Tarif_tindakan Umum Revisi 2015

7/25/2019 Tarif_tindakan Umum Revisi 2015

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322419149.xls Page 1

1 Injeksi

No Bahan Jumlah Harga (Rp) Unit ost (Rp)

1 !puit 3 "" 1 #uah $%& 1'1%&2 apas 1 gr $%

3 l*ohol 1 "" 2%

4 Nee+le 1 #uah 3&&

2 Skin test


1 !puit 3 "" 1 #uah $%& 1'1%&

2 apas 1 gr $%

3 l*ohol 1 "" 2%

4 Nee+le 1 #uah 3&&

3 Pasang infus


1 ##o"ath 1 #uah ,'&&& 24'$4%

2 -nus set 1 #uah 4'%&&

3 airan inus 1 #uah 4',2&

4 assa % #uah ,%&% H/paix %& "m2 0&&

0 Betha+ine 2 "" 1&&

$ l*ohol 2 "" %&

, apas 1 gr $%

9 Hans"oon steril 1 pasang %'2%&

1& as*er 1 #uah %&&

4 Pelepasan infus


1 apas 1 gr $% 42%

2 l*ohol 2 "" %&

3 hipaix 2% "m2 3&&

5 Perbaikan infus


1 !puit 3 "" 1 #uah $%& 3'$2%

2 apas 1 gr $%3 l*ohol 2 "" %&


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322419149.xls Page 2

7 Pelepasan kateterNo Bahan Jumlah Harga (Rp) Unit ost (Rp)

1 !puit 1& "" 1 #uah 1'%&& $',%&


3 *assa % #uah ,%&

4 #eta+ine % "" 2%&

8 Lavement


1 6l/"erin 1&& "" 0'3&& 12'&%&

2 Hans"oen steril 1 pasang %'2%&

3 mas*er 1 #uah %&&

9 esusitasi

No Bia/a Bahan Jumlah Harga (Rp) Unit ost (Rp)

1 7*sigen 3l8menit 1 am 2'3%& %'&%&

2 a+renalin 1 ampul 4%&

3 !ulas atropin 1 ampul %&&4 spuit 3 "" 2 #uah 1'%&&

% *apas 2 gr 1%&

0 al*ohol 4 "" 1&&

1! Pemasangan "ksigen


1 nasal *anul 1 #uah 13'&&& 14'&&&

2 ua+est %& "" 1'&&&

11 #ksigenasi


1 7*sigen 3 l8menit 1 am 2'3%& 2'3%&

12 Pasang $%&


1 N6 1#uah 1%'&&& 2&'4&&

2 Jell/ % gr 2'4&&3 Plester 1% "m 1'%&&


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322419149.xls Page 3


1 ;entolin 1 #uah 9'&&& 9',&&

2 Nal 2 "" %&3 !puit 3 "" 1 #uah $%&

16 *e+ikasi luka


1 assa 1& #uah 1'$&& $'4%&

2 Betha+ine 1& "" %&&


17 ,ebri+emen se+er(ana


1 Nal 2%& "" 2'%&& 23'%2%

2 assa 3& #uah %'1&&

3 H/paix 2& "m 2 3'&&&

4 Betha+ine 2& "" 1'&&&

% hi+rogen pero*si+a 1& "" 42%

0 Hans"oon steril 2 pasang 1&'%&&

$ mas*er 2 #uah 1'&&&

18 ,ebri+emen k"mpleks


1 Nal %&& "" %'&&& 30'%%&

2 assa 0& #uah 1&'2&&

3 H/paix 4& "m 0'&&&

4 Betha+ine %& "" 2'%&&

% hi+rogen pero*si+a 2& "" ,%&

0 Hans"oon steril 2 pasang 1&'%&&

$ mas*er 2 #uah 1'&&&

, ri:anol 1&& "" %&&

19 -e'ting 1 sampai 5


1 Jarum ahit +an #enang $& "m 1 pa*et ,'9&& 34'12%

2 Betha+ine %& "" 2'%&&

3 *assa steril 2& #uah 3'4&&4 Nal 2%& "" 2'%&&


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322419149.xls Page 4

0 H/paix 2& "m2 3'&&&

$


5/10

322419149.xls Page %

R-


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322419149.xls Page 0

29 Luka bakar +ibaa( 1! tanpa k"mplikasiNo Bahan Jumlah Harga (Rp) Unit ost (Rp)

1 Nal 2%& "" 2'%&& 23'0%&

2 assa 2& #uah 3'4&&

3 plester %& "m %'&&&

4 Ri:anol 3&& "" 1'%&&

% =al lu*a #a*ar (#iopla"enton) 3& gr 0'&&&


3! Luka bakar +iatas 1! tanpa k"mplikasi


1 Nal %&& "" %'&&& 4%'4%&

2 assa 0& #uah 1&'2&&

3 plester 1&& "m 1&'&&&

4 Ri:anol 0&& "" 3'&&&

% =al lu*a #a*ar 0& gr 12'&&&0 Hans"oon steril 1 pasang %'2%&

31 tirpasi *in"r Surger


1 Jarum ahit +an #enang $& "m 1 pa*et ,'9&& 3$'9&&

2 Betha+ine 1&& "" %'&&&

3 *assa steril 2& #uah 3'4&&

4 Nal 2%& "" 2'%&&

% !oratule 2& "m2 %&&

0 H/paix 2& "m2 3'&&&

$


7/10

322419149.xls Page $

1 !puit 3 "" 1 #uah $%& $%',%&

2 apas 1 gr $%

3 l*ohol 1 "" 2%4 ! 1 ampul $%'&&&

34 kstraksi '"rpus alineum mata


1 Nal 1&& "" 1'&&& $'$&&

2 !puit 1& "" 1 #uah 1'%&&

3 *assa 1& #uah 1'$&&

4 panto*ain 1 "" 3'%&&

35 -"r+e"lum


1 panto*ain 1 "" 3'%&& $'&&&

2 nee+le 1 #uah 3&&

3 salep anti#ioti* 1 tu#e 1'%&&4 *assa 1& #uah 1'$&&

36 &"n"metri


1 panto*ain 1 "" 3'%&& 3'%&&

37 erumen Pr"p


1 spuit 1& "" 1 #uah 1'%&& 3'2%&

2 Nal %& "" %&&

3 *ar#ogliserin 2 "" 4&&

4 *assa % #uah ,%&

38 "rpus /lienum &-&


1 *assa 1& #uah 1'$&& 4'2&&

2 Nal 1&& "" 1'&&&3 !puit 1& "" 1 #uah 1'%&&


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N7 J>N-! P>R? (Rp) R!P! (Rp) 7R7 (Rp)

1 -ne*si 1'&&& 2'&&&

2 s*in test 2'&&&

3 Pasang inus %'&&& 3$'%&& 1&'&&&

4 pelepasan inus 2'&&&

% per#ai*an inus 1'&&&

0 Pasang *ateter %'&&& 1$'%&& 1&'&&&

$ pelepasan *ateter %'&&&

, xtirpasi (inor !urger/ ) 2%'&&& 31&'&&& %&'&&&

3& *trasi *u*u %'&&& 1$'%&& 1&'&&&

33 ! 2'&&&

34 Rera*si %'&&& 1$'%&& 1%'&&&

3% >*stra*si "orpus alineum mata %'&&& 1$%'&&& 1&'&&&

30 Hor+eolum %'&&& 1$%'&&& 1&'&&&3$ onometri %'&&& 1$'%&& 1&'&&&


9/10

322419149.xls

$# :$IS PL/;/$/$

/$,I$%

p PL/;/$/$:/S/ SPS

&/I= P


10/10

322419149.xls

$# :$IS PL/;/$/$

/$,I$%

p PL/;/$/$ :/S/ SPS &/I= P*stra*si "orpus alineum mata $'$&& 2&'&&& 2$'$&& 1$%'&&& %3'4&& 2,'23&

30 Hor+eolum $'&&& 3&'&&& 3$'&&& 1$%'&&& 99'&%& 2$'2$&

3$ onometri 3'%&& 1&'&&& 13'%&& 1$'%&&

3, erumen Prop 3'2%& 1&'&&& 13'2%& 1$'%&& 19'1&& 1$'3$&

39 orpus lienum H 4'2&& 1%'&&& 19'2&& 1$'%&& 10'4&& 19'23&

4& Pasang spal* 30'1&& %'&&& 41'1&&

41 6anti ;er#an ,'%&& 2'&&& 1&'%&& $'&&& 14'41&

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Tarif_tindakan Umum Revisi 2015