PACKAGE PRICE IN OUT PATIENT SMALL TREATMENT
Not Include Medicine, X ray, Laboratory

	General Practitioner Rupia	General Practitioner US$	Dr Specialist Rupia	Dr Specialist US$
Hospital fee	50,000	6.25	50,000	6.25
Dr. fee General - Spesialis	100,000	12.50	200,000	25.00
Treatment	100,000	12.50	200,000	25.00
total	250,000	31.25	450,000	56.25

PACKAGE PRICE IN OUT PATIENT MEDIUM TREATMENT
Not Include Medicine, X ray, Laboratory

	General Practitioner Rupia	General Practitioner US$	Dr Specialist Rupia	Dr Specialist US$
Hospital fee	50,000	6.25	50,000	6.25
Dr. fee General - Spesialis	100,000	12.50	200,000	25.00
Treatment	200,000	25.00	400,000	25.00
total	350,000	43.75	650,000	81.25

DENTAL CLINIC
Not Include Medicine, X ray, Laboratory

	Dentist Rupia	Dentist US$
Hospital fee	50,000	6.25
Dr. fee	100,000	12.50
Emergency Treatment	100,000	12.50
total	250,000	31.25

PACKAGE PRICE IN THE OPERATION THEATER
Not Include Medicine, X-ray, Laboratory & Nursing

ELECTIVE OPERATION	Price in Rupia	Price in US$
Small Operation	3,049,300	381.16
Medium Operation	4,062,800	507.85
Large Operation	5,499,200	687.40
CITO OPERATION
Small Operation	3,319,200	414,90
Madium Operation	4,424,600	553.08
Large Operation	5,990,400	748.80

DELIVERY PRICE
Not Include Medicine, X-ray, Laboratory & Nursing

	Price in Rupia	Price in US$
Normal Delivery By Midwife	1,089,000	136.13
Normal Delivery By General Practicione	1,650,000	206.25
Normal Delivery By Specialist	2,557,500	319.69
Induction Delivery By Specialist	2,871,000	358.88
Vacum Delivery By Spesialist	3,184,500	398.06
Sectio Cesaria	10,173,500	1,271.69
Cito Sectio Cesaria	11,262,000	1,407.75

ROOM RATE
Including meal and Nursing
Not Include Medicine, X-ray, Laboratory & Doctor visite

	Price in Rupia	Price in US$
VIP- A AC, TV, Refregerator, Living Room,Private Bath Room with Cool and Hot Water,Adjusted Bed, Telephone, Extra Bed.	1,250,000	156.25
VIP- B AC, TV, Refregerator, Private Bath Room with Cool and Hot Water,Adjusted Bed, Telephone,Extra Bed.	1,110,000	138.75
Class I AC, TV, Private Bath Room, Adjusted Bed,Telephone	977,500	122.19
Class II Private Fan, Private Bath Room,Adjusted Bed, Telephone.	705,000	88.13

BABY ROOM RATE
Including meal and Nursing
Not Include Medicine, X-ray, Laboratory & Doctor visite

	Price in Rupia	Price in US$
NORMAL	135,000	16.88
WITH PROBLEM	240,000	30.00

SPECIALIST CONSULTATION

	Price in Rupia	Price in US$
Bed Consultation	300,000	37.50
Cito Bed Consultation	400,000	50.00
Emergency Consultation In The Operation Theater	500,000	62.50

AMBULANCE
Including Fee General Practitioner & assistant

	Price in Rupia	Price in US$
0 To 19 km	250,000	31.25
20 To 50 km	500,000	62.50
More then 50 km	1,400,000	175.00

Röntgen:

Dagelijks van 09.00 t/m 15.00
Per onderzoek komt bij deze tarieven nog één keer hospitial fee US$ 6.25

NO	ITEMS	TARIEVEN
NO		Rupia	US$
1	Cranium	150,000	18.75
2	Mastoid	150,000	18.75
3	Lumbosakral AP/Lat	150,000	18.75
4	Cervical AP/Lat	150,000	18.75
5	Thorax PA (AP)	150,000	18.75
6	Thorax AP/Lat	150,000	18.75
7	Thoracolumbal AP/Lat	150,000	18.75
8	Coxygeus AP/Lat	150,000	18.75
9	Abdomen AP	150,000	18.75
10	Abdomen AP/Lat	150,000	18.75
11	Pelvis	150,000	18.75
12	Clavicula	150,000	18.75
13	Humerus AP	150,000	18.75
14	Antebrachii AP/Lat	150,000	18.75
15	Manus AP/Lat	150,000	18.75
16	Femur AP/Lat	150,000	18.75
17	Scapula	150,000	18.75
18	Angkle AP/Lat	150,000	18.75
19	Pedis AP/Lat	150,000	18.75
20	Cruris AP/Lat	150,000	18.75
21	Water"s	150,000	18.75
22	Wrist AP/Lat	150,000	18.75
23	Elbow/Cubiti AP/Lat	150,000	18.75
24	Genu AP/Lat	150,000	18.75

Labaritorium

Dagelijks van 09.00 t/m 15.00
Het is gebruikelijk dat een arts U (de eerste keer) verwijst voor zo'n onderzoek, voor herhaling van sommige onderzoeken kan dat zonder tussenkomst van een arts.

NO	TARIEVEN	RATE
	Per onderzoek komt bij deze tarieven nog één keer hospitial fee US$ 6.25	RUPIA	U$
	HEMATOLOGY
1	Hematology Rutine	67,500	8.44
2	Haemoglobine	10,500	1.31
3	Leukocyte	10,500	1.31
4	Erythrocyte	10,500	1.31
5	BBS	10,500	1.31
6	Trombocyte	12,750	1.59
7	Hematokrit/PCV/HCT	12,750	1.59
8	Diff.Count	15,000	1.88

	HEMOSTASIS FUNCTION
9	Hemostasis Function, Complete	225,000	28.13
10	Bleeding Time	9,750	1.22
11	Clotting Time	9,750	1.22
12	Masa Protrombine Plasma/PPT	132,000	16.50
13	APTT	78,750	9.84
14	Blood Group	15,000	1.88
15	Rh Factor	22,500	2.81

	URINE ANALYSIS
16	Urine, Complete	30,000	3.75
17	Pregnancy Test	45,000	5.63

	FAECES
18	Faeces, Complete	27,000	3.38
19	Blood Faeces	27,000	3.38

	CSF /LIQUOR	90,000	11.25

	RENAL FUNCTION / RFT
20	Ureum/Bun	30,000	3.75
21	Creatinin	30,000	3.75
22	Uric Acid	31,500	3.94

	LIPID PROFILE
23	Cholesterol Total	31,500	3.94
24	Triglyseride	41,250	5.16
25	HDL-Cholesterol	41,250	5.16
26	LDL- Cholesterol	90,000	11.25

	BLOOD SUGAR
27	Fasting Blood Sugar / 2 hours After Meal	20,250	2.53

	SEROLOGY / IMMUNOLOGY
28	Widal	62,250	7.78
29	HBsAG	63,750	7.97
30	Anti HBsAG	85,500	10.69
31	VDRL	550,002	68.75

	SPERM ANALYSIS	75,000	9.38

	MICROBIOLOGY
32	Rectal Swab	75,000	9.38
33	Gram Staining	24,000	3.00
34	Bacteria Acid Resistance Stain	24,000	3.00
35	Malaria	22,500	2.81
36	Trichomonas	22,500	2.81
37	Food Bacteria	112,500	14.06
38	Water Bacteria	112,500	14.06
39	Kitchen Ware Checking	112,500	14.06
40	Bacteria Culture	112,500	14.06
41	Culture Resistance	225,000	28.13
42	Bile Culture	112,500	14.06
43	Colony Count	112,500	14.06

	LEVER FUNCTION
44	Total Protein	30,000	3.75
45	Albumin	30,000	3.75
46	Globuline	30,000	3.75
47	Direct Billirubin	31,500	3.94
48	Total Billirubin	31,500	3.94
49	SGOT	30,000	3.75
50	SGPT	30,000	3.75
51	Gamma GT	60,000	7.50
52	Alkaline Phosphatase	34,500	4.31

Yours sincerely

General Hospital Bali AGA

Director,

Dr. Johnny Irawan, MPH, Akp.

25-04-2004