Non-covered Fees
Non-covered fees
Non-covered fees at Jalboneun Seongmo Eye Clinic, listed by item.
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Procedure fee
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| Mid-level category | Subcategory | Code | Name | Category | Fee | Lowest fee | Highest fee | Notes | Last updated |
|---|---|---|---|---|---|---|---|---|---|
| Test fees | Visual function tests | E7801 | Ocular biometry (laser interferometry) IOL-Master | One eye | 20,000 | Non-covered when performed outside insurance coverage criteria | 2026.01.01 | ||
| Test fees | Visual function tests | EX795 | Scheimpflug photography (one side), analysis included | One eye | 30,000 | 500,000 | Non-covered when performed outside insurance coverage criteria | 2026.01.01 | |
| Test fees | Visual function tests | EX796 | Corneal tomography | One eye | 25,000 | 500,000 | Non-covered when performed outside insurance coverage criteria | 2026.01.01 | |
| Test fees | Visual function tests | EZ799 | Tear lipid-layer thickness measurement by interferometry | One eye | 100,000 | Non-covered when performed outside insurance coverage criteria | 2026.01.01 | ||
| Test fees | Visual function tests | EZ796 | Optical coherence tomography — OCT | One eye | 40,000 | Non-covered when performed outside insurance coverage criteria | 2026.01.01 | ||
| Ultrasound fees | Ultrasound fees | E7800 | Head and neck–ocular ultrasound (biometry) A-SCAN | One eye | 50,000 | Non-covered when performed outside insurance coverage criteria | 2026.01.01 | ||
| Ultrasound fees | Ultrasound fees | EB411 | Head and neck–ocular ultrasound (globe) B-SCAN | One eye | 300,000 | Non-covered when performed outside insurance coverage criteria | 2026.01.01 | ||
| Procedure and surgery fees | Sense organ — vision (eye) | SZ677 | Eyedrop treatment — autologous platelet-rich plasma | per session | 99,000 | 2026.01.01 | |||
| Procedure and surgery fees | Sense organ — vision (eye) | Upper eyelid correction | Both eyes | 1,000,000 | For cosmetic purposes; VAT extra | 2026.01.01 | |||
| Procedure and surgery fees | Sense organ — vision (eye) | Lower-eyelid fat removal | Both eyes | 1,000,000 | For cosmetic purposes; VAT extra | 2026.01.01 | |||
| Procedure and surgery fees | Sense organ — vision (eye) | Conjunctival nevus (spot) removal — laser | One eye | 10,000 | 100,000 | For cosmetic purposes; price varies by size | 2026.01.01 | ||
| Procedure and surgery fees | Sense organ — vision (eye) | Botox | per session | 10,000 | 100,000 | For cosmetic purposes | 2026.01.01 | ||
| Physical therapy fees | Other physical therapy fees | MZ013 | Dry eye treatment — massage therapy | per session | 50,000 | Varies by site | 2026.01.01 | ||
| Physical therapy fees | Other physical therapy fees | MZ014 | Dry eye treatment — thermal treatment of obstructed meibomian glands | per session | 300,000 | Varies by site | 2026.01.01 | ||
| Physical therapy fees | Other physical therapy fees | MZ015 | Dry eye treatment — laser light therapy | per session | 100,000 | 300,000 | Varies by site | 2026.01.01 |
Materials
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| Subcategory | Code | Name | Category | Fee | Lowest fee | Highest fee | Last updated |
|---|---|---|---|---|---|---|---|
| Accommodative intraocular lens | BI0200VG | HOYA VIVINEX TORIC | One eye | 784,640 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0214EB | CLAREON TORIC | One eye | 781,550 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0208EB | PANOPTIX IOL | One eye | 2,281,550 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0200EB | PANOPTIX -TORIC IOL | One eye | 2,281,550 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0211EB | CLAREON PanOptix | One eye | 3,281,550 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0212EB | CLAREON PanOptix-toric | One eye | 3,281,550 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0201TE | LENTIS MPLUS | One eye | 1,284,640 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0204HY | ARTIS SYMBIOSE PLUS | One eye | 1,784,640 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0205HY | ARTIS SYMBIOSE MID | One eye | 1,284,640 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0203HY | ARTIS PL M | One eye | 1,284,640 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0202YX | ARTISAN | One eye | 700,000 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0200LN | TECNIS EYHANCE TORIC II IOL, TECNIS EYHANCE TORIC II IOL WITH TECNIS SIMPLICITY DELIVERY SYSTEM | One eye | 1,284,640 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0207LN | TECNIS EYHANCE IOL, TECNIS EYHANCE IOL WITH TECNIS SIMPLICITY DELIVERY SYSTEM | One eye | 784,640 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0203OZ | AT LISA 839MP | One eye | 2,281,550 | 2026.01.01 | ||
| Accommodative intraocular lens | BI0210EB | ACRYSOF IQ VIVITY TORIC | One eye | 1,381,550 | 2026.01.01 | ||
| Orthokeratology lens | Orthokeratology lens α Ortho-K | One eye | 400,000 | 2026.01.01 | |||
| Orthokeratology lens | Orthokeratology lens Ortho-K LK®-Lens PREMIER | One eye | 450,000 | 2026.01.01 | |||
| Orthokeratology lens | Orthokeratology lens Ortho-K LK-Lens Toric PREMIER | One eye | 550,000 | 2026.01.01 | |||
| Orthokeratology lens | Orthokeratology lens Paragon CRT 100 | One eye | 500,000 | 2026.01.01 | |||
| Orthokeratology lens | Orthokeratology lens Paragon CRT 100 Dual Axis | One eye | 600,000 | 2026.01.01 | |||
| Orthokeratology lens | Orthokeratology lens Euclid Systems Orthokeratology | One eye | 550,000 | 2026.01.01 | |||
| Orthokeratology lens | Misight1day | One eye | 70,000 | 2026.01.01 | |||
| Orthokeratology lens | RGP lens | Both eyes | 250,000 | 300,000 | 2026.01.01 | ||
| Treatment materials | BI3002FW | Autologous platelet-rich plasma eye-drop treatment | per session | 99,000 | 2026.01.01 | ||
| Treatment materials | SZ677 | [Non-covered] Eyedrop treatment — autologous platelet-rich plasma | per session | 99,000 | 2026.01.01 |
Drugs
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| Subcategory | Code | Name | Category | Lowest fee | Highest fee | Notes | Last updated |
|---|---|---|---|---|---|---|---|
| Drugs | 645000361 | Avastin injection (bevacizumab) | One eye | 10,000 | 200,000 | Off-label drugs | 2026.01.01 |
| Drugs | 643309371 | Lucen-BS prefilled syringe | One eye | 100,000 | 300,000 | Off-label drugs | 2026.01.01 |
| Drugs | 653603301 | Beovu prefilled syringe (brolucizumab) | One eye | 100,000 | 300,000 | Off-label drugs | 2026.01.01 |
| Drugs | 641105771 | Eylea prefilled syringe (aflibercept) | One eye | 100,000 | 600,000 | Off-label drugs | 2026.01.01 |
Document fees
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| Name | Category | Fee | Last updated |
|---|---|---|---|
| General medical certificate | 10,000 | 2021.05.06 | |
| Surgery confirmation | 10,000 | 2021.05.06 | |
| Medical opinion | 10,000 | 2021.05.06 | |
| Disability certificate | 15,000 | 2021.05.06 | |
| Injury certificate | Estimated treatment period of 3 weeks or more | 150,000 | 2021.05.06 |
| Injury certificate | Estimated treatment period under 3 weeks | 100,000 | 2021.05.06 |
| Outpatient confirmation | 3,000 | 2021.05.06 | |
| Admission/discharge confirmation | 3,000 | 2021.05.06 | |
| Certificate of care | 3,000 | 2021.05.06 | |
| Operative record | 3,000 | 2021.05.06 | |
| Nursing record | 3,000 | 2021.05.06 | |
| Admission/discharge record | 3,000 | 2021.05.06 | |
| Initial visit chart | 1,000 | 2021.05.06 | |
| Basic copy of medical records (1–5 sheets) | 1,000 | 2021.05.06 | |
| Copy of medical records (6 sheets or more) | per sheet | 100 | 2021.05.06 |
| Test result sheet (color) | per sheet | 1,000 | 2021.05.06 |
| Test result sheet (black and white) | per sheet | 500 | 2021.05.06 |
| Quality-improvement checklist | 10,000 | 2021.05.06 | |
| Certificate for work-capacity evaluation | 10,000 | 2021.05.06 | |
| Insurer advisory opinion | 50,000 | 2021.05.06 |