RSUD KEBAYORAN BARU

Jln H Abdul Majid No. 28 Kec. Keb Baru, Jakarta Selatan, DKI Jakarta
(021) 22774429, E-mail : rsudkebayoranbaru@gmail.com

BILLING
Unit/Instansi  : IGD Non Covid
Jenis Bayar  : BPJS
Tanggal & Jam  : 18-10-2022 08:06:37
No RM  : 063190
Nama Pasien  : TARJO
Alamat  : JL. DAMAI II
dokter  : dr. Stefanus Ariyanto Wibowo
 : dr. Yoga Putra, Sp N
Data Perawatan
Registrasi Rp 40,000
Ruang
801 (Lavender 801) 1 100000 100000
Total Kamar Inap : 100,000
Rincian Biaya
1. Tindakan Rawat Inap
Visite dokter 1 40000 40000
Intensive Care 1 45000 45000
Pasang monitor EKG 1 150000 150000
Observasi > 2 jam 1 45000 45000
Total Tindakan Rawat Inap Kelas 3 : 280,000
2. Tindakan Rawat Jalan
- 1 0 0
EKG 1 50000 50000
Injeksi IV 1 20000 20000
O2 > 2 jam 1 30000 30000
Observasi < 8 jam 1 30000 30000
Pasang Infus 1 10000 10000
Pasang Kateter 1 25000 25000
Pasang monitor EKG 1 150000 150000
Pemasangan NGT 1 30000 30000
Syringe Pump 1 20000 20000
Total Tindakan Rawat Jalan : 365,000
3. Pemeriksaan Lab
Analisa Gas Darah (AGD) 1 120000 120000
Elektrolit (Na, K, Cl) 1 100000 100000
Glukosa Sewaktu 1 25000 25000
Hema Lengkap (Hema
1 50000 50000
I+hj+E+NER+LED)
Kreatinin 1 35000 35000
RT-PCR SARS Cov2 ( reguler ) 1 245000 245000
SARS CoV2 antigen (Rapid Test) 1 0 0
SGOT 1 30000 30000
SGPT 1 30000 30000
Ureum 1 35000 35000
Total Periksa Lab : 670,000
4. Tindakan Operasi
Total Tindakan Operasi : 0
5. Pemeriksaan Radiologi
Thorax PA / AP 1 100000 100000
Total Pemeriksaan Radiologi : 100,000
6. Pemulasaran Jenasah
Pemulasaran Jenazah 1 550000 550000
Kantong Jenazah 1 100000 100000
Plastik Erat 1 260000 260000
Disinfektan Jenazah 1 100000 100000
Total Pemulasaran Jenasah : 1,010,000
7. Obat & BMHP
NGT No. 16 1 15100 15100
Urine Bag 2 6900 13800
Handscoon Sterile No. 7.5 2 10200 20400
Catheter Tip 50 cc 1 14400 14400
IV Catheter No. 22 BD 1 17500 17500
Leukomed 6x8CM 1 4000 4000
Makro Set Otsu 1 10400 10400
Natrium Klorida 0,9% 500 ml 1 8200 8200
Omeprazol Injeksi 40 mg 1 6200 6200
Ondansentron 4 mg/2ml injeksi 2 1400 2800
Spuit 5 cc stera 2 800 1600
Nasal Canul Adult 1 8800 8800
 Guedel Orange no 110 MM 1 15100 15100
Foley Catheter 2 Way No. 16 1 14200 14200
Spuit 10 cc stera 1 1100 1100
Lubragel 12.5 gram 2 28700 57400
Nicardipine Hcl 10 mg 5 9500 47500
Needle No. 18 1 1300 1300
Three way Buntut 1 10200 10200
Perfusor Syringe White 50 CC 1 26700 26700
Perfusor Tubing White 150 cm 1 50000 50000
Natrium Klorida 0,9% 500 ml 1 8200 8200
Electroda adult 3 1700 5100
Parasetamol 1 gr/100ml infus 1 14600 14600
Masker NRM Dewasa 1 18000 18000
Simple Mask Dewasa 1 10000 10000
Parasetamol 1 gr/100ml infus 1 14600 14600
Nicardipine Hcl 10 mg 1 9500 9500
Spuit 10 cc stera 1 1100 1100
Nicardipine Hcl 10 mg 4 9500 38000
Spuit 10 cc stera 2 1100 2200
Fitomenadion (vitamin K 1) inj 2 mg/mL 15 1700 25500
Spuit 5 cc stera 3 800 2400
Nitrogliserin Injeksi 10 mg/10 mL 2 70000 140000
Perfusor Tubing White 150 cm 1 50000 50000
Perfusor Syringe White 50 CC 1 26700 26700
Three way Buntut 1 10200 10200
Nicardipine Hcl 10 mg 5 9500 47500
Spuit 10 cc stera 1 1100 1100
Spuit 5 cc stera 1 800 800
Manitol 250 ml 1 29500 29500
Omeprazol Injeksi 40 mg 2 6200 12400
Perfusor Syringe White 50 CC 1 26700 26700
Perfusor Tubing White 150 cm 1 50000 50000
Three way Buntut 1 10200 10200
IV Catheter 20 BD 1 17500 17500
IV Catheter No. 22 BD 1 17500 17500
Makro Set Otsu 1 10400 10400
Asam Traneksamat Injeksi 500mg/5mL 2 2500 5000
Spuit 5 cc stera 2 800 1600
Parasetamol 1 gr/100ml infus 2 14600 29200
Masker NRM Dewasa 1 18000 18000
Nicardipine Hcl 10 mg 4 9500 38000
Parasetamol 1 gr/100ml infus 2 14600 29200
Omeprazol Injeksi 40 mg 2 6200 12400
Asam Traneksamat Injeksi 500mg/5mL 6 2500 15000
Spuit 10 cc stera 3 1100 3300
Nitrogliserin Injeksi 10 mg/10 mL 5 70000 350000
Needle No. 18 1 1300 1300
Nicardipine Hcl 10 mg 5 9500 47500
Omeprazol Injeksi 40 mg 6 6200 37200
Parasetamol 1 gr/100ml infus 1 14600 14600
Spuit 10 cc stera 3 1100 3300
Spuit 3 cc stera 3 700 2100
Spuit 1 cc 3 800 2400
Spuit 3 cc stera 3 700 2100
Parasetamol 1 gr/100ml infus 1 14600 14600
Resfar injeksi 200 mg/ml 25 ml 1 220700 220700
Ceftriaxon 1 gram 4 3300 13200
Metronidazol lar inf 5 mg/mL 3 7500 22500
Resfar injeksi 200 mg/ml 25 ml 1 220700 220700
Bfluid infus 500 ml 1 92500 92500
Fitomenadion (vitamin K 1) inj 2 mg/mL 3 1700 5100
Spuit 10 cc stera 3 1100 3300
Fentanyl 0.05 mg/mL 2 mL 2 32700 65400
Lubragel 12.5 gram 1 28700 28700
Midazolam 5 mg/5 ml 1 5400 5400
Propofol inj 1 12000 12000
Spuit 10 cc stera 3 1100 3300
Spuit 3 cc stera 3 700 2100
Spuit 5 cc stera 3 800 2400
Breathing circuit heaterwire ADULT 1 500000 500000
Total Obat & BMHP : 2,770,500
Retur Obat & BMHP :
Nitrogliserin Injeksi 10 mg/10 mL 2 70000 140000
Fentanyl 0.05 mg/mL 2 mL 1 32700 32700
Fitomenadion (vitamin K 1) inj 2 mg/mL 6 1700 10200
Nicardipine Hcl 10 mg 3 9500 28500
 Asam Traneksamat Injeksi 500mg/5mL 1 2500 2500
Midazolam 5 mg/5 ml 1 5400 5400
Ceftriaxon 1 gram 2 3300 6600
Metronidazol lar inf 5 mg/mL 2 7500 15000
Parasetamol 1 gr/100ml infus 1 14600 14600
Resfar injeksi 200 mg/ml 25 ml 1 220700 220700
Perfusor Syringe White 50 CC 1 26700 26700
Spuit 5 cc stera 2 800 1600
Needle No. 18 1 1300 1300
Perfusor Tubing White 150 cm 1 50000 50000
Retur Obat & BMHP : - 555800
Total Obat Bersih Obat : 2,214,700

Resep Pulang  :
Tambahan Biaya  :
Potongan Biaya  :
Total Biaya  : 4,779,700
PPN  : 0
Tagihan + PPN  : 4,779,700
Deposit  : 0
Uang Muka  : 0
Sisa Piutang  : 4,779,700
Mengetahui, Jakarta, 18-10-2022
a/n Direktur Kasir
Kabid Umum & Keuangan

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