| TARIF RADIOLOGI | ||
| NO | URAIAN | HARGA |
| (TARIF) | ||
| I | PEMERIKSAAN RUTIN ( TANPA KONTRAST) | |
| 1 | Schedel / Tulang tengkorak( AP + Lateral ) | 95,000 |
| 2 | Sinus Series / Tlg Rongga Muka ( Water's + Lateral ) | 95,000 |
| 3 | Mandibula (tulang rahang bawah) | 95,000 |
| 4 | Bahu / Clavicula | 85,000 |
| 5 | Mastoid | 95,000 |
| 6 | Thorax (PA) | 85,000 |
| 7 | Thorax (PA + Lateral) | 140,000 |
| 8 | Cor Analisa | 130,000 |
| 9 | BNO | 85,000 |
| 10 | Abdomen | 90,000 |
| 11 | Pelvis / Blaas | 85,000 |
| 12 | Pelvimetri | 95,000 |
| 13 | VERTEBRAE | |
| - Vertebrae Cervicalis ( AP + Lateral ) | 140,000 | |
| - Vertebrae Cervicalis ( AP + Lateral + Oblique ) | 140,000 | |
| - Vertebrae Thoracalis / Lumbalis ( AP + Lateral ) | 130,000 | |
| - Vertebrae Thoracolumbalis ( AP + Lateral ) | 130,000 | |
| - Vertebrae Lumbosacral ( AP + Lateral ) | 130,000 | |
| - Vertebrae Lumbosacral ( AP + Lateral + Oblique ) | 140,000 | |
| - Vertebrae Sacrum / Coccygeus | 130,000 | |
| 14 | Brachii / Antebrachii | 90,000 |
| 15 | Lutut / Siku ( AP + Lateral ) | 90,000 |
| 16 | Manus / Pedis ( AP + Oblique ) | 90,000 |
| 17 | Pergelangan tangan / tumit | 90,000 |
| 18 | Femur / Cruris ( AP + Lateral ) | 90,000 |
| II | PEMERIKSAAN DENGAN KONTRAST | |
| 1 | Oesophagus | 275,000 |
| 2 | Maagduodenal Foto (Ba-MEAL DOUBLE CONTRAST) | 425,000 |
| 3 | Ba-FOLLOW THROUGH | 425,000 |
| 4 | Ba-ENEMA DOUBLE CONTRAST (COLON INLOOP) | 500,000 |
| 5 | BNO + IVP : - 1 AMPUL OMNIPAQUE | 450,000 |
| 6 | BNO + IVP : - 2 AMPUL OMNIPAQUE | 500,000 |
| 7 | Hysterosalpingograpy (HSG) | 350,000 |
| 8 | Appendix | 250,000 |
| 9 | Lopography | 225,000 |
| 10 | Cystography | 350,000 |
| 11 | Fistulpgraphy | 350,000 |
| 12 | Arthrography | 325,000 |
| 13 | Myelography | 425,000 |
| 14 | Sialography | 450,000 |
| 15 | Urethrography | 350,000 |
| termasuk obat dan bahan habis pakai) | ||