Tarif Harga RADIOLOGI Murni Teguh

RADIOLOGY
NO PEMERIKSAAN/TINDAKAN KODE HARGA

I OTHER EXAM
FILM UK.BESAR RADFILMBSR01 100,000.00
II CT
1 CT ANGIO ABDOMEN RCAABDO00001 6,000,000.00
2 CT ANGIO CERVICAL RCACERV00001 3,600,000.00
3 CT ANGIO CRANIAL RCACRAN00001 3,600,000.00
4 CT ANGIO LOWER EXTREMITY RCALOWE00002 3,600,000.00
5 CT ANGIO RENALIS RCARENA00001 3,600,000.00
6 CT ANGIO THORAX RCATHOX00001 3,600,000.00
7 CT ANGIO UPPER EXTREMITY RCAUPPE00002 3,600,000.00
8 CT AORTOGRAFI RCAORTO00001 9,000,000.00
9 CT CALCIUM SCORE (HEART) RCSHEAR00001 1,500,000.00
10 CT SCAN ANKLE JOINT DEXTRA RCSANKL00001 1,100,000.00
11 CT SCAN ANKLE JOINT DEXTRA 3D RCSANKL00005 2,160,000.00
CT SCAN ANKLE JOINT DEXTRA WITH

12 CONTRAST
RCSANKL00003 2,040,000.00
13 CT SCAN ANKLE JOINT SINISTRA RCSANKL00002 1,100,000.00
14 CT SCAN ANKLE JOINT SINISTRA 3D RCSANKL00004 2,160,000.00
CT SCAN ANKLE JOINT SINISTRA WITH

15 CONTRAST
RCSANKL00006 2,040,000.00
16 CT SCAN APPENDIX RCSAPPE00001 1,500,000.00
17 CT SCAN APPENDIX WITH CONTRAST RCSAPPE00002 2,700,000.00
18 CT SCAN BRAIN PERFUSION RCSBRAI00001 1,680,000.00
19 CT SCAN BRONCHOSCOPY RCSBRONCH001 2,500,000.00
20 CT SCAN CARDIAC (HEART) RCSCARD00001 4,500,000.00
21 CT SCAN CERVICAL RCSCERV00001 1,320,000.00
22 CT SCAN CERVICAL SPINE 3D RCSCERV00002 2,640,000.00
23 CT SCAN CITO (21.00 - 07.00) RCSCITO00001 240,000.00
24 CT SCAN CUBITI DEXTRA WITH CONTRAST RCSCUBI00003 2,000,000.00
25 CT SCAN CUBITI DEXTRA RCSCUBI00001 1,100,000.00
26 CT SCAN CUBITI SINISTRA RCSCUBI00004 1,080,000.00
27 CT SCAN CUBITI SINISTRA WITH CONTRAST RCSCUBI00005 2,000,000.00
28 CT SCAN CUBITI/ELBOW DEXTRA JOINT 3D RCSCUBI00002 1,900,000.00
29 CT SCAN CUBITI/ELBOW SINISTRA JOINT 3D RCSCUBI00006 1,900,000.00
30 CT SCAN DENTAL RCSDENT00001 1,440,000.00
31 CT SCAN DIGITAL PELVIMETRY RCSDIGI00001 1,000,000.00
32 CT SCAN ESOFAGUS RCSESOF00001 2,400,000.00

33 CT SCAN ESOFAGUS WITH CONTRAST RCSESOF00002 3,000,000.00
CT SCAN EXTREMITY LONG BONE (FEMUR,

34 CRURIS,
RCSEXTR00002 1,400,000.00
35 CT SCAN EXTREMITY LONG BONE 3D RCSEXTR00001 2,700,000.00
CT SCAN EXTREMITY LONG BONE WITH

36 CONTRAST
RCSEXTR00003 2,600,000.00
37 CT SCAN GENU DEXTRA RCSGENU00001 1,100,000.00
38 CT SCAN GENU DEXTRA WITH CONTRAST RCSGENU00003 2,040,000.00
39 CT SCAN GENU SINISTRA RCSGENU00004 1,100,000.00
40 CT SCAN GENU SINISTRA WITH CONTRAST RCSGENU00005 2,040,000.00
41 CT SCAN GENU/KNEE DEXTRA 3D RCSGENU00002 2,100,000.00
42 CT SCAN GENU/KNEE SINISTRA 3D RCSGENU00006 2,100,000.00
43 CT SCAN GUIDING BIOPSY RCSGUIDIB001 5,000,000.00
44 CT SCAN HIP JOINT RCSHIP000001 1,680,000.00
45 CT SCAN HIP JOINT 3D RCSHIP000002 3,360,000.00
46 CT SCAN INNER AUDITORY CANAL RCSINNE00001 1,080,000.00
CT SCAN INNER AUDITORY CANAL WITH

47 CONTRAST
RCSINNE00002 2,040,000.00
48 CT SCAN KEPALA + KONTRAS / CT SCAN LIDAH + RSCKEPA00004 2,100,000.00
CT SCAN KEPALA + KONTRAS / CT SCAN

49 PAROTIS +
RSCKEPA00002 2,100,000.00
50 CT SCAN KEPALA / CT SCAN LIDAH RSCKEPA00003 1,100,000.00
51 CT SCAN KEPALA / CT SCAN PAROTIS RSCKEPA00001 1,100,000.00
52 CT SCAN LIVER 3 PHASE (WITH CONTRAST) RCSLIVE00001 4,200,000.00
53 CT SCAN LOWER ABDOMEN RCSLOWE00001 1,680,000.00
54 CT SCAN LOWER ABDOMEN 3D RCSLOWE00002 3,360,000.00
55 CT SCAN LOWER ABDOMEN WITH CONTRAST RCSLOWE00003 2,880,000.00
56 CT SCAN LUMBAL RCSLUMB00001 1,320,000.00
57 CT SCAN LUMBAL SPINE 3D RCSLUMB00002 2,640,000.00
58 CT SCAN LUMBAL WITH CONTRAST RCSLUMB00003 2,520,000.00
59 CT SCAN MANDIBULA RCSMAND00001 1,100,000.00
60 CT SCAN MANDIBULA 3D RCSMAND00002 2,100,000.00
61 CT SCAN MANDIBULA WITH CONTRAST RCSMAND00003 2,100,000.00
62 CT SCAN MANUS DEXTRA RCSMANU00001 1,100,000.00
63 CT SCAN MANUS DEXTRA 3D RCSMANU00002 2,100,000.00
64 CT SCAN MANUS DEXTRA WITH CONTRAST RCSMANU00003 2,100,000.00
65 CT SCAN MANUS SINISTRA RCSMANU00004 1,100,000.00
66 CT SCAN MANUS SINISTRA 3D RCSMANU00006 2,100,000.00
67 CT SCAN MANUS SINISTRA WITH CONTRAST RCSMANU00005 2,100,000.00
68 CT SCAN MIDFACE RCSMIDF00002 1,100,000.00
69 CT SCAN MIDFACE 3D RCSMIDF00001 2,100,000.00
70 CT SCAN NASOPHARYNX RCSNASO00001 1,100,000.00

71 CT SCAN NASOPHARYNX 3D RCSNASO00002 2,100,000.00
72 CT SCAN NASOPHARYNX WITH CONTRAST RCSNASO00003 2,100,000.00
73 CT SCAN NECK / CT SCAN LARYING RCSNECK00001 1,100,000.00
CT SCAN NECK / CT SCAN LARYING WITH

74 CONTRAST
RCSNECK00003 2,100,000.00
75 CT SCAN NECK 3D RCSNECK00002 2,100,000.00
76 CT SCAN ORBITA RCSORBI00001 1,100,000.00
77 CT SCAN ORBITA 3D RCSORBI00002 2,100,000.00
78 CT SCAN ORBITA WITH CONTRAST RCSORBI00003 2,100,000.00
79 CT SCAN PARANASAL SINUS RCSPARA00001 1,100,000.00
80 CT SCAN PARANASAL SINUS 3D RCSPARA00002 2,100,000.00
81 CT SCAN PARANASAL SINUS WITH CONTRAST RCSPARA00003 2,100,000.00
82 CT SCAN PEDIS DEXTRA RCSPEDIS00001 1,100,000.00
83 CT SCAN PEDIS DEXTRA 3D RCSPEDIS00002 2,100,000.00
84 CT SCAN PEDIS SINISTRA RCSPEDIS00003 1,100,000.00
85 CT SCAN PEDIS SINISTRA 3D RCSPEDIS00004 2,100,000.00
86 CT SCAN PELVIS RCSPELV00001 1,680,000.00
87 CT SCAN PELVIS 3D RCSPELV00003 3,360,000.00
88 CT SCAN PELVIS WITH CONTRAST RCSPELV00002 2,880,000.00
89 CT SCAN ROUTINE BRAIN RCSROUT00001 1,100,000.00
90 CT SCAN ROUTINE BRAIN 3D RCSROUT00003 2,100,000.00
91 CT SCAN ROUTINE BRAIN WITH CONTRAST RCSROUT00002 2,100,000.00
92 CT SCAN SELLA TURSICA RCSSELL00001 1,100,000.00
93 CT SCAN SELLA TURSICA 3D RCSSELL00002 2,100,000.00
94 CT SCAN SELLA TURSICA WITH CONTRAST RCSSELL00003 2,100,000.00
95 CT SCAN SHOULDER DEXTRA JOINT RCSSHOU00001 1,100,000.00
96 CT SCAN SHOULDER DEXTRA JOINT 3D RCSSHOU00002 2,100,000.00
CT SCAN SHOULDER JOINT DEXTRA WITH

97 CONTRAST
RCSSHOU00003 2,100,000.00
CT SCAN SHOULDER JOINT SINISTRA WITH

98 CONTRAST
RCSSHOU00005 2,100,000.00
99 CT SCAN SHOULDER SINISTRA JOINT RCSSHOU00004 1,100,000.00
100 CT SCAN SHOULDER SINISTRA JOINT 3D RCSSHOU00006 2,100,000.00
101 CT SCAN TEMPORAL BONE RCSTEMP00001 1,200,000.00
102 CT SCAN TEMPORAL BONE 3D RCSTEMP00002 2,400,000.00
103 CT SCAN TEMPORAL BONE WITH CONTRAST RCSTEMP00003 2,400,000.00
104 CT SCAN THORACIC SPINE RCSTHOC00001 1,700,000.00
105 CT SCAN THORACIC SPINE 3D RCSTHOC00002 2,700,000.00
106 CT SCAN THORAX RCSTHOX00001 2,000,000.00
107 CT SCAN THORAX 3D RCSTHOX00002 3,000,000.00
108 CT SCAN THORAX PERFUSION + CONTRAST RCSTHOR00004 3,500,000.00

109 CT SCAN THORAX WITH CONTRAST RCSTHOR00003 3,500,000.00
110 CT SCAN UPPER ABDOMEN RCSUPPE00001 1,500,000.00
111 CT SCAN UPPER ABDOMEN 3D RCSUPPE00002 2,800,000.00
112 CT SCAN UPPER ABDOMEN WITH CONTRAST RCSUPPE00005 3,000,000.00
113 CT SCAN UPPER+LOWER ABDOMEN RCSUPPE00003 2,500,000.00
114 CT SCAN UPPER+LOWER ABDOMEN 3D RCSUPPE00004 4,500,000.00
CT SCAN UPPER+LOWER ABDOMEN WITH

115 CONTRAST
RCSUPPE00006 4,200,000.00
116 CT SCAN UROGRAPHY (WITH CONTRAST) RCSURO000001 4,320,000.00
117 CT SCAN VIRTUAL COLONOSCOPY RCSVIRTUAL01 3,000,000.00
118 CT SCAN WHOLE BODY RCSWHOL00001 6,000,000.00
119 CT SCAN WRIST DEXTRA JOINT RCSWRIS00001 1,080,000.00
120 CT SCAN WRIST JOINT DEXTRA 3D RCSWRIS00002 2,160,000.00
121 CT SCAN WRIST JOINT DEXTRA WITH CONTRAST RCSWRIS00003 2,040,000.00
122 CT SCAN WRIST JOINT SINISTRA 3D RCSWRIS00006 2,160,000.00
CT SCAN WRIST JOINT SINISTRA WITH

123 CONTRAST
RCSWRIS00005 2,040,000.00
124 CT SCAN WRIST SINISTRA JOINT RCSWRIS00004 1,080,000.00
125 PRE-EXAM CT SCAN CARDIAC RCSPREEXAM01 360,000.00
III MRI
1 MRA ABDOMINALIS RMRAABD00001 2,200,000.00
2 MRA CERVICAL (CAROTIS) RMRACER00002 2,000,000.00
3 MRA CERVICAL WITH CONTRAST (CAROTIS) RMRACER00003 2,700,000.00
4 MRA CRANIAL (SIRKULUS WILLISI) RMRACRA00001 2,000,000.00
MRA CRANIAL WITH CONTRAST (SIRKULUS

5 WILLISI)
RMRACRA00002 2,700,000.00
MRA CRANIAL+CERVICAL (SIRKULUS

6 WILLISI+CAROTIS)
RMRACRA00003 2,520,000.00
7 MRA LOWER EXTREMITY (UNILATERAL) RMRALOW00001 2,200,000.00
MRA LOWER EXTREMITY WITH CONTRAST

8 (UNILATERAL)
RMRALOW00002 4,200,000.00
9 MRA RENALIS RMRAREN00003 1,500,000.00
10 MRA RENALIS WITH CONTRAST RMRAREN00004 2,700,000.00
11 MRA THORACAL RMRATHO00001 2,200,000.00
12 MRA UPPER EXTREMITY (UNILATERAL) RMRAUPP00001 2,200,000.00
MRA UPPER EXTREMITY WITH CONTRAST

13 (UNILATERAL)
RMRAUPP00002 4,200,000.00
14 MRI ANKLE JOINT DEXTRA RMRANKL00001 2,520,000.00
15 MRI ANKLE JOINT DEXTRA WITH CONTRAST RMRANKL00002 3,600,000.00
16 MRI ANKLE JOINT SINISTRA RMRANKL00003 2,520,000.00
17 MRI ANKLE JOINT SINISTRA WITH CONTRAST RMRANKL00004 3,600,000.00
18 MRI BRAIN RMRBRAI00001 2,520,000.00
19 MRI BRAIN + MRA CRANIAL RMRBRAI00004 3,350,000.00

20 MRI BRAIN + MRA CRANIAL WITH CONTRAST RMRBRAI00005 4,500,000.00
21 MRI BRAIN WITH CONTRAST RMRBRAI00002 3,600,000.00
22 MRI BREAST RMRBREA00003 2,520,000.00
23 MRI BREAST WITH CONTRAST RMRBREA00001 3,600,000.00
24 MRI CERVICAL SPINE RMRCERV00001 2,520,000.00
25 MRI CERVICAL SPINE WITH CONTRAST RMRCERV00002 3,600,000.00
26 MRI CITO (21.00 - 07.00) RMRCITO00001 240,000.00
27 MRI CUBITI DEXTRA RMRCUBI00001 2,520,000.00
28 MRI CUBITI DEXTRA WITH CONTRAST RMRCUBI00002 3,600,000.00
29 MRI CUBITI SINISTRA RMRCUBI00003 2,520,000.00
30 MRI CUBITI SINISTRA WITH CONTRAST RMRCUBI00004 3,600,000.00
MRI EXTREMITIES LONG BONE (CRURIS

31 DEXTRA)
RMREXTR00005 2,520,000.00

32 DEXTRA) WITH
RMREXTR00006 3,600,000.00

33 SINISTRA)
RMREXTR00007 2,520,000.00

34 SINISTRA) WITH
RMREXTR00008 3,600,000.00
35 MRI EXTREMITIES LONG BONE (FEMUR DEXTRA) RMREXTR00001 2,520,000.00
MRI EXTREMITIES LONG BONE (FEMUR DEXTRA)

36 WITH
RMREXTR00002 3,600,000.00
MRI EXTREMITIES LONG BONE (FEMUR

37 SINISTRA)
RMREXTR00003 2,520,000.00
MRI EXTREMITIES LONG BONE (FEMUR

38 SINISTRA) WITH
RMREXTR00004 3,600,000.00
39 MRI FISTULOGRAPHY RMRIFIS00001 1,680,000.00
40 MRI FISTULOGRAPHY WITH CONTRAST RMRIFIS00002 4,800,000.00
41 MRI GENU DEXTRA RMRGENU00001 2,520,000.00
42 MRI GENU DEXTRA WITH CONTRAST RMRGENU00002 3,600,000.00
43 MRI GENU SINISTRA RMRGENU00003 2,520,000.00
44 MRI GENU SINISTRA WITH CONTRAST RMRGENU00004 3,600,000.00
45 MRI HIP JOINT RMRHIPJ00001 2,520,000.00
MRI KEPALA + KONTRAS / MRI LIDAH +

46 CONTRAST
RMRKEPA00004 3,600,000.00
MRI KEPALA + KONTRAS / MRI PAROTIS +

47 CONTRAST
RMRKEPA00002 3,600,000.00
48 MRI KEPALA / MRI LIDAH RMRKEPA00003 2,520,000.00
49 MRI KEPALA / MRI PAROTIS RMRKEPA00001 2,520,000.00
50 MRI LIVER 3 PHASE (WITH CONTRAST) RMRILIV00001 7,200,000.00
51 MRI LOWER ABDOMEN / FISTULOGRAPHY RMRLOWE00001 2,760,000.00
MRI LOWER ABDOMEN / FISTULOGRAPHY WITH

52 CONTRAST
RMRLOWE00003 3,960,000.00
53 MRI LUMBAR SPINE RMRLUMR0001 2,520,000.00
54 MRI LUMBAR SPINE WITH CONTRAST RMRLUMR0002 3,600,000.00
55 MRI LUMBAR+MYELOGRAPHY RMRLUML00001 3,000,000.00
56 MRI MANUS DEXTRA RMRMANU00001 2,520,000.00
57 MRI MANUS DEXTRA WITH CONTRAST RMRMANU00002 3,600,000.00

58 MRI MANUS SINISTRA RMRMANU00003 2,520,000.00
59 MRI MANUS SINISTRA WITH CONTRAST RMRMANU00004 3,600,000.00
60 MRI MINI RMRMINI00001 1,200,000.00
61 MRI MRCP RMRMRCP00001 2,520,000.00
62 MRI MRCP WITH CONTRAST RMRMRCP00002 3,600,000.00
63 MRI NASOPHARNYX RMRNASO00001 2,520,000.00
64 MRI NASOPHARNYX WITH CONTRAST RMRNASO00002 3,600,000.00
65 MRI NECK / MRI LARYNG RMRNECK00001 2,520,000.00
66 MRI NECK / MRI LARYNG WITH CONTRAST RMRNECK00002 3,600,000.00
67 MRI OESOPHAGUS RMROESO00001 2,760,000.00
68 MRI OESOPHAGUS WITH CONTRAST RMROESO00002 3,960,000.00
69 MRI ORBITA RMRORBI00001 2,520,000.00
70 MRI ORBITA WITH CONTRAST RMRORBI00002 3,600,000.00
71 MRI PARANASAL SINUS RMRPARA00001 2,520,000.00
72 MRI PARANASAL SINUS WITH CONTRAST RMRPARA00002 3,600,000.00
73 MRI PEDIS DEXTRA RMRPEDD00002 2,520,000.00
74 MRI PEDIS SINISTRA RMRPEDS00001 2,520,000.00
75 MRI PELVIS RMRPELV00001 2,760,000.00
76 MRI PELVIS WITH CONTRAST RMRPELV00002 3,960,000.00
77 MRI SELLA TURSICA RMRSELL00001 2,520,000.00
78 MRI SELLA TURSICA WITH CONTRAST RMRSELL00002 3,600,000.00
79 MRI SHOULDER JOINT DEXTRA RMRSHOU00001 2,520,000.00
80 MRI SHOULDER JOINT DEXTRA WITH CONTRAST RMRSHOU00002 3,600,000.00
81 MRI SHOULDER JOINT SINISTRA RMRSHOU00003 2,520,000.00
MRI SHOULDER JOINT SINISTRA WITH

82 CONTRAST
RMRSHOU00004 3,600,000.00
83 MRI SUPERFICIAL RMRSUPE00001 2,520,000.00
84 MRI TEMPORAL BONE RMRTEML00001 2,520,000.00
85 MRI TEMPORAL BONE WITH CONTRAST RMRTEML00002 3,600,000.00
86 MRI TEMPORO MANDIBULAR JOINT RMRTEMO00001 2,520,000.00
87 MRI TESTIS RMRTEST00001 2,760,000.00
88 MRI TESTIS WITH CONTRAST RMRTEST00002 3,960,000.00
89 MRI THORACIC SPINE RMRTHOC00001 2,520,000.00
90 MRI THORACIC SPINE WITH CONTRAST RMRTHOC00002 3,600,000.00
91 MRI THORAX RMRTHOX00001 2,520,000.00
92 MRI THORAX WITH CONTRAST RMRTHOX00002 3,600,000.00
93 MRI UPPER ABDOMEN RMRUPPE00001 2,760,000.00
94 MRI UPPER ABDOMEN + MRCP RMRIUPP00001 4,000,000.00
95 MRI UPPER ABDOMEN WITH CONTRAST RMRUPPE00003 3,960,000.00

96 MRI UPPER+LOWER ABDOMEN RMRUPPE00002 4,800,000.00
97 MRI UPPER+LOWER ABDOMEN WITH CONTRAST RMRUPPE00004 5,640,000.00
98 MRI UROGRAPHY RMRURO000001 2,800,000.00
99 MRI WHOLE SPINE RMRSPIN00001 4,800,000.00
100 MRI WHOLE SPINE WITH CONTRAST RMRSPIN00002 6,000,000.00
101 MRI WRIST JOINT DEXTRA RMRWRIS00001 2,520,000.00
102 MRI WRIST JOINT DEXTRA WITH CONTRAST RMRWRIS00002 3,600,000.00
103 MRI WRIST JOINT SINISTRA RMRWRIS00003 2,520,000.00
104 MRI WRIST JOINT SINISTRA WITH CONTRAST RMRWRIS00004 3,600,000.00
105 MRS BRAIN RMRBRAI00003 4,800,000.00
106 MRS BREAST RMRBREA00002 5,400,000.00
107 MRV CRANIAL RMRVCRA00001 1,500,000.00
108 MRV CRANIAL WITH CONTRAST RMRVCRA00002 2,700,000.00
109 MRV LOWER EXTREMITY (UNILATERAL) RMRVLOW00001 2,520,000.00
MRV LOWER EXTREMITY WITH CONTRAST

110 (UNILATERAL)
RMRVLOW00002 4,200,000.00
111 MRV UPPER EXTREMITY (UNILATERAL) RMRVUPP00001 2,520,000.00
MRV UPPER EXTREMITY WITH CONTRAST

112 (UNILATERAL)
RMRVUPP00002 4,200,000.00
IV ULTRASONOGRAPHY
1 PROCEDURE USG OPD RUSPROC00001 220,000.00
2 USG APPENDIX RUSAPPE00001 440,000.00
3 USG BREAST RUSBREA00001 430,000.00
4 USG CITO (21.00-07.00) RUSCITO00001 220,000.00
5 USG DOPLER RUSDOPL00001 770,000.00
6 USG DOPLER VASCULAR (1 SISI) RUSDOPL00002 2,000,000.00
7 USG DOPLER VASCULAR (2 SISI) RUSDOPL00003 3,000,000.00
8 USG GUIDED RUSGUID00001 440,000.00
9 USG KIDNEY+BLADDER RUSKIDN00001 550,000.00
10 USG KIDNEY+BLADDER+PROSTAT RUSKIDN00002 825,000.00
11 USG MATA RUSMATA00001 198,000.00
12 USG MUSCULOSKELETAL RUSMUSC00001 1,100,000.00
13 USG NECK / THYROID RUSTHYR00001 440,000.00
14 USG PELVIS (LOWER ABDOMEN) RUSPELV00001 430,000.00
15 USG PELVIS DELIVERY RUSPELV00002 165,000.00
16 USG SUPERFICIAL RUSSUPE00001 440,000.00
17 USG TESTIS RUSTEST00001 770,000.00
18 USG TRANSRECTAL PROSTAT RUSTRAN00001 550,000.00
19 USG UPPER & LOWER ABDOMEN RUSUPPE00001 770,000.00

20 USG UPPER ABDOMEN RUSUPPE00002 500,000.00
V X-RAY
1 GALACTOGRAPHY RXRGALA00001 840,000.00
2 MAMMOGRAPHY RXRMAMM00002 420,000.00
3 MAMMOGRAPHY+USG BREAST RXRMAMM00001 840,000.00
4 X-RAY ABDOMEN 2 POSISI RXRABDO00003 360,000.00
5 X-RAY ABDOMEN 3 POSISI RXRABDO00001 600,000.00
6 X-RAY ANKLE JOINT DEXTRA RXRANKL00001 180,000.00
7 X-RAY ANKLE JOINT SINISTRA RXRANKL00003 180,000.00
8 X-RAY ANTEBRACHI DEXTRA RXRANTE00001 180,000.00
9 X-RAY ANTEBRACHI SINISTRA RXRANTE00003 180,000.00
10 X-RAY APPENDIX RXRAPPE00001 600,000.00
11 X-RAY BA-FOLLOW THROUGH RXRBAFO00001 1,200,000.00
12 X-RAY BABY GRAM RXRBABY00001 540,000.00
13 X-RAY BARIUM MEAL RXRBARI00001 720,000.00
14 X-RAY BNO+IVP RXRBNO000003 1,020,000.00
15 X-RAY BNO/POLOS ABDOMEN RXRBNO000001 180,000.00
16 X-RAY CALCANEUS DEXTRA RXRCALC00001 180,000.00
17 X-RAY CALCANEUS SINISTRA RXRCALC00002 180,000.00
18 X-RAY CERVICAL (AP+LAT+OBLIQUE) RXRCERV00001 300,000.00
19 X-RAY CERVICAL (AP+LATERAL) RXRCERV00003 250,000.00
20 X-RAY CITO ABDOMEN 2 POSISI RXRCABD00003 720,000.00
21 X-RAY CITO ABDOMEN 3 POSISI RXRCABD00001 1,080,000.00
22 X-RAY CITO ANKLE JOINT DEXTRA RXRCANK00001 360,000.00
23 X-RAY CITO ANKLE JOINT SINISTRA RXRCANK00002 360,000.00
24 X-RAY CITO ANTEBRACHI DEXTRA RXRCANT00001 360,000.00
25 X-RAY CITO ANTEBRACHI SINISTRA RXRCANT00002 360,000.00
26 X-RAY CITO BNO/POLOS ABDOMEN RXRCBNO00001 360,000.00
27 X-RAY CITO CALCANEUS DEXTRA RXRCCAL00001 360,000.00
28 X-RAY CITO CALCANEUS SINISTRA RXRCCAL00002 360,000.00
29 X-RAY CITO CERVICAL (AP+LAT+OBLIQUE) RXRCCER00001 504,000.00
30 X-RAY CITO CERVICAL (AP+LATERAL) RXRCCER00002 360,000.00
31 X-RAY CITO CLAVICULA DEXTRA RXRCCLA00002 360,000.00
32 X-RAY CITO CLAVICULA SINISTRA RXRCCLA00001 360,000.00
33 X-RAY CITO COR ANALYSE RXRCCOR00001 480,000.00
34 X-RAY CITO CRURIS DEXTRA RXRCCRU00001 480,000.00
35 X-RAY CITO CRURIS SINISTRA RXRCCRU00002 480,000.00

36 X-RAY CITO CUBITI DEXTRA RXRCCUB00001 360,000.00
37 X-RAY CITO CUBITI SINISTRA RXRCCUB00002 360,000.00
38 X-RAY CITO FEMUR DEXTRA RXRCFEM00001 480,000.00
39 X-RAY CITO FEMUR SINISTRA RXRCFEM00002 480,000.00
40 X-RAY CITO GENU DEXTRA RXRCGEN00001 360,000.00
41 X-RAY CITO GENU SINISTRA RXRCGEN00002 360,000.00
42 X-RAY CITO HIP JOINT DEXTRA (AP+LAT) RXRCHIP00001 660,000.00
43 X-RAY CITO HIP JOINT SINISTRA (AP+LAT) RXRCHIP00002 660,000.00
44 X-RAY CITO HUMERUS DEXTRA RXRCHUM00001 360,000.00
45 X-RAY CITO HUMERUS SINISTRA RXRCHUM00002 360,000.00
46 X-RAY CITO LUMBOSACRAL (AP+LAT+OBLIQUE) RXRCLUM00001 624,000.00
47 X-RAY CITO LUMBOSACRAL (AP+LATERAL) RXRCLUM00002 504,000.00
48 X-RAY CITO MAMMOGRAPHY RXRCMAM00001 840,000.00
49 X-RAY CITO MANDIBULA RXRCMAD00001 420,000.00
50 X-RAY CITO MANUS DEXTRA RXRCMAN00001 360,000.00
51 X-RAY CITO MANUS SINISTRA RXRCMAN00002 360,000.00
52 X-RAY CITO MASTOID DEXTRA RXRCMAS00001 420,000.00
53 X-RAY CITO MASTOID SINISTRA RXRCMAS00002 420,000.00
54 X-RAY CITO OS. NASAL RXRCOSN00001 360,000.00
55 X-RAY CITO PEDIS DEXTRA RXRCPED00001 360,000.00
56 X-RAY CITO PEDIS SINISTRA RXRCPED00002 360,000.00
57 X-RAY CITO PELVIS RXRCPEL00001 360,000.00
58 X-RAY CITO PORTABLE THORAX (PA) RXRCTHOX0001 624,000.00
59 X-RAY CITO PORTABLE THORAX (PA+LATERAL) RXRCTHOX0002 960,000.00
60 X-RAY CITO SHOULDER JOINT DEXTRA RXRCSHO00001 360,000.00
61 X-RAY CITO SHOULDER JOINT SINISTRA RXRCSHO00002 360,000.00
62 X-RAY CITO SINUS SERIES (WATERS+LATERAL) RXRCSIN00001 420,000.00
63 X-RAY CITO SKULL (SCHEDEL) RXRCSKU00001 420,000.00
64 X-RAY CITO TEMPORO MANDIBULAR JOINT RXRCTMJ00001 552,000.00
65 X-RAY CITO THORACAL (AP+LATERAL) RXRCTHO00001 504,000.00
66 X-RAY CITO THORAX (PA) RXRCTHR00001 300,000.00
67 X-RAY CITO THORAX (PA+LAT) RXRCTHR00002 480,000.00
68 X-RAY CITO THORAX FOTO BESAR RXRCTHR00003 360,000.00
69 X-RAY CITO WRIST JOINT DEXTRA RXRCWRI00001 360,000.00
70 X-RAY CITO WRIST JOINT SINISTRA RXRCWRI00002 360,000.00
71 X-RAY CLAVICULA DEXTRA RXRCLAV00002 180,000.00
72 X-RAY CLAVICULA SINISTRA RXRCLAV00001 180,000.00
73 X-RAY COCCYGEAL RXRCOCGEA001 180,000.00

74 X-RAY COLON IN LOOP BARIUM ENEMA RXRCOLO00001 780,000.00
75 X-RAY COR ANALYSE RXRCORA00001 240,000.00
76 X-RAY CRURIS DEXTRA RXRCRUR00001 240,000.00
77 X-RAY CRURIS SINISTRA RXRCRUR00003 240,000.00
78 X-RAY CUBITI DEXTRA RXRCUBI00001 180,000.00
79 X-RAY CUBITI SINISTRA RXRCUBI00003 180,000.00
80 X-RAY CYSTOGRAPHY (BLASS CONTRAST) RXRCYST00001 1,200,000.00
81 X-RAY FEMUR DEXTRA RXRFEMU00001 240,000.00
82 X-RAY FEMUR SINISTRA RXRFEMU00003 240,000.00
83 X-RAY FISTULOGRAPHY RXRFIST00001 720,000.00
X-RAY GENU DEXTRA (AP BERDIRI

84 +LAT+SKYLINE VIEW)
RXRGENU00006 300,000.00
85 X-RAY GENU DEXTRA (AP BERDIRI+LAT) RXRGENU00008 180,000.00
86 X-RAY GENU DEXTRA (AP+LAT) RXRGENU00001 180,000.00
87 X-RAY GENU SINISTRA (AP BERDIRI+LAT) RXRGENU00007 180,000.00
88 X-RAY GENU SINISTRA (AP+LAT) RXRGENU00003 180,000.00
X-RAY GENU SINISTRA(AP BERDIRI

89 +LAT+SKYLINE
RXRGENU00005 300,000.00
90 X-RAY HIP JOINT DEXTRA (AP+LAT) RXRHIPD00001 300,000.00
91 X-RAY HIP JOINT SINISTRA (AP+LAT) RXRHIPS00002 300,000.00
92 X-RAY HUMERUS DEXTRA RXRHUME00001 180,000.00
93 X-RAY HUMERUS SINISTRA RXRHUME00003 180,000.00
94 X-RAY HYSTEROSALPINGOGRAPH (HSG) RXRHYST00001 1,500,000.00
95 X-RAY LOPOGRAPHY RXRLOPO00001 840,000.00
96 X-RAY LUMBOSACRAL (AP+LAT+OBLIQUE) RXRLUMB00001 420,000.00
97 X-RAY LUMBOSACRAL (AP+LATERAL) RXRLUMB00003 300,000.00
X-RAY LUMBOSACRAL (AP+LATERAL) FOTO

98 BESAR
RXRLUMB00005 360,000.00
99 X-RAY MAAG DUODENUM WITH CONTRAST RXRMAAG00001 1,080,000.00
100 X-RAY MANDIBULA RXRMAND00001 216,000.00
101 X-RAY MANUS DEXTRA RXRMANU00001 180,000.00
102 X-RAY MANUS SINISTRA RXRMANU00003 180,000.00
103 X-RAY MASTOID DEXTRA RXRMAST00001 216,000.00
104 X-RAY MASTOID SINISTRA RXRMAST00002 216,000.00
X-RAY OCLUSAL (RAHANG ATAS & RAHANG

105 BAWAH)
RXROCLU00003 600,000.00
106 X-RAY OCLUSAL (RAHANG ATAS/MAXILLA) RXROCLU00001 280,000.00
X-RAY OCLUSAL (RAHANG

107 BAWAH/MANDIBULLA)
RXROCLU00002 280,000.00
108 X-RAY OESOPHAGUS RXROESO00001 636,000.00
109 X-RAY OS. NASAL RXROSNA00001 180,000.00
110 X-RAY PANORAMIC RXRPANO00001 260,000.00
111 X-RAY PEDIS DEXTRA RXRPEDI00001 180,000.00

112 X-RAY PEDIS SINISTRA RXRPEDI00003 180,000.00
113 X-RAY PELVIS RXRPELV00001 180,000.00
114 X-RAY PORTABLE ABDOMEN 2 POSISI RXRABDO00004 720,000.00
115 X-RAY PORTABLE ABDOMEN 3 POSISI RXRABDO00002 1,080,000.00
116 X-RAY PORTABLE ANKLE JOINT DEXTRA RXRANKL00002 360,000.00
117 X-RAY PORTABLE ANKLE JOINT SINISTRA RXRANKL00004 360,000.00
118 X-RAY PORTABLE ANTEBRACHI DEXTRA RXRANTE00002 360,000.00
119 X-RAY PORTABLE ANTEBRACHI SINISTRA RXRANTE00004 360,000.00
120 X-RAY PORTABLE BNO/POLOS ABDOMEN RXRBNO000002 360,000.00
121 X-RAY PORTABLE CALCANEUS DEXTRA RXRCALC00003 360,000.00
122 X-RAY PORTABLE CALCANEUS SINISTRA RXRCALC00004 360,000.00
X-RAY PORTABLE CERVICAL

123 (AP+LAT+OBLIQUE)
RXRCERV00002 504,000.00
124 X-RAY PORTABLE CERVICAL (AP+LATERAL) RXRCERV00004 360,000.00
125 X-RAY PORTABLE CLAVICULA DEXTRA RXRCLAVP0002 360,000.00
126 X-RAY PORTABLE CLAVICULA SINISTRA RXRCLAVP0001 360,000.00
127 X-RAY PORTABLE COR ANALYSE RXRCOR000001 480,000.00
128 X-RAY PORTABLE CRURIS DEXTRA RXRCRUR00002 480,000.00
129 X-RAY PORTABLE CRURIS SINISTRA RXRCRUR00004 480,000.00
130 X-RAY PORTABLE CUBITI DEXTRA RXRCUBI00002 360,000.00
131 X-RAY PORTABLE CUBITI SINISTRA RXRCUBI00004 360,000.00
132 X-RAY PORTABLE FEMUR DEXTRA RXRFEMU00002 480,000.00
133 X-RAY PORTABLE FEMUR SINISTRA RXRFEMU00004 480,000.00
134 X-RAY PORTABLE GENU DEXTRA (AP+ LAT) RXRGENU00002 360,000.00
135 X-RAY PORTABLE GENU SINISTRA (AP+ LAT) RXRGENU00004 360,000.00
136 X-RAY PORTABLE HUMERUS DEXTRA RXRHUME00002 360,000.00
137 X-RAY PORTABLE HUMERUS SINISTRA RXRHUME00004 360,000.00
X-RAY PORTABLE LUMBOSACRAL

138 (AP+LAT+OBLIQUE)
RXRLUMB00002 624,000.00
X-RAY PORTABLE LUMBOSACRAL

139 (AP+LATERAL)
RXRLUMB00004 504,000.00
140 X-RAY PORTABLE MANDIBULA RXRMAND00002 432,000.00
141 X-RAY PORTABLE MANUS DEXTRA RXRMANU00002 360,000.00
142 X-RAY PORTABLE MANUS SINISTRA RXRMANU00004 360,000.00
143 X-RAY PORTABLE MASTOID DEXTRA RXRMAST00003 432,000.00
144 X-RAY PORTABLE MASTOID SINISTRA RXRMAST00004 432,000.00
145 X-RAY PORTABLE OS. NASAL RXROSNA00002 360,000.00
146 X-RAY PORTABLE PEDIS DEXTRA RXRPEDI00002 360,000.00
147 X-RAY PORTABLE PEDIS SINISTRA RXRPEDI00004 360,000.00
148 X-RAY PORTABLE PELVIS RXRPELV00002 360,000.00
149 X-RAY PORTABLE SHOULDER JOINT DEXTRA RXRSHOU00003 360,000.00

150 X-RAY PORTABLE SHOULDER JOINT SINISTRA RXRSHOU00004 360,000.00
X-RAY PORTABLE SINUS SERIES

151 (WATERS+LATERAL)
RXRSINU00002 432,000.00
152 X-RAY PORTABLE SKULL (SCHEDEL) RXRSKUL00002 432,000.00
X-RAY PORTABLE TEMPORO MANDIBULAR

153 JOINT
RXRTEMP00002 552,000.00
154 X-RAY PORTABLE THORACAL (AP+LATERAL) RXRTHOL00001 504,000.00
155 X-RAY PORTABLE THORAX (PA) RXRTHOX00002 312,000.00
156 X-RAY PORTABLE THORAX (PA+LATERAL) RXRTHOX00004 480,000.00
157 X-RAY PORTABLE WRIST DEXTRA RXRWRIS00001 360,000.00
158 X-RAY PORTABLE WRIST SINISTRA RXRWRIS00004 360,000.00
159 X-RAY RETROGRADEPYELOGRAPHY (RPG) RXTRETRO00001 900,000.00
160 X-RAY SCOLIOSIS PROGRAM RXRSCOL00001 780,000.00
161 X-RAY SHOULDER JOINT DEXTRA RXRSHOU00001 200,000.00
162 X-RAY SHOULDER JOINT SINISTRA RXRSHOU00002 200,000.00
163 X-RAY SIALOGRAPHY RXRSIAL00001 660,000.00
164 X-RAY SINUS SERIES (WATERS+LATERAL) RXRSINU00001 216,000.00
165 X-RAY SKULL (SCHEDEL) RXRSKUL00001 216,000.00
166 X-RAY T-TUBE CHOLANGIOGRAPHY RXRTTUB00001 840,000.00
167 X-RAY TEMPORO MANDIBULAR JOINT RXRTEMP00001 276,000.00
168 X-RAY THORACAL (AP+LATERAL) RXRTHOC00001 300,000.00
169 X-RAY THORACAL (AP+LATERAL) FOTO BESAR RXRTHOC00002 400,000.00
170 X-RAY THORAX (PA) RXRTHOX00001 160,000.00
171 X-RAY THORAX (PA+LAT) RXRTHOX00003 300,000.00
172 X-RAY THORAX FOTO BESAR RXRTHOX00005 180,000.00
173 X-RAY THORAX LORDOSIS RXRTHOX00006 180,000.00
174 X-RAY URETHROCYSTOGRAPHY RXRURET00001 1,440,000.00
175 X-RAY URETHROGRAPHY RXRURET00002 1,008,000.00
176 X-RAY WRIST JOINT DEXTRA RXRWRIS00002 180,000.00
177 X-RAY WRIST JOINT SINISTRA RXRWRIS00003 180,000.00
NB : Harga dapat berubah sewaktu-waktu.

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Tarif Harga RADIOLOGI Murni Teguh

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RADIOLOGY

NO PEMERIKSAAN/TINDAKAN KODE HARGA

2 CT ANGIO CERVICAL RCACERV00001 3,600,000.00

3 CT ANGIO CRANIAL RCACRAN00001 3,600,000.00

4 CT ANGIO LOWER EXTREMITY RCALOWE00002 3,600,000.00

5 CT ANGIO RENALIS RCARENA00001 3,600,000.00

6 CT ANGIO THORAX RCATHOX00001 3,600,000.00

7 CT ANGIO UPPER EXTREMITY RCAUPPE00002 3,600,000.00

8 CT AORTOGRAFI RCAORTO00001 9,000,000.00

9 CT CALCIUM SCORE (HEART) RCSHEAR00001 1,500,000.00

10 CT SCAN ANKLE JOINT DEXTRA RCSANKL00001 1,100,000.00

11 CT SCAN ANKLE JOINT DEXTRA 3D RCSANKL00005 2,160,000.00

CT SCAN ANKLE JOINT DEXTRA WITH

13 CT SCAN ANKLE JOINT SINISTRA RCSANKL00002 1,100,000.00

14 CT SCAN ANKLE JOINT SINISTRA 3D RCSANKL00004 2,160,000.00

CT SCAN ANKLE JOINT SINISTRA WITH

16 CT SCAN APPENDIX RCSAPPE00001 1,500,000.00

17 CT SCAN APPENDIX WITH CONTRAST RCSAPPE00002 2,700,000.00

18 CT SCAN BRAIN PERFUSION RCSBRAI00001 1,680,000.00

19 CT SCAN BRONCHOSCOPY RCSBRONCH001 2,500,000.00

20 CT SCAN CARDIAC (HEART) RCSCARD00001 4,500,000.00

21 CT SCAN CERVICAL RCSCERV00001 1,320,000.00

22 CT SCAN CERVICAL SPINE 3D RCSCERV00002 2,640,000.00

23 CT SCAN CITO (21.00 - 07.00) RCSCITO00001 240,000.00

24 CT SCAN CUBITI DEXTRA WITH CONTRAST RCSCUBI00003 2,000,000.00

25 CT SCAN CUBITI DEXTRA RCSCUBI00001 1,100,000.00

26 CT SCAN CUBITI SINISTRA RCSCUBI00004 1,080,000.00

27 CT SCAN CUBITI SINISTRA WITH CONTRAST RCSCUBI00005 2,000,000.00

28 CT SCAN CUBITI/ELBOW DEXTRA JOINT 3D RCSCUBI00002 1,900,000.00

29 CT SCAN CUBITI/ELBOW SINISTRA JOINT 3D RCSCUBI00006 1,900,000.00

30 CT SCAN DENTAL RCSDENT00001 1,440,000.00

31 CT SCAN DIGITAL PELVIMETRY RCSDIGI00001 1,000,000.00

32 CT SCAN ESOFAGUS RCSESOF00001 2,400,000.00

CT SCAN EXTREMITY LONG BONE (FEMUR,

35 CT SCAN EXTREMITY LONG BONE 3D RCSEXTR00001 2,700,000.00

CT SCAN EXTREMITY LONG BONE WITH

37 CT SCAN GENU DEXTRA RCSGENU00001 1,100,000.00

38 CT SCAN GENU DEXTRA WITH CONTRAST RCSGENU00003 2,040,000.00

39 CT SCAN GENU SINISTRA RCSGENU00004 1,100,000.00

40 CT SCAN GENU SINISTRA WITH CONTRAST RCSGENU00005 2,040,000.00

41 CT SCAN GENU/KNEE DEXTRA 3D RCSGENU00002 2,100,000.00

42 CT SCAN GENU/KNEE SINISTRA 3D RCSGENU00006 2,100,000.00

43 CT SCAN GUIDING BIOPSY RCSGUIDIB001 5,000,000.00

44 CT SCAN HIP JOINT RCSHIP000001 1,680,000.00

45 CT SCAN HIP JOINT 3D RCSHIP000002 3,360,000.00

46 CT SCAN INNER AUDITORY CANAL RCSINNE00001 1,080,000.00

CT SCAN INNER AUDITORY CANAL WITH

48 CT SCAN KEPALA + KONTRAS / CT SCAN LIDAH + RSCKEPA00004 2,100,000.00

CT SCAN KEPALA + KONTRAS / CT SCAN

50 CT SCAN KEPALA / CT SCAN LIDAH RSCKEPA00003 1,100,000.00

51 CT SCAN KEPALA / CT SCAN PAROTIS RSCKEPA00001 1,100,000.00

52 CT SCAN LIVER 3 PHASE (WITH CONTRAST) RCSLIVE00001 4,200,000.00

53 CT SCAN LOWER ABDOMEN RCSLOWE00001 1,680,000.00

54 CT SCAN LOWER ABDOMEN 3D RCSLOWE00002 3,360,000.00

55 CT SCAN LOWER ABDOMEN WITH CONTRAST RCSLOWE00003 2,880,000.00

56 CT SCAN LUMBAL RCSLUMB00001 1,320,000.00

57 CT SCAN LUMBAL SPINE 3D RCSLUMB00002 2,640,000.00

58 CT SCAN LUMBAL WITH CONTRAST RCSLUMB00003 2,520,000.00

59 CT SCAN MANDIBULA RCSMAND00001 1,100,000.00

60 CT SCAN MANDIBULA 3D RCSMAND00002 2,100,000.00

61 CT SCAN MANDIBULA WITH CONTRAST RCSMAND00003 2,100,000.00

62 CT SCAN MANUS DEXTRA RCSMANU00001 1,100,000.00

63 CT SCAN MANUS DEXTRA 3D RCSMANU00002 2,100,000.00

64 CT SCAN MANUS DEXTRA WITH CONTRAST RCSMANU00003 2,100,000.00