DRAFT TARIF RUMAH SAKIT UMUM BHAKTI WALUYO

TARIF PENDAFTARAN
NO URAIAN JS RS JS DR TOTAL
PDF001 POLIKLINIK SPES PENY DALAM 25,000 100,000 125,000
PDF002 POLIKLINIK SPES ANAK 25,000 100,000 125,000
PDF003 POLIKLINIK SPES OBGYN 25,000 100,000 125,000
PDF004 POLIKLINIK SPES THT 25,000 100,000 125,000
PDF005 POLIKLINIK UMUM 25,000 50,000 75,000
PDF006 POLIKLINIK FISIOTERAPI 10,000 40,000 50,000
PDF007 IGD 25,000 50,000 75,000
DRAFT TARIF RUMAH SAKIT UMUM BHAKTI WALUYO

TARIF KONSUL DOKTER

NO URAIAN TOTAL
JASA KONSULTASI

KON001 KONSULTASI ANTAR POLIKLINIK SPESIALIS 100,000

KON002 KONSULTASI DOKTER SPESIALIS DI VIA TELP 25,000

KON003 IGD (HARI KERJA) 100,000

KON004 IGD (HARI LIBUR) 125,000

KON005 RUANG RAWAT INAP (HARI KERJA) 25,000

KON006 RUANG RAWAT INAP (HARI LIBUR) 50,000

DRAFT TARIF RUMAH SAKIT UMUM BHAKTI WALUYO

TARIF KAMAR
NO URAIAN Tarif

01KMR VVIP 500,000

02KMR VIP 400,000

03KMR KELAS 1 300,000

04KMR KELAS 2 200,000

05KMR KELAS 3 150,000

06KMR ISOLASI 200,000

* SEWA KAMAR TIDAK TERMASUK TINDAKAN DAN VISITE

DRAFT TARIF RUMAH SAKIT UMUM BHAKTI WALUYO

TARIF VISITE DOKTER

NO URAIAN TARIF
VIS01 DOKTER UMUM

VIS0101 VVIP 70,000

VIS0102 VIP 60,000

VIS0103 KELAS 1 50,000

VIS0104 KELAS 2 45,000

VIS0105 KELAS 3 40,000

VIS02 DOKTER SPESIALIS

VIS0201 VVIP 200,000

VIS0202 VIP 175,000

VIS0203 KELAS 1 150,000

VIS0204 KELAS 2 125,000

VIS0205 KELAS 3 100,000

JKP01 JASA ASKEP/ASKEB (PERHARI)

JKP0101 MINIMAL (MINIMAL CARE) 30,000

JKP0102 SEDANG (PARTIAL CARE) 40,000

JKP0103 BERAT (TOTAL CARE) 50,000

DRAFT TARIF RUMAH SAKIT UMUM BHAKTI WALUYO

TARIF VISITE LABORATORIUM

NO URAIAN VVIP VIP KLS 1 KLS 2 KLS 3 RJ
LABORATORIUM
Darah Lengkap
LAB0101 analyser 95,000 90,000 85,000 80,000 75,000 75,000

LAB0102 Hb 15,000

LAB0103 Lekosit 15,000

LAB0104 Diff 15,000

LAB0105 LED 15,000

LAB0106 Hematrokrit 10,000 10,000 10,000 10,000 10,000 15,000

LAB0107 Trombosit 10,000 10,000 10,000 10,000 10,000 15,000

LAB0108 CT-BT 10,000 10,000 10,000 10,000 10,000 10,000

LAB0109 Widal 42,000 40,000 37,000 35,000 32,000 30,000

LAB0110 GDT 37,000 35,000 30,000 27,000 25,000 22,000

LAB0111 Malaria manual 37,000 35,000 30,000 27,000 25,000 25,000

LAB0112 SGOT 50,000 45,000 40,000 38,000 35,000 35,000

LAB0113 SGPT 50,000 45,000 40,000 38,000 35,000 35,000

LAB0114 Bilirubin T/D 75,000 70,000 65,000 60,000 57,000 57,000

LAB0115 Alkali Phospatase 70,000 65,000 60,000 57,000 55,000 55,000

LAB0116 Gamma GT 75,000 70,000 65,000 60,000 57,000 57,000

LAB0117 Ureum 50,000 45,000 40,000 37,000 33,000 33,000

LAB0118 Creatinin 50,000 45,000 40,000 37,000 33,000 33,000

LAB0119 Tatal Protein + Alb 55,000 50,000 45,000 41,000 37,000 37,000

LAB0120 Gula Darah 1 x 40,000 35,000 30,000 25,000 20,000 25,000

LAB0121 Gula Darah 1/II 55,000 50,000 45,000 40,000 35,000 35,000
LAB0122 Cholesterol
DRAFT TARIF RUMAH SAKIT UMUM BHAKTI WALUYO

TARIF VISITE LABORATORIUM

55,000 52,000 49,000 47,000 45,000 45,000

LAB0123 Protein Total 30,000 28,000 25,000 23,000 20,000 20,000

LAB0124 Albumin 30,000 28,000 25,000 23,000 20,000 20,000

LAB0125 Triglycerid 60,000 57,000 52,000 48,000 44,000 44,000

LAB0126 Asam Urat 50,000 45,000 40,000 35,000 31,000 31,000

LAB0127 Hb, Trombo, Ht, Leko 55,000 50,000 43,000 40,000 33,000 33,000

LAB0128 Urine Rutine 40,000 35,000 30,000 27,000 25,000 25,000

LAB0129 Faeces Rutin 25,000 21,000 19,000 17,000 15,000 15,000

LAB0130 LCS 33,000 32,000 30,000 28,000 26,000 26,000

LAB0131 HbsAG 45,000 42,000 39,000 37,000 35,000 35,000

LAB0132 Gol Darah + Rhesus 40,000 35,000 30,000 27,000 25,000 25,000

LAB0133 Dengue Blot 198,000 198,000 198,000 198,000 198,000 198,000

LAB0134 ICT Malaria 120,000 115,000 110,000 105,000 100,000 198,000

LAB0135 TB PAP 110,000 99,000 97,000 95,000 90,000 90,000

LAB0136 IgM Salmonella 190,000 185,000 180,000 175,000 170,000 170,000

DRAFT TARIF RUMAH SAKIT UMUM BHAKTI WALUYO

TARIF IGD
NO URAIAN TARIF

IGD001 JAHIT LUKA 1 X JAHITAN Rp. 15000

IGD008 JASA PEMASANGAN INFUS/NGT 50,000

CABUT NGT/INFUS/WSD 50,000

JASA PEMASANGAN KATETER (PERKALI) 100,000

CABUT KATETER/DRAIN.NGT/INFUS/WSD 100,000

IGD009 PEMASANGAN INFUS PUMP ATAU SYRINGE PUMP (PERKALI) 50,000

IGD039 RESUSITASI JANTUNG PARU (RJP) 50,000

IGD040 DC SHOCK 250,000

IGD041 PEMAKAIAN BEDSIDE MONITOR PER JAM
30,000

IGD042 PEMAKAIAN VENTILATOR PERJAM 30,000

IGD044 PASANG NEBULIZER 50,000

IGD045 EKG (ELEKTROKARDIOGRAPH) 150,000

IGD067 PEMERIKSAAN VAGINAL TUSSEY/COLOK DUBUR 50,000

IGD068 TEST PACK 10,000

DRAFT TARIF RUMAH SAKIT UMUM BHAKTI WALUYO

TARIF TINDAKAN RANAP

KODE DESKRIPSI KLS 3 KLS 2 KLS 1 VIP VVIP
29,000 47,000 72,000
IPD001 Pasang Dan Lepas Kateter 90,000 112,500
29,000 43,000 72,000
IPD002 EKG 90,000 112,500
29,000 43,000 72,000
IPD003 Pasang Dan Lepas NGT 90,000 112,500
23,000 27,000 50,000
IPD004 EKG 62,500 78,500
99,000 148,000 247,000
IPD005 Resusitasi (RJP) 308,000 386,000
25,000 38,000 63,000
IPD006 Buka Jahitan 78,000 98,500
29,000 43,000 72,000
IPD007 Klisma 90,000 112,500
47,000 70,000 117,000
IPD008 Vena Secti 146,000 183,000
31,000 46,000 77,000
IPD009 Pemberian Nebulizer 96,000 121,000
111,000 167,000 278,000
IPD010 Pemasangan CVP 347,500 435,000
30,000 70,000 100,000
IPD011 Pemasanangan Monitor 125,000 156,000
136,000 278,000 464,000
IPD012 Pemasangan WSD 580,000 725,000
28,000 43,000 71,000
IPD013 Spooling NGT 89,000 111,000
177,000 205,000 382,000
IPD014 Intubatssi dan ekstubasi 477,500 597,000
40,400 66,600 107,000
IPD015 insisi/cross insisi 134,000 168,000
24,000 35,700 59,700
IPD016 Rawat luka/ganti verban 75,000 93,000
26,000 39,000 65,000
IPD017 Combustio Kecil 82,000 102,000
85,900 128,100 214,000
IPD018 Combustio sedang 267,500 334,000
112,500 169,500 282,000
IPD019 Combustio besar 352,500 441,000
39,000 58,000 97,000
IPD020 Pemasangan Rsansel verban 122,000 152,000
41,000 60,000 101,000
IPD021 Jahitan luka kecil (1 s/d 5 Jahitan) 127,000 158,000
55,000 82,000 137,000
IPD022 Jahitan Luka Sedang (6 s/d 10 Jahitan) 171,000 214,000
DRAFT TARIF RUMAH SAKIT UMUM BHAKTI WALUYO

TARIF TINDAKAN RANAP

80,000 119,000 199,000
IPD023 Jahitan Luka Besar (> 10 jahitan) 248,000 311,000
30,400 45,600 76,000
IPD024 Insalasi Perhari 95,000 119,000
44,400 67,600 112,000
IPD025 ekstraksi kuku 140,000 175,000
25,400 38,600 64,000
IPD026 Observasi dengan O2/tanpa O2 80,000 100,000
25,000 45,000 70,000
IPD027 Suntikan ATS 87,000 109,000
65,000 98,000 163,000
IPD028 Debridement 203,000 255,000
58,000 87,000 145,000
IPD029 Lavage Lambung 181,000 227,000