Pelayanan Tindakan Medik Mata No Pelayanan Tindakan Medik Kebidanan No Pelayanan Tindakan Poli Anak No

31 21 Pengambilan benda asing hidung telinga Rp 10,000 Rp 15,000 Rp 25,000 22 Fungsi Pleura Rp 35,000 Rp 220,000 Rp 255,000 23 Pungsi Asites Rp 35,000 Rp 90,000 Rp 125,000 24 Pungsi Buli-buli Rp 35,000 Rp 90,000 Rp 125,000 25 Jahit rekontruksi mata Rp 35,000 Rp 120,000 Rp 155,000 26 Inspikulo Rp 2,500 Rp 7,500 Rp 10,000 27 Infus Intraoseal Rp 10,000 Rp 15,000 Rp 25,000 28 Foto therapie Rp 25,000 Rp 32,000 Rp 57,000 29 Fungsi Lumbal Rp 30,000 Rp 90,000 Rp 120,000 30 Nebulizer Rp 5,000 Rp 3,000 Rp 8,000 31 Imunisasi Rp 2,000 Rp 3,000 Rp 5,000 32 Mantoux tes Rp 25,000 Rp 28,000 Rp 53,000 33 Buka Jahitan 1 - 5 Rp 5,000 Rp 5,000 Rp 10,000 34 Buka Jahitan 6 - 10 Rp 7,500 Rp 7,500 Rp 15,000 35 Buka Jahitan 11 - 20 Rp 10,000 Rp 10,000 Rp 20,000 36 Buka Jahitan 20 - 30 Rp 10,000 Rp 15,000 Rp 25,000 37 Insici Abses 5 cm Rp 20,000 Rp 15,000 Rp 35,000 38 Pasang kateter dengan ManDokterin Rp 10,000 Rp 25,000 Rp 35,000 39 Spoelling Serumen Rp 10,000 Rp 15,000 Rp 25,000 40 Nekrotomi Jaringan Rp 25,000 Rp 25,000 Rp 50,000 41 Ekstraksi Kuku Rp 20,000 Rp 30,000 Rp 50,000 42 Ekstraksi Cairan Rp 10,000 Rp 15,000 Rp 25,000 43 Sirkumsisi Rp 75,000 Rp 125,000 Rp 200,000 44 Sirkumsisi dengan phimosis Rp 100,000 Rp 150,000 Rp 250,000 45 exsisi clavus, veruka, N.prementosis Rp 50,000 Rp 50,000 Rp 100,000 46 Ekstraksi tumor 5 CM Rp 50,000 Rp 100,000 Rp 150,000 47 Ekstraksi tumor 5 CM Rp 100,000 Rp 200,000 Rp 300,000 48 Up Kateter Rp 5,000 Rp 5,000 Rp 10,000 49 Up Dokterain Rp 5,000 Rp 5,000 Rp 10,000

3. Pelayanan Tindakan Medik Mata No

Jenis Pelayanan Jasa Sarana Jasa Pelayanan Jumlah 1 Refraksi Rp 5,000 Rp 5,000 Rp 10,000 2 Optholmos dir Rp 5,000 Rp 5,000 Rp 10,000 3 Optholmos in Rp 5,000 Rp 10,000 Rp 15,000 4 Keratometri Rp 5,000 Rp 5,000 Rp 10,000 5 Tonometri non kontak Rp 5,000 Rp 5,000 Rp 10,000 6 Ishihara test Rp 5,000 Rp 5,000 Rp 10,000 7 Streak retinoskopi Rp 5,000 Rp 10,000 Rp 15,000 8 Ganti verband Rp 3,000 Rp 3,000 Rp 6,000 9 Auto refrakto meter Rp 10,000 Rp 15,000 Rp 25,000 10 Kampimetri Rp 4,000 Rp 4,500 Rp 8,500 11 Slit lamp examination Rp 5,000 Rp 5,500 Rp 10,500 12 Slit lamp exam + monitor Rp 15,000 Rp 15,000 Rp 30,000

4. Pelayanan Tindakan Medik Kebidanan No

Jenis Pelayanan Jasa Sarana Jasa Pelayanan Jumlah 1 Tindik telinga Rp 5,000 Rp 10,000 Rp 15,000 2 Sunat Rp 12,000 Rp 18,000 Rp 30,000 3 Incisi Abces Rp 4,000 Rp 6,000 Rp 10,000 4 Suntik KB Rp 12,000 Rp 3,000 Rp 15,000 5 Pasang IUD Rp 50,000 Rp 24,000 Rp 74,000 32 6 Cabut IUD Rp 20,000 Rp 20,000 Rp 40,000 7 Kontrol IUD Rp 10,000 Rp 10,000 Rp 20,000 8 Pasang Implant Rp 30,000 Rp 20,000 Rp 50,000 9 Cabut Implant Rp 20,000 Rp 30,000 Rp 50,000 10 Jahit luka episisiotomi Rp 20,000 Rp 30,000 Rp 50,000 11 Buka tampon Rp 2,500 Rp 5,000 Rp 7,500 12 Visum Kebidanan Rp 5,000 Rp 15,000 Rp 20,000 13 Biopsi Rp 20,000 Rp 30,000 Rp 50,000 14 Papsmear Rp 35,000 Rp 10,000 Rp 45,000 15 Periksa hamil Rp 5,000 Rp 10,000 Rp 15,000

5. Pelayanan Tindakan Poli Anak No

Jenis Pelayanan Jasa Sarana Jasa Pelayanan Jumlah 1 Mantoux tes Rp 25,000 Rp 28,000 Rp 53,000

6. Pelayanan Tindakan Medik Poli THT No