Page 16 - TARIF BPJS (Update Nov 2017)

TINDAKAN DI KAMAR TINDAKAN KEBIDANAN (RBK) OLEH
DOKTER
Jasa Medis Jasa Medis
I TINDAKAN RAWAT INAP KELAS I Biaya Sarana Total Tarif
Dokter Anastesi
1 Kuretase 415,800 124,740 614,460 1,155,000
2 Kuretase Hisap (Molla Hydatidosa) 415,800 124,740 614,460 1,155,000
3 Abses / Kista Bartholini 415,800 124,740 614,460 1,155,000
Jasa Medis Jasa Medis
II TINDAKAN RAWAT INAP KELAS II Biaya Sarana Total Tarif
Dokter Anastesi
1 Kuretase 324,000 97,200 478,800 900,000
2 Kuretase Hisap (Molla Hydatidosa) 324,000 97,200 478,800 900,000
3 Abses / Kista Bartholini 324,000 97,200 478,800 900,000
Jasa Medis Jasa Medis
III TINDAKAN RAWAT INAP KELAS III Biaya Sarana Total Tarif
Dokter Anastesi
1 Kuretase 270,900 81,270 400,330 752,500
2 Kuretase Hisap (Molla Hydatidosa) 270,900 81,270 400,330 752,500
3 Abses / Kista Bartholini 270,900 81,270 400,330 752,500

Catatan :
Biaya belum termasuk Obat-obatan dan Medical Supply

GIGI DAN MULUT

KLINIK GIGI UMUM / ESSENSIAL
TINDAKAN Jasa Medis Biaya Sarana Total Tarif
I KONSULTASI
1 Konsul Dokter Gigi Tanpa Tindakan 19,110 26,390 45,500
II TAMBALAN SEMENTARA
1 Pit & fissure / element 43,200 76,800 120,000
2 Pulp capping / element 43,200 76,800 120,000
3 Semi permanent filling / element 43,200 76,800 120,000
4 Tambalan sementara / element 43,200 76,800 120,000
III PERAWATAN ENDODONSI
1 Biochemical preparation / visit 39,600 70,400 110,000
2 Pengisian ruang pulpa (tanpa Guttap percha) 43,200 76,800 120,000
3 Pengisian saluran akar gigi / root canal dengan gutta percha point 54,000 96,000 150,000
4 Pengisian saluran akar/ruang pulpa + Amalgam + pin 75,240 133,760 209,000
5 Pengisian saluran akar/ruang pulpa + Amalgam klas I 63,360 112,640 176,000
6 Pengisian saluran akar/ruang pulpa + Amalgam klas II MO / DO 67,320 119,680 187,000
7 Pengisian saluran akar/ruang pulpa + Amalgam klas II MOD 59,400 105,600 165,000
8 Pengisian saluran akar/ruang pulpa + Komplek light curing 61,200 108,800 170,000
9 Pengisian saluran akar/ruang pulpa + Komposit resin klas III / IV 75,240 133,760 209,000
10 Pengisian saluran akar/ruang pulpa + Komposit resin komplek + pin72,000 128,000 200,000
11 Pengisian saluran akar/ruang pulpa + Single light curing 72,000 128,000 200,000
12 Perawatan endodonsi / visit 43,200 76,800 120,000
13 Perawatan endodonsi dengan injeksi / tindakan 54,000 96,000 150,000
14 Perawatan endodonsi dengan paper point 43,200 76,800 120,000
15 Pulpotomy anterior / visit 43,200 76,800 120,000
16 Pulpotomy posterior / visit 46,800 83,200 130,000
IV TAMBALAN PERMANENT
1 Amalgam + pin 54,000 96,000 150,000
2 Amalgam klas I fissure caries 54,000 96,000 150,000
3 Amalgam klas I pit caries 49,680 88,320 138,000
4 Amalgam klas II MO / DO 49,680 88,320 138,000
5 Amalgam klas II MOD 53,820 95,680 149,500
6 Complex light cure filling 79,200 140,800 220,000
7 G I C Cement / element 49,680 88,320 138,000