XX. TARIF INSTALASI PEMULASARAN PRAWATAN JENAZAH RSUD
NO JENIS TINDAKAN
BAKHP JASA PELAYANAN
JASA SARANA JUMLAH
A Perawatan Jenazah
1 Meninggal wajar
50,000 175,000
75,000 300,000
2 Meninggal tidak wajar
50,000 175,000
75,000 300,000
Tarif perawatan jenazah 25 3
Penyimpanan Jenazah 50,000
75,000 125,000
Tarif Penyimpanan jenazah per hari Rp. 50.000,-
XXI. TARIF LABORATORIUM RSUD
NO JENIS
PEMERIKSAA N
PoliKLS III SwastaKLS II
KLSI VIPICU
BAKHP JP
JRS Total
BAKH P
JP JRS
Total BAKH
P JP
JRS Total
BAKH P
JP JRS
Total
1
HEMATOLOG I
a
Darah Lengkap Otomatis
25,000 6,000
2,000 33,000
25,000 10,000
3,500 38,500
25,000 14,000
5,000 44,000
25,000 15,000
5,000 45,000
b Hb
5,000 2,000
700 7,700
5,000 4,000
1,500 10,500
5,000 6,000
2,000 13,000 5,000
8,000 3,000
16,000 c
Eritrosit 5,000
2,000 700
7,700 5,000
4,000 1,500
10,500 5,000
6,000 2,000
13,000 5,000
8,000 3,000
16,000 d
Lekosit 5,000
2,000 700
7,700 5,000
4,000 1,500
10,500 5,000
6,000 2,000
13,000 5,000
8,000 3,000
16,000 e
DiffCount 5,000
2,000 700
7,700 5,000
4,000 1,500
10,500 5,000
6,000 2,000
13,000 5,000
8,000 3,000
16,000 f
LEDBBS 5,000
2,000 700
7,700 5,000
4,000 1,500
10,500 5,000
6,000 2,000
13,000 5,000
8,000 3,000
16,000 g
Retikulosit 5,000
2,000 700
7,700 5,000
4,000 1,500
10,500 5,000
6,000 2,000
13,000 5,000
8,000 3,000
16,000 h
Trombosit 5,000
2,000 700
7,700 5,000
4,000 1,500
10,500 5,000
6,000 2,000
13,000 5,000
8,000 3,000
16,000 i
HTPCVHCT 5,000
2,000 700
7,700 5,000
4,000 1,500
10,500 5,000
6,000 2,000
13,000 5,000
8,000 3,000
16,000 j
MDT 5,000
2,000 700
7,700 5,000
4,000 1,500
10,500 5,000
6,000 2,000
13,000 5,000
8,000 3,000
16,000 k
Malaria 5,000
4,000 700
9,700 5,000
6,000 2,000
13,000 5,000
8,000 2,500
15,500 5,000
10,000 3,500
18,500 l
Gol darah 10,000
5,000 700
15,700 10,000
6,000 2,000
18,000 10,000
8,000 2,500
20,500 10,000
10,000 3,500
23,500
m Analiasa Gas
darah 150,000
8,000 2,500
160,50 150,00
10,000 3,500
163,500 150,00
14,000 5,000
169,000 150,000
16,000 5,000
171,00
n CT
5,000 2,000
700 7,700
5,000 4,000
1,500 10,500
5,000 6,000
2,000 13,000
5,000 8,000
3,000 16,000
BT 5,000
2,000 700
7,700 5,000
4,000 1,500
10,500 5,000
6,000 2,000
13,000 5,000
8,000 3,000
16,000 p
MCV 2,000
2,000 700
4,700 2,000
4,000 1,500
7,500 1,000
4,000 1,500
6,500 2,000
5,000 1,500
8,500 q
MCH 2,000
2,000 700
4,700 2,000
4,000 1,500
7,500 1,000
4,000 1,500
6,500 2,000
5,000 1,500
8,500 r
APTT 50,000
8,000 2,500
60,500 50,000
10,000 3,500
63,500 50,000
14,000 5,000
69,000 50,000
16,000 5,000
71,000 s
PTT 50,000
8,000 2,500
60,500 50,000
10,000 3,500
63,500 50,000
14,000 5,000
69,000 50,000
16,000 5,000
71,000
t Fibrinogen
80,000 8,000
2,500 90,500
80,000 10,000
3,500 93,500
80,000 14,000
5,000 99,000
80,000 16,000
5,000 101,00
2 URINALISA
a Urin rutin
12,000 4,000
1,500 17,500
12,000 6,000
2,000 20,000
12,000 8,000
2,500 22,500
12,000 9,000
3,000 24,000
b Sedimen
5,000 4,000
1,500 10,500
5,000 6,000
2,000 13,000
5,000 8,000
2,500 15,500
5,000 10,000
3,500 18,500
c Urobilin
5,000 2,000
700 7,700
5,000 4,000
1,500 10,500
6,000 6,000
2,000 14,000
5,000 7,000
2,500 14,500
3 SEROLOGI
a Widal
10,000 4,000
1,500 15,500
10,000 6,000
2,000 18,000
10,000 8,000
2,500 20,500
10,000 10,000
3,500 23,500
b RAFCRP
25,000 4,000
1,500 30,500
25,000 6,000
2,000 33,000
25,000 8,000
2,500 35,500
25,000 10,000
3,500 38,500
c HBs Ag Anti
HBs-Ag 20,000
4,000 1,500
25,500 20,000
6,000 2,000
28,000 20,000
8,000 2,500
30,500 20,000
12,000 4,000
36,000 d
ASTOASO 25,000
3,000 1,000
29,000 25,000
5,000 1,500
31,500 25,000
8,000 2,500
35,500 25,000
10,000 3,500
38,500 e
PST 10,000
3,000 1,000
14,000 10,000
5,000 1,500
16,500 15,000
8,000 2,500
25,500 15,000
10,000 3,500
28,500 f
SI 70,000
3,000 1,000
74,000 70,000
4,000 1,500
75,500 70,000
5,000 1,500
76,500 70,000
6,000 2,000
78,000 g
TIBC 70,000
3,000 1,000
74,000 70,000
4,000 1,500
75,500 70,000
5,000 1,500
76,500 70,000
6,000 2,000
78,000 h
Feritin 70,000
3,000 1,000
74,000 70,000
4,000 1,500
75,500 70,000
5,000 1,500
76,500 70,000
6,000 2,000
78,000
4 ANALISA
CAIRAN
a LCS Lengkap
30,000 8,000
2,500 40,500
30,000 10,000
3,500 43,500
30,000 14,000
5,000 49,000
30,000 16,000
5,500 51,500
b Cairan Sendi
50,000 10,000
3,500 63,500
50,000 15,000
5,000 70,000
50,000 19,000
6,500 75,500
50,000 20,000
7,000 77,000
TransudatEksuda t
5 Lain-lain
a Analisa sperma
10,000 8,000
2,500 20,500
10,000 10,000
3,500 23,500
10,000 14,000
5,000 29,000
10,000 16,000
3,000 29,000
b Faeces rutin
5,000 3,000
1,000 9,000
5,000 6,000
2,000 13,000
5,000 8,000
2,500 15,500
5,000 10,000
3,000 18,000
c Gula darah
10,000 2,000
700 12,700
10,000 3,000
1,000 14,000
10,000 4,000
1,500 15,500
10,000 5,000
3,000 18,000
d Sekret lengkap
5,000 3,000
1,000 9,000
5,000 6,000
2,000 13,000
5,000 8,000
2,500 15,500
5,000 10,000
3,000 18,000
6
KIMIA DARAH
a BSNGDP
8,000 1,500
500 10,000
8,000 2,000
700 10,700
8,000 5,000
1,500 14,500
8,000 6,000
2,000 16,000
b 2JPP
10,000 1,500
500 12,000
10,000 2,000
700 12,700
10,000 4,000
1,500 15,500
10,000 6,000
2,000 18,000
c GDS
8,000 1,500
500 10,000
8,000 2,000
700 10,700
8,000 5,000
1,500 14,500
8,000 6,000
2,000 16,000
d Cholesterol
Total 12,000
1,500 500
14,000 12,000
2,000 700
14,700 12,000
4,000 1,500
17,500 12,000
6,000 2,000
20,000 e
Trigliserida 20,000
1,500 500
22,000 20,000
2,000 700
22,700 20,000
5,000 1,500
26,500 20,000
6,000 2,000
28,000 f
Asam Urat 10,000
1,500 500
12,000 10,000
2,000 700
12,700 10,000
4,000 1,500
15,500 10,000
6,000 2,000
18,000 g
UreumBUN 8,000
1,500 500
10,000 8,000
2,000 700
10,700 8,000
5,000 1,500
14,500 8,000
6,000 2,000
16,000 h
Kreatinin 15,000
1,500 500
17,000 15,000
2,000 700
17,700 15,000
5,000 1,500
21,500 15,000
6,000 2,000
23,000 i
Uriic Acid 12,000
1,500 500
14,000 12,000
2,000 700
14,700 12,000
5,000 1,500
18,500 12,000
6,000 2,000
20,000 j
SGOT 12,000
1,500 500
14,000 12,000
2,000 700
14,700 12,000
5,000 1,500
18,500 12,000
6,000 2,000
20,000 k
SGPT 12,000
1,500 500
14,000 12,000
2,000 700
14,700 12,000
5,000 1,500
18,500 12,000
6,000 2,000
20,000 l
Bil Total 20,000
1,500 500
22,000 20,000
2,000 700
22,700 20,000
5,000 1,500
26,500 20,000
6,000 2,000
28,000 m
Bil Direct 20,000
1,500 500
22,000 20,000
2,000 700
22,700 20,000
5,000 1,500
26,500 20,000
6,000 2,000
28,000
n Bil Indirect
20,000 1,500
500 22,000
20,000 2,000
700 22,700
20,000 5,000
1,500 26,500
20,000 6,000
2,000 28,000
o Protein total
8,000 1,500
500 10,000
8,000 2,000
700 10,700
8,000 5,000
1,500 14,500
8,000 6,000
2,000 16,000
p Albumin
8,000 1,500
500 10,000
8,000 2,000
700 10,700
8,000 5,000
1,500 14,500
8,000 6,000
2,000 16,000
q Globulin
8,000 1,500
500 10,000
8,000 2,000
700 10,700
8,000 5,000
1,500 14,500
8,000 6,000
2,000 16,000
r Alkali
phospate 12,000
1,500 500
14,000 12,000
2,000 700
14,700 12,000
5,000 1,500
18,500 12,000
6,000 2,000
20,000 s
HDL-Chol 10,000
1,500 500
12,000 10,000
2,000 700
12,700 10,000
4,000 1,500
15,500 10,000
6,000 2,000
18,000 t
LDL-Chol 10,000
1,500 500
12,000 10,000
2,000 700
12,700 10,000
4,000 1,500
15,500 10,000
6,000 2,000
18,000 u
Gamma - GT 12,000
1,500 500
14,000 12,000
2,000 700
14,700 12,000
5,000 1,500
18,500 12,000
6,000 2,000
20,000 v
Calcium 30,000
3,000 1,000
34,000 30,000
4,000 1,500
35,500 30,000
6,000 2,000
38,000 30,000
7,000 2,500
39,500 w
Kalium 30,000
3,000 1,000
34,000 30,000
4,000 1,500
35,500 30,000
6,000 2,000
38,000 30,000
7,000 2,500
39,500 x
Natrium 25,000
1,000 500
26,500 25,000
2,000 700
27,700 25,000
5,000 1,500
31,500 25,000
6,000 2,000
33,000 y
Khlorida 25,000
1,000 500
26,500 25,000
2,000 700
27,700 25,000
5,000 1,500
31,500 25,000
6,000 2,000
33,000 z
CK-MB 25,000
1,000 500
26,500 25,000
2,000 700
27,700 25,000
5,000 1,500
31,500 25,000
6,000 2,000
33,000
7
MIKROBIOL OGI
a BTA
5,000 5,000
1,500 11,500
5,000 5,000
1,500 11,500
5,000 8,000
2,500 15,500
5,000 10,000
3,500 18,500
b NESSER
5,000 5,000
1,500 11,500
5,000 5,000
1,500 11,500
5,000 8,000
2,500 15,500
5,000 10,000
3,500 18,500
c Gram
5,000 5,000
1,500 11,500
5,000 5,000
1,500 11,500
5,000 8,000
2,500 15,500
5,000 10,000
3,500 18,500
d Kultur
120,000 10,000
3,500 133,50
120,00 10,000
3,500 133,500
120,00 12,000
4,000 136,000
120,000 14,000
5,000 139,00
e Kultur +
Sensitivitas 200,000
10,000 3,500
213,50 200,00
10,000 3,500
213,500 200,00
12,000 4,000
216,000 200,000
14,000 5,000
219,00
8 PEMERIKSAAN HASIL LABORATORIUM OLEH DOKTER
SPESIALIS
a Pembacaan MDT
20,000 30,000
40,000
9 SAMPLING
` a
Dewasa 2,000
3,000 3,000
b Bayianak
3,000 4,000
4,000 c
Perifer 1,000
1,000 1,000
XXII. DAFTAR TARIF RETRIBUSI RADIOLOGI RSUD
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