Selamat datang di RSU PURBOWANGI
| USG Upper Abdomen | - | Rp. 170.000,- |
| USG Lower Abdomen | - | Rp. 170.000,- |
| USG Upper-Lower Abdomen | - | Rp. 300.000,- |
| USG Mamae Tunggal | - | Rp. 200.000,- |
| USG Mamae Bilateral | - | Rp. 350.000,- |
| USG Thorax | - | Rp. 170.000,- |
| USG Doppler Veskuler Perifer | - | Rp. 400.000,- |
| USG Small Part (Testis,Thyroid,Hemangioma,Tumor) | - | Rp. 170.000,- |
| USG Small Part dengan Doppler | - | Rp. 250.000,- |
| Double Expose Vetebrae Cito | - | Rp. 133.500,- |
| Double Expose Lumbal Cito | - | Rp. 133.500,- |
| BNO Dua Posisi Cito | - | Rp. 220.400,- |
| USG Upper Abdomen L | - | Rp. 204.000,- |
| USG Lower Abdomen L | - | Rp. 204.000,- |
| USG Upper-Lower Abdomen L | - | Rp. 360.000,- |
| USG Mamae Tunggal L | - | Rp. 240.000,- |
| USG Mamae Bilateral L | - | Rp. 420.000,- |
| USG Thorax L | - | Rp. 204.000,- |
| USG Doppler Veskuler Perifer L | - | Rp. 480.000,- |
| USG Small Part dengan Doppler L | - | Rp. 300.000,- |
| Single Expose Thorax Cito L | - | Rp. 132.240,- |
| Single Expose Clavicula Cito L | - | Rp. 132.240,- |
| Single Expose BNO Cito L | - | Rp. 132.240,- |
| Single Expose Pelvis Cito L | - | Rp. 132.240,- |
| Single Expose Waters Cito L | - | Rp. 132.240,- |
| Single Expose Eruris Ap/Lat Cito L | - | Rp. 166.320,- |
| Single Expose Angkle Joint Cito L | - | Rp. 166.320,- |
| Single Expose Pedis Cito L | - | Rp. 166.320,- |
| Single Expose Calcaneus Cito L | - | Rp. 166.320,- |
| Double Expose Vetebrae Cito L | - | Rp. 160.200,- |
| Double Expose Lumbal Cito L | - | Rp. 160.200,- |
| Single Expose Ekstremitas Cito L | - | Rp. 166.320,- |
| EKG | - | Rp. 64.500,- |
| OCT (Cornea Pachimetry) | - | Rp. 100.000,- |
| OCT (Cornea Angle) | - | Rp. 100.000,- |
| OCT (Makula/Retinal Map) | - | Rp. 200.000,- |
| OCT Glukoma (ONH dan GCC) | - | Rp. 200.000,- |
| OCT ONH | - | Rp. 100.000,- |
| OCT GCC | - | Rp. 100.000,- |
| OCT (Cornea Pachimetri) OD/OS | - | Rp. 100.000,- |
| USG 1 mata | - | Rp. 100.000,- |
| USG 2 mata | - | Rp. 175.000,- |
| (USG/Biometri,TIO,Autorefraktor,GDS,TD) | - | Rp. 250.000,- |
| USG KANDUNGAN | - | Rp. 150.000,- |
| USG Transvaginal | - | Rp. 184.000,- |
| USG Kandungan Dopler | - | Rp. 272.500,- |
| Foto Fundus 1 mata | - | Rp. 100.000,- |
| Foto Fundus 2 mata | - | Rp. 175.000,- |
| CTG | - | Rp. 60.000,- |
| Endoscopy | - | Rp. 170.800,- |
| Endoscopy Kanan Kiri | - | Rp. 341.600,- |
| Nasoendoskopi Rigid | - | Rp. 170.800,- |
| Nasofaringoskopi Endoskopi Fleksibel | - | Rp. 188.800,- |
| Otoendoskopi | - | Rp. 56.400,- |
| Otoendoskopi Kanan Kiri | - | Rp. 112.800,- |
| EEG | - | Rp. 171.000,- |
| Otoscopy | - | Rp. 35.500,- |
| Rhinoskopi | - | Rp. 35.500,- |
| Tes Garpu Tala | - | Rp. 170.800,- |
| Ekokardiografi | - | Rp. 373.000,- |
| Ultrasound Pembuluh Darah | - | Rp. 506.800,- |
| CT Scan | - | Rp. 799.500,- |
| USG Upper Abdomen L | - | Rp. 204.000,- |
| USG Lower Abdomen L | - | Rp. 204.000,- |
| USG Upper-Lower Abdomen L | - | Rp. 360.000,- |
| USG Mamae Tunggal L | - | Rp. 240.000,- |
| USG Mamae Bilateral L | - | Rp. 420.000,- |
| USG Thorax L | - | Rp. 204.000,- |
| USG Doppler Veskuler Perifer L | - | Rp. 480.000,- |
| USG Small Part (Testis,Thyroid,Hemangioma,Tumor) L | - | Rp. 204.000,- |
| USG Small Part dengan Doppler L | - | Rp. 300.000,- |
| Double Expose Vetebrae Cito L | - | Rp. 160.200,- |
| Double Expose Lumbal Cito L | - | Rp. 160.200,- |
| BNO Dua Posisi Cito L | - | Rp. 264.480,- |
| EKG L | - | Rp. 77.400,- |
| OCT (Cornea Pachimetry) L | - | Rp. 120.000,- |
| OCT (Cornea Angle) L | - | Rp. 120.000,- |
| OCT (Makula/Retinal Map) L | - | Rp. 240.000,- |
| OCT Glukoma (ONH dan GCC) L | - | Rp. 240.000,- |
| OCT ONH L | - | Rp. 120.000,- |
| OCT GCC L | - | Rp. 120.000,- |
| OCT (Cornea Pachimetri) OD/OS L | - | Rp. 120.000,- |
| USG 1 mata L | - | Rp. 120.000,- |
| USG 2 mata L | - | Rp. 210.000,- |
| (USG/Biometri,TIO,Autorefraktor,GDS,TD) L | - | Rp. 300.000,- |
| USG KANDUNGAN L | - | Rp. 180.000,- |
| USG Transvaginal L | - | Rp. 220.800,- |
| USG Kandungan Dopler L | - | Rp. 327.000,- |
| Foto Fundus 1 mata L | - | Rp. 120.000,- |
| Foto Fundus 2 mata L | - | Rp. 210.000,- |
| CTG L | - | Rp. 72.000,- |
| Endoscopy L | - | Rp. 204.960,- |
| Endoscopy Kanan Kiri L | - | Rp. 409.920,- |
| Nasoendoskopi Rigid L | - | Rp. 204.960,- |
| Nasofaringoskopi Endoskopi Fleksibel L | - | Rp. 226.560,- |
| Otoendoskopi L | - | Rp. 67.680,- |
| Otoendoskopi Kanan Kiri L | - | Rp. 135.360,- |
| EEG L | - | Rp. 205.200,- |
| Otoscopy L | - | Rp. 42.600,- |
| Rhinoskopi L | - | Rp. 42.600,- |
| Tes Garpu Tala L | - | Rp. 204.960,- |
| Ekokardiografi L | - | Rp. 446.400,- |
| Ultrasound Pembuluh Darah L | - | Rp. 608.160,- |
| USG UPPER ABDOMEN | - | Rp. 135.000,- |
| USG LOWER ABDOMEN | - | Rp. 135.000,- |
| Perimetri | - | Rp. 273.000,- |
| Single Expose Thorax | Rawat Jalan | Rp. 84.000,- |
| Double Expose Eruris Ap/Lat | Rawat Jalan | Rp. 105.000,- |
| Double Expose Vertebrae | Rawat Jalan | Rp. 122.000,- |
| Cranium 3 Posisi AP/Lateral Dantownes | Rawat Jalan | Rp. 206.000,- |
| Kontras (Uretrografi, Appendeicogram, Cystografi) | Rawat Jalan | Rp. 401.600,- |
| BNO IVP / Colon In Loop | Rawat Jalan | Rp. 612.000,- |
| USG Dr. Dalam | Rawat Jalan | Rp. 146.000,- |
| USG Dr. Radiologi | Rawat Jalan | Rp. 146.000,- |
| ELEKTOMEDIKA / EKG | Rawat Jalan | Rp. 64.500,- |
| USG Kandungan | Rawat Jalan | Rp. 150.000,- |
| USG Transvaginal | Rawat Jalan | Rp. 184.000,- |
| USG Dopler | Rawat Jalan | Rp. 216.500,- |
| Retensi Plasenta dan Mola Hidrolosa | Rawat Jalan | Rp. 693.000,- |
| Curatage Aborus | Rawat Jalan | Rp. 396.000,- |
| Single Expose Clavicula | Rawat Jalan | Rp. 84.000,- |
| Single Expose Pelvis | Rawat Jalan | Rp. 84.000,- |
| Single Expose Waters | Rawat Jalan | Rp. 84.000,- |
| Double Expose Angkle Joint | Rawat Jalan | Rp. 105.000,- |
| Double Expose Pedis | Rawat Jalan | Rp. 105.000,- |
| Double Expose Calcaneus | Rawat Jalan | Rp. 105.000,- |
| Double Expose Lumbal | Rawat Jalan | Rp. 122.000,- |
| Double Expose Throcal | Rawat Jalan | Rp. 122.000,- |
| Double Expose Cervical | Rawat Jalan | Rp. 122.000,- |
| BNO Dua Posisi Cito | Rawat Jalan | Rp. 220.400,- |
| Single Expose Thorax L | Rawat Jalan | Rp. 100.800,- |
| Double Expose Eruris Ap/Lat L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Vertebrae L | Rawat Jalan | Rp. 146.400,- |
| Cranium 3 Posisi L | Rawat Jalan | Rp. 201.600,- |
| BNO IVP / Colon In Loop L | Rawat Jalan | Rp. 734.400,- |
| USG Dr. Dalam L | Rawat Jalan | Rp. 175.200,- |
| USG Dr. Radiologi L | Rawat Jalan | Rp. 175.200,- |
| ELEKTOMEDIKA / EKG L | Rawat Jalan | Rp. 77.400,- |
| USG Berwarna L | Rawat Jalan | Rp. 175.200,- |
| USG Transvaginal L | Rawat Jalan | Rp. 220.800,- |
| USG Dopler L | Rawat Jalan | Rp. 259.800,- |
| Retensi Plasenta dan Mola Hidrolosa L | Rawat Jalan | Rp. 831.600,- |
| Curatage Aborus L | Rawat Jalan | Rp. 475.200,- |
| Single Expose Clavicula L | Rawat Jalan | Rp. 100.800,- |
| Single Expose Pelvis L | Rawat Jalan | Rp. 100.800,- |
| Single Expose Waters L | Rawat Jalan | Rp. 100.800,- |
| Double Expose Angkle Joint L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Pedis L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Calcaneus L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Lumbal L | Rawat Jalan | Rp. 146.400,- |
| Double Expose Throcal L | Rawat Jalan | Rp. 146.400,- |
| Double Expose Cervical L | Rawat Jalan | Rp. 146.400,- |
| Double Expose Ekstremitas Knee Joint /Genu | Rawat Jalan | Rp. 105.000,- |
| Mastoid | Rawat Jalan | Rp. 122.000,- |
| Cranium AP/Waters AP | Rawat Jalan | Rp. 84.000,- |
| Cranium Lateral | Rawat Jalan | Rp. 84.000,- |
| Double Expose Cranium AP/Lateral | Rawat Jalan | Rp. 168.000,- |
| Cranium AP/Lateral Cito | Rawat Jalan | Rp. 194.200,- |
| Mandibula AP/Lateral | Rawat Jalan | Rp. 122.000,- |
| Double Expose Ekstremitas Manus AP/Lateral | Rawat Jalan | Rp. 105.000,- |
| Double Expose Ekstremitas Manus AP/Lateral Cito | Rawat Jalan | Rp. 138.600,- |
| Double Expose Ekstremitas Wrist Joint | Rawat Jalan | Rp. 105.000,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral | Rawat Jalan | Rp. 105.000,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral Cito | Rawat Jalan | Rp. 138.600,- |
| Double Expose Ekstremitas Elbow Joint Ap/L | Rawat Jalan | Rp. 105.000,- |
| Double Expose Ekstremitas Elbow Joint Ap/L Cito | Rawat Jalan | Rp. 138.600,- |
| Double Expose Ekstremitas Humerus AP/Lateral | Rawat Jalan | Rp. 105.000,- |
| Double Expose Ekstremitas Shoulders Joint AP/Lateral | Rawat Jalan | Rp. 105.000,- |
| Single Expose Ekstremitas Humerus AP | Rawat Jalan | Rp. 84.000,- |
| Single Expose Ekstremitas Shoulders Joint | Rawat Jalan | Rp. 84.000,- |
| Single Expose Ekstremitas Clavicula | Rawat Jalan | Rp. 84.000,- |
| Double Expose Ekstremitas Pedis AP/Lateral | Rawat Jalan | Rp. 105.000,- |
| Double Expose Ekstremitas Calcaneus AP/Lateral | Rawat Jalan | Rp. 105.000,- |
| Double Expose Ekstremitas Ankle Joint AP/Lateral | Rawat Jalan | Rp. 105.000,- |
| Double Expose Ekstremitas Cruris AP/Lateral | Rawat Jalan | Rp. 105.000,- |
| Double Expose Ekstremitas Knee Joint /Genu Cito | Rawat Jalan | Rp. 138.600,- |
| Double Expose Ekstremitas Femur AP/Lateral | Rawat Jalan | Rp. 105.000,- |
| Double Expose Ekstremitas Hip Joint | Rawat Jalan | Rp. 105.000,- |
| Double Expose Ekstremitas Hip Joint | Rawat Jalan | Rp. 105.000,- |
| Double Expose Thoracal | Rawat Jalan | Rp. 122.000,- |
| Double Expose Thoracolumbal | Rawat Jalan | Rp. 122.000,- |
| Double Expose Lumbosacral | Rawat Jalan | Rp. 122.000,- |
| Thorax AP/ Lateral | Rawat Jalan | Rp. 168.000,- |
| Thorax AP/ Lateral Cito | Rawat Jalan | Rp. 220.400,- |
| OMD | Rawat Jalan | Rp. 600.000,- |
| Double Expose Ekstremitas L | Rawat Jalan | Rp. 126.000,- |
| Single Expose Ekstremitas L | Rawat Jalan | Rp. 100.800,- |
| Single Expose Abdomen L | Rawat Jalan | Rp. 100.800,- |
| Cranium 2 Posisi L | Rawat Jalan | Rp. 100.800,- |
| Cranium AP L | Rawat Jalan | Rp. 100.800,- |
| Laringoskopi | Rawat Jalan | Rp. 36.000,- |
| Single Expose Thorax Cito | Rawat Jalan | Rp. 117.600,- |
| Single Expose Clavicula Cito | Rawat Jalan | Rp. 117.600,- |
| Single Expose Clavicula Cito | Rawat Jalan | Rp. 117.600,- |
| Single Expose BNO Cito | Rawat Jalan | Rp. 117.600,- |
| Single Expose Pelvis Cito | Rawat Jalan | Rp. 117.600,- |
| Single Expose Waters Cito | Rawat Jalan | Rp. 117.600,- |
| Single Expose Eruris Ap/Lat Cito | Rawat Jalan | Rp. 147.000,- |
| Single Expose Angkle Joint Cito | Rawat Jalan | Rp. 147.000,- |
| Single Expose Pedis Cito | Rawat Jalan | Rp. 147.000,- |
| Single Expose Calcaneus Cito | Rawat Jalan | Rp. 147.000,- |
| Single Expose Ekstremitas Cito | Rawat Jalan | Rp. 147.000,- |
| Double Expose Ekstremitas Humerus AP/Lateral Cito | Rawat Jalan | Rp. 147.000,- |
| Abdomen BNO | Rawat Jalan | Rp. 78.800,- |
| Abdomen 2 Posisi | Rawat Jalan | Rp. 144.000,- |
| Double Expose Ekstremitas Knee Joint /Genu Cito | Rawat Jalan | Rp. 147.000,- |
| Double Expose Ekstremitas Manus AP/Lateral Cito | Rawat Jalan | Rp. 147.000,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral Cito | Rawat Jalan | Rp. 147.000,- |
| Double Expose Ekstremitas Elbow Joint Ap/L Cito | Rawat Jalan | Rp. 147.000,- |
| Single Expose Thorax L | Rawat Jalan | Rp. 100.800,- |
| Double Expose Eruris Ap/Lat L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Vertebrae L | Rawat Jalan | Rp. 146.400,- |
| Cranium 3 Posisi AP/Lateral Dantownes L | Rawat Jalan | Rp. 247.200,- |
| Kontras (Uretrografi, Appendeicogram, Cystografi) L | Rawat Jalan | Rp. 481.920,- |
| BNO IVP / Colon In Loop L | Rawat Jalan | Rp. 734.400,- |
| USG Dr. Dalam L | Rawat Jalan | Rp. 175.200,- |
| USG Dr. Radiologi L | Rawat Jalan | Rp. 175.200,- |
| ELEKTOMEDIKA / EKG L | Rawat Jalan | Rp. 77.400,- |
| USG Kandungan L | Rawat Jalan | Rp. 180.000,- |
| USG Transvaginal L | Rawat Jalan | Rp. 220.800,- |
| USG Dopler L | Rawat Jalan | Rp. 259.800,- |
| Retensi Plasenta dan Mola Hidrolosa L | Rawat Jalan | Rp. 831.600,- |
| Curatage Aborus L | Rawat Jalan | Rp. 475.200,- |
| Single Expose Clavicula L | Rawat Jalan | Rp. 100.800,- |
| Single Expose Pelvis L | Rawat Jalan | Rp. 100.800,- |
| Single Expose Waters L | Rawat Jalan | Rp. 100.800,- |
| Double Expose Angkle Joint L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Pedis L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Calcaneus L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Lumbal L | Rawat Jalan | Rp. 146.400,- |
| Double Expose Throcal L | Rawat Jalan | Rp. 146.400,- |
| Double Expose Cervical L | Rawat Jalan | Rp. 146.400,- |
| BNO Dua Posisi Cito L | Rawat Jalan | Rp. 264.480,- |
| Double Expose Ekstremitas Knee Joint /Genu L | Rawat Jalan | Rp. 126.000,- |
| Mastoid L | Rawat Jalan | Rp. 146.400,- |
| Cranium AP/Waters AP L | Rawat Jalan | Rp. 100.800,- |
| Cranium Lateral L | Rawat Jalan | Rp. 100.800,- |
| Double Expose Cranium AP/Lateral L | Rawat Jalan | Rp. 201.600,- |
| Cranium AP/Lateral Cito L | Rawat Jalan | Rp. 233.040,- |
| Mandibula AP/Lateral L | Rawat Jalan | Rp. 146.400,- |
| Double Expose Ekstremitas Manus AP/Lateral L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Ekstremitas Manus AP/Lateral Cito L | Rawat Jalan | Rp. 166.320,- |
| Double Expose Ekstremitas Wrist Joint L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral Cito L | Rawat Jalan | Rp. 166.320,- |
| Double Expose Ekstremitas Elbow Joint Ap/L L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Ekstremitas Elbow Joint Ap/L Cito L | Rawat Jalan | Rp. 166.320,- |
| Double Expose Ekstremitas Humerus AP/Lateral L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Ekstremitas Shoulders Joint AP/Lateral L | Rawat Jalan | Rp. 126.000,- |
| Single Expose Ekstremitas Humerus AP L | Rawat Jalan | Rp. 100.800,- |
| Single Expose Ekstremitas Shoulders Joint L | Rawat Jalan | Rp. 100.800,- |
| Single Expose Ekstremitas Clavicula L | Rawat Jalan | Rp. 100.800,- |
| Double Expose Ekstremitas Pedis AP/Lateral L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Ekstremitas Calcaneus AP/Lateral L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Ekstremitas Ankle Joint AP/Lateral L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Ekstremitas Cruris AP/Lateral L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Ekstremitas Knee Joint /Genu Cito L | Rawat Jalan | Rp. 166.320,- |
| Double Expose Ekstremitas Femur AP/Lateral L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Ekstremitas Hip Joint L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Ekstremitas Hip Joint L | Rawat Jalan | Rp. 126.000,- |
| Double Expose Thoracal L | Rawat Jalan | Rp. 146.400,- |
| Double Expose Thoracolumbal L | Rawat Jalan | Rp. 146.400,- |
| Double Expose Lumbosacral L | Rawat Jalan | Rp. 146.400,- |
| Thorax AP/ Lateral L | Rawat Jalan | Rp. 201.600,- |
| Thorax AP/ Lateral Cito L | Rawat Jalan | Rp. 264.480,- |
| OMD L | Rawat Jalan | Rp. 720.000,- |
| Double Expose Ekstremitas L L | Rawat Jalan | Rp. 151.200,- |
| Single Expose Ekstremitas L L | Rawat Jalan | Rp. 120.960,- |
| Single Expose Abdomen L L | Rawat Jalan | Rp. 120.960,- |
| Cranium 2 Posisi L L | Rawat Jalan | Rp. 120.960,- |
| Cranium AP L L | Rawat Jalan | Rp. 120.960,- |
| Laringoskopi L | Rawat Jalan | Rp. 43.200,- |
| Single Expose Thorax Cito L | Rawat Jalan | Rp. 141.120,- |
| Single Expose Clavicula Cito L | Rawat Jalan | Rp. 141.120,- |
| Single Expose Clavicula Cito L | Rawat Jalan | Rp. 141.120,- |
| Single Expose BNO Cito L | Rawat Jalan | Rp. 141.120,- |
| Single Expose Pelvis Cito L | Rawat Jalan | Rp. 141.120,- |
| Single Expose Waters Cito L | Rawat Jalan | Rp. 141.120,- |
| Single Expose Eruris Ap/Lat Cito L | Rawat Jalan | Rp. 176.400,- |
| Single Expose Angkle Joint Cito L | Rawat Jalan | Rp. 176.400,- |
| Single Expose Pedis Cito L | Rawat Jalan | Rp. 176.400,- |
| Single Expose Calcaneus Cito L | Rawat Jalan | Rp. 176.400,- |
| Single Expose Ekstremitas Cito L | Rawat Jalan | Rp. 176.400,- |
| Double Expose Ekstremitas Humerus AP/Lateral Cito L | Rawat Jalan | Rp. 176.400,- |
| Abdomen BNO L | Rawat Jalan | Rp. 94.560,- |
| Abdomen 2 Posisi L | Rawat Jalan | Rp. 172.800,- |
| Double Expose Ekstremitas Knee Joint /Genu Cito L | Rawat Jalan | Rp. 176.400,- |
| Double Expose Ekstremitas Manus AP/Lateral Cito L | Rawat Jalan | Rp. 176.400,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral Cito L | Rawat Jalan | Rp. 176.400,- |
| Double Expose Ekstremitas Elbow Joint Ap/L Cito L | Rawat Jalan | Rp. 176.400,- |
| Single Expose Thorax | Kelas 1 | Rp. 100.800,- |
| Double Expose Eruris Ap/Lat | Kelas 1 | Rp. 126.000,- |
| Double Expose Vertebrae | Kelas 1 | Rp. 124.500,- |
| Cranium 3 Posisi AP/Lateral Dantownes | Kelas 1 | Rp. 239.000,- |
| Kontras (Uretrografi, Appendeicogram, Cystografi) | Kelas 1 | Rp. 448.300,- |
| BNO IVP / Colon In Loop | Kelas 1 | Rp. 738.200,- |
| USG Dr. Dalam | Kelas 1 | Rp. 159.500,- |
| USG Dr. Radiologi | Kelas 1 | Rp. 159.500,- |
| ELEKTOMEDIKA / EKG | Kelas 1 | Rp. 71.500,- |
| USG Kandungan | Kelas 1 | Rp. 155.000,- |
| USG Transvaginal | Kelas 1 | Rp. 197.500,- |
| USG Dopler | Kelas 1 | Rp. 217.500,- |
| Retensi Plasenta dan Mola Hidrolosa | Kelas 1 | Rp. 1.386.000,- |
| Curatage Aborus | Kelas 1 | Rp. 841.500,- |
| Single Expose Clavicula | Kelas 1 | Rp. 100.800,- |
| Single Expose Pelvis | Kelas 1 | Rp. 100.800,- |
| Single Expose Waters | Kelas 1 | Rp. 100.800,- |
| Double Expose Angkle Joint | Kelas 1 | Rp. 126.000,- |
| Double Expose Pedis | Kelas 1 | Rp. 126.000,- |
| Double Expose Calcaneus | Kelas 1 | Rp. 126.000,- |
| Double Expose Lumbal | Kelas 1 | Rp. 124.500,- |
| Double Expose Throcal | Kelas 1 | Rp. 124.500,- |
| Double Expose Cervical | Kelas 1 | Rp. 124.500,- |
| Single Expose Thorax L | Kelas 1 | Rp. 120.960,- |
| Double Expose Eruris Ap/Lat L | Kelas 1 | Rp. 151.200,- |
| Double Expose Vertebrae L | Kelas 1 | Rp. 149.400,- |
| Cranium 3 Posisi L | Kelas 1 | Rp. 213.600,- |
| BNO IVP / Colon In Loop L | Kelas 1 | Rp. 885.840,- |
| USG Dr. Dalam L | Kelas 1 | Rp. 191.400,- |
| USG Dr. Radiologi L | Kelas 1 | Rp. 191.400,- |
| ELEKTOMEDIKA / EKG L | Kelas 1 | Rp. 85.800,- |
| USG Berwarna L | Kelas 1 | Rp. 191.400,- |
| USG Transvaginal L | Kelas 1 | Rp. 237.000,- |
| USG Dopler L | Kelas 1 | Rp. 261.000,- |
| Retensi Plasenta dan Mola Hidrolosa L | Kelas 1 | Rp. 1.663.200,- |
| Curatage Aborus L | Kelas 1 | Rp. 1.009.800,- |
| Single Expose Clavicula L | Kelas 1 | Rp. 120.960,- |
| Single Expose Pelvis L | Kelas 1 | Rp. 120.960,- |
| Single Expose Waters L | Kelas 1 | Rp. 120.960,- |
| Double Expose Angkle Joint L | Kelas 1 | Rp. 151.200,- |
| Double Expose Pedis L | Kelas 1 | Rp. 151.200,- |
| Double Expose Calcaneus L | Kelas 1 | Rp. 151.200,- |
| Double Expose Lumbal L | Kelas 1 | Rp. 149.400,- |
| Double Expose Throcal L | Kelas 1 | Rp. 149.400,- |
| Double Expose Cervical L | Kelas 1 | Rp. 149.400,- |
| Cranium AP/Waters AP | Kelas 1 | Rp. 100.800,- |
| Cranium Lateral | Kelas 1 | Rp. 100.800,- |
| Double Expose Cranium AP/Lateral | Kelas 1 | Rp. 178.000,- |
| Mandibula AP/Lateral | Kelas 1 | Rp. 124.500,- |
| Double Expose Ekstremitas Manus AP/Lateral | Kelas 1 | Rp. 126.000,- |
| Double Expose Ekstremitas Wrist Joint | Kelas 1 | Rp. 126.000,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral | Kelas 1 | Rp. 126.000,- |
| Double Expose Ekstremitas Elbow Joint Ap/L | Kelas 1 | Rp. 126.000,- |
| Double Expose Ekstremitas Humerus AP/Lateral | Kelas 1 | Rp. 126.000,- |
| Double Expose Ekstremitas Shoulders Joint AP/Lateral | Kelas 1 | Rp. 126.000,- |
| Single Expose Ekstremitas Humerus AP | Kelas 1 | Rp. 100.800,- |
| Single Expose Ekstremitas Shoulders Joint | Kelas 1 | Rp. 100.800,- |
| Single Expose Ekstremitas Clavicula | Kelas 1 | Rp. 100.800,- |
| Double Expose Ekstremitas Pedis AP/Lateral | Kelas 1 | Rp. 126.000,- |
| Double Expose Ekstremitas Calcaneus AP/Lateral | Kelas 1 | Rp. 126.000,- |
| Double Expose Ekstremitas Ankle Joint AP/Lateral | Kelas 1 | Rp. 126.000,- |
| Double Expose Ekstremitas Cruris AP/Lateral | Kelas 1 | Rp. 126.000,- |
| Double Expose Ekstremitas Knee Joint /Genu | Kelas 1 | Rp. 126.000,- |
| Double Expose Ekstremitas Femur AP/Lateral | Kelas 1 | Rp. 126.000,- |
| Double Expose Ekstremitas Hip Joint | Kelas 1 | Rp. 126.000,- |
| Double Expose Thoracal | Kelas 1 | Rp. 124.500,- |
| Double Expose Thoracolumbal | Kelas 1 | Rp. 124.500,- |
| Double Expose Lumbosacral | Kelas 1 | Rp. 124.500,- |
| Single Expose Thorax Cito | Kelas 1 | Rp. 141.120,- |
| Single Expose Clavicula Cito | Kelas 1 | Rp. 141.120,- |
| Single Expose Clavicula Cito | Kelas 1 | Rp. 117.600,- |
| Single Expose BNO Cito | Kelas 1 | Rp. 141.120,- |
| Single Expose Pelvis Cito | Kelas 1 | Rp. 141.120,- |
| Single Expose Waters Cito | Kelas 1 | Rp. 141.120,- |
| Single Expose Eruris Ap/Lat Cito | Kelas 1 | Rp. 176.400,- |
| Single Expose Angkle Joint Cito | Kelas 1 | Rp. 176.400,- |
| Single Expose Pedis Cito | Kelas 1 | Rp. 176.400,- |
| Single Expose Calcaneus Cito | Kelas 1 | Rp. 176.400,- |
| Single Expose Ekstremitas Cito | Kelas 1 | Rp. 176.400,- |
| Double Expose Ekstremitas Humerus AP/Lateral Cito | Kelas 1 | Rp. 176.400,- |
| Abdomen BNO | Kelas 1 | Rp. 83.000,- |
| Abdomen 2 Posisi | Kelas 1 | Rp. 166.000,- |
| Double Expose Ekstremitas Knee Joint /Genu Cito | Kelas 1 | Rp. 176.400,- |
| Double Expose Ekstremitas Manus AP/Lateral Cito | Kelas 1 | Rp. 176.400,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral Cito | Kelas 1 | Rp. 176.400,- |
| Double Expose Ekstremitas Elbow Joint Ap/L Cito | Kelas 1 | Rp. 176.400,- |
| Single Expose Thorax L | Kelas 1 | Rp. 120.960,- |
| Double Expose Eruris Ap/Lat L | Kelas 1 | Rp. 151.200,- |
| Double Expose Vertebrae L | Kelas 1 | Rp. 149.400,- |
| Cranium 3 Posisi AP/Lateral Dantownes L | Kelas 1 | Rp. 286.800,- |
| Kontras (Uretrografi, Appendeicogram, Cystografi) L | Kelas 1 | Rp. 537.960,- |
| BNO IVP / Colon In Loop L | Kelas 1 | Rp. 885.840,- |
| USG Dr. Dalam L | Kelas 1 | Rp. 191.400,- |
| USG Dr. Radiologi L | Kelas 1 | Rp. 191.400,- |
| ELEKTOMEDIKA / EKG L | Kelas 1 | Rp. 85.800,- |
| USG Kandungan L | Kelas 1 | Rp. 186.000,- |
| USG Transvaginal L | Kelas 1 | Rp. 237.000,- |
| USG Dopler L | Kelas 1 | Rp. 261.000,- |
| Retensi Plasenta dan Mola Hidrolosa L | Kelas 1 | Rp. 1.663.200,- |
| Curatage Aborus L | Kelas 1 | Rp. 1.009.800,- |
| Single Expose Clavicula L | Kelas 1 | Rp. 120.960,- |
| Single Expose Pelvis L | Kelas 1 | Rp. 120.960,- |
| Single Expose Waters L | Kelas 1 | Rp. 120.960,- |
| Double Expose Angkle Joint L | Kelas 1 | Rp. 151.200,- |
| Double Expose Pedis L | Kelas 1 | Rp. 151.200,- |
| Double Expose Calcaneus L | Kelas 1 | Rp. 151.200,- |
| Double Expose Lumbal L | Kelas 1 | Rp. 149.400,- |
| Double Expose Throcal L | Kelas 1 | Rp. 149.400,- |
| Double Expose Cervical L | Kelas 1 | Rp. 149.400,- |
| Cranium AP/Waters AP L | Kelas 1 | Rp. 120.960,- |
| Cranium Lateral L | Kelas 1 | Rp. 120.960,- |
| Double Expose Cranium AP/Lateral L | Kelas 1 | Rp. 213.600,- |
| Mandibula AP/Lateral L | Kelas 1 | Rp. 149.400,- |
| Double Expose Ekstremitas Manus AP/Lateral L | Kelas 1 | Rp. 151.200,- |
| Double Expose Ekstremitas Wrist Joint L | Kelas 1 | Rp. 151.200,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral L | Kelas 1 | Rp. 151.200,- |
| Double Expose Ekstremitas Elbow Joint Ap/L L | Kelas 1 | Rp. 151.200,- |
| Double Expose Ekstremitas Humerus AP/Lateral L | Kelas 1 | Rp. 151.200,- |
| Double Expose Ekstremitas Shoulders Joint AP/Lateral L | Kelas 1 | Rp. 151.200,- |
| Single Expose Ekstremitas Humerus AP L | Kelas 1 | Rp. 120.960,- |
| Single Expose Ekstremitas Shoulders Joint L | Kelas 1 | Rp. 120.960,- |
| Single Expose Ekstremitas Clavicula L | Kelas 1 | Rp. 120.960,- |
| Double Expose Ekstremitas Pedis AP/Lateral L | Kelas 1 | Rp. 151.200,- |
| Double Expose Ekstremitas Calcaneus AP/Lateral L | Kelas 1 | Rp. 151.200,- |
| Double Expose Ekstremitas Ankle Joint AP/Lateral L | Kelas 1 | Rp. 151.200,- |
| Double Expose Ekstremitas Cruris AP/Lateral L | Kelas 1 | Rp. 151.200,- |
| Double Expose Ekstremitas Knee Joint /Genu L | Kelas 1 | Rp. 151.200,- |
| Double Expose Ekstremitas Femur AP/Lateral L | Kelas 1 | Rp. 151.200,- |
| Double Expose Ekstremitas Hip Joint L | Kelas 1 | Rp. 151.200,- |
| Double Expose Thoracal L | Kelas 1 | Rp. 149.400,- |
| Double Expose Thoracolumbal L | Kelas 1 | Rp. 149.400,- |
| Double Expose Lumbosacral L | Kelas 1 | Rp. 149.400,- |
| Single Expose Thorax Cito L | Kelas 1 | Rp. 169.344,- |
| Single Expose Clavicula Cito L | Kelas 1 | Rp. 169.344,- |
| Single Expose Clavicula Cito L | Kelas 1 | Rp. 141.120,- |
| Single Expose BNO Cito L | Kelas 1 | Rp. 169.344,- |
| Single Expose Pelvis Cito L | Kelas 1 | Rp. 169.344,- |
| Single Expose Waters Cito L | Kelas 1 | Rp. 169.344,- |
| Single Expose Eruris Ap/Lat Cito L | Kelas 1 | Rp. 211.680,- |
| Single Expose Angkle Joint Cito L | Kelas 1 | Rp. 211.680,- |
| Single Expose Pedis Cito L | Kelas 1 | Rp. 211.680,- |
| Single Expose Calcaneus Cito L | Kelas 1 | Rp. 211.680,- |
| Single Expose Ekstremitas Cito L | Kelas 1 | Rp. 211.680,- |
| Double Expose Ekstremitas Humerus AP/Lateral Cito L | Kelas 1 | Rp. 211.680,- |
| Abdomen BNO L | Kelas 1 | Rp. 99.600,- |
| Abdomen 2 Posisi L | Kelas 1 | Rp. 199.200,- |
| Double Expose Ekstremitas Knee Joint /Genu Cito L | Kelas 1 | Rp. 211.680,- |
| Double Expose Ekstremitas Manus AP/Lateral Cito L | Kelas 1 | Rp. 211.680,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral Cito L | Kelas 1 | Rp. 211.680,- |
| Double Expose Ekstremitas Elbow Joint Ap/L Cito L | Kelas 1 | Rp. 211.680,- |
| Single Expose Thorax | Kelas 2 | Rp. 92.400,- |
| Double Expose Eruris Ap/Lat | Kelas 2 | Rp. 115.500,- |
| Double Expose Vertebrae | Kelas 2 | Rp. 122.000,- |
| Cranium 3 Posisi AP/Lateral Dantownes | Kelas 2 | Rp. 206.000,- |
| Kontras (Uretrografi, Appendeicogram, Cystografi) | Kelas 2 | Rp. 443.600,- |
| BNO IVP / Colon In Loop | Kelas 2 | Rp. 672.000,- |
| USG Dr. Dalam | Kelas 2 | Rp. 146.000,- |
| USG Dr. Radiologi | Kelas 2 | Rp. 146.000,- |
| ELEKTOMEDIKA / EKG | Kelas 2 | Rp. 64.500,- |
| USG Kandungan | Kelas 2 | Rp. 150.000,- |
| USG Transvaginal | Kelas 2 | Rp. 184.000,- |
| USG Dopler | Kelas 2 | Rp. 216.500,- |
| Retensi Plasenta dan Mola Hidrolosa | Kelas 2 | Rp. 891.000,- |
| Curatage Aborus | Kelas 2 | Rp. 544.500,- |
| Single Expose Clavicula | Kelas 2 | Rp. 92.400,- |
| Single Expose Pelvis | Kelas 2 | Rp. 92.400,- |
| Single Expose Waters | Kelas 2 | Rp. 92.400,- |
| Double Expose Angkle Joint | Kelas 2 | Rp. 115.500,- |
| Double Expose Pedis | Kelas 2 | Rp. 115.500,- |
| Double Expose Calcaneus | Kelas 2 | Rp. 115.500,- |
| Double Expose Lumbal | Kelas 2 | Rp. 122.000,- |
| Double Expose Throcal | Kelas 2 | Rp. 122.000,- |
| Double Expose Cervical | Kelas 2 | Rp. 122.000,- |
| Single Expose Thorax L | Kelas 2 | Rp. 110.880,- |
| Double Expose Eruris Ap/Lat L | Kelas 2 | Rp. 138.600,- |
| Double Expose Vertebrae L | Kelas 2 | Rp. 146.400,- |
| Cranium 3 Posisi L | Kelas 2 | Rp. 201.600,- |
| BNO IVP / Colon In Loop L | Kelas 2 | Rp. 806.400,- |
| USG Dr. Dalam L | Kelas 2 | Rp. 175.200,- |
| USG Dr. Radiologi L | Kelas 2 | Rp. 175.200,- |
| ELEKTOMEDIKA / EKG L | Kelas 2 | Rp. 77.400,- |
| USG Berwarna L | Kelas 2 | Rp. 175.200,- |
| USG Transvaginal L | Kelas 2 | Rp. 220.800,- |
| USG Dopler L | Kelas 2 | Rp. 259.800,- |
| Retensi Plasenta dan Mola Hidrolosa L | Kelas 2 | Rp. 1.069.200,- |
| Curatage Aborus L | Kelas 2 | Rp. 653.400,- |
| Single Expose Clavicula L | Kelas 2 | Rp. 110.880,- |
| Single Expose Pelvis L | Kelas 2 | Rp. 110.880,- |
| Single Expose Waters L | Kelas 2 | Rp. 110.880,- |
| Double Expose Angkle Joint L | Kelas 2 | Rp. 138.600,- |
| Double Expose Pedis L | Kelas 2 | Rp. 138.600,- |
| Double Expose Calcaneus L | Kelas 2 | Rp. 138.600,- |
| Double Expose Lumbal L | Kelas 2 | Rp. 146.400,- |
| Double Expose Throcal L | Kelas 2 | Rp. 146.400,- |
| Double Expose Cervical L | Kelas 2 | Rp. 146.400,- |
| Cranium AP/Waters AP | Kelas 2 | Rp. 92.400,- |
| Cranium Lateral | Kelas 2 | Rp. 92.400,- |
| Double Expose Cranium AP/Lateral | Kelas 2 | Rp. 168.000,- |
| Mandibula AP/Lateral | Kelas 2 | Rp. 122.000,- |
| Double Expose Ekstremitas Manus AP/Lateral | Kelas 2 | Rp. 115.500,- |
| Double Expose Ekstremitas Wrist Joint | Kelas 2 | Rp. 115.500,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral | Kelas 2 | Rp. 115.500,- |
| Double Expose Ekstremitas Elbow Joint Ap/L | Kelas 2 | Rp. 115.500,- |
| Double Expose Ekstremitas Humerus AP/Lateral | Kelas 2 | Rp. 115.500,- |
| Double Expose Ekstremitas Shoulders Joint AP/Lateral | Kelas 2 | Rp. 115.500,- |
| Single Expose Ekstremitas Humerus AP | Kelas 2 | Rp. 92.400,- |
| Single Expose Ekstremitas Shoulders Joint | Kelas 2 | Rp. 92.400,- |
| Single Expose Ekstremitas Clavicula | Kelas 2 | Rp. 92.400,- |
| Double Expose Ekstremitas Pedis AP/Lateral | Kelas 2 | Rp. 115.500,- |
| Double Expose Ekstremitas Calcaneus AP/Lateral | Kelas 2 | Rp. 115.500,- |
| Double Expose Ekstremitas Ankle Joint AP/Lateral | Kelas 2 | Rp. 115.500,- |
| Double Expose Ekstremitas Cruris AP/Lateral | Kelas 2 | Rp. 115.500,- |
| Double Expose Ekstremitas Knee Joint /Genu | Kelas 2 | Rp. 115.500,- |
| Double Expose Ekstremitas Femur AP/Lateral | Kelas 2 | Rp. 115.500,- |
| Double Expose Ekstremitas Hip Joint | Kelas 2 | Rp. 115.500,- |
| Double Expose Thoracal | Kelas 2 | Rp. 122.000,- |
| Double Expose Thoracolumbal | Kelas 2 | Rp. 122.000,- |
| Double Expose Lumbosacral | Kelas 2 | Rp. 122.000,- |
| Single Expose Thorax Cito | Kelas 2 | Rp. 129.360,- |
| Single Expose Clavicula Cito | Kelas 2 | Rp. 129.360,- |
| Single Expose Clavicula Cito | Kelas 2 | Rp. 117.600,- |
| Single Expose BNO Cito | Kelas 2 | Rp. 129.280,- |
| Single Expose Pelvis Cito | Kelas 2 | Rp. 129.360,- |
| Single Expose Waters Cito | Kelas 2 | Rp. 129.360,- |
| Single Expose Eruris Ap/Lat Cito | Kelas 2 | Rp. 161.700,- |
| Single Expose Angkle Joint Cito | Kelas 2 | Rp. 161.700,- |
| Single Expose Pedis Cito | Kelas 2 | Rp. 161.700,- |
| Single Expose Calcaneus Cito | Kelas 2 | Rp. 161.700,- |
| Single Expose Ekstremitas Cito | Kelas 2 | Rp. 161.700,- |
| Double Expose Ekstremitas Humerus AP/Lateral Cito | Kelas 2 | Rp. 161.700,- |
| Abdomen BNO | Kelas 2 | Rp. 77.500,- |
| Abdomen 2 Posisi | Kelas 2 | Rp. 155.000,- |
| Double Expose Ekstremitas Knee Joint /Genu Cito | Kelas 2 | Rp. 161.700,- |
| Double Expose Ekstremitas Manus AP/Lateral Cito | Kelas 2 | Rp. 161.700,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral Cito | Kelas 2 | Rp. 161.700,- |
| Double Expose Ekstremitas Elbow Joint Ap/L Cito | Kelas 2 | Rp. 161.700,- |
| Single Expose Thorax L | Kelas 2 | Rp. 110.880,- |
| Double Expose Eruris Ap/Lat L | Kelas 2 | Rp. 138.600,- |
| Double Expose Vertebrae L | Kelas 2 | Rp. 146.400,- |
| Cranium 3 Posisi AP/Lateral Dantownes L | Kelas 2 | Rp. 247.200,- |
| Kontras (Uretrografi, Appendeicogram, Cystografi) L | Kelas 2 | Rp. 532.320,- |
| BNO IVP / Colon In Loop L | Kelas 2 | Rp. 806.400,- |
| USG Dr. Dalam L | Kelas 2 | Rp. 175.200,- |
| USG Dr. Radiologi L | Kelas 2 | Rp. 175.200,- |
| ELEKTOMEDIKA / EKG L | Kelas 2 | Rp. 77.400,- |
| USG Kandungan L | Kelas 2 | Rp. 180.000,- |
| USG Transvaginal L | Kelas 2 | Rp. 220.800,- |
| USG Dopler L | Kelas 2 | Rp. 259.800,- |
| Retensi Plasenta dan Mola Hidrolosa L | Kelas 2 | Rp. 1.069.200,- |
| Curatage Aborus L | Kelas 2 | Rp. 653.400,- |
| Single Expose Clavicula L | Kelas 2 | Rp. 110.880,- |
| Single Expose Pelvis L | Kelas 2 | Rp. 110.880,- |
| Single Expose Waters L | Kelas 2 | Rp. 110.880,- |
| Double Expose Angkle Joint L | Kelas 2 | Rp. 138.600,- |
| Double Expose Pedis L | Kelas 2 | Rp. 138.600,- |
| Double Expose Calcaneus L | Kelas 2 | Rp. 138.600,- |
| Double Expose Lumbal L | Kelas 2 | Rp. 146.400,- |
| Double Expose Throcal L | Kelas 2 | Rp. 146.400,- |
| Double Expose Cervical L | Kelas 2 | Rp. 146.400,- |
| Cranium AP/Waters AP L | Kelas 2 | Rp. 110.880,- |
| Cranium Lateral L | Kelas 2 | Rp. 110.880,- |
| Double Expose Cranium AP/Lateral L | Kelas 2 | Rp. 201.600,- |
| Mandibula AP/Lateral L | Kelas 2 | Rp. 146.400,- |
| Double Expose Ekstremitas Manus AP/Lateral L | Kelas 2 | Rp. 138.600,- |
| Double Expose Ekstremitas Wrist Joint L | Kelas 2 | Rp. 138.600,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral L | Kelas 2 | Rp. 138.600,- |
| Double Expose Ekstremitas Elbow Joint Ap/L L | Kelas 2 | Rp. 138.600,- |
| Double Expose Ekstremitas Humerus AP/Lateral L | Kelas 2 | Rp. 138.600,- |
| Double Expose Ekstremitas Shoulders Joint AP/Lateral L | Kelas 2 | Rp. 138.600,- |
| Single Expose Ekstremitas Humerus AP L | Kelas 2 | Rp. 110.880,- |
| Single Expose Ekstremitas Shoulders Joint L | Kelas 2 | Rp. 110.880,- |
| Single Expose Ekstremitas Clavicula L | Kelas 2 | Rp. 110.880,- |
| Double Expose Ekstremitas Pedis AP/Lateral L | Kelas 2 | Rp. 138.600,- |
| Double Expose Ekstremitas Calcaneus AP/Lateral L | Kelas 2 | Rp. 138.600,- |
| Double Expose Ekstremitas Ankle Joint AP/Lateral L | Kelas 2 | Rp. 138.600,- |
| Double Expose Ekstremitas Cruris AP/Lateral L | Kelas 2 | Rp. 138.600,- |
| Double Expose Ekstremitas Knee Joint /Genu L | Kelas 2 | Rp. 138.600,- |
| Double Expose Ekstremitas Femur AP/Lateral L | Kelas 2 | Rp. 138.600,- |
| Double Expose Ekstremitas Hip Joint L | Kelas 2 | Rp. 138.600,- |
| Double Expose Thoracal L | Kelas 2 | Rp. 146.400,- |
| Double Expose Thoracolumbal L | Kelas 2 | Rp. 146.400,- |
| Double Expose Lumbosacral L | Kelas 2 | Rp. 146.400,- |
| Single Expose Thorax Cito L | Kelas 2 | Rp. 155.232,- |
| Single Expose Clavicula Cito L | Kelas 2 | Rp. 155.232,- |
| Single Expose Clavicula Cito L | Kelas 2 | Rp. 141.120,- |
| Single Expose BNO Cito L | Kelas 2 | Rp. 155.136,- |
| Single Expose Pelvis Cito L | Kelas 2 | Rp. 155.232,- |
| Single Expose Waters Cito L | Kelas 2 | Rp. 155.232,- |
| Single Expose Eruris Ap/Lat Cito L | Kelas 2 | Rp. 194.040,- |
| Single Expose Angkle Joint Cito L | Kelas 2 | Rp. 194.040,- |
| Single Expose Pedis Cito L | Kelas 2 | Rp. 194.040,- |
| Single Expose Calcaneus Cito L | Kelas 2 | Rp. 194.040,- |
| Single Expose Ekstremitas Cito L | Kelas 2 | Rp. 194.040,- |
| Double Expose Ekstremitas Humerus AP/Lateral Cito L | Kelas 2 | Rp. 194.040,- |
| Abdomen BNO L | Kelas 2 | Rp. 93.000,- |
| Abdomen 2 Posisi L | Kelas 2 | Rp. 186.000,- |
| Double Expose Ekstremitas Knee Joint /Genu Cito L | Kelas 2 | Rp. 194.040,- |
| Double Expose Ekstremitas Manus AP/Lateral Cito L | Kelas 2 | Rp. 194.040,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral Cito L | Kelas 2 | Rp. 194.040,- |
| Double Expose Ekstremitas Elbow Joint Ap/L Cito L | Kelas 2 | Rp. 194.040,- |
| Single Expose Thorax | Kelas 3 | Rp. 84.000,- |
| Double Expose Eruris Ap/Lat | Kelas 3 | Rp. 105.000,- |
| Double Expose Vertebrae | Kelas 3 | Rp. 122.000,- |
| Cranium 3 Posisi AP/Lateral Dantownes | Kelas 3 | Rp. 206.000,- |
| Kontras (Uretrografi, Appendeicogram, Cystografi) | Kelas 3 | Rp. 401.600,- |
| BNO IVP / Colon In Loop | Kelas 3 | Rp. 612.000,- |
| USG Dr. Dalam | Kelas 3 | Rp. 146.000,- |
| USG Dr. Radiologi | Kelas 3 | Rp. 146.000,- |
| ELEKTOMEDIKA / EKG | Kelas 3 | Rp. 64.500,- |
| USG Kandungan | Kelas 3 | Rp. 150.000,- |
| USG Transvaginal | Kelas 3 | Rp. 184.000,- |
| USG Dopler | Kelas 3 | Rp. 216.500,- |
| Retensi Plasenta dan Mola Hidrolosa | Kelas 3 | Rp. 693.000,- |
| Curatage Aborus | Kelas 3 | Rp. 396.000,- |
| Single Expose Clavicula | Kelas 3 | Rp. 84.000,- |
| Single Expose Pelvis | Kelas 3 | Rp. 84.000,- |
| Single Expose Waters | Kelas 3 | Rp. 84.000,- |
| Double Expose Angkle Joint | Kelas 3 | Rp. 105.000,- |
| Double Expose Pedis | Kelas 3 | Rp. 105.000,- |
| Double Expose Calcaneus | Kelas 3 | Rp. 105.000,- |
| Double Expose Lumbal | Kelas 3 | Rp. 122.000,- |
| Double Expose Throcal | Kelas 3 | Rp. 122.000,- |
| Double Expose Cervical | Kelas 3 | Rp. 122.000,- |
| Single Expose Thorax L | Kelas 3 | Rp. 100.800,- |
| Double Expose Eruris Ap/Lat L | Kelas 3 | Rp. 126.000,- |
| Double Expose Vertebrae L | Kelas 3 | Rp. 146.400,- |
| Cranium 3 Posisi L | Kelas 3 | Rp. 201.600,- |
| BNO IVP / Colon In Loop L | Kelas 3 | Rp. 734.400,- |
| USG Dr. Dalam L | Kelas 3 | Rp. 175.200,- |
| USG Dr. Radiologi L | Kelas 3 | Rp. 175.200,- |
| ELEKTOMEDIKA / EKG L | Kelas 3 | Rp. 77.400,- |
| USG Berwarna L | Kelas 3 | Rp. 175.200,- |
| USG Transvaginal L | Kelas 3 | Rp. 220.800,- |
| USG Dopler L | Kelas 3 | Rp. 259.800,- |
| Retensi Plasenta dan Mola Hidrolosa L | Kelas 3 | Rp. 831.600,- |
| Curatage Aborus L | Kelas 3 | Rp. 475.200,- |
| Single Expose Clavicula L | Kelas 3 | Rp. 100.800,- |
| Single Expose Pelvis L | Kelas 3 | Rp. 100.800,- |
| Single Expose Waters L | Kelas 3 | Rp. 100.800,- |
| Double Expose Angkle Joint L | Kelas 3 | Rp. 126.000,- |
| Double Expose Pedis L | Kelas 3 | Rp. 126.000,- |
| Double Expose Calcaneus L | Kelas 3 | Rp. 126.000,- |
| Double Expose Lumbal L | Kelas 3 | Rp. 146.400,- |
| Double Expose Throcal L | Kelas 3 | Rp. 146.400,- |
| Double Expose Cervical L | Kelas 3 | Rp. 146.400,- |
| Double Expose Ekstremitas Knee Joint /Genu | Kelas 3 | Rp. 105.000,- |
| Mastoid | Kelas 3 | Rp. 122.000,- |
| Cranium AP/Waters AP | Kelas 3 | Rp. 84.000,- |
| Cranium Lateral | Kelas 3 | Rp. 84.000,- |
| Double Expose Cranium AP/Lateral | Kelas 3 | Rp. 168.000,- |
| Mandibula AP/Lateral | Kelas 3 | Rp. 122.000,- |
| Double Expose Ekstremitas Manus AP/Lateral | Kelas 3 | Rp. 105.000,- |
| Double Expose Ekstremitas Wrist Joint | Kelas 3 | Rp. 105.000,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral | Kelas 3 | Rp. 105.000,- |
| Double Expose Ekstremitas Elbow Joint Ap/L | Kelas 3 | Rp. 105.000,- |
| Double Expose Ekstremitas Humerus AP/Lateral | Kelas 3 | Rp. 105.000,- |
| Double Expose Ekstremitas Shoulders Joint AP/Lateral | Kelas 3 | Rp. 105.000,- |
| Single Expose Ekstremitas Humerus AP | Kelas 3 | Rp. 84.000,- |
| Single Expose Ekstremitas Shoulders Joint | Kelas 3 | Rp. 84.000,- |
| Single Expose Ekstremitas Clavicula | Kelas 3 | Rp. 84.000,- |
| Double Expose Ekstremitas Pedis AP/Lateral | Kelas 3 | Rp. 105.000,- |
| Double Expose Ekstremitas Calcaneus AP/Lateral | Kelas 3 | Rp. 105.000,- |
| Double Expose Ekstremitas Ankle Joint AP/Lateral | Kelas 3 | Rp. 105.000,- |
| Double Expose Ekstremitas Cruris AP/Lateral | Kelas 3 | Rp. 105.000,- |
| Double Expose Ekstremitas Femur AP/Lateral | Kelas 3 | Rp. 105.000,- |
| Double Expose Thoracal | Kelas 3 | Rp. 122.000,- |
| Double Expose Thoracolumbal | Kelas 3 | Rp. 122.000,- |
| Double Expose Lumbosacral | Kelas 3 | Rp. 122.000,- |
| Single Expose Thorax Cito | Kelas 3 | Rp. 117.600,- |
| Single Expose Clavicula Cito | Kelas 3 | Rp. 117.600,- |
| Single Expose Clavicula Cito | Kelas 3 | Rp. 117.600,- |
| Single Expose BNO Cito | Kelas 3 | Rp. 117.600,- |
| Single Expose Pelvis Cito | Kelas 3 | Rp. 117.600,- |
| Single Expose Waters Cito | Kelas 3 | Rp. 117.600,- |
| Single Expose Eruris Ap/Lat Cito | Kelas 3 | Rp. 147.000,- |
| Single Expose Angkle Joint Cito | Kelas 3 | Rp. 147.000,- |
| Single Expose Pedis Cito | Kelas 3 | Rp. 147.000,- |
| Single Expose Calcaneus Cito | Kelas 3 | Rp. 147.000,- |
| Single Expose Ekstremitas Cito | Kelas 3 | Rp. 147.000,- |
| Double Expose Ekstremitas Humerus AP/Lateral Cito | Kelas 3 | Rp. 147.000,- |
| Abdomen BNO | Kelas 3 | Rp. 78.800,- |
| Abdomen 2 Posisi | Kelas 3 | Rp. 144.000,- |
| Double Expose Ekstremitas Knee Joint /Genu Cito | Kelas 3 | Rp. 147.000,- |
| Double Expose Ekstremitas Manus AP/Lateral Cito | Kelas 3 | Rp. 147.000,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral Cito | Kelas 3 | Rp. 147.000,- |
| Double Expose Ekstremitas Elbow Joint Ap/L Cito | Kelas 3 | Rp. 147.000,- |
| Single Expose Thorax L | Kelas 3 | Rp. 100.800,- |
| Double Expose Eruris Ap/Lat L | Kelas 3 | Rp. 126.000,- |
| Double Expose Vertebrae L | Kelas 3 | Rp. 146.400,- |
| Cranium 3 Posisi AP/Lateral Dantownes L | Kelas 3 | Rp. 247.200,- |
| Kontras (Uretrografi, Appendeicogram, Cystografi) L | Kelas 3 | Rp. 481.920,- |
| BNO IVP / Colon In Loop L | Kelas 3 | Rp. 734.400,- |
| USG Dr. Dalam L | Kelas 3 | Rp. 175.200,- |
| USG Dr. Radiologi L | Kelas 3 | Rp. 175.200,- |
| ELEKTOMEDIKA / EKG L | Kelas 3 | Rp. 77.400,- |
| USG Kandungan L | Kelas 3 | Rp. 180.000,- |
| USG Transvaginal L | Kelas 3 | Rp. 220.800,- |
| USG Dopler L | Kelas 3 | Rp. 259.800,- |
| Retensi Plasenta dan Mola Hidrolosa L | Kelas 3 | Rp. 831.600,- |
| Curatage Aborus L | Kelas 3 | Rp. 475.200,- |
| Single Expose Clavicula L | Kelas 3 | Rp. 100.800,- |
| Single Expose Pelvis L | Kelas 3 | Rp. 100.800,- |
| Single Expose Waters L | Kelas 3 | Rp. 100.800,- |
| Double Expose Angkle Joint L | Kelas 3 | Rp. 126.000,- |
| Double Expose Pedis L | Kelas 3 | Rp. 126.000,- |
| Double Expose Calcaneus L | Kelas 3 | Rp. 126.000,- |
| Double Expose Lumbal L | Kelas 3 | Rp. 146.400,- |
| Double Expose Throcal L | Kelas 3 | Rp. 146.400,- |
| Double Expose Cervical L | Kelas 3 | Rp. 146.400,- |
| Double Expose Ekstremitas Knee Joint /Genu L | Kelas 3 | Rp. 126.000,- |
| Mastoid L | Kelas 3 | Rp. 146.400,- |
| Cranium AP/Waters AP L | Kelas 3 | Rp. 100.800,- |
| Cranium Lateral L | Kelas 3 | Rp. 100.800,- |
| Double Expose Cranium AP/Lateral L | Kelas 3 | Rp. 201.600,- |
| Mandibula AP/Lateral L | Kelas 3 | Rp. 146.400,- |
| Double Expose Ekstremitas Manus AP/Lateral L | Kelas 3 | Rp. 126.000,- |
| Double Expose Ekstremitas Wrist Joint L | Kelas 3 | Rp. 126.000,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral L | Kelas 3 | Rp. 126.000,- |
| Double Expose Ekstremitas Elbow Joint Ap/L L | Kelas 3 | Rp. 126.000,- |
| Double Expose Ekstremitas Humerus AP/Lateral L | Kelas 3 | Rp. 126.000,- |
| Double Expose Ekstremitas Shoulders Joint AP/Lateral L | Kelas 3 | Rp. 126.000,- |
| Single Expose Ekstremitas Humerus AP L | Kelas 3 | Rp. 100.800,- |
| Single Expose Ekstremitas Shoulders Joint L | Kelas 3 | Rp. 100.800,- |
| Single Expose Ekstremitas Clavicula L | Kelas 3 | Rp. 100.800,- |
| Double Expose Ekstremitas Pedis AP/Lateral L | Kelas 3 | Rp. 126.000,- |
| Double Expose Ekstremitas Calcaneus AP/Lateral L | Kelas 3 | Rp. 126.000,- |
| Double Expose Ekstremitas Ankle Joint AP/Lateral L | Kelas 3 | Rp. 126.000,- |
| Double Expose Ekstremitas Cruris AP/Lateral L | Kelas 3 | Rp. 126.000,- |
| Double Expose Ekstremitas Femur AP/Lateral L | Kelas 3 | Rp. 126.000,- |
| Double Expose Thoracal L | Kelas 3 | Rp. 146.400,- |
| Double Expose Thoracolumbal L | Kelas 3 | Rp. 146.400,- |
| Double Expose Lumbosacral L | Kelas 3 | Rp. 146.400,- |
| Single Expose Thorax Cito L | Kelas 3 | Rp. 141.120,- |
| Single Expose Clavicula Cito L | Kelas 3 | Rp. 141.120,- |
| Single Expose Clavicula Cito L | Kelas 3 | Rp. 141.120,- |
| Single Expose BNO Cito L | Kelas 3 | Rp. 141.120,- |
| Single Expose Pelvis Cito L | Kelas 3 | Rp. 141.120,- |
| Single Expose Waters Cito L | Kelas 3 | Rp. 141.120,- |
| Single Expose Eruris Ap/Lat Cito L | Kelas 3 | Rp. 176.400,- |
| Single Expose Angkle Joint Cito L | Kelas 3 | Rp. 176.400,- |
| Single Expose Pedis Cito L | Kelas 3 | Rp. 176.400,- |
| Single Expose Calcaneus Cito L | Kelas 3 | Rp. 176.400,- |
| Single Expose Ekstremitas Cito L | Kelas 3 | Rp. 176.400,- |
| Double Expose Ekstremitas Humerus AP/Lateral Cito L | Kelas 3 | Rp. 176.400,- |
| Abdomen BNO L | Kelas 3 | Rp. 94.560,- |
| Abdomen 2 Posisi L | Kelas 3 | Rp. 172.800,- |
| Double Expose Ekstremitas Knee Joint /Genu Cito L | Kelas 3 | Rp. 176.400,- |
| Double Expose Ekstremitas Manus AP/Lateral Cito L | Kelas 3 | Rp. 176.400,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral Cito L | Kelas 3 | Rp. 176.400,- |
| Double Expose Ekstremitas Elbow Joint Ap/L Cito L | Kelas 3 | Rp. 176.400,- |
| Single Expose Thorax | Kelas VIP | Rp. 110.200,- |
| Double Expose Eruris Ap/Lat | Kelas VIP | Rp. 138.600,- |
| Double Expose Vertebrae | Kelas VIP | Rp. 133.500,- |
| Cranium 3 Posisi AP/Lateral Dantownes | Kelas VIP | Rp. 245.000,- |
| Kontras (Uretrografi, Appendeicogram, Cystografi) | Kelas VIP | Rp. 525.000,- |
| BNO IVP / Colon In Loop | Kelas VIP | Rp. 794.800,- |
| USG Dr. Dalam | Kelas VIP | Rp. 163.500,- |
| USG Dr. Radiologi | Kelas VIP | Rp. 163.500,- |
| ELEKTOMEDIKA / EKG | Kelas VIP | Rp. 78.500,- |
| USG Kandungan | Kelas VIP | Rp. 158.000,- |
| USG Transvaginal | Kelas VIP | Rp. 202.500,- |
| USG Dopler | Kelas VIP | Rp. 222.500,- |
| Retensi Plasenta dan Mola Hidrolosa | Kelas VIP | Rp. 693.000,- |
| Curatage Aborus | Kelas VIP | Rp. 396.000,- |
| Retensi Plasenta dan Mola Hidrolosa | Kelas VIP | Rp. 1.663.200,- |
| Curatage Aborus | Kelas VIP | Rp. 1.009.800,- |
| Single Expose Clavicula | Kelas VIP | Rp. 110.200,- |
| Single Expose Pelvis | Kelas VIP | Rp. 110.200,- |
| Single Expose Waters | Kelas VIP | Rp. 110.200,- |
| Double Expose Angkle Joint | Kelas VIP | Rp. 138.600,- |
| Double Expose Pedis | Kelas VIP | Rp. 138.600,- |
| Double Expose Calcaneus | Kelas VIP | Rp. 138.600,- |
| Double Expose Lumbal | Kelas VIP | Rp. 133.500,- |
| Double Expose Throcal | Kelas VIP | Rp. 133.500,- |
| Double Expose Cervical | Kelas VIP | Rp. 133.500,- |
| Single Expose Thorax L | Kelas VIP | Rp. 132.240,- |
| Double Expose Eruris Ap/Lat L | Kelas VIP | Rp. 166.320,- |
| Double Expose Vertebrae L | Kelas VIP | Rp. 160.200,- |
| Cranium 3 Posisi L | Kelas VIP | Rp. 225.600,- |
| BNO IVP / Colon In Loop L | Kelas VIP | Rp. 953.760,- |
| USG Dr. Dalam L | Kelas VIP | Rp. 196.200,- |
| USG Dr. Radiologi L | Kelas VIP | Rp. 196.200,- |
| ELEKTOMEDIKA / EKG L | Kelas VIP | Rp. 94.200,- |
| USG Berwarna L | Kelas VIP | Rp. 196.200,- |
| USG Transvaginal L | Kelas VIP | Rp. 243.000,- |
| USG Dopler L | Kelas VIP | Rp. 267.000,- |
| Retensi Plasenta dan Mola Hidrolosa L | Kelas VIP | Rp. 831.600,- |
| Curatage Aborus L | Kelas VIP | Rp. 475.200,- |
| Retensi Plasenta dan Mola Hidrolosa L | Kelas VIP | Rp. 1.995.840,- |
| Curatage Aborus L | Kelas VIP | Rp. 1.211.760,- |
| Single Expose Clavicula L | Kelas VIP | Rp. 132.240,- |
| Single Expose Pelvis L | Kelas VIP | Rp. 132.240,- |
| Single Expose Waters L | Kelas VIP | Rp. 132.240,- |
| Double Expose Angkle Joint L | Kelas VIP | Rp. 166.320,- |
| Double Expose Pedis L | Kelas VIP | Rp. 166.320,- |
| Double Expose Calcaneus L | Kelas VIP | Rp. 166.320,- |
| Double Expose Lumbal L | Kelas VIP | Rp. 160.200,- |
| Double Expose Throcal L | Kelas VIP | Rp. 160.200,- |
| Double Expose Cervical L | Kelas VIP | Rp. 160.200,- |
| Cranium AP/Waters AP | Kelas VIP | Rp. 110.200,- |
| Cranium Lateral | Kelas VIP | Rp. 110.200,- |
| Double Expose Cranium AP/Lateral | Kelas VIP | Rp. 188.000,- |
| Mandibula AP/Lateral | Kelas VIP | Rp. 133.500,- |
| Double Expose Ekstremitas Manus AP/Lateral | Kelas VIP | Rp. 138.600,- |
| Double Expose Ekstremitas Wrist Joint | Kelas VIP | Rp. 138.600,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral | Kelas VIP | Rp. 138.600,- |
| Double Expose Ekstremitas Elbow Joint Ap/L | Kelas VIP | Rp. 138.600,- |
| Double Expose Ekstremitas Humerus AP/Lateral | Kelas VIP | Rp. 138.600,- |
| Double Expose Ekstremitas Shoulders Joint AP/Lateral | Kelas VIP | Rp. 138.600,- |
| Single Expose Ekstremitas Humerus AP | Kelas VIP | Rp. 110.200,- |
| Single Expose Ekstremitas Shoulders Joint | Kelas VIP | Rp. 110.200,- |
| Single Expose Ekstremitas Clavicula | Kelas VIP | Rp. 110.200,- |
| Double Expose Ekstremitas Pedis AP/Lateral | Kelas VIP | Rp. 138.600,- |
| Double Expose Ekstremitas Calcaneus AP/Lateral | Kelas VIP | Rp. 138.600,- |
| Double Expose Ekstremitas Ankle Joint AP/Lateral | Kelas VIP | Rp. 138.600,- |
| Double Expose Ekstremitas Cruris AP/Lateral | Kelas VIP | Rp. 138.600,- |
| Double Expose Ekstremitas Knee Joint /Genu | Kelas VIP | Rp. 138.600,- |
| Double Expose Ekstremitas Femur AP/Lateral | Kelas VIP | Rp. 138.600,- |
| Double Expose Ekstremitas Hip Joint | Kelas VIP | Rp. 138.600,- |
| Double Expose Thoracal | Kelas VIP | Rp. 133.500,- |
| Double Expose Thoracolumbal | Kelas VIP | Rp. 133.500,- |
| Double Expose Lumbosacral | Kelas VIP | Rp. 133.500,- |
| Single Expose Thorax Cito | Kelas VIP | Rp. 154.280,- |
| Single Expose Clavicula Cito | Kelas VIP | Rp. 154.280,- |
| Single Expose BNO Cito | Kelas VIP | Rp. 154.280,- |
| Single Expose Pelvis Cito | Kelas VIP | Rp. 154.280,- |
| Single Expose Waters Cito | Kelas VIP | Rp. 154.280,- |
| Single Expose Eruris Ap/Lat Cito | Kelas VIP | Rp. 194.040,- |
| Single Expose Angkle Joint Cito | Kelas VIP | Rp. 194.040,- |
| Single Expose Pedis Cito | Kelas VIP | Rp. 194.040,- |
| Single Expose Calcaneus Cito | Kelas VIP | Rp. 194.040,- |
| Single Expose Ekstremitas Cito | Kelas VIP | Rp. 194.040,- |
| Double Expose Ekstremitas Humerus AP/Lateral Cito | Kelas VIP | Rp. 194.040,- |
| Abdomen BNO | Kelas VIP | Rp. 102.000,- |
| Abdomen 2 Posisi | Kelas VIP | Rp. 204.000,- |
| Double Expose Ekstremitas Knee Joint /Genu Cito | Kelas VIP | Rp. 194.040,- |
| Double Expose Ekstremitas Manus AP/Lateral Cito | Kelas VIP | Rp. 194.040,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral Cito | Kelas VIP | Rp. 194.040,- |
| Double Expose Ekstremitas Elbow Joint Ap/L Cito | Kelas VIP | Rp. 194.040,- |
| Single Expose Thorax L | Kelas VIP | Rp. 132.240,- |
| Double Expose Eruris Ap/Lat L | Kelas VIP | Rp. 166.320,- |
| Double Expose Vertebrae L | Kelas VIP | Rp. 160.200,- |
| Cranium 3 Posisi AP/Lateral Dantownes L | Kelas VIP | Rp. 294.000,- |
| Kontras (Uretrografi, Appendeicogram, Cystografi) L | Kelas VIP | Rp. 630.000,- |
| BNO IVP / Colon In Loop L | Kelas VIP | Rp. 953.760,- |
| USG Dr. Dalam L | Kelas VIP | Rp. 196.200,- |
| USG Dr. Radiologi L | Kelas VIP | Rp. 196.200,- |
| ELEKTOMEDIKA / EKG L | Kelas VIP | Rp. 94.200,- |
| USG Kandungan L | Kelas VIP | Rp. 189.600,- |
| USG Transvaginal L | Kelas VIP | Rp. 243.000,- |
| USG Dopler L | Kelas VIP | Rp. 267.000,- |
| Retensi Plasenta dan Mola Hidrolosa L | Kelas VIP | Rp. 831.600,- |
| Curatage Aborus L | Kelas VIP | Rp. 475.200,- |
| Retensi Plasenta dan Mola Hidrolosa L | Kelas VIP | Rp. 1.995.840,- |
| Curatage Aborus L | Kelas VIP | Rp. 1.211.760,- |
| Single Expose Clavicula L | Kelas VIP | Rp. 132.240,- |
| Single Expose Pelvis L | Kelas VIP | Rp. 132.240,- |
| Single Expose Waters L | Kelas VIP | Rp. 132.240,- |
| Double Expose Angkle Joint L | Kelas VIP | Rp. 166.320,- |
| Double Expose Pedis L | Kelas VIP | Rp. 166.320,- |
| Double Expose Calcaneus L | Kelas VIP | Rp. 166.320,- |
| Double Expose Lumbal L | Kelas VIP | Rp. 160.200,- |
| Double Expose Throcal L | Kelas VIP | Rp. 160.200,- |
| Double Expose Cervical L | Kelas VIP | Rp. 160.200,- |
| Cranium AP/Waters AP L | Kelas VIP | Rp. 132.240,- |
| Cranium Lateral L | Kelas VIP | Rp. 132.240,- |
| Double Expose Cranium AP/Lateral L | Kelas VIP | Rp. 225.600,- |
| Mandibula AP/Lateral L | Kelas VIP | Rp. 160.200,- |
| Double Expose Ekstremitas Manus AP/Lateral L | Kelas VIP | Rp. 166.320,- |
| Double Expose Ekstremitas Wrist Joint L | Kelas VIP | Rp. 166.320,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral L | Kelas VIP | Rp. 166.320,- |
| Double Expose Ekstremitas Elbow Joint Ap/L L | Kelas VIP | Rp. 166.320,- |
| Double Expose Ekstremitas Humerus AP/Lateral L | Kelas VIP | Rp. 166.320,- |
| Double Expose Ekstremitas Shoulders Joint AP/Lateral L | Kelas VIP | Rp. 166.320,- |
| Single Expose Ekstremitas Humerus AP L | Kelas VIP | Rp. 132.240,- |
| Single Expose Ekstremitas Shoulders Joint L | Kelas VIP | Rp. 132.240,- |
| Single Expose Ekstremitas Clavicula L | Kelas VIP | Rp. 132.240,- |
| Double Expose Ekstremitas Pedis AP/Lateral L | Kelas VIP | Rp. 166.320,- |
| Double Expose Ekstremitas Calcaneus AP/Lateral L | Kelas VIP | Rp. 166.320,- |
| Double Expose Ekstremitas Ankle Joint AP/Lateral L | Kelas VIP | Rp. 166.320,- |
| Double Expose Ekstremitas Cruris AP/Lateral L | Kelas VIP | Rp. 166.320,- |
| Double Expose Ekstremitas Knee Joint /Genu L | Kelas VIP | Rp. 166.320,- |
| Double Expose Ekstremitas Femur AP/Lateral L | Kelas VIP | Rp. 166.320,- |
| Double Expose Ekstremitas Hip Joint L | Kelas VIP | Rp. 166.320,- |
| Double Expose Thoracal L | Kelas VIP | Rp. 160.200,- |
| Double Expose Thoracolumbal L | Kelas VIP | Rp. 160.200,- |
| Double Expose Lumbosacral L | Kelas VIP | Rp. 160.200,- |
| Single Expose Thorax Cito L | Kelas VIP | Rp. 185.136,- |
| Single Expose Clavicula Cito L | Kelas VIP | Rp. 185.136,- |
| Single Expose BNO Cito L | Kelas VIP | Rp. 185.136,- |
| Single Expose Pelvis Cito L | Kelas VIP | Rp. 185.136,- |
| Single Expose Waters Cito L | Kelas VIP | Rp. 185.136,- |
| Single Expose Eruris Ap/Lat Cito L | Kelas VIP | Rp. 232.848,- |
| Single Expose Angkle Joint Cito L | Kelas VIP | Rp. 232.848,- |
| Single Expose Pedis Cito L | Kelas VIP | Rp. 232.848,- |
| Single Expose Calcaneus Cito L | Kelas VIP | Rp. 232.848,- |
| Single Expose Ekstremitas Cito L | Kelas VIP | Rp. 232.848,- |
| Double Expose Ekstremitas Humerus AP/Lateral Cito L | Kelas VIP | Rp. 232.848,- |
| Abdomen BNO L | Kelas VIP | Rp. 122.400,- |
| Abdomen 2 Posisi L | Kelas VIP | Rp. 244.800,- |
| Double Expose Ekstremitas Knee Joint /Genu Cito L | Kelas VIP | Rp. 232.848,- |
| Double Expose Ekstremitas Manus AP/Lateral Cito L | Kelas VIP | Rp. 232.848,- |
| Double Expose Ekstremitas Antebrachii AP/Lateral Cito L | Kelas VIP | Rp. 232.848,- |
| Double Expose Ekstremitas Elbow Joint Ap/L Cito L | Kelas VIP | Rp. 232.848,- |