1.RUANG VIP DAN KELAS No Jenis Pelayanan Jasa Rumah Sakit Jasa Pelayanan JLH BPH JASA SARANA JM JPM JNM 1 2 3 4 5 6 7 8 I RAWAT INAP 1 Kelas VIP Dokter Umum 77,000 44,000 44,000 39,600 15,400 220,000 Dokter Spesialis 87,500 50,000 50,000 45,000 17,500 250,000 2 Kelas I Dokter Umum 61,250 35,000 35,000 31,500 12,250 175,000 Dokter Spesialis 70,000 40,000 40,000 36,000 14,000 200,000 3 Kelas II Dokter Umum 52,500 30,000 30,000 27,000 10,500 150,000 Dokter Spesialis 61,250 35,000 35,000 31,500 12,250 175,000 4 Kelas III Dokter Umum 42,000 24,000 24,000 21,600 8,400 120,000 Dokter Spesialis 52,500 30,000 30,000 27,000 10,500 150,000 5 Ruang Perinatologi Dokter Umum 31,500 18,000 18,000 16,200 6,300 90,000 Dokter Spesialis 38,500 22,000 22,000 19,800 7,700 110,000 6 Recovery Room/ Kamar Isolasi Dokter Umum 52,500 30,000 30,000 27,000 10,500 150,000 Dokter Spesialis 61,250 35,000 35,000 31,500 12,250 175,000 7 ICU Dokter Umum 87,500 50,000 50,000 45,000 17,500 250,000 Dokter Spesialis 96,250 55,000 55,000 49,500 19,250 275,000
2.RUANG INTENSIF (ICU) No Jenis Pelayanan Jasa Rumah Sakit Jasa Pelayanan JLH BPH JASA SARANA JM JPM JNM ICU (INTENSIVE CARE UNIT ) I Perawatan Khusus di ICU 8,750 5,000 5,000 4,500 1,750 25,000 1 Dokter Spesialis 119,700 68,400 68,400 61,560 23,940 342,000 2 Dokter Umum /Dokter Jaga ICU 98,700 56,400 56,400 50,760 19,740 282,000 II Tindakan Pelayanan 10,500 6,000 6,000 5,400 2,100 30,000 1 kanulasi Vena Periver /Infus 10,500 6,000 6,000 5,400 2,100 30,000 2 Kanulasi vena Sentral (CVC) Dewasa 126,000 72,000 72,000 64,800 25,200 360,000 3 Kanulasi Vena Sentral (CVC) Anak 126,000 72,000 72,000 64,800 25,200 360,000 4 WSD (Water Sealad Drainage 252,000 144,000 144,000 129,600 50,400 720,000 5 Vena Sectie 37,800 21,600 21,600 19,440 7,560 108,000 6 DC Shock 46,200 26,400 26,400 23,760 9,240 132,000 jdih.pakpakbharatkab.go.id 7 Tracheostomy 189,000 108,000 108,000 97,200 37,800 540,000 8 Intubasi Trakhea 84,000 48,000 48,000 43,200 16,800 240,000 9 Ekstubasi Trakhea 42,000 24,000 24,000 21,600 8,400 120,000 10 RJP 77,000 44,000 44,000 39,600 15,400 220,000 11 Setting Ventilator 54,600 31,200 31,200 28,080 10,920 156,000 12 Suction /Wasing /Hari 14,700 8,400 8,400 7,560 2,940 42,000 13 Nubulijer /Kali 14,700 8,400 8,400 7,560 2,940 42,000 14 Insersi NGT 33,600 19,200 19,200 17,280 6,720 96,000 15 Magg -Cooling /Cooling Spoeling 42,000 24,000 24,000 21,600 8,400 120,000 16 Pasang Kateter Urine 33,600 19,200 19,200 17,280 6,720 96,000 17 Lepas Kateter Urine 8,400 4,800 4,800 4,320 1,680 24,000 18 Klisma 18,900 10,800 10,800 9,720 3,780 54,000 19 EKG 27,300 15,600 15,600 14,040 5,460 78,000 20 Ventilator 113,400 64,800 64,800 58,320 22,680 324,000 21 Siringe Pump 27,300 15,600 15,600 14,040 5,460 78,000 22 Infusion pump 27,300 15,600 15,600 14,040 5,460 78,000 23 Bed Decubitus 16,800 9,600 9,600 8,640 3,360 48,000 24 Warm Matress 16,800 9,600 9,600 8,640 3,360 48,000 C. PELAYANAN MEDIS DASAR DAN ATAU SPESIALISTIK
1.DALAM / LUAR KAMAR OPERASI No Jenis Pelayanan Jasa Rumah Sakit Jasa Pelayanan JLH BPH JASA SARANA JM JPM JNM DI DALAM KAMAR OPERASI 1 Kecil Terencana 437,500 250,000 250,000 225,000 87,500 1,250,000 2 Kecil Akut 525,000 300,000 300,000 270,000 105,000 1,500,000 3 Sedang Terencana 700,000 400,000 400,000 360,000 140,000 2,000,000 4 Sedang Akut 875,000 500,000 500,000 450,000 175,000 2,500,000 5 Besar Terencana 1,050,000 600,000 600,000 540,000 210,000 3,000,000 6 Besar Akut 1,260,000 720,000 720,000 648,000 252,000 3,600,000 7 Khusus 1,575,000 900,000 900,000 810,000 315,000 4,500,000 DI LUAR KAMAR OPERASI 1 Kecil 175,000 100,000 100,000 90,000 35,000 500,000 2 Sedang 245,000 140,000 140,000 126,000 49,000 700,000 3 Besar 297,500 170,000 170,000 153,000 59,500 850,000
2.PERSALINAN No Jenis Pelayanan Jasa Rumah Sakit Jasa Pelayanan JLH BPH JASA SARANA JM JPM JNM PERSALINAN 1 Persalinan Normal 192,500 110,000 110,000 99,000 38,500 550,000 2 Persalinan Giemeli/Kembar,dst 231,000 132,000 132,000 118,800 46,200 660,000 3 Persalinan dengan tindakan Vakum 245,000 140,000 140,000 126,000 49,000 700,000 4 Persalinan dengan Resiko Tinggi 297,500 170,000 170,000 153,000 59,500 850,000 5 Kuretase 168,000 96,000 96,000 86,400 33,600 480,000 6 Maual Plasenta 147,000 84,000 84,000 75,600 29,400 420,000 7 Embriotomi 260,750 149,000 149,000 134,100 52,150 745,000
3.TINDAKAN RUTIN No Jenis Pelayanan Jasa Rumah Sakit Jasa Pelayanan BPH JASA SARANA JM JPM JLH 1 2 3 4 5 6 7 TINDAKAN RUTIN 1 Pemasangan Infus/tindakan 1,794 4,100 5,125 4,100 20,500 2 Pemasangan Kateter/tindakan 8,400 19,200 24,000 19,200 96,000 3 Lepas Kateter (Aff Chateter) 2,188 5,000 6,250 5,000 25,000 4 Pemasangan NGT 7,350 16,800 21,000 16,800 84,000 5 Pemberian Injeksi/tindakan 613 1,400 1,750 1,400 7,000 6 Klisma/tindakan 1,313 3,000 3,750 3,000 15,000 7 Voorbreding/tindakan 1,225 2,800 3,500 2,800 14,000 8 Vulva Hygiene/tindakan 1,225 2,800 3,500 2,800 14,000 9 Sonde/tindakan 1,400 3,200 4,000 3,200 16,000 10 Pasang Tanpon/Aff Tampon 1,225 2,800 3,500 2,800 14,000 11 Memandikan Pasien 744 1,700 2,125 1,700 8,500 12 Cooling Spooling/tindakan 9,188 21,000 26,250 21,000 105,000 jdih.pakpakbharatkab.go.id 13 Ganti Verban/ Debridement Luka Kecil/hari 2,188 5,000 6,250 5,000 25,000 Sedang/hari 3,500 8,000 10,000 8,000 40,000 Besar/hari 4,813 11,000 13,750 11,000 55,000 D. PELAYANAN PENUNJANG MEDIK DAN ATAU DIAGNOSTIK
1.INSTALASI RADIOLOGI No Jenis Pelayanan Jasa Rumah Sakit Jasa Pelayanan BPH JASA SARANA JM JPM JLH JLH INSTALASI RADIOLOGI 1 Thorax PA/AP 29,750 17,000 17,000 15,300 5,950 85,000 2 Thorax Lateral 29,750 17,000 17,000 15,300 5,950 85,000 3 Schaedel 33,250 19,000 19,000 17,100 6,650 95,000 4 Sinus Paranasal/ Mastoid 33,250 19,000 19,000 17,100 6,650 95,000 5 Maxilla/ Mandibula 33,250 19,000 19,000 17,100 6,650 95,000 6 Ekstremitas Superior/ Inferior 26,250 15,000 15,000 13,500 5,250 75,000 7 Manus/ Pedis 22,750 13,000 13,000 11,700 4,550 65,000 8 Polos Abdomen/ BNO 38,500 22,000 22,000 19,800 7,700 110,000 9 Vertebra 38,500 22,000 22,000 19,800 7,700 110,000 10 Lumbosacral 38,500 22,000 22,000 19,800 7,700 110,000 11 Pelvic 38,500 22,000 22,000 19,800 7,700 110,000 12 MDF/ Oesofagus 147,000 84,000 84,000 75,600 29,400 420,000 13 BNO/ IVP 157,500 90,000 90,000 81,000 31,500 450,000 14 Appendic 157,500 90,000 90,000 81,000 31,500 450,000 INSTALASI ELEKTRO MEDIK 1 EKG 21,000 12,000 12,000 10,800 4,200 60,000 2 USG Kebidanan 28,000 16,000 16,000 14,400 5,600 80,000 3 USG Upper Abdomen 43,750 25,000 25,000 22,500 8,750 125,000 4 USG Lower Abdomen 43,750 25,000 25,000 22,500 8,750 125,000 5 Head CT-Scann 227,500 130,000 130,000 117,000 45,500 650,000 6 Endoscopy 175,000 100,000 100,000 90,000 35,000 500,000 7 MRI 962,500 550,000 550,000 495,000 192,500 2,750,000 8 Monitor Pasien 26,250 15,000 15,000 13,500 5,250 75,000 9 Ventilator 52,500 30,000 30,000 27,000 10,500 150,000 REHABILITASI MEDIK Sederhana 7,875 4,500 4,500 4,050 1,575 22,500 Sedang 12,250 7,000 7,000 6,300 2,450 35,000 10 Ortotik/ Prostotik Sederhana 38,500 22,000 22,000 19,800 7,700 110,000 Sedang 70,000 40,000 40,000 36,000 14,000 200,000 Canggih 113,750 65,000 65,000 58,500 22,750 325,000
2.INSTALASI LABORATORIUM No Jenis Pelayanan Jasa Rumah Sakit Jasa Pelayanan BPH JASA SARANA JM JPM JLH JLH INSTALASI LABORATORIUM 1 Darah Lengkap 17,500 10,000 10,000 9,000 3,500 50,000 Haemoglobin 4,725 2,700 2,700 2,430 945 13,500 Leukosit 4,725 2,700 2,700 2,430 945 13,500 Eritrosit 4,725 2,700 2,700 2,430 945 13,500 Trombosit 5,250 3,000 3,000 2,700 1,050 15,000 LED 4,725 2,700 2,700 2,430 945 13,500 Golongan Darah 7,000 4,000 4,000 3,600 1,400 20,000 Morfologi Darah Tepi 17,500 10,000 10,000 9,000 3,500 50,000 2 KIMIA KLINIK HATI SGOT 14,175 8,100 8,100 7,290 2,835 40,500 SGPT 14,175 8,100 8,100 7,290 2,835 40,500 Gamma GT 14,175 8,100 8,100 7,290 2,835 40,500 LDH 14,175 8,100 8,100 7,290 2,835 40,500 Bilirubin Total 14,175 8,100 8,100 7,290 2,835 40,500 Bilirubin Direk 14,175 8,100 8,100 7,290 2,835 40,500 Protein Total 11,900 6,800 6,800 6,120 2,380 34,000 Albumin 11,900 6,800 6,800 6,120 2,380 34,000 Globulin 11,900 6,800 6,800 6,120 2,380 34,000 3 IMUNOSEROLOGI MARKER HbsAg 26,250 15,000 15,000 13,500 5,250 75,000 Anti-Hbs 35,000 20,000 20,000 18,000 7,000 100,000 Anti-Hbc 52,500 30,000 30,000 27,000 10,500 150,000 Anti-Hbc IGM 87,500 50,000 50,000 45,000 17,500 250,000 Hbe-Ag 70,000 40,000 40,000 36,000 14,000 200,000 Anti-HAV 70,000 40,000 40,000 36,000 14,000 200,000 Anti-HCV 87,500 50,000 50,000 45,000 17,500 250,000 jdih.pakpakbharatkab.go.id 4 GLUKOSA DARAH Glukosa Puasa 9,625 5,500 5,500 4,950 1,925 27,500 Glukosa 2 jam PP 9,625 5,500 5,500 4,950 1,925 27,500 Glukosa Sewaktu 9,625 5,500 5,500 4,950 1,925 27,500 OGTT 52,500 30,000 30,000 27,000 10,500 150,000 5 KOAGULASI Waktu Perdarahan 5,250 3,000 3,000 2,700 1,050 15,000 Waktu Pembekuan 5,250 3,000 3,000 2,700 1,050 15,000 6 LEMAK DARAH Cholesterol Total 17,500 10,000 10,000 9,000 3,500 50,000 Cholesterol HDL 21,525 12,300 12,300 11,070 4,305 61,500 Cholesterol LDL 21,525 12,300 12,300 11,070 4,305 61,500 Trigliserida 15,750 9,000 9,000 8,100 3,150 45,000 7 PROFILE JANTUNG Ck-Nac 28,000 16,000 16,000 14,400 5,600 80,000 Ck-MB 45,500 26,000 26,000 23,400 9,100 130,000 LDH 12,250 7,000 7,000 6,300 2,450 35,000 8 FUNGSI GINJAL Ureum 11,200 6,400 6,400 5,760 2,240 32,000 Kreatinin 11,200 6,400 6,400 5,760 2,240 32,000 Urea Clearance 15,750 9,000 9,000 8,100 3,150 45,000 Kreatinin Clearance 15,750 9,000 9,000 8,100 3,150 45,000 9 ELEKTROLIT/ GAS DARAH Kalium 14,525 8,300 8,300 7,470 2,905 41,500 Natrium 14,525 8,300 8,300 7,470 2,905 41,500 Clorida 22,750 13,000 13,000 11,700 4,550 65,000 Magnesium 22,750 13,000 13,000 11,700 4,550 65,000 AGDA 52,500 30,000 30,000 27,000 10,500 150,000 10 KIMIA KLINIK LAIN Asam Urat 11,200 6,400 6,400 5,760 2,240 32,000 Amilase 38,500 22,000 22,000 19,800 7,700 110,000 Lipase 38,500 22,000 22,000 19,800 7,700 110,000 11 INFEKSI LAIN Widal Test 19,250 11,000 11,000 9,900 3,850 55,000 Malaria 14,000 8,000 8,000 7,200 2,800 40,000 HIV Dipstick 61,250 35,000 35,000 31,500 12,250 175,000 DengueNS/Ag 99,750 57,000 57,000 51,300 19,950 285,000 12 HORMON/ ENDOKRINOLOGI Tes Kehamilan 8,750 5,000 5,000 4,500 1,750 25,000 Beta-HCG Serum 70,000 40,000 40,000 36,000 14,000 200,000 13 TEST NARKOBA Methampetamine (Ectasy, Shabu-shabu) 28,000 16,000 16,000 14,400 5,600 80,000 Opiates (Putao, Morphine, Heroin) 28,000 16,000 16,000 14,400 5,600 80,000 THC (Ganja) 28,000 16,000 16,000 14,400 5,600 80,000 14 CSP 1.Albumin 13,440 7,680 7,680 6,912 2,688 38,400 2.Nonne - Pandy 13,860 7,920 7,920 7,128 2,772 39,600 15 LAIN - LAIN 1.Analisa Sperma 15,960 9,120 9,120 8,208 3,192 45,600 2.Test Kehamilan 11,760 6,720 6,720 6,048 2,352 33,600 3.KOH 10 % 10,080 5,760 5,760 5,184 2,016 28,800 4.ASTO 18,900 10,800 10,800 9,720 3,780 54,000 5.IRON 18,900 10,800 10,800 9,720 3,780 54,000 6.Reumatoid Factor ( RF ) 27,300 15,600 15,600 14,040 5,460 78,000 7.CRF 16,800 9,600 9,600 8,640 3,360 48,000 8.HFV 35,700 20,400 20,400 18,360 7,140 102,000
3.UNIT TRANSPUSI DARAH No Jenis Pelayanan Jasa Rumah Sakit Jasa Pelayanan BPH JASA SARANA JM JPM JNM JLH UNIT TRANSPUSI DARAH 1 Whole Blood/ kantong 134,750 77,000 77,000 69,300 26,950 385,000 2 PRC/ kantong 157,500 90,000 90,000 81,000 31,500 450,000
4.PEMAKAIAN OKSIGEN No Jenis Pelayanan Jasa Rumah Sakit Jasa Pelayanan BPH JASA SARANA JM JPM JNM JLH PEMAKAIAN OKSIGEN 1 Oksigen per liter 175 100 100 90 35 500 2 Oksigen per tabung 35,000 20,000 20,000 18,000 7,000 100,000 jdih.pakpakbharatkab.go.id E. PELAYANAN INSTALASI
1.KAMAR JENAZAH No Jenis Pelayanan Jasa Rumah Sakit Jasa Pelayanan BPH JASA SARANA JM JPM JNM JLH INSTALASI KAMAR JENAZAH I Penyimpanan Jenazah 1 Ruang biasa/ hari 15,750 9,000 9,000 8,100 3,150 45,000 2 Ruang pendingin/ hari 47,250 27,000 27,000 24,300 9,450 135,000 II Pemeriksaan Jenazah 1 Periksa Luar 26,250 15,000 15,000 13,500 5,250 75,000 2 Periksa Dalam/otopsi 210,000 120,000 120,000 108,000 42,000 600,000 III Perbaikan Jenazah 1 Hecting 1-10 21,000 12,000 12,000 10,800 4,200 60,000 2 Hecting 10-20 26,250 15,000 15,000 13,500 5,250 75,000 3 Hecting >20 45,500 26,000 26,000 23,400 9,100 130,000 IV Pengawetan Jenazah 1 Untuk 1 hari 87,500 50,000 50,000 45,000 17,500 250,000 2 Untuk 2 hari 157,500 90,000 90,000 81,000 31,500 450,000 3 Untuk 3 hari 227,500 130,000 130,000 117,000 45,500 650,000 4 Untuk > 3hari 297,500 170,000 170,000 153,000 59,500 850,000 V Pemakaman Jenazah 157,500 90,000 90,000 81,000 31,500 450,000 F. PELAYANAN LAINNYA
1.MOBIL AMBULANCE No Jenis Pelayanan Jasa Rumah Sakit Jasa Pelayanan BPH JASA SARANA JM JPM JNM JLH MOBIL AMBULANCE 1 Dalam Daerah