Page 27 - TARIF BPJS (Update Nov 2017)

87 Sella Khusus 120,750 13,200 107,550 120,750
88 Shoulder - L 120,750 13,200 107,550 120,750
89 Shoulder - R 120,750 13,200 107,550 120,750
90 Shoulder Axillaris - L 120,750 13,200 107,550 120,750
91 Shoulder Axillaris - R 120,750 13,200 107,550 120,750
92 Sternoclavicular 152,250 13,200 139,050 152,250
93 Sternum 152,250 13,200 139,050 152,250
94 Thoracal 210,000 13,200 196,800 210,000
95 Thoracal Bending 210,000 13,200 196,800 210,000
96 Thoracal Oblique 210,000 13,200 196,800 210,000
97 Thoracolombal Hyper Flexi / Extensi 210,000 13,200 196,800 210,000
98 Thoracolumbal 210,000 13,200 196,800 210,000
99 Thoracolumbal L Bending 210,000 13,200 196,800 210,000
100 Thoracolumbal Oblique 210,000 13,200 196,800 210,000
101 Thorax di tempat 152,250 13,200 139,050 152,250
102 Thorax Lat 120,750 13,200 107,550 120,750
103 Thorax Obl - L 120,750 13,200 107,550 120,750
104 Thorax Obl - R 120,750 13,200 107,550 120,750
105 Thorax PA/AP 120,750 13,200 107,550 120,750
106 TMJ - L 210,000 13,200 196,800 210,000
107 TMJ - R 210,000 13,200 196,800 210,000
108 Top Lordotik 120,750 13,200 107,550 120,750
109 Water's 120,750 13,200 107,550 120,750
110 Wrist joint - L 152,250 12,900 139,350 152,250
111 Wrist Joint - R 152,250 12,900 139,350 152,250
112 Xypoideus 152,250 12,900 139,350 152,250
113 Zygomaticus - L 120,750 12,900 107,850 120,750
114 Zygomaticus - R 120,750 12,900 107,850 120,750
RADIOGRAFI KONTRAS
1 Appendicografi 472,500 472,500
2 BNO - IVP 1,134,000 1,134,000
3 Caudografi 840,000 840,000
4 Cholangiografi 1,207,500 1,207,500
5 Colon Inloop 787,500 787,500
6 Cor Analyse 472,500 472,500
7 Cystografi 630,000 630,000
8 Fistulografi 708,750 708,750
9 Follow Trought 496,125 496,125
10 H S G 787,500 787,500
11 Lopografi Atas 525,000 525,000
12 Lopografi Bawah 525,000 525,000
13 Maag Duodenografi 577,500 577,500
14 Myelografy / Caudografy 945,000 945,000
15 Oesophagografi 496,125 496,125
16 R P G 992,250 992,250
17 Uretrografi 630,000 630,000
18 Venografi / Plebhografi 1,417,500 1,417,500
USG LOGIQ 5 COLOUR DOPPLER - 3D
1 Guidance USG 315,000 60,000 255,000 315,000
2 Paket Mammae 577,500 105,000 472,500 577,500
3 USG Abdomen 472,500 90,000 382,500 472,500
4 USG Abdomen Cyto 577,500 108,000 469,500 577,500
5 USG Carotis 630,000 120,000 510,000 630,000
6 USG Kandungan 367,500 75,000 292,500 367,500
7 USG Kepala bayi 420,000 75,000 345,000 420,000
8 USG Lower Abdomen 367,500 60,000 307,500 367,500
9 USG Mammae 367,500 75,000 292,500 367,500