RUMAH SAKIT DR CIPTO MANGUNKUSUMO

DAFTAR TARIF UNIT BEDAH RAWAT SEHARI

RSCM TAHUN 2015

NO JENIS PELAYANAN TARIF

A KECIL
OPERASI KECIL I
1 CABUT CDL 1,788,000
2 CABUT CELLSITE 1,788,000
3 EKSISI LYMPADENOPATI COLLI LOKAL 1,788,000
4 SIRKUMSISI LOKAL 1,788,000

OPERASI KECIL II
1 Biopsi LOKAL 3,988,000
2 DC LOKAL 3,988,000
3 Eksterp. Tumor Jinak LOKAL 3,988,000
4 Pasang Epidural LOKAL 5,088,000

B SEDANG
OPERASI SEDANG I
1 Aff Tampon Beloq 6,833,000
2 Biopsi dengan Hepatitis/HIV 7,838,000
3 Biopsi Hepar 7,838,000
4 Biopsi KGB 6,460,000
5 Cimino Bius Umum 6,833,000
6 Cimino LOKAL 5,088,000
7 DC Eksterpasi 6,080,000
8 DC Eksterpasi/ EKSPLORASI VAGINA 6,460,000
9 Debridement Mastitis 6,833,000
10 Eksisi Buritis Kecil 7,838,000
11 EKSISI FAM BESAR 6,833,000
12 Eksisi FAM KECIL 6,460,000
13 Eksisi Fibroma 6,833,000
14 Eksisi Hemangioma Sederhana 6,833,000
15 Eksisi Keloid 7,838,000
16 Eksisi KGB Bius Umum 6,833,000
17 Eksisi KGB Bius Lokal 5,088,000
18 Eksisi KGB Besar 7,838,000
19 Eksisi Kista Atheroma/Dermoid 6,833,000
20 Eksisi Mastitis 7,838,000
21 Eksisi Nevus 7,838,000
22 Eksisi Sinekia 6,833,000
23 EKSISI SISTOKEL KECIL 6,833,000
24 Eksisi Soft Tissue Massa 7,838,000
25 Eksisi Tumor 6,833,000
26 Eksisi Tumor Recti 7,421,000
27 Eksterpasi Ganglion KECIL ANAK 6,460,000
28 Eksterpasi Ganglion KECIL DEWASA 6,833,000
29 Eksterpasi Ganglion SEDANG I 7,421,000
30 Eksterpasi Ganglion SEDANG II 7,838,000
31 Eksterpasi Lipoma BESAR 7,421,000
32 Eksterpasi Lipoma KECIL 6,460,000
33 Eksterpasi Lipoma SEDANG 6,833,000
34 Fistel Pre Auriculer 8,388,000

24. Unit Bedah Rawat Sehari/2015

 RUMAH SAKIT DR CIPTO MANGUNKUSUMO
DAFTAR TARIF UNIT BEDAH RAWAT SEHARI
RSCM TAHUN 2015

NO JENIS PELAYANAN TARIF

35 Fistulektomy 7,421,000
36 Fistulektomy dg komplikasi 8,388,000
37 Hemoroidektomi 7,421,000
38 Hemoroidektomi dg komplikasi 8,388,000
39 Injeksi Bleomycin 6,833,000
40 Jahit Seconder 6,833,000
41 Konisasi 7,838,000
42 Ligasi Vena Cabang Bius Lokal 5,088,000
43 Ligasitinggi 6,460,000
44 Pasang CDL Bius Umum 6,833,000
45 Pasang Cellsite dalam Narkose 6,833,000
46 Pasang Cellsite LOKAL 6,326,000
47 Pasang CVP LOKAL 5,088,000
48 Pasang double lument LOKAL 5,088,000
49 Pasang WSD Bius Umum 6,833,000
50 Remove Implant Lokal 6,326,000
51 Sirkumsisi Anestesi 5,293,000
52 Sirkumsisi Anestesi DGN HEMOFILIA 5,293,000
53 Sirkumsisi Anestesi DGN PHIMOSIS 5,293,000
54 Stimulator 6,833,000
55 Tracheostomi Bius Lokal 5,088,000
56 Tracheostomi Bius Umum 6,833,000

OPERASI SEDANG II
1 Adenoidectomi 6,899,000
2 Amputasi > 1 Jari 8,255,000
3 Apendiktomy AKUT/ KRONIS ANAK 7,273,000
4 Apendiktomy Dewasa 8,255,000
5 Apendiktomy Dewasa DGN HIV + / HEP B 10,038,000
6 Apendiktomy Dewasa DGN PERLENGKETAN 10,038,000
7 Biopsi Otot 7,838,000
8 Bronchoscopy 7,273,000
9 Cabut K Wire CLAVICULA 7,861,000
10 Cabut K Wire PATELLA 7,861,000
11 Cabut K Wire TANGAN 7,861,000
12 CABUT PLATE SCREW CLAVICULA 8,255,000
13 Cabut Plate Screw LENGAN 8,255,000
14 CABUT PLATE SCREW PAHA 8,801,000
15 CABUT PLATE SCREW TUNGKAI 8,255,000
16 Colostomy 8,255,000
17 Core Biopsi 7,838,000
18 DEBRIDEMANT LUAS 10,038,000
19 Debridement SEDERHANA 8,801,000
20 Eksisi Biopsi KGB Bilateral 8,801,000
21 Eksisi FAM bilateral 8,801,000
22 Eksisi FAM bilateral BESAR 10,038,000
23 Eksisi Kista Tyroglosis 7,861,000
24 Eksterpasi KGB dengan HBSAg Positif/HIV 8,801,000
25 Eksterpasi Tumor Jinak Multiple 8,801,000

24. Unit Bedah Rawat Sehari/2015

 RUMAH SAKIT DR CIPTO MANGUNKUSUMO
DAFTAR TARIF UNIT BEDAH RAWAT SEHARI
RSCM TAHUN 2015

NO JENIS PELAYANAN TARIF

26 Esksplorasi Nasofaring 7,273,000

27 Esofaguscopy 7,273,000
28 Gastrostomi 7,273,000
29 Herniatomi anak 6,899,000
30 Labioplasty 7,273,000
31 Laringoskopi 7,273,000
32 OD 1-2 Elemen 8,801,000
33 Orhidopeksi 8,801,000
34 Palatoplasty 8,801,000
35 Pleuroscopy 7,273,000
36 Release Chordee 8,801,000
37 Release Web Penis 8,801,000
38 Revisi Scar 8,801,000
39 Revisi Stump 9,162,000
40 TA + DAWO 8,801,000
41 TBNA 7,838,000
42 Tonsilektomi 7,273,000
43 Tonsilektomi Adenoidectomy 7,273,000

C BESAR
OPERASI BESAR I
1 Aff Implant Multiple 18,700,000
2 Bone Graft 11,362,000
3 Colostomi Per Laparascopy 10,455,000
4 EKSISI BASALIOMA 9,525,000
5 Eksisi Bursitis Besar 9,525,000
6 Eksisi FAM Multiple 10,060,000
7 Eksisi Ginecomasty 9,525,000
8 Eksisi Mamae Aberants 9,525,000
9 Eksisi Osteochondroma 9,525,000
10 Eksterpasi Hemangioma cavumnasi 9,525,000
11 Eksterpasi Granuloma Alanasi 9,525,000
12 Esofaguscopy + Laringoscopy 11,362,000
13 Fistulektomi Pre Auriculer Bilateral 10,038,000
14 Hernia Anak Bilateral 10,038,000
15 Hernia Dengan Mesh 10,455,000
16 Hernia Dengan Mesh Komplikasi 12,083,000
17 OD 3 Elemen 12,083,000
18 ORIF K Wire I 11,001,000
ORIF TBW ( OPEN REDUKSI FRAKTUR/ DISLOKASI LAMA )
19 12,083,000
20 Osteotomy 11,362,000
21 Radikal Curretage 9,525,000
22 Rekonstruksi 12,083,000
23 Release CTEV I Kaki 12,083,000
24 Release CTEV II Kaki 17,466,000
25 Release Kontraktur 12,083,000
26 Release Tendon 9,525,000
27 Release Trigger Thumn Bilateral 11,362,000

24. Unit Bedah Rawat Sehari/2015

 RUMAH SAKIT DR CIPTO MANGUNKUSUMO
DAFTAR TARIF UNIT BEDAH RAWAT SEHARI
RSCM TAHUN 2015

NO JENIS PELAYANAN TARIF

28 Striping I Tungkai 9,914,000

29 Striping II Tungkai 13,843,000
30 Synovektomi 11,362,000
31 Tutup Defect 12,083,000
32 Urethroplasty 12,083,000
33 Wide Eksisi 9,525,000

OPERASI BESAR II
1 Arthtroscopy Menisectomi 18,700,000
2 Eksisi Hemangioma luas 12,817,000
3 Hernia Dewasa Bilateral 18,913,000
4 OD > 4 Elemen 14,236,000
5 ORIF Plate Screw > 2 FRAKTUR 22,000,000
6 ORIF Plate Screw 2 FRAKTUR 18,700,000
7 ORIF Plate Screw CLAVICULA 11,735,000
8 ORIF Plate Screw FEMUR 16,638,000
9 ORIF Plate Screw RADIUS ULNA 12,817,000
10 ORIF Plate Screw TIBIA 12,817,000
11 Sialadenectomy 12,817,000
12 Transfer Tendon 12,817,000
13 Tutup Defek dengan STSG 18,913,000

D KHUSUS
OPERASI KHUSUS
1 FESS 18,700,000
2 Histerektomy 18,700,000
3 LAPARASCOPI APPENDICTOMI 14,575,000
4 LAPARASCOPI CHOLESISTECTOMI 18,700,000
5 Miringoplasty 15,538,000
6 Pasang Prothese 22,000,000
7 Potong Stump 15,538,000
8 RFA 7,838,000
9 Septorhinoplasty 15,538,000
10 Timpanoplasty 15,538,000

24. Unit Bedah Rawat Sehari/2015