Page 18 - TARIF BPJS (Update Nov 2017)

6 Klammer 3 jari 24,000
7 Jacket acrylic / unit 96,000
8 Temporary crown 48,000
9 Sendok cetak per orang 90,000
10 Bite rime / rahang 24,000
11 Proses Acrylic Full denture 210,000
12 Proses Acrylic Partial denture 102,000
IV Reparasi :
1 Heat cure 84,000
2 Self cure 60,000
V Relening / Rebasing :
1 Full denture 180,000
2 Partial denture 102,000
VI Orthodontie :
1 Plat Ortho, per rahang 120,000
2 Pasang expansives screw 102,000
3 Molar band 120,000
4 Plat Ortho transparan 120,000
VII Inlay / Uplay :
1 Inlay 90,000
2 Uplay 108,000
3 Core pin 90,000
4 Full cast crown 162,000
5 Onlay 132,000
6 Acrlic jacket crown + baking metal 132,000
Catatan :
Biaya belum termasuk Obat-obatan dan Medical Supply

BEDAH

DOKTER / OPERATOR
KELAS I Jasa Medis Jasa Medis
OPERASI KATEGORI I Operator Anastesi Biaya Sarana Total Tarif
1 Operasi Sedang 2,177,280 653,184 3,217,536 6,048,000
2 Operasi Besar 4,082,400 1,224,720 6,032,880 11,340,000
3 Operasi Besar Lanjutan 4,898,880 1,469,664 7,239,456 13,608,000
4 Operasi Khusus 8,164,800 2,449,440 12,065,760 22,680,000
OPERASI KATEGORI II
1 Operasi Kecil 882,504 264,751 1,304,145 2,451,400
2 Operasi Sedang 1,181,502 354,451 1,745,997 3,281,950
3 Operasi Besar 1,584,954 475,486 2,342,210 4,402,650
4 Operasi Khusus 2,208,150 662,445 3,263,155 6,133,750
5 Operasi Khusus Lanjutan 3,058,272 917,482 4,519,446 8,495,200
OPERASI KATEGORI III
1 Operasi Kecil 749,196 224,759 1,107,145 2,081,100
2 Operasi Sedang 1,109,430 332,829 1,639,491 3,081,750
3 Operasi Besar 1,487,682 446,305 2,198,463 4,132,450
4 Operasi Khusus 2,031,624 609,487 3,002,289 5,643,400
ORTHOPAEDIC SPINE SURGERY
1 LEVEL 1 9,695,700 2,908,710 14,328,090 26,932,500
2 LEVEL 2 19,391,400 5,817,420 28,656,180 26,932,500
3 LEVEL 3 24,777,900 7,433,370 36,616,230 26,932,500
LAMINOSTOMY MICRODISECTOMI
1 LEVEL 1 19,235,475 3,847,095 12,538,680 35,621,250
2 LEVEL 2 36,202,950 7,240,590 23,598,960 67,042,500
CERVICAL ANTERIOR INTERNAL FIKSASI (CAIF)
1 LEVEL 1 9,695,700 2,908,710 14,328,090 26,932,500
2 LEVEL 2 19,391,400 5,817,420 28,656,180 53,865,000