- 76 -

4 Frozen Section 500,000.00 55,000.00 402,500.00 957,500.00

B. SITOLOGI

5 Pap Sm ear 54,000.00 7,425.00 110,575.00 172,000.00

6 Cairan Sitologi 240,000.00 33,000.00 197,500.00 470,500.00

PENGAMBILAN DAN
C.
PEMERIKSAAN
7 Paps sm ear 54,000.00 7,425.00 154,575.00 216,000.00

8 Biopsi aspirasi organ lu ar 70,000.00 8,250.00 276,250.00 354,500.00

9 Biopsi aspirasi organ dalam 80,000.00 13,750.00 396,250.00 490,000.00

10 Im print 150,000.00 41,250.00 418,750.00 610,000.00

11 IH C/item 400,000.00 27,500.00 242,500.00 670,000.00

o. L ayanan R adiodiagnostik
JASA JASA
NO JENIS PELAYANAN BHP TARIF
SARANA PELAYANAN

1 Abdomen (1 film kecil) 35,000.00 19,800.00 63,700.00 118,500.00

2 Abdomen (2 film besar) 90,000.00 19,800.00 82,700.00 192,500.00

3 Abdomen (2 film kecil) 70,000.00 19,800.00 82,700.00 172,500.00

4 Abdomen (3 film besar) 135,000.00 19,800.00 101,700.00 256,500.00

5 Abdomen (3 film keel) 115,000.00 19,800.00 101,700.00 236,500.00

6 Abdomen) 1 film besar) 45,000.00 19,800.00 63,700.00 128,500.00

7 A ntebrachi dextra (lfllm besar) 42,430.00 19,800.00 82,700.00 144,930.00

8 Antebrachi dextra (lfilm kecil) 35,000.00 19,800.00 82,700.00 137,500.00

Antebrachi sinistra (lfilm 82,700.00 147,500.00
9 45,000.00 19,800.00
besar)
10 Antebrachi sin istra (lfilm kecil) 35,000.00 19,800.00 82,700.00 137,500.00

11 Appendix 3 film besar 226,270.00 19,800.00 101,700.00 347,770.00

12 Appendix 3 film kecil 197,020.00 19,800.00 101,700.00 318,520.00

13 Atresiani ( 2 film kecil) 70,000.00 19,800.00 111,200.00 201,000.00

14 Babygram (1 film besar) 45,000.00 19,800.00 111,200.00 176,000.00

15 B asis Cranii (1 film kecil) 35,000.00 19,800.00 82,700.00 137,500.00

16 BNO (lfilm besar) 45,000.00 19,800.00 63,700.00 128,500.00

17 BNO (lfilm kecil) 35,000.00 19,800.00 63,700.00 118,500.00

BNO-IVP (5 film), 2 film ke 3 158,700.00 370,470.00
18 191,970.00 19,800.00
film besar