QUICK UNIT PRICE FOR DIAGNOSIS : GEA -> INACBGS I : 2.027.800, II : 1.738.

100, III :

Nama
Usia
Lama Perawatan 2-3 hari

Hari
NO Aktifitas Pelayanan
1 2 3
1 PELAYANAN KAMAR
Kamar Kelas 3 1 1 1
2 DOKTER
1 Visite Dokter IGD 1
2 Visite Dokter Jaga 1
3 Visite DPJP 1 1 1
4 Visite DPJP Lain/Raber
3 TINDAKAN MEDIS
1 EKG (Usia ≥ 40 tahun) 1
2
3
4
4 LABORATORIUM
1 Darah Lengkap 1
2 Hitung Jenis 1
3 GDS 1
4
5
6
7
8
9
10
5 RADIOLOGI
1 Ro Thorax 1
2
3
4
5
6 PENUNJANG LAIN
1
2
3
7 OBAT-OBATAN DAN ALKES
OBAT INJEKSI & CAIRAN
1 Cairan Infus RL 20 Tpm 3 3 3
2 Polyflek 1
 3 Blood set 1
4 LEUKOMED 1
5 alkohol swab 2
6 Handscoen 4
7 Spuit 10 cc 1
8 Spuit 3 cc 1
9 Spuit 1 cc 1
10 cairan Aquabidest 1
11 Ceftriaxone 1x2gr/Viccilin sx 2x1.5gr 2 2 2
12 Ondansetron 4mg (KP) 1
13 Ranitidin (KP) 1
14
15
OBAT ORAL DAN TOPIKAL
1 New diatab 3x2 tab 6
2 Antacyd syr 1
3
4
5
OBAT PULANG
1 Cefixime 100mg
2 Antacyd syr
3
4
JASA KEPERAWATAN
1 Suntik 1 1 1
2 Pasang Infus 1
3 Asuhan Keperawatan 1 1 1
4
5
6
7
8
9
10
AKTIFITAS LAIN
1 Adm 1
2
3
4
10 ADMINISTRASI
1 Admin rawat inap
2.027.800, II : 1.738.100, III : 1.448.400

HARGA TOTAL
Hari Perawatan SATUAN HARGA
JUMLAH
4 5 6 7 8 9 10 TARIF INA TARIF INA
CBGs CBGs
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
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
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

0 0
0 0
0 0
0 0
0 0
0 0
10 0 0
1 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

1 0 0
0 0
0 0
0 0

1 0 0
GRAND TOTAL BIAYA KASUS 2 0
SATUAN HARGA
TARIF TAIF
UMUM UMUM

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
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
QUICK UNIT PRICE FOR DIAGNOSIS : Colic Abdomen -> INACBGS I : 2.027.800, II : 1.7

Nama
Usia
Lama Perawatan 2-3 hari

Hari
NO Aktifitas Pelayanan
1 2 3
1 PELAYANAN KAMAR
Kamar Kelas 3 1 1 1
2 DOKTER
1 Visite Dokter IGD 1
2 Visite Dokter Jaga 1
3 Visite DPJP 1 1 1
4 Visite DPJP Lain/Raber
3 TINDAKAN MEDIS
1 EKG (Usia ≥ 40 tahun) 1
2
3
4
4 LABORATORIUM
1 Darah Lengkap 1
2 Hitung Jenis 1
3 GDS 1
4
5
6
7
8
9
10
5 RADIOLOGI
1 Ro Thorax 1
2 BNO Polos (KP)
3
4
5
6 PENUNJANG LAIN
1 USG Abdomen (KP)
2
3
7 OBAT-OBATAN DAN ALKES
OBAT INJEKSI & CAIRAN
1 Cairan Infus RL 20 Tpm 3 3 3
2 Polyflek 1
 3 Blood set 1
4 LEUKOMED 1
5 alkohol swab 2
6 Handscoen 4
7 Spuit 10 cc 1
8 Spuit 3 cc 1
9 Spuit 1 cc 1
10 cairan Aquabidest 1
11 Ceftriaxone 1x2gr/Viccilin sx 2x1.5gr 2 2 2
12 Ondansetron 4mg (KP) 1
13 Ranitidin /12 Jam 2 2 2
14 Ketorolac (KP) 1
15
OBAT ORAL DAN TOPIKAL
1 Antacyd syr 1
2
3
4
5
OBAT PULANG
1 Ranitidin tablet
2 Antacyd syr
3
4
JASA KEPERAWATAN
1 Suntik 1 1 1
2 Pasang Infus 1
3 Asuhan Keperawatan 1 1 1
4
5
6
7
8
9
10
AKTIFITAS LAIN
1 Adm 1
2
3
4
10 ADMINISTRASI
1 Admin rawat inap
NACBGS I : 2.027.800, II : 1.738.100, III : 1.448.400

HARGA TOTAL
Hari Perawatan SATUAN HARGA
JUMLAH
4 5 6 7 8 9 10 TARIF INA TARIF INA
CBGs CBGs
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
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
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

0 0
0 0
0 0
0 0
0 0
0 0
10 0 0
1 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

1 0 0
0 0
0 0
0 0

1 0 0
GRAND TOTAL BIAYA KASUS 2 0
SATUAN HARGA
TARIF TAIF
UMUM UMUM

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
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
QUICK UNIT PRICE FOR DIAGNOSIS :
Nama STROKE HAEMORAGIC (kls 1: 4.386.200 kls 2:3759.6
Usia
Lama Perawatan 7 hari

Hari
NO Aktifitas Pelayanan
1 2 3
1 PELAYANAN KAMAR
Kamar Kelas 3 1 1 1
2 DOKTER
1 Visite Dokter Jaga 3 3 3
2 Visite DPJP Anastesi 1
3 Visite DPJP 1 1 1
4 Visite DPJP Lain/Raber 1
5 Visite Dokter UGD 1
3 TINDAKAN MEDIS
1 EKG (Usia >/= 35 tahun) 1
2
3
4
4 LABORATORIUM
1 Darah Lengkap 1
2 elektrolit 1
3 GDS 1
4 ureum,kreatinin 1
5 propilipid 1
6
7
8
9
10
5 RADIOLOGI
1 Ro Thorax 1
2 CT SCAN BRAIN POLOS 1
3
4
5
6 PENUNJANG LAIN
1 EKG (Usia >/= 35 tahun) 1
2
3
7 OBAT-OBATAN DAN ALKES
OBAT INJEKSI & CAIRAN
1 Cairan Infus RL 14 Tpm 2 2 2
 2 cairan Aquabidest 2 2 2
3 Ceftriaxone ( 2 x 1gr ) 2 2 2
4 ranitidin ( 2 x 1 ampul ) 2 2 2
5 cholinar ( 2 x 1 gr ) 2 2 2
6 nycardipine ( sesuai tekanan darah ) 4
7
8
9
10
11
12
13
14
15
OBAT ORAL
1 amlodipine 10 mg(ix 10 mg) 1 1 1
2 ramipryl ( 2x2,5 mg) 2 2 2
3 CPG 75 mg (1x75 mg 1 1 1
4 PCT tablet ( 3 x 650 mg ) 3 3 3
5
6
7
8
9
10
ALKES
1 Polyflek no 20 1
2 Infus set 1
3 LEUKOMED 1
4 alkohol swab 2 2 2
5 Handscoen disposible 20 psg 10psg 10psg
6 Spuit 10 cc 2
7 Spuit 3 cc 2
8 Spuit 1 cc 2
9 NGT No 16 1
10 DC no 16 1
11 Urine bag 1
12 spuit 50 cc 1
13 betadine 20cc
14 hypavic 30cm
15 selang 02 dewasa 1
16 Kasa Box 10 pcs
20
25
26
 27
28
8 JASA KEPERAWATAN
1 Suntik 1 1 1
2 Pasang Infus 1
3 Asuhan Keperawatan 1 1 1
4 Pasang NGT 1
5 Pasang DC 1
6
7
8
9
10
9 AKTIFITAS LAIN
1 Ekg Monitor 1 1 1
2 Infus pump 1 1 1
3 syring pump 1 1 1
4 oksigen 3L 3L 3L
10 ADMINISTRASI
1 Admin rawat inap
kls 1: 4.386.200 kls 2:3759.600 kls3: 3.133.000)

HARGA TOTAL
Hari Perawatan SATUAN HARGA
JUMLAH
4 5 6 7 8 9 10 TARIF INA TARIF INA
CBGs CBGs
1 1 1 1 0 0

3 3 3 3 0 0
1 1 0 0
1 1 1 1 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
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0

2 2 2 2 0 0
 2 2 2 2 0 0
2 2 2 2 0 0
2 2 2 2 0 0
2 2 2 2 0 0
2 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

1 1 1 1 0 0
2 2 2 2 0 0
1 1 1 1 0 0
3 3 3 3 0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

2 2 2 2
10psg 5psg 5psg 5psg 0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 0
0 0

1 1 1 1 0 0
1 0 0
1 1 1 1 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

1 1 1 1 0 0
1 1 1 1 0 0
1 1 0 0
3L 3L 2L 0 0

1 0 0
GRAND TOTAL BIAYA KASUS 2 0
SATUAN HARGA
TARIF TAIF
UMUM UMUM

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
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
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
0
0
0
0
0
0
0