LAPORAN DAFTAR HARGA

Kel. Pelanggan : SIAGA 21 Tipe Aging : Insidentil

Nama Agreement : KLINIK SIAGA 21 Bill : Tidak
No Agreement : AGREE-6101-211000076 Isi Default : Tidak
Tanggal berlaku : 30/10/2021 s/d 30/10/2022 Tanggal Release : 00/00/0000
Tipe Agreement : Lokal Tanggal Verify : 00/00/0000
Klasifikasi omset : Rujukan JPA : (0%) , (0%) , (0%) , (0%)
NO KODE TEST HARGA TEST DARAH SIAGA 21
1 10110100 Hematologi Lengkap 169400
2 10110200 Hematologi Rutin 155100
3 10110300 Hematologi Lengkap + Retikulosit 291500
4 10110400 Hemoglobin 112200
5 10110500 Leukosit 105600
6 10110600 Hitung Jenis 155100
7 10110700 Laju Endap Darah (LED) 105600
8 10110800 Trombosit 113300
9 10110900 Hematokrit 105600
10 10111000 Erytrosit 105600
11 10111100 MCV 97900
12 10111200 MCH 97900
13 10111300 MCHC 97900
14 10111400 RDW 0
15 10111500 Eosinophil 133100
16 10111550 Neutrophil Lymphocyte Count Ratio 59400
17 10111600 Neutrofil (absolut) 148500
18 10111700 Limfosit (absolut) 150700
19 10111800 Retikulosit 187000
20 10111900 Panel Hapusan Darah 445500
21 10112000 Hapusan Darah 335500
22 10112100 Immature Platelet Fraction (IPF) 176000
23 10112200 Immature Reticulocyte Fraction (IRF) 172700
24 10112300 Immature Granulocyte (IG) 0
25 10112400 NRBC 0
26 10112500 IT Ratio 0
27 10112600 Hemoglobin Retikulosit 163900
28 10112800 Indeks Produksi Retikulosit (RPI) 0
29 10120100 Panel Faal Hemostasis 833800
30 10120200 Panel Faal Hemostasis (Non Hapusan Darah) 451000
31 10120300 Panel Faal Hemostasis (Paket DL & FH) 838200
32 10120400 Waktu Perdarahan (BT) 90200
33 10120500 Waktu Pembekuan (CT) 90200
34 10120600 Protrombin Time (PT) 409200
35 10120700 APTT 295900
36 10120800 Protrombin Time (PT - INR) 409200
37 10120900 Fibrinogen 455400
38 10121000 Test Agregasi Trombosit (TAT) 630300
39 10121100 Test Agregasi Trombosit - (3 Stimulan) 632500
40 10121200 Test Agregasi Trombosit - (4 Stimulan) 1038400
41 10121300 Asam Arachidonic 371800
42 10121400 Platelic Activation Factor (PAF) 394900
43 10121500 Restocestin 0
44 10121600 Agregasi Eritrosit 0
45 10121700 Trombotest Owren 567600
46 10121800 D Dimer 880000
47 10121900 Trombin Time (TT) 606100
48 10122100 Von Willebrond Factor 0
49 10122200 Faktor VIII 1576300
50 10122300 Faktor IX 1576300
51 10122400 Protein S 1776500
52 10122500 Protein C 1360700
53 10122600 Retraksi Bekuan 119900
54 10122700 FDP 799700
55 10122800 Anti Trombin 3 1062600
56 10122900 Plasma Recalsification Time 0
57 10123100 Uji Respon Clopidogrel ( PFA P2Y ) 0
58 10123200 Uji Respon Asam Asetil Salisilat ( PFA ASA ) 0
59 10123300 Trombelastogram 1010900
60 10123400 Platelet Rich Fibrin (PRF) 110000
61 10123500 Lupus Anticoagulant 1381600
62 10123600 CTS Circulating Anticoagulant PTT 0
63 10123700 CTS Subtitusi aPTT 0
64 10123800 Rumple Leed 68200
65 10130100 Golongan Darah 135300
66 10130200 Golongan Darah ABO System 0
67 10130300 Golongan Darah Rhesus 82500
68 10130400 CD4 415800
69 10131400 MRD Leukemia 0
70 10131500 CD4 Absolut 0
71 10131600 Immunophenotyping Leukemia Akut 0
72 10131700 NK Cell (Nature Killer Cell) 0
73 10140100 Panel Iron 558800
74 10140200 Serum Iron 262900
75 10140300 TIBC 269500
76 10140400 UIBC 0
77 10140500 Ferritin 455400
78 10140600 Transferin 789800
79 10140700 Saturasi Transferin 390500
80 1014070001 Serum Iron 0
81 1014070002 TIBC 0
82 10140800 Asam Folat 907500
83 10140900 Vitamin B 12 742500
84 10141000 G 6 PD 485100
85 10141100 G 6 PD Neonatus 0
86 10141200 BJ. Plasma 170500
87 10141300 Hemoglobin Elektroforesis (Hb ELP) 863500
88 10141400 HbF 863500
89 10141500 Hb H 863500
90 10141600 Hb A2 Column 863500
91 10141700 Analisa Hb (HPLC) 863500
92 10141800 Haptoglobin 0
93 10150100 Malaria 158400
94 10150200 Mikrofilaria 155100
95 10150300 Limfosit Plasma Biru 267300
96 10150400 Viscositas Darah 187000
97 10150500 Viscositas Plasma 187000
98 10150600 Resistensi Osmotik 0
99 10150700 Ham's (Acid Hemolysin) Test 301400
100 10150800 Sugar Water Test 0
101 10150900 Sucrose water Test 0
102 10151000 Badan Inklusi Hb H 190300
103 10160100 Hapusan Sumsum Tulang 1257300
104 10160200 Bone Marrow Aspiration (BMA) 0
105 1016020102 Jasa Medis Bone Marrow Aspiration (BMA) 0
106 10160213 Jasa Medis Bone Marrow Aspiration (BMA) 0
107 10160300 Janus Kinase 2 (JAK 2) 2604800
108 10210100 Urine Lengkap 108900
109 10210200 Urine Rutin 108900
110 10210300 Urinalysis (Flowcytometry) 163900
111 10210600 BJ Urine 81400
112 10210700 pH Urine 81400
113 10210800 Protein (Albumin) Urine 81400
114 10210900 Glukosa Urine 81400
115 10211000 Keton 81400
116 10211100 Bilirubin urine 81400
117 10211300 Urobilin Urine 81400
118 10211400 Nitrit (Urine Lengkap) 0
119 10211500 Urine Blood (Urine Lengkap) 111100
120 10211600 Lekosit Esterase (Urine Lengkap) 0
121 10212000 Bence Jones Protein 214500
122 10212100 Protein Esbach 192500
123 10212200 Mikroalbumin Kualitatif 326700
124 10212300 Darah Samar Urine 0
125 10212400 Osmolaritas Urine 0
126 10212500 Oval Fat Bodies 0
127 10220100 Plano Test 184800
128 10220200 Test Pack (Test Kehamilan card) 225500
129 10220300 Betta HCG kuantitatif Urine 838200
130 10220400 Menopause Test ( FSH Screening ) 0
131 10230100 Protein Kuantitatif 146300
132 10230200 Elektroforesis Protein Urine (Urine ELP) 540100
133 10230300 Mikroalbumin Sewaktu 326700
134 10230400 Albumin-Creatinine Ratio (ACR) 326700
135 10230500 Mikroalbumin (Urin 24 jam) 291500
136 10230600 Amylase Urine 408100
137 10230700 Ureum Urine 105600
138 10230800 Urea N Urine 106700
139 10230900 Ureum Urine (Pagi Pertama) 106700
140 10231000 Urea N Urine (Pagi Pertama) 106700
141 10231100 Creatinin Urine 106700
142 10231200 Creatinin urine (Pagi Pertama) 106700
143 10231300 Asam Urat Urine 106700
144 10231400 Natrium Urine 193600
145 10231500 Kalium Urine 193600
146 10231600 Chloride Urine 193600
147 10231700 Calsium Urine 180400
148 10231800 Phosphor Anorganik Urine 180400
149 10231900 Magnesium Urine 180400
150 10232000 Mercuri (Hg) Urine 0
151 10232100 Pb Urine 352000
152 10232200 Arsen (As) Urine 300300
153 10232300 Benzena 273900
154 10232400 Toluena 273900
155 10232500 Xylena 0
156 10232600 Cadmium (Urine) 0
157 10232700 Yodium Urine 0
158 10232800 Imunofiksasi Urine 0
159 10240100 Panel Screening Narkoba (6 Jenis) 740300
160 1024010001 Morphine (Screening Test) 0
161 1024010002 Cocaine (Screening Test) 0
162 1024010003 Metamphetamine (Screening Test) 0
163 1024010004 Cannabinoid (Screening Test) 0
164 1024010005 Benzodiazepin (Screening Test) 0
165 1024010006 Amphetamin (Screening Test) 0
166 10240200 Panel Screening Narkoba (3 Jenis) 407000
167 10240300 Morphine (Screening Test) 213400
168 10240400 Cocaine (Screening Test) 213400
169 10240500 Metamphetamine (Screening Test) 213400
170 10240600 Cannabinoid (Screening Test) 213400
171 10240700 Benzodiazepin (Screening Test) 213400
172 10240800 Opiate (Screening Test) 213400
173 10240900 Barbiturat (Screening Test) 213400
174 10241000 Phencyclidine (PCP) 213400
175 10241100 Amphetamin (Screening Test) 213400
176 10241200 Cotinine Urine 0
177 10241300 Alkohol Urine 284900
178 10241400 Methadone 0
179 10241500 Propoxyphene 0
180 10310100 Faeces Rutin 137500
181 10310200 Faeces Rutin (Metode Konsentrasi) 0
182 10310300 Benzidine/darah samar 280500
183 10310400 Occult Blood Test 280500
184 10310500 Floating Test 157300
185 10310600 Clinitest 125400
186 10310700 Pencernaan 122100
187 10310800 Karbohidrat/Amylum Faeces 0
188 10310900 Lemak Faeces 110000
189 10311000 Protein Faeces 0
190 10311100 Stercobilin 183700
191 10311200 pH Faeces 89100
192 10311300 Fecal Calprotectin 910800
193 10410100 Analisa Semen 515900
194 10410200 Preparasi Sperma 2599300
195 10410300 Direct MAR 487300
196 10410400 Indirect MAR 815100
197 10410500 Uji Fragmentasi DNA (Analisa Sperma) 1361800
198 1041060202 Jasa Medis Vaksin Hepatitis A (II) 0
199 10410700 Massage Prostat 0
200 1042010001 Analisa Liquor (CSF) 772200
201 1042010002 Glukosa (Liquor) 101200
202 1042010003 Protein (Liquor) 133100
203 1042010004 LDH (Liquor) 0
204 10420200 Analisa Liquor (CSF) 0
205 10420300 Glukosa (Liquor) 0
206 10420400 Protein (Liquor) 0
207 1042060001 Analisa Pleura 816200
208 1042060002 Protein (Pleura) 129800
209 1042060003 Glukosa (Pleura) 101200
210 1042060005 LDH (Pleura) 239800
211 10420601 Analisa Pleura 0
212 10421000 Protein (Pleura) 0
213 10421100 Glukosa (Pleura) 0
214 10421200 Albumin (Pleura) 0
215 10421300 LDH (Pleura) 0
216 1042140001 Analisa Asites 754600
217 1042140002 Protein (Asites) 0
218 1042140003 Glukosa (Asites) 0
219 1042140007 LDH (Asites) 0
220 10421500 Analisa Asites 754600
221 10421700 Protein (Asites) 0
222 10421800 Glukosa (Asites) 0
223 1042230001 Analisa Cairan Sendi 754600
224 1042230002 Protein (cairan sendi) 0
225 1042230003 Glukosa (Cairan sendi) 0
226 1042230004 Asam Urat (cairan Sendi) 0
227 10422400 Analisa Cairan Sendi 0
228 10422500 Protein (cairan sendi) 0
229 10422600 Glukosa (Cairan sendi) 0
230 1042280001 Analisa Cairan Tubuh 754600
231 1042280002 Protein (Analisa Cairan Tubuh) 0
232 1042280003 Glukosa (Analisa Cairan Tubuh) 99000
233 1042280006 LDH (Analisa Cairan Tubuh) 0
234 10422900 Analisa Cairan Tubuh 0
235 10423100 Protein (Analisa Cairan Tubuh) 0
236 10423200 Glukosa (Analisa Cairan Tubuh) 0
237 10423500 None 133100
238 10423600 Pandi 111100
239 10423800 Liquor Protein Elektroforesis 0
240 10423900 Ascites Protein Elektroforesis 0
241 10430100 Analisa Batu Empedu 0
242 10430200 Analisa Batu Ginjal 515900
243 10510100 SGOT 88000
244 10510200 SGPT 88000
245 10510300 Gamma GT 156200
246 10510400 Alkali Fosfatase 139700
247 10510500 Cholinesterase 267300
248 10510600 Bilirubin 214500
249 10510700 Bile Acid 1409100
250 10510800 Panel Protein 292600
251 10510900 Total Protein 129800
252 10511000 Albumin 129800
253 10511100 Globulin 129800
254 10511200 Ratio Alb/Glo 199100
255 10511300 Gamma Globulin 514800
256 10511400 Protein Elektroforesis (ELP) 475200
257 10511500 Protein Elektroforesis (ELP) 5 Fraksi 441100
258 10511600 TTT 155100
259 10511700 Gross Titrasi 173800
260 10511800 GLDH 1134100
261 10511900 Pre-Albumin 0
262 10512000 Isoenzyme ALP 1521300
263 10512100 Alfa 1 Anti Tripsin 554400
264 10520100 Panel Profil Lemak 432300
265 10520200 Panel Profile Lemak (Ratio Chol/HDL) 432300
266 10520300 Cholesterol 91300
267 10520400 Trigliserida 92400
268 10520500 HDL Cholesterol 115500
269 10520600 LDL Cholesterol 115500
270 10520700 LDL Cholesterol Direct 166100
271 10520800 Cholesterol/HDL Chol. Ratio 190300
272 10520900 LDL/HDL Chol. Ratio 250800
273 10521000 Total Lipid 174900
274 10521100 Lp (a) 664400
275 10521200 Chol Apo A-1 491700
276 10521300 Chol Apo B 353100
277 10521400 Apolipoprotein B/A-1 Ratio 0
278 10521500 Small Dense LDL 536800
279 1052150003 Small Dense LDL (Small Dense LDL) 0
280 10521600 VLDL Cholesterol 214500
281 10530100 Ureum 89100
282 10530200 BUN 89100
283 10530300 Panel Creatinin 89100
284 10530400 Serum Creatinin 89100
285 10530500 Asam Urat 88000
286 10530601 Panel Urea Clearence 0
287 10530701 Panel Creatinin Clearence 210100
288 10530800 Acid Phosphatase 838200
289 10530900 P.A.P 910800
290 10531000 Panel Cystatine C 0
291 10531100 Cystatine C 540100
292 10531101 eGFR (Cystatine C ) 0
293 10531200 Glomerolus Filtration Rate (GFR) 89100
294 10531300 FENa (Fractional Excretion of Sodium) 0
295 1053130001 Natrium Urine 0
296 1053130002 Natrium 0
297 1053130003 Creatinin Urine 0
298 1053130004 Serum Creatinin 0
299 10540100 Panel Glukosa Puasa 73700
300 10540200 Glukosa Darah Puasa 56100
301 10540300 Panel Glukosa 2 Jam PP 73700
302 10540400 Glukosa Darah 2 Jam PP 56100
303 10540700 Panel Glukosa Sewaktu 73700
304 10540800 Glukosa Darah Sewaktu 56100
305 10540900 Panel HbA1c 271700
306 10541000 HbA1c 271700
307 10541100 Panel Resistensi Insulin 666600
308 10541200 Insulin 662200
309 10541300 Insulin (2 jamPP) 662200
310 10541400 C Peptide 718300
311 10541500 C Peptide 2jam PP 718300
312 10541600 Glycated Albumin 301400
313 10541700 Fruktosamin 624800
314 10541800 Homa 1-1R 729300
315 10541900 Test Toleransi Glukosa (GTT) 309100
316 10542000 Test Toleransi Glukosa (GTT - 5X) 316800
317 10542100 Test Toleransi Glukosa (GTT-3 jam) 299200
318 10542200 Gestasional TTGO (50 gr) 176000
319 10542300 Gestasional TTGO (100 gr) 316800
320 10542400 Glukosa Kurva Harian 317900
321 10542500 Glukosa Darah 1 JPP 56100
322 10542600 Panel Glukosa 2 Jam PP Oral 0
323 10542700 Glukosa Darah 2 Jam PP Oral 0
324 10542800 Adiponectin Total 1116500
325 10550100 Panel Elektrolit (Na, K, Cl) 500500
326 10550200 Natrium 193600
327 10550300 Kalium 193600
328 10550400 Chlorida 193600
329 10550500 Calsium 171600
330 10550600 Calsium Ion 328900
331 10550700 Phosphor Anorganik 171600
332 10550800 Bikarbonat 500500
333 10550900 Magnesium 180400
334 10551000 Phosphate (PO4) 0
335 10551100 Asam Laktat 0
336 10551200 Anion Gab 0
337 10551300 Pb Darah 361900
338 10551400 Zinc (Zn) Darah 575300
339 10551500 Mercury (Hg) Darah 300300
340 10551600 Arsen (As) Darah 0
341 10551700 Cuprum (Cu) Darah 381700
342 10551800 Cadmium Darah 0
343 10551900 Cyanida 0
344 10552000 Iodine 0
345 10552100 Mangan (Mn) 567600
346 10552200 Iron (Fe) 567600
347 10552300 Chromium (Cr) 0
348 10552400 Selenium (Se) 0
349 10552500 Cobalt (Co) 0
350 10552600 Vanadium (V) 0
351 10552700 Molybdenum (Mo) 0
352 10552800 Status Antioksidan Total 0
353 10560100 CPK / CK 309100
354 10560200 CK MB 609400
355 10560300 LDH 213400
356 10560400 Troponin T 696300
357 10560500 Troponin I 440000
358 10560550 HS Troponin I 761200
359 10560600 Hs-CRP 415800
360 10560700 Homocystein 1112100
361 10560800 Alfa HBDH 423500
362 10560900 NT-Pro BNP 1141800
363 10561000 Myoglobin 0
364 1056110001 Pro BNP 0
365 1056110002 CK MB - MAS 0
366 1056110003 ST 2 0
367 10561200 Pro BNP 1141800
368 10561300 CK MB - MAS 599500
369 10561400 ST 2 981200
370 10570100 Phenytoin/Dilantin 1595000
371 10570200 Digoxin 1936000
372 10570300 Carbamazepin 2029500
373 10570400 Cyclosporin 2338600
374 10570500 Theophilin / Amynophilin 2926000
375 10570600 Phenobarbital / Luminal 3245000
376 10570700 Amikasin/Serum 0
377 10570800 Tacrolimus 1490500
378 10590100 Amylase 379500
379 10590200 P-Amylase 423500
380 10590300 Lipase 379500
381 10590400 Adenosin Deaminase (ADA) - Cairan Tubuh 385000
382 10590500 Vitamin D 534600
383 10590600 Betta Crosslap (CTx) 817300
384 10590700 C-Telo Peptide (CTx) 817300
385 10590800 N Mid Osteocalsin 797500
386 10590900 Total P1NP 0
387 10591000 Urea Breath Test ( UBT ) 2074600
388 10591100 Vitamin B 3 0
389 10591200 Alkohol 768900
390 10591300 Osmolaritas Serum 343200
391 10591400 Superoxide Dismutase (SOD) 0
392 10591500 Total Antioksidan 0
393 10591600 Pb (Rambut) 0
394 10591700 Cadmium (Rambut) 0
395 10591800 Aluminium (Rambut) 0
396 10591900 Zinc (Zn) Rambut 0
397 10592000 Alkohol (Air Liur) 284900
398 10592200 Vitamin C (Obat) 0
399 10610100 HBsAg 255200
400 10610200 HBs Ag (Titer) 621500
401 10610300 HBs Ag Confirmatory 1292500
402 10610400 Anti HBs 287100
403 10610500 Anti HBs Titer 544500
404 10610600 Anti HBc 564300
405 10610700 IgM Anti HBc 897600
406 10610800 HBe Ag 756800
407 10610900 Anti HBe 948200
408 10611000 Anti HAV 772200
409 10611100 IgM Anti HAV 687500
410 10611200 Anti HCV 666600
411 10611300 IgM Anti HCV 974600
412 10611400 IgG Anti HAV 0
413 10620100 IgG Toxoplasma 468600
414 10620200 IgM Toxoplasma 468600
415 10620300 IgG Toxoplasma Avidity 795300
416 10620400 IgG Rubella 503800
417 10620500 IgM Rubella 632500
418 10620600 IgG CMV 475200
419 10620700 IgM CMV 651200
420 10620800 IgG CMV Avidity 728200
421 10620900 Antigenemia CMV 1835900
422 10621000 IgG HSV1 550000
423 10621100 IgM HSV1 550000
424 10621200 IgG HSV 2 544500
425 10621300 IgM HSV 2 544500
426 10621400 Panel TORCH I 4566100
427 10621500 Panel TORCH II 4043600
428 10621600 TPHA 269500
429 10621700 VDRL 166100
430 10621800 Anti HIV 617100
431 10621900 Anti HIV (SCREENING) 378400
432 10622000 Western Blot 2290200
433 10622100 IgG Chlamydia 1142900
434 10622200 IgM Chlamydia 1142900
435 10622300 VDRL TITER 275000
436 10622400 Weil Felix 0
437 10622500 HTLV - I/II 0
438 10630100 Widal Slide 254100
439 10630200 IgM Anti Salmonella typhi ( Tubex TF ) 507100
440 10630300 IgG Anti Salmonella Typhi 660000
441 10630400 Salmonella - Antigen 0
442 10630500 Panel Anti Salmonella 0
443 10630600 IgG Anti DHF 700700
444 10630700 IgM Anti DHF 663300
445 10630800 Anti DHF (rapid) 765600
446 10630900 IgA Anti DHF Rapid 0
447 10631000 Dengue NS1 (Elisa) 606100
448 10631100 Dengue NS1 (Rapid) 592900
449 10631200 Panel DHF 854700
450 1063120004 Dengue NS1 (Rapid) 0
451 10631300 Malaria - ICT 682000
452 10631400 IgM Anti Leptospira 991100
453 10631500 IgM Chikungunya 531300
454 10631600 IgM Anti EBV VCA 1507000
455 10631700 IgG Anti EBV VCA 1456400
456 10631800 IgA Anti EBV VCA 1452000
457 10631900 IgG Anti EBV EA 0
458 10632000 IgA Anti EBV EA 1695100
459 10632100 IgA Anti EBV EBNA 0
460 10632200 Mono (Mononucleosis) Test 0
461 10632300 TB-IGRA 1348600
462 10632400 Anti M TBC (ICT) 532400
463 10632500 IgG Anti M. TBC 0
464 10632600 TB Antigen Rapid Test 434500
465 10632700 IgG Anti Mycoplasma 1846900
466 10632800 IgM Anti Mycoplasma 1846900
467 10632900 IgG Anti Mycoplasma Pneumonia 2173600
468 10633000 IgM Anti Mycoplasma Pneumonia 2173600
469 10633100 IgM Helicobacter Pylori 817300
470 10633200 IgG Helicobacter Pylori 965800
471 10633300 Helicobacter Pylori (Rapid) 0
472 1063330001 IgM Helicobacter Pylori 0
473 1063330002 IgG Helicobacter Pylori 0
474 10633303 Helicobacter Pylori Antigen 330000
475 10633400 Seramoeba 655600
476 10633500 Seramoeba/IDT Titer 0
477 10633600 Rotavirus Antigen Test 0
478 10633700 IgG Anti Measless 1689600
479 10633800 IgM Anti Measless 1950300
480 10633900 IgM Anti PGL-1 512600
481 10634000 IgG Anti PGL-1 512600
482 10634500 IgG Mumps 1689600
483 10634600 IgM Mumps 1938200
484 10634700 IgG Anti Varicella 1689600
485 10634800 IgM Anti Varicella 1938200
486 10634900 Anti SARS CoV-2 (IgM & IgG) 0
487 10635000 Anti SARS CoV-2 0
488 10635300 Pengambilan Spesimen Swab 385000
489 10635400 Anti SARS CoV-2 (Serologi Test) 0
490 10635500 SARS CoV-2 Antigen Test 119900
491 10635700 Clostridium difficile GDH 605000
492 10635800 Pengambilan Swab Antigen 110000
493 1063590002 Pengambilan Swab Antigen 110000
494 10636000 Anti SARS CoV-2 S-RBD (Kuantitatif) 275000
495 10636100 Anti SARS CoV-2 S-RBD (Kuantitatif) Titer 440000
496 10636200 IgG Anti SARS CoV-2 S-RBD (Kuantitatif) 0
497 10640100 IgG 831600
498 10640200 IgM 831600
499 10640300 IgA 797500
500 10640400 C3 Complemen 853600
501 10640500 C4 Complemen 853600
502 10640600 Rhematoid Factor (RF) Kualitatif 191400
503 10640700 Rhematoid Factor (RF) Kuantitatif 446600
504 10640800 IgM Rheumathoid Factor 602800
505 10640900 Rose Wealer 180400
506 10641000 CRP Kualitatif 280500
507 10641100 CRP Kuantitatif 405900
508 10641200 ASO/ASTO 189200
509 10641300 ASO/ASTO Kuantitatif/Titer 430100
510 10641400 Pro - Calcitonin (PCT) 1301300
511 10641500 Anti CCP Antibodi 1210000
512 10641600 Panel Anti - MCV 678700
513 10641700 Rhematoid Factor (RF) Anti MCV 0
514 10641800 Anti MCV 430100
515 10641900 Anti RA - 33 667700
516 10642000 LE Test 638000
517 10642100 ANA Test 638000
518 10642200 ANA IF 965800
519 10642300 ANA IF (Titer) 1413500
520 10642400 ANA PANEL TEST 1769900
521 10642500 Anti Ds DNA 891000
522 10642600 ACA-IgG 852500
523 10642700 ACA-IgM 852500
524 10642800 AMA 644600
525 10642900 SMA / ASMA 694100
526 10643000 ANCA 801900
527 10643100 Anti - SM Antibodi 0
528 10643200 Anti ß2 - Glycoprotein 1 (ß2-GP1) IgM 977900
529 10643300 Anti ß2 - Glycoprotein 1 ((ß2-GP1) IgG 977900
530 10643400 β2 - Microglobulin 845900
531 10643500 Anti SS / A (RO) 0
532 10643600 Anti SS / B (LA) 0
533 10643700 EMA/tTG 0
534 10643800 Human Leucocyte Antigen - B27 (HLA-B27) 2242900
535 10643900 Interleukin 6 (IL 6) 550000
536 10644000 Imunoelektroforesis 1345300
537 10644100 Immunofiksasi 0
538 10644200 Immunofiksasi Serum Light Chain 0
539 10644400 Antibody Sperm Autoimmune (ASA) 0
540 10650100 AFP 544500
541 10650200 CEA 511500
542 10650300 PSA Total 672100
543 10650400 Panel Free PSA 1243000
544 10650500 MCA 0
545 10650600 CA 15-3 998800
546 10650700 Ca 19-9 1038400
547 10650800 Ca 72-4 1399200
548 10650900 CA-125 1007600
549 10651000 Human Epididymis 4 (HE-4) 965800
550 10651100 ROMA 1320000
551 10651200 Panel Penanda Ca Cerviks 0
552 10651300 NSE 1045000
553 10651400 SCC 998800
554 10651500 Cyfra 21-1 1161600
555 10651600 M2 - PK (Piruvat Kinase) 976800
556 10660100 T3 414700
557 10660200 T4 414700
558 10660300 TSHs 422400
559 10660400 TSHs (Neonatus) 236500
560 10660500 Free T4 522500
561 10660600 Free T3 675400
562 10660700 Free T4 Index 568700
563 1066070001 T4 0
564 1066070003 T-uptake 0
565 10660800 T-uptake 851400
566 10660900 FTI 687500
567 1066090001 T4 0
568 1066090002 T-uptake 0
569 10661000 T3-Uptake 852500
570 10661100 Tyroglobulin 815100
571 10661200 Anti Tyroglobulin 715000
572 10661300 Anti-TPO 1525700
573 10661400 TSH Receptor Antibodies (TRAB) 632500
574 10661500 Thyroid Autoantibodies 0
575 10661600 Parathyroid Hormon 1203400
576 10661700 impact Parathyroid Hormone / IPTH 0
577 10661800 Intact Parathyroid Hormone / IPTH 1293600
578 10661900 LH 576400
579 10662000 FSH 583000
580 10662100 Prolaktin 561000
581 10662200 Estradiol 735900
582 10662300 Progesteron 752400
583 10662400 Estrogen Total 2442000
584 10662500 Estriol 1800700
585 10662600 Betta HCG kuantitatif serum 839300
586 10662700 Free Betta HCG 1103300
587 10662800 PAPP-A 1032900
588 10662900 Anti Mulerien Hormon (AMH) 894300
589 10663000 Soluble FMS-Like Tyrosine Kinase-1 (sFlt-1) 1101100
590 10663100 Placental Growth Factor (PlGF) 1152800
591 10663200 sFlt-1/PlGF ratio 2246200
592 10663300 VEGF-A 0
593 10663400 Endoglin 0
594 10663500 Endothelin-1 0
595 10663600 Testosteron 693000
596 10663700 Free Testosteron 1349700
597 10663800 Dehydrotestosteron / DHT 2290200
598 10663900 Sex Hormone Binding Globulin (SHBG) 2259400
599 10664000 Free Testosterone Index 3030500
600 10664100 Aldosteron 0
601 10664200 Growth Hormon Basal 772200
602 10664300 Growth Hormon Excersice 772200
603 10664400 Cortisol 766700
604 10664500 Cortisol Urine 0
605 10664600 Cortisol Saliva 0
606 10664700 Calcitonin 1535600
607 10664800 Pregnenolone 1635700
608 10664900 DHEA-S 1172600
609 10665000 ACTH 3258200
610 10665100 IgF - 1 1668700
611 10665200 Renin 0
612 10665300 Anti Diuretic Hormone (ADH) 0
613 10670100 IgE Total 592900
614 10670200 IgE Spesifik Aspergillus 1157200
615 10670300 IgE Spesifik Bulu Ayam 988900
616 10670400 IgE Spesifik Coklat 822800
617 10670500 IgE Spesifik Daging Ayam 970200
618 10670600 IgE Spesifik Debu Rumah 805200
619 10670700 IgE Spesifik Epitel Anjing 863500
620 10670800 IgE Spesifik Epitel Tikus 902000
621 10670900 IgE Spesifik Epitel Kucing 836000
622 10671000 IgE Spesifik Ikan 829400
623 10671100 IgE Spesifik Jamur Mukor 1081300
624 10671200 IgE Spesifik Kacang 1089000
625 10671300 IgE Spesifik Kecoa 1215500
626 10671400 IgE Spesifik Kepiting 944900
627 10671500 IgE Spesifik Kerang 915200
628 10671600 IgE Spesifik Penisilin 766700
629 10671700 IgE Spesifik Susu Sapi 992200
630 10671800 IgE Spesifik Kuning Telur 998800
631 10671900 IgE Spesifik Putih Telur 998800
632 10672000 IgE Spesifik Tungau 998800
633 10672100 IgE Spesifik Udang 1072500
634 10672200 IgE Spesifik Gandum 1072500
635 10672300 IgE Spesifik Daging Sapi 885500
636 10672400 IgE Rast Susu Kedelai 849200
637 10672500 Panel IgE Atopy 0
638 10672600 Panel IgE Spesifik Makanan 2374900
639 10672700 Panel IgE Rast Hirupan 0
640 10672800 Panel IgE Spesifik 52 Jenis 2355100
641 10672900 Panel IgE Spesifik 54 Jenis 2355100
642 10673000 Panel Food Intolerance Screening 8682300
643 10673100 Skin Test - Debu Rumah 0
644 10673200 Panel Food Sensitivity Screening (46 Jenis) 3478200
645 10710100 Preparat Gram 143000
646 10710200 Preparat BTA 143000
647 10710300 Preparat BTA serial 254100
648 1071030001 Preparat BTA I 0
649 10710301 Preparat BTA I 143000
650 10710302 Preparat BTA II 143000
651 10710303 Preparat BTA III 143000
652 10710400 Preparat Diphteri 143000
653 10710500 Preparat Trichomonas 143000
654 10710600 Preparat GO 143000
655 10710700 Preparat Jamur 143000
656 10710800 Preparat Candida 143000
657 10710900 Preparat Sekret 232100
658 1071090001 Preparat Gram 0
659 1071090002 Preparat Trichomonas 0
660 1071090003 Preparat GO 0
661 1071090004 Preparat Jamur 0
662 10711000 Preparat Stool 143000
663 10711100 Preparat Lepra (Leprosy) 143000
664 10711200 Panel Preparat Bakterial Vaginosis 378400
665 10711300 Preparat Jamur Acanthamoeba Sp 143000
666 10711400 Preparat Demodex 138600
667 10711500 Preparat Giemsa 0
668 10720100 Kultur Darah (Vitek) 936100
669 10720200 Kultur Urine (Vitek) 856900
670 10720400 Kultur Gall (Vitek) 900900
671 10720500 Kultur Pus (Vitek) 885500
672 10720600 Kultur Sputum (Vitek) 936100
673 10720700 Kultur Faeces (Vitek) 885500
674 10720800 Kultur Sekret (Vitek) 885500
675 10720900 Kultur G.O (Vitek) 936100
676 10721000 Kultur Usap Mata (Vitek) 877800
677 10721100 kultur Usap Tenggorok (Vitek) 936100
678 10721200 Kultur Usap Hidung (Vitek) 936100
679 10721300 Kultur Usap Telinga (Vitek) 862400
680 10721400 Kultur Usap Rectal (Vitex) 966900
681 10721500 Kultur Cairan Pleura (Vitek) 900900
682 10721600 Kultur Cairan Liquor (Vitek) 940500
683 10721700 Kultur Liquor (Vitek) 862400
684 10721800 Kultur Cairan Sendi (Vitek) 936100
685 10721900 Kultur Cairan Asites (Vitek) 936100
686 10722000 Kultur Sperma (vitek) 900900
687 10722100 Kultur Biopsi Jaringan (Vitek) 0
688 10722200 Kultur Muntahan (Vitek) 862400
689 10722300 Kultur Wash Bronchii (Vitek) 862400
690 10722400 Kultur Bullion I (Vitek) 0
691 10722500 Kultur Bullion II (Vitex) 0
692 10722600 Kultur Bullion III (Vitex) 0
693 10722700 Kultur MRSA (Vitek) 877800
694 10722800 Kultur MRSS (Vitek) 0
695 10722900 Kultur Luka/Ulkus (Vitek) 795300
696 10723000 Kultur Bakteri/Mikroorganisme (Vitek) 862400
697 10723100 Kultur Mikroorganisme (vitek) 936100
698 10723200 Uji Kepekaan Antibiotika (Vitex) 0
699 10730100 Kultur Darah 752400
700 10730200 Kultur Urine 662200
701 10730201 Hitung Kuman (Kultur Urine) 0
702 10730300 Kultur Gall 662200
703 10730400 Kultur Pus 687500
704 10730500 Kultur Sputum 735900
705 10730600 Kultur BTA 867900
706 10730700 Kultur Faeces 745800
707 10730800 Kultur Sekret 705100
708 10730900 Kultur G O 612700
709 10731000 Kultur Diphteri 293700
710 10731100 Kultur Cairan Liquor/CSF 621500
711 10731200 Kultur Cairan Pleura 662200
712 10731300 Kultur Cairan Sendi 606100
713 10731400 Kultur Cairan Empedu 877800
714 10731500 Kultur Cairan Asites 715000
715 10731600 Kultur Usap Mata 679800
716 10731700 Kultur Usap Hidung 679800
717 10731800 Kultur Usap Tenggorok 655600
718 10731900 Kultur Usap Telinga 713900
719 10732000 Kultur Rectal Swab 639100
720 10732100 Kultur Muntahan 715000
721 10732200 Kultur Wash Bronchii 713900
722 10732300 Kultur Bullion I 680900
723 10732400 Kultur Bullion II 680900
724 10732500 Kultur Bullion III 680900
725 10732600 Stool - Salmonella 409200
726 10732700 Stool - Salmonella-Shigella (SS) 433400
727 10732800 Stool - SS & EPEC 713900
728 10732900 Stool - SS, EPEC & Vibrio 713900
729 10733000 Kultur Staphylococcus 713900
730 10733100 Kultur Biopsi Jaringan 957000
731 10733200 Kultur Luka/Ulkus 713900
732 10733300 Kultur MRSA 696300
733 10733400 Kultur MRSS 0
734 10733500 Kultur Bakteri/Mikroorganisme 718300
735 10733600 Kultur Bakteri - Anaerob 0
736 10733700 Uji Kepekaan Antibiotika 0
737 10733800 Uji Resistensi M. TBC 0
738 10740100 Kultur Jamur 557700
739 10740200 Kultur Jamur Acanthamoeba Sp 0
740 10740300 Panel Kultur Jamur Acanthamoeba Sp 0
741 10740400 Kultur Jamur - Faeces 1357400
742 10740500 Uji Kepekaan - Jamur 814000
743 10810100 HBV DNA 2471700
744 10810200 HBV DNA Genotyping 4639800
745 10810300 HCV RNA 3477100
746 10810400 HCV RNA Genotyping 4675000
747 10810500 Human Papilloma Virus / HPV (PCR) 982300
748 1081050101 Human Papilloma Virus / HPV (PCR) 982300
749 10810550 Human Papilloma Virus / HPV (PCR) - Urine 0
750 1081055101 Human Papilloma Virus / HPV (PCR) - Urine 0
751 10810600 HIV DNA Kualitatif PCR 1434400
752 10810700 HIV Viral Load 2411200
753 10810800 CMV PCR 0
754 10810900 EBV DNA PCR 0
755 10811000 Salmonella PCR 982300
756 10811100 Salmonella PCR (Faeces) 0
757 10811200 M. TBC PCR 982300
758 10811300 M.TBC PCR (Sputum) 1428900
759 10811400 M.TBC PCR (Liquor) 982300
760 10811500 M.TBC PCR (Urin) 982300
761 10811600 M.TBC PCR (Pleura) 982300
762 10811700 M.TBC PCR (Ascites) 982300
763 10811800 M.TBC PCR (............) 982300
764 10811900 M.TBC PCR (Darah) 982300
765 10812000 M.TBC PCR (Cairan Sendi) 982300
766 10812100 M.TBC PCR (Pus) 982300
767 10812200 M.TBC PCR (FNAB) 982300
768 10812300 M.TBC PCR (Pericard) 982300
769 10812400 M.TBC PCR (Broncus) 982300
770 10812500 Chlamydia trachomatis PCR 2095500
771 10812600 Chlamydia Pneumonia PCR 860200
772 10812700 Mycoplasma pneumonia PCR 0
773 10812800 Malaria - PCR 0
774 10812900 Legionella pneumonia PCR 860200
775 1081300002 Pengambilan Spesimen Swab 385000
776 1081300003 Konsultasi Pemeriksaan 0
777 10813100 SARS CoV-2 RNA 577500
778 10813700 Entherpex (Clart) 0
779 10813800 Pneumovir (Clart) 0
780 10813900 Pneumobac (Clart) 0
781 10814000 HPV2 (Clart) 0
782 10820100 BCR-ABL Qualitative PCR 0
783 10820200 BCR-ABL Quantitative PCR 3339600
784 10820300 H - RAS 0
785 10820400 Interleukin 28B (IL28B) 783200
786 10820500 K - RAS 0
787 10820600 N - RAS 0
788 10820700 B - RAF 0
789 10820800 PI3K 0
790 10830100 Non Invasive Prenatal Test (NIPT) 6479000
791 10830200 Non Invasive Prenatal Test (NIPT) Plus 10340000
792 10830300 Non Invasive Prenatal Test (NIPT) Microdeletion 13090000
793 10830400 BRCA Screening 3575000
794 10830500 Hereditary Cancer Screening (HCS) 10000100
795 10830600 Farmakogenetika 10000100
796 10830800 Genetic Analysis - AZF Microdeletions 0
797 10830900 Karyotyping 0
798 10831000 Karyotyping (Cairan Amnion) 0
799 10910100 Pap Smear 368500
800 1091010102 Jasa Ekspertisi Pap Smear 60500
801 10910200 Pap Smear (Liquid C Prep) 507100
802 1091020102 Jasa Ekspertisi Pap Smear (Liquid C Prep) 60500
803 10910300 FNA 0
804 1091030101 FNA 1118700
805 1091030102 Jasa Medis FNA 756800
806 1091030103 Jasa Medis FNA Cyto 0
807 10910302 Jasa Medis FNA 756800
808 10910303 Jasa Medis FNA Cyto 0
809 10910400 Cytologi Urine 735900
810 10910500 Cytologi Pleura 684200
811 10910600 Cytologi Liquor 684200
812 10910700 Cytologi Cairan Tubuh 684200
813 10910800 Cytologi Sputum 718300
814 10920100 PA Jaringan (Kecil) 0
815 10920200 PA Jaringan (Sedang) 0
816 10920300 PA Jaringan (Besar) 0
817 11010100 Manthoux Test 480700
818 11010200 IVA Test 130900
819 11010300 Uroflowmetri 421300
820 11010500 Plasma Separasi 57200
821 2011010101 Elektroencephalografi (EEG) 1116500
822 2011010102 Jasa Ekspertisi Elektroencephalografi (EEG) 231000
823 2011020101 Elektroencephalografi (EEG) Tidur 1181400
824 2011020102 Jasa Ekspertisi Elektroencephalografi (EEG) Tidur 231000
825 20110203 Obat EEG 48400
826 2011030101 Transcranial Doppler (TCD) 1243000
827 2011030102 Jasa Medis TCD 289300
828 2012010101 ECG 174900
829 2012010102 Jasa Ekspertisi ECG 19800
830 2012020101 Treadmill 891000
831 2012020102 Jasa Medis Treadmill 173800
832 2012030101 Echocardiografi 1027400
833 2012030102 Jasa Medis Echocardiografi 184800
834 2012040101 Echocardiography Anak 0
835 2012040102 Jasa Medis Echocardiography Anak 0
836 2012050101 Holter Monitoring 1401400
837 2012050102 Jasa Ekspertisi Holter Monitoring 156200
838 2012060101 Holter Monitoring 48 Jam 0
839 2012070101 Holter Monitoring 72 Jam 0
840 2012070102 Jasa Ekspertisi Holter Monitoring 72 Jam 0
841 2012080101 PAD Test 319000
842 2012080102 Jasa Eksperti PAD Test 0
843 20120900 Ankle Brachial Index 0
844 20121000 Ambulatory Blood Pressure Monitoring (ABPM) 0
845 2012100101 Ambulatory Blood Pressure Monitoring (ABPM) 0
846 2013010101 Audiometry 249700
847 2013010102 Jasa Ekspertisi Audiometry 26400
848 2013020101 Tympanometry 0
849 2013030101 Bera Screening 319000
850 2013030102 Jasa Ekspertisi Bera Screening 0
851 2013040101 Bera Test 425700
852 2013040102 Jasa Ekspertisi Bera Test 0
853 20130403 Premedikasi Obat Bera 0
854 2014010101 Autospirometry 238700
855 2014010102 Jasa Ekpertisi Autospirometry 28600
856 2015010101 EMG 1060400
857 2015010102 Jasa Ekspertisi EMG 308000
858 3011010101 WATERS 394900
859 3011010102 Jasa Ekspertisi Waters 30800
860 3011020101 Waters Sinus Paranasalis 418000
861 3011020102 Jasa Ekspertisi Waters Paranasalis 30800
862 3011030101 Basis Cranii 437800
863 3011030102 Jasa Ekspertisi Basis Cranii 30800
864 3011040101 Cald-Well 404800
865 3011040102 Jasa Ekspertisi Cald-well 30800
866 3011050101 Eisler dex 397100
867 3011050102 Jasa Ekspertisi Eisler dex 0
868 3011060101 Eisler Sin 397100
869 3011060102 Jasa Ekspertisi Eisler sin 0
870 3011070101 Rheese Dex 397100
871 3011070102 Jasa Ekspertisi Rheese Dex 27500
872 3011080101 Rheese Sin 397100
873 3011080102 Jasa Ekspertisi Rheese Sin 27500
874 3011090101 Schuler Dex 397100
875 3011090102 Jasa Ekspertisi Schuler Dex 30800
876 3011100101 Schuler Sin 397100
877 3011100102 Jasa Ekspertisi Schuler Sin 30800
878 3011110101 Sella Tursica 397100
879 3011110102 Jasa Ekspertisi Sella Tursica 30800
880 3011120101 Skull AP 437800
881 3011120102 Jasa Ekspertisi Skull AP 30800
882 3011130101 Skull Lat 437800
883 3011130102 Jasa Ekspertisi Skull LAT 30800
884 3011140101 Skull AP/Lat 680900
885 3011140102 Jasa Ekspertisi Skull Ap/Lat 30800
886 3011150101 Soft Tissue Leher AP 390500
887 3011150102 Jasa Ekspertisi Soft Tissue Leher AP 27500
888 3011160101 Spot Nasal Lat 380600
889 3011160102 Jasa Ekspertisi Spot Nasal Lat 0
890 3011170101 Stenvers Dex 390500
891 3011170102 Jasa Ekspertisi Stenvers Dex 30800
892 3011180101 Stenvers Sin 390500
893 3011180102 Jasa Ekspertisi Stenvers Sin 30800
894 3011190101 Towne 442200
895 3011190102 Jasa Ekspertisi Towne 27500
896 3011200101 Mastoid Schuller Dex 442200
897 3011200102 Jasa Ekspertisi Mastoid Schuller Dex 30800
898 3011210101 Mastoid Schuller Sin 442200
899 3011210102 Jasa Ekspertisi Mastoid schuller Sin 30800
900 3011220101 Mastoid Schuller Dex/Sin 0
901 3011220102 Jasa Ekspertisi Mastoid Schuller Dex/Sin 30800
902 3011230101 Mandibula AP 442200
903 3011230102 Jasa Ekspertisi Mandibula AP 27500
904 3011240101 Mandibula Lat 442200
905 3011240102 Jasa Ekspertisi Mandibula Lat 27500
906 3011250101 Mandibula Eisler Dex 442200
907 3011250102 Jasa Ekspertisi Mandibula Eisl. Dex 0
908 3011260101 Mandibula Eisler Sin 442200
909 3011260102 Jasa Ekspertisi Mandibula Eisl. Sin 0
910 3011270101 Os Nasal 420200
911 3011270102 Jasa Ekspertisi OS Nasal 26400
912 3011280101 Skull Lat. Adenoid 0
913 3011280102 Jasa Ekspertisi Skull Lat. Adenoid 0
914 3011290101 Nasal Tangensial 0
915 3011290102 Jasa Ekspertisi Nasal Tangensial 0
916 3011300101 TMJ Dex Close Mouth 316800
917 3011300102 Cetak Film TMJ Dex Close Mouth 50600
918 30113003 Cetak CD TMJ Dex Close Mouth 0
919 30113004 Jasa Ekspertisi TMJ Dex Close Mouth 27500
920 3011310101 TMJ Dex Open Mouth 316800
921 3011310102 Cetak Film TMJ Dex Open Mouth 50600
922 30113103 Cetak CD TMJ Dex Open Mouth 0
923 30113104 Jasa Ekspertisi TMJ Dex Open Mouth 27500
924 3011320101 TMJ Sin Close Mouth 316800
925 3011320102 Cetak Film TMJ Sin Close Mouth 50600
926 30113203 Cetak CD TMJ Sin Close Mouth 0
927 30113204 Jasa Ekspertisi TMJ Sin Close Mouth 27500
928 3011330101 TMJ Sin Open Mouth 316800
929 3011330102 Cetak Film TMJ Sin Open Mouth 50600
930 30113303 Cetak CD TMJ Sin Open Mouth 0
931 30113304 Jasa Ekspertisi TMJ Sin Open Mouth 27500
932 3011340101 TMJ Dex/Sin - Open/Close 453200
933 3011340102 Cetak Film TMJ Dex/Sin - Open/Close 199100
934 30113403 Cetak CD TMJ Dex/Sin - Open/Close 0
935 30113404 Jasa Ekspertisi TMJ SIN/Dex - Open/Close 0
936 3012010101 Cervical AP. 397100
937 3012010102 Jasa Ekspertisi Cervical AP 27500
938 30120200 Cervical Lateral 0
939 3012020101 Cervical Lateral 397100
940 3012020102 Jasa Ekspertisi Cervical Lateral 27500
941 3012030101 Cervical Obl.Dex 397100
942 3012030102 Jasa Ekspertisi Cervical Obl.Dex 27500
943 3012040101 Cervical Obl.Sin 397100
944 3012040102 Jasa Ekspertisi Cervical Obl.Sin 27500
945 3012050101 Cervical AP/LAT 633600
946 3012050102 Jasa Ekspertisi Cervical Ap/lat 33000
947 3012060101 Cervical AP/Lat/obl.D/S 1189100
948 3012060102 Jasa Ekspertisi Cervical AP/Lat/obl.D/S 49500
949 3012070101 Cervical Ap Open Mouth 397100
950 3012070102 Jasa Ekspertisi Cervical Ap Open Mouth 0
951 3012080101 Cervical Ap Close Mouth 397100
952 3012080102 Jasa Ekspertisi Cervical Ap Close Mouth 0
953 3012090101 Cervical I/Odontoid 442200
954 3012090102 Jasa Ekspertisi Cervical I/Odontoid 27500
955 3012100101 Cervical Extensi 397100
956 3012100102 Jasa Ekspertisi Cervical Flexi 27500
957 3012110101 Cervical Flexi 397100
958 3012110102 Jasa Ekspertisi Cervical Extensi 27500
959 3012120101 Neutral Lat Cervical 432300
960 3012120102 Jasa Ekspertisi Neutral Lat Cervical 0
961 3012130101 Fleksi & Ekstensi Cervical 684200
962 3012130102 Jasa Ekspertisi Fleksi & Ekstensi Cervical 0
963 3012140101 Soft Tissue Leher Lat 390500
964 3012140102 Jasa Ekspertisi Soft Tissue Leher Lat 27500
965 3012150101 Thoracalis AP 442200
966 3012150102 Jasa Ekspertisi Thoracalis AP 27500
967 3012160101 Thoracalis Lat. 442200
968 3012160102 Jasa Ekspertisi Thoracalis Lat. 27500
969 3012170101 Thoracalis Obl. Dex. 442200
970 3012170102 Jasa Ekspertisi Thorac. Obl. Dex 27500
971 3012180101 Thoracalis Obl. Sin. 442200
972 3012180102 Jasa Ekspertisi Thoracalis. Obl. sin 27500
973 3012190101 Thoracalis AP/Lat/Obl - Dex/Sin 1454200
974 3012190102 Jasa Ekspertisi Thoracalis AP/Lat/Obl - Dex/Sin 49500
975 3012200101 Thoraco-Lumbalis AP 442200
976 3012200102 Jasa Ekspertisi Thoraco-Lumbalis AP 27500
977 3012230101 Thoraco-Lumbalis Lat. 442200
978 3012230102 Jasa Ekspertisi Thoraco-Lumbalis Lat. 27500
979 3012240101 Thoraco Lumbalis AP/Lat 0
980 3012240102 Jasa Ekspertisi Thoraco Lumbalis AP/Lat) 0
981 3012250101 Thoraco Lumbalis Dex. Oblique 0
982 3012250102 Jasa Ekspertisi Thoraco Lumbalis Dex. Oblique 0
983 3012260101 Thoraco Lumbalis Sin. Oblique 0
984 3012260102 Jasa Ekspertisi Thoraco Lumbalis Sin. Oblique 0
985 3012270101 Thoraco Lumbalis AP/Lat/Obl - Dex/Sin 1454200
986 3012270102 Jasa Ekspertisi Thoraco Lumbalis AP/Lat/Obl - Dex/Sin 49500
987 3012280101 Thoraco-Lumbalis Bending Dex. 442200
988 3012280102 Jasa Ekspertisi Thoraco-Lumbalis Bending Dex 27500
989 3012290101 Thoraco-Lumbalis Bending Sin. 442200
990 3012290102 Jasa Ekspertisi Thoraco-Lumbalis Bending Sin. 27500
991 3012300101 Thoraco-Lumbal Bending Dex/Sin 696300
992 3012300102 Jasa Ekspertisi Thoraco-Lumbal Binding Dex/Sin 38500
993 3012310101 Dinamic Fleksi 0
994 3012310102 Jasa Ekspertisi Dinamic Fleksi 0
995 3012320101 Dinamic Ekstensi 0
996 3012320102 Jasa Ekspertisi Dinamic Ekstensi 0
997 3012330101 Lumbo-Sacral AP 442200
998 3012330102 Jasa Ekspertisi Lumbo-Sacral AP 27500
999 3012340101 Lumbo-Sacral Lat 442200
1000 3012340102 Jasa Ekspertisi Lumbo-Sacral Lat 27500
1001 3012350101 Lumbo-Sacral AP/Lat 0
1002 3012350102 Jasa Ekspertisi Lumbo-sacral AP/Lat 30800
1003 3012360101 Lumbo Sacral Dex. Obl 0
1004 3012360102 Jasa Ekspertisi Lumbo Sacral Dex. Obl 0
1005 3012370101 Lumbo Sacral Sin. Obl 0
1006 3012370102 Jasa Ekspertisi Lumbo Sacral Sin. Obl 0
1007 3012380101 Lumbo-Sacral Oblique Dex/Sin 0
1008 3012380102 Jasa Ekspertisi Lumbo-Sacral Oblique Dex/Sin 0
1009 3012390101 Lumbo-Sacral AP/Lat/Obl - Dex/Sin 1454200
1010 3012390102 Jasa Ekspertisi Lumbo-Sacral AP/Lat/Obl - Dex/Sin 82500
1011 3012400101 Lumbo-Sacral Lat Extensi 442200
1012 3012400102 Jasa Ekspertisi Lumbo-Sacral Lat Extensi 27500
1013 3012410101 Lumbo-Sacral Lat Flexi 442200
1014 3012410102 Jasa Ekspertisi Lumbo-Sacral Lat. Flexi 27500
1015 3012420101 Coccygeus AP 456500
1016 3012420102 Jasa Ekspertisi Coccygeus AP 27500
1017 3012430101 Coccygeus Lat. 456500
1018 3012430102 Jasa Ekspertisi Coccygeus Lat 27500
1019 3012440101 Coxae Dex 442200
1020 3012440102 Jasa Ekspertisi Coxae Dex 27500
1021 3012450101 Coxae Sin 442200
1022 3012450102 Jasa Ekspertisi Coxae Sin 27500
1023 3012460101 Pelvis AP 442200
1024 3012460102 Jasa Ekspertisi Pelvis AP 27500
1025 3012470101 Pelvis Lat 442200
1026 3012470102 Jasa Ekspertisi Pelvis LAT 27500
1027 3012480101 Pelvis Oblique 442200
1028 3012480102 Jasa Ekspertisi Pelvis Oblique 27500
1029 3012490101 Pelvis Lat/Sacrum Lat 442200
1030 3012500101 Pelvis Inlet 0
1031 3012500102 Jasa Ekspertisi Pelvis Inlet 0
1032 3012510101 Pelvis Outlet 0
1033 3012510102 Jasa Ekspertisi Pelvis Outlet 0
1034 3012520101 Frog Position 280500
1035 3012520102 Jasa Ekspertisi Frog Position 25300
1036 3012530101 Artc. Coxae Dex 0
1037 3012530102 Jasa Ekspertisi Artc. Coxae Dex 0
1038 3012540101 Artc. Coxae Sin 0
1039 3012540102 Jasa Ekspertisi Artc. Coxae Sin 0
1040 3012550101 Artc. Coxae Axial Dex 0
1041 3012550102 Jasa Ekspertisi Artc. Coxae Axial Dex 0
1042 3012560101 Artc. Coxae Axial Sin 0
1043 3012560102 Jasa Ekspertisi Artc. Coxae Axial Sin 0
1044 3012570101 Artc. Coxae Oblique Dex 0
1045 3012570102 Jasa Ekspertisi Artc. Coxae Oblique Dex 0
1046 3012580101 Artc. Coxae Oblique Sin 0
1047 3012580102 Jasa Ekspertisi Artc. Coxae Oblique Sin 0
1048 3012590101 Artc. Coxae Lat. Dex 0
1049 3012590102 Jasa Ekspertise (Artc. Coxae Lat. Dex) 0
1050 3012600101 Artc. Coxae Lat. Sin 0
1051 3012600102 Jasa Ekspertise (Artc. Coxae Lat. Sin) 0
1052 3012610101 Whole Spine AP 908600
1053 3012610102 Jasa Ekspertisi Whole Spine AP 52800
1054 3012620101 Whole Spine Lat 908600
1055 3012620102 Jasa Ekspertisi Whole Spine Lat 52800
1056 3012630101 Whole Body Foto 548900
1057 3012630102 Jasa Ekspertisi Whole Body Foto 88000
1058 3012640101 Bone Survey 0
1059 3012640102 Jasa Exspertisi Bone Survey 0
1060 30126500 Cervical Lateral Dex/Sin 0
1061 3012650101 Cervical Lateral Dex/Sin 0
1062 3012650102 Jasa Ekspertisi Cervical Lateral Dex/Sin 0
1063 30126502 Jasa Ekspertisi Cervical Lateral Dex/Sin 0
1064 30126600 Thoracalis Lat. Dex/Sin 0
1065 3012660101 Thoracalis Lat. Dex/Sin 0
1066 3012660102 Jasa Ekspertisi Thoracalis Lat. Dex/Sin 0
1067 30126602 Jasa Ekspertisi Thoracalis Lat. Dex/Sin 0
1068 30126700 Lumbo-sacral Lat Dex/Sin 0
1069 3012670101 Lumbo-sacral Lat Dex/Sin 0
1070 3012670102 Jasa Ekspertisi Lumbo-sacral Lat Dex/Sin 0
1071 30126702 Jasa Ekspertisi Lumbo-sacral Lat Dex/Sin 0
1072 3013010101 Clavicula Dex AP 389400
1073 3013010102 Jasa Ekspertisi Clav dex AP 27500
1074 3013020101 Clavicula Sin AP 389400
1075 3013020102 Jasa Ekspertisi Clav sin AP 27500
1076 3013030101 Clavicula AP Axial 389400
1077 3013030102 Jasa Ekspertisi Clav Axial AP 0
1078 3013040101 Clavicula AP Dex/Sin 0
1079 3013040102 Jasa Ekspertisi Clavicula AP Dex/Sin 0
1080 3013050101 Scapula Dex AP 442200
1081 3013050102 Jasa Ekspertisi Scapula Dex AP 27500
1082 3013060101 Scapula Sin AP 442200
1083 3013060102 Jasa Ekspertisi Scap Sin AP 27500
1084 3013070101 Scapula Dex Lat 442200
1085 3013070102 Jasa Ekspertisi Scap dex LAT 27500
1086 3013080101 Scapula Sin Lat 442200
1087 3013080102 Jasa Ekspertisi Scap sin LAT 27500
1088 3013090101 Sternum PA 378400
1089 3013090102 Jasa Ekspertisi Sternum PA 0
1090 3013100101 Costae PA 389400
1091 3013100102 Jasa Ekspertisi Costae PA 0
1092 3013110101 Costae AP 389400
1093 3013110102 Jasa Ekspertisi Costae AP 0
1094 3013120101 Costae Axial 389400
1095 3013120102 Jasa Ekspertisi Costae Axial 0
1096 3013130101 Costae Lat. Dex. 0
1097 3013130102 Jasa Ekspertisi Costae Lat. Dex 0
1098 3013140101 Costae Lat. Sin 389400
1099 3013140102 Jasa Ekspertisi Costae Lat. Sin 0
1100 3013150101 Shoulder Dex AP/Oblique 442200
1101 3013150102 Jasa Ekspertisi Shoulder Dex AP/Oblique 27500
1102 3013160101 Shoulder Sin AP/Oblique 442200
1103 3013160102 Jasa Ekspertisi Shoulder Sin AP/Oblique 27500
1104 3013170101 Shoulder Dex.Exo/Endo 442200
1105 3013170102 Jasa Ekspertisi Shoulder Dex Exo/Endo 33000
1106 3013180101 Shoulder sin. Exo/Endo 442200
1107 3013180102 Jasa Ekspertisi Shoulder Sin Exo/Endo 33000
1108 3013190101 Shoulder Axial Dex 378400
1109 3013190102 Jasa Ekspertisi Shoulder Axial Dex 27500
1110 3013200101 Shoulder Axial Sin 378400
1111 3013200102 Jasa Ekspertisi Shoulder Axial Sin 27500
1112 3013210101 Humerus Dex. AP/Lat 493900
1113 3013210102 Jasa Ekspertisi Humerus Dex. AP/Lat 33000
1114 3013220101 Humerus Sin AP/Lat 493900
1115 3013220102 Jasa Ekspertisi Humerus Sin AP/Lat 33000
1116 3013230101 Elbow Dex. AP/Lat 442200
1117 3013230102 Jasa Ekspertisi Elbow Dex. AP/Lat 33000
1118 3013240101 Elbow Sin. AP/Lat 442200
1119 3013240102 Jasa Ekspertisi Elbow Sin. AP/Lat 33000
1120 3013250101 Antebrachii Dex. AP/Lat 493900
1121 3013250102 Jasa Ekspertisi Antebrachii Dex. AP/Lat 33000
1122 3013260101 Antebrachii Sin. AP/Lat 493900
1123 3013260102 Jasa Ekspertisi Antebrachii Sin. AP/Lat 33000
1124 3013270101 Wrist Joint Dex. AP/Lat 422400
1125 3013270102 Jasa Ekspertisi Wrist Joint Dex. AP/Lat 30800
1126 3013280101 Wrist Joint Sin. AP/Lat 422400
1127 3013280102 Jasa Ekspertisi Wrist Joint Sin. AP/Lat 30800
1128 3013290101 Bone Age 397100
1129 3013290102 Jasa Ekspertisi Bone Age 30800
1130 3013300101 Manus Dex. AP/Lat 389400
1131 3013300102 Jasa Ekspertisi Manus Dex. AP/Lat 30800
1132 3013310101 Manus Sin. AP/Lat 389400
1133 3013310102 Jasa Ekspertisi Manus Sin. AP/Lat 30800
1134 30133200 Manus Dex. AP/Oblique 481800
1135 3013320301 Manus Dex. AP/Oblique 481800
1136 3013320302 Jasa Ekspertisi Manus Dex. AP/Oblique 30800
1137 3013330101 Manus Sin. AP/Oblique 481800
1138 3013330102 Jasa Ekspertisi Manus Sin. AP/Oblique 30800
1139 3014010101 Hip Joint Dex AP/Oblique 377300
1140 3014010102 Jasa Ekspertisi Hip Joint Dex AP/Oblique 30800
1141 3014020101 Hip Joint Sin AP/Oblique 377300
1142 3014020102 Jasa Ekspertisi Hip Joint Sin AP/Oblique 30800
1143 3014030101 Femur Dex. AP/Lat 493900
1144 3014030102 Jasa Ekspertisi Femur Dex. AP/Lat 30800
1145 3014040101 Femur Sin. AP/Lat 493900
1146 3014040102 Jasa Ekspertisi Femur Sin. AP/Lat 30800
1147 3014050101 Genu Dex. AP/Lat 493900
1148 3014050102 Jasa Ekspertisi Genu Dex. AP/Lat 30800
1149 3014060101 Genu Sin. AP/Lat 493900
1150 3014060102 Jasa Ekspertisi Genu Sin. AP/Lat 30800
1151 3014070101 Genu Dex. AP/Lat Berdiri 481800
1152 3014070102 Jasa Ekspertisi Genu Dex. AP/Lat Berdiri 30800
1153 3014080101 Genu Sin. AP/Lat Berdiri 481800
1154 3014080102 Jasa Ekspertisi Genu Sin AP/Lat Berdiri 30800
1155 30140850 Genu Rosenberg View Sin 389400
1156 3014090101 Sky Line View Dex 389400
1157 3014090102 Jasa Ekspertisi Sky Line View Dex 30800
1158 3014100101 Sky Line View Sin 389400
1159 3014100102 Jasa Ekspertisi Sky Line View Sin 30800
1160 3014110101 Cruris Dex. AP/Lat 493900
1161 3014110102 Jasa Ekspertisi Cruris Dex. AP/Lat 30800
1162 3014120101 Cruris Sin. AP/Lat 493900
1163 3014120102 Jasa Ekspertisi Cruris Sin. AP/Lat 30800
1164 3014130101 Ankle Dex. AP/Lat 442200
1165 3014130102 Jasa Ekspertisi Ankle Dex. AP/Lat 30800
1166 3014140101 Ankle Sin. AP/Lat 442200
1167 3014140102 Jasa Ekspertisi Ankle Sin . AP/Lat 30800
1168 3014150101 Ankle Mortise View Dex 442200
1169 3014150102 Jasa Ekspertisi Ankle Mortise View Dex 30800
1170 3014160101 Ankle Mortise View Sin 442200
1171 3014160102 Jasa Ekspertisi Ankle Mortise View Sin 30800
1172 3014170101 Ankle Valrus Stres 0
1173 3014170102 Jasa Ekspertisi Ankle Valrus Stres 0
1174 3014180101 Ankle Valgus Stres 0
1175 3014180102 Jasa Ekspertisi Ankle Valgus Stres 0
1176 3014190101 Pedis Dex. AP/Oblique 389400
1177 3014190102 Jasa Ekspertisi Pedis Dex. AP/Oblique 30800
1178 3014200101 Pedis Sin. AP/Oblique 389400
1179 3014200102 Jasa Ekspertisi Pedis Sin. AP/Oblique 30800
1180 3014210101 Pedis Dex. AP/Lat 389400
1181 3014210102 Jasa Ekspertisi Pedis Dex. AP/Lat 30800
1182 3014220101 Pedis Sin. AP/Lat 389400
1183 3014220102 Jasa Ekspertisi Pedis Sin. AP/Lat 30800
1184 3014230101 Calcaneus Dex. Lat/Tg. 442200
1185 3014230102 Jasa Ekspertisi Calcaneus Dex. Lat/Tg. 33000
1186 3014240101 Calcaneus Sin. Lat/Tg. 442200
1187 3014240102 Jasa Ekspertisi Calcaneus Sin. Lat/Tg. 33000
1188 3014250101 Full Ekstremitas Inferior 972400
1189 3014250102 Jasa Ekspertisi Full Ekstremitas Inferior 0
1190 30142600 Caput Femur Dex/Sin. 0
1191 3014260101 Caput Femur Dex/Sin. 0
1192 3014260102 Jasa Ekspertisi Caput Femur Dex/Sin. 0
1193 30142602 Jasa Ekspertisi Caput Femur Dex/Sin. 0
1194 30142700 Caput Femur Dex 432300
1195 3014270101 Caput Femur Dex 0
1196 3014270102 Jasa Ekspertisi Caput Femur Dex 0
1197 30142702 Jasa Ekspertisi Caput Femur Dex 0
1198 30142800 Caput Femur Sin 432300
1199 3014280101 Caput Femur Sin 0
1200 3014280102 Jasa Ekspertisi Caput Femur Sin 0
1201 30142802 Jasa Ekspertisi Caput Femur Sin 0
1202 3015010101 Thorax PA (CR) 272800
1203 3015010103 Cetak Film Sedang 26 x 36 (Thorax PA (CR)) 57200
1204 3015010109 Jasa Ekspertisi Thorax PA (CR) 27500
1205 30150102 Cetak Film Kecil 20 x 25 (Thorax PA (CR)) 44000
1206 30150104 Cetak Film Besar 35 x 43 (Thorax PA (CR)) 115500
1207 30150105 Cetak Kertas Kecil (Thorax PA (CR)) 14300
1208 30150106 Cetak Kertas Sedang (THorax PA (CR)) 28600
1209 30150107 Cetak Kertas Besar (Thorax PA (CR)) 41800
1210 3015020101 Thorax PA (Konvensional) 309100
1211 3015020102 Jasa Ekspertisi Thorax PA 27500
1212 3015030101 Thorax AP 272800
1213 3015030102 Jasa Ekspertisi Thorax AP 27500
1214 3015040101 Thorax Lat 404800
1215 3015040102 Jasa Ekspertisi Thorax LAT 27500
1216 3015050101 Thorax PA/Lat. 0
1217 3015050102 Jasa Ekspertisi Thorax PA/Lat 0
1218 3015060101 Thorax Lat Dex 0
1219 3015060102 Jasa Ekspertisi Thorax Lat Dex 0
1220 3015070101 Thorax Lat Sin 442200
1221 3015070102 Jasa Ekspertisi thorax Lat Sin 0
1222 3015080101 Thorax Oblique Dex 424600
1223 3015080102 Jasa Ekspertisi Thorax Oblique Dex 27500
1224 3015090101 Thorax Oblique Sin 424600
1225 3015090102 Jasa Ekspertisi Thorax Oblique Sin 27500
1226 3015100101 Top Lordotik 442200
1227 3015100102 Jasa Ekspertisi Top Lordotik 27500
1228 3015110101 Thorax RLD 0
1229 3015110102 Jasa Ekspertisi Thorax RLD 0
1230 3015120101 Thorax LLD 0
1231 3015120102 Jasa Ekspertisi Thorax LLD 0
1232 3015130101 Mammography Dex 631400
1233 3015130102 Jasa Ekspertisi Mammography Dex 55000
1234 3015140101 Mammography Sin 631400
1235 3015140102 Jasa Ekspertisi Mammography Sin 55000
1236 3015150101 Mammography Dex/Sin 0
1237 3015150102 Jasa Ekspertisi Mammography Dex/Sin 0
1238 3015160101 BOF/BNO/KUB 404800
1239 3015160102 Jasa Ekspertisi BOF/BNO/KUB 30800
1240 3015170101 BOF/BNO/KUB (3 Posisi) 1030700
1241 3015170102 Jasa Ekspertisi (BOF/BNO/KUB 3 Posisi) 39600
1242 3015180101 BOF/BNO/KUB Erect 0
1243 3015180102 Jasa Ekspertisi BOF/BNO/KUB Erect 0
1244 3015190101 Right Lat. Decubitus 368500
1245 3015190102 Jasa Ekspertisi Right Lat. Decubitus 0
1246 3015200101 Left Lat. Decubitus 368500
1247 3015200102 Jasa Ekspertisi Left Lat. Decubitus 0
1248 3015210101 Babygram 265100
1249 3015210102 Jasa Ekspertisi Babygram 27500
1250 3015220101 Atresiani 0
1251 3015220102 Jasa Ekspertisi Atresiani 0
1252 3015230101 Sonde Uterus 1076900
1253 3015230102 Jasa Ekspertisi Sonde Uterus 0
1254 3021010101 Panoramic 236500
1255 3021010102 Cetak Film Panoramic 85800
1256 30210103 Cetak CD Panoramic 18700
1257 30210104 Cetak Kertas Panoramic 0
1258 30210105 Jasa Ekspertisi Panoramic 27500
1259 3021020101 Cephalometry AP 294800
1260 3021020102 Cetak Film Cephalometry AP 95700
1261 3021020105 Jasa Ekspertisi cephalometry AP 0
1262 30210203 Cetak CD Cephalometry AP 0
1263 30210204 Cetak Kertas Cephalometry AP 0
1264 3021030101 Cephalometry PA 0
1265 3021030102 Cetak Film Cephalometry PA 0
1266 3021030105 Jasa Ekspertisi Cephalometry PA 0
1267 30210303 Cetak CD Cephalometry PA 0
1268 30210304 Cetak Kertas Cephalometry PA 0
1269 3021040101 Cephalometry Lat 294800
1270 3021040102 Cetak Film Cephalometry Lat 95700
1271 3021040105 Jasa Ekspertisi cephalometry Lat 27500
1272 30210403 Cetak CD Cephalometry Lat 0
1273 30210404 Cetak Kertas Cephalometry Lat 0
1274 3022010101 Dental I CR 170500
1275 3022010102 Cetak Film Dental I CR 75900
1276 3022010105 Jasa Ekspertisi Dental I CR 23100
1277 30220103 Cetak CD Dental I CR 0
1278 30220104 Cetak Kertas Dental I CR 0
1279 3022020101 Dental II CR 238700
1280 3022020102 Cetak Film Dental II CR 75900
1281 3022020105 Jasa Ekspertisi Dental II CR 28600
1282 30220203 Cetak CD Dental II CR 0
1283 30220204 Cetak Kertas Dental II CR 0
1284 3022030101 Dental III CR 315700
1285 3022030102 Cetak Film Dental III CR 75900
1286 3022030105 Jasa Ekspertisi Dental III CR 40700
1287 30220303 Cetak CD Dental III CR 0
1288 30220304 Cetak Kertas Dental III CR 0
1289 3022040101 Dental IV CR 293700
1290 3022040102 Cetak Film Dental IV CR 68200
1291 3022040105 Jasa Ekspertisi Dental IV CR 40700
1292 30220403 Cetak CD Dental IV CR 0
1293 30220404 Cetak Kertas Dental IV CR 0
1294 3022050101 Dental V CR 0
1295 3022050102 Cetak Film Dental V CR 0
1296 3022050103 Cetak CD Dental V CR 0
1297 3022050104 Jasa Ekspertisi Dental V CR 40700
1298 3022060101 Dental I Anl. 145200
1299 3022060102 Jasa Ekspertisi Dental I Anl. 23100
1300 3022070101 Dental II Anl. 332200
1301 3022070102 Jasa Ekspertisi Dental II Anl. 29700
1302 3022080101 Dental III Anl. 332200
1303 3022080102 Jasa Ekspertisi Dental III Anl. 38500
1304 3022090101 Dental IV Anl. 0
1305 3022090102 Jasa Ekspertisi Dental IV Anl. 0
1306 3022100101 Dental V Anl. 0
1307 3022100102 Jasa Ekspertisi Dental V Anl. 0
1308 3022110101 Dental VI Anl. 0
1309 3022110102 Jasa Ekspertisi Dental VI Anl. 0
1310 3022120101 Dental VII Anl. 0
1311 3022120102 Jasa Ekspertisi Dental VII Anl. 0
1312 3022130101 Dental VIII Anl. 0
1313 3022130102 Jasa Ekspertisi Dental VIII Anl. 0
1314 3022140101 Dental IX Anl. 0
1315 3022140102 Jasa Ekspertisi Dental IX Anl. 0
1316 3022150101 Dental X Anl. 0
1317 3022150102 Jasa Ekspertisi Dental X Anl. 0
1318 3022160101 Shift Scath I 0
1319 3022160102 Cetak Film Shift Scath I 0
1320 3022160103 Cetak CD Shift Scath I 0
1321 3022160104 Jasa Ekspertisi Shift Scath I 0
1322 3022170101 Shift Scath II 0
1323 3022170102 Cetak Film Shift Scath II 0
1324 3022170103 Cetak CD Shift Scath II 0
1325 3022170104 Jasa Ekspertisi Shift Scath II 0
1326 3022180101 Oclusal Rahang Atas 316800
1327 3022180102 Cetak Film Oclusal Rahang Atas 75900
1328 3022180103 Cetak CD Oclusal Rahang Atas 25300
1329 3022180105 Jasa Ekspertisi Oclusal Rahang Atas 27500
1330 30221804 Cetak Kertas Oclusal Rahang Atas 0
1331 3022190101 Oclusal Rahang Bawah 316800
1332 3022190102 Cetak Film Oclusal Rahang Bawah 75900
1333 3022190103 Cetak CD Oclusal Rahang Bawah 25300
1334 3022190105 Jasa Ekspertisi Oclusal Rahang Bawah 27500
1335 30221904 Cetak Kertas Oclusal Rahang Bawah 0
1336 3023010101 Cone Beam CT (CB - CT) 1736900
1337 3023010102 Jasa Ekspertisi Cone Beam CT (CB - CT) 165000
1338 3031010101 Dacriocystography 0
1339 3031010102 Obat Kontras Dacriocystography 0
1340 3031010103 Jasa Ekspertisi Dacriocystography 0
1341 3031020101 Sialography 1076900
1342 3031020102 Obat Kontras Sialography 0
1343 3031020103 Jasa Medis Sialography 0
1344 3031030101 Oesophagus 1102200
1345 3031030102 Obat Kontras Oesophagus 243100
1346 3031030103 Jasa Medis Oesophagus 220000
1347 3031040101 Maagduodenography 1076900
1348 3031040102 Obat Kontras Maagduonography 0
1349 3031040103 Jasa Medis Maagduodenography 110000
1350 3031050101 Upper Gastrointestinal (Upper GI) 1190200
1351 3031050103 Obat Kontras Upper Gastrointestinal 243100
1352 3031050104 Jasa Medis Upper Gastrointestinal 144100
1353 3031060101 Cholangiography 1161600
1354 3031060102 Obat Kontras Cholangiography 0
1355 3031060103 Jasa Medis Cholangiography 0
1356 3031070101 Followtrough 721600
1357 3031070102 Obat Kontras Followtrough 0
1358 3031070103 Jasa Medis Followtrough 0
1359 3031080101 Colon in Loop 1190200
1360 3031080102 Obat Kontras Colon In Loop 244200
1361 3031080103 Jasa Medis Colon In Loop 144100
1362 3031090101 Colon In Loop Water Soluble 0
1363 3031090102 Obat Kontras Colon In Loop Water Soluble 0
1364 3031090103 Jasa Medis Colon In Loop Water Soluble 0
1365 3031100101 Appendicogram 1073600
1366 3031100102 Obat Appendicogram 243100
1367 3031100103 Jasa Medis Appendicogram 220000
1368 3031110101 IVP Foto 1190200
1369 3031110102 Obat Kontras IVP 574200
1370 3031110103 Jasa Medis IVP 220000
1371 3031120101 APG ( Antegrade Pyelography ) 0
1372 3031120102 Obat APG (Antegrade Pyelography) 0
1373 3031120103 Jasa Ekspertisi APG ( Antegrade Pyelography ) 0
1374 3031130101 Cystourethrography 1190200
1375 3031130102 Obat Kontras Cystourethrography 243100
1376 3031130103 Jasa Medis Cystourethrography 144100
1377 3031140101 Cystography 0
1378 3031140102 Obat Kontras Cystography 243100
1379 3031140103 Jasa Medis Cystography 144100
1380 3031150101 Urethrography 1190200
1381 3031150102 Obat Kontras Urethrography 243100
1382 3031150105 Jasa Medis Urethrography 144100
1383 3031160101 Urethrocystography 0
1384 3031160102 Jasa Ekspertisi Urethrocystography 0
1385 3031160103 Obat Kontras Urethrocystography 0
1386 30311603 Jasa Ekspertisi Urethrocystography 0
1387 3031170101 Fistulography 1190200
1388 3031170102 Obat Kontras Fistulography 243100
1389 3031170103 Jasa Medis fistulography 144100
1390 3031180101 HSG 1267200
1391 3031180102 Obat Kontras HSG 324500
1392 3031180103 Jasa Medis HSG 220000
1393 3031190101 Lopografi 606100
1394 3031190102 Obat Kontras Lopografi 0
1395 3031190103 Jasa Ekspertisi Lopografi 0
1396 3041010101 Bone Densitometri Spine - Hip 1236400
1397 3041010102 Jasa Ekspertisi (Bone Densitometry Spine - Hip) 115500
1398 3041020101 Bone Densitometry Spine - Forearm 1236400
1399 3041020102 Jasa Ekspertisi (Bone Densitometry Spine - Forearm) 115500
1400 3041030101 Bone Densitometry Hip - Forearm 889900
1401 3041030102 Jasa Ekspertisi (Bone Densitometry Hip - Forearm) 115500
1402 3041040101 Bone Densitometry Spine/Hip/Fore Arm 1261700
1403 3041040102 Jasa Ekspertisi Bone Densitometry Spine/Hip/Fore Arm 115500
1404 3041050101 Bone Densitometry Spine Lat - Hip 889900
1405 3041050102 Jasa Ekspertisi (Bone Densitometry Spine Lat - Hip) 115500
1406 30410502 Jasa Ekspertisi (Bone Densitometry Spine Lat - Hip) 115500
1407 30510100 CT-Scan Kepala 0
1408 30510200 CT-Scan Cervical 0
1409 30510300 CT-Scan Thorax 0
1410 30510400 CT-Scan Abdomen 0
1411 30520100 CT-Scan Jantung 0
1412 3061010101 USG Upp & Low Abdomen 936100
1413 3061010102 Jasa Medis USG Upp & Low Abdomen 143000
1414 3061020101 USG Upper Abdomen 883300
1415 3061020102 Jasa Medis USG Upper Abdomen 121000
1416 3061030101 USG Lower Abdomen 883300
1417 3061030102 Jasa Medis USG Lower Abdomen 121000
1418 3061040101 USG Liver 889900
1419 3061040103 Jasa Medis USG Liver 0
1420 3061050101 USG Empedu 889900
1421 3061050102 Jasa Medis USG Empedu 0
1422 3061060101 USG Hepatobilier 889900
1423 3061060102 Jasa Medis (USG Hepatobilier) 121000
1424 3061070101 USG Pankreas 889900
1425 3061070102 Jasa Medis USG Pankreas 0
1426 3061080101 USG Ginjal 889900
1427 3061080102 Jasa Medis USG Ginjal 0
1428 3061090101 USG Vaskuler Ras Ginjal dan Renovascular 1527900
1429 3061090102 Jasa Medis USG Doppler Ras Ginjal dan Renovascular 289300
1430 3061100101 USG Appendiks 889900
1431 3061100102 Jasa Medis USG Appendiks 104500
1432 3061120101 USG Pelvis 889900
1433 3061120102 Jasa Medis USG Pelvis 0
1434 3061130101 USG Tractus Urinarius 856900
1435 3061130102 Jasa Medis (USG Tractus Urinarius) 121000
1436 3061140101 USG Prostat 889900
1437 3061140102 Jasa Medis USG Prostat 121000
1438 3061150101 USG Transrectal 0
1439 3061150102 Jasa Medis USG Transrectal 0
1440 3061160101 USG Thorax 889900
1441 3061160102 Jasa Medis USG Thorax 121000
1442 3062010101 USG Kandungan 889900
1443 3062010102 Jasa Medis USG Kandungan 121000
1444 3062020101 USG Kandungan 4 Dimensi 1441000
1445 3062020102 Jasa Medis USG Kandungan 4 Dimensi 231000
1446 3062030101 USG Transvaginal 889900
1447 3062030102 Jasa Medis USG Transvaginal 115500
1448 3062040101 USG Tracking Follicle 420200
1449 3062040102 Jasa Medis USG Tracking Follicle 0
1450 3063010101 USG Kepala Bayi 889900
1451 3063010102 Jasa Medis USG Kepala Bayi 115500
1452 3063020101 USG Mata 0
1453 3063020102 Jasa Medis USG Mata 0
1454 3063030101 USG Soft Tissue 889900
1455 3063030102 Jasa Medis USG Soft Tissue 121000
1456 3063040101 USG Thyroid 889900
1457 3063040102 Jasa Medis USG Thyroid 121000
1458 3063050101 USG Mammae 889900
1459 3063050102 Jasa Medis USG Mammae 121000
1460 3063060101 USG Testis 1019700
1461 3063060102 Jasa Medis USG Testis 121000
1462 3063070101 USG Inguinal Dex/Sin 0
1463 3063070102 Jasa Medis USG Inguinal Dex/Sin 0
1464 3064010101 USG Carotis (Doppler) 1310100
1465 3064010102 Jasa Medis USG Carotis 121000
1466 3064020101 USG Vaskuler Ekstremitas Superior Dex/Sin 0
1467 3064020102 Jasa Medis USG Vaskuler Ekstremitas Superior Dex/Sin 0
1468 3064030101 USG Vaskuler Extrimitas Superior Dextra 0
1469 3064030102 Jasa Medis USG Vaskuler Ekstremitas Superior Dextra 0
1470 3064040101 USG Vaskuler Ekstremitas Superior Sinistra 0
1471 3064040102 Jasa Medis USG Vaskuler Ekstremitas Superior Sinistra 0
1472 3064050101 USG Arteri Ekstrimitas Superior Dex/Sin 1310100
1473 3064050102 Jasa Ekspertisi USG Arteri Ekstrimitas Superior Dex/Sin 0
1474 3064060101 USG Arteri Ekstrimitas Superior Dextra 745800
1475 3064060102 Jasa Ekspertisi USG Arteri Ekstrimitas Superior Dextra 0
1476 3064070101 USG Arteri Ekstrimitas Superior Sinistra 745800
1477 3064070102 Jasa USG Arteri Ekstrimitas Superior Sinistra 0
1478 3064080101 USG Vena Ekstrimitas Superior Dex/Sin 0
1479 3064080102 Jasa Ekspertisi USG Vena Ekstrimitas Superior Dex/Sin 0
1480 3064090101 USG Vena Ekstrimitas Superior Dextra 1019700
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