新菩提醫院       院所(代號:1536201065 )  自費項目價目表

                    【健保不給付】                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           

品項名稱

規格/數量

廠牌

收費明細

備註

健保雙人床差額

(552-1  . 552-2)

 

1000

本資料如有

異動隨時公

告更新(若

公告價格與

現 場 有誤

時,以現場

為主)

健保單人房差額(351 .352.)

 

2000

自費單人房(351.352)

 

2000

自費單人房(551)

 

1000

自費雙人床

 

1000

一般病床(/)

 

700

掛號費

 

100

急門診掛號費

 

200

補一週Nicotine戒菸藥品費差額

 

250

 

一般體檢

 

200

 

一般體檢+胸部X

 

400

 

英文體檢表

 

200

 

勞工健檢

 

500

 

勞工健檢(供膳)

 

800

 

保姆體檢

 

780

 

各家人壽體檢(自行負擔含掛號費)

 

350

 

保險公司問診費

 

950

 

人壽索引

 

50

 

汽車體檢

 

170

 

製表日期  9909  02                 修訂日期 10806 01

 

       新菩提醫院       院所(代號:1536201065 )  自費項目價目表

                    【健保不給付】                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           

品項名稱

規格/數量

廠牌

收費明細

備註

職業小客車體檢

 

170

本資料如有

異動隨時公

告更新(若

公告價格與

現 場 有誤

時,以現場

為主)

審驗(汽車)

 

170

審驗(汽車)-60~65

 

750

職業大客車體檢

 

170

機車體檢

 

120

GONOZYME(尿液)淋病檢驗

 

600

GONOZYME(血液)淋病檢驗

 

900

H1N1病毒抗原檢驗-A

 

300

HEROINE(海洛因檢驗)

 

375

 

無痛分娩

 

6000

 

術後止痛費

 

6000

 

龐貝氏症篩檢

 

200

 

影印費 (檢驗單. 代客影印)

1

 

5

 

收據影印費

1

 

5

 

甲種診斷書(訴訟用)

1

 

1500

 

受理家庭暴力事件驗傷診斷書

1

 

300

 

出生證明正本

1

 

100

首次2份內免費

出生證明副本

1

 

10

 

製表日期 99   09 02                修訂日期 1080601

 

        新菩提醫院       院所(代號:1536201065 )  自費項目價目表

                    【健保不給付】                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       

品項名稱

規格/數量

廠牌

收費明細

備註

乙種診斷書

1

 

120

 

勞工保險殘癈診斷書

1

 

500

 

就醫證明書

1

 

50

 

聘用外勞診斷證明書

1

 

200

 

英文版診斷證明書

1

 

200

 

死亡診斷書(5份以上收費)

1

 

100

 

死亡診斷書(4份以內不收費)

 

0

首次

大陸人民來台探病診斷書

1

 

200

 

病歷複製影印基本費(1-10)

1

 

200

本資料如有

異動隨時公

告更新(若

公告價格與

現 場 有誤

時,以現場

為主)

病歷影印費-11張起

1

 

5

病歷摘要影本

1

 

200

體檢複本

1

 

100

外籍監護工診斷書

1

 

500

COPY X光片或CT(傳統膠片或光碟片)

1

 

200

挺立--鈣加強錠(60T)

1

惠氏

490

製表日期 99   09  02               修訂日期 1080601

 

 

 

        新菩提醫院       院所(代號:1536201065 )  自費項目價目表

                    【健保不給付】                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              

品項名稱

規格/數量

廠牌

收費明細

備註

Viartril-S 80cap

1

羅達

720

本資料如有

異動隨時公

告更新(若

公告價格與

現 場 有誤

時,以現場

為主)

Viartril-S(peili) 500cap

1

培力

1500

Viartril-S 500Cap

1

羅達

4900

銀寶善存-60Tab

1

惠氏

420

舒痕凝膠-15g

1

法瑪林珂

1800

美康錠(Mecal)

1

井田

150

Prevenar(肺炎雙球菌疫苗)出生滿2個月

1

惠氏

3000

Prevenar(肺炎雙球菌疫苗)出生滿4個月

1

惠氏

3000

Prevenar(肺炎雙球菌疫苗)出生滿6個月

1

惠氏

3000

 

Prevenar(肺炎雙球菌疫苗)出生滿12-15個月

1

惠氏

3000

 

Engerix-B 20ug(成人B型肝炎疫苗) 

1

GSK

350

 

自費流感疫苗

1

SANOFI AVENTIS

350

 

1"抗過敏紙膠

1

3M

60

 

紙膠(3M)

1

3M

45

 

紙膠(3M)

1

3M

45

 

Microlife 10秒體溫計

1

Microlife

280

 

6"有消大沖洗棉棒(61)

1

中衛

10

 

Finger splint(快意固手指護木)(chrisofix)

1

chrisofix

370

 

製表日期  99 09 02                修訂日期 10806 01

 

        新菩提醫院       院所(代號:1536201065 )  自費項目價目表

                    【健保不給付】                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

品項名稱

規格/數量

廠牌

收費明細

備註

沖洗棉棒

1

中衛

50

本資料如有

異動隨時公

告更新(若

公告價格與

現 場 有誤

時,以現場

為主)

黃疸眼罩

1

喜兒生

50

吸球

1

喜兒生

50

產墊

1

利衛

85

紙褲

1

美滿

95

鴨嘴(拋棄式)

1

北極光

35

Multilop[母體樂]

1

拜耳

1000

人造皮 2*8" 超薄型

1

ConveTAC Inc

120

臍護包(攜回)

1

立祐

110

 

生理沖洗器(攜回)

1

美滿

50

 

足弓墊

1

Painless

1500

 

美容膠(R1546)(攜回)

1

3M

120

 

美容膠(R1547)(攜回)

1

3M

120

 

人工皮 4*4" 超薄型

1

ConveTAC Inc

120

 

奶嘴

1

Jiabao

30

 

高齡駕駛人認知檢查75歲以上

1

 

200

 

製表日期 99 09  02                 修訂日期 10806 01