quotation for surgery (dr.

jason brockwell)

mr paul carr date of surgery: (to be confirm)

diagnosis: impingement right ankle

planned surgery: ankle arthroscopic + debridement

prices are in hk$ (hk$7.8=us$1)

procedure: ankle arthroscopy & debridement (limited) (100%)

cpt code:29897 class i class ii class iii day case

(private) (shared) (ward) room
surgeon’s fee $25095 $19001 $12548 $17567
anaesthetist’s fee $8365 $6334 $4183 $5856

if more than one procedure is performed, they are charged as follows: for procedures on the
same site, the largest procedure is billed at 100% of the figure above; the next largest at 50%
and any subsequent procedures at 25% each. additional procedures on different sites will be
charged at 75% of the figure as calculated above. charges based on one night hospital stay and in-
patient care charge applies for extra stay in hospital:

ward round charge:

class 1 class ii class iii day case

(private) (shared) (ward)
$2900/day $1800/day $1100/day na

hospital charges:

the matilda international hospital has been contacted for a quotation of the hospital charges and
they will fax it to you when it is ready.

should you have questions about the hospital charges or if your insurance company needs to make
any arrangements regarding payment with the hospital, please contact mr. carlos ma on +852
2849 0375 or the admission office on +852 28490708.

please visit www.matilda.org to pre-register on line, this will save time on arrival at the
hospital.

feel free to contact me at any time if you have any other questions regarding your surgery.

linda fung, nurse manager

lf@sportsmed.hk
direct line: +852 3420 6606