Page 28 - TARIF BPJS (Update Nov 2017)

10 USG Massa 420,000 75,000 345,000 420,000
11 USG Musculo Sceletal 420,000 75,000 345,000 420,000
12 USG Prostat 367,500 75,000 292,500 367,500
13 USG Scrotum 420,000 75,000 345,000 420,000
14 USG Thorax 420,000 75,000 345,000 420,000
15 USG Thyroid 367,500 75,000 292,500 367,500
16 USG Tractus Urinarius 367,500 75,000 292,500 367,500
17 USG Transvaginal 367,500 75,000 292,500 367,500
18 USG Upper Abdomen 367,500 60,000 307,500 367,500
19 USG Vasculer Extremitas satu sisi 525,000 105,000 420,000 525,000
CT SCAN HELICAL 3 DIMENSI
CT CARDIAC
1 CT Calsium Scoring - 150,881 1,049,119 1,200,000
2 CT Cardiac Angio Coroner + Calsium Scoring - 426,830 3,023,170 3,450,000
3 CT Cardiac Angio Coroner - 413,136 2,906,864 3,320,000
CT ANGIO
1 CT Intracranial / Circulus Willisi CTA - 465,813 3,284,187 3,750,000
2 CT Carotid & Circulus Willisi CTA - 465,813 3,284,187 3,750,000
3 CT Neck / Carotid CTA - 465,813 3,284,187 3,750,000
4 CT Thoracal Aorta CTA - 465,813 3,284,187 3,750,000
5 CT Thoraco Abdominal Aorta CTA - 465,813 3,284,187 3,750,000
6 CT Abdominal Aorta CTA - 465,813 3,284,187 3,750,000
7 CT Renals Artery CTA - 465,813 3,284,187 3,750,000
8 CT Mesentric Artery CTA - 465,813 3,284,187 3,750,000
9 CT Upper Extremities CTA - 465,813 3,284,187 3,750,000
10 CT Lower Extremities CTA - 465,813 3,284,187 3,750,000
CT 3D
1 CT 3D Head - 164,575 1,185,425 1,350,000
2 CT 3D maxilla / Mandibulla - 164,575 1,185,425 1,350,000
3 CT 3D Face Bone - 164,575 1,185,425 1,350,000
4 CT 3D Spine Cervical - 196,268 1,388,732 1,585,000
5 CT 3D Spine Thoracal - 196,268 1,388,732 1,585,000
6 CT 3D Spine Lumbal - 196,268 1,388,732 1,585,000
7 CT 3D Pelvis - 196,268 1,388,732 1,585,000
8 CT 3D Upper Extremities - 178,268 1,291,732 1,470,000
9 CT 3D Lower Extremities - 178,268 1,291,732 1,470,000
10 CT 3D Abdomen - 187,268 1,397,732 1,585,000
11 CT 3D Thorax - 200,962 1,419,038 1,620,000
12 CT 3D - 47,187 332,813 380,000
CT NON-CONTRAST
1 CT Brain - 100,000 750,000 850,000
2 CT Basis Cranii - 120,000 930,000 1,050,000
3 CT Sinus Paranasal (Axial) - 120,000 930,000 1,050,000
4 CT Sinus Paranasal (Coronal) - 120,000 930,000 1,050,000
5 CT Sella Tursika - 120,000 930,000 1,050,000
6 CT Mastoid - 120,000 930,000 1,050,000
7 CT Neck - 120,000 930,000 1,050,000
8 CT Maxilla / Mandibula - 120,000 930,000 1,050,000
9 CT Nasopharynx - 120,000 930,000 1,050,000
10 CT Thorax - 120,000 930,000 1,050,000
11 CT Orbita - 120,000 930,000 1,050,000
12 CT whole Abdomen - 120,000 930,000 1,050,000
13 CT Upper Abdomen - 120,000 930,000 1,050,000
14 CT Lower Abdomen - 120,000 930,000 1,050,000
15 CT Pelvis - 120,000 930,000 1,050,000
16 CT Vert Cervical - 120,000 930,000 1,050,000
17 CT Vert Thoracal - 120,000 930,000 1,050,000
18 CT Vert Lumbosacral - 120,000 930,000 1,050,000
19 CT Upper Extremitas - 120,000 930,000 1,050,000