 FBSF2GS21NG0 GSS TITANIUM SPINAL ROD 40-100MM 1089 FBSF2GS22NG0 GSS TITANIUM SPINAL ROD 110-600MM 3218 252

特材代碼中英文品名支付點數 FBSF2M2SRNZ6 TITANIUM SPINAL ROD 4.5:10.5CM 679 FBSF2M3LRDZ6 TITANIUM M3 SPINAL POSTERIOR ROD 125:300MM 3218 FBSF2M3SRDZ6 TITANIUM M3 SPINAL POSTERIOR ROD 45:105MM 1089 FBSF2P2LRDZ6 PROT II POSTERIOR SPINE ROD 12.5:20CM 3218 FBSF2P2SRDZ6 PROT II POSTERIOR SPINE ROD 4.5:10.5CM 1089 FBSF2PR040B0 TITANIUM SPINAL ROD 40MM:100MM 免事前審查 679 FBSF2PR041B0 TITANIUM SPINAL ROD 110MM:450MM 免事前審查 1851 FBSF2R063NXA TITANIUM SPINAL ROD 4:11CM 1089 FBSF2R068NXA TITANIUM SPINAL ROD 13:40CM 3218 FBSF2R482NS9 XIA REDUCTION ROD 30:90MM 1089 FBSF2R8550M4 TITANIUM CD HORIZON M8 SPINAL ROD 20"( 免術前審查 ) 1851 FBSF2R855LM4 TITANIUM CD HORIZON M8 SPINAL ROD 長節 50.4CM 3218 FBSF2R869SM4 TITANIUM CD HORIZON M8 SPINAL ROD 短節 3CM,8CM 1089 FBSF2RADLTDP TITANIUM ISOLA SPINAL ROD 10:46CM 3218 FBSF2RF00LRX RF SPINAL ROD 110:150MM( 免事前審查 ) 1851 FBSF2RF00SRX RF SPINAL ROD 40:100MM( 免事前審查 ) 679 FBSF2RY63NXA Y TYPE POSTERIOR TITANIUM SPINAL ROD 5:10CM( 免事前審查 ) 679 FBSF2RY68NXA Y TYPE POSTERIOR TITANIUM SPINAL ROD 12:40CM( 免事前審查 ) 1851 FBSF2S192NS9 SR90D RODDING SYSTEM ROD 110:600MM 3218 FBSF2S812NS9 SR90D RODDING SYSTEM ROD 30:90MM 1089 FBSF2SR125Z6 TITANIUM SPINAL ROD 125MM:200MM( 免事前審查 ) 1851 FBSF2SW35NAE TITANIUM S4 SPINE SYSTEM:ROD 35MM:120MM 1089 FBSF2SW50NAE TITANIUM S4 SPINE SYSTEM:ROD 150MM:500MM 3218 FBSF2SX10NAE TITANIUM SPINE ROD 40-200MM (96 年 10 月 1 日起免事前審查 ) 679 FBSF2SX12NAE TITANIUM SPINE ROD 250-500MM (96 年 10 月 1 日起免事前審查 ) 1851 FBSF2T1FRMCM TI-FRAME TITANIUM( 後頸椎固定架 ) 7607 253

特材代碼中英文品名支付點數 FBSF2TL01TJA TITANIUM SPINAL ROD 30:100MM 1089 FBSF2TL01TSJ TITANIUM SHIRAZ JAVA ROD 40-100MM 1089 FBSF2TL02TJA TITANIUM SPINAL ROD 120:800MM 3218 FBSF2TL02TSJ TITANIUM SHIRAZ JAVA ROD 120-200MM 3218 FBSF2TS01TJA TITANIUM SPINAL ROD 30:100MM( 免事前審查 ) 679 FBSF2TS01TSJ TITANIUM SHIRAZ JAVA ROD 40:120MM( 免事前審查 ) 679 FBSF2TS02TJA TITANIUM SPINAL ROD 120-200MM( 免事前審查 ) 1851 FBSF2X204NS9 XIA TITANIUM SPINAL ROD 70:100MM 1089 FBSF2X211NS9 XIA TITANIUM SPINAL ROD 360:600MM 3218 FBSF300003ZV VIMAX SPINAL HOOK 5375 FBSF300013ZV VIM SPINAL HOOK 5375 FBSF301020B0 TITANIUM SPINAL HOOK 5375 FBSF30559NDP M-M TITANIUM HOOK 5375 FBSF3080TMDA TITANIUM TSRH SPINAL HOOK 5375 FBSF308XXNDA STANLESS TSRH SPINAL IMPLANT SYSTEM HOOK 4424 FBSF3140XNTD TITANIUM TREND SPINAL HOOK 5375 FBSF348150S9 XIA TITANIUM SPINAL HOOK 5375 FBSF34983NS1 TITANIUM UNIVERSAL SPINAL HOOK, 頇事前審查 5375 FBSF35911NDX TITANIUM DIAPASON SPINAL HOOK, 頇事前審查 5375 FBSF36132NY2 TITANIUM CERVICAL CLAMP( 配合 FBSF46132NY2 使用 ) 4110 FBSF36201NS1 TITANIUM PANGEA SPINAL HOOK 5375 FBSF37410NZ1 SILHOUETTE SPINAL FIXATION SYSTEM-HOOK 5375 FBSF375504Y2 STAINLESS SPINAL HOOK 4424 FBSF376504Y2 TITANIUM SPINAL HOOK 5375 FBSF377041Y2 TITANIUM SPINAL HOOK( 免術前審查 ) 2420 FBSF386520M4 BASIS SPINAL TITANIUM HOOK( 免事前審查 ) 2420 254

特材代碼中英文品名支付點數 FBSF3961TMDA TITANIUM CD HORIZON SPINAL HOOK 5375 FBSF39970SDP STAINLESS ISOLA SPINAL SYSTEM HOOK 4424 FBSF39970TDP TITANIUM ISOLA SPINAL SYSTEM HOOK 5375 FBSF3A3H1NXA A3 POSTERIOR TITANIUM SPINAL HOOK 5375 FBSF3ASLH1AQ TITANIUM SPINAL HOOK 5375 FBSF3ASYH1AQ TITANIUM SMARTLOC SPINAL HOOK 5375 FBSF3BA001RK TITANIUM SPINAL HOOK 5375 FBSF3H212NXA TITANIUM SPINAL PEDICLE HOOK 5375 FBSF3H8415M4 TITANIUM CD REDUCTION SCREW CONNECTOR HOOK( 免術前審查 ) 2420 FBSF3H859PM4 TITANIUM CDH M8 PEDIATRIC HOOK 5375 FBSF3H859SM4 TITANIUM CD HORIZON M8 SPINAL HOOK 5375 FBSF3H869RM4 TITANIUM CDH M8 REDUCTION SPINAL HOOK 5375 FBSF3HAAKNDP STANLESS ISOLA SPINAL HOOK 鉤 4424 FBSF3HAAKTDP TITANIUM ISOLA SPINAL HOOK 5375 FBSF3HK01NZ6 TITANIUM SPINAL HOOK 5375 FBSF3HY12NXA Y TYPE POSTERIOR TITANIUM SPINAL HOOK( 免事前審查 ) 2420 FBSF3M3SHKZ6 TITANIUM M3 SPINAL POSTERIOR HOOK 5375 FBSF3R382NS9 XIA REDUCTION HOOK 5375 FBSF3S600NS9 SR90D RODDING SYSTEM HOOK 5375 FBSF3SX30NAE TITANIUM SPINE HOOK 5375 FBSF3X600NS9 XIA TITANIUM SPINAL HOOK(03820200:20215;03820220;20221;20230;20231 自 980401 生效 ) 5375 FBSF400004ZV VIMAX SPINAL SCREW 6381 FBSF400014ZV VIM SPINAL SCREW 6381 FBSF400024ZV VIMAX SPINAL SCREW 免事前審查 3114 FBSF4010RNZ6 TITANIUM SPINAL SCREW 6381 FBSF40536NDP M-M TITANIUM SCREW MONO( 型號 1755-29125:29155 自 92/1/1 生效 ) 6381 255

FBSF40543NDP M-M TITANIUM SCREW POLY( 型號 1755-37125:37155 自 92/1/1 生效 ) 6381 FBSF4080TMDA TITANIUM TSRH SPINAL SCREW 6381 FBSF409099DP TITANIUM MOSS MIAMI SPINAL SCREW 6381 FBSF410001TT TITANIUM SPINAL SCREW( 免事前審查 ) 3114 FBSF4110XNTD TITANIUM TREND SPINAL SCREW 6381 FBSF41300NB0 TITANIUM SPINAL FIXATION SYSTEM:SCREW 脊椎固定螺絲 6381 FBSF42236NDP TITANIUM PEDICLE SCREW 6381 FBSF448146S9 XIA 4.5 TITANIUM SPINAL SCREW 6381 FBSF44985NS1 TITANIUM UNIVERSAL SPINAL SCREW 6381 FBSF44988NS1 TITANIUM CLICK'X SPINAL SCREW 6381 FBSF44989NS1 TITANIUM CLICK'X SPINAL SCREW (499.500V:507V;520V:527V 自 981001 刪除 ) 6381 FBSF452102DP KANEDA SR-ANTERIOR TITANIUM SPINAL SCREW 3114 FBSF455030B0 TITANIUM SPINAL SCREW( 免事前審查 ) 3114 FBSF46121NY2 STAINLESS CERVICAL SCREW 17:24MM 188 FBSF461221Y2 STAINLESS SPINAL RESCUABLE SCREW(FBSF46121NY2 失敗時用, 配合 FBSF661202Y2 用 ) 188 FBSF461321Y2 TITANIUM SPINAL RESCUABLE SCREW(FBSF66131NY2 失敗時用, 配合 FBSF661302Y2 用 ) 194 FBSF46132NY2 TITANIUM CERVICAL SCREW( 配合 FBSF36132NY2 使用 ) 2400 FBSF46201NS1 TITANIUM PANGEA PEDICLE SCREW 6381 FBSF46400NDX TITANIUM DIAPASON SPINAL SCREW 型號 48485030:9060,XL 自 90/07/01 生效 6381 FBSF46700NDX OPUS SPINAL FIXATION SCREW 6381 FBSF4670BNS9 TITANIUM OPUS SPINAL FIXATION SCREW( 免事前審查 ) 3114 FBSF471201Z1 SILHOUETTE SPINAL FIXATION SYSTEM-SCREW 免事前審查 3114 FBSF47120NZ1 SILHOUETTE SPINAL FIXATION SYSTEM-SCREW 6381 FBSF471545B0 TITANIUM SPINAL SCREW( 型號含 120-6035:45) 6381 FBSF4765NNY2 TITANIUM SPINAL SCREW 6381 FBSF4769NNY2 TITANIUM SPINAL PEDICLE SCREW 4.5:8,30:55MM 3114 256

FBSF4770NNY2 TITANIUM SPINAL PEDICLE SCREW( 免術前審查 ) 3114 FBSF477253Y2 TITANIUM SPINAL OSTEOPOROTIC SCREW( 免術前審查 ) 3114 FBSF4772NNY2 TITANIUM SPINAL SCREW 6381 FBSF4774NNY2 TITANIUM O TYPE SPINAL FIXATION SCREW 6381 FBSF4780NNY2 ARTEST SPINAL FIXATION SYSTEM:TITANIUM SPINAL PEDICLE SCREW( 免事前審查 ) 3114 FBSF4781NNY2 ARTEST SPINAL FIXATION SYSTEM:TITANIUM SPINAL POLYAXIAL PEDICLE SCREW( 免事前審查 ) 3114 FBSF4782NNY2 PEDICLE SCREW( 免事前審查 ) 3114 FBSF4790NNY2 FBSF4791NNY2 ARTEST SPINAL FIXATION SYSTEM:TITANIUM SPINAL CANNULATED PEDICLE SCREW( 免事前審查 ) ARTEST SPINAL FIXATION SYSTEM:TITANIUM SPINAL CANNULATED POLYAXIAL PEDICLE SCREW( 免事前審查 ) 3114 3114 FBSF4803NNY2 ARTEST SPINAL FIXATION SYSTEM:PEDICLE SCREW 亞力士脊椎固定系統 : 骨釘 6381 FBSF4804NNY2 ARTEST SPINAL FIXATION SYSTEM:CANNULATED PEDICLE SCREW 亞力士脊椎固定系統 : 骨釘 6381 FBSF4806NNY2 ARTEST SPINAL FIXATION SYSTEM:POLYAXIAL PEDICLE SCREW 亞力士脊椎固定系統 : 骨釘 6381 FBSF4807NNY2 ARTEST SPINAL FIXATION SYSTEM:CANNULATED POLYAXIAL PEDICLE SCREW 亞力士脊椎固定系統骨釘 6381 FBSF4807TMDA TITANIUM CD HORIZON SPINAL SCREW 6381 FBSF4816NNY2 REDUCTION PEDICLE SCREW 免事前審查 3114 FBSF4818NNY2 POLYAXIAL PEDICLE SCREW 免事前審查 3114 FBSF4827MNM4 TITANIUM MULTI AXIAL SPINAL SCREW 6381 FBSF4865MNM4 BASIS SPINAL TITANIUM SCREW( 免事前審查 ) 3114 FBSF4A3S1NXA A3 POSTERIOR TITANIUM SPINAL SCREW 6381 FBSF4AS001AQ TITANIUM SPINAL SCREW 免術前審查 3114 FBSF4AS002AQ TITANIUM SPINAL FIXATION SYSTEM:SCREW 免事前審查 3114 FBSF4ASLS1AQ TITANIUM SPINAL SCREW 6381 FBSF4ASNS1AQ TITANIUM SMARTLOC SPINAL SCREW 免事前審查 3114 FBSF4ASYS1AQ TITANIUM SMARTLOC SPINAL SCREW 6381 FBSF4ASYS2AQ SMARTLOC SPINAL SCREW 6381 FBSF4B0001RK TITANIUM SPINAL SCREW 免事前審查 3114 257

特材代碼中英文品名支付點數 FBSF4BA001RK TITANIUM SPINAL SCREW 6381 FBSF4BA002RK TITANIUM SPINAL SCREW 6381 FBSF4GS41NG0 GSS TITANIUM SPINAL PEDICLE SCREW 6381 FBSF4LB05NAE STANLESS SPONGIOSA CERVICAL CASPAR SCREW 3.5MM WIDE THREAD 10MM:19MM 188 FBSF4LB06NAE STANLESS SPONGIOSA CERVICAL CASPAR SCREW 3.5MM WIDE THREAD 20MM 以上 228 FBSF4M2PWNZ6 TITANIUM SPINAL SCREW 3114 FBSF4M3SSEZ6 TITANIUM M3 SPINAL POSTERIOR SCREW 6381 FBSF4P2SCWZ6 PROT II POSTERIOR SPINE SCREW 6381 FBSF4R382NS9 XIA REDUCTION SCREW 6381 FBSF4RF001RX RF SPINAL SCREW( 免事前審查 ) 3114 FBSF4S475NS9 SR90D RODDING SYSTEM SCREW 6381 FBSF4S859FM4 TITANIUM CD HORIZON M8 SPINAL SCREW 6381 FBSF4S8655M4 TITANIUM CD TULIP SCREW( 免術前審查 ) 3114 FBSF4S869MM4 TITANIUM CDH M8 MULTIAXIAL SCREW 6381 FBSF4S9603M4 TITANIUM CD REDUCTION SCREW( 免術前審查 ) 3114 FBSF4SW70NAE TITANIUM S4 SPINE SYSTEM:TRANSPEDICULAR BONE SCREW 6381 FBSF4SX07NAE TITANIUM SPINE SCREW (96 年 10 月 1 日起免事前審查 ) 3114 FBSF4TL01TJA TITANIUM SPINAL PEDICLE SCREW 6381 FBSF4TL01TSJ TITANIUM SHIRAZ JAVA PEDICLE SCREW 6381 FBSF4TL02TSJ TITANIUM SHIRAZ JAVA SCREW 6381 FBSF4TL03TSJ TITANIUM SHIRAZ JAVA SCREW 6381 FBSF4TS01TJA TITANIUM SPINAL PEDICLE SCREW( 免事前審查 ) 3114 FBSF4TS02TSJ TITANIUM SHIRAZ JAVA SCREW( 免事前審查 ) 3114 FBSF4UP04NXA TITANIUM SPINAL SCREW 6381 FBSF4X380NS9 XIA TITANIUM SPINAL SCREW( 型號 03820425:860,03821425:760 自 92/4/1 生效 ) 6381 FBSF4YP04NXA Y TYPE POSTERIOR TITANIUM SPINAL PEDICLE SCREW( 免事前審查 ) 3114 258

特材代碼中英文品名支付點數 FBSF500005ZV VIMAX SPINAL TRANSVERSE LINK 7208 FBSF500015ZV VIM SPINAL TRANSVERSE LINK 7208 FBSF500025ZV VIMAX SPINAL LINK 免事前審查 3331 FBSF50055TJA TITANIUM SPINAL TRANSVERSE CONNECTOR 7208 FBSF50055TSJ TITANIUM SHIRAZ JAVA TRANSVERSE CONNECTOR 7208 FBSF5010TNZ6 TITANIUM SPINAL TRANSVERSE LINK 7208 FBSF50380NS9 XIA SPINAL SYSTEM:CROSS LINK ( 免事前審查 ) 3331 FBSF50382NS9 XIA TITANIUM CROSS CONNECTOR 7208 FBSF50565NDP M-M TITANIUM TRANSVERSE CONNECTOR 7208 FBSF5080TMDA TITANIUM TSRH SPINAL CROSSLINK PLATE 7208 FBSF510001TT TITANIUM SPINAL TRANSVERSE LINK( 免事前審查 ) 3331 FBSF5170XNTD TITANIUM TREND TRANSVERSE LINK 7208 FBSF518010B0 TITANIUM TRANSVERSE LINK 7208 FBSF518012B0 TITANIUM TRANSVERSE LINK( 免事前審查 ) 3331 FBSF52230TDP TITANIUM ISOLA TRANSVERSE ROD CONNECTOR 7208 FBSF53210NAD TITANIUM KANEDA SR ANTERIOR TRANSVERSE SMOOTH ROD COUPLERS 7208 FBSF53210NDP KANEDA SR-ANTERIOR TITANIUM SPINAL LINK 3331 FBSF54107NS9 MAC TATINIUM TRANSVERSE LINK 7208 FBSF548149S9 XIA 4.5 TITANIUM SPINAL CROSSLINK 7208 FBSF54981NS1 TITANIUM UNIVERSAL SPINAL CROSS LINK, 頇事前審查 7208 FBSF56452NDX TITANIUM DIAPASON TRANSVERSE LINK(730000+720040:100 自 86/11/17 生效 ) 7208 FBSF57200NS9 TITANIUM TRANSVERSE LINKS( 免事審查 ) 3331 FBSF57301NZ1 SILHOUETTE SPINAL FIXATION SYSTEM-TRANSVERSE CONNECTOR( 免術前申請 ) 3331 FBSF57310NZ1 SILHOUETTE SPINAL FIXATION SYSTEM-TRANSVERSE CONNECTOR 7208 FBSF57651NY2 TITANIUM SPINAL CROSS-LINK 7208 FBSF577003Y2 TITANIUM SPINAL TRANSVERSE LINK( 免術前審查 ) 3331 259

FBSF5811XNDA TATINIUM TSRH LOW PROFILE CROSSLINK PLATE 7208 FBSF5821NHY2 BRIDGE TRANSVERSE LINK 免事前審查 3331 FBSF5A3C1NXA A3 POSTERIOR TITANIUM SPINAL CROSSLINK HOOK 7208 FBSF5AS001AQ TITANIUM SPINAL LINK 免術前審查 3331 FBSF5ASLL1AQ TITANIUM SPINAL LINK 7208 FBSF5ASNL1AQ TITANIUM SMARTLOC TRANSVERSE LINK 免事前審前 3331 FBSF5ASYL1AQ TITANIUM SMARTLOC TRANSVERSE LINK 7208 FBSF5B0001RK TITANIUM SPINAL LINK 免事前審查 3331 FBSF5BA001RK TITANIUM SPINAL TRANSVERSE LINK 7208 FBSF5C111NXA TITANIUM SPINAL CROSS LINK 7208 FBSF5CY11NXA Y TYPE POSTERIOR TITANIUM SPINAL LINK( 免事前審查 ) 3331 FBSF5DTT4TDA TITANIUM CD HORIZON SPINAL D.T.T#4( 橫向固定桿 ) 7208 FBSF5GS51NG0 GSS TITANIUM SPINAL TRANSVERSE LINK 7208 FBSF5L8414M4 TITANIUM CD DTT #4 TRANSVERSE LINK( 免術前審查 ) 3331 FBSF5M2TKNZ6 TITANIUM SPINAL TRANSVERSE LINK 3331 FBSF5M3SLKZ6 TITANIUM M3 SPINAL POSTERIOR TRANSVERSE LINK 7208 FBSF5P2CLKZ6 PROT II POSTERIOR SPINE CROSS LINK 7208 FBSF5P2CNTZ6 PROT II POSTERIOR SPINE ROD CONNECTOR 7208 FBSF5P2TLKZ6 PROT II POSTERIOR SPINE TRANSVERSE LINK 7208 FBSF5R382NS9 XIA REDUCTION CROSS LINK 7208 FBSF5RF001RX RF SPINAL LINK( 免事前審查 ) 3331 FBSF5S500NS9 SR90D RODDING SYSTEM CROSS LINK 7208 FBSF5SW69NAE TITANIUM S4 SPINE SYSTEM:CROSS CONNECTOR 7208 FBSF5SX17NAE TITANIUM SPINE CROSSLINK (96 年 10 月 1 日起免事前審查 ) 3331 FBSF5TS55TJA TITANIUM SPINAL TRANSVERSE CONNECTOR( 免事前審查 ) 3331 FBSF5X380NS9 XIA TITANIUM SPINAL CROSS LINK 7208 260

特材代碼中英文品名支付點數 FBSF610001TT TITANIUM CERVICAL PLATE( 免術前審查 ) 4046 FBSF610002TT TITANIUM CERVICAL SCREW( 免術前審查 ) 194 FBSF62225NDP TITANIUM VSP PLATE 1089 FBSF661202Y2 STAINLESS CERVICAL PLATE 28:72CM 3747 FBSF661302Y2 TITANIUM CERVICAL PLATE 28:72MM 4046 FBSF66131NY2 TITANIUM CERVICAL SCREW 17:24MM 194 FBSF6613NNY2 TITANIUM DYNAMIC CERVICAL FIXATION SYSTEM 194 FBSF6CPU16XA TITANIUM CERVICAL PLATE ( 免術前審查 ) 4046 FBSF6CPU20XA TITANIUM CERVICAL PLATE ( 免術前審查 ) 4046 FBSF6CSA35XA TITANIUM CERVICAL SCREW ( 免術前審查 ) 194 FBSF6CSB35XA TITANIUM CERVICAL SCREW ( 免術前審查 ) 194 FBSF6FF930AE STANLESS CASPAR OSTEOSYNTH CERVICAL PLATE 28:33MM LONG 3747 FBSF6FF934AE STANLESS CASPAR OSTEOSYNTH CERVICAL PLATE 37:46MM LONG 4098 FBSF6FF939AE STANLESS CASPAR OSTEOSYNTH.CERVICAL PLATE.48:54MM LONG 4273 FBSF6FF944AE STANLESS CASPAR OSTEOSYNTH CERVICAL PLATE 60MM LONG 4536 FBSF6FF946AE STANLESS CASPAR OSTEOSYNTH CERVICAL PLATE 66MM LONG 5128 FBSF6FF947AE STANLESS CASPAR OSTEOSYNTH CERVICAL PLATE 72MM LONG 5763 FBSF700027ZV VIMAX SPINAL HOOK SCREW SYSTEM(SX2+HX2+RX2) 免事前審查 23306 FBSF7295NNS1 STANLESS STEEL HOOK SCREW SYSTEM(SCREWX2+HOOKX2+NUTX4+SPRINGX2) 21604 FBSF7804NHY2 BRIDGE SPINAL HOOK SCREW SYSTEM(HX2+SX4+NX2) 免事前審查 23306 FBSF7SX25NAE TITANIUM SPINE EVOLUTION HOOK SYSTEM(SCREWX2+HOOKX2+NUTX2) 23306 FBSF8T1SFWCM TITANIUM CABLE SOFWIRE( 後頸椎固定軟鋼絲索 ) 8000 FBSFA00001RK TITANIUM INTERVERTEBRAL CAGE 椎間融合器 17550 FBSFA2740LB0 TITANIUM LUMBAR SPINAL CAGE 腰椎椎間融合器 17550 FBSFA6720NS9 TITANIUM OIC CAGE SYSTEM 9:13MMX20:25MM 17550 FBSFA706NNY2 TITANIUM VETEBRAL INTERBODY CAGE 高 9:14MM 長 20:24 17550 261

FBSFA7091NY2 TITANIUM VETEBRAE INTERBODY CAGE 9:14MMX20:24MM 17550 FBSFA7092NY2 TITANIUM VETEBRAE INTERBODY CAGE 9:14MMX20:24MM 17550 FBSFA908MNM4 TELAMON FUSION DEVICE 17550 FBSFA9501NS1 TITANIUM CONTACT FUSION CAGE 9:15MM X8:11MM 17550 FBSFAALS01AQ TITANIUM LUMBAR DISC SPACER 17550 FBSFAALS01TT TITANIUM LUMBAR DISC SPACER 17550 FBSFACA11NXA TITANIUM VERTEBRAL FUSION CAGE 20:24MMX8:15MM 17550 FBSFACG15NZ6 TITANIUM SPINAL SPACER 5:11MMX7:13MM 17550 FBSFAFJ00NAE TSPACE PEEK TLIF SYSTEM 樹脂椎間盤支撐架植入物 ( 側開型, 每節椎體置放 1 個 ) 50000 FBSFALCAGEZV GOALIE LUMBAR INTERVERTEBRAL CAGE 17550 FBSFC0912NS9 ALPHA CERVICAL SCREW 1125 FBSFC10030AD TITANIUM PEAK ANTERIOR CERVICAL SCREW( 型號含 1749-02019:13026) 1125 FBSFC10108AD TITANIUM SLIM-LOC ANTERIOR CERVICAL SCREW 1125 FBSFC1742SDP TITANIUM PEAK ANTERIOR CERVICAL PLATE 二節 22426 FBSFC1743SDP TITANIUM PEAK ANTERIOR CERVICAL PLATE 三節 23285 FBSFC1792SDP TITANIUM SLIM-LOC ANTERIOR CERVICAL PLATE 二節 22426 FBSFC1793SDP TITANIUM SLIM-LOC ANTERIOR CERVICAL PLATE 三節 23285 FBSFC2485NS9 REFLEX HYBRID ANTERIOR CERVICAL PLATE SYSTEM(PX1+SX4) 二節芮菲斯前置頸椎固定系統 22426 FBSFC2486NS9 TI REFLEX ANTERIOR CERVICAL PLATE SYSTEM 二節 ( 型號 48624010:522 自 92/4/1 生效 ) 22426 FBSFC27551B0 TITANIUM CERVICAL SPINAL SYSTEM(PX1+SX4) 22426 FBSFC27552B0 TITANIUM CERVICAL SPINAL SYSTEM(HOOKX4+RODX2) 22426 FBSFC27553B0 TITANIUM CERVICAL SPINAL SYSTEM(PX1+SX6) 23285 FBSFC27555B0 TITANIUM CERVICAL SCREW 1125 FBSFC27556B0 TITANIUM CERVICAL PLATE 24:90MM( 免術前審查 ) 4046 FBSFC27557B0 TITANIUM CERVICAL SCREW( 免術前審查 ) 194 FBSFC3400NZ1 TRINICA AND TRINICA SELECT ANTERIOR CERVICAL PLATE SYSTEM 二節 (PX1+SX4) 22426 262

FBSFC3401NZ1 TRINICA AND TRINICA SELECT ANTERIOR CERVICAL PLATE SYSTEM 三節 (PX1+SX6) 23285 FBSFC3485NS9 REFLEX HYBRID ANTERIOR CERVICAL PLATE SYSTEM(PX1+SX6) 三節芮菲斯前置頸椎固定系統 23285 FBSFC3486NS9 TI REFLEX ANTERIOR CERVICAL PLATE SYSTEM 三節 ( 型號 48624010:522 自 92/4/1 生效 ) 23285 FBSFC4010NS9 REFLEX ANTERIOR CERVICAL SCREW 1125 FBSFC4020NS9 REFLEX HYBRID ANTERIOR CERVICAL SCREW 芮菲斯前置頸椎骨釘 1125 FBSFC450XNS1 CERVICAL SPINE SOLID EXPANSION HEAD SCREW 4.0/4.35MM 擴張頭實心骨釘 1125 FBSFC4871NS1 TITANIUM CERVICAL SPINE LOCKING PLATE SYSTEM 二節 22426 FBSFC487XNS1 TITANIUM CERVICAL SPINE LOCKING PLATE SYSTEM 三節 23285 FBSFC6113NY2 TITANIUM CERVICAL SPINE SCREW 1125 FBSFC8792NM4 ZEPHIR ANTERIOR CERVICAL SCREW 1125 FBSFC879N2M4 ZEPHIR ANTERIOR CERVICAL SYSTEM 二節 (SX4+PX1) 22426 FBSFC879N3M4 ZEPHIR ANTERIOR CERVICAL SYSTEM 三節 (SX6+PX1) 23285 FBSFCASC01AQ TITANIUM CERVICAL PLATE SYSTEM 二節 (PX1+SX4) 22426 FBSFCASC02AQ TITANIUM CERVICAL PLATE SYSTEM 三節 (PX1+SX6) 23285 FBSFCASCS1AQ TITANIUM CERVICAL SCREW 1125 FBSFCASP01AQ TITANIUM CERVICAL PLATE ( 免事前審查 ) 4046 FBSFCASS02AQ TITANIUM CERVICAL SCREW( 免事前審查 ) 194 FBSFCBA001RK TITANIUM CERVICAL PLATE SYSTEM (PX1+SX4) 二節 22426 FBSFCBA002RK TITANIUM CERVICAL PLATE SYSTEM (PX1+SX6) 三節 23285 FBSFCCPCN2XA TITANIUM CERVICAL PLATE SYSTEM(PX1+SX4) 二節 22426 FBSFCCPCN3XA TITANIUM CERVICAL PLATE SYSTEM(PX1+SX6) 三節 23285 FBSFCCSC35XA TITANIUM CERVICAL SCREW 1125 FBSFCCSD35XA TITANIUM CERVICAL SCREW 1125 FBSFCCSF12Y2 TITANIUM CERVICAL SPINE FIXATION SYSTEM 二節 (PX1+SX4) 22426 FBSFCCSF13Y2 TITANIUM CERVICAL SPINEFIXATION SYSTEM 三節 (PX1+SX6) 23285 FBSFCFG2XNAE TITANIUM CASPAR CERVICAL SYSTEM 二節 (PLATEX1+SCREWX4), 頇事前審查 22426 263

FBSFCFG3XNAE TITANIUM CASPAR CERVICAL SYSTEM 三節 (PLATEX1+SCREWX6), 頇事前審查 23285 FBSFCFG4XNAE CASPAR EVOLUTION CERVICAL SYSTEM( 型號含 LA017T:028T) 二節 (PLATEX1+SCREWX4) 22426 FBSFCFG4XXAE CASPAR EVOLUTION CERVICAL SYSTEM ANTERIOR( 型號含 LA017T:028T) 三節 (PX1+SX6) 23285 FBSFCFJ700AE TITANIUM ABC ANTERIOR CERVICAL PLATING SYSTEM(PX1+SX4) 22426 FBSFCFJ790AE ABC TITANIUM CERVICAL SCREW 1125 FBSFCFJ800AE TITANIUM ABC ANTERIOR CERVICAL PLATING SYSTEM(PX1+SX6) 23285 FBT01020MLHE SUPLASYN STERILE SODIUM HYALURONATE SOLUTION(2ML/ 瓶裝 ) 每次療程注射三次 1095 FBT01020MSHE SUPLASYN STERILE SODIUM HYALURONATE SOLUTION(2ML/ 注射筒裝 ) 每次療程注射三次 1099 FBT01025MLH8 HIKAMILON DISPO 1% 2.5ML/SYRINGE 25MG 關節內注射劑 ( 每次療程注射五次 ) 659 FBT01025MLN0 "NISSIN"LUMISTERON DISPO (2.5ML/SYRINGE)" 日新 " 倍利骨關節腔注射劑 ( 每次療程注射五次 ) 659 FBT01025MLR7 ARTZ/ARTZDISPO 雅節關節內注射劑 ( 每次療程注射五次 ) 659 FBT01025MLU5 UNIHYLON DISPO 2.5ML W/SYRINGE( 每次療程注射五次 ) 659 FBT01AA25CLB ARTIAID INTRA-ARTICULAR INJECTION( 每次療程注射 5 次 ) 659 FBT01HJ001V0 HYA-JOINT SYNOVIAL FLUID SUPPLEMENT(2.5ML/ 支 ) 每次療程注射三次 1099 FBT01HY001FD HYALGAN INTRA-ARTICULAR INJECTOR W/SYRINGE( 自 97 年 4 月 1 日起改每次療程注射 3 次 ) 1099 FBT01HY002FD HYALGAN INTRA-ARTICULAR INJECTOR WITHOUT/SYRINGE( 自 97 年 4 月 1 日起改每次療程注射 3 次 ) 1095 FBT01N25MLR7 ARTZ/ARTZDISPO 2.5ML 25MG WITHOUT SYRINGE( 每次療程注射五次 ) 655 FBTCM1102NU0 CUSTOMER MADE TIBIAL TUMOR PROSTHESIS, 申報費用應檢附發票備查 160000 FBW0106321M1 KIRSCHNER WIRE (K-PIN) 1.0:1.2MM 300MM 80 FBW0106324M1 KIRSCHNER WIRE (K-PIN) 1.5:1.8MM 300MM 80 FBW0106325M1 KIRSCHNER WIRE (K-PIN) 2.0MM 300MM 80 FBW0106326M1 KIRSCHNER WIRE (K-PIN) 2.4MM 300MM 80 FBW0106327M1 KIRSCHNER WIRE (K-PIN) 3.0MM 300MM 80 FBW011610NSN K-WIRE 0.6:1.6MM,2.0MM 80 FBW012900NY2 KIRSCHNER WIRES(SHANK)0.7MM,0.9MM,1.1MM,1.6MM *4"(101.6MM) 80 FBW0129101Y2 KIRSCHNER WIRE 80 264

FBW012910NY2 KIRSCHNER WIRES(SHANK)0.7MM,0.9MM,1.1MM,1.6MM *9"(230MM) 80 FBW012911NY2 KIRSCHNER WIRES(SHANK)0.7MM,0.9MM,1.1MM,1.6MM *12"(300MM) 80 FBW012915NY2 KIRSCHNER WIRES(THREADED)0.9MM,1.1MM,1.6MM *9"(230MM) 305 FBW0129200V2 K-PIN,GUIDEWIRE WITH THREAD 305 FBW012926NY2 KIRSCHNER WIRE W/THREADED 305 FBW012927NS1 K-PIN,GUIDEWIRE WITH THREAD 305 FBW01292NNS1 KIRSCHNER WIRE (K-PIN)1.25MM 80 FBW01294XNY2 KIRSCHNER WIRE WITH THREADED TIP 305 FBW01LX08NAE K-WIRE 0.8MM,1.0MMX310MM 80 FBW01LX08SAE KIRSCHNER WIRE (K-PIN)0.8MMx150MM 80 FBW01LX105AE K-WIRE 2.5MMx70MM 80 FBW01LX10SAE KIRSCHNER WIRE (K-PIN)1.0MMx150MM 80 FBW01LX12NAE K-WIRE 310MM,1.2:1.7MM 80 FBW01LX12SAE KIRSCHNER WIRE (K-PIN)1.2MMx150MM 80 FBW01LX14SAE KIRSCHNER WIRE (K-PIN)1.4MMx150MM 80 FBW01LX15SAE KIRSCHNER WIRE (K-PIN)1.5MMx150MM 80 FBW01LX16SAE KIRSCHNER WIRE (K-PIN)1.6MMx150MM 80 FBW01LX17SAE K-WIRE 150MM 1.7MM 80 FBW01LX18NAE K-WIRE 310MM,1.8MM 80 FBW01LX18SAE KIRSCHNER WIRE (K-PIN)1.8MMx150MM 80 FBW01LX20NAE K-WIRE 310MM,2.0MM 80 FBW01LX20SAE KIRSCHNER WIRE (K-PIN)2.0MMx150MM 80 FBW01LX22NAE K-WIRE 310MM,2.2MM 80 FBW01LX22SAE KIRSCHNER WIRE (K-PIN)2.2MMx150MM 80 FBW01LX25NAE K-WIRE 310MM,2.5MM 80 FBW01LX25SAE KIRSCHNER WIRE (K-PIN)2.5MMx150MM 80 265

特材代碼中英文品名支付點數 FBW01LX28SAE KIRSCHNER WIRE (K-PIN)0.8MMx150MM 80 FBW01LX30NAE K-WIRE 210MM,1.0MM 80 FBW01LX30SAE KIRSCHNER WIRE (K-PIN)1.0MMx150MM 80 FBW01LX32NAE K-WIRE 310MM,1.2:1.6MM 80 FBW01LX32SAE KIRSCHNER WIRE (K-PIN)1.2MMx150MM 80 FBW01LX34SAE KIRSCHNER WIRE (K-PIN)1.4MMx150MM 80 FBW01LX35SAE KIRSCHNER WIRE (K-PIN)1.5MMx150MM 80 FBW01LX36SAE KIRSCHNER WIRE (K-PIN)1.6MMx150MM 80 FBW01LX37SAE KIRSCHNER WIRE 1.7MMx150MM 80 FBW01LX38NAE K-WIRE 310MM,1.8MM 80 FBW01LX38SAE KIRSCHNER WIRE (K-PIN)1.8MMx150MM 80 FBW01LX40NAE K-WIRE 310MM,2.0MM 80 FBW01LX40SAE KIRSCHNER WIRE (K-PIN)2.0MMx150MM 80 FBW01LX42NAE K-WIRE 310MM,2.2MM 80 FBW01LX42SAE KIRSCHNER WIRE (K-PIN)2.2MMx150MM 80 FBW01LX45NAE K-WIRE 310MM,2.5MM 80 FBW01LX45SAE KIRSCHNER WIRE (K-PIN)2.5MMx150MM 80 FBW01LX46SAE KIRSCHNER WIRE (K-PIN)3.0MMx150MM 80 FBW01LX47SAE KIRSCHNER WIRE 雅式鋼針 80 FBW01LX90NAE KIRSCHNER WIRE 雅式鋼針 80 FBW01LX915AE KIRSCHNER WIRE 雅式鋼針 80 FBW01LX91NAE KIRSCHNER WIRE 雅式鋼針 80 FBW01LX925AE KIRSCHNER WIRE 雅式鋼針 80 FBW01LX92NAE KIRSCHNER WIRE 雅式鋼針 80 FBW01LX955AE KIRSCHNER WIRE 雅式鋼針 80 FBW01LX95NAE KIRSCHNER WIRE 雅式鋼針 80 266

特材代碼中英文品名支付點數 FBW01LX98SAE K-WIRE 0.8MM,1.0MMX70MM 80 FBW03C018NM1 KIRSCHNER WIRE( 田島 PIN) 0.7:1.5MM 100:120MM 80 FEP0356324XT FISCH TEF-WIRE PISTON 1365 FEP0456210XT MCGEE MODIFIED LOOP PISTON 1250 FEP0456211XT MCGEE MODIFIED LOOP PISTON 1250 FEP0456212XT MCGEE MODIFIED LOOP PISTON 1250 FES0256362XT AUSTIN MODIFIED PARTIAL OSSICULAR REPLACEMENT 3500 FES0256363XT AUSTIN MODIFIED PARTIAL OSSICULAR REPLACEMENT 3500 FES0270141GS MICRON ALL TITANIUM PORP 全鈦部分人工聽小骨置換物 3500 FHG110304NGX STRAIGHT VASCULAR PROSTHESIS 3MM,4MM,5MM,6MM,7MM,8MM,10MM 40CM 11560 FHG110307NGX STRAIGHT VASCULAR PROSTHESIS 3MM,4MM,5MM,6MM,7MM,8MM,10MM 70CM 16800 FHG1104010MP STRAIGHT GRAFT 4MM 10CM 3440 FHG110401CMP CARBOFLO GRAFT,STRAIGHT,10CM 卡邦人工血管 3440 FHG1104040MP STRAIGHT GRAFT 4MM 40CM 11560 FHG110404CMP CARBOFLO GRAFT,STRAIGHT,40CM 卡邦人工血管 11560 FHG110405CMP CARBOFLO GRAFT,STRAIGHT,50CM 卡邦人工血管 13600 FHG110503NGX GORE-TEX VASCULAR GRAFTS 5MM,6MM,8MMX30CM 9180 FHG1105040MP STRAIGHT GRAFT 5MM 40CM 11560 FHG1106020MP STRAIGHT GRAFT 6,8MM 20CM 6500 FHG1106020QM FHG1106020SB " 邁柯唯 " 人工血管 "MAQUET"EXXCEL SOFT EPTFE VASCULAR GRAFT(STANDARD WALL STRAIGHT4-8MM*20CM) EXXCEL SOFT EPTFE VASCULAR STANDARD WALL GRAFT 4,6,8MMX20CM 型號 381026,28 自 92.10.1 生效 6500 6500 FHG110602CMP CARBOFLO GRAFT,STRAIGHT,20CM 卡邦人工血管 6500 FHG110603CMP CARBOFLO GRAFT,STRAIGHT,30CM 卡邦人工血管 9180 FHG1106040MP STRAIGHT GRAFT 6MM 40CM 11560 FHG1106040QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 4-6MM*40CM 11560 FHG1106040SB EXXCEL SOFT EPTFE VASCULAR STANDARD WALL GRAFT 4:8MMX40CM 型號 381046,47,48 自 92.10.1 生效 11560 267

FHG1106050AH STRAIGHT GRATF STANDARD WALL 6MM,7MM,8MM 50CM 13600 FHG1106050MP STRAIGHT GRAFT 6MM 50CM 13600 FHG1106050QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 6MM*50CM 13600 FHG1106050SB EXXCEL SOFT EPTFE VASCULAR STANDARD WALL GRAFT 4:8MMX50CM 型號 381056,57,58 自 92.10.1 生效 13600 FHG1106060QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL STRAIGHT 6MM*60CM 15300 FHG1106060SB EXXCEL SOFT EPTFE VASCULAR STANDARD WALL GRAFT 6MMX60CM 型號 381066 自 92.10.1 生效 15300 FHG1106070MP STRAIGHT GRAFT 6MM 70CM 16800 FHG1106070QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL STRAIGHT 4-8MM*70CM FHG1106070SB EXXCEL SOFT EPTFE VASCULAR STANDARD WALL GRAFT 4:8MMX70CM 型號 381076,77,78 自 92.10.1 生效 16800 16800 FHG110607CMP CARBOFLO GRAFT,STRAIGHT,70CM 卡邦人工血管 16800 FHG1106080QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL STRAIGHT 4-8MM*80CM FHG1106080SB EXXCEL SOFT EPTFE VASCULAR STANDARD WALL GRAFT 4,5,6,8MMX80CM 型號 381086,88 自 92.10.1 生效 18080 18080 FHG110608CMP CARBOFLO GRAFT,STRAIGHT,80CM 卡邦人工血管 18080 FHG1106090SB EXXCEL SOFT EPTFE VASCULAR STANDARD WALL GRAFT 6MMX90CM 19080 FHG1106S10TM FHG1106S20TM FHG1106S30TM FHG1106S40TM FHG1106S50TM FHG1106S60TM FHG1106S70TM FHG1106S80TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES STRAIGHT GRAFT 10CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES STRAIGHT GRAFT 20CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES STRAIGHT GRAFT 30CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES STRAIGHT GRAFT 40CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES STRAIGHT GRAFT 50CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES STRAIGHT GRAFT 60CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES STRAIGHT GRAFT 70CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES STRAIGHT GRAFT 80CM*6,7,8,10MM 3440 6500 9180 11560 13600 15300 16800 18080 FHG1107040MP STRAIGHT GRAFT 7MM 40CM 11560 FHG1116040QM " 邁柯唯 " 人工血管 "MAQUET" EXXCEL SOFT EPTFE VASCULAR GRAFT 5-8MM*40CM 11560 FHG1116050QM FHG1121000AH " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL STRAIGHT 5-8MM*50CM " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS STANDARD WALL-STRAIGHT,6MM 10CM 13600 3440 268

FHG1121012AH " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS STANDARD 11560 WALL-STRAIGHT,6MM 8MM 40CM FHG1130S06BA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(STRAIGHT 6MM*30CM) 9180 FHG1140S08BA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(STRAIGHT 3.5,8,10MM*40CM) 11560 FHG11D5008BA " 巴德 " 迪斯塔人工血管 "BARD"DISTAFLO BYPASS GRAFTS 50CM 13600 FHG11D500CBA " 巴德 " 迪斯塔人工血管 "BARD" DISTAFLO BYPASS GRAFTS 13600 FHG11D6008BA " 巴德 " 迪斯塔人工血管 "BARD"DISTAFLO BYPASS GRAFTS 60CM 15300 FHG11D600CBA " 巴德 " 迪斯塔人工血管 "BARD" DISTAFLO BYPASS GRAFTS 60CM 15300 FHG11D7008BA " 巴德 " 迪斯塔人工血管 "BARD"DISTAFLO BYPASS GRAFTS 70CM 16800 FHG11D700CBA " 巴德 " 迪斯塔人工血管 "BARD" DISTAFLO BYPASS GRAFTS 70CM 16800 FHG11D8008BA " 巴德 " 迪斯塔人工血管 "BARD"DISTAFLO BYPASS GRAFTS 80CM 18080 FHG11D800CBA " 巴德 " 迪斯塔人工血管 "BARD" DISTAFLO BYPASS GRAFTS 80CM 18080 FHG11V106CMP VENAFLO GRAFT,STRAIGHT,10CM 維那人工血管 3440 FHG11V206CMP VENAFLO GRAFT,STRAIGHT,20CM 維那人工血管 6500 FHG11V306CMP VENAFLO GRAFT,STRAIGHT,30CM 維那人工血管 9180 FHG11V406CMP VENAFLO GRAFT,STRAIGHT,40CM 維那人工血管 11560 FHG11V506CMP VENAFLO GRAFT,STRAIGHT,50CM 維那人工血管 13600 FHG11VL100MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS-STRAIGHT GRAFT(6,7MM,10CM) 維那人工血管直式 3440 FHG11VL200MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS-STRAIGHT GRAFT(6,7MM,20CM) 維那人工血管直式 6500 FHG11VL300MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS-STRAIGHT GRAFT(6,7MM,30CM) 維那人工血管直式 9180 FHG11VL400MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS-STRAIGHT GRAFT(6,7MM,40CM) 維那人工血管直式 11560 FHG11VL500MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS-STRAIGHT GRAFT(6,7MM,50CM) 維那人工血管直式 13600 FHG120304NGX THIN WALLED VASCULAR GRAFT 3MM,4MM,5MM,6MM,7MM,8MM,10MM 40CM 11560 FHG120307NGX THIN WALLED VASCULAR GRAFT 3MM,4MM,5MM,6MM,7MM,8MM,10MM 70CM 16800 FHG120401TMP CARBOFLO GRAFT,STRAIGHT THINWALL,10CM 卡邦人工血管 3440 FHG120405TMP CARBOFLO GRAFT,STRAIGHT THINWALL,50CM 卡邦人工血管 13600 FHG120407TMP CARBOFLO GRAFT,STRAIGHT THINWALL,70CM 卡邦人工血管 16800 269

FHG120508TMP CARBOFLO GRAFT,STRAIGHT THINWALL,80CM 卡邦人工血管 18080 FHG1206020QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT 6-8MM*20CM 6500 FHG1206020SB EXXCEL SOFT EPTFE VASCULAR THIN WALL GRAFT 6,8MMX20CM 型號 391026,28 自 92.10.1 生效 6500 FHG120602TMP CARBOFLO GRAFT,STRAIGHT THINWALL,20CM 卡邦人工血管 6500 FHG120603TMP CARBOFLO GRAFT,STRAIGHT THINWALL,30CM 卡邦人工血管 9180 FHG1206040QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT 6-10MM*40CM 11560 FHG1206040SB EXXCEL SOFT EPTFE VASCULAR THIN WALL GRAFT 6,8,10MMX40CM 型號 391046,48,41 自 92.10.1 生效 11560 FHG120604TMP CARBOFLO GRAFT,STRAIGHT THINWALL,40CM 卡邦人工血管 11560 FHG1206050QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT 6-10MM*50CM 13600 FHG1206050SB EXXCEL SOFT EPTFE VASCULAR THIN WALL GRAFT 6,8,10MMX50CM 型號 391056,51 自 92.10.1 生效 13600 FHG1206060QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT 6MM*60CM 15300 FHG1206060SB EXXCEL SOFT EPTFE VASCULAR THIN WALL GRAFT 6MMX60CM 型號 391066 自 92.10.1 生效 15300 FHG1206070QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT 5-10MM*70CM 16800 FHG1206070SB EXXCEL SOFT EPTFE VASCULAR THIN WALL GRAFT 4,5,6,7,8,10MMX70CM 16800 FHG1206075TM FHG1206076TM "TERUMO"GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELSOFT PLUS EXTERNALLY REINFORCED STRAIGHT GRAFTS6:10MM 75CM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELSEAL EXTERNALLY REINFORCEED STRAIGHT 6:10MM 75CM FHG1206080QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT 5-10MM*80CM) FHG1206080SB EXXCEL SOFT EPTFE VASCULAR THIN WALL GRAFT 4,5,6,7,8,10MMX80CM 型號 391086:88,81 自 92.10.1 生效 19600 19600 18080 18080 FHG1206090SB EXXCEL SOFT EPTFE VASCULAR THIN WALL GRAFT 6MMX90CM 19080 FHG1221185AH " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS THIN WALL- STRAIGHT,6MM 7MM 8MM *70CM 16800 FHG1230STWBA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(STRAIGHT THINWALL 6MM*30CM) 9180 FHG1240STWBA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(STRAIGHT THINWALL 3,6,8MM*40CM) 11560 FHG12F0470MP P.T.F.E FLEX GRAFT 4:10MM 70CM 24000 FHG12F0650MP FLEX GRAFT 6:10MM 50CM 19250 FHG12F0660MP FLEX GRAFT 6:10MM 60CM 21840 FHG12F0680MP FLEX GRAFT 6:10MM 80CM 25760 270

FHG130504NGX STANDARD STREATCH GRAFT 5MM,6MM,7MM,8MM,10MM 40CM 12840 FHG130507NGX STANDARD STRETCH GRAFT 5MM,6MM,7MM,8MM 70CM 18620 FHG1321010AH FHG1321015AH FHG1321024AH FHG1321179AH FHG1406070QM " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS(STANDARD 4MM,6-8MM,40CM) " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS(STANDARD 4-8MM;10MM*50CM) " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS(STANDARD 4:8MM,10MM 70CM) " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS(STANDARD 6MM*60CM) " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL STRAIGHT EXTERNALLY SUPPORTED 6-8MM*70CM*20-50CM 11560 13600 16800 15300 21700 FHG1406070SB EXXCEL SOFT EPTFE GRAFT STRAIGHT EXTERNALLY SUPPORTED 6MM,8MM/70CM/20-50CM 21700 FHG1406080QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL STRAIGHT EXTERNALLY SUPPORTED 6-8MM*80CM*20-50CM 23280 FHG1406080SB EXXCEL SOFT EPTFE GRAFT STRAIGHT EXTERNALLY SUPPORTED 6MM,8MM/80CM/20-50CM 23280 FHG140623NGX " 戈爾 " 戈爾特賜內植人工血管 "GORE" GORE-TEX VASCULAR GRAFTS 6MM,8MMX(20CM 環 )X30CM 11850 FHG140624NGX " 戈爾 " 戈爾特賜內植人工血管 "GORE" GORE-TEX VASCULAR GRAFTS 6MM,8MMX(20CM 環 )X40CM 14920 FHG1406545GX RINGED GRAFT 5CM 6MM 45CM 14920 FHG140657NGX RINGED GRAFT 50CM 6MM,8MM 70CM 21700 FHG140677NGX " 戈爾 " 戈爾特賜內植人工血管 "GORE" GORE-TEX VASCULAR GRAFTS 6MM,8MM,10MMX(70CM 環 )X70CM 21700 FHG1406C40QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 6MM*45CM 14920 FHG1406C40SB EXXCEL SOFT EPTFE GRAFT STRAIGHT CENTRALLY SUPPORTED 6MM/40CM,45CM/5CM 14920 FHG1406C50QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL STRAIGHT CENTRALLY SUPPORTED 6MM*50CM*5CM 17550 FHG1406C50SB EXXCEL SOFT EPTFE GRAFT STRAIGHT CENTRALLY SUPPORTED 6MM/50CM/5CM 17550 FHG1408030QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL STRAIGHT EXTERNALLY SUPPORTED 8MM*30CM*12CM 11850 FHG1408030SB EXXCEL SOFT EPTFE GRAFT STRAIGHT EXTERNALLY SUPPORTED 8MM/30CM/12CM 11850 FHG1410330GX " 戈爾 " 戈爾特賜內植人工血管 "GORE" GORE-TEX VASCULAR GRAFTS 10MMX(30CM 環 )X30CM 11850 FHG1416C40QM FHG1421092AH FHG1506040QM FHG1506040SB " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL STRAIGHT CENTRALLY SUPPORTED 6MM*40CM*5CM " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS STANDARD WALL-CENTER HELIX,6MM* 45CM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6-8MM*40CM*20-30CM EXXCEL SOFT EPTFE GRAFT THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6MM,8MM/40CM/20-30CM 14920 14920 14920 14920 271

FHG1506070QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 5MM*70CM 21700 FHG1506070SB FHG1506080QM FHG1506080SB FHG1506440QM EXXCEL SOFT EPTFE GRAFT THIN WALL STRAIGHT EXTERNALLY SUPPORTED 5MM,6MM,8MM/70CM/20-60CM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6-8MM*80CM*30-70CM EXXCEL SOFT EPTFE GRAFT THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6MM,8MM/80CM/30-60CM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6MM*40CM*40CM 21700 23280 23280 14920 FHG1506440SB EXXCEL SOFT EPTFE GRAFT THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6MM/40CM/40CM 14920 FHG1506550QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 6MM*50CM 19250 FHG1506550SB EXXCEL SOFT EPTFE VASCULAR THIN WALL GRAFT WITH EXTERNALLY RING SUPPORTED 6MM,10MMX50CM/RING50CM 19250 FHG150657NGX RINGED THIN WALLED GRAFT 50CM 6MM,8MM,10MM 70CM 21700 FHG1506660QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 6MM*60CM 21840 FHG1506660SB EXXCEL SOFT EPTFE GRAFT THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6MM/60CM/60CM 21840 FHG1506770QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 6-8MM*70CM 24000 FHG1506770SB EXXCEL SOFT EPTFE GRAFT THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6MM,8MM,10MM/70CM/70CM 24000 FHG1506880QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 8MM*80CM 25760 FHG1506880SB FHG1508030QM EXXCEL SOFT EPTFE GRAFT THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6MM,8MM/80CM/80CM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED 8MM*30CM*12CM 25760 11850 FHG1508030SB EXXCEL SOFT EPTFE GRAGT THIN WALL STRAIGHT EXTERNALLY SUPPORTED 8MM/30CM/12CM 11850 FHG1516070QM FHG1516550QM FHG1516880QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6-8MM*70CM*20-30CM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED 10MM*50CM*50CM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(THIN WALL STRAIGHT EXTERNALLY SUPPORTED 6MM*80CM*80CM 21700 19250 25760 FHG154515NGX RINGED THIN WALLED GRAFT 5CM 4MM,5MM 15CM 4440 FHG15F30TWBA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(FLEX THINWALL 6MM*30CM) 11850 FHG15F4007BA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(FLEX THINWALL 6,8MM*40CM) 14920 FHG15F408SBA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(FLEX SMALL BEADING 8MM*40CM) 14920 FHG160577NGX REMOVABLE RINGED THIN WALLED GRAFT 70CM 5MM,6MM,8MM 70CM 24000 FHG1606050AH HELIX SUPPORT STRAIGHT GRAFT STANDARD WALL 6MM,8MM 50CM( 型號 21664 自 90/10/01 生效 ) 19250 272

FHG1606080AH HELIX SUPPORT STRAIGHT GRAFT STANDARD WALL 6MM,8MM,10MM 80CM( 型號 21677,21678 自 25760 90/10/01 生效 ) FHG160623NGX REMOVABLE RINGED THIN WALLED GRAFT 20CM RS 30CM,6MM,8MM 11850 FHG160634NGX REMOVABLE RINGED THIN WALLED GRAFT 8MM 40CM 16360 FHG1606550QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL STRAIGHT EXTERNALLY SUPPORTED 6-8MM*50CM*50CM 19250 FHG1606550SB EXXCEL SOFT EPTFE GRAFT STRAIGHT EXTERNALLY SUPPORTED 6MM,8MM/50CM/50CM 19250 FHG1606660QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 5MM*70CM 21840 FHG1606660SB EXXCEL SOFT EPTFE GRAFT STRAIGHT EXTERNALLY SUPPORTED 6MM/60CM/60CM 21840 FHG1606670GX REMOVABLE RINGED THIN WALLED GRAFT 60CM 6MM 70CM 24000 FHG1606680GX REMOVABLE RINGED THIN WALLED GRAFT 60CM RS 80CM,6MM 25760 FHG1606770QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 6MM*70CM 24000 FHG1606770SB EXXCEL SOFT EPTFE GRAFT STRAIGHT EXTERNALLY SUPPORTED 6MM,8MM/70CM/70CM 24000 FHG1606880QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 6-8MM*80CM 25760 FHG1606880SB EXXCEL SOFT EPTFE GRAFT STRAIGHT EXTERNALLY SUPPORTED 6MM,8MM/80CM/80CM 25760 FHG1606C40TM FHG1606C50TM FHG1606E50TM FHG1606S10TM FHG1606S20TM FHG1606S30TM FHG1606S40TM FHG1606S50TM FHG1606S60TM FHG1606S70TM FHG1606S80TM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES CENTRAL SUPPORT STRAIGHT GRAFT 40CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES CENTRAL SUPPORT STRAIGHT GRAFT 50CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES END SUPPORT STRAIGHT GRAFT 50CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES FULL SUPPORT STRAIGHT GRAFT 10CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES FULL SUPPORT STRAIGHT GRAFT 20CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES FULL SUPPORT STRAIGHT GRAFT 30CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES FULL SUPPORT STRAIGHT GRAFT 40CM*6,7,8,10MM " 泰爾茂 " 緻密人工血管 "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES- PTFE FULL SUPPORT STRAIGHT GRAFT 50CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES FULL SUPPORT STRAIGHT GRAFT 60CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES FULL SUPPORT STRAIGHT GRAFT 70CM*6,7,8,10MM "TERUMO" SEALPTFE GELATIN SEALED EPTFE VASCULAR PROSTHESES FULL SUPPORT STRAIGHT GRAFT 80CM*6,7,8,10MM 14920 17550 17550 4440 8400 11850 14920 19250 21840 24000 25760 FHG1608780GX REMOVABLE RINGED THIN WALLED GRAFT 70CM RS 80CM,8MM 25760 FHG1621062AH " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS STANDARD WALL-HELIX SUPPORTED,6MM * 50CM 19250 273

FHG16CF604MP CARBOFLO GRAFT,CENTERFLEX,40CM 卡邦人工血管 14920 FHG16CF605MP CARBOFLO GRAFT,CENTERFLEX,50CM 卡邦人工血管 17550 FHG16CV604MP VENAFLO GRAFT,CENTERFLEX,40CM 維那人工血管 14920 FHG16CV605MP VENAFLO GRAFT,CENTERFLEX,50CM 維那人工血管 17550 FHG16CVL40MP FHG16CVL50MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS CENTERFLEX(6-7MM,40CM) 印帕維那人工血管中間螺旋式 IMPRA VENAFLO EPTFE VASCULAR GRAFTS CENTERFLEX(6MM,50CM) 印帕維那人工血管中間螺旋式 14920 17550 FHG16DF508BA " 巴德 " 迪斯塔人工血管 "BARD"DISTAFLO BYPASS GRAFTS WITH FLEX SMALL BEADING 50CM 19250 FHG16DF5SCBA " 巴德 " 迪斯塔人工血管 "BARD" DISTAFLO BYPASS GRAFTS WITH FLEX SMALL BEADING 50CM 19250 FHG16DF600BA " 巴德 " 迪斯塔人工血管 "BARD"DISTAFLO BYPASS GRAFTS WITH FLEX SMALL BEADING 60CM 21840 FHG16DF6SCBA " 巴德 " 迪斯塔人工血管 "BARD" DISTAFLO BYPASS GRAFTS WITH FLEX SMALL BEADING 60CM 21840 FHG16DF700BA " 巴德 " 迪斯塔人工血管 "BARD"DISTAFLO BYPASS GRAFTS WITH FLEX SMALL BEADING 70CM 24000 FHG16DF7SCBA " 巴德 " 迪斯塔人工血管 "BARD" DISTAFLO BYPASS GRAFTS WITH FLEX SMALL BEADING 70CM 24000 FHG16DF800BA " 巴德 " 迪斯塔人工血管 "BARD"DISTAFLO BYPASS GRAFTS WITH FLEX SMALL BEADING 80CM 25760 FHG16DF8SCBA " 巴德 " 迪斯塔人工血管 "BARD" DISTAFLO BYPASS GRAFTS WITH FLEX SMALL BEADING 80CM 25760 FHG16F0640MP FLEX GRAFT 6,7,8,10MM 40CM 14920 FHG16F3006BA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(FLEX 6MM*30CM) 11850 FHG16F4007BA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(FLEX 7;8;10MM*40CM) 14920 FHG16F401TMP CARBOFLO GRAFT,FLEX THINWALL SMALL BEADING,10CM 卡邦人工血管 4440 FHG16F507TMP CARBOFLO GRAFT,FLEX THINWALL SMALL BEADING,70CM 卡邦人工血管 24000 FHG16F601CMP CARBOFLO GRAFT,STRAIGHT FLEX,10CM 卡邦人工血管 4440 FHG16F603TMP CARBOFLO GRAFT,FLEX THINWALL SMALL BEADING,30CM 卡邦人工血管 11850 FHG16F604CMP CARBOFLO GRAFT,STRAIGHT FLEX,40CM 卡邦人工血管 14920 FHG16F605CMP CARBOFLO GRAFT,STRAIGHT FLEX,50CM 卡邦人工血管 19250 FHG16F605TMP CARBOFLO GRAFT,FLEX THINWALL SMALL BEADING,50CM 卡邦人工血管 19250 FHG16F606CMP CARBOFLO GRAFT,STRAIGHT FLEX,60CM 卡邦人工血管 21840 FHG16F606TMP CARBOFLO GRAFT,FLEX THINWALL SMALL BEADING,60CM 卡邦人工血管 21840 274

FHG16F607CMP CARBOFLO GRAFT,STRAIGHT FLEX,70CM 卡邦人工血管 24000 FHG16F608CMP CARBOFLO GRAFT,STRAIGHT FLEX,80CM 卡邦人工血管 25760 FHG16F608TMP CARBOFLO GRAFT,FLEX THINWALL SMALL BEADING,80CM 卡邦人工血管 25760 FHG170534NGX FHG170577NGX FHG170645NGX FHG1721068AH FHG1721220AH FHG1722063AH FHG1806040GX FHG180604NGX FHG180606NGX FHG180608NGX FHG1860520GX FHG1861020GX FHG2106030TM FHG2106031TM FHG2106060TM FHG2106061TM FHG2112025TM " 戈爾 " 戈爾特賜內植人工血管 "GORE" GORE-TEX VASCULAR GRAFTS(STRETCH VASCULAR GRAFT WITH REMOVABLE RINGS 5MM,6MM,8MM*30CM RS*40CM " 戈爾 " 戈爾特賜內植人工血管 "GORE" GORE-TEX VASCULAR GRAFTS(STRETCH VASCULAR GRAFT WITH REMOVABLE RINGS 5MM,6MM,8MM*70CM RS*70CM " 戈爾 " 戈爾特賜內植人工血管 "GORE" GORE-TEX VASCULAR GRAFTS(STRETCH VASCULAR GRAFT WITH REMOVABLE RINGS 6MM,8MM*40CM RS*50CM " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS(STANDARD WALL-HELIX SUPPORTED 4:8MM,70CM) " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS THIN WALL- HELIX SUPPORTED,6MM 7MM 8MM* 70CM " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS(WALL-HELIX SUPPORTED STANDARD 5MM:8MM*50CM) " 戈爾 " 戈爾特賜內植人工血管 ( 內環伸展性人工血管 )"GORE" GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)6MM X 40CM " 戈爾 " 戈爾特賜內植人工血管 ( 內環伸展性薄壁人工血管 )"GORE" GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)6MM,7MM,8MM X 40CM " 戈爾 " 戈爾特賜內植人工血管 ( 內環伸展性薄壁人工血管 )"GORE" GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)6MM,7MM,8MM X 60CM " 戈爾 " 戈爾特賜內植人工血管 ( 內環伸展性薄壁人工血管 )"GORE" GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)6MM,7MM,8MM X 80CM " 戈爾 " 戈爾特賜內植人工血管 ( 內環伸展性人工血管 )"GORE" GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)6MM X 5CM X 20CM " 戈爾 " 戈爾特賜內植人工血管 ( 內環伸展性人工血管 )"GORE" GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)6MM X 10CM X 20CM "TERUMO"GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELSEAL STRAIGHT GRAFTS6:10MM 30CM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELSEAL TRIAXIAL,GELSOFT STRAIGHT 6:10MM 30CM "TERUMO"GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELSEAL STRAIGHT GRAFTS6:10MM 60CM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELSEAL TRIAXIAL,GELSOFT STRAIGHT 6:10MM 60CM "TERUMO"GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELSEAL STRAIGHT GRAFTS12:18MM 25,30CM 17990 26400 21170 24000 24000 19250 15440 17990 26400 28330 9240 9240 8340 8340 14000 14000 7920 FHG2112030AH ULTRAMAX VASCULAR GRAFT STRAIGHT 12MM:18MM 30CM 9900 FHG2112050TM FHG2112051TM FHG211752PQM "TERUMO"GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELSEAL STRAIGHT GRAFTS12:18MM 60CM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELSEAL TRIAXIAL,GELSOFT STRAIGHT 12:18MM 50,60CM " 邁柯唯 " 白金雙重絲絨人工血管 "MAQUET"HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT6-10MM*30CM 10140 10550 8340 FHG211752PSB HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT 6-10MM*30CM 8340 FHG2117542QM " 邁柯唯 " 白金雙重絲絨人工血管 "MAQUET"HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT20:38MM*30CM 12000 275

FHG2117542SB HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT 20-38MM*30CM 12000 FHG211754PQM " 邁柯唯 " 白金雙重絲絨人工血管 "MAQUET"HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT12:18MM*30CM 9900 FHG211754PSB HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT 12-18MM*30CM 9900 FHG2120020TM FHG2120025TM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELSEAL TRIAXIAL,GELSOFT STRAIGHT 20:38MM 20,25CM " 泰爾茂 " 傑斯弗特加強型人工血管 "TERUMO" GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR PROSTHESES-GELSEAL STRAIGHT GRAFTS,20:24MM,25CM 9600 9600 FHG2120030AH ULTRAMAX VASCULAR GRAFT STRAIGHT 20MM:30MM 30CM 12000 FHG2143108TM FHG2173108TM FHG2175406QM FHG2175406SB FHG2175407QM FHG2175420QM FHG2175420SB FHG2175422QM FHG2175920QM FHG2175920SB "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR PROSTHESES SPECIAL FOUR BRANCH(PLEXUS)40CM*4@15CM* "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR PROSTHESES SPECIAL FOUR BRANCH(PLEXUS)40CM*4@15CM * " 邁柯唯 " 白金雙重絲絨人工血管 "MAQUET"HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT8-10MM*60CM " 波士頓科技 " 白金雙重絲絨人工血管 "BOSTON SCIENTIFIC"HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT 60CM " 邁柯唯 " 白金雙重絲絨人工血管 "MAQUET" HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR GRAFT 6-7MM*60CM " 邁柯唯 " 白金雙重絲絨人工血管 "MAQUET"HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT20:28MM*60CM " 波士頓科技 " 白金雙重絲絨人工血管 "BOSTON SCIENTIFIC"HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT 60CM " 邁柯唯 " 白金雙重絲絨人工血管 "MAQUET"HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT24:38MM*60CM " 邁柯唯 " 白金雙重絲絨人工血管 - 四分支 "MAQUET"HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT 4 BRANCH " 波士頓科技 " 四分支白金雙重絲絨人工血管 HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT* FHG21GK020V8 "INTERVASCULAR"INTERGARD KNITTED VASCULAR GRAFTS" 英特維 " 英特佳針織系列人工血管 6-10MM,20CM FHG21GK021V8 "INTERVASCULAR"INTERGARD KNITTED VASCULAR GRAFTS" 英特維 " 英特佳針織系列人工血管 12-24MM,20CM FHG21GK040V8 "INTERVASCULAR"INTERGARD KNITTED VASCULAR GRAFTS" 英特維 " 英特佳針織系列人工血管 6-10MM,40CM FHG21GK041V8 "INTERVASCULAR"INTERGARD KNITTED VASCULAR GRAFTS" 英特維 " 英特佳針織系列人工血管 12-24MM,40CM FHG21GK070V8 "INTERVASCULAR"INTERGARD KNITTED VASCULAR GRAFTS" 英特維 " 英特佳針織系列人工血管 6-10MM,70CM FHG21GK100V8 FHG21GKRS1V8 FHG21GKRS2V8 "INTERVASCULAR"INTERGARD KNITTED VASCULAR GRAFTS" 英特維 " 英特佳針織系列人工血管 8MM,100CM " 英特維 " 英特佳針織系列人工血管 "INTERVASCULAR" INTERGARD KNITTED VASCULAR GRAFTS RADIALLY SUPPORTED 6-8MM,70CM,R15-30CM " 英特維 " 英特佳針織系列人工血管 "INTERVASCULAR" INTERGARD KNITTED VASCULAR GRAFTS RADIALLY SUPPORTED ULTRA THIN 6MM,85CM,R45CM FHG21GKUT1V8 " 英特維 " 英特佳 "INTERVASCULAR" INTERGARD KNITTED VASCULAR GRAFTS ULTRA THIN 5-8MM,70CM FHG21GKUT2V8 " 英特維 " 英特佳 "INTERVASCULAR" INTERGARD KNITTED VASCULAR GRAFTS ULTRA THIN 5-8MM,40CM 59000 59000 14000 14000 14000 15360 15360 15360 59000 59000 5900 7920 9600 10550 14000 19400 19600 21030 14000 9600 276

FHG21GKUT3V8 " 英特維 " 英特佳 "INTERVASCULAR" INTERGARD KNITTED VASCULAR GRAFTS ULTRA THIN 6-5900 8MM,20CM FHG21HEWAAV8 FHG21K1206V8 FHG21W0630TM FHG21W0660TM FHG21W1230TM FHG21W1260TM "INTERVASCULAR"INTERGARD WOVEN VASCULAR GRAFTS" 英特維 " 英特佳編織系列四分叉主動脈弓人工血管 20-34MM*8-10MM,50CM "INTERVASCULAR"INTERGARD KNITTED VASCULAR GRAFTS" 英特維 " 英特佳針織系列雙叉人工血管 12-24MM,50CM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELWEAVE STRAIGHT VASCULAR GRAFTS 30CM*6,8,10MM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELWEAVE STRAIGHT VASCULAR GRAFTS 60CM*6-10MM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELWEAVE STRAIGHT VASCULAR GRAFTS 30CM*12-18MM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELWEAVE STRAIGHT VASCULAR GRAFTS 60CM*12-18MM 59000 16000 8340 14000 9900 10140 FHG21W1407V8 "INTERVASCULAR"INTERGARD WOVEN VASCULAR GRAFTS" 英特維 " 英特佳編織系列人工血管 14-24MM,50CM 16000 FHG21W2030TM FHG21W2050TM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELWEAVE STRAIGHT VASCULAR GRAFTS 30CM*20-38MM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR PROSTHESES GELWEAVE STRAIGHT VASCULAR GRAFTS 50CM*20-34MM 12000 12800 FHG21WK015V8 "INTERVASCULAR"INTERGARD WOVEN VASCULAR GRAFTS" 英特維 " 英特佳編織系列人工血管 12-24MM,15CM FHG21WK016V8 "INTERVASCULAR"INTERGARD WOVEN VASCULAR GRAFTS" 英特維 " 英特佳編織系列人工血管 26-36MM,15CM FHG21WK030V8 "INTERVASCULAR"INTERGARD WOVEN VASCULAR GRAFTS" 英特維 " 英特佳編織系列人工血管 6-10MM,30CM FHG21WK031V8 "INTERVASCULAR"INTERGARD WOVEN VASCULAR GRAFTS" 英特維 " 英特佳編織系列人工血管 12-18MM,30CM FHG21WK032V8 "INTERVASCULAR"INTERGARD WOVEN VASCULAR GRAFTS" 英特維 " 英特佳編織系列人工血管 20-38MM,30CM FHG21WK060V8 "INTERVASCULAR"INTERGARD WOVEN VASCULAR GRAFTS" 英特維 " 英特佳編織系列人工血管 22-32MM,60CM 4750 5760 8340 9900 12000 15360 FHG3121112AH " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS SHORT TAPER STRAIGHT,4-6MM,4-7MM* 40CM,45CM 13200 FHG3140A64BA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(SHORT TAPERED 6,7-4MM*40CM) 13200 FHG3146040GX " 戈爾 " 戈爾特賜內植人工血管 "GORE"GORE-TEX VASCULAR GRAFTS-TAPERED GRAFT 4-6MM*40CM 13200 FHG3146040QM FHG3146040SB FHG3146040TM FHG3146041TM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL SHORT TAPER 4-7MM*40-45CM EXXCEL SOFT EPTFE GRAFT SHORT TAPER,STEP 4-6MM,4-7MM*40CM,45CM 型號 389446,389447 自 92.10.1 生效 " 泰爾茂 " 特普弗人工血管 "TERUMO" TAPERFLO GELATIN SEALED EPTFE VASCULAR PROSTHESES SHORT TAPER GRAFT40,45CM 4-6,4-7MM " 泰爾茂 " 麥斯弗人工血管 "TERUMO" MAXIFLO EXPANDED EPTFE VASCULAR PROSTHESES(SHORT TAPER GRAFT40,50CM*4-6:4-7MM) 13200 13200 13200 13200 FHG3146045QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 4-7MM*45CM 13200 FHG3146045SB EXXCEL SOFT EPTFE VASCULAR STANDARD WALL GRAFT(STEP)4-6MM,4-7MMX45CM 型號 382456,57 自 92.10.1 生效 13200 FHG3146050GX " 戈爾 " 戈爾特賜內植人工血管 "GORE"GORE-TEX VASCULAR GRAFTS-TAPERED GRAFT 4-6MM*50CM 15500 277

FHG3146050QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL SHORT 15500 TAPER 4-7MM*50CM FHG3146050SB EXXCEL SOFT EPTFE GRAFT SHORT TAPER 4-6MM,4-7MM/50CM 型號 389546,47 自 92.10.1 生效 15500 FHG3146S30TM FHG3146S40TM FHG3146S41TM FHG3146S45TM FHG3146S46TM FHG3146S50TM FHG3147030TM " 泰爾茂 " 特普弗人工血管 TAPERFLO GELATIN SEALED EPTFE VASCULAR PROSTHESES GELATIN SEALED STEPPED TAPER GRAFT 30,35CM 4-6:5-8MM " 泰爾茂 " 特普弗人工血管 TAPERFLO GELATIN SEALED EPTFE VASCULAR PROSTHESES GELATIN SEALED STEPPED TAPER GRAFT 40,45CM 4-6:5-8MM " 泰爾茂 " 麥斯弗人工血管 "TERUMO" MAXIFLO EXPANDED EPTFE VASCULAR PROSTHESES(STEPPED TAPER GRAFT40,45CM*4-6:5-8MM) " 泰爾茂 " 特普弗人工血管 "TERUMO" TAPERFLO GELATIN SEALED EPTFE VASCULAR PROSTHESES STEPPED TAPER CENTRAL SUPPORT GRAFT 40,45CM 4-7,5-8MM " 泰爾茂 " 麥斯弗人工血管 "TERUMO" MAXIFLO EXPANDED EPTFE VASCULAR PROSTHESES(SHORT TAPER WITH CENTRAL REINFORCEMENT40,45CM*4-7:5-8MM) " 泰爾茂 " 特普弗人工血管 TAPERFLO GELATIN SEALED EPTFE VASCULAR PROSTHESES GELATIN SEALED STEPPED TAPER CENTRAL SUPPORT GRAFT 50CM 4-7MM " 泰爾茂 " 特普弗人工血管 "TERUMO" TAPERFLO GELATIN SEALED EPTFE VASCULAR PROSTHESES SHORT TAPER GRAFT 30CM 4-7MM 10500 13200 13200 15800 15800 15500 10500 FHG3147040AH SHORT TAPER STRAIGHT GRAFT STANDARD WALL 4-6MM,4-7MM * 40CM,45CM( 型號 21713 自 91/1/1 生效 ) 13200 FHG3147040GX TAPERED GRAFT 4-7MM 40CM 13200 FHG3147S45MP STEPPED GRAFT 4-7MM 45CM 13200 FHG3147T40AH STEP TAPER STRAIGHT GRAFT STANDARD WALL 4-6MM,4-7MM * 40CM,45CM 13200 FHG3148045QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL STEP 4-6MM*45CM 13200 FHG3164A40MP CARBOFLO GRAFT,SHORT TAPERED,40CM 卡邦人工血管 13200 FHG316CF50MP CENTER FLEX 6:8MM 50CM 17550 FHG3174T40MP TAPERED GRAFT 7-4MM 40CM 13200 FHG31T4645MP CARBOFLO GRAFT,STEPPED,45CM 卡邦人工血管 13200 FHG31T4750MP CARBOFLO GRAFT,STEPPED,50CM 卡邦人工血管 15500 FHG31VLT20MP FHG31VLT30MP FHG31VLT40MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS STEPPED GRAFT(4-6,4-7MM,20CM,25CM) 印帕維那人工血管階級式 IMPRA VENAFLO EPTFE VASCULAR GRAFTS STEPPED GRAFT(4-6,4-7MM,30CM,35CM) 印帕維那人工血管階級式 IMPRA VENAFLO EPTFE VASCULAR GRAFTS STEPPED GRAFT(4-6,4-7MM,40CM,45CM) 印帕維那人工血管階級式 7000 10500 13200 FHG31VT246MP VENAFLO GRAFT,STEPPED,20/25CM 維那人工血管 7000 FHG31VT346MP VENAFLO GRAFT,STEPPED,30CM 維那人工血管 10500 FHG3274070MP CARBOFLO GRAFT,TAPERED THINWALL,70CM 卡邦人工血管 19180 FHG3322114AH " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS(SHORT TAPER STANDARD WALL 4-6MM,4-7MM*40CM,45CM) 13200 278

FHG3346045GX " 戈爾 " 戈爾特賜內植人工血管 "GORE"GORE-TEX VASCULAR GRAFTS-TAPERED STRETCH GRAFT 4-14640 6MM*45CM FHG3347040GX TAPERED STRETCH VASCULAR GRAFT 4:7MMX40CM 14640 FHG336CF40MP CENTER FLEX GRAFT 6:10MM 40CM 14920 FHG3421125AH " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS SHORT TAPER CENTER HELIX,4-7MM* 45CM 14400 FHG3447045AH SHORT TAPER HELIX SUPPORT STRAIGHT GRAFT STANDARD WALL 4-7MM,45CM( 型號 21723,21725 自 91/1/1 生效 ) 14400 FHG3447940QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT(STANDARD WALL SHORT TAPER CENTRALLY SUPPORTED 4-7MM*40-45CM*5-10CM 14400 FHG3447C40QM " 邁柯唯 " 人工血管 "MAQUET" EXXCELSOFT EPTFE VASCULAR GRAFT 4-7MM*45CM 14400 FHG3447C40SB EXXCEL SOFT EPTFE GRAFT SHORT TAPER,STEP CENTRALLY SUPPORTED 4-7MM/40CM,45CM/5-15CM 14400 FHG3447S45MP CENTERFLEX STEPPED GRAFT 4-7MM,5-8MM 45CM 14400 FHG34CF40ABA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(SHORT TAPERED CENTERFLEX 6,7-4MM*40CM) FHG34CFT40BA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(STEPPED CENTERFLEX 4-7MM*40CM) 14400 14400 FHG3622125AH " 亞翠恩 " 艾德凡達聚四氟乙烯人工血管 "ATRIUM" ADVANTA PTFE VASCULAR GRAFTS(SHORT TAPER CENTER HELIX STANDARD 4-7MM*45CM) 15800 FHG3630A74BA " 印帕 " 聚四氟乙烯人工血管 "IMPRA" EPTFE VASCULAR GRAFT(SHORT TAPERED 7-4MM*30CM) 10500 FHG3647145GX TAPERED GRAFT WITH REMOVAL RINGED 15800 FHG3674A40MP CARBOFLO GRAFT,SHORT TAPERED CENTERFLEX,40CM 卡邦人工血管 15800 FHG36CVLT4MP IMPRA VENAFLO EPTFE VASCULAR GRAFTS STEPPED CENTERFLEX(4-7MM,45CM) 印帕維那人工血管階級中間螺旋式 14400 FHG36F7407MP CARBOFLO GRAFT,FLEX THINWALL TAPERED SMALL BEADING,70CM 卡邦人工血管 22960 FHG36T4740MP CARBOFLO GRAFT,STEPPED CENTERFLEX,40/45CM 卡邦人工血管 15800 FHG36T4750MP CARBOFLO GRAFT,STEPPED CENTERFLEX,50CM 卡邦人工血管 16950 FHG36VT454MP VENAFLO GRAFT,STEPPED CENTERFLEX,45CM 維那人工血管 15800 FHG3846045GX FHG3847045GX " 戈爾 " 戈爾特賜內植人工血管 ( 錐狀內環伸展性人工血管 )"GORE" GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)4-6MM X 45CM 戈爾特賜內植人工血管 ( 錐狀內環伸展性人工血管 )GORE-TEX VASCULAR GRAFTS(INTERING GRAFT)4-7MM X 45CM 17380 17380 FHG4108R10AH ULTRAMAX VASCULAR GRAFT AXILLO-BIFEMORAL 8MM,10MM,100X60CM 26000 FHG4112040AH ULTRAMAX VASCULAR GRAFT BIFURCATES-STANDARD,ANATOMICAL 40CM 16000 FHG421664PQM " 邁柯唯 " 白金雙重絲絨人工血管 "MAQUET"HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT(BIFURCATIONS)14:24MM*7:12MM*40CM 16000 FHG421664PSB HEMASHIELD PLATINUM WOVEN DOUBLE VELOUR VASCULAR GRAFT BIFURCATIONS 12-24MM*6-12MM*40CM 16000 279

FHG4312645TM "TERUMO"GELSOFT PLUS GELATIN SEALED POLYESTER VASCULAR PROSTHESES BIFURCATION 16000 WOVEN GRAFTS12:24*6:12MM 45CM FHG4312646TM FHG43W1245TM "TERUMO" GELSEAL GELATIN SEALED POLYESTER VASCULAR PROSTHESES BIFURCATION WOVEN GRAFT 12:24*6:12MM 45CM "TERUMO" GELWEAVE GELATIN SEALED POLYESTER VASCULAR PROSTHESES BIFURCATION WOVEN GRAFT 12:24*6:12MM 45CM 16000 16000 FHP0100KSRM4 KAPPA SR PULSE GENERATOR 頇檢附心電圖報告專案報備使用 74070 FHP0105172ST SINGLE CHAMBER PULSE GENERATOR SSIR* 頇檢附心電圖報告專案報備使用 74070 FHP0110SS1M4 SIGMA SSI PACEMAKER WITHOUT LEAD 頇檢附心電圖報告專案報備使用 56540 FHP0111940GU " 佳騰 " 因施尼亞心律調節器 "GUIDANT" INSIGNIA I PLUS GENERATOR* 74070 FHP0112400PR REGENCY SR+SSIR PULSE GENERATOR W/AUTOCAPTURE 頇檢附心電圖報告專案報備使用 74070 FHP0112402PR REGENCY SC+SSIC PULSE GENERATOR W/AUTOCAPTURE 頇檢附心電圖報告專案報備使用 62260 FHP0112525PR REGENCY/MICRONY SSIR PULSE GENERATOR 頇附心電圖報告專案報備使用 ( 不頇事前審查 ) 74070 FHP011SS1RM4 SIGMA SSIR PACEMAKER WITHOUT LEAD 頇檢附心電圖報告專案報備使用 74070 FHP012404NPR REGENCY SR SSIR PULSE GENERATOR WITHOUT LEAD 頇檢附心電圖報告專案報備使用 74070 FHP012406NPR REGENCY SC/SCX SSI PULSE GENERATOR WITHOUT LEAD 頇檢附心電圖報告專案報備使用 56540 FHP0134115BK FHP0134119BK BIOTRONIK IMPLANTABLE PACEMAKER-PHILOS II 拜耳德尼克植入式心律調整器 (VVIR) 需檢附心電圖報告專案報備使用 BIOTRONIK IMPLANTABLE PACEMAKER-PHILOS II 拜耳德尼克植入式心律調整器 (VVI) 需檢附心電圖報告專案報備使用 74070 62260 FHP0134981BK " 拜耳德尼克 " 璽洛植入式心律調節器 "BIOTRONIK"CYLOS IMPLANTABLE CARDIAC PACEMAKERS* 74070 FHP01AVTSRGU FHP01AVTSSGU " 佳騰 " 因施尼亞內植用雅密特心臟整律器 "GUIDANT"INSIGNIA I AVT PULSE GENERATOR SSIR* 頇檢附心電圖報告專案報備適用 " 佳騰 " 因施尼亞內植用雅密特心臟整律器 "GUIDANT"INSIGNIA I AVT PULSE GENERATOR* 頇檢附心電圖報告專案報備適用 74070 62260 FHP01DDD20SB " 波士頓科技 " 歐超心臟整律器 "BOSTON SCIENTIFIC" ALTRUA 20 PACEMAKER * 適應症見備註欄 102500 FHP01ESS1RM4 ENPULSE PACING GENERATOR 頇檢附心電圖報告專案報備使用 74070 FHP01K9KSRM4 KAPPA PULSE GENERATOR 頇檢附心電圖報告專案報備使用 74070 FHP01KAKSRM4 KAPPA PULSE GENERATOR (SSIR) * 頇檢附心電圖報告專案報備使用 74070 FHP01M2535ST " 聖猶達 " 植入式心臟節律器 * 需檢附心電圖報告專案報備使用 74070 FHP01S1195GU INSIGNIA I ENTRA PULSE GENERATOR 頇檢附心電圖報告專案報備使用 74070 FHP01S484NGU INSIGNIA I ENTRA PULSE GENERATOR 頇檢附心電圖報告專案報備使用 56540 FHP01SENAAM4 " 美敦力 " 賽亞心臟節律系統 "MEDTRONIC" SENSIA PACING SYSTEM VVI/AAI* 需檢附心電圖報告專案報備使用 62260 280

FHP01SENARM4 " 美敦力 " 賽亞心臟節律系統 "MEDTRONIC" SENSIA PACING SYSTEM VVIR/AAIR* 需檢附心電圖報告專 74070 案報備使用 FHP01SSR20SB " 波士頓科技 " 歐超心臟整律器 "BOSTON SCIENTIFIC" ALTRUA 20 PACEMAKER * 適應症見備註欄 74070 FHP01SSR40SB " 波士頓科技 " 歐超心臟整律器 "BOSTON SCIENTIFIC" ALTRUA 40 PACEMAKER * 適應症見備註欄 74070 FHP01SSR50SB FHP01SSR60SB " 波士頓科技 " 歐超心臟整律器 "BOSTON SCIENTIFIC" ALTRUA 50 PACEMAKER * 需檢附心電圖報告專案報備使用 " 波士頓科技 " 歐超心臟整律器 "BOSTON SCIENTIFIC" ALTRUA 60 PACEMAKER * 需檢附心電圖報告專案報備使用 74070 74070 FHP01SSS20SB " 波士頓科技 " 歐超心臟整律器 "BOSTON SCIENTIFIC" ALTRUA 20 PACEMAKER * 適應症見備註欄 56540 FHP01UTASRGU FHP01V56SRST " 佳騰 " 因施尼亞內植用雅密特心臟整律器 "GUIDANT"INSIGNIA I ULTRA PULSE GENERATOR SSIR* 頇檢附心電圖報告專案報備適用 " 聖猶達 " 維奇植入式心臟節律器 "SJM" VICTORY IMPLANTABLE CARDIAC PULSE GENERATOR * 頇檢附心電圖報告專案報備使用 74070 74070 FHP01VDSS5SB " 波士頓科技 " 歐超心臟整律器 "BOSTON SCIENTIFIC" ALTRUA 50 PACEMAKER * 適應症見備註欄 62260 FHP01VEESRST IMPLANTABLE CARDIAC PULSE GENERATOR 單腔型植入式心臟節律器 * 頇檢附心電圖報告專案報備使用 74070 FHP01VERSCST 植入式心臟節律器 IMPLANTABLE CARDIAC PULSE GENERATOR 62260 FHP01VERSRST 植入式心臟節律器 IMPLANTABLE CARDIAC PULSE GENERATOR# 頇檢附心電圖報告專案報備使用 74070 FHP01ZESR6ST " 聖猷達 " 神風植入式心臟節律器 "SJM" ZEPHYR IMPLANTABLE CARDIAC PULSE GENERATOR * 74070 FHP02DDD12GU 因施尼亞內植用心律調節器 GUIDANT INSIGNIA I ENTRA PULSE GENERATOR* 102500 FHP02DDD18BK 雙腔型心臟節律器 "BIOTRONIK" IMPLANTABLE PACEMAKERS-PHILOS II D* 102500 FHP02DDD2SST 雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR * 102500 FHP02DDD2UST 雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR * 102500 FHP02DDD32GU 內植用雅密特心臟整律器 GUIDANT INSIGNIA I AVT PULSE GENERATOR* 102500 FHP02DDD50SB " 波士頓科技 " 歐超心臟整律器 "BOSTON SCIENTIFIC" ALTRUA 50 PACEMAKER * 需檢附心電圖報告專案報備使用 102500 FHP02DDD6SST 雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR * 102500 FHP02DDD6UST 雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR * 102500 FHP02DDDADM4 美敦力黛拉心臟節律器 MEDTRONIC ADAPTA PACING GENERATOR* 102500 FHP02DDDENM4 美敦力心臟節律系統 MEDTRONIC ENPULSE PACING GENERATOR* 102500 FHP02DDDKKM4 美敦力卡帕人工心律調節器 MEDTRONIC KAPPA PULSE GENERATOR* 102500 FHP02DDDSEM4 美敦力賽亞心臟節律器 MEDTRONIC SENSIA PACING GENERATOR* 102500 FHP02DDDSGM4 希格瑪人工心律調節器 * 102500 281

FHP02DDR11GU 因施尼亞內植用心律調節器 GUIDANT INSIGNIA I ENTRA PULSE GENERATOR*, 按同類近似特材支付 102500 點數 102500 點支付, 超過部分由病患自付 FHP02DDR20SB FHP02DDR21BK FHP02DDR21GU FHP02DDR31GU FHP02DDR34BK FHP02DDR3SST FHP02DDR3UST FHP02DDR40SB FHP02DDR41GU FHP02DDR50SB FHP02DDR5SST FHP02DDR5UST FHP02DDR60SB FHP02DDR7SST FHP02DDR7UST FHP02DDR8SST FHP02DDR8UST FHP02DDRADM4 " 波士頓科技 " 歐超心臟整律器 "BOSTON SCIENTIFIC" ALTRUA 20 PACEMAKER * 適應症見備註欄, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付雙腔型心臟節律器 "BIOTRONIK" IMPLANTABLE PACEMAKERS-PHILOS II*, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付因施尼亞心律調節器 GUIDANT INSIGNIA I PLUS PULSE GENERATOR*, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付內植用雅密特心臟整律器 GUIDANT INSIGNIA I AVT PULSE GENERATOR*, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付雙腔型心律調節器 "BIOTRONIK" CYLOS IMPLANTABLE CARDIAC PACEMAKERS*, 按同類近似特材支付點數 102500 點給付超過部分由病患自付雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR *, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR *, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付 " 波士頓科技 " 歐超心臟整律器 "BOSTON SCIENTIFIC" ALTRUA 40 PACEMAKER * 適應症見備註欄, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付因施尼亞心臟整律器 GUIDANT INSIGNIA I ULTRA PULSE GENERATOR*, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付 " 波士頓科技 " 歐超心臟整律器 "BOSTON SCIENTIFIC" ALTRUA 50 PACEMAKER * 適應症見備註欄, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR *, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR *, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付 " 波士頓科技 " 歐超心臟整律器 "BOSTON SCIENTIFIC" ALTRUA 60 PACEMAKER * 適應症見備註欄, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付雙腔型心臟節律器 "SJM" DUAL CHAMBER PULSE GENERATOR *, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR *, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付維奇植入式心臟節律器 "SJM"VICTORY IMPLANTABLE CARDIAC PULSE GENERATOR, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付雙腔型心臟節律器 "SJM" VICTORY IMPLANTABLE CARDIAC PULSE GENERATOR *, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付美敦力黛拉心臟節律器 MEDTRONIC ADAPTA PACING GENERATOR*, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付 102500 102500 102500 102500 102500 102500 102500 102500 102500 102500 102500 102500 102500 102500 102500 102500 102500 102500 FHP02DDRENM4 美敦力心臟節律系統 MEDTRONIC ENPULSE PACING GENERATOR*, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付 102500 FHP02DDRKKM4 FHP02DDRSEM4 美敦力卡帕人工心律調節器 MEDTRONIC KAPPA PULSE GENERATOR*, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付美敦力賽亞心臟節律器 MEDTRONIC SENSIA PACING GENERATOR*, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付 102500 102500 FHP02DDRSGM4 希格瑪人工心律調節器 *, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付 102500 FHP02DDRTHM4 植入式心臟節律系統 ENRHYTHM IMPLANTABLE PACEMAKER SYSTEMS*, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付 102500 FHP02DDRVEM4 美敦力維莎心臟節律器 MEDTRONIC VERSA PACING GENERATOR*, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付 102500 FHP02VDDADM4 美敦力黛拉心臟節律器 MEDTRONIC ADAPTA PACING GENERATOR* 102500 282

FHP02VDDENM4 美敦力心臟節律系統 MEDTRONIC ENPULSE PACING GENERATOR* 102500 FHP02VDDKKM4 美敦力卡帕人工心律調節器 MEDTRONIC KAPPA PULSE GENERATOR* 102500 FHP02VDDSGM4 希格瑪人工心律調節器 * 102500 FHP02VDR16BK 雙腔型心臟節律器 "BIOTRONIK" IMPLANTABLE PACEMAKERS-PHILOS II SLR* 102500 FHP02VDR1SST 雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR * 102500 FHP02VDR1UST 雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR * 102500 FHP02VDR4SST 雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR * 102500 FHP02VDR4UST 雙腔型心臟節律器 "SJM" IMPLANTABLE CARDIAC PULSE GENERATOR * 102500 FHP02ZEDRSST FHP02ZEDRUST 神風植入式心臟節律器 "SJM"ZEPHYR IMPLANTABLE CARDIAC PULSE GENERATOR, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付神風植入式心臟節律器 "SJM"ZEPHYR IMPLANTABLE CARDIAC PULSE GENERATOR, 按同類近似特材支付點數 102500 點支付, 超過部分由病患自付 102500 102500 FHP1106120GX " 戈爾 " 普瑞得福心包膜代用膜 "GORE" PRECLUDE PRECARDIAL MEMBRANE 6*12CM 4310 FHP1115200GX " 戈爾 " 普瑞得福心包膜代用膜 "GORE" PRECLUDE PRECARDIAL MEMBRANE 15*20CM 14500 FHP41V1017VW " 維喜 " 人工血管接環 "VASORING" VASCULAR RING CONNECTOR 35000 FHPHF02187M4 CARDIAC VEIN PACING LEAD 21850 FHPL203830M4 " 美敦力 " 賽西兒導線 "MEDTRONIC"SELECTSURE LEAD* 22500 FHPL205038M4 美敦力蓋普夏整律導管 "METRONIC" CAPSURE VDD-2 LEAD* 18500 FHPL21368NST " 聖猷達 " 植入式心臟節律器電刺激導線 "SJM" IMPLANTABLE CARDIAC PACING LEAD* 18500 FHV01EZ770M4 HALL EASY-FIT PROSTHETIC HEART VALVE 39900 FHV01VAVGJST " 聖猶達 " 馬斯特機械性人工心臟瓣膜 "SJM" MASTERS MECHANICAL HEART VALVE* 85000 FHV0200995M4 FREESTYLE AORTIC ROOT BIOPROSTHESIS(19MM:27MM) 63000 FHV022500PED PRIMA PLUS STENTLESS BIOPROSTHESIS 63000 FHV0299500M4 THE PRESTYLED FREESTYLE BIOPROSTHESIS 56000 FHV02A2625ED CARPENTIER-EDWARDS BIOPROSTHESES 32250 FHVR104100ED 卡本特 - 麥卡錫亞當二尖瓣修補環 "EDWARDS"CARPENTIER-MCCARTHY-ADMA IMR ETLOGIX ANNULOPLASTY RING24MM:34MM 20100 FHVR104450ED C/E PHYSIO ANNULOPLASTY RING(24:40MM) 20100 FHVR104600ED COSGROVE-EDWARDS ANNULOPLASTY SYSTEM(26:38MM) 20100 283

FHVR1CG638M4 COLVIN-GALLOWAY FUTURE ANNULOPLASTY BAND 瓣膜成型帶 20100 FHVR1D610BM4 DURAN FLEXIBLE ANNULOPLASTY RING 25MM:35MM 擴增產品型號 620R 620B-25:35 自 93.1.1 生效 20100 FHVR1H608HM4 DURAN FLEXIBLE ANNULOPLASTY RING 25:35MM 20100 FHVR1M4900ED " 愛德華 " 三尖瓣環成形術系統 "EDWARDS"MC3 TRICUSPID ANNULOPLASTY SYSTEM 20100 FHVR1RSARNST " 聖猷達 " 環狀成形術環 "SJM" RIGID SADDLE RING 15700 FHVR1SARNNST 環狀成形術環 SEGUIN ANNULOPLASTY RING 20100 FHVR1SARPNST 環狀成形術環 SEGUIN ANNULOPLASTY RING 20100 FHVR1T4528ED CARPENTIER-EDWARDS CLASSIC ANNULOPLASTY RING(26:36MM) 15700 FHVR1TARNNST SJM TAILOR ANNULOPLASTY RING(25MM:35MM) 20100 FHVR1TARPNST TAILOR ANNULOPLASTY RING 泰勒環狀成形術環 20100 FHX0203381M4 MINIMAX PLUS OXYGENATOR 10920 FHX0229400M4 OCTOPUS 4 TISSUE STABILIZER SYSTEM ( 產品型號 29403 自 94 年 10 月 1 日生效 )29700&29800 自 95 年 9 月 1 日刪除給付 44800 FHX02BL0MSM4 " 美敦力 " 噴射灌洗器 "MEDTRONIC" BLOWER/MISTER(WITH TUBING SET) 2425 FHX02E4012E8 SYNERGY ATTACHMENT * 心臟不停跳冠狀動脈繞道手術用吸引式穩定器 37598 FHX02E401SE8 CORONARY ARTERY STABILIZER * 心臟不停跳冠狀動脈繞道手術用穩定器 37598 FHX02RX050TM CAPIOX RX HOLLOW FIBER OXYGENATOR WITHOUT RESERVOIR BY X-COATING 10920 FHX02RX150TM 泰爾茂膜型人工心肺 RX TERUMO CAPIOX RX OXYGENATOR(WITHOUT RESERVOIR)* 13998 FHX02RX250TM FHX02SCTSPM4 CAPIOX RX OXYGENATOR WITHOUT/RESERVOIR W/HYDROPHILIC POLYMER COATED( 二 )( 產品型號 CX*RX25W,CX*RX25E 自 94 年 10 月 1 日生效 ) " 美敦力 " 穩定器 "MEDTRONIC" CARDIOVASCULAR SURGICAL INSTRUMENTS(STERILE)-OCTOPUS TISSUE STABILIZER 心臟不停跳冠狀動脈繞道手術用穩定器 13998 44800 FHX02UM400GU ULTIMA OPCAB SYSTEM(AXIUS VACCUM STABILIZER SYETEM WITH STANDARD BLADE) 44800 FHX02UM600GU ACROBAT OFF-PUMP SYSTEM STABILIZER WITH BLADES 心臟不停跳穩定器 44800 FHX02UM900QM ACROBAT VACUUM OFF PUMP SYSTEM(ACCESS RAIL PLATFORM+STABILIZER+VACCUM TUBING SET) 44800 FHX0303301M4 MINIMAX PLUS OXYGENATOR WITH RESERVOIR 12587 FHX0307850TM DISPOSABLE PUMP HEAD (BIO PUMP) 9528 FHX030BP80M4 BIO-PUMP 9528 FHX030DP38M4 BIO-PROBE INSERT 914 284

FHX0312500M4 艾克模薄膜式人工心肺 MEDTRONIC ECMO SILICON MEMBRANE OXGENATOR* 23486 FHX03541TTM4 AFFINITY NT HOLLOW FIBER OXYGENATOR WITH TRILLIUM BIOPASSIVE SURFACE AND INTEGRATED CVR NT 含心臟切開術靜脈貯槽之人工心肺 * 14558 FHX036000SGH GISH IBC FLOPUMP WITH GBS COATING* 9528 FHX03A5410M4 AFFINITY NT HOLLOW FIBER OXYGENATOR WITH TRILLIUM BIOPASSIVE SURFACE AND INTEGRATED CVR NT 12587 FHX03A541TM4 AFFINITY NT HOLLOW FIBER OXYGENATOR W/RESERVOIR (TRILLIUM COATED) 13458 FHX03BPX80M4 BIO-PUMP PLUS CENTRIFUGAL BLOOD PUMP * 9528 FHX03CB511M4 AFFINITY HOLLOW FIBER OXYGENATOR BIOACTIVE SURFACE 限重大複雜之心臟血管手術 13998 FHX03FC038TM 泰爾茂血液幫浦 - 流量接頭 TERUMO CAPIOX SP PUMP-FLOW CONNECTOR* 914 FHX03FS038TM CAPIOX SP BLOOD FLOW SENSOR 914 FHX03ME002ML FHX03ME062ML HOLLOW FIBER OXYGENATOR WITH RESERVOIR,RHEOPARIN COATED(HILITE 7000ADULT/HILITE 2800PEDIATRIC/HILITE 1000INFANT) HOLLOW FIBER OXYGENATOR WITH RESERVOIR,(HILITE 7000ADULT/HILITE 2800PEDIATRIC/HILITE 1000INFANT) 13458 12587 FHX03MECL6ML " 美德思 " 人工心肺 "MEDOS"OXYGENATOR* 23486 FHX03MEDP2ML " 美德思 " 血液幫浦系統 "MEDOS"DELTASTREAM BLOOD PUMP SYSTEM* 9528 FHX03PHEADH9 " 華億 " 體外循環管組 "HYM" HEART LUNG PACK(PUMP HEAD)* 9528 FHX03RRF32QM " 邁柯唯 " 離心幫浦 ( 未含肝素塗層 ) "MAQUET" CENTRIFUGAL PUMP ROTAFLOW WITHOUT BIOLINE COATING* 9528 FHX03RX05RTM CAPIOX RX HOLLOW FIBER OXYGENATOR WITH RESERVOIR BY X-COATING 12587 FHX03RX15RTM 泰爾茂膜型人工心肺 RX TERUMO CAPIOX RX OXYGENATOR* 14558 FHX03RX25RTM CAPIOX RX OXYGENATOR W/RESERVOIR W/HYDROPHILIC COATED( 二 )( 產品型號 CX*RX25RW,CX*RX25RE 於 941001 生效 ) 14558 FHX03SP045TM CAPIOX SP PUMP HEAD 9528 FHX03SX10RTM CAPIOX SX MEMBRANE OXYGENATOR WITH HARD-SHELL RESERVOIR (PEDIATRIC) 12587 FHX03SX18RTM CAPIOX SX MEMBRANE OXYGENATOR WITH HARD-SHELL RESERVOIR (ADULT) 12587 FHX04A20E1H9 "HYM" HEART LUNG PACK(W/OXYGENATOR+PUMP HEAD+FLOW PROBE+TUBING SET 等 ) 44695 FHX04A21E1H9 "HYM" HEART LUNG PACK(W/OXYGENATOR+FLOW PROBE+TUBING SET 等 ) 33129 FHX04A31CPH9 FHX04CB1V9M4 HEART LUNG PACK 適應症備註 PRE BYPASS FILTER+ORGANIZER+SUCKER*2+ARTERIAL FILTER+TRANSDUCER+PROBE CONNECTOR+SATURATION CUVETTE+PUMP HEAD BLOOD TUBING PACK 血液套裝組 (OXYGENATOR+BIO-PUMP+TUBING SET+DISPOSABLE PROBE) 型號 CB1Q91R4,CB2503R1 自 940701 生效 19301 44695 FHX04CB4P7M4 " 美敦力 " 血液套裝組 MEDTRONIC BLOOD TUBING PACK(WITHOUT OXYGENATOR)* 28028 285

FHX04CBCCSM4 ECMO CLOSE CHEST SUPPORT CIRCUIT W/OXYGENATOR+BIO-PUMP+TUBING SET 使用參考見備註 44695 欄 CB2506 於 920401 擴增 FHX04CXESLTM CAPIOX EBS OXYGENATOR KIT(HP) 人工心肺套 /OXYGENATOR+SP-PUMP+TUBING SET 使用參考請見備註欄 44695 FHX04ME620ML ECMO LT SYSTEM(OXGENATOR+TUBING,A-V LOOP,ADAPTOR,ACCESSORY+PUMP HEAD) 44695 FHX04ME623ML ECMO LT SYSTEM WITHOUT PUMPHEAD 33129 FHXR200321M4 AFFINITY VENOUS RESERVOIR BAG 3297 FHXR20CR40TM CARDIOTOMY RESERVOIR 4000CC 3297 FHXR2CAPDFGH CARDIOTOMY RESERVOIR/AUTOTRANSFUSION/PLEURAL DRAINAGE RESERVOIR 3596 FHXR2EL400M4 CARDIOTOMY RESERVOIR* 3596 FHXR2RV500M4 VENOUS RESERVOIR 1820 FNP9140380T0 WIRE MESH 10X10CM 263 FNP91DUR01CK " 曲克 " 硬腦膜替代物 "COOK" DURASIS DURAL SUBSTITUTE 7CM 10CM 14182 FNP91DUR02CK " 曲克 " 硬腦膜替代物 "COOK" DURASIS DURAL SUBSTITUTE 7CM 20CM 24192 FPM0119604HH MICROGRAFT GAUZE WITH CORKPLATE 1:4 1700 FPM0119606HH MICROGRAFT GAUZE WITH CORKPLATE 1:6 1700 FPM0119609HH MICROGRAFT GAUZE WITH CORKPLATE 1:9 1700 FPP010574NLE MINI DOUBLE Y PLATE 7 HOLE 2469 FPP010575NLE MINI Y PLATE W/BAR 5 HOLE 2022 FPP010576NLE MINI LOCKING PLATE W/BAR 5-6 HOLE 1923 FPP0106002M3 2HOLE MINI LOW PROFILE PLATE 1207 FPP0106106LE 0.6,1.0MM MINI BONE PLATE 5,6HOLE REGULAR STR 1207 FPP0106109LE 0.6,1.0MM MINI BONE PLATE 8HOLE REGULAR STR 1504 FPP0106112LE 0.6,1.0MM MINI BONE PLATE 4 HOLE REGULAR STR 1207 FPP0106120LE 0.6,1.0MM MINI L-PLATE REGULAR RIGHT 4HOLE 1937 FPP0106121LE L-PLATE LEFT 0.6MM 1937 FPP0106122LE 0.6,1.0MM MINI L-PLATE LONG RIGHT 4HOLE 1937 FPP0106123LE 0.6,1.0MM MINI L-PLATE LONG LEFT 4HOLE 1937 286

FPP0106124LE 0.6,1.0MM MINI L-PLATE REGULAR LEFT 4HOLE 1937 FPP0106140LE 0.6,1.0MM MINI T-PLATE REGULAR 90 度 6HOLE 2190 FPP0106141LE 0.6,1.0MM MINI T-PLATE LONG 90 度 5HOLE 2190 FPP0106142LE 0.6,1.0MM MINI T-PLATE LONG 80 度 RIGHT 5HOLE 2190 FPP0106143LE 0.6,1.0MM MINI T-PLATE LONG 80 度 LEFT 5HOLE 2190 FPP0106144LE 0.6,1.0MM MINI DOUBLE T PLATE REGULAR 6HOLE 2379 FPP0106145LE 0.6,1.0MM MINI DOUBLE T LONG 90 度 4HOLE 2379 FPP0106160LE 0.6,1.0MM MINI Y PLATE(REGULAR LONG)5HOLE 2154 FPP0106162LE 0.6,1.0MM MINI DOUBLE Y PLATE LONG 6HOLE 2905 FPP0106164LE 0.6,1.0MM MINI DOUBLE Y PLATE LONG EXTENDED 8HOLE 2905 FPP0106181LE LOW PROFILE ORBITA PLATE CURVE 6,8 HOLE 0.6MM REGULAR 2222 FPP0106214M3 TITANIUM 0.6MM MINI PLATE L SHAPE 1937 FPP0106763M3 0.6MM,1.0MM TIANIUM LOW PROFILE MINI PLATE DOUBLE Y 6HOLE 2469 FPP010677NLE MINI T PLATE 5 HOLE 2076 FPP0106906M3 TITANIUM 0.6MM LOW PROFILE MINI PLATE ORBITA SHAPE 6,8 HOLES 2222 FPP0108216LE 1.0MM MINI BONE PLATE 16HOLE REGULAR STR 2038 FPP0108260LE 1.0MM MINI DOUBLE Y PLATE REGULAR 6HOLE 2905 FPP0110000EJ 2.0 MM MINI "L" PLATE 90 DEGREE, 4 HOLE 1923 FPP0110001EJ 2.0 MM MINI "L" PLATE 4 HOLE 1923 FPP0110002EJ 2.0 MM MINI ZED PLATE 4 HOLE 2170 FPP0110003EJ 2.0 MM MINI "Y" PLATE 7 HOLE 2022 FPP0110021EJ 2.0 MM MINI L PLATE 4 HOLE 1923 FPP0110022EJ 2.0 MM MINI ZED PLATE 4 HOLE 2170 FPP0110023EJ 2.0 MM MINI Y PLATE 7 HOLE 2022 FPP0110030EJ 2.0 MM MINI STRAIGHT PLATE 4 HOLE 1207 FPP0110032EJ 2.0 MM MINI STRAIGHT PLATE 10 HOLE 1284 287

特材代碼中英文品名支付點數 FPP0110034EJ 2.0 MM MINI STRAIGHT PLATE 16 HOLE 2038 FPP0110036EJ 2.0 MM MINI T PLATE 5 HOLE 2076 FPP0110039EJ 2.0 MM MINI LARGE BUR HOLE PLATE 6 HOLE 6400 FPP0110052EJ 2.0 MM MINI X PLATE 4 HOLE 2469 FPP0110103LE 1.0MM MINI BONE PLATE 4HOLE LONG STR 1207 FPP0110106LE 0.6,1.0MM MINI BONE PLATE 6HOLE LONG STR 1415 FPP0110230EJ 2.0 MM MINI STRAIGHT PLATE 4 HOLE 1207 FPP0110232EJ 2.0 MM MINI STRAIGHT PLATE 10 HOLE 1284 FPP0110235EJ 2.0 MM MINI I PLATE 4 HOLE 2379 FPP0110236EJ 2.0 MM MINI Y PLATE 5 HOLE 2022 FPP0110239EJ 2.0 MM MINI DOUBLE Y PLATE 6 HOLE 2469 FPP011051NLE MINI PLATE 16 HOLE 2038 FPP011054NLE MINI PLATE 4 HOLE 1207 FPP011056NLE MINI PLATE 6 HOLE 1284 FPP011057NLE MINI STRAIGHT PLATE 8 HOLE 1284 FPP01105NNLE MINI LOCKING STRAIGHT PLATE 16 HOLES 2038 FPP011067NLE MINI PLATE 4 HOLE W/BAR 1207 FPP0111031EJ 2.0 MM MINI STRAIGHT PLATE 6 HOLE 1284 FPP0111032EJ 2.0 MM MINI STRAIGHT PLATE 8 HOLE 1284 FPP0114008EJ 2.0 MM MINI TR BSSO PLATE 4 HOLE 2379 FPP0120211Y2 MINI PLATE 1.0MM 4HOLE STR 1207 FPP0120213Y2 MINI PLATE 1.0MM 8HOLE STR 1284 FPP0120216Y2 MINI PLATE 1.0MM 16HOLE STR 2038 FPP0120221Y2 MINI PLATE 1.0MM 4HOLE L-SHAPE 1923 FPP0120231Y2 MINI PLATE 1.0MM 5HOLE T-SHAPE 80,90 度 2076 FPP0120241Y2 MINI PLATE 1.0MM 5HOLE DOUBLE T-SHAPE 2379 288

特材代碼中英文品名支付點數 FPP0120246Y2 MINI PLATE 1.0MM 6HOLE Y-SHAPE 2022 FPP0120251Y2 MINI PLATE 1.0MM 6HOLE DOUBLE Y-SHAPE 2469 FPP0120256Y2 MINI NASAL BONE PLATE 1.0MM 4560 FPP0147004S1 MINI PLATE 1.5/2.0 2:4HOLE 16:28MM 1207 FPP0147016S1 MINI PLATE 2.0 6HOLE 35:40MM 1415 FPP0147018S1 2.0MM MANDIBLE MINI PLATE 6HOLE,70D( 轉 70 度 ) TWISTED 40MM 2670 FPP0147100S1 ADAPTION MINI PLATE 1.5,2.0 20HOLE STR 2038 FPP0147220S1 ORBITAL RIM PLATE 1.5,2.0 CURVED 8:12 HOLES 2222 FPP01475NNS1 L- PLATE 1.5,2.0 5:10 HOLES 1937 FPP0147620S1 Y- PLATE 1.5,2.0 5:8 HOLES 2154 FPP0147680S1 DOUBLE Y-PLATE 2.0 8HOLE 2905 FPP0147810S1 X-PLATE 1.5,2.0 4 HOLES 2508 FPP0147850S1 MINI H-PLATE 2.0 8:9 HOLES 4930 FPP0147910S1 MINI BURR HOLE COVER 1.5,2.0 6 HOLES 6400 FPP0151004M3 TITANIUM 0.6MM,1.0MM MINI PLATE 4 HOLES STR 1207 FPP0151006M3 TITANIUM 0.6MM,1.0MM MINIP LATE 6 HOLES STR 1300 FPP0151008M3 TITANIUM 0.6MM,1.0MM MINIP LATE 8HOLE STR 1504 FPP0151016M3 TITANIUM 0.6MM,1.0MM MINI PLATE 16 HOLE STR 2038 FPP0152014M3 TITANIUM 1.0MM MINI PLATE L SHAPE 4 HOLE 1937 FPP0152414M3 TITANIUM 0.6MM,1.0MM MINI PLATE L SHAPE 4HOLE 1937 FPP0152520M3 TITANIUM0.6MM,1.0MM MINI PLATE 110 度 4HOLE 1937 FPP0154015M3 TITANIUM 0.6MM,1.0MM MIN IPLATE T SHAPE 90 度 4HOLE 2190 FPP0154315M3 TITANIUM 0.6MM,1.0MM MINI PLATE T SHAPE 80 度 4HOLE 2190 FPP0154816M3 TITANIUM 0.6MM,1.0MM MINI PLATE DOUBLE T SHAPE 90 度 4,6HOLE 2379 FPP0155015M3 TITANIUM0.6MM,1.0MM MINI PLATE Y SHAPE 5HOLE 2154 FPP0156016M3 TITANIUM 0.6MM,1.0MM MINI PLATE DOUBLE Y SHAPE 6HOLE 2905 289

FPP0156217M3 TITANIUM 0.6MM,1.0MM MINI PLATE DOUBLE Y SHAPE 7HOLE 2905 FPP0157012M3 TITANIUM 0.6MM,1.0MM MINI PLATE H SHAPE 12HOLE 4560 FPP0187004MC TITANIUM 1MM MINI PLATE 4HOLE STR 1207 FPP0187005MC TITANIUM 1MM MINI PLATE 5HOLE STR 1207 FPP0187006MC TITANIUM 1MM MINI PLATE 6 HOLE STR 1365 FPP0187008MC TITANIUM 1MM MINI PLATE 8 HOLE STR 1504 FPP0187014MC TITANIUM 1MM MINI PLATE 4 HOLE 9MM STR 1207 FPP0187024MC TITANIUM 1MM MINI PLATE 4 HOLE 12MM STR 1207 FPP0187031MC TITANIUM 1MM MINI L-PLATE RIGHT 9MM 4 HOLE 1923 FPP0187032MC TITANIUM 1MM MINI L-PLATE LEFT 9MM 4 HOLE 1923 FPP0187033MC TITANIUM 1MM MINI L-PLATE R 9MM 4 HOLE 1923 FPP0187034MC TITANIUM 1MM MINI L-PLATE LEFT 12MM 4 HOLE 1923 FPP0187035MC TITANIUM 1MM MINI L-PLATE RIGHT 12MM 4 HOLE 1923 FPP0187042MC TITANIUM 1MM MINI L-PLATE LEFT 9MM 4 HOLE 1923 FPP0187053MC TITANIUM 1MM MINI Y PLATE 9MM 4 HOLE 2022 FPP0187054MC TITANIUM 1MM MINI Y PLATE 12MM 4HOLE 2022 FPP0187055MC TITANIUM 1MM MINI DOUBLE Y PLATE 9MM 6HOLE 2469 FPP0187077MC TITANIUM 1MM MANDIBULAR ANGLE PLATE 4HOLE LEFT 2170 FPP0187078MC TITANIUM 1MM MINI MANDIBULAR ANGLE PLATE 4HOLE RIGHT 2170 FPP0187079MC TITANIUM 1MM MINI MANDIBULAR ANGLE PLATE 6HOLE LEFT 2450 FPP0187080MC TITANIUM 1MM MINI MANDIBULAR ANGLE PLATE 6HOLE RIGHT 2450 FPP0187085MC 1MM MINI TI-ORBITA PLATE 12MM 4HOLE 2222 FPP0187424MC TITANIUM 1MM MINI PLATE 4 HOLE 10MM STR 1207 FPP0189501MC TITANIUM MANDIBULAR RECONSTRUCTION PLATE STRAIGHT 100MM 2MM 4900 FPP0189512MC TITANIUM MANDIBULAR RECONSTRUCTION PLATE ANGLE 105MM 2MM 14HOLE R/L 8836 FPP01A7072WR 0.6MM MINI L-PLATE 100 度 4-6 HOLE 1.5MM 1923 290

特材代碼中英文品名支付點數 FPP01A7106WR MINI PREFORMED ORBITAL FLOOR PLATE 8220 FPP01A7120WR MINI X-PLATE REGULAR 4 HOLE 2469 FPP01A7135WR 0.6MM NASAL H PLATE, REGULAR 12HOLE 4560 FPP01A7316WR MESH BURR HOLE PLATE 1.5MM 6400 FPP01A7345WR NEURO MINI PLATE STRAIGHT 2 HOLE 1.5MM 1207 FPP01A8046WR 0.6MM MINI BONE PLATE, MEDIUM 2 HOLE STRAIGHT 2.0MM 1207 FPP01A8057WR 0.6MM MINI L-PLATE 5 HOLE 1923 FPP01A8068WR MINI BURR HOLE PLATE 6400 FPP01A8081WR 0.6MM MINI Z PLATE 4 HOLE 2170 FPP01A9204WR 0.6,1.0MM MINI BONE PLATE 4 HOLE STRAIGHT 1207 FPP01A9206WR 0.6,1.0MM MINI BONE PLATE 6 HOLE STRAIGHT 1284 FPP01A9207WR 0.6,1.0MM MINI BONE PLATE 6 HOLE LONG STRAIGHT 1284 FPP01A9208WR 0.6,1.0MM MINI BONE PLATE 8 HOLE STRAIGHT 1284 FPP01A9215WR 1.0MM MINI BONE PLATE, EXTRA LONG 4 HOLE STRAIGHT 2.0MM 1207 FPP01A9216WR 0.6;1.0MM MINI BONE PLATE 16 HOLE STRAIGHT 2038 FPP01A9226WR 0.6;1.0MM MINI ORBITAL PLATE 6:10HOLE 2222 FPP01A9228WR MINI PLATE, 6-8 HOLE ANGLE 2.0MM 2450 FPP01A9230WR 0.6;1.0MM MINI L-PLATE 4 HOLE 1923 FPP01A9235WR MINI V PLATE, 9 HOLE 2.0MM 4560 FPP01A9240WR 0.6;1.0MM MINI T PLATE 5:7 HOLE 2076 FPP01A9250WR 0.6;1.0MM MINI Y PLATE 5 HOLE 2022 FPP01A9260WR 0.6,1.0MM MINI DOUBLE Y PLATE 6:8HOLE 2469 FPP01A9264WR 0.6;1.0MM MINI L-PLATE 6 HOLE 1923 FPP01A9294WR 0.6;1.0MM MINI DOUBLE T-PLATE 4,6 HOLE 2379 FPP0208732LE BRIDGING PLATE STR 6:10HOLE 2.8MM ( 型號 5620006,8,5629008,10 自 92/1/1 生效 ) 3918 FPP0208733LE BRIDGING PLATE STRAIGHT 11HOLE(4+3+4HOLE) 2.8MM 5370 291

FPP0208734LE BRIDGING PLATE STR 11:17 H (5620011:7,8003:11,3,9012:6,5415070,5633034:139 92/1/1 生效 ) 適應症見備 5870 註 FPP0208735LE BRIDGING PLATE STRAIGHT 13HOLE(4+5+4HOE)2.8MM 5870 FPP0208736LE BRIDGING PLATE STRAIGHT 14HOLE(4+6+4HOLE)2.8MM 5870 FPP0208737LE BRIDGING PLATE STRAIGHT 15HOLE(4+7+4HOLE)2.8MM 5870 FPP0208743LE BRIDGING PLATE ANGLE LEFT 11HOLE(4+3+4HOLE)2.8MM ( 型號 5415076 自 92/1/1/ 生效 ) 7920 FPP0208745LE BRIDGING PLATE L-ANGLE 12:21H( 型號 5620048:59,8025:87,9038:76 自 92/1/1 生效 ) 8836 FPP0208747LE BRIDGING PLATE ANGLE LEFT 15HOLE(4+7+4HOLE)2.8MM 8836 FPP0208749LE BRIDGING PLATE ANGLE LEFT 17HOLE (4+9+4HOLE)2.8MM 8836 FPP0208753LE BRIDGING PLATE ANGLE RIGHT 11HOLE(4+3+4HOLE)2.8MM 7920 FPP0208755LE BRIDGING PLATE ANGLE RIGHT 13HOLE(4+5+4HOLE)2.8MM 8836 FPP0208757LE BRIDGING PLATE ANGLE RIGHT 15HOLE(4+7+4HOLE)2.8MM 8836 FPP0208759LE BRIDGING PLATE ANGLE RIGHT 17HOE(4+9+4HOLE)2.8MM 8836 FPP0208770LE CONDYLAR IMPLANT LEFT 14MM 9007 FPP0208771LE CONDYLAR IMPLANT RIGHT 14MM 9007 FPP021552NLE ANGLE PLATE 6-10 HOLE 7920 FPP021591NLE RECON PLATE STRAIGHT 11-24 HOLE 4900 FPP021592NLE RECON PLATE HEMI/FULL 9007 FPP0220511Y2 COMPRESSION PLATE 1.6MM 4,8HOLE STR 3918 FPP0220518Y2 COMPRESSION PLATE 1.6MM 16HOLE STR 4900 FPP0220521Y2 COMPRESSION PLATE 1.6MM 4HOLE STR/ 斜孔 3918 FPP0220610Y2 TOTAL MANDIBULAR BRIDGING STR PLATE 3.0MM(4+9+4) HOLE 19060 FPP0220611Y2 MANDIBULAR BRIDGING STR PLATE 3.0MM(4+2+4) HOLE 3918 FPP0220612Y2 MANDIBULAR BRIDGING STR PLATE 3.0MM(4+3,4,5,6,7+4)HOLE 4900 FPP0220621Y2 MANDIBULAR BRIDGING STR PLATE 3.0MM(4+3,5,7,9+4)HOLE 7920 FPP0240008M3 TITANIUM RECONSTRUCTION PLATE 8HOLE STR 3918 FPP0240010M3 TITANIUM RECONSTRUCTION PLATE 10:14HOLE STR 5870 292

FPP0240016M3 TITANIUM RECONSTRUCTION PLATE 16,18HOLE STR 5870 FPP0240028M3 TITANIUM RECONSTRUCTION PLATE 5+8HOLE ANG 7920 FPP0240032M3 TITANIUM RECONSTRUCTION PLATE 5+12HOLE ANG 8836 FPP0240036M3 TITANIUM RECONSTRUCTION PLATE 5+16HOLE,5+20HOLE ANG 8836 FPP0240080M3 TITANIUM RECONSTRUCTION PLATE 5+20+5HOLE COMPLETE MANDIBLE 19060 FPP024009KM3 TITANIUM CONDYLAR PROTHESIS W/2 FIXATION HOLES 9007 FPP0241509LE COMPRESSION PLATE ANGLE 4HOLE 7920 FPP0249630S1 2.4MM RECONSTRUCTION PLATE STRAIGHT 12HOLE 95MM 5870 FPP0249720S1 2.4MM RECONSTRUCTION PLATE STRAIGHT 20:24HOLE 159MM 5870 FPP024988NS1 2.4MM RECONSTRUCTION PLATE ANGLED 18:27HOLE 146MM 8836 FPP025633NLE TOTAL BRIDGING PLATE 25:30HOLE( 型號含 5633154:69) 19060 FPP0269502MC TITANIUM MANDIBULAR RECONSTRACTION PLATE 14HOLE 4900 FPP0269510MC TITANIUM MANDIBULAR RECONSTRACTION PLATE ANGLE 12HOLE 7920 FPP02A4506WR 2.4 LOCKING RECON PLATES6,12 HOLE 4900 FPP02A4507WR 2.0 LOCKING FRACTURE PLATES 6 HOLE,ANGLE 7920 FPP02A4518WR 2.4 LOCKING RECON PLATES 18,24 HOLE 4900 FPP02A4540WR 2.4 LOCKING RECON 5+11 PLATES,ANGLE 7920 FPP02A4542WR 2.4 LOCKING RECON 5+22 PLATES,ANGLE 7920 FPP02A4544WR 2.4 LOCKING RECON PLATE,DOUBLE ANGLE 19060 FPP0308640LE FRACTURE PLATE 4:8HOLE 35MM 1.8MM( 型號 5415-031:064,081:084 自 92/1/1 生效 ) 3918 FPP0308642LE FRACTURE PLATE 4 HOLE 40MM 1.8MM 3918 FPP0308644LE FRACTURE PLATE 4 HOLE 50MM 1.8MM 3918 FPP0308650LE FRACTURE PLATE 8 HOLE 60MM 1.8MM 3918 FPP0308652LE FRACTURE PLATE 8 HOLE 70MM 1.8MM 3918 FPP0308660LE MAND ANGLE PLATE 60 R "TS 1.8MM 4560 FPP0308670LE FRACTURE PLATE 4H 35MM 1.8MM STR 3918 293

特材代碼中英文品名支付點數 FPP0308672LE FRACTURE PLATE 4H 40MM 1.8MM STR 3918 FPP0308674LE FRACTURE PLATE 4H 50MM 1.8MM STR 3918 FPP0315064LE MANDIBULAR COMPRESSION PLATE 8HOLE 3918 FPP0315070LE MANDIBULAR COMPRESSION PLATE 14HOLE 4900 FPP0315131M3 MRS FRACTURE BONE PLATE 4:8HOLE STR 3918 FPP0315170M3 MRS FRACTURE BONE PLATE 14HOLE STR 4900 FPP031550NLE COMPRESSION PLATE 2-10 HOLE 3918 FPP0320526Y2 COMPRESSION PLATE 1.6MM 4HOLE STR/60 度 4560 FPP03434NNS1 2.0MM ZYGOMATIC DCP 4:6HOLE STR 3918 FPP0349038S1 DCP 2.0 7:8 HOLES 3918 FPP0349110S1 TENSION BAND PLATE 2.0,2.4 4:6HOLE STR 22:35MM 3918 FPP0349160S1 2.4MM LC-DCP STRAIGHT 4:6HOLE 36:52MM 3918 FPP0349236S1 2.4MM LIMITED CONTACT-DCP ECCENTRIC 4:6HOLE 36:52MM 4560 FPP0349260S1 2.4MM LC-DCP CURVED 4:6HOLE 35:50MM 4560 FPP0349380S1 UNIVERSAL FRACTURE PLATE 2.4 STRAIGHT 8 HOLES 3918 FPP0349400S1 UNIVERSAL FRACTURE PLATE 2.4 STRAIGHT 10 HOLES 3918 FPP0349424S1 UNIVERSAL FRACTURE PLATE 2.4 STRAIGHT 24 HOLES (447.021 自 90/10/01 生效 ) 5870 FPP034944NS1 UNIVERSAL FRACTURE PLATE 2.4 ANGLED 20:27 HOLES 8836 FPP034984NS1 UNIVERSAL FRACTURE PLATE 2.4 ANGLED 6:10 HOLES 7920 FPP035415NLE MANDIBULAR COMPRESSION PLATE 4:6HOLE 3918 FPP0358104M3 MINIPLATE JALLUT GLIDING 4HOLE 3918 FPP0389601MC 1.7MM MINI MANDIBULAR FRACTURE PLATE 4,6HOLE STR 3918 FPP0389604MC 1.7MM MINI MANDIBULAR FRACTURE PLATE 8HOLE STR 3918 FPP0389605MC 1.7MM MINI MANDIBULAR FRACTURE PLATE 16HOLE STR 5870 FPP03A1060WR 2.4 FRACTURE PLATES 16 HOLE 4900 FPP03A1068WR 2.4 FRACTURE PLATES,6 HOLE CURVED 7920 294

特材代碼中英文品名支付點數 FPP03A4504WR 2.0 LOCKING FRACTURE PLATES 4,6 HOLE 3918 FPP03A4516WR 2.0 LOCKING FRACTURE PLATES 16 HOLE 4900 FPP03A9282WR COMPRESSION STRAIGHT PLATE, 4,6,8 HOLE 3918 FPP03C1050WR 1.8MM FRACTURE PLATE, STRAIGHT 4,6,8 HOLE 3918 FPP03C1064WR 1.8MM FRACTURE PLATE, 6,8 HOLE ANGLED 7920 FPP03C1068WR 1.8MM FRACTURE PLATE, 6 HOLE CURVED 2450 FPP0606310LE TITAN MINI 3-D BONE PLATE 2X2 HOLES SQUARE 0.6MM 4053 FPP0606312LE TITAN MINI 3-D BONE PLATE 2X2 HOLES RECTANGULAR SEGMENT 0.6MM 4053 FPP0606320LE TITAN MINI 3-D BONE PLATE 3X2 HOLES SQUARE SEGMENT 0.6MM 6240 FPP0606322LE TITAN MINI 3-D BONE PLATE 3X2 HOLES RECTANGULAR SEGMENT 0.6MM 6240 FPP0606332LE TITAN 3-D BONE PLATE 4X2 HOLES RECTANGULAR SEGMENT 0.6MM 8220 FPP0610054EJ 2.0 MM MINI SQUARE PLATE 4 HOLE 4053 FPP0610310LE TITAN MINI 3-D BONE PLATE 2X2 HOLES SQUARE SEGMENT 1.0MM 4053 FPP0610312LE TITAN MINI 3-D BONE PLATE 2X2 HOLES RECTANGULAR SEGMENT 1.0MM 4053 FPP0610322LE TITAN MINI 3-D BONE PLATE 3X2 HOLES RECTANGULAR SEGMENT 1.0MM 6240 FPP0610330LE TITAN MINI 3-D BONE PLATE 4X2 HOLES SQUARE SEGMENT 1.0MM 8220 FPP0610332LE TITAN MINI 3-D BONE PLATE 4X2 HOLES RECTANGULAR SEGMENT 1.0MM 8220 FPP0610532LE 3 D PLATE 3X2 HOLE 6240 FPP0610542LE 3 D PLATE 4X2 HOLE 8220 FPP0610562LE 3 D PLATE 6X2 HOLE 12480 FPP0620261Y2 MINI H-SHAPE(3-D)PLATE 2X2 HOLE 4053 FPP0620262Y2 MINI 1.0MM H-SHAPE(3-D)PLATE 3X2 HOLE 6240 FPP0620263Y2 MINI 1.0MM H-SHAPE(3-D)PLATE 4X2 HOLE 8220 FPP0620266Y2 MINI 1.0MM H-SHAPE(3-D)PLATE 2X2 HOLE 4053 FPP0620267Y2 MINI 1.0MM H-SHAPE(3-D)PLATE 3X2 HOLE 6240 FPP0620268Y2 MINI 1.0MM H-SHAPE(3-D)PLATE 4X2 HOLE 8220 295

FPP0657710M3 MINI 2000 CAD 4 HOLE PLATE SQUARE,RECTANGULAR 0.6MM,1.0MM 4053 FPP0657720M3 MINI 2000 CAD 6 HOLE PLATE SQUARE,RECTANGULAR 0.6MM,1.0MM 6240 FPP0657730M3 MINI 2000 CAD 8 HOLE PLATE SQUARE,RECTANGULAR 0.6MM,1.0MM 8220 FPP06A7131WR NEURO SQUARE PLATE 4053 FPP06A7132WR NEURO TRIANGLE PLATE 4773 FPP06A7136WR 1.5MM MINI MATRIX PLATE 2X3 HOLE 6240 FPP06A7137WR 1.5MM MINI MATRIX PLATE 2X4 HOLE 8220 FPP06A7357WR 1.5MM NEURO PLATE,2X2 HOLE 4053 FPP06A9270WR 2.0MM MINI MATRIX,2X2 HOLE 4053 FPP06A9274WR 2.0MM MINI MATRIX,2X4 HOLE 8220 FPP06A9278WR 2.0MM MINI MATRIX,2X6 HOLE 12480 FPP06A9281WR 2.0MM MINI MATRIX,2X8 HOLE 12480 FPP0706104M3 MONDEAL TITANIUM 0.6MM MICRO 1200 PLATE 4HOLE STR 限顏面骨折患者使用 3048 FPP0706106M3 MONDEAL TITANIUM 0.6MM MICRO 1200 PLATE 6HOLE STR 3300 FPP0706107M3 MICRO 1200 TITANIUM STR PLATE 6HOLE 7.5MM 2993 FPP0706108M3 MONDEAL TITANIUM 0.6MM MICRO 1200 8HOLE PLATE STR 3300 FPP0706114M3 MICRO 1200 TITANIUM STR PLATE 4HOLE 6MM:9MM 2830 FPP0706116M3 MONDEAL TITANIUM 0.6MM MICRO 1200 16HOLE PLATE STR 5605 FPP0706120M3 MONDEAL TITANIUM 0.6MM MICRO 1200 L PLATE 5,8HOLE 4970 FPP0706124M3 MONDEAL TITANIUM 0.6MM MICRO 1200 L PLATE 4HOLE 4431 FPP0706126M3 MONDEAL TITANIUM 0.6MM MICRO 1200 L PLATE 5HOLE 4970 FPP0706141M3 MONDEAL TITANIUM 0.6MM MICRO 1200 T PLATE 7 HOLE 限顏面骨折患者使用 5543 FPP0706142M3 MONDEAL TITANIUM 0.6MM MICRO 1200 T PLATE 4 HOLE 4816 FPP0706144M3 MONDEAL TITANIUM 0.6MM MICRO 1200 H PLATE 9,14HOLE 限顏面骨折患者使用 6622 FPP0706160M3 MONDEAL TITANIUM 0.6MM MICRO 1200 Y PLATE 6 HOLE 5564 FPP0706162M3 MONDEAL TITANIUM 0.6MM MICRO 1200 X PLATE 6,7 HOLE 6818 296

FPP0706174M3 MONDEAL TITANIUM 0.6MM MICRO 1200 Y PLATE 4 HOLE 5308 FPP0706182M3 MONDEAL TITANIUM 0.6MM MICRO 1200 ORBITAL 8HOLE 5210 FPP0706204LE MICROPLUS BONE PLATE 0.55MM 4 HOLE STR 3048 FPP0706206LE MICROPLUS BONE PLATE 0.55MM 6 HOLE STR 3300 FPP0706208LE MICROPLUS BONE PLATE 0.55MM 8 HOLE STR 3300 FPP0706209LE MICROPLUS BONE PLATE 0.55MM 12 HOLE STR 5605 FPP0706210LE MICROPLUS BONE PLATE 0.55MM 16HOLE STR 5605 FPP0706211LE MICROPLUS BONE PLATE 0.55MM 24 HOLE STR 5605 FPP0706220LE MICROPLUS BONE PLATE 0.55MM L SHAPE 5 HOLE 4970 FPP0706222LE MICROPLUS BONE PLATE 0.55 MM L SHAPE 8 HOLE 5118 FPP070622NLE MICRO STRAIGHT PLATE 24HOLE 5170 FPP070623NLE MICRO 3D PLATE 2X2 HOLE 4053 FPP0706240LE MICROPLUS BONE PLATE 0.55MM T SHAPE 5 HOLE 90 DE 5360 FPP0706241LE MICROPLUS BONE PLATE 0.55MM T SHSPE 7 HOLE 90 DE 5543 FPP0706244LE MICROPLUS BONE PLATE 0.55MM DOUBLE T SHAPE 9 HOLE 6622 FPP0706246LE MICROPLUS BONE PLATE 0.55MM DOUBLE T SHAPE 14 HOLE 6622 FPP0706249LE MICROPLUS BONE PLATE 0.55MM DOUBLE T SHAPE 7 HOLE 6040 FPP070624NLE MICRO DOUBLE Y PLATE 7HOLE 6040 FPP070625NLE MICRO ORBITA PLATE 4,10 HOLE 4970 FPP0706260LE MICROPLUS BONE PLATE 0.55MM Y SHAPE 6 HOLE 5564 FPP0706262LE MICROPLUS BONE PLATE 0.55MM DOUBLE Y SHAPE 6 HOLE 6818 FPP0706263LE MICROPLUS BONE PLATE 0.55MM DOUBLE Y SHAPE 7 HOLE 6818 FPP070626NLE MICRO L PLATE 8HOLE 4431 FPP0706270LE MICROPLUS BURR 0.55MM H COVERING & BONE FLAP FIXATION PLATE 7,10,14MM 6616 FPP070627NLE MICRO T PLATE 7HOLE 4816 FPP0706282LE MICROPLUS BONE PLATE 0.55MM ORBITA PLATE 8 HOLE CURVED 5210 297

FPP0706303M3 MONDEAL TITANIUM 0.6MM MICRO 1200 CAD PLATE 3 HOLE,4HOLE SQUARE 4773 FPP0706325M3 MONDEAL TITANIUM 0.6MM MICRO 1200 CAD PLATE 6HOLE 6942 FPP0706335M3 MONDEAL TITANIUM 0.6MM MICRO 1200 CAD PLATE 8HOLE 8654 FPP070633NLE MICRO 3D PLATE 6X2 HOLE 12340 FPP070637NLE MICRO MALLEABLE BURR HOLE COVER PLATE 7,10,14MM 6616 FPP0706415LE MICROPLUS BONE PLATE 0.55MM 4(2X2)HOLE SQUARE SEGMENTS,REGANG ULAR SEGMENT 4773 FPP0706425LE MICROPLUS BONE PLATE 0.55MM 6(3X2)HOLE SQUARE,RECTANG ULAR SEAGMENT 6942 FPP0706435LE MICROPLUS BONE PLATE 0.55MM 8(4X2)HOLE SQUARE,REGANG ULAR SEGMENT 8654 FPP0706445LE MICROPLUS BONE PLATE 0.55MM 16(4X4)HOLE SQUARE SEGMENTS 12340 FPP0706467LE TITANIUM MICRO 3-D PLATE 0.55MM 6X4HOLE 13460 FPP0707007M3 MICRO BURR HOLE COVER PLATE 7:14MM 6616 FPP0712003EJ M4 RIGID FIXATION SYSTEM 7, 11 HOLE Y PLATE, 0.5MM 5308 FPP0712006EJ M4 RIGID FIXATION SYSTEM 6 HOLE LARGE, SMALL BUR HOLE PLATE, 0.5MM 6616 FPP0712032EJ M4 RIGID FIXATION SYSTEM 6 HOLE H PLATE, 0.5MM 6040 FPP0712034EJ M4 RIGID FIXATION SYSTEM 18 HOLE STRAIGHT PLATE, 0.55MM 5170 FPP0712036EJ M4 RIGID FIXATION SYSTEM 12 HOLE CURVED PLATE, 0.55MM 4970 FPP0712038EJ M4 RIGID FIXATION SYSTEM 5 HOLE STRAIGHT PLATE, 0.5MM 2830 FPP0712039EJ M4 RIGID FIXATION SYSTEM 10 HOLE STRAIGHT PLATE, 0.5MM 2993 FPP0712045EJ M4 RIGID FIXATION SYSTEM 4 HOLE 13, 16 MM LEFT, RIGHT L PLATE, 0.5MM 4431 FPP0712046EJ M4 RIGID FIXATION SYSTEM 2X4 HOLE QUAD PLATE, 0.5MM 8654 FPP0712052EJ M4 RIGID FIXATION SYSTEM 5 HOLE19 MM T PLATE, 0.5MM 4816 FPP0712068EJ M4 RIGID FIXATION SYSTEM 5 HOLE X PLATE, 0.5MM 6040 FPP0712086EJ M4 RIGID FIXATION SYSTEM ORBITAL FLOOR PLATE 0.35MM;0.25MM 14160 FPP0712104EJ M4 RIGID FIXATION SYSTEM MICRO 6 HOLE DOUBLE Y PLATE, 0.5MM 6040 FPP0712130EJ M4 RIGID FIXATION SYSTEM MICRO 4 HOLE STRAIGHT PLATE, 0.5MM 2830 FPP0712312EJ M4 RIGID FIXATION SYSTEM MICRO 6, 8 HOLE STRAIGHT PLATE, 0.5MM 2993 298

特材代碼中英文品名支付點數 FPP0720010S1 MICRO STRUT PLATE 16:22HOLE( 網狀 ) 12340 FPP0720100S1 MICRO 0.5MM ADAPTION PLATE 24HOLES( 型號 420.100 另編代碼 FPP072010N) 5605 FPP072010NS1 MICRO 0.5MM ADAPTION PLATE 34HOLE 7430 FPP0720111Y2 MICRO PLATE 0.6MM 4HOLE STR 2830 FPP0720112Y2 MICRO PLATE 0.6MM 6,8HOLE STR 2993 FPP0720114Y2 MICRO PLATE 0.6MM 12,16,24HOLE STR 5170 FPP0720121Y2 MICRO PLATE 0.6MM 5,8HOLE L-SHAPE 4431 FPP0720131Y2 MICRO PLATE 0.6MM 5,7HOLE T-SHAPE 4816 FPP0720135Y2 MICRO PLATE 0.6MM 6HOLE Y-SHAPE 5308 FPP0720136Y2 MICRO PLATE 0.6MM 6,7HOLE DOUBLE Y-SHAPE 6040 FPP0720141Y2 MICRO ORBITA PLATE 0.6MM 8HOLE 4970 FPP0720150Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 2X2 HOLE 4773 FPP0720151Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 3X2 HOLE 6942 FPP0720152Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 4X2 HOLE 8654 FPP0720153Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 4X4 HOLE 12340 FPP0720154Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 6X4 HOLE 13460 FPP0720155Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 2X2 HOLE 4773 FPP0720156Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 3X2 HOLE 6942 FPP0720157Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 4X2 HOLE 8654 FPP0720158Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 4X4 HOLE 12340 FPP0720159Y2 MICRO 0.6MM H-SHAPE(3-D)PLATE 6X4 HOLE 13460 FPP072016NY2 MICRO BURR HOLES PLATE 0.6MM 7:14MM 6616 FPP0720210S1 MICRO 0.5MM ORBITAL RIM PLATE CURVED 8:12HOLE 5210 FPP07204NNS1 MICRO ORBITAL FLOOR PLATE UNIVERSAL/L/R (421.040,044,045 自 89/10/1 生效 ) 14160 FPP07205NNS1 MICRO 0.5MM L-PLATE 5:9HOLE 4970 FPP0720620S1 MICRO 0.5MM Y-PLATE 5:13HOLE 5564 299

FPP0720680S1 MICRO 0.5MM DOUBLE Y-PLATE 6HOLE( 型號 421.068,069 自 89/10/1 生效 ) 6818 FPP0720710S1 MICRO 0.5MM T-PLATE 7:12HOLE 5543 FPP0720810S1 MICRO 0.5MM X-PLATE 4HOLE 6040 FPP0720850S1 MICRO 0.5MM H-PLATE 6:11HOLE 6622 FPP0720910S1 TITANIUM MICRO BURR HOLE COVER 6616 FPP0721024S1 MICRO 0.5MM PLATE 2:4HOLE STR 3048 FPP0721096S1 MICRO BOX PLATE 4 HOLES 4773 FPP0750306S1 CRANIAL PLATE 2:4HOLE 2830 FPP075030NS1 MICRO T PLATE 3+4HOLE 0.5:0.8MM 4816 FPP075031NS1 ORBITAL RIM PLATE 12HOLE 0.4:0.7MM 4970 FPP075032NS1 MICRO ADAPTION PLATE 20HOLE 0.4:0.8MM 5170 FPP075033NS1 MICRO Y PLATE (3+2HOLE) 0.4:0.7MM 5308 FPP075034NS1 MICRO DOUBLE Y PLATE 6HOLE 0.4:0.7MM 6040 FPP075035NS1 MICRO BOX PLATE 4HOLE 0.4:0.7MM 4053 FPP075036NS1 MICRO X PLATE 4HOLE 0.4:0.7MM 6040 FPP075037NS1 MICRO STRUT PLATE 18HOLE 0.4:0.7MM 12340 FPP075038NS1 MICRO L PLATE 3+2HOLE 0.5:0.8MM 4431 FPP075039NS1 MICRO L PLATE 3+4HOLE;4+6HOLE 0.5:0.8MM 4431 FPP07503FNS1 ORBITAL FLOOR MESH PLATE 0.2:0.4MM 14160 FPP07503HNS1 MICRO H PLATE 11HOLE 0.5:0.8MM 6040 FPP07503NNS1 ANATOMICAL ORBITAL FLOOR PLATE 14160 FPP07503XNS1 UNIVERSAL ORBITAL FLOOR PLATE 0.4:0.5MM 14160 FPP075403NLE ORBITAL FLOOR PLATE 14160 FPP0788704MC MICRO PLATE 4 HOLE 6.0,4.5MM 0.6MM STR 2830 FPP0788706MC MICRO PLATE 6 HOLE 0.6MM STR 2993 FPP0788708MC MICRO PLATE 8 HOLE 0.6MM STR 3300 300

特材代碼中英文品名支付點數 FPP0788734MC MICRO PLATE 4HOLE 7.5,9MM 0.6MM STR 3048 FPP0788745MC MICRO PLATE 4HOLE 12MM 0.6MM STR 3048 FPP0788747MC MICRO PLATE 6HOLE 7.5MM 0.6MM STR 3300 FPP0788748MC MICRO PLATE 6HOLE 12MM 0.6MM STR 3300 FPP0788750MC MICRO L-PLATE 4HOLE 7.5,9MM 0.6MM LEFT,RIGHT 4431 FPP0788754MC MICRO L-PLATE 6HOLE 12MM 0.6MM LEFT,RIGHT 4970 FPP0788760MC MICRO T-PLATE 4HOLE 7.5,9MM 0.6MM 4816 FPP0788764MC MICRO T-PLATE 5HOLE 12MM 0.6MM 5360 FPP0788765MC TITANIUM MICRO 0.6MM H-PLATE 9HOLE 限顏面骨折患者使用 6622 FPP0788770MC TITANIUM 0.6MM MICRO Y-PLATE 4HOLE 8,12,15MM 5308 FPP0788774MC TITANIUM 0.6MM MICRO DOUBLE Y-PLATE 6,7HOLE 6818 FPP0788780MC TITANIUM MICRO 0.6MM ORBITAL PLATE 6,7HOLE 8,12,15MM 5210 FPP0789050MC 0.4MM TITANIUM BURR HOLES PLATE 6:13MM 6616 FPP0789104MC 0.55MM MICRO CRANIO MAXILLO FACIAL TITANIUM PLATE 4HOLE STR 限顏面骨折患者使用 3048 FPP0789106MC 0.55MM MICRO CRANIO MAXILLO FACIAL TITANIUM PLATE 6HOLE STR 3300 FPP0789116MC 0.55MM MICRO CRANIO MAXILLO FACIAL TITANIUM PLATE 16HOLE STR 5605 FPP0789126MC 0.55MM MICRO CRANIO MAXILLO FACIAL TITANIUM H-PLATE 9HOLE 限顏面骨折患者使用 6622 FPP0789133MC 0.55MM MICRO CRANIO MAXILLO FACIAL TITANIUM Y-PLATE 6HOLE 5564 FPP0789134MC 0.55MM MICRO CRANIO MAXILLO FACIAL TITANIUM DOUBLE Y-PLATE 6HOLE 6818 FPP0789145MC 0.55MM MICRO CRANIO MAXILLO FACIAL TITANIUM ORBITA PLATE 8HOLE 5210 FPP07A7504WR MICRO STRAIGHT PLATE, 4-HOLE, REGULAR 2830 FPP07A7516WR MICRO STRAIGHT PLATE, 16 HOLE, REGULAR 5170 FPP07A7524WR MICRO STRAIGHT PLATE, 24-HOLE, ADAPTION 5170 FPP07A7530WR MICRO L-PLATE 5,8 HOLE 4431 FPP07A7540WR MICRO T-PLATE, 5-HOLE, REGULAR 4816 FPP07A7541WR MICRO T-PLATE, 7-HOLE, REGULAR 4816 301

FPP07A7548WR MICRO DOUBLE T-SHAPE, 11-HOLE REGULAR 6040 FPP07A7550WR MICRO Y-PLATE, 6-HOLE, REGULAR 5308 FPP07A7560WR MICRO DOUBLE Y-PLATE 6,7 HOLE 6040 FPP07A7568WR MICRO ORBITAL PLATE, 8-HOLE, CURVED 4970 FPP07A7570WR MICRO SQUARE PLATE 2X2 HOLE 1.0MM 4773 FPP07A7572WR MATRIX PLATE 2X3 HOLE 1.0MM 6942 FPP07A7574WR 1.0MM MICRO MATRIX PLATE 2X4 HOLE 8654 FPP07A7576WR MICRO BURR HOLE PLATE 6616 FPP0903104LE TITANIUM LIGATURE WIRE 0.4MM 30CM 147 FPP0903105LE TITANIUM LIGATURE WIRE 0.5MM 30CM 154 FPP0903106LE TITANIUM LIGATURE WIRE 0.6MM 30CM 154 FPP0910004EJ 2.0 MM MINI CHIN PLATE 3000 FPP0913511LE CHIN PLATE 4MM 3000 FPP0913512LE CHIN PLATE 6MM 3000 FPP0913513LE CHIN PLATE 8MM 3000 FPP0913514LE CHIN PLATE 10MM 3000 FPP0913515LE CHIN PLATE 12MM 3000 FPP0913516LE CHIN PLATE 14MM 3000 FPP0920185Y2 SKULL TITANIUM WIRE 0.4:0.6MM 147 FPP094707NS1 TITANIUM MINI CHIN PLATE 2.0 DOUBLE BEND 5 HOLE 3000 FPP0957504M3 TIANIUM CHINPLATE 4HOLE 4:12MM 3000 FPP09A6471WR 2.0MM DUAL RAIL CHIN PLATES 3000 FPP1042736W2 TENDON SPACER 3:6MM 2500 FPP1101501FV BONAMATES BIOFIXATION SYSTEM:STR 4 HOLE 1.0X1.5MM,1.2X2.0MM,1.5X2.5MM 3048 FPP1101502FV BONAMATES BIOFIXATION SYSTEM:STR 6 HOLE 1.0X1.5MM,1.2X2.0MM,1.5X2.5MM 3300 FPP1101503FV BONAMATES BIOFIXATION SYSTEM:C 型 7 HOLE 1.0X1.5MM,1.2X2.0MM 5210 302

FPP1101504FV BONAMATES BIOFIXATION SYSTEM:Y 型 8 HOLE 1.0X1.5MM,1.2X2.0MM,1.5X2.5MM 5564 FPP1101505FV BONAMATES BIOFIXATION SYSTEM:L 型 8/10 HOLE 1.0X1.5MM,1.2X2.0MM,1.5X2.5MM 5118 FPP1101507FV BONAMATES BIOFIXATION SYSTEM:X 型 10 HOLE 1.0X1.5MM,1.2X2.0MM,1.5X2.5MM 6818 FPP1101508FV BONAMATES BIOFIXATION SYSTEM:STR 8 HOLE 1.5X2.5MM 3300 FPS010071NS1 1.5 MM CORTEX SCREW SELF-TAPPING 4:18 MM 390 FPS0100NNNS1 1.0:1.3 MM MICRO,1.2:1.7 MM EMERGENCY SCREW 2:8MM 1700 FPS010151NS1 2.4 MM,2.0MM CORTEX SCREW SELF-TAPPING 8:18 MM 823 FPS010156NS1 2.7MM EMERGENCY SCREW 8:18MM 823 FPS0108405LE MINI BONE SCREW 2.0X5MM( 型號 52-17012:52-82308 自 90/07/01 生效 ) 390 FPS0108407LE MINI BONE SCREW 2.0x7MM 390 FPS0108409LE MINI BONE SCREW 2.0x8MM/9MM 390 FPS0108411LE MINI BONE SCREW 2.0x10MM/11MM 390 FPS0108413LE MINI BONE SCREW 2.0x12MM/13MM 390 FPS0108415LE MINI BONE SCREW 2.0x14MM/15MM 390 FPS0108417LE MINI 2.0MM BONE SCREW 17MM 390 FPS0108459LE MINI 2.3MM EMERGENCY BONE SCREW 9MM 390 FPS0108780LE BRIFGING BONE SCREW 3.5X10MM 710 FPS0108782LE BRIFGING BONE SCREW 3.5X12MM 760 FPS0108784LE BRIFGING BONE SCREW 3.5X14MM 800 FPS0108786LE BRIDGING BONE SCREW ( 型號 5227-375:822,5230-008:135,5108:5130 自 92/1/1 生效 ) 823 FPS0108788LE BRIFGING BONE SCREW 3.5X18MM 823 FPS0108790LE BRIFGING BONE SCREW 3.5X20MM 823 FPS0108795LE BRIFGING BONE SCREW 3.5X25MM 823 FPS0109650LE COMPREDSSION BONE SCREW SELF-TAPPING 2.7x10MM 823 FPS0109652LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x12MM 823 FPS0109654LE BONE SCREW SELF-TAPPING 2.7x14MM 823 303

FPS0109656LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x16MM 823 FPS0109658LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x18MM 823 FPS0109660LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x20MM 823 FPS0109662LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x22MM 823 FPS0109664LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x24MM 823 FPS0109666LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x26MM 823 FPS0109668LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x28MM 823 FPS0109670LE COMPRESSION BONE SCREW SELF-TAPPING 2.7x30MM 823 FPS0109674LE COMPRESSION EMERGENCY BONE SCREW 3.2x12MM 823 FPS0109676LE EMERGENCY BONE SCREW 3.2x16MM 823 FPS0109678LE COMPRESSION EMERGENCY BONE SCREW 3.2x20MM 823 FPS0109680LE COMPRESSION EMERGENCY BONE SCREW 3.2x24MM 823 FPS01119NNS1 2MM MINI CORTEX 2.4MM,EMERGENCY SCREW SELF-TAPPING 390 FPS0112102LE MICROPLUS BONE SCREW SELF-TAPPING( 型號 52-10002:81409,59-14105:14111 自 90/07/01 生效 ) 1700 FPS0112104LE MICROPLUS BONE SCREW SELF-TAPPING 1.2x4MM,1.2x5MM 1700 FPS0112106LE MICROPLUS BONE SCREW SELF-TSPPING 1.2x6MM:1.2x12MM 1700 FPS011210NLE MICRO BONE SCREW 1.2MM 1.4MM 1470 FPS0114103LE MICROPLUS EMERGENCY BONE SCREW SELF-TAPPING 1.4x3MM 1700 FPS0115104LE BONE SCREW 1.5x4MM 390 FPS0115105LE LOW PROFILE BONE SCREW 1.5x5MM 390 FPS0115106LE LOE PROFILE BONE SCREW 1.5x6MM 390 FPS0115107LE LOW PROFILE BONE SCREW 1.5x7MM 390 FPS0115108LE LOW PROFILE BONE SCREW 1.5x8MM 390 FPS0115109LE LOW PROFILE BONE SCREW 1.5x9MM 390 FPS0115110LE LOW PROFILE BONE SCREW 1.5x10MM 390 FPS0115111LE BONE SCREW 1.5x11MM 390 304

特材代碼中英文品名支付點數 FPS0115112LE BONE SCREW 1.5x12MM 390 FPS0115113LE BONE SCREW 1.5x13MM 390 FPS011700NLE MINI BONE SCREW 1.7MM,1.9MM 390 FPS0120013M3 TITANIUM LOCK-DRIVE TRANSPLANT SCREW 2.0X7:17MM SELF-CUTTING 823 FPS012009NLE TITANIUM FASTENING SCREW FOR TEMPORARY CONDYLAR PROSTHESES 710 FPS012017NY2 MICRO BONE SCREW 1.2MM 2:12MM 1470 FPS0120220EJ M4 RIGID FIXATION SYSTEM 2.0MM SCREW 390 FPS012028NY2 MINI BONE SCREW 2.0MM 5:19MM 390 FPS0120412EJ M4 RIGID FIXATION SYSTEM MICRO SCREW 1.2MM(SCREW 1.2 X 2, 3, 4, 6, 8, 10, 12, 14MM) 1470 FPS0120415EJ M4 RIGID FIXATION SYSTEM MICRO SAFETY SCREW 1.5MM 1470 FPS012042NLE MINI SCREW 2.0:2.7MM 710 FPS012053NY2 COMPRESSION BONE SCREW 2.7,3.2MM 710 FPS0120624EJ M4 RIGID FIXATION SYSTEM 2.4MM MAXI FRACTURE SCREW 710 FPS0120627EJ M4 RIGID FIXATION SYSTEM 2.7MM MAXI FRACTURE SCREW 710 FPS0120641Y2 MANDIBULAR BONE SCREW 3.5MM 10:20MM 710 FPS0120819EJ M4 RIGID FIXATION SYSTEM 1.9MM SCREW 390 FPS0121112EJ M4 RIGID FIXATION SYSTEM:AUTO-DRIVE SCREW 1470 FPS0121116EJ M4 RIGID FIXATION SYSTEM 1.6 MM SCREW 390 FPS0121120EJ M4 RIGID FIXATION SYSTEM 2.0 MM SCREW 390 FPS014009SM3 TITANIUM CONDYLAR PROTHESIS FIXATION SCREW 710 FPS01503CNS1 1.5MM SELF-TAPPING MICRO SCREW 3:12MM 1470 FPS01503DNS1 1.5MM SELF-DRILLING MICRO SCREW 3:8MM 1470 FPS01503ENS1 1.8MM EMERGENCY MICRO SCREW 3:12MM 1470 FPS015223NLE MANDIBULAR SCREW 2.3MM 6:22MM 739 FPS015227NLE MANDIBULAR SCREW 2.7MM 6:22MM 739 FPS0152306M3 MRS TITANIUM SCREW 710 305

FPS017020NM3 MONDEAL TITANIUM 1.2MM MICRO LOCK DRIVE SCREW 2:8MM,1.5MMX4:6MM 1700 FPS01702NNM3 TITANIUM 1.2MM MICRO LOCK DRIVE SCREW 1470 FPS0172005M3 TITANIUM 2.0MM MINI STANDARD SCREW 5MM:19MM 390 FPS0172007M3 TITANIUM 2.0MM MINI LOCK-DRIVE SCREW 5MM:19MM 390 FPS0172305M3 TITANIUM 2.3MM MINI EMERGENCY SCREW 5MM:9MM 390 FPS0172307M3 TITANIUM 2.3MM MINI EMERGENCY LOCK-DRIVE SCREW 5MM:9MM 390 FPS018020NM3 MONDEAL TITANIUM 1.2MM MICRO CROSS FIT SCREW 2:8MM,1.5X4:6MM 1700 FPS0182004M3 CROSS-FIT,LOCK-DRIVE SCREW 2.0 4MM 390 FPS0182005M3 TITANIUM 2.0MM MINI CROSS-FIT SCREW 5MM:19MM 390 FPS0182305M3 TITANIUM 2.3MM MINI EMERGENCY CROSS-FIT SCREW 5MM:9MM 390 FPS0182716M3 TITANIUM LOCK-DRIVE SCREW 2.7X8:22MM SELF-CUTTING 823 FPS0183012M3 TITANIUM LOCK-DRIVE EMERGENCY SCREW 3.0X8:14MM SELF-CUTTING 823 FPS0187505MC TITANIUM 2MM MINI SCREW 5.5MM 390 FPS0187507MC TITANIUM 2MM MINI SCREW 7MM 390 FPS0187509MC TITANIUM 2MM MINI SCREW 9MM 390 FPS0187511MC TITANIUM 2MM MINI SCREW 11MM 390 FPS0187515MC TITANIUM 2MM MINI SCREW 15MM 390 FPS0188303MC MICRO SCREW 3.5X1.5MM 1470 FPS0188305MC MICRO SCREW 5X1.5MM 1616 FPS0188307MC MICRO SCREW 7X1.5MM 1693 FPS0188309MC MICRO SCREW 9X1.5MM 1700 FPS0188311MC MICRO SCREW 11X1.5MM 1700 FPS0188313MC TITANIUM 1.5MM MICRO SCREW 13,15,16,17MM 1700 FPS0188334MC MICRO EMERGENCY SCREW 4X1.9MM 1508 FPS0188339MC MICRO EMERGENCY SCREW 9X1.9MM 1700 FPS0189222MC MICRO 1.2MM MAXILLO FACIAL TITANIUM SCREW 2:12MM 1700 306

特材代碼中英文品名支付點數 FPS0189521MC TITANIUM SCREWS 2.7X9MM 750 FPS0189522MC TITANIUM SCREWS 2.7X11MM 770 FPS0189523MC TITANIUM SCREWS 2.7X13MM 793 FPS0189524MC TITANIUM SCREWS 2.7X15MM 816 FPS0189525MC TITANIUM SCREWS 2.7X17MM 823 FPS0189526MC TITANIUM SCREWS 2.7X19MM 823 FPS0189527MC TITANIUM SCREWS 2.7X21MM 823 FPS0189528MC TITANIUM SCREWS 2.7X23MM 823 FPS0189531MC TITANIUM EMERGENCY SCREWS 3.2X9MM 823 FPS0189532MC TITANIUM EMERGENCY SCREWS 3.2X13MM 823 FPS0192004M3 NEWS S-DRIVE SELF-DRILLING SCREW(MINI 2000) 390 FPS01A1803WR TITANIUM MINI EMERGENCY SCREW 1.5MM,1.8MM,2.3MM 390 FPS01A2406WR MINI 2.4 TITANIUM SCREWS 710 FPS01A2706WR MINI 2.7 TITANIUM SCREWS 710 FPS01A7002WR 1.5 MINI CROSS-DRIVE TITANIUM SCREWS 390 FPS01A7283WR 1.5 MINI CENTER-DRIVE TITANIUM SCREWS 390 FPS01A7372WR MICRO TITANIUM SCREWS 1.0MM 1470 FPS01A7383WR MICRO TITANIUM EMERGENCY SCREW 1.0MM 1470 FPS01A7604WR MINI CROSS-DRIVE TITANIUM SCREWS 2.0MM 390 FPS01A9474WR MINI CENTER-DRIVE TITANIUM SCREWS 2.0MM 390 FPS0201N2NS1 2.0,2.4,2.7MM CORTEX SCREW 20:28MM 1030 FPS0201N3NS1 2.0,2.4,2.7MM CORTEX SCREW 30:40MM 1150 FPS02A2424WR TITANIUM LAG SCREWS 2.4MM 1030 FPS1150400FV BONAMATES BIOFIXATION SYSTEM:SCREW 1.5X4.0~2.5X25MM( 單支包裝 ) 1700 FPS1150401FV BONAMATES BIOFIXATION SYSTEM:SCREW 1.5X4.0~2.5X25MM(2 支 / 包 ) 3400 FPS1150402FV BONAMATES BIOFIXATION SYSTEM:SCREW 1.5X4.0~2.5X25MM(4 支 / 包 ) 6800 307

特材代碼中英文品名支付點數 FPT0120789L0 TISSUE EXPANDER 1CC~1000CC 9000 FPT01TAX2NN2 TISSUE EXPANSION DEVICES 9000 FPT01TCS2NN2 TISSUE EXPANSION DEVICES 9000 FPT01TRC2NN2 TISSUE EXPANSION DEVICES 9000 FPT01TRD2NN2 FSP7103657AM FSP711VS12TY FSP7181004ET TISSUE EXPANDER 50:1100CC TYPE ROUND RECTANGLE U'DESIGN CRESCENT CROISSANT 適應症見備註欄 "AMS"SPARC SLING SYSTEM 懸吊手術系統 ( 兩支不銹鋼彎曲弓狀穿引針 ( 不需再使用 INTRODUCER)+ 一條聚丙烯懸帶 ) IVS TUNNELLER INTRA-VAGINAL SLING PLACEMENT INSTRUMENT( 含 INTRODUCER 及 CATHETER GUIDE) TENSION-FREE VAGINAL TAPE(TVT)DEVICE 含 INTRODUCER 及 RIGID CATHETER GUIDE(810081,810041B 自 940701 起生效, 文號 0940011575) 9000 13680 13680 13680 FSP71BRD16BA "BARD"ALIGN URETHRAL SUPPORT SYSTEM( 含 INTRODUCER+MESH ASSEMBLY) 艾萊尿道支撐系統 13680 FUK0501000GA PRISMAFLEX SET(CVVH TUBING+HEMOFILTER) 膜面積 1.1M 平方 * 5400 FUK0501400GA PRISMAFLEX SET(CVVH TUBING+HEMOFILTER) 膜面積 1.4M 平方 * 5400 FUK050M100GA PRISMA SET(CVVH TUBING+HEMOFILTER) 膜面積 0.9M 平方, 連續式血液透析器及迴路套管 * 5400 FUK05FM100GA PRISMAFLEX SET(CVVH TUBING+HEMOFILTER)0.9M 平方 * 5400 FUK05FM150GA "GAMBRO"PRISMAFLEX SET(CVVH TUBING+HEMOFILTER 膜面積 1.5M 平方 ) 普利司馬弗列克斯套組 * 5400 FUK05HD150E9 CVVH HEMOFILTER* 3645 FUK05HD200E9 CVVH HEMOFILTER* 3645 FUK05HD300E9 CVVH HEMOFILTER* 4095 FUK05PF150GA "GAMBRO"PRISMAFLEX SET* 5400 FUK05PFXSTGA "GAMBRO"PRISMAFLEX SET(CVVH TUBING+HEMOFILTER) 膜面積 1M 平方 *. 5400 FUK05PR100GA "GAMBRO"PRISMA SET (CVVH TUBING+HEMOFILTER)1.15M 平方 * 5400 FUK05ST100GA "GAMBRO"PRISMA SET(CVVH TUBING+HEMOFILTER) 膜面積 1.0M 平方連續式血液透析器及迴路管套 * 5400 FUK05U1000FA "FRESENIUS"POLYSULFONE HAEMOFILTERS(CVVH FILTER 1.8M 平方 ) 人工合成膜血液過濾器 * 4095 FUK05U400SFA "FRESENIUS"POLYSULFONE HAEMOFILTERS(CVVH FILTER 0.7M 平方 ) 人工合成膜血液過濾器 * 3645 FUK05U600SFA "FRESENIUS"POLYSULFONE HAEMOFILTERS(CVVH FILTER 1.4M 平方 ) 人工合成膜血液過濾器 * 4095 HEF030P005AS PLASMAFLO 4500 HEF030P008AS PLASMAFLO(PLASMA FILTER) 4500 308

特材代碼中英文品名支付點數 HEF030PS06KU PVA FILTER,PLASMACURE 4500 HEF030PS08KU 固拉力血漿分離器 KURARAY PLASMACURE PE PLASMA SEPARATOR 4500 HEF032011NF5 MJ BLOOD LINE SET FOR BLOOD PURIFICATION 邁捷血液淨化迴路導管 1500 HEF03AC177AS PLASMA FILTER 附血液迴路管 6000 HEF03EC030AS " 旭 " 血漿成分分離器 "ASAHI" CASCADEFLO EC PLASMA COMPONENT SEPARATOR 4500 HEF03EVACUKA EVACURE PLASMA SEPARATOR 4500 HEF03EVAFLKA EVAFLUX 血液成份分離器加血液迴路管組 6000 HEF03HD400E9 雙重濾過血液濾過器 HEMOFILTER 6000 HEF03HD500E9 雙重濾過血液濾過器 HEMOFILTER 6000 HEF03LF030FN " 英弗梅 " 血漿過濾器 "INFOMED"PLASMAFILTER 4500 HEF03LF050FN " 英弗梅 " 血漿過濾器 "INFOMED"PLASMAFILTER 4500 HEF03LF070FN " 英弗梅 " 血漿過濾器 "INFOMED"PLASMAFILTER 4500 HEF03PLA20E9 MEDICA PLASMAFILTERS 0.15 平方公尺 4500 HEF03PLA40E9 MEDICA PLASMAFILTERS 0.35 平方公尺 4500 HEF03PLA60E9 MEDICA PLASMAFILTERS 0.55 平方公尺 4500 HEF03PRFPEGA "GAMBRO"PRISMAFLEX SET 血漿透析器及血液迴路管 6000 HEF03PRLPEGA "GAMBRO"PRISMAFLEX SET 血液透析器及迴路管套 6000 HEF03PRTPEGA "GAMBRO"PRISMA SET 連續式血液透析器及迴路管套 6000 HEF03TS402FN "INFOMED"EXTRACORPOREAL BLOOD CIRCUITS TUBING SET FOR HF400-PLASMA EXCHANGE 體外血液循環管路 - 血漿置換 1500 HEF05CPS02P3 PALL EXTRACORPOREAL CIRCUIT FILTER* 722 HEF05VBT16QM " 邁柯唯 " 氣泡過濾器 "MAQUET" VENOUS BUBBLE TRAP 722 HEF060BC1BP3 PALL EXTRACORPOREAL CIRCUIT FILTER 限開心手術使用於 BLOOD CARDIOPIEGIA SOLUTION 時申報 2995 HEH011000TMY HEMOCONCENTRATOR WITH TUBING 4600 HEH01400TSMY HEMOCONCENTRATOR WITH TUBING 3300 HEH01511SLTM HEMOCONCENTRATOR W/HEMODIALYSIS OR HEMOCARE TUBING SET 4600 HEH01HF53TFA " 比孚 " 血液濃縮器 "B.V."HEMOCONCENTRATORS(WITH TUBING)* 4600 309

HEH01M1N1TMY HEMOCONCENTRATOR WITH CONNECTOR PACKAGE,TUBING" 米得克 " 血液濃縮器 * 3300 HFF01096NTP3 TPN FILTER 0.2UUM 80 HFF0209930BB STERIFIX INFUSION FILTER 00.2UM(T.P.N) 80 HFF02C1103BT TPN FILTER W/EXTENSION TUBE 80 HFF02C8363BT TPN 0.22 MICRO FILTER 80 HFF02E25YFLL TPN FILTER W/EXTENSION TUBE 80 HFF02EF010SG TPN FILTER SET 0.22UM 80 HFF02EF15YSG TPN FILTER SET 0.22UM 80 HFF02ET15FLL TPN FILTER W/EXTENSION TUBE 80 HHF01P1ASDTM LEUKOCYTE REMOVAL FILTER IMUGARD III-PL* 1400 HHF01P214YTM LEUKOCYTE REMOVAL FILTER IMUGARD III-PL 12UNIT Y TYPE 1400 HHF01PLX10AS SEPACELL LEUKOCYTE REMOVAL FILTER( 血小板專用 ) 過濾 12 UNIT* 1400 HHF01PPBBFFA LENKOCYTE REMOVAL FILTER FOR PLATELET CONCENTRATES* 1400 HHF01PPBSFFA LENKOCYTE REMOVAL FILTER FOR PLATELET CONCENTRATES* 1400 HHF01PXL8YP3 LEUKOCYTE REMOVAL FILTER FOR PLATELATE 1400 HHF02R204YTM LEUKOCYTE REMOVAL FILTER IMUGARD III-RC 500CC Y TYPE 615 HHF02R500AAS SEPACELL LEUKOCYTE REMOVAL FILTER 1000CC( 紅血球專用 ) 820 HHF02R602ETM IMUGARD III-RC LEUKOCYTE REMOVAL FILTER* 615 HHF02RCL1YP3 LEUKOCYTE REMOVAL FILTER FOR RBC 615 HHF02RM1N1FA LENKOCYTE REMOVAL FILTER FOR RED CELL CONCENTRATES* 615 HHF02RPBB2FA LEUKOCYTE REMOVAL FILTER FOR RED CELL CONCENTRATE 過濾 1000CC* 820 HHF02RPBBFFA LENKOCYTE REMOVAL FILTER FOR RED CELL CONCENTRATES* 615 HHF02RPBS2FA LEUKOCYTE REMOVAL FILTER FOR RED CELL CONCENTRATE 過濾 1000CC* 820 HHF02RPBSFFA LENKOCYTE REMOVAL FILTER FOR RED CELL CONCENTRATES* 615 HHF04500A3AS SEPACELL LEUKOCYTE REMOVAL FILTER FOR RBC 2 UNIT 820 HHF04R500AAS LEUKOCYTE REMOVAL FILTER( 紅血球專用 ) 過濾 1000CC 820 310

特材代碼中英文品名支付點數 HHM010040SP3 BLOOD TRANSFUSION FILTER 40UM 1500CC 305 HHM0104435BB " 柏朗 " 永久性腔靜脈過濾器 "B.BRAUN" VENATECH LP PERMANENT VENA CAVA FILTER( 含 PUNCTURE KIT,GUIDE WIRE,FILTER INTRODUCER,DILATOR,FILTER,SHEATH) 35000 HHM0111649AB " 亞培 " 阿克奈防血塊栓塞保護系統 "ABBOTT" RX ACCUNET EMBOLIC PROTECTION SYSTEM* 35000 HHM012120FN6 VERSATILE VENA CAVA FILTER SYSTEM 含 FILTER+INTRO+DILA+DELIVERY KIT(PUSHWIRE+Y ADAPTER) 35000 HHM01445TWSB FILTER WIRE EX SYETEM L 190CM,300CM* 35000 HHM01466XNCD TRAPEASE PERMANENT VENA CAVA FILTER AND INTRODUCTION KIT 35000 HHM01500TWSB GREENFIELD VENA CAVA FILTER SET(INTRODUCER+FILTER+SHEATH/DILATOR+ADAPTER) 35000 HHM0150300SB GREENFIELD VENA CAVA FILTER SYSTEM(INTRODUCER+FILTER+SHEATH/DILATOR+ADAPTER) 35000 HHM0150301SB GREENFIELD VENA CAVA FILTER SYSTEM(INTRODUCER+FILTER+SHEATH/DILATOR+ADAPTER) 35000 HHM0182945AB "ABBOTT"EMBOSHIELD PRO EMBOLIC PROTECTION SYSTEM 血管保護盾 35000 HHM0192010SB FILTERWIRE EMBOLIC PROTECTION SYSTEM L190CM,300CM* 35000 HHM01CELECCK " 曲克 " 色列克特腔靜脈濾器 "COOK" CELECT VENA CAVA FILTER 35000 HHM01DV445F2 " 英泰克 " 戴芙血栓清除導管 "INVATEC"DIVER CE RAPID EXCHANGE CLOT EXTRACTION CATHETER* 15000 HHM01DVMAXF2 " 英泰克 " 戴芙血栓清除導管加大型 "INVATEC" DIVER CE MAX CLOT EXTRACTIOM CATHETER 15000 HHM01EPSNNST " 聖猷達 " 栓塞防護系統 "SJM"PROXIS EMBOLIC PROTECTION SYSTEM* 35000 HHM01EXPRTM4 美敦力吸除導管 "MEDTRONIC" EXPORT XT ASPIRATION CATHETER* 15000 HHM01FETCHF3 " 普希士 " 快取血栓清除導管 "POSSIS" FETCH ASPIRATION CATHETER* 15000 HHM01G1462M4 " 美敦力 " 保護導線加上暫時阻斷吸除系統 GUARDWIRE PLUS TEMPORARY OCCLUSION AND ASPIRATION SYSTEM(EXPORT XT ASPIRATION CATHETER)* 15000 HHM01G146SM4 GUARDWIRE PLUS TEMPORARY OCCLUSION AND ASPIRATION SYSTEM* 35000 HHM01P5010VS " 法斯樂舒順 " 普倫特羅賓血栓清除導管 "VASCULAR SOLUTIONS" PRONTO LP EXTRACTION CATHETER* 15000 HHM01Q5070VS " 法斯樂舒順 " 快特血栓清除導管 "VASCULAR SOLUTIONS" QXT EXTRACTION CATHETER* 15000 HHM01SPDEREY 史派德栓塞防護系統 "EV3"SPIDER FX EMBOLIC PROTECTION DEVICE* 35000 HHM01T2R9SKE 卡內卡史隆巴斯特血栓抽吸導管 "KANEKA" THROMBUSTER II* 15000 HHM01TUL1PCK HHM01TULIPCK COOK GUNTHER TULIP VENA CAVA MREYE FILTER SET(INTRODUCER+FILTER+SHEATH/DILATOR+ADAPTER) COOK GUNTHER TULIP VENA CAVA MREYE FILTER SET(INTRODUCER+FILTER+SHEATH/DILATOR+ADAPTER) 35000 35000 HHM02040SNP3 BLOOD TRANSFUSION FILTER 40UM 移除微血栓輸血過濾器 ( 小兒科專用 ) 305 311

LEE012266PKD 肯特利柯登斯去顫器電極貼片 KENDALL MEDI-TRACE CADENCE ELECTRODES ( 小兒用 ) 490 LEE01AP518G2 PEDIATRIC DEFIB ELECTRODES 體外心律調節器貼片 490 LEE01AP915G4 DEFIBRILLATOR/PEDIATRIC DEFIBRILLATION ELECTRODES 小兒可拋棄式去顫電極片 490 LEE01M3504HP MULTIFUNCTION PEDIATRIC DEFIB ELECTRODES 490 LEE01M3717HP MULTIFUNCTION PEDIATRIC PLUS PADS 多功能兒童用電擊貼片 490 LEE01M3870HP INFANT/CHILD PADS 多功能嬰幼兒用電擊貼片 490 LEE01N1749HP DEFIB PACING PADS CHILD (2 EA/SET) 490 NAN011530NSP DISPOSABLE NEEDLE 15G:30G 0.5 NAN011627NBB NEEDLE 0.5 NAN011826NV4 DISPOSABLE NEEDLE 18G:26G 0.5 NAN011827NBD NEEDLE 0.5 NAN011827NFE SAFETY NEEDLE 1 NAN011827NHG HYPODERMIC NEEDLE 0.5 NAN011827NNR NEEDLE 0.5 NAN011827NTM NEEDLE 0.5 NAN011827NTP NEEDLE 0.5 NAN011827NUY NEEDLE 0.5 NAN011923NBN NEEDLE 0.5 NAN020031NBD PEN NEEDLE 胰島素筆型針頭 3.2 NAN020050NNR NOVOFINE NEEDLE 30G 胰島素筆型注射器針頭 3.2 NAN0291676BB OMNICAN FINE NEEDLES 29:31G 胰島素注射筆專用針頭 3.2 NAN041823NNR IC NEEDLE 心肌長針 4.9 NAN0618150TP P.T.C.D NEEDLE 102 NAN061822NHK P.T.C.D NEEDLE 150:200MM 102 NAN061822NTP P.T.C..D NEEDLE 102 NAN061823MTP P.T.C.D NEEDLE MS TYPE 18G:23G 102 312

特材代碼中英文品名支付點數 NAN0620200TP P.T.C.D NEEDLE 102 NAN0621150TP P.T.C.D NDDELE 102 NAN0622150TP P.T.C.D NEEDLE 102 NAN0623150TP P.T.C.D NEEDLE 23GX150MM 102 NAN1118275AG AMC/4 ARTERIAL NEEDLE 18Gx23/4"(7.0CM) 導線導引針 120 NAN1121200AG AMC/4 ARTERIAL NEEDLE 21Gx2"(5.1CM) 導線導引針 120 NAN115324NAR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION SETS:INTRODUCER NEEDLE( 單針 )" 亞諾 " 多重輸液導管 ( 單針 ) 60 NAN11AP1NEH9 ANGIO PACK :INTRODUCER NEEDLE( 單針 ) 60 NAN141822NCK DISPOSABLE ONE PART NEEDLE 導線導引針 132 NAN1418275AG AMC/4 ARTERIAL NEEDLE WITH FIXED WINGS 18Gx23/4"(7.0CM) 導線導引針 132 NAN1421100AG AMC/3 ARTERIAL NEEDLE 21Gx1"(2.5CM) 導線導引針 132 NAN1447662BS ARTERIAL NEEDLE FOR PERCUTANEOUS ENTRY ( 單針 ) 60 NAN145312NAG AMC/3 ARTERIAL NEEDLE 18GX7CM,3.8CM 19GX3.8CM 132 NAN1521500C3 DISPOSABLE SELDING NEEDLE 18G 7.5CM 150 NAN1547073BS ARTERIAL NEEDLE FOR PERCUTANEOUS ENTRY ( 外管 + 內針 ) 150 NAN1547661BS ARTERIAL NEEDLE FOR PERCUTANEOUS ENTRY ( 外管 + 內針 ) 150 NAN1550400PB PUNCTURE NEEDLE W/STYLET 雙針 ( 外套管 + 內針 ) 150 NAN155324NAG PERCUTANEOUS ENTRY NEEDLE 16GX7.3CM,18GX7.3CM,19GX3.8,7.3CM,21GX3.8CM 150 NAN155324NAR "ARROW"MULTI-LUMEN CENTRAL VENOUS CATHETERIZATION:INTRODUCER NEEDLE ( 外套管 + 內針 ) 150 NAN15ADVANMR ADVANCE ANGIOGRAPHIC NEEDLES 高昇血管攝影穿刺針 ( 外管 + 內針 ) 150 NAN15AN72SMR MAJESTIK SERIES ANGIOGRAPHY NEEDLES 16-21G( 雙針 ) 150 NAN15DCM18CK DISPOSABLE PERCUTANEOUS ENTRY THINWALL NEEDLES 18:22G 2.5:9.0CM 150 NAN1647664BS ARTERIAL NEEDLE FOR PERCUTANEOUS ENTRY ( 外管 + 內針 +STYLE) 203 NAN165341NAG ARTERIAL CATHETER NEEDLE 16GX6.4CM,18GX6.4CM,20GX3.8CM 203 NAN16AN18TMR MAJESTIK SERIES ANGIOGRAPHY NEEDLES 18G 7CM(3-PART)( 外管 + 內針 + 填充器 ) 203 NBS010001NBD 1CC SYRINGE WITHOUT NEEDLE 1.9 313

特材代碼中英文品名支付點數 NBS010001NSP 1CC SYRINGE WITHOUT NEEDLE 1.9 NBS010001NV4 1 CC SYRINGE WITHOUT NEEDLE 1.9 NBS010001PTM 1CC SYRINGE WITHOUT/NEEDLE 1.9 NBS010001VPW 1CC SYRINGE WITHOUT NEEDLE 1.9 NBS010002NSP 2-3CC SYRINGE WITHOUT NEEDLE 1 NBS010003NBD 3CC SYRINGE WITHOUT NEEDLE 1 NBS010003NPW 3CC SYRINGE WITHOUT NEEDLE 1 NBS010003NV4 2 CC,3CC SYRINGE WITHOUT NEEDLE 1 NBS010003PTM 3CC SYRINGE WITHOUT/NEEDLE 1 NBS010003VPW 3CC SYRINGE WITHOUT NEEDLE 1 NBS010005NBD 5CC SYRINGE WITHOUT NEEDLE 1.4 NBS010005NHG RETRACTABLE SAFETY SYRINGE 5CC WITHOUT NEEDLE 2.6 NBS010005NSP 5CC SYRINGE WITHOUT NEEDLE 1.4 NBS010005NV4 5 CC SYRINGE WITHOUT NEEDLE 1.4 NBS010005PTM 5CC SYRINGE WITHOUT/NEEDLE 1.4 NBS010005VPW 5CC SYRINGE WITHOUT NEEDLE 1.4 NBS010010NBD 10CC SYRINGE WITHOUT NEEDLE 2.7 NBS010010NFR 10 CC SYRINGE WITHOUT NEEDLE 2.7 NBS010010NPW 10CC SYRINGE WITHOUT NEEDLE 2.7 NBS010010NSP 10CC SYRINGE WITHOUT NEEDLE 2.7 NBS010010NUY 10CC SYRINGE WITHOUT/NEEDLE 2.7 NBS010010NV4 10 CC SYRINGE WITHOUT NEEDLE 2.7 NBS010010PTM 10CC SYRINGE WITHOUT/NEEDLE 2.7 NBS010010VPW 10CC SYRINGE WITHOUT NEEDLE 2.7 NBS010020NBB 20 CC SYRINGE WITHOUT NEEDLE 3.5 NBS010020NBD 20 CC SYRINGE WITHOUT NEEDLE 3.5 314

特材代碼中英文品名支付點數 NBS010020NBN 20 CC SYRINGE WITHOUT NEEDLE 3.5 NBS010020NFR 20 CC SYRINGE WITHOUT NEEDLE 3.5 NBS010020NNR 20 CC SYRINGE WITHOUT NEEDLE 3.5 NBS010020NPD 20CC SYRINGE WITHOUT NEEDLE 3.5 NBS010020NPW 20 CC SYRINGE WITHOUT NEEDLE 3.5 NBS010020NSP 20CC SYRINGE WITHOUT NEEDLE 3.5 NBS010020NTM 20 CC SYRINGE WITHOUT NEEDLE 3.5 NBS010020NTP 20 CC SYRINGE WITHOUT NEEDLE 3.5 NBS010020NUY 20CC SYRINGE WITHOUT/NEEDLE 3.5 NBS010020NV4 20CC SYRINGE WITHOUT NEEDLE 3.5 NBS010020NYF 20 CC SYRINGE WITHOUT NEEDLE 3.5 NBS010020PTM 20CC SYRINGE WITHOUT/NEEDLE 3.5 NBS010020VPW 20CC SYRINGE WITHOUT NEEDLE 3.5 NBS010025NPW 25CC SYRINGE WITHOUT NEEDLE 3.5 NBS010030NBB 30 CC SYRINGE WITHOUT NEEDLE 6.8 NBS010030NBD 30 CC SYRINGE WITHOUT NEEDLE 6.8 NBS010030NBN 30 CC SYRINGE WITHOUT NEEDLE 6.8 NBS010030NFR 30 CC SYRINGE WITHOUT NEEDLE 6.8 NBS010030NNR 30 CC SYRINGE WITHOUT NEEDLE 6.8 NBS010030NPW 30 CC SYRINGE WITHOUT NEEDLE 6.8 NBS010030NSH 30 CC SYRINGE WITHOUT NEEDLE 6.8 NBS010030NSP 30CC SYRINGE WITHOUT NEEDLE 6.8 NBS010030NTM 30 CC SYRINGE WITHOUT NEEDLE 6.8 NBS010030NTP 30 CC SYRINGE WITHOUT NEEDLE 6.8 NBS010030NUY 30CC SYRINGE WITHOUT/NEEDLE 6.8 NBS010030NV4 30CC SYRINGE WITHOUT NEEDLE 6.8 315

特材代碼中英文品名支付點數 NBS010030VPW 30CC SYRINGE WITHOUT NEEDLE 6.8 NBS010050NBB 50 CC SYRINGE WITHOUT NEEDLE 12.1 NBS010050NBD 50 CC SYRINGE WITHOUT NEEDLE 12.1 NBS010050NBN 50 CC SYRINGE WITHOUT NEEDLE 12.1 NBS010050NFR 50CC SYRINGE WITHOUT NEEDLE 12.1 NBS010050NNR 50 CC SYRINGE WITHOUT NEEDLE 12.1 NBS010050NPW 50 CC SYRINGE WITHOUT NEEDLE 12.1 NBS010050NSP 50CC,60CC SYRINGE WITHOUT NEEDLE 12.1 NBS010050NTM 50 CC SYRINGE WITHOUT NEEDLE 12.1 NBS010050NTP 50 CC SYRINGE WITHOUT NEEDLE 12.1 NBS010050NUY 60CC SYRINGE WITHOUT/NEEDLE 12.1 NBS010050NV4 50CC SYRINGE WITHOUT NEEDLE 12.1 NBS010050VPW 50CC SYRINGE WITHOUT NEEDLE 12.1 NBS01005SSFE 5CC RETRACTABLE SAFETY SYRINGE WITHOUT NEEDLE 2.6 NBS010060NBD 60CC SYRINGE WITHOUT NEEDLE 12.1 NBS010060NPW 60CC SYRINGE WITHOUT NEEDLE 12.1 NBS0100N20BD PLASTIPAK SYRINGE 20CC WITHOUT NEEDLE 3.5 NBS0100N30BD PLASTIPAK SYRINGE 30CC WITHOUT NEEDLE 6.8 NBS0100N50BD PLASTIPAK SYRINGE 50CC WITHOUT NEEDLE 12.1 NBS01010SSFE 10CC RETRACTABLE SAFETY SYRINGE WITHOUT/NEEDLE 4 NBS01020SSFE 20CC RETRACTABLE SAFETY SYRINGE WITHOUT/NEEDLE 6.6 NBS020060NNN NOVOPEN 3 WITHOUT NEEDLE( 筆型胰島素注射筒 ) 每支以使用三年以上為原則 900 NBS0216155NN NOVOPEN 4 WITHOUT NEEDLE( 筆型胰島素注射筒 ) 每支以使用三年以上為原則 900 NBS02M9662HQ INSULIN DELIVERY DEVICE 胰島素注射筆, 每支以使用三年以上為原則 900 NBS02M9673HQ HUMAPEN LUXURA HD INSULIN DELIVERY DEVICE 胰島素注射筆, 每支以使用三年以上為原則 900 NBS0700060MH DISPOSABLE SYRINGE 顯影劑注射筒 237 316

NBS0700096LF OPTIVANTAGE DUAL-HEAD INJECTOR 200CC SYRINGE ( 注射筒 X1+ 吸管 X1) 240 NBS0700099LF OPTIVANTAGE DUAL-HEAD INJECTOR 200CC SYRINGE ( 注射筒 X1+ 吸管 X1+ 螺旋管 X1) 315 NBS0700150MH CONTRAST MEDIUM INJECTION SYRINGE 130,150CC( 型號 DSK130 自 91/4/1 生效 ) 237 NBS0700172LF DISPOSABLE SYRINGE FOR DIGITAL INJECTION 130CC W/H-FIL 高壓注射器用拋棄式針筒 240 NBS0700200MH CONTRAST MEDIUM INJECTION SYRINGE 200CC 顯影劑注射筒 237 NBS070060QMH DISPOSABLE SYRINGE 60CC W/FILL TUBE 260 NBS070125FMH DISPOSABLE SYRINGE 顯影劑注射筒 125CC 237 NBS070130QMH DISPOSABLE SYRINGE 130CC W/FILL TUBE 260 NBS070150QMH DISPOSABLE SYRINGE 150CC W/FILL TUBE 顯影劑注射筒 260 NBS070200FMH CONTRAST MEDIUM INJECTION SYRINGE 200CC 237 NBS070200QMH CONTRAST MEDIUM INJECTION SYRINGE 200ML W/FILL TUBE 顯影劑注射筒 260 NBS070260QMH DISPOSABLE SYRINGE 260CC W/FILL TUBE 顯影劑注射筒 260 NBS071010TTY OPTIRAY 350 造影劑注射筒 237 NBS07125FQMH DISPOSABLE SYRINGE 125CC W/FILL TUBE 260 NBS07137NASD ANGIOGRAPHIC POWER SYRINGE 100ML 130ML W/J-CURVED FILL TUBE 240 NBS07137NCSD ANGIOGRAPHIC POWER SYRINGE 200ML W/J-CURVED FILL TUBE 260 NBS07137NESD ANGIOGRAPHIC POWER SYRINGE 150ML W/J-CURVED FILL TUBE 260 NBS07150AQMH DISPOSABLE SYRINGE 150CC W/FILL TUBE 顯影劑注射筒 260 NBS07200FCMH DISPOSABLE SYRINGE KIT 200ML( 注射筒 + 吸管 + 螺旋連接管 ) 315 NBS07200FQMH DISPOSABLE SYRINGE 200CC W/FILL TUBE 顯影劑注射筒 260 NBS0730210N8 DISPOSABLE SYRINGE SYSTEM WITH ACCESSORIES( 注射筒 + 吸管 ) 240 NBS0732377MA OPTIRAY 320 IOVERSOL INJECTION SYRINGE 125ML 歐得利 320 造影劑注射筒 237 NBS0742040AB ANGIOGRAPHIC SYRINGE 10,12CC 177 NBS0744020LF OPTIVANTAGE DUAL-HEAD INJECTOR( 注射筒 X1+ 吸管 X1+Y 型螺旋接管 X1) 315 NBS0744022LF OPTIVANTAGE DUAL-HEAD INJECTOR( 注射筒 X2+ 吸管 X2+Y 型螺旋接管 X1) 455 NBS0760269N8 DISPOSABLE SYRINGE SYSTEM WITH ACCESSORIES( 注射筒 + 吸管 + 螺旋低壓連接管 ) 315 317

特材代碼中英文品名支付點數 NBS0790064LF 150ML SYRINGE W/HANDI-FIL 240 NBS0790073LF 200ML FRONT LOADING SYRINGE W/HANDI-FIL 240 NBS0790103N8 DISPOSABLE SYRINGE SYSTEM 150CC W/HANDI FIL LINDEN LUER 注射筒 + 吸管 240 NBS07C8536CC ANGIOGRAPHIC SYRINGE AND HAND-FILL SET 100~200ML 240 NBS07C8539CC ANGIOGRAPHIC SYRINGE CT PACK(SYRINGE+HAND-FILL 100~200ML+ 螺旋連接管 ) 315 NBS07CCS60MR CORONARY CONTROL SYRINGE 6CC 10CC 12CC 177 NBS07DCTPQMH DISPOSABLE 200 CC SYRINGE 二支 KIT( 注射筒 X2+ 吸管 + 連接管 +PRIME TUBE) 455 NBS07DCTPSMH DISPOSABLE 200 CC SYRINGE 二支 KIT( 注射筒 X2+SPIKE+ 連接管 +PRIME TUBE) 455 NBS07SCTPQMH DISPOSABLE 200 CC SYRINGE KIT( 含吸管 + 連接管 +PRIME TUBE) 315 NBS07SCTPSMH DISPOSABLE 200 CC SYRINGE KIT( 含 SPIKE+ 連接管 +PRIME TUBE) 277 NBS07SSQFTMH DISPOSABLE 200 CC SYRINGE KIT( 含吸管 ) 240 NBS07SSSPKMH DISPOSABLE 200 CC SYRINGE KIT( 含 SPIKE) 237 NCS010001NBD 1 CC SYRINGE 2.7 NCS010001NBN 1 CC SYRINGE 2.7 NCS010001NDD 1CC SYRINGE 2.7 NCS010001NFR 1 CC SYRINGE 2.7 NCS010001NNR 1 CC SYRINGE 2.7 NCS010001NPD 1CC SYRINGE W/NEEDLE 2.7 NCS010001NPW 1 CC SYRINGE 2.7 NCS010001NSH 1 CC SYRINGE 2.7 NCS010001NSP 1CC SYRINGE W/NEEDLE 2.7 NCS010001NTM 1 CC SYRINGE 2.7 NCS010001NTP 1 CC SYRINGE 2.7 NCS010001NUY 1 CC SYRINGE W/NEEDLE 2.7 NCS010001NV4 1CC SYRINGE W/NEEDLE 2.7 NCS010001PTM 1CC SYRINGE W/NEEDLE 2.7 318

特材代碼中英文品名支付點數 NCS010001VPW 1CC SYRINGE W/NEEDLE 2.7 NCS010002NPW 2 CC SYRINGE 1.6 NCS010002NSP 2-3CC SYRINGE W/NEEDLE 1.6 NCS010003NBB 3 CC SYRINGE 1.6 NCS010003NBD 3 CC SYRINGE 1.6 NCS010003NBN 3 CC SYRINGE 1.6 NCS010003NDD 3CC SYRINGE 1.6 NCS010003NFR 3CC SYRINGE W/NEEDLE 1.6 NCS010003NNR 3 CC SYRINGE 1.6 NCS010003NPD 3CC SYRINGE W/NEEDLE 1.6 NCS010003NPW 3 CC SYRINGE 1.6 NCS010003NSH 3 CC SYRINGE 1.6 NCS010003NTM 3 CC SYRINGE 1.6 NCS010003NTP 3 CC SYRINGE 1.6 NCS010003NUY 3 CC SYRINGE W/NEEDLE 1.6 NCS010003NV4 2CC,3CC SYRINGE W/NEEDLE 1.6 NCS010003NYF 3 CC SYRINGE 1.6 NCS010003PTM 3CC SYRINGE W/NEEDLE 1.6 NCS010003VPW 3CC SYRINGE W/NEEDLE 1.6 NCS010005NBB 5 CC SYRINGE 2.2 NCS010005NBD 5 CC SYRINGE 2.2 NCS010005NBN 5 CC SYRINGE 2.2 NCS010005NDD 5CC SYRINGE 2.2 NCS010005NFR 5CC SYRINGE W/NEEDLE 2.2 NCS010005NNR 5 CC SYRINGE 2.2 NCS010005NPD 5CC SYRINGE W/NEEDLE 2.2 319

特材代碼中英文品名支付點數 NCS010005NPW 5 CC SYRINGE 2.2 NCS010005NSP 5CC SYRINGE W/NEEDLE 2.2 NCS010005NTM 5 CC SYRINGE 2.2 NCS010005NTP 5 CC SYRINGE 2.2 NCS010005NUY 5CC SYRINGE W/NEEDLE 2.2 NCS010005NV4 5CC SYRINGE W/NEEDLE 2.2 NCS010005NYF 5 CC SYRINGE 2.2 NCS010005PTM 5CC SYRINGE W/NEEDLE 2.2 NCS010005VPW 5CC SYRINGE W/NEEDLE 2.2 NCS010006NSH 6 CC SYRINGE 2.2 NCS010010NBB 10 CC SYRINGE 3.2 NCS010010NBD 10 CC SYRINGE 3.2 NCS010010NBN 10 CC SYRINGE 3.2 NCS010010NDD 10CC SYRINGE 3.2 NCS010010NFR 10CC SYRINGE W/NEEDLE 3.2 NCS010010NNR 10 CC SYRINGE 3.2 NCS010010NPD 10CC SYRINGE W/NEEDLE 3.2 NCS010010NPW 10 CC SYRINGE 3.2 NCS010010NSP 10CC SYRINGE W/NEEDLE 3.2 NCS010010NTM 10 CC SYRINGE 3.2 NCS010010NTP 10 CC SYRINGE 3.2 NCS010010NUY 10CC SYRINGE W/NEEDLE 3.2 NCS010010NV4 10CC SYRINGE W/NEEDLE 3.2 NCS010010NYF 10 CC SYRINGE 3.2 NCS010010PTM 10CC SYRINGE W/NEEDLE 3.2 NCS010010VPW 10CC SYRINGE W/NEEDLE 3.2 320

特材代碼中英文品名支付點數 NCS010020NBD 20 CC SYRINGE ( 附針 ) 4 NCS010020NBN 20CC SYRINGE W/NEEDLE 4 NCS010020NDD 20CC SYRINGE 4 NCS010020NFR 20CC SYRINGE W/NEEDLE 4 NCS010020NNR 20 CC SYRINGE( 附針 ) 4 NCS010020NPD 20CC SYRINGE W/NEEDLE 4 NCS010020NPW 20CC SYRINGE W/NEEDLE 4 NCS010020NSP 20CC SYRINGE W/NEEDLE 4 NCS010020NTM 20 CC SYRINGE ( 附針 ) 4 NCS010020NTP 20CC SYRINGE W/NEEDLE 4 NCS010020NUY 20CC SYRINGE W/NEEDLE 4 NCS010020NV4 20CC SYRINGE W/NEEDLE 4 NCS010020NYF 20 CC SYRINGE ( 附針 ) 4 NCS010020VPW 20CC SYRINGE W/NEEDLE 4 NCS010030NFR 30CC SYRINGE W/NEEDLE 7.3 NCS010030NPD 30CC SYRINGE W/NEEDLE 7.3 NCS010030NPW 30CC SYRINGE W/NEEDLE 7.3 NCS010030NSP 30CC SYRINGE W/NEEDLE 7.3 NCS010030NUY 30CC SYRINGE W/NEEDLE 7.3 NCS010030NV4 30CC SYRINGE W/NEEDLE 7.3 NCS010030VPW 30CC SYRINGE W/NEEDLE 7.3 NCS010050NBN DISPOSABLE SYRINGE 50CC W/NEEDLE 12.6 NCS010050NFR 50CC SYRINGE W/NEEDLE 12.6 NCS010050NPD 50CC SYRINGE W/NEEDLE 12.6 NCS010050NPW 50CC SYRINGE W/NEEDLE 12.6 NCS010050NSP 50CC,60CC SYRINGE W/NEEDLE 12.6 321

特材代碼中英文品名支付點數 NCS010050NUY 60CC SYRINGE W/NEEDLE 12.6 NCS010050NV4 50CC SYRINGE W/NEEDLE 12.6 NCS010050VPW 50CC SYRINGE W/NEEDLE 12.6 NCS0300100NR INSULIN SYRINGE 1CC 4.3 NCS03001S1FE 1CC RETRACTABLE SAFETY INSULIN SYRINGE W/NEEDLE 7 NCS030310NHG RETRACTABLE SAFETY SYRINGE(FIXED NEEDLE) 一次性使用無菌回縮式安全自毀注射器胰島素專用 ( 固定針 ) 7 NCS030310NSP INSULIN SYRINGE W/NEEDLE 4.3 NCS030510NBB 0.3:1.0CC INSULIN SYRINGE W/NEEDLE 4.3 NCS030510NBD INSULIN SYRINGE(30G 自 87/12/23 起生效 ) 4.3 NCS030510NBN INSULIN SYRINGE 100UNIT 4.3 NCS030510NMJ INSULIN SYRINGE 4.3 NCS030510NNR INSULIN SYRINGE 1 CC 4.3 NCS030510NPW INSULIN SYRINGE W/NEEDLE 4.3 NCS030510NTM INSULIN SYRINGE 0.3,0.5,1CC(0.3CC 自 87/12/19 收錄 )( 型號 SS30M,05M3009(A) 自 91/10/01 生效 ) 4.3 NCS0388816KD INSULINE SYRINGE W/NEEDLE(8881-600137,145,350,368,1358,1366,600700,800,601600) 4.3 NCS0391511BB OMNICAN INSULIN SYRINGES W/NEEDLE 0.5/1.0ML 4.3 NCS0391613BB INSULIN SYRINGE 4.3 NDD04N8008SG INJECTION CAP W/FREE SITE 無針式接頭 * 50 NDN0100022GW SCALP VEIN SET 22:25G 5.5 NDN01023XNPW SCALP NEEDLE 5.5 NDN011825NV4 SCALP SET 18G:25G 5.5 NDN011827NFR SCALP NEEDLE 5.5 NDN011827NJS SCALP NEEDLE 5.5 NDN011827NNR SCALP NEEDLE 5.5 NDN011827NTP SCALP NEEDLE 5.5 NDN011925NLL SCALP 頭皮針 5.5 322

特材代碼中英文品名支付點數 NDN011925NTM SCALP NEEDLE 5.5 NDN01A010NPW SCALP VEIN SET 16:27G 5.5 NDN020112NBA HUBER PLUS NON-CORING NEEDLE SAFETY INFUSION SET W/TUBING 94 NDN0202006HJ PORT-A-CATH NEEDLE 85 NDN02027NNHJ PORT-A-CATH GRIPPER NEEDLE W/EXTENSION TUBING 94 NDN0206023BA STRAIGHT AND RIGHT-ANGLE NON-CORING NEEDLE 直式或直角無心彎針 85 NDN0206025BA PORT-A NON-CORING NEEDLE 限癌症化學治療及癌症未期之疼痛治療使用 85 NDN0206033BA WINGED INFUSION SET 蝴蝶彎針注射套組 94 NDN0220012US PORT-A NON-CORING NEEDLE/RIGHT ANGLE 85 NDN0220013US PORT-A NON-CORING NEEDLE/STRAIGHT 85 NDN0222052BA 蝴蝶彎針 WINGED INFUSION SET 94 NDN0239759BB CYTOCAN NEEDLES FOR ACCESS PORT W/EXTENSION TUBING 94 NDN0239953BB SURECAN NON-CORING NEEDLE FOR PORT A 85 NDN0248430BB SURECAN NON-CORING NEEDLE W/EXTENSION TUBE FOR ACCESS PORTS 94 NDN02A180NPW WINGED CORE RESISTANT NEEDLE SETS 94 NDN02A190NPW WINGED NEEDLE SET( 含輸液管 ) 94 NDN02P1922KA PORT ACCESS INFUSION SET(NON-DEHP TUBING)19:22G 94 NDN02PN001SG PORT ACCESS INFUSION SET 94 NDN040002AMX PROTECTIV IV CATHETER SAFETY SYSTEM 32.4 NDN040024CBB INTROCAN CERTO-IV CATHETER 24G(PU) 14.5 NDN0404000MX JELCO IV CATHETER(TEFLON) 14 NDN0405000MX OPTIVA IV CATHETER(PU) 14.5 NDN041214NAY IV CATHETER(TEFLON) 14 NDN041422CBB INTROCAN CERTO-IV CATHETER 14:22G (PU)( 產品型號 0405-5756,64,72,6272,99) 14.5 NDN041422NBB IV CATHETER(TEFLON) 14 NDN041422NBN IV CATHETER(TEFLON) 14 323

NDN041424ABD INSYTE AUTOGUARD INTRAVASCULAR CATHETER 安全性靜脈導管 32.4 NDN041424NBD IV CATHETER(TEFLON) 14 NDN041424NTM IV CATHETER(TEFLON) 14 NDN041424STM SURFLO IV CATHETER 14G:24G(ETFE) 14 NDN041622NBD IV CATHETER(TEFLON) 14 NDN041622NNR IV CATHETER(TEFLON) 14 NDN041622NTM IV CATHETER(TEFLON) 14 NDN041624ABD IV CATHETER(PU) 14.5 NDN041627NTM IV CATHETER 16:27G (PU) 14.5 NDN041824NTP IV CATHETER MN(TEFLON) 14 NDN042400NBB IV CATHETER(TEFLON) 14 NDN042400NNR IV CATHETER(TEFLON) 14 NDN0442603BB VASOFIX SAFETY I.V. CANNULAE 菲適免針加藥安全靜脈留置針 47.7 NDN0442689BB VASOFIX I.V. CANNULAE 菲適免針加藥靜脈留置針 26.2 NDN0442CWSBB INTROCAN CERTO SAFETY PU 18:24G 安全靜脈留置針 32.4 NDN0442NWSBB INTROCAN CERTO SAFETY TEF 18:24G 安全靜脈留置針 32.4 NDN04SR01NTM SURFLO I.V CATHETER 14G:24G 14 NDN04T1424BD INSYTE IV CATHETER(PU/VIALON) 14.5 NDN04W1624BD INSYTE-W IV CATHETER(PU/VIALON) 14.5 NDN050024WBB INTROCAN CERTO IV CATHETER W/WING 24G(PU) 14.5 NDN050024WBD IV CATHETER 24G(TEFLON) 14 NDN051422WBB INTROCAN CERTO IV CATHETER W/WING (PU) 14:22G( 產品型號 0405-6280,5780,5799,6264,7802) 14.5 NDN051622NBB VASOCAN IV CATHETER(TEFLON)( 蠂翼靜脈留置針 ) 14 NDN051622WBD IV CATHETER 16:22G(TEFLON) 14 NES04QCS01CK "COOK"COAXIAL QUICK-CORE BIOPSY SETS 同軸庫可取樣針組 * 1500 RRB0119009HU HUDSON INCENTIVE SPIROMETER VOLDYNE 5000* 140 324

RRB0119017HU HUDSON INCENTIVE SPIROMETER PEDIATRIC VOLDYNE * 140 RRB0119025HU HUDSON INCENTIVE SPIROMETER VOLDYNE 2500* 140 RRB024301NGF GALEMED SPIROMETER AND ACCESSORY* 140 SAS026025SUS " 優施西 "GIA 自動手術縫合器 "USSC"AUTO SUTURE MULTIFIRE GIA DISPOSABLE SURGICAL STAPLER* 2459 SAS02TLC75JJ LINEAR CUTTER SAFETY LOCKOUT 75MM 腸胃自動縫合器 2459 SAS02TLHNNJJ TITANIUM LINEAR STAPLE 30,60,90MM ( 自動縫合器 + 釘 ) 2300 SAS03CDHXXET " 愛惜康 " 普克美釘合器 "ETHICON"PROXIMATE ILS INTRALUMINAL STAPLER* 5196 SAS03EEA25US " 優施西 " 一次性彎形端對端縫合器 "USSC" AUTO SUTURE CEEA SINGLE USE STAPLERS* 5196 SAS03SDH21JJ CIRCULAR STAPLE 消化道動吻合器 + 釘 21,25,29,33MM 5196 SAS0608025RA REFLEX SKIN STAPLE (REGULAR SIZE)(25) 410 SAS0608525RA REFLEX SKIN STAPLE (WIDE SIZE)(25) 410 SAS0654854US DISPOSIBLE ROYAL SKIN STAPLE 25W 410 SAS0680341DG SKIN STAPLE 25W 25R 410 SAS0680361DG SKIN STAPLE 25W 25R 410 SAS06FJ125WK VISISTAT SKIN STAPLE 25R 367 SAU0115441US TA 30 P-V3 DLU 胸腹器吻合釘 TA30P-V 2.5MM 2294 SAU01XR30RJJ PROXIMATE RELOADABLE LINEAR STAPLER 30MM VASCULAR 2294 SAU01XR30VET " 愛惜康 " 普克美縫合釘 "ETHICON" PROXIMATE LINEAR CUTTERS & RELOAD UNITS(RELOADABLE LINEAR STAPLER)* 2294 SAU0282534DG VALTRAC BIOFRAGMENTABLE ANASTOMOSIS RING 1.5:2.5MMX25:34MM 3900 SAU0730416US 優施西 GIA 自動手術縫合器 30MM 4000 SAU0730426US 優施西 GIA 自動手術縫合器 45MM 4900 SCS0101037CM RANEY SCALP CLIP 頭皮夾 20 排 / 盒 10 支 / 排 13 SCS0103100P2 " 太平洋 " 頭皮夾 "PAHSCO" SCALP CLIP 13 SCS01FF15PAE RANEY SCALP CLIPS 13 SCV0104120V7 " 威坦鐵克 " 鈦金屬血管夾 "VITALITEC" SLS-CLIP TITANIUM HEMOSTATIC CLIP 大型 35 SCV01FD870WK TITANIUM HEMOCLIP(LARGE) 35 325

特材代碼中英文品名支付點數 SCV01LT400JJ TITANIUM LIGA CLIP (L) 6 CLIP/ 排 35 SCV029380NM1 SUGITA ANEURYSM CLIPS(FENESTRATED LARGE TYPE)NO.7,9,12,14 3000 SCV029404NM1 SUGITA ANEURYSM CLIP (FENESTRATED LARGE TYPE) 3000 SCV029405NM1 SUGITA ANEURYSM CLIP (TEMPORARY TYPE) 3000 SCV029407SM1 SUGITA ANEURYSM CLIP (FENESTRATED LARGE TYPE) 3000 SCV029408SM1 SUGITA ANEURYSM CLIP (MINI TYPE) 3000 SCV0300001PA " 安培 " 腹腔鏡血管夾 "APPLIED"LAPAROSCOPIC CLIP APPLIER SYSTEM 200 SCV0300005ET LIGACLIP MULTIPLE CLIP APPLIER 多釘縫合釘 175 SCV031112CRG SCV031113LQX 內視鏡多發式可重複使用血管夾 "MICROLINE"M/L-10 ENDOSCOPIC MULTI-FIRE RATCHETED REUSABLE CLIP APPLIER-DISPOSABLE 19 TITANIUM CLIP " 麥克嵐潘特斯 " 傑尼多發式血管夾 "MICROLINE PENTAX" GEMINI MULTI-FIRE LARGE CLIP APPLIER 175 175 SCV03530MLCH " 康美 " 拋棄式血管夾 "CONMED" DISPOSABLE CLIP APPLIER 175 SCV03615MLUS ENDO CLIP APPLIER M/L CLIPS 內視鏡自動血管夾 175 SCV03625LLUS ENDO CLIP APPLIER M/L CLIPS 內視鏡自動血管夾 200 SCV2023701WK HEMOCLIP AUTOMATIC CLIP APPLIER WITH CLIPS S15 102 SCV2023703WK HEMOCLIP AUTOMATIC CLIP APPLIER WITH CLIPS M20 104 SCV2032081US SURGI-CLIP M-9.5 ( 每支 20 CLIP) 104 SCV2032091US SURGI-CLIP M-11 ( 每支 20 CLIP) 104 SCV2034031US PREMIUM SURGI-CLIP ( 每支 20 CLIP) M-11.5 104 SCV2034044US PREMIUM SURGI-CLIP M9.75 ( 每支 15 CLIP) 104 SCV2034046US PREMIUM SURGI-CLIP ( 每支 20 CLIP) S9.0 102 SCV2034048US PREMIUM SURGI-CLIP L-13.0 ( 每支 15 CLIP) 122 SCV2034051US AUTO SUTURE DISPOSABLE AUTOMATIC CLIP APPLIER PREMIUM SURGICLIP II(M-9.75) 104 SCV2034053US AUTO SUTURE DISPOSABLE AUTOMATIC CLIP APPLIER PREMIUM SURGICLIP II(M-11.5) 104 SCV2035220CH CONMED DISPOSABLE CLIP APPLIER 拋棄式血管夾 104 SCV20MCL20JJ MULTIPLE CLIPS APPLIER (20 CLIP/PC) 122 SCV20MCM20JJ MULTIPLE CLIP APPLIER (20 CLIP/PC) 104 326

特材代碼中英文品名支付點數 SCV20MCM30JJ MULTIPLE CLIP APPLIER (30 CLIP/PC) 104 SCV20MCS20JJ MULTIPLE CLIP APPLIER (20 CLIP/PC) 102 TKC0202100K2 SUPERBLADE TREPHINE VACUUM 2350 TKC028260NJM HESSBURG-BARRON VACUUM TREPHINE 漢氏伯手動環鉅 2350 TKF0108120A1 LIGHT GUIDE 20G 1450 TKF0192801ZT FIBER OPTIC ENDOILLUMINATOR PROBE 後房手術用光纖 1450 TKF01DP602B9 ILLUMINATORS 眼科手術儀用光纖導管 1450 TKF01MVS01B9 ILLUMINATORS 眼科手術儀用光纖導管 1450 TKP0113509WF EHL 9FR 電擊線 3477 TKP0113713WF EHL 3.5FR 電擊線 3477 TKP0113715WF EHL 5FR 電擊線 3477 TKP012280NWF LITHOTRIPTER:RIWOLITH PROBES 2280.XXX 3477 TKP012708NKL EHL PROBE 電擊碎石線 3477 TKVC1CX408B9 HIGH SPEED VITRECTOMY CUTTER TIPS 高速玻璃體切割頭 600-1500 次 / 分 4500 TKVS1D4801B9 VITREOUS ASPIRATION AND CUTTING INSTRUMENT PACKS:VENTURI BASIC POSTERIOR VITRECTOMY ( 含盒子 ) 4500 TKVS1D4801SZ BASIC POSTERIOR VITRECTOMY PACK 4500 TKVS1D4803B9 VITREOUS ASPIRATION AND CUTTING INSTRUMENT PACKS:POSTERIOR VITRECTOMY CUTTER PACKS( 不含盒子 ) 4500 TKVS1D4803SZ MICROVIT VITRECTOMY CUTER POSTERIOR 4500 WBB0402050A8 ELASTIC BANDAGE 10.6 WBB0402050C7 ELASTIC BANDAGE 10.6 WBB0402050EX ELASTIC BANDAGE 10.6 WBB0402050EZ ELASTIC BANDAGE 2"x5Y * 10.6 WBB0402050F0 FOR CARE ELASTIC BANDAGE* 適應正請見備註欄 10.6 WBB0402050GM ELASTIC BANDAGE 10.6 WBB0402050KB DURELASTIC-M 5CMx4.5M * 10.6 WBB0402050KF ELASTIC BANDAGE 10.6 327

特材代碼中英文品名支付點數 WBB0402050MG ELASTIC BANDAGE 2"x5Y 10.6 WBB0402050TW ELASTIC BANDAGE* 10.6 WBB0402050YS ELASTIC BANDAGE 2"X5Y 10.6 WBB0402050YU YU CHUNG ELASTIC BANDAGE (NON-STERILE)* 10.6 WBB0402050Z5 S.S BANDAGE 2x5* 10.6 WBB0402050ZB ELASTIC BANDAGE* 10.6 WBB0403050A8 ELASTIC BANDAGE 15.2 WBB0403050B5 ELASTIC BANDAGE 15.2 WBB0403050C7 ELASTIC BANDAGE 15.2 WBB0403050EX ELASTIC BANDAGE 15.2 WBB0403050EZ ELASTIC BANDAGE 3"x5Y * 15.2 WBB0403050F0 FOR CARE ELASTIC BANDAGE* 適應正請見備註欄 15.2 WBB0403050FF ELASTIC BANDAGE 15.2 WBB0403050GM ELASTIC BANDAGE 15.2 WBB0403050KB DURELASTIC-M 7.5CMx4.5M * 15.2 WBB0403050KF ELASTIC BANDAGE 15.2 WBB0403050MG ELASTIC BANDAGE 3"x5Y 15.2 WBB0403050TW ELASTIC BANDAGE* 15.2 WBB0403050YS ELASTIC BANDAGE 3"x5Y 15.2 WBB0403050YU YU CHUNG ELASTIC BANDAGE (NON-STERILE)* 15.2 WBB0403050Z5 S.S BANDAGE 3x5* 15.2 WBB0403050ZB ELASTIC BANDAGE* 15.2 WBB0403050ZE O.P.S ELASTIC BANDAGE(NON-STERILE) 15.2 WBB0404050A8 ELASTIC BANDAGE 19.3 WBB0404050B5 ELASTIC BANDAGE 19.3 WBB0404050C7 ELASTIC BANDAGE 19.3 328

特材代碼中英文品名支付點數 WBB0404050EX ELASTIC BANDAGE 19.3 WBB0404050EZ ELASTIC BANDAGE 4"x5Y * 19.3 WBB0404050F0 FOR CARE ELASTIC BANDAGE* 適應正請見備註欄 19.3 WBB0404050FF ELASTIC BANDAGE 19.3 WBB0404050GM ELASTIC BANDAGE 19.3 WBB0404050KB DURELASTIC-M 10CMx4.5M * 19.3 WBB0404050KF ELASTIC BANDAGE 19.3 WBB0404050MG ELASTIC BANDAGE 4"x5Y 19.3 WBB0404050TW ELASTIC BANDAGE* 19.3 WBB0404050YS ELASTIC BANDAGE 4"x5Y 19.3 WBB0404050YU YU CHUNG ELASTIC BANDAGE (NON-STERILE)* 19.3 WBB0404050ZB ELASTIC BANDAGE* 19.3 WBB0404050ZE O.P.S ELASTIC BANDAGE(NON-STERILE) 19.3 WBB0406050A8 ELASTIC BANDAGE 25.5 WBB0406050B5 ELASTIC BANDAGE 25.5 WBB0406050C7 ELASTIC BANDAGE 25.5 WBB0406050EX ELASTIC BANDAGE 25.5 WBB0406050EZ ELASTIC BANDAGE 6"x5Y * 25.5 WBB0406050F0 FOR CARE ELASTIC BANDAGE* 適應正請見備註欄 25.5 WBB0406050FF ELASTIC BANDAGE 25.5 WBB0406050GM ELASTIC BANDAGE 25.5 WBB0406050KB DURELASTIC-M 15CMx4.5M * 25.5 WBB0406050KF ELASTIC BANDAGE 25.5 WBB0406050MG ELASTIC BANDAGE 6"x5Y 25.5 WBB0406050TW ELASTIC BANDAGE* 25.5 WBB0406050YS ELASTIC BANDAGE 6"x5Y 25.5 329

WBB0406050YU YU CHUNG ELASTIC BANDAGE (NON-STERILE)* 25.5 WBB0406050ZB ELASTIC BANDAGE* 25.5 WBB0406050ZE O.P.S ELASTIC BANDAGE(NON-STERILE) 25.5 WBB0702030AZ "M&A"POP PLASTER OF PARIS BANDAGE EXTRA FAST SETTING 2"X3Y 石膏繃帶 20.5 WBB0702050AZ PLASTER OF PARIS BANDAGE 2"x5Y 23 WBB0702050JN "JOIN"OPTIMA POP PLASTER OF PARIS BANDAGE2"X5Y 歐替瑪石膏繃帶 23 WBB0703030A5 CAST BANDAGE 23 WBB0703030AZ "M&A"POP PLASTER OF PARIS BANDAGE EXTRA FAST SETTING 3"X3Y 石膏繃帶 23 WBB0703030C7 "CSD"PLASTER OF PAIRS BANDAGE 3"X3Y 石膏繃帶 23 WBB0703030NJ PLASTER BANDAGE 3"X3Y 23 WBB0703030U6 PLASTER OF PARIS BANDAGE 3"X3Y 23 WBB0703030ZD DUK-IN PLASTER BANDAGE 23 WBB0703040U6 PLASTER OF PARIS BANDAGE 3"X4Y 25 WBB0703050AZ PLASTER OF PARIS BANDAGE 3"X5Y 32 WBB0703050C7 CAST BANDAGE 32 WBB0703050JN "JOIN"OPTIMA POP PLASTER OF PARIS BANDAGE3"X5Y 歐替瑪石膏繃帶 32 WBB0703050U6 PLASTER OF PARIS BANDAGE 3"X5Y 32 WBB0704030DQ PLASTER OF PARIS BANDAGE B.P 25 WBB0704030U6 PLASTER OF PARIS BANDAGE 4"X3Y 25 WBB0704040U6 PLASTER OF PARIS BANDAGE 4"X4Y 34.1 WBB0704040ZD DUK-IN PLASTER BANDAGE 34.1 WBB0704050A5 CAST BANDAGE 40 WBB0704050AZ PLASTER OF PARIS BANDAGE 4"X5Y 40 WBB0704050C7 CAST BANDAGE 40 WBB0704050JN "JOIN"OPTIMA POP PLASTER OF PARIS BANDAGE4"X5Y 歐替瑪石膏繃帶 40 WBB0704050MB CAST BANDAGE 40 330

特材代碼中英文品名支付點數 WBB0704050NJ PLASTER BANDAGE 4"X5Y 40 WBB0704050NS NOK-SAN CAST PLASTER BANDAGE 10CMX4.5M(4"X5Y) 40 WBB0704050U6 PLASTER OF PARIS BANDAGE 4"X5Y 40 WBB0705050AZ "M&A"POP PLASTER OF PARIS BANDAGE EXTRA FAST SETTING 5"X5Y 石膏繃帶 50 WBB0705050JN "JOIN"OPTIMA POP PLASTER OF PARIS BANDAGE5"X5Y 歐替瑪石膏繃帶 50 WBB0705050NJ PLASTER BANDAGE 5"X5Y 50 WBB0705050U6 PLASTER OF PARIS BANDAGE 5"X5Y 50 WBB0706030U6 PLASTER OF PARIS BANDAGE 6"X3Y 39 WBB0706040U6 PLASTER OF PARIS BANDAGE 6"X4Y 47 WBB0706040ZD DUK-IN PLASTER BANDAGE 47 WBB0706050A5 "Alcare"casting 6"x5y 53 WBB0706050AZ PLASTER OF PARIS BANDAGE 6"X5Y 53 WBB0706050C7 CAST BANDAGE 53 WBB0706050JN "JOIN"OPTIMA POP PLASTER OF PARIS BANDAGE6"X5Y 歐替瑪石膏繃帶 53 WBB0706050MB CAST BANDAGE 53 WBB0706050NJ PLASTER BANDAGE 6"X5Y 53 WBB0706050NS NOK-SAN CAST PLASTER BANDAGE 15CMX4.5M(6"X5Y) 53 WBB0706050U6 PLASTER OF PARIS BANDAGE 6"X5Y 53 WBB0708050AZ PLASTER OF PARIS BANDAGE 8"X5Y 70 WBB0708050JN "JOIN"OPTIMA POP PLASTER OF PARIS BANDAGE8"X5Y 歐替瑪石膏繃帶 70 WBB0801020KB "KOB"KOBRA CAST 易速石膏繃帶 ( 聚脂石膏繃帶 )1 吋 X2 碼 * 100 WBB0801020Q9 "TOMATO"ORTHOPAEDIC CASTING TAPE(NON-STERILE) 玻璃纖維石膏繃帶 1 吋 X2 碼 * 100 WBB08020403M SCOTCHCAST PLUS CASTING TAPE 玻璃纖維石膏繃帶 2 吋 X4 碼 * 240 WBB0802040KB "KOB"KOBRA CAST 易速石膏繃帶 ( 聚脂石膏繃帶 )2 吋 X4 碼 * 240 WBB0802040NJ FIBERGLASS CAST TAPE 玻璃纖維石膏繃帶 2 吋 X4Y* 240 WBB0802040Q3 "DONG HAE"ORTHOPEDIC CASTING TAPE 輕石膏 ( 玻璃纖維 )2 吋 X4 碼 * 240 331

WBB0802040Q5 "S&F"ROBO CASTING TAPE 若玻樹脂石膏繃帶 ( 聚脂纖維 )2 吋 X4 碼 * 240 WBB0802040Q6 NEMOA CAST ORTHOPAEDIC CASTING TAPE(POLYESTER) 米尼亞聚脂繃帶 2 吋 X4 碼 * 240 WBB0802040Q7 "KJC"PP-BAND CASTING TAPE 必庇綁樹脂石膏 ( 聚脂纖維 )2 吋 X4 碼 * 240 WBB0802040Q8 "OPTIMA CAST"ORTHOPAEDIC CASTING TAPE(NON-STERILE) 樹脂石膏繃帶 ( 玻璃纖維 )2 吋 X4 碼 * 240 WBB0802040Q9 "TOMATO"ORTHOPAEDIC CASTING TAPE(NON-STERILE) 玻璃纖維石膏繃帶 2 吋 X4 碼 * 240 WBB08020413M SCOTCHCAST PREMIUM CASTING TAPE 玻璃纖維石膏繃帶 2 吋 X4 碼 * 240 WBB0802041NJ POLYESTER CAST TAPE 聚脂纖維石膏繃帶 2 吋 X4Y* 240 WBB08030403M SCOTCHCAST PLUS CASTING TAPE 玻璃纖維石膏繃帶 3 吋 X4 碼 * 280 WBB0803040KB "KOB"KOBRA CAST 易速石膏繃帶 ( 聚脂石膏繃帶 )3 吋 X4 碼 * 280 WBB0803040NJ FIBERGLASS CAST TAPE 玻璃纖維石膏繃帶 3 吋 X4Y* 280 WBB0803040Q3 "DONG HAE"ORTHOPEDIC CASTING TAPE 輕石膏 ( 玻璃纖維 )3 吋 X4 碼 * 280 WBB0803040Q5 "S&F"ROBO CASTING TAPE 若玻樹脂石膏繃帶 ( 聚脂纖維 )3 吋 X4 碼 * 280 WBB0803040Q6 NEMOA CAST ORTHOPAEDIC CASTING TAPE(POLYESTER) 米尼亞聚脂繃帶 3 吋 X4 碼 * 280 WBB0803040Q7 "KJC"PP-BAND CASTING TAPE 必庇綁樹脂石膏 ( 聚脂纖維 )3 吋 X4 碼 * 280 WBB0803040Q8 "OPTIMA CAST"ORTHOPAEDIC CASTING TAPE(NON-STERILE) 樹脂石膏繃帶 ( 玻璃纖維 )3 吋 X4 碼 * 280 WBB0803040Q9 "TOMATO"ORTHOPAEDIC CASTING TAPE(NON-STERILE) 玻璃纖維石膏繃帶 3 吋 X4 碼 * 280 WBB08030413M SCOTCHCAST PREMIUM CASTING TAPE 玻璃纖維石膏繃帶 3 吋 X4 碼 * 280 WBB0803041NJ POLYESTER CAST TAPE 聚脂纖維石膏繃帶 3 吋 X4Y* 280 WBB08040403M SCOTCHCAST PLUS CASTING TAPE 玻璃纖維石膏繃帶 4 吋 X4 碼 * 320 WBB0804040KB "KOB"KOBRA CAST 易速石膏繃帶 ( 聚脂石膏繃帶 )4 吋 X4 碼 * 320 WBB0804040NJ FIBERGLASS CAST TAPE 玻璃纖維石膏繃帶 4 吋 X4Y* 320 WBB0804040Q3 "DONG HAE"ORTHOPEDIC CASTING TAPE 輕石膏 ( 玻璃纖維 )4 吋 X4 碼 * 320 WBB0804040Q5 "S&F"ROBO CASTING TAPE 若玻樹脂石膏繃帶 ( 聚脂纖維 )4 吋 X4 碼 * 320 WBB0804040Q6 NEMOA CAST ORTHOPAEDIC CASTING TAPE(POLYESTER) 米尼亞聚脂繃帶 4 吋 X4 碼 * 320 WBB0804040Q7 "KJC"PP-BAND CASTING TAPE 必庇綁樹脂石膏 ( 聚脂纖維 )4 吋 X4 碼 * 320 WBB0804040Q8 "OPTIMA CAST"ORTHOPAEDIC CASTING TAPE(NON-STERILE) 樹脂石膏繃帶 ( 玻璃纖維 )4 吋 X4 碼 * 320 332

WBB0804040Q9 "TOMATO"ORTHOPAEDIC CASTING TAPE(NON-STERILE) 玻璃纖維石膏繃帶 4 吋 X4 碼 * 320 WBB08040413M SCOTCHCAST PREMIUM CASTING TAPE 玻璃纖維石膏繃帶 4 吋 X4 碼 * 320 WBB0804041NJ POLYESTER CAST TAPE 聚脂纖維石膏繃帶 4 吋 X4Y* 320 WBB08050403M SCOTCHCAST PLUS CASTING TAPE 玻璃纖維石膏繃帶 5 吋 X4 碼 * 360 WBB0805040KB "KOB"KOBRA CAST 易速石膏繃帶 ( 聚脂石膏繃帶 )5 吋 X4 碼 * 360 WBB0805040NJ FIBERGLASS CAST TAPE 玻璃纖維石膏繃帶 5 吋 X4Y* 360 WBB0805040Q3 "DONG HAE"ORTHOPEDIC CASTING TAPE 輕石膏 ( 玻璃纖維 )5 吋 X4 碼 * 360 WBB0805040Q5 "S&F"ROBO CASTING TAPE 若玻樹脂石膏繃帶 ( 聚脂纖維 )5 吋 X4 碼 * 360 WBB0805040Q6 NEMOA CAST ORTHOPAEDIC CASTING TAPE(POLYESTER) 米尼亞聚脂繃帶 5 吋 X4 碼 * 360 WBB0805040Q7 "KJC"PP-BAND CASTING TAPE 必庇綁樹脂石膏 ( 聚脂纖維 )5 吋 X4 碼 * 360 WBB0805040Q8 "OPTIMA CAST"ORTHOPAEDIC CASTING TAPE(NON-STERILE) 樹脂石膏繃帶 ( 玻璃纖維 )5 吋 X4 碼 * 360 WBB0805040Q9 "TOMATO"ORTHOPAEDIC CASTING TAPE(NON-STERILE) 玻璃纖維石膏繃帶 5 吋 X4 碼 * 360 WBB08050413M SCOTCHCAST PREMIUM CASTING TAPE 玻璃纖維石膏繃帶 5 吋 X4 碼 * 360 WBB0805041NJ POLYESTER CAST TAPE 聚脂纖維石膏繃帶 5 吋 X4Y* 360 WBB0806040Q3 "DONG HAE"ORTHOPEDIC CASTING TAPE 輕石膏 ( 玻璃纖維 )6 吋 X4 碼 * 400 WBB0806040Q5 "S&F"ROBO CASTING TAPE 若玻樹脂石膏繃帶 ( 聚脂纖維 )6 吋 X4 碼 * 400 WBB0806040Q6 NEMOA CAST ORTHOPAEDIC CASTING TAPE(POLYESTER) 米尼亞聚脂繃帶 6 吋 X4 碼 * 400 WBB0806040Q9 "TOMATO"ORTHOPAEDIC CASTING TAPE(NON-STERILE) 玻璃纖維石膏繃帶 6 吋 X4 碼 * 400 WBB0815381A5 玻璃纖維石膏繃帶 2 吋 X4 碼 * 240 WBB0815382A5 玻璃纖維石膏繃帶 3 吋 X4 碼 * 280 WBB0815383A5 玻璃纖維石膏繃帶 4 吋 X4 碼 * 320 WBB0815384A5 玻璃纖維石膏繃帶 5 吋 X4 碼 * 360 WBB0817941A5 聚脂纖維石膏繃帶 2 吋 X4 碼 * 240 WBB0817942A5 聚脂纖維石膏繃帶 3 吋 X4 碼 * 280 WBB0817943A5 聚脂纖維石膏繃帶 4 吋 X4 碼 * 320 WBB0817944A5 聚脂纖維石膏繃帶 5 吋 X4 碼 * 360 333

WBB0820400Q5 "S&F"ROBO CASTING TAPE 若玻樹脂石膏繃帶 ( 玻璃纖維 )2 吋 X4 碼 * 240 WBB0830400Q5 "S&F"ROBO CASTING TAPE 若玻樹脂石膏繃帶 ( 玻璃纖維 )3 吋 X4 碼 * 280 WBB0840400Q5 "S&F"ROBO CASTING TAPE 若玻樹脂石膏繃帶 ( 玻璃纖維 )4 吋 X4 碼 * 320 WBB0850400Q5 "S&F"ROBO CASTING TAPE 若玻樹脂石膏繃帶 ( 玻璃纖維 )5 吋 X4 碼 * 360 WBB0860400Q5 "S&F"ROBO CASTING TAPE 若玻樹脂石膏繃帶 ( 玻璃纖維 )6 吋 X4 碼 * 400 WBP0102040JN OPTIMA PAD 石膏棉捲 11 WBP0103030C7 CSD ORTHOPAEDIC CAST COTTON PADDING 13.5 WBP0103030DQ SABHARWAL'S BANDAGE ORTHOPAEDIC CAST PADDING 13.5 WBP0103030LD LANTOR ORTHOPEDIC COTTON BANDAGE 13.5 WBP0103030TH ORTHOPEDIC COTTON BANDAGE 13.5 WBP0103040C7 CSD ORTHOPAEDIC CAST COTTON PADDING 14 WBP0103040FC ORTHOPEDIC COTTON BANDAGE 14 WBP0103040FF ORTHOPEDIC COTTON BANDAGE 14 WBP0103040JN OPTIMA PAD 石膏棉捲 14 WBP0103040KF ORTHOPEDIC COTTON BANDAGE 14 WBP0103040LD LANTOR ORTHOPEDIC COTTON BANDAGE 14 WBP0103040ZC CAST PADDING SOFT COTTON BANDAGE 14 WBP0104030C7 CSD ORTHOPAEDIC CAST COTTON PADDING 14 WBP0104030LD LANTOR ORTHOPEDIC COTTON BANDAGE 14 WBP0104033DQ ORTHOPAEDIC CAST PADDING 14 WBP0104040BP B.P.I UNDER CAST PADDING BANDAGE COTTON 18.3 WBP0104040C7 CSD ORTHOPAEDIC CAST COTTON PADDING 18.3 WBP0104040FC ORTHOPEDIC COTTON BANDAGE 18.3 WBP0104040FF ORTHOPEDIC COTTON BANDAGE 18.3 WBP0104040GM ORTHOPEDIC COTTON BANDAGE 18.3 WBP0104040JN OPTIMA PAD 石膏棉捲 18.3 334

特材代碼中英文品名支付點數 WBP0104040KF ORTHOPEDIC COTTON BANDAGE 18.3 WBP0104040LD LANTOR ORTHOPEDIC COTTON BANDAGE 18.3 WBP0104040NJ ORTHOPEDIC COTTON BANDAGE 18.3 WBP0104040TH ORTHOPEDIC COTTON BANDAGE 18.3 WBP0104040ZC CAST PADDING SOFT COTTON BANDAGE 18.3 WBP0104050C7 CSD ORTHOPAEDIC CAST COTTON PADDING 24.3 WBP0104050LD LANTOR ORTHOPEDIC COTTON BANDAGE 24.3 WBP0105040C7 CSD ORTHOPAEDIC CAST COTTON PADDING 24.3 WBP0105040LD LANTOR ORTHOPEDIC COTTON BANDAGE 24.3 WBP0106030C7 CSD ORTHOPAEDIC CAST COTTON PADDING 24 WBP0106030LD LANTOR ORTHOPEDIC COTTON BANDAGE 24 WBP0106033DQ ORTHOPAEDIC CAST PADDING 24 WBP0106040BP B.P.I UNDER CAST PADDING BANDAGE COTTON 27.5 WBP0106040C7 CSD ORTHOPAEDIC CAST COTTON PADDING 27.5 WBP0106040FC ORTHOPEDIC COTTON BANDAGE 27.5 WBP0106040FF ORTHOPEDIC COTTON BANDAGE 27.5 WBP0106040GM ORTHOPEDIC COTTON BANDAGE 27.5 WBP0106040JN OPTIMA PAD 石膏棉捲 27.5 WBP0106040KF ORTHOPEDIC COTTON BANDAGE 27.5 WBP0106040LD LANTOR ORTHOPEDIC COTTON BANDAGE 27.5 WBP0106040NJ ORTHOPEDIC COTTON BANDAGE 27.5 WBP0106040TH ORHTOPEDIC COTTON BANDAGE 27.5 WBP0106040ZC CAST PADDING SOFT COTTON BANDAGE 27.5 WBP0106050A5 ORTHOPEDIC COTTON BANDAGE 34.4 WBP0106050C7 CSD ORTHOPAEDIC CAST COTTON PADDING 34.4 WBP0106050LD LANTOR ORTHOPEDIC COTTON BANDAGE 34.4 335

特材代碼中英文品名支付點數 WDD0800025SN INTRASITE GEL 25GM * 276 WDD0800100CA COMFEEL DRESSING 10X10CM 123 WDD0800451SN "SMITH&NEPHEW"ALLEVYN DRESSING(SACRUM)22CMX22CM 愛力膟親水性的聚乙烯膟料 * 400 WDD0800607ZK OMIDERM WOUND DRESSING (STERILE)5X7CM* 73 WDD0800707SN HYDROCELLULAR ADHESIVE DRESSING 7.5X7.5CM 73 WDD0801010SN HYDROPHILIC POLYURETHANE DRESSING 10X10CM 123 WDD0802020SN HYDROPHILIC POLYURETHANE DRESSING 20X20CM 400 WDD0802222SN HYDROCELLULAR ADHESIVE DRESSING 22.5X22.5CM 400 WDD080300BDB BIO-BRANE 13CMX38CM 1500 WDD0809921HL RESTORE EXTRA THIN 10CMMX10CM 55 WDD0809953HL RESTORE PLUS WOUND CARE DRESSING STERILE 10X10CM 123 WDD0809955HL RESTORE PLUS WOUND CARE DRESSING STERILE 20X20CM 400 WDD0809956HL RESTORE PLUS TAPERED EDGE WOUND CARE DRESSING STERILE 10X10CM 123 WDD081010TSN REPLICARE ULTRA 10X10CM 55 WDD0815181A5 KARAYAHESIVE HYDROCOLLOID WOUND DRESSING 37.5CM2, 親水性敷料 * 26 WDD0815183A5 KARAYAHESIVE HYDROCOLLOID WOUND DRESSING 113CM2, 親水性敷料 * 55 WDD0815191A5 KARAYAHESIVE HYDROCOLLOID WOUND DRESSING 25CM2, 親水性敷料 * 26 WDD0815192A5 KARAYAHESIVE HYDROCOLLOID WOUND DRESSING 100CM2, 親水性敷料 * 55 WDD0831100CA COMFEEL PLUS ULCER DRESSING 10X10CM 123 WDD0831200CA COMFEEL PLUS ULCER DRESSING 20X20CM 400 WDD0831460CA COMFEEL PLUS ULCER DRESSING 4X6CM 30 WDD0834100CA "COLOPLAST"BIATAIN NON-ADHESIVE DRESSING 10X10CM 平而坦非黏性泡綿敷料 * 123 WDD0834160CA "COLOPLAST"BIATAIN DRESSING NON-ADHESIVE 20CMX20CM 平而坦傷口敷料 * 400 WDD0834700CA "COLOPLAST"BIATAIN DRESSING SOFT-HOLD 10CMX10CM 平而坦傷口敷料 * 123 WDD0835300CA COMFEEL PLUS TRANSPARENT DRESSING 5X7CM 26 WDD0835330CA COMFEEL PLUS TRANSPARENT DRESSING 10X10CM 55 336

WDD0835500CA "COLOPLAST"BIATAIN AG NON-ADHESIVE FOAM DRESSING 10X10CM 平而坦銀離子非黏性泡綿敷 228 料 * WDD0837100CA COMFEEL SEASORB DRESSING 10X10CM 123 WDD0839030CA COMFEEL PURILON GEL 25GM* 276 WDD0841010BB "B.BRAUN"ASKINA FOAM WOUND DRESSING(STERILE)10CMX10CM 雅膟泡棉敷料 * 123 WDD0842005BB "B.BRAUN"ASKINA FOAM WOUND DRESSING(STERILE)20CMX20CM 雅膟泡棉敷料 * 400 WDD0850554BB "B.BRAUN"ASKINA THINSITE DRESSING(STERILE)10CMX10CM* 55 WDD0850557BB ASKINA THINSITE 5CMX20CM* 55 WDD0860924P8 TENDERWET 10X10CM 123 WDD0860928P8 TENDERWET 10X10CM 123 WDD0872041BB "B.BRAUN"ASKINA HYDRO 10CMX10CM 雅膟親水膞敷料 * 123 WDD0872047BB "B.BRAUN"ASKINA HYDRO 20CMX20CM 雅膟親水膞敷料 * 400 WDD08900223M HYDROCOLLOID DRESSING 10X10CM( 薄 ) 55 WDD08900333M TEGASORB THIN HYDROCOLLOID DRESSING 10CMX10CM * 55 WDD08900523M 3M TEGASORB THIN HYDROCOLLOID DRESSING 5CMX20CM* 55 WDD0890670P8 HYDROCOLL 10X10CM 123 WDD0890674P8 HYDROCOLL 20X20CM 400 WDD0890685P8 HYDROCOLL TRANSPARENT 10X10CM( 薄 ) 55 WDD0894300LN MEPILEX STERILE 15CMX15CM 250 WDD0895400LN MEPILEX BORDER SAFETAC SILICON FOAM DRESSING 15X15CM* 250 WDD0899581P8 "HARTMANN"HYDROPHILIC WOUND DRESSING(THIN)(STERILE)HYDROTUL 5X5CM 親水性創傷覆蓋材 * 26 WDD0899595P8 SORBALGON 10X10CM 123 WDD0899598P8 SORBALGON 5X5CM 30 WDD08C0506SN "SMITH&NEPHEW"CUTINOVA HYDRO DRESSING 新世代人工皮膟 5CMX6CM* 30 WDD08C1010SN "SMITH&NEPHEW"CUTINOVA HYDRO DRESSING 10X10CM* 123 WDD08F0102ZW "SAVDERM"FOAM DRESSING (STERILE)10X10CM 泡棉敷料 * 123 WDD08S0101ZW "SAVDERM"SELF-ADHESIVE FOAM DRESSING(STERILE) 自黏性泡棉敷料 5X5CM* 30 337

WDD08S0202ZW "SAVDERM"SELF-ADHESIVE FOAM DRESSING(STERILE) 自黏性泡棉敷料 10X10CM* 123 WDD08S0404ZW "SAVDERM"SELF-ADHESIVE FOAM DRESSING(STERILE) 自黏性泡棉敷料 20X20CM* 400 WDD08T0520RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創傷敷料 ( 滅菌 )5X20CM*( 薄型 )* 55 WDD08T1010RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創傷敷料 ( 滅菌 )10X10CM*( 薄型 )* 55 WDD08W0505RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創傷敷料 ( 滅菌 )5X5CM* 30 WDD08W1010RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創傷敷料 ( 滅菌 )10X10CM* 123 WDD08W2020RW "TEAM POWER"HYDROPHILIC WOUND DRESSING (STERILE) 親水性創傷敷料 ( 滅菌 )20X20CM* 400 338