JENIS

JENIS LAYANAN Jumlah dan

BHP Jumlah dan satuan Harga LAYANAN BHP Harga
LUKA satuan
LUKA
Kontrol
Luka Kecil Kasa Steril kecil 1 Rp 5,000 Kasa Steril Besar 1 Rp 10,000
luka/jahitan
Betadine 5 ml Rp 1,500 Betadine 10 ml Rp 3,000
NS 0,9% 50 ml Rp 10,000 Hipafik 5x5 cm Rp 3,000
Hipafik 5x5cm Rp 2,000 Lumatul 5x5 cm Rp 10,000

Handscoon 1 pasang Rp 1,500 Handscoon 1 pasang Rp 1,500

Total Rp 20,000 Total Rp 27,500
Jahit Luka
Luka Sedang Kasa Steril Besar 1 Rp 10,000 Infus NACL 100 ml Rp 18,000
A,B
Betadine 10 ml Rp 3,000 Spuit 3cc Rp 15,000
NS 0,9% 100 ml Rp 18,000 Kasa Rp 5,000
Benang jahit silk
Hipafik 5x5 cm Rp 2,500 Rp 5,000
3/0 dengan jarum
Handscoon 1 pasang Rp 1,500 Lidocain/pehacain Rp 2,000
Total Rp 35,000 Total Rp 45,000
Luka Berat Kasa Steril Besar 2 Rp 20,000 Jahit Luka C Infus NACL 250 ml Rp 22,000
Betadine 10 ml Rp 3,000 Spuit 3cc Rp 15,000
NS 0,9% 250 ml Rp 22,000 Kasa Rp 5,000
Benang jahit silk
Hipafik 10x10 cm Rp 5,000 Rp 5,000
3/0 dengan jarum
Lumatul 5x5 cm Rp 10,000 Lidocain/pehacain Rp 2,000
Handscoon 1 pasang Rp 2,000 Total Rp 49,000
Total Rp 62,000 Lepas Jahitan Betadine 10 ml Rp 3,000
Kasa Rp 5,000
Gentamicin cr Rp 3,000
Handscoon 1 pasang Rp 1,500
Total Rp 12,500
LAYANAN RAWAT LUKA

Presentase Jasa NAKES (40%)

No.JENIS PELAYANAN BHP TARIF KLINIK JASA klinik (60%) NAKES (40%) dokter (100%)dokter (30%) perawat (70%)

1 Luka Kecil Rp 20,000 Rp 60,000 Rp 40,000 Rp 24,000 Rp 16,000 Rp 16,000 Rp 4,800 Rp 11,200
2 Luka Sedang A Rp 35,000 Rp 85,000 Rp 50,000 Rp 30,000 Rp 20,000 Rp 20,000 Rp 6,000 Rp 14,000
3 Luka Sedang B Rp 62,000 Rp 112,000 Rp 50,000 Rp 30,000 Rp 20,000 Rp 20,000 Rp 6,000 Rp 14,000
4 Luka Besar A Rp 35,000 Rp 110,000 Rp 75,000 Rp 45,000 Rp 30,000 Rp 30,000 Rp 9,000 Rp 21,000
5 Luka Besar B Rp 62,000 Rp 137,000 Rp 75,000 Rp 45,000 Rp 30,000 Rp 30,000 Rp 9,000 Rp 21,000

6 Kontrol Luka/J Rp 27,500 Rp 57,500 Rp 30,000 Rp 18,000 Rp 12,000 Rp 12,000 Rp 3,600 Rp 8,400
7 Jahit Luka A Rp 45,000 Rp 105,000 Rp 60,000 Rp 36,000 Rp 24,000 Rp 24,000 Rp 7,200 Rp 16,800
8 Jahit Luka B Rp 45,000 Rp 115,000 Rp 70,000 Rp 42,000 Rp 28,000 Rp 28,000 Rp 8,400 Rp 19,600
9 Jahit Luka C Rp 49,000 Rp 139,000 Rp 90,000 Rp 54,000 Rp 36,000 Rp 36,000 Rp 10,800 Rp 25,200
10 Lepas Jahitan Rp 12,500 Rp 42,500 Rp 30,000 Rp 18,000 Rp 12,000 Rp 12,000 Rp 3,600 Rp 8,400
11 Lepas Jahitan Rp 12,500 Rp 57,500 Rp 45,000 Rp 27,000 Rp 18,000 Rp 18,000 Rp 5,400 Rp 12,600
 LAYANAN SYMPTOMATIC RELIEVER

No. DRIP INJEKSI UAP (Nebulizer)

BHP Harga BHP Harga BHP Harga
1 Spuit (3 cc, 5 cc) Rp 10,000 Spuit (3 cc, 5 cc) Rp 10,000 Infus Nacl 100cc Rp 15,000
2 Alcohol swab Rp 1,000 Alcohol swab Rp 1,000 Spuit 10 cc Rp 15,000
3 Infus Nacl 100cc Rp 15,000 Plesterin Rp 1,000 Micromize dewasa* Rp 55,000
4 Infus set Rp 8,000 Handscoon Rp 1,500 Micromize anak* Rp 32,000
5 IV Line Rp 15,000 *Wing needle 25 Rp 10,000 Handscoon Rp 1,500
6 Hipafik (10x10 cm) Rp 5,000
7 Plesterin Rp 1,000
8 Handscoon Rp 1,500
TOTAL Rp 56,500 TOTAL: TOTAL:
Dengan WN25 (A) Rp 23,500 DEWASA Rp 86,500
TANPA WN25 (B) Rp 13,500 ANAK Rp 63,500

ALAT
Nebulizer Rp 510,000
jumlah pemakaian 25
Rp 20,400
20000
 KODE : B

JASA DI TARIF
No. CARA PEMBERIAN BHP ALAT JASA HC TARIF HC
KLINIK KLINIK

1 DRIP Rp 56,500 Rp 50,000 Rp 106,500 Rp 75,000 Rp 131,500

2 INJEKSI A Rp 13,500 Rp 25,000 Rp 38,500 Rp 50,000 Rp 63,500
3 INJEKSI B Rp 23,500 Rp 25,000 Rp 48,500 Rp 50,000 Rp 73,500
4 UAP DEWASA Rp 86,500 Rp 20,000 Rp 25,000 Rp 131,500 Rp 75,000 Rp 181,500
5 UAP ANAK Rp 63,500 Rp 20,000 Rp 25,000 Rp 108,500 Rp 75,000 Rp 158,500

KODE: C DAFTAR OBAT

TARIF OBAT PROFIT
No. Reliever Jumlah Harga
RELIEVER OBAT
a Metoclopramide ampul 1 Rp 15,000 Rp 20,000 Rp 5,000
b Ondansetron 4 mg amp 1 Rp 7,500 Rp 12,500 Rp 5,000
c Ranitidin ampul 1 Rp 10,000 Rp 15,000 Rp 5,000
d Ketorolac ampul 1 Rp 22,000 Rp 25,000 Rp 3,000
e Antrain ampul 1 Rp 15,000 Rp 20,000 Rp 5,000
f Parasetamol Infus 1 Rp 30,000 Rp 35,000 Rp 5,000
g Ventolin respule 5 Rp 60,000 1 Rp 15,000 Rp 20,000 Rp 5,000
h Bisolvon solution 50 ml Rp 100,000 5 ml Rp 10,000 Rp 15,000 Rp 5,000
i Neurobion 1 Rp 15,000 Rp 20,000 Rp 5,000

PRESENTASE FEE NAKES (40%)

TARIF JASA KLINIK 60% NAKES 40% DOKTER AJA DOKTER PERAWAT
JASA DI KLINIK Rp 25,000 Rp 15,000 Rp 10,000 Rp 10,000 Rp 3,000 Rp 7,000
JASA DI KLINIK Rp 50,000 Rp 30,000 Rp 20,000 Rp 20,000 Rp 6,000 Rp 14,000
JASA HC Rp 50,000 Rp 30,000 Rp 20,000 Rp 20,000 Rp 6,000 Rp 14,000
JASA HC Rp 75,000 Rp 45,000 Rp 30,000 Rp 30,000 Rp 9,000 Rp 21,000
 LAYANAN VITAMIN BOOSTER

Vitamin C +
No. Bahan Habis Pakai Jumlah Neurobion Cernevit
Collagen
1 Infus Nacl 100 cc 1 Rp 15,000 15,000 15,000
2 IV Line 22G 3 Rp 15,000 Rp 15,000 Rp 15,000
3 Infus set dewasa 1 Rp 8,000 8,000 8,000
4 Alcohol swab 1 Rp 1,000 1,000 1,000
5 Plesterin 1 Rp 1,000 Rp 1,000 Rp 1,000
6 Hipafik (10x10 cm) 1 Rp 5,000 Rp 5,000 Rp 5,000
8 Spuit (3cc,5 cc) 2 Rp 10,000 Rp 10,000 Rp 10,000
Vitamin/obat
9 1 30,000 20,000 270,000
(ampul/vial)
10 Handschoon (Pasang) 1 Rp 1,500 1,500 1,500
TOTAL 86,500 76,500 326,500

KODE: D
No. Vitamin Booster BHP JASA DI KLINIK TARIF DI KLINIK JASA HC TARIF HC
1 Vit C + Kolagen Rp 86,500 Rp 50,000 Rp 136,500 Rp 75,000 Rp 161,500
2 Neurobion Rp 76,500 Rp 50,000 Rp 126,500 Rp 75,000 Rp 151,500
3 Cernevit Rp326,500 Rp 50,000 Rp 376,500 Rp 75,000 Rp 401,500

Persentase Fee
PRESENTASE FEE NAKES
TARIF JASA KLINIK 60%NAKES 40% DOKTER AJA DOKTER PERAWAT
Jasa di Klinik Rp 50,000 Rp30,000 Rp 20,000 Rp 20,000 Rp 6,000 Rp 14,000
Jasa HC Rp 75,000 Rp45,000 Rp 30,000 Rp 30,000 Rp 9,000 Rp 21,000
 LAYANAN REHIDRASI PARENTERAL (INFUS CAIRAN TUBUH)

No. Bahan Habis Pakai Jumlah Cairan NaCl 0,9% Cairan RL

1 Cairan (500 cc) 1 25,000 20,000

2 IV Line 22 G 3 15000 15,000
3 Infus set dewasa 1 8,000 8,000
4 Alcohol swab 1 1,000 1,000
5 Hipafik (10x10 cm) 1 5,000 5,000
6 Plesterin 1 1000 500
7 Handschoon 1 pasang 1,500 1,500
TOTAL 56,500 51,000

KODE: E

No. Layanan BHP Jasa di Klinik Tarif Klinik Jasa HC Tarif HC

1 Cairan NaCl 0,9% Rp 56,500 Rp 50,000 Rp 106,500 Rp 75,000 Rp 131,500

2 Cairan RL Rp 51,000 Rp 50,000 Rp 101,000 Rp 75,000 Rp 126,000

Persentase Fee
PRESENTASE FEE NAKES

TARIF JASA KLINIK 60% NAKES 40% DOKTER AJA DOKTER PERAWAT

Jasa di Klinik Rp 50,000 Rp 30,000 Rp 20,000 Rp 20,000 Rp 6,000 Rp 14,000

Jasa HC Rp 75,000 Rp 45,000 Rp 30,000 Rp 30,000 Rp 9,000 Rp 21,000
 LAYANAN KATETER

PASANG KATETER LEPAS KATETER

No. BHP Harga BHP Harga
1 Infus NACL 100 Rp 15,000 Spuit 10cc Rp 10,000
2 Spuit 10cc Rp 10,000 Handscoon Rp 2,000
3 Kateter Urin Rp 12,000
4 Urin Bag Rp 5,000
5 Gel Rp 5,000
6 Handscoon Rp 2,000
7 Plester Rp 1,000
TOTAL Rp 50,000 TOTAL Rp 12,000

KODE: F
No. Layanan BHP Jasa di Klinik Tarif Klinik Jasa HC Tarif HC
1 Pasang Kateter Rp 50,000 Rp 50,000 Rp 100,000 Rp 75,000 Rp 125,000
2 Lepas kateter Rp 12,000 Rp 50,000 Rp 62,000 Rp 75,000 Rp 87,000

Persentase Fee
PRESENTASE FEE NAKES
TARIF JASA KLINIK 60% NAKES 40% DOKTER AJA DOKTER PERAWAT
Jasa di Kl Rp 50,000 Rp 30,000 Rp 20,000 Rp 20,000 Rp 6,000 Rp 14,000
Jasa HC Rp 75,000 Rp 45,000 Rp 30,000 Rp 30,000 Rp 9,000 Rp 21,000
 LAYANAN NGT

PASANG NGT LEPAS KATETER

No. BHP Harga BHP Harga
1 NGT Rp 20,000 Handscoon Rp 2,000
2 Spuit 50cc Rp 15,000
3 Gel Rp 5,000
6 Handscoon Rp 2,000
7 Plester Rp 1,000
TOTAL Rp 43,000 TOTAL Rp 2,000

KODE: G
No. Layanan BHP Jasa di Klinik Tarif Klinik Jasa HC Tarif HC
1 Pasang Kateter Rp 43,000 Rp 50,000 Rp 93,000 Rp 75,000 Rp 118,000
2 Lepas kateter Rp 2,000 Rp 50,000 Rp 52,000 Rp 75,000 Rp 77,000

Persentase Fee
PRESENTASE FEE NAKES
TARIF JASA KLINIK 60% NAKES 40% DOKTER AJA DOKTER PERAWAT
Jasa di Kl Rp 50,000 Rp 30,000 Rp 20,000 Rp 20,000 Rp 6,000 Rp 14,000
Jasa HC Rp 75,000 Rp 45,000 Rp 30,000 Rp 30,000 Rp 9,000 Rp 21,000
 LAYANAN TAMBAHAN

No. Layanan BHP Harga KET

Nacl 500 ml Rp 25,000
spuit 3 cc Rp 5,000
Dengan Obat
1. handscoon Rp 1,500
obat* KODE C
Ganti Infus
Total Rp 31,500
Nacl 500 ml Rp 25,000
Tanpa Obat
2. handscoon Rp 1,500
Total Rp 26,500
handscoon Rp 1,500
spuit 3 cc Rp 5,000
3. INJ TAMBAHAN Total Rp 6,500

KODE: H
No. Layanan BHP Tambahan (T) Jasa Klinik (JK) Tarif Klinik Jasa HC (JHC) Tarif HC
1 Dengan Obat Rp 31,500 obat KODE C Rp 50,000 BHP+T+JK Rp 75,000 BHP+T+JHC
Ganti Infus
2 Tanpa Obat Rp 26,500 Rp 50,000 Rp 76,500 Rp 50,000 Rp 76,500

Persentase Fee
PRESENTASE FEE NAKES
TARIF JASA KLINIK 60% NAKES 40%DOKTER AJA DOKTER PERAWAT
Jasa di Kl Rp 50,000 Rp 30,000 Rp 20,000 Rp 20,000 Rp 6,000 Rp 14,000
Jasa HC Rp 75,000 Rp 45,000 Rp 30,000 Rp 30,000 Rp 9,000 Rp 21,000