ANESTESI DENGAN GA MEMAKAI LMA

KASUS APOTIK ESTIMASI IGD

JUMLAH HARGA TINDAKAN & BEKKES TARIF
Lipoma Ondan 1 9,000 Pendaftaran 30,000
Ganglion Myloz 1 31,000 Infus 25,000
STT Fentanyl 1 217,500 TTV 30,000
FAM Propafol 1 54,900 Layanan dokter umum 50,000
Tramadol 1 63,900 Konsul spesialis 75,000
Ketorolac 2 15,400 EKG 75,000
Cairan RL 2 19,800 Injeksi 25,000
Sevofluran 20 ml/jam 212,000 Scaren 15,000
O2 2 lt/mnt 50,000 BHP 20,000
N2O 2 lt/jam 150,000
Betadine 120 cc 21,000
Alkohol 100 cc 10,000
Minoscrab 30 cc 30,000
Gamex 7 psg 237,000
Masker 7 122,500
Nursecap 7 98,000
Hipafix 20 cm 12,100
Polisorb 2.0 1 223,600
Polisorb 3.0 1 208,600
Dermalon 3.0 1 102,000
Silk 2.0 1 95,250
Chromic 2.0 1 110,000
Mesh 10 1 6,500
Electroda 3 bh 45,000
Kasa 3 meter 45,000
NaCl 1 9,800
Spuit 1 cc 1 3,000
Spuit 3 cc 1 3,000
Spuit 5 cc 1 3,000
Spuit 10 cc 1 3,000
2,211,850 345,000

ANESTESI DENGAN SAB

KASUS APOTIK ESTIMASI IGD
JUMLAH HARGA TINDAKAN & BEKKES TARIF
Torsio Testis Ondan 1 9,000 Pendaftaran 30,000
HIL Bunascan 1 85,000 Infus 25,000
Appendiks Spinocain 1 86,000 TTV 30,000
Hidrokel Tramadol 1 63,900 Layanan dokter umum 50,000
Batu Buli Ketorolac 2 15,400 Konsul spesialis 75,000
Hansaplas 1 1,000 EKG 75,000
Cairan RL 2 19,800 Injeksi 25,000
O2 2 lt/menit 50,000 Scaren 15,000
BEKKES BHP 20,000
OBAT Jumlah
Betadine 120 cc 21,000
Alkohol 100 cc 10,000
Minoscrab 30 cc 30,000
 Gamex 7 psg 237,000
Masker 7 17,500
Cap Kepala 7 14,000
Hipafix 20 cm 20,000
Polisorb 2.0 1 223,600
Polisorb 3.0 1 212,950
Dermalon 3.0 1 102,000
Silk 2.0 1 95,250
Chromic 2.0 1 109,600
Mesh 10 1 6,500
Eletroda 3 biji 45,000
Kasa 3 meter 15,000
NaCl 1 9,800

1,169,200 345,000

ANESTESI DENGAN GA MEMAKAI ETT

KASUS APOTIK ESTIMASI IGD
JUMLAH HARGA TINDAKAN & BEKKES TARIF
Ileus Ondan 1 9,000 Pendaftaran 30,000
Laparatomy Myloz 1 31,000 Infus 25,000
Trauma Fentanyl 1 217,500 TTV 30,000
Propafol 1 54,900 Layanan dokter umum 50,000
Tramadol 1 63,900 Konsul spesialis 75,000
Ketorolac 2 15,400 EKG 75,000
RL 2 19,800 Injeksi 25,000
Sevofluren 20 ml/jam 212,100 Scaren 15,000
Ecron 1 142,600 BHP 20,000
SA 2 6,000
prostigmin 2 36,000
O2 2 lt/menit 50,000
N2O 2 lt/jam 150,000
BEKKES
OBAT Jumlah
Betadine 120 cc 40,000
Alkohol 100 cc 10,000
Minoscrab 30 cc 11,100
Gamex 7 psg 237,000
Masker 7 122,500
Cap Kepala 7 98,000
Hipafix 20 cm 20,000
Polisorb 2.0 1 223,600
Polisorb 3.0 1 212,950
Dermalon 3.0 1 102,000
Silk 2.0 1 95,250
Chromic 2.0 1 109,600
Mesh 10 1 6,500
Eletroda 3 biji 45,000
Kasa 3 meter 15,000
NaCl 1 9,800

2,366,500 345,000
GA MEMAKAI LMA
LAB/RO RANAP
JENIS RIK TARIF TINDAKAN/BEKKES TARIF
Rapid 90,000 Injeksi 25,000
DL 65,000 TTV 30,000
CT/BT 30,000 R Luka 75,000
GDS 25,000 Aff Infus 20,000
HIV 150,000 Perawatan Infus 25,000
Thorax 100,000 Cefotaxime 69,000
Ketorolac 39,000
Ranitidin 24,000
Cefadroxil Tab 18,000
Asam Mefenamat Tab 5,000
Betadine 7,000
Hypafix 15,000
Kasa 8,000
Sarung Tangan 300,000
Nursecap 6,000
Spuit 1 cc 3,000
Spuit 3 cc 3,000
Spuit 5 cc 3,000
Alkohol 10,000

460,000 685,000

3,701,850

ENGAN SAB
LAB/RO RANAP
JENIS RIK TARIF TINDAKAN/BEKKES TARIF
Rapid 90,000 Injeksi 25,000
DL 65,000 TTV 30,000
CT/BT 30,000 R Luka 75,000
GDS 25,000 Aff Infus 20,000
HIV 150,000 Perawatan Infus 25,000
Thorax 100,000 Cefotaxime 69,000
Ketorolac 39,000
Ranitidin 24,000
Cefadroxil Tab 18,000
Asam Mefenamat Tab 5,000
Betadine 7,000
Hypafix 15,000
Kasa 8,000
 Sarung Tangan 300,000
Nursecap 6,000
Spuit 1 cc 3,000
Spuit 3 cc 3,000
Spuit 5 cc 3,000
Alkohol 10,000

460,000 685,000
2,659,200

GA MEMAKAI ETT
LAB/RO RANAP
JENIS RIK TARIF TINDAKAN/BEKKES TARIF
Rapid 90,000 Injeksi 25,000
DL 65,000 TTV 30,000
CT/BT 30,000 R Luka 75,000
GDS 25,000 Aff Infus 20,000
HIV 150,000 Perawatan Infus 25,000
Thorax 100,000 Cefotaxime 69,000
Ketorolac 39,000
Ranitidin 24,000
Cefadroxil Tab 18,000
Asam Mefenamat Tab 5,000
Betadine 7,000
Hypafix 15,000
Kasa 8,000
Sarung Tangan 300,000
Nursecap 6,000
Spuit 1 cc 3,000
Spuit 3 cc 3,000
Spuit 5 cc 3,000
Alkohol 10,000

460,000 685,000
3,856,500
 ANESTESI DENGAN SAB
KASUS APOTIK ESTIMASI IGD
JUMLAH HARGA TINDAKAN & BEKKES TARIF
SC Ondan 1 9,000 Pendaftaran 30,000
Tubektomi Bunascan 1 85,000 Infus 25,000
Mioma Uteri Spinocain 1 86,000 TTV 30,000
Oxy 3 30,000 Layanan dokter umum 50,000
Metargin 1 6,000 Konsul spesialis 75,000
Tramadol 1 63,900 EKG 75,000
Ketorolac 2 15,400 Injeksi 25,000
RL 3 29,700 Scaren 15,000
O2 2lt/menit 50,000 BHP 20,000
Betadine 120 cc 40,000
Alkohol 100 cc 10,000
Minoscrab 30 cc 30,000
Gamex 7 pasang 237,000
Masker 7 buah 17,500
Cap Kepala 7 buah 14,000
Hypafix 20 cm 30,000
BioCYN 1 245,000
Chromic 1 115,000
Dermalon 1 103,000
Kasa 3 meter 15,000
NaCl 1 9,800
Elektroda 3 biji 45,000

1,286,300 345,000

ANESTESI DENGAN GA
KASUS APOTIK ESTIMASI IGD
JUMLAH HARGA TINDAKAN & BEKKES TARIF
Kurete Ondan 1 9,000 Pendaftaran 30,000
Propafol 1 54,900 Infus 25,000
Ketorolac 2 15,400 TTV 30,000
Tramadol 1 63,900 Layanan dokter umum 50,000
Sevofluran 20 ml/ jam 212,100 Konsul spesialis 75,000
O2 2 lt/menit 50,000 EKG 75,000
N2O 2l/jam 150,000 Injeksi 25,000
Fentanyl 1 217,500 Scaren 15,000
Myloz 1 31,000 BHP 20,000
Betadine 120 cc 40,000
Alkohol 100 cc 10,000
Minoscrab 30 cc 11,100
Gamex 7 pasang 237,000
Masker 7 buah 17,500
Cap Kepala 7 buah 14,000
Hypafix 20 cm 30,000
BioCYN 1 245,000
Chromic 1 115,000
Dermalon 1 103,000
Kasa 3 meter 15,000
NaCl 1 9,800
Elektroda 3 biji 45,000

1,696,200 345,000
ENGAN SAB
LAB/RO RANAP
JENIS RIK TARIF TINDAKAN/BEKKES TARIF
Rapid 90,000 Injeksi 25,000
DL 65,000 TTV 30,000
CT/BT 30,000 R Luka 75,000
GDS 25,000 Aff Infus 20,000
HIV 150,000 Perawatan Infus 25,000
Thorax 100,000 Cefotaxime 69,000
Ketorolac 39,000
Ranitidin 24,000
Cefadroxil Tab 18,000
Asam Mefenamat Tab 5,000
Betadine 7,000
Hypafix 15,000
Kasa 8,000
Sarung Tangan 300,000
Nursecap 6,000
Spuit 1 cc 3,000
Spuit 3 cc 3,000
Spuit 5 cc 3,000
Alkohol 10,000

460,000 685,000

2,776,300

ENGAN GA
LAB/RO RANAP
JENIS RIK TARIF TINDAKAN/BEKKES TARIF
Rapid 90,000 Injeksi 25,000
DL 65,000 TTV 30,000
CT/BT 30,000 R Luka 75,000
GDS 25,000 Aff Infus 20,000
HIV 150,000 Perawatan Infus 25,000
Thorax 100,000 Cefotaxime 69,000
Ketorolac 39,000
Ranitidin 24,000
Cefadroxil Tab 18,000
Asam Mefenamat Tab 5,000
Betadine 7,000
Hypafix 15,000
Kasa 8,000
Sarung Tangan 300,000
Nursecap 6,000
Spuit 1 cc 3,000
Spuit 3 cc 3,000
Spuit 5 cc 3,000
Alkohol 10,000
 460,000 685,000

3,186,200
 ANESTESI DENGAN SAB
KASUS APOTIK ESTIMASI IGD
JUMLAH HARGA TINDAKAN & BEKKES TARIF
Fraktur Ext Bawah Ondan 1 9,000 Pendaftaran 30,000
Bunascan 1 85,000 Infus 25,000
Spinocain 1 86,000 TTV 30,000
Tramadol 2 127,800 Layanan dokter umum 50,000
Ketorolac 2 15,400 Konsul spesialis 75,000
RL 2 19,800 EKG 75,000
O2 2lt/menit 50,000 Injeksi 25,000
Hansaplast 1 150,000 Scaren 15,000
Betadine 120 cc 40,000 BHP 20,000
Alkohol 100 cc 10,000
Minoscrab 30 cc 30,000
Gamex 7 pasang 236,789
Masker 7 pasang 17,500
Cap Kepala 7 buah 14,000
Hypafix 20 cm 30,000
Dermalon 3.0 1 102,000
Polisorb 2.0 1 212,900
mesh 1 6,500
Elektroda 3 biji 45,000
Kasa 3 meter 15,000
NaCl 3 29,400

1,332,089 345,000

ANESTESI DENGAN GA
KASUS APOTIK ESTIMASI IGD
JUMLAH HARGA TINDAKAN & BEKKES TARIF
Fraktur Ext Atas Ondan 1 9,000 Pendaftaran 30,000
Propafol 1 54,900 Infus 25,000
Myloz 1 31,000 TTV 30,000
Ecron 1 142,600 Layanan dokter umum 50,000
Sevofluran 20 ml/ jam 212,100 Konsul spesialis 75,000
O2 2 lt/menit EKG 75,000
N2O 2l/jam Injeksi 25,000
Fentanyl 1 217,500 Scaren 15,000
SA 2 13,000 BHP 20,000
prostigmin 2 36,000
Betadine 120 cc 40,000
Alkohol 100 cc 10,000
Minoscrab 30 cc 11,100
Gamex 7 pasang 237,000
Masker 7 pasang 17,500
Cap Kepala 7 buah 14,000
Hypafix 20 cm 30,000
Dermalon 3.0 1 102,000
Polisorb 2.0 1 212,000
mesh 1 6,500
Elektroda 3 biji 45,000
Kasa 3 meter 15,000
NaCl 3 29,400

1,485,600 345,000
ENGAN SAB
LAB/RO RANAP
JENIS RIK TARIF TINDAKAN/BEKKES TARIF
Rapid 90,000 Injeksi 25,000
DL 65,000 TTV 30,000
CT/BT 30,000 R Luka 75,000
GDS 25,000 Aff Infus 20,000
HIV 150,000 Perawatan Infus 25,000
Thorax 100,000 Cefotaxime 69,000
Ketorolac 39,000
Ranitidin 24,000
Cefadroxil Tab 18,000
Asam Mefenamat Tab 5,000
Betadine 7,000
Hypafix 15,000
Kasa 8,000
Sarung Tangan 300,000
Nursecap 6,000
Spuit 1 cc 3,000
Spuit 3 cc 3,000
Spuit 5 cc 3,000
Alkohol 10,000

460,000 685,000

2,822,089

ENGAN GA
LAB/RO RANAP
JENIS RIK TARIF TINDAKAN/BEKKES TARIF
Rapid 90,000 Injeksi 25,000
DL 65,000 TTV 30,000
CT/BT 30,000 R Luka 75,000
GDS 25,000 Aff Infus 20,000
HIV 150,000 Perawatan Infus 25,000
Thorax 100,000 Cefotaxime 69,000
Ketorolac 39,000
Ranitidin 24,000
Cefadroxil Tab 18,000
Asam Mefenamat Tab 5,000
Betadine 7,000
Hypafix 15,000
Kasa 8,000
Sarung Tangan 300,000
Nursecap 6,000
Spuit 1 cc 3,000
Spuit 3 cc 3,000
Spuit 5 cc 3,000
Alkohol 10,000
 460,000 685,000

2,975,600
 TARIF LAYANAN RAWAT INAP & OPERASI
RS TK IV SINGARAJA
KASUS
FASKES TINDAKAN & BEKKES
BEDAH
KLS I KLS II KLS III
GA Dengan LMA
Lipoma 300,000 240,000 180,000 3,701,850
Ganglion 300,000 240,000 180,000 3,701,850
STT 300,000 240,000 180,000 3,701,850
FAM 300,000 240,000 180,000 3,701,850
Anestesi Dengan SAB
Torsio Testis 300,000 240,000 180,000 2,659,200
HIL 300,000 240,000 180,000 2,659,200
Appendiks 300,000 240,000 180,000 2,659,200
Hidrokel 300,000 240,000 180,000 2,659,200
Batu Buli 300,000 240,000 180,000 2,659,200
GA Dengan ETT
Ileus 450,000 390,000 300,000 3,856,500
Laparatomy 450,000 390,000 300,000 3,856,500
Trauma 450,000 390,000 300,000 3,856,500
OBGYN
Anestesi Dengan SAB
SC 450,000 390,000 300,000 2,776,300
Tubektomi 450,000 390,000 300,000 2,776,300
Mioma Uteri 450,000 390,000 300,000 2,776,300
Anestesi Dengan GA
Kurete 300,000 240,000 180,000 3,186,200
Anestesi Dengan SAB
Fraktur Ext Bawah 500,000 500,000 500,000 2,822,089
Anestesi Dengan GA
Fraktur Ext Atas 500,000 500,000 500,000 2,975,600

KETERANGAN TAMBAHAN
kategori operasi sedang
kategori operasi berat
kategori operasi khusus
operasi khusus (orthopedi) tarif belum termasuk biaya alat
untuk kategori operasi cito, tarif harga di up/naikkan 25% dari tarif normal
INAP & OPERASI
ARAJA
KAMAR
KLS I KLS II KLS III OPERATOR
KLS I KLS II KLS III

375,000 232,500 180,000 1,000,000 800,000 600,000

375,000 232,500 180,000 1,000,000 800,000 600,000
375,000 232,500 180,000 1,000,000 800,000 600,000
375,000 232,500 180,000 1,000,000 800,000 600,000

375,000 232,500 180,000 1,000,000 800,000 600,000

375,000 232,500 180,000 1,000,000 800,000 600,000
375,000 232,500 180,000 1,000,000 800,000 600,000
375,000 232,500 180,000 1,000,000 800,000 600,000
375,000 232,500 180,000 1,000,000 800,000 600,000

375,000 232,500 180,000 1,500,000 1,300,000 1,000,000

375,000 232,500 180,000 1,500,000 1,300,000 1,000,000
375,000 232,500 180,000 1,500,000 1,300,000 1,000,000

375,000 232,500 180,000 1,500,000 1,300,000 1,000,000

375,000 232,500 180,000 1,500,000 1,300,000 1,000,000
375,000 232,500 180,000 1,500,000 1,300,000 1,000,000

375,000 232,500 180,000 1,000,000 800,000 600,000

375,000 232,500 180,000 3,000,000 2,500,000 2,000,000

375,000 232,500 180,000 3,000,000 2,500,000 2,000,000

 PELAKSANA
DR. AN PENATA ASISTEN
KLS I KLS II KLS III KLS I KLS II KLS III KLS I

400,000 320,000 240,000 200,000 160,000 120,000 200,000

400,000 320,000 240,000 200,000 160,000 120,000 200,000
400,000 320,000 240,000 200,000 160,000 120,000 200,000
400,000 320,000 240,000 200,000 160,000 120,000 200,000

400,000 320,000 240,000 200,000 160,000 120,000 200,000

400,000 320,000 240,000 200,000 160,000 120,000 200,000
400,000 320,000 240,000 200,000 160,000 120,000 200,000
400,000 320,000 240,000 200,000 160,000 120,000 200,000
400,000 320,000 240,000 200,000 160,000 120,000 200,000

600,000 520,000 400,000 300,000 260,000 200,000 300,000

600,000 520,000 400,000 300,000 260,000 200,000 300,000
600,000 520,000 400,000 300,000 260,000 200,000 300,000

600,000 520,000 400,000 300,000 260,000 200,000 300,000

600,000 520,000 400,000 300,000 260,000 200,000 300,000
600,000 520,000 400,000 300,000 260,000 200,000 300,000

400,000 320,000 240,000 200,000 160,000 120,000 200,000

1,200,000 1,000,000 800,000 600,000 500,000 400,000 600,000

1,200,000 1,000,000 800,000 600,000 500,000 400,000 600,000

 JUMLAH
ASISTEN INSTRUMEN
KLS II KLS III KLS I KLS II KLS III KLS I

160,000 120,000 200,000 160,000 120,000 6,376,850

160,000 120,000 200,000 160,000 120,000 6,376,850
160,000 120,000 200,000 160,000 120,000 6,376,850
160,000 120,000 200,000 160,000 120,000 6,376,850

160,000 120,000 200,000 160,000 120,000 6,376,850

160,000 120,000 200,000 160,000 120,000 6,376,850
160,000 120,000 200,000 160,000 120,000 6,376,850
160,000 120,000 200,000 160,000 120,000 6,376,850
160,000 120,000 200,000 160,000 120,000 6,376,850

260,000 200,000 300,000 260,000 200,000 7,681,500

260,000 200,000 300,000 260,000 200,000 7,681,500
260,000 200,000 300,000 260,000 200,000 7,681,500

260,000 200,000 300,000 260,000 200,000 7,681,500

260,000 200,000 300,000 260,000 200,000 7,681,500
260,000 200,000 300,000 260,000 200,000 7,681,500

160,000 120,000 200,000 160,000 120,000 6,376,850

500,000 400,000 600,000 500,000 400,000 9,697,089

500,000 400,000 600,000 500,000 400,000 9,697,089

JUMLAH

KLS II KLS III

5,774,350 5,261,850
5,774,350 5,261,850
5,774,350 5,261,850
5,774,350 5,261,850

5,774,350 5,261,850
5,774,350 5,261,850
5,774,350 5,261,850
5,774,350 5,261,850
5,774,350 5,261,850

7,079,000 6,336,500
7,079,000 6,336,500
7,079,000 6,336,500

7,079,000 6,336,500
7,079,000 6,336,500
7,079,000 6,336,500

5,774,350 5,261,850

8,554,589 7,502,089

8,554,589 7,502,089