TARIF PE

TARIF JASA
NO. KODE JENIS PELAYANAN PELAYANAN SARANA

1 ADMRI001 Adninistrasi Rawat Jalan Pasien Baru 10000 10000

2 ADMRI002 Adninistrasi Rawat Jalan Pasien Lama 5000 5000
3 UGD001 Konsul Dokter Umum UGD 40000 0
4 UGD002 Konsul Dokter Ahli UGD 60000 10000
5 UGD003 Konsul Dokter Ahli UGD via telpon 50000 10000
6 UGD004 Aff Hecting 25000 17500
7 UGD005 Pasang Kateter 30000 21000
8 UGD006 Aff Kateter 20000 14000
9 UGD007 Bilas lambung 50000 35000
10 UGD008 Cross insisi luka 50000 35000
11 UGD009 Extervasi 60000 42000
12 UGD010 Ekstraksi (cabut) kuku 60000 42000
13 UGD011 Ekstraksi Corpus Alienum Tenggorok 50000 35000
14 UGD012 EKG 60000 42000
15 UGD013 Ganti perban luka ringan 25000 17500
16 UGD014 Ganti perban luka sedang 30000 21000
17 UGD015 Ganti perban luka berat 50000 35000
18 UGD016 Ganti perban Post Secsio (hefafix) 25000 17500
19 UGD017 Hecting Luka 1 - 2 25000 17500
20 UGD018 Hecting Luka 3 - 5 35000 24500
21 UGD019 Hecting Luka 1 - 4 50000 35000
22 UGD020 Hecting Luka 6 - 10 100000 70000
23 UGD021 Hecting Luka 11 - 20 150000 105000
24 UGD022 Hecting Luka 20 - 25 270000 189000
25 UGD023 Hecting Luka 25 -30 350000 245000
26 UGD024 Hecting Luka 30 - 35 420000 294000
27 UGD025 Hecting Luka 35 - 40 500000 350000
28 UGD026 Hecting Luka > 40 40000 28000
29 UGD027 Intubasi (Pemasangan ETT) 35000 24500
30 UGD028 Insisi Abses/punksi abses 35000 24500
31 UGD029 Luka Bakar 5 - 10 % 40000 28000
32 UGD030 Luka Bakar 10 - 20 % 60000 42000
33 UGD031 Luka Bakar > 20% 80000 56000
34 UGD032 Nebulizer 60000 50000
35 UGD033 Observasi pasien 50000 35000
36 UGD034 Pasang Infuse Dewasa 25000 18000
37 UGD035 Pasang Infuse Anak 35000 24000
38 UGD036 Pasang Kateter 40000 26000
39 UGD037 Pasang mag slang / NGT 30000 20000
40 UGD038 Pasang Guidel 15000 9000
41 UGD039 Perawatan luka gangren 40000 26000
42 UGD040 Pemakaian DC Shock 50000 30000
43 UGD041 Pemakaian Suction 10000 5000
44 UGD042 Pemasangan Monitor 60000 45000
45 UGD043 Pasang Spalk Dewasa 10000 5000
46 UGD044 Pasang Spalk Anak 15000 8000
47 UGD045 Pasang O2 15000 10000
48 UGD046 Rawat luka/cuci luka (necrotomi, gigitan) 35000 25000
49 UGD047 Resusitasi kordiopulmonar (RSP) 50000 30000
50 UGD048 Repusisi tulang sendi/Tempro 30000 15000
51 UGD049 mediabular joint Mandibular Joint 30000 15000
52 UGD050 Sircum sisi 350000 250000
53 UGD051 Spooling telinga/hidung/mata 35000 20000
54 UGD052 Transfusi darah 40000 30000
55 UGD053 Tampon Episkasis Masif 30000 15000
56 UGD054 Spuling Past Op 30000 20000
57 UGD055 Visum Hidup 60000 40000
58 UGD056 Visum mayat 200000 150000
59 UGD057 Syringe Pump/ infus pump perhari 75000 50000
60 UGD058 Spoling untuk trauma bahan kimia 30000 20000
61 UGD059 Irigasi 30000 20000
62 UGD060 Spooling Cateter 20000 10000
63 UGD061 Resusitasi bayi patologis 50000 20000
64 UGD062 Pasang rangsel 40000 20000
 TARIF PELAYANAN UNIT GAWAT DARURAT RSU AISYIYAH ST KHADIJAH

JASA DOKTER JASA DOKTER JASA DOKTER JASA PENATA JASA PERAWAT
DPJP ANESTESI ANAK (LAIN) ANESTESI

0 0 0 0 0
0 0 0 0 0
40000 0 0 0 0
50000 0 0 0 0
40000 0 0 0 0
2500 0 0 0 2500
3000 0 0 0 3000
2000 0 0 0 2000
5000 0 0 0 5000
5000 0 0 0 5000
6000 0 0 0 6000
6000 0 0 0 6000
5000 0 0 0 5000
6000 0 0 0 6000
2500 0 0 0 2500
3000 0 0 0 3000
5000 0 0 0 5000
2500 0 0 0 2500
2500 0 0 0 2500
3500 0 0 0 3500
5000 0 0 0 5000
10000 0 0 0 10000
15000 0 0 0 15000
27000 0 0 0 27000
35000 0 0 0 35000
42000 0 0 0 42000
50000 0 0 0 50000
4000 0 0 0 4000
3500 0 0 0 3500
3500 0 0 0 3500
4000 0 0 0 4000
6000 0 0 0 6000
8000 0 0 0 8000
0 0 0 0 5000
0 0 0 0 7500
0 0 0 0 3500
0 0 0 0 6000
4000 0 0 0 5000
4000 0 0 0 3000
2000 0 0 0 2000
4000 0 0 0 5000
10000 0 0 0 5000
0 0 0 0 2500
 5000 0 0 0 5000
0 0 0 0 2500
0 0 0 0 3500
0 0 0 0 2500
0 0 0 0 5000
10000 0 0 0 5000
10000 0 0 0 2500
10000 0 0 0 2500
50000 0 0 0 25000
8000 0 0 0 3500
0 0 0 0 5000
8000 0 0 0 3500
0 0 0 0 5000
10000 0 0 0 5000
30000 0 0 0 10000
5000 0 0 0 10000
0 0 0 0 5000
4000 0 0 0 3000
0 0 0 0 5000
20000 0 0 0 5000
10000 0 0 0 5000
ST KHADIJAH

JASA
JASA ANALIS JASA SUPIR JASA NON MEDIS JASA EVAKUATOR
RADIOGRAFER

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 2500 0
0 0 0 3000 0
0 0 0 2000 0
0 0 0 5000 0
0 0 0 5000 0
0 0 0 6000 0
0 0 0 6000 0
0 0 0 5000 0
0 0 0 6000 0
0 0 0 2500 0
0 0 0 3000 0
0 0 0 5000 0
0 0 0 2500 0
0 0 0 2500 0
0 0 0 3500 0
0 0 0 5000 0
0 0 0 10000 0
0 0 0 15000 0
0 0 0 27000 0
0 0 0 35000 0
0 0 0 42000 0
0 0 0 50000 0
0 0 0 4000 0
0 0 0 3500 0
0 0 0 3500 0
0 0 0 4000 0
0 0 0 6000 0
0 0 0 8000 0
0 0 0 5000 0
0 0 0 7500 0
0 0 0 3500 0
0 0 0 5000 0
0 0 0 5000 0
0 0 0 3000 0
0 0 0 2000 0
0 0 0 5000 0
0 0 0 5000 0
0 0 0 2500 0
0 0 0 5000 0
0 0 0 2500 0
0 0 0 3500 0
0 0 0 2500 0
0 0 0 5000 0
0 0 0 5000 0
0 0 0 2500 0
0 0 0 2500 0
0 0 0 25000 0
0 0 0 3500 0
0 0 0 5000 0
0 0 0 3500 0
0 0 0 5000 0
0 0 0 5000 0
0 0 0 10000 0
0 0 0 10000 0
0 0 0 5000 0
0 0 0 3000 0
0 0 0 5000 0
0 0 0 5000 0
0 0 0 5000 0
 JASA
PEMULASARAN

0 10000 0
0 5000 0
0 40000 0
0 60000 0
0 50000 0
0 25000 0
0 30000 0
0 20000 0
0 50000 0
0 50000 0
0 60000 0
0 60000 0
0 50000 0
0 60000 0
0 25000 0
0 30000 0
0 50000 0
0 25000 0
0 25000 0
0 35000 0
0 50000 0
0 100000 0
0 150000 0
0 270000 0
0 350000 0
0 420000 0
0 500000 0
0 40000 0
0 35000 0
0 35000 0
0 40000 0
0 60000 0
0 80000 0
0 60000 0
0 50000 0
0 25000 0
0 35000 0
0 40000 0
0 30000 0
0 15000 0
0 40000 0
0 50000 0
0 10000 0
0 60000 0
0 10000 0
0 15000 0
0 15000 0
0 35000 0
0 50000 0
0 30000 0
0 30000 0
0 350000 0
0 35000 0
0 40000 0
0 30000 0
0 30000 0
0 60000 0
0 200000 0
0 75000 0
0 30000 0
0 30000 0
0 20000 0
0 50000 0
0 40000 0
 TARIF PELAYANAN UNIT GAWAT DARURAT RSU AISYIYAH ST KHADIJAH

TARIF JASA
NO. KODE JENIS PELAYANAN PELAYANAN SARANA

1 ADMRI001 Adninistrasi Rawat Jalan Pasien Baru 10000 10000

2 ADMRI002 Adninistrasi Rawat Jalan Pasien Lama 5000 5000
3 UGD001 Konsul Dokter Umum 45000 10000
6 UGD004 Aff Hecting 25000 17500
7 UGD005 Pasang Kateter 30000 21000
8 UGD006 Aff Kateter 20000 14000
9 UGD007 Bilas lambung 50000 35000
10 UGD008 Cross insisi luka 50000 35000
11 UGD009 Extervasi 60000 42000
12 UGD010 Ekstraksi (cabut) kuku 60000 42000
13 UGD011 Ekstraksi Corpus Alienum Tenggorok 50000 35000
14 UGD012 EKG 60000 42000
15 UGD013 Ganti perban luka ringan 25000 17500
16 UGD014 Ganti perban luka sedang 30000 21000
17 UGD015 Ganti perban luka berat 50000 35000
18 UGD016 Ganti perban Post Secsio (hefafix) 25000 17500
19 UGD017 Hecting Luka 1 - 2 25000 17500
20 UGD018 Hecting Luka 3 - 5 35000 24500
21 UGD019 Hecting Luka 1 - 4 50000 35000
22 UGD020 Hecting Luka 6 - 10 100000 70000
23 UGD021 Hecting Luka 11 - 20 150000 105000
24 UGD022 Hecting Luka 20 - 25 270000 189000
25 UGD023 Hecting Luka 25 -30 350000 245000
26 UGD024 Hecting Luka 30 - 35 420000 294000
27 UGD025 Hecting Luka 35 - 40 500000 350000
28 UGD026 Hecting Luka > 40 40000 28000
29 UGD027 Intubasi (Pemasangan ETT) 35000 24500
30 UGD028 Insisi Abses/punksi abses 35000 24500
31 UGD029 Luka Bakar 5 - 10 % 40000 28000
32 UGD030 Luka Bakar 10 - 20 % 60000 42000
33 UGD031 Luka Bakar > 20% 80000 56000
34 UGD032 Nebulizer 60000 50000
35 UGD033 Observasi pasien 50000 35000
36 UGD034 Pasang Infuse Dewasa 25000 18000
37 UGD035 Pasang Infuse Anak 35000 24000
38 UGD036 Pasang Kateter 40000 26000
39 UGD037 Pasang mag slang / NGT 30000 20000
40 UGD038 Pasang Guidel 15000 9000
41 UGD039 Perawatan luka gangren 40000 26000
42 UGD040 Pemakaian DC Shock 50000 30000
43 UGD041 Pemakaian Suction 10000 5000
44 UGD042 Pemasangan Monitor 60000 45000
45 UGD043 Pasang Spalk Dewasa 10000 5000
46 UGD044 Pasang Spalk Anak 15000 8000
47 UGD045 Pasang O2 15000 10000
48 UGD046 Rawat luka/cuci luka (necrotomi, gigitan) 35000 25000
49 UGD047 Resusitasi kordiopulmonar (RSP) 50000 30000
50 UGD048 Repusisi tulang sendi/Tempro 30000 15000
51 UGD049 mediabular joint Mandibular Joint 30000 15000
52 UGD050 Sircum sisi 350000 250000
53 UGD051 Spooling telinga/hidung/mata 35000 20000
54 UGD052 Transfusi darah 40000 30000
55 UGD053 Tampon Episkasis Masif 30000 15000
56 UGD054 Spuling Past Op 30000 20000
57 UGD055 Visum Hidup 60000 40000
58 UGD056 Visum mayat 200000 150000
59 UGD057 Syringe Pump/ infus pump perhari 75000 50000
60 UGD058 Spoling untuk trauma bahan kimia 30000 20000
61 UGD059 Irigasi 30000 20000
62 UGD060 Spooling Cateter 20000 10000
63 UGD061 Resusitasi bayi patologis 50000 20000
64 UGD062 Pasang rangsel 40000 20000
RSU AISYIYAH ST KHADIJAH

JASA DOKTER JASA PERAWAT JASA NON MEDIS

DPJP

0 0 0
0 0 0
30000 2500 2500
2500 2500 2500
3000 3000 3000
2000 2000 2000
5000 5000 5000
5000 5000 5000
6000 6000 6000
6000 6000 6000
5000 5000 5000
6000 6000 6000
2500 2500 2500
3000 3000 3000
5000 5000 5000
2500 2500 2500
2500 2500 2500
3500 3500 3500
5000 5000 5000
10000 10000 10000
15000 15000 15000
27000 27000 27000
35000 35000 35000
42000 42000 42000
50000 50000 50000
4000 4000 4000
3500 3500 3500
3500 3500 3500
4000 4000 4000
6000 6000 6000
8000 8000 8000
0 5000 5000
0 7500 7500
0 3500 3500
0 6000 5000
4000 5000 5000
4000 3000 3000
2000 2000 2000
4000 5000 5000
10000 5000 5000
 0 2500 2500
5000 5000 5000
0 2500 2500
0 3500 3500
0 2500 2500
0 5000 5000
10000 5000 5000
10000 2500 2500
10000 2500 2500
50000 25000 25000
8000 3500 3500
0 5000 5000
8000 3500 3500
0 5000 5000
10000 5000 5000
30000 10000 10000
5000 10000 10000
0 5000 5000
4000 3000 3000
0 5000 5000
20000 5000 5000
10000 5000 5000