Daftar Jenis Tindakan Kebidanan

NO Jenis Tindakan Kebidanan Jasa Pelayanan Jasa Sarana Jumlah

1 Aff Cateter, Infus, NGT Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
2 angkat jahitan 1-5 jahitan Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
3 angkat jahitan 6-10 jahitan Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
4 balut luka Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
5 bidai Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
6 bladder training Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
7 ganti verban luka kecil Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
8 injeksi IM (intra Muscular) Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
9 injeksi IV (inta Vascular) Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
10 injeksi SC/IC (subcutan/Intracutan) Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
11 insisi kecil Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
12 irigasi mata Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
13 irigasi telinga Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
14 jahitan luka 1-5 jahitan Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
15 kompres hangat/dingin Rp 16,000.00 Rp 24,000.00 Rp 40,000.00

lavement/ Prosedur pemasukan cairan ke

16 dalam kolon melalui anus Rp 16,000.00 Rp 24,000.00 Rp 40,000.00

17 leopold Rp 16,000.00 Rp 24,000.00 Rp 40,000.00

18 memandikan pasien Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
19 oksigen 1-3 L/jam Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
20 oksigen 4-6 L/jam Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
21 pemakaian dopler Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
22 pemakaian infus pump Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
23 pemberian obat dripp Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
24 pemberian obat per oral Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
25 pemberian obat per rectal Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
26 pemberian obat topikal Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
27 perawatan luka kecil Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
28 phlebotomy Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
29 rawat luka ringan Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
30 rumple leed test Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
31 vital sigh Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
32 vulva hygiene Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
33 angkat > 10 jahitan Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
34 bilas lambung Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
35 EKG Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
36 ganti verban luka sedang Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
37 infus Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
38 insisi sedang Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
39 jahit luka 6-10 jahitan Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
40 Nebulizer Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
41 Observasi Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
42 Oksigen 7-8L/jam Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
43 oksigen 9-11 L/jam Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
44 pasang Spalk Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
45 pemakaian Syring Pump/hari Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
46 pemasangan Dower Cateter Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
47 pemasangan Elastis Verban Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
48 penggunaan Incubator/infant warmer Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
49 perawatan luka sedang Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
50 rawat luka berat Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
51 rawat luka sedang Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
52 suction Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
53 transfer pasien internal Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
54 vagina Toucher (VT) Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
55 biopsi Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
56 ganti verban luka besar Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
57 jahit luka >11 Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
58 oksigen >12 L/jam Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
59 pemasangan IUD Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
60 pemasangan NGT Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
61 pemasangan OPA/NPA Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
62 pengelolaan Shock Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
63 perawatan luka besar Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
64 rawat luka berat Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
65 RJP (resusitasi Jantung Paru) Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
66 transfusi Darah Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
67 Transfer pasien ke RS lain Rp 88,000.00 Rp 132,000.00 Rp 220,000.00
68 DC Shock Rp 128,000.00 Rp 192,000.00 Rp 320,000.00
69 GDS Cito Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
70 Perawatan Jenazah Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
71 Klisma/ Lavement Rp 32,000.00 Rp 48,000.00 Rp 80,000.00
72 CTG Kebidanan Rp 74,400.00 Rp 111,600.00 Rp 186,000.00
73 Inkubator Rp 74,400.00 Rp 111,600.00 Rp 186,000.00
74 Pasang Pulse Oxymetri Rp 22,000.00 Rp 33,000.00 Rp 55,000.00
75 Pemakaian Bedside Monitor & Pulse Oxymet Rp 22,000.00 Rp 33,000.00 Rp 55,000.00
76 Pasang / Angkat Tampon Vagina Rp 22,000.00 Rp 33,000.00 Rp 55,000.00
77 Colok Dubur Rp 16,000.00 Rp 24,000.00 Rp 40,000.00
78 Pasang ETT/ Intubasi Rp 128,000.00 Rp 192,000.00 Rp 320,000.00
79 Pasang Ventilator Rp 128,000.00 Rp 192,000.00 Rp 320,000.00
80 Vena Sectie Rp 128,000.00 Rp 192,000.00 Rp 320,000.00
81 WSD (Water Seal Drainage) Rp 128,000.00 Rp 192,000.00 Rp 320,000.00

Persalinan fisiologis oleh Bidan Rp 386,000.00 Rp 579,000.00 Rp 965,000.00

Persalinan fisiologis oleh Dokter Rp 540,000.00 Rp 810,000.00 Rp 1,350,000.00
Persalinan Patologis oleh Dokter Rp 630,000.00 Rp 945,000.00 Rp 1,575,000.00

Rp -
1 Clisma Pada Letak Rendah Rp 22,000.00 Rp 33,000.00 Rp 55,000.00
2 Pasang/ Lepas IUD Rp 22,000.00 Rp 33,000.00 Rp 55,000.00
3 Pasang/ angkat Tampon Vagina Rp 22,000.00 Rp 33,000.00 Rp 55,000.00
4 Blue Light Terapi Rp 27,400.00 Rp 41,100.00 Rp 68,500.00
 5 Foto Terapi Rp 27,400.00 Rp 41,100.00 Rp 68,500.00
6 Pasang/ Angkat Susuk KB Rp 27,400.00 Rp 41,100.00 Rp 68,500.00
7 Pemakaian CPEP Rp 27,400.00 Rp 41,100.00 Rp 68,500.00
8 Tindakan dengan Blood Warmer Rp 27,400.00 Rp 41,100.00 Rp 68,500.00
9 Wing Needle/ IV line Rp 27,400.00 Rp 41,100.00 Rp 68,500.00
10 CTG Rp 74,400.00 Rp 111,600.00 Rp 186,000.00
11 Kemoterapi Rp 74,400.00 Rp 111,600.00 Rp 186,000.00
12 Pasang CPEP Rp 74,400.00 Rp 111,600.00 Rp 186,000.00
13 Umbilical Infus Rp 74,400.00 Rp 111,600.00 Rp 186,000.00
14 Manual Plasenta Rp 550,000.00 Rp 825,000.00 Rp 1,375,000.00
15 Resusitasi Volume Cairan Rp 74,400.00 Rp 111,600.00 Rp 186,000.00
16 USG Kebidanan Rp 22,000.00 Rp 33,000.00 Rp 55,000.00
17 Perawatan Kolostomi Rp 32,000.00 Rp 48,000.00 Rp 80,000.00

1 USG Kebidanan 4D
2 Inspekulo
3 ANC (Antenatal Care)
4 Manual Plasenta oleh Bidan
5 Perawatan Bayi Baru Lahir
6 Resusitasi Neonatus
7 Imunisasi
8 Memandikan Bayi
9 Perawatan tali pusat
10 Pengukuran Antropometri Pada Bayi
11 Pemeriksaan Swab Vagina
12 Induksi Persalinan
13 Pemberian makanan melalui NGT
14 Pemberian asi/ pasi melalui OGT
15 Transfusi Albumin
16 Tindik Bayi
17 Pelepasan OGT
18 Pemberian Obat Pervaginam
19 USG Transvaginal
20 Douching Vagina
21 Perawatan bayi dengan metode kangguru
22 Pijat Oksitosin
23 Perawatan Payudara
24 Asemen Kebidanan
25 Persalinan patologis oleh bidan
 Jenis Tindakan Kebidanan Jasa Pelayanan Jasa Sarana
Ganti Balutan / angkat Jahitan ( 1-5 Jahitan) Rp 22,000.00 Rp 33,000.00
Ganti Baluta luka Rp 22,000.00 Rp 33,000.00
Oxygen Comsumption (Kanule) Rp 22,000.00 Rp 33,000.00
Oxygen Comsumption (Masker) Rp 22,000.00 Rp 33,000.00
Oxygen Comsumption (Nr/Rm) Rp 22,000.00 Rp 33,000.00
Pasang / Angkat IUD Rp 22,000.00 Rp 33,000.00

SkinTest Rp 22,000.00 Rp 33,000.00

Pemakaian Infusion Pum Rp 27,400.00 Rp 41,100.00
pemberian obat dripp Rp 16,000.00 Rp 24,000.00
pemberian obat per oral Rp 16,000.00 Rp 24,000.00
pemberian obat per rectal Rp 16,000.00 Rp 24,000.00
pemberian obat topikal Rp 16,000.00 Rp 24,000.00

oksigen 1-3 L/jam Rp 16,000.00 Rp 24,000.00

oksigen 4-6 L/jam Rp 16,000.00 Rp 24,000.00

Oksigen 7-8L/jam Rp 32,000.00 Rp 48,000.00
oksigen 9-11 L/jam Rp 32,000.00 Rp 48,000.00
pemakaian dopler Rp 16,000.00 Rp 24,000.00
vital sigh Rp 16,000.00 Rp 24,000.00
EKG Rp 32,000.00 Rp 48,000.00
Tindakan dengan Infant Warmer Rp 27,400.00 Rp 41,100.00
 Jumlah
Rp 55,000.00
Rp 55,000.00
Rp 55,000.00
Rp 55,000.00
Rp 55,000.00
Rp 55,000.00

Rp 55,000.00
Rp 68,500.00
Rp 40,000.00
Rp 40,000.00
Rp 40,000.00
Rp 40,000.00

Rp 40,000.00

Rp 40,000.00
Rp 80,000.00
Rp 80,000.00
Rp 40,000.00
Rp 40,000.00
Rp 80,000.00
Rp 68,500.00
 Daftar Jenis Tindakan Ranap Kebidanan
NO Jenis Tindakan Ranap Kebidanan Jasa Pelayanan Jasa Sarana
1 Ganti Balutan / angkat Jahitan ( 1-5 Jahitan) Rp 22,000.00 Rp 33,000.00
2 Ganti Baluta luka Rp 22,000.00 Rp 33,000.00
3 Oxygen Comsumption (Kanule) Rp 22,000.00 Rp 33,000.00
4 Oxygen Comsumption (Masker) Rp 22,000.00 Rp 33,000.00
5 Oxygen Comsumption (Nr/Rm) Rp 22,000.00 Rp 33,000.00
Pasang / Angkat IUD Rp 22,000.00 Rp 33,000.00
Pasang / Angkat Tampon Vagina Rp 22,000.00 Rp 33,000.00
6 Pasang Pulse Oxymetri Rp 22,000.00 Rp 33,000.00
7 Pemakaian Bedside Monitor & Pulse Oxymetri Rp 22,000.00 Rp 33,000.00
8 SkinTest Rp 22,000.00 Rp 33,000.00
9 Pemakaian Infusion Pum Rp 27,400.00 Rp 41,100.00
10 pemberian obat dripp Rp 16,000.00 Rp 24,000.00
11 pemberian obat per oral Rp 16,000.00 Rp 24,000.00
12 pemberian obat per rectal Rp 16,000.00 Rp 24,000.00
13 pemberian obat topikal Rp 16,000.00 Rp 24,000.00
14 oksigen 1-3 L/jam Rp 16,000.00 Rp 24,000.00
15 oksigen 4-6 L/jam Rp 16,000.00 Rp 24,000.00
16 Oksigen 7-8L/jam Rp 32,000.00 Rp 48,000.00
17 oksigen 9-11 L/jam Rp 32,000.00 Rp 48,000.00
18 pemakaian dopler Rp 16,000.00 Rp 24,000.00
19 vital sigh Rp 16,000.00 Rp 24,000.00
20 EKG Rp 32,000.00 Rp 48,000.00
21 Tindakan dengan Infant Warmer Rp 27,400.00 Rp 41,100.00
22 CTG Kebidanan Rp 74,400.00 Rp 111,600.00
23 Inkubator Rp 74,400.00 Rp 111,600.00
 Jumlah
Rp 55,000.00
Rp 55,000.00
Rp 55,000.00
Rp 55,000.00
Rp 55,000.00
Rp 55,000.00
Rp 55,000.00
Rp 55,000.00
Rp 55,000.00
Rp 55,000.00
Rp 68,500.00
Rp 40,000.00
Rp 40,000.00
Rp 40,000.00
Rp 40,000.00
Rp 40,000.00
Rp 40,000.00
Rp 80,000.00
Rp 80,000.00
Rp 40,000.00
Rp 40,000.00
Rp 80,000.00
Rp 68,500.00
Rp 186,000.00
Rp 186,000.00
Clisma Pada Letak Rp 22,000.00 Rp 33,000.00 Rp 55,000.00
Pemakaian CPEP Rp 27,400.00 Rp 41,100.00 Rp 68,500.00
Wing Needle/ IV lin Rp 27,400.00 Rp 41,100.00 Rp 68,500.00
CTG Rp 74,400.00 Rp 111,600.00 Rp 186,000.00
Pasang CPEP Rp 74,400.00 Rp 111,600.00 Rp 186,000.00
Umbilical Infus Rp 74,400.00 Rp 111,600.00 Rp 186,000.00
Manual Plasenta Rp 550,000.00 Rp 825,000.00 Rp 1,375,000.00
Resusitasi Volume C Rp 74,400.00 Rp 111,600.00 Rp 186,000.00
USG Kebidanan Rp 22,000.00 Rp 33,000.00 Rp 55,000.00

Inspekulo
ANC (Antenatal Care)
Manual Plasenta oleh Bidan
Perawatan Bayi Baru Lahir
Resusitasi Neonatus
Imunisasi
Perawatan tali pusat
Pengukuran Antropometri Pada Bayi
Pemeriksaan Swab Vagina
Tindik Bayi
Pemberian Obat Pervaginam
Douching Vagina
Asemen Kebidanan
Persalinan patologis oleh bidan