Rekap Paket RANAP Kanwil II - Muara Enim

7/26/2019 Rekap Paket RANAP Kanwil II - Muara Enim

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Cakupan % tarif bawah

Mondok makan 55,000

Visite dokter 40,000

Asuhan keperawatan 10,000

Tindakan keperawatan 9,000

Tindakan Operasi kecil 100% 1,290,000

ia!a Operasional "1%Operator 4#%

Anestesi 1$%

Asisten, &, lain2 $%

Tindakan operasi sedan' 100% 2,1$0,000

ia!a Operasional "1%

Operator 4#%

Anestesi 1$%


Tindakan operasi (esar 100% 2,$"5,000


Operator 4#%

Anestesi 1$%


Tindakan operasi (esar isterektomi 100% 2,$"5,000


Operator 4#%

Anestesi 1$%



Operator 4#%

Anestesi 1$%


Tindakan )uret *50,000

Tindakan partus risiko tin''i #50,000

Tindakan partus +akum ekstraksi 9"5,000

PAKET ISOLASI

)amar isolasi 55,000

Visite dokter 40,000asuhan keperawatan 10,000

Tindakan keperawatan 9,000

PAKET ICU

Mondok Makan

Visite dokter -./

Visite dokter spesialis



50

20

5




Operator 4#%

Anestesi 1$%



Operator 4#%

Anestesi 1$%



Operator 4#%

Anestesi 1$%




Operator 4#%

Anestesi 1$%




Tindakan Operasi kecil 1,000,000 2,100,000

ia!a Operasional "0#,14" $45,000

Operator 4#2,4$* 992,1*"

Anestesi 15#,24$ ""0,21$

Asisten, &, lain2 $",14" 1"2,$01

Tindakan operasi sedan' 1,#00,000 ","00,000

ia!a Operasional 522,14" 1,01",5#2

Operator *0",19$ 1,559,145

Anestesi 2$#,"1* 51*,911

Asisten, &, lain2 10#,"44 20*,"#"

Tindakan operasi (esar 2,500,000 4,#50,000

ia!a Operasional #$#,*5# 1,45*,929

Operator 1,1*1,1#0 2,244,224

Anestesi "9",114 #4$,91#

Asisten, &, lain2 15#,*5* 299,9"1



Operator 2,055,2"$ ",*2$,992

Anestesi $*4,019 1,2#",$90

Asisten, &, lain2 2#4,$#" 511,4$1



Mondok makan #0,000 120,000

Visite dr spesialis "5,000 $5,000

Asuhan keperawatan "0,000 "0,000

Tindakan keperawatan 25,000 25,000



Rawat Jalan Lanjutan awat -nap

No ia!no"a Obat-obatan Penunjang Diagnostik Phisioterapi Emergency Rawat Inap Obat-obatan Rontgen Lab Pem Khusus PA

1 Astma pada anak 1"2,99* 4#,500 $5,000 5*,500 "42,000 "49,4#"

2 ronchopneumonia Anak 9",0$1 4#,500 $5,000 #0,500 5#0,000 #0",#$#

" ronchopneumonia ewasa 94,*5" 4#,500 $5,000 #0,500 5#0,000 #4#,1*9

4 emam Th!poid Anak 2$2,500 525,000 5"2,**1

5 emam Th!poid ewasa 2$2,500 5#0,000 5"#,5#0

$ 'rade --- Anak 1"5,000 45$,000 41",1$1

# 'rade --- ewasa 90,000 45$,000 "1$,02*

* 3A anak 122,500 25,000 "42,000 "$9,91*

9 3A dewasa 122,500 25,000 "42,000 "4#,*0910 )ean' emam #1,599 $5,000 90,000 "42,000 24$,9"0

11 O(ser+asi 6e(ris "$,4"* 95,000 25,000 "42,000 15*,000

12 &aket arian -./ 78 78 78 78 78 78 78 78 78 78 78

1" Tari6 &aket arian 78 78 78 78 78 78 78 78 78 78 78

14 Tari6 &aket arian -solasi 78 78 78 78 78 78 78 78 78 78 78

15 A(ortus den'an kuretase pada li'hted o+um 111,02$ 129,000 100,000 114,000 1$0,"41

1$ A(ortus inkomplit den'an kuretase 111,02$ 129,000 100,000 114,000 1$0,"41

1# &artus den'an -nduksi 45",000 $0,550

1* &artus den'an risiko tin''i 544,500 1#,##*

19 &artus den'an +akum ekstraksi, 6orceps 544,500 1#,##*

20 ectio aecaria ai 'a'al drip **2,000 1,200,$*1

21 ectio aecaria elekti6 :.&, )&, oli'ohidramnion; 90#,500 "$0,15$

22 ectio aecaria emer'ensi :'awa anin, &erdarahan antepa 90#,500 "$0,15$

2" isterektomi 45$,000 595,94$

24 appendisitis akut tanpa per6orasi 1#4,"$9 1$0,000 100,000 $5,000 "02,000 *1",12#

25 AM 114,000 1*,0#0

2$ 3an'lion 114,000 1*,0#0

2# <ipoma Multipel 114,000 1*,0#0

2* aemorroid disertai tindakan operasi 45$,000 #$2,*00 29 )atarak "9,40" 22*,000

"0 &teri'ium 105,000

"1 Tonsilitis hipertropi anak 5$,*50 22*,000 11",#00

"2 Tonsilitis hipertropi dewasa 22*,000 "*,4*4

"" Tari6 &aket Operasi )ecil 140,1"1 112,500 114,000 1*,0#0

"4 Tari6 &aket Operasi edan' 1#",*94 1$0,000 "02,000 554,504

"5 Tari6 &aket Operasi esar 1#",*94 1$0,000 5"0,000 1,145,$"0

okt#rSp#"iali"TinakanKhusus



A=A ATA Rawat Jalan Lanjutan

Lain-!ain " Physioterapi TOTA< <-- TOTA< Obat-obatan Penunjang Diagnostik PhisioteraLabu Darah ATAA=A Rontgen Lab Pem Khusus PA

$4,500 1,059,9#0 :1,059,9#0;

*$,000 1,#00,*2* :1,#00,*2*;

$4,500 1,#24,542 :1,#24,542;

1,"20,"*1 :1,"20,"*1;

1,"#0,0#0 :1,"#0,0#0;

1,199,1$1 :1,199,1$1;

1,0#",52* :1,0#",52*;

*59,41* :*59,41*;

*"#,"09 :*"#,"09; 9$0,529 :9$0,529;

#21,4"* :#21,4"*;

78 78 78 78 78 78 78

78 78 78 78 78 78 78

78 78 78 78 78 78 78

50,000 1,514,"$# :1,514,"$#;

1,4$4,"$# :1,4$4,"$#;

2,29$,40* :2,29$,40*;

1,5$2,05$ :1,5$2,05$; 1,#4#,05$ :1,#4#,05$;

#,92",9"2 :#,92",9"2;

5,4$0,#04 :5,4$0,#04;

5,4$0,#04 :5,4$0,#04;

5,121,5## :5,121,5##;

4,#*0,52# :4,#*0,52#;

",44*,$#1 :",44*,$#1;

",44*,$#1 :",44*,$#1;

",44*,$#1 :",44*,$#1;

4,5"9,$$$ :4,5"9,$$$; 500,000 4,09*,20" :4,09*,20";

9#5,"00 :9#5,"00;

",*$5,220 :",*$5,220;

",#"",154 :",#"",154;

2,2"#,444 :2,2"#,444;

2,""5,429 :2,""5,429;

5,$50,555 :5,$50,555;

TinakanKhusus

o #r

Sp#"iali" TinakanKhususrans us

Darahn$ a e$%crew



Penunjang Diagnostik Lain-!ain "Physioterapi

Rontgen Lab Pem Khusus PA Labu Darah

Persa!inanPato!ogis

TinakanKhusus rans us

Pin$ P!ate$ %crew

K K j P hi T if P k R I



Asthma ronchiale Anakalaman 1$ dari 25#

K#rta" K#rja P#rhitun!an Tarif Pak#t Rawat Inap

)A/ > Asthma ronchiale

/-A > Anakanak s?d? # tahun

ari 1 ari 2 ari "

ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah ar'a

RA$AT JALAN LANJUTAN

okt#r Sp#"iali"

ObatObatan 1"2,99*

Antiasma VTO<- /< 2?5M3 2?5M< 2 AM& *,910 1 *,910

Antiasma BAMTAO AM& 5M3 1M< 100 AM& *01 1 *01

ahan a(is &akai AO.AT T 223 1*,#50 1 1*,#50

ahan a(is &akai M-.O-& OT 1*,5$" 1 1*,5$" ahan a(is &akai T =AC TO& .O.) 2",292 1 2",292

.airan Mineral O-/M .<O- 0?9% 500M< OT T< *,"0# 1 *,"0#

-O<VO AM& 4m' AM& 42,000 1 42,000

AA< .A/< 12,"#5 1 12,"#5

P#nunjan! ia!no"tik

Ront!#n 4#,500

Thoraks A&D&A 4#,500 1 4#,500

Laboratoriu& $5,000

arah <en'kap :arah utin, iE count, <; $5,000 1 $5,000

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

ari 1 ari 2 ari "



Asthma ronchiale Anakalaman 1# dari 25#

ari 1 ari 2 ari "


Ph("ioth#rapi

E&#r!#n"i 5*,500

@asa dokter 25,000 1 25,000

Oksi'en per am $,000 2 12,000

ewa e(uliFer 21,500 1 21,500

A=AT -A&

Ko&pon#n Rawat Inap 114,000 114,000 114,000

Mondok makan 55,000 1 55,000 1 55,000 1 55,000

Visite dokter spesialis 40,000 1 40,000 1 40,000 1 40,000

Asuhan keperawatan 10,000 1 10,000 1 10,000 1 10,000

Tindakan keperawatan 9,000 1 9,000 1 9,000 1 9,000

Obatobatan 14#,0"$ 14#,$44 54,#94

Anti(iotik 'ol se6alospori .AOB-< 125M3D5 M< C 3) T< 9,5*$

Antiasma VTO<- /< 2?5M3 2?5M< 2 AM& *,910 1 *,910 1 *,910 1 *,910

Antiasma )A<MTAO 4M3 1M< AM&G AM& #,"91 1 #,"91 2 14,#*" 2 14,#*"

kspektoran dan Mukoliti AMOBO< C 15M3D5M< $0M< 3- T< ",2"0 1 ",2"0

OO<VA 50M3D5M< C 100 M< T< 11,9$2

.airan Mineral O-/M .<O- 0?9% 500M< OT T< *,"0# 1 *,"0# 2 1$,$14 2 1$,$14

ahan a(is &akai AH/A-T 50 M< -)A < #,150 1 #,150 1 #,150

ahan a(is &akai -& C-3 1 M< T/MO T 2,$12 1 2,$12

ahan a(is &akai -& C-3 " M< T/MO 1,"#5 " 4,125 " 4,125 " 4,125

ahan a(is &akai AA&<AT T T-& G 10 4"* 1 4"*

ahan a(is &akai )AA C?T-< 1$D1$ ) $,9"0 0?10 $9" ahan a(is &akai -O- &OV-O O< 10% "0M< T< 2,500 0?10 250

ahan a(is &akai A<)OO< #0 % 100 M< AMA) < ",5*# 0?20 #1#

Oksi'en per 24 am 100,000 1 100,000 1 100,000

A-T-- -@ 3B ",212 1 ",212 1 ",212 1 ",212

Op#ra"i

ari 1 ari 2 ari "



Asthma ronchiale Anakalaman 1* dari 25#

ari 1 ari 2 ari "


P#rawatan Khu"u"

P#r"alinan Patolo!i"

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u" 21,500 21,500 21,500

e(uliFer tanpa materi 21,500 1 21,500 1 21,500 1 21,500

Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w

ari 1 ari 2 ari "



Asthma ronchiale Anakalaman 19 dari 25#

ari 1 ari 2 ari "


&in

&late

rew

-O<

Ph("ioth#rapi

Total +ia(a ,-.),// 0-/)122 134)032




ari 4 Total

@umlah ar'a @umlah ar'a

1"2,99*

1 *,910

1 *01

1 1*,#50

1 1*,5$" 1 2",292

1 *,"0#

1 42,000

1 12,"#5

4#,500

1 4#,500

$5,000

1 $5,000

ari 4 Total





5*,500

1 25,000

2 12,000

1 21,500

"42,000

" 1$5,000

" 120,000

" "0,000

" 2#,000

"49,4#"

" 2$,#"0

5 "$,95$

1 ",2"0

5 41,5"5

2 14,"00

1 2,$12

9 12,"#5

1 4"*

0 $9" 0 250

0 #1#

2 200,000

" 9,$"$

ari 4 Total





$4,500

" $4,500

ari 4 Total

@ l h @ l h



Asthma ronchiale Anakalaman 2" dari 25#


1,059,9#0



ronchopneumonia Anakalaman 24 dari 25#


)A/ > O.O&/MO-A


ari 1 ari 2 ari " ari 4

ediaan @umlah ar'a @umlah ar'a @umlah ar'a @umlah ar'a


okt#r Sp#"iali"

ObatObatan 9",0$1

Anti(iotik 'ol se6alospori .OTAB-M 1 3 3) V-A 14,4"* 1 14,4"* Antiasma VTO<- /< 2?5M3 2?5M< 2 AM& *,910 1 *,910

Antiasma )A<MTAO AM& 4M3 1M< 100 AM& *01 1 *01


ahan a(is &akai M-.O-& OT 1*,5$" 1 1*,5$"

ahan a(is &akai T =AC TO& .O.) 2",292 1 2",292

.airan Mineral O-/M .<O- 0?9% 500M< OT T< *,"0# 1 *,"0#

-O<VO /< AM& 1

AA< .A/< 1

P#nunjan! ia!no"tik

Ront!#n 4#,500

ont'enon)ontras Thoraks A&D&A 4#,500 1 4#,500

Laboratoriu& $5,000

&emeriksaanematolo'i


P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

ar'aatuan





ediaan @umlah ar'a @umlah ar'a @umlah ar'a @umlah ar'aar'a

atuan

Ph("ioth#rapi

E&#r!#n"i #0,500

@asa dokter 25,000 1 25,000

Oksi'en per am $,000 4 24,000

ewa e(uliFer 21,500 1 21,500

A=AT -A&

Ko&pon#n Rawat Inap 114,000 114,000 114,000 114,000

Mondok makan 55,000 1 55,000 1 55,000 1 55,000 1 55,000

Visite dokter spesialis 40,000 1 40,000 1 40,000 1 40,000 1 40,000

Asuhan keperawatan 10,000 1 10,000 1 10,000 1 10,000 1 10,000

Tindakan keperawatan 9,000 1 9,000 1 9,000 1 9,000 1 9,000

Obatobatan 1$2,*## 159,"2$ 1##,$*2 159,"2$

Anal'esik, Antipiretik AMO< C $0 M< T< 11,20$ 1 11,20$ 1 11,20$


Anti(iotik 'ol se6alospori .OTAB-M 1 3 3) V-A 14,4"* 1 14,4"* 1 14,4"* 1 14,4"*

Antiasma VTO<- /< 2?5M3 2?5M< 2 AM& *,910 1 *,910 1 *,910 1 *,910 1 *,910

Antiasma )A<MTAO AM& 5M3 1M< 100 AM& 1

.airan Mineral O-/M .<O- 0?9% 500M< OT T< *,"0# 1 *,"0# 2 1$,$14 2 1$,$14 2 1$,$14

kspektoran dan Mukoliti AMOBO< C 15M3D5M< $0M< 3- T< ",2"0 1 ",2"0

.airan Mineral O-/M .<O- 0?9% 500M< OT T< *,"0# 2 1$,$14 2 1$,$14 2 1$,$14 2 1$,$14



ahan a(is &akai -& C-3 " M< T/MO 1,"#5 2 2,#50 2 2,#50 2 2,#50 2 2,#50


ahan a(is &akai )AA C?T-< 1$D1$ ) $,9"0 0?10 $9"

ahan a(is &akai -O- &OV-O O< 10% "0M< T< 2,500 0?10 250


Oksi'en per 24 am 100,000 1 100,000 1 100,000 1 100,000 1 100,000

-O<VO /< AM& 1 2 2

Op#ra"i



ronchopneumonia Anakalaman 2$ dari 25#



atuan

P#rawatan Khu"u"


P#nunjan! ia!no"tik

Ront!#n

Laboratoriu& $5,000



P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u" 21,500 21,500 21,500 21,500

e(uliFer tanpa materi 21,500 1 21,500 1 21,500 1 21,500 1 21,500

Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w



ronchopneumonia Anakalaman 2# dari 25#



atuan

&in

&late

rew

-O<

Ph("ioth#rapi

Total +ia(a ,52)2/- 032)-0. /1/)1-0 /,3)-0.



ronchopneumonia Anakalaman 2* dari 25#

ari 5 Total


9",0$1

1 14,4"* 1 *,910

1 *01

1 1*,#50

1 1*,5$"

1 2",292

1 *,"0#

1

1

4#,500

1 4#,500

$5,000

1 $5,000




ari 5 Total


#0,500

1 25,000

4 24,000

1 21,500

114,000 5#0,000

1 55,000 5 2#5,000

1 40,000 5 200,000

1 10,000 5 50,000

1 9,000 5 45,000

44,55$ #0",#$#

1 11,20$ " "",$1*

1 9,5*$ 1 9,5*$

" 4","14

4 "5,$40

1

1 *,"0# * $$,45$

1 ",2"0

1 *,"0# 9 #4,#$"

1 #,150 " 21,450

1 2,$12

* 11,000

1 4"*

0 $9"

0 250

0 #1#

4 400,000

5



ronchopneumonia Anakalaman "0 dari 25#

ari 5 Total


$5,000

1 $5,000

*$,000

4 *$,000



ronchopneumonia Anakalaman "1 dari 25#

ari 5 Total


1,-),,. 1,#00,*2*



ronchopneumonia

alaman "2 dari 25#


)A/ > O.O&/MO-A termasuk ronchitisDronchiolitis

/-A > ewasa


ediaan @umlah ar'a @umlah ar'a @umlah ar'a @umlah ar'aRA$AT JALAN LANJUTAN

okt#r Sp#"iali"

ObatObatan 94,*5"

Anti(iotik 'ol se6alospori .OTAB-M 1 3 3) V-A 14,4"* 1 14,4"*

Antiasma VTO<- /< 2?5M3 2?5M< 2 AM& *,910 1 *,910

Antiasma )A<MTAO AM& 4M3 1M< 100 AM& *01 " 2,40"


ahan a(is &akai -/ T =AA TM 15,125 1 15,125


.airan Mineral BT 5% I A.< 0?225% OT < 11,9"5 1 11,9"5

-O<VO /< AM&

AA< .A/<

P#nunjan! ia!no"tik

Ront!#n 4#,500

Thoraks A&D&A 4#,500 1 4#,500

Laboratoriu& $5,000


P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

ar'a

atuan



ronchopneumonia

alaman "" dari 25#



atuan

E&#r!#n"i #0,500

@asa dokter 25,000 1 25,000

Oksi'en per am $,000 4 24,000

e(uliFer tanpa materi 21,500 1 21,500

A=AT -A&


Mondok makan 55,000 1 55,000 1 55,000 1 55,000 1 55,000




Obatobatan 1#1,1** 1#0,0"* 1##,1** 159,1$"

Anal'esik, Antipiretik &AA.TAMO< 500 M3 G 100 3) TA 95 4 "*0 4 "*0 4 "*0 4 "*0Anti(iotik 'ol se6alospori .OTAB-M 1 3 3) V-A 14,4"* 2 2*,*#$ 2 2*,*#$ 2 2*,*#$ 2 2*,*#$

Anti(iotik 'ol se6alospori .-B-M 100m' cap ",000

Antiasma VTO<- /< 2?5M3 2?5M< 2 AM& *,910 1 *,910 1 *,910 1 *,910

kspektoran dan Mukoliti AMOBO< "0 M3 TA G 100 3- TA 141 " 42" " 42" " 42" " 42"

.airan Mineral O-/M .<O- 0?9% 500M< OT T< *,"0# 2 1$,$14 " 24,921 " 24,921 " 24,921



ahan a(is &akai -& C-3 " M< T/MO 1,"#5 " 4,125 " 4,125 " 4,125 " 4,125

ahan a(is &akai AA&<AT T T-& G 10 4"* 1 4"* 1 4"*

ahan a(is &akai )AA C?T-< 1$D1$ ) $,9"0 0?10 $9" ahan a(is &akai -O- &OV-O O< 10% "0M< T< 2,500 0?10 250


Oksi'en per 24 am 100,000 1 100,000 1 100,000 1 100,000 1 100,000

Antiasma )A<MTAO AM& 4M3 1M< 100 AM& *01 " 2,40" " 2,40"

Op#ra"i

P#rawatan Khu"u"



ronchopneumonia

alaman "4 dari 25#



atuan


P#nunjan! ia!no"tik

Ront!#n

Laboratoriu& $5,000


P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&late

rew

-O<

Ph("ioth#rapi 21,500 21,500 21,500



ronchopneumonia

alaman "5 dari 25#



atuan

ewa e(uliFer 21,500 1 21,500 1 21,500 1 21,500

Total +ia(a ,-2),21 /4,),/- /10).-- //-)1./



ronchopneumonia

alaman "$ dari 25#

ari 5 Total


94,*5"

1 14,4"*

1 *,910

" 2,40"

1 1*,#50

1 15,125

1 2",292

1 11,9"5

4#,500

1 4#,500

$5,000

1 $5,000

ari 5 Total



ronchopneumonia

alaman "# dari 25#

ari 5 Total


#0,500

1 25,000

4 24,000

1 21,500

114,000 5#0,000

1 55,000 5 2#5,000

1 40,000 5 200,000

1 10,000 5 50,000

1 9,000 5 45,000

$9,$12 #4#,1*9

1$ 1,5201 14,4"* 9 129,942

10 "0,000 10 "0,000

" 2$,#"0

10 1,410 22 ",102

2 1$,$14 1" 10#,991

1 #,150 " 21,450

1 2,$12

12 1$,500

2 *#$

0 $9" 0 250

0 #1#

4 400,000

$ 4,*0$

ari 5 Total



ronchopneumonia

alaman "* dari 25#

ari 5 Total


$5,000

1 $5,000

$4,500

ari 5 Total



ronchopneumonia

alaman "9 dari 25#

ari 5 Total


" $4,500

1-/).10 1)502),20




T !poi

alaman 40 dari 25#


)A/ > emam Th!poid

/sia > Anak


ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah ar'a @umlah ar'a


okt#r Sp#"iali"

ObatObatan

P#nunjan! ia!no"tikRont!#n

Laboratoriu&

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

E&#r!#n"i 21#,500


@asa dokter 25,000 1 25,000

3OT 1#,500 1 1#,500 3&T 1#,500 1 1#,500

=idal 45,000 1 45,000

/rine utin "0,000 1 "0,000

eses utin 1#,500 1 1#,500




Th!poid

alaman 41 dari 25#



A=AT -A&


Mondok makan 55,000 1 55,000 1 55,000 1 55,000 1 55,000




Obatobatan 1#1,2$5 5$,#"0 $",**0 4#,"12

Anal'esik, AntipiretAMO< C $0 M< T< 11,20$ 1 11,20$ 1 11,20$

Anti(iotik 'ol se6al .e6triaJon 1 'r V-A< 14,000 1 14,000 1 14,000 1 14,000 1 14,000

Antasid dan antitu A-T-- 150M3 G"0 3) TA 250 1 250 1 250 1 250 1 250

Antiemetik &-M&A -@ AM& 10,"12 2 20,$24 2 20,$24 2 20,$24 Antasid dan antitu .-<O) /& 100 M< C& 4*,125 1 4*,125

.airan Mineral BT 5% 500 M< OT < *,#2* 2 1#,45$ 2 1#,45$ 2 1#,45$ 2 1#,45$



ahan a(is &akai -& C-3 " M< T/MO 1,"#5 2 2,#50 2 2,#50 2 2,#50 2 2,#50

ahan a(is &akai -& C-3 5 M< TM 1,$50 1 1,$50 1 1,$50 1 1,$50 1 1,$50




ahan a(is &akai )AA C?T-< 1$D1$ ) $,9"0 0?2 1,"*$


ahan a(is &akai A<)OO< #0 % 100 M< AMA) < ",5*# 0?" 1,0#$

Anti(iotik T-AMC.- 250M3D5M< C $0M< < #5,000

Op#ra"i

P#rawatan Khu"u"


P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&




Th!poid

alaman 42 dari 25#



P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&late

rew

-O<

Ph("ioth#rapi

Total +ia(a 23/)5., 1.1)5/4 1.-)--4 1,0)/10



Th!poid

alaman 4" dari 25#

ari 5 Total


45,000 2$2,500

1 $5,000

1 25,000

1 1#,500 1 1#,500

1 45,000 2 90,000

1 "0,000

1 1#,500

ari 5 Total



Th!poid

alaman 44 dari 25#


105,000 525,000

1 55,000 5 2#5,000

1 40,000 5 200,000

1 10,000 5 50,000

1 9,000 5 45,000

19",$94 5"2,**1

2 22,412

1 14,000 5 #0,000

1 250 5 1,250

$ $1,*#2 1 4*,125

2 1#,45$ 10 *#,2*0

1 #,150 " 21,450

1 2,$12

2 2,#50 10 1",#50

1 1,$50 5 *,250

1 1*,#50

1 2",292

1 4"* 2 *#$

0 1,"*$ 0 500

0 1,0#$

2 150,000 2 150,000

ari 5 Total

l h l h



Th!poid

alaman 45 dari 25#


/2/).32 1)/04)/-1


)A/ emam Th!poid



T !poi

alaman 4$ dari 25#

)A/ > emam Th!poid

/sia > ewasa


ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah ar'a @umlah ar'a @umlah


okt#r Sp#"iali"

ObatObatan


Laboratoriu&

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

E&#r!#n"i 21#,500


@asa dokter 25,000 1 25,000

3OT 1#,500 1 1#,500 3&T 1#,500 1 1#,500

=idal 45,000 1 45,000 1

/rine utin "0,000 1 "0,000

eses utin 1#,500 1 1#,500





Th!poid

alaman 4# dari 25#


A=AT -A&


Mondok makan 55,000 1 55,000 1 55,000 1 55,000 1 55,000 1

Visite dokter spesialis 40,000 1 40,000 1 40,000 1 40,000 1 40,000 1

Asuhan keperawatan 10,000 1 10,000 1 10,000 1 10,000 1 10,000 1

Tindakan keperawatan 9,000 1 9,000 1 9,000 1 9,000 1 9,000 1

Obatobatan 19$,#54 9",425 100,5#5 5*,"$4

Anal'esik, Antipiretik &AA.TAMO< 500 M3 G 100 3) TA 95 4 "*0 4 "*0 4 "*0 4 "*0 4

Anti(iotik 'ol se6alosporin .e6triaJon 1 'r V-A< 14,000 2 2*,000 2 2*,000 2 2*,000 2 2*,000 2

Antasid dan antitukak A-T-- 150M3 G"0 3) TA 250 2 500 2 500 2 500 2 500 2

Antiemetik &-M&A -@ AM& 10,"12 " "0,9"$ " "0,9"$ " "0,9"$ Antasid dan antitukak .-<O) /& 100 M< C& 4*,125 1 4*,125

.airan Mineral BT 5% 500 M< OT < *,#2* " 2$,1*4 " 2$,1*4 " 2$,1*4 " 2$,1*4 "

ahan a(is &akai AH/A-T 50 M< -)A < #,150 1 #,150 1 #,150 1


ahan a(is &akai -& C-3 " M< T/MO 1,"#5 " 4,125 " 4,125 " 4,125

ahan a(is &akai -& C-3 5 M< TM 1,$50 2 ","00 2 ","00 2 ","00 2 ","00 2



ahan a(is &akai AA&<AT T T-& G 10 4"* 1 4"* 1

ahan a(is &akai )AA C?T-< 1$D1$ ) $,9"0 0?2 1,"*$ ahan a(is &akai -O- &OV-O O< 10% "0M< T< 2,500 0?2 500

ahan a(is &akai A<)OO< #0 % 100 M< AMA) < ",5*# 0?" 1,0#$

Anti(iotik BC.O< 500M3 .A&G100 cap 1,500 15

Op#ra"i

P#rawatan Khu"u"


P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&





Th!poid

alaman 4* dari 25#


P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&late

rew

-O<

Ph("ioth#rapi

Total +ia(a ,0-)0,2 045)20, 012),5, 150)/.2



Th!poid

alaman 49 dari 25#

ri 5 Total

ar'a @umlah ar'a

45,000 2$2,500

1 $5,000

1 25,000

1 1#,500 1 1#,500

45,000 2 90,000

1 "0,000

1 1#,500

ri 5 Total

ar'a @umlah ar'a



Th!poid

alaman 50 dari 25#

114,000 5#0,000

55,000 5 2#5,000

40,000 5 200,000

10,000 5 50,000

9,000 5 45,000

**,452 5"#,5#0

"*0 20 1,900

2*,000 10 140,000

500 10 2,500

9 92,*0* 1 4*,125

2$,1*4 15 1"0,920

#,150 " 21,450

1 2,$12

9 12,"#5

","00 10 1$,500

1 1*,#50

1 2",292

4"* 2 *#$

0 1,"*$ 0 500

0 1,0#$

22,500 15 22,500

ri 5 Total

ar'a @umlah ar'a



Th!poid

alaman 51 dari 25#

025)2,0 1)/54)454


)A/ 3 - --



)A/ > 3r ---

/-A > Anak

ari 1 ari 2 ari "

ediaan ar'a atua @umlah ar'a @umlah ar'a @umlah ar'a @umlah

RJLRA$AT JALAN LANJUTAN


@< A=AT @A<A <A@/TA

RJL okt#r Sp#"iali" okt#r Sp#"iali"

@< o

@< o

RJL Obat ObatObatan

@< O(atO

@< O(atO @< O(atO

RJL P#nunjan! ia!no"tik P#nunjan! ia!no"tik

@< &enunan' ia'nostik ont'enRont!#n

@< &enunan' ia'nostik ont'en



@< &enunan' ia'nostik <a(oratorium

Laboratoriu&

@<&enunan' ia'nostik <a(oratorium



@< &enunan' ia'nostik&emeriksaan)husus

P#&#rik"aan Khu"u"

@< &enunan' ia'nostik &emeriksaan)husus



@< &enunan' ia'nostik &atolo'i Anatomi

Patolo!i Anato&i




RJL Tin'akan Khu"u" Tin'akan Khu"u"

@< Tindakan )husus

@< Tindakan )husus

@< Tindakan )husus

RJL Ph Ph("ioth#rapi

@< &h!si

@< &h!si @< &h!si

RJL E&#r!# E&#r!#n"i 1"5,000

@< mer'en

@< mer'en<a(oratorium &emeriksaan ematolo'i


@< mer'en @asa dokter 25,000 1 25,000

@< mer'en <a( =idal 45,000 1 45,000

@< mer'en

-& A=AT - A=AT -A&-& A=AT -

RIP Ko&pon#n Rawat Inap Ko&pon#n Rawat Inap 114,000 114,000 114,000


ediaan ar'a atua @umlah ar'a @umlah ar'a @umlah ar'a @umlah ar'a



' @ ' @ ' @ ' @ '

-& )omponen awat -nap Visite dokter spesialis 40,000 1 40,000 1 40,000 1 40,000 1 40

-& )omponen awat -nap Asuhan keperawatan 10,000 1 10,000 1 10,000 1 10,000 1 10

-& )omponen awat -nap Tindakan keperawatan 9,000 1 9,000 1 9,000 1 9,000 1 9-& )omponen awat -nap

-& )omponen awat -nap

RIP Obat Obatobatan 159,050 *2,5*5 *9,#"5 *1

-& O(atO

@< O(atO Anal'esik, Antipiretik AMO< C $0 M< T< 11,20$ 1 11,20$ 1 11

-& O(atO Antasid dan antitukak 3AT-- -@ -@ 25,000 1 25,000 1 25,000 1 25,000

-& O(atO .airan Mineral )A "A -/ 500M< OT < 1*,$45 " 55,9"5 " 55,9"5 " 55,9"5 " 55

@< O(atO ahan a(is &akai AH/A-T 50 M< -)A < #,150 1 #,150 1 #,150

@< O(atO ahan a(is &akai -& C-3 1 M< T/MO T 2,$12 1 2,$12 @< O(atO ahan a(is &akai -& C-3 " M< T/MO 1,"#5

@< O(atO ahan a(is &akai -& C-3 5 M< TM 1,$50 1 1,$50 1 1,$50 1 1,$50 1 1

@< O(atO ahan a(is &akai AO.AT T 223 1*,#50 1 1*,#50

@< O(atO ahan a(is &akai T =AC TO& .O.) 2",292 1 2",292

@< O(atO ahan a(is &akai AA&<AT T T-& G 10 4"* 1 4"*

@< O(atO ahan a(is &akai )AA C?T-< 1$D1$ ) $,9"0 1 $,9"0

@< O(atO ahan a(is &akai -O- &OV-O O< 10% "0M< T< 2,500 1 2,500

@< O(atO ahan a(is &akai A<)OO< #0 % 100 M< AMA) < ",5*# 1 ",5*#

@< O(atO Vitamin M/<TCV-T C/& )&< 1",000 1 1"

-& O(atO

-& O(atO

RIP Op#ra"i Op#ra"i

-& Operasi

-& Operasi

-& Operasi

-& Operasi

RIP P#rawatan Khu"u" P#rawatan Khu"u"

-& &erawatan )husus

-& &erawatan )husus

-& &erawatan )husus

RIP P#r"alinan Patolo!i" P#r"alinan Patolo!i"

-& &ersalinan &atolo'is



RIP P#nunjan! ia!no"tik P#nunjan! ia!no"tik

-&&enunan' ia'nostik ont'en

Ront!#n -& &enunan' ia'nostik ont'en

-& &enunan' ia'nostik ont'en

-& &enunan' ia'nostik ont'en

-& &enunan' ia'nostik <a(oratorium

Laboratoriu& #9,500 49,500 49,500 1$


-& &enunan' ia'nostik <a(oratorium &emeriksaan ematolo'i

arah utin :paket Trom(osit, t; 1$,500 " 49,500 " 49,500 " 49,500 1 1$

@< &enunan' ia'nostik <a(oratorium &emeriksaan/rine

/rin utin "0,000 1 "0,000


-&&enunan' ia'nostik <a(oratorium

-& &enunan' ia'nostik&emeriksaan)husus

P#&#rik"aan Khu"u"


ediaan ar'a atua @umlah ar'a @umlah ar'a @umlah ar'a @umlah ar'a




-& &enunan' ia'nostik &emeriksaan)husus


-& &enunan' ia'nostik &atolo'i Anatomi

Patolo!i Anato&i


-& &enunan' ia'nostik&atolo'i Anatomi


RIP Tin'akan Khu"u" Tin'akan Khu"u"

-& Tindakan )husus

-& Tindakan )husus

-& Tindakan )husus

RIP Lainlai Lainlain-& <ainlain Labu arah

-& <ainlain

-& <ainlain

-& <ainlain

-& <ainlain Tranfu"i 'arah

-& <ainlain

-& <ainlain

-& <ainlain

-& <ainlain

-& <ainlain Pin) Plat# S*r#w

-& <ainlain &in

-& <ainlain &late

-& <ainlain rew

-& <ainlain -O<

RIP Ph Ph("ioth#rapi

-& &h!si

-& &h!si

-& &h!si

Total +ia(a 2-5),,4 02.)4-, 0,/)0/, 010



Anakalaman 55 dari 25#

ari 5 Total


1"5,000

1 $5,000

1 25,000

1 45,000

45$,000

4 220,000

ari 5 Total


4 1$0,000



Anakalaman 5$ dari 25#

4 40,000

4 "$,000

41",1$1

2 22,412

" #5,000

12 22",#40

2 14,"00

1 2,$12

4 $,$00

1 1*,#50

1 2",292

1 4"*

1 $,9"0

1 2,500

1 ",5*#

1 1",000

195,000

10 1$5,000

1 "0,000

ari 5 Total




Anakalaman 5# dari 25#

1)133)1.1


)A/ > 3r ---

/-A > ewasa




ewasaalaman 5* dari 25#


ediaan ar'a atua @umlah ar'a @umlah ar'a @umlah ar'a @umlah ar'a @umlah


okt#r Sp#"iali"

ObatObatan

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

E&#r!#n"i 90,000


@asa dokter 25,000 1 25,000

A=AT -A&




Mondok makan 55,000 1 55,000 1 55,000 1 55,000 1 55,000



ewasaalaman 59 dari 25#

, , , , ,




Obatobatan 1"*,"22 *9,9"4 44,4"4 4",""*

Anal'esik, Antipiretik &AA.TAMO< 500 M3 G 100 3 TA 95 4 "*0 4 "*0 4 "*0 10 950

Antasid dan antitukak A-T-- TA 250 2 500 2 500

Antasid dan antitukak 3AT-- -@ -@ 2",000 2 4$,000 2 4$,000

.airan Mineral -3 <A.TAT 500M< OT < 10,4#$ 4 41,904 4 41,904 4 41,904 " "1,42*

ahan a(is &akai -& C-3 1 M< T/MO T 2,$12 1 2,$12 ahan a(is &akai -& C-3 " M< T/MO 1,"#5

ahan a(is &akai -& C-3 5 M< TM 1,$50 1 1,$50 1 1,$50 1 1,$50 1 1,$50




ahan a(is &akai )AA C?T-< 1$D1$ ) $,9"0 0?" 2,0#9

ahan a(is &akai -O- &OV-O O< 10% "0M<T< 2,500 0?2 500


Vitamin O-M- A G"0 T<D/ )&< **1 10 *,*10

Op#ra"i

P#rawatan Khu"u"


P#nunjan! ia!no"tik

Ront!#n

Laboratoriu& #9,500 49,500 49,500 "",000



Trom(osit *,250 " 24,#50 " 24,#50 " 24,#50 2 1$,500

ematokrit *,250 " 24,#50 " 24,#50 " 24,#50 2 1$,500



ewasaalaman $0 dari 25#

/rin utin "0,000 1 "0,000

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&late

rew

-O<

Ph("ioth#rapi

Total +ia(a 201)-00 0,/)2/2 045)3/2 134)//-

ri 5 Total




ar'a @umlah ar'a

90,000

1 $5,000

1 25,000

45$,000

ri 5 Total

ar'a @umlah ar'a

4 220,000

4 1$0 000




4 1$0,000

4 40,000

4 "$,000

"1$,02*

22 2,090

4 1,000

4 92,000

15 15#,140

1 2,$12

4 $,$00

1 1*,#50

1 2",292

1 4"*

0 2,0#9

0 500

0 #1#

10 *,*10

211,500

ri 5 Total

ar'a @umlah ar'a

11 90,#50

11 90,#50

1 "0 000



ewasaalaman $" dari 25#

1 "0,000

1)45/),0-


)A/ > 3A :M/TA; den'an dehidrasi sedan'(erat

/sia > Anakanak

ari 1 ari 2



3astroenteritis dehidrasi sedan'(eratalaman $4 dari 25#

ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah


okt#r Sp#"iali"

ObatObatan

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu& 122,500

arah utin $5,000 1 $5,000

&aket elektrolit :a, ); 40,000 1 40,000

eses utin 1#,500 1 1#,500

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

ari 1 ari 2


E&#r!#n"i 25 000




E&#r!#n"i 25,000

@asa dokter 25,000 1 25,000

A=AT -A&

Ko&pon#n Rawat Inap 114,000 114,000

Mondok makan 55,000 1 55,000 1 55,000 1

Visite dokter spesialis 40,000 1 40,000 1 40,000 1

Asuhan keperawatan 10,000 1 10,000 1 10,000 1

Tindakan keperawatan 9,000 1 9,000 1 9,000 1Obatobatan 221,55" ##,"2$

Anal'esik, Antipiretik &O- OT C $0M< T< 25,4"* 1 25,4"*

Anti(iotik 'ol se6alosporin .T-ABO V-A< C 13 3BG V-A 1",2$2 1 1",2$2 1 1",2$2 1

Antasid dan antitukak A-T-- AM& 50M3DM< 2M< AM& ",125 1 ",125 1 ",125

Antiemetik &-M&A -@ AM& 10,"12 2 20,$24 2 20,$24 1

.airan Mineral )A "A -/ 500M< OT < 1*,$45 4 #4,5*0 2 "#,290 2

ahan a(is &akai AH/A-T 50 M< -)A < #,150 1 #,150 1


ahan a(is &akai -& C-3 " M< T/MO 1,"#5 1 1,"#5 1 1,"#5 1

ahan a(is &akai -& C-3 5 M< TM 1,$50 1 1,$50 1 1,$50 1





ahan a(is &akai -O- &OV-O O< 10% "0M< T< 2,500 1 2,500

ahan a(is &akai A<)OO< #0 % 100 M< AMA) < ",5*# 0?5 1,#94

Antidiare O )AO<AA /& 120M< T< 1",5#* 1 1",5#*

palk pemasan'an in6us 10,000 1 10,000 Op#ra"i

ari 1 ari 2


P#rawatan Khu"u"



3astroenteritis dehidrasi sedan'(eratalaman $$ dari 25#


P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah

ari 1 ari 2


Pin) Plat# S*r#w

&in



3astroenteritis dehidrasi sedan'(eratalaman $# dari 25#

&in

&late rew

-O<

Ph("ioth#rapi

Total +ia(a 2-/)4,/ 131)/0.

ri " Total

ar'a @umlah ar'a



3astroenteritis dehidrasi sedan'(eratalaman $* dari 25#

' @ '

122,500

1 $5,000

1 40,000

1 1#,500

ri " Total

ar'a @umlah ar'a

25,000




1 25,000

114,000 "42,000

55,000 " 1$5,000

40,000 " 120,000

10,000 " "0,000

9,000 " 2#,000#1,0"9 "$9,91*

1 25,4"*

1",2$2 " "9,#*$

2 $,250

10,"12 5 51,5$0

"#,290 * 149,1$0

#,150 2 14,"00

1 2,$12

1,"#5 " 4,125

1,$50 " 4,950

1 1*,#50

1 2",292

1 4"*

0 1,"*$

1 2,500

1 1,#94

1 1",5#*

1 10,000

ri " Total

ar'a @umlah ar'a



3astroenteritis dehidrasi sedan'(eratalaman #0 dari 25#

ri " Total

ar'a @umlah ar'a




1-,)4/3 -,3)21-


)A/ > 3A :M/TA; den'an dehidrasi sedan'(erat

/sia > ewasa

ari 1 ari 2






okt#r Sp#"iali"

ObatObatan

P#nunjan! ia!no"tik

Ront!#n


arah utin $5,000 1 $5,000

&aket elektrolit :a, ); 40,000 1 40,000

eses utin 1#,500 1 1#,500

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

ari 1 ari 2


E&#r!#n"i 25,000



3astroenteritis dehidrasi sedan'(eratalaman #" dari 25#

@asa dokter 25,000 1 25,000

A=AT -A&


Mondok makan 55,000 1 55,000 1 55,000 1



Tindakan keperawatan 9,000 1 9,000 1 9,000 1Obatobatan 1$#,$44 90,$$1

Anal'esik, Antipiretik &AA.TAMO< 500 M3 G 100 3) TA 95 4 "*0 4 "*0 4

Anti(iotik 'ol se6alosporin .T-ABO V-A< C 13 3BG V-A 1",2$2 2 2$,524 2 2$,524 2

Antasid dan antitukak A-T-- AM& 50M3DM< 2M< AM& ",125 2 $,250 2 $,250 2

Antiemetik &-M&A -@ AM& 10,"12 " "0,9"$ " "0,9"$ "

.airan Mineral O-/M .<O- 0?9% 500M< OT T< *,"0# 5 41,5"5 " 24,921 2

ahan a(is &akai AH/A-T 50 M< -)A < #,150 1 #,150 1


ahan a(is &akai -& C-3 " M< T/MO 1,"#5 1 1,"#5

ahan a(is &akai -& C-3 5 M< TM 1,$50 1 1,$50 1 1,$50 1





ahan a(is &akai -O- &OV-O O< 10% "0M< T< 2,500 1 2,500

ahan a(is &akai A<)OO< #0 % 100 M< AMA) < ",5*# 0?5 1,#94

ahan a(is &akai <O-A 2M3 TAG$0 TA 1,0#" 1 1,0#"

Op#ra"i

ari 1 ari 2


P#rawatan Khu"u"





P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah

ari 1 ari 2


Pin) Plat# S*r#w

&in




&late rew

-O<

Ph("ioth#rapi

Total +ia(a 203)122 042)..1

ri " Total

ar'a @umlah ar'a



3astroenteritis dehidrasi sedan'(eratalaman #$ dari 25#

122,500

1 $5,000

1 40,000

1 1#,500

ri " Total

ar'a @umlah ar'a

25,000

1 25 000



3astroenteritis dehidrasi sedan'(eratalaman ## dari 25#

1 25,000

114,000 "42,000

55,000 " 1$5,000

40,000 " 120,000

10,000 " "0,000

9,000 " 2#,000*9,504 "4#,*09

"*0 12 1,140

2$,524 $ #9,5#2

$,250 $ 1*,#50

"0,9"$ 9 92,*0*

1$,$14 10 *",0#0

#,150 2 14,"00

1 2,$12

1 1,"#5

1,$50 " 4,950

1 1*,#50

1 2",292

1 4"*

0 1,"*$

1 2,500

1 1,#94

1 1,0#"

ri " Total

ar'a @umlah ar'a



3astroenteritis dehidrasi sedan'(eratalaman #* dari 25#

ri " Total

ar'a @umlah ar'a




04/),42 -/5)/43


)A/ > )ean' emam

/-A > Anakanak s?d? 5 tahun

ari 1 ari 2 ari " )o

ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah ar'a @umlah




)ean' emamalaman *0 dari 25#

J J

okt#r Sp#"iali"

@asa dokter spesialis 1

ObatObatan "5,#50

Antiepilepsi TO<- O< .TA< 10M3 2?5 T/ "5,#50 1 "5,#50

V-TAM- M/<T-V-TA&<B <-B 125M< T< 2$,2$" 1

Anti(iotik 'ol se6alospori .AOB-< 125M3D5 M< C 3) T< 9,5*$ 1

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu& $5,000


/rine utin "0,000

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"



Ph("ioth#rapi

E&#r!#n"i 90,000





@asa dokter 25,000 1 25,000

A=AT -A&

Ko&pon#n Rawat Inap 114,000 114,000 114,000

Mondok makan 55,000 1 55,000 1 55,000 1 55,000Visite dokter spesialis 40,000 1 40,000 1 40,000 1 40,000



Obatobatan 9#,5"5 $5,520 *",*#$

Anal'esik, Antipiretik AMO< C $0 M< T< 11,20$ 1 11,20$ 1 11,20$

Anti(iotik 'ol se6alospori .OTAB-M 1 3 3) V-A 14,4"* 1 14,4"* 1 14,4"* 1 14,4"*

Antiepilepsi VA<-/M 10M3D2M< -@ AM&G5 AM& "",09" 1 "",09" 1 "",09"


.airan Mineral O-/M .<O- 0?9% 500M< OT< *,"0# 2 1$,$14 2 1$,$14 2 1$,$14


ahan a(is &akai -& C-3 " M< T/MO 1,"#5 1 1,"#5 1 1,"#5 1 1,"#5





ahan a(is &akai -O- &OV-O O< 10% "0M< T< 2,500 0?10 250 ahan a(is &akai A<)OO< #0 % 100 M< AMA) < ",5*# 0?20 #1#

ahan a(is &akai O)-3 4

ahan a(is &akai AA< .A/< 1

Op#ra"i



P#rawatan Khu"u"





P#nunjan! ia!no"tik

Ront!#n



&aket elektrolit :a, ), .l, .a; *0,000 1 *0,000

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

LainlainLabu arah

Tranfu"i 'arah



Pin) Plat# S*r#w

&in

&late rew



)ean' emamalaman *" dari 25#

rew

-O<

Ph("ioth#rapi

Total +ia(a ,25)0-, 153),04 135)-5.

trol Total

ar'a @umlah ar'a




1

"5,*49 #1,599

1 "5,#50

2$,2$" 1 2$,2$"

9,5*$ 1 9,5*$

$5,000

1 $5,000

trol Total

ar'a @umlah ar'a

90,000




1 $5,000

1 25,000

"42,000

" 1$5,000 " 120,000

" "0,000

" 2#,000

24$,9"0

2 22,412

" 4","14

2 $$,1*5

2 14,"00

$ 49,*42

1 2,$12

" 4,125

1 1*,#50

1 2",292

1 4"*

0 $9"

0 250 0 #1#

4

1

ntrol Total

ar'a @umlah ar'a



)ean' emamalaman *$ dari 25#

145,000

1 $5,000

1 *0,000

trol Total

ar'a @umlah ar'a



)ean' emamalaman *# dari 25#

/,)-23 3.4),03


)A/ > O(ser+asi e(ris


ari 1 ari 2



okt#r Sp#"iali"



O(ser+asi e(risalaman ** dari 25#

ObatObatan "$,4"*

Anti(iotik 'ol se6alospori .OTAB-M 1 3 3) V-A 14,4"* 1 14,4"*

Anal'esik, Antipiretik /M- .TA< 125 M3 /&& 11,000 2 22,000

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu& 95,000


/rine utin "0,000 1 "0,000

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

ari 1 ari 2


Ph("ioth#rapi

E&#r!#n"i 25,000

@asa dokter 25,000 1 25,000



O(ser+asi e(risalaman *9 dari 25#

A=AT -A&


Mondok makan 55,000 1 55,000 1 55,000 1



Tindakan keperawatan 9,000 1 9,000 1 9,000 1

Obatobatan *",09# "2,42#

Anal'esik, Antipiretik AMO< C $0 M< T< 11,20$ 1 11,20$ 1


Anti(iotik 'ol se6alospori .OTAB-M 1 3 3) V-A 14,4"* 1 14,4"* 1

.airan Mineral O-/M .<O- 0?9% 500M< OT T< *,"0# 2 1$,$14 2 1$,$14 1ahan a(is &akai AH/A-T 50 M< -)A < #,150 1 #,150 1


ahan a(is &akai -& C-3 " M< T/MO 1,"#5 1 1,"#5 1 1,"#5 1







Op#ra"i

ari 1 ari 2


P#rawatan Khu"u"

P li P t l i



O(ser+asi e(risalaman 90 dari 25#


P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&

arah <en'kap :arah utin, iE count, <; $5,000 1

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

ari 1 ari 2


Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&l t




&late

rew

-O<

Ph("ioth#rapi

Total +ia(a /,/),/, 12.)205

ari " Total

ar'a @umlah ar'a




"$,4"*

1 14,4"*

2 22,000

95,000

1 $5,000

1 "0,000

ari " Total

ar'a @umlah ar'a

25,000

1 25,000



O(ser+asi e(risalaman 9" dari 25#

114,000 "42,000

55,000 " 1$5,000

40,000 " 120,000

10,000 " "0,000

9,000 " 2#,000

42,4#$ 15*,000

11,20$ 2 22,412

14,4"* 2 2*,*#$

*,"0# 5 41,5"5#,150 2 14,"00

1 2,$12

1,"#5 " 4,125

1 1*,#50

1 2",292

1 4"*

0 $9"

0 250

0 #1#

ari " Total

ar'a @umlah ar'a




$5,000 $5,000

$5,000 1 $5,000

ari " Total

ar'a @umlah ar'a




001)25. #21,4"*


)A/ > AOT/ 3A )/TA a?i li'hted O+um

/-A > =AA

ari 1 ari 2



okt#r Sp#"iali"

ObatObatan 95,99# 15,029



A(ortus den'an )uretase

Vitamin OOT )&< 10

A-35 -/ 500 M< < 15,029 " 45,0*# 1 15,029

AO.AT T 203 1*,#50 1 1*,#50

T =AC TO& .O.) 2",292 1 2",292

AA&<AT T T-& G 10 4"* 1 4"*

A/3 TA3A BAM 500 " 1,500

)AA C?T-< 1$D1$ ) $,9"0 1 $,9"0

P#nunjan! ia!no"tik

Ront!#n


arah <en'kap :arah utin, iE count, <; $5,000 1 $5,000 T :leeddin' Time; D Masa &erdarahan *,250 1 *,250

.T :.lotin' Time; D Masa &em(ekuan *,250 1 *,250

3olon'an darah 11,000

(sA' 4#,500 1 4#,500

P#&#rik"aan Khu"u" 100,000

/3 )andun'an print 100,000 1 100,000

Patolo!i Anato&i

Tin'akan Khu"u"

ari 1 ari 2


Ph("ioth#rapi

E&#r!#n"i

A=AT -A&




Ko&pon#n Rawat Inap 114,000

Mondok makan 55,000 1 55,000

Visite dokter 40,000 1 40,000

Asuhan keperawatan 10,000 1 10,000

Tindakan keperawatan 9,000 1 9,000

Obatobatan 1$0,"41

Anal'esik, Antipiretik )TO&O 100 M3 TA TA 1,5"5 10 15,"50

Anti(iotik 'ol se6alospori .-B-M 100m' cap ",000 10 "0,000

emostatik )A<B .A& 250M3 G100 .A& 1,45* 10 14,5#5

Antiansietas VA<-/M AM&? 10M3D2M< AM& "",092 1 "",092

/terotonin MTC< 3OMT- TA 3) TA 1"* 10 1,"*0

/terotonin MT3- 0,2 M3 AM& 10 AM& 9,5$9 1 9,5$9

TA- $0 M< T< 4,125 1 4,125 <AM-A-A M 52,250 1 52,250

Op#ra"i *50,000

Tin'akan Kur#ta"# 'i OK *50,000 1 *50,000

ia!a Operasional

Operator

Asisten, &, lain2

P#rawatan Khu"u"

ari 1 ari 2



P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&




P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u" 50,000

&asan' laminaria 50,000 1 50,000

LainlainLabu arah

Tranfu"i 'arah

Pin) Plat# S*r#w &in

&late

rew

-O<

Ph("ioth#rapi

ari 1 ari 2


Total +ia(a 1)233)//- 1,)403




ri " Total

ar'a @umlah ar'a

111,02$

10




10

4 $0,11$

1 1*,#50

1 2",292

1 4"*

" 1,500

1 $,9"0

129,000

1 $5,000 1 *,250

1 *,250

1 4#,500

100,000

1 100,000

ri " Total

ar'a @umlah ar'a




114,000

1 55,000

1 40,000

1 10,000

1 9,000

1$0,"41

10 15,"50

10 "0,000

10 14,5#5

1 "",092

10 1,"*0

1 9,5$9

1 4,125 1 52,250

*50,000

1 *50,000

ri " Total

ar'a @umlah ar'a




50,000

1 50,000

ri " Total

ar'a @umlah ar'a

1,514,"$#





)A/ > AOT/ -)OM&<-T 3A )/TA

/-A > =AA

ari 1 ari 2



okt#r Sp#"iali"

ObatObatan 95,99# 15,029

Vitamin OOT )&< 10

A-3 5 -/ 500 M< < 15 029 " 45 0*# 1 15 029




A-35 -/ 500 M< < 15,029 " 45,0*# 1 15,029

AO.AT T 203 1*,#50 1 1*,#50

T =AC TO& .O.) 2",292 1 2",292

AA&<AT T T-& G 10 4"* 1 4"*

A/3 TA3A BAM 500 " 1,500

)AA C?T-< 1$D1$ ) $,9"0 1 $,9"0

P#nunjan! ia!no"tik

Ront!#n


arah <en'kap :arah utin, iE count, <; $5,000 1 $5,000 T :leeddin' Time; D Masa &erdarahan *,250 1 *,250


3olon'an darah 11,000

(sA' 4#,500 1 4#,500


/3 )andun'an print 100,000 1 100,000

Patolo!i Anato&i

Tin'akan Khu"u"

ari 1 ari 2


Ph("ioth#rapi

E&#r!#n"i

A=AT -A&

Ko&pon#n Rawat Inap 114 000





Mondok makan 55,000 1 55,000

Visite dokter 40,000 1 40,000



Obatobatan 1$0,"41

Anal'esik, Antipiretik )TO&O 100 M3 TA TA 1,5"5 10 15,"50

Anti(iotik 'ol se6alospori .-B-M 100m' cap ",000 10 "0,000

emostatik )A<B .A& 250M3 G100 .A& 1,45* 10 14,5#5

Antiansietas VA<-/M AM&? 10M3D2M< AM& "",092 1 "",092

/terotonin MTC< 3OMT- TA 3) TA 1"* 10 1,"*0


TA- $0 M< T< 4,125 1 4,125 <AM-A-A M 52,250 1 52,250

Op#ra"i *50,000

Tin'akan Kur#ta"# 'i OK *50,000 1 *50,000

ia!a Operasional

Operator

Asisten, &, lain2

P#rawatan Khu"u"

ari 1 ari 2



P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&




P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

LainlainLabu arah

Tranfu"i 'arah


&late

rew

-O<

Ph("ioth#rapi

ari 1 ari 2


Total +ia(a 1)223)//- 1,)403




ri " Total

ar'a @umlah ar'a

111,02$

10

4 $0,11$




1 1*,#50

1 2",292

1 4"*

" 1,500

1 $,9"0

129,000

1 $5,000

1 *,250

1 *,250

1 4#,500

100,000

1 100,000

ri " Total

ar'a @umlah ar'a

114,000




1 55,000

1 40,000

1 10,000

1 9,000

1$0,"41

10 15,"50

10 "0,000

10 14,5#5

1 "",092

10 1,"*0

1 9,5$9

1 4,125

1 52,250

*50,000

1 *50,000

ri " Total

ar'a @umlah ar'a




ri " Total

ar'a @umlah ar'a

1,4$4,"$#





)A/ > &artus den'an -nduksi

/-A > =AA

ari 1 ari 2 ari "



okt#r Sp#"iali"

ObatObatan



Operasi edan'alaman 112 dari 25#

P#nunjan! ia!no"tik

o Ront!#n

o

o

o

<a(oratorium Laboratoriu&

<a(oratorium

<a(oratorium

<a(oratorium

<a(oratorium

&emeriksaan )husus P#&#rik"aan Khu"u"

&emeriksaan )husus

&emeriksaan )husus

&emeriksaan )husus

&atolo'i AnatomiPatolo!i Anato&i

&atolo'i Anatomi

&atolo'i Anatomi

&atolo'i Anatomi

Tin'akan Khu"u"

Ph("ioth#rapi

E&#r!#n"i

ari 1 ari 2 ari "


A=AT -A&

Ko&pon#n Rawat Inap 22$,500 22$,500

Mondok Makan -(u 55,000 1 55,000 1 55,000

Mondok Makan a!i 2# 500 1 2# 500 1 2# 500



Operasi edan'alaman 11" dari 25#

Mondok Makan a!i 2#,500 1 2#,500 1 2#,500

Visite dokter spesialis O(s'in 40,000 1 40,000 1 40,000

Visite dokter spesialis Anak 40,000 1 40,000 1 40,000

Asuhan keperawatan i(u 10,000 1 10,000 1 10,000

Tindakan keperawatan i(u 9,000 1 9,000 1 9,000

Asuhan keperawatan anak 20,000 1 20,000 1 20,000

Tindakan keperawatan anak 25,000 1 25,000 1 25,000

Obatobatan $0,550

OAT AC-

eo ) -nect 1",200 1 1",200

OTM 1,500 1 1,500

AlkaKl 1#,952 1 1#,952

arun' Tan'an 129 $ ##2

/m(ilikal ","00 1 ","00

)assa teril $,$00 1 $,$00 &anen' Anak 1,05$ 1 1,05$

&anen' -(u 1,1** 1 1,1**

eddle 24 1,452 1 1,452

!rin'e 1 cc 4,*1* 1 4,*1*

arun' Tan'an teril *,#12 1 *,#12

Op#ra"i

P#rawatan Khu"u"

ari 1 ari 2 ari "


P#r"alinan Patolo!i" 1,5*$,""5 *4,2"2 20,#91

&ersalinan per+a'inam d'n induksi 1,250,000 1 1,250,000

@asa dokter kandun'an ewa )amar ersalin

Alkes dan &

1 .e6triaJone +ial r! 13 3BG2 +ial 5,15# 2 10,"1" 2 10,"1"

2 MetronidaFole -n6 +ial 14,1$0 " 42,4*0 " 42,4*0

" &ospar'in -n amp $ $00 1 $ $00




" &ospar'in -n amp $,$00 1 $,$00

4 &ito'in amp 1,2#0 5 $,"49

5 Alinamin -n amp #,424

$ in'er <actat Ls 5,$#$ 1 5,$#$ 2 11,"52

# uma'esic cap 1"# " 412 12 1,$4*

* Amoksisilin 500 m' cap 2*# 10 2,*#4

9 Meth!l r'ometrine Ta( 3) ta( 4$ " 1"9 10 4$"

10 &renamia kpl 1,129 1 1,129 14 15,*0$

11 /nderpad (h #,#09 1 #,#09

12 -V .ath urLo 1* (h 29,"04

1" olle! .atheter no 24 2 wa! (h 12,4#4

14 !rin'e 1 cc (h 4,*1*

15 !rin'e " cc (h ",49* 1 ",49*

1$ !rin'e 10 cc (h 1,*2$ 2 ",$52 " 5,4#*

1# ansaplast (h "2# 1 "2# 1* Micropore 0?5 cm J 10 (h 1",*$0 1 1",*$0

19 Oksi'enDam 5 ltDmeni 1,150 $ $,900 $ $,900

esusitasi eonatus 1 2"5,000 1 2"5,000

P#nunjan! ia!no"tik

o Ront!#n

o

o

o

<a(oratorium Laboratoriu& 91,500

<a(oratorium 1 sA' 4#,500 1 4#,500

<a(oratorium 2 .ell .ounter 44,000 1 44,000

<a(oratorium

ari 1 ari 2 ari "


&emeriksaan) hususP#&#rik"aan Khu"u"

&emeriksaan) husus

&emeriksaan) husus

&emeriksaan) husus

&atolo'i AnatomiPatolo!i Anato&i

&atolo'i Anatomi

&atolo'i Anatomi

&atolo'i Anatomi

&atolo'i Anatomi

Tin'akan Khu"u"




Lainlain

Labu arah

Tranfu"i 'arah


&late

rew

-O<

Ph("ioth#rapi

Total +ia(a 1)342)//, /51)0-0 04)531

Total

@umlah ar'a



Operasi edan'alaman 11$ dari 25#

Total

@umlah ar'a

45",000

2 110,000

2 55,000



Operasi edan'alaman 11# dari 25#

2 *0,000

2 *0,000

2 20,000

2 1*,000

2 40,000

2 50,000

$0,550

1 1",200

1 1,500

1 1#,952

$ ##2

1 ","00

1 $,$001 1,05$

1 1,1**

1 1,452

1 4,*1*

1 *,#12

Total

@umlah ar'a

1,$91,"5*

1 1,250,000

4 20,$2$

$ *4,9$0

1 $,$00

$ " 9



Operasi edan'alaman 11* dari 25#

5 $,"49

" 1#,02*

15 2,0$0

10 2,*#4

1" $02

15 1$,9"5

1 #,#09

1 ",49*

5 9,1"0

1 "2#1 1",*$0

12 1",*00

1 2"5,000

91,500

1 4#,500

1 44,000

Total

@umlah ar'a




0)03.)24-


)A/ > &AT/ den'an isiko Tin''i :&reeklampsi, sun'san', asma;

/-A > =AA

ari 1 ari 2 ari " ari 4 ari 5

ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah ar'a @umlah ar'a @umlah a


okt#r Sp#"iali"

ObatObatan




Laboratoriu&

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

E&#r!#n"i

A=AT -A&

Ko&pon#n Rawat Inap 1*1,500 1*1,500 1*1,500

Mondok Makan 55,000 1 55,000 1 55,000 1 55,000

Visite dokter spesialis O3C 40,000 1 40,000 1 40,000 1 40,000

Visite dokter spesialis AA) 40,000 1 40,000 1 40,000 1 40,000

&erawatan (a!i :roomin' in; 2#,500 1 2#,500 1 2#,500 1 2#,500

asuhan )eperawatan 10,000 1 10,000 1 10,000 1 10,000

Tindakan )eperawatan 9,000 1 9,000 1 9,000 1 9,000


ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah ar'a @umlah ar'a @umlah a

Anal'esik, Antipiretik )TO&O 100 M3 TA TA 1,5"5 2 ",0#0 2 ",0#0 2 ",0#0

Anti(iotik 'ol se6alospori .AOB-< .A& 250M3 3 .A& $12 2 1,224 2 1,224 10 $,120

Op#ra"i

P#rawatan Khu"u"



P#r"alinan Patolo!i" 90#,2#*

&ersalinan ormal d'n resiko tin''i #50,000 1 #50,000

un'san'

asma

&reeklamsi

@asa dokter kandun'an

ewa )amar ersalin

Alkes dan &

Alkes, & a!i eo ) in AM& 1",#50 1 1",#50

/m(ilical klem 2,100 1 2,100

&enen' a!i 1,000 1 1,000

MT3- 0,2 M3 AM& 10 AM& 9,5$9 1 9,5$9

OBCTO.- AM&? 10-/D1M< 100 AM& 4,00* 2 *,01$

<OO TA/-O T TM "9,12$ 1 "9,12$

-3 <A.TAT 500M< OT 11,""0 " "",990

AO.AT T 203 1*,#50 1 1*,#50 -& C-3 1 M< T/MO T 2,$12 1 2,$12

-& C-3 " M< T/MO 1,"#5 2 2,#50

-& C-3 5 M< TM 1,$50 1 1,$50

-O- &OV-O O< 10% "0M< T< 2,500 2 5,000

--./ 100 ml 24,0#0 1 12,0"5

)AA C?T-< 1$D1$ &A) $,9"0 1 $,9"0

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu& 92,500

-(u arah utin $5,000 1 $5,000

Anak iliru(in 2#,500 1 2#,500

krinin' hipotiroid 1

P#&#rik"aan Khu"u"

ari 1 ari 2 ari " ari 4 ari


Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah



Pin) Plat# S*r#w

&in

&late

rew

-O<

Ph("ioth#rapi

Total +ia(a 666 1-,)532 134).34

ri $ ari # Total

ar'a @umlah ar'a @umlah ar'a



544,500

" 1$5,000

" 120,000

" 120,000

" *2,500

" "0,000

" 2#,000

ri $ ari # Total


$ 9,210

14 *,5$*



90#,2#*

1 #50,000

1 1",#50

1 2,100

1 1,000

1 9,5$9

2 *,01$

1 "9,12$

" "",990

1 1*,#50 1 2,$12

2 2,#50

1 1,$50

2 5,000

1 12,0"5

1 $,9"0

92,500

1 $5,000

1 2#,500

1

ri $ ari # Total




1),.0)4,.


)A/ > &AT/ den'an VA)/M )TA)- atau O.&

/-A > =AA

ari 1 ari 2



okt#r Sp#"iali"

ObatObatan



&AT/ den'an VA)/M )TA)-DO.&D&)<AM&-AD)<AM&-A

alaman 12$ dari 25#

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

ari 1 ari 2


E&#r!#n"i

A=AT -A&

Ko&pon#n Rawat Inap 1*1,500 1*1,500

Mondok Makan 55,000 1 55,000 1 55,000 1

Visite dokter spesialis O3C 40,000 1 40,000 1 40,000 1

Visite dokter spesialis AA) 40,000 1 40,000 1 40,000 1

&erawatan (a!i :roomin' in; 2#,500 1 2#,500 1 2#,500 1

asuhan )eperawatan 10,000 1 10,000 1 10,000 1




alaman 12# dari 25#

Tindakan )eperawatan 9,000 1 9,000 1 9,000 1

Obatobatan 4,294 4,294

Anal'esik, Antipiretik )TO&O 100 M3 TA TA 1,5"5 2 ",0#0 2 ",0#0 2

Anti(iotik 'ol se6alospori .AOB-< .A& 250M3 3 .A& $12 2 1,224 2 1,224 10

Op#ra"i

P#rawatan Khu"u"

P#r"alinan Patolo!i" 1,092,2#*

&ersalinan per+a'inam d'n +accum 9"5,000 1 9"5,000

orceps

@asa dokter kandun'an

ari 1 ari 2


ewa )amar ersalin

Alkes dan &

Alkes, & a!i eo ) in AM& 1",#50 1 1",#50

/m(ilical klem 2,100 1 2,100

&enen' a!i 1,000 1 1,000

MT3- 0,2 M3 AM& 10 AM& 9,5$9 1 9,5$9

OBCTO.- AM&? 10-/D1M< 100 AM& 4,00* 2 *,01$

<OO TA/-O T TM "9,12$ 1 "9,12$

-3 <A.TAT 500M< OT 11,""0 " "",990

AO.AT T 203 1*,#50 1 1*,#50

-& C-3 1 M< T/MO T 2,$12 1 2,$12

-& C-3 " M< T/MO 1,"#5 2 2,#50




alaman 12* dari 25#

-& C-3 5 M< TM 1,$50 1 1,$50

-O- &OV-O O< 10% "0M< T< 2,500 2 5,000

--./ 100 ml 24,0#0 1 12,0"5 )AA C?T-< 1$D1$ &A) $,9"0 1 $,9"0

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu& 92,500

arah utin $5,000 1 $5,000 Anak iliru(in 2#,500 1 2#,500


P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

ari 1 ari 2


Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w




alaman 129 dari 25#

&in

&late

rew -O<

Ph("ioth#rapi

Total +ia(a 666 1-,)532

ri " Total

ar'a @umlah ar'a




alaman 1"0 dari 25#

ri " Total

ar'a @umlah ar'a

1*1,500 544,500

55,000 " 1$5,000

40,000 " 120,000

40,000 " 120,000

2#,500 " *2,500

10,000 " "0,000

9 000 " 2# 000




alaman 1"1 dari 25#

9,000 " 2#,000

9,190 1#,##*

",0#0 $ 9,210

$,120 14 *,5$*

1,092,2#*

1 9"5,000

ri " Total

ar'a @umlah ar'a

1 1",#50

1 2,100

1 1,000

1 9,5$9 2 *,01$

1 "9,12$

" "",990

1 1*,#50

1 2,$12

2 2,#50

1 1,$50




alaman 1"2 dari 25#

,$50

2 5,000

1 12,0"5

1 $,9"0

92,500

1 $5,000 1 2#,500

1

ri " Total

ar'a @umlah ar'a




alaman 1"" dari 25#

134).34 1)525)4,.

)A/ > ectio aecaria a?i? 3a'al rip

/-A > =AA

ari 1 ari 2




@< A=AT @A<A <A@/TA


@< o @< o

RJL Obat ObatObatan

@< O(atO

@< O(atO

@< O(atO

@< O(atO

@<



@< O(atO

@< O(atO


@< &enunan' ia'nostik o Ront!#n

@< &enunan' ia'nostik o



@< &enunan' ia'nostik <a(oratorium Laboratoriu&







@< &enunan' ia'nostik &emeriksaan)hus usP#&#rik"aan Khu"u"

@< &enunan' ia'nostik &emeriksaan)hus us



@< &enunan' ia'nostik &atolo'i Anatomi Patolo!i Anato&i @< &enunan' ia'nostik &atolo'i Anatomi




@< Tindakan )husus

@< Tindakan )husus

@< Tindakan )husus


@< &h!si

@< &h!si

@< &h!si

RJL E&#r!# E&#r!#n"i

@< mer'en

@< mer'en

@< mer'en

@< mer'en

@< mer'en

ari 1 ari 2 ari "


-& A=AT -

RIP Ko&pon#n Rawat Inap Ko&pon#n Rawat Inap 220,500 2$0,500 200,500


-& )omponen awat -nap Mondok Makan -(u 55,000 1 55,000 1 55,000 1 55,000

-& )omponen awat -nap Mondok Makan a!i 2#,500 1 2#,500 1 2#,500 1 2#,500

-& )omponen awat -nap Visite dokter spesialis O(s'in 40,000 1 40,000 1 40,000 1 40,000

-& )omponen awat -nap Visite dokter spesialis Anak 40,000 1 40,000 1 40,000 1 40,000

-& )omponen awat -nap asuhan )eperawatan -(u 10,000 1 20,000 1 40,000 1 10,000

-& )omponen awat -nap T-A)A )eperawatan -(u 9,000 1 9,000 1 9,000 1 9,000

-& )omponen awat -nap asuhan )eperawatan anak 10,000 1 20,000 1 40,000 1 10,000

-& )omponen awat -nap T-A)A )eperawatan anak 9,000 1 9,000 1 9,000 1 9,000


RIP Obat Obatobatan 412,41# 4$2,#$2 2"5,0*#

-/

-& O( O .e6triaJone Vial r! 13 3BG2 +ial 10 "1" 2 20 $2$ 2 20 $2$ 2 20 $2$



Operasi edan'alaman 1"5 dari 25#

-& O(atO .e6triaJone Vial r! 13 3BG2 +ial 10,"1" 2 20,$2$ 2 20,$2$ 2 20,$2$

-& O(atO MetronidaFole -n6 +ial 42,4*0 " 12#,440 " 12#,440

-& O(atO &ospar'in -n amp $,$00 2 1",200

-& O(atO !ntocinon amp 10,000 1 10,000

-& O(atO &ito'in amp $,"49 2 12,$9* 2 12,$9*

-& O(atO pidosin amp 2",95* " #1,*#4

-& O(atO Tramadol 100 m' -n amp 9,219 1 9,219

-& O(atO Alinamin -n amp 14,*4* 1 14,*4* " 44,544 " 44,544

-& O(atO anitidin Amp 50 m' Dml 2 ml amp ",#01 2 #,402 2 #,402

-& O(atO Asam Traneksamat 250 amp 4,$20 2 9,240 2 9,240

-& O(atO in'er <actat Ls 11,"52 2 22,#04 " "4,05$ " "4,05$ -& O(atO &roto6en uppos 100 m' G 20 supp 9,0$2 2 1*,124 " 2#,1*$

-& O(atO uma'esic cap 412 " 1,2"$

-& O(atO .eKJime 100 m' cap 2,*#4

-& O(atO Meth!l r'ometrine Ta( 3) ta( 1"9 " 41#

-& O(atO &renamia kpl 1,129

-& O(atO -kamicetine 2% Oint 15 'r tu( 4,$20

-& O(atO Trans6usi et (h 2#,#20 1 2#,#20

-& O(atO /nderpad (h #,#09 1 #,#09 2 15,41*

-& O(atO -V .ath urLo 1* (h 29,"04 1 29,"04 1 29,"04

-& O(atO olle! .atheter no 24 2 wa! (h 12,4#4 1 12,4#4

-& O(atO olle! .atheter no 1$ 2 wa! (h 12,4#4 1 12,4#4

-& O(atO /rine a' (h $,$00 1 $,$00

-& O(atO !rin'e 1 cc (h 4,*1* 1 4,*1*

-& O(atO !rin'e " cc (h ",49* 4 1",992 9 "1,4*2 $ 20,9**

-& O(atO !rin'e 10 cc (h 5,4#* " 1$,4"4 5 2#,"90 5 2#,"90

-& O(atO Jtradine (tl 1",400 1 1",400

-& O(atO ansaplast (h "2# 1 "2# -& O(atO acl 0,9% 100 ml (tl 1#,1*$ 1 1#,1*$

-& O(atO Micropore 0?5 cm J 10 (h 1",*$0 1 1",*$0

-& O(atO )assa teril pak $,$00 1

-& O(atO Oksi'enDam 5 ltDmeni $,900

-& O(atO

ari 1 ari 2 ari "


-& O(atO OAT AC-

-& O(atO eo ) -nect 1",200 1 1",200

-& O(atO OTM 1,500 1 1,500

-& O(atO AlkaKl 1#,952 1 1#,952

-& O(atO arun' Tan'an 129 $ ##2

-& O(atO /m(ilikal ","00 1 ","00

-& O(atO )assa teril $,$00 1 $,$00

-& O(atO &anen' Anak 1,05$ 1 1,05$ -& O(atO &anen' -(u 1,1** 1 1,1**

-& O(atO eddle 24 1,452 1 1,452

-& O(atO !rin'e 1 cc 4,*1* 1 4,*1*

-& O(atO arun' Tan'an teril *,#12 1 *,#12

-& O(atO

RIP O i 5 51" 251 21# 000



Operasi edan'alaman 1"$ dari 25#

RIP Op#ra"i Op#ra"i 5,51",251 21#,000

-& Operasi

-& Operasi Op#ra"i b#"ar 2,$"5,000 1 2,$"5,000

-& Operasi ia!a Operasional

-& Operasi Operator

-& Operasi Anestesi

-& Operasi Asisten, &, lain2

-& Operasi

-& Operasi

-& Operasi esusitasi eonatus 21#,000 1 21#,000 21#,000

-& Operasi

-& Operasi Materi Operasi > -& Operasi 1 -soLurane cc *,1*4 #0 5#2,**0

-& Operasi 2 entan!l amp 42,$*9 1 42,$*9

-& Operasi " &ethidin amp 15,*"0 1 15,*"0

-& Operasi 4 ecopol D cc cc 11,**0 "0 "5$,400

-& Operasi 5 O2 ltDam 4#,520 2 95,040

-& Operasi $ Oksi'enDam ltDam $,000 4 24,000

-& Operasi # eJamethasone amp 2,400 1 2,400

-& Operasi * &rotopen upp supp 9,0$2 1 9,0$2

-& Operasi 9 emopain amp 40,920 2 *1,*40

-& Operasi 10 Tramus 50 m'Dcc cc 50,1$0 4 200,$40

-& Operasi 11 Asam Traneksamat 250 amp 4,$20 1 4,$20

-& Operasi 12 !rin'e 5 cc (h 4,092 1 4,092

-& Operasi 1" !irin'e 10 cc (h 5,4#* 1 5,4#*

-& Operasi 14 !rin'e " cc amp "4,99* 2 $9,99$

-& Operasi 15 Tramal -n 100 amp 41,#12 1 41,#12

-& Operasi 1$ Ondancetron amp #,2$0 1 #,2$0

-& Operasi 1# o+al'in amp 10,5"* 1 10,5"*

-& Operasi 1* < (tl 11,"52 2 22,#04

-& Operasi 19 acl (tl 19,2#* 1 19,2#* -& Operasi 20 Tutopusin Ops (tl 5$,100 1 5$,100

-& Operasi 21 -n6us et Adult (h 14,520 1 14,520

-& Operasi 22 Tree =a! T2) (h 25,*#2 1 25,*#2

-& Operasi 2" TT cuE # (h 112,200 1 112,200

ari 1 ari 2 ari "

ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah ar'a @u

-& Operasi 24 isturi no 24 (h 2,$** 1 2,$**

-& Operasi 25 .romic 1 pcs 11,9"0 1 11,9"0

-& Operasi 2$ .romic 2 pcs *#,*4$ 1 *#,*4$

-& Operasi 2# .romic 2?0 pcs *$,5"9 1 *$,5"9

-& Operasi 2* &lain 0 pcs *0,441 1 *0,441

-& Operasi 29 &ol!sor( 1 pcs 101,5$0 1 101,5$0

-& Operasi "0 ios!n "?0 pcs 12*,040 1 12*,040 -& Operasi "1 Asam TraneJamat amp 4,$20 1 4,$20

-& Operasi "2 &!to'in amp $,"49 2 12,$9*

-& Operasi "" &ospar'in -n amp $,$00 1 $,$00

-& Operasi "4 )assa teril (undle 1$,500 5 *2,500

-& Operasi "5 <inapen (h 25,**1 1 25,**1

-& Operasi "$ Opsite &ost op 25 J 10 (h "*,2*0 1 "*,2*0

-& Operasi "# /nderpad (h #,#09 1 #,#09

-& Operasi "* ariantule (h 1$ 500 1 1$ 500



Operasi edanalaman 1"# dari 25

-& Operasi "* ariantule (h 1$,500 1 1$,500

-& Operasi"9

.ap ouEant ur'ical D Topi Operasi (h 1,#1$ $ 10,29$

-& Operasi 40 Jtradine cc 1"4 100 1",400

-& Operasi 41 i(iscru( cc 290 50 14,500

-& Operasi 42 irst Aid cc 222 50 11,100

-& Operasi 4" Masker Tali iau (h 1,214 $ #,2*4

-& Operasi 44 Medipack 140D250 (h 2,922 1 2,922

-& Operasi 45 Medipak 190D""0 (h 5,12* 2 10,25$

-& Operasi 4$ Medipak "00D"$5 (h #,*$$ 1 #,*$$

-& Operasi 4# ed ot Adult (h 4,**4 " 14,$52

-& Operasi 4* arun' Tan'an teril #?5 (h 12,"#5 1 12,"#5

-& Operasi 49 arun' Tan'an teril (h 12,"#5 " "#,125

-& Operasi 50 uction .ath no * (h 10,1$4 2 20,"2*

-& Operasi 51 uction .ath no 10 (h 10,1$4 1 10,1$4

-& Operasi

-& Operasi


-& &erawatan )husus

-& &erawatan )husus

-& &erawatan )husus






-& &enunan' ia'nostik o Ront!#n

-& &enunan' ia'nostik o

-& &enunan' ia'nostik o 1

-& &enunan' ia'nostik o

-& &enunan' ia'nostik <a(oratorium Laboratoriu& 11,000 -& &enunan' ia'nostik <a(oratorium

-& &enunan' ia'nostik <a(oratorium sA' 4#,500 1 4#,500

-& &enunan' ia'nostik <a(oratorium .ell .ounter 44,000 1 44,000

-& &enunan' ia'nostik <a(oratorium T :leeddin' Time; D Masa &erdarahan *,250 1 *,250

-& &enunan' ia'nostik <a(oratorium .T :.lotin' Time; D Masa &em(ekuan *,250 1 *,250

-& &enunan' ia'nostik <a(oratorium 3lukosa ewaktu 20,000 1 20,000

ari 1 ari 2 ari "

ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah ar

-& &enunan' ia'nostik <a(oratorium 3olon'an darah 11,000 1 11,000

-& &enunan' ia'nostik <a(oratorium .rossmach 1


-& &enunan' ia'nostik &emeriksaan)hususP#&#rik"aan Khu"u" 100,000

-& &enunan' ia'nostik &emeriksaan)hususT 1 1

-& &enunan' ia'nostik &emeriksaan)husus/3 100,000 1 100,000

-& &enunan' ia'nostik &emeriksaan)husus

-& &enunan' ia'nostik &atolo'i AnatomiPatolo!i Anato&i






-&



-& Tindakan )husus

-& Tindakan )husus -& Tindakan )husus

RIP Lainlai Lainlain

-& <ainlain Labu arah

-& <ainlain

-& <ainlain

-& <ainlain


-& <ainlain

-& <ainlain -& <ainlain

-& <ainlain


-& <ainlain &in

-& <ainlain &late

-& <ainlain rew

-& <ainlain -O<

RIP Ph Ph("ioth#rapi

-& &h!si

-& &h!si

-& &h!si

Total +ia(a 52/)315 .)0/.),1/ .

ri 4 Total

ar'a @umlah ar'a



Operasi edan'alaman 1"9 dari 25#

ri 4 Total

ar'a @umlah ar'a

200,500 **2,000

55,000 4 220,000

2#,500 4 110,000

40,000 4 1$0,000

40,000 4 1$0,000

10,000 4 *0,0009,000 4 "$,000

10,000 4 *0,000

9,000 4 "$,000

90,415 1,200,$*1

$ $1,*#*

$ 254,**0




$ 254,**0

2 1",200 1 10,000

4 25,"9$

" #1,*#4

1 9,219

# 10",9"$

4 14,*04

4 1*,4*0

* 90,*1$

2#,1*$ * #2,49$4,944 15 $,1*0

2*,#40 10 2*,#40

1,"90 1" 1,*0#

1$,9"5 15 1$,9"5

4,$20 1 4,$20

1 2#,#20

" 2",12#

2 5*,$0*

1 12,4#4

1 12,4#4

1 $,$00

1 4,*1*

19 $$,4$2

1" #1,214

1 1",400

1 "2#

1 1#,1*$

1 1",*$0

$,$00 1 $,$00

ri 4 Total

ar'a @umlah ar'a

1 1",200

1 1,500

1 1#,952

$ ##2

1 ","00

1 $,$00

1 1,05$ 1 1,1**

1 1,452

1 4,*1*

1 *,#12

5,#"0,251




1 2,$"5,000

1 4"4,000

#0 5#2,**0

1 42,$*9

1 15,*"0

"0 "5$,400

2 95,040

4 24,000

1 2,400

1 9,0$2

2 *1,*40

4 200,$40

1 4,$20

1 4,092

1 5,4#*

2 $9,99$

1 41,#12

1 #,2$0

1 10,5"*

2 22,#04

1 19,2#* 1 5$,100

1 14,520

1 25,*#2

1 112,200

ri 4 Total

ar'a @umlah ar'a

1 2,$**

1 11,9"0

1 *#,*4$

1 *$,5"9

1 *0,441

1 101,5$0

1 12*,040

1 4,$20 2 12,$9*

1 $,$00

5 *2,500

1 25,**1

1 "*,2*0

1 #,#09

1 1$,500

$ 10,29$

100 1" 400




100 1",400

50 14,500

50 11,100

$ #,2*4

1 2,922

2 10,25$

1 #,*$$

" 14,$52

1 12,"#5

" "#,125

2 20,"2* 1 10,1$4

1

11,000

1 4#,500 1 44,000

1 *,250

1 *,250

1 20,000

ri 4 Total

ar'a @umlah ar'a

1 11,000

1

100,000

2

1 100,000




034)31, 5)30/)3/0


)A/ > ectio aecaria elekti6 atas indikasi .&, )&, Oli'ohidramnion

/-A > ewasa


ediaan ar'a atuan @ml ar'a @ml ar'a @ml ar'a @ml ar'a


okt#r Sp#"iali"

ObatObatan

P#nunjan! ia!no"tik

Ront!#n



ectio aecariaalaman 144 dari 25#

Ront!#n

Laboratoriu&

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

E&#r!#n"i



A=AT -A&

Ko&pon#n Rawat Inap 1*1,500 1*1,500 1*1,500 1*1,500

Mondok Makan 55,000 1 55,000 1 55,000 1 55,000 1 55,000

Visite dokter spesialis O3C 40,000 1 40,000 1 40,000 1 40,000 1 40,000Visite dokter spesialis AA) 40,000 1 40,000 1 40,000 1 40,000 1 40,000

&erawatan (a!i :roomin' in; 2#,500 1 2#,500 1 2#,500 1 2#,500 1 2#,500

asuhan )eperawatan 10,000 1 10,000 1 10,000 1 10,000 1 10,000

Tindakan )eperawatan 9,000 1 9,000 1 9,000 1 9,000 1 9,000

Obatobatan $",504 105,951 $$,4$" "",91$

Anal'esik arkotik TAMAO< 50M3 .A& 3- .A& 4$9




'

Anal'esik, Antipiretik &OTO /&&O 100 M3 G 20 /&& *,5*0 " 25,#40 " 25,#40 " 25,#40Anal'esik, Antipiretik OVA<3- 500 M3DM< 2 M< AM& AM& 9,4*2 2 1*,9$4

Anti(iotik 'ol se6alosporin .T-ABO V-A< C 13 3BG2 V-A 1",2$2 2 2$,524 2 2$,524

Anti(iotik 'ol se6alosporin .-B-M 100m' cap ",000 2 $,000 2 $,000

Antasid dan antitukak A-T-- AM& 50M3DM< 2M< AM& ",125 2 $,250

Antiemetik &-M&A -@ AM& 10,"12 1 10,"12

/terotonin MTC< 3OMT- TA 3) TA 1"* " 414 " 414 " 414


Vitamin O-M- A G"0 T<D/ )&< **1 2 1,#$2 2 1,#$2 2 1,#$2

.airan Mineral -3 BTO 5% 500 M< OT < 10,*49 1 10,*49 " "2,54# " "2,54#

Topikal )ulit Anti(akteri )M-.T- 2% O-T 15 3 T/ 10,"12

Op#ra"i

P#rawatan Khu"u"

P#r"alinan Patolo!i" 4,005,54*

S#*tio Sa#*aria 2,$"5,000 1 2,$"5,000

ia!a Operasional 1



Operator 1

Anestesi 1

Asisten, &, lain2 1

1

1

uan' pemulihan 1

Alkes, & -(u ? &<A- 0 ,"# *5,"00 1 *5,"00

Alkes, & -(u ./A&O *0 B 50B10 MM 49,$00 1 49,$00

Alkes, & -(u A.O * :T-<; 12,"#5 1 12,"#5

A.O #,5 :T-<; 5,*44 2 11,$**

&-A/ --- 20 ",100 1 ",100

OTA.A< $,5 55,400 1 55,400

&O<CO O? 1 .<?905 3?25 1"5,500 1 1"5,500

&/-T " .. 4,100 1 4,100



ectio aecariaalaman 14$ dari 25#

?.OM-. 2 .3?*$$D3?25 *2,#00 1 *2,#00 O<< 3A 5,200 1 5,200

V-)A 3A 5,200 1 5,200

/.T-O .ATT 10 10,*00 1 10,*00

&/-T 10 .. $,400 1 $,400

&/-T 5 .. 4,900 1 4,900

A &A. <.TO .O/T $9,"00 1 $9,"00

? /3-.C< MO-< "D0 ?24 112,900 1 112,900

? &<A- 20 .3?*4" *5,000 1 *5,000

A.O $,5 T-< 12,"00 2 24,$00

A.< 0,9 % 1000 M< 10,4#0 1 10,4#0

< 500 M< OT/ 11,#19 1 11,#19

A-3 500 M< 1*,225 1 1*,225

ATO&- /<A -@ 2,900 2 5,*00

&T-- AM& -@ #5 M3 14,990 1 14,990

&-M&A -@ 11,$** 1 11,$**

.OO< 1 % 20 M< $2,000 1 $2,000

TAMA< /&& 1#,"94 1 1#,"94

TAC< 2 M< 125 M.3 "*,500 1 "*,500

M-<O 15 M3 1*,11" 5?0 90,5$5 TA.-/M 2,5 M< 2#,225 1?0 2#,225

-O</A 250 M< *,10# "0 24",210

BTA- 10 % 4,$00 1 4,$00

)TOO<A. " % -@ 1$,#00 " 50,100




Laboratoriu& 1*#,500


T :leeddin' Time; D Masa &erdarahan *,250 1 *,250




ectio aecariaalaman 14# dari 25#

3lukosa ewaktu 20,000 1 20,000 3olon'an darah 11,000 1 11,000

(sA' 4#,500 1 4#,500

An iliru(in 2#,500 1 2#,500


P#&#rik"aan Khu"u"

.T3 1

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah



Pin) Plat# S*r#w

&in

&late

rew

-O<

Ph("ioth#rapi

Total +ia(a 2)2/-)4,0 0-5)2,1 025)3./ 01,)21.



ectio aecariaalaman 14* dari 25#

ari 5 Total

@ml ar'a @ml ar'a




ari 5 Total

@ml ar'a @ml ar'a

1*1,500 90#,500

1 55,000 5 2#5,000

1 40,000 5 200,0001 40,000 5 200,000

1 2#,500 5 1"#,500

1 10,000 5 50,000

1 9,000 5 45,000

90,"22 "$0,15$

12 5,$2* 12 5,$2*

" 25 #40 12 102 9$0




" 25,#40 12 102,9$0 2 1*,9$4

4 5",04*

12 "$,000 1$ 4*,000

2 $,250

1 10,"12

15 2,0#0 24 ","12

1 9,5$9

12 10,5#2 1* 15,*5*

# #5,94"

1 10,"12 1 10,"12

4,005,54*

1 2,$"5,000

1

ari 5 Total

@ml ar'a @ml ar'a

1

1

1

1

1

1

1 *5,"00

1 49,$00

1 12,"#5

2 11,$**

1 ",100

1 55,400

1 1"5,500

1 4,100

1 *2 #00




1 *2,#00 1 5,200

1 5,200

1 10,*00

1 $,400

1 4,900

1 $9,"00

1 112,900

1 *5,000

2 24,$00

1 10,4#0

1 11,#19

1 1*,225

2 5,*00

1 14,990

1 11,$**

1 $2,000

1 1#,"94

1 "*,500

5 90,5$5 1 2#,225

"0 24",210

1 4,$00

" 50,100

ari 5 Total

@ml ar'a @ml ar'a

1*#,500

1 $5,000

1 *,250

1 *,250

1 20 000




1 20,000 1 11,000

1 4#,500

1 2#,500

1

1

ari 5 Total

@ml ar'a @ml ar'a

051)-00 ,)2.4)542



ectio aecariaalaman 15" dari 25#


)A/ > ectio aecaria emer'ensi

/-A > ewasa

ari 1 ari 2 ari "

ediaan @ml ar'a @ml ar'a @ml ar'a @ml



@< A=AT @A<A <A@/TA


@< o

@< o

RJL Obat ObatObatan

@< O(atO

@< O(atO

@< O(atO

ar'a atuan



@< O(atO


@< &enunan' ia'nostik ont'e Ront!#n

@< &enunan' ia'nostik ont'e



@< &enunan' ia'nostik < Laboratoriu&

@< &enunan' ia'nostik <

@< &enunan' ia'nostik < @< &enunan' ia'nostik <

@< &enunan' ia'nostik &emeriksaan )hususP#&#rik"aan Khu"u"

@< &enunan' ia'nostik &emeriksaan )husus



@< &enunan' ia'nostik &atolo'i Anatomi Patolo!i Anato&i





@< Tindakan )husus

@< Tindakan )husus

@< Tindakan )husus


@< &h!sio

@< &h!sio

@< &h!sio RJL E&#r!# E&#r!#n"i

@< mer'ens

@< mer'ens

@< mer'ens

-& A=AT - A=AT -A&

-& A=AT -

RIPKo&pon#n Rawat Inap

Ko&pon#n Rawat Inap 1*1,500 1*1,500 1*1,500


-& )omponen awat -nap Mondok Makan 55,000 1 55,000 1 55,000 1 55,000 1

-& )omponen awat -nap Visite dokter spesialis O3C 40,000 1 40,000 1 40,000 1 40,000 1

-& )omponen awat -nap Visite dokter spesialis AA) 40,000 1 40,000 1 40,000 1 40,000 1

-& )omponen awat -nap &erawatan (a!i :roomin' in; 2#,500 1 2#,500 1 2#,500 1 2#,500 1

-& )omponen awat -nap asuhan )eperawatan 10,000 1 10,000 1 10,000 1 10,000 1-& )omponen awat -nap Tindakan )eperawatan 9,000 1 9,000 1 9,000 1 9,000 1



RIP Obat Obatobatan $",504 105,951 $$,4$"

-& O(atO

-& O(atO Anal'esik arkotik TAMAO< 50M3 .A& 3- .A& 4$9

-& O(atO Anal'esik, Antipiretik &OTO /&&O 100 M3 G 20 /&& *,5*0 " 25,#40 " 25,#40 "

-& O(atO Anal'esik, Antipiretik OVA<3- 500 M3DM< 2 M< AM& AM& 9,4*2 2 1*,9$4

-& O(atO Anti(iotik 'ol se6alosporin .T-ABO V-A< C 13 3BG2 V-A 1",2$2 2 2$,524 2 2$,524 -& A ti(i tik l 6 l i .-B-M 100 " 000 2 $ 000 2



-& O(atO Anti(iotik 'ol se6alosporin .-B-M 100m' cap ",000 2 $,000 2

-& O(atO Antasid dan antitukak A-T-- AM& 50M3DM< 2M< AM& ",125 2 $,250

-& O(atO Antiemetik &-M&A -@ AM& 10,"12 1 10,"12

-& O(atO /terotonin MTC< 3OMT- TA 3) TA 1"* " 414 " 414 "

-& O(atO /terotonin MT3- 0,2 M3 AM& 10 AM& 9,5$9 1 9,5$9

-& O(atO Vitamin O-M- A G"0 T<D/ )&< **1 2 1,#$2 2 1,#$2 2

-& O(atO .airan Mineral -3 BTO 5% 500 M< OT < 10,*49 1 10,*49 " "2,54# " "2,54#

-& O(atO Topikal )ulit Anti(akteri )M-.T- 2% O-T 15 3 T/ 10,"12

-& O(atO -& O(atO

-& O(atO

RIP Op#ra"i Op#ra"i

-& Operasi

-& Operasi

-& Operasi

-& Operasi


-& &erawatan )husus -& &erawatan )husus

-& &erawatan )husus

RIP P#r"alinan Patolo!i" P#r"alinan Patolo!i" 4,005,54*


-& &ersalinan &atolo'is S#*tio Sa#*aria 2,$"5,000 1 2,$"5,000

-& &ersalinan &atolo'is ia!a Operasional 1

-& &ersalinan &atolo'is Operator 1

-& &ersalinan &atolo'is Anestesi 1

-& &ersalinan &atolo'is Asisten, &, lain2 1 -& &ersalinan &atolo'is 1

-& &ersalinan &atolo'is 1

-& &ersalinan &atolo'is uan' pemulihan 1


-& &ersalinan &atolo'is Alkes, & -(u ? &<A- 0 ,"# *5,"00 1 *5,"00

-& &ersalinan &atolo'is Alkes, & -(u ./A&O *0 B 50B10 MM 49,$00 1 49,$00

-& &ersalinan &atolo'is Alkes, & -(u A.O * :T-<; 12,"#5 1 12,"#5

-& &ersalinan &atolo'is A.O #,5 :T-<; 5,*44 2 11,$**

-& &ersalinan &atolo'is &-A/ --- 20 ",100 1 ",100 -& &ersalinan &atolo'is OTA.A< $,5 55,400 1 55,400

-& &ersalinan &atolo'is &O<CO O? 1 .<?905 3?25 1"5,500 1 1"5,500

-& &ersalinan &atolo'is &/-T " .. 4,100 1 4,100

-& &ersalinan &atolo'is ?.OM-. 2 .3?*$$D3?25 *2,#00 1 *2,#00

-& &ersalinan &atolo'is O<< 3A 5,200 1 5,200

-& &ersalinan &atolo'is V-)A 3A 5,200 1 5,200

-& &ersalinan &atolo'is /.T-O .ATT 10 10,*00 1 10,*00

-& &ersalinan &atolo'is &/-T 10 .. $,400 1 $,400

-& &ersalinan &atolo'is &/-T 5 .. 4,900 1 4,900 -& A &A. <.TO .O/T $9 "00 1 $9 "00



-& &ersalinan &atolo'is A &A. <.TO .O/T $9,"00 1 $9,"00

-& &ersalinan &atolo'is ? /3-.C< MO-< "D0 ?24 112,900 1 112,900

-& &ersalinan &atolo'is ? &<A- 20 .3?*4" *5,000 1 *5,000

-& &ersalinan &atolo'is A.O $,5 T-< 12,"00 2 24,$00

-& &ersalinan &atolo'is A.< 0,9 % 1000 M< 10,4#0 1 10,4#0

-& &ersalinan &atolo'is < 500 M< OT/ 11,#19 1 11,#19

-& O(atO A-3 500 M< 1*,225 1 1*,225

-& O(atO ATO&- /<A -@ 2,900 2 5,*00

-& &ersalinan &atolo'is &T-- AM& -@ #5 M3 14,990 1 14,990

-& &ersalinan &atolo'is &-M&A -@ 11,$** 1 11,$**

-& &ersalinan &atolo'is .OO< 1 % 20 M< $2,000 1 $2,000

-& &ersalinan &atolo'is TAMA< /&& 1#,"94 1 1#,"94

-& &ersalinan &atolo'is TAC< 2 M< 125 M.3 "*,500 1 "*,500

-& &ersalinan &atolo'is M-<O 15 M3 1*,11" 5?0 90,5$5

-& &ersalinan &atolo'is TA.-/M 2,5 M< 2#,225 1?0 2#,225

-& &ersalinan &atolo'is -O</A 250 M< *,10# "0 24",210

-& &ersalinan &atolo'is BTA- 10 % 4,$00 1 4,$00 -& &ersalinan &atolo'is )TOO<A. " % -@ 1$,#00 " 50,100





-& &enunan' ia'nostik ont'e Ront!#n

-& &enunan' ia'nostik ont'e


-& &enunan' ia'nostik ont'e -& &enunan' ia'nostik < Laboratoriu& 1*#,500

-& &enunan' ia'nostik <

-& &enunan' ia'nostik < arah <en'kap :arah utin, iE count, <; $5,000 1 $5,000

-& &enunan' ia'nostik < T :leeddin' Time; D Masa &erdarahan *,250 1 *,250

-& &enunan' ia'nostik < .T :.lotin' Time; D Masa &em(ekuan *,250 1 *,250

-& &enunan' ia'nostik < 3lukosa ewaktu 20,000 1 20,000

-& &enunan' ia'nostik < 3olon'an darah 11,000 1 11,000

-& &enunan' ia'nostik < (sA' 4#,500 1 4#,500

-& &enunan' ia'nostik < An iliru(in 2#,500 1 2#,500

-& &enunan' ia'nostik < krinin' hipotiroid 1

-& &enunan' ia'nostik &emeriksaan )husus P#&#rik"aan Khu"u"

-& &enunan' ia'nostik &emeriksaan )husus .T3 1

-& &enunan' ia'nostik &emeriksaan )husus


-& &enunan' ia'nostik &atolo'i Anatomi Patolo!i Anato&i





-& Tindakan )husus -& Tindakan )husus



Tindakan )husus

-& Tindakan )husus

RIP Lainlain Lainlain


-& <ainlain

-& <ainlain

-& <ainlain


-& <ainlain -& <ainlain

-& <ainlain

-& <ainlain


-& <ainlain &in

-& <ainlain &late

-& <ainlain rew

-& <ainlain -O<

RIP Ph Ph("ioth#rapi -& &h!sio

-& &h!sio

-& &h!sio

Total +ia(a 2)2/-)4,0 0-5)2,1 025)3./

ari 4 ari 5 Total

ar'a @ml ar'a @ml ar'a



1*1,500 1*1,500 90#,500

55,000 1 55,000 5 2#5,000

40,000 1 40,000 5 200,000

40,000 1 40,000 5 200,000

2#,500 1 2#,500 5 1"#,500

10,000 1 10,000 5 50,000

9,000 1 9,000 5 45,000

"",91$ 90,"22 "$0,15$

12 5,$2* 12 5,$2*

25,#40 " 25,#40 12 102,9$0

2 1*,9$4

4 5",04*

$,000 12 "$,000 1$ 4*,000

2 $,250

1 10 "12



1 10,"12

414 15 2,0#0 24 ","12

1 9,5$9

1,#$2 12 10,5#2 1* 15,*5*

# #5,94"

1 10,"12 1 10,"12

4,005,54*

1 2,$"5,000

1

1

1

1

1

1

1

1 *5,"00

1 49,$00

1 12,"#5

2 11,$**

1 ",100

1 55,400

1 1"5,500 1 4,100

1 *2,#00

1 5,200

1 5,200

1 10,*00

1 $,400

1 4,900

1 $9,"00

1 112,900

1 *5,000

2 24 $00



2 24,$00

1 10,4#0

1 11,#19

1 1*,225

2 5,*00

1 14,990

1 11,$**

1 $2,000

1 1#,"94 1 "*,500

5 90,5$5

1 2#,225

"0 24",210

1 4,$00

" 50,100

1*#,500

1 $5,000

1 *,250

1 *,250

1 20,000

1 11,000

1 4#,500

1 2#,500

1

1



01,)21. 051)-00 ,)2.4)542

)A/ > -T)TOM- TOTA<

/-A > =AA



RJL RA$AT JALAN LANJUTAN

@<

RJL okt#r Sp#"iali"

@<

@< RJL ObatObatan

@<

@<

@<

@<

@<

@<

RJL P#nunjan! ia!no"tik

@< Ront!#n

@<

@<



Operasi edan'alaman 1$2 dari 25#

@

@<

@< Laboratoriu&

@<

@<

@<

@<

@< P#&#rik"aan Khu"u"

@< @<

@<

@< Patolo!i Anato&i

@<

@<

@<

RJL Tin'akan Khu"u"

@<

@<

@< RJL Ph("ioth#rapi

@<

@<

@<

RJL E&#r!#n"i

@<

@<

@<

@<



@<

@<

-& A=AT -A&

-&

RIP Ko&pon#n Rawat Inap 114,000 114,000 114,000 114,000

-&

-& Mondok Makan 55,000 1 55,000 1 55,000 1 55,000 1 55,000-& Visite dokter spesialis 40,000 1 40,000 1 40,000 1 40,000 1 40,000

-& asuhan )eperawatan 10,000 1 10,000 1 10,000 1 10,000 1 10,000

-& tindakan )eperawatan 9,000 1 9,000 1 9,000 1 9,000 1 9,000

RIP Obatobatan 109,20* 1$2,24$ 1$2,24$ 1$2,24$

-& Anal'esik arkotik TAMAO< 50M3 -@ G5 3- AM& *,$44 " 25,9"2 " 25,9"2 " 25,9"2

-& Anti(iotik 'ol se6alosporin .TA--M 13 V-A<G2 3 V-A< 4#,025 2 94,050 2 94,050 2 94,050 2 94,050

-& Antasid dan antitukak A-T-- AM& 50M3DM< 2M< AM& ",215 2 $,4"0 2 $,4"0 2 $,4"0 2 $,4"0

-& .airan Mineral BT 5% 500 M< OT < *,#2* 1 *,#2* 1 *,#2* 1 *,#2* 1 *,#2*

-& .airan Mineral -3 <A.TAT 500M< OT < 10,4#$ 2 20,952 2 20,952 2 20,952

-& Topikal )ulit Anti(akteri OAT/<< < 15,110



Operasi edan'alaman 1$" dari 25#

-& ahan a(is &akai -& C-3 " M< T/MO 2,544 1 2,544 1 2,544 1 2,544

-& ahan a(is &akai -& C-3 5 M< TM ",$10 1 ",$10 1 ",$10 1 ",$10

RIP Op#ra"i ",$41,0"1 50,100

-&

-& Op#ra"i b#"ar 2,$"5,000 1 2,$"5,000

-& ia!a Operasional 1 -& Operator 1

-& Anestesi 1

-& Asisten, &, lain2 1

-&

-& & &lain 2D0 2$ (uah *2,200 1 *2,200

-& & andschoen $,5 teril ps' 12,"#5 2 24,#50

-& & /rine(a' ro!al :non steril; (uah 5,$00 1 5,$00

-& & ole!catteter 20 2 wa! (uah 24,$00 1 24,$00

-& & andschoen # teril (uah 12,"#5 2 24,#50

-& & andschoen #,5 teril (uah 5,*44 1 5,*44 -& & &isau insisi 20 :&isau (isturi; (uah ",100 1 ",100

-& & ios!n "0 sm $9" c?14 (uah 14$,"00 1 14$,"00

-& & oLilk "0 3*"2 +?20 (uah #0,*00 1 #0,*00

-& & ansaplas (uah "00 1 "00

-& & )asa idroKl citra Jra! l(r 1,1#0 20 2",400

-& & @arum isp 2# pinal : raun; (uah "*,500 1 "*,500

-& & .erplast aeroKlm 50 J 50 mm l(r #",200 1 #",200

-& & puit 10 cc :Terumo; (uah $,400 1 $,400

-& & spuit 5 cc :Terumo; (uah 4,900 2 9,*00



-& & and &eace electro couter :--; (uah $9,"00 2 1"*,$00

-& & ? ur'!cal 910 o? 2D0 2$ mm (uah *$,000 1 *$,000

-& O(at O) a.l 0?9% 1000ml (uah 10,4#0 1 10,4#0

-& O(at O) < 500 ml (uah 11,#19 2 2",4"*

-& O(at O) &ethidin amp in 50M3 m' 14,990 1 14,990

-& O(at O) &rimperan in amp 11,$** 1 11,$**

-& O(at O) Marcain spinal hea+! 0,5% in amp 5$,#*9 1 5$,#*9 -& O(at O) entan!l 2ml 50M3 mc' "*,500 1 "*,500

-& O(at O) MiloF 15m' in mc' 1*,11" 1 1*,11"

-& O(at O) Jtradine 10 % G 1 'alon 4,$00 2 9,200

-& O(at O) )etorolac "% in amp 1$,#00 " 50,100 " 50,100

-& O(at O) Tramadol 100m' in amp *,$00 1 *,$00

-&

-&

RIP P#rawatan Khu"u"

-&

-&

-&

RIP P li P l i




RIP P#r"alinan Patolo!i"

-&

-&

-&

RIP P#nunjan! ia!no"tik

-& Ront!#n 4#,500

-&

-& OT3 TOA) 4#,500 1 4#,500 -&

-& Laboratoriu& 1*$,000

-&

-& arah utin $0,000 1 $0,000

-& &TT, A&TT 1

-& 3lukosa ewaktu 20,000 1 20,000

-& 3olon'an darah 11,000 1 11,000

-& un'si hati :s'ot, s'pt; "5,000 1 "5,000

-& un'si 'inal :As urat, /reum, kreatinin; $0,000 1 $0,000

-& -&

-& P#&#rik"aan Khu"u" 145,000

-& EK7 45,000 1 45,000

-& /3 100,000 1 100,000

-&

-& Patolo!i Anato&i

-&

-&

-&



-&

RIP Tin'akan Khu"u"

-&

-&

-&

RIP Lainlain

-& Labu arah -&

-&

-&

-& Tranfu"i 'arah

-&

-&

-&

-&

-& Pin) Plat# S*r#w

-& &in

-& &late

-&




-& rew

-& -O<

RIP Ph("ioth#rapi

-&

-&

-&

Total +ia(a 666 /0.)/2. 05.)02. 05.)02.

ri 5 Total

ar'a @umlah ar'a



Operasi edan'alaman 1$$ dari 25#

ri 5 Total

ar'a @umlah ar'a

45$,000

4 220,000 4 1$0,000

4 40,000

4 "$,000

595,94$

9 ##,#9$

* "#$,200

* 25,#20

4 "4,912

$ $2,*5$

" # $"2



Operasi edan'alaman 1$# dari 25#

" #,$"2

" 10,*"0

",$91,1"1

1 2,$"5,000

1

1

1

1

1 *2,200

2 24,#50

1 5,$00

1 24,$00

2 24,#50

1 5,*44 1 ",100

1 14$,"00

1 #0,*00

1 "00

20 2",400

1 "*,500

1 #",200

1 $,400

2 9,*00

ri 5 Total

ar'a @umlah ar'a

2 1"*,$00

1 *$,000

1 10,4#0

2 2",4"*

1 14,990

1 11,$**

1 5$,#*9 1 "*,500

1 1*,11"

2 9,200

$ 100,200

1 *,$00



Operasi edan'alaman 1$* dari 25#

4#,500

1 4#,500

1*$,000

1 $0,000

1

1 20,000

1 11,000

1 "5,000

1 $0,000

145,000

1 45,000

1 100,000

ri 5 Total

ar'a @umlah ar'a




,)101),55


)A/ > Appendisitis Akut Tanpa &er6orasi

/-A > =AA

ari 1 ari 2 ari "



okt#r Sp#"iali"

)ontrol pasca rawat inap "5,000

ObatObatan 140,*$9

Anti(iotik 'ol se6alosporin ce6triaJon 1 'r V-A 14,000 1 14,000

Antiamoe(a N Anti'iardiasis MTO-AO< -/ 3-MA 2","#5 1 2","#5

.airan Mineral -3 <A.TAT 500M< OT < 10,4#$ 1 10,4#$

ahan a(is &akai AH/A-T 50 M< -)A < #,150 1 #,150

ahan a(is &akai <OO TA/-O T TM "9,12$ 1 "9,12$



ahan a(is &akai -& C-3 5 M< TM 1,$50 1 1,$50 ahan a(is &akai T =AC TO& .O.) 2",292 1 2",292




Appendisitis

)OTO< &A.A A=AT -A&

Anal'esik, Antipiretik AAM MAMAT TA "50 10

Anti(iotik 'ol se6alosporin .-B-M 100m' cap ",000 10

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu& 1$0,000




3lukosa ewaktu 20,000 1 20,000 .ross Match :Vena; 1

3olon'an darah 11,000 1 11,000

(sA' 4#,500 1 4#,500


A&&-.O3AMD/3 100,000 1 100,000

Patolo!i Anato&i

ari 1 ari 2 ari "


Tin'akan Khu"u"

Ph("ioth#rapi

E&#r!#n"i $5,000

@asa dokter 25,000 1 25,000

)onsul dr spesialis 40,000 1 40,000

A=AT -A&

Ko&pon#n Rawat Inap #4,000 114,000 114,000

Mondok makan 55 000 1 55 000 1 55 000 1 55 000



Appendisitis

Mondok makan 55,000 1 55,000 1 55,000 1 55,000

Visite dokter 40,000 1 40,000 1 40,000



Obatobatan 15$,094 254,12* 20$,00"

Anal'esik arkotik TAMAO< 50M3 -@ G5 3- AM& *,$44 " 25,9"2 " 25,9"2 15

Anal'esik, Antipiretik )TO&O 100 M3 TA TA 1,5"5 2

Anti(iotik 'ol se6alosporin .TA--M 1'r V-A 55,000 2 110,000 2 110,000 2 110,000

Anti(iotik 'ol se6alosporin .-B-M 100m' cap ",000 10

Antasid dan antitukak A-T-- AM& 50M3DM< 2M< AM& ",215 2 $,4"0 2 $,4"0 2 $,4"0 2

Antasid dan antitukak OM&AO< 20 M3 .A& B .A& 9#$ 4

Antasid dan antitukak .-<O) /& 100 M< C& 4*,125 1 4*,125

Antiemetik &-M&A -@ AM& 10,"12 " "0,9"$ " "0,9"$ " "0,9"$

.airan Mineral BT 5% 500 M< OT < *,#2* 1 *,#2* 1 *,#2* 1 *,#2* 1

.airan Mineral -3 <A.TAT 500M< OT < 10,4#$ 2 20,952 2 20,952 Topikal )ulit Anti(akteri OAT/<< < 15,110 1

ahan a(is &akai -& C-3 " M< T/MO 1,"#5 1 1,"#5 1 1,"#5

ahan a(is &akai -& C-3 5 M< TM 1,$50 1 1,$50 1 1,$50

Op#ra"i ",1$$,0"1

Op#ra"i "#'an! 2,1$0,000 1 2,1$0,000

ia!a Operasional 1

Operator 1 Anestesi 1

ari 1 ari 2 ari "


Asisten, &, lain2 1

uan' &emulihan 1

& &lain 2D0 2$ (uah *2,200 1 *2,200

& andschoen $,5 teril ps' 12,"#5 2 24,#50

& /rine(a' ro!al :non steril; (uah 5,$00 1 5,$00

& ole!catteter 20 2 wa! (uah 24,$00 1 24,$00 & andschoen # teril (uah 12,"#5 2 24,#50

& andschoen #,5 teril (uah 5,*44 1 5,*44

& &isau insisi 20 :&isau (isturi; (uah ",100 1 ",100

& ios!n "0 sm $9" c?14 (uah 14$,"00 1 14$,"00

& oLilk "0 3*"2 +?20 (uah #0,*00 1 #0,*00

& ansaplas (uah "00 1 "00

& )asa idroKl citra Jra! l(r 1,1#0 20 2",400

& @arum isp 2# pinal : raun; (uah "*,500 1 "*,500

& .erplast aeroKlm 50 J 50 mm l(r #",200 1 #",200

& puit 10 cc :Terumo; (uah $,400 1 $,400 & spuit 5 cc :Terumo; (uah 4,900 2 9,*00

& and &eace electro couter :--; (uah $9,"00 2 1"*,$00

& ur'!cal 910 o 2D0 2$ mm (uah *$ 000 1 *$ 000



Appendisitis

& ? ur'!cal 910 o? 2D0 2$ mm (uah *$,000 1 *$,000

O(at O) a.l 0?9% 1000ml (uah 10,4#0 1 10,4#0

O(at O) < 500 ml (uah 11,#19 2 2",4"*

O(at O) &ethidin amp in 50M3 m' 14,990 1 14,990

O(at O) &rimperan in amp 11,$** 1 11,$**

O(at O) Marcain spinal hea+! 0,5% in amp 5$,#*9 1 5$,#*9

O(at O) entan!l 2ml 50M3 mc' "*,500 1 "*,500

O(at O) MiloF 15m' in mc' 1*,11" 1 1*,11"

O(at O) Jtradine 10 % G 1 'alon 4,$00 2 9,200

O(at O) )etorolac "% in amp 1$,#00 " 50,100

O(at O) Tramadol 100m' in amp *,$00 1 *,$00

P#rawatan Khu"u"


P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&

ari 1 ari 2 ari "


P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah



Appendisitis

Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&late

rew

-O<

Ph("ioth#rapi

Total +ia(a 666 /.-)10- /04)44/

ri 4 Total

ar'a @umlah ar'a

"",500 1#4,"$9

1 14,000

1 2","#5

1 10,4#$

1 #,150

1 "9,12$

1 1*,#50

1 2,$12

1 1,$50 1 2",292

1 4"*



Appendisitis

",500 10 ",500

"0,000 10 "0,000

1$0,000

1 $5,000

1 *,250

1 *,250

1 20,000 1

1 11,000

1 4#,500

100,000

1 100,000

ri 4 Total

ar'a @umlah ar'a

$5,000

1 25,000

1 40,000

"02,000

" 1$5,000



Appendisitis

2 *0,000

" "0,000

" 2#,000

19$,902 *1",12#

129,$$0 21 1*1,524

",0#0 2 ",0#0

$ ""0,000

"0,000 10 "0,000

$,4"0 * 25,#20

",904 4 ",904

1 4*,125

9 92,*0*

*,#2* 4 "4,912

4 41,90415,110 1 15,110

2 2,#50

2 ","00

",1$$,0"1

1 2,1$0,000

1

1 1

ri 4 Total

ar'a @umlah ar'a

1

1

1 *2,200

2 24,#50

1 5,$00

1 24,$00

2 24,#50

1 5,*44

1 ",100

1 14$,"00

1 #0,*00

1 "00

20 2",400

1 "*,500

1 #",200

1 $,400 2 9,*00

2 1"*,$00

1 *$,000



Appendisitis

1 10,4#0

2 2",4"*

1 14,990

1 11,$**

1 5$,#*9

1 "*,500

1 1*,11"

2 9,200

" 50,100

1 *,$00

ri 4 Total

ar'a @umlah ar'a



Appendisitis

0/4)240

4,#*0,52#


)A/ > AM :-OAOMA MAMMA;

/-A > =AA

ari 1 ari 2



okt#r Sp#"iali"

ObatObatan

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&

P#&#rik"aan Khu"u"



AMD3A3<-OD<-&OMAalaman 1#* dari 25#

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

ari 1 ari 2


E&#r!#n"i

A=AT -A&


Mondok makan 55,000 1 55,000 1 Visite dokter spesialis 40,000 1 40,000 1

Asuhan keperawatan 10,000 1 10,000 1

Tindakan keperawatan 9,000 1 9,000 1

Obatobatan 1*,0#0

Anal'esik, Antipiretik AAM MAMA TA 1"* 15 2,0#0

Anti(iotik 'ol se6alospori .AOB-< .A& .A& 1,$00 10 1$,000

Op#ra"i ",120,101

Op#ra"i "#'an! 2,1$0,000 1 2,1$0,000



AMD3A3<-OD<-&OMAalaman 1#9 dari 25#

ia!a Operasional 1

Operator 1

Anestesi 1

Asisten, &, lain2 1

Materi dan (ahan ha(is p .OO< AM& -V AM& 101,200 1 101,200

Materi dan (ahan ha(is pTAC< .-TAT V-A #1,$10 1 #1,$10

A-T-- -@ 3B 4,125 2 *,250

Anestetik /mum -soLurane cc *,10# 50 405,"50

ari 1 ari 2


)TOO<A. "% -@G10 3B 1*,5$" 1 1*,5$" AH/A-T 50 M< #,150 1 #,150

-/ T =AA TM 15,125 1 15,125

-3 <A.TAT 500M< OT 11,""0 " "",990

TT 100,95* 1 100,95*

AO.AT T 203 1*,#50 1 1*,#50

</)OM #2"*001 * B 10 5,4"1 1 5,4"1

-& C-3 1 2,$12 1 2,$12

-& C-3 " 1,"#5 2 2,#50

-O- &OV-O T< 2,500 2 5,000

--./ 100 ml 24,0#0 0?25 $,01* /3-.A< 3<OV 4,400 4 1#,$00

/3-.A< <A ",4"* 1 ",4"*

.AA )A&A $,504 0?25 1,$2$

.AT 3/T .OM- $$,20$ 1 $$,20$

.OM-. 20 := $*,4#5 1 $*,4#5

P#rawatan Khu"u"




AMD3A3<-OD<-&OMAalaman 1*0 dari 25#

P#nunjan! ia!no"tik

Ront!#n 4#,500

Thoraks &A 4#,500 1 4#,500





ari 1 ari 2


3ula arah &uasa 20,000 1 20,000 (sA' 4#,500 1 4#,500

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah




Pin) Plat# S*r#w

&in

&late

rew

-O< Ph("ioth#rapi

Total +ia(a /)22-).51

ri " Total

ar'a @umlah ar'a




ri " Total

ar'a @umlah ar'a

114,000

1 100,000 1 40,000

1 20,000

1 20,000

1*,0#0

15 2,0#0

10 1$,000

",120,101

1 2,1$0,000

1



AMD3A3<-OD<-&OMAalaman 1*" dari 25#

1

1

1

1

1 101,200

1 #1,$10

2 *,250

50 405,"50

ri " Total

ar'a @umlah ar'a

1 1*,5$" 1 #,150

1 15,125

" "",990

1 100,95*

1 1*,#50

1 5,4"1

1 2,$12

2 2,#50

2 5,000

0 $,01* 4 1#,$00

1 ",4"*

0 1,$2$

1 $$,20$

1 $*,4#5




4#,500

1 4#,500

149,000

1 $5,000

1 *,250

1 *,250

ri " Total

ar'a @umlah ar'a

1 20,000 1 4#,500




/)22-).51


)A/ > 3A3<-O

/-A > =AA

ari 1 ari 2



okt#r Sp#"iali"

ObatObatan

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&



AMD3A3<-OD<-&OMAalaman 1*$ dari 25#

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

ari 1 ari 2


E&#r!#n"i

A=AT -A&


Mondok makan 55,000 1 55,000

Visite dokter spesialis 40,000 1 40,000



Obatobatan 1*,0#0

Anal'esik, Antipiretik AAM MAMAT 500 M3 3) TA 1"* 15 2,0#0

Anti(iotik 'ol se6alospori .AOB-< .A& 500M3 3- .A& 1,$00 10 1$,000

Op#ra"i ",120,101

Op#ra"i "#'an! 2,1$0,000 1 2,1$0,000

ia!a Operasional 1



AMD3A3<-OD<-&OMAalaman 1*# dari 25#

ia!a Operasional 1

Operator 1

Anestesi 1

Asisten, &, lain2 1

Materi dan (ahan ha(is p.OO< AM& -V 10M3DM< 20M< AM& 101,200 1 101,200

Materi dan (ahan ha(is p TAC< .-TAT -@ 10 M< V-A #1,$10 1 #1,$10

A-T-- -@ 3B 4,125 2 *,250


)TOO<A. "% -@G10 3B 1*,5$" 1 1*,5$"

AH/A-T 50 M< -)A < #,150 1 #,150

-/ T =AA TM 15,125 1 15,125 -3 <A.TAT 500M< OT 11,""0 " "",990

ari 1 ari 2


TT 100,95* 1 100,95*

AO.AT T 203 1*,#50 1 1*,#50

</)OM #2"*001 * B 10 5,4"1 1 5,4"1

-& C-3 1 M< T/MO T 2,$12 1 2,$12

-& C-3 " M< T/MO 1,"#5 2 2,#50

-O- &OV-O O< 10% "0M< T< 2,500 2 5,000

--./ 100 ml 24,0#0 0?25 $,01*

/3-.A< 3<OV O #?5 4,400 4 1#,$00 /3-.A< <A 15 ",4"* 1 ",4"*

.AA )A&A O<A 50 3 $,504 0?25 1,$2$

.AT 3/T .OM-. 20 $$,20$ 1 $$,20$

.OM-. 20 :=44*; $*,4#5 1 $*,4#5

P#rawatan Khu"u"


P#nunjan! ia!no"tik



AMD3A3<-OD<-&OMAalaman 1** dari 25#

P#nunjan! ia!no"tik

Ront!#n 4#,500

Thoraks &A 4#,500 1 4#,500





3ula arah &uasa 20,000 1 20,000

(sA' 4#,500 1 4#,500

P#&#rik"aan Khu"u"

ari 1 ari 2


Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&late

rew




rew

-O<

Ph("ioth#rapi

Total +ia(a 666

ri " Total

ar'a @umlah ar'a



AMD3A3<-OD<-&OMAalaman 190 dari 25#

ri " Total

ar'a @umlah ar'a

114,000

1 100,000

1 40,000

1 20,000

1 20,000

1*,0#0

15 2,0#0

10 1$,000

",120,101

1 2,1$0,000

1




1

1

1

1 101,200

1 #1,$10

2 *,250

50 405,"50

1 1*,5$"

1 #,150

1 15,125 " "",990

ri " Total

ar'a @umlah ar'a

1 100,95*

1 1*,#50

1 5,4"1

1 2,$12

2 2,#50

2 5,000

0 $,01*

4 1#,$00 1 ",4"*

0 1,$2$

1 $$,20$

1 $*,4#5




4#,500

1 4#,500

149,000

1 $5,000

1 *,250

1 *,250

1 20,000

1 4#,500

ri " Total

ar'a @umlah ar'a



AMD3A3<-OD<-&OMAalaman 19" dari 25#

/)22-).51


)A/ > <-&OMA M/<T-&<

/-A > =AA

ari 1 ari 2



okt#r Sp#"iali"

ObatObatan

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&

P#&#rik"aan Khu"u"




Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

ari 1 ari 2


E&#r!#n"i

A=AT -A&


Mondok makan 55,000 1 55,000 1

Visite dokter spesialis 40,000 1 40,000 1

Asuhan keperawatan 10,000 1 10,000 1

Tindakan keperawatan 9,000 1 9,000 1

Obatobatan 1*,0#0

Anal'esik, Antipiretik AAM MAMAT 500 M3 3) TA 1"* 15 2,0#0

Anti(iotik 'ol se6alospori .AOB-< .A& 500M3 3- .A& 1,$00 10 1$,000

Op#ra"i ",120,101

Op#ra"i "#'an! 2,1$0,000 1 2,1$0,000

ia!a Operasional 1

Operator 1




Operator 1

Anestesi 1

Asisten, &, lain2 1

Materi dan (ahan ha(is p .OO< AM& -V 10M3DM< 20M< AM& 101,200 1 101,200


A-T-- -@ 3B 4,125 2 *,250


)TOO<A. "% -@G10 3B 1*,5$" 1 1*,5$"

AH/A-T 50 M< -)A < #,150 1 #,150

-/ T =AA TM 15,125 1 15,125 -3 <A.TAT 500M< OT 11,""0 " "",990

ari 1 ari 2 ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah

TT 100,95* 1 100,95*

AO.AT T 203 1*,#50 1 1*,#50

</)OM #2"*001 * B 10 5,4"1 1 5,4"1

-& C-3 1 M< T/MO T 2,$12 1 2,$12

-& C-3 " M< T/MO 1,"#5 2 2,#50

-O- &OV-O O< 10% "0M< T< 2,500 2 5,000

--./ 100 ml 24,0#0 0?25 $,01*

/3-.A< 3<OV O #?5 4,400 4 1#,$00

/3-.A< <A 15 ",4"* 1 ",4"*

.AA )A&A O<A 50 3 $,504 0?25 1,$2$

.AT 3/T .OM-. 20 $$,20$ 1 $$,20$

.OM-. 20 :=44*; $*,4#5 1 $*,4#5

P#rawatan Khu"u"


P#nunjan! ia!no"tik

Ront!#n 4#,500



AMD3A3<-OD<-&OMAalaman 19$ dari 25#

! ,

Thoraks &A 4#,500 1 4#,500





3ula arah &uasa 20,000 1 20,000

(sA' 4#,500 1 4#,500

P#&#rik"aan Khu"u"

ari 1 ari 2


Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&late

rew

-O<



AMD3A3<-OD<-&OMAalaman 19# dari 25#

-O<

Ph("ioth#rapi

Total +ia(a 666

)eteran'an>

; Tari6 paket untuk kasus lipoma !an' dimaksud adalah pada kasus <ipoma den'an>

ü

ukuran P *cm, atau

ü <etak pada ten'kuk :nuche;, umlah

ü @umlah Q " (uah !an' dioperasi pada saat (ersamaan

ri " Total

ar'a @umlah ar'a



AMD3A3<-OD<-&OMAalaman 19* dari 25#

ri " Totalar'a @umlah ar'a

114,000

1 100,000

1 40,000

1 20,000

1 20,000

1*,0#0

15 2,0#0

10 1$,000

",120,101

1 2,1$0,000

1

1

1




1

1

1 101,200

1 #1,$10

2 *,250

50 405,"50

1 1*,5$"

1 #,150

1 15,125

" "",990


1 100,95*

1 1*,#50

1 5,4"1

1 2,$12

2 2,#50

2 5,000

0 $,01*

4 1#,$00

1 ",4"*

0 1,$2$

1 $$,20$

1 $*,4#5

4#,500




1 4#,500

149,000

1 $5,000

1 *,250

1 *,250

1 20,000

1 4#,500





/)22-).51


)A/ > AMOO- 'r ----- :den'an tindakan staples;

/-A > =AA




okt#r Sp#"iali"

ObatObatan

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&

P#&#rik"aan Khu"u"



aemorrhoid 'r -----alaman 202 dari 25#

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

E&#r!#n"i

A=AT -A&


Mondok makan 55,000 1 55,000 1 55,000 1 55,000 1 55,000






Obatobatan 2#4,1"5 14",0*5 150,2"5 195,"45



ahan a(is &akai -/ T =AA TM 15,125 1 15,125


ahan a(is &akai -& C-3 5 M< TM 1,$50 1 1,$50



Anal'esik arkotik TAMAO< 50M3 -@ G5 3- AM& *,$44 " 25,9"2

Anal'esik, Antipiretik )TO&O 100 M3 TA TA 1,5"5 2 ",0#0 2 ",0#0 2 ",0#0 2 ",0#0

Anti(iotik 'ol se6alospori .TA--M 13 V-A<G2 3 AM& 4#,025 2 94,050 2 94,050 2 94,050 2 94,050

)atartik /<.O<AB TA 5M3 G200 TA 904 2 1,*0* 2 1,*0* 2 1,*0* 2 1,*0*

ahan a(is &akai AH/A-T 50 M< -)A < #,150 1 #,150 1 #,150 1 #,150

Anti(iotik 'ol se6alospori .-B-M 100m' cap ",000 10 "0,000Antasid dan antitukak OM&AO< 20 M3 .A& B .A& 9#$ 1 9#$ 1 9#$ 1 9#$ 1 9#$

.airan Mineral BT 5% 500 M< OT < *,#2* 1 *,#2* 1 *,#2* 1 *,#2* 1 *,#2*

.airan Mineral -3 <A.TAT 500M< OT < 10,4#$ " "1,42* " "1,42* " "1,42* " "1,42*

Topikal )ulit Anti(akteri OAT/<< < 15,110 1 15,110

ahan a(is &akai -& C-3 " M< T/MO 1,"#5 1 1,"#5 1 1,"#5 1 1,"#5

ahan a(is &akai -& C-3 5 M< TM 1,$50 1 1,$50 1 1,$50 1 1,$50



aemorrhoid 'r -----alaman 20" dari 25#

Op#ra"i ",1$0,*$$

Op#ra"i "#'an! 2,1$0,000 1 2,1$0,000

ia!a Operasional 1

Operator 1

Anestesi 1

Asisten, &, lain2 1

Materi dan & .OO< AM& -V 10M3DM< 20M< AM& 101,200 1 101,200 Materi dan & TAC< .-TAT -@ 10 M< V-A #1,$10 1 #1,$10

)TOO<A. "% -@G10 3B 1*,5$" 2 "#,125


TT 100,95* 1 100,95*

AH/A-T 50 M< -)A < #,150 1 #,150

<OO TA/-O T TM "9,12$ 1 "9,12$

-3 <A.TAT 500M< OT 11,""0 4 45,"20

AO.AT T 223 1*,#50 1 1*,#50

</)OM #2"*001 * B 10 5,4"1 1 5,4"1

-& C-3 1 M< T/MO T 2,$12 1 2,$12 -& C-3 " M< T/MO 1,"#5 1 1,"#5

-& C-3 5 M< TM 1,$50 1 1,$50

-& C-3 10 M< TM 2,""* 1 2,""*



-O- &OV-O O< 10% "0M< T< 2,500 1 2,500

A<)OO< #0 % 100 M< AMA) < ",5*# 1 ",5*#

--./ 100 ml 24,0#0 0?25 $,01*

)AA C?T-< 24 1$D1$ #,$22 1 #,$22

/3-.A< 3<OV O #?5 4,400 5 22,000

/3-.A< <A 15 ",4"* 1 ",4"*

M-.O&O 0,5R B 10 $,*#5 0?2 1,"#5

.AT 3/T .OM-. 20 $$,20$ 1 $$,20$

.AT 3/T M-<) "O 4*,125 1 4*,125

P#rawatan Khu"u"


P#nunjan! ia!no"tik

Ront!#n

.olon -n <oop 1




p





3lukosa ewaktu 20,000 1 20,000

.ross Match :Vena; 1

3olon'an darah 11,000 1 11,000

A' 4#,500 1 4#,500

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

ectal Taucher 1



Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&late

rew

-O<

Ph("ioth#rapi

Total +ia(a /)543)441 0,5)4-, 0.2)0/, /43)/2,




)ontrol Total


1 1

1 1



aemorrhoid 'r -----alaman 20$ dari 25#

45$,000

4 220,000

4 1$0,000

4 40,000

)ontrol Total


4 "$,000

#$2,*00

1 "9,12$

1 1*,#50

1 15,125

1 2,$12

1 1,$50

1 2",292

1 4"*

" 25,9"2

* 12,2*0

* "#$,200

* #,2"2

" 21,450

10 "0,000 4 ",904

4 "4,912

12 125,#12

1 15,110

" 4,125

" 4,950



aemorrhoid 'r -----alaman 20# dari 25#

",1$0,*$$

1 2,1$0,000

1

1

1

1

1 101,200 1 #1,$10

2 "#,125

50 405,"50

1 100,95*

1 #,150

1 "9,12$

4 45,"20

1 1*,#50

1 5,4"1

1 2,$12 1 1,"#5

1 1,$50

1 2,""*

)ontrol Total


1 2,500

1 ",5*#

0 $,01*

1 #,$22

5 22,000

1 ",4"*

0 1,"#5

1 $$,20$

1 4*,125

1



aemorrhoid 'r -----alaman 20* dari 25#

1$0,000

1 $5,000

1 *,250

1 *,250

1 20,000

1

1 11,000

1 4#,500

1

)ontrol Total


2),/3)...




)A/ > Operasi )atarak

ari 1 ari 2

ediaan ar'a atuan @umlah ar'a @umlah ar'a @um

RJL RA$AT JALAN LANJUTAN RA$AT JALAN LANJUTAN

@< A=AT @A<A <A@/TA

RJL okt#r okt#r Sp#"iali"

@< okter

@< okter

RJL ObatOba ObatObatan "9,40"

@< O(atO(ata cendoJitrol tm "2,"1" 1 "2,"1"

@< O(atO(ata Amoksisilin 500 m' 550 10 5,500

@< O(atO(ata Asam me6enamat 159 10 1,590

@< O(atO(ata

@< O(atO(ata

@< O(atO(ata

RJL P#nunjan! ia!no"tik P#nunjan! ia!no"tik@< &enunan' ia'nostik ont'e Ront!#n




@< &enunan' ia'nostik < Laboratoriu&


@< & i tik <









@< &enunan' ia'nostik &emeriksaan )husus P#&#rik"aan Khu"u"







RJL Tin' Tin'akan Khu"u"

@< Tindakan

@< Tindakan

@< Tindakan

RJL Ph("ioth Ph("ioth#rapi

@< &h!siother

@< &h!siother

@< &h!siother

RJL E&#r!#n"i E&#r!#n"i

@< mer'ensi

ari 1 ari 2


@< mer'ensi

@< mer'ensi

-& A=AT -A& A=AT -A&

-& A=AT -A&

RIP Ko&pon#n Rawat Inap Ko&pon#n Rawat Inap 22*,000

-& )omponen awat -nap Mondok makan 55,000 2 110,000

-& )omponen awat -nap Visite dokter 40,000 2 *0,000 -& )omponen awat -nap Asuhan keperawatan 10,000 2 20,000

-& )omponen awat -nap Tindakan keperawatan 9,000 2 1*,000


RIP Obatobat Obatobatan

-& O(atO(ata

-& O(atO(ata

-& O(atO(ata

-& O(atO(ata

-& O(atO(ata -& O(atO(ata

-& O(atO(ata

RIP Op#ra"i Op#ra"i ",""0,*00

-& Operasi

-& Operasi Pak#t op#ra"i IOL 8ol'abl# 9op#r"i b#"ar: ",""0,*00 1 ",""0,*00

-& Operasi

-& Operasi

-& Operasi




-& Operasi

-& Operasi -& Operasi

RIP P P#rawatan Khu"u"

-& &erawa

-& &erawa

-& &erawa

-& &erawa

-& &erawa

-& &erawa


-& &ers

-& &ers

-& &ers


-& &enunan' ia'nostik ont'e Ront!#n




-& &enunan' ia'nostik < Laboratoriu&



ari 1 ari 2








-& &enunan' ia'nostik &emeriksaan )husus P#&#rik"aan Khu"u" -& &enunan' ia'nostik &emeriksaan )husus








RIP Tin' Tin'akan Khu"u"

-& Tindakan

-& Tindakan

-& Tindakan



-& <ainlain

-& <ainlain




-& <ainlain

-& <ainlain -& <ainlain Tranfu"i 'arah

-& <ainlain

-& <ainlain

-& <ainlain

-& <ainlain

-& <ainlain Pin) Plat# S*r#w 500,000

-& <ainlain &in

-& <ainlain &late

-& <ainlain rew -& <ainlain -O< lensa mata tanam :-O<; 500,000 1 500,000

RIP Ph("ioth Ph("ioth#rapi

-& &h!siother

-& &h!siother

-& &h!siother

Total +ia(a 2)43-)04/

ri " Total

ar'a @umlah ar'a

"9,40" 1 "2,"1"

10 5,500

10 1,590



Operasi edan'

alaman 21" dari 25#

ri " Total

ar'a @umlah ar'a

22*,000

2 110,000

2 *0,000

2 20,000 2 1*,000

",""0,*00

1 ",""0,*00



Operasi edan'

alaman 214 dari 25#

ri " Total

ar'a @umlah ar'a



Operasi edan'

alaman 215 dari 25#

500,000

1 500,000

2)43-)04/

)A/ > &teri'ium anap

ari 1 Total

ediaan ar'a atuan @umlah ar'a @umlah ar'a

RJL RA$AT JALAN LANJUTAN RA$AT JALAN LANJUTAN

@< A=AT @A<A <A@/TA

RJL okt#r okt#r Sp#"iali" @< okter p

@< okter p

RJL ObatOba ObatObatan

@< O(atO(ata

@< O(atO(ata

@< O(atO(ata

@< O(atO(ata

@< O(atO(ata

@< O(atO(ata

@< O(atO(ata

@< O(atO(ata


@< &enunan' ia'nostik ont'e Ront!#n






@< &enunan' ia'nostik <a(oratorium Laboratoriu&





@< &enunan' ia'nostik &emeriksaan )husus P#&#rik"aan Khu"u"







RJL Tin' Tin'akan Khu"u"

@< Tindaka

@< Tindaka

@< Tindaka

RJL Ph("ioth Ph("ioth#rapi

@< &h!siothera @< &h!siothera

@< &h!siothera

RJL E&#r!#n"i E&#r!#n"i

@< mer'ensi

@< mer'ensi

@< mer'ensi

-& A=AT -A& A=AT -A&

ari 1 Total

ediaan ar'a atuan @umlah ar'a @umlah ar'a





-& &enunan' ia'nostik &atolo'i Anatomi -& &enunan' ia'nostik &atolo'i Anatomi



RIP Tin' Tin'akan Khu"u"

-& Tindaka

-& Tindaka

-& Tindaka


-& <ainlain Labu arah -& <ainlain

-& <ainlain

-& <ainlain


-& <ainlain

-& <ainlain

-& <ainlain

-& <ainlain



-& <ainlain Pin) Plat# S*r#w -& <ainlain &in

-& <ainlain &late

-& <ainlain rew

-& <ainlain -O<

RIP Ph("ioth Ph("ioth#rapi

-& &h!siothera

-& &h!siothera

-& &h!siothera

Total +ia(a 35,)/44 35,)/44

*29005

)A/ > TO-<-T- )O- -&TO&- :O&A-; &AA AA)

ari 1 ari 2 ari "



okt#r Sp#"iali"

ObatObatan

Anal'esik, Antipiretik &O- OT C $0M< (tl 20,"50

Anti(iotik 'ol se6alospori .-B-M s!rup (tl "$,500

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&

P#&#rik"aan Khu"u"



Tonsilitis )ronis ipertroK :Operasi; &ada Anakalaman 21* dari 25#

Patolo!i Anato&i

Tin'akan Khu"u"

Ph("ioth#rapi

E&#r!#n"i

ari 1 ari 2 ari "ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah ar'a

A=AT -A&


Mondok makan 55,000 1 55,000 1 55,000

Visite dokter spesialis 40,000 1 40,000 1 40,000

Asuhan keperawatan 10,000 1 10,000 1 10,000

Tindakan keperawatan 9,000 1 9,000 1 9,000

Obatobatan 11",#00

Anal'esik, Antipiretik &O- OT C $0M< (tl 20,"50 2 40,#00

Anti(iotik 'ol se6alospori .-B-M s!rup (tl "$,500 2 #",000

Op#ra"i ","1#,$#0

Op#ra"i "#'an! 2,1$0,000 1 2,1$0,000

ia!a Operasional 1

Operator 1

Anestesi 1

Asisten, &, lain2 1



Tonsilitis )ronis ipertroK :Operasi; &ada Anakalaman 219 dari 25#

uan' &emulihan 1

Materi dan (ahan ha(is p .OO< AM& -V 10M3DM< 20M< AM& 101,200 1 101,200


Anestetik /mum -soLurane cc *,10# #5 $0*,025

TT 100,95* 1 100,95*

A-T-- -@ 3B 4,125 2 *,250

)TOO<A. "% -@G10 3B 1*,5$" 1 1*,5$"

AH/A-T 50 M< -)A < #,150 1 #,150

-/ T =AA TM 15,125 1 15,125

-3 <A.TAT 500M< OT 11,""0 " "",990

AO.AT T 203 1*,#50 1 1*,#50

-& C-3 1 M< T/MO T 2,$12 1 2,$12


-& C-3 " M< T/MO 1,"#5 2 2,#50

-O- &OV-O O< 10% "0M< T< 2,500 2 5,000

--./ 100 ml 24,0#0 0?25 $,01*

/3-.A< 3<OV O #?5 4,400 4 1#,$00

/3-.A< <A 15 ",4"* 1 ",4"*

.AA )A&A O<A 50 3 $,504 0 1,951

.AT 3/T .OM-. 20 $$,20$ 1 $$,20$

.OM-. 20 :=44*; $*,4#5 1 $*,4#5

P#rawatan Khu"u"


P#nunjan! ia!no"tik

Ront!#n







&emeriksaanematolo'i T :leeddin' Time; D Masa &erdarahan *,250 1 *,250 &emeriksaanematolo'i


&emeriksaan )adar 3ulaarah

3ula arah &uasa 20,000 1 20,000

A' 4#,500 1 4#,500

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"


Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&late

rew

-O<

Ph("ioth#rapi

Total +ia(a /).32)/54 112)444




kontrol Total


5$,*50 5$,*50

1 20,"50 1 20,"50

1 "$,500 1 "$,500




kontrol Total @umlah ar'a @umlah ar'a

22*,000

2 110,000

2 *0,000

2 20,000

2 1*,000

11",#00

2 40,#00

2 #",000

","1#,$#0

1 2,1$0,000

1

1

1

1

1



Tonsilitis )ronis ipertroK :Operasi; &ada Anakalaman 22" dari 25#

1

1 101,200

1 #1,$10

50 $0*,025

1 100,95*

2 *,250

1 1*,5$"

1 #,150

1 15,125

" "",990

1 1*,#50

1 2,$12


2 2,#50

2 5,000

0 $,01*

4 1#,$00

1 ",4"*

0 1,951

1 $$,20$

1 $*,4#5

149,000

1 $5,000

1 *,250

1 * 250




1 *,250 1 20,000

1 4#,500


,.)-,4 /)-.,)004




)A/ > TO-<-T- )O- -&TO&- :Operasi; pada usia ewasa

ari 1 ari 2 ari "



okt#r Sp#"iali"

ObatObatan

Anal'e AAM MAMAT 500 M3 3) TA 1"*

Anti(io .-B-M 100m' cap "000

P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&

P#&#rik"aan Khu"u"

Patolo!i Anato&i



Tonsilitis )ronis ipertroK pada /sia ewasaalaman 22$ dari 25#

Tin'akan Khu"u"

Ph("ioth#rapi

ari 1 ari 2 ari "


E&#r!#n"i

A=AT -A&


Mondok makan 55,000 1 55,000 1 55,000 Visite dokter spesialis 40,000 1 40,000 1 40,000

Asuhan keperawatan 10,000 1 10,000 1 10,000

Tindakan keperawatan 9,000 1 9,000 1 9,000

Obatobatan $,414 "2,0#0

Anal'esik, Antipiretik AAM M TA 1"* " 414 15 2,0#0

Anti(iotik 'ol se6alospori .-B-M 1 cap ",000 2 $,000 10 "0,000

Op#ra"i ","1#,$#0

Op#ra"i "#'an! 2,1$0,000 1 2,1$0,000

ia!a Operasional 1

Operator 1

Anestesi 1

Asisten, &, lain2 1



Tonsilitis )ronis ipertroK pada /sia ewasaalaman 22# dari 25#

uan' &emulihan 1

Materi dan (ahan ha(is p .OO< A AM& 101,200 1 101,200

Materi dan (ahan ha(is pTAC< .-V-A #1,$10 1 #1,$10

Anestetik /mum -soLurane cc *,10# #5 $0*,025

TT 100,95* 1 100,95*

A-T-- -@ 3B 4,125 2 *,250

)TOO<A. "% -@G10 1*,5$" 1 1*,5$"

ari 1 ari 2 ari "


AH/A- < #,150 1 #,150

-/ T =AA TM 15,125 1 15,125

-3 <A.TAT 500M< 11,""0 " "",990

AO.AT T 203 1*,#50 1 1*,#50

-& C-3 2,$12 1 2,$12

-& C-3 1,"#5 2 2,#50

-O- &OV- T< 2,500 2 5,000

--./ 100 ml 24,0#0 0?25 $,01*

/3-.A< 3 4,400 4 1#,$00 /3-.A< ",4"* 1 ",4"*

.AA )A& $,504 0 1,951

.AT 3/T . $$,20$ 1 $$,20$

.OM-. 2 $*,4#5 1 $*,4#5

P#rawatan Khu"u"


P#nunjan! ia!no"tik

Ront!#n



Tonsilitis )ronis ipertroK pada /sia ewasaalaman 22* dari 25#








&emeriksaan )adar3ula arah

3ula arah &uasa 20,000 1 20,000

A' 4#,500 1 4#,500

P#&#rik"aan Khu"u"

ari 1 ari 2 ari "


Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&late

rew

-O<

Ph("ioth#rapi



Tonsilitis )ronis ipertroK pada /sia ewasaalaman 229 dari 25#

Total +ia(a /),-5)4-2 12.)454

Total

ar'a @umlah ar'a



Tonsilitis )ronis ipertroK pada /sia ewasaalaman 2"0 dari 25#

Total

ar'a @umlah ar'a

22*,000

2 110,000 2 *0,000

2 20,000

2 1*,000

"*,4*4

1* 2,4*4

12 "$,000

","1#,$#0

1 2,1$0,000

1

1

1

1

1




1

1 101,200

1 #1,$10

50 $0*,025

1 100,95*

2 *,250

1 1*,5$"

Total

ar'a @umlah ar'a

1 #,150

1 15,125

" "",990

1 1*,#50

1 2,$12

2 2,#50

2 5,000

0 $,01*

4 1#,$00 1 ",4"*

0 1,951

1 $$,20$

1 $*,4#5

149,000




1 $5,000

1 *,250

1 *,250

1 20,000

1 4#,500

Total

ar'a @umlah ar'a



Tonsilitis )ronis ipertroK pada /sia ewasaalaman 2"" dari 25#

/)5//)1,2

)A/ > O&A- ).-<

ari 1

ediaan ar'a atuan @umlah ar'a @umlah


okt#r Sp#"iali"

ObatObatan 140,1"1

Anti(iotik 'ol se6alospori .T-ABO V-A< C 13 3BG2 V-A 1",2$2 1 1",2$2

Antiamoe(a N Anti'iardi MTO-AO< -/ 3-MA 2","#5 1 2","#5







ahan a(is &akai T =AC TO& .O.) 2",292 1 2",292ahan a(is &akai AA&<AT T T-& G 10 4"* 1 4"*

Anal'esik, Antipiretik AAM MAMAT 500 M3 3) TA 1"*

Anti(iotik 'ol se6alospori .AOB-< .A& 500M3 3- .A& 1,$00

P#nunjan! ia!no"tik

Ront!#n




Operasi )ecilalaman 2"4 dari 25#






3olon'an darah 11,000 1 11,000

P#&#rik"aan Khu"u"



ari 1


Anestesi 1 Asisten, &, lain2 1

& &lain 2D0 2$ (uah *2,200 1 *2,200


& andschoen # teril (uah 12,"#5 2 24,#50


& &isau insisi 20 :&isau (isturi; (uah ",100 1 ",100

& oLilk "0 3*"2 +?20 (uah #0,*00 1 #0,*00




& puit 10 cc :Terumo; (uah $,400 1 $,400

& spuit 5 cc :Terumo; (uah 4,900 2 9,*00

& ? ur'!cal 910 o? 2D0 2$ mm (uah *$,000 1 *$,000

O(at O) a.l 0?9% 1000ml (uah 10,4#0 1 10,4#0

O(at O) < 500 ml (uah 11,#19 2 2",4"*




O(at O) MiloF 15m' in mc' 1*,11" 1 1*,11"

O(at O) Jtradine 10 % G 1 'alon 4,$00 2 9,200

O(at O) Tramadol 100m' in amp *,$00 " 25,*00

P#rawatan Khu"u"



Operasi )ecilalaman 2"$ dari 25#


P#nunjan! ia!no"tik

Ront!#n

ari 1


Laboratoriu&

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&late rew

-O<



Operasi )ecilalaman 2"# dari 25#

-O<

Ph("ioth#rapi

Total +ia(a 0)0/5)222

Total

ar'a @umlah ar'a

140,1"1

1 1",2$2

1 2","#5

1 10,4#$

1 #,150

1 "9,12$

1 1*,#50

1 2,$12

1 1,$50

1 2",292

1 4"*

112,500



Operasi )ecilalaman 2"* dari 25#

1 $5,000

1 *,250

1 *,250

1 20,000

1

1 11,000

Total

ar'a @umlah ar'a

114,000

1 55,000

1 40,000

1 10,000

1 9,000

1*,0#0



Operasi )ecilalaman 2"9 dari 25#

15 2,0#0

10 1$,000

1)-,0)520

1 1,290,000

1

1

Total

ar'a @umlah ar'a

1 1

1 *2,200

2 24,#50

2 24,#50

1 5,*44

1 ",100

1 #0,*00 1 "00

20 2",400

1 #",200

1 $,400

2 9,*00

1 *$,000

1 10,4#0

2 2",4"*

1 14,990

1 11,$**

1 "*,500

1 1*,11"

2 9,200

" 25,*00



Operasi )ecilalaman 240 dari 25#

Total

ar'a @umlah ar'a



Operasi )ecilalaman 241 dari 25#

0)0/5)222

)A/ > O&A- A3

ari 1 ari 2 ari "



okt#r Sp#"iali"

@asa medis dr spesialis

&erawatan luka

ObatObatan 1#",*94

Anti(iotik 'ol se6alospori .TA--M 13 V-A<G2 3 V-A< 4#,025 1 4#,025 Antiamoe(a N Anti'iardiaMTO-AO< -/ 3-MA 2","#5 1 2","#5









Anal'esik, Antipiretik )TO&O 100 M3 TA TA 1,5"5


Antasid dan antitukak OM&AO< 20 M3 .A& B .A& 9#$

P#nunjan! ia!no"tik

Ront!#n










3olon'an darah 11,000 1 11,000

A' 4#,500 1 4#,500

P#&#rik"aan Khu"u"

Patolo!i Anato&i

ari 1 ari 2 ari "


Tin'akan Khu"u"

Ph("ioth#rapi

E&#r!#n"i

A=AT -A&

Ko&pon#n Rawat Inap #4,000 114,000 114,000

Mondok makan 55,000 1 55,000 1 55,000 1 55,000

Visite dokter spesialis 40,000 1 40,000 1 40,000



Obatobatan 1$$,0#$ 2"*,1#* 150,250

Anal'esik arkotik TAMAO< 50M3 -@ G5 3- AM& *,$44 " 25,9"2 " 25,9"2 " 25,9"2

Anti(iotik 'ol se6alospori .TA--M 13 V-A<G2 3 V-A< 4#,025 2 94,050 2 94,050 2 94,050

Antasid dan antitukak A-T-- AM& 50M3DM< 2M< AM& ",215 2 $,4"0 2 $,4"0 2 $,4"0

Antasid dan antitukak .-<O) /& 100 M< C& 4*,125 1 4*,125 Antiemetik &-M&A -@ AM& 10,"12 " "0,9"$ " "0,9"$

.airan Mineral BT 5% 500 M< OT < *,#2* 1 *,#2* 1 *,#2* 1 *,#2*

. i Mi l -3 <A.TAT 500M< OT < 10 4#$ 2 20 952




.airan Mineral -3 <A.TAT 500M< OT < 10,4#$ 2 20,952


ahan a(is &akai -& C-3 " M< T/MO 1,"#5 1 1,"#5


Op#ra"i 1,145,0"1

Op#ra"i S#'an! 2,1$0,000

ia!a Operasional 1

Operator 1

ari 1 ari 2 ari "


Anestesi 1 Asisten, &, lain2 1

uan' &emulihan 1"9,000 1 1"9,000

& &lain 2D0 2$ (uah *2,200 1 *2,200


& /rine(a' ro!al :non steril; (uah 5,$00 1 5,$00

& ole!catteter 20 2 wa! (uah 24,$00 1 24,$00


& andschoen #,5 teril (uah 5,*44 1 5,*44 & &isau insisi 20 :&isau (isturi; (uah ",100 1 ",100

& ios!n "0 sm $9" c?14 (uah 14$,"00 1 14$,"00

& oLilk "0 3*"2 +?20 (uah #0,*00 1 #0,*00



& @arum isp 2# pinal : raun; (uah "*,500 1 "*,500



& spuit 5 cc :Terumo; (uah 4,900 2 9,*00

& and &eace electro couter :--; (uah $9,"00 2 1"*,$00

& ? ur'!cal 910 o? 2D0 2$ m (uah *$,000 1 *$,000

O(at O) a.l 0?9% 1000ml (uah 10,4#0 1 10,4#0

O(at O) < 500 ml (uah 11,#19 2 2",4"*



O(at O) Marcain spinal hea+! 0,5% in amp 5$,#*9 1 5$,#*9


O(at O) MiloF 15m' in mc' 1*,11" 1 1*,11" O(at O) Jtradine 10 % G 1 'alon 4,$00 2 9,200


O(at O) Tramadol 100m' in amp * $00 1 * $00





P#rawatan Khu"u"


ari 1 ari 2 ari "



Laboratoriu&

P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah

Pin Plat# S*r#w




Pin) Plat# S*r#w

&in

&late

rew

-O<

Ph("ioth#rapi

Total +ia(a 1)513)441 /,0)15- 0.2)0,4

Total


1#",*94

1 4#,025 1 2","#5

1 10,4#$

1 #,150

1 "9,12$

1 1*,#50

1 2,$12

1 1,$50

1 2",292

1 4"*

1$0,000

1 $5,000

1 *,250



Operasi edan'alaman 24$ dari 25#

1 *,250

1 *,250

1 20,000

1

1 11,000

1 4#,500

Total


"02,000

" 1$5,000

2 *0,000

" "0,000

" 2#,000

554,504

9 ##,#9$

$ 2*2,150

$ 19,290

1 4*,125 $ $1,*#2

" 2$,1*4

2 20,952



Operasi edan'alaman 24# dari 25#

1 15,110

1 1,"#5

1 1,$50

1)12,)4/1

1

1

Total


1 1

1 1"9,000

1 *2,200

2 24,#50

1 5,$00

1 24,$00

2 24,#50

1 5,*44 1 ",100

1 14$,"00

1 #0,*00

1 "00

20 2",400

1 "*,500

1 #",200

1 $,400

2 9,*00

2 1"*,$00

1 *$,000

1 10,4#0

2 2",4"*

1 14,990

1 11,$**

1 5$,#*9

1 "*,500

1 1*,11" 2 9,200

" 50,100

1 *,$00



Operasi edan'alaman 24* dari 25#

Total





0)//,)203

K#rta" K#rja P#rhitun!an Tarif Pak#t Rawat Inap)A/ > O&A- A

/-A > =AA


ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah ar'a @umlah ar'a @umla ar'a


okt#r Sp#"iali"

ObatObatan 1#",*94

Anti(iotik 'ol se6alospori .TA--M 13 V-A V-A< 4#,025 1 4#,025

Antiamoe(a N Anti'iardiaMTO-AO< -/ 2","#5 1 2","#5

.airan Mineral -3 <A.TAT 500 < 10,4#$ 1 10,4#$

ahan a(is &akai AH/A-T 50 M< -) < #,150 1 #,150



ahan a(is &akai -& C-3 1 M< T 2,$12 1 2,$12

ahan a(is &akai -& C-3 5 M< T 1,$50 1 1,$50 ahan a(is &akai T =AC TO& .O. 2",292 1 2",292

ahan a(is &akai AA&<AT T T- 4"* 1 4"*

Anal'esik, Antipiretik )TO&O 100 M3 TA 1,5"5


Antasid dan antitukak OM&AO< 20 M3 ..A& 9#$

P#nunjan! ia!no"tik

Ront!#n




Operasi esaralaman 250 dari 25#






3olon'an darah 11,000 1 11,000

A' 4#,500 1 4#,500

P#&#rik"aan Khu"u"

1

Patolo!i Anato&i

Tin'akan Khu"u"

ari 1 ari 2 ari " ari 4 ari 5ediaan ar'a atuan @umlah ar'a @umlah ar'a @umlah ar'a @umlah ar'a @umla ar'a

Ph("ioth#rapi

E&#r!#n"i

A=AT -A&

Ko&pon#n Rawat Inap #4,000 114,000 114,000 114,000 114,000

Mondok makan 55,000 1 55,000 1 55,000 1 55,000 1 55,000 1 55,000


Asuhan keperawatan 10,000 1 10,000 1 10,000 1 10,000 1 10,000 1 10,000

Tindakan keperawatan 9,000 1 9,000 1 9,000 1 9,000 1 9,000 1 9,000

Obatobatan 140,144 2"*,1#* 2"*,1#* 2"*,1#* 290,952

Anal'esik arkotik TAMAO< 50M3 -@ AM& *,$44 " 25,9"2 " 25,9"2 " 25,9"2 15 129,$$0

Anal'esik, Antipiretik )TO&O 100 M3 TA 1,5"5 2 ",0#0

Anti(iotik 'ol se6alospori .TA--M 13 V-A V-A< 4#,025 2 94,050 2 94,050 2 94,050 2 94,050 2 94,050Anti(iotik 'ol se6alospori .-B-M 100m' cap ",000 10 "0,000

Antasid dan antitukak A-T-- AM& 50M3D AM& ",215 2 $,4"0 2 $,4"0 2 $,4"0 2 $,4"0 2 $,4"0

Antasid dan antitukak OM&AO< 20 M3 ..A& 9#$ 4 ",904




Antasid dan antitukak .-<O) /& 100 MC& 4*,125 1 4*,125 1 4*,125 1 4*,125

Antiemetik &-M&A -@ AM& 10,"12 " "0,9"$ " "0,9"$ " "0,9"$ " "0,9"$

.airan Mineral BT 5% 500 M< OT < *,#2* 1 *,#2* 1 *,#2* 1 *,#2* 1 *,#2* 1 *,#2*

.airan Mineral -3 <A.TAT 500 < 10,4#$ 2 20,952 2 20,952 2 20,952


ahan a(is &akai -& C-3 " M< 1,"#5 1 1,"#5 1 1,"#5 1 1,"#5

ahan a(is &akai -& C-3 5 M< T 1,$50 1 1,$50 1 1,$50 1 1,$50

Op#ra"i ",$41,0"1

Op#ra"i +#"ar 2,$"5,000 1 2,$"5,000

ia!a Operasional 1

Operator 1

Anestesi 1

Asisten, &, lain2 1 1


1

uan' pemulihan 1"9,000

& &lain 2D0 2$ (uah *2,200 1 *2,200


& /rine(a' ro!al :non st (uah 5,$00 1 5,$00

& ole!catteter 20 2 wa (uah 24,$00 1 24,$00



& &isau insisi 20 :&isau ((uah ",100 1 ",100

& ios!n "0 sm $9" c (uah 14$,"00 1 14$,"00

& oLilk "0 3*"2 +? (uah #0,*00 1 #0,*00


& )asa idroKl citra Jra l(r 1,1#0 20 2",400

& @arum isp 2# pinal : (uah "*,500 1 "*,500

& .erplast aeroKlm 50 l(r #",200 1 #",200


& spuit 5 cc :Terumo; (uah 4,900 2 9,*00 & and &eace electro co (uah $9,"00 2 1"*,$00

& ? ur'!cal 910 o? 2 (uah *$,000 1 *$,000

O(at O) a.l 0?9% 1000ml (uah 10,4#0 1 10,4#0

O(at O) < 500 ml (uah 11,#19 2 2",4"*

O(at O) &ethidin amp in 50M3m' 14,990 1 14,990


O(at O) Marcain spinal hea+! amp 5$,#*9 1 5$,#*9


O(at O) MiloF 15m' in mc' 1*,11" 1 1*,11" O(at O) Jtradine 10 % G 1 'alon 4,$00 2 9,200






P#rawatan Khu"u"


P#nunjan! ia!no"tik

Ront!#n

Laboratoriu&


P#&#rik"aan Khu"u"

Patolo!i Anato&i

Tin'akan Khu"u"

Lainlain

Labu arah

Tranfu"i 'arah

Pin) Plat# S*r#w

&in

&late rew

-O<

Ph("ioth#rapi



Operasi esaralaman 25" dari 25#

Total +ia(a 2)1-3)4.3 /,0)15- /,0)15- /,0)15- 242)3,0

Total


1#",*94

1 4#,025

1 2","#5

1 10,4#$

1 #,150

1 "9,12$

1 1*,#50

1 2,$12

1 1,$50 1 2",292

1 4"*

1$0,000




1 $5,000

1 *,250

1 *,250

1 20,000

1

1 11,000

1 4#,500

1

Total @umlah ar'a @umlah ar'a

5"0,000

5 2#5,000

4 1$0,000

5 50,000

5 45,000

1,145,$"0

24 20#,45$

2 ",0#0

10 4#0,250 10 "0,000

10 "2,150

4 ",904

" 144,"#5




" 144,"#5

12 12",#44

5 4",$40

$ $2,*5$

1 15,110

" 4,125

" 4,950

/).21)4/1

1 2,$"5,000

1

1

1

1 1


1

1 *2,200

2 24,#50

1 5,$00

1 24,$00

2 24,#50

1 5,*44

1 ",100

1 14$,"00

1 #0,*00

1 "00

20 2",400

1 "*,500

1 #",200

1 $,400

2 9,*00 2 1"*,$00

1 *$,000

1 10,4#0

2 2",4"*

1 14,990

1 11,$**

1 5$,#*9

1 "*,500

1 1*,11" 2 9,200

" 50,100

1 *,$00



Operasi esaralaman 25$ dari 25#




Operasi esaralaman 25# dari 25#

,).,4),,,

Rekap Paket RANAP Kanwil II - Muara Enim

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