TARIF 50 % RS METRO MEDIKA TNP BHP (Edited 19-5-2018)

RUMAH SAKIT METRO MEDIKA
Jl. Jendral Sudirman No. 18 A Rembiga, Mataram

Telp. 081917998947 / 085337927072
Email : Rsmetromedikalombok@gmail.com
TARIF UMUM DAN TINDAKAN
NO. JENIS TINDAKAN TARIF
1.1 Administrasi Rawat Jalan 70,000

1.2 Administrasi Rawat Inap 250,000
1.3 Administrasi Pengisian Mendical Report (Klaim Asuransi) 75,000
Surat Keterangan Sehat / Sakit dengan Pemeriksaan (termasuk
1.4 100,000
Loket) + RM
1.5 Jasa Medis Poliklinik Umum 80,000
1.6 Aff Drain 70,000
1.7 Aff Hecting 60,000
1.8 Aff Hecting 1-5 Jahitan 65,000
1.11 Aff Hecting > 15 Jahitan 80,000
1.12 Aff Infus/Katheter/NGT 60,000
1.13 Aff Tampon Hidung/Telinga/vagina 60,000
1.14 Darm Boizt 65,000
1.15 Diet Via Sonde 60,000
1.16 EKG 100,000
1.17 Eksplorasi Luka (Ictum/Snape Bite) 70,000
1.18 Ekstirpasi Kecil dr. Umum 200,000
1.19 Ekstirpasi Sedang dr. Umum 250,000
1.20 Ekstirpasi Besar dr. Umum 300,000
1.21 Ekstraksi Corpus Alienum 90,000
1.22 Ekstrasksi Kuku 90,000
1.23 Injeksi IM/IV/IC/SC 55,000
1.24 Insisi Abses 100,000
1.25 Intubasi/Pasang ETT 225,000
1.26 Irigasi/Spoeling Mata/Telinga 75,000
1.27 Kumbah Lambung 95,000
1.28 Luka Bakar 1 (<5%) 70,000
1.29 Luka Bakar 2 (5 - 15%) 100,000
1.30 Luka Bakar 3 (15 - 20%) 150,000
1.31 Luka Bakar Luas >20% 200,000
1.32 Luka Lecet 1 (<5%) 60,000
1.33 Luka Lecet 2 (5 - 10%) 80,000
1.34 Luka Lecet 3 (>10%) 100,000
1.35 Luka Robek 1 (HT<5) 75,000
Telp. 081917998947 / 085337927072

1.36 Luka Robek 2(HT 5-10) 90,000
1.37 Luka Robek 3(HT > 10) 110,000
1.38 Nebulizer 110,000
1.39 NST (Non Stress Test) 140,000
1.40 Observasi UGD per jam 85,000
1.41 Pasang Guedel 65,000
1.42 Pasang Infus Akses V. Umbilical 110,000
1.43 Pasang Infus Anak/Bayi 85,000
1.44 Pasang Infus Dewasa 75,000
1.45 Pasang Katheter 90,000
1.46 Perawatan Infus 55,000
1.47 Pasang NGT 81,000
1.48 Pasang spalk kecil 1 bilah 65,000
1.49 Pasang spalk panjang 2 bilah 75,000
1.50 Pasang spalk sedang 2 bilah 70,000
1.51 Pasang Tampon Hidung Anterior / Telinga 80,000
1.52 Pasang Tampon Hidung Posterior 105,000
1.53 Pemakaian Collar Brace (incl. sewa Collar) 70,000
1.54 Pemakaian Collar Brace 70,000
1.55 Pemakaian O2 Kanul per 30 Menit 120,000
1.56 Pemakaian O2 Kanul per 1 Jam 180,000
1.57 Pemakaian O2 Tabung Besar 450,000
1.58 Pemakaian O2 Tabung Kecil 250,000
1.59 Rawat Luka 1 (HT< 5 ) 65,000
1.60 Rawat Luka 2 (HT 5 - 10 ) 70,000
1.61 Rawat Luka 3 (HT > 10 ) 90,000
1.62 Rawat Luka Diabetic 1 / Post Op. Sedang 85,000
1.63 Rawat Luka Diabetic 2 / Post Op. Besar 90,000
1.64 Rawat Luka Diabetic 3 / Post Op. Extra 120,000
1.65 Rectal Toucher/Colok Dubur 65,000
1.66 Rumple Leed 60,000
1.67 Skin Test 58,000
1.68 Surface Cooling 62,000
1.69 Syring Pump 150,000
1.70 Tindakan Suction 75,000
1.71 Visum Et Repertum 105,000
1.72 Pasang Infus Anak/Bayi Sulit (On Call) 170,000
1.73 Monitor 80,000
1.74 Pemakaian Continous Suction Pump (WSD) 210,000
1.75 Transfusi 75,000
1.76 Tarif pasang Bandage
1.77
1.78
1.79
Catatan :
Resusitasi O : Pasien Meninggal
Resusitasi I : Pasien Hidup
Telp. 081917998947 / 085337927072
TARIF TINDAKAN dr. SPESIALIS
A. TARIF TINDAKAN SPESIALIS UMUM

2.1 Aff Cateter 88,000
2.2 Aff Drain/WSD 280,000
2.3 Aff NGT 90,000
2.4 Biopsi Lokal 450,000
2.5 First Konsul 175,000
2.7 Jasa Pasang Infus 165,000
2.8 Lumbal Punksi 500,000
2.9 Pasang ETT 335,000
2.10 Pasang Kateter/NGT 165,000
2.11 Pasang WSD 500,000
2.12 Punksi Ascites 450,000
2.13 Rawat Luka Post Op. Obgyn/Bedah Sedang RJ 100,000
2.14 Rawat Luka Post Op. Obgyn/Bedah Berat RJ 120,000
Rawat Luka Post Op. Obgyn/Bedah Extra Berat
2.15 150,000
RJ
2.16 Tindik Telinga 145,000
2.17 Tuberculin Test 275,000
2.18 Vena Section 395,000
2.19 Vena Umbilical 170,000
2.20 Pasang Ventilator 160,000
2.21 Vaginal Taucher (SP) 85000
Telp. 081917998947 / 085337927072

B. TARIF TINDAKAN SPESIALIS BEDAH DAN ORTHOPAEDI
2.22 Biopsi FNAB (Sp) 495,000
2.23 Buka gips short arm/leg (Sp) 138,000
2.24 Buka gips long arm/leg (Sp) 220,000
2.25 Circumsisi (Sp) 515,000
2.26 Debridement + Heeting (Sp) 340,000
2.27 Dilatasi phimosis (Sp) 170,000
2.28 Eksisi/ekstirpasi kecil (Sp) 390,000
2.29 Eksisi/ekstirpasi sedang (Sp) 445,000
2.30 Eksisi/ekstirpasi besar (Sp) 500,000
2.31 Incisi Abses (Sp) 225,000
2.32 Pasang gips tanpa reposisi short arm/leg (Sp) 385,000
2.33 Pasang gips tanpa reposisi long arm/leg (Sp) 495,000
2.34 Pasang gips dengan reposisi short arm/leg (Sp) 605,000
2.35 Pasang gips dengan reposisi long arm/leg (Sp) 715,000
2.36 Pasang Ransel Verban (Sp) 231,000
2.37 Pasang Skin Traksi (Sp) 275,000
2.38 Pungsi Sendi/Sinopial (Sp) 332,000
2.39 Rawat Luka Kecil RI (Sp) 115,000
2.40 Rawat Luka Sedang RI (Sp) 170,000
2.41 Rawat Luka Besar RI (Sp) 225,000
2.42 Rawat Luka Ekstra Besar RI (Sp) 335,000
2.43 Rawat Luka Post Op. Ortho Sedang (Sp) 126,000
2.44 Rawat Luka Post Op. Ortho Berat (Sp) 170,000
2.45 Rawat Luka Post Op. Ortho Exstra Berat (Sp) 258,000
2.46 Reposisi & Pasang Ransel Verban (Sp) 445,000
2.47 Kemoterapi Grade I (Sp) 620,000
2.48 Kemoterapi Grade II (Sp) 345,000
2.49 Luka Bakar (Sp) 350,000

Telp. 081917998947 / 085337927072
NO. JENIS TINDAKAN Tarif

C. TARIF TINDAKAN SPESIALIS OBGYN
2.50 Pap Smear 550,000
2.51 Aff Implant / Susuk KB 280,000
2.52 Aff Tampon Vagina 88,000
2.53 Ekstraksi Fragmen IUD 250,000
2.54 Ekstraksi IUD Biasa 167,000
2.55 Ekstraksi IUD Missing Tile /Sp 275,000
2.56 Explorasi Post Abortus 340,000
2.57 Explorasi Post Partum 340,000
2.58 Pasang/Insersi IUD 475,000
2.59 Pasang Tampon Vagina 110,000
2.60 Pasang Ring Pesarium 225,000
2.61 USG Intra Vaginal 185,000
2.62 USG Obgyn dengan Print pada ANC 140,000
2.63 USG Obgyn tanpa Print pada ANC 135,000
2.64 Vaginal Swab 85,000
2.65 Vaginal Taucher/VT (SP) 85,000
2.66 VT (Bidan) 70,000
2.67 Pasang Tampon Sayeba Kondom 634,000
2.68 DJJ 60,000
2.69 Explorasi Post SC 70,000
2.70 Imunisasi Dasar 120,000
2.71 Injeksi Delladryl/Xyllo della/TT 55,000
2.72 Observasi VK < 12 Jam 160,000
2.73 Observasi VK > 12 Jam -< 24 Jam 255,000
2.74 Pasang Ring Pesarium 125,000
2.75 Pasang Ransel Verban 85,000
2.76 Pasang Tampon Vagina 80,000
2.77 Rectal/ Per Vaginam Supp 55,000
2.78 Resusitasi 0 (Dewasa) 75,000
2.79 Resusitasi 1 (Dewasa) 195,000
2.80 Resusitasi Bayi 110,000
2.81 Test Lakmus 55,000
2.82 Suntik KB (Tidak ada biaya Loket) 80,000
2.83 Tes IVA 125,000
Catatan :
- Setiap Tindakan Spesialistik di UGD, VK dan OK yang dirawat / observasi ≥ 2 jam sampai dengan ≤ 12 jam
ditambahkan Tarif Akomodasi ONE DAY CARE (ODC)
Telp. 081917998947 / 085337927072

D. TARIF TINDAKAN SPESIALIS THT
2.84 Aff Tampon Hidung / Telinga (Sp) 88,000
2.85 Ext. Corpus Alineum THT/Scrumen/Krusta Hidung (Sp) 112,000
2.86 Irigasi Sinus Satu Sisi (Sp) 615,000
2.87 Irigasi Sinus Dua Sisi (Sp) 898,000
2.88 Parasintesa/Pungsi Aspirasi Othematom (Sp) 220,000
2.89 Paasang Tampon Hidung Anterior Telinga (Sp) 143,000
2.90 Pasang Tampon Hidung Posterior (Sp) 285,000
2.91 Reposisi Hidung (Sp) 500,000
2.92 Spooling Telinga (Sp) 111,000
2.93 Biopsi THT (Sp) 615,000
2.94 Aff Tampon Hidung/Telinga RI (Sp) 253,000
NO. JENIS TINDAKAN

TARIF
E. TARIF TINDAKAN SPESIALIS MATA
2.95 BHP Pemeriksaan Mata Rutin (Sp) 5,000
2.96 Ekstirpasi Plerigium (Sp) BS / CLG 500.000 - 100.0000
2.97 Ekstraksi Corpus Alineum Mata dg alat khusus (Sp) 150,000
2.98 Ekstraksi Corpus Alineum Mata dg cotton bud (Sp) 150,000
2.99 Insisi & Kuretase Hordeolum (Sp) 250,000
2.100 Irigasi Ductus Nasolakrimalis (Sp) 75,000
2.101 Lithiasis 345,000
2.102 Probbing 230,000
2.103 Ruptur Konjuntiva 400,000
2.104 Ruptur Palbera 345,000
2.105 Refraksi (Sp) 20,000
2,106 Heacting Kornea 1,500,000
2,107 Katarak SICS + IOL 9,000,000
NO. JENIS TINDAKAN

TARIF
F. TARIF TINDAKAN KULIT
2,106 Tindakan Kulit Ringan 142,000
2,107 Tindakan Kulit Sedang 213,000
2,108 Tindakan Kulit Besar 284,000
Telp. 081917998947 / 085337927072
PAKET PERSALINAN NORMAL 1 HARI

(Dalam Rupiah)
No Kelas Tindakan Sewa Konsumsi Total
1 VVIP 3,438,000 400,000 90,000 3,928,000
2 VIP 2,638,000 300,000 75,000 3,013,000
3 Kelas I 2,190,000 150,000 60,000 2,400,000
4 Kelas II 1,875,000 110,000 45,000 2,030,000
5 Kelas III 1,653,000 85,000 30,000 1,768,000
Ket: Biaya belum termasuk obat, akomodasi,perawatan dan pemeriksaan penunjang
PAKET TINDAKAN SC 4 HARI PERAWATAN

(Dalam Rupiah)
NO. Kelas Tindakan Sewa Konsumsi Total
1 VVIP 7,462,000 1,600,000 360,000 9,422,000
2 VIP 5,977,000 1,200,000 300,000 7,477,000
3 Kelas I 4,861,000 600,000 240,000 5,701,000
4 Kelas II 4,267,000 440,000 180,000 4,887,000
5 Kelas III 3,946,000 340,000 120,000 4,406,000

Telp. 081917998947 / 085337927072
A. TARIF TINDAKAN PARTUS NORMAL DI TOLONG OBGYN (1 HARI PERAWATAN)

(Dalam Rupiah)
NO. URAIAN VIP KELAS I KELAS II KELAS III
1 DOKTER OBGYN 1,300,000 1,075,000 925,000 900,000
2 ASISTEN OPERATOR 130,000 107,000 92,000 80,000
3 RESUSITASI BAYI (ASISTEN) 125,000 100,000 75,000 65,000
4 SEWA KAMAR BERSALIN 450,000 350,000 275,000 225,000
5 BIAYA PERAWATAN 425,000 350,000 300,000 275,000
6 BHP 200,000 150,000 125,000 100,000
8 BIAYA KAMAR + VISITE dr. UMUM 600,000 300,000 220,000 170,000
JUMLAH 3,230,000 2,432,000 2,012,000 1,815,000
B. TARIF TINDAKAN PARTUS NORMAL DI TOLONG BIDAN ( 2 HARI PERAWATAN)

(Dalam Rupiah)
1 BIDAN 700,000 650,000 600,000 600,000
3 RESUSITASI BAYI 125,000 100,000 75,000 65,000
4 SEWA KAMAR BERSALIN 450,000 350,000 275,000 225,000
5 BIAYA PERAWATAN 425,000 350,000 300,000 275,000
6 VISITE DOKTER ANAK 200,000 150,000 125,000 100,000
7 VISITE DOKTER OBGYN 200,000 150,000 125,000 100,000
8 BIAYA KAMAR 600,000 300,000 220,000 170,000
JUMLAH 2,830,000 2,157,000 1,812,000 1,615,000
C. TARIF TINDAKAN SC 3 HARI PERAWATAN

(Dalam Rupiah)
1 OPERATOR 2,250,000 1,650,000 1,350,000 1,200,000
3 dr. ANESTESI 788,000 578,000 473,000 420,000
4 ASISTEN dr. ANESTESI 225,000 165,000 135,000 120,000
5 INSTRUMENT 160,000 116,000 100,000 84,000
6 ON LOOP 113,000 83,000 68,000 60,000
7 dr. ANAK (RESUSITASI) 275,000 225,000 175,000 150,000
8 ASISTEN dr. ANAK 97,000 80,000 62,000 53,000
9 BIAYA PERAWATAN 780,000 735,000 705,000 675,000
10 SEWA KAMAR OPERASI 1,460,000 1,415,000 1,385,000 1,355,000
11 BIAYA KAMAR 900,000 450,000 330,000 225,000
12 VISITE DR ANAK 200,000 150,000 125,000 100,000
13 VISITE DR OBGYN 200,000 150,000 125,000 100,000
JUMLAH 7,673,000 5,962,000 5,168,000 4,662,000
D. TARIF TINDAKAN CURETAGE
(Dalam Rupiah)
NO. URAIAN TARIF
1 OPERATOR 500,000
2 ASISTEN OPERATOR 50,000
3 dr. ANESTESI 250,000
4 ON LOOP 25,000
5 SEWA KAMAR OPERASI 500,000
JUMLAH 1,325,000
E. TARIF TINDAKAN RESUSITASI BAYI

(Dalam Rupiah)
1 DOKTER ANAK 275,000 225,000 175,000 150,000
Catatan :
- Biaya tersebut belum termasuk Akomodasi, Visite Dokter, Perawatan, Pemeriksaan Penunjang dan Obat.
- Tarif Partus Gemeli (Persalinan Kembar) adalah 1 1/2 (satu setengah) kali dari Tarif Partus Normal
- PN : - Persalinan Tanpa Komplikasi
- Persalinan dengan Episiotomi Grade I-II
- Persalinan Prematur
- PP A : - Persalinan dengan Epsiotomi / Ruptur Grade III
- Persalinan dengan Induksi
- Persalinan dengan Penyakit Pada Ibu
- Persalinan dengan Vacuum / Forcep
- PP B : - Persalinan dengan Ruptur Total
- Persalinan dengan Plasenta Manual / Kuretase
- Persalinan dengan LMR
- Persalinan Letak Sungsang
- Persalinan dengan HPP
Telp. 081917998947 / 085337927072
TARIF PELAYANAN INSTALASI RADIOLOGI
A. TARIF RADIOLOGI RONTGEN DEWASA TARIF

1 Thorax PA 160,000
2 Thorax Lateral 140,000
3 Shoulder AP 120,000
4 Humerus AP-Lateral 130,000
5 Elbow AP-Lateral 130,000
6 Antebrachi AP-Lateral 140,000
7 Wrist AP-Lateral 130,000
8 Manus AP-Oblik 130,000
9 Femur AP-Lat 140,000
10 Genu D/S 130,000
11 Genu Bilateral 200,000
12 Cruris AP-Lat 140,000
13 Ankle AP-Lat 130,000
14 Calcaneus 130,000
15 Pedis AP-Oblik 130,000
16 Kepala AP-Lat 180,000
17 Waters 130,000
18 SPN 180,000
19 Nasal 130,000
20 Cervical AP-Lat 200,000
21 BNO 3 Posisi 290,000
22 USG Abdomen :
23 a. USG Abdomen Atas 300,000
24 b. USG Abdomen Bawah 300,000
25 USG Thorax 300,000
26
B. TARIF RADIOLOGI RONTGEN ANAK TARIF

1 Thorax PA 130,000
2 Thorax Lateral 130,000
3 Shoulder AP 110,000
4 Humerus AP-Lateral 120,000
5 Elbow AP-Lateral 120,000
6 Antebrachi AP-Lateral 120,000
7 Wrist AP-Lateral 120,000
8 Manus AP-Oblik 120,000
9 Femur AP-Lat 130,000
10 Genu D/S 120,000
11 Genu Bilateral 190,000
12 Cruris AP-Lat 130,000
13 Ankle AP-Lat 120,000
14 Calcaneus 120,000
15 Pedis AP-Oblik 120,000
16 Kepala AP-Lat 170,000
17 Waters 120,000
18 SPN 170,000
19 Nasal 120,000
20 Cervical AP-Lat 190,000
21 BNO 3 Posisi 290,000
22 USG Abdomen :
23 a. USG Abdomen Atas 300,000
24 b. USG Abdomen Bawah 300,000
25 USG Thorax 300,000
Telp. 081917998947 / 085337927072
TARIF PEMERIKSAAN LABORATORIUM
KELAS III / Rawat

NO JENIS PEMERIKSAAN VIP KELAS I KELAS II Ket.
Jalan
Hematologi
1 Darah Lengkap +LED 69,000 64,000 59,000 55,000
2 Golongan Darah 19,000 17,000 16,000 15,000
3 Bleding Time 17,000 14,000 12,000 12,000
4 Cloting Time 17,000 14,000 12,000 12,000
Urinalisa
5 Urine Lengkap 30,000 27,000 24,000 22,000
6 PP Test 25,000 24,000 22,000 17,000
7 Reduksi 17,000 14,000 12,000 10,000
Imunologi
8 Widal 37,000 34,000 30,000 27,000
9 HBsAg 37,000 34,000 30,000 27,000
10 Malaria Stik 39,000 37,000 32,000 27,000
11 Malaria DDR 44,000 42,000 39,000 37,000
Analisa Fases
12 Fases Lengkap 29,000 27,000 26,000 25,000
13 Besidin Test 35,000 32,000 27,000 22,000
Kimia Klinik
14 Gula Darah Puasa 29,000 24,000 22,000 19,000
15 Gula Darah 2JPP 29,000 24,000 22,000 19,000
16 Ureum 36,000 34,000 33,000 32,000
17 Creatinin 36,000 34,000 33,000 32,000
18 Asam Urat 36,000 34,000 33,000 32,000
19 SGOT 34,000 32,000 28,000 26,000
20 SGPT 34,000 32,000 28,000 26,000
21 Cholesterol 38,000 36,000 34,000 32,000
22 HDL 41,000 39,000 37,000 34,000
23 LDL 23,000 22,000 21,000 19,000
24 Trielycerida 42,000 41,000 40,000 39,000
25 Tes Sperma 114,000 114,000 114,000 114,000
Yang Dirujuk
Demam Berdarah
26 DHF Ig M/ Ig G 264,000 254,000 244,000 234,000
27 DHF NS J (Antigen) 264,000 254,000 244,000 234,000
Protein
28 Albumin 39,000 36,000 34,000 31,000
29 Total Protein 39,000 37,000 36,000 34,000
30 Globulin 39,000 36,000 34,000 31,000
TBC
31 Sputum BTA 64,000 54,000 49,000 44,000
Telp. 081917998947 / 085337927072
G. TINDAKAN PERAWATAN GIGI

NO. URAIAN TARIF
KONSULTASI/RESEP 100,000
A. PERIODONTIS
SCALLING
Ringan 250,000
1.
Sedang 300,000
Berat 350,000
2. KURETASE 150.000/gigi
3. OPERKULEKTOMI 350.000 - 450.000
B. KONSERVASI
1. DEVITALISASI/TEMPAT SEMENTARA 150,000
STERILISASI
2. 1 Akar 130,000
> 1 Akar 200,000
PENGISIAN SALURAN AKAR
3. 1 Akar 150,000
> 1 Akar 200,000
4. POLP CAPING/MUMIFIKASI 150,000
TAMBAL GIC
Kecil 170,000
5.
Sedang 200,000
Besar 250.000 - 300.000
TAMBAL KOMPOSIT (LASER)
Kecil 200,000
6.
Sedang 250,000
Besar 300.000 - 400.000
7. VENEER 500.000 - 650.00
C. BEDAH MULUT
1. PENCABUTAN DENGAN TOPIKAL ANASTESI 80.000 - 150.000
2. PENCABUTAN GIGI DEWASA DENGAN INJEKSI 200.000 - 400.000
3. INSISI ABSES 150.000 - 250.000
4. ODONTECTOMI 1.050.000 - 1.550.000
D. ORTHODONTI
1. BRACKET (KAWAT PERMANEN)
Ringan 4,050,000
Sedang 5,050,000
Berat 6,050,000
2. BRACKET LEPASAN 2,050,000
3. RETAINER 1,050,000
4. KONTROL 150,000
E. PROSTHO
1. CETAK GIGI 100.000/RAHANG
BRIDE/CROWN
2. PFM 1.250.000/Unit
Full porceline 1.850.000/ Unit
GIGI TIRUAN LEPASAN
Akrilik (Gigi Pertama) 850,000
3. (Gigi berikut) 100,000
Valpas (Gigi Pertama) 850,000
(Gigi Berikut) 150,000
4. GIGI TIRUAN LENGKAP 4,050,000
Jl. Jendral Sudirman No. 18 A Rembiga,Selaparang Mataram
Telp. 081917998947 / 085337927072 , Email : rsmetromedikalombok@gmail.com
A. TARIF TINDAKAN BEDAH RINGAN

NO URAIAN VIP Kelas I Kelas II Kelas III
1 OPERATOR 1,300,000 900,000 700,000 600,000
3 ANASTESI 455,000 315,000 245,000 210,000
4 ASISTEN ANASTESI 130,000 90,000 70,000 60,000
5 INSTRUMENT 91,000 63,000 49,000 42,000
6 ON LOOP 65,000 45,000 35,000 30,000
7 PEMAKAIAN KAMAR OPERASI 778,000 748,000 718,000 688,000
8 BHP 150,000 150,000 150,000 150,000
JUMLAH 3,099,000 2,401,000 2,037,000 1,840,000
B. TARIF TINDAKAN BEDAH SEDANG

1 OPERATOR 1,600,000 1,200,000 1,000,000 900,000
3 ANASTESI 560,000 420,000 350,000 315,000
5 INSTRUMENT 112,000 84,000 70,000 63,000
6 ON LOOP 80,000 60,000 50,000 45,000
7 PEMAKAIAN KAMAR OPERASI 945,000 915,000 885,000 855,000
8 BHP 384,000 384,000 384,000 384,000
JUMLAH 4,001,000 3,273,000 2,909,000 2,712,000
C. TARIF TINDAKAN BEDAH BESAR

1 OPERATOR 2,250,000 1,650,000 1,350,000 1,200,000
3 ANASTESI 788,000 576,000 473,000 420,000
5 INSTRUMENT 158,000 116,000 95,000 84,000
6 ON LOOP 113,000 830,000 68,000 60,000
7 PEMAKAIAN KAMAR OPERASI 1,360,000 1,315,000 1,285,000 1,255,000
8 BHP 681,000 681,000 681,000 681,000
JUMLAH 5,800,000 5,498,000 4,222,000 3,940,000
D. TARIF TINDAKAN BEDAH KHUSUS (EKSTRA BESAR)

1 OPERATOR 2,550,000 1,950,000 1,650,000 1,500,000
3 ANASTESI 892,500 682,000 577,500 525,000
5 INSTRUMENT 178,500 136,500 115,500 105,000
6 ON LOOP 127,500 97,500 82,500 75,000
7 PEMAKAIAN KAMAR OPERASI 1,490,000 1,445,000 1,415,000 1,385,000
8 BHP 690,000 690,000 690,000 690,000
JUMLAH 6,438,500 5,391,000 4,860,500 4,580,000
Catatan :
- Biaya tersebut belum termasuk akomodasi, visite dokter, perawatan, pemeriksaan penunjang dan obat
- Untuk tindakan CITO dieknakan tambahan tarif sebesar 25% dari tarif normal
Telp. 081917998947 / 085337927072
JASA MEDIS ON CALL
NO. JASA BIAYA (Rp)
1.1 Jasa Medis Dokter Umum On Call 1 200,000

1.2 Jasa Perawat /Bidan On Call/Home Care 1 140,000
1.4 Jasa Medis On Call Dokter Spesialis 1 300,000
1.5 Konsul Antar Dokter Spesialis (Sp) 250,000
1.6 Konsul di atas Meja Oprasi (Sp) 600,000
1.7 Konsul Via Telepon (RJ) (Sp) 150,000
JASA VISITE dr. Spesialis

NO. KELAS PERAWATAN BIAYA (Rp)
1 VIP 300,000
2 Kelas I 250,000
3 Kelas II 225,000
4 Kelas III 200,000
Telp. 081917998947 / 085337927072
PAKET MCU STANDAR
NO PEMERIKSAAN
1 Pemeriksaan Fisik + Anamnesis (oleh dr. umum)
2 Pemeriksaan Foto Thorax (Bacaan Sp. Rad)
Pemeriksaan Laboratorium
3 Darah Lengkap
4 Urine Lengkap
5 Admininstrasi
TOTAL Rp. 250.000
Telp. 081917998947 / 085337927072
PAKET MCU MEDIUM
NO PEMERIKSAAN
1 Pemeriksaan Fisik + Anamnesis (oleh dr. umum)
2 Pemeriksaan Foto Thorax
3 Pemeriksaan EKG
4 Darah Lengkap
5 Urine Lengkap
Fungsi Hati
6 SGOT
7 SGPT
Fungsi Ginjal
8 Ureum
9 Kreatinin
10 Asam Urat
Profile Lemak
11 Kolesterol
12 HDL
13 LDL
14 Trigliserida
Karbohidrat (Gula Darah Puasa)
15 Gula Darah Puasa
16 2 Jam PP
17 Administrasi
TOTAL Rp. 880.000
Telp. 081917998947 / 085337927072
PAKET MCU LENGKAP
NO PEMERIKSAAN
1 Pemeriksaan Fisik + Anamnesis (oleh dr. Penyakit Dalam)
2 Pemeriksaan Foto Thorax
3 Pemeriksaan EKG
4 Darah Lengkap
5 Urine Lengkap
Fungsi Hati
6 SGOT
7 SGPT
Fungsi Ginjal
8 Ureum
9 Kreatinin
10 Asam Urat
Profile Lemak
11 Kolesterol
12 HDL
13 LDL
14 Trigliserida
Pemeriksaan Hepatitis
15 HbsAg
16 HbA1C
Karbohidrat (Gula Darah Puasa)
17 Gula Darah Puasa
18 2 Jam PP
19 Administrasi
TOTAL Rp. 1.000.000
Telp. 081917998947 / 085337927072
TARIF OPERASI ODC
Jasa
Fasilitas
Paket Operasi Dokter Asisten / Penata
Ruang OK Operator Adm Total
Anastesi Instrumen Anastesi
PAKET I (Kecil) 280,000 900,000 316,000 180,000 84,000 10,000 1,770,000
PAKET II (Sedang) 320,000 1,020,000 360,000 204,000 96,000 10,000 2,010,000
PAKET III (Besar) 400,000 1,500,000 500,000 300,000 110,000 25,000 2,835,000
Observasi ODC Tarif

2 Jam Pertama OP 60,000
2 Jam Selanjutnya OP 20,000
*Keterangan :
Biaya tersebut tidak termasuk bila terjadi komplikasi dan rawat bersama serta tindakan lain di luar operasi.
Telp. 081917998947 / 085337927072
TARIF RAWAT INAP RS METRO MEDIKA
No. Kelas Perawatan Biaya Perawatan

1 VIP 350,000
2 KELAS I 200,000
3 KELAS II 160,000
4 KELAS III 135,000
5. Box Bayi ( Rooming In ) VIP 150,000
6. Box Bayi ( Rooming In ) Kelas I 125,000
7. Box Bayi ( Rooming In ) Kelas II 115,000
8. Box Bayi ( Rooming In ) Kelas III 100,000
9. Kamar Bersalin (VK) 275,000
TARIF KONSULTASI SPESIALIS

NO. KETERANGAN HARGA
POLIKLINIK SPESIALIS
KONSULTASI 1 130,000
1 KONSULTAS1 2 150,000
2 JASA MEDIS ON CALL 100,000
Catatan :
Tarif tersebut diatas dapat berubah sewaktu-waktu tanpa
pemberitahuan terlebih dahulu
RUMAH SAKIT METRO MEDIKA Jl. Jendral Sudirman No. 18 A Rembige, MataramTelp.
081917998947/085337927072Email : Rsmetromedikalombok@gmail.com
V. TARIF TINDAKAN OBGYN

A. TARIF TINDAKAN PARTUS NORMAL
(Dalam Rupiah)
NO. URAIAN VIP I II III
1 DOKTER OBGYN 1,300,000 1,075,000 925,000 800,000
4 VK 450,000 350,000 275,000 225,000
5 RSU 425,000 350,000 300,000 275,000
6 BHP 208,000 208,000 208,000 208,000
JUMLAH 2,638,000 2,190,000 1,875,000 1,653,000
B. TARIF TINDAKAN PARTUS PATOLOGIS A

(Dalam Rupiah)
1 DOKTER OBGYN 1,500,000 1,225,000 1,075,000 950,000
4 VK 525,000 425,000 350,000 300,000
5 RSU 500,000 425,000 375,000 350,000
6 BHP 227,000 227,000 227,000 227,000
JUMLAH 3,042,000 2,537,000 2,222,000 1,997,000
C. TARIF TINDAKAN PARTUS PATOLOGIS B

(Dalam Rupiah)
1 DOKTER OBGYN 1,675,000 1,375,000 1,225,000 1,100,000
4 VK 525,000 425,000 350,000 300,000
5 RSU 500,000 425,000 375,000 350,000
6 BHP 227,000 227,000 227,000 227,000
JUMLAH 3,233,000 2,703,000 2,388,000 2,162,000
D. TARIF TINDAKAN RESUSITASI BAYI

(Dalam Rupiah)
1 DOKTER ANAK 275,000 225,000 175,000 150,000
Catatan :
- Tarif Partus Gemeli (Persalinan Kembar) adalah 1 ½ ( satu setengah ) kali dari Tarif Partus Normal
- PN : - Persalinan Tanpa Komplikasi
- Persalinan dengan Episiotomi Garde I-II
- Persalinan Premature
- PP A : - Persalinan dengan Epsiotomi / Ruptur grade III
- Persalinan dengan Induksi
- Persalinan dengan Penyakit Pada Ibu
- Persalinan dengan Vacuum / Forcep
- PP B : - Persalinan dengan Ruptur Total
- Persalinan dengan Plasenta Manual / Kuretase
- Persalinan dengan LMR
- Persalinan Letak Sungsang
- Persalinan dengan HPP
E. TARIF TINDAKAN CURETAGE

(Dalam Rupiah)
NO. URAIAN D&CI D & C II D & C IV D&CV
1 OPERATOR 550,000 650,000 750,000 850,000
3 DR. ANESTESI 275,000 325,000 375,000 425,000
4 ON LOOP 28,000 33,000 38,000 43,000
5 VK 350,000 425,000 525,000 650,000
6 RSU 225,000 275,000 350,000 450,000
7 BHP 175,000 225,000 300,000 400,000
JUMLAH 1,658,000 1,998,000 2,413,000 2,903,000
F. TARIF TINDAKAN OBGYN LAINNYA

(Dalam Rupiah)
Ass Operator
NO. URAIAN VK RSU Total
1 MARSUPIALISASI 35,000 150,000 150,000 746,000

2 MANUAL PLASENTA 50,000 150,000 150,000 917,000
3 REPAIR JALAN LAHIR 1 40,000 150,000 150,000 805,000
4 REPAIR JALAN LAHIR 2 55,000 150,000 150,000 995,000
5 REPAIR JALAN LAHIR 3 180,000 600,000 600,000 3,463,000
JUMLAH 360,000 1,200,000 1,200,000 6,926,000
Catatan :
- Biaya tersebut belum termasuk Akomodasi, Observasi, Pemeriksaan Penunjang dan Obat.
- Tindakan Spesialistik di UGD, VK, dan OK yang dirawat / observasi ≥ 2 jam sampai dengan ≤ 12 jam ditambahkan Tarif
Akomodasi ONE DAY CARE (ODC)
G. TARIF TINDAKAN SC
(Dalam Rupiah)
1 OPERATOR 2,250,000 1,650,000 1,350,000 1,200,000
3 DR. ANESTESI 788,000 578,000 473,000 420,000
4 ASISTEN DR. ANESTESI 225,000 165,000 135,000 120,000
5 INSTRUMENT 160,000 116,000 100,000 84,000
6 ON LOOP 113,000 83,000 68,000 60,000
7 DR. ANAK (RESUSITASI) 275,000 225,000 175,000 150,000
8 ASISTEN DR. ANAK 97,000 80,000 62,000 53,000
9 RSU 780,000 735,000 705,000 675,000
10 PKO 680,000 680,000 680,000 680,000
11 BHP 384,000 384,000 384,000 384,000
JUMLAH 5,977,000 4,861,000 4,267,000 3,946,000
H. TARIF TINDAKAN SC +STERIL

(Dalam Rupiah)
1 OPERATOR 2,400,000 1,800,000 1,500,000 1,350,000
3 DR. ANESTESI 840,000 630,000 525,000 473,000
5 INSTRUMENT 168,000 126,000 105,000 95,000
6 ON LOOP 120,000 90,000 75,000 68,000
8 ASISTEN DR. ANAK 97,000 80,000 62,000 53,000
9 RSU 810,000 735,000 710,000 695,000
10 PKO 680,000 680,000 680,000 680,000
11 BHP 430,000 430,000 430,000 430,000
JUMLAH 6,300,000 5,156,000 4,562,000 4,264,000
I. TARIF TINDAKAN SC PADA KEHAMILAN GEMELLI

(Dalam Rupiah)
1 OPERATOR 3,375,000 2,475,000 2,025,000 1,800,000
3 DR. ANESTESI 1,182,000 867,000 710,000 630,000
5 INSTRUMENT 237,000 174,000 142,000 126,000
6 ON LOOP 170,000 124,000 102,000 90,000
8 ASISTEN DR. ANAK 193,000 158,000 123,000 105,000
9 RSU 1,170,000 1,103,000 1,058,000 1,013,000
10 PKO 1,020,000 1,020,000 1,020,000 1,020,000
11 BHP 576,000 576,000 576,000 576,000
JUMLAH 9,149,000 7,443,000 6,512,000 6,020,000
Catatan :
- Untuk Tindakan Cito dikenakan Tambahan Tarif sebesar 25% dari Tarif Normal.
J. TARIF TINDAKAN GYNEKOLOGI SEDANG

(Dalam Rupiah)
1 OPERATOR 2,350,000 1,650,000 1,250,000 1,050,000
3 DR. ANESTESI 823,000 578,000 428,000 368,000
5 INSTRUMENT 165,000 116,000 88,000 74,000
6 ON LOOP 118,000 83,000 63,000 53,000
7 RSU 525,000 495,000 465,000 435,000
8 PKO 420,000 420,000 420,000 420,000
9 BHP 384,000 384,000 384,000 384,000
JUMLAH 5,255,000 4,056,000 3,348,000 2,994,000
K. TARIF TINDAKAN GYNEKOLOGI BERAT

(Dalam Rupiah)
1 OPERATOR 2,800,000 2,100,000 1,700,000 1,500,000
3 DR. ANESTESI 980,000 735,000 595,000 525,000
5 INSTRUMENT 196,000 147,000 119,000 105,000
6 ON LOOP 140,000 105,000 85,000 75,000
7 RSU 680,000 635,000 605,000 575,000
8 PKO 680,000 680,000 680,000 680,000
9 BHP 641,000 641,000 641,000 641,000
JUMLAH 6,677,000 5,463,000 4,765,000 4,401,000
L. TARIF TINDAKAN GYNEKOLOGI EXTRA BERAT

(Dalam Rupiah)
1 OPERATOR 3,200,000 2,500,000 2,100,000 1,900,000
3 DR. ANESTESI 1,120,000 875,000 735,000 665,000
5 INSTRUMENT 224,000 175,000 147,000 133,000
6 ON LOOP 160,000 125,000 105,000 95,000
7 RSU 755,000 710,000 680,000 650,000
8 PKO 735,000 735,000 735,000 735,000
9 BHP 690,000 690,000 690,000 690,000
JUMLAH 7,524,000 6,310,000 5,612,000 5,248,000
Catatan :
TARIF TINDAKAN BEDAH

(Dalam Rupiah)
1 OPERATOR 1,300,000 900,000 700,000 600,000
3 DR. ANESTESI 455,000 315,000 245,000 210,000
5 INSTRUMENT 91,000 63,000 49,000 42,000
6 ON LOOP 65,000 45,000 35,000 30,000
7 RSU 440,000 410,000 380,000 350,000
8 PKO 338,000 338,000 338,000 338,000
9 BHP 150,000 150,000 150,000 150,000
JUMLAH 3,099,000 2,401,000 2,037,000 1,840,000

(Dalam Rupiah)
1 OPERATOR 1,600,000 1,200,000 1,000,000 900,000
3 DR. ANESTESI 560,000 420,000 350,000 315,000
5 INSTRUMENT 112,000 84,000 70,000 63,000
6 ON LOOP 80,000 60,000 50,000 45,000
7 RSU 525,000 495,000 465,000 435,000
8 PKO 420,000 420,000 420,000 420,000
9 BHP 384,000 384,000 384,000 384,000
JUMLAH 4,001,000 3,303,000 2,939,000 2,742,000
Catatan :
C. TARIF TINDAKAN BEDAH BERAT

(Dalam Rupiah)
1 OPERATOR 2,250,000 1,650,000 1,350,000 1,200,000
3 DR. ANESTESI 788,000 576,000 473,000 420,000
5 INSTRUMENT 158,000 116,000 95,000 84,000
6 ON LOOP 113,000 83,000 68,000 60,000
7 RSU 680,000 635,000 605,000 575,000
8 PKO 680,000 680,000 680,000 680,000
9 BHP 681,000 681,000 681,000 681,000
JUMLAH 5,800,000 4,751,000 4,222,000 3,940,000
D. TARIF TINDAKAN BEDAH EXTRA BERAT

(Dalam Rupiah)
1 OPERATOR 2,550,000 1,950,000 1,650,000 1,500,000
3 DR. ANESTESI 892,500 682,500 577,500 525,000
5 INSTRUMENT 178,500 136,500 115,500 105,000
6 ON LOOP 127,500 97,500 82,500 75,000
7 RSU 755,000 710,000 680,000 650,000
8 PKO 735,000 735,000 735,000 735,000
9 BHP 690,000 690,000 690,000 690,000
JUMLAH 6,438,500 5,391,500 4,860,500 4,580,000
Catatan :
VII. TARIF OPERASI ORTHOPAEDI

A. TARIF TINDAKAN OPERASI ORTHOPAEDI RINGAN
(Dalam Rupiah)
1 OPERATOR 1,800,000 1,200,000 900,000 750,000
3 DR. ANESTESI 630,000 420,000 315,000 263,000
5 INSTRUMENT 270,000 180,000 135,000 112,500
6 ON LOOP 90,000 60,000 45,000 37,500
7 RSU 525,000 495,000 465,000 435,000
8 PKO 420,000 420,000 420,000 420,000
9 BHP 384,000 384,000 384,000 384,000
JUMLAH 4,569,000 3,459,000 2,889,000 2,589,500
B. TARIF TINDAKAN OPERASI ORTHOPAEDI SEDANG

(Dalam Rupiah)
1 OPERATOR 2,250,000 1,650,000 1,350,000 1,200,000
3 DR. ANESTESI 788,000 578,000 473,000 420,000
5 INSTRUMENT 338,000 248,000 203,000 180,000
6 ON LOOP 113,000 83,000 68,000 60,000
7 RSU 680,000 635,000 605,000 575,000
8 PKO 680,000 680,000 680,000 680,000
9 BHP 641,000 641,000 641,000 641,000
JUMLAH 6,053,000 4,928,000 4,358,000 4,056,000
C. TARIF TINDAKAN OPERASI ORTHOPAEDI BESAR

(Dalam Rupiah)
1 OPERATOR 3,000,000 2,200,000 1,800,000 1,600,000
3 DR. ANESTESI 1,050,000 770,000 630,000 560,000
5 INSTRUMENT 450,000 330,000 270,000 240,000
6 ON LOOP 150,000 110,000 90,000 80,000
7 RSU 755,000 710,000 680,000 650,000
8 PKO 735,000 735,000 735,000 735,000
9 BHP 690,000 690,000 690,000 690,000
JUMLAH 7,580,000 6,095,000 5,345,000 4,955,000
Catatan :
- Biaya tersebut belum termasuk Akomodasi, Visite Dokter, Perawatan, Obat dan Inplant / Sewa Alat (bila ada).
D. TARIF TINDAKAN OPERASI ORTHOPAEDI KHUSUS I

(Dalam Rupiah)
1 OPERATOR 5,050,000 3,850,000 3,050,000 2,650,000
3 DR. ANESTESI 1,768,000 1,348,000 1,068,000 928,000
5 INSTRUMENT 738,000 578,000 458,000 398,000
6 ON LOOP 253,000 193,000 153,000 133,000
7 RSU 905,000 805,000 755,000 725,000
8 PKO 785,000 785,000 785,000 785,000
9 BHP 765,000 765,000 765,000 765,000
JUMLAH 11,527,000 9,260,000 7,797,000 7,047,000
E. TARIF TINDAKAN OPERASI ORTHOPAEDI KHUSUS II

(Dalam Rupiah)
1 OPERATOR 5,850,000 4,850,000 4,050,000 3,550,000
3 DR. ANESTESI 2,048,000 1,698,000 1,418,000 1,243,000
5 INSTRUMENT 878,000 728,000 608,000 533,000
6 ON LOOP 293,000 243,000 203,000 178,000
7 RSU 955,000 855,000 805,000 755,000
8 PKO 835,000 835,000 835,000 835,000
9 BHP 865,000 865,000 865,000 865,000
JUMLAH 13,187,000 11,287,000 9,797,000 8,847,000
F. TARIF TINDAKAN OPERASI ORTHOPAEDI KHUSUS III

(Dalam Rupiah)
1 OPERATOR 6,300,000 5,300,000 4,500,000 4,000,000
3 DR. ANESTESI 2,205,000 1,855,000 1,575,000 1,400,000
5 INSTRUMENT 945,000 795,000 675,000 600,000
6 ON LOOP 315,000 265,000 225,000 200,000
7 RSU 1,030,000 930,000 880,000 850,000
8 PKO 910,000 910,000 910,000 910,000
9 BHP 965,000 965,000 965,000 965,000
JUMLAH 14,245,000 12,345,000 10,855,000 9,925,000
Catatan :
G. TARIF TINDAKAN OPERASI ORTHOPAEDI KHUSUS IV

(Dalam Rupiah)
1 OPERATOR 7,300,000 6,300,000 5,500,000 5,000,000
2 ASISTEN OPERATOR 1,095,000 945,000 825,000 750,000
3 DR. ANESTESI 2,555,000 2,205,000 1,925,000 1,750,000
5 INSTRUMENT 1,095,000 945,000 825,000 750,000
6 ON LOOP 365,000 315,000 275,000 250,000
7 RSU 1,130,000 1,030,000 980,000 950,000
8 PKO 1,010,000 1,010,000 1,010,000 1,010,000
9 BHP 1,065,000 1,065,000 1,065,000 1,065,000
JUMLAH 16,345,000 14,445,000 12,955,000 12,025,000
H. TARIF TINDAKAN OPERASI ORTHOPAEDI KHUSUS V

(Dalam Rupiah)
1 OPERATOR 8,300,000 7,300,000 6,500,000 6,000,000
2 ASISTEN OPERATOR 1,245,000 1,095,000 975,000 900,000
3 DR. ANESTESI 2,905,000 2,555,000 2,275,000 2,100,000
5 INSTRUMENT 1,245,000 1,095,000 975,000 900,000
6 ON LOOP 415,000 365,000 325,000 300,000
7 RSU 1,230,000 1,130,000 1,080,000 1,050,000
8 PKO 1,110,000 1,110,000 1,110,000 1,110,000
9 BHP 1,165,000 1,165,000 1,165,000 1,165,000
JUMLAH 18,445,000 16,545,000 15,055,000 14,125,000
Catatan :
VIII. TARIF LABORATORIUM
JASA TINDAKAN
NO. JENIS TINDAKAN BHP Tarif ( Rp )
Medis Pelayanan
1 ALBUMIN 1,000 5,000 15,000 21,000
2 ALP 1,000 6,000 18,000 25,000
3 AMILASE 5,000 26,000 77,000 108,000
4 ANTI HCV 5,000 30,000 88,000 123,000
5 B.T 1,000 2,000 6,000 9,000
6 BIL. DIRECT 1,000 5,000 15,000 21,000
7 BIL. INDIRECT 1,000 5,000 14,000 20,000
8 BIL. TOTAL 1,000 5,000 14,000 20,000
9 BLOOD SMEAR 5,000 15,000 43,000 63,000
10 BS 2 JAM PP 1,000 7,000 18,000 26,000
11 BTA 1 KALI 1,000 3,000 10,000 14,000
12 BTA 3 KALI 1,000 8,000 23,000 32,000
13 BUN / UREUM 1,000 6,000 15,000 22,000
14 C.T 1,000 2,000 6,000 9,000
15 CREATININ (S) 1,000 5,000 15,000 21,000
16 DARAH SAMAR / OB TEST 1,000 7,000 20,000 28,000
17 DL 2,000 10,000 28,000 40,000
18 ELEKTROLIT 3 PARAMETER 5,000 26,000 75,000 106,000
19 FL 2,000 7,000 20,000 29,000
20 GLOBULIN 1,000 5,000 15,000 21,000
21 GOL DARAH + RHESUS 1,000 5,000 15,000 21,000
22 GULA DARAH 1,000 4,000 10,000 15,000
23 HBSAG 2,000 12,000 33,000 47,000
24 HCG 2,000 12,000 33,000 47,000
25 HDL CHOLESTEROL 1,000 5,000 15,000 21,000
26 HELICO PYLORY 6,000 34,000 100,000 140,000
27 IG G,IG M ANTI DENGUE 7,000 35,000 105,000 147,000
28 LDL. CHOLESTEROL 1,000 4,000 13,000 18,000
29 LED 1,000 2,000 5,000 8,000
30 LFT (SGOT, SGPT, BIL. DIREK, BIL. 6,000 31,000 91,000 128,000
31 LIPID PROFIL (CHOLES. TOTAL, 4,000 21,000 60,000 85,000
32 MLARIA MIKROSKOPIS 1,000 5,000 15,000 21,000
33 RFT (BUN, SC, ASAM URAT) 3,000 15,000 39,000 57,000
34 SGOT 1,000 5,000 15,000 21,000
35 SGPT 1,000 5,000 15,000 21,000
36 TES KEHAMILAN 1,000 6,000 16,000 23,000
37 TG 1,000 6,000 17,000 24,000
38 TOTAL CHOLESTEROL 1,000 5,000 15,000 21,000
39 TOTAL PROTEIN 1,000 5,000 15,000 21,000
40 URIC. ACID 1,000 5,000 15,000 21,000
41 URINE LENGKAP 1,000 5,000 15,000 21,000
42 WIDAL 2,000 10,000 25,000 37,000
43 NS I 8,000 45,000 125,000 178,000
44 IT RATIO 3,000 15,000 42,000 60,000
45 Ig- M Anti HAV 10,000 51,000 150,000 211,000
46 Ig- M Anti Salmonella Thypi 10,000 34,000 100,000 144,000
JUMLAH 115,000 567,000 1,634,000 2,316,000
IX. TARIF RADIOLOGI
NO. JENIS PEMERIKSAAN SIZE FILM Tarif

1 JASA HAND SCHOEN &MASKER - 10,000
2 ABDOMEN 3 (TIGA) POSISI 30 X 40 192,000
3 ABDOMEN LATERAL DECUBITIS 30 X 40 72,000
4 ANKLE AP & LAT 24 X 30 66,000
5 ANTEBRACHII AP & LAT 24 X 30 96,000
6 ANTEBRACHII AP/LAT 24 X 30 66,000
7 ART GENU I 24 X 30 66,000
8 ART GENU II 30 X 40 72,000
9 ART. CUBITI AP & LAT 24 X 30 66,000
10 BASIS CRANII 24 X 30 72,000
11 BOF/BNO 35 X 35 72,000
12 BOF/BNO 24 X 30 66,000
13 CERVICAL AP&LAT 24 X 30 120,000
14 CERVICAL AP, LAT, OBLIQUE 24 X 30 216,000
15 CERVICAL AP/LAT 24 X 30 66,000
16 CERVICAL OBLIQUE 24 X 30 120,000
17 CLAVICULA 24 X 30 66,000
18 CRURIS AP&LAT 30 X 40 72,000
19 CRURIS AP&LAT 24 X 30 66,000
20 EISLER 24 X 30 72,000
21 FEMUR AP&LAT 30 X 40 132,000
22 FEMUR AP&LAT 24 X 30 120,000
23 FEMUR AP/LAT 30 X 40 72,000
24 FEMUR AP/LAT 24 X 30 66,000
25 HIP JOINT/ART. COXAE 24 X 30 72,000
26 HUMERUS AP&LAT 24 X 30 96,000
27 HUMERUS AP&LAT 24 X 30 66,000
28 LUMBOSACRAL AP&LAT 30 X 40 132,000
29 LUMBOSACRAL AP, LAT, OBLIQ 30 X 40 264,000
30 LUMBOSACRAL AP/ LAT 30 X 40 72,000
31 MANDIBULAE 24 X 30 66,000
32 MANUS AP&OBLIQUE 24 X 30 66,000
33 MASTOID 24 X 30 72,000
34 NASAL 24 X 30 66,000
35 NASAL AP/LAT 24 X 30 120,000
36 ORBITAL 24 X 30 72,000
37 PEDIS AP&OBLIQUE 24 X 30 66,000
38 PELVIS 30 X 40 72,000
39 PELVIS 24 X 30 66,000
40 SCAPULA 24 X 30 66,000
41 SCULLER 24 X 30 72,000
42 SHOULDER 24 X 30 66,000
43 SKUL AP&LATERAL 24 X 30 120,000
44 SKUL AP/LATERAL 24 X 30 66,000
45 SKULL 3 (TIGA) POSISI 24 X 30 180,000
46 TEMPORO MANDIBULA JOINT 24 X 30 72,000
47 THORACOLUMBAL AP&LAT 30 X 40 132,000
35 X 35,
48 THORACOLUMBAL AP, LAT, OBLIQ 264,000
30 X 40
49 THORACOLUMBAL AP/LAT 30 X 40 72,000
50 THORAX (TOP LORDOTIC VIEW) 35 X 35 72,000
51 WRIST JOINT AP&LAT 24 X 30 66,000
52 THORAX AP/PA 35 X 35 72,000
53 THORAX AP/PA 24 X 30 66,000
54 THORAX LATERAL DECUBITIS 24 X 30 72,000
55 WATERS 24 X 30 66,000
JUMLAH 4,996,000
Jasa
NO JENIS PEMERIKSAAN BHP TARIF (Rp)
Medis Pelayanan
56 BNO IVP 300,000 113,000 225,000 638,000
57 HSG 160,000 60,000 120,000 340,000
58 URETRO SYTROGRAFI 263,000 94,000 338,000 695,000
59 USG ABDOMEN ATAS/BAWAH 105,000 30,000 22,000 157,000
60 USG WHOLE ABDOMEN 132,000 38,000 30,000 200,000
61 USG MAMMAE 132,000 38,000 30,000 200,000
62 USG TESTIS/SCROTUM 114,000 350,000 25,000 489,000
63 USG UROLOGI 114,000 35,000 25,000 174,000
64 USG TYROID 132,000 38,000 30,000 200,000
65 USG DOPPLER ABDOMEN 202,000 58,000 45,000 305,000
66 USG DOPPLER TESTIS/SCROTUM 202,000 58,000 45,000 305,000
67 CT SCAN TANPA KONTRAS KEPALA 114,000 82,000 65,000 261,000
68 CT SCAN TANPA KONTRAS ABDOMEN/TIORA 158,000 113,000 90,000 361,000
69 CT SCAN DGN KONTRAS KEPALA 161,000 144,000 230,000 535,000
70 CT SCAN DGN KONTRAS ABDOMEN/THORAX 224,000 200,000 320,000 744,000
JUMLAH 2,513,000 1,451,000 1,640,000 5,604,000
X. TARIF TINDAKAN OPERASI MATA

A. TARIF TINDAKAN OPERASI MATA RINGAN
(Dalam Rupiah)
1 OPERATOR 1,300,000 900,000 750,000 600,000
3 DR. ANESTESI 455,000 315,000 263,000 210,000
5 INSTRUMENT 91,000 63,000 53,000 42,000
6 ON LOOP 65,000 45,000 38,000 30,000
7 RSU 440,000 410,000 380,000 350,000
8 PKO 338,000 338,000 338,000 338,000
9 BHP 150,000 150,000 150,000 150,000
JUMLAH 3,099,000 2,401,000 2,122,000 1,840,000
B. TARIF TINDAKAN OPERASI MATA SEDANG

(Dalam Rupiah)
1 OPERATOR 1,600,000 1,200,000 1,000,000 800,000
3 DR. ANESTESI 560,000 420,000 350,000 280,000
5 INSTRUMENT 112,000 84,000 70,000 56,000
6 ON LOOP 80,000 60,000 50,000 40,000
7 RSU 525,000 495,000 465,000 435,000
8 PKO 420,000 420,000 420,000 420,000
9 BHP 150,000 150,000 150,000 150,000
JUMLAH 3,767,000 3,069,000 2,705,000 2,341,000
C. TARIF TINDAKAN OPERASI MATA BESAR

(Dalam Rupiah)
1 OPERATOR 2,250,000 1,650,000 1,400,000 1,200,000
3 DR. ANESTESI 788,000 578,000 490,000 420,000
5 INSTRUMENT 158,000 116,000 98,000 84,000
6 ON LOOP 113,000 83,000 70,000 60,000
7 RSU 680,000 635,000 605,000 575,000
8 PKO 680,000 680,000 680,000 680,000
9 BHP 150,000 150,000 150,000 150,000
JUMLAH 5,269,000 4,222,000 3,773,000 3,409,000
Catatan :
D. TARIF TINDAKAN OPERASI MATA KHUSUS

(Dalam Rupiah)
1 OPERATOR 3,000,000 2,400,000 1,900,000 1,500,000
3 DR. ANESTESI 1,050,000 840,000 665,000 525,000
5 INSTRUMENT 210,000 168,000 133,000 105,000
6 ON LOOP 150,000 120,000 95,000 75,000

7 RSU 755,000 710,000 680,000 650,000
8 PKO 735,000 735,000 735,000 735,000
9 BHP 150,000 150,000 150,000 150,000
JUMLAH 6,650,000 5,603,000 4,738,000 4,040,000
Catatan :
XI. TARIF TINDAKAN OPERASI ONKOLOGI

A. TARIF TINDAKAN OPERASI ONKOLOGI RINGAN
(Dalam Rupiah)
1 OPERATOR 2,500,000 1,700,000 1,200,000 900,000
3 DR. ANESTESI 875,000 595,000 420,000 315,000
5 INSTRUMENT 175,000 119,000 84,000 63,000
6 ON LOOP 125,000 85,000 60,000 45,000
7 RSU 525,000 495,000 465,000 435,000
8 PKO 420,000 420,000 420,000 420,000
9 BHP 384,000 384,000 384,000 384,000
JUMLAH 5,504,000 4,138,000 3,273,000 2,742,000
B. TARIF TINDAKAN OPERASI ONKOLOGI SEDANG

(Dalam Rupiah)
1 OPERATOR 3,100,000 2,300,000 1,800,000 1,500,000
3 DR. ANESTESI 1,085,000 805,000 630,000 525,000
5 INSTRUMENT 217,000 161,000 126,000 105,000
6 ON LOOP 155,000 115,000 90,000 75,000
7 RSU 680,000 635,000 605,000 575,000
8 PKO 680,000 680,000 680,000 680,000
9 BHP 641,000 641,000 641,000 641,000
JUMLAH 7,177,800 5,796,800 4,931,800 4,400,800
C. TARIF TINDAKAN OPERASI ONKOLOGI BESAR

(Dalam Rupiah)
1 OPERATOR 4,000,000 2,900,000 2,200,000 1,800,000
3 DR. ANESTESI 1,400,000 1,015,000 770,000 630,000
5 INSTRUMENT 280,000 203,000 154,000 126,000
6 ON LOOP 200,000 145,000 110,000 90,000
7 RSU 755,000 710,000 680,000 650,000
8 PKO 735,000 735,000 735,000 735,000
9 BHP 690,000 690,000 690,000 690,000
JUMLAH 8,860,000 6,978,000 5,779,000 5,081,000
Catatan :
D. TARIF TINDAKAN OPERASI ONKOLOGI KHUSUS I

(Dalam Rupiah)
1 OPERATOR 5,100,000 3,800,000 3,000,000 2,500,000
3 DR. ANESTESI 1,785,000 1,330,000 1,050,000 875,000
5 INSTRUMENT 357,000 266,000 210,000 175,000

6 ON LOOP 255,000 190,000 150,000 125,000
7 RSU 905,000 805,000 755,000 725,000
8 PKO 785,000 785,000 785,000 785,000
9 BHP 765,000 765,000 765,000 765,000
JUMLAH 10,972,000 8,701,000 7,315,000 6,450,000
E. TARIF TINDAKAN OPERASI ONKOLOGI KHUSUS II

(Dalam Rupiah)
1 OPERATOR 5,800,000 4,500,000 3,700,000 3,200,000
3 DR. ANESTESI 2,030,000 1,575,000 1,295,000 1,120,000
5 INSTRUMENT 406,000 315,000 259,000 224,000
6 ON LOOP 290,000 225,000 185,000 160,000
7 RSU 955,000 855,000 805,000 775,000
8 PKO 835,000 835,000 835,000 835,000
9 BHP 865,000 865,000 865,000 865,000
JUMLAH 12,341,000 10,070,000 8,684,000 7,819,000
F. TARIF TINDAKAN OPERASI ONKOLOGI KHUSUS III

(Dalam Rupiah)
1 OPERATOR 6,600,000 5,300,000 4,500,000 4,000,000
3 DR. ANESTESI 1,310,000 1,855,000 1,575,000 1,400,000
5 INSTRUMENT 462,000 371,000 315,000 280,000
6 ON LOOP 330,000 265,000 225,000 200,000
7 RSU 1,030,000 930,000 880,000 850,000
8 PKO 910,000 910,000 910,000 910,000
9 BHP 965,000 965,000 965,000 965,000
JUMLAH 12,927,000 11,656,000 10,270,000 9,405,000
Catatan :
G. TARIF TINDAKAN OPERASI ONKOLOGI KHUSUS IV

(Dalam Rupiah)
1 OPERATOR 7,600,000 6,300,000 5,500,000 5,000,000
3 DR. ANESTESI 2,660,000 2,205,000 1,925,000 1,750,000
5 INSTRUMENT 532,000 441,000 385,000 350,000
6 ON LOOP 380,000 315,000 275,000 250,000
7 RSU 1,130,000 1,030,000 980,000 950,000
8 PKO 1,010,000 1,010,000 1,010,000 1,010,000
9 BHP 1,065,000 1,065,000 1,065,000 1,065,000
JUMLAH 15,897,000 13,626,000 12,240,000 11,375,000
H. TARIF TINDAKAN OPERASI ONKOLOGI KHUSUS V

(Dalam Rupiah)
1 OPERATOR 8,600,000 7,300,000 6,500,000 6,000,000
3 DR. ANESTESI 3,010,000 2,555,000 2,275,000 2,100,000
5 INSTRUMENT 602,000 511,000 455,000 420,000

6 ON LOOP 430,000 365,000 325,000 300,000
7 RSU 1,230,000 1,130,000 1,080,000 1,050,000
8 PKO 1,110,000 1,110,000 1,110,000 1,110,000
9 BHP 1,165,000 1,165,000 1,165,000 1,165,000
JUMLAH 17,867,000 15,596,000 14,210,000 13,345,000
Catatan :
D. TARIF TINDAKAN OPERASI BEDAH DIGESTIF KHUSUS I

(Dalam Rupiah)
1 OPERATOR 5,050,000 3,850,000 3,050,000 2,650,000
3 DR. ANESTESI 1,768,000 1,348,000 1,068,000 928,000
5 INSTRUMENT 354,000 270,000 214,000 186,000
6 ON LOOP 253,000 193,000 153,000 133,000
7 RSU 905,000 805,000 755,000 725,000
8 PKO 785,000 785,000 785,000 785,000
9 BHP 765,000 765,000 765,000 765,000
JUMLAH 10,890,000 8,786,000 7,400,000 6,702,000
E. TARIF TINDAKAN OPERASI BEDAH DIGESTIF KHUSUS II

(Dalam Rupiah)
1 OPERATOR 5,850,000 4,850,000 4,050,000 3,550,000
3 DR. ANESTESI 2,048,000 1,698,000 1,418,000 1,243,000
5 INSTRUMENT 410,000 340,000 284,000 249,000
6 ON LOOP 293,000 243,000 203,000 178,000
7 RSU 955,000 855,000 805,000 775,000
8 PKO 835,000 835,000 835,000 835,000
9 BHP 865,000 865,000 865,000 865,000
JUMLAH 12,426,000 10,656,000 9,270,000 8,405,000
Catatan :
Telp. 081917998947 / 085337927072
TARIF TINDAKAN BEDAH

(Dalam Rupiah)
1 OPERATOR 1,300,000 900,000 700,000 600,000
3 DR. ANESTESI 455,000 315,000 245,000 210,000
5 INSTRUMENT 91,000 63,000 49,000 42,000
6 ON LOOP 65,000 45,000 35,000 30,000
7 RSU 440,000 410,000 380,000 350,000
8 PKO 338,000 338,000 338,000 338,000
9 BHP 150,000 150,000 150,000 150,000
JUMLAH 3,099,000 2,401,000 2,037,000 1,840,000

(Dalam Rupiah)
1 OPERATOR 1,600,000 1,200,000 1,000,000 900,000
3 DR. ANESTESI 560,000 420,000 350,000 315,000
5 INSTRUMENT 112,000 84,000 70,000 63,000
6 ON LOOP 80,000 60,000 50,000 45,000
7 RSU 525,000 495,000 465,000 435,000
8 PKO 420,000 420,000 420,000 420,000
9 BHP 384,000 384,000 384,000 384,000
JUMLAH 4,001,000 3,303,000 2,939,000 2,742,000
Catatan :
C. TARIF TINDAKAN BEDAH BERAT

(Dalam Rupiah)
1 OPERATOR 2,250,000 1,650,000 1,350,000 1,200,000
3 DR. ANESTESI 788,000 576,000 473,000 420,000
5 INSTRUMENT 158,000 116,000 95,000 84,000
6 ON LOOP 113,000 83,000 68,000 60,000
7 RSU 680,000 635,000 605,000 575,000
8 PKO 680,000 680,000 680,000 680,000
9 BHP 681,000 681,000 681,000 681,000
JUMLAH 5,800,000 4,751,000 4,222,000 3,940,000
D. TARIF TINDAKAN BEDAH EXTRA BERAT

(Dalam Rupiah)
1 OPERATOR 2,550,000 1,950,000 1,650,000 1,500,000
3 DR. ANESTESI 892,500 682,500 577,500 525,000
5 INSTRUMENT 178,500 136,500 115,500 105,000
6 ON LOOP 127,500 97,500 82,500 75,000
7 RSU 755,000 710,000 680,000 650,000
8 PKO 735,000 735,000 735,000 735,000
9 BHP 690,000 690,000 690,000 690,000
JUMLAH 6,438,500 5,391,500 4,860,500 4,580,000
Catatan :
Telp. 081917998947 / 085337927072
TARIF OPERASI ORTHOPAEDI

A. TARIF TINDAKAN OPERASI ORTHOPAEDI RINGAN
(Dalam Rupiah)
1 OPERATOR 1,800,000 1,200,000 900,000 750,000
3 DR. ANESTESI 630,000 420,000 315,000 263,000
5 INSTRUMENT 270,000 180,000 135,000 112,500
6 ON LOOP 90,000 60,000 45,000 37,500
7 RSU 525,000 495,000 465,000 435,000
8 PKO 420,000 420,000 420,000 420,000
9 BHP 384,000 384,000 384,000 384,000
JUMLAH 4,569,000 3,459,000 2,889,000 2,589,500
B. TARIF TINDAKAN OPERASI ORTHOPAEDI SEDANG

(Dalam Rupiah)
1 OPERATOR 2,250,000 1,650,000 1,350,000 1,200,000
3 DR. ANESTESI 788,000 578,000 473,000 420,000
5 INSTRUMENT 338,000 248,000 203,000 180,000
6 ON LOOP 113,000 83,000 68,000 60,000
7 RSU 680,000 635,000 605,000 575,000
8 PKO 680,000 680,000 680,000 680,000
9 BHP 641,000 641,000 641,000 641,000
JUMLAH 6,053,000 4,928,000 4,358,000 4,056,000
C. TARIF TINDAKAN OPERASI ORTHOPAEDI BESAR

(Dalam Rupiah)
1 OPERATOR 3,000,000 2,200,000 1,800,000 1,600,000
3 DR. ANESTESI 1,050,000 770,000 630,000 560,000
5 INSTRUMENT 450,000 330,000 270,000 240,000
6 ON LOOP 150,000 110,000 90,000 80,000
7 RSU 755,000 710,000 680,000 650,000
8 PKO 735,000 735,000 735,000 735,000
9 BHP 690,000 690,000 690,000 690,000
JUMLAH 7,580,000 6,095,000 5,345,000 4,955,000
Catatan :
D. TARIF TINDAKAN OPERASI ORTHOPAEDI KHUSUS I
(Dalam Rupiah)
1 OPERATOR 5,050,000 3,850,000 3,050,000 2,650,000
3 DR. ANESTESI 1,768,000 1,348,000 1,068,000 928,000
5 INSTRUMENT 738,000 578,000 458,000 398,000
6 ON LOOP 253,000 193,000 153,000 133,000
7 RSU 905,000 805,000 755,000 725,000
8 PKO 785,000 785,000 785,000 785,000
9 BHP 765,000 765,000 765,000 765,000
JUMLAH 11,527,000 9,260,000 7,797,000 7,047,000
E. TARIF TINDAKAN OPERASI ORTHOPAEDI KHUSUS II

(Dalam Rupiah)
1 OPERATOR 5,850,000 4,850,000 4,050,000 3,550,000
3 DR. ANESTESI 2,048,000 1,698,000 1,418,000 1,243,000
5 INSTRUMENT 878,000 728,000 608,000 533,000
6 ON LOOP 293,000 243,000 203,000 178,000
7 RSU 955,000 855,000 805,000 755,000
8 PKO 835,000 835,000 835,000 835,000
9 BHP 865,000 865,000 865,000 865,000
JUMLAH 13,187,000 11,287,000 9,797,000 8,847,000
F. TARIF TINDAKAN OPERASI ORTHOPAEDI KHUSUS III

(Dalam Rupiah)
1 OPERATOR 6,300,000 5,300,000 4,500,000 4,000,000
3 DR. ANESTESI 2,205,000 1,855,000 1,575,000 1,400,000
5 INSTRUMENT 945,000 795,000 675,000 600,000
6 ON LOOP 315,000 265,000 225,000 200,000
7 RSU 1,030,000 930,000 880,000 850,000
8 PKO 910,000 910,000 910,000 910,000
9 BHP 965,000 965,000 965,000 965,000
JUMLAH 14,245,000 12,345,000 10,855,000 9,925,000
Catatan :
G. TARIF TINDAKAN OPERASI ORTHOPAEDI KHUSUS IV
(Dalam Rupiah)
1 OPERATOR 7,300,000 6,300,000 5,500,000 5,000,000
2 ASISTEN OPERATOR 1,095,000 945,000 825,000 750,000
3 DR. ANESTESI 2,555,000 2,205,000 1,925,000 1,750,000
5 INSTRUMENT 1,095,000 945,000 825,000 750,000
6 ON LOOP 365,000 315,000 275,000 250,000
7 RSU 1,130,000 1,030,000 980,000 950,000
8 PKO 1,010,000 1,010,000 1,010,000 1,010,000
9 BHP 1,065,000 1,065,000 1,065,000 1,065,000
JUMLAH 16,345,000 14,445,000 12,955,000 12,025,000
H. TARIF TINDAKAN OPERASI ORTHOPAEDI KHUSUS V

(Dalam Rupiah)
1 OPERATOR 8,300,000 7,300,000 6,500,000 6,000,000
2 ASISTEN OPERATOR 1,245,000 1,095,000 975,000 900,000
3 DR. ANESTESI 2,905,000 2,555,000 2,275,000 2,100,000
5 INSTRUMENT 1,245,000 1,095,000 975,000 900,000
6 ON LOOP 415,000 365,000 325,000 300,000
7 RSU 1,230,000 1,130,000 1,080,000 1,050,000
8 PKO 1,110,000 1,110,000 1,110,000 1,110,000
9 BHP 1,165,000 1,165,000 1,165,000 1,165,000
JUMLAH 18,445,000 16,545,000 15,055,000 14,125,000
Catatan :

TARIF 50 % RS METRO MEDIKA TNP BHP (Edited 19-5-2018)

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RUMAH SAKIT METRO MEDIKA

Jl. Jendral Sudirman No. 18 A Rembiga, Mataram

TARIF UMUM DAN TINDAKAN

NO. JENIS TINDAKAN TARIF

1.1 Administrasi Rawat Jalan 70,000

NO. JENIS TINDAKAN TARIF

TARIF TINDAKAN dr. SPESIALIS

NO. JENIS TINDAKAN TARIF

A. TARIF TINDAKAN SPESIALIS UMUM

NO. JENIS TINDAKAN TARIF

2.22 Biopsi FNAB (Sp) 495,000

2.23 Buka gips short arm/leg (Sp) 138,000

2.24 Buka gips long arm/leg (Sp) 220,000

2.25 Circumsisi (Sp) 515,000

2.26 Debridement + Heeting (Sp) 340,000

2.27 Dilatasi phimosis (Sp) 170,000

2.28 Eksisi/ekstirpasi kecil (Sp) 390,000

2.29 Eksisi/ekstirpasi sedang (Sp) 445,000

2.30 Eksisi/ekstirpasi besar (Sp) 500,000

2.31 Incisi Abses (Sp) 225,000

2.32 Pasang gips tanpa reposisi short arm/leg (Sp) 385,000

2.33 Pasang gips tanpa reposisi long arm/leg (Sp) 495,000

2.34 Pasang gips dengan reposisi short arm/leg (Sp) 605,000

2.35 Pasang gips dengan reposisi long arm/leg (Sp) 715,000

2.36 Pasang Ransel Verban (Sp) 231,000

2.37 Pasang Skin Traksi (Sp) 275,000

2.38 Pungsi Sendi/Sinopial (Sp) 332,000

2.39 Rawat Luka Kecil RI (Sp) 115,000

2.40 Rawat Luka Sedang RI (Sp) 170,000

2.41 Rawat Luka Besar RI (Sp) 225,000

2.42 Rawat Luka Ekstra Besar RI (Sp) 335,000

2.43 Rawat Luka Post Op. Ortho Sedang (Sp) 126,000

2.44 Rawat Luka Post Op. Ortho Berat (Sp) 170,000

2.46 Reposisi & Pasang Ransel Verban (Sp) 445,000

2.47 Kemoterapi Grade I (Sp) 620,000

2.48 Kemoterapi Grade II (Sp) 345,000

2.49 Luka Bakar (Sp) 350,000

NO. JENIS TINDAKAN Tarif

2.52 Aff Tampon Vagina 88,000

2.53 Ekstraksi Fragmen IUD 250,000

2.54 Ekstraksi IUD Biasa 167,000

2.55 Ekstraksi IUD Missing Tile /Sp 275,000

2.56 Explorasi Post Abortus 340,000

2.57 Explorasi Post Partum 340,000

2.58 Pasang/Insersi IUD 475,000

2.59 Pasang Tampon Vagina 110,000

2.60 Pasang Ring Pesarium 225,000

2.61 USG Intra Vaginal 185,000

2.62 USG Obgyn dengan Print pada ANC 140,000

2.63 USG Obgyn tanpa Print pada ANC 135,000

2.64 Vaginal Swab 85,000

2.65 Vaginal Taucher/VT (SP) 85,000

2.66 VT (Bidan) 70,000

2.67 Pasang Tampon Sayeba Kondom 634,000

2.68 DJJ 60,000

2.69 Explorasi Post SC 70,000

2.70 Imunisasi Dasar 120,000

2.71 Injeksi Delladryl/Xyllo della/TT 55,000

2.72 Observasi VK < 12 Jam 160,000

2.73 Observasi VK > 12 Jam -< 24 Jam 255,000

2.74 Pasang Ring Pesarium 125,000

2.75 Pasang Ransel Verban 85,000

2.76 Pasang Tampon Vagina 80,000