住院费用清单2

城厢区医院住院费用汇总清单,,,,,,,,,,

姓名：徐美香,,住院号：000000659,,,区1床,眼科,科起止日期：2011.01.09～2011.01.12,,,

"药品或医疗

项目编码",,"费用项目

名称",,,规格,"计量

单位",数量,"单价

（元）","总额

（元）","医保自付比例

（%）"

700000000001,,苯巴比妥注射液,,,1ml:0.1g*10支,支,1,0.66,0.66,非医保

950030,,一次性注射器,,,5ml,支,8,0.31,2.48,非医保

950029,,一次性注射器,,,7#,支,5,0.95,4.75,35%自付

10502001206541810101,,盐酸布比卡因,,,5毫升/37.5毫克,支,1,0.85,0.85,甲类

10502003177489010102,,盐酸利多卡因,,,5毫升/0.1克/支,支,1,0.32,0.32,甲类

10601010068637310502,,维生素AD胶丸,,,10000单位/10粒,粒,36,0.03,1.08,甲类

10603001177084910103,,维生素C片,,,0.1克/100片,片,36,0.02,0.76,乙类

10801045023265411001,,地塞米松磷酸钠滴眼液,,,5毫升/1.25毫克,支,2,0.73,1.46,甲类

10801045177076510102,,地塞米松磷酸钠注射液,,,1毫升/5毫克/支,支,2,0.17,0.17,甲类

11505005177616211001,,盐酸肾上腺素,,,1毫升/1毫克/支,支,2,0.32,0.64,甲类

950029,,一次性输血器,,,,支,2,1.56,3.12,35%自付

11802003206708210501,,复方氯化钠（塑料瓶）,,,500ml,瓶,2,3.66,7.32,甲类

10202016023678711001,,乳酸左氧氟沙星滴眼液,,,24mg;8ml,瓶,1,10.94,10.94,乙类

120600004,,小换药,,,创面在15cm2以内,次,3,4.5,13.5,甲类

110900001-2,,普通病房床位费-双人间,,,,日,2,18.00,36,甲类

120100004,,Ⅱ级护理,,,,日,3,6.00,18,甲类

310205008,,电脑血糖监测,,,,次,1,9.00,9,甲类

250101015,,血细胞分析,,,,项,1,16.20,16.2,甲类

210101001,,普通透视,,,,每部位,1,4.50,4.5,甲类

210101,,X线透视检查,,,使用影像增强,每部位,1,1.80,1.8,甲类

250101017,,出血时间测定,,,项,项,1,0.90,0.9,甲类

250101018,,凝血时间测定（CT）,,,项,项,1,0.90,0.9,甲类

250102001,,尿常规检查（尿液分析）,,,,项,1,9.00,9,甲类

250103001,,粪常规,,,,次,1,1.80,1.8,甲类

330100001,,局部浸润麻醉（含表面麻醉）,,,含表面麻醉,次,1,18.00,18,甲类

310300039,,角膜曲率测量（单）,,,,次,1,4.50,4.5,甲类

950059,,爱尔康尼龙缝合线,,,,条,2,129.60,259.2,35%自付

11903026206053811002,,透明质酸钠,,,,支,2,88.12,176.24,35%自付

910050,,人工晶体,,,博士伦P359U,支,1,842.40,842.4,35%自付

310300036,,泪道冲洗,,,,次,1,3.60,3.6,甲类

310701022,,心电监测,,,含无创血压测,次,2,4.50,9,甲类

110200005,,住院诊查费,,,,日,3,2.00,6,甲类

120300001-1,,低流量吸氧,,,每小时,次,2,2.70,5.4,甲类

120400001,,肌肉注射,,,,次,1,1.40,1.4,甲类

330406010,,白内障超声乳化摘除术+人,,,,次,1,1350.00,1350,甲类

310701004,,心电图检查（频谱心电图）,,,,次,1,25.00,25,甲类

910051,,一次性乳化专用刀,,,,支,3,113.40,340.2,35%自付

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