Self-pay Items and Fees

 
  • ．Contracted Medical Institution (Code: 1505350015) — Self-Paid Items Price List
 
(According to Article 39 of the National Health Insurance Act: Items Not Covered by NHI)
CategoryItem NameSpecification / UnitFee (NT$)Remarks
Ward / Postpartum Meal
Single Room (Private)
Per Bed / Day3,300 ~ 5,000 
Double Room (Private)
Per Bed / Day2,300 ~ 3,300 
Meals
Per Day1,500Postpartum Meal (3 meals)
Prenatal Examinations
Down Syndrome Screening (Quad Test)
Per Test2,000 
Spinal Muscular Atrophy (SMA) Gene Screening
Per Test2,000 
Detailed Ultrasound (Single / Twin)
Per Test3,000 / 5,500 
Comprehensive Non-Invasive Prenatal Chromosome Test (V3.0)
Per Test38,000 
Fragile X Syndrome (FXS) Gene Test
Per Test4,000 
Amniocentesis (Subsidized / Self-Paid)
Per Test4,500 / 9,500 
Amniotic Fluid Chromosome Microarray
Per Test18,000 
SMA Amniotic Fluid Analysis
Per Test5,000 
Non-Invasive Fetal Cell-Free DNA Test
Per Test14,000 ~ 38,000 
Prenatal Checkup Packages (I–V)
Per PackageDepends on selected package 
Health Screening Packages
Liquid-Based Pap Smear
Per Test1,300 
Human Papillomavirus (HPV) Test
Per Test1,500 
Pap Smear + HPV Combo Test
Per Test2,500 
Allergen Test
Per Test1,500 ~ 3,000 
Basic Health Check (Set A)
Per Test500 
Executive Package (Set B)
Per Test1,500 
Premium Package (Set H)
Per Test1,800 
Busy Professional Package (Set C)
Per Test3,900 
Pre-Marital Checkup (Male / Female)
Per Test2,300 / 2,500 
Cancer Prevention Package (4 Tests / Male)
Per Test1,500 
Cancer Prevention Package (5 Tests / Female)
Per Test1,900 
Cancer Prevention Package (6 Tests / Male)
Per Test2,500 
Cancer Prevention Package (7 Tests / Female)
Per Test2,900 
Self-Paid Medical Products
Artificial Skin Hydrogel Dressing (10×10 cm)
Per Piece100 
Hyaluronic Acid Vaginal Lubricant
Per Tube400 
Wound Healing Gel (Weilun)
Per Tube1,100 
Polyxal Scar Care Gel
Per Tube1,800 
Dermatix Ultra Scar Gel
Per Tube1,980 
Herli Scar Patch (Box)
Per Box2,500 
Herli Antimicrobial Wound Dressing (6×20 cm)
Per Box4,250 
Herli Hydrogel Wound Dressing (10 ml)
Per Bottle3,800 
Skin Adhesive (Wound Sealer)
Per Piece6,000 
Hylao Hyaluronic Acid Anti-Adhesion Gel
Per Syringe14,000 
BarriGel Absorbable Anti-Adhesion Gel
Per Syringe14,000 
Self-Paid Vaccines
(Including Registration Fee)
Hepatitis B Vaccine
Per Dose350 
MMR (Measles, Mumps & Rubella) Vaccine
Per Dose1,000 
Quadrivalent Influenza Vaccine
Per Dose1,000 
Pediatric Hepatitis A Vaccine
Per Dose1,100 
Adult Hepatitis A Vaccine
Per Dose1,800 
Varicella (Chickenpox) Vaccine
Per Dose2,400 
Pertussis (Whooping Cough) Vaccine
Per Dose2,000 
Hexavalent Combination Vaccine
Per Dose1,800 
RotaTeq Oral Pentavalent Rotavirus Vaccine (3-dose)
Per Dose2,000 
Rotarix Oral Bivalent Rotavirus Vaccine (2-dose)
Per Dose2,700 
HBIG – Hepatitis B Immunoglobulin Injection
Per Dose3,600 
Pneumococcal 13-Valent Conjugate Vaccine
Per Dose3,800 
Zoster Live Attenuated Vaccine
Per Dose5,300 
9-Valent HPV (Cervical Cancer) Vaccine
Per Dose6,000 
Bexsero Meningococcal Group B Vaccine
Per Dose6,500 
 
*For the most up-to-date information or newly added self-paid items, please refer to the on-site announcements at the hospital.
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