Jasa

Prasarana
No Jenis Tindakan Jasa Pelayanan (RP) (RP) Jumlah
1 Poli Umum 6 9 15
2 Poli Spesialis 12 18 30
3 Poiklinik Gigi 6 9 15
4 Konsultasi Gizi 6 9 15
5 UGD
Dokter Umum 8 12 20
Dokter Spesialis 12 18 30

Jasa
Sarana
No Jenis Tindakan Jasa Pelayanan (RP) (RP) Jumlah
1 Insisi 60 90,000 150,000
2 Eksterpasi 120,000 180,000 300,000
3 Khitan 60 000 90,000 150,000
4 Biopsi 200 300,000 500,000

5 Cuci Luka 6,000 9,000 15,000

6 Rectal toucheé 6,000 9,000 15,000
7 Aff Hecting 6,000 9,000 15,000
8 Buka Gips 20,000 30,000 50,000
9 Ganti Perban 5,000 7,500 12,500

1 Tarif poliklinik

Jasa
Sarana
No Jenis Tindakan Jasa Pelayanan (RP) (RP) Jumlah
1 Vagina Toile 10,000 15,000 25
2 Amnioskopi 20,000 30,000 50
3 Biopsi / papsmear 30,000 45,000 75
4 Perawatan luka post
operasi 10,000 15,000 25
5 Pemasangan IUD 32,000 48,000 80
6 Pemasangan
IMPLANT 46,000 69,000 115
7 Pencabutan IUD 20,000 30,000 50
8 Pencabutan
IMPLANT 50,000 75,000 125
 9 Suntik KB 8,000 12,000 20

2.           Tarif
Tindakan
Poliklinik
Telinga,
Hidung,
Dan
Tenggorok
an

Jasa
Sarana
No Jenis Tindakan Jasa Pelayanan (RP) (RP) Jumlah
1 Spuling Serumen 8,000 12,000 20,000
2 Tamponade telinga 7,000 10,500 17,500
3 Parasentesis / 14,000 21,000 35,000
Myerimotomi
4 Insisi Furunkel 10,000 15,000 25,000
5 Exitirpasi granuloma 20,000 30,000 50,000
6 Spuling Hidung 30,000 45,000 75,000
7 Tampon Hidung 8,000 12,000 20,000
Sementara
8 Tamponade hidung 12,000 18,000 30,000
tetap
9 Katetrisasi tuba 14,000 21,000 35,000
eustachi
10 Insisi Abces 20,000 30,000 50,000
peritonsiller
11 Punksi sinus maksil 20,000 30,000 50,000
laris
12 Profokasi sinus 20,000 30,000 50,000
ethmoidalis
13 Ekstraksi korpus 14,000 21,000 35,000
alineum
dari dalam THT

3.           Tarif
Tindakan
Poliklinik
Mata
 Jasa
Sarana
No Jenis Tindakan Jasa Pelayanan (RP) (RP) Jumlah
Pemasangan
Tambahan
1 Refraksi 7,000 10,500 17,500
2 Tonometri 14,000 21,000 35,000
3 Funduskopi 14,000 21,000 35,000
4 Slit Lamp 14,000 21,000 35,000
5 II Tindakan Bebat 6,000 9,000 15,000
Mata / GV
6 Epilesi 7,000 10,500 17,500
7 Injeksi 12,000 18,000 30,000
subkonjungtival
8 Absisi corpus alenum 12,000 18,000 30,000

Konjungtiva palpebra
9 Absisi Corpus alenum 20,000 30,000 50,000
Kornea
10 Hordeolum / 20,000 30,000 50,000
Kalazion
11 Spooling Punctum 30,000 45,000 75,000
Lakrimal
12 Spooling Kornea 20,000 30,000 50,000
13 Heacting Palpebra 40,000 60,000 100,000

4.           Tarif
Tindakan
Poliklinik
Gigi –
Mulut

Jasa Jumlah
Sarana
No. Jenis Pelayanan Jasa Pelayanan (Rp) (Rp) (Rp)
1 2 3 4 5
10000 15 25
1 Medikasi keluhan gigi
2 Tumpatan sementara 16000 24000 40
3 Medikasi pulpa 20 30 50
Pencabutan gigi susu
4 (per gigi) 16 24 40
Pencabutan gigi tetap
(per gigi) tanpa
5 penyulit 24 36 60
Pencabutan gigi tetap
(pergigi) dengan
6 penyulit 32 48 80
 Pencabutan gigi
dengan
7 komplikasi/fraktur 48 72 120
Scaling Gigi/regio
8 (RA/RB) 30 45 75
Pembersihan karang
gigi dengan scaler
9 (per regio RA/RB) 50 75 125

Penambalan gigi
dengan
amalgam/silikat (per
10 gigi) 20 30 50
Penambalan gigi
dengan glass
11 ionommer (per gigi) 28 42 70
Penambalan gigi
dengan komposite
12 (per gigi) 38 57 95
13 Sterilisasi Saluran 10 15 35
akar gigi (pulpotomi)

14 Pengisian saluran 10 15 30
akar
15 Insisi Abses gigi 20 30 50
16 Ondotektomi kasus 60 90 160
mudah (Pencabutan
Gigi Belakang MIII)
17 Pembuatan prothesa
gigi
- Gigi I 70,000 105,000 175,000
- Gigi II 50,000 75,000 125,000
- Gigi III 32,000 48,000 80,000
- Gigi rahang 400,000 600,000 1,000,000
atas/rahang
bawah penuh

5.           Tarif
Tindakan
Gawat
Darurat

Jasa Jasa
Sarana
No Jenis Tindakan Pelayanan (RP) (RP) Jumlah
Kompres luka tanpa
1 perban 4 6 10

Kompres luka dengan

memakai perban /
2 lokasi luka 4,000 6,000 10,000
 Jahit luka dengan
luka ringan
3 ( <5 jahitan ) 18,000 27,000 45,000
Jahit luka dengan
luka ringan
4 ( <6-10 jahitan ) 36,000 54,000 90,000
Jahit luka dengan
luka berat
5 ( <11 jahitan ) 70,000 105,000 175,000
Pencucian lambung
pada
6 Keracunan 20,000 30,000 50,000
Resusitasi
7 kardiopulmoner 18,000 27,000 45

8 Venaseksi 32,000 48,000 80

Eksporasi benda
9 asing 22,000 33,000 55
10 Keteterisasi Uretra 22,000 33,000 55
Pemasangan Sonde
11 Lambung 18,000 27,000 45
12 Pemasangan Infus 10,000 15,000 25
13 Punksi Bles 18,000 27,000 45
Pemasangan
14 endoktrachal tube 34,000 51,000 85
Luka Bakar sampai
15 30% 24,000 36,000 60
Luka Bakar lebih 30
16 % 50,000 75,000 125
Reposisi tulang /
17 sendi 36,000 54,000 90
Reposisi tulang /
18 sendi dgn gips 50,000 75,000 125,000
19 Pasang skin traksi 60,000 90,000 150
Pemakaian
20 oksigen/ltr 1,400 2,100 3500

Pemakaian alat
21 pengisap lendir / hari 16,000 24,000 40
Pemakaian
22 nebuliser / kali 20,000 30,000 50
23 Injeksi TT 10,000 15,000 25

Bagian II
Rawat Inap

a.     Tarif di masing – masing Kelas Perawatan

 JASA
MEDIK
VISITE/H
No KELAS AKOMODASI /HARI ARI
1 VIP 100,000 40,000
2 Kelas I 50,000 35,000
3 Kelas II 40,000 25,000

Biaya Visite konsul Dokter / Dokter Ahli (Kontak I) atau konsul antar bagian

Visite
Konsultasi
Dokter Antar
No Kelas Dokter Umum Spesialis Spesialis
1 VIP 25,000 60,000 50,000
2 Kelas I 20,000 50,000 40,000
3 Kelas II 15,000 35,000 30,000
4 Kelas III 10,000 25,000 20,000

Jenis dan besarnya tarif tindakan medik dan terapi pada rawat inap sebagai berikut :
Jenis Tindakan :
1 . Penyakit Dalam
-          Punksi Pleura
-          Punksi Acites
-          WSD
-          Punksi Sum – sum
-          Punksi Abses Hati

Jasa
Sarana
No Kelas Perawatan Jasa Pelayanan (Rp) (Rp) Jumlah
1 VIP 50,000 75,000 125,000
2 Kelas I 35,000 50,000 85,000
3 Kelas II 25,000 30,000 55,000
4 Kelas III 15,000 25,000 40,000

2. Anak
-          Punksi Pleura
-          Punksi Acites
-          Pemakaian Sum – sum tulang
-          Resusitasi bayi
-          Pemakaian cup bayi
-          Foto Terapi
-          Sonde Per hari
 Jasa
Sarana
No Kelas Perawatan Jasa Pelayanan (Rp) (Rp) Jumlah
1 VIP 50,000 75,000 125,000
2 Kelas I 35,000 50,000 85,000
3 Kelas II 25,000 30,000 55,000
4 Kelas III 15,000 25,000 40,000

3. Mata

Jasa
Sarana
No Kelas Perawatan Jasa Pelayanan (Rp) (Rp) Jumlah
1 Tonometri 14,000 21,000 35,000
2 Funduskopi 12,000 18,000 30,000
3 Injeksi subkonjuksi 12,000 18,000 30,000

4. Kebidanan dan Kandungan

Jasa
Sarana
No Kelas Perawatan Jasa Pelayanan (Rp) (Rp) Jumlah
1 Persalinan Biasa
- Di tolong bidan 300,000 180,000 480,000
- Di tolong Dokter
Umum 240,000 360,000 600,000
- Di tolong Dokter
Ahli 300,000 450,000 750,000
2 Persalinan patologis - -
- Di tolong bidan 200,000 300,000 600,000
- Di tolong Dokter
Umum 300,000 450,000 750,000
- Di tolong Dokter
Ahli 400,000 600,000 1,000,000
3 Kuret 320,000 480,000 800,000
4 Manual 200,000 300,000 500,000
5 Dopler 14,000 21,000 35,000
6 Vagina Touch 12,000 18,000 30,000
7 Vagina Toilet 20,000 30,000 50,000
8 Hecting Jelijur 40,000 60,000 100,000
9 Palpasi 8,000 12,000 20,000
Memandikan Pasien /
10 Hari 12,000 18,000 30,000
11 Perawatan Bayi 20,000 30,000 50,000

13 UST / Inj TT 6,000 9,000 15,000

 Perawatan Payu
14 darah 20,000 30,000 50,000
15 Perawatan Nifas 10,000 15,000 25,000
16 Chemoterapi 53,200 79,800 133,000

5. Syaraf

Jasa
Sarana
No Kelas Perawatan Jasa Pelayanan (Rp) (Rp) Jumlah
1 Punksi Lumbal
- Kelas I 40,000 60,000 100,000
- Kelas II 30,000 45,000 75,000
- Kelas III 20,000 30,000 50,000
2 Funduskopi 80,000 120,000 200,000

6. Tindakan Perawat
Jasa
Sarana
No Jenis Tindakan Jasa Pelayanan (Rp) (Rp) Jumlah
1 EKG 18,000 27,000 45,000
2 Pasang Infus 16,800 25,200 42,000
3 Aff Infus 6,000 9,000 15,000
4 Pasang Kateter 26,000 39,000 65,000
Spoling Kateter /
5 Hari 8,000 12,000 20,000

6 Pasang Magslang 20,000 30,000 50,000

7 aff Cateter 6,000 9,000 15,000
8 Aff Magslang 8,000 12,000 20,000
9 injeksi IM/IF/Hari 6,000 9,000 15,000
Ganti
10 Verban/Lokasi/hari 8,000 12,000 20,000
11 Pasang Tampon 8,000 12,000 20,000
12 Aff Tampon 6,000 9,000 15,000
Perawatan Luka Post
13 Operasi 10,000 15,000 25,000
14 Rectal Touche 10,000 15,000 25,000
15 Aff Hecting 8,000 12,000 20,000
16 Aff drain 8,000 12,000 20,000
17 Sucition/Hari 16,000 24,000 40,000
18 Luka bakar (<30%) 30,000 45,000 75,000
19 Luka bakar (>30%) 52,000 78,000 130,000
Memandikan
20 Pasien/Bayi/Hari 12,000 18,000 30,000

18,000 30,000
21 Sonde/Hari 12,000 18,000 30,000
22 Foto Teraphy/hari 24,000 36,000 60,000
23 Resusitasi/Hari 20,000 30,000 50,000
24 Rawat Tali pusat 10,000 15,000 25,000

25 Tindakan supositoria 6,000 9,000 15,000

26 Pasang O2 1.2 1.8 3,000

27 Ambulasi Pasien 8,000 12,000 20,000

Pasang
28 ECG/Monitoring 8,000 12,000 20,000
29 Pasang SP2 8,000 12,000 20,000
30 Pasang Syring pump 8,000 12,000 20,000
31 pasang ventilator 8,000 12,000 20,000
32 pasang blangket 8,000 12,000 20,000
33 pasang CVP 8,000 12,000 20,000
34 ganti abbocath 16,000 24,000 40,000
perawatan luka DM
35 sedang 16,000 24,000 40,000

perawatan luka DM
36 berat 30,000 45,000 75,000

a.     Tarif Tindakan Medik Operasi

Jasa Jumlah
Sarana
(Rp)
No Jenis Operasi Jasa Pelayanan (Rp)
1 Kelompok I 750,000 754 1,504,000
2 Kelompok II 1,250,000 1.250.000 2,500,000
3 Kelompok III 1,870,000 1.880.000 3,750,000
4 Khusus 2,700,000 2.500.000 5,200,000

           I.          Pemeriksaan Penunjang Diagnostik

Jasa
Sarana
No Jenis Tindakan Jasa Pelayanan (Rp) (Rp) Jumlah
1 Reitz Serum 6,000 9,000 15,000
2 DDR ( Malaria ) 10,000 15,000 25,000
3 Jumlah Sel Liquer 6,000 9,000 15,000
4 Hitung jenis lique 6,000 9,000 15,000
5 Glukosa Lique 6,000 9,000 15,000
6 Protern Liquer 6,000 9,000 15,000
7 None Liquer 6,000 9,000 15,000
8 Pardi liquer 6,000 9,000 15,000
9 Basil tahan panas 6,000 9,000 15,000
10 Pemeriksaan Foeces 6,000 9,000 15,000
11 Golongan darah 6,000 9,000 15,000
Waktu pembekuan
12 (CT) 180,000 270,000 10,000
13 Waktu pendarahan 180,000 270,000 10,000
14 Glukosa darah Puasa 12,000 18,000 30,000
15 Glukosa darah 2 jam
PP 12,000 18,000 30,000
16 Glukosa Darah
Sewaktu 12,000 18,000 30,000
17 Ureum 12,000 18,000 30,000
18 Kreatinin 12,000 18,000 30,000
19 SGOT/ASAT 12,000 18,000 30,000
20 SGPT/Alat 12,000 18,000 30,000
21 GTT 12,000 18,000 30,000
22 Cholesterol Total 12,000 18,000 30,000
23
Asam Urat (Uric Acid) 12,000 18,000 30,000
24 Total bilirubin 12,000 18,000 30,000
25 Direk Bilirubin 12,000 18,000 30,000
26 Kreatinin Clearance 12,000 18,000 30,000
27 Alkali Phospotase
(ALP) 20,000 30,000 50,000
28 Triglerisida 20,000 30,000 50,000
29 Protein Total 12,000 18,000 30,000
30 Albumin 12,000 18,000 30,000
31 Cholesterol HDL 12,000 18,000 30,000
32 Cholesterol LDL 12,000 18,000 30,000
33 L.D.H 12,000 18,000 30,000
34 Plano test /
grevindex test 12,000 18,000 30,000
35 HBs Ag 20,000 30,000 50,000
36 Anti HBs 20,000 30,000 50,000
37 DDR (Malaria) 24,000 36,000 60,000
38 HIV 40,000 60,000 100,000
39 Urine Rutin 16,000 24,000 40,000
39.1 Reduksi 6,000 9,000 15,000
39.2 Albumen Urine 6,000 9,000 15,000

39.3 Biliruben Urine 4,000 6,000 10,000

39.4
Urobilino
gen
Urine 2,000 3,000 5,000
39.5 Seditmen Urine 4,000 6,000 10,000
39.6 PH Urine 2,000 3,000 5,000
 39.7 Keton 2,000 3,000 5,000
39.8 Nitrit 2,000 3,000 5,000
39.9 Berat jenis
urine 2,000 3,000 5,000
39.10 Esbach Urine 2,000 3,000 5,000
39.11 Aseton Urine 2,000 3,000 5,000
40 Widal 20,000 30,000 50,000
41 VDRL 20,000 30,000 50,000
42 Gambaran darah tepi 20,000 30,000 50,000
43 Napza 40,000 60,000 100,000
44 Darah Lengkap 25,000 35,000 60,000
44.1 Hemoglobin 5,000 10,000 15,000
44.2 Laju Endap
Darah 4,000 6,000 10,000
44.3 Hematikrit 5,000 10,000 15,000
44.4 Eritrosit 4,000 6,000 10,000
44.5 Lekosit 4,000 6,000 10,000
44.6 Trombosit 5,000 10,000 15,000
44.7 Differential
Count 4,000 6,000 10,000
47 Elektrolit 60,000 90,000 150,000
47.1 Natrium ( Na + ) 20,000 30,000 50,000
47.1 Kalium ( K + ) 20,000 30,000 50,000
47.3 Calsium 20,000 30,000 50,000
48 CPK 15,000 35,000 50,000
49 Mikrobiologi 80,000 120,000 200,000
49.1 Pengecetan
mikroba 5,000 10,000 15,000
49.2 Biakan mikroba 40,000 60,000 100,000
49.3 Uji Biokimia 50,000 100,000 150,000
50 Test Sentisifasi 80,000 120,000 200,000
 1. Rawat Jalan
Jasa Pelayanan
No Jenis Pelayanan (Rp)
1 2 4
Poliklinik umum/BP
1 Puskesmas/UKS 3,500
2 Puskesmas pembantu 3,500
3 Puskesmas keliling 3,500
350,000
4 Persalinan normal
500,000
2 Persalinan dengan penyulit
10,000
2 ANC PNC
1 Rawat Inap : 20,000
One day care/Perawatan
2 6-12 Jam 20,000
1 UGD 15,000
1 Insisi abses 14,000
2 Insisi hordiulum 14,000
3 Sirkumsisi 52,500
4 Pemasangan kateter dengan 10,500
urine bag
5 Lepas Jahitan atau Perawatan 3,500
Luka
6 Tindik daun telinga bayi 10,500
7 Ekstraksi kuku 8,750
8 Irigasi serumen 7,000
9 Corpus alienum 7,000
10 Luka bakar tanpa komplikasi > 14,000
25%
11 Pemasangan Implant / IUD 14,000
12 Pencabutan implant/IUD 14,000
13 Vasektomi 105,000
14 Bilas lambung 10,500
15 Pemasangan spalk 17,500
16 Pemasangan Naso Gastric Tube 14,000

17 Curetage 98,000
18 tumpatan gigi sementara 10,500
19 pengobatan pulpa 10,500
20 cabut gigi susu 8,500
21 cabut gigi tetap 10,500
22 cabut gigi dengan komplikasi 35,000
23 pengobatan periodental 10,500
24 pembersihan karang gigi 42,000
25 penambalan gigi tetap 8,500
26 penambalan gigi tetap dengan 8,500
ionometer
27 penampalan gigi tetap dengan 8,500
komposite
28 perawatan saluran akar 10,500
29 pengisian saluran akar 17,500
30 insisi abses gigi 21,000
31
2 4
32 Home Visite (perkunjungan)

8,000
33 Paket Keer/pemeriksaan
kesehatan haji 160,000
31 Pelayanan Oksigen per liter 1,000

32 Darah Lengkap : 17,500

33 dengan Hematologi 17,500
34 - Darah Rutin / Sederhana : 7,000
35 - Penetapan kadar Hb 3,500
36 - Laju Endap Darah 3,500
37 - Hitung jenis 7,000
38 - Golongan darah 3,500

39 - Malaria (apusan darah tebal) 3,500

40 Urine Lengkap :
41 Pemeriksaan urine analyzer 10,500
42 urin rutin 7,000
43 Pemeriksaan sputum/dahak 7,000
44 Feces Rutin: 7,000
45 mikrobiologi air 5,000

46 Pemeriksaan dengan Fotometer 10,500

47 PP test 2,000
48 Pengambilan specimen 7,000
49 Pemeriksaan USG 42,000
foto ronstgen 24,500
50
KonsUL KESEHATAN (Gizi,
51 Kesling,dll)
3,500
Visuum et repertum : korban 17,500
52 hidup
Visuum et repertum : korban 21,000
53 mati

54 KIR pemeriksaan umum :

55 a. Anak sekolah/mahasiswa 3,500
56 b. Umum/PNS 5,500
57 kir haji 170,000

Jasa Pelayanan

Kecamatan/Wilayah/
No. Puskesmas
 Perawat
Kecamatan/Wilayah/ Pendampin
No. Puskesmas Sopir (Rp) g (Rp)
1 2 5 6
1 Tanjung Raya 15000 16000
2 Panca Jaya 25000 23000
3 Simpang Pematang 30000 25000
4 Mesuji 45000 47000
5 Way Serdang 45000 47000
6 Mesuji Timur 45000 47000
7 Rawa Jitu Utara 65000 66000

a.          ke luar Kabupaten Mesuji (Provinsi)

No. Uraian
1 2
1 Biaya operasional 50000 + 1500/KM
2 Jasa sopir 200,000
Jasa perawat pendamping
3 130,000
4 Jasa Puskesmas 10 % dari operasional
 JASA
SARANA JASA
No Jenis Pelayanan ( RP) PELAYANAN
rekam medis 1,500
para medis 4,000
medis umum gigi 6,500
medis Spesialis 19,500
hecting 1/5 6,500 16,900
hecting 6/10 6,500 25,350
hecting 11/20 6,500 39,000
hecting 20/40 13,000 58,500
diatas 40 13,000 68,250
infus anak 5,200 17550
infus dewasa 5,200 13000
infus intra osseus 5,200 17550
ngt 5,200 19500
cateter 5,200 16250
bilas lambung 5,200 22750
clisma 5,200 16250
nebuliser 3,250 6500
FOTO THERAPY 2,600 6500
VENA SECTIO 13,000 39000
RESUSITASI 6,500 22750
COMBUSIO _
GRADE 1 6,500 22100
GRADE II 6,500 26000
GRADE II 6,500 45500
EXPLORASI COSPUS ALIENUM _
TELINGA 19,500 32500
HIDUNG 13,000 32500
WSD 19,500 19500
PUNGTIE PLEURA 6,500 13000
BLAST FUNGSIE 13,000 39000
EXTRAKSI KUKU 6,500 26000
TAMPON EPISTAKSIS 5,200 9750
SIRKUMSISI 19,500 123500
PASANG ETT 6,500 19500
DEBRIDMENT LUKA TANPA ANESTESI 6,500 26000
AMPUTASI DENGAN ANESTESI ( JARI) 19,500 123500
LUKA LECET MULTIPLE 3,900 13000
INSISI/ EKSISI KECIL 13,000 26000
INSISI/EKSISI SEDANG DENGAN HEACTING 13,000 32500
PUNKSI HAEMATON 13,000 32500
PEMBIDAIAN (SPALK) _ _
TULANG PANJANG (BESAR) 13,000 9750
TULANG PENDEK ( KECIL) 6,500 9750
RANKSEL VERBAN 6,500 9750
ALLERGIE TEST 2,600 10400
EKG 2,600 15600
EKSTRAKSI KULIT KARENA TRAUMA 2,600 16250
ASPIRASI CAIRAN LAMBUNG 6,500 26000
LUMBAL FUNKSI 6,500 39000
REPAIR TENDON JARI 19,500 715000
REPAIR TENDON JARI DENGAN HEACTING 19,500 71500
REPOSISI FRAKTUR/DISLOKASI 6,500 39000
REPOSISI FRAKTUR/DISLOKASI + HEACTING 6,500 39000
PEMASANGAN GIPS 13,000 45500
 OBSERVASI _
1 S/D 3 JAM 2,600 13000
4 S/D 6 JAM 6,500 13000

RAWAT JALAN
RAWAT JALAN POLIKLINIK

NO RUANGAN
POLI BEDAH 4,000 4000
POLI MATA 4,000 4000
POLI PARU- PARU 4,000 4000
POLI ANAK 4,000 4000
POLI PENYAKIT DALAM 4,000 4000
POLI GIGI 4,000 9500
POLI UMUM 4,000 9500
POLI KEBIDANAN 4,000 4000

JASA TINDAKAN POLIKLINIK

NO JENIS TINDAKAN
A POLI BEDAH
1 DEBRIMENT LUKA 6,500 19500
2 EKSISI/ INSISI 6,500 32500
3 EKSTERPASI 6,500 78000
4 COMBUSTIO _
GRADE I 6,500 22100
GRADE II 6,500 26000
GRADE III 6,500 45500
5 WSD 6,500 104000
6 CIRCUMSISI 6,500 143000
7 AMPUTASI JARI 6,500 110500

B POLI KEBIDANAN
1 INPLANT BIDAN 6,500 32500
2 INPLANT DOKTER 6,500 74000
3 IUD BIDAN 6,500 65000
4 IUD DOKTER 6,500 74000
5 EXTERPASI CANDILUM OCUMINATA 6,500 78000
6 CATETER CONDILUM OCUMINATE 6,500 78000
7 PUNKSI CAVUM OPUGLASI 6,500 78000

C POLI GIGI
1 PENCABUTAN GIGI SULUNG TANPA ANESTESI, INSISI 4,000 9100
2 PENCABUTAN BIASA TANPA KOMPLIKASI, TUMPATAN 4,000 19500
3 PENCABUTAN DENGAN KOMPLIKASI TUMPATAN TETAP 4,000 24700
4 TUMPATAN POST PERAWATAN, PEMBERSIHAN KARANG GI 4,000 32500
5 OPERASI GIGI M3 MIRING 32,500 292500

D POLI ANAK
1 LUMBAL PUNKSI 6,500 84500
2 PLEURA PUNKSI 6,500 71500
3 SUBDURAL TP 6,500 84500

E POLI PENYAKIT DALAM

1 MAAG CORLING 6,500 36400
2 ASPIRASI CAIRAN LAMBUNG 6,500 36400
 3 LUMBAL PUNKSI 6,500 84500
4 PLEURA PUNKSI 6,500 58500
5 EKG 6,500 19500

F JASA KEPERAWATAN DAN VISITE RAWAT INAP PER HARI JASA SARANAJASA PELAYANAN DOKTER+ PERAWAT)
NO KELAS
1 KELAS III 6,500 19500
2 KELAS II 6,500 27300
3 KELAS I 7,800 31200
4 VIP 13,000 32500
5 ICU 13,000 36400

G JASA TINDAKAN KEPERAWATAN PER HARI JASA TINDAKAN (RP)

NO RUANGAN
1 RUANG BERSALIN 32,500
2 RUANG BEDAH 26,000
3 RUANG PENYAKIT DALAM 26,000
4 RUANG ANAK 32,500
5 RUNAG BAYI 39,000
6 RUNAG ICU 65,000
7 RUANG VIP 52,000

H JASA KONSUL DOKTER SPESIALIS JASA KONSUL (RP)

NO KELAS
1 KELAS III 13,000
2 KELAS II 19,500
3 KELAS I 22,100
4 VIP 23,400
5 ICU 26,000
6 UGD 19,500
Pelayanan Medik
No Uraian Tarif
1 Jasa Sarana 5,000
2 Jasa Pelayanan Rekam Medis 1,500
3 Jasa Pelayanan Paramedis 4,000
4 Jasa Pelayanan Medis Umum/Gigi 6,500
5 Jasa Pelayanan Medis Spesialis 19,500

Pelayanan Medik dan Keperawatan

Jasa Pelayanan
No Uraian Jasa Sarana Dokter Perawat
Umum Spesialis Assiten
1 Hecting
1 s/d 5 6,500 10,400 19,500 6,500
6 s/d 10 6,500 15,600 26,000 9,750
11 s/d 20 6,500 26,000 39,000 13,000
20 s/d 40 13,000 32,500 52,000 26,000
> 40 13,000 35,750 65,000 32,500

2 Infus
Anak 5,200 7,800 19,500 9,750
Dewasa 5,200 6,500 13,000 6,500
2.a Infus Intra Osseus 5,200 7,800 19,500 9,750
3 NGT 5,200 9,750 19,500 9,750
4 Cateter 5,200 6,500 19,500 9,750
5 Bilas Lambung 5,200 13,000 19,500 9,750
6 Clisma 5,200 9,750 13,000 6,500
7 Nebulizer 3,250 3,250 9,750 3,250
8 Foto Therapy 2,600 6,500
9 Vena Sectio 13,000 26,000 39,000 13,000
10 Resusitasi 6,500 13,000 26,000 9,750
11 Combustip
Grade I 6,500 15,600 6,500
Grade II 6,500 19,500 6,500
Grade III 6,500 32,500 45,500 13,000
12 Explorasi Corpus Alienum
Telinga 19,500 19,500 39,000 13,000
Hidung 13,000 19,500 39,000 13,000
13 WSD 19,500 91,000 19,500
14 Pungtie Pleura 6,500 71,500 13,000
15 Blast Fungsie 13,000 26,000 39,000 13,000
16 Extraksi Kuku 6,500 19,500 26,000 6,500
17 Tampon Epistaksis 5,200 6,500 3,250
18 Sirkumsisi 19,500 91,000 130,000 32,500
19 Pasang ETT 6,500 19,500 19,500
20 Debridement Luka tanpa Anastesi 6,500 19,500 6,500
21 Amputasi dengan anastesi (jari) 19,500 91,000 130,000 32,500
22 Luka lecet multiple 3,900 7,800 5,200
23 Insisi/ Eksisi kecil 13,000 19,500 6,500
24 Insisi/ Eksisi sedang dg heacting 13,000 19,500 13,000
25 Punksi haematom 13,000 26,000 6,500
26 Pembidaian (spalk)
Tulang panjang (besar) 13,000 6,500 3,250
Tulang pendek (kecil) 6,500 6,500 3,250
27 Ranksel verban 6,500 6,500 3,250
28 Allergie test 2,600 6,500 3,900
29 EKG 2,600 9,100 13,000 6,500
30 Ekstraksi kulit karena trauma 2,600 9,750 13,000 6,500
31 Aspirasi cairan lambung 6,500 13,000 26,000 13,000
32 Lumbal Funksi 6,500 26,000 71,500 13,000
33 Repair tendon jari 19,500 39,000 130,000 32,500
34 Repair tendon jari dg heacting 19,500 39,000 130,000 32,500
35 Reposisi fraktur/dislokasi 6,500 26,000 65,000 13,000
36 Reposisi fraktur/dislokasi + heacting 6,500 26,000 65,000 13,000
37 Pemasangan gips 13,000 26,000 71,500 19,500
38 Observasi
1 s/d 3 jam 2,600 6,500 13,000 6,500
4 s/d 6 jam 6,500 6,500 13,000 6,500

Rawat Jalan
Jasa Pelayanan
No Ruangan Jasa Sarana Dokter Perawat
Umum Spesialis Assiten
1 Poli Bedah 4,000 10,500 4,000
2 Poli Mata 4,000 10,500 4,000
3 Poli Paru-Paru 4,000 10,500 4,000
4 Poli Anak 4,000 10,500 4,000
5 Poli Penyakit Dalam 4,000 10,500 4,000
6 Poli Gigi 4,000 8,000 4,000
7 Poli Umum 4,000 8,000 4,000
8 Poli Kebidanan 4,000 10,500 4,000

Jasa Tindakan Poliklinik

Jasa
No Jenis Tindakan Jasa Sarana Jumlah Jaspel
No Jenis Tindakan Jasa Sarana Jumlah Jaspel
Dokter Perawat
A Poli Bedah
1 Debridement Luka 6,500 13,000 6,500 19,500
2 Eksisi/ Insisi 6,500 19,500 13,000 32,500
3 Eksterpasi 6,500 65,000 13,000 78,000
4 Combustio
Grade I 6,500 15,600 6,500 22,100
Grade II 6,500 19,500 6,500 26,000
Grade III 6,500 32,500 13,000 45,500
5 WSD 6,500 91,000 13,000 104,000
6 Circumsisi 6,500 130,000 13,000 143,000
7 Amputasi Jari 6,500 97,500 13,000 110,500

B Poli Kebidanan
1 Implant Bidan 6,500 32,500 32,500
2 Implant Dokter 6,500 65,000 9,100 74,100
3 IUD Bidan 6,500 65,000 65,000
4 IUD Dokter 6,500 65,000 9,100 74,100
5 Exterpasi Candilum Ocuminate 6,500 65,000 13,000 78,000
6 Cateter Condilum Ocuminate 6,500 65,000 13,000 78,000
7 Punksi Cavum Oplugasi 6,500 65,000 13,000 78,000

C Poli Gigi
1 Pencabutan gigi sulung tanpa 4,000 5,200 3,900 9,100
Anastesi, Insisi
2 Pencabutan biasa tanpa komplikasi, 4,000 13,000 6,500 19,500
tumpatan
3 Pencabutan dengan komplikasi, 4,000 16,900 7,800 24,700
tumpatan tetap
4 Tumpatan post perawatan, pembersihan 4,000 26,000 6,500 32,500
karang gigi
5 Operasi gigi M3 miring 32,500 260,000 32,500 292,500

D Poli Anak
1 Lumbal Punksi 6,500 71,500 13,000 84,500
2 Pleura Punksi 6,500 58,500 13,000 71,500
3 Subdural TP 6,500 71,500 13,000 84,500

E Poli Penyakit Dalam

1 Maag Corling 6,500 29,900 6,500 36,400
2 Aspirasi cairan lambung 6,500 29,900 6,500 36,400
3 Lumbal Punksi 6,500 71,500 13,000 84,500
4 Pleura Punksi 6,500 52,000 6,500 58,500
 5 EKG 6,500 13,000 6,500 19,500

Jasa Keperawatan dan Visite Rawat Inap Per Hari

Jasa Pelayanan Jasa Asuhan
No Kelas Jasa Sarana
Dokter Perawat Keperawatan
1 Kelas III 6,500 6,500 13,000 5,200
2 Kelas II 6,500 7,800 19,500 6,500
3 Kelas I 7,800 9,100 22,100 7,800
4 VIP 13,000 9,100 23,400 10,400
5 ICU 13,000 10,400 26,000 13,000

Jasa Tindakan Keperawatan Per Hari

No Ruangan Jasa Tindakan
1 Ruang Bersalin 32,500
2 Ruang Bedah 26,000
3 Ruang Penyakit Dalam 26,000
4 Ruang Anak 32,500
5 Ruang Bayi 39,000
6 Ruang ICU 65,000
7 Ruang VIP 52,000

Jasa Konsul Dokter Spesialis

No Kelas Jasa Konsul
1 Kelas III 13,000
2 Kelas II 19,500
3 Kelas I 22,100
4 VIP 23,400
5 ICU 26,000
6 UGD 19,500

Tindakan Kebidanan
Jasa
No Uraian Jasa Sarana BHP
Dokter Perawat
1 Partus Normal
Kelas III 39,000 130,000 52,000 50,000
Kelas II 52,000 143,000 78,000 50,000
Kelas I 84,500 325,000 97,500 50,000
VIP 117,000 390,000 130,000 50,000
ICU 117,000 520,000 195,000 50,000

2 Persalinan Tindakan Stimulan

Kelas III 39,000 162,500 52,000 50,000
 Kelas II 52,000 195,000 78,000 50,000
Kelas I 84,500 390,000 97,500 50,000
VIP 130,000 455,000 130,000 50,000

3 Gamelli
Kelas III 39,000 175,500 52,000 75,000
Kelas II 52,000 260,000 78,000 75,000
Kelas I 84,500 455,000 97,500 75,000
VIP 130,000 520,000 130,000 75,000

4 Manual Plasenta/ Vakum

Kelas III 39,000 130,000 52,000 50,000
Kelas II 52,000 195,000 78,000 50,000
Kelas I 84,500 390,000 97,500 50,000
VIP 130,000 520,000 130,000 50,000

5 Komplikasi
Kelas III 39,000 175,000 52,000 150,000
Kelas II 52,000 325,000 78,000 150,000
Kelas I 84,500 455,000 97,500 150,000
VIP 130,000 585,000 130,000 150,000

6 Letsu/ Bra
Kelas III 39,000 195,000 52,000 150,000
Kelas II 52,000 325,000 78,000 150,000
Kelas I 84,500 390,000 97,500 150,000
VIP 130,000 520,000 130,000 150,000

7 MOW/MOP
Kelas III 39,000 195,000 19,500 50,000
Kelas II 52,000 325,000 32,500 50,000
Kelas I 84,500 390,000 45,500 50,000
VIP 130,000 520,000 65,000 50,000

8 Resusitasi Bayi 13,000 97,500 26,000 25,000

Tindakan OK
Jasa
No Uraian Jasa Sarana BHP
Dokter Perawat
1 Operasi Ringan
Kelas III 26,000 72,000 36,000 756,888
Kelas II 32,500 84,500 45,500 756,888
Kelas I 39,000 97,500 58,500 756,888
 VIP 65,000 195,000 65,000 756,888

2 Operasi Sedang
Kelas III 39,000 292,500 97,500 910,978
Kelas II 52,000 429,000 130,000 910,978
Kelas I 97,500 585,000 195,000 910,978
VIP 130,000 650,000 260,000 910,978

3 Operasi Berat
Kelas III 65,000 520,000 130,000 956,888
Kelas II 130,000 650,000 195,000 956,888
Kelas I 195,000 910,000 260,000 956,888
VIP 260,000 1,170,000 325,000 956,888

4 Operasi Khusus
Kelas III 260,000 650,000 130,000 956,888
Kelas II 260,000 910,000 195,000 956,888
Kelas I 325,000 1,040,000 195,000 956,888
VIP 390,000 1,300,000 260,000 956,888

5 Operasi Cito
Kelas III
Kelas II Operasi cito dinaikkan 25% dari tindakan terencana, tidak termasuk pasien Jam
Kelas I Jamkesda
VIP

6 Anastesi Sedang
Kelas III 39,000 130,000 65,000 510,800
Kelas II 52,000 143,000 78,000 510,800
Kelas I 84,500 195,000 97,500 510,800
VIP 130,000 227,500 110,500 510,800

Anasthesi Berat
Kelas III 39,000 162,500 84,500 993,890
Kelas II 52,000 195,000 97,500 993,890
Kelas I 84,500 260,000 130,000 993,890
VIP 130,000 390,000 195,000 993,890
Tindakan Cito dinakkan 25 % dari jenis tindakan terencana, baik anasthesi sedang maupun berat

7 Recovery Room 6,500 97,500 52,000

Penunjang Medik
Tarif Pelayanan Instalasi Laboratorium
Jasa Pelayanan
No Jenis Pelayanan Jasa Sarana BHP
Medis Paramedis
1 Hemoglobin 3,250 1,950 1,300 5,000
2 Leukosit 3,250 1,950 1,300 5,000
3 Hitung Jenis Leukosit 3,250 1,950 1,300 5,000
4 Laju endap darah 3,250 1,950 1,300 5,000
5 Trombosit 3,250 1,950 1,300 5,000
6 Hematokrit 3,250 1,950 1,300 5,000
7 Eritrosit 3,250 1,950 1,300 5,000
8 Waktu pembekuan 3,250 1,950 1,300 7,000
9 Waktu Perdarahan 3,250 1,950 1,300 7,000
10 PH Urine 3,250 1,950 1,300 15,000
11 Protein Urine 3,250 1,950 1,300 15,000
12 Reduksi Urine 3,250 1,950 1,300 15,000
13 Sedimen Urine 3,250 1,950 1,300 15,000
14 Bilirubin Urine 3,250 1,950 1,300 15,000
15 Bakteri Tahan Asam 3,900 3,250 1,950 10,000
16 Malaria 3,900 3,250 1,950 5,000
17 Faeces Rutin 3,900 3,250 3,250 10,000
18 Test Kehamilan 3,900 3,250 3,250 8,000
19 Dengue 9,100 19,500 13,000 5,000
20 Widal 6,500 10,400 6,500 20,000
21 Ureum 3,900 5,200 3,900 8,000
22 Alkali Pospat 3,900 5,200 3,900 15,000
23 Glukosa 3,900 5,200 3,900 5,000
24 Creatinin 3,900 5,200 3,900 8,000
25 Bilirubin Total 3,900 5,200 3,900 5,000
26 Bilirubin Direk/ Indirek 3,900 5,200 3,900 5,000
27 Albumin dan Glabulin 3,900 5,200 3,900 12,000
28 Protein Total 3,900 5,200 3,900 5,000
29 Triglycerida 3,900 5,200 3,900 12,000
30 Cholesterol/ HDL/ LDL 3,900 5,200 3,900 10,000
31 Asam Urat 3,900 5,200 3,900 12,000
32 SGOT 6,500 7,800 5,200 9,000
33 SGPT 6,500 7,800 5,200 9,000
34 Hb Sag 7,800 10,400 7,800 5,000
35 Golongan Darah 3,250 3,250 2,600 3,500
36 VDRL 3,900 5,200 3,900 15,000
37 HCV 6,500 10,400 9,100 126,000
38 Narkoba (THC-AMP) 19,500 13,000 6,500
39 HIV 7,800 10,400 7,800 42,000
40 Crosmel 32,500 32,500 26,000 175,000
Tarif Pelayanan Instalasi Radiologi
Jasa Pelayanan
No Jenis Pelayanan Jasa Sarana BHP
Radiologi Radiografer
A Non Contras
1 Thorax 10,400 31,200 15,600 27,000
2 Extermitas/ objek 10,400 31,200 15,600 27,000
3 Cranium 10,400 31,200 15,600 27,000
4 Vertebrae 10,400 31,200 15,600 27,000
5 Abdomen 10,400 31,200 15,600 27,000
6 Pelvis 10,400 31,200 15,600 27,000
7 Dental 10,400 15,600 7,800 27,000

B Dengan Contras
1 BNO/IVP 15,600 97,500 45,500 240,000
2 Cystogram 15,600 52,000 31,200 240,000
3 HSG 15,600 52,000 31,200 240,000
4 Appendicogram 15,600 52,000 31,200 240,000
5 OMD 15,600 52,000 31,200 240,000
6 Colon In Loop 15,600 52,000 31,200 240,000

C Lain - Lain
1 USG Abdomen 10,400 22,100 7,800 27,000
2 USG Obgyn 10,400 22,100 7,800 27,000
3 EKG 10,400 20,800 7,800 15,000
Ket:
1 Jasa Pelayanan Medik tidak ditarik jika belum ada dokter Radiologi
2 Pemeriksaan kontras, tarif belum termasuk obat-obatan dan alkes/ BHP
3 Cito dinaikkan 25% dari tarif terencana

Tarif Pelayanan Instalasi Fisiotheraphy

Jasa Pelayanan
No Jenis Pelayanan Jasa Sarana BHP
Medis Paramedis
Pelayanan Infra Merah/ fibrator rawat
1 jalan 6,500 9,750
dan inap
Pelayanan short wave diatherm (SWD)
2 rawat 6,500 13,000 3,000
jalan dan inap
Pelayanan Ultra Sound (US) rawat jalan
3 dan 6,500 9,750
inap
Pelayanan tenaga latihan (TL) rawat jalan
4 dan 3,900 13,000
inap
 Pelayanan Electrical Stimulasi rawat jalan
5 dan 6,500 6,500
inap

Tarif Pelayanan Gizi

Jasa Pelayanan
No Jenis Pelayanan Jasa Sarana BHP
Perawat Paramedis
A Tarif Pelayanan Gizi
1 Kelas III 3,900 1,950 35,000
2 Kelas II 5,200 4,550 45,000
3 Kelas I 5,850 5,200 50,000
4 VIP 6,500 6,500 60,000
5 Diet Khusus Modisko 6,500 6,500 6,500 35,000
6 ICU 9,750 6,500 50,000

B Tarif Konsultasi Gizi

Konsultasi 1,300 3,250

Tarif Pelayanan Farmasi Per Hari

No Jenis Pelayanan Jasa Sarana Jasa Pelayanan BHP
1 Rawat Inap dan Rawat Jalan 700 1,300

Tarif Pelayanan Kesling Per Hari

No Jenis Pelayanan Jasa Sarana Jasa Pelayanan BHP
1 Rawat Inap 1,300 1,300 1,000
2 Rawat Jalan/ UGD 1,300 1,300 500
3 Insenerator 1,300 1,300 1,000
4 Pengelola IPAL 1,300 1,300 1,500
5 Insenerator Umum 1,300 1,300 3,000
6 Kesling 1,300 2,500

Tarif Pemeriksaan Kesehatan

Jasa Pelayanan
No Jenis Pelayanan Jasa Sarana BHP
Dokter Perawat
1 Kir Majelis Penguji Kesehatan 5,200 6,500 1,300
2 Kir CPNS/ dokter penguji tersendiri 5,200 6,500 1,300
3 Kir Pemeriksaan Umum 5,200 6,500 1,300
4 Kir Pemeriksaan ke Luar Negeri 9,100 15,600 1,300
5 Visum Et Revertum 10,400 13,000 2,600 15,000
6 Jasa Raharja/ Asuransi 10,400 13,000 2,600

Tarif Pelayanan Pemakaian Darah Per Kantong

Jasa Pelayanan
No Jenis Pelayanan Jasa Sarana BHP
No Jenis Pelayanan Jasa Sarana BHP
Medis Paramedis
1 Pengambilan donor darah 19,500 32,500 13,000 220,000
2 Uji Saring/ Crosmet 19,500 32,500 13,000 220,000

Retribusi Pelayanan Penunjang Non Medik

Tarif Pelayanan Pemulasaraan Jenazah
No Jenis Pelayanan Jasa Sarana Jasa Pelayanan BHP
1 Perawatan/ pemandian jenazah 26,000 78,000 20,000
2 Pengafanan jenazah 26,000 104,000 100,000
3 Pengawetan/formalin 91,000 260,000 180,000
4 Penyimpanan/ hari 6,500 15,600 3,000
5 Pendinginan 32,500 26,000 25,000
6 Kebersihan 6,500 15,600 3,000
7 Penguburan 32,500 325,000 75,000
8 Pemetian 65,000 195,000 500,000
Pembenahan Luka Mayat di Kamar Mayat
9

a. Ringan < 20 6,500 19,500 15,000

b. Sedang 21 s/d 50 9,750 52,000 22,500
c. Berat 51 s/d 100 19,500 78,000 25,000
d. Khusus (berantakan > 100) 19,500 97,500 35,000

Tarif Pelayanan Instalasi Prasarana dan Sarana Rumah Sakit (IPSRS)

No Jenis Pelayanan Jasa Sarana Jasa Pelayanan BHP
1 Kebersihan loundry 1,300 1,300 5,000
2 Jasa penunjang IPSRS 1,300 1,300 1,000

Tarif Pelayanan Ambulan/ Jenazah

Jasa Pelayanan
No Jenis Pelayanan Jasa Sarana BHP
Sopir Paramedis
1 Ambulance (5 km pertama) 15,000 20,000
Ambulance (tambahan setiap km) 500 500
Perawat Pendamping (5 km pertama) 15,000 20,000
tambahan setiap km berikutnya 500

2 Ambulance Jenazah (5 km pertama) 2,000 30,000

tambahan setiap km berikutnya 500 500
Cat: Belum termasuk biaya BBM

Retribusi Pelayanan Non Medik

Tarif Parkir
No Jenis Pelayanan Jasa Sarana Jasa Pelayanan BHP
1 Jasa parkir kendaraan roda 4 1,300 650
2 Jasa parkir kendaraan roda 2 650 650
BHP Jumlah Jaspel Jumlah

16,500 36,400 59,400

16,500 51,350 74,350
63,700 78,000 148,200
63,700 110,500 187,200
172,400 133,250 318,650
-
-
16,800 37,050 59,050
16,800 26,000 48,000
16,800 37,050 59,050
16,800 39,000 61,000
63,700 35,750 104,650
16,800 42,250 64,250
16,800 29,250 51,250
16,800 16,250 36,300
6,500 9,100
63,700 78,000 154,700
16,800 48,750 72,050
- -
16,800 22,100 45,400
16,800 26,000 49,300
63,700 91,000 161,200
- -
63,700 71,500 154,700
63,700 71,500 148,200
63,700 110,500 193,700
63,700 84,500 154,700
16,800 78,000 107,800
63,700 52,000 122,200
 16,800 9,750 31,750
63,700 253,500 336,700
63,700 39,000 109,200
16,800 26,000 49,300
172,400 253,500 445,400
16,800 13,000 33,700
16,800 26,000 55,800
63,700 32,500 109,200
16,800 32,500 62,300
- -
63,700 9,750 86,450
63,700 9,750 79,950
16,800 9,750 33,050
16,800 10,400 29,800
16,800 28,600 48,000
63,700 29,250 95,550
16,800 52,000 75,300
63,700 110,500 180,700
16,800 201,500 237,800
63,700 201,500 284,700
16,800 104,000 127,300
63,700 104,000 174,200
63,700 117,000 193,700
- -
16,800 26,000 45,400
16,800 26,000 49,300

Rekam Medis Jumlah Jaspel BHP Total

1,500 16,000 20,000

1,500 16,000 20,000
1,500 16,000 20,000
1,500 16,000 20,000
1,500 16,000 20,000
1,500 13,500 17,500
1,500 13,500 17,500
1,500 16,000 20,000

BHP Total
BHP Total

26,000
39,000
84,500

28,600
32,500
52,000
110,500
149,500
117,000

39,000
80,600
71,500
80,600
84,500
84,500
84,500

10,000 23,100

13,000 36,500

33,000 61,700

50,000 86,500

325,000

91,000
78,000
91,000

42,900
42,900
91,000
65,000
 26,000

Jumlah Jaspel Total

24,700 31,200
33,800 40,300
39,000 46,800
42,900 55,900
49,400 62,400

Jumlah Jaspel Total

- -
182,000 271,000
221,000 323,000
422,500 557,000
520,000 687,000
715,000 882,000
- -
- -
214,500 303,500
 273,000 375,000
487,500 622,000
585,000 765,000
- -
- -
227,500 341,500
338,000 465,000
552,500 712,000
650,000 855,000
- -
- -
182,000 271,000
273,000 375,000
487,500 622,000
650,000 830,000
- -
- -
227,000 416,000
403,000 605,000
552,500 787,000
715,000 995,000
- -
- -
247,000 436,000
403,000 605,000
487,500 722,000
650,000 930,000
- -
- -
214,500 303,500
357,500 459,500
435,500 570,000
585,000 765,000
- -
123,500 161,500

Jumlah Jaspel Total

108,000 890,888
130,000 919,388
156,000 951,888
 260,000 1,081,888

390,000 1,339,978
559,000 1,521,978
780,000 1,788,478
910,000 1,950,978

650,000 1,671,888
845,000 1,931,888
1,170,000 2,321,888
1,495,000 2,711,888

780,000 1,996,888
1,105,000 2,321,888
1,235,000 2,516,888
1,560,000 2,906,888

, tidak termasuk pasien Jamkesmas/

195,000 744,800
221,000 783,800
292,500 887,800
338,000 978,800

247,000 1,279,890
292,500 1,338,390
390,000 1,468,390
585,000 1,708,890
rat

149,500 156,000
Jumlah Jaspel Total

3,250 11,500
3,250 11,500
3,250 11,500
3,250 11,500
3,250 11,500
3,250 11,500
3,250 11,500
3,250 13,500
3,250 13,500
3,250 21,500
3,250 21,500
3,250 21,500
3,250 21,500
3,250 21,500
5,200 19,100
5,200 14,100
6,500 20,400
6,500 18,400
32,500 46,600
16,900 43,400
9,100 21,000
9,100 28,000
9,100 18,000
9,100 21,000
9,100 18,000
9,100 18,000
9,100 25,000
9,100 18,000
9,100 25,000
9,100 23,000
9,100 25,000
13,000 28,500
13,000 28,500
18,200 31,000
5,850 12,600
9,100 28,000
19,500 152,000
19,500 39,000
18,200 68,000
58,500 266,000
Jumlah Jaspel Total

46,800 84,200
46,800 84,200
46,800 84,200
46,800 84,200
46,800 84,200
46,800 84,200
23,400 60,800

143,000 398,600
83,200 338,800
83,200 338,800
83,200 338,800
83,200 338,800
83,200 338,800

29,900 67,300
29,900 67,300
28,600 54,000

Jumlah Jaspel Total

9,750 16,250

13,000 22,500

9,750 16,250

13,000 16,900
 6,500 13,000

Jumlah Jaspel Total

1,950 40,850
4,550 54,750
5,200 61,050
6,500 73,000
13,000 54,500
6,500 66,250

3,250 4,550

Jumlah Jaspel Total

1,300 2,000

Jumlah Jaspel Total

1,300 3,600
1,300 3,100
1,300 3,600
1,300 4,100
1,300 5,600
2,500 3,800

Jumlah Jaspel Total

7,800 13,000
7,800 13,000
7,800 13,000
16,900 26,000
15,600 41,000
15,600 26,000

Jumlah Jaspel Total

Jumlah Jaspel Total

32,500 285,000
32,500 285,000

Jumlah Jaspel Total

78,000 124,000
104,000 230,000
260,000 531,000
15,600 25,100
26,000 83,500
15,600 25,100
325,000 432,500
195,000 760,000

19,500 41,000
52,000 84,250
78,000 122,500
97,500 152,000

Jumlah Jaspel Total

1,300 7,600
1,300 3,600

Jumlah Jaspel Total

20,000 35,000
500 1,000
- 35,000
- 500
- -
30,000 32,000
500 1,000

Jumlah Jaspel Total

650 1,950
650 1,300