| Layanan | Harga |
|---|---|
| RADIOLOGI KONVENTIONAL NON KONTRAS | |
| THORAX | |
| Thorax AP/PA | Rp 170.000 |
| Thorax AP+Lat | Rp 250.000 |
| Thorax RLD/LLD | Rp 170.000 |
| Thorax Top Lordotik | Rp 170.000 |
| SKULL | |
| Skull AP | Rp 160.000 |
| Skull AP+Lat | Rp 210.000 |
| Waters | Rp 160.000 |
| Mastoid R+L | Rp 270.000 |
| Mandibula | Rp 160.000 |
| TMJ R+L (Open+Mouth) | Rp 210.000 |
| Orbita | Rp 160.000 |
| Sinus Paranassalis | Rp 180.000 |
| LEHER | |
| Cervical AP+Lat | Rp 210.000 |
| Cervical AP+Lat+Oblique R+L | Rp 420.000 |
| Cervical Soft Tissue | Rp 210.000 |
| THORACAL | |
| Thoracal AP+Lat | Rp 400.000 |
| Thoracal AP+Lat+Oblique R+L | Rp 790.000 |
| Thoracolumbal AP+Lat | Rp 400.000 |
| LUMBAL | |
| Lumbosacral AP+Lat | Rp 400.000 |
| Lumbosacral AP+Lat +oblique R+L | Rp 790.000 |
| Lumbal Dinamik (Fleksi + Ekstensi) | Rp 400.000 |
| Scoliosis Program 4 Posisi | Rp 790.000 |
| LONG SPINE | |
| Long spine | Rp 790.000 |
| Bone Survey | Rp 1.500.000 |
| ABDOMEN | |
| Abdomen/BOF | Rp 170.000 |
| Abdomen 2 posisi ( BOF + LLD/RLD) | Rp 340.000 |
| Abdomen 3 posisi | Rp 290.000 |
| Knee chest | Rp 340.000 |
| Babygram | Rp 170.000 |
| Wangenstan Rice ( Atresiani) | Rp 340.000 |
| Pelvis | |
| Pelvis AP | Rp 170.000 |
| Sacral & Cocygeal AP + Lat | Rp 340.000 |
| Pelvis AP + Inlet + Outlet | Rp 510.000 |
| Frogleg | Rp 340.000 |
| Ekstremitas Atas | |
| Shoulder AP | Rp 150.000 |
| Shoulder AP R+L | Rp 180.000 |
| Scapula | Rp 180.000 |
| Clavicula | Rp 180.000 |
| Humerus AP + Lat | Rp 180.000 |
| Humerus AP + Lat R + L | Rp 370.000 |
| Antebrachi AP+ Lat | Rp 180.000 |
| Antebrachi AP+ Lat R + L | Rp 370.000 |
| Wrist Joint AP + Lat | Rp 180.000 |
| Wrist Joint AP + Lat R + L | Rp 370.000 |
| Manus AP + Obl | Rp 180.000 |
| Manus AP + Obl R + L | Rp 370.000 |
| Bone Age | Rp 150.000 |
| Ekstremitas Bawah | |
| Femur AP + Lat | Rp 170.000 |
| Femur AP + Lat R + L | Rp 340.000 |
| Genu AP + Lat | Rp 170.000 |
| Genu AP + Lat R + L | Rp 340.000 |
| Skyline View | Rp 170.000 |
| Skyline view R + L | Rp 340.000 |
| Cruris AP + Lat | Rp 170.000 |
| Cruris AP + Lat R + L | Rp 340.000 |
| Ankle AP + Lat | Rp 170.000 |
| Ankle AP + Lat R + L | Rp 340.000 |
| Mortis view | Rp 170.000 |
| Mortis view R + L | Rp 340.000 |
| Pedis AP + Oblique | Rp 170.000 |
| Pedis AP + Oblique R + L | Rp 340.000 |
| Pedis With Bearing | Rp 170.000 |
| Pedis With Bearing R + L | Rp 340.000 |
| Calcaneus AP + Lat | Rp 170.000 |
| Calcaneus AP + Lat R + L ( 4 posisi) | Rp 340.000 |
| Panoramic | |
| Panoramic | Rp 170.000 |
| Cephalometri | Rp 170.000 |
| Mammografi | |
| Mammografi | Rp 600.000 |
| BMD | |
| BMD ( Bone Mineral Densitometri) | Rp 540.000 |
| RADIOLOGI KONVENTIONAL POST KONTRAS | |
| TRACTUS DIGESTIVUS | |
| Oesofagus | Rp 500.000 |
| OMD ( Oesofagus Maag Duodenum) | Rp 500.000 |
| Barium Follow Through | Rp 590.000 |
| Colon In Loop | Rp 500.000 |
| Lopografi | Rp 590.000 |
| Apendicogram | Rp 500.000 |
| TRACTUS URINARIUS | |
| IVP | Rp 410.000 |
| Uretrografi | Rp 330.000 |
| Uretrocystografi | Rp 330.000 |
| Cystografi | Rp 330.000 |
| APG / RPG | Rp 410.000 |
| Bipolar Voiding Uretrocystografi | Rp 330.000 |
| Genitografi | Rp 410.000 |
| TRACTUS BILIARY | |
| Cholangiografi | Rp 980.000 |
| KEPALA | |
| Dacriografi | Rp 980.000 |
| Sialografi | Rp 980.000 |
| LAIN - LAIN | |
| HSG | Rp 1.200.000 |
| Fistulografi | Rp 500.000 |
| C-Arm per Film | Rp 212.500 |
| Pencetakan tambahan film perlembar | Rp 100.000 |
| Copy CD/DVD | Rp 50.000 |
| Expertise dokter dari RS luar per item Konvensional | Rp 50.000 |
| Expertise dokter dari RS luar per item CT Scan | Rp 150.000 |
| Expertise dokter dari RS luar per item MRI | Rp 250.000 |
| ULTRASONOGRAPHY (USG) | |
| USG Kepala Neonatus | Rp 500.000 |
| USG Mata | Rp 500.000 |
| USG Thyroid | Rp 500.000 |
| USG Leher | Rp 500.000 |
| USG Thorax | Rp 500.000 |
| USG Mammae | Rp 500.000 |
| USG Urologi | Rp 500.000 |
| USG Upper Abdominal | Rp 500.000 |
| USG Lower Abdominal | Rp 500.000 |
| USG Whole Abdominal | Rp 500.000 |
| USG Ginekologis | Rp 500.000 |
| USG Kehamilan | Rp 500.000 |
| USG Muskuloskeletal | Rp 500.000 |
| USG Testis | Rp 500.000 |
| USG Transrectal | Rp 500.000 |
| USG Transvaginal | Rp 500.000 |
| USG Doppler | Rp 620.000 |
| USG Doppler Extremitas Atas 1 Sisi | Rp 620.000 |
| USG Doppler Extremitas Bawah 1 Sisi | Rp 620.000 |
| USG Transcranial Doppler | Rp 620.000 |
| USG Guiding / Marker | Rp 600.000 |
| KEDOKTERAN NUKLIR | |
| Renal Scan dengan Hipuran I 131/Renogram | Rp 1.740.000 |
| Thyroid Uptake dengan I 131 | Rp 1.740.000 |
| RIA Kit | Rp 1.740.000 |
| MRI Non Kontras | |
| MRI BRAIN | |
| MRI Head | Rp 2.340.000 |
| MRI + MRA Brain | Rp 3.130.000 |
| MRI NECK | |
| MRI Nasopharinx | Rp 2.340.000 |
| MRI Larinx | Rp 2.340.000 |
| MRI SPINE | |
| MRI Cervical | Rp 2.340.000 |
| MRI Thoracic | Rp 2.340.000 |
| MRI Lumbal | Rp 2.340.000 |
| MRI Sacral | Rp 2.340.000 |
| MRI Myelography | Rp 2.340.000 |
| MRI Abdomen + Pelvis | |
| MRI Upper Abdomen | Rp 2.340.000 |
| MRI Pelvis | Rp 2.340.000 |
| MRI Abdomen + Pelvis | Rp 4.460.000 |
| MRI Urography | Rp 2.340.000 |
| MRI MUSKULOSKELETAL | |
| MRI Knee Joint | Rp 2.340.000 |
| MRI Ankle | Rp 2.340.000 |
| MRI Shoulder | Rp 2.340.000 |
| MRI Elbow | Rp 2.340.000 |
| MRI Wrist Joint/Fingers | Rp 2.340.000 |
| MRI TMJ | Rp 2.340.000 |
| MRI Hip Joint | Rp 2.340.000 |
| MRI Extermity | Rp 2.340.000 |
| MRI Upper Extermity | Rp 2.340.000 |
| MRI Lower Extermity | Rp 2.340.000 |
| MRCP | Rp 2.340.000 |
| MRI Post Kontras | |
| MRI BRAIN | |
| MRI Head | Rp 4.670.000 |
| MRI + MRA Brain | Rp 5.150.000 |
| MRI NECK | |
| MRI Nasopharinx | Rp 4.670.000 |
| MRI Larinx | Rp 4.670.000 |
| MRI SPINE | |
| MRI Cervical | Rp 4.670.000 |
| MRI Thoracic | Rp 4.670.000 |
| MRI Lumbal | Rp 4.670.000 |
| MRI Sacral | Rp 4.670.000 |
| MRI Myelography | Rp 4.670.000 |
| MRI Abdomen + Pelvis | |
| MRI Upper Abdomen | Rp 4.670.000 |
| MRI Pelvis | Rp 4.670.000 |
| MRI Abdomen + Pelvis | Rp 5.150.000 |
| MRI Urography | Rp 4.670.000 |
| MRI MUSKULOSKELETAL | |
| MRI Knee Joint | Rp 4.670.000 |
| MRI Ankle | Rp 4.670.000 |
| MRI Shoulder | Rp 4.670.000 |
| MRI Elbow | Rp 4.670.000 |
| MRI Wrist Joint/Fingers | Rp 4.670.000 |
| MRI TMJ | Rp 4.670.000 |
| MRI Hip Joint | Rp 4.670.000 |
| MRI Extermity | Rp 4.670.000 |
| MRI Upper Extermity | Rp 5.210.000 |
| MRI Lower Extermity | Rp 4.670.000 |
| MRCP | Rp 4.670.000 |
| CT Scan Non Kontras | |
| CT Kepala | |
| CT Scan Brain | Rp 2.100.000 |
| CT Scan Brain Trauma | Rp 2.100.000 |
| CT Scan Orbita | Rp 2.100.000 |
| CT Head Neck | |
| CT Scan Kepala dan Leher | Rp 2.100.000 |
| CT Scan Nasopharing | Rp 2.100.000 |
| CT Scan Laryng | Rp 2.100.000 |
| CT Scan Thyroid | Rp 2.100.000 |
| CT Scan Sinus Paranasal | Rp 2.100.000 |
| CT Scan Mastoid | Rp 2.100.000 |
| CT Thorax | |
| CT Scan Thorax | Rp 2.400.000 |
| CT Vertebrae | |
| CT Scan Cervical Spine | Rp 3.220.000 |
| CT Scan Thoracal Spine | Rp 3.220.000 |
| CT Scan Lumbal Spine | Rp 3.220.000 |
| CT Scan Long Spine | Rp 5.150.000 |
| CT Abdomen | |
| CT Scan Upper Abdomen | Rp 2.400.000 |
| CT Scan Lower Abdomen | Rp 2.400.000 |
| CT Scan Whole Abdomen | Rp 2.400.000 |
| CT Scan Stonogram | Rp 2.400.000 |
| CT Scan Pelvis | Rp 2.400.000 |
| CT Ekstermitas Atas/Bawah | |
| CT Scan Extremitas Atas | Rp 2.100.000 |
| CT Scan Extremitas Bawah | Rp 2.100.000 |
| Lain- Lain | |
| CT Scan Calcium score | Rp 3.300.000 |
| CT Scan FNAB Guiding | Rp 2.800.000 |
| CT Scan Post Kontras | |
| CT Kepala | |
| CT Scan Brain | Rp 3.150.000 |
| CT Scan Orbita | Rp 3.150.000 |
| CT Head Neck | |
| CT Scan Kepala dan Leher | Rp 3.220.000 |
| CT Scan Nasopharing | Rp 3.150.000 |
| CT Scan Laryng | Rp 3.150.000 |
| CT Scan Sinus Paranasal | Rp 3.150.000 |
| CT Scan Mastoid | Rp 3.150.000 |
| CT Thorax | |
| CT Scan Thorax | Rp 3.500.000 |
| CT Vertebrae | |
| CT Scan Cervical Spine | Rp 3.150.000 |
| CT Scan Thoracal Spine | Rp 3.150.000 |
| CT Scan Lumbal Spine | Rp 3.150.000 |
| CT Abdomen | |
| CT Scan Upper Abdomen | Rp 3.220.000 |
| CT Scan Lower Abdomen | Rp 3.220.000 |
| CT Scan Whole Abdomen | Rp 3.500.000 |
| CT Scan Whole Abdomen Multiphase | Rp 3.800.000 |
| CT Scan Urography | Rp 3.220.000 |
| CT Scan Pelvis Abdomen Bawah | Rp 3.220.000 |
| CT Ekstermitas Atas/Bawah | |
| CT Scan Extremitas Atas | Rp 3.150.000 |
| CT Scan Extremitas Bawah | Rp 3.150.000 |
| CT Vaskuler | |
| CT Scan Angiography Coronary + Calcium score | Rp 5.390.000 |
| CT Scan Angiography kepala | Rp 3.780.000 |
| CT Scan Angiography leher | Rp 3.780.000 |
| CT Scan Angiography upper / lower ekstremitas | Rp 4.410.000 |
| CT Scan Angiography Abdomen | Rp 3.880.000 |
| CT Scan Angiography | Rp 4.410.000 |
| RADIOLOGI INTERVENSIONAL | |
| DSA/Arteriografi/Phlebografi | Rp 10.500.000 |
| Transarterial Chemoinfusion (TACI) | Rp 25.000.000 |
| Transarterial Chemoembolization (TACE) | Rp 29.000.000 |
| TACE dengan beadblock | Rp 38.000.000 |
| Trombolisis/Intraarterial heparin flushing | Rp 32.000.000 |
| Embolisasi dengan PVA | Rp 28.000.000 |
| Coiling sederhana (1 buah) | Rp 35.000.000 |
| Embolisasi dengan spongostan | Rp 19.000.000 |
| Embolisasi dengan glue | Rp 31.000.000 |
| Embolisasi dengan ethylene vinyl alcohol (EVOH + DMSO) (1 | Rp 48.000.000 |
| PTBD+Biliary Stenting | Rp 48.000.000 |
| Percutaneus Transhepatic Billiary Drainage (PTBD) | Rp 19.000.000 |
| Pig Tail Catheter Drainage cairan | Rp 7.000.000 |
| USG guided punksi cairan | Rp 5.000.000 |
| USG guided biopsi | Rp 5.000.000 |
| Radio Frequency Abiation (RFA) | Rp 36.000.000 |
| PTA (percutaneus transluminal angioplasty) | Rp 31.000.000 |
| Central venousplasty | Rp 31.000.000 |
| Embolisasi dengan gold baloon | Rp 68.000.000 |
| Pemasangan Stent (1 buah) | Rp 43.000.000 |
| Venogram/Cathetogram | Rp 10.500.000 |
| Fistulografi AVF | Rp 10.500.000 |
| Skleroterapi | Rp 10.500.000 |
| Embolisasi CCF dengan coil sederhana | Rp 91.130.000 |
| Recanalisasi Tuba | Rp 19.000.000 |
Keterangan :