Professional Documents
Culture Documents
SEWA
NO JENIS TINDAKAN KLAS SEWA OK BAHAN OPERATOR
ALAT
1 OPERASI KHUSUS
1 a.1 Elektif / Biasa VIP 200,000 250,000 100,000 3,600,000
1 a.2 Cito / Darurat 200,000 250,000 100,000 3,960,000
1 b.1 Elektif / Biasa I 200,000 250,000 100,000 3,300,000
1 b.2 Cito / Darurat 200,000 250,000 100,000 3,600,000
1 c.1 Elektif / Biasa II / III 200,000 250,000 100,000 3,000,000
1 c.2 Cito / Darurat 200,000 250,000 100,000 3,300,000
2 OPERASI BESAR
2 a.1 Elektif / Biasa VIP 175,000 200,000 100,000 3,300,000
2 a.2 Cito / Darurat 175,000 200,000 100,000 3,600,000
2 b.1 Elektif / Biasa I 175,000 200,000 100,000 3,000,000
2 b.2 Cito / Darurat 175,000 200,000 100,000 3,300,000
2 c.1 Elektif / Biasa II / III 175,000 200,000 100,000 2,400,000
2 c.2 Cito / Darurat 175,000 200,000 100,000 2,760,000
3 OPERASI SEDANG
3 a.1 Elektif / Biasa VIP 175,000 200,000 100,000 2,645,000
3 a.2 Cito / Darurat 175,000 200,000 100,000 2,875,000
3 b.1 Elektif / Biasa I 175,000 200,000 100,000 2,300,000
3 b.2 Cito / Darurat 175,000 200,000 100,000 2,645,000
3 c.1 Elektif / Biasa II / III 175,000 200,000 100,000 1,725,000
3 c.2 Cito / Darurat 175,000 200,000 100,000 2,070,000
4 OPERASI KECIL
4 a.1 Elektif / Biasa VIP 100,000 100,000 25,000 1,100,000
4 a.2 Cito / Darurat 100,000 100,000 25,000 1,650,000
4 b.1 Elektif / Biasa I 100,000 100,000 25,000 825,000
4 b.2 Cito / Darurat 100,000 100,000 25,000 935,000
4 c.1 Elektif / Biasa II / III 100,000 100,000 25,000 550,000
4 c.2 Cito / Darurat 100,000 100,000 25,000 715,000
SEWA
NO JENIS TINDAKAN KLAS SEWA OK BAHAN OPERATOR
NO JENIS TINDAKAN KLAS SEWA OK BAHAN OPERATOR
ALAT
1 OPERASI KHUSUS
1 a.1 Elektif / Biasa VIP 200,000 250,000 100,000 2,160,000
1 a.2 Cito / Darurat 200,000 250,000 100,000 2,376,000
1 b.1 Elektif / Biasa I 200,000 250,000 100,000 1,980,000
1 b.2 Cito / Darurat 200,000 250,000 100,000 2,160,000
1 c.1 Elektif / Biasa II / III 200,000 250,000 100,000 1,800,000
1 c.2 Cito / Darurat 200,000 250,000 100,000 1,980,000
2 OPERASI BESAR
2 a.1 Elektif / Biasa VIP 175,000 200,000 100,000 1,980,000
2 a.2 Cito / Darurat 175,000 200,000 100,000 2,160,000
2 b.1 Elektif / Biasa I 175,000 200,000 100,000 1,800,000
2 b.2 Cito / Darurat 175,000 200,000 100,000 1,980,000
2 c.1 Elektif / Biasa II / III 175,000 200,000 100,000 1,440,000
2 c.2 Cito / Darurat 175,000 200,000 100,000 1,656,000
3 OPERASI SEDANG
3 a.1 Elektif / Biasa VIP 175,000 200,000 100,000 1,587,000
3 a.2 Cito / Darurat 175,000 200,000 100,000 1,725,000
3 b.1 Elektif / Biasa I 175,000 200,000 100,000 1,380,000
3 b.2 Cito / Darurat 175,000 200,000 100,000 1,587,000
3 c.1 Elektif / Biasa II / III 175,000 200,000 100,000 1,035,000
3 c.2 Cito / Darurat 175,000 200,000 100,000 1,242,000
4 OPERASI KECIL
4 a.1 Elektif / Biasa VIP 100,000 100,000 25,000 660,000
4 a.2 Cito / Darurat 100,000 100,000 25,000 990,000
4 b.1 Elektif / Biasa I 100,000 100,000 25,000 495,000
4 b.2 Cito / Darurat 100,000 100,000 25,000 561,000
4 c.1 Elektif / Biasa II / III 100,000 100,000 25,000 330,000
4 c.2 Cito / Darurat 100,000 100,000 25,000 429,000
Pasien Umum
Pasien BPJS
93,750 9,375
93,750 9,375
93,750 9,375
93,750 9,375
250,000 25,000
250,000 25,000
250,000 25,000
218,750 21,875
218,750 21,875
250,000 25,000
250,000 100,000 62,500 25,000 40,000
250,000 100,000 62,500 25,000 40,000
218,750 87,500 54,688 21,875 36,875
218,750 87,500 54,688 21,875 36,875
187,500 18,750
187,500 18,750
156,250 15,625
156,250 15,625
250,000 25,000 40,000
250,000 25,000 40,000
218,750 21,875 36,875
218,750 21,875 36,875
93,750 9,375
93,750 9,375
87,500 8,750
87,500 8,750
37,500 3,750
37,500 3,750
187,500 18,750
187,500 18,750
156,250 15,625
1,062,500 106,250
956,250 95,625
860,625 86,063
1,562,500 156,250
1,406,250 140,625
1,265,625 126,563
187,500 18,750
187,500 18,750
156,250 15,625
437,500 43,750
437,500 43,750
406,250 40,625
625,000 250,000 156,250 62,500 87,500
562,500 225,000 140,625 56,250 81,250
506,250 202,500 126,563 50,625 75,625
1,250,000 500,000 312,500 125,000 175,000
1,125,000 450,000 281,250 112,500 162,500
1,012,500 405,000 253,125 101,250 151,250
1,250,000 500,000 312,500 125,000 175,000
1,125,000 450,000 281,250 112,500 162,500
1,012,500 405,000 253,125 101,250 151,250
2,250,000 900,000 562,500 225,000 337,500 275,000 150,000
2,025,000 810,000 506,250 202,500 303,750 252,500 150,000
1,822,500 729,000 455,625 182,250 273,375 232,250 150,000
3,125,000 1,250,000 781,250 312,500 468,750 362,500 150,000
2,812,500 1,125,000 703,125 281,250 421,875 331,250 150,000
2,531,250 1,012,500 632,813 253,125 379,688 303,125 150,000
3,500,000 1,400,000 875,000 350,000 525,000 400,000 150,000
3,150,000 1,260,000 787,500 315,000 472,500 365,000 150,000
2,835,000 1,134,000 708,750 283,500 425,250 333,500 150,000
3,937,500 1,575,000 984,375 393,750 590,625 443,750 150,000
3,543,750 1,417,500 885,938 354,375 531,563 404,375 150,000
3,189,375 1,275,750 797,344 318,938 478,406 368,938 150,000
- - -
937,500 375,000 234,375 93,750 128,750
843,750 337,500 210,938 84,375 119,375
759,375 303,750 189,844 75,938 110,938
683,438 273,375 170,859 68,344 103,344
937,500 375,000 234,375 93,750
843,750 337,500 210,938 84,375
759,375 303,750 189,844 75,938
1,125,000 450,000 281,250 112,500 162,500
1,012,500 405,000 253,125 101,250 151,250
911,250 364,500 227,813 91,125 141,125
820,125 328,050 205,031 82,013 132,013
1,125,000 450,000 281,250 112,500
1,012,500 405,000 253,125 101,250
911,250 364,500 227,813 91,125
1,125,000 450,000 281,250 112,500 162,500
1,012,500 405,000 253,125 101,250 151,250
911,250 364,500 227,813 91,125 141,125
1,125,000 450,000 281,250 112,500 162,500
1,012,500 405,000 253,125 101,250 151,250
911,250 364,500 227,813 91,125 141,125
820,125 328,050 205,031 82,013 132,013
1,125,000 450,000 281,250 112,500 162,500
1,012,500 405,000 253,125 101,250 151,250
911,250 364,500 227,813 91,125 141,125
820,125 328,050 205,031 82,013 132,013
1,125,000 450,000 281,250 112,500 162,500
1,012,500 405,000 253,125 101,250 151,250
911,250 364,500 227,813 91,125 141,125
820,125 328,050 205,031 82,013 132,013
- -
1,250,000 125,000 175,000 150,000
1,125,000 112,500 162,500 150,000
1,012,500 101,250 151,250 150,000
1,250,000 500,000 312,500 125,000 175,000 150,000
1,125,000 450,000 281,250 112,500 162,500 150,000
1,012,500 405,000 253,125 101,250 151,250 150,000
1,250,000 500,000 312,500 125,000 175,000 150,000
1,125,000 450,000 281,250 112,500 162,500 150,000
1,012,500 405,000 253,125 101,250 151,250 150,000
1,250,000 500,000 312,500 125,000 175,000 150,000
1,125,000 450,000 281,250 112,500 162,500 150,000
1,012,500 405,000 253,125 101,250 151,250 150,000
56,250 5,625
56,250 5,625
56,250 5,625
56,250 5,625
150,000 15,000
150,000 15,000
150,000 15,000
131,250 13,125
131,250 13,125
150,000 15,000
150,000 60,000 37,500 15,000 30,000
150,000 60,000 37,500 15,000 30,000
131,250 52,500 32,813 13,125 28,125
131,250 52,500 32,813 13,125 28,125
112,500 11,250
112,500 11,250
93,750 9,375
93,750 9,375
150,000 15,000 30,000
150,000 15,000 30,000
131,250 13,125 28,125
131,250 13,125 28,125
56,250 5,625
56,250 5,625
52,500 5,250
52,500 5,250
22,500 2,250
22,500 2,250
112,500 11,250
112,500 11,250
93,750 9,375
637,500 63,750
573,750 57,375
516,375 51,638
937,500 93,750
843,750 84,375
759,375 75,938
112,500 11,250
112,500 11,250
93,750 9,375
262,500 26,250
262,500 26,250
243,750 24,375
375,000 150,000 93,750 37,500 62,500
337,500 135,000 84,375 33,750 58,750
303,750 121,500 75,938 30,375 55,375
750,000 300,000 187,500 75,000 125,000
675,000 270,000 168,750 67,500 117,500
607,500 243,000 151,875 60,750 110,750
750,000 300,000 187,500 75,000 125,000
675,000 270,000 168,750 67,500 117,500
607,500 243,000 151,875 60,750 110,750
1,350,000 540,000 337,500 135,000 202,500 185,000 150,000
1,215,000 486,000 303,750 121,500 182,250 171,500 150,000
1,093,500 437,400 273,375 109,350 164,025 159,350 150,000
1,875,000 750,000 468,750 187,500 281,250 237,500 150,000
1,687,500 675,000 421,875 168,750 253,125 218,750 150,000
1,518,750 607,500 379,688 151,875 227,813 201,875 150,000
2,100,000 840,000 525,000 210,000 315,000 260,000 150,000
1,890,000 756,000 472,500 189,000 283,500 239,000 150,000
1,701,000 680,400 425,250 170,100 255,150 220,100 150,000
2,362,500 945,000 590,625 236,250 354,375 286,250 150,000
2,126,250 850,500 531,563 212,625 318,938 262,625 150,000
1,913,625 765,450 478,406 191,363 287,044 241,363 150,000
- - -
562,500 225,000 140,625 56,250 91,250
506,250 202,500 126,563 50,625 85,625
455,625 182,250 113,906 45,563 80,563
410,063 164,025 102,516 41,006 76,006
562,500 225,000 140,625 56,250
506,250 202,500 126,563 50,625
455,625 182,250 113,906 45,563
675,000 270,000 168,750 67,500 117,500
607,500 243,000 151,875 60,750 110,750
546,750 218,700 136,688 54,675 104,675
492,075 196,830 123,019 49,208 99,208
675,000 270,000 168,750 67,500
607,500 243,000 151,875 60,750
546,750 218,700 136,688 54,675
675,000 270,000 168,750 67,500 117,500
607,500 243,000 151,875 60,750 110,750
546,750 218,700 136,688 54,675 104,675
675,000 270,000 168,750 67,500 117,500
607,500 243,000 151,875 60,750 110,750
546,750 218,700 136,688 54,675 104,675
492,075 196,830 123,019 49,208 99,208
675,000 270,000 168,750 67,500 117,500
607,500 243,000 151,875 60,750 110,750
546,750 218,700 136,688 54,675 104,675
492,075 196,830 123,019 49,208 99,208
675,000 270,000 168,750 67,500 117,500
607,500 243,000 151,875 60,750 110,750
546,750 218,700 136,688 54,675 104,675
492,075 196,830 123,019 49,208 99,208
- -
750,000 75,000 125,000 150,000
675,000 67,500 117,500 150,000
607,500 60,750 110,750 150,000
750,000 300,000 187,500 75,000 125,000 150,000
675,000 270,000 168,750 67,500 117,500 150,000
607,500 243,000 151,875 60,750 110,750 150,000
750,000 300,000 187,500 75,000 125,000 150,000
675,000 270,000 168,750 67,500 117,500 150,000
607,500 243,000 151,875 60,750 110,750 150,000
750,000 300,000 187,500 75,000 125,000 150,000
675,000 270,000 168,750 67,500 117,500 150,000
607,500 243,000 151,875 60,750 110,750 150,000
KETERANGAN
Pasien BPJS
KETERANGAN
Bila di OK tambah 125 rb
Bila di OK tambah 125 rb
Bila di OK tambah 125 rb
1 Visite I
2 Visite II
3 Visite III
4 Jasa Periksa Klinik
5 Asessment Kelainan Papil Klinik
6 Asessment Pergerakan Bola Mata Klinik
Diagnostik I
7 Biometri Clinic/All Class
8 Refraksi Clinic/All Class
9 Tonometri Clinic/All Class
Diagnostik II
10 Fundoscopy I
II
III
Klinik
Tindakan Non Bedah
11 Epilasi Bulu Mata I
II
III
Klinik
12 Ekstraksi Corpus Alienum Cornea/ I
conjungtiva 150.000 II
III
Klinik
13 Lithiasis I
II
III
Klinik
14 Spoelling / irigasi bola mata I
II
III
Klinik
Tindakan Bedah Minor
15 Eksisi Chalazion / Hordeolum I 50,000 25,000
II 50,000 25,000
III 50,000 25,000
16 Corpus Alienum dengan operating microsc I 50,000 25,000
II 50,000 25,000
III 50,000 25,000
Kamar Bedah
17 Angkat Jahitan Kornea I 175,000 200,000 50,000
II 175,000 200,000 50,000
III 175,000 200,000 50,000
18 Aspirasi / Irigasi / Reformasi COA I 175,000 200,000 50,000
II 175,000 200,000 50,000
III 175,000 200,000 50,000
19 Flap Conjungtiva / Amnion Graf I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
20 ECCE/ICCE/SICS I 175,000 250,000 100,000
II 175,000 250,000 100,000
III 175,000 250,000 100,000
21 ECCE/SICS + IOL I 175,000 250,000 100,000
II 175,000 250,000 100,000
III 175,000 250,000 100,000
22 Eksisi Pterigium I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
23 Phakik IOL I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
24 Repair Of Laceration, Cornea, Non Perforati I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
25 Repair Of Laceration, Cornea and/ I 175,000 250,000 75,000
or Sclera, Perforating II 175,000 250,000 75,000
III 175,000 250,000 75,000
26 Reposisi IOL I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
27 Reposisi Iris I 175,000 200,000 75,000
II 175,000 200,000 75,000
III 175,000 200,000 75,000
28 Sekunder IOL I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
29 Ekstraksi IOL I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
30 Ekstraksi Corpus Alienum Cornea I 175,000 200,000 25,000
II 175,000 200,000 25,000
III 175,000 200,000 25,000
31 Ekstraksi Corpus Alienum segmen anterior I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
32 Exchange IOL I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
Glaukoma
33 Iridectomy Perifer I 175,000 200,000 25,000
II 175,000 200,000 25,000
III 175,000 200,000 25,000
34 Paracentesis I 175,000 200,000 25,000
II 175,000 200,000 25,000
III 175,000 200,000 25,000
35 Trabekulektomi I 175,000 200,000 25,000
II 175,000 200,000 25,000
III 175,000 200,000 25,000
36 Reformasi COA I 175,000 200,000 25,000
II 175,000 200,000 25,000
III 175,000 200,000 25,000
37 Injeksi Intravitreal I 175,000 200,000 25,000
II 175,000 200,000 25,000
III 175,000 200,000 25,000
Rekonstruksi Bedah Mata
38 Eksisi tumor kecil kelopak I 175,000 200,000 50,000
II 175,000 200,000 50,000
III 175,000 200,000 50,000
39 Eviserasi / enukleasi I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
40 Fraktur multiple I 175,000 250,000 100,000
II 175,000 250,000 100,000
III 175,000 250,000 100,000
41 Repair ruptur palpebra I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
42 Repair ruptur palpebra I 175,000 250,000 100,000
(dgn rupture canalis lacrimalis) II 175,000 250,000 100,000
III 175,000 250,000 100,000
43 Tarsoraf I 175,000 250,000 50,000
II 175,000 250,000 50,000
III 175,000 250,000 50,000
1 Visite I
2 Visite II
3 Visite III
4 Jasa Periksa Klinik
5 Asessment Kelainan Papil Klinik
6 Asessment Pergerakan Bola Mata Klinik
Diagnostik I
7 Biometri Clinic/All Class
8 Refraksi Clinic/All Class
9 Tonometri Clinic/All Class
Diagnostik II
10 Fundoscopy I
II
III
Klinik
Tindakan Non Bedah
11 Epilasi Bulu Mata I
II
III
Klinik
12 Ekstraksi Corpus Alienum Cornea/ I
conjungtiva 150.000 II
III
Klinik
13 Lithiasis I
II
III
Klinik
14 Spoelling / irigasi bola mata I
II
III
Klinik
Tindakan Bedah Minor
15 Eksisi Chalazion / Hordeolum I 50,000 25,000
II 50,000 25,000
III 50,000 25,000
16 Corpus Alienum dengan operating microsc I 50,000 25,000
II 50,000 25,000
III 50,000 25,000
Kamar Bedah
17 Angkat Jahitan Kornea I 175,000 200,000 50,000
II 175,000 200,000 50,000
III 175,000 200,000 50,000
18 Aspirasi / Irigasi / Reformasi COA I 175,000 200,000 50,000
II 175,000 200,000 50,000
III 175,000 200,000 50,000
19 Flap Conjungtiva / Amnion Graf I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
20 ECCE/ICCE/SICS I 175,000 250,000 100,000
II 175,000 250,000 100,000
III 175,000 250,000 100,000
21 ECCE/SICS + IOL I 175,000 250,000 100,000
II 175,000 250,000 100,000
III 175,000 250,000 100,000
22 Eksisi Pterigium I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
23 Phakik IOL I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
24 Repair Of Laceration, Cornea, Non Perforati I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
25 Repair Of Laceration, Cornea and/ I 175,000 250,000 75,000
or Sclera, Perforating II 175,000 250,000 75,000
III 175,000 250,000 75,000
26 Reposisi IOL I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
27 Reposisi Iris I 175,000 200,000 75,000
II 175,000 200,000 75,000
III 175,000 200,000 75,000
28 Sekunder IOL I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
29 Ekstraksi IOL I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
30 Ekstraksi Corpus Alienum Cornea I 175,000 200,000 25,000
II 175,000 200,000 25,000
III 175,000 200,000 25,000
31 Ekstraksi Corpus Alienum segmen anterior I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
32 Exchange IOL I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
Glaukoma
33 Iridectomy Perifer I 175,000 200,000 25,000
II 175,000 200,000 25,000
III 175,000 200,000 25,000
34 Paracentesis I 175,000 200,000 25,000
II 175,000 200,000 25,000
III 175,000 200,000 25,000
35 Trabekulektomi I 175,000 200,000 25,000
II 175,000 200,000 25,000
III 175,000 200,000 25,000
36 Reformasi COA I 175,000 200,000 25,000
II 175,000 200,000 25,000
III 175,000 200,000 25,000
37 Injeksi Intravitreal I 175,000 200,000 25,000
II 175,000 200,000 25,000
III 175,000 200,000 25,000
Rekonstruksi Bedah Mata
38 Eksisi tumor kecil kelopak I 175,000 200,000 50,000
II 175,000 200,000 50,000
III 175,000 200,000 50,000
39 Eviserasi / enukleasi I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
40 Fraktur multiple I 175,000 250,000 100,000
II 175,000 250,000 100,000
III 175,000 250,000 100,000
41 Repair ruptur palpebra I 175,000 250,000 75,000
II 175,000 250,000 75,000
III 175,000 250,000 75,000
42 Repair ruptur palpebra I 175,000 250,000 100,000
(dgn rupture canalis lacrimalis) II 175,000 250,000 100,000
III 175,000 250,000 100,000
43 Tarsoraf I 175,000 250,000 50,000
II 175,000 250,000 50,000
III 175,000 250,000 50,000
10% Pasien Umum
40% 25% 15% 10% 10%
ANASTESI ASISTEN ASISTEN ANASTESI
OPERATOR
DATANG BY PHONE OPERATOR Mas Huda Ast Luar
75,000
65,000
55,000
75,000
70,000
70,000
25,000
25,000
25,000
125,000 12,500
112,500 11,250
100,000 10,000
125,000 12,500
125,000 12,500
112,500 11,250
100,000 10,000
125,000 12,500
225,000 22,500
202,500 20,250
180,000 18,000
225,000 22,500
225,000 22,500
202,500 20,250
180,000 18,000
225,000 22,500
225,000 22,500
202,500 20,250
180,000 18,000
225,000 22,500
60,000
50,000
40,000
60,000
60,000
60,000
25,000
25,000
25,000
75,000 7,500
67,500 6,750
60,000 6,000
75,000 7,500
75,000 7,500
67,500 6,750
60,000 6,000
75,000 7,500
135,000 13,500
121,500 12,150
108,000 10,800
135,000 13,500
135,000 13,500
121,500 12,150
108,000 10,800
135,000 13,500
135,000 13,500
121,500 12,150
108,000 10,800
135,000 13,500