JASA DOKTER

NO DAFTAR TINDAKAN TARIF

(BPJS) (UMUM)
RADIOLOGI KONVENSIONAL
1 Schedell Rp 180,000 Rp 60,000 Rp 70,000
2 Waters Rp 155,000 Rp 30,000 Rp 35,000
3 SPN Rp 205,000 Rp 90,000 Rp 105,000
4 Os Nasal Rp 155,000 Rp 30,000 Rp 35,000
5 Orbita Rp 170,000 Rp 30,000 Rp 35,000
6 Mastoid Rp 195,000 Rp 60,000 Rp 70,000
7 Adenoid Rp 155,000 Rp 30,000 Rp 35,000
8 Celatursica Rp 180,000 Rp 30,000 Rp 35,000
9 TMJ Rp 165,000 Rp 60,000 Rp 70,000
10 Petrosum Rp 180,000 Rp 30,000 Rp 35,000
11 Mandibula Rp 165,000 Rp 30,000 Rp 35,000
12 Maxila Rp 165,000 Rp 30,000 Rp 35,000
13 Thorax Rp 130,000 Rp 30,000 Rp 35,000
14 Thorax ap + lat Rp 180,000 Rp 60,000 Rp 70,000
15 Top lordotik Rp 130,000 Rp 30,000 Rp 35,000
16 Scapula Rp 165,000 Rp 30,000 Rp 35,000
17 BNO Rp 155,000 Rp 30,000 Rp 35,000
18 Abd 2 pss Rp 230,000 Rp 60,000 Rp 70,000
19 Abd 3 pss Rp 280,000 Rp 90,000 Rp 105,000
20 Shoulder Rp 155,000 Rp 30,000 Rp 35,000
21 Humerus Rp 180,000 Rp 30,000 Rp 35,000
22 Elbow Rp 180,000 Rp 30,000 Rp 35,000
23 Antebrachy Rp 180,000 Rp 30,000 Rp 35,000
24 Wrist Rp 180,000 Rp 30,000 Rp 35,000
25 Manus Rp 180,000 Rp 30,000 Rp 35,000
26 Pelvic Rp 180,000 Rp 30,000 Rp 35,000
27 Hipp Rp 180,000 Rp 30,000 Rp 35,000
28 Femur Rp 180,000 Rp 30,000 Rp 35,000
29 Genue Rp 180,000 Rp 30,000 Rp 35,000
30 Cruris Rp 180,000 Rp 30,000 Rp 35,000
31 Ankle Rp 180,000 Rp 30,000 Rp 35,000
32 Pedis Rp 180,000 Rp 30,000 Rp 35,000
33 Cervical Rp 195,000 Rp 60,000 Rp 70,000
34 Thoracal Rp 230,000 Rp 60,000 Rp 70,000
35 Lumbal Rp 230,000 Rp 60,000 Rp 70,000
36 Thoracolumbal Rp 230,000 Rp 60,000 Rp 70,000
37 Lumbosacral Rp 230,000 Rp 60,000 Rp 70,000
38 Sacrum Rp 195,000 Rp 60,000 Rp 70,000
39 Cervical 3 pss Rp 230,000 Rp 90,000 Rp 105,000
40 Thoracal 3 pss Rp 290,000 Rp 90,000 Rp 105,000
41 Lumbal 3 pss Rp 290,000 Rp 90,000 Rp 105,000
42 Thoracolumbal 3 pss Rp 290,000 Rp 90,000 Rp 105,000
43 Lumbosacral 3 pss Rp 290,000 Rp 90,000 Rp 105,000
44 Sacrum 3 pss Rp 230,000 Rp 90,000 Rp 105,000
 JASA DOKTER
NO DAFTAR TINDAKAN TARIF
(BPJS) (UMUM)
KONVENSIONAL KONTRAS
1 BNO IVP Rp 650,000 Rp 380,000 Rp 410,000
2 Coloon In Loop Rp 650,000 Rp 380,000 Rp 410,000
3 Cholongiografy Rp 600,000 Rp 320,000 Rp 340,000
4 Fistulografy Rp 600,000 Rp 320,000 Rp 340,000
5 HSG Rp 500,000 Rp 320,000 Rp 340,000
6 Lopografy Rp 550,000 Rp 320,000 Rp 340,000
7 OMD Rp 500,000 Rp 320,000 Rp 340,000
8 Uretrocystografy Rp 550,000 Rp 320,000 Rp 340,000
10 Apendicografy Rp 400,000 Rp 190,000 Rp 205,000
11 Esofagografy Rp 450,000 Rp 290,000 Rp 305,000
12 Cystografy Rp 500,000 Rp 320,000 Rp 340,000

JASA DOKTER
NO DAFTAR TINDAKAN TARIF
(BPJS) (UMUM)
RADIOLOGI CT
1 CT-Scan Kepala Rp 860,000 Rp 170,000 Rp 200,000
2 CT-Scan Cervical Rp 860,000 Rp 170,000 Rp 200,000
3 CT-Scan Nasopharing Rp 860,000 Rp 170,000 Rp 200,000
4 CT-Scan Ekstremitas Rp 860,000 Rp 170,000 Rp 200,000
5 CT-Scan Thorax Rp 1,060,000 Rp 170,000 Rp 200,000
6 CT-Scan Lumbal Rp 1,160,000 Rp 170,000 Rp 200,000
7 CT-Scan Abdomen Rp 1,160,000 Rp 170,000 Rp 200,000
8 CT-Scan Kepala Contras Rp 1,910,000 Rp 300,000 Rp 350,000
9 CT-Scan Cervical Contras Rp 1,910,000 Rp 300,000 Rp 350,000
10 CT-Scan Nasopharing Contras Rp 1,910,000 Rp 300,000 Rp 350,000
11 CT-Scan Ekstremitas Contras Rp 1,910,000 Rp 300,000 Rp 350,000
12 CT-Scan Thorax Contras Rp 2,610,000 Rp 300,000 Rp 350,000
13 CT-Scan Lumbal Contras Rp 2,610,000 Rp 300,000 Rp 350,000
14 CT-Scan Abdomen Contras Rp 2,610,000 Rp 300,000 Rp 350,000

JASA DOKTER
NO DAFTAR TINDAKAN TARIF
(BPJS) (UMUM)
RADIOLOGI USG
1 USG Abdomen Rp 220,000 Rp 95,000 Rp 95,000
2 USG Tyroid Rp 220,000 Rp 95,000 Rp 95,000
3 USG Mamae Rp 220,000 Rp 95,000 Rp 95,000
4 USG Pelvic Rp 220,000 Rp 95,000 Rp 95,000
5 USG Dopler Rp 220,000 Rp 95,000 Rp 95,000
6 USG Scrotum Rp 220,000 Rp 95,000 Rp 95,000
7 USG Kepala Rp 220,000 Rp 95,000 Rp 95,000
radiologi Konvensional 44
tindakan kontras 12
tindakan radiologi ct 14
tindakan usg 7
jumlah 77