Tarif Tindakan Dokter Umum

7/24/2019 Tarif Tindakan Dokter Umum

1/22

Kode Produ Tindakan Sim B H P Js. RS.

Unit : TINDAKAN DOKTER

Sub Unit : Tindakan Dokter Tetap

Keas : Dokter Tetap Umum

JA!A"#" Tambaan Posterior$Kom%osit Ke&i #'(""" )*("""

JA!A"#+ Tambaan Posterior$Kom%osit Sedan, -"(""" *#("""

JA!A"## Tambaan Posterior$Kom%osit Besar -'(""" /("""JA!A"#- Pera0atan Sauran + Akar '"(""" "("""

JA!A"#1 Pera0atan Sauran # Akar )'(""" +/"("""

JA!A"#' Pera0atan Sauran - Akar +""(""" ##'("""

JA!A"#/ Pera0atan Sauran 1 Akar +#'(""" #)'("""

JA!A"#) 2I3 Rin,an +-(--/ 1/("""

JA!A"#* 2I3 Sedan, +/(/)" ')('""

JA!A"# 2I3 Berat #"(*-* )+(*)'

JA!A"-" Tambaan Anterior 4 +$# 2i,i #'(""" */(#'"

JA!A"-+ Tambaan Anterior 5 +$# 2i,i 1+(/"" +1-()'"

6A6AN""+ 3ureta,e 2i,i -#('"" '"("""

7UNI""- S&ain, Rin,an $ Ra8an, )('"" 1*()'"

7UNI""1 S&ain, Sedan, $ Ra8an, +"(""" /'("""

7UNI""' S&ain, Berat $ Ra8an, +#('"" *+(#'"

7UNI""/ Tamba Sementara (""" -"("""

7UNI"+" 2I3 + Permukaan $ 9issure Seae -#(1"" -(*""

7UNI"++ 3om%osite ke&i +"#(1"" '-(*""

Keas : Dokter Tetap Spesialis

JA!A""- Bea&in, Rin,an *""(""" '*"("""

JA!A""1 Bea&in, Sedan, ""(""" "/("""

JA!A""' Bea&in, Berat ""(""" +(---("""

JA!A""/ Bea&in, Non ita # 2i,i Kun;un,an '"(""" ##/("""

JA!A"") Bea&in, Non ita + 2i,i Kun;un,an -)('"" +/('""

JA!A""* Tambaan Posterior$Kom%osit Ke&i #'(""" *'("""

JA!A"" Tambaan Posterior$Kom%osit Sedan, -"(""" ++)('""

JA!A"+" Tambaan Posterior$Kom%osit Besar -'(""" +'"("""

JA!A"++ Pera0atan Sauran + Akar '"(""" +)/("""

JA!A"+# Pera0atan Sauran # Akar )'(""" #+#("""

JA!A"+- Pera0atan Sauran - Akar +""(""" #)"("""

JA!A"+1 Pera0atan Sauran 1 Akar +#'(""" ##(#""

JA!A"+' 2I3 Rin,an +-(--/ '"(*""

JA!A"+/ 2I3 Sedan, +/(/)" /-('""

JA!A"+) 2I3 Berat #"(*-* )(-)'

JA!A"+* Tambaan Anterior 4 +$# 2i,i #'(""" +"/(#'"

JA!A"+ Tambaan Anterior 5 +$# 2i,i 1+(/"" +*-()'"

JA!BO


2/22

7UNI"" Pen,isian Sauran Akar "(1"" 1'(*""

7UNI"+# 3om%osite sedan, +"#(1"" '-(*""

7UNI"+- 3om%osite besar +"#(1"" /)(*""

Keas : Ekstraksi gigi dan bedah minor

7UNI"+1 E=O 2i,i Anak To%i&a Anestesi +/(#'" #'("""

7UNI"+' E=O 2i,i Anak In;eksi #1(-)' -)('""

7UNI"+ Insisi Abses -#('"" '"("""

7UNI"#" E%uis -#('"" '"("""

7UNI"#+ Pasan, 2i,i Pasu ()'" +'("""

7UNI"## 3etak 2T $ Ona> ##()'" -'("""

7UNI"#- Pat ? + 2i,i Pertama +""(""" #"("""

7UNI"#1 Penamba8an 2i,i Berikutn>a #"(""" 1("""

7UNI"#' Re%arasi ? + 2i,i "(""" '-("""

7UNI"#/ Re%arasi 2i,i '"(""" #1("""

7UNI"#) Rebasin, /'(""" -)('""

7UNI"#* a%ast @Past ? + 2i,i 1+'(""" ')"("""

7UNI"# a%ast @2i,i Berikutn>a '"(""" #-("""

7UNI"-" Ona> Porseen #)'(""" +"1("""

7UNI"-+ Ona> o,am +)'(""" *1("""

7UNI"-# Pre%anasi one> -#(1"" -(*""

7UNI"-- Brid,e Eemen + 2i,i Porsein 1""(""" ++'("""

7UNI"-1 Ja&ket 3ro0n A&r>i& #""(""" )'("""

7UNI"-' Ja&ket 3ro0n Porseen 1""(""" ++'("""

7UNI"-/ S%intin, -#(1"" -(*""

Keas : Gigi Tiruan dan Rehabilitatif

7UNI"-) Ona> Porseen 1"(""" #1"("""

7UNI"-* Ona> o,am #/'(""" +"("""

7UNI"- Ja&ket A&ri>& #-()'" +#-()'"

7UNI"1" Ja&ket A&ri>& Ba&kin, !eta #*1()'" +--()'"

7UNI"1+ Ja&ket Porseen 1+()'" +/-()'"

7UNI"1# Pera0atan Ort8odonti # Ra8an, #(#)'(""" '"("""

7UNI"1- Pera0atan Ort8odonti + Ra8an, +(-)'(""" )'"("""

7UNI"11 Kontro Pus AktiCasi Aat ##(""" )/("""

7UNI"1' Pen,,antian Bra&ket (#'" /('""

7UNI"1/ Pen,,antian Bu&&a Tube +*(#'" *('""

Keas : Foto Dental

JA!"+9D Denta Ront,en I ('"" '"("""

JA!"#9D Denta Ront,en II +*(""" /'("""

Keas : E! Gigi De"asa Ringan

E=O2R""+ E=O 2i,i + Akar @Rin,an #'(""" )"("""

E=O2R""# E=O 2i,i # Akar @Rin,an #'(""" *'("""

E=O2R""- E=O 2i,i - Akar @Rin,an #'(""" +"'("""

Keas : E! Gigi De"asa Sedang

E=O2S""+ E=O 2i,i + Akar @Sedan, #'(""" '("""

E=O2S""# E=O 2i,i # Akar @Sedan, #'(""" ++"("""

E=O2S""- E=O 2i,i - Akar @Sedan, #'(""" +-'("""

Keas : E! Gigi De"asa Sulit

E=O2


3/22

E=O2stem )/('"" )"(*)'

7UNI++* B#+ Tambaan Resesi 2in,iCa 1+(""" #-('""

7UNI++ B## Ina> $ Ona> 3om%osite #'+(""" ++)(#'"

7UNI+#" B#- Ina> $ Ona> PP! -"+(""" +1()'"

7UNI+#+ B#1 Ina> $ Ona> Por&eain 1'+(""" ##1()'"

7UNI+## B#' Ja&ket 3om%osite -"+(""" +1()'"

7UNI+#- B#/ Ja&ket A&rii& #'+(""" ++)(#'"

7UNI+#1 B#) Ja&ket 9use to !eta 1'+(""" ##1()'"

Keas : Ekstraksi gigi dan bedah minor

7UNI#"" 3+ Ekstraksi +/(""" +*('""

7UNI#"+ 3# Ekstraksi #/(""" #)(#'"

7UNI#"# 3- Ekstraksi #+(""" #*('""

7UNI#"- 31 Ekstraksi '+(""" '1()'"

7UNI#"1 3' Ondotektomi Im%aksi Eru%si +""(""" #1"()""

7UNI#"' 3/ Ondontektomi Non Eru%si +'"(""" 1""("""

7UNI#"/ 3) Penan,anan Im%aksi 2i,i De%an #("'+(""" /+#(#'"

7UNI#") 3* !arsu%iaisasi Kista Retensi 1/(""" +1/("""

7UNI#"* 3 In&isi Abs&es Intra Ora -+(""" #/("""

7UNI#" 3+" In&isi Abs&es Eksrtra Ora 1+(""" -1()'"


4/22

7UNI#+" 3++ EF&isi Jarin,an ri& +*1(""" ))("""

7UNI-"1 D' 2i,i A&>ri& Sean;utn>a #'(""" +*()'"

7UNI-"' D/ 2i,i -*1('"" +)-(*)'

7UNI-"/ D) 2i,i '"(""" -#('""

7UNI-") D* 2i,i Tiruan 9rame -*1('"" +)-(*)'

7UNI-"* D 2i,i 9rame Sean;utn>a '"(""" -#('""

7UNI-" D+" 2i,i Tiruan Kombinasi ''#('"" +(-)'

7UNI-+" D++ 2i,i Sean;utn>a '"(""" -#('""

7UNI-++ D+# 2i,i Tiruan 1(""*(""" +(#1*("""

7UNI-+/ D+) !ini Denta Im%an Prot8esa "+(""" ##1()'"

7UNI-+) D+* Obturator Immediate Paska O%erasi "(""" /)('""

7UNI-+* D+ Obturator DeCinitiG 2i,i #11('"" -**(*)'

7UNI-+ D#" Tamba8an Denta Im%an Obur 1(""*(""" +(#1*("""

7UNI-#" D#+ Bootte 9eedin, Obturator /*(""" '('""

7UNI-#+ D## !out8 2uard '/*(""" +'('""

7UNI-## D#- Snoorin, 2uard -("/*(""" *"*("""

Keas : !rthodontik

E+ E+ Ort8odontik


5/22

Se0a Tm% Se0a Aat Js. Struk. Js. an Js. Ass. Js. Pera0at Js. Dokter


6/22

+(*" ++(**" '(1"

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7/22

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8/22

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9/22

Tari%

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10/22

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11/22

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12/22

1#"("""

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13/22

Kode Produ Tindakan Sim B H P Js. RS.

Keas : D!KTER U#U#

T2DU""+ Ra0at #('"" +)('""

T2DU"-* Pasan, InGus Anak 1(""" #+(#""

T2DU"- Tra&8eostom> -('"" )/('""

T2DU"1" Eks%orasi 3or%us Aienum +(""" #1(#""

T2DU"1+ InGus Umbiika #('"" '#('""

T2DU"1# He&tin, +++' '(""" -)("""

T2DU"1- Ra0at


14/22

T2DU"1* Ra0at Ukus 2rade III '(""" -)("""

T2DU"1 Pasan, S%ak Besar +#('"" #('""

T2DU"'" He&tin, Perineum #('"" -('""

T2DU"'+ He&tin, +/#" )('"" '#("""

T2DU"'# He&tin, #+#' *(""" )/("""

T2DU"'- He&tin, #/-" *('"" *#('""

T2DU"'1 He&tin, -+-' (""" *("""

T2DU"'' He&tin, -/1" ('"" '('""

T2DU"'/ He&tin, 1+1' +"(""" +-"("""

T2DU"') He&tin, '+/" +"('"" +1)("""

T2DU"'* He&tin, /+)" ++(""" +/1("""

T2DU"' He&tin, )+*" ++('"" +*+("""

T2DU"/" He&tin, *+" +#(""" +*("""

T2DU"/+ He&tin, ++"" +#('"" #+'("""

T2DU"/# He&tin, Jarin,an Ra%u8 -(""" 1/("""

T2DU"/- Kista At8eroma Ke&i '(""" )("""

T2DU"/1 3aCus '(""" )#("""

T2DU"/' Sambun, Tendon '(""" )#("""

T2DU"// A Im%an -(""" )1("""

T2DU"/) Am%utasi Jari )('"" /('""

T2DU"/* Ekstraksi Kuku -('"" *"('""

T2DU"/ Sirkumsisi Anak /(""" +-1("""

T2DU")" Sirkumsisi De0asa *(""" #"#("""

T2DU")+ EF%ertisi EK2 +("""

T2DU")# Iri,asi !ata #(""" /("""

T2DU")- Iri,asi Tein,a #(""" +#("""

T2DU")1 Pasan, Tam%on Hidun, atau Tein,a #(""" /("""

T2DU")' Pen,ambian Sekret @Pa%smeir #(""" +-("""

T2DU")/ Pasan, easti& Banded +(""" #("""

T2DU")) Pemeriksaan Ins%ikuo +(""" ++("""

T2DU")* a,ina Tou&8e +(""" '("""


15/22

Se0a Tm% Se0a Aat Js. Struk. Js. an Js. Ass. Js. Pera0at Js. Dokter


16/22

-(""" +*(""" ("""

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+'(""" -("""

++("""


17/22

Tari%

+1(1""

+1(1""

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+1(1""

+1(1""++)('""

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18/22

)#("""

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+)("""


19/22

Tindakan $ % P/ !bat &s' Pera"at &s' Dokter

D!KTER U#U# -# +" '*

Ra0at


20/22

He&tin, 1+1' #'(/"" *(""" 1/(1""

He&tin, '+/" #*(*"" (""" '#(#""

He&tin, /+)" -+('#" (*'" ')(+-"

He&tin, )+*" -1('/" +"(*"" /#(/1"

He&tin, *+" -)(11" ++()"" /)(*/"

He&tin, ++"" 1"(/1" +#()"" )-(//"

He&tin, Jarin,an Ra%u8 *(*"" #()'" +'('"

Kista At8eroma Ke&i +'("1" 1()"" #)(#/"3aCus +-(#" 1(-'" #'(#-"

Sambun, Tendon +-(#" 1(-'" #'(#-"

A Im%an +-(#*" 1(+'" #1(")"

Am%utasi Jari ##(**" )(+'" 1+(1)"

Ekstraksi Kuku +1('/" 1(''" #/(-"

Sirkumsisi Anak #1(-#" )(/"" 11("*"

Sirkumsisi De0asa -/(*"" ++('"" //()""

EF%ertisi EK2 +(/"" #(""

Iri,asi !ata #(**" '(##"

Iri,asi Tein,a '()/" +"(11"

Pasan, Tam%on Hidun, atau Tein,a #(**" '(##"

Pen,ambian Sekret @Pa%smeir '(11" (*/"

Pasan, easti& Banded /" +()1"

Pemeriksaan Ins%ikuo '(+#" (#*"

a,ina Tou&8e -(*1" /(/"

Pemeriksaan Dokter Jasa RS Jasa Dokter

/" 1"

+#(""" *("""


21/22

Total

+""

/('""

/('""

'('""

'('""

'('""

*("""/('""

/('""

/('""

/('""

/('""

++('""

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++('""

++('""

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+/("""

++("""

+"('""

+"('""

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+)("""

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+)('""

+)('""+'('""

+)('""

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+#('""

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+/('""

*('""

+-('""

##('""#/("""

#/("""

#/("""

#-("""

*"('""

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#/("""

--('""

#-('""

-)('""

'"("""

''("""

'*("""

/#("""


22/22

*"("""

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+#)("""

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