TARIF PELAYANAN

RS ANTAM POMALAA TAHUN 2023

UNIT GAWAT DARURAT / RAWAT INAP TARIF LAMA TARIF BARU

MAINTENENCE
NO TINDAKAN BHP JASA MEDIS TOTAL BHP
ALAT
1 Pemeriksaan / konsul dokter 22,000 22,000
2 Pasang Infus :
a Dewasa 11,000 33,000 44,000 5,500 Rp 33,825
b anak-anak (5-17 tahun) 11,000 33,000 44,000 5,500 Rp 33,825
c Bayi (<5 tahun) 11,000 33,000 44,000 5,500 Rp 35,516
3 Jahit Luka (Hecting):
a Luka 1 - 5 11,000 55,000 66,000 5,500 Rp 56,000
b Luka 6 - 10 16,500 93,500 110,000 5,500 Rp 77,000
c Luka 11 - 20 33,000 154,000 187,000 5,500 Rp 85,000
d Luka > 20 55,000 275,000 330,000 5,500 Rp 180,000
4 AF HT 1 - 5 5,500 22,000 27,500 5,500 Rp 15,000
5 AF HT 6 - 10 11,000 33,000 44,000 5,500 Rp 21,000
6 AF HT 11 - 20 16,500 33,000 49,500 5,500 Rp 29,000
7 AF HT > 20 16,500 44,000 60,500 5,500 Rp 20,000
8 Perawatan lukan tanpa jahitan ( kecil ) 11,000 44,000 55,000 5,500 Rp 25,000
9 Perawatan lukan tanpa jahitan ( sedang ) 11,000 44,000 55,000 5,500 Rp 30,000
10 Perawatan lukan tanpa jahitan ( besar ) 22,000 55,000 77,000 5,500 Rp 35,000
11 Perawatan luka bakar 5 % 11,000 27,500 38,500 5,500 Rp 23,000
12 Perawatan luka bakar 5 - 10 % 22,000 44,000 66,000 5,500 Rp 29,000
13 Perawatan luka bakar > 10 % 33,000 77,000 110,000 5,500 Rp 44,000
14 Perawatan luka kecil ( 1 x ganti verban ) 5,500 16,500 22,000 5,500 Rp 20,000
15 Perawatan luka sedang ( 1 x ganti verban ) 7,700 22,000 29,700 5,500 Rp 25,000
16 Perawatan luka besar ( 1 x ganti verban ) 22,000 33,000 55,000 5,500 Rp 29,000
17 Perawatan patah tulang tertutup 33,000 44,000 77,000 5,500 Rp 159,000
18 Perawatan patah tulang terbuka 27,500 110,000 137,500 5,500 Rp 214,000
19 Eksterpasi kecil 33,000 132,000 165,000 5,500 Rp 50,000
20 Eksterpasi sedang 55,000 220,000 275,000 5,500 Rp 65,000
21 Fungsi kandung kemih 16,500 93,500 110,000 5,500 Rp 33,815
22 Maag spuling 55,000 165,000 220,000 5,500 Rp 65,000
23 Corpus allenum 11,000 66,000 77,000 5,500 Rp 11,550
24 Kateterisasi/Aff Kateter 33,000 55,000 88,000 5,500 Rp 64,550
25 Oksigen ( O2 ) per jam 16,500 16,500 33,000 5,500 Rp 17,325
26 Observasi per jam 11,000 33,000 44,000 5,500 Rp 12,705
27 Nebulezer 33,000 49,500 82,500 5,500 Rp 97,880
28 Insisi drainage 27,500 55,000 82,500 5,500 Rp 28,875
29 Suntik 2,200 14,300 16,500 5,500 Rp 7,572
30 Pasang / buka gips 27,500 110,000 137,500 5,500 Rp 30,000
31 Circumsisi Manual 33,000 242,000 275,000 5,500 Rp 86,625
32 Circumsisi Laser 0 0 0 5,500 Rp 155,100
33 Rectal Toncher 11,000 33,000 44,000 5,500 Rp 11,550
34 Pemasangan maag slang 44,000 44,000 88,000 5,500 Rp 68,087
35 Spooling telinga 11,000 44,000 55,000 5,500 Rp 12,100
36 Putus tendon ( per 1 tendon ) 82,500 302,500 385,000 5,500 Rp 90,000
37 Amputasi ( per ruas ) 82,500 302,500 385,000 5,500 Rp 90,000
38 Patien monitor ( setiap jam ) 27,500 38,500 66,000 5,500 Rp 28,875
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

UNIT GAWAT DARURAT / RAWAT INAP TARIF LAMA TARIF BARU

MAINTENENCE
NO TINDAKAN BHP JASA MEDIS TOTAL BHP
ALAT
39 Suction 22,000 33,000 55,000 5,500 Rp 23,100
40 Layanan via telepon dokter ahli 5,500 27,500 33,000 5,500 Rp 5,500
41 RJP 0 5,500 Rp 23,100
42 Visum Et Repertum (include dengan surat) 5,500 Rp 12,100
43 Visum Et Repertum jenazah(include dengan surat) 5,500 Rp 34,650
44 Vaksin TT 5,500 Rp 19,060
45 Gelang identitas Pasien 5,500 Rp 2,000
46 Infuse Pump 5,500 Rp 25,000
47 Syringe Pump 5,500 Rp 25,000
48 Transfusi Darah 5,500 Rp 28,000
49 Aff Infus 5,500 Rp 32,000
50 Pemberian Obat Supposutoria 5,500 Rp 16,800
51 GDS 5,500 Rp 27,500
ANAN
TAHUN 2023
3,300.00 128%
TARIF BARU SELISIH / KENAIKAN TARIF PEMBANDING SELISIH DENGAN PEMB
Tarif RSBG
JASA MEDIS TOTAL RP % RP
Bahan/Alat Jasa Medis TOTAL
Rp 32,000 Rp 32,000 Rp 10,000 45% 42,000 33,000 75,000 -Rp 43,000
0
Rp 36,300 Rp 75,625 Rp 31,625 72% 28,000 22,000 50,000 Rp 25,625
Rp 42,350 Rp 81,675 Rp 37,675 86% 42,000 33,000 75,000 Rp 6,675
Rp 48,400 Rp 89,416 Rp 45,416 103% 56,000 44,000 100,000 -Rp 10,584
0
Rp 55,000 Rp 116,500 Rp 50,500 77% 61,600 48,400 110,000 Rp 6,500
Rp 93,500 Rp 176,000 Rp 66,000 60% 84,000 66,000 150,000 Rp 26,000
Rp 154,000 Rp 244,500 Rp 57,500 31% 106,400 83,600 190,000 Rp 54,500
Rp 275,000 Rp 460,500 Rp 130,500 40% 134,400 105,600 240,000 Rp 220,500
Rp 22,000 Rp 42,500 Rp 15,000 55% 0 Rp 42,500
Rp 33,000 Rp 59,500 Rp 15,500 35% 0 Rp 59,500
Rp 33,000 Rp 67,500 Rp 18,000 36% 0 Rp 67,500
Rp 44,000 Rp 69,500 Rp 9,000 15% 0 Rp 69,500
Rp 48,400 Rp 78,900 Rp 23,900 43% 33,600 26,400 60,000 Rp 18,900
Rp 60,500 Rp 96,000 Rp 41,000 75% 50,400 39,600 90,000 Rp 6,000
Rp 90,750 Rp 131,250 Rp 54,250 70% 61,600 48,400 110,000 Rp 21,250
Rp 30,250 Rp 58,750 Rp 20,250 53% 42,000 33,000 75,000 -Rp 16,250
Rp 48,400 Rp 82,900 Rp 16,900 26% 56,000 44,000 100,000 -Rp 17,100
Rp 96,800 Rp 146,300 Rp 36,300 33% 112,000 88,000 200,000 -Rp 53,700
Rp 18,150 Rp 43,650 Rp 21,650 98% 28,000 22,000 50,000 -Rp 6,350
Rp 30,250 Rp 60,750 Rp 31,050 105% 42,000 33,000 75,000 -Rp 14,250
Rp 48,400 Rp 82,900 Rp 27,900 51% 56,000 44,000 100,000 -Rp 17,100
Rp 48,400 Rp 212,900 Rp 135,900 176% 196,000 154,000 350,000 -Rp 137,100
Rp 121,000 Rp 340,500 Rp 203,000 148% 252,000 198,000 450,000 -Rp 109,500
Rp 132,000 Rp 187,500 Rp 22,500 14% 0 Rp 187,500
Rp 220,000 Rp 290,500 Rp 15,500 6% 0 Rp 290,500
Rp 93,500 Rp 132,815 Rp 22,815 21% 0 Rp 132,815
Rp 165,000 Rp 235,500 Rp 15,500 7% 168,000 132,000 300,000 -Rp 64,500
Rp 72,600 Rp 89,650 Rp 12,650 16% 0 Rp 89,650
Rp 60,500 Rp 130,550 Rp 42,550 48% 0 Rp 130,550
Rp 16,500 Rp 39,325 Rp 6,325 19% 11,200 8,800 20,000 Rp 19,325
Rp 36,300 Rp 54,505 Rp 10,505 24% 39,200 30,800 70,000 -Rp 15,495
Rp 49,500 Rp 152,880 Rp 70,380 85% 42,000 33,000 75,000 Rp 77,880
Rp 60,500 Rp 94,875 Rp 12,375 15% 84,000 66,000 150,000 -Rp 55,125
Rp 15,730 Rp 28,802 Rp 12,302 75% 14,000 11,000 25,000 Rp 3,802
Rp 110,000 Rp 145,500 Rp 8,000 6% 0 Rp 145,500
Rp 275,000 Rp 367,125 Rp 92,125 34% 0 Rp 367,125
Rp 361,900 Rp 522,500 Rp 522,500 100% 0 Rp 522,500
Rp 36,300 Rp 53,350 Rp 9,350 21% 33,600 26,400 60,000 -Rp 6,650
Rp 71,500 Rp 145,087 Rp 57,087 65% 56,000 44,000 100,000 Rp 45,087
Rp 48,400 Rp 66,000 Rp 11,000 20% 0 Rp 66,000
Rp 302,500 Rp 398,000 Rp 13,000 3% 0 Rp 398,000
Rp 302,500 Rp 398,000 Rp 13,000 3% 0 Rp 398,000
Rp 38,500 Rp 72,875 Rp 6,875 10% 0 Rp 72,875
ANAN
TAHUN 2023
3,300.00 128%
TARIF BARU SELISIH / KENAIKAN TARIF PEMBANDING SELISIH DENGAN PEMB
Tarif RSBG
JASA MEDIS TOTAL RP % RP
Bahan/Alat Jasa Medis TOTAL
Rp 36,300 Rp 64,900 Rp 9,900 18% 56,000 44,000 100,000 -Rp 35,100
Rp 38,500 Rp 49,500 Rp 16,500 50% 56,000 44,000 100,000 -Rp 50,500
Rp 60,500 Rp 89,100 Rp 89,100 100% 0 Rp 89,100
Rp 48,400 Rp 66,000 Rp 66,000 100% 0 Rp 66,000
Rp 145,200 Rp 185,350 Rp 185,350 100% 0 Rp 185,350
Rp 18,150 Rp 42,710 Rp 42,710 100% 0 Rp 42,710
Rp 5,000 Rp 12,500 Rp 12,500 100% 19,600 15,400 35,000 -Rp 22,500
Rp 60,000 Rp 90,500 Rp 90,500 100% Rp 90,500
Rp 60,000 Rp 90,500 Rp 90,500 100% Rp 90,500
Rp 22,000 Rp 55,500 Rp 55,500 100% Rp 55,500
Rp 20,000 Rp 57,500 Rp 57,500 100% Rp 57,500
Rp 13,200 Rp 35,500 Rp 35,500 100% Rp 35,500
Rp 16,500 Rp 49,500 Rp 49,500 100% Rp 49,500
SELISIH DENGAN PEMBANDING
%
-134%

34%
8%
-12%

6%
15%
22%
48%
100%
100%
100%
100%
24%
6%
16%
-28%
-21%
-37%
-15%
-23%
-21%
-64%
-32%
100%
100%
100%
-27%
100%
100%
49%
-28%
51%
-58%
13%
100%
100%
100%
-12%
31%
100%
100%
100%
100%
SELISIH DENGAN PEMBANDING
%
-54%
-102%
100%
100%
100%
100%
-180%
100%
100%
100%
100%
100%
100%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023
UNIT GAWAT DARURAT / RAWAT INAP
TARIF LAMA TARIF BARU
MAINTENENCE
NO TINDAKAN BHP JASA MEDIS TOTAL BHP
ALAT
1 Pemeriksaan / konsul dokter 22,000 22,000
2 Pasang Infus :
a Dewasa 11,000 33,000 44,000 10,000 35,000
b anak-anak (5-17 tahun) 11,000 33,000 44,000 10,000 35,000
c Bayi (<5 tahun) 11,000 33,000 44,000 10,000 35,000
3 Jahit Luka (Hecting):
a Luka 1 - 5 11,000 55,000 66,000 10,000 56,000
b Luka 6 - 10 16,500 93,500 110,000 10,000 77,000
c Luka 11 - 20 33,000 154,000 187,000 10,000 85,000
d Luka > 20 55,000 275,000 330,000 10,000 150,000
4 AF HT 1 - 5 5,500 22,000 27,500 10,000 15,000
5 AF HT 6 - 10 11,000 33,000 44,000 10,000 21,000
6 AF HT 11 - 20 16,500 33,000 49,500 10,000 29,000
7 AF HT > 20 16,500 44,000 60,500 10,000 20,000
8 Perawatan lukan tanpa jahitan ( kecil ) 11,000 44,000 55,000 10,000 25,000
9 Perawatan lukan tanpa jahitan ( sedang ) 11,000 44,000 55,000 10,000 30,000
10 Perawatan lukan tanpa jahitan ( besar ) 22,000 55,000 77,000 10,000 35,000
11 Perawatan luka bakar 5 % 11,000 27,500 38,500 10,000 30,000
12 Perawatan luka bakar 5 - 10 % 22,000 44,000 66,000 10,000 40,000
13 Perawatan luka bakar > 10 % 33,000 77,000 110,000 10,000 90,000
14 Perawatan luka kecil ( 1 x ganti verban ) 5,500 16,500 22,000 10,000 25,000
15 Perawatan luka sedang ( 1 x ganti verban ) 7,700 22,000 29,700 10,000 35,000
16 Perawatan luka besar ( 1 x ganti verban ) 22,000 33,000 55,000 10,000 50,000
17 Perawatan patah tulang tertutup 33,000 44,000 77,000 10,000 200,000
18 Perawatan patah tulang terbuka 27,500 110,000 137,500 10,000 250,000
19 Eksterpasi kecil 33,000 132,000 165,000 10,000 50,000
20 Eksterpasi sedang 55,000 220,000 275,000 10,000 65,000
21 Fungsi kandung kemih 16,500 93,500 110,000 10,000 35,000
22 Maag spuling 55,000 165,000 220,000 10,000 150,000
23 Corpus allenum 11,000 66,000 77,000 10,000 15,000
24 Kateterisasi/Aff Kateter 33,000 55,000 88,000 10,000 65,000
25 Oksigen ( O2 ) per jam 16,500 16,500 33,000 10,000 20,000
26 Observasi per jam 11,000 33,000 44,000 10,000 35,000
27 Nebulezer 33,000 49,500 82,500 10,000 20,000
28 Insisi drainage 27,500 55,000 82,500 10,000 100,000
29 Suntik 2,200 14,300 16,500 10,000 5,000
30 Pasang / buka gips 27,500 110,000 137,500 10,000 30,000
31 Circumsisi Manual 33,000 242,000 275,000 10,000 90,000
32 Circumsisi Laser - - - 10,000 160,000
33 Rectal Toncher 11,000 33,000 44,000 10,000 15,000
34 Pemasangan maag slang 44,000 44,000 88,000 10,000 70,000
35 Spooling telinga 11,000 44,000 55,000 10,000 15,000
36 Putus tendon ( per 1 tendon ) 82,500 302,500 385,000 10,000 90,000
37 Amputasi ( per ruas ) 82,500 302,500 385,000 10,000 90,000
38 Patien monitor ( setiap jam ) 27,500 38,500 66,000 10,000 30,000
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023
UNIT GAWAT DARURAT / RAWAT INAP
TARIF LAMA TARIF BARU
MAINTENENCE
NO TINDAKAN BHP JASA MEDIS TOTAL BHP
ALAT
39 Suction 22,000 33,000 55,000 10,000 60,000
40 Layanan via telepon dokter ahli 5,500 27,500 33,000 10,000 40,000
41 RJP - 10,000 25,000
42 Visum Et Repertum (include dengan surat) 10,000 15,000
43 Visum Et Repertum jenazah(include dengan surat) 10,000 35,000
44 Vaksin TT 10,000 20,000
45 Gelang identitas Pasien 10,000 25,000
46 Infuse Pump 10,000 25,000
47 Syringe Pump 10,000 25,000
48 Transfusi Darah 10,000 28,000
49 Aff Infus 10,000 32,000
50 Pemberian Obat Supposutoria 10,000 16,000
51 GDS 10,000 28,000
ANAN
TAHUN 2023

TARIF BARU SELISIH / KENAIKAN TARIF PEMBANDING SELISIH DENGAN PEMBA

Tarif RSBG
Pelayanan TOTAL RP % RP
Sarana Pelayanan TOTAL
75,000 75,000 53,000 241% 42,000 33,000 75,000 -
-
40,000 85,000 41,000 93% 28,000 22,000 50,000 35,000
45,000 90,000 46,000 105% 42,000 33,000 75,000 15,000
55,000 100,000 56,000 127% 56,000 44,000 100,000 -
-
60,000 126,000 60,000 91% 61,600 48,400 110,000 16,000
93,500 180,500 70,500 64% 84,000 66,000 150,000 30,500
154,000 249,000 62,000 33% 106,400 83,600 190,000 59,000
275,000 435,000 105,000 32% 134,400 105,600 240,000 195,000
22,000 47,000 19,500 71% - 47,000
33,000 64,000 20,000 45% - 64,000
33,000 72,000 22,500 45% - 72,000
44,000 74,000 13,500 22% - 74,000
50,000 85,000 30,000 55% 33,600 26,400 60,000 25,000
60,000 100,000 45,000 82% 50,400 39,600 90,000 10,000
70,000 115,000 38,000 49% 61,600 48,400 110,000 5,000
35,000 75,000 36,500 95% 42,000 33,000 75,000 -
50,000 100,000 34,000 52% 56,000 44,000 100,000 -
100,000 200,000 90,000 82% 112,000 88,000 200,000 -
25,000 60,000 38,000 173% 28,000 22,000 50,000 10,000
35,000 80,000 50,300 169% 42,000 33,000 75,000 5,000
45,000 105,000 50,000 91% 56,000 44,000 100,000 5,000
150,000 360,000 283,000 368% 196,000 154,000 350,000 10,000
200,000 460,000 322,500 235% 252,000 198,000 450,000 10,000
132,000 192,000 27,000 16% - 192,000
220,000 295,000 20,000 7% - 295,000
93,500 140,000 30,000 27% - 140,000
175,000 335,000 115,000 52% 168,000 132,000 300,000 35,000
75,000 100,000 23,000 30% - 100,000
60,000 135,000 47,000 53% - 135,000
20,000 50,000 17,000 52% 11,200 8,800 20,000 30,000
35,000 80,000 36,000 82% 39,200 30,800 70,000 10,000
55,000 85,000 2,500 3% 42,000 33,000 75,000 10,000
60,000 170,000 87,500 106% 84,000 66,000 150,000 20,000
15,000 30,000 13,500 82% 14,000 11,000 25,000 5,000
110,000 150,000 12,500 9% - 150,000
275,000 375,000 100,000 36% - 375,000
360,000 530,000 530,000 100% - 530,000
36,300 61,300 17,300 39% 33,600 26,400 60,000 1,300
50,000 130,000 42,000 48% 56,000 44,000 100,000 30,000
50,000 75,000 20,000 36% - 75,000
305,000 405,000 20,000 5% - 405,000
305,000 405,000 20,000 5% - 405,000
40,000 80,000 14,000 21% - 80,000
ANAN
TAHUN 2023

TARIF BARU SELISIH / KENAIKAN TARIF PEMBANDING SELISIH DENGAN PEMBA

Tarif RSBG
Pelayanan TOTAL RP % RP
Sarana Pelayanan TOTAL
40,000 110,000 55,000 100% 56,000 44,000 100,000 10,000
50,000 100,000 67,000 203% 56,000 44,000 100,000 -
60,000 95,000 95,000 100% - 95,000
50,000 75,000 75,000 100% - 75,000
145,000 190,000 190,000 100% - 190,000
20,000 50,000 50,000 100% - 50,000
- 35,000 35,000 100% 19,600 15,400 35,000 -
60,000 95,000 95,000 100% 95,000
60,000 95,000 95,000 100% 95,000
22,000 60,000 60,000 100% 60,000
20,000 62,000 62,000 100% 62,000
14,000 40,000 40,000 100% 40,000
17,000 55,000 55,000 100% 55,000
ISIH DENGAN PEMBANDING
%
0%

41%
17%
0%

13%
17%
24%
45%
100%
100%
100%
100%
29%
10%
4%
0%
0%
0%
17%
6%
5%
3%
2%
100%
100%
100%
10%
100%
100%
60%
13%
12%
12%
17%
100%
100%
100%
2%
23%
100%
100%
100%
100%
ISIH DENGAN PEMBANDING
%
9%
0%
100%
100%
100%
100%
0%
100%
100%
100%
100%
100%
100%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

POLI GIGI TARIF LAMA

Maint.
No Jenis Tindakan
Bahan/Alat Jasa Medis TOTAL Alat
1 Cabut gigi susu 16,500 27,500 44,000 Rp 5,500
2 Cabut gigi permanen 22,000 60,500 82,500 Rp 5,500
3 Tambal sementara 22,000 49,500 71,500 Rp 5,500
4 Tumpatan tetap composit 33,000 55,000 88,000 Rp 5,500
5 Insisi abses intra oral 16,500 27,500 44,000 Rp 5,500
6 Buka jahitan 11,000 22,000 33,000 Rp 5,500
7 Pembersihan karang gigi per rahang 27,500 104,500 132,000 Rp 5,500
8 Odontektomy 55,000 220,000 275,000 Rp 5,500
9 Pencabutan gigi dengan komplikasi 55,000 110,000 165,000 Rp 5,500
10 Insisi abses extra oral 1 kali tindakan 44,000 88,000 132,000 Rp 5,500
11 Alveotectomy per regio 55,000 143,000 198,000 Rp 5,500
12 Reparasi gigi palsu tanpa cetak 99,000 121,000 220,000 Rp 5,500
 TARIF BARU SELISIH KENAIKAN TARIF PEMBANDING
TARIF
BHP Jasa Medis TOTAL RP %
Klinik Alodia

Rp 39,853 Rp 27,500 Rp 72,853 Rp 28,853 66% 100,000

Rp 91,753 Rp 60,500 Rp 157,753 Rp 75,253 91% 250,000
Rp 26,353 Rp 49,500 Rp 81,353 Rp 9,853 14% 50,000
Rp 89,583 Rp 110,000 Rp 205,083 Rp 117,083 133% 250,000
Rp 23,800 Rp 27,500 Rp 56,800 Rp 12,800 29% 100,000
Rp 33,000 Rp 22,000 Rp 60,500 Rp 27,500 83% 50,000
Rp 53,500 Rp 104,500 Rp 163,500 Rp 31,500 24% 300,000
Rp 598,000 Rp 220,000 Rp 823,500 Rp 548,500 199% 2,500,000
Rp 149,200 Rp 110,000 Rp 264,700 Rp 99,700 60% 400,000
Rp 56,800 Rp 88,000 Rp 150,300 Rp 18,300 14%
Rp 70,000 Rp 143,000 Rp 218,500 Rp 20,500 10% 750,000
Rp 122,000 Rp 121,000 Rp 248,500 Rp 28,500 13% 0
SELISIH DENGAN PEMBANDING

RP %

-27,147 -37%
-92,247 -58%
31,353 39%
-44,917 -22%
-43,200 -76%
10,500 17%
-136,500 -83%
-1,676,500 -204%
-135,300 -51%
150,300 100%
-531,500 -243%
248,500 100%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023
POLI GIGI
TARIF LAMA
Maint.
No Jenis Tindakan Bahan/Alat Jasa Medis TOTAL
Alat
1 Cabut gigi susu 16,500 27,500 44,000 10,000
2 Cabut gigi permanen 22,000 60,500 82,500 10,000
3 Tambal sementara 22,000 49,500 71,500 10,000
4 Tumpatan tetap composit 33,000 55,000 88,000 10,000
5 Insisi abses intra oral 16,500 27,500 44,000 10,000
6 Buka jahitan 11,000 22,000 33,000 10,000
7 Pembersihan karang gigi per rahang 27,500 104,500 132,000 10,000
8 Odontektomy 0 0 0 -
9 Pencabutan gigi dengan komplikasi 55,000 110,000 165,000 10,000
10 Insisi abses extra oral 1 kali tindakan 44,000 88,000 132,000 10,000
11 Alveotectomy per regio 55,000 143,000 198,000 10,000
12 Reparasi gigi palsu tanpa cetak 99,000 121,000 220,000 10,000
 TARIF BARU SELISIH KENAIKAN TARIF PEMBANDING
Tarif RSBG
BHP Pelayanan TOTAL RP %
Bahan/Alat Jasa Medis
25,000 30,000 65,000 21,000 48% 22,400 17,600
30,000 65,000 105,000 22,500 27% 56,000 44,000
25,000 50,000 85,000 13,500 19% 22,400 17,600
110,000 130,000 250,000 162,000 184% 140,000 110,000
25,000 30,000 65,000 21,000 48% 30,800 24,200
33,000 25,000 68,000 35,000 106% 0 0
30,000 120,000 160,000 28,000 21% 67,200 52,800
- - - - 0% 0 0
70,000 120,000 200,000 35,000 21% 84,000 66,000
56,800 88,000 154,800 22,800 17% 56,000 44,000
60,000 143,000 213,000 15,000 8% 84,000 66,000
122,000 121,000 253,000 33,000 15% 0 0
EMBANDING
Selilsih dengan pembanding
rif RSBG
TOTAL Rp %
40,000 25,000 63%
100,000 5,000 5%
40,000 45,000 113%
250,000 - 0%
55,000 10,000 18%
0 68,000 100%
120,000 40,000 33%
0 - 0%
150,000 50,000 33%
100,000 54,800 55%
150,000 63,000 42%
0 253,000 100%
 TARIF
RS ANTAM PO

RADIOLOGI TARIF LAMA TARIF

No Jenis Tindakan / Foto Total
Maint. Alat Film + ATK Jasa Medis Main. Alat
1 Kepala :
a. Kepala AP/Lat 2 kali expose 1 Film 93,500 22,000 90,750 206,250 Rp 93,500
b. Kepala AP 1 kali expose 1 Film 46,750 22,000 60,500 129,250 Rp 46,750
c. Sinus PA 46,750 22,000 60,500 129,250 Rp 46,750
d. Gigi 16,500 16,500 44,000 77,000 Rp 16,500

2 Dada :
a. Thorax Dewasa PA ( 1 kali expose ) 44,000 22,000 60,500 126,500 Rp 44,000
b. Thorax Dewasa PA/Lat ( 2 kali expose ) 88,000 22,000 90,750 200,750 Rp 88,000
c. Thorax Anak-Anak AP ( 1 kali expose ) 41,250 22,000 60,500 123,750 Rp 41,250
d. Thorax Anak-Anak AP/Lat ( 2 kali expose ) 82,500 22,000 90,750 195,250 Rp 82,500

1 kali expose 1 Film 42,350 22,000 60,500 124,850 Rp 42,350

2 kali expose 1 Film 84,700 22,000 90,750 197,450 Rp 84,700
2 kali expose 2 Film 84,700 44,000 90,750 219,450 Rp 84,700

4 Vertebra :
a. Pelvis 1 kali expose 1 Film 46,750 22,000 60,500 129,250 Rp 46,750
b. Cervical, Throracal, Lumbal
- 2 kali expose 1 Film 93,500 22,000 90,750 206,250 Rp 93,500
- 2 kali expose 2 Film 93,500 44,000 90,750 228,250 Rp 93,500

5 Abdomen :
a. B N O
- 1 kali expose 1 Film 44,000 22,000 60,500 126,500 Rp 44,000
- 3 kali expose 3 Film ( 3 posisi ) 132,000 66,000 132,000 330,000 Rp 132,000
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

TARIF BARU SELISIH KENAIKAN TARIF PEMBANDING

Tarif RSBG
TOTAL Rp % Total
Film + Atk Jasa Medis Film + Atk Jasa Medis

Rp 55,000 Rp 96,250 Rp 244,750 Rp 38,500 19% 123,648 97,152 220,800

Rp 55,000 Rp 66,000 Rp 167,750 Rp 38,500 30%
Rp 55,000 Rp 66,000 Rp 167,750 Rp 38,500 30% 61,824 48,576 110,400
Rp 49,500 Rp 49,500 Rp 115,500 Rp 38,500 50% 50,400 39,600 90,000

Rp 55,000 Rp 66,000 Rp 165,000 Rp 38,500 30% 90,720 71,280 162,000

Rp 55,000 Rp 96,250 Rp 239,250 Rp 38,500 19%
Rp 55,000 Rp 66,000 Rp 162,250 Rp 38,500 31%
Rp 55,000 Rp 96,250 Rp 233,750 Rp 38,500 20%

Rp 55,000 Rp 66,000 Rp 163,350 Rp 38,500 31%

Rp 55,000 Rp 96,250 Rp 235,950 Rp 38,500 19%
Rp 110,000 Rp 96,250 Rp 290,950 Rp 71,500 33%

Rp 55,000 Rp 66,000 Rp 167,750 Rp 38,500 30% 90,720 71,280 162,000

Rp 55,000 Rp 96,250 Rp 244,750 Rp 38,500 19% 181,440 142,560 324,000

Rp 110,000 Rp 96,250 Rp 299,750 Rp 71,500 31%

Rp 55,000 Rp 66,000 Rp 165,000 Rp 38,500 30% 90,720 71,280 162,000

Rp 165,000 Rp 137,500 Rp 434,500 Rp 104,500 32% 272,160 213,840 486,000
SELISIH TARIF PEMBANDING

RP %

Rp 23,950 10%
Rp 167,750 100%
Rp 57,350 34%
Rp 25,500 22%

Rp 3,000 2%
Rp 239,250 100%
Rp 162,250 100%
Rp 233,750 100%

Rp 163,350 100%
Rp 235,950 100%
Rp 290,950 100%

Rp 5,750 3%

-Rp 79,250 -32%

Rp 299,750 100%

Rp 3,000 2%
-Rp 51,500 -12%
 TARIF
RS ANTAM PO

RADIOLOGI TARIF LAMA TARIF

No Jenis Tindakan / Foto Total
Maint. Alat Film + ATK Jasa Medis Main. Alat
1 Kepala :
a. Kepala AP/Lat 2 kali expose 1 Film 93,500 22,000 90,750 206,250 Rp 95,000
b. Kepala AP 1 kali expose 1 Film 46,750 22,000 60,500 129,250 Rp 50,000
c. Sinus PA 46,750 22,000 60,500 129,250 Rp 50,000
d. Gigi 16,500 16,500 44,000 77,000 Rp 20,000

2 Dada :
a. Thorax Dewasa PA ( 1 kali expose ) 44,000 22,000 60,500 126,500 Rp 44,000
b. Thorax Dewasa PA/Lat ( 2 kali expose ) 88,000 22,000 90,750 200,750 Rp 88,000
c. Thorax Anak-Anak AP ( 1 kali expose ) 41,250 22,000 60,500 123,750 Rp 44,000
d. Thorax Anak-Anak AP/Lat ( 2 kali expose ) 82,500 22,000 90,750 195,250 Rp 88,000

1 kali expose 1 Film 42,350 22,000 60,500 124,850 Rp 44,000

2 kali expose 1 Film 84,700 22,000 90,750 197,450 Rp 88,000
2 kali expose 2 Film 84,700 44,000 90,750 219,450 Rp 88,000

4 Vertebra :
a. Pelvis 1 kali expose 1 Film 46,750 22,000 60,500 129,250 Rp 50,000
b. Cervical, Throracal, Lumbal
- 2 kali expose 1 Film 93,500 22,000 90,750 206,250 Rp 95,000
- 2 kali expose 2 Film 93,500 44,000 90,750 228,250 Rp 95,000

5 Abdomen :
a. B N O
- 1 kali expose 1 Film 44,000 22,000 60,500 126,500 Rp 44,000
- 3 kali expose 3 Film ( 3 posisi ) 132,000 66,000 132,000 330,000 Rp 132,000
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

TARIF BARU SELISIH KENAIKAN TARIF PEMBANDING

Tarif RSBG
TOTAL Rp % Total
Film + Atk Jasa Medis Film + Atk Jasa Medis

Rp 100,000 Rp 100,000 Rp 295,000 Rp 88,750 43% 123,648 97,152 220,800

Rp 100,000 Rp 100,000 Rp 250,000 Rp 120,750 93%
Rp 100,000 Rp 100,000 Rp 250,000 Rp 120,750 93% 61,824 48,576 110,400
Rp 100,000 Rp 100,000 Rp 220,000 Rp 143,000 186% 50,400 39,600 90,000

Rp 100,000 Rp 100,000 Rp 244,000 Rp 117,500 93% 90,720 71,280 162,000

Rp 100,000 Rp 200,000 Rp 388,000 Rp 187,250 93%
Rp 100,000 Rp 100,000 Rp 244,000 Rp 120,250 97%
Rp 100,000 Rp 200,000 Rp 388,000 Rp 192,750 99%

Rp 100,000 Rp 100,000 Rp 244,000 Rp 119,150 95%

Rp 100,000 Rp 200,000 Rp 388,000 Rp 190,550 97%
Rp 200,000 Rp 200,000 Rp 488,000 Rp 268,550 122%

Rp 100,000 Rp 100,000 Rp 250,000 Rp 120,750 93% 90,720 71,280 162,000

Rp 100,000 Rp 200,000 Rp 395,000 Rp 188,750 92% 181,440 142,560 324,000

Rp 200,000 Rp 200,000 Rp 495,000 Rp 266,750 117%

Rp 100,000 Rp 100,000 Rp 244,000 Rp 117,500 93% 90,720 71,280 162,000

Rp 300,000 Rp 100,000 Rp 532,000 Rp 202,000 61% 272,160 213,840 486,000
SELISIH TARIF PEMBANDING

RP %

Rp 74,200 25%
Rp 250,000 100%
Rp 139,600 56%
Rp 130,000 59%

Rp 82,000 34%
Rp 388,000 100%
Rp 244,000 100%
Rp 388,000 100%

Rp 244,000 100%
Rp 388,000 100%
Rp 488,000 100%

Rp 88,000 35%

Rp 71,000 18%
Rp 495,000 100%

Rp 82,000 34%
Rp 46,000 9%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023
RADIOLOGI
TARIF LAMA TARIF BARU

No Jenis Tindakan / Foto Maint. Alat Film + ATK Jasa Medis Total Main. Alat Film + Atk Jasa Medis
1 Kepala :
a. Kepala AP/Lat 2 kali expose 1 Film 93,500 22,000 90,750 206,250 95,000 100,000 96,250
b. Kepala AP 1 kali expose 1 Film 46,750 22,000 60,500 129,250 50,000 100,000 66,000
c. Sinus PA 46,750 22,000 60,500 129,250 50,000 100,000 66,000
d. Gigi 16,500 16,500 44,000 77,000 20,000 100,000 49,500

2 Dada :
a. Thorax Dewasa PA ( 1 kali expose ) 44,000 22,000 60,500 126,500 44,000 100,000 66,000
b. Thorax Dewasa PA/Lat ( 2 kali expose ) 88,000 22,000 90,750 200,750 88,000 100,000 96,250
c. Thorax Anak-Anak AP ( 1 kali expose ) 41,250 22,000 60,500 123,750 44,000 100,000 66,000
d. Thorax Anak-Anak AP/Lat ( 2 kali expose ) 82,500 22,000 90,750 195,250 88,000 100,000 96,250

1 kali expose 1 Film 42,350 22,000 60,500 124,850 44,000 100,000 66,000
2 kali expose 1 Film 84,700 22,000 90,750 197,450 88,000 100,000 96,250
2 kali expose 2 Film 84,700 44,000 90,750 219,450 88,000 200,000 96,250

4 Vertebra :
a. Pelvis 1 kali expose 1 Film 46,750 22,000 60,500 129,250 50,000 100,000 66,000
b. Cervical, Throracal, Lumbal
- 2 kali expose 1 Film 93,500 22,000 90,750 206,250 95,000 100,000 150,000
- 2 kali expose 2 Film 93,500 44,000 90,750 228,250 95,000 200,000 96,250

5 Abdomen :
a. B N O
- 1 kali expose 1 Film 44,000 22,000 60,500 126,500 44,000 100,000 66,000
- 3 kali expose 3 Film ( 3 posisi ) 132,000 66,000 132,000 330,000 132,000 300,000 137,500
ANAN
TAHUN 2023

U SELISIH KENAIKAN TARIF PEMBANDING SELISIH TARIF PEMBANDING

Tarif RSBG
TOTAL Rp % Total
Film + Atk Jasa Medis RP %

291,250 85,000 41% 123,648 97,152 220,800 70,450 24%

216,000 86,750 67% 216,000 100%
216,000 86,750 67% 61,824 48,576 110,400 105,600 49%
169,500 92,500 120% 50,400 39,600 90,000 79,500 47%

210,000 83,500 66% 90,720 71,280 162,000 48,000 23%

284,250 83,500 42% 284,250 100%
210,000 86,250 70% 210,000 100%
284,250 89,000 46% 284,250 100%

210,000 85,150 68% 210,000 100%

284,250 86,800 44% 284,250 100%
384,250 164,800 75% 384,250 100%

216,000 86,750 67% 90,720 71,280 162,000 54,000 25%

345,000 138,750 67% 181,440 142,560 324,000 21,000 6%

391,250 163,000 71% 391,250 100%

210,000 83,500 66% 90,720 71,280 162,000 48,000 23%

569,500 239,500 73% 272,160 213,840 486,000 83,500 15%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

PENUNJANG MEDIS

ULTRASONOGRAFY ( USG ) TARIF LAMA

No Jenis Tindakan TOTAL Maint. Alat
Maint. Alat Bahan/Alat Jasa Medis
1 Thyroid 104,500 16,500 99,000 220,000 Rp 88,000
2 Abdomen 104,500 16,500 99,000 220,000 Rp 88,000
3 Mammae 104,500 16,500 99,000 220,000 Rp 88,000
4 Transvaginal Rp 88,000
5
catatan : total biaya USG =biaya tindakan USG (Rp.338.000) + biaya konsul dokter (Rp.75.000)

ELECTRO CARDIOGRAFY ( ECG )

No Jenis Tindakan TOTAL Maint. Alat
Maint. Alat Bahan/Alat Jasa Medis
1 ECG Record 11,000 27,500 82,500 121,000 Rp 16,500
2 Tele ECG 11,000 137,500 82,500 231,000 Rp 16,500

jasa medis selain antam apakah ada sharing

2023

TARIF BARU SELISIH KENAIKAN TARIF PEMBANDING

Tarif RSBG
Bahan/Alat Jasa Medis TOTAL RP %
Bahan/Alat Jasa Medis
Rp 137,500 Rp 112,500 Rp 338,000 Rp 118,000 54% 168,000 132,000
Rp 137,500 Rp 112,500 Rp 338,000 Rp 118,000 54% 168,000 132,000
Rp 137,500 Rp 112,500 Rp 338,000 Rp 118,000 54% 168,000 132,000
Rp 137,500 Rp 112,500 Rp 338,000 Rp 338,000 100%

TARIF Tarif RSBG

Bahan/Alat Jasa Medis RP %
PELAYANAN Bahan/Alat Jasa Medis
Rp 33,000 Rp 82,500 Rp 132,000 Rp 11,000 9% 84,000 66,000
Rp 150,000 Rp 82,500 Rp 249,000 Rp 18,000 8%
IF PEMBANDING SELISIH TARIF PEMBANDING
TOTAL
RP %
TARIF RSBG
300,000 Rp 38,000 11%
300,000 Rp 38,000 11%
300,000 Rp 38,000 11%
Rp 338,000 100%

TOTAL
TARIF RSBG
150,000 -Rp 18,000 -14%
Rp 249,000 100%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

PENUNJANG MEDIS

ULTRASONOGRAFY ( USG ) TARIF LAMA

No Jenis Tindakan TOTAL Maint. Alat
Maint. Alat Bahan/Alat Jasa Medis
1 Thyroid 104,500 16,500 99,000 220,000 105,000
2 Abdomen 104,500 16,500 99,000 220,000 105,000
3 Mammae 104,500 16,500 99,000 220,000 105,000
4 Transvaginal 105,000
5
catatan : total biaya USG =biaya tindakan USG (Rp.338.000) + biaya konsul dokter (Rp.75.000)

ELECTRO CARDIOGRAFY ( ECG TARIF LAMA

No Jenis Tindakan Maint. Alat Bahan/Alat Jasa Medis TOTAL Maint. Alat

1 ECG Record 11,000 27,500 82,500 121,000 20,000

2 Tele ECG 11,000 137,500 82,500 231,000 20,000

jasa medis selain antam apakah ada sharing

2023

TARIF BARU SELISIH KENAIKAN TARIF PEMBANDING

Tarif RSBG
Bahan/Alat Jasa Medis TOTAL RP %
Bahan/Alat Jasa Medis
140,000 100,000 345,000 125,000 57% 168,000 132,000
140,000 100,000 345,000 125,000 57% 168,000 132,000
140,000 100,000 345,000 125,000 57% 168,000 132,000
140,000 100,000 345,000 345,000 100%

TARIF BARU SELISIH KENAIKAN TARIF PEMBANDING

TARIF Tarif RSBG
Bahan/Alat Jasa Medis RP %
PELAYANAN Bahan/Alat Jasa Medis
50,000 82,500 152,500 31,500 26% 84,000 66,000
150,000 82,500 252,500 21,500 9%
IF PEMBANDING SELISIH TARIF PEMBANDING
TOTAL
RP %
TARIF RSBG
300,000 45,000 13%
300,000 45,000 13%
300,000 45,000 13%
345,000 100%

IF PEMBANDING SELISIH TARIF PEMBANDING

TOTAL
RP %
TARIF RSBG
150,000 2,500 2%
252,500 100%
 TARIF PELAY
RS ANTAM POMALAA

FISIOTERAPI TARIF LAMA TARIF BA

No Jenis Tindakan TOTAL Maint. Alat BHP
Maint. Alat BHP Jasa Medis
1 Infra Red ( IRR ) 11,000 11,000 22,000 44,000 Rp 15,000 Rp 15,000
2 Short Wave Diathermi ( SWD ) 11,000 11,000 27,500 49,500 Rp 15,000 Rp 15,000
3 Ultra Sound Diathermi ( USD ) 11,000 11,000 27,500 49,500 Rp 15,000 Rp 15,000
4 Micro Wave Diathermi ( MWD ) 11,000 11,000 27,500 49,500 Rp 15,000 Rp 15,000
5 Traksi Lumbal 11,000 16,500 33,000 60,500 Rp 15,000 Rp 20,000
6 Traksi Cervical 11,000 16,500 33,000 60,500 Rp 15,000 Rp 20,000
7 Faradic / Galvanik 11,000 16,500 33,000 60,500 Rp 15,000 Rp 20,000
8 Interferential Therapi 11,000 16,500 33,000 60,500 Rp 15,000 Rp 20,000
9 Exercise Therapi 11,000 5,500 15,000 26,000 Rp 15,000 Rp 11,000
10 Static Bicycle 11,000 5,500 11,000 27,500 Rp 15,000 Rp 15,000
11 Paralel Bars 11,000 5,500 11,000 27,500 Rp 15,000 Rp 11,000
12 Kru Axilla 11,000 5,500 11,000 16,500 Rp 15,000 Rp 11,000
13 Tangga latihan Rp 15,000 Rp 11,000
14 Trampolin Rp 15,000 Rp 11,000
15 Walker Rp 15,000 Rp 11,000
16 Quadriceps Bands Rp 15,000 Rp 11,000
 TARIF PELAYANAN
TAM POMALAA TAHUN 2023

TARIF BARU SELISIH KENAIKAN TARIF PEMBANDING SELISIH TARIF PEMBANDING

TARIF Tarif RSBG TOTAL
Jasa Medis RP % RP %
PELAYANAN Bahan/Alat Jasa Medis TARIF RSBG
Rp 24,500 Rp 54,500 Rp 10,500 24% 42,000 33,000 75,000 -Rp 20,500 -38%
Rp 30,500 Rp 60,500 Rp 11,000 22% 42,000 33,000 75,000 -Rp 14,500 -24%
Rp 30,500 Rp 60,500 Rp 11,000 22% 42,000 33,000 75,000 -Rp 14,500 -24%
Rp 30,500 Rp 60,500 Rp 11,000 22% 42,000 33,000 75,000 -Rp 14,500 -24%
Rp 36,500 Rp 71,500 Rp 11,000 18% 50,400 39,600 90,000 -Rp 18,500 -26%
Rp 36,500 Rp 71,500 Rp 11,000 18% 50,400 39,600 90,000 -Rp 18,500 -26%
Rp 36,500 Rp 71,500 Rp 11,000 18% - Rp 71,500 100%
Rp 36,500 Rp 71,500 Rp 11,000 18% 50,400 39,600 90,000 -Rp 18,500 -26%
Rp 18,000 Rp 44,000 Rp 18,000 69% 28,000 22,000 50,000 -Rp 6,000 -14%
Rp 12,000 Rp 42,000 Rp 14,500 53% 14,000 11,000 25,000 Rp 17,000 40%
Rp 12,000 Rp 38,000 Rp 10,500 38% 14,000 11,000 25,000 Rp 13,000 34%
Rp 12,000 Rp 38,000 Rp 21,500 130% 14,000 11,000 25,000 Rp 13,000 34%
Rp 11,000 Rp 37,000 Rp 37,000 100% Rp 37,000 100%
Rp 11,000 Rp 37,000 Rp 37,000 100% Rp 37,000 100%
Rp 12,000 Rp 38,000 Rp 38,000 100% 14,000 11,000 25,000 Rp 13,000 34%
Rp 17,600 Rp 43,600 Rp 43,600 100% 22,400 17,600 40,000 Rp 3,600 8%
PEMBANDING
 TARIF PEL
RS ANTAM POMAL

FISIOTERAPI TARIF LAMA TARIF B

No Jenis Tindakan TOTAL Maint. Alat
Maint. Alat BHP Jasa Medis
1 Infra Red ( IRR ) 11,000 11,000 22,000 44,000 15,000
2 Short Wave Diathermi ( SWD ) 11,000 11,000 27,500 49,500 15,000
3 Ultra Sound Diathermi ( USD ) 11,000 11,000 27,500 49,500 15,000
4 Micro Wave Diathermi ( MWD ) 11,000 11,000 27,500 49,500 15,000
5 Traksi Lumbal 11,000 16,500 33,000 60,500 15,000
6 Traksi Cervical 11,000 16,500 33,000 60,500 15,000
7 Faradic / Galvanik 11,000 16,500 33,000 60,500 15,000
8 Interferential Therapi 11,000 16,500 33,000 60,500 15,000
9 Exercise Therapi 11,000 5,500 15,000 26,000 15,000
10 Static Bicycle 11,000 5,500 11,000 27,500 15,000
11 Paralel Bars 11,000 5,500 11,000 27,500 15,000
12 Kru Axilla 11,000 5,500 11,000 16,500 15,000
13 Tangga latihan 15,000
14 Trampolin 15,000
15 Walker 15,000
16 Quadriceps Bands 15,000
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

TARIF BARU SELISIH KENAIKAN TARIF PEMBANDING

TARIF Tarif RSBG
BHP Jasa Medis RP %
PELAYANAN Sarana Pelayanan TOTAL
25,000 35,000 75,000 31,000 70% 42,000 33,000 75,000
25,000 35,000 75,000 25,500 52% 42,000 33,000 75,000
25,000 35,000 75,000 25,500 52% 42,000 33,000 75,000
25,000 35,000 75,000 25,500 52% 42,000 33,000 75,000
40,000 35,000 90,000 29,500 49% 50,400 39,600 90,000
40,000 35,000 90,000 29,500 49% 50,400 39,600 90,000
20,000 36,500 71,500 11,000 18% -
40,000 35,000 90,000 29,500 49% 50,400 39,600 90,000
15,000 20,000 50,000 24,000 92% 28,000 22,000 50,000
15,000 12,000 42,000 14,500 53% 14,000 11,000 25,000
11,000 12,000 38,000 10,500 38% 14,000 11,000 25,000
11,000 12,000 38,000 21,500 130% 14,000 11,000 25,000
11,000 11,000 37,000 37,000 100%
11,000 11,000 37,000 37,000 100%
11,000 12,000 38,000 38,000 100% 14,000 11,000 25,000
11,000 17,600 43,600 43,600 100% 22,400 17,600 40,000
SELISIH TARIF PEMBANDING
RP %

Rp - 0%
Rp - 0%
Rp - 0%
- 0%
- 0%
- 0%
71,500 100%
- 0%
- 0%
17,000 40%
13,000 34%
13,000 34%
37,000 100%
37,000 100%
13,000 34%
3,600 8%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

POLI KIA TARIF LAMA

No Jenis Tindakan TOTAL
Maint. Alat Bahan/Alat Jasa Medis
1 Kateterisasi 33,000 55,000 88,000
2 Vagina Toucher (VT) 33,000 77,000 110,000
3 Maag Slang 55,000 110,000 165,000
4 Pemasangan Infus 11,000 33,000 44,000
5 Jahit Luka Episiotomy 55,000 110,000 165,000
6 Pemeriksaan DJJ dengan Monoaural 11,000 44,000 55,000
7 Pemeriksaan DJJ dengan Daptone 22,000 55,000 77,000
8 Clisma rendah/tinggi 22,000 44,000 66,000
10 Pasang Sceren 11,000 44,000 55,000
11 Pasang Gastrul 22,000 33,000 55,000
12 Palpasi 11,000 22,000 33,000
13 Pemasangan IUD 165,000 220,000 385,000
14 Lepas IUD 27,500 110,000 137,500
15 Pemasangan Implant KB 55,000 110,000 165,000
16 Lepas Implant KB 110,000 220,000 330,000
17 Suntik KB 16,500 22,000 38,500
18 Pemeriksaan Hamil ( CB ) 8,800 13,200 22,000
19 Pemeriksaan Bayi ( Penimbangan ) 11,000 16,500 27,500
20 Perawatan Luka SC (Caesar) 5,500 22,000 27,500
20 Perawatan Luka SC (Caesar)dgn komplikasi 0 0 0
21 Observasi / Jam Inpartu 11,000 33,000 44,000
22 Vaksin Toksoit Tetanus (TT) 11,000 27,500 38,500
23 Transfusi Darah 5,500 16,500 22,000
24 Pasang Oksigen (O2)/Jam 16,500 16,500 33,000
N
UN 2023

TARIF BARU SELISIH KENAIKAN TARIF P

TARIF Tarif RSB
Maint Alat Bahan/Alat Jasa Medis RP %
PELAYANAN Bahan/Alat
5,500 Rp 33,000 Rp 55,000 Rp 93,500 Rp 5,500 6% 28,000
5,500 Rp 33,000 Rp 77,000 Rp 115,500 Rp 5,500 5% 33,600
5,500 Rp 55,000 Rp 110,000 Rp 170,500 Rp 5,500 3%
5,500 Rp 33,825 Rp 36,300 Rp 75,625 Rp 31,625 72%
5,500 Rp 55,000 Rp 110,000 Rp 170,500 Rp 5,500 3%
5,500 Rp 11,000 Rp 44,000 Rp 60,500 Rp 5,500 10% 19,600
5,500 Rp 22,000 Rp 55,000 Rp 82,500 Rp 5,500 7% 19,600
5,500 Rp 22,000 Rp 44,000 Rp 71,500 Rp 5,500 8%
5,500 Rp 11,000 Rp 44,000 Rp 60,500 Rp 5,500 10%
5,500 Rp 22,000 Rp 33,000 Rp 60,500 Rp 5,500 10%
5,500 11,000 22,000 38,500 Rp 5,500 17%
5,500 Rp 165,000 Rp 220,000 Rp 390,500 Rp 5,500 1% 112,000
5,500 Rp 27,500 Rp 110,000 Rp 143,000 Rp 5,500 4% 89,000
5,500 Rp 55,000 Rp 110,000 Rp 170,500 Rp 5,500 3% 112,000
5,500 Rp 110,000 Rp 220,000 Rp 335,500 Rp 5,500 2% 98,000
5,500 16,500 22,000 Rp 44,000 Rp 5,500 14%
5,500 8,800 13,200 Rp 27,500 Rp 5,500 25%
5,500 11,000 16,500 Rp 33,000 Rp 5,500 20%
5,500 Rp 5,500 Rp 22,000 Rp 33,000 Rp 5,500 20% 56,000
5,500 Rp 22,000 Rp 22,000 Rp 49,500 Rp 49,500 100%
5,500 Rp 11,000 Rp 33,000 Rp 49,500 Rp 5,500 13%
5,500 Rp 27,500 Rp 27,500 Rp 60,500 Rp 22,000 57%
5,500 Rp 33,825 Rp 16,500 Rp 55,825 Rp 33,825 154%
5,500 Rp 16,500 Rp 16,500 Rp 38,500 Rp 5,500 17%
 TARIF PEMBANDING SELISIH TARIF PEMBANDING
Tarif RSBG TARIF
RP %
Jasa Medis RSBG

22,000 50,000 Rp 43,500 47%

26,400 60,000 Rp 55,500 48%
- Rp 170,500 100%
- Rp 75,625 100%
- Rp 170,500 100%
15,400 35,000 Rp 25,500 42%
15,400 35,000 Rp 47,500 58%
- Rp 71,500 100%
- Rp 60,500 100%
- Rp 60,500 100%
- Rp 38,500 100%
88,000 200,000 Rp 190,500 49%
66,000 155,000 -Rp 12,000 -8%
88,000 200,000 -Rp 29,500 -17%
77,000 175,000 Rp 160,500 48%
- Rp 44,000 100%
- Rp 27,500 100%
- Rp 33,000 100%
44,000 100,000 -Rp 67,000 -203%
- Rp 49,500 100%
- Rp 49,500 100%
- Rp 60,500 100%
- Rp 55,825 100%
- Rp 38,500 100%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

POLI KIA TARIF LAMA

No Jenis Tindakan TOTAL Maint Alat
Bahan/Alat Jasa Medis
1 Kateterisasi 33,000 55,000 88,000 10,000
2 Vagina Toucher (VT) 33,000 77,000 110,000 10,000
3 Maag Slang 55,000 110,000 165,000 10,000
4 Pemasangan Infus 11,000 33,000 44,000 10,000
5 Jahit Luka Episiotomy 55,000 110,000 165,000 10,000
6 Pemeriksaan DJJ dengan Monoaural 11,000 44,000 55,000 10,000
7 Pemeriksaan DJJ dengan Daptone 22,000 55,000 77,000 10,000
8 Clisma rendah/tinggi 22,000 44,000 66,000 10,000
10 Pasang Sceren 11,000 44,000 55,000 10,000
11 Pasang Gastrul 22,000 33,000 55,000 10,000
12 Palpasi 11,000 22,000 33,000 10,000
13 Pemasangan IUD 165,000 220,000 385,000 10,000
14 Lepas IUD 27,500 110,000 137,500 10,000
15 Pemasangan Implant KB 55,000 110,000 165,000 10,000
16 Lepas Implant KB 110,000 220,000 330,000 10,000
17 Suntik KB 16,500 22,000 38,500 10,000
18 Pemeriksaan Hamil ( CB ) 8,800 13,200 22,000 10,000
19 Pemeriksaan Bayi ( Penimbangan ) 11,000 16,500 27,500 10,000
20 Perawatan Luka SC (Caesar) 5,500 22,000 27,500 10,000
20 Perawatan Luka SC (Caesar)dgn komplikasi 0 0 0 10,000
21 Observasi / Jam Inpartu 11,000 33,000 44,000 10,000
22 Vaksin Toksoit Tetanus (TT) 11,000 27,500 38,500 10,000
23 Transfusi Darah 5,500 16,500 22,000 10,000
24 Pasang Oksigen (O2)/Jam 16,500 16,500 33,000 10,000
023

TARIF BARU SELISIH KENAIKAN TARIF PEMBANDI

TARIF Tarif RSBG
Bahan/Alat Jasa Medis RP %
PELAYANAN Bahan/Alat
33,000 55,000 98,000 10,000 11% 28,000
33,000 77,000 120,000 10,000 9% 33,600
55,000 110,000 175,000 10,000 6%
20,000 35,000 65,000 21,000 48%
55,000 110,000 175,000 10,000 6%
11,000 44,000 65,000 10,000 18% 19,600
22,000 55,000 87,000 10,000 13% 19,600
22,000 44,000 76,000 10,000 15%
11,000 44,000 65,000 10,000 18%
22,000 33,000 65,000 10,000 18%
11,000 22,000 43,000 10,000 30%
165,000 220,000 395,000 10,000 3% 112,000
40,000 110,000 160,000 22,500 16% 89,000
85,000 110,000 205,000 40,000 24% 112,000
110,000 220,000 340,000 10,000 3% 98,000
16,500 22,000 48,500 10,000 26%
8,800 13,200 32,000 10,000 45%
11,000 16,500 37,500 10,000 36%
55,000 45,000 110,000 82,500 300% 56,000
65,000 55,000 130,000 130,000 100%
11,000 33,000 54,000 10,000 23%
27,500 27,500 65,000 26,500 69%
33,825 16,500 60,325 38,325 174%
20,000 20,000 50,000 17,000 52%
 TARIF PEMBANDING SELISIH TARIF PEMBANDING
Tarif RSBG TARIF
RP %
Jasa Medis RSBG
22,000 50,000 48,000 49%
26,400 60,000 60,000 50%
- 175,000 100%
- 65,000 100%
- 175,000 100%
15,400 35,000 30,000 46%
15,400 35,000 52,000 60%
- 76,000 100%
- 65,000 100%
- 65,000 100%
- 43,000 100%
88,000 200,000 195,000 49%
66,000 155,000 5,000 3%
88,000 200,000 5,000 2%
77,000 175,000 165,000 49%
- 48,500 100%
- 32,000 100%
- 37,500 100%
44,000 100,000 10,000 9%
- 130,000 100%
- 54,000 100%
- 65,000 100%
- 60,325 100%
- 50,000 100%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

KAMAR OPERASI
OPERASI
TARIF LAMA
No Tindakan
Kecil Sedang Besar
1 Operator (dokter) Rp 825,000 Rp 1,200,000 Rp 1,900,000
2 Asisten Operator Rp 413,000 Rp 600,000 Rp 950,000
3 Dokter Anesthesi Rp 413,000 Rp 600,000 Rp 950,000
4 Anesthesi Rp 247,500 Rp 360,000 Rp 570,000
5 Instrumen Rp 247,500 Rp 360,000 Rp 570,000
6 Kamar Operasi Rp 330,000 Rp 480,000 Rp 760,000
JUMLAH Rp 2,476,000 Rp 3,600,000 Rp 5,700,000

7 Bahan Habis Pakai 100,000 200,000 400,000

8 Visite / Konsul **) **) **)

TARIF RSBG

NB : Rencana kenaikan margin untuk jasa dokter yang langsung dinaikan dari tarif
Minta pembanding untuk tindakan operasi
Jasa dan Maintenence
Perubahan tarif kamar
Harga paket
AMA TARIF BARU
Besar Khusus Kecil Sedang Besar
Rp 1,900,000 Rp 2,500,000 Rp 907,500 Rp 1,320,000 Rp 2,090,000
Rp 950,000 Rp 1,350,000 Rp 454,300 Rp 660,000 Rp 1,045,000
Rp 950,000 Rp 1,350,000 Rp 454,300 Rp 660,000 Rp 1,045,000
Rp 570,000 Rp 790,000 Rp 272,250 Rp 396,000 Rp 627,000
Rp 570,000 Rp 790,000 Rp 272,250 Rp 396,000 Rp 627,000
Rp 760,000 Rp 1,180,000 Rp 363,000 Rp 528,000 Rp 836,000
Rp 5,700,000 Rp 7,960,000 Rp 2,723,600 Rp 3,960,000 Rp 6,270,000

400,000 500,000 110,000 220,000 440,000

**) **) **) **) **)

2,500,000 3,750,000 4,500,000

Operator (dokter) 1,100,000 Jasa operator

Asisten Operator 440,000 40 % dari Jasa operator
Dokter anak 330,000 30 % dari Jasa operator
Dokter Anesthesi 550,000 50 % dari Jasa operator
Anesthesi 220,000 40 % dari Jasa Dokter anestesi
Instrumen 330,000 30 % dari Jasa operator
Kamar Operasi 440,000 40 % dari Jasa operator
TARIF OPERASI 3,410,000
 SELISIH KENAIKAN
RP %
Khusus Kecil Sedang Besar Khusus Kecil
Rp 2,750,000 Rp 82,500 Rp 120,000 Rp 190,000 Rp 250,000 10%
Rp 1,485,000 Rp 41,300 Rp 60,000 Rp 95,000 Rp 135,000 10%
Rp 1,485,000 Rp 41,300 Rp 60,000 Rp 95,000 Rp 135,000 10%
Rp 869,000 Rp 24,750 Rp 36,000 Rp 57,000 Rp 79,000 10%
Rp 869,000 Rp 24,750 Rp 36,000 Rp 57,000 Rp 79,000 10%
Rp 1,298,000 Rp 33,000 Rp 48,000 Rp 76,000 Rp 118,000 10%
Rp 8,756,000 Rp 247,600 Rp 360,000 Rp 570,000 Rp 796,000 10%

550,000 10,000 20,000 40,000 50,000 10%

**)

5,750,000
 %
Sedang Besar Khusus

10% 10% 10%

10% 10% 10%
10% 10% 10%
10% 10% 10%
10% 10% 10%
10% 10% 10%
10% 10% 10%

10% 10% 10%

 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

KAMAR OPERASI
TARIF LAMA TARIF BARU
No Tindakan
Kecil Sedang Besar Khusus Kecil Sedang Besar Khusus
1 Operator (dokter) 825,000 1,200,000 1,900,000 2,500,000 900,000 1,320,000 2,090,000 2,750,000
2 Asisten Operator 413,000 600,000 950,000 1,350,000 455,000 660,000 1,045,000 1,485,000
3 Dokter Anesthesi 413,000 600,000 950,000 1,350,000 455,000 660,000 1,045,000 1,485,000
4 Anesthesi 247,500 360,000 570,000 790,000 275,000 396,000 627,000 869,000
5 Instrumen 247,500 360,000 570,000 790,000 275,000 396,000 627,000 869,000
6 Kamar Operasi 330,000 480,000 760,000 1,180,000 365,000 528,000 836,000 1,298,000
JUMLAH 2,476,000 3,600,000 5,700,000 7,960,000 2,725,000 3,960,000 6,270,000 8,756,000

7 Bahan Habis Pakai 100,000 200,000 400,000 500,000 110,000 220,000 440,000 550,000
8 Visite / Konsul **) **) **) **) **) **) **) **)

TARIF RSBG 2,500,000 3,750,000 4,500,000 5,750,000

225,000 210,000 1,770,000 3,006,000
Selisih tarif Pembanding
9% 6% 39% 52%

NB : Rencana kenaikan margin untuk jasa dokter yang langsung dinaikan dari tarif
Minta pembanding untuk tindakan operasi
Jasa dan Maintenence
Perubahan tarif kamar
Harga paket
 SELISIH KENAIKAN
RP %
Kecil Sedang Besar Khusus Kecil Sedang Besar Khusus
75,000 120,000 190,000 250,000 9% 10% 10% 10%
42,000 60,000 95,000 135,000 10% 10% 10% 10%
42,000 60,000 95,000 135,000 10% 10% 10% 10%
27,500 36,000 57,000 79,000 11% 10% 10% 10%
27,500 36,000 57,000 79,000 11% 10% 10% 10%
35,000 48,000 76,000 118,000 11% 10% 10% 10%
249,000 360,000 570,000 796,000 10% 10% 10% 10%

10,000 20,000 40,000 50,000 10% 10% 10% 10%

 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

KAMAR OPERASI
TARIF LAMA TARIF BARU
No Tindakan
Kecil Sedang Besar Khusus Kecil Sedang Besar Khusus
1 Operator (dokter) 825,000 1,200,000 1,900,000 2,500,000 825,000 1,200,000 1,900,000 2,500,000
2 Asisten Operator 413,000 600,000 950,000 1,350,000 413,000 600,000 950,000 1,350,000
3 Dokter Anesthesi 413,000 600,000 950,000 1,350,000 413,000 600,000 950,000 1,350,000
4 Anesthesi 247,500 360,000 570,000 790,000 247,500 360,000 570,000 790,000
5 Instrumen 247,500 360,000 570,000 790,000 275,000 450,000 627,000 869,000
6 Kamar Operasi 330,000 480,000 760,000 1,180,000 365,000 600,000 836,000 1,298,000
JUMLAH 2,476,000 3,600,000 5,700,000 7,960,000 2,538,500 3,810,000 5,833,000 8,157,000

7 Bahan Habis Pakai 100,000 200,000 400,000 500,000 110,000 220,000 440,000 550,000
8 Visite / Konsul **) **) **) **) **) **) **) **)

TARIF RSBG 2,500,000 3,750,000 4,500,000 5,750,000

38,500 60,000 1,333,000 2,407,000
Selisih tarif Pembanding
2% 2% 30% 42%

NB : Rencana kenaikan margin untuk jasa dokter yang langsung dinaikan dari tarif
Minta pembanding untuk tindakan operasi
Jasa dan Maintenence
Perubahan tarif kamar
Harga paket
 SELISIH KENAIKAN
RP %
Kecil Sedang Besar Khusus Kecil Sedang Besar Khusus
Rp - Rp - Rp - Rp - 0% 0% 0% 0%
Rp - Rp - Rp - Rp - 0% 0% 0% 0%
- - - - 0% 0% 0% 0%
- - - - 0% 0% 0% 0%
27,500 90,000 57,000 79,000 11% 25% 25% 10%
35,000 120,000 76,000 118,000 11% 25% 25% 10%
62,500 210,000 133,000 197,000 3% 6% 6% 2%

10,000 20,000 40,000 50,000 10% 10% 10% 10%

 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2

Rawat Inap
TARIF LAMA Tarif Tarif Baru
No Uraian Biaya Ruang Perawatan Peg&Kel Biaya Ruang Perawatan
Kelas I Kelas II Kelas III Kls 1 Kelas I Kelas II Kelas III VIP Kelas I
1 Rawat inap/hari 82,500 66,000 49,500 45,000 200,000 150,000 100,000 900,000 117,500
2 Gizi 88,000 77,000 66,000 60,000 100,000 90,000 75,000 200,000 12,000
3 Visite dokter umum 38,500 27,000 22,000 40,000 33,000 27,500 45,000 1,500
4 Jasa Perawat 35,000 33,000 27,500 35,000 33,000 27,500 40,000 0
5 Administrasi 27,500 22,000 16,500 30,500 25,000 20,000 35,000 3,000
6 Loundry - - - 20,000 20,000 20,000 20,000 20,000
TOTAL 271,500 225,000 181,500 425,500 351,000 270,000 1,240,000 154,000
7 Visite Dokter Spesialis 88,000 82,500 77,000 75,000 100,000 100,000 100,000 125,000 12,000
8 Konsultasi Spesialis Via Telpo 33,000 27,500 22,000 25,000 33,000 33,000 33,000 55,000 0
CATATAN : DILUAR BHP TINDAKAN MEDIS

untuk margin di persentase kan

untuk point 7 & 8 tarif lama
LAYANAN
LAA TAHUN 2023

TARIF PEMBANDING SELISIH TAR

SELISIH KENAIKAN TARIF RSBG RP
RP % Biaya Ruang Perawatan
Kelas II Kelas III VIP Kelas I Kelas II Kelas III VIP Kelas I Kelas II Kelas III VVIP
84,000 50,500 900,000 142% 127% 102% 100% 200,000 150,000 100,000 0 0
13,000 9,000 200,000 14% 17% 14% 100% 65,000 50,000 45,000 35,000 40,000
6,000 5,500 45,000 4% 22% 25% 100% 75,000 75,000 75,000 -35,000 -42,000
0 0 40,000 0% 0% 0% 100% 35,000 33,000
3,000 3,500 35,000 11% 14% 21% 100% 30,500 25,000
20,000 20,000 20,000 100% 100% 100% 100% 20,000 20,000
126,000 88,500 1,240,000 57% 56% 49% 100% 340,000 275,000 220,000 1,400,000
17,500 23,000 125,000 14% 21% 30% 100% 100,000 100,000 100,000 0 0
5,500 11,000 55,000 0% 20% 50% 100% 33,000 33,000
 SELISIH TARIF PEMBANDING
RP %

0 0% 0% 0%
30,000 35% 44% 40%
-47,500 -88% -127% -173%
27,500 100% 100% 100%
20,000 100% 100% 100%
20,000 100% 100% 100%

0 0% 0% 0%
33,000 100% 100% 100%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

Rawat Inap
TARIF LAMA Tarif Baru SELISIH KENAIKAN

No Uraian Biaya Ruang Perawatan Peg&Kel Biaya Ruang Perawatan RP %

Kelas I Kelas II Kelas III Kls 1 Kelas I Kelas II Kelas III VIP Kelas I Kelas II Kelas III VIP Kelas I
1 Rawat inap/hari 82,500 66,000 49,500 45,000 200,000 150,000 100,000 900,000 117,500 84,000 50,500 900,000 142%
2 Gizi 88,000 77,000 66,000 60,000 100,000 90,000 75,000 200,000 12,000 13,000 9,000 200,000 14%
3 Visite dokter umum 38,500 27,000 22,000 75,000 75,000 75,000 75,000 36,500 48,000 53,000 75,000 95%
4 Jasa Perawat 35,000 33,000 27,500 35,000 33,000 27,500 40,000 - - - 40,000 0%
5 Administrasi 27,500 22,000 16,500 30,000 25,000 20,000 35,000 2,500 3,000 3,500 35,000 9%
6 Loundry - - - 20,000 20,000 20,000 20,000 20,000 20,000 20,000 20,000 100%
TOTAL 271,500 225,000 181,500 460,000 393,000 317,500 1,270,000 188,500 168,000 136,000 1,270,000 69%
7 Visite Dokter Spesialis 88,000 82,500 77,000 75,000 100,000 100,000 100,000 100,000 12,000 17,500 23,000 100,000 14%
33,000
8 Konsultasi Spesialis Via Te 27,500 22,000 25,000 33,000 33,000 33,000 33,000 - 5,500 11,000 33,000 0%
CATATAN : DILUAR BHP TINDAKAN MEDIS

untuk margin di persentase kan

untuk point 7 & 8 tarif lama
 TARIF PEMBANDING SELISIH TARIF PEMBANDING
TARIF RSBG
RP %
% Biaya Ruang Perawatan
Kelas II Kelas III VIP Kelas I Kelas II Kelas III VVIP Kelas I Kelas II Kelas III VIP Kelas I Kelas II Kelas III VVIP
127% 102% 100% 200,000 150,000 100,000 620,000 0 0 0 280,000 0% 0% 0% 31%
17% 14% 100% 65,000 50,000 45,000 130,000 35,000 40,000 30,000 70,000 35% 44% 40% 35%
178% 241% 100% 75,000 75,000 75,000 75,000 0 0 0 0 0% 0% 0% 0%
0% 0% 100% 35,000 33,000 27,500 40,000 100% 100% 100% 100%
14% 21% 100% 30,000 25,000 20,000 35,000 100% 100% 100% 100%
100% 100% 100% 20,000 20,000 20,000 20,000 100% 100% 100% 100%
75% 75% 100% 340,000 275,000 220,000 825,000 120,000 118,000 97,500 445,000 26% 30% 31% 35%
21% 30% 100% 100,000 100,000 100,000 100,000 0 0 0 0 0% 0% 0% 0%
20% 50% 100% 33,000 33,000 33,000 33,000 100% 100% 100% 100%
 TA
RS ANTAM
Rawat Inap

TARIF LAMA Tarif Baru

No Uraian Biaya Ruang Perawatan Peg&Kel Biaya Ruang Pera

Kelas I Kelas II Kelas III Kls 1 Kelas I
1 Rawat inap/hari 82,500 66,000 49,500 45,000 200,000
2 Gizi 88,000 77,000 66,000 60,000 100,000
3 Visite dokter umum 38,500 27,000 22,000 150,000
4 Jasa Perawat 35,000 33,000 27,500 50,000
5 Administrasi 27,500 22,000 16,500 30,000
6 Loundry - - - 20,000
TOTAL 271,500 225,000 181,500 550,000
7 Visite Dokter Spesialis 88,000 82,500 77,000 75,000 100,000
8 Konsultasi Spesialis Via Telpon 33,000 27,500 22,000 25,000 33,000
CATATAN : DILUAR BHP TINDAKAN MEDIS

untuk margin di persentase kan

untuk point 7 & 8 tarif lama
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

Tarif Baru SELISIH KENAIKAN

Biaya Ruang Perawatan RP %

Kelas II Kelas III VIP Kelas I Kelas II Kelas III VIP Kelas I Kelas II Kelas III VIP
150,000 100,000 900,000 117,500 84,000 50,500 900,000 142% 127% 102% 100%
90,000 75,000 200,000 12,000 13,000 9,000 200,000 14% 17% 14% 100%
100,000 75,000 200,000 111,500 73,000 53,000 200,000 290% 270% 241% 100%
50,000 50,000 50,000 15,000 17,000 22,500 50,000 43% 52% 82% 100%
25,000 20,000 35,000 2,500 3,000 3,500 35,000 9% 14% 21% 100%
20,000 20,000 20,000 20,000 20,000 20,000 20,000 100% 100% 100% 100%
435,000 340,000 1,405,000 278,500 210,000 158,500 1,405,000 103% 93% 87% 100%
100,000 100,000 100,000 12,000 17,500 23,000 100,000 14% 21% 30% 100%
33,000 33,000 33,000 0 5,500 11,000 33,000 0% 20% 50% 100%
 TARIF PEMBANDING SELISIH TARIF PEMBANDING
TARIF RSBG Tarif RS Tiara Sentosa
RP
Biaya Ruang Perawatan Biaya Ruang Perawatan
Kelas I Kelas II Kelas III VVIP Kelas I Kelas II Kelas III Kelas I Kelas II Kelas III
200,000 150,000 100,000 620,000 0 0 0
65,000 50,000 45,000 130,000 35,000 40,000 30,000
75,000 75,000 75,000 75,000 75,000 25,000 0
50,000 50,000 50,000
30,000 25,000 20,000
20,000 20,000 20,000
340,000 275,000 220,000 825,000 700,000 500,000 350,000 210,000 160,000 120,000
100,000 100,000 100,000 100,000 0 0 0
33,000 33,000 33,000
 SELISIH TARIF PEMBANDING

RP %

VIP Kelas I Kelas II Kelas III VVIP

280,000 0% 0% 0% 31%
70,000 35% 44% 40% 35%
125,000 50% 25% 0% 63%
50,000 100% 100% 100% 100%
35,000 100% 100% 100% 100%
20,000 100% 100% 100% 100%
580,000 38% 37% 35% 41%
0 0% 0% 0% 0%
33,000 100% 100% 100% 100%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

LABORATORIUM TARIF LAMA TARIF BAR

No Jenis Pemeriksaan Maint.Alat BHP

Maint.Alat BHP jas. Med T o t a l
I HEMATOLOGI
a. Hematologi Rutin 5,500 55,000 27,500 88,000 Rp 5,500 Rp 80,000
b. Hemoglobine ( Hb ) 5,500 11,000 16,500 33,000 Rp 5,500 Rp 11,000
c. Trombosit ( Mikroskopik ) 5,500 11,000 16,500 33,000 Rp 5,500 Rp 11,000
d. Hitung Jenis Lekosit ( diff ) 5,500 11,000 22,000 38,500 Rp 5,500 Rp 11,000
e. Lekosit 5,500 5,500 16,500 27,500 Rp 5,500 Rp 5,500
f. Eritrosit 5,500 5,500 16,500 27,500 Rp 5,500 Rp 5,500
g. Laju Endap Darah ( LED ) 5,500 27,500 16,500 49,500 Rp 5,500 Rp 35,000
h. Golongan Darah A, B, O, AB 5,500 11,000 16,500 33,000 Rp 5,500 Rp 20,000
i. Gol. Darah A,B,O,AB + Kartu Gol. D 5,500 16,500 16,500 38,500 Rp 5,500 Rp 25,000
j. GDT( gambaran darah tepi) 5,500 16,500 16,500 38,500 Rp 5,500 Rp 60,000
k. Hematologi Lengkap 5,500 71,500 33,000 110,000 Rp 5,500 Rp 120,000

II FAAL HEMOSTASIS
a. Waktu perdarahan 5,500 11,000 22,000 38,500 Rp 5,500 Rp 18,000
b. Waktu pembekuan 5,500 16,500 22,000 44,000 Rp 5,500 Rp 20,000

III KIMIA DARAH

a. Faal hati :
1. Bilirubin total 5,500 34,100 22,000 61,600 Rp 5,500 Rp 38,000
2. Bilirubin direk 5,500 29,700 22,000 57,200 Rp 5,500 Rp 35,000
3. G O T 5,500 29,700 22,000 57,200 Rp 5,500 Rp 35,000
4. G P T 5,500 29,700 22,000 57,200 Rp 5,500 Rp 35,000
5. Gamma GT 5,500 38,500 22,000 66,000 Rp 5,500 Rp 40,000
6. Alkali fosfatase 5,500 33,000 22,000 60,500 Rp 5,500 Rp 33,000
7. Protein total 5,500 27,500 22,000 55,000 Rp 5,500 Rp 29,000
8. Albumin 5,500 27,500 22,000 55,000 Rp 5,500 Rp 32,000

b. Diabetes :
1. Glucosa puasa 5,500 27,500 16,500 49,500 Rp 5,500 Rp 30,000
2. Glucosa 2 jam PP 5,500 27,500 16,500 49,500 Rp 5,500 Rp 25,000
3. Glucosa sewaktu Strip 5,500 27,500 16,500 49,500 Rp 5,500 Rp 25,000
4. Glucosa puasa / sewaktu 2 JPP 5,500 22,000 16,500 44,000 Rp 5,500 Rp 25,000
5. HbA1c ( Lab Klinik Prodia ) 5,500 49,500 16,500 66,000 Rp 5,500 Rp 49,500

c. Jantung / Lemak :
1. Kolesterol Total 5,500 33,000 16,500 55,000 Rp 5,500 Rp 33,000
2. Kolesterol HDL 5,500 44,000 22,000 71,500 Rp 5,500 Rp 46,000
3. Trigliserida 5,500 33,000 22,000 60,500 Rp 5,500 Rp 33,000
4. Kolesterol LDL ( Direk ) 5,500 77,000 22,000 104,500 Rp 5,500 Rp 80,000

d. Ginjal :
1. Ureum 5,500 33,000 16,500 55,000 Rp 5,500 Rp 40,000
2. Kreatinin 5,500 33,000 16,500 55,000 Rp 5,500 Rp 40,000
3. Uric Acid 5,500 29,700 22,000 57,200 Rp 5,500 Rp 39,200

IV IMMUNO SEROLOGI
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

LABORATORIUM TARIF LAMA TARIF BAR

No Jenis Pemeriksaan Maint.Alat BHP

Maint.Alat BHP jas. Med T o t a l
a. Hepatitis :
1. HBsAg 5,500 99,000 49,500 154,000 Rp 5,500 Rp 99,000
2. HBsAg dengan Card Acon 5,500 60,500 27,500 93,500 Rp 5,500 Rp 70,000
3. Anti HBs 5,500 121,000 49,500 176,000 Rp 5,500 Rp 121,000
4. Anti HCV 5,500 335,500 55,000 396,000 Rp 5,500 Rp 335,500
5. HBeAg ( Lab Klinik Prodia ) 5,500 49,500 33,000 82,500 Rp 5,500 Rp 49,500

b. Infeksi Lain :
1. Widal 5,500 33,000 27,500 66,000 Rp 5,500 Rp 45,000
2. Malaria ( Mikroskopik ) 5,500 11,000 27,500 44,000 Rp 5,500 Rp 56,000
3. Repid Dengue Test ( DBD ) 5,500 209,000 27,500 242,000 Rp 5,500 Rp 250,000
4. Anti HIV ( Lab Klinik Prodia ) + On 5,500 49,500 33,000 88,000 Rp 5,500 Rp 49,500

V URINALISA
1. Urine Rutin 5,500 27,500 22,000 55,000 Rp 5,500 Rp 30,000
2. Urine Sedimen 5,500 11,000 22,000 38,500 Rp 5,500 Rp 30,000
3. Tes Kehamilan 5,500 22,000 16,500 44,000 Rp 5,500 Rp 25,000
4. Tes Narkoba
5. Protein & Reduksi 5,500 11,000 16,500 33,000 Rp 5,500 Rp 25,000
6. Reduksi 5,500 11,000 16,500 33,000 Rp 5,500 Rp 11,000

VI ANALISA FAESES
1. Faeses Rutin 5,500 16,500 33,000 55,000 Rp 5,500 Rp 35,000
2. Benzidin tes 5,500 16,500 33,000 55,000 Rp 5,500 Rp 16,500

VII MICROBIOLOGI / PARASITOLOGI

1. BTA ( Mikroskopik ) SPS 5,500 16,500 33,000 55,000 Rp 5,500 Rp 16,500
2. GO ( Mikroskopik ) 5,500 16,500 38,500 60,500 Rp 5,500 Rp 16,500

VIII M.H ( Micri Hansen ) Lepra

IX TYROID / ENDOKRIN
1. FT 4 5,500 253,000 38,500 297,000 Rp 5,500 Rp 253,000
2. FT 3 5,500 253,000 38,500 297,000 Rp 5,500 Rp 253,000
3. TsHs 5,500 214,500 38,500 258,500 Rp 5,500 Rp 214,500

X TRANSFUSI ( tidak termasuk kantong 5,500 66,000 33,000 104,500 Rp 5,500 Rp 66,000
2023

TARIF PEMBANDING
TARIF BARU SELISIH KENAIKAN
Biaya RS RSBG Biaya RSBG
jas. Med Total RP %
Maint.Alat BHP jas. Med TOTAL

Rp 45,000 Rp 130,500 Rp 42,500 48% 56,000 44,000 100,000

Rp 16,500 Rp 33,000 Rp - 0% -
Rp 16,500 Rp 33,000 Rp - 0% -
Rp 22,000 Rp 38,500 Rp - 0% -
Rp 16,500 Rp 27,500 Rp - 0% -
Rp 16,500 Rp 27,500 Rp - 0% -
Rp 20,000 Rp 60,500 Rp 11,000 22% 11,200 8,800 20,000
Rp 18,000 Rp 43,500 Rp 10,500 32% -
Rp 18,000 Rp 48,500 Rp 10,000 26% -
Rp 45,000 Rp 110,500 Rp 72,000 187% 56,000 44,000 100,000
Rp 35,000 Rp 160,500 Rp 50,500 46% -
Rp - Rp - -
Rp - Rp - -
Rp 25,000 Rp 48,500 Rp 10,000 26% 11,200 8,800 20,000
Rp 25,000 Rp 50,500 Rp 6,500 15% 11,200 8,800 20,000
Rp - Rp - -
Rp - Rp - -
Rp - Rp - -
Rp 25,000 Rp 68,500 Rp 6,900 11% 22,400 17,600 40,000
Rp 25,000 Rp 65,500 Rp 8,300 15% 22,400 17,600 40,000
Rp 25,000 Rp 65,500 Rp 8,300 15% 22,400 17,600 40,000
Rp 25,000 Rp 65,500 Rp 8,300 15% 22,400 17,600 40,000
Rp 30,000 Rp 75,500 Rp 9,500 14% -
Rp 22,000 Rp 60,500 Rp - 0% -
Rp 25,000 Rp 59,500 Rp 4,500 8% -
Rp 25,000 Rp 62,500 Rp 7,500 14% -
Rp - Rp - -
Rp - Rp - -
Rp 20,000 Rp 55,500 Rp 6,000 12% 19,600 15,400 35,000
Rp 20,000 Rp 50,500 Rp 1,000 2% 19,600 15,400 35,000
Rp 20,000 Rp 50,500 Rp 1,000 2% 19,600 15,400 35,000
Rp 20,000 Rp 50,500 Rp 6,500 15% 19,600 15,400 35,000
Rp 16,500 Rp 71,500 Rp 5,500 8% -
Rp - Rp - -
Rp - Rp - -
Rp 22,000 Rp 60,500 Rp 5,500 10% 28,000 22,000 50,000
Rp 33,000 Rp 84,500 Rp 13,000 18% 41,440 32,560 74,000
Rp 25,000 Rp 63,500 Rp 3,000 5% 25,760 20,240 46,000
Rp 33,000 Rp 118,500 Rp 14,000 13% 41,440 32,560 74,000
Rp - Rp - -
Rp - Rp - -
Rp 20,000 Rp 65,500 Rp 10,500 19% 22,400 17,600 40,000
Rp 20,000 Rp 65,500 Rp 10,500 19% 22,400 17,600 40,000
Rp 30,800 Rp 75,500 Rp 18,300 32% 39,200 30,800 70,000
Rp - Rp - -
Rp - Rp - -
2023

TARIF PEMBANDING
TARIF BARU SELISIH KENAIKAN
Biaya RS RSBG Biaya RSBG
jas. Med Total RP %
Maint.Alat BHP jas. Med TOTAL
Rp - Rp - -
Rp 49,500 Rp 154,000 Rp - 0% 70,000 55,000 125,000
Rp 55,000 Rp 130,500 Rp 37,000 40% -
Rp 49,500 Rp 176,000 Rp - 0% -
Rp 55,000 Rp 396,000 Rp - 0% -
Rp 33,000 Rp 88,000 Rp 5,500 7% -
Rp - Rp - -
Rp - Rp - -
Rp 35,000 Rp 85,500 Rp 19,500 30% 42,000 33,000 75,000
Rp 44,000 Rp 105,500 Rp 61,500 140% -
Rp 30,000 Rp 285,500 Rp 43,500 18% -
Rp 33,000 Rp 88,000 Rp - 0% -
Rp - Rp - -
Rp - Rp - -
Rp 30,000 Rp 65,500 Rp 10,500 19% 19,600 15,400 35,000
Rp 30,000 Rp 65,500 Rp 27,000 70% 14,000 11,000 25,000
Rp 20,000 Rp 50,500 Rp 6,500 15% 16,800 13,200 30,000
Rp - Rp - -
Rp 20,000 Rp 50,500 Rp 17,500 53% -
Rp 16,500 Rp 33,000 Rp - 0% -
Rp - Rp - -
Rp - Rp - -
Rp 30,000 Rp 70,500 Rp 15,500 28% 25,200 19,800 45,000
Rp 33,000 Rp 55,000 Rp - 0% -
Rp - Rp - -
Rp - Rp - -
Rp 33,000 Rp 55,000 Rp - 0% -
Rp 38,500 Rp 60,500 Rp - 0% -
Rp - Rp - -
Rp - Rp - -
Rp - Rp - -
Rp - Rp - -
Rp 38,500 Rp 297,000 Rp - 0% -
Rp 38,500 Rp 297,000 Rp - 0% -
Rp 38,500 Rp 258,500 Rp - 0% -
Rp - Rp - -
Rp 33,000 Rp 104,500 Rp - 0%
SELISIH TARIF PEMBANDING

RP %

Rp 30,500 23%
Rp 33,000 100%
Rp 33,000 100%
Rp 38,500 100%
Rp 27,500 100%
Rp 27,500 100%
Rp 40,500 67%
Rp 43,500 100%
Rp 48,500 100%
Rp 10,500 10%
Rp 160,500 100%
Rp -
Rp -
Rp 28,500 59%
Rp 30,500 60%
Rp -
Rp -
Rp -
Rp 28,500 42%
Rp 25,500 39%
Rp 25,500 39%
Rp 25,500 39%
Rp 75,500 100%
Rp 60,500 100%
Rp 59,500 100%
Rp 62,500 100%
Rp -
Rp -
Rp 20,500 37%
Rp 15,500 31%
Rp 15,500 31%
Rp 15,500 31%
Rp 71,500 100%
Rp -
Rp -
Rp 10,500 17%
Rp 10,500 12%
Rp 17,500 28%
Rp 44,500 38%
Rp -
Rp -
Rp 25,500 39%
Rp 25,500 39%
Rp 5,500 7%
Rp -
Rp -
SELISIH TARIF PEMBANDING

RP %

Rp -
Rp 29,000 19%
Rp 130,500 100%
Rp 176,000 100%
Rp 396,000 100%
Rp 88,000 100%
Rp -
Rp -
Rp 10,500 12%
Rp 105,500 100%
Rp 285,500 100%
Rp 88,000 100%
Rp -
Rp -
Rp 30,500 47%
Rp 40,500 62%
Rp 20,500 41%
Rp -
Rp 50,500 100%
Rp 33,000 100%
Rp -
Rp -
Rp 25,500 36%
Rp 55,000 100%
Rp -
Rp -
Rp 55,000 100%
Rp 60,500 100%
Rp -
Rp -
Rp -
Rp -
Rp 297,000 100%
Rp 297,000 100%
Rp 258,500 100%
Rp -
Rp 104,500 100%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

LABORATORIUM
TARIF LAMA TARIF BAR

No Jenis Pemeriksaan Maint.Alat BHP jas. Med T o t a l Maint.Alat BHP

I HEMATOLOGI
a. Hematologi Rutin 5,500 55,000 27,500 88,000 10,000 70,000
b. Hemoglobine ( Hb ) 5,500 11,000 16,500 33,000 10,000 15,000
c. Trombosit ( Mikroskopik ) 5,500 11,000 16,500 33,000 10,000 15,000
d. Hitung Jenis Lekosit ( diff ) 5,500 11,000 22,000 38,500 10,000 15,000
e. Lekosit 5,500 5,500 16,500 27,500 10,000 10,000
f. Eritrosit 5,500 5,500 16,500 27,500 10,000 10,000
g. Laju Endap Darah ( LED ) 5,500 27,500 16,500 49,500 10,000 35,000
h. Golongan Darah A, B, O, AB 5,500 11,000 16,500 33,000 10,000 20,000
i. Gol. Darah A,B,O,AB + Kartu Gol. D 5,500 16,500 16,500 38,500 10,000 25,000
j. GDT( gambaran darah tepi) 5,500 16,500 16,500 38,500 10,000 60,000
k. Hematologi Lengkap 5,500 71,500 33,000 110,000 10,000 120,000

II FAAL HEMOSTASIS
a. Waktu perdarahan 5,500 11,000 22,000 38,500 10,000 15,000
b. Waktu pembekuan 5,500 16,500 22,000 44,000 10,000 15,000

III KIMIA DARAH

a. Faal hati :
1. Bilirubin total 5,500 34,100 22,000 61,600 10,000 38,000
2. Bilirubin direk 5,500 29,700 22,000 57,200 10,000 35,000
3. G O T 5,500 29,700 22,000 57,200 10,000 35,000
4. G P T 5,500 29,700 22,000 57,200 10,000 35,000
5. Gamma GT 5,500 38,500 22,000 66,000 10,000 40,000
6. Alkali fosfatase 5,500 33,000 22,000 60,500 10,000 35,000
7. Protein total 5,500 27,500 22,000 55,000 10,000 30,000
8. Albumin 5,500 27,500 22,000 55,000 10,000 30,000

b. Diabetes :
1. Glucosa puasa 5,500 27,500 16,500 49,500 10,000 30,000
2. Glucosa 2 jam PP 5,500 27,500 16,500 49,500 10,000 30,000
3. Glucosa sewaktu Strip 5,500 27,500 16,500 49,500 10,000 30,000
4. Glucosa puasa / sewaktu 2 JPP 5,500 22,000 16,500 44,000 10,000 25,000
5. HbA1c ( Lab Klinik Prodia ) 5,500 49,500 16,500 66,000 10,000 50,000

c. Jantung / Lemak :
1. Kolesterol Total 5,500 33,000 16,500 55,000 10,000 35,000
2. Kolesterol HDL 5,500 44,000 22,000 71,500 10,000 45,000
3. Trigliserida 5,500 33,000 22,000 60,500 10,000 35,000
4. Kolesterol LDL ( Direk ) 5,500 77,000 22,000 104,500 10,000 80,000
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

LABORATORIUM
TARIF LAMA TARIF BAR

No Jenis Pemeriksaan Maint.Alat BHP jas. Med T o t a l Maint.Alat BHP

d. Ginjal :
1. Ureum 5,500 33,000 16,500 55,000 10,000 40,000
2. Kreatinin 5,500 33,000 16,500 55,000 10,000 40,000
3. Uric Acid 5,500 29,700 22,000 57,200 10,000 40,000

IV IMMUNO SEROLOGI
a. Hepatitis :
1. HBsAg 5,500 99,000 49,500 154,000 10,000 100,000
2. HBsAg dengan Card Acon 5,500 60,500 27,500 93,500 10,000 70,000
3. Anti HBs 5,500 121,000 49,500 176,000 10,000 121,000
4. Anti HCV 5,500 335,500 55,000 396,000 10,000 350,000
5. HBeAg ( Lab Klinik Prodia ) 5,500 49,500 33,000 82,500 10,000 50,000

b. Infeksi Lain :
1. Widal 5,500 33,000 27,500 66,000 10,000 45,000
2. Malaria ( Mikroskopik ) 5,500 11,000 27,500 44,000 10,000 20,000
3. Repid Dengue Test ( DBD ) 5,500 209,000 27,500 242,000 10,000 220,000
4. Anti HIV ( Lab Klinik Prodia ) + On 5,500 49,500 33,000 88,000 10,000 50,000

V URINALISA
1. Urine Rutin 5,500 27,500 22,000 55,000 10,000 30,000
2. Urine Sedimen 5,500 11,000 22,000 38,500 10,000 20,000
3. Tes Kehamilan 5,500 22,000 16,500 44,000 10,000 25,000
4. Tes Narkoba
5. Protein & Reduksi 5,500 11,000 16,500 33,000 10,000 20,000
6. Reduksi 5,500 11,000 16,500 33,000 10,000 20,000

VI ANALISA FAESES
1. Faeses Rutin 5,500 16,500 33,000 55,000 10,000 20,000
2. Benzidin tes 5,500 16,500 33,000 55,000 10,000 20,000

VII MICROBIOLOGI / PARASITOLOGI

1. BTA ( Mikroskopik ) SPS 5,500 16,500 33,000 55,000 10,000 20,000
2. GO ( Mikroskopik ) 5,500 16,500 38,500 60,500 10,000 20,000

VIII M.H ( Micri Hansen ) Lepra

IX TYROID / ENDOKRIN
1. FT 4 5,500 253,000 38,500 297,000 10,000 260,000
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023

LABORATORIUM
TARIF LAMA TARIF BAR

No Jenis Pemeriksaan Maint.Alat BHP jas. Med T o t a l Maint.Alat BHP

2. FT 3 5,500 253,000 38,500 297,000 10,000 260,000
3. TsHs 5,500 214,500 38,500 258,500 10,000 220,000

X TRANSFUSI ( tidak termasuk kantong 5,500 66,000 33,000 104,500 10,000 70,000
N 2023

TARIF PEMBANDING
TARIF BARU SELISIH KENAIKAN
Tarif RSBG
jas. Med Total RP %
Maint.Alat BHP jas. Med TOTAL

30,000 110,000 22,000 25% 56,000 44,000 100,000

20,000 45,000 12,000 36% -
20,000 45,000 12,000 36% -
22,000 47,000 8,500 22% -
17,000 37,000 9,500 35% -
17,000 37,000 9,500 35% -
20,000 65,000 15,500 31% 11,200 8,800 20,000
20,000 50,000 17,000 52% -
20,000 55,000 16,500 43% -
45,000 115,000 76,500 199% 56,000 44,000 100,000
35,000 165,000 55,000 50% -
- - -
- - -
25,000 50,000 11,500 30% 11,200 8,800 20,000
25,000 50,000 6,000 14% 11,200 8,800 20,000
- - -
- - -
- - -
25,000 73,000 11,400 19% 22,400 17,600 40,000
25,000 70,000 12,800 22% 22,400 17,600 40,000
25,000 70,000 12,800 22% 22,400 17,600 40,000
25,000 70,000 12,800 22% 22,400 17,600 40,000
30,000 80,000 14,000 21% -
25,000 70,000 9,500 16% -
25,000 65,000 10,000 18% -
25,000 65,000 10,000 18% -
- - -
- - -
20,000 60,000 10,500 21% 19,600 15,400 35,000
20,000 60,000 10,500 21% 19,600 15,400 35,000
20,000 60,000 10,500 21% 19,600 15,400 35,000
20,000 55,000 11,000 25% 19,600 15,400 35,000
20,000 80,000 14,000 21% -
- - -
- - -
20,000 65,000 10,000 18% 28,000 22,000 50,000
25,000 80,000 8,500 12% 41,440 32,560 74,000
25,000 70,000 9,500 16% 25,760 20,240 46,000
30,000 120,000 15,500 15% 41,440 32,560 74,000
N 2023

TARIF PEMBANDING
TARIF BARU SELISIH KENAIKAN
Tarif RSBG
jas. Med Total RP %
Maint.Alat BHP jas. Med TOTAL
- - -
- - -
20,000 70,000 15,000 27% 22,400 17,600 40,000
20,000 70,000 15,000 27% 22,400 17,600 40,000
30,000 80,000 22,800 40% 39,200 30,800 70,000
- - -
- - -
- - -
50,000 160,000 6,000 4% 70,000 55,000 125,000
30,000 110,000 16,500 18% -
50,000 181,000 5,000 3% -
55,000 415,000 19,000 5% -
35,000 95,000 12,500 15% -
- - -
- - -
35,000 90,000 24,000 36% 42,000 33,000 75,000
30,000 60,000 16,000 36% -
30,000 260,000 18,000 7% -
35,000 95,000 7,000 8% -
- - -
- - -
25,000 65,000 10,000 18% 19,600 15,400 35,000
25,000 55,000 16,500 43% 14,000 11,000 25,000
20,000 55,000 11,000 25% 16,800 13,200 30,000
- - -
20,000 50,000 17,000 52% -
20,000 50,000 17,000 52% -
- - -
- - -
35,000 65,000 10,000 18% 25,200 19,800 45,000
35,000 65,000 10,000 18% -
- - -
- - -
35,000 65,000 10,000 18% -
40,000 70,000 9,500 16% -
- - -
- - -
- - -
- - -
40,000 310,000 13,000 4% -
N 2023

TARIF PEMBANDING
TARIF BARU SELISIH KENAIKAN
Tarif RSBG
jas. Med Total RP %
Maint.Alat BHP jas. Med TOTAL
40,000 310,000 13,000 4% -
40,000 270,000 11,500 4% -
- - -
35,000 115,000 10,500 10%
SELISIH TARIF PEMBANDING
RP %

10,000 9%
45,000 100%
45,000 100%
47,000 100%
37,000 100%
37,000 100%
45,000 69%
50,000 100%
55,000 100%
15,000 13%
165,000 100%
-
-
30,000 60%
30,000 60%
-
-
-
33,000 45%
30,000 43%
30,000 43%
30,000 43%
80,000 100%
70,000 100%
65,000 100%
65,000 100%
-
-
25,000 42%
25,000 42%
25,000 42%
20,000 36%
80,000 100%
-
-
15,000 23%
6,000 8%
24,000 34%
46,000 38%
SELISIH TARIF PEMBANDING
RP %

-
-
30,000 43%
30,000 43%
10,000 13%
-
-
-
35,000 22%
110,000 100%
181,000 100%
415,000 100%
95,000 100%
-
-
15,000 17%
60,000 100%
260,000 100%
95,000 100%
-
-
30,000 46%
30,000 55%
25,000 45%
-
50,000 100%
50,000 100%
-
-
20,000 31%
65,000 100%
-
-
65,000 100%
70,000 100%
-
-
-
-
310,000 100%
SELISIH TARIF PEMBANDING
RP %

310,000 100%
270,000 100%
-
115,000 100%
 TARIF PELAYANAN
RS ANTAM POMALAA TAHUN 2023
ADMINISTRASI / TU
TARIF LAMA
No Uraian BIAYA

1 Surat Keterangan Berbadan Sehat untuk Anak Sekolah 10,000

2 Surat Keterangan Berbadan Sehat untuk Umum 15,000
3 Surat Keterangan Rawat Inap ( Opname ) 10,000
4 Surat Keterangan Keperluan Klaim Asuransi 30,000
5 Surat Keterangan Sakit / Istirahat 10,000
6 Surat Keterangan Kelahiran / Kematian 20,000
7 Visum Et Repertum 50,000
 PELAYANAN
MALAA TAHUN 2023

TARIF LAMA TARIF BARU SELISIH KENAIKAN

ATK TOTAL BIAYA ATK TOTAL RP

1,000 11,000 20,000 5,000 25,000 14,000

1,500 16,500 20,000 5,000 25,000 8,500
1,000 11,000 20,000 5,000 25,000 14,000
3,000 33,000 40,000 60,000 100,000 67,000
1,000 11,000 20,000 5,000 25,000 14,000
2,000 22,000 20,000 5,000 25,000 3,000
5,000 55,000 50,000 50,000 100,000 45,000
SELISIH KENAIKAN TARIF PEMBANDING SELISIH TARIF PEMBANDING
% Tarif RSBG RP %

127% 25,000 0 0%
52% 25,000 0 0%
127% 25,000 0 0%
203% 100,000 0 0%
127% 25,000 0 0%
14% 25,000 0 0%
82% 100,000 0 0%
 TINDAKAN BAYI BARU LAHIR
TARIF LAMA TARIF BARU
No KELAS Perawatan Perawatan Incubator Pasang Perawatan
Bayi Normal Bayi Prematur Sonde Bayi Normal
1 KELAS I :

a. Bidan
b. Dokter Umum 80,000 110,000 90,000 100,000 80,000
c. Dokter Spesialis *) *) *) *) 155,000

2 KELAS II :

a. Bidan
b. Dokter Umum 60,000 90,000 70,000 80,000 60,000
c. Dokter Spesialis *) *) *) *) 135,000

3 KELAS III :

a. Bidan
b. Dokter Umum 50,000 80,000 60,000 70,000 50,000
c. Dokter Spesialis *) *) *) *) 125,000
 TARIF BARU SELISIH KENAIKAN
Perawatan Incubator Pasang
RP
Bayi Prematur Sonde %

110,000 90,000 100,000 0 0 0 0 0% 0%

185,000 165,000 175,000 155,000 185,000 165,000 175,000 100% 100%

90,000 70,000 80,000 0 0 0 0 0% 0%

165,000 145,000 155,000 135,000 165,000 145,000 155,000 100% 100%

80,000 60,000 70,000 0 0 0 0 0% 0%

155,000 135,000 145,000 125,000 155,000 135,000 145,000 100% 100%
AN

0% 0%
100% 100%

0% 0%
100% 100%

0% 0%
100% 100%
 TINDAKAN BAYI BARU LAHIR
TARIF LAMA TARIF BARU
No KELAS Perawatan Perawatan Incubator Pasang Perawatan
Bayi Normal Bayi Prematur Sonde Bayi Normal
1 KELAS I :

a. Bidan
b. Dokter Umum 80,000 110,000 90,000 100,000 100,000
c. Dokter Spesialis *) *) *) *) 175,000

2 KELAS II :

a. Bidan
b. Dokter Umum 60,000 90,000 70,000 80,000 80,000
c. Dokter Spesialis *) *) *) *) 155,000

3 KELAS III :

a. Bidan
b. Dokter Umum 50,000 80,000 60,000 70,000 70,000
c. Dokter Spesialis *) *) *) *) 145,000
 TARIF BARU SELISIH KENAIKAN
Perawatan Incubator Pasang
RP
Bayi Prematur Sonde %

120,000 100,000 100,000 20,000 10,000 10,000 0 25% 9%

195,000 175,000 175,000 175,000 195,000 175,000 175,000 100% 100%

100,000 100,000 100,000 20,000 10,000 30,000 20,000 33% 11%

175,000 175,000 175,000 155,000 175,000 175,000 175,000 100% 100%

100,000 100,000 100,000 20,000 20,000 40,000 30,000 40% 25%

175,000 175,000 175,000 145,000 175,000 175,000 175,000 100% 100%
AN

11% 0%
100% 100%

43% 25%
100% 100%

67% 43%
100% 100%
 TINDAKAN PERSALINAN
TARIF LAMA TARIF BARU
No KELAS Persalinan Persalinan Placenta Curetage Curetage Induksi Persalinan Persalinan Placenta Curetage Curetage Induksi
Normal Pathologi Manual Biasa Provokatus Persalinan Normal Pathologi Manual Biasa Provokatus Persalinan
KELAS I :
1
a. Bidan 700,000 800,000 500,000 400,000 770,000 880,000 550,000 - - 440,000
b. Dokter Umum *) *) *) 700,000 *) *) 770,000
c. Dokter Spesialis *) *) *) 700,000 *) *) 1,200,000 1,800,000 600,000 770,000

2 KELAS II :

a. Bidan 700,000 800,000 500,000 900,000 400,000 770,000 880,000 550,000 - 990,000 440,000
b. Dokter Umum *) *) *) 700,000 *) *) 770,000
c. Dokter Spesialis *) *) *) 700,000 *) *) 1,150,000 1,400,000 770,000

3 KELAS III :

a. Bidan 700,000 800,000 500,000 900,000 400,000 770,000 880,000 550,000 - 990,000 440,000
b. Dokter Umum *) *) *) 700,000 *) *) 770,000
c. Dokter Spesialis *) *) *) 700,000 *) *) 1,000,000 1,200,000 770,000

4 Kamar VK 250,000 250,000 250,000 250,000 250,000 250,000 300,000 300,000 300,000 300,000 300,000 300,000

Normal Pathologi Placenta

Tarif RSBG 1,000,000 1,500,000 350,000
KAMAR VK 250,000 250,000 250,000
Selisih Tarif Pembanding 200,000 300,000 250,000
50,000 50,000 50,000
20% 20% 71%
20% 20% 20%
 SELISIH KENAIKAN
RP %

70,000 80,000 50,000 - - 40,000 10% 10% 10% 0 0 10%

70,000 10%
1,200,000 1,800,000 600,000 70,000 100% 100% 100% 10%

70,000 80,000 50,000 - 90,000 40,000 10% 10% 10% 10%

70,000 10%
1,150,000 1,400,000 70,000 10%

70,000 80,000 50,000 - 90,000 40,000 10% 10% 10% 10%

70,000 10%
1,000,000 1,200,000 70,000 10%

50,000 50,000 50,000 50,000 50,000 50,000 20% 20% 20% 20% 20% 20%
 TINDAKAN PERSALINAN

TARIF LAMA TARIF BARU

No KELAS Persalinan Persalinan Placenta Curetage Curetage Induksi Persalinan Persalinan Placenta Curetage Curetage Induksi
Normal Pathologi Manual Biasa Provokatus Persalinan Normal Pathologi Manual Biasa Provokatus Persalinan
KELAS I :
1
a. Bidan 500,000 650,000 350,000 750,000 300,000 800,000 - - - -
b. Dokter Umum 650,000 700,000 400,000 600,000 800,000 350,000 900,000 - - - - -
c. Dokter Spesialis 900,000 1,000,000 - 700,000 - - 1,300,000 1,600,000 1,800,000 1,600,000 1,800,000 1,600,000

2 KELAS II :

a. Bidan 400,000 600,000 300,000 700,000 250,000 800,000 - - - -

b. Dokter Umum 550,000 650,000 350,000 550,000 750,000 300,000 900,000 - - - - -
c. Dokter Spesialis 800,000 900,000 - 700,000 - - 1,300,000 1,600,000 1,800,000 1,600,000 1,800,000 1,600,000

3 KELAS III :

a. Bidan 400,000 600,000 300,000 500,000 700,000 250,000 800,000 - - - -

b. Dokter Umum 550,000 650,000 350,000 550,000 750,000 300,000 900,000 - - - - -
c. Dokter Spesialis 800,000 900,000 - 700,000 - - 1,300,000 1,600,000 1,800,000 1,600,000 1,800,000 1,600,000

4 Kamar VK 250,000 250,000 250,000 250,000 250,000 250,000 350,000 350,000 350,000 350,000 350,000 350,000

Normal Pathologi Placenta

Tarif RSBG 1,000,000 1,500,000 350,000
KAMAR VK 250,000 250,000 250,000
Selisih Tarif Pembanding 300,000 100,000 1,450,000
RP 100,000 100,000 100,000
30% 7% 414%
%
40% 40% 40%
 SELISIH KENAIKAN
RP %

300,000 (650,000) (350,000) - (750,000) (300,000) 60% -100% -100% -100% -100%
250,000 (700,000) (400,000) (600,000) (800,000) (350,000) 38% -100% -100% -100% -100% -100%
400,000 600,000 1,800,000 900,000 1,800,000 1,600,000 44% 60% 129%
- - - - - -
- - - - - -
- - - - - -
400,000 (600,000) (300,000) - (700,000) (250,000) 100% -100% -100% -100% -100%
350,000 (650,000) (350,000) (550,000) (750,000) (300,000) 64% -100% -100% -100% -100% -100%
500,000 700,000 1,800,000 900,000 1,800,000 1,600,000 63% 78% 129%
- - - - - -
- - - - - -
- - - - - -
- - - - - -
400,000 (600,000) (300,000) (500,000) (700,000) (250,000) 100% -100% -100% -100% -100%
350,000 (650,000) (350,000) (550,000) (750,000) (300,000) 64% -100% -100% -100% -100% -100%
500,000 700,000 1,800,000 900,000 1,800,000 1,600,000 63% 78% 129%
- - - - - -
100,000 100,000 100,000 100,000 100,000 100,000 40% 40% 40% 40% 40% 40%