UGD Qty Harga Total Harga

Administrasi Rawat jalan 1 25,000 25,000

Pasang Infus 1 50,000 50,000
Injeksi 2 10,000 20,000
EKG 1 50,000 50,000
Pemeriksaan Dokter UGD 1 50,000 50,000
Konsul Spesialis 1 100,000 100,000
Konsul IPD 1 100,000 100,000
Total 395,000

RADIOLOGI QTY HARGA TOTAL HARGA

THORAX 1 110,000 110,000
TOTAL 110,000

Laboratorium Qty Harga Total Harga

DL 1 100,000 100,000
BT 1 36,000 36,000
CT 1 36,000 36,000
GDS 1 45,000 45,000
SC 1 49,000 49,000
BUN 1 49,000 49,000
OT 1 49,000 49,000
PT 1 49,000 49,000
Swab Test Antigen 1 99,000 99,000
Total 512,000

OK Qty Harga Total Harga

Administrasi OK 1 100,000 100,000
Monitor 1 50,000 50,000
O2 2 30,000 60,000
Observasi 2 30,000 60,000
Kamar OK Sedang 1 800,000 800,000
Operator 1 1,500,000 1,500,000
Ass. Operator 1 150,000 150,000
Dokter Anestesi 1 600,000 600,000 GA 40%, Lumbal 35%
Ass. Anestesi 1 60,000 60,000
Instrumen 1 75,000 75,000
Onlop 1 45,000 45,000
Dr. Anak 1 - - 25% diluar jam jaga, 20 % jam jaga, 10% tidak hadir
Ass. Dr. Anak 1 - -
Pasang Kateter 1 - -
BHP 1 400,000 400,000
 Total 3,900,000

Rawat Inap Qty Harga Total Harga

Administrasi rawat inap 1 100,000 100,000
Perawatan pasien 3 75,000 225,000
Kamar Kelas 3 2 150,000 300,000
Konsumsi 2 60,000 120,000
Visite 2 50,000 100,000
Rawat Luka 2 25,000 50,000
BHP 2 10,000 20,000
Total 915,000

Farmasi
1,300,000

TOTAL 7,132,000
20 % jam jaga, 10% tidak hadir
 UGD Qty Harga Total Harga
Administrasi Rawat jalan 1 25,000 25,000
Pasang Infus 1 50,000 50,000
Injeksi 2 10,000 20,000
EKG 1 50,000 50,000
Pemeriksaan Dokter UGD 1 50,000 50,000
Konsul Spesialis 1 100,000 100,000
Konsul IPD 1 100,000 100,000
Total 395,000

RADIOLOGI QTY HARGA TOTAL HARGA

THORAX 1 110,000 110,000
TOTAL 110,000

Laboratorium Qty Harga Total Harga

DL 1 100,000 100,000
BT 1 36,000 36,000
CT 1 36,000 36,000
GDS 1 45,000 45,000
SC 1 49,000 49,000
BUN 1 49,000 49,000
OT 1 49,000 49,000
PT 1 49,000 49,000
Swab Test Antigen 1 99,000 99,000
Total 512,000

OK Qty Harga Total Harga

Administrasi OK 1 100,000 100,000
Monitor 1 50,000 50,000
O2 2 30,000 60,000
Observasi 2 30,000 60,000
Kamar OK Sedang 1 800,000 800,000
Operator 1 1,600,000 1,600,000
Ass. Operator 1 160,000 160,000
Dokter Anestesi 1 640,000 640,000 GA 40%, Lumbal 35%
Ass. Anestesi 1 64,000 64,000
Instrumen 1 80,000 80,000
Onlop 1 48,000 48,000
Dr. Anak 1 - - 25% diluar jam jaga, 20 % jam jaga, 10% tidak hadir
Ass. Dr. Anak 1 - -
Pasang Kateter 1 - -
BHP 1 400,000 400,000
 Total 4,062,000

Rawat Inap Qty Harga Total Harga

Administrasi rawat inap 1 100,000 100,000
Perawatan pasien 3 100,000 300,000
Kamar Kelas 2 2 250,000 500,000
Konsumsi 2 60,000 120,000
Visite 2 75,000 150,000
Rawat Luka 2 25,000 50,000
BHP 2 10,000 20,000
Total 1,240,000

Farmasi
1,300,000

TOTAL 7,619,000
20 % jam jaga, 10% tidak hadir
 UGD Qty Harga Total Harga
Administrasi Rawat jalan 1 25,000 25,000
Pasang Infus 1 50,000 50,000
Injeksi 2 10,000 20,000
EKG 1 50,000 50,000
Pemeriksaan Dokter UGD 1 50,000 50,000
Konsul Spesialis 1 100,000 100,000
Konsul IPD 1 100,000 100,000
Total 395,000

RADIOLOGI QTY HARGA TOTAL HARGA

THORAX 1 110,000 110,000
TOTAL 110,000

Laboratorium Qty Harga Total Harga

DL 1 100,000 100,000
BT 1 36,000 36,000
CT 1 36,000 36,000
GDS 1 45,000 45,000
SC 1 49,000 49,000
BUN 1 49,000 49,000
OT 1 49,000 49,000
PT 1 49,000 49,000
Swab Test Antigen 1 99,000 99,000
Total 512,000

OK Qty Harga Total Harga

Administrasi OK 1 100,000 100,000
Monitor 1 50,000 50,000
O2 2 30,000 60,000
Observasi 2 30,000 60,000
Kamar OK Sedang 1 800,000 800,000
Operator 1 1,700,000 1,700,000
Ass. Operator 1 170,000 170,000
Dokter Anestesi 1 680,000 680,000 GA 40%, Lumbal 35%
Ass. Anestesi 1 68,000 68,000
Instrumen 1 85,000 85,000
Onlop 1 51,000 51,000
Dr. Anak 1 - - 25% diluar jam jaga, 20 % jam jaga, 10% tidak hadir
Ass. Dr. Anak 1 - -
Pasang Kateter 1 - -
BHP 1 400,000 400,000
 Total 4,224,000

Rawat Inap Qty Harga Total Harga

Administrasi rawat inap 1 100,000 100,000
Perawatan pasien 3 125,000 375,000
Kamar Kelas 1 2 350,000 700,000
Konsumsi 2 75,000 150,000
Visite 2 100,000 200,000
Rawat Luka 2 25,000 50,000
BHP 2 10,000 20,000
Total 1,595,000

Farmasi
1,300,000

TOTAL 8,136,000
20 % jam jaga, 10% tidak hadir
 UGD Qty Harga Total Harga
Administrasi Rawat jalan 1 25,000 25,000
Pasang Infus 1 50,000 50,000
Injeksi 2 10,000 20,000
EKG 1 50,000 50,000
Pemeriksaan Dokter UGD 1 50,000 50,000
Konsul Spesialis 1 100,000 100,000
Konsul IPD 1 100,000 100,000
Total 395,000

RADIOLOGI QTY HARGA TOTAL HARGA

THORAX 1 110,000 110,000
TOTAL 110,000

Laboratorium Qty Harga Total Harga

DL 1 100,000 100,000
BT 1 36,000 36,000
CT 1 36,000 36,000
GDS 1 45,000 45,000
SC 1 49,000 49,000
BUN 1 49,000 49,000
OT 1 49,000 49,000
PT 1 49,000 49,000
Swab Test Antigen 1 99,000 99,000
Total 512,000

OK Qty Harga Total Harga

Administrasi OK 1 100,000 100,000
Monitor 1 50,000 50,000
O2 2 30,000 60,000
Observasi 2 30,000 60,000
Kamar OK Sedang 1 800,000 800,000
Operator 1 1,800,000 1,800,000
Ass. Operator 1 180,000 180,000
Dokter Anestesi 1 720,000 720,000 GA 40%, Lumbal 35%
Ass. Anestesi 1 72,000 72,000
Instrumen 1 90,000 90,000
Onlop 1 54,000 54,000
Dr. Anak 1 - - 25% diluar jam jaga, 20 % jam jaga, 10% tidak hadir
Ass. Dr. Anak 1 - -
Pasang Kateter 1 - -
BHP 1 400,000 400,000
 Total 4,386,000

Rawat Inap Qty Harga Total Harga

Administrasi rawat inap 1 100,000 100,000
Perawatan pasien 3 150,000 450,000
Kamar VIP 2 450,000 900,000
Konsumsi 2 75,000 150,000
Visite 2 125,000 250,000
Rawat Luka 2 25,000 50,000
BHP 2 10,000 20,000
Total 1,920,000

Farmasi
1,300,000

TOTAL 8,623,000
20 % jam jaga, 10% tidak hadir