NY AI IDA

SC
KELAS 2

ELEKTIF
NO URAIAN QTY
PENDAFTARAN
1 Administrasi Rawat Darurat IGD 1 Rp 50,000
2 Administrasi Ranap 1 Rp 65,000

SEWA KAMAR
1 SEWA KAMAR 4 Rp 1,000,000

VISITE DR
1 VISITE DR SPESIALIS 2 Rp 140,000
2 VISITE PENGGANTI 1 Rp 35,000

TINDAKAN OPERATIF
1 ANESTESI SC 1 Rp 656,200
2 ASS ANESTESI SC 1 Rp 131,250
3 ASS OP 1 SC 1 Rp 131,250
4 ASS OP 2 SC 1 Rp 131,250
5 BAHP SC SPINAL
DR.KETUT Rp 849,877
DR. AHMADO Rp 463,648
6 OPERATOR SC 1 Rp 1,312,500
7 RESUSITASI SC 1 Rp 328,125
8 SEWA RUANG OK 1 Rp 500,000

TINDAKAN NON OPERATIF

1 Infus + cateter 1 Rp 100,000
2 CTG 1 Rp 50,000
3 BAHP GV RANAP 1 Rp 81,250
4 PERMERIKSAAN DARURAT DR UMUM 1 Rp 24,500
5 Jasa Asuhan OK 1 Rp 20,000
6 Jasa GV 1 Rp 45,000

LAIN-LAIN
1 ASA 1 Rp 187,500
LABORATORIUM 1 Rp 338,400
1 Eritrosit 2
3 HBsAg (Elisa) 1
4 Hematokrit 2
5 Hemoglobin 2
 6 Lekosit 2
7 Trombosit 1
8 Waktu Pembekuan 1
9 Waktu Perdarahan 1
10 GDS 1
ALAT/FASILITAS LAIN
1 ALKES IGD-RANAP Rp 184,606
OBAT DAN ALKES
1 OBAT IGD-PULANG 1 Rp 368,572

TOTAL Rp 7,193,928
COVER BPJS
 ALKES IGD - RANAP

No Alkes Jumlah harga

1 Abocath 1 Rp 28,600
2 Bloodset 1 Rp 34,710
3 Spuit 10 cc 3 Rp 18,525
4 Spuit 1 cc 1 Rp 4,504
5 Catheter 1 Rp 24,310
6 Gelang ping 1 Rp 1,976
8 Urine Bag 1 Rp 11,011
9 Water Inj 5 Rp 41,470
10 Gamex 1 Rp 19,500
Jumlah Rp 184,606

OBAT IGD-PULANG
Nama obat Jumlah Harga
1 Asam Mefenamat 25 Rp 5,500
3 Ceftriaxone Inj 8 Rp 114,400
4 Cefadroxil 15 Rp 15,750
5 Fetik Supp 2 Rp 39,325
6 Cetirizine 10 Rp 3,925
7 D5% 1 Rp 8,970
8 Nonemi 20 Rp 35,750
9 RL 5 Rp 46,475
10 Metro Inf 3 Rp 85,800
11 Metro Inf Novel 3 Rp 155,298
12 pct tab 3 Rp 4,124
Jumlah Rp 515,317

BAHP GV RANAP
No Nama Jumlah Harga
1 Curavor 1 44200
2 Handscoon steril 1 19500
3 Lomatul 1 17550
Jumlah Err:509