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ROWSPAN=2>RUMAH&nbsp;SAKIT&nbsp;MEDIKA&nbsp;STANNIA</TH>

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<TH ALIGN=right COLSPAN=3>Hal 1 dari 1</TH>

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COLSPAN=4>Jl.&nbsp;Jenderal&nbsp;Sudirman&nbsp;No.3,&nbsp;Sungailiat,&nbsp;Prov.&nb
sp;Kepulauan&nbsp;Bangka&nbsp;Belitung&nbsp;33215,&nbsp;Telp.&nbsp;+62&nbsp;
(717)&nbsp;95837,&nbsp;Fax&nbsp;+62&nbsp;(717)&nbsp;93335</TH>

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<TH ALIGN=right COLSPAN=3>22/12/2022</TH>

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<TH COLSPAN=14>DAFTAR&nbsp;TINDAKAN&nbsp;DAN&nbsp;TARIF&nbsp;POLIKLINIK</TH>

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<TD COLSPAN=6>POLI PARU</TD>

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<TD>No.</TD>
<TD ALIGN=center COLSPAN=2>Kode</TD>

<TD ALIGN=center>Deskripsi Tindakan</TD>


<TD ALIGN=center COLSPAN=2>Tarif RJ</TD>

<TD ALIGN=center>Tarif IGD</TD>


<TD ALIGN=center>Tarif Kls VIP</TD>
<TD ALIGN=center>Tarif Kls 1</TD>
<TD ALIGN=center COLSPAN=2>Tarif Kls 2</TD>

<TD ALIGN=center>Tarif Kls 3</TD>


<TD ALIGN=center>Tarif ICU</TD>
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<TD></TD>
<TD>1</TD>
<TD COLSPAN=2>000057</TD>

<TD>AMBULANCE DI LUAR KOTA / KM</TD>


<TD ALIGN=right COLSPAN=2>10.000</TD>

<TD ALIGN=right>10.000</TD>
<TD ALIGN=right>10.000</TD>
<TD ALIGN=right>10.000</TD>
<TD ALIGN=right COLSPAN=2>10.000</TD>

<TD ALIGN=right>10.000</TD>
<TD ALIGN=right>10.000</TD>
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<TD></TD>
<TD>2</TD>
<TD COLSPAN=2>000055</TD>

<TD>AMBULANCE KE BANDARA PKP</TD>


<TD ALIGN=right COLSPAN=2>400.000</TD>

<TD ALIGN=right>400.000</TD>
<TD ALIGN=right>400.000</TD>
<TD ALIGN=right>400.000</TD>
<TD ALIGN=right COLSPAN=2>400.000</TD>

<TD ALIGN=right>400.000</TD>
<TD ALIGN=right>400.000</TD>
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<TD></TD>
<TD>3</TD>
<TD COLSPAN=2>000972</TD>

<TD>AMBULANCE KE DEPATI HAMZAH PKP</TD>


<TD ALIGN=right COLSPAN=2>500.000</TD>

<TD ALIGN=right>500.000</TD>
<TD ALIGN=right>500.000</TD>
<TD ALIGN=right>500.000</TD>
<TD ALIGN=right COLSPAN=2>500.000</TD>

<TD ALIGN=right>500.000</TD>
<TD ALIGN=right>500.000</TD>
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<TD></TD>
<TD>4</TD>
<TD COLSPAN=2>000970</TD>

<TD>AMBULANCE KE KIM</TD>
<TD ALIGN=right COLSPAN=2>350.000</TD>

<TD ALIGN=right>350.000</TD>
<TD ALIGN=right>350.000</TD>
<TD ALIGN=right>350.000</TD>
<TD ALIGN=right COLSPAN=2>350.000</TD>

<TD ALIGN=right>350.000</TD>
<TD ALIGN=right>350.000</TD>
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<TD></TD>
<TD>5</TD>
<TD COLSPAN=2>000051</TD>

<TD>AMBULANCE KE RS. ARSANI SUNGAILIAT</TD>


<TD ALIGN=right COLSPAN=2>100.000</TD>

<TD ALIGN=right>100.000</TD>
<TD ALIGN=right>100.000</TD>
<TD ALIGN=right>100.000</TD>
<TD ALIGN=right COLSPAN=2>100.000</TD>

<TD ALIGN=right>100.000</TD>
<TD ALIGN=right>100.000</TD>
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<TD></TD>
<TD>6</TD>
<TD COLSPAN=2>000054</TD>

<TD>AMBULANCE KE RSBT PANGKALPINANG</TD>


<TD ALIGN=right COLSPAN=2>300.000</TD>

<TD ALIGN=right>300.000</TD>
<TD ALIGN=right>300.000</TD>
<TD ALIGN=right>300.000</TD>
<TD ALIGN=right COLSPAN=2>300.000</TD>

<TD ALIGN=right>300.000</TD>
<TD ALIGN=right>300.000</TD>
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<TD></TD>
<TD>7</TD>
<TD COLSPAN=2>000052</TD>

<TD>AMBULANCE KE RSJ SUNGAILIAT</TD>


<TD ALIGN=right COLSPAN=2>100.000</TD>

<TD ALIGN=right>100.000</TD>
<TD ALIGN=right>100.000</TD>
<TD ALIGN=right>100.000</TD>
<TD ALIGN=right COLSPAN=2>100.000</TD>

<TD ALIGN=right>100.000</TD>
<TD ALIGN=right>100.000</TD>
</TR>
<TR>
<TD></TD>
<TD>8</TD>
<TD COLSPAN=2>000050</TD>

<TD>AMBULANCE KE RSUD DEPATI BAHRIN SUNGAILIAT</TD>


<TD ALIGN=right COLSPAN=2>100.000</TD>

<TD ALIGN=right>100.000</TD>
<TD ALIGN=right>100.000</TD>
<TD ALIGN=right>100.000</TD>
<TD ALIGN=right COLSPAN=2>100.000</TD>

<TD ALIGN=right>100.000</TD>
<TD ALIGN=right>100.000</TD>
</TR>
<TR>
<TD></TD>
<TD>9</TD>
<TD COLSPAN=2>000053</TD>

<TD>AMBULANCE KE RSUP AIR ANYIR </TD>


<TD ALIGN=right COLSPAN=2>250.000</TD>

<TD ALIGN=right>250.000</TD>
<TD ALIGN=right>250.000</TD>
<TD ALIGN=right>250.000</TD>
<TD ALIGN=right COLSPAN=2>250.000</TD>
<TD ALIGN=right>250.000</TD>
<TD ALIGN=right>250.000</TD>
</TR>
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<TD></TD>
<TD>10</TD>
<TD COLSPAN=2>000056</TD>

<TD>AMBULANCE RS SILOAM</TD>
<TD ALIGN=right COLSPAN=2>400.000</TD>

<TD ALIGN=right>400.000</TD>
<TD ALIGN=right>400.000</TD>
<TD ALIGN=right>400.000</TD>
<TD ALIGN=right COLSPAN=2>400.000</TD>

<TD ALIGN=right>400.000</TD>
<TD ALIGN=right>400.000</TD>
</TR>
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<TD></TD>
<TD>11</TD>
<TD COLSPAN=2>000228</TD>

<TD>EKG </TD>
<TD ALIGN=right COLSPAN=2>130.000</TD>

<TD ALIGN=right>130.000</TD>
<TD ALIGN=right>130.000</TD>
<TD ALIGN=right>130.000</TD>
<TD ALIGN=right COLSPAN=2>130.000</TD>

<TD ALIGN=right>130.000</TD>
<TD ALIGN=right>130.000</TD>
</TR>
<TR>
<TD></TD>
<TD>12</TD>
<TD COLSPAN=2>000659</TD>

<TD>JASA BACA EKG</TD>


<TD ALIGN=right COLSPAN=2>30.000</TD>

<TD ALIGN=right>30.000</TD>
<TD ALIGN=right>30.000</TD>
<TD ALIGN=right>30.000</TD>
<TD ALIGN=right COLSPAN=2>30.000</TD>

<TD ALIGN=right>30.000</TD>
<TD ALIGN=right>30.000</TD>
</TR>
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<TD></TD>
<TD>13</TD>
<TD COLSPAN=2>000027</TD>

<TD>KONSUL DR SPESIALIS PARU</TD>


<TD ALIGN=right COLSPAN=2>120.000</TD>
<TD ALIGN=right>120.000</TD>
<TD ALIGN=right>120.000</TD>
<TD ALIGN=right>120.000</TD>
<TD ALIGN=right COLSPAN=2>120.000</TD>

<TD ALIGN=right>120.000</TD>
<TD ALIGN=right>120.000</TD>
</TR>
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<TD></TD>
<TD>14</TD>
<TD COLSPAN=2>001036</TD>

<TD>PA 1</TD>
<TD ALIGN=right COLSPAN=2>300.000</TD>

<TD ALIGN=right>300.000</TD>
<TD ALIGN=right>300.000</TD>
<TD ALIGN=right>300.000</TD>
<TD ALIGN=right COLSPAN=2>300.000</TD>

<TD ALIGN=right>300.000</TD>
<TD ALIGN=right>300.000</TD>
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<TD></TD>
<TD>15</TD>
<TD COLSPAN=2>001037</TD>

<TD>PA 2</TD>
<TD ALIGN=right COLSPAN=2>350.000</TD>

<TD ALIGN=right>350.000</TD>
<TD ALIGN=right>350.000</TD>
<TD ALIGN=right>350.000</TD>
<TD ALIGN=right COLSPAN=2>350.000</TD>

<TD ALIGN=right>350.000</TD>
<TD ALIGN=right>350.000</TD>
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<TD></TD>
<TD>16</TD>
<TD COLSPAN=2>001038</TD>

<TD>PA 3</TD>
<TD ALIGN=right COLSPAN=2>400.000</TD>

<TD ALIGN=right>400.000</TD>
<TD ALIGN=right>400.000</TD>
<TD ALIGN=right>400.000</TD>
<TD ALIGN=right COLSPAN=2>400.000</TD>

<TD ALIGN=right>400.000</TD>
<TD ALIGN=right>400.000</TD>
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<TD></TD>
<TD>17</TD>
<TD COLSPAN=2>001039</TD>

<TD>PA 4</TD>
<TD ALIGN=right COLSPAN=2>450.000</TD>

<TD ALIGN=right>450.000</TD>
<TD ALIGN=right>450.000</TD>
<TD ALIGN=right>450.000</TD>
<TD ALIGN=right COLSPAN=2>450.000</TD>

<TD ALIGN=right>450.000</TD>
<TD ALIGN=right>450.000</TD>
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<TD></TD>
<TD>18</TD>
<TD COLSPAN=2>001040</TD>

<TD>PA 5</TD>
<TD ALIGN=right COLSPAN=2>500.000</TD>

<TD ALIGN=right>500.000</TD>
<TD ALIGN=right>500.000</TD>
<TD ALIGN=right>500.000</TD>
<TD ALIGN=right COLSPAN=2>500.000</TD>

<TD ALIGN=right>500.000</TD>
<TD ALIGN=right>500.000</TD>
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<TD></TD>
<TD>19</TD>
<TD COLSPAN=2>001041</TD>

<TD>PA 6</TD>
<TD ALIGN=right COLSPAN=2>550.000</TD>

<TD ALIGN=right>550.000</TD>
<TD ALIGN=right>550.000</TD>
<TD ALIGN=right>550.000</TD>
<TD ALIGN=right COLSPAN=2>550.000</TD>

<TD ALIGN=right>550.000</TD>
<TD ALIGN=right>550.000</TD>
</TR>
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<TD></TD>
<TD>20</TD>
<TD COLSPAN=2>001042</TD>

<TD>PA 7</TD>
<TD ALIGN=right COLSPAN=2>600.000</TD>

<TD ALIGN=right>600.000</TD>
<TD ALIGN=right>600.000</TD>
<TD ALIGN=right>600.000</TD>
<TD ALIGN=right COLSPAN=2>600.000</TD>
<TD ALIGN=right>600.000</TD>
<TD ALIGN=right>600.000</TD>
</TR>
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<TD></TD>
<TD>21</TD>
<TD COLSPAN=2>001043</TD>

<TD>PA 8</TD>
<TD ALIGN=right COLSPAN=2>650.000</TD>

<TD ALIGN=right>650.000</TD>
<TD ALIGN=right>650.000</TD>
<TD ALIGN=right>650.000</TD>
<TD ALIGN=right COLSPAN=2>650.000</TD>

<TD ALIGN=right>650.000</TD>
<TD ALIGN=right>650.000</TD>
</TR>
<TR>
<TD></TD>
<TD>22</TD>
<TD COLSPAN=2>000884</TD>

<TD>PENGISIAN BERKAS ASURANSI</TD>


<TD ALIGN=right COLSPAN=2>50.000</TD>

<TD ALIGN=right>50.000</TD>
<TD ALIGN=right>50.000</TD>
<TD ALIGN=right>50.000</TD>
<TD ALIGN=right COLSPAN=2>50.000</TD>

<TD ALIGN=right>50.000</TD>
<TD ALIGN=right>50.000</TD>
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<TD></TD>
<TD>23</TD>
<TD COLSPAN=2>000883</TD>

<TD>PENGISIAN VISUM</TD>
<TD ALIGN=right COLSPAN=2>50.000</TD>

<TD ALIGN=right>50.000</TD>
<TD ALIGN=right>50.000</TD>
<TD ALIGN=right>50.000</TD>
<TD ALIGN=right COLSPAN=2>50.000</TD>

<TD ALIGN=right>50.000</TD>
<TD ALIGN=right>50.000</TD>
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<TD></TD>
<TD>24</TD>
<TD COLSPAN=2>000226</TD>

<TD>PUNGSI PLEURA</TD>
<TD ALIGN=right COLSPAN=2>310.000</TD>
<TD ALIGN=right>310.000</TD>
<TD ALIGN=right>542.000</TD>
<TD ALIGN=right>484.000</TD>
<TD ALIGN=right COLSPAN=2>440.000</TD>

<TD ALIGN=right>400.000</TD>
<TD ALIGN=right>400.000</TD>
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<TD></TD>
<TD>25</TD>
<TD COLSPAN=2>000048</TD>

<TD>SPIROMETRI </TD>
<TD ALIGN=right COLSPAN=2>120.000</TD>

<TD ALIGN=right>120.000</TD>
<TD ALIGN=right>162.500</TD>
<TD ALIGN=right>145.200</TD>
<TD ALIGN=right COLSPAN=2>132.000</TD>

<TD ALIGN=right>120.000</TD>
<TD ALIGN=right>120.000</TD>
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<TD></TD>
<TD>26</TD>
<TD COLSPAN=2>000978</TD>

<TD>SPIROMETRI JASA BACA</TD>


<TD ALIGN=right COLSPAN=2>80.000</TD>

<TD ALIGN=right>80.000</TD>
<TD ALIGN=right>80.000</TD>
<TD ALIGN=right>80.000</TD>
<TD ALIGN=right COLSPAN=2>80.000</TD>

<TD ALIGN=right>80.000</TD>
<TD ALIGN=right>80.000</TD>
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<TR>
<TD></TD>
<TD>27</TD>
<TD COLSPAN=2>000215</TD>

<TD>UP HECHTING</TD>
<TD ALIGN=right COLSPAN=2>60.000</TD>

<TD ALIGN=right>60.000</TD>
<TD ALIGN=right>60.000</TD>
<TD ALIGN=right>60.000</TD>
<TD ALIGN=right COLSPAN=2>60.000</TD>

<TD ALIGN=right>60.000</TD>
<TD ALIGN=right>60.000</TD>
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