香港港安醫院 - 荃灣 Hong Kong Adventist Hospital - Tsuen Wan 香港港安醫院 X. OBSTETRIC PACKAGES 產科分娩計劃 A. NORMAL DELIVERY 自然分娩 (3 DAYS 日 / 2 NIGHTS 夜 )

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1 香港港安醫院 - 荃灣 Hong Kong Adventist Hospital - Tsuen Wan 香港港安醫院 TABLE OF CONTENT 目錄 Section Page I. REGISTRATION FEES 登記費 A. GENERAL OUT-PATIENT 全科門診 I 1 B. SPECIALISTS 專科門診 I 1 C. PRIORITY CARE BY GENERAL PHYSICIAN 全科特診服務 I 1 D. EMERGENCY CONSULTATION 緊急診症 I 1 E. DIETARY COUNSELLING SERVICES 營養輔導服務 I 2 F. REGISTRATION CARD 登記咭 I 2 G. OTHER CHARGES 其他收費 I 2 II. CARDIAC CATHETERIZATION & INTERVENTION CENTER 心導管檢查及介入治療中心 A. BASIC CHARGES 1 CORO ONLY (RADIO / FEMORAL APPROACH) 心導管及冠狀動脈造影檢查 II 1 2 CORO + LV GRAM (RADIO / FEMORAL APPROACH) 心導管及冠狀動脈造影檢查 + 左心室造影 II 1 3 PTCA (RADIO / FEMORAL APPROACH) 冠狀動脈氣球擴張術 II 1 4 CORO + PTCA (RADIO / FEMORAL APPROACH) 心導管及冠狀動脈造影檢查 + 冠狀動脈氣球擴張術 II 1 5 CORO + LV GRAM + PTCA (RADIO / FEMORAL APPROACH) 心導管及冠狀動脈造影檢查 + 左心室造影 + 冠狀動 II 1 脈氣球擴張術 6 PTCA PACKAGE (EXCLUDE STENT & BALLOON) II 1 7 CORO + IVUS (INCLUDING IVUS CATHER) II 1 8 CORO + LV GRAM + PTCA (EXCLUDE STENT & BALLOON) II 1 9 ASD Closure (Basic Charge) II 1 10 EP +/- RF Basic Charge II 1 11 Biventricular ICD (2 Hours) II 1 12 Biventricular ICD (2 Hours) II 1 13 ASD Occlusion Basic charge II 1 14 PTMC Basic Charge II 1 15 Pericardiocenthesis II 1 16 Percutaneous Biliary Drainage II 1 17 Embolization II 1 18 Peripheral STENT II 1 19 Renal STENT II 1 B. OFF HOUR CHARGE & TREATMENT ROOM CHARGE II 1 C. EQUIPMENT / PROCEDURES / SUPPLIES CHARGES II 2-4 III. DAILY CHARGES (HOSPITALISATION) 每日收費 A. DAILY CHARGES FOR MEDICAL & SURGICAL SERVICES 內科及外科服務每日收費 III 1 B. DAILY CHARGES FOR PEDIATRIC SERVICES 兒科服務每日收費 III 1 C. DAILY CHARGES FOR OBSTETRIC SERVICES 產科服務每日收費 III 1 D. DAILY CHARGES FOR NURSERY SERVICES 育嬰服務每日收費 III 1 E. MEALS 膳食 III 1 F. SPECIAL DIET 特別膳食 III 2 G. CHANGE OF BED LOCATION REQUESTED BY PATIENTS 病床轉換費 III 2 IV. DENTAL CHARGES 牙科收費 IV 1 V. DIAGNOSTIC IMAGING CHARGES 診斷造影收費 V 1-25 VI. FACILITIES / EQUIPMENT RENTAL 設施及儀器使用收費 VI 1-3 VII. HEALTH PROMOTION CLASSES 健康推廣課程 VII 1-2 VIII. LABORATORY CHARGES 化驗室收費 VIII 1-23 IX. MEDICAL DOCUMENTATION 醫療文件 IX 1 All prices are subject to changes without prior notice 價目如有更改, 恕不另行通告 - Revised Date 更新日期 : 4 January 2016 Content - 1

2 香港港安醫院 - 荃灣 Hong Kong Adventist Hospital - Tsuen Wan 香港港安醫院 X. OBSTETRIC PACKAGES 產科分娩計劃 A. NORMAL DELIVERY 自然分娩 (3 DAYS 日 / 2 NIGHTS 夜 ) X 1 B. C-SECTION DELIVERY 剖腹分娩 (4 DAYS 日 / 3 NIGHTS 夜 ) X 1 C. OTHER CHARGES 其他收費 X 2 XI. OPERATING THEATER 手術室費用 A. ANESTHETIST FEE 麻醉科醫生收費 XI 1 B. OPERATING ROOM CHARGE 手術室房租 XI 1 C. EQUIPMENT CHARGES 儀器收費 XI 1 XII. OTHER PACKAGES 其他計劃 A. BREAST LUMPDECTOMY 乳房腫塊切除 XII 1 B. CIRCUMCISION 包皮環切術 XII 1 C. COLONSCOPY 大腸內窺鏡檢查 XII 1 D. COLONSCOPY + OGD 大腸內窺鏡檢查 + 胃鏡檢查 XII 1 E. COLPOSCOPY 陰道窺鏡 XII 1 F. CYSTOSCOPY 膀胱窺鏡檢查 (DAY CASE) XII 1 G. CYSTOSCOPY - WITH BIOPSY (DAY CASE) 膀胱窺鏡檢查 ( 活組織檢查法 ) XII 1 H. HEMORRHOIDECTOMY 痔瘡切除術 XII 1 I. LAPAROSCOPIC CHOLECYSTECOMY 腹腔鏡膽囊切除術 XII 1 J. LAPAROSCOPIC HERNIA REPAIR (GA) 腹腔鏡疝修補術 ( 全身麻醉 ) XII 1 K. LITHOTRIPSY - EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY 體外衝擊波碎石治療 XII 1 L. LUMPS & BUMPS - (GA) & (LA) 各類小型瘤腫切除術 XII 1 M. MODIFIED RADICAL MASTECTOMY 乳房根治術 XII 1 N. OGD DIAGNOSTIC PACKAGE (DAYCASE) 日間胃鏡診斷計劃 XII 1 O. OPTHALMIC SURGERY PACKAGE (DAY CASE) 日間眼科手術 XII 2 P. REPAIR DIRECT / INDIRECT HERNIA 直接或間接性疝氣縫合術 XII 2 Q. SKIN LASER PACKAGE 皮膚激光計劃 XII 2 R. SLEEP STUDY PACKAGE 睡眠分析計劃 XII 2 S. RENAL STONE SCRENNING PACKAGE 小兒及成人腎結石普查套餐 XII 2 T. THYROIDECTOMY 甲狀腺切除術 XII 2 XIII. REHABILIATION CENTER CHARGES 復康治療中心收費 XIII 1 XIV. SPECIAL OUT-PATIENT PROGRAMS 門診特別服務 A. PHYSICIAN CHECK-UP 身體檢查 XIV 1 B. PRENATAL CARE 產前檢查 XIV 2 C. MATERNAL FETAL MEDICINE CLINIC 母胎醫療診所 XIV 2 D. BREAST HEALTH CENTRE 乳房健康中心 XIV 3 XV. SPECIAL PROFESSIONAL FEES 特別專業收費 A. MINOR SURGERY 小手術 XV 1 B. OTHER DOCTOR PROCEDURES 其他醫生治療程序 XV 2 C. SPECIALIST CONSULTATION RATE 專科醫生會診費 XV 3 D. NURSING PROCEDURES 護理程序 XV 4-6 E. OPD NURSING PROCEDURE PACKAGE 門診病人護理程序計劃 XV 7-8 XVI. SPECIAL TREATMENT / SERVICES 特別治療服務 XVI 1-2 XVII. SURGERY CHARGES 手術收費 A. GENERAL SURGERY 外科 XVII 1 B. EAR, NOSE & THROAT (ENT) 耳鼻喉科 XVII 1 C. GYNAECOLOGY 婦科 XVII 1 All prices are subject to changes without prior notice 價目如有更改, 恕不另行通告 - Revised Date 更新日期 : 4 January 2016 Content - 2

3 香港港安醫院 - 荃灣 Hong Kong Adventist Hospital - Tsuen Wan 香港港安醫院 D. ORTHOPEDICS 骨科 XVII 1 E. ENDOSCOPY 內窺鏡檢查 XVII 2 XVIII. WARD SUPPLIES 病房物料供應 XVIII 1 XIX. THIRD PARTY CHARGE & EXPENSIVE ITEMS CHARGE FOR LOW CHARGE-BED - THIRD PARTY CHARGES FOR LOW CHARGE BED SCHEME - OPERATING THEATRE - EXPENSIVE SINGLE USE CONSUMABLES FOR LOW CHARGE BED SCHEME - OPERATING THEATRE - CLINICAL LABORATORY - OUTSOURCED SERVICE - DIAGNOSTIC IMAGING - THIRD PARTY CHARGE - REHABILITATION CENTRE - THIRD PARTY CHARGE - MISCELLANEOUS - THIRD PARTY CHARGE All prices are subject to changes without prior notice 價目如有更改, 恕不另行通告 - Revised Date 更新日期 : 4 January 2016 Content - 3

4 I. REGISTRATION FEES ( 登記費 ) Charges 收費 A. GENERAL OUT-PATIENT 全科門診 - Resident Family Physician 全科 $200 / Call 每次 (RE70) B. SPECIALISTS 專科門診 - OB-GYN 婦產科 $400 / Call 每次 (RE15) - Pediatrics 兒科 $350 / Call 每次 (RE10) - Cardiology 心臟科 $500 / Call 每次 (RE50) - Cardio-Thoracic Surgery 胸肺外科 $400 / Call 每次 (RE08) - Dermatology 皮膚科 $450 / Call 每次 (RE35) - E.N.T. 耳鼻喉科 $450 / Call 每次 (RE40) - Endocrinology, Diabetes and Metabolism ( 內分泌及糖尿科 ) $400 / Call 每次 (RE16) - Geriatric 老人科 First visit $800 / Call 每次 (RE63 ) Second Visit $400 / Call 每次 - Hepatology 肝臟科 First visit $600 / Call 每次 (RE12) Second Visit $450 / Call 每次 - Internal Medicine 內科 $400 / Call 每次 (RE20) - Mental Health 心理健康科 (1/2 hour call 半小時計 ) Follow up $600 / Call 每次 (RE60) First visit $1,000 / Call 每次 - Neurology 腦科 First visit $600 / Call 每次 (RE01) Second Visit $450 / Call 每次 - Neurosurgery 腦外科 $800 / Call 每次 (RE09) - Nephrology 腎科 $400 / Call 每次 (RE05) - Oncology 腫瘤科 1st visit $1,000 / Call 每次 (RE03) 2nd visit $800 / Call 每次 - Opathalmology (Eye) 眼科 $450 / Call 每次 (RE25) - Orthopedics 骨科 1st Consultation $450 / Call 每次 (RE45) 2nd Consultation (same day) $550 - $650 / Call 每次 - Plastic Surgery 整形外科 $500 / Call 每次 (RE02) - Respiratory 呼吸系統科 1st visit $600 / Call 每次 (RE06) 2nd visit $450 / Call 每次 - Rheumatology 風濕科 $600 / Call 每次 (RE04) - Surgery 外科 $400 / Call 每次 (RE30) - Urology 泌尿科 $400 / Call 每次 (RE55) - Haematology 血液科 $1,200 / Call 每次 (RE13) C. PRIORITY CARE BY GENERAL PHYSICIAN 全科特診服務 - Priority Care by General Physician 09:00-21:00 $300 / Call 每次 (RE65) 21:00-09 :00 $330 / Call 每次 (RE66) D. EMERGENCY CONSULTATION 緊急診症 $1,000 / up 起 Call 每次 (PD73) (Specialist Emergency - refer to specialist) All prices are subject to changes without prior notice 價目如有更改, 恕不另行通告 - Revised Date 更新日期 : 4 January 2016 I - Page 1

5 E. DIETARY COUNSELLING SERVICES 營養輔導服務 (DI35) 分鐘 - 60mins 分鐘 ) - IPD ( ) $480 all classes - OPD ( 門診 ) $430 Remarks: IPD Dietary Counselling Services is applied to Low Charge Bed, the charge is HK$ Diabates Dietary Therapy 糖尿病飲食計劃 (8 sessions 八節 ) $2, Heart Disease Meal Planning 心臟病飲食計劃 (8 sessions 八節 ) $2, Fatty Liver Dietary Theray 脂肪肝飲食計劃 (8 sessions 八節 ) $2, Cancer Nutrition Therapy 癌症飲食計劃 (4 sessions 四節 ) $1, Prenatal Nutrition and Postpartum Weight Loss 懷孕期營養及產後修身 (8 sesssions 八節 ) $2, Weight Management 體重管理計劃 10 sessions( 十節 ) $3, Other consultation services (outpatient) - 1 sessoin ( 一節 ) $430-4 sessions ( 四節 ) $1,480-8 session ( 八節 ) $2, sessions ( 十節 ) $3,080 F. NEW REGISTRATION 新登記 1. First Issue 首次 $30 (RE75) 2. Replacement Card 補領新咭 $15 (RE76) G. OTHER CHARGES 其他收費 1. Translator Charge (IPD, OPD, DC) $1,000 up (XXTRA) All prices are subject to changes without prior notice 價目如有更改, 恕不另行通告 - Revised Date 更新日期 : 4 January 2016 I - Page 2

6 II. CARDIAC CATHETERIZATIN & INTERVENTION CENTER 心導管檢查及介入治療中心 3rd Class 2nd Class 1st Class A. Basic Charges 基本收費 1) Coro Only (Radio / Femoral Approach) 心導管及冠狀動脈造影檢查 1 KPH01 20,000 $ 25,600 29,330 2) Coro + LV Gram (Radio / Femoral Approach) 心導管及冠狀動脈造影檢查 + 左心室造影 2 KPH02 20,000 24,910 28,170 3) PTCA (Radio / Femoral Approach) 冠狀動脈氣球擴張術 3 KHP03 55,000 70,400 80,680 4) Coro + PTCA (Radio / Femoral Approach) KHP04 66,200 86,060 99,300 心導管及冠狀動脈造影檢查 + 冠狀動脈氣球擴張術 4 5) Coro + LV Gram + PTCA (Radio / Femoral Approach) KHP05 62,000 79,500 91,170 心導管及冠狀動脈造影檢查 + 左心室造影 + 冠狀動脈氣球擴張術 5 6) PTCA (exclude STENT & Balloon) 6 KHP06 30,000 37,900 43,180 7) Coro + IVUS (including IVUS Cather) 7 KHP07 36,000 46,110 52,850 8) Coro + PTCA (exclude STENT & Balloon) 8 KHP09 36,000 45,680 52,120 9) ASD Closure (Basic charge) 9 KHP13 25,000 32,500 37,500 10) EP +/- RF Basic Charge 10 KHP14 52,800 68,220 78,500 11) Biventricular ICD (2 hours) 11 KHP15 33,200 43,160 49,800 12) Biventricular ICD (4 hours) 12 KHP16 41,000 53,300 61,500 13) ASD Occlusion Basic Charge 13 KHP17 36,200 45,880 52,330 14) PTMC Basic Charge 14 KHP18 35,400 44,820 51,100 15) Pericardiocenthesis 15 KHP19 13,000 16,900 19,500 16) Percutaneous Biliary Drainage 16 KHP20 25,000 32,080 36,800 17) Embolization 17 KHP21 26,600 34,160 39,200 18) Peripheral STENT 18 KHP22 32,500 41,500 47,500 19) Renal STENT 19 KHP23 32,600 41,630 47,660 B. Off-Hour Charge & Treatment Room Charge 1. CCIC examination cases that begin during out-of-hours will incur a 50% surcharge on top of the normal CCIC basic charges. 於非辦工時間開始之手術, 將按房別收取額外 50% 之手術室費用 KH Out-of-hours are defined as 17:00 p.m. to 08:30 a.m. daily, plus Friday after 17:00 p.m. and all day Saturday. 手術室之非辦工時間為平日晚上五時至翌日早上八時三十分, 星期五下午五時後及星期六全日 3. Off-hour sur-charge : a procedure prolonged and completed after working hours. 非辦工時間附加費 : 如手術完成於辦工時間後 4. Emergency call back : Staff are called and back to hospital within 45 to 60 minutes. 緊急手術 : 員工需於 45 至 60 分鐘內緊急召回之附加費 5. Basic CCIC Treatment Room Charges 手術室收費 (KH041) 3rd Class 2nd Class 1st Class - First 60 minutes $4,550 $5,915 $6,825 - extra 30 minutes $2,500 $3,250 $3, CCIC Treatment Room CHARGE 心導管檢查及介入治療中心收費 7. EQUIPMENT CHARGES 儀器收費 KHN01 KHE01 All prices are subject to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 II - Page 1

7 II. CARDIAC CATHETERIZATIN & INTERVENTION CENTER 心導管檢查及介入治療中心 C. Equipment / Procedures / Supplies Charges 3rd Class 2nd Class 1st Class Code Description size KH600 J & J - Other consumable - KH601 J & J - Guidewire FC J KH602 J & J - Guidewire FC J KH603 J & J - Exch GW FC J KH604 J & J - Guidewire FC STR KH605 J & J -Dx cath JL 3.5 5F KH606 J & J - Dx cath JL 3.5 6F ST KH607 J & J - Dx cath JL 4 5F KH608 J & J - Dx cath JL 4 6F ST KH609 J & J - Dx cath JL 5 5F KH610 J & J - Dx cath JL 5 6F ST KH611 J & J - Dx cath JL 6 5F KH612 J & J - Dx cath JL 6 6F ST KH613 J & J - Dx cath JR 3.5 5F KH614 J & J - Dx cath JR 3.5 6F ST KH615 J & J - Dx cath JR 4 5F KH616 J & J - Dx cath JR 4 6F ST KH617 J & J - Dx cath JR 5 5F KH618 J & J - Dx cath JR 5 6F ST KH619 J & J - Dx cath JR 6 5F KH620 J & J - Dx cath JR 6 6F ST KH621 J & J - Dx cath AL1 5F KH622 J & J - Dx cath AL1 6F ST KH623 J & J - Dx cath AL2 TL 5F KH624 J & J - Dx cath AL2 6F ST KH625 J & J - Dx cath MOD TL 5F KH626 J & J - Dx cath AR-MOD 6F ST KH627 J & J - Dx cath PIG 5F KH628 J & J - Dx cath PIG 6F ST KH629 J & J - Dx cath PIG 145 5F KH630 J & J - Cath PIG 145 SH 6F ST KH631 J & J - Dx cath NIH 5.2F ST KH632 J & J - Dx cath NIH 6F ST KH633 J & J - Dx cath MPA 1 5.2F ST KH634 J & J - Dx cath MPA 1 6F ST KH635 J & J - Dx cath MPA 2 TL 5F KH636 J & J -Dx cath MPA 2 6F ST KH637 J & J - Dx cath MPA 2 6F ST KH638 J & J - Dx cath IM TL 5F KH639 J & J - Dx cath IM 6F ST KH640 J & J - Dx cath RCB TL 5F KH641 J & J - Dx cath RCB 6F ST KH642 J & J - Dx cath LCB TL 5F KH643 J & J - Dx cath LCB 6F ST KH644 J & J - Tempo.038 Cobrai C1 65cm 5F KH645 J & J - Tempo.038 Cobrai C2 100cm 5F KH700 King Health - Other consumable KH701 King Health - Merit Advance needle 18G x KH702 King Health - Pressure Tubing "48" KH703 King Health - Syringe Vaclok 20ml KH704 King Health - InQwire.035 x 150cm 3mm J KH705 King Health - InQwire.035 x 260cm 3mm J KH706 King Health - Disp. Inflation Syringe ,050 KH707 King Health - Hemostatsis Valve /w tubing & Torque & GW introducer KH708 King Health - Control syringe 10ml KH709 King Health - Pericardiocentesis Kit 8.3F Pigtail 1,425 1,850 2,130 KH710 King Health - MAK PED 4F 780 1,010 1,170 KH711 King Health - En Snare ( 2-4mm) 3.2F 6,240 8,110 9,360 KH712 King Health - En Snare ( 4-8mm) 3.2F 6,240 8,110 9,360 KH713 King Health - Compressor KH714 King Health - IAB 35 ml 7 F 9,360 12,170 14,040 KH715 King Health - IAB 40 ml 7 F 9,360 12,170 14,040 KH760 GMS - Optiray ml KH761 GMS - Optiray ml KH762 Constrast KH770 Cemma - Cath tray: Angio Pack / radial 825 1,070 1,230 KH780 St Jude - Pacing lead KH790 3M - 3M drape KH791 Covidien - Injector syringe & cath KH800 Mekim - Other Consumable KH801 Mekim - Terumo Radifocus Introducer II 4F 10cm KH802 Mekim - Terumo Radifocus Introducer II 5F 10 cm $ All prices arre subject to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 II - Page 1

8 II. CARDIAC CATHETERIZATIN & INTERVENTION CENTER 心導管檢查及介入治療中心 C. Equipment / Procedures / Supplies Charges 3rd Class 2nd Class 1st Class Code Description size KH803 Mekim - Terumo Radifocus Introducer II 6F 10 cm KH804 Mekim - Terumo Radifocus Introducer II 7F 10cm KH805 Mekim - Terumo Radifocus Introducer II 8F 10cm KH806 Mekim - Terumo Radifocus Introducer II 4F 16cm KH807 Mekim - Terumo Radifocus Introducer II 5F 16cm KH808 Mekim - Terumo Radifocus Introducer II 6F 16 cm KH809 Mekim - Terumo TR band KH810 Mekim - Terumo Outlook Tiger angio cath 4F SH KH811 Mekim - Terumo Outlook Tiger angio cath 5F SH KH812 Mekim - Terumo Radifocus Gwire cm KH813 Mekim - Terumo Radifocus Gwire cm KH900 Abott - Other consumable KH901 Abott - 20/20 Priorty Pack 1,125 1,460 1,680 KH902 Abott - Indeflator 20/ ,090 1,260 KH903 Abott- GW assessory Kit i/c CoPoilot KH904 Abott- GW assessory Kit i/c RHV KH905 Abott- Duostat rotating Hemostatic Valve KH906 Abott-Hemostatic Valve ( RHV) KH907 Abott-GW Introducer (ten pack) KH908 Abott-Torque Device ( ten pack) ,080 KH500 Medtronic - Other consignment KH501 Medtronic - Launcher 1,500 1,950 2,250 KH502 Medtronic - Guidewire Zinger 1,500 1,950 2,250 KH503 Medtronic - Export Aspiration cath 7,540 9,800 11,310 KH504 Medtronic - Balloon Sprinter Legend 4,550 5,910 6,820 KH505 Medtronic - Balloon NC sprinter 4,290 5,580 6,430 KH506 Medtronic - Stent Endeavor Resolute 25,740 33,460 38,610 KH550 Biosensors - Other consignment KH551 Biosensors - Balloon Powerline/TIN/BEO/NC 3,900 5,070 5,850 KH552 Biosensors - Balloon OPN NC 6,500 8,450 9,750 KH553 DES Biomatrix Flex (11-28mm) 17,940 23,320 26,910 KH554 Biosensors - DES Biomatrix Flex (33, 36mm) 20,150 26,190 30,220 KH555 PKG: Biomatrix 11-28mm + Powerline/TIN/BEO 20,540 26,700 30,810 KH556 PKG: Biomatrix 11-28mm + OPN 21,840 28,390 32,760 KH557 PKG: Biomatrix 33,36mm + Powerline/TIN/BEO 22,750 29,570 34,120 KH558 PKG: Biomatrix 33,36mm + OPN 24,050 31,260 36,070 KH559 overlapping Biomatrix 2 pc, i/c same diameter & < 14mm, no free balloon 19,500 25,350 29,250 KH560 PKG: 3 DES + 2 pc Balloon Powerline/TIN/BEO, 49,400 64,220 74,100 KH561 Extra charge x 3 DES PKG > 1 long DES (33,36mm) 2,600 3,380 3,900 KH562 4th DES Biomatrix 11-28mm (same pt) 13,000 16,900 19,500 KH563 4th DES Biomatrix 33 or 36mm ( same pt) 15,600 20,280 23,400 KH atm Indeflator 900 1,170 1,350 KH400 Mekim - Other consignment KH401 Mekim - G Cath Heartrail II 1,800 2,340 2,700 KH402 Mekim - Micro Cath Finecross 4,550 5,910 6,820 KH403 Mekim - PTCA GW Runthrough 1,500 1,950 2,250 KH404 Mekim - PTCA GW Runthrough Tapered 2,080 2,700 3,120 KH405 Mekim - PTCA GW Runthrough extension 1,275 1,660 1,910 KH406 Mekim - Balloon Tazuna RX SC 5,200 6,760 7,800 KH407 Mekim - Balloon Hiryu NC 5,200 6,760 7,800 KH408 Mekim - PTCA Nobori DES 2nd stent 22,100 28,730 33,150 KHC01 Mekim - PKG: Nobori DES + Balloon + GW 25,740 33,460 38,610 KH450 Abbott - Other consignment KH451 Abbott - GW S/S Floppy, Traverse,Intermediate, standard, extra S port, cross-it, Iron man 1,875 2,440 2,810 KH452 Abbott - GW BMW, BHW, pilot 2,025 2,630 3,030 KH453 Abbott - DOC GW extension 1,200 1,560 1,800 KH454 Abbott - Polymer GW, whisper, Advance 2,100 2,730 3,150 KH455 Abbott - Balloon, OTW Voyager 4,160 5,410 6,240 KH456 Abbott - BalloonVoyager NC 5,200 6,760 7,800 KH457 Abbott - Stent: Multi- link 8 all 14,040 18,250 21,060 KH458 Abbott - Stent: Multi- link Vision all 13,520 17,570 20,280 KH459 Abbott - Stent: Multi-link Mini Vision all 13,520 17,570 20,280 KH460 Abbott - Jostent GraftMaster all 19,240 25,010 28,860 KH461 Abbott - DES: Xience prime all 24,440 31,770 36,660 KH462 Abbott - DES: Xience V all 22,750 29,570 34,120 KH463 Abbott - Vessel Closure: Proglide, perclose AT, Starclose SE 3,900 5,070 5,850 KH464 Abbott - PKG: OTW Voyager + GW 3,900 5,070 5,850 KH465 Abbott - PKG:Voyager NC/Trek Rx/Mini TrekRx + GW 5,200 6,760 7,800 KH466 Abbott - PKG: Xience prime + Balloon + GW 24,440 31,770 36,660 KH467 Abbott - PKG: Xience Prime + Balloon + Proglide/PercloseAT/Starclose SE 27,040 35,150 40,560 KH468 Abbott - PKG: Xience Prime 38mm + Xience V 8mm + GW 27,040 35,150 40,560 KH469 Abbott - PKG: Xience Perclose Proglide/ StarClose SE + GW 5,200 6,760 7,800 KH470 Abbott - PKG: Xience prime + Voyager NC/OTW Voyager/ Trek Rx/Mini TrekRx + GW 27,040 35,150 40,560 $ All prices arre subject to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 II - Page 2

9 II. CARDIAC CATHETERIZATIN & INTERVENTION CENTER 心導管檢查及介入治療中心 C. Equipment / Procedures / Supplies Charges 3rd Class 2nd Class 1st Class Code Description size KH471 Abbott - PKG: Xience V + Rx Voyager/ OTW Voyager + Proglide/Perclose AT/ StarClose SE + Voyager NC 30,290 39,380 45,430 KH300 J & J - Other consignment KH301 J & J - PKG: DES Cypher Select + 1balloon 15,600 20,280 23,400 KH302 J & J - PKG: 2nd DES Cypher Select + 1balloon (FOC) 13,000 16,900 19,500 KHP99 other CCIC procedure KH030 Intravascular Ultrasound (IVUS) 3,000 3,900 4,500 KH031 Fractional Flow Reserve (FFR) 3,000 3,900 4,500 KH032 Optical Coronary Tomography (OTC) 2,500 3,250 3,750 KH033 Cardioversion 2,500 3,250 3,750 KH034 Transoesophageal Echo (TEE) 4,200 5,460 6,300 KH036 Pericardiocentesis 2,500 3,250 3,750 KH037 Temparory pacing 2,500 3,250 3,750 KH044 Use of Snare 1,200 1,560 1,800 KH038 DVD 810 1,050 1,210 KH039 Codonic Paper 800 1,040 1,200 KH040 Doctor assist KH041 Extra exam time per 1/2 hour (normal hours) 2,600 3,380 3,900 KH042 Off-hr exam sur-charge 50% 8,500 11,050 12,750 KH043 Off hour sur-charge for staff KH044 Emergency Call back sur-charge 3,000 3,900 4,500 KH507 OPEN item KH550 OPEN item - - $ All prices arre subject to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 II - Page 3

10 III. DAILY CHARGES (HOSPITALISATION) 每日收費 20 A. DAILY CHARGES FOR MEDICAL & SURGICAL SERVICES 內科及外科服務每日收費 Old Wing New Wing Physician Management Fee 醫生收費 Room Type 房間類別 Admission Charge 入院服務費 Ward 房租 GP 全科 & SP 專科 6-7-Bed 六至七人房 $300 (RC135) $500 (RC113) NIL $600 (WF111) 5-Bed 五人房 $300 (RC135) $550 (RC113) NIL $650 (WF111) 3-Bed 三人房 $300 (RC135) $650 (RC113) $700 (RC113) $700 (WF111) Semi-Pri 雙人房 $300 (RC135) $1,000 (RC113) $1,100 (RC113) $950 (WF111) Private 單人房 $300 (RC135) $1,600 (RC113) $2,000 (RC113) $1,350 (WF111) HDU 加護病房 $300 (RC135) $1,500 (RC150) $2,000 (RC150) $1,500 (WF221) Isolation 隔離病房 $300 (RC135) $1,600 (RC117) $2,000 (RC117) $850 (WF311) Low Charged Bed 資助床 $300 (RC135) $100 (RC113) $100 (RC113) $650 (WF111) B. DAILY CHARGES FOR PEDIATRIC SERVICES 兒科服務每日收費 Old Wing New Wing Physician Management Fee 醫生收費 Room Type 房間類別 Admission Charge 入院服務費 Ward 房租 GP 全科 & SP 專科 General 普通病房 $300 (RC135) $600 (RC115) $750 (RC115) $700 (WF411) Semi-Pri 雙人房 $300 (RC135) $1,000 (RC113) $1,200 (RC113) $950 (WF111) Private 單人房 $300 (RC135) $1,600 (RC113) $2,000 (RC113) $1,350 (WF111) C. DAILY CHARGES FOR OBSTETRIC SERVICES 產科服務每日收費 Old Wing New Wing Room Type 房間類別 Admission Charge 入院服務費 Ward 房租 5-Bed 五人房 $300 (RC135) $550 (RC120) NIL 3-Bed 三人房 $300 (RC135) $650 (RC120) $700 (RC120) Semi-Pri 雙人房 $300 (RC135) $1,000 (RC120) $1,100 (RC120) Private 單人房 $300 (RC135) $1,600 (RC120) $2,000 (RC120) Deluxe Private $300 (RC135) $3,000 (RC120) Premium Private 優質單人房 $300 (RC135) $1,800 (RC120) $4,000 (RC120) Birthing Suite 分娩室 $300 (RC135) $1,600 (RC118) $2,000 (RC118) D. DAILY CHARGES FOR NURSERY SERVICES 育嬰服務每日收費 1. NURSERY 育嬰室 Room Type 房間類別 NURSERY 育嬰室 Admit 入院費 $300 (RC135) Ward 房租 $600 (RC119) 2. Packages 計劃費用 21 - Nursery ward and diapers 育嬰室 尿片 $700 (RCP01) - Nursery ward, diapers and admission $1,000 (RCP03) 22 育嬰室 尿片 入院費 3 Other Charges 其他收費 - Acute Care 緊急護理 Add 加 $550 (PN11) - Intensive Care 加護護理 Add 加 $1,200 (PN12) - Isolation 隔離護理 Add 加 $500 (PN071) - Intensive Care for Nursery 育嬰室加護護理 $650 (PN52) - Mike Power (Therapeutic) Day $100 (MA09) - Admission Pack $100 (TRA004) - Dressing Pack $15 (TRA005) - Father Cut Cord $350 (PN90) - Father Accompany ( 陪產 ) $500 (RC133) - Cancellation Booked C-Section $5,000 (OT80) (After Admission - within 4 hours of the Appointment Time) - Accompany Fee (guest bed) $180 (RC111) E. MEALS 膳食 (DIXX) All prices are subject to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January 2016 III - Page 1

11 1. Breakfast 早餐 Depends on items 視乎個別菜單 2. Lunch 午餐 - Regular set meal 一般套餐 $60 3. Dinner 晚餐 - Regular set meal 一般套餐 $60 F. SPECIAL DIET 特別膳食 Bed Ward (includes Dietian Assessment - 1st assessment) 1. Breakfast 早餐 Depends on items 視乎個別菜單 (DIXX) 只有糖尿特餐供應 Provide Diabetic 2. Lunch 午餐 $100 Set Meal only 只有糖尿特餐供應 Provide Diabetic 3. Dinner 晚餐 $100 Set Meal only 4. Baby Milk 嬰兒奶粉 - Regular (Bottle) 普通奶粉 $50 / bottle 瓶 (MA08) - Water Milk $100 / Day 日 (MA46) G. NURSING PROCEDURE - CHANGE OF BED LOCATION REQUESTED BY PATIENTS 護理程序 - 在病人要求下轉換病床費用 $110 / move 每次 (XXBED) All prices are subject to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January 2016 III - Page 2

12 Fee Schedule 收費表 - Effective from 1 Decmeber 年 12 月 1 日生效 IV. DENTAL CHARGES 牙科收費 General Adult 成人 Child 小童 Specialist 首次登記費 First Registration Fee $30 $30 牙科檢查 Dental Examination $200 - $350 $500 牙科 X 光片 Dental X-ray, BW, PA ( 細 ) 牙科 X 光片 Dental X-ray, PAN ( 大 ) 牙科 X 光片 Dental X-ray, 3D $150 $400 $600 - $2,400 洗牙 Scaling & Prophylaxis $450 - $700 $300 - $350 Deep Scaling/Root Planing (Per quadrant) 深層洗 牙, 牙腳刮治 ) $1,000 - $3,500 Nil 補牙 Restoration $500 - $1,000 $350 - $ $450 普通脫牙 Extraction $500 - $1,000 $250 - $350 脫智慧齒 ( 不需手術 ) Wisdom Tooth Non-surgical Extraction 脫智慧齒 ( 需手術 ) Wisdom Tooth Surgical Extraction 根管治療 Endodontics 固定假牙 - 合金及磁牙冠 Fixed Prosthodontics - porcelain on N.P. Crown 全磁牙冠 Full Procelain $1,500 - $2,500 Nil $3,000 - $5,000 $6,000 up $3,200 - $5,000 $3,000 Nil $6,000 - $8,000 Nil 固定假牙 - 合金牙冠 $2,400 Nil Fixed Prosthodontics - Full N.P. Crown 活動假牙 Removable Prosthodontics 漂牙 Bleaching - Home Bleaching - Office Bleaching (Laser) 植牙 Implant Oral Surgery 激光治療牙週病 Laser Treatment for Periodontal Disease 激光洗牙 Dental Hygiene service $3,500 - $7,000 $3,500 $8,000 $20,000 - $25,000 Depends on Condition $1,500 如有疑問, 請與本院牙科部聯絡 電話 : Please call our Dental Clinic at for any enquiries. All prices are subject to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 IV - Page 1

13 Fee Schedule 收費表 - Effective from 4 January 2016 (2016 年 1 月 4 日生效 ) XIV. DIAGNOSTIC IMAGING CHARGES 診斷造影收費 1.1 GENERAL X-RAY EXAMINATION UX--- COD E DESCRIPTION ** After office hour After office hour OPC 門診 HA 代號 項目 TWAH Drs Low Cost 1st Class 2nd Class 3rd Class Regular Regular THORAX No. of view (0.5 of 2nd) (1.5) (1.4) (1.0) 1 XRA01 Chest XRA02 Chest- L. Lateral XRA03 Chest- R. Lateral XRA04 Chest - L. Decubitus XRA05 Chest - R. Decubitus XRA06 L. Ribs ,170 1, XRA07 R. Ribs ,170 1, XRA08 Apical Lordotic XRA09 Sternum XRA10 Additional view Each ABDOMINAL 11 XRB01 KUB XRB02 Abdomen - Supine XRB03 Abdomen - Erect XRB04 Pelvis XRB05 Pelvimetry XRB06 Additional view Each SPINE 17 XRC01 Cervical Spine ,170 1, XRC02 Thoracic Spine XRC03 Lumbar Spine XRC04 Lumbo Sacral Spine ,170 1, XRC05 Sacro-coccygeal Spine ,170 1, XRC06 Sacro-iliac Joints ,170 1, XRC07 Additional view Each HEAD 24 XRD01 Facial Bones ,170 1, XRD02 Internal Auditory Meati (IAM) ,560 1,456 1, XRD03 Mandible -L.side XRD04 Mandible -R. side XRD05 Mastoids ,950 1,820 1,300 1, XRD06 Nasal Bone XRD07 N.P.C ,560 1,456 1, XRD08 Orbits (for injury) XRD17 Orbits (for foreign body) ,170 1, XRD09 Paranasal Sinuses ,170 1, XRD10 Paranasal Sinuses (O.M.view) XRD11 Pituitary Fossa XRD12 Skull XRD13 Skull (Towne's) XRD14 Soft Tissue of Neck XRD15 T-M Joints (Both) ,950 1,820 1,300 1, XRD16 Additional view (each) Each GENERAL X-RAY EXAMINATION All prices are subjected to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 v - Page 1

14 Fee Schedule 收費表 - Effective from 4 January 2016 (2016 年 1 月 4 日生效 ) XIV. DIAGNOSTIC IMAGING CHARGES 診斷造影收費 UX--- COD E DESCRIPTION 項目 ** After office hour After office hour OPC 門診 HA 代號項目 TWAH Drs Low Cost 1st Class 2nd Class 3rd Class Regular Regular EXTREMITIES 41 XRE01 L. Hand & Fingers XRE02 R. Hand & Fingers XRE03 L. Wrist XRE04 R. Wrist XRE05 L. Scaphoid view XRE06 R. Scaphoid view XRE07 L. Forearm XRE08 R. Forearm XRE09 L. Elbow XRE10 R. Elbow XRE11 L. Humerus XRE12 R. Humerus XRE13 L. Clavicle XRE14 R. Clavicle XRE15 L. Scapular XRE16 R. Scapular XRE17 L. Shoulder XRE18 R. Shoulder XRE19 L. Heel XRE20 R. Heel XRE21 L. Foot & Toes XRE22 R. Foot & Toes XRE23 L. Ankle XRE24 R. Ankle XRE25 Ankles (Stress view) ,092 2,340 2,184 1,560 1, XRE26 L. Leg XRE27 R. Leg XRE28 L. Knee XRE29 R. Knee XRE36 L. Knee (Skyline view only) XRE37 R. Knee (Skyline view only) XRE38 Both Knees (Skyline view only) XRE30 Knees (Stress view) ,092 2,340 2,184 1,560 1, XRE31 L. Femur XRE32 R. Femur XRE33 L. Hip XRE34 R. Hip XRE35 Additional view (each) XR999 X-ray examination OTHER 80 XRF01 Bone Age Hand AP XRF02 Skeletal Survey ,730 5,850 5,460 3,900 3,300 2, XRF07 Babygram Each View CONTRAST X-RAY EXAMINATION UX--- All prices are subjected to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 v - Page 2

15 Fee Schedule 收費表 - Effective from 4 January 2016 (2016 年 1 月 4 日生效 ) XIV. DIAGNOSTIC IMAGING CHARGES 診斷造影收費 COD E DESCRIPTION 項目 ** After office hour After office hour OPC 門診 HA 代號項目 TWAH Drs Low Cost 1st Class 2nd Class 3rd Class Regular Regular BARIUM 83 XRG01 Barium Enema 2,500 1,500 2,450 5,250 4,900 3,500 3,000 2, XRG02 Barium Meal 2,500 1,500 1,400 3,000 2,800 2,000 1,500 1, XRG03 Barium Meal & Follow Through 2,500 1,500 2,450 5,250 4,900 3,500 3,000 2, XRG04 Barium Follow Through 2,500 1,500 2,450 5,250 4,900 3,500 3,000 2, XRG05 Barium Swallow 2,500 1,500 1,400 3,000 2,800 2,000 1,500 1, XRG09 Gastrografin Meal 2,500 1,500 1,750 3,750 3,500 2,500 2,000 1, XRG10 Gastrografin Meal & Follow Through 2,500 1,500 3,150 6,750 6,300 4,500 4,000 2, XRG08 Additional Film CONTRAST 91 XRH01 ERCP (first 2 hour) 2,000 2,450 5,250 4,900 3,500 3, XRH02 ERCP (extra 1 hour) 1, ,800 1,680 1,200 1, XRH04 Intravenous Urogram (I.V.U.) 2,500 1,500 2,450 5,250 4,900 3,500 3,000 2, XRH08 Operative Cholangiogram 2,000 1,190 2,550 2,380 1,700 1, XRH11 Renal Biopsy 2,000 1,680 3,600 3,360 2,400 2,000 (X-Ray Guided by Referring Dr.) 96 XRH12 Retrograde Cholangiogram 2,500 1,500 1,680 3,600 3,360 2,400 2, XRH19 Additional Film (each) OTHER 98 XRH21 Fluoroscopy in X-ray (first 2 hrs) 2,000 2,100 4,500 4,200 3,000 2, XRH22 Fluoroscopy in X-ray (extra 1 hr) 1, ,800 1,680 1,200 1, XRF03 Fluoroscopy in O.T. (C-arm) 2,100 4,500 4,200 3,000 3,000 (Sunday- Friday: ) (first 2 hours) 101 XRF04 Fluoroscopy in O.T. (C-arm) 1,050 2,250 2,100 1,500 1,500 (Sunday- Friday: ) (extra 1 hour) 102 XRF05 Fluoroscopy in O.T. (C-arm) 3,150 6,750 6,300 4,500 4,500 (After Office Hour) (first 2 hours) 103 XRF06 Fluoroscopy in O.T. (C-arm) 1,050 2,250 2,100 1,500 1, XRS01 (After Office Hour) Videofluoroscopic Swallow Study (VFSS) (extra 1 hour) (Monday - Friday: ) (first 2 hours) Videofluoroscopic Swallow Study 105 XRS02 (VFSS) (extra 1 hour) 3,000 1,750 3,750 3,500 2,500 2,500 1, ,500 1,400 1,000 1, XIR XIR02 Interventional Radiology (IR) Room Charge Interventional Radiology (IR) Room Charge (first 2 hours) 10,000 7,000 15,000 14,000 10,000 10,000 (extra 1 hour) 2,000 2,800 6,000 5,600 4,000 4, ULTRASOUND EXAMINATION UU--- All prices are subjected to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 v - Page 3

16 Fee Schedule 收費表 - Effective from 4 January 2016 (2016 年 1 月 4 日生效 ) XIV. DIAGNOSTIC IMAGING CHARGES 診斷造影收費 COD E DESCRIPTION 項目 ** After office hour After office hour OPC 門診 HA 代號 項目 TWAH Drs Low Cost 1st Class 2nd Class 3rd Class Regular Regular ABDOMEN 108 XUA01 Whole abdomen 2,000 2,000 2,100 4,500 4,200 3,000 2,500 1, XUA02 Upper abdomen 2,000 2,000 1,610 3,450 3,220 2,300 1,800 1, XUA03 Liver & GB 2,000 2, ,950 1,820 1, XUA04 Kidneys 2,000 2, ,950 1,820 1, XUA09 Kidney (Left / Right side) 2,000 2, ,800 1,680 1, XUA05 Kidneys & Bladder 2,000 2,000 1,260 2,700 2,520 1,800 1, XUA06 Pancreas 2,000 2, ,950 1,820 1, XUA07 Spleen 2,000 2, ,950 1,820 1, XUA08 GB 2,000 2, ,950 1,820 1, LOWER ABDOMEN 117 XUB01 Pelvis 2,000 2,000 1,120 2,400 2,240 1,600 1, XUB08 Lower Abdomen / Appendix 2,000 2,000 1,120 2,400 2,240 1,600 1, XUB02 Obstetrics (1-16 weeks) 2,000 2,000 1,540 3,300 3,080 2,200 1,800 1, XUB03 Obstetrics (Over 16 weeks) 2,000 2,000 1,680 3,600 3,360 2,400 2,000 1, XUB04 Obstetrics (Twin) 2,000 2,000 2,030 4,350 4,060 2,900 2,500 1, XUB05 Transvaginal (TVS) 2,000 2,000 1,260 2,700 2,520 1,800 1, XUB06 Prostate / Bladder 2,000 2,000 1,120 2,400 2,240 1,600 1, XUB07 Prostate / Transrectal 2,000 2,000 1,260 2,700 2,520 1,800 1, SUPERFICIAL 125 XUC01 Breasts 2,000 2,000 1,120 2,400 2,240 1,600 1, XUC02 Breast (Unilateral-Mastectomy) 2,000 2, ,800 1,680 1, XUC03 Neck (Thyroid & Parotid are included) 2,000 2,000 1,680 3,600 3,360 2,400 2,000 1, XUC04 Scrotum / Testes 2,000 2,000 1,120 2,400 2,240 1,600 1, DOPPLER 129 XUE01 Doppler -Left Carotid 2,000 2,000 1,540 3,300 3,080 2,200 1,800 1, XUE02 Doppler -Right Carotid 2,000 2,000 1,540 3,300 3,080 2,200 1,800 1, XUE03 Doppler - Left Leg (vein) 2,000 2,000 1,540 3,300 3,080 2,200 1,800 1, XUE04 Doppler - Right leg (vein) 2,000 2,000 1,540 3,300 3,080 2,200 1,800 1, XUE05 Doppler-Aorta 2,000 2,000 1,260 2,700 2,520 1,800 1, XUE06 Doppler-Left Kidney 2,000 2,000 1,540 3,300 3,080 2,200 1,800 1, XUE07 Doppler-Right Kidney 2,000 2,000 1,540 3,300 3,080 2,200 1,800 1, XUE08 Doppler-Artery ( ) -each 2,000 2,000 1,540 3,300 3,080 2,200 1,800 1, XUE09 Doppler- Vein ( ) - each 2,000 2,000 1,540 3,300 3,080 2,200 1,800 1, ULTRASOUND EXAMINATION UU--- All prices are subjected to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 v - Page 4

17 Fee Schedule 收費表 - Effective from 4 January 2016 (2016 年 1 月 4 日生效 ) XIV. DIAGNOSTIC IMAGING CHARGES 診斷造影收費 COD E DESCRIPTION 項目 ** After office hour After office hour OPC 門診 HA 代號項目 TWAH Drs Low Cost 1st Class 2nd Class 3rd Class Regular Regular OTHERS 138 XUG01 Brain (Neonatal) 2,000 2,000 1,120 2,400 2,240 1,600 1, XUG02 Congenital Dislocation Hips 2,000 2,000 1,680 3,600 3,360 2,400 2,000 1, XUG03 Rotator Cuff / Shoulder 2,000 2,000 1,120 2,400 2,240 1,600 1, XUG04 Hip 2,000 2,000 1,120 2,400 2,240 1,600 1, XUG05 Knee 2,000 2,000 1,120 2,400 2,240 1,600 1, XUG06 Ankle 2,000 2,000 1,120 2,400 2,240 1,600 1, XUG07 Lump 2,000 2,000 1,120 2,400 2,240 1,600 1, XU997 Machine Charge 2,000 2,000 1,890 4,050 3,780 2,700 2, XU998 Machine Charge 2,000 2, ,500 1,400 1,000 1, XU999 Ultrasound examination 2,000 2,000 1,120 2,400 2,240 1,600 1, CT COD E DESCRIPTION 項目 UT--- **After office hour After office hour OPC 門診 HA 代號 項目 TWAH Dr. Low Cost 1st Class 2nd Class 3rd Class Regular Regular HEAD & NECK 148 XC101 Brain 1C P 1,000 2,000 1,470 3,150 2,940 2,100 1,800 1,170 XC102 1C C 1,000 2,000 2,030 4,350 4,060 2,900 2,600 1,690 XC103 1C P+C 1,000 2,000 2,590 5,550 5,180 3,700 3,300 2, XC111 Brain & Orbits 1C P 1,000 2,000 2,170 4,650 4,340 3,100 2,800 1,820 XC112 1C C 1,000 2,000 2,730 5,850 5,460 3,900 3,600 2,340 XC113 1C P+C 1,000 2,000 3,850 8,250 7,700 5,500 5,100 3, XC121 Orbits 1C P 1,000 2,000 1,820 3,900 3,640 2,600 2,300 1,495 XC122 1C C 1,000 2,000 2,380 5,100 4,760 3,400 3,100 2,015 XC123 1C P+C 1,000 2,000 3,220 6,900 6,440 4,600 4,200 2, XC131 Facial Bones 1C P 1,000 2,000 1,820 3,900 3,640 2,600 2,300 1,495 XC132 1C C 1,000 2,000 2,380 5,100 4,760 3,400 3,100 2,015 XC133 1C P+C 1,000 2,000 3,220 6,900 6,440 4,600 4,200 2, XC141 Paranasal Sinuses 1C P 1,000 2,000 1,820 3,900 3,640 2,600 2,300 1,495 XC142 1C C 1,000 2,000 2,380 5,100 4,760 3,400 3,100 2,015 XC143 1C P+C 1,000 2,000 3,220 6,900 6,440 4,600 4,200 2, XC161 Pituitary Fossa Only 1C P 1,000 2,000 1,820 3,900 3,640 2,600 2,300 1,495 XC162 1C C 1,000 2,000 2,380 5,100 4,760 3,400 3,100 2,015 XC163 1C P+C 1,000 2,000 3,220 6,900 6,440 4,600 4,200 2, XC171 Nasopharynx 1C P 1,000 2,000 2,030 4,350 4,060 2,900 2,600 1,690 XC172 1C C 1,000 2,000 2,590 5,550 5,180 3,700 3,400 2,210 XC173 1C P+C 1,000 2,000 3,570 7,650 7,140 5,100 4,700 3, XC181 Internal Auditory Meati 1C P 1,000 2,000 2,030 4,350 4,060 2,900 2,600 1,690 XC182 1C C 1,000 2,000 2,590 5,550 5,180 3,700 3,400 2,210 XC183 1C P+C 1,000 2,000 3,570 7,650 7,140 5,100 4,700 3, XC191 Petrous Temp Bones 1C P 1,000 2,000 2,030 4,350 4,060 2,900 2,600 1,690 XC192 1C C 1,000 2,000 2,590 5,550 5,180 3,700 3,400 2,210 XC193 1C P+C 1,000 2,000 3,570 7,650 7,140 5,100 4,700 3, XC201 Neck 1C P 1,000 2,000 2,030 4,350 4,060 2,900 2,600 1,690 All prices are subjected to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 v - Page 5

18 Fee Schedule 收費表 - Effective from 4 January 2016 (2016 年 1 月 4 日生效 ) XIV. DIAGNOSTIC IMAGING CHARGES 診斷造影收費 XC202 1C C 1,000 2,000 2,590 5,550 5,180 3,700 3,400 2,210 XC203 1C P+C 1,000 2,000 3,570 7,650 7,140 5,100 4,700 3,055 BODY 157 XC301 Thorax 1C P 4,000 2,000 2,100 4,500 4,200 3,000 2,700 1,755 XC302 1C C 4,000 2,000 2,730 5,850 5,460 3,900 3,600 2,340 XC303 1C P+C 4,000 2,000 3,640 7,800 7,280 5,200 4,800 3, XC371 High Resolution Lung (HRCT) 1C P 4,000 2,000 2,100 4,500 4,200 3,000 2,700 1, XC381 Lung Cancer Screening (Low dose) 1C P 4,000 2,000 2,100 4,500 4,200 3,000 2,700 1, XC311 Upper Abdomen 1C P 4,000 2,000 2,100 4,500 4,200 3,000 2,600 1,690 XC312 1C C 4,000 2,000 2,730 5,850 5,460 3,900 3,600 2,340 XC313 1C P+C 4,000 2,000 3,640 7,800 7,280 5,200 4,800 3, XC321 Pelvis 1C P 4,000 2,000 2,030 4,350 4,060 2,900 2,600 1,690 XC322 1C C 4,000 2,000 2,730 5,850 5,460 3,900 3,600 2,340 XC323 1C P+C 4,000 2,000 3,570 7,650 7,140 5,100 4,800 3, XC341 Lower Abdomen / Appendix 1C P 4,000 2,000 2,030 4,350 4,060 2,900 2,600 1,690 XC342 1C C 4,000 2,000 2,730 5,850 5,460 3,900 3,600 2,340 XC343 1C P+C 4,000 2,000 3,570 7,650 7,140 5,100 4,800 3, XC331 Whole Abdomen 1C P 4,000 2,000 3,080 6,600 6,160 4,400 4,100 2,665 XC332 1C C 4,000 2,000 4,130 8,850 8,260 5,900 5,600 3,640 XC333 1C P+C 4,000 2,000 5,390 11,550 10,780 7,700 7,300 4, CT COD E DESCRIPTION 項目 UT--- **After office hour After office hour OPC 門診 HA 代號項目 TWAH Dr. Low Cost 1st Class 2nd Class 3rd Class Regular Regular 164 XC351 Virtual Colonoscopy 1C P 4,000 2,000 4,060 8,700 8,120 5,800 5,500 4,675 XC353 1C P+C 4,000 2,000 5,950 12,750 11,900 8,500 8,200 6, XC361 Virtual Endo. 1C P 4,000 2,000 2,870 6,150 5,740 4,100 3,800 3,230 XC363 1C P+C 4,000 2,000 4,340 9,300 8,680 6,200 5,800 4, XC391 CT KUB 1C P 4,000 2,000 3,080 6,600 6,160 4,400 4,100 2, XC393 CT Urogram 1C P+C 4,000 2,000 5,390 11,550 10,780 7,700 7,300 4,745 SPECIAL PACKAGE (0.5 of 2nd) (1.5) (1.4) (1.0) 168 XC901 Neck+Thorax 2C P 5,000 4,000 3,150 6,750 6,300 4,500 4,100 3,075 XC902 2C C 5,000 4,000 4,130 8,850 8,260 5,900 5,500 4,125 XC903 2C P+C 5,000 4,000 5,320 11,400 10,640 7,600 7,200 5, XC801 Neck+Thorax+Upper abdomen 2C P 5,000 4,000 4,970 10,650 9,940 7,100 6,300 4,725 XC802 2C C 5,000 4,000 6,440 13,800 12,880 9,200 8,800 6,600 XC803 2C P+C 5,000 4,000 8,680 18,600 17,360 12,400 11,400 8, XC991 Neck+Thorax+Whole abdomen 2C P 5,000 4,000 5,460 11,700 10,920 7,800 7,400 5,550 XC992 2C C 5,000 4,000 7,980 17,100 15,960 11,400 11,000 8,250 XC993 2C P+C 5,000 4,000 9,660 20,700 19,320 13,800 13,300 9, XC911 Thorax+Upper Abdomen 2C P 5,000 4,000 3,500 7,500 7,000 5,000 4,600 3,450 XC912 2C C 5,000 4,000 5,040 10,800 10,080 7,200 6,800 5,100 XC913 2C P+C 5,000 4,000 5,950 12,750 11,900 8,500 8,000 6, XC921 Thorax+Whole Abdomen 2C P 5,000 4,000 3,990 8,550 7,980 5,700 5,300 3,975 XC922 2C C 5,000 4,000 5,040 10,800 10,080 7,200 6,800 5,100 XC923 2C P+C 5,000 4,000 7,000 15,000 14,000 10,000 9,500 7, XC981 Whole Abdomen+CTU 2C P 5,000 4,000 4,200 9,000 8,400 6,000 5,600 4,200 XC982 2C C 5,000 4,000 5,600 12,000 11,200 8,000 7,300 5,475 XC983 2C P+C 5,000 4,000 7,350 15,750 14,700 10,500 10,000 7, XC931 NPC + Neck 2C P 5,000 4,000 3,150 6,750 6,300 4,500 4,100 3,075 XC932 2C C 5,000 4,000 3,710 7,950 7,420 5,300 4,900 3,675 XC933 2C P+C 5,000 4,000 4,690 10,050 9,380 6,700 6,200 4, XC943 Stroke Package 2C P+C 4,000 5,000 6,790 14,550 13,580 9,700 9,200 7,360 (Brain + Neck + Carotid arteries +COW) All prices are subjected to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 v - Page 6

19 Fee Schedule 收費表 - Effective from 4 January 2016 (2016 年 1 月 4 日生效 ) XIV. DIAGNOSTIC IMAGING CHARGES 診斷造影收費 176 XC953 Hypertension Package P+C 4,000 5,000 5,740 12,300 11,480 8,200 7,700 6,160 (Kidneys + Adrenal glands + Renal arteri 177 XC963 Pulmonary Embolism 2C P+C 4,000 5,000 6,790 14,550 13,580 9,700 9,200 7,360 (Pulmonary angiogram + Lower limb b Venogram) 178 XC973 Triple Rule Out 2C P+C 4,000 5,000 7,140 15,300 14,280 10,200 9,700 7,760 (Coronary artery + Thoracic aorta + pulmonary artery) 4.3 CT COD E DESCRIPTION 項目 UT--- **After office hour After office hour OPC 門診 HA 代號項目 TWAH Dr. Low Cost 1st Class 2nd Class 3rd Class Regular Regular CARDIAC CT 179 XC211 Calcium Score 1C P 4,000 2,000 2,240 4,800 4,480 3,200 3,000 2, XC223 Coronary Angiogram 2C P+C 4,000 5,000 4,480 9,600 8,960 6,400 6,200 5, XC233 Calcium Score + Coronary Angiogra 2C P+C 4,000 5,000 4,480 9,600 8,960 6,400 6,200 5,270 ANGIOGRAM (CTA) 183 XC403 Cerebral (Circle of Willis) 2C C 4,000 5,000 4,480 9,600 8,960 6,400 6,200 4, XC413 Brain + Perfusion 2C C 4,000 5,000 4,480 9,600 8,960 6,400 6,200 4, XC493 Brain + Diamox Perfusion 2C C 4,000 5,000 4,480 9,600 8,960 6,400 6,200 4, XC423 Carotid (Neck) 2C C 4,000 5,000 4,480 9,600 8,960 6,400 6,200 4, XC253 Aorta (Including aortic arch) 2C C 4,000 5,000 5,040 10,800 10,080 7,200 7,000 5, XC433 Pulmonary 2C C 4,000 5,000 4,620 9,900 9,240 6,600 6,400 5, XC443 Abdominal 2C C 4,000 5,000 4,620 9,900 9,240 6,600 6,400 5, XC453 Renal 2C C 4,000 5,000 4,480 9,600 8,960 6,400 6,200 4, XC463 Upper limb 2C C 4,000 5,000 4,480 9,600 8,960 6,400 6,200 4, XC473 Lower limb 2C C 4,000 5,000 4,480 9,600 8,960 6,400 6,200 4, XC483 Peripheral (upper or lower limb) veno 2C C 4,000 5,000 4,480 9,600 8,960 6,400 6,200 4, CT COD E DESCRIPTION 項目 UT--- **After office hour After office hour OPC HA 代號項目 TWAH Dr. Low Cost 1st Class 2nd Class 3rd Class Regular Regular SPINE 脊柱 194 XC501 Spine (each vertebra or disc) 1C P 1,000 2,000 2,240 4,800 4,480 3,200 3,000 2, XC571 Whole Cervical Spine (C1-7) 1C P 1,000 2,000 3,220 6,900 6,440 4,600 4,400 3, XC581 Whole Thoracic Spine (T1-12) 1C P 1,000 2,000 4,060 8,700 8,120 5,800 5,600 3, XC591 Whole Lumbar Spine (L1-5) 1C P 1,000 2,000 3,220 6,900 6,440 4,600 4,400 3, XC531 Pelvis 1C P 1,000 2,000 2,240 4,800 4,480 3,200 3,000 2, XC541 Sacrum 1C P 1,000 2,000 2,240 4,800 4,480 3,200 3,000 2, XC551 Sacroiliac Joint 1C P 1,000 2,000 2,240 4,800 4,480 3,200 3,000 2,100 All prices are subjected to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 v - Page 7

20 Fee Schedule 收費表 - Effective from 4 January 2016 (2016 年 1 月 4 日生效 ) XIV. DIAGNOSTIC IMAGING CHARGES 診斷造影收費 201 XC561 Coccyx 1C P 1,000 2,000 2,240 4,800 4,480 3,200 3,000 2, XC521 Pelvimetry 1C P 1,000 2,000 1,190 2,550 2,380 1,700 1,500 1, XC651 Upper Jaw (maxilla) 1C P 1,000 2,000 2,240 4,800 4,480 3,200 3,000 2, XC661 Lower Jaw (mandible) 1C P 1,000 2,000 2,240 4,800 4,480 3,200 3,000 2, XC671 Upper Jaw + Lower Jaw 1C P 1,000 2,000 3,500 7,500 7,000 5,000 5,000 4,000 EXTREMITIES 四肢 206 XC601 Each region 1C P 1,000 2,000 2,240 4,800 4,480 3,200 3,000 2,100 XC602 1C C 1,000 2,000 2,870 6,150 5,740 4,100 3,800 2,660 XC603 1C P+C 1,000 2,000 3,920 8,400 7,840 5,600 5,300 3,710 OTHERS 其他 207 XC821 Lung Volume measurement 1C 1,000 2,000 1,750 3,750 3,500 2,500 2,000 1, XC831 Liver Volume measurement 1C 1,000 2,000 1,750 3,750 3,500 2,500 2,000 1, XC998 CT Scan 1C P 4,000 2,000 2,940 6,300 5,880 4,200 4,000 2, XC999 CT Scan 1C P+C 4,000 2,000 5,040 10,800 10,080 7,200 7,000 4, MRI COD E DESCRIPTION 項目 UM--- ** After office hour After office hour OPC 門診 HA 代號 項目 TWAH Dr. Low Cost 1st Class 2nd Class 3rd Class Regular Regular HEAD & NECK 211 XA101 Brain 1M P 3,000 2,000 3,780 8,100 7,560 5,400 5,100 2,805 XA103 1M P+C 3,000 2,000 5,950 12,750 11,900 8,500 8,100 4, XA111 Brain & Orbits 2M P 6,000 4,000 5,600 12,000 11,200 8,000 7,700 4,235 XA113 2M P+C 6,000 4,000 8,680 18,600 17,360 12,400 12,000 6, XA121 Brain & Pituitary Gland 2M P 6,000 4,000 5,600 12,000 11,200 8,000 7,700 4,235 XA123 2M P+C 6,000 4,000 8,680 18,600 17,360 12,400 12,000 6, XA131 Brain & Nasopharynx 2M P 6,000 4,000 5,600 12,000 11,200 8,000 7,700 4,235 XA133 2M P+C 6,000 4,000 8,680 18,600 17,360 12,400 12,000 6, XA141 Brain & IAM 2M P 6,000 4,000 5,600 12,000 11,200 8,000 7,700 4,235 XA143 2M P+C 6,000 4,000 8,680 18,600 17,360 12,400 12,000 6, XA153 Brain & perfusion 2M P+C 6,000 4,000 6,300 13,500 12,600 9,000 8,500 4, XA161 Pituitary Gland 1M P 3,000 2,000 3,780 8,100 7,560 5,400 5,100 2,805 XA163 1M P+C 3,000 2,000 5,950 12,750 11,900 8,500 8,100 4, XA171 Orbits 1M P 3,000 2,000 3,780 8,100 7,560 5,400 5,100 2,805 XA173 1M P+C 3,000 2,000 5,950 12,750 11,900 8,500 8,100 4, XA181 IAM 1M P 3,000 2,000 3,780 8,100 7,560 5,400 5,100 2,805 XA183 1M P+C 3,000 2,000 5,950 12,750 11,900 8,500 8,100 4, XA191 PNS 1M P 3,000 2,000 3,780 8,100 7,560 5,400 5,100 2,805 XA193 1M P+C 3,000 2,000 5,950 12,750 11,900 8,500 8,100 4, XA201 NPC 1M P 3,000 2,000 3,780 8,100 7,560 5,400 5,100 2,805 XA203 1M P+C 3,000 2,000 5,950 12,750 11,900 8,500 8,100 4,455 All prices are subjected to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 v - Page 8

21 Fee Schedule 收費表 - Effective from 4 January 2016 (2016 年 1 月 4 日生效 ) XIV. DIAGNOSTIC IMAGING CHARGES 診斷造影收費 222 XA211 Neck 1M P 3,000 2,000 3,780 8,100 7,560 5,400 5,100 2,805 XA213 1M P+C 3,000 2,000 5,950 12,750 11,900 8,500 8,100 4, XA231 T-M Joints 2M P 6,000 4,000 5,600 12,000 11,200 8,000 7,700 4,235 XA233 2M P+C 6,000 4,000 8,680 18,600 17,360 12,400 12,000 6, XA221 Brain (2 regions) 2M P 6,000 4,000 5,600 12,000 11,200 8,000 7,700 4,235 XA223 2M P+C 6,000 4,000 8,680 18,600 17,360 12,400 12,000 6, MRI COD E DESCRIPTION 項目 UM--- ** After office hour After office hour OPC 門診 HA 代號 項目 TWAH Dr. Low Cost 1st Class 2nd Class 3rd Class Regular Regular BODY 身體 239 XA301 Breasts 1M P 4,000 2,000 4,200 9,000 8,400 6,000 5,700 3,135 XA303 1M P+C 4,000 2,000 6,440 13,800 12,880 9,200 8,800 4, XA311 Thorax 1M P 4,000 2,000 3,990 8,550 7,980 5,700 5,400 2,970 XA313 1M P+C 4,000 2,000 6,090 13,050 12,180 8,700 8,300 4, XA321 Liver 1M P 4,000 2,000 4,200 9,000 8,400 6,000 5,700 3,135 XA323 1M P+C 4,000 2,000 6,440 13,800 12,880 9,200 8,800 4, XA331 Cholangio-pancreatogram (MRCP) 1M P 4,000 2,000 3,360 7,200 6,720 4,800 4,500 2,475 XA333 1M P+C 4,000 2,000 5,110 10,950 10,220 7,300 6,900 3, XA341 Upper Abdomen 1M P 4,000 2,000 4,200 9,000 8,400 6,000 5,700 3,135 XA343 1M P+C 4,000 2,000 6,440 13,800 12,880 9,200 8,800 4, XA351 Pelvis 1M P 4,000 2,000 4,200 9,000 8,400 6,000 5,700 3,135 XA353 1M P+C 4,000 2,000 6,440 13,800 12,880 9,200 8,800 4, XA361 Peri-anal region (fistula) 1M P 4,000 2,000 3,780 8,100 7,560 5,400 5,200 2,860 XA363 1M P+C 4,000 2,000 6,090 13,050 12,180 8,700 8,500 4, XA371 Lower Abdomen 1M P 4,000 2,000 4,200 9,000 8,400 6,000 5,700 3,135 XA373 1M P+C 4,000 2,000 6,440 13,800 12,880 9,200 8,800 4, XA381 Whole Abdomen 2M P 6,000 4,000 7,280 15,600 14,560 10,400 10,100 5,555 XA383 2M P+C 6,000 4,000 10,220 21,900 20,440 14,600 14,200 7, XAP01 Liver Liver 4,000 2,000 6,440 13,800 12,880 9,200 8,800 4,840 (Primovist contrast) Primovist P+C 1,750 3,750 3,500 2,500 2,500 2,400 2M Total 8,190 17,550 16,380 11,700 11,300 7, XAP02 Upper Abdomen Upper Abdomen 4,000 2,000 6,440 13,800 12,880 9,200 8,800 4,840 (Primovist contrast) Primovist P+C 1,750 3,750 3,500 2,500 2,500 2,400 1M Total 8,190 17,550 16,380 11,700 11,300 7, XAP03 Whole Abdomen Whole Abdomen 6,000 4,000 10,220 21,900 20,440 14,600 14,200 7,810 (Primovist contrast) Primovist P+C 1,750 3,750 3,500 2,500 2,500 2,400 1M Total 11,970 25,650 23,940 17,100 16,700 10, XA391 Urogram 1M P 4,000 2,000 4,200 9,000 8,400 6,000 5,700 3, XA403 Colonography 1M P+C 4,000 2,000 6,020 12,900 12,040 8,600 8,200 4,920 All prices are subjected to changes without prior notice 價目如有更改, 恕不另行通知 - Revised Date 更新日期 : 4 January, 2016 v - Page 9