so Y TE TiNH TWA THIEN H1.JEBENH VIEN MAT HUE

S6:~.u IBVMH

BANG GrA DlCH Vl) KlIAMB$NH, carrAB=E:NIIBAO HIEM Y TEGnJA cAe BE.NHVJlN cUNG ~G TRENTOAN ouoc

(Ap dung theo thong to'sa: 15/201&ITT-BYT ngay 30/5/2018 cua BC}Y T~)

Thua ThienHui, ngay J(/--lhang 7nom 2018

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s6 GIAAPUQNGIT cAe LO~ DICHVV tir ngay 151712018 om cmi

A. l()Ica vu KJI]AMB£NH ,.

1 Benh visn hang IT 29,600B nlCI:{VV NGA;Y GtlUdNG r ,I Ngay ghrirng benh Roi khoa1 Ngay giirong u91khoa 135,100II Ngay ghrimg benh ngoai khoa1 Sau cac pMu thu~t loai di,icbi~t 222,1002 Sau cac phau thuat loai 1 192,7003 Sau cac phau thu~t loai 2 171,2004 Sau cac phau thu~t loai 3 147,400C CAC~PfIAU muA11;THTI THUAT ~1 Bam fila l~d?o 35,000

~

2 C~t be ap MMC hoac ap 5FU 1.160.00QChua bao g&mthudc MMC; 5FU.3 C~t bo tui l~ 804,000

.~ ~~4 C~t dich kinh don thuan hoi,iel:1y di v~t uQinhan Chua bao g&m:thuy tinh th8 nhan tao, d~udt dich kinh, d~u laser, day d~u sang

1.200.000 ~J'5 CAtmoog ap Mytornycin 940,000 Chua bao g&mthuoc MMC. I'6 C~t m6ngm~t ehu bien b~ngLaser 300,0007 C~t u hi k~t giac m?e co ho~ekhong ghep k~tm?e 1.115.0008 C~t u k~t m~e khong va 750,0009 Chich eh~p hoi,ic)~o 75,60010 Chich fiu h6c m~t 429,00011 ChQcthao dioh dum h~c lli?c, bam hoi ti~n phOug 1.06Q.00012 Chua bongm~t do him di~n 27,00013 Ch\lp m?ch lCG 230,000 Chua bao g6m t11u6c14 Daub bami 34,90015 Di~n eh§.m 382,00016 Di~n di di@utri (1 IAn) 17,6.0017 f)i~n don,g thSmi 439,00018 . 'Di~nvong m?c 86,500

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~s6 GIAApDVNGIT cAc LO~ DICM VV tir ngay 151712018 GIDCUU

19 Di~u tri Laser h6ng ngoai; T~p nhuoc thi 27,000

20 DiSu tri m9t s6 benh vong mac bing laser (benh vong mac ti~u dirong, caoJ93,OOOhuyet ap, tre de non ... ); Laser diBu tri u nguyen bao vong mac

21 Do d.9 day giac mac; D@mt~ bao 1191.mo giac mac; Chup ban d6 giac mac 129,OQO

22 Do d9 lac; Xac djnh sa d6 song tbi; Do bien d9 diSu tiet; Do thi giac 2 m~t; Do58,600thi giac nrong phan

-23 Do duong kinh giac lU?C;do d916i 49,60024 Do Javal 34,00025 Do khuc xa may 8,80026 Do nhan ap 23,70027 Do thi lire khach quan 65,50028 Do thi tnrong, am di€m 28,00029 Do tinh cong suit thuy tinh th~ nhan tao 55,00030 D6t longxieu 45,70031 Ghep giac mac (01 m~t) 3.223.000 Chua bao g6m giac mac, thuy tinh tbS nhan tao.32 m~c 1.177.000 Chua bao g6m chi phi mang &i.33 Ghep mang 6i diBu trj 10et giac m?c 1.004.000 Chua bao g6m chi phi mang 6i.34 G<;>.tgiac m?c 734,00035 khau co mi 380,00036 Khau cung m?c dan thuftn 800,00037 Khau cUng giacm~c phuc t?P 1.200.00038 Khau cling rn~c phU'c i?P 1.060.00039 Khau da mi, k~t m?c mi bi rach -2Y_ me 1.379.00040 Khan da mi, k~t m~c mi bi dch - gay te 774,000'41 Khau giac tn?C dan thu§n 750,00042 Khau giac m?c phuc ~p 1.060.00043 Khau phl,lc h6i bo-rni 645,00044 Khau v@ttlmong ph§n m~m, t&n thlIan_g Vlll'lgm~t 879,00045 Khoet b6 nban du 704,00046 L?rib dong dan thu§n phOng bong vong m~ 1.690.00047 baG v5ng m?c 10410.00048 L.iy dilv~t giac tn~c nong, 1114)t mit (gay me) 640,00049 Lfiy di v~t giac m?C nong, m9t mlit (gay te) 15;30050 Liy dj v~t giac m~c sau, m9t mlit (gfu7_me) 829,00051 Liy di.v~t giac mt;lcsau, mQt m~t (gay tS) 314,00052 Uy oi V?t 116cm~t 845,000

-•

-so GIAAPDl)NG .IT cAc LO~ DICD VV tir ngay 15/7/2018 GIDcmJ

53 L§.ydj v~t k~tmac nong mQtmat 61,60054 LAydj v~t ti~n phong 1.060.00055 Lilyhuyet thanh dong 6ng 49,20056 LAysan voi k~tmac 33,00057 Lieu phap di~u tri viem k~t mac mila xuan(ap tia 13) 53,70058 Ma bao sau b§ngLaseT 244;00059 M6 quam 1 rni - gay me 1.189.00060 M6 quam 1mi - gay te 614,00061 M6 quam 2 mi - gayme 1.356.00062 M6 quam 2 rni - g~yte 809,00063 M6 quam 3 mi - gay te 1,020~00064 M6 quam 3 mi - gayme 1.563.00065 M6 quam 4 mi - gay me 1.745.00066 M6 quam 4 rni - gay te 1.176.00067 Ma ti8n phong nra mau hoac mu 704,00068 Mong tai phat plnrc t~p co_g_hepmang 6i k~t mac 904,00069 Muc nQinhan.(co dQnhoac khong dQn) 516,000 Chua bao g6m v~t li~u dQn.70 Ni_in tuyenbo mi 33,00071 Nang san h6c m~t 2.689.000 Chua bao g6rn t§:mlot sann Nghiem phap phat hi~n Glocom 97,90073 N6i thong l~ mili 1mitt 1.004.000 Chua bao g6m 6ng Silicon.74 Phiu thuat bong vang mac kinh di~n 2.173.000 Chua bao g6rn dai Silicon.75 Phiu thu~t c~t bao sau 554;000

' J; ,Chua bao gam dau cat bao sau.76 Phiu thu~tdt be 1.065.00077 Phiu thu~tdt djch ldnhva di~u trj bong v5ng m?c (0 1m~t) 2.838.000 Chua bao g6m d§.usilicon, dai silicon, d~u c~t djch kinh, Laser nQinban.78 Ph§:uthu~t c~t mang d6ng tiI 895,000 Chua bao g6m d~u citt.79 Phfruthu~t citt mQnggbep mang 6i, k~t m?c - gay me 1.416.000 Chua bao g6m chi phi mang 6i.80 Phfruthu~t elit m9ng ghep mang 6i, kSt ni?c - gay te 915,000 Chua ba0 g6m chi phf mang 6i.81 Phfruthu~t citt m6ng miit chu bien 500,00082 Phfru thu~t citt thuy tinh th~ 1.160.000 Chua bao g6m d~udt, thuy tinh th@liMn t?O83 Pl1~uthll~t di_itIOL (1 mitt) 1.950.000 Chua.bao g6m th~ tht1y .tinh nhan i?o.84 Phfru thu~t di.it6ng Silicon ti8n pl:iOng 1.460.000 Chua ban g6m 6ng silicon.85 Phfruthu~t di€u tri b~nhvong m?c tre de non (2 m~t) 1.723.000 Chua bao g6m diu dt djch klnh, laser n(>inhan, day dfrnsang.

86 Phfruthu~t 01,lC thuy tinh tha b~ng phuong pbap Phaco (0 I mit' 2.615;000Chua bao g6m thuy tinh th~ nMn t?O; dllbao g6m casset dung nhi8u I~, djchnhfty.

87 Ph~u thu~t Epicanthl!s (1 mitt) 804,000

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"so GIAAPDVNGTT CACLO';'I DICH vu tir ng~y 1517/2018 GIDCHU

88 Ph~u thu~t hep khe mi 595,00089 Ph~u thu~t lac (1mat) 704,00090 Ph~u thu~t lac (2 m~t) 1.150.00091 Ph~u thu~t lac co Faden (I m~t) 745,00092 Ph~u thu~t tAy thuy tinh th~ ngoai bao, d~t IOL+ c~t be (1 mllt) 1.760.000 Chirabao g6m thuy tinh th~ nhan tao,93 Ph~u th u~t mQng don m!)t m;it - gay me 1.376.00094 Ph~u thu~t mQng don thuan ml}t m;it - gay te 834,00095 Ph~u thu~t mQng ghep ket mac t1! than 804,00096 Ph~u thuat phi) k€t mac l~p mkgia 695,00097 Ph§.u thuat sup mi (1m;it) 1.265.00098 Ph§.u thu~t tai tao l~ quan k~t hop khau mi 1.460.000 Chua bao g6m 3.qg silicon.99 Ph§.u thu~t tao cling d6 l;ip tn;it gia 1.060:000100 Phfru thu~t tao ml (I m;it) 804,000101 Ph§.u thuat tao mi (2 m;it) 1.045.000102 Pb§.u thu~t thao dai dQn Silicon 1.629.000

103 Ph§.u thu~t th~ thtiy tirih bfuIg phaco va femtosecond co ho~c khong co d~t IOL 4.799.000 Chua bao g6ni fuuy tinh th8 nhan t~o, thiet hi c6 dinh m;it (pateient interface).

104 Ph~u thu~t thily tinh thS ngoro bao (1 m;it}_ 1.600.000 Chua bao g6in thUYt.inh thS nhan t~o.105 Ph§.u thu~t u co va da tl;lOhinh 1.200.000106 Ph§.u thu~t u ket m~c nong 645,000107 Phfru thu~t u lUi khong va da 689,000108 Ph§.u thu~t u t6 ch(re h6c mit 1.200.000109 Ph~u thu~t va da di~u trj l~tmi 1.010.000110 Phil ket ml;lC 614,000111 Quang dong thS mi di~u tti Glocom 275,000112 Rl;lchgoc ti~n pbOng 1.060.0.00113 Rira cling d6 39,000 Ap dl,lDgcho 1 mit ho~c 2 m~t114 sic giac 60,000115 Sieu fun ban phftn tmac (UBM) 195,000116 Sicu am mtt chfu1 doan 55,400117 Sieu fun di~u tri (1 ngay) 60;000,118 Sinh thiet u, te bao hQc, dieh t6 c:h;(rc 150,000119 Soi bong d6ng tir 28,400120 Soi day !TI~tho~c Soi goe ti~n phOng 49;600121 Tach dinhmi cclu gMpk~tml;lc 2.088.000 Chua baQ g6m chi phi mango122 Tl;lohlnh vung be b~ng Laser 210,000

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"

. GIAAPDlJNG.so cAc LO~I DICM VlJ tir ngay 15/7/2018 GIDCmJTT

123 Test tlnr cam giac giac mac 36,90.0.124 TMo d~u Silicon ph§.uthu~t 745,0.0.0.125 ThOngl~dao hai m~t 89,90.0.126 Thong l~dl;1otnQtm~t 57,20.0.127 Tiem duo-ik8t mac mQtmM 44,60.0. Chua bao g6m thu8c.128 Tiem Mu nhan du mQtm~t 44,60.0. Chua bao gam thuoc,129 Va san h6c mit 3.0.85.0.0.0. Chua bao gam tAm16tsan ho~c va xirong,130. Sieu am +do true nhan du 70.,60.0.131 Tiem (b~p/dl1mda/tinh mach) 10.,0.0.0.Chi ap dung voi ngum b~nh ngoai tni132 Truyen tinh mach 20..0.0.0.,0.0.0.Chi ao dung voi ngUai b~nh ngoai tni133 Ph~u thu~t u h6 m~t 5.297.0.0.0. Chua bao gam nep, ghim, &, vit, kinh vi ph~u.l34 Chup Angiography 211,o.Qo. Chl)POCT

Cac ohiu thilat, thu thufit con lai khac tU'o1JgdU011g1 Pbau tbu~t loai d~ebi~t 2.0.81.0.0.0.2 Phau thuat loai I 1.195.0.0.0...,

845,0.0.0."4 Phau thuat loai III 590.,0.0.0.5 Thu thu~t lo?i d~cbi~t 519,0.0.0.6 Tho thu~t lo?i I 337;0.0.0.7 Thil tbu~t lo~ II 191,0.0.0.8 ThUthu~t lo~i III 121.,0.0.0.

Truirng hQ1)khi thlfc bi~n phau (huat chuyen khoa.mat hoac cac thii thuat can gay me thl cong them phan gh meOaymekMc 632;0.0.0.

D XEJ'NGHIEMI Huytt hoc1 Thai gian mau chay (phuong' phip Duke) 12,30.0.2 Thai gian mau dong 12,30.0.3 Tong phan tich te bao mau ngo~i vi bang may clemtv dQng 39,20.0.II H6a sinh

1 Dinh luqng Bilirubin toan ph~ ho~c tr1Jcti8p; cae enzym: 21,20.0. Khong thanh toan d6i vo'i ci16xet nghi~mBilirubin gian tiSp;phosphataze ki€m ho?c GOT ho?c OPT ... Ty L~AlG Iiinhling xet nghi~m co th~ ngo?i suy duQ'c.

2 Dinh hrQ'ngcae ch§t Albumine; Creatine; G1Qbuline;GluMse; 21,20.0.Phospho, Protein toan ph~n,Ure, Axit Uric, Amylase, ... (m6i chftt)

3 Dinh hrqng TrygLycerideho~e Phospholipid ho~c Lipid toan phlin ho?c 26,500.Cholesterol toan phlin ho~cHDL-CholesteroI ho?c LDL ~Cbolest~rol

4 Duemgmau mao m~eh 15,0.0.0m Nuo'c tieu

":s6 GIAAPDl)NGTT cAc LO~I DICH VV tir ngay 15/7/2018 GmCHU

1 Tonz ohan tich mroc tieu 27,000IV Vi sinh1 Anti-HIV (nhanh) 51,700,2 HBsAg (nhanh) 51,7003 K.y sinh trt\ng; Vi nAm soi nroi 40,2004 Vi khuan nhuem soi 65,500K 'l'H.6:M DO COOG NANG 11 Sieu fun 38,0002 Ch1,1pX - Quang s6 hoa 1 phim 62,000 I( Ch,1,1pkhu tru di v~t n{>inhan; Chup 16thi ghic)3 £)i~n tam de; 30,000