EMG DR FEE (CLASS 4) 急診醫師診察費 ( 檢傷 4) EMG DR FEE (CLASS 1) 職業傷害急診醫師診察費 ( 檢傷 1) 夜間職業傷害急診檢傷第一

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1 馬偕紀念醫院自費收費標準 CODE 福音樓健保差額單人床福音樓健保差額產房單人床福音樓健保差額雙人床福音樓自費單人床福音樓自費產房單人床福音樓自費雙人床福音樓自費健保床平安樓健保差額單人床平安樓健保差額雙人床平安樓自費單人床平安樓自費雙人床馬偕樓健保差額單人床馬偕樓健保差額雙人床馬偕樓自費單人床馬偕樓自費雙人床馬偕樓自費健保床恩典樓健保差額單人床恩典樓健保差額雙人床恩典樓自費單人床恩典樓自費雙人床恩典樓自費健保床安寧健保床差額單人床 ( 和室 ) 安寧健保差額單人床安寧健保床差額雙人床安寧健自費單人床 ( 和室 ) 安寧自費單人床安寧自費雙人床名稱自費收費 3,200 2,200 1,600 4,380 3,380 2,780 1,500 4,500 2,500 5,680 3,680 3,200 1,750 4,380 2,930 1,500 2,600 1,350 3,780 2,530 1,500 3,800 2,900 1,600 4,890 3,990 2, FIRST RGST 初診掛號手續費 REGISTER FEE 複診掛號手續費 EMG RGST 急診初診掛號手續費 EMG RGST FEE 急診複診掛號手續費夜診掛號手續費週六下午門診掛號手續費 OPD DR FEE 複診一般醫師診察費 OPD DR FEE 流感疫苗醫師診察費 H1N1 新型流感疫苗接種診察費 C OPD DR FEE 一般門診診察費 - 開具慢性病連續處方箋本院自行調劑 ( 合理量內 ) C2 OPD DR FEE 一般門診診察費 - 開具連續 2 次以上慢性病連續處方箋本院自行調劑 ( 合理量內 ) CG OPD DR FEE 一般門診診察費 - 開具慢性病連續處方箋交付藥局調劑 ( 合理量內 ) CG2 OPD DR FEE 一般門診診察費 - 開具連續 2 次以上慢性病連續處方箋交付藥局調劑 ( 合理量內 ) G OPD DR FEE 一般門診診察費 - 處方交付藥局調劑 ( 合理量內 ) EMG DR FEE 急診醫師診察費 EMG DR FEE (CLASS 1) 急診醫師診察費 ( 檢傷 1) EMG DR FEE (CLASS 2) 急診醫師診察費 ( 檢傷 2) EMG DR FEE (CLASS 3) 急診醫師診察費 ( 檢傷 3) 550 1/89

自費健保床安寧健保床差額單人床 ( 和室 ) 安寧健保差額單人床安寧健保床差額雙人床安寧健自費單人床 ( 和室 ) 安寧自費單人床安寧自費雙人床名稱自費收費 3,200 2,200 1,600 4,380 3,380 2,780 1,500 4,500 2,500 5,680

2 EMG DR FEE (CLASS 4) 急診醫師診察費 ( 檢傷 4) EMG DR FEE (CLASS 1) 職業傷害急診醫師診察費 ( 檢傷 1) 夜間職業傷害急診檢傷第一級醫師診察費 ( 檢傷 1) 例假日職業傷害急診檢傷第一級醫師診察費 ( 檢傷 1) 例假日夜間職業傷害急診檢傷第一級醫師診察費 ( 檢傷 1) EMG DR FEE (CLASS 2) 職業傷害急診醫師診察費 ( 檢傷 2) 夜間職業傷害急診檢傷第二級醫師診察費 ( 檢傷 2) 例假日職業傷害急診檢傷第二級醫師診察費 ( 檢傷 2) 例假日夜間職業傷害急診檢傷第二級醫師診察費 ( 檢傷 2) EMG DR FEE (CLASS 3) 職業傷害急診醫師診察費 ( 檢傷 3) 夜間職業傷害急診檢傷第三級醫師診察費 ( 檢傷 3) 例假日職業傷害急診檢傷第三級醫師診察費 ( 檢傷 3) 例假日夜間職業傷害急診檢傷第三級醫師診察費 ( 檢傷 3) EMG DR FEE (CLASS 4) 職業傷害急診醫師診察費 ( 檢傷 4) 夜間職業傷害急診檢傷第四級醫師診察費 ( 檢傷 4) 例假日職業傷害急診檢傷第四級醫師診察費 ( 檢傷 4) 例假日夜間職業傷害急診檢傷第四級醫師診察費 ( 檢傷 4) OPD DR FEE 職業傷害門診初診診察費 DEPT 精神科初診醫師診察費 EMG DR FEE (CLASS 5) 急診醫師診察費 ( 檢傷 5) EMG DR FEE (CLASS 5) 職業傷害急診醫師診察費 ( 檢傷 5) 夜間職業傷害急診檢傷第五級醫師診察費 ( 檢傷 5) 例假日職業傷害急診檢傷第五級醫師診察費 ( 檢傷 5) 例假日夜間職業傷害急診檢傷第五級醫師診察費 ( 檢傷 5) PSYCHIATRIC DR FEE 精神科複診醫師診察費 C 精神科複診診察費 - 開具慢性病連續處方箋本院自行調劑 C2 精神科複診診察費 - 開具連續二次慢性病連續處方箋本院自行調劑 CG 精神科複診診察費 - 開具慢性病連續處方箋交付藥局調劑 CG2 精神科複診診察費 - 開具連續二次慢性病連續處方箋交付藥局調劑 G 精神科複診診察費 - 處方交付藥局調劑 SAIKY 精神科急診醫師診察費立體超音波醫師診察費妊娠評估診察費 1, PED HEALTH 早產兒兒科門診診察費 C 早產兒特別門診診察費 - 開具慢性病連續處方箋本院自行調劑 ( 合理量內 ) C2 早產兒特別門診診察費 - 開具連續 2 次以上慢性病連續處方箋本院自行調劑 ( 合理量 EMERGENCY TEMPORARY OCCUPIED PHYSICIAN FEE 急診暫住診察費 NURO DR FEE 牙科醫師診察費 G 牙科醫師診察費 ( 交付處方 ) 中度身心障礙 ( 非精神疾病 ) 者診察費牙科門診診察費 ( 山地離島地區 -- 未開處方或處方由本院所自行調劑 ) 中度以上精神疾病患者診察費輕度特定身心障礙 ( 非精神疾病 ) 者診察費環口全景 X 光初診診察年度初診 X 光檢查高齲齒罹患率族群年度初診 X 光片檢查 PF FEE CLASS 0 (12F) 總院 12 樓特等醫師費 PF FEE CLASS 1 (13F) 總院 13 樓雙人醫師費 380 2/89

診察費 ( 檢傷 2) 708 1200462 例假日職業傷害急診檢傷第二級醫師診察費 ( 檢傷 2) 708 1200463 例假日夜間職業傷害急診檢傷第二級醫師診察費 ( 檢傷 2) 708 120047 EMG DR FEE (CLASS 3) 職業傷害急診醫師診察費 ( 檢傷 3)

3 PF FEE CLASS 1 總院雙人 (B- 新 ) 醫師費 PF FEE CLASS 1 總院燙傷雙人醫師費 EMG DRFEE 急診次日起醫師診察費 PF FEE CLASS 2 總院三人醫師費 PF FEE CLASS 2 總院保護隔離醫師費 PF FEE CLASS 2 總院新生兒醫師費 PF FEE CLASS 2 總院新生兒加保溫箱醫師費 RCC 醫師費 PF FEE CLASS 3 總院新生嬰兒室一般床醫師費 PF FEE CLASS 3 總院燙傷四人醫師費 PF FEE 燙傷病房住院診察費 PF FEE CLASS 4 總院成人加護醫師費 PF FEE CLASS 4 總院新生兒加護醫師費 PF FEE CLASS 0 淡水特等醫師費 PF FEE CLASS 1 淡水 (TB) 加護醫師費 PF FEE CLASS 2 淡水三人 ( 新 ) 醫師費 PF FEE CLASS 4 淡水加護醫師費 PF FEE CLASS 4 淡水隔離醫師費 PF FEE CLASS 0 淡水特等 ( 舊 ) 醫師費 PF FEE CLASS 1 淡水雙人 ( 舊 ) 醫師費 PF FEE CLASS 1 淡水安寧病房二人醫師費 PF FEE CLASS 2 淡水安寧病房三人醫師費 INPAT CONSULTATION FEE 住院 ( 一般 ) 會診費 OUT PAT CONSULTATION FEE 出 ( 往 ) 診會診費 : 藥費治療費醫材費交通費 1, CONSULTATION FEE 院外醫師會診費 1, 牙科健檢會診醫師費 INPAT CONSULTATION FEE 住院 ( 緊急 ) 會診費 ER CONSULTATION FEE 急診會診費 DRUG SERVICE FEE DAY/1-13 門診藥事服務費 1 13 天門診藥事服務費 - 慢性病處方給藥 13 天以內門診藥事服務費 - 慢性病處方給藥天戒菸藥品一週調劑費戒菸藥品二週調劑費門診藥事服務費 - 慢性病處方給藥 28 天以上 DRUG SERVICE FEE DAY/1-13 門診藥事服務費 1 13 天 INP DRUG SERVICE FEE 1-5 住院藥事服務費第 1 5 天 PHARMACEUTICAL SERVICE FEE OF INPATIENT UDDS PRESRIPTION 住院藥事服務費 - 單一劑量 PHARMACEUTICAL SERVICE FEE OF TPN PROSCRIPTION 全靜脈營養處方藥事服務費 T.P.N.(TOTAL PARENTERAL NUTRITION,DAY) 靜脈營養術 ( 天 ) DRUG SERVICE FEE DAY/1-13 門診藥事服務費牙科 1 13 天慢性病處方給藥 13 天以內 - 牙科慢性病處方給藥天 - 牙科慢性病處方給藥 28 天以上 - 牙科門診藥事服務費 - 慢性病處方給藥 28 天以上 EMG DRUG SERVICE 1ST DAY 急診次日起藥師服務費 EMG DRUG SERVICE 1ST DAY 藥師服務費 EMG DRUG SERVICE 1ST DAY 藥師服務費胃鏡大腸鏡施打 DORMICUM 護理照護費 130 3/89

FEE CLASS 3 總院燙傷四人醫師費 850 1211363 PF FEE 燙傷病房住院診察費 750 1211412 PF FEE CLASS 4 總院成人加護醫師費 850 1211422 PF FEE CLASS 4 總院新生兒加護醫師費 850 1221012 PF FEE CLASS 0 淡水特等醫師費

4 176M72 DIET M7 管灌流質配方費 / 天 LOCAL INFILTRATION DRUG 局部注射 I.M.INFILTRATION DRUG,HYPODERMO INJECTION 肌肉皮下注射 IV.DRIP 靜脈點滴臨終病患護理訪視費 -- 山地離島地區 3, HYPODERMO CLYSIS 皮下點滴 BLOOD TRANSFUSION 輸血趾甲部分摘除併組織切除術 1, IV.INJECTION IV CAP 小量靜脈注射 IV.PUSH( 包括塑膠空針 ) C.V.P.CANULATION 中心靜脈導管 SKIN TEST 皮膚試驗 I.C. INJECTION 心臟注射 JOINT INJECTION 關節注射 ARTERIC PUNCTURE 動脈穿刺 ELECTRIC CAUTERIZATION 電燒灼列印報告 / 影印病歷費 TREATMENT 5-10CM 淺部創傷處理 - 傷口長 5-10 公分 REMOVE STITCH <10CM 拆線 <10CM ALCOHOL SPONGE 酒精拭浴 TAP WATER ENEMA 清水灌腸 S.S. ENEMA 肥皂灌腸 GLYCERINE ENEMA 甘油灌腸 CLEANSING ENEMA 結腸灌腸 RETENTION ENEMA 保留灌腸 OTHER ENEMA 其他灌腸合 : 鹽水灌腸 GASTRIC LAVAGE 胃灌洗護理訪視時間 1 小時以內 -- 山地離島地區 1, BLADDER IRRIGATION 膀胱灌洗會陰清洗治療 ON N.G. TUBE 鼻胃管插入 MULLAR-ABOTT(M.A.TUBE) 長小腸管 DUODENAL TUBE 十二指腸管 URINARY CATHETERIZATION 導尿 FOLEY CARE RECTAL TUBE 肛管插管 CHANGE TRACHEAL TUBE AFTER TRACHEOSTOMY 更換氣管套管 TRACHEOSTOMY CARE 氣切護理 SKIN PREPARATION 預備皮膚 URINE SUGAR TEST 尿糖試驗 URINE ACETON TEST 尿酮試驗 CHANGE DRESSING SMALL <10CM 換藥小 <10CM CHANGE DRESSING MEDIUM 10-20CM 換藥中 10-20CM CHANGE DRESSING LARGE >20CM 換藥大 >20CM DROP EYES DRUG/DAY 眼科給藥天糖尿病試辦 - 開立慢性病連續處方 EMERSON SUCTION/DAY *GANCO SUCTION/DAY RIPPLE BED/DAY 波動床 ( 氣墊床 ) 120 4/89

5 40052 ICE RUG/DAY 冰毯 ICE BLANKET UNDER 12HRS 冰毯 12 小時以內 TURNING FRAME/DAY 翻轉床 IV PUMP ABSCESS INCISION 小膿瘍切開個 I.T.(INTRATHECAL)/EACH DILUTED TO OPHTHALMIC SAL DISPENSING FEE 注射液稀釋成點眼或耳鼻喉科用藥 ON DOUBLE LUMEN for 血液透析 2, PERICARDIAL TAP. 心包膜穿刺 1, JOINT TAP. 關節穿刺 BLADDER TAP. 膀胱穿刺術 ASPIRATION,CYST,ABSCESS ETC 囊腫, 腫瘍抽吸 URINE PH 酸鹼度反應 SUBDURAL TAP. 硬腦膜下 ( 頭頂 ) 穿刺術 1, LUMBAR PUNCTURE 腰椎穿刺術 ABDOMINAL TAP. 腹腔穿刺 BLOOD SUGER TEST 快速血糖儀檢驗 BABY CARE 新生兒護理急診看護費 / 時 ENDOTRACHEAL INTUBATION 氣管內插管 *FEMERIL VEIN PUNCTURE 股靜脈穿刺 FOLEY TRAINING 留置尿管膀胱訓練天 PLEURAL BIOPSY 肋膜切片 CHEST TAP 胸腔穿刺 1, CHEST TUBE 插胸管 2, CUT DOWN 靜脈切開術 NEEDLE BIOPSY,SUPERFACIAL 組織切片淺部 PACEMAKER MAINTENANCE 暫時性心節律器處置 3, BREST PUNCTURE 乳房穿刺 C.P.R. 心肺甦醒術 CARDIOVERSION 電擊 APPLE OF ESOPHAGEAL BALLOON 食道球放置費 2, NERVE BLOCK 末稍神經阻斷術 SUBCLAVIAN FIXATION 鎖骨固定術 PHC NR.FEE 精神科居家治療專業人員處置費 1, RIVANOL PACKING ON SWAN-GANG 肺動脈導管 3, RETENTION ENEMA 礦物油留置灌腸 HEATING LAMP/DAY 烤燈 KEEP WET DRESSING 傷口濕敷烤燈使用 ( 次 ) Heating lamp 高週波腫瘤燒灼術 <3cm( 處置 ) 9, 希克曼氏皮下植入法 Hickman,s Catheter implantation 4, POTMORTEM CARE 屍體護理燒烤心導管治療光碟片 1, CHEST CONTINOUS SUCTION/DAY 胸腔引流與壓力抽吸 *HEATING BAG/DAY 電熱墊天 INTERMITTED SUCTION/DAY 間歇性壓力抽吸天 I.M INFILTRATION DRUG 預防注射費 25 5/89

RNING FRAME/DAY 翻轉床 230 40057 IV PUMP 180 40058 ABSCESS INCISION 小膿瘍切開個 230 40060 I.T.

6 40113 I.M INFILTRATION DRUGB 型肝炎預防注射費 ( 含疫苗 ) PEYRONIC'S INJECTIONPEYRONIC'S 病灶內注射 CO2 LASER SURGICALCO2 雷射使用費次 1, SKELETAL EXTRA FIXED RENT/U 骨外固定器租金 - 股骨踝部骨折 HEALTH EDUCATION CLASS-S 保健講座 ( 單次 ) 超音波影像光碟燒錄 PPF (W) 婚前檢查醫師費 ( 女 ) MENTHOL PACKING 動脈導管置放術 ( 化學治療用 ) Arterial line insertion for 3, RESTING SPLINT,SHORT LEG (THERAPY) 塑膠製短腿固定副木治療費 RESTING SPLINT,SHORT LEG (MATERIAL) 塑膠製短腿固定副木材料費 1, RESTING SPLINT,LONG LEG (THERAPY) 塑膠製長腿固定副木治療費 RESTING SPLINT,LONG LEG (MATERIAL) 塑膠製長腿固定副木材料費 2, COCK-UP,SPLINT(THERAPY) 腕副木治療費 COCK-UP,SPLINT(MATERIAL) 腕副木材料費 SPASTICITY REDUCTION SPLINT (THERAPY) 手部固定副木治療費 SPASTICITY REDUCTION SPLINT (MATERIAL) 手部固定副木材料費 INDIVIDUAL FINGER SPLINT (THERAPY) 手指伸展副木治療費 INDIVIDUAL FINGER SPLINT (MATERIAL) 手指伸展副木材料費 SHORT OPPONEUS SPLINT (THERAPY) 短型對掌副木 ( 治療費 ) SHORT OPPONEUS SPLINT (MATERIAL) 短型對掌副木 ( 處置費 ) Fibertic Bronchoscopy 2, 麻醉中聽覺誘發電位監測 1, HOT PACK 熱敷 COLD/ICE PACK 冷冰敷 UV TEST 紫外線致紅劑測試食道汽球擴張術 ( 含內視鏡及特材 )Esophageal balloon catheter 2, DEBRIDMENT 5-10 CM 深部複雜創傷處理 - 傷口 5-10 公分 2, DEBRIDMENT 10 CM 深部複雜創傷處理 - 傷口長 10 公分以上 4, REMOVE STICHES >10 CM 拆線 ( 次 ) 傷口在 10 公分以上 URINAL INDWELLING CATHETERLIZATION 留置導尿 SUCTION 呯吸道抽吸 ( 次 ) 註 : 一天八次以下 SUCTION/DAY 呯吸道抽吸 ( 天 ) 註 : 一天八 ( 含 ) 次以上 NASAL FEEDING/DAY 鼻灌食一天 GASTRIC FEEDING/DAY 胃灌食一天 GASTRIC DECOMPRESSION/DAY 胃減壓一天 CHEST DRAINAGE/DAY 胸腔引流 ( 一天 ) ABDOMINAL DRAINAGE/DAY 腹腔引流一天 VENTRICULAR DRAINAGE/DAY 腦室引流一天 THERMOMETER 溫度測定儀 ( 手外科 ) CLEANING FECAL IMPACTION 糞嵌塞清除 PARALYZED PATIENT CARE/DAY 癱瘓病人作業 ( 天 ) ANTE/POST PARTUS HEMORRHAGE 產前產後出血處理 2, ECLAMPSIA 子處置 4, CAVHD 連續性動靜脈血液過濾透析 3, TREATMENT OF FACIAL LACERATION < 5 CM 臉部創傷處理 ( 小 ) 1, TREATMENT OF FACIAL LACERATION 5-10 CM 臉部創傷處理 ( 中 )5 3, TREATMENT OF FACIAL LACERATION >10 CM 臉部創傷處理 ( 大 ) 超 3, UNNA BOOT 包紮治療術 150 6/89

骨踝部骨折 265 40118 HEALTH EDUCATION CLASS-S 保健講座 ( 單次 ) 100 40119 超音波影像光碟燒錄 200 40120 PPF (W) 婚前檢查醫師費 ( 女 ) 240 40123 MENTHOL PACKING 50 40124 動脈導管置放術 ( 化學治療用 ) Arterial

7 40174 INCISION DRAINAGE 填塞排膿 WOUND TREATMENT <5CM 淺部創傷處理 5 公分以 WOUND TREATMENT >10CM 淺部創傷處理 10 公分 CAVH 連續性動靜脈血液過濾 3, ANTERIOR CHAMBER INJECTION 前房內注射 CVVH 連續性靜 - 靜脈血液過濾術 1, CVVHD 連續性靜 - 靜脈血液透析術 3, 頸胸椎固定價租金 ( 天 ) 32, 顱顏面骨折 - 骨骼外固定器使用 Application of fixation apparatusfacial bone fracture 家暴 -- 心理協談及治療肉毒桿菌素注射費 Botolinum toxin local injection 性侵 -- 心理協談及治療 2, 醫事服務費 1, 高週波腫瘤燒灼術 >=3cm, <5cm 13, 高週波腫瘤燒灼術 >=5cm 18, 硬脊膜外神經根阻斷病患術後自控式止痛 (PCEA) 8, RADIUM WARMER 加熱器次 Post operative pain control ( 自費 )/3 天 7, Post OP pain control - over 3 天 1, THYROID PUNCTURE 甲狀腺穿刺 HOSPICE 安息暫留費 4 小時以後 ( 每小時 ) 新生兒一氧化氮吸入療法 / 裝置費 / 次 BABY CAR 娃娃車租金 AUTOPSY( 出生未滿 30 天 ) 10, AUTOPSY ( 出生滿 30 天 ) 20, 營養指導次 NUTRITIONAL CONSULTATION (O.P.D.) 雙頻腦部血氧濃度偵測 3, EVALUATION OF C.V.A. C.P. AND OTHER CHRONIC DISEASE PATIENT 中風腦性麻痺及其他慢性病人評估 OCCUPATION THERAPY EVALUATION COMMUNICATION THERAPY & DIAGNOSIS 語言治療評估 SWALLOWING EVALUATION SIMPLE SWALLOWING THERAPY 吞嚥治療 MODIFICATION OF ORTHOSES EPIDURAL BLOCK 硬脊膜外腔注射 2, ULTRASOUND GUIDED PERIPHERAL NERVE BLOCK 超音波導引週邊神經阻斷 2, TRIGGER POINT BLOCK 肌膜痛點注射 ( 每一點 ) NERVE PLEXUS BLOCK 神經叢阻斷術 2, ULTRASOUND GUIDED STELLATE GANGLION BLOCK 超音波引導星狀神經節阻斷 1, ULTRASOUND GUIDED TRIGGER POINT INJECTION 超音波引導激痛點注射 1, NERVE BLOCK,TRIGEMINAL 三叉神經阻斷術 1, 癌症治療計劃諮詢規劃費 2, CERTIFICATES FEE 殘障鑑定 TALC PLEURODESIS 滑石粉肋膜黏連術 PHC DR.FEE 精神科居家治療醫師診治費 1, PATIENT-CONTROLLED ANALGESIA 1DAY/U 病患自控式止痛 ( 一天為一計價單位 ) 1, BATHING 洗澡機沐浴 CARBOXYLHEMOGLOBIN 一氧化碳血紅素測定 180 7/89

$apparatusfacial bone fracture 140 40187 家暴 -- 心理協談及治療 430 40188 肉毒桿菌素注射費 Botolinum toxin local injection 240 40189 性侵 -- 心理協談及治療 2,060 40190 醫事服務費 1,500 40193 高週波腫瘤燒灼術$

8 40256 HOSPICE DR.FEE 安寧居家醫師訪視費 1, 安寧居家護理訪視費 ( 次 ) 訪視時間一小時以內 1, HOSPICE NR.FEE (>1H) 安寧居家護理訪視費 ( 次 ) 訪視時間一小時以上 1, HOSPICE NR.FEE 安寧居家治療專業人員處置費 REMOVE CHEST TUBE REMOVE CVP FEMEROL CATH TUBE DRAINGE 導管引流 extra medication of labor analgesia ( 自然生產過久之分娩止痛藥 ) 1, PAINLESS LABOR 減痛分娩 ( 含藥材費用 ) 8, TC PCO2 OR END TIDAL CO2 MONITOR (DAY) 經皮測二氧化碳分壓器或呯氣末二氧化碳分壓器 ( 日 ) LOCAL IRRIGATION 局部沖洗 AMBU-BAG 手按式急救氣囊 TC MONITOR LIVER BIOPSY 肝臟切片 5, TEPID WATER SPONGE 溫水拭浴 DEXTROSTIX 血醇 ( 試紙法或血醣儀 URINE SP GR. 尿液比重 WOUND IRRIGATION 傷口沖洗 HICKMAN CATH IRRIGATION 中央靜脈導管沖洗 ANAL DILATATION 肛門擴張 CORT ENEMA 腎上腺素灌腸 ( 藥費另 PERCUTANEOUS ETHANOL INJECTION THERAPY 肝腫瘤內酒精注射 2, Inhaled Nitric oxide therapy 一氧化氮吸入療法天 7, Hemostasis with automatical tourniquet 自動止血帶止血戒菸治療服務費 -- 自行調劑戒菸藥品費 ( 一週量 ) 低收入戶戒菸藥品費 ( 一週量 ) 戒菸藥品費 ( 二週量 ) 低收入戶戒菸藥品費 ( 二週量 ) 1, BONE MARROW BIOPSY PROCEDURE 骨髓切片 1, BONE MARROW ASPIRATION PROCEDURE 骨髓穿刺 BONE MARROW EXAMINATION 骨髓檢查 *BLOOD SMEAR INTERPRETATION 抹片檢查及判讀骨髓穿刺併骨髓切片 1, 切除 CAPD 導管外袖口及導管擴創術 4, 電腦化神經心理測驗 1, 感覺神經功能檢查 SKIN TEST INTERPRETATION 皮膚試驗判讀 ALLERGIC SPUTUM SMEAR 痰過敏抹片 BODY ACUPUNCTURE 體針 EAR ACUPUNCTURE 耳針 SSP BODY OR EAR ACUPUNCTURE AND SSP 體針加 SSP 或耳針加 LASER AND BODY ACUPUNCTURE 雷射加體針 INSULIN HYPOGLYCEMIC TEST 胰島素降血糖刺激試驗 2, ORAL GLUCOSE TOLERANCE 口服葡萄糖耐量試驗 WATER DEPRIVATION+PITRESSIN TEST 脫水與抗利尿激素試驗 2, ACTH STIMULATION(ONE DAY) 促腎上腺皮質素刺激試驗 ( 一天 ) 1,370 8/89

1,000 40266 PAINLESS LABOR 減痛分娩 ( 含藥材費用 ) 8,800 40267 TC PCO2 OR END TIDAL CO2 MONITOR (DAY) 經皮測二氧化碳分壓器或呯氣末二氧化碳分壓器 ( 日 ) 680 40275 LOCAL IRRIGATION 局部沖洗 150 40276

9 40515 EXERCISE TEST FOR GH 運動試驗與生長激素測定調制中頻電刺激術 / 次 SQUINT EXAMINATION 斜視檢查 PHOTOKERATOSCOPY 彩色角膜屈度攝影 MALINGERY TEST 詐盲檢查 PED RETINA EXAMINATION OF PREMATURITY 早產兒視網膜檢查 CAM 條紋型弱視訓練 RENOVAL OF FOREIGN BODY FROM SURFACE OF CONJUNCTIVA 結膜表面異物除去術 PRK 雷射屈光角膜切除術 20, LASIK 雷射原位角膜磨鑲術 30, 細隙燈眼接觸鏡眼底檢查 Slit lamp contact mirror fundascopy 鼻淚管淚道汽球擴張術 7, 體脂肪測量 / 次運動處方 ( 含體適能測定 ) 針灸 /4 次 1, IQ TEST M M P I 1, 行為治療計劃 (60 分鐘 ) 1, Psychiatric diagnostic interview(time)--adult 精神科診斷性會談 ( 次 )-- 成 1, IQ PERSONALITY TEST 包括全套測驗 1, B:THE NEAR SIDE OF H. (OUTSIDE & ACTIVITY) 戶外活動 : 短程如公園 FAMILY THERAPY 家庭治療 E.C.T. 電痙攣治療 2, 催眠分析單項簡易心理健康評估診間醫師現場執行之成人特殊心理治療診間醫師執行之支持性治療心理健康諮詢累進費率 (10 分鐘 ) 進階心理健康諮詢 (40mins) 1, 兒童潛質開發與諮詢初次心理健康諮詢 (20 分鐘 ) PSYCHODRAMA 心理演劇治療潛質評估 A( 全套 ) 4, 潛質評估 B( 發展能力 ) 2, 潛質評估 C( 情行為 ) 2, BIOFEED BACK (A) 生理回饋治療之評估與計劃 1, INDIVIDUAL INTERVIEW (A) 個別會談 1, INDIVIDUAL INTERVIEW (B) Psychiatric social function assessment 精神科社會生活功能評估 Re-educative individual psychotherapy--adult 特殊心理治療 -- 成人 SUPPORTIVE PSYCHOTHERAPY 支持性治療 ACTIVITY THERAPY (DAY) 活動治療 ( 天 ) INTENSIVE INDIVIDUAL PSYCHOTHERAPY--adult 深度心理治療 ( 每 40 分鐘 )-- 成 1, CRISIS INTERVENTION 危機調適諮詢性團體 (1-1.5 時 ) 治療性團體 (1.5-2 時 ) FORENSIC EVALUATION 精神鑑定費 14, SPECIAL OCCUPATIONAL THERAPY 特殊職能治療 ( 次 ) 390 9/89

20,000 40614 LASIK 雷射原位角膜磨鑲術 30,000 40618 細隙燈眼接觸鏡眼底檢查 Slit lamp contact mirror fundascopy 330 40619 鼻淚管淚道汽球擴張術 7,800 40701 體脂肪測量 / 次 150 40703 運動處方 ( 含體適能測定 )

10 41049 PSYCHIATIVE NURSING CARE(DAY) 精神科特別護理 INPATIENT SPECIAL CARE(DAY) 住院病患特別處理費 1, SPECIAL DRUG THERAPY (DAY) 藥物治療特別處理費 ( Behavior modification assesment 行為治療評估 OCCUPATIONAL ASSESSMENT 職能評鑑 ( 每日 ) General Occupational therapy 一般職能治療 ( 次 ) 團體生理回饋治療之執行 ( 每次 ) Re-educative group psychotherapy 特殊團體心理治療 ( 每人次 ) SUPPORTIVE GROUP PSYCHOTHERAPY 一般團體心理治療 ( 每人次 ) INTENSIVE GROUP PSYCHOTHERAPY 特殊團體心理治療 ( 每人次 ) 馬偕情障兒童青少年父母團體治療 PSYCHPSYCHOPHYSIOLOGICAL FUNCTION EXAMINATION--ADULT 生理心理功能檢查 INTENSIVE INDIVIDUAL PSYCHOTHERAPY--6 to 15 years OLD 深度心理治療 ( 每 40 分鐘 )--6 至 15 歲 1, PSYCHPSYCHOPHYSIOLOGICAL FUNCTION EXAMINATION--6 to 15 years old 生理心理功能檢查 --6 至 15 歲 Psychiatric diagnostic interview(time)--6 to 15 years old 精神科診斷性會談 ( 次 )--6 至 15 歲 1, Re-educative individual psychotherapy--6 to 15 years old 特殊心理治療 -- 6 至 15 歲 INTENSIVE INDIVIDUAL PSYCHOTHERAPY--under 6 years old 深度心理治療 ( 每 40 分鐘 )--6 歲以下 2, PSYCHPSYCHOPHYSIOLOGICAL FUNCTION EXAMINATION--under 6 years old 生理心理功能檢查 --6 歲以下 Psychiatric diagnostic interview(time)--under 6 years old 精神科診斷性會談 ( 次 )--6 歲以下 1, Re-educative individual psychotherapy--under 6 years old 特殊心理治療 - -6 歲以下 SKIN BIOPSY,ONE SUTURE,PUNCH,EACH 皮膚切片穿片與縫合 SKIN BIOPSY,TWO SUTURE,PUNCH 皮膚切片穿片與縫合 SKIN SURGERY,TWO SUTURE 皮膚手術與縫合二針以 SKIN SUGERY, NO SUTURE, EACH 皮膚簡單切開或切除不縫合 SKIN SURGERY,SMALL OPERATION,EACH 皮膚腫瘤囊腫全切除 2, ELECTROCAUTERIZATION,SIMPLE,EACH 皮膚電灼治療 ( 單純 ) ELECTROCAUTERIZATION,COMPLICATED,EACH 皮膚電灼治療 ( 複雜 ) 脈衝光開機費 3, 脈衝光治療費 / 每單位 1, CHEMICAL CAUTERIZATION,SIMPLE,EACH 藥物燒灼治療 ( 單純 ) CHEMICAL CAUTERIZATION,COMPLICATED,EACH 藥物燒灼治療 ( 複雜 ) LIQUID NITROGEN CRYOSURGERY (COMPLICATED) 液態氮冷凍治療 ( 複雜 ) INTRA-LESIONAL INJECTION,UNDER 5CM SQ 皮膚病灶內部注射,5 平方公分以下 INTRA-LESIONAL INJECTION,UNDER 10CM SQ 皮膚病灶內部注射,5 至 10 平方公分 INTRA-LESIONAL INJECTION,OVER 10CM SQ 皮膚病灶內部注射, 大於 10 平方公分 PATCH TEST,ONE ANTIGEN 皮膚貼布試驗每種 EXAMINATION OF KOH PREPARATION,EACH CASE 皮膚黴菌檢查低能量氦氖雷射治療 CYTOLOGY EXAMINATION INCLUDED STANING,EACH 病灶細胞檢查或細菌染 INCISION AND DRAINAGE,SIMPLE,EACH 排膿開刀手術 ( 單純 ) INCISION AND DRAINAGE,COMPLICATED,EACH 排膿開刀手術 ( 複雜 ) /89

psychotherapy 特殊團體心理治療 ( 每人次 ) 150 41058 SUPPORTIVE GROUP PSYCHOTHERAPY 一般團體心理治療 ( 每人次 ) 80 41059 INTENSIVE GROUP PSYCHOTHERAPY 特殊團體心理治療 ( 每人次 ) 410 41060 馬偕情障兒童青少年

11 41123 ACNE SUSGERY,SIMPLE 痤瘡特別治療 ( 單純 ) ACNE SUSGERY,COMPLICATED 痤瘡特別治療 ( 複雜 ) PHOTOTHERAPY,INCLUDING SUN-LAMP AND UVL,WHOLE BODY 光線治療包括太陽光紫 SUCTION BLISTER AND GRAFT 水泡吸著及植皮 1, 磁波雷射拉皮術 /1 次 22, NAIL REMOVAL 拔指甲 NAIL PLASTY 指甲成型術 1, NAIR REMOVAL 拔毛及狐臭治療每半 MOLLUSINM CONTAGIOSUM 軟疣治療每個 IONTOPHORESIS 多汗症離子泳動療法 MEDICATED BATH THERAPY (REGIONAL) 藥浴治療 ( 局部 ) EXCISION BIOPSY SPECIAL 切片 - 螢光特別 CONDYLOMA EXCISION & CAUTERIZATION 濕疣切除及電燒 1, CRYOTHERAPY (N20 FREEZING)-SIMPLE 冷凍治療 CRYOTHERAPY (N20 FREEZING)-COMPLICATED 冷凍治療 PHOTOTHERAHY,PUVA 光線治療超長波紫外 1, WOODS LIGHT SEBUM QUANTITATION 皮脂定量 URETHRAL SOUNDING 尿道擴張震動式高頻呼吸器治療 4, PED TRANSTUMINATION CHEST 00M03 兒科 - 胸廓穿透照明 PREMATURITY TRANSPORT 院外接送早產兒 1, SEPARATION OF VULVA ADHESION 陰唇粘連分離術 1, PED ASSESSMENT OF BONE AGE 00Y06 兒科 - 骨骼年齡評估血液腫瘤疾病染色體檢查 14, 常規染色體檢查 3, AUTOMATIC CYCLER 自動腹膜透析換液機 RECTAL SUCTION BIOPSY 00Y06 直腸抽吸切片術 2, BLOOD SAMPLING 00Y06 嬰幼兒抽血次 BR FEE 新生兒費每人次 2, C/S BR FEE 剖腹生產新生兒費每人次 4, On PCVC( 兒童經皮靜脈導管放置術 ) 1, 嬰兒靜脈留置導管 (6 個月以下 ) 1, 幼兒靜脈留置導管 (6 個月以上至 2 歲 ) 兒童靜脈留置導管 (2 歲至 6 歲 ) UMBILICAL V.CATH 00Y06 臍靜脈導管 1, UMBILICAL A.CATH 00Y06 臍動脈導管 2, EXCHANGE TRANSFUSION N.B. 00Y06 新生兒換血 5, PHTOTHERAPY 00Y06 光線治療 INTENSIVE PHOTOTHERAPY 加強照光治療 FORMULA FEE 奶瓶消毒費 ( 自備奶 ) TREATMENT MILK/DAY 治療奶粉費天 PREMATURE MILK/DAY 早產兒奶水費 UMBILICAL GRANULOMA LIGATION 00Y06 臍息肉處理 - 硝酸銀處置 Anti-reflux procedure with subtrigonal injection 治療尿路迴流之膀胱三角下層注射 5, MILK DIETRY 奶粉飲食費, 每人日 BREATH HYDROGEN TEST (BHT) 呼吸氫氣測定法 PERCUTANEOUS VENOUS CATHETER 經皮靜脈導管術 3,540 11/89

CONTAGIOSUM 軟疣治療每個 150 41134 IONTOPHORESIS 多汗症離子泳動療法 300 41141 MEDICATED BATH THERAPY (REGIONAL) 藥浴治療 ( 局部 ) 110 41144 EXCISION BIOPSY SPECIAL 切片 - 螢光特別 680 41149 CONDYLOMA

12 41373 PRESSURE/VOLUME CONTROL VENTILATOR (VCR),DAY 侵襲性呯吸輔助器使用費天 2, PED IV INJECTION IV 00Y06 兒科 - 小量靜脈注射 O2 INHALATION 氧氣吸入 ( 小時 ) O2 TENT/DAY (O2 ANALYZER) 氧氣帳天 ( 含氧氣濃度分析 ) O2 HOOD/DAY 氧氣頭罩天 OXYGEN INHALATION 氧氣吸入使用費 ( 天 ) 含氧氣費 INCUBATOR ON O2 INHALATION/DAY 保溫箱內氧氣費天 NON-INVASIVE POSITIVE PRESSURE 非侵襲性陽壓呯吸治療 1, C.P.T & POSTURAL DRAINAGE 體位引流 STEAM OR NEBULIZATION INHALATION-TIME 蒸氣或噴霧吸入治療 - 次 STEAM OR NEBULIZATION INHALATION-DAY 蒸氣或噴霧吸入治療 - 天 AEROSOL THERAPY FOR VENTILATOR (DAY) 人工呯吸器噴霧吸入治療 ( 天 ) CLONIDINE TEST FOR GH 1, 極低出生體重早產兒心智發展檢查 2, 嬰兒保溫箱 ( 天 ) 前哨淋巴腺切片術 7, TRECHEOSTOMY 氣管切開 6, INCISION & DRAINAGE 切開引流 ELECTROCAUTERIZATION 雞眼痣電燒雞眼痣電燒 --- 每增加一個 PUNCTURE TEST 空針抽吸 DEBRIDEMENT <5CM 深部複雜創傷處理 5 公分以下 2, Sclerosing injection on foot-single 靜脈瘤硬化劑注射 ( 單腳 ) Sclerosing injection on foot-both 靜脈瘤硬化劑注射 ( 雙腳 ) APPLICATION OF SPECIAL MACHINES--CUSA 腦神經外科術中特殊儀 7, APPLICATION OF SPECIAL MACHINES--EVOKE POTENTIAL 腦神經外科術中特殊儀 4, APPLICATION OF SPECIAL MACHINE--MICROSCOPE 腦神經外科術中特殊儀 2, MONITORING OF ICP(DAY) 顱內壓監視器 / 天 ACT 活化再鈣化凝血時間 RIB FIXATION 肋骨固定術 CHECK CARDIAC OUTPUT 測量心輸出量首次 1, EXTRA-CIRCULATION(DAY) 體外循環 - 第二天起每日照護費 2, INTRA-AORTIC BALOON ASSIT,DAY 主動脈氣球輔助器使用費 ( 天 ) I.A.B.P.INSERTION 主動脈氣球幫浦裝置術 4, RECHECK CARDIAC OUTPUT 測量心輸出量第二次後 ( 每日限至多二次 ) SCAR INJECTION TREATMENT 疤痕局部注射治療 ( 中 REMOVAL OF SPLINTING WIRE 固定鋼線移除 TREATMENT OF SKIN BURN < 10 BSA 皮面創傷處理 - 體表面 2, TREATMENT OF SKIN BURN BSA 皮面創傷處理 - 體表面 5, TREATMENT OF SKIN BURN BSA 皮面創傷處理 - 體表面 8, TREASKIN WOUND TREATMENT BSA 皮面創傷處理 - 體表面積 51-70BSA 12, C.D. OF SKIN BURN < 10 BSA 皮面創傷 1, C.D. OF SKIN BURN BSA 皮面創傷 2, C.D. OF SKIN BURN BSA 皮面創傷 4, C.D. OF SKIN BURN BSA 皮面創傷 4, 皮面創傷處理 ( 火. 燙. 電. 凍. 藥品燒灼傷及燒膿瘍之處理及換藥 )- 體表面 BSA ( 軀幹四肢者 ) 15,930 12/89

13 41724 皮面創傷處理 ( 火. 燙. 電. 凍. 藥品燒灼傷及燒膿瘍之處理及換藥 )- 體表面 >91 BSA ( 軀幹四肢者 ) 17, 皮面創傷換藥 ( 火. 燙. 電. 凍. 藥品燒灼傷及燒膿瘍之換藥 ) 體表面積 BSA ( 軀幹四肢者 ) 7, 皮面創傷換藥 ( 火. 燙. 電. 凍. 藥品燒灼傷及燒膿瘍之換藥 ) 體表面積 >91 BSA ( 軀幹四肢者 ) 8, 深部複雜臉部創傷處理 - 小 5 公分以內 2, 深部複雜臉部創傷處理 - 中 5 公分至 10 公分 3, 深部複雜臉部創傷處理 - 大超過 10 公分 4, 膀胱內血塊清除術 Bladder blood clot evacuation with toomy INCISION & DRAINING 切開引流 BLADDER INSTILLATION 膀胱灌注 CHANGE CYSTOSTOMIC TUBE WITH OR WITHOUT BLADDER IRRIGATION 膀胱造廔管換 CHANGE NEPHROSTOMIC TUBE WITH, WITHOUT IRRIGATION 腎引流管灌洗疝氣徒手復位術 Closed reduction of hernia PROSTATIC MASSAGE 前列腺按摩 URETHRAL BOUGIE METAL 金屬型尿道擴張術 FIBEROCYSTOSCOPY 膀胱纖維鏡檢查 2, (WITHOUT TEST) COMPLETE URODYNAMIC EXAMINATION 尿動力學全項檢查 4, Pressure -flow study 壓力尿流速圖 1, URINE CATHETERIZATION IRRIZATION 導尿管沖洗 Stress urethral pressure profile(stress UPP) 應力尿道壓力測量檢查 1, UROFLOWMETRY (U.F.M) 尿流速測驗 URETHRAL PRESSURE PROFILE(U.P.P.)UROFLOWMETRY 尿道壓力圖 1, CYSTOMETRY 膀胱壓檢查 1, HOUR BLADDER IRRIGATION 膀胱 24 小時連續沖洗 CATHETER CHANGE 更換腎臟引流或膀胱引流管 MANUAL REDUCTION TESTICULAR TORSION 徒手睪丸扭轉整復骨盆肌肉生理回饋訓練尿失禁電刺激治療膀胱掃描膀胱超音波尿量測量 SELF CATHETERIZATION 自行導尿法訓練 P.C.N.(PERCUTANEOUS NEPHROSTOMY) 皮下穿刺腎造廔術 ( 單側 ) 9, ESWL FOR UROLITHIASIS --FIST TIME 尿路結石體外震波碎石術 -- 第一次 32, ESWL FOR UROLITHIASIS --SECOND TIME 尿路結石體外震波碎石術 -- 第二次 23, 錄影尿流動力學檢查 Video urodynamic study 9, 鼻咽喉支氣管鏡檢查 1, IMPACTED CERUMEN, UNILTERAL 耳垢崁塞取出單側 Myringotomy without microscope 傳統耳膜切開術聽覺穩定狀態電位反映 ASSR 1, E.N.T. BIOPSY 耳鼻喉切片 SIMPLE F. B. 簡易異物取出 COMPLICATED F.B. 複雜異物取出 ( 視情況 1, E-TUBE INFLATION,UNILATERAL 耳咽管通氣術單側 PAPER TYMPANOPLASTY 耳膜紙成形術 TYMPANOCENTESIS 鼓室穿刺術 I & D OF EXT EYT,EAR 外耳切開引流術 CALORIC TEST 內耳溫差試驗 /89

藥品燒灼傷及燒膿瘍之換藥 ) 體表面積 >91 BSA ( 軀幹四肢者 ) 8,925 41727 深部複雜臉部創傷處理 - 小 5 公分以內 2,670 41728 深部複雜臉部創傷處理 - 中 5 公分至 10 公分 3,855 41729 深部複雜臉部創傷處理 - 大超過 10 公分

14 41914 SIMPLE EPISTAXIS 單純性鼻血處理 COMPLICATED EPISTAXIS 複雜性鼻血處理 1, INTRANASAL INJECTION 鼻內注射術 INTRANASAL CAUTERIZATION 鼻內電燒術 3, MAXILLARY SINUS PUNCTURE IRRIGATION-UNIL 上額竇穿刺沖洗 - 單側 1, NASAL BONE FRACTURE 鼻骨復位數 5, SIMPLE FRENECTOMY 簡易舌繫帶切開術 I & D FOR PERITONSILLAR ABSCESS 周邊性扁桃腺膿瘍切開 PURE TONE AUDIOMETRY 純音聽力檢查 LARYNGOSCOPY 喉內視鏡檢查 1, ESOPHAGEAL BOUGINATION 食道擴張術 HUMIDITY INHALATION 濕氣吸入治療 NASOPHARYNGOSCOPY 鼻咽內視鏡檢查 1, CAUTERIZATION 扁桃腺術後出血電燒 3, RECRUITMENT TEST S.I.S.I. 響音重振檢查 IMPEDANCE AUDIOMETRY 聽音電阻檢查 TYMPANOMETRY 鼓室圖檢查 MEDIUM SPEECH EVALUATION 一般語言檢查 SOUND RECORD TESTING 語言錄音檢查 SOUND FIELD TESTING 聲場聽力檢查 2, SOUND SPECTROGRAPHY 音聲頻譜儀檢查 SWALLOWING EVALUATION 吞嚥檢查 SPEECH DISCRIMINATION 語言分辨聽力檢查其他耳鼻喉囊種穿刺引流疤痕注射療法耳廓囊腫抽吸及注射幼兒聽力篩檢 ( 腦幹聽反射 ) 前庭誘發肌電位 SPEECH AUDIOMETRY 語言聽力檢查 E.R.A.(ELECTRICAL RESPONCE AUDIOMETRY) 誘發反應聽力檢查 ENG (ELECTRONYSTAGMOGRAPHY) 眼振圖 V.F.T.(VESTIBULAR FUNCTION TEST) 平衡檢查 B.S.R.(BRAIN STEM RESPONSE) 腦幹反應檢查 2, RHINOMANOMETRY 鼻阻壓計檢查 SINOSCOPY 鼻竇內視鏡檢查 1, STROBOSCOPY 喉頻閃光源內視鏡檢查 2, ENDOSCOPY-PHOTO,EACH 顯微內視鏡照相 / 每張耳石復位術 E-TUBE INFLATION-BILATERAL 耳咽管通氣術 - 雙側 INTRATYMPANIC INJECTION UNDER MICRO 顯微鏡下耳內注射 NASAL SPLINT FIXATION 鼻甲板放置術 1, NASAL PACKING(AXT.) 鼻填塞 ( 前側 ) NASAL PACKING(POST) 鼻填塞 ( 後側 ) REMOVE OF NASAL PACKING 鼻填塞物取出 NASAL DOUCHING 鼻孔灌水 STALOGRAM INBUBATION 唾液腺插管術 FACIAL NCV 顏面神經刺激檢查聽反射測驗 (ART) *ACOUSTIC REFLEX DECAY TEST 鐙骨肌反射衰退檢查 /89

41922 PURE TONE AUDIOMETRY 純音聽力檢查 450 41924 LARYNGOSCOPY 喉內視鏡檢查 1,200 41925 ESOPHAGEAL BOUGINATION 食道擴張術 310 41926 HUMIDITY INHALATION 濕氣吸入治療 120 41927 NASOPHARYNGOSCOPY 鼻咽內視鏡

15 41990 耳咽管功能檢查 ENT LOCAL TREATMENT-REMOVAL OR SUCTION OF ABSCESS OR CRUST 耳鼻喉局部治療 - 膿或痂皮之取出或抽吸 ENT LOCAL TREATMENT-WOUND TREATMENT AND CHANGE DRESSING 耳鼻喉局部治療 - 傷口處置及換藥 ENT LOCAL TREATMENT-REMOVAL OR SUCTION OF ABSCESS OR CRUST BIL EAR 耳鼻喉局部治療 - 耳部雙側膿或痂皮之 ENT LOCAL TREATMENT-WOUND TREATMENT AND CHANGE DRESSING BIL EAR 耳鼻喉局部治療 - 耳部雙側傷處置及換 *OTOACOUSTIC EMISSION (OAE) 耳音傳射 1, 新生兒聽力檢查篩檢 ( 自動聽性腦幹反應儀 ) 免費新生兒聽篩 ( 限台北院區批價用 ) HEMORRHOID THROMBECTOMY( 痔單純血栓切除 ) 1, 大腸直腸癌篩檢表補助費 FLEET ENEMA 磷酸鹽灌腸 ( 藥費另計 RECTAL IRRIGATION 直腸灌洗 COLOSTOMY IRRIGATION 人工肛門灌洗 ( 術前或 COLOSTOMY CARE 人工肛門護理 POSTERIOR WOUND CARE POST A.P.R THREE WAY IRRIGATION 三路灌洗 PERINEAL ABCESS,I & D 肛門周圍膿瘍切開引流 AG NO3 CAUTERIZATION 硝酸銀棒燒灼 PERINEAL CARE & FISTULA IRRIGATION 會陰清洗及管沖洗 ILEOCONDUIT CARE 人工膀胱護理 ILEOCONDUIT CARE WITH BAG 人工膀胱貼袋子經大腸鏡結腸止血術 5, 直腸抽取吸片術 1, REMOVAL OF FOREIGN BODY 異物清除 2, REMOVAL OF STOOL IMPACTION 糞嵌塞移除 INCISION & DRAINAGE FOR PERIPROCTAL ABSCESS 直腸周圍膿腫之切開引流 3, RECTAL INCISIONAL BIOPSY 直腸活體組織切片 4, EPILATION,MANNAL 睫毛拔除術 EPILATION,ELECTRIC 睫毛電氣分解術 I & D FOR HORDEOLUM 眼瞼膿瘍切開術 INCISION & CURETTAGE FOR CHALAZION 霰粒腫手術 1, EYELID SUTURE/STITCH 眼瞼皮縫合每針 REMOVE STITCHES/MONOCULAR 拆腺單眼皮膚 LACRIMAL IRRIGATION 淚囊沖洗 LACRIMAL DUCT BOUGIE 淚管探子 REMOVAL CONJUNCTIVAL LITHIASIS,SIMPLE 結膜結石摘除 ( 單純 ) REMOVAL CONJUNCTIVAL LITHIASIS,COMPLICATED 結膜結石摘除 ( 複雜 ) SUBCONJUNCTIVAL INJECTION 結膜下注射 CONJUNCTIVAL SUTURE/STITCH 結膜縫合每針 CORNEAL FOREIGN BODY REMOVAL,SIMPLE 角膜異物除去術 ( 單純 CORNEAL FOREIGN BODY REMOVAL,RUST RING 角膜異物除去術 ( 特殊 CORNEAL SUTURE/STITCH 角膜縫合每針 PARACENTESIS 前房穿刺 RETROBULBAR INJECTION 眼球後注射 INCISION & CURETTAGE OF O'RBITAL ABSCESS 眼窩膿瘍切開術 1,170 15/89

BIL EAR 耳鼻喉局部治療 - 耳部雙側傷處置及換 220 41995 *OTOACOUSTIC EMISSION (OAE) 耳音傳射 1,000 41997 新生兒聽力檢查篩檢 ( 自動聽性腦幹反應儀 ) 800 41998-1 免費新生兒聽篩 ( 限台北院區批價用 ) 500 42001

16 42121 CHANGE DRESSING 術後治療 COPY 片子光動力療法 (photodynamic therapy) 7, VISUAL ACUITY WITH CORRECTION 視力矯正 REFRACTOMETER 紅外線驗光儀檢查 OPHTHALMOMETRY EXAM. 角膜曲度測度 PRESCRIPTION FOR GLASSES 普通眼鏡處方 OCULAR BIOMETRY (A SCAN) SKIASCOPE EXAM 屈折調節檢查 COLAR BLINDNESS TEST 色盲檢查 SYNOPTOPHORE 立體官能檢查 PRISM COVER TEST 三稜鏡檢查 TITMUS TEST 立體感視覺檢查 COMITANCE TEST 協調檢查 CHEIROSCOPE 斜視鏡檢查 SCHIOTZS TONOMETRY 眼壓測定 APPLANATION TONOMETRY 眼壓測定 TONOGRAPHY 眼壓電圖檢查 DARK ROOM PRONE TEST 暗房俯臥激發試驗 SLIT LAMP EXAM. 細隙燈頭顯微鏡檢查 GONIOSCOPE EXAM. 前房隔角鏡檢查 GDX 視網膜神經纖維層分析儀 OCT 光學共軛地圖儀 SPECULAR MICROSCOPE FUNDOSCOPIC EXAM. 眼底檢查 FUNDUS PHOTO PICTURE/PICTURE 眼底攝影 FLUORESCEIN ANGIOGRAPHY 螢光眼底攝影術 1, ICG 循血綠眼底血管攝影 ( 不含 ICG 藥 ) 1, ULTRASONIC PACHOMETRY 超音波角膜厚度計 DIPLEPIA TEST 眼肌機能檢查 VISUAL FIELD EXAM.(PERIMETRY) 週邊視野檢查 SCOTOMETRY EXAM. 中心視野檢查 VAGOSTIGMIN TEST EXOPHTHALMOMETRY EXAM. 眼球突出測定 ELECTRO-RETINOGRAM (ERG) 網膜電圖 SCHINMER TEST 淚液分泌機能檢查 FLUORESCEIN STAIN OF CORNEA 角膜活體細胞染色檢查 INDIRECT OPHTHALMOSCOPY 間接式眼底鏡檢查 COMPUTARIZED PERIMETRY 自動視野檢查 1, OPTICAL PACHOMETRY 光學角膜厚度計 EXTERNAL EYE PHOTOGRAPHY 外眼攝影 REMOVAL OF CORNEAL STITCHES UNDER MICROSCOPE 角膜縫線拆除術 - 顯微 1, PENUMA TONOMETRY 氣壓式眼壓測定 PUPIL DILATATION 瞳孔放大 LASER FOR MACULA - FIRST VISIT 黃斑部雷射術 - 初診 5, LASER FOR MACULA - RETURN VISITE 黃斑部雷射術 - 複診 2, PRP - FIRST VISIT 全網膜雷射術 - 初診 5, PRP - RETURN VISITE 全網膜雷射術 - 複診 2, FOCAL LASER FOR PERIPHERAL RETINA-FIRST VISIT 週邊 ( 局部 ) 網膜雷射 5,200 16/89

角膜曲度測度 120 42127 PRESCRIPTION FOR GLASSES 普通眼鏡處方 100 42129 OCULAR BIOMETRY (A SCAN) 430 42130 SKIASCOPE EXAM 屈折調節檢查 150 42131 COLAR BLINDNESS TEST 色盲檢查 50 42133 SYNOPTOPHORE 立體官能

17 42182 FOCAL LASER FOR PERIPHERAL RETINA-RETURN VISITE 週邊 ( 局部 ) 網膜雷射 2, LASER FOR TRABECULAR MESHWORK(GLAUCOMA)-FIRST VISI 小樑雷射術 - 青光眼初 4, LASER FOR IRIS(GLAUCOMA)-FIRST VISIT 虹膜雷射術 - 青光眼初 4, LASER FOR IRIS(GLAUCOMA)-RETURN VISIT 虹膜雷射術 - 青光眼複 2, LASER C.B DESTRUCTION,FOR GLAUCOMA-FIRST VISIT 睫狀體雷射破壞術 - 初 3, LASER C.B DESTRUCTION,FOR GLAUCOMA-RETURN VISIT 睫狀體雷射破壞術 - 複 1, LASER CAPSULOTOMY - FIRST VISIT 雷射後囊切開術 - 初診 4, LASER CAPSULOTOMY - RETURN VISIT 雷射後囊切開術 - 複診 2, VISUAL FUNCTION TEST 綜合視覺機能檢查 Wide angle fundus photography 1, ECHO EXAM (A.SCAN) 超音波掃描 (A 掃描 ) ECHO EXAM (B.SCAN) 超音波掃描 (B 掃描 ) AMBLYOPIA EXAMINATION 弱視檢查 ORTHOPTIC TRAINING 斜視訓練 SKIN TRACTION 皮膚牽引一次 SKELETAL TRACTION 骨骼牽引一次 2, PELVIC TRACTION 骨盆牽引一次 CRUTCH FIELD CERVICAL TRACTION 頭骨夾頸椎牽引一次 1, REMOVAL OF K-PINS OR WIRE 拔除骨釘鋼線 CRUTCHFIELD TONGS TRACTION 頭部牽引 ( 一次 ) 2, VERPON FIXATION,ARM 手臂固定 TENDON INJECTION 肌鍵注射 CAST SPLITING,BIVALVE 石膏切開, 開窗 CAST WEDGING 石膏楔形矯正 1, CAST REMOVAL 石膏拆除 P.P. SPLINT,SHORT ARM 石膏副本固定, 短臂 P.P. SPLINT,LONG ARM 石膏副本固定, 長臂 1, P.P. SPLINT,SHORT LEG 石膏副本固定, 短腿 1, P.P. SPLINT,LONG LEG 石膏副本固定, 長腿 1, P.P. CAST,SHORT ARM 石膏固定, 短臂 1, P.P. CAST,LONG ARM 石膏固定, 長臂 1, P.P. CAST SHORT LEG 石膏固定, 短腿 1, P.P. CAST,LONG LEG 石膏固定, 長腿 2, P.T.B. CAST 膝腱石膏固定 2, WALKING CAST,SHORT 步行石膏固定, 短 1, CYLINDER CAST 圓筒石膏固定 1, SHOULDER SPICA 肩石膏固定 3, 超音波骨骼癒合加速系統 (6 次 / 週 ) 4, Cast brace of knee 膝蓋可動性石膏固定 2, FLUOROSCOPY 簡單物理治療 -air cast 冷敷 / 日 CONTINUEOUS PASSIVE MOTION/DAY 連續被動關節運動器 REMOVE EXTERNAL FIXATOR 骨骼外固定器取除術 2, CAST AND ENHANCEMENT 補打石膏 CAST BRACE 功能性梏具 1, CLOSE REDUCTION FOR UPPER LIMB FRACTURE 上肢骨折復位術 1, TRACTION ADJUSTMENT 牽引調整技術費 ( 每日 TIBIA FRACTURE OR KNEE ARTHRODESIS 脛骨一般骨折及膝關節 TIBIA UP 1/3 FRACTURE (HIGH TIBIA OSTEOTOMY) 脛骨上 1 3 骨折 /89

B DESTRUCTION,FOR GLAUCOMA-RETURN VISIT 睫狀體雷射破壞術 - 複 1,790 42189 LASER CAPSULOTOMY - FIRST VISIT 雷射後囊切開術 - 初診 4,680 42190 LASER CAPSULOTOMY - RETURN VISIT 雷射後囊切開術 - 複診 2,340

18 42251 TIBIA SEGMENTAL FRACTURE 脛骨分段性骨折 FEMUR FRACTURE 股骨骨折 PELVIC FRACTURE (UNSTABLE) 骨盤不穩定性骨折 RADIUS OR ULNA SIMPLE FRACTURE 撓骨或尺骨一般性骨折 P.P. SPLINT,FINGER OR TOE (ANKLE) 石膏副木固定指趾 ( 踝 ) 比照 FINGER,TOE P.P CAST 手指腳趾石膏固定 CULDOCENTESIS 窩穿刺 ( 陰道陷凹穿刺 HYDROTUBATION 輸卵管通水檢查 REMOVAL OF RING 取出避孕器 Pelvic Examination 骨盆檢查費 CU-IUD INSERTION 銅類避孕器裝置 ( 不含 DOLPOSCOPY 子宮頸擴張術 COLPOSCOPY 陰道鏡檢查子宮頸出血藥物治療 WET SMEAR EXAMINATION 陰道濕抹片檢查 POST COITAL TEST 同房後檢查 CERVIX BIOPSY 子宮頸活體組織檢查 ENDOMETRIAL SAMPLING AND BIOPSY 子宮內膜活體組織檢查 1, EGG AND EMBRYO CULTURE 卵子及胚胎培養 10, EMBRYO TRANSFER (ET) 胚胎植入 ( 含 ET 管 ) 4, IUI WITH SPERM MIGRATION 人工受精 ( 洗精 ) 4, X-Y SPERM SPERATIONX-Y 精蟲分離 6, AMNIOTIC FLUID CELL CULTURE & CHROMOSOME 羊水細胞培養及染色體 6, CHORIONIC VILLI CELL CULTURE & CHROMOSOME 絨毛膜細胞培養 4, BLOOD CELL CULTURE & CHROMOSOME 血液細胞培養及染色體 3, INTRODUCTION OF MEDICATION OF VAGINAL 陰道藥物放置 REMOVE OF VAGINAL GAZE 取陰道紗布 VAGINAL C.D. 人工陰道換藥滲尿試驗 PANPANICOLAOUS SMEAR 子宮頸抹片取樣 POST CERVIX CAUTERIZATION OR CRYOTHERAPY TREATMENT 子宮頸燒灼後或冷凍後 REMOVAL OF FOREIGN BOBY SIMPLE 單純除去陰道異物 PERINEAL CARE PER DAY 會陰沖洗 - 住院 ( 日 ) DOLPOSCOPY 子宮頸擴張術 ( 藥物 ) ThinPrep 取樣費 CRYO & THAW OF EMBRYOS 胚胎冷凍及解凍 6, 胚胎玻璃化冷凍 10, 胚胎玻璃化解凍 8, AMNIOCENTESIS 羊膜穿刺 1, Vaginal Bx MANUAL REMOVAL OF PLACENTA 胎盤用手剝離 REPAIR OF CERVICAL LACERATION 子宮頸縫合修補 HUMAN PAPILLOMA VIRUS 人類乳頭狀瘤病毒感染採檢費 SITZ BATH 坐浴 LABOR ROOM CARE 生產前護理 LAMINARIA APPLICATION 乾海草置放 ( 含材料 ) ARTICIFIAL RUPTURE OF MEMBRANES 人工破水孕期乙型鏈球菌篩檢採檢費母血唐氏症檢查判讀費 /89

P CAST 手指腳趾石膏固定 620 42301 CULDOCENTESIS 窩穿刺 ( 陰道陷凹穿刺 200 42302 HYDROTUBATION 輸卵管通水檢查 300 42304 REMOVAL OF RING 取出避孕器 750 42306 Pelvic Examination 骨盆檢查費 70 42307 CU-IUD

19 42370 GAMETES OR EMBRYOS MICROMANIPULATION 精卵或胚胎顯微操作 11, REMOVAL OF FOREIGN BOBY,COMPLICATED EMBEDED 複雜嵌於陰道異物去除術肌肉萎縮症 (SMA) 判讀費精蟲抗體篩檢 VAGINAL WASHING (IRRIGATION) 陰道灌洗 REMOVE LAMINARIA 取出乾海草羊水穿刺放液 SPERM STAIN 精蟲染色 1, SEMEN CRYOPRESERVE 精液冷凍 3, STORAGE OF FROZEN EMBRYO 胚胎冷凍保存費 3, STORAGE OF FROZEN SEMEN 精液冷凍保存費 3, 產後即時熱飲 ( 壓腹 ) D 立體超音波檢查 ( 兩張照片 + 光碟 ) 1, 精蟲染色檢查及抗體篩檢 1, 會陰沖洗 - 門診, 每次 PERINEAL IRRIGATION CARE OPD,EACH TIME LAMAZE 拉梅茲生產班 NUTRITIONAL CONSULTATION (O.P.D.) 成人門診營養指導次 OPD HEALTH EX. BREAKFAST 門診健康檢查早餐費兒科營養指導費次保腎營養諮詢 DM NUTRI-INDI NUTRITIONAL CONSULTATION (I.P.D.) 住院營養指導費 ( 指導時間半小時以上 ) NUTRITIONAL CONSULTATION (I.P.D.) 住院營養指導費 ( 指導時間半小時以內 ) NUTRITIONAL CONSULTATION (I.P.D.) 住院營養指導費 ( 職牧家使用之項目 ) CHARGE FOR CONSULTATION 營養醫療會診費 *FEEDING PUMP 定量灌食機每日使用費 NUTRITIONAL ASSESSMENT 營養評估費減重飲食指導 /5 次 2, 減重飲食指導 /1 次 ADVANCED SLEEP STUDY 15, MULTIPLE SLEEP LATENCY TEST 5, NON-INVASIVE POSITIVE PRESSURE 非侵襲性陽壓呯吸治療 1, PULSE OR EAR OXIMETRY/TIME 脈動式或耳垂式血氧飽和監視器次 PULSE OR EAR OXIMETER/DAY 脈動式或耳垂式血氧飽和監視器天 HYPOXIC STIMULATION TEST 缺氧刺激試驗 DELIVERY OF NORMAL BABY 正常分娩 11, FORCEPS DELIVERY 產鉗生產 11, Vaginal delivery of twins 雙胎分娩 ( 註 : 包括會陰切開術. 縫合術及胎盤剝離等 ) 17, Medical induction for fetal death (12-24 weeks) 死胎之引 (12-24 週 ) 8, Medical induction for fetal death (after 24 weeks) 死胎之引產 ( 超過 24 15, 前胎剖腹產後之陰道生產 - 單胎 ( 接生費 ) 11, 前胎剖腹產後之陰道生產 - 雙胎 ( 接生費 ) 17, EXCISION AND/OR REPAIR FOR THE SCAR OF FACE AND NECK 17, CO2 LASER OPERATION 二氧化碳雷射手術 4, CO2 LASER (MEDIUM) 多層皮膚移植 5, CO2 LASER (LARGE) 多層皮膚移植 9, CO2 LASER 2, ND-YAG LASER SURGERY(<1CM2) 2, vel I 第一級外科病理 ( 眼觀檢查 )-- 如異物 ( 金屬玻璃結石寄生蟲等 ) /89

EMBRYO 胚胎冷凍保存費 3,000 42383 STORAGE OF FROZEN SEMEN 精液冷凍保存費 3,000 42384 產後即時熱飲 ( 壓腹 ) 40 42387 4D 立體超音波檢查 ( 兩張照片 + 光碟 ) 1,400 42388 精蟲染色檢查及抗體篩檢 1,300 42389 會陰沖

20 LIVER BIOPSY 肝穿刺病理切片檢查 5, ND-YAG LASER SURGERY(>1CM2/1CM2) 1, 柔膚雷射 - 塗碳 - 黑娃娃 3, 柔膚雷射 - 不塗碳 - 白娃娃 2, 柔膚雷射 -( 黑 + 白 ) 各 5 次療程 27, ARTHROSCOPY 關節鏡檢查 4, BRONCHOSCOPY 支氣管鏡檢查 2, FIBER CHOLEDOCHOSCOPY 膽道纖維鏡檢查 2, CHOLEDOCHOSCOPY AND REMOVAL OF STONES 膽道鏡檢查及截石術 7, THORACOSCOPY 肋膜腔鏡檢查 5, SIGMOIDOSCOPYS 狀結腸鏡檢查 ESOPHAGEAL ENDOSCOPY 食道鏡檢查 1, UPPER GI PANENDOSCOPY 上消化道汎內視鏡檢查 1, COLON FIBEROSCOPY 大腸纖維鏡檢查 2, FIBROCYSTOSCOPY 膀胱纖維鏡檢查 2, UTEROSCOPY,DIAGNOSTIC,INCLUDING DILATATION OF URETERO-VESICAL... 輸尿管鏡診斷包括輸尿管膀胱接合處 3, URETHROSCOPY 尿道鏡檢查 2, HYSTEROSCOPY 子宮鏡檢查 2, GLYROLIC ACID PEELING 果酸換膚術 2, TRANSPLANATATION, PUNCH GRAFT FOR HAIR TRANSPLANT 12, DERMABRASION, TOTAL, FACE FOR SCARS, TATTOOS, ACTINIC CHANGES 22, THORACOCENTESIS 胸腔穿刺 1, ARTHROCENTESIS 關節穿刺 HYDROTUBATION,RUBIN TEST,OR INSUFFLATION OF TUBE WITH AIR.. 輸卵管通水通色素或通氣檢查 CULDOCENTESIS 陰道陷凹穿刺 DERMABRATION, REGIONAL 1/4 FACE, CHEEKS, CHIN, FOREHEAD, ETC. 11, CHEMOSURGERY, SUPERFICIAL ACID PEEL TOTAL FACE & NECK 22, CHEMOSURGERY, SUPERFICIAL ACID PEEL REGIONAL, FACE, NECK OR 11, DERMABRASION COMBINED WITH SUPERFICIAL CHEMOSURGERY 18, RHYTIDECTOMY, LOWER EYELIDS 18, RHYTIDECTOMY, LOWER EYELIDS UPPER EYELIDS, ORIENTAL 7, PHYTIDECTOMY, LOWER EYELIDS UPPER EYELIDS, RADICAL ORIENTAL 15, RHYTIDECTOMY, LOWER EYELIDS FOREHEAD 13, RHYTIDECTOMY, LOWER EYELIDS GLABELLAR FROWN 7, RHYTIDECTOMY, LOWER EYELIDS UPPER & LOWER EYELIDS COMBINED 30, RHYTIDECTOMY, CHEEKS, CHIN & NECK, ONLY PROCEDURES 45, RHYTIDECTOMY, CHEEKS, CHIN & NECK, WITH EYES 60, RHYTIDECTOMY CHEEKS, ABDOMEN, LEGS, HIPS OR BUTTOCKS INCLUDING 12, INJECTION, SILASTIC LIQUID 4, EXCISION, INJECTED FOREIGN BODY FACE 22, MICRO CRYSTAL DERMABRASION STAGE 1 微晶顯微磨皮手術 - 第 1, OPERATIVE CHOLANGIOGRAPHY 開刀時膽管 X 光造影法 1, ANGIOGRAPHY, UPPER OR LOWER LIMB ONE SIDE 8, ANTEGRADE VENOGRAPHY 順行性靜脈 X 光攝影 7, Myelography lumbar spine 2, 血管整形術 P.T.A 12, MICRO CRYSTAL DERMABRASION STAGE 2 微晶顯微磨皮手術 - 第 2,125 20/89

7,135 4328009 THORACOSCOPY 肋膜腔鏡檢查 5,768 4328011 SIGMOIDOSCOPYS 狀結腸鏡檢查 759 4328015 ESOPHAGEAL ENDOSCOPY 食道鏡檢查 1,214 4328016 UPPER GI PANENDOSCOPY 上消化道汎內視鏡檢查 1,973 4328017 COLON

21 經皮椎體成形術 ( 第一節 ) 腸骨動脈血管支架放置術 Stenting for Iliac vessel 15, MICRO CRYSTAL DERMABRASION STAGE 3 微晶顯微磨皮手術 - 第 3, MICRO CRYSTAL DERMABRASION STAGE 4 微晶顯微磨皮手術 - 第 3, SIMPLE MASTECTOMY, COMPLETE UNILATERAL SUBCUTANEOUS FOR BENIGN 9, SIMPLE MASTECTOMY, COMPLETE BILATERAL SUBCUTANEOUS, FOR BENIGN 12, BRACHYTHERAPY,INSERTION OF APPLICATION IN OR 近接安裝裝療器手術室裝置 3, MAMMOPLASTY, REDUCTION OR REPOSITIONING BILATERAL, ONE STAGE 24, MAMMOPLASTY, REDUCTION OR REPOSITIONING BILATERAL, TWO STAGE 24, MAMMOPLASTY, AUGMENTATION PROSTHETIC UNILATERAL 12, MAMMOPLASTY, PRIMARY, BILATERAL (COSMATIC) 37, MAMMOPLASTY, AUGMENTATION DERMA-FAT-FASCIA UNILATERAL 15, MAMMOPLASTY, AUGMENTATION DERMA-FAT-FASCIA BILATERAL 24, SIMPLE MASTECTOMY, COMPLETE, UNILATERAL, SUBCUTANEOUS, FOR 12, SIMPLE MASTECTOMY, COMPLETE, BILATERAL, SUBCUTANEOUS, FOR 18, MAMMOPLASTY, AUGMENTATION, REPEAT 26, EXTERNAL CAPSULOTOMY 6, NIPPLE RECONSTRUCTION, UNILATERAL 8, NIPPLE RECONSTRUCTION, BILATERAL 11, ESOPHAGEAL BALLOON INSERTION 食道球置入術 2, 食道異物取出複雜 3, ASPIRATION ABSCESS,CYST ETC 腫瘍囊腫抽吸經內試鏡施行食道擴張術 2, 治療性導管植入術希克曼氏導管植入術 4, PORT A CATHETER IMPLATATIPORT-A 導管植入術 4, 體外循環維生系統管線更換 5, DEBRIDMENT-<5CM 深部複雜創傷處理 2, DEBRIDEMENT-5-10CM 深部複雜創傷處理 - 傷口長五公分以下 2, DEBRIDEMENT 10CM 深部複雜創傷處理 -10 公分 4, SILASTIC-GEL OR BLOCK CONTOURING 13, TRANSANAL REMOVAL OF FB 經肛門取出直腸異物 2, ENDOSCOPIC CONTROL OF HEMORRHAGE, RECTUM AND/OR FULGURATION 直腸內視鏡止 2, 經大腸鏡結腸止血術 4, MEATOTOMY 尿道口切開術 PHIMOSIS,DORSAL/LATERAL SLIT 包莖側面或背面切開 1, FOREIGN BODY REMOVAL,GENITALIA 生殖器異物摘除術 2, ELECTROCAUTERIZATION FOR CONDYLOMA 濕疣電燒灼 1, CHANGE NEPHROSTOMIC TUBE WITH OR WITHOUT IRRIGATION 腎造口引流管換洗 CYSTOSCOPY+RETROGRADED URETERAL CATHETERIZATION 經膀胱鏡逆行尿管導管 2, URETHRAL SOUNDING 尿道擴張 DOUBLE "J" URETHRAL STANT INSERTION 雙 J 輸尿管導管置入術 3, PHYMOSIS,CIRCUMCISION 包莖環切術 2, INCISION AND DRAINAGE 切開排膿 SKELETAL TRACTION 骨骼牽引 ( 鋼線牽引 ) 2, EPILATION,ELECTROLYSIS 睫毛電氣分解術 LACRIMAL DUCT BOUGIE 淚管探子 NASO-LACRIMAL DRCT CATHETERIZATION 鼻淚導管裝置術 2, PAPER TYMPANOPLASTY 耳膜紙成形術 COMPLICATED EPISTAXIS 鼻後部鼻流血處理 1,518 21/89

22 INTRANASAL INJECTION 鼻內注射術 SIMPLE FRENECTOMY 簡易繫帶切開術 CERVIX BIOPSY 子宮頸切片 ELECTRO/CHEMICAL CAUTERIZATION 電或化學燒灼 CONDYLOMA,CXCISION &CAUTERIZATION 濕疣切除及電燒 1, VAGINAL IRRIGATION 陰道灌洗 ANTE/POST PARTUM HEMORRHAGE 產前產後出血處置 3, BIOPSY OF PERINEUM INSERTION 會陰切片 TRACHEOSTOMY 氣管切開造口術 6, NAIL EXTRACTION 拔指甲每指 ( 趾 ) 趾甲部分摘除併母組織切除術 Partial nail renoral and matricetomy 1, 一般性支氣管鏡雷射切除腫瘤或疤痕 11, 全肺灌洗 9, 複雜性支氣管鏡雷射切除腫瘤或疤痕 16, Excision of face skin and subcutaneous tumor -winthin 1cm in diameter 顏面皮膚及皮下腫瘤切除術 2, Excision of face skin and subcutaneous tumor (1-2cm in diameter) 顏面皮膚及皮下腫瘤切除術 5, Excision of face skin and subcutaneous tumor (over2cm in diameter) 顏面皮膚及皮下腫瘤切除術 9, FTSG 皮膚全層植補術 11, TUBE PEDICLE GRAFT 管形皮膚移術 18, Excision of muscle or deep tissue tumoror,deep foreign body 肌肉或深部組織腫瘤切除及異物取出術 4, Excision of skin or subcutaneous tumor(except face) 臉部以外皮膚及皮下腫瘤摘除術 - 小於 2 公分 3, Excision of skin or subcutaneous tumor(except face) 臉部以外皮膚及皮下腫瘤摘除術 - 中 2-4 公分 3, Exciorsion of skin or subcutaneous tumor(exept face) 臉部以外皮膚及皮下腫瘤摘除術 - 大 4-10 公分 6, CROSS FINGER SKIN FLAP 交指皮瓣移植術 11, SPLIT THICKNESS SKIN GRAFT-<25 平方公分多層皮膚移植 - 小於 25 平方公分下 9, SPLIT THICKNESS SKIN GRAFT S.T.S.G 平方公分多層皮膚移植 - 小於平方公分 10, SPLIT THICKNESS SKIN GRAFT S.T.S.G- 每增加 100 平方公分多層皮膚移植 - 每增加 100 平方公分 7, Composite graft 複合移植 6, Z-PLASTYZ- 形皮瓣 8, CO2 LASER OPERATION 二氧化碳雷射手術 6, SKOOG OPERATION 腋下汗腺切除術二邊 6, EXCISION OF SKIN CANCER&SSG-WITHIIN 2CM 皮膚惡性腫瘤切除及植皮術 - 直徑 2 公分以內 17, EXCISION OF SKIN CANCER & SSG-2 TO 5CM 皮膚惡性腫瘤切除及植皮術 - 直徑 2-5 公分 21, EXCISION OF SKIN CANCER & SSG-OVER 5 CM 皮膚惡性腫瘤切除及植皮術 - 直徑 5 公分以上 26, Muscle or myocutaneous flap 肌肉瓣或肌皮瓣 20, PHARYNGEAL FLAP 咽部皮瓣手術 21, Lip flap 唇部皮瓣手術 18,671 22/89

23 CROSS ARM SKIN FLAP 交臂皮瓣移植術 18, Microvascular skin flap 顯微血管游離皮瓣手術 - 皮瓣移植 48, Microvascular muscle flap 顯微血管游離皮瓣手術 - 肌肉移植 49, Microvascular bone flap 顯微血管游離皮瓣手術 - 骨移植 70, Microvascular intestinal flap 顯微血管游離皮瓣手術 - 小腸移植 70, Microvascular free function muscle transfer flap 顯微血管游離皮瓣手術 - 游離功能性肌瓣移植 70, 管型皮片整位術 15, 肌肉切片 Muscle biopsy 4, 局部皮瓣 (1 公分以內 )Local flap (<1cm) 6, 局部皮瓣 (1-2 公分以內 )Local flap (1-2cm) 6, 局部皮瓣 (2 公分以上 )Local flap (>2cm) 14, 手部 V-Y 型皮瓣手術 V-Y advancement flap (hand) 10, 三角胸皮瓣 Delto-pectoralis flap 21, 舌瓣 Tongue flap 17, 肌移位術 Muscle rotation flap 21, 皮腱膜移位術 Fasciocutaneous rotation flap 21, 皮肌移位 Myocutaneous rotation flap 21, 腹股溝皮瓣移植術 Groin flap 15, 大胸肌皮瓣 Pectoralis major myocutaneous flap 48, 旋轉皮瓣移植術 ( 手部以外 )Rotation flap 註 : 限手部以外之大型皮瓣移植 14, 腫瘤組織檢查切片術, 部位未明示 Tumor unspecified site biosy 2, Full-thickness skin graft--add 10 平方公分皮膚全層植補術 - 每增 10 平方公分 10, Face,neck,perineum,and foot-5 平方公分臉頸部植皮 -5 平方公分 12, Face,neck,perineum,and foot-every5 平方公分 of increase 臉. 頸部植皮 - 每增加 5 平方公分 3, Skin graft for hand,perineum,and foot-5 平方公分手部. 會陰. 腳植皮 -5 平方 11, Skin graft for hand,perineum,and foot-every5 平方公分手部. 會陰. 腳植皮 - 每增加 5 平方公分 3, Oral mucous flap 口腔粘膜皮瓣手術 15, PARTIAL MASTECTOMY -UNILATERAL 部分乳房切除術 - 單側 9, PARTIAL MASTECTOMY - BILATERAL 部分乳房切除術 - 雙側 15, SIMPLE MASTECTOMY - UNILATERAL 單純乳房切除術 - 單側 11, SIMPLE MASTECTOMY - BILATERAL 單純乳房切除術 - 雙側 17, EXCISION OF BREAST TUMOR - UNILATERAL 乳房腫瘤切除術 - 單側 7, EXCISION OF BREAST TUMOR - BILATERAL 乳房腫瘤切除術 - 雙側 8, RADICAL MASTECTOMY - UNILATERAL 乳癌根除術 - 單側 22, RADICAL MASTECTOMY--BILATERAL 乳癌根除術 - 雙側 30, SUBCUTANEOUS MASTECTOMY 皮下乳房切除術 13, BREAST TUMOR BIOPSY 乳房腫瘤組織檢查切片術 5, Breast tumor excision after needle localigation 術前定位下乳房腫瘤切除術 - 單側 9, FENESTRATION 骨開窗術 8, Bone or osteochondral graft 骨或軟骨移植術 8, Seguestretomy or saucerization&debridement for osteomyelitis(including phalanges,metacarpals,meta..) 11, SEGUESTRESTOMY OR SAUCERIZATION & DEBRIMENT(TIBIA,FIBULA,RADIUS.. 骨髓炎之死髓切除術或蝶形手術及擴創 13,662 23/89

24 SEGUESTRECTOMY OR SAUCERIZATION & DEBRIDMENT FOR OSTEOMYOLITIS 骨髓炎之死骨切除術或蝶形手術及擴創術 13, Corrective osteotomy of humerus,ulna,radius,femur,tibia or fibula 矯正切骨術 ( 肱. 尺. 橈. 股. 脛或腓骨 ) 11, OSTECTOMY 骨片切取術 8, Closed reduction of nasal borne fracture 鼻骨骨折閉鎖復位術 5, EXCISION OF CLAVICLE,PARTIAL 鎖骨部分摘除術 8, EXCISION OF CLAVICLE, TOTAL 鎖骨全部摘除術 12, OPEN REDUCTION OF CLAVICLE FRACTURE 鎖骨骨折開放復位術 11, EXCISION OF RIB 肋骨切除術 7, EXCISION OF RIB-ONE ADDED 肋骨切除術 - 每增加一支加算 1, PARTIAL EXCISION OF RIB 肋骨部分切除術 5, AMPUTATION OF LIMBS-THIGH 四肢切斷術 - 大腿 14, AMPUTATION OF LIMBS-LOW LEG, ARM, FOREARM 四肢切斷術 - 小腿上臂前臂 12, AMPUTATION OF LIMBS--wrist,ankle 四肢切斷術 - 腕踝 9, AMPUTATION OF LIMBS-FINGER,TOE 四肢切斷術 - 指趾 7, Revision of amputated stump (need osteoplasty)thigh, leg, arm, forearm. 斷端成形術 - 大. 小. 上臂. 前臂 9, REVISION OF AMPUTATION STUMP- TOE,FINGER 斷端成形術 - 指趾 5, OPEN REDUCTION FOR FX OF FEMORAL SHAFT 股骨幹骨折開放性復位術 22, OPEN REDUCTION FOR FX OF FEMORAL NECK (INCLUDING INTERTROCHAN... 股骨頸骨折開放性復位術 ( 含股骨粗隆 24, OPEN REDUCTION FOR FX OF TIBIA 脛骨骨折開放性復位術 20, OPEN REDUCTION FOR FX OF RADIUS,ULNA 撓骨尺骨骨折開放性復位術 9, OPEN REDUCTION FOR FX. OF PATELLA 滕蓋骨骨折開放性復位術 8, OPEN REDUCTION FOR FX OF CARPAL TARSAL.. 腕跗掌蹠骨骨折開放性復位 11, Open reduction for fracture of fingers and toes 指趾骨骨折開放性復位術 5, EXCISION OF CARPAL AND TARSAL BONE 手足骨摘除術 6, CLOSED REDUCTION FOR FX OF FEMUR BONE 大腿骨骨折徒手復位術 6, CLOSED REDUCTION FOR FX OF SPINE OR PE.. 脊椎骨盆骨骨折徒手復位術 7, Close reduction for fracture of tibia, humerus 下腿骨上臂骨骨折徒手復 5, CLOSED REDUCTION FOR FX OF FOREARM BONE 前臂骨骨折徒手復位術 5, CLOSED REDUCTION FOR FX OF CARPAL BONE 腕骨骨折徒手復位術 5, CLOSED REDUCTION FOR FX OF ANKLE BONE 踝骨骨折徒手復位術 4, CLOSED REDUCTION FOR FX..METACARPAL BONE 掌骨骨折徒手復位術 3, CLOSED REDUCTION FOR FX..METATARSAL BONE 蹠骨骨折徒手復位術 2, Close reduction for fracture of bones for fingers and toes 指趾骨骨折徒手復位術 2, REALIQNMENT OF PATELLA 膝蓋骨 ( 臏骨 ) 位置重整術 12, ARTHROTOMY FOR ACUTE SEPTIC JOINT-HIP 急性化膿性關節炎切開術 - 股關節 14, ARTHROTOMY FOR ACUTE SEPTIC JOINT-SHOU.. 急性化膿性關節炎切開術 - 肩肘腕膝踝關節 12, SYNOVECTOMY OR/AND CAPSULECTOMY-HIP 滑膜切除術或關節囊切開術 - 股關節 16, SYNOVECTOMY OR/AND CAPSULECTOMY-KNEE 滑膜切除術或關節囊切除術 - 膝關節 14, SYNOVECTOMY OR/AND CAPSULECTOMY-SHOULDER 滑膜切除術或關節囊切除術 - 肩肘腕踝關節 11, SYNOVECTOMY OR/AND CAPSULECTOMY-PHALANGE 滑膜切除術或關節囊切除術 - 指趾 8, ARTHRODESIS OF FINGER,TOE 指趾關節固定術 9, DISARTICULATION OF KNEE 膝關節截斷術 11,537 24/89

25 DISARTICULATION OF FINGER OR TOE 指趾關節截斷術 7, OPEN REDUCTION FOR DISLOCATION OF HIP JOINT 股關節脫位開放性復位術 14, OPEN REDUCTION FOR DISLOCATION OF SHOULD 肩關節脫位開放性復位術 11, OPEN REDUCT FOR DISLOCAT OF ELBOW JOINT 肘關節脫位開放性復位術 11, OPEN REDUCTION FOR DISLOCATION OF KNEE JOINT 膝關節脫位開放性復位術 12, OPEN REDUCT FOR DISLOCAT OF WRIST JOINT 腕關節脫位開放性復位術 8, OPEN REDUCTION FOR DISLOCATION OF ANKLE. 踝關節脫位開放性復位術 8, OPEN REDUCTION FOR DISLOCATI..FINGER,TOE 指趾關節脫位開放性復位術 6, OPEN REDUCT FOR DISLOCAT OF ACROMIOCLAVI 肩鎖關節脫位開放性復位術 11, CLOSED REDUCTION FOR DISLOCATION OF HIP. 股關節脫位徒手復位術 4, CLOSED REDUCT FOR DISLOCAT OF SHOULDER.. 肩關節脫位徒手復位術 3, CLOSE REDUCTION FOR DISLOCATION OF ELBOW 肘關節脫位徒手復位術 2, CLOSED REDUCTION FOR DISLOCATION OF KNEE 膝關節脫位徒手復位術 3, CLOSED REDUCT FOR DISLOCAT OF WRIST JOIN 腕關節脫位徒手復位術 3, CLOSED REDUCTION FOR DISLOC..ANKLE JOINT 踝關節脫位徒手復位術 2, CLOSED REDUCTION FOR DISLOCA..FINGER,TOE 指趾關節脫位徒手復位術 1, BRISEMENT FORCE(MANIPULATION OF JOINT) 徒手關節授動術 5, TRIGER FINGER 板機指手術 5, MYOSITIS OF POSITIS,OTHERS MYOSITIS 肌炎手術 - 其他部位 6, Operation for torticollis/wry neck 斜頸手術 10, EXCISION OF GANGLION OR HYGROM 腱鞘囊摘出術液囊腫瘤摘出術 5, TENDON REPAIR -SINGLE 肌腱修補術 - 單腱 8, TENDON REPAIR-ONE ADDED 肌腱修補術 - 每增加一條 3, GILLIES OPeration Gillie 氏手術 ( 瞼外翻手 ) 5, ZYGOMA,CLOSE REDUCTION 顴骨封閉性復位 6, ZYGOMA;OPEN REDUCTION-SIMPLE 顴骨開放性復位 - 簡單 7, ZYGOMA, OPEN REDUCTION-COMPLICATED 顴骨複雜開放性復位 16, EXTIRPATION OF BENIGN TUMORS ON PALATE OR TONGUE 顎骨口蓋舌良性腫瘤摘除術 5, OPEN REDUCTION FOR FX. OF PALATE-SINGLE 顎骨骨折開放手術 - 單一骨折 8, OPEN REDUCTION FOR FX.OF PALATE-MUTIPLE 顎骨骨折開放手術 - 複雜骨折 11, MANDIBULAR OSTEOTOMY 下顎骨離斷術 11, RESECTION OF MANDIBLE -MARGINAL 下顎骨切除術 - 邊緣切除 8, RESECTION OF MANDIBLE-PARTIAL 下顎骨切除術 - 部份切除 12, REDUCTION OF DISLOCATION OF MANDIBULAR 下顎骨脫位復位術 5, Open reduction of mandible(simple) 下顎骨骨折開放性復位 ( 簡單 ) 13, MAXILLA SUSPENSION WIRING 上顎骨懸掛式鋼絲 10, MAXILLA OPEN REDUCTION,SIMPLE 上顎骨簡單開放性復位 8, MAXILLA OPEN REDUCTION, COMPLICATION 上顎骨複雜開放性復位 17, Orbital floor open reduction-silicon sheet implant 眼眶底開放性復位術 - 矽板植入 14, ORBITAL FLOOR OPEN REDUCTION-AUTOGRAFT 眼底板開放性復位 - 自體植入 19, LNTER-MAXILLARY WIRING(INTER-DENTAL WIRI 上下額間鋼絲固定 12, BENIGN NECK MASS EXCISION (SIMPLE) 頸部良性腫瘤切除簡單 8, RUPTURE OF ACHILLES TENDON PRIMARY SUTUR 跟腱斷裂縫合術 13, RUPTURE OF PATELLA TENDON REPAIR 臏骨韌帶斷裂縫合術 10, RUPTURE OF BICEPS TENDON REPAIR 雙頭肌腱斷裂縫合術 11, RUPTURE OF QUADRICEPS TENDON REPAIR 四頭肌腱斷裂縫合術 11, ROTATOR CUFF TEAR REPAIR-MILD 肩旋轉袖破裂修補術 - 輕度 11,081 25/89

26 ROTATOR CUFF TEAR REPAIR-MASSIVE 肩旋轉袖破裂修補術 - 重度 14, GLUTEAL DELTOID MUSCLE CONTRACTURE OR SNAPING HIP RELEASE. 臂大肌肩三角肌纖維化 ( 攣縮 ) 鬆弛術 10, ACROMIOPLASTY 肩峰成形術 7, Excision or fusion of tibial tuberosity 脛骨粗隆結節切除術或骨融合術 10, PETELLA SUBLUXATION LATERAL RELEASE 臏骨半脫位外側放鬆術 9, CHONDROMALASIA OF PATELLA(DRILLING OR SHAVING) 臏骨軟骨軟化症造孔術 10, Repair of ankle joint ligaments 足踝韌帶修補術 10, HALLUX VALGUS(MCBRIDE PROCEDURE) 大腳趾外翻 9, HALLUX VALGUS(CHEVRON) 大腳趾外翻 ( 截骨術 ) 10, LIGNMENT RECONSTRUCTION OF BASAL JOINT 拇指基關節韌帶成形術 17, REGIONAL HAND PEDICLE 手部根芾皮瓣移植術 10, DIVISION OF PEDICLE FLAP 根蒂皮瓣分離術 9, RECONSTRUCTION OF NAIL 指甲重建術 9, Release of scar countracture.. 一般瘢痕彎縮鬆弛術 ( 限有顯著運動限制者 ) 14, EPIPHYSIODESIS(INCLUDE STAPLING) 骨廔抑制術 9, EXCISION OF TUMOR MASS OF BONE AND JOINT 骨關節腫瘤摘除術 12, Curettage or excision of single vertebral body 脊椎椎體搔爬術或切除術, 單節椎體 16, REPLANTATION!]ONE FINGER 斷指再接手術 - 一隻手指 35, REPANTATION 2 FINGER 斷指再接手術 - 二隻手指 57, REPLANTATION 3 FINGER 斷指再接術 - 三隻手指 83, REPLANTATION-FOUR FINGERS 斷指再接手術 - 四隻手指 110, REPLANTATION-ARM,LEG,METATARSAL OR FOOT 斷肢再接手術 74, REPLANTATION,TOE TO FINGER INCLUD TOE... 趾至指斷指再接手術一指包括趾切斷及及受植部位準備 95, OPEN REDUCTION FOR FX OF SPINE 脊椎骨折開放性復位術 26, OPEN REDUCTION FOR FRACTRUE OF PELVIS 骨盆骨折開放性復位術 21, TOTAL HIP REPLACEMENT 全股關節置換術 37, TOTAL KNEE REPLACEMENT 全膝關節置換術 38, TOTAL ELBOW REPLACEMENT 全肘關節置換術 18, Partial joint replacement-femoral condylar orticial plateau or unicompartment 股. 髁. 脛骨高丘或半膝關 22, Partial joint replacement-cup or hip prosthesis or unicompartment 髖臼. 股. 半股. 半肩膝關 23, Arthroplasty of hip joint 股關節整型術 ( 不含關節置換手術的關節整型術 ) 27, Arthroplasty of elbow joint 肘關節整型術 ( 不含關節置換手術的關節整型術 ) 17, Arthroplasty of finger.toe.metatarsal or metacarpal joint 全指. 趾關節. 全掌指及蹠趾成形術 12, ARTHRODESIS OF WRIST JOINT OR CARPAL JOINT 腕關節或腕骨掌骨關節固定術 12, ARTHRODESIS OF ANKLE JOINT 踝關節固定術 16, DISARTICULATION OF HIP 股關節截斷術 29, DISARTICULATION OF SHOULDER 肩關節截斷術 21, RECONSTRUCTION CRUCIATE LIGAMENT 十字韌帶重建術 23, REPAIR OF CRUCIATE LIGAMENT 十字韌帶修補術 14, TENDON GRAFT-SINGLE 肌腱移植術 - 單腱 12, TENDON GRAFT-SINGLE+ONE ADDED 肌腱移植術 - 每增加一條 4, TENDON TRANSPOSITION OR TENDON TRANSFER 肌腱轉移或移位 12, TENDON TRANSPOSITION OR TENDON TRANSFER+ONE 肌腱轉移或移位 ( 每增加一條 ) 5,920 26/89

27 TENDON LENGTHENING 肌腱放長術 8, TENOLYSIS 肌腱黏連分離術 8, TENDON OR LIGMENT REPAIR-EXTRAARTICULAR 肌腱或韌帶修補 - 囊外 10, TENOTOMY OR FASCIOTOMY 肌腱切開或筋膜切開 10, REMOVAL OF PROSTHESIS-HIP,SHOULDER,KNEE 人工關節移除 - 股肩膝 12, REVISION TOTAL HIP REPLACEMENT 人工全髖關節再置換 50, REVISION TOTAL KNEE REPLACEMENT 人工全膝關節再置換 50, WIDE EXCISION-BONE TUMOR,MALIGNANT 惡性骨瘤廣泛切除 ( 一次 ) 42, Benign bone tumor,curettage and bone graft 良性骨瘤刮除術及骨移植 19, Wide excision-soft tissue,tumor,malignant 軟組織惡性腫瘤廣泛切除 34, EXCISION SOFT TISSUE TUMOR, BENIGN, LARGE OR DEEP 軟組織良性切除術大或 18, RUPTURE OF ACHILLES TENDON RECONSTRUCTIO 跟腱斷裂重建術 13, RUPTURE OF PATELLA TENDON RECONSTRUCTION 臏骨韌帶斷裂重建術 13, MCL,LCL RPAIR 滕內外側韌帶修補術 13, MCL,LCL RECONSTRUCTION 膝內外側韌帶重建術 18, ATF RECONSTRUCTION 踝前脛腓韌帶重建術 13, Partial menisetomy or meniscus repair 半月軟骨部分切除或修補術 16, RECURRENT ANTERIOR SHOULDER DISLOCATIO.. 復發性肩關節前脫臼開放性復及位關節囊成 15, REGIONAL FASCIECTOMY 區域筋膜切除術 10, ISLAND PEDICLE FLAP 島狀根帶皮瓣 18, TENDON PROSTHESIS IMPLANT 人工肌鍵植入術 10, OPEN REDUCTION FOR SCAPULA FX JUXTA-ARTI 近關節肩岬骨骨折開放性復位術 11, OPEN REDUCTION FOR ACETABULUM OR HIP FX. 髖臼骨折開放性復位術 16, APPLICATION OF EXTERNAL FIXATION APPRATU 骨骼外固定器裝置術 9, CORD DECOMPRESSION FOR ANFH( TREPHING) 股骨頭壞死鑽洞手術 12, Open reduction for closed or open humeral fracture;tuberosite,shsft or coudyles 開放或閉鎖肱粗隆或骨 16, OSTEOPLASTY- SHORTING 骨整形術 - 縮短 22, OSTEOPLASTY- LENGTHENING 骨整形術 - 延長 24, EXCISION RADIAL HEAD 橈骨頭切除術 9, ARTHOSCOPY WITH SYNOVIAL BIOPSY,IRRIGATION, LAVAGE, DEBRIDEMENT 關節鏡探查手術併施行滑膜切片灌洗 6, ARTHROSCOPIC SHAVING OR REMOVAL OF LOOSE BODY,OSTEOCHONDRAL FRAGME 關節鏡下游離體或骨軟骨碎片取出術 16, Removal of internal fixator 骨內固定物拔除術 ( 骨盆. 髖骨. 肱骨. 股骨. 尺骨. 橈骨. 脛骨 ) 8, REMOVAL OF INTERNAL FIXATOR (SPINE) 骨內固定物拔除術 ( 脊椎 ) 12, Removal of internal fixator(other) 骨內固定物拔除術 ( 其他 ) 7, 杵狀足解除術 Club foot release 10, 貝克氏囊腫截除術 b 4, 顏面骨移植術 ( 先天畸形或外傷腫瘍摘除 )Facial bone graft 19, 人工半髖關節再置換術 Revision of bipolar prothesis 31, 半肩關節成形術 Shoulder joint hemiarthroplasty 23, 三重骨盆股骨切開加股骨縮短術 ( 先天髖關節脫臼 ) 27, 肌肉修補術 ( 四肢 ) Muscle repair 10, 膝關節半月軟骨修補術 Meniscus repair 註 : 不含內視鏡之費用 15, 肌切開術 Myotomy 6, 內視鏡腕道減壓術 Endoscopiccarpal tunnel release 6,527 27/89

28 椎骨全部切除術 Vertebroectomy 30, Corrective osteotomy-others;pelvic bone 矯正切骨術 - 其他部位 ; 骨盆除外 8, Percutaneous internal fixstion for fracture of distal radius or ulna 橈. 尺遠心端骨折經皮穿刺術 8, Open reduction for unimalleolar fracture of ankler 腓外踝或脛內踝單一骨折開放性復位術 11, Open reduction for bimalleolar or trimalleolar fracture of ankler 內. 外或後足踝關節開放性復位術 12, Release of scar contracture,face,neck 臉. 頸部瘢痕攣縮鬆弛術 13, Release of scar contracture,hand,foot,perineum 手. 腳. 會陰瘢痕攣縮鬆弛術 12, Curettage or excision of vertebral body,each additionalertebral body 脊椎椎體搔爬術或切除術, 增一節 7, Tendon or ligament repair(incomplete disrupyion) 肌腱或韌帶不完全切斷修 7, Transposition of digit for finger reconstruction 手指移位以重建手指 64, NASAL POLYPECTOMY - SINGLE 鼻息肉切除術 - 孤立性 4, NASAL POLYPECTOMY - MULTIPLE 鼻息肉切除術 - 多發性 4, NASAL TURBINATE, ELECTRIC CAUTERIZATION 鼻甲電燒灼 3, SUBMUCOUS RESECTON OF SEPTUM 粘膜下中膈矯正術 8, TURBINECTOMY, TOTAL OR PARTIAL 全部或部分鼻甲切除 4, CYROSURGERY 冷凍手術 3, NASOPHARYNGENAL BIOPSY 鼻咽切片 2, CALDWELL LUCS OPERATION,UNILATERAL 上頷竇切開術單側 10, CALDWELL LUCS OPERATION&ETHMOIDECTOMY 上頷竇與篩竇切開術 16, REPAIR OF SINUS FISTULA 竇管修復術 7, ENDONASAL ETHMOIDECTOMY 鼻內篩骨竇手術 8, MUTIPLE SINUSECTOMY 多竇副鼻竇手術 17, PANSINUSECTOMY 全竇副鼻竇手術註 : 含鼻外及口內徑路 20, LYSIS OF NASAL SYNECHIA 鼻粘連解除術 5, SEPTOMEATAL PLASTY-UNILATERAL 鼻中膈鼻道成形術 - 單側 13, SEPTOMEATAL PLASTY-BILATERAL 鼻中膈鼻道成形術 - 雙側 17, BIOPSY NOSE SOFT TISSUE 3, SMT-UNILATERAL 粘膜下鼻甲切除術 - 單側 8, SMT-BILATERAL 粘膜下鼻甲切除術 - 雙側 10, Repair of oroantral fistula 口腔鼻腔廔管修補術 12, ORDINARY CONCHOTOMY 一般鼻甲黏膜切除術 7, RHINOPLASTY 鼻成形術 17, EXCISION OF NASAL TUMOR WITH SKIN GRAFT 鼻腫瘤切除並植皮 15, MAXILLECTOMY PARTIAL 上顎骨切除術 - 部份 30, MAXILLECTOMY-TOTAL 上顎骨切除術 - 全部 36, EXCISION OF INTRANASAL TUMOR,MALIGNANT 鼻內惡性腫瘤切除術 28, OPENING OF CHOANAL ATRESIA 後鼻孔閉鎖症開放術 14, EXCISION OF TUMOR FROM MAXILLARY SINUS 腫瘤切除從上額竇 10, CHOANALPLASTY,TRANSNASAL 鼻後孔成形術 - 經鼻 14, CHOANALPLASTY ;TRANSORAL 鼻後孔成形術 - 經 25, DENKERS OPERATIONDENKERS 手術 18, EXCISION OF NASOPHARYNGEAL TUMOR 鼻咽瘤切除術 33, EXCISION OF NASOPALATINAL CYST 鼻與顎囊腫切除 18, REPAIR CHOANAL ATRESIA TRANSSPALATINE 經上額鼻後孔閉塞修補 13,966 28/89

29 Degloving midfacial surgery with facial bone reposition 脫手套法正中顏面手術併顏面骨復位術 28, OPEN REDUCTION OF NASAL FRACTURE 鼻骨骨折開放性復位 16, ENDOSCOPIC FUNCTIONAL SINUS SURGERY-UNILATERL 內視鏡功能鼻竇手術 - 單側 11, ENDOSCOPIC FUNCTIONAL SINUS OP-BILATERAL 內視鏡功能鼻竇手術 - 雙側 13, EXTERNAL FRONTOETHMOIDECTOMY 經外側前額竇及篩竇切除術 21, OSTEOPLASTIC APPROACH FOR..SINUS SURGERY 前額竇骨成形術 27, TREPHINATION OF FRONTAL SINUS 前額竇開窗術 20, Simple laryngoscopy, operative including excision of tumor and/or stripping or vocal cords or epiglo 8, TEFLON INTRACORDAL INJECTION 聲帶內 TEFLON 注射 12, LARYNGEAL PLASTY-SIMPLE 喉管成形術 - 單純性 13, LARYNGEAL PLASTY - COMPLICATED 喉管成形術 - 複雜性 20, Permanent tracheostomy 氣管永久造孔術 10, THYROID CARTILAGE PLASTY-COMPLICATED 機能性喉頭軟骨整形術 - 複雜性 24, Laryngectomy without neck dissection 全喉切除術不含頸淋巴腺根除術 36, Laryngectomy with radical neck dissection 全喉切除術併行頸淋巴腺根除術 57, LARYNGECTOMY WITH T-E SHUNT 全喉切除併氣管食道分路手術 48, RADICAL NECK LYMPHATIC DISSECTION 頸淋巴腺根除術 33, ARYTENOIDECTOMY,ENDOSCOPIC 經內視鏡做杓狀軟骨切除 14, LARYNGOTRACHEAL RECONSTRUCTION 氣管膺復重建 32, LARYNX RECONSTRUCTION 喉膺復重建 27, LARYNGOHPARYNGECTOMY 喉咽切除術 48, UPPP UVULOPLASTOPHARYNGOPLASTY 懸壅顎咽成形術 18, CRICOPHARYGEAL MYOTOMY 環咽肌切開術 18, STOMAPLASTY 氣管造口整形術 19, TOTAL EXCISION OF THYROGLOSSAL DUCT CYST 甲狀舌骨囊腫切除 9, 喉部腫瘤雷射手術 Laryngomicro-surgery with CO2 laser 12, Complicated laryngoscopy, operative including excision of tumor and/or stripping or vocal cords or e 12, Chest wall resection<10cm 胸壁切除術 ( 小於 10 公分 ) 20, EXPLORATORY THORACOTOMY 開胸探查術 17, CORRECTION FOR STERNAL OR RIB FX OPEN.. 胸骨或肋骨骨折開放復位手術 16, THYMECTOMY 胸腺切除術 29, CLOSED DRAINAGE 密閉式引流術 6, OPEN DRAINAGE 開放性引流術 18, Simple debridement of chest wall <10cm 簡單胸廓擴創術 <10 公分 ) 10, SEGMENTAL RESECTION 肺單位切除術 40, WEDGE OR PARTIAL RESECTION OF LUNG 肺楔狀或部份切除術 40, REMOVAL OF TRACHEAL,BRONCHIAL OR BRONCHIORAL FOREIGN BODY 氣管支氣管細支氣管異物除去術 3, REPAIR OF TRACHEO-BRONCHIAL TREE 氣管支氣管傷修補術 32, Reconstruction of tracheo-bronchial tree 氣管支氣管再造術 35, CHEST WALL RESECTION & MYOPLASTY 胸壁切除術及肌肉移植術 50, Thoracoplasty with myoplasty (or mesh) 胸腔成形術合併肌肉移植或人工網膜修補術 34, DECORTICATION OF PLEURA 肺膜剝脫術 44, PNEUMONOLYSIS,EXTRAPLEURAL 胸膜外肺鬆解術 ( 剝離術 ) 39,772 29/89

30 PNEUMONECTOMY WITH CONCOMITENT THORACOPLASTY OR BRONCHOPLASTY 全肺切除及胸廓成形術或支氣管成形術 51, Lobectomy 一葉肺葉切除 47, PNEUMONECTOMY,TOTAL 肺全切除術 51, PLOMBAGE THORACOPLASTY 球填充術 15, CLOSE OF BRONCHIAL FISTULA 支氣管廔管閉鎖術 42, COMBINED RESECTION OF LUNG CANCER 肺合併臟器切除 45, SLEEVE RESECTION 肺袖式切除術 54, REMOVAL OF TRACHEAL,BRONCHIAL OR BRONCHIORAL FOREIGEN BODY 氣管支氣管細支氣管異物除去術 - 開胸術 38, Bronchoscopic excision/removal of tumor 支氣管鏡併做腫瘤切 ( 摘 ) 除 ( 含一般材料費及特殊材料費 ) 25, Pleurodesis 胸膜固定 ( 黏合 ) 術 17, Lung incision for abscess 肺膿瘍切開術 15, Reconstruction of congenital funnel or pigeon chest 先天性凹凸胸矯正術 43, Endobronchial dilatation 支氣管內擴張術 2, Chest wall resection 10cm 胸壁切除術 ( 10 公分 ) 28, Wide excision of malignant chest wall diseases 惡性腫瘤胸壁切除 34, Extensive thymectomy 廣泛性胸腺切除 33, Complicated debridement of chest wall 10cm 複雜胸廓擴創術 10 公分 15, Bilobectomy 二葉肺葉切除 51, Correction of adult chest wall deformity 成人凹凸胸矯正術 41, Tracheal stent intubation 氣管內腔置管術 15, Thoracoscopic Decortication of Pleura 胸腔鏡肺膜剝脫術 53, Thoracoscopic Pleurodesis 胸腔鏡肋膜黏合術 20, Thoracoscopic Pneumonectomy 胸腔鏡全肺切除術 61, Thoracoscopic Lobectomy 胸腔鏡肺葉切除術 56, Thoracoscopic wedge or Partial resection of the Lung 胸腔鏡肺楔狀或部分切除術 48, PERICARDIOTOMY WITH EXPLORATION 探查性心包膜切開術 21, PERICARDIECTOMY 心包膜切除術 32, CARDIORRHAPHY FOR HEART WOUND OR INJURY 心臟縫補術 34, Exploratory cardiotomy including removal of foreign body 探查性開心術 ( 包括移除異物 ) 38, Creation of atrial septal defect, Blalock-Hanlon type, closed 人工 A.S.D. Blalock-Hanlon 法 34, CREATION ATRIAL-SEPTAL-DEFECT RASHKIND TYPE INCLUDING-CARDIAC CATH 人工 A S D 26, EXCISION OF TUMOR INTRACARDIAC 心內腫瘤切除及繞道手術 52, INSERTION OR REPLACEMENT OF PERMANENT... 經胸切開術裝置或置換永久性心內節律器 28, Insertion or replacement of permanent pacemaker -Single electrode catheter 插入或置換永久性節律器 11, Valvular and/or annuloplasty 瓣膜成形術 64, SINGLE VALVE REPLACEMENT 主動脈瓣或二尖瓣或三尖瓣之置換手術 73, DOUBLE VALVES REPLACEMENT 兩個瓣膜換置 83, Repair, ventricular aneurysm 心室動脈瘤之修補註 : 有 ( 無 ) 繞道之手術費用一致 79,543 30/89

31 Repair, atrial septal defect, secunduma.s.d. 修補註 : 有 ( 無 ) 繞道之手術費用一致 48, Repair, endocardial cushion defect 心內膜墊缺陷之修補手術 65, CORONARY ARTERIAL GRAFT BY PASS-1 VESSEL 冠狀動脈繞道手術 - 一條血管 70, CORONARY ARTERIAL..PASS(CABG)-TWO VESSEL 冠狀動脈繞道手術 - 二條血管 86, CORONARY ARTERIAL GRAFT BY PASS-3 VESSEL 冠狀動脈繞道手術 - 三條血管 100, Repair, anomalous venous return total or partial 腔靜脈回流右心房異常之修補手術 68, REPAIR VENTRICULAR SEPTAL DEFECT 室中膈缺損 (vsd) 修補手術 67, REPAIR TETRALOGY OF FALLOT 四合群症之修補及繞道手術 100, HEART PROCUREMENT 心臟摘取 31, 體外循環維生系統建立 ( 第一次 ) 20, LUNG HARVEST(DONOR PNEUMONECTOMY) 肺臟摘取 28, B-T shunt of TF 四合群症之繞道手術 54, Insertion or replacement of permanent pacemaker -Multiple electrode catheter 插入或置換永久性節律器 14, Fontan operation( 6-year-old) 心房 - 肺動脈迴路成形術 ( 六歲以下 ) 102, Thoracoscopic Pericardial Window 胸腔鏡心包膜開窗術 38, 心房切割隔間之不整脈手術 49, 心室輔助裝置植入 Ventricular Assist System implantation 177, 體外心肺循環 (Cardiopulmonary bypass) 20, EMBOLECTOMY,ARTERIAL 動脈栓塞物切除術 13, EMBOLECTOMY,ARTERIAL CATHETER 經動脈導管之栓塞物切除術 13, THROMBECTOMY,VENOUS 靜脈血栓切除術 13, Arterial endarterectomy with or without bypass graft 動脈內膜切除術 31, Exploration, vascular 血管探查 9, INSER CANNULA FOR HEMODIALYSIS OR OTHE.. 血液透析用之血管插管 ( 自靜脈到靜脈 ) 2, ANASTOMOSIS OF BLOOD VESSEL 血管吻合術 ( 指主動脈或主靜脈之吻合 ) 18, ARTERIORRHAPHY 動脈縫合 17, LIGATION EXTERNAL,CAROTID ARTERY 頸動脈之結紮 10, LIGATION,FEMORAL VEIN 股靜脈結紮 10, LIGATION AND/OR DIVISION OF COMMON ILI.. 骼靜脈的結紮與分離 12, LIGATION&DIVISION OF LONG SAPHENOUS 長隱靜脈於隱 - 股交接處的結紮與分離 10, LIGAT&DIVISION&COMPL.LONG OR SHORT..UNIL 長或短隱靜脈的結紮分離和完全剝出 - 單側 11, LIGAT&DIVISION&COMPL.LONG AND SHORT.UNIL 長及短隱靜脈的結紮分離和完全剝出 - 單側 14, LIGAT&DIVISION&COMPL.LONG AND SHORT..BIL 長及短隱靜脈的結紮分離和完全剝出 - 雙側 16, LIGATION OF JUGULAR VENOUS 頸靜脈結紮 9, STRIPPING,SUBFASCIAL,RADICAL AS LINTON.. 根除性筋膜下剝出有或無皮膚移植 ( 如 Luinton 法 ) 16, LIGATION AND DIVISION OF SHORT SAPHENO.. 小隱靜脈在隱 - 膝膕靜脈交接處的結紮和分離 9, SUTURE,LIGATION OR STRIPPING OF MINOR... 其他小靜脈曲張之縫合結紮或剝 6, EMBOLECTOMY ARTERIAL,PULMONARY ARTERY 肺動脈栓塞切除術 33, EXCISION & GRAFT BYPASS OR DIRECT REPAIR A-V FISTULA NECK OR EXTRE 頸 ( 肢體 ) 動靜脈廔管之切除移植及直 23,833 31/89

32 Excision and graft bypass or direct repair A-V fistula of chest or abdomen- 升主動脈 53, PULMONARY ARTERY BANDING 肺動肺結紮 35, REPAIR AORTO-PULMONARY WINDOW 主動脈 - 肺動脈開窗之修補手術 50, REPAIR COARCTATION AORTA 主動脈狹窄之修補 39, EXCISION TUMOR CAROTID BODY 頸動脈體瘤切除術 24, EXP.FOR POSTOPERATIVE HEMORRHAGE...-NECK 術後出血或栓塞探查術 - 頸部 11, EXP.FOR POSTOPERATIVE HEMORRHAGE..-CHEST 術後出血或栓塞探查術 - 胸部 9, SURGICAL OBLITERATION FOR PDA 存開性動脈導管手術 29, REPAIR OF PERIPHERAL BLOOD VESSEL 末梢血管修補及吻合術 13, A-V shunt with Goretex graft 動靜脈造廔術合併人工血管使用 ( 兩處吻合 ) 18, Excision and graft bypass or direct repair A-V fistula of chest or abdomen- 主動脈弓 64, Excision and graft bypass or direct repair A-V fistula of chest or abdomen- 降主動脈 56, Repair or anastomosis of peripheral vessel with graft 末稍血管修補及吻合術併血管移植 16, 內頸靜脈切開, 永久導管放置術 14, SPLENECTOMY 脾臟切除術 21, PARTIAL SPLENECTOMY 部份脾切除術 23, Laparoscopic Splenectomy 腹腔鏡脾切除術 25, BIOPSY LYMPHNODE 淋巴腺活體切片 1, EXCISION T.B LYMPHADENITIS FISTULA-DEEP 結核性淋巴腺炎管切除 - 深部 3, REMOVAL OF AXILLARY LYMPHNODE 腋下淋巴腺腫切除術 5, DISSECTION OF AXILLARY LYMPHATICS 腋窩淋巴腺清除術 14, INGUINAL LN EXCISION 腹股溝淋巴腫瘤切除術 4, RADICAL INGUINAL LYMPHNODE DISSECTION 腹股溝淋巴腺腫跟治清除術 15, PELVIC LYMPHADENECTOMY 股盆腔淋巴腺切除術 29, Retroperitoneal lymphadenectomy 後腹膜腔淋巴腺切除術 21, 根除性淋巴切除術 ( 肺葉切除或全葉切除時 ) 27, Mediastinal or thoacic L.N. dissections 縱膈腔或胸腔內淋巴根除術 21, Benign mediastinal mass excision (< 5cm) 良性簡單縱膈腔腫瘤切除 (<5 公分 ) 30, MEDIASTINOTOMY 縱膈膜切開術 20, DIAPHRAGMATIC FUNDO-PLICATION 橫膈摺疊術 22, REPAIR,DIAPHRAGMATIC HERNIA TRANS-ABDO.. 經由腹腔之橫膈赫尼亞之修補 29, REPAIR,DIAPHRAGMATIC HERNIA TRANSTHORACI 經胸廓進入橫膈赫尼亞之修補 25, REPAIR,DIAPHRAGMATIC HERNIA TRAUMATIC... 外傷性急性橫膈赫尼亞之修補 22, MEDIASTINOTOMY...CERVICAL APPROACH 由頸部進入縱膈腔切開術合併探查或引流 11, MEDIASTINOTOMY WITH EXPLORATION OR DRA.. 由胸部進入縱膈腔切開術合併探查或引流 20, MEDIASTINOTOMY WITH EXPLORATION OR... 由胸骨切開進入縱膈腔切開術合併探查或引流 21, REPAIR, DIAPHRAGMATIC HERNIA, COMBINED.. 由胸腹部合併進入橫膈赫尼亞之修 35, Benign complicated mediastinal mass excision ( 5cm) 良性複雜縱膈腔腫瘤切除 ( 5 公分 ) 35, Malignant mediastinal tumor resection 惡性縱膈腔腫瘤切除 40, Thorecoscopic Excision of Mediastinal Tumor (<5cm) 胸腔鏡縱膈腔腫瘤切除術 (<5cm) 36,432 32/89

33 Thorecoscopic Excision of Mediastinal Tumor ( >=5cm) 胸腔鏡縱膈腔腫瘤切除術 ( >=5cm) 42, Laparoscopic Nissen Fundoplication 腹腔鏡 Nissen 氏胃摺疊術 27, Oral tumor or oropharynx excision 口腔或口咽腫瘤切除 19, EXCISION OF RANULA 蝦蟆切除術 9, PARTIAL/WEDGE GLOSSECTOMY 舌部份楔狀切除術 15, REPAIR OF TONGUE INJURY OR WOUND 舌修補術 5, RESECTION OF PLATINE TONSIL(BILATERAL) 顎扁桃摘出術 10, Adenoid tonsillectomy 咽扁桃切除術 10, CRYOTHERAPY FOR TONSILLAR 冷凍扁桃腺手術 1, ABLATION OF SUBMAXILLARY GLAND 下頷腺切除術 15, BIOPSY OF ORAL MUCOSA 口腔黏膜切片 3, Oral tumor or oropharynx excision with radical neck dissection 口腔或口咽腫瘤切除, 併頸淋巴腺根除術 57, TONGUE CANCER EXCISION WITH LYMPHADENE.. 舌癌摘出術包括淋巴節切除及頸部清除術 54, SUPRAHYOID DISSECTION 舌骨上區清除術 33, EXCISION OF PARCTID TUMOR 耳下腺腫瘤切除術 24, HEMIGLOSSECTOMY 舌半切除術 17, TOTAL GLOSSECTOMY 舌全切除術 30, PAROTIDECTOMY, TOTAL LOBECTOMY 腮腺切除術全葉摘除 33, PAROTIDECTOMY,EXCISION 腮腺切除術 28, COMPOSITE RESECTION FOR ORAL CANCER 口腔腺難瘤切除術 39, 深頸部切開引流術 Deep neck incision & drainage 11, ESOPHAGEAL MYOMECTOMY 食道肌切開術 23, EXCISION OF ESOPHAGEAL DIVERTICULUM 食道憩窒切除術 31, ENDOESOPHAGEAL INTUBATION 食道內腔置管術 16, ESOPHAGOFUNDOSTOMY 食道胃底吻合術 57, RETROGRADE ESOPHAGEAL DILATATION(ESOPH.. 逆行食道擴張術 2, ESOPHAGOGASTRIC FISTULA CLOSURE 食道胃廔管縫合術 17, ESOPHAGECTOMY 食道切除術 68, ESOPHAGECTOMY & RECONSTRUCTION 食道切除再造術 80, ESOPHAGOTOMY 食道切開術 ( 經頸或經胸 ) 28, Esophageal reconstruction-with gastric tube 食道再造術 - 以胃管重建 67, REPAIR OF ESOPHAGEAL LACERATION 食道裂傷修補術 29, Simple excision of esophageal cancer, with lymphadenectomy 一般性食道癌摘除術 ( 含淋巴節清掃 ) 57, LIGATION OF ESOPHAGEAL VARICES,TRANSTH.. 食道靜脈瘤曲張結紮經胸或經腹 28, DEVASCULARIZATION PROCEDURE-TRANSABDOMINAL 食道靜脈瘤曲張結紮脾臟切除併近心端胃血管去除 - 經腹 35, E-G STENT FOR E OR C PORTION CA 胃食道內管留置 ( 胃賁門癌或食道癌 ) 21, Esophageal reconstruction-with colon 食道再造術 - 以大腸重建 51, Complicated excision of esophageal cancer, with lymphadenectomy 複雜性食道癌摘除術 ( 含淋巴節清掃 ) 81, Thoracoscopic Esophagectomy 胸腔鏡食道切除術 82, Thoracoscopic Esophagomyotomy (Heller myotomy) 胸腔鏡食道肌肉切開術 ( 註 :Heller type 為限 ) 27, GASTROTOMY, EXPLORATION 胃切開術 - 探查性 15, GASTROTOMY - REMOVAL OFF FOREIGN BODY 胃切除 - 異物移除 15,939 33/89

34 PYLOROMYOTOMY, FREDET-RAMSTEDT 幽門肌肉切開術 12, LOCAL EXCISION, ULCER OR TUMOR 胃潰瘍或腫瘤局部切除 20, GASTROSTOMY & PYLOROPLASTY 胃造廔術及幽門成形術 20, Subtotal gastrectomy or hemigastrectomy with gastro-duodenostomywithout vagotomy 次全或半胃.. 34, GASTRECTOMY,SUB.OR HEMI.-WITH VAGOTOMY 次全或半胃切除術 - 伴有迷走神經切 41, VAGOTOMY AND PYLOROPLASTY 迷走神經切斷術加幽門成形術 27, PYLOROPLASTY 幽門成形術 17, GASTRO-DUODENOSTOMY 胃十二指腸造口吻合術 19, GASTROJEJUNOSTOMY 胃空腸造口吻合術 20, GASTROJEJUNOSTOMY WITH VAGOTOMY 胃空腸造吻合術 ( 伴有迷走神經切斷 ) 24, GASTROSTOMY 胃造口術 15, DUODENORRHPAHY,SUTURE OF PERFORATED ULCE 十二指腸縫合術 ( 十二指腸潰瘍穿孔的縫合 ) 20, GASTRORRHAPHY,SUTURE OR REPAIR WOUND,.. 胃縫合術 ( 胃潰瘍穿孔及胃部傷口的縫合 ) 19, REVISION OF GASTRODUODENOSTOMY WITH... 胃十二指腸造再修正併或不併迷走神經切除 27, RE-EXPLORATION FOR POSTGASTRECTOMY BLE.. 胃切除後因出血再剖開 15, CLOSURE OF GASTROSTOMY 胃造口閉口 15, DUODENOSTOMY 十二指腸造口術 19, EXCISION OF DEUODENUM TUMOR 十二指腸腫瘤切除 18, EXCISION OR INVERSION OF DUODENAL DIVERTICULUM 十二指腸憩室切除或內翻 17, CLOSURE OF DUODENALFISTULA 十二指腸管閉合 23, VAGOTOMY 迷走神經切斷術 16, PROXIMAL GASTRECTOMY & ESOPHAGECTOMY & RECONSTRECTION 胃賁門及食道切除再 52, Total gastrectomy, with LN dissection, with reconstruction (any type) 全胃切除及淋巴清除及腸胃重建 52, REVISION OF GASTROJEJUNOSTOMY 胃空腸造口再修正 27, RESECTION OF RETAIMED ANTRUM, POSTGASTRECTOMY 殘留胃竇切除術 23, GASTRIC PARTITION 胃間隔術 32, TRANSDUODENAL SPHINTEROPLASTY 經十二指腸括約肌成形術 29, PLICATION OF STOMACH 胃折疊術 22, GASTROPEXY FOR GASTRIC VOLVULUS 胃固定術 21, 腹腔鏡胃隔間手術 Laparoscopic gastric partition 32, with suture repair of bleeding ulcer 潰瘍縫合及止血 22, Subtotal gastrectomy or hemigastrectomy with gastrojejunostomy-without vagotomy 次全或半胃.. 34, Roux-en-Y 型 - 無迷走神經切除... 次全或半胃切除術及胃空腸吻合術 30, % 胃切除及淋巴清除及腸胃重建 45, 次全胃切除及淋巴清除及腸胃重建 45, Laparoscopic subtotal gastrectomy 腹腔鏡胃亞全切除術 40, ENTEROLYSIS, FREEING ADHESION 腸粘連分離術 20, Enterolysis-with bowel decompression 腸粘連分離術 - 併行腸減壓 21, Enterolysis-with resection & anastomosis of intestine 腸粘連分離術 - 併腸切除及吻合 26, REDUCTION OF INTUSSUSCEPTION 腸套疊之還原 17, REDUCTION OF INTUSSUSCEPTION WITH BOWE.. 腸套疊還原及腸切除和吻合 24, REDUCTION OF INTUSSUSCEPTION WITH ENTE.. 腸套疊還原及腸造口或結腸造口 23,377 34/89

35 EXCISION, BENIGN BOWEL LESION 良性腸病灶切除術 18, MECKELS DIVERTICULECTOMY 邁克氏憩室切除術 17, RESECTION OF SMALL BOWEL,WITH ANASTOMOSI 小腸切除術加吻合術 23, COLECTOMY,PARTIAL,WITH ANASTOMOSIS 結腸部分切除術加吻合術 21, COLECTOMY,RADICAL HEMICOLECTOMY WITH... 根治性半結腸切除術加吻合術升 50, Left hemicolectomy or sigmoid colectomy 降結腸或乙狀結腸切除術加吻合術 33, Left hemicolectomy or sigmoid colectomy with anast 降結腸或乙狀結腸切除術併行吻合術及淋巴節清掃 51, Colectomy, total or subtotal 結腸全切或次全切除術 37, REVISION OF COLOSTOMY OR ENTEROSTOMY 結腸造口或腸造口矯正 10, Closure of enterostomy or Colostomy(loop or double-barrel) 蹄形小腸或結腸造廔管關閉 15, Enterostomy (including colostomy Jujunostomy permanent enterostomy) 腸造口術 ( 包括結腸. 空腸.. 18, Closure of intestinal fistula-enterocutaneous 小腸廔管關閉術 - 小腸與皮膚 20, Closure of intestinal fistula-entero-colic or entero-entero 小腸管關閉術 - 小腸與結腸 ( 或與小腸 ) 21, Closure of intestinal fistula-fistula of bowel with other organs or complicated 小腸廔管關閉術 23, ANASTOMOSIS OF BOWEL 腸吻合術 - 小腸與小腸 ( 十二指腸 ) 吻合術 18, ANASTOMOSIS OF BOWEL-ANASTOMOSIS OF... 腸吻合術 - 迴腸與結腸吻合術有間 23, REPAIR OF INTESTINAL PERFORATION 小腸穿孔縫補術 18, SUTURE AND REPAIR OF MESENTRY 腸系膜之縫合及修補 14, INTESTINAL PLICATION, NOBLE TYPE 小腸內切除術 18, TUBE ENTEROSTOMY OR TUBE CECOSTOMY 管腸造口或管盲腸造口 10, Take down of anastomosis, revision of ileo-colostomy and reconstruction 腸吻合處切除, 吻合重建術 21, Closure of enterostomy or colostomy anastomosis,by laparotomy 經由剖腹術行小腸或結腸造廔管關閉及吻合 20, Laparoscopic adhesionolysis 腹腔鏡腸粘連剝離術 24, Laparoscopic right colectomy and anastomosis 經腹腔鏡右側大腸切除術加吻 60, Laparoscopic Anterior resection and anastomosis 經腹腔鏡乙狀結腸切除術加吻合術 40, DRAINAGE OF APPENDICEAL ABSCESS TRANSABDOMINAL 闌尾膿瘍之引流 14, APPENDECTOMY 闌尾切除術 14, CLOSURE OF APPENDICEAL FISTULA 闌尾和關閉 19, Laparoscopic appendectomy 腹腔鏡闌尾切除術 17, INCISION & DRAINAGE FOR PERIPROCTAL ABSCESS 直腸周圍膿腫之切開引流 3, RECTAL INCISIONAL BIOPSY 直腸活體組織切片 4, REPAIR OF RECTAL LACERATION OR INJURY (REPAIR OF RECTAL FISTULA) 直腸裂傷或損傷之修補 21, RADICAL PROTECTOMY 根治性直腸切除術 57, HARMANN'S OPERATION 氏直腸手術 33, TRANSRECTAL COLONIC POLYPECTOMY 經直腸大腸息肉切除術 13, Rectal procidentia, perineal approach,with resection & anastomosis 直腸脫出根治 ( 經會陰接近及吻合 ) 23, Rectal procidentia, abdominal approach.. 直腸脫出手術 ( 腹部接近 ) 29, EXCISION,SACROCOCCYGEAL TUMOR,BENIGN 絖骨與尾骨腫瘤切除良性 17,912 35/89

36 EXTENSIVE EXCISION OF SACROCOCCYGEAL RECTAL VILLOUS ADENOMA OR... 直腸上皮絨毛腺腫廣泛性切除術或癌症 25, RECTOPLASTY FOR STRICTURE OR STENOSIS 直腸狹窄整形術 10, RESTORATIVE PROCTECTOMY WITH COLO-ANAL.. 復原性直腸切除以及直腸肛門吻 60,416 合術 RESTORATIVE PROCTOCOLECTOMY, PELVIC... 復原性大腸直腸切除迴腸儲存袋以及 63,452 迴 Combined abdomino perineal resection for rectal cancer 直腸癌腹部及會陰聯合切除術 62, PROCTOSIGMOIDECTOMY WITH PULL THROUGH COLON ANASTOMOSIS 乙狀結腸及直腸切除後 PULL THROUGH 51, Fistulotomy or fistulectomy,simple, subcutaneous 皮下廔管切開術或切除術 4, SPHINCTEROTOMY ANAL 肛門括約肌切開術 3, FISSURECTOMY OR ULCERECTOMY, ANAL 肛門裂縫切除術或潰瘍切除術 3, HEMORRHOIDECTOMY,PARTIAL,INTERNAL&EXTERN 內外痔部分切除術 6, PAPILLECTOMY ANAL - MULTIPLE 肛門乳突切除術 - 多數 3, HEMORRHOIDECTOMY,INTERNAL&EXTERNAL 內外痔完全切除術 13, ANAL FISTULECTOMY OR HEMORRHOIDECTOMY 肛門廔管切除或切開術併痔瘡切除 9, THROMBECTOMY, EXTERNAL HEMORRHOID 外痔血栓切除 3, ANOPLASTY FOR STRICTURE OR IMPERFORATE 肛門狹窄整形術 22, Sphincteroplasty for anal incontinence 肛門括約肌失禁整形術 30, Check anal or colon bleeding 結腸肛門止血術 3, Internal hemorrhoid ligation 內痔結紮 5, ANAL RECONSTRUCTION OR ANOPLASTY WITH S-PEDICLE GRAFT 肛門重建或整形術以 S 形蒂狀移植 21, Fistulotomy or fistulectomy,complicated, subcutaneous 複雜性皮下廔管切開術或切除術 8, WEDGE BIOPSY OF LIVER, LAPAROTOMY 楔狀活體切片 ( 剖腹探查術 ) 18, PARTIAL HEPATECTOMY 肝部分切除術 33, ONE SEGEMENT HEPATECTOMY 肝一區域切除術 38, TWO SEGEMENT HEPATECTOMY 肝二區域切除術 41, THREE SEGEMENT HEPATECTOMY 肝三區域切除術 62, DRAINAGE OR MARSUPIALIZATION OF CYST... 肝囊腫或肝膿瘍引流或造袋術 19, HEPATORRHAPHY, SUTURE OF LIVER WOUND<5CM 縫肝術 ( 肝損傷縫合小於 5 公 21,252 分 ) HEPATORRHAPHY,WITH COMMON DUCT OR... 縫肝術及總膽管或膽囊之引流術 28, HEPATORRHAPHY, SUTURE OF LIVER WD COMPLICATED OR >5CM 縫肝術 ( 複雜肝損傷之縫合或大於 5 公分 ) 23, TOTAL RIGHT LOBECTOMY 右肝葉切除術 52, TOTAL LEFT LOBECTOMY 左肝葉切除術 46, EXTENDED RT LOBECTOMY 擴大右肝葉切除術 75, EXTENDED LT LOBECTOMY 擴大左肝葉切除術 74, LIVER(HEPATIC) TRANSPLANTATION 肝臟移植 500, CADAVERIC LIVER HARVEST(DONOR HEPATECTOMY) 屍體捐肝摘取 71, CHOLECYSTOSTOMY (HEPATICOSTOMY) 膽囊造廔術 17, CHOLECYSTECTOMY 膽囊切除術 23, Choledochojejunostomy 總膽管空腸吻合術 27, CHOLECYSTOENTEROSTOMY 膽囊消化管吻合術 21, TOTAL EXCISION OF CBD 總膽管全切除行 29,146 36/89

37 CHOLEDOCHOTOMY WITH T-TUBE DRAINAGE 總膽管切開及 T 型管引流 26, CHOLEDOCHOLITHOTOMY WITH T-TUBE... 總膽管切開摘石術及 T 形管引流 41, CHOLEDOCHOPLASTY 膽管成形術 29, BIOPSY OF BILIARY TRACT 膽道組織檢查切片術 8, CHOLEDOCHODUODENOSTOMY 總膽管十二指腸吻合術 27, PLASTY OF EXTRAHEPATIC BILE DUCT 肝外膽管成形術 32, CLOSURE OF BILIARY FISTULA 肝廔管縫合術 26, LAPAROSCOPIC CHOLECYSTECTOMY 腹腔鏡膽囊切除 25, ROUX-EN-Y 總肝管腸吻合術 ROUX-EN-Y hepaticojejunostomy 22, Laparoscopic choledocholithotripsy 腹腔鏡膽管截石術 30, DIAINAGE OF PANCREATIC ABSCESS OR PANCREATITIS 胰臟膿瘍或胰炎引流術 16, PANCREAS INCISIONAL BIOPSY 胰組織檢查切片 15, EXCISION OR ENUCLEATION OF PANCREATIC... 胰臟腫瘤或囊腫切除或摘除術 23, DISTAL PARTIAL PANCREATE 胰臟尾端切除術 22, PANCREATIC FISTULECTOMY 胰切除術 23, ANASTOMOSIS OF PANCREATIC CYST TO GI... 胰囊腫至腸胃道之內部直接引流吻合 23, PANCREATECTOMY SUBTOTAL 胰臟次全切除術 28, TOTAL PANCREATECTOMY (95%) 胰臟全切除術 42, PANCREATICO-DUODENECTOMY, WHIPPLE TYPE,.Whipple 氏胰十二指腸切除術 78, PANCREATICO-JEJUNOSTOMY 胰臟空腸吻合術 30, MARSUPIALIZATION OF PANCREATIC CYST 胰囊腫造袋術 21, 胰臟尾端部分切除術 - 脾臟保留 26, 屍體胰臟器官移植 Cadaver Pancreas Transplant 355, 屍體捐胰摘取 Pancreas Harvest 215, EXCISION OF ABDOMINAL WALL - BENIGN 腹壁腫瘤切除術 - 良性 11, EXCISION OF ABDOMINAL WALL - MALIGNANT 腹壁腫瘤切除術 - 惡性 24, REPAIR OF VENTRAL HERNIA-WITH BOWEL RESECTION 腹壁疝氣修補術 - 併腸切除 22, REPAIR OF VENTRAL HERNIA-WITHOUT BOWEL.. 腹壁疝氣修補術 - 無腸切除 18, REPAIR OF ING.HERNIA-WITH BOWEL RESECTIO 01Y99 鼠蹊疝氣修補術 - 併腸切 22, REPAIR OF INGUINAL HERNIA-WITHOUT... 01Y99 鼠蹊疝氣修補術 19, REPAIR OF LUMBAR HERNIA 腰椎疝氣修補術 17, 腹腔膿瘍灌洗 Peritoneal toilet 2, 腹腔鏡疝氣修補術 Laparoscopic herniorrhaphy 13, 腹壁疝氣修補術, 嵌頓性 - 無腸切除 20, 腹壁疝氣修補術, 復發性 - 無腸切除 20, 鼠蹊疝氣修補術, 嵌頓性 - 無腸切除 20, 鼠蹊疝氣修補術, 復發性 - 無腸切除 21, 股疝氣修補術 - 無腸切除 17, DRAINAGE OF INTRAABDOMINAL ABSCESS FOR.. 腹腔內膿瘍引流術治療急性穿孔性腹膜炎 20, DRAINAGE OF SUBPHRENIC ABSCESS 膈下膿瘍引流術 19, DRAINAGE OF PELVIC ABSCESS-TRANSABDOMIN 骨盆腔膿瘍引流術 - 經腹 16, DRAINAGE OF PELVIC ABSCESS-TRANSANAL 骨盆腔膿瘍引流術 - 經肛門 8, EXPLORATORY LAPAROTOMY 剖腹探查術 19, EXCISION OF INTRAABDOMINAL TUMOR, BENIGN 腹腔良性腫瘤切除術 22, EXCISION OF RETROPEROTONNEAL TUMOR BENI 後腹腔良性腫瘤切除術 28, REMOVAL OF INTRAABDOMINAL FOREIGN BODY 腹腔內異物卻除術 15, RETROPERITONEAL EXPLORATORY LAPAROTOMY 後腹腔剖腹探查術 17,912 37/89

38 EXCISION OF INTRAABDOMINAL TUMOR,MALIGNANT 腹腔惡性腫瘤切除術 26, EXCISION OF RETROPERITONEAL,MALIGNANT WITH RETROPERITONEAL... 後腹腔惡性腫瘤切除術併後後腹腔淋巴腺 33, PERITONEO-VENOUS SHUNT 腹腔靜脈分流術 19, EXCISION OF URACHAL DUCT OR FISTULA... 臍尿管或廔管切除術與與部分膽囊切除術 18, REPAIR OF ABDOMINAL WALL INJURY-SIMPLE.. 腹壁損傷修復術 - 簡單 15, REPAIR OF ABDOMINAL WALL INJURY-EXTENS.. 腹壁損傷修復術 - 廣泛性 23, SUTURE OF ABDORMINAL WALL FOR EVISCERA.. 腹壁縫合裂開剜臟術第二次縫合 14, DRAINAGE ABSCESS PERIRENAL OR RENAL 腎周圍或腎臟腫瘤引流術 11, OPEN RENAL BIOPSY 腎臟切片手術 12, NEPHRECTOMY 腎切除術 20, PARTIAL NEPHRECTOMY 腎部分切除術 28, DECAPSULATION CYST KIDNEY,UNILATERAL 腎囊切除術單側 11, Radical nephrectomy with lymphadectomy,or with regional LND 根治性腎切除術併行淋巴清掃術 25, NEPHROPEXY FIXATION OR SUSPENSION 腎臟固定術 : 固定式懸掛 11, NEPHRO-PYELOLITHOTOMY 腎內取石及腎盂取石術 18, STAG-HORN STONE NEPHRO-PYELOLITHOTOMY 腎鹿角石取石術 25, PYELOPLASTY 腎盂成形術 25, PERCUTANEOUS NEPHROSTOLITHOTOMY(PCNSL) 經皮腎結石取石術 27, NEPHROSCOPE(INCLUD 2 SURGICAL OP PCNSL) 經 PCN 腎臟鏡術 14, NEPHRECTOMY FROM CADAVER DONOR 屍體捐腎切除術 122, RENAL IMPLANTATION 腎臟移植 120, 腹腔鏡腎切除術 23, 內視鏡腎盂切開術 Endoscopic pyelotomy 12, Nephroureterectomy without bladder cuff excision 腎輸尿管切除術, 不包括輸尿管膀胱袖口切除術 30, Nephroureterectomy with bladder cuff excision 腎輸尿管切除術, 包括輸尿管膀胱袖口切除術 37, Radical nephrectomy 根治性腎切除術 25, (Retroperitoneoscopy) Laparoscopy, Renal cyst unroofing ( 後 ) 腹腔鏡腎臟囊腫除頂術 14, Nephroureterectomy ( 後 ) 腹腔鏡腎臟輸尿管切除術 36, (Retroperitoneoscopy) Laparoscopy, Partial nephrectomy( 後 ) 腹腔鏡部分腎臟切除術 34, (Retroperitoneoscopy) Laparoscopy, Pyeloplasty ( 後 ) 腹腔鏡腎盂成形術 30, URETEOLITHOTOMY-UPPER OR LOWER 1/3 輸尿管除 ( 取 ) 石術 - 上或下 1 3 輸尿 15, URETEOLITHOTOMY-1/3 MIDDLE 輸尿管除 ( 取 ) 石術 - 中 1 3 輸尿管 13, URETERECTOMY,WITH BLADDER CUFF 輸尿管切除術包括膀胱袖口 20, URETEROPLASTY-UNILATERAL 輸尿管成形術 - 單側 14, URETEROLYSIS-UNILATERAL 輸尿管剝離術 - 單側 14, URETEROLYSIS-BILATERAL 輸尿管剝離術 - 雙側 17, URETEROPYELOSTOMY OR URETEROPYELOPLASTY 輸尿管腎盂造口吻合術或重建術 24, URETEROURETEROSTOMY 輸尿管和輸尿管吻合術 24, URETERONEOCYSTOMY-UNILATERAL 輸尿管膀胱重建術 - 單側 24, URETERONEOCYSTOMY-BILATERAL 輸尿管膀胱重建術 - 雙側 28, URETEROSTOMY,UNI. TRANSPLANT..-UNILATERA 輸尿管皮膚吻合術 - 單側 13, CLOSURER FISTULA,URETEROCUTANEOUS 表皮輸尿管管閉合術 14,269 38/89

39 URETER CATHETERIZATION 輸尿管插管術 ( 手術中插管不另支付 ) 5, INTERNAL DILATATION URETER STRICTURE 輸尿管狹窄內擴張術 5, URETHROSCOPY & REMOVAL URETERAL STONE - SIMPLE ENDOSCOPIC 輸取管鏡取石術及碎石術 - 單純內視鏡操作方式 11, URETEROSCOPY&REMOVAL..STONE-SONO/EHL 輸尿鏡取石術併超音波或電擊方式 18, URETEROSCOPY & REMOVAL OF URETERAL STONE-WITH ND-YAR LASER 輸尿管鏡取石術及碎石術 - 併用雷射治療方式 ( 15, Abdominal perineal urethral suspension (APUS) 腹式會陰尿道懸吊術 23, 腹腔鏡輸尿管取石術 Ureterolithotomy 14, 經內視鏡輸尿管切開術 Endoscopic ureterotomy 15, 經尿道輸尿管憩室切開術 Transurethral incision of ureterocele 12, CYSTOSTOMY-OPEN METHOD 膀胱造口術 - 10, CYSTOSTOMY-TROCAR METHOD 膀胱造口術 6, CLOSURE OF CYSTOSTOMY 膀胱造閉合 9, CYSTOLITHOTOMY 膀胱取石術 9, CYSTOTOMY FOR SIMPLE EXCISION OF BLADD.. 單純膀胱頸切除 10, CYSTOTOMY FOR EXCISION OF BLADDER TUMOR-TURB TUMOR RESECTION 膀胱腫瘤之切除 - 內視鏡下 16, CYSTOTOMY FOR EXCISION OF BLADDER TUMOR-OPEN METHOD 膀胱腫瘤之切除 - 手術 13, PARTIAL CYSTECTOMY 膀胱部分切除術 19, TOTAL CYSTECTOMY W/O LD-WITH CYSTO 膀胱全部切除術 - 有人造膀胱 45, Cystectomy with pelvis LND without urethrectomy without bladder reconstruction 35, TOTAL CYSTECTOMY,WITH LYMPHA..-WITH CYST 膀胱全部切除術併淋巴節切除術 - 有人造膀胱 58, CYSTOURETHROPLASTY WITH UNILATERAL OR.. 膀胱尿道成形術併單側或雙側輸尿管膀胱吻合 21, CYSTORRHAPHY 膀胱縫合術 11, CL.FISTULA,VERICOVAGINAL ABDOMINAL APP.. 膀胱陰道管閉合術由腹部開刀 21, CUTANEOUS VESICOSTOMY 皮膚膀胱造口術 12, TUR FOR BLADDER NECK 女經尿道膀胱頸切除術 7, Endoscopic cystolitholapaxy, simple crushing of calculus in bladder and remove( 註 : 結石 < 1cm) 9, Endoscopic cystalitholapaxy, complicated( 註 : 結石 >1cm) 碎石洗出術複雜性或大結石石 10, Transabdominal urinary incontinence surgery 腹式尿失禁手術 10, Transvaginal urinary incontinence surgery( 含 Kelly plication) 陰道式尿失禁手術 8, Colposuspension or Burch operation 陰道懸吊術 19, CYSTOURETHROSCOPY WITH DILATION OF BLA.. 間質性膀胱炎尿道鏡擴張術 5, 膀胱破裂修補術 Repair of bladder rupture 14, Augmentation of U-B with intestine 小腸膀胱增大術 23, 膀胱懸吊術 Suspension of urinary bladder 13, Artificial urinary sphincter implantation 尿道人工擴約肌植入術 20, Cystectomy with pelvis LND with urethrectomy without bladder 46, 膀胱腫瘤之切除 - 內視鏡下 -- 含膀胱鏡檢及輸尿管鏡檢查 17, REMOVE OF URETHRAL STONE OR F.B. 尿道結石 ( 異物 ) 除去術 8, REPAIR OF URETHRAL STRICTURE-ANTERIOR.. 尿道狹窄修補手術 - 前段尿道 13, URETHROPLASTY,FORMATION OF URETH..-URINA 尿道整形術 - 包括陰莖或陰囊轉換 17,305 39/89

40 Urethroplasty, formation of urethral as Dennis Brown type procedure- 重複 repeat procedure 22, POLYPECTOMY,EXTERNAL URETHRAL 外尿道口息肉切除術 4, URETHROSTOMY 尿道造廔術 6, URETHRAL DIVERTICULECTOMY,ANTERIOR(POS.. 尿道憩室手術 - 前 ( 後 ) 部尿道 10, OTIS URETHROTOMY 尿道內切開術 6, OPITIC URETHROTOMY 直視下尿道切開術 8, REPAIR OF URETHRAL RUPTURE-POSTERIOR 尿道破裂手術 - 後段尿道 14, OPERATION FOR HYPOSPADIA-GLANDULAR TYPE 尿道下裂手術 17, OPERATION FOR HYPOSPADIA-OTHERS 尿道下裂手術 - 其它 24, 經尿道前列腺切開術 TUI(Transurothral incision of prostate) 12, 尿道腫瘤切除術 Resectionof urethral urethral tumor 9, Repair of urethral cutanous fistula 修補尿道皮? 術 9, Repair of ruptured corpus cavernosum, bilateral 雙側海棉體破裂修復術 14, Urethral fistulectomy (anterior) 尿道? 管修補術 ( 前段 ) 9, 尿道周膿瘍切開引流術 I&D for peri-urethral abscess 4, BIOPSY PENIS 陰莖切片 4, PARTIAL AMPUTATION OF PENIS 陰莖部分切除術 9, PENIS REPAIR FOR SEVERE TRAUMA 陰莖重度創傷修補術 14, HYDROCELECTOMY 陰囊水腫切除術 10, REMOVAL OF FOREIGN BODY,SCROTUM 陰囊異物移除 7, RESECTION OF SCROTUM 陰囊切除術 8, Nesbit procedure for curvature of penis 芮斯比氏治療陰莖彎曲術 11, 陰囊修補術 Scrotal repair 6, 陰囊膿瘍切開引流術 I&D for scrotal abscess 4, TESTIS BIOPSY-INCISIONAL,UNILATERAL 睪丸切片 - 單側切開 3, TESTIS BIOPSY-INCISIONAL,BILATERAL 睪丸切片 - 雙側切開 5, ORCHIECTOMY-UNILATERAL(TESTICLE LESION.. 睪丸切除術 - 單側 10, ORCHIECTOMY-BILATERAL(TESTICLE LESION... 睪丸切除術 - 雙側 12, ORCHIOPEXY-UNITERAL 睪丸固定術 - 單側 11, ORCHIOPEXY-BILATERAL (WITH OR NOT HEERNI 睪丸固定術 - 雙側 ( 併或不併疝氣修補 ) 18, Orchiopexy for undescended testis,unilateral 隱睪單側睪丸固定術 16, ORCHIDECTOMY FOR MALIGNANT TUMOR 睪丸惡性腫瘤高位切除術 10, Orchiopexy for undescended testis,bilateral 隱睪雙側睪丸固定術 20, EPIDIDYMECTOMY-BUNILATERAL 副睪丸除術 - 單側 9, EPIDIDYMO-VASOSTOMY-BILATERAL 輸精管副睪丸吻合術 - 雙側 18, 副睪丸膿瘍切開引流 I & D forepididymal abscess drainage 6, VASOTOMY,UNILATERAL OR BILATERAL 輸精管切開單側或雙側 5, EXCISION LESION,SPERMATIC CORD 精索切除 6, VARICO-CELECTOMY 精索靜脈瘤手術 9, High ligation or internal spermatic vein for varicocele 精索靜脈高位結紮 11, Laparoscopic high ligation of internal spormatic vein 腹腔鏡精索靜脈曲張 6, BIOPSY PROSTATE(PUNCH) 前列腺切片 - 控取式 3, PROSTATECTOMY RADICAL 前列腺根治術 35, TUR of prostate gland-turp 5-15gms 經尿道攝護腺切除術 - 切除攝護腺重量 5-15 公克 22, TUR FOR PROSTATE GLAND BX 經尿道前列腺切片術 8, ABSCESS DRAINAGE PROSTATIC 前列腺膿瘍切開引流 7,742 40/89

41 Radical prostatectomy with bilateral pelvic lymph node dissection 46, TUR of prostate gland-turp gms 經尿道攝護腺切除術 - 切除攝護腺重量公克 26, TUR of prostate gland-turp>50 gms 經尿道攝護腺切除術 - 切除攝護腺重量大於 50 公克 30, Incision and drainage of perineal abscess (Non-obstetric) 會陰囊腫切開引流 ( 非產科 ) 2, REPAIR OF PERINEUN 會陰修補 3, 女陰白斑切除術 Excision of genital leukoderma 2, Repair of perinueum with repair of anal defects 會陰修補及肛門損傷修補 7, Repair of perinueum with sphincter repair 會陰修補及括約肌修補 6, Extended drainage of external genital abscess 廣泛性外陰膿瘍引流術 4, Marsupialization of Bartholins gland cyst 巴氏腺囊腫造袋術 3, EXCISION OF BARTHOLIN GLAND 巴氏腺囊切除術 3, VULVECTOMY 女陰切除術 - 未合併皮膚或組織重建 14, Extensive clitoridectomy 廣泛陰蒂切除術 3, HYMENOTOMY 處女膜切開術 1, RADICAL VULVECTOMY 根治女陰切除術 45, VULVECTOMY 女陰切除術 - 合併皮膚或組織重建 20, Vaginotomy or drainage of pelvic abscess 陰道切開探查術或骨盆腔膿腫引流 4, EXCISION OF VAGINAL CYST 陰道囊腫切除術 6, RESECTION OF VAGINAL SEPTUM 陰道中膈切除術 4, Vaginal wall repair (Non-obstetric) 陰道縫合術 ( 縫合陰道損傷, 非產科 ) 6, COLPOPERINEORRHAPHY,SUTURE OF INJURY.. 陰道會陰縫合術 : 縫合陰道及會陰損 7, COLPORRHAPHY,ANTERIOR 前側陰道縫合術 6, COLPORRHAPHY,POSTERIOR 後側陰道縫合術 5, Anterior and posterior colporrhaphy 前後側陰道縫合術 9, Anterior and posterior colporrhaphy, (including repair of enterocele) 前後側陰道縫合術含腸膨出修補術 11, Transabdominal colpopexy 從腹腔進入陰道固定術 14, DILATION VAGINA-UNDER ANESTHESIA 麻醉下之陰道擴張術 1, LAPAROSCOPY OPERATIVE 腹腔鏡手術 10, COLPECTOMY-PARTIAL RESECTION OF VAGINA 陰道切除術 - 陰道部分切除 8, COLPECTOMY-COMPLETE RESECTION OF VAGINA 陰道切除術 - 陰道全部切除 12, LEFORT COLPOCLEISIS 陰道閉合術 10, Reconstruction of vagina (vaginal stenosis or vaginal defects,without skin graft) 人工陰道重建術 16, Reconstruction of vagina (vagina stenosis or vaginal defects, with skin, colon or o 人工陰道重建術 26, RECTO-VAGINAL FISTULA REPAIR 直腸陰道廔管修補術 18, URETHRAL VAGINAL FISTULA 尿道陰道廔管修補術 11, VESICO VAGINAL FISTULA 膀胱陰道廔管修補術 12, 經陰道骨盆底重建手術 ( 含子宮切除術陰道懸吊術陰道前後壁修補含子宮切除術但不含尿失禁手術 ) 29, 經陰道骨盆底重建手術 ( 陰道懸吊術陰道前後壁修補不含尿失禁手術 ) 23, 腹腔鏡式骨盆腔子宮內膜異位症電燒及切除 - 中度 : 子宮內膜異位症分級指數 6 至 17, 陰道切除術 - 陰道全部切除, 腹式合併陰道式 14, 腹腔鏡式骨盆腔子宮內膜異位症電燒及切除 - 重度 : 子宮內膜異位症分級指數大於 23, 再次直腸陰道管修補術 19,886 41/89

42 經腹腔之骨盆底重建手術 23, TRACHELECTOMY(CERVICECTOMY) 子宮頸切除術 4, TRACHELOPLASTY 子宮頸整形術 4, Cervical cerclage 子宮頸縫合術 5, Dilation and curettage of cervical stump 子宮頸殘餘部擴張刮除術 2, Cervical conization 5, CERVICAL AMPUTATION 子宮頸切斷術 4, CERVICAL POLYPECTOMY 子宮頸蒂瘤切除術腹式子宮頸切除術 9, 根除式子宮頸切除術 49, Diagnostic or therapeutic dilation and curettage (Non- obstetric)( 非產 3, MYOMECTOMY 子宮肌瘤切除術 16, TOTAL HYSTERECTOMY 子宮完全切除術 ( 經腹部或經陰道 ) 21, SUBTOTAL HYSTERECTOMY 子宮次全切除術 15, LYSIS OF PELVIC (ABDOMINAL) ADHESION 骨盆腔粘連分離術 6, Uterine suspension 子宮頸懸吊術 8, HYSTERORRHAPHY 子宮縫合術 13, Metroplastic surgery 子宮整形術 19, Extended hysterectomy 廣泛性全子宮切除術 40, HYSTERECTOMY RADICAL CERVICAL CANCER 子宮頸癌全子宮根除術 59, HYSTEROSCOPIC MYOMECTOMY(TRANSCERVICAL RESECTION OF MYOMA) 子宮鏡子宮肌瘤切除術 27, Laparoscopy hysterectomy 腹腔鏡全子宮切除術 34, BSO+OMENTECTOMY+ATH+RETROPERITONEAL 婦癌分期手術 45, (BSO+OMENTECTOMY+ATH+RETROPERITONEAL LYMPHADENECTOMY)+RADICAL DISS 婦癌減積手術 60, LAPAROTOMY OF ABDOMEN FOR "2ND LOOK" 婦癌二次剖腹探查術 26, 複雜性子宮肌瘤切除術 23, 複雜性全子宮切除術 ( 經腹部或經陰道 ) 27, 子宮鏡移除異物或瘜肉 14, 子宮鏡剝離子宮腔黏膜或子宮內膜電燒 18, 腹腔鏡式婦癌分期手術 47, 腹腔鏡子宮肌瘤切除術 34, SALPINGOPLASTY 輸卵管整形術 15, 輸卵管剝離術 Salpingolysis with microscopic 9, 輸卵管吻合術 End to end anastomosis 註 : 結紮後重建者, 非屬本保險給付範圍 23, 輸卵管造口術 Salpingostomywithout microscopic 15, OOPHORECTOMY WITH TOTAL OMENTECTOMY 卵巢切除術附加大網膜切除術 27, OOPHORECTOMY,PARTIAL OR TOTAL 卵巢部分或全部切除術 13, Incision and drainage of ovarian abscess 卵巢膿瘍切開引流術 11, BIOPSY OVARY,INCISIONAL 卵巢部分切片術 5, LAPAROSCOPIC OOPHORECTOMY(PARTIAL OR TOTAL) 腹腔鏡卵巢部分或全部切除術 25, REMOVAL OF HYDATIDIFORM MOLE 葡萄胎除去術 10, Ectopic pregnancy operation 子宮外孕手術 14, MANUAL REMOVAL OF PLACENTA 胎盤取出術 2, CESAREAN SECTION 剖腹產術 17, C/S WITH HYSTERECTOMY SUBTOTAL(TOTAL) 剖腹產合併次全 ( 全 ) 子宮切除術 26, D&C ( < OR = 12. WEEKS ) 妊娠前十二週流產刮宮術 5, D&C (>12 WEEKS) 妊娠超過十二週流產或死胎刮宮術 8,501 42/89

43 Hysterotomy for termination of pregnancy 子宮切開流產術 15, Medical induction for fetal death (12-24 weeks) 死胎之引 (12-24 週 ) 8, Medical induction for fetal death (after 24 weeks) 死胎之引產 ( 超過 24 15, PELVIC EXENTERATION-TOTAL OR ANTERIOR OR POSTERIOR 骨盤腔臟器摘除術 91, EXCISION & ELECTRIC COAGULATION OF PELVIC ENDOMETRIOSIS 骨盆腔子宮內膜異位症電燒及切除 9, PRE-SACRAL SYMPATHECTOMY, WITHOUT OTHER PROCEDURE 薦骨前神經截斷術 10, NORMAL VAGINAL DELIVERY 接生費 ( 含會陰切開縫合術及胎盤剝離 ) 17, LAPAROSCOPIC ECTOPIC PREGNANCY 腹腔鏡子宮外孕手術 25, Debulking operation for pelvic cancer 骨盆腔惡性腫瘤消滅術 24, 子宮內膜電燒及切除術 Eendometrial ablation or transcervical endometrial resection 9, 前置胎盤或植入性胎盤之剖腹產術 23, 剖腹產合併全子宮切除術 26, 引產無效後之流產或死胎刮宮術 8, 子宮內管括除術 1, 骨盆腔子宮內膜異位症, 電燒及切除 - 中度 : 子宮內膜異位症分級指數 6 至 40 分 13, 骨盆腔子宮內膜異位症, 電燒及切除 - 重度 : 子宮內膜異位症分級指數大於 40 分 17, 腹腔鏡式薦骨前神經截斷術 11, UNILATERAL SUBTOTAL THYROIDECTOMY 單側次全甲狀腺切除術 13, BILATERAL SUBTOTAL THYROIDECTOMY 雙側次全甲狀腺切除術 20, EXCISION OF THYROID CYST OR THYROYGLOS.. 甲狀腺囊腫或甲狀舌囊腫切除術 14, 單側甲狀腺全葉切除術 20, NECK LYMPH NODE DISSECTION - UNILATERAL 頸部淋巴腺刮除術 - 單側 18, NECK LYMPH NODE DISSECTION - BILATERAL 頸部淋巴腺刮除術 - 雙側 35, PARATHYROIDECTOMY 副甲狀腺切除術 18, RADICAL THYROIDECTOMY WITH UNILATERAL... 根治性甲狀腺切除術 - 含單側頸部淋巴腺切除 33, ADRENALECTOMY, UNILATERAL 腎上腺切除術單側 20, ADRENALECTOMY WITH RETROPERITONEAL..-UNI 腎上腺切除術合併後腹腔腫瘤切除 - 單側 22, Adrenalectomy 腹腔鏡腎上腺切除 20, 單側甲狀腺全葉切除術及另一側次全甲狀腺切除術 25, 雙側甲狀腺全葉切除術 27, Parathyroidectomy re-exploration 再次副甲狀腺切除術 25, MICROVASCULAR DECOMPRESSION 腦微血管減壓術 39, LAMINECTOMY FOR DECOMPRESSION<=2SEGMENTS 椎弓切除術 ( 減壓 )- 二節以內 22, LAMINECTOMY FOR RECOMPRESS >2 SEGMENTS 椎弓切除術 ( 減壓 ) 超過二節 32, SUBTEMPORAL DECOMPRESSION-UNILATERAL 脅下減壓術 - 單側 22, Decompression of mediun of ulnar nerve at wrist-unilateral 正中神經或尺神經腕部減壓術 - 單側 8, Decompression of mediun of ulnar nerve at wrist-bilateral 正中神經或尺神經腕部減壓術 - 雙側 16, DEPRESSED FRACTURE OF SKULL, SIMPLE... 凹陷性顱骨骨折之手術 - 簡單骨折 17, DEPRESSED FRACTURE OF SKULL-OPEN FRACTUR 凹陷性顱骨骨折之手術 - 開放骨折 21, BURR HOLE(TREPHINATION)FOR HEMOSTASIS,.. 頭顱穿洞術 ( 止血引流穿刺檢 7, BURR HOLE (TREPHINATION) HEMOSTASIS, DRAIN.OR.PUNCT.-ONE HOLE ADD 頭顱穿洞術 ( 止血引流穿刺 ) 每加一孔 5, CRANIECTOMY 顱骨切除術 22,315 43/89

44 CRANIOPLASTY 頭顱成形術 20, BRAIN TUMOR(I.C.T. /CEPHALOCELE)-<4HRS 腦瘤切除 - 手術時間在 4 小時以內 46, BRAIN TUMOR(I.C.T./CEPHALOCELE)OP 4-8HRS 腦瘤切除 - 手術時間 4-8 小時 66, BRAIN TUMOR(I.C.T /CEPHALOCELE)->8 HRS 腦瘤切除 - 手術時間在 8 小時以上 70, CERVICAL DISKECTOMY 椎間盤切除術 - 頸椎 40, DISKECTOMY THORACIC 椎間盤切除術 - 胸椎 32, DISKECTOMY LUMBAR 椎間盤切除術 - 腰椎 26, LUMBAR SYMPATHECTOMY 腰交感神經切斷術 16, NEURECTOMY 神經切斷術 9, Neurolysis 神經分離術 - 肩臀關節以上, 包括臂神經叢, 坐骨神經 18, Nerve graft 神經移植 - 肩臀關節以上, 包括臂神經叢, 坐骨神經 33, LAMINO PLASTY 椎弓整形術 32, Nerve repair 神經修補 - 肩臀關節以上, 包括臂神經叢, 坐骨神經 23, FAICIAL HYPOGLOSSAL NERVE ANASTOMOSIS 顏面舌下神經吻合術 24, REMOVAL OF EPIDURAL HEMATOMA 硬腦膜外血腫清除術 27, REMOVAL OF ACUTE SUBDURAL HEMATOMA 急性硬腦膜下血腫清除術 31, REMOVAL OF CHRONIC SUBDURAL HEMATOMA 慢性硬腦膜下血腫清除術 21, REMOVAL OF INTRACEREBRAL HEMATOMA 腦內血腫清除術 35, BENIGN INTRASPINAL TUMOR,EXCISION 良性脊髓腫瘤切除術 46, MALIGNANT INTRASPINAL TUMOR, EXCISION 惡性脊髓腫瘤切除術 48, INTRASPINAL INTRAMEDULLARY TUMOR,EXCISIO 脊椎內脊髓內腫瘤切除術 53, Spinal fusion-anterior spinal fusion(without spinal instrumentation- 4 motion segments) 30, Spinal fusion-anterior spinal fusion(with spinal instrumentation - 4 motion segments) 38, posterior spinal fusion-without spinal instrumentation ( 後融合 - 有固定物 27, posterior spinal fusion-with spinal instrumentation( 六節 ) 後融合 - 有固定物 39, REPAIR OF MENINGOCELE OR ENCCPHALOCELE 腦膜或脊髓膜突出修補術 34, SCALP TUMOR 頭皮腫瘤 ( 包括頭皮縫合 ) 8, V-P SHUNT 腦室腹腔分流術 21, V-A SHUNT 水腫症腦室心房分流手術 21, EXTERNAL VENTRICULAR DRAINAGE 腦室體外引流 8, OMAYA RESERVOIR IMPLANTATION 歐氏貯囊置放手術 9, EXTERNAL LUMBAR CISTERNAL DRAINAGE 腰椎腦脊髓液池體外引流 6, TRANSPHENOIDAL REMOVAL OF PITUITARY... 經由蝶竇之腦下垂體瘤切除 50, CRANIOTOMY FOR VASCULAR LESIONS-ANEURYSMS-SYMPTOMATIC 開顱術摘除血管病變 - 腦血管瘤 - 有病徵的 93, CRANIOTOMY VASCULAR LESIONS-ARTERIOVENOUS MALFORMATIONS-SMALL,DEEP 開顱摘除血管病變 - 動靜脈畸型 - 小型 84, CRANIOTOMY FOR VASCULAR LESIONS-AVM MEDIUM-DEEP 開顱術摘除血管病變 - 動靜脈畸型 - 中型深部 108, CRANIOTOMY FOR VASCULAR LESIONS-AVM-LARGE 開顱術摘除血管病變 - 動靜脈畸型 - 大型 120, EXCISION OF INTRASPINAL AVM-<=2 SEGMENTS 脊椎腔內動靜脈畸型切除術 - 二節以內 ( 限神經外科專科醫師施行 ) 72, EXCISION OF INTRASPINAL AVM-> 2 SEGMENTS 脊椎腔內動靜脈畸型切除術 - 超過二節 ( 限神經外科專科醫師施行 ) 84, RADIOFREQUENCY COAGULATION 高頻熱凝療法 10,778 44/89

45 ICP MONITORING 顱內壓監視置入 ( 限神經外科專科醫師施行 ) 14, STEREOTAXIC PROCEDURE-FOR BIOPSY 立體定位術 - 切片 36, STEREOTAXIC PROCEDURE-FOR ASPIRATION 立體定位術 - 抽吸 36, STEREOTAXIC PROCEDURE-FOR FUNCTIONAL... 立體定位術 - 功能性失調 50, TRANSENDOSCOPIC DORSAL SYMPATHECTOMY 內視鏡胸交感神經切除術 8, 顏面神經減壓術 Facial nerve decompression 22, Skull Base Tumor Surgery 顱底瘤手術 156, Neurolysis 神經分離術 - 上臂前臂大腿小腿處之神經 15, Neurolysis 神經分離術 - 手足的神經 14, Nerve graft 神經移植 - 上臂前臂大腿小腿處之神經 36, Nerve repair 神經修補 - 上臂前臂大腿小腿處之神經 19, Nerve repair 神經修補 - 手足的神經 16, posterior spinal fusion-with spinal instrumentation( 每增加六節 ) 後融合 - 有固定物 29, Never transfer 神經移轉手術 - 上肢腕下肢足踝關節以上, 神經的轉移 14, I & D FOR AURICLE ABSCESS OR HEMATOMA 耳介膿瘍或血腫切開引流術 5, EAR CANAL FOREIGN BODY REMOVAL, WITH... 外耳道異物除去術使用耳道鏡並有麻醉 2, MYRINGOTOCMY WITH T.D. PLUNGERT D 傳統耳膜切開術 1, EXCISION OF PREAURICULAR FISTULA OR CYST 耳前廔管或囊腫切除術 6, SUTURE OF EAR INJURY 外耳道普通創傷縫合術 1, MYRINGOTOMY 鼓膜切開術 4, REMOVAL OF EXTERNAL EAR TUMOR(MICROSCOPE 外耳道腫瘤顯微鏡切除術 8, REMOVAL OF EXTERNAL EAR MALIGNANT TUMOR 外耳道惡性腫瘤切除術 24, MEATOPLASTY & CANALOPLASTY 外耳道閉鎖症手術 21, TRAUMATIC OTOPLASTY 外傷性耳整形術 21, EAR CANAL PLASTIC OPERATION 外耳道成形術 15, MYRINGOPLASTY 耳膜成形術 15, POLYPECTOMY,MIDDLE EAR 中耳耳茸摘出術 8, MYRINGOTOMY WITH EUSTACHIAN TUBE... 顯微鏡下鼓膜切開術併鼓室通氣管插入 7, EXPLORATORY TYMPANOTOMY 鼓室探查術 10, TYMPANOPLASTY-WITHOUT MASTOIDECTOMY 鼓室成形術 - 不包括乳突鑿開術 23, TYMPANOPLASTY WITH MASTOIDECTOMY 鼓室成形術 - 包括乳突鑿開術 30, OSSICULOPLASTY 聽小骨重建術 22, MASTOIDECTOMY - SIMPLE 乳突鑿開術 - 簡單式 14, MASTOIDECTOMY - MODIFIED 乳突鑿開術 - 修正式 19, STAPEDECTOMY WITH PROSTHESIS 鐙骨截除及修補 20, STAPES MOBILIZATION 鐙骨鬆動術 10, SUTURE OF POSTARUICULAR 耳後孔縫合術 5, LABYRINTHECTOMY (INCLUDING MASTOIDECTOMY) 迷路切除術 ( 包含乳突鑿開術在 21, TEMPORAL BONE DISSECTION WITH MASTOIDE.. 聶骨全切除術併乳突鑿開術 40, ENUCLEATION 眼球剜出術 13, EVISCCRATION OF EYEBALL 眼球內容物剜除術 11, REPAIR OF EYEBALL WOUND-SCLERAL PEFORATI 眼球傷口之修補 - 鞏膜穿孔 10, REPAIR OF EYEBALL WOUND-CORNEOSCLERAL... 眼球傷口之修補 - 角鞏膜穿孔 9, KERATOTOMY 角膜切開術 5, EXCISION PTERYGIUM,SIMPLE WITH KERATECTO 翼狀贅肉簡單切除合併角膜切除 5, EXCISION PTERYGIUM,COMPLICATED WITH KE.. 翼狀贅肉複雜切除合併角膜切除術 8, SUTURE OF CORNEA 角膜縫合術 7,438 45/89

46 Peritomy 角膜周邊結膜切開術 3, REMOVAL OF CORNEAL EMBEDDED FOREIGN BODY 角膜崁頓異物摘除 2, KERATECTOMY 角膜切除術 7, LAMELLAR KERATOPLASTY 板層角膜移植術 21, PENETRATING KERATOPLASTY 穿透性角膜移植術 24, LIMBAL TRANSPLANTATION 輪部移植術 9, REMOVAL OF FOREIGN BODY IN ANTERIOR... 前房異物取出術 8, DIAGNOSTIC ASPIRATION AQUEOUS 前房水抽吸診斷 3, AIR INJECTION INTO ANTERIOR CHAMBER 前房空氣注入術 3, REMOVAL OF HYPHEMA PARACENTESIS 眼前房血塊清除 6, Perforating injury of eye ball, any type of scleral repair. 眼球穿傷, 鞏膜任何方式切除及修復 18, RESECTION,SCLERAL,WITH GRAFT OR BUCKLING 鞏膜切除併植入或扣壓 23, REMOVAL OF SCLERAL SURFACE FOREIGN BODY 鞏膜表面異物除去術 2, SYNECHIOTOMY(IRIDODIALYSIS) 虹膜粘連分離術 13, CYCLOCRYOTHERAPY 睫狀體冷凍治療 6, TRABECULOTOMY UNDER MICROSCOPE 小樑切除術 15, TRABECULECTOMY UNDER MICROSCOPE 小樑切除術 13, PERIPHERAL IRIDECTOMY 週邊虹膜切除術 5, IRIDOPLASIS FIXATION TRANSFIXATION 虹膜成形術 : 固定戳穿 ( 顯微鏡下手術 ) 6, DIVISION OF GONIOPUNTURE 前粘連分離術 5, DISCISSION OF MEMBRANOUS CATARACT... 膜性白內障切開術 6, LINEAR EXTRACTION FOR CATARACT 白內障線狀摘除術 8, LENS CAPSULOTOMY AND ASPIRATION OF... 水晶體囊切開吸引術 9, (ECLE)(LCLE) 水晶體囊外 ( 內 ) 摘除術 15, (ECLE)(ICLE)UNDER MICROSCOPE+IOL INSER.. [CASE PATMENT] 水晶體囊內 ( 外 ) 摘除術及人工水晶體置入 18, Phacoemulsification 囊外水晶體超音波乳化術 14, PARS PLANA LENSECTOMY(OCUTOME) 坦部水晶體切除術 16, IOL IMPLANTATION-PRIMARY 人工水晶體植入術 - 第一次植入 3, IOL IMPLANTATION-SECONDARY 人工水晶體植入術 - 第二次植入 10, IOL PLANTATION-REPOSITION 水晶體植入術 - 調整術 10, INTRAVITREOUS INJECTION 玻璃狀體內注射 3, ANTERIOR VITRECTOMY 前玻璃體切除術 6, PARS PLANA VITRECTOMY(VITRECTOR)- SIMPLE 眼坦部玻璃體切除術 - 簡單 18, PARS PLANA VITRECTOMY(VITRECTOR)-COMPLICATED 眼坦部玻璃體切除術 - 複雜 29, LENSECTOMY&VITRECTOMY(VITRECTOR) 晶體切除術合併玻璃體切除術 35, REMAVAL OF DISLOCATED LENS COMBINED WITH VITRECTOMY( VITRECTOR) 移位晶體摘除合併玻璃體切除 34, ASPIRATION OF VITREOUS 玻璃體吸引術 3, REMOVE INTRAOCULAR F.B. 玻離體內異物除去術 13, REMOVAL OF SILICON OIL 矽油排除術 5, 液氣體交換術 Fluid gas exchange 4, RMOVAL OF INTRAOCULAR FOREIGN BODY WITH MAGNET. (EMBEDED) 磁鐵吸除眼內磁性異物 ( 植床 ) 11, PHOTOCOAGULATION THERAPY-SIMPLE 光線凝固治療 - 簡單 7, PHOTOCOAGULATION THERAPY - COMPLICATED 光線凝固治療 - 複雜 18, RECESSION AND RESECTION-STRABISMUS 1 斜視矯正手術放鬆及切除 - 一條 8, RECESSION AND RESECTION-STRABISMUS 2 斜視矯正手術放鬆及切除 - 二條 10,930 46/89

47 RECESSION AND RESECTION-STRABISMUS+ONE 斜視矯正手術放鬆及切除 - 超過二 3, ORBITOTOMY WITH EXPLORATION 眼眶剖開探查術 12, ORBITOTOMY & DRAINAGE OF INTRAORBITAL AB 眼窩剖開術 - 併膿瘍引流 14, REMOVAL OF ORBITAL TUMOR-ANTERIOR APPRO. 眼窩腫瘤切除術 - 經前方途徑 19, RECONSTRUCTION OF ORBITAL SOCKET 眼窩形成術 19, ORBITAL DECOMPRESSION 眼窩減壓術 23, REPAIR OF ORBITAL FLOOR 眼窩底修補術 16, EXCISION OF LID TUMOR, BENIGN 眼瞼良性腫瘤切除術 3, EXCISION OF LID TUMOR,MALIGNANT 眼瞼惡性腫瘤切除術 10, EXCISION OF LID TUMOR WITH LID RECONSTUC 眼瞼瘤切除術合併眼瞼成形術 14, FRONTALIS SLING FOR PTOSIS 眼瞼下垂矯正術 ( 註 : 美容手術不給付 ) 10, Fascia lata sling 眼瞼下垂擴筋膜懸吊術註 : 美容手術不予給付 15, SKIN GRAFT FOR ECTROPION OR ENTROPION 外翻或內翻植皮術註 : 含外或內翻矯正手術 11, Z-PLASTY 眼瞼乙狀成形術 6, CORRECTIVE OPERATION FOR ECTROPION 眼瞼外翻矯正手術 8, CORRECTION OF ENTROPION 眼瞼內翻矯正手術 8, OP FOR ENTROPION SIMPLE (INCLUDING HOTZS OPERATION) 簡單眼瞼內翻手術含賀氏手術 6, REPAIR LACERATED EYELID 眼瞼裂傷之修補 6, TARSORRHAPHY FOR INTERMARGIN LID... 眼緣縫合 4, CANTHOPLASTY 眥成形術 6, CRYTHERAPY ON LID TUMOR - BENIGN 眼瞼腫瘤冷凍術 - 良性 2, Levator muscle resection 鍉上眼瞼肌切除術 ( 註 : 先天性 (congenital) 不予給 11, SUTURE OF EYELID 眼瞼皮縫合術 ( 外眼部 ) 2, EXCISION OF TARSAL PLATE 瞼板腺除術 4, RELIEF OF SYMBLEPHARON WITH CONJUNCTIVA OR MUCOSA GRAFT 眼瞼黏連分離併用粘膜移植 11, INCISION&CURETTAGE FOR CHALAZION 霰粒腫手術 1, 眼瞼板之硬顎移植術 Hard palate graft 13, 苗勒氏肌切除及提瞼肌放鬆 Mullerectomy 11, 下眼瞼攣縮併角膜暴露矯正術 Correction of lower lid retraction corneal exposure 11, SURTURE OF CONJUNCTIVA 結膜縫合 1, EXCISION LESION OF CONJUNCTIVA, - <3MM 結膜病灶切除 - 小於 3 公厘 2, EXCISION LESION OF CONJUNCTIV,BENIGN>3MM 結膜病灶切除 - 大於 3 公厘 3, EXCISION LESION OF CONJUNCTIVE,MALIGNANT WITH MUCOUS MEMBRANE GRAF 結膜病灶切除惡性併粘膜移植 9, CONJUNCTIVA PLASTY - WITH GRAFT 結膜成形術 - 有移植 8, CONJUNCTIVA PLASTY - WITHOUT GRAFT 結膜成形術 - 無移植 5, CRYOTHERAPY OF CONJUNCTIVAL TUMOR, BENIGN 結膜良性腫瘤冷凍術 2, EXCISION OF PTERYGIUM - PRIMARY 翼狀贅肉切除術 - 初發 4, EXCISION PTERYGIUM COMPLICATED OR RECURR 翼狀奴肉切除 - 複發 6, PARTIAL CONJUNCTIVAL SAC REFORMATION 結膜囊部份成形術 4, TOTAL CONJUNCTIVAL SAC REFORMATION 結膜囊全部成形術 6, CONJUNCTIVE FLAP FOR PERFORATING INJ... 穿透傷或二次性傷縫合結膜移植 5, DACRYOCYSTORHINOSTOMY 淚囊鼻腔造孔術 14, CONJUNCTIVODACRYOCYSTORHINOSTOMY 結膜淚囊鼻腔造孔術 16, FISTULECTOMY FORLACRIMAL FISTULA 淚管管切除術 5,313 47/89

48 LACRIMAL APPARATUS,PRIMARY REPAIR 淚器基本性修復 10, 淚管開口縫合術 Suture of punctum 2, Meconium Peritonitsis 胎糞性腹膜炎 34, CHOLEDOCHOCYST,EXCISION & CHOLEDOCHO-JEJUNOSTOMY PEDIATRIC SURGERY 總膽管囊腫切除術, 膽管迴腸吻合術 80, ESOPHAGOPLASTY WITH REPAIR OF T-E FISTULA PEDIATRIC SURGERY 食道腸吻合術及食道氣管廔管修補術 67, REPAIR IDIOPATHIC GASTRIC PERFORATION NEONATAL 新生兒胃穿孔修補術 41, REPAIR OF DIAPHRAGMATIC HERNIA PEDIATRIC SURGERY 橫膈疝氣修補術 46, PLICATION OF DIAPHRAGM, FOR DIAPHRAGM EVENTRATION PEDIATRIC SUGERY 橫膈折疊術 39, CONGENITAL DUODENAL ATRESIA, OR ANNULAR PANCREAS 先天性十二指腸閉鎖或輪 49, MALROTATION LADDS PROCEDURE 腸旋轉復形術 25, RESECTION & ANASTOMOSIS, INTESTINAL ATRESIA 腸閉鎖, 腸切除及吻合術 45, SACROCOCCYGEAL TUMOR, EXCISION 尾骨囊腫切除術 20, CONGENITAL BILIARY ATRESIA, KASAIS PROCEDURE,OR HEPATO/JEJUNAL A 先天性道閉鎖葛西手術或其他肝腸 71, CONGENITAL ABDOMINAL WALL DEFECT, PRIMARY CLOSURE - COMPLEX 先天性腹壁缺損直接修補術 56, OMPHALOCELE PRIMARY CLOSURE - SIMPLE 新生兒臍疝氣修補術 - 單純性 11, OMPHALOCELE REPAIR, PRIMARY CLOSURE - COMPLEX 新生兒臍疝氣修補術 - 複雜性 32, CYSTIC HYGROMA, COMPLICATED, EXCISION 囊狀淋巴管瘤切除術 42, IMPERFORATE ANUS, LOW TYPE 低位肛門成形術 37, IMPERFORATED ANUS,HIGH TYPE 高位肛門成形術 70, CONGENITAL MEGACOLON, PULL-THROUGH 先天性巨結腸症 56, CONGENITAL MEGACOLON TOTAL AGANGLIONOSIS,PULL-THROUTH 先天性無神經巨結腸 79, URETHROPLASTY, ISLAND FLAP PROCEDURE 尿道下裂島皮瓣尿道整形術 45, INGUINAL HERNIA OPERATION (<1Y/O) 00Y01 嬰兒鼠蹊疝氣 ( 小於一歲 ) 14, CORRECTION OF CHODEE 矯正尿道纖維黏連 22, EXCISION OF BRACHIAL CLEFT SINUS OR CYST 鰓裂腫切除廔管切除 18, EXCISION OF URACHUS OR ITS FISTULA 臍尿管或廔管切除 20, EXCISION OF VITELLINE ITS FISTULA PEDIATRIC SURGERY 臍腸系膜廔管切除 35, REPAIR OF MENIGOCELE OR MENIGOMYOCELE 腦膜或脊髓突出修補術 39, BONE VALGUS OR VARUS 骨內翻外翻 20, CONGENITAL DISLOCATION OF HIPS - OPEN REDUCTION 先天性髖脫臼 - 開放復位 18, CONGENITAL DISLOCATION OF HIPS - CLOSE REDUCTION 先天性髖脫臼 - 閉鎖復位 5, RECONSTRUCTION OF POLYDACTYLY OR SYNDACTYLY 併指多指 ( 趾 ) 切除 10, POLYDECTYLY OR SYNDACTYLY EXCISION - ONE ADDED 多趾 ( 指 ) 切除每多加一個 8, CHEILOPLASTY-SINGLE 兔唇修補 - 單部位 11, CHEILOPLASTY-BIL 兔唇修補 - 雙部位 17, CHEILOPASTY-COMPLICATE 兔唇修補 - 複部位 25, HEMANGIOMA EXCISION - < 2CM 血管瘤切除 - 未達 2 公分 7, HEMANGIOMA EXCISION - 2-5CM 血管瘤切除 -2 公分至 5 公分 13, HEMANGIOMA EXCISION - > 5CM 血管瘤切除 - 超過 5 公分 17, OTOPLASTY FIRST WITH TISSUE EXPLORE 小兒重建第一期組織擴張 22, OTOPLASTY SECOND 小兒重建第二期義耳 17, Microtia,stage three 小耳重建第三期 21, Congenital dislocation of hips-change cast 先天性髖脫臼 - 換石膏 3, SIMPLE EXTRACTION 簡單性拔牙 /89

49 COMPLICATED EXTRACTION 複雜性拔牙 1, ODOMTERTOMY,COMPLICATED CASE 複雜齒切除術 5, CYSTIC ENUCLEATION: SAMALL 囊腫摘除術 ( 小 ) 1, CYSTIC ENUCLEATION: MIDDLE 囊腫摘除術 ( 中 ) 3, CYSTIC ENUCLEATION: LARGE 囊腫摘除術 ( 大 ) 3, INTRAORAL EXCISION OF SOFT TISSUE TUMOR 口內軟組織腫瘤切除 1, ALVEOLOPLASTY 齒槽骨成形術 SUBCONDYLAR OSTEOTOMY WITH...UNILATERAL 單側髁狀突下截骨術或關節成形術 18, SIALOLITHOTOMY. IN GLAND 涎石切除術在腺體內 3, SAUCERIZATION AND SEQUESTRECTOMY 造碟術及腐骨清除術 8, OPEN REDUCTION OF CONDYLAR FX,UNILATERAL 髁狀突骨折手術復位術單側 12, PALATOPLASY 補顎術 6, OPEN REDUCTION OF THE JAWS FX-SINGLE 顎骨折整復術 - 單一骨折 8, OPEN REDUCTION OF THE JAWS FX-MULTIPLE 顎骨折整復術 - 複雜骨折 11, RESECTION OF THE JAW(EACH),MARGINAL 顎骨切除術邊緣切除 8, RESECTION OF THE JAW(EACH),PARTIAL 顎骨切除術部分切除 14, RESECTION OF THE JAW(EACH)HEMI-RESECTION 顎骨切除術半切除 14, RECONSTRUCTION OF THE JAW BY BONE GRAF.. 顎骨重建術骨移植 15, RECONSTRUCTION OF THE JAW BY METAL SPLIN 顎骨重建術金屬夾板 ( 材料另 9, SIALOADENECTOMY-SUPERFICIAL OR BENIGN 唾液腺切除術 - 表淺或良性 4, SIALOADENECTOMY-MALIGNANT 唾液腺切除術 - 惡性 8, P.P CAST--SHORT ARM 石膏固定 - 短臂 1, P.P CAST--LONG ARM 石膏固定 - 長臂 1, P.P CAST--SHORT LEG 石膏固定 - 短腿 1, P.P CAST--LONG LEG 石膏固定 - 長腿 2, WALKING CAST 步行石膏固定 - 長 2, CYLINDER CAST 圓筒石膏固定 2, SHOULDER SPICA 肩人形石膏固定 3, HIP SPICA 股軀人形石膏固定 3, BODY CAST 軀部石膏固定 4, P.P SPLINT--SHORT ARM 石膏副木固定 - 短臂 1, P.P SPLINT--LING ARM 石膏副木固定 - 長臂 1, HALO TYPE FIXATION &BODY CASTHALO 式固定及軀部石膏固定 3, CRYOSURGERY PROSTATE GLAND, TRANSURETHRAL WITH OR WITHOUT 15, CIRCUMCISION, MALE, SURGICAL EXCISION NEWBORN PLASTIC REPAIR PENILE PROSTHESIS INSENT 9, BLADDER MUCOSA GRAFT, URETHROPLASTY FOR POSPADIA 43, INTRACARVERNOSAL INJECTION THERAPY 陰莖海棉體勃起治療 1, VASECTOMY, UNILATERAL OR BILATERAL 6, LIGATION VAS DEFERENS, PERCUTANEOUS UNILATERAL OR BILATERAL HYMENOPLASTY 4, INSERTION INTRAUTERINE DEVICE, IUD, IAMINALIA, PACKING, ETC TRANSECTION FALLOPIAN TUBE, POMEROY'S METHOD 5, TRANSECTION FALLOPIAN TUBE, UCHIDA METHOD 5, TRANSECTION FALLOPIAN TUBE, PARKLAND METHOD 5, TRANSECTION FALLOPIAN TUBE, POSTPARTUM, DURING SAME 4, LAPAROSCOPY WITH GIFT 14, LAPAROSCOPIC OPU (IVF) 14, ULTRASONIC OPU 16,394 49/89

50 46418 TRANSMYOMETRIAL EMBRYO TRANSFER (TMET) 穿透子宮肌層胚胎植入術 10, TIME-OPERATION FEE 看時手術費 ( 平日 17:00-21:59, 假日 07:30-21:59) 10, TIME-OPERATION FEE 看時手術費 (22:00-07:29) 15, STEREOTAXIC RADIOSURGERY FOR IMPLANTATION 放射手術定位器植入及定位 18, TATTOO, CORNEA, MOCHANICAL OR CHEMICAL 6, BLEPHAROPLASTY FOR DOUBLE LID FOLD, BILATERAL 15, CAUTERY CLOSURE PUNCTUM CATHETERIZATION, EUSTACHIAN TUBE, 無線電波鼻甲成形術 6, 無線電波軟顎 / 扁桃 / 舌根成形術 10, 軟顎植入術 OTOPLASTY MICROTIA REPOSITION LABULE WITH OR WITHOUT FTSG, 13, OTOPLASTY MICROTIA, RECONSTRUCTION STAGE II SILASTIC PROSTHESIS 20, OTOPLASTY, RECONSTRUCTION WITH CONSTO 19, OTOPLASTY, STAGE III ELEVATION WITH STSG 9, RECONSTRUCTIVE OTOPLASTY CUP EAR 15, OTOPLASTY, BILATERAL LOP EAR 22, FLUOROSCOPIC GUIDED DIAGNOSTIC AND THERAPEUTIC BLOCK 單一部位 5, INTRATHECAL PUMP IMPLANTATION(TRIAL) 6, ULTRASOUND GUIDED DIAGNOSTIC & THERAPEUTIC BLOCK ( 單一部位 ) 超音波引導治療阻斷 ( 單一部位 ) 2, ULTRASOUND GUIDED DIAGNOSTIC & THERAPEUTIC BLOCK ( 雙部 ) 超音波引導治療阻斷 ( 雙部 ) 3, ULTRASOUND GUIDED DIAGNOSTIC & THERAPEUTIC BLOCK ( 多處 ) 超音波引導治療阻斷 ( 多處 ) 4, FLUOROSCOPIC NEUROLYTIC BLOCK( 單一部位 ) X 光定位神經溶解阻斷 ( 單一部位 ) 6, FLUOROSCOPIC NEUROLYTIC BLOCK( 雙部位 ) X 光定位神經溶解阻斷 ( 雙部位 ) 7, ORTHOGNATHIC SURGERY-MANDIBLE,UNILATERAL 正顎手術 - 下顎單側 45, ORTHOGNATHIC SURGERY-MAXILLA,ONE PIECE 正顎手術 - 上顎單片 45, ORTHOGNATHIC SURGERY-MAXILLA,TWO PIECE 正顎手術 - 上顎雙片 60, PREPROTHODONTIC SURGERY-VESTIBULOPLASTY WITHOUT GRAFT 膺復前手術 - 前庭整型術無軟組織移植 3, PREPROTHODONTIC SURGERY-VESTIBULOPLASTY WITH GRAFT 膺復前手術 - 前庭整型術併軟組織移植 5, PREPROTHODONTIC SURGERY-BONE GRAFT 膺復前手術 - 骨移植 5, DENTAL IMPLANTATION 植牙手術 45, 人工植牙 -- 一般型 ( 門診手術 ) 26, 人工植牙 -- 複雜型 ( 門診手術 ) 29, Microscopic surgical special treatment&examination( 前牙 ) 5, Microscopic surgical special treatment&examination( 小臼齒 ) 7, HAIR TRANSPLANTATION, PUNCH GRAFT, STRIP GRAFT 25, SCALP FLAP FOR ALOPECIA, ROTATION FLAP 55, SCALP FLAP FOR ALOPECIA, FREE FLAP 91, EXCISION OF ALOPECIA,THE AID OF TISSUE EXPANDER(INSERTION OF TE) 21, AUG.RHINOPLASTY 18, TIP RHINOPLASTY 20, BURRING,NASAL HUMP 18, DOUBLE EYEID BLEPHAROPLASTY,OPEN METHOD BIL 19, DOUBLE EYEID BLEPHAROPLASTY,OPEN METHOD UNIL 11,233 50/89

51 48681 DOUBLE EYEID BLEPHAROPLASTY,SUTURE METHOD BIL 17, DOUBLE EYEID BLEPHAROPLASTY,SUTURE METHOD UNIL 10, LOWER EYELID BLEPHAROPLASTY,EXTERNAL APPROACH BIL 23, LOWER EYELID BLEPHAROPLASTY,EXTERNAL APPROACH UNIL 12, LOWER EYELID BLEPHAROPLASTY,TRANSCONIUNTIVAL BIL 23, LOWER EYELID BLEPHAROPLASTY,TRANSCONIUNTIVAL UNIL 12, BLEPHAROPLASTY RHYTIDECTOMY,UPPER 24, BLEPHAROPLASTY RHYTIDECTOMY,LOWER 24, BLEPHAROPLASTY RHYTIDECTOMY,UPPER AND LOWER 44, REVISION BLEPHAROPLASTY 4, BLEPHAROPLASTY FOR EPIBLEPHARM,BIL 11, EPICANTHOPLASTY,UCHIDA Z-PLASTY BIL 7, EPICANTHOPLASTY,UCHIDA Z-PLASTY UNIL 5, BLEPHAROPTOSIS,TARSAL PLATE RESECTION BIL 20, BLEPHAROPTOSIS,TARSAL PLATE RESECTION UNIL 12, FASCIA GRAFT 15, LATERAL CANTHOPLASTY,BIL 7, LATERAL CANTHOPLASTY,UNIL 4, FREE FAT GRAFT 18, TISSUE EXPANDER,INSERTION 12, TISSUE EXPANDER,REMOVAL AND SETTING FLAP 24, FACE LIFING,FOREHEAD 48, FACE LIFING,CHEEK,CHIN&NECK 72, FACE LIFING,TOTAL 109, FACE LIFING,ENDOSCOPE ASSISTED FOREHEAD 72, BROMIODROSIS-EXCISION OF APOCRINE GLAND,BIL 24, BROMIODROSIS-EXCISION OF APOCRINE GLAND,UNIL 12, TUMOR EXCISION<1CM 3, TUMOR EXCISION>1CM 6, AUG.MAMMOPLASTY,PRIMARY BIL 75, AUG.MAMMOPLASTY,SECONDRY BIL 75, AUG.MAMMOPLASTY,PRIMARY UNIL 40, AUG.MAMMOPLASTY,SECONDRY UNIL 40, REDUCTION MAMMOPLASTY,BIL 70, INTERNAL CAPSULECTOMY,UNIL 12, EXTERNAL CAPSULECTOMY 3, NIPPLOPLASTY BIL 28, NIPPLOPLASTY UNIL 15, NIPPLE REDUCTION 9, Varicose vein with transilluminated powered phlebectomy 7, DERMABRATION,MECHANCIAL OR LASER(TOTAL FACE) 30, DERMABRATION,MECHANCIAL OR LASER(HALF FACE) 20, DERMABRATION,MECHANCIAL OR LASER(REGIONAL FACE) 8, CHEMICAL PEELING,GLYCOLIC ACID 2, INJECTION COLLAGEN 4, SCAR REVISION & Z-PLASTY<1CM 5, SCAR REVISION & Z-PLASTY 1-5CM 18, SCAR REVISION & Z-PLASTY 5-10CM 30, SCAR REVISION & Z-PLASTY >10CM 40, LIPOSUCTION(ABDOMEN) 50, LIPOSUCTION(ABD+THIGH) 60,720 51/89

52 48752 LIPOSUCTION(ABD+THIGH+HIP) 70, LIPOSUCTION(CALF LEG) 36, ABDOMINOPLASTY CLASSICAL OPEN METHOD 83, ABDOMINOPLASTY WITH LIPOSUCTION 83, UMBILICOPLASTY 12, REMOVAL OF F.B.(SILICONE,PARAFFIN)BUCCAL BIL 52, REMOVAL OF F.B.(SILICONE,PARAFFIN)FOREHEAD 46, REMOVAL OF F.B.(SILICONE,PARAFFIN)CHIN 40, FACE CONTOURING-MANDIBLE ANGLE 48, FACE CONTOURING-GENIOPLASTY(AUG.WITH PROSTHESIS) 32, EAR RECONSTRUTION MICROTIA UNIT 30, CIRCUMSCION 5, 靜脈曲張血管內二極體雷射治療 18, 腹腔鏡可調式胃束帶手術 32, 副刀闌尾切除術 ( 純自費 ) 7, RFA 手術 9, HEAVY SEDATION IV OR IM ANESTHESIA 靜脈或肌肉麻醉註 : 1, EPIDURAL ANESTHESIA OVER 2HR PER 30MIN 硬脊膜外麻醉 3, EPIDURAL ANESTHESIA (> 2 HR) SPINAL ANESTHESIA OVER 2HR PER 30MIN 脊髓麻醉 1, SPINAL ANESTHESIA (>2HR) CONDUCTION ANESTHESIA--RETROBULBAR ANESTHESIA 傳導麻醉 - 球後麻醉 1, CONDUCTION ANESTHESIA-RETROBULBAR ANESTHESIA OVER 2HR PER 30 MIN 傳導麻醉 - 球後麻醉 ( 超過二小時每增 CAUDAL BLOCK 尾椎麻醉 1, SEMI-OPENED OR SEMI-CLOSED MASK INHALATION GENERAL ANESTHESIA 半開放式或半閉鎖式面罩吸入全身麻醉法 - 4, OVER 4 HOURS,EACH 30 MINUTES ADDED 面罩吸入全身麻醉 >2 小時 1, OVER 4 HOURS,EACH 30 MINUTES ADDED 面罩吸入全身麻醉 >4 小時 1, OVER 4 HOURS,EACH 30 MINUTES ADDED 氣管內插管麻醉法 <2 4, HOURS,EACH 30 MINUTES ADDED 氣管內插管麻醉法 1, OVER 4 HOURS,EACH 30 MINUTES ADDED 氣管內插管麻醉法 1, PRE-OP EVALUATION 麻醉前評估 POST-ANESTHETIC CARE 麻醉恢復照護費 IONTOPHONESIS 離子電泳法局部麻醉 CONDUCTION ANESTHESIA--NERVE PLEXUS BLOOK 傳導麻醉 - 神經叢阻斷術 1, CONDUCTION ANESTHESIA-NERVE PLEXUS BLOOK OVER 2HR PER 30MIN 傳導麻醉 - 神經叢阻斷術 ( 超過二小時每 TIME-ANESTHETIC CARE 看時麻醉費 ( 平日 17:00-21:59, 假日 07:30-21:59) 1, 麻醉意識監測 Bis 1, 內視鏡減痛鎮靜麻醉 3, 肝腫瘤高熱頻電燒 - 麻醉 (60 分鐘內 ) 6, 肝腫瘤高熱頻電燒 - 麻醉 ( 大於 60 分鐘後, 每 30 分鐘 ) 2, WHOLE BLOOD 250CC 捐血中心全血 WHOLE BLOOD 250CC 捐血中心全血 BLOOD ADMIMISTRATION 血液管理費 PACKOD CELL R.B.C. 捐血中心紅血球濃厚液 PACKOD CELL R.B.C. 捐血中心紅血球濃厚 -- 血液道義金 BLOOD ADMIMISTRATION 血液管理費 60 52/89

53 48903 WASHED,R.B.C. 捐血中心洗滌紅血球 WASHED,R.B.C. 捐血中心洗滌紅血球 BLOOD ADMIMISTRATION 血液管理費 PLATELET CONCENTRATE 捐血中心血小板濃厚液 PLATELET CONCENTRATE 捐血中心血小板濃厚 BLOOD ADMIMISTRATION 血液管理費 FROZEN PLASMA 捐血中心冷凍血漿 FROZEN PLASMA 捐血中心冷凍血漿 BLOOD ADMIMISTRATION 血液管理費 FRESH PLASMA 捐血中心新鮮冷凍血漿 FRESH PLASMA 捐血中心新鮮冷凍血 BLOOD ADMIMISTRATION 血液管理費 CRYOPRECIPITATE 捐血中心冷凍沈澱品 CRYOPRECIPITATE 捐血中心冷凍沈澱品 BLOOD ADMIMISTRATION 血液管理費 W.B.C. CONCENTRATE 捐血中心白血球濃厚液 W.B.C. CONCENTRATE 捐血中心白血球濃厚液 -- 血液道義金 BLOOD ADMIMISTRATION 血液管理費 AUTOLOGUS TRANSFUSION(PRE-DEPOSIT) 自體輸血 BLOOD ADMIMISTRATION 血液管理費 PLATELET PHORESIS/TIME (CONCENTRATE) 分離血小板 ( 捐中 ) 5, PLATELET PHORESIS/TIME (CONCENTRATE) 分離血小板 ( 捐中 ) BLOOD ADMIMISTRATION 血液管理費 W.B.C.PHORESIS/TIME(CONCENTRATE) 分離白血球 ( 捐中 ) 7, W.B.C.PHORESIS/TIME(CONCENTRATE) 分離白血球 ( 捐中 ) BLOOD ADMIMISTRATION 血液管理費血漿交換 22, FROZEN REDCELLS 捐血中心冷凍紅血球 1, FROZEN REDCELLS 捐血中心冷凍紅血球 -- 血液道義金 BLOOD ADMIMISTRATION 血液管理費 LEUCOCYTE-POOR RED BLOOD CELLS PER UNIT 減除白血球之紅血球濃厚液 1, 減除白血球之紅血球濃厚液 -- 血液道義金 BLOOD ADMIMISTRATION 血液管理費 AUTOLOGUS TRANSFUSION 自體輸血 1, 非捐中血液管理費 BLOOD ADMIMISTRATION (Aliguot of Blood) 分袋血減白分離術血小板 8, 減白分離術血小板 BLOOD ADMIMISTRATION 血液管理費 ORAL EXAM 臨床口腔檢查全瓷燒付牙冠 20, T.M.J.RADIOGRAPHY - UNILATERAL 脅顎關節 X 光攝影 ( 單側 ) 註 : 包括開及閉相 PERIAPICAL RADIOGRAPHY 根尖周 X 光攝影 BITE-WING RADIOGRAPHY 咬翼式 X 光攝影 OCCLUSAL RADIOGRAPHY 咬合片 X 光攝影 CEPHALOMETRIC RADIOGRAPHY 測顱 X 光攝影 PANORAMIC RADIOGRAPHY 齒顎全景 X 光攝影註 : 每人限支付一張 FLOSS THREADER 牙線 30 53/89

54 49031 PULP CAPPING 覆髓註 :1 包括暫時填充 2 每月限申請一次前牙三面複合樹脂充填 1, COMPOSITE RESIN RESTORATION ACID ETCHING-SINGLE SURFACE 複合樹脂充填酸使填補照鹵素光 - 單面 ENFORCING PIN EACH 釘強化術 ( 每支 ) 特殊狀況之銀粉充填 -- 單面 DIASTEMA RESTORATION 齒間隙修復 1, AMALGAM RESTORATION-SINGLE SURFACE 銀粉充填 - 單面 AMALGAM RESTORATION-TWO SURFACE 銀粉充填 - 雙面 AMALGAM RESTORATION-THREE SURFACE 銀粉充填 - 三面人工植牙 - 牙冠 ( 簡單型 ) 35, 人工植牙 - 牙冠 ( 複雜型 ) 40, Flexible resin RPD(<4 teeth) 20, Flexible resin RPD(4-8 teeth) 30, Flexible resin RPD(>8 teeth) 40, 特殊狀況之銀粉充填 -- 三面特殊狀況之前牙複合樹脂充填 -- 單面特殊狀況之前牙複合樹脂充填 -- 雙面特殊狀況之後牙複合樹脂充填 -- 單面特殊狀況之後牙複合樹脂充填 -- 雙面特殊狀況之後牙複合樹脂充填 -- 三面 1, POSTERIOR TEETH COMPOSITE RESIN-SINGLE SURFACE 後牙複合樹脂充填 - 單面註 : 包含酸蝕填補照滷素光步驟在 POSTERIOR TEETH COMPOSITE RESIN-TWO SURFACE 後牙複合樹脂充填 - 雙面註 : 包含酸蝕填補照滷素光步驟在內 POSTERIOR TEETH COMPOSITE RESIN-THREE SURFACE 後牙複合樹脂充填 - 三面註 : 包含酸蝕填補照滷素光步驟在 1, 特殊狀況之前牙三面複合樹脂充填 1, 特殊狀況之玻璃子體充填 Microscopic special treatment&examination (I) 3, COMPOSITE RESIN RESTORATION ACID ETCHING-TWO SURFACE 複合樹脂充填酸使填補照鹵素光 - 雙面 Microscopically endoscopic special treatment (II)(complicated) 5, Microscopic endoscopic special treatment examination for difficultcase correction of(referal case) 7, Microscopic MTA repair program 3, SEALANT 密封 Behavior fee(15 分鐘以下或 handicaper ) Behavior fee(15 至 30 分鐘 ) Behavior fee(30 分鐘以上 ) 塗氟恆牙斷髓處理 --- 限中度以上身心障礙者 MILK TOOTH PULPOTOMY 乳牙斷髓處理 MILK TOOTH PULPECTOMY 乳牙根管治療 1, MILK TOOTH EXTRATION 乳牙拔除 Milk tooth pulpectomy 乳牙多根管治療 1, APEXIFICATION-ANTERIOR TEETH 根尖成形術 - 前牙註 : 限開根尖式根管者 (O PEN APEX) /89

55 49134 APEXIFICATION-POSTERIOR TEETH 根尖成形術 - 後牙註 : 限開根尖式根管者 (O PEN APEX) 1, REPLANTATION 牙齒再植術註 : 不包括根管治療 ENDODONTICS 根管治療 ( 單根 ) 2, ENDODONTICS 根管治療 ( 雙根 ) 3, ENDODONTICS 根管治療 ( 三根 ) 4, ENDODONTICS 根管治療 ( 四根 ) 4, ENDODONTICS 根管治療 ( 五根 ( 含 ) 以上 ) 6, RUBBER DAM APPLIANCE 橡皮障防濕裝置 BLEACHING(PER TOOTH) 牙齒漂白術 2, 雷射漂白 15, ENDODONTIC EMERGENCY TREATMENT 齒內治療緊急處理 REMOVE OF CASTING POST CROWN 去除金屬鑄心 ( 顆 ) REMOVAL OF S-P CROWN 去除縫成牙冠 REMOVAL OF CASTING CROWN 去除鑄造牙冠 DIFFICULT CASE SPECIAL TREATMENT(C-shaped) 難症特別處理 -- 大臼齒根管 DIFFICULT CASE SPECIAL TREATMENT 難症特別處理 -- 有額外根管者 DIFFICULT CASE SPECIAL TREATMENT 難症特別處理 -- 根管特別彎曲根管鈣化器械斷折根管治療在 X 光片上 root canal 內顯現出 radioopaque 之根管個案 CANAL ENLARGE & DEBRIDEMENT 髓腔開擴 RETROGRADE FILLING 根尖逆充填術 DIFFICULT CASE SPECIAL TREATMENT 難症特別處理 -- 符合附表標準之多根管治療 ( 雙根管 ) 1, DIFFICULT CASE SPECIAL TREATMENT 難症特別處理 -- 符合附表標準之多根管治療 ( 三根管 ) 1, DIFFICULT CASE SPECIAL TREATMENT 難症特別處理 -- 符合附表標準之多根管治療 ( 四根管及四根以上根管 ) 2, SUBGINGIVAL CURETTAGE (ROOT PLANING)-LOCALIZED 齒齦下刮除術 ( 含牙根整平術 ) 局部註 : 牙周囊袋 5MM 以 SUBGINGIVAL CURETTAGE (ROOT PLANING)- 1/2 ARCH 齒齦下刮除術 ( 含牙根整平術 )1 2 顎註 : 牙周囊袋 5M 特殊牙周疾病控制基本處置 TEMPORARY 齒間暫時固定術每齒 PROPHYLAXIS 牙周預防保養 STAINS REMOVE 牙垢去除牙齦切除術 GINGIVECTOMY-LOCALIZED 牙齦切除術 - 局部註 : 三齒以內包括牙齦修整術在 1, GINGIVECTOMY-1/3 ARCH 牙齦切除術 -1 3 顎註 : 包括牙齦修整術在內 1, PERIODONTAL FLAP OPERATION-LOCALIZED 牙周骨膜翻開術 - 局部註 : 牙周囊袋 5MM 以上三齒以內 3, PERIODONTAL FLAP OPERATION-1/3 ARCH 牙周骨膜翻開術 -1 3 顎 6, PLAQUE CONTROL Rubber dam appliance 特殊狀況橡皮障防濕裝置牙周疾病控制基本處置特殊狀況牙結石清除 - 全口 GLASS LONOMER COMENT 玻璃璃子體充填 SCALING FULL MOUTH 全口牙結石清除 - 簡單 MOCOGINGIVAL GRAFT II 6,000 55/89

56 49234 MUCOGINGIVAL GRAFT 3 7, GINGIVECTOMY AND GINGIVOPLASTY II 4, PERIODONTAL EMERGENCY TREATMENT 牙周病緊急處置 BONE GRAFT II 6, PERIODONTAL CHARTING 2, HEMISECTION OR ROOT AMPUTATION 牙齒切半術或牙根切斷術 1, SCALING LOCALIZED 局部牙結石清除 SUBGINGIVAL CURETTAGE-FULL MOUTH 齒齦下刮除術 - 全 3, 骨瘤切除術 Tumor extration < 1CM 6, DENTAL INJECTION: BLOCK 牙科阻斷麻醉 SIMPLE EXTRACTION 簡單性拔牙 COMPLICATED EXTRACTION 複雜性拔牙 1, 骨瘤切除術 Tumor extration > 1CM 12, 骨瘤切除術 Tumor extration > 2CM 18, 手術去除陷入上顎竇內牙齒或異物 7, ALVELOPLASTY <1-2 JAW 齒槽骨成形術 (1 2 顎內 ) INTRAORAL INCISION & DRAINAGE 口內切開排膿手術拔除深部阻生齒 9, EXTRAORAL INCISION & DRAINAGE 口外切開排膿 1, BIOPSY,SOFT TISSUE 軟組織切片 INTRAORAL EXCISION OF SOFT TISSUE TUMOR 口內軟組織腫瘤切除 1, BIOPSY HARD TISSURE 硬組織切片 1, 癌前病變軟組織切片 Biopsy, soft tissue 2, 癌前病變硬組織切片 Biopsy, hard tissue 3, TOOTH TRANSPLANTATION 自體牙齒移植 2, 口腔顎顏面頸部惡性腫瘤術後照護 SPECIAL TREATMENT OF EXTRACTION WOUND 拔牙後特別處理註 : 包括附 SOCK ET 或止血 HOMOSTASI REMOVAL OF STITCHES EACH TIME 拆線 OPERCULECTOMY 齦蓋切除術 DEBRIDEMENT < 5CM 深部複雜創傷處理 - 傷口長 5 公分以下者 2, DEBRIDMENT >10CM 深部複雜創傷處理 - 傷口長 10 公分以上者 4, DEBRIDEMENT 5-10CM 深部複雜創傷處理 :5-10 公分 2, POSTOPERATION TREATMENT 手術後治療註 : 局部藥物治療或燒灼 CHANGE DRESSING MEDIUM 10-20CM 手術創傷處置及換藥 : 中換藥 Closed Reduction With Wiring Fixation >=4Teech 鋼線固定 ( 上顎或下顎固定術 )4 齒以上 2, INTERMAXILLARY FIXATION (I.M.F.) 顎間固定法註 : 包含 ARCH BAR 材料費在內 11, REMOVE OF SPLINTING WIRE 固定鋼線移除 Removal of Splinting Plate 去除齒列夾板 MARSUPIALIZATION 囊腫造袋術 1, Specific Local treatment 特定局部治療 FISTULECTOMY 廔管切除術 1, FRENECTOMY-SIMPLE METHOD 繫帶切除術 - 簡單法 FRENECTOMY-Z-PLASTY 繫帶切除術 -Z 字法 SALIVARY GLAND CATHETERIZATION 唾液腺導管 1, SEQUESTRECTOMY: SIMPLE CASE UNDER 1/3 ARCH 腐骨消除術 - 簡單 1/3 顎以下 2,400 56/89

57 49356 SEQUESTRECTOMY: COMPLICATED CASE MORE THAN 1/3 ARCH 腐骨消除術 - 複雜 1/3 顎以上 3, OCCLUSAL BITE SPLINT 咬合板治療 4, OBTURATOR APPLIANCE 閉塞器裝置 6, REPAIR OF OROANTRAL FISTULA 口竇廔管修補術 6, DISLOCATION TMJ,CLOSED REDUCTION-WITHOUT FIXATION 脅顎關節脫臼整復 - 無固 1, DISLOCATION TMJ,CLOSED REDUCTION-WITH FIXATION 脅顎關節脫臼整復 - 有固定 2, Injection of TMJ 顎關節內注射 FLUORIDE CARRIER 塗氟持器 1, SUBMUCOSAL INJECTION 黏膜下注射 ODONTECTOMY, SIMPLE CASE (FLAP REPAIR) 單純齒切除術註 : 包括牙瓣修整術之需附 X 光片 1, ODONTECTOMY,COMPLICATED CASE 複雜齒切除術註 : 包括牙瓣修整術之需檢附 X 3, CYSTIC ENUCLEATION SMALL <2 CM 囊腫摘除術 - 小 2 公分以下 CYSTIC ENUCLEATION MIDDLE 2-4 CM 囊腫摘除術 - 中 2-4 公分 3, OCCLUSAL ADJUSTMENT (FIRST) 咬合調整 ( 第一次 ) SURGICAL EXPOSURE OF IMPACTED TOOTH 埋伏齒露出手術 1, FLUORIDE APPLICATION 塗氟 APICOECTOMY ANTERIOR 前齒根尖切除術 1, APICOECTOMY PREMOLAR 小臼齒根尖切除術 2, APICOECTOMY MOLAR 大臼齒根尖切除術 4, Closed Reduction With Wiring Fixation <-3Teech 鋼線固定 3 齒以內 1, ALVEOLOPLASTY >1/2 JAW 齒槽骨成形術 (1 2 顎以上 ) 1, FLAP REPAIR <4CM/2 皮瓣手術 - 小 (4 平方公分以下 ) FLAP REPAIR 4-16CM/2 皮瓣手術 - 中 (4-16 平方公分 ) 2, FLAP REPAIR 16CM/2 皮瓣手術 - 大 (16 平方公分以上 ) 3, 矯正檢查, 部分 ( 口腔檢查石膏檢查照相 ) ( 次 ) 2, 矯正檢查 ( 口腔檢查石膏模型照相測顱 X 光全景 X 光 ) ( 次 ) 3, 活動牙齒矯正裝置 ( 單顎 ) 5, 活動牙齒矯正裝置 ( 雙顎 ) 8, 空間維持器 ( 單側 ), 固定或活動式 1, 空間維持器 ( 雙側 ), 固定或活動式 3, 單齒矯正裝置及直接黏著裝置環勾, 彈力線或唇面弧線, 每件亞克力基底板 2, 咬合板或斜面板 2, 矯正調整及矯正追蹤檢查 ( 次 ) 1, 面罩 A 14, 面罩 B 4, 顎弓擴大器 7, 恆牙期牙齒矯正 ( 單顎 ) 第一次給付 7, 恆牙期牙齒矯正 ( 雙顎 ) 第一次給付 14, 恆牙期牙齒矯正 ( 單顎 ) 第二次給付 5, 恆牙期牙齒矯正 ( 雙顎 ) 第二次給付 8, 恆牙期牙齒矯正 ( 單顎 ) 第三次給付 5, 恆牙期牙齒矯正 ( 雙顎 ) 第三次給付 8, 恆牙期牙齒矯正 ( 單顎 ) 第四次給付 7, 恆牙期牙齒矯正 ( 雙顎 ) 第四次給付 11, 恆牙期牙齒矯正 ( 單顎 ) 第五次給付 11,940 57/89

58 49523 恆牙期牙齒矯正 ( 雙顎 ) 第五次給付 18, 正顎手術術前牙板 6, 唇顎裂嬰兒鼻型齒槽骨矯正治療前印模單側鼻型齒槽骨矯正牙板 14, 唇顎裂嬰兒鼻型齒槽骨矯正治療前印模雙側鼻型齒槽骨矯正牙板 18, 鼻型齒槽骨矯正定期調整 1, 半口活動假牙 ( 中低收入身心障礙 ) 37, BAND-LOOP SP. MAINT. 帶環空間維持器 3, CROWN-LOOP SP. MAINT. 齒冠環空間維持器 3, REMOVABLE TYPE SP. MAINT. 可撤式空間維持器 8, LINGUAL ARCH SP. MAINT. 可撤式空間維持器 5, NANCE,S APPLIANCE 5, DISTAL SHOE SP. MAINT. 遠心楔空間維持器 4, SP. REGAINER (SIMPLE) 空間回復器 5, STEEL CROWN 不鏽鋼冠 2, METAL CERAMIC CROWN (A)( 含金量 85%) 22, METAL CERAMIC CROWN(B)( 含金量 74%) 20, METAL CERAMIC CROWN(C)( 含金量 50%) 17, METAL CERAMIC CROWN(D)( 含金量 2%) 15, METAL CERAMIC CROWN (E) -F( 含 PD-AG) 12, METAL CERAMIC CROWN ( F) 13, METAL CERAMIC CROWN (F) -F 10, NOBLE METAL CROWN(A) ( 含金量 75%) 18, NOBLE.METAL.CROWN(B)( 含金量 40%) 14, METAL CROWN (C) ( 含金量 2%) 12, METAL CROWN (D)-F ( 含金量 12%) 10, NOBLE METAL INLAY ( 含金量 75%) 11, NOBLE METAL ONLAY ( 含金量 75%) 13, PROVISIONAL CROWN 治療性暫時牙冠 2, POST+CORE (NON PRECIOUS M) 1, POST+CORE (ANCHOR M) 1, RESIN POST CROWN WITH STAINLESS STEEL POST 2, Interim RPD : 1 tooth (no clasp & no packing) 3, Interim RPD : 2 teeth (no clasp & no packing) 6, Interim RPD : 3 teeth (no clasp & no packing) 8, Interim RPD : 4 teeth ( clasp & no packing) 11, Interim RPD : 5 teeth ( clasp & no packing) 13, Interim RPD : 6 teeth( clasp & packing) 15, Interim CD (one jaw): simple (no facebow & no VD determined) 20, Interim CD (one jaw): complicated (facebow & VD determined) 30, PORCELAIN LAMINATE VENEER( 瓷貼片 ) 15, RPD FULL DENTURE FRAME WORK ONE JAW 純鈦合金 20, KEY WAY EACH 3, RPD tooth supported (one side or anterior: 4 teeth) 30, RPD tooth supported RPD (one side: 5-7 teeth; both side: 10 teeth) (anterior: 5-6 teeth) 33, RPD free end (one side: 4 teeth; anterior: 7-8 teeth) 36, RPD free end (one side: 5-7 teeth; both side: 10 teeth) (anterior: 9-10 teeth) 39, RPD (with metal framework) ( 11 teeth) 51,000 58/89

59 49781 PARTIAL DENTURE: C CRUTANUM NO.3 ONE JAW 28, PARTIAL DENTURE: C CRUTANUM NO.4 FREE JAW 32, PARTIAL DENTURE: D WRONGHT WIRE NO.1 1/4 JAW 2, PARTIAL DENTURE: D WRONGHT WIRE NO.2 1/2 JAW 4, PARTIAL DENTURE: D WRONGHT WIRE NO.3 ONE JAW 8, PARTIAL DENTURE: D WRONGHT WIRE NO.4 FREE JAW 10, RPD (denture metal framework) 11, FULL DENTURE B (BOTH JAW) 50, FULL DENTURE C (BOTH JAW) 40, IMPRESSION FOR REPRAIR 1, DENTURE REPAIR REPAIR OF FRACTURE WITH RESIN 義齒修護 1, Interim RPD: adding each clasp 1, DENTURE REPAIR ADD ONE TOOTH WITH S.R. 1, DENTURE REBASING, RELINING:WITH S.R. 義齒換床 2, 更換基底床 8, ALVEOLAR RIDGE TREATMENT WITH SOFT LINER 牙床組織調理使用軟性襯底 2, COMPOSITE ONLAY OR INLAY 3, PORCELAIN ONLAY 6, PORCELAIN CR. METAL BOND D:JELSTAR 7, PORCELAIN INLAY 4, LAMINATE:COMPOSITE 2, ETCHED-METAL RESION BONDING RETAINER 3, BUCCAL BUTT PORCELAIN MARGIN 2, SEMIPRECISION ATTACHMENT 3, MAXILLOFACIAL OBTURATOR COMPLICATED 15, OCCLUSAL ADJUSTMENT SPECIAL PROSTHESIS FEE 10, CEMENTATION OF CROWN WITH ZPC OR PCC(EACH ABUTMENT) 固定假牙黏著 ( 每顆 ) CEMENTATION OF CROWN WITH RESIN CEMENT(EACH ABUTMENT) 固定假牙黏著 ( 每 1, HAWLEY RETAINER (ONE ARCH): INITIAL 海氏齒顎固定器 ( 單顎 4, EXPANSION PLATE WITH SCREW: INITIAL 顎擴張板 9, ACTIVATER: INITIAL 官能性觸動器 15, BITE PLANE: INITIAL 咬合平面板 5, ADJUSTMENT OF MOVABLE PLATE/EA. 矯正裝置調整費 LINGUAL RETAINERS: CUSPID TO CUSPID 5, LINGUAL RETAINERS: INCISORS (DBS) 4, DBS STANDARD, ONE ARCH: INITIAL 直接黏著式 ( 單顎 ) 30, DBS STANDARD, BOTH ARCH: INITIAL 直接黏著式 ( 雙顎 ) 40, DBS STANDARD, BOTH ARCH: PER-MONTH 直接黏著式 ( 雙顎 ) 1, INITIAL 簡單的牙齒矯正套環 10, REPLACEMENT OF ORTHO-RESIN, PARTIAL REPLACEMENT OF DBS BRACKET 1, REPLACEMENT OF BAND+MOLAR TUBE 1, REPLACEMENT OF DBS MOLAR TUBE 1, TUBE AND FACE LOW):INTIAL 8, PLANING 矯正檢查 3, CONSULTATION 2, FACIAL MASK 15, CHIN CAP 6,000 59/89

60 49902 ACTIVATOR RENEW 8, EXPANSION PLATE RENEW 5, LINGUAL ARCH 5, RECALL 定期回診 ( 牙齒矯正後追蹤檢查 ) SWING-LOCK DENTURE 55, WITH HARD RESIN TOOTH 前牙或後牙 ( 一組 ) 2, PORCELAIN TOOTH 前牙或後牙 ( 一組 ) 4, MAGNET ATTACHMENT 15, O 環牙根維持裝置 6, ARTERIAL EVALUATION (PVR) 1, VENAUS EVALUATION (PRG) 2, EXTRACRANIAL ARTERIRL EVATUATION (CPA) 1, 雷射杜朴勒造影 (Laser Doppler image) 1, 動脈硬化狹窄篩檢 (Peripheral artery atherosclerotic and stenosis 2, 簡易周邊血管狹窄篩檢 (ABI Ankle Brachial Index) AWAKE E.E.G. 清醒 1, SLEEP E.E.G. 睡眠 1, AWAKE AND SLEEP E.E.G. 清醒和睡眠 2, NARCOLEPSY 猝睡腦波 1, SPHENOIDAL LEAD E.E.G 蝶竇腦波 1, NASOPHARYNGEAL LEAD E.E.G 鼻咽電極腦波檢查 1, E.N.G (ELECTRONYSTAGMOGRAPHY) 眼振圖 SURFACE EMG 表面肌電圖 1, EMG 肌電圖 1, SINGLE FIBER EMG 單纖維肌電圖 1, MOTOR NCV-UPPER 運動神經傳導速度測定 - 上肢 MOTOR NCV-LOWER 運動神經傳導速度測定 - 下肢 FACIAL NCV 顏面神經刺激檢查 SENSORY NCV 感覺神經傳導速度測定 REPETITIVE STIMULATION 重複刺激檢查 BLINK REFLEX 瞬眼反應 1, F WAVEF 波 H REFLEXH 反射 VEP 視覺性誘發電位檢查 ( 神經內科 ) AEP 聽覺性誘發電位檢查 ( 神經內科 ) 1, MIDDLE LATENCY A.E.P. 中程聽覺性誘發電位檢查 SSEP-UPPER 體覺性誘發電位檢查 - 上肢 SSEP-LOWER 體覺性誘發電位檢查 - 下肢 MEP-UPPER 運動神經誘發電位檢查 - 上肢 MEP-LOWER 運動神經誘發電位檢查 - 下肢 Dopscan 頸動脈血流超音波 B-Mode Carotid Echo 頸動脈影像超音波 1, OCULOPLETHYSMOGRAPHY 眼動脈流速測定 DSEP 神經根體覺性誘發電位檢查 SYMPATHETIC SKIN RESPONSE 皮膚交感神經反應測試 CALORIC TEST 內耳溫差試驗 SPINAL TAPPING 脊椎穿刺 *MINI-MENTAL STATUS EXAM (MMSE) 簡易心智測驗 1,030 60/89

61 61039 *HIGHER CORTICAL FUNCTION TEST 大腦皮層功能測定 1, TRANSCRANIAL DOPPLER SONOGRAPHY 穿顱都卜勒超音波檢查 2, KIDNEY ECHO ABDOMEN ECHO 1, O.B.S. ECHO G.Y.N.ECHO BRAIN ECHO CHEST ECHO 胸部超音波掃描 1, THYROID 甲狀腺超音掃描 BREAST ECHO 乳部超音波掃描 BASIC OBG U/S 婦產科超音波檢查 1, LEVEL II OBS ULTRASOUND 高層次產科超音波檢查 2, ECHO-GUIDE ASPIRATION 超音波引導下穿刺 1, ECHO-GUIDE BIOPSY 超音波引導下生檢 1, LOCALIZATION 定位 BLADDER ECHO (TRANS ABDOMINAL) 膀胱 ( 經腹部 ) 檢查 1, PROSTATE ECHO(TRANS RECTAL) 前列腺 ( 經肛門 ) 檢查 2, PROSTATE (TRANS URETHRAL) 前列腺 ( 經尿道 ) 檢查 2, TESTIS & SCROTUM ECHO 睪丸及陰囊超音波檢查 1, ECHO FOR OTHERS 其他超音波新生兒腎臟超音波篩檢新生兒顱部超音波篩檢 COLOR DOPPLER ULTRASOUND (KIDNEY) 1, 腹部超音波, 追蹤性 INTRA-OPERATIVE ECHO 術中超音波 1, *ECHO FOR JOINT 關節超音波週邊血管超音波 1, 骨骼肌肉關節超音波三維彩色心臟超音波 2, 週邊動靜脈血管超音波檢查胎兒生理評估 1, 心臟組織都卜勒超音波 1, 頭頸部軟組織超音波立體骨盆腔掃描小兒顱部彩色立體超音波 1, 復健科超音波婦科立體超音波檢查 LUNG VOLUME SUBDIVISON FLOW-VOLUME LOOP MVV CLOSING VOLUME & DISTRIBUTION DIFFUSION(DLCO) BRONCHODILATOR TEST(PRE & POST RX) 支氣管擴張劑試驗 1, BODY PLETHYSMOGRAPHY PIMAX & PEMAX 最大吸氣壓及最大吐氣壓 WRIGHTS PEAK FLOW METER-PORTABLE 萊特氏最高流量計 BRONCHIAL PROVOCATION TEST 支氣管激發試驗 ALLERGIC SKIN TEST (EACH AG) 皮膚過敏試驗 ( 每種抗原 ) $EKG ORDINARY /89

62 61302 MASTER'S TEST TREADMILL EXERCISE TEST 1, HOLTER MONITORING 5, WRIST ECG RECORDER (ZVENT RECORDER) 手腕式心律紀錄檢查 1, OXYTOCIN CHALLENGE TEST (O.C.T.) NON-STRESS TEST (N.S.T.) INLABOR CONTINUNES MONITORING ORDINARY E.K.G. MONITOR B.P. MONITOR/DAY GRT-CGMS 連續血糖監測 ( 三日 ) 2, FETAL MONITOR>3HRS EACH HOUR 胎心音監視 3 小時後每小時 FETAL MONITOR,PERDAY 胎心音監視每日 DOPPLER FLOWMETRY (PERIVASCULARY) 杜卜勒氏血流測定 ( 週邊血管 ) CARDIAC CATH-ONE SIDE 心導管 - 一側 5, use non-iornic contrast mitum 1, CARDIAC CATH-BOTH SIDE 心導管 - 二側 7, 血管內超音波 9, CORONARY ARTERIOGRAPHY 冠狀動脈攝影 8, AORTOGRAPHY(CINEANGIOGRAPHY) 主動脈造影 6, 冠狀動脈旋轉研磨鑽系統 11, ACT( 活化凝血時間 ) CARDIOVERSION/(ONE COURSE) 心律調復術 1, ELECTROPHYSIOLOGY-GENERAL(Tilt-table test) 電氣生理檢查 6, M-MODE ECHOCARDIOGRAPHY 1, M-MODE AND 2 DIMENSIONAL ECHOCARDIOGRAPHY 1, DOPPLE AND 2 DIMENSIONAL ECHOCARDIOGRAPHY 1, SWAN-GANZ CATHETERIZATION 5, 洗腎管超音波 1, ISERTION OR REPLACEMENT OF PERMANENT PACEMAKER( 雙導線 ) 插入或置換永久性節律器 8, ISERTION OR REPLACEMENT OF PERMANENT PACEMAKER( 單導線 ) 插入或置換永久性節律器 6, TEMPORARY PACEMAKER MAINTENANCE 暫時性心節律器處置 3, *CONTRAST ECHOCARDIOGRAPHY COLOR ECHOCARDIOGRAM 彩色心臟超音波 2, T.E.E. 經食道超音波心圖 4, 血管內皮功能超音波 1, PTCA ONE VESSEL 經皮冠狀動脈擴張術一條血管 52, PTCA TWO VESSELS 經皮冠狀動脈擴張術二條血管 72, PTCA THREE VESSELS 經皮冠狀動脈擴張術三條血管 91, INTRA AORTIC BALLOON INSERTION 主動脈氣球裝置術 4, PED CRANIAL DOPPLER SONO 小兒顱部杜卜勒超音波 2, PED CRAN 2D & DOPPLER SON 小兒顱部雙面及杜卜勒 2, CARDIAC OUTPUT (FIRST TIME) 心輸出量測定首次 1, CLOSED OR OPEN PULMONIC COMMISSUROTOMY(PTPV) 肺動脈瓣狹窄擴張術 50, PERICARDIOCENTESIS 心包膜穿刺術 2, 經由心導管治療開放性動脈導管 (2.5mm( 含 ) 以上 ) 24, 經由心導管治療開放性動脈導管 24, ELECTROPHYSIOLOGY-COMPLEX 電氣生理檢查 - 複雜性 6,600 62/89

63 61549 PULMONARY ANGIOGRAPHY 肺動脈造影 5, SUBCLAVIAN ANGIOGRAPHY 鎖骨下動脈造影 5, ARTERIOGRAPHY OF EXTREMITY 四肢動靜脈造影 9, VENOGRAPHY OF EXTREMITY 四肢動靜脈造影 9, ANTEGRADE VENOGRAPHY 順行性靜脈 X 光攝影 7, AORTOGRAPHY ( THORACIC+ABDOMINAL) 主動靜脈造影 - 兩項同時實施 7, CREATION,ASD,TRANSVENOUS OR BALLOON METHOD(SEPTOSTOMY) 心房中膈氣球造口 25, GARDIOANGIOGRAPHY 心室造影 6, P.T.A.(PERCUTANEOUS TRANSLUMINAL ANGIOGRAPHY) 血管整形術 13, RENAL ANGIOGRAPHY(ONE AND BOTH SIDE) 腎動靜脈造影 ( 包括單雙側 ) 6, 腸骨動脈血管支架置放術 Stenting for Iliac vessel 15, T.A.E.(TRANS-ARTERIAL EMBOLIZATION) 血管阻塞術 24, Transcarher Radiofrequency Ablation for Arrhythmia 不整脈經導管燒灼術 44, Stenting for head & neck vessel (one vessel) 頭頸部血管支撐架置放術 ( 一條血管 ) 12, Amplatzer 心房中膈缺損關閉器治療中膈缺損 AOS 24, Percutaneous transluminal deployment of veinous device 經皮穿腔靜脈過濾裝置置放術 19, Percutaneous transluminal catheter retrieval of vasculer /intracardiac foreign body 12, EMG 肌電圖 1, MOTOR NCV 上肢運動神經傳導速率 SENSORY NCV REPETATITIVE STIMULATION 重複刺激檢查 VEP 視覺性誘發電位檢查 ( 兒科 ) 1, AEP 聽覺性誘發電位檢查 ( 兒科 ) 1, SSEP 體覺性誘發電位檢查 1, 運動神經傳導速度測定一下肢 MORTOR NERVE CONDUCTION VELOCITY-LOWER BLINK REFLEX 瞬眼反應 1, F WAVEF 波 H REFLEXH 反射 EXTERNAL SPHINCTER ELECTROMYOGRAM 外括約肌肌電圖 FACIAL NCV 面神經刺激檢查 ANTI-SPASTICITY BLOCK 抗痙攣阻斷術心肺運動測試 2, 第一級外科病理 ( 眼觀檢查 ) 第二級外科病理 ( 組織鏡檢確認 ) 第三級外科病理 ( 一般性 ) 1, 第四級外科病理 ( 複雜性 ) 2, 第五級外科病理 ( 中度複雜性 ) 3, 第六級外科病理 ( 高度複雜性 ) 5, 冰凍切片檢查 6, 組織化學染色第一類組織化學染色第二類 ( 結核菌 & 酵素 ) 1, 免疫組織化學染色 ( 每一抗體 ) 1, ELECTRON MICROSCOPICY 電子顯微鏡檢查 14, BONE MARROW MLL-ENL translocation RT-PCR 白血病 MLL-ENL 定性 2, TB PCR 結核分枝桿菌聚合? 連鎖反應 ) 組織 / 蠟塊 1,200 63/89

64 62030 In situ hybridization 原位雜交法 ( 自費 ) 4, 核酸序列分析 2, 切片諮詢費 BCR/ABL translocation real time PCR 費城染色體定量 5, BCR/ABL translocation RT-PCR 費城染色體定性 2, 肺炎黴漿菌聚合連鎖反應 (Mycoplasma pneumoniae-pcr 法 ) 1, HHV8 PCR 人類疹病毒第八型聚合連鎖反應 1, HSV PCR 單純疹病毒聚合連鎖反應 1, Polyomavirus (BK & JC) PCR 多瘤病毒聚合連鎖反應 1, Her2/neu 螢光原位雜交 FISH 12, T cell gene rearrangement- β chain 3, T cell gene rearrangement- γ chain 3, B cell gene rearrangement- IgH chain 3, KIT gene exon9,11,13,17 and PDGFRA exon10,12,14,18 胃腸道基質瘤 (GIST) 16, EGFR gene exon18,19,20,21 非小細胞型肺癌 8, CML Glivec 抗藥性基因突變 8, K-ras; hot spot (codon12,13,61) 4, H-ras; hot spot (codon12,13,61) 4, 聚合連鎖反應 1, 代工組織化學染色第一類 ( 不診斷 ) 代工組織化學染色第二類 ( 不診斷 ) 代工免疫組織化學染色第三類 ( 不診斷 ) 切片數位照相法院委託病理鑑定 8, SKIN, DIRCET IMMUNOFLUORESCENCE 5, 間接性螢光性切片檢查 6, PAP smear 婦科細胞檢查尿 - 細胞檢查甲狀腺穿刺 - 細胞檢查體液細胞檢查加細胞切片 1, 薄片細胞學檢查 (ASCUS) 1, 腹水 - 細胞檢查肺臟穿刺 - 胸腔細胞檢查脊髓液 - 細胞檢查心包膜積水 - 細胞檢查截腸沖洗液 - 細胞檢查婦科細胞檢查 ( 限免疫不全, 每年一次 ) 轉介薄片細胞檢查 (ASCUS) 1, 痰 - 胸腔細胞檢查胸水 - 胸腔細胞檢查氣管刷取 - 胸腔細胞檢查氣管沖洗 - 胸腔細胞檢查 THINPREP PAP TEST 高品質薄膜單層婦科細胞檢查 1, 淋巴腺穿刺 - 細胞檢查乳房穿刺 - 細胞檢查肝臟穿刺 - 細胞檢查胰臟穿刺 - 細胞檢查腫瘤穿刺 - 細胞檢查痰 (sputum)for PCP /89

65 63001 IGE 球蛋白 E 放射免疫分析 FREE PSA 游離攝護腺特異抗原 HCV-RNA type 3, HBV-DNA 1, CA72-4 1, NSE 1, 紅血球生成因子 Erythroprotein HGH BEAT-2 MICROGLOBULINβ-2 微小球蛋白 ALPHA-OH PROGESTERONE17α- 氫氧基黃體脂酮 TSH FSH LH PROLACTIN (PRL) PROGESTERONE RECEPTOR (PR) 黃體激素接受體 2, TBG 甲狀腺素結合球蛋白 F.T.I FREE T T3 RIA T4 RIA THYROGLOBUBIN 甲狀腺球蛋白 INTACT PTH 副甲狀腺素放射免疫分析 DHEA-SO4(Dehydroepiandrosterone) GASTRIN CALCITONIN 降血鈣素 OSTEOCALCIN 骨原蛋白 ADH 抗利尿激素 T3 UPTAKE 甲狀腺原氨酸攝取率檢查 HBSAGB 型肝炎表面抗原放射免疫分析 ANTI-HBS ANTI-HBC HBEAG ANTI-HBE ANTI-HAV ANTI-HAV-IGM ASD(Androstenedion) (OH)2-D PLASMA RENIN ACTIVITY ANTI-HBC-IGM PROSTATE SPECIFIC ANTIGEN 攝護腺特異抗原 CA-153CA-153 腫瘤標記 ALDOSTERONE CORTISOL ESTRADIOL (E2) 二氫基春情素放射免疫分析 PROGESTERONE 黃體脂酮放射免疫分析 TESTOSTERONE 睪丸脂醇放射免疫分析 HCV-RNA titer 2, INSULIN 胰島素放射免疫分析 OH-D /89

66 63067 C-PEPTIDEC- 審鍊胰島素放射免疫分析 INSULIN ANTIBODY 原生 B 型利鈉太 (Pro BNP N-terminal) 1, B-Cross Laps TPA CEA 胚胎致癌抗原 AFP (ALPHA-FETOPROTEIN) Urine Cortisol Urine Aldosterone ANTI-THYROGLOBULIN ANTIBODY TSH RECEPTOR ANTIBODY ANTI-MICROSOMAL ANTIBODY CYFRA , FOLIC ACID 葉酸放射免疫分析 PROSTATIC ACID PHOSPHATASE 攝護腺酸性磷酸鹽醇素放射免疫分析 FERRITIN 鐵蛋白放射免疫分析 VITAMIN B12 維生素 B12 放射免疫分析 ANTI-D DNA CA 125CA-125 腫瘤標記第二孕期二指標母血唐氏症篩檢 1, 第二孕期四指標母血唐氏症篩檢 1, Anti-GAD-Ab 1, Anti-IA2 1, Free Testosterone 1, CA 199CA-199 腫瘤標記 1, S.C.C. 抗 -SCC 腫瘤標記 1, FREE-BETA-HCG 游離型人類絨毛膜刺激素 ACTH 腎上腺促素 1, Somatomedine C(insulin-like growth factor I) 類胰島素成長因子 Inhibin-B ACH(Acetylcholine-receptor Ab) 1, DHT(Dihydrotestosterone) FK506 1, Plasma Renin-Concentration I-131 THYROID UPTAKE I-131 THYROID SCAN AND 24 HRS UPTAKE 碘 -131 甲狀腺掃描及 24 小時攝取量測定 1, TC-99M THYROID SCAN 鎝 -99m 甲狀腺掃描 1, I-131 CANCER WORK-UP 碘 -131 癌症追蹤檢查 3, PARATHYROID SCAN 副甲狀腺掃描註 : 限副甲狀腺腫瘤及術後復發功能亢進病患 6, BRAIN SCAN 腦部掃描 3, TC-99M MDP WHOLE BODY SCAN 骨骼掃描 2, 'GA-67 TUMOR SURVEY 鎵 -67 腫瘤攝影 7, LIVER AND SPLEEN SCAN 肝脾臟掃描 2, SPLEEN SCAN WITH 99M TC-TAGGED RBC 鎝 99m 脾臟攝影 ( 用紅血球 ) 2, CHOLESCINTIGRAPHY 肝膽道閃爍攝影 3, TC-99M RENAL IMAGING (DMSA) 腎臟掃描 2, BONE MARROW SCAN (WHOLE BODY) 骨髓全身檢查 4, RETAINED GASTRIC ANTRUM SCINTIGRAPHY 胃幽門竇殘餘閃爍檢查 2,430 66/89

67 63620 MECKELS DIVERTICULUM SCAN 邁克氏憩室掃描 2, MYOCARDIAL INFARCT STUDY 心肌梗塞攝影 2, C-13 UREA BREATH TEST 碳 -13 尿素呼吸試驗 1, F-18 FDG PET scan(whole body) 正子造影 ( 全身 ) 36, F-18 FDG PET scan(heart or brain) 正子造影 ( 局部 ) 32, LUNG PERFUSION STUDY 肺灌注檢查 2, BLEEDING SCAN;TC-99M RBC 核醫出血檢查 3, ESOPHAGEAL TRANSIT STUDY 食道通過檢查 2, ENTEROGASTRIC REFLEUX STUDY 2, GASTRIC EMPTYING TIME 胃排空測定 3, VENTRICULAR EJECTION FRACTION DITERMINATIONS 心臟搏出分率測定 2, VENTRICULAR EJECTION FRACTIONS DETERMINATION PLUS WALL MOTION STUD 心臟搏出分率及心室壁活動測定 2, COPY POLAROID FILM 拷貝拍立得照片 SPLIT RENAL FUNCTION 核醫腎功能測定 2, I-131 MIBG ADRENAL SCAN 14, NP-59 ADRENAL SCAN 腎上腺掃描 14, TC-99M MDP & GA-67 SCINTIGRAPHY FOR OSTEOMYELITIS OR PAINFUL PRO.. 8, THREE-PHASE BONE SCAN 三相骨骼掃描 2, QUANTITATIVE SACROILIAC SCAN 薦腸關節定量檢查 2, SCROTAL IMAGING 陰囊攝影 2, VENOGRAPHY 靜脈檢查 2, DACROCYSTOGRAPHY 淚腺閃爍攝影檢查 1, SIALOSCINTIGRAPHY 唾腺閃爍攝影 2, GA INFLAMMATION SCAN 鎵 -67 炎症掃描 6, TL CANCER WORK-UP 電 -201 癌症追蹤檢查 5, Lymphoscintigraphy 3, DIURETIC RENOGRAPHY 3, CAPTOPRIL RENOGRAPHY 3, DIRECT CYSTOURETEROGRAPHY 2, INDIRECT CYSTOURETEROGRAPHY 2, Brain perfusion scan with SPECT 11, SPECT STUDY 核子斷層檢查術 1, LUNG VENTILATION STUDY 肺通氣檢查 3, 全身骨骼掃描 -Tc-99m 鎝 -99m TRODAT-1 腦部多巴神經元斷層造影 10, PENITONEAL SCAN 2, I-131 NECK AND CHEST SCAN 碘 -131 頸及胸部掃描 2, MYOCARDIAL PERFUSION SCAN,STRESS AND REDISTRIBUTION WITH SPECT STUDY 9, In 111 Pentetreotide scan 7, 碘 -131 癌症追蹤檢查 - 施打 Thyrogen 23, I-131 TREATMENT( 請開總劑量 ) 碘 -131 治療 <EXM>'I-131 TREATMENT< 檢核 > <DSP>'I-131 TREATMENT< 處置 > BRONCHOSCOPY 支氣管鏡檢查 2, PANENDOSCOPY 泛上胃腸道內視鏡檢查 2, ESOPHAGOSCOPY 食道鏡檢查 1, ERCP 經內視鏡逆行膽道胰管攝影 (x 光費另計 ) 4, COLON-FIBEROSCOPY 大腸纖維鏡檢查 2,700 67/89

68 COLON-FIBEROSCOPY 大腸纖維鏡檢查 2, COLON-FIBEROSCOPY 大腸纖維鏡檢查 2, COLON-FIBEROSCOPY 大腸纖維鏡檢查 2, SIGMOIDOSCOPYS 狀結腸鏡檢查 SIGMOIDOSCOPIC BIOPSY,HIGH 直腸鏡檢查並做切片深 1, ANOSCOPY 肛門鏡檢查 U.G.I. WITH POLYPECTOMY 上消化道內視鏡息肉切除 4, RECTUM 直腸鏡檢查 COLON 大腸內視鏡息肉切除 4, 上消化道息肉切除術 2, (E.P.T.) ENDOSCOPIC PAPILLOTOMY 內視鏡乳頭切開術 21, 其他經內視鏡治療 (Theraputic endoscopy) 3, Replacement of percutaneous endoscopic gastrostomy 經皮內視鏡胃造廔管替 2, PERCUTANEOUS LUNG NEEDLE ASPIRATION BIOPSY 經皮穿胸細針吸引活體生檢 2, LAPAROSCOPY 腹腔鏡 4, ENDOSCOPIC SCLEROTHERAPY FOR ESOPHAGEAL VARICES 經內視鏡食道靜脈瘤硬化劑注射治療 3, FLEXIBLE SIGMOIDOSCOPY 軟性乙狀結腸纖維鏡 1, BRONCHOALVEOLAR LAVAGE 支氣管肺泡灌洗術 2, 經胸腔超音波導引下抽吸 2, 內視鏡逆行性膽道引流術 3, ENDOSCOPIC ULTRASENOGRAPHY 內視鏡超音波 2, THORACOSCOPY WITH BIOPSY 胸腔鏡檢查術及活體切片 5, JEJUNOFIBERSCOPY 小腸纖維鏡檢查 3, ORGAN PUNCTURE 臟器穿刺 1, COMMON BACTERAL CULTURE AND IDENTIFICATION 細菌培養鑑定檢查 ENDOSCOPIC BIOPSY EACH EXAM 上消化道內視鏡切片 ( 每一診次 ) BIOPSY OF COLON FIBEROSCOPY OR JEJUNOFIBEROSCOPY EACH EXAM 大腸或小腸內視鏡切片 ( 每一診次 ) 上消化道出血之局部注射止血法 3, 經內視鏡消化道華達壺腹切開併截石術 14, 經內視鏡施行食道擴張術 2, 上消化道內視鏡異物摘除術 3, 經內視鏡食道靜脈瘤結紮術 5, 膠囊內視鏡檢查費 9, 經胸腔超音波導引下肺組織切片 3, 光動力療法 Photodynamic therapy (PDT) 13, 支氣管鏡無痛處置 ( 不含支氣管鏡檢查費用 ) 4, Total β-hcg 絨毛膜促性線激素 - 乙亞單體 B 型肝炎表面抗原檢查 HBSAG-EIA A 型肝炎抗體 ANTI-HAV 婦兒科 C 型肝炎篩檢 Abscess - Routine culture ( 需氧 ) Abscess - Routine culture ( 厭氧 ) Abscess - Gram stain Abscess - TB culture Abscess - AFB stain Abscess - Fungus culture Abscess - KOH mount 60 68/89

69 65708 Abscess-Blood bottle culture( 使用血瓶採檢 ) Abscess-TB culture(myco/f-lytic 血瓶 ) Abscess-Fungus culture(myco/f-lytic 血瓶 ) Ascites - Routine culture ( 需氧 ) Ascites - Routine culture ( 厭氧 ) Ascites - Blood bottle culture( 使用血瓶採檢 ) Ascites - Gram stain Ascites - TB culture Ascites - AFB stain Ascites - Fungus culture Ascites - KOH mount Ascites-TB culture(myco/f-lytic 血瓶 ) Ascites-Fungus culture(myco/f-lytic 血瓶 ) BAL - Routine culture ( 需氧 ) BAL- Gram stain BAL - TB culture BAL - AFB stain BAL - Fungus culture BAL- KOH mount BAL- India ink stain Bronchial Brush (smear)- Gram stain Bronchial Brush (smear)- AFB stain PSB - Routine culture ( 需氧 ) PSB - Routine culture ( 厭氧 ) PSB - Gram stain PSB - India ink stain PSB - TB culture PSB - AFB stain PSB - KOH mount Sputum ( 痰液 ) - Routine culture( 需氧 ) Sputum ( Endobronchial suction) - Routine culture( 需氧 ) Sputum ( 痰液 ) - Gram stain Sputum ( 痰液 ) - TB culture Sputum ( 痰液 ) - AFB stain Sputum ( 痰液 ) - Fungus culture Sputum ( 痰液 ) - KOH mount Sputum ( Suction tube)( 限兒科 )- Routine culture ( 需氧 ) Nose- Routine culture ( 需氧 ) Nose- Routine culture ( 厭氧 ) Nose- Fungus culture Throat - Routine culture( 需氧 ) Oral - Routine culture( 需氧 ) Dental-Routine culture ( 厭氧 ) Bile - Routine culture ( 需氧 ) Bile - Routine culture ( 厭氧 ) Bile - Gram stain Blood culture ( 大人 )- for catheter lines Blood culture ( 大人 )- for peripheral Blood culture ( 小兒 )- for catheter lines /89

70 65778 Blood culture ( 小兒 )- for peripheral Blood Fungus culture ( MYCO/F-Lytic 血瓶 ) Blood TB culture ( MYCO/F-Lytic 血瓶 ) Serum - Serum Bactericide titer ( peak ) 1, Serum - Serum Bactericide titer ( trough ) 1, Bone Marrow- Routine culture( 需氧 ) Bone Marrow - Blood bottle culture( 使用血瓶採檢 ) Bone Marrow - Fungus culture ( MYCO/F-Lytic 血瓶 ) Bone Marrow - TB culture ( MYCO/F-Lytic 血瓶 ) Bone Marrow -Gram Stain Body fluid - Routine culture ( 需氧 ) Body fluid - Routine culture ( 厭氧 ) Body fluid - Blood bottle culture( 使用血瓶採檢 ) Body fluid - Gram stain Body fluid - TB culture Body fluid - AFB stain Body fluid - Fungus culture Body fluid - KOH mount Body fluid-fungus culture(myco/f-lytic 血瓶 ) Body fluid-tb culture(myco/f-lytic 血瓶 ) CSF - Routine culture ( 需氧 ) CSF - Gram stain CSF - India ink stain CSF - TB culture CSF - AFB stain CSF - Fungus culture Dialysate - Routine culture ( 需氧 ) Dialysate - Routine culture ( 厭氧 ) Dialysate - Gram stain Dialysate -TB culture Dialysate -AFB stain Dialysate - Fungus culture Dialysate - KOH mount Drain discharge - Routine culture ( 需氧 ) Drain discharge - Routine culture ( 厭氧 ) Drain discharge - Gram stain Drain discharge - TB culture Drain discharge - AFB stain Drain discharge - Fungus culture Ear - Routine culture (external)( 需氧 ) Ear - Routine culture (middle)( 需氧 ) Ear - Routine culture (middle)( 厭氧 ) Ear - Fungus culture Endocervix - Routine culture ( 需氧 ) Endocervix - Routine culture ( 厭氧 ) Endocervix - N. gonorrhoeae culture Endocervix - Gram stain Vagina - Routine culture ( 需氧 ) Vagina- N. gonorrhoeae culture /89

71 65850 Vagina- GBS screen culture Vagina - Gram stain Genital ( male ) - Routine culture ( 需氧 ) Genital( male ) - N. gonorrhoeae culture Genital( male ) - Gram stain Semen ( 精液 ) - Routine culture( 需氧 ) Eye - Routine culture( 需氧 ) Eye - Fungus culture Eye -Gram Stain Gastric juice - Routine culture ( 需氧 )( 限新生兒 ) Gastric juice - TB culture Gastric juice - AFB stain Hair - Fungus culture Joint fluid - Routine culture ( 需氧 ) Joint fluid - Routine culture ( 厭氧 ) Joint fluid - Blood bottle culture( 使用血瓶採檢 ) Joint fluid - Gram stain Joint fluid - TB culture Joint fluid - AFB stain Joint fluid - Fungus culture Joint fluid- KOH mount Nail - Fungus culture Pleural effusion - Routine culture ( 需氧 ) Pleural effusion - Routine culture ( 厭氧 ) Pleural effusion - Blood bottle culture( 使用血瓶採檢 ) Pleural effusion - Gram stain Pleural effusion - India ink stain Pleural effusion - TB culture Pleural effusion - AFB stain Pleural effusion - Fungus culture Pleural effusion - KOH mount Pleural effusion-tb cuture Pleural effusion-fungus cuture(myco/f-lytic 血瓶 ) Pus / wound - Routine culture ( 淺部 ) ( 需氧 ) Pus / wound - Routine culture ( 深部 ) ( 需氧 ) Pus / wound - Routine culture ( 深部 ) ( 厭氧 ) Pus / wound - Gram stain Pus / wound - TB culture Pus / wound - AFB stain Pus / wound - Fungus culture Skin (for 皮庫 ) -Routine culture ( 需氧 ) Skin scraping - Fungus culture Skin - Cutaneous Mycobacterium (only TB culture) Skin - Atypical Mycobacterium (only TB culture) Skin( 漢生病追蹤專用 )-AFB stain Stool ( 糞便 ) - Salmonella, Shigella culture Stool ( 糞便 ) - Campylobacter culture Stool ( 糞便 )- Vibrio., Aeromonas, Plesiomonas culture Stool ( 糞便 )- Clostridium difficile culture( 厭氧 ) /89

72 65921 Stool ( 糞便 )- Clostridium difficile toxin A Stool ( 糞便 ) - TB culture Stool ( 糞便 ) - AFB stain Tip ( I.V Catheter Tip ) - Routine culture( 需氧 ) Tissue - Routine culture ( 需氧 ) Tissue - Routine culture ( 厭氧 ) Tissue - Gram stain Tissue - TB culture Tissue - AFB stain Tissue - Fungus culture Tissue - KOH mount Tissue-Cutaneous Mycobacterium(only TB culture) Tissue-Atypical Mycobacterium(only TB culture) Urine ( 中段尿 ) - Routine culture( 需氧 ) Urine( 存留導管尿 ) - Routine culture( 需氧 ) Urine( 單次導管尿 ) - Routine culture ( 需氧 ) Urine( 穿刺尿 )- Routine culture ( 需氧 ) Urine ( 穿刺尿 ) - Routine culture ( 厭氧 ) Urine ( 尿液 )- Gram stain Urine ( 尿液 )- TB culture Urine( 尿液 )- AFB stain Urine ( 尿液 )- Fungus culture Urine ( 尿液 )- Legionella pneumophila Ag 退伍軍人桿菌尿中抗原測定 Other - KOH mount Other - Fungus culture Other-Routine culture( 需氧 ) 細菌 ( 黴菌 ) 最低抑制濃度藥物敏感性試驗 MIC for yeasts- Amphotericine B Fluconazole Flucytosine Itraconazole Voriconazole Drug sensitivity test - one pathogen 細菌藥物敏感性試驗 Drug sensitivity test - two pathogens 細菌藥物敏感性試驗 Mycobacterium drug sensitivity test ( 抗酸菌藥物敏感性試驗 ) Mycobacterium identification test ( 抗酸菌鑑定檢查 ) 抗生素敏感試驗 (MIC 法 )-- 三種菌 ACS panel 限急診病人 (myoglobin, CKMB, TPI) Chest pain pannel 限急診病人 (myoglobin, CKMB, TPI, BNP) 1, SOB pannel 限急診病人 (myoglobin, CKMB, TPI, BNP, D-diamer) 2, BNP 肌肉萎縮症 (SMA) 2, UMBILICAL BLOOD SCREEN 臍血檢驗費 PHARMACY BLOOD DRAWING 藥化採血費黏多醣定量分析 ( 雙甲基甲烯藍方法 ) 1, 黏多醣分型 ( 二次元電泳法 ) 1, 龐貝氏症及法布瑞氏症篩檢血液游離脂肪酸氣相層析質譜分析 1, PYRUVATE 丙銅酸 LACTATE ACID 乳酸 QUANTITATION OF SPECIFIC ORGANIC ACIDS (GC/MS) 特殊有機酸定量 2, Organic Acid Analysis by GC/MS 有機酸定性檢查 1,300 72/89

73 66055 AMINO ACID ANALYSIS 胺基酸定量分析 2, URITEST PLASMA FREE TOTAL CARNITINE QUANTITATION 血漿肉毒鹼定量分析 1, 代謝性罕見疾病篩檢 ( 串聯式質譜儀 ) 血液非常長鏈脂肪酸氣相層析質譜分析 2, CARBAMAZEPINE-TEGRETOL 卡巴馬平 ( 癲通 ) CYCLOSPORINE TDMCYCLOSPORINE 藥物血中濃度監測 1, DIGOXIN 長葉毛地黃 EPILEPSIN GENTAMICIN PEAK MTX THERAPEUTIC DURG MONITOR 滅殺除癌血中濃度監測 1, PHENOBARBITAL(BARBITURATE) 巴比妥酸鹽 PHENYTOIN(DILANTIN) THEOPHYLLINE 茶鹼 VALPROIC ACID 發爾波克註 : 蒂拔癲 VANCOMYCIN PEAK 穩可信藥物血中濃度監測 VANCOMYCIN TROUGH 穩可信藥物血中濃度測定 GENTAMICIN TROUGH ACETAMINOPHEN 乙醯對氨基涓 ETHYL ALCOHOL 乙醇 ( 一般傷病血中乙醇 ) Salicylate 1, Cholinesterase Adenosine Deaminase 腺甘脫胺脢 Amikacin peak 毒物篩檢 ( 嗜睡型 ) 2, 毒物篩檢 ( 躁動型 ) 2, 毒物篩檢 ( 全項 ) 2, 二氧化碳 CO Amikacin trough GLUCOSE (AC) 血糖 ( 飯前 ) Blood sugar test 快速血糖儀檢驗 GLUCOSE PC. 血糖 ( 飯後 ) 空腹及口服 75 公克葡萄糖兩小時後血漿葡萄糖測定 HbA1c 醣化血色素 GTT(75GM)4 支葡萄糖耐量試驗 A/G (TOTAL PROTEIN+ALBUMIN) 蛋白比值 ALBUMIN 白蛋白 GLUCOSE 50GM/1 小時血糖測定 KETONE 酮體 DIRECT BILIRUBIN 直接膽紅素 TOTAL BILIRUBIN 總膽紅素 ALK-PHOSPHATASE 鹼性磷酸脢 GOT 麩胺酸轉氨 GPT 丙酮酸轉胺 LDH. 乳酸脫氫脢 CK. 肌酸磷化脢 ICG Test 循血綠試驗 CHOLESTEROL TOTAL 總膽固醇 85 73/89

74 66120 TRIGLYCERIDE (TG) 中性脂肪 Troponin-I( 定量 ) CATECHOLAMINE FOR URINE 兒荼涓脢測定 1, AMMONIA 氨 Stat CRP AMYLASE 澱粉 LIPASE 解脂脢 BUN 尿素氮 URIC-ACID 尿酸 CREATININE 肌酸酐 GTT(100GM)4 支葡萄糖耐量試驗 K (POTASSIUM) 鉀 NA (SODIUM) 鈉 CL (CHLORIDE) 氯 P 磷 CA 鈣 SERUM IRON+TIBC 血清鐵和總鐵結合試驗 HIAA (5-HYDROXYINDOLEACETIC-ACID)5- 氫氧靛基醋酸 CADMIUM (CD) 鎘 CU 銅 HbCO 一氧化碳中毒 LI 鋰 MG 鎂 PB 鉛微量元素鋅 ZN PROTEIN ELECTROPHORESIS 蛋白電泳分析 NEW BORN SCREEN( 補同意書申請再驗 ) LIPOPROTEIN ELECTROPHORESIS 脂蛋白電泳分析 NEW BORN SCREENING TEST 新生兒篩選試驗 Y-GT 麩胺醯轉移 STONE ANALYSIS 結石分析 FREE CA 游離鈣 CK-MB 肌酸磷酸脢 LDH ISOENZYME 乳酸脫氫同功脢 LDL CHOLESTEROL 低密度膽固醇 HDL CHOLESTEROL 高密度膽固醇 ALUMINUM (AL) 鋁 CK ISOENZYME 肌酸磷化同功脢 SERUM OSMOLALITY 血液滲透力 G-6-P-D 葡萄糖六磷酸脫氫脢 VISCOSITY 血清黏度 CERULOPLASMIN-NEPHELOMETRY 轉銅素 - 免疫比濁法 GC/MS FOR AMPHETAMINE 1, GC/MS FOR MORPHINE 1, BLOOD GAS 血液氣體分析 GLUCOSE FOR P.F 血糖 PROTEIN FOR P.F 全蛋白 CL FOR P.F 氯 LDH FOR P.F 乳酸脫氫脢 /89

75 66169 GLUCOSE FOR A.S 血糖 PROTEIN FOR A.S 全蛋白 GLUCOSE FOR URINE 血糖血液及體液葡萄糖 GTT FOR URINE 血糖耐量 PROTEIN FOR URINE 全蛋白 AMYLASE FOR URINE 澱粉 K FOR URINE 鉀 NA FOR URINE 鈉 CL FOR URINE 氯 P FOR URINE 磷 CA FOR URINE 鈣 KS FOR URINE17 酮類固醇類 OHC FOR URINE17 氫氧根腎上腺酮 VMA FOR URINE 香莢杏仁酸定量 BUN FOR URINE 尿素氮血中尿素氮 CREATININE FOR URINE 肌濟酸肌酸酐血 URIC ACID FOR URINE 尿酸 PROTEIN ELECTROPHORESIS FOR URINE 蛋白電泳分析 CU FOR URINE 銅 MG FOR URINE 鎂 PB FOR URINE 鉛 ZN FOR URINE 鋅 URINE OSMOLARITY 尿滲透壓檢查 URINE AMPHETAMINE 尿液安非他命 CL FOR A.S 氯 GLUCOSE FOR CSF 血糖 PROTEIN FOR CSF 全蛋白 CL FOR CSF 氯 LDH FOR CSF 乳酸脫氫脢 LDH FOR A.S 乳酸脫氫脢 HB 血色素 RBC 紅血球計數 HT 血球容積比 MCV 平均紅血球容積 MCH 平均紅血球血紅素量 MCHC 平均紅血球血紅素量 WBC 白血球計數 WBC-DC (DIFF COUNT) 白血球分類計數 PLATELET 血小板計數 RETICULOCYTE 網狀紅血球計數 BLEED TIME (BT) 出血時間 IVY'S BLEED TIME 出血時間 RBC MORPHOLOGY 紅血球形態 CLOT RETRACTION TEST 血塊收縮試驗 MALARIA 瘧原蟲檢查 ( 血中寄生蟲檢查 ) PT (PROTHROMBIN TIME) 凝血脢原時間 /89

76 66217 APTT. 部份活化凝血脢原時間 THROMBIN TIME 凝血脢時間 PROTEIN-S 蛋白 -S UREA SOLUBILITY TEST 尿素溶解試驗 FDP 纖維蛋白溶解產物 RH TYPING D Blood Group 本人血型測定 (Slide method) ESR. 紅血球沉降速度測定 HB.H 血色素 H 染色 HB.F 血色素 F 值測定 FILARIA 血絲蟲檢查 METHEMOGLOBIN 變性血色素檢查 CRYOGLOBULIN 冷凝球蛋白 CYTOCHEMICAL STAIN (ANBE,CAE,POS,PAS) 1, LE CELL 紅斑性狼瘡細胞 EOSINO COUNT 嗜酸球計數 IRON STAIN 鐵染色 PEROXIDASE STAIN 過氧化脢染色 ALK-P-TASE STAIN 鹼性磷酸脢染色 PAS. STAIN 肝糖染色試驗 CONBINED ESTERASE STAIN (ANBE+CAE) 特異性脂脢染色 FIBRINOGEN 纖維蛋白原測定 FRAGILITY TEST (1) 脆性檢查 (1) FRAGILITY TEST (2) 脆性檢查 (2) SUGAR WATER TEST 糖水試驗 HAM'S TEST 酸溶血試驗 ACID ELUTION TEST THROMBIN TIME CORRECTION TEST PLATELET AGGREGATION TEST 血小板凝集試驗 1, ANTI THROMBIN III (AT III) 抗凝血脢 HB. ELECTROPHORESIS 血色素電泳 P TEST 硫酸魚精蛋白副凝固試驗 Von willebrand factor LUPUS ANTICOAGULANT test PROTEIN C TEST 蛋白 C 試驗 1, FACTOR 2 ASSAY 第二因子測定 FACTOR 5 ASSAY 第五因子測定 FACTOR 7 ASSAY 第七因子測定 FACTOR 8 ASSAY 第八因子測定 FACTOR 9 ASSAY 第九因子測定 FACTOR 10 ASSAY 第十因子測定 FACTOR 11 ASSAY 第十一因子測定 1, Factor 8 inhibitor test 第八因子阻滯子分析 D-dimer( 定量法 ) CBC-1 (WBC,RBC,HB,HT,PLATELET,MCV,MCH,MCHC) 全套血液檢查 ( 八項 ) CBC-II (WBC,RBC,HB,HT,MCV,MCH,MCHC) 全套血液檢查 ( 七項 ) CBC-III (WBC,RBC,HB,HT,MCV) 全套血液檢查 III Blood routine (WBC,RBC,HB) 血液一般檢查 Non-self Blood Group 非本人血型測定 (Slide method) 40 76/89

77 66301 RPR 梅毒檢查 WIDAL REACTION 發熱疾病的凝集試驗 RA (RHEUMATOID FACTOR TEST) 類風濕性關節炎 CRP (C-REACTIVE PROTEIN)C 反應性蛋白試驗 ANTISTREPTOLYSIN O TITER (ASLO) 抗鏈球菌溶血素 O COLD HEMAGGLUTIN 冷凝集素 IHA AMOEBA 阿米巴抗體 MUMPS IGM 腮腺炎病毒 IGM 抗體 RUBELLA IGG 德國麻疹 IGG 抗體 RUBELLA IGM 德國麻疹 IGM 抗體 ANTI-EBV VCA-IGG AB ANTI-EBV VCA-IGM AB HSV-1 IgG 疹病毒 1- 抗體 HSV-II IgG 泡疹病毒 2- 抗體 S. PNEUMONIA AG MEASLES IGM 麻疹病毒 IGM 抗體 VARICELLA ZOSTER IGM 水痘病毒 IGM 抗體 1, H. INFUENZA AG N MENINGITIS AG B-STREP GROUP B S. PNEUMONIA AG For P.F CRYPTOCOCCUS 芽生菌抗原 M. pneumoniae IgG Ab ( 肺炎黴漿菌 IgG 抗體 ) TOXOPLASMA IGG 弓漿蟲 IGG 抗體 CMV IGG AB 巨細胞病毒 IGG 抗體 MUMPS IGG 腮腺炎病毒 IGG 抗體 MEASLES IGG AB 麻疹抗體 VARICELLA-ZOSTER IGG 水痘 H.INFLUENZA AG For P.F HIV AB. 人類免疫缺乏病毒檢查 TOXOPLASMA IGM 弓漿蟲 IGM 抗體 CMV IGM AB 巨細胞病毒抗體 HCV ABC 型肝炎病毒 TPHA TEST 梅毒螺旋體 ANTI-EBV EA-IGG ABEB 病毒囊鞘免疫球蛋白 G M A (IFA 法 ) ANTI-EBV NA-IGG ABEB 病毒核抗原抗體 1, HSV- I IGM 泡疹病毒 I 抗體 HSV- II IGM 泡疹病毒 II 抗體 Anti EBV VCA-IgA Ab TRANSFERRIN-NEPHELOMETRY 運鐵蛋白 - 免疫比濁法 HIV Viral Load 4, HELICOBACTER PYLORI IgG Anti-HTLV 1/2 成人 T 淋巴白血病病毒抗體 Prealbumin hs-crp Stool α1-antitrypsin VDRL For CSF S.PNEUMONIA AG FOR CSF H.INFUENZA AG FOR CSF /89

78 66353 N.MENINGITIS AG FOR CSF B-STREP GROUP B FOR CSF CRYPTOCOCCUS FOR CSF 芽生菌抗原 HIV 健保孕婦篩檢 HIV Ab 健保性病篩檢 EBV(EA+EBNA-1) IgA 1, S. Pneumonia Ag (urine) H.INFUENZA AG FOR URINE N.MENINGITIS AG FOR URINE B-STREP GROUP B FOR URINE MICRO-ALBUMIN (NEPHELOMETRY) N MENINGITIS AG For P.F ROTAVIRUS FOR STOOL 輪狀病毒 Binax now streptococcus pneumoniae Ag(urine) Binax now streptococcus pneumoniae Ag(CSF) B-STREP GROUP B For A.S SERUM HAPTOGLOBIN 結合蛋白 M. PNEUMONIA IGM AB GENERAL URINE EXAMINATION 尿一般檢查 SP.GR 比重檢查 URINE BIOCHEMISTRY EXAMINATION 尿生化檢查 SEDIMENT 尿沉渣顯微鏡檢查 PROTEIN 蛋白質定性檢查 URINE GLUCOSE 尿糖定性檢查 URINE KETONE 尿酮檢查 BENCE JONES PROTEIN 本周氏蛋白試驗 PH (URINE) 酸鹼度反應 UROBILINOGEN 尿膽素原檢查 PORPHYRIN 胞體紫質檢查 PORPHOBILINOGEN 紫質原 MYOGLOBIN 肌球蛋白 FAT STAIN 脂肪染色 CHYLURIA 乳糜尿 PARAQUET TEST 巴拉圭試驗 HEMOSIDERIN 血鐵質測定 PREGNANCY TEST(EIA METHOD) 懷孕試驗 OCCULT BLOOD (URINE O.B) 潛血反應 Influenza A & B Ag 快速偵測 OCCULT BLOOD (STOOL O.B) 糞便潛血反應檢查 ( 化學法 ) APT TEST STARCH 澱粉質 FAT STAIN (HEAT) 脂肪酸染色 TRYPSIN TEST 胰蛋白脢試驗 PH 酸鹼值 REDUCING SUBSTANCE 還原物質測定 STOOL SUCROSE 蔗糖 AMOEBA 阿米巴檢查 PARASITE OVA 寄生蟲卵檢查 PARASITE OVA: (CONCENTRATION METHOD) 寄生蟲卵 - 濃縮法 /89

79 66517 PUS CELL (MICROSCOPIC) 糞便膿細胞顯微檢查 FAT STAIN (UNHEAT) 中性脂肪染色 Stool routine 糞便一般檢查 ( 限兒科 ) 糞便潛血反應檢查 ( 免疫定性法 ) 糞便潛血反應檢查 ( 免疫定量法 )( 限國健局專用 ) 蟯蟲膠片檢測法常見特異性過敏原 (Specific IgE:d1,d2,e1,e5,i6,f1,f2,f3) 2, MULTIPLE ALLERGOSORBENT CHEMILUMINISOUT ASSAY(MAST) 多種過敏原螢光反應檢 2, PHADIATOP 過敏原篩檢 ECP TEST 嗜伊紅血球陽離子蛋白檢驗食入性過敏原 (Specific IgE:f3,f10,f14,f23,f24,f84,f87,m81) 2, 吸入性過敏原 (Specific IgE:d1,d2,e1,e5,i6,m5,w1,g2) 2, 特異性過敏原 ( 自選六項 ) 2, IGG IGA IGM IGE IFE (IMMUNOELECTROPHORESIS) 1, C Kappa/Lambda light chain 1, C CH Homocysteine PAPP-A Free B - HCG Anti-mullerian hormone(amh) Procalcitonin 1, IG D 免疫球蛋白 D PMN BACTERIA KILLING 1, PMN PHAGOCYTOSIS PMN CHEMOTAXIS Anti-cyclic citrullinated peptide(anti-ccp) 1, ANTINUCLEAR FACTOR ANTI-DS-DNA ANTI ENA (SM,RNP) IGG SUBCLASS 1-4 免疫球蛋白 G 亞群 1, ANTI ENA SCREENING ANTI ENA (SSA,SSB) Anti B2 glycoprotein 1 IgG / IgM ANTI ENA (SCL 70) ANTI-CARDIOLIPIN (IGG/IGM) AMA+ASMA ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY(ANCA) ( 感染科 )INFECTIOUS DISEASE(CD3,4,8,19) 感染性疾病檢查 LYMPHOCYTE SURFACE MARKER (CD2,CD19) IMMUNOLOGICAL DISEASE CELL MARKER (CD3,CD4,CD8,CD19,CD57,ACIVE T) 2, LEUKEMIA/LYMPHOMA CELL MARKER(CD2,3,4,8,10,19,25,HLA-DR..) 2, MYELOID CELL MARKER (CD13,CD14,CD33,CD34,CD61) 1, LEUKEMIA/LYMPHOMA MARKER FOR B.M (CD2,3,4,8,10,19,25,HLA-DR..) 2,400 79/89

80 66660 MYELOID CELL MARKER FOR B.M (CD13,CD14,CD33,CD34,CD61) 1, IGG FOR CSF IFE FOR CSF 1, IFE FOR URINE 1, SEMEN ANALYSIS 精液分析 C.S.F. 腦脊髓液分析 ASCITE FLUID 腹水分析 PLEURAL FLUID 胸水分析 CYTOSPIN PH of body fluid 酸鹼度 ( 體液 ) GASTRIC JUICE O.B. 胃液潛血反應檢查腹膜透析液分析 SYNOVIAL FLUID ANALYSIS 關節囊液分析 ( 含常規及偏光鏡檢查 ) Indirect Antiglobulin Test ( Indirect Coombs Test ) 不規則抗體篩選 Direct Antiglobulin Test ( Direct Coombs Test ) DIRECT GAMMA & NON GAMMA COOMB,S TEST ANTIBODY IDENTIFICATION 不規則抗體鑑定 ELUTION & ANTIBODY IDENTIFICATION 不規則抗體之沖出及鑑定 ANTIBODY SCREENING 不規則抗體篩檢 ANTI RH (D) TITER THERAPEUTIC PHLEBOTOMY 放血治療 T ANTIGEN HLA-B27 1, HLA-A.B.C TYPING 6, HLA-DR TYPING 5, LYMPHOCYTOTOXICITY & LYMPHOCYTE CROSSMATCH TEST 淋巴毒殺試驗 1, HDNB (HEMOLYTIC DISEASE OF NEWBORN) SPECIAL BLOOD GROUP STUDIES 1, INVESTIGATION OF TRANSFUSION REACTION 輸血反應 PLATELET ANTIBODY-SCREENING TEST 血小板抗體篩選 PLATELET CROSSMATCH TEST PATERNITY TEST 親子鑑定 8, CROSSMATCHING TEST 交叉配合試驗自體周邊幹細胞冷凍費 12, 周邊血液幹細胞分離術 7, HLA-B 1502 基因檢測 3, HLA-A.B.C TYPING( 自費初篩 ) 1, 特殊血型 ---D E C e c 特殊血型 ---Lewis antigen 小血袋無菌分裝處理費 ( 新生兒輸血 ) TB PCR test( 非痰檢體 ) 1, TUBERCULIN TEST 結核菌素皮膚試驗 TB PCR TEST( 痰檢體 ) 1, HCV viral load 及 HCV genotype C 型肝炎病毒量及基因分型 5, Virus Culture (HSV,ADV,RSV,CMV,Entero,Influenza,Parainfluenza) 病毒培養 RSV Ag 呼吸道融合細胞病毒抗原 Chlamydia IgG Ab 披衣菌抗體 IgG HCV viral load C 型肝炎病毒量 3, HBV viral load B 型肝炎病毒量 2,500 80/89

81 66948 HBV YMDD Detecton 2, HCV genotype C 型肝炎基因分型 2, HBV YMDD Detection & HBV viral load 4, CMV PCR 巨細胞病毒分生檢測 (PCR 法 ) 1, Human papilloma virus HPV 人類乳頭瘤狀病毒 Enterovirus RT-PCR 腸病毒分生檢測 (RT-PCR 法 ) 1, HSV PCR 單純疹病毒分生檢測 (PCR 法 ) 1, Chlamydia trachomatis PCR 1, Chlamydia pneumoniae PCR 1, Norovirus Ag Adenovirus Ag HIV-I Ab(westem blot) 1, Aspergillus Ag Gr.A Strep. Rapid Test A 群鏈球菌快速偵測 Helicobacter pylori Stool Antigen Test 1, M.R.I. WITHOUT CONTRAST MEDIUM 核磁共振儀 - 無造影劑 12, M.R.I. WITH&WITHOUT CONTRAST MEDIUM 核磁共振儀 - 有 / 無造影劑 17, 資源共享 --- 原檢查醫院提供 CT 複製片及報告費 1, USE NONIORNIC CONTRAST MEDIUM 使用非離子性顯影劑 1, 多層次電腦斷層掃描冠狀動脈攝影 ( 一般門診適用 ) 15, 資源共享 --- 原檢查醫院提供 MRI 複製片及報告費 2, 資源共享 -- 二次處方醫院 CT 複製片放射科醫師判讀費 1, 資源共享 -- 二次處方醫院 MRI 複製片放射科醫師判讀費 2, 醫學影像光碟燒錄 ( 一項檢查 ) 醫學影像光碟燒錄 ( 二項檢查 ) 醫學影像光碟燒錄三 ( 含 ) 項檢查以上 Spine 2 AP view for scoliosis 14*17"* MEGA-COLON SERIES REGULAR (BARIUM ENEMA) 1, 冠狀動脈鈣化評估 5, Spine AP view for scoliosis( 四呎大片 ) Spine Lat view for scoliosis( 四呎大片 ) Spine 2 AP view for scoliosis lateral bending( 四呎大片 ) 1, 肺部腫瘤篩檢 5, 心肌血流灌注磁振造影 Cardiac MRI perfusion-persantin 24, MAMMOGRAPHY 乳房造影術 1, GALACTOGRAPHY (DUCT INJECTION) 3, Core Biopsy 介入性乳房立體定位切片檢查 8, 乳房攝影立體定位組織切片術 Mammography sterotactic biopsy 3, SELLA TURCICA FISTULOGRAM 1, SKULL 2 VIEWS (PA+LAT OR STEREO WATERS) SKULL 4 VIEWS 1, SKULL 1 VIEW (FOR WATERS,TOWNES,BASAL,ADENOID) Skull 2 views(stereo waters) Skull 2 views(styloid process) Skull 1 view(townes) SKULL TANGENTIAL VIEWS Skull 1 view(basal) Skull 1 view(adenoid) /89

82 71120 Skull 1 view JUGULAR VENOGRAPHY ONE SIDE 6, AORTIC ARCH ANGIOGRAPHY (NECK 4 VESSELS) 6, SUBCLAVIAN ARTERIOGRAPHY 7, VERTEBRAL ARTERIOGRAPHY 8, COMMON CAROTID ARTERIOGRAPHY (ONE SIDE) 9, EXTERNAL CAROTID ARTERIOGRAPHY (ONE SIDE) 9, INTERNAL CAROTID ARTERIOGRAPHY(ONE SIDE) 9, COMMON CAROTID ARTERIOGRAPHY (BOTH SIDE) 13, INTERNAL CAROTID ARTERIOGRAPHY (BOTH SIDE) 13, PETROUS BONE, STENVER'S ZYGOMATIC ARCH MASTOIDS SIALOGRAPHY 1 SIDE 1, SIALOGRAPHY 2 SIDE 2, ORBITS SINUSES (PNS) MANDIBLE TEMPOROMANDIBULAR JOINTS (T-M JOINTS) NASAL BONE LATERAL VIEW OF NECK FOR SOFT TISSUE SPINE 2 AP VIEWS FOR SCOLIOSIS (LATERAL BENDING) SPINE 2 LATERAL VIEW (EXTENSION & FLEXION) T-Spine 2 lateral views (extension & flexion) L-Spine 2 lateral views (extension & flexion) Spine 1 view for (T+L) Spine 1 view for (L+S) Spine 2 view for (T+L) Spine 2 view for (L+S) Myelography (T+L) 3, Myelography (L+S) 3, BIOPSY OF SPINE 4, SPINAL ANGIOGRAPHY 12, SPOT FILM OF SPINE CERVICAL SPINE 2 VIEWS CERVICAL SPINE 4 VIEWS 1, SPOT FILM FOR C1 C2 WITH OPEN MOUTH CERVICAL SPINE BOTH OBLIQUE VIEWS CERVICAL SPINE 6 VIEW 1, SPINE ONE VIEW FOR (C+T OR T+L OR L+S) SPINE 2 VIEW FOR ( C+T or T+L, L+S) THORACIC SPINE 2 VIEWS THORACIC SPINE 4 VIEWS 1, LUMBAR SPINE 2 VIEWS LUMBAR SPINE 4 VIEWS 1, SACROILIAC JOINTS SACRUM COCCYX MYELOGRAPHY LUMBAR SPINE 2,500 82/89

83 74013 BONE SURVEY (INCLUDE SKULL, SPINE, PELVIS LONG BONE) 3, ARTHROGRAPHY 關節造影術 3, Scanography(Femur and lower leg) Split Scanography BONE AGE DETERMINATION BONE DENSITOMERTRY ONE PORT 骨骼密度測定 BONE DENSITOMERTRY TW0 PORT 骨骼密度測定 - 多部位 1, SCAPULA CLAVICLE ACRONIOCLAVICULAR JOINT SHOULDER JOINT SHOULDER JOINT ONE SIDE-3view Humerus one side ELBOW JOINT FOREARM ONE SIDE HAND ONE SIDE WRIST JOINT ONE SIDE PELVIS HIP JOINT (FEMORAL NECK) BILATERAL HIPS (AP+FROG LEG) THIGH Joint stress views 單側 (varus) Joint stress views 單腳 (posterior) Joint stress views(lateral) KNEE JOINT KNEE JOINT, TUNNEL VIEW Joint stress views 單側 (valgus ) Joint Stress Views 單腳 (anterior) KNEE JOINT 3 VIEW (AP+LAT+MERCHENT) PATELLA LOWER LEG ANKLE JOINT 2VIEW CALCANEUS,3 VIEWS FOOT (2 VIEWS) RIBS STERNUM STERNOCLAVICULAR JOINT (ONE SIDE) STERNOCLAVICULAR JOINT (TWO SIDE) SUPERIOR INFERIOR VENACAVOGRAM 7, THORACIC AORTOGRAM 6, ABDOMINAL AORTOGRAM 6, THORACIC & ABDOMINAL AORTOGRAM 主動靜脈造影 ( 兩項同時實施 ) 7, FLUOROSCOPY 透視 X 光攝影 Chest one view CHEST PA+LAT VIEWS Chest one view (oblique) LORDOTIC VIEW Chest decubitus film Abdomen one view(supine) /89

84 77001 Abdomen one view(standing) Abdomen one view(prone) Abdomen one view(decubitus) ESOPHAGEAL BALLOON DILATATION 食道狹窄氣球擴張術 1, ENTEROCLYSIS (DOUBLE CONTRSAT SI SERIES) BOWEL SERIES 1, P.T.C.D. STONE REMOVAL 3, OPERATIVE CHOLANGIOGRAPHY 1, POSTOPERATIVE CHOLANGIOGRAPHY (T-TUBE) 1, P.T.C.(PERCUTANEOUS TRANSHEPATIC CHANGIOGRAPHY) 3, ERCP 3, Swallowing video fluorography 螢光透視吞嚥錄影攝影檢查 1, UPPER GI SERIES (BARIUM MEAL) 2, ESOPHAGUS BARIUM SWALLOWING SMALL INTESTINE (BARIUM FOLLOW THROUGH) 1, SPECIAL CONTRAST MEDIUM STUDY OF S.I. 3, COLON SERIES REGULAR (BARIUM ENEMA) 1, COLON SERIES DOUBLE CONTRAST 3, COLON SERIES DOUBLE CONTRAST 3, 大腸蠕動功能評估 Functional evaluation of colon peristalsis 2, INTUSSUSCEPTION BARIUM ENEMA 腸套疊鋇劑灌腸復位 3, L'T GASTRIC ARTERIOGRAPHY 9, CELIAC ANGIOGRAPHY 9, HEPATIC ANGIOGRAPHY 9, SUPERIOR MESENTERIC ANGIOGRAPHY 9, INFERIOR MESENTERIC ANGIOGRAPHY 9, PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE (PTCD) 11, FOLLOW UP (BILIARY OR ABSCESS DRAINAGE) 1, 經皮穿刺膽囊引流術 5, 腸胃道出血栓塞治療 G-I bleeding embolisation 12, 經皮輸尿管內管置放術 Percutaneous placement of ureter stent 7, 經皮腎造引流管重置術 PCN follow up 1, LIVER ABSCESS PUNCTURE & DRAINAGE 11, KUB INTRAVENOUS UROGRAPHY I.V.U 2, Retrograde pyeloureterography (R.P.)one side 1, HYPERTENSIVE IVU 3, LOOPOGRAM 2, RETROGRADE PYELOURETEROGRAPHY (R.P.)-BOTH SIDE 2, RENAL ANGIOGRAPHY 6, PELVIC ANGIOGRAPHY 6, PERCUTANEOUS NEPHROSTOMY 9, FOLLOW UP PERCUTOUENOUS NEPHROSTOMY 2, PELVIMETRY 1, HSG (SYSTEROSALPINGOGRAPHY) 2, CYSTOGRAPHY 1, CYSTOGRAPHY WITH VOIDING URETHROGRAPHY MALE 1, RETROGRADE URETHROGRAPHY 1, CHAIN CYSTOURETHROGRAPHY 1, ANGIOGRAPHY, UPPER OR LOWER LIMB ONE SIDE 9,000 84/89

85 79101 Stenting for head & neck vessel (one vessel) 頭頸部血管支撐架置放術 ( 一條血管 ) 12, 血管內異物摘取術 Intravascular foreign body removal 12, Percutaneous transluminal deployment of veinous device 經皮穿腔靜脈裝置置放術 19, THERAPEUTIC EMBOLIZATION 24, 腸骨動脈血管支架置放術 Stenting for Iliac vessel 15, ANTEGRADE VENOGRAM UPPER OR LOWER LIMB ONE SIDE 9, RETROGRADE VENOGRAM UPPER OR LOWER LIMB ONE SIDE 9, INTRA-ARTERIAL INFUSION 24, PERTUTANEOUS TRANSLUMINAL ANGIOGRAPHY (P.T.A) 13, 'C.T.WITH & WITHOUT ENHANCEMENT 電腦斷層造影 - 有無造影劑 9, 'C.T. WITHOUT ENHANCEMENT 電腦斷層造影 - 無造影劑 4, 'C.T.WITH ENHANCEMENT 電腦斷層造影 - 有造影劑 6, MICROWAVE DIATHERMY 微波 ULTRASOUND 超音波 10 分鐘以內 ULTRASOUND 超音波 10 分鐘以上 SHORT WAVE DIATHERMY 短波 ELECTRIC STIMULATION 電刺激 20 分鐘以內 ELECTRIC STIMULATION 電刺激 20 分鐘以上 ULTRAVIOLET 紫外線 INFRARED 紅內線 E.M.G BIOFEEDBACK 肌電圖生理迴饋器 TRANSCUTANEOUS NERVE STIMULATION 經皮神經刺激 CIRCULATOR 循環治療 BURN HYDROTHERAPY GENERAL 燙傷水療 - 全身 1, HYDROTHERAPY, GENERAL 一般水療 - 全身 HYDROTHERAPY-U/E 一般水療 - 上肢 HYDROTHERAPY-L/E 一般水療 - 下肢 INTERMITTENT TRACTION (CERVICAL) 頸椎間隔牽引 INTERMITTENT TRACTION (LUMBAR) 腰椎間隔牽引 CONTINUOUS (C.T. OR L.T.) 頸椎或腰椎固定牽引全觸式鞋墊 3, PARAFFIN BATH 石臘浴衣著類輔具評估氣墊床評估 THERAPEUTIC EXERCISE 運動治療 PASSIVE R.O.M. 被動性關節運動 POSTURE TRAINING 步態訓練 LOCAL MASSAGE 局部按摩 MOBILIZATION 鬆動術 POSTURAL DRAINAGE 體位引流 PROSTHESIS TRAINING 義肢訓練站立架評估 INTERFERENTIAL THERAPY 向量干擾 LOW POWER LASER 低能雷射治療 STRETCHING EXS 牽拉運動 STRENGTHENING TX 肌力訓練 FACILITATION TECHNIQUES 促進技術 /89

86 80050 HIGH FREQUENCE DISCHARGE 超高頻 TILTING TABLE TRAINING 傾斜台訓練 BALANCE TRAINING 平衡訓練 AMBULATION TRAINING 行走訓練 ENDURANCE TRAINING 耐力訓練 HOT/COLD PACK 治療性熱冷敷肌內效貼布貼紮 ISOKINETIC TRAINING CARDIOPULMONARY TRAINING ACTIVITY THERAPY 活動治療 ADL TRAINING & COUNSELING 日常生活訓練與諮詢 THERAPEUTIC MECHANICAL EXERCISE 治療性機械運動 HAND FUNCTION TRAINING 手功能訓練 U/E PROSTHESIS EVALUATION & TRAINING 上肢義肢功能檢查與訓練 U/E PASSIVE R.O.M. EXERCISE 上肢被動運動 CPM TRAINING & TESTING 認知知覺運動測驗與訓練 POSTURE TRAINING BALANCE TRAINING MOVING TRAINING COMITANCE TEAINING COGNITIVE TRAINING RECREATION THERAPY SPASTICITY REDUCTION MOTION 頸部固定副木 ( 材料費 ) Neck splint (material) MATERIAL 教材 ( 構音異常治療手冊 ) AUDITORY COMPREHENSION TRAINING 聽能暸解訓練 VERBAL PRODUCTION 口語訓練 AUGMENTATIVE CEMMUNICATION SYSTEM READING TRAINING WRITING TRAINING VISUAL PERECEPTION HIGH LEVEL COGNITIVE FUNCTION TRAINING 高階層認知訓練 TACTILE STIMULATION ORAL TX PHONETIC PLACEMENT 發音部位法 AUDIOVISUAL FEEDBACK MONITORING 視聽迴饋法 ACOUSTIC ANALYSIS 語言分析 OTHERS 其他 AUDITORY DISCRIMINATION 聽辨訓練 RHYTHM TRAINING 特殊心理社會治療 - 成人特殊心理社會治療 -6 歲至 15 歲特殊心理社會治療 -6 歲以下支持性心理社會治療特殊心理社會團體治療 ( 每人每次 ) O2 MASK,FACE MASK,O2 HOOD,T-PICEC,CANNULAR,COLLAR (DAY,INCLUDE O2) 氧氣罩面罩頭罩 T 型管雙路氧 O2 INHALATION 氧氣吸入 ( 小時 ) O2 TENT/DAY 氧氣帳 ( 天 ) 兒科含氧氣 /89

87 83004 PRESSURE/VOLUME CONTROL VENTILATOR (VCR),DAY 侵襲性呯吸輔助器使用費天 2, Six minute Walking Test 六分鐘走路測試肺功能 1, 心肺復原訓練前後之簡易肺功能檢測 AEROSOL THERAPHY FOR VENTILATOR (DAY) 人工呯吸器噴霧吸入治療 ( 天 ) BREATHING EXERCISE (TIME) 呼吸運動 ( 次 ) POSTURAL DRAINAGE 體位痰引流 ( 次 ) PERCUSSION OR VIBRATION 震盪療法 ( 次 ) RECONDITIONING EXERCISE (TIME) 復原運動 BLOOD GAS ANALIZATION 血液氣體分析 O2 6M 醫用氧氣支 ( 桶裝大 ) O2 1M 醫用氧氣支 ( 桶裝小 ) NON-INVASIVE POSITIVE PRESSURE 非侵襲性陽壓呯吸治療 1, TC PO2 MONITOR (DAY) 經皮測氧氣分壓器 ( 天 ) O2/H 醫用氧氣 ( 小時 ) 麻醉科使用 STEAM OR NEBULIZATION INHALATION/DAY 蒸氣或噴霧吸入治療天 ENDOTRACHEAL TUBE INSERTION 氣管內管插管 INCENTIVE SPIROMETRY/DAY PI MAX & PE MAX 最大吸氣壓及最大吐氣壓 HALOSCALE RESPIRETION 全階呯吸量測定 RESUSITATOR(AMBU BAG) 甦醒器使用 MIXER O2 (5% CO2,95%O2) 醫用混合氣體壹桶 1, O2 REGULATOR RENT/DAY 小支氧氣桶及錶租金 O2 CONCENTRATOR RENT/DAY 氧氣濃縮機租金 / 日 ENGSTROM METABOLIC COMPUTER + CO 2 ANALYZEN ELIZA MC 新陳代謝微電腦及二氧化碳分析儀 STEAM OR NEBULIZATION INHALATION/TIME 蒸氣或噴霧吸入治療 ( 次 ) O2 TENT/H 氧氣帳 ( 時 ) 兒科 ( 含氧氣 ) HUMIDITY INHALATION 濕氣吸入治療 APNEA MONITOR 呯吸暫停監視器 PULSE OR EAR OXIMETER/TIME 脈動式或耳垂式血氧飽和監視器次 PULSE OR EAR OXIMETER/DAY 脈動式或耳垂式血氧飽和監視器天吐氣尖峰流量計 / 次呼氣時部分吐氣一氧化氮量 (Fraction Exhaled: FENO) 1, 心肺功能訓練皮下化學藥物注射腦室內注射留置器或脊髓腔內化學藥物注射 1, 肋膜或腹膜腔內化學藥物注射 1, 動脈血管內化學藥物注射一小時 ( 藥費另計 ) 1, 動脈血管內化學藥物注射一至四小時 ( 藥費另計 ) 2, 動脈血管內化學藥物注射四至八小時 ( 藥費另計 ) 2, 癌症動脈注射化學療法 1, D 電腦斷層模擬攝影 10, 動脈血管內化學藥物注射八小時以上 3, 靜脈血管內化學藥物注射一小時內 1, 靜脈血管內化學藥物注射一至四小時 1, 靜脈血管內化學藥物注射四至八小時 2, 靜脈血管內化學藥物注射八小時以上 2, 電腦治療規劃 -- 複雜 13, 劑量計算 /89

88 84023 鈷六十遠隔照射治療 --- 每一複雜照野 1, 模擬訂位攝影 4, DOSIMETRY & PLANNING 一般照射治療計畫及劑量術 3, STEREOTACTIC RADIOSURGERY PLANNING 立體定位放射手術計劃 11, PORTAL FILM 定位照相 2 張 RADIOSURGERY PORTAL FILM 放射手術定位照像 1, 血袋放射線照射 - 鈷六十 1, COBALT 60 THERAPY, ONE PORT PER DAY 鈷六十遠隔治療 ( 天 ) 1, LINEAR ACCELERATOR TELETHERAPY SINGLE PART 直線加速器遠隔治療 ( 單部份 ) 每一照野 1, LINEAR ACCELERATOR TELETHERAPY MULTIPLE PORTAL 直線加速器遠隔治療 ( 複部份 ) 每一照野 1, LINEAR ACCELERATOR CALIBRATION 直線加速器校正技術費 1, CHEMOTHERAPY AND HORMONE THERAPY 化學藥物及激素治療 ( 藥費另計 ) PHARMACEUTICAL SERVICE FEE OF ONCOLOGY PRESCRIPTION 化學腫瘤藥品處方藥事服務費 BRACHYTHERAPY,INSERTION OF APPLICATION IN OR 近接安裝裝療器手術室裝置 3, MENT ROOM 近接安裝裝療器治療室裝療 2, REMOTE CONTROLED AFTERLOADER BRACHYTHERAPY-SINGLE 遙控後荷式近距治療 - 單 4, REMOTE CONTROLED AFTERLOADER BRACHYTHERAPY-MUTIPLE 遙控後荷式近距治療 - 8, DESIGN & FORMULATE OF BLOCK 合金模塊之設計及製作 2, DESIGN & FORMULATE OF BOLUS 填充模塊之設計及製作 1, DESIGN & FORMULATE OF COMPENSATORCOMPENSATOR 之設計及製作 1, DESIGN & FORMULATE OF CAST 固定模具之設計及製作 ( 大 ) 2, 固定模具之設計及製作 ( 小 ) 1, HEMODIALYSIS WITH AV FISTULA 經動靜脈廔管血液透析術 4, PERITONEAL DIALYSIS 腹膜透析術 1, HEMOPERFUSION 血液灌洗 3, HEMODIAFILTRATION 血液透析併血液過濾術 DOUBLE LUMEN 2, 住院血液透析 ( 一次 ) 4, 急重症透析 4, 緩慢低效率每日血液透析過濾治療 6, CAPD,IPD INSTRUCTIONCAPD 住院患者指導 2, CAPD IPD TRANSFER MATER..CAPD 住院患者輸液 CAPD FOLLOW UP THERAPY 連續性可攜帶式腹膜透 10, CAPD TENCKHOFF CA.. IMPL. 連續性可攜帶式腹膜透 4, 更換腹膜透析延長管 ( 自費 ) APD FOLLOW UP THERAPY 全自動腹膜透析治療 10, 腹膜透析居家訪視 1, 全自動腹膜透析機相關費用 (APD monthly fee) 2, Double filtration plasmapheresis 二重過濾血漿置換療法 2, Plasma exchange 血漿置換術 ( 血液透析專用 ) 2, CARBON MONOXIDE TOXICITY-66 呎 /180 分一氧化碳中毒 ( 氰化物及氣體中毒 ) 7, CARBON MONOXIDE TOXICITY-66 呎 /90 分一氧化碳中毒 ( 氰化物及氣體中毒 ) 3, CLOSTRIDIAL GAS GANGRENE66 呎 /90 分氣壞疽病 3, OSTEOMYELITIS REFRACTORY50 呎 /120 分慢性復發性骨髓炎 2, CRUSH INJURY WITH ACUTE TRAUMATIC ISCHEMIA50 呎 /120 分肢體壓傷伴有創傷性 2, OSTEORADIONECROSIS 放射性組織壞死 -50 呎 /120 分 2,880 88/89

89 87014 糖尿病足高壓氧治療 2, 一般高壓氧治療 2ATA 60 分精神科醫事專業人員社區服務費用 3, 甲種診斷書 CERTIFICATES FEE( 鑑定訴訟兵役 ) 乙種診斷書 ( 中文 )CERTIFICATES FEE 非當年出生證明書 ( 學生團保傷害合約機構 ) 乙種診斷書 ( 英文 )CERTIFICATES FEE 就醫診斷書 CERTIFICATES FEE 出生證明書 ( 中文 )CERTIFICATES FEE 二份 50 元, 另加一份出生證明書 ( 中文 ): 第二 ( 含 ) 次以上開立使用出生證明書 ( 英文 )CERTIFICATES FEE 每份死亡證明 ( 中文 ): 第二 ( 含 ) 次以上開立使用死亡證明 ( 英文 )CERTIFICATES FEE 每份印鑑證明用診斷證明書 CERTIFICATES FEE 人體器官移植之腦死判定費 2, 職能治療證明書費勞保診斷證明書 CERTIFICATES FEE( 傷害流死產職員勞安健檢表 ) 公勞保及一般殘廢證明書 CERTIFICATES FEE 醫療費用明細證明醫療費用繳費彙總證明收據影印証明費 CERTIFICATES FEE 職員勞安健檢表 ( 中文 )CERTIFICATES FEE 中 / 英文病歷摘要醫療資料查詢費 FEE FOR RELEASE OF HEALTH INFORMATION 1, 病歷號索引費 PATIENT NUMBER RETRIEVING FEE 非精神科司法機關醫療鑑定報告費 ( 限法院委託之鑑定 ) 2, 重大傷病申請書費 CERTIFICATES FEE 出院病歷摘要 ( 正本 ) 外籍監護工專用診斷證明書職業病鑑定診斷證明書費 2, 影印病歷基本費強制鑑定診斷證明書費親子鑑定加發鑑定報告書驗傷診斷書 ( 第一張 1000, 第二張以上 500) 1, 國民年金身心障礙年金給付評量表費 RGST.STAMP 30 89/89

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5k951.indd

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