Page 25 - TARIF BPJS (Update Nov 2017)

61 Kultur TB 450,000 450,000
62 Lipase 173,500 173,500
63 Lp(a) 293,500 4,680 288,820 293,500
64 Ms AFP 225,000 225,000
65 Organic Chemical Air 767,500 767,500
66 PAPP-AA dan Free BHCG-1 St Trisemester 2,340,000 2,340,000
67 Pengecatan Sudan Black B Sumsum Tulang 100,000 100,000
68 Phospor Anorganik Serum 81,500 4,680 76,820 81,500
69 Physical Air 200,000 200,000
70 Progesteron 17 OH 1,250,000 4,680 1,245,320 1,250,000
71 Protein Elektroforesa
72 SCC 463,000 4,680 458,320 463,000
73 Tacrolymus 907,000 907,000
74 TB PCR 610,000 610,000
75 Tiroglobulin 538,500 538,500
76 Uji Naza Amphethamine Urin (Kuantitatif) 500,000 500,000
77 Uji Naza Barbiturat Urin (Kuantitatif) 500,000 500,000
78 Uji Naza Benzodiazepine Urin (Kuantitatif) 500,000 500,000
79 Uji Naza Cannabinoid Urin (Kuantitatif) 500,000 500,000
80 Uji Naza Coccaine Urin (Kuantitatif) 500,000 500,000
81 Uji Naza Opiate Urin (Kuantitatif) 500,000 500,000
82 Viral load HIV 1,640,000 1,640,000
83 Von Willebrand Factor 630,000 630,000
84 IGRA
AMBIL DAN PROSES BAHAN LAB
1 Ambil bahan non darah luar RS,lokal/jam -
2 Ambil darah di luar RS,lokal/sampel -

Catatan :
Pemeriksaan Cito ditambah 10% dari tarif

RADIOLOGY
2017
RONTGENT NON KONTRAS 2015
Jasa Medis Biaya Sarana Total Tarif
1 Abdomen (BNO) 120,750 13,200 107,550 120,750
2 Abdomen Tegak 120,750 13,200 107,550 120,750
3 Ankle - L 152,250 12,900 139,350 152,250
4 Ankle - R 152,250 12,900 139,350 152,250
5 Antebrachii - L 152,250 12,900 139,350 152,250
6 Antebrachii - R 152,250 12,900 139,350 152,250
7 Atresia Ani 220,500 13,200 207,300 220,500
8 Baca Foto Radiografi Non Kontras 52,500 13,200 39,300 52,500
9 Basis Cranii / Submentovertex 120,750 13,200 107,550 120,750
10 Bone Survey 593,250 33,000 560,250 593,250
11 Calcaneus - L 152,250 12,900 139,350 152,250
12 Calcaneus - R 152,250 12,900 139,350 152,250
13 Caldwell 120,750 13,200 107,550 120,750
14 Cavum Orbita 120,750 13,200 107,550 120,750
15 Cervical 152,250 13,200 139,050 152,250
16 Cervical Oblique 152,250 13,200 139,050 152,250
17 Cervicothoracal 152,250 13,200 139,050 152,250
18 Clavicula - L 120,750 13,200 107,550 120,750
19 Clavicula - R 120,750 13,200 107,550 120,750
20 Clavicula Axial - L 120,750 13,200 107,550 120,750
21 Clavicula Axial - R 120,750 13,200 107,550 120,750
22 Coccigeus 152,250 12,900 139,350 152,250
23 Collum Femur - L 120,750 13,200 107,550 120,750
24 Collum Femur - R 120,750 13,200 107,550 120,750
25 Collum Femur Exorotasi - L 120,750 13,200 107,550 120,750