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["    根据《陕西省医疗保障局关于规范实施口腔种植医疗服务价格有关事项的通知》（陕医保函〔2023〕47号）规定，自2023年3月15日起，我省三级公立医疗机构全流程单颗常规种植医疗服务价格调控最高限价为4171元；二级及以下公立医疗机构调控最高限价为3337元。同时明确，口腔种植医疗服务价格全流程最高限价包含种植全过程的诊查费、生化检验、影像检查费、种植体植入费、牙冠置入费、扫描设计建模费、麻醉费、药品费用的总和，不包括拔牙、牙周洁治、根管治疗、植骨、软组织移植；种植体和牙冠等耗材费用。"]
["陕西省口腔种植医疗服务项目价格公示表                                                   "]
["项目名称","医疗服务\n项目编码","医疗服务项目","计价\n单位","最高限价（元）",null,null,"项目内涵","除外内容","说明"]
[{"$nulls":4},"三级","二级","一级（未定级）"]
["门诊诊查",110200001,"普通门诊诊查费","次",{"v":8,"d":"8.00"},{"v":6.5,"d":"6.50"},{"v":5,"d":"5.00"},"指医护人员提供(技术劳务)的诊疗服务"]
[null,"110200002a","主任医师诊查费","次",{"v":15,"d":"15.00"},{"v":12,"d":"12.00"},{"v":9.5,"d":"9.50"},"指高级职称医务人员提供(技术劳务)的诊疗服务"]
[null,"110200002b","副主任医师诊查费","次",{"v":12,"d":"12.00"},{"v":9.5,"d":"9.50"},{"v":7.5,"d":"7.50"}]
["生化检验","250101015b","血细胞分析+五分类","项",{"v":18,"d":"18.00"},{"v":14,"d":"14.00"},{"v":12,"d":"12.00"}]
[null,250203020,"血浆凝血酶原时间测定（PT）","项",{"v":15,"d":"15.00"},{"v":12,"d":"12.00"},{"v":9.5,"d":"9.50"},null,null,"①手工法②仪器法"]
[null,250203025,"活化部分凝血活酶时间测定（APTT）","项",{"v":15,"d":"15.00"},{"v":12,"d":"12.00"},{"v":9.5,"d":"9.50"},null,null,"①手工法②仪器法"]
[null,250203030,"血浆纤维蛋白原测定","项",{"v":14,"d":"14.00"},{"v":12,"d":"12.00"},{"v":9,"d":"9.00"},null,null,"①手工法②仪器法"]
[null,250203035,"凝血酶时间测定(TT)","项",{"v":14,"d":"14.00"},{"v":12,"d":"12.00"},{"v":9,"d":"9.00"},null,null,"①手工法②仪器法"]
[null,250301001,"血清总蛋白测定","项",{"v":3,"d":"3.00"},{"v":2.5,"d":"2.50"},{"v":2,"d":"2.00"},null,null,"化学法"]
[null,"250301001a","血清总蛋白测定","项",{"v":6,"d":"6.00"},{"v":5,"d":"5.00"},{"v":4,"d":"4.00"},null,null,"干化学法"]
[null,250301002,"血清白蛋白测定","项",{"v":3,"d":"3.00"},{"v":2.5,"d":"2.50"},{"v":2,"d":"2.00"},null,null,"化学法"]
[null,"250302001a","葡萄糖测定","次",{"v":4.5,"d":"4.50"},{"v":3.5,"d":"3.50"},{"v":3,"d":"3.00"},"包括血清、脑脊液、尿标本。",null,"①各种酶法\n②酶电极法"]
[null,"250302001b","葡萄糖测定","次",{"v":7,"d":"7.00"},{"v":6,"d":"6.00"},{"v":6,"d":"6.00"},null,null,"干化学法"]
[null,250305001,"血清总胆红素测定","项",{"v":4.5,"d":"4.50"},{"v":3.5,"d":"3.50"},{"v":3,"d":"3.00"},null,null,"化学法或酶促法"]
[null,250305002,"血清直接胆红素测定","项",{"v":4.5,"d":"4.50"},{"v":3.5,"d":"3.50"},{"v":3,"d":"3.00"},null,null,"①干化学法\n②化学法或酶促法"]
[null,250305007,"血清丙氨酸氨基转移酶测定","项",{"v":3.5,"d":"3.50"},{"v":2.5,"d":"2.50"},{"v":2,"d":"2.00"},null,null,"①手工法②速率法"]
[null,"250305007a","血清丙氨酸氨基转移酶测定","项",{"v":6,"d":"6.00"},{"v":5,"d":"5.00"},{"v":4,"d":"4.00"},null,null,"干化学法"]
[null,250305008,"血清天门冬氨酸氨基转移酶测定","项",{"v":4.5,"d":"4.50"},{"v":3.5,"d":"3.50"},{"v":3,"d":"3.00"},null,null,"①手工法②速率法"]
[null,"250305008a","血清天门冬氨酸氨基转移酶测定","项",{"v":6,"d":"6.00"},{"v":5,"d":"5.00"},{"v":4,"d":"4.00"},null,null,"干化学法"]
[null,250305009,"血清γ-谷氨酰基转移酶测定","项",{"v":3.5,"d":"3.50"},{"v":2.5,"d":"2.50"},{"v":2,"d":"2.00"},null,null,"①手工法②速率法"]
[null,"250305009a","血清γ-谷氨酰基转移酶测定","项",{"v":6,"d":"6.00"},{"v":5,"d":"5.00"},{"v":4,"d":"4.00"},null,null,"干化学法"]
[null,250305011,"血清碱性磷酸酶测定","项",{"v":3.5,"d":"3.50"},{"v":2.5,"d":"2.50"},{"v":2,"d":"2.00"},null,null,"①手工法②速率法"]
[null,"250305011a","血清碱性磷酸酶测定","项",{"v":6,"d":"6.00"},{"v":5,"d":"5.00"},{"v":4,"d":"4.00"},null,null,"干化学法"]
[null,250403004,"乙型肝炎表面抗原测定(HBsAg)","项",{"v":4,"d":"4.00"},{"v":3,"d":"3.00"},{"v":2.5,"d":"2.50"}]
[null,"250403004a","乙型肝炎表面抗原测定(HBsAg)","项",{"v":20,"d":"20.00"},{"v":16,"d":"16.00"},{"v":13,"d":"13.00"},null,null,"化学发光法，定量。"]
[null,"250403004b","乙型肝炎表面抗原测定(HBsAg)","项",{"v":15,"d":"15.00"},{"v":12,"d":"12.00"},{"v":9.5,"d":"9.50"},null,null,"时间分辨荧光免疫法"]
[null,250403005,"乙型肝炎表面抗体测定(Anti-HBs)","项",{"v":4,"d":"4.00"},{"v":3,"d":"3.00"},{"v":2.5,"d":"2.50"}]
[null,"250403005a","乙型肝炎表面抗体测定(Anti-HBs)","项",{"v":30,"d":"30.00"},{"v":24,"d":"24.00"},{"v":19,"d":"19.00"},null,null,"化学发光法，定量。"]
[null,"250403005b","乙型肝炎表面抗体测定(Anti-HBs)","项",{"v":15,"d":"15.00"},{"v":12,"d":"12.00"},{"v":9.5,"d":"9.50"},null,null,"时间分辨荧光免疫法"]
[null,250403006,"乙型肝炎e抗原测定(HBeAg)","项",{"v":4,"d":"4.00"},{"v":3,"d":"3.00"},{"v":2.5,"d":"2.50"}]
[null,"250403006a","乙型肝炎e抗原测定(HBeAg)","项",{"v":30,"d":"30.00"},{"v":24,"d":"24.00"},{"v":19,"d":"19.00"},null,null,"化学发光法，定量。"]
[null,"250403006b","乙型肝炎e抗原测定(HBeAg)","项",{"v":15,"d":"15.00"},{"v":12,"d":"12.00"},{"v":9.5,"d":"9.50"},null,null,"时间分辨荧光免疫法"]
[null,250403007,"乙型肝炎e抗体测定(Anti-HBe)","项",{"v":4,"d":"4.00"},{"v":3,"d":"3.00"},{"v":2.5,"d":"2.50"}]
[null,"250403007a","乙型肝炎e抗体测定(Anti-HBe)","项",{"v":30,"d":"30.00"},{"v":24,"d":"24.00"},{"v":19,"d":"19.00"},null,null,"化学发光法，定量。"]
[null,"250403007b","乙型肝炎e抗体测定(Anti-HBe)","项",{"v":15,"d":"15.00"},{"v":12,"d":"12.00"},{"v":9.5,"d":"9.50"},null,null,"时间分辨荧光免疫法"]
[null,250403009,"乙型肝炎核心抗体测定(Anti-HBc)","项",{"v":4,"d":"4.00"},{"v":3,"d":"3.00"},{"v":2.5,"d":"2.50"}]
[null,"250403009a","乙型肝炎核心抗体测定(Anti-HBc)","项",{"v":30,"d":"30.00"},{"v":24,"d":"24.00"},{"v":19,"d":"19.00"},null,null,"化学发光法，定量。"]
[null,"250403009b","乙型肝炎核心抗体测定(Anti-HBc)","项",{"v":15,"d":"15.00"},{"v":12,"d":"12.00"},{"v":9.5,"d":"9.50"},null,null,"时间分辨荧光免疫法"]
[null,250403014,"丙型肝炎抗体测定\n（Anti-HCV）","项",{"v":20,"d":"20.00"},{"v":16,"d":"16.00"},{"v":13,"d":"13.00"}]
[null,250403019,"人免疫缺陷病毒抗体测定(Anti-HIV)","项",{"v":20,"d":"20.00"},{"v":16,"d":"16.00"},{"v":13,"d":"13.00"},null,null,"各种免疫学方法"]
[null,250403053,"梅毒螺旋体特异抗体测定","项",{"v":20,"d":"20.00"},{"v":16,"d":"16.00"},{"v":13,"d":"13.00"},null,null,"①凝集法②荧光探针法③印迹法"]
["影像检查","210300001c","单次多层CT平扫","每个部位",{"v":210,"d":"210.00"},{"v":180,"d":"180.00"},{"v":150,"d":"150.00"}]
[null,"210300001d","三维重建","次",{"v":50,"d":"50.00"},{"v":43,"d":"43.00"},{"v":32,"d":"32.00"},"指在容积扫描的基础上重建冠状及矢状位图像"]
[null,310502003,"口腔X线一次成像(RVG)","片数",{"v":20,"d":"20.00"},{"v":16,"d":"16.00"},{"v":12,"d":"12.00"}]
["种植体植入",330609014,"种植体植入费（单颗）","牙位",{"v":1900,"d":"1900.00"},{"v":1520,"d":"1520.00"},{"v":1216,"d":"1216.00"},"实现口腔单颗种植体植入。价格构成涵盖方案设计、术前准备，备洞，种植体植入，二期手术，术后处理，手术复查等步骤人力资源和基本物资消耗。","种植体、基台及其相关配件","1.种植体即刻种植加收30%。2.颅颌面种植体植入加收100%。"]
[null,"330609014a","种植体植入费（单颗）-种植体即刻种植（加收）","牙位",{"v":570,"d":"570.00"},{"v":456,"d":"456.00"},{"v":365,"d":"365.00"},null,null,"种植体即刻种植加收项目"]
[null,"330609014b","种植体植入费（单颗）-颅颌面种植体植入（加收）","牙位",{"v":1900,"d":"1900.00"},{"v":1520,"d":"1520.00"},{"v":1216,"d":"1216.00"},null,null,"颅颌面种植体植入加收项目"]
["牙冠置入",310517010,"种植牙冠修复置入费（单颗）","牙位",{"v":1420,"d":"1420.00"},{"v":1136,"d":"1136.00"},{"v":909,"d":"909.00"},"实现种植体上部固定义齿的修复置入。价格构成涵盖方案设计、印模制取、颌位确定、位置转移、模型制作、试排牙、戴入、调改、宣教等人力资源和基本物资消耗。","基台及其配件、其他类型种植修复上部配件、义齿","1.即刻修复置入加收30%。2.临时冠修复置入减收40%。"]
[null,"310517010a","种植牙冠修复置入费（单颗）-即刻修复置入（加收）","牙位",{"v":426,"d":"426.00"},{"v":341,"d":"341.00"},{"v":273,"d":"273.00"},null,null,"即刻修复置入加收项目"]
[null,"310517010b","种植牙冠修复置入费（单颗）-临时冠修复置入（减收）","牙位",{"v":852,"d":"852.00"},{"v":682,"d":"682.00"},{"v":546,"d":"546.00"},null,"基台及其配件、其他类型种植修复上部配件、义齿","按种植牙冠修复置入费（单颗）收费标准减收40%"]
["扫描建模",310517013,"医学3D建模（口腔）","例",{"v":240,"d":"240.00"},{"v":192,"d":"192.00"},{"v":154,"d":"154.00"},"利用医学影像检查等手段获得患者特定部位的真实信息。通过数字技术构建的虚拟3D模型、真实再现口腔及颌面特定部位的形态，能够满足疾病诊断、手术规划、治疗及导板设计的需要。价格构成涵盖数字化扫描、建模、存储、传输，装置设计等步骤的人力资源和基本物资消耗。",null,"单颗常规种植中确需使用的，按其项目价格 (含全部耗材)的7%收费。"]
["医学3D打印",310523009,"医学3D模型打印（口腔）","件",{"v":440,"d":"440.00"},{"v":352,"d":"352.00"},{"v":282,"d":"282.00"},"将虚拟3D模型打印或切削制作成仅用于口腔疾病诊断、手术规划、治疗及导板设计的实体模型。价格构成涵盖3D打印或切削制作的人力资源和基本物资消耗。",null,"单颗常规种植中确需使用的，按其项目价格 (含全部耗材)的7%收费。"]
[null,310523010,"医学3D导板打印（口腔）","件",{"v":1350,"d":"1350.00"},{"v":1080,"d":"1080.00"},{"v":864,"d":"864.00"},"将虚拟3D模型打印或切削制作成用于治疗部位、确保植（置）入物精准到达和处理预定位置的实物模板或手术操作对治疗部位进行精确处理。价格构成涵盖3D打印或切削制作的人力资源和基本物资消耗。",null,"单颗常规种植中确需使用的，按其项目价格 (含全部耗材)的7%收费。"]