Kode Layanan (RS) | Nama Layanan (Nomenklatur Kepdirjen) | Tarif Baru Reguler | Tarif Baru Non Reguler |
UM.001 | Pendaftaran Rawat Jalan/Poliklinik | 10,000 | 10,000 |
UM.002 | Pemeriksaan Dokter Umum | 40,000 | 80,000 |
UM.003 | Pemeriksaan Dokter Spesialis | 90,000 | 175,000 |
UM.004 | Telekonsultasi | 150,000 | 150,000 |
UM.005 | Observasi > 2 jam | 21,000 | 210,000 |
UM.006 | Observasi > 6 jam | 52,500 | 550,000 |
UM.007 | Kartu Identitas Berobat (KIB) | 10,000 | 10,000 |
UM.008 | Peminjaman Rekam Medis (RM) untuk penelitian dari luar RSUP | 5,000 | 5,000 |
UM.009 | Cetak dokumen per lembar | 5,000 | 5,000 |
UM.010 | Pengesahan surat pe 5 lembar | 10,000 | 10,000 |
UM.011 | Surat Keterangan Kelahiran ( karena hilang, rusak ) | 37,500 | 37,500 |
UM.012 | Pengisian data medis pasien pada form penelitian perRM | 37,500 | 37,500 |
UM.013 | Tarif Pengiriman Resume Medis (Ke Jakarta) | 50,000 | 50,000 |
UM.016 | Resume Medis untuk klaim asuransi | 75,000 | 75,000 |
UM.017 | Medical setrificate | 125,000 | 125,000 |
UM.018 | Data Laporan pertahun untuk penelitian | 130,000 | 130,000 |
UM.019 | Data biaya perawatan pasien untuk keperluan penelitian (per rekam medik) | 10,000 | 10,000 |
AKM.001 | Pendaftaran Kelas III | 31,500 | – |
AKM.002 | Pendaftaran Kelas II | 35,000 | – |
AKM.003 | Pendaftaran Kelas I | 35,000 | – |
AKM.004 | Pendaftaran Kelas VIP | – | 35,000 |
AKM.005 | Pendaftaran Kelas VVIP | – | 35,000 |
AKM.006 | Ruang Rawat Kelas III | 210,000 | – |
AKM.007 | Ruang Rawat Kelas II | 280,000 | – |
AKM.008 | Ruang Rawat Kelas I | 350,000 | – |
AKM.009 | Ruang Rawat Kelas VIP | – | 550,000 |
AKM.010 | Ruang Rawat Kelas VVIP | – | 1,500,000 |
AKM.011 | Visit Kelas III | 72,000 | – |
AKM.012 | Visit Kelas II | 80,000 | – |
AKM.013 | Visit Kelas I | 100,000 | – |
AKM.014 | Visit Kelas VIP | – | 200,000 |
AKM.015 | Visit Kelas VVIP | – | 300,000 |
AKM.016 | Asuhan Keperawatan Kelas III | 25,000 | – |
AKM.017 | Asuhan Keperawatan Kelas II | 40,000 | – |
AKM.018 | Asuhan Keperawatan Kelas I | 50,000 | – |
AKM.019 | Asuhan Keperawatan Kelas VIP | – | 100,000 |
AKM.020 | Asuhan Keperawatan Kelas VVIP | – | 150,000 |
AKM.021 | Pemakaian Kamar Operasi | 1,000,000 | 1,000,000 |
INT.001 | Pendaftaran | 35,000 | 35,000 |
INT.002 | Ruang Rawat Intensive (Intensive) | 550,000 | 550,000 |
INT.003 | Ruang Rawat Intermediate Care (HCU) | 350,000 | 350,000 |
INT.004 | Visit dokter subspesialis Intensive Care (Intensivist) | 200,000 | 200,000 |
INT.005 | Visit dokter subspesialis Intermediate Care (HCU) | 100,000 | 100,000 |
INT.006 | Asuhan Keperawatan (Intensive) | 120,000 | 120,000 |
INT.007 | Asuhan Keperawatan Intermediate Care (HCU) | 50,000 | 50,000 |
INT.008 | Oral Hygiene | 20,000 | 20,000 |
INT.009 | Perawatan Tali Pusat | 30,000 | 30,000 |
INT.010 | Melakukan Penis / vulva Hygine | 60,000 | 60,000 |
INT.011 | Ganti Balutan / Dressing Akses Central | 75,000 | 75,000 |
INT.012 | Blood warmer | 113,000 | 113,000 |
INT.013 | Clisma Neonatus | 150,000 | 150,000 |
INT.014 | Syringe pump | 165,000 | 165,000 |
INT.015 | Inhalasi pasien neonatus | 180,000 | 180,000 |
INT.016 | Infus pump | 210,000 | 210,000 |
INT.017 | Perawatan Luka Ringan | 225,000 | 225,000 |
INT.018 | EKG Neonatus | 225,000 | 225,000 |
INT.019 | Monitoring End tidal CO2 Harian oleh DPJP pasien pediatrik | 300,000 | 300,000 |
INT.020 | Pencabutan Akses intraoseus | 300,000 | 300,000 |
INT.021 | Pungsi Arteri | 300,000 | 300,000 |
INT.022 | Suction Neonatus | 300,000 | 300,000 |
INT.023 | Pemasangan alat Trancutaneous CO2 | 300,000 | 300,000 |
INT.024 | Bubble CPAP + HFFN | 360,000 | 360,000 |
INT.025 | Pasang infus Neonatus | 360,000 | 360,000 |
INT.026 | Imunisasi Hepatitis B – Uniject umum | 375,000 | 375,000 |
INT.027 | Perawatan WSD/pigtail | 413,000 | 413,000 |
INT.028 | Pemasangan Catheter Urin pada Neonatus | 435,000 | 435,000 |
INT.029 | Cerebral Monitoring | 450,000 | 450,000 |
INT.030 | Ekstubasi dengan penyulit pasien pediatrik | 450,000 | 450,000 |
INT.031 | Pencabutan arteri line | 450,000 | 450,000 |
INT.032 | Monitoring Hemodinamik Non Invasive Harian oleh DPJP (Eria) | 525,000 | 525,000 |
INT.033 | Monitoring Cardiac Output | 525,000 | 525,000 |
INT.034 | Tindakan (monitor cardio respiratory) | 525,000 | 525,000 |
INT.035 | Tindakan (monitor SPO2 – saturasi) | 525,000 | 525,000 |
INT.036 | Perawatan Stoma Anak | 555,000 | 555,000 |
INT.037 | Perawatan Luka Sedang | 563,000 | 563,000 |
INT.038 | PIjat Stimulasi Bayi Prematur | 585,000 | 585,000 |
INT.039 | Pencabutan PICC | 600,000 | 600,000 |
INT.040 | Perawatan CVC per-3 hari | 600,000 | 600,000 |
INT.041 | Ekstubasi Neonatus | 675,000 | 675,000 |
INT.042 | Removal CVP | 750,000 | 750,000 |
INT.043 | Monitoring Tekanan Intracranial | 750,000 | 750,000 |
INT.044 | Monitoring Hemodinamik invasive oleh DPJP | 750,000 | 750,000 |
INT.045 | Tatalaksana sedasi kontinu (critical care) | 750,000 | 750,000 |
INT.046 | Monitoring Hemodinamik invasive harian oleh DPJP | 750,000 | 750,000 |
INT.047 | Setting harian HFNC / HFOT | 750,000 | 750,000 |
INT.048 | Titrasi vasopresor dan inotropik kontinu bed side (critical care) | 750,000 | 750,000 |
INT.049 | Konsultasi ruang intensif anak pada kondisi khusus | 750,000 | 750,000 |
INT.050 | Pemasangan non-invasive respiratory support | 750,000 | 750,000 |
INT.051 | Pemberian Surfaktan | 750,000 | 750,000 |
INT.052 | Pelepasan Akses Central | 750,000 | 750,000 |
INT.053 | Monitoring Hemodinamik Non Invasive Harian oleh DPJP | 750,000 | 750,000 |
INT.054 | Ruang Rawat HCU / SCN / SCN Isolasi | 825,000 | 825,000 |
INT.055 | Pemasangan Akses Intraoseus (Eria) | 900,000 | 900,000 |
INT.056 | Reposisi Kateter Peritoneal Dialisis Akut | 1,005,000 | 1,005,000 |
INT.057 | Tindakan Sedasi Sedang pasien pediatrik | 1,050,000 | 1,050,000 |
INT.058 | Acute Peritoneal Dialysis Cath Removal | 1,050,000 | 1,050,000 |
INT.059 | Aff akses peritoneal dialisis akut | 1,050,000 | 1,050,000 |
INT.060 | Pemberian Terapi Parentral Nutrisi Harian oleh DPJP | 1,125,000 | 1,125,000 |
INT.061 | Transfusi darah dengan filter pasien neonatus | 1,425,000 | 1,425,000 |
INT.062 | Setting harian HNFC / HFOT pasien pediatrik | 1,500,000 | 1,500,000 |
INT.063 | Setting ventilator harian pasien pediatrik | 1,500,000 | 1,500,000 |
INT.064 | Monitoring harian IABP | 1,500,000 | 1,500,000 |
INT.065 | NICU | 1,500,000 | 1,500,000 |
INT.066 | Terapi sinar/light Terapi intensif | 1,500,000 | 1,500,000 |
INT.067 | Infant flow SIPAP | 1,500,000 | 1,500,000 |
INT.068 | Pemasangan Non-invasive respiratory support | 1,500,000 | 1,500,000 |
INT.069 | Monitoring Nitric Oxide | 1,500,000 | 1,500,000 |
INT.070 | Kalorimetri indirek | 1,500,000 | 1,500,000 |
INT.071 | Pemasangan NIV+ NAVA pasien neonatus | 1,500,000 | 1,500,000 |
INT.072 | Ventilator (invasif & NIPPV) konvensional Neonatus | 1,500,000 | 1,500,000 |
INT.073 | Pemasangan Umbilical | 1,590,000 | 1,590,000 |
INT.074 | Setting harian HNFC / HFOT pasien neonatus | 1,650,000 | 1,650,000 |
INT.075 | Pungsi Pleura Emergency pada Neonatus | 1,746,000 | 1,746,000 |
INT.076 | Echocardiography hemodynamic pasien neonatus | 1,800,000 | 1,800,000 |
INT.077 | Aspirasi supra Pubik | 1,800,000 | 1,800,000 |
INT.078 | Penggunaan monitoring NIRS | 1,875,000 | 1,875,000 |
INT.079 | Pemasangan Amplitude EEG | 1,875,000 | 1,875,000 |
INT.080 | Nasal HFO | 1,875,000 | 1,875,000 |
INT.081 | Lumbal Pungsi Neonatus | 1,950,000 | 1,950,000 |
INT.082 | Cvvh/Cvvhd/Cvvhdf Harian | 2,223,000 | 2,223,000 |
INT.083 | Blanket warmer/ Matras cooling | 2,250,000 | 2,250,000 |
INT.084 | Pemasangan HFOV pertama Pediatrik | 2,250,000 | 2,250,000 |
INT.085 | Pemasangan Ventilator awal | 2,250,000 | 2,250,000 |
INT.086 | Blanket warmer/ Matras cooling (Manajemen Hipohipotermia) | 2,250,000 | 2,250,000 |
INT.087 | Setting ventilator harian pasien neonatus | 2,250,000 | 2,250,000 |
INT.088 | Lung recruitment manuver | 2,250,000 | 2,250,000 |
INT.089 | Reposisi CVC | 2,250,000 | 2,250,000 |
INT.090 | Ventilator + HFO | 2,250,000 | 2,250,000 |
INT.091 | RJP pasien neonatus | 2,250,000 | 2,250,000 |
INT.092 | Tindakan kardioversi pasien neonatus | 2,250,000 | 2,250,000 |
INT.093 | Pemasangan Akses Intraoseus | 3,000,000 | 3,000,000 |
INT.094 | Pemasangan Peritoneal Dialisis Akut | 3,000,000 | 3,000,000 |
INT.095 | Pemasangan Arteri line oleh DPJP | 4,200,000 | 4,200,000 |
INT.096 | Sled | 4,200,000 | 4,200,000 |
INT.097 | Pemasangan Ventilator awal | 4,500,000 | 4,500,000 |
INT.098 | Pemasangan PICC pasien neonatus | 4,500,000 | 4,500,000 |
INT.099 | CVC / CVP/ Akses Femoral Neonatus | 4,500,000 | 4,500,000 |
INT.100 | CVP Akses Vaskuler | 4,500,000 | 4,500,000 |
INT.101 | Pemasangan PICC pasien pediatrik | 4,800,000 | 4,800,000 |
INT.102 | CVP Akses Vaskuler dengan USG | 5,250,000 | 5,250,000 |
INT.103 | Pemasangan Arteri Line dengan bantuan USG oleh DPJP | 5,250,000 | 5,250,000 |
INT.104 | Pemberian Nitrit Oxide Neonatus | 6,000,000 | 6,000,000 |
INT.105 | Transfusi tukar pasien neonatus | 7,500,000 | 7,500,000 |
INT.106 | Plasmaferesis CRRT | 22,064,000 | 22,064,000 |
INT.107 | Cvvh/Cvvhd/Cvvhdf Harian | 24,675,000 | 24,675,000 |
IGD.001 | Pendaftaran | 25,000 | 25,000 |
IGD.002 | Pemeriksaan Dokter Umum | 50,000 | 50,000 |
IGD.003 | Pemeriksaan Dokter Spesialis | 90,000 | 90,000 |
IGD.004 | Konsultasi antar KSM | 65,000 | 65,000 |
IGD.005 | Vulnus Excoriatum | 41,000 | 41,000 |
IGD.006 | Inset Bite | 57,000 | 57,000 |
IGD.007 | Arm sling | 112,500 | 112,500 |
IGD.008 | Butterfly gip | 112,500 | 112,500 |
IGD.009 | Skin Traksi | 112,500 | 112,500 |
IGD.010 | Vulnus Ictum | 126,000 | 126,000 |
IGD.011 | Dilatasi/Preputium (IRD) | 142,500 | 142,500 |
IGD.012 | Buick Punctic | 150,000 | 150,000 |
IGD.013 | Vulnus Apertum < 5 cm | 153,000 | 153,000 |
IGD.014 | Insisi Abses/Explorasi | 162,000 | 162,000 |
IGD.015 | Vulnus Amputatum | 190,500 | 190,500 |
IGD.016 | Combustio < 15% | 193,500 | 193,500 |
IGD.017 | 5 – 10 jahitan | 193,500 | 193,500 |
IGD.018 | Vulnus Apertum denga jahitan < 5 jahitan | 193,500 | 193,500 |
IGD.019 | Tarif Rawat jalan Reposisi tanpa GA di Triage Bedah – Tindakan Ransel Verban dan Elbow+Back Slab | 200,250 | 200,250 |
IGD.020 | Combustio > 15% | 217,500 | 217,500 |
IGD.021 | Ekstraksi kuku | 300,000 | 300,000 |
IGD.022 | Shoc Cast | 300,750 | 300,750 |
IGD.023 | Tarif Rawat jalan Reposisi tanpa GA di Triage Bedah – Long Arm Gips dan Long Leg | 307,500 | 307,500 |
IGD.024 | Tarif Rawat jalan Reposisi tanpa GA di Triage Bedah – Short Arm | 307,500 | 307,500 |
IGD.025 | Multiple Vulnus Apertum | 325,500 | 325,500 |
IGD.026 | Tarif Rawat jalan Reposisi dg GA di OK IRD – Short Arm | 367,500 | 367,500 |
IGD.027 | Dorsumsisi | 387,000 | 387,000 |
IGD.028 | Trocat Cystostomy | 406,500 | 406,500 |
IGD.029 | High Below Knee | 427,500 | 427,500 |
IGD.030 | Tarif Rawat jalan Reposisi dg GA di OK IRD – Long Arm | 427,500 | 427,500 |
IGD.031 | Explorasi C. Alienum | 433,500 | 433,500 |
IGD.032 | Tarif Rawat jalan Reposisi dg GA di OK IRD – Long Leg | 552,000 | 552,000 |
IGD.033 | Thoracostomy/WSD | 1,200,000 | 1,200,000 |
IGD.034 | Resusitasi ringan | 1,275,000 | 1,275,000 |
IGD.035 | Resusitasi sedang | 1,950,000 | 1,950,000 |
IGD.036 | Resusitasi berat | 3,150,000 | 3,150,000 |
IGD.037 | Alkohol bath | 9,000 | 9,000 |
IGD.038 | Lavomen Bayi | 18,750 | 18,750 |
IGD.039 | Pasang Infus (Triage medik) | 19,500 | 19,500 |
IGD.040 | Nebulizer + Oksigen | 22,500 | 22,500 |
IGD.041 | Extraksi Corpus Alienum sederhana | 33,000 | 33,000 |
IGD.042 | Injeksi IM/IV | 37,500 | 37,500 |
IGD.043 | Spoeling | 38,250 | 38,250 |
IGD.044 | Kumbah lambung | 57,000 | 57,000 |
IGD.045 | Pasang Kateter | 57,000 | 57,000 |
IGD.046 | Nebulizer + Syringe Pump + Oksigenasi | 64,500 | 64,500 |
IGD.047 | Pemakaian EKG Monitor | 120,000 | 120,000 |
IGD.048 | Resusitasi (ABC) | 172,500 | 172,500 |