DAFTAR TARIF LAYANAN KESEHATAN BLUD PUSKESMAS PIYUNGAN
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BERDASARKAN PERBUP 45 TAHUN 2016 DAN PERBUP 49 TAHUN 2016 |
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I. TARIF RETRIBUSI | |||
A | TARIF PELAYANAN RAWAT JALAN | TARIF BANTUL | TARIF LUAR BANTUL |
1 | Penduduk Bantul | 5,500 | 9,000 |
2 | UKS | 2,750 | |
B | TARIF PELAYANAN GAWAT DARURAT | 11,000 | 18,000 |
C | TARIF PELAYANAN RAWAT INAp | ||
1 | Rawat Inap Umum | 63,500 | 74,000 |
2 | Rawat Inap Utama | 185,000 | 185,000 |
II. TARIF PELAYANAN TINDAKAN MEDIK DAN TERAPI | |||
NO | JENIS PELAYANAN | TARIF BANTUL | TARIF LUAR BANTUL |
A | TINDAKAN MEDIS UMUM | ||
1 | Injeksi | 5,800 | 9,500 |
2 | Injeksi ekstra needle | 6,100 | 10,000 |
3 | Skin test | 6,050 | 10,500 |
4 | Pasang infus (mikro set) | 34,100 | 61,000 |
5 | Pasang infus (makro set) | 56,500 | 56,500 |
6 | Pelepasan infus | 5,200 | 8,500 |
7 | Perbaikan infus | 13,450 | 18,500 |
8 | Pasang kateter+urinbag | 40,700 | 75,500 |
9 | Pelepasan kateter | 12,150 | 12,500 |
10 | Lavement | 22,800 | 35,500 |
11 | Resusitasi | 25,250 | 59,000 |
12 | Pemasangan Oksigen | 8,600 | 15,500 |
13 | Oksigenasi (per liter per menit) | 40 | 75 |
14 | Pasang NGT | 44,500 | 51,000 |
15 | Scorstein | 24,750 | 35,000 |
16 | Rectal Toucher | 11,550 | 16,500 |
17 | Nebulizer | 24,800 | 39,000 |
18 | Perawatan luka (Perda lama : medikasi luka) | ||
a. Kecil | 16,350 | 22,000 | |
b, Sedang | 33,500 | 33,500 | |
c. Besar | 56,000 | 56,000 | |
19 | Debridemen sederhana | 26,200 | 49,000 |
20 | Debridemen kompleks | 74,050 | 129,000 |
21 | Hecting 1 sampai 5 | 39,050 | 61,500 |
22 | Hecting 6 sampai 10 | 58,600 | 87,500 |
23 | Perjahitan (setelah jahitan ke 10) | 5,000 | 5,000 |
24 | Ambil jahitan | 16,550 | 19,000 |
25 | Insisi / Eksisi | 29,000 | 59,500 |
26 | Cross incisi | 19,450 | 30,500 |
27 | Bilas lambung | 152,500 | 152,500 |
28 | Suction lendir | 34,500 | 34,500 |
29 | Irigasi mata | 33,000 | 33,000 |
30 | Pemberian supositoria | 13,000 | 13,000 |
31 | Pemasangan elastis verban | 46,000 | 46,000 |
32 | Chlorethyl spray | 15,000 | 21,700 |
33 | Circumsisi non cauther | 77,850 | 134,250 |
34 | Circumsisi cauther | 75,100 | 138,500 |
35 | Reposisi Dawir 1 telinga | 40,400 | 60,050 |
36 | Reposisi Dawir 2 telinga | 99,200 | 99,200 |
37 | Luka bakar dibawah 10 % tanpa komplikasi | 49,650 | 57,500 |
38 | Luka bakar diatas 10 % tanpa komplikasi | 119,300 | 143,600 |
39 | Extirpasi (Minor Surgery ) | 51,600 | 91,900 |
40 | Ektrasi kuku (Per kuku) | 26,800 | 48,200 |
41 | ATS | 234,450 | 234,450 |
42 | Ekstraksi corpus alineum mata (per Mata) | 22,200 | 34,100 |
43 | Refraksi Mata | 5,000 | 7,500 |
44 | Hordeolum | 26,150 | 39,100 |
45 | Tonometri | 18,500 | 27,500 |
46 | Cerumen Prop (per Telinga) | 12,950 | 17,500 |
47 | Corpus Alienum THT | 16,500 | 27,100 |
48 | Pasang Spalk | 38,400 | 58,300 |
49 | Pasang Tampon | 30,500 | 30,500 |
50 | Visum di TKP | 20,000 | 40,000 |
51 | Visum di Puskesmas | 15,000 | 32,500 |
52 | EKG | 18,000 | 22,000 |
B. | TINDAKAN KEBIDANAN | ||
1 | Partus Normal | 216,100 | 345,200 |
2 | Partus Gemelli | 272,800 | 478,200 |
3 | Induksi Persalinan | 69,300 | 164,100 |
4 | Jahit Luka Perineum (Jelujur) | 39,500 | 88,400 |
5 | Evakuasi Digital Placenta | 26,750 | 61,700 |
6 | Evakuasi Manual Placenta | 61,500 | 96,500 |
7 | Toucher/Kontrol IUD | 25,750 | 37,500 |
8 | Pemasangan IUD | 26,250 | 76,800 |
9 | Pelepasan IUD | 25,750 | 50,300 |
10 | Pemasangan dan Lepas IUD | 46,250 | 96,800 |
11 | Pemasangan Inplant | 30,450 | 83,300 |
12 | Pelepasan Impant | 30,450 | 102,300 |
13 | Pemasangan dan Lepas Inplant/Norplant | 50,450 | 142,300 |
14 | Pap Smear (Lab dan Transport) | 21,500 | 86,900 |
14 | IVA | 25,500 | 29,200 |
15 | Suntik KB | 5,800 | 11,400 |
16 | Perawatan Bayi Normal | 51,500 | 73,400 |
17 | Tindik | 6,400 | 21,700 |
18 | Dopler | 5,000 | 10,000 |
18 | Pra Rujukan Perdarahann PP | 446,800 | 446,800 |
19 | Antenatal care | 0 | 15,000 |
20 | Post natal care | 25,000 | 25,000 |
21 | Krioterapi | 150,000 | 150,000 |
C. | TINDAKAN PELAYANAN KESEHATAN GIGI DAN MULUT | ||
1 | Oral diagnostik/ konsultasi/ premedikasi | 5,000 | 5,000 |
2 | Pembersihan Karang Gigi per regio (total RA dan RB = 6 regio) | 13,750 | 39,500 |
3 | Tumpatan Amalgam | 18,400 | 46,000 |
4 | Tumpatan GIC 1 permukaan | 24,300 | 49,500 |
5 | Tumpatan GIC 2 permukaan | 24,300 | 64,500 |
6 | Tumpatan GIC lebih dari 2 permukaan | 24,300 | 70,000 |
7 | Tumpatan Komposit Light Cured (kecil/1 permukaan) | 21,550 | 52,000 |
8 | Tumpatan Komposit Light Cured (sedang/2 permukaan) | 38,900 | 73,500 |
9 | Tumpatan Komposit Light Cured (besar/lebih dari 2 permukaan) | 45,950 | 86,500 |
10 | Perawatan Pulp Capping | 12,200 | 26,500 |
11 | Perawatan Syaraf A (Devitalisasi pulpa) | 15,000 | 29,000 |
12 | Perawatan Saraf B (Sterilisasi kamar pulpa) | 14,300 | 30,000 |
13 | Perawatan Syaraf C (Pengisian kamar pulpa) | 15,800 | 35,500 |
14 | Trepanasi gigi | 19,000 | 19,000 |
15 | Pengambilan Tumpatan (Up Filling) | 17,500 | 17,500 |
16 | Koreksi Oklusi | 12,800 | 30,500 |
17 | Koreksi ulcus Decubitus | 20,000 | 20,000 |
18 | Pencabutan Gigi Decidui dengan topikal anestesi | 10,600 | 20,000 |
19 | Pencabutan Gigi Decidui dengan citoject | 10,600 | 28,500 |
20 | Pencabutan Gigi Dewasa dg spuit dispossible | 12,100 | 22,500 |
21 | Pencabutan Gigi Dewasa dg spuit dispossible dengan penyulit | 29,350 | 75,500 |
22 | Pencabutan Gigi Dewasa dg citoject | 29,350 | 50,000 |
23 | Pencabutan Gigi Dewasa dg citoject dengan penyulit | 29,350 | 90,000 |
24 | Incisi Abses per regio | 19,200 | 27,000 |
25 | Perawatan Dry Socket | 39,000 | 39,000 |
26 | Operkulektomi | 16,150 | 27,000 |
27 | Operasi Gigi | 86,250 | 165,000 |
28 | Hecting oral | 40,000 | 40,000 |
29 | Kontrol Post exo / op (Hecting Up) | 17,000 | 17,000 |
30 | Alveolectomy per regio | 46,000 | 46,000 |
31 | Reposisi Mandibula | 44,800 | 60,000 |
32 | Imobilisasi dengan komposit (3-5 gigi) | 123,000 | 123,000 |
33 | Gigi Tiruan Sebagian (harga per gigi blm termasuk base plate) | 65,600 | 80,000 |
34 | Jacket Crown Akrilik per unit | 127,100 | 215,000 |
35 | Jacket Porcelain fused to metal per unit | 247,100 | 545,000 |
36 | Reparasi gigi tiruan akrilik per rahang | 140,000 | 140,000 |
III. TARIF RETRIBUSI PELAYANAN PENUNJANG DIAGNOSIS | |||
NO | JENIS PELAYANAN | TARIF BANTUL | TARIF LUAR BANTUL |
A. | RADIOLOGI | ||
1 | 30X40 1x | 40,000 | 52,000 |
2 | 30X40 2x | 50,000 | 61,000 |
3 | 35X35 1x | 35,000 | 54,000 |
4 | 35X35 2x | 45,000 | 63,000 |
5 | 24X30 1x | 30,000 | 44,000 |
6 | 24X30 2x | 40,000 | 50,000 |
7 | 18X24 1x | 30,000 | 41,000 |
8 | 18X24 2x | 40,000 | 48,000 |
9 | 15X30 (OPG) | 24,000 | 37,000 |
10 | USG (Print 1 lbr) | 45,000 | 51,000 |
B. | LABORATORIUM | ||
1 | Hb Sahli | 2,150 | 4,000 |
2 | AL | 2,950 | 4,000 |
3 | HJL ( Hitung Jenis Leukosit) | 4,700 | 10,000 |
4 | Malaria | 4,700 | 10,000 |
5 | LPB (Limposit Plasma Biru) | 4,700 | 10,000 |
6 | AE | 4,750 | 7,500 |
7 | KED | 2,600 | 6,000 |
8 | AT Rees Ecker | 7,000 | 10,000 |
9 | HMT | 3,050 | 5,000 |
10 | CT | 3,000 | 7,000 |
11 | BT | 2,550 | 4,500 |
12 | Golongan Darah | 4,900 | 7,000 |
13 | Protein Urine | 3,600 | 5,000 |
14 | Reduksi Urine | 3,600 | 5,000 |
15 | Sedimen | 3,850 | 5,000 |
16 | Faeses | 4,150 | 10,000 |
17 | Glukosa Stik | 12,450 | 15,000 |
18 | Asam urat Stik | 18,950 | 20,000 |
19 | Kolesterol Stik | 24,350 | 25,000 |
20 | Trigliserid Stik | 27,700 | 30,000 |
21 | HBs Ag Rapid Tes | 23,000 | 25,000 |
22 | Narkoba (untuk setiap jenis) | 24,350 | 30,000 |
23 | PP Test lateks | 13,600 | 15,000 |
24 | Hb Spektro | 7,900 | 10,000 |
25 | Glukosa spektro | 13,400 | 15,000 |
26 | Asam Urat Spektro | 16,900 | 22,000 |
27 | Kolesterol Spektro | 17,100 | 22,000 |
28 | Trigliserid Spektro | 18,300 | 27,000 |
29 | SGOT Spektro | 16,900 | 22,000 |
30 | SGPT Spektro | 16,900 | 22,000 |
31 | Ureum Spektro | 13,600 | 20,000 |
32 | Kreatinin Spektro | 13,600 | 20,000 |
33 | Widal | 16,000 | 20,000 |
34 | Darah Lengkap Otomatis (DLO) | 40,000 | 40,000 |
35 | Hb/Hmt Stik | 8,000 | 15,000 |
36 | Rhesus | 7,000 | 7,000 |
37 | NS1 | 110,000 | 110,000 |
38 | IgG/IgM Dengue | 110,000 | 110,000 |
39 | HIV | 70,000 | 70,000 |
40 | syphilis RPR | 25,000 | 25,000 |
41 | syphilis RPR | 30,000 | 30,000 |
42 | Leptotek | 80,000 | 80,000 |
43 | Gonorhoe (GO) | 15,000 | 15,000 |
44 | Jamur | 10,000 | 10,000 |
45 | BTA | 20,000 | 20,000 |
46 | Stik urine 10 P | 10,000 | 10,000 |
47 | Urine Rutin | 15,000 | 15,000 |
48 | Urine Lengkap | 20,000 | 20,000 |
49 | Sampling Darah Kapiler | 2,000 | 2,000 |
50 | Sampling Darah Vena | 5,000 | 5,000 |
IV. TARIF PELAYANAN REHABILITASI MEDIK | |||
NO | JENIS PELAYANAN | TARIF BANTUL | TARIF LUAR BANTUL |
1 | Terapi Latihan Kecil | 5,500 | 8,000 |
2 | Terapi Latihan Sedang | 9,200 | 12,000 |
3 | Terapi Latihan Besar | 10,700 | 17,000 |
4 | Massage Bayi | 2,950 | 12,000 |
5 | Massage dewasa | 3,000 | 15,000 |
6 | Infra Red | 7,150 | 9,000 |
7 | TENS | 6,200 | 10,000 |
8 | Elektrical Stimulation (ES) | 6,000 | 10,000 |
9 | Static bycicle lamanya | 7,500 | 10,000 |
11 | Senam Hamil/Nifas/asma/DM dll | 3,350 | 5,000 |
12 | Ultra Sound (US) | 11,500 | 11,500 |
13 | Chest Therapy | 6,000 | 6,000 |
14 | Short Wave Diathermy | 15,150 | 15,150 |
15 | Micro Wave Diathermy | 14,000 | 14,000 |
16 | Terapi Manipulasi | 11,000 | 12,000 |
17 | Ice Massage | 7,000 | 10,000 |
18 | Traksi Cervical/Lumbal elektrik | 14,000 | 14,000 |
19 | Cold Pack | 13,000 | 13,000 |
20 | Hot Pack | 13,000 | 13,000 |
21 | Pararel Bar | 8,000 | 8,000 |
22 | Standing Bar | 8,000 | 8,000 |
23 | Shoulder wheel/Pulley/wallbar | 8,000 | 8,000 |
24 | Latihan transfer dan ambulasi menggunakan alat jalan (Kruk/Walker/Tripot) | 4,000 | 4,000 |
25 | Pemasangan/fitting orthosis | 4,500 | 4,500 |
26 | Parafin bath | 22,500 | 22,500 |
V. TARIF PELAYANAN KESEHATAN TRADISIONAL | |||
NO | JENIS PELAYANAN | TARIF BANTUL | TARIF LUAR BANTUL |
1 | Akupresur | 17000 | 17,000 |
2 | Akupuntur | 40000 | 40,000 |
VI. TARIF PELAYANAN KESEHATAN INFEKSI MENULAR SEKSUAL (IMS) | |||
NO | JENIS PELAYANAN | TARIF BANTUL | TARIF LUAR BANTUL |
A. | TINDAKAN | ||
1 | inspekulo pervaginam | 26,000 | 26,000 |
2 | Rectal toucher | 12,000 | 12,000 |
3 | pengambilan duh urethra | 8,000 | 8,000 |
B. | PEMERIKSAAN LABORATORIUM | ||
1 | Pemeriksaan basah duh tubuh servik, duh tubuh vagina dan duh tubuh urethra | 5,000 | 5,000 |
2 | Pemeriksaan kering duh tubuh anus | 2,000 | 4,500 |
3 | Pemeriksaan sipilis Rapid test | 17,000 | 25,000 |
4 | Pemeriksaan sipilis RPR | 25,000 | 30,000 |
5 | Rapid test HIV | 6,000 | 70,000 |
VII. TARIF PELAYANAN AMBULANCE | |||
NO | JENIS PELAYANAN | TARIF BANTUL | TARIF LUAR BANTUL |
1 | Dalam Kabupaten | ||
sampai dg 5 km pertama | 65,000 | 65,000 | |
> 5 km biaya per kilometer | |||
2 | Luar Kabupaten | ||
sampai dg 5 km pertama | 85,000 | 85,000 | |
> 5 km biaya per kilometer | |||
VIII. TARIF PELAYANAN KESEHATAN LAINNYA | |||
NO | JENIS PELAYANAN | TARIF BANTUL | TARIF LUAR BANTUL |
1 | Pemeriksaan Kesehatan | 5,000 | 7,500 |
2 | Pemeriksaan Dokter Spesialis | 15,000 | 22,500 |
3 | Tes Buta Warna | 5,000 | 7,500 |
4 | Konsultasi Kesehatan | 5,000 | 7,500 |
5 | BUKU KIA tiap Buku | 6,500 | 12,000 |
6 | Home Care (per petugas) | 20,000 | 20,000 |
7 | Tes kebugaran CJH | 42,500 | 42,500 |
8 | Poli Sore | 11,000 | 11,000 |
IX. TARIF PELAYANAN PENDIDIKAN | |||
NO | JENIS PELAYANAN | TARIF BANTUL | TARIF LUAR BANTUL |
1 | Praktek Klinik per minggu | ||
a. profesi | 30000 | 30,000 | |
b. D4/S1 | 26500 | 26,500 | |
c. D3 | 22500 | 22,500 | |
2 | Praktek non Klinik per minggu | ||
a. profesi | 25000 | 25,000 | |
b. D4/S1 | 20000 | 20,000 | |
c. D3 | 18000 | 18,000 | |
d SMA/SMK | |||
3 | Penelitian | ||
a. Profesi (S2/S3) | 250000 | 250,000 | |
b. D4/S1 | 200000 | 200,000 | |
c. D3 | 100000 | 100,000 | |
d. Pengambilan data dalam rangka studi pendahuluan (1 paket) di puskesmas | |||
4 | Pelayanan Studi banding | ||
a. narasumber(perJPL/org) | 250000 | 250,000 | |
b. Sarana Prasarana | |||
– konsumsi/orang | 37000 | 37,000 | |
– jasa sarana perpaket | 200000 | 200,000 |