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["泉州市超声检查类医疗服务价格项目及公立医疗机构价格表"]
["序号","项目代码","项目名称","服务产出","价格构成","计价\n单位","计价说明","价格\n(市级)","价格\n(县级)","价格\n(基层)","医保\n属性","医保限定支付范围","个人先行自付比例"]
["使用说明：\n1. 本类别以超声检查为重点，按检查方式的服务产出设立价格项目。所定价格属于政府指导价为最高限价，下浮不限；同时，医疗机构、医务人员实施超声检查过程中有关创新改良，采取“现有项目兼容”的方式简化处理，无需申报新增医疗服务价格项目，直接按照对应的整合项目执行即可。\n2. “价格构成”，指项目价格应涵盖的各类资源消耗，用于确定计价单元的边界，不应作为临床技术标准理解，不是实际操作方式、路径、步骤、程序的强制性要求。\n3. “加收项”，指同一项目以不同方式提供或在不同场景应用时，确有必要制定差异化收费标准而细分的一类子项，实际应用中，同时涉及多个加收项的，以项目单价为基础计算相应的加/减收水平后，据实收费。\n4. “扩展项”，指同一项目下以不同方式提供或在不同场景应用时，只扩展价格项目适用范围、不额外加价的一类子项，子项的价格按主项目执行。\n5. “基本物耗”指原则上限于不应或不必要与医疗服务项目分割的易耗品，包括但不限于各类消杀用品、储存用品、清洁用品、个人防护用品、垃圾处理用品、润滑剂、护（尿）垫、治疗巾（单）、中单、标签、无菌设备保护套、耦合剂、可复用的操作器具、软件（版权、开发、购买）成本等。基本物耗成本计入项目价格，不另行收费。除基本物耗以外的其他耗材，按照实际采购价格零差率销售。\n6.“床旁检查”，指因患者病情危重或无法自行前往检查科室，由检查科室人员移动设备至患者病床旁进行检查。\n7.“B型超声检查”和“彩色多普勒超声检查（常规）”中的“部位”，指颅脑、涎腺（含腮腺、颌下腺、引流区淋巴结）、甲状腺（含甲状旁腺、颈部淋巴结）、五官、胸部、腹部（含肝胆胰脾）、胃肠道（含胃、大肠、小肠、肠系膜）、腹膜后（含肾上腺、腹膜后淋巴结）、泌尿系（含肾、输尿管、膀胱、前列腺）、女性生殖系统、男性生殖系统、盆底、乳腺（双侧，含引流区淋巴结）、关节、体表软组织、浅表淋巴结（含颈部、腋窝、腹腔、腹股沟）、周围神经。关节具体指：单个大关节（如：肩、肘、腕、髋、膝、踝关节）、颈椎、胸椎、腰椎、单侧手掌部及指间关节、单侧足跖趾及趾间关节、单侧颞颌关节、单侧肩锁关节、胸锁关节。应开展双侧超声检查，实际情况中单侧开展的，减半收费。\n8.“彩色多普勒超声检查（血管）”和“超声造影（血管）”中的“部位”，指双侧球后血管、双侧颈动脉、双侧锁骨下动脉、双侧椎动脉、腹主动脉、肠系膜动脉、子宫动脉、单侧上肢动脉、单侧下肢动脉、双侧肾动脉、腹腔动脉（含腹腔动脉、脾动脉、肝动脉）、双侧髂动脉、双侧足动脉、双侧颈静脉、单侧上肢静脉、下腔静脉、肝静脉、门脉系统（含门静脉、脾静脉、肠系膜上静脉）、双侧肾静脉、双侧髂静脉、单侧下肢静脉、体表血管、双侧精索静脉等。\n9.“对比剂”含药品及非药品类对比剂，非药品类对比剂包含在价格构成中，药品类对比剂按药品管理收费。\n10.涉及的对比分析类检查类项目，可按照实际检查次数收费，例如胆囊和胆道收缩功能检查、膀胱残余尿量检查等，可在出具报告时体现两次检查的不同结论。\n11.“人工智能辅助诊断”是指应用人工智能技术辅助进行的超声检查诊断，不得与主项目同时收费。\n12.涉及“包括……”“……等”的，属于开放型表述，所指对象不仅局限于表述中列明的事项，也包括未列明的同类事项。\n13.术中需行各类超声检查的，按本类别中相应项目进行收费，各类引导项目拟在辅助操作立项指南中另行立项。"]
[null,"230201","A型超声检查"]
[1,"012302010010000","A型超声检查","通过A型超声技术，对组织器官进行超声成像及诊断。","所定价格涵盖设备调试、超声检查、数据分析、数据存储、出具诊断结果（含图文报告）等所需的人力资源和基本物质资源消耗。","单侧",null,6.5,6,5.4,"医保"]
[null,"230202","B型超声检查"]
[2,"012302020010000","B型超声检查","通过B型超声技术，对组织器官及病灶进行超声成像及诊断。","所定价格涵盖设备调试、体位摆放、超声检查、摄取图像、数据分析、数据存储、出具诊断结果（含图文报告）等步骤所需的人力资源、设备运转成本消耗与基本物质资源消耗。","部位",null,31,28,24,"医保"]
["分项","012302020010001","B型超声检查-床旁检查(加收)",null,null,"次","同一次检查中仅加收一次",23,21,18,"医保"]
["分项","012302020010011","B型超声检查-腔内检查(加收)",null,null,"部位",null,34,32,27,"医保"]
["分项","012302020010021","B型超声检查-立体成像(加收)",null,null,"部位",null,27,24.5,21,"医保"]
["分项","012302020010031","B型超声检查-排卵监测(减收)",null,null,"部位",null,18,16.5,14,"医保"]
["分项","012302020010100","B型超声检查-人工智能辅助诊断(扩展)",null,null,"部位",null,31,28,24,"医保"]
[null,"230205","多普勒检查"]
[3,"012302050010000","多普勒检查（周围血管）","利用多普勒技术，检测周围血管形态、血流速度和方向来评估血管的功能和病变情况，并作出诊断。","所定价格涵盖设备调试、超声测量、获取数据、数据分析、数据储存、出具诊断结果（含图文报告）等步骤所需的人力资源、设备运转成本消耗与基本物质资源消耗。","次","“多普勒检查（周围血管）”指根据临床需要，多普勒超声对周围血管内皮功能、硬化状态、静脉回流、踝/趾臂指数等指标的检测。",54,50,42.5,"医保"]
["分项","012302050010001","多普勒检查（周围血管）-床旁检查（加收）",null,null,"次","同一次检查中仅加收一次",23,21,18,"医保"]
["分项","012302050010100","多普勒检查（周围血管）-人工智能辅助诊断（扩展）",null,null,"次",null,54,50,42.5,"医保"]
[4,"012302050020000","多普勒检查（颅内血管）","通过多普勒技术，测定动脉血流方向及速度，对颅底动脉血流动力学进行评价并作出诊断。","所定价格涵盖设备调试、体位摆放、超声检查、获取数据、数据分析、数据存储、出具诊断结果（含图文报告）等步骤所需的人力资源、设备运转成本消耗与基本物质资源消耗。","次",null,96,92,79,"医保",null,"20%"]
["分项","012302050020001","多普勒检查（颅内血管）-床旁检查（加收）",null,null,"次","同一次检查中仅加收一次",23,21,18,"医保",null,"20%"]
["分项","012302050020011","多普勒检查（颅内血管）-特殊方式检查（加收）",null,null,"次","特殊方式检查指发泡试验、CO2试验。",45,41,35,"医保",null,"20%"]
["分项","012302050020100","多普勒检查（颅内血管）-人工智能辅助诊断（扩展）",null,null,"次",null,96,92,79,"医保",null,"20%"]
["分项","012302050021100","多普勒检查（颅内血管）-栓子监测（扩展）",null,null,"次",null,96,92,79,"医保",null,"20%"]
[null,230203,"彩色多普勒超声检查"]
[5,"012302030010000","彩色多普勒超声检查（常规）","通过彩色多普勒超声技术，对组织器官及病灶进行超声成像及诊断。","所定价格涵盖设备调试、体位摆放、超声检查、摄取图像、数据分析、数据存储、出具诊断结果（含图文报告）等步骤所需的人力资源、设备运转成本消耗与基本物质资源消耗。","部位","胆囊收缩试验检查全过程按一部位收取",86,82,71,"医保",null,"20%"]
["分项","012302030010001","彩色多普勒超声检查（常规）-床旁检查（加收）",null,null,"次","同一次检查中仅加收一次",23,21,18,"医保",null,"20%"]
["分项","012302030010011","彩色多普勒超声检查（常规）-腔内检查（加收）",null,null,"部位",null,34,32,27,"医保",null,"20%"]
["分项","012302030010021","彩色多普勒超声检查（常规）-立体成像（加收）",null,null,"部位",null,27,24.5,21,"医保",null,"20%"]
["分项","012302030010031","彩色多普勒超声检查（常规）-排卵监测（减收）",null,null,"部位",null,41,37,31,"医保",null,"20%"]
["分项","012302030010100","彩色多普勒超声检查（常规）-人工智能辅助诊断（扩展）",null,null,"部位",null,86,82,71,"医保",null,"20%"]
[6,"012302030020000","彩色多普勒超声检查（心脏）","通过彩色多普勒超声技术（包括M型超声），观察测量心脏及大血管的形态结构、运动状态、血流动力学情况进行综合分析，作出诊断。","所定价格涵盖设备调试、体位摆放、超声检查、摄取图像、数据分析、数据存储、出具诊断结果（含图文报告）等步骤所需的人力资源、设备运转成本消耗与基本物质资源消耗。","次",null,235,220,185,"医保",null,"20%"]
["分项","012302030020001","彩色多普勒超声检查（心脏）-床旁检查（加收）",null,null,"次","同一次检查中仅加收一次，",23,21,18,"医保",null,"20%"]
["分项","012302030020011","彩色多普勒超声检查（心脏）-心脏负荷超声检查（加收）",null,null,"次",null,108,98,83,"医保",null,"20%"]
["分项","012302030021100","彩色多普勒超声检查（心脏）-彩色多普勒超声心动图检查（经食管）（扩展）",null,null,"次",null,235,220,185,"医保",null,"20%"]
["分项","012302030020100","彩色多普勒超声检查（心脏）-人工智能辅助诊断（扩展）",null,null,"次",null,235,220,185,"医保",null,"20%"]
[7,"012302030030000","彩色多普勒超声检查（血管）","通过彩色多普勒超声技术，对相关血管进行超声成像及诊断。","所定价格涵盖设备调试、体位摆放、超声检查、摄取图像、数据分析、数据存储、出具诊断结果（含图文报告）等步骤所需的人力资源、设备运转成本消耗与基本物质资源消耗。","部位",null,82,78,66,"医保",null,"20%"]
["分项","012302030030001","彩色多普勒超声检查（血管）-床旁检查（加收）",null,null,"次","同一次检查中仅加收一次",23,21,18,"医保",null,"20%"]
["分项","012302030030100","彩色多普勒超声检查（血管）-人工智能辅助诊断（扩展）",null,null,"部位",null,82,78,66,"医保",null,"20%"]
[8,"012302030040000","彩色多普勒超声检查（弹性成像）","通过彩色多普勒超声弹性成像技术，对病变组织器官及病灶进行超声弹性成像及诊断。","所定价格涵盖设备调试、体位摆放、超声检查、摄取图像、数据分析、数据存储、出具诊断结果（含图文报告）等步骤所需的人力资源、设备运转成本消耗与基本物质资源消耗。","器官",null,100,90,77,"医保"]
["分项","012302030040001","彩色多普勒超声检查（弹性成像）-床旁检查（加收）",null,null,"次","同一次检查中仅加收一次",23,21,18,"医保"]
["分项","012302030040100","彩色多普勒超声检查（弹性成像）-人工智能辅助诊断（扩展）",null,null,"器官",null,100,90,77,"医保"]
[9,"012302030050000","彩色多普勒超声检查（胎儿）","通过彩色多普勒超声技术，对胎儿进行超声成像及诊断。","所定价格涵盖设备调试、体位摆放、超声检查、获取数据、数据分析、数据存储、出具诊断结果（含图文报告）等步骤所需的人力资源、设备运转成本消耗与基本物质资源消耗。","胎·次",null,145,130,110,"医保",null,"20%"]
["分项","012302030050001","彩色多普勒超声检查（胎儿）-床旁检查（加收）",null,null,"次","同一次检查中仅加收一次",23,21,18,"医保",null,"20%"]
["分项","012302030050011","彩色多普勒超声检查（胎儿）-腔内检查（加收）",null,null,"胎·次",null,34,32,27,"医保",null,"20%"]
["分项","012302030050100","彩色多普勒超声检查（胎儿）-人工智能辅助诊断（扩展）",null,null,"胎·次",null,145,130,110,"医保",null,"20%"]
["分项","012302030052100","彩色多普勒超声检查（胎儿）-胎儿血流动力学检查（扩展）",null,null,"胎·次","同时行彩色多普勒超声检查（胎儿）时减半收取。",145,130,110,"医保",null,"20%"]
["分项","012302030052100","彩色多普勒超声检查（胎儿）-胎儿血流动力学检查（同时行彩色多普勒超声检查）",null,null,"胎·次",null,72.5,65,55,"医保",null,"20%"]
["分项","012302030051100","彩色多普勒超声检查（胎儿）-早孕期筛查（扩展）",null,null,"胎·次",null,145,130,110,"医保",null,"20%"]
[10,"012302030060000","彩色多普勒超声检查（胎儿系统性筛查）","通过彩色多普勒超声技术，对胎儿组织器官进行超声成像及诊断，排查胎儿结构畸形等异常情况。","所定价格涵盖设备调试、体位摆放、超声检查、摄取图像、数据分析、数据存储、出具诊断结果（含图文报告）等步骤所需的人力资源、设备运转成本消耗与基本物质资源消耗。","胎·次","“彩色多普勒超声检查（胎儿系统性筛查）”指通过彩色多普勒超声对胎儿系统性（神经、呼吸、消化、心血管、脐带胎盘等）结构性畸形的筛查及对胎儿器官发育情况的检查。",295,280,252,"医保",null,"20%"]
["分项","012302030060001","彩色多普勒超声检查（胎儿系统性筛查）-可疑胎儿产前诊断（加收）",null,null,"胎·次",null,88.5,84,75.5,"医保",null,"20%"]
["分项","012302030060100","彩色多普勒超声检查（胎儿系统性筛查）-人工智能辅助诊断（扩展）",null,null,"胎·次",null,295,280,252,"医保",null,"20%"]
[11,"012302030070000","彩色多普勒超声检查（胎儿心脏）","通过各种超声技术，观察测量胎儿心脏及大血管的形态结构、运动状态、血流动力学情况，观测左右心室收缩功能和舒张功能参数，进行综合分析，作出诊断。","所定价格涵盖设备调试、体位摆放、超声检查、摄取图像、数据分析、数据存储、出具诊断结果（含图文报告）等步骤所需的人力资源、设备运转成本消耗与基本物质资源消耗。","胎·次",null,235,220,185,"医保",null,"20%"]
["分项","012302030070100","彩色多普勒超声检查（胎儿心脏）-人工智能辅助诊断（扩展）",null,null,"胎·次",null,235,220,185,"医保",null,"20%"]
[null,"230204","超声造影"]
[12,"012302040010000","超声造影（常规）","通过超声检查，对使用对比剂后器官、组织和病灶的大小、形态、回声、血流信息等情况进行成像及分析，并作出诊断。（不含穿刺/插管）","所定价格涵盖使用对比剂操作、设备调试、体位摆放、超声动态观察、获取数据、成像、数据分析、数据存储、出具诊断结果（含图文报告）等步骤所需的人力资源、设备运转成本消耗与基本物质资源消耗。","器官",null,124,117,105,"医保",null,"20%"]
["分项","012302040010001","超声造影（常规）-立体成像（加收）",null,null,"器官",null,27,24.5,21,"医保",null,"20%"]
["分项","012302040010100","超声造影（常规）-人工智能辅助诊断（扩展）",null,null,"器官",null,124,117,105,"医保",null,"20%"]
[13,"012302040020000","超声造影（血管）","通过超声检查，对使用对比剂后血管的形态、血流、血管病变等信息进行成像及分析，并作出诊断。（不含穿刺/插管）","所定价格涵盖使用对比剂操作、设备调试、体位摆放、超声动态观察、获取数据、成像、数据分析、数据存储、出具诊断结果（含图文报告）等步骤所需的人力资源、设备运转成本消耗与基本物质资源消耗。","部位",null,124,117,105,"医保",null,"20%"]
["分项","012302040020100","超声造影（血管）-人工智能辅助诊断（扩展）",null,null,"部位",null,124,117,105,"医保",null,"20%"]