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1. Biaya Obat Rawat Jalan TK I

Perhitungan Tarif Obat :

A. ISPAAmoxicillin ( 372 x 12 x 1.25 ) + 1 !" 5#$%.Paracetamol ( 5% x 12 x 1.25 ) + 1 !" %7.O & ' ( 235 x 1 x 1.25 ) + 1 !" 3#3.75&. om"lex ( 31 x 12 x 1.25 ) + 1 !" $5.

Rp 10,058.75

B. Diareortimoxa*ol ( 1% x 12 x 1.25 ) + 1 !" 2#32.e, -iatab ( 3 x x 1#25 ) +1 !" 3#57$.25Pa"a/erine ( 7$ x x 1.25 ) + 1 !" 55.Oralit ( 2% x 3 x 1.25 ) + 1 !" 25.

Rp 7,056.5

!. "a#triti#Anta0ia ( 33 x x 1.25 ) + 1 !" 71.25xtra &ellaona ( 15 x x 1.25 ) + 1 !" 2$%.75

Paracetamol ( 5% x x 1.25 ) + 1 !" 752.5Rp 1,$%.50

D. K&litOx4tetrac4line alf ( %52 x 1.25 )+ 1 !" 1#1$5. t m (2 x x 1.25 ) + 1 !" 325.-examentha0one ( $5 x x 1.25 ) + 1 !" %31.25Am"icilin ( 35 x x 1.25 ) + 1 !" 3#%1.25

Rp 6,'0.50

(. )ebri#hloram"enicol ( 15 x 2 x 1.25 ) + 1 !" #5.Paracetamol 5 mg ( 5% x x 1.25 ) + 1 !" 752.5 t m ( 2 x x 1.25 ) + 1 !" 325.& om"lex ( 31 x x 1.25 ) + 1 !" %.75

Rp 5,%76.5

Tari* Riil Obat+ Jeni# Pelayanan Biaya - Rp Perban/inan1 6PA 1#5%.75 1$2 -6A! 7#5$.25 53 8AT!6T6 1#2.5 9;6T $#32.5

5

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B. D28libenlami ( 13 x 1 x 1.25 ) + 16n0ulin 6n? + 1 "uit ( x 1 x 1.25 ) + 1"uit ( 2 x 1 x 25 ) + 1

!. 4iperten#i

a"ten0in 25 ( 177 x 2 x 1.25 ) + 1

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6nfu0 et ( 5 x 1 x 1.25 ) + 1Abocath ( 23 x 1 x 1.25 ) + 1

B. D4)i"rooa0in ( 1732.5 x 1 x 1.25 ) + 1Paracetamol ( 5% x 15 x 1.25 ) + 1&.om"lex ( 31 x 15 x 1.25 ) + 1@aga0ia iru" ( % x x 1.25 ) + 1

6nfu0 ( airan ) ( %5 x 15 x 1.25 ) + 1"uit ( 25 x x 1.25 ) + 16nfu0 et ( 5 x 1 x 1.25 ) + 1Abocath ( 23 x 1 x 1.25 ) + 1

!. Diare& 12 6n? ( 23 x 3 x 1.25 ) + 1Anta0i ( 32 x 1.25 ) + 19ao0"ecta ( 11725 x 1.25 ) + 19aftrim 4r ( 52%2.2 x 1.25 ) + 1!6 ( %5 x x 1.25 ) + 1

"uit ( 25 x x 1.25 ) + 16nfu0 et ( 5 x 1 x 1.25 ) + 1Abocath ( 23 x 1 x 1.25 ) + 1

D. Brnpne&niPu4eri"roola0a0in 5 @g ( 1732.5 x 1 x 1.25 ) + 1Panaol 4r ( 15 x 1 x 1.25 ) + 1Preni0on Tab ( 727 x 7.5 x 1.25 ) + 1"uit ( 25 x x 1.25 ) + 16nfu0 et ( 5 x 1 x 1.25 ) + 1Abocath ( 23 x 1 x 1.25 ) + 1

(. P#t Opi"roola0a0in 5 @g ( 1732.5 x 1 x 1.25 ) + 1Profenit u" ( $2 x 2 x 1.25 ) + 1@ectan 5 @g ( $2% x x 1.25 ) + 16n? Bit ( 725 x 3 x 1.25 ) + 16nfu0 !6 ( %5 x 1 x 1.25 ) + 1"uit ( 25 x x 1.25 ) + 16nfu0 et ( 5 x 1 x 1.25 ) + 1

Abocath ( 23 x 1 x 1.25 ) + 1

). 4iperten#iata"re0 6n? ( 171$ x x 1.25 ) + 1

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". Ke9ante0oli u" ( 7 x 1 x 1.25 ) + 1

Panaol 4r ( 15 x 1 x 1.25 ) + 1Pu4er-ia*e"am ( 2$.25 x 1 x 1.25 ) + 1Amox ( 372 x $ x 1.25 ) + 1tm ( 37.5 x % x 1.25 ) + 1!6 ( %5 x x 1.25 ) + 1"uit ( 25 x x 1.25 ) + 16nfu0 et ( 5 x 1 x 1.25 ) + 1Abocath ( 23 x 1 x 1.25 ) + 1

Tari* Riil Obat Rawat Inap

+ Jeni# Pelayanan Biaya -Rp Perban/inan1 Thi"oi !" 2$3#2%1 2 -hf !" 337#15 3 -iare !" 1%3#%3 $ &roncho"neumonia !" 5#25 35 'i"erten0i !" 112#115 2$ Po0t O" !" 252#77 37 9e?ang !" 17%#35 2

J&la Rp 1,158,$71 2Tarif !iil Obat !a,at 6na" aalah

$. Biaya Obat Rawat Inap -:an /ire#epan

A. Thi"oi9emicitin 6n? ( 2 x $ x 1.25 ) + 1

&. -hf 9ea0ilin 6n? ( 21 x $ x 1.25 ) + 1

. 8en*4fort ( 3 C 15 C 1.25 ) + 1;40mine 4ru" ( 17$ x 1.25) + 1

-. &"9al"icilin 6n? ( 1 x 1 x 2 x 3 x 1.25) + 19almeta0on 6n? mg ( %% x 3 x 1.25) + 1

. 9"Aona 6n? ( 3% x $ x 1.25 ) + 1a"0 Aona ( 11$ x 15 x 1.25 ) + 1'emafort ( $$ x 15 x 1.25 ) + 19al"icilin 6n? ( 1 x 2 x 3 x 1 x 1.25 ) + 1

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6n? efota0im 1 8r ( 3 x 3 x 2$ x 1.25 ) + 16n?

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F ;aboratorium 215 .5F Pemeri0aan 9hu0u0 % .1F Phatologi Anatomi . .%

e Phi0iotera"i 2 .5g mergenc4 % .1

S&b Ttal 771.5 1.615%

Tabel '. J&la K&n9&nan Rawat 3an9&tan /i Bapel 2e/ia /ala 1 b&lan

+ Jeni# Pelayanan J&la K&n9&nan Pr#enta#e'. RA

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1 AnemiaE

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Per0alinan ormal

Tabel 11. Tari* Dter "ii -Pelayanan Ke#eatan "ii

Jeni# Pelayanan Tari* Perban/inan PelayananPemeri0aan !" 1# 2

Tambal 0ementara !" 15# 15Tambal "ermanen !" 2# 13abut gigi 0u0u !" 15# 5

abut gigi "ermanen !" 25# %abut gigi engan om"lia0i !" 5#

Dumlah!ataFrata bia4a "ela4anan e0ehatan gigi a0ar

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Ttal Biaya!" 1$#!" 35#2%1!" 5#7!" 25#21

!" 7#%1!" 275#211

!" #512.5!" 75.!" 1#537.5!" 275.

!" #2%7.5!" 1$#3$2.5

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!" 1#775.!" 1#13#1.!" 7#%5.!" 1#%%1#725.

!" #35!" 1#3%!" 75!" 1#1!" %#17

!" 7#75!" $#2%%!" 1#1%%!" 1#55

!" 25#552.

!" 21#75$!" 3#727!" 55!" 2$#2

!" 1$#2%!" 2#%2!" 1#32

Ttal Biaya!" %1#%13!" 1#%%1#725!" $#23!" 5%#2!" 25#552!" 7%#127

!" 77#27%!" 2#2%#%7

!" 11#537.5!" 1#1%7.5!" $%1.25!" 1#225.

!" 5#725.!" 12#$.

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!" 11#75.!" 2#35.!" 2$3#2%1.25

!" 21#75$!" 1#1%%!" 5%1!" 1#225

!" 15#75!" 12#$!" 11#75!" 2#35!" 337#15

!" %#725!" #1!" 1#$5$!" $#73!" 5#725

!" 12#$!" 11#75!" 2#35!" 1%3#%3

!" 21#75$!" 12#$$3!" $#1$!" 12#$!" 11#75!" 2#35!" 5#25

!" 21#$5$!" 15#%25!" 7#1$5!" 2#%1!" 1#725!" 12#$!" 11#75

!" 2#35!" 112#115

!" %5#$3!" 3#$$3!" 11#1$3!" 1#7%!" 5!" 5#725!" 12#$!" 11#%75

!" 2#35!" 252#77

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!" 12#225

!" 12#$$3

!" 133!" 2#%!" 75!" 5#725!" 12#$!" 11#75!" 2#35!" 17%#35

Ttal Biaya!" 2#3$#531!" 1#3%#$!" 1#13#!" 2%5#77%!" 22#23!" 75$#232!" 35$#71!" $#3#$

!" 7#.!" 7#.

!" 1#5#175!" 1#5#175

!" 7#5%1!" 22#1!" 2#$%1

!" 7%#%5!" 1$#3!" 5#735

!" 2$#335!" 1#15!" 12#75!" 7%#%5!" 13$#7$5

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!" 27#1!" 135#1!" 32#2

!" 2$#2!" !" 2$#51

!" 13#%%!" 133#5%5!" 1%#$!" 3#25!" 2#

Ttal Biaya!" #$!" $##7!" 1%#$!" 2%7#25!" 1#25!" 1#2$#$!" 13#3%!" 5%#1%!" #$#%1

lan

1 b&lan

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Ttal Biaya -Rp

$7#513#15#

15,000$#

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500,000

Ttal Biaya -Rp!" 2#!" 225#!" 2$#!" 75#

!" 2#!" 2#

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Tabel 10. Tari* Pelayanan Ke#eatan Da#ar

Deni0 Pela4anan

Pe4anan 9& :

Pil 9&

unti 9&

6-

!ataFrata bia4a untu "il 9&

&ia4a 6muni0a0i a0ar

Per0alinan ormal