Page 26 - TARIF BPJS (Update Nov 2017)

26 Collum Femur Exorotasi - R 120,750 13,200 107,550 120,750
27 Coxae - L 120,750 13,200 107,550 120,750
28 Coxae - R 120,750 13,200 107,550 120,750
29 Cruris - L 189,000 13,200 175,800 189,000
30 Cruris - R 189,000 12,000 177,000 189,000
31 Digiti Manus - L 152,250 12,900 139,350 152,250
32 Digiti Manus - R 152,250 12,900 139,350 152,250
33 Digiti Pedis - L 152,250 12,900 139,350 152,250
34 Digiti Pedis - R 152,250 12,900 139,350 152,250
35 Elbow - L 152,250 12,900 139,350 152,250
36 Elbow - R 152,250 12,900 139,350 152,250
37 Facial Bone 120,750 12,900 107,850 120,750
38 Femur - L 189,000 12,000 177,000 189,000
39 Femur - R 189,000 12,000 177,000 189,000
40 Foramen Opticum - L 120,750 13,200 107,550 120,750
41 Foramen Opticum - R 120,750 13,200 107,550 120,750
42 Genu - L 152,250 12,900 139,350 152,250
43 Genu - R 152,250 12,900 139,350 152,250
44 Hip Joint - L 120,750 13,200 107,550 120,750
45 Hip Joint - R 120,750 13,200 107,550 120,750
46 Humerus - L 152,250 12,900 139,350 152,250
47 Humerus - R 152,250 12,900 139,350 152,250
48 Kepala / Sinus Lat 120,750 13,200 107,550 120,750
49 Kepala Ap 120,750 13,200 107,550 120,750
50 LLD 120,750 13,200 107,550 120,750
51 Lumbal 210,000 13,200 196,800 210,000
52 LUMBAL Bending 210,000 13,200 196,800 210,000
53 Lumbal Hyper Flexi / Extensi 210,000 13,200 196,800 210,000
54 Lumbal Oblique 210,000 13,200 196,800 210,000
55 Lumbosacral 210,000 13,200 196,800 210,000
56 Lumbosacral Bending 210,000 13,200 196,800 210,000
57 Lumbosacral Hyper Flexi / Extensi 210,000 13,200 196,800 210,000
58 Lumbosacral Oblique 210,000 13,200 196,800 210,000
59 Mammografi - L 204,750 13,200 191,550 204,750
60 Mammografi - R 204,750 13,200 191,550 204,750
61 Mandibula - L 120,750 13,200 107,550 120,750
62 Mandibula - R 120,750 13,200 107,550 120,750
63 Mandibula Ap 120,750 13,200 107,550 120,750
64 Manus - L 152,250 12,900 139,350 152,250
65 Manus - R 152,250 12,900 139,350 152,250
66 Mastoid - L 120,750 13,200 107,550 120,750
67 Mastoid - R 120,750 13,200 107,550 120,750
68 NASAL 120,750 13,200 107,550 120,750
69 Occipital 120,750 13,200 107,550 120,750
70 Odontoid / Cervical 1 120,750 13,200 107,550 120,750
71 Os Pubis 152,250 13,200 139,050 152,250
72 Patella - L 152,250 12,900 139,350 152,250
73 Patella - R 152,250 12,900 139,350 152,250
74 Pedis - L 152,250 12,900 139,350 152,250
75 Pedis - R 152,250 12,900 139,350 152,250
76 Pelvis 120,750 13,200 107,550 120,750
77 Petrosum - L 120,750 13,200 107,550 120,750
78 Petrosum - R 120,750 13,200 107,550 120,750
79 RLD 120,750 13,200 107,550 120,750
80 Sacroilliaca joint - L 120,750 13,200 107,550 120,750
81 Sacroilliaca joint - R 120,750 13,200 107,550 120,750
82 Sacrum 152,250 13,200 139,050 152,250
83 Scapula - L 152,250 13,200 139,050 152,250
84 Scapula - R 152,250 13,200 139,050 152,250
85 Scapula Lat - L 120,750 13,200 107,550 120,750
86 Scapula Lat - R 120,750 13,200 107,550 120,750