TARIF TINDAKAN DI ICU UMUM

No. JENIS TINDAKAN

jasa RS
1 Visite dr spesialis icu -
2 Pemakaian alat
3 Ventilator 695,000
4 Bed side monitor 70,000
5 Defebrilator idc shock 80,000
6 Ecg 58,000
7 Nebulaizer 28,000
8 Syring pump 23,000
9 Infusion pump 43,000
10 Pemakaian o2 - oksigen / liter / jam 1,000
11 Pulse oxymeter neontaus/ anak 25,000
12 Tindakan medis
13 Intubasi oleh dr. Umum 118,000
14 Ekstubasi dr. Umum
15 Memasang ngt 23,000
16 Memasang infus 13,000
17 Memasang canulasi vena sentral (cvp) 260,000
18 Arteri line / swan gans 260,000
19 Aplikasi baru ventilator 35,000
20 Aplikasi baru ventilator oleh dr. Spesialis 35,000
21 Lumbal punksi dewasa 50,000
22 Trombolitic therapy 100,000
23 Intubasi (pasang) oleh dr spesialis 118,000
24 Extubasi (lepas) oleh dr spesialis 50,000
25 Setting ventilator oleh dr spesialis 135,000
26 Setting ventilator 135,000
27 Fisioterapi 45,000
28 Memasang pipa naso gastrik (ngt) dr spesialis 27,000
29 Memasang kanulasi vena perifer (infus) dr spesialis 100,000
30 Pasang epidural 50,000
31 Aff epidural 50,000
32 Memasang dower cateter oleh spesialis 30,000
33 Memasang dower cateter 28,000
34 Aff cpv oleh perawat 50,000
35 Injeksi im/ic/sc/iv per set 8,000
35 Punksi pleura 140000
35 Debridement / rawat luka ringan 18,000
35 Debridement / rawat luka berat 33,000
35 Pasang infus dewasa 48,000
35 Aff ngt 28,000
35 Kumbah lambung 13,000
35 Lavement 10,000
35 Aff kateter anak-anak 18,000
35 Pasang infus - perawat on call 11,000
35 Bs (blood sugar) 28,000
35 Aff drain 8,000
35 Perawatan pasien meninggal 18,000
35 Vulva hygiene 26,000
35 Aff wsd 7,000
35 Aff drainen dr spesialis 7,000
35 Aplikasi block fletsus oleh dr spesialis 42,000
35 Wsd besar 38,000
35 Pro functie 19,000
35 Darm buis 23,000
35 Mengganti infus set 18,000
35 Aff Drain 18,000
35 Sceren 18,000
35 Perawatan Pasien Meninggal 40,000
35 PEMBERIAN OBAT SUPOSITORIA 11,000
35 VULVA HYGIENE 8,000
35 PEMASANGAN O2 NASAL KANUL 13,000
35 PEMASANGAN O2 NASAL MASKER 13,000
35 Aff WSD 67,000
35 Aff HECTING 67,000
35 Aff Drainen dr Spesialis 67,000
35 Aff tampon anus post op fistulektomi dan drain 67,000
35 Konsultasi Gizi 60,000
35 Terapi Akupuntur 67,000
35 Pamakaian alat WSD/hr 115,000
35 Konsul VCT 118,000
35 AFF Tampon Hidung 28,000
35 AFF Gigi Palsu 60,000
35 Aplikasi Block Fletsus oleh dr Spesialis 67,000
35 Psikoterafi 67,000
35 WSD BESAR 350,000
35 WSD MINI 300,000
35 PRO FUNCTIE 130,000
35 PLEURODISIS 150,000
35 Darm buis 38,000
35 INJEKSI IV 13,000
35 Pemberian Obat Pervagina 9,000
35 Transfusi 17,000
35 Mengganti Infus Set 8,000
35 Chest Fisioterafi 45,000
 Tarif Baru
TOTAL
BHP tindakan Asisten
- 180,000 - 180,000
-
5,000 150,000 850,000
5,000 - 45,000 120,000
50,000 85,000 20,000 235,000
10,000 33,000 18,000 119,000
3,000 23,000 16,000 70,000
5,000 - 28,000 56,000
5,000 - 23,000 71,000
1,000 500 - 2,500
5,000 - 20,000 50,000
- -
5,000 83,000 23,000 229,000

10,000 28,000 13,000 74,000

10,000 19,000 11,000 53,000
65,000 240,000 25,000 590,000
65,000 240,000 25,000 590,000
5,000 45,000 15,000 100,000
5,000 75,000 10,000 125,000
5,000 160,000 20,000 235,000
5,000 145,000 25,000 275,000
5,000 100,000 22,000 245,000
5,000 75,000 25,000 155,000
5,000 200,000 20,000 360,000
50,000 100,000 285,000
25,000 70,000 140,000
10,000 50,000 13,000 100,000
45,000 200,000 30,000 375,000
5,000 160,000 20,000 235,000
5,000 95,000 25,000 175,000
5,000 100,000 15,000 150,000
5,000 33,000 14,000 80,000
5,000 95,000 25,000 175,000
5,000 9,000 22,000
200000 300000 100000 740,000
20,000 20,000 12,000 70,000
30,000 23,000 14,000 100,000
40,000 28,000 16,000 132,000
15,000 29,000 19,000 91,000
10,000 19,000 11,000 53,000
3,000 8,000 21,000
2,000 18,000 11,000 49,000
5,000 12,000 28,000
5,000 27,000 15,000 75,000
 5,000 9,000 22,000
8,000 28,000 11,000 65,000
10,000 30,000 19,000 85,000
2,000 10,000 4,000 23,000
2,000 10,000 6,000 25,000
5,000 47,000 32,000 126,000
20,000 83,000 18,000 159,000
14,000 33,000
10,000 28,000 61,000
5,000 23,000 46,000
5,000 28,000 51,000
5,000 23,000 13,000 59,000
20,000 45,000 30,000 135,000
2,000 13,000 26,000
5,000 10,000 23,000
2,000 13,000 28,000
2,000 13,000 28,000
100,000 167,000
100,000 167,000
100,000 167,000
100,000 167,000
70,000 130,000
100,000 167,000
157,000 272,000
166,000 284,000
34,000 62,000
70,000 130,000
100,000 167,000
100,000 167,000
1,000,000 480,000 72,000 1,902,000
900,000 340,000 51,000 1,591,000
130,000 230,000 105,000 595,000
170,000 280,000 105,000 705,000
10,000 23,000 16,000 87,000
5,000 18,000 36,000
5,000 9,000 9,000 32,000
2,000 14,000 33,000
2,000 10,000 20,000
25,000 70,000 140,000
TARIF TINDAKAN DI ICU ASING
AN DI ICU ASING
TARIF TINDAKAN DI ICU UMUM

No. JENIS TINDAKAN

jasa RS
1 Visite dr Spesialis ICU -
2 Pemakaian Alat
3 Ventilator 695,000
4 Bed Side Monitor 70,000
5 Defebrilator IDC Shock 80,000
6 ECG 58,000
7 Nebulaizer 28,000
8 Syring Pump 23,000
9 Infusion Pump 43,000
10 Pemakaian O2 - Oksigen / liter / jam 1,000
11 Pulse Oxymeter neontaus/ anak 25,000
12 Tindakan Medis
13 Intubasi oleh dr. umum 118,000
14 ekstubasi dr. umum
15 Memasang NGT 23,000
16 Memasang infus 13,000
17 Memasang Canulasi Vena Sentral (CVP) 260,000
18 Arteri line / Swan Gans 260,000
19 Aplikasi baru Ventilator 35,000
20 Aplikasi baru Ventilator oleh dr. spesialis 35,000
21 Lumbal Punksi Dewasa 50,000
22 Trombolitic Therapy 100,000
23 Intubasi (Pasang) oleh dr Spesialis 118,000
24 Extubasi (Lepas) oleh dr Spesialis 50,000
25 Setting ventilator oleh dr Spesialis 135,000
26 Setting ventilator 135,000
27 Fisioterapi 45,000
28 Memasang Pipa Naso Gastrik (NGT) dr Spesialis 27,000
29 Memasang Kanulasi Vena Perifer (Infus) dr Spesialis 100,000
30 Pasang Epidural 50,000
Aff Epidural 50,000
32 Memasang Dower Cateter oleh spesialis 30,000
33 Memasang Dower Cateter 28,000
34 Aff CPV oleh Perawat 50,000
35 Injeksi IM/IC/SC/IV per set 8,000
35 punksi Pleura 140000
35 DEBRIDEMENT / RAWAT LUKA RINGAN 18,000
35 DEBRIDEMENT / RAWAT LUKA SEDANG 33,000
35 DEBRIDEMENT / RAWAT LUKA BERAT 48,000
35 PASANG INFUS ANAK 28,000
35 PASANG INFUS DEWASA 13,000
35 AFF INFUS 10,000
35 AFF NGT 18,000
35 PEMBERIAN MAKAN MELALUI SONDE 11,000
35 KUMBAH LAMBUNG 28,000
35 INJEKSI IM/IC/SC/IV Per Set 8,000
35 LAVEMENT 18,000
35 PASANG KATETER ANAK-ANAK 26,000
35 Aff kateter Dewasa 7,000
35 Aff kateter anak-anak 7,000
35 Resusitasi (RJP) 42,000
35 PASANG INFUS - PERAWAT ON CALL 38,000
35 BIAYA KONSUL PER TELPON 19,000
35 BS (Blood Sugar) 23,000
35 Suction hidung dan mulut 18,000
35 Aff Drain 18,000
35 Sceren 18,000
35 Perawatan Pasien Meninggal 40,000
35 PEMBERIAN OBAT SUPOSITORIA 11,000
35 VULVA HYGIENE 8,000
35 PEMASANGAN O2 NASAL KANUL 13,000
35 PEMASANGAN O2 NASAL MASKER 13,000
35 Aff WSD 67,000
35 Aff HECTING 67,000
35 Aff Drainen dr Spesialis 67,000
35 Aff tampon anus post op fistulektomi dan drain 67,000
35 Konsultasi Gizi 60,000
35 Terapi Akupuntur 67,000
35 Pamakaian alat WSD/hr 115,000
35 Konsul VCT 118,000
35 AFF Tampon Hidung 28,000
35 AFF Gigi Palsu 60,000
35 Aplikasi Block Fletsus oleh dr Spesialis 67,000
35 Psikoterafi 67,000
35 WSD BESAR 350,000
35 WSD MINI 300,000
35 PRO FUNCTIE 130,000
35 PLEURODISIS 150,000
35 Darm buis 38,000
35 INJEKSI IV 13,000
35 Pemberian Obat Pervagina 9,000
35 Transfusi 17,000
35 Mengganti Infus Set 8,000
35 Chest Fisioterafi 45,000
 Tarif Baru
TOTAL
BHP tindakan Asisten
- 180,000 - 180,000
-
5,000 150,000 850,000
5,000 - 45,000 120,000
50,000 85,000 20,000 235,000
10,000 33,000 18,000 119,000
3,000 23,000 16,000 70,000
5,000 - 28,000 56,000
5,000 - 23,000 71,000
1,000 500 - 2,500
5,000 - 20,000 50,000
- -
5,000 83,000 23,000 229,000

10,000 28,000 13,000 74,000

10,000 19,000 11,000 53,000
65,000 240,000 25,000 590,000
65,000 240,000 25,000 590,000
5,000 45,000 15,000 100,000
5,000 75,000 10,000 125,000
5,000 160,000 20,000 235,000
5,000 145,000 25,000 275,000
5,000 100,000 22,000 245,000
5,000 75,000 25,000 155,000
5,000 200,000 20,000 360,000
50,000 100,000 285,000
25,000 70,000 140,000
10,000 50,000 13,000 100,000
45,000 200,000 30,000 375,000
5,000 160,000 20,000 235,000
5,000 95,000 25,000 175,000
5,000 100,000 15,000 150,000
5,000 33,000 14,000 80,000
5,000 95,000 25,000 175,000
5,000 9,000 22,000
200000 300000 100000 740,000
20,000 20,000 12,000 70,000
30,000 23,000 14,000 100,000
40,000 28,000 16,000 132,000
15,000 29,000 19,000 91,000
10,000 19,000 11,000 53,000
3,000 8,000 21,000
2,000 18,000 11,000 49,000
5,000 12,000 28,000
5,000 27,000 15,000 75,000
5,000 9,000 22,000
8,000 28,000 11,000 65,000
10,000 30,000 19,000 85,000
2,000 10,000 4,000 23,000
2,000 10,000 6,000 25,000
5,000 47,000 32,000 126,000
 20,000 83,000 18,000 159,000
14,000 33,000
10,000 28,000 61,000
5,000 23,000 46,000
5,000 28,000 51,000
5,000 23,000 13,000 59,000
20,000 45,000 30,000 135,000
2,000 13,000 26,000
5,000 10,000 23,000
2,000 13,000 28,000
2,000 13,000 28,000
100,000 167,000
100,000 167,000
100,000 167,000
100,000 167,000
70,000 130,000
100,000 167,000
157,000 272,000
166,000 284,000
34,000 62,000
70,000 130,000
100,000 167,000
100,000 167,000
1,000,000 480,000 72,000 1,902,000
900,000 340,000 51,000 1,591,000
130,000 230,000 105,000 595,000
170,000 280,000 105,000 705,000
10,000 23,000 16,000 87,000
5,000 18,000 36,000
5,000 9,000 9,000 32,000
2,000 14,000 33,000
2,000 10,000 20,000
25,000 70,000 140,000
TARIF TINDAKAN DI ICU ASING
AN DI ICU ASING