6.1 Tarif

60
DAFTAR TARIF PELAYANAN RS UNUD TAHUN 2016 50

110
BULE KITAS BULE TANPA KITAS
Poli Kode Jenis Pemeriksaan Harga Poli Kode Jenis Pemeriksaan Harga Poli Kode Jenis Pemeriksaan Harga
UMUM KIGD1 Karcis 35,000 GENERAL KIGD1K Administration 35,000 GENERAL KIGD1A Administration 70,000
KIGD2 Karcis 18,000 KIGD2K Administration 18,000 KIGD2A Administration 36,000
KPOL1 Karcis Poli 30,000 KPOL1K Administration Polyclinic 30,000 KPOL1A Administration Polyclinic 60,000
KPOL2 Karcis Poli 15,000 KPOL2K Administration Polyclinic 15,000 KPOL2A Administration Polyclinic 30,000
TBWU Test Buta Warna 15,000 TBWUK Test Buta Warna TBWUA Test Buta Warna
PXUM Poli Umum 25,000 PXUMK General Polyclinic 25,000 PXUMA General Polyclinic 50,000
PXSP Pol. Spesialis 50,000 PXSPK Specialist Polyclinic 50,000 PXSPA Specialist Polyclinic 100,000
TMK4A Tindakan Medik Kecil 4A 387,500
SSPO2 Sensor SP O2 60,000 SSPO2K SSPO2A
KNS Konsultasi Dokter 50,000 KNSK Doctor's Consultation 50,000 KNSA Doctor's Consultation 100,000
ekg umum EKGU Eleektrokardiogram 100,000 EKGUK Electrocardiogram 100,000 EKGUA Electrocardiogram 200,000
nebulizer umum NBZU Nebulizer 95,000 NBZUK Nebulizer 95,000 NBZUA Nebulizer 190,000
AFF<5 Aff Heacting < 5 Heacting 35,000 AFFH1K 35,000 AFF<5A Aff Heacting < 5 Heacting 70,000
AFFH2 Aspirasi Hematome < 5 cm 35,000 AFFH2K 35,000 AFFH2A 70,000
BC Balance cairan 35,000 35,000 BCA 70,000
Businasi 35,000 35,000 A 70,000
SLS Selang Sungkup 32,000
INJK Innjeksi 15,000
Cukur Lapangan Operasi 35,000 35,000 A 70,000
Darm bouis 35,000 35,000 A 70,000
HT1 Heacting 1-3 35,000 Heacting 1-3 35,000 HT1A Heacting 1-3 70,000
Injeksi Obat (tidak dihitung jumlah obat) 35,000 35,000 A 70,000
Memberi kompres hangat dingin 35,000 35,000 A 70,000
per JAM + 10.000 O2 Memberi oksigen 35,000 O2K Oxygen 35,000 O2A Oxygen 70,000
OB Observasi < 2 jam 35,000 OBK 35,000 OBA 70,000
OBS2 Observasi 2 jam 46,000 OBS2K 46,000 OBS2A Observation 2 hours 92,000
SPO2 Saturasi Pemasangan O2 50,000
PB Pasang Bidai/Spalk 35,000 PBK 35,000 PBA 70,000
Pasang color brace 35,000 K 35,000 A 70,000
PID Pasang infus dewasa 35,000 PIDK Infus 30,000 PIDA Installation Of Adult Infusion 60,000
Pasang lingkar abdomen 35,000 K 35,000 A 70,000
KTTW Pasang/lepas kateter (wanita) 35,000 KTTWK 35,000 KTTWA 70,000
RT Rectal Toucher 35,000 RTK Rectal Toucher 35,000 RTA Rectal Toucher 70,000
SCT Suction 35,000 SCTK Suction 35,000 SCTA Suction 70,000
Transfusi 35,000 K 35,000 A 70,000
WT Rawat luka kecil 35,000 WTK Wound Care Light 35,000 WTA Wound Care Light 70,000
WTB Rawat luka besar 69,000 WTBK WTBA
AFF>5 Aff Heacting > 5 heacting 46,000 AFF>5K Aff Heacting > 5 heacting 46,000 AFF>5A Aff Heacting > 5 heacting 92,000
EXP Eksplorasi luka tusuk/gigit binatang 46,000 EXPK Exploration stab wound 46,000 Fusg Exploration stab wound 92,000
ECA Ekstraksi corpus allienum 46,000 ECAK 46,000 ECAA 92,000
EKK Ekstraksi kuku 46,000 EKKK 46,000 EKKA Extraction Nails 92,000
HTC3 Heacting 3-6 46,000 HTC3K Heacting 3-6 46,000 HTC3A Heacting 3-6 92,000
LAV Lavement 46,000 LAVK 46,000 LAVA 92,000
PLCL Pasang cateter/lepas (laki-laki) 46,000 PLCLK 46,000 PLCLA 92,000
PEB Pasang Elastic Bandage 46,000 PEBK 46,000 PEBA 92,000
PIA Pasang infus anak/bayi 46,000 PIAK 46,000 PIAA Intravenous Fluid Infusion insert 92,000
PNGT Pasang NGT (decompresi)+nutrisi 46,000 PNGTK 46,000 PNGTA 92,000
RLB<10 Rawat luka bakar sama<10% 46,000 RLB<10K 46,000 RLB<10A 92,000
SGIP Split Gyp 46,000 SGIPK 46,000 SGIPA 92,000
WTLS WT luka sedang 46,000 WTLSK Wound care Medium 46,000 WTLSA Wound care Medium 92,000
Amputasi jari dengan lokal anastesi 69,000 K 69,000 A 138,000
Bulectomy tanpa GA 69,000 K 69,000 A 138,000
HTC7 Heacting luka 7-12 69,000 HTC7K Heacting > 7-12 69,000 HTC7A Heacting > 7-12 138,000
pasang cateter dengan penyulit 69,000 K 69,000 A 138,000
Pasang ransel verban/sling 69,000 K 69,000 A 138,000
Pasang skin traksi 69,000 K 69,000 A 138,000
RLB11 Rawat Luka Bakar 11-20% 69,000 RLB11K 69,000 Frawat luka 138,000
RW Rectal Washing 69,000 RWK Rectal Washing 69,000 RWA Rectal Washing 138,000
WT1 WT luka besar/decubitus/ganggren 69,000 WT1K Wound care Heavy 69,000 WT1A Wound care Heavy 138,000
BGIP Buka Gyp 92,000 BGIPK 92,000 BGIPA Open Gyp 184,000
Dilatasi megacolon pada anak 92,000 K 92,000 A 184,000
Dilatasi preputium pada anak 92,000 K 92,000 A 184,000
Eksplorasi Vulnus Ictum, Morsum Canis 92,000 K 92,000 A 184,000
HTC13 Heacting 13-20 92,000 HTC13K Heacting 13-20 92,000 HTC13A Heacting 13-20 184,000
Jahit Luka pada wajah 92,000 K 92,000 A 184,000
Luka Bakar > 20% 92,000 K 92,000 A 184,000
Pasang NGT + kumbah lambung 92,000 K 92,000 A 184,000
Perawatan Decubitus, diabetic foot 92,000 K 92,000 A 184,000
Perawatan Gangren ok keganasan, colostomy 92,000 K 92,000 A 184,000
PA Pasang Amsling 92,000
Ekstubasi ETT 115,000 K 115,000 A 230,000
HT>20 Heacting >20 115,000 HT>20K Fsurya 115,000 HT>20A Heacting >20 230,000
Pemberian khemotherapi 115,000 K 115,000 A 230,000
RJPO RJP/ Pijat Jantung 115,000 RJPOK 115,000 RJPOA 230,000
Sambung tendon parsial 115,000 K 115,000 A 230,000
Buka WSD 165,000 K 165,000 A 330,000
Eksplorasi/Ekstraksi kuku 165,000 K 165,000 A 330,000
IA Insisi abses 165,000 IAK 165,000 IAA 330,000
Pasang infus umbilical 165,000 K 165,000 A 330,000
Pemasangan skin traksi 165,000 K 165,000 A 330,000
Perawatan luka bakar derajat II < 15% 165,000 K 165,000 A 330,000
Reposisi MT Join 165,000 K 165,000 A 330,000
RJP + DC shock 165,000 K 165,000 A 330,000
Sambung tendon total 165,000 K 165,000 A 330,000
Lumbal fungsi 222,500 K 222,500 A 445,000
PLK Perawatan luka bakar derajat II > 15% 222,500 PLKK 222,500 PLKA 445,000
Perawatan luka terbuka multiple > 5 cm 222,500 K 222,500 A 445,000
Resusitasi cairan 222,500 K 222,500 A 445,000
Visum at repertum 222,500 K 222,500 A 445,000
Vulnus appertum 5-10 jahitan 222,500 K 222,500 A 445,000
Resusitasi bayi aphiksia 280,000 K 280,000 A 560,000
Pungsi cairan sinovial 280,000 K 280,000 A 560,000
Lobuloplasti dg lokal anastesi 280,000 K 280,000 A 560,000
Electro cauter condiloma, veruka 280,000 K 280,000 A 560,000
Pasang CVC 320,000 K 320,000 A 640,000
Dorsumsisi 337,500 K 337,500 A 675,000
Amputasi jari tangan dengan LA 337,500 K 337,500 A 675,000
cystostomy dgn lokal anastesi 395,000 K 395,000 A 790,000
Vena seksi 395,000 K 395,000 A 790,000
Pasang WSD continus 395,000 K 395,000 A 790,000
Reposisi fr. OS nasal+pasang Gyp kupu-kupu 395,000 K 395,000 A 790,000
Gyp Pemasangan Gyp 395,000 GypK Gyp 395,000 GypA Gyp 790,000
Intubasi ETT 395,000 K 395,000 A 790,000
Ekstraksi-eksplorasi corpus aleanum dg LA 395,000 K 395,000 A 790,000
SYR Syrnge pump/30 menit 62,500 62,500 125,000
ELD ELEKTRODA 30,000 ELDK ELDA
PJ Perawatan Jenazah 175,000 PJK PJA
RANAP KMR Kamar 300,000 KMRK Room 300,000 KMRA Room 600,000
VST Visite Dokter 100,000 VSTK Doctor Visite 100,000 VSTA Doctor Visite 200,000
JSP Jasa Perawat 25,000 JSPK Nurse Service 25,000 JSPA Nurse Service 50,000
UGD Biaya UGD - UGDK UGD - UGDA UGD -
INJKM Injeksi IM 10,000 INJKMK Injection IM 10,000 INJKMA Injection IM 20,000
INJKV Injeksi IV 15,000 INJKVK Injection IV 15,000 INJKVA Injection IV 30,000
INJKSC Injeksi SC 15,000 INJKSCK Injection SC 15,000 INJKSCA
INJKIC Injeksi IC 15,000 INJKICK INJKICA
IDB ID Band 3,000 IDBK IDBA
PPT Cek Kehamilan 5,000 PPTK 5,000 PPTA 10,000
GP Gelang pasien 2,000
IP InfusPump 125,000
LINF Lepas Infus 30,000 LINFK Remove the infusion 30,000 LINFA Remove the infusion 60,000
PSINF Pasang infus 35,000 PSINFK PAIRS INFUSION 35,000 PSINFA PAIRS INFUSION 60,000
AFFINF Aff Infus 35,000 AFFINFK AFFINFA
MRP Permintaan pembuatan medical record pasien yg sudah pulang 50,000 MRPK MRPA Medical Report
nebulizer ranap NEBRI Nebulizer 90,000 NEBRIK Nebulizer 45,000 NEBRIA Nebulizer 90,000
EKBED Ekstra bed 25,000 EKBEDK Ekstra bed 25,000 EKBEDA Ekstra bed 50,000
LIA Lepas infus anak/bayi 35,000 LIAK 35,000 LIAA Intravenous Fluid Infusion Remove 70,000
AMBULANCE AMB1 Ambulance (RS Surya Husada Nusa Dua) 250,000 AMB1K Ambulance (RS Surya Husada Nusa Dua) 250,000 AMB1A Ambulance (RS Surya Husada Nusa Dua) 500,000
AMB2 Ambulance (RS kasih Ibu Kedonganan) 250,000 AMB2K Ambulance (RS kasih Ibu Kedonganan) 250,000 AMB2A Ambulance (RS kasih Ibu Kedonganan) 500,000
AMB3 Ambulance (RS BIMC Nusa Dua) 250,000 AMB3K Ambulance (RS BIMC Nusa Dua) 250,000 AMB3A Ambulance (RS BIMC Nusa Dua) 500,000
AMB4 Ambulance (RS Siloam) 300,000 AMB4K Ambulance (RS Siloam) 300,000 AMB4A Ambulance (RS Siloam) 600,000
AMB5 Ambulance (RS BIMC Bay Pas Ngurah Rai) 250,000 AMB5K Ambulance (RS BIMC Bay Pas Ngurah Rai) 250,000 AMB5A Ambulance (RS BIMC Bay Pas Ngurah Rai) 500,000
AMB6 Ambulance (RS Badung/Kapal) 350,000 AMB6K Ambulance (RS Badung/Kapal) 350,000 AMB6A Ambulance (RS Badung/Kapal) 700,000
AMB7 Ambulance (Sanglah) 300,000 AMB7K Ambulance (Sanglah) 300,000 AMB7A Ambulance (Sanglah) 600,000
AMB8 Ambulance (RS Surya husada Denpasar) 300,000 AMB8K Ambulance (RS Surya husada Denpasar) 300,000 AMB8A Ambulance (RS Surya husada Denpasar) 600,000
AMB9 Ambulance (RS Kasih Ibu Denpasar) 300,000 AMB9K Ambulance (RS Kasih Ibu Denpasar) 300,000 AMB9A Ambulance (RS Kasih Ibu Denpasar) 600,000
AMB10 Ambulance (RS Prima Medika) 300,000 AMB10K Ambulance (RS Prima Medika) 300,000 AMB10A Ambulance (RS Prima Medika) 600,000
AMB11 Ambulance (RSAD) 350,000 AMB11K Ambulance (RSAD) 350,000 AMB11A Ambulance (RSAD) 700,000
AMB12 Ambulance (RS Trijata) 350,000 AMB12K Ambulance (RS Trijata) 350,000 AMB12A Ambulance (RS Trijata) 700,000
AMB13 Ambulance (RS Puri raharja) 350,000 AMB13K Ambulance (RS Puri raharja) 350,000 AMB13A Ambulance (RS Puri raharja) 700,000
AMB14 Ambulance (RS Bhakti Rahayu) 350,000 AMB14K Ambulance (RS Bhakti Rahayu) 350,000 AMB14A Ambulance (RS Bhakti Rahayu) 700,000
AMB15 Ambulance (RS Wangaya) 300,000 AMB15K Ambulance (RS Wangaya) 300,000 AMB15A Ambulance (RS Wangaya) 600,000
AMB16 Ambulance (RS Puri Bunda) 350,000 AMB16K Ambulance (RS Puri Bunda) 350,000 AMB16A Ambulance (RS Puri Bunda) 700,000
AMB17 Ambulance (RS Bros) 300,000 AMB17K Ambulance (RS Bros) 300,000 AMB17A Ambulance (RS Bros) 600,000
AMB18 Ambulance (RS Dharma Yadnya) 350,000 AMB18K Ambulance (RS Dharma Yadnya) 350,000 AMB18A Ambulance (RS Dharma Yadnya) 700,000
AMB19 Ambulance (RS Balimed) 350,000 AMB19K Ambulance (RS Balimed) 350,000 AMB19A Ambulance (RS Balimed) 700,000
AMB20 Ambulance (Klinik Utama Bina usada) 350,000 AMB20K Ambulance (Klinik Utama Bina usada) 350,000 AMB20A Ambulance (Klinik Utama Bina usada) 700,000
AMB21 Ambulance (Klinik Petanu) 300,000 AMB21K Ambulance (Klinik Petanu) 300,000 AMB21A Ambulance (Klinik Petanu) 600,000
AMB22 Ambulance (Klinik Utama Dharma Sidhi) 300,000 AMB22K Ambulance (Klinik Utama Dharma Sidhi) 300,000 AMB22A Ambulance (Klinik Utama Dharma Sidhi) 600,000
LABORATORIUM WDL Widal 84,000 WDLK WIDAL 35,000 WDLA Widal 70,000
DLRS Cek darah lengkap RS 51,000 DLRSK Complete Blood Count 51,000 DLRSA Complete Blood Count 102,000
DLC Cek Darah lengkap CAYA 102,300 DLCK DLCA
DLP Cek darah lengkap Prodia 113,300 DLPK DLPA
DLS Cek darah lengkap surya husada 95,000 DLSK Complete Blood Count Surya husada 95,000 DLSA Complete Blood Count Surya husada 190,000
HR Hematologi Rutin 95,000 HRK Complete Blood Count 95,000 HRA Complete Blood Count
SR Lab (serologi) 285,000 SRK Cerologi 285,000 SRA
AU Asam urat 26,000 AUK Uric acid 18,500 AUA Uric acid 37,000
CT Cholesterol total 31,000 CTK Total Cholesterol 20,500 CTA Total Cholesterol 41,000
NTP Natrium Prodia 121,000 NTPK NTPA -
KLP Kalium Prodia 121,000 KLPK KLPA -
CLP Chlorida Prodia 121,000 CLPK CLPA
TA Thoracalis AP 179,850 TAK TAA -
BTA Sputum 82,500 BTAK BTAA -
GP1 Glukosa puasa 23,000 GP1K Fasting glucose 21,000 GP1A Fasting glucose 42,000
GP2 Glukosa 2 jam pp 23,000 GP2K Glucose 2 hours 21,000 GP2A Glucose 2 hours 42,000
GP3 Glukosa tes toleransi 24,000 GP3K Glucose tolerance test 24,000 GP3A Glucose tolerance test 48,000
UL Urine lengkap 23,000 ULK Urine complete 20,000 ULA Urine complete 40,000
CTP Test pack 45,000 CTPK Test pack 45,000 CTPA Test pack 90,000
GDS Glukosa sewaktu 23,000 GDSK Glucose when 21,000 GDSA Glucose when 42,000
GDSC Glukosa sewaktu Caya 36,300 GDSCK GDSCA
GDA Glukosa Acak 23,000
HBSAG HBsAG 75,000 HBSAGK Blood sugar 75,000 HBSAGA Blood sugar 150,000
SGOT SGOT 27,500 SGOTK SGOT 27,500 SGOTA SGOT 55,000
SGPT SGPT 27,500 SGPTK SGPT 27,500 SGPTA SGPT 55,000
SGPTC SGPT CAYA 54,450
SKS Surat Keterangan Sehat 50,000 SKSK Certificate of health 10,000 SKSA Certificate of health 20,000
CGOL Cek golongan darah 18,000 CGOLK Check blood type 18,000 CGOLA Check blood type 36,000
BUNP BUN Prodia 57,200 BUNPK BUNPA
SCP SC Prodia 57,200 SCPK SCPA
BUN BUN 26,000 BUNK BUNA
SC SC 26,000 SCK SCA
SCC SC Caya 56,100 SCCK SCCA
BUNC BUN Caya 56,100 BUNCK BUNCA
BSP Blood Smear Prodia 198,000 BSPK BSPA
AAP Antibody Antitrombosit Prodia 88,000 AAPK AAPA
TTMP Tetes Tebal Tipis Malaria Prodia 104,500 TTMPK TTMPA
USGP Abdomen Kasih Ibu 407,000 USGPK USGPA
SSBS SGOT,SGPT,BUN,SC 112,200 SSBSK SSBSA
UR Ureum 22,000 URK URA
FR Feses rutin 27,000 FRK Feses Routine 27,000 FRA Feses Routine 54,000
IGMP Anti HSV IgM prodia 333,300
IGGP Anti HSV IgG prodia 333,300
AD Anti Dengue 285,000
PGP Pengecatan Gram Prodia 93,500
KP Kultur Prodia 522,500
GPC Glukosa Puasa Caya 36,300
CTC Cholesterol Total Caya 61,050
LDLC LDL Caya 118,000
HDLC HDL Caya 55,550
TGTSC Trigeliserida Caya 58,300
AUC Asam Urat Caya 57,200
FISIOTERAPI FTP Fisioterapi 85,000 FTPK Physiotherapy 85,000 FTPA Physiotherapy 170,000
OBAT OBAT Obat - MDCK Medicine - MDCA Medicine -

VAR Vaksinasi var 200,000 VARK Rabies vaccination 200,000 VARA Rabies vaccination 400,000
AHIV Anti HIV 355,000 355,000 AHIVA 710,000
ATT Tetagram/Anti Tetanus 250,500 ATTA
FC Faeces rutin 19,000 CFK Faeces routine 19,000 FCA Faeces routine 38,000
WTS Rawat luka sedang 46,000 WTSK Wound Care Are 46,000 WTSA Wound Care Are 92,000
PR PROLINE 125,000 PRA
HT1 Heacting sedang 46,000 HT1K 46,000 HT1A HEACTING 92,000
HT2 Heacting ringan 35,000 HT2K 35,000 HT2A 70,000
HEACTING Heacting kuku 46,000 HT3K 46,000 HEACTINGA 92,000
BMHP1 Benang Prolene 2/0 130,000 BMHP1K Prolenen Yarn 2/0 130,000 BMHP1A Prolenen Yarn 2/0 260,000
BMHP6 Poli Gyp 76,500 BMHP6K Poly Gyp 76,500 BMHP6A Poly Gyp 153,000
TTG Tetagam 259,000 TTGK Tetagam 259,000 TTGA Tetagam 518,000
BMHP BMHP Bahan Medis Habis Pakai - BMHPK BMHPK Consumable medical materials BMHPA Consumable medical materials
70,000
50,000
92,000
212,000
BEDAH AFH Aff Heacting < 5 Heacting 35,000 AFHK Aff Heacting < 5 Heacting 35,000 AFHA Aff Heacting < 5 Heacting 70,000
Aspirasi hematome < 5 cm 35,000 K 35,000 A 70,000
Businasi 35,000 K 35,000 A 70,000
Cukur lapangan operasi 35,000 K 35,000 A 70,000
HT1 Heacting 1-3 35,000 HT1K 35,000 HT1A 70,000
PB Pasang bidai/spalk 35,000 PBK 35,000 PBA 70,000
Pasang color brace 35,000 K 35,000 A 70,000
Pasang lingkar abdomen 35,000 K 35,000 A 70,000
Pasang/lepas cateter (wanita) 35,000 K 35,000 A 70,000
PLCA Pasang/lepas cateter (Anak) 30,000
RT Rectal Toucher 35,000 RTK 35,000 RTA 70,000
SCT Suction 35,000 SCTK 35,000 SCTA 70,000
WT dengan luka kecil (1-3 lebar kasa/gaas) 35,000 K 35,000 A 70,000
AFFB Aff Heacting > 5 Heacting 46,000 AFFBK 46,000 AFFBA 92,000
EKSS Eksplorasi luka tusuk/gigit binatang 46,000 EKSSK 46,000 EKSSA EXPLORASI 92,000
Ekstraksi corpus allienum 46,000 K 46,000 A 92,000
KUKU Ekstraksi kuku 46,000 KUKUK 46,000 KUKUA 92,000
Lavement 46,000 K 46,000 A 92,000
Pasang cateter (laki-laki) 46,000 K 46,000 A 92,000
PSB Pasang Elastic Bandage 46,000 PSBK 46,000 PSBA BANDAGE 92,000
Pasang NGT (decompresi)+nutrisi 46,000 K 46,000 A 92,000
Rawat luka bakar sama < 10% 46,000 K 46,000 A 92,000
Split Gyp 46,000 K 46,000 A 92,000
WTLS WT luka sedang (4-6 lebar kasa/gaas) 46,000 WTLSK 46,000 WTLSA 92,000
Amputasi jari dengan lokal anastesi 69,000 K 69,000 A 138,000
Bulectomy tanpa GA 69,000 K 69,000 A 138,000
HT7 Heacting luka 7-12 69,000 HT7K 69,000 HT7A 138,000
Pasang cateter dengan penyulit 69,000 K 69,000 A 138,000
Pasang ransel verban/sling 69,000 K 69,000 A 138,000
Pasang skin traksi 69,000 K 69,000 A 138,000
RLB Rawat Luka Bakar 11-20% 69,000 RLBK Hospital of Wounds 69,000 RLBA Hospital of Wounds 138,000
Rectal Washing 69,000 K 69,000 A 138,000
WTLB WT luka besar/decubitus/ganggren 69,000 WTLBK 69,000 WTLBA 138,000
Pasang NGT + Kumbah Lambung 92,000 K 92,000 A 184,000
LB20 Luka Bakar > 20% 92,000 LB20K 92,000 LB20A 184,000
PDB Perawatan Decubitus, diabetic foot 92,000 PDBK 92,000 PDBA 184,000
Perawatan Gangren ok keganasan, colostomy 92,000 K 92,000 A 184,000
Dilatasi preputium pada anak 92,000 K 92,000 A 184,000
Dilatasi megacolon pada anak 92,000 K 92,000 A 184,000
Eksplorasi Vulnus Ictum, Morsum Canis 92,000 K 92,000 A 184,000
Jahit Luka pada Wajah 92,000 K 92,000 A 184,000
Ekstubasi ETT 115,000 K 115,000 A 230,000
HT20 Heacting > 20 115,000 HT20K 115,000 HT20A 230,000
Pemberian khemotherapi 115,000 K 115,000 A 230,000
Sambung tendon parsial 115,000 K 115,000 A 230,000
Sambung tendon total 165,000 K 165,000 A 330,000
Pemasangan skin traksi 165,000 K 165,000 A 330,000
Perawatan luka bakar derajat II < 15% 165,000 K 165,000 A 330,000
Insisi abses 165,000 K 165,000 A 330,000
Eksplorasi/Ekstraksi kuku 165,000 K 165,000 A 330,000
Buka WSD 165,000 K 165,000 A 330,000
Reposisi MT Joint 165,000 K 165,000 A 330,000
Resusitasi cairan 222,500 K 222,500 A 445,000
Perawatan Luka Bakar derajat II > 15% 222,500 K 222,500 A 445,000
Perawatan Luka terbuka multiple > 5 cm 222,500 K 222,500 A 445,000
Vulnus appertum 5-10 jahitan 222,500 K 222,500 A 445,000
Pungsi cairan sinovial 280,000 K 280,000 A 560,000
Lobuloplasti dg lokal anastesi 280,000 K 280,000 A 560,000
Electro cauter condiloma, veruka 280,000 K 280,000 A 560,000
Pemasangan ransel verban 337,500 K 337,500 A 675,000
Dorsumsisi 337,500 K 337,500 A 675,000
Amputasi jari tangan dg LA 337,500 K 337,500 A 675,000
Cystostomy dgn lokal anastesi 395,000 K 395,000 A 790,000
Vena seksi 395,000 K 395,000 A 790,000
Pasang WSD continus 395,000 K 395,000 A 790,000
Reposisi fr. Os nasal + pasang Gyp kupu-kupu 395,000 K 395,000 A 790,000
GYP Pemasangan Gyp 395,000 GYPK 395,000 GYPA 790,000
Intubasi ETT 395,000 K 395,000 A 790,000
Ekstraksi-eksplorasi corpus aleanum dg LA 395,000 K 395,000 A 790,000
GIGI WIRE 0,12 RA=RB WIRE RA+RB 100,000 WIRE 0,12 RA=RBK 100,000 WIRE 0,12 RA=RBA 200,000
ET Emergency Treatment 50,000 ETK Emergency Treatment 50,000 ETA Emergency Treatment 100,000
MM Perawatan Mumifikasi saraf gigi 50,000 MMK Mummification perwatan dental nerve 50,000 MMA Mummification perwatan dental nerve 100,000
GIC Tumpatan Glass Ionomer Cement 200,000 GICK Glass ionomer fillings Cement 200,000 GICA Glass ionomer fillings Cement 400,000
TC Tumpatan Composite 300,000 TCK Filling Composite 300,000 TCA Filling Composite 600,000
Tumpatan Inlay, Uplay, Onlay 1,000,000 K 1,000,000 A 2,000,000
Fissure sealant per regio 200,000 K 200,000 A 400,000
Preparasi saluran akar 300,000 K 300,000 A 600,000
Sterilisasi saluran akar 150,000 K 150,000 A 300,000
Pengisian saluran akar 450,000 K 450,000 A 900,000
Pemutihan gigi/Bleaching 3,000,000 K 3,000,000 A 6,000,000
Plat pertama 800,000 K 800,000 A 1,600,000
Plat berikutnya 500,000 K 500,000 A 1,000,000
Tambahan expansi/screw 200,000 K 200,000 A 400,000
KNTR Kontrol per kunjungan 100,000 KNTRK 100,000 KNTRA 200,000
Ortho cekat 3,000,000 K 3,000,000 A 6,000,000
Gigi tiruan lengkap RA&RB 6,000,000 K 6,000,000 A 12,000,000
Gigi tiruan sebagian berikutnya 1,000,000 K 1,000,000 A 2,000,000
Tambahan gigi berikutnya 250,000 K 250,000 A 500,000
Perbaikan plat patah/Retak 500,000 K 500,000 A 1,000,000
Relining gigi tiruan lengkap per rahang 750,000 K 750,000 A 1,500,000
Rebasing gigi tiruan lengkap per rahang 1,000,000 K 1,000,000 A 2,000,000
Metal Porcelaine per gigi 2,000,000 K 2,000,000 A 4,000,000
All porcelaine per gigi 4,000,000 K 4,000,000 A 8,000,000
Pemasangan mahkota/ jembatan per gigi 300,000 K 300,000 A 600,000
Mahkota sementara per gigi 400,000 K 400,000 A 800,000
Cerec 3,000,000 K 3,000,000 A 6,000,000
PGT Pencabutan Gigi dg Topical Anastesi 100,000 PGTK Revocation Teeth with Topical Anesthesia 100,000 PGTA Revocation Teeth with Topical Anesthesia 200,000
PGA Pencabutan Gigi permanen dg lokal anastesi 300,000 PGAK tooth extraction with local anastesi 300,000 PGAA tooth extraction with local anastesi 600,000
PGK Pencabutan Gigi kompilasi/ pecah bifurkasi/trifurkasi 850,000 PGKK Dental revocation compilation / broken bifurcation / trifurkasi 850,000 PGKA Dental revocation compilation / broken bifurcation / trifurkasi 1,700,000
Pencabutan gigi dgn open method 1,500,000 K 1,500,000 A 3,000,000
Cabut gigi tertanam/ miring/ impaksi 3,000,000 K 3,000,000 A 6,000,000
Incisi abses intra oral 250,000 K 250,000 A 500,000
Alveolectomy 1,000,000 K 1,000,000 A 2,000,000
SCL Scalling ringan 200,000 SCLK Scalling with one visit 200,000 SCLA Scalling with one visit 400,000
Scalling sedang 300,000 K 300,000 A 600,000
Scalling berat 400,000 K 400,000 A 800,000
CG Curretage gingiva close methode non anastesi 200,000 CGK 200,000 CGA 400,000
Curretage gingiva open methode non anastesi + jahit 750,000 K 750,000 A 1,500,000
Alviolectomy per regio + jahit 1,000,000 K 1,000,000 A 2,000,000
Upperculectomy 1,000,000 K 1,000,000 A 2,000,000
Splinting per rahang 1,500,000 K 1,500,000 A 3,000,000
CGG1 Cabut gigi sulung dg topikal anastesi 50,000 CGG1K Toath extraction tropical 50,000 CGG1A Toath extraction tropical 100,000
CGG2 Cabut gigi sulung dg lokal anestesi 100,000 CGG2K Toath extraction local 100,000 CGG2A Toath extraction local 200,000
Mumifikasi gigi sulung per kunjungan 50,000 K A
Tumpat GIC gigi sulung 100,000 K A
Tumpat composite gigi sulung 200,000 K A
Tumpatan sementara 1 gigi/dg bor 41,000 K Temporary Filling 41,000 A Temporary Filling 82,000
Kuretase 1 gigi 41,000 K Curretage of the tooth 41,000 A Curretage of the tooth 82,000
Buka jahitan 41,000 K Open Suturing 41,000 A Open Suturing 82,000
Ganti Perban 41,000 K 41,000 A 82,000
Ganti drain 41,000 K 41,000 A 82,000
Kontrol tindakan post operatif 41,000 K 41,000 A 82,000
Kontrol protase 41,000 K Control protheses 41,000 A Control protheses 82,000
Lacici intra/ekstra oral 90,000 K 90,000 A 180,000
Buka kawat fiksasi 90,000 K 90,000 A 180,000
Aktvir plat orthodontie 90,000 K 90,000 A 180,000
Tumpatan amalgam 90,000 K amalgam filling 90,000 A amalgam filling 180,000
Tumpatan Silikai 90,000 K Silicate Filling 90,000 A Silicate Filling 180,000
Alveolektomi per gigi 180,000 K Alveolektomy 180,000 A Alveolektomy 360,000
TKF Tricresol Formalin 50,000 TKFK TKFA
Apex Reseksi 1 gigi 180,000 K 180,000 A 360,000
Operculextomi 1 gigi 180,000 K 180,000 A 360,000
Ginggivektomi per gigi 180,000 K 180,000 A 360,000
Frenektomy 180,000 K 180,000 A 360,000
Alveolektomi per gigi 185,000 K 185,000 A 370,000
Ginggivektomi per gigi 185,000 K 185,000 A 370,000
Eksisi epulis per gigi/mucocele 230,000 K 230,000 A 460,000
CHKM CHKm 50,000 CHKMK CHKMA
BHL Kontrol behel 100,000 BHLK BHLA
Fiksasi gigi per regio dg lokal anastesi 230,000 K 230,000 A 460,000
Protese 1 gigi/gigi pertama 275,000 K 275,000 A 550,000
Reposisi gigi per regio 275,000 K 275,000 A 550,000
Odontocctomi Partial Impacted 320,000 K 320,000 A 640,000
Rellining Partial Dentur Per rahang 320,000 K 320,000 A 640,000
BCL BUCAL TUBE 50,000 BCLK 50,000 BCLA 100,000
CGGD Cabut Gigi Dewasa 300,000 CGGDK CGGDA
MTP METAPEX +GIC 200,000 MTPK METAPEX +GIC 200,000 MTPA METAPEX +GIC 400,000
CGG3 Pencabutan gigi dan jahitan 75,000 CGG3K Toath extraction & sewing 75,000 CGG3A Toath extraction & sewing 150,000
CGG4 Pencabutan gigi sulit 60,000 CGG4K Toath extraction difficult 60,000 CGG4A Toath extraction difficult 120,000
CRR Cetak RA Dan Rb 100,000 CRRK CRRA
KNSP Konsultasi Spesialis 100,000 KNSPK KNSPA
GT Gigi Tiruan 750,000 GTK GTA
OBGYN VT Vagina Touce (VT) 35,000 VTK 35,000 VTA Vagina Touce (VT) 70,000
PBD Pemeriksaan Kebidanan 35,000 PBDK 35,000 PBDA 70,000
LT Lakmus test 35,000 LTK 35,000 LTA 70,000
PP Perawatan payudara 35,000 PPK 35,000 PPA 70,000
BOU Bouginasi 35,000 BOUK 35,000 BOUA 70,000
VHY Vulva hygiene 35,000 VHYK 35,000 VHYA 70,000
Surat Keterangan Kelahiran 35,000 K 35,000 A 70,000
Lavement 46,000 K 46,000 A 92,000
PIA Pasang infus bayi/anak 46,000 PIAK 46,000 PIAA 92,000
Dilatasi portio 46,000 K 46,000 A 92,000
Inisiasi menyusui dini 46,000 K 46,000 A 92,000
Perawatan bayi baru lahir 69,000 K 69,000 A 138,000
Obs. Bayi Phatologis 69,000 K 69,000 A 138,000
Pasang NGT + kumbah lambung 92,000 K 92,000 A 184,000
Vaginal swab 92,000 K 92,000 A 184,000
Bongkar pasang pesarium 92,000 K 92,000 A 184,000
Doppler 92,000 K 92,000 A 184,000
PSP IVA/Pap Smear Prodia 200,000
NST 115,000 K 115,000 A 230,000
IUD Pasang/Buka IUD 115,000 IUDK 115,000 IUDA 230,000
Pemberian Citostika 115,000 K 115,000 A 230,000
Foto Terapi 165,000 K 165,000 A 330,000
Pasang infus umbilikus 165,000 K 165,000 A 330,000
Pemakaian inkubator 165,000 K 165,000 A 330,000
Insisi abses 165,000 K 165,000 A 330,000
USGT USG Tranzvarginal 165,000
Insiminasi (infertilitas) 222,500 K 222,500 A 445,000
KBE/KBI 222,500 K 222,500 A 445,000
Kolposkopi + foto 280,000 K 280,000 A 560,000
Biopsi 280,000 K 280,000 A 560,000
Pasang/Buka Susuk KB 337,500 K 337,500 A 675,000
Tumor jinak genetalia (lokal anastesi) 337,500 K 337,500 A 675,000
Hydrotubasi (gynekologi) 337,500 K 337,500 A 675,000
Placenta digital/manual 337,500 K 337,500 A 675,000
Insisi abses bartolini 337,500 K 337,500 A 675,000
USG 4 Dimensi 395,000
Kryo terapi 395,000 K 395,000 A 790,000
Repair vagina, robekan perineum 450,000 K 450,000 A 900,000
kunjungan 1 Imunisasi 47,500
kunjungan 2, dst Imunisasi 32,500
kunjungan 1 KB Suntik (1 bulan) 57,500
kunjungan 2, dst KB Suntik (1 bulan) 42,500
kunjungan 1 KB Suntik (3 bulan) 47,500
kunjungan 2, dst KB Suntik (3 bulan) 32,500
Usg di RS UNUD USG USG 260,000 USGK USG 250,000 USGA USG 500,000
INTERNA Surat Keterangan Sehat Sekolah-Pendidikan 25,000 K 25,000 A 50,000

Surat Keterangan Tidak berpenyakit Menular 25,000 K 25,000 A 50,000
SKKEM Surat Keterangan Kematian 35,000 SKKEMK 35,000 SKKEMA 70,000
PLCW Pasang/lepas cateter wanita 35,000 PLCWK 35,000 PLCWA 70,000
Surat Keterangan untuk Asuransi 46,000 K 46,000 A 92,000
Pasang infus 46,000 K 46,000 A 92,000
O2I Oksigen 46,000
NGT Pasang NGT 46,000 NGTK 46,000 NGTA 92,000
Surat Keterangan Sehat Melamar Kerja 46,000
KLL Pasang/lepas kateter (laki-laki) 46,000 KLLK 46,000 KLLA 92,000
Kumbah Lambung dengan NGT 92,000 K 92,000 A 184,000
NBZI Nebulizer 92,000
Surat Keterangan Sehat ke Luar Negeri 115,000
PEDIATRI/ANAK Imunisasi 35,000 K 35,000 A 70,000

Memberi Oksigen 25,000 K 35,000 A 70,000
Tindik 35,000 K 35,000 A 70,000
Darm Buis 35,000 K 35,000 A 70,000
Merawat Tali Pusat 35,000 K 35,000 A 70,000
Rectal Therapy 35,000 K 35,000 A 70,000
INJKK Injeksi 35,000 INJKKK 35,000 INJKKA 70,000
Mantoux test 46,000 K 46,000 A 92,000
PIA Memasang infus anak 46,000 PIAK 46,000 PIAA 92,000
Memasang infus bayi/konsul 69,000 K 69,000 A 138,000
NBZA Nebulizer 92,000 NBZAK 92,000 NBZAA 184,000
Tes Alergi 115,000 TAK Alergy Test 115,000 TAA Alergy Test 230,000
Resusitasi bayi asphiksia 280,000 K 280,000 A 560,000
THT TT Tampon telinga 35,000 TTK 35,000 TTA 70,000

Parasintesa Telinga 46,000 K 46,000 A 92,000
AEP Aspirasi Efusi Perikondrial 46,000 AEPK 46,000 AEPA 92,000
THT4 Spoeling Telinga 46,000 THT4K 46,000 THT4A Spoeling Ears 92,000
THT5 Ekstraksi c. Alienum Telinga 46,000 THT5K 46,000 THT5A 92,000
Ekstraksi c. Alienum Hidung 46,000 K 46,000 A 92,000
Ekstraksi Cerumen 46,000 K 46,000 A 92,000
Rawat Luka post op Mastoidektomy 46,000 K 46,000 A 92,000
Rawat Luka post op sinus/hidung 46,000 K 46,000 A 92,000
Lepas canula trakheostomy 69,000 K 69,000 A 138,000
Rawat stoma trakheostomy 69,000 K 69,000 A 138,000
Ekstraksi C.Alineum Tenggorok 92,000 K 92,000 A 184,000
Tampon Hidung 92,000 K 92,000 A 184,000
Irigasi sinus maxilaris dg lokal anastesi 115,000 K 115,000 A 230,000
Pemasangan Gromet dg lokal anstesi 165,000 K 165,000 A 330,000
Polipectomy tanpa anastesi umum 165,000 K 165,000 A 330,000
Biopsi tanpa anastesi umum 165,000 K 165,000 A 330,000
Lobuloplasti tanpa anastesi umum 165,000 K 165,000 A 330,000
Incisi Abses Leher tanpa anastesi umum 165,000 K 165,000 A 330,000
Incisi Abses Septum Nasi tanpa anastesi umum 165,000 K 165,000 A 330,000
Incisi Abses Retroaurikuler tanpa anastesi umum 165,000 K 165,000 A 330,000
ELEKTROMEDIK Pemeriksaan OAE 69,000 K 69,000 A 138,000

Pemeriksaan Audiometri 92,000 K 92,000 A 184,000
Pemeriksaan Tympanometri 92,000 K 92,000 A 184,000
Dopller 92,000 K 92,000 A 184,000
NBZE Nebulizer 92,000 NBZEK 92,000 NBZEA 184,000
Blood Warmer 115,000 K 115,000 A 230,000
EKGE EKG 115,000 EKGEK 115,000 EKGEA 230,000
SM Set monitor 115,000 SMK 115,000 SMA 230,000
NST 115,000 K 115,000 A 230,000
SYPE Syringe pump 115,000 SYPEK 115,000 SYPEA 230,000
INFP Infuse pump 115,000 INFPK 125,000 INFPA 250,000
USGT USG Transvaginal 165,000 USGTK 165,000 USGTA 330,000
USGAB USG Abdominal 165,000 USGABK 165,000 USGABA 330,000
EEG 222,500 K 222,500 A 445,000
DC shock 222,500 K 222,500 A 445,000
USG-4D 395,000 K 395,000 A 790,000
MATA Pemeriksaan Visus 35,000 K 35,000 A 70,000

TMS Tono metri Schiotz 35,000 TMSK 35,000 TMSA 70,000
Fluorescin/Midriacyl 35,000 K 35,000 A 70,000
TBW Buta Warna 35,000 TBWK 35,000 TBWA 70,000
Ekstraski Membran/Scrapping 35,000 K 35,000 A 70,000
Slit Lamp 46,000 K 46,000 A 92,000
Autorefraksi dan Refraksi 46,000 K 46,000 A 92,000
EKCO Ekstraksi Corpus Aleanum Conjungtiva 46,000 EKCOK 46,000 EKCOA 92,000
Epilasi 46,000 K 46,000 A 92,000
Funduskopi direk 46,000 K 46,000 A 92,000
Funduskopi Indirek 46,000 K 46,000 A 92,000
Goniskopi 46,000 K 46,000 A 92,000
EKCONE Ekstraksi Corpus Alienum Cornea 92,000 EKCONEK 92,000 EKCONEA 184,000
Anel tes 92,000 K 92,000 A 184,000
Buka Jahitan 92,000 K 92,000 A 184,000
TAM Tonometri Aplansi 92,000 TAMK 92,000 TAMA 184,000
IM Irigasi Mata 115,000 IMK 115,000 IMA 230,000
Buka Jahitan Palpebra (1-3 buah) 115,000 K 115,000 A 230,000
Heacting Luka Palpebra simple (1-3 buah) 165,000 K 165,000 A 330,000
Biometri 165,000 K 165,000 A 330,000
Heacting Luka Palpebra simple (>3buah) 222,500 K 222,500 A 445,000
Heacting Luka Palpebra Full Theckness 280,000 K 280,000 A 560,000
Heacting Konjungtiva 280,000 K 280,000 A 560,000
Ekstraksi Nevus 280,000 K 280,000 A 560,000
Ekstraksi Granuloma 280,000 K 280,000 A 560,000
Tarshoraphi 280,000 K 280,000 A 560,000
Kalazion/Hordeolum Dewasa 280,000 K 280,000 A 560,000
KULIT KELAMIN TMS1 Tindakan Medik Sederhana 1 35,000 Tindakan Medik Sederhana 1 35,000
Incisi abses 46,000 K 46,000 A 92,000
Angkat jahitan 46,000 K 46,000 A 92,000
Injeksi Antihistamin 46,000 K 46,000 A 92,000
Konsultasi Kosmetik 46,000 K 46,000 A 92,000
Injeksi Kenacort 115,000 K 115,000 A 230,000
Injeksi Jerawat 115,000 K 115,000 A 230,000
Eksterpasi Komedo 115,000 K 115,000 A 230,000
Electro couter dg Anastesi topikal ((Millium, Keratosis seboroik, Syringioma) 165,000 K 165,000 A 330,000
Electro couter dg Anastesi topikal (Veruka Vulgaris) 222,500 K 222,500 A 445,000
Biopsi Kulit 222,500 K 222,500 A 445,000
Eksterpasi Tumor Jinak Kulit 222,500 K 222,500 A 445,000
Electrocouter dg Anastesi lokal pada kelamin (Condiloma Acuminta, Cysta Bartholin) 280,000 K 280,000 A 560,000
K 280,000 A 560,000
PSIKIATRI Psikotherapi Edukasi 35,000 K 35,000 A 70,000

Surat Keterangan bebas Narkoba 35,000 K 35,000 A 70,000
Psikotherapy suportif 69,000 K 69,000 A 138,000
Psikotherapy kognitif dan perilaku 115,000 K 115,000 A 230,000
NEUROLOGI Tes Fungsi Luhur 35,000 K 35,000 A 70,000
O2N Memberikan Oksigen 35,000 O2NK 35,000 O2NA 70,000
Pasang infus dewasa 35,000 K 35,000 A 70,000
Pasang NGT (decompresi) + nutrisi 46,000 K 46,000 A 92,000
Pemeriksaan Neuroopthalmology 46,000 K 46,000 A 92,000
Tes Pembauan, Pengecapan 46,000 K 46,000 A 92,000
Fungsi Lumbal 165,000 K 165,000 A 330,000
Injeksi tendon 165,000 K 165,000 A 330,000
Penanganan kejang lama dan syok 165,000 K 165,000 A 330,000
EEG 222,500 K 222,500 A 445,000
RADIOLOGI THA Thorax AP/PA (Anak) 110,000 THAK Thorax AP/PA (Anak) 110,000 THAA Thorax AP/PA (Anak) 220,000
Bone Age 110,000 K Bone Age 110,000 A Bone Age 220,000
Cadwell 110,000 K Cadwell 110,000 A Cadwell 220,000
Mandibula (1 Posisi) 110,000 K Mandibula (1 Posisi) 110,000 A Mandibula (1 Posisi) 220,000
Orbita AP/PA 110,000 K Orbita AP/PA 110,000 A Orbita AP/PA 220,000
OS Nasal 110,000 K OS Nasal 110,000 A OS Nasal 220,000
Rhesee (Foramen Opticum) 110,000 K Rhesee (Foramen Opticum) 110,000 A Rhesee (Foramen Opticum) 220,000
Sella Tursica 110,000 K Sella Tursica 110,000 A Sella Tursica 220,000
BOF (Anak) 120,000 K BOF (Anak) 120,000 A BOF (Anak) 240,000
BG Babygram 120,000 BGK Babygram 120,000 BGA Babygram 240,000
ANF Anfebrachii 150,000 ANFK Anfebrachii 150,000 ANFA Anfebrachii 300,000
Basis Cranii 120,000 K Basis Cranii 120,000 A Basis Cranii 240,000
Clavicula AP 120,000 K Clavicula AP 120,000 A Clavicula AP 240,000
Frog Leg Position Anak 120,000 K Frog Leg Position Anak 120,000 A Frog Leg Position Anak 240,000
Pelvise (Anak) 120,000 K Pelvise (Anak) 120,000 A Pelvise (Anak) 240,000
Skull AP/PA 120,000 K Skull AP/PA 120,000 A Skull AP/PA 240,000
Skull Lateral/Adenoid 120,000 K Skull Lateral/Adenoid 120,000 A Skull Lateral/Adenoid 240,000
THS Thorax (Ukuran Film Sedang) 120,000 THSK Thorax (Ukuran Film Sedang) 120,000 THSA Thorax (Ukuran Film Sedang) 240,000
Towne 120,000 K Towne 120,000 A Towne 240,000
Waters 120,000 K Waters 120,000 A Waters 240,000
APP Ankel AP/LAT 150,000 APPK Ankel AP/LAT 150,000 APPA Ankel AP/LAT 300,000
APPM Ankel AP/LAT/MORTIS 170,000 APPMK Ankel AP/LAT/MORTIS 170,000 APPMA Ankel AP/LAT/MORTIS 340,000
ACAL Artic. Cubiti AP/LAT 150,000 ACALK Artic. Cubiti AP/LAT 150,000 ACALA Artic. Cubiti AP/LAT 300,000
Calcaneus Lat/Tangensial 150,000 K Calcaneus Lat/Tangensial 150,000 A Calcaneus Lat/Tangensial 300,000
Eisler (Mandibula) R/L 150,000 K Eisler (Mandibula) R/L 150,000 A Eisler (Mandibula) R/L 300,000
GNL Genu AP/LAT 150,000 GNLK Genu AP/LAT 150,000 GNLA Genu AP/LAT 300,000
Hip Joint AP/LAT 150,000 K Hip Joint AP/LAT 150,000 A Hip Joint AP/LAT 300,000
MNS Manus AP/Oblique 150,000 MNSK Manus AP/Oblique 150,000 MNSA Manus AP/Oblique 300,000
Mastoid Schuller R + L 150,000 K Mastoid Schuller R + L 150,000 A Mastoid Schuller R + L 300,000
APO Pedis AP/Oblique 150,000 APOK Pedis AP/Oblique 150,000 APOA Pedis AP/Oblique 300,000
Rhese R + L 150,000 K Rhese R + L 150,000 A Rhese R + L 300,000
Scapula 150,000 K Scapula 150,000 A Scapula 300,000
CC Clavi cula 150,000
SHD Shoulder Exo /Endo 150,000 SHDK Shoulder Exo /Endo 150,000 SHDA Shoulder Exo /Endo 300,000
Stenvers R + L 150,000 K Stenvers R + L 150,000 A Stenvers R + L 300,000
Vert. Cervical AP + LAT 150,000 K Vert. Cervical AP + LAT 150,000 A Vert. Cervical AP + LAT 300,000
Vert. TH/LS AP + LAT (Anak) 150,000 K Vert. TH/LS AP + LAT (Anak) 150,000 A Vert. TH/LS AP + LAT (Anak) 300,000
Vert. Coccygeus (Anak) 150,000 K Vert. Coccygeus (Anak) 150,000 A Vert. Coccygeus (Anak) 300,000
WJAP Wrist Joint AP/LAT 150,000 WJAPK Wrist Joint AP/LAT 150,000 WJAPA Wrist Joint AP/LAT 300,000
K film sedang:2, besar: 1 A film sedang:2, besar: 1
Abdomen LLD 130,000 K Abdomen LLD 130,000 A Abdomen LLD 260,000
Abdomen RLD 130,000 K Abdomen RLD 130,000 A Abdomen RLD 260,000
Clavicula Bilateral 130,000 K Clavicula Bilateral 130,000 A Clavicula Bilateral 260,000
Frog Leg Position 130,000 K Frog Leg Position 130,000 A Frog Leg Position 260,000
Pelvis AP (Dewasa) 130,000 K Pelvis AP (Dewasa) 130,000 A Pelvis AP (Dewasa) 260,000
Pelvise Lateral (Dewasa) 130,000 K Pelvise Lateral (Dewasa) 130,000 A Pelvise Lateral (Dewasa) 260,000
Plaon Foto Abdomen (BOF) DWS 130,000 K Plaon Foto Abdomen (BOF) DWS 130,000 A Plaon Foto Abdomen (BOF) DWS 260,000
THAD Thorax AP/PA (Dewasa) 130,000 THADK Thorax AP/PA (Dewasa) 130,000 THADA Thorax AP/PA (Dewasa) 260,000
THL Thorax Lateral 130,000 THLK Thorax Lateral 130,000 THLA Thorax Lateral 260,000
THLLD Thorax LLD 130,000 THLLDK Thorax LLD 130,000 THLLDA Thorax LLD 260,000
THLD Thorax Lordotic 130,000 THLDK Thorax Lordotic 130,000 THLDA Thorax Lordotic 260,000
THRLD Thorax RLD 130,000 THRLDK Thorax RLD 130,000 THRLDA Thorax RLD 260,000
CRS Cruris AP/LAT 170,000 CRSK Cruris AP/LAT 170,000 CRSA Cruris AP/LAT 340,000
FML Femur AP/LAT 170,000 FMLK Femur AP/LAT 170,000 FMLA Femur AP/LAT 340,000
Pelvis AP + LAT (Anak) 170,000 K Pelvis AP + LAT (Anak) 170,000 A Pelvis AP + LAT (Anak) 340,000
THALA Thorax AP + LAT (Anak) 170,000 THALAK Thorax AP + LAT (Anak) 170,000 THALAA Thorax AP + LAT (Anak) 340,000
Vert. Coccygeus 170,000 K Vert. Coccygeus 170,000 A Vert. Coccygeus 340,000
Vert. Lumbosacral AP/LAT 170,000 K Vert. Lumbosacral AP/LAT 170,000 A Vert. Lumbosacral AP/LAT 340,000
Vert. Thoracalis AP/LAT 170,000 K Vert. Thoracalis AP/LAT 170,000 A Vert. Thoracalis AP/LAT 340,000
Vert. Thoracolumbal AP/LAT 170,000 K Vert. Thoracolumbal AP/LAT 170,000 A Vert. Thoracolumbal AP/LAT 340,000
ACAL2 Artic. Cubiti Bilateral 210,000 ACAL2K Artic. Cubiti Bilateral 210,000 ACAL2A Artic. Cubiti Bilateral 420,000
Calcaneus Bilateral 210,000 K Calcaneus Bilateral 210,000 A Calcaneus Bilateral 420,000
GENUD Genu Bilateral 210,000 GENUDK Genu Bilateral 210,000 GENUDA Genu Bilateral 420,000
Humerus Bilateral 210,000 K Humerus Bilateral 210,000 A Humerus Bilateral 420,000
Manus Bilateral 210,000 K Manus Bilateral 210,000 A Manus Bilateral 420,000
Scapula Bilateral 210,000 K Scapula Bilateral 210,000 A Scapula Bilateral 420,000
SHDB Shoulder Bilateral 210,000 SHDBK Shoulder Bilateral 210,000 SHDBA Shoulder Bilateral 420,000
Shoulder EXO /Endo Bilateral 210,000 K Shoulder EXO /Endo Bilateral 210,000 A Shoulder EXO /Endo Bilateral 420,000
TMJ 210,000 K TMJ 210,000 A TMJ 420,000
Vert. Cervical AP/ LAT/OBL 210,000 K Vert. Cervical AP/ LAT/OBL 210,000 A Vert. Cervical AP/ LAT/OBL 420,000
Wrist Joint Bilateral 210,000 K Wrist Joint Bilateral 210,000 A Wrist Joint Bilateral 420,000
Vert. Thoracalis AP/LAT/OBL 250,000 K Vert. Thoracalis AP/LAT/OBL 250,000 A Vert. Thoracalis AP/LAT/OBL 500,000
Vert. Lumboscral AP/LAT/OBL 250,000 K Vert. Lumboscral AP/LAT/OBL 250,000 A Vert. Lumboscral AP/LAT/OBL 500,000
FEMURD Femur Bilateral 250,000 FEMURDK Femur Bilateral 250,000 FEMURDA Femur Bilateral 500,000
Cruris Bilateral 250,000 K Cruris Bilateral 250,000 A Cruris Bilateral 500,000
Scoliosis View 350,000 K Scoliosis View 350,000 A Scoliosis View 700,000
MB Mortise Bilateral 150,000 MBK Mortise Bilateral 150,000 MBA Mortise Bilateral 300,000
AB Ankel Bilateral 210,000 ABK Ankel Bilateral 210,000 ABA Ankel Bilateral 420,000
AKLE Ankle AP/LAT 150,000
USGARSKA USG ABDOMEN RS KASIH IBU 407,000
BCG JASA PEMBERIAN VAKSIN BCG 10,000

ELB ELBOW (D) AP LAT 150,000 ELBK ELBOW (D) AP LAT 150,000
Kode Jenis Pemeriksaan Jenis Pemeriksaan
JAS00477 17 Hidro Cort. Steroid

JAS00478 17 Ketosteroid
JAS00479 17-OH Progesteron (LC-MS/MS)
JAS00480 21 - Hydroxylase Antibody
JAS00481 5-HIAA ()
JAS00482 96 Food Allergy IgE
JAS00483 96 Food Allergy IgG
JAS00484 96 Food Allergy IgG & Ig E
JAS00485 a1-Acid Glycoprotein
JAS00486 a2 -Macroglobulin
JAS00008 Abdomen Kasih Ibu
JAS00009 Abdomen LLD Abdomen LLD
JAS00010 Abdomen RLD Abdomen RLD
JAS00487 ACA IgA
JAS00488 ACA IgG
JAS00489 ACA IgM
JAS00490 Acetylcholine Receptor Antibodies (ACAB)
JAS00491 Acetylcholine Receptor Binding Abs
JAS00492 Acetylcholine Receptor Blocking Abs
JAS00493 Acetylcholine Receptor Modulating Auto Abs
JAS00494 ACID PHOSPHATASE
JAS00495 ACTH (#*)
JAS00496 Activated Protein C Resistance
JAS00497 Adenosine Deaminase (ADA)
JAS00498 Adenovirus Antibody Serum
JAS00499 Adiponektin
JAS00500 Adrenal Total Autoantibodies
JAS00011 Aff Heacting < 5 Heacting Aff Heacting < 5 Heacting
JAS00001 Aff Heacting > 5 heacting Aff Heacting > 5 heacting
JAS00012 Aff Heacting > 5 Heacting
JAS00013 Aff Infus
JAS00501 AFP
JAS00502 AFP
JAS00503 Agarose Gel Electrophoresis
JAS00504 AGREGASI TROMB.(TAT)
JAS00505 Agregasi Trombosit
JAS00506 Agregasi Trombosit
JAS00507 a-HBDH
JAS00014 Aktvir plat orthodontie
JAS00508 ALAR VIEW
JAS00509 Albumin
JAS00510 ALBUMIN
JAS00511 Albumin Urine Kuantitatif (Urine 24 Jam)
JAS00512 Albumin Urine Kuantitatif (Dalam Waktu Tertentu)
JAS00513 Albumin Urine Kuantitatif Sewaktu (Rasio Albumin per Creatinin Urine)
JAS00514 Albumin, Globulin, Protein Total
JAS00515 Aldolase
JAS00516 Aldosteron (*)
JAS00517 Aldosteron Urine (*)
JAS00518 Aldosterone/Plasma Renin Activity Ratio
JAS00519 Alkaline Phosphatase Bone Spesific
JAS00520 Alkohol kuantitatif urine
JAS00521 Alkohol Kuantitatif Whole Blood
JAS00522 Alkohol saliva
JAS00015 All porcelaine per gigi
JAS00523 ALP Isoenzymes
JAS00524 ALPHA AMILASE PANKREATIK
JAS00525 Alpha-fetoprotein Triple Marker Screen 2,5 MoM
JAS00526 Aluminium
JAS00527 Alumunium Serum
JAS00528 Alumunium Urine
JAS00016 Alveolectomy
JAS00017 Alveolektomi per gigi Alveolektomy
JAS00018 Alviolectomy per regio + jahit
JAS00019 Ambulance (Klinik Petanu) Ambulance (Klinik Petanu)
JAS00020 Ambulance (Klinik Utama Bina usada) Ambulance (Klinik Utama Bina
JAS00021 Ambulance (Klinik Utama Dharma Sidhi) Ambulance (Klinik Utama Dhar
JAS00022 Ambulance (RS Badung/Kapal) Ambulance (RS Badung/Kapal)
JAS00023 Ambulance (RS Balimed) Ambulance (RS Balimed)
JAS00024 Ambulance (RS Bhakti Rahayu) Ambulance (RS Bhakti Rahayu
JAS00025 Ambulance (RS BIMC Bay Pas Ngurah Rai) Ambulance (RS BIMC Bay Pas
JAS00026 Ambulance (RS BIMC Nusa Dua) Ambulance (RS BIMC Nusa Du
JAS00027 Ambulance (RS Bros) Ambulance (RS Bros)
JAS00028 Ambulance (RS Dharma Yadnya) Ambulance (RS Dharma Yadny
JAS00029 Ambulance (RS Kasih Ibu Denpasar) Ambulance (RS Kasih Ibu Denp
JAS00030 Ambulance (RS kasih Ibu Kedonganan) Ambulance (RS kasih Ibu Ked
JAS00031 Ambulance (RS Prima Medika) Ambulance (RS Prima Medika)
JAS00032 Ambulance (RS Puri Bunda) Ambulance (RS Puri Bunda)
JAS00033 Ambulance (RS Puri Raharja) Ambulance (RS Puri Raharja)
JAS00034 Ambulance (RS Siloam) Ambulance (RS Siloam)
JAS00035 Ambulance (RS Surya husada Denpasar) Ambulance (RS Surya husada
JAS00036 Ambulance (RS Surya Husada Nusa Dua) Ambulance (RS Surya Husada
JAS00037 Ambulance (RS Trijata) Ambulance (RS Trijata)
JAS00038 Ambulance (RS Wangaya) Ambulance (RS Wangaya)
JAS00039 Ambulance (RSAD) Ambulance (RSAD)
JAS00040 Ambulance (Sanglah) Ambulance (Sanglah)
JAS00529 Amikacin
JAS00530 Amino Acid Plasma With R.Interpretation
JAS00531 Amonia darah
JAS00532 Amphetamin
JAS00533 Amphetamin kualitatif urine
JAS00534 Amphetamin Kuantitatif Serum
JAS00535 Amphetamin Kuantitatif Urine
JAS00536 AMPHETAMINE
JAS00041 Amputasi jari dengan lokal anastesi
JAS00042 Amputasi jari tangan dengan LA
JAS00043 Amputasi jari tangan dg LA
JAS00537 Amylase Pancreatic
JAS00538 Amylase Pancreatic Urine
JAS00539 AMYLASE(Pancreatic)
JAS00540 ANA (IF)
JAS00541 ANA (IF) & ANA Profile
JAS00542 ANA Profile
JAS00543 ANA TEST (IF)
JAS00544 Analisa Batu Empedu
JAS00545 Analisa Batu Ginjal
JAS00546 Analisa DNA 5 Alfa Reductase
JAS00547 Analisa DNA A Chondroplasia
JAS00548 Analisa DNA Gen SRY
JAS00549 Analisa Gas Darah
JAS00550 Analisa Gen P (Anti Viral Tenofovir & Etacafier)
JAS00551 Analisa Kromosom
JAS00552 Analisa Kromosom (Cairan amnion)
JAS00553 Analisa Kromosom DNA Pradder Wili
JAS00554 Analisa Kromosom Jaringan Janin
JAS00555 Analisa Kromosom Philadelphia
JAS00556 Analisa Protein Membran Eritrosit
JAS00557 Analisa Sperma (#)
JAS00558 Analisis DNA SMA
JAS00559 Analisis DNA Thalassemia
JAS00560 Analisis DNA Thalassemia cairan amnion
JAS00561 Analisis Gas Darah
JAS00562 Analisis Hb HPLC
JAS00563 Analyzer
JAS00564 Anaplastic Limpoma Kinase
JAS00565 Androstenedione
JAS00044 Anel tes
JAS00045 Anfebrachii Anfebrachii
JAS00566 Angiotensin (ACE)
JAS00567 Angiotensin II
JAS00046 Angkat jahitan
JAS00568 Anion GAP
JAS00047 Ankel AP/LAT Ankel AP/LAT
JAS00048 Ankel AP/LAT/MORTIS Ankel AP/LAT/MORTIS
JAS00049 Ankel Bilateral Ankel Bilateral
JAS00569 ANKLE D.AP&LAT
JAS00570 ANKLE D.VALGUS VARUS
JAS00571 ANKLE LAT D/S (FCR)
JAS00572 ANKLE S.AP&LAT
JAS00573 ANKLE S.VALGUS VARUS
JAS00574 ANTEBR D.AP&LAT
JAS00575 ANTEBR S.AP&LAT
JAS00576 Anti Chikunguya IgM
JAS00577 Anti Dengue
JAS00578 Anti Dnase B
JAS00579 ANTI Ds DNA
JAS00580 Anti ENA Identification
JAS00581 ANTI HAV Total
JAS00582 ANTI HBc
JAS00583 ANTI HBe
JAS00584 Anti HBs
JAS00585 ANTI HCV
JAS00586 ANTI HIV
JAS00587 Anti HIV 3 Metode
JAS00588 Anti H-Pylori IgM
JAS00589 Anti HSV IgG
JAS00590 Anti HSV IgM
JAS00591 Anti Leptospira IgM
JAS00592 ANTI M.TBC
JAS00593 ANTI M.TBC (ICT TBC)
JAS00594 Anti Mullerian Hormone Assessor
JAS00595 Anti-Amoeba
JAS00596 Anti-b2-Glycoprotein 1
JAS00597 Antibodi Filariasis
JAS00598 Antibodi Leptospira
JAS00599 Antibodi Sperma (#)
JAS00600 Antibody Antitrombosit Prodia
JAS00601 Antibody Trombosit
JAS00602 Anti-CCP IgG
JAS00603 Anti-Chlamydia IgM Total
JAS00604 Anti-Chlamydia pneumonia IgG
JAS00605 Anti-Chlamydia trachomatis IgG
JAS00606 Anti-Chlamydia trachomatis IgM
JAS00607 Anti-CMV IgG
JAS00608 Anti-CMV IgM
JAS00609 Anti-Dengue IgG & IgM
JAS00610 Anti-ds-DNA-NcX
JAS00611 Anti-EBV EA IgA
JAS00612 Anti-EBV EA IgM
JAS00613 Anti-EBV VCA IgA
JAS00614 Anti-GAD
JAS00615 Antigen Filariasis
JAS00616 Anti-H. Pylori IgG
JAS00617 Anti-HAV
JAS00618 Anti-HAV IgM
JAS00619 Anti-HBc
JAS00620 Anti-HBc IgM
JAS00621 Anti-HBe
JAS00622 Anti-HBs pasca vaksinasi
JAS00623 Anti-HCV
JAS00624 Anti-HEV IgG
JAS00625 Anti-HEV IgM
JAS00626 Anti-HIV
JAS00627 Anti-HIV Konfirmasi
JAS00628 Anti-HSV 1 IgG
JAS00629 Anti-HSV 1 IgM
JAS00630 Anti-HSV 2 IgG
JAS00631 Anti-HSV 2 IgM
JAS00632 Anti-Mullerian Hormone (AMH)
JAS00633 Anti-Mycoplasma IgG
JAS00634 Anti-Mycoplasma IgM
JAS00635 Anti-Mycoplasma Pneumoniae IgG
JAS00636 Anti-Parietal Sel
JAS00637 Antiphospholipid Antibody Panel
JAS00638 Anti-Proliferasi Cell Nuclear Antigen
JAS00639 Anti-Rubella IgG
JAS00640 Anti-Rubella IgM
JAS00641 Anti-Salmonella typhi IgM
JAS00642 Anti-Strepto A
JAS00643 Anti-Tiroglobulin
JAS00644 Anti-Toxoplasma IgA
JAS00645 Anti-Toxoplasma IgG
JAS00646 Anti-Toxoplasma IgM
JAS00647 Anti-TPO
JAS00648 AP LUMBAL BMD
JAS00050 Apex Reseksi 1 gigi
JAS00649 APG (ANTEGRADE PYEL)
JAS00650 Apo A1 (*)
JAS00651 Apo B (*)
JAS00652 Apolipoprotein E Genotyping
JAS00653 APPENDICOGRAM (FCR)
JAS00654 APTT
JAS00655 Arginine Vasopressin (AVP, ADH)
JAS00656 Arsenic Urine 24 jam
JAS00657 ARTC.COXAE D.LAT
JAS00658 ARTC.COXAE S.LAT
JAS00659 ARTC.CUB D.AP&LAT
JAS00660 ARTC.CUB S.AP&LAT
JAS00661 ARTC.HUM.D EN&EX ROT
JAS00662 ARTC.HUM.S EN&EX ROT
JAS00051 Artic. Cubiti AP/LAT Artic. Cubiti AP/LAT
JAS00663 Artic. Cubiti Bilateral Artic. Cubiti Bilateral
JAS00664 Asam Folat (*)
JAS00665 Asam Urat
JAS00666 Asam Urat Urine ()
JAS00667 ASO/ASTO (KUANTITATIF)
JAS00052 Aspirasi Efusi Perikondrial
JAS00053 Aspirasi Hematome < 5 cm
JAS00668 Aspirin
JAS00669 ASTO
JAS00670 AT III
JAS00671 AUDIOGRAM
JAS00054 Autorefraksi dan Refraksi
JAS00672 Aviditas Anti-CMV IgG
JAS00673 Aviditas Anti-Toxo IgG
JAS00674 b2-Microglobulin
JAS00055 Babygram Babygram
JAS00675 Badan Inklusi HbH
JAS00056 Bahan Medis Habis Pakai Consumable medical material
JAS00057 Balance Cairan
JAS00676 Barbiturat Kualitatif
JAS00677 Barbiturat Kuantitatif Serum
JAS00678 Barbiturat Kuantitatif Urine
JAS00679 BARBITURATE
JAS00680 Bartonella Henselae IgG Abs
JAS00058 Basis Cranii Basis Cranii
JAS00681 BASIS CRANII
JAS00682 BCLPD (B-Cell Lymphoproliverative Disease)
JAS00683 BCR ABL
JAS00684 BCR-ABL Kualitatif
JAS00059 Benang Prolene 2/0 Prolenen Yarn 2/0
JAS00685 Benzen Metabolite S Phenyl Mercapturic Acid
JAS00686 Benzodiazepin
JAS00687 Benzodiazepin Kualitatif Urine
JAS00688 Benzodiazepine Kuantitatif Serum
JAS00689 Benzodiazepine Kuantitatif Urine
JAS00690 Besi
JAS00691 Beta 2 Microglobulin
JAS00692 b-HCG
JAS00693 B-hCG KUANTITATIF
JAS00064 Biaya UGD UGD
JAS00694 BICARBONAT
JAS00695 Bikarbonat
JAS00696 BILE ACID
JAS00697 BILIRUBIN
JAS00698 Bilirubin Direk
JAS00699 BILIRUBIN INDIREK
JAS00700 Bilirubin Neonatus
JAS00701 Bilirubin Total
JAS00065 Biometri
JAS00702 Biopsi
JAS00703 Biopsi Kulit
JAS00704 Biopsi Tanpa Anastesi Umum
JAS00705 BLAAS FOTO AP.
JAS00706 Blood
JAS00707 BLOOD COMPLETE
JAS00708 BLOOD GROUP + RH
JAS00709 Blood Group and Rhesus
JAS00710 Blood Smear Prodia
JAS00711 Blood Warmer
JAS00066 BOF (Anak) BOF (Anak)
JAS00712 BOF/KUB
JAS00067 Bone Age Bone Age
JAS00068 Bongkar Pasang Pesarium
JAS00713 Bordetella pertusis IgG/IgA Abs
JAS00714 Borellia burgdorferi IgG & IgM-Antbodies
JAS00069 Bouginasi
JAS00715 Brain Natriuretic Peptide (BNP)
JAS00716 BTA (mikroskopik)
JAS00717 BTA 3 kali
JAS00070 BUCAL TUBE
JAS00071 Buka Gyp
JAS00072 Buka Jahitan Open Suturing
JAS00073 Buka Jahitan Palpebra (1-3 buah)
JAS00074 Buka kawat fiksasi
JAS00002 Buka WSD
JAS00075 Buka WSD
JAS00003 Bulectomy tanpa GA
JAS00076 Bulectomy tanpa GA
JAS00718 BUN
JAS00077 Businasi
JAS00078 Buta Warna
JAS00719 C1 Esterase Inhibitor Protein
JAS00720 C3 Komplemen
JAS00721 C4 Komplemen
JAS00722 C5 Complement
JAS00723 CA 125
JAS00724 CA 15-3
JAS00725 Ca 15-3
JAS00726 Ca 19-9
JAS00727 Ca 27.29
JAS00728 Ca 72-4
JAS00729 Ca Ion
JAS00730 CA-125
JAS00079 Cabut Gigi Dewasa
JAS00080 Cabut gigi sulung dg lokal anestesi Toath extraction local
JAS00081 Cabut gigi sulung dg topikal anastesi Toath extraction tropical
JAS00082 Cabut gigi tertanam/ miring/ impaksi
JAS00083 Cadwell Cadwell
JAS00731 Caffein Plasma EDTA
JAS00732 Caffein Plasma Heparin
JAS00733 Caffein Urine
JAS00734 Cairan Tubuh Kultur Resistensi Aerob
JAS00735 CALC.DEX TG&LAT
JAS00736 CALC.SIN TG&LAT
JAS00084 Calcaneus Bilateral Calcaneus Bilateral
JAS00737 CALCANEUS D/S LAT
JAS00085 Calcaneus Lat/Tangensial Calcaneus Lat/Tangensial
JAS00738 Calcitonin
JAS00739 Calcium
JAS00740 Calcium Ion
JAS00741 Calcium Urine
JAS00742 CALD-WELL/CAV.ORB
JAS00743 CALSIUM
JAS00744 CALSIUM (ION)
JAS00745 Camphylobacter Jejuni Total Antibodi
JAS00746 Canabis
JAS00747 CANNABINOID
JAS00748 Cannabis Serum
JAS00749 Capillary Electrophoresis
JAS00750 Carbamazepin
JAS00751 Carotenes, alpha and beta
JAS00752 CARPAL TUNNEL VIEW D
JAS00753 CARPAL TUNNEL VIEW S
JAS00754 Catecholamin Fractionated
JAS00755 Cathecholamine Fractionated (Urine 24 jam)
JAS00756 CAVERNOSOGRAPHY(FCR)
JAS00757 CD 117
JAS00758 CD RADIOLOGI
JAS00759 Cd, Whole Blood
JAS00760 CD133
JAS00761 CD20
JAS00762 CD-4
JAS00763 CD4 - CD8
JAS00764 CEA
JAS00765 Cek Golongan Darah Check blood type
JAS00086 Cek Kehamilan
JAS00766 CEPHALOMETRI (FCR)
JAS00087 Cerec
JAS00767 Ceruloplasmin
JAS00768 CERV I/ODONTOID
JAS00769 CERV. LAT FLEXI
JAS00770 CERV.AP/LAT/OBL D.
JAS00771 CERV.AP/LAT/OBL S.
JAS00772 CERV.AP/LAT/OBL.D/S
JAS00773 CERV.LAT EXTENSI
JAS00774 CERVICAL AP
JAS00775 CERVICAL LAT
JAS00776 CERVICAL OBL D.
JAS00777 CERVICAL OBL S.
JAS00778 CERVICAL OPEN MOUTH
JAS00088 Cetak RA Dan Rb
JAS00779 CHE
JAS00089 CHKm
JAS00780 CHLAMYDIA IgG
JAS00781 CHLAMYDIA IgM
JAS00782 Chlamydia Pneumonie IgG/A/M
JAS00783 Chlamydia Pneumonie IgM
JAS00784 Chlamydia Psittaci IgG & IgM Abs
JAS00785 Chlamydia trachomatis (PCR) (#)
JAS00786 Chlamydia tracomatis PCR Kualitatif Urine
JAS00787 Chlorida
JAS00788 Chlorida Urine
JAS00789 CHOL APO A-1
JAS00790 CHOL APO B
JAS00791 CHOLANGIOGRAFI (FCR)
JAS00792 Cholesterol HDL
JAS00793 Cholesterol LDL Direk
JAS00794 Cholesterol Total
JAS00795 CHOLESTEROL TOTAL (DIHAPUS SAJA INI YAAA)
JAS00796 CHOLINESTERASE / CHE
JAS00797 Chromogranin - A
JAS00798 Circulating Tumor Cell (CTC)
JAS00799 CK
JAS00800 CK-MB
JAS00801 CLAV. DEX. AP.
JAS00802 CLAV. SIN. AP.
JAS00090 Clavi cula
JAS00091 Clavicula AP Clavicula AP
JAS00092 Clavicula Bilateral Clavicula Bilateral
JAS00803 CLINITEST
JAS00804 Clomipramine & Desmethylcclomipramine
JAS00805 Clonazepam
JAS00806 Clostridium difficile (GDH)
JAS00807 Clostridium difficile (Toksin A/B)
JAS00808 CMV DNA Quant PCR
JAS00809 CMV IgG (LCS)
JAS00810 CMV IgM (LCS)
JAS00811 CMV PCR
JAS00812 CMV-DNA (Real Time PCR)
JAS00813 Co, Serum
JAS00814 COCAIN
JAS00815 Coccain Kuantitatif Urine
JAS00816 COCCYGEUS AP.
JAS00817 COCCYGEUS LAT.
JAS00818 Cold Agglutinins
JAS00819 COLON IN LOOP (FCR)
JAS00820 Complement C1q
JAS00821 Complement Component C2
JAS00822 Complement Total (CH50)
JAS00823 COMPLETE BLOOD COUNT
JAS00824 Coombs' Test
JAS00825 Copper Urine/Serum
JAS00826 CoQ10(Ubiquinone)
JAS00827 CORSTUDY (JANTUNG)
JAS00828 CORTISOL
JAS00829 Cortisol free 24 jam urine Ultraquant
JAS00830 Cortisol Free Serum
JAS00831 Cortisol Saliva
JAS00832 Cortisol-free (# o)
JAS00833 COSTAE DEX.AP.
JAS00834 COSTAE DEX.OBL.
JAS00835 COSTAE SIN.AP.
JAS00836 COSTAE SIN.OBL.
JAS00837 Cotinine
JAS00838 COX/HIP&FOREARM D BM
JAS00839 COX/HIP&FOREARM S BM
JAS00840 COXAE DEX AP
JAS00841 COXAE DEX LAT
JAS00842 COXAE SIN
JAS00843 COXAE SIN LAT (FCR)
JAS00844 COXAE/HIP D/S BMD
JAS00845 COXAE/HIP DEXTRA BMD
JAS00846 COXAE/HIP SIN BMD
JAS00847 Coxsackie A Ab Panel Serum
JAS00848 C-PEPTIDE
JAS00849 C-peptide (*)
JAS00850 CPK/CK
JAS00851 CREATININ
JAS00852 CREATININ CLEARANCE
JAS00853 CRP Kualitatif
JAS00854 CRP Kuantitatif
JAS00093 Cruris AP/LAT Cruris AP/LAT
JAS00094 Cruris Bilateral Cruris Bilateral
JAS00855 CRURIS D.AP&LAT
JAS00856 CRURIS S.AP&LAT
JAS00857 Cryptococcus Abs
JAS00858 Cryptococcus Antigen Screen With Refex to Titer
JAS00859 CT SCAN CUBITI
JAS00860 CTx (C-Telopeptide) (*)
JAS00861 CTx/BETA CROSSLAPS
JAS00862 Cu, Serum
JAS00095 Cukur Lapangan Operasi
JAS00096 Curretage gingiva close methode non anastesi
JAS00097 Curretage gingiva open methode non anastesi + jahit
JAS00863 Cyclospora
JAS00864 Cyclosporin Parent
JAS00865 CYFRA 21.1
JAS00866 CYP2C19 - Genotipe *2,*3
JAS00867 Cystatin-C
JAS00868 Cysticercus IgG WB
JAS00869 CYSTOGRAPHY (FCR)
JAS00098 Cystostomy dgn lokal anastesi
JAS00870 CYSTOURETHROGRAPHY
JAS00871 CYTOLOGI ...
JAS00872 CYTOLOGI PLEURA
JAS00873 CYTOLOGI SPUTUM
JAS00874 CYTOLOGI URINE
JAS00875 Darah Kultur Resistensi Aerob
JAS00876 Darah Lengkap
JAS00877 Darah Lengkap Surya Husada Complete Blood Count Surya
JAS00878 Darah Samar
JAS00099 Darm bouis
JAS00100 Darm Buis
JAS00101 DC shock
JAS00879 D-Dimer
JAS00880 Dengue NS1 Antigen
JAS00881 Dengue-RNA (Real Time PCR)
JAS00882 Deoxycortisol 11
JAS00883 Dexametason
JAS00884 DHEA - S
JAS00885 DHT Saliva
JAS00886 Diazepam Serum
JAS00887 Diazepam Urine
JAS00888 Digoxin
JAS00102 Dilatasi megacolon pada anak
JAS00103 Dilatasi portio
JAS00104 Dilatasi preputium pada anak
JAS00889 Diphteri Mikroskopik
JAS00890 DIREK
JAS00891 DMD (Duthenne Muscular Distropin)
JAS00892 DNA Thalasemia
JAS00105 Doppler
JAS00106 Dorsumsisi
JAS00893 DRH Samar/BENSIDIN
JAS00894 EBV - EBNA IgA
JAS00895 EBV-DNA Quantitative
JAS00896 ECG
JAS00897 Echinococcus IgG abs
JAS00898 ECHOCARDIOGRAPHY CLR
JAS00107 EEG
JAS00899 EGF-R
JAS00900 Eipstein Barr Virus PCR
JAS00108 Eisler (Mandibula) R/L Eisler (Mandibula) R/L
JAS00109 EKG Ranap
JAS00110 Eksisi epulis per gigi/mucocele
JAS00111 Eksplorasi luka tusuk/gigit binatang Exploration stab wound
JAS00112 Eksplorasi Vulnus Ictum, Morsum Canis
JAS00113 Eksplorasi/Ekstraksi kuku (Poli Bedah)
JAS00114 Eksterpasi Komedo
JAS00115 Eksterpasi Tumor Jinak Kulit
JAS00116 Ekstra bed Ekstra bed
JAS00117 Ekstraksi c. Alienum Hidung
JAS00118 Ekstraksi c. Alienum Telinga
JAS00119 Ekstraksi C.Alineum Tenggorok
JAS00120 Ekstraksi Cerumen
JAS00121 Ekstraksi Corpus Aleanum Conjungtiva
JAS00122 Ekstraksi Corpus Alienum Cornea
JAS00123 Ekstraksi corpus allienum
JAS00124 Ekstraksi Granuloma
JAS00125 Ekstraksi kuku (POLI LAIN)
JAS00126 Ekstraksi Nevus
JAS00127 Ekstraksi-eksplorasi corpus aleanum dg LA
JAS00128 Ekstraski Membran/Scrapping
JAS00129 Ekstubasi ETT
JAS00130 ELBOW (D) AP LAT ELBOW (D) AP LAT
JAS00131 Electro cauter condiloma, veruka
JAS00132 Electro couter dg Anastesi topikal ((Millium, Keratosis seboroik, Syringioma)
JAS00133 Electro couter dg Anastesi topikal (Veruka Vulgaris)
JAS00134 Electrocouter dg Anastesi lokal pada kelamin (Condiloma Acuminta, Cysta Bartholin)
JAS00135 Elektrokardiogram (INI YANG UNTUK NON RANAP (POLI DLL) Electrocardiogram
JAS00136 ELEKTRODA
JAS00901 Elektroforesa Urine
JAS00902 ELP PROTEIN SERUM
JAS00903 ELP URINE
JAS00137 Emergency Treatment Emergency Treatment
JAS00904 Endomysial Ab Screen (IgA) Reflex to Titer
JAS00905 Endomysial IgA Autoantibodies
JAS00906 Endomysial IgG
JAS00907 Entamoeba histolytica IgG Antibodies
JAS00908 Eosinofil Absolut
JAS00909 Eosinofil Total
JAS00910 Ephinephine Urine 24 hour
JAS00138 Epilasi
JAS00911 Epinephrine Plasma
JAS00912 Epinephrine Urine Random
JAS00913 ER (Estrogen Receptor) - Patologi Anatomi FKUI
JAS00914 Erythropoietin
JAS00915 Erythropoietin (EPO)
JAS00916 Estradiol
JAS00917 Estrogen Metabolite Comprehensive : 2(OH):4(OH):16 (OH) E1
JAS00918 Estrogen Total
JAS00919 Estrone
JAS00920 Ethylene Glycol-Quest
JAS00921 Everolimus
JAS00922 Extractable Nuclear Antigen (ENA) IgG Abd
JAS00923 FAAL HEMOSTASIS WKT PEMBEKUAN (CT)
JAS00924 FAAL HEMOSTASIS WKT PERDARAHAN(BT)
JAS00925 FAAL HEMOSTASIS WKT.PEMBEKUAN(CT)
JAS00926 FAAL HEMOSTASIS WKT.PERDARAHAN(BT)
JAS00927 Factor II Activity, Clotting
JAS00928 Factor V Activity, Clotting
JAS00929 Factor VIII Inhibitor
JAS00930 Factor X Activity Clotting
JAS00931 Factor XI Activity, Clotting
JAS00932 Factor XII Activity, Clotting
JAS00933 Faecal Elastase-1
JAS00934 Faeces Kultur Resistensi Aerob
JAS00935 Faeces Rutin
JAS00936 Faeces Vibrio Kultur Resistensi Aerob
JAS00937 Faecess
JAS00938 Faktor IX
JAS00939 Faktor VIII
JAS00940 Fe, Serum
JAS00941 Fecal Calprotectin
JAS00139 Femur AP/LAT Femur AP/LAT
JAS00140 Femur Bilateral Femur Bilateral
JAS00942 FEMUR D.AP&LAT
JAS00943 FEMUR S.AP&LAT
JAS00944 Ferritin
JAS00945 Fibrinogen
JAS00946 Fibrinogen Degradation Product
JAS00141 Fiksasi gigi per regio dg lokal anastesi
JAS00947 Fish
JAS00948 FISH Kromosom 13,18,21,X,Y
JAS00949 FISH Kromosom 13,21
JAS00950 FISH Kromosom 18,X,Y
JAS00951 Fish Kromosom 21
JAS00952 Fish SRY
JAS00953 Fish X,Y
JAS00142 Fisioterapi Physiotherapy
JAS00143 Fissure sealant per regio
JAS00954 FISTULOGRAPHY (FCR)
JAS00955 FLOATING TEST
JAS00144 Fluorescin/Midriacyl
JAS00956 FOLLOWTROUGH (FCR)
JAS00957 FORE ARM DEX/SIN BMD
JAS00958 FORE ARM DEXSTRA BMD
JAS00959 FORE ARM SIN BMD
JAS00960 Fosfatase Alkali
JAS00961 Fosfor Anorganik
JAS00962 Fosfor Anorganik Urine
JAS00145 Foto Terapi
JAS00963 Fragile X (Molekuler Gen FMR-1)
JAS00964 Fragile X (Sitogenetika)
JAS00965 Free Estriol (uE3) (***)
JAS00966 Free Fatty Acids
JAS00967 Free PSA
JAS00968 FREE T-3 (ECLIA)
JAS00969 FREE T-4 (ECLIA)
JAS00970 FREE T4 Index
JAS00971 Free Testosteron
JAS00972 Free Testosteron Index
JAS00146 Frenektomy
JAS00147 Frog Leg Position Frog Leg Position
JAS00148 Frog Leg Position Anak Frog Leg Position Anak
JAS00973 FROG POSITION
JAS00974 Fruktosamin
JAS00975 FSH
JAS00976 FT3
JAS00977 FT4
JAS00978 Functional Liver Detoxification Profile
JAS00149 Funduskopi direk
JAS00150 Funduskopi Indirek
JAS00151 Fungsi Lumbal
JAS00979 G6PD
JAS00980 G6PD Neonatus
JAS00981 G6PD Neonatus & TSH Neonatus (bundling)
JAS00982 Galactomanan
JAS00983 Gall Kultur Bact/Alert
JAS00984 Gall Kultur Bactec
JAS00985 Gall Kultur Manual
JAS00986 Gall Kultur Resistensi Aerob
JAS00987 Gall Kultur Vitec
JAS00988 Gambaran Darah Tepi
JAS00989 Gambaran Sumsum Tulang
JAS00990 GAMMA GLOBULIN
JAS00991 Gamma GT
JAS00992 Ganglioside GM-1 Antibodies (IgG & IgM)
JAS00993 Ganja Kualitatif
JAS00994 Ganja Kuantitatif Serum
JAS00995 Ganja Kuantitatif Urine
JAS00152 Ganti drain
JAS00153 Ganti Perban
JAS00996 Gastrin
JAS00154 Gelang pasien
JAS00997 Genotipe Fenotipe Sel Darah Merah
JAS00155 Genu AP/LAT Genu AP/LAT
JAS00156 Genu Bilateral Genu Bilateral
JAS00998 GENU DEX AP&LAT
JAS00999 GENU SIN AP&LAT
JAS01000 GENU VALGUS STRESS
JAS01001 GENUDEX/SIN AP
JAS01002 GENUVALRUS STRESS
JAS01003 Giardia Lambia IgG/M/A
JAS00157 Gigi Tiruan
JAS00158 Gigi tiruan lengkap RA&RB
JAS00159 Gigi tiruan sebagian berikutnya
JAS00160 Ginggivektomi per gigi
JAS01004 GLDH
JAS01005 Gliadin (Deamidated Peptide) Antibody IgG
JAS01006 Globulin (saja)
JAS01007 GLOBULIN ^ (disertai px TP dan Albumin)
JAS01008 Glomerular Basement Membrane IgG Autoantibodies
JAS01009 Glucagon
JAS01010 Glukosa (Analisa CSF)
JAS01011 Glukosa 2 Jam PP
JAS01012 Glukosa Acak
JAS01013 Glukosa Puasa
JAS01014 Glukosa Sewaktu
JAS01015 Glukosa tes toleransi Glucose tolerance test
JAS01016 GLUKOSA-URINE
JAS01017 Glycated Albumin
JAS01018 GO (Mikroskopik)
JAS01019 GO Kultur Resistensi Aerob
JAS01020 GOL.DARAH ABO
JAS01021 GOLONGAN DARAH (ABO+RH)
JAS01022 Golongan Darah A,B,O dan Rh (Eldoncard)
JAS01023 Golongan Darah A,B,O dan Rh (Non Eldoncard)
JAS00161 Goniskopi
JAS01024 GOT
JAS01025 GPT
JAS01026 Growth Hormon Basal
JAS01027 Growth Hormon Exerc.
JAS01028 Growth Hormone
JAS01029 GTT (TES TOLERANSI)
JAS01030 H.S.G (FCR)
JAS01031 Haemophilus Influenzae B IgG Abs
JAS01032 Haemophilus Influenzae Type B AG Detection
JAS01033 Haptoglobin
JAS01034 HAPUSAN DARAH TEPI
JAS01035 HB El p.
JAS01036 HBA1c
JAS01037 HbA1c (A1c)
JAS01038 HBDH
JAS01039 HBeAg
JAS01040 HbF
JAS01041 HBsAg
JAS01042 HBsAG Blood sugar
JAS01043 HBsAg Konfirmasi
JAS01044 HBsAg Kuantitatif
JAS01045 HBV DNA Genotipe
JAS01046 HBV DNA KUALITATIF
JAS01047 HBV DNA KUANTITATIF (REAL TIME - PCR)
JAS01048 HBV-DNA (Real Time PCR)
JAS01049 HCV Genotipe (Sequencing) (***)
JAS01050 HCV RNA KUALITATIF
JAS01051 HCV RNA KUANTITATIF (REAL TIME - PCR)
JAS01052 HCV RNA TYPING
JAS01053 HCV Viral Load
JAS01054 HCV-RNA (Real Time PCR)
JAS01055 HCV-RNA (Real Time PCR) & HCV Genotipe
JAS01056 HDL CHOL. [DIRECT]
JAS01057 HE4
JAS01058 HE4+CA 125 (ROMA)
JAS00162 Heacting >20 Fsurya
JAS00163 Heacting 12-20 (PAKAI YANG DATA INI SAJA)
JAS00164 Heacting 1-3 Heacting 1-3
JAS00165 Heacting 13-20 (INI DIHAPUS) Heacting 13-20
JAS00166 Heacting 3-6 Heacting 3-6
JAS00167 Heacting Konjungtiva
JAS00168 Heacting kuku
JAS00169 Heacting luka 7-12 Heacting > 7-12
JAS00170 Heacting Luka Palpebra Full Theckness
JAS00171 Heacting Luka Palpebra simple (>3buah)
JAS00172 Heacting Luka Palpebra simple (1-3 buah)
JAS00173 Heacting ringan
JAS00174 Heacting sedang
JAS01059 Hematologi Lengkap (CBC, LED, Hitung jenis lekosit)
JAS01060 Hematologi Lengkap + Retikulosit
JAS01061 Hematologi Lengkap + Retikulosit (Otomatis)
JAS01062 Hematologi Rutin Complete Blood Count
JAS01063 Hematologi Rutin + Retikulosit (otomatis)
Hematologi Rutin/CBC (Hemoglobin, Leukosit, Trombosit, Eritrosit, Hematokrit, Nilai-nilai
JAS01064
MC)
JAS01065 Hemoglobin
JAS01066 Hepatitis C Virus Antibodies (RIBA)
JAS01067 Hepatitis D Virus (HDV) Antibody Panel
JAS01068 Hepatitis Delta Virus Total Antibodies
JAS01069 Hepatitis E Antibodies (IgG,IgM)
JAS01070 Hepatitis E Antibody (IgG)
JAS01071 Hepatitis E Antibody (IgM)
JAS01072 HER2 - Patologi Anatomi FKUI
JAS01073 HER-2/neu
JAS01074 Herpes Virus-6, Human IgG & IgM Antibodies
JAS01075 Hg, Whole Blood
JAS00175 Hip Joint AP/LAT Hip Joint AP/LAT
JAS01076 Histone Antibodies
JAS01077 Histoplasma Antibody
JAS01078 Hitung Jenis Leukosit
JAS01079 HIV Western Bloot
JAS01080 HIV-1 Genotype
JAS01081 HIV-1 RNA (PCR)
JAS01082 HLA A,B,DR
JAS01083 HLA A,B,DR,DQ
JAS01084 HLA C
JAS01085 HLA DQ*A
JAS01086 HLA DQ*B
JAS01087 HLA-A, B
JAS01088 HLA-ABC
JAS01089 HLA-ABDR
JAS01090 HLA-B27
JAS01091 HLA-C
JAS01092 HLA-DR
JAS01093 HOME SERVICE 2
JAS01094 Home Service 3
JAS01095 Home Service 4
JAS01096 Home service 5
JAS01097 Homocysteine
JAS01098 HpSA
JAS01099 HPV-DNA High Risk (HC)
JAS01100 HPV-Genotype
JAS01101 hs-CRP
JAS01102 hs-Troponin I (Kuantitatif)
JAS01103 HSV PCR
JAS01104 HSV1 IgG (LCS)
JAS01105 HSV1 IgM (LCS)
JAS01106 HSV2 IgG (LCS)
JAS01107 HSV2 IgM (LCS)
JAS01108 HTLV I/II Confirmatory Assay
JAS00176 Humerus Bilateral Humerus Bilateral
JAS01109 HUMERUS D.AP&LAT
JAS01110 HUMERUS S.AP&LAT
JAS00177 Hydrotubasi (gynekologi)
JAS01111 ICA, Complement Fixing
JAS01112 ICT MALARIA
JAS00178 ID Band
JAS01113 IFN-Gamma Release Assay (IGRA)
JAS01114 IG BP3
JAS01115 IgA
JAS01116 IgE Atopy
JAS01117 IgE Atopy (Panel Pediatri)
JAS01118 IgE RAST ASPERGILUS
JAS01119 IgE RAST BULU AYAM
JAS01120 IgE RAST COKLAT
JAS01121 IgE RAST DAGING AYAM
JAS01122 IgE RAST DEBU RUMAH
JAS01123 IgE RAST EPT.ANJING
JAS01124 IgE RAST EPT.KUCING
JAS01125 IgE RAST EPT.TIKUS
JAS01126 IgE RAST GANDUM
JAS01127 IgE RAST IKAN
JAS01128 IgE RAST JAMUR MUCOR
JAS01129 IgE RAST KACANGTANAH
JAS01130 IgE RAST KECOA
JAS01131 IgE RAST KEPITING
JAS01132 IgE RAST KERANG
JAS01133 IgE RAST KN.TELUR
JAS01134 IgE RAST PENNICILIUM
JAS01135 IgE RAST PUTIH TELUR
JAS01136 IgE RAST SUSU
JAS01137 IgE RAST TUNGAU
JAS01138 IgE RAST UDANG
JAS01139 IgE Spesifik Bulu Ayam
JAS01140 IgE Spesifik Coklat
JAS01141 IgE Spesifik Daging Ayam
JAS01142 IgE Spesifik Daging Kambing
JAS01143 IgE Spesifik Daging Sapi
JAS01144 IgE Spesifik Debu Rumah
JAS01145 IgE Spesifik Epitel Anjing
JAS01146 IgE Spesifik Epitel Kucing
JAS01147 IgE Spesifik Epitel Tikus
JAS01148 IgE Spesifik Gandum
JAS01149 IgE Spesifik Ikan (Codfish)
JAS01150 IgE Spesifik Jamur Aspergilus
JAS01151 IgE Spesifik Jamur Penicilin
JAS01152 IgE Spesifik Kacang (Peanut)
JAS01153 IgE Spesifik Kacang Tanah
JAS01154 IgE Spesifik Kapuk
JAS01155 IgE Spesifik Kecoa
JAS01156 IgE Spesifik Kedelai
JAS01157 IgE Spesifik Kepiting
JAS01158 IgE Spesifik Kerang
JAS01159 IgE Spesifik Kotoran Burung
JAS01160 IgE Spesifik Kuning Telur
JAS01161 IgE Spesifik Lobster
JAS01162 IgE Spesifik Mucor
JAS01163 IgE Spesifik Nasi
JAS01164 IgE Spesifik Orange
JAS01165 IgE Spesifik Pisang
JAS01166 IgE Spesifik Putih telur
JAS01167 IgE Spesifik Serpihan Kulit Kuda
JAS01168 IgE Spesifik Strawberry
JAS01169 IgE Spesifik Susu
JAS01170 IgE Spesifik Susu sapi
JAS01171 IgE Spesifik Susu soya
JAS01172 IgE Spesifik Tomat
JAS01173 IgE Spesifik Tuna
JAS01174 IgE Spesifik Tungau Debu Rumah
JAS01175 IgE Spesifik Udang
JAS01176 IgE Total
JAS01177 IGF BP-3
JAS01178 IGF-1
JAS01179 IgG
JAS01180 IgG ACA
JAS01181 IgG ANTI CMV
JAS01182 IgG ANTI HSV1
JAS01183 IgG ANTI HSV2
JAS01184 IgG ANTI RUBELLA
JAS01185 IgG ANTI SALMONELLA
JAS01186 IgG CMV AVIDITAS
JAS01187 IgG CMV AVIDITY
JAS01188 IgG Food Sensitivity Profile
JAS01189 IgG HELICOBACTER pylori
JAS01190 IgG MYCOPLASMA
JAS01191 IgG Subclass 4
JAS01192 IgG Subclasses 1,2,3,& 4
JAS01193 IgG TOXO AVIDITY
JAS01194 IgG TOXOPLASMA
JAS01195 IgG&IgM DENGUE RAPID
JAS01196 IgM
JAS01197 IgM ACA
JAS01198 IgM ANTI HAV
JAS01199 IgM ANTI HBc ^
JAS01200 IgM Anti HCV
JAS01201 IgM ANTI HSV1
JAS01202 IgM ANTI HSV2
JAS01203 IgM ANTI RUBELLA
JAS01204 IgM ANTI SALMONELLA
JAS01205 IgM HELICOBACTER Pylori
JAS01206 IgM SALLMONELLA (TUBEX)
JAS01207 IgM TOXOPLASMA
JAS01208 IL28B - rs12979860
JAS01209 Immunotyping
JAS00179 Imunisasi
JAS01210 Imunofiksasi
JAS01211 Imunofiksasi urine
JAS01212 Imunohistokimia (Panel Limfoma & Cytokeratin)
JAS01213 Imunohistokimia (CD20)
JAS01214 Imunohistokimia CD3
JAS01215 Imunohistokimia CD68
JAS01216 Imunohistokimia C-KIT
JAS01217 Imunohistokimia Kappa Lamda
JAS01218 Imunohistokimia Ki-67
JAS01219 Imunohistokimia SMA
JAS01220 Imunologi seluler
JAS00180 Incisi abses
JAS00181 Incisi abses intra oral
JAS00182 Incisi Abses Leher tanpa anastesi umum
JAS00183 Incisi Abses Retroaurikuler tanpa anastesi umum
JAS00184 Incisi Abses Septum Nasi tanpa anastesi umum
JAS01221 INDIREK (disertai px Bil direct,Bil tot)
JAS00185 Infuse Pump
JAS01222 Inhibin A
JAS01223 Inhibin B
JAS00186 Inisiasi menyusui dini
JAS00187 Injeksi
JAS00188 Injeksi Antihistamin
JAS00189 Injeksi IC
JAS00190 Injeksi IM Injection IM
JAS00191 Injeksi IV Injection IV
JAS00192 Injeksi Jerawat
JAS00193 Injeksi Kenacort
JAS00194 Injeksi Obat (tidak dihitung jumlah obat)
JAS00195 Injeksi SC Injection SC
JAS00196 Injeksi tendon
JAS01224 INR/Trombotest
JAS00197 Insiminasi (infertilitas)
JAS00198 Insisi abses
JAS00199 Insisi abses bartolini
JAS01225 Insulin
JAS01226 Insulin Autoantibody
JAS01227 Interleukin 2
JAS01228 Interleukin 2 Receptor
JAS01229 Interleukin-1 Beta
JAS01230 Intrinsic Factor Blocking Autoantibodies
JAS00200 Intubasi ETT
JAS01231 Iodine Urine 24 Jam
JAS00201 Irigasi Mata
JAS00202 Irigasi sinus maxilaris dg lokal anastesi
JAS01232 Islet Cell Autoantibodies Evaluation
JAS01233 IT Ratio
JAS00203 IVA/Pap Smear Prodia
JAS01234 IVP NON IONIC (FCR)
JAS00204 Jahit Luka pada wajah
JAS01235 Jamur Mikroskopis
JAS01236 Jamur Candida Kultur Resistensi Aerob
JAS00205 Jasa Pemberian Vaksin BCG
JAS00206 Jasa Perawat Nurse Service
JAS01237 JC Polyoma Virus DNA Quantitative R-T PCR,CSF
JAS01238 JO-1 Antibody
JAS01239 Jumlah sel
JAS00207 Kalazion/Hordeolum Dewasa
JAS01240 Kalium
JAS01241 Kalium Urine
JAS00208 Kamar Room
JAS00209 Karcis Kunjungan Pertama Administration
JAS00210 Karcis Kunjungan Selanjutnya Administration
JAS00211 Karcis Poli Kunjungan Pertama Administration Polyclinic
JAS00212 Karcis Poli Kunjungan Selanjutnya Administration Polyclinic
JAS00213 KB Suntik (1 bulan)
JAS00217 KBE/KBI
JAS01242 Kokain kualitatif urine
JAS01243 Kokain Kuantitatif Serum
JAS01244 Kokain kuantitatif urine
JAS00218 Kolposkopi + foto
JAS01245 Konfirmasi ABO & RH
JAS00219 Konsultasi Dokter Doctor's Consultation
JAS00220 Konsultasi Kosmetik
JAS00221 Konsultasi Spesialis (Poli Gigi)
JAS00222 Kontrol behel
JAS00223 Kontrol per kunjungan
JAS00224 Kontrol protase Control protheses
JAS00225 Kontrol tindakan post operatif
JAS01246 Kreatinin
JAS01247 Kreatinin Clearance ( o )
JAS01248 Kreatinin Urine
JAS00226 Kryo terapi
JAS01249 KULT CAIRAN PLEURA
JAS01250 KULT CAIRAN SENDI
JAS01251 KULT M.tuberculosis
JAS01252 KULT USAP HIDUNG
JAS01253 KULT.USAP TENGGOROK
JAS01254 Kultur AEROBIC
JAS01255 Kultur BTA + Lini 2
JAS01256 Kultur dan Resistensi GO
JAS01257 KULTUR DARAH
JAS01258 Kultur Darah Bact/Alert
JAS01259 Kultur Darah Bactec
JAS01260 Kultur Darah Manual
JAS01261 Kultur Darah Vitec
JAS01262 Kultur Diphteri
JAS01263 KULTUR FAECES
JAS01264 Kultur Feses Manual
JAS01265 Kultur Feses Vitec
JAS01266 KULTUR G.O
JAS01267 KULTUR GALL
JAS01268 Kultur GO Manual
JAS01269 Kultur GO Vitec
JAS01270 Kultur Jamur
JAS01271 Kultur Jamur Candida
JAS01272 KULTUR LIQUOR
JAS01273 KULTUR LUKA/ULKUS
JAS01274 KULTUR PUS
JAS01275 Kultur Rektal Swab Manual
JAS01276 Kultur Rektal Swab Vitec
JAS01277 KULTUR SEKRET
JAS01278 KULTUR SPERMA
JAS01279 KULTUR SPUTUM
JAS01280 Kultur Urin Manual
JAS01281 Kultur Urin Vitec
JAS01282 KULTUR URINE
JAS01283 KULTUR USAP MATA
JAS00227 Kumbah Lambung dengan NGT
JAS00228 Kuretase 1 gigi Curretage of the tooth
JAS01284 Lab (serologi) Cerologi
JAS00229 Lacici intra/ekstra oral
JAS01285 Lain- Lain Manual
JAS01286 Lain- Lain Vitec
JAS00230 Lakmus test
JAS01287 Laktat
JAS01288 Lamotrigine
JAS01289 LAT. LEFT DECUBITUS
JAS01290 LAT. RIGHT DECUBITUS
JAS00231 Lavement
JAS01291 LDH
JAS01292 LDL
JAS01293 LDL CHOL. [DIRECT]
JAS01294 LE TEST
JAS01295 Lead urine (Random)
JAS01296 Lead Urine 24 jam
JAS01297 LED
JAS01298 LEGIONELLA ANTIGEN
JAS01299 Legionella Pneumophila Ag Detection Urine
JAS00232 Lepas canula trakheostomy
JAS00233 Lepas Infus Remove the infusion
JAS00234 Lepas infus anak/bayi
JAS01300 Leptin
JAS01301 Leukemia Phenotyping
JAS01302 Levetiracetam (KEPPRA)
JAS01303 LH
JAS01304 Limfosit subset
JAS01305 Lipase
JAS01306 LIPOPROTEIN(a)/ Lp(a)
JAS01307 LIQUOR
JAS01308 Lithium
JAS01309 Liver Kidney Microsome ( LKM-1) IgG Auto Abs
JAS00004 Lobuloplasti dg lokal anastesi
JAS00235 Lobuloplasti dg lokal anastesi
JAS00236 Lobuloplasti tanpa anastesi umum
JAS01310 LOPOGRAPHY (FCR)
JAS01311 Lp (a) (*)
JAS01312 L-S AP/LAT/OBL. D/S
JAS00237 Luka Bakar > 20%
JAS01313 LUMB&COX/HIP DEX BMD
JAS01314 LUMB&COX/HIP SIN BMD
JAS01315 LUMB&FOREARM DEX BMD
JAS01316 LUMB&FOREARM SIN BMD
JAS00238 Lumbal fungsi
JAS01317 LUMBO-SACR LAT EXTEN
JAS01318 LUMBO-SACR LAT FLEXI
JAS01319 LUMBO-SACR.OBL.D
JAS01320 LUMBO-SACR.OBL.S
JAS01321 LUMBOSACRALIS AP
JAS01322 LUMBOSACRALIS LAT
JAS01323 Lupus Antikoagulan
JAS01324 M Band Quantitative
JAS01325 M. TBC PCR
JAS01326 M2PK
JAS01327 MAG & SGPG IgM Autoabs
JAS01328 Magnesium
JAS01329 Magnesium Urine
JAS00239 Mahkota sementara per gigi
JAS01330 MALARIA
JAS01331 Malaria (mikroskopik)
JAS01332 Malaria Antigen
JAS01333 MAMMOGRAPHY DEX-SIN.
JAS01334 MAMMOGRAPHY DEXTRA
JAS01335 MAMMOGRAPHY SINISTRA
JAS00240 Mandibula (1 Posisi) Mandibula (1 Posisi)
JAS01336 MANDIBULA AP
JAS01337 MANDIBULA EISLER DEX
JAS01338 MANDIBULA EISLER SIN
JAS01339 MANDIBULA LAT
JAS00241 Mantoux test
JAS00242 Manus AP/Oblique Manus AP/Oblique
JAS00243 Manus Bilateral Manus Bilateral
JAS01340 MANUS DEX
JAS01341 MANUS DEX/SIN AP
JAS01342 MANUS SIN
JAS01343 MANUS SIN (BONE AGE)
JAS01344 MASTOID SCHULLER DEX
JAS00244 Mastoid Schuller R + L Mastoid Schuller R + L
JAS01345 MASTOID SCHULLER SIN
JAS01346 MDMA
JAS01347 MDMA Kualitatif
JAS01348 Melatonin Saliva
JAS00245 Memasang infus anak
JAS00246 Memasang infus bayi/konsul
JAS00247 Memberi kompres hangat dingin
JAS00248 Memberi oksigen (POLI UMUM. UGD DLL) Oxygen
JAS00249 Memberi oksigen per jam selanjutnya
JAS00250 Merawat Tali Pusat
JAS01349 Merkuri Urine
JAS01350 Metadone Kualitatif
JAS01351 Metadone Kuantitatif Serum
JAS01352 Metadone Kuantitatif Urine
JAS00251 Metal Porcelaine per gigi
JAS01353 METAMPHETAMIN
JAS01354 Metanephrine Fractionated Plasma
JAS01355 Metanephrine Fractionated Total Urine 24 jam
JAS01356 Metanephrines Urine Random
JAS00252 METAPEX +GIC METAPEX +GIC
JAS01357 Methamphetamine
JAS01358 Methamphetamine Kualitatif
JAS01359 Methamphetamine Kuantitatif Serum
JAS01360 Methamphetamine Kuantitatif Urine
JAS01361 Methaqualone Kualitatif
JAS01362 Methaqualone Kualitatif urine
JAS01363 Methaqualone Kuantitatif Serum
JAS01364 Methaqualone Kuantitatif Serum
JAS01365 Methaqualone Kuantitatif Urine
JAS01366 Methotrexate
JAS01367 Methylenetetrahydrofolate Reductase Variant
JAS01368 Methylmanolic acid
JAS01369 Microfilaria (mikroskopik)
JAS01370 MIKROALBUMIN URINE
JAS01371 Mikroskopik Diphteria
JAS01372 Mikroskopik Jamur
JAS01373 Mikroskopik Pengecatan Gram
JAS01374 Mikroskopik Trichomonas
JAS01375 Minimal Residual Disease (MRD)
JAS01376 Mn, Serum
JAS01377 MORPHIN
JAS00253 Mortise Bilateral Mortise Bilateral
JAS01378 MS AFP (Maternal Serum)
JAS01379 MTB-DNA (Real Time PCR)
JAS01380 MTHFR, DNA Mutation Analysis
JAS00254 Mumifikasi gigi sulung per kunjungan
JAS01381 Mumps IgG & IgM Antibodies
JAS01382 Mumps IgG Antibodies
JAS01383 Mumps IgM Antibodies
JAS01384 Musk Antibody
JAS01385 Mycophenolic acid
JAS01386 Mycoplasma IgG
JAS01387 Mycoplasma IgG & IgM Ab
JAS01388 Mycoplasma IgM
JAS01389 Mycoplasma Pneumoniae IgG
JAS01390 Myelin basic protein CSF
JAS01391 Myelin IgG Antibody, IFA
JAS01392 Myeloperoxidase & Proteinase 3 Autoabs
JAS01393 Myoglobin
JAS01394 Na,K,CL
JAS01395 NAP
JAS01396 Napza (1 analit)
JAS01397 Napza Panel (5 analit)
JAS01398 Natrium
JAS01399 Natrium Urine
JAS00255 Nebulizer Nebulizer
JAS01400 Neuromyelitis Optical/Aquaporin-4-IgG CBA
JAS01401 Nikotin
JAS01402 NIPT
JAS01403 N-MID Osteocalcin
JAS01404 Nonne & Pandy
JAS01405 NS1 Ag (RAPID)
JAS01406 NSE
JAS00256 NST
JAS01407 NT-proBNP
JAS01408 Nucleotidase-5
JAS00257 Obs. Bayi Phatologis
JAS00258 Observasi < 2 jam
JAS00259 Observasi 2 jam
JAS01409 OBTURATOR VIEW
JAS01410 OCCLUSAL RA
JAS01411 OCCLUSAL RB
JAS00260 Odontocctomi Partial Impacted
JAS01412 OESOPHAGUS (FCR)
JAS00261 Oksigen (Poli Interna)
Oksigen Anak (Poli Anak)
JAS01413 Oligoclonal Bands in CSF
JAS01414 Omega 3,6,9
JAS01415 OMNIPAQUE for APG
JAS01416 OMNIPAQUE for CHOLA
JAS01417 OMNIPAQUE For IVP
JAS01418 OMNIPAQUE for SPLIN
JAS01419 OMNIPAQUE INFUSION P
JAS00262 Operculextomi 1 gigi
JAS01420 Opiat
JAS01421 Opiat Kualitatif
JAS01422 Opiat Kuantitatif Urine
JAS01423 Opiat Kuantitatif Serum
JAS00263 Orbita AP/PA Orbita AP/PA
JAS01424 Organic Acids Serum
JAS00264 Ortho cekat
JAS00265 OS Nasal OS Nasal
JAS01425 OS NASAL
JAS01426 Osmolalitas Serum
JAS01427 Osmolalitas Urine
JAS01428 Osmolalitas Urine 24 Jam
JAS01429 Oxcar Bazepine
JAS01430 Oxytocin Saliva
JAS01431 p53
JAS01432 PA Besar
JAS01433 PA Kecil
JAS01434 PA Sedang
JAS01435 PAKET HAPUSAN DARAH
JAS01436 PAN-ANCA PLUS
JAS01437 Pancreatic Amilase
JAS01438 Panel Anti Aging Serum dan Whole Blood
JAS01439 Panel breast (ER,PR,HER2, KI67, Topo 2 Alpha)
JAS01440 Panel Nutrisi dan Logam Berat, Serum & Whole
JAS01441 Panel Nutrisi Serum
JAS01442 Panel Toksik Serum dan Whole Blood
JAS01443 Pap Smear
JAS01444 PAPP-A & Free b-HCG-1st Trimester
JAS00266 Parasintesa Telinga
JAS01445 Pariental Cell Total autoantibodies
JAS01446 Parvovirus B19 IgG & IgM
JAS00267 Pasang Amsling
JAS00268 Pasang Bidai/Spalk
JAS00269 Pasang cateter (laki-laki)
JAS00270 pasang cateter dengan penyulit
JAS00271 Pasang color brace
JAS00272 Pasang CVC
JAS00273 Pasang Elastic Bandage
JAS00274 Pasang infus bayi/anak
JAS00275 Pasang infus dewasa Infus
JAS00276 Pasang infus umbilical
JAS00277 Pasang infus umbilikus
JAS00278 Pasang lingkar abdomen
JAS00279 Pasang NGT
JAS00280 Pasang NGT (decompresi) + nutrisi
JAS00281 Pasang NGT + Kumbah Lambung
JAS00282 Pasang ransel verban/sling
JAS00283 Pasang skin traksi
JAS00284 Pasang WSD continus
JAS00285 Pasang/Buka IUD
JAS00286 Pasang/Buka Susuk KB
JAS00287 Pasang/lepas cateter (Anak)
JAS00288 Pasang/lepas cateter wanita
JAS00289 Pasang/lepas kateter (laki-laki)
JAS01447 Pb, Whole Blood
JAS01448 PCP Pneumocitis Carini Pneumonia
JAS01449 PCP(Phencyclidine)
JAS00290 Pedis AP/Oblique Pedis AP/Oblique
JAS01450 PEDIS DEX
JAS01451 PEDIS DEX/SIN AP
JAS01452 PEDIS SIN
JAS01453 PELVIS A.P.
JAS00291 Pelvis AP (Dewasa) Pelvis AP (Dewasa)
JAS00292 Pelvis AP + LAT (Anak) Pelvis AP + LAT (Anak)
JAS01454 PELVIS INLET
JAS01455 PELVIS LAT/SACR LAT
JAS01456 PELVIS OUTLET
JAS00293 Pelvise (Anak) Pelvise (Anak)
JAS00294 Pelvise Lateral (Dewasa) Pelvise Lateral (Dewasa)
JAS00295 Pemakaian inkubator
JAS00296 Pemasangan Gromet dg lokal anstesi
JAS00297 Pemasangan Gyp Gyp
JAS00298 Pemasangan mahkota/ jembatan per gigi
JAS00299 Pemasangan ransel verban
JAS00300 Pemasangan skin traksi
JAS00301 Pemberian Citostika
JAS00302 Pemberian khemotherapi
JAS00303 Pemeriksaan Audiometri
JAS00304 Pemeriksaan Kebidanan
JAS00305 Pemeriksaan Neuroopthalmology
JAS00306 Pemeriksaan OAE
JAS00307 Pemeriksaan Tympanometri
JAS00308 Pemeriksaan Visus
JAS00309 Pemutihan gigi/Bleaching
JAS00310 Penanganan kejang lama dan syok
JAS00311 Pencabutan Gigi kompilasi/ pecah bifurkasi/trifurkasi Dental revocation compilation /
JAS00312 Pencabutan gigi dan jahitan Toath extraction & sewing
JAS00313 Pencabutan Gigi dg Topical Anastesi Revocation Teeth with Topical
JAS00314 Pencabutan gigi dgn open method
JAS00315 Pencabutan Gigi permanen dg lokal anastesi tooth extraction with local ana
JAS00316 Pencabutan gigi sulit Toath extraction difficult
JAS01457 Pencyclidine
JAS01458 Pengecatan Gram Mikroskopik
JAS00317 Pengisian saluran akar
JAS01459 PENIS AP/LAT (FCR)
JAS00318 Perawatan bayi baru lahir
JAS00319 Perawatan Decubitus, diabetic foot
JAS00320 Perawatan Gangren ok keganasan, colostomy
JAS00321 Perawatan Jenazah
JAS00322 Perawatan luka bakar derajat II < 15%
JAS00323 Perawatan Luka Bakar derajat II > 15%
JAS00324 Perawatan Luka terbuka multiple > 5 cm
JAS00325 Perawatan Mumifikasi saraf gigi Mummification perwatan denta
JAS00326 Perawatan payudara
JAS00327 Perbaikan plat patah/Retak
JAS00328 Permintaan pembuatan medical record pasien yg sudah pulang
JAS01460 Pewarnaan Diphteria
JAS01461 PHANORAMIC
JAS01462 Phencyclidine Kualitatif
JAS01463 Phencyclidine Kuantitatif Urine
JAS01464 Phencyclidine Serum
JAS01465 Phenobarbital
JAS01466 Phenylalanine ( PKU )
JAS01467 Phenylalanine and Tyrosine
JAS01468 Phenytoin
JAS01469 Pheochromaocytoma Evaluation Urine 24 jam
JAS01470 Phicalprotectin
JAS01471 PHOSPOR ANORGANIK
JAS00329 Placenta digital/manual
JAS00330 Plaon Foto Abdomen (BOF) DWS Plaon Foto Abdomen (BOF) D
JAS01472 Plasminogen
JAS00331 Plat berikutnya
JAS00332 Plat pertama
JAS01473 Platelet Function Test Anti P2Y12
JAS01474 Platelet Function Test Aspirin
JAS01475 PLEURA
JAS00333 Pol. Spesialis Specialist Polyclinic
JAS00334 Poli Gyp Poly Gyp
JAS00335 Poli Umum General Polyclinic
JAS01476 Poliovirus AB Neutralization
JAS00336 Polipectomy tanpa anastesi umum
JAS01477 POLS DEX AP&LAT
JAS01478 POLS SIN AP&LAT
JAS01479 Porphyrins Total Plasma
JAS01480 Porphyrins, Fractionated, Quantitative Urine
JAS01481 PPT
JAS01482 Prealbumin
JAS01483 Prenatal Diagnosis Thalassemia (Eijkman)
JAS01484 PREP GO
JAS01485 PREP.JAMUR/SPORA
JAS01486 PREP.TRICHOMONAS
JAS00337 Preparasi saluran akar
JAS01487 PREPARAT BTA
JAS01488 PREPARAT BTA (SPS)
JAS01489 PREPARAT CANDIDA
JAS01490 PREPARAT DIPHTHERI
JAS01491 PREPARAT GRAM
JAS01492 Procalcitonin (PCT)
JAS01493 PROGESTERON
JAS01494 PROLAKTIN
JAS00338 PROLINE
JAS01495 Propoxyphene Kualitatif Urine
JAS01496 Propoxyphene Kuantitatif Serum
JAS01497 Propoxyphene Kuantitatif Urine
JAS01498 Protein C
JAS01499 Protein S
JAS01500 Protein per Kreatinin Urin Sewaktu
JAS01501 Protein Total
JAS01502 Protein Total ( o )
JAS01503 Protein Total (Analisa CSF)
JAS00339 Protese 1 gigi/gigi pertama
JAS01504 PSA
JAS00340 Psikotherapi Edukasi
JAS00341 Psikotherapy kognitif dan perilaku
JAS00342 Psikotherapy suportif
JAS01505 PTH intact (*)
JAS00343 Pungsi cairan sinovial
JAS01506 RADIAL FLEXION
JAS01507 RATIO ALB/GLOB
JAS01508 RATIO LDL/HDL CHOL
JAS00344 Rawat luka besar
JAS00345 Rawat luka kecil Wound Care Light
JAS00346 Rawat Luka Bakar 11-20% Hospital of Wounds
JAS00347 Rawat luka bakar sama < 10%
JAS00005 Rawat luka bakar sama<10%
JAS00348 Rawat Luka post op Mastoidektomy
JAS00349 Rawat Luka post op sinus/hidung
JAS00350 Rawat luka sedang Wound Care Are
JAS00351 Rawat stoma trakheostomy
JAS00352 Rebasing gigi tiruan lengkap per rahang
JAS01509 RECTAL SWAB
JAS00353 Rectal Therapy
JAS00354 Rectal Toucher Rectal Toucher
JAS00006 Rectal Washing Rectal Washing
JAS00355 Rectal Washing
JAS00356 Relining gigi tiruan lengkap per rahang
JAS00357 Rellining Partial Dentur Per rahang
JAS01510 Renin (PRA) (#*)
JAS00358 Repair vagina, robekan perineum
JAS00359 Reposisi fr. Os nasal + pasang Gyp kupu-kupu
JAS00360 Reposisi gigi per regio
JAS00361 Reposisi MT Joint
JAS01511 Resistensi Jamur
JAS01512 RESISTENSI OSMOTIK
JAS01513 Respiratory Syncytial Virus Abs
JAS00362 Resusitasi bayi asphiksia
JAS00363 Resusitasi cairan
JAS01514 Retikulosit
JAS01515 Retraksi Bekuan
JAS01516 RF
JAS01517 RHEESE/FOR.ORB.D
JAS01518 RHEESE/FOR.ORB.S
JAS01519 RHEMATOID FAKTOR (KUANTITATIF)
JAS00364 Rhese R + L Rhese R + L
JAS00365 Rhesee (Foramen Opticum) Rhesee (Foramen Opticum)
JAS01520 Rhesus Genotype
JAS01521 Rickettsia ricketsii and R.thypi IgG & IgM Ab Ev
JAS01522 Rickettsia rickettsii IgM Abs
JAS01523 Rivalta
JAS00366 RJP + DC shock
JAS00367 RJP/ Pijat Jantung
JAS01524 ROSE WAALER
JAS01525 Rotavirus Antigen
JAS01526 RPG (RETROGRADE PYE)
JAS01527 rT3
JAS01528 Rubella IgG (LCS)
JAS01529 Rubella IgM(LCS)
JAS01530 Rumpel Leede
JAS01531 Saccharomyces Cerevisiae IgG dan IgA Antibodies
JAS01532 SACROILIACA DEX.
JAS01533 SACROILIACA SIN.
JAS01534 SACRUM AP.
JAS01535 SACRUM LAT.
JAS00368 Sambung tendon parsial
JAS00369 Sambung tendon total
JAS00370 Saturasi Pemasangan O2
JAS01536 SC
JAS00371 Scalling berat
JAS00372 Scalling ringan Scalling with one visit
JAS00373 Scalling sedang
JAS01537 SCAP. DEX.AP.
JAS01538 SCAP. DEX.LAT.
JAS01539 SCAP. SIN.AP.
JAS01540 SCAP. SIN.LAT
JAS00374 Scapula Scapula
JAS00375 Scapula Bilateral Scapula Bilateral
JAS01541 SCC
JAS01542 Schistosoma IgG
JAS01543 Scl-70 Antibody
JAS00376 Scoliosis View Scoliosis View
JAS01544 Se, Serum
JAS01545 Sekuensing Alpha Thalasemia Teknik MLPA
JAS01546 Sekuensing Beta Thalasemia
JAS01547 Sekuensing Delta Thalasemia
JAS01548 Sekuensing Gen SRY
JAS01549 SEL LE
JAS00377 Selang Sungkup
JAS01550 SELLA TURS KHUSUS
JAS00378 Sella Tursica Sella Tursica
JAS00379 Sensor SP O2
JAS01551 SERAMOBA / ANTI AMOEBA
JAS01552 Serologi Jamur Aspergillosis
JAS01553 Serologi Jamur Candidiasis
JAS01554 Serologi Jamur Kriptokokosis
JAS01555 Serotonin / Hydroxytryptamine,5
JAS01556 SERUM IRON (Fe/SI)
JAS00380 Set monitor
JAS01557 SGOT
JAS01558 SGPT
JAS01559 SHBG
JAS01560 SHOULDER AP ROTASI EKSTERNAL
JAS01561 SHOULDER AP ROTASI INTERNAL
JAS00381 Shoulder Bilateral Shoulder Bilateral
JAS01562 SHOULDER DEX AP
JAS01563 SHOULDER DEX AXIAL
JAS00382 Shoulder Exo /Endo Shoulder Exo /Endo
JAS00383 Shoulder EXO /Endo Bilateral Shoulder EXO /Endo Bilateral
JAS01564 SHOULDER SIN AP
JAS01565 SHOULDER SIN AXIAL
JAS01566 Single Antigen Antibody Ident. Class I&II
JAS01567 Sirolimus
JAS01568 Sitologi
JAS01569 Sitologi Serviks Berbasis Cairan (SSBC) (#)
JAS01570 Sitologi Urin
JAS01571 Sjogren's Antibody (SS-A)
JAS01572 Sjogren's Antibody (SS-B)
JAS01573 SKULL AP
JAS00384 Skull AP/PA Skull AP/PA
JAS01574 SKULL D.ANT-POST
JAS01575 SKULL LAT
JAS01576 SKULL LAT. ADENOID
JAS00385 Skull Lateral/Adenoid Skull Lateral/Adenoid
JAS01577 SKULL TANGENSIAL
JAS01578 SKY LINE GENU D
JAS01579 SKY LINE GENU S
JAS00386 Slit Lamp
JAS01580 Sm Antibody
JAS01581 Small-Dense LDL
JAS01582 Smooth Muscle Total Autoantibodies
JAS01583 Soluble Liver Antigen (SLA) Autoabs
JAS01584 SPE
JAS01585 SPIROMETRI
JAS00387 Splinting per rahang
JAS01586 SPLINTOGRAPHY
JAS00007 Split Gyp
JAS00388 Spoeling Telinga
JAS01587 SPOT VIEW (FCR)
JAS00389 Sputum
JAS01588 SQUAMOS CELL Ca/SCC
JAS01589 ST2
JAS01590 Status Antioksidan Total
JAS01591 STENVERS DEX.
JAS00390 Stenvers R + L Stenvers R + L
JAS01592 STENVERS SIN.
JAS00391 Sterilisasi saluran akar
JAS01593 STERNUM AP.
JAS01594 STERNUM LAT.
JAS01595 Strepto. Pyogenes Group A Ab
JAS01596 Streptococcus Pneumonie IgG ABS, 14 Serptype
JAS01597 Striational Total autoantibodies
JAS01598 Strongyloides IgG Antibody
JAS01599 Subtipe Limfosit : CD 34
JAS01601 Subtipe Limfosit : CD 4 dan CD 8
JAS00392 Suction Suction
JAS00393 Surat Keterangan bebas Narkoba
JAS00394 Surat Keterangan Kelahiran
JAS00395 Surat Keterangan Kematian
JAS00396 Surat Keterangan Sehat Certificate of health
JAS00397 Surat Keterangan Sehat ke Luar Negeri
JAS00398 Surat Keterangan Sehat Melamar Kerja
JAS00399 Surat Keterangan Sehat Sekolah-Pendidikan
JAS00400 Surat Keterangan Tidak berpenyakit Menular
JAS00401 Surat Keterangan untuk Asuransi
JAS00402 Syringe pump
JAS00403 Syrnge pump/30 menit
JAS01603 T.M.J/D.CLS MTH
JAS01604 T.M.J/D.OP MTH
JAS01605 T.M.J/S.CLS MTH
JAS01606 T.M.J/S.OP MTH
JAS01607 T3 Total
JAS01608 T4 Total
JAS01609 Tacrolimus
JAS00404 Tambahan expansi/screw
JAS00405 Tambahan gigi berikutnya
JAS00406 Tampon Hidung
JAS00407 Tampon telinga
JAS00408 Tarshoraphi
JAS01610 TB-PCR
JAS01611 TEG
JAS00409 Tes Alergi Alergy Test
JAS00410 Tes Fungsi Luhur
JAS01612 Tes Kehamilan
JAS00411 Tes Pembauan, Pengecapan
JAS00412 Test Buta Warna Test Buta Warna
JAS01613 Test Free Light Chain
JAS00413 Test pack Test pack
JAS01614 TESTOSTERON
JAS01615 Testosterone Free & Total
JAS00414 Tetagam Tetagam
JAS00415 Tetagram/Anti Tetanus
JAS01616 Tetes Tebal Tipis Malaria Prodia
JAS01617 Theophyllin
JAS00416 Thoracalis AP
JAS01618 THORACALIS AP
JAS01619 THORACALIS LAT
JAS01620 THORACALIS OBL D
JAS01621 THORACALIS OBL S
JAS01622 THORACOLUMBAL LAT.
JAS01623 THORACO-LUMBALIS AP
JAS00417 Thorax (Ukuran Film Sedang) Thorax (Ukuran Film Sedang)
JAS00418 Thorax AP + LAT (Anak) Thorax AP + LAT (Anak)
JAS00419 Thorax AP/PA (Anak) Thorax AP/PA (Anak)
JAS00420 Thorax AP/PA (Dewasa) Thorax AP/PA (Dewasa)
JAS01624 THORAX LAT
JAS01625 THORAX LAT DEX
JAS01626 THORAX LAT SIN
JAS00421 Thorax Lateral Thorax Lateral
JAS00422 Thorax LLD Thorax LLD
JAS00423 Thorax Lordotic Thorax Lordotic
JAS01627 THORAX OBL DEX.(FCR)
JAS01628 THORAX OBL SIN
JAS01629 THORAX PA
JAS00424 Thorax RLD Thorax RLD
JAS01630 THORC.AP/LAT/OBL D/S
JAS01631 THOR-LUM AP BEND DEX
JAS01632 THOR-LUM AP BEND SIN
JAS01633 Thrombotest Owren
JAS01634 Thyroid Autoantibodies
JAS01635 Thyrotropin Releasing Hormone-TSH
JAS01636 TIBC
JAS01637 TIBC (disertai hasil serum iron)
JAS00425 Tindakan Medik Kecil 4A
JAS00426 Tindakan Medik Sederhana 1
JAS00427 Tindik
JAS01638 Tiroglobulin
JAS01639 Tissue Transglutaminase Antibody IgA
JAS01640 Tissue Transglutaminase Antibody IgG
JAS00428 TMJ TMJ
JAS01641 Toluene
JAS00429 Tono metri Schiotz
JAS00430 Tonometri Aplansi
JAS01642 TOP LORDOTIC VIEW
JAS01643 Topiramate
JAS01644 TOTAL
JAS01645 Total P1NP
JAS01646 TOTAL PROTEIN
JAS00431 Towne Towne
JAS01647 TOWNE/WINGS PETR
JAS01648 Toxoplasma IgG (LCS)
JAS01649 Toxoplasma IgM (LCS)
JAS01650 TPHA
JAS01651 TRAb
JAS01652 Transferin
JAS00432 Transfusi
JAS01653 Transglutaminase IgG & IgA Abs
JAS01654 Treadmill ^
JAS01655 Treponema Pallidum Ab
JAS01656 Trichomonas Mikroskopis
JAS00433 Tricresol Formalin
JAS01657 Trigliserida (*)
JAS01658 Triple Cardiac Marker (CK-MB, Troponin I, Myoglobin)
JAS01659 Trombosit
JAS01660 Troponin I
JAS01661 TSH Neonatus
JAS01662 TSHs
JAS01663 TTGO (*)
JAS00434 Tumor jinak genetalia (lokal anastesi)
JAS00435 Tumpat composite gigi sulung
JAS00436 Tumpat GIC gigi sulung
JAS00437 Tumpatan amalgam amalgam filling
JAS00438 Tumpatan Composite Filling Composite
JAS00439 Tumpatan Glass Ionomer Cement Glass ionomer fillings Cement
JAS00440 Tumpatan Inlay, Uplay, Onlay
JAS00441 Tumpatan sementara 1 gigi/dg bor Temporary Filling
JAS00442 Tumpatan Silikai Silicate Filling
JAS01664 T-UPTAKE
JAS01665 UGI (FCR)
JAS01666 UIBC
JAS01667 ULNAR FLEXION
JAS00443 Upperculectomy
JAS01668 Urea Breath Test
JAS01669 Urea N
JAS01670 Urea N Urine
JAS01671 URETHROGRAPHY (FCR)
JAS01672 UREUM
JAS01673 URINALYSIS
JAS01674 Urine Kultur Resistensi Aerob
JAS01676 Urine Lengkap Urine complete
JAS01677 Urine Rutin
JAS01678 Urine Rutin Flow Cytometri
JAS00444 USG USG
JAS00445 USG 4 Dimensi
JAS00446 USG Abdomen RS Kasih Ibu
JAS00447 USG Abdominal
JAS01679 USG CAROTIS DOPLER
JAS01680 USG KANDUNGAN (ALK)
JAS01681 USG KANDUNGAN 4-DIMENSI
JAS01682 USG KEPALA BAYI (ALK
JAS01683 USG LAIN-LAIN (CLR)
JAS01684 USG LOWER ABD.(CLR)
JAS01685 USG MAMMA (CLR)
JAS01686 USG MUSCULOSKELETAL
JAS01687 USG PENIS
JAS01688 USG TESTIS (ALK)
JAS00448 USG Transvaginal
JAS01689 USG TYROID (ALK)
JAS01690 USG UP.& LOW.ABD CLR
JAS01691 USG UPPER ABD.(CLR)
JAS01692 USG UPP-LOW ABD. 4D
JAS01693 USG UROLOGI
JAS01694 USG VASCULER PERIFER
JAS00449 USG-4D
JAS00450 Vagina Touce (VT)
JAS00451 Vaginal swab
JAS00452 Vaksinasi var Rabies vaccination
JAS01695 Vancomycin
JAS01696 Varicella Zoster IgG
JAS01697 Varicella Zoster Virus IgG
JAS01698 Varicella Zoster Virus IgM
JAS01699 Varicella Zoster Virus IgM Antibodies
JAS01700 Varicella Zoster Virus Sero-Dx, IgG & IgM
JAS01701 Vascular Endothelial Growth Factor (VEGF)
JAS01702 VDRL
JAS00453 Vena seksi
JAS00454 Vert. Cervical AP + LAT Vert. Cervical AP + LAT
JAS00455 Vert. Cervical AP/ LAT/OBL Vert. Cervical AP/ LAT/OBL
JAS00456 Vert. Coccygeus Vert. Coccygeus
JAS00457 Vert. Coccygeus (Anak) Vert. Coccygeus (Anak)
JAS00458 Vert. Lumbosacral AP/LAT Vert. Lumbosacral AP/LAT
JAS00459 Vert. Lumboscral AP/LAT/OBL Vert. Lumboscral AP/LAT/OBL
JAS00460 Vert. TH/LS AP + LAT (Anak) Vert. TH/LS AP + LAT (Anak)
JAS00461 Vert. Thoracalis AP/LAT Vert. Thoracalis AP/LAT
JAS00462 Vert. Thoracalis AP/LAT/OBL Vert. Thoracalis AP/LAT/OBL
JAS00463 Vert. Thoracolumbal AP/LAT Vert. Thoracolumbal AP/LAT
JAS01703 Vi tamin D
JAS01704 Vibrio Manual
JAS01705 Vibrio Vitec
JAS01706 Viral Load
JAS00464 Visite Dokter Doctor Visite
JAS01707 Viskositas Darah
JAS01708 VISKOSITAS PLASMA
JAS00465 Visum at repertum
JAS01709 Vitamin A & E
JAS01710 Vitamin B1 (Thiamine)
JAS01711 Vitamin B12
JAS01712 Vitamin B12 Binding Capacity
JAS01713 Vitamin C
JAS01714 Vitamin D 1,25-Dihydroxy
JAS01715 Vitamin D 25-OH Total
JAS01716 Vitamin K1
JAS01717 VMA Urine (#)
JAS01718 Von Willebrand Factor
JAS00466 Vulnus appertum 5-10 jahitan
JAS00467 Vulva hygiene
JAS01719 Waktu Pembekuan
JAS01720 Waktu Perdarahan
JAS01721 Waktu Protrombin
JAS01722 Waktu Trombin
JAS00468 Waters Waters
JAS01723 WATERS
JAS01724 WHOLE BODY BMD
JAS00469 Widal WIDAL
JAS01725 Widal (INI DIHAPUS SAJA)
JAS00470 WIRE RA+RB
JAS00471 Wrist Joint AP/LAT Wrist Joint AP/LAT
JAS00472 Wrist Joint Bilateral Wrist Joint Bilateral
JAS00473 WT dengan luka kecil (1-3 lebar kasa/gaas)
JAS00474 WT luka besar/decubitus/ganggren Wound care Heavy
JAS00475 WT luka sedang Wound care Medium
JAS00476 WT luka sedang (4-6 lebar kasa/gaas)
JAS01726 Xylene
JAS01727 Zn, Serum
JAS01728 Zonisamide
Komponen Harga Kategori Group
Laboratorium - Lain - Lain Laboratorium

Laboratorium - Endokrinologi Laboratorium
Laboratorium - Molekular Laboratorium
Tindakan 407,000.00 Tindakan Tindakan
Laboratorium - Hematologi Laboratorium
Laboratorium - Kimia Laboratorium
Laboratorium - Tuberkulosis Laboratorium
Laboratorium - Penanda Tumor Laboratorium
Laboratorium - Imuno Serologi Laboratorium
Tindakan 4,000,000.00 Tindakan Tindakan
Ambulance 300,000.00 Ambulance Ambulance
Laboratorium - Mikronutrisi & Logam Laboratorium
RSU 150,000.00 Radiologi Radiologi
Laboratorium 285,000 Imuno Serologi Laboratorium
Laboratorium 88,000 Lain - Lain Laboratorium
Laboratorium 26,000 Kimia Laboratorium
Tindakan 46,000.00 tindakan tindakan
BHP - Bahan Habis Pakai Bahan Habis Pakai
RSU 35,000.00 Pemeriksaan Fisik Pemeriksaan Fisik
BHP 130,000.00 Bahan Habis Pakai Bahan Habis Pakai
Laboratorium - Growth Hormon Laboratorium
Tindakan - Tindakan Tindakan
Laboratorium 115,000 Hematologi Laboratorium
Laboratorium - Mikrobiologi Laboratorium
Laboratorium - Kadar Obat Dalam Laboratorium
Laboratorium - Faecess Laboratorium
Laboratorium - Osteoporosis Laboratorium
Kamar 25,000.00 Sewa Kamar Sewa Kamar
Laboratorium - Urine Laboratorium
Laboratorium - Alergi Laboratorium
Laboratorium 27,000 Faecess Laboratorium
RSU 85,000.00 Tindakan Fisioterapi Tindakan Fisioterapi
RSU 165,000.00 Foto Terapi Radiologi
Laboratorium Hematologi Laboratorium
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RSU 47,500.00 Imunisasi Imunisasi
Perawatan 25,000.00 Perawatan Perawatan
Kamar 300,000.00 Sewa Kamar Sewa Kamar
Administrasi 35,000.00 Administrasi Administrasi
Perawatan 69,000.00 Perawatan Perawatan
RSU 92,000.00 Perawatan Perawatan
RSU 50,000.00 Lain - lain Lain - lain
Laboratorium - Urinalisa Laboratorium
Laboratorium 23,000 Urine Laboratorium
Visite 100,000.00 Visite Dokter Visite Dokter
Laboratorium 84,000.00 Imuno Serologi Laboratorium
-
JasaID SectionID Nomor
JAS00209 SECT0022 JAS00045 SECT0017
JAS00017 SECT0022
JAS00018 SECT0022
JAS00041 SECT0022
JAS00042 SECT0022
JAS00043 SECT0022
JAS00044 SECT0022
JAS00046 SECT0022
JAS00050 SECT0022
JAS00052 SECT0022
JAS00053 SECT0022
JAS00054 SECT0022
JAS00064 SECT0022
JAS00066 SECT0022
JAS00067 SECT0022
JAS00068 SECT0022
JAS00069 SECT0022
JAS00070 SECT0022
JAS00071 SECT0022
JAS00072 SECT0022
JAS00073 SECT0022
JAS00074 SECT0022
JAS00075 SECT0022
JAS00076 SECT0022
JAS00077 SECT0022
JAS00078 SECT0022
JAS00079 SECT0022
JAS00080 SECT0022
JAS00081 SECT0022
JAS00082 SECT0022
JAS00083 SECT0022
JAS00084 SECT0022
JAS00085 SECT0022
JAS00086 SECT0022
JAS00087 SECT0022
JAS00088 SECT0022
JAS00089 SECT0022
JAS00095 SECT0022
JAS00096 SECT0022
JAS00097 SECT0022
JAS00098 SECT0022
JAS00099 SECT0022
JAS00100 SECT0022
JAS00101 SECT0022
JAS00102 SECT0022
JAS00103 SECT0022
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DAFTAR TARIF PELAYANAN RS UNUD TAHUN 2016 50

OBAT OBAT Obat - MDCK Medicine - MDCA Medicine -

INTERNA Surat Keterangan Sehat Sekolah-Pendidikan 25,000 K 25,000 A 50,000

PEDIATRI/ANAK Imunisasi 35,000 K 35,000 A 70,000

THT TT Tampon telinga 35,000 TTK 35,000 TTA 70,000

ELEKTROMEDIK Pemeriksaan OAE 69,000 K 69,000 A 138,000

MATA Pemeriksaan Visus 35,000 K 35,000 A 70,000

PSIKIATRI Psikotherapi Edukasi 35,000 K 35,000 A 70,000

BCG JASA PEMBERIAN VAKSIN BCG 10,000

JAS00477 17 Hidro Cort. Steroid

Laboratorium - Lain - Lain Laboratorium

Laboratorium - Hematologi Laboratorium

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