LAMPIRAN PERATURAN PERATURAN BUPATI INDRAGIRI HILIR NOMOR TAHUN 2018 TENTANG TARIF TARIF LAYANAN RUMAH RUMAH SAKIT SAKIT UMUM DAERAH DAERAH PUSAT KESEHATAN KESEHATAN MASYARAKAT MASYARAKAT TARIF LAYANAN LAYANAN RUMAH SAKIT UMUM DAERAH PUSAT KESEHATAN MASYARAKAT I.
REKAM MEDIS
NO
JENIS TINDAKAN
1 1 2 3
2 Karcis Kartu Berobat Pasien Surat Ke Keteran rangan Se Sehat/K t/KIR Kesehatan
JASA SARANA SARANA JASA PELAYANAN PELAYANAN (Rp) (Rp) 3
4
JUMLAH 5
2,000 5,000
1,000 -
3,000 5,000
-
15,000
15,000
II. INSTA INSTALAS LASII GAWA GAWAT T DARUR DARURAT AT (IGD (IGD)) NO
JENIS TINDAKAN
JASA SARANA SARANA JASA PELAYANAN PELAYANAN (Rp) (Rp)
JUMLAH
Askep - Nic/noc Visite dokter spesialis VIP Visite dokter umum/dokter gigi Cito visite dokter spesialis Cito Visite dokter umum/ dokter gigi
Konsul dokter antar bagian
-
40,000 80,000 40,000 100,000 50,000 100,000
40,000 80,000 40,000 100,000 50,000 100,000
IV. IV. HCU HCU / ISO ISOLA LASI SI NO
JENIS TINDAKAN
1 1 2
2
3 4 5
Kamar rawatan Askep - Nic/noc Visite dokter spesialis Visite dokter Umum Tindakan
JASA SARANA SARANA JASA PELAYANAN PELAYANAN (Rp) (Rp) 3 4 150,000 -
60,000 100,000 50,000
JUMLAH 5 15 150,000 60,000 100,000 50,000
VIII. TINDAKAN TINDAKAN IGD, IGD, RAWAT INAP, INAP, ICU, ICU, NICU DAN DAN PERINATOLO PERINATOLOGI GI NO 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
JASA SARANA (Rp) 2 3 Pemasangan Vena line anak 5,000 Pemasangan Vena line dewasa 5,000 Pemasangan CVP 80,000 Tindakan Trombolitik 80,000 Setting awal ventilator (1 kali) 80,000 Intubasi tracheal (1 kali) 50,000 Suction/bronchial wash/hari 10,000 Pemakaian syring pump/hari 20,000 Pemakaian infusion pump/hari 10,000 Pemakaian ventilator/hari 150,000 Pemakaian DC Shock/1 kali 75,000 Lumbal pungsi 60,000 Subdural Tap 80,000 Setting CPAP 60,000 Pemasangan longline 80,000 WSD 90,000 Squi Squiz z kant kanton ong g gast gastri risc schi hisi sis/ s/on onip iphal haloc oche hell ll 30,00 30,000 0 Pemas Pemasan anga gan n Um Umbi bili lica call cate catete terr 25,00 25,000 0 JENIS TINDAKAN
PELAYANAN 4 20,000 10,000 125,000 125,000 120,000 100,000 20,000 10,000 10,000 50,000 150,000 90,000 120,000 90,000 120,000 210,000 45,00 45,000 0 75,00 75,000 0
JUMLAH 5 25,000 15,000 205,000 205,000 200,000 150,000 30,000 30,000 20,000 200,000 225,000 150,000 200,000 150,000 200,000 300,000 75,0 75,000 00 100, 100,00 000 0
1 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
2 Buka jahitan dan ganti balutan Spalk kaki spalk tangan Irigasi mata Ekstraksi kuku Nekrotomi/Amputasi Pasang NGT/OGT Kumbah lambung klisma Setting Awal Ventilator (1 Kali) Pemantauan CPAP/Hari Inkubator/Hari Terapi Sinar
3 10,000 20,000 15,000 15,000 10,000 20,000 5,000 20,000 15,000 75,000 30,000 100,000
4 15,000 30,000 20,000 20,000 50,000 110,000 30,000 70,000 20,000 200,000 25,000 20,000 50,000 5,000 3,000 3,000
Injeksi Intravena/ Intramosculer Per-Kali
Injeksi Bolus Via IVFD >3 Intrakutan/ Sub-Kutan
5 25,000 50,000 35,000 35,000 60,000 130,000 35,000 90,000 35,000 200,000 100,000 50,000 150,000 5,000 3 ,000 3 ,000
61
Vulva Higien
5,000
10,000
15,000
62
Cukur Rambut Pubis
5,000
10,000
15,000
63
Eksisi/ Ekstirpasi
5,000
10,000
15,000
VII. RUANG RAWATAN KEBIDANAN KELAS II
KELAS I
VI P
JENIS TINDAKAN JS 320, 320,00 000 0 320, 320,00 000 0 380,000
JP 400, 400,00 000 0 500, 500,00 000 0 600,000
PARTUS DENGAN PENYULIT BERAT
400,000
800,000
KURETASE NON KAMAR OPERASI/ SC/ Operasi lainnya RESUSITASI NEONATUS
400,000
800,000
NORM NORMAL AL BIDA BIDAN N NORM NORMAL AL (DOK (DOKTE TER) R) PARTUS DENGAN PENYULIT RINGAN
290,000
JUMLAH 720, 720,00 000 0 820, 820,00 000 0 980,000 1,200,000 1,200,000 290,000
JS 350, 350,00 000 0 350, 350,00 000 0 400,000
JP 450, 450,00 000 0 550, 550,00 000 0 670,000
420,000
900,000
420,000
900,000
SESUAI TARIF KAMAR 320,000
JUMLAH 800, 800,00 000 0 900, 900,00 000 0 1,070,000 1,320,000 1,320,000 OPERASI 320,000
JS 500, 500,00 000 0 500, 500,00 000 0 520,000
JP 550, 550,00 000 0 650, 650,00 000 0 700,000
JUMLAH 1,05 1,050, 0,00 000 0 1,15 1,150, 0,00 000 0 1,220,000
580,000
1,000,000
1,580,000
580,000
1,000,000
1,580,000
350,000
350,000
X. POLIKLINIK UMUM DAN SPESIALIS NO 1 1 2 3 4 5 6
JENIS TINDAKAN 2 TARIF PEMERIKSAAN PEMERIKSAAN Pemeriksaan/konsultasi dokter spesialis Pemeriksaan/dokter umum/ dokter gigi Konsultasi Gizi Konsultasi Farmasi Askep Jasa Farmasi per Pasien
TARIF POLIKLINIK POLIKLINIK A Pol Polikli iklini nik k Anak Anak 1 Imunisasi/kali a ) BCG
JASA SARANA (Rp)
JASA PELAYANAN (Rp)
JUMLAH
3
4
5
-
30,000
30,000
-
15,000 8,000 8,000 6,000 3,000
15,000 8,000 8, 8,000 6,000 3,000
6 000
10 000
16 000
14
15 16 17 18 19 20
Jahit luka a. 4 jahitan pertama b. >4 jahitan/jahitan Aff Hecting Pasang kateter biasa Pasang kateter dengan penyulit Dilatasi
30,000 4,500 6,000 10,000 15,000 10,000
20,000 3,000 10,000 15,000 25,000 40,000 5,000 3,000
50,000 7,500 16,000 25,000 40,000 50,000 5,000 3,000
21,000 15,000 15,000 21,000
15,000 15,000 15,000 15,000
36,000 30,000 30,000 36,000
22,000
10,000
32,000
Injeksi Intravena/ Intramosculer Per-Kali
Intrakutan/ Sub-Kutan
C Pol Polikil ikilin inik ik Gi Gigi 1 Tambalan sementara a.) Perawatan saluran akar b.) Open bour c.) Eksterpasi d.) Pengisian saluran akar 2 Tambal tetap a.) Tambal amalgam b.) Tambal
2 3 4 5 6 7 8 9
Injeksi sendi/intracurticuler Endoskopi BMP Punksi cairan pleura (Diagnostik)
Punksi cairan asites Nekrotomi EKG USG Print USG >2
E Poli Polikl klin inik ik Keb Kebid idan anan an 1 Ganti balutan tanpa/dengan buka jahitan 2 Ganti balutan + penyulit 3 Pasang IUD 4 Buka IUD 5 Biopsi/ekstirpasi polip 6 Pasang implant 7 Lepas implant
20,000 380,000 80,000 40,000 30,000 30,000 12,000 20,000 15,000
66,000 306,000 110,000 60,000 50,000 50,000 30 3 0,000 50 50,000
86,000 686,000 190,000 100,000 80,000 80,000 42,000 70,000 15,000
10,000 10,000 40,000 40,000 40,000 30,000
10,000 10,000 75,000 75,000 80,000 70,000
20,000 20,000 115,000 115,000 120,000 10 100,000
6 7 8 9 10 11
Incisi abses Peeling Ganti balutan Aplikasi TCA Microdermabrasi Pem Inspekulo
G Pol Polikli iklini nik k Mat Mata a 1 Angkat benang kornea 2 Angkat benang konjungtiva 3 Ekstraksi corpus alienum mata 4 Injeksi subkonjungtiva 5 Pengukuran tekanan suhu ocular 6 Refraksi 7 Geneoskopi 8 Funduskopi (dgn midriasil) 9 Autofraktemetri 10 Slit lamp 11 Test ischihara 12 Tes stereoskopi
30,000 30,000 9,000 30,000 90,000 6,000
20,000 80,000 6,000 80,000 60,000 27,000
50,000 110,000 15 1 5,000 110,000 150,000 33,000
12,000 10,000 20,000 15,000 9,000 6,000 10,000 10,000 10,000 30,000 5,000 10,000
18,000 15,000 60,000 20,000 16,000 15 15,000 25,000 15,000 16,000 15,000 10,000 15,000
30,000 25,000 80,000 35,000 25,000 21,000 35,000 25,000 26,000 45,000 15,000 25,000
7 8 9 10 11 12
Timpanometri Manufer CRT Tes Alergi Nasoskopi Nasofaringoskopi Laringoskopi
40,000 15,000 50,000 100,000 150,000 200,000
60,000 65,000 150,000 100,000 150,000 200,000
100,000 80,000 200,000 200,000 300,000 400,000
14 Insisi Insisi Abses Abses Preaur Preauriku ikula/ la/mas mastoi toid d 15 Ekstirpa Ekstirpasi si Jaring Jaringan an Granul Granulasi asi Liang Telinga 16 Insisi Insisi + Kuret Kuret Perikondr Perikondritis itis Teling Teling 17 Insisi Insisi + Drainase Drainase Abses Abses Septum Septum Hidung 18 Biopsi Tumor Superfisial 19 Insi Insisi si Drai Draina nase se Abse Abses s Peri Perito tons nsil il I
Poli Polikl klin inik ik Jiwa Jiwa dan dan Psi Psiko kolo logi gi a. Tindak Tindakan an seder sederhana hana - Assesment Psikologi - Assesment Assesment Dewasa Dewasa dan Lanj - Assesment Anak dan Remaja b. Tindak Tindakan an seda sedang ng - Psikoterapi per Paket - Psikoterapi Komplek - Psikoter Psikoterapi api Suppurtiv Suppurtive/Ed e/Edu u
40,00 40,000 0
60,000 60,000
100,00 100,000 0
40,000 40,000 40,000
60,000 60,000 60,000
10 100,000 100,000 100,000
40,000 40,000 48,0 48,000 00
60,000 60,000 72,0 72,000 00
100,000 100,000 120, 120,00 000 0
5,000 6,000 6,000 5,000
20,000 24,000 24,000 20,000
25,000 30,000 30,000 25,000
10,000 10,000 10,000 10,000
50,000 50,000 50,000 50,000
60,000 60,000 60,000 60,000
Uji Fungsi Defekasi Uji Kekuatan Otot Uji Fleksibilitas Fleksibilitas dan Lingkup G Uji Motorik Halus Uji Fungsi Lokomotor Uji Pola Jalan Uji Dekondisi Uji Kemampuan Kemampuan Fungsiona Fungsionall da Motor Lession Program Low Level laser Therapy
15,000 20,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000
35,000 30,000 35,000 35,000 35,000 35,000 35,000 35,000 35,000 35,000 40,000
50,000 50,000 50,000 50,000 50,000 50,000 50,000 50,000 50,000 50,000 55,000
c. Tindak Tindakan an Cangg Canggih ih Evaluasi Orthosis Evaluasi Prosthesis Biof Biofee eedb dbac ack k (EMG (EMG,, Pres Pressu sure re)) Uji Kardiorespirasi Dry Needing Spray dan Stretch Tapping dan Strapping Strapping Injeksi Botulinum Toksin A (tia
20,000 20,000 35,0 35,000 00 25,000 20,000 20,000 20,000 40,000
45,000 45,000 45,0 45,000 00 40,000 45,000 45,000 45,000 110,000
65,000 65,000 80,0 80,000 00 65,000 65,000 65,000 65,000 150,000
Mc.K Mc.Ken enzy zy,B ,Bra rand ndar arof offf exc) exc) - Terapi Edukasi - Latihan Pernafasan - Drainage
7,00 7,000 0 5,500 7,000 8,000
28,0 28,000 00 22,500 27,000 31,500
35,0 35,000 00 28,000 34,000 39,500
- Osteoporosis, Koreksi Postur) - Kardiopulmonal c. Tindak Tindakan an Cangg Canggih ih - Pemeri Pemeriksa ksaan an / Assesm Assesment ent F - Ultrasound Terapi - Sock Wave Therapy - Inte Interf rfer eren enci cial al Tera Terapi pi (TEN (TENS S
7,000 9,000
28,000 36,000
35,000 45,000
8,000 8,000 7,000 12,000 7,00 7,000 0
32,000 32,000 28,000 33,000 28,0 28,000 00
40,00 40,000 0 35,000 45,000 35,0 35,000 00
- Nebu Nebuli lize zerr / Tera Terapi pi Inha Inhala lasi si - Lati Latiha han n deng dengan an Ala Alatt (Sw, (Sw,Qs Qs
7,00 7,000 0
28,0 28,000 00
7,500
29,500
35,0 35,000 00 37,000
Training / Latihan Ambulasi & Keseimbangan/balance Massage Bayi Senam Senam stroke stroke/ha /hami mil/l l/lans ansia ia Mobilisasi Saraf Tera Terapi pi ma mani nipu pula lasi si Ekst Ekstri rimi mi Tera Terapi pi ma mani nipu pula lasi si Spin Spinal al ( Senam Kelompok
7,000 9,000 8,000 8,000 8,000 13,0 13,000 00 18,0 18,000 00 7 000
28,000 35,000 32,000 32,000 32,000 52,0 52,000 00 72,0 72,000 00 28 000
35,000 44,000 40,00 40,000 0 40,000 65,0 65,000 00 90,0 90,000 00 35 000
-
3 4 5
Pemeriksaan dokter CST Pemeriksaan dokter konsulen Askep
20,000 40,000 -
30,000 30,000 20,000
50,000 70,000 20,000
L Poli Polikl klin inik ik Neor Neorol olog ogii 1 Tindakan - EEG - Injeksi Intra articular M Poli Polikl klin inik ik Jan Jantu tung ng 1 Tindakan - Echo Cardiografi Askep - Treatmill Askep - EK EKG Askep N Peme Pemeri riks ksaa aan n Can Cangg ggih ih Sarana Diagnostik Tindakan - Endoscopy Askep Colonoscopy
100,00 100,000 0 25,000
150,00 150,000 0 75,000
250,00 250,000 0 100,000
200,000
100,000 10,000 150,000 25,000 20,000 6,000
300,000 10,000 350,000 25,000 32,000 6,000
400,000
500,000 100,000
900,000 100,000
300 000
400 000
700 000
200,000 12,000
7 Sinu Sinus s Par Para a Na Nasal salle Radiolog Radiografer
75,000 -
45,000 40,000
120,000 40,000
8 Mastho sthoiid dex dex/ /sin sin Radiolog Radiografer
50,000 -
45,000 40,000
95,000 40,000
9 Dental Radiolog Radiografer
15,000 -
13,000 10,000
28,000 10,000
10 TMJ TMJ dex/ dex/si sin n Radiolog Radiografer
40,000 -
45,000 40,000
85,000 40,000
11 Verteb Vertebre re cervi cervikal kal AP/ AP/ latera laterall Radiolog Radiografer
42,000 -
45,000 40,000
87,000 40,000
12 Verteb Vertebre re Thora Thoracal cal AP AP Latera Laterall
21 Os. Femur Femur AP/lat AP/latera erall Radiolog Radiografer
70,000 -
45,000 40,000
115,000 40,000
22 Art.ge Art.genu nu AP/lat AP/latera erall Radiolog Radiografer
50,000 -
45,000 40,000
95,000 40,000
23 Crur Cruris is AP/l AP/lat ater eral al Radiolog Radiografer
50,000 -
45,000 40,000
95,000 40,000
24 Ankle Ankle joint joint AP/lat AP/latera erall Radiolog Radiografer
50,000 -
45,000 40,000
95,000 40,000
25 Ossa Ossa pedi pedis s AP/l AP/late ateral ral Radiolog Radiografer
50,000 -
45,000 40,000
95,000 40,000
26 Calcan Calcaneus eus latera lateral/A l/Axi xial al
Radiolog/Operator Radiografer/Asisten b. USG USG Low Lower er Abd Abdomen omen Radiolog/Operator Radiografer/Asisten c.
USG Thyroid Radiolog/Operator Radiografer/Asisten
d. USG USG Mam Mamma mae e de dexts xtsin Radiolog/Operator Radiografer/Asisten e.
f.
USG Va Vaskuler Radiolog/Operator Radiografer/Asisten USG Echografi
35,000 -
40,000 12,000
75,000 12,000
35,000 -
40,000 12,000
75,000 12,000
35,000 -
40,000 12,000
75,000 12,000
35,000 -
40,000 12,000
75,000 12,000
100,000 -
75,000 12,000
175,000 12,000
XII. TINDAKAN OPERATIF NO
JENIS TINDAKAN
1
2
JASA SARANA (Rp)
JASA PELAYANAN (Rp)
3 65,0 65,000 00 -
100,00 100,000 0 750,00 750,000 0
B Tindakan Sedang Sedang - Askep - Penata Anestesi - Dokter Anestesi - Operator Jumlah A
275,00 275,000 0 -
135,00 135,000 0 190,00 190,000 0 388,50 388,500 0 950,00 950,000 0
275,00 275,000 0 135,00 135,000 0 190,00 190,000 0 388,50 388,500 0 950,00 950,000 0 1,938,500
C Tindakan besar besar - Askep - Penata Anestesi Dokter Anestesi
400,00 400,000 0 -
202,50 202,500 0 337,50 337,500 0 525,00 525,000 0
400,00 400,000 0 202,50 202,500 0 337,50 337,500 0 525,00 525,000 0
A Tindakan kecil kecil - Askep - Operator
4
Jumlah A
I I I S A L E K
JUMLAH 5 65,0 65,000 00 100,00 100,000 0 750,00 750,000 0 915,000
1
2 A Tindakan kecil kecil - Askep - Pena Penata ta Anes Aneste tesi si Dokter Anestesi Operator Jumlah A
I S A L E K
3 250,00 250,000 0 -
4 106,00 106,000 0 220,00 220,000 0 472,50 472,500 0 1,100, 1,100,000 000
5 250,00 250,000 0 106,00 106,000 0 220,00 220,000 0 472,50 472,500 0 1,100, 1,100,00 000 0 2,148,500
B Tindakan Sedang Sedang - Askep - Penata Anestesi - Dokter Anestesi - Operator Jumlah A
300,00 300,000 0 -
210,00 210,000 0 394,00 394,000 0 612,50 612,500 0 1,482, 1,482,500 500
300,00 300,000 0 210,00 210,000 0 394,00 394,000 0 612,50 612,500 0 1,482, 1,482,50 500 0 2,999,000
C Tindakan besar besar - Askep - Penata Anestesi Dokter Anestesi - Operator Jumlah C
400,00 400,000 0 -
316,00 316,000 0 439,00 439,000 0 683,00 683,000 0 1,950, 1,950,000 000
400,00 400,000 0 316,00 316,000 0 439,00 439,000 0 683,00 683,000 0 1,950, 1,950,00 000 0 3,788,000
XIII. XIII. RAWAT RAWAT INAP INAP NO
JENIS TINDAKAN
1 1 2 3 4 4 5 6
2 Kamar Perawatan Askep Visite dokter spesialis Cito Visite dokter umum Visite dokter umum/ dokter gigi Cito visite dokter spesialis Konsul dokter antar bgn
JASA JASA PELAYANAN SARANA (Rp) (Rp) 3 25,000 -
4 12,500 25,000 30,000 15,000 35,000 40,000
JUMLAH 5 25,000 12,500 25,000 20,000 15,000 35,000 40,000
XIV. TINDAKAN TINDAKAN OPERATIF OPERATIF NO
JENIS TINDAKAN
1
2
JASA PELAYANAN SARANA (Rp) 3 4
JUMLAH 5
XVI. XVI. LABOR LABORATO ATORIU RIUM M NO
JENIS PEMERIKSAAN
1 A 1 2 3 4 5 6 7 8 9 10 11 12 13
2 HEMATOLOGI COMPLE COMPLETE TE BLOOD BLOOD COUNT COUNT HEMO HEMOGL GLOB OBIN IN GOLO GOLONG NGAN AN DARA DARAH H ABO ABO GOLO GOLONGA NGAN N DARAH DARAH RHESU RHESUS S MORFO MORFOLO LOGI GI DARAH DARAH TEPI TEPI HITU HITUNG NG JENI JENIS S TOTAL TOTAL LIMFO LIMFOSIT SIT COUNT COUNT ABSOL ABSOLUT UT NETRO NETROFIL FIL COUNT COUNT ABSOL ABSOLUT UT EOSINO EOSINOFIL FIL COUNT COUNT RETIKU RETIKULO LOSIT SIT MALARI MALARIA A MANUAL MANUAL LAJU LAJU ENDAP ENDAP DARAH DARAH MASSA MASSA PERDAR PERDARAHA AHAN N (BT)
JASA JASA PELAYANAN SARANA (Rp) (Rp) 3 4 60,000 60,000 8,000 8,000 10,0 10,000 00 10,000 10,000 12,000 12,000 19,0 19,000 00 25,000 25,000 25,000 25,000 25,000 25,000 12,000 12,000 12,000 12,000 7,000 7,000 6,000 6,000
12,000 12,000 6,000 6,000 4,000 4,000 4,000 4,000 25,000 25,000 47,000 47,000 6,000 6,000 6,000 6,000 6,000 6,000 25,000 25,000 25,000 25,000 4,000 4,000 3,500 3,500
JUMLAH 5 72,000 72,000 14,000 14,000 14,000 14,000 14,000 14,000 37,000 37,000 66,000 66,000 31,000 31,000 31,000 31,000 31,000 31,000 37,000 37,000 37,000 37,000 11,000 11,000 9,500 9,500
1 D 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
2 IMUNOLOGI HBsA HBsAg g Anti AntiHB HBs s ANTI ANTI HCV HCV NS-1 NS-1 IgM-Ig IgM-IgG G anti anti DHF DHF HIV HIV ICT ICT TB ICT ICT MALA MALARI RIA A WIDA WIDAL L SLID SLIDE E O WIDAL WIDAL SLIDE SLIDE H TPHA TPHA VDRL VDRL CRP CRP ASTO ASTO REMATO REMATOID ID FACTOR FACTOR TUBE TUBEX X FAECES FAECES LENGK LENGKAP AP
3 36,0 36,000 00 27,0 27,000 00 42,0 42,000 00 165, 165,00 000 0 123,000 123,000 58,0 58,000 00 70,0 70,000 00 107,0 107,000 00 22,0 22,000 00 23,000 23,000 12,0 12,000 00 17,0 17,000 00 13,0 13,000 00 14,0 14,000 00 12,000 12,000 155,0 155,000 00 6,000 6,000
4 11,0 11,000 00 10,0 10,000 00 12,0 12,000 00 30,0 30,000 00 26,000 26,000 17,0 17,000 00 16,0 16,000 00 19,000 19,000 9,000 9,000 9,000 9,000 7,000 7,000 8,000 8,000 7,000 7,000 7,500 7,500 7,000 7,000 18,000 18,000 45,000 45,000
5 47,0 47,000 00 37,0 37,000 00 54,0 54,000 00 195, 195,00 000 0 149,000 149,000 75,0 75,000 00 86,0 86,000 00 126, 126,000 000 31,000 31,000 32,000 32,000 19,000 19,000 25,000 25,000 20,000 20,000 21,500 21,500 19,000 19,000 173, 173,000 000 51,000 51,000
1 2 4 CKMB CKMB 5 Tropon Troponim im I Kwiti Kwititat tatif if 6 Feri Feriti tin n 7 Fe Iron Iron 8 TiBC TiBC 9 Dara Darah h Sama Samarr 10 Calsiu Calsium m Darah Darah 11 Ft3 Ft3 12 Pemeri Pemeriksa ksaan an Cairan Cairan Tubuh Tubuh 13 CD4 CD4 14 Cairan Otak 15 Cairan Pleura
3 141, 141,00 000 0 189,000 189,000 102,0 102,000 00 69,0 69,000 00 118, 118,00 000 0 149,0 149,000 00 34,000 34,000 179,0 179,000 00 80,000 80,000 192,0 192,000 00 105,000 105,000
4 19,0 19,000 00 26,000 26,000 14,000 14,000 9,00 9,000 0 16,0 16,000 00 18,000 18,000 6,000 6,000 26,000 26,000 85,000 85,000 50,000 50,000 85,000 85,000
5 160, 160,00 000 0 215,000 215,000 116, 116,000 000 78,0 78,000 00 134, 134,00 000 0 167, 167,000 000 40,000 40,000 205, 205,000 000 165,000 165,000 242, 242,000 000 190,000 190,000
TARIF LAINNYA XVII. SANITASI DAN STERILISASI
No 1 1
2
JENIS TINDAKAN 2 Pembakaran sampah medis menggunakan incenerator a. 0 - 5 Kg b. 5 - 10 Kg c. Penambahan 1 kg berikutnya
JASA SARANA (Rp)
JASA PELAYANAN (Rp)
JUMLAH
3
4
5
60,000 100,000 6,000
10,000 20,000 2,000
70,000 120,000 8,000
Sterilisasi a. Tromol - Kecil - Sedang - Besar
5,000 7,500 10,000
10,000 12,500 15,000
15,000 20,000 25,000
b. Instrumen - Kecil
5,000
10,000
15,000
XX. XX. LOUNDR LOUNDRY Y
No
JENIS TINDAKAN
1 1 Kain /kg a. Infeksi b. Non infeksi
2
2 Bed Bed cove cover/ r/le lemb mbar ar a. Bed cover cover kecil/le kecil/lembar mbar - infeksi - non infeksi b. Bed cover cover besar/lmb besar/lmbrr - infeksi - non infeksi
JASA SARANA (Rp)
JASA PELAYANAN (Rp)
JUMLAH
KETERANGAN
4
5
8
9
10,000 6,000
4,500 3,500
14,500 9,500
20,000 10,000
13,500 4,500
33,500 14,500
25,000 15,000
18,000 9,000
43,000 24,000
XXII XXII.. NO
LABO LABORA RATO TORI RIUM UM JENI JENIS S PEME PEMERI RIKS KSAA AAN N 2
KELA KELAS S III III , UGD UGD dan dan Rawa Rawatt Jala Jalan n JS JP JUMLAH 3 4 5
JS 6
KELA KELAS S II dan dan ICU ICU JP JUMLAH 7 8
JS 9
KELA KELAS SI JP 10
JUMLAH 11
JS 9
VIP VIP JP 10
JUMLAH 11
1 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
HEMATOLOGI COMPLETE BLOOD COUNT HEMOGLO HEMOGLOBIN BIN GOLONGAN GOLONGAN DARAH ABO GOLONGAN GOLONGAN DARAH RHESUS MORFOLOGI MORFOLOGI DARAH TEPI HITUNG HITUNG JENIS JENIS TOTAL LIMFOSIT LIMFOSIT COUNT ABSOLUT ABSOLUT NETROFIL COUNT ABSOLUT ABSOLUT EOSINOFIL EOSINOFIL COUNT RETIKULOSIT RETIKULOSIT MALARIA MALARIA MANUAL MANUAL LAJU ENDAP DARAH MASSA PERDARAHAN PERDARAHAN MASSA PEMBEKUAN PEMBEKUAN PPT APPT INR
32,000 32,000 32,000 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500
14,000 14,000 14,000 4,500 4,500 27,500 50,000 50,000 7,000 7,000 7,000 27,500 27,500 4,000 3,500 3,500 8,000 8,000 8,000
46,000 46,000 46,000 15,000 15,000 38,000 60,500 60,500 17,500 17,500 17,500 38,000 38,000 14,500 14,000 14,000 18,500 18,500 18,500
32,000 32,000 32,000 11,000 11,000 14,000 11,550 11,550 28,000 28,000 28,000 14,000 14,000 8,000 7,000 7,000 27,500 27,500 55,000
18,000 18,000 18,000 5,000 5,000 30,000 55,000 55,000 7,500 7,500 7,500 30,000 30,000 4,500 4,500 4,500 9,000 9,000 9,000
50,000 50,000 50,000 16,000 16,000 44,000 66,550 66,550 35,500 35,500 35,500 44,000 44,000 12,500 11,500 11,500 36,500 36,500 64,000
37,000 37,000 37,000 13,000 13,000 16,000 12,075 12,075 32,500 32,500 32,500 16,000 16,000 9,000 8,000 8,000 31,500 31,500 63,000
21,000 21,000 21,000 6,000 6,000 34,500 63,000 63,000 8,500 8,500 8,500 34,500 34,500 5,000 5,000 5,000 10,500 10,500 10,500
58,000 58,000 58,000 19,000 19,000 50,500 75,075 75,075 41,000 41,000 41,000 50,500 50,500 14,000 13,000 13,000 42,000 42,000 73,500
44,500 44,500 44,500 15,500 15,500 19,000 28,000 28,000 39,000 39,000 39,000 19,000 19,000 11,000 9,500 9,500 38,000 38,000 75,500
25,000 25,000 25,000 7,000 7,000 41,500 75,500 75,500 10,000 10,000 10,000 41,500 41,500 6,000 6,000 6,000 12,500 12,500 12,500
69,500 69,500 69,500 22,500 22,500 60,500 103,500 103,500 49,000 49,000 49,000 60,500 60,500 17,000 15,500 15,500 50,500 50,500 88,000
B 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
KIMIA KLINIK UREUM UREUM KREATIN KREATININ IN ALBUMIN ALBUMIN GLOBUL GLOBULIN IN TOTAL TOTAL PROTEIN PROTEIN SGOT SGOT SGPT SGPT ALP GAMMA GAMMA GT BILIRUBIN BILIRUBIN TOTAL BILIRUBIN BILIRUBIN DIRRECT BILIRUBIN BILIRUBIN INDIRECT ASAM URAT CHOLESTEROL CHOLESTEROL TRIGLISERIDA TRIGLISERIDA LDL KOLESTEROL KOLESTEROL
12,000 12,000 24,000 24,000 15,000 15,000 10,000 10,000 15,000 15,000 13,000 13,000 13,000 13,000 24,000 24,000 16,000 16,000 14,500 14,500 12,000 13,000 16,500 16,500 58,000
6,000 6,000 8,000 8,000 6,000 6,000 6,000 6,000 6,000 6,000 6,500 6,500 7,000 7,000 7,000 6,500 6,500 6,500 6,500 6,500 6,500 13,500
18,000 18,000 32,000 32,000 21,000 21,000 16,000 16,000 21,000 19,500 19,500 19,500 19,500 31,000 31,000 23,000 23,000 21,000 21,000 18,500 19,500 23,000 23,000 71,500
14,000 14,000 25,500 25,500 16,000 16,000 10,500 10,500 16,000 16,000 14,500 14,500 14,500 14,500 25,000 25,000 16,500 16,500 15,500 15,500 12,500 14,000 18,000 18,000 58,500
7,000 7,000 9,000 9,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 8,000 8,000 8,000 8,000 7,000 7,000 7,000 7,000 7,000 7,000 14,000
21,000 21,000 34,500 34,500 23,000 23,000 17,500 17,500 23,000 23,000 21,500 21,500 21,500 21,500 33,000 33,000 24,500 24,500 22,500 22,500 19,500 21,000 25,000 25,000 72,500
16,000 16,000 29,000 29,000 18,000 18,000 12,000 12,000 18,000 18,000 17,000 17,000 17,000 17,000 28,500 28,500 19,000 19,000 16,500 16,500 14,500 16,000 21,000 21,000 67,000
8,000 8,000 10,000 10,000 8,000 8,000 8,000 8,000 8,000 8,000 8,000 8,000 8,000 8,000 9,000 9,000 9,000 9,000 8,000 8,000 8,000 8,000 8,000 8,000 16,000
24,000 24,000 39,000 39,000 26,000 26,000 20,000 20,000 26,000 26,000 25,000 25,000 25,000 25,000 37,500 37,500 28,000 28,000 24,500 24,500 22,500 24,000 29,000 29,000 83,000
19,500 19,500 35,000 35,000 21,500 21,500 14,500 14,500 21,500 21,500 20,500 20,500 20,500 20,500 34,000 34,000 23,000 23,000 20,000 20,000 17,500 19,000 25,000 25,000 80,500
9,500 9,500 12,000 12,000 9,500 9,500 9,500 9,500 9,500 9,500 9,500 9,500 9,500 9,500 11,000 11,000 11,000 11,000 9,500 9,500 9,500 9,500 9,500 9,500 19,000
29,000 29,000 47,000 47,000 31,000 31,000 24,000 24,000 31,000 31,000 30,000 30,000 30,000 30,000 45,000 45,000 34,000 34,000 29,500 29,500 27,000 28,500 34,500 34,500 99,500
1 17 18 19 20 21 22
2 HDL KOLESTEROL KOLESTEROL GLU GLUKOS KOSA DARA DARAH H PUA PUASA GLUKOSA GLUKOSA DARAH SEWAKTU SEWAKTU GLUKOSA GLUKOSA DARAH 2 JAM PP CKMB TROPONIN TROPONIN I
3 32,000 12,0 12,000 00 12,000 12,000 56,000 56,000
4 9,500 6,00 6,000 0 6,000 6,000 14,000 14,000
5 41,500 18,0 18,000 00 18,000 18,000 70,000 70,000
6 32,500 13, 13,00 000 0 13,000 13,000 56,500 56,500
7 10,000 6,50 6,500 0 6,500 6,500 15,000 15,000
8 42,500 19,5 19,500 00 19,500 19,500 71,500 71,500
9 37,000 14, 14,00 000 0 14,000 14,000 14,000 65,000 65,000
10 11,500 7,50 7,500 0 7,500 7,500 17,000 17,000
11 48,500 21,5 21,500 00 21,500 21,500 82,000 82,000
9 44,000 17, 17,00 000 0 17,000 17,000 17,000 78,000 78,000
10 14,000 9,00 9,000 0 9,000 9,000 20,500 20,500
11 58,000 26,0 26,000 00 26,000 26,000 98,500 98,500
C 1 2 3 4 5 6 7 8 9 10 11
URIN URIN LENGKAP LENGKAP SEDIMEN SEDIMEN URIN URIN PROTEIN PROTEIN URIN URIN REDUKSI REDUKSI URIN URIN ASETON ASETON BILIRU BILIRUBIN BIN URIN BERAT BERAT JENIS JENIS NITRIT NITRIT UROBIL UROBILINO INOGEN GEN TES KEHAMILAN KEHAMILAN BETA HCG
17,000 8,000 8,000 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 10,500 9,000 22,000
52,500 51,500 51,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 5,000 9,000
69,500 59,500 59,500 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 15,000 14,000 31,000 31,000
17,500 8,500 11,000 11,000 11,000 11,000 11,000 11,000 11,000 11,000 11,000 11,000 11,000 11,000 11,000 11,000 10,000 23,000
73,000 72,000 72,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,500 10,000
90,500 80,500 80,500 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 15,500 33,000
20,000 10,000 10,000 13,000 13,000 13,000 13,000 13,000 13,000 13,000 13,000 13,000 13,000 13,000 13,000 13,000 13,000 12,000 26,000
84,000 83,000 83,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 7,000 12,000
104,000 93,000 93,000 19,000 19,000 19,000 19,000 19,000 19,000 19,000 19,000 19,000 19,000 19,000 19,000 19,000 19,000 19,000 38,000
24,000 12,000 12,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 14,500 31,000
100,000 100,000 100,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 7,000 8,500 14,500
124,000 112,000 112,000 23,000 23,000 23,000 23,000 23,000 23,000 23,000 23,000 23,000 23,000 23,000 23,000 23,000 23,000 23,000 45,500
D 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
IMUNOLOGI HBsAg HBsAg AntiHBs AntiHBs ANTI ANTI HCV NS-1 NS-1 IgM-IgG anti DHF HIV ICT TB ICT MALARIA MALARIA WIDAL WIDAL SLIDE SLIDE O WIDAL SLIDE H TPHA VDRL CRP ASTO REMATOID REMATOID FACTOR TUBEX FAECES LENGKAP LENGKAP
38,000 38,000 29,000 29,000 44,000 44,000 175,000 175,000 130,000 61,000 61,000 74,000 74,000 112,000 25,000 25,000 25,000 13,000 18,000 14,000 15,000 13,000 163,000 6,000
12,000 12,000 10,000 10,000 12,000 12,000 32,000 32,000 28,000 18,000 18,000 17,000 17,000 20,000 9,000 9,000 9,000 8,000 8,450 7,850 8,000 7,700 20,000 52,500
50,000 50,000 39,000 39,000 56,000 56,000 207,000 207,000 158,000 79,000 79,000 91,000 132,000 34,000 34,000 34,000 21,000 26,450 21,850 23,000 20,700 183,000 58,500
40,000 40,000 31,000 31,000 45,000 45,000 179,500 179,500 132,000 63,000 63,000 77,000 77,000 117,000 27,000 27,000 27,000 15,000 18,500 13,500 15,500 13,500 170,500 6,500
13,000 13,000 11,000 11,000 13,000 13,000 33,000 33,000 29,000 19,000 19,000 18,000 18,000 21,000 10,000 10,000 10,000 9,000 9,100 8,350 8,650 8,350 22,000 73,000
53,000 53,000 42,000 42,000 58,000 58,000 212,500 212,500 161,000 82,000 82,000 95,000 95,000 138,000 37,000 37,000 37,000 24,000 27,600 21,850 24,150 21,850 192,500 79,500
45,000 45,000 34,000 34,000 51,000 51,000 206,000 206,000 150,000 70,000 70,000 85,000 85,000 125,000 30,000 30,000 30,000 18,000 21,500 15,500 18,000 15,500 178,000 7,500
15,000 15,000 12,000 12,000 15,000 15,000 38,000 38,000 33,000 22,000 22,000 20,000 20,000 24,000 12,000 12,000 12,000 10,000 10,500 9,500 10,000 9,500 25,000 84,000
60,000 60,000 46,000 46,000 66,000 66,000 244,000 244,000 183,000 92,000 92,000 105,000 105,000 149,000 42,000 42,000 42,000 28,000 32,000 25,000 28,000 25,000 203,000 91,500
54,000 54,000 41,000 41,000 61,000 61,000 247,000 247,000 180,000 84,000 84,000 102,000 102,000 150,000 36,000 36,000 36,000 21,500 26,000 18,500 21,500 19,000 214,000 9,000
18,000 18,000 14,000 14,000 18,000 18,000 46,000 46,000 40,000 26,500 26,500 24,000 24,000 29,000 14,500 14,500 14,500 12,000 12,500 11,500 12,000 11,000 30,000 100,000
72,000 72,000 55,000 55,000 79,000 79,000 293,000 293,000 220,000 110,500 110,500 126,000 126,000 179,000 50,500 50,500 50,500 33,500 38,500 30,000 33,500 30,000 244,000 109,000
E 1 2 3 4 5 6
MIKR MIKROB OBIO IOLO LOGI GI SEDE SEDERH RHAN ANA A BTA PENGECA PENGECATAN TAN GRAM GRAM PEWARN PEWARNAAN AAN KOH M. LEPRAE LEPRAE ANALISIS ANALISIS SPERMA BIAKAN MIKRO ORGANISME MEDIA PADAT (MRSA)
13,000 13,000 8,000 8,000 8,000 8,000 13,000 13,000 25,000 150,000
27,500 27,500 12,700 12,700 12,700 12,700 27,500 125,000 100,000
40,500 40,500 20,700 20,700 20,700 20,700 40,500 40,500 150,000 250,000
14,000 14,000 8,500 8,500 8,500 14,000 14,000 28,000 157,500
30,250 30,250 13,350 13,350 13,350 13,350 30,250 30,250 135,000 1 04 , 50 0
44,250 44,250 21,850 21,850 21,850 21,850 44,250 44,250 163,000 262,000
16,000 16,000 10,000 10,000 10,000 10,000 16,000 16,000 30,000 1 6 5 , 00 0
31,625 31,625 15,000 15,000 15,000 15,000 31,625 31,625 20,000 110,000
47,625 47,625 25,000 25,000 25,000 25,000 47,625 47,625 50,000 2 75 , 00 0
19,000 19,000 12,000 12,000 12,000 12,000 19,000 19,000 36,000 198,000
37,950 37,950 18,000 18,000 18,000 18,000 37,950 37,950 24,000 1 3 2 , 00 0
56,950 56,950 30,000 30,000 30,000 30,000 56,950 56,950 60,000 330,000
7
BIAKAN MIKRO MEDIA CAIR
150,000
100,000
250,000
157,500
104,500
262,000
165,000
110,000
275,000
198,000
132,000
330,000
F 1 2 3 4 5 6 7 8 9 10 11 12
HORMON T3 T4 TSH FT4 Toxoplasma Toxoplasma IgG Toxoplasma Toxoplasma IgM Rubella Rubella IgG Rubella Rubella IgM CMV IgG CMV IgM HSV-I IgM HSV-I IgG
121,500 121,500 121,500 121,500 121,500 121,500 176,500 176,500 205,500 205,500 205,500 205,500 205,500 205,500 205,500 205,500
18,500 18,500 18,500 18,500 18,500 18,500 25,500 25,500 32,500 32,500 32,500 32,500 32,500 32,500 32,500 32,500
140,000 140,000 140,000 140,000 140,000 140,000 202,000 202,000 238,000 238,000 238,000 238,000 238,000 238,000 238,000 238,000
123,000 123,000 123,000 123,000 123,000 123,000 178,000 178,000 206,500 206,500 206,500 206,500 206,500 206,500 206,500 206,500
19,000 19,000 19,000 19,000 19,000 19,000 26,000 26,000 32,500 32,500 32,500 32,500 32,500 32,500 32,500 32,500
142,000 142,000 142,000 142,000 142,000 142,000 204,000 204,000 239,000 239,000 239,000 239,000 239,000 239,000 239,000 239,000
144,000 144,000 144,000 144,000 144,000 144,000 207,000 207,000 240,500 240,500 240,500 240,500 240,500 240,500 240,500 240,500
22,000 22,000 22,000 22,000 22,000 22,000 31,000 31,000 38,500 38,500 38,500 38,500 38,500 38,500 38,500 38,500
166,000 166,000 166,000 166,000 166,000 166,000 238,000 238,000 279,000 279,000 279,000 279,000 279,000 279,000 279,000 279,000
173,000 173,000 173,000 173,000 173,000 173,000 248,500 248,500 289,000 289,000 289,000 289,000 289,000 289,000 289,000 289,000
26,500 26,500 26,500 26,500 26,500 26,500 37,000 37,000 46,000 46,000 46,000 46,000 46,000 46,000 46,000 46,000
199,500 199,500 199,500 199,500 199,500 199,500 285,500 285,500 335,000 335,000 335,000 335,000 335,000 335,000 335,000 335,000
G 1
BDRS Crosma Crosmatch tch
40,000 40,000
9,000 9,000
49,000 49,000
42,000 42,000
10,000 10,000
52,000 52,000
46,000 46,000
12,000 12,000
58,000 58,000
55,000 55,000
14,500 14,500
69,500 69,500
H 1 2 3 4 5 6
NARKOBA METHAMP METHAMPHETA HETAMIN MIN OPIAT OPIAT MARPHIN MARPHINE E THC BARTIBU BARTIBURA RA BENZODI BENZODIAZE AZEPIN PIN CANABI CANABINOI NOID D
35,000 35,000 35,000 35,000 35,000 35,000 35,000 35,000 35,000 35,000 35,000 35,000
4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000
39,000 39,000 39,000 39,000 39,000 39,000 39,000 39,000 39,000 39,000 39,000
38,000 38,000 38,000 38,000 38,000 38,000 38,000 38,000 38,000 38,000 38,000 38,000
4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500 4,500
42,500 42,500 42,500 42,500 42,500 42,500 42,500 42,500 42,500 42,500 42,500 42,500
42,000 42,000 42,000 42,000 42,000 42,000 42,000 42,000 42,000 42,000 42,000 42,000
5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000
47,000 47,000 47,000 47,000 47,000 47,000 47,000 47,000 47,000 47,000 47,000 47,000
50,500 50,500 50,500 50,500 50,500 50,500 50,500 50,500 50,500 50,500 50,500 50,500
6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000
56,500 56,500 56,500 56,500 56,500 56,500 56,500 56,500 56,500 56,500 56,500 56,500
I 1 2 3 4
PE ME MER IK IK SA SAAN KH KHUSUS HbA1C HbA1C Elektrolit Elektrolit Analisa Analisa Gas Darah CKMB
129,500 129,500 150,000 300,000 148,000 148,000
55,500 45,000 50,000 20,000 20,000
185,000 185,000 195,000 350,000 168,000 168,000
135,500 135,500 158,000 313,500 155,000 155,000
58,500 58,500 47,000 51,500 22,000 22,000
194,000 194,000 205,000 365,000 177,000 177,000
142,000 142,000 165,000 328,000 162,000 162,000
61,000 61,000 50,000 54,000 25,000 25,000
203,000 203,000 215,000 382,000 187,000 187,000
170,000 170,000 198,000 393,500 194,500 194,500
73,000 73,000 60,000 65,000 30,000 30,000
243,000 243,000 258,000 458,500 224,500 224,500
5 6 7 8 9 10 11 12 13 14 15
Troponim I Kuantitat Kuantitatif if Feritin Feritin Fe Iron Iron TiBC TiBC Darah Samar Samar Calsium Calsium Darah Ft3 Pemeriksaan Pemeriksaan Cairan Tubuh CD4 Cairan Otak Cairan Pleura
199,000 107,000 73,000 73,000 124,000 124,000 157,000 35,000 188,000 84,000 202,000 110,000 110,000
27,000 14,000 10,000 10,000 17,000 17,000 19,000 7,000 27,000 89,000 53,000 90,000 90,000
226,000 121,000 83,000 83,000 141,000 141,000 176,000 42,000 42,000 215,000 173,000 255,000 200,000 200,000
208,000 112,000 76,000 76,000 130,000 130,000 164,000 37,000 197,000 88,000 211,000 116,000 116,000
29,000 16,000 11,000 11,000 18,000 18,000 21,000 7,500 30,000 98,000 58,000 95,000 95,000
237,000 128,000 87,000 87,000 148,000 148,000 185,000 44,500 227,000 186,000 269,000 211,000 211,000
218,000 117,000 80,000 80,000 136,000 136,000 172,000 39,000 206,000 92,000 221,000 1 2 3 , 00 0 1 2 3 , 00 0
34,000 18,000 12,000 12,000 21,000 21,000 24,000 8,000 34,000 113,000 66,000 100,000 100,000
252,000 135,000 92,000 92,000 157,000 157,000 196,000 47,000 240,000 205,000 287,000 2 23 ,0 0 0 2 23 , 00 0
261,500 140,500 96,000 96,000 163,000 163,000 206,500 47,000 247,000 110,500 265,000 148,000 148,000
40,000 21,500 14,500 14,500 25,000 25,000 29,000 9,500 41,000 135,500 79,000 1 2 0 , 00 0 1 20 ,0 0 0
301,500 162,000 110,500 110,500 188,000 188,000 235,500 56,500 288,000 246,000 344,000 268,000 268,000
XXIII. TARIF DIKLAT DAN PENELITIAN KEGIATAN 1 Praktek Belajar Lapangan a. SMU sederajat - Negeri - Swasta
JASA SARANA 2
JASA PELAYANAN 3
JUMLAH 4
Rp.1.000/hari/orang Rp.1.500/hari/orang
Rp. 500/hari/orang Rp.1.000/hari/orang
Rp.1.500/hari/orang Rp.2.500/hari/orang
b. Program DIII - Negeri - Swasta
Rp.2.000/hari/orang Rp.2.500/hari/orang
Rp.1.500/hari/orang Rp.2.000/hari/orang
Rp.3.500/hari/orang Rp.4.500/hari/orang
c. Program S1, Ners, S2 - Negeri - Swasta
Rp.3.000/hari/orang Rp.3.500/hari/orang
Rp.2.500/hari/orang Rp.3.000/hari/orang
Rp.5.500/hari/orang Rp.6.500/hari/orang
Studi Banding a. 1 s.d 5 orang b. 6 s.d 10 orang c. 11 s.d 15 orang d. > 15 orang Penelitian a. Pr og ogr am am DII I b. Pr Program S1 S1 c. Pro Progr gram am S2 dan dan S3 S3
Rp. Rp. Rp. Rp.
75,000 70,000 65,000 60,000
/ / / /
hari/orang hari/orang hari/orang hari/orang
R p. p.10 0, 0,00 0/ 0/or an ang (per topik p en enelitian) Rp.150,000/orang (p (per to topik pe penelitian) Rp.2 Rp.200 00,0 ,000 00/o /ora ran ng (per (per to topik pik pen penelit elitiian) an)
Rp. Rp. Rp. Rp.
Rp. 25 25,0 00 00/or an ang (per topik penelitian) Rp.50,000/orang (p (per to topik pe penelitian) Rp.7 Rp.75, 5,00 000/ 0/o oran rang (per (per to topik pik pen penelit elitia ian) n)
Keterangan : - Bagi Mahasiswa/Mahasiswi, Mahasiswa/Mahasiswi, Siswa/Siswi Siswa/Siswi yang yang mendapat Beasiswa dari Pemerintah Kabupaten Indragiri Hilir, dibebaskan dari biaya Diklat dan Penelitian.
75,000 70,000 65,000 60,000
/ / / /
hari/orang hari/orang hari/orang hari/orang
R p. p.12 5, 5,000 /o /or an ang (p er er topik p en enelitian) Rp.200,000/orang (p (per to topik pe penelitian) Rp.2 Rp.275 75,0 ,000 00/o /ora ran ng (pe (perr top topik ik pen penelit elitia ian) n)
TARIF AMBULANCE DAN MOBIL JENAZAH A. DALAM KOTA RADIUS 25 KM NO
TUJUAN
1 1
2 Pulau Kijang
JASA SARANA (Rp)
JASA PELAYANAN (Rp)
3
4
30,000
JUMLAH 5
15,000
45,000 1 Kali Jalan
2
Pulau Kecil
30,000
15,000
45,000 1 Kali Jalan
3
Reteh Reteh Lama Lama
40,000 40,000
20,000 20,000
60,000 60,000 1 Kali Kali Jalan Jalan
4
Sanglar
50,000
25,000
75,000 1 Kali Jalan
B. LUAR KOTA/ Ambulance NO
TUJUAN
1
2
JARAK TEMPUH (KM)
JASA SARANA (Rp)
3
4
TOTAL PEMBAYARAN (Rp)
JASA PELAYANAN BAHAN BAKAR MINYAK SOPIR
JUMLAH BBM (Rp)
PERAWAT 5
6
7
8
(+/-) 35
100,000
100,000
100,000
25 L X Rp 6,600
(6.000 s/d 10000)*
Rp
165,000
Rp
465,000
TEMBILAHAN
(+/-) 131
200,000
200,000
200,000
40 L X Rp 6,600
(6.000 s/d 10000)*
Rp
264,000
Rp
864,000
PULAU KIJANG
RENGAT
(+/-) 131
200,000
200,000
200,000
40 L X Rp 6,600
(6.000 s/d 10000)*
Rp
264,000
Rp
864,000
4
PULAU KI KIJANG
PEKANBARU
(+/-) 305
450,000
450,000
450,000
70 L X Rp 6,600
(6.000 s/d 10000)*
Rp
462,000
Rp
1,812,000
5
PULAU KIJANG
JAMBI
(+/-) 345
450,000
450,000
450,000
70 L X Rp 6,600
(6.000 s/d 10000)*
Rp
462,000
Rp
1,812,000
6
PULAU KI KIJANG
PALEMBANG
(+/-) 695
1,00 1,000, 0,00 000 0
1,00 1,000, 0,00 000 0
1,00 1,000, 0,00 000 0
140 140 L X Rp 6,60 6,600 0
(6.0 (6.000 00 s/d s/d 1000 10000) 0)**
Rp
924, 924,00 000 0
Rp
3,92 3,924, 4,00 000 0
7
PULAU KIJANG
BUKIT TINGGI
(+/-) 585
1,00 1,000, 0,00 000 0
1,00 1,000, 0,00 000 0
1,00 1,000, 0,00 000 0
140 140 L X Rp 6,60 6,600 0
(6.0 (6.000 00 s/d s/d 1000 10000) 0)**
Rp
924, 924,00 000 0
Rp
3,92 3,924, 4,00 000 0
8
PULAU KIJANG
PADANG
(+/-) 635
1,00 1,000, 0,00 000 0
1,00 1,000, 0,00 000 0
1,00 1,000, 0,00 000 0
140 140 L X Rp 6,60 6,600 0
(6.0 (6.000 00 s/d s/d 1000 10000) 0)**
Rp
924, 924,00 000 0
Rp
3,92 3,924, 4,00 000 0
1
PULAU KIJANG
KOTA BARU
2
PULAU KIJANG
3
B. LUAR KOTA/ Boat NO
TUJUAN
JARAK TEMPUH (KM)
JASA SARANA (Rp)
1
2
3
4
TOTAL PEMBAYARAN (Rp)
JASA PELAYANAN BAHAN BAKAR MINYAK PAGI
JUMLAH BBM (Rp)
SORE 5
6
7
8
2
PULAU KIJANG
TEMBILAHAN
(+/-) 130
-
250,000
350,000
Rp
-
Rp
3
PULAU KIJANG
TUNGKAL
(+/-) 130
-
200,000
300,000
Rp
-
Rp
500,000
4
PULAU KIJANG
JAMBI
(+/-) 345
-
500,000
500,000
Rp
-
Rp
1,000,000
5
PULAU KIJANG
BATAM
(+/-) 635
-
1,200,000
1,200,000
Rp
-
Rp
2,400,000
6
AMBIL AMBIL DARA DARAH H ke Temb Tembil ilah ahan an
(+/-) 130
-
250,000
250,000
Rp
-
Rp
500,000
Keterangan : Harga bahan bakar minyak dipakai sesuai dengan harga pemerintah yang berlaku pada saat itu. Jarak tempuh yang tidak tersebut diatas, disesuaikan disesuaikan dengan argometer kendaraan. kendaraan.
BUPATI INDRAGIRI HILIR,
600,000
H. MUHAMMAD WARDAN
