Tindakan Rawat Inap Fix

8/16/2019 Tindakan Rawat Inap Fix

1/60

UNIT COST

RUANG PERAWA

PERTAMINA HOSPITA

NO. PELAYANAN TARIF EXISTING UNIT COST

1 VVIP Rp 1,150,000 Rp -

2 VIP Rp 800,000 Rp -

3 Kelas I/UTAMA Rp 600,000 Rp -4 Kelas I Rp 450,000 Rp -

5 Kelas II A Rp 250,000 Rp -

6 Kelas II B (KOTAK KECI! Rp 150,000 Rp -

" Kelas III

8 Is#las$ Rp 450,000 Rp -

% ICU Rp 800,000 Rp -


2/60

TAN

CILACAP

MARGIN TARIF SETELAH MARGINKOMPETITOR

20% 30% 40% 20% 30% 40%

Rp - Rp - Rp - Rp - Rp - Rp - Rp 1,000,000

Rp - Rp - Rp - Rp - Rp - Rp - Rp 500,000

Rp - Rp - Rp - Rp - Rp - Rp - Rp 250,000Rp - Rp - Rp - Rp - Rp - Rp - Rp 200,000

Rp - Rp - Rp - Rp - Rp - Rp - Rp 110,000

Rp - Rp - Rp - Rp - Rp - Rp - Rp 150,000

Rp - Rp - Rp - Rp - Rp - Rp - Rp 450,000

Rp - Rp - Rp - Rp - Rp - Rp - Rp 400,000


3/60

TARI& U'UA

Rp 1,100,000

Rp 8"0,000

Rp 685,000Rp 350,000

Rp 200,000

Rp 200,000

Rp 150,000

Rp 400,000

Rp 450,000


4/60

U

TINDAK

PERTAMINA


1 A)$*es P+s$ Rp 200,000 Rp 10,455

2 A)$*es P+s$ C$*# Rp 300,000 Rp 10,455

3 Al#.#l Ba*. Rp 10,000 Rp 1,5114 Aal l$)e$ Rp 40,000 Rp 2%,3"4

5 Aa* a.$*a Rp %0,000 Rp 1%,806

6 BMP Rp 240,000 Rp 32,432

" Bl## ae Rp 50,000 Rp 2,111

8 C++ Pa T$aa Rp 15,000 Rp 3,311

% C+**e C$)$ / ela Rp "5,000 Rp ",3"1

10 C#ss I)$s$ Rp %5,000 Rp 36,"31

11 e7$ee Rp 400,000 Rp 56,656

12 e)+7$*+s Rp 20,000 Rp 34,%26

13 EK 12 ea (Res*$! Rp 40,000 Rp 6,%4%

14 EK M#$*#$ / a$ Rp 132,000 Rp 21,886

15 Espl#as$ C#pal Rp 250,000 Rp 24,55616 Es*epas$ Rp 5"5,000 Rp 31,%"5

1" Ele*#a Pape / EK Rp 3",500 Rp 3,%55

18 E9e Pe +*+ *#*eap$ Rp 121,000 Rp 4,286

1% *#*eap$ Rp 10,000 Rp 2,111

20 a*$ Bal+* I (+a 5-15)! Rp "5,000 Rp 5,882

21 a*$ Bal+* II (+a 16-30)! Rp 150,000 Rp 11,5%%

22 l+)#*es* '*$) Rp 26,000 Rp 10,042

23 I:+s$# P+p / a$ Rp 40,000 Rp 2,111

24 I.alas$ (Tapa O7a*! Rp 3",500 Rp 21,"52

25 I*+7as$ Rp 200,000 Rp 153,"5"

26 Res+s$*as$ Rp 210,000 Rp 65,381

2" a;ee* '*aa Rp 40,000 Rp 8,%6828 +7al P+s$ Rp 165,000 Rp 31,384

2% Maa 'p#el$ Rp 35,000 Rp 2%,"1"

30 Peasaa #


5/60

IT COST

N RAWAT INAP

HOSPITAL CILACAP

MARGIN TARIF SETELAH MARGIN KET

20% 30% 40% 20% 30% 40%

Rp 2,0%1 Rp 3,136 Rp 4,182 Rp 12,545 Rp 13,5%1 Rp 14,636

Rp 2,0%1 Rp 3,136 Rp 4,182 Rp 12,545 Rp 13,5%1 Rp 14,636

Rp 302 Rp 453 Rp 604 Rp 1,813 Rp 1,%64 Rp 2,115Rp 5,8"5 Rp 8,812 Rp 11,"50 Rp 35,24% Rp 38,186 Rp 41,124

Rp 3,%61 Rp 5,%42 Rp ",%22 Rp 23,"6" Rp 25,"48 Rp 2","28

Rp 6,486 Rp %,"30 Rp 12,%"3 Rp 38,%1% Rp 42,162 Rp 45,405

Rp 422 Rp 633 Rp 844 Rp 2,533 Rp 2,"44 Rp 2,%55

Rp 662 Rp %%3 Rp 1,324 Rp 3,%"3 Rp 4,304 Rp 4,635

Rp 1,4"4 Rp 2,211 Rp 2,%48 Rp 8,845 Rp %,582 Rp 10,31%

Rp ",346 Rp 11,01% Rp 14,6%2 Rp 44,0"" Rp 4","50 Rp 51,423

Rp 11,331 Rp 16,%%" Rp 22,662 Rp 6",%8" Rp "3,653 Rp "%,318

Rp 6,%85 Rp 10,4"8 Rp 13,%"1 Rp 41,%12 Rp 45,404 Rp 48,8%"

Rp 1,3%0 Rp 2,085 Rp 2,"80 Rp 8,33% Rp %,034 Rp %,"2%

Rp 4,3"" Rp 6,566 Rp 8,"54 Rp 26,263 Rp 28,452 Rp 30,640

Rp 4,%11 Rp ",36" Rp %,822 Rp 2%,46" Rp 31,%22 Rp 34,3"8Rp 6,3%5 Rp %,5%3 Rp 12,"%0 Rp 38,3"0 Rp 41,568 Rp 44,"65

Rp "%1 Rp 1,18" Rp 1,582 Rp 4,"46 Rp 5,142 Rp 5,53"

Rp 85" Rp 1,286 Rp 1,"14 Rp 5,143 Rp 5,5"1 Rp 6,000

Rp 422 Rp 633 Rp 844 Rp 2,533 Rp 2,"44 Rp 2,%55

Rp 1,1"6 Rp 1,"65 Rp 2,353 Rp ",058 Rp ",646 Rp 8,235

Rp 2,320 Rp 3,480 Rp 4,640 Rp 13,%1% Rp 15,0"% Rp 16,23%

Rp 2,008 Rp 3,012 Rp 4,01" Rp 12,050 Rp 13,054 Rp 14,058

Rp 422 Rp 633 Rp 844 Rp 2,533 Rp 2,"44 Rp 2,%55

Rp 4,350 Rp 6,526 Rp 8,"01 Rp 26,102 Rp 28,2"" Rp 30,453

Rp 30,"51 Rp 46,12" Rp 61,503 Rp 184,508 Rp 1%%,884 Rp 215,260

Rp 13,0"6 Rp 1%,614 Rp 26,152 Rp "8,45" Rp 84,%%5 Rp %1,533

Rp 1,"%4 Rp 2,6%0 Rp 3,58" Rp 10,"62 Rp 11,658 Rp 12,555Rp 6,2"" Rp %,415 Rp 12,554 Rp 3",661 Rp 40,"%% Rp 43,%3"

Rp 5,%43 Rp 8,%15 Rp 11,88" Rp 35,660 Rp 38,632 Rp 41,604

Rp 13,84" Rp 20,""0 Rp 2",6%4 Rp 83,082 Rp %0,005 Rp %6,%2%

Rp 8,683 Rp 13,025 Rp 1",366 Rp 52,0%8 Rp 56,440 Rp 60,"81

Rp 1,411 Rp 2,11" Rp 2,823 Rp 8,468 Rp %,1"4 Rp %,880

Rp 4,584 Rp 6,8"5 Rp %,16" Rp 2",502 Rp 2%,"%4 Rp 32,086

Rp %,514 Rp 14,2"1 Rp 1%,02" Rp 5",082 Rp 61,83% Rp 66,5%6

Rp 1,862 Rp 2,"%3 Rp 3,"24 Rp 11,1"3 Rp 12,104 Rp 13,035

Rp 13,582 Rp 20,3"2 Rp 2",163 Rp 81,4%0 Rp 88,281 Rp %5,0"1

Rp 34,51" Rp 51,""6 Rp 6%,035 Rp 20",105 Rp 224,363 Rp 241,622

Rp 3,62% Rp 5,444 Rp ",258 Rp 21,""5 Rp 23,5%0 Rp 25,404

Rp 30,563 Rp 45,845 Rp 61,126 Rp 183,3"% Rp 1%8,660 Rp 213,%42Rp 85" Rp 1,286 Rp 1,"14 Rp 5,143 Rp 5,5"1 Rp 6,000


6/60


7/60

USULAN TARIF

TINDAKAN RAWAT INAPPERTAMINA HOSPITAL CILACAP

TARIF SETELAH MARGIN JASAASKEP

SEWA

40% 20% 30% 40% DR ALAT

Rp 4,182 Rp 12,545 Rp 13,5%1 Rp 14,636 Rp 125,000 Rp 40,000

Rp 4,182 Rp 12,545 Rp 13,5%1 Rp 14,636 Rp 150,000 Rp 53,000

Rp 604 Rp 1,813 Rp 1,%64 Rp 2,115 Rp - Rp ",500

Rp 11,"50 Rp 35,24% Rp 38,186 Rp 41,124 Rp - Rp 1%,800

Rp ",%22 Rp 23,"6" Rp 25,"48 Rp 2","28 Rp 35,000 Rp 1",500

Rp 12,%"3 Rp 38,%1% Rp 42,162 Rp 45,405 Rp %0,000 Rp 18,000

Rp 844 Rp 2,533 Rp 2,"44 Rp 2,%55 Rp - Rp 20,000

Rp 1,324 Rp 3,%"3 Rp 4,304 Rp 4,635 Rp - Rp ",500

Rp 2,%48 Rp 8,845 Rp %,582 Rp 10,31% Rp 30,000 Rp 15,000

Rp 14,6%2 Rp 44,0"" Rp 4","50 Rp 51,423 Rp 42,000 Rp 21,000

Rp 22,662 Rp 6",%8" Rp "3,653 Rp "%,318 Rp %0,000 Rp 45,000

Rp 13,%"1 Rp 41,%12 Rp 45,404 Rp 48,8%" Rp - Rp 10,000

Rp 11,118 Rp 33,355 Rp 36,135 Rp 38,%14 Rp 15,000 Rp 10,000

Rp 8,"54 Rp 26,263 Rp 28,452 Rp 30,640 Rp - Rp 35,000

Rp %,822 Rp 2%,46" Rp 31,%22 Rp 34,3"8 Rp 120,000 Rp 60,000

Rp 12,"%0 Rp 38,3"0 Rp 41,568 Rp 44,"65 Rp 125,000 Rp 62,500

Rp 1,582 Rp 4,"46 Rp 5,142 Rp 5,53" Rp - Rp -

Rp 1,"14 Rp 5,143 Rp 5,5"1 Rp 6,000 Rp - Rp 5,000

Rp 844 Rp 2,533 Rp 2,"44 Rp 2,%55 Rp - Rp 12,500

Rp 2,353 Rp ",058 Rp ",646 Rp 8,235 Rp 30,000 Rp 10,000

Rp 4,640 Rp 13,%1% Rp 15,0"% Rp 16,23% Rp 40,000 Rp 20,000

Rp 4,01" Rp 12,050 Rp 13,054 Rp 14,058 Rp - Rp 6,240

Rp 844 Rp 2,533 Rp 2,"44 Rp 2,%55 Rp - Rp 25,000

Rp 8,"01 Rp 26,102 Rp 28,2"" Rp 30,453 Rp - Rp 10,000

Rp 61,503 Rp 184,508 Rp 1%%,884 Rp 215,260 Rp 36,000 Rp -

Rp 26,152 Rp "8,45" Rp 84,%%5 Rp %1,533 Rp 3",800 Rp 25,000

Rp 3,58" Rp 10,"62 Rp 11,658 Rp 12,555 Rp - Rp 15,000

Rp 12,554 Rp 3",661 Rp 40,"%% Rp 43,%3" Rp %0,000 Rp 18,000

Rp 11,88" Rp 35,660 Rp 38,632 Rp 41,604 Rp - Rp 25,000

Rp 2",6%4 Rp 83,082 Rp %0,005 Rp %6,%2% Rp - Rp 14,400

Rp 1",366 Rp 52,0%8 Rp 56,440 Rp 60,"81 Rp - Rp %,600

Rp 2,823 Rp 8,468 Rp %,1"4 Rp %,880 Rp - Rp 3,600

Rp %,16" Rp 2",502 Rp 2%,"%4 Rp 32,086 Rp - Rp 8,400

Rp 1%,02" Rp 5",082 Rp 61,83% Rp 66,5%6 Rp - Rp 100,000

Rp 3,"24 Rp 11,1"3 Rp 12,104 Rp 13,035 Rp - Rp 10,000

Rp 2",163 Rp 81,4%0 Rp 88,281 Rp %5,0"1 Rp - Rp 8,000

Rp 6%,035 Rp 20",105 Rp 224,363 Rp 241,622 Rp 250,000 Rp 65,000

Rp ",258 Rp 21,""5 Rp 23,5%0 Rp 25,404 Rp - Rp 25,000

Rp 61,126 Rp 183,3"% Rp 1%8,660 Rp 213,%42 Rp 360,000 Rp 144,000

Rp 1,"14 Rp 5,143 Rp 5,5"1 Rp 6,000 Rp - Rp 200,000 Rp 150,333


8/60


9/60

OBJECT : ACITES PUNKSI

COST POOL : INSTALASI RAWAT INAP

ACTIITY DRIER RESOURCESCOST DRIE

KEBUTUHANHA

ITEM SATUAN KECIL SATUAN

ACITES PUNKSI BIAYA MEDIS

BP

A7#)a*. # 18 B p)s 0 Rp 3",800

Tas:+s$ 'e* Tea# B+a. 0 Rp 21,420Kassa B+a. 4 Rp 346

Is#pas B+a. 4 Rp 25%

9pa;$@ e7a 10 Rp 21"

e+#plas ) 15 Rp 55

al+;es ae@ p)s 0 Rp 10,800

'p+$* Te+# 10)) p)s 1 Rp 1,806

'p+$* Te+# 3)) p)s 1 Rp 1,133

Mase $ap# p)s 2 Rp %11

Be*a$ )) 3 Rp %2

OBAT

$#)a$ Ap 0 Rp 1,"68

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : ACITES PUNKSI CITO



KEBUTUHANHA


ACITES PUNKSI CITO BIAYA MEDIS

BP

Tas:+s$ 'e* B+a. 0 Rp 21,420

Kassa B+a. 4 Rp 346


9pa;$@ e7a 10 Rp 21"

e+)#plas ) 15 Rp 55

al+;es ae@ B+a. 0 Rp 10,800

Mase $ap# B+a. 2 Rp %11

'p+$* Te+# 10)) p)s 1 Rp 1,806

'p+$* Te+# 3)) p)s 1 Rp 1,133

Be*a$ )) 3 Rp %2

OBAT

$#)a$ Ap 0 Rp 1,"68

A'A MEIK

asa #*e

Asep

TOTAL TARIF


10/60


11/60

asa #*e

Asep

TOTAL TARIF

OBJECT : BMP



KEBUTUHANHA


BMP BIAYA MEDIS

BP

al#;e ae@ B+a. 2 Rp 10,800


9pa;$@ e7a 10 Rp 21"

Be*a$ )) 5 Rp %2

Kassa e7a 5 Rp 346

'p+$* Te+# 10)) p)s 2 Rp 1,806

Is#pas p)s 4 Rp 25%

OBAT

$#)a$ Ap 0 Rp 1,"68

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : BLOOD WARMER



KEBUTUHANHA


BLOOD WARMER BIAYA MEDIS

BP

al#;e B+a. 2 Rp 600


OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : CUKUR PRA TINDAKAN



KEBUTUHANHA


CUKUR PRA TINDAKAN BIAYA MEDIS

BP

al#;e B+a. 2 Rp 600


'$le* #al B+a. 1 Rp 1,200

OBAT


12/60

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : CUTTER CINCIN ! GELANG



KEBUTUHANHA


CUTTER CINCIN ! GELAN BIAYA MEDIS

BP

al#;e p)s 2 Rp 600


a)l )) 100 Rp 18

assa le7a 10 Rp 346

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : CROSS INCISI



KEBUTUHANHA


CROSS INCISI BIAYA MEDIS

BP

al#;e ae@ pasa 1 Rp 15,840

.as)## p)s 2 Rp 600


Be*a$ )) 10 Rp %2

apas a)a 7+a. 2 Rp %5

assa l7 20 Rp 346

a)l )) 100 Rp 26

s+e9 7lae 7+a. 1 Rp 2,250

.epa;$) ) 5 Rp 105

sp+$* 1 )) 7+a. 1 Rp 2,42%

$#)a$ Ap 2 Rp 1,4"3

OBAT

- Ap 0 Rp 1,"68

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : DEBRIDEMEN



KEBUTUHANHA



13/60

BP

al#;e ae@ p)s 1 Rp 12,3"5

as)## p)s 2 Rp 600


Kassa l7 40 Rp 346

assa a)a 7+a. 4 Rp %5

Be*a$ )) 100 Rp %2

aC )) 500 Rp 38

OBAT

Me*# Ta7le* 0 Rp 152

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : DECUBITUS


ACTIITY DRIER RESOURCES COST DRIE KEBUTUHAN HARITEM SATUAN KECIL SATUAN

DECUBITUS BIAYA MEDIS

BP

al#;e ae@ p)s 2 Rp 10,800


Plas*e ) 20 Rp 21"

Be*a$ )) 50 Rp %2

Al.#.#l )) 50 Rp 51

OBAT

Me*# Ta7le* 0 Rp 152

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : EKG "2 LEAD #RESTING$



KEBUTUHANHAR


EKG "2 LEAD #RESTING$ BIAYA MEDIS

BP


al#;e B+a. 2 Rp 600


e*as EK ) 60 Rp "2

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF


14/60



KEBUTUHANHA


MONITOR EKG BIAYA MEDIS

BP

Ele*#e p)s 5 Rp 3,6%6

as)## p)s 2 Rp 600

Is#pas p)s 5 Rp 25%

Mase p)s 1 Rp %11

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : EKSPLORASI CORPAL



KEBUTUHANHA


EKSPLORASI CORPAL BIAYA MEDIS

BP



.as)## p)s 2 Rp 600

assa s*e$l l7* 5 Rp 200

sp+$* 1 )) 7+a. 1 Rp 2,42%

sp+$* 10 )) 7+a. 1 Rp 1,806

7e*.a$ )) 5 Rp %2

OBAT

$#)a$ Ap Rp 1,"68

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : EKSTERPASI SIMPEL # TANPA JAHITAN $



KEBUTUHANHA


EKSTERPASI SIMPEL # TABIAYA MEDIS

BP



Plas*e ) 10 Rp 21"

Al.#.#l )) 50 Rp 51

Be*a$ )) 50 Rp %2

aC )) 50 Rp 18

'p+$* 1 )) p)s 1 Rp 2,42%

Kapas Ka)a p)s 20 Rp %5

K l 7 2 R 346


15/60

OBAT

'alp e*a$)$ p)s 0 Rp 1,852

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : ELEKTRODA EKG # " &' $



KEBUTUHANHA


BIAYA MEDIS

BP

Ele*#a p)s 1 Rp 3,6%6


OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : EYE PED UNTUK FOTOTERAPI



KEBUTUHANHA


EYE PED UNTUK FOTOTE BIAYA MEDIS

BP

al#;e p)s 2 Rp 600

Mase$ap# p)s 1 Rp %11

Plas*e ) 10 Rp 21"

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : FOTOTERAPI



KEBUTUHANHA


FOTOTERAPI BIAYA MEDIS

BP


al#;e p)s 2 Rp 600

OBAT

A'A MEIK

asa #*e

Asep

ELEKTRODA EKG # "&' $


16/60

OBJECT : GANTI BALUT STANDAR # LUKA BERSIH ( 4 &) $



KEBUTUHANHA


GANTI BALUT STANDAR BIAYA MEDIS

BP

Kassa '*e$l e7a 2 Rp 346

aC )) 100 Rp 18

M$)#p+e ) " Rp 4"

al#;e p)s 2 Rp 600


Kapas a)a 7. 10 Rp %5

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : GANTI BALUT SEDANG # LUKA ( "0 &) *+,-, E/'*1 $



KEBUTUHANHA


BIAYA MEDIS

BP

Kassa '*e$l e7a 4 Rp 346

aC )) 200 Rp 18

9pa@ ) 12 Rp 21"


al#;e p)s 2 Rp 600

Kapas Ka)a 7. 20 Rp %5

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : GLUCOTES



KEBUTUHANHA


GLUCOTES BIAYA MEDIS

BP


al#;e p)s 2 Rp 600

'*$) p)s 1 Rp ",500

ele ACCU-C.e p)s 1 Rp 1"2

Is#pas p)s 1 Rp 25%

GANTI BALUT SEDANG #LUKA ( "0 &) *+,-,E/'*1 $


17/60

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : INFUSION PUMP ! HARI



KEBUTUHANHA


INFUSION PUMP ! HARI BIAYA MEDIS

BP

al#;e p)s 2 Rp 600


OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : INHALASI #TANPA OBAT$



KEBUTUHANHA


INHALASI #TANPA OBAT$ BIAYA MEDIS

BP

al#;e p)s 2 Rp 600


Mase e7+l$e B+a. Rp "%,200

'p+$* Te+# 5 )) p)s 1 Rp 1,551

Ve*#l$ e7+l$e ap Rp 8,640

Os$e l* 360 50

a)l )) 5 18

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : INTUBASI



KEBUTUHANHA


INTUBASI BIAYA MEDIS

BP

al#;e ae@ B+a. 1 Rp 10,800


E#*a).eal T+7e p)s 1 Rp "6,800

ell9 )) 5 Rp 2,286


18/60

'p+$* *e+# 10)) p)s 1 Rp 1,806

Plas*e ) 20 Rp 21"

as)## p)s 2 Rp 600

C#e)*# O2 p)s 1 Rp 3%,2"0

Ca+l s+)*$# p)s 1 Rp ",200

OBAT

A'A MEIK

asa #*eAsep

TOTAL TARIF

OBJECT : RESUSITASI



KEBUTUHANHAR


RESUSITASI BIAYA MEDIS

BPC#e)*# O2 p)s 1 Rp 3%,2"0

as)## p)s 2 Rp 600

ase p)s 1 Rp %11

#s$e l* 480 Rp 50

OBAT

'A Ap Rp 2,%30

Aeal$ Ap Rp 15,654

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : LAEMENT STANDAR



KEBUTUHANHAR


LAEMENT STANDAR BIAYA MEDIS

BP

al#;e p)s 2 Rp 600


ell9 K-D )) 3 Rp 2,286

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : LUMBAL PUNKSI



KEBUTUHANHAR


LUMBAL PUNKSI BIAYA MEDIS

BP


2 R 10 800


19/60

A77#)a*. 18 p)s 0 Rp 3",800

Tas:+s$ 'e* p)s 0 Rp 21,420

Kassa e7a 4 Rp 346

Is#pas p)s 4 Rp 25%

9pa;$@ e7a 10 Rp 21"

'p+$* Te+# 10)) p)s 1 Rp 1,806

'p+$* Te+# 3)) p)s 1 Rp 1,133

Be*a$ )) 3 Rp %2

Al.#.#l )) 3 Rp 51

OBAT

$#)a$ Ap 0 Rp 1,"68

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : MAAG SPOELING


ACTIITY DRIER RESOURCES

COST DRIE

KEBUTUHAN

HA


MAAG SPOELING BIAYA MEDIS

BP

al#;e p)s 2 Rp 600


'p+$* Te+# 10)) p)s 1 Rp 1,806

U$e Ba p)s 1 Rp ",800

a)ll )) 1000 Rp 18

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : PEMASANGAN DOWER CATHETER



KEBUTUHANHA


PEMASANGAN DOWER C BIAYA MEDIS

BP

C 'es+a$ U+a B+a. 1 Rp 24,6%6as)## ae@ B+a. 1 Rp 15,840

Kassa '*e$l B+a. 4 Rp 346

U$e Ba B+a. 1 Rp ",800


'p+$* Te+# 10)) B+a. 1 Rp 1,806

sp+$* Te+# 5 )) B+a. 1 Rp 1,381

Plas*e ) 10 Rp 21"

K9 K9 )) 5 Rp 2,286

Be*a$ )) 10 Rp %2

Ca$a A+a7$*s/aC )) 50 Rp 18

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : PEMASANGAN INFUS



20/60


KEBUTUHANHA


PEMASANGAN INFUS BIAYA MEDIS

BP

I:+s 'e* Te+# B+a. 0 Rp 20,460

e+# 22 B B+a. 0 Rp 43,313

al#;e p)s 2 Rp 600


Plas*e ) 10 Rp 21"


Teae e7a 1 Rp 38,616

R O*s+a K#l: 0 Rp %,450

*

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : PEMASANGAN SCHORSTEENCOST POOL : INSTALASI RAWAT INAP


KEBUTUHANHA


PEMASANGAN SCHORST BIAYA MEDIS

BP

ell9 K9 )) 1 Rp 2,286

al#;e p)s 2 Rp 600

Kassa e7a 2 Rp 346

A$ )) 200 Rp 14

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : PEMASANGAN NGT


ACTIITY DRIER RESOURCES COST DRIE KEBUTUHAN HAITEM SATUAN KECIL SATUAN

PEMASANGAN NGT BIAYA MEDIS

BP

T p)s 0 Rp 18,648

al#;e p)s 1 Rp 12,3"5

ell9 K-D )) 2 Rp 2,286


9pa;$@ ) 15 Rp 21"

'p+$* Te+# 50)) B+a. 0 Rp 10,214

'p+$* Te+# 10)) B+a. 1 Rp 1,806

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF


21/60

OBJECT : PEMBERIAN KEMOTERAPI



KEBUTUHANHA


BIAYA MEDIS

BP

'p+$* 3 )) p)s 1 Rp 1,133

'p+$* 10 )) p)s 1 Rp 1,806

=a+ # 23 p)s 2 Rp "45

Is#pas p)s 2 Rp 25%

Teae p)s 1 Rp 38,616

asaplas* p)s 2 Rp 302

VeF# # 20 p)s 0 Rp 3",800

I:+s 'e* Ma# p)s 0 Rp 40,560

aCl 500 )) )) 0 Rp 14,8%"

al#;e p)s 4 Rp 600

ase p)s 2 Rp 500

OBAT

Oase*# ap 0 Rp 10,%03

Oepa#l ap 0 Rp 41,"60

Zoladek ap 0 Rp 1,300,000

A'A OKTER

asa #*e

Asep

TOTAL TARIF

OBJECT : SUCTION PUMP ! HARI



KEBUTUHANHA


SUCTION PUMP ! HARI BIAYA MEDIS

BP

al#;e p)s 2 Rp 600


ell9 K-D )) 0 Rp 2,286'+)*$# Ca*.e*e p)s 1 Rp ",200

Pas).#

OBAT

A'A MEIK

asa #*e

Asep

PEMBERIANKEMOTERAPI


22/60

TOTAL TARIF

OBJECT : SYRINGE PUMP ! HARI



KEBUTUHANHA


SYRINGE PUMP ! HARI BIAYA MEDIS

BPal#;e p)s 2 Rp 600


T.ee a9 '*#p C#) Te+ p)s 1 Rp 23,100

E@s*es$# T+7e Te+# p)s 1 Rp 31,332

'p+$* 50 )) p)s 1 Rp 10,214

'p+$* 5 )) p)s 1 Rp 1,151

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : ENASECTIE



KEBUTUHANHA


ENASECTIE BIAYA MEDIS

BP

al#;e ae@ B+a. 1 Rp 10,800

I:+s 'e* Te+# B+a. 1 Rp 20,460


7+a. 1 65,"%0

Be*a$e )) 5 %2

B$s*+$ # 10 7+a. 1 2,"00

Kassa '*e$l le7a 10 346

'p+$* 1 )) 7+a. 1 2,42%

sp+$* 10 )) p)s 1 1,551

VeF# 7+a. 1 3",800

$#)a$ ap 1 1,"68

spale p)s 1 13,200

Mase 7. 1 %11

Kassa R#l 10 ) ) 2 4,845

9pa ) 10 105

OBAT

$#)a$ ap 0 1,"68

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : TINDIK BAYI



KEBUTUHANHA


TINDIK BAYI BIAYA MEDIS

BP

al#;e s*e$l p)s 1 Rp 15,840

Bea C.#$) 2/0


23/60

$le # 23 Te+# p)s 1 Rp "45

Be*a$ )) 5 Rp %2

apas a)a 7. 2 Rp %5

OBAT

A'A MEIK

asa #*e

Asep

TOTAL TARIF

OBJECT : UMBILICAL CATHETER



KEBUTUHANHA


UMBILICAL CATHETER BIAYA MEDIS

BP

Kassa B+a. 20 Rp 346

Be*a$ )) 30 Rp %2

T # 3,5 Te+# p)s 1 Rp 20,400

7+a. 1 65,"%0

'p+$* Te+# 3)) p)s 1 Rp 1,133

'p+$* Te+# 5)) p)s 1 Rp 1,381

I:+s 'e* Te+# p)s 1 Rp 40,560

9pa;$@/e+#plas M$)#p+ 7 10 Rp 21"

al#;e ae@ B+a. 1 Rp 10,800


OBAT

A'A MEIK asa #*e

Asep

TOTAL TARIF

OBJECT : ENTILATOR MOBILE ! HARI



KEBUTUHANHA


BIAYA MEDIS

BP

Bea C.#$) 2/0

ENTILATOR MOBILE !HARI


24/60

as)## p)s 2 Rp

Mase $ap# p)s 1 Rp

Plas*e ) 10 Rp

OBAT

BIAYA NON MEDIS

'ARAA

B$a9a $s*$

PEMEIARAA

B$a9a Peel$.aaa Ba+a

B$a9a Peel$.aaa Me7ele

B$a9a Peel$.aaa ele*#$,ales,saaa la$

B$a9a Kal$7as$

Pe7a$a $:*

Ala* Ve*$la*#

A'A MEIK

asa #*e

Asep

TOTAL TARIF


25/60

GACOST OBJECT

TOTAL

Rp 10,455

Rp -

Rp -Rp 1,382

Rp 1,03"

Rp 2,1"5

Rp 825

Rp -

Rp 1,806

Rp 1,133

Rp 1,822

Rp 2"5

Rp -

Rp -

Rp -

R "04

GACOST OBJECT

TOTAL

Rp 10,455

Rp -

Rp 1,382

Rp 1,03"

Rp 2,1"5

Rp 825

Rp -

Rp 1,822

Rp 1,806

Rp 1,133

Rp 2"5

Rp -

Rp -

Rp -

R "04


26/60


27/60

R "607

GACOST OBJECT

TOTAL

Rp 32,432

Rp 21,600

Rp 1,822

Rp 2,1"5

Rp 45%

Rp 1,"28

Rp 3,612

Rp 1,03"

Rp -

Rp -

Rp -

R 32432

GACOST OBJECT

TOTAL

Rp 2,111

Rp 1,200

Rp %11

Rp -

Rp -

R 2"""

GA COST OBJECTTOTAL

Rp 3,311

Rp 1,200

Rp %11

Rp 1,200


28/60

Rp -

R 33""

GACOST OBJECT

TOTAL

Rp ",3"1

Rp 1,200

Rp %11

Rp 1,800

Rp 3,460

Rp -

Rp -

R 535"

GACOST OBJECT

TOTAL

Rp 36,"31

Rp 15,840

Rp 1,200

Rp %11

Rp %20

Rp 1%0

Rp 6,%20

Rp 2,600

Rp 2,250

Rp 525

Rp 2,42%

Rp 2,%46

Rp -

Rp -

Rp -

R 3753"

GACOST OBJECT

TOTAL


29/60

Rp 56,656

Rp 12,3"5

Rp 1,200

Rp %11

Rp 13,840

Rp 380

Rp %,200

Rp 18,"50

Rp -

Rp -

Rp -

R 777

GACOST OBJECT

TOTAL

Rp 34,%26

Rp 21,600

Rp 1,822

Rp 4,350

Rp 4,5%0

Rp 2,565

Rp -

Rp -

Rp -

R 3427

GACOST OBJECT

TOTAL

Rp 6,%4%

Rp %11

Rp 1,200

Rp 518

Rp 4,320

Rp -

Rp -

R 74


30/60

GACOST OBJECT

TOTAL

Rp 21,886

Rp 18,480

Rp 1,200

Rp 1,2%5Rp %11

Rp -

Rp -

R 2"667

GACOST OBJECT

TOTAL

Rp 24,556

Rp 1,822

Rp 15,840

Rp 1,200

Rp 1,000

Rp 2,42%

Rp 1,806

Rp 45%

Rp -

Rp -

Rp -

R 247

GACOST OBJECT

TOTAL

Rp 31,%"5

Rp 15,840

Rp %11

Rp 2,1"0

Rp 2,550

Rp 4,5%0

Rp 8%4

Rp 2,42%


31/60

Rp -

Rp -

Rp -

R 3"5

GACOST OBJECT

TOTAL

Rp 3,%55

Rp 3,6%6

Rp 25%

Rp -

Rp -

Rp 3,%55

GACOST OBJECT

TOTAL

Rp 4,286

Rp 1,200

Rp %11

Rp 2,1"5

Rp -

Rp -

R 4267

GACOST OBJECT

TOTAL

Rp 2,111

Rp %11

Rp 1,200

Rp -

Rp -


32/60

GACOST OBJECT

TOTAL

Rp 5,882

Rp 6%2

Rp 1,800

Rp 32%

Rp 1,200

Rp %11

Rp %50

Rp -

Rp -

R 662

GA COST OBJECTTOTAL

Rp 11,5%%

Rp 1,384

Rp 3,600

Rp 2,604

Rp %11

Rp 1,200

Rp 1,%00

Rp -

Rp -

R ""

GACOST OBJECT

TOTAL

Rp 10,042

Rp %11

Rp 1,200

Rp ",500

Rp 1"2


33/60

Rp -

Rp -

R "0042

GACOST OBJECT

TOTAL

Rp 2,111

Rp 1,200

Rp %11

Rp -

Rp -

R 2"""

GACOST OBJECT

TOTAL

Rp 21,"52

Rp 1,200

Rp %11

Rp -

Rp 1,551

Rp -

Rp 18,000Rp %0

Rp -

Rp -

R 2"52

GACOST OBJECT

TOTAL

Rp 153,"5"

Rp 10,800

Rp %11

Rp "6 800


34/60

Rp 1,806

Rp 4,340

Rp 1,200

Rp 3%,2"0

Rp ",200

Rp -

Rp -

R "355

GACOST OBJECT

TOTAL

Rp 65,381

Rp 3%,2"0

Rp 1,200

Rp %11

Rp 24,000

Rp -

Rp -

Rp -

Rp -

R 736"

GACOST OBJECT

TOTAL

Rp 8,%68

Rp 1,200

Rp %11

Rp 6,85"

Rp -

Rp -

R 676

GACOST OBJECT

TOTAL

Rp 31,384


35/60

Rp -

Rp -

Rp 1,382

Rp 1,03"

Rp 2,1"5

Rp 1,806

Rp 1,133

Rp 2"5

Rp 154

Rp -

Rp -

Rp -

R 3"364

GA COST OBJECTTOTAL

Rp 2%,"1"

Rp 1,200

Rp %11

Rp 1,806

Rp ",800

Rp 18,000

Rp -

Rp -

R 25"5

GACOST OBJECT

TOTAL

Rp 6%,235

Rp 24,6%6

Rp 15,840

Rp 1,382

Rp ",800

Rp %11

Rp 1,806

Rp 1,381

Rp 2,1"0

Rp 11,42%

Rp %20

Rp %00

Rp -

Rp -

R 723


36/60

GACOST OBJECT

TOTAL

Rp 43,415

Rp -

Rp -

Rp 1,200

Rp %11

Rp 2,1"0

Rp 518

Rp 38,616

Rp -

Rp -

Rp -

R 434"

GACOST OBJECT

TOTAL

Rp ",05"

Rp 2,286

Rp 1,200

Rp 6%1

Rp 2,880

Rp -

Rp -

R 505

GACOST OBJECT

TOTAL

Rp 22,%18

Rp -

Rp 12,3"5

Rp 4,5"1

Rp %11

Rp 3,255

Rp -

Rp 1,806

Rp -

Rp -

R 22"6


37/60

GACOST OBJECT

TOTAL

Rp 4",568

Rp 1,133

Rp 1,806

Rp 1,4%0

Rp 518

Rp 38,616

Rp 605

Rp -

Rp -

Rp -Rp 2,400

Rp 1,000

R 8

Rp -

Rp -

Rp -

Rp -

R 4576

GACOST OBJECT

TOTAL

Rp %,311

Rp 1,200

Rp %11

Rp -

Rp ",200

Rp -

Rp -

Rp -


38/60

R 3""

GACOST OBJECT

TOTAL

Rp 6",%08Rp 1,200

Rp %11

Rp 23,100

Rp 31,332

Rp 10,214

Rp 1,151

Rp -

Rp -

R 7506

GACOST OBJECT

TOTAL

Rp 1"2,58"

Rp 10,800

Rp 20,460

Rp 518

Rp 65,"%0

Rp 460

Rp 2,"00

Rp 3,460

Rp 2,42%

Rp 1,551

Rp 3",800

Rp 1,"68

Rp 13,200

Rp %11

Rp %,6%0

Rp 1,050

Rp -

Rp -

Rp -

R "5265

GACOST OBJECT

TOTAL

Rp 18,146


39/60

Rp "45

Rp 460

Rp 1%0

Rp -

Rp -

R "6"47

GACOST OBJECT

TOTAL

Rp 152,816

Rp 6,%12

Rp 2,"54Rp 20,400

Rp 65,"%0

Rp 1,133

Rp 1,381

Rp 40,560

Rp 2,1"5

Rp 10,800

Rp %11

Rp -

Rp -

R "26"7

GACOST OBJECT

TOTAL


40/60

Rp 1,200

Rp %11

Rp 2,1"5

Rp -

Rp -

Rp -

Rp -

Rp -

Rp -

Rp -

Rp -

Rp -

Rp -

Rp -

R 4267


41/60

UNIT COST

TINDAKAN RAWAT INAP

PERTAMINA HOSPITAL CILACAP


A RUA PERAATA

1 VVIP Rp 1,150,000

2 VIP Rp 800,000

3 Kelas I Rp 600,000

4 Kelas II Rp 450,000

5 Kelas III A Rp 250,000

6 Kelas III B Rp 150,000

" Is#las$ Rp 450,000

8 ICU Rp 800,000

% Kaa Ba9$

TOTAL TT

B VI'ITE OKTER RAAT IAP 'TAAR KEA' VIP

1 V$s$*e 'pe)$al$s Rp "5,000 Rp 80,000 Rp 85,000

2 V$s$*e U+ Rp 40,000 Rp 45,000 Rp 50,000

3 V$s$*e ++ C$*# Rp 40,000 Rp 45,000 Rp 50,000

4 V$s$*e 'pe)$al$s C$*# Rp 100,000 Rp 125,000 Rp 140,000

C EMOIAI'A KEA'

1 Ele*$: Rp %30,000

2 C$*# Rp 1,3%5,000

TIAKA RAAT IAP 'TAAR KEA' VIP

1 A)$*es P+s$ Rp 200,000 Rp 240,000 Rp 280,000

2 A)$*es P+s$ C$*# Rp 300,000 Rp 360,000 Rp 420,000

3 Al#.#l Ba*. Rp 10,000 Rp 12,000 Rp 14,000

4 Aal l$)e$ Rp 40,000 Rp 48,000 Rp 56,000

5 Aa* a.$*a Rp %0,000 Rp 108,000 Rp 126,000

6 BMP Rp 240,000 Rp 288,000 Rp 336,000

" Bl## ae Rp 50,000 Rp 60,000 Rp "0,000

8 C++ Pa T$aa Rp 15,000 Rp 18,000 Rp 21,000

% C+**e C$)$ / ela Rp "5,000 Rp %0,000 Rp 105,000

10 C#ss I)$s$ Rp %5,000 Rp 114,000 Rp 133,000


42/60

11 e7$ee Rp 400,000 Rp 480,000 Rp 560,000

12 e)+7$*+s Rp 20,000 Rp 24,000 Rp 28,000

13 EK 12 ea (Res*$! Rp 40,000 Rp 48,000 Rp 56,000

14 EK M#$*#$ / a$ Rp 132,000 Rp 132,000 Rp 132,000

15 Espl#as$ C#pal Rp 250,000 Rp 300,000 Rp 350,000

16 Es*epas$ Rp 5"5,000 Rp 6%0,000 Rp 805,000

1" Ele*#a Pape / EK Rp 3",500 Rp 45,000 Rp 52,500

18 E9e Pe +*+ *#*eap$ Rp 121,000 Rp 145,200 Rp 16%,400

1% *#*eap$ Rp 10,000 Rp 12,000 Rp 14,000

20 a*$ Bal+* I (+a 5-15)! Rp "5,000 Rp %0,000 Rp 105,000

21 a*$ Bal+* II (+a 16-30)! Rp 150,000 Rp 180,000 Rp 210,000

22 l+)#*es* '*$) Rp 26,000 Rp 31,200 Rp 36,400

23 I:+s$# P+p / a$ Rp 40,000 Rp 48,000 Rp 56,000

24 I.alas$ (Tapa O7a*! Rp 3",500 Rp 45,000 Rp 52,500


43/60

IF SETELAH MARGIN

30% 40%

Rp - Rp - 1

Rp - Rp - 10

Rp - Rp - 10

Rp - Rp - 6

Rp - Rp -1%

Rp - Rp -

Rp - Rp - 2

Rp - Rp - 2

50

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

JUMLAH


44/60

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -


45/60

O AMA TIAKA

1 Asep I / .a$

2 Asep II / .a$

3 Asep III / .a$

4 Ie*$*as Pas$e / ela Pas$e

5 Al#.#l Ba*.

6 Peasaa I:+s

" Peasaa T

8 Peasaa ').#s*ee

% Pe7e$a Ke#*eap$

10 '+)*$# P+p / .a$

O AMA TIAKA

11 '9$ P+p

12 Os$e*$

13 '+*$ I*a C+*a (IC!

14 '+*$ I*a M+s+le (IM!


46/60

15 '+*$ '+7 C+*a ('C!

16 '+*$ I*a Vea

1" '+*$ e;a)

18 '+*$ I*a A*$)+le

1% '+*$ ela$l

O AMA TIAKA

20 Os$e / $*e

21 K#s+l*as$ $$

22 '*$ l+)#s Tes*

23 V$s$*e #*e 'pes$al$s Ra


47/60

2% As$*es P+s$ C$*#

30 BMP

O AMA TIAKA

31 C++ Pa T$aa

32 EK 12 ea

33 EK M#$*#$ / .a$

34 EK Pa=a

35 Ele*#a Pape

36 a;ee* '*aa

3" I:+s P+p

38 I.alas$ Tapa O7a*

3% *#*eap$

40 E9e Pe +*+ :#*#*eap$

41 asa I*+7as$ #*e

42 asa I*+7as$ Pea


48/60

45 K#s+l*as$ #*e U+ pe*elp#

46 +7al P+s$

46 Maa 'p#el$

4" T$$ Ba9$

48 Pea


49/60

RICIA TARI& RAAT IAP PC 2012

RICIA TARI& 'TAART TARI& KEA'

asa R' 30 G 3,000 10,000 3,500

asa Pela9aa ",000 8,400

asa R' 30 G 4,500 15,000 5,400

asa Pela9aa 10,500 12,600 asa R' 30 G 6,000 20,000 ",200

asa Pela9aa 14,000 16,800

10,000

asa R' 30 G 3,000 10,000 3,600

asa Pela9aa 20 G 5,000 2,400

asa Ma*e$al (al#.#l! 2,000 6,000

asa R' 30 G 12,000 40,000 14,400

asa Pela9aa 20 G 8,000 %,600

asa Ma*e$al ($s#pas, *eae, 20,000 24,000asaplas, sa+ *aa!

asa R' 30 G 10,500 35,000 12,600

asa Pela9aa 20 G ",000 8,400

asa Ma*e$al (K9 ell9,.9pa;$@ 1",500 21,000

sa+ *aa, ase!

asa R' 30 G 5,400 18,000 6,480

asa Pela9aa 20 G 3,600 4,320

asa Ma*e$al (K9 ell9, sa+ *aa, %,000 10,800

ase!

asa R' 30 G 45,000 150,000 54,000 asa Pela9aa 20 G 105,000 126,000

asa R' 30 G 6,000 20,000 ",200

asa Pela9aa 20 G 4,000 4,800

asa Ma*e$al (sa+ *aa, ase 10,000 12,000

K9 ell9, Kasa!

RICIA TARI& 'TAART TARI& KEA'

asa R' 30 G 12,000 40,000 14,400

asa Pela9aa 28,000 33,600

asa R' 100 G 20,000 20,000 24,000

asa R' 30 G 4,500 15,000 5,400

asa Pela9aa 20 G 3,000 3,600

asa Ma*e$al (


50/60

sa+ *aa!

asa R' 30 G 4,500 15,000 5,400

asa Pela9aa 20 G 3,000 3,600

asa Ma*e$al (


51/60

sa+ *aa!

asa R' 30 G %0,000 300,000 108,000

asa Pela9aa 20 G 60,000 "2,000

asa Ma*e$al (asa, 7e*a$,


52/60

asa Pela9aa 1",500 21,000

asa R' 30 G 3,000 10,000 3,600

asa Pela9aa ",000 8,400

asa R' 30 G 4%,500 165,000 5%,400

asa Pela9aa 155,500 138,600

asa R' 30 G 10,500 35,000 12,600

asa Pela9aa 24,500 2%,400 asa R' 30 G 8,100 2",000 %,"20

asa Pela9aa 20 G 5,400 6,480

asa Ma*e$al (asa, 7e*a$, =a+, 13,500 16,200

sa+ *aa!

asa R' 30 G 300,000 1,000,000 360,000

asa Pela9aa 20 G 200,000 240,000

asa Ma*e$al (a$ a:a, apas, 500,000 600,000

sa+ *aa, sa7+ a$, sap#,

$9a


53/60

TARI& VIP TARI&

12,000 4,200 14,000

%,800

18,000 ",200 24,000

16,80024,000 8,400 28,000

1%,600

12,000 14,000

12,000 4,200 14,000

2,800 ",000

48,000 16,800 56,000

11,200

28,000

42,000 14,"00 4%,000

%,800

24,500

21,600 ",560 25,200

5,040

12,600

180,000 63,000 210,00014",000

24,000 8,400 28,000

5,600

14,000

TARI& VIP TARI&

48,000 16,800 56,000

3%,200

24,000 28,000 28,000

18,000 6,300 21,000

4,200

10,500

18,000 6,300 21,000

4,200

10,500


54/60

18,000 6,300 21,000

4,200

10,500

24,000 8,400 28,000

5,60014,000

30,000 10,500 35,000

",000

1",500

132,000 46,200 154,000

"",000

30,800

20,400 ",140 23,800

4,"60

11,%00

TARI& VIP TARI&

60 "0 "0

30,000 10,500 35,000

24,500

31,200 10,%20 36,400

",280

18,200

"2,000 25,200 84,000

58,800

30,000 10,500 35,000

24,500

45,000 15,"50 52,500

36,"50

108,000 3",800 126,000

88,200

"2,000 25,200 84,000

16,800

42,000

240,000 84,000 280,000

56,000

140,000


55/60

360,000 126,000 420,000

84,000

210,000

288,000 100,800 336,000

6",200168,000

336,000

TARI& VIP TARI&

18,000 6,300 21,000

4,200

10,500

48,000 16,500 56,000

11,200

2","0086,000 112,000 112,000

86,000 33,600 112,000

22,400

56,000

45,000 15,"50 52,500

36,"50

48,000 16,800 56,000

11,200

28,000

48,000 16,800 56,000

11,200

28,000

36,000 12,600 42,000

8,400

21,000

12,000 4,200 14,000

%,800

145,200 16%,400 16%,400

240,000 84,000 280,000

1%6,000

180,000 63,000 210,000

14",000

180,000 63,000 210,000

14",000

TARI& VIP TARI&

30,000 10,500 35,000


56/60

24,500

12,000 4,200 14,000

%,800

1%8,000 6%,300 231,000

161,"00

42,000 14,"00 4%,000

34,30032,400 11,340 3",800

",560

18,%00

1,200,000 420,000 1,400,000

280,000

"00,000

%60,000 336,000 1,120,000

224,000

560,000

12

* Is*alla*$#


57/60


1 A)$*es P+s$ Rp 200,000 Rp 10,455

2 A)$*es P+s$ C$*# Rp 300,000 Rp 10,455

3 Al#.#l Ba*. Rp 10,000 Rp 1,511

4 Aal l$)e$ Rp 40,000 Rp 2%,3"4

5 Aa* a.$*a Rp %0,000 Rp 1%,806

6 BMP Rp 240,000 Rp 32,432

" Bl## ae Rp 50,000 Rp 2,111

8 C++ Pa T$aa Rp 15,000 Rp 3,311

% C+**e C$)$ / ela Rp "5,000 Rp ",3"1

10 C#ss I)$s$ Rp %5,000 Rp 36,"31

11 e7$ee Rp 400,000 Rp 56,656

12 e)+7$*+s Rp 20,000 Rp 34,%26

13 EK 12 ea (Res*$! Rp 40,000 Rp 6,%4%

14 EK M#$*#$ / a$ Rp 132,000 Rp 21,886

15 Espl#as$ C#pal Rp 250,000 Rp 24,556

16 Es*epas$ Rp 5"5,000 Rp 31,%"5

1" Ele*#a Pape / EK Rp 3",500 Rp 3,%55

18 E9e Pe +*+ *#*eap$ Rp 121,000 Rp 4,286

1% *#*eap$ Rp 10,000 Rp 2,111

20 a*$ Bal+* I (+a 5-15)! Rp "5,000 Rp 5,882

21 a*$ Bal+* II (+a 16-30)! Rp 150,000 Rp 11,5%%

22 l+)#*es* '*$) Rp 26,000 Rp 10,042

23 I:+s$# P+p / a$ Rp 40,000 Rp 2,111

24 I.alas$ (Tapa O7a*! Rp 3",500 Rp 21,"52

25 I*+7as$ Rp 200,000 Rp 153,"5"

26 Res+s$*as$ Rp 210,000 Rp 65,381

2" a;ee* '*aa Rp 40,000 Rp 8,%68

28 +7al P+s$ Rp 165,000 Rp 31,384

2% Maa 'p#el$ Rp 35,000 Rp 2%,"1"

30 Peasaa #


58/60

USULAN TARIF

TINDAKAN RAWAT INAPPERTAMINA HOSPITAL CILACAP

MARGIN TARIF SETELAH MARGIN JASA

20% 30% 40% 20% 30% 40% DR

Rp 2,0%1 Rp 3,136 Rp 4,182 Rp 12,545 Rp 13,5%1 Rp 14,636 Rp 125,000

Rp 2,0%1 Rp 3,136 Rp 4,182 Rp 12,545 Rp 13,5%1 Rp 14,636 Rp 18",500

Rp 302 Rp 453 Rp 604 Rp 1,813 Rp 1,%64 Rp 2,115 Rp -

Rp 5,8"5 Rp 8,812 Rp 11,"50 Rp 35,24% Rp 38,186 Rp 41,124 Rp -

Rp 3,%61 Rp 5,%42 Rp ",%22 Rp 23,"6" Rp 25,"48 Rp 2","28 Rp -

Rp 6,486 Rp %,"30 Rp 12,%"3 Rp 38,%1% Rp 42,162 Rp 45,405 Rp %0,000

Rp 422 Rp 633 Rp 844 Rp 2,533 Rp 2,"44 Rp 2,%55 Rp -

Rp 662 Rp %%3 Rp 1,324 Rp 3,%"3 Rp 4,304 Rp 4,635 Rp -

Rp 1,4"4 Rp 2,211 Rp 2,%48 Rp 8,845 Rp %,582 Rp 10,31% Rp 30,000

Rp ",346 Rp 11,01% Rp 14,6%2 Rp 44,0"" Rp 4","50 Rp 51,423 Rp 35,000

Rp 11,331 Rp 16,%%" Rp 22,662 Rp 6",%8" Rp "3,653 Rp "%,318 Rp 200,000

Rp 6,%85 Rp 10,4"8 Rp 13,%"1 Rp 41,%12 Rp 45,404 Rp 48,8%" Rp -

Rp 1,3%0 Rp 2,085 Rp 2,"80 Rp 8,33% Rp %,034 Rp %,"2% Rp 15,000

Rp 4,3"" Rp 6,566 Rp 8,"54 Rp 26,263 Rp 28,452 Rp 30,640 Rp -

Rp 4,%11 Rp ",36" Rp %,822 Rp 2%,46" Rp 31,%22 Rp 34,3"8 Rp 120,000

Rp 6,3%5 Rp %,5%3 Rp 12,"%0 Rp 38,3"0 Rp 41,568 Rp 44,"65 Rp 200,000

Rp "%1 Rp 1,18" Rp 1,582 Rp 4,"46 Rp 5,142 Rp 5,53" Rp -

Rp 85" Rp 1,286 Rp 1,"14 Rp 5,143 Rp 5,5"1 Rp 6,000 Rp -

Rp 422 Rp 633 Rp 844 Rp 2,533 Rp 2,"44 Rp 2,%55 Rp -

Rp 1,1"6 Rp 1,"65 Rp 2,353 Rp ",058 Rp ",646 Rp 8,235 Rp -

Rp 2,320 Rp 3,480 Rp 4,640 Rp 13,%1% Rp 15,0"% Rp 16,23% Rp -

Rp 2,008 Rp 3,012 Rp 4,01" Rp 12,050 Rp 13,054 Rp 14,058 Rp -

Rp 422 Rp 633 Rp 844 Rp 2,533 Rp 2,"44 Rp 2,%55 Rp -

Rp 4,350 Rp 6,526 Rp 8,"01 Rp 26,102 Rp 28,2"" Rp 30,453 Rp -

Rp 30,"51 Rp 46,12" Rp 61,503 Rp 184,508 Rp 1%%,884 Rp 215,260 Rp 30,000

Rp 13,0"6 Rp 1%,614 Rp 26,152 Rp "8,45" Rp 84,%%5 Rp %1,533 Rp 31,500

Rp 1,"%4 Rp 2,6%0 Rp 3,58" Rp 10,"62 Rp 11,658 Rp 12,555 Rp -

Rp 6,2"" Rp %,415 Rp 12,554 Rp 3",661 Rp 40,"%% Rp 43,%3" Rp %0,000

Rp 5,%43 Rp 8,%15 Rp 11,88" Rp 35,660 Rp 38,632 Rp 41,604 Rp -

Rp 13,84" Rp 20,""0 Rp 2",6%4 Rp 83,082 Rp %0,005 Rp %6,%2% Rp -

Rp 8,683 Rp 13,025 Rp 1",366 Rp 52,0%8 Rp 56,440 Rp 60,"81 Rp -

Rp 1,411 Rp 2,11" Rp 2,823 Rp 8,468 Rp %,1"4 Rp %,880 Rp -

Rp 4,584 Rp 6,8"5 Rp %,16" Rp 2",502 Rp 2%,"%4 Rp 32,086 Rp -

Rp %,514 Rp 14,2"1 Rp 1%,02" Rp 5",082 Rp 61,83% Rp 66,5%6 Rp -

Rp 1,862 Rp 2,"%3 Rp 3,"24 Rp 11,1"3 Rp 12,104 Rp 13,035 Rp -

Rp 13,582 Rp 20,3"2 Rp 2",163 Rp 81,4%0 Rp 88,281 Rp %5,0"1 Rp -

Rp 34,51" Rp 51,""6 Rp 6%,035 Rp 20",105 Rp 224,363 Rp 241,622 Rp 252,000

Rp 3,62% Rp 5,444 Rp ",258 Rp 21,""5 Rp 23,5%0 Rp 25,404 Rp -

Rp 30,563 Rp 45,845 Rp 61,126 Rp 183,3"% Rp 1%8,660 Rp 213,%42 Rp 360,000

Rp 85" Rp 1,286 Rp 1,"14 Rp 5,143 Rp 5,5"1 Rp 6,000 Rp -


59/60

ASKEPSEWA USULAN TARIF USULAN

ALAT 20% 30% 40% TARIF

Rp 40,000 Rp 1"",545 Rp 1"8,5%1 Rp 1"%,636 Rp 180,000

Rp 60,000 Rp 260,045 Rp 261,0%1 Rp 262,136 Rp 265,000

Rp 5,000 Rp 6,813 Rp 6,%64 Rp ",115 Rp 15,000

Rp 8,000 Rp 43,24% Rp 46,186 Rp 4%,124 Rp 45,000

Rp 18,000 Rp 41,"6" Rp 43,"48 Rp 45,"28 Rp 35,000

Rp 18,000 Rp 146,%1% Rp 150,162 Rp 153,405 Rp 155,000

Rp 20,000 Rp 22,533 Rp 22,"44 Rp 22,%55 Rp 25,000

Rp 5,000 Rp 8,%"3 Rp %,304 Rp %,635 Rp 10,000

Rp 15,000 Rp 53,845 Rp 54,582 Rp 55,31% Rp 60,000

Rp 1%,000 Rp %8,0"" Rp 101,"50 Rp 105,423 Rp 110,000

Rp 80,000 Rp 34",%8" Rp 353,653 Rp 35%,318

Rp 5,000 Rp 46,%12 Rp 50,404 Rp 53,8%" Rp 55,000

Rp 8,000 Rp 31,33% Rp 32,034 Rp 32,"2% Rp 35,000

Rp 26,400 Rp 52,663 Rp 54,852 Rp 5",040 Rp 55,000

Rp 60,000 Rp 20%,46" Rp 211,%22 Rp 214,3"8 Rp 215,000

Rp 115,000 Rp 353,3"0 Rp 356,568 Rp 35%,"65 Rp 350,000

Rp ",500 Rp 12,246 Rp 12,642 Rp 13,03" Rp 30,000

Rp 24,200 Rp 2%,343 Rp 2%,""1 Rp 30,200 Rp 30,000

Rp 10,000 Rp 12,533 Rp 12,"44 Rp 12,%55 Rp 15,000

HHH Rp 22,058 Rp 22,646 Rp 23,235

Rp 30,000 Rp 43,%1% Rp 45,0"% Rp 46,23%

Rp 5,200 Rp 1",250 Rp 18,254 Rp 1%,258

Rp 15,000 Rp 1",533 Rp 1","44 Rp 1",%55 Rp 20,000

Rp ",500 Rp 33,602 Rp 35,""" Rp 3",%53 Rp 15,000

Rp 40,000 Rp 254,508 Rp 26%,884 Rp 285,260 Rp 130,000

Rp 42,000 Rp 151,%5" Rp 158,4%5 Rp 165,033 Rp 1"0,000

Rp 10,000 Rp 20,"62 Rp 21,658 Rp 22,555 Rp 25,000

Rp 18,000 Rp 145,661 Rp 148,"%% Rp 151,%3" Rp 155,000

Rp ",000 Rp 42,660 Rp 45,632 Rp 48,604

Rp 12,000 Rp %5,082 Rp 102,005 Rp 108,%2% Rp 65,000

Rp 8,000 Rp 60,0%8 Rp 64,440 Rp 68,"81 Rp "0,000

Rp 3,600 Rp 12,068 Rp 12,""4 Rp 13,480 Rp 15,000

Rp ",000 Rp 34,502 Rp 36,"%4 Rp 3%,086 Rp 40,000

Rp 30,000 Rp 8",082 Rp %1,83% Rp %6,5%6 Rp 100,000

Rp 4,000 Rp 15,1"3 Rp 16,104 Rp 1",035 Rp 20,000

Rp 8,000 Rp 8%,4%0 Rp %6,281 Rp 103,0"1 Rp 30,000

Rp 100,800 Rp 55%,%05 Rp 5"",163 Rp 5%4,422 Rp 4"5,000

Rp 14,000 Rp 35,""5 Rp 3",5%0 Rp 3%,404 Rp 20,000

Rp 144,000 Rp 68",3"% Rp "02,660 Rp "1",%42 Rp 650,000

Rp 2"6,"%0 Rp 150,333 Rp 432,266 Rp 42",123 Rp 583,45" Rp 600,000


60/60

KOMPETITOR

Rp 300,000

Rp 50,000

Rp 112,500

Rp 25,000

Rp "",000

Rp 100,000

Rp 300,000

Rp 300,000

Rp 65,000

Rp 80,000

Rp 30,000

Rp 300,000

Rp 100,000

Rp 30,000

Rp 300,000

Rp 200,000

Rp 30,000

Rp 14,000

Rp 11,000

Rp 30,000

Rp 650,000

Rp 25,000

Rp 80,000

Rp 650,000

Rp 45,500

Rp 400,000

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