美沙拉嗪等68种西药最高临时零售价格表

附表1：美沙拉嗪等68种西药最高临时零售价格表金额单位：元序号省医保编号药品名称剂型规格单位最高临时零售价备注1764美沙拉嗪缓释颗粒剂500mg*10袋盒70.72532丁咯地尔注射剂250ml:0.1g袋40.23648多索茶碱注射剂100ml:0.3g袋67.54729苦参素片剂0.1g*12片*2板盒13.45705托烷司琼注射剂100ml:5mg瓶146.8630头孢西丁注射剂2g支82.57407白消安注射液60mg*10ml支18508386草分枝杆菌F.U.36注射剂1.72ug支55.29582依达拉奉注射液30mg:20ml支147.31044头孢地嗪注射剂1.5g,溶媒结晶瓶136.111258艾司洛尔注射剂0.1g:1ml支95.912258艾司洛尔注射剂0.2g:2ml支16313685泮托拉唑注射剂40mg盒168685泮托拉唑肠溶片40mg*7片盒110141077聚甲酚磺醛溶液剂36%,25ml盒96.41077聚甲酚磺醛阴道栓剂90mg*6枚盒47.215841复方利血平氨苯蝶啶片剂20片盒18.716927羟乙基淀粉200/0.5注射剂500ml*6%,复合软塑袋袋120927羟乙基淀粉200/0.5注射剂500ml*6%,玻璃瓶瓶11617895坦洛新缓释片0.2mg*6片盒49.6序省医保编药品名称剂型规格单位最高临时备注号号零售价18400小牛脾提取物注射剂5mg*2ml多肽*380ug核糖支43.619501西替利嗪分散片10mg*12片盒25.320740肝水解肽注射剂20mg:2ml支15.8211072乙酰吉他霉素颗粒剂1g:10万单位*14袋盒19.922★(823)复方依那普利片剂14片(每片含马酸依那普利10mg与氢噻嗪25mg)*14片盒5123135伐昔洛韦片剂0.3g*7片盒103.5135伐昔洛韦片剂0.3g*10片盒145.924495氯雷他定颗粒剂5mg*6袋盒1825308地塞米松磷酸钠注射剂2mg，冻干粉瓶3.3308地塞米松磷酸钠注射剂5mg，冻干粉瓶3.526139司他夫定胶囊20mg*60粒盒7082725头孢丙稀片剂250mg*6片盒58.528138去羟肌苷分散片100mg*60片瓶30629972转化糖注射液250ml*果糖6.25g与葡萄糖6.25g袋54.930387胸腺肽肠溶片20mg*10片盒102.13117替卡西林克拉维酸钾注射剂1.6g瓶41.717替卡西林克拉维酸钾注射剂3.2g瓶70.932914低分子量肝素注射剂0.4ml*4250IuaXa(预注针筒)支35917低分子量肝素注射剂2500AXaIU*0.5ml支25.3917低分子量肝素注射剂5000AXaIU*0.5ml支48.6917低分子量肝素注射剂4100AXaIU*0.4ml(预灌针)支35.6917低分子量肝素注射剂6150AXaIU*0.6ml(预灌针)支43.633402匹多莫德片剂0.4g*6片盒75402匹多莫德片剂0.4g*6片*5板盒360序号省医保编号药品名称剂型规格单位最高临时零售价备注34567甘油果糖注射液500ml塑瓶122567甘油果糖注射液250ml塑瓶64.23529头孢替安注射剂0.5g,冻干粉针瓶7629头孢替安注射剂1g,冻干粉针瓶129.236384重组人干扰素a-2b泡腾胶囊80万IU*2粒盒49384重组人干扰素a-2b泡腾胶囊80万IU*4粒盒8937768乌司他丁注射剂5万IU,冻干粉针支95.2768乌司他丁注射剂10万IU,冻干粉针支174.338594利培酮片剂1mg*20片盒49.939825厄贝沙坦氢氯噻嗪片剂75mg:6.25*10片*2板盒49.940589奥氮平片剂10mg*7片盒170589奥氮平片剂10mg*14片盒331.541250罗哌卡因注射剂10ml*89.4mg支49.7250罗哌卡因注射剂10ml*119.2mg支6242234高乌甲素注射剂4mg,冻干粉针支36.243705托烷司琼注射剂5ml*5mg支141.844933葡萄糖酸亚铁糖浆剂10ml*0.25g*10支盒13.345900托特罗定片剂2mg*14片盒59461124纳洛酮注射剂1ml*0.4mg支20.447275复方三维Ｂ（II)注射剂复方，冻干支4548365阿仑膦酸钠片剂10mg*6片盒24.949229曲马多缓释片0.1g*10片盒44.850550奥拉西坦胶囊剂0.4g*24粒盒16451195来氟米特片剂10mg*16片盒154商品名：爱若华195来氟米特片剂20mg*10片盒166.8商品名：爱若华序号省医保编号药品名称剂型规格单位最高临时零售价备注52206氨基葡萄糖/吲哚美辛片剂100mg*24片盒30.553502依巴斯汀片剂10mg*10片盒5054270维生素Ｄ2注射剂1ml*10mg(40万单位）支37.155562扎来普隆胶囊剂5mg*14粒盒44.9562扎来普隆胶囊剂5mg*7粒盒23562扎来普隆胶囊剂10mg*7粒盒39.1562扎来普隆片剂5mg*7片*2板盒44.9565苯唑西林注射剂1g,粉针支2.25716美洛西林注射剂3g粉针支65.516美洛西林注射剂2g粉针支47.558837川芎嗪注射剂100mg,冻干粉针支31.3837川芎嗪注射剂50mg冻干粉针支18.45967罗红霉素胶囊剂75mg*24粒盒26.360207酮洛芬肠溶胶囊50mg*12粒盒17.561卤米松+三氯生软膏剂5g盒28卤米松+三氯生软膏剂10g盒456219美洛西林/舒巴坦钠注射剂0.5g*0.125g，溶媒结晶支2663桂哌齐特注射剂2ml:80mg支6664西酞普兰片剂20mg*10片盒7865头孢氨苄颗粒剂125mg*10袋盒666罗格列酮片剂2mg*14片盒49.5片剂4mg*7片盒48.5片剂4mg*14片盒96.567苯磺酸左旋氨氯地平片剂2.5mg*14片盒77.7商品名：施慧达68阿托品眼用凝胶剂2.5g*25mg支25