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KESEHATAN DAERAH MILITER VI/MULAWARMAN

RUMAH SAKIT TINGKAT II Dr.R.HARDJANTO

RAB
JENIS PENERIMAAN
NEGARA BUKAN PAJAK

SATUAN

JASA

TARIF

MEDIS

PARAMEDIS

HAR

MATERIAL

OPERASIONAL

VIII BEDAH
A. BEDAH THORAX
1. Pasang

WSD/PasangCell
Site/Varises/
PasangDouble
Lumen/Ekstraksi
PermanentPace
Maker(PPM)
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

3,600,000

2,597,732

472,268

110,000

420,000

C.Kelas I

Per tindakan

2,800,000

1,969,876

358,124

110,000

362,000

d. Kelas II

Per tindakan

2,400,000

1,684,718

306,282

110,000

299,000

e. Kelas III

Per tindakan

2,000,000

1,399,137

254,363

110,000

236,500

2. AV Shunt/
DebridementVaskuler
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

6,000,000

4,628,533

841,467

110,000

362,000

C.Kelas I

Per tindakan

5,600,000

4,339,144

788,856

110,000

299,000

d. Kelas II

Per tindakan

5,200,000

4,053,985

737,015

110,000

236,500

e. Kelas III

Per tindakan

4,000,000

3,091,471

562,029

110,000

420,000

VIII BEDAH
D. BEDAH DIGESTIVE
1.Operasi Kecil
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

3.216.000

2,272,804

413,196

110,000

420,000

C.Kelas I

Per tindakan

2.692.000

1,878,490

341,510

110,000

362,000

d. Kelas II

Per tindakan

2.194.400

1,510,746

274,654

110,000

299,000

e. Kelas III

Per tindakan

1.503.000

978,592

177,908

110,000

236,500

2. Operasi Sedang
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

6.512.800

5.306.300

665.300

110,000

431.200

C.Kelas I

Per tindakan

5.571.200

4.520.431

566.769

110,000

374.000

d. Kelas II

Per tindakan

4.630.400

3.747.981

469.919

110,000

302,500

e. Kelas III

Per tindakan

2.780.000

110,000

244,200

2,155,540

270.260

3. Operasi Besar
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

9.359.200

7.823.851

980.949

110,000

444,400

C.Kelas I

Per tindakan

7.557.600

6.273.796

786.604

110,000

387,200

d. Kelas II

Per tindakan

6.616.800

5.498.413

689.387

110,000

319,000

e. Kelas III

Per tindakan

4.080.000

3.300.931

413.869

110,000

255,200

4. Operasi Khusus I
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

11.545.600

9,741,249

1,221,351

110,000

473,000

C.Kelas I

Per tindakan

9.703.200

8,172,533

1,024,667

110,000

396,000

d. Kelas II

Per tindakan

8.721.600

7,353,076

921,924

110,000

336,600

e. Kelas III

Per tindakan

5.416.000

4,470,493

560,507

110,000

275,000

5. Operasi Khusus II
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

16.337.600

13,982,486

1,753,114

110,000

492,000

C.Kelas I

Per tindakan

13.634.400

11,653,315

1,461,085

110,000

410,000

d. Kelas II

Per tindakan

12.223.200

10,459,762

1,311,438

110,000

342,000

e. Kelas III

Per tindakan

6.784.000

5,677,197

711,803

110,000

285,000

E. BEDAH TUMOR
1.Operasi Kecil
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

3.216.000

2,272,804

413,196

110,000

420,000

C.Kelas I

Per tindakan

2.692.000

1,878,490

341,510

110,000

362,000

d. Kelas II

Per tindakan

2.194.400

1,510,746

274,654

110,000

299,000

e. Kelas III

Per tindakan

1.503.000

978,592

177,908

110,000

236,500

2. Operasi Sedang
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

6.512.800

5.306.300

665.300

110,000

431.200

C.Kelas I

Per tindakan

5.571.200

4.520.431

566.769

110,000

374.000

d. Kelas II

Per tindakan

4.630.400

3.747.981

469.919

110,000

302,500

e. Kelas III

Per tindakan

2.780.000

2,155,540

270.260

110,000

244,200

3. Operasi Besar
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

9.359.200

7.823.851

980.949

110,000

444,400

C.Kelas I

Per tindakan

7.557.600

6.273.796

786.604

110,000

387,200

d. Kelas II

Per tindakan

6.616.800

5.498.413

689.387

110,000

319,000

e. Kelas III

Per tindakan

4.080.000

3.300.931

413.869

110,000

255,200

4. Operasi Khusus I
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

11.545.600

9,741,249

1,221,351

110,000

473,000

C.Kelas I

Per tindakan

9.703.200

8,172,533

1,024,667

110,000

396,000

d. Kelas II

Per tindakan

8.721.600

7,353,076

921,924

110,000

336,600

e. Kelas III

Per tindakan

5.416.000

4,470,493

560,507

110,000

275,000

5. Operasi Khusus II
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

16.337.600

13,982,486

1,753,114

110,000

492,000

C.Kelas I

Per tindakan

13.634.400

11,653,315

1,461,085

110,000

410,000

d. Kelas II

Per tindakan

12.223.200

10,459,762

1,311,438

110,000

342,000

e. Kelas III

Per tindakan

6.784.000

5,677,197

711,803

110,000

285,000

F. BEDAH ANAK
1.Operasi Kecil
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

3.216.000

2,272,804

413,196

110,000

420,000

C.Kelas I

Per tindakan

2.692.000

1,878,490

341,510

110,000

362,000

d. Kelas II

Per tindakan

2.194.400

1,510,746

274,654

110,000

299,000

e. Kelas III

Per tindakan

1.503.000

978,592

177,908

110,000

236,500

2. Operasi Sedang
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

6.512.800

5.306.300

665.300

110,000

431.200

C.Kelas I

Per tindakan

5.571.200

4.520.431

566.769

110,000

374.000

d. Kelas II

Per tindakan

4.630.400

3.747.981

469.919

110,000

302,500

e. Kelas III

Per tindakan

2.780.000

2,155,540

270.260

110,000

244,200

3. Operasi Besar
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

9.359.200

7.823.851

980.949

110,000

444,400

C.Kelas I

Per tindakan

7.557.600

6.273.796

786.604

110,000

387,200

d. Kelas II

Per tindakan

6.616.800

5.498.413

689.387

110,000

319,000

e. Kelas III

Per tindakan

4.080.000

3.300.931

413.869

110,000

255,200

4. Operasi Khusus
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

11.545.600

9,741,249

1,221,351

110,000

473,000

C.Kelas I

Per tindakan

9.703.200

8,172,533

1,024,667

110,000

396,000

d. Kelas II

Per tindakan

8.721.600

7,353,076

921,924

110,000

336,600

e. Kelas III

Per tindakan

5.416.000

4,470,493

560,507

110,000

275,000

G. BEDAH PASTIK
1.Operasi Kecil
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

3,196,000

2,255,881

410,119

110,000

420,000

C.Kelas I

Per tindakan

2,792,000

1,963,107

356,893

110,000

362,000

d. Kelas II

Per tindakan

2,204,000

1,518,870

276,130

110,000

299,000

e. Kelas III

Per tindakan

1,611,000

1,069,978

194,522

110,000

236,500

2. Operasi Sedang
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

2,780,000

5,810,308

728,492

110,000

431.200

C.Kelas I

Per tindakan

4,936,000

4,908,567

615,433

110,000

374.000

d. Kelas II

Per tindakan

6,008,000

4,019,534

503,966

110,000

302,500

e. Kelas III

Per tindakan

7,080,000

2,155,540

270,260

110,000

244,200

3. Operasi Besar
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

9,554,400

7,997,304

1,002,696

110,000

444,400

C.Kelas I

Per tindakan

7,730,400

6,427,344

805,856

110,000

387,200

d. Kelas II

Per tindakan

6,658,400

5,535,378

694,022

110,000

319,000

e. Kelas III

Per tindakan

3,680,000

2,945,496

369,304

110,000

255,200

4. Operasi Khusus
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

12,480,000

10,571,547

1,325,453

110,000

473,000

C.Kelas I

Per tindakan

10,428,000

8,816,583

1,105,417

110,000

396,000

d. Kelas II

Per tindakan

9,296,000

7,863,482

985,918

110,000

336,600

e. Kelas III

Per tindakan

5,180,000

4,260,786

534,214

110,000

275,000

H. BEDAH UROLOGI
1.Operasi Kecil
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

3.216.000

2,272,804

413,196

110,000

420,000

C.Kelas I

Per tindakan

2.692.000

1,878,490

341,510

110,000

362,000

d. Kelas II

Per tindakan

2.194.400

1,510,746

274,654

110,000

299,000

e. Kelas III

Per tindakan

1.503.000

978,592

177,908

110,000

236,500

2. Operasi Sedang
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

6.512.800

5.306.300

665.300

110,000

431.200

C.Kelas I

Per tindakan

5.571.200

4.520.431

566.769

110,000

374.000

d. Kelas II

Per tindakan

4.630.400

3.747.981

469.919

110,000

302,500

e. Kelas III

Per tindakan

2.780.000

2,155,540

270.260

110,000

244,200

3. Operasi Besar
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

9.359.200

7.823.851

980.949

110,000

444,400

C.Kelas I

Per tindakan

7.557.600

6.273.796

786.604

110,000

387,200

d. Kelas II

Per tindakan

6.616.800

5.498.413

689.387

110,000

319,000

e. Kelas III

Per tindakan

4.080.000

3.300.931

413.869

110,000

255,200

4. Operasi Khusus I
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

11.545.600

9,741,249

1,221,351

110,000

473,000

C.Kelas I

Per tindakan

9.703.200

8,172,533

1,024,667

110,000

396,000

d. Kelas II

Per tindakan

8.721.600

7,353,076

921,924

110,000

336,600

e. Kelas III

Per tindakan

5.416.000

4,470,493

560,507

110,000

275,000

5. Operasi Khusus II
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

16.337.600

13,982,486

1,753,114

110,000

492,000

C.Kelas I

Per tindakan

13.634.400

11,653,315

1,461,085

110,000

410,000

d. Kelas II

Per tindakan

12.223.200

10,459,762

1,311,438

110,000

342,000

e. Kelas III

Per tindakan

6.784.000

5,677,197

711,803

110,000

285,000

I BEDAH ORTOPEDI
1.Operasi Kecil
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

4,968,000

3,755,289

682,711

110,000

420,000

C.Kelas I

Per tindakan

4,152,000

3,113,894

566,106

110,000

362,000

d. Kelas II

Per tindakan

2,680,000

1,921,645

349,355

110,000

299,000

e. Kelas III

Per tindakan

1,784,000

1,216,365

221,135

110,000

236,500

2. Operasi Sedang
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

8,862,400

7,394,129

927,071

110,000

431.200

C.Kelas I

Per tindakan

7,394,400

6,140,507

769,893

110,000

374.000

d. Kelas II

Per tindakan

5,924,000

4,897,460

614,040

110,000

302,500

e. Kelas III

Per tindakan

3,275,200

2,595,569

325,431

110,000

244,200

3. Operasi Besar
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

10,372,000

8,723,814

1,093,786

110,000

444,400

C.Kelas I

Per tindakan

8,902,400

7,468,771

936,429

110,000

387,200

d. Kelas II

Per tindakan

7,434,400

6,224,923

780,477

110,000

319,000

e. Kelas III

Per tindakan

4,672,000

3,826,976

479,824

110,000

255,200

4. Operasi Khusus
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

12,080,000

10,216,111

1,280,889

110,000

473,000

C.Kelas I

Per tindakan

10,572,000

8,944,540

1,121,460

110,000

396,000

d. Kelas II

Per tindakan

9,063,200

7,656,618

959,982

110,000

336,600

e. Kelas III

Per tindakan

5,948,800

4,943,933

619,867

110,000

275,000

a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

19,998,400

17,235,433

2,160,967

110,000

492,000

C.Kelas I

Per tindakan

15,672,000

13,463,905

1,688,095

110,000

410,000

d. Kelas II

Per tindakan

10,652,000

9,063,611

1,136,389

110,000

342,000

e. Kelas III

Per tindakan

5,988,800

4,970,591

623,209

110,000

285,000

5. Spine

6. Reconstruksi Arthoscopi
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

19,998,400

17,235,433

2,160,967

19,998,400

492,000

C.Kelas I

Per tindakan

15,672,000

13,463,905

1,688,095

15,672,000

410,000

d. Kelas II

Per tindakan

10,652,000

9,063,611

1,136,389

10,652,000

342,000

e. Kelas III

Per tindakan

5,988,800

4,970,591

623,209

5,988,800

285,000

J.BEDAH UMUM
1.Anuscopy
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

800,000

647,318

117,682

25000

10000

C.Kelas I

Per tindakan

720,000

579,624

105,376

25000

10000

d. Kelas II

Per tindakan

640,000

511,931

93,069

25000

10000

e. Kelas III

Per tindakan

560,000

444,238

80,762

25000

10000

2. Biopsi
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

1,040,000

850,398

154,602

25000

10000

C.Kelas I

Per tindakan

880,000

715,011

129,989

25000

10000

d. Kelas II

Per tindakan

720,000

579,624

105,376

25000

10000

e. Kelas III

Per tindakan

560,000

444,238

80,762

25000

10000

3. Sigmoidescopi
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

1,440,000

770,012

139,988

110,000

420,000

C.Kelas I

Per tindakan

1,280,000

683,703

124,297

110,000

362,000

d. Kelas II

Per tindakan

1,120,000

601,625

109,375

110,000

299,000

e. Kelas III

Per tindakan

960,000

519,123

94,377

110,000

236,500

K. BEDAH SARAF
1. Operasi Khusus
a. Kraniotomi/Trepanasi
Konvensional
1)

Neoplasma/ Proses
Desak Ruang

a) Lama Operasi s.d.


4Jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

110,000

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

110,000

410,000

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

110,000

342,000

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

110,000

285,000

492,000

b) Lama Operasi Lebihdari


4 Jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

420,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

362,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

299,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

236,500

2) Koreksi Likworhoe
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

110,000

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

110,000

410,000

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

110,000

342,000

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

110,000

285,000

1,444,440

492,000

3) Penyakit Vaskuler
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

492,000

110,000
110,000

410,000

110,000

342,000

110,000

285,000

1
4)

Epidural/ Subdura;
Hematoma

a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

110,000

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

110,000

410,000

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

110,000

342,000

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

110,000

285,000

492,000

b. Kraniotomi/ Trepanasi
Bedah Mikro
1)

Neoplasma Basis
Kranium

a) Lama Operasi s.d.


4Jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

410,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

342,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

285,000

492,000

b) Lama operasi lebih dari 4


Jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

40,700,000

35,630,653

4,467,347

C.Kelas I

Per tindakan

32,800,000

28,683,662

3,596,338

d. Kelas II

Per tindakan

21,000,000

18,258,733

2,289,267

e. Kelas III

Per tindakan

15,320,000

13,262,195

1,662,805

492,000

110,000
110,000

410,000

110,000

342,000

110,000

285,000

2) AVM / Aneurisma
a) Lama Operasi s.d.
4Jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

410,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

342,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

285,000

492,000

b) Lama operasi
lebih dari 4 Jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

40,700,000

35,630,653

4,467,347

110,000

C.Kelas I

Per tindakan

32,800,000

28,683,662

3,596,338

110,000

410,000

d. Kelas II

Per tindakan

21,000,000

18,258,733

2,289,267

110,000

342,000

e. Kelas III

Per tindakan

15,320,000

13,262,195

1,662,805

110,000

285,000

492,000

3) Transpenoidal
Approach
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

410,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

342,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

285,000

492,000

c. Operasi Neuro
Endoskopi
1. Lama Operasi s.d 4
jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

26,880,000

23,350,349

2,927,651

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

20,960,000

18,162,765

2,277,235

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

13,800,000

11,860,890

1,487,110

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

12,200,000

10,489,797

1,315,203

2. Lama Operasi lebih


dari 4 jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

410,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

342,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

285,000

492,000

d. Kranioplasti
1. Lama Operasi s.d 4
jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

26,880,000

23,350,349

2,927,651

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

20,960,000

18,162,765

2,277,235

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

13,800,000

11,860,890

1,487,110

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

12,200,000

10,489,797

1,315,203

2. Lama Operasi lebih


dari 4 jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

410,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

342,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

285,000

492,000

e. Koreksi Impresi Fractur


Komplikata(Disertai
Laserasi Serebri)

1. Lama Operasi s.d 4


jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

110,000

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

110,000

410,000

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

110,000

342,000

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

110,000

285,000

492,000

2. Lama Operasi lebih


dari 4 jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

410,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

342,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

285,000

492,000

f. Rekontruksi
Meningoensefalokel
1) Kranial Anterior / posterior
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

110,000

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

110,000

410,000

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

110,000

342,000

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

110,000

285,000

492,000

2) Spinal (Spina Bipida)


a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

110,000

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

110,000

492,000

410,000

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

110,000

342,000

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

110,000

285,000

g. Pembedahan Tulang
Belakang
1) Fusi Korpus Vertebrata
a) Approach Anterior
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

40,700,000

35,630,653

4,467,347

110,000

C.Kelas I

Per tindakan

32,800,000

28,683,662

3,596,338

110,000

410,000

d. Kelas II

Per tindakan

21,000,000

18,258,733

2,289,267

110,000

342,000

e. Kelas III

Per tindakan

15,320,000

13,262,195

1,662,805

110,000

285,000

492,000

b)Approach Posterior
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

110,000

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

110,000

410,000

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

110,000

342,000

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

110,000

285,000

492,000

2) Laminektomi
a) Laminektomi Kompleks
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

410,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

342,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

285,000

492,000

b) Laminektomi Sederhana
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

110,000

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

110,000

410,000

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

110,000

342,000

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

110,000

285,000

492,000

3) Tumor Spinal
a) Daerah Kraniosevikal
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

40,700,000

35,630,653

4,467,347

C.Kelas I

Per tindakan

32,800,000

28,683,662

3,596,338

d. Kelas II

Per tindakan

21,000,000

18,258,733

2,289,267

e. Kelas III

Per tindakan

15,320,000

13,262,195

1,662,805

492,000

110,000
110,000

410,000

110,000

342,000

110,000

285,000

b) Daerah Servikal
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

410,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

342,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

285,000

492,000

h. NeuroPlasti/Anastomosis
dan Ekplorasi
1) BedahMikro
a) Pleksus Brakhial
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

40,700,000

35,630,653

4,467,347

C.Kelas I

Per tindakan

32,800,000

28,683,662

3,596,338

d. Kelas II

Per tindakan

21,000,000

18,258,733

2,289,267

e. Kelas III

Per tindakan

15,320,000

13,262,195

1,662,805

492,000

110,000
110,000

410,000

110,000

342,000

110,000

285,000

b) araf Perifer
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

410,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

342,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

285,000

492,000

2) Konvensional
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

110,000

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

110,000

410,000

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

110,000

342,000

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

110,000

285,000

492,000

i. Anastomosis /
Pemasangan
Pintasan
1) Ventriculo Atrium (VA
Shunt)
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

110,000

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

110,000

410,000

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

110,000

342,000

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

110,000

285,000

492,000

2) Ventriculo Peritonium
(VP Shunt)
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

26,880,000

23,350,349

2,927,651

110,000

C.Kelas I

Per tindakan

20,960,000

18,162,765

2,277,235

110,000

410,000

d. Kelas II

Per tindakan

13,800,000

11,860,890

1,487,110

110,000

342,000

e. Kelas III

Per tindakan

12,200,000

10,489,797

1,315,203

110,000

285,000

492,000

j. Complicated
Fucntional
Neurosurgery
1) Operasi
Stereotaktik
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

410,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

342,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

285,000

492,000

1
2) Perkutaneus
Paravertebral /
Viseral Blok

a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

410,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

342,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

285,000

492,000

3) Perkutaneus
Kordotomi
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

34,320,000

29,961,454

3,756,546

110,000

C.Kelas I

Per tindakan

30,000,000

26,195,612

3,284,388

110,000

410,000

d. Kelas II

Per tindakan

18,580,000

16,108,347

2,019,653

110,000

342,000

e. Kelas III

Per tindakan

13,360,000

11,520,560

1,444,440

110,000

285,000

492,000

2. Operasi Besar
a. Koreksi Impresi
Fractur Sederhana
1) Lama Operasi s.d
4 jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

20,320,000

17,521,204

2,196,796

110,000

C.Kelas I

Per tindakan

16,440,000

14,146,341

1,773,659

110,000

410,000

d. Kelas II

Per tindakan

12,280,000

10,510,234

1,317,766

110,000

342,000

e. Kelas III

Per tindakan

9,900,000

8,446,041

1,058,959

110,000

285,000

492,000

2) Lama Operasi
lebih dari 4jam
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

24,000,000

20,791,212

2,606,788

110,000

C.Kelas I

Per tindakan

19,600,000

16,954,284

2,125,716

110,000

410,000

d. Kelas II

Per tindakan

13,600,000

11,683,172

1,464,828

110,000

342,000

e. Kelas III

Per tindakan

11,020,000

9,441,261

1,183,739

110,000

285,000

492,000

b. Pemasangan Fiksasi
Interna
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

24,000,000

20,791,212

2,606,788

110,000

C.Kelas I

Per tindakan

19,600,000

16,954,284

2,125,716

110,000

410,000

d. Kelas II

Per tindakan

13,600,000

11,683,172

1,464,828

110,000

342,000

e. Kelas III

Per tindakan

11,020,000

9,441,261

1,183,739

110,000

285,000

492,000

c. Pemutusan danEksisi
Saraf
1) Neurektomy/Neurolise
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

20,320,000

17,521,204

2,196,796

110,000

C.Kelas I

Per tindakan

16,440,000

14,146,341

1,773,659

110,000

410,000

d. Kelas II

Per tindakan

12,280,000

10,510,234

1,317,766

110,000

342,000

e. Kelas III

Per tindakan

9,900,000

8,446,041

1,058,959

110,000

285,000

492,000

2) Decompresi Saraf
Perifer Reseksi
Ligamentum
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

20,320,000

17,521,204

2,196,796

110,000

C.Kelas I

Per tindakan

16,440,000

14,146,341

1,773,659

110,000

410,000

d. Kelas II

Per tindakan

12,280,000

10,510,234

1,317,766

110,000

342,000

e. Kelas III

Per tindakan

9,900,000

8,446,041

1,058,959

110,000

285,000

492,000

d. Simple Functional
Neurosurgery
1) Perkutaneus
Rhizotomi (Prgr)
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

24,000,000

20,791,212

2,606,788

110,000

C.Kelas I

Per tindakan

19,600,000

16,954,284

2,125,716

110,000

410,000

d. Kelas II

Per tindakan

13,600,000

11,683,172

1,464,828

110,000

342,000

e. Kelas III

Per tindakan

11,020,000

9,441,261

1,183,739

110,000

285,000

492,000

2) Perkutaneus Pacet
Denervasi
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

20,320,000

17,521,204

2,196,796

110,000

C.Kelas I

Per tindakan

16,440,000

14,146,341

1,773,659

110,000

410,000

d. Kelas II

Per tindakan

12,280,000

10,510,234

1,317,766

110,000

342,000

e. Kelas III

Per tindakan

9,900,000

8,446,041

1,058,959

110,000

285,000

492,000

3. Operasi Sedang
a. Eksterpasi Tumor
1) Eksterpasi Kista
Jinak Kranium
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

17,828,000

15,306,839

1,919,161

110,000

C.Kelas I

Per tindakan

13,713,600

11,723,692

1,469,908

110,000

410,000

d. Kelas II

Per tindakan

11,142,400

9,499,375

1,191,025

110,000

342,000

e. Kelas III

Per tindakan

6,856,800

5,741,886

719,914

110,000

285,000

492,000

2) Eksterpasi
Eksostose Tulang
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

13,760,000

11,692,058

1,465,942

110,000

492,000

C.Kelas I

Per tindakan

10,720,000

9,063,611

1,136,389

110,000

410,000

d. Kelas II

Per tindakan

8,600,000

7,240,226

907,774

110,000

342,000

e. Kelas III

Per tindakan

5,400,000

4,447,389

557,611

110,000

285,000

b. Ventrikulostomi
Continous Ventricular
Drainage
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

13,760,000

11,692,058

1,465,942

110,000

492,000

C.Kelas I

Per tindakan

10,720,000

9,063,611

1,136,389

110,000

410,000

d. Kelas II

Per tindakan

8,600,000

7,240,226

907,774

110,000

342,000

e. Kelas III

Per tindakan

5,400,000

4,447,389

557,611

110,000

285,000

c. Pemasangan Traksi
Servikal
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

13,760,000

11,692,058

1,465,942

110,000

492,000

C.Kelas I

Per tindakan

10,720,000

9,063,611

1,136,389

110,000

410,000

d. Kelas II

Per tindakan

8,600,000

7,240,226

907,774

110,000

342,000

e. Kelas III

Per tindakan

5,400,000

4,447,389

557,611

110,000

285,000

4. Tindakan Bedah Lain


a. Pungsi cairan otak Per
Paket Pengobatan
a.Kelas Super VIP
b. Kelas VIP

5,880,000

4,689,974

588,026

110,000

492,000

C.Kelas I

4,600,000

3,625,444

454,556

110,000

410,000

d. Kelas II

3,960,000

3,117,171

390,829

110,000

342,000

e. Kelas III

2,640,000

1,994,883

250,117

110,000

285,000

b. Biopsi Saraf
Kutaneus/otot
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

5,880,000

4,689,974

588,026

110,000

492,000

C.Kelas I

Per tindakan

4,600,000

3,625,444

454,556

110,000

410,000

d. Kelas II

Per tindakan

3,960,000

3,117,171

390,829

110,000

342,000

e. Kelas III

Per tindakan

2,640,000

1,994,883

250,117

110,000

285,000

c. Blok Saraf Perifer


a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

5,880,000

4,689,974

588,026

110,000

492,000

C.Kelas I

Per tindakan

4,600,000

3,625,444

454,556

110,000

410,000

d. Kelas II

Per tindakan

3,960,000

3,117,171

390,829

110,000

342,000

e. Kelas III

Per tindakan

2,640,000

1,994,883

250,117

110,000

285,000

IX PENGGUNAAN ALAT
INSTALASI KAMAR
OPER5ASI
A. C-ARM
a.Kelas Super VIP

Per tindakan

1,080,000

216,000

54,000

648,000

162,000

b. Kelas VIP

Per tindakan

900,000

180,000

45,000

540,000

135,000

C.Kelas I

Per tindakan

720,000

144,000

36,000

432,000

108,000

d. Kelas II

Per tindakan

450,000

90,000

22,500

270,000

67,500

e. Kelas III

Per tindakan

270,000

54,000

13,500

162,000

40,500

a.Kelas Super VIP

Per tindakan

1,800,000

360,000

90,000

1,080,000

270,000

b. Kelas VIP

Per tindakan

1,575,000

315,000

78,750

945,000

236,250

C.Kelas I

Per tindakan

1,350,000

270,000

67,500

810,000

202,500

d. Kelas II

Per tindakan

1,125,000

225,000

56,250

675,000

168,750

e. Kelas III

Per tindakan

630,000

126,000

31,500

378,000

94,500

a.Kelas Super VIP

Per tindakan

1,125,000

225,000

56,250

675,000

168,750

b. Kelas VIP

Per tindakan

900,000

180,000

45,000

540,000

135,000

C.Kelas I

Per tindakan

810,000

162,000

40,500

486,000

121,500

d. Kelas II

Per tindakan

720,000

144,000

36,000

432,000

108,000

e. Kelas III

Per tindakan

540,000

108,000

27,000

324,000

81,000

a.Kelas Super VIP

Per tindakan

1,080,000

216,000

54,000

648,000

162,000

b. Kelas VIP

Per tindakan

850,500

170,100

42,525

510,300

127,575

C.Kelas I

Per tindakan

803,300

160,660

40,165

481,980

120,495

d. Kelas II

Per tindakan

756,000

151,200

37,800

453,600

113,400

e. Kelas III

Per tindakan

708,800

141,760

35,440

425,280

106,320

a.Kelas Super VIP

Per tindakan

2,700,000

540,000

135,000

1,620,000

405,000

b. Kelas VIP

Per tindakan

2,250,000

450,000

112,500

1,350,000

337,500

C.Kelas I

Per tindakan

1,800,000

360,000

90,000

1,080,000

270,000

d. Kelas II

Per tindakan

1,350,000

270,000

67,500

810,000

202,500

e. Kelas III

Per tindakan

900,000

180,000

45,000

540,000

135,000

B. LASER

C. MICROSCOPE
SURGERY

D. EXTRACOPAREAL
SHOCK WAVE
LITHOTRIPSY (ESWL)

E. ARTHOSCOPY

G. ENDOSCOPY NEURO
SURGERY
a.Kelas Super VIP

Per tindakan

3,600,000

720,000

180,000

2,160,000

540,000

b. Kelas VIP

Per tindakan

3,307,500

661,500

165,375

1,984,500

496,125

C.Kelas I

Per tindakan

2,835,000

567,000

141,750

1,701,000

425,250

d. Kelas II

Per tindakan

2,362,500

472,500

118,125

1,417,500

354,375

e. Kelas III

Per tindakan

1,890,000

378,000

94,500

1,134,000

283,500

a.Kelas Super VIP

Per tindakan

3,600,000

720,000

180,000

2,160,000

540,000

b. Kelas VIP

Per tindakan

3,307,500

661,500

165,375

1,984,500

496,125

C.Kelas I

Per tindakan

2,835,000

567,000

141,750

1,701,000

425,250

d. Kelas II

Per tindakan

2,362,500

472,500

118,125

1,417,500

354,375

e. Kelas III

Per tindakan

1,890,000

378,000

94,500

1,134,000

283,500

a.Kelas Super VIP

Per tindakan

1,080,000

216,000

54,000

648,000

162,000

b. Kelas VIP

Per tindakan

810,000

162,000

40,500

486,000

121,500

C.Kelas I

Per tindakan

540,000

108,000

27,000

324,000

81,000

d. Kelas II

Per tindakan

450,000

90,000

22,500

270,000

67,500

e. Kelas III

Per tindakan

270,000

54,000

13,500

162,000

40,500

a.Kelas Super VIP

Per tindakan

1,350,000

270,000

67,500

810,000

202,500

b. Kelas VIP

Per tindakan

900,000

180,000

45,000

540,000

135,000

C.Kelas I

Per tindakan

630,000

126,000

31,500

378,000

94,500

d. Kelas II

Per tindakan

540,000

108,000

27,000

324,000

81,000

e. Kelas III

Per tindakan

360,000

72,000

18,000

216,000

54,000

a.Kelas Super VIP

Per tindakan

3,600,000

720,000

180,000

2,160,000

540,000

b. Kelas VIP

Per tindakan

3,307,500

661,500

165,375

1,984,500

496,125

C.Kelas I

Per tindakan

2,835,000

567,000

141,750

1,701,000

425,250

d. Kelas II

Per tindakan

2,362,500

472,500

118,125

1,417,500

354,375

e. Kelas III

Per tindakan

1,890,000

378,000

94,500

1,134,000

283,500

H. STEREOTACTIC

I. DIATHERMI BIPOOLAR

J. HIGH SPEED DRILL

G. ENDOSCOPY NEURO
SURGERY

K. N.50
a.Kelas Super VIP

Per tindakan

1,125,000

225,000

56,250

675,000

168,750

b. Kelas VIP

Per tindakan

803,300

160,660

40,165

481,980

120,495

C.Kelas I

Per tindakan

756,000

151,200

37,800

453,600

113,400

d. Kelas II

Per tindakan

708,800

141,760

35,440

425,280

106,320

e. Kelas III

Per tindakan

661,500

132,300

33,075

396,900

99,225

a.Kelas Super VIP

Per tindakan

540,000

108,000

27,000

324,000

81,000

b. Kelas VIP

Per tindakan

283,500

56,700

14,175

170,100

42,525

C.Kelas I

Per tindakan

236,300

47,260

11,815

141,780

35,445

d. Kelas II

Per tindakan

189,000

37,800

9,450

113,400

28,350

e. Kelas III

Per tindakan

141,800

28,360

7,090

85,080

21,270

a.Kelas Super VIP

Per tindakan

180,000

36,000

9,000

108,000

27,000

b. Kelas VIP

Per tindakan

141,800

28,360

7,090

85,080

21,270

C.Kelas I

Per tindakan

94,500

18,900

4,725

56,700

14,175

d. Kelas II

Per tindakan

70,900

14,180

3,545

42,540

10,635

e. Kelas III

Per tindakan

47,300

9,460

2,365

28,380

7,095

a.Kelas Super VIP

Per tindakan

2,700,000

540,000

135,000

1,620,000

405,000

b. Kelas VIP

Per tindakan

2,250,000

450,000

112,500

1,350,000

337,500

C.Kelas I

Per tindakan

1,800,000

360,000

90,000

1,080,000

270,000

d. Kelas II

Per tindakan

1,350,000

270,000

67,500

810,000

202,500

e. Kelas III

Per tindakan

900,000

180,000

45,000

540,000

135,000

a.Kelas Super VIP

Per tindakan

225,000

45,000

11,250

135,000

33,750

b. Kelas VIP

Per tindakan

180,000

36,000

9,000

108,000

27,000

C.Kelas I

Per tindakan

157,500

31,500

7,875

94,500

23,625

d. Kelas II

Per tindakan

135,000

27,000

6,750

81,000

20,250

e. Kelas III

Per tindakan

90,000

18,000

4,500

54,000

13,500

L. Aspirastion Perkutaneus
Lumbar Diskectomy
(APLD)

M. UROFLOMETRI

N. TUR/SACHSE/URS

O. USG

P. CYSTOSCOPY/RPG
a.Kelas Super VIP

Per tindakan

1,800,000

360,000

90,000

1,080,000

270,000

b. Kelas VIP

Per tindakan

1,350,000

270,000

67,500

810,000

202,500

C.Kelas I

Per tindakan

900,000

180,000

45,000

540,000

135,000

d. Kelas II

Per tindakan

675,000

135,000

33,750

405,000

101,250

e. Kelas III

Per tindakan

450,000

90,000

22,500

270,000

67,500

a.Kelas Super VIP

Per tindakan

2,700,000

540,000

135,000

1,620,000

405,000

b. Kelas VIP

Per tindakan

2,250,000

450,000

112,500

1,350,000

337,500

C.Kelas I

Per tindakan

1,800,000

360,000

90,000

1,080,000

270,000

d. Kelas II

Per tindakan

1,575,000

315,000

78,750

945,000

236,250

e. Kelas III

Per tindakan

1,125,000

225,000

56,250

675,000

168,750

a.Kelas Super VIP

Per tindakan

2,250,000

450,000

112,500

1,350,000

337,500

b. Kelas VIP

Per tindakan

1,800,000

360,000

90,000

1,080,000

270,000

C.Kelas I

Per tindakan

1,350,000

270,000

67,500

810,000

202,500

d. Kelas II

Per tindakan

1,125,000

225,000

56,250

675,000

168,750

e. Kelas III

Per tindakan

900,000

180,000

45,000

540,000

135,000

a.Kelas Super VIP

Per tindakan

2,700,000

540,000

135,000

1,620,000

405,000

b. Kelas VIP

Per tindakan

2,250,000

450,000

112,500

1,350,000

337,500

C.Kelas I

Per tindakan

2,025,000

405,000

101,250

1,215,000

303,750

d. Kelas II

Per tindakan

1,800,000

360,000

90,000

1,080,000

270,000

e. Kelas III

Per tindakan

1,350,000

270,000

67,500

810,000

202,500

a.Kelas Super VIP

Per tindakan

2,700,000

540,000

135,000

1,620,000

405,000

b. Kelas VIP

Per tindakan

2,025,000

405,000

101,250

1,215,000

303,750

C.Kelas I

Per tindakan

1,575,000

315,000

78,750

945,000

236,250

d. Kelas II

Per tindakan

1,350,000

270,000

67,500

810,000

202,500

e. Kelas III

Per tindakan

900,000

180,000

45,000

540,000

135,000

Q. URS LITHOTRIPSI

R. URS DIAGNOSTIK

S. LITHOTRIPSI

T. TUNA

1
U.

L.A.B.P
a.Kelas Super VIP

Per tindakan

2,700,000

540,000

135,000

1,620,000

405,000

b. Kelas VIP

Per tindakan

1,890,000

378,000

94,500

1,134,000

283,500

C.Kelas I

Per tindakan

1,417,500

283,500

70,875

850,500

212,625

d. Kelas II

Per tindakan

1,181,300

236,260

59,065

708,780

177,195

e. Kelas III

Per tindakan

945,000

189,000

47,250

567,000

141,750

a.Kelas Super VIP

Per tindakan

2,700,000

540,000

135,000

1,620,000

405,000

b. Kelas VIP

Per tindakan

1,890,000

378,000

94,500

1,134,000

283,500

C.Kelas I

Per tindakan

1,417,500

283,500

70,875

850,500

212,625

d. Kelas II

Per tindakan

1,181,300

236,260

59,065

708,780

177,195

e. Kelas III

Per tindakan

945,000

189,000

47,250

567,000

141,750

a.Kelas Super VIP

Per tindakan

2,700,000

540,000

135,000

1,620,000

405,000

b. Kelas VIP

Per tindakan

1,890,000

378,000

94,500

1,134,000

283,500

C.Kelas I

Per tindakan

1,417,500

283,500

70,875

850,500

212,625

d. Kelas II

Per tindakan

1,181,300

236,260

59,065

708,780

177,195

e. Kelas III

Per tindakan

945,000

189,000

47,250

567,000

141,750

a.Kelas Super VIP

Per tindakan

2,700,000

540,000

135,000

1,620,000

405,000

b. Kelas VIP

Per tindakan

2,025,000

405,000

101,250

1,215,000

303,750

C.Kelas I

Per tindakan

1,575,000

315,000

78,750

945,000

236,250

d. Kelas II

Per tindakan

1,350,000

270,000

67,500

810,000

202,500

e. Kelas III

Per tindakan

900,000

180,000

45,000

540,000

135,000

a.Kelas Super VIP

Per tindakan

3,307,500

661,500

165,375

1,984,500

496,125

b. Kelas VIP

Per tindakan

3,307,500

661,500

165,375

1,984,500

496,125

C.Kelas I

Per tindakan

3,307,500

661,500

165,375

1,984,500

496,125

d. Kelas II

Per tindakan

3,307,500

661,500

165,375

1,984,500

496,125

e. Kelas III

Per tindakan

3,307,500

661,500

165,375

1,984,500

496,125

V. OCTOPUS ARM

W. MESIN JANTUNG SAM


500-700

X. SORENSENT

Y. SONOCA

Z. MICROSCOPE COVER
a.Kelas Super VIP

1,800,000

360,000

90,000

1,080,000

270,000

b. Kelas VIP

Per tindakan

1,800,000

360,000

90,000

1,080,000

270,000

C.Kelas I

Per tindakan

1,800,000

360,000

90,000

1,080,000

270,000

d. Kelas II

Per tindakan

1,800,000

360,000

90,000

1,080,000

270,000

e. Kelas III

Per tindakan

1,800,000

360,000

90,000

1,080,000

270,000

a.Kelas Super VIP

Per tindakan

1,530,000

306,000

76,500

918,000

229,500

b. Kelas VIP

Per tindakan

1,530,000

306,000

76,500

918,000

229,500

C.Kelas I

Per tindakan

1,530,000

306,000

76,500

918,000

229,500

d. Kelas II

Per tindakan

1,530,000

306,000

76,500

918,000

229,500

e. Kelas III

Per tindakan

1,530,000

306,000

76,500

918,000

229,500

a.Kelas Super VIP

Per tindakan

2,700,000

540,000

135,000

1,620,000

405,000

b. Kelas VIP

Per tindakan

2,250,000

450,000

112,500

1,350,000

337,500

C.Kelas I

Per tindakan

2,250,000

450,000

112,500

1,350,000

337,500

d. Kelas II

Per tindakan

2,250,000

450,000

112,500

1,350,000

337,500

e. Kelas III

Per tindakan

2,250,000

450,000

112,500

1,350,000

337,500

a.Kelas Super VIP

per tindakan

3,150,000

630,000

157,500

1,890,000

472,500

b. Kelas VIP

Per tindakan

2,700,000

540,000

135,000

1,620,000

405,000

C.Kelas I

Per tindakan

2,250,000

450,000

112,500

1,350,000

337,500

d. Kelas II

Per tindakan

2,025,000

405,000

101,250

1,215,000

303,750

e. Kelas III

Per tindakan

1,575,000

315,000

78,750

945,000

236,250

a.Kelas Super VIP

Per tindakan

360,000

72,000

18,000

216,000

54,000

b. Kelas VIP

Per tindakan

360,000

72,000

18,000

216,000

54,000

C.Kelas I

Per tindakan

315,000

63,000

15,750

189,000

47,250

d. Kelas II

Per tindakan

270,000

54,000

13,500

162,000

40,500

e. Kelas III

Per tindakan

225,000

45,000

11,250

135,000

33,750

AA. COLONOSCOPY

BB. SHAVER

CC. PERCUTANEUS
NEPROLHITOTOMY
(PCNL)

DD. DC SHOCK

OBSTETRI GINECOLOGI
SECTIOCAESARIA
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

7,200,000

6,020,188

625,412

110,000

444,400

C.Kelas I

Per tindakan

6,200,000

5,166,115

536,685

110,000

387,200

d. Kelas II

Per tindakan

5,200,000

4,322,005

448,995

110,000

319,000

e. Kelas III

Per tindakan

4,400,000

3,655,089

379,711

110,000

255,200

1.Operasi Kecil
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

3,096,000

2,171,264

394,736

110,000

420,000

C.Kelas I

Per tindakan

2,652,000

1,844,644

335,356

110,000

362,000

d. Kelas II

Per tindakan

2,076,000

1,410,560

256,440

110,000

299,000

e. Kelas III

Per tindakan

1,656,000

1,108,056

201,444

110,000

236,500

2. Operasi Sedang
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

7,656,000

6,322,135

792,665

110,000

431.200

C.Kelas I

Per tindakan

6,012,000

4,912,122

615,878

110,000

374.000

d. Kelas II

Per tindakan

4,560,000

3,685,424

462,076

110,000

302,500

e. Kelas III

Per tindakan

3,040,000

2,386,573

299,227

110,000

244,200

3. Operasi Besar
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

11,404,000

9,640,838

1,208,762

110,000

444,400

C.Kelas I

Per tindakan

9,644,000

8,127,748

1,019,052

110,000

387,200

d. Kelas II

Per tindakan

7,412,000

6,205,019

777,981

110,000

319,000

e. Kelas III

Per tindakan

5,972,000

4,982,142

624,658

110,000

255,200

4. Operasi Khusus
a.Kelas Super VIP

Per tindakan

b. Kelas VIP

Per tindakan

14,040,000

11,957,746

1,499,254

110,000

473,000

C.Kelas I

Per tindakan

12,688,000

10,824,795

1,357,205

110,000

396,000

d. Kelas II

Per tindakan

10,456,000

8,894,246

1,115,154

110,000

336,600

e. Kelas III

Per tindakan

9,144,000

7,783,154

975,846

110,000

275,000