部分抗微生物药品补充剂型规格最高零售价格表

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1、附表一：部分抗微生物药品补充剂型规格最高零售价格表医保编码通用名剂型规格单位层次最高零售限价备注1青霉素钠粉针剂0.2MIU瓶GMP0.71青霉素钠粉针剂6.4MIU瓶GMP4.51青霉素钠粉针剂8MIU瓶GMP5.41青霉素钠粉针剂10万单位瓶GMP0.52青霉素V颗粒剂125mg*24袋盒GMP7.22青霉素V颗粒剂125mg*10袋盒GMP3.12青霉素V片剂500mg*9片盒GMP6.72青霉素V片剂625mg*10片盒GMP8.82青霉素V片剂625mg*8片盒GMP7.02青霉素V胶囊剂250mg*12粒盒GMP5.54普鲁卡因青霉素粉针剂100万u瓶GMP1

2、.24普鲁卡因青霉素粉针剂400万u瓶GMP3.45苯唑西林胶囊剂250mg*12粒盒GMP5.35苯唑西林胶囊剂250mg*24粒盒GMP10.35苯唑西林胶囊剂250mg*25粒盒GMP10.75苯唑西林胶囊剂250mg*10粒盒GMP4.45苯唑西林片剂250mg*24片盒GMP9.87哌拉西林/三唑巴坦冻干粉0.5g/625mg支GMP20.610氨苄西林粉针剂500mg支GMP1.110氨苄西林溶媒结晶500mg瓶GMP1.710氨苄西林粉针剂2g支GMP3.110氨苄西林溶媒结晶2g瓶GMP4.810氨苄西林胶囊剂250mg*12粒盒GMP4.610氨苄西林胶

3、囊剂250mg*36粒盒GMP13.310氨苄西林胶囊剂250mg*40粒盒GMP14.710氨苄西林胶囊剂125mg*12粒盒GMP2.710氨苄西林胶囊剂250mg*24粒盒GMP9.410氨苄西林胶囊剂100mg*24粒盒GMP4.511哌拉西林粉针剂500mg瓶GMP1.31512阿洛西林粉针剂1.5g瓶GMP28.812阿洛西林粉针剂3g瓶GMP48.917美洛西林粉针剂1g瓶GMP20.117美洛西林粉针剂3.5g瓶GMP48.917美洛西林粉针剂4g瓶GMP61.019头孢氨苄缓释片250mg*10片盒GMP15.119头孢氨苄缓释胶囊250mg*24粒盒G

4、MP34.319头孢氨苄胶囊剂125mg*12粒盒GMP2.619头孢氨苄胶囊剂125mg*25粒盒GMP5.319头孢氨苄胶囊剂125mg*30粒盒GMP6.319头孢氨苄胶囊剂125mg*48粒盒GMP10.019头孢氨苄胶囊剂125mg*60粒盒GMP12.419头孢氨苄胶囊剂125mg*80粒盒GMP16.319头孢氨苄胶囊剂62.5mg*10粒盒GMP1.319头孢氨苄胶囊剂62.5mg*15粒盒GMP1.619头孢氨苄胶囊剂75mg*15粒盒GMP2.219头孢氨苄胶囊剂250mg*10粒盒GMP3.719头孢氨苄胶囊剂250mg*12粒盒GMP4.419头孢

5、氨苄胶囊剂250mg*20粒盒GMP7.119头孢氨苄胶囊剂250mg*10粒*4板盒GMP13.919头孢氨苄胶囊剂250mg*20粒*2板盒GMP13.919头孢氨苄胶囊剂250mg*10粒*5板盒GMP17.219头孢氨苄泡腾片125mg*20片盒GMP4.819头孢氨苄颗粒剂50mg*20袋盒GMP2.319头孢氨苄颗粒剂125mg*20袋盒GMP4.719头孢氨苄颗粒剂500mg*20袋盒GMP13.919头孢氨苄颗粒剂50mg*18袋盒GMP2.219头孢氨苄干混悬剂1.5g瓶GMP2.520头孢拉定颗粒剂100mg*6袋盒GMP1.920头孢拉定颗粒剂100

6、mg*9袋盒GMP2.820头孢拉定颗粒剂100mg*12袋盒GMP3.720头孢拉定胶囊剂500mg*24粒盒GMP22.620头孢拉定胶囊剂500mg*20粒*2板盒GMP37.020头孢拉定胶囊剂500mg*12粒盒GMP11.620头孢拉定胶囊剂500mg*10粒*4板盒GMP37.020头孢拉定胶囊剂500mg*50粒盒GMP45.81520头孢拉定胶囊剂125mg*20粒盒GMP6.720头孢拉定胶囊剂250mg*10粒*4板盒GMP22.120头孢拉定胶囊剂250mg*20粒*2板盒GMP22.120头孢拉定胶囊剂250mg*8粒盒GMP4.720头孢拉定胶

7、囊剂250mg*6粒盒GMP3.620头孢拉定片剂250mg*12片盒GMP6.722头孢唑林溶媒结晶1g盒GMP5.022头孢唑林溶媒结晶2g盒GMP7.123头孢丙烯干混悬剂125mg*4袋盒GMP22.223头孢丙烯胶囊剂125mg*6粒盒GMP25.226头孢美唑粉针剂500mg瓶GMP35.326头孢美唑粉针剂1g瓶GMP60.027头孢替安粉针剂2g瓶GMP108.327头孢替安粉针剂0.5g瓶GMP36.927头孢替安粉针剂0.25g瓶GMP22.027头孢替安溶媒结晶0.5g瓶GMP38.129头孢地尼分散片1