J S J P JLH( Rp ) ( Rp ) ( Rp )

1 3 4 5VII. PEMERIKSAAN / PELAYANAN DIAGNOSTIK ELEKTROMEDIK

A. SEDERHANA1. Spirometri 90,000 60,000 150,0002. EKG 18,000 12,000 30,000

B. SEDANG1. TTLB 360,000 240,000 600,0002. TTLB dengan USG 450,000 300,000 750,0003. Biopsi Pleura 300,000 200,000 500,0004. EMG / Evoke Potensial SSP 165,000 110,000 275,0005. EEG Mapping 120,000 80,000 200,0006. Fungsi Cairan Asites 600,000 400,000 1,000,0007. Fungsi Pluera 516,000 344,000 860,0008. Biopsi Hati 600,000 400,000 1,000,0009. USG Color Dopler P. Dalam, Ginjal 150,000 100,000

250,000 10. USG Color Dopler Thorax / Paru 300,000 200,000

500,000 11. USG Tuntunan Biopsi 94,500 63,000

157,500 12. Biopsi Prostat 600,000 400,000 1,000,00013. Biopsi Ginjal 600,000 400,000 1,000,00014. Transcranial Dopler (TCD) 180,000 120,000 300,000

C. CANGGIH1. Skleroterapy Gastroscopy / Varices Esophagus 780,000 520,000 1,300,0002. Colonoskopy 450,000 300,000 750,0003. Colonoskopy + Polipeptomy 510,000 340,000 850,0004. Colonoskopy + Biopsi 510,000 340,000 850,0005. Colonoskopy dengan Clipping 510,000 340,000 850,0006. Colonoskopy dengan Anestesi Umum 720,000 1,080,000 1,800,0007. Gastroskopy 390,000 260,000 650,000

TARIF PELAYANAN / TINDAKAN KELAS IIIRSUP. H. ADAM MALIK TAHUN ANGGARAN 2014

NO J E N I S P E L A Y A N A NBESARAN TARIF TA. 2014

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7. Gastroskopy 390,000 260,000 650,0008. Gastroskopy Biopsi 450,000 300,000 750,0009. Gastroskopy dengan Clipping 480,000 320,000 800,000

10. Gastroskopy Dilatasi Esopagus (Pumping) 2,052,000 1,368,000 3,420,00011. Gastroskopy dengan Anestesi Umum 720,000 1,080,000 1,800,00012. Skleroterapy Varices Esophagus 390,000 260,000 650,00013. Ligasi Varices Esophagus 390,000 260,000 650,00014. Savary Bougy Esophagus 390,000 260,000 650,00015. a. ERCP Tidak Berhasil

- ERCP Diagnostik 750,000 500,000 1,250,000b. ERCP Berhasil - ERCP Spirinterektomy 1,860,000 1,240,000 3,100,000 - ERCP Stenting 1,860,000 1,240,000 3,100,000 - ERCP Basket 1,860,000 1,240,000 3,100,000(Seluruh tindakan ERCP memakai anasthesi)

20. Fibroscan 300,000 200,000 500,00021. Urocystoskopy 150,000 100,000 250,00022. RPG 600,000 400,000 1,000,00023. ESWL 1,200,000 1,800,000 3,000,00024. ESWL Fase II 940,000 1,410,000 2,350,00025. Bronchoskopy 510,000 340,000 850,00026. Bronchoskopy + Biopsi 570,000 380,000 950,00027. Bronchoskopy + Sikatan 570,000 380,000 950,00028. Bronchoskopy + Bilasan 570,000 380,000 950,00029. Bronchoskopy dengan Anestesi Umum 720,000 1,080,000 1,800,00030. Pengambilan Benda Asing dengan Bronchoskopy 720,000 1,080,000 1,800,00031. Thoracoscopy + Biopsi 1,080,000 1,620,000 2,700,00032. Treadmill Test 120,000 80,000 200,00033. Double Lumen Tunnel 1,440,000 960,000 2,400,00034. Double Lumen Tunnel (Temporer) 900,000 600,000 1,500,00035. Repair Double Lumen 450,000 300,000 750,000

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