TARIF PEMERIKSAAN DI INSTALASI RADIOLOGI PADA RUMAH SAKIT UMUM
DAERAH ADE MUHAMMAD DJOEN SINTANG
Berdasarkan Peraturan Bupati Sintang Nomor 27 Tahun 2015
tentang Tarif Pelayanan Kesehatan
NO |
JENIS PELAYANAN RADIOLOGI |
JASA SARANA |
JASA PELAYANAN |
TARIF/UC |
1. |
Foto Thorax AP |
56,000 |
50,000 |
106,000 |
2. |
Foto Thorax AP/Lat |
112,000 |
90,000 |
202,000 |
3. |
Foto abdomen polos |
58,000 |
50,000 |
108,000 |
4. |
Foto Abdomen 2 posisi |
115,000 |
90,000 |
205,000 |
5. |
Foto Abdomen 3 posisi |
160,000 |
130,000 |
290,000 |
6. |
Foto cranium |
69,000 |
60,000 |
129,000 |
7. |
Sinus Paranasal 3 foto |
83,000 |
80,000 |
163,000 |
8. |
Mastoid 2 foto |
69,000 |
50,000 |
119,000 |
9. |
TMJ |
60,000 |
50,000 |
110,000 |
10. |
TMJ 4 posisi |
110,000 |
100,000 |
210,000 |
11. |
Cervical |
64,000 |
60,000 |
124,000 |
12. |
Cervical 4 posisi |
127,000 |
120,000 |
247,000 |
13. |
Lumbosacral AP/Lat |
115,000 |
90,000 |
205,000 |
14. |
Thoraco Lumbal AP/Lat |
123,000 |
90,000 |
213,000 |
15. |
Vertebrae 4 posisi |
250,000 |
200,000 |
450,000 |
16. |
Pelvis |
58,000 |
50,000 |
108,000 |
17. |
Coxigeus |
64,000 |
60,000 |
124,000 |
18. |
Waters |
64,000 |
50,000 |
114,000 |
19. |
Antebrachii 2 posisi |
88,000 |
50,000 |
138,000 |
20. |
Bone survey |
760,000 |
250,000 |
1,010,000 |
21. |
Scoliosis program |
304,000 |
200,000 |
504,000 |
22. |
Bone age |
64,000 |
50,000 |
114,000 |
23. |
Dental panoramic |
58,000 |
50,000 |
108,000 |
24. |
Dental alveolar |
56,000 |
30,000 |
86,000 |
25. |
USG 4 D |
60,000 |
90,000 |
150,000 |
26. |
BNO IVP |
260,000 |
150,000 |
410,000 |
27. |
Cystogram |
256,000 |
250,000 |
506,000 |
28. |
URETHROCYCTOGRAM |
256,000 |
250,000 |
506,000 |
29. |
Cystogram Bipolar |
348,000 |
250,000 |
598,000 |
30. |
Appendicogram |
200,000 |
150,000 |
350,000 |
31. |
Colon Inloop |
464,000 |
300,000 |
764,000 |
32. |
HSG |
384,000 |
250,000 |
634,000 |
33. |
Fistulografi |
384,000 |
250,000 |
634,000 |
34. |
OMD |
464,000 |
300,000 |
764,000 |
35. |
ERCP |
220,000 |
150,000 |
370,000 |
36. |
Foto clavicula |
64,000 |
50,000 |
114,000 |
37. |
Foto scapula |
64,000 |
50,000 |
114,000 |
38. |
Shoulder joint 2 position |
64,000 |
50,000 |
114,000 |
39. |
Humerus |
88,000 |
50,000 |
138,000 |
40. |
Elbow joint |
64,000 |
50,000 |
114,000 |
41. |
Manus AP/Lat |
64,000 |
50,000 |
114,000 |
42. |
Wrist Joint |
64,000 |
50,000 |
114,000 |
43. |
Femur AP/Lat |
88,000 |
50,000 |
138,000 |
44. |
Cruris AP/Lat |
88,000 |
50,000 |
138,000 |
45. |
Genue AP/Lat |
64,000 |
50,000 |
114,000 |
46. |
Pedis AP/Lat |
64,000 |
50,000 |
114,000 |
47. |
Ankle Joint AP/Lat |
64,000 |
50,000 |
114,000 |
48. |
Esofagram |
290,000 |
250,000 |
540,000 |
49. |
Follw through |
580,000 |
300,000 |
880,000 |
50. |
USG whole Abdomen |
70,000 |
120,000 |
190,000 |
51. |
USG Musculoskeletal |
70,000 |
120,000 |
190,000 |
52. |
USG Obstetri |
70,000 |
120,000 |
190,000 |
53. |
USG Ginekologi |
60,000 |
100,000 |
160,000 |
54. |
USG Upper Abdomen |
60,000 |
100,000 |
160,000 |
55. |
USG Ilower Abdomen |
60,000 |
100,000 |
160,000 |
56. |
USG thyroid |
60,000 |
100,000 |
160,000 |
57. |
USG Colli (non thyroid ) |
60,000 |
100,000 |
160,000 |
58. |
USG Mammae |
60,000 |
100,000 |
160,000 |
59. |
USG Testis |
60,000 |
100,000 |
160,000 |
60. |
USG Kepala |
60,000 |
100,000 |
160,000 |
61. |
USG Thorax |
60,000 |
100,000 |
160,000 |
62. |
USG Soft Tissue |
60,000 |
100,000 |
160,000 |
63. |
USG Doppler |
150,000 |
600,000 |
750,000 |
64. |
Antebrachii 2 posisi |
88,000 |
50,000 |
138,000 |
65. |
USG Ginekologi |
60,000 |
100,000 |
160,000 |