Non-Covered Services Information

ClassificationFee CodeInsurance CodeNamePriceRemarks
Premium Room Fee DifferenceSingle Room (VIP)310,000
Premium Room Fee DifferenceSingle Room280,000
Premium Room Fee Difference2-Person Room170,000
MealAdditional Steamed Rice1,500
MealCaregiver Meal8,000
MRIMRI (General) 1 (Post-op)390,000
MRIMRI (General) 2390,000
MRIMRI (General) 3490,000
MRIMRI (General) 4590,000
MRIMRI (General) 5740,000
MRIMRI (General) 6840,000
MRIMRI (General) 7890,000
MRIMRI Contrast Agent190,000
MRIMR-Arthrogram740,000
UltrasoundUltrasound (SONO) 355,000
UltrasoundUltrasound (SONO) 888,000
UltrasoundUltrasound (SONO) 1165,000
UltrasoundUltrasound (SONO) 2110,000
UltrasoundEB422EB422(RAD) Rib 1 Ultrasound (Rib SONO)110,000
UltrasoundEB422AEB422(RAD) Rib 2 Ultrasound (Rib SONO)165,000
UltrasoundEB503EZ985Intraoperative Ultrasound300,000
UltrasoundEB415EB415(RAD) Neck Ultrasound (Cervical SONO, excluding thyroid)165,000
UltrasoundEB414EB414(RAD) Thyroid Ultrasound (Thyroid and Parathyroid)165,000
UltrasoundEB432EB432Echocardiography (General Heart Ultrasound)240,000
UltrasoundEB482EB482(RAD) Carotid Doppler Ultrasound240,000
UltrasoundEB463PElbow Ultrasound + Cryotherapy250,000
UltrasoundEB562CEB562Joint Contrast Ultrasound (SONO)165,000
UltrasoundUS005PSONO (Muscle) + Prolotherapy + Cryotherapy385,000
UltrasoundUS005PPSONO (Muscle) + Prolotherapy + Cryotherapy330,000
UltrasoundEB488AEB488(RAD) Lower Extremity Venous Doppler Ultrasound (Unilateral)150,000
UltrasoundEB488EB488(RAD) Lower Extremity Venous Doppler Ultrasound (Bilateral)240,000
UltrasoundEB487AEB487(RAD) Lower Extremity Arterial Doppler Ultrasound (Unilateral)150,000
UltrasoundEB487EB487(RAD) Lower Extremity Arterial Doppler Ultrasound (Bilateral)240,000
UltrasoundEB470-MEB470(RAD) Mass Ultrasound165,000
UltrasoundEB470-MMEB470(RAD) Multiple Mass Ultrasound220,000
UltrasoundEB470-MSEB470(RAD) MSK (Soft Tissue) Ultrasound165,000
UltrasoundEB445EB445(RAD) Lower Abdomen Ultrasound – Inguinal Area88,000
UltrasoundEB444EB444(RAD) Lower Abdomen Ultrasound – Small & Large Intestines88,000
UltrasoundEB443EB443(RAD) Lower Abdomen Ultrasound – Appendix88,000
UltrasoundEB441EB441(RAD) Upper Abdomen Ultrasound (Liver, Gallbladder, Bile Duct, Spleen, Pancreas – General)165,000
UltrasoundEB449EB449(RAD) Urinary Ultrasound – Kidneys & Adrenal Glands88,000
UltrasoundEB448EB448(RAD) Urinary Ultrasound – Kidneys, Adrenal Glands, Bladder88,000
UltrasoundEB562BEB562Ultrasound (SONO Block Guide)120,000
Physical TherapyMCRYO1MZ007(SST) Stretch-Spray Therapy 135,0001 minute of cryotherapy + 5 minutes of stretching
Physical TherapyMCRYO2MZ007(SST) Stretch-Spray Therapy 255,0001 minute of cryotherapy + 10 minutes of stretching
Physical TherapyMCRYO4MZ007(SST) Stretch-Spray Therapy (Complex) A140,0001 minute of cryotherapy + 30 minutes of stretching
Physical TherapyMCRYO5MZ007(SST) Stretch-Spray Therapy (Complex) B210,0002 minutes of cryotherapy + 30 minutes of stretching
Physical TherapyMCH1MZ007(SST) Stretch-Spray Therapy H1120,0001 minute of cryotherapy + 10 minutes of field laser
Physical TherapyMCRYO8MZ007Stretch-Spray Therapy (Complex) AH200,0002 minutes of cryotherapy + 20 minutes of stretching + 15 minutes of HILT
Physical TherapyMCRYO10MZ007(SST) Stretch-Spray Therapy (Complex) A (Initial)140,0002 minutes of cryotherapy + 20 minutes of field laser
Physical TherapyMCRY1MZ007Stretch-Spray Therapy (TKR)60,000Post-TKR: 1 minute of cryotherapy + 15 minutes of stretching
Physical TherapyMCRYO4-SMZ007(SST) Stretch-Spray Therapy (Simple)6,00020 seconds performed during outpatient visit when injecting into tendon sheath
Physical TherapyMX122-1MX122Manual Therapy 1-A120,00030 minutes
Physical TherapyMX122-2MX122Manual Therapy 1-B190,00050 minutes
Physical TherapyMX122-4MX122Manual Therapy 2-B220,00070 minutes
Physical TherapyMX122-5MX122Manual Therapy 3270,00090 minutes
Physical TherapyMX122DMX122Manual Therapy 1-A (Edema)120,00060 minutes
Physical TherapyMX122CMX122Manual Therapy 2-B (Initial)220,00070 minutes (Initial)
Physical TherapyMX122HMX122Manual Therapy 1-G155,00040 minutes
Physical TherapyMX122IMX122Manual Therapy 2-G255,00080 minutes
Physical TherapyMEH1SZ084Extracorporeal Shockwave Therapy H1 (ESWT)140,000ESWT 500 shots + 20 minutes of laser
Physical TherapyMEH3SZ084Extracorporeal Shockwave Therapy H3 (ESWT)160,000ESWT 2000 shots + 20 minutes of laser
Physical TherapyMEH4SZ084Complex Shockwave Therapy A140,000Over 3000 shots of ESWT for 1 site
Physical TherapyMEH5SZ084Complex Shockwave Therapy B210,000Over 4000 shots of ESWT for 1 site
Physical TherapyMESBSZ084Dual Bone Shockwave Therapy140,000ESWT 2000 shots + 30 minutes of Bone Papa therapy
Physical TherapyMESWT5SZ084Extracorporeal Shockwave Therapy 0.5 (ESWT)60,0001000 shocks
Physical TherapyMESWT1SZ084Extracorporeal Shockwave Therapy 1 (ESWT)120,000Over 2000 shocks for 1 site
Physical TherapyMESWT2SZ084Extracorporeal Shockwave Therapy 2 (ESWT)230,000Over 2000 shocks for 2 sites
Physical TherapyMESWT7SZ084Extracorporeal Shockwave Therapy 1C (ESWT) + Cryotherapy140,0002000 shocks + 1 minute of cryotherapy
Physical TherapyMY142MY142Prolotherapy 1 (Single Area)60,000Performed on 1 site only
Physical TherapyMY142AMY142Prolotherapy 2 (Multiple Areas)120,000Performed on 2 or more sites
Physical TherapyMY142BMY142Surgical Prolotherapy (sh+kn: Shoulder or Knee without Tendon/Ligament Repair)385,000For simple surgeries of shoulder or knee without tendon/ligament repair
Physical TherapyMY142CMY142Surgical Prolotherapy (UCL + Labral: Elbow or Shoulder Tear Repair)800,000For surgeries involving UCL tear in elbow or labral tear in shoulder
Surgery and ProceduresMBPP-5SZ088Bone Papa A (Low-Intensity Pulsed Ultrasound for Fracture Healing)60,000
Surgery and ProceduresMBPP-12SZ088Bone Papa B (Low-Intensity Pulsed Ultrasound for Fracture Healing)140,000
Surgery and ProceduresMBPP-18SZ088Bone Papa C (Low-Intensity Pulsed Ultrasound for Fracture Healing)210,000
Surgery and ProceduresSZ634SZ634Percutaneous Epidural Neuroplasty (Including Catheter) – 1 Level2,200,000
Surgery and ProceduresSZ634ASZ634Percutaneous Epidural Neuroplasty (Including Catheter) – 2 Levels3,400,000
Diagnostic and Functional TestsEZ7771EZ777Dynamic Plantar Pressure Measurement (Outpatient Diagnosis)95,000
Diagnostic and Functional TestsCZ246CZ246IMA Ischemic Modified Albumin Test60,000
Diagnostic and Functional TestsCZ394CZ394Influenza A/B Antigen Test (On-site Testing)30,000
Diagnostic and Functional TestsD6630D6630In-Hospital Combined Flu + COVID-19 Antigen Test (Influenza A/B & SARS-CoV-2) [General Immunoassay] – Rapid Test50,000
Diagnostic and Functional TestsLCHMGrowth Hormone Blood Test and Analysis180,000
Diagnostic and Functional TestsGWH(Bone Age) Whole Spine AP/Lat + Left Hand AP72,000
Diagnostic and Functional TestsBZ078BZ078TRAP – Platelet Aggregation Test60,000
Diagnostic and Functional TestsCZ242CZ242Amyloid A (SAA Serum Amyloid – Inflammatory Response Test)50,000
Materials and ConsumablesBF0101VT-1BF0101VTHighbury 1.5ml480,000
Materials and ConsumablesBF0101VTBF0101VTHighbury 3ml960,000
Materials and ConsumablesTCSCast Shoes (Standard Use)12,000
Materials and ConsumablesTCS1Cast Shoes (M-Gypsum Use)12,000
Materials and ConsumablesBC0101KJBC0101KJDemios DBM 0.5cc420,000
Materials and ConsumablesBC0101KJ1BC0101KJDemios DBM 1cc600,000
Materials and ConsumablesBC0101KJ3BC0101KJDemios DBM 2.5cc2,200,000
Materials and ConsumablesBC0103EDBC0103EDSUREFUSE™ DBM 1cc600,000
Materials and ConsumablesBK7102VS4BK7102VSROGG Latex-Free Haft Crepp (4cm × 4m)8,400
Materials and ConsumablesBK7102VS8BK7102VSROGG Latex-Free Haft Crepp (8cm × 4m)16,000
Materials and ConsumablesBM5001DYBM5001DYLACUDY100,000
Materials and ConsumablesBM5003DYBM5003DYS-CUDY, HYLACELL S, HIRACELL S100,000
Materials and ConsumablesBM2601QQBM2601QQRegenseal 3% × 1ml240,000
Materials and ConsumablesBM2601QQ2BM2601QQRegenseal 3% × 3ml800,000
Materials and ConsumablesBM2601QQ3BM2601QQRegenseal 6% × 1ml1,200,000
Materials and ConsumablesBC1301ASBC1301ASCENS (Toenail Fixation Material)210,000
Materials and ConsumablesBM5104ALBM5104ALKit, Dressing Tray (Daehan) / Daehan Fixing Roll (White)4,800
Materials and ConsumablesBM5100RWBM5100RWMedicure Roll Bandage – 4″ × 10M12,500
Materials and ConsumablesBM5100RW6BM5100RWMedicure Roll Bandage – 6″ × 10M17,000
Materials and ConsumablesJ0060Crutch, A/L (BMK Type)34,000
Materials and ConsumablesBK7001EVBK7001EVLIO QUET (Hemostasis Band)72,000
Materials and ConsumablesBJ1000JNBJ1000JNFixation (Nasal-fix with Cannula)6,000
Materials and ConsumablesTPRP1한시적PRP Kit + Intraoperative Autologous Platelet-Rich Plasma Therapy (Shoulder)800,000
Surgery and ProceduresBL6050GH2BL6050GH(BMAC Injection) Intra-Articular Bone Marrow Aspirate Concentrate for Knee Osteoarthritis1,000,000
Materials and ConsumablesBL6050GH1BL6050GH(Material) TRICELL BMC (BMAC) for Knee Injection1,000,000
Materials and ConsumablesBL6050GHBL6050GHTRICELL BMC (BMAC) for Surgery2,760,000
Materials and ConsumablesBL6051VYBL6051VYCHONDRO-GIDE (Chondron Guide) 20 × 305,640,000
Materials and ConsumablesBK7000SJBK7000SJTC-band 4, 6, 836,000
Materials and ConsumablesBK7000CMBK7000CMSANESCO I36,000
Materials and ConsumablesBK7000XVPreCuff (Upper Limb Type)90,000
Materials and ConsumablesBK7102UIICEWRAP – Self-Adhesive Compression Bandage (YOUI)20,000
Materials and Consumables12060ARM SLING (Sling for Arm Support, Basic Type)6,000
Materials and ConsumablesX0020Patient Gown Rental (Top)30,000
Materials and ConsumablesX0021Patient Gown Rental (Bottom)30,000
Materials and ConsumablesX100M01Urinal (Charged if Damaged or Taken Home)4,000
Materials and ConsumablesBM5001EDBM5001EDMEDITOUCH SCAR (Scar Care Sheet)24,000
Materials and ConsumablesBM2000JHBM2000JHSRTO (Soft Reconstructive Tissue Option) – 251515,000
Materials and ConsumablesBM2000JHBM2000JHSRTO (Soft Reconstructive Tissue Option) – 501524,000
Materials and ConsumablesBM2600ARPolygen (20×10mm)2,300,000
Materials and ConsumablesBM2600AR1Polygen (24×20mm)2,400,000
Materials and ConsumablesBK7104RLBK7104RLECO BAND – Self-Adhesive Elastic Bandage No. 448,000
Materials and ConsumablesBM5001XWBM5001XWBAP Scar Care Gel 15g (For Scar Treatment)72,000
Materials and ConsumablesBM5000FIMEDITOUCH Wound Cleansing Solution50,000
Materials and ConsumablesBK7000VWBK7000VWRAPBAND180,000
Materials and ConsumablesBM7100IPBK7101HNS-BAND = Suction Tube24,000
Materials and ConsumablesBM5302TJM3304002CAREGEL800,000
Materials and ConsumablesBM5110BLBM5110BLSUPER FIX (BNG FIX Plus)12,000
Materials and ConsumablesBM5102SZBM5102SZEASY FIX EYE12,000
Materials and ConsumablesBC1000VOBC1000VOEX-Band Disposable Compression Band180,000
Materials and ConsumablesBC1000VOBC1000VOCOBAN 2″5,000
Materials and ConsumablesBK7101EA1BC1000VOCOBAN 4″12,000
Materials and ConsumablesK9205037K9205037TAP SEAL, REDCLOT (Topical Hemostatic Dressing)50,000
Materials and ConsumablesBC1000RNBC1000RNRASSETT (ICE Pack)120,000
Materials and ConsumablesBM2600RHBM2600RHENCOL / INCOL 1cc (601)800,000
Materials and ConsumablesBM2600RH1BM2600RHENCOL / INCOL 1cc (901)1,430,000
Materials and ConsumablesBM2600RH2BM2600RH(P)ENCOL / INCOL 1cc (901)1,800,000
Materials and ConsumablesBTS01025BTS01025ENderm Link (Allograft Dermis)2,200,000
Materials and ConsumablesBTS01131BTS01131ARTHROFLEX4,200,000
Materials and ConsumablesBL3000JPBL3000JPPenKo Sono Gel (Ultrasound Gel) 20g13,000
Materials and ConsumablesBL3000FUBL3000FUM SKIN COVER (Ultrasound Cover Gel)10,000
Materials and ConsumablesBM2002FYBM2002FYECHOMATE COVER (Ultrasound Probe Cover)10,000
Materials and ConsumablesBC1201JOBC1201JOTONIC BAND (Cuff Band)90,000
Materials and ConsumablesBD1001ATBD1001ATSPACER 5.0mm (Drain Tube Fixation Plate)120,000
Materials and ConsumablesBM3001RQBM3001RQNDA PLUS (Skin Protector)120,000
Materials and ConsumablesM3300010M3300010GENTA Q 5×5cm200,000
Materials and Consumables12062Figure-8 Bandage25,000
Materials and ConsumablesBC6005HPINION FREEDOM SCREW, COMPRESSION SCREW700,000
Materials and ConsumablesBC0101OTBC0101OTMEGA DBM S, INOSS DBM, DYM 1cc600,000
Materials and ConsumablesBC0101OT3BC0101OTMEGA DBM 3cc2,200,000
Injections645604000645604001Nothrom Injection 3ml6,000
Injections684900040684900041Fibrovein Injection 1%, 2ml240,000
Injections653403901653403901Vitamin D (Vita Bella Prefilled Injection)50,000
Injections670600790670600791Merit-C Injection 20ml (Vitamin C & P)24,000
Injections644912060644912060Nutamin Injection 250ml (Protein Amino Acid Solution)72,000
Injections678900850678900850Combiflex MCT Peri Injection 375ml144,000
Injections681100026681100026Laennec Injection 2ml36,000
Injections654802040654802041Liquid Hylase Injection 1,500 IU / 1ml180,000
Injections654802040A654802211Liquid Hylase Injection 2,000 IU / 1.3ml420,000
Injections654802110654802111Liquid Hylase Injection 750 IU / 0.5ml60,000
Injections622900010622900021Cartistem (Stem Cell Therapy)12,600,000
Injections662800061662800061Placentex Injection (Wound Healing Agent)145,000
Injections681100261681100261Hepagene-C Injection 20ml24,000
Injections647801080647801081Samjin Taurolin Injection 2% / 250ml250,000
Injections650001801650001801Havrix Injection (Hepatitis A Vaccine)70,000
Injections654400661Wegovy Prefilled Pen 0.25mg (Semaglutide) 1.5ml750,000
Injections654400671Wegovy Prefilled Pen 0.5mg (Semaglutide) 1.5ml750,000
Injections654400681Wegovy Prefilled Pen 1.0mg (Semaglutide) 3ml750,000
Injections6555009065550090SkyZoster Injection (Herpes Zoster Vaccine)130,000
Injections642505131Grotropin Injection Cartridge 30 IU / 2.7ml (Growth Hormone)185,000
Injections648902270648902271Pneumococcal Vaccine / Prevenar 13 Injection 0.5ml130,000
Injections668902161668902161Euvax B Prefilled Injection 1mL (Hepatitis B Vaccine)25,000
Injections056400031B056400031BGeneral Influenza Vaccine (Teratect Prefilled)38,000
Injections670607761670607761Amobuprofen Injection 800mg (Non-insured)46,000
Injections668901281668901281Hiruan Injection (1 Vial)60,000
InjectionsIGLA1Placenta & Garlic Injection72,000
InjectionsLAENHISHI7Placenta & Licorice Injection84,000
InjectionsMAYR1Myers Cocktail144,000
InjectionsMERI670600790Mega Vitamin Injection30,000
InjectionsTHIOCT3Cinderella Injection36,000
Injections5960068159600681Lipotasone Injection (Dexamethasone Palmitate) 1ml140,000
Injections654802271HIDR Injection (Wound Healing Agent) 3ml145,000
Injections650003220AShingrix Injection (Herpes Zoster)300,000
Injections642505131Grotropin Injection Cartridge 30 IU / 2.7ml (Growth Hormone)185,000
Medications641601460641601460Beazym Tablets (Simultaneous Prescription)600
Medications652001030652001030Dulcolax EC Tablets 5mg1,100
Medications659901270659901271Mega D3 Tablets 25,000 IU (Vitamin D) (4 Tablets)48,000
Medications680300162680300162BD Chloraprep 26ml (Antiseptic Solution)60,000
Medications659900821659900821Monofer Injection 2ml120,000
Medications673300041673300041CartiLife (Autologous Cartilage Cell) 1 Syringe – Material18,000,000
Medications673300041A673300041CartiLife (Autologous Cartilage Cell) 2 Syringes – Material21,000,000
Medications655501931B655501931Gardasil 9 Prefilled Syringe (General)220,000
Certificates and DocumentsPZ011Certificate for Insurance Company100,000
Certificates and DocumentsPZ012Hospital Admission/Discharge Certificate3,000
Certificates and DocumentsPZ012AOutpatient Visit Confirmation3,000
Certificates and DocumentsPZ013Treatment Certificate (Procedure/Surgery)3,000
Certificates and DocumentsPZ014A(English) Procedure/Surgery Confirmation10,000
Certificates and DocumentsPZ015Estimated Future Medical Expenses Certificate (Under 10 Million KRW)50,000
Certificates and DocumentsPZ015AEstimated Future Medical Expenses Certificate (Over 10 Million KRW)100,000
Certificates and DocumentsPZ016Employment Medical Checkup (General)30,000
Certificates and DocumentsPZ016AEmployment Medical Checkup (For Public Officials)50,000
Certificates and DocumentsPZ1General Medical Certificate20,000
Certificates and DocumentsPZ17Medical Record Video CD Copy10,000
Certificates and DocumentsPZ1AGeneral Medical Certificate (English)20,000
Certificates and DocumentsPZ1BPermanent Impairment Certificate (AMA, McBride)100,000
Certificates and DocumentsPZ2Health Checkup Certificate20,000
Certificates and DocumentsPZ2ADormitory Health Certificate40,000
Certificates and DocumentsPZ2BDOA 4-Panel Test + Certificate50,000
Certificates and DocumentsPZ3Military Service Medical Certificate20,000
Certificates and DocumentsPZ30Certificate Copy (Per Page)1,000
Certificates and DocumentsPZ3AWork Ability Evaluation Certificate10,000
Certificates and DocumentsPZ4Injury Certificate (Less than 3 Weeks)100,000
Certificates and DocumentsPZ4AInjury Certificate (3 Weeks or More)150,000
Certificates and DocumentsPZ5Death Certificate10,000
Certificates and DocumentsPZ6Disability Certificate (Physical Disability)15,000
Certificates and DocumentsPZ6ADisability Certificate (Mental Disability)40,000
Certificates and DocumentsPZ7National Pension Disability Assessment Certificate15,000
Certificates and DocumentsPZ8Medical Record Copy (1–5 Pages: Per Page)1,000
Certificates and DocumentsPZ8AMedical Record Copy (Over 6 Pages: Per Page)100
Certificates and DocumentsPZ9Medical Opinion Letter20,000
Certificates and Documents70103External MRI CD Interpretation Fee50,000
Certificates and DocumentsPZ17BSurgery Room Video Recording Copy Fee700,000

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