Tarif jasa pelayanan kesehatan kulit dan kecantikan

Tarif (Rp)
No. Kode Jenis Pelayanan Jasa

Jasa Sarana Jumlah
Pelayanan
1 0001 Darm Bouis 12,000 8,000 20,000
2 0002 Echo Cardiography (Poli Jantung) 150,000 100,000 250,000
3 0003 Holter dan Recorder 162,000 108,000 270,000
12 0004 Treadmill 237,000 158,000 395,000
13 0005 Angkat dan Pasang KB Susuk 121,800 81,200 203,000
14 0006 Angkat Jahitan 22,200 14,800 37,000
20 0007 Ekstirpasi Kiste Bartholine 609,000 406,000 1,015,000
22 0008 Ekstraksi IUD Kebidanan 72,000 48,000 120,000
24 0009 Extractie IUD dengan G A 609,000 406,000 1,015,000
32 0010 Pap Smear Biasa 49,800 33,200 83,000
38 0011 Pasang Pesarium 33,000 22,000 55,000
42 0012 USG 55,200 36,800 92,000
43 0013 Bedah Sakpel 150,000 100,000 250,000
44 0014 Biopsi Kulit 121,500 81,000 202,500
48 0015 Eksisi Granuloma 315,600 210,400 526,000
49 0016 Eksisi Granuloma Pyogenikum 300,000 200,000 500,000
50 0017 Eksisi Hordeleum/Granuloma 150,000 100,000 250,000
51 0018 Eksisi Syringoma 36,000 24,000 60,000
52 0019 Eksisi Xantalasma 1,500,000 1,000,000 2,500,000
53 0020 Eksisi Xantoma 450,000 300,000 750,000
54 0021 Ekstirpasi Komedo 42,000 28,000 70,000
55 0022 Ekstraksi Kalium Oksalat 36,000 24,000 60,000
56 0023 Elektro Kauter dengan Anestesi Topikal (Condiloma) 180,000 120,000 300,000
57 0024 Elektro Kauter dengan Anestesi Topikal (Millium) 120,000 80,000 200,000
58 0025 Elektro Kauter dengan Anestesi Topikal (Veruka...) 121,500 81,000 202,500
59 0026 Elektrofulgasi 36,000 24,000 60,000
60 0027 Elektrokauter dengan Anestesi Injeksi 180,000 120,000 300,000
61 0028 Elektrokauter dengan Anestesi Topikal 121,500 81,000 202,500
62 0029 Enulkleasi Milia Lesi < 20 48,900 32,600 81,500
63 0030 Enulkleasi Milia Lesi > 20 66,900 44,600 111,500
64 0031 Enulkleasi Moluskum 42,000 28,000 70,000
65 0032 Enulkleasi Moluskum lesi < 20 30,900 20,600 51,500
66 0033 Enulkleasi Moluskum Lesi > 20 48,900 32,600 81,500
67 0034 Injeksi Triamcinolon Acetonide Kenacort lesi < 50 cm² 42,000 28,000 70,000
68 0035 Injeksi Triamcinolon Acetonide Kenacort Lesi > 50 cm² 60,000 40,000 100,000
69 0036 IPL (Pemakaian Alat Canggih) Kaki Kanan - Kiri 540,000 360,000 900,000
70 0037 IPL (Pemakaian Alat Canggih) Tangan Kanan - Kiri 420,000 280,000 700,000
71 0038 IPL (Pemakaian Alat Canggih) Wajah 300,000 200,000 500,000
72 0039 Pengangkatan Neuro Fibroma 300,000 200,000 500,000
73 0040 Pengangkatan Tandur Kulit 450,000 300,000 750,000
74 0041 Suntik Keloid 10,800 7,200 18,000
75 0042 Tindakan Bedah Flap 450,000 300,000 750,000
76 0043 Tindakan Dermabrasi 150,000 100,000 250,000
77 0044 Tindakan pada Keratosis Seboroika Lesi < 20 121,500 81,000 202,500
78 0045 Tindakan pada Keratosis Seboroika Lesi > 20 300,000 200,000 500,000
79 0046 Tatto Removal 1/4 card 165,000 110,000 275,000
82 0049 Tatto Removal 1 card 660,000 440,000 1,100,000
83 0050 Dark Circle Around Eyes 1/4 card 165,000 110,000 275,000
86 0053 Dark Circle Around Eyes 1 card 660,000 440,000 1,100,000
87 0054 Wrinkle Around Eyes 1/4 card 165,000 110,000 275,000
90 0057 Wrinkle Around Eyes 1 card 660,000 440,000 1,100,000
91 0058 Skin Lightening 1/4 card 165,000 110,000 275,000
94 0061 Skin Lightening 1 card 660,000 440,000 1,100,000
95 0062 Rosacea 1/4 card 165,000 110,000 275,000
96 0063 Rosacea 1/2 card 330,000 220,000 550,000
97 0064 Rosacea 3/4 card 495,000 330,000 825,000
98 0065 Rosacea 1 card 660,000 440,000 1,100,000
99 0066 QS Pixel Melasma 1/4 card 165,000 110,000 275,000
102 0069 QS Pixel Melasma 1 card 660,000 440,000 1,100,000
103 0070 QS Pixel Freckles 1/4 card 165,000 110,000 275,000
106 0073 QS Pixel Freckles 1 card 660,000 440,000 1,100,000
107 0074 QS Pixel Lentigo 1/4 card 165,000 110,000 275,000
110 0077 QS Pixel Lentigo 1 card 660,000 440,000 1,100,000
111 0078 Whole Face Rejuvenation 780,000 520,000 1,300,000
112 0079 Siringoma 1/4 card 165,000 110,000 275,000
113 0080 Siringoma 1/2 card 330,000 220,000 550,000
114 0081 Siringoma 3/4 card 495,000 330,000 825,000
115 0082 Siringoma 1 card 660,000 440,000 1,100,000
116 0083 Gentle Peel 1/4 card 165,000 110,000 275,000
117 0084 Gentle Peel 1/2 card 330,000 220,000 550,000
118 0085 Gentle Peel 3/4 card 495,000 330,000 825,000
119 0086 Gentle Peel 1 card 660,000 440,000 1,100,000
120 0087 SSR Melasma 1/4 card 165,000 110,000 275,000
121 0088 SSR Melasma 1/2 card 330,000 220,000 550,000
122 0089 SSR Melasma 3/4 card 495,000 330,000 825,000
123 0090 SSR Melasma 1 card 660,000 440,000 1,100,000
124 0091 SSR Freckles 1/4 card 165,000 110,000 275,000
127 0094 SSR Freckles 1 card 660,000 440,000 1,100,000
128 0095 SSR Lentigo 1/4 card 165,000 110,000 275,000
129 0096 SSR Lentigo 1/2 card 330,000 220,000 550,000
130 0097 SSR Lentigo 3/4 card 495,000 330,000 825,000
131 0098 SSR Lentigo 1 card 660,000 440,000 1,100,000
132 0099 Telangietacstatitas 1/4 card 165,000 110,000 275,000
135 0102 Telangietacstatitas 1 card 660,000 440,000 1,100,000
136 0103 Hemangiomas 1/4 card 165,000 110,000 275,000
137 0104 Hemangiomas1/2 card 330,000 220,000 550,000
138 0105 Hemangiomas 3/4 card 495,000 330,000 825,000
139 0106 Hemangiomas 1 card 660,000 440,000 1,100,000
140 0107 Venous Lake 1/4 card 165,000 110,000 275,000
141 0108 Venous Lake 1/2 card 330,000 220,000 550,000
142 0109 Venous Lake 3/4 card 495,000 330,000 825,000
143 0110 Venous Lake 1 card 660,000 440,000 1,100,000
144 0111 Port Wine Stain 1/4 card 165,000 110,000 275,000
147 0114 Port Wine Stain 1 card 660,000 440,000 1,100,000
148 0115 Full Face Rejuvenation 780,000 520,000 1,300,000
149 0116 Ekstraksi Komedo Jumlah > 10 150,000 100,000 250,000
150 0117 Ekstraksi Komedo Jumlah < 10 120,000 80,000 200,000
151 0118 3. Mikrodermabrasi 150,000 100,000 250,000
152 0119 4. Checimal Peeling 120,000 80,000 200,000
153 0120 5. Botox 390,000 260,000 650,000
154 0121 6. Filler 390,000 260,000 650,000
155 0122 7. Subsisi (Acne Scar)
156 0123 8. Jumlah > 5 210,000 140,000 350,000
157 0124 9. Jumlah < 5 120,000 80,000 200,000
158 0125 10. Prp 180,000 120,000 300,000
159 0126 11. Mikroneedle (Paket 4 Kali) 270,000 180,000 450,000
160 0127 12. Mikroneedle (Paket 1 Kali) 120,000 80,000 200,000
161 0128 13. Thread 600,000 400,000 1,000,000
162 0129 14. Ftd 120,000 80,000 200,000
163 0130 15. Injeksi Vitamin C 90,000 60,000 150,000
164 0131 16. Injeksi 1 Acne 21,000 14,000 35,000
165 0132 Konsultasi Gizi 15,000 10,000 25,000
167 0133 Angkat Implant Interna 688,200 458,800 1,147,000
170 0134 Audiometri (Pelayanan Eksekutif Rawat Jalan) 159,600 106,400 266,000
173 0135 Biopsi Nosopharynk dengan Lokal Anastesi 159,600 106,400 266,000
175 0136 Buka Fiksasi 2 Rahang 76,800 51,200 128,000
191 0137 Ekstraksi Corpus Alaienum Hidung/Telinga 22,200 14,800 37,000
192 0138 Ekstraksi Corpus Alaienum pada Tenggorokan 22,200 14,800 37,000
195 0139 Ekstraski Polip dengan Lokal Anastesi 189,600 126,400 316,000
196 0140 Ekterpasi Granuloma dan Milium 22,200 14,800 37,000
197 0141 Epilasi (Pelayanan Eksekutif Rawat Jalan) 22,200 14,800 37,000
200 0142 Extractie Korpus Alenium Kornea 54,600 36,400 91,000
202 0143 Fiksasi 1 Rahang 76,800 51,200 128,000
207 0144 Home Exercise Program 9,000 6,000 15,000
208 0145 Incisi Abces Peritonsil 189,600 126,400 316,000
209 0146 Incisi Abses (Tindakan Sederhana) 22,200 14,800 37,000
211 0147 Incisi Hordeolum 365,400 243,600 609,000
213 0148 Irigasi/Extraksi Cerumen 189,600 126,400 316,000
214 0149 Kista Dermoid 284,400 189,600 474,000
215 0150 Kolposcopy 304,200 202,800 507,000
216 0151 Konsultasi Ahli Gizi 25,000 25,000
217 0152 Konsultasi Psychiatri 40,200 26,800 67,000
219 0153 Koreksi Refraksi 22,200 14,800 37,000
220 0154 Laringoskopi Indirect 16,200 10,800 27,000
221 0155 Latihan Fisik 35,700 23,800 59,500
240 0156 Peeling 33,000 22,000 55,000
244 0157 Perawatan Gips: Lac, Sac, Bkc 43,800 29,200 73,000
246 0158 Ps. Gips Ekstremitas 121,800 81,200 203,000
249 0159 Punctie Daun Telinga 22,200 14,800 37,000
251 0160 Rectoscopy 609,000 406,000 1,015,000
252 0161 Rehab Obesitas 18,000 12,000 30,000
259 0162 Slit Lamp (Pelayanan Eksekutif Rawat Jalan) 22,200 14,800 37,000
260 0163 Spirometri 30,600 20,400 51,000
261 0164 Spoel Kateter 22,200 14,800 37,000
264 0165 Test Garputala 79,800 53,200 133,000
265 0166 Tonometri Aplanasi 22,200 14,800 37,000
266 0167 Tonometri Schiotz 22,200 14,800 37,000
270 0168 USG Abdomen Atas 55,200 36,800 92,000
271 0169 USG Abdomen Bawah (Pelayanan Eksekutif Rawat Jalan) 55,200 36,800 92,000
272 0170 WT dan HT 1 - 10 Jahitan 33,000 22,000 55,000
273 0171 WT dan HT 11 - 20 Jahitan 43,800 29,200 73,000
276 0172 Antrostomi Sinus Maksilaris 304,200 202,800 507,000
277 0173 Buka Jahitan Palpebra 54,600 36,400 91,000
286 0174 Circumcisi (Sunat) 182,400 121,600 304,000
292 0175 Ekstirpasi Kista Dermoid 304,200 202,800 507,000
294 0176 Ekstirpasi Tumor Tulang 304,200 202,800 507,000
300 0177 Hecting Luka Konjungtiva 33,000 22,000 55,000
302 0178 Incisi Abses dengan Lokal Anastesi 22,200 14,800 37,000
315 0179 Pasang Spalk 10,800 7,200 18,000
316 0180 Pasang Tindik pada Telinga 33,000 22,000 55,000
322 0181 Reposisi Fraktur dan Atm Dislokasi 182,400 121,600 304,000
324 0182 Skin Tractie/Pasang Traksi Kulit 121,800 81,200 203,000
329 0183 Up Inter Dental Wire 243,600 162,400 406,000
339 0184 Delatasi Phymosis Tanpa Bius 22,200 14,800 37,000
340 0185 Delatasi Phymosis dengan Lokal Anastesi 22,200 14,800 37,000
341 0186 Dilatasi dengan Bougie 199,200 132,800 332,000
343 0187 Extraksi Batu Uretra dengan GA 275,400 183,600 459,000
364 0188 Mantoux Test 79,800 53,200 133,000
371 0189 Pasang Tindik Tembak 60,000 40,000 100,000
388 0190 Aspirasi Cairan Sendi Superfisial 54,600 36,400 91,000
393 0191 Cauterisasi Kutil 1 - 10 Buah 33,000 22,000 55,000
394 0192 Cauterisasi Kutil 11 - 20 Buah 43,800 29,200 73,000
395 0193 Cauterisasi Kutil Lebih dari 20 Buah 54,600 36,400 91,000
404 0194 Needling Muscle Band 54,600 36,400 91,000
409 0195 Pasang Gips Tulang Belakang 243,600 162,400 406,000
417 0196 Perawatan Gips : Tulang Belakang 54,600 36,400 91,000
433 0197 Ekstirpasi Tumor Jinak Kulit 182,400 121,600 304,000
444 0198 Aktifir Plat Orthodentie/Kontrol 48,000 32,000 80,000
445 0199 Alveolektomi Per Regio 300,000 200,000 500,000
446 0200 Apex Reseksi 1 Gigi 120,000 80,000 200,000
447 0201 Buka Kawat Fiksasi 51,000 34,000 85,000
448 0202 Cementing Per Gigi 106,500 71,000 177,500
449 0203 Eksisi Epulis (Mucocele) 150,000 100,000 250,000
450 0204 Eksplorasi Abses Mandibula 900,000 600,000 1,500,000
451 0205 Ekstirpasi Polip Rongga Mulut 108,000 72,000 180,000
452 0206 Ekstirpasi Tumor Jinak Sinonasal, Oral Cavity 900,000 600,000 1,500,000
453 0207 Emergency Treatment 30,000 20,000 50,000
454 0208 Fiksasi Rahang dengan Pembiusan Umum 810,000 540,000 1,350,000
455 0209 Fissure Sealant/Regio 60,000 40,000 100,000
456 0210 Frenektomi 138,000 92,000 230,000
457 0211 Ganti Perban 30,000 20,000 50,000
458 0212 Gingivektomi Per Rahang 180,000 120,000 300,000
459 0213 Incisi Ekstra Oral 60,000 40,000 100,000
460 0214 Incisi Intra Oral 60,000 40,000 100,000
461 0215 Jahit Luka Mulut < 5 60,000 40,000 100,000
462 0216 Jahit Luka Mulut > 5 90,000 60,000 150,000
463 0217 Kontrol Protese Gigi 51,000 34,000 85,000
464 0218 Kontrol Tindakan Post Operatif 60,000 40,000 100,000
465 0219 Kuretase 1 Gigi Close Method Non Anastesi 51,000 34,000 85,000
466 0220 Kuretase Open Method + Anastesi (Jahit Per Gigi) 180,000 120,000 300,000
467 0221 Mahkota Jaket/Dowel Acrilic Per Gigi 450,000 300,000 750,000
468 0222 Mahkota Sementara 60,000 40,000 100,000
469 0223 Mahkota/Dowel Perselen Per Gigi 1,200,000 800,000 2,000,000
470 0224 Odontektomi Anestesi Umum 1,800,000 1,200,000 3,000,000
471 0225 Odontektomi dengan Anestesi Lokal 600,000 400,000 1,000,000
472 0226 Ortho Cekat/Rahang 1,800,000 1,200,000 3,000,000
473 0227 Pembuatan Plat Orthodontik/Rahang 300,000 200,000 500,000
474 0228 Pemeriksaan atau Check Up Per Kunjungan 18,000 12,000 30,000
475 0229 Pemutihan Gigi (Bleaching)/Rahang 900,000 600,000 1,500,000
476 0230 Penambahan Protese Per Gigi (Akrilik) 120,000 80,000 200,000
477 0231 Pencabutan Gigi dengan Anestesi Lokal (Tindakan Sederhana) 90,000 60,000 150,000
478 0232 Pencabutan Gigi dengan Komplikasi dan Open Method 180,000 120,000 300,000
479 0233 Pencabutan Gigi dengan Topical Anestesi 30,000 20,000 50,000
480 0234 Pengisian Saluran Akar (Gigi Permanen) 120,000 80,000 200,000
481 0235 Pengisian Saluran Akar Gigi Sulung 48,000 32,000 80,000
482 0236 Preparasi Saluran Akar 60,000 40,000 100,000
483 0237 Protese (Akrilik Full Denture/Per Rahang) 1,500,000 1,000,000 2,500,000
484 0238 Protese 1 Gigi/Gigi Pertama (Akrilik) 345,000 230,000 575,000
485 0239 Pulp Capping 48,000 32,000 80,000
486 0240 Pulpotomi 90,000 60,000 150,000
487 0241 Rebasing Gigi Tiruan/Rahang 480,000 320,000 800,000
488 0242 Rellining Full Dentur Per Rahang 270,000 180,000 450,000
489 0243 Rellining Partial Dentur Per Rahang 180,000 120,000 300,000
490 0244 Reparasi Protese 220,500 147,000 367,500
491 0245 Reposisi Gigi Per Regio 150,000 100,000 250,000
492 0246 Scalling Per Rahang 60,000 40,000 100,000
493 0247 Splinting Per Rahang 240,000 160,000 400,000
494 0248 Sterilisasi Saluran Akar 60,000 40,000 100,000
495 0249 Tambahan Ekspansi Atau Screw Orthodontik 60,000 40,000 100,000
496 0250 Tumpatan Composite Light Cure 138,000 92,000 230,000
497 0251 Tumpatan Glass Ionomer 106,500 71,000 177,500
498 0252 Tumpatan Inlay, Onlay, dan Uplay 300,000 200,000 500,000
499 0253 Tumpatan Sementara 1 Gigi Tanpa/dengan Open Boor 30,000 20,000 50,000
500 0254 Upperculectomy 180,000 120,000 300,000
501 0255 Konsultasi Hasil 90,000 60,000 150,000
502 0256 Konsultasi Psikologi 45,000 30,000 75,000
503 0257 Tindakan Psikologi 75,000 50,000 125,000
504 0258 Exercise Terapi 31,200 20,800 52,000
505 0259 Faradic/Galvanik 41,400 27,600 69,000
506 0260 Fisioterapi dengan Alat (4 x tindakan) 175,800 117,200 293,000
507 0261 Hidro Terapi 41,400 27,600 69,000
508 0262 Home Exercis Eprogram 31,200 20,800 52,000
509 0263 Hot Pack/ Cold Pack 41,400 27,600 69,000
510 0264 Infra Red 41,400 27,600 69,000
511 0265 Massage 31,200 20,800 52,000
512 0266 Micro Wave Diathermy/MWD 41,400 27,600 69,000
513 0267 Parafin Bath 41,400 27,600 69,000
514 0268 Short Wave Diathermy/SWD 41,400 27,600 69,000
515 0269 Tens 41,400 27,600 69,000
516 0270 Terapi Bermain/Support 12,000 8,000 20,000
517 0271 Terapi Klp Asma 9,000 6,000 15,000
518 0272 Terapi Klp Stroke 9,000 6,000 15,000
519 0273 Terapi Laser 41,400 27,600 69,000
520 0274 Terapi Latihan Asma 31,200 20,800 52,000
521 0275 Terapi Latihan Fraktur 31,200 20,800 52,000
522 0276 Terapi Latihan Stroke 31,200 20,800 52,000
523 0277 Terapi Okupasi (4x tindakan) 175,800 117,200 293,000
524 0278 Terapi Wicara (4x tindakan) 175,800 117,200 293,000
525 0279 Traksi Cervical dan Lumbal 41,400 27,600 69,000
526 0280 Ultra Sound Diathermy/USD 41,400 27,600 69,000
527 0281 Psikoterapi Kognitif 84,000 56,000 140,000
528 0282 Psikoterapi Suportif 84,000 56,000 140,000
529 0283 Psikoterapi Edukasi 30,000 20,000 50,000
530 0284 Restrain 30,000 20,000 50,000
531 0285 Surat Keterangan Bebas Narkoba (Pelayanan Psikoterapi) 30,000 20,000 50,000
532 0286 Surat Keterangan Sehat Jiwa 30,000 20,000 50,000
533 0287 Tes Anak Berkebutuhan Khusus 90,000 60,000 150,000
534 0288 Tes IQ Individu 90,000 60,000 150,000
535 0289 Tes Kejiwaan (MMPI) 90,000 60,000 150,000
536 0290 Tindakan Psikoterapi 90,000 60,000 150,000
537 0291 Mengeluarkan Bayi dari Jenazah Ibu 360,000 240,000 600,000
538 0292 Visum - Otopsi 600,000 400,000 1,000,000
539 0293 Visum - Otopsi - Hari Libur 900,000 600,000 1,500,000
540 0294 Visum - Pemeriksaan Jenazah Bagian Luar Saja 105,000 70,000 175,000
541 0295 Visum - Pemeriksaan Jenazah Bagian Luar Saja - Hari Libur 150,000 100,000 250,000
542 0296 Visum di Luar RS - TKP dengan Penggalian 84,000 56,000 140,000
543 0297 Visum Luar RS - TKP (diluar Rumah Sakit) 510,000 340,000 850,000
544 0298 Medical Certificate 60,000 40,000 100,000
546 0299 Surat Keterangan Buta Warna 15,000 10,000 25,000
547 0300 Surat Keterangan Sehat 15,000 10,000 25,000
548 0301 Surat Keterangan Sehat Untuk ke Luar Negeri 15,000 10,000 25,000
549 0302 Manicure 18,000 12,000 30,000
550 0303 Pedicure 18,000 12,000 30,000
551 0304 Bali Body Massage 30 Menit 30,000 20,000 50,000
552 0305 Bali Body Massage 1 Jam 36,000 24,000 60,000
553 0306 Bali Body Massage + Scrub 1,5 Jam 42,000 28,000 70,000
554 0307 Pelayanan Spa ke Ruang Rawat Inap Tambahan Biaya 20,000 20,000
555 0308 Akupuntur Estetika 36,000 24,000 60,000
556 0309 Akupuntur Kebugaran 36,000 24,000 60,000
557 0310 Akupuntur Terapi 42,000 28,000 70,000
558 0311 Pelayanan Akupuntur ke Ruang Rawat Inap Tambahan Biaya 20,000 20,000
559 0312 Pijat Refleksi 30 Menit 18,000 12,000 30,000
560 0313 Pijat Refleksi 1 Jam 30,000 20,000 50,000
561 0314 Pijat Refleksi ke Ruang Rawat Inap Tambahan Biaya 20,000 20,000
562 0315 Cuci Rambut 15,000 10,000 25,000
563 0316 Cuci Rambut + Blow/Catok 24,000 16,000 40,000
564 0317 Cuci Rambut + Blow/Catok ke Ruang Rawat Inap Tambahan Biaya 20,000 20,000
565 0318 IGD Pelayanan Ambulance Keperawatan Dalam Kota 159,000 106,000 265,000
566 0319 IGD Pelayanan Ambulance Keperawatan Gianyar 249,000 166,000 415,000
567 0320 IGD Pelayanan Ambulance Keperawatan Badung 315,000 210,000 525,000
568 0321 IGD Pelayanan Ambulance Keperawatan Tabanan 315,000 210,000 525,000
569 0322 IGD Pelayanan Ambulance Keperawatan Klungkung 315,000 210,000 525,000
570 0323 IGD Pelayanan Ambulance Keperawatan Bangli 315,000 210,000 525,000
571 0324 IGD Pelayanan Ambulance Keperawatan Karangasem 459,000 306,000 765,000
572 0325 IGD Pelayanan Ambulance Keperawatan Buleleng 621,000 414,000 1,035,000
573 0326 IGD Pelayanan Ambulance Keperawatan Negara 621,000 414,000 1,035,000
574 0327 IGD Pelayanan Ambulance Keperawatan Luar Bali 1,500,000 1,000,000 2,500,000
575 0328 Pelayanan Ambulance Medik Umum Dalam Kota 177,000 118,000 295,000
576 0329 Pelayanan Ambulance Medik Umum Gianyar 267,000 178,000 445,000
577 0330 Pelayanan Ambulance Medik Umum Badung 333,000 222,000 555,000
578 0331 Pelayanan Ambulance Medik Umum Tabanan 333,000 222,000 555,000
579 0332 Pelayanan Ambulance Medik Umum Klungkung 333,000 222,000 555,000
580 0333 Pelayanan Ambulance Medik Umum Bangli 333,000 222,000 555,000
581 0334 Pelayanan Ambulance Medik Umum Karangasem 477,000 318,000 795,000
582 0335 Pelayanan Ambulance Medik Umum Buleleng 639,000 426,000 1,065,000
583 0336 Pelayanan Ambulance Medik Umum Negara 639,000 426,000 1,065,000
584 0337 Pelayanan Ambulance Medik Umum Luar Bali 1,518,000 1,012,000 2,530,000
585 0338 Pelayanan Ambulance Medik Spesialis Dalam Kota 222,600 148,400 371,000
586 0339 Pelayanan Ambulance Medik Spesialis Gianyar 348,600 232,400 581,000
587 0340 Pelayanan Ambulance Medik Spesialis Badung 441,000 294,000 735,000
588 0341 Pelayanan Ambulance Medik Spesialis Tabanan 441,000 294,000 735,000
589 0342 Pelayanan Ambulance Medik Spesialis Klungkung 441,000 294,000 735,000
590 0343 Pelayanan Ambulance Medik Spesialis Bangli 441,000 294,000 735,000
591 0344 Pelayanan Ambulance Medik Spesialis Karangasem 642,600 428,400 1,071,000
592 0345 Pelayanan Ambulance Medik Spesialis Buleleng 869,400 579,600 1,449,000
593 0346 Pelayanan Ambulance Medik Spesialis Negara 869,400 579,600 1,449,000
594 0347 Pelayanan Ambulance Medik Spesialis Luar Bali 2,100,000 1,400,000 3,500,000
595 0348 Amputasi Jari 609,000 406,000 1,015,000
597 0349 Arm Sling 45,000 30,000 75,000
601 0350 Blaas Punctie 33,000 22,000 55,000
604 0351 Bulectomy 10% - 20% 43,800 29,200 73,000
605 0352 Bullectomy 10% 33,000 22,000 55,000
606 0353 Bullectomy Diatas 10% 54,600 36,400 91,000
607 0354 Bullectomy Lebih dari 20% 54,600 36,400 91,000
609 0355 Cauter Perdarahan Tonsil 243,600 162,400 406,000
611 0356 Combutio < 10% 78,000 52,000 130,000
612 0357 Combutio > 30% 150,000 100,000 250,000
613 0358 Combutio 10% - 30% 108,000 72,000 180,000
614 0359 Cukur Lapangan Operasi 12,000 8,000 20,000
615 0360 Cystostomy 304,200 202,800 507,000
617 0361 DC Shock (Tindakan IGD) 123,000 82,000 205,000
621 0362 Dilatasi Phymosis Tanpa Bius 22,200 14,800 37,000
622 0363 Dislokasi Rahang 33,000 22,000 55,000
624 0364 Dusinasi (Dilatasi dengan Businator) 24,000 16,000 40,000
625 0365 Eksplorasi Luka Gigitan Sengatan Binatang 84,000 56,000 140,000
626 0366 Eksplorasi Vulnus Iktum 84,000 56,000 140,000
627 0367 Eksplorasi/Ekstraksi Kuku 120,000 80,000 200,000
628 0368 Ekstraksi Batu Uretra 43,800 29,200 73,000
629 0369 Ekstraksi Benda Asing dengan Penyulit 120,000 80,000 200,000
630 0370 Ekstraksi Cincin 120,000 80,000 200,000
631 0371 Ekstraksi Corpus Alienum pada Telinga, Kuku 43,800 29,200 73,000
632 0372 Ekstraksi Kuku dengan Lokal Anastesi 33,000 22,000 55,000
633 0373 Evakuasi Batu Urethra Anterior tanpa Anastesi 90,000 60,000 150,000
634 0374 Evakuasi Batu Urethra Anterior dengan Anastesi Lokal 600,000 400,000 1,000,000
635 0375 Explorasi Kecil 22,200 14,800 37,000
636 0376 Explorasi Luka Gigitan Binatang 33,000 22,000 55,000
637 0377 Extractie Corpus Alienium Konjungtiva 54,600 36,400 91,000
638 0378 Extraksi Batu Uretra Tanpa Anastesi 275,400 183,600 459,000
643 0379 Fnab/Fine Needle Aspirasi Biopsi 182,400 121,600 304,000
646 0380 Glyserin Spuit 33,000 22,000 55,000
647 0381 High Below Knee Gips 180,000 120,000 300,000
649 0382 Incisi Furunkell Abses 48,000 32,000 80,000
650 0383 Injeksi Intra Artikuler (Tindakan IGD) 30,000 20,000 50,000
652 0384 Incisi Biopsi Kelenjar dengan Lokal Anastesi 243,600 162,400 406,000
655 0385 Irigasi Mata 22,200 14,800 37,000
658 0386 Konsultasi Tak Langsung Dokter Spesialis/Per Telepon 6,000 6,000
659 0387 Kumbah Lambung 15,000 10,000 25,000
661 0388 Lavement 33,000 22,000 55,000
662 0389 Luka Bakar 20% 90,000 60,000 150,000
663 0390 Lumbal Pungsi 0 - 5 Tahun 121,800 81,200 203,000
664 0391 Lumbal Pungsi 5 - 12 Tahun 182,400 121,600 304,000
665 0392 Lumbal Pungsi Diatas 12 Tahun 243,600 162,400 406,000
670 0393 Multiple Vulnus Apertum 132,000 88,000 220,000
671 0394 Nekrotomi Luka 33,000 22,000 55,000
672 0395 Observasi < 2 Jam 12,000 8,000 20,000
673 0396 Observasi Lebih dari 2 Jam 30,000 20,000 50,000
679 0397 Pasang Arteri Line 182,400 121,600 304,000
681 0398 Pasang Colar Brace 10,800 7,200 18,000
682 0399 Pasang Collar Brace 30,000 20,000 50,000
683 0400 Pasang Elastic Bandage 30,000 20,000 50,000
684 0401 Pasang Gips 1,320,000 880,000 2,200,000
685 0402 Pasang Gips 182,400 121,600 304,000
689 0403 Pasang Kateter dengan Alat Bantu 199,200 132,800 332,000
691 0404 Pasang Mitella/Pembalut Elastis 10,800 7,200 18,000
696 0405 Pasang Tampon pada Hidung/Telinga 10,800 7,200 18,000
697 0406 Pasang Traksi Kulit (Ekstremitas, Kepala) 121,800 81,200 203,000
698 0407 Pasang Traksi Vertebra (Tulang Selangkang) 900,000 600,000 1,500,000
699 0408 Pasang WSD Continus 600,000 400,000 1,000,000
701 0409 Pasang/Angkat Buak Gips Sirkular 270,000 180,000 450,000
703 0410 Pemasangan Endotracheal Tube 54,600 36,400 91,000
705 0411 Pemasangan Monitor 121,800 81,200 203,000
706 0412 Pemasangan Ransel Perban, Colar dan Cuf, Back Slab Cast, Bandage 72,000 48,000 120,000
707 0413 Pemasangan Skin Traksi 150,000 100,000 250,000
713 0414 Perawatan Luka Bakar Derajat II - III Lebih 20% 1,260,000 840,000 2,100,000
714 0415 Perawatan Luka Bakar Derajat II 15% - 20% 1,014,000 676,000 1,690,000
715 0416 Perawatan Luka Bakar Derajat II s/d 15% 81,000 54,000 135,000
721 0417 Puntie Hematros 48,000 32,000 80,000
722 0418 RJP 36,000 24,000 60,000
723 0419 Rawat Luka Bakar < 10% 30,000 20,000 50,000
724 0420 Rawat Luka Bakar Diatas 1% - 20% 42,000 28,000 70,000
725 0421 Repair Daun Telinga 94,800 63,200 158,000
726 0422 Repair Tendon Jari Tangan 204,000 136,000 340,000
727 0423 Repair Tendon Jari Tangan (Diatas 2 Buah) 405,000 270,000 675,000
728 0424 Reposisi 54,600 36,400 91,000
729 0425 Reposisi + Gips Ekstremitas Atas 1 Sisi 688,200 458,800 1,147,000
730 0426 Reposisi dengan Anastesi 450,000 300,000 750,000
731 0427 Reposisi dengan Anastesi Lokal 405,000 270,000 675,000
732 0428 Reposisi Dislokasi MT Joint tanpa Anastesi 600,000 400,000 1,000,000
733 0429 Reposisi Dislokasi MT Joint dengan Anastesi 1,380,000 920,000 2,300,000
734 0430 Reposisi Dislokasi Sendi Mandibula 120,000 80,000 200,000
735 0431 Reposisi Ekstremitas Atas dengan Anastesi Umum 450,000 300,000 750,000
736 0432 Reposisi Ekstremitas Atas Tanpa Anastesi 405,000 270,000 675,000
737 0433 Reposisi Ekstremitas Bawah Tanpa Anastesi 612,000 408,000 1,020,000
738 0434 Reposisi Fr. Os Nasal + Pasang Gips Kupu-Kupu 288,000 192,000 480,000
739 0435 Reposisi Fraktur dan Dislokasi 182,400 121,600 304,000
740 0436 Reposisi Haemorrhoid 22,200 14,800 37,000
741 0437 Reposisi Long Arm dengan Anastesi Umum 450,000 300,000 750,000
742 0438 Reposisi Long Arm Gips dan Long Leg Tanpa Anastesi Umum 192,000 128,000 320,000
743 0439 Reposisi Long Leg dengan Anastesi Umum 450,000 300,000 750,000
744 0440 Reposisi MT Joint 600,000 400,000 1,000,000
745 0441 Reposisi Os Nasal 60,000 40,000 100,000
746 0442 Reposisi Short Arm dengan Anastesi Umum 360,000 240,000 600,000
747 0443 Reposisi Short Arm Tanpa Anastesi Umum 117,000 78,000 195,000
748 0444 Sambung Tendon Parsial 90,000 60,000 150,000
749 0445 Sambung Tendon Total 180,000 120,000 300,000
751 0446 Screening Hypotyroid 22,200 14,800 37,000
752 0447 Sistostomi dengan Anastesi Lokal 600,000 400,000 1,000,000
753 0448 Spalks Long 80 - 100 Cm 30,000 20,000 50,000
754 0449 Speech Audiometer 42,000 28,000 70,000
756 0450 Suprapubic Punctie 48,000 32,000 80,000
757 0451 Tendo Plasty 33,000 22,000 55,000
758 0452 Tennoraphy Tendon Ekstensor 1 Jari 459,000 306,000 765,000
759 0453 Thoracostomy (WSD) Bilateral 585,000 390,000 975,000
760 0454 Thoracostomy (WSD) Unilateral 405,000 270,000 675,000
761 0455 Tindakan Pembuatan Visum Et Repertum Korban Hidup 36,000 24,000 60,000
762 0456 Trocar Sistostomi 168,000 112,000 280,000
763 0457 Vulnum Amputatum Sederhana 108,000 72,000 180,000
764 0458 Vulnus Apertum < 5 Jahitan 78,000 52,000 130,000
765 0459 Vulnus Avertum > 10 Jahitan 210,000 140,000 350,000
766 0460 Vulnus Avertum 5 - 10 Jahitan 144,000 96,000 240,000
767 0461 Vulnus Excoriatum 18,000 12,000 30,000
772 0462 Asistensi Induksi 12,000 8,000 20,000
820 0463 Rehabilitasi Vertibuler 79,800 53,200 133,000
822 0464 USD 27,000 18,000 45,000
823 0465 Visite Dokter Spesialis 30,000 30,000
827 0466 Tindakan Medik Sederhana 1 10,500 7,000 17,500
828 0467 Tindakan Medik Sederhana 1 A 11,700 7,800 19,500
830 0469 Tindakan Medik Sederhana 2A 19,800 13,200 33,000
837 0476 Tindakan Medik Kecil 1 75,000 50,000 125,000
838 0477 Tindakan Medik Kecil 1A 87,000 58,000 145,000
847 0486 Tindakan Medik Sedang 1 405,000 270,000 675,000
848 0487 Tindakan Medik Sedang 1A 465,000 310,000 775,000
849 0488 Tindakan Medik Sedang 2 577,500 385,000 962,500
850 0489 Tindakan Medik Sedang 2A 667,500 445,000 1,112,500
851 0490 Tindakan Medik Sedang 3 750,000 500,000 1,250,000
852 0491 Tindakan Medik Sedang 3A 870,000 580,000 1,450,000
853 0492 Tindakan Medik Sedang 4 922,500 615,000 1,537,500
854 0493 Tindakan Medik Sedang 4A 1,072,500 715,000 1,787,500
855 0494 Tindakan Medik Sedang 5 1,095,000 730,000 1,825,000
856 0495 Tindakan Medik Sedang 5A 1,275,000 850,000 2,125,000
857 0496 Tindakan Medik Besar 1 1,440,000 960,000 2,400,000
858 0497 Tindakan Medik Besar 1A 1,680,000 1,120,000 2,800,000
859 0498 Tindakan Medik Besar 2 1,725,000 1,150,000 2,875,000
867 0506 Tindakan Medik Khusus 1 3,450,000 2,300,000 5,750,000
868 0507 Tindakan Medik Khusus 1A 4,050,000 2,700,000 6,750,000
877 0516 Tindakan Medik Canggih 1 8,625,000 5,750,000 14,375,000
878 0517 Tindakan Medik Canggih 1A 10,125,000 6,750,000 16,875,000
887 0526 Amput/Dear Tgk Fore Quarter 1 Sisi 4,590,000 3,060,000 7,650,000
888 0527 Amput/Dear Tgk Fore Quarter 2 Sisi 6,885,000 4,590,000 11,475,000
889 0528 Amput/Dear Tgk Hid Quarter 2 Sisi 9,180,000 6,120,000 15,300,000
890 0529 Amput/Dear Tgk Hind Quarter 1 Sisi 5,737,200 3,824,800 9,562,000
891 0530 Amput/Dear Tgk Kru/Ante 2 Sisi 2,754,000 1,836,000 4,590,000
892 0531 Amput/Dear Tgk Kruris/Ante 1 Sisi 1,836,000 1,224,000 3,060,000
893 0532 Amput/Dear Tgk Lengan Ats/Paha 1 Sisi 2,295,000 1,530,000 3,825,000
894 0533 Amput/Dear Tgk Lgn Ats/Paha 2 Sisi 3,213,000 2,142,000 5,355,000
895 0534 Amput/Dear Tgk Panggl /Bahu 2 Sisi 4,590,000 3,060,000 7,650,000
896 0535 Amput/Dear Tgk Panggl Bahu 1 Sisi 3,213,000 2,142,000 5,355,000
898 0536 Amput/Dear Tgk Siku/Lutut 1 Sisi 3,672,000 2,448,000 6,120,000
899 0537 Amput/Dear Tgk Wrsi Ankle 2 Sisi 3,213,000 2,142,000 5,355,000
900 0538 Amput/Dear Tgkt Wris/Ankle 1 Sisi 2,295,000 1,530,000 3,825,000
901 0539 Amput/Dera 1-2 Snd Jr Tgk Kar,Tar 1,836,000 1,224,000 3,060,000
902 0540 Amputasi Deartikualsi Lbh 2 Jr 1,377,000 918,000 2,295,000
903 0541 Amputasi/ Dear 1-2 Snd Jr Tgk Kar 918,000 612,000 1,530,000
904 0542 Amputasi/Dearti 1 - 2 Jari 918,000 612,000 1,530,000
905 0543 Anastomis Vaskuler Distal Wrist 3,213,000 2,142,000 5,355,000
906 0544 Anastomosis Vaskuler Proksimal Wrist 2,754,000 1,836,000 4,590,000
907 0545 Angkat Fiksasi Ext. 1 Regio Ekstr. 459,000 306,000 765,000
908 0546 Angkat Fiksasi In 1 Regio Ekstr. 1,147,200 764,800 1,912,000
909 0547 Angkat Fiksasi In Lebih 1 Regio Ekstr. 1,836,000 1,224,000 3,060,000
910 0548 Angkat Fiksasi Tulang Belakang 2,754,000 1,836,000 4,590,000
912 0549 Angkatfiksasi Ext. Lebih 1 Regioekst 688,200 458,800 1,147,000
913 0550 Arthriplasty Eks Bahu/Panggl 1 Sisi 2,754,000 1,836,000 4,590,000
914 0551 Arthrodesis 1-2 Jari 2,295,000 1,530,000 3,825,000
915 0552 Arthrodesis Bahu/Panggul 1 Sisi 3,213,000 2,142,000 5,355,000
916 0553 Arthrodesis Bahu/Panggul 2 Sisi 4,590,000 3,060,000 7,650,000
917 0554 Arthrodesis Lbh Dr 2 Jari 3,213,000 2,142,000 5,355,000
918 0555 Arthrodesis Siku/Lutut 1 Sisi 2,295,000 1,530,000 3,825,000
919 0556 Arthrodesis Siku/Lutut 2 Sisi 3,672,000 2,448,000 6,120,000
920 0557 Arthrodesis Wrist/Angkle 1 Sisi 2,754,000 1,836,000 4,590,000
921 0558 Arthrodesis Wrist/Angkle 2 Sisi 3,672,000 2,448,000 6,120,000
922 0559 Arthroplasty Eks Bahu/Pangl 2 Sisi 3,213,000 2,142,000 5,355,000
923 0560 Arthroplasty Eks Siku/Lutut 1 Sisi 1,836,000 1,224,000 3,060,000
924 0561 Arthroplasty Eks Wrist/Ankle 2 Sisi 2,754,000 1,836,000 4,590,000
925 0562 Arthroplasty Eksisi Wrist/Ankle 1 Sisi 2,295,000 1,530,000 3,825,000
926 0563 Arthroplasty Exsisi 1-2 Jari 2,295,000 1,530,000 3,825,000
927 0564 Arthroplasty Siku/Lutut 2 Sisi 2,295,000 1,530,000 3,825,000
928 0565 Arthroscopy Bahu 3,213,000 2,142,000 5,355,000
929 0566 Arthroscopy Lutut 2,295,000 1,530,000 3,825,000
930 0567 Arthroscopy Panggul 2,754,000 1,836,000 4,590,000
933 0568 Aspirasi Biopsi Tumor Muskuloskeletal 182,400 121,600 304,000
934 0569 Aspirasi Cairan Sendi Dalam 182,400 121,600 304,000
935 0570 Debri dan Drai Osteo Eks dengan Penyulit 2,295,000 1,530,000 3,825,000
936 0571 Debri dan Drai Osteo Eks Lbh 1 Reg 3,213,000 2,142,000 5,355,000
937 0572 Debri dan Drainge Osteomyelitis Eks 1,836,000 1,224,000 3,060,000
938 0573 Debrid dan Drai Osteo Tlg Belakang 4,590,000 3,060,000 7,650,000
939 0574 Debridement Luka (WT, HT) 182,400 121,600 304,000
940 0575 Dekom Sten Srf Fer Reg Akar Spi Kan 3,672,000 2,448,000 6,120,000
941 0576 Dekom Sten Srf Fer Reg Medula Spina 6,885,000 4,590,000 11,475,000
942 0577 Dekom Sten Srf Fer Reg Siku 1 Sisi 2,295,000 1,530,000 3,825,000
943 0578 Dekom Sten Srf Fer Reg Siku 2 Sisi 3,672,000 2,448,000 6,120,000
944 0579 Dekom Sten Srf Fer Reg Thor Outlet 6,885,000 4,590,000 11,475,000
945 0580 Dekom Sten Srf Fer Reg W/A 2 Sisi 2,754,000 1,836,000 4,590,000
946 0581 Dekom Sten Srf Per Regio W/A 1 Sisi 1,836,000 1,224,000 3,060,000
947 0582 Eksisi Biopsi Tumor Jaringan Lunak 243,600 162,400 406,000
948 0583 Eksisi Biopsi Tumor Jinak Jar. Lunak 688,200 458,800 1,147,000
950 0584 Fascio Dekom Comp Dist Wrist/Angkle 1,836,000 1,224,000 3,060,000
951 0585 Fascio Dekom Comp Prok Wrist/Ankle 1,377,000 918,000 2,295,000
952 0586 Fiksasi Ext 1Regio Ektr 1,836,000 1,224,000 3,060,000
953 0587 Fiksasi Ext Ekst 1 Regio dengan Penyulit 2,295,000 1,530,000 3,825,000
954 0588 Fiksasi Ext Ekstr Lebih dari 1 Regio 2,754,000 1,836,000 4,590,000
955 0589 Hemi Joint Repl. Panggul Satu Sisi 3,672,000 2,448,000 6,120,000
956 0590 Hemi JoinT Replacement Panggul 2 Sisi 4,590,000 3,060,000 7,650,000
957 0591 Hemi Joint Replecement Lutut 1 Sisi 3,672,000 2,448,000 6,120,000
958 0592 Hemi Joint Replecement Lutut 2 Sisi 4,590,000 3,060,000 7,650,000
959 0593 Hemi Joint Replecement Panggul 1 Sisi 3,213,000 2,142,000 5,355,000
960 0594 Incisi dan Drai Abses Sendi Dlm (Pro) 1,836,000 1,224,000 3,060,000
961 0595 Incisi dan Drainase AB Sendi Superfisial 121,800 81,200 203,000
962 0596 Incisi dan Drainase Abses Jar. Lunak 121,800 81,200 203,000
967 0597 Moulding Dislokasi + Bandaging dengan Ga 229,200 152,800 382,000
968 0598 Moulding Fraktur/Dislokasi + Gips 459,000 306,000 765,000
969 0599 Orif Fr Kom Diaf 1-2 Meta, Tar, Fa 2,754,000 1,836,000 4,590,000
970 0600 Orif Fr Kom Diaf Ante + 2 Reg Lain 3,672,000 2,448,000 6,120,000
971 0601 Orif Fr Kom Diaf Ante + Ibh 2 Reg Ln 5,737,200 3,824,800 9,562,000
972 0602 Orif Fr Kom Diaf Antebra + 1 Reg Ln 3,213,000 2,142,000 5,355,000
973 0603 Orif Fr Kom Diaf Antebrakhii 2,295,000 1,530,000 3,825,000
974 0604 Orif Fr Kom Diaf Fem Kla Lbh 2 Reg L 5,737,200 3,824,800 9,562,000
975 0605 Orif Fr Kom Diaf Fem, Kla + 2 Reg Ln 3,672,000 2,448,000 6,120,000
976 0606 Orif Fr Kom Diaf Fem, Klavi + 1 Reg 3,213,000 2,142,000 5,355,000
977 0607 Orif Fr Kom Diaf Femur, Klaficula 1,836,000 1,224,000 3,060,000
978 0608 Orif Fr Kom Diaf Hum Lbh 2 Reg Ln 5,737,200 3,824,800 9,562,000
979 0609 Orif Fr Kom Diaf Hume + 2 Reg Lain 3,213,000 2,142,000 5,355,000
980 0610 Orif Fr Kom Diaf Humerus + 1 Reg L 3,213,000 2,142,000 5,355,000
981 0611 Orif Fr Kom Diaf Kru Fat + 1 Reg Ln 3,213,000 2,142,000 5,355,000
982 0612 Orif Fr Kom Diaf Kru Fat + 2 Reg Ln 3,672,000 2,448,000 6,120,000
983 0613 Orif Fr Kom Diaf Kru Fat Lbh 2 Reg 5,737,200 3,824,800 9,562,000
984 0614 Orif Fr Kom Diaf Kruris Fatela 1,836,000 1,224,000 3,060,000
985 0615 Orif Fr Kom Diaf Lbh 2 Met, Tar, Fal 3,672,000 2,448,000 6,120,000
986 0616 Orif Fr Kom Diaf Umerus 2,754,000 1,836,000 4,590,000
987 0617 Orif Fr Perd Tlpk dan Jr Tgn/Kk Lbh 2 Jr 5,737,200 3,824,800 9,562,000
988 0618 Orif Fr Pers Siku 3,213,000 2,142,000 5,355,000
989 0619 Orif Fr Pers Siku + 2 Reg Lain 5,737,200 3,824,800 9,562,000
990 0620 Orif Fr Persd Bahu, Perg Tgn + 1 Reg 4,590,000 3,060,000 7,650,000
991 0621 Orif Fr Persd Bh, Perg Tgn Lbh 2 Reg 6,885,000 4,590,000 11,475,000
992 0622 Orif Fr Persd Lutut, Perg Kaki Lbh 2 6,885,000 4,590,000 11,475,000
993 0623 Orif Fr Persd Lutut, Pergl Kaki 2,295,000 1,530,000 3,825,000
995 0624 Orif Fr Persd Panggl Lbh 2 Reg Lain 6,885,000 4,590,000 11,475,000
996 0625 Orif Fr Persd Panggul 3,672,000 2,448,000 6,120,000
997 0626 Orif Fr Persd Siku Lbh 2 Reg Lain 6,885,000 4,590,000 11,475,000
998 0627 Orif Fr Persd Tlpk dan Jr Tgn/Kk + 2 Rg 5,737,200 3,824,800 9,562,000
999 0628 Orif Fr Persd Tlpk dan Jr Tgn/Kk Lbh 2Jr 6,885,000 4,590,000 11,475,000
1000 0629 Orif Fr Persd Tlpk Jr Tgn/Kk 1 - 2 Jr 6,885,000 4,590,000 11,475,000
1001 0630 Orif Fr Pesd Bh,Perg Tgn + 2 Reg Ln 5,737,200 3,824,800 9,562,000
1002 0631 Orif Fr Pesd Lutut,Perg Kaki + 1 Reg 4,590,000 3,060,000 7,650,000
1003 0632 Orif Fr Pesd Panggl + 1 Reg Lain 4,590,000 3,060,000 7,650,000
1004 0633 Orif Fr Pesd Pangl + 2 Reg Ln 5,737,200 3,824,800 9,562,000
1005 0634 Orif Fr Pesd Siku + 1 Reg Lain 4,590,000 3,060,000 7,650,000
1006 0635 Orif Fr Pesd Tlpk dan Jari Tgn/Kaki Lbh2 4,590,000 3,060,000 7,650,000
1007 0636 Orif Fr Pesd Tlpk/Jr Tgn/ Kaki 1 - 2Jr 4,590,000 3,060,000 7,650,000
1008 0637 Orif Fr Pesen Bhu, Pegl Tgn 2,754,000 1,836,000 4,590,000
1009 0638 Orif Fr Simpel Diaf. 1 - 2 Metakarpal 1,836,000 1,224,000 3,060,000
1010 0639 Orif Fr Simpel Diaf. Femur, Klavikula 1,836,000 1,224,000 3,060,000
1011 0640 Orif Fr Simpel Diaf. Lbh Dr 2 Meta. 2,295,000 1,530,000 3,825,000
1012 0641 Orif Fr Simpel Diaf.Humerus + 1 Regio 2,754,000 1,836,000 4,590,000
1013 0642 Orif Fr Simpel Diafisis Antebrakhi 1,836,000 1,224,000 3,060,000
1014 0643 Orif Fr Simpel Diafisis Humerus 2,295,000 1,530,000 3,825,000
1015 0644 Orif Fr Smp Diaf Antebrakhii 2,754,000 1,836,000 4,590,000
1016 0645 Orif Fr Smpl Diad Lebh 2 Met Karval 3,672,000 2,448,000 6,120,000
1017 0646 Orif Fr Smpl Diaf 1 - 2 Met, Tar, Fal 4,590,000 3,060,000 7,650,000
1018 0647 Orif Fr Smpl Diaf 1 - 2 Meta Tar, Fal 2,754,000 1,836,000 4,590,000
1019 0648 Orif Fr Smpl Diaf Ante + Lbh 2 Reg 4,590,000 3,060,000 7,650,000
1020 0649 Orif Fr Smpl Diaf Fem, Kla + Lbh 2 R 4,590,000 3,060,000 7,650,000
1021 0650 Orif Fr Smpl Diaf Hum Lbh 2 Reg 4,590,000 3,060,000 7,650,000
1022 0651 Orif Fr Smpl Diaf Kru, Fat + Lbh 2 R 4,590,000 3,060,000 7,650,000
1023 0652 Orif Fr Smpl Diaf Kruris, Pat + 1 Reg 2,754,000 1,836,000 4,590,000
1024 0653 Orif Fr Smpl Diaf Lbh 2 Met, Tar, Fal 4,590,000 3,060,000 7,650,000
1025 0654 Orif Fr Smpl Diaf Lbh 2 Meta Tar, Fal 2,754,000 1,836,000 4,590,000
1026 0655 Orif Fr Smpl Diaf Ume + 2 Reg Lain 3,672,000 2,448,000 6,120,000
1027 0656 Orif Fr Smpl Diap Antebrak + 2 Reg 3,672,000 2,448,000 6,120,000
1028 0657 Orif Fr Smpl Diap Fem, Kla + 2Reg 3,672,000 2,448,000 6,120,000
1029 0658 Orif Fr Smpl Diap Kru. Fat + Reg Lain 3,672,000 2,448,000 6,120,000
1030 0659 Orif Fr Tlpk Kaki/Jari 1 - 2 Jari 1,836,000 1,224,000 3,060,000
1031 0660 Orif Fr.Smp Diaf Fem Klav 1 Reg Lain 2,754,000 1,836,000 4,590,000
1032 0661 Orif Fr.Smpl Diaf 1 s/d 2 Met Kar 3,672,000 2,448,000 6,120,000
1033 0662 Orif Frak Persd Tlpk/Jr Tgn Lbh 2 Jr 2,754,000 1,836,000 4,590,000
1034 0663 Orif Fraktur Simpel Diaf, Kruris, Fat 1,377,000 918,000 2,295,000
1035 0664 Pasang Gips Ekstremitas 121,800 81,200 203,000
1037 0665 Pasang Traksi Tulang Ekstremitas 304,200 202,800 507,000
1038 0666 Pasang Traksi Tulang Kepala 459,000 306,000 765,000
1040 0667 Pengangkatan Bnd Asg di Ekstremitas 1,377,000 918,000 2,295,000
1041 0668 Pengangkatan Bnd Asg di Tlg Belkg 3,672,000 2,448,000 6,120,000
1042 0669 Perawatan Gips: LLC, Body Spica 54,600 36,400 91,000
1045 0670 Rekonstruksi Lebih Satu Jari 4,590,000 3,060,000 7,650,000
1046 0671 Rekonstruksi Satu Jari 2,754,000 1,836,000 4,590,000
1047 0672 Rekonstruksi Tgk Bahu/Panggl 1 Sisi 5,737,200 3,824,800 9,562,000
1048 0673 Rekonstruksi Tgk Bahu/Panggl 2 Sisi 6,885,000 4,590,000 11,475,000
1049 0674 Rekonstruksi Tgk Manus/Pedis 1 Sisi 5,737,200 3,824,800 9,562,000
1050 0675 Rekonstruksi Tgk Siku/Litut 1 Sisi 4,590,000 3,060,000 7,650,000
1051 0676 Rekonstruksi Tgk Siku/Lutut 2 Sisi 5,737,200 3,824,800 9,562,000
1052 0677 Rekonstruksi Tgk Wrist/Ankle 1 Sisi 5,737,200 3,824,800 9,562,000
1053 0678 Rekonstruksi Tgk Wrist/Ankle 2 Sisi 4,590,000 3,060,000 7,650,000
1054 0679 Rekostruksi Tgk Manus/Pedis 2 Sisi 4,590,000 3,060,000 7,650,000
1055 0680 Replantasi Distal Wrist 5,737,200 3,824,800 9,562,000
1056 0681 Replantasi Proksimal Wrist 4,590,000 3,060,000 7,650,000
1057 0682 Reposisi + Gips Ekst Atas 2 Sisi 918,000 612,000 1,530,000
1058 0683 Reposisi + Gips Ekstr. Bawah 1 Sisi 918,000 612,000 1,530,000
1059 0684 Reposisi + Gips Ekstr. Bawah 2 Sisi 1,147,200 764,800 1,912,000
1060 0685 Reposisi+Gips Ekstremitas Atas 1 Sisi 688,200 458,800 1,147,000
1061 0686 Stab Anterior Vertb Servikal 9,180,000 6,120,000 15,300,000
1062 0687 Stab Anterior Vertb Thorako - Lumbal 6,885,000 4,590,000 11,475,000
1063 0688 Stab Post Vertb Thorako - Lumbal 5,737,200 3,824,800 9,562,000
1064 0689 Stabil Anterior Vertb dan Fusion 11,475,000 7,650,000 19,125,000
1065 0690 Stabil Post Vertb dan Fusion 8,032,200 5,354,800 13,387,000
1066 0691 Stabil Posterior Vertb Servikal 6,885,000 4,590,000 11,475,000
1067 0692 Sulih Tulang Besar 2,295,000 1,530,000 3,825,000
1068 0693 Tendon Fleks. Lbh 2 Jr Luar Man Area 1,836,000 1,224,000 3,060,000
1069 0694 Tendon Fleks. 2 Jr Didlm Nm Landarea 1,377,000 918,000 2,295,000
1070 0695 Tennoraphy Tendon Ekst dari 2 Jari 688,200 458,800 1,147,000
1071 0696 Tennoraphy Tendon Ekst Lebih 2 Jari 918,000 612,000 1,530,000
1073 0697 Tenoraphy Ten. Fleks 2 Jr diluar 918,000 612,000 1,530,000
1074 0698 Tenoraphy Tendon Flek Lbh 2 Jr didlm 2,295,000 1,530,000 3,825,000
1075 0699 Tenorapy Tendon Fleksor 1 Jari 688,200 458,800 1,147,000
1076 0700 Tenorraphy Satu Tendon Ekstensor Jari 304,200 202,800 507,000
1077 0701 Total Joint Replacement 1-2 Jari 3,672,000 2,448,000 6,120,000
1078 0702 Total Joint Replacement Lebih 2 Jari 5,737,200 3,824,800 9,562,000
1079 0703 Total Joint Replacement Panggul 1 Sisi 5,737,200 3,824,800 9,562,000
1080 0704 Total Joint Replacement Panggul 2 Sisi 6,885,000 4,590,000 11,475,000
1081 0705 Total Joint Replacement Siku/Lutut 1 Sisi 6,885,000 4,590,000 11,475,000
1082 0706 Total Joint Replacement Siku/Lutut 2 Sisi 8,032,200 5,354,800 13,387,000
1087 0707 Wide Exc Tumor Tl + Rek Bahu/Panggul 8,032,200 5,354,800 13,387,000
1088 0708 Wide Exc Tumor Tl + Rek Siku/Lutut 6,885,000 4,590,000 11,475,000
1089 0709 Wide Exc Tumor Tl + Rek Tlpk dan Jari Tgn 3,672,000 2,448,000 6,120,000
1090 0710 Wide Exc Tumor Tl + Rek Wrist/Ankle 5,737,200 3,824,800 9,562,000
1091 0711 Wide Excision Tumor Tulang 1 Reg 2,295,000 1,530,000 3,825,000
1092 0712 Wide Excision Tumor Tulang 2 Reg 3,213,000 2,142,000 5,355,000
1093 0713 Adenoidektomi 2,250,000 1,500,000 3,750,000
1094 0714 Adenolisis 2,280,000 1,520,000 3,800,000
1095 0715 Adranalektomi Abdominotorakal 6,480,000 4,320,000 10,800,000
1096 0716 Amputasi Digiti Single 1,380,000 920,000 2,300,000
1097 0717 Amputasi Eksisi Kista Branchiogenik 2,940,000 1,960,000 4,900,000
1098 0718 Anal Fistulektomi 2,790,000 1,860,000 4,650,000
1099 0719 Anal Fistulotomi 2,790,000 1,860,000 4,650,000
1100 0720 Angkat "Plate Screw" Fraktur Os Maksilofacial 1 - 2 tempat 2,280,000 1,520,000 3,800,000
1101 0721 Angkat "Plate Screw" Fraktur Os Maksilofasial 3 tempat atau lebih 2,790,000 1,860,000 4,650,000
1102 0722 Angkat "Plate Screw" Sederhana 1,380,000 920,000 2,300,000
1103 0723 Anthroscopy Therapeutik 2,790,000 1,860,000 4,650,000
1104 0724 Anthrotomi/Synovektomi 1,560,000 1,040,000 2,600,000
1105 0725 Apendektomi (Elektif) 2,280,000 1,520,000 3,800,000
1106 0726 Apendektomi dengan Laparoskopi 4,050,000 2,700,000 6,750,000
1107 0727 Apendektomi Insidental Lainnya (darurat) 3,375,000 2,250,000 5,625,000
1108 0728 Aspirasi Hemarthrosis 93,000 62,000 155,000
1109 0729 Aspirasi Hematome 15,000 10,000 25,000
1110 0730 Aspirasi Kista 360,000 240,000 600,000
1111 0731 AV Shunt dengan Anestesi Lokal 1,380,000 920,000 2,300,000
1112 0732 AV Shunt Radiosefalika 2,790,000 1,860,000 4,650,000
1113 0733 Babcock 2,280,000 1,520,000 3,800,000
1114 0734 Bedah Listrik 36,000 24,000 60,000
1115 0735 Bilateral Excision of Ectopic Breast Tissue (Mamma Aberans) 4,050,000 2,700,000 6,750,000
1116 0736 Bilateral Multiple Excision of Lession of Breast dengan Anestesi 4,050,000 2,700,000 6,750,000
1117 0737 Bilateral Repair of Direct Inguinal Hernia (diluar mesh) 3,375,000 2,250,000 5,625,000
1118 0738 Bilateral Repair of Indirect Hernia 3,375,000 2,250,000 5,625,000
1119 0739 Bilateral Repair of Inguinal Hernia, One Direct and One Indirect 3,375,000 2,250,000 5,625,000
1120 0740 Bilatreal Repair of Femoral Hernia 3,375,000 2,250,000 5,625,000
1121 0741 Biopsi Anus dengan Anestesi Lokal 600,000 400,000 1,000,000
1122 0742 Biopsi Kelenjar Getah Bening 1,410,000 940,000 2,350,000
1123 0743 Biopsi Prostat 1,410,000 940,000 2,350,000
1124 0744 Biopsi Saraf Kutaneus/Otot 1,560,000 1,040,000 2,600,000
1125 0745 Biopsi Terbuka Tumor di Dinding Thorak 2,280,000 1,520,000 3,800,000
1126 0746 Biopsi Testis 1,560,000 1,040,000 2,600,000
1127 0747 Bladder Neck Incision 3,480,000 2,320,000 5,800,000
1128 0748 Bouginasi 25,800 17,200 43,000
1129 0749 Buka Gips 51,600 34,400 86,000
1130 0750 Buka IOIDW 48,000 32,000 80,000
1131 0751 Bulektomi tanpa Anestesi 39,000 26,000 65,000
1132 0752 Chemo Surgary Podophylin 36,000 24,000 60,000
1133 0753 Cholecystectomy Terbuka 4,725,000 3,150,000 7,875,000
1134 0754 Clipping Costae (diluar plate) 4,050,000 2,700,000 6,750,000
1135 0755 Closure Anal Fistel 2,790,000 1,860,000 4,650,000
1136 0756 Closure of Appendicial Fistuyla 4,050,000 2,700,000 6,750,000
1137 0757 Closure of Fistula of Small Intestine 5,400,000 3,600,000 9,000,000
1138 0758 Closure of Fistule of Large Intestine 4,050,000 2,700,000 6,750,000
1139 0759 Closure of Intestinal Stoma 5,400,000 3,600,000 9,000,000
1140 0760 Closure of Laceration of Liver 6,750,000 4,500,000 11,250,000
1141 0761 Complicated Functional Neuro Perculteneus Kordotomi 11,730,000 7,820,000 19,550,000
1142 0762 Complicated Functional Neuro Perculteneus Paravarteb/Visceral Block 12,900,000 8,600,000 21,500,000
1143 0763 Complicated Functional Neuro Steraotaxy Kompleks 1,560,000 1,040,000 2,600,000
1144 0764 Complicated Functional Neuro Steraotaxy Sederhana 14,880,000 9,920,000 24,800,000
1145 0765 Condilotomi Mandibula 2,940,000 1,960,000 4,900,000
1146 0766 Control of Hemorrhage of Anus 2,790,000 1,860,000 4,650,000
1147 0767 DCR + Silicon Tube 5,520,000 3,680,000 9,200,000
1148 0768 Debridement - Nekrotomi Luka Gangren 1,380,000 920,000 2,300,000
1149 0769 Debridement + Skin Graft 2,880,000 1,920,000 4,800,000
1150 0770 Debridement Fraktur Terbuka Sederhana dengan Eksternal Cast 2,280,000 1,520,000 3,800,000
1151 0771 Debulking 6,750,000 4,500,000 11,250,000
1152 0772 Dekompresi Syaraf 4,740,000 3,160,000 7,900,000
1153 0773 Dekompresi Syaraf Tepi 9,060,000 6,040,000 15,100,000
1154 0774 Deseksi Axila 4,050,000 2,700,000 6,750,000
1155 0775 Dilatasi Megacolon pada Anak 42,000 28,000 70,000
1156 0776 Dilatasi Phimosis 57,000 38,000 95,000
1157 0777 Dilatasi Uretra 1,560,000 1,040,000 2,600,000
1158 0778 Disartikulasi Sendi Ekstremitas 2,280,000 1,520,000 3,800,000
1159 0779 Diseksi Kelenjar Getah Bening (KGB) Pelvis 10,800,000 7,200,000 18,000,000
1160 0780 Diseksi Kelenjar Inguinal 7,380,000 4,920,000 12,300,000
1161 0781 Diseksi Leher Radikal Modifikasi/Fungsional 11,700,000 7,800,000 19,500,000
1162 0782 Dorsumsisi dengan Anestesi Lokal 600,000 400,000 1,000,000
1163 0783 Drainage of Appediceal Abses 4,050,000 2,700,000 6,750,000
1164 0784 Drainage of Pancreatic Cyst with Catheter 6,750,000 4,500,000 11,250,000
1165 0785 Drainase Abses Hepar 3,375,000 2,250,000 5,625,000
1166 0786 Drainase Kista Pankreas 2,250,000 1,500,000 3,750,000
1167 0787 Drainase Periureter 2,250,000 1,500,000 3,750,000
1168 0788 Eksenterasi 5,520,000 3,680,000 9,200,000
1169 0789 Eksisi Biopsi Tumor Pembuluh Darah 2,280,000 1,520,000 3,800,000
1170 0790 Eksisi Chodee 2,850,000 1,900,000 4,750,000
1171 0791 Eksisi Clavus 120,000 80,000 200,000
1172 0792 Eksisi Fistel 1,560,000 1,040,000 2,600,000
1173 0793 Eksisi Hemmoroid 2,790,000 1,860,000 4,650,000
1174 0794 Eksisi Hidradenitis Unilateral 2,280,000 1,520,000 3,800,000
1175 0795 Eksisi Higroma Coli 6,750,000 4,500,000 11,250,000
1176 0796 Eksisi Kelainan pada Payudara dengan Pembiusan Umum 2,280,000 1,520,000 3,800,000
1177 0797 Eksisi Kelainan Perianal Lainnya 1,380,000 920,000 2,300,000
1178 0798 Eksisi Kelenjar Sub Mandibula 4,050,000 2,700,000 6,750,000
1179 0799 Eksisi Kista Ateroma/Lipoma/Ganglion < 2cm 120,000 80,000 200,000
1180 0800 Eksisi Kista Duktus Tiroglosus 4,050,000 2,700,000 6,750,000
1181 0801 Eksisi Luas Radikal + Rekonstruksi 8,220,000 5,480,000 13,700,000
1182 0802 Eksisi Luas Tumor Ganas Bibir dengan Rekonstruksi Flap Lokal 6,750,000 4,500,000 11,250,000
1183 0803 Eksisi Nevus Sederhana dengan Lokal Anestesi 600,000 400,000 1,000,000
1184 0804 Eksisi Parsial + Marsupiliasi Ranula 1,380,000 920,000 2,300,000
1185 0805 Eksisi Perianal Skin Tags 1,380,000 920,000 2,300,000
1186 0806 Eksisi Pretigium Bare Sklera 360,000 240,000 600,000
1187 0807 Eksisi Skin Grafting 150,000 100,000 250,000
1188 0808 Eksisi Tumor Adneksa Kecil 1,365,000 910,000 2,275,000
1189 0809 Eksisi Tumor Adneksa Sedang 2,280,000 1,520,000 3,800,000
1190 0810 Eksisi Tumor Ganas Kulit dengan Flap Lokal atau Graft Kulit 4,725,000 3,150,000 7,875,000
1191 0811 Eksisi Tumor Ganas Kulit tanpa Rekonstruksi 4,050,000 2,700,000 6,750,000
1192 0812 Eksisi Tumor Jinak dengan Anestesi Lokal 600,000 400,000 1,000,000
1193 0813 Eksisi Tumor Jinak Kulit dan Tumor Non Neoplastik Kulit (LA) 600,000 400,000 1,000,000
1194 0814 Eksisi Tumor Jinak Mama (FAM) < 2 cm satu sisi 1,380,000 920,000 2,300,000
1195 0815 Eksochiliasi 1,560,000 1,040,000 2,600,000
1196 0816 Eksplorasi Nasofaring 2,280,000 1,520,000 3,800,000
1197 0817 Eksplorasi Testis Mikro Surgery 4,800,000 3,200,000 8,000,000
1198 0818 Eksplorasi Vaskuler (trauma/nontrauma) 4,725,000 3,150,000 7,875,000
1199 0819 Ekstirpasi Angiofibroma Nasofaring 3,000,000 2,000,000 5,000,000
1200 0820 Ekstirpasi Ganglion Poplitea 2,280,000 1,520,000 3,800,000
1201 0821 Ekstirpasi Kelenjar Sub Mandibula 2,400,000 1,600,000 4,000,000
1202 0822 Ekstirpasi Kista Bronchialis 2,280,000 1,520,000 3,800,000
1203 0823 Ekstirpasi Kista Dermoid dengan Anastesi 1,380,000 920,000 2,300,000
1204 0824 Ekstirpasi Plunkina Ranula 2,280,000 1,520,000 3,800,000
1205 0825 Ekstirpasi Tumor Ganas Adneksia + Rekonstruksi 8,280,000 5,520,000 13,800,000
1206 0826 Ekstirpasi Tumor Jinak Kulit 150,000 100,000 250,000
1207 0827 Ekstirpasi Tumor Scalp/Cranium 8,640,000 5,760,000 14,400,000
1208 0828 Ekstirpasi/Eksisi Tumor Jaringan Lunak Ukuran < 2cm 2,280,000 1,520,000 3,800,000
1209 0829 Ekstraksi Corpus Alienum 27,000 18,000 45,000
1210 0830 Ekstraksi Corpus Alienum di Regio Thorak 5,400,000 3,600,000 9,000,000
1211 0831 Ekstraksi Kolesteatum 150,000 100,000 250,000
1212 0832 Ekstraksi Kuku 30,000 20,000 50,000
1213 0833 Ekstraksi Linear 2,940,000 1,960,000 4,900,000
1214 0834 Elektro Kauter Kondiloma, Veruka 180,000 120,000 300,000
1215 0835 Endoskopi Polipektomi of Rectum 1,380,000 920,000 2,300,000
1216 0836 Enukleasi Kista 1,350,000 900,000 2,250,000
1217 0837 Enukleasi Kista D42 2,940,000 1,960,000 4,900,000
1218 0838 Enukleasi Kista Ginjal 2,940,000 1,960,000 4,900,000
1219 0839 Enukleasi/Eviscerasi + DFG 4,140,000 2,760,000 6,900,000
1220 0840 Epiddimovasostomi 4,830,000 3,220,000 8,050,000
1221 0841 Ethmoidektomi (Intranasal) 2,250,000 1,500,000 3,750,000
1222 0842 Evakuasi Corpus Alienum Sederhana dengan Anestesi Lokal 600,000 400,000 1,000,000
1223 0843 Evakuasi Corpus Alienum Sederhana dengan Anestesi Umum 2,790,000 1,860,000 4,650,000
1224 0844 Evakuasi Hematome Buli-buli 2,280,000 1,520,000 3,800,000
1225 0845 Evakuasi Hematome di Ekstremitas 2,280,000 1,520,000 3,800,000
1226 0846 Evakuasi Hematome Pasca Operasi Leher tanpa Trakeostomi 2,280,000 1,520,000 3,800,000
1227 0847 Eviscerasi 1,620,000 1,080,000 2,700,000
1228 0848 Extended Pyelolithektomi (Gilveme) 6,900,000 4,600,000 11,500,000
1229 0849 Exteriozation of Large Intestine 4,725,000 3,150,000 7,875,000
1230 0850 Exteriozation of Small Intestine 4,725,000 3,150,000 7,875,000
1231 0851 Faringotomi 2,940,000 1,960,000 4,900,000
1232 0852 Fasciotomi 3,375,000 2,250,000 5,625,000
1233 0853 Fibroadenoma Mama 1,380,000 920,000 2,300,000
1234 0854 Fiksasi Interna Fraktur Maksilofasial 1-2 Tempat Patahan 5,400,000 3,600,000 9,000,000
1235 0855 Fiksasi Interna Fraktur Nasal 5,400,000 3,600,000 9,000,000
1236 0856 Fistula Ureterovesika 2,940,000 1,960,000 4,900,000
1237 0857 Flebektomi 1,530,000 1,020,000 2,550,000
1238 0858 FNA (Fine Needle Aspiration) 36,000 24,000 60,000
1239 0859 Foto Koagulasi Laser 1,530,000 1,020,000 2,550,000
1240 0860 Fraktur Antebrachii 3,375,000 2,250,000 5,625,000
1241 0861 Fraktur Clavikula 2,280,000 1,520,000 3,800,000
1242 0862 Fraktur Coles dan Pergelangan Tangan Lainnya 2,280,000 1,520,000 3,800,000
1243 0863 Fraktur Cruris 4,725,000 3,150,000 7,875,000
1244 0864 Fraktur Femur 4,725,000 3,150,000 7,875,000
1245 0865 Fraktur Humerus 4,050,000 2,700,000 6,750,000
1246 0866 Fraktur Olecranon 3,375,000 2,250,000 5,625,000
1247 0867 Fraktur Supracondiler Humerus 4,725,000 3,150,000 7,875,000
1248 0868 Free Flap Surgery 7,440,000 4,960,000 12,400,000
1249 0869 Frontoethmoidektomi (Ekstranasal) 2,940,000 1,960,000 4,900,000
1250 0870 Full Thickness Skin Graft to Hand 2,280,000 1,520,000 3,800,000
1251 0871 Full Thickness Skin Graft to Other Site 4,050,000 2,700,000 6,750,000
1252 0872 Ganglion Carpi 1,380,000 920,000 2,300,000
1253 0873 Ganti Balut Besar 24,000 16,000 40,000
1254 0874 Ganti Balut Kecil 9,000 6,000 15,000
1255 0875 Ganti Balut Sedang 15,000 10,000 25,000
1256 0876 Ganti Sendi (Arthroplasti) tidak termasuk alat 1,260,000 840,000 2,100,000
1257 0877 Gastrektomi (Bilroth 1 dan 2) 9,060,000 6,040,000 15,100,000
1258 0878 Glosektomi Totalis 8,220,000 5,480,000 13,700,000
1259 0879 Grafting pada Arterial Insufisiensi 6,060,000 4,040,000 10,100,000
1260 0880 Groin Disection 6,750,000 4,500,000 11,250,000
1261 0881 Hemiatomi Bilateral 2,940,000 1,960,000 4,900,000
1262 0882 Hemiglosektomi 4,725,000 3,150,000 7,875,000
1263 0883 Hemiglosektomi + RNO 6,480,000 4,320,000 10,800,000
1264 0884 Hemipelvektomi 7,350,000 4,900,000 12,250,000
1265 0885 Hidrokel per Inguinal/Ligasi Tinggi 2,280,000 1,520,000 3,800,000
1266 0886 Horseshoe Kidney Koreksi 5,190,000 3,460,000 8,650,000
1267 0887 Ileostomi 4,725,000 3,150,000 7,875,000
1268 0888 Ileostomi Permanen 4,725,000 3,150,000 7,875,000
1269 0889 Incisi Abses (Tindakan Bedah) 27,000 18,000 45,000
1270 0890 Incisi Abses dengan Anestesi Lokal 600,000 400,000 1,000,000
1271 0891 Incisi Abses Perianal 1,380,000 920,000 2,300,000
1272 0892 Incisi Mucocele dengan Anestesi Lokal 600,000 400,000 1,000,000
1273 0893 Incisional Biopsi Tumor dengan Anestesi Lokal 600,000 400,000 1,000,000
1274 0894 Injeksi Haemoroid (termasuk obat) 360,000 240,000 600,000
1275 0895 Injeksi Varises (termasuk obat) 360,000 240,000 600,000
1276 0896 Incisi Flegmon Dasar Mulut 2,790,000 1,860,000 4,650,000
1277 0897 Internal Fiksasi Fraktur Maksilofasial 5 Tempat atau Lebih 6,750,000 4,500,000 11,250,000
1278 0898 Internal Fiksasi Fraktur Mandibula Segmental 6,750,000 4,500,000 11,250,000
1279 0899 Internal Urethrotomi 2,940,000 1,960,000 4,900,000
1280 0900 Intra Abdominal Manipulation of Small Intestine 4,725,000 3,150,000 7,875,000
1281 0901 Kapsulektomi Posterior 2,850,000 1,900,000 4,750,000
1282 0902 Keratoplasti 7,590,000 5,060,000 12,650,000
1283 0903 Keratoplastie Lamelar 2,940,000 1,960,000 4,900,000
1284 0904 Koledoko Jejunostomi 11,700,000 7,800,000 19,500,000
1285 0905 Kolesistektomi Laparoskopik 6,750,000 4,500,000 11,250,000
1286 0906 Kolostomi Permanen 4,725,000 3,150,000 7,875,000
1287 0907 Konkoplasti 2,940,000 1,960,000 4,900,000
1291 0908 Koreksi Atresia Ani 2,940,000 1,960,000 4,900,000
1292 0909 Koreksi Conoenital Talipes Eouino Varus (CTEV) 2,940,000 1,960,000 4,900,000
1293 0910 Koreksi Disartikulasi 2,280,000 1,520,000 3,800,000
1294 0911 Koreksi Ekstropion / Entropion 2,250,000 1,500,000 3,750,000
1295 0912 Koreksi Fraktur Impresif 12,075,000 8,050,000 20,125,000
1296 0913 Koreksi Priapismus 2,280,000 1,520,000 3,800,000
1297 0914 Koreksi Skoliosis 15,540,000 10,360,000 25,900,000
1298 0915 Koreksi Spondilitis 15,540,000 10,360,000 25,900,000
1299 0916 Koreksi Tortikolis 2,940,000 1,960,000 4,900,000
1300 0917 Kraniotomi + Bedah Mikro 15,120,000 10,080,000 25,200,000
1301 0918 Kraniotomi + Endoskopi 15,540,000 10,360,000 25,900,000
1302 0919 Kraniotomi/Trenpanasi Konvensional 12,090,000 8,060,000 20,150,000
1303 0920 Labioschizis Simpel 2,280,000 1,520,000 3,800,000
1304 0921 Laminektomi Kompleks 12,090,000 8,060,000 20,150,000
1305 0922 Laminektomi Sederhana 12,090,000 8,060,000 20,150,000
1306 0923 Laparoscopy 6,750,000 4,500,000 11,250,000
1307 0924 Laparoscopyc Lysis of Peritoneal Adhesion 6,750,000 4,500,000 11,250,000
1308 0925 Laparoskopi Appendektomi 4,725,000 3,150,000 7,875,000
1309 0926 Laparotomi Eksplorasi 4,725,000 3,150,000 7,875,000
1310 0927 Laparotomi Percobaan 2,280,000 1,520,000 3,800,000
1311 0928 Laparotomi VC 2,880,000 1,920,000 4,800,000
1312 0929 Large to Large Intestinal Anastomose 5,400,000 3,600,000 9,000,000
1313 0930 Le-Ford Advancement Surgery 4,740,000 3,160,000 7,900,000
1314 0931 Left Hemicolectomy 5,400,000 3,600,000 9,000,000
1315 0932 Left Lateral Anal Sphincterotomy 4,050,000 2,700,000 6,750,000
1316 0933 Lepas Arch Barr 600,000 400,000 1,000,000
1317 0934 Lepas Drain 21,000 14,000 35,000
1318 0935 Lepas Jahitan < 5 Buah 18,000 12,000 30,000
1319 0936 Lepas Jahitan > 5 Buah 27,000 18,000 45,000
1320 0937 Lepas Kateter Pria/Wanita 12,000 8,000 20,000
1321 0938 Ligasi Hemmorroid 1,380,000 920,000 2,300,000
1322 0939 Ligasi Vaskuler Ekstremitas 1,380,000 920,000 2,300,000
1323 0940 Limfadenektomi Ileonguinal 4,740,000 3,160,000 7,900,000
1324 0941 Limfadenektomi Retroperinoteal 4,740,000 3,160,000 7,900,000
1325 0942 Lipoma 1,380,000 920,000 2,300,000
1326 0943 Litotripsi 2,940,000 1,960,000 4,900,000
1327 0944 Lobuloplasti Unilateral dengan Anestesi Lokal 600,000 400,000 1,000,000
1328 0945 Lokal Eksisi Kelainan pada Rectum atau Jaringan Sekitar 1,380,000 920,000 2,300,000
1329 0946 Long Arm Cast Anak 36,000 24,000 60,000
1330 0947 Long Arm Cast Dewasa 60,000 40,000 100,000
1331 0948 Long Leg Cast Anak 78,000 52,000 130,000
1332 0949 Long Leg Dewasa 102,000 68,000 170,000
1333 0950 Longitudinal Nefrolithotomi (Kadet) 4,740,000 3,160,000 7,900,000
1334 0951 Maksilektomi Partialis 2,940,000 1,960,000 4,900,000
1335 0952 Maksilektomi Totalis 6,480,000 4,320,000 10,800,000
1336 0953 Mama Aberant Unilateral 2,280,000 1,520,000 3,800,000
1337 0954 Mandibulektomi Marainalis 2,940,000 1,960,000 4,900,000
1338 0955 Mandibulektomi Partialis dengan Rekonstruksi 11,700,000 7,800,000 19,500,000
1339 0956 Mandibulektomi Totalis 4,320,000 2,880,000 7,200,000
1340 0957 Masektomi Radikal dengan Penyulit 7,380,000 4,920,000 12,300,000
1341 0958 Masektomi Simpel Bilateral 5,400,000 3,600,000 9,000,000
1342 0959 Mastektomi Radikal 6,750,000 4,500,000 11,250,000
1343 0960 Mastektomi Simple Unilateral 3,375,000 2,250,000 5,625,000
1344 0961 Mastektomi Subtotal 4,725,000 3,150,000 7,875,000
1345 0962 Meatotomi 600,000 400,000 1,000,000
1346 0963 Microsurgery (Tulang-Syaraf) 1,260,000 840,000 2,100,000
1347 0964 Microsurgery Ligasi Vena Spermatika 4,800,000 3,200,000 8,000,000
1348 0965 Minor Besar 252,000 168,000 420,000
1349 0966 Minor Kecil 48,000 32,000 80,000
1350 0967 Minor Sedang 105,000 70,000 175,000
1351 0968 MRM tanpa Rekontruksi 6,300,000 4,200,000 10,500,000
1352 0969 Myocutaneus Flap/Pectoral Mavor 9,060,000 6,040,000 15,100,000
1353 0970 Nefrektomi Partial 7,380,000 4,920,000 12,300,000
1354 0971 Nefrektomi Radikal 9,330,000 6,220,000 15,550,000
1355 0972 Nefro Uterektomi 6,480,000 4,320,000 10,800,000
1356 0973 Nefropexie 2,940,000 1,960,000 4,900,000
1357 0974 Nefrostomi Open 2,940,000 1,960,000 4,900,000
1358 0975 Nefrostomi Percutan 4,740,000 3,160,000 7,900,000
1359 0976 Neurektomi Saraf Vidian 2,940,000 1,960,000 4,900,000
1360 0977 Neurektomi/Neurolise 11,220,000 7,480,000 18,700,000
1361 0978 Oivertikulektomi Vesika 6,900,000 4,600,000 11,500,000
1362 0979 Open Biopsi of Breast 2,280,000 1,520,000 3,800,000
1363 0980 Open Biopsi of Liver 4,050,000 2,700,000 6,750,000
1364 0981 Open Biopsi of Salivary Gland or Duct 2,280,000 1,520,000 3,800,000
1365 0982 Open Biopsi Rektum dengan Anestesi Lokal 600,000 400,000 1,000,000
1366 0983 Open Prostatektomi 4,050,000 2,700,000 6,750,000
1367 0984 Open Reduction of Mandibula Fraktur 4,725,000 3,150,000 7,875,000
1368 0985 Open Reduction of Nasal and Zygomatic Fraktur 4,725,000 3,150,000 7,875,000
1369 0986 Open Reduktion of Alveolar Fraktur 4,050,000 2,700,000 6,750,000
1370 0987 Open Reduktion of Maxila Fraktur 4,725,000 3,150,000 7,875,000
1371 0988 Operasi Aneurisma Aorta 6,480,000 4,320,000 10,800,000
1372 0989 Operasi Arteri Coritis 6,480,000 4,320,000 10,800,000
1373 0990 Operasi Arteri Rehalis Stenosis 6,480,000 4,320,000 10,800,000
1374 0991 Operasi Fraktur Kompleks (Acetabulum, Tulang Belakang Pelvis) 12,510,000 8,340,000 20,850,000
1375 0992 Operasi Fraktur Muka Multiple 12,510,000 8,340,000 20,850,000
1376 0993 Operasi Fraktur Tripodo/Multiple 12,510,000 8,340,000 20,850,000
1377 0994 Operasi Fronto-Orbital Advancement pada Craniosynoostosis 15,780,000 10,520,000 26,300,000
1378 0995 Operasi Fusi Korpus Vertebra Approach Posterior 12,960,000 8,640,000 21,600,000
1380 0996 Operasi Hipospadia 2,250,000 1,500,000 3,750,000
1381 0997 Operasi Ileal Condoit (Bricker) 5,190,000 3,460,000 8,650,000
1382 0998 Operasi Konvensional Plexus Brakhialis/Lumbalis Sacralis/Cranialis/Spinalis 12,540,000 8,360,000 20,900,000
Perfier
1383 0999 Operasi Kranioplasti/Koreksi Fraktur 12,960,000 8,640,000 21,600,000
1384 1000 Operasi Manchester Fortegil 2,280,000 1,520,000 3,800,000
1385 1001 Operasi Mega Kolon (Hirschpruoa) 12,540,000 8,360,000 20,900,000
1386 1002 Operasi Mikro Craialis/Spinalis Perifer 14,280,000 9,520,000 23,800,000
1387 1003 Operasi Mikro Plexus Brakhialis/Lumbalis Sacralis 15,540,000 10,360,000 25,900,000
1388 1004 Operasi Mikrotia 2,280,000 1,520,000 3,800,000
1389 1005 Operasi pada Atresia Esofagus 12,090,000 8,060,000 20,150,000
1390 1006 Operasi Palatoplasti 2,280,000 1,520,000 3,800,000
1391 1007 Operasi Pemasangan Fiksasi Interna pada Kasus Bedah Syaraf 12,090,000 8,060,000 20,150,000
1392 1008 Operasi Pemasangan Pintasan VA/VP Shunt 4,830,000 3,220,000 8,050,000
1393 1009 Operasi Pemasangan Traksi Cervical/dan Pemasangan Halo Vest 3,450,000 2,300,000 5,750,000
1394 1010 Operasi Peyronie 2,940,000 1,960,000 4,900,000
1395 1011 Operasi Psoas Hiscth/Boari Flap 2,940,000 1,960,000 4,900,000
1396 1012 Operasi Shunting Femoralis 4,740,000 3,160,000 7,900,000
1397 1013 Operasi Shunting Poplitea Tibialis 4,740,000 3,160,000 7,900,000
1398 1014 Operasi Shunting Splenorenal 6,060,000 4,040,000 10,100,000
1399 1015 Operasi Tumor Jinak Genetalia dengan Anestesi Umum 420,000 280,000 700,000
1400 1016 Operasi Tumor Pembuluh Darah 2,940,000 1,960,000 4,900,000
1401 1017 Operasi Tumor Spinal Daerah Gervikal 14,280,000 9,520,000 23,800,000
1402 1018 Operasi Tumor Spinal Daerah Kraniospinal 15,540,000 10,360,000 25,900,000
1403 1019 Operasi Tumor Spinal Daerah Torakolumbal 12,960,000 8,640,000 21,600,000
1404 1020 Operasi Vaskuler yang memerlukan Teknik Operasi Khusus 5,190,000 3,460,000 8,650,000
1405 1021 Operculectomy 360,000 240,000 600,000
1406 1022 Orbitomi Anterior 2,940,000 1,960,000 4,900,000
1407 1023 Orbitotomi Lateral 7,770,000 5,180,000 12,950,000
1408 1024 Orchidektomi Subkapsuler 2,280,000 1,520,000 3,800,000
1409 1025 Orkhidektomi 2,280,000 1,520,000 3,800,000
1410 1026 Orthoanatic Surgery 7,770,000 5,180,000 12,950,000
1411 1027 Orthoonatie Surgery 2,940,000 1,960,000 4,900,000
1412 1028 Osteotektomi Sederhana 36,000 24,000 60,000
1413 1029 Osteotomi Eksisi Tulang Maksilofacial 6,750,000 4,500,000 11,250,000
1414 1030 Other Operation of Intestine 4,050,000 2,700,000 6,750,000
1415 1031 Other Prosedur of Hemmorroids 2,790,000 1,860,000 4,650,000
1416 1032 Other Repair and Plastic Operation of Tongue 6,750,000 4,500,000 11,250,000
1417 1033 Other Repair of Abdominal Wall 4,050,000 2,700,000 6,750,000
1418 1034 Other Skin Graft to Other Sites 4,050,000 2,700,000 6,750,000
1419 1035 OtherLlysis of Peritoneal Adhesion 4,725,000 3,150,000 7,875,000
1420 1036 Ovariektomi Bilateral 4,050,000 2,700,000 6,750,000
1421 1037 Paket Bedah Paru : Air Plumbage + Dikortikasi+Lobektomi+Muscle Plumbage + 20,700,000 13,800,000 34,500,000
Pnemunektomi + Segmenektomi +Torakoplasti + Omentumpexy
1422 1038 Palatoshizis 4,050,000 2,700,000 6,750,000
1423 1039 Pankreaktektomi 15,780,000 10,520,000 26,300,000
1424 1040 Parasintesa 2,940,000 1,960,000 4,900,000
1425 1041 Parotidektomi Radikal + Maridibulektomi 6,480,000 4,320,000 10,800,000
1426 1042 Parotidektomy Superficial 4,725,000 3,150,000 7,875,000
1427 1043 Pasang Arch Barr (Interdental Wiring) 1,380,000 920,000 2,300,000
1428 1044 Pasang Bidai/Spalk 15,000 10,000 25,000
1429 1045 Pasang Central Venous Catheter (CVC) 600,000 400,000 1,000,000
1430 1046 Pasang Doublelumen Hemodialisis 2,790,000 1,860,000 4,650,000
1431 1047 Pasang Foley Kateter 36,000 24,000 60,000
1432 1048 Pasang Kateter dengan Penyulit 39,000 26,000 65,000
1433 1049 Pasang Sling 30,000 20,000 50,000
1434 1050 Pemasangan Gips 312,000 208,000 520,000
1435 1051 Pemasangan Peritoneal Dialysis - diluar Alat 1,380,000 920,000 2,300,000
1436 1052 Pemasangan Pipa Shepard 2,280,000 1,520,000 3,800,000
1437 1053 Pemasangan WSD (diluar alat) 2,280,000 1,520,000 3,800,000
1438 1054 Pembedahan Fore Quarter 8,640,000 5,760,000 14,400,000
1439 1055 Pembuatan Stoma (Gastrostomy, Iliostomy, Kolostomy, Sigmoidostomi) 2,280,000 1,520,000 3,800,000
1440 1056 Penektomi Parsial 3,375,000 2,250,000 5,625,000
1441 1057 Pengobatan Epistaksis 36,000 24,000 60,000
1442 1058 Penutupan Oroantral Fistula 360,000 240,000 600,000
1443 1059 Percutaneous Nephrolithostripsy (PCNL) 6,210,000 4,140,000 10,350,000
1444 1060 Pericardiuocentesis 2,790,000 1,860,000 4,650,000
1445 1061 Phaceomulsifikisi 4,500,000 3,000,000 7,500,000
1446 1062 Phacoemulsifikasi 2,940,000 1,960,000 4,900,000
1447 1063 Pleurodesis (Pleurosklerosis) 600,000 400,000 1,000,000
1448 1064 Postero Saaital Anorectoplasty (PSA) 3,450,000 2,300,000 5,750,000
1449 1065 Potong Flap 2,280,000 1,520,000 3,800,000
1450 1066 Prosedure Sistrunk Kista Duktus Tiroglosus 4,050,000 2,700,000 6,750,000
1451 1067 Prostatektomi Radikal 5,190,000 3,460,000 8,650,000
1452 1068 Ptergium + CLG 1,410,000 940,000 2,350,000
1453 1069 Pthisis Bulbi (Graf Mukosa Bibir) 2,250,000 1,500,000 3,750,000
1454 1070 Ptosis 4,140,000 2,760,000 6,900,000
1455 1071 Pungsi Ascitas 360,000 240,000 600,000
1456 1072 Pungsi Aspirasi Hematoma/Seroma 600,000 400,000 1,000,000
1457 1073 Pungsi Batu 36,000 24,000 60,000
1458 1074 Pungsi Cairan Otak dengan Anestesi 1,530,000 1,020,000 2,550,000
1459 1075 Pungsi Efusi Pleura 348,000 232,000 580,000
1460 1076 Pyelolithotorni 2,940,000 1,960,000 4,900,000
1461 1077 Pyeloplasti 2,700,000 1,800,000 4,500,000
1462 1078 Radical Neck Desection 3,450,000 2,300,000 5,750,000
1463 1079 Rartial Spleenctomy 6,750,000 4,500,000 11,250,000
1464 1080 Reclosure of Postoperative Disruption of Abdominal Wall 4,725,000 3,150,000 7,875,000
1465 1081 Rectoskopi/Anoskopi 600,000 400,000 1,000,000
1466 1082 Reduksi Prolap Anus 3,375,000 2,250,000 5,625,000
1467 1083 Rekanalisasi Ruptura/Transkanal 2,250,000 1,500,000 3,750,000
1468 1084 Rekonstruksi Blassemeck 2,940,000 1,960,000 4,900,000
1469 1085 Rekonstruksi Defek/Kelainan Tubuh yang Kompleks 2,940,000 1,960,000 4,900,000
1470 1086 Rekonstruksi Duktus Lacrimalis/Stenosis Sederhana 2,940,000 1,960,000 4,900,000
1471 1087 Rekonstruksi Kelainan Jari/Ekstrimitas (Polidaktili, Sindaktili, Construction 2,790,000 1,860,000 4,650,000
Hand) Sederhana
1472 1088 Rekonstruksi Kontraktur Kompleks 2,940,000 1,960,000 4,900,000
1473 1089 Rekonstruksi Laserisasi Daun Telinga 2,790,000 1,860,000 4,650,000
1474 1090 Rekonstruksi Menfngokel Kranial (Anterior/Posterior) 12,510,000 8,340,000 20,850,000
1475 1091 Rekonstruksi Meninaokel Spina Bifida 12,090,000 8,060,000 20,150,000
1476 1092 Rekonstruksi Renovaskuler 5,190,000 3,460,000 8,650,000
1477 1093 Rekonstruksi Saket Berat 6,480,000 4,320,000 10,800,000
1478 1094 Rekonstruksi Vesika 2,940,000 1,960,000 4,900,000
1479 1095 Release Kontraktur Mandibula 6,750,000 4,500,000 11,250,000
1480 1096 Removal of Foreign Body From Peritoneal Cavity 4,725,000 3,150,000 7,875,000
1481 1097 Reopening of Rescent Laparotomy Site 6,750,000 4,500,000 11,250,000
1482 1098 Repair Anal Sphincter Lainnya 4,050,000 2,700,000 6,750,000
1483 1099 Repair Filitel Uretra Pasca Uretroplasi 1,530,000 1,020,000 2,550,000
1484 1100 Repair Herniasi Muscle 2,280,000 1,520,000 3,800,000
1485 1101 Repair Laserasi Hepar pada Trauma 6,750,000 4,500,000 11,250,000
1486 1102 Repair of Direct Inguinal Hernia (diluar mesh) 2,280,000 1,520,000 3,800,000
1487 1103 Repair of Femoral Hernia Unilateral 2,280,000 1,520,000 3,800,000
1488 1104 Repair of Indirect Inguinal Hernia (diluar mesh) 2,280,000 1,520,000 3,800,000
1489 1105 Repair of Other Hernia of Anterior Wall With Prosthesis 3,375,000 2,250,000 5,625,000
1490 1106 Repair of Umbilical Hernia 2,790,000 1,860,000 4,650,000
1491 1107 Repair Ruptur Buli-buli 4,725,000 3,150,000 7,875,000
1492 1108 Repair Ruptur Tendon Achiles 2,280,000 1,520,000 3,800,000
1493 1109 Replantasi 4,830,000 3,220,000 8,050,000
1494 1110 Reposisi Dislokasi Bahu 1,380,000 920,000 2,300,000
1495 1111 Reposisi Fiksasi (Compucate) 2,250,000 1,500,000 3,750,000
1496 1112 Reposisi Fistel 2,250,000 1,500,000 3,750,000
1497 1113 Reposisi Fraktur Tertutup Sederhana Ekstrimitas dengan Gips 600,000 400,000 1,000,000
1498 1114 Reposisi Tertutup Fraktur Condilus Mandibula 1,380,000 920,000 2,300,000
1499 1115 Reposisi Torsio Testis dengan Orkhidopeksi 2,790,000 1,860,000 4,650,000
1500 1116 Resection of Transverse Colon 5,400,000 3,600,000 9,000,000
1501 1117 Reseksi Anastomosis 2,940,000 1,960,000 4,900,000
1502 1118 Reseksi Esofagus + Interosisi Kolon 15,540,000 10,360,000 25,900,000
1503 1119 Reseksi Hepar 9,060,000 6,040,000 15,100,000
1504 1120 Reseksi Partial Vesika 2,940,000 1,960,000 4,900,000
1505 1121 Reseksi Rahang 2,940,000 1,960,000 4,900,000
1506 1122 Reseksi Urachus 2,940,000 1,960,000 4,900,000
1507 1123 Reshapino untuk Torus/Tumor Tulang 1,530,000 1,020,000 2,550,000
1508 1124 Ret Cam + Anestesi 1,530,000 1,020,000 2,550,000
1509 1125 Revisi AV Shunt 4,050,000 2,700,000 6,750,000
1510 1126 Revisi Trakeostomy 2,790,000 1,860,000 4,650,000
1511 1127 Revisi WSD 2,280,000 1,520,000 3,800,000
1512 1128 Revision of Anastomose of Small or Large Intestine 6,750,000 4,500,000 11,250,000
1513 1129 Revision of Stoma of Large Intestine 4,050,000 2,700,000 6,750,000
1514 1130 Revision of Stoma of Small Intestine 4,050,000 2,700,000 6,750,000
1515 1131 Right Hemicolektomi 5,400,000 3,600,000 9,000,000
1516 1132 Rinotomi Literalis 2,940,000 1,960,000 4,900,000
1517 1133 Rinotomi Literalis (Tindakan Khusus) 5,190,000 3,460,000 8,650,000
1518 1134 RPLND 4,830,000 3,220,000 8,050,000
1519 1135 Scheral Buckel 5,190,000 3,460,000 8,650,000
1520 1136 Scleroterapi dan atau Ligasi Hemangioma 2,790,000 1,860,000 4,650,000
1521 1137 Segmentektomi 2,280,000 1,520,000 3,800,000
1522 1138 Sequesterektomi dengan Anestesi 1,530,000 1,020,000 2,550,000
1523 1139 Simpatektomi 2,940,000 1,960,000 4,900,000
1524 1140 Simple Functional Neuro Surgery 9,060,000 6,040,000 15,100,000
1525 1141 Sindroma Blefaophimosis 7,590,000 5,060,000 12,650,000
1526 1142 Siok Saraf Tepi 1,530,000 1,020,000 2,550,000
1527 1143 Siptoplasti Reduksi 2,940,000 1,960,000 4,900,000
1528 1144 Sirklase 1,530,000 1,020,000 2,550,000
1529 1145 Sirkumsisi dengan Anestesi Lokal 600,000 400,000 1,000,000
1530 1146 Sirkumsisi dengan Anestesi Umum 1,380,000 920,000 2,300,000
1531 1147 Sirkumsisi One Day Care 1,380,000 920,000 2,300,000
1532 1148 Sistektomi Radikal 4,830,000 3,220,000 8,050,000
1533 1149 Sistostomi dengan Anestesi Umum 1,380,000 920,000 2,300,000
1534 1150 Skingraftina yang Luas 4,050,000 2,700,000 6,750,000
1535 1151 Skingraftina yang Tidak Luas 2,280,000 1,520,000 3,800,000
1536 1152 Sklera Buckling 2,940,000 1,960,000 4,900,000
1537 1153 Skleroterapi Vena (Varises, Hemangiona) 600,000 400,000 1,000,000
1538 1154 Sklerotomi 2,280,000 1,520,000 3,800,000
1539 1155 Sleep Nasoendoscopy 360,000 240,000 600,000
1540 1156 Small to Small Intestinal Anastomose 5,400,000 3,600,000 9,000,000
1541 1157 Solenektomi 2,940,000 1,960,000 4,900,000
1542 1158 Somnoplasti 1,530,000 1,020,000 2,550,000
1543 1159 Splenektomi 4,725,000 3,150,000 7,875,000
1544 1160 Split Thickness Skin Graft 2,280,000 1,520,000 3,800,000
1545 1161 Stapedektomi 6,060,000 4,040,000 10,100,000
1546 1162 Stripping Varises Ektremitas Inferior 4,050,000 2,700,000 6,750,000
1547 1163 Surgical Stagina 7,770,000 5,180,000 12,950,000
1548 1164 Suture of Laceration of Large Intestine 4,050,000 2,700,000 6,750,000
1549 1165 Suture of Laseration of Anus 2,790,000 1,860,000 4,650,000
1550 1166 Suture of Laseration of Small Intestine, Except Duodenum 4,050,000 2,700,000 6,750,000
1551 1167 Synovektomi 2,940,000 1,960,000 4,900,000
1552 1168 Taping dan Strapping 150,000 100,000 250,000
1553 1169 Temporal Bone Resection 6,480,000 4,320,000 10,800,000
1554 1170 Tindakan Anoscopy 36,000 24,000 60,000
1555 1171 Tindakan Argon laser/Kenon 2,280,000 1,520,000 3,800,000
1556 1172 Tindakan Bedah Beku 150,000 100,000 250,000
1557 1173 Tindakan Blok Reseksi 2,280,000 1,520,000 3,800,000
1558 1174 Tindakan Congenital Fornix Plastik 2,280,000 1,520,000 3,800,000
1559 1175 Tindakan Cyclodia Termi 2,280,000 1,520,000 3,800,000
1560 1176 Tindakan Deepening Sulcus 360,000 240,000 600,000
1561 1177 Tindakan Dekomoresi Fasialis 2,940,000 1,960,000 4,900,000
1562 1178 Tindakan Dekompresi Fasialis 6,210,000 4,140,000 10,350,000
1563 1179 Tindakan Pharnaeal Flap 2,940,000 1,960,000 4,900,000
1564 1180 Tiroid Lobektomi Unilateral 4,050,000 2,700,000 6,750,000
1565 1181 Tiroidektomi Complete 5,400,000 3,600,000 9,000,000
1566 1182 Tiroidektomi Parsial Lainnya 4,050,000 2,700,000 6,750,000
1567 1183 Tiroidektomi Subtotal 4,050,000 2,700,000 6,750,000
1568 1184 Torakosentesis 2,790,000 1,860,000 4,650,000
1569 1185 Torakotomi 6,750,000 4,500,000 11,250,000
1570 1186 Total Tiroidektomi 6,750,000 4,500,000 11,250,000
1571 1187 Trabekulektomi 4,500,000 3,000,000 7,500,000
1572 1188 Trabekulektomi + ECCE/Phaceomulsifikasi 5,190,000 3,460,000 8,650,000
1573 1189 Trakeostomi dengan Penyulit Tumor pada Akses Trakea 2,790,000 1,860,000 4,650,000
1574 1190 Trakeostomi Temporary 1,380,000 920,000 2,300,000
1575 1191 Transeksi Esofagus 2,940,000 1,960,000 4,900,000
1576 1192 Trikeopitelioma 150,000 100,000 250,000
1577 1193 Tumor Ganas/Adneksa Luas dengan Rekonstruksi 2,940,000 1,960,000 4,900,000
1578 1194 TUR Prostat 4,620,000 3,080,000 7,700,000
1579 1195 TUR Tumor Buli-Buli 4,650,000 3,100,000 7,750,000
1580 1196 Turbinoplasti 1,530,000 1,020,000 2,550,000
1581 1197 Uretero Sigmoidostomi 2,940,000 1,960,000 4,900,000
1582 1198 Uretero Ureterostomi 2,940,000 1,960,000 4,900,000
1583 1199 Ureterocutaheostomi 2,940,000 1,960,000 4,900,000
1584 1200 Ureterolisis 2,280,000 1,520,000 3,800,000
1585 1201 Ureterolithotomi 2,940,000 1,960,000 4,900,000
1586 1202 Ureteroneo Sistostomi 4,770,000 3,180,000 7,950,000
1587 1203 Ureterostomi 2,280,000 1,520,000 3,800,000
1588 1204 Urethrektomi 2,940,000 1,960,000 4,900,000
1589 1205 Urethrenuskopi (URS) 4,770,000 3,180,000 7,950,000
1590 1206 Uretroplasti 4,440,000 2,960,000 7,400,000
1591 1207 Uteroplasti 2,940,000 1,960,000 4,900,000
1592 1208 Vasektomi dengan Anestesi Lokal 600,000 400,000 1,000,000
1593 1209 Vasektomi dengan Anestesi Umum 1,380,000 920,000 2,300,000
1594 1210 Vasografi 2,280,000 1,520,000 3,800,000
1595 1211 Vasoligasi V Spermatika (Varicocele) Unilateral 2,400,000 1,600,000 4,000,000
1596 1212 Vena Seksi dengan Anestesi Lokal 600,000 400,000 1,000,000
1597 1213 Ventrikulostomi/VE Drainase 5,190,000 3,460,000 8,650,000
1598 1214 Vesicolithotomi (Sectio Alta) 2,280,000 1,520,000 3,800,000
1603 1215 Vitrektomi + Endo Laser + SB + Silicon Oil/Gas 13,110,000 8,740,000 21,850,000
1604 1216 Vulvektomi 6,060,000 4,040,000 10,100,000
1605 1217 Wide Eksisi Soft Tisue Tumor 6,750,000 4,500,000 11,250,000
1606 1218 WT dengan Luka Kecil (1 - 3 Lebar Kasa/Gaas) 15,600 10,400 26,000
1607 1219 Yag Laser 1,530,000 1,020,000 2,550,000
1608 1220 Angkat/Ekstraksi KB Susuk 121,800 81,200 203,000
1611 1221 Biopsi 195,600 130,400 326,000
1612 1222 Biopsi Portio 243,600 162,400 406,000
1613 1223 CTG (Cardio Tocografi) Perhari 54,600 36,400 91,000
1614 1224 Curetase dengan General Anastesi 609,000 406,000 1,015,000
1616 1225 Dilatasi Hegar 900,000 600,000 1,500,000
1617 1226 Eksisi/Konisasi 1,560,000 1,040,000 2,600,000
1618 1227 Ekstirpasi Kista Bartolin 1,560,000 1,040,000 2,600,000
1619 1228 Ekstirpasi Kista Gardner (Vagina) 720,000 480,000 1,200,000
1620 1229 Ekstirpasi Myoma Pedunculata 1,320,000 880,000 2,200,000
1621 1230 Ekstirpasi Papiloma Vagina 1,320,000 880,000 2,200,000
1622 1231 Ekstirpasi Polip Serviks 607,500 405,000 1,012,500
1623 1232 Ekstraksi IUD (Tindakan Obgyn) 90,000 60,000 150,000
1624 1233 Extractie Iud dengan GA 609,000 406,000 1,015,000
1626 1234 Histerektomi Radikal 6,075,000 4,050,000 10,125,000
1627 1235 Histerektomi Supra Vaginal 3,645,000 2,430,000 6,075,000
1628 1236 Histerektomi Supra Vaginal + BSO 3,945,000 2,630,000 6,575,000
1629 1237 Histerektomi Total 3,825,000 2,550,000 6,375,000
1630 1238 Histerektomi Total + BSO 4,125,000 2,750,000 6,875,000
1631 1239 Histerektomi Vaginal 4,500,000 3,000,000 7,500,000
1632 1240 Incisi Abses Bartolini dengan Anestesi Lokal 300,000 200,000 500,000
1633 1241 Incisi Abses Bartolini dengan Anestesi Umum 780,000 520,000 1,300,000
1634 1242 Incisi Bartolin + Marsupialisasi 900,000 600,000 1,500,000
1635 1243 Incisi Abses Bartholine 304,200 202,800 507,000
1637 1244 IVA/Pap Smear 48,000 32,000 80,000
1638 1245 Kauter Kondiloma Akuminata 720,000 480,000 1,200,000
1639 1246 Kistektomi Bilateral 1,515,000 1,010,000 2,525,000
1640 1247 Kistektomi Unilateral 1,260,000 840,000 2,100,000
1644 1248 Kryo Terapi 300,000 200,000 500,000
1646 1249 Kuretase + Steril 1,800,000 1,200,000 3,000,000
1647 1250 Kuretase Abortus/Sisa Plasenta 720,000 480,000 1,200,000
1648 1251 Kuretase Diagnostik 405,000 270,000 675,000
1649 1252 Kuretase Infeksi/Missed Abortion 960,000 640,000 1,600,000
1650 1253 Laparoskopi Diagnostik Infertilitas 5,820,000 3,880,000 9,700,000
1651 1254 Laparoskopi Operatif Adesiolis Endometriosis 7,500,000 5,000,000 12,500,000
1652 1255 Laparoskopi Operatif Hamil Ektopik 8,220,000 5,480,000 13,700,000
1653 1256 Laparoskopi Operatif Kiste Endometriosis 7,800,000 5,200,000 13,000,000
1654 1257 Laparoskopi Operatif Salfingektomi Bilateral (Hidrosalfing Bilateral) 8,220,000 5,480,000 13,700,000
1655 1258 Laparoskopi Ovarian Driling (LOD) PCOS 7,800,000 5,200,000 13,000,000
1656 1259 Laparoskopi Tubektomi Bilateral 5,820,000 3,880,000 9,700,000
1658 1260 Marsupialisasi Abses Bartholin 1,410,000 940,000 2,350,000
1665 1261 Miomektomi 1,650,000 1,100,000 2,750,000
1666 1262 Nitrogen Cair 36,000 24,000 60,000
1667 1263 NST (Non Stres Test) 54,600 36,400 91,000
1671 1264 Operasi Tumor Ganas Ovarium 5,190,000 3,460,000 8,650,000
1672 1265 Partus Abnormal Bayi Sungsang 1,269,000 846,000 2,115,000
1673 1266 Partus Abnormal ditolong Residen/Dokter Umum 1,272,000 848,000 2,120,000
1674 1267 Partus Abnormal ditolong Spesialis Jaga 1,425,000 950,000 2,375,000
1675 1268 Partus Abnormal Spesialis Khusus 1,605,000 1,070,000 2,675,000
1676 1269 Partus Kembar Ditolong Bidan Jaga 627,000 418,000 1,045,000
1677 1270 Partus Normal Bayi Kembar Oleh Spesialis 1,083,000 722,000 1,805,000
1678 1271 Partus Normal Bidan Khusus 634,200 422,800 1,057,000
1679 1272 Partus Normal Ditolong Residen/Dokter Umum 784,200 522,800 1,307,000
1680 1273 Partus Normal Ditolong Bidan Jaga 502,200 334,800 837,000
1681 1274 Partus Normal Ditolong Spesialis Jaga 922,200 614,800 1,537,000
1682 1275 Partus Normal Spesialis Khusus 1,102,200 734,800 1,837,000
1683 1276 Pasang/Buka Susuk KB 246,000 164,000 410,000
1686 1277 Pasang Infuse Umbilical 15,000 10,000 25,000
1687 1278 Pasang IUD Pasca Plasenta 183,600 122,400 306,000
1688 1279 Pasang KB 54,600 36,400 91,000
1692 1280 Pasang Tampon pada Vagina 54,600 36,400 91,000
1693 1281 Pasang/Lepas Pesarium 40,200 26,800 67,000
1699 1282 Perineorafi Anestesi Lokal 510,000 340,000 850,000
1700 1283 Perineorafi Anestesi Umum 720,000 480,000 1,200,000
1701 1284 Perineorafi Sub Total Anestesi lokal 405,000 270,000 675,000
1702 1285 Perineorafi Sub Total dengan Anestesi Umum 600,000 400,000 1,000,000
1703 1286 Persalinan Tanpa Nyeri 1,920,000 1,280,000 3,200,000
1705 1287 Placenta Manual Partus Luar 609,000 406,000 1,015,000
1708 1288 Repair Vagina dan Robekan Total Perinium 365,400 243,600 609,000
1709 1289 Repair Vagina dengan GA 365,400 243,600 609,000
1710 1290 Repair Velsco Vagina Fistel Kompleks 5,190,000 3,460,000 8,650,000
1711 1291 Reparasi Vistula Vesiko Vaginal 2,940,000 1,960,000 4,900,000
1712 1292 Resusitasi Bayi Baru Lahir 121,800 81,200 203,000
1713 1293 Salpingo-Ooporektomy Bilateral (Tind.Med.Bes.1) 1,620,000 1,080,000 2,700,000
1714 1294 Salpingo-Ooporektomy Unilateral 1,215,000 810,000 2,025,000
1715 1295 Salvagino Operasi Mikro 2,940,000 1,960,000 4,900,000
1718 1296 Screening Pendengaran pada Bayi 33,000 22,000 55,000
1719 1297 Seksio Sesarea 2,040,000 1,360,000 3,400,000
1720 1298 Seksio Sesarea + Histerektomi 4,080,000 2,720,000 6,800,000
1721 1299 Seksio Sesarea dengan Hamil Ganda 2,130,000 1,420,000 3,550,000
1722 1300 Seksio Sesarea dengan Hamil Ganda dengan Steril 2,430,000 1,620,000 4,050,000
1723 1301 Seksio Sesarea dengan Penyulit (Riwayat SC) 2,400,000 1,600,000 4,000,000
1724 1302 Seksio Sesarea dengan Steril 2,340,000 1,560,000 3,900,000
1725 1303 Tampon Uterus/Kondom Kateter 240,000 160,000 400,000
1726 1304 Tampon Vagina 150,000 100,000 250,000
1727 1305 Tindakan pada Kolpodeksis 2,280,000 1,520,000 3,800,000
1728 1306 Tindakan Pelayanan Gizi 12,000 8,000 20,000
1729 1307 Tubektomi 1,410,000 940,000 2,350,000
1730 1308 Turbinektomi/Konkotomi 1,500,000 1,000,000 2,500,000
1731 1309 USG 2D 42,000 28,000 70,000
1732 1310 USG 4 Dimensi 300,000 200,000 500,000
1733 1311 USG Organ 120,000 80,000 200,000
1734 1312 USG Transvaginal 102,000 68,000 170,000
1735 1313 Vaginal Swab 40,200 26,800 67,000
1736 1314 Vaginoplasti 1,560,000 1,040,000 2,600,000
1742 1315 Aspirasi Efusi Perikondrial 60,000 40,000 100,000
1743 1316 Audiometri (THT) 60,000 40,000 100,000
1744 1317 Bedah Sinus Endoskopik Fungsional (BSEF) Bilateral 3,900,000 2,600,000 6,500,000
1745 1318 Bedah Sinus Endoskopik Fungsional (BSEF) Unilateral 3,000,000 2,000,000 5,000,000
1746 1319 Beloq Tampon dengan Anestesi Lokal 180,000 120,000 300,000
1747 1320 Beloq Tampon dengan Anestesi Umum 1,320,000 880,000 2,200,000
1748 1321 Biopsi Sinus Maksila 150,000 100,000 250,000
1749 1322 Biopsi Tumor Hidung 120,000 80,000 200,000
1750 1323 Biopsi Tumor Hipofaring dengan Anestesi Umum 1,200,000 800,000 2,000,000
1751 1324 Biopsi Tumor Lidah/Palatum 120,000 80,000 200,000
1752 1325 Biopsi Tumor Nasofaring 120,000 80,000 200,000
1753 1326 Cadwell Luc Anthrostomi Bilateral 2,535,000 1,690,000 4,225,000
1754 1327 Cadwell Luc Anthrostomi Unilateral 1,950,000 1,300,000 3,250,000
1755 1328 Eksisi Ranula atau Kista pada Mukosa Mulut 1,500,000 1,000,000 2,500,000
1756 1329 Eksplorasi Abses Parafaringeal 1,950,000 1,300,000 3,250,000
1757 1330 Eksplorasi Abses Peritonsiler dengan Anestesi Lokal 300,000 200,000 500,000
1758 1331 Eksplorasi Abses Peritonsiler dengan Anestesi Umum 1,260,000 840,000 2,100,000
1759 1332 Eksplorasi Pre Aurikuler Fistel dengan Abses 1,950,000 1,300,000 3,250,000
1760 1333 Eksplorasi Tumor Jinak Kelenjar Liur 2,535,000 1,690,000 4,225,000
1761 1334 Ekstirpasi Papiloma Laring 2,100,000 1,400,000 3,500,000
1762 1335 Ekstirpasi Papiloma Mulut 108,000 72,000 180,000
1763 1336 Ekstirpasi Polip Nasi dengan Anestesi Lokal 150,000 100,000 250,000
1764 1337 Ekstirpasi Polip Nasi dengan Anestesi Umum 1,350,000 900,000 2,250,000
1765 1338 Ekstraksi Corpus Alienum Esofagus 1,950,000 1,300,000 3,250,000
1766 1339 Ekstraksi Corpus Alienum Hidung 60,000 40,000 100,000
1767 1340 Ekstraksi Corpus Alienum Hidung dengan Anestesi Umum 1,020,000 680,000 1,700,000
1768 1341 Ekstraksi Corpus Alienum Telinga 60,000 40,000 100,000
1769 1342 Ekstraksi Corpus Alienum Telingan dengan Anestesi Umum 1,020,000 680,000 1,700,000
1770 1343 Ekstraksi Corpus Alienum Tenggorokan 60,000 40,000 100,000
1771 1344 Ekstraksi Jaringan Granulasi CAE 150,000 100,000 250,000
1772 1345 Ekstraksi Keratosis dengan Anestesi Lokal 180,000 120,000 300,000
1773 1346 Ekstraksi Keratosis dengan Anestesi Umum 1,020,000 680,000 1,700,000
1774 1347 Ekstraksi Serumen 30,000 20,000 50,000
1775 1348 Ekstraksi Serumen dengan Penyulit 60,000 40,000 100,000
1776 1349 Ekstraksi Sialolithiasis 2,535,000 1,690,000 4,225,000
1777 1350 Endoskopi Hidung 30,000 20,000 50,000
1778 1351 Endoskopi Telinga/Tenggorok 30,000 20,000 50,000
1779 1352 Fistulektomi Pre Aurikuler Bilateral 1,755,000 1,170,000 2,925,000
1780 1353 Fistulektomi Pre Aurikuler Unilateral 1,350,000 900,000 2,250,000
1781 1354 Hemimaksilektomi Partial 3,000,000 2,000,000 5,000,000
1782 1355 Hemimaksilektomi Total 3,600,000 2,400,000 6,000,000
1783 1356 Incisi Abses Leher Anestesi Lokal 150,000 100,000 250,000
1784 1357 Incisi Abses Leher dengan Anestesi Umum 900,000 600,000 1,500,000
1785 1358 Incisi Abses Preaurikula dengan Anestesi Lokal 150,000 100,000 250,000
1786 1359 Incisi Abses Retroaurikuler Anestesi Lokal 150,000 100,000 250,000
1787 1360 Irigasi Telinga 45,000 30,000 75,000
1788 1361 Irigrasi Sinus Maxilaris dengan Anestesi Umum 1,020,000 680,000 1,700,000
1792 1362 Laringektomi 4,125,000 2,750,000 6,875,000
1793 1363 Lepas Beloq Tampon 120,000 80,000 200,000
1794 1364 Lepas Tampon Hidung 90,000 60,000 150,000
1795 1365 Mastoidektomi Radikal 3,000,000 2,000,000 5,000,000
1796 1366 Mastoidektomi Simple 2,400,000 1,600,000 4,000,000
1797 1367 Otoplasti THT 2,535,000 1,690,000 4,225,000
1798 1368 Parasintesis Telinga Bilateral 90,000 60,000 150,000
1799 1369 Parasintesis Telinga Unilateral 45,000 30,000 75,000
1800 1370 Pemasangan Paper Patch Komprehensif 240,000 160,000 400,000
1801 1371 Pemasangan Paper Patch Sederhana 60,000 40,000 100,000
1802 1372 Pemasangan Tampon Telinga 30,000 20,000 50,000
1803 1373 Pemasangan Timpanic Tube dengan Anestesi Lokal 240,000 160,000 400,000
1804 1374 Pemasangan Timpanic Tube dengan Anestesi Umum 960,000 640,000 1,600,000
1805 1375 Pungsi Hematoma Telinga 180,000 120,000 300,000
1806 1376 Rawat Luka Post Op Mastoidektomi 60,000 40,000 100,000
1807 1377 Rawat Luka Post Op Sinus/Hidung 60,000 40,000 100,000
1808 1378 Rawat Stoma Trakeostomi 120,000 80,000 200,000
1809 1379 Rekonstruksi/flap 1,800,000 1,200,000 3,000,000
1810 1380 Repair Lobulus Telinga Bilateral dengan Anestesi Lokal 420,000 280,000 700,000
1811 1381 Repair Lobulus Telinga Unilateral dengan Anestesi Lokal 240,000 160,000 400,000
1812 1382 Reposisi Fraktur Os Nasal (Hidung) 1,500,000 1,000,000 2,500,000
1813 1383 Rinotomi Lateral 2,535,000 1,690,000 4,225,000
1814 1384 Screening OAE 45,000 30,000 75,000
1815 1385 Septoplasti 2,535,000 1,690,000 4,225,000
1816 1386 Septoplasti EC Trauma Hidung 2,535,000 1,690,000 4,225,000
1817 1387 Septorinoplasti THT 4,500,000 3,000,000 7,500,000
1818 1388 Septum Reseksi 1,950,000 1,300,000 3,250,000
1819 1389 Sinuskopi 60,000 40,000 100,000
1820 1390 Skin Prick Test Alergen Debu dan Makanan 180,000 120,000 300,000
1821 1391 Skin Prick Test Alergen Debu/Makanan 120,000 80,000 200,000
1822 1392 Timpanometri 45,000 30,000 75,000
1823 1393 Timpanoplasti Tipe I/Miringoplasti 1,800,000 1,200,000 3,000,000
1824 1394 Timpanoplasti Tipe II 1,800,000 1,200,000 3,000,000
1825 1395 Timpanoplasti Tipe III 2,400,000 1,600,000 4,000,000
1826 1396 Timpanoplasti Tipe IV 3,600,000 2,400,000 6,000,000
1827 1397 Tindakan Cuci Sinus (Perawatan) 90,000 60,000 150,000
1828 1398 Toilet Telinga 30,000 20,000 50,000
1829 1399 Tonsilektomi 1,800,000 1,200,000 3,000,000
1830 1400 Tonsilo Adenoidektomi 1,950,000 1,300,000 3,250,000
1835 1401 EEG 180,000 120,000 300,000
1836 1402 Facialis Parase 39,000 26,000 65,000
1840 1403 Pain Intervensi Ringan 60,000 40,000 100,000
1841 1404 Pemeriksaan Fungsi Luhur 120,000 80,000 200,000
1842 1405 Pemeriksaan Neuroligi Sederhana 24,000 16,000 40,000
1843 1406 Pemeriksaan Neuroopthalmologi 48,000 32,000 80,000
1844 1407 Tes Pembauan, Pengecapan 48,000 32,000 80,000
1845 1408 Tindakan Electro Convulsive Therapy (ECT) 135,000 90,000 225,000
1846 1409 Tindakan Roser Plasty 36,000 24,000 60,000
1851 1410 Anel Test 36,000 24,000 60,000
1852 1411 Anterior/Posterior Sklerotomi 2,550,000 1,700,000 4,250,000
1853 1412 Biometri 81,000 54,000 135,000
1854 1413 Biopsi Tumor Kelopak 525,600 350,400 876,000
1855 1414 Biopsi Tumor Orbita 2,550,000 1,700,000 4,250,000
1856 1415 Eksisi Chalazion/Hordiolum 480,000 320,000 800,000
1857 1416 Ekstraksi Corpus Alienum Conjungtiva 18,000 12,000 30,000
1858 1417 Ekstraksi Corpus Alienum Kornea 36,000 24,000 60,000
1859 1418 Ekstraksi Granuloma 480,000 320,000 800,000
1860 1419 Ekstraksi Katarak (SICS dan LOL) dengan Anestesi Lokal 2,100,000 1,400,000 3,500,000
1861 1420 Ekstraksi Katarak (SICS + LOL + PPC) Anak-Anak dengan Anestesi Umum 2,430,000 1,620,000 4,050,000
1862 1421 Ekstraksi Membran/Scrapping 30,000 20,000 50,000
1863 1422 Ekstraksi Nevus 480,000 320,000 800,000
1864 1423 Ekstraksi Tumor Kecil Palpebra 405,000 270,000 675,000
1865 1424 Ekstropion Siktratis/Entropion dengan Laser 2,550,000 1,700,000 4,250,000
1866 1425 Epilasi (Tindakan Mata) 18,000 12,000 30,000
1868 1426 Funduskopi Indirect 60,000 40,000 100,000
1869 1427 Gonioskopi 30,000 20,000 50,000
1870 1428 Incisi dan Kuretase Kalazion/Granuloma Anak-Anak dengan Anestesi Umum 607,200 404,800 1,012,000
1871 1429 Jahit Luka Kornea dan Repair Iris 810,000 540,000 1,350,000
1872 1430 Jahit Luka Korneo Sclera 1,620,000 1,080,000 2,700,000
1873 1431 Jahit Luka Palpebra Full Theckness 300,000 200,000 500,000
1874 1432 Kalazion Dewasa 480,000 320,000 800,000
1875 1433 Koreksi Strabismus 2,550,000 1,700,000 4,250,000
1876 1434 Koreksi Symbleparon Berat 6,600,000 4,400,000 11,000,000
1877 1435 Koreksi Symblepharon 1,950,000 1,300,000 3,250,000
1878 1436 Laser Iridotomi Perifer 1,320,000 880,000 2,200,000
1879 1437 Lepas Jahitan Palpebra < 3 Buah 42,000 28,000 70,000
1880 1438 Lepas Jahitan Palpebra > 3 Buah 90,000 60,000 150,000
1881 1439 Lithiasis 180,000 120,000 300,000
1882 1440 Operasi Ablatio Retina 5,625,000 3,750,000 9,375,000
1883 1441 Operasi Katarak ICCE/ECCE (Ekstraksi Katarak ) 2,550,000 1,700,000 4,250,000
1884 1442 Operasi Phaceomulsifikasi + LOL 3,900,000 2,600,000 6,500,000
1885 1443 Pemeriksaan Visus 9,000 6,000 15,000
1886 1444 Pengangkatan Nevus Marga Palpebra 480,000 320,000 800,000
1887 1445 Pengangkatan Skin Tag 480,000 320,000 800,000
1888 1446 Pterigoplasti 1,500,000 1,000,000 2,500,000
1889 1447 Pterygium 900,000 600,000 1,500,000
1890 1448 Rekonstruksi Kelopak Mata Berat 5,625,000 3,750,000 9,375,000
1891 1449 Rekonstruksi Kelopak Mata/Kontraktur Palpebra 2,550,000 1,700,000 4,250,000
1892 1450 Rekonstruksi Orbita Conaenital 10,875,000 7,250,000 18,125,000
1893 1451 Repair Ruptur Kornea Sklera 2,550,000 1,700,000 4,250,000
1894 1452 Repair Ruptur Palpebra Simple 1,320,000 880,000 2,200,000
1895 1453 Repair Ruptur Palpebra Transkanal 1,950,000 1,300,000 3,250,000
1896 1454 Reposisi LOL 1,410,000 940,000 2,350,000
1897 1455 Ruptur Palpebra Moderat 2,550,000 1,700,000 4,250,000
1898 1456 Slit Lamp (Tindakan Mata) 18,000 12,000 30,000
1899 1457 Slit Lamp Examination 42,000 28,000 70,000
1900 1458 Sondage Canaliculi Lacrimaris 33,600 22,400 56,000
1901 1459 Spooling Bola Mata 45,000 30,000 75,000
1902 1460 Starbimus (3 - 4) Otot 4,800,000 3,200,000 8,000,000
1903 1461 Tes Ishihara (Buta Warna) 9,000 6,000 15,000
1904 1462 Tindakan Cryosurgery 150,000 100,000 250,000
1905 1463 Tonometri 12,000 8,000 20,000
1906 1464 Triple Produser Keratiplasti dengan Glaukoma 3,600,000 2,400,000 6,000,000
1907 1465 Doubel Lumen 1,377,000 918,000 2,295,000
1908 1466 Ganti Transfer Set 54,000 36,000 90,000
1909 1467 Hemodialisis Baru Bicarbonat 409,200 272,800 682,000
1910 1468 Hemodialisis Re-use Bicarbonat 370,200 246,800 617,000
1912 1469 Penggantian Cairan/Training 31,200 20,800 52,000
1915 1470 Kardiosintesis + Indwelling Kateter 210,600 140,400 351,000
1916 1471 Kardiosintesis Tanpa Indwelling Kateter 210,600 140,400 351,000
1917 1472 Kateterisasi Ka/Ki Tanpa Angio 683,100 455,400 1,138,500
1918 1473 Temporary Peacemaker 683,100 455,400 1,138,500
1919 1474 Kateterisasi Ka/Ki Angio Valvuler 1,603,800 1,069,200 2,673,000
1920 1475 Kateterisasi Ka/Ki dengan Angio 1,843,020 1,228,680 3,071,700
1921 1476 Penyadapan Angio Valvuler + Koroner 1,897,020 1,264,680 3,161,700
1922 1477 Koronarografo 2,091,420 1,394,280 3,485,700
1923 1478 Dilatasi Katup Mitral (BMW) 2,123,820 1,415,880 3,539,700
1924 1479 Jantung Anak Penyadapan (Diagnostik) 2,349,540 1,566,360 3,915,900
1925 1480 Anastesi Bronchoscopy 760,200 506,800 1,267,000
1926 1481 Biopsi Aspirasi Transthorakal 3,621,000 2,414,000 6,035,000
1927 1482 Biopsi Pleura 1,285,800 857,200 2,143,000
1928 1483 Bronchoscopy 3,297,600 2,198,400 5,496,000
1929 1484 Bronchoscopy dan Biopsi 3,960,000 2,640,000 6,600,000
1930 1485 Pleurodesis 626,400 417,600 1,044,000
1931 1486 Punksi Pleura 943,800 629,200 1,573,000
1932 1487 Spyrometri 184,200 122,800 307,000
1933 1488 WSD (Water Seal Drainage) 365,400 243,600 609,000
1934 1489 Endoskopi Atas 439,200 292,800 732,000
1935 1490 Endoskopi Bawah 658,800 439,200 1,098,000
1936 1491 Skleroterafi Ligasi 1 Ikatan 585,600 390,400 976,000
1937 1492 Skleroterafi Ligasi 2 Ikatan 622,200 414,800 1,037,000
1942 1497 Skleroterafi Ligasi Lebih dari 6 Ikatan 878,400 585,600 1,464,000
1943 1498 AFF Tampon Hidung 79,800 53,200 133,000
1947 1499 BMP (Bone Merrow Punctie) 243,600 162,400 406,000
1948 1500 Buka WSD 33,000 22,000 55,000
1955 1501 Debridemen Luka Kecil 609,000 406,000 1,015,000
1959 1502 Echo Cardiography (Tindakan Khusus ICU) 152,100 101,400 253,500
1960 1503 Extraksi Cerumen 22,200 14,800 37,000
1966 1504 Injeksi dengan Platelet Rich Plasma 1,500,000 1,000,000 2,500,000
1968 1505 Injeksi Intraartikuler dengan USG Guidance 240,000 160,000 400,000
1972 1506 Konsultasi Psikologi (Tindakan Khusus ICU) 61,200 40,800 102,000
1983 1507 Parasintesis 10,800 7,200 18,000
1994 1508 Pemasangan Epidural/Chateter 243,600 162,400 406,000
1996 1509 Pemasangan Swan Ganz Catheter 138,000 92,000 230,000
2003 1510 Perikardiosintesis Tanpa G A 1,602,000 1,068,000 2,670,000
2004 1511 Persiapan Pasien Pre Op 15,000 10,000 25,000
2007 1512 Punctie Cairan Sendi 121,800 81,200 203,000
2010 1513 Rehab Jantung 44,400 29,600 74,000
2013 1514 Repair Burst Abdoment/Dehiscensi/Luka 1,068,000 712,000 1,780,000
2014 1515 SWD 27,000 18,000 45,000
2018 1516 Spooling Cateter Post Turp Bph 33,000 22,000 55,000
2020 1517 Traksi L/C 27,000 18,000 45,000
2030 1518 Allergi Test/Pateh Test/Prick Test 180,000 120,000 300,000
2031 1519 EKG Anak 45,000 30,000 75,000
2032 1520 Foto Terapi 96,000 64,000 160,000
2033 1521 Foto Terapi Double Lamp 120,000 80,000 200,000
2034 1522 Imunisasi 9,000 6,000 15,000
2035 1523 Konsultasi Dokter Gigi 25,000 25,000
2036 1524 Konsultasi Dokter Spesialis di IRD 30,000 30,000
2038 1525 Lumbal Pungsi 87,000 58,000 145,000
2040 1526 Pasang dan Lepas Kateter Bayi 18,000 12,000 30,000
2041 1527 Pasang Infus Anak (Tindakan Khusus Perinatologi) 60,000 40,000 100,000
2042 1528 Pasang Infus Bayi/Konsul 90,000 60,000 150,000
2043 1529 Pasang Monitor Per Hari 18,000 12,000 30,000
2044 1530 Pasang Tindik 12,000 8,000 20,000
2045 1531 Pasang/Lepas Infus Umbilikalis 90,000 60,000 150,000
2046 1532 Pemakaian C - PAP 75,000 50,000 125,000
2047 1533 Pemakaian Ventilator pada Bayi 84,000 56,000 140,000
2048 1534 Pengambilan Darah Bayi 15,000 10,000 25,000
2049 1535 Rectal Terapi 12,000 8,000 20,000
2050 1536 Resusitasi Bayi Asphiksia 195,000 130,000 325,000
2051 1537 Visite Ahli Gizi 25,000 25,000
2053 1538 Visite Dokter Umum 25,000 25,000
2058 1539 Asistensi Intra Operatif 15,000 10,000 25,000
2059 1540 Bandaging Khusus (Pembalut Khusus) 22,200 14,800 37,000
2061 1541 Buka Kateter 10,800 7,200 18,000
2063 1542 Cabut Gigi dengan Penyulit 38,400 25,600 64,000
2064 1543 Cabut Gigi Tetap dengan Lokal Anastesi 22,800 15,200 38,000
2065 1544 Cauter Coloctomi 243,600 162,400 406,000
2067 1545 Chemoterapi 182,400 121,600 304,000
2068 1546 Ches Fisioterapi 35,700 23,800 59,500
2071 1547 Dekontiminasi Racun 15,000 10,000 25,000
2072 1548 Dressing Luka (Perawatan Luka) 10,800 7,200 18,000
2073 1549 Dryneeding 120,000 80,000 200,000
2074 1550 Eko Kardiografi 152,100 101,400 253,500
2076 1551 Extubasi 15,000 10,000 25,000
2077 1552 Fiksasi pada Fraktur 33,000 22,000 55,000
2078 1553 Fnab Hati, Kelenjar 121,800 81,200 203,000
2079 1554 Funduskopi Direct 22,200 14,800 37,000
2081 1555 Galvanic/Faradic/Tens 18,000 12,000 30,000
2082 1556 Glyserin Spoit 33,000 22,000 55,000
2083 1557 Heating Ir/Uv 18,000 12,000 30,000
2085 1558 Incisi dengan General Anastesi 304,200 202,800 507,000
2089 1559 Incisional Biopsi Kelenjar dengan Lokal Ans 243,600 162,400 406,000
2090 1560 Intubasi 15,000 10,000 25,000
2092 1561 Konsultasi Dokter Spesialis 30,000 30,000
2093 1562 Konsultasi Dokter Psychiatri 67,000 67,000
2095 1563 Konsultasi VCT 45,000 45,000
2100 1564 Massage/Vibrator 18,000 12,000 30,000
2101 1565 Melakukan Suction 12,000 8,000 20,000
2102 1566 Memberi Obat Injeksi 12,000 8,000 20,000
2103 1567 Memberi Tranfusi Darah 12,000 8,000 20,000
2104 1568 Merawat Catheter 9,000 6,000 15,000
2105 1569 Merawat Infus 9,000 6,000 15,000
2106 1570 Merawat NGT 9,000 6,000 15,000
2107 1571 Oksigenasi dengan Canula 9,000 6,000 15,000
2108 1572 Oksigenasi dengan Masker 12,000 8,000 20,000
2109 1573 Oksigenasi Rebreathing/Non Rebreathing 15,000 10,000 25,000
2110 1574 One Day Care 81,000 54,000 135,000
2111 1575 Pasang Bidai/Splint/Spalk 22,200 14,800 37,000
2112 1576 Pasang Infus Anak 12,000 8,000 20,000
2113 1577 Pasang Infus Bayi 15,000 10,000 25,000
2114 1578 Pasang Infus Dewasa 12,000 8,000 20,000
2115 1579 Pasang Kateter Folley Bag 22,200 14,800 37,000
2116 1580 Pasang Monitor 12,000 8,000 20,000
2117 1581 Pasang NGT 33,000 22,000 55,000
2118 1582 Pasang PASG 10,800 7,200 18,000
2120 1583 Pasang WSD 365,400 243,600 609,000
2121 1584 Pemasangan CPAP 15,000 10,000 25,000
2122 1585 Pemasangan CVP 243,600 162,400 406,000
2123 1586 Pemasangan Infusion Pump 12,000 8,000 20,000
2124 1587 Pemasangan Syring Pump 12,000 8,000 20,000
2125 1588 Pemasangan Ventilator 243,600 162,400 406,000
2126 1589 Pemeriksaan EKG 22,200 14,800 37,000
2127 1590 Pengambilan Spesimen Darah Anak/Bayi 15,000 10,000 25,000
2128 1591 Pengambilan Spesimen Darah Dewasa 9,000 6,000 15,000
2129 1592 Pengelolaan Jalan Napas/Nebulizer 10,800 7,200 18,000
2130 1593 Penyesuaian Gigitan 15,600 10,400 26,000
2131 1594 Premedikasi 12,000 8,000 20,000
2132 1595 Psikoterapi Suportip 124,200 82,800 207,000
2133 1596 Punctie Cairan Acites 121,800 81,200 203,000
2134 1597 Punctie Pleura 79,800 53,200 133,000
2137 1598 Rehab Paru 44,400 29,600 74,000
2138 1599 Rehab Stroke 44,400 29,600 74,000
2139 1600 Saturasi Oksigen 12,000 8,000 20,000
2140 1601 Toilet Hidung 16,200 10,800 27,000
2141 1602 Vena Sectie 365,400 243,600 609,000
2142 1603 Visite Dokter Residen 25,000 25,000
2143 1604 Visite Dokter Spesialis di Intermediate 30,000 30,000
2144 1605 Visite Dokter Umum di Intermediate 25,000 25,000
2145 1606 Visite Farmasi Klinis 25,000 25,000
2148 1607 WT dan HT Lebih dari 20 Jahitan 54,600 36,400 91,000
2149 1608 Zonde Feeding 12,000 8,000 20,000
2150 1609 Perawatan Jenazah 45,000 30,000 75,000
2151 1610 Bedah Jenazah 450,000 300,000 750,000
2152 1611 Konservasi Jenazah/Suntik Formalin 45,000 250,000 295,000
2153 1612 Konservasi Jenazah/Suntik Formalin di Luar Jam Kerja 450,000 325,000 775,000
2154 1613 Visum Mayat 120,000 80,000 200,000
2155 1614 Visum Mayat di Luar Jam Kerja 150,000 100,000 250,000
2156 1615 Otopsi di Dalam Jam Kerja 360,000 240,000 600,000
2157 1616 Otopsi di Luar Jam Kerja/Hari Libur 450,000 300,000 750,000
2158 1617 Penyimpanan Jenazah Tanpa Cooling/Hari 30,000 20,000 50,000
2159 1618 Penyimpanan Jenazah dengan Cooling/Hari 60,000 40,000 100,000
2160 1619 Mengeluarkan Bayi dari Jenazah Ibunya 60,000 40,000 100,000
2161 1620 Mengeluarkan Bayi dari Jenazah Ibunya di Luar Jam Kerja 90,000 60,000 150,000
2162 1621 Penjahitan Jenazah < 25 Cm 30,000 30,000 60,000
2163 1622 Penjahitan Jenazah > 25 Cm 50,000 40,000 90,000
2164 1623 Penjahitan Jenazah > 100 Cm 150,000 100,000 250,000
2165 1624 Ambulance Jenazah Kabupaten Buleleng 990,000 825,000 165,000
2166 1625 Ambulance Jenazah Kabupaten Badung 315,000 262,500 52,500
2167 1626 Ambulance Jenazah Kabupaten Tabanan 630,000 525,000 105,000
2168 1627 Ambulance Jenazah Kabupaten Jembrana 990,000 825,000 165,000
2169 1628 Ambulance Jenazah Kabupaten Gianyar 315,000 262,500 52,500
2170 1629 Ambulance Jenazah Kabupaten Bangli 630,000 525,000 105,000
2171 1630 Ambulance Jenazah Kabupaten Klungkung 315,000 262,500 52,500
2172 1631 Ambulance Jenazah Kabupaten Karangasem 832,500 693,750 138,750
2173 1632 Ambulance Jenazah Dalam Kota Denpasar 225,000 187,500 37,500
2174 1633 Small Film (1 Foto) 78,000 52,000 130,000
2175 1634 Small Film (2 Foto) 87,000 58,000 145,000
2176 1635 Medium Film (1 Foto) 90,000 60,000 150,000
2177 1636 Medium Film (2 Foto) 99,000 66,000 165,000
2178 1637 Large Film (1 Foto) 102,000 68,000 170,000
2179 1638 Large Film (2 Foto) 111,000 74,000 185,000
2180 1639 Mammografi 180,000 120,000 300,000
2181 1640 Panoramic 120,000 80,000 200,000
2182 1641 IVP 270,000 180,000 450,000
2183 1642 Colon In Loop/Barium Enema 270,000 180,000 450,000
2184 1643 Esopagografi/Barium Swallow 240,000 160,000 400,000
2185 1644 OMD / UGI (Upper GI Sudy) 240,000 160,000 400,000
2186 1645 Barium Follow Through 240,000 160,000 400,000
2187 1646 Uretrografi 180,000 120,000 300,000
2188 1647 Fistulogarafi 180,000 120,000 300,000
2189 1648 Bvcug 240,000 160,000 400,000
2190 1649 Cystografi 240,000 160,000 400,000
2191 1650 Caudografi/Myelografi 240,000 160,000 400,000
2192 1651 HSG 270,000 180,000 450,000
2193 1652 Cholangiografi 240,000 160,000 400,000
2194 1653 Sialografi 240,000 160,000 400,000
2195 1654 Retrograe Pyelografi (Rpg) 240,000 160,000 400,000
2196 1655 Antegrade Pyelografi (Apg) 240,000 160,000 400,000
2197 1656 Lopografi Proksimal/Distal 240,000 160,000 400,000
2198 1657 MRI Kepala Tanpa Kontras 1,320,000 880,000 2,200,000
2199 1658 MRI Kepala dengan Kontras 1,500,000 1,000,000 2,500,000
2200 1659 MRI Leher Tanpa Kontras 1,320,000 880,000 2,200,000
2201 1660 MRI Leher dengan Kontras 1,500,000 1,000,000 2,500,000
2202 1661 MRI Thorax Tanpa Kontras 1,500,000 1,000,000 2,500,000
2203 1662 MRI Thorax dengan Kontras 1,800,000 1,200,000 3,000,000
2204 1663 MRI Abdomen Atas Tanpa Kontras 1,440,000 960,000 2,400,000
2205 1664 MRI Abdomen Atas Tanpa Kontras + Mrcp 1,500,000 1,000,000 2,500,000
2206 1665 MRI Abdomen Atas dengan Kontras 1,800,000 1,200,000 3,000,000
2207 1666 MRI Abdomen Bawah Tanpa Kontras 1,440,000 960,000 2,400,000
2208 1667 MRI Abdomen Bawah dengan Kontras; 1,500,000 1,000,000 2,500,000
2209 1668 MRI Whole Abdomen (Atas+ Bawah) Tanpa Kontras 2,100,000 1,400,000 3,500,000
2210 1669 MRI Whole Abdomen (Atas+ Bawah) dengan Kontras 2,400,000 1,600,000 4,000,000
2211 1670 MRI Cervical Spine Tanpa Kontras 1,080,000 720,000 1,800,000
2212 1671 MRI Cervical Spine dengan Kontras 1,320,000 880,000 2,200,000
2213 1672 MRI Thoracal Spine Tanpa Kontras 1,080,000 720,000 1,800,000
2214 1673 MRI Thoracal Spine dengan Kontras 1,320,000 880,000 2,200,000
2215 1674 MRI Lumobosacral Spine Tanpa Kontras 1,080,000 720,000 1,800,000
2216 1675 MRI Lumbosacral Spine dengan Kontras 1,320,000 880,000 2,200,000
2217 1676 MRI Whole Spine Tanpa Kontras 2,100,000 1,400,000 3,500,000
2218 1677 MRI Whole Spine dengan Kontras 2,400,000 1,600,000 4,000,000
2219 1678 MRI Extremitas Tanpa Kontras 1,080,000 720,000 1,800,000
2220 1679 MRI Extremitas dengan Kontras 1,320,000 880,000 2,200,000
2221 1680 USG Abdomen Atas dan Bawah 180,000 120,000 300,000
2222 1681 USG Abdomen Atas 90,000 60,000 150,000
2223 1682 USG Abdomen Bawah (Pelayanan Penunjang Diagnostik, Tidak Termasuk Obat Kon 90,000 60,000 150,000
2224 1683 USG Pelvis/Gynaecology 90,000 60,000 150,000
2225 1684 USG Urologi 90,000 60,000 150,000
2226 1685 USG Doppler Testis 240,000 160,000 400,000
2227 1686 USG Tyroid 180,000 120,000 300,000
2228 1687 USG Mamma/Payudara 180,000 120,000 300,000
2229 1688 USG Doppler Vascular (1 Extremitas) 420,000 280,000 700,000
2230 1689 CT Scan Kepala Tanpa Kontras 450,000 300,000 750,000
2231 1690 CT Scan Kepala Dengan Kontras 600,000 400,000 1,000,000
2232 1691 CT Scan Leher/Colli Tanpa Kontras 450,000 300,000 750,000
2233 1692 CT Scan Leher/Colli Dengan Kontras 600,000 400,000 1,000,000
2234 1693 CT Scan Thorax Tanpa Kontras 510,000 340,000 850,000
2235 1694 CT Scan Thorax Dengan Kontras 720,000 480,000 1,200,000
2236 1695 CT Scan Abdomen Tanpa Kontras 540,000 360,000 900,000
2237 1696 CT Scan Abdomen Dengan Kontras 720,000 480,000 1,200,000
2238 1697 CT Scan Pelvis Tanpa Kontras 450,000 300,000 750,000
2239 1698 CT Scan Pelvis Dengan Kontras 600,000 400,000 1,000,000
2240 1699 CT Scan Cervical Spine 450,000 300,000 750,000
2241 1700 CT Scan Thoracal Spine 450,000 300,000 750,000
2242 1701 CT Scan Lumbosacral Spine 450,000 300,000 750,000
2243 1702 CT Scan Extremitas Tanpa Kontras 480,000 320,000 800,000
2244 1703 CT Scan Extremitas Dengan Kontras 720,000 480,000 1,200,000
2245 1704 Msct Cardiac 2,100,000 1,400,000 3,500,000
2246 1705 CT Angiografi 2,100,000 1,400,000 3,500,000
2247 1706 C-Arm 216,000 144,000 360,000
2248 1707 Tindakan Anastesi Diagnostik 300,000 200,000 500,000
2249 1708 Darah lengkap 3 diff 24,000 16,000 40,000
2250 1709 Darah lengkap 5 diff 36,000 24,000 60,000
2251 1710 LED 8,040 5,360 13,400
2252 1711 Golongan darah (ABO + Rhesus) 9,000 6,000 15,000
2253 1712 Hitung jenis leukosit 9,000 6,000 15,000
2254 1713 Platelet Antobodi 24,000 16,000 40,000
2255 1714 G6PD 24,000 16,000 40,000
2256 1715 CD-4 72,000 48,000 120,000
2257 1716 Hitung eosinofil 72,000 48,000 120,000
2258 1717 Hams test 16,500 11,000 27,500
2259 1718 Hb F 16,500 11,000 27,500
2260 1719 NAP 39,600 26,400 66,000
2261 1720 NSE 33,000 22,000 55,000
2262 1721 Pewarnaan Acid Phospatase 21,780 14,520 36,300
2263 1722 Pewarnaan Besi 21,780 14,520 36,300
2264 1723 Pewarnaan Sumsum Tulang 21,780 14,520 36,300
2265 1724 Serum Iron Binding Capacity (SIBC) 39,600 26,400 66,000
2266 1725 Sugar Water Test 11,550 7,700 19,250
2267 1726 Transferrin 65,340 43,560 108,900
2268 1727 Elektroforesis Hb 115,500 77,000 192,500
2269 1728 Retikulosit 33,000 22,000 55,000
2270 1729 Besi 36,000 24,000 60,000
2271 1730 Total Iron Binding Capacity (TIBC) 36,000 24,000 60,000
2272 1731 Feritin 100,800 67,200 168,000
2273 1732 Vitamin B12 36,000 24,000 60,000
2274 1733 Asam Folat 36,000 24,000 60,000
2275 1734 Gambaran Darah Tepi 38,400 25,600 64,000
2276 1735 Gambaran Sumsum Tulang 84,000 56,000 140,000
2277 1736 Masa Perdarahan (BT) 8,400 5,600 14,000
2278 1737 Masa Pembekuan (CT) 8,400 5,600 14,000
2279 1738 Masa Protrombin (PT) 45,000 30,000 75,000
2280 1739 APTT 45,000 30,000 75,000
2281 1740 Fibrinogen 38,400 25,600 64,000
2282 1741 Retraksi Bekuan 38,400 25,600 64,000
2283 1742 Agregasi Trombosit 123,000 82,000 205,000
2284 1743 D-dimer 155,400 103,600 259,000
2285 1744 Anti Faktor Xa 118,800 79,200 198,000
2286 1745 Anti Trombin III 72,600 48,400 121,000
2287 1746 Assay Faktor IX 165,000 110,000 275,000
2288 1747 Assay Faktor VIII 163,350 108,900 272,250
2289 1748 F.Von Willebrands 115,500 77,000 192,500
2290 1749 Inhibitor VIII 150,480 100,320 250,800
2291 1750 Lupus Anticoagulant 112,530 75,020 187,550
2292 1751 Masa Iisis Euglobin 33,000 22,000 55,000
2293 1752 Tromboplastin Generation Time (TGT) 60,720 40,480 101,200
2294 1753 Trombotest 59,400 39,600 99,000
2295 1754 Sel LE 11,400 7,600 19,000
2296 1755 IT Rasio 11,400 7,600 19,000
2297 1756 SGOT 13,500 9,000 22,500
2298 1757 SGPT 13,500 9,000 22,500
2299 1758 LDH 42,000 28,000 70,000
2300 1759 Bilirubin total 15,000 10,000 25,000
2301 1760 Bilirubin direk 15,000 10,000 25,000
2302 1761 Bilirubin indirek 15,000 10,000 25,000
2303 1762 Gamma GT 33,000 22,000 55,000
2304 1763 Alkali Phospat 18,000 12,000 30,000
2305 1764 Protein total 15,000 10,000 25,000
2306 1765 Albumin 15,000 10,000 25,000
2307 1766 Globulin 15,000 10,000 25,000
2308 1767 Glukosa sewaktu 15,000 10,000 25,000
2309 1768 Glukosa puasa 15,000 10,000 25,000
2310 1769 TTGO (5x GDS) 16,638 11,092 27,730
2311 1770 HBA1c 99,792 66,528 166,320
2312 1771 Insulin 108,000 72,000 180,000
2313 1772 C-peptide 108,000 72,000 180,000
2314 1773 Kolesterol total 18,000 12,000 30,000
2315 1774 Kolesterol HDL 34,800 23,200 58,000
2316 1775 Kolesterol LDL 36,000 24,000 60,000
2317 1776 Trigliserida 21,000 14,000 35,000
2318 1777 Apo A1 18,000 12,000 30,000
2319 1778 Apo B 18,000 12,000 30,000
2320 1779 CK-total 48,000 32,000 80,000
2321 1780 CK-MB 48,000 32,000 80,000
2322 1781 Troponin I 99,000 66,000 165,000
2323 1782 Ureum 13,500 9,000 22,500
2324 1783 Urea Clearance 18,000 12,000 30,000
2325 1784 Kreatinin 13,500 9,000 22,500
2326 1785 Kreatinin Clearance 27,000 18,000 45,000
2327 1786 Asam urat 16,800 11,200 28,000
2328 1787 Na, K, Cl (elektrolit darah) 72,000 48,000 120,000
2329 1788 Kalsium (Ca) 39,600 26,400 66,000
2330 1789 Fosfor 20,400 13,600 34,000
2331 1790 Magnesium 34,800 23,200 58,000
2332 1791 Analisa Gas Darah 150,000 100,000 250,000
2333 1792 CRP kualitatif 123,000 82,000 205,000
2334 1793 CRP kuantitatif 123,000 82,000 205,000
2335 1794 Alfa 1 Antitrifsin Kuantitatif 47,190 31,460 78,650
2336 1795 Alfa 2 makro Globulin Kuantitatif 33,000 22,000 55,000
2337 1796 ANA Titrasi 105,600 70,400 176,000
2338 1797 Anti Kappa 38,940 25,960 64,900
2339 1798 Anti Lamda 38,940 25,960 64,900
2340 1799 C3 38,940 25,960 64,900
2341 1800 C4 38,940 25,960 64,900
2342 1801 Cryoglobulin 13,200 8,800 22,000
2343 1802 IgA/IgG/IgM 50,820 33,880 84,700
2344 1803 IgE 136,320 90,880 227,200
2345 1804 Imuno Elektroforesis Anti IgA/IgG/IgM 50,820 33,880 84,700
2346 1805 Imuno Elektroforesis Whole Anti Serum 50,820 33,880 84,700
2347 1806 Smooth Muscle Antibody (SMA) 28,050 18,700 46,750
2348 1807 T Cel dan B Cel 36,300 24,200 60,500
2349 1808 HBsAg 45,000 30,000 75,000
2350 1809 HBsAg Elisa 45,000 30,000 75,000
2351 1810 Anti HBs 58,800 39,200 98,000
2352 1811 Anti HBs (Elisa) 58,800 39,200 98,000
2353 1812 Anti HCV 96,000 64,000 160,000
2354 1813 Anti HAV 123,000 82,000 205,000
2355 1814 Anti HBe 120,000 80,000 200,000
2356 1815 Anti HBc 93,000 62,000 155,000
2357 1816 Widal 33,000 22,000 55,000
2358 1817 IgM anti Salmonella (Tubex) 96,000 64,000 160,000
2359 1818 Anti Dengue IgM, IgG 168,000 112,000 280,000
2360 1819 NS1 111,000 74,000 185,000
2361 1820 Anti H Pylori IgG 144,000 96,000 240,000
2362 1821 Anti H Pylori IgM 42,900 28,600 71,500
2363 1822 Malaria 15,000 10,000 25,000
2364 1823 Filaria 18,600 12,400 31,000
2365 1824 Anti HIV (rapid) 33,000 22,000 55,000
2366 1825 HIV Western Blot* 33,000 22,000 55,000
2367 1826 Anti Rubella IgC 135,000 90,000 225,000
2368 1827 Anti Rubella IgM 135,000 90,000 225,000
2369 1828 Anti Toxoplasma IgG 120,000 80,000 200,000
2370 1829 Anti Toxoplasma IgM 120,000 80,000 200,000
2371 1830 Anti HSV I IgG 66,000 44,000 110,000
2372 1831 Anti HSV I IgM 66,000 44,000 110,000
2373 1832 Anti HSV II IgG 66,000 44,000 110,000
2374 1833 Anti HSV II IgM 66,000 44,000 110,000
2375 1834 Dengue Blot IgG 99,000 66,000 165,000
2376 1835 Dengue Blot IgM 99,000 66,000 165,000
2377 1836 HSV I IgG 66,000 44,000 110,000
2378 1837 HSV II IgM 66,000 44,000 110,000
2379 1838 ASTO 28,500 19,000 47,500
2380 1839 RF (Rheumatoid Factor) 48,600 32,400 81,000
2381 1840 ANA (IF) 240,000 160,000 400,000
2382 1841 ANA Profile 450,000 300,000 750,000
2383 1842 VDRL 21,000 14,000 35,000
2384 1843 TPHA 30,600 20,400 51,000
2385 1844 Urin lengkap (Rutin + Sedimen) 24,000 16,000 40,000
2386 1845 Reduksi urin 6,000 4,000 10,000
2387 1846 Protein Bence Jones 30,000 20,000 50,000
2388 1847 Tes Kehamilan (25 mIU/mL) 15,000 10,000 25,000
2389 1848 Beta HCG 115,500 77,000 192,500
2390 1849 Esbach 9,900 6,600 16,500
2391 1850 Hemosiderin 19,800 13,200 33,000
2392 1851 Oval Fat Body 13,200 8,800 22,000
2393 1852 Protein Kuantitatif 13,200 8,800 22,000
2394 1853 Lengkap (Rutin + pH + Reduksi) 15,000 10,000 25,000
2395 1854 Darah samar 18,000 12,000 30,000
2396 1855 Rectal Swab 60,000 40,000 100,000
2397 1856 TIROID - - -
2398 1857 FT3 93,600 62,400 156,000
2399 1858 FT4 87,600 58,400 146,000
2400 1859 TSHS 69,600 46,400 116,000
2401 1860 T3 Total 60,600 40,400 101,000
2402 1861 T4 Total 60,600 40,400 101,000
2403 1862 LH 127,200 84,800 212,000
2404 1863 FSH 127,200 84,800 212,000
2405 1864 Testosteron 136,800 91,200 228,000
2406 1865 Progesteron 141,900 94,600 236,500
2407 1866 Prolactine 105,600 70,400 176,000
2408 1867 Estradiol 138,600 92,400 231,000
2409 1868 Estrogen 52,140 34,760 86,900
2410 1869 BTA 1x 105,000 70,000 175,000
2411 1870 Anti Tb IgG (PAP TB) 123,000 82,000 205,000
2412 1871 AFP 120,000 80,000 200,000
2413 1872 CEA 120,000 80,000 200,000
2414 1873 CA 19-9 192,000 128,000 320,000
2415 1874 CA 125 II 165,000 110,000 275,000
2416 1875 CA 72-4 165,000 110,000 275,000
2417 1876 CA 15-3 183,600 122,400 306,000
2418 1877 Prostat Specific Antigen (PSA) 113,400 75,600 189,000
2419 1878 CA 12-5 141,900 94,600 236,500
2420 1879 MCA 49,500 33,000 82,500
2421 1880 Analisa cairan otak 120,000 80,000 200,000
2422 1881 Analisa sperma 37,800 25,200 63,000
2423 1882 Analisa cairan sendi 60,000 40,000 100,000
2424 1883 Analisa cairan tubuh lain (pleura/lain-lain) 60,000 40,000 100,000
2425 1884 Tes Narkoba per Parameter 22,200 14,800 37,000
2426 1885 Narkoba A mffetamin 22,200 14,800 37,000
2427 1886 Narkoba Canabis 22,200 14,800 37,000
2428 1887 Narkoba Opiat 22,200 14,800 37,000
2429 1888 Narkoba Barbiturat 22,200 14,800 37,000
2430 1889 Narkoba Benzodiazepine 22,200 14,800 37,000
2431 1890 Pewarnaan Gram 23,400 15,600 39,000
2432 1891 Jamur (KOH) 44,400 29,600 74,000
2433 1892 BTA 27,000 18,000 45,000
2434 1893 Biakan Aerob + Uji Kepekaan Konvensional 289,200 192,800 482,000
2435 1894 Kultur GO 289,200 192,800 482,000
2436 1895 Kultur Legionella 990,000 660,000 1,650,000
2437 1896 Grup B Streptococcus 289,200 192,800 482,000
2438 1897 Kultur TB Uji Kepekaan OAT Lini I 270,000 180,000 450,000
2439 1898 Kultur TB 123,600 82,400 206,000
2440 1899 Biaya pemeriksaan resitensi ke BBLK 96,000 64,000 160,000
2441 1900 Biaya pengiriman kultur TB ke BBLK 72,000 48,000 120,000
2442 1901 Kultur Darah (Biakan Aerob) 309,000 206,000 515,000
2443 1902 Kultur Urine (Biakan Aerob) 309,000 206,000 515,000
2444 1903 Kultur Feses 309,000 206,000 515,000
2445 1904 Kultur Cairan (Likuor serebrospinalis/Ascites/Pleura/lain-lain) (Biakan Aerob) 309,000 206,000 515,000
2446 1905 Kultur Pus/Dasarl luka/Jaringan (Biakan Aerob) 309,000 206,000 515,000
2447 1906 Kultur Sputum (Biakan Aerob) 309,000 206,000 515,000
2448 1907 Kultur Spesimen lainnya (Biakan Aerob) 309,000 206,000 515,000
2449 1908 Kultur jamur tanpa uji kepekaan 192,600 128,400 321,000
2450 1909 Kultur jamur dengan uji kepekaan 308,400 205,600 514,000
2451 1910 Skrining MRSA (tenggorokan,hidung, lipatan paha/ketiak) 385,200 256,800 642,000
2452 1911 Rectal Swab (Indentifikasi Otomatis Vitek) 289,200 192,800 482,000
2453 1912 Kultur Darah (Biakan Anaerob) 346,800 231,200 578,000
2454 1913 Kultur Urine (Biakan Anaerob) 346,800 231,200 578,000
2455 1914 Kultur Cairan (Likuor serebrospinalis/Ascites/Pleura/lain-lain) (Biakan Anaerob) 346,800 231,200 578,000
2456 1915 Kultur Pus/Dasarl luka/Jaringan (Biakan Anaerob) 346,800 231,200 578,000
2457 1916 Kultur Sputum (Biakan Anaerob) 346,800 231,200 578,000
2458 1917 Kultur Spesimen lainnya (Biakan Anaerob) 346,800 231,200 578,000
2459 1918 PCR TB 350,400 233,600 584,000
2460 1919 PCR RABIES 867,600 578,400 1,446,000
2461 1920 PCR GO 385,200 256,800 642,000
2462 1921 PCR Chlamydia 385,200 256,800 642,000
2463 1922 PCR Mycoplasma 385,200 256,800 642,000
2464 1923 PCR Ureaplasma 385,200 256,800 642,000
2465 1924 PCR Streptococcus 350,400 233,600 584,000
2466 1925 PCR Legionella 385,200 256,800 642,000
2467 1926 Kultur Ruangan 555,000 370,000 925,000
2468 1927 Jasa Pembacaan Kultur 15,000 10,000 25,000
2469 1928 PA Kecil (1-4 Blok) 180,000 120,000 300,000
2470 1929 Biopsi Endoscopy 1-2 Blok (Kategori Sedang) 180,000 120,000 300,000
2471 1930 Bone Marrow aspirasi atau biopsi 262,500 175,000 437,500
2472 1931 Bone Marrow aspirasi dab biopsi 262,500 175,000 437,500
2473 1932 Biopsi Endoscopy 3 Blok (Kategori Canggih) 262,500 175,000 437,500
2474 1933 PA Sedang (5-8 Blok) 375,000 250,000 625,000
2475 1934 Ca Cervic Stadium IB Keatas (Kategori Canggih) 375,000 250,000 625,000
2476 1935 PA Besar (> 8 Blok) 487,500 325,000 812,500
2477 1936 Ca Cervic Stadium IA, insitu (Kategori Canggih) 487,500 325,000 812,500
2478 1937 Konsultasi Dokter (Tidak jadi FNAB) 45,000 30,000 75,000
2479 1938 Pap Smear-Kiriman Slide 90,000 60,000 150,000
2480 1939 Pap Smear-Diambil di Lab PA 90,000 60,000 150,000
2481 1940 Urine, Sputum dan Sitologi Eksfoliatif lainnya (Bronchoscopy, Bronchial washing) 108,000 72,000 180,000
2482 1941 FNAB-Kiriman Slide 120,000 80,000 200,000

2483 1942 Cell Blok 150,000 100,000 250,000
2484 1943 FNAB-Diambil di lab PA dan di ruangan (Superfisial) 150,000 100,000 250,000
2485 1944 Urine dan Sputum Seri 3 Kali 180,000 120,000 300,000
2486 1945 FNAB-FNAB Deep (diluar Lab PA) 360,000 240,000 600,000
2487 1946 Frozen Zection (FZ) Pemeriksaan 1-2 Blok 255,000 170,000 425,000
2488 1947 Frozen Zection (FZ) Pemeriksaan > 2 Blok 390,000 260,000 650,000
2489 1948 Frozen Zection (FZ) Dari Rumah Sakit Swasta Pemeriksaan 1-2 Blok 660,000 440,000 1,100,000
2490 1949 Frozen zection (FZ) dari Rumah Sakit Swasta Pemeriksaan > 2 Blok 1,110,000 740,000 1,850,000
2491 1950 1 jenis pemeriksaan 36,000 24,000 60,000
2492 1951 2 jenis pemeriksaan (Kategori Kecil) 45,000 30,000 75,000
2493 1952 3 pemeriksaan 327,000 218,000 545,000
2494 1953 Bone Marrow Aspirasi dan Biopsi 168,000 112,000 280,000
2495 1954 Imunohistokimia 1 jenis pemeriksaan (Kategori Sedang) 210,000 140,000 350,000
2496 1955 Imunohistokimia 2 jenis pemeriksaan (Kategori Sedang) 420,000 280,000 700,000
2497 1956 Imunohistokimia 3 jenis pemeriksaan (Kategori Sedang) 660,000 440,000 1,100,000
2498 1957 Imunohistokimia > 3 jenis pemeriksaan (Kategori Sedang) 720,000 480,000 1,200,000
2499 1958 Otopsi bahan kecil (1 Organ) 456,000 304,000 760,000
2500 1959 Otopsi bahan sedang (2-3 Organ) 900,000 600,000 1,500,000
2501 1960 Otopsi bahan besar > 3 Organ 1,380,000 920,000 2,300,000
2502 1961 Pemeriksaan PA kecil ( 1-4 Blok) 151,200 100,800 252,000
2503 1962 Pemeriksaan PA sedang ( 5-8 Blok) 241,800 161,200 403,000
2504 1963 Pemeriksaan PA besar (> 8 Blok) 218,800 547,000
2505 1964 Ca Cervic Stadium IB keatas (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi 240,000 160,000 400,000
2506 1965 Ca Cervic Stadium IA, insitu (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi 315,000 210,000 525,000
2507 1966 Kulit 151,200 100,800 252,000
2508 1967 Biopsi Endoscopy 1-2 Blok (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi An 150,000 100,000 250,000
2509 1968 Biopsi Endoscopy 3 Blok (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anat 165,000 110,000 275,000
2510 1969 Pap Smear Kiriman - 1 Slide 45,000 30,000 75,000
2511 1970 Pap Smear Kiriman - 2 Slide 48,000 32,000 80,000
2512 1971 Urine, Sputum dan Sitilogi Eksfoliatif lain 71,400 47,600 119,000
2513 1972 Bronchoscopy, Broncial Washsing 71,400 47,600 119,000
2514 1973 FNAP Kiriman Slide 195,000 130,000 325,000
2515 1974 1 Jenis Pemeriksaan 24,000 16,000 40,000
2516 1975 2 jenis Pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi) 36,000 24,000 60,000
2517 1976 3 Jenis Pemeriksaan 45,000 30,000 75,000
2518 1977 Imunohistokimia 1 jenis pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis 135,000 90,000 225,000
Patologi Anatomi)
Patologi Anatomi)
Patologi Anatomi)
2521 1980 Imunohistokimia > 3 jenis pemeriksaan (Prosesing Tanpa Pembacaan Oleh 423,000 282,000 705,000
Spesialis Patologi Anatomi)
2522 1981 Konsultasi Farmasi Klinis Pasien Rawat Jalan 6,000 4,000 10,000
2523 1982 Visite Farmasi Klinis Pasien Rawat Inap 18,000 12,000 30,000
1. PELAYANAN RAWAT JALAN

1 RJ1 Rawat Jalan Dasar 5,000 30,000 35,000
2 RJ2 Rawat Jalan Umum/Gigi 5,000 40,000 45,000
3 RJ3 Rawat Jalan Spesialis 5,000 50,000 55,000
4 RJ4 Rawat Jalan VIP/Eksekutif 15,000 85,000 100,000
1. PELAYANAN INSTALASI GAWAT DARURAT

1 RD1 Gawat Darurat Dasar 30,000 20,000 50,000
2 RD2 Gawat Darurat Umum/Gigi 36,000 24,000 60,000
3 RD3 Gawat Darurat Spesialis 42,000 28,000 70,000
4 RD4 Gawat Darurat Spesialis Cito/Konsul 52,500 35,000 87,500
RI 1. PELAYANAN RAWAT INAP

1 Tarif Kelas III
III.Umum - Kelas III Umum 45,000 30,000 75,000
III.Sp - Kelas III Spesialis 54,000 36,000 90,000
III.Kons - Kelas III Spesialis Libur/Konsul 60,000 40,000 100,000
2 Tarif Kelas II
II.Umum - Kelas II Umum 60,000 40,000 100,000
II.Sp - Kelas II Spesialis 66,000 44,000 110,000
II.Kons - Kelas II Spesialis Libur/Konsul 78,000 52,000 130,000
3 Tarif Kelas I
I.Umum - Kelas I Umum 96,000 64,000 160,000
I.Sp - Kelas I Spesialis 105,000 70,000 175,000
I.Kons - Kelas I Spesialis Libur/Konsul 111,000 74,000 185,000
4 Tarif VIP
VIP.Sp - VIP Spesialis 360,000 240,000 600,000
VIP.Kons - VIP Spesialis Libur/Konsul 420,000 280,000 700,000
5 Tarif VVIP
VVIP.Sp - VVIP Spesialis 540,000 360,000 900,000
VVIP.Kons- VVIP Spesialis Libur/Konsul 600,000 400,000 1,000,000
6 Tarif Suite
Suite.Sp - Suite Spesialis 1,500,000 1,000,000 2,500,000
Suite.Kons- Suite Spesialis Libur/Konsul 1,800,000 1,200,000 3,000,000
7 Tarif ICU/ICCU/HCU
ICU/ICCU/HCU.Sp- ICU/ICCU/HCU Spesialis 315,000 210,000 525,000
- ICU/ICCU/HCU Spesialis Libur /Konsul
ICU/ICCU/HCU.Kons 360,000 240,000 600,000
8 Tarif NICU/PICU
NICU/PICU.Sp - NICU/PICU Spesialis 315,000 210,000 525,000
NICU/PICU.Kons- NICU/PICU Spesialis Libur/Konsul 360,000 240,000 600,000
Keterangan
± 100
± 35
± 50
± 100
± 35
± 50
± 35
± 80
± 15
1. Tarif tidak termasuk obat, tindakan medik, tindakan medik gigi dan mulut, penunjang medik.
2. Untuk pasien asing yang tidak memiliki KITAS dikenakan tarif sebesar 1,5 kali dari tarif RS.
1. Tarif tidak termasuk obat, tindakan medik, tindakan medik gigi dan mulut, penunjang medik.
2. Untuk pasien asing yang tidak memiliki KITAS dikenakan tarif sebesar 1,5 kali dari tarif RS.
1. Tarif tidak termasuk obat,

tindakan medik, tindakan
medik gigi dan mulut,
penunjang medik.
2. Untuk pasien asing yang
tidak memiliki KITAS
dikenakan tarif sebesar
1,5 kali dari tarif RS.
No. Kode
2515 1974
2491 1950
158 0125
159 0126
160 0127
161 0128
162 0129
163 0130
164 0131
2492 1951
2516 1975
2517 1976
2493 1952
151 0118
152 0119
153 0120
154 0121
155 0122
156 0123
157 0124
1093 0713
1094 0714
1095 0715
1943 1498
2412 1871
2283 1742
444 0198
555 0308
556 0309
557 0310
2306 1765
2335 1794
2336 1795
2304 1763
2030 1518
445 0199
2173 1632
2166 1625
2170 1629
2165 1624
2169 1628
2168 1627
2172 1631
2171 1630
2167 1626
887 0526
888 0527
889 0528
890 0529
891 0530
892 0531
893 0532
894 0533
895 0534
896 0535
898 0536
899 0537
900 0538
901 0539
902 0540
1096 0716
1097 0717
595 0348
903 0541
904 0542
2381 1840
2382 1841
2337 1796
1098 0718
1099 0719
2421 1880
2423 1882
2424 1883
2332 1791
2422 1881
1925 1480
905 0543
906 0544
1851 1410
1100 0720
1101 0721
1102 0722
13 0005
907 0545
908 0546
909 0547
910 0548
167 0133
14 0006
1608 1220
912 0549
2196 1655
1852 1411
1103 0723
1104 0724
2359 1818
2285 1744
2361 1820
2362 1821
2354 1813
2356 1815
2355 1814
2351 1810
2352 1811
2353 1812
2365 1824
2371 1830
2372 1831
2373 1832
2374 1833
2338 1797
2339 1798
2367 1826
2368 1827
2411 1870
2369 1828
2370 1829
2286 1745
276 0172
1105 0725
1106 0726
1107 0727
446 0200
2318 1777
2319 1778
2280 1739
597 0349
913 0550
914 0551
915 0552
916 0553
917 0554
918 0555
919 0556
920 0557
921 0558
922 0559
923 0560
924 0561
925 0562
926 0563
927 0564
928 0565
929 0566
930 0567
2274 1733
2327 1786
772 0462
2058 1539
933 0568
934 0569
388 0190
1742 1315
1108 0728
1109 0729
1110 0730
2287 1746
2288 1747
2379 1838
170 0134
1743 1316
1111 0731
1112 0732
1113 0733
553 0306
552 0305
551 0304
2059 1540
2186 1645
2151 1610
1114 0734
43 0013
1744 1317
1745 1318
1746 1319
1747 1320
2270 1729
2389 1848
2434 1893
2440 1899
2441 1900
1115 0735
1116 0736
2301 1760
2302 1761
2300 1759
1853 1412
1611 1221
1121 0741
1926 1481
2470 1929
2508 1967
2473 1932
2509 1968
1122 0742
44 0014
173 0135
1927 1482
1612 1222
1123 0743
1124 0744
1748 1321
1125 0745
1126 0746
1749 1322
1750 1323
1854 1413
1751 1324
1752 1325
1855 1414
601 0350
1127 0747
1947 1499
2471 1930
2472 1931
2494 1953
1128 0748
1928 1483
1929 1484
2513 1972
2433 1892
2410 1869
175 0136
1129 0749
1130 0750
277 0173
2061 1541
447 0201
1948 1500
604 0351
1131 0751
605 0352
606 0353
607 0354
2189 1648
2340 1799
2341 1800
2419 1878
2415 1874
2417 1876
2414 1873
2416 1875
2477 1936
2506 1965
2475 1934
2505 1964
1753 1326
1754 1327
2247 1706
2191 1650
2065 1544
609 0355
393 0191
394 0192
395 0193
2256 1715
2413 1872
2483 1942
448 0202
1132 0752
2067 1545
2068 1546
2193 1652
1133 0753
286 0174
2321 1780
2320 1779
1134 0754
1135 0755
1136 0756
1137 0757
1138 0758
1139 0759
1140 0760
2183 1642
611 0356
612 0357
613 0358
1141 0761
1142 0762
1143 0763
1144 0764
1145 0765
1146 0766
2313 1772
2333 1792
2334 1793
2342 1801
2246 1705
2237 1696
2236 1695
2240 1699
2244 1703
2243 1702
2231 1690
2230 1689
2233 1692
2232 1691
2242 1701
2239 1698
2238 1697
2241 1700
2235 1694
2234 1693
1613 1223
562 0315
563 0316
564 0317
614 0359
1614 1224
2190 1649
615 0360
2249 1708
2250 1709
2395 1854
86 0053
84 0051
83 0050
85 0052
1 0001
617 0361
1147 0767
2284 1743
935 0570
936 0571
937 0572
938 0573
1955 1501
1148 0768
1149 0769
1150 0770
939 0574
1151 0771
940 0575
941 0576
942 0577
943 0578
944 0579
945 0580
946 0581
1152 0772
1153 0773
2071 1547
340 0185
339 0184
1156 0776
621 0362
2375 1834
2376 1835
1154 0774
341 0186
1616 1225
1923 1478
1155 0775
1157 0777
1158 0778
1159 0779
1160 0780
1161 0781
622 0363
1162 0782
1907 1465
1163 0783
1164 0784
1165 0785
1166 0786
1167 0787
2072 1548
2073 1549
624 0364
2 0002
1959 1502
1835 1401
2031 1519
2074 1550
2126 1589
1168 0788
947 0582
948 0583
1169 0789
1856 1415
1170 0790
1171 0791
449 0203
1172 0792
48 0015
49 0016
1173 0793
1174 0794
1175 0795
50 0017
1176 0796
1177 0797
1178 0798
1179 0799
1180 0800
1181 0801
1182 0802
1183 0803
1184 0804
1185 0805
1186 0806
1755 1328
1187 0807
51 0018
1188 0808
1189 0809
1190 0810
1191 0811
1192 0812
1193 0813
1194 0814
52 0019
53 0020
1617 1226
1195 0815
450 0204
1756 1329
1757 1330
1758 1331
625 0365
636 0376
1196 0816
1759 1332
1197 0817
1760 1333
1198 0818
626 0366
627 0367
1199 0819
1200 0820
1201 0821
1618 1227
1202 0822
292 0175
1203 0823
1619 1228
20 0007
54 0021
1620 1229
1761 1334
1762 1335
1621 1230
1204 0824
1763 1336
1764 1337
451 0205
1622 1231
1205 0825
1206 0826
433 0197
452 0206
1207 0827
294 0176
1208 0828
628 0368
629 0369
630 0370
191 0137
192 0138
1768 1341
1770 1343
1766 1339
1209 0829
1857 1416
1210 0830
1765 1338
1767 1340
1858 1417
631 0371
1769 1342
1859 1418
1623 1232
22 0008
1771 1344
55 0022
1861 1420
1860 1419
1772 1345
1773 1346
1211 0831
150 0117
149 0116
1212 0832
632 0372
1213 0833
1862 1421
1863 1422
1774 1347
1775 1348
1776 1349
1864 1423
195 0139
1865 1424
196 0140
56 0023
57 0024
58 0025
1214 0834
2268 1727
59 0026
60 0027
61 0028
453 0207
1934 1489
1935 1490
1777 1350
1215 0835
1778 1351
1216 0836
1217 0837
1218 0838
1219 0839
62 0029
63 0030
64 0031
65 0032
66 0033
1220 0840
197 0141
1866 1425
2390 1849
2184 1643
2408 1867
2409 1868
1221 0841
634 0374
633 0373
1222 0842
1223 0843
1224 0844
1225 0845
1226 0846
1227 0847
504 0258
635 0375
1228 0848
1229 0849
1230 0850
637 0377
24 0009
1624 1233
200 0142
343 0187
638 0378
1960 1503
2076 1551
2289 1748
1836 1402
505 0259
1231 0851
950 0584
951 0585
1232 0852
2272 1731
2281 1740
1233 0853
202 0143
952 0586
953 0587
954 0588
1234 0854
1235 0855
2077 1552
454 0208
2364 1823
506 0260
455 0209
1236 0856
1779 1352
1780 1353
2188 1647
1237 0857
1238 0858
2078 1553
643 0379
2484 1943
2486 1945
2482 1941
2514 1973
2330 1789
1239 0859
2032 1520
2033 1521
1240 0860
1241 0861
1242 0862
1243 0863
1244 0864
1245 0865
1246 0866
1247 0867
1248 0868
456 0210
1249 0869
2490 1949
2489 1948
2488 1947
2487 1946
2404 1863
2398 1857
2399 1858
148 0115
1250 0870
1251 0871
2079 1554
1868 1426
2255 1714
2081 1555
2275 1734
2276 1735
2303 1762
1252 0872
1253 0873
1254 0874
1255 0875
457 0211
1256 0876
1908 1466
1257 0877
119 0086
117 0084
116 0083
118 0085
458 0212
2307 1766
1258 0878
2309 1768
2308 1767
2082 1556
646 0380
2252 1711
1869 1427
1259 0879
1260 0880
2437 1896
2258 1717
2259 1718
2311 1770
2349 1808
2350 1809
2083 1557
300 0177
139 0106
136 0103
138 0105
137 0104
955 0589
959 0593
956 0590
957 0591
958 0592
1261 0881
1262 0882
1263 0883
1781 1354
1782 1355
1264 0884
1909 1467
1910 1468
2391 1850
507 0261
1265 0885
647 0381
1626 1234
1627 1235
1628 1236
1629 1237
1630 1238
1631 1239
2257 1716
2253 1712
2366 1825
3 0003
508 0262
207 0144
1266 0886
509 0263
2192 1651
2377 1836
2378 1837
2182 1641
2343 1802
567 0320
570 0323
572 0325
565 0318
566 0319
571 0324
569 0322
574 0327
573 0326
568 0321
2344 1803
2358 1817
1267 0887
1268 0888
2034 1522
2345 1804
2346 1805
2498 1957
2521 1980
2495 1954
2518 1977
2496 1955
2519 1978
2497 1956
2520 1979
208 0145
1269 0889
209 0146
1635 1243
1632 1240
1633 1241
1270 0890
302 0178
1783 1356
1784 1357
1271 0891
1785 1358
1786 1359
1634 1242
652 0384
960 0594
961 0595
962 0596
1870 1428
2085 1558
459 0213
1276 0896
649 0382
211 0147
460 0214
1272 0892
2089 1559
1273 0893
510 0264
2290 1749
1966 1504
1274 0894
650 0383
1968 1505
67 0034
68 0035
1275 0895
2312 1771
1277 0897
1278 0898
1279 0899
1280 0900
2090 1560
69 0036
70 0037
71 0038
655 0385
1787 1360
213 0148
1788 1361
2296 1755
1637 1244
1871 1429
1872 1430
461 0215
462 0216
1873 1431
2432 1891
1924 1479
2468 1927
1874 1432
2329 1788
1281 0901
1915 1470
1916 1471
1919 1474
1920 1475
1917 1472
1638 1245
1282 0902
1283 0903
214 0149
1639 1246
1640 1247
1284 0904
1285 0905
2315 1774
2316 1775
2314 1773
1286 0906
215 0150
1287 0907
2152 1611
2153 1612
216 0151
2478 1937
2035 1523
2093 1562
2092 1561
2036 1524
2522 1981
165 0132
501 0255
502 0256
1972 1506
217 0152
658 0386
2095 1563
463 0217
464 0218
1291 0908
1292 0909
1293 0910
1294 0911
1295 0912
1296 0913
219 0153
1297 0914
1298 0915
1875 1433
1876 1434
1877 1435
1299 0916
1922 1477
1300 0917
1301 0918
1302 0919
2325 1784
2326 1785
1644 1248
2507 1966
2445 1904
2455 1914
2442 1901
2453 1912
2444 1903
2435 1894
2450 1909
2449 1908
2436 1895
2446 1905
2456 1915
2467 1926
2448 1907
2458 1917
2447 1906
2457 1916
2439 1898
2438 1897
2443 1902
2454 1913
659 0387
1646 1249
465 0219
1647 1250
1648 1251
1649 1252
466 0220
1303 0920
1304 0921
1305 0922
1306 0923
1307 0924
1308 0925
1650 1253
1651 1254
1652 1255
1653 1256
1654 1257
1655 1258
1656 1259
1309 0926
1310 0927
1311 0928
2178 1637
2179 1638
1312 0929
1792 1362
220 0154
1878 1436
221 0155
661 0388
2299 1758
2251 1710
1313 0930
1314 0931
1315 0932
2394 1853
1316 0933
1793 1363
1317 0934
1318 0935
1319 0936
1879 1437
1880 1438
1320 0937
1794 1364
2403 1862
1321 0938
1322 0939
1323 0940
1324 0941
1325 0942
1881 1439
1326 0943
1327 0944
1328 0945
1329 0946
1330 0947
1331 0948
1332 0949
1333 0950
2197 1656
2038 1525
663 0390
664 0391
665 0392
2291 1750
2331 1790
467 0221
468 0222
469 0223
1334 0951
1335 0952
2363 1822
1336 0953
2180 1639
1337 0954
1338 0955
1339 0956
549 0302
364 0188
1658 1260
2292 1751
2278 1737
2277 1736
2279 1738
1340 0957
1341 0958
511 0265
2100 1564
1342 0959
1343 0960
1344 0961
1795 1365
1796 1366
2420 1879
1345 0962
544 0298
2176 1635
2177 1636
2101 1565
2102 1566
2103 1567
537 0291
2160 1619
2161 1620
2104 1568
2105 1569
2106 1570
512 0266
1346 0963
1347 0964
1348 0965
1349 0966
1350 0967
1665 1261
967 0597
968 0598
2204 1663
2207 1666
2206 1665
2205 1664
2208 1667
2212 1671
2211 1670
2220 1679
2219 1678
2199 1658
2198 1657
2201 1660
2200 1659
2216 1675
2215 1674
2214 1673
2213 1672
2203 1662
2202 1661
2210 1669
2209 1668
2218 1677
2217 1676
1351 0968
2245 1704
670 0393
1352 0969
2328 1787
2260 1719
2426 1885
2429 1888
2430 1889
2427 1886
2428 1887
404 0194
1353 0970
1354 0971
1355 0972
1356 0973
1357 0974
1358 0975
671 0394
1359 0976
1360 0977
1666 1262
2360 1819
2261 1720
1667 1263
672 0395
673 0396
470 0224
471 0225
1361 0978
2107 1571
2108 1572
2109 1573
2185 1644
2110 1574
1362 0979
1363 0980
1364 0981
1365 0982
1366 0983
1367 0984
1368 0985
1369 0986
1370 0987
1882 1440
1371 0988
1372 0989
1373 0990
1374 0991
1375 0992
1376 0993
1377 0994
1378 0995
1380 0996
1381 0997
1883 1441
1382 0998
1383 0999
1384 1000
1385 1001
1386 1002
1387 1003
1388 1004
1389 1005
1390 1006
1391 1007
1392 1008
1393 1009
1394 1010
1884 1442
1395 1011
1396 1012
1397 1013
1398 1014
1671 1264
1399 1015
1400 1016
1401 1017
1402 1018
1403 1019
1404 1020
1405 1021
1406 1022
1407 1023
1408 1024
969 0599
970 0600
971 0601
972 0602
973 0603
974 0604
975 0605
976 0606
977 0607
978 0608
979 0609
980 0610
981 0611
982 0612
983 0613
984 0614
985 0615
986 0616
987 0617
988 0618
989 0619
990 0620
991 0621
992 0622
993 0623
995 0624
996 0625
997 0626
998 0627
999 0628
1000 0629
1001 0630
1002 0631
1003 0632
1004 0633
1005 0634
1006 0635
1007 0636
1008 0637
1009 0638
1010 0639
1011 0640
1012 0641
1013 0642
1014 0643
1015 0644
1016 0645
1017 0646
1018 0647
1019 0648
1020 0649
1021 0650
1022 0651
1023 0652
1024 0653
1025 0654
1026 0655
1027 0656
1028 0657
1029 0658
1030 0659
1031 0660
1032 0661
1033 0662
1034 0663
1409 1025
472 0226
1410 1026
1411 1027
1412 1028
1413 1029
1414 1030
1415 1031
1416 1032
1417 1033
1418 1034
1419 1035
1797 1367
2501 1960
2499 1958
2500 1959
2156 1615
2157 1616
2392 1851
1420 1036
2476 1935
2469 1928
2474 1933
1840 1403
1421 1037
1422 1038
1423 1039
2181 1640
32 0010
2510 1969
2511 1970
2480 1939
2479 1938
513 0267
1424 1040
1983 1507
1798 1368
1799 1369
1425 1041
1426 1042
1672 1265
1673 1266
1674 1267
1675 1268
1676 1269
1677 1270
1678 1271
1679 1272
1680 1273
1681 1274
1682 1275
1427 1043
679 0397
1428 1044
2111 1575
1429 1045
681 0398
682 0399
2040 1526
1430 1046
683 0400
1431 1047
684 0401
685 0402
1434 1050
1035 0664
246 0158
409 0195
2112 1576
2041 1527
2113 1577
2042 1528
2114 1578
1686 1277
2045 1531
1687 1278
689 0403
1432 1048
2115 1579
1688 1279
691 0404
2116 1580
705 0411
2043 1529
2117 1581
2118 1582
38 0011
1433 1049
315 0179
696 0405
1692 1280
2044 1530
316 0180
371 0189
697 0406
1037 0665
1038 0666
698 0407
1933 1488
1511 1127
2120 1583
1437 1053
699 0408
759 0453
760 0454
701 0409
1683 1276
1693 1281
2462 1921
2461 1920
2466 1925
2463 1922
2460 1919
2465 1924
2459 1918
2464 1923
550 0303
240 0156
558 0311
587 0340
590 0343
592 0345
585 0338
586 0339
591 0344
589 0342
594 0347
593 0346
588 0341
577 0330
580 0333
582 0335
575 0328
576 0329
581 0334
579 0332
584 0337
583 0336
578 0331
554 0307
2046 1532
2121 1584
2047 1533
2122 1585
703 0410
1994 1508
2123 1586
1800 1370
1801 1371
1435 1051
1436 1052
706 0412
707 0413
1996 1509
2124 1587
1802 1372
1803 1373
1804 1374
2125 1588
1438 1054
473 0227
1439 1055
474 0228
1841 1404
1842 1405
1843 1406
2504 1963
2502 1961
2503 1962
1885 1443
475 0229
476 0230
477 0231
2064 1543
478 0232
479 0233
2063 1542
1440 1056
2048 1534
2127 1590
2128 1591
1040 0667
1041 0668
72 0039
1886 1444
1887 1445
73 0040
2129 1592
1912 1469
480 0234
481 0235
1441 1057
2162 1621
2164 1623
2163 1622
1442 1058
1921 1476
2130 1593
2159 1618
2158 1617
417 0196
244 0157
1042 0669
2150 1609
1443 1059
1444 1060
2003 1510
1699 1282
1700 1283
1701 1284
1702 1285
1703 1286
2004 1511
2262 1721
2263 1722
2431 1890
2264 1723
1445 1061
1446 1062
560 0313
559 0312
561 0314
1705 1287
2254 1713
1930 1485
1447 1063
147 0114
145 0112
144 0111
146 0113
1448 1064
1449 1065
2131 1594
482 0236
2406 1865
2407 1866
1450 1066
2418 1877
1451 1067
2387 1846
2393 1852
2305 1764
483 0237
484 0238
529 0283
527 0281
528 0282
2132 1595
1452 1068
1888 1446
1889 1447
1453 1069
1454 1070
485 0239
486 0240
2133 1596
2007 1512
249 0159
2134 1597
1455 1071
1456 1072
1457 1073
1458 1074
1459 1075
1805 1375
1931 1486
721 0417
1460 1076
1461 1077
106 0073
104 0071
103 0070
105 0072
110 0077
108 0075
107 0074
109 0076
102 0069
100 0067
99 0066
101 0068
722 0418
1462 1078
1463 1079
723 0419
724 0420
662 0389
713 0414
714 0415
715 0416
1806 1376
1807 1377
1808 1378
487 0241
1464 1080
2396 1855
2452 1911
2049 1535
251 0160
1465 1081
1466 1082
2386 1845
2010 1513
252 0161
2137 1598
2138 1599
820 0463
1467 1083
1468 1084
1469 1085
1470 1086
1471 1087
1890 1448
1891 1449
1472 1088
1473 1089
1045 0670
1474 1090
1475 1091
1892 1450
1476 1092
1477 1093
1046 0671
1047 0672
1048 0673
1049 0674
1050 0675
1051 0676
1052 0677
1053 0678
1478 1094
1809 1379
1054 0679
1479 1095
488 0242
489 0243
1480 1096
1481 1097
1482 1098
2013 1514
725 0421
1483 1099
1484 1100
1485 1101
1810 1380
1811 1381
1486 1102
1487 1103
1488 1104
1489 1105
1490 1106
1117 0737
1118 0738
1119 0739
1120 0740
1491 1107
1893 1451
1894 1452
1895 1453
1492 1108
726 0422
727 0423
1708 1288
1709 1289
1710 1290
490 0244
1711 1291
1493 1109
1055 0680
1056 0681
728 0424
1057 0682
1058 0683
1059 0684
729 0425
730 0426
731 0427
1494 1110
733 0429
732 0428
734 0430
735 0431
736 0432
737 0433
1495 1111
1496 1112
738 0434
322 0181
739 0435
1812 1382
1497 1113
491 0245
740 0436
1896 1454
741 0437
742 0438
743 0439
744 0440
745 0441
746 0442
747 0443
1498 1114
1499 1115
1060 0685
1500 1116
1501 1117
1502 1118
1503 1119
1504 1120
1505 1121
1506 1122
1507 1123
530 0284
2050 1536
1712 1292
1508 1124
2269 1728
2282 1741
2195 1654
1509 1125
1510 1126
1512 1128
1513 1129
1514 1130
2380 1839
1515 1131
1813 1383
1516 1132
1517 1133
98 0065
96 0063
95 0062
97 0064
1518 1134
1897 1455
1713 1293
1714 1294
1715 1295
748 0444
749 0445
2139 1600
492 0246
1519 1135
1520 1136
751 0446
1814 1384
1718 1296
1521 1137
1719 1297
1720 1298
1721 1299
1722 1300
1723 1301
1724 1302
2295 1754
1815 1385
1816 1386
1817 1387
1818 1388
1522 1138
2265 1724
2297 1756
2298 1757
2014 1515
514 0268
2194 1653
1523 1139
1524 1140
1525 1141
1819 1389
1526 1142
1527 1143
115 0082
113 0080
112 0079
114 0081
1528 1144
1529 1145
1530 1146
1531 1147
1532 1148
752 0447
1533 1149
94 0061
92 0059
91 0058
93 0060
1820 1390
1821 1391
324 0182
1534 1150
1535 1151
1536 1152
1936 1491
1937 1492
1938 1493
1939 1494
1940 1495
1941 1496
1942 1497
1537 1153
1538 1154
2451 1910
1539 1155
259 0162
1898 1456
1899 1457
2174 1633
2175 1634
1540 1156
2347 1806
1541 1157
1542 1158
1900 1458
753 0448
754 0449
260 0163
1543 1159
493 0247
1544 1160
261 0164
1901 1459
2018 1516
1932 1487
127 0094
125 0092
124 0091
126 0093
131 0098
129 0096
128 0095
130 0097
123 0090
121 0088
120 0087
122 0089
1061 0686
1062 0687
1063 0688
1064 0689
1065 0690
1066 0691
1545 1161
1902 1460
494 0248
1546 1162
2266 1725
1067 0692
74 0041
756 0450
531 0285
546 0299
547 0300
532 0286
548 0301
1547 1163
1548 1164
1549 1165
1550 1166
1551 1167
2348 1807
2401 1860
2402 1861
495 0249
1725 1303
1726 1304
1552 1168
82 0049
80 0047
79 0046
81 0048
135 0102
133 0100
132 0099
134 0101
1553 1169
1918 1473
757 0451
1068 0693
1069 0694
1070 0695
1071 0696
758 0452
1073 0697
1074 0698
1075 0699
1076 0700
515 0269
516 0270
517 0271
518 0272
519 0273
520 0274
521 0275
522 0276
523 0277
524 0278
533 0287
534 0288
1903 1461
2388 1847
535 0289
2425 1884
1844 1407
264 0165
2405 1864
1822 1392
1823 1393
1824 1394
1825 1395
1826 1396
2248 1707
1554 1170
1555 1171
1556 1172
75 0042
1557 1173
1558 1174
1904 1462
1827 1397
1559 1175
1560 1176
1561 1177
1562 1178
76 0043
1845 1408
857 0496
858 0497
859 0498
860 0499
861 0500
862 0501
863 0502
864 0503
865 0504
866 0505
877 0516
878 0517
879 0518
880 0519
881 0520
882 0521
883 0522
884 0523
885 0524
886 0525
837 0476
838 0477
839 0478
840 0479
841 0480
842 0481
843 0482
844 0483
845 0484
846 0485
867 0506
868 0507
869 0508
870 0509
871 0510
872 0511
873 0512
874 0513
875 0514
876 0515
847 0486
848 0487
849 0488
850 0489
851 0490
852 0491
853 0492
854 0493
855 0494
856 0495
827 0466
828 0467
829 0468
830 0469
831 0470
832 0471
833 0472
834 0473
835 0474
836 0475
77 0044
78 0045
1727 1305
1728 1306
761 0455
1563 1179
503 0257
536 0290
1846 1409
2397 1856
1564 1180
1565 1181
1566 1182
1567 1183
2140 1601
1828 1398
1905 1463
265 0166
266 0167
1829 1399
1830 1400
1568 1184
1569 1185
2271 1730
1077 0701
1078 0702
1079 0703
1080 0704
1081 0705
1082 0706
1570 1186
2384 1843
1571 1187
1572 1188
1573 1189
1574 1190
525 0279
2020 1517
1575 1191
2267 1726
12 0004
2317 1776
1576 1192
1906 1464
762 0456
2293 1752
2294 1753
2322 1781
2400 1859
2310 1769
1729 1307
1577 1193
496 0250
497 0251
498 0252
499 0253
1578 1194
1579 1195
1730 1308
1580 1196
526 0280
329 0183
500 0254
2324 1783
1581 1197
1582 1198
1583 1199
1584 1200
1585 1201
1586 1202
1587 1203
1588 1204
1589 1205
2187 1646
1590 1206
2323 1782
2385 1844
2485 1944
2481 1940
2512 1971
822 0464
42 0012
1731 1309
1732 1310
270 0168
2222 1681
2221 1680
271 0169
2223 1682
2226 1685
2229 1688
2228 1687
1733 1311
2224 1683
1734 1312
2227 1686
2225 1684
1591 1207
1735 1313
1736 1314
1592 1208
1593 1209
1594 1210
1595 1211
2383 1842
2141 1602
1596 1212
143 0110
141 0108
140 0107
142 0109
1597 1213
1598 1214
2051 1537
2142 1603
823 0465
2143 1604
2053 1538
2144 1605
2145 1606
2523 1982
538 0292
539 0293
540 0294
541 0295
542 0296
543 0297
2154 1613
2155 1614
2273 1732
1603 1215
763 0457
764 0458
765 0459
766 0460
767 0461
1604 1216
111 0078
2357 1816
1605 1217
1087 0707
1088 0708
1089 0709
1090 0710
1091 0711
1092 0712
90 0057
88 0055
87 0054
89 0056
272 0170
273 0171
2148 1607
1606 1218
1607 1219
2149 1608
1 RJ1
2 RJ2
3 RJ3
4 RJ4
1 RD1
2 RD2
3 RD3
4 RD4
RI
1
III.Umum
III.Sp
III.Kons
2
II.Umum
II.Sp
II.Kons
3
I.Umum
I.Sp
I.Kons
4
VIP.Sp
VIP.Kons
5
VVIP.Sp
VVIP.Kons
6
Suite.Sp
Suite.Kons
7
ICU/ICCU/HCU.Sp
ICU/ICCU/HCU.Kons
8
NICU/PICU.Sp
NICU/PICU.Kons
Jenis Pelayanan
1 Jenis Pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)

1 jenis pemeriksaan (Kategori Kecil)
Prp
Mikroneedle (Paket 4 Kali)
Thread
Ftd
Injeksi Vitamin C
Injeksi 1 Acne
2 jenis Pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
3 pemeriksaan (Kategori Kecil)
Mikrodermabrasi
Checimal Peeling
Botox
Filler
Subsisi (Acne Scar)
Jumlah > 5 (SSR)
Jumlah < 5 (SSR)
Adenoidektomi
Adenolisis
Adranalektomi Abdominotorakal
AFF Tampon Hidung
AFP
Agregasi Trombosit
Aktifir Plat Orthodentie/Kontrol
Akupuntur Estetika
Akupuntur Kebugaran
Akupuntur Terapi
Albumin
Alfa 1 Antitrifsin Kuantitatif
Alfa 2 makro Globulin Kuantitatif
Alkali Phospat
Allergi Test/Pateh Test/Prick Test
Alveolektomi Per Regio
Ambulance Jenazah Dalam Kota Denpasar
Ambulance Jenazah Kabupaten Badung
Ambulance Jenazah Kabupaten Bangli
Ambulance Jenazah Kabupaten Buleleng
Ambulance Jenazah Kabupaten Gianyar
Ambulance Jenazah Kabupaten Jembrana
Ambulance Jenazah Kabupaten Karangasem
Ambulance Jenazah Kabupaten Klungkung
Ambulance Jenazah Kabupaten Tabanan
Amput/Dear Tgk Fore Quarter 1 Sisi
Amput/Dear Tgk Hid Quarter 2 Sisi
Amput/Dear Tgk Hind Quarter 1 Sisi
Amput/Dear Tgk Kru/Ante 2 Sisi
Amput/Dear Tgk Kruris/Ante 1 Sisi
Amput/Dear Tgk Lengan Ats/Paha 1 Sisi
Amput/Dear Tgk Lgn Ats/Paha 2 Sisi
Amput/Dear Tgk Panggl /Bahu 2 Sisi
Amput/Dear Tgk Panggl Bahu 1 Sisi
Amput/Dear Tgk Siku/Lutut 1 Sisi
Amput/Dear Tgk Wrsi Ankle 2 Sisi
Amput/Dear Tgkt Wris/Ankle 1 Sisi
Amput/Dera 1-2 Snd Jr Tgk Kar,Tar
Amputasi Deartikualsi Lbh 2 Jr
Amputasi Digiti Single
Amputasi Eksisi Kista Branchiogenik
Amputasi Jari
Amputasi/ Dear 1-2 Snd Jr Tgk Kar
Amputasi/Dearti 1 - 2 Jari
ANA (IF)
ANA Profile
ANA Titrasi
Anal Fistulektomi
Anal Fistulotomi
Analisa cairan otak
Analisa cairan sendi
Analisa cairan tubuh lain (pleura/lain-lain)
Analisa Gas Darah
Analisa sperma
Anastesi Bronchoscopy
Anastomis Vaskuler Distal Wrist
Anastomosis Vaskuler Proksimal Wrist
Anel Test
Angkat "Plate Screw" Fraktur Os Maksilofacial 1 - 2 tempat
Angkat "Plate Screw" Fraktur Os Maksilofasial 3 tempat atau lebih
Angkat "Plate Screw" Sederhana
Angkat dan Pasang KB Susuk
Angkat Fiksasi Ext. 1 Regio Ekstr.
Angkat Fiksasi In 1 Regio Ekstr.
Angkat Fiksasi In Lebih 1 Regio Ekstr.
Angkat Fiksasi Tulang Belakang
Angkat Implant Interna
Angkat Jahitan
Angkat/Ekstraksi KB Susuk
Angkatfiksasi Ext. Lebih 1 Regioekst
Antegrade Pyelografi (Apg)
Anterior/Posterior Sklerotomi
Anthroscopy Therapeutik
Anthrotomi/Synovektomi
Anti Dengue IgM, IgG
Anti Faktor Xa
Anti H Pylori IgG
Anti H Pylori IgM
Anti HAV
Anti HBc
Anti HBe
Anti HBs
Anti HBs (Elisa)
Anti HCV
Anti HIV (rapid)
Anti HSV I IgG
Anti HSV I IgM
Anti HSV II IgG
Anti HSV II IgM
Anti Kappa
Anti Lamda
Anti Rubella IgC
Anti Rubella IgM
Anti Tb IgG (PAP TB)
Anti Toxoplasma IgG
Anti Toxoplasma IgM
Anti Trombin III
Antrostomi Sinus Maksilaris
Apendektomi (Elektif)
Apendektomi dengan Laparoskopi
Apendektomi Insidental Lainnya (darurat)
Apex Reseksi 1 Gigi
Apo A1
Apo B
APTT
Arm Sling
Arthriplasty Eks Bahu/Panggl 1 Sisi
Arthrodesis 1-2 Jari
Arthrodesis Bahu/Panggul 1 Sisi
Arthrodesis Lbh Dr 2 Jari
Arthrodesis Siku/Lutut 1 Sisi
Arthrodesis Wrist/Angkle 1 Sisi
Arthroplasty Eks Bahu/Pangl 2 Sisi
Arthroplasty Eks Siku/Lutut 1 Sisi
Arthroplasty Eks Wrist/Ankle 2 Sisi
Arthroplasty Eksisi Wrist/Ankle 1 Sisi
Arthroplasty Exsisi 1-2 Jari
Arthroplasty Siku/Lutut 2 Sisi
Arthroscopy Bahu
Arthroscopy Lutut
Arthroscopy Panggul
Asam Folat
Asam urat
Asistensi Induksi
Asistensi Intra Operatif
Aspirasi Biopsi Tumor Muskuloskeletal
Aspirasi Cairan Sendi Dalam
Aspirasi Cairan Sendi Superfisial
Aspirasi Efusi Perikondrial
Aspirasi Hemarthrosis
Aspirasi Hematome
Aspirasi Kista
Assay Faktor IX
Assay Faktor VIII
ASTO
Audiometri (Pelayanan Eksekutif Rawat Jalan)
Audiometri (THT)
AV Shunt dengan Anestesi Lokal
AV Shunt Radiosefalika
Babcock
Bali Body Massage + Scrub 1,5 Jam
Bali Body Massage 1 Jam
Bali Body Massage 30 Menit
Bandaging Khusus (Pembalut Khusus)
Barium Follow Through
Bedah Jenazah
Bedah Listrik
Bedah Sakpel
Bedah Sinus Endoskopik Fungsional (BSEF) Bilateral
Bedah Sinus Endoskopik Fungsional (BSEF) Unilateral
Beloq Tampon dengan Anestesi Lokal
Beloq Tampon dengan Anestesi Umum
Besi
Beta HCG
Biakan Aerob + Uji Kepekaan Konvensional
Biaya pemeriksaan resitensi ke BBLK
Biaya pengiriman kultur TB ke BBLK
Bilateral Excision of Ectopic Breast Tissue (Mamma Aberans)
Bilateral Multiple Excision of Lession of Breast dengan Anestesi
Bilirubin direk
Bilirubin indirek
Bilirubin total
Biometri
Biopsi
Biopsi Anus dengan Anestesi Lokal
Biopsi Aspirasi Transthorakal
Biopsi Endoscopy 1-2 Blok (Kategori Sedang)
Biopsi Endoscopy 1-2 Blok (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
Biopsi Endoscopy 3 Blok (Kategori Canggih)
Biopsi Endoscopy 3 Blok (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
Biopsi Kelenjar Getah Bening
Biopsi Kulit
Biopsi Nosopharynk dengan Lokal Anastesi
Biopsi Pleura
Biopsi Portio
Biopsi Prostat
Biopsi Saraf Kutaneus/Otot
Biopsi Sinus Maksila
Biopsi Terbuka Tumor di Dinding Thorak
Biopsi Testis
Biopsi Tumor Hidung
Biopsi Tumor Hipofaring dengan Anestesi Umum
Biopsi Tumor Kelopak
Biopsi Tumor Lidah/Palatum
Biopsi Tumor Nasofaring
Biopsi Tumor Orbita
Blaas Punctie
Bladder Neck Incision
BMP (Bone Merrow Punctie)
Bone Marrow aspirasi atau biopsi
Bone Marrow aspirasi dab biopsi (Histopatologi)
Bone Marrow Aspirasi dan Biopsi (Histokimia)
Bouginasi
Bronchoscopy
Bronchoscopy dan Biopsi
Bronchoscopy, Broncial Washsing
BTA
BTA 1x
Buka Fiksasi 2 Rahang
Buka Gips
Buka IOIDW
Buka Jahitan Palpebra
Buka Kateter
Buka Kawat Fiksasi
Buka WSD
Bulectomy 10% - 20%
Bulektomi tanpa Anestesi
Bullectomy 10%
Bullectomy Diatas 10%
Bullectomy Lebih dari 20%
Bvcug
C3
C4
CA 12-5
CA 125 II
CA 15-3
CA 19-9
CA 72-4
Ca Cervic Stadium IA, insitu (Kategori Canggih)
Ca Cervic Stadium IA, insitu (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
Ca Cervic Stadium IB Keatas (Kategori Canggih)
Ca Cervic Stadium IB keatas (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
Cadwell Luc Anthrostomi Bilateral
Cadwell Luc Anthrostomi Unilateral
C-Arm
Caudografi/Myelografi
Cauter Coloctomi
Cauter Perdarahan Tonsil
Cauterisasi Kutil 1 - 10 Buah
Cauterisasi Kutil Lebih dari 20 Buah
CD-4
CEA
Cell Blok
Cementing Per Gigi
Chemo Surgary Podophylin
Chemoterapi
Ches Fisioterapi
Cholangiografi
Cholecystectomy Terbuka
Circumcisi (Sunat)
CK-MB
CK-total
Clipping Costae (diluar plate)
Closure Anal Fistel
Closure of Appendicial Fistuyla
Closure of Fistula of Small Intestine
Closure of Fistule of Large Intestine
Closure of Intestinal Stoma
Closure of Laceration of Liver
Colon In Loop/Barium Enema
Combutio < 10%
Combutio > 30%
Combutio 10% - 30%
Complicated Functional Neuro Perculteneus Kordotomi
Complicated Functional Neuro Perculteneus Paravarteb/Visceral Block
Complicated Functional Neuro Steraotaxy Kompleks
Complicated Functional Neuro Steraotaxy Sederhana
Condilotomi Mandibula
Control of Hemorrhage of Anus
C-peptide
CRP kualitatif
CRP kuantitatif
Cryoglobulin
CT Angiografi
CT Scan Abdomen Dengan Kontras
CT Scan Abdomen Tanpa Kontras
CT Scan Cervical Spine
CT Scan Extremitas Dengan Kontras
CT Scan Extremitas Tanpa Kontras
CT Scan Kepala Dengan Kontras
CT Scan Kepala Tanpa Kontras
CT Scan Leher/Colli Dengan Kontras
CT Scan Leher/Colli Tanpa Kontras
CT Scan Lumbosacral Spine
CT Scan Pelvis Dengan Kontras
CT Scan Pelvis Tanpa Kontras
CT Scan Thoracal Spine
CT Scan Thorax Dengan Kontras
CT Scan Thorax Tanpa Kontras
CTG (Cardio Tocografi) Perhari
Cuci Rambut
Cuci Rambut + Blow/Catok
Cuci Rambut + Blow/Catok ke Ruang Rawat Inap Tambahan Biaya
Cukur Lapangan Operasi
Curetase dengan General Anastesi
Cystografi
Cystostomy
Darah lengkap 3 diff
Darah samar
Dark Circle Around Eyes 1 card
Dark Circle Around Eyes 1/2 card
Darm Bouis
DC Shock (Tindakan IGD)
DCR + Silicon Tube
D-dimer
Debri dan Drai Osteo Eks dengan Penyulit
Debri dan Drai Osteo Eks Lbh 1 Reg
Debri dan Drainge Osteomyelitis Eks
Debrid dan Drai Osteo Tlg Belakang
Debridemen Luka Kecil
Debridement - Nekrotomi Luka Gangren
Debridement + Skin Graft
Debridement Fraktur Terbuka Sederhana dengan Eksternal Cast
Debridement Luka (WT, HT)
Debulking
Dekom Sten Srf Fer Reg Akar Spi Kan
Dekom Sten Srf Fer Reg Medula Spina
Dekom Sten Srf Fer Reg Siku 1 Sisi
Dekom Sten Srf Fer Reg Thor Outlet
Dekom Sten Srf Fer Reg W/A 2 Sisi
Dekom Sten Srf Per Regio W/A 1 Sisi
Dekompresi Syaraf
Dekompresi Syaraf Tepi
Dekontiminasi Racun
Delatasi Phymosis dengan Lokal Anastesi
Delatasi Phymosis Tanpa Bius
Dilatasi Phimosis
Dilatasi Phymosis Tanpa Bius
Dengue Blot IgG
Dengue Blot IgM
Deseksi Axila
Dilatasi dengan Bougie
Dilatasi Hegar
Dilatasi Katup Mitral (BMW)
Dilatasi Megacolon pada Anak
Dilatasi Uretra
Disartikulasi Sendi Ekstremitas
Diseksi Kelenjar Getah Bening (KGB) Pelvis
Diseksi Kelenjar Inguinal
Diseksi Leher Radikal Modifikasi/Fungsional
Dislokasi Rahang
Dorsumsisi dengan Anestesi Lokal
Doubel Lumen
Drainage of Appediceal Abses
Drainage of Pancreatic Cyst with Catheter
Drainase Abses Hepar
Drainase Kista Pankreas
Drainase Periureter
Dressing Luka (Perawatan Luka)
Dryneeding
Dusinasi (Dilatasi dengan Businator)
Echo Cardiography (Poli Jantung)
Echo Cardiography (Tindakan Khusus ICU)
EEG
EKG Anak
Eko Kardiografi
Pemeriksaan EKG
Eksenterasi
Eksisi Biopsi Tumor Jaringan Lunak
Eksisi Biopsi Tumor Jinak Jar. Lunak
Eksisi Biopsi Tumor Pembuluh Darah
Eksisi Chalazion/Hordiolum
Eksisi Chodee
Eksisi Clavus
Eksisi Epulis (Mucocele)
Eksisi Fistel
Eksisi Granuloma
Eksisi Granuloma Pyogenikum
Eksisi Hemmoroid
Eksisi Hidradenitis Unilateral
Eksisi Higroma Coli
Eksisi Hordeleum/Granuloma
Eksisi Kelainan pada Payudara dengan Pembiusan Umum
Eksisi Kelainan Perianal Lainnya
Eksisi Kelenjar Sub Mandibula
Eksisi Kista Ateroma/Lipoma/Ganglion < 2cm
Eksisi Kista Duktus Tiroglosus
Eksisi Luas Radikal + Rekonstruksi
Eksisi Luas Tumor Ganas Bibir dengan Rekonstruksi Flap Lokal
Eksisi Nevus Sederhana dengan Lokal Anestesi
Eksisi Parsial + Marsupiliasi Ranula
Eksisi Perianal Skin Tags
Eksisi Pretigium Bare Sklera
Eksisi Ranula atau Kista pada Mukosa Mulut
Eksisi Skin Grafting
Eksisi Syringoma
Eksisi Tumor Adneksa Kecil
Eksisi Tumor Adneksa Sedang
Eksisi Tumor Ganas Kulit dengan Flap Lokal atau Graft Kulit
Eksisi Tumor Ganas Kulit tanpa Rekonstruksi
Eksisi Tumor Jinak dengan Anestesi Lokal
Eksisi Tumor Jinak Kulit dan Tumor Non Neoplastik Kulit (LA)
Eksisi Tumor Jinak Mama (FAM) < 2 cm satu sisi
Eksisi Xantalasma
Eksisi Xantoma
Eksisi/Konisasi
Eksochiliasi
Eksplorasi Abses Mandibula
Eksplorasi Abses Parafaringeal
Eksplorasi Abses Peritonsiler dengan Anestesi Lokal
Eksplorasi Abses Peritonsiler dengan Anestesi Umum
Eksplorasi Luka Gigitan Sengatan Binatang
Explorasi Luka Gigitan Binatang
Eksplorasi Nasofaring
Eksplorasi Pre Aurikuler Fistel dengan Abses
Eksplorasi Testis Mikro Surgery
Eksplorasi Tumor Jinak Kelenjar Liur
Eksplorasi Vaskuler (trauma/nontrauma)
Eksplorasi Vulnus Iktum
Eksplorasi/Ekstraksi Kuku
Ekstirpasi Angiofibroma Nasofaring
Ekstirpasi Ganglion Poplitea
Ekstirpasi Kelenjar Sub Mandibula
Ekstirpasi Kista Bartolin
Ekstirpasi Kista Bronchialis
Ekstirpasi Kista Dermoid
Ekstirpasi Kista Dermoid dengan Anastesi
Ekstirpasi Kista Gardner (Vagina)
Ekstirpasi Kiste Bartholine
Ekstirpasi Komedo
Ekstirpasi Myoma Pedunculata
Ekstirpasi Papiloma Laring
Ekstirpasi Papiloma Mulut
Ekstirpasi Papiloma Vagina
Ekstirpasi Plunkina Ranula
Ekstirpasi Polip Nasi dengan Anestesi Lokal
Ekstirpasi Polip Nasi dengan Anestesi Umum
Ekstirpasi Polip Rongga Mulut
Ekstirpasi Polip Serviks
Ekstirpasi Tumor Ganas Adneksia + Rekonstruksi
Ekstirpasi Tumor Jinak Kulit
Ekstirpasi Tumor Jinak Kulit
Ekstirpasi Tumor Jinak Sinonasal, Oral Cavity
Ekstirpasi Tumor Scalp/Cranium
Ekstirpasi Tumor Tulang
Ekstirpasi/Eksisi Tumor Jaringan Lunak Ukuran < 2cm
Ekstraksi Batu Uretra
Ekstraksi Benda Asing dengan Penyulit
Ekstraksi Cincin
Ekstraksi Corpus Alaienum Hidung/Telinga
Ekstraksi Corpus Alaienum pada Tenggorokan
Ekstraksi Corpus Alienum Telinga
Ekstraksi Corpus Alienum Tenggorokan
Ekstraksi Corpus Alienum Hidung
Ekstraksi Corpus Alienum
Ekstraksi Corpus Alienum Conjungtiva
Ekstraksi Corpus Alienum di Regio Thorak
Ekstraksi Corpus Alienum Esofagus
Ekstraksi Corpus Alienum Hidung dengan Anestesi Umum
Ekstraksi Corpus Alienum Kornea
Ekstraksi Corpus Alienum pada Telinga, Kuku
Ekstraksi Corpus Alienum Telingan dengan Anestesi Umum
Ekstraksi Granuloma
Ekstraksi IUD (Tindakan Obgyn)
Ekstraksi IUD Kebidanan
Ekstraksi Jaringan Granulasi CAE
Ekstraksi Kalium Oksalat
Ekstraksi Katarak (SICS + LOL + PPC) Anak-Anak dengan Anestesi Umum
Ekstraksi Katarak (SICS dan LOL) dengan Anestesi Lokal
Ekstraksi Keratosis dengan Anestesi Lokal
Ekstraksi Keratosis dengan Anestesi Umum
Ekstraksi Kolesteatum
Ekstraksi Komedo Jumlah < 10
Ekstraksi Komedo Jumlah > 10
Ekstraksi Kuku
Ekstraksi Kuku dengan Lokal Anastesi
Ekstraksi Linear
Ekstraksi Membran/Scrapping
Ekstraksi Nevus
Ekstraksi Serumen
Ekstraksi Serumen dengan Penyulit
Ekstraksi Sialolithiasis
Ekstraksi Tumor Kecil Palpebra
Ekstraski Polip dengan Lokal Anastesi
Ekstropion Siktratis/Entropion dengan Laser
Ekterpasi Granuloma dan Milium
Elektro Kauter dengan Anestesi Topikal (Condiloma)
Elektro Kauter dengan Anestesi Topikal (Millium)
Elektro Kauter dengan Anestesi Topikal (Veruka...)
Elektro Kauter Kondiloma, Veruka
Elektroforesis Hb
Elektrofulgasi
Elektrokauter dengan Anestesi Injeksi
Elektrokauter dengan Anestesi Topikal
Emergency Treatment
Endoskopi Atas
Endoskopi Bawah
Endoskopi Hidung
Endoskopi Polipektomi of Rectum
Endoskopi Telinga/Tenggorok
Enukleasi Kista
Enukleasi Kista D42
Enukleasi Kista Ginjal
Enukleasi/Eviscerasi + DFG
Enulkleasi Milia Lesi < 20
Enulkleasi Milia Lesi > 20
Enulkleasi Moluskum
Enulkleasi Moluskum lesi < 20
Enulkleasi Moluskum Lesi > 20
Epiddimovasostomi
Epilasi (Pelayanan Eksekutif Rawat Jalan)
Epilasi (Tindakan Mata)
Esbach
Esopagografi/Barium Swallow
Estradiol
Estrogen
Ethmoidektomi (Intranasal)
Evakuasi Batu Urethra Anterior dengan Anastesi Lokal
Evakuasi Batu Urethra Anterior tanpa Anastesi
Evakuasi Corpus Alienum Sederhana dengan Anestesi Lokal
Evakuasi Corpus Alienum Sederhana dengan Anestesi Umum
Evakuasi Hematome Buli-buli
Evakuasi Hematome di Ekstremitas
Evakuasi Hematome Pasca Operasi Leher tanpa Trakeostomi
Eviscerasi
Exercise Terapi
Explorasi Kecil
Extended Pyelolithektomi (Gilveme)
Exteriozation of Large Intestine
Exteriozation of Small Intestine
Extractie Corpus Alienium Konjungtiva
Extractie IUD dengan GA
Extractie Iud dengan GA
Extractie Korpus Alenium Kornea
Extraksi Batu Uretra dengan GA
Extraksi Batu Uretra Tanpa Anastesi
Extraksi Cerumen
Extubasi
F.Von Willebrands
Facialis Parase
Faradic/Galvanik
Faringotomi
Fascio Dekom Comp Dist Wrist/Angkle
Fascio Dekom Comp Prok Wrist/Ankle
Fasciotomi
Feritin
Fibrinogen
Fibroadenoma Mama
Fiksasi 1 Rahang
Fiksasi Ext 1Regio Ektr
Fiksasi Ext Ekst 1 Regio dengan Penyulit
Fiksasi Ext Ekstr Lebih dari 1 Regio
Fiksasi Interna Fraktur Maksilofasial 1-2 Tempat Patahan
Fiksasi Interna Fraktur Nasal
Fiksasi pada Fraktur
Fiksasi Rahang dengan Pembiusan Umum
Filaria
Fisioterapi dengan Alat (4 x tindakan)
Fissure Sealant/Regio
Fistula Ureterovesika
Fistulektomi Pre Aurikuler Bilateral
Fistulektomi Pre Aurikuler Unilateral
Fistulogarafi
Flebektomi
FNA (Fine Needle Aspiration)
Fnab Hati, Kelenjar
Fnab/Fine Needle Aspirasi Biopsi
FNAB-Diambil di lab PA dan di ruangan (Superfisial)
FNAB-FNAB Deep (diluar Lab PA)
FNAB-Kiriman Slide
FNAP Kiriman Slide
Fosfor
Foto Koagulasi Laser
Foto Terapi
Foto Terapi Double Lamp
Fraktur Antebrachii
Fraktur Clavikula
Fraktur Coles dan Pergelangan Tangan Lainnya
Fraktur Cruris
Fraktur Femur
Fraktur Humerus
Fraktur Olecranon
Fraktur Supracondiler Humerus
Free Flap Surgery
Frenektomi
Frontoethmoidektomi (Ekstranasal)
Frozen zection (FZ) dari Rumah Sakit Swasta Pemeriksaan > 2 Blok
Frozen Zection (FZ) Dari Rumah Sakit Swasta Pemeriksaan 1-2 Blok
Frozen Zection (FZ) Pemeriksaan > 2 Blok
Frozen Zection (FZ) Pemeriksaan 1-2 Blok
FSH
FT3
FT4
Full Face Rejuvenation
Full Thickness Skin Graft to Hand
Full Thickness Skin Graft to Other Site
Funduskopi Direct
Funduskopi Indirect
G6PD
Galvanic/Faradic/Tens
Gambaran Darah Tepi
Gambaran Sumsum Tulang
Gamma GT
Ganglion Carpi
Ganti Balut Besar
Ganti Balut Kecil
Ganti Balut Sedang
Ganti Perban
Ganti Sendi (Arthroplasti) tidak termasuk alat
Ganti Transfer Set
Gastrektomi (Bilroth 1 dan 2)
Gentle Peel 1 card
Gentle Peel 1/2 card
Gingivektomi Per Rahang
Globulin
Glosektomi Totalis
Glukosa puasa
Glukosa sewaktu
Glyserin Spoit
Glyserin Spuit
Golongan darah (ABO + Rhesus)
Gonioskopi
Grafting pada Arterial Insufisiensi
Groin Disection
Grup B Streptococcus
Hams test
Hb F
HBA1c
HBsAg
HBsAg Elisa
Heating Ir/Uv
Hecting Luka Konjungtiva
Hemangiomas 1 card
Hemangiomas 1/4 card
Hemangiomas1/2 card
Hemi Joint Repl. Panggul Satu Sisi
Hemi Joint Replecement Panggul 1 Sisi
Hemi JoinT Replacement Panggul 2 Sisi
Hemi Joint Replecement Lutut 1 Sisi
Hemiatomi Bilateral
Hemiglosektomi
Hemiglosektomi + RNO
Hemimaksilektomi Partial
Hemimaksilektomi Total
Hemipelvektomi
Hemodialisis Baru Bicarbonat
Hemodialisis Re-use Bicarbonat
Hemosiderin
Hidro Terapi
Hidrokel per Inguinal/Ligasi Tinggi
High Below Knee Gips
Histerektomi Radikal
Histerektomi Supra Vaginal
Histerektomi Supra Vaginal + BSO
Histerektomi Total
Histerektomi Total + BSO
Histerektomi Vaginal
Hitung eosinofil
Hitung jenis leukosit
HIV Western Blot*
Holter dan Recorder
Home Exercis Eprogram
Home Exercise Program
Horseshoe Kidney Koreksi
Hot Pack/ Cold Pack
HSG
HSV I IgG
HSV II IgM
IVP
IgA/IgG/IgM
IGD Pelayanan Ambulance Keperawatan Badung
IGD Pelayanan Ambulance Keperawatan Bangli
IGD Pelayanan Ambulance Keperawatan Buleleng
IGD Pelayanan Ambulance Keperawatan Dalam Kota
IGD Pelayanan Ambulance Keperawatan Gianyar
IGD Pelayanan Ambulance Keperawatan Karangasem
IGD Pelayanan Ambulance Keperawatan Klungkung
IGD Pelayanan Ambulance Keperawatan Luar Bali
IGD Pelayanan Ambulance Keperawatan Negara
IGD Pelayanan Ambulance Keperawatan Tabanan
IgE
IgM anti Salmonella (Tubex)
Ileostomi
Ileostomi Permanen
Imunisasi
Imuno Elektroforesis Anti IgA/IgG/IgM
Imuno Elektroforesis Whole Anti Serum
Imunohistokimia > 3 jenis pemeriksaan (Kategori Sedang)
Imunohistokimia > 3 jenis pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi An
Imunohistokimia 1 jenis pemeriksaan (Kategori Sedang)

Imunohistokimia 1 jenis pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anat


Incisi Abces Peritonsil

Incisi Abses (Tindakan Bedah)
Incisi Abses (Tindakan Sederhana)
Incisi Abses Bartholine
Incisi Abses Bartolini dengan Anestesi Lokal
Incisi Abses Bartolini dengan Anestesi Umum
Incisi Abses dengan Anestesi Lokal
Incisi Abses dengan Lokal Anastesi
Incisi Abses Leher Anestesi Lokal
Incisi Abses Leher dengan Anestesi Umum
Incisi Abses Perianal
Incisi Abses Preaurikula dengan Anestesi Lokal
Incisi Abses Retroaurikuler Anestesi Lokal
Incisi Bartolin + Marsupialisasi
Incisi Biopsi Kelenjar dengan Lokal Anastesi
Incisi dan Drai Abses Sendi Dlm (Pro)
Incisi dan Drainase AB Sendi Superfisial
Incisi dan Drainase Abses Jar. Lunak
Incisi dan Kuretase Kalazion/Granuloma Anak-Anak dengan Anestesi Umum
Incisi dengan General Anastesi
Incisi Ekstra Oral
Incisi Flegmon Dasar Mulut
Incisi Furunkell Abses
Incisi Hordeolum
Incisi Intra Oral
Incisi Mucocele dengan Anestesi Lokal
Incisional Biopsi Kelenjar dengan Lokal Ans
Incisional Biopsi Tumor dengan Anestesi Lokal
Infra Red
Inhibitor VIII
Injeksi dengan Platelet Rich Plasma
Injeksi Haemoroid (termasuk obat)
Injeksi Intra Artikuler (Tindakan IGD)
Injeksi Intraartikuler dengan USG Guidance
Injeksi Triamcinolon Acetonide Kenacort lesi < 50 cm²
Injeksi Triamcinolon Acetonide Kenacort Lesi > 50 cm²
Injeksi Varises (termasuk obat)
Insulin
Internal Fiksasi Fraktur Maksilofasial 5 Tempat atau Lebih
Internal Fiksasi Fraktur Mandibula Segmental
Internal Urethrotomi
Intra Abdominal Manipulation of Small Intestine
Intubasi
IPL (Pemakaian Alat Canggih) Kaki Kanan - Kiri
IPL (Pemakaian Alat Canggih) Tangan Kanan - Kiri
IPL (Pemakaian Alat Canggih) Wajah
Irigasi Mata
Irigasi Telinga
Irigasi/Extraksi Cerumen
Irigrasi Sinus Maxilaris dengan Anestesi Umum
IT Rasio
IVA/Pap Smear
Jahit Luka Kornea dan Repair Iris
Jahit Luka Korneo Sclera
Jahit Luka Mulut < 5
Jahit Luka Mulut > 5
Jahit Luka Palpebra Full Theckness
Jamur (KOH)
Jantung Anak Penyadapan (Diagnostik)
Jasa Pembacaan Kultur
Kalazion Dewasa
Kalsium (Ca)
Kapsulektomi Posterior
Kardiosintesis + Indwelling Kateter
Kardiosintesis Tanpa Indwelling Kateter
Kateterisasi Ka/Ki Angio Valvuler
Kateterisasi Ka/Ki dengan Angio
Kateterisasi Ka/Ki Tanpa Angio
Kauter Kondiloma Akuminata
Keratoplasti
Keratoplastie Lamelar
Kista Dermoid
Kistektomi Bilateral
Kistektomi Unilateral
Koledoko Jejunostomi
Kolesistektomi Laparoskopik
Kolesterol HDL
Kolesterol LDL
Kolesterol total
Kolostomi Permanen
Kolposcopy
Konkoplasti
Konservasi Jenazah/Suntik Formalin
Konservasi Jenazah/Suntik Formalin di Luar Jam Kerja
Konsultasi Ahli Gizi
Konsultasi Dokter (Tidak jadi FNAB)
Konsultasi Dokter Gigi
Konsultasi Dokter Psychiatri
Konsultasi Dokter Spesialis
Konsultasi Dokter Spesialis di IRD
Konsultasi Farmasi Klinis Pasien Rawat Jalan
Konsultasi Gizi
Konsultasi Hasil
Konsultasi Psikologi
Konsultasi Psikologi (Tindakan Khusus ICU)
Konsultasi Psychiatri
Konsultasi Tak Langsung Dokter Spesialis/Per Telepon
Konsultasi VCT
Kontrol Protese Gigi
Kontrol Tindakan Post Operatif
Koreksi Atresia Ani
Koreksi Conoenital Talipes Eouino Varus (CTEV)
Koreksi Disartikulasi
Koreksi Ekstropion / Entropion
Koreksi Fraktur Impresif
Koreksi Priapismus
Koreksi Refraksi
Koreksi Skoliosis
Koreksi Spondilitis
Koreksi Strabismus
Koreksi Symbleparon Berat
Koreksi Symblepharon
Koreksi Tortikolis
Koronarografo
Kraniotomi + Bedah Mikro
Kraniotomi + Endoskopi
Kraniotomi/Trenpanasi Konvensional
Kreatinin
Kreatinin Clearance
Kryo Terapi
Kulit
Kultur Cairan (Likuor serebrospinalis/Ascites/Pleura/lain-lain) (Biakan Aerob)
Kultur Cairan (Likuor serebrospinalis/Ascites/Pleura/lain-lain) (Biakan Anaerob)
Kultur Darah (Biakan Aerob)
Kultur Darah (Biakan Anaerob)
Kultur Feses
Kultur GO
Kultur jamur dengan uji kepekaan
Kultur jamur tanpa uji kepekaan
Kultur Legionella
Kultur Pus/Dasarl luka/Jaringan (Biakan Aerob)
Kultur Pus/Dasarl luka/Jaringan (Biakan Anaerob)
Kultur Ruangan
Kultur Spesimen lainnya (Biakan Aerob)
Kultur Spesimen lainnya (Biakan Anaerob)
Kultur Sputum (Biakan Aerob)
Kultur Sputum (Biakan Anaerob)
Kultur TB
Kultur TB Uji Kepekaan OAT Lini I
Kultur Urine (Biakan Aerob)
Kultur Urine (Biakan Anaerob)
Kumbah Lambung
Kuretase + Steril
Kuretase 1 Gigi Close Method Non Anastesi
Kuretase Abortus/Sisa Plasenta
Kuretase Diagnostik
Kuretase Infeksi/Missed Abortion
Kuretase Open Method + Anastesi (Jahit Per Gigi)
Labioschizis Simpel
Laminektomi Kompleks
Laminektomi Sederhana
Laparoscopy
Laparoscopyc Lysis of Peritoneal Adhesion
Laparoskopi Appendektomi
Laparoskopi Diagnostik Infertilitas
Laparoskopi Operatif Adesiolis Endometriosis
Laparoskopi Operatif Hamil Ektopik
Laparoskopi Operatif Kiste Endometriosis
Laparoskopi Operatif Salfingektomi Bilateral (Hidrosalfing Bilateral)
Laparoskopi Ovarian Driling (LOD) PCOS
Laparoskopi Tubektomi Bilateral
Laparotomi Eksplorasi
Laparotomi Percobaan
Laparotomi VC
Large Film (1 Foto)
Large Film (2 Foto)
Large to Large Intestinal Anastomose
Laringektomi
Laringoskopi Indirect
Laser Iridotomi Perifer
Latihan Fisik
Lavement
LDH
LED
Le-Ford Advancement Surgery
Left Hemicolectomy
Left Lateral Anal Sphincterotomy
Lengkap (Rutin + pH + Reduksi)
Lepas Arch Barr
Lepas Beloq Tampon
Lepas Drain
Lepas Jahitan < 5 Buah
Lepas Jahitan > 5 Buah
Lepas Jahitan Palpebra < 3 Buah
Lepas Jahitan Palpebra > 3 Buah
Lepas Kateter Pria/Wanita
Lepas Tampon Hidung
LH
Ligasi Hemmorroid
Ligasi Vaskuler Ekstremitas
Limfadenektomi Ileonguinal
Limfadenektomi Retroperinoteal
Lipoma
Lithiasis
Litotripsi
Lobuloplasti Unilateral dengan Anestesi Lokal
Lokal Eksisi Kelainan pada Rectum atau Jaringan Sekitar
Long Arm Cast Anak
Long Arm Cast Dewasa
Long Leg Cast Anak
Long Leg Dewasa
Longitudinal Nefrolithotomi (Kadet)
Lopografi Proksimal/Distal
Lumbal Pungsi
Lumbal Pungsi 0 - 5 Tahun
Lumbal Pungsi Diatas 12 Tahun
Lupus Anticoagulant
Magnesium
Mahkota Jaket/Dowel Acrilic Per Gigi
Mahkota Sementara
Mahkota/Dowel Perselen Per Gigi
Maksilektomi Partialis
Maksilektomi Totalis
Malaria
Mama Aberant Unilateral
Mammografi
Mandibulektomi Marainalis
Mandibulektomi Partialis dengan Rekonstruksi
Mandibulektomi Totalis
Manicure
Mantoux Test
Marsupialisasi Abses Bartholin
Masa Iisis Euglobin
Masa Pembekuan (CT)
Masa Perdarahan (BT)
Masa Protrombin (PT)
Masektomi Radikal dengan Penyulit
Masektomi Simpel Bilateral
Massage
Massage/Vibrator
Mastektomi Radikal
Mastektomi Simple Unilateral
Mastektomi Subtotal
Mastoidektomi Radikal
Mastoidektomi Simple
MCA
Meatotomi
Medical Certificate
Medium Film (1 Foto)
Melakukan Suction
Memberi Obat Injeksi
Memberi Tranfusi Darah
Mengeluarkan Bayi dari Jenazah Ibu
Mengeluarkan Bayi dari Jenazah Ibunya
Mengeluarkan Bayi dari Jenazah Ibunya di Luar Jam Kerja
Merawat Catheter
Merawat Infus
Merawat NGT
Micro Wave Diathermy/MWD
Microsurgery (Tulang-Syaraf)
Microsurgery Ligasi Vena Spermatika
Minor Besar
Minor Kecil
Minor Sedang
Miomektomi
Moulding Dislokasi + Bandaging dengan Ga
Moulding Fraktur/Dislokasi + Gips
MRI Abdomen Atas Tanpa Kontras
MRI Abdomen Bawah Tanpa Kontras
MRI Abdomen Atas dengan Kontras
MRI Abdomen Atas Tanpa Kontras + Mrcp
MRI Abdomen Bawah dengan Kontras;
MRI Cervical Spine dengan Kontras
MRI Cervical Spine Tanpa Kontras
MRI Extremitas dengan Kontras
MRI Extremitas Tanpa Kontras
MRI Kepala dengan Kontras
MRI Kepala Tanpa Kontras
MRI Leher dengan Kontras
MRI Leher Tanpa Kontras
MRI Lumbosacral Spine dengan Kontras
MRI Lumobosacral Spine Tanpa Kontras
MRI Thoracal Spine dengan Kontras
MRI Thoracal Spine Tanpa Kontras
MRI Thorax dengan Kontras
MRI Thorax Tanpa Kontras
MRI Whole Abdomen (Atas+ Bawah) dengan Kontras
MRI Whole Abdomen (Atas+ Bawah) Tanpa Kontras
MRI Whole Spine dengan Kontras
MRI Whole Spine Tanpa Kontras
MRM tanpa Rekontruksi
Msct Cardiac
Multiple Vulnus Apertum
Myocutaneus Flap/Pectoral Mavor
Na, K, Cl (elektrolit darah)
NAP
Narkoba A mffetamin
Narkoba Barbiturat
Narkoba Benzodiazepine
Narkoba Canabis
Narkoba Opiat
Needling Muscle Band
Nefrektomi Partial
Nefrektomi Radikal
Nefro Uterektomi
Nefropexie
Nefrostomi Open
Nefrostomi Percutan
Nekrotomi Luka
Neurektomi Saraf Vidian
Neurektomi/Neurolise
Nitrogen Cair
NS1
NSE
NST (Non Stres Test)
Observasi < 2 Jam
Observasi Lebih dari 2 Jam
Odontektomi Anestesi Umum
Odontektomi dengan Anestesi Lokal
Oivertikulektomi Vesika
Oksigenasi dengan Canula
Oksigenasi dengan Masker
Oksigenasi Rebreathing/Non Rebreathing
OMD / UGI (Upper GI Sudy)
One Day Care
Open Biopsi of Breast
Open Biopsi of Liver
Open Biopsi of Salivary Gland or Duct
Open Biopsi Rektum dengan Anestesi Lokal
Open Prostatektomi
Open Reduction of Mandibula Fraktur
Open Reduction of Nasal and Zygomatic Fraktur
Open Reduktion of Alveolar Fraktur
Open Reduktion of Maxila Fraktur
Operasi Ablatio Retina
Operasi Aneurisma Aorta
Operasi Arteri Coritis
Operasi Arteri Rehalis Stenosis
Operasi Fraktur Kompleks (Acetabulum, Tulang Belakang Pelvis)
Operasi Fraktur Muka Multiple
Operasi Fraktur Tripodo/Multiple
Operasi Fronto-Orbital Advancement pada Craniosynoostosis
Operasi Fusi Korpus Vertebra Approach Posterior
Operasi Hipospadia
Operasi Ileal Condoit (Bricker)
Operasi Katarak ICCE/ECCE (Ekstraksi Katarak )
Operasi Konvensional Plexus Brakhialis/Lumbalis Sacralis/Cranialis/Spinalis Perfier
Operasi Kranioplasti/Koreksi Fraktur
Operasi Manchester Fortegil
Operasi Mega Kolon (Hirschpruoa)
Operasi Mikro Craialis/Spinalis Perifer
Operasi Mikro Plexus Brakhialis/Lumbalis Sacralis
Operasi Mikrotia
Operasi pada Atresia Esofagus
Operasi Palatoplasti
Operasi Pemasangan Fiksasi Interna pada Kasus Bedah Syaraf
Operasi Pemasangan Pintasan VA/VP Shunt
Operasi Pemasangan Traksi Cervical/dan Pemasangan Halo Vest
Operasi Peyronie
Operasi Phaceomulsifikasi + LOL
Operasi Psoas Hiscth/Boari Flap
Operasi Shunting Femoralis
Operasi Shunting Poplitea Tibialis
Operasi Shunting Splenorenal
Operasi Tumor Ganas Ovarium
Operasi Tumor Jinak Genetalia dengan Anestesi Umum
Operasi Tumor Pembuluh Darah
Operasi Tumor Spinal Daerah Gervikal
Operasi Tumor Spinal Daerah Kraniospinal
Operasi Tumor Spinal Daerah Torakolumbal
Operasi Vaskuler yang memerlukan Teknik Operasi Khusus
Operculectomy
Orbitomi Anterior
Orbitotomi Lateral
Orchidektomi Subkapsuler
Orif Fr Kom Diaf 1-2 Meta, Tar, Fa
Orif Fr Kom Diaf Ante + 2 Reg Lain
Orif Fr Kom Diaf Ante + Ibh 2 Reg Ln
Orif Fr Kom Diaf Antebra + 1 Reg Ln
Orif Fr Kom Diaf Antebrakhii
Orif Fr Kom Diaf Fem Kla Lbh 2 Reg L
Orif Fr Kom Diaf Fem, Kla + 2 Reg Ln
Orif Fr Kom Diaf Fem, Klavi + 1 Reg
Orif Fr Kom Diaf Femur, Klaficula
Orif Fr Kom Diaf Hum Lbh 2 Reg Ln
Orif Fr Kom Diaf Hume + 2 Reg Lain
Orif Fr Kom Diaf Humerus + 1 Reg L
Orif Fr Kom Diaf Kru Fat + 1 Reg Ln
Orif Fr Kom Diaf Kru Fat Lbh 2 Reg
Orif Fr Kom Diaf Kruris Fatela
Orif Fr Kom Diaf Lbh 2 Met, Tar, Fal
Orif Fr Kom Diaf Umerus
Orif Fr Perd Tlpk dan Jr Tgn/Kk Lbh 2 Jr
Orif Fr Pers Siku
Orif Fr Pers Siku + 2 Reg Lain
Orif Fr Persd Bahu, Perg Tgn + 1 Reg
Orif Fr Persd Bh, Perg Tgn Lbh 2 Reg
Orif Fr Persd Lutut, Perg Kaki Lbh 2
Orif Fr Persd Lutut, Pergl Kaki
Orif Fr Persd Panggl Lbh 2 Reg Lain
Orif Fr Persd Panggul
Orif Fr Persd Siku Lbh 2 Reg Lain
Orif Fr Persd Tlpk dan Jr Tgn/Kk + 2 Rg
Orif Fr Persd Tlpk dan Jr Tgn/Kk Lbh 2Jr
Orif Fr Persd Tlpk Jr Tgn/Kk 1 - 2 Jr
Orif Fr Pesd Bh,Perg Tgn + 2 Reg Ln
Orif Fr Pesd Lutut,Perg Kaki + 1 Reg
Orif Fr Pesd Panggl + 1 Reg Lain
Orif Fr Pesd Pangl + 2 Reg Ln
Orif Fr Pesd Siku + 1 Reg Lain
Orif Fr Pesd Tlpk dan Jari Tgn/Kaki Lbh2
Orif Fr Pesd Tlpk/Jr Tgn/ Kaki 1 - 2Jr
Orif Fr Pesen Bhu, Pegl Tgn
Orif Fr Simpel Diaf. 1 - 2 Metakarpal
Orif Fr Simpel Diaf. Femur, Klavikula
Orif Fr Simpel Diaf. Lbh Dr 2 Meta.
Orif Fr Simpel Diaf.Humerus + 1 Regio
Orif Fr Simpel Diafisis Antebrakhi
Orif Fr Simpel Diafisis Humerus
Orif Fr Smp Diaf Antebrakhii
Orif Fr Smpl Diad Lebh 2 Met Karval
Orif Fr Smpl Diaf 1 - 2 Met, Tar, Fal
Orif Fr Smpl Diaf 1 - 2 Meta Tar, Fal
Orif Fr Smpl Diaf Ante + Lbh 2 Reg
Orif Fr Smpl Diaf Fem, Kla + Lbh 2 R
Orif Fr Smpl Diaf Hum Lbh 2 Reg
Orif Fr Smpl Diaf Kru, Fat + Lbh 2 R
Orif Fr Smpl Diaf Kruris, Pat + 1 Reg
Orif Fr Smpl Diaf Lbh 2 Met, Tar, Fal
Orif Fr Smpl Diaf Lbh 2 Meta Tar, Fal
Orif Fr Smpl Diaf Ume + 2 Reg Lain
Orif Fr Smpl Diap Antebrak + 2 Reg
Orif Fr Smpl Diap Fem, Kla + 2Reg
Orif Fr Smpl Diap Kru. Fat + Reg Lain
Orif Fr Tlpk Kaki/Jari 1 - 2 Jari
Orif Fr.Smp Diaf Fem Klav 1 Reg Lain
Orif Fr.Smpl Diaf 1 s/d 2 Met Kar
Orif Frak Persd Tlpk/Jr Tgn Lbh 2 Jr
Orif Fraktur Simpel Diaf, Kruris, Fat
Orkhidektomi
Ortho Cekat/Rahang
Orthoanatic Surgery
Orthoonatie Surgery
Osteotektomi Sederhana
Osteotomi Eksisi Tulang Maksilofacial
Other Operation of Intestine
Other Prosedur of Hemmorroids
Other Repair and Plastic Operation of Tongue
Other Repair of Abdominal Wall
Other Skin Graft to Other Sites
OtherLlysis of Peritoneal Adhesion
Otoplasti THT
Otopsi bahan besar > 3 Organ
Otopsi bahan kecil (1 Organ)
Otopsi bahan sedang (2-3 Organ)
Otopsi di Dalam Jam Kerja
Otopsi di Luar Jam Kerja/Hari Libur
Oval Fat Body
Ovariektomi Bilateral
PA Besar (> 8 Blok)
PA Kecil (1-4 Blok)
PA Sedang (5-8 Blok)
Pain Intervensi Ringan
Paket Bedah Paru : Air Plumbage + Dikortikasi+Lobektomi+Muscle Plumbage + Pnemunektomi +
Segmenektomi +Torakoplasti + Omentumpexy
Palatoshizis
Pankreaktektomi
Panoramic
Pap Smear Biasa
Pap Smear Kiriman - 1 Slide
Pap Smear-Diambil di Lab PA
Pap Smear-Kiriman Slide
Parafin Bath
Parasintesa
Parasintesis
Parasintesis Telinga Bilateral
Parasintesis Telinga Unilateral
Parotidektomi Radikal + Maridibulektomi
Parotidektomy Superficial
Partus Abnormal Bayi Sungsang
Partus Abnormal ditolong Residen/Dokter Umum
Partus Abnormal ditolong Spesialis Jaga
Partus Abnormal Spesialis Khusus
Partus Kembar Ditolong Bidan Jaga
Partus Normal Bayi Kembar Oleh Spesialis
Partus Normal Bidan Khusus
Partus Normal Ditolong Residen/Dokter Umum
Partus Normal Ditolong Bidan Jaga
Partus Normal Ditolong Spesialis Jaga
Partus Normal Spesialis Khusus
Pasang Arch Barr (Interdental Wiring)
Pasang Arteri Line
Pasang Bidai/Spalk
Pasang Bidai/Splint/Spalk
Pasang Central Venous Catheter (CVC)
Pasang Colar Brace
Pasang Collar Brace
Pasang dan Lepas Kateter Bayi
Pasang Doublelumen Hemodialisis
Pasang Elastic Bandage
Pasang Foley Kateter
Pasang Gips
Pasang Gips
Pemasangan Gips
Pasang Gips Ekstremitas
Ps. Gips Ekstremitas
Pasang Gips Tulang Belakang
Pasang Infus Anak
Pasang Infus Anak (Tindakan Khusus Perinatologi)
Pasang Infus Bayi
Pasang Infus Bayi/Konsul
Pasang Infus Dewasa
Pasang Infuse Umbilical
Pasang/Lepas Infus Umbilikalis
Pasang IUD Pasca Plasenta
Pasang Kateter dengan Alat Bantu
Pasang Kateter dengan Penyulit
Pasang Kateter Folley Bag
Pasang KB
Pasang Mitella/Pembalut Elastis
Pasang Monitor
Pemasangan Monitor
Pasang Monitor Per Hari
Pasang NGT
Pasang PASG
Pasang Pesarium
Pasang Sling
Pasang Spalk
Pasang Tampon pada Hidung/Telinga
Pasang Tampon pada Vagina
Pasang Tindik
Pasang Tindik pada Telinga
Pasang Tindik Tembak
Pasang Traksi Kulit (Ekstremitas, Kepala)
Pasang Traksi Tulang Ekstremitas
Pasang Traksi Tulang Kepala
Pasang Traksi Vertebra (Tulang Selangkang)
WSD (Water Seal Drainage)
Revisi WSD
Pasang WSD
Pemasangan WSD (diluar alat)
Pasang WSD Continus
Thoracostomy (WSD) Bilateral
Thoracostomy (WSD) Unilateral
Pasang/Angkat Buak Gips Sirkular
Pasang/Buka Susuk KB
Pasang/Lepas Pesarium
PCR Chlamydia
PCR GO
PCR Legionella
PCR Mycoplasma
PCR RABIES
PCR Streptococcus
PCR TB
PCR Ureaplasma
Pedicure
Peeling
Pelayanan Akupuntur ke Ruang Rawat Inap Tambahan Biaya
Pelayanan Ambulance Medik Spesialis Badung
Pelayanan Ambulance Medik Spesialis Bangli
Pelayanan Ambulance Medik Spesialis Buleleng
Pelayanan Ambulance Medik Spesialis Dalam Kota
Pelayanan Ambulance Medik Spesialis Gianyar
Pelayanan Ambulance Medik Spesialis Karangasem
Pelayanan Ambulance Medik Spesialis Klungkung
Pelayanan Ambulance Medik Spesialis Luar Bali
Pelayanan Ambulance Medik Spesialis Negara
Pelayanan Ambulance Medik Spesialis Tabanan
Pelayanan Ambulance Medik Umum Badung
Pelayanan Ambulance Medik Umum Bangli
Pelayanan Ambulance Medik Umum Buleleng
Pelayanan Ambulance Medik Umum Dalam Kota
Pelayanan Ambulance Medik Umum Gianyar
Pelayanan Ambulance Medik Umum Karangasem
Pelayanan Ambulance Medik Umum Klungkung
Pelayanan Ambulance Medik Umum Luar Bali
Pelayanan Ambulance Medik Umum Negara
Pelayanan Ambulance Medik Umum Tabanan
Pelayanan Spa ke Ruang Rawat Inap Tambahan Biaya
Pemakaian C - PAP
Pemasangan CPAP
Pemakaian Ventilator pada Bayi
Pemasangan CVP
Pemasangan Endotracheal Tube
Pemasangan Epidural/Chateter
Pemasangan Infusion Pump
Pemasangan Paper Patch Komprehensif
Pemasangan Paper Patch Sederhana
Pemasangan Peritoneal Dialysis - diluar Alat
Pemasangan Pipa Shepard
Pemasangan Ransel Perban, Colar dan Cuf, Back Slab Cast, Bandage
Pemasangan Skin Traksi
Pemasangan Swan Ganz Catheter
Pemasangan Syring Pump
Pemasangan Tampon Telinga
Pemasangan Timpanic Tube dengan Anestesi Lokal
Pemasangan Timpanic Tube dengan Anestesi Umum
Pemasangan Ventilator
Pembedahan Fore Quarter
Pembuatan Plat Orthodontik/Rahang
Pembuatan Stoma (Gastrostomy, Iliostomy, Kolostomy, Sigmoidostomi)
Pemeriksaan atau Check Up Per Kunjungan
Pemeriksaan Fungsi Luhur
Pemeriksaan Neuroligi Sederhana
Pemeriksaan Neuroopthalmologi
Pemeriksaan PA besar (> 8 Blok)
Pemeriksaan PA kecil ( 1-4 Blok)
Pemeriksaan PA sedang ( 5-8 Blok)
Pemeriksaan Visus
Pemutihan Gigi (Bleaching)/Rahang
Penambahan Protese Per Gigi (Akrilik)
Pencabutan Gigi dengan Anestesi Lokal (Tindakan Sederhana)
Cabut Gigi Tetap dengan Lokal Anastesi
Pencabutan Gigi dengan Komplikasi dan Open Method
Pencabutan Gigi dengan Topical Anestesi
Cabut Gigi dengan Penyulit
Penektomi Parsial
Pengambilan Darah Bayi
Pengambilan Spesimen Darah Anak/Bayi
Pengambilan Spesimen Darah Dewasa
Pengangkatan Bnd Asg di Ekstremitas
Pengangkatan Bnd Asg di Tlg Belkg
Pengangkatan Neuro Fibroma
Pengangkatan Nevus Marga Palpebra
Pengangkatan Skin Tag
Pengangkatan Tandur Kulit
Pengelolaan Jalan Napas/Nebulizer
Penggantian Cairan/Training
Pengisian Saluran Akar (Gigi Permanen)
Pengisian Saluran Akar Gigi Sulung
Pengobatan Epistaksis
Penjahitan Jenazah < 25 Cm
Penjahitan Jenazah > 100 Cm
Penutupan Oroantral Fistula
Penyadapan Angio Valvuler + Koroner
Penyesuaian Gigitan
Penyimpanan Jenazah dengan Cooling/Hari
Penyimpanan Jenazah Tanpa Cooling/Hari
Perawatan Gips : Tulang Belakang
Perawatan Gips: Lac, Sac, Bkc
Perawatan Gips: LLC, Body Spica
Perawatan Jenazah
Percutaneous Nephrolithostripsy (PCNL)
Pericardiuocentesis
Perikardiosintesis Tanpa G A
Perineorafi Anestesi Lokal
Perineorafi Anestesi Umum
Perineorafi Sub Total Anestesi lokal
Perineorafi Sub Total dengan Anestesi Umum
Persalinan Tanpa Nyeri
Persiapan Pasien Pre Op
Pewarnaan Acid Phospatase
Pewarnaan Besi
Pewarnaan Gram
Pewarnaan Sumsum Tulang
Phaceomulsifikisi
Phacoemulsifikasi
Pijat Refleksi 1 Jam
Pijat Refleksi 30 Menit
Pijat Refleksi ke Ruang Rawat Inap Tambahan Biaya
Placenta Manual Partus Luar
Platelet Antobodi
Pleurodesis
Pleurodesis (Pleurosklerosis)
Port Wine Stain 1 card
Port Wine Stain 1/2 card
Postero Saaital Anorectoplasty (PSA)
Potong Flap
Premedikasi
Preparasi Saluran Akar
Progesteron
Prolactine
Prosedure Sistrunk Kista Duktus Tiroglosus
Prostat Specific Antigen (PSA)
Prostatektomi Radikal
Protein Bence Jones
Protein Kuantitatif
Protein total
Protese (Akrilik Full Denture/Per Rahang)
Protese 1 Gigi/Gigi Pertama (Akrilik)
Psikoterapi Edukasi
Psikoterapi Kognitif
Psikoterapi Suportif
Psikoterapi Suportip
Ptergium + CLG
Pterigoplasti
Pterygium
Pthisis Bulbi (Graf Mukosa Bibir)
Ptosis
Pulp Capping
Pulpotomi
Punctie Cairan Acites
Punctie Cairan Sendi
Punctie Daun Telinga
Punctie Pleura
Pungsi Ascitas
Pungsi Aspirasi Hematoma/Seroma
Pungsi Batu
Pungsi Cairan Otak dengan Anestesi
Pungsi Efusi Pleura
Pungsi Hematoma Telinga
Punksi Pleura
Puntie Hematros
Pyelolithotorni
Pyeloplasti
QS Pixel Freckles 1 card
QS Pixel Freckles 1/2 card
QS Pixel Lentigo 1 card
QS Pixel Lentigo 1/2 card
QS Pixel Melasma 1 card
QS Pixel Melasma 1/2 card
RJP
Radical Neck Desection
Rartial Spleenctomy
Rawat Luka Bakar < 10%
Rawat Luka Bakar Diatas 1% - 20%
Luka Bakar 20%
Perawatan Luka Bakar Derajat II - III Lebih 20%
Perawatan Luka Bakar Derajat II 15% - 20%
Perawatan Luka Bakar Derajat II s/d 15%
Rawat Luka Post Op Mastoidektomi
Rawat Luka Post Op Sinus/Hidung
Rawat Stoma Trakeostomi
Rebasing Gigi Tiruan/Rahang
Reclosure of Postoperative Disruption of Abdominal Wall
Rectal Swab
Rectal Swab (Indentifikasi Otomatis Vitek)
Rectal Terapi
Rectoscopy
Rectoskopi/Anoskopi
Reduksi Prolap Anus
Reduksi urin
Rehab Jantung
Rehab Obesitas
Rehab Paru
Rehab Stroke
Rehabilitasi Vertibuler
Rekanalisasi Ruptura/Transkanal
Rekonstruksi Blassemeck
Rekonstruksi Defek/Kelainan Tubuh yang Kompleks
Rekonstruksi Duktus Lacrimalis/Stenosis Sederhana
Rekonstruksi Kelainan Jari/Ekstrimitas (Polidaktili, Sindaktili, Construction Hand) Sederhana
Rekonstruksi Kelopak Mata Berat
Rekonstruksi Kelopak Mata/Kontraktur Palpebra
Rekonstruksi Kontraktur Kompleks
Rekonstruksi Laserisasi Daun Telinga
Rekonstruksi Lebih Satu Jari
Rekonstruksi Menfngokel Kranial (Anterior/Posterior)
Rekonstruksi Meninaokel Spina Bifida
Rekonstruksi Orbita Conaenital
Rekonstruksi Renovaskuler
Rekonstruksi Saket Berat
Rekonstruksi Satu Jari
Rekonstruksi Tgk Bahu/Panggl 1 Sisi
Rekonstruksi Tgk Manus/Pedis 1 Sisi
Rekonstruksi Tgk Siku/Litut 1 Sisi
Rekonstruksi Tgk Siku/Lutut 2 Sisi
Rekonstruksi Tgk Wrist/Ankle 1 Sisi
Rekonstruksi Vesika
Rekonstruksi/flap
Rekostruksi Tgk Manus/Pedis 2 Sisi
Release Kontraktur Mandibula
Rellining Full Dentur Per Rahang
Rellining Partial Dentur Per Rahang
Removal of Foreign Body From Peritoneal Cavity
Reopening of Rescent Laparotomy Site
Repair Anal Sphincter Lainnya
Repair Burst Abdoment/Dehiscensi/Luka
Repair Daun Telinga
Repair Filitel Uretra Pasca Uretroplasi
Repair Herniasi Muscle
Repair Laserasi Hepar pada Trauma
Repair Lobulus Telinga Bilateral dengan Anestesi Lokal
Repair Lobulus Telinga Unilateral dengan Anestesi Lokal
Repair of Direct Inguinal Hernia (diluar mesh)
Repair of Femoral Hernia Unilateral
Repair of Indirect Inguinal Hernia (diluar mesh)
Repair of Other Hernia of Anterior Wall With Prosthesis
Repair of Umbilical Hernia
Bilateral Repair of Direct Inguinal Hernia (diluar mesh)
Bilateral Repair of Indirect Hernia
Bilateral Repair of Inguinal Hernia, One Direct and One Indirect
Bilatreal Repair of Femoral Hernia
Repair Ruptur Buli-buli
Repair Ruptur Kornea Sklera
Repair Ruptur Palpebra Simple
Repair Ruptur Palpebra Transkanal
Repair Ruptur Tendon Achiles
Repair Tendon Jari Tangan
Repair Tendon Jari Tangan (Diatas 2 Buah)
Repair Vagina dan Robekan Total Perinium
Repair Vagina dengan GA
Repair Velsco Vagina Fistel Kompleks
Reparasi Protese
Reparasi Vistula Vesiko Vaginal
Replantasi
Replantasi Distal Wrist
Replantasi Proksimal Wrist
Reposisi
Reposisi + Gips Ekst Atas 2 Sisi
Reposisi + Gips Ekstr. Bawah 1 Sisi
Reposisi + Gips Ekstremitas Atas 1 Sisi
Reposisi dengan Anastesi
Reposisi dengan Anastesi Lokal
Reposisi Dislokasi Bahu
Reposisi Dislokasi MT Joint dengan Anastesi
Reposisi Dislokasi MT Joint tanpa Anastesi
Reposisi Dislokasi Sendi Mandibula
Reposisi Ekstremitas Atas dengan Anastesi Umum
Reposisi Ekstremitas Atas Tanpa Anastesi
Reposisi Ekstremitas Bawah Tanpa Anastesi
Reposisi Fiksasi (Compucate)
Reposisi Fistel
Reposisi Fr. Os Nasal + Pasang Gips Kupu-Kupu
Reposisi Fraktur dan Atm Dislokasi
Reposisi Fraktur dan Dislokasi
Reposisi Fraktur Os Nasal (Hidung)
Reposisi Fraktur Tertutup Sederhana Ekstrimitas dengan Gips
Reposisi Gigi Per Regio
Reposisi Haemorrhoid
Reposisi LOL
Reposisi Long Arm dengan Anastesi Umum
Reposisi Long Arm Gips dan Long Leg Tanpa Anastesi Umum
Reposisi Long Leg dengan Anastesi Umum
Reposisi MT Joint
Reposisi Os Nasal
Reposisi Short Arm dengan Anastesi Umum
Reposisi Short Arm Tanpa Anastesi Umum
Reposisi Tertutup Fraktur Condilus Mandibula
Reposisi Torsio Testis dengan Orkhidopeksi
Reposisi+Gips Ekstremitas Atas 1 Sisi
Resection of Transverse Colon
Reseksi Anastomosis
Reseksi Esofagus + Interosisi Kolon
Reseksi Hepar
Reseksi Partial Vesika
Reseksi Rahang
Reseksi Urachus
Reshapino untuk Torus/Tumor Tulang
Restrain
Resusitasi Bayi Asphiksia
Resusitasi Bayi Baru Lahir
Ret Cam + Anestesi
Retikulosit
Retraksi Bekuan
Retrograe Pyelografi (Rpg)
Revisi AV Shunt
Revisi Trakeostomy
Revision of Anastomose of Small or Large Intestine
Revision of Stoma of Large Intestine
Revision of Stoma of Small Intestine
RF (Rheumatoid Factor)
Right Hemicolektomi
Rinotomi Lateral
Rinotomi Literalis
Rinotomi Literalis (Tindakan Khusus)
Rosacea 1 card
Rosacea 1/2 card
Rosacea 1/4 card
Rosacea 3/4 card
RPLND
Ruptur Palpebra Moderat
Salpingo-Ooporektomy Bilateral (Tind.Med.Bes.1)
Salpingo-Ooporektomy Unilateral
Salvagino Operasi Mikro
Sambung Tendon Parsial
Sambung Tendon Total
Saturasi Oksigen
Scalling Per Rahang
Scheral Buckel
Scleroterapi dan atau Ligasi Hemangioma
Screening Hypotyroid
Screening OAE
Screening Pendengaran pada Bayi
Segmentektomi
Seksio Sesarea
Seksio Sesarea + Histerektomi
Seksio Sesarea dengan Hamil Ganda
Seksio Sesarea dengan Hamil Ganda dengan Steril
Seksio Sesarea dengan Penyulit (Riwayat SC)
Seksio Sesarea dengan Steril
Sel LE
Septoplasti
Septoplasti EC Trauma Hidung
Septorinoplasti THT
Septum Reseksi
Sequesterektomi dengan Anestesi
Serum Iron Binding Capacity (SIBC)
SGOT
SGPT
SWD
Short Wave Diathermy/SWD
Sialografi
Simpatektomi
Simple Functional Neuro Surgery
Sindroma Blefaophimosis
Sinuskopi
Siok Saraf Tepi
Siptoplasti Reduksi
Siringoma 1 card
Siringoma 1/2 card
Siringoma 1/4 card
Siringoma 3/4 card
Sirklase
Sirkumsisi dengan Anestesi Lokal
Sirkumsisi dengan Anestesi Umum
Sirkumsisi One Day Care
Sistektomi Radikal
Sistostomi dengan Anastesi Lokal
Sistostomi dengan Anestesi Umum
Skin Lightening 1 card
Skin Lightening 1/2 card
Skin Prick Test Alergen Debu dan Makanan
Skin Prick Test Alergen Debu/Makanan
Skin Tractie/Pasang Traksi Kulit
Skingraftina yang Luas
Skingraftina yang Tidak Luas
Sklera Buckling
Skleroterafi Ligasi 1 Ikatan
Skleroterafi Ligasi Lebih dari 6 Ikatan
Skleroterapi Vena (Varises, Hemangiona)
Sklerotomi
Skrining MRSA (tenggorokan,hidung, lipatan paha/ketiak)
Sleep Nasoendoscopy
Slit Lamp (Pelayanan Eksekutif Rawat Jalan)
Slit Lamp (Tindakan Mata)
Slit Lamp Examination
Small Film (1 Foto)
Small Film (2 Foto)
Small to Small Intestinal Anastomose
Smooth Muscle Antibody (SMA)
Solenektomi
Somnoplasti
Sondage Canaliculi Lacrimaris
Spalks Long 80 - 100 Cm
Speech Audiometer
Spirometri
Splenektomi
Splinting Per Rahang
Split Thickness Skin Graft
Spoel Kateter
Spooling Bola Mata
Spooling Cateter Post Turp Bph
Spyrometri
SSR Freckles 1 card
SSR Freckles 1/2 card
SSR Lentigo 1 card
SSR Lentigo 1/2 card
SSR Melasma 1 card
SSR Melasma 1/2 card
Stab Anterior Vertb Servikal
Stab Anterior Vertb Thorako - Lumbal
Stab Post Vertb Thorako - Lumbal
Stabil Anterior Vertb dan Fusion
Stabil Post Vertb dan Fusion
Stabil Posterior Vertb Servikal
Stapedektomi
Starbimus (3 - 4) Otot
Sterilisasi Saluran Akar
Stripping Varises Ektremitas Inferior
Sugar Water Test
Sulih Tulang Besar
Suntik Keloid
Suprapubic Punctie
Surat Keterangan Bebas Narkoba (Pelayanan Psikoterapi)
Surat Keterangan Buta Warna
Surat Keterangan Sehat
Surat Keterangan Sehat Jiwa
Surat Keterangan Sehat Untuk ke Luar Negeri
Surgical Stagina
Suture of Laceration of Large Intestine
Suture of Laseration of Anus
Suture of Laseration of Small Intestine, Except Duodenum
Synovektomi
T Cel dan B Cel
T3 Total
T4 Total
Tambahan Ekspansi Atau Screw Orthodontik
Tampon Uterus/Kondom Kateter
Tampon Vagina
Taping dan Strapping
Tatto Removal 1 card
Tatto Removal 1/2 card
Telangietacstatitas 1 card
Telangietacstatitas 1/2 card
Temporal Bone Resection
Temporary Peacemaker
Tendo Plasty
Tendon Fleks. Lbh 2 Jr Luar Man Area
Tendon Fleks. 2 Jr Didlm Nm Landarea
Tennoraphy Tendon Ekst dari 2 Jari
Tennoraphy Tendon Ekst Lebih 2 Jari
Tennoraphy Tendon Ekstensor 1 Jari
Tenoraphy Ten. Fleks 2 Jr diluar
Tenoraphy Tendon Flek Lbh 2 Jr didlm
Tenorapy Tendon Fleksor 1 Jari
Tenorraphy Satu Tendon Ekstensor Jari
Tens
Terapi Bermain/Support
Terapi Klp Asma
Terapi Klp Stroke
Terapi Laser
Terapi Latihan Asma
Terapi Latihan Fraktur
Terapi Latihan Stroke
Terapi Okupasi (4x tindakan)
Terapi Wicara (4x tindakan)
Tes Anak Berkebutuhan Khusus
Tes IQ Individu
Tes Ishihara (Buta Warna)
Tes Kehamilan (25 mIU/mL)
Tes Kejiwaan (MMPI)
Tes Narkoba per Parameter
Tes Pembauan, Pengecapan
Test Garputala
Testosteron
Timpanometri
Timpanoplasti Tipe I/Miringoplasti
Timpanoplasti Tipe II
Timpanoplasti Tipe III
Timpanoplasti Tipe IV
Tindakan Anastesi Diagnostik
Tindakan Anoscopy
Tindakan Argon laser/Kenon
Tindakan Bedah Beku
Tindakan Bedah Flap
Tindakan Blok Reseksi
Tindakan Congenital Fornix Plastik
Tindakan Cryosurgery
Tindakan Cuci Sinus (Perawatan)
Tindakan Cyclodia Termi
Tindakan Deepening Sulcus
Tindakan Dekomoresi Fasialis
Tindakan Dekompresi Fasialis
Tindakan Dermabrasi
Tindakan Electro Convulsive Therapy (ECT)
Tindakan Medik Besar 1
Tindakan Medik Besar 1A
Tindakan Medik Canggih 1
Tindakan Medik Canggih 1A
Tindakan Medik Kecil 1
Tindakan Medik Kecil 1A
Tindakan Medik Khusus 1
Tindakan Medik Khusus 1A
Tindakan Medik Sedang 1
Tindakan Medik Sedang 1A
Tindakan Medik Sederhana 1
Tindakan Medik Sederhana 1 A
Tindakan Medik Sederhana 2A
Tindakan pada Keratosis Seboroika Lesi < 20
Tindakan pada Keratosis Seboroika Lesi > 20
Tindakan pada Kolpodeksis
Tindakan Pelayanan Gizi
Tindakan Pembuatan Visum Et Repertum Korban Hidup
Tindakan Pharnaeal Flap
Tindakan Psikologi
Tindakan Psikoterapi
Tindakan Roser Plasty
TIROID
Tiroid Lobektomi Unilateral
Tiroidektomi Complete
Tiroidektomi Parsial Lainnya
Tiroidektomi Subtotal
Toilet Hidung
Toilet Telinga
Tonometri
Tonometri Aplanasi
Tonometri Schiotz
Tonsilektomi
Tonsilo Adenoidektomi
Torakosentesis
Torakotomi
Total Iron Binding Capacity (TIBC)
Total Joint Replacement 1-2 Jari
Total Joint Replacement Lebih 2 Jari
Total Joint Replacement Panggul 1 Sisi
Total Joint Replacement Siku/Lutut 1 Sisi
Total Tiroidektomi
TPHA
Trabekulektomi
Trabekulektomi + ECCE/Phaceomulsifikasi
Trakeostomi dengan Penyulit Tumor pada Akses Trakea
Trakeostomi Temporary
Traksi Cervical dan Lumbal
Traksi L/C
Transeksi Esofagus
Transferrin
Treadmill
Trigliserida
Trikeopitelioma
Triple Produser Keratiplasti dengan Glaukoma
Trocar Sistostomi
Tromboplastin Generation Time (TGT)
Trombotest
Troponin I
TSHS
TTGO (5x GDS)
Tubektomi
Tumor Ganas/Adneksa Luas dengan Rekonstruksi
Tumpatan Composite Light Cure
Tumpatan Glass Ionomer
Tumpatan Inlay, Onlay, dan Uplay
Tumpatan Sementara 1 Gigi Tanpa/dengan Open Boor
TUR Prostat
TUR Tumor Buli-Buli
Turbinektomi/Konkotomi
Turbinoplasti
Ultra Sound Diathermy/USD
Up Inter Dental Wire
Upperculectomy
Urea Clearance
Uretero Sigmoidostomi
Uretero Ureterostomi
Ureterocutaheostomi
Ureterolisis
Ureterolithotomi
Ureteroneo Sistostomi
Ureterostomi
Urethrektomi
Urethrenuskopi (URS)
Uretrografi
Uretroplasti
Ureum
Urin lengkap (Rutin + Sedimen)
Urine dan Sputum Seri 3 Kali
Urine, Sputum dan Sitologi Eksfoliatif lainnya (Bronchoscopy, Bronchial washing)
Urine, Sputum dan Sitilogi Eksfoliatif lain
USD
USG
USG 2D
USG 4 Dimensi
USG Abdomen Atas
USG Abdomen Atas
USG Abdomen Atas dan Bawah
USG Abdomen Bawah (Pelayanan Eksekutif Rawat Jalan)
USG Abdomen Bawah (Pelayanan Penunjang Diagnostik, Tidak Termasuk Obat Kontras Media)
USG Doppler Testis
USG Doppler Vascular (1 Extremitas)
USG Mamma/Payudara
USG Organ
USG Pelvis/Gynaecology
USG Transvaginal
USG Tyroid
USG Urologi
Uteroplasti
Vaginal Swab
Vaginoplasti
Vasektomi dengan Anestesi Lokal
Vasektomi dengan Anestesi Umum
Vasografi
Vasoligasi V Spermatika (Varicocele) Unilateral
VDRL
Vena Sectie
Vena Seksi dengan Anestesi Lokal
Venous Lake 1 card
Venous Lake 1/2 card
Ventrikulostomi/VE Drainase
Vesicolithotomi (Sectio Alta)
Visite Ahli Gizi
Visite Dokter Residen
Visite Dokter Spesialis
Visite Dokter Spesialis di Intermediate
Visite Dokter Umum
Visite Dokter Umum di Intermediate
Visite Farmasi Klinis
Visite Farmasi Klinis Pasien Rawat Inap
Visum - Otopsi
Visum - Otopsi - Hari Libur
Visum - Pemeriksaan Jenazah Bagian Luar Saja
Visum - Pemeriksaan Jenazah Bagian Luar Saja - Hari Libur
Visum di Luar RS - TKP dengan Penggalian
Visum Luar RS - TKP (diluar Rumah Sakit)
Visum Mayat
Visum Mayat di Luar Jam Kerja
Vitamin B12
Vitrektomi + Endo Laser + SB + Silicon Oil/Gas
Vulnum Amputatum Sederhana
Vulnus Apertum < 5 Jahitan
Vulnus Avertum > 10 Jahitan
Vulnus Avertum 5 - 10 Jahitan
Vulnus Excoriatum
Vulvektomi
Whole Face Rejuvenation
Widal
Wide Eksisi Soft Tisue Tumor
Wide Exc Tumor Tl + Rek Bahu/Panggul
Wide Exc Tumor Tl + Rek Siku/Lutut
Wide Exc Tumor Tl + Rek Tlpk dan Jari Tgn
Wide Exc Tumor Tl + Rek Wrist/Ankle
Wide Excision Tumor Tulang 1 Reg
Wrinkle Around Eyes 1 card
Wrinkle Around Eyes 1/2 card
WT dan HT 1 - 10 Jahitan
WT dan HT Lebih dari 20 Jahitan
WT dengan Luka Kecil (1 - 3 Lebar Kasa/Gaas)
Yag Laser
Zonde Feeding

Rawat Jalan Dasar
Rawat Jalan Umum/Gigi
Rawat Jalan Spesialis
Rawat Jalan VIP/Eksekutif

Gawat Darurat Dasar
Gawat Darurat Umum/Gigi
Gawat Darurat Spesialis
Gawat Darurat Spesialis Cito/Konsul
1. PELAYANAN RAWAT INAP

Tarif Kelas III
- Kelas III Umum
- Kelas III Spesialis
- Kelas III Spesialis Libur/Konsul
Tarif Kelas II
- Kelas II Umum
- Kelas II Spesialis
- Kelas II Spesialis Libur/Konsul
Tarif Kelas I
- Kelas I Umum
- Kelas I Spesialis
- Kelas I Spesialis Libur/Konsul
Tarif VIP
- VIP Spesialis
- VIP Spesialis Libur/Konsul
Tarif VVIP
- VVIP Spesialis
- VVIP Spesialis Libur/Konsul
Tarif Suite
- Suite Spesialis
- Suite Spesialis Libur/Konsul
Tarif ICU/ICCU/HCU
- ICU/ICCU/HCU Spesialis
Tarif NICU/PICU
- NICU/PICU Spesialis
- NICU/PICU Spesialis Libur/Konsul
Tarif (Rp)
Jasa
Jasa Sarana Jumlah
Pelayanan
24,000 16,000 40,000
36,000 24,000 60,000
180,000 120,000 300,000
270,000 180,000 450,000
120,000 80,000 200,000
600,000 400,000 1,000,000
120,000 80,000 200,000
90,000 60,000 150,000
21,000 14,000 35,000
45,000 30,000 75,000
36,000 24,000 60,000
45,000 30,000 75,000
327,000 218,000 545,000
150,000 100,000 250,000
120,000 80,000 200,000
390,000 260,000 650,000
390,000 260,000 650,000
210,000 140,000 350,000

120,000 80,000 200,000
2,250,000 1,500,000 3,750,000
2,280,000 1,520,000 3,800,000
6,480,000 4,320,000 10,800,000
79,800 53,200 133,000
120,000 80,000 200,000
123,000 82,000 205,000
48,000 32,000 80,000
36,000 24,000 60,000
36,000 24,000 60,000
42,000 28,000 70,000
15,000 10,000 25,000
47,190 31,460 78,650
33,000 22,000 55,000
18,000 12,000 30,000
180,000 120,000 300,000
300,000 200,000 500,000
225,000 187,500 37,500 ± 15
315,000 262,500 52,500 ± 35
630,000 525,000 105,000 ± 50
990,000 825,000 165,000 ± 100
315,000 262,500 52,500 ± 35
990,000 825,000 165,000 ± 100
832,500 693,750 138,750 ± 80
315,000 262,500 52,500 ± 35
630,000 525,000 105,000 ± 50
4,590,000 3,060,000 7,650,000
6,885,000 4,590,000 11,475,000
9,180,000 6,120,000 15,300,000
5,737,200 3,824,800 9,562,000
2,754,000 1,836,000 4,590,000
1,836,000 1,224,000 3,060,000
2,295,000 1,530,000 3,825,000
3,213,000 2,142,000 5,355,000
4,590,000 3,060,000 7,650,000
3,213,000 2,142,000 5,355,000
3,672,000 2,448,000 6,120,000
3,213,000 2,142,000 5,355,000
2,295,000 1,530,000 3,825,000
1,836,000 1,224,000 3,060,000
1,377,000 918,000 2,295,000
1,380,000 920,000 2,300,000
2,940,000 1,960,000 4,900,000
609,000 406,000 1,015,000
918,000 612,000 1,530,000
918,000 612,000 1,530,000
240,000 160,000 400,000
450,000 300,000 750,000
105,600 70,400 176,000
2,790,000 1,860,000 4,650,000
2,790,000 1,860,000 4,650,000
120,000 80,000 200,000
60,000 40,000 100,000
60,000 40,000 100,000
150,000 100,000 250,000
37,800 25,200 63,000
760,200 506,800 1,267,000
3,213,000 2,142,000 5,355,000
2,754,000 1,836,000 4,590,000
36,000 24,000 60,000
2,280,000 1,520,000 3,800,000
2,790,000 1,860,000 4,650,000
1,380,000 920,000 2,300,000
121,800 81,200 203,000
459,000 306,000 765,000
1,147,200 764,800 1,912,000
1,836,000 1,224,000 3,060,000
2,754,000 1,836,000 4,590,000
688,200 458,800 1,147,000
22,200 14,800 37,000
121,800 81,200 203,000
688,200 458,800 1,147,000
240,000 160,000 400,000
2,550,000 1,700,000 4,250,000
2,790,000 1,860,000 4,650,000
1,560,000 1,040,000 2,600,000
168,000 112,000 280,000
118,800 79,200 198,000
144,000 96,000 240,000
42,900 28,600 71,500
123,000 82,000 205,000
93,000 62,000 155,000
120,000 80,000 200,000
58,800 39,200 98,000
58,800 39,200 98,000
96,000 64,000 160,000
33,000 22,000 55,000
66,000 44,000 110,000
66,000 44,000 110,000
66,000 44,000 110,000
66,000 44,000 110,000
38,940 25,960 64,900
38,940 25,960 64,900
135,000 90,000 225,000
135,000 90,000 225,000
123,000 82,000 205,000
120,000 80,000 200,000
120,000 80,000 200,000
72,600 48,400 121,000
304,200 202,800 507,000
2,280,000 1,520,000 3,800,000
4,050,000 2,700,000 6,750,000
3,375,000 2,250,000 5,625,000
120,000 80,000 200,000
18,000 12,000 30,000
18,000 12,000 30,000
45,000 30,000 75,000
45,000 30,000 75,000
2,754,000 1,836,000 4,590,000
2,295,000 1,530,000 3,825,000
3,213,000 2,142,000 5,355,000
4,590,000 3,060,000 7,650,000
3,213,000 2,142,000 5,355,000
2,295,000 1,530,000 3,825,000
3,672,000 2,448,000 6,120,000
2,754,000 1,836,000 4,590,000
3,672,000 2,448,000 6,120,000
3,213,000 2,142,000 5,355,000
1,836,000 1,224,000 3,060,000
2,754,000 1,836,000 4,590,000
2,295,000 1,530,000 3,825,000
2,295,000 1,530,000 3,825,000
2,295,000 1,530,000 3,825,000
3,213,000 2,142,000 5,355,000
2,295,000 1,530,000 3,825,000
2,754,000 1,836,000 4,590,000
36,000 24,000 60,000
16,800 11,200 28,000
12,000 8,000 20,000
15,000 10,000 25,000
182,400 121,600 304,000
182,400 121,600 304,000
54,600 36,400 91,000
60,000 40,000 100,000
93,000 62,000 155,000
15,000 10,000 25,000
360,000 240,000 600,000
165,000 110,000 275,000
163,350 108,900 272,250
28,500 19,000 47,500
159,600 106,400 266,000
60,000 40,000 100,000
1,380,000 920,000 2,300,000
2,790,000 1,860,000 4,650,000
2,280,000 1,520,000 3,800,000
42,000 28,000 70,000
36,000 24,000 60,000
30,000 20,000 50,000
22,200 14,800 37,000
240,000 160,000 400,000
450,000 300,000 750,000
36,000 24,000 60,000
150,000 100,000 250,000
3,900,000 2,600,000 6,500,000
3,000,000 2,000,000 5,000,000
180,000 120,000 300,000
1,320,000 880,000 2,200,000
36,000 24,000 60,000
115,500 77,000 192,500
289,200 192,800 482,000
96,000 64,000 160,000
72,000 48,000 120,000
4,050,000 2,700,000 6,750,000
4,050,000 2,700,000 6,750,000
15,000 10,000 25,000
15,000 10,000 25,000
15,000 10,000 25,000
81,000 54,000 135,000
195,600 130,400 326,000
600,000 400,000 1,000,000
3,621,000 2,414,000 6,035,000
180,000 120,000 300,000
150,000 100,000 250,000
262,500 175,000 437,500
165,000 110,000 275,000
1,410,000 940,000 2,350,000
121,500 81,000 202,500
159,600 106,400 266,000
1,285,800 857,200 2,143,000
243,600 162,400 406,000
1,410,000 940,000 2,350,000
1,560,000 1,040,000 2,600,000
150,000 100,000 250,000
2,280,000 1,520,000 3,800,000
1,560,000 1,040,000 2,600,000
120,000 80,000 200,000
1,200,000 800,000 2,000,000
525,600 350,400 876,000
120,000 80,000 200,000
120,000 80,000 200,000
2,550,000 1,700,000 4,250,000
33,000 22,000 55,000
3,480,000 2,320,000 5,800,000
243,600 162,400 406,000
262,500 175,000 437,500
262,500 175,000 437,500
168,000 112,000 280,000
25,800 17,200 43,000
3,297,600 2,198,400 5,496,000
3,960,000 2,640,000 6,600,000
71,400 47,600 119,000
27,000 18,000 45,000
105,000 70,000 175,000
76,800 51,200 128,000
51,600 34,400 86,000
48,000 32,000 80,000
54,600 36,400 91,000
10,800 7,200 18,000
51,000 34,000 85,000
33,000 22,000 55,000
43,800 29,200 73,000
39,000 26,000 65,000
33,000 22,000 55,000
54,600 36,400 91,000
54,600 36,400 91,000
240,000 160,000 400,000
38,940 25,960 64,900
38,940 25,960 64,900
141,900 94,600 236,500
165,000 110,000 275,000
183,600 122,400 306,000
192,000 128,000 320,000
165,000 110,000 275,000
487,500 325,000 812,500
315,000 210,000 525,000
375,000 250,000 625,000
240,000 160,000 400,000
2,535,000 1,690,000 4,225,000
1,950,000 1,300,000 3,250,000
216,000 144,000 360,000
240,000 160,000 400,000
243,600 162,400 406,000
243,600 162,400 406,000
33,000 22,000 55,000
43,800 29,200 73,000
54,600 36,400 91,000
72,000 48,000 120,000
120,000 80,000 200,000
150,000 100,000 250,000
106,500 71,000 177,500
36,000 24,000 60,000
182,400 121,600 304,000
35,700 23,800 59,500
240,000 160,000 400,000
4,725,000 3,150,000 7,875,000
182,400 121,600 304,000
48,000 32,000 80,000
48,000 32,000 80,000
4,050,000 2,700,000 6,750,000
2,790,000 1,860,000 4,650,000
4,050,000 2,700,000 6,750,000
5,400,000 3,600,000 9,000,000
4,050,000 2,700,000 6,750,000
5,400,000 3,600,000 9,000,000
6,750,000 4,500,000 11,250,000
270,000 180,000 450,000
78,000 52,000 130,000
150,000 100,000 250,000
108,000 72,000 180,000
11,730,000 7,820,000 19,550,000
12,900,000 8,600,000 21,500,000
1,560,000 1,040,000 2,600,000
14,880,000 9,920,000 24,800,000
2,940,000 1,960,000 4,900,000
2,790,000 1,860,000 4,650,000
108,000 72,000 180,000
123,000 82,000 205,000
123,000 82,000 205,000
13,200 8,800 22,000
1,400,000 3,500,000
480,000 1,200,000
360,000 900,000
300,000 750,000
480,000 1,200,000
320,000 800,000
400,000 1,000,000
300,000 750,000
400,000 1,000,000
300,000 750,000
300,000 750,000
400,000 1,000,000
300,000 750,000
300,000 750,000
480,000 1,200,000
340,000 850,000
54,600 36,400 91,000
15,000 10,000 25,000
24,000 16,000 40,000
20,000 20,000
12,000 8,000 20,000
609,000 406,000 1,015,000
240,000 160,000 400,000
304,200 202,800 507,000
24,000 16,000 40,000
36,000 24,000 60,000
18,000 12,000 30,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
12,000 8,000 20,000
123,000 82,000 205,000
5,520,000 3,680,000 9,200,000
155,400 103,600 259,000
2,295,000 1,530,000 3,825,000
3,213,000 2,142,000 5,355,000
1,836,000 1,224,000 3,060,000
4,590,000 3,060,000 7,650,000
609,000 406,000 1,015,000
1,380,000 920,000 2,300,000
2,880,000 1,920,000 4,800,000
2,280,000 1,520,000 3,800,000
182,400 121,600 304,000
6,750,000 4,500,000 11,250,000
3,672,000 2,448,000 6,120,000
6,885,000 4,590,000 11,475,000
2,295,000 1,530,000 3,825,000
3,672,000 2,448,000 6,120,000
6,885,000 4,590,000 11,475,000
2,754,000 1,836,000 4,590,000
1,836,000 1,224,000 3,060,000
4,740,000 3,160,000 7,900,000
9,060,000 6,040,000 15,100,000
15,000 10,000 25,000
22,200 14,800 37,000
22,200 14,800 37,000
57,000 38,000 95,000
22,200 14,800 37,000
99,000 66,000 165,000
99,000 66,000 165,000
4,050,000 2,700,000 6,750,000
199,200 132,800 332,000
900,000 600,000 1,500,000
2,123,820 1,415,880 3,539,700
42,000 28,000 70,000
1,560,000 1,040,000 2,600,000
2,280,000 1,520,000 3,800,000
10,800,000 7,200,000 18,000,000
7,380,000 4,920,000 12,300,000
11,700,000 7,800,000 19,500,000
33,000 22,000 55,000
600,000 400,000 1,000,000
1,377,000 918,000 2,295,000
4,050,000 2,700,000 6,750,000
6,750,000 4,500,000 11,250,000
3,375,000 2,250,000 5,625,000
2,250,000 1,500,000 3,750,000
2,250,000 1,500,000 3,750,000
10,800 7,200 18,000
120,000 80,000 200,000
24,000 16,000 40,000
150,000 100,000 250,000
152,100 101,400 253,500
180,000 120,000 300,000
45,000 30,000 75,000
152,100 101,400 253,500
22,200 14,800 37,000
5,520,000 3,680,000 9,200,000
243,600 162,400 406,000
688,200 458,800 1,147,000
2,280,000 1,520,000 3,800,000
480,000 320,000 800,000
2,850,000 1,900,000 4,750,000
120,000 80,000 200,000
150,000 100,000 250,000
1,560,000 1,040,000 2,600,000
315,600 210,400 526,000
300,000 200,000 500,000
2,790,000 1,860,000 4,650,000
2,280,000 1,520,000 3,800,000
6,750,000 4,500,000 11,250,000
150,000 100,000 250,000
2,280,000 1,520,000 3,800,000
1,380,000 920,000 2,300,000
4,050,000 2,700,000 6,750,000
120,000 80,000 200,000
4,050,000 2,700,000 6,750,000
8,220,000 5,480,000 13,700,000
6,750,000 4,500,000 11,250,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
1,380,000 920,000 2,300,000
360,000 240,000 600,000
1,500,000 1,000,000 2,500,000
150,000 100,000 250,000
36,000 24,000 60,000
1,365,000 910,000 2,275,000
2,280,000 1,520,000 3,800,000
4,725,000 3,150,000 7,875,000
4,050,000 2,700,000 6,750,000
600,000 400,000 1,000,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
1,500,000 1,000,000 2,500,000
450,000 300,000 750,000
1,560,000 1,040,000 2,600,000
1,560,000 1,040,000 2,600,000
900,000 600,000 1,500,000
1,950,000 1,300,000 3,250,000
300,000 200,000 500,000
1,260,000 840,000 2,100,000
84,000 56,000 140,000
33,000 22,000 55,000
2,280,000 1,520,000 3,800,000
1,950,000 1,300,000 3,250,000
4,800,000 3,200,000 8,000,000
2,535,000 1,690,000 4,225,000
4,725,000 3,150,000 7,875,000
84,000 56,000 140,000
120,000 80,000 200,000
3,000,000 2,000,000 5,000,000
2,280,000 1,520,000 3,800,000
2,400,000 1,600,000 4,000,000
1,560,000 1,040,000 2,600,000
2,280,000 1,520,000 3,800,000
304,200 202,800 507,000
1,380,000 920,000 2,300,000
720,000 480,000 1,200,000
609,000 406,000 1,015,000
42,000 28,000 70,000
1,320,000 880,000 2,200,000
2,100,000 1,400,000 3,500,000
108,000 72,000 180,000
1,320,000 880,000 2,200,000
2,280,000 1,520,000 3,800,000
150,000 100,000 250,000
1,350,000 900,000 2,250,000
108,000 72,000 180,000
607,500 405,000 1,012,500
8,280,000 5,520,000 13,800,000
150,000 100,000 250,000
182,400 121,600 304,000
900,000 600,000 1,500,000
8,640,000 5,760,000 14,400,000
304,200 202,800 507,000
2,280,000 1,520,000 3,800,000
43,800 29,200 73,000
120,000 80,000 200,000
120,000 80,000 200,000
22,200 14,800 37,000
22,200 14,800 37,000
60,000 40,000 100,000
60,000 40,000 100,000
60,000 40,000 100,000
27,000 18,000 45,000
18,000 12,000 30,000
5,400,000 3,600,000 9,000,000
1,950,000 1,300,000 3,250,000
1,020,000 680,000 1,700,000
36,000 24,000 60,000
43,800 29,200 73,000
1,020,000 680,000 1,700,000
480,000 320,000 800,000
90,000 60,000 150,000
72,000 48,000 120,000
150,000 100,000 250,000
36,000 24,000 60,000
2,430,000 1,620,000 4,050,000
2,100,000 1,400,000 3,500,000
180,000 120,000 300,000
1,020,000 680,000 1,700,000
150,000 100,000 250,000
120,000 80,000 200,000
150,000 100,000 250,000
30,000 20,000 50,000
33,000 22,000 55,000
2,940,000 1,960,000 4,900,000
30,000 20,000 50,000
480,000 320,000 800,000
30,000 20,000 50,000
60,000 40,000 100,000
2,535,000 1,690,000 4,225,000
405,000 270,000 675,000
189,600 126,400 316,000
2,550,000 1,700,000 4,250,000
22,200 14,800 37,000
180,000 120,000 300,000
120,000 80,000 200,000
121,500 81,000 202,500
180,000 120,000 300,000
115,500 77,000 192,500
36,000 24,000 60,000
180,000 120,000 300,000
121,500 81,000 202,500
30,000 20,000 50,000
439,200 292,800 732,000
658,800 439,200 1,098,000
30,000 20,000 50,000
1,380,000 920,000 2,300,000
30,000 20,000 50,000
1,350,000 900,000 2,250,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
4,140,000 2,760,000 6,900,000
48,900 32,600 81,500
66,900 44,600 111,500
42,000 28,000 70,000
30,900 20,600 51,500
48,900 32,600 81,500
4,830,000 3,220,000 8,050,000
22,200 14,800 37,000
18,000 12,000 30,000
9,900 6,600 16,500
240,000 160,000 400,000
138,600 92,400 231,000
52,140 34,760 86,900
2,250,000 1,500,000 3,750,000
600,000 400,000 1,000,000
90,000 60,000 150,000
600,000 400,000 1,000,000
2,790,000 1,860,000 4,650,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
1,620,000 1,080,000 2,700,000
31,200 20,800 52,000
22,200 14,800 37,000
6,900,000 4,600,000 11,500,000
4,725,000 3,150,000 7,875,000
4,725,000 3,150,000 7,875,000
54,600 36,400 91,000
609,000 406,000 1,015,000
609,000 406,000 1,015,000
54,600 36,400 91,000
275,400 183,600 459,000
275,400 183,600 459,000
22,200 14,800 37,000
15,000 10,000 25,000
115,500 77,000 192,500
39,000 26,000 65,000
41,400 27,600 69,000
2,940,000 1,960,000 4,900,000
1,836,000 1,224,000 3,060,000
1,377,000 918,000 2,295,000
3,375,000 2,250,000 5,625,000
100,800 67,200 168,000
38,400 25,600 64,000
1,380,000 920,000 2,300,000
76,800 51,200 128,000
1,836,000 1,224,000 3,060,000
2,295,000 1,530,000 3,825,000
2,754,000 1,836,000 4,590,000
5,400,000 3,600,000 9,000,000
5,400,000 3,600,000 9,000,000
33,000 22,000 55,000
810,000 540,000 1,350,000
18,600 12,400 31,000
175,800 117,200 293,000
60,000 40,000 100,000
2,940,000 1,960,000 4,900,000
1,755,000 1,170,000 2,925,000
1,350,000 900,000 2,250,000
180,000 120,000 300,000
1,530,000 1,020,000 2,550,000
36,000 24,000 60,000
121,800 81,200 203,000
182,400 121,600 304,000
150,000 100,000 250,000
360,000 240,000 600,000
120,000 80,000 200,000
195,000 130,000 325,000
20,400 13,600 34,000
1,530,000 1,020,000 2,550,000
96,000 64,000 160,000
120,000 80,000 200,000
3,375,000 2,250,000 5,625,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
4,725,000 3,150,000 7,875,000
4,725,000 3,150,000 7,875,000
4,050,000 2,700,000 6,750,000
3,375,000 2,250,000 5,625,000
4,725,000 3,150,000 7,875,000
7,440,000 4,960,000 12,400,000
138,000 92,000 230,000
2,940,000 1,960,000 4,900,000
1,110,000 740,000 1,850,000
660,000 440,000 1,100,000
390,000 260,000 650,000
255,000 170,000 425,000
127,200 84,800 212,000
93,600 62,400 156,000
87,600 58,400 146,000
780,000 520,000 1,300,000
2,280,000 1,520,000 3,800,000
4,050,000 2,700,000 6,750,000
22,200 14,800 37,000
60,000 40,000 100,000
24,000 16,000 40,000
18,000 12,000 30,000
38,400 25,600 64,000
84,000 56,000 140,000
33,000 22,000 55,000
1,380,000 920,000 2,300,000
24,000 16,000 40,000
9,000 6,000 15,000
15,000 10,000 25,000
30,000 20,000 50,000
1,260,000 840,000 2,100,000
54,000 36,000 90,000
9,060,000 6,040,000 15,100,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
180,000 120,000 300,000
15,000 10,000 25,000
8,220,000 5,480,000 13,700,000
15,000 10,000 25,000
15,000 10,000 25,000
33,000 22,000 55,000
33,000 22,000 55,000
9,000 6,000 15,000
30,000 20,000 50,000
6,060,000 4,040,000 10,100,000
6,750,000 4,500,000 11,250,000
289,200 192,800 482,000
16,500 11,000 27,500
16,500 11,000 27,500
99,792 66,528 166,320
45,000 30,000 75,000
45,000 30,000 75,000
18,000 12,000 30,000
33,000 22,000 55,000
660,000 440,000 1,100,000
165,000 110,000 275,000
495,000 330,000 825,000
330,000 220,000 550,000
3,672,000 2,448,000 6,120,000
3,213,000 2,142,000 5,355,000
4,590,000 3,060,000 7,650,000
3,672,000 2,448,000 6,120,000
4,590,000 3,060,000 7,650,000
2,940,000 1,960,000 4,900,000
4,725,000 3,150,000 7,875,000
6,480,000 4,320,000 10,800,000
3,000,000 2,000,000 5,000,000
3,600,000 2,400,000 6,000,000
7,350,000 4,900,000 12,250,000
409,200 272,800 682,000
370,200 246,800 617,000
19,800 13,200 33,000
41,400 27,600 69,000
2,280,000 1,520,000 3,800,000
180,000 120,000 300,000
6,075,000 4,050,000 10,125,000
3,645,000 2,430,000 6,075,000
3,945,000 2,630,000 6,575,000
3,825,000 2,550,000 6,375,000
4,125,000 2,750,000 6,875,000
4,500,000 3,000,000 7,500,000
72,000 48,000 120,000
9,000 6,000 15,000
33,000 22,000 55,000
162,000 108,000 270,000
31,200 20,800 52,000
9,000 6,000 15,000
5,190,000 3,460,000 8,650,000
41,400 27,600 69,000
270,000 180,000 450,000
66,000 44,000 110,000
66,000 44,000 110,000
270,000 180,000 450,000
50,820 33,880 84,700
315,000 210,000 525,000
315,000 210,000 525,000
621,000 414,000 1,035,000
159,000 106,000 265,000
249,000 166,000 415,000
459,000 306,000 765,000
315,000 210,000 525,000
1,500,000 1,000,000 2,500,000
621,000 414,000 1,035,000
315,000 210,000 525,000
136,320 90,880 227,200
96,000 64,000 160,000
4,725,000 3,150,000 7,875,000
4,725,000 3,150,000 7,875,000
9,000 6,000 15,000
50,820 33,880 84,700
50,820 33,880 84,700
720,000 480,000 1,200,000
423,000 282,000 705,000
210,000 140,000 350,000

135,000 90,000 225,000
420,000 280,000 700,000

246,000 164,000 410,000
660,000 440,000 1,100,000

312,000 208,000 520,000
189,600 126,400 316,000

27,000 18,000 45,000
22,200 14,800 37,000
304,200 202,800 507,000
300,000 200,000 500,000
780,000 520,000 1,300,000
600,000 400,000 1,000,000
22,200 14,800 37,000
150,000 100,000 250,000
900,000 600,000 1,500,000
1,380,000 920,000 2,300,000
150,000 100,000 250,000
150,000 100,000 250,000
900,000 600,000 1,500,000
243,600 162,400 406,000
1,836,000 1,224,000 3,060,000
121,800 81,200 203,000
121,800 81,200 203,000
607,200 404,800 1,012,000
304,200 202,800 507,000
60,000 40,000 100,000
2,790,000 1,860,000 4,650,000
48,000 32,000 80,000
365,400 243,600 609,000
60,000 40,000 100,000
600,000 400,000 1,000,000
243,600 162,400 406,000
600,000 400,000 1,000,000
41,400 27,600 69,000
150,480 100,320 250,800
1,500,000 1,000,000 2,500,000
360,000 240,000 600,000
30,000 20,000 50,000
240,000 160,000 400,000
42,000 28,000 70,000
60,000 40,000 100,000
360,000 240,000 600,000
108,000 72,000 180,000
6,750,000 4,500,000 11,250,000
6,750,000 4,500,000 11,250,000
2,940,000 1,960,000 4,900,000
4,725,000 3,150,000 7,875,000
15,000 10,000 25,000
540,000 360,000 900,000
420,000 280,000 700,000
300,000 200,000 500,000
22,200 14,800 37,000
45,000 30,000 75,000
189,600 126,400 316,000
1,020,000 680,000 1,700,000
11,400 7,600 19,000
48,000 32,000 80,000
810,000 540,000 1,350,000
1,620,000 1,080,000 2,700,000
60,000 40,000 100,000
90,000 60,000 150,000
300,000 200,000 500,000
44,400 29,600 74,000
2,349,540 1,566,360 3,915,900
15,000 10,000 25,000
480,000 320,000 800,000
39,600 26,400 66,000
2,850,000 1,900,000 4,750,000
210,600 140,400 351,000
210,600 140,400 351,000
1,603,800 1,069,200 2,673,000
1,843,020 1,228,680 3,071,700
683,100 455,400 1,138,500
720,000 480,000 1,200,000
7,590,000 5,060,000 12,650,000
2,940,000 1,960,000 4,900,000
284,400 189,600 474,000
1,515,000 1,010,000 2,525,000
1,260,000 840,000 2,100,000
11,700,000 7,800,000 19,500,000
6,750,000 4,500,000 11,250,000
34,800 23,200 58,000
36,000 24,000 60,000
18,000 12,000 30,000
4,725,000 3,150,000 7,875,000
304,200 202,800 507,000
2,940,000 1,960,000 4,900,000
45,000 250,000 295,000
450,000 325,000 775,000
25,000 25,000
45,000 30,000 75,000
25,000 25,000
67,000 67,000
30,000 30,000
30,000 30,000
6,000 4,000 10,000
15,000 10,000 25,000
90,000 60,000 150,000
45,000 30,000 75,000
61,200 40,800 102,000
40,200 26,800 67,000
6,000 6,000
45,000 45,000
51,000 34,000 85,000
60,000 40,000 100,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,280,000 1,520,000 3,800,000
2,250,000 1,500,000 3,750,000
12,075,000 8,050,000 20,125,000
2,280,000 1,520,000 3,800,000
22,200 14,800 37,000
15,540,000 10,360,000 25,900,000
15,540,000 10,360,000 25,900,000
2,550,000 1,700,000 4,250,000
6,600,000 4,400,000 11,000,000
1,950,000 1,300,000 3,250,000
2,940,000 1,960,000 4,900,000
2,091,420 1,394,280 3,485,700
15,120,000 10,080,000 25,200,000
15,540,000 10,360,000 25,900,000
12,090,000 8,060,000 20,150,000
13,500 9,000 22,500
27,000 18,000 45,000
300,000 200,000 500,000
151,200 100,800 252,000
309,000 206,000 515,000
346,800 231,200 578,000
309,000 206,000 515,000
346,800 231,200 578,000
309,000 206,000 515,000
289,200 192,800 482,000
308,400 205,600 514,000
192,600 128,400 321,000
990,000 660,000 1,650,000
309,000 206,000 515,000
346,800 231,200 578,000
555,000 370,000 925,000
309,000 206,000 515,000
346,800 231,200 578,000
309,000 206,000 515,000
346,800 231,200 578,000
123,600 82,400 206,000
270,000 180,000 450,000
309,000 206,000 515,000
346,800 231,200 578,000
15,000 10,000 25,000
1,800,000 1,200,000 3,000,000
51,000 34,000 85,000
720,000 480,000 1,200,000
405,000 270,000 675,000
960,000 640,000 1,600,000
180,000 120,000 300,000
2,280,000 1,520,000 3,800,000
12,090,000 8,060,000 20,150,000
12,090,000 8,060,000 20,150,000
6,750,000 4,500,000 11,250,000
6,750,000 4,500,000 11,250,000
4,725,000 3,150,000 7,875,000
5,820,000 3,880,000 9,700,000
7,500,000 5,000,000 12,500,000
8,220,000 5,480,000 13,700,000
7,800,000 5,200,000 13,000,000
8,220,000 5,480,000 13,700,000
7,800,000 5,200,000 13,000,000
5,820,000 3,880,000 9,700,000
4,725,000 3,150,000 7,875,000
2,280,000 1,520,000 3,800,000
2,880,000 1,920,000 4,800,000
102,000 68,000 170,000
111,000 74,000 185,000
5,400,000 3,600,000 9,000,000
4,125,000 2,750,000 6,875,000
16,200 10,800 27,000
1,320,000 880,000 2,200,000
35,700 23,800 59,500
33,000 22,000 55,000
42,000 28,000 70,000
8,040 5,360 13,400
4,740,000 3,160,000 7,900,000
5,400,000 3,600,000 9,000,000
4,050,000 2,700,000 6,750,000
15,000 10,000 25,000
600,000 400,000 1,000,000
120,000 80,000 200,000
21,000 14,000 35,000
18,000 12,000 30,000
27,000 18,000 45,000
42,000 28,000 70,000
90,000 60,000 150,000
12,000 8,000 20,000
90,000 60,000 150,000
127,200 84,800 212,000
1,380,000 920,000 2,300,000
1,380,000 920,000 2,300,000
4,740,000 3,160,000 7,900,000
4,740,000 3,160,000 7,900,000
1,380,000 920,000 2,300,000
180,000 120,000 300,000
2,940,000 1,960,000 4,900,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
36,000 24,000 60,000
60,000 40,000 100,000
78,000 52,000 130,000
102,000 68,000 170,000
4,740,000 3,160,000 7,900,000
240,000 160,000 400,000
87,000 58,000 145,000
121,800 81,200 203,000
182,400 121,600 304,000
243,600 162,400 406,000
112,530 75,020 187,550
34,800 23,200 58,000
450,000 300,000 750,000
60,000 40,000 100,000
1,200,000 800,000 2,000,000
2,940,000 1,960,000 4,900,000
6,480,000 4,320,000 10,800,000
15,000 10,000 25,000
2,280,000 1,520,000 3,800,000
180,000 120,000 300,000
2,940,000 1,960,000 4,900,000
11,700,000 7,800,000 19,500,000
4,320,000 2,880,000 7,200,000
18,000 12,000 30,000
79,800 53,200 133,000
1,410,000 940,000 2,350,000
33,000 22,000 55,000
8,400 5,600 14,000
8,400 5,600 14,000
45,000 30,000 75,000
7,380,000 4,920,000 12,300,000
5,400,000 3,600,000 9,000,000
31,200 20,800 52,000
18,000 12,000 30,000
6,750,000 4,500,000 11,250,000
3,375,000 2,250,000 5,625,000
4,725,000 3,150,000 7,875,000
3,000,000 2,000,000 5,000,000
2,400,000 1,600,000 4,000,000
49,500 33,000 82,500
600,000 400,000 1,000,000
60,000 40,000 100,000
90,000 60,000 150,000
99,000 66,000 165,000
12,000 8,000 20,000
12,000 8,000 20,000
12,000 8,000 20,000
360,000 240,000 600,000
60,000 40,000 100,000
90,000 60,000 150,000
9,000 6,000 15,000
9,000 6,000 15,000
9,000 6,000 15,000
41,400 27,600 69,000
1,260,000 840,000 2,100,000
4,800,000 3,200,000 8,000,000
252,000 168,000 420,000
48,000 32,000 80,000
105,000 70,000 175,000
1,650,000 1,100,000 2,750,000
229,200 152,800 382,000
459,000 306,000 765,000
1,440,000 960,000 2,400,000
1,440,000 960,000 2,400,000
1,800,000 1,200,000 3,000,000
1,500,000 1,000,000 2,500,000
1,500,000 1,000,000 2,500,000
1,320,000 880,000 2,200,000
1,080,000 720,000 1,800,000
1,320,000 880,000 2,200,000
1,080,000 720,000 1,800,000
1,500,000 1,000,000 2,500,000
1,320,000 880,000 2,200,000
1,500,000 1,000,000 2,500,000
1,320,000 880,000 2,200,000
1,320,000 880,000 2,200,000
1,080,000 720,000 1,800,000
1,320,000 880,000 2,200,000
1,080,000 720,000 1,800,000
1,800,000 1,200,000 3,000,000
1,500,000 1,000,000 2,500,000
2,400,000 1,600,000 4,000,000
2,100,000 1,400,000 3,500,000
2,400,000 1,600,000 4,000,000
2,100,000 1,400,000 3,500,000
6,300,000 4,200,000 10,500,000
1,400,000 3,500,000
132,000 88,000 220,000
9,060,000 6,040,000 15,100,000
72,000 48,000 120,000
39,600 26,400 66,000
22,200 14,800 37,000
22,200 14,800 37,000
22,200 14,800 37,000
22,200 14,800 37,000
22,200 14,800 37,000
54,600 36,400 91,000
7,380,000 4,920,000 12,300,000
9,330,000 6,220,000 15,550,000
6,480,000 4,320,000 10,800,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
4,740,000 3,160,000 7,900,000
33,000 22,000 55,000
2,940,000 1,960,000 4,900,000
11,220,000 7,480,000 18,700,000
36,000 24,000 60,000
111,000 74,000 185,000
33,000 22,000 55,000
54,600 36,400 91,000
12,000 8,000 20,000
30,000 20,000 50,000
1,800,000 1,200,000 3,000,000
600,000 400,000 1,000,000
6,900,000 4,600,000 11,500,000
9,000 6,000 15,000
12,000 8,000 20,000
15,000 10,000 25,000
240,000 160,000 400,000
81,000 54,000 135,000
2,280,000 1,520,000 3,800,000
4,050,000 2,700,000 6,750,000
2,280,000 1,520,000 3,800,000
600,000 400,000 1,000,000
4,050,000 2,700,000 6,750,000
4,725,000 3,150,000 7,875,000
4,725,000 3,150,000 7,875,000
4,050,000 2,700,000 6,750,000
4,725,000 3,150,000 7,875,000
5,625,000 3,750,000 9,375,000
6,480,000 4,320,000 10,800,000
6,480,000 4,320,000 10,800,000
6,480,000 4,320,000 10,800,000
12,510,000 8,340,000 20,850,000
12,510,000 8,340,000 20,850,000
12,510,000 8,340,000 20,850,000
15,780,000 10,520,000 26,300,000
12,960,000 8,640,000 21,600,000
2,250,000 1,500,000 3,750,000
5,190,000 3,460,000 8,650,000
2,550,000 1,700,000 4,250,000
12,540,000 8,360,000 20,900,000
12,960,000 8,640,000 21,600,000
2,280,000 1,520,000 3,800,000
12,540,000 8,360,000 20,900,000
14,280,000 9,520,000 23,800,000
15,540,000 10,360,000 25,900,000
2,280,000 1,520,000 3,800,000
12,090,000 8,060,000 20,150,000
2,280,000 1,520,000 3,800,000
12,090,000 8,060,000 20,150,000
4,830,000 3,220,000 8,050,000
3,450,000 2,300,000 5,750,000
2,940,000 1,960,000 4,900,000
3,900,000 2,600,000 6,500,000
2,940,000 1,960,000 4,900,000
4,740,000 3,160,000 7,900,000
4,740,000 3,160,000 7,900,000
6,060,000 4,040,000 10,100,000
5,190,000 3,460,000 8,650,000
420,000 280,000 700,000
2,940,000 1,960,000 4,900,000
14,280,000 9,520,000 23,800,000
15,540,000 10,360,000 25,900,000
12,960,000 8,640,000 21,600,000
5,190,000 3,460,000 8,650,000
360,000 240,000 600,000
2,940,000 1,960,000 4,900,000
7,770,000 5,180,000 12,950,000
2,280,000 1,520,000 3,800,000
2,754,000 1,836,000 4,590,000
3,672,000 2,448,000 6,120,000
5,737,200 3,824,800 9,562,000
3,213,000 2,142,000 5,355,000
2,295,000 1,530,000 3,825,000
5,737,200 3,824,800 9,562,000
3,672,000 2,448,000 6,120,000
3,213,000 2,142,000 5,355,000
1,836,000 1,224,000 3,060,000
5,737,200 3,824,800 9,562,000
3,213,000 2,142,000 5,355,000
3,213,000 2,142,000 5,355,000
3,213,000 2,142,000 5,355,000
3,672,000 2,448,000 6,120,000
5,737,200 3,824,800 9,562,000
1,836,000 1,224,000 3,060,000
3,672,000 2,448,000 6,120,000
2,754,000 1,836,000 4,590,000
5,737,200 3,824,800 9,562,000
3,213,000 2,142,000 5,355,000
5,737,200 3,824,800 9,562,000
4,590,000 3,060,000 7,650,000
6,885,000 4,590,000 11,475,000
6,885,000 4,590,000 11,475,000
2,295,000 1,530,000 3,825,000
6,885,000 4,590,000 11,475,000
3,672,000 2,448,000 6,120,000
6,885,000 4,590,000 11,475,000
5,737,200 3,824,800 9,562,000
6,885,000 4,590,000 11,475,000
6,885,000 4,590,000 11,475,000
5,737,200 3,824,800 9,562,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
5,737,200 3,824,800 9,562,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
2,754,000 1,836,000 4,590,000
1,836,000 1,224,000 3,060,000
1,836,000 1,224,000 3,060,000
2,295,000 1,530,000 3,825,000
2,754,000 1,836,000 4,590,000
1,836,000 1,224,000 3,060,000
2,295,000 1,530,000 3,825,000
2,754,000 1,836,000 4,590,000
3,672,000 2,448,000 6,120,000
4,590,000 3,060,000 7,650,000
2,754,000 1,836,000 4,590,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
2,754,000 1,836,000 4,590,000
4,590,000 3,060,000 7,650,000
2,754,000 1,836,000 4,590,000
3,672,000 2,448,000 6,120,000
3,672,000 2,448,000 6,120,000
3,672,000 2,448,000 6,120,000
3,672,000 2,448,000 6,120,000
1,836,000 1,224,000 3,060,000
2,754,000 1,836,000 4,590,000
3,672,000 2,448,000 6,120,000
2,754,000 1,836,000 4,590,000
1,377,000 918,000 2,295,000
2,280,000 1,520,000 3,800,000
1,800,000 1,200,000 3,000,000
7,770,000 5,180,000 12,950,000
2,940,000 1,960,000 4,900,000
36,000 24,000 60,000
6,750,000 4,500,000 11,250,000
4,050,000 2,700,000 6,750,000
2,790,000 1,860,000 4,650,000
6,750,000 4,500,000 11,250,000
4,050,000 2,700,000 6,750,000
4,050,000 2,700,000 6,750,000
4,725,000 3,150,000 7,875,000
2,535,000 1,690,000 4,225,000
1,380,000 920,000 2,300,000
456,000 304,000 760,000
900,000 600,000 1,500,000
360,000 240,000 600,000
450,000 300,000 750,000
13,200 8,800 22,000
4,050,000 2,700,000 6,750,000
487,500 325,000 812,500
180,000 120,000 300,000
375,000 250,000 625,000
60,000 40,000 100,000
20,700,000 13,800,000 34,500,000
4,050,000 2,700,000 6,750,000

15,780,000 10,520,000 26,300,000
120,000 80,000 200,000
49,800 33,200 83,000
45,000 30,000 75,000
48,000 32,000 80,000
90,000 60,000 150,000
90,000 60,000 150,000
41,400 27,600 69,000
2,940,000 1,960,000 4,900,000
10,800 7,200 18,000
90,000 60,000 150,000
45,000 30,000 75,000
6,480,000 4,320,000 10,800,000
4,725,000 3,150,000 7,875,000
1,269,000 846,000 2,115,000
1,272,000 848,000 2,120,000
1,425,000 950,000 2,375,000
1,605,000 1,070,000 2,675,000
627,000 418,000 1,045,000
1,083,000 722,000 1,805,000
634,200 422,800 1,057,000
784,200 522,800 1,307,000
502,200 334,800 837,000
922,200 614,800 1,537,000
1,102,200 734,800 1,837,000
1,380,000 920,000 2,300,000
182,400 121,600 304,000
15,000 10,000 25,000
22,200 14,800 37,000
600,000 400,000 1,000,000
10,800 7,200 18,000
30,000 20,000 50,000
18,000 12,000 30,000
2,790,000 1,860,000 4,650,000
30,000 20,000 50,000
36,000 24,000 60,000
1,320,000 880,000 2,200,000
182,400 121,600 304,000
312,000 208,000 520,000
121,800 81,200 203,000
121,800 81,200 203,000
243,600 162,400 406,000
12,000 8,000 20,000
60,000 40,000 100,000
15,000 10,000 25,000
90,000 60,000 150,000
12,000 8,000 20,000
15,000 10,000 25,000
90,000 60,000 150,000
183,600 122,400 306,000
199,200 132,800 332,000
39,000 26,000 65,000
22,200 14,800 37,000
54,600 36,400 91,000
10,800 7,200 18,000
12,000 8,000 20,000
121,800 81,200 203,000
18,000 12,000 30,000
33,000 22,000 55,000
10,800 7,200 18,000
33,000 22,000 55,000
30,000 20,000 50,000
10,800 7,200 18,000
10,800 7,200 18,000
54,600 36,400 91,000
12,000 8,000 20,000
33,000 22,000 55,000
60,000 40,000 100,000
121,800 81,200 203,000
304,200 202,800 507,000
459,000 306,000 765,000
900,000 600,000 1,500,000
365,400 243,600 609,000
2,280,000 1,520,000 3,800,000
365,400 243,600 609,000
2,280,000 1,520,000 3,800,000
600,000 400,000 1,000,000
585,000 390,000 975,000
405,000 270,000 675,000
270,000 180,000 450,000
246,000 164,000 410,000
40,200 26,800 67,000
385,200 256,800 642,000
385,200 256,800 642,000
385,200 256,800 642,000
385,200 256,800 642,000
867,600 578,400 1,446,000
350,400 233,600 584,000
350,400 233,600 584,000
385,200 256,800 642,000
18,000 12,000 30,000
33,000 22,000 55,000
20,000 20,000
441,000 294,000 735,000
441,000 294,000 735,000
869,400 579,600 1,449,000
222,600 148,400 371,000
348,600 232,400 581,000
642,600 428,400 1,071,000
441,000 294,000 735,000
2,100,000 1,400,000 3,500,000
869,400 579,600 1,449,000
441,000 294,000 735,000
333,000 222,000 555,000
333,000 222,000 555,000
639,000 426,000 1,065,000
177,000 118,000 295,000
267,000 178,000 445,000
477,000 318,000 795,000
333,000 222,000 555,000
1,518,000 1,012,000 2,530,000
639,000 426,000 1,065,000
333,000 222,000 555,000
20,000 20,000
75,000 50,000 125,000
15,000 10,000 25,000
84,000 56,000 140,000
243,600 162,400 406,000
54,600 36,400 91,000
243,600 162,400 406,000
12,000 8,000 20,000
240,000 160,000 400,000
60,000 40,000 100,000
1,380,000 920,000 2,300,000
2,280,000 1,520,000 3,800,000
72,000 48,000 120,000
150,000 100,000 250,000
138,000 92,000 230,000
12,000 8,000 20,000
30,000 20,000 50,000
240,000 160,000 400,000
960,000 640,000 1,600,000
243,600 162,400 406,000
8,640,000 5,760,000 14,400,000
300,000 200,000 500,000
2,280,000 1,520,000 3,800,000
18,000 12,000 30,000
120,000 80,000 200,000
24,000 16,000 40,000
48,000 32,000 80,000
218,800 547,000
151,200 100,800 252,000
241,800 161,200 403,000
9,000 6,000 15,000
900,000 600,000 1,500,000
120,000 80,000 200,000
90,000 60,000 150,000
22,800 15,200 38,000
180,000 120,000 300,000
30,000 20,000 50,000
38,400 25,600 64,000
3,375,000 2,250,000 5,625,000
15,000 10,000 25,000
15,000 10,000 25,000
9,000 6,000 15,000
1,377,000 918,000 2,295,000
3,672,000 2,448,000 6,120,000
300,000 200,000 500,000
480,000 320,000 800,000
480,000 320,000 800,000
450,000 300,000 750,000
10,800 7,200 18,000
31,200 20,800 52,000
120,000 80,000 200,000
48,000 32,000 80,000
36,000 24,000 60,000
30,000 30,000 60,000
150,000 100,000 250,000
50,000 40,000 90,000
360,000 240,000 600,000
1,897,020 1,264,680 3,161,700
15,600 10,400 26,000
60,000 40,000 100,000
30,000 20,000 50,000
54,600 36,400 91,000
43,800 29,200 73,000
54,600 36,400 91,000
45,000 30,000 75,000
6,210,000 4,140,000 10,350,000
2,790,000 1,860,000 4,650,000
1,602,000 1,068,000 2,670,000
510,000 340,000 850,000
720,000 480,000 1,200,000
405,000 270,000 675,000
600,000 400,000 1,000,000
1,920,000 1,280,000 3,200,000
15,000 10,000 25,000
21,780 14,520 36,300
21,780 14,520 36,300
23,400 15,600 39,000
21,780 14,520 36,300
4,500,000 3,000,000 7,500,000
2,940,000 1,960,000 4,900,000
30,000 20,000 50,000
18,000 12,000 30,000
20,000 20,000
609,000 406,000 1,015,000
24,000 16,000 40,000
626,400 417,600 1,044,000
600,000 400,000 1,000,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
3,450,000 2,300,000 5,750,000
2,280,000 1,520,000 3,800,000
12,000 8,000 20,000
60,000 40,000 100,000
141,900 94,600 236,500
105,600 70,400 176,000
4,050,000 2,700,000 6,750,000
113,400 75,600 189,000
5,190,000 3,460,000 8,650,000
30,000 20,000 50,000
13,200 8,800 22,000
15,000 10,000 25,000
1,500,000 1,000,000 2,500,000
345,000 230,000 575,000
30,000 20,000 50,000
84,000 56,000 140,000
84,000 56,000 140,000
124,200 82,800 207,000
1,410,000 940,000 2,350,000
1,500,000 1,000,000 2,500,000
900,000 600,000 1,500,000
2,250,000 1,500,000 3,750,000
4,140,000 2,760,000 6,900,000
48,000 32,000 80,000
90,000 60,000 150,000
121,800 81,200 203,000
121,800 81,200 203,000
22,200 14,800 37,000
79,800 53,200 133,000
360,000 240,000 600,000
600,000 400,000 1,000,000
36,000 24,000 60,000
1,530,000 1,020,000 2,550,000
348,000 232,000 580,000
180,000 120,000 300,000
943,800 629,200 1,573,000
48,000 32,000 80,000
2,940,000 1,960,000 4,900,000
2,700,000 1,800,000 4,500,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
36,000 24,000 60,000
3,450,000 2,300,000 5,750,000
6,750,000 4,500,000 11,250,000
30,000 20,000 50,000
42,000 28,000 70,000
90,000 60,000 150,000
1,260,000 840,000 2,100,000
1,014,000 676,000 1,690,000
81,000 54,000 135,000
60,000 40,000 100,000
60,000 40,000 100,000
120,000 80,000 200,000
480,000 320,000 800,000
4,725,000 3,150,000 7,875,000
60,000 40,000 100,000
289,200 192,800 482,000
12,000 8,000 20,000
609,000 406,000 1,015,000
600,000 400,000 1,000,000
3,375,000 2,250,000 5,625,000
6,000 4,000 10,000
44,400 29,600 74,000
18,000 12,000 30,000
44,400 29,600 74,000
44,400 29,600 74,000
79,800 53,200 133,000
2,250,000 1,500,000 3,750,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,790,000 1,860,000 4,650,000
5,625,000 3,750,000 9,375,000
2,550,000 1,700,000 4,250,000
2,940,000 1,960,000 4,900,000
2,790,000 1,860,000 4,650,000
4,590,000 3,060,000 7,650,000
12,510,000 8,340,000 20,850,000
12,090,000 8,060,000 20,150,000
10,875,000 7,250,000 18,125,000
5,190,000 3,460,000 8,650,000
6,480,000 4,320,000 10,800,000
2,754,000 1,836,000 4,590,000
5,737,200 3,824,800 9,562,000
6,885,000 4,590,000 11,475,000
5,737,200 3,824,800 9,562,000
4,590,000 3,060,000 7,650,000
5,737,200 3,824,800 9,562,000
5,737,200 3,824,800 9,562,000
4,590,000 3,060,000 7,650,000
2,940,000 1,960,000 4,900,000
1,800,000 1,200,000 3,000,000
4,590,000 3,060,000 7,650,000
6,750,000 4,500,000 11,250,000
270,000 180,000 450,000
180,000 120,000 300,000
4,725,000 3,150,000 7,875,000
6,750,000 4,500,000 11,250,000
4,050,000 2,700,000 6,750,000
1,068,000 712,000 1,780,000
94,800 63,200 158,000
1,530,000 1,020,000 2,550,000
2,280,000 1,520,000 3,800,000
6,750,000 4,500,000 11,250,000
420,000 280,000 700,000
240,000 160,000 400,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
3,375,000 2,250,000 5,625,000
2,790,000 1,860,000 4,650,000
3,375,000 2,250,000 5,625,000
3,375,000 2,250,000 5,625,000
3,375,000 2,250,000 5,625,000
3,375,000 2,250,000 5,625,000
4,725,000 3,150,000 7,875,000
2,550,000 1,700,000 4,250,000
1,320,000 880,000 2,200,000
1,950,000 1,300,000 3,250,000
2,280,000 1,520,000 3,800,000
204,000 136,000 340,000
405,000 270,000 675,000
365,400 243,600 609,000
365,400 243,600 609,000
5,190,000 3,460,000 8,650,000
220,500 147,000 367,500
2,940,000 1,960,000 4,900,000
4,830,000 3,220,000 8,050,000
5,737,200 3,824,800 9,562,000
4,590,000 3,060,000 7,650,000
54,600 36,400 91,000
918,000 612,000 1,530,000
918,000 612,000 1,530,000
1,147,200 764,800 1,912,000
688,200 458,800 1,147,000
450,000 300,000 750,000
405,000 270,000 675,000
1,380,000 920,000 2,300,000
1,380,000 920,000 2,300,000
600,000 400,000 1,000,000
120,000 80,000 200,000
450,000 300,000 750,000
405,000 270,000 675,000
612,000 408,000 1,020,000
2,250,000 1,500,000 3,750,000
2,250,000 1,500,000 3,750,000
288,000 192,000 480,000
182,400 121,600 304,000
182,400 121,600 304,000
1,500,000 1,000,000 2,500,000
600,000 400,000 1,000,000
150,000 100,000 250,000
22,200 14,800 37,000
1,410,000 940,000 2,350,000
450,000 300,000 750,000
192,000 128,000 320,000
450,000 300,000 750,000
600,000 400,000 1,000,000
60,000 40,000 100,000
360,000 240,000 600,000
117,000 78,000 195,000
1,380,000 920,000 2,300,000
2,790,000 1,860,000 4,650,000
688,200 458,800 1,147,000
5,400,000 3,600,000 9,000,000
2,940,000 1,960,000 4,900,000
15,540,000 10,360,000 25,900,000
9,060,000 6,040,000 15,100,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
1,530,000 1,020,000 2,550,000
30,000 20,000 50,000
195,000 130,000 325,000
121,800 81,200 203,000
1,530,000 1,020,000 2,550,000
33,000 22,000 55,000
38,400 25,600 64,000
240,000 160,000 400,000
4,050,000 2,700,000 6,750,000
2,790,000 1,860,000 4,650,000
6,750,000 4,500,000 11,250,000
4,050,000 2,700,000 6,750,000
4,050,000 2,700,000 6,750,000
48,600 32,400 81,000
5,400,000 3,600,000 9,000,000
2,535,000 1,690,000 4,225,000
2,940,000 1,960,000 4,900,000
5,190,000 3,460,000 8,650,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
4,830,000 3,220,000 8,050,000
2,550,000 1,700,000 4,250,000
1,620,000 1,080,000 2,700,000
1,215,000 810,000 2,025,000
2,940,000 1,960,000 4,900,000
90,000 60,000 150,000
180,000 120,000 300,000
12,000 8,000 20,000
60,000 40,000 100,000
5,190,000 3,460,000 8,650,000
2,790,000 1,860,000 4,650,000
22,200 14,800 37,000
45,000 30,000 75,000
33,000 22,000 55,000
2,280,000 1,520,000 3,800,000
2,040,000 1,360,000 3,400,000
4,080,000 2,720,000 6,800,000
2,130,000 1,420,000 3,550,000
2,430,000 1,620,000 4,050,000
2,400,000 1,600,000 4,000,000
2,340,000 1,560,000 3,900,000
11,400 7,600 19,000
2,535,000 1,690,000 4,225,000
2,535,000 1,690,000 4,225,000
4,500,000 3,000,000 7,500,000
1,950,000 1,300,000 3,250,000
1,530,000 1,020,000 2,550,000
39,600 26,400 66,000
13,500 9,000 22,500
13,500 9,000 22,500
27,000 18,000 45,000
41,400 27,600 69,000
240,000 160,000 400,000
2,940,000 1,960,000 4,900,000
9,060,000 6,040,000 15,100,000
7,590,000 5,060,000 12,650,000
60,000 40,000 100,000
1,530,000 1,020,000 2,550,000
2,940,000 1,960,000 4,900,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
1,530,000 1,020,000 2,550,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
1,380,000 920,000 2,300,000
4,830,000 3,220,000 8,050,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
180,000 120,000 300,000
120,000 80,000 200,000
121,800 81,200 203,000
4,050,000 2,700,000 6,750,000
2,280,000 1,520,000 3,800,000
2,940,000 1,960,000 4,900,000
585,600 390,400 976,000
622,200 414,800 1,037,000
658,800 439,200 1,098,000
695,400 463,600 1,159,000
732,000 488,000 1,220,000
768,600 512,400 1,281,000
878,400 585,600 1,464,000
600,000 400,000 1,000,000
2,280,000 1,520,000 3,800,000
385,200 256,800 642,000
360,000 240,000 600,000
22,200 14,800 37,000
18,000 12,000 30,000
42,000 28,000 70,000
78,000 52,000 130,000
87,000 58,000 145,000
5,400,000 3,600,000 9,000,000
28,050 18,700 46,750
2,940,000 1,960,000 4,900,000
1,530,000 1,020,000 2,550,000
33,600 22,400 56,000
30,000 20,000 50,000
42,000 28,000 70,000
30,600 20,400 51,000
4,725,000 3,150,000 7,875,000
240,000 160,000 400,000
2,280,000 1,520,000 3,800,000
22,200 14,800 37,000
45,000 30,000 75,000
33,000 22,000 55,000
184,200 122,800 307,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
9,180,000 6,120,000 15,300,000
6,885,000 4,590,000 11,475,000
5,737,200 3,824,800 9,562,000
11,475,000 7,650,000 19,125,000
8,032,200 5,354,800 13,387,000
6,885,000 4,590,000 11,475,000
6,060,000 4,040,000 10,100,000
4,800,000 3,200,000 8,000,000
60,000 40,000 100,000
4,050,000 2,700,000 6,750,000
11,550 7,700 19,250
2,295,000 1,530,000 3,825,000
10,800 7,200 18,000
48,000 32,000 80,000
30,000 20,000 50,000
15,000 10,000 25,000
15,000 10,000 25,000
30,000 20,000 50,000
15,000 10,000 25,000
7,770,000 5,180,000 12,950,000
4,050,000 2,700,000 6,750,000
2,790,000 1,860,000 4,650,000
4,050,000 2,700,000 6,750,000
2,940,000 1,960,000 4,900,000
36,300 24,200 60,500
60,600 40,400 101,000
60,600 40,400 101,000
60,000 40,000 100,000
240,000 160,000 400,000
150,000 100,000 250,000
150,000 100,000 250,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
6,480,000 4,320,000 10,800,000
683,100 455,400 1,138,500
33,000 22,000 55,000
1,836,000 1,224,000 3,060,000
1,377,000 918,000 2,295,000
688,200 458,800 1,147,000
918,000 612,000 1,530,000
459,000 306,000 765,000
918,000 612,000 1,530,000
2,295,000 1,530,000 3,825,000
688,200 458,800 1,147,000
304,200 202,800 507,000
41,400 27,600 69,000
12,000 8,000 20,000
9,000 6,000 15,000
9,000 6,000 15,000
41,400 27,600 69,000
31,200 20,800 52,000
31,200 20,800 52,000
31,200 20,800 52,000
175,800 117,200 293,000
175,800 117,200 293,000
90,000 60,000 150,000
90,000 60,000 150,000
9,000 6,000 15,000
15,000 10,000 25,000
90,000 60,000 150,000
22,200 14,800 37,000
48,000 32,000 80,000
79,800 53,200 133,000
136,800 91,200 228,000
45,000 30,000 75,000
1,800,000 1,200,000 3,000,000
1,800,000 1,200,000 3,000,000
2,400,000 1,600,000 4,000,000
3,600,000 2,400,000 6,000,000
300,000 200,000 500,000
36,000 24,000 60,000
2,280,000 1,520,000 3,800,000
150,000 100,000 250,000
450,000 300,000 750,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
150,000 100,000 250,000
90,000 60,000 150,000
2,280,000 1,520,000 3,800,000
360,000 240,000 600,000
2,940,000 1,960,000 4,900,000
6,210,000 4,140,000 10,350,000
150,000 100,000 250,000
135,000 90,000 225,000
1,440,000 960,000 2,400,000
1,680,000 1,120,000 2,800,000
1,725,000 1,150,000 2,875,000
2,025,000 1,350,000 3,375,000
2,070,000 1,380,000 3,450,000
2,430,000 1,620,000 4,050,000
2,415,000 1,610,000 4,025,000
2,835,000 1,890,000 4,725,000
2,760,000 1,840,000 4,600,000
3,240,000 2,160,000 5,400,000
8,625,000 5,750,000 14,375,000
10,125,000 6,750,000 16,875,000
10,350,000 6,900,000 17,250,000
12,150,000 8,100,000 20,250,000
12,075,000 8,050,000 20,125,000
14,175,000 9,450,000 23,625,000
13,800,000 9,200,000 23,000,000
16,200,000 10,800,000 27,000,000
15,525,000 10,350,000 25,875,000
18,450,000 12,300,000 30,750,000
75,000 50,000 125,000
87,000 58,000 145,000
109,500 73,000 182,500
127,500 85,000 212,500
144,000 96,000 240,000
168,000 112,000 280,000
184,500 123,000 307,500
214,500 143,000 357,500
219,000 146,000 365,000
255,000 170,000 425,000
3,450,000 2,300,000 5,750,000
4,050,000 2,700,000 6,750,000
4,312,500 2,875,000 7,187,500
5,062,500 3,375,000 8,437,500
5,175,000 3,450,000 8,625,000
6,075,000 4,050,000 10,125,000
6,037,500 4,025,000 10,062,500
7,087,500 4,725,000 11,812,500
6,900,000 4,600,000 11,500,000
8,100,000 5,400,000 13,500,000
405,000 270,000 675,000
465,000 310,000 775,000
577,500 385,000 962,500
667,500 445,000 1,112,500
750,000 500,000 1,250,000
870,000 580,000 1,450,000
922,500 615,000 1,537,500
1,072,500 715,000 1,787,500
1,095,000 730,000 1,825,000
1,275,000 850,000 2,125,000
10,500 7,000 17,500
11,700 7,800 19,500
17,400 11,600 29,000
19,800 13,200 33,000
24,300 16,200 40,500
27,900 18,600 46,500
32,400 21,600 54,000
37,200 24,800 62,000
40,500 27,000 67,500
46,500 31,000 77,500
121,500 81,000 202,500
300,000 200,000 500,000
2,280,000 1,520,000 3,800,000
12,000 8,000 20,000
36,000 24,000 60,000
2,940,000 1,960,000 4,900,000
75,000 50,000 125,000
90,000 60,000 150,000
36,000 24,000 60,000
- - -
4,050,000 2,700,000 6,750,000
5,400,000 3,600,000 9,000,000
4,050,000 2,700,000 6,750,000
4,050,000 2,700,000 6,750,000
16,200 10,800 27,000
30,000 20,000 50,000
12,000 8,000 20,000
22,200 14,800 37,000
22,200 14,800 37,000
1,800,000 1,200,000 3,000,000
1,950,000 1,300,000 3,250,000
2,790,000 1,860,000 4,650,000
6,750,000 4,500,000 11,250,000
36,000 24,000 60,000
3,672,000 2,448,000 6,120,000
5,737,200 3,824,800 9,562,000
5,737,200 3,824,800 9,562,000
6,885,000 4,590,000 11,475,000
6,885,000 4,590,000 11,475,000
8,032,200 5,354,800 13,387,000
6,750,000 4,500,000 11,250,000
30,600 20,400 51,000
4,500,000 3,000,000 7,500,000
5,190,000 3,460,000 8,650,000
2,790,000 1,860,000 4,650,000
1,380,000 920,000 2,300,000
41,400 27,600 69,000
27,000 18,000 45,000
2,940,000 1,960,000 4,900,000
65,340 43,560 108,900
237,000 158,000 395,000
21,000 14,000 35,000
150,000 100,000 250,000
3,600,000 2,400,000 6,000,000
168,000 112,000 280,000
60,720 40,480 101,200
59,400 39,600 99,000
99,000 66,000 165,000
69,600 46,400 116,000
16,638 11,092 27,730
1,410,000 940,000 2,350,000
2,940,000 1,960,000 4,900,000
138,000 92,000 230,000
106,500 71,000 177,500
300,000 200,000 500,000
30,000 20,000 50,000
4,620,000 3,080,000 7,700,000
4,650,000 3,100,000 7,750,000
1,500,000 1,000,000 2,500,000
1,530,000 1,020,000 2,550,000
41,400 27,600 69,000
243,600 162,400 406,000
180,000 120,000 300,000
18,000 12,000 30,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,280,000 1,520,000 3,800,000
2,940,000 1,960,000 4,900,000
4,770,000 3,180,000 7,950,000
2,280,000 1,520,000 3,800,000
2,940,000 1,960,000 4,900,000
4,770,000 3,180,000 7,950,000
180,000 120,000 300,000
4,440,000 2,960,000 7,400,000
13,500 9,000 22,500
24,000 16,000 40,000
180,000 120,000 300,000
108,000 72,000 180,000
71,400 47,600 119,000
27,000 18,000 45,000
55,200 36,800 92,000
42,000 28,000 70,000
300,000 200,000 500,000
55,200 36,800 92,000
90,000 60,000 150,000
180,000 120,000 300,000
55,200 36,800 92,000
90,000 60,000 150,000
240,000 160,000 400,000
420,000 280,000 700,000
180,000 120,000 300,000
120,000 80,000 200,000
90,000 60,000 150,000
102,000 68,000 170,000
180,000 120,000 300,000
90,000 60,000 150,000
2,940,000 1,960,000 4,900,000
40,200 26,800 67,000
1,560,000 1,040,000 2,600,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
2,280,000 1,520,000 3,800,000
2,400,000 1,600,000 4,000,000
21,000 14,000 35,000
365,400 243,600 609,000
600,000 400,000 1,000,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
5,190,000 3,460,000 8,650,000
2,280,000 1,520,000 3,800,000
25,000 25,000
25,000 25,000
30,000 30,000
30,000 30,000
25,000 25,000
25,000 25,000
25,000 25,000
18,000 12,000 30,000
600,000 400,000 1,000,000
900,000 600,000 1,500,000
105,000 70,000 175,000
150,000 100,000 250,000
84,000 56,000 140,000
510,000 340,000 850,000
120,000 80,000 200,000
150,000 100,000 250,000
36,000 24,000 60,000
13,110,000 8,740,000 21,850,000
108,000 72,000 180,000
78,000 52,000 130,000
210,000 140,000 350,000
144,000 96,000 240,000
18,000 12,000 30,000
6,060,000 4,040,000 10,100,000
780,000 520,000 1,300,000
33,000 22,000 55,000
6,750,000 4,500,000 11,250,000
8,032,200 5,354,800 13,387,000
6,885,000 4,590,000 11,475,000
3,672,000 2,448,000 6,120,000
5,737,200 3,824,800 9,562,000
2,295,000 1,530,000 3,825,000
3,213,000 2,142,000 5,355,000
660,000 440,000 1,100,000
330,000 220,000 550,000
165,000 110,000 275,000
495,000 330,000 825,000
33,000 22,000 55,000
43,800 29,200 73,000
54,600 36,400 91,000
15,600 10,400 26,000
1,530,000 1,020,000 2,550,000
12,000 8,000 20,000
5,000 30,000 35,000 1.

5,000 40,000 45,000
5,000 50,000 55,000 2.
15,000 85,000 100,000
30,000 20,000 50,000 1.

36,000 24,000 60,000
42,000 28,000 70,000 2.
52,500 35,000 87,500
1.
45,000 30,000 75,000
54,000 36,000 90,000
60,000 40,000 100,000
2.
60,000 40,000 100,000
66,000 44,000 110,000
78,000 52,000 130,000
96,000 64,000 160,000

105,000 70,000 175,000
111,000 74,000 185,000
360,000 240,000 600,000

420,000 280,000 700,000
540,000 360,000 900,000

600,000 400,000 1,000,000
1,500,000 1,000,000 2,500,000

1,800,000 1,200,000 3,000,000
315,000 210,000 525,000

360,000 240,000 600,000
315,000 210,000 525,000

360,000 240,000 600,000
Keterangan
Hid atau Hind?
Kru atau kruris?
Lengan atau Lgn?
Wrsi atau wris?

Eks, eksisi atau exsisi?
Osteo atau Osteomyelitis
Debri atau Debrid atau Debridemen atau Debridement?
Reg atau Regio?
Delatasi atau Dilatasi, Phimosis atau Phimosis

Eko Kardiografi atau Echo Cardiography?
0376 Sama???
0365 sama???
sama???
sama???
Tanya???
Tanya???
Tanya???
Tanya???
Tanya???
Tanya???
Tanya???
1531 sama???
1277 sama???
Tanya???
Tanya???
Tanya???
Tanya???
Tanya???
Apa???
Apa???
Tarif tidak termasuk obat, tindakan medik, tindakan medik gigi dan mulut, penunjang medik.
Untuk pasien asing yang tidak memiliki KITAS dikenakan tarif sebesar 1,5 kali dari tarif RS.
Tarif tidak termasuk obat,

penunjang medik.
Untuk pasien asing yang
No. Kode
1 0001
2 0002
3 0003
12 0004
13 0005
14 0006
20 0007
22 0008
24 0009
32 0010
38 0011
42 0012
43 0013
44 0014
48 0015
49 0016
50 0017
51 0018
52 0019
53 0020
54 0021
55 0022
56 0023
57 0024
58 0025
59 0026
60 0027
61 0028
62 0029
63 0030
64 0031
65 0032
66 0033
67 0034
68 0035
69 0036
70 0037
71 0038
72 0039
73 0040
74 0041
75 0042
76 0043
77 0044
78 0045
79 0046
80 0047
81 0048
82 0049
83 0050
84 0051
85 0052
86 0053
87 0054
88 0055
89 0056
90 0057
91 0058
92 0059
93 0060
94 0061
95 0062
96 0063
97 0064
98 0065
99 0066
100 0067
101 0068
102 0069
103 0070
104 0071
105 0072
106 0073
107 0074
108 0075
109 0076
110 0077
111 0078
112 0079
113 0080
114 0081
115 0082
116 0083
117 0084
118 0085
119 0086
120 0087
121 0088
122 0089
123 0090
124 0091
125 0092
126 0093
127 0094
128 0095
129 0096
130 0097
131 0098
132 0099
133 0100
134 0101
135 0102
136 0103
137 0104
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2522 1981
2523 1982
1 RJ1
2 RJ2
3 RJ3
4 RJ4
1 RD1
2 RD2
3 RD3
4 RD4
RI
1
III.Umum
III.Sp
III.Kons
2
II.Umum
II.Sp
II.Kons
3
I.Umum
I.Sp
I.Kons
4
VIP.Sp
VIP.Kons
5
VVIP.Sp
VVIP.Kons
6
Suite.Sp
Suite.Kons
7
ICU/ICCU/HCU.Sp
ICU/ICCU/HCU.Kons
8
NICU/PICU.Sp
NICU/PICU.Kons
Jenis Pelayanan
Darm Bouis
Echo Cardiography (Poli Jantung)
Holter dan Recorder
Treadmill
Angkat dan Pasang KB Susuk
Angkat Jahitan
Ekstirpasi Kiste Bartholine
Ekstraksi IUD Kebidanan
Extractie IUD dengan GA
Pap Smear Biasa
Pasang Pesarium
USG
Bedah Sakpel
Biopsi Kulit
Eksisi Granuloma
Eksisi Granuloma Pyogenikum
Eksisi Hordeleum/Granuloma
Eksisi Syringoma
Eksisi Xantalasma
Eksisi Xantoma
Ekstirpasi Komedo
Ekstraksi Kalium Oksalat
Elektro Kauter dengan Anestesi Topikal (Condiloma)
Elektro Kauter dengan Anestesi Topikal (Millium)
Elektro Kauter dengan Anestesi Topikal (Veruka...)
Elektrofulgasi
Elektrokauter dengan Anestesi Injeksi
Elektrokauter dengan Anestesi Topikal
Enulkleasi Milia Lesi < 20
Enulkleasi Milia Lesi > 20
Enulkleasi Moluskum
Enulkleasi Moluskum lesi < 20
Enulkleasi Moluskum Lesi > 20
Injeksi Triamcinolon Acetonide Kenacort lesi < 50 cm²
Injeksi Triamcinolon Acetonide Kenacort Lesi > 50 cm²
IPL (Pemakaian Alat Canggih) Kaki Kanan - Kiri
IPL (Pemakaian Alat Canggih) Tangan Kanan - Kiri
IPL (Pemakaian Alat Canggih) Wajah
Pengangkatan Neuro Fibroma
Pengangkatan Tandur Kulit
Suntik Keloid
Tindakan Bedah Flap
Tindakan Dermabrasi
Tindakan pada Keratosis Seboroika Lesi < 20
Tindakan pada Keratosis Seboroika Lesi > 20
Tatto Removal 1 card
Dark Circle Around Eyes 1 card
Wrinkle Around Eyes 1 card
Skin Lightening 1 card
Rosacea 1/4 card
Rosacea 1/2 card
Rosacea 3/4 card
Rosacea 1 card
QS Pixel Melasma 1 card
QS Pixel Freckles 1 card
QS Pixel Lentigo 1 card
Whole Face Rejuvenation
Siringoma 1/4 card
Siringoma 1/2 card
Siringoma 3/4 card
Siringoma 1 card
Gentle Peel 1 card
SSR Melasma 1 card
SSR Freckles 1 card
SSR Lentigo 1 card
Telangietacstatitas 1 card
Hemangiomas1/2 card
Hemangiomas 1 card
Venous Lake 1 card
Port Wine Stain 1 card
Full Face Rejuvenation
Ekstraksi Komedo Jumlah > 10
Ekstraksi Komedo Jumlah < 10
Mikrodermabrasi
Checimal Peeling
Botox
Filler
Subsisi (Acne Scar)
Jumlah > 5 (SSR)
Jumlah < 5 (SSR)
Prp
Thread
Ftd
Injeksi Vitamin C
Injeksi 1 Acne
Konsultasi Gizi
Angkat Implant Interna
Audiometri (Pelayanan Eksekutif Rawat Jalan)
Biopsi Nosopharynk dengan Lokal Anastesi
Buka Fiksasi 2 Rahang
Ekstraski Polip dengan Lokal Anastesi
Ekterpasi Granuloma dan Milium
Epilasi (Pelayanan Eksekutif Rawat Jalan)
Extractie Korpus Alenium Kornea
Fiksasi 1 Rahang
Home Exercise Program
Incisi Abces Peritonsil
Incisi Abses (Tindakan Sederhana)
Incisi Hordeolum
Irigasi/Extraksi Cerumen
Kista Dermoid
Kolposcopy
Konsultasi Ahli Gizi
Konsultasi Psychiatri
Koreksi Refraksi
Laringoskopi Indirect
Latihan Fisik
Peeling
Perawatan Gips: Lac, Sac, Bkc
Ps. Gips Ekstremitas
Punctie Daun Telinga
Rectoscopy (Eksekutif rawat jalan)
Rehab Obesitas
Slit Lamp (Pelayanan Eksekutif Rawat Jalan)
Spirometri
Spoel Kateter
Test Garputala
Tonometri Aplanasi
Tonometri Schiotz
USG Abdomen Atas (Tanpa Print Gambar)
USG Abdomen Bawah (Tanpa Print Gambar)
Antrostomi Sinus Maksilaris
Buka Jahitan Palpebra
Circumcisi (Sunat)
Ekstirpasi Kista Dermoid
Ekstirpasi Tumor Tulang
Hecting Luka Konjungtiva
Incisi Abses dengan Lokal Anastesi
Pasang Spalk
Pasang Tindik pada Telinga
Reposisi Fraktur dan Atm Dislokasi
Skin Tractie/Pasang Traksi Kulit
Up Inter Dental Wire
Delatasi Phymosis dengan Lokal Anastesi
Dilatasi dengan Bougie
Extraksi Batu Uretra dengan GA
Mantoux Test
Pasang Tindik Tembak
Aspirasi Cairan Sendi Superfisial
Cauterisasi Kutil Lebih dari 20 Buah
Needling Muscle Band
Pasang Gips Tulang Belakang
Perawatan Gips : Tulang Belakang
Ekstirpasi Tumor Jinak Kulit (poli Kebidanan)
Aktifir Plat Orthodentie/Kontrol
Alveolektomi Per Regio
Apex Reseksi 1 Gigi
Buka Kawat Fiksasi
Cementing Per Gigi
Eksisi Epulis (Mucocele)
Eksplorasi Abses Mandibula
Ekstirpasi Polip Rongga Mulut
Ekstirpasi Tumor Jinak Sinonasal, Oral Cavity
Emergency Treatment
Fiksasi Rahang dengan Pembiusan Umum
Fissure Sealant/Regio
Frenektomi
Ganti Perban
Gingivektomi Per Rahang
Incisi Ekstra Oral
Incisi Intra Oral
Jahit Luka Mulut < 5
Jahit Luka Mulut > 5
Kontrol Protese Gigi
Kontrol Tindakan Post Operatif
Kuretase 1 Gigi Close Method Non Anastesi
Kuretase Open Method + Anastesi (Jahit Per Gigi)
Mahkota Jaket/Dowel Acrilic Per Gigi
Mahkota Sementara
Mahkota/Dowel Perselen Per Gigi
Odontektomi Anestesi Umum
Odontektomi dengan Anestesi Lokal
Ortho Cekat/Rahang
Pembuatan Plat Orthodontik/Rahang
Pemeriksaan atau Check Up Per Kunjungan
Pemutihan Gigi (Bleaching)/Rahang
Penambahan Protese Per Gigi (Akrilik)
Pencabutan Gigi dengan Anestesi Lokal (Tindakan Sederhana)
Pencabutan Gigi dengan Komplikasi dan Open Method
Pencabutan Gigi dengan Topical Anestesi
Pengisian Saluran Akar (Gigi Permanen)
Pengisian Saluran Akar Gigi Sulung
Preparasi Saluran Akar
Protese (Akrilik Full Denture/Per Rahang)
Protese 1 Gigi/Gigi Pertama (Akrilik)
Pulp Capping
Pulpotomi
Rebasing Gigi Tiruan/Rahang
Rellining Full Dentur Per Rahang
Rellining Partial Dentur Per Rahang
Reparasi Protese
Reposisi Gigi Per Regio
Scalling Per Rahang
Splinting Per Rahang
Sterilisasi Saluran Akar
Tambahan Ekspansi Atau Screw Orthodontik
Tumpatan Composite Light Cure
Tumpatan Glass Ionomer
Tumpatan Inlay, Onlay, dan Uplay
Tumpatan Sementara 1 Gigi Tanpa/dengan Open Boor
Upperculectomy
Konsultasi Hasil
Konsultasi Psikologi
Tindakan Psikologi
Exercise Terapi
Faradic/Galvanik
Fisioterapi dengan Alat (4 x tindakan)
Hidro Terapi
Home Exercis Eprogram
Hot Pack/ Cold Pack
Infra Red
Massage
Micro Wave Diathermy/MWD
Parafin Bath
Short Wave Diathermy/SWD (REHABILITASI MEDIK/FISIOTERAPI)
Tens
Terapi Bermain/Support
Terapi Klp Asma
Terapi Klp Stroke
Terapi Laser
Terapi Latihan Asma
Terapi Latihan Fraktur
Terapi Latihan Stroke
Terapi Okupasi (4x tindakan)
Terapi Wicara (4x tindakan)
Traksi Cervical dan Lumbal
Ultra Sound Diathermy/USD
Psikoterapi Kognitif
Psikoterapi Suportif (Rawat jalan)
Psikoterapi Edukasi
Restrain
Surat Keterangan Bebas Narkoba (Pelayanan Psikoterapi)
Surat Keterangan Sehat Jiwa
Tes Anak Berkebutuhan Khusus
Tes IQ Individu
Tes Kejiwaan (MMPI)
Tindakan Psikoterapi
Mengeluarkan Bayi dari Jenazah Ibu (PELAYANAN MEDICO LEGAL)
Visum - Otopsi
Visum - Otopsi - Hari Libur
Visum - Pemeriksaan Jenazah Bagian Luar Saja
Visum - Pemeriksaan Jenazah Bagian Luar Saja - Hari Libur
Visum di Luar RS - TKP dengan Penggalian
Visum Luar RS - TKP (diluar Rumah Sakit)
Medical Certificate
Surat Keterangan Buta Warna
Surat Keterangan Sehat
Surat Keterangan Sehat Untuk ke Luar Negeri
Manicure
Pedicure
Bali Body Massage 30 Menit
Bali Body Massage 1 Jam
Bali Body Massage + Scrub 1,5 Jam
Pelayanan Spa ke Ruang Rawat Inap Tambahan Biaya
Akupuntur Estetika
Akupuntur Kebugaran
Akupuntur Terapi
Pelayanan Akupuntur ke Ruang Rawat Inap Tambahan Biaya
Pijat Refleksi 30 Menit
Pijat Refleksi 1 Jam
Pijat Refleksi ke Ruang Rawat Inap Tambahan Biaya
Cuci Rambut
Cuci Rambut + Blow/Catok
Cuci Rambut + Blow/Catok ke Ruang Rawat Inap Tambahan Biaya
IGD Pelayanan Ambulance Keperawatan Dalam Kota
IGD Pelayanan Ambulance Keperawatan Gianyar
IGD Pelayanan Ambulance Keperawatan Badung
IGD Pelayanan Ambulance Keperawatan Tabanan
IGD Pelayanan Ambulance Keperawatan Klungkung
IGD Pelayanan Ambulance Keperawatan Bangli
IGD Pelayanan Ambulance Keperawatan Karangasem
IGD Pelayanan Ambulance Keperawatan Buleleng
IGD Pelayanan Ambulance Keperawatan Negara
IGD Pelayanan Ambulance Keperawatan Luar Bali
Pelayanan Ambulance Medik Umum Dalam Kota
Pelayanan Ambulance Medik Umum Gianyar
Pelayanan Ambulance Medik Umum Badung
Pelayanan Ambulance Medik Umum Tabanan
Pelayanan Ambulance Medik Umum Klungkung
Pelayanan Ambulance Medik Umum Bangli
Pelayanan Ambulance Medik Umum Karangasem
Pelayanan Ambulance Medik Umum Buleleng
Pelayanan Ambulance Medik Umum Negara
Pelayanan Ambulance Medik Umum Luar Bali
Pelayanan Ambulance Medik Spesialis Dalam Kota
Pelayanan Ambulance Medik Spesialis Gianyar
Pelayanan Ambulance Medik Spesialis Badung
Pelayanan Ambulance Medik Spesialis Tabanan
Pelayanan Ambulance Medik Spesialis Klungkung
Pelayanan Ambulance Medik Spesialis Bangli
Pelayanan Ambulance Medik Spesialis Karangasem
Pelayanan Ambulance Medik Spesialis Buleleng
Pelayanan Ambulance Medik Spesialis Negara
Pelayanan Ambulance Medik Spesialis Luar Bali
Amputasi Jari
Arm Sling
Blaas Punctie
Bulectomy 10% - 20%
Bullectomy < 10%
Bullectomy Lebih dari 20%
Cauter Perdarahan Tonsil
Combutio < 10%
Combutio > 30%
Combutio 10% - 30%
Cukur Lapangan Operasi
Cystostomy
DC Shock (Tindakan IGD)
Dilatasi Phymosis Tanpa Bius
Dislokasi Rahang
Dusinasi (Dilatasi dengan Businator)
Eksplorasi Luka Gigitan Sengatan Binatang (IGD)
Eksplorasi Vulnus Iktum
Eksplorasi/Ekstraksi Kuku
Ekstraksi Batu Uretra
Ekstraksi Benda Asing dengan Penyulit
Ekstraksi Cincin
Ekstraksi Corpus Alienum pada Telinga, Kuku
Ekstraksi Kuku dengan Lokal Anastesi
Evakuasi Batu Urethra Anterior tanpa Anastesi
Evakuasi Batu Urethra Anterior dengan Anastesi Lokal
Explorasi Kecil
Explorasi Luka Gigitan Binatang (Poliklinik)
Extractie Corpus Alienium Konjungtiva
Extraksi Batu Uretra Tanpa Anastesi
Fnab/Fine Needle Aspirasi Biopsi
Glyserin Spuit
High Below Knee Gips
Incisi Furunkell Abses
Injeksi Intra Artikuler (Tindakan IGD)
Incisi Biopsi Kelenjar dengan Lokal Anastesi
Irigasi Mata
Konsultasi Tak Langsung Dokter Spesialis/Per Telepon
Kumbah Lambung
Lavement
Luka Bakar Diatas 20%
Lumbal Pungsi Diatas 12 Tahun
Multiple Vulnus Apertum
Nekrotomi Luka
Observasi < 2 Jam
Observasi Lebih dari 2 Jam
Pasang Arteri Line
Pasang Collar Brace
Pasang Elastic Bandage
Pasang Gips dengan GA
Pasang Gips (IGD)
Pasang Kateter dengan Alat Bantu
Pasang Mitella/Pembalut Elastis
Pasang Tampon pada Hidung/Telinga
Pasang Traksi Kulit (Ekstremitas, Kepala)
Pasang Traksi Vertebra (Tulang Selangkang)
Pasang WSD Continus
Pasang/Angkat Buak Gips Sirkular
Pemasangan Endotracheal Tube
Pemasangan Monitor
Pemasangan Ransel Perban, Colar dan Cuf, Back Slab Cast, Bandage
Pemasangan Skin Traksi
Perawatan Luka Bakar Derajat II - III Lebih 20%
Perawatan Luka Bakar Derajat II 15% - 20%
Perawatan Luka Bakar Derajat II s/d 15%
Puntie Hematros
RJP
Rawat Luka Bakar < 10%
Rawat Luka Bakar 10% - 20%
Repair Daun Telinga
Repair Tendon Jari Tangan
Repair Tendon Jari Tangan (Diatas 2 Buah)
Reposisi
Reposisi + Gips Ekstremitas Atas 1 Sisi
Reposisi dengan Anastesi
Reposisi dengan Anastesi Lokal
Reposisi Dislokasi MT Joint tanpa Anastesi
Reposisi Dislokasi MT Joint dengan Anastesi
Reposisi Dislokasi Sendi Mandibula
Reposisi Ekstremitas Atas dengan Anastesi Umum
Reposisi Ekstremitas Atas Tanpa Anastesi
Reposisi Ekstremitas Bawah Tanpa Anastesi
Reposisi Fr. Os Nasal + Pasang Gips Kupu-Kupu
Reposisi Fraktur dan Dislokasi
Reposisi Haemorrhoid
Reposisi Long Arm dengan Anastesi Umum
Reposisi Long Arm Gips dan Long Leg Tanpa Anastesi Umum
Reposisi Long Leg dengan Anastesi Umum
Reposisi MT Joint
Reposisi Os Nasal
Reposisi Short Arm dengan Anastesi Umum
Reposisi Short Arm Tanpa Anastesi Umum
Sambung Tendon Parsial
Sambung Tendon Total
Screening Hypotyroid
Sistostomi dengan Anastesi Lokal
Spalks Long 80 - 100 Cm
Speech Audiometer
Suprapubic Punctie
Tendo Plasty
Tennoraphy Tendon Ekstensor 1 Jari
Thoracostomy (WSD) Bilateral
Thoracostomy (WSD) Unilateral
Tindakan Pembuatan Visum Et Repertum Korban Hidup
Trocar Sistostomi
Vulnum Amputatum Sederhana
Vulnus Apertum < 5 Jahitan
Vulnus Avertum > 10 Jahitan
Vulnus Avertum 5 - 10 Jahitan
Vulnus Excoriatum
Asistensi Induksi
Rehabilitasi Vertibuler
USD
Visite Dokter Spesialis
Tindakan Medik Sederhana 1 A
Amput/Dear Tgk Hid Quarter 2 Sisi
Amput/Dear Tgk Hind Quarter 1 Sisi
Amput/Dear Tgk Kru/Ante 2 Sisi
Amput/Dear Tgk Kruris/Ante 1 Sisi
Amput/Dear Tgk Lengan Ats/Paha 1 Sisi
Amput/Dear Tgk Lgn Ats/Paha 2 Sisi
Amput/Dear Tgk Panggl /Bahu 2 Sisi
Amput/Dear Tgk Panggl Bahu 1 Sisi
Amput/Dear Tgk Siku/Lutut 1 Sisi
Amput/Dear Tgk Wrsi Ankle 2 Sisi
Amput/Dear Tgkt Wris/Ankle 1 Sisi
Amput/Dera 1-2 Snd Jr Tgk Kar,Tar
Amputasi Deartikualsi Lbh 2 Jr
Amputasi/ Dear 1-2 Snd Jr Tgk Kar
Amputasi/Dearti 1 - 2 Jari
Anastomis Vaskuler Distal Wrist
Anastomosis Vaskuler Proksimal Wrist
Angkat Fiksasi Ext. 1 Regio Ekstr.
Angkat Fiksasi In 1 Regio Ekstr.
Angkat Fiksasi In Lebih 1 Regio Ekstr.
Angkat Fiksasi Tulang Belakang
Angkatfiksasi Ext. Lebih 1 Regioekst
Arthriplasty Eks Bahu/Panggl 1 Sisi
Arthrodesis 1-2 Jari
Arthrodesis Lbh Dr 2 Jari
Arthroplasty Eks Bahu/Pangl 2 Sisi
Arthroplasty Eks Siku/Lutut 1 Sisi
Arthroplasty Eks Wrist/Ankle 2 Sisi
Arthroplasty Eksisi Wrist/Ankle 1 Sisi
Arthroplasty Exsisi 1-2 Jari
Arthroplasty Siku/Lutut 2 Sisi
Arthroscopy Bahu
Arthroscopy Lutut
Arthroscopy Panggul
Aspirasi Biopsi Tumor Muskuloskeletal
Aspirasi Cairan Sendi Dalam
Debri dan Drai Osteo Eks dengan Penyulit
Debri dan Drai Osteo Eks Lbh 1 Reg
Debri dan Drainge Osteomyelitis Eks
Debrid dan Drai Osteo Tlg Belakang
Debridement Luka (WT, HT)
Dekom Sten Srf Fer Reg Akar Spi Kan
Dekom Sten Srf Fer Reg Medula Spina
Dekom Sten Srf Fer Reg Thor Outlet
Dekom Sten Srf Fer Reg W/A 2 Sisi
Dekom Sten Srf Per Regio W/A 1 Sisi
Eksisi Biopsi Tumor Jaringan Lunak
Eksisi Biopsi Tumor Jinak Jar. Lunak
Fascio Dekom Comp Dist Wrist/Angkle
Fascio Dekom Comp Prok Wrist/Ankle
Fiksasi Ext 1Regio Ektr
Fiksasi Ext Ekst 1 Regio dengan Penyulit
Fiksasi Ext Ekstr Lebih dari 1 Regio
Hemi JoinT Replacement Panggul 2 Sisi
Hemi Joint Replecement Panggul 1 Sisi (Orthopedi)
Incisi dan Drai Abses Sendi Dlm (Pro)
Incisi dan Drainase AB Sendi Superfisial
Incisi dan Drainase Abses Jar. Lunak
Moulding Dislokasi + Bandaging dengan Ga
Moulding Fraktur/Dislokasi + Gips
Orif Fr Kom Diaf 1-2 Meta, Tar, Fa
Orif Fr Kom Diaf Ante + 2 Reg Lain
Orif Fr Kom Diaf Ante + Ibh 2 Reg Ln
Orif Fr Kom Diaf Antebra + 1 Reg Ln
Orif Fr Kom Diaf Antebrakhii
Orif Fr Kom Diaf Fem Kla Lbh 2 Reg L
Orif Fr Kom Diaf Fem, Kla + 2 Reg Ln
Orif Fr Kom Diaf Fem, Klavi + 1 Reg
Orif Fr Kom Diaf Femur, Klaficula
Orif Fr Kom Diaf Hum Lbh 2 Reg Ln
Orif Fr Kom Diaf Hume + 2 Reg Lain
Orif Fr Kom Diaf Humerus + 1 Reg L
Orif Fr Kom Diaf Kru Fat Lbh 2 Reg
Orif Fr Kom Diaf Kruris Fatela
Orif Fr Kom Diaf Lbh 2 Met, Tar, Fal
Orif Fr Kom Diaf Umerus
Orif Fr Perd Tlpk dan Jr Tgn/Kk Lbh 2 Jr
Orif Fr Pers Siku
Orif Fr Pers Siku + 2 Reg Lain
Orif Fr Persd Bahu, Perg Tgn + 1 Reg
Orif Fr Persd Bh, Perg Tgn Lbh 2 Reg
Orif Fr Persd Lutut, Perg Kaki Lbh 2
Orif Fr Persd Lutut, Pergl Kaki
Orif Fr Persd Panggl Lbh 2 Reg Lain
Orif Fr Persd Panggul
Orif Fr Persd Siku Lbh 2 Reg Lain
Orif Fr Persd Tlpk dan Jr Tgn/Kk + 2 Rg
Orif Fr Persd Tlpk dan Jr Tgn/Kk Lbh 2Jr
Orif Fr Persd Tlpk Jr Tgn/Kk 1 - 2 Jr
Orif Fr Pesd Bh,Perg Tgn + 2 Reg Ln
Orif Fr Pesd Lutut,Perg Kaki + 1 Reg
Orif Fr Pesd Panggl + 1 Reg Lain
Orif Fr Pesd Pangl + 2 Reg Ln
Orif Fr Pesd Siku + 1 Reg Lain
Orif Fr Pesd Tlpk dan Jari Tgn/Kaki Lbh2
Orif Fr Pesd Tlpk/Jr Tgn/ Kaki 1 - 2Jr
Orif Fr Pesen Bhu, Pegl Tgn
Orif Fr Simpel Diaf. 1 - 2 Metakarpal
Orif Fr Simpel Diaf. Femur, Klavikula
Orif Fr Simpel Diaf. Lbh Dr 2 Meta.
Orif Fr Simpel Diaf.Humerus + 1 Regio
Orif Fr Simpel Diafisis Antebrakhi
Orif Fr Simpel Diafisis Humerus
Orif Fr Smp Diaf Antebrakhii
Orif Fr Smpl Diad Lebh 2 Met Karval
Orif Fr Smpl Diaf 1 - 2 Met, Tar, Fal
Orif Fr Smpl Diaf 1 - 2 Meta Tar, Fal
Orif Fr Smpl Diaf Ante + Lbh 2 Reg
Orif Fr Smpl Diaf Fem, Kla + Lbh 2 R
Orif Fr Smpl Diaf Hum Lbh 2 Reg
Orif Fr Smpl Diaf Kru, Fat + Lbh 2 R
Orif Fr Smpl Diaf Kruris, Pat + 1 Reg
Orif Fr Smpl Diaf Lbh 2 Met, Tar, Fal
Orif Fr Smpl Diaf Lbh 2 Meta Tar, Fal
Orif Fr Smpl Diaf Ume + 2 Reg Lain
Orif Fr Smpl Diap Antebrak + 2 Reg
Orif Fr Smpl Diap Fem, Kla + 2Reg
Orif Fr Smpl Diap Kru. Fat + Reg Lain
Orif Fr Tlpk Kaki/Jari 1 - 2 Jari
Orif Fr.Smp Diaf Fem Klav 1 Reg Lain
Orif Fr.Smpl Diaf 1 s/d 2 Met Kar
Orif Frak Persd Tlpk/Jr Tgn Lbh 2 Jr
Orif Fraktur Simpel Diaf, Kruris, Fat
Pasang Traksi Tulang Ekstremitas
Pasang Traksi Tulang Kepala
Pengangkatan Bnd Asg di Ekstremitas
Pengangkatan Bnd Asg di Tlg Belkg
Perawatan Gips: LLC, Body Spica
Rekonstruksi Lebih Satu Jari
Rekonstruksi Satu Jari
Rekonstruksi Tgk Manus/Pedis 1 Sisi
Rekonstruksi Tgk Siku/Litut 1 Sisi
Rekonstruksi Tgk Siku/Lutut 2 Sisi
Rekostruksi Tgk Manus/Pedis 2 Sisi
Replantasi Distal Wrist
Replantasi Proksimal Wrist
Reposisi + Gips Ekst Atas 2 Sisi
Reposisi+Gips Ekstremitas Atas 1 Sisi
Stab Anterior Vertb Servikal
Stab Anterior Vertb Thorako - Lumbal
Stab Post Vertb Thorako - Lumbal
Stabil Anterior Vertb dan Fusion
Stabil Post Vertb dan Fusion
Stabil Posterior Vertb Servikal
Sulih Tulang Besar
Tendon Fleks. Lbh 2 Jr Luar Man Area
Tendon Fleks. 2 Jr Didlm Nm Landarea
Tennoraphy Tendon Ekst 2 Jari
Tennoraphy Tendon Ekst Lebih 2 Jari
Tenoraphy Ten. Fleks 2 Jr diluar
Tenoraphy Tendon Flek Lbh 2 Jr didlm
Tenorapy Tendon Fleksor 1 Jari
Tenorraphy Satu Tendon Ekstensor Jari
Total Joint Replacement 1-2 Jari
Total Joint Replacement Lebih 2 Jari
Wide Exc Tumor Tl + Rek Bahu/Panggul
Wide Exc Tumor Tl + Rek Siku/Lutut
Wide Exc Tumor Tl + Rek Tlpk dan Jari Tgn
Wide Exc Tumor Tl + Rek Wrist/Ankle
Adenoidektomi
Adenolisis
Adranalektomi Abdominotorakal
Amputasi Digiti Single
Amputasi Eksisi Kista Branchiogenik
Anal Fistulektomi
Anal Fistulotomi
Angkat "Plate Screw" Fraktur Os Maksilofacial 1 - 2 tempat
Angkat "Plate Screw" Fraktur Os Maksilofasial 3 tempat atau lebih
Angkat "Plate Screw" Sederhana
Anthroscopy Therapeutik
Anthrotomi/Synovektomi
Apendektomi (Elektif)
Apendektomi dengan Laparoskopi
Apendektomi Insidental Lainnya (darurat)
Aspirasi Hemarthrosis
Aspirasi Hematome
Aspirasi Kista
AV Shunt dengan Anestesi Lokal
AV Shunt Radiosefalika
Babcock
Bedah Listrik
Bilateral Excision of Ectopic Breast Tissue (Mamma Aberans)
Bilateral Multiple Excision of Lession of Breast dengan Anestesi
Bilateral Repair of Direct Inguinal Hernia (diluar mesh)
Bilateral Repair of Indirect Hernia
Bilateral Repair of Inguinal Hernia, One Direct and One Indirect
Bilatreal Repair of Femoral Hernia
Biopsi Anus dengan Anestesi Lokal
Biopsi Kelenjar Getah Bening
Biopsi Prostat
Biopsi Saraf Kutaneus/Otot
Biopsi Terbuka Tumor di Dinding Thorak
Biopsi Testis
Bladder Neck Incision
Bouginasi
Buka Gips
Buka IOIDW
Bulektomi tanpa Anestesi
Chemo Surgary Podophylin
Cholecystectomy Terbuka
Clipping Costae (diluar plate)
Closure Anal Fistel
Closure of Appendicial Fistuyla
Closure of Fistula of Small Intestine
Closure of Fistule of Large Intestine
Closure of Intestinal Stoma
Closure of Laceration of Liver
Complicated Functional Neuro Perculteneus Kordotomi
Complicated Functional Neuro Perculteneus Paravarteb/Visceral Block
Complicated Functional Neuro Steraotaxy Kompleks
Complicated Functional Neuro Steraotaxy Sederhana
Condilotomi Mandibula
Control of Hemorrhage of Anus
DCR + Silicon Tube
Debridement - Nekrotomi Luka Gangren
Debridement + Skin Graft
Debridement Fraktur Terbuka Sederhana dengan Eksternal Cast
Debulking
Dekompresi Syaraf
Dekompresi Syaraf Tepi
Deseksi Axila
Dilatasi Megacolon pada Anak
Dilatasi Phimosis (Pelayanan eksekutif)
Dilatasi Uretra
Disartikulasi Sendi Ekstremitas
Diseksi Kelenjar Getah Bening (KGB) Pelvis
Diseksi Kelenjar Inguinal
Diseksi Leher Radikal Modifikasi/Fungsional
Dorsumsisi dengan Anestesi Lokal
Drainage of Appediceal Abses
Drainage of Pancreatic Cyst with Catheter
Drainase Abses Hepar
Drainase Kista Pankreas
Drainase Periureter
Eksenterasi
Eksisi Biopsi Tumor Pembuluh Darah
Eksisi Chodee
Eksisi Clavus
Eksisi Fistel
Eksisi Hemmoroid
Eksisi Hidradenitis Unilateral
Eksisi Higroma Coli
Eksisi Kelainan pada Payudara dengan Pembiusan Umum
Eksisi Kelainan Perianal Lainnya
Eksisi Kelenjar Sub Mandibula
Eksisi Kista Ateroma/Lipoma/Ganglion < 2cm
Eksisi Kista Duktus Tiroglosus
Eksisi Luas Radikal + Rekonstruksi
Eksisi Luas Tumor Ganas Bibir dengan Rekonstruksi Flap Lokal
Eksisi Nevus Sederhana dengan Lokal Anestesi
Eksisi Parsial + Marsupiliasi Ranula
Eksisi Perianal Skin Tags
Eksisi Pretigium Bare Sklera
Eksisi Skin Grafting
Eksisi Tumor Adneksa Kecil
Eksisi Tumor Adneksa Sedang
Eksisi Tumor Ganas Kulit dengan Flap Lokal atau Graft Kulit
Eksisi Tumor Ganas Kulit tanpa Rekonstruksi
Eksisi Tumor Jinak dengan Anestesi Lokal
Eksisi Tumor Jinak Kulit dan Tumor Non Neoplastik Kulit (LA)
Eksisi Tumor Jinak Mama (FAM) < 2 cm satu sisi
Eksochiliasi
Eksplorasi Nasofaring
Eksplorasi Testis Mikro Surgery
Eksplorasi Vaskuler (trauma/nontrauma)
Ekstirpasi Angiofibroma Nasofaring
Ekstirpasi Ganglion Poplitea
Ekstirpasi Kelenjar Sub Mandibula
Ekstirpasi Kista Bronchialis
Ekstirpasi Kista Dermoid dengan Anastesi
Ekstirpasi Plunkina Ranula
Ekstirpasi Tumor Ganas Adneksia + Rekonstruksi
Ekstirpasi Tumor Jinak Kulit (tindakan bedah)
Ekstirpasi Tumor Scalp/Cranium
Ekstirpasi/Eksisi Tumor Jaringan Lunak Ukuran < 2cm
Ekstraksi Corpus Alienum
Ekstraksi Corpus Alienum di Regio Thorak
Ekstraksi Kolesteatum
Ekstraksi Kuku
Ekstraksi Linear
Elektro Kauter Kondiloma, Veruka
Endoskopi Polipektomi of Rectum
Enukleasi Kista
Enukleasi Kista D42
Enukleasi Kista Ginjal
Enukleasi/Eviscerasi + DFG
Epiddimovasostomi
Ethmoidektomi (Intranasal)
Evakuasi Corpus Alienum Sederhana dengan Anestesi Lokal
Evakuasi Corpus Alienum Sederhana dengan Anestesi Umum
Evakuasi Hematome Buli-buli
Evakuasi Hematome di Ekstremitas
Evakuasi Hematome Pasca Operasi Leher tanpa Trakeostomi
Eviscerasi
Extended Pyelolithektomi (Gilveme)
Exteriozation of Large Intestine
Exteriozation of Small Intestine
Faringotomi
Fasciotomi
Fibroadenoma Mama
Fiksasi Interna Fraktur Maksilofasial 1-2 Tempat Patahan
Fiksasi Interna Fraktur Nasal
Fistula Ureterovesika
Flebektomi
FNA (Fine Needle Aspiration)
Foto Koagulasi Laser
Fraktur Antebrachii
Fraktur Clavikula
Fraktur Coles dan Pergelangan Tangan Lainnya
Fraktur Cruris
Fraktur Femur
Fraktur Humerus
Fraktur Olecranon
Fraktur Supracondiler Humerus
Free Flap Surgery
Frontoethmoidektomi (Ekstranasal)
Full Thickness Skin Graft to Hand
Full Thickness Skin Graft to Other Site
Ganglion Carpi
Ganti Balut Besar
Ganti Balut Kecil
Ganti Balut Sedang
Ganti Sendi (Arthroplasti) tidak termasuk alat
Gastrektomi (Bilroth 1 dan 2)
Glosektomi Totalis
Grafting pada Arterial Insufisiensi
Groin Disection
Hemiatomi Bilateral
Hemiglosektomi
Hemiglosektomi + RNO
Hemipelvektomi
Hidrokel per Inguinal/Ligasi Tinggi
Horseshoe Kidney Koreksi
Ileostomi
Ileostomi Permanen
Incisi Abses (Tindakan Bedah)
Incisi Abses dengan Anestesi Lokal
Incisi Abses Perianal
Incisi Mucocele dengan Anestesi Lokal
Incisional Biopsi Tumor dengan Anestesi Lokal
Injeksi Haemoroid (termasuk obat)
Injeksi Varises (termasuk obat)
Incisi Flegmon Dasar Mulut
Internal Fiksasi Fraktur Maksilofasial 5 Tempat atau Lebih
Internal Fiksasi Fraktur Mandibula Segmental
Internal Urethrotomi
Intra Abdominal Manipulation of Small Intestine
Kapsulektomi Posterior
Keratoplasti
Keratoplastie Lamelar
Koledoko Jejunostomi
Kolesistektomi Laparoskopik
Kolostomi Permanen
Konkoplasti
Koreksi Atresia Ani
Koreksi Conoenital Talipes Eouino Varus (CTEV)
Koreksi Disartikulasi
Koreksi Ekstropion / Entropion
Koreksi Fraktur Impresif
Koreksi Priapismus
Koreksi Skoliosis
Koreksi Spondilitis
Koreksi Tortikolis
Kraniotomi + Bedah Mikro
Kraniotomi + Endoskopi
Kraniotomi/Trenpanasi Konvensional
Labioschizis Simpel
Laminektomi Kompleks
Laminektomi Sederhana
Laparoscopy
Laparoscopyc Lysis of Peritoneal Adhesion
Laparoskopi Appendektomi
Laparotomi Eksplorasi
Laparotomi Percobaan
Laparotomi VC
Large to Large Intestinal Anastomose
Le-Ford Advancement Surgery
Left Hemicolectomy
Left Lateral Anal Sphincterotomy
Lepas Arch Barr
Lepas Drain
Lepas Jahitan < 5 Buah
Lepas Jahitan > 5 Buah
Lepas Kateter Pria/Wanita
Ligasi Hemmorroid
Ligasi Vaskuler Ekstremitas
Limfadenektomi Ileonguinal
Limfadenektomi Retroperinoteal
Lipoma
Litotripsi
Lobuloplasti Unilateral dengan Anestesi Lokal
Lokal Eksisi Kelainan pada Rectum atau Jaringan Sekitar
Long Arm Cast Anak
Long Arm Cast Dewasa
Long Leg Cast Anak
Long Leg Dewasa
Longitudinal Nefrolithotomi (Kadet)
Maksilektomi Partialis
Maksilektomi Totalis
Mama Aberant Unilateral
Mandibulektomi Marainalis
Mandibulektomi Partialis dengan Rekonstruksi
Mandibulektomi Totalis
Masektomi Radikal dengan Penyulit
Masektomi Simpel Bilateral
Mastektomi Radikal
Mastektomi Simple Unilateral
Mastektomi Subtotal
Meatotomi
Microsurgery (Tulang-Syaraf)
Microsurgery Ligasi Vena Spermatika
Minor Besar
Minor Kecil
Minor Sedang
MRM tanpa Rekontruksi
Myocutaneus Flap/Pectoral Mavor
Nefrektomi Partial
Nefrektomi Radikal
Nefro Uterektomi
Nefropexie
Nefrostomi Open
Nefrostomi Percutan
Neurektomi Saraf Vidian
Neurektomi/Neurolise
Oivertikulektomi Vesika
Open Biopsi of Breast
Open Biopsi of Liver
Open Biopsi of Salivary Gland or Duct
Open Biopsi Rektum dengan Anestesi Lokal
Open Prostatektomi
Open Reduction of Mandibula Fraktur
Open Reduction of Nasal and Zygomatic Fraktur
Open Reduktion of Alveolar Fraktur
Open Reduktion of Maxila Fraktur
Operasi Aneurisma Aorta
Operasi Arteri Coritis
Operasi Arteri Rehalis Stenosis
Operasi Fraktur Kompleks (Acetabulum, Tulang Belakang Pelvis)
Operasi Fraktur Muka Multiple
Operasi Fraktur Tripodo/Multiple
Operasi Fronto-Orbital Advancement pada Craniosynoostosis
Operasi Fusi Korpus Vertebra Approach Posterior
Operasi Hipospadia
Operasi Ileal Condoit (Bricker)
Operasi Konvensional Plexus Brakhialis/Lumbalis Sacralis/Cranialis/Spinalis Perfier
Operasi Kranioplasti/Koreksi Fraktur
Operasi Manchester Fortegil
Operasi Mega Kolon (Hirschpruoa)
Operasi Mikro Craialis/Spinalis Perifer
Operasi Mikro Plexus Brakhialis/Lumbalis Sacralis
Operasi Mikrotia
Operasi pada Atresia Esofagus
Operasi Palatoplasti
Operasi Pemasangan Fiksasi Interna pada Kasus Bedah Syaraf
Operasi Pemasangan Pintasan VA/VP Shunt
Operasi Pemasangan Traksi Cervical/dan Pemasangan Halo Vest
Operasi Peyronie
Operasi Psoas Hiscth/Boari Flap
Operasi Shunting Femoralis
Operasi Shunting Poplitea Tibialis
Operasi Shunting Splenorenal
Operasi Tumor Jinak Genetalia dengan Anestesi Umum
Operasi Tumor Pembuluh Darah
Operasi Tumor Spinal Daerah Gervikal
Operasi Tumor Spinal Daerah Kraniospinal
Operasi Tumor Spinal Daerah Torakolumbal
Operasi Vaskuler yang memerlukan Teknik Operasi Khusus
Operculectomy
Orbitomi Anterior
Orbitotomi Lateral
Orchidektomi Subkapsuler
Orkhidektomi
Orthoanatic Surgery
Orthoonatie Surgery
Osteotektomi Sederhana
Osteotomi Eksisi Tulang Maksilofacial
Other Operation of Intestine
Other Prosedur of Hemmorroids
Other Repair and Plastic Operation of Tongue
Other Repair of Abdominal Wall
Other Skin Graft to Other Sites
OtherLlysis of Peritoneal Adhesion
Ovariektomi Bilateral
Paket Bedah Paru : Air Plumbage + Dikortikasi+Lobektomi+Muscle Plumbage + Pnemunektomi +
Segmenektomi +Torakoplasti + Omentumpexy
Palatoshizis
Pankreaktektomi
Parasintesa (Bedah)
Parotidektomi Radikal + Maridibulektomi
Parotidektomy Superficial
Pasang Arch Barr (Interdental Wiring)
Pasang Bidai/Spalk
Pasang Central Venous Catheter (CVC)
Pasang Doublelumen Hemodialisis
Pasang Foley Kateter
Pasang Kateter dengan Penyulit
Pasang Sling
Pemasangan Gips (tindakan bedah)
Pemasangan Peritoneal Dialysis - diluar Alat
Pemasangan Pipa Shepard
Pemasangan WSD (diluar alat)
Pembedahan Fore Quarter
Pembuatan Stoma (Gastrostomy, Iliostomy, Kolostomy, Sigmoidostomi)
Penektomi Parsial
Pengobatan Epistaksis
Penutupan Oroantral Fistula
Percutaneous Nephrolithostripsy (PCNL)
Pericardiuocentesis
Phaceomulsifikisi
Phacoemulsifikasi
Pleurodesis (Pleurosklerosis)
Postero Saaital Anorectoplasty (PSA)
Potong Flap
Prosedure Sistrunk Kista Duktus Tiroglosus
Prostatektomi Radikal
Ptergium + CLG
Pthisis Bulbi (Graf Mukosa Bibir)
Ptosis
Pungsi Ascitas
Pungsi Aspirasi Hematoma/Seroma
Pungsi Batu
Pungsi Cairan Otak dengan Anestesi
Pungsi Efusi Pleura
Pyelolithotorni
Pyeloplasti
Radical Neck Desection
Rartial Spleenctomy
Reclosure of Postoperative Disruption of Abdominal Wall
Rectoskopi/Anoskopi
Reduksi Prolap Anus
Rekanalisasi Ruptura/Transkanal
Rekonstruksi Blassemeck
Rekonstruksi Defek/Kelainan Tubuh yang Kompleks
Rekonstruksi Duktus Lacrimalis/Stenosis Sederhana
Rekonstruksi Kelainan Jari/Ekstrimitas (Polidaktili, Sindaktili, Construction Hand) Sederhana
Rekonstruksi Kontraktur Kompleks
Rekonstruksi Laserisasi Daun Telinga
Rekonstruksi Menfngokel Kranial (Anterior/Posterior)
Rekonstruksi Meninaokel Spina Bifida
Rekonstruksi Renovaskuler
Rekonstruksi Saket Berat
Rekonstruksi Vesika
Release Kontraktur Mandibula
Removal of Foreign Body From Peritoneal Cavity
Reopening of Rescent Laparotomy Site
Repair Anal Sphincter Lainnya
Repair Filitel Uretra Pasca Uretroplasi
Repair Herniasi Muscle
Repair Laserasi Hepar pada Trauma
Repair of Direct Inguinal Hernia (diluar mesh)
Repair of Femoral Hernia Unilateral
Repair of Indirect Inguinal Hernia (diluar mesh)
Repair of Other Hernia of Anterior Wall With Prosthesis
Repair of Umbilical Hernia
Repair Ruptur Buli-buli
Repair Ruptur Tendon Achiles
Replantasi
Reposisi Dislokasi Bahu
Reposisi Fiksasi (Compucate)
Reposisi Fistel
Reposisi Fraktur Tertutup Sederhana Ekstrimitas dengan Gips
Reposisi Tertutup Fraktur Condilus Mandibula
Reposisi Torsio Testis dengan Orkhidopeksi
Resection of Transverse Colon
Reseksi Anastomosis
Reseksi Esofagus + Interosisi Kolon
Reseksi Hepar
Reseksi Partial Vesika
Reseksi Rahang
Reseksi Urachus
Reshapino untuk Torus/Tumor Tulang
Ret Cam + Anestesi
Revisi AV Shunt
Revisi Trakeostomy
Revisi WSD
Revision of Anastomose of Small or Large Intestine
Revision of Stoma of Large Intestine
Revision of Stoma of Small Intestine
Right Hemicolektomi
Rinotomi Literalis
Rinotomi Literalis (Tindakan Khusus)
RPLND
Scheral Buckel
Scleroterapi dan atau Ligasi Hemangioma
Segmentektomi
Sequesterektomi dengan Anestesi
Simpatektomi
Simple Functional Neuro Surgery
Sindroma Blefaophimosis
Siok Saraf Tepi
Siptoplasti Reduksi
Sirklase
Sirkumsisi dengan Anestesi Lokal
Sirkumsisi dengan Anestesi Umum
Sirkumsisi One Day Care
Sistektomi Radikal
Sistostomi dengan Anestesi Umum
Skingraftina yang Luas
Skingraftina yang Tidak Luas
Sklera Buckling
Skleroterapi Vena (Varises, Hemangiona)
Sklerotomi
Sleep Nasoendoscopy
Small to Small Intestinal Anastomose
Solenektomi
Somnoplasti
Splenektomi
Split Thickness Skin Graft
Stapedektomi
Stripping Varises Ektremitas Inferior
Surgical Stagina
Suture of Laceration of Large Intestine
Suture of Laseration of Anus
Suture of Laseration of Small Intestine, Except Duodenum
Synovektomi
Taping dan Strapping
Temporal Bone Resection
Tindakan Anoscopy
Tindakan Argon laser/Kenon
Tindakan Bedah Beku
Tindakan Blok Reseksi
Tindakan Congenital Fornix Plastik
Tindakan Cyclodia Termi
Tindakan Deepening Sulcus
Tindakan Dekomoresi Fasialis
Tindakan Dekompresi Fasialis
Tindakan Pharnaeal Flap
Tiroid Lobektomi Unilateral
Tiroidektomi Complete
Tiroidektomi Parsial Lainnya
Tiroidektomi Subtotal
Torakosentesis
Torakotomi
Total Tiroidektomi
Trabekulektomi
Trabekulektomi + ECCE/Phaceomulsifikasi
Trakeostomi dengan Penyulit Tumor pada Akses Trakea
Trakeostomi Temporary
Transeksi Esofagus
Trikeopitelioma
Tumor Ganas/Adneksa Luas dengan Rekonstruksi
TUR Prostat
TUR Tumor Buli-Buli
Turbinoplasti
Uretero Sigmoidostomi
Uretero Ureterostomi
Ureterocutaheostomi
Ureterolisis
Ureterolithotomi
Ureteroneo Sistostomi
Ureterostomi
Urethrektomi
Urethrenuskopi (URS)
Uretroplasti
Uteroplasti
Vasektomi dengan Anestesi Lokal
Vasektomi dengan Anestesi Umum
Vasografi
Vasoligasi V Spermatika (Varicocele) Unilateral
Vena Seksi dengan Anestesi Lokal
Ventrikulostomi/VE Drainase
Vesicolithotomi (Sectio Alta)
Vitrektomi + Endo Laser + SB + Silicon Oil/Gas
Vulvektomi
Wide Eksisi Soft Tisue Tumor
WT dengan Luka Kecil (1 - 3 Lebar Kasa/Gaas)
Yag Laser
Angkat/Ekstraksi KB Susuk
Biopsi
Biopsi Portio
CTG (Cardio Tocografi) Perhari
Curetase dengan General Anastesi
Dilatasi Hegar
Eksisi/Konisasi
Ekstirpasi Kista Bartolin
Ekstirpasi Kista Gardner (Vagina)
Ekstirpasi Myoma Pedunculata
Ekstirpasi Papiloma Vagina
Ekstirpasi Polip Serviks
Ekstraksi IUD (Tindakan Obgyn)
Histerektomi Radikal
Histerektomi Supra Vaginal
Histerektomi Supra Vaginal + BSO
Histerektomi Total
Histerektomi Total + BSO
Histerektomi Vaginal
Incisi Abses Bartolini dengan Anestesi Lokal
Incisi Abses Bartolini dengan Anestesi Umum
Incisi Bartolin + Marsupialisasi
Incisi Abses Bartholine
IVA/Pap Smear
Kauter Kondiloma Akuminata
Kistektomi Bilateral
Kistektomi Unilateral
Kryo Terapi
Kuretase + Steril
Kuretase Abortus/Sisa Plasenta
Kuretase Diagnostik
Kuretase Infeksi/Missed Abortion
Laparoskopi Diagnostik Infertilitas
Laparoskopi Operatif Adesiolis Endometriosis
Laparoskopi Operatif Hamil Ektopik
Laparoskopi Operatif Kiste Endometriosis
Laparoskopi Operatif Salfingektomi Bilateral (Hidrosalfing Bilateral)
Laparoskopi Ovarian Driling (LOD) PCOS
Laparoskopi Tubektomi Bilateral
Marsupialisasi Abses Bartholin
Miomektomi
Nitrogen Cair
NST (Non Stres Test)
Operasi Tumor Ganas Ovarium
Partus Abnormal Bayi Sungsang
Partus Abnormal ditolong Residen/Dokter Umum
Partus Abnormal ditolong Spesialis Jaga
Partus Abnormal Spesialis Khusus
Partus Kembar Ditolong Bidan Jaga
Partus Normal Bayi Kembar Oleh Spesialis
Partus Normal Bidan Khusus
Partus Normal Ditolong Residen/Dokter Umum
Partus Normal Ditolong Bidan Jaga
Partus Normal Ditolong Spesialis Jaga
Partus Normal Spesialis Khusus
Pasang/Buka Susuk KB
Pasang Infuse Umbilical (Rawat inap)
Pasang IUD Pasca Plasenta
Pasang KB
Pasang Tampon pada Vagina
Pasang/Lepas Pesarium
Perineorafi Anestesi Lokal
Perineorafi Anestesi Umum
Perineorafi Sub Total Anestesi lokal
Perineorafi Sub Total dengan Anestesi Umum
Persalinan Tanpa Nyeri
Placenta Manual Partus Luar
Repair Vagina dan Robekan Total Perinium
Repair Vagina dengan GA
Repair Velsco Vagina Fistel Kompleks
Reparasi Vistula Vesiko Vaginal
Resusitasi Bayi Baru Lahir
Salpingo-Ooporektomy Bilateral (Tind.Med.Bes.1)
Salpingo-Ooporektomy Unilateral
Salvagino Operasi Mikro
Screening Pendengaran pada Bayi
Seksio Sesarea
Seksio Sesarea + Histerektomi
Seksio Sesarea dengan Hamil Ganda
Seksio Sesarea dengan Hamil Ganda dengan Steril
Seksio Sesarea dengan Penyulit (Riwayat SC)
Seksio Sesarea dengan Steril
Tampon Uterus/Kondom Kateter
Tampon Vagina
Tindakan pada Kolpodeksis
Tindakan Pelayanan Gizi
Tubektomi
Turbinektomi/Konkotomi
USG 2D
USG 4 Dimensi
USG Organ
USG Transvaginal
Vaginal Swab
Vaginoplasti
Aspirasi Efusi Perikondrial
Audiometri (THT)
Bedah Sinus Endoskopik Fungsional (BSEF) Bilateral
Bedah Sinus Endoskopik Fungsional (BSEF) Unilateral
Beloq Tampon dengan Anestesi Lokal
Beloq Tampon dengan Anestesi Umum
Biopsi Sinus Maksila
Biopsi Tumor Hidung
Biopsi Tumor Hipofaring dengan Anestesi Umum
Biopsi Tumor Lidah/Palatum
Biopsi Tumor Nasofaring
Cadwell Luc Anthrostomi Bilateral
Cadwell Luc Anthrostomi Unilateral
Eksisi Ranula atau Kista pada Mukosa Mulut
Eksplorasi Abses Parafaringeal
Eksplorasi Abses Peritonsiler dengan Anestesi Lokal
Eksplorasi Abses Peritonsiler dengan Anestesi Umum
Eksplorasi Pre Aurikuler Fistel dengan Abses
Eksplorasi Tumor Jinak Kelenjar Liur
Ekstirpasi Papiloma Laring
Ekstirpasi Papiloma Mulut
Ekstirpasi Polip Nasi dengan Anestesi Lokal
Ekstirpasi Polip Nasi dengan Anestesi Umum
Ekstraksi Corpus Alienum Esofagus
Ekstraksi Corpus Alienum Hidung (Tindakan THT)
Ekstraksi Corpus Alienum Hidung dengan Anestesi Umum
Ekstraksi Corpus Alienum Telinga (Tindakan THT)
Ekstraksi Corpus Alienum Telingan dengan Anestesi Umum
Ekstraksi Corpus Alienum Tenggorokan (Tindakan THT)
Ekstraksi Jaringan Granulasi CAE
Ekstraksi Keratosis dengan Anestesi Lokal
Ekstraksi Keratosis dengan Anestesi Umum
Ekstraksi Serumen
Ekstraksi Serumen dengan Penyulit
Ekstraksi Sialolithiasis
Endoskopi Hidung
Endoskopi Telinga/Tenggorok
Fistulektomi Pre Aurikuler Bilateral
Fistulektomi Pre Aurikuler Unilateral
Hemimaksilektomi Partial
Hemimaksilektomi Total
Incisi Abses Leher Anestesi Lokal
Incisi Abses Leher dengan Anestesi Umum
Incisi Abses Preaurikula dengan Anestesi Lokal
Incisi Abses Retroaurikuler Anestesi Lokal
Irigasi Telinga
Irigrasi Sinus Maxilaris dengan Anestesi Umum
Laringektomi
Lepas Beloq Tampon
Lepas Tampon Hidung
Mastoidektomi Radikal
Mastoidektomi Simple
Otoplasti THT
Parasintesis Telinga Bilateral
Parasintesis Telinga Unilateral
Pemasangan Paper Patch Komprehensif
Pemasangan Paper Patch Sederhana
Pemasangan Tampon Telinga
Pemasangan Timpanic Tube dengan Anestesi Lokal
Pemasangan Timpanic Tube dengan Anestesi Umum
Pungsi Hematoma Telinga
Rawat Luka Post Op Mastoidektomi
Rawat Luka Post Op Sinus/Hidung
Rawat Stoma Trakeostomi
Rekonstruksi/flap
Repair Lobulus Telinga Bilateral dengan Anestesi Lokal
Repair Lobulus Telinga Unilateral dengan Anestesi Lokal
Reposisi Fraktur Os Nasal (Hidung)
Rinotomi Lateral
Screening OAE
Septoplasti
Septoplasti EC Trauma Hidung
Septorinoplasti THT
Septum Reseksi
Sinuskopi
Skin Prick Test Alergen Debu dan Makanan
Skin Prick Test Alergen Debu/Makanan
Timpanometri
Timpanoplasti Tipe I/Miringoplasti
Timpanoplasti Tipe II
Timpanoplasti Tipe III
Timpanoplasti Tipe IV
Tindakan Cuci Sinus (Perawatan)
Toilet Telinga
Tonsilektomi
Tonsilo Adenoidektomi
EEG
Facialis Parase
Pain Intervensi Ringan
Pemeriksaan Fungsi Luhur
Pemeriksaan Neuroligi Sederhana
Pemeriksaan Neuroopthalmologi
Tes Pembauan, Pengecapan
Tindakan Electro Convulsive Therapy (ECT)
Tindakan Roser Plasty
Anel Test
Anterior/Posterior Sklerotomi
Biometri
Biopsi Tumor Kelopak
Biopsi Tumor Orbita
Eksisi Chalazion/Hordiolum
Ekstraksi Corpus Alienum Conjungtiva
Ekstraksi Corpus Alienum Kornea
Ekstraksi Granuloma
Ekstraksi Katarak (SICS dan LOL) dengan Anestesi Lokal
Ekstraksi Katarak (SICS + LOL + PPC) Anak-Anak dengan Anestesi Umum
Ekstraksi Membran/Scrapping
Ekstraksi Nevus
Ekstraksi Tumor Kecil Palpebra
Ekstropion Siktratis/Entropion dengan Laser
Epilasi (Tindakan Mata)
Funduskopi Indirect
Gonioskopi
Incisi dan Kuretase Kalazion/Granuloma Anak-Anak dengan Anestesi Umum
Jahit Luka Kornea dan Repair Iris
Jahit Luka Korneo Sclera
Jahit Luka Palpebra Full Theckness
Kalazion Dewasa
Koreksi Strabismus
Koreksi Symbleparon Berat
Koreksi Symblepharon
Laser Iridotomi Perifer
Lepas Jahitan Palpebra < 3 Buah
Lepas Jahitan Palpebra > 3 Buah
Lithiasis
Operasi Ablatio Retina
Operasi Katarak ICCE/ECCE (Ekstraksi Katarak )
Operasi Phaceomulsifikasi + LOL
Pemeriksaan Visus
Pengangkatan Nevus Marga Palpebra
Pengangkatan Skin Tag
Pterigoplasti
Pterygium
Rekonstruksi Kelopak Mata Berat
Rekonstruksi Kelopak Mata/Kontraktur Palpebra
Rekonstruksi Orbita Conaenital
Repair Ruptur Kornea Sklera
Repair Ruptur Palpebra Simple
Repair Ruptur Palpebra Transkanal
Reposisi LOL
Ruptur Palpebra Moderat
Slit Lamp (Tindakan Mata)
Slit Lamp Examination
Sondage Canaliculi Lacrimaris
Spooling Bola Mata
Starbimus (3 - 4) Otot
Tes Ishihara (Buta Warna)
Tindakan Cryosurgery
Tonometri
Triple Produser Keratiplasti dengan Glaukoma
Doubel Lumen
Ganti Transfer Set
Hemodialisis Baru Bicarbonat
Hemodialisis Re-use Bicarbonat
Penggantian Cairan/Training
Kardiosintesis + Indwelling Kateter
Kardiosintesis Tanpa Indwelling Kateter
Kateterisasi Ka/Ki Tanpa Angio
Temporary Peacemaker
Kateterisasi Ka/Ki Angio Valvuler
Kateterisasi Ka/Ki dengan Angio
Penyadapan Angio Valvuler + Koroner
Koronarografo
Dilatasi Katup Mitral (BMW)
Jantung Anak Penyadapan (Diagnostik)
Anastesi Bronchoscopy
Biopsi Aspirasi Transthorakal
Biopsi Pleura
Bronchoscopy
Bronchoscopy dan Biopsi
Pleurodesis
Punksi Pleura
Spyrometri
WSD (Water Seal Drainage)
Endoskopi Atas
Endoskopi Bawah
Skleroterafi Ligasi Lebih dari 6 Ikatan
AFF Tampon Hidung
BMP (Bone Merrow Punctie)
Buka WSD
Debridemen Luka Kecil
Echo Cardiography (Tindakan Khusus ICU)
Extraksi Cerumen
Injeksi dengan Platelet Rich Plasma
Injeksi Intraartikuler dengan USG Guidance
Konsultasi Psikologi (Tindakan Khusus ICU)
Parasintesis (THT)
Pemasangan Epidural/Chateter
Pemasangan Swan Ganz Catheter
Perikardiosintesis Tanpa G A
Persiapan Pasien Pre Op
Punctie Cairan Sendi
Rehab Jantung
Repair Burst Abdoment/Dehiscensi/Luka
SWD (ICU)
Spooling Cateter Post Turp Bph
Traksi L/C
Allergi Test/Pateh Test/Prick Test
EKG Anak
Foto Terapi
Foto Terapi Double Lamp
Imunisasi
Konsultasi Dokter Gigi
Konsultasi Dokter Spesialis di IRD
Lumbal Pungsi
Pasang dan Lepas Kateter Bayi
Pasang Infus Anak (Tindakan Khusus Perinatologi)
Pasang Infus Bayi/Konsul
Pasang Monitor Per Hari
Pasang Tindik
Pasang/Lepas Infus Umbilikalis (Perinatologi)
Pemakaian C - PAP
Pemakaian Ventilator pada Bayi
Pengambilan Darah Bayi
Rectal Terapi
Resusitasi Bayi Asphiksia
Visite Ahli Gizi
Visite Dokter Umum
Asistensi Intra Operatif
Bandaging Khusus (Pembalut Khusus)
Buka Kateter
Cabut Gigi dengan Penyulit
Cabut Gigi Tetap dengan Lokal Anastesi (HCU)
Cauter Coloctomi
Chemoterapi
Ches Fisioterapi
Dekontiminasi Racun
Dressing Luka (Perawatan Luka)
Dryneeding
Extubasi
Fiksasi pada Fraktur
Fnab Hati, Kelenjar
Funduskopi Direct
Galvanic/Faradic/Tens
Heating Ir/Uv
Incisi dengan General Anastesi
Incisional Biopsi Kelenjar dengan Lokal Ans
Intubasi
Konsultasi Dokter Spesialis
Konsultasi Dokter Psychiatri
Konsultasi VCT
Massage/Vibrator
Melakukan Suction
Memberi Obat Injeksi
Memberi Tranfusi Darah
Merawat Catheter
Merawat Infus
Merawat NGT
Oksigenasi dengan Canula
Oksigenasi dengan Masker
Oksigenasi Rebreathing/Non Rebreathing
One Day Care
Pasang Bidai/Splint/Spalk
Pasang Infus Anak
Pasang Infus Bayi
Pasang Infus Dewasa
Pasang Kateter Folley Bag
Pasang NGT
Pasang PASG
Pasang WSD
Pemasangan CPAP
Pemasangan CVP
Pemasangan Infusion Pump
Pemasangan Syring Pump
Pemasangan Ventilator
Pemeriksaan EKG
Pengambilan Spesimen Darah Anak/Bayi
Pengambilan Spesimen Darah Dewasa
Pengelolaan Jalan Napas/Nebulizer
Penyesuaian Gigitan
Premedikasi
Psikoterapi Suportif (Rawat inap)
Punctie Cairan Acites
Punctie Pleura
Rehab Paru
Rehab Stroke
Saturasi Oksigen
Toilet Hidung
Vena Sectie
Visite Dokter Residen
Visite Dokter Spesialis di Intermediate
Visite Dokter Umum di Intermediate
Visite Farmasi Klinis
WT dan HT Lebih dari 20 Jahitan
Zonde Feeding
Perawatan Jenazah
Bedah Jenazah
Konservasi Jenazah/Suntik Formalin
Konservasi Jenazah/Suntik Formalin di Luar Jam Kerja
Visum Mayat
Visum Mayat di Luar Jam Kerja
Otopsi di Dalam Jam Kerja
Otopsi di Luar Jam Kerja/Hari Libur
Penyimpanan Jenazah Tanpa Cooling/Hari
Penyimpanan Jenazah dengan Cooling/Hari
Mengeluarkan Bayi dari Jenazah Ibunya (Pelayanan Jenazah)
Mengeluarkan Bayi dari Jenazah Ibunya di Luar Jam Kerja
Penjahitan Jenazah < 25 Cm
Ambulance Jenazah Kabupaten Buleleng
Ambulance Jenazah Kabupaten Badung
Ambulance Jenazah Kabupaten Tabanan
Ambulance Jenazah Kabupaten Jembrana
Ambulance Jenazah Kabupaten Gianyar
Ambulance Jenazah Kabupaten Bangli
Ambulance Jenazah Kabupaten Klungkung
Ambulance Jenazah Kabupaten Karangasem
Ambulance Jenazah Dalam Kota Denpasar
Small Film (1 Foto)
Small Film (2 Foto)
Large Film (1 Foto)
Large Film (2 Foto)
Mammografi
Panoramic
IVP
Colon In Loop/Barium Enema
Esopagografi/Barium Swallow
OMD / UGI (Upper GI Sudy)
Barium Follow Through
Uretrografi
Fistulogarafi
Bvcug
Cystografi
Caudografi/Myelografi
HSG
Cholangiografi
Sialografi
Retrograe Pyelografi (Rpg)
Antegrade Pyelografi (Apg)
Lopografi Proksimal/Distal
MRI Kepala Tanpa Kontras
MRI Kepala dengan Kontras
MRI Leher Tanpa Kontras
MRI Leher dengan Kontras
MRI Thorax Tanpa Kontras
MRI Thorax dengan Kontras
MRI Abdomen Atas Tanpa Kontras
MRI Abdomen Atas Tanpa Kontras + Mrcp
MRI Abdomen Atas dengan Kontras
MRI Abdomen Bawah Tanpa Kontras
MRI Abdomen Bawah dengan Kontras;
MRI Whole Abdomen (Atas+ Bawah) Tanpa Kontras
MRI Whole Abdomen (Atas+ Bawah) dengan Kontras
MRI Cervical Spine Tanpa Kontras
MRI Cervical Spine dengan Kontras
MRI Thoracal Spine Tanpa Kontras
MRI Thoracal Spine dengan Kontras
MRI Lumobosacral Spine Tanpa Kontras
MRI Lumbosacral Spine dengan Kontras
MRI Whole Spine Tanpa Kontras
MRI Whole Spine dengan Kontras
MRI Extremitas Tanpa Kontras
MRI Extremitas dengan Kontras
USG Abdomen Atas dan Bawah
USG Abdomen Atas
USG Abdomen Bawah
USG Pelvis/Gynaecology
USG Urologi
USG Doppler Testis
USG Tyroid
USG Mamma/Payudara
USG Doppler Vascular (1 Extremitas)
CT Scan Kepala Tanpa Kontras
CT Scan Kepala Dengan Kontras
CT Scan Leher/Colli Tanpa Kontras
CT Scan Leher/Colli Dengan Kontras
CT Scan Thorax Tanpa Kontras
CT Scan Thorax Dengan Kontras
CT Scan Abdomen Tanpa Kontras
CT Scan Abdomen Dengan Kontras
CT Scan Pelvis Tanpa Kontras
CT Scan Pelvis Dengan Kontras
CT Scan Cervical Spine
CT Scan Thoracal Spine
CT Scan Lumbosacral Spine
CT Scan Extremitas Tanpa Kontras
CT Scan Extremitas Dengan Kontras
Msct Cardiac
CT Angiografi
C-Arm
Tindakan Anastesi Diagnostik
LED
Golongan darah (ABO + Rhesus)
Hitung jenis leukosit
Platelet Antobodi
G6PD
CD-4
Hitung eosinofil
Hams test
Hb F
NAP
NSE
Pewarnaan Acid Phospatase
Pewarnaan Besi
Pewarnaan Sumsum Tulang
Serum Iron Binding Capacity (SIBC)
Sugar Water Test
Transferrin
Elektroforesis Hb
Retikulosit
Besi
Total Iron Binding Capacity (TIBC)
Feritin
Vitamin B12
Asam Folat
Gambaran Darah Tepi
Gambaran Sumsum Tulang
Masa Perdarahan (BT)
Masa Pembekuan (CT)
Masa Protrombin (PT)
APTT
Fibrinogen
Retraksi Bekuan
Agregasi Trombosit
D-dimer
Anti Faktor Xa
Anti Trombin III
Assay Faktor IX
Assay Faktor VIII
F.Von Willebrands
Inhibitor VIII
Lupus Anticoagulant
Masa Iisis Euglobin
Tromboplastin Generation Time (TGT)
Trombotest
Sel LE
IT Rasio
SGOT
SGPT
LDH
Bilirubin total
Bilirubin direk
Bilirubin indirek
Gamma GT
Alkali Phospat
Protein total
Albumin
Globulin
Glukosa sewaktu
Glukosa puasa
TTGO (5x GDS)
HBA1c
Insulin
C-peptide
Kolesterol total
Kolesterol HDL
Kolesterol LDL
Trigliserida
Apo A1
Apo B
CK-total
CK-MB
Troponin I
Ureum
Urea Clearance
Kreatinin
Kreatinin Clearance
Asam urat
Na, K, Cl (elektrolit darah)
Kalsium (Ca)
Fosfor
Magnesium
Analisa Gas Darah
CRP kualitatif
CRP kuantitatif
Alfa 1 Antitrifsin Kuantitatif
Alfa 2 makro Globulin Kuantitatif
ANA Titrasi
Anti Kappa
Anti Lamda
C3
C4
Cryoglobulin
IgA/IgG/IgM
IgE
Imuno Elektroforesis Anti IgA/IgG/IgM
Imuno Elektroforesis Whole Anti Serum
Smooth Muscle Antibody (SMA)
T Cel dan B Cel
HBsAg
HBsAg Elisa
Anti HBs
Anti HBs (Elisa)
Anti HCV
Anti HAV
Anti HBe
Anti HBc
Widal
IgM anti Salmonella (Tubex)
Anti Dengue IgM, IgG
NS1
Anti H Pylori IgG
Anti H Pylori IgM
Malaria
Filaria
Anti HIV (rapid)
HIV Western Blot*
Anti Rubella IgC
Anti Rubella IgM
Anti Toxoplasma IgG
Anti Toxoplasma IgM
Anti HSV I IgG
Anti HSV I IgM
Anti HSV II IgG
Anti HSV II IgM
Dengue Blot IgG
Dengue Blot IgM
HSV I IgG
HSV II IgM
ASTO
RF (Rheumatoid Factor)
ANA (IF)
ANA Profile
VDRL
TPHA
Urin lengkap (Rutin + Sedimen)
Reduksi urin
Protein Bence Jones
Tes Kehamilan (25 mIU/mL)
Beta HCG
Esbach
Hemosiderin
Oval Fat Body
Protein Kuantitatif
Lengkap (Rutin + pH + Reduksi)
Darah samar
Rectal Swab
TIROID
FT3
FT4
TSHS
T3 Total
T4 Total
LH
FSH
Testosteron
Progesteron
Prolactine
Estradiol
Estrogen
BTA 1x
Anti Tb IgG (PAP TB)
AFP
CEA
CA 19-9
CA 125 II
CA 72-4
CA 15-3
Prostat Specific Antigen (PSA)
CA 12-5
MCA
Analisa cairan otak
Analisa sperma
Analisa cairan sendi
Analisa cairan tubuh lain (pleura/lain-lain)
Tes Narkoba per Parameter
Narkoba A mffetamin
Narkoba Canabis
Narkoba Opiat
Narkoba Barbiturat
Narkoba Benzodiazepine
Pewarnaan Gram
Jamur (KOH)
BTA
Biakan Aerob + Uji Kepekaan Konvensional
Kultur GO
Kultur Legionella
Grup B Streptococcus
Kultur TB Uji Kepekaan OAT Lini I
Kultur TB
Biaya pemeriksaan resitensi ke BBLK
Biaya pengiriman kultur TB ke BBLK
Kultur Darah (Biakan Aerob)
Kultur Urine (Biakan Aerob)
Kultur Feses
Kultur Cairan (Likuor serebrospinalis/Ascites/Pleura/lain-lain) (Biakan Aerob)
Kultur Pus/Dasarl luka/Jaringan (Biakan Aerob)
Kultur Sputum (Biakan Aerob)
Kultur Spesimen lainnya (Biakan Aerob)
Kultur jamur tanpa uji kepekaan
Kultur jamur dengan uji kepekaan
Skrining MRSA (tenggorokan,hidung, lipatan paha/ketiak)
Rectal Swab (Indentifikasi Otomatis Vitek)
Kultur Darah (Biakan Anaerob)
Kultur Urine (Biakan Anaerob)
Kultur Cairan (Likuor serebrospinalis/Ascites/Pleura/lain-lain) (Biakan Anaerob)
Kultur Pus/Dasarl luka/Jaringan (Biakan Anaerob)
Kultur Sputum (Biakan Anaerob)
Kultur Spesimen lainnya (Biakan Anaerob)
PCR TB
PCR RABIES
PCR GO
PCR Chlamydia
PCR Mycoplasma
PCR Ureaplasma
PCR Streptococcus
PCR Legionella
Kultur Ruangan
Jasa Pembacaan Kultur
PA Kecil (1-4 Blok)
Biopsi Endoscopy 1-2 Blok (Kategori Sedang)
Bone Marrow aspirasi
Bone Marrow biopsi
Biopsi Endoscopy 3 Blok (Kategori Canggih)
PA Sedang (5-8 Blok)
Ca Cervic Stadium IB Keatas (Kategori Canggih)
PA Besar (> 8 Blok)
Ca Cervic Stadium IA, insitu (Kategori Canggih)
Konsultasi Dokter (Tidak jadi FNAB)
Pap Smear-Kiriman Slide
Pap Smear-Diambil di Lab PA
Urine, Sputum dan Sitologi Eksfoliatif lainnya (Bronchoscopy, Bronchial washing)
FNAB-Kiriman Slide
Cell Blok
FNAB-Diambil di lab PA dan di ruangan (Superfisial)
Urine dan Sputum Seri 3 Kali
FNAB-FNAB Deep (diluar Lab PA)
Frozen Zection (FZ) Pemeriksaan 1-2 Blok
Frozen Zection (FZ) Pemeriksaan > 2 Blok
Frozen Zection (FZ) Dari Rumah Sakit Swasta Pemeriksaan 1-2 Blok
Frozen zection (FZ) dari Rumah Sakit Swasta Pemeriksaan > 2 Blok
3 Jenis pemeriksaan (Kategori Kecil)
Bone Marrow Aspirasi dan Biopsi (Histokimia)
Imunohistokimia > 3 jenis pemeriksaan (Kategori Sedang)
Otopsi bahan kecil (1 Organ)
Otopsi bahan sedang (2-3 Organ)
Otopsi bahan besar > 3 Organ
Pemeriksaan PA kecil ( 1-4 Blok)
Pemeriksaan PA sedang ( 5-8 Blok)
Pemeriksaan PA besar (> 8 Blok)
Ca Cervic Stadium IB keatas (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
Ca Cervic Stadium IA, insitu (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
Kulit
Biopsi Endoscopy 1-2 Blok (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
Biopsi Endoscopy 3 Blok (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
Urine, Sputum dan Sitilogi Eksfoliatif lain
Bronchoscopy, Broncial Washsing
FNAB-Tindakan langsung
2 jenis Pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
Imunohistokimia > 3 jenis pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi An
Konsultasi Farmasi Klinis Pasien Rawat Jalan

Visite Farmasi Klinis Pasien Rawat Inap
Rawat Jalan Dasar
Rawat Jalan Umum/Gigi
Rawat Jalan Spesialis
Rawat Jalan VIP/Eksekutif

Gawat Darurat Dasar
Gawat Darurat Umum/Gigi
Gawat Darurat Spesialis
Gawat Darurat Spesialis Cito/Konsul
1. PELAYANAN RAWAT INAP

Tarif Kelas III
- Kelas III Umum
- Kelas III Spesialis
- Kelas III Spesialis Libur/Konsul
Tarif Kelas II
- Kelas II Umum
- Kelas II Spesialis
- Kelas II Spesialis Libur/Konsul
Tarif Kelas I
- Kelas I Umum
- Kelas I Spesialis
- Kelas I Spesialis Libur/Konsul
Tarif VIP
- VIP Spesialis
- VIP Spesialis Libur/Konsul
Tarif VVIP
- VVIP Spesialis
- VVIP Spesialis Libur/Konsul
Tarif Suite
- Suite Spesialis
- Suite Spesialis Libur/Konsul
Tarif ICU/ICCU/HCU
- ICU/ICCU/HCU Spesialis
Tarif NICU/PICU
- NICU/PICU Spesialis
- NICU/PICU Spesialis Libur/Konsul
Tarif (Rp)
Jasa
Jasa Sarana Jumlah
Pelayanan
12,000 8,000 20,000
150,000 100,000 250,000
162,000 108,000 270,000
237,000 158,000 395,000
121,800 81,200 203,000
22,200 14,800 37,000
609,000 406,000 1,015,000
72,000 48,000 120,000
609,000 406,000 1,015,000
49,800 33,200 83,000
33,000 22,000 55,000
55,200 36,800 92,000
150,000 100,000 250,000
121,500 81,000 202,500
315,600 210,400 526,000
300,000 200,000 500,000
150,000 100,000 250,000
36,000 24,000 60,000
1,500,000 1,000,000 2,500,000
450,000 300,000 750,000
42,000 28,000 70,000
36,000 24,000 60,000
180,000 120,000 300,000
120,000 80,000 200,000
121,500 81,000 202,500
36,000 24,000 60,000
180,000 120,000 300,000
121,500 81,000 202,500
48,900 32,600 81,500
66,900 44,600 111,500
42,000 28,000 70,000
30,900 20,600 51,500
48,900 32,600 81,500
42,000 28,000 70,000
60,000 40,000 100,000
540,000 360,000 900,000
420,000 280,000 700,000
300,000 200,000 500,000
300,000 200,000 500,000
450,000 300,000 750,000
10,800 7,200 18,000
450,000 300,000 750,000
150,000 100,000 250,000
121,500 81,000 202,500
300,000 200,000 500,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
780,000 520,000 1,300,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
165,000 110,000 275,000
330,000 220,000 550,000
495,000 330,000 825,000
660,000 440,000 1,100,000
780,000 520,000 1,300,000
150,000 100,000 250,000
120,000 80,000 200,000
150,000 100,000 250,000
120,000 80,000 200,000
390,000 260,000 650,000
390,000 260,000 650,000
210,000 140,000 350,000

120,000 80,000 200,000
180,000 120,000 300,000
270,000 180,000 450,000
120,000 80,000 200,000
600,000 400,000 1,000,000
120,000 80,000 200,000
90,000 60,000 150,000
21,000 14,000 35,000
15,000 10,000 25,000
688,200 458,800 1,147,000
159,600 106,400 266,000
159,600 106,400 266,000
76,800 51,200 128,000
189,600 126,400 316,000
22,200 14,800 37,000
22,200 14,800 37,000
54,600 36,400 91,000
76,800 51,200 128,000
9,000 6,000 15,000
189,600 126,400 316,000
22,200 14,800 37,000
365,400 243,600 609,000
189,600 126,400 316,000
284,400 189,600 474,000
304,200 202,800 507,000
25,000 25,000
40,200 26,800 67,000
22,200 14,800 37,000
16,200 10,800 27,000
35,700 23,800 59,500
33,000 22,000 55,000
43,800 29,200 73,000
121,800 81,200 203,000
22,200 14,800 37,000
609,000 406,000 1,015,000
18,000 12,000 30,000
22,200 14,800 37,000
30,600 20,400 51,000
22,200 14,800 37,000
79,800 53,200 133,000
22,200 14,800 37,000
22,200 14,800 37,000
55,200 36,800 92,000
55,200 36,800 92,000
33,000 22,000 55,000
43,800 29,200 73,000
304,200 202,800 507,000
54,600 36,400 91,000
182,400 121,600 304,000
304,200 202,800 507,000
304,200 202,800 507,000
33,000 22,000 55,000
22,200 14,800 37,000
10,800 7,200 18,000
33,000 22,000 55,000
182,400 121,600 304,000
121,800 81,200 203,000
243,600 162,400 406,000
22,200 14,800 37,000
199,200 132,800 332,000
275,400 183,600 459,000
79,800 53,200 133,000
60,000 40,000 100,000
54,600 36,400 91,000
33,000 22,000 55,000
43,800 29,200 73,000
54,600 36,400 91,000
54,600 36,400 91,000
243,600 162,400 406,000
54,600 36,400 91,000
182,400 121,600 304,000
48,000 32,000 80,000
300,000 200,000 500,000
120,000 80,000 200,000
51,000 34,000 85,000
106,500 71,000 177,500
150,000 100,000 250,000
900,000 600,000 1,500,000
108,000 72,000 180,000
900,000 600,000 1,500,000
30,000 20,000 50,000
810,000 540,000 1,350,000
60,000 40,000 100,000
138,000 92,000 230,000
30,000 20,000 50,000
180,000 120,000 300,000
60,000 40,000 100,000
60,000 40,000 100,000
60,000 40,000 100,000
90,000 60,000 150,000
51,000 34,000 85,000
60,000 40,000 100,000
51,000 34,000 85,000
180,000 120,000 300,000
450,000 300,000 750,000
60,000 40,000 100,000
1,200,000 800,000 2,000,000
1,800,000 1,200,000 3,000,000
600,000 400,000 1,000,000
1,800,000 1,200,000 3,000,000
300,000 200,000 500,000
18,000 12,000 30,000
900,000 600,000 1,500,000
120,000 80,000 200,000
90,000 60,000 150,000
180,000 120,000 300,000
30,000 20,000 50,000
120,000 80,000 200,000
48,000 32,000 80,000
60,000 40,000 100,000
1,500,000 1,000,000 2,500,000
345,000 230,000 575,000
48,000 32,000 80,000
90,000 60,000 150,000
480,000 320,000 800,000
270,000 180,000 450,000
180,000 120,000 300,000
220,500 147,000 367,500
150,000 100,000 250,000
60,000 40,000 100,000
240,000 160,000 400,000
60,000 40,000 100,000
60,000 40,000 100,000
138,000 92,000 230,000
106,500 71,000 177,500
300,000 200,000 500,000
30,000 20,000 50,000
180,000 120,000 300,000
90,000 60,000 150,000
45,000 30,000 75,000
75,000 50,000 125,000
31,200 20,800 52,000
41,400 27,600 69,000
175,800 117,200 293,000
41,400 27,600 69,000
31,200 20,800 52,000
41,400 27,600 69,000
41,400 27,600 69,000
31,200 20,800 52,000
41,400 27,600 69,000
41,400 27,600 69,000
41,400 27,600 69,000
41,400 27,600 69,000
12,000 8,000 20,000
9,000 6,000 15,000
9,000 6,000 15,000
41,400 27,600 69,000
31,200 20,800 52,000
31,200 20,800 52,000
31,200 20,800 52,000
175,800 117,200 293,000
175,800 117,200 293,000
41,400 27,600 69,000
41,400 27,600 69,000
84,000 56,000 140,000
84,000 56,000 140,000
30,000 20,000 50,000
30,000 20,000 50,000
30,000 20,000 50,000
30,000 20,000 50,000
90,000 60,000 150,000
90,000 60,000 150,000
90,000 60,000 150,000
90,000 60,000 150,000
360,000 240,000 600,000
600,000 400,000 1,000,000
900,000 600,000 1,500,000
105,000 70,000 175,000
150,000 100,000 250,000
84,000 56,000 140,000
510,000 340,000 850,000
60,000 40,000 100,000
15,000 10,000 25,000
15,000 10,000 25,000
15,000 10,000 25,000
18,000 12,000 30,000
18,000 12,000 30,000
30,000 20,000 50,000
36,000 24,000 60,000
42,000 28,000 70,000
20,000 20,000
36,000 24,000 60,000
36,000 24,000 60,000
42,000 28,000 70,000
20,000 20,000
18,000 12,000 30,000
30,000 20,000 50,000
20,000 20,000
15,000 10,000 25,000
24,000 16,000 40,000
20,000 20,000
159,000 106,000 265,000
249,000 166,000 415,000
315,000 210,000 525,000
315,000 210,000 525,000
315,000 210,000 525,000
315,000 210,000 525,000
459,000 306,000 765,000
621,000 414,000 1,035,000
621,000 414,000 1,035,000
1,500,000 1,000,000 2,500,000
177,000 118,000 295,000
267,000 178,000 445,000
333,000 222,000 555,000
333,000 222,000 555,000
333,000 222,000 555,000
333,000 222,000 555,000
477,000 318,000 795,000
639,000 426,000 1,065,000
639,000 426,000 1,065,000
1,518,000 1,012,000 2,530,000
222,600 148,400 371,000
348,600 232,400 581,000
441,000 294,000 735,000
441,000 294,000 735,000
441,000 294,000 735,000
441,000 294,000 735,000
642,600 428,400 1,071,000
869,400 579,600 1,449,000
869,400 579,600 1,449,000
2,100,000 1,400,000 3,500,000
609,000 406,000 1,015,000
45,000 30,000 75,000
33,000 22,000 55,000
43,800 29,200 73,000
33,000 22,000 55,000
54,600 36,400 91,000
243,600 162,400 406,000
78,000 52,000 130,000
150,000 100,000 250,000
108,000 72,000 180,000
12,000 8,000 20,000
304,200 202,800 507,000
123,000 82,000 205,000
22,200 14,800 37,000
33,000 22,000 55,000
24,000 16,000 40,000
84,000 56,000 140,000
84,000 56,000 140,000
120,000 80,000 200,000
43,800 29,200 73,000
120,000 80,000 200,000
120,000 80,000 200,000
43,800 29,200 73,000
33,000 22,000 55,000
90,000 60,000 150,000
600,000 400,000 1,000,000
22,200 14,800 37,000
33,000 22,000 55,000
54,600 36,400 91,000
275,400 183,600 459,000
182,400 121,600 304,000
33,000 22,000 55,000
180,000 120,000 300,000
48,000 32,000 80,000
30,000 20,000 50,000
243,600 162,400 406,000
22,200 14,800 37,000
6,000 6,000
15,000 10,000 25,000
33,000 22,000 55,000
90,000 60,000 150,000
121,800 81,200 203,000
182,400 121,600 304,000
243,600 162,400 406,000
132,000 88,000 220,000
33,000 22,000 55,000
12,000 8,000 20,000
30,000 20,000 50,000
182,400 121,600 304,000
30,000 20,000 50,000
30,000 20,000 50,000
1,320,000 880,000 2,200,000
182,400 121,600 304,000
199,200 132,800 332,000
10,800 7,200 18,000
10,800 7,200 18,000
121,800 81,200 203,000
900,000 600,000 1,500,000
600,000 400,000 1,000,000
270,000 180,000 450,000
54,600 36,400 91,000
121,800 81,200 203,000
72,000 48,000 120,000
150,000 100,000 250,000
1,260,000 840,000 2,100,000
1,014,000 676,000 1,690,000
81,000 54,000 135,000
48,000 32,000 80,000
36,000 24,000 60,000
30,000 20,000 50,000
42,000 28,000 70,000
94,800 63,200 158,000
204,000 136,000 340,000
405,000 270,000 675,000
54,600 36,400 91,000
688,200 458,800 1,147,000
450,000 300,000 750,000
405,000 270,000 675,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
120,000 80,000 200,000
450,000 300,000 750,000
405,000 270,000 675,000
612,000 408,000 1,020,000
288,000 192,000 480,000
182,400 121,600 304,000
22,200 14,800 37,000
450,000 300,000 750,000
192,000 128,000 320,000
450,000 300,000 750,000
600,000 400,000 1,000,000
60,000 40,000 100,000
360,000 240,000 600,000
117,000 78,000 195,000
90,000 60,000 150,000
180,000 120,000 300,000
22,200 14,800 37,000
600,000 400,000 1,000,000
30,000 20,000 50,000
42,000 28,000 70,000
48,000 32,000 80,000
33,000 22,000 55,000
459,000 306,000 765,000
585,000 390,000 975,000
405,000 270,000 675,000
36,000 24,000 60,000
168,000 112,000 280,000
108,000 72,000 180,000
78,000 52,000 130,000
210,000 140,000 350,000
144,000 96,000 240,000
18,000 12,000 30,000
12,000 8,000 20,000
79,800 53,200 133,000
27,000 18,000 45,000
30,000 30,000
10,500 7,000 17,500
11,700 7,800 19,500
17,400 11,600 29,000
19,800 13,200 33,000
24,300 16,200 40,500
27,900 18,600 46,500
32,400 21,600 54,000
37,200 24,800 62,000
40,500 27,000 67,500
46,500 31,000 77,500
75,000 50,000 125,000
87,000 58,000 145,000
109,500 73,000 182,500
127,500 85,000 212,500
144,000 96,000 240,000
168,000 112,000 280,000
184,500 123,000 307,500
214,500 143,000 357,500
219,000 146,000 365,000
255,000 170,000 425,000
405,000 270,000 675,000
465,000 310,000 775,000
577,500 385,000 962,500
667,500 445,000 1,112,500
750,000 500,000 1,250,000
870,000 580,000 1,450,000
922,500 615,000 1,537,500
1,072,500 715,000 1,787,500
1,095,000 730,000 1,825,000
1,275,000 850,000 2,125,000
1,440,000 960,000 2,400,000
1,680,000 1,120,000 2,800,000
1,725,000 1,150,000 2,875,000
2,025,000 1,350,000 3,375,000
2,070,000 1,380,000 3,450,000
2,430,000 1,620,000 4,050,000
2,415,000 1,610,000 4,025,000
2,835,000 1,890,000 4,725,000
2,760,000 1,840,000 4,600,000
3,240,000 2,160,000 5,400,000
3,450,000 2,300,000 5,750,000
4,050,000 2,700,000 6,750,000
4,312,500 2,875,000 7,187,500
5,062,500 3,375,000 8,437,500
5,175,000 3,450,000 8,625,000
6,075,000 4,050,000 10,125,000
6,037,500 4,025,000 10,062,500
7,087,500 4,725,000 11,812,500
6,900,000 4,600,000 11,500,000
8,100,000 5,400,000 13,500,000
8,625,000 5,750,000 14,375,000
10,125,000 6,750,000 16,875,000
10,350,000 6,900,000 17,250,000
12,150,000 8,100,000 20,250,000
12,075,000 8,050,000 20,125,000
14,175,000 9,450,000 23,625,000
13,800,000 9,200,000 23,000,000
16,200,000 10,800,000 27,000,000
15,525,000 10,350,000 25,875,000
18,450,000 12,300,000 30,750,000
4,590,000 3,060,000 7,650,000
6,885,000 4,590,000 11,475,000
9,180,000 6,120,000 15,300,000
5,737,200 3,824,800 9,562,000
2,754,000 1,836,000 4,590,000
1,836,000 1,224,000 3,060,000
2,295,000 1,530,000 3,825,000
3,213,000 2,142,000 5,355,000
4,590,000 3,060,000 7,650,000
3,213,000 2,142,000 5,355,000
3,672,000 2,448,000 6,120,000
3,213,000 2,142,000 5,355,000
2,295,000 1,530,000 3,825,000
1,836,000 1,224,000 3,060,000
1,377,000 918,000 2,295,000
918,000 612,000 1,530,000
918,000 612,000 1,530,000
3,213,000 2,142,000 5,355,000
2,754,000 1,836,000 4,590,000
459,000 306,000 765,000
1,147,200 764,800 1,912,000
1,836,000 1,224,000 3,060,000
2,754,000 1,836,000 4,590,000
688,200 458,800 1,147,000
2,754,000 1,836,000 4,590,000
2,295,000 1,530,000 3,825,000
3,213,000 2,142,000 5,355,000
4,590,000 3,060,000 7,650,000
3,213,000 2,142,000 5,355,000
2,295,000 1,530,000 3,825,000
3,672,000 2,448,000 6,120,000
2,754,000 1,836,000 4,590,000
3,672,000 2,448,000 6,120,000
3,213,000 2,142,000 5,355,000
1,836,000 1,224,000 3,060,000
2,754,000 1,836,000 4,590,000
2,295,000 1,530,000 3,825,000
2,295,000 1,530,000 3,825,000
2,295,000 1,530,000 3,825,000
3,213,000 2,142,000 5,355,000
2,295,000 1,530,000 3,825,000
2,754,000 1,836,000 4,590,000
182,400 121,600 304,000
182,400 121,600 304,000
2,295,000 1,530,000 3,825,000
3,213,000 2,142,000 5,355,000
1,836,000 1,224,000 3,060,000
4,590,000 3,060,000 7,650,000
182,400 121,600 304,000
3,672,000 2,448,000 6,120,000
6,885,000 4,590,000 11,475,000
2,295,000 1,530,000 3,825,000
3,672,000 2,448,000 6,120,000
6,885,000 4,590,000 11,475,000
2,754,000 1,836,000 4,590,000
1,836,000 1,224,000 3,060,000
243,600 162,400 406,000
688,200 458,800 1,147,000
1,836,000 1,224,000 3,060,000
1,377,000 918,000 2,295,000
1,836,000 1,224,000 3,060,000
2,295,000 1,530,000 3,825,000
2,754,000 1,836,000 4,590,000
4,590,000 3,060,000 7,650,000
3,672,000 2,448,000 6,120,000
4,590,000 3,060,000 7,650,000
3,213,000 2,142,000 5,355,000
1,836,000 1,224,000 3,060,000
121,800 81,200 203,000
121,800 81,200 203,000
229,200 152,800 382,000
459,000 306,000 765,000
2,754,000 1,836,000 4,590,000
3,672,000 2,448,000 6,120,000
5,737,200 3,824,800 9,562,000
3,213,000 2,142,000 5,355,000
2,295,000 1,530,000 3,825,000
5,737,200 3,824,800 9,562,000
3,672,000 2,448,000 6,120,000
3,213,000 2,142,000 5,355,000
1,836,000 1,224,000 3,060,000
5,737,200 3,824,800 9,562,000
3,213,000 2,142,000 5,355,000
3,213,000 2,142,000 5,355,000
3,213,000 2,142,000 5,355,000
3,672,000 2,448,000 6,120,000
5,737,200 3,824,800 9,562,000
1,836,000 1,224,000 3,060,000
3,672,000 2,448,000 6,120,000
2,754,000 1,836,000 4,590,000
5,737,200 3,824,800 9,562,000
3,213,000 2,142,000 5,355,000
5,737,200 3,824,800 9,562,000
4,590,000 3,060,000 7,650,000
6,885,000 4,590,000 11,475,000
6,885,000 4,590,000 11,475,000
2,295,000 1,530,000 3,825,000
6,885,000 4,590,000 11,475,000
3,672,000 2,448,000 6,120,000
6,885,000 4,590,000 11,475,000
5,737,200 3,824,800 9,562,000
6,885,000 4,590,000 11,475,000
6,885,000 4,590,000 11,475,000
5,737,200 3,824,800 9,562,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
5,737,200 3,824,800 9,562,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
2,754,000 1,836,000 4,590,000
1,836,000 1,224,000 3,060,000
1,836,000 1,224,000 3,060,000
2,295,000 1,530,000 3,825,000
2,754,000 1,836,000 4,590,000
1,836,000 1,224,000 3,060,000
2,295,000 1,530,000 3,825,000
2,754,000 1,836,000 4,590,000
3,672,000 2,448,000 6,120,000
4,590,000 3,060,000 7,650,000
2,754,000 1,836,000 4,590,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
2,754,000 1,836,000 4,590,000
4,590,000 3,060,000 7,650,000
2,754,000 1,836,000 4,590,000
3,672,000 2,448,000 6,120,000
3,672,000 2,448,000 6,120,000
3,672,000 2,448,000 6,120,000
3,672,000 2,448,000 6,120,000
1,836,000 1,224,000 3,060,000
2,754,000 1,836,000 4,590,000
3,672,000 2,448,000 6,120,000
2,754,000 1,836,000 4,590,000
1,377,000 918,000 2,295,000
304,200 202,800 507,000
459,000 306,000 765,000
1,377,000 918,000 2,295,000
3,672,000 2,448,000 6,120,000
54,600 36,400 91,000
4,590,000 3,060,000 7,650,000
2,754,000 1,836,000 4,590,000
5,737,200 3,824,800 9,562,000
6,885,000 4,590,000 11,475,000
5,737,200 3,824,800 9,562,000
4,590,000 3,060,000 7,650,000
5,737,200 3,824,800 9,562,000
5,737,200 3,824,800 9,562,000
4,590,000 3,060,000 7,650,000
4,590,000 3,060,000 7,650,000
5,737,200 3,824,800 9,562,000
4,590,000 3,060,000 7,650,000
918,000 612,000 1,530,000
918,000 612,000 1,530,000
1,147,200 764,800 1,912,000
688,200 458,800 1,147,000
9,180,000 6,120,000 15,300,000
6,885,000 4,590,000 11,475,000
5,737,200 3,824,800 9,562,000
11,475,000 7,650,000 19,125,000
8,032,200 5,354,800 13,387,000
6,885,000 4,590,000 11,475,000
2,295,000 1,530,000 3,825,000
1,836,000 1,224,000 3,060,000
1,377,000 918,000 2,295,000
688,200 458,800 1,147,000
918,000 612,000 1,530,000
918,000 612,000 1,530,000
2,295,000 1,530,000 3,825,000
688,200 458,800 1,147,000
304,200 202,800 507,000
3,672,000 2,448,000 6,120,000
5,737,200 3,824,800 9,562,000
5,737,200 3,824,800 9,562,000
6,885,000 4,590,000 11,475,000
6,885,000 4,590,000 11,475,000
8,032,200 5,354,800 13,387,000
8,032,200 5,354,800 13,387,000
6,885,000 4,590,000 11,475,000
3,672,000 2,448,000 6,120,000
5,737,200 3,824,800 9,562,000
2,295,000 1,530,000 3,825,000
3,213,000 2,142,000 5,355,000
2,250,000 1,500,000 3,750,000
2,280,000 1,520,000 3,800,000
6,480,000 4,320,000 10,800,000
1,380,000 920,000 2,300,000
2,940,000 1,960,000 4,900,000
2,790,000 1,860,000 4,650,000
2,790,000 1,860,000 4,650,000
2,280,000 1,520,000 3,800,000
2,790,000 1,860,000 4,650,000
1,380,000 920,000 2,300,000
2,790,000 1,860,000 4,650,000
1,560,000 1,040,000 2,600,000
2,280,000 1,520,000 3,800,000
4,050,000 2,700,000 6,750,000
3,375,000 2,250,000 5,625,000
93,000 62,000 155,000
15,000 10,000 25,000
360,000 240,000 600,000
1,380,000 920,000 2,300,000
2,790,000 1,860,000 4,650,000
2,280,000 1,520,000 3,800,000
36,000 24,000 60,000
4,050,000 2,700,000 6,750,000
4,050,000 2,700,000 6,750,000
3,375,000 2,250,000 5,625,000
3,375,000 2,250,000 5,625,000
3,375,000 2,250,000 5,625,000
3,375,000 2,250,000 5,625,000
600,000 400,000 1,000,000
1,410,000 940,000 2,350,000
1,410,000 940,000 2,350,000
1,560,000 1,040,000 2,600,000
2,280,000 1,520,000 3,800,000
1,560,000 1,040,000 2,600,000
3,480,000 2,320,000 5,800,000
25,800 17,200 43,000
51,600 34,400 86,000
48,000 32,000 80,000
39,000 26,000 65,000
36,000 24,000 60,000
4,725,000 3,150,000 7,875,000
4,050,000 2,700,000 6,750,000
2,790,000 1,860,000 4,650,000
4,050,000 2,700,000 6,750,000
5,400,000 3,600,000 9,000,000
4,050,000 2,700,000 6,750,000
5,400,000 3,600,000 9,000,000
6,750,000 4,500,000 11,250,000
11,730,000 7,820,000 19,550,000
12,900,000 8,600,000 21,500,000
1,560,000 1,040,000 2,600,000
14,880,000 9,920,000 24,800,000
2,940,000 1,960,000 4,900,000
2,790,000 1,860,000 4,650,000
5,520,000 3,680,000 9,200,000
1,380,000 920,000 2,300,000
2,880,000 1,920,000 4,800,000
2,280,000 1,520,000 3,800,000
6,750,000 4,500,000 11,250,000
4,740,000 3,160,000 7,900,000
9,060,000 6,040,000 15,100,000
4,050,000 2,700,000 6,750,000
42,000 28,000 70,000
57,000 38,000 95,000
1,560,000 1,040,000 2,600,000
2,280,000 1,520,000 3,800,000
10,800,000 7,200,000 18,000,000
7,380,000 4,920,000 12,300,000
11,700,000 7,800,000 19,500,000
600,000 400,000 1,000,000
4,050,000 2,700,000 6,750,000
6,750,000 4,500,000 11,250,000
3,375,000 2,250,000 5,625,000
2,250,000 1,500,000 3,750,000
2,250,000 1,500,000 3,750,000
5,520,000 3,680,000 9,200,000
2,280,000 1,520,000 3,800,000
2,850,000 1,900,000 4,750,000
120,000 80,000 200,000
1,560,000 1,040,000 2,600,000
2,790,000 1,860,000 4,650,000
2,280,000 1,520,000 3,800,000
6,750,000 4,500,000 11,250,000
2,280,000 1,520,000 3,800,000
1,380,000 920,000 2,300,000
4,050,000 2,700,000 6,750,000
120,000 80,000 200,000
4,050,000 2,700,000 6,750,000
8,220,000 5,480,000 13,700,000
6,750,000 4,500,000 11,250,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
1,380,000 920,000 2,300,000
360,000 240,000 600,000
150,000 100,000 250,000
1,365,000 910,000 2,275,000
2,280,000 1,520,000 3,800,000
4,725,000 3,150,000 7,875,000
4,050,000 2,700,000 6,750,000
600,000 400,000 1,000,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
1,560,000 1,040,000 2,600,000
2,280,000 1,520,000 3,800,000
4,800,000 3,200,000 8,000,000
4,725,000 3,150,000 7,875,000
3,000,000 2,000,000 5,000,000
2,280,000 1,520,000 3,800,000
2,400,000 1,600,000 4,000,000
2,280,000 1,520,000 3,800,000
1,380,000 920,000 2,300,000
2,280,000 1,520,000 3,800,000
8,280,000 5,520,000 13,800,000
150,000 100,000 250,000
8,640,000 5,760,000 14,400,000
2,280,000 1,520,000 3,800,000
27,000 18,000 45,000
5,400,000 3,600,000 9,000,000
150,000 100,000 250,000
30,000 20,000 50,000
2,940,000 1,960,000 4,900,000
180,000 120,000 300,000
1,380,000 920,000 2,300,000
1,350,000 900,000 2,250,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
4,140,000 2,760,000 6,900,000
4,830,000 3,220,000 8,050,000
2,250,000 1,500,000 3,750,000
600,000 400,000 1,000,000
2,790,000 1,860,000 4,650,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
1,620,000 1,080,000 2,700,000
6,900,000 4,600,000 11,500,000
4,725,000 3,150,000 7,875,000
4,725,000 3,150,000 7,875,000
2,940,000 1,960,000 4,900,000
3,375,000 2,250,000 5,625,000
1,380,000 920,000 2,300,000
5,400,000 3,600,000 9,000,000
5,400,000 3,600,000 9,000,000
2,940,000 1,960,000 4,900,000
1,530,000 1,020,000 2,550,000
36,000 24,000 60,000
1,530,000 1,020,000 2,550,000
3,375,000 2,250,000 5,625,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
4,725,000 3,150,000 7,875,000
4,725,000 3,150,000 7,875,000
4,050,000 2,700,000 6,750,000
3,375,000 2,250,000 5,625,000
4,725,000 3,150,000 7,875,000
7,440,000 4,960,000 12,400,000
2,940,000 1,960,000 4,900,000
2,280,000 1,520,000 3,800,000
4,050,000 2,700,000 6,750,000
1,380,000 920,000 2,300,000
24,000 16,000 40,000
9,000 6,000 15,000
15,000 10,000 25,000
1,260,000 840,000 2,100,000
9,060,000 6,040,000 15,100,000
8,220,000 5,480,000 13,700,000
6,060,000 4,040,000 10,100,000
6,750,000 4,500,000 11,250,000
2,940,000 1,960,000 4,900,000
4,725,000 3,150,000 7,875,000
6,480,000 4,320,000 10,800,000
7,350,000 4,900,000 12,250,000
2,280,000 1,520,000 3,800,000
5,190,000 3,460,000 8,650,000
4,725,000 3,150,000 7,875,000
4,725,000 3,150,000 7,875,000
27,000 18,000 45,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
600,000 400,000 1,000,000
600,000 400,000 1,000,000
360,000 240,000 600,000
360,000 240,000 600,000
2,790,000 1,860,000 4,650,000
6,750,000 4,500,000 11,250,000
6,750,000 4,500,000 11,250,000
2,940,000 1,960,000 4,900,000
4,725,000 3,150,000 7,875,000
2,850,000 1,900,000 4,750,000
7,590,000 5,060,000 12,650,000
2,940,000 1,960,000 4,900,000
11,700,000 7,800,000 19,500,000
6,750,000 4,500,000 11,250,000
4,725,000 3,150,000 7,875,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,280,000 1,520,000 3,800,000
2,250,000 1,500,000 3,750,000
12,075,000 8,050,000 20,125,000
2,280,000 1,520,000 3,800,000
15,540,000 10,360,000 25,900,000
15,540,000 10,360,000 25,900,000
2,940,000 1,960,000 4,900,000
15,120,000 10,080,000 25,200,000
15,540,000 10,360,000 25,900,000
12,090,000 8,060,000 20,150,000
2,280,000 1,520,000 3,800,000
12,090,000 8,060,000 20,150,000
12,090,000 8,060,000 20,150,000
6,750,000 4,500,000 11,250,000
6,750,000 4,500,000 11,250,000
4,725,000 3,150,000 7,875,000
4,725,000 3,150,000 7,875,000
2,280,000 1,520,000 3,800,000
2,880,000 1,920,000 4,800,000
5,400,000 3,600,000 9,000,000
4,740,000 3,160,000 7,900,000
5,400,000 3,600,000 9,000,000
4,050,000 2,700,000 6,750,000
600,000 400,000 1,000,000
21,000 14,000 35,000
18,000 12,000 30,000
27,000 18,000 45,000
12,000 8,000 20,000
1,380,000 920,000 2,300,000
1,380,000 920,000 2,300,000
4,740,000 3,160,000 7,900,000
4,740,000 3,160,000 7,900,000
1,380,000 920,000 2,300,000
2,940,000 1,960,000 4,900,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
36,000 24,000 60,000
60,000 40,000 100,000
78,000 52,000 130,000
102,000 68,000 170,000
4,740,000 3,160,000 7,900,000
2,940,000 1,960,000 4,900,000
6,480,000 4,320,000 10,800,000
2,280,000 1,520,000 3,800,000
2,940,000 1,960,000 4,900,000
11,700,000 7,800,000 19,500,000
4,320,000 2,880,000 7,200,000
7,380,000 4,920,000 12,300,000
5,400,000 3,600,000 9,000,000
6,750,000 4,500,000 11,250,000
3,375,000 2,250,000 5,625,000
4,725,000 3,150,000 7,875,000
600,000 400,000 1,000,000
1,260,000 840,000 2,100,000
4,800,000 3,200,000 8,000,000
252,000 168,000 420,000
48,000 32,000 80,000
105,000 70,000 175,000
6,300,000 4,200,000 10,500,000
9,060,000 6,040,000 15,100,000
7,380,000 4,920,000 12,300,000
9,330,000 6,220,000 15,550,000
6,480,000 4,320,000 10,800,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
4,740,000 3,160,000 7,900,000
2,940,000 1,960,000 4,900,000
11,220,000 7,480,000 18,700,000
6,900,000 4,600,000 11,500,000
2,280,000 1,520,000 3,800,000
4,050,000 2,700,000 6,750,000
2,280,000 1,520,000 3,800,000
600,000 400,000 1,000,000
4,050,000 2,700,000 6,750,000
4,725,000 3,150,000 7,875,000
4,725,000 3,150,000 7,875,000
4,050,000 2,700,000 6,750,000
4,725,000 3,150,000 7,875,000
6,480,000 4,320,000 10,800,000
6,480,000 4,320,000 10,800,000
6,480,000 4,320,000 10,800,000
12,510,000 8,340,000 20,850,000
12,510,000 8,340,000 20,850,000
12,510,000 8,340,000 20,850,000
15,780,000 10,520,000 26,300,000
12,960,000 8,640,000 21,600,000
2,250,000 1,500,000 3,750,000
5,190,000 3,460,000 8,650,000
12,540,000 8,360,000 20,900,000
12,960,000 8,640,000 21,600,000
2,280,000 1,520,000 3,800,000
12,540,000 8,360,000 20,900,000
14,280,000 9,520,000 23,800,000
15,540,000 10,360,000 25,900,000
2,280,000 1,520,000 3,800,000
12,090,000 8,060,000 20,150,000
2,280,000 1,520,000 3,800,000
12,090,000 8,060,000 20,150,000
4,830,000 3,220,000 8,050,000
3,450,000 2,300,000 5,750,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
4,740,000 3,160,000 7,900,000
4,740,000 3,160,000 7,900,000
6,060,000 4,040,000 10,100,000
420,000 280,000 700,000
2,940,000 1,960,000 4,900,000
14,280,000 9,520,000 23,800,000
15,540,000 10,360,000 25,900,000
12,960,000 8,640,000 21,600,000
5,190,000 3,460,000 8,650,000
360,000 240,000 600,000
2,940,000 1,960,000 4,900,000
7,770,000 5,180,000 12,950,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
7,770,000 5,180,000 12,950,000
2,940,000 1,960,000 4,900,000
36,000 24,000 60,000
6,750,000 4,500,000 11,250,000
4,050,000 2,700,000 6,750,000
2,790,000 1,860,000 4,650,000
6,750,000 4,500,000 11,250,000
4,050,000 2,700,000 6,750,000
4,050,000 2,700,000 6,750,000
4,725,000 3,150,000 7,875,000
4,050,000 2,700,000 6,750,000
20,700,000 13,800,000 34,500,000
4,050,000 2,700,000 6,750,000

15,780,000 10,520,000 26,300,000
2,940,000 1,960,000 4,900,000
6,480,000 4,320,000 10,800,000
4,725,000 3,150,000 7,875,000
1,380,000 920,000 2,300,000
15,000 10,000 25,000
600,000 400,000 1,000,000
2,790,000 1,860,000 4,650,000
36,000 24,000 60,000
39,000 26,000 65,000
30,000 20,000 50,000
312,000 208,000 520,000
1,380,000 920,000 2,300,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
8,640,000 5,760,000 14,400,000
2,280,000 1,520,000 3,800,000
3,375,000 2,250,000 5,625,000
36,000 24,000 60,000
360,000 240,000 600,000
6,210,000 4,140,000 10,350,000
2,790,000 1,860,000 4,650,000
4,500,000 3,000,000 7,500,000
2,940,000 1,960,000 4,900,000
600,000 400,000 1,000,000
3,450,000 2,300,000 5,750,000
2,280,000 1,520,000 3,800,000
4,050,000 2,700,000 6,750,000
5,190,000 3,460,000 8,650,000
1,410,000 940,000 2,350,000
2,250,000 1,500,000 3,750,000
4,140,000 2,760,000 6,900,000
360,000 240,000 600,000
600,000 400,000 1,000,000
36,000 24,000 60,000
1,530,000 1,020,000 2,550,000
348,000 232,000 580,000
2,940,000 1,960,000 4,900,000
2,700,000 1,800,000 4,500,000
3,450,000 2,300,000 5,750,000
6,750,000 4,500,000 11,250,000
4,725,000 3,150,000 7,875,000
600,000 400,000 1,000,000
3,375,000 2,250,000 5,625,000
2,250,000 1,500,000 3,750,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,790,000 1,860,000 4,650,000
2,940,000 1,960,000 4,900,000
2,790,000 1,860,000 4,650,000
12,510,000 8,340,000 20,850,000
12,090,000 8,060,000 20,150,000
5,190,000 3,460,000 8,650,000
6,480,000 4,320,000 10,800,000
2,940,000 1,960,000 4,900,000
6,750,000 4,500,000 11,250,000
4,725,000 3,150,000 7,875,000
6,750,000 4,500,000 11,250,000
4,050,000 2,700,000 6,750,000
1,530,000 1,020,000 2,550,000
2,280,000 1,520,000 3,800,000
6,750,000 4,500,000 11,250,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
3,375,000 2,250,000 5,625,000
2,790,000 1,860,000 4,650,000
4,725,000 3,150,000 7,875,000
2,280,000 1,520,000 3,800,000
4,830,000 3,220,000 8,050,000
1,380,000 920,000 2,300,000
2,250,000 1,500,000 3,750,000
2,250,000 1,500,000 3,750,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
2,790,000 1,860,000 4,650,000
5,400,000 3,600,000 9,000,000
2,940,000 1,960,000 4,900,000
15,540,000 10,360,000 25,900,000
9,060,000 6,040,000 15,100,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
1,530,000 1,020,000 2,550,000
1,530,000 1,020,000 2,550,000
4,050,000 2,700,000 6,750,000
2,790,000 1,860,000 4,650,000
2,280,000 1,520,000 3,800,000
6,750,000 4,500,000 11,250,000
4,050,000 2,700,000 6,750,000
4,050,000 2,700,000 6,750,000
5,400,000 3,600,000 9,000,000
2,940,000 1,960,000 4,900,000
5,190,000 3,460,000 8,650,000
4,830,000 3,220,000 8,050,000
5,190,000 3,460,000 8,650,000
2,790,000 1,860,000 4,650,000
2,280,000 1,520,000 3,800,000
1,530,000 1,020,000 2,550,000
2,940,000 1,960,000 4,900,000
9,060,000 6,040,000 15,100,000
7,590,000 5,060,000 12,650,000
1,530,000 1,020,000 2,550,000
2,940,000 1,960,000 4,900,000
1,530,000 1,020,000 2,550,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
1,380,000 920,000 2,300,000
4,830,000 3,220,000 8,050,000
1,380,000 920,000 2,300,000
4,050,000 2,700,000 6,750,000
2,280,000 1,520,000 3,800,000
2,940,000 1,960,000 4,900,000
600,000 400,000 1,000,000
2,280,000 1,520,000 3,800,000
360,000 240,000 600,000
5,400,000 3,600,000 9,000,000
2,940,000 1,960,000 4,900,000
1,530,000 1,020,000 2,550,000
4,725,000 3,150,000 7,875,000
2,280,000 1,520,000 3,800,000
6,060,000 4,040,000 10,100,000
4,050,000 2,700,000 6,750,000
7,770,000 5,180,000 12,950,000
4,050,000 2,700,000 6,750,000
2,790,000 1,860,000 4,650,000
4,050,000 2,700,000 6,750,000
2,940,000 1,960,000 4,900,000
150,000 100,000 250,000
6,480,000 4,320,000 10,800,000
36,000 24,000 60,000
2,280,000 1,520,000 3,800,000
150,000 100,000 250,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
2,280,000 1,520,000 3,800,000
360,000 240,000 600,000
2,940,000 1,960,000 4,900,000
6,210,000 4,140,000 10,350,000
2,940,000 1,960,000 4,900,000
4,050,000 2,700,000 6,750,000
5,400,000 3,600,000 9,000,000
4,050,000 2,700,000 6,750,000
4,050,000 2,700,000 6,750,000
2,790,000 1,860,000 4,650,000
6,750,000 4,500,000 11,250,000
6,750,000 4,500,000 11,250,000
4,500,000 3,000,000 7,500,000
5,190,000 3,460,000 8,650,000
2,790,000 1,860,000 4,650,000
1,380,000 920,000 2,300,000
2,940,000 1,960,000 4,900,000
150,000 100,000 250,000
2,940,000 1,960,000 4,900,000
4,620,000 3,080,000 7,700,000
4,650,000 3,100,000 7,750,000
1,530,000 1,020,000 2,550,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,940,000 1,960,000 4,900,000
2,280,000 1,520,000 3,800,000
2,940,000 1,960,000 4,900,000
4,770,000 3,180,000 7,950,000
2,280,000 1,520,000 3,800,000
2,940,000 1,960,000 4,900,000
4,770,000 3,180,000 7,950,000
4,440,000 2,960,000 7,400,000
2,940,000 1,960,000 4,900,000
600,000 400,000 1,000,000
1,380,000 920,000 2,300,000
2,280,000 1,520,000 3,800,000
2,400,000 1,600,000 4,000,000
600,000 400,000 1,000,000
5,190,000 3,460,000 8,650,000
2,280,000 1,520,000 3,800,000
13,110,000 8,740,000 21,850,000
6,060,000 4,040,000 10,100,000
6,750,000 4,500,000 11,250,000
15,600 10,400 26,000
1,530,000 1,020,000 2,550,000
121,800 81,200 203,000
195,600 130,400 326,000
243,600 162,400 406,000
54,600 36,400 91,000
609,000 406,000 1,015,000
900,000 600,000 1,500,000
1,560,000 1,040,000 2,600,000
1,560,000 1,040,000 2,600,000
720,000 480,000 1,200,000
1,320,000 880,000 2,200,000
1,320,000 880,000 2,200,000
607,500 405,000 1,012,500
90,000 60,000 150,000
6,075,000 4,050,000 10,125,000
3,645,000 2,430,000 6,075,000
3,945,000 2,630,000 6,575,000
3,825,000 2,550,000 6,375,000
4,125,000 2,750,000 6,875,000
4,500,000 3,000,000 7,500,000
300,000 200,000 500,000
780,000 520,000 1,300,000
900,000 600,000 1,500,000
304,200 202,800 507,000
48,000 32,000 80,000
720,000 480,000 1,200,000
1,515,000 1,010,000 2,525,000
1,260,000 840,000 2,100,000
300,000 200,000 500,000
1,800,000 1,200,000 3,000,000
720,000 480,000 1,200,000
405,000 270,000 675,000
960,000 640,000 1,600,000
5,820,000 3,880,000 9,700,000
7,500,000 5,000,000 12,500,000
8,220,000 5,480,000 13,700,000
7,800,000 5,200,000 13,000,000
8,220,000 5,480,000 13,700,000
7,800,000 5,200,000 13,000,000
5,820,000 3,880,000 9,700,000
1,410,000 940,000 2,350,000
1,650,000 1,100,000 2,750,000
36,000 24,000 60,000
54,600 36,400 91,000
5,190,000 3,460,000 8,650,000
1,269,000 846,000 2,115,000
1,272,000 848,000 2,120,000
1,425,000 950,000 2,375,000
1,605,000 1,070,000 2,675,000
627,000 418,000 1,045,000
1,083,000 722,000 1,805,000
634,200 422,800 1,057,000
784,200 522,800 1,307,000
502,200 334,800 837,000
922,200 614,800 1,537,000
1,102,200 734,800 1,837,000
246,000 164,000 410,000
15,000 10,000 25,000
183,600 122,400 306,000
54,600 36,400 91,000
54,600 36,400 91,000
40,200 26,800 67,000
510,000 340,000 850,000
720,000 480,000 1,200,000
405,000 270,000 675,000
600,000 400,000 1,000,000
1,920,000 1,280,000 3,200,000
609,000 406,000 1,015,000
365,400 243,600 609,000
365,400 243,600 609,000
5,190,000 3,460,000 8,650,000
2,940,000 1,960,000 4,900,000
121,800 81,200 203,000
1,620,000 1,080,000 2,700,000
1,215,000 810,000 2,025,000
2,940,000 1,960,000 4,900,000
33,000 22,000 55,000
2,040,000 1,360,000 3,400,000
4,080,000 2,720,000 6,800,000
2,130,000 1,420,000 3,550,000
2,430,000 1,620,000 4,050,000
2,400,000 1,600,000 4,000,000
2,340,000 1,560,000 3,900,000
240,000 160,000 400,000
150,000 100,000 250,000
2,280,000 1,520,000 3,800,000
12,000 8,000 20,000
1,410,000 940,000 2,350,000
1,500,000 1,000,000 2,500,000
42,000 28,000 70,000
300,000 200,000 500,000
120,000 80,000 200,000
102,000 68,000 170,000
40,200 26,800 67,000
1,560,000 1,040,000 2,600,000
60,000 40,000 100,000
60,000 40,000 100,000
3,900,000 2,600,000 6,500,000
3,000,000 2,000,000 5,000,000
180,000 120,000 300,000
1,320,000 880,000 2,200,000
150,000 100,000 250,000
120,000 80,000 200,000
1,200,000 800,000 2,000,000
120,000 80,000 200,000
120,000 80,000 200,000
2,535,000 1,690,000 4,225,000
1,950,000 1,300,000 3,250,000
1,500,000 1,000,000 2,500,000
1,950,000 1,300,000 3,250,000
300,000 200,000 500,000
1,260,000 840,000 2,100,000
1,950,000 1,300,000 3,250,000
2,535,000 1,690,000 4,225,000
2,100,000 1,400,000 3,500,000
108,000 72,000 180,000
150,000 100,000 250,000
1,350,000 900,000 2,250,000
1,950,000 1,300,000 3,250,000
60,000 40,000 100,000
1,020,000 680,000 1,700,000
60,000 40,000 100,000
1,020,000 680,000 1,700,000
60,000 40,000 100,000
150,000 100,000 250,000
180,000 120,000 300,000
1,020,000 680,000 1,700,000
30,000 20,000 50,000
60,000 40,000 100,000
2,535,000 1,690,000 4,225,000
30,000 20,000 50,000
30,000 20,000 50,000
1,755,000 1,170,000 2,925,000
1,350,000 900,000 2,250,000
3,000,000 2,000,000 5,000,000
3,600,000 2,400,000 6,000,000
150,000 100,000 250,000
900,000 600,000 1,500,000
150,000 100,000 250,000
150,000 100,000 250,000
45,000 30,000 75,000
1,020,000 680,000 1,700,000
4,125,000 2,750,000 6,875,000
120,000 80,000 200,000
90,000 60,000 150,000
3,000,000 2,000,000 5,000,000
2,400,000 1,600,000 4,000,000
2,535,000 1,690,000 4,225,000
90,000 60,000 150,000
45,000 30,000 75,000
240,000 160,000 400,000
60,000 40,000 100,000
30,000 20,000 50,000
240,000 160,000 400,000
960,000 640,000 1,600,000
180,000 120,000 300,000
60,000 40,000 100,000
60,000 40,000 100,000
120,000 80,000 200,000
1,800,000 1,200,000 3,000,000
420,000 280,000 700,000
240,000 160,000 400,000
1,500,000 1,000,000 2,500,000
2,535,000 1,690,000 4,225,000
45,000 30,000 75,000
2,535,000 1,690,000 4,225,000
2,535,000 1,690,000 4,225,000
4,500,000 3,000,000 7,500,000
1,950,000 1,300,000 3,250,000
60,000 40,000 100,000
180,000 120,000 300,000
120,000 80,000 200,000
45,000 30,000 75,000
1,800,000 1,200,000 3,000,000
1,800,000 1,200,000 3,000,000
2,400,000 1,600,000 4,000,000
3,600,000 2,400,000 6,000,000
90,000 60,000 150,000
30,000 20,000 50,000
1,800,000 1,200,000 3,000,000
1,950,000 1,300,000 3,250,000
180,000 120,000 300,000
39,000 26,000 65,000
60,000 40,000 100,000
120,000 80,000 200,000
24,000 16,000 40,000
48,000 32,000 80,000
48,000 32,000 80,000
135,000 90,000 225,000
36,000 24,000 60,000
36,000 24,000 60,000
2,550,000 1,700,000 4,250,000
81,000 54,000 135,000
525,600 350,400 876,000
2,550,000 1,700,000 4,250,000
480,000 320,000 800,000
18,000 12,000 30,000
36,000 24,000 60,000
480,000 320,000 800,000
2,100,000 1,400,000 3,500,000
2,430,000 1,620,000 4,050,000
30,000 20,000 50,000
480,000 320,000 800,000
405,000 270,000 675,000
2,550,000 1,700,000 4,250,000
18,000 12,000 30,000
60,000 40,000 100,000
30,000 20,000 50,000
607,200 404,800 1,012,000
810,000 540,000 1,350,000
1,620,000 1,080,000 2,700,000
300,000 200,000 500,000
480,000 320,000 800,000
2,550,000 1,700,000 4,250,000
6,600,000 4,400,000 11,000,000
1,950,000 1,300,000 3,250,000
1,320,000 880,000 2,200,000
42,000 28,000 70,000
90,000 60,000 150,000
180,000 120,000 300,000
5,625,000 3,750,000 9,375,000
2,550,000 1,700,000 4,250,000
3,900,000 2,600,000 6,500,000
9,000 6,000 15,000
480,000 320,000 800,000
480,000 320,000 800,000
1,500,000 1,000,000 2,500,000
900,000 600,000 1,500,000
5,625,000 3,750,000 9,375,000
2,550,000 1,700,000 4,250,000
10,875,000 7,250,000 18,125,000
2,550,000 1,700,000 4,250,000
1,320,000 880,000 2,200,000
1,950,000 1,300,000 3,250,000
1,410,000 940,000 2,350,000
2,550,000 1,700,000 4,250,000
18,000 12,000 30,000
42,000 28,000 70,000
33,600 22,400 56,000
45,000 30,000 75,000
4,800,000 3,200,000 8,000,000
9,000 6,000 15,000
150,000 100,000 250,000
12,000 8,000 20,000
3,600,000 2,400,000 6,000,000
1,377,000 918,000 2,295,000
54,000 36,000 90,000
409,200 272,800 682,000
370,200 246,800 617,000
31,200 20,800 52,000
210,600 140,400 351,000
210,600 140,400 351,000
683,100 455,400 1,138,500
683,100 455,400 1,138,500
1,603,800 1,069,200 2,673,000
1,843,020 1,228,680 3,071,700
1,897,020 1,264,680 3,161,700
2,091,420 1,394,280 3,485,700
2,123,820 1,415,880 3,539,700
2,349,540 1,566,360 3,915,900
760,200 506,800 1,267,000
3,621,000 2,414,000 6,035,000
1,285,800 857,200 2,143,000
3,297,600 2,198,400 5,496,000
3,960,000 2,640,000 6,600,000
626,400 417,600 1,044,000
943,800 629,200 1,573,000
184,200 122,800 307,000
365,400 243,600 609,000
439,200 292,800 732,000
658,800 439,200 1,098,000
585,600 390,400 976,000
622,200 414,800 1,037,000
658,800 439,200 1,098,000
695,400 463,600 1,159,000
732,000 488,000 1,220,000
768,600 512,400 1,281,000
878,400 585,600 1,464,000
79,800 53,200 133,000
243,600 162,400 406,000
33,000 22,000 55,000
609,000 406,000 1,015,000
152,100 101,400 253,500
22,200 14,800 37,000
1,500,000 1,000,000 2,500,000
240,000 160,000 400,000
61,200 40,800 102,000
10,800 7,200 18,000
243,600 162,400 406,000
138,000 92,000 230,000
1,602,000 1,068,000 2,670,000
15,000 10,000 25,000
121,800 81,200 203,000
44,400 29,600 74,000
1,068,000 712,000 1,780,000
27,000 18,000 45,000
33,000 22,000 55,000
27,000 18,000 45,000
180,000 120,000 300,000
45,000 30,000 75,000
96,000 64,000 160,000
120,000 80,000 200,000
9,000 6,000 15,000
25,000 25,000
30,000 30,000
87,000 58,000 145,000
18,000 12,000 30,000
60,000 40,000 100,000
90,000 60,000 150,000
18,000 12,000 30,000
12,000 8,000 20,000
90,000 60,000 150,000
75,000 50,000 125,000
84,000 56,000 140,000
15,000 10,000 25,000
12,000 8,000 20,000
195,000 130,000 325,000
25,000 25,000
25,000 25,000
15,000 10,000 25,000
22,200 14,800 37,000
10,800 7,200 18,000
38,400 25,600 64,000
22,800 15,200 38,000
243,600 162,400 406,000
182,400 121,600 304,000
35,700 23,800 59,500
15,000 10,000 25,000
10,800 7,200 18,000
120,000 80,000 200,000
15,000 10,000 25,000
33,000 22,000 55,000
121,800 81,200 203,000
22,200 14,800 37,000
18,000 12,000 30,000
18,000 12,000 30,000
304,200 202,800 507,000
243,600 162,400 406,000
15,000 10,000 25,000
30,000 30,000
67,000 67,000
45,000 45,000
18,000 12,000 30,000
12,000 8,000 20,000
12,000 8,000 20,000
12,000 8,000 20,000
9,000 6,000 15,000
9,000 6,000 15,000
9,000 6,000 15,000
9,000 6,000 15,000
12,000 8,000 20,000
15,000 10,000 25,000
81,000 54,000 135,000
22,200 14,800 37,000
12,000 8,000 20,000
15,000 10,000 25,000
12,000 8,000 20,000
22,200 14,800 37,000
33,000 22,000 55,000
10,800 7,200 18,000
365,400 243,600 609,000
15,000 10,000 25,000
243,600 162,400 406,000
12,000 8,000 20,000
12,000 8,000 20,000
243,600 162,400 406,000
22,200 14,800 37,000
15,000 10,000 25,000
9,000 6,000 15,000
10,800 7,200 18,000
15,600 10,400 26,000
12,000 8,000 20,000
124,200 82,800 207,000
121,800 81,200 203,000
79,800 53,200 133,000
44,400 29,600 74,000
44,400 29,600 74,000
12,000 8,000 20,000
16,200 10,800 27,000
365,400 243,600 609,000
25,000 25,000
30,000 30,000
25,000 25,000
25,000 25,000
54,600 36,400 91,000
12,000 8,000 20,000
45,000 30,000 75,000
450,000 300,000 750,000
45,000 250,000 295,000
450,000 325,000 775,000
120,000 80,000 200,000
150,000 100,000 250,000
360,000 240,000 600,000
450,000 300,000 750,000
30,000 20,000 50,000
60,000 40,000 100,000
60,000 40,000 100,000
90,000 60,000 150,000
30,000 30,000 60,000
50,000 40,000 90,000
150,000 100,000 250,000
990,000 825,000 165,000
315,000 262,500 52,500
630,000 525,000 105,000
990,000 825,000 165,000
315,000 262,500 52,500
630,000 525,000 105,000
315,000 262,500 52,500
832,500 693,750 138,750
225,000 187,500 37,500
78,000 52,000 130,000
87,000 58,000 145,000
90,000 60,000 150,000
99,000 66,000 165,000
102,000 68,000 170,000
111,000 74,000 185,000
180,000 120,000 300,000
120,000 80,000 200,000
270,000 180,000 450,000
270,000 180,000 450,000
240,000 160,000 400,000
240,000 160,000 400,000
240,000 160,000 400,000
180,000 120,000 300,000
180,000 120,000 300,000
240,000 160,000 400,000
240,000 160,000 400,000
240,000 160,000 400,000
270,000 180,000 450,000
240,000 160,000 400,000
240,000 160,000 400,000
240,000 160,000 400,000
240,000 160,000 400,000
240,000 160,000 400,000
1,320,000 880,000 2,200,000
1,500,000 1,000,000 2,500,000
1,320,000 880,000 2,200,000
1,500,000 1,000,000 2,500,000
1,500,000 1,000,000 2,500,000
1,800,000 1,200,000 3,000,000
1,440,000 960,000 2,400,000
1,500,000 1,000,000 2,500,000
1,800,000 1,200,000 3,000,000
1,440,000 960,000 2,400,000
1,500,000 1,000,000 2,500,000
2,100,000 1,400,000 3,500,000
2,400,000 1,600,000 4,000,000
1,080,000 720,000 1,800,000
1,320,000 880,000 2,200,000
1,080,000 720,000 1,800,000
1,320,000 880,000 2,200,000
1,080,000 720,000 1,800,000
1,320,000 880,000 2,200,000
2,100,000 1,400,000 3,500,000
2,400,000 1,600,000 4,000,000
1,080,000 720,000 1,800,000
1,320,000 880,000 2,200,000
180,000 120,000 300,000
90,000 60,000 150,000
90,000 60,000 150,000
90,000 60,000 150,000
90,000 60,000 150,000
240,000 160,000 400,000
180,000 120,000 300,000
180,000 120,000 300,000
420,000 280,000 700,000
450,000 300,000 750,000
600,000 400,000 1,000,000
450,000 300,000 750,000
600,000 400,000 1,000,000
510,000 340,000 850,000
720,000 480,000 1,200,000
540,000 360,000 900,000
720,000 480,000 1,200,000
450,000 300,000 750,000
600,000 400,000 1,000,000
450,000 300,000 750,000
450,000 300,000 750,000
450,000 300,000 750,000
480,000 320,000 800,000
720,000 480,000 1,200,000
2,100,000 1,400,000 3,500,000
2,100,000 1,400,000 3,500,000
216,000 144,000 360,000
300,000 200,000 500,000
24,000 16,000 40,000
36,000 24,000 60,000
8,040 5,360 13,400
9,000 6,000 15,000
9,000 6,000 15,000
24,000 16,000 40,000
24,000 16,000 40,000
72,000 48,000 120,000
72,000 48,000 120,000
16,500 11,000 27,500
16,500 11,000 27,500
39,600 26,400 66,000
33,000 22,000 55,000
21,780 14,520 36,300
21,780 14,520 36,300
21,780 14,520 36,300
39,600 26,400 66,000
11,550 7,700 19,250
65,340 43,560 108,900
115,500 77,000 192,500
33,000 22,000 55,000
36,000 24,000 60,000
36,000 24,000 60,000
100,800 67,200 168,000
36,000 24,000 60,000
36,000 24,000 60,000
38,400 25,600 64,000
84,000 56,000 140,000
8,400 5,600 14,000
8,400 5,600 14,000
45,000 30,000 75,000
45,000 30,000 75,000
38,400 25,600 64,000
38,400 25,600 64,000
123,000 82,000 205,000
155,400 103,600 259,000
118,800 79,200 198,000
72,600 48,400 121,000
165,000 110,000 275,000
163,350 108,900 272,250
115,500 77,000 192,500
150,480 100,320 250,800
112,530 75,020 187,550
33,000 22,000 55,000
60,720 40,480 101,200
59,400 39,600 99,000
11,400 7,600 19,000
11,400 7,600 19,000
13,500 9,000 22,500
13,500 9,000 22,500
42,000 28,000 70,000
15,000 10,000 25,000
15,000 10,000 25,000
15,000 10,000 25,000
33,000 22,000 55,000
18,000 12,000 30,000
15,000 10,000 25,000
15,000 10,000 25,000
15,000 10,000 25,000
15,000 10,000 25,000
15,000 10,000 25,000
16,638 11,092 27,730
99,792 66,528 166,320
108,000 72,000 180,000
108,000 72,000 180,000
18,000 12,000 30,000
34,800 23,200 58,000
36,000 24,000 60,000
21,000 14,000 35,000
18,000 12,000 30,000
18,000 12,000 30,000
48,000 32,000 80,000
48,000 32,000 80,000
99,000 66,000 165,000
13,500 9,000 22,500
18,000 12,000 30,000
13,500 9,000 22,500
27,000 18,000 45,000
16,800 11,200 28,000
72,000 48,000 120,000
39,600 26,400 66,000
20,400 13,600 34,000
34,800 23,200 58,000
150,000 100,000 250,000
123,000 82,000 205,000
123,000 82,000 205,000
47,190 31,460 78,650
33,000 22,000 55,000
105,600 70,400 176,000
38,940 25,960 64,900
38,940 25,960 64,900
38,940 25,960 64,900
38,940 25,960 64,900
13,200 8,800 22,000
50,820 33,880 84,700
136,320 90,880 227,200
50,820 33,880 84,700
50,820 33,880 84,700
28,050 18,700 46,750
36,300 24,200 60,500
45,000 30,000 75,000
45,000 30,000 75,000
58,800 39,200 98,000
58,800 39,200 98,000
96,000 64,000 160,000
123,000 82,000 205,000
120,000 80,000 200,000
93,000 62,000 155,000
33,000 22,000 55,000
96,000 64,000 160,000
168,000 112,000 280,000
111,000 74,000 185,000
144,000 96,000 240,000
42,900 28,600 71,500
15,000 10,000 25,000
18,600 12,400 31,000
33,000 22,000 55,000
33,000 22,000 55,000
135,000 90,000 225,000
135,000 90,000 225,000
120,000 80,000 200,000
120,000 80,000 200,000
66,000 44,000 110,000
66,000 44,000 110,000
66,000 44,000 110,000
66,000 44,000 110,000
99,000 66,000 165,000
99,000 66,000 165,000
66,000 44,000 110,000
66,000 44,000 110,000
28,500 19,000 47,500
48,600 32,400 81,000
240,000 160,000 400,000
450,000 300,000 750,000
21,000 14,000 35,000
30,600 20,400 51,000
24,000 16,000 40,000
6,000 4,000 10,000
30,000 20,000 50,000
15,000 10,000 25,000
115,500 77,000 192,500
9,900 6,600 16,500
19,800 13,200 33,000
13,200 8,800 22,000
13,200 8,800 22,000
15,000 10,000 25,000
18,000 12,000 30,000
60,000 40,000 100,000
- - -
93,600 62,400 156,000
87,600 58,400 146,000
69,600 46,400 116,000
60,600 40,400 101,000
60,600 40,400 101,000
127,200 84,800 212,000
127,200 84,800 212,000
136,800 91,200 228,000
141,900 94,600 236,500
105,600 70,400 176,000
138,600 92,400 231,000
52,140 34,760 86,900
105,000 70,000 175,000
123,000 82,000 205,000
120,000 80,000 200,000
120,000 80,000 200,000
192,000 128,000 320,000
165,000 110,000 275,000
165,000 110,000 275,000
183,600 122,400 306,000
113,400 75,600 189,000
141,900 94,600 236,500
49,500 33,000 82,500
120,000 80,000 200,000
37,800 25,200 63,000
60,000 40,000 100,000
60,000 40,000 100,000
22,200 14,800 37,000
22,200 14,800 37,000
22,200 14,800 37,000
22,200 14,800 37,000
22,200 14,800 37,000
22,200 14,800 37,000
23,400 15,600 39,000
44,400 29,600 74,000
27,000 18,000 45,000
289,200 192,800 482,000
289,200 192,800 482,000
990,000 660,000 1,650,000
289,200 192,800 482,000
270,000 180,000 450,000
123,600 82,400 206,000
96,000 64,000 160,000
72,000 48,000 120,000
309,000 206,000 515,000
309,000 206,000 515,000
309,000 206,000 515,000
309,000 206,000 515,000
309,000 206,000 515,000
309,000 206,000 515,000
309,000 206,000 515,000
192,600 128,400 321,000
308,400 205,600 514,000
385,200 256,800 642,000
289,200 192,800 482,000
346,800 231,200 578,000
346,800 231,200 578,000
346,800 231,200 578,000
346,800 231,200 578,000
346,800 231,200 578,000
346,800 231,200 578,000
350,400 233,600 584,000
867,600 578,400 1,446,000
385,200 256,800 642,000
385,200 256,800 642,000
385,200 256,800 642,000
385,200 256,800 642,000
350,400 233,600 584,000
385,200 256,800 642,000
555,000 370,000 925,000
15,000 10,000 25,000
180,000 120,000 300,000
180,000 120,000 300,000
262,500 175,000 437,500
262,500 175,000 437,500
262,500 175,000 437,500
375,000 250,000 625,000
375,000 250,000 625,000
487,500 325,000 812,500
487,500 325,000 812,500
45,000 30,000 75,000
90,000 60,000 150,000
90,000 60,000 150,000
108,000 72,000 180,000
120,000 80,000 200,000
150,000 100,000 250,000
150,000 100,000 250,000
180,000 120,000 300,000
360,000 240,000 600,000
255,000 170,000 425,000
390,000 260,000 650,000
660,000 440,000 1,100,000
1,110,000 740,000 1,850,000
36,000 24,000 60,000
45,000 30,000 75,000
327,000 218,000 545,000
168,000 112,000 280,000
210,000 140,000 350,000
420,000 280,000 700,000
660,000 440,000 1,100,000
720,000 480,000 1,200,000
456,000 304,000 760,000
900,000 600,000 1,500,000
1,380,000 920,000 2,300,000
151,200 100,800 252,000
241,800 161,200 403,000
218,800 547,000
240,000 160,000 400,000
315,000 210,000 525,000
151,200 100,800 252,000
150,000 100,000 250,000
165,000 110,000 275,000
45,000 30,000 75,000
48,000 32,000 80,000
71,400 47,600 119,000
71,400 47,600 119,000
195,000 130,000 325,000
24,000 16,000 40,000
36,000 24,000 60,000
45,000 30,000 75,000
135,000 90,000 225,000
246,000 164,000 410,000
312,000 208,000 520,000
423,000 282,000 705,000
6,000 4,000 10,000

18,000 12,000 30,000
5,000 30,000 35,000 1.
5,000 40,000 45,000
5,000 50,000 55,000 2.
15,000 85,000 100,000
30,000 20,000 50,000 1.

36,000 24,000 60,000
42,000 28,000 70,000 2.
52,500 35,000 87,500
1.
45,000 30,000 75,000
54,000 36,000 90,000
60,000 40,000 100,000
2.
60,000 40,000 100,000
66,000 44,000 110,000
78,000 52,000 130,000
96,000 64,000 160,000

105,000 70,000 175,000
111,000 74,000 185,000
360,000 240,000 600,000

420,000 280,000 700,000
540,000 360,000 900,000

600,000 400,000 1,000,000
1,500,000 1,000,000 2,500,000

1,800,000 1,200,000 3,000,000
315,000 210,000 525,000

360,000 240,000 600,000
315,000 210,000 525,000

360,000 240,000 600,000
Keterangan
Darm Bouis
Tarif tidak termasuk obat,

penunjang medik.
Untuk pasien asing yang
Tarif (Rp)
Keterangan
Jumlah
NEW
20,000 Darm Bouis
250,000 Echo Cardiography (Poli Jantung)
270,000 Holter dan Recorder
395,000 Treadmill
203,000 Angkat dan Pasang KB Susuk
37,000 Angkat Jahitan
1,015,000 Ekstirpasi Kiste Bartholine
120,000 Ekstraksi IUD Kebidanan
1,015,000 Extractie IUD dengan GA
83,000 Pap Smear Biasa
55,000 Pasang Pesarium
92,000 USG
250,000 Bedah Sakpel
202,500 Biopsi Kulit
526,000 Eksisi Granuloma
500,000 Eksisi Granuloma Pyogenikum
250,000 Eksisi Hordeleum/Granuloma
60,000 Eksisi Syringoma
2,500,000 Eksisi Xantalasma
750,000 Eksisi Xantoma
70,000 Ekstirpasi Komedo
60,000 Ekstraksi Kalium Oksalat
300,000 Elektro Kauter dengan Anestesi Topikal (Condiloma)
200,000 Elektro Kauter dengan Anestesi Topikal (Millium)
202,500 Elektro Kauter dengan Anestesi Topikal (Veruka...)
60,000 Elektrofulgasi
300,000 Elektrokauter dengan Anestesi Injeksi
202,500 Elektrokauter dengan Anestesi Topikal
81,500 Enulkleasi Milia Lesi < 20
111,500 Enulkleasi Milia Lesi > 20
70,000 Enulkleasi Moluskum
51,500 Enulkleasi Moluskum lesi < 20
81,500 Enulkleasi Moluskum Lesi > 20
70,000 Injeksi Triamcinolon Acetonide Kenacort lesi < 50 cm²
100,000 Injeksi Triamcinolon Acetonide Kenacort Lesi > 50 cm²
900,000 IPL (Pemakaian Alat Canggih) Kaki Kanan - Kiri
700,000 IPL (Pemakaian Alat Canggih) Tangan Kanan - Kiri
500,000 IPL (Pemakaian Alat Canggih) Wajah
500,000 Pengangkatan Neuro Fibroma
750,000 Pengangkatan Tandur Kulit
18,000 Suntik Keloid
750,000 Tindakan Bedah Flap
250,000 Tindakan Dermabrasi
202,500 Tindakan pada Keratosis Seboroika Lesi < 20
500,000 Tindakan pada Keratosis Seboroika Lesi > 20
275,000 Tatto Removal 1/4 card
1,100,000 Tatto Removal 1 card
275,000 Dark Circle Around Eyes 1/4 card
1,100,000 Dark Circle Around Eyes 1 card
275,000 Wrinkle Around Eyes 1/4 card
1,100,000 Wrinkle Around Eyes 1 card
275,000 Skin Lightening 1/4 card
1,100,000 Skin Lightening 1 card
275,000 Rosacea 1/4 card
1,100,000 Rosacea 1 card
275,000 QS Pixel Melasma 1/4 card
1,100,000 QS Pixel Melasma 1 card
275,000 QS Pixel Freckles 1/4 card
1,100,000 QS Pixel Freckles 1 card
275,000 QS Pixel Lentigo 1/4 card
1,100,000 QS Pixel Lentigo 1 card
1,300,000 Whole Face Rejuvenation
275,000 Siringoma 1/4 card
1,100,000 Siringoma 1 card
275,000 Gentle Peel 1/4 card
1,100,000 Gentle Peel 1 card
275,000 SSR Melasma 1/4 card
1,100,000 SSR Melasma 1 card
275,000 SSR Freckles 1/4 card
1,100,000 SSR Freckles 1 card
275,000 SSR Lentigo 1/4 card
1,100,000 SSR Lentigo 1 card
275,000 Telangietacstatitas 1/4 card
1,100,000 Telangietacstatitas 1 card
275,000 Hemangiomas 1/4 card
550,000 Hemangiomas1/2 card
825,000 Hemangiomas 3/4 card
1,100,000 Hemangiomas 1 card
275,000 Venous Lake 1/4 card
1,100,000 Venous Lake 1 card
275,000 Port Wine Stain 1/4 card
1,100,000 Port Wine Stain 1 card
1,300,000 Full Face Rejuvenation
250,000 Ekstraksi Komedo Jumlah > 10
200,000 Ekstraksi Komedo Jumlah < 10
250,000 Mikrodermabrasi
200,000 Checimal Peeling
650,000 Botox
650,000 Filler
Subsisi (Acne Scar)
350,000 Jumlah > 5 (SSR)
200,000 Jumlah < 5 (SSR)
300,000 Prp
450,000 Mikroneedle (Paket 4 Kali)
200,000 Mikroneedle (Paket 1 Kali)
1,000,000 Thread
200,000 Ftd
150,000 Injeksi Vitamin C
35,000 Injeksi 1 Acne
25,000 Konsultasi Gizi
1,147,000 Angkat Implant Interna
266,000 Audiometri (Pelayanan Eksekutif Rawat Jalan)
266,000 Biopsi Nosopharynk dengan Lokal Anastesi
128,000 Buka Fiksasi 2 Rahang
37,000 #N/A
37,000 #N/A
316,000 Ekstraski Polip dengan Lokal Anastesi
37,000 Ekterpasi Granuloma dan Milium
37,000 Epilasi (Pelayanan Eksekutif Rawat Jalan)
91,000 Extractie Korpus Alenium Kornea
128,000 Fiksasi 1 Rahang
15,000 Home Exercise Program
316,000 Incisi Abces Peritonsil
37,000 Incisi Abses (Tindakan Sederhana)
609,000 Incisi Hordeolum
316,000 Irigasi/Extraksi Cerumen
474,000 Kista Dermoid
507,000 Kolposcopy
25,000 Konsultasi Ahli Gizi
67,000 Konsultasi Psychiatri
37,000 Koreksi Refraksi
27,000 Laringoskopi Indirect
59,500 Latihan Fisik
55,000 Peeling
73,000 Perawatan Gips: Lac, Sac, Bkc
203,000 Ps. Gips Ekstremitas
37,000 Punctie Daun Telinga
1,015,000 Rectoscopy (Eksekutif rawat jalan)
30,000 Rehab Obesitas
37,000 Slit Lamp (Pelayanan Eksekutif Rawat Jalan)
51,000 Spirometri
37,000 Spoel Kateter
133,000 Test Garputala
37,000 Tonometri Aplanasi
37,000 Tonometri Schiotz
92,000 USG Abdomen Atas (Tanpa Print Gambar)
92,000 USG Abdomen Bawah (Tanpa Print Gambar)
55,000 WT dan HT 1 - 10 Jahitan
73,000 WT dan HT 11 - 20 Jahitan
507,000 Antrostomi Sinus Maksilaris
91,000 Buka Jahitan Palpebra
304,000 Circumcisi (Sunat)
507,000 Ekstirpasi Kista Dermoid
507,000 Ekstirpasi Tumor Tulang
55,000 Hecting Luka Konjungtiva
37,000 Incisi Abses dengan Lokal Anastesi
18,000 Pasang Spalk
55,000 Pasang Tindik pada Telinga
304,000 Reposisi Fraktur dan Atm Dislokasi
203,000 Skin Tractie/Pasang Traksi Kulit
406,000 Up Inter Dental Wire
37,000 #N/A
37,000 Delatasi Phymosis dengan Lokal Anastesi
332,000 Dilatasi dengan Bougie
459,000 Extraksi Batu Uretra dengan GA
133,000 Mantoux Test
100,000 Pasang Tindik Tembak
91,000 Aspirasi Cairan Sendi Superfisial
55,000 Cauterisasi Kutil 1 - 10 Buah
73,000 Cauterisasi Kutil 11 - 20 Buah
91,000 Cauterisasi Kutil Lebih dari 20 Buah
91,000 Needling Muscle Band
406,000 Pasang Gips Tulang Belakang
91,000 Perawatan Gips : Tulang Belakang
304,000 Ekstirpasi Tumor Jinak Kulit (poli Kebidanan)
80,000 Aktifir Plat Orthodentie/Kontrol
500,000 Alveolektomi Per Regio
200,000 Apex Reseksi 1 Gigi
85,000 Buka Kawat Fiksasi
177,500 Cementing Per Gigi
250,000 Eksisi Epulis (Mucocele)
1,500,000 Eksplorasi Abses Mandibula
180,000 Ekstirpasi Polip Rongga Mulut
1,500,000 Ekstirpasi Tumor Jinak Sinonasal, Oral Cavity
50,000 Emergency Treatment
1,350,000 Fiksasi Rahang dengan Pembiusan Umum
100,000 Fissure Sealant/Regio
230,000 Frenektomi
50,000 Ganti Perban
300,000 Gingivektomi Per Rahang
100,000 Incisi Ekstra Oral
100,000 Incisi Intra Oral
100,000 Jahit Luka Mulut < 5
150,000 Jahit Luka Mulut > 5
85,000 Kontrol Protese Gigi
100,000 Kontrol Tindakan Post Operatif
85,000 Kuretase 1 Gigi Close Method Non Anastesi
300,000 Kuretase Open Method + Anastesi (Jahit Per Gigi)
750,000 Mahkota Jaket/Dowel Acrilic Per Gigi
100,000 Mahkota Sementara
2,000,000 Mahkota/Dowel Perselen Per Gigi
3,000,000 Odontektomi Anestesi Umum
1,000,000 Odontektomi dengan Anestesi Lokal
3,000,000 Ortho Cekat/Rahang
500,000 Pembuatan Plat Orthodontik/Rahang
30,000 Pemeriksaan atau Check Up Per Kunjungan
1,500,000 Pemutihan Gigi (Bleaching)/Rahang
200,000 Penambahan Protese Per Gigi (Akrilik)
150,000 Pencabutan Gigi dengan Anestesi Lokal (Tindakan Sederhana)
300,000 Pencabutan Gigi dengan Komplikasi dan Open Method
50,000 Pencabutan Gigi dengan Topical Anestesi

200,000 Pengisian Saluran Akar (Gigi Permanen)
80,000 Pengisian Saluran Akar Gigi Sulung
100,000 Preparasi Saluran Akar
2,500,000 Protese (Akrilik Full Denture/Per Rahang)
575,000 Protese 1 Gigi/Gigi Pertama (Akrilik)
80,000 Pulp Capping
150,000 Pulpotomi
800,000 Rebasing Gigi Tiruan/Rahang
450,000 Rellining Full Dentur Per Rahang
300,000 Rellining Partial Dentur Per Rahang
367,500 Reparasi Protese
250,000 Reposisi Gigi Per Regio
100,000 Scalling Per Rahang
400,000 Splinting Per Rahang
100,000 Sterilisasi Saluran Akar
100,000 Tambahan Ekspansi Atau Screw Orthodontik
230,000 Tumpatan Composite Light Cure
177,500 Tumpatan Glass Ionomer
500,000 Tumpatan Inlay, Onlay, dan Uplay
50,000 Tumpatan Sementara 1 Gigi Tanpa/dengan Open Boor
300,000 Upperculectomy
150,000 Konsultasi Hasil
75,000 Konsultasi Psikologi
125,000 Tindakan Psikologi
52,000 Exercise Terapi
69,000 Faradic/Galvanik
293,000 Fisioterapi dengan Alat (4 x tindakan)
69,000 Hidro Terapi
52,000 Home Exercis Eprogram
69,000 Hot Pack/ Cold Pack
69,000 Infra Red
52,000 Massage
69,000 Micro Wave Diathermy/MWD
69,000 Parafin Bath
69,000 Short Wave Diathermy/SWD (REHABILITASI MEDIK/FISIOTERAPI)
69,000 Tens
20,000 Terapi Bermain/Support
15,000 Terapi Klp Asma
15,000 Terapi Klp Stroke
69,000 Terapi Laser
52,000 Terapi Latihan Asma
52,000 Terapi Latihan Fraktur
52,000 Terapi Latihan Stroke
293,000 Terapi Okupasi (4x tindakan)
293,000 Terapi Wicara (4x tindakan)
69,000 Traksi Cervical dan Lumbal
69,000 Ultra Sound Diathermy/USD
140,000 Psikoterapi Kognitif
140,000 Psikoterapi Suportif (Rawat jalan)
50,000 Psikoterapi Edukasi
50,000 Restrain
50,000 Surat Keterangan Bebas Narkoba (Pelayanan Psikoterapi)
50,000 Surat Keterangan Sehat Jiwa
150,000 Tes Anak Berkebutuhan Khusus
150,000 Tes IQ Individu
150,000 Tes Kejiwaan (MMPI)
150,000 Tindakan Psikoterapi
600,000 Mengeluarkan Bayi dari Jenazah Ibu (PELAYANAN MEDICO LEGAL)
1,000,000 Visum - Otopsi
1,500,000 Visum - Otopsi - Hari Libur
175,000 Visum - Pemeriksaan Jenazah Bagian Luar Saja
250,000 Visum - Pemeriksaan Jenazah Bagian Luar Saja - Hari Libur
140,000 Visum di Luar RS - TKP dengan Penggalian

850,000 Visum Luar RS - TKP (diluar Rumah Sakit)
100,000 Medical Certificate
25,000 Surat Keterangan Buta Warna
25,000 Surat Keterangan Sehat
25,000 Surat Keterangan Sehat Untuk ke Luar Negeri
30,000 Manicure
30,000 Pedicure
50,000 Bali Body Massage 30 Menit
60,000 Bali Body Massage 1 Jam
70,000 Bali Body Massage + Scrub 1,5 Jam
20,000 Pelayanan Spa ke Ruang Rawat Inap Tambahan Biaya
60,000 Akupuntur Estetika
60,000 Akupuntur Kebugaran
70,000 Akupuntur Terapi
20,000 Pelayanan Akupuntur ke Ruang Rawat Inap Tambahan Biaya
30,000 Pijat Refleksi 30 Menit
50,000 Pijat Refleksi 1 Jam
20,000 Pijat Refleksi ke Ruang Rawat Inap Tambahan Biaya
25,000 Cuci Rambut
40,000 Cuci Rambut + Blow/Catok
20,000 Cuci Rambut + Blow/Catok ke Ruang Rawat Inap Tambahan Biaya
265,000 IGD Pelayanan Ambulance Keperawatan Dalam Kota

415,000 IGD Pelayanan Ambulance Keperawatan Gianyar
525,000 IGD Pelayanan Ambulance Keperawatan Badung
525,000 IGD Pelayanan Ambulance Keperawatan Tabanan
525,000 IGD Pelayanan Ambulance Keperawatan Klungkung
525,000 IGD Pelayanan Ambulance Keperawatan Bangli
765,000 IGD Pelayanan Ambulance Keperawatan Karangasem
1,035,000 IGD Pelayanan Ambulance Keperawatan Buleleng
1,035,000 IGD Pelayanan Ambulance Keperawatan Negara
2,500,000 IGD Pelayanan Ambulance Keperawatan Luar Bali
295,000 Pelayanan Ambulance Medik Umum Dalam Kota
445,000 Pelayanan Ambulance Medik Umum Gianyar
555,000 Pelayanan Ambulance Medik Umum Badung
555,000 Pelayanan Ambulance Medik Umum Tabanan
555,000 Pelayanan Ambulance Medik Umum Klungkung
555,000 Pelayanan Ambulance Medik Umum Bangli
795,000 Pelayanan Ambulance Medik Umum Karangasem
1,065,000 Pelayanan Ambulance Medik Umum Buleleng
1,065,000 Pelayanan Ambulance Medik Umum Negara
2,530,000 Pelayanan Ambulance Medik Umum Luar Bali
371,000 Pelayanan Ambulance Medik Spesialis Dalam Kota
581,000 Pelayanan Ambulance Medik Spesialis Gianyar
735,000 Pelayanan Ambulance Medik Spesialis Badung
735,000 Pelayanan Ambulance Medik Spesialis Tabanan
735,000 Pelayanan Ambulance Medik Spesialis Klungkung
735,000 Pelayanan Ambulance Medik Spesialis Bangli
1,071,000 Pelayanan Ambulance Medik Spesialis Karangasem
1,449,000 Pelayanan Ambulance Medik Spesialis Buleleng
1,449,000 Pelayanan Ambulance Medik Spesialis Negara
3,500,000 Pelayanan Ambulance Medik Spesialis Luar Bali
1,015,000 Amputasi Jari
75,000 Arm Sling
55,000 Blaas Punctie
73,000 Bulectomy 10% - 20%
55,000 Bullectomy < 10%
91,000 #N/A
91,000 Bullectomy Lebih dari 20%
406,000 Cauter Perdarahan Tonsil
130,000 Combutio < 10%
250,000 Combutio > 30%
180,000 Combutio 10% - 30%
20,000 Cukur Lapangan Operasi
507,000 Cystostomy
205,000 DC Shock (Tindakan IGD)
37,000 Dilatasi Phymosis Tanpa Bius
55,000 Dislokasi Rahang
40,000 Dusinasi (Dilatasi dengan Businator)
140,000 Eksplorasi Luka Gigitan Sengatan Binatang (IGD)
140,000 Eksplorasi Vulnus Iktum
200,000 Eksplorasi/Ekstraksi Kuku
73,000 Ekstraksi Batu Uretra
200,000 Ekstraksi Benda Asing dengan Penyulit
200,000 Ekstraksi Cincin
73,000 Ekstraksi Corpus Alienum pada Telinga, Kuku
55,000 Ekstraksi Kuku dengan Lokal Anastesi
150,000 Evakuasi Batu Urethra Anterior tanpa Anastesi
1,000,000 Evakuasi Batu Urethra Anterior dengan Anastesi Lokal
37,000 Explorasi Kecil
55,000 Explorasi Luka Gigitan Binatang (Poliklinik)
91,000 Extractie Corpus Alienium Konjungtiva
459,000 Extraksi Batu Uretra Tanpa Anastesi
304,000 Fnab/Fine Needle Aspirasi Biopsi
55,000 Glyserin Spuit
300,000 High Below Knee Gips
80,000 Incisi Furunkell Abses
50,000 Injeksi Intra Artikuler (Tindakan IGD)
406,000 Incisi Biopsi Kelenjar dengan Lokal Anastesi
37,000 Irigasi Mata
6,000 Konsultasi Tak Langsung Dokter Spesialis/Per Telepon
25,000 Kumbah Lambung

55,000 Lavement
150,000 Luka Bakar Diatas 20%
203,000 Lumbal Pungsi 0 - 5 Tahun
304,000 Lumbal Pungsi 5 - 12 Tahun
406,000 Lumbal Pungsi Diatas 12 Tahun
220,000 Multiple Vulnus Apertum
55,000 Nekrotomi Luka
20,000 Observasi < 2 Jam
50,000 Observasi Lebih dari 2 Jam
304,000 Pasang Arteri Line
18,000 #N/A
50,000 Pasang Collar Brace
50,000 Pasang Elastic Bandage
2,200,000 Pasang Gips dengan GA
304,000 Pasang Gips (IGD)
332,000 Pasang Kateter dengan Alat Bantu
18,000 Pasang Mitella/Pembalut Elastis
18,000 Pasang Tampon pada Hidung/Telinga
203,000 Pasang Traksi Kulit (Ekstremitas, Kepala)
1,500,000 Pasang Traksi Vertebra (Tulang Selangkang)
1,000,000 Pasang WSD Continus
450,000 Pasang/Angkat Buak Gips Sirkular
91,000 Pemasangan Endotracheal Tube
203,000 Pemasangan Monitor
120,000 Pemasangan Ransel Perban, Colar dan Cuf, Back Slab Cast, Bandage
250,000 Pemasangan Skin Traksi

2,100,000 Perawatan Luka Bakar Derajat II - III Lebih 20%
1,690,000 Perawatan Luka Bakar Derajat II 15% - 20%
135,000 Perawatan Luka Bakar Derajat II s/d 15%
80,000 Puntie Hematros
60,000 RJP
50,000 Rawat Luka Bakar < 10%
70,000 Rawat Luka Bakar 10% - 20%
158,000 Repair Daun Telinga
340,000 Repair Tendon Jari Tangan
675,000 Repair Tendon Jari Tangan (Diatas 2 Buah)
91,000 Reposisi
1,147,000 Reposisi + Gips Ekstremitas Atas 1 Sisi
750,000 Reposisi dengan Anastesi
675,000 Reposisi dengan Anastesi Lokal
1,000,000 Reposisi Dislokasi MT Joint tanpa Anastesi
2,300,000 Reposisi Dislokasi MT Joint dengan Anastesi
200,000 Reposisi Dislokasi Sendi Mandibula
750,000 Reposisi Ekstremitas Atas dengan Anastesi Umum
675,000 Reposisi Ekstremitas Atas Tanpa Anastesi
1,020,000 Reposisi Ekstremitas Bawah Tanpa Anastesi
480,000 Reposisi Fr. Os Nasal + Pasang Gips Kupu-Kupu
304,000 Reposisi Fraktur dan Dislokasi
37,000 Reposisi Haemorrhoid
750,000 Reposisi Long Arm dengan Anastesi Umum
320,000 Reposisi Long Arm Gips dan Long Leg Tanpa Anastesi Umum
750,000 Reposisi Long Leg dengan Anastesi Umum

1,000,000 Reposisi MT Joint
100,000 Reposisi Os Nasal
600,000 Reposisi Short Arm dengan Anastesi Umum
195,000 Reposisi Short Arm Tanpa Anastesi Umum
150,000 Sambung Tendon Parsial
300,000 Sambung Tendon Total
37,000 Screening Hypotyroid
1,000,000 Sistostomi dengan Anastesi Lokal
50,000 Spalks Long 80 - 100 Cm
70,000 Speech Audiometer
80,000 Suprapubic Punctie
55,000 Tendo Plasty
765,000 Tennoraphy Tendon Ekstensor 1 Jari
975,000 Thoracostomy (WSD) Bilateral
675,000 Thoracostomy (WSD) Unilateral
60,000 Tindakan Pembuatan Visum Et Repertum Korban Hidup
280,000 Trocar Sistostomi

180,000 Vulnum Amputatum Sederhana
130,000 Vulnus Apertum < 5 Jahitan
350,000 Vulnus Avertum > 10 Jahitan
240,000 Vulnus Avertum 5 - 10 Jahitan
30,000 Vulnus Excoriatum
20,000 Asistensi Induksi
133,000 Rehabilitasi Vertibuler
45,000 USD
30,000 Visite Dokter Spesialis
17,500 Tindakan Medik Sederhana 1
19,500 Tindakan Medik Sederhana 1 A
33,000 Tindakan Medik Sederhana 2A
125,000 Tindakan Medik Kecil 1
145,000 Tindakan Medik Kecil 1A
675,000 Tindakan Medik Sedang 1
775,000 Tindakan Medik Sedang 1A
962,500 Tindakan Medik Sedang 2
1,112,500 Tindakan Medik Sedang 2A
1,250,000 Tindakan Medik Sedang 3
2,400,000 Tindakan Medik Besar 1
2,800,000 Tindakan Medik Besar 1A
5,750,000 Tindakan Medik Khusus 1
6,750,000 Tindakan Medik Khusus 1A
14,375,000 Tindakan Medik Canggih 1
16,875,000 Tindakan Medik Canggih 1A
7,650,000 Amput/Dear Tgk Fore Quarter 1 Sisi
11,475,000 Amput/Dear Tgk Fore Quarter 2 Sisi
15,300,000 Amput/Dear Tgk Hid Quarter 2 Sisi
9,562,000 Amput/Dear Tgk Hind Quarter 1 Sisi
4,590,000 Amput/Dear Tgk Kru/Ante 2 Sisi
3,060,000 Amput/Dear Tgk Kruris/Ante 1 Sisi
3,825,000 Amput/Dear Tgk Lengan Ats/Paha 1 Sisi
5,355,000 Amput/Dear Tgk Lgn Ats/Paha 2 Sisi
7,650,000 Amput/Dear Tgk Panggl /Bahu 2 Sisi
5,355,000 Amput/Dear Tgk Panggl Bahu 1 Sisi
6,120,000 Amput/Dear Tgk Siku/Lutut 1 Sisi
5,355,000 Amput/Dear Tgk Wrsi Ankle 2 Sisi
3,825,000 Amput/Dear Tgkt Wris/Ankle 1 Sisi
3,060,000 Amput/Dera 1-2 Snd Jr Tgk Kar,Tar
2,295,000 Amputasi Deartikualsi Lbh 2 Jr
1,530,000 Amputasi/ Dear 1-2 Snd Jr Tgk Kar
1,530,000 Amputasi/Dearti 1 - 2 Jari
5,355,000 Anastomis Vaskuler Distal Wrist
4,590,000 Anastomosis Vaskuler Proksimal Wrist
765,000 Angkat Fiksasi Ext. 1 Regio Ekstr.
1,912,000 Angkat Fiksasi In 1 Regio Ekstr.
3,060,000 Angkat Fiksasi In Lebih 1 Regio Ekstr.
4,590,000 Angkat Fiksasi Tulang Belakang
1,147,000 Angkatfiksasi Ext. Lebih 1 Regioekst
4,590,000 Arthriplasty Eks Bahu/Panggl 1 Sisi
3,825,000 Arthrodesis 1-2 Jari
5,355,000 Arthrodesis Bahu/Panggul 1 Sisi
7,650,000 Arthrodesis Bahu/Panggul 2 Sisi
5,355,000 Arthrodesis Lbh Dr 2 Jari
3,825,000 Arthrodesis Siku/Lutut 1 Sisi
6,120,000 Arthrodesis Siku/Lutut 2 Sisi
4,590,000 Arthrodesis Wrist/Angkle 1 Sisi
6,120,000 Arthrodesis Wrist/Angkle 2 Sisi
5,355,000 Arthroplasty Eks Bahu/Pangl 2 Sisi
3,060,000 Arthroplasty Eks Siku/Lutut 1 Sisi
4,590,000 Arthroplasty Eks Wrist/Ankle 2 Sisi
3,825,000 Arthroplasty Eksisi Wrist/Ankle 1 Sisi
3,825,000 Arthroplasty Exsisi 1-2 Jari
3,825,000 Arthroplasty Siku/Lutut 2 Sisi
5,355,000 Arthroscopy Bahu
3,825,000 Arthroscopy Lutut
4,590,000 Arthroscopy Panggul
304,000 Aspirasi Biopsi Tumor Muskuloskeletal
304,000 Aspirasi Cairan Sendi Dalam
3,825,000 Debri dan Drai Osteo Eks dengan Penyulit
5,355,000 Debri dan Drai Osteo Eks Lbh 1 Reg
3,060,000 Debri dan Drainge Osteomyelitis Eks
7,650,000 Debrid dan Drai Osteo Tlg Belakang
304,000 Debridement Luka (WT, HT)
6,120,000 Dekom Sten Srf Fer Reg Akar Spi Kan
11,475,000 Dekom Sten Srf Fer Reg Medula Spina
3,825,000 Dekom Sten Srf Fer Reg Siku 1 Sisi
6,120,000 Dekom Sten Srf Fer Reg Siku 2 Sisi
11,475,000 Dekom Sten Srf Fer Reg Thor Outlet
4,590,000 Dekom Sten Srf Fer Reg W/A 2 Sisi
3,060,000 Dekom Sten Srf Per Regio W/A 1 Sisi
406,000 Eksisi Biopsi Tumor Jaringan Lunak
1,147,000 Eksisi Biopsi Tumor Jinak Jar. Lunak
3,060,000 Fascio Dekom Comp Dist Wrist/Angkle
2,295,000 Fascio Dekom Comp Prok Wrist/Ankle
3,060,000 Fiksasi Ext 1Regio Ektr
3,825,000 Fiksasi Ext Ekst 1 Regio dengan Penyulit
4,590,000 Fiksasi Ext Ekstr Lebih dari 1 Regio
6,120,000 #N/A
7,650,000 Hemi JoinT Replacement Panggul 2 Sisi
6,120,000 Hemi Joint Replecement Lutut 1 Sisi
7,650,000 Hemi Joint Replecement Lutut 2 Sisi
5,355,000 Hemi Joint Replecement Panggul 1 Sisi (Orthopedi)
3,060,000 Incisi dan Drai Abses Sendi Dlm (Pro)
203,000 Incisi dan Drainase AB Sendi Superfisial
203,000 Incisi dan Drainase Abses Jar. Lunak
382,000 Moulding Dislokasi + Bandaging dengan Ga
765,000 Moulding Fraktur/Dislokasi + Gips
4,590,000 Orif Fr Kom Diaf 1-2 Meta, Tar, Fa
6,120,000 Orif Fr Kom Diaf Ante + 2 Reg Lain
9,562,000 Orif Fr Kom Diaf Ante + Ibh 2 Reg Ln
5,355,000 Orif Fr Kom Diaf Antebra + 1 Reg Ln
3,825,000 Orif Fr Kom Diaf Antebrakhii
9,562,000 Orif Fr Kom Diaf Fem Kla Lbh 2 Reg L
6,120,000 Orif Fr Kom Diaf Fem, Kla + 2 Reg Ln
5,355,000 Orif Fr Kom Diaf Fem, Klavi + 1 Reg
3,060,000 Orif Fr Kom Diaf Femur, Klaficula
9,562,000 Orif Fr Kom Diaf Hum Lbh 2 Reg Ln
5,355,000 Orif Fr Kom Diaf Hume + 2 Reg Lain
5,355,000 Orif Fr Kom Diaf Humerus + 1 Reg L
5,355,000 Orif Fr Kom Diaf Kru Fat + 1 Reg Ln
6,120,000 Orif Fr Kom Diaf Kru Fat + 2 Reg Ln
9,562,000 Orif Fr Kom Diaf Kru Fat Lbh 2 Reg
3,060,000 Orif Fr Kom Diaf Kruris Fatela
6,120,000 Orif Fr Kom Diaf Lbh 2 Met, Tar, Fal
4,590,000 Orif Fr Kom Diaf Umerus
9,562,000 Orif Fr Perd Tlpk dan Jr Tgn/Kk Lbh 2 Jr
5,355,000 Orif Fr Pers Siku
9,562,000 Orif Fr Pers Siku + 2 Reg Lain
7,650,000 Orif Fr Persd Bahu, Perg Tgn + 1 Reg
11,475,000 Orif Fr Persd Bh, Perg Tgn Lbh 2 Reg
11,475,000 Orif Fr Persd Lutut, Perg Kaki Lbh 2
3,825,000 Orif Fr Persd Lutut, Pergl Kaki
11,475,000 Orif Fr Persd Panggl Lbh 2 Reg Lain
6,120,000 Orif Fr Persd Panggul
11,475,000 Orif Fr Persd Siku Lbh 2 Reg Lain
9,562,000 Orif Fr Persd Tlpk dan Jr Tgn/Kk + 2 Rg
11,475,000 Orif Fr Persd Tlpk dan Jr Tgn/Kk Lbh 2Jr
11,475,000 Orif Fr Persd Tlpk Jr Tgn/Kk 1 - 2 Jr
9,562,000 Orif Fr Pesd Bh,Perg Tgn + 2 Reg Ln
7,650,000 Orif Fr Pesd Lutut,Perg Kaki + 1 Reg
7,650,000 Orif Fr Pesd Panggl + 1 Reg Lain
9,562,000 Orif Fr Pesd Pangl + 2 Reg Ln
7,650,000 Orif Fr Pesd Siku + 1 Reg Lain
7,650,000 Orif Fr Pesd Tlpk dan Jari Tgn/Kaki Lbh2
7,650,000 Orif Fr Pesd Tlpk/Jr Tgn/ Kaki 1 - 2Jr
4,590,000 Orif Fr Pesen Bhu, Pegl Tgn
3,060,000 Orif Fr Simpel Diaf. 1 - 2 Metakarpal
3,060,000 Orif Fr Simpel Diaf. Femur, Klavikula
3,825,000 Orif Fr Simpel Diaf. Lbh Dr 2 Meta.
4,590,000 Orif Fr Simpel Diaf.Humerus + 1 Regio
3,060,000 Orif Fr Simpel Diafisis Antebrakhi
3,825,000 Orif Fr Simpel Diafisis Humerus
4,590,000 Orif Fr Smp Diaf Antebrakhii
6,120,000 Orif Fr Smpl Diad Lebh 2 Met Karval
7,650,000 Orif Fr Smpl Diaf 1 - 2 Met, Tar, Fal
4,590,000 Orif Fr Smpl Diaf 1 - 2 Meta Tar, Fal
7,650,000 Orif Fr Smpl Diaf Ante + Lbh 2 Reg
7,650,000 Orif Fr Smpl Diaf Fem, Kla + Lbh 2 R
7,650,000 Orif Fr Smpl Diaf Hum Lbh 2 Reg
7,650,000 Orif Fr Smpl Diaf Kru, Fat + Lbh 2 R
4,590,000 Orif Fr Smpl Diaf Kruris, Pat + 1 Reg
7,650,000 Orif Fr Smpl Diaf Lbh 2 Met, Tar, Fal
4,590,000 Orif Fr Smpl Diaf Lbh 2 Meta Tar, Fal
6,120,000 Orif Fr Smpl Diaf Ume + 2 Reg Lain
6,120,000 Orif Fr Smpl Diap Antebrak + 2 Reg
6,120,000 Orif Fr Smpl Diap Fem, Kla + 2Reg
6,120,000 Orif Fr Smpl Diap Kru. Fat + Reg Lain
3,060,000 Orif Fr Tlpk Kaki/Jari 1 - 2 Jari
4,590,000 Orif Fr.Smp Diaf Fem Klav 1 Reg Lain
6,120,000 Orif Fr.Smpl Diaf 1 s/d 2 Met Kar
4,590,000 Orif Frak Persd Tlpk/Jr Tgn Lbh 2 Jr
2,295,000 Orif Fraktur Simpel Diaf, Kruris, Fat
203,000 #N/A
507,000 Pasang Traksi Tulang Ekstremitas
765,000 Pasang Traksi Tulang Kepala
2,295,000 Pengangkatan Bnd Asg di Ekstremitas
6,120,000 Pengangkatan Bnd Asg di Tlg Belkg
91,000 Perawatan Gips: LLC, Body Spica
7,650,000 Rekonstruksi Lebih Satu Jari
4,590,000 Rekonstruksi Satu Jari
9,562,000 Rekonstruksi Tgk Bahu/Panggl 1 Sisi
11,475,000 Rekonstruksi Tgk Bahu/Panggl 2 Sisi
9,562,000 Rekonstruksi Tgk Manus/Pedis 1 Sisi
7,650,000 Rekonstruksi Tgk Siku/Litut 1 Sisi
9,562,000 Rekonstruksi Tgk Siku/Lutut 2 Sisi
9,562,000 Rekonstruksi Tgk Wrist/Ankle 1 Sisi
7,650,000 Rekonstruksi Tgk Wrist/Ankle 2 Sisi
7,650,000 Rekostruksi Tgk Manus/Pedis 2 Sisi
9,562,000 Replantasi Distal Wrist
7,650,000 Replantasi Proksimal Wrist
1,530,000 Reposisi + Gips Ekst Atas 2 Sisi
1,530,000 Reposisi + Gips Ekstr. Bawah 1 Sisi
1,912,000 Reposisi + Gips Ekstr. Bawah 2 Sisi
1,147,000 Reposisi+Gips Ekstremitas Atas 1 Sisi
15,300,000 Stab Anterior Vertb Servikal
11,475,000 Stab Anterior Vertb Thorako - Lumbal
9,562,000 Stab Post Vertb Thorako - Lumbal
19,125,000 Stabil Anterior Vertb dan Fusion
13,387,000 Stabil Post Vertb dan Fusion
11,475,000 Stabil Posterior Vertb Servikal
3,825,000 Sulih Tulang Besar
3,060,000 Tendon Fleks. Lbh 2 Jr Luar Man Area
2,295,000 Tendon Fleks. 2 Jr Didlm Nm Landarea
1,147,000 Tennoraphy Tendon Ekst 2 Jari
1,530,000 Tennoraphy Tendon Ekst Lebih 2 Jari
1,530,000 Tenoraphy Ten. Fleks 2 Jr diluar
3,825,000 Tenoraphy Tendon Flek Lbh 2 Jr didlm
1,147,000 Tenorapy Tendon Fleksor 1 Jari
507,000 Tenorraphy Satu Tendon Ekstensor Jari
6,120,000 Total Joint Replacement 1-2 Jari
9,562,000 Total Joint Replacement Lebih 2 Jari
9,562,000 Total Joint Replacement Panggul 1 Sisi
11,475,000 Total Joint Replacement Panggul 2 Sisi
11,475,000 Total Joint Replacement Siku/Lutut 1 Sisi
13,387,000 Total Joint Replacement Siku/Lutut 2 Sisi
13,387,000 Wide Exc Tumor Tl + Rek Bahu/Panggul
11,475,000 Wide Exc Tumor Tl + Rek Siku/Lutut
6,120,000 Wide Exc Tumor Tl + Rek Tlpk dan Jari Tgn
9,562,000 Wide Exc Tumor Tl + Rek Wrist/Ankle
3,825,000 Wide Excision Tumor Tulang 1 Reg
5,355,000 Wide Excision Tumor Tulang 2 Reg
3,750,000 Adenoidektomi
3,800,000 Adenolisis
10,800,000 Adranalektomi Abdominotorakal
2,300,000 Amputasi Digiti Single
4,900,000 Amputasi Eksisi Kista Branchiogenik
4,650,000 Anal Fistulektomi
4,650,000 Anal Fistulotomi
3,800,000 Angkat "Plate Screw" Fraktur Os Maksilofacial 1 - 2 tempat
4,650,000 Angkat "Plate Screw" Fraktur Os Maksilofasial 3 tempat atau lebih
2,300,000 Angkat "Plate Screw" Sederhana

4,650,000 Anthroscopy Therapeutik
2,600,000 Anthrotomi/Synovektomi
3,800,000 Apendektomi (Elektif)
6,750,000 Apendektomi dengan Laparoskopi
5,625,000 Apendektomi Insidental Lainnya (darurat)
155,000 Aspirasi Hemarthrosis
25,000 Aspirasi Hematome
600,000 Aspirasi Kista
2,300,000 AV Shunt dengan Anestesi Lokal
4,650,000 AV Shunt Radiosefalika
3,800,000 Babcock
60,000 Bedah Listrik
6,750,000 Bilateral Excision of Ectopic Breast Tissue (Mamma Aberans)
6,750,000 Bilateral Multiple Excision of Lession of Breast dengan Anestesi
5,625,000 Bilateral Repair of Direct Inguinal Hernia (diluar mesh)
5,625,000 Bilateral Repair of Indirect Hernia

5,625,000 Bilateral Repair of Inguinal Hernia, One Direct and One Indirect
5,625,000 Bilatreal Repair of Femoral Hernia

1,000,000 Biopsi Anus dengan Anestesi Lokal
2,350,000 Biopsi Kelenjar Getah Bening
2,350,000 Biopsi Prostat
2,600,000 Biopsi Saraf Kutaneus/Otot
3,800,000 Biopsi Terbuka Tumor di Dinding Thorak
2,600,000 Biopsi Testis
5,800,000 Bladder Neck Incision
43,000 Bouginasi
86,000 Buka Gips
80,000 Buka IOIDW
65,000 Bulektomi tanpa Anestesi
60,000 Chemo Surgary Podophylin
7,875,000 Cholecystectomy Terbuka
6,750,000 Clipping Costae (diluar plate)
4,650,000 Closure Anal Fistel
6,750,000 Closure of Appendicial Fistuyla
9,000,000 Closure of Fistula of Small Intestine
6,750,000 Closure of Fistule of Large Intestine
9,000,000 Closure of Intestinal Stoma
11,250,000 Closure of Laceration of Liver
19,550,000 Complicated Functional Neuro Perculteneus Kordotomi
21,500,000 Complicated Functional Neuro Perculteneus Paravarteb/Visceral Block
2,600,000 Complicated Functional Neuro Steraotaxy Kompleks

24,800,000 Complicated Functional Neuro Steraotaxy Sederhana
4,900,000 Condilotomi Mandibula
4,650,000 Control of Hemorrhage of Anus
9,200,000 DCR + Silicon Tube
2,300,000 Debridement - Nekrotomi Luka Gangren
4,800,000 Debridement + Skin Graft
3,800,000 Debridement Fraktur Terbuka Sederhana dengan Eksternal Cast
11,250,000 Debulking
7,900,000 Dekompresi Syaraf
15,100,000 Dekompresi Syaraf Tepi
6,750,000 Deseksi Axila
70,000 Dilatasi Megacolon pada Anak
95,000 Dilatasi Phimosis (Pelayanan eksekutif)
2,600,000 Dilatasi Uretra
3,800,000 Disartikulasi Sendi Ekstremitas
18,000,000 Diseksi Kelenjar Getah Bening (KGB) Pelvis
12,300,000 Diseksi Kelenjar Inguinal
19,500,000 Diseksi Leher Radikal Modifikasi/Fungsional
1,000,000 Dorsumsisi dengan Anestesi Lokal
6,750,000 Drainage of Appediceal Abses
11,250,000 Drainage of Pancreatic Cyst with Catheter
5,625,000 Drainase Abses Hepar
3,750,000 Drainase Kista Pankreas
3,750,000 Drainase Periureter
9,200,000 Eksenterasi
3,800,000 Eksisi Biopsi Tumor Pembuluh Darah
4,750,000 Eksisi Chodee
200,000 Eksisi Clavus
2,600,000 Eksisi Fistel
4,650,000 Eksisi Hemmoroid
3,800,000 Eksisi Hidradenitis Unilateral
11,250,000 Eksisi Higroma Coli
3,800,000 Eksisi Kelainan pada Payudara dengan Pembiusan Umum
2,300,000 Eksisi Kelainan Perianal Lainnya

6,750,000 Eksisi Kelenjar Sub Mandibula
200,000 Eksisi Kista Ateroma/Lipoma/Ganglion < 2cm
6,750,000 Eksisi Kista Duktus Tiroglosus
13,700,000 Eksisi Luas Radikal + Rekonstruksi
11,250,000 Eksisi Luas Tumor Ganas Bibir dengan Rekonstruksi Flap Lokal
1,000,000 Eksisi Nevus Sederhana dengan Lokal Anestesi

2,300,000 Eksisi Parsial + Marsupiliasi Ranula
2,300,000 Eksisi Perianal Skin Tags
600,000 Eksisi Pretigium Bare Sklera
250,000 Eksisi Skin Grafting
2,275,000 Eksisi Tumor Adneksa Kecil
3,800,000 Eksisi Tumor Adneksa Sedang
7,875,000 Eksisi Tumor Ganas Kulit dengan Flap Lokal atau Graft Kulit
6,750,000 Eksisi Tumor Ganas Kulit tanpa Rekonstruksi

1,000,000 Eksisi Tumor Jinak dengan Anestesi Lokal
1,000,000 Eksisi Tumor Jinak Kulit dan Tumor Non Neoplastik Kulit (LA)
2,300,000 Eksisi Tumor Jinak Mama (FAM) < 2 cm satu sisi

2,600,000 Eksochiliasi
3,800,000 Eksplorasi Nasofaring
8,000,000 Eksplorasi Testis Mikro Surgery
7,875,000 Eksplorasi Vaskuler (trauma/nontrauma)
5,000,000 Ekstirpasi Angiofibroma Nasofaring
3,800,000 Ekstirpasi Ganglion Poplitea
4,000,000 Ekstirpasi Kelenjar Sub Mandibula
3,800,000 Ekstirpasi Kista Bronchialis
2,300,000 Ekstirpasi Kista Dermoid dengan Anastesi
3,800,000 Ekstirpasi Plunkina Ranula
13,800,000 Ekstirpasi Tumor Ganas Adneksia + Rekonstruksi
250,000 Ekstirpasi Tumor Jinak Kulit (tindakan bedah)
14,400,000 Ekstirpasi Tumor Scalp/Cranium
3,800,000 Ekstirpasi/Eksisi Tumor Jaringan Lunak Ukuran < 2cm
45,000 Ekstraksi Corpus Alienum

9,000,000 Ekstraksi Corpus Alienum di Regio Thorak
250,000 Ekstraksi Kolesteatum
50,000 Ekstraksi Kuku
4,900,000 Ekstraksi Linear
300,000 Elektro Kauter Kondiloma, Veruka
2,300,000 Endoskopi Polipektomi of Rectum
2,250,000 Enukleasi Kista
4,900,000 Enukleasi Kista D42
4,900,000 Enukleasi Kista Ginjal
6,900,000 Enukleasi/Eviscerasi + DFG
8,050,000 Epiddimovasostomi
3,750,000 Ethmoidektomi (Intranasal)
1,000,000 Evakuasi Corpus Alienum Sederhana dengan Anestesi Lokal
4,650,000 Evakuasi Corpus Alienum Sederhana dengan Anestesi Umum
3,800,000 Evakuasi Hematome Buli-buli

3,800,000 Evakuasi Hematome di Ekstremitas
3,800,000 Evakuasi Hematome Pasca Operasi Leher tanpa Trakeostomi
2,700,000 Eviscerasi
11,500,000 Extended Pyelolithektomi (Gilveme)
7,875,000 Exteriozation of Large Intestine
7,875,000 Exteriozation of Small Intestine
4,900,000 Faringotomi
5,625,000 Fasciotomi
2,300,000 Fibroadenoma Mama
9,000,000 Fiksasi Interna Fraktur Maksilofasial 1-2 Tempat Patahan
9,000,000 Fiksasi Interna Fraktur Nasal

4,900,000 Fistula Ureterovesika
2,550,000 Flebektomi
60,000 FNA (Fine Needle Aspiration)
2,550,000 Foto Koagulasi Laser
5,625,000 Fraktur Antebrachii
3,800,000 Fraktur Clavikula
3,800,000 Fraktur Coles dan Pergelangan Tangan Lainnya
7,875,000 Fraktur Cruris
7,875,000 Fraktur Femur
6,750,000 Fraktur Humerus
5,625,000 Fraktur Olecranon
7,875,000 Fraktur Supracondiler Humerus
12,400,000 Free Flap Surgery
4,900,000 Frontoethmoidektomi (Ekstranasal)
3,800,000 Full Thickness Skin Graft to Hand
6,750,000 Full Thickness Skin Graft to Other Site
2,300,000 Ganglion Carpi
40,000 Ganti Balut Besar
15,000 Ganti Balut Kecil
25,000 Ganti Balut Sedang
2,100,000 Ganti Sendi (Arthroplasti) tidak termasuk alat
15,100,000 Gastrektomi (Bilroth 1 dan 2)
13,700,000 Glosektomi Totalis
10,100,000 Grafting pada Arterial Insufisiensi
11,250,000 Groin Disection
4,900,000 Hemiatomi Bilateral
7,875,000 Hemiglosektomi
10,800,000 Hemiglosektomi + RNO
12,250,000 Hemipelvektomi
3,800,000 Hidrokel per Inguinal/Ligasi Tinggi
8,650,000 Horseshoe Kidney Koreksi
7,875,000 Ileostomi
7,875,000 Ileostomi Permanen
45,000 Incisi Abses (Tindakan Bedah)
1,000,000 Incisi Abses dengan Anestesi Lokal
2,300,000 Incisi Abses Perianal
1,000,000 Incisi Mucocele dengan Anestesi Lokal
1,000,000 Incisional Biopsi Tumor dengan Anestesi Lokal
600,000 Injeksi Haemoroid (termasuk obat)
600,000 Injeksi Varises (termasuk obat)
4,650,000 Incisi Flegmon Dasar Mulut
11,250,000 Internal Fiksasi Fraktur Maksilofasial 5 Tempat atau Lebih
11,250,000 Internal Fiksasi Fraktur Mandibula Segmental

4,900,000 Internal Urethrotomi
7,875,000 Intra Abdominal Manipulation of Small Intestine
4,750,000 Kapsulektomi Posterior
12,650,000 Keratoplasti
4,900,000 Keratoplastie Lamelar
19,500,000 Koledoko Jejunostomi
11,250,000 Kolesistektomi Laparoskopik
7,875,000 Kolostomi Permanen
4,900,000 Konkoplasti
4,900,000 Koreksi Atresia Ani
4,900,000 Koreksi Conoenital Talipes Eouino Varus (CTEV)
3,800,000 Koreksi Disartikulasi
3,750,000 Koreksi Ekstropion / Entropion
20,125,000 Koreksi Fraktur Impresif
3,800,000 Koreksi Priapismus
25,900,000 Koreksi Skoliosis
25,900,000 Koreksi Spondilitis
4,900,000 Koreksi Tortikolis
25,200,000 Kraniotomi + Bedah Mikro
25,900,000 Kraniotomi + Endoskopi
20,150,000 Kraniotomi/Trenpanasi Konvensional
3,800,000 Labioschizis Simpel
20,150,000 Laminektomi Kompleks
20,150,000 Laminektomi Sederhana
11,250,000 Laparoscopy
11,250,000 Laparoscopyc Lysis of Peritoneal Adhesion
7,875,000 Laparoskopi Appendektomi
7,875,000 Laparotomi Eksplorasi
3,800,000 Laparotomi Percobaan
4,800,000 Laparotomi VC
9,000,000 Large to Large Intestinal Anastomose
7,900,000 Le-Ford Advancement Surgery
9,000,000 Left Hemicolectomy
6,750,000 Left Lateral Anal Sphincterotomy
1,000,000 Lepas Arch Barr
35,000 Lepas Drain
30,000 Lepas Jahitan < 5 Buah
45,000 Lepas Jahitan > 5 Buah
20,000 Lepas Kateter Pria/Wanita
2,300,000 Ligasi Hemmorroid
2,300,000 Ligasi Vaskuler Ekstremitas
7,900,000 Limfadenektomi Ileonguinal
7,900,000 Limfadenektomi Retroperinoteal
2,300,000 Lipoma
4,900,000 Litotripsi
1,000,000 Lobuloplasti Unilateral dengan Anestesi Lokal
2,300,000 Lokal Eksisi Kelainan pada Rectum atau Jaringan Sekitar
60,000 Long Arm Cast Anak

100,000 Long Arm Cast Dewasa
130,000 Long Leg Cast Anak
170,000 Long Leg Dewasa
7,900,000 Longitudinal Nefrolithotomi (Kadet)
4,900,000 Maksilektomi Partialis
10,800,000 Maksilektomi Totalis
3,800,000 Mama Aberant Unilateral
4,900,000 Mandibulektomi Marainalis
19,500,000 Mandibulektomi Partialis dengan Rekonstruksi
7,200,000 Mandibulektomi Totalis
12,300,000 Masektomi Radikal dengan Penyulit
9,000,000 Masektomi Simpel Bilateral
11,250,000 Mastektomi Radikal
5,625,000 Mastektomi Simple Unilateral
7,875,000 Mastektomi Subtotal
1,000,000 Meatotomi
2,100,000 Microsurgery (Tulang-Syaraf)
8,000,000 Microsurgery Ligasi Vena Spermatika
420,000 Minor Besar
80,000 Minor Kecil
175,000 Minor Sedang
10,500,000 MRM tanpa Rekontruksi
15,100,000 Myocutaneus Flap/Pectoral Mavor
12,300,000 Nefrektomi Partial
15,550,000 Nefrektomi Radikal
10,800,000 Nefro Uterektomi
4,900,000 Nefropexie
4,900,000 Nefrostomi Open
7,900,000 Nefrostomi Percutan
4,900,000 Neurektomi Saraf Vidian
18,700,000 Neurektomi/Neurolise
11,500,000 Oivertikulektomi Vesika
3,800,000 Open Biopsi of Breast
6,750,000 Open Biopsi of Liver
3,800,000 Open Biopsi of Salivary Gland or Duct
1,000,000 Open Biopsi Rektum dengan Anestesi Lokal
6,750,000 Open Prostatektomi
7,875,000 Open Reduction of Mandibula Fraktur
7,875,000 Open Reduction of Nasal and Zygomatic Fraktur
6,750,000 Open Reduktion of Alveolar Fraktur
7,875,000 Open Reduktion of Maxila Fraktur
10,800,000 Operasi Aneurisma Aorta
10,800,000 Operasi Arteri Coritis
10,800,000 Operasi Arteri Rehalis Stenosis
20,850,000 Operasi Fraktur Kompleks (Acetabulum, Tulang Belakang Pelvis)
20,850,000 Operasi Fraktur Muka Multiple

20,850,000 Operasi Fraktur Tripodo/Multiple
26,300,000 Operasi Fronto-Orbital Advancement pada Craniosynoostosis
21,600,000 Operasi Fusi Korpus Vertebra Approach Posterior

3,750,000 Operasi Hipospadia
8,650,000 Operasi Ileal Condoit (Bricker)
20,900,000 Operasi Konvensional Plexus Brakhialis/Lumbalis Sacralis/Cranialis/Spinalis Perfier
21,600,000 Operasi Kranioplasti/Koreksi Fraktur

3,800,000 Operasi Manchester Fortegil
20,900,000 Operasi Mega Kolon (Hirschpruoa)
23,800,000 Operasi Mikro Craialis/Spinalis Perifer
25,900,000 Operasi Mikro Plexus Brakhialis/Lumbalis Sacralis
3,800,000 Operasi Mikrotia
20,150,000 Operasi pada Atresia Esofagus
3,800,000 Operasi Palatoplasti
20,150,000 Operasi Pemasangan Fiksasi Interna pada Kasus Bedah Syaraf
8,050,000 Operasi Pemasangan Pintasan VA/VP Shunt

5,750,000 Operasi Pemasangan Traksi Cervical/dan Pemasangan Halo Vest
4,900,000 Operasi Peyronie

4,900,000 Operasi Psoas Hiscth/Boari Flap
7,900,000 Operasi Shunting Femoralis
7,900,000 Operasi Shunting Poplitea Tibialis
10,100,000 Operasi Shunting Splenorenal
700,000 Operasi Tumor Jinak Genetalia dengan Anestesi Umum
4,900,000 Operasi Tumor Pembuluh Darah

23,800,000 Operasi Tumor Spinal Daerah Gervikal
25,900,000 Operasi Tumor Spinal Daerah Kraniospinal
21,600,000 Operasi Tumor Spinal Daerah Torakolumbal
8,650,000 Operasi Vaskuler yang memerlukan Teknik Operasi Khusus
600,000 Operculectomy
4,900,000 Orbitomi Anterior
12,950,000 Orbitotomi Lateral
3,800,000 Orchidektomi Subkapsuler
3,800,000 Orkhidektomi
12,950,000 Orthoanatic Surgery
4,900,000 Orthoonatie Surgery
60,000 Osteotektomi Sederhana
11,250,000 Osteotomi Eksisi Tulang Maksilofacial
6,750,000 Other Operation of Intestine
4,650,000 Other Prosedur of Hemmorroids
11,250,000 Other Repair and Plastic Operation of Tongue
6,750,000 Other Repair of Abdominal Wall
6,750,000 Other Skin Graft to Other Sites
7,875,000 OtherLlysis of Peritoneal Adhesion
6,750,000 Ovariektomi Bilateral
34,500,000 Paket Bedah Paru : Air Plumbage + Dikortikasi+Lobektomi+Muscle Plumbage + Pnemunektomi + Segmenektomi +Torakoplasti + Omentumpexy
6,750,000 Palatoshizis
26,300,000 Pankreaktektomi
4,900,000 Parasintesa (Bedah)
10,800,000 Parotidektomi Radikal + Maridibulektomi
7,875,000 Parotidektomy Superficial
2,300,000 Pasang Arch Barr (Interdental Wiring)
25,000 Pasang Bidai/Spalk
1,000,000 Pasang Central Venous Catheter (CVC)
4,650,000 Pasang Doublelumen Hemodialisis
60,000 Pasang Foley Kateter
65,000 Pasang Kateter dengan Penyulit
50,000 Pasang Sling
520,000 Pemasangan Gips (tindakan bedah)
2,300,000 Pemasangan Peritoneal Dialysis - diluar Alat
3,800,000 Pemasangan Pipa Shepard
3,800,000 Pemasangan WSD (diluar alat)
14,400,000 Pembedahan Fore Quarter
3,800,000 Pembuatan Stoma (Gastrostomy, Iliostomy, Kolostomy, Sigmoidostomi)
5,625,000 Penektomi Parsial

60,000 Pengobatan Epistaksis
600,000 Penutupan Oroantral Fistula
10,350,000 Percutaneous Nephrolithostripsy (PCNL)
4,650,000 Pericardiuocentesis
7,500,000 Phaceomulsifikisi
4,900,000 Phacoemulsifikasi
1,000,000 Pleurodesis (Pleurosklerosis)
5,750,000 Postero Saaital Anorectoplasty (PSA)
3,800,000 Potong Flap
6,750,000 Prosedure Sistrunk Kista Duktus Tiroglosus
8,650,000 Prostatektomi Radikal
2,350,000 Ptergium + CLG
3,750,000 Pthisis Bulbi (Graf Mukosa Bibir)
6,900,000 Ptosis
600,000 Pungsi Ascitas
1,000,000 Pungsi Aspirasi Hematoma/Seroma
60,000 Pungsi Batu
2,550,000 Pungsi Cairan Otak dengan Anestesi
580,000 Pungsi Efusi Pleura
4,900,000 Pyelolithotorni
4,500,000 Pyeloplasti
5,750,000 Radical Neck Desection
11,250,000 Rartial Spleenctomy
7,875,000 Reclosure of Postoperative Disruption of Abdominal Wall
1,000,000 Rectoskopi/Anoskopi
5,625,000 Reduksi Prolap Anus
3,750,000 Rekanalisasi Ruptura/Transkanal
4,900,000 Rekonstruksi Blassemeck
4,900,000 Rekonstruksi Defek/Kelainan Tubuh yang Kompleks
4,900,000 Rekonstruksi Duktus Lacrimalis/Stenosis Sederhana
4,650,000 Rekonstruksi Kelainan Jari/Ekstrimitas (Polidaktili, Sindaktili, Construction Hand) Sederhana
4,900,000 Rekonstruksi Kontraktur Kompleks

4,650,000 Rekonstruksi Laserisasi Daun Telinga
20,850,000 Rekonstruksi Menfngokel Kranial (Anterior/Posterior)
20,150,000 Rekonstruksi Meninaokel Spina Bifida
8,650,000 Rekonstruksi Renovaskuler
10,800,000 Rekonstruksi Saket Berat
4,900,000 Rekonstruksi Vesika
11,250,000 Release Kontraktur Mandibula
7,875,000 Removal of Foreign Body From Peritoneal Cavity
11,250,000 Reopening of Rescent Laparotomy Site
6,750,000 Repair Anal Sphincter Lainnya
2,550,000 Repair Filitel Uretra Pasca Uretroplasi
3,800,000 Repair Herniasi Muscle
11,250,000 Repair Laserasi Hepar pada Trauma
3,800,000 Repair of Direct Inguinal Hernia (diluar mesh)
3,800,000 Repair of Femoral Hernia Unilateral
3,800,000 Repair of Indirect Inguinal Hernia (diluar mesh)
5,625,000 Repair of Other Hernia of Anterior Wall With Prosthesis
4,650,000 Repair of Umbilical Hernia

7,875,000 Repair Ruptur Buli-buli
3,800,000 Repair Ruptur Tendon Achiles
8,050,000 Replantasi
2,300,000 Reposisi Dislokasi Bahu
3,750,000 Reposisi Fiksasi (Compucate)
3,750,000 Reposisi Fistel
1,000,000 Reposisi Fraktur Tertutup Sederhana Ekstrimitas dengan Gips
2,300,000 Reposisi Tertutup Fraktur Condilus Mandibula

4,650,000 Reposisi Torsio Testis dengan Orkhidopeksi
9,000,000 Resection of Transverse Colon
4,900,000 Reseksi Anastomosis
25,900,000 Reseksi Esofagus + Interosisi Kolon
15,100,000 Reseksi Hepar
4,900,000 Reseksi Partial Vesika
4,900,000 Reseksi Rahang
4,900,000 Reseksi Urachus
2,550,000 Reshapino untuk Torus/Tumor Tulang
2,550,000 Ret Cam + Anestesi
6,750,000 Revisi AV Shunt
4,650,000 Revisi Trakeostomy
3,800,000 Revisi WSD
11,250,000 Revision of Anastomose of Small or Large Intestine
6,750,000 Revision of Stoma of Large Intestine
6,750,000 Revision of Stoma of Small Intestine
9,000,000 Right Hemicolektomi
4,900,000 Rinotomi Literalis
8,650,000 Rinotomi Literalis (Tindakan Khusus)
8,050,000 RPLND
8,650,000 Scheral Buckel
4,650,000 Scleroterapi dan atau Ligasi Hemangioma
3,800,000 Segmentektomi
2,550,000 Sequesterektomi dengan Anestesi
4,900,000 Simpatektomi
15,100,000 Simple Functional Neuro Surgery
12,650,000 Sindroma Blefaophimosis
2,550,000 Siok Saraf Tepi
4,900,000 Siptoplasti Reduksi
2,550,000 Sirklase
1,000,000 Sirkumsisi dengan Anestesi Lokal
2,300,000 Sirkumsisi dengan Anestesi Umum
2,300,000 Sirkumsisi One Day Care
8,050,000 Sistektomi Radikal
2,300,000 Sistostomi dengan Anestesi Umum
6,750,000 Skingraftina yang Luas
3,800,000 Skingraftina yang Tidak Luas
4,900,000 Sklera Buckling
1,000,000 Skleroterapi Vena (Varises, Hemangiona)
3,800,000 Sklerotomi
600,000 Sleep Nasoendoscopy
9,000,000 Small to Small Intestinal Anastomose
4,900,000 Solenektomi
2,550,000 Somnoplasti
7,875,000 Splenektomi
3,800,000 Split Thickness Skin Graft
10,100,000 Stapedektomi
6,750,000 Stripping Varises Ektremitas Inferior
12,950,000 Surgical Stagina
6,750,000 Suture of Laceration of Large Intestine
4,650,000 Suture of Laseration of Anus
6,750,000 Suture of Laseration of Small Intestine, Except Duodenum
4,900,000 Synovektomi
250,000 Taping dan Strapping
10,800,000 Temporal Bone Resection
60,000 Tindakan Anoscopy
3,800,000 Tindakan Argon laser/Kenon
250,000 Tindakan Bedah Beku
3,800,000 Tindakan Blok Reseksi
3,800,000 Tindakan Congenital Fornix Plastik
3,800,000 Tindakan Cyclodia Termi
600,000 Tindakan Deepening Sulcus
4,900,000 Tindakan Dekomoresi Fasialis
10,350,000 Tindakan Dekompresi Fasialis
4,900,000 Tindakan Pharnaeal Flap
6,750,000 Tiroid Lobektomi Unilateral
9,000,000 Tiroidektomi Complete
6,750,000 Tiroidektomi Parsial Lainnya
6,750,000 Tiroidektomi Subtotal
4,650,000 Torakosentesis
11,250,000 Torakotomi
11,250,000 Total Tiroidektomi
7,500,000 Trabekulektomi
8,650,000 Trabekulektomi + ECCE/Phaceomulsifikasi
4,650,000 Trakeostomi dengan Penyulit Tumor pada Akses Trakea
2,300,000 Trakeostomi Temporary

4,900,000 Transeksi Esofagus
250,000 Trikeopitelioma
4,900,000 Tumor Ganas/Adneksa Luas dengan Rekonstruksi
7,700,000 TUR Prostat
7,750,000 TUR Tumor Buli-Buli
2,550,000 Turbinoplasti
4,900,000 Uretero Sigmoidostomi
4,900,000 Uretero Ureterostomi
4,900,000 Ureterocutaheostomi
3,800,000 Ureterolisis
4,900,000 Ureterolithotomi
7,950,000 Ureteroneo Sistostomi
3,800,000 Ureterostomi
4,900,000 Urethrektomi
7,950,000 Urethrenuskopi (URS)
7,400,000 Uretroplasti
4,900,000 Uteroplasti
1,000,000 Vasektomi dengan Anestesi Lokal
2,300,000 Vasektomi dengan Anestesi Umum
3,800,000 Vasografi
4,000,000 Vasoligasi V Spermatika (Varicocele) Unilateral
1,000,000 Vena Seksi dengan Anestesi Lokal
8,650,000 Ventrikulostomi/VE Drainase
3,800,000 Vesicolithotomi (Sectio Alta)
21,850,000 Vitrektomi + Endo Laser + SB + Silicon Oil/Gas
10,100,000 Vulvektomi
11,250,000 Wide Eksisi Soft Tisue Tumor
26,000 WT dengan Luka Kecil (1 - 3 Lebar Kasa/Gaas)
2,550,000 Yag Laser
203,000 Angkat/Ekstraksi KB Susuk
326,000 Biopsi
406,000 Biopsi Portio
91,000 CTG (Cardio Tocografi) Perhari
1,015,000 Curetase dengan General Anastesi
1,500,000 Dilatasi Hegar
2,600,000 Eksisi/Konisasi
2,600,000 Ekstirpasi Kista Bartolin
1,200,000 Ekstirpasi Kista Gardner (Vagina)
2,200,000 Ekstirpasi Myoma Pedunculata
2,200,000 Ekstirpasi Papiloma Vagina
1,012,500 Ekstirpasi Polip Serviks
150,000 Ekstraksi IUD (Tindakan Obgyn)
1,015,000 #N/A
10,125,000 Histerektomi Radikal
6,075,000 Histerektomi Supra Vaginal
6,575,000 Histerektomi Supra Vaginal + BSO
6,375,000 Histerektomi Total
6,875,000 Histerektomi Total + BSO
7,500,000 Histerektomi Vaginal
500,000 Incisi Abses Bartolini dengan Anestesi Lokal
1,300,000 Incisi Abses Bartolini dengan Anestesi Umum
1,500,000 Incisi Bartolin + Marsupialisasi
507,000 Incisi Abses Bartholine
80,000 IVA/Pap Smear
1,200,000 Kauter Kondiloma Akuminata
2,525,000 Kistektomi Bilateral
2,100,000 Kistektomi Unilateral
500,000 Kryo Terapi
3,000,000 Kuretase + Steril
1,200,000 Kuretase Abortus/Sisa Plasenta
675,000 Kuretase Diagnostik
1,600,000 Kuretase Infeksi/Missed Abortion
9,700,000 Laparoskopi Diagnostik Infertilitas
12,500,000 Laparoskopi Operatif Adesiolis Endometriosis
13,700,000 Laparoskopi Operatif Hamil Ektopik
13,000,000 Laparoskopi Operatif Kiste Endometriosis
13,700,000 Laparoskopi Operatif Salfingektomi Bilateral (Hidrosalfing Bilateral)
13,000,000 Laparoskopi Ovarian Driling (LOD) PCOS

9,700,000 Laparoskopi Tubektomi Bilateral
2,350,000 Marsupialisasi Abses Bartholin
2,750,000 Miomektomi
60,000 Nitrogen Cair
91,000 NST (Non Stres Test)
8,650,000 Operasi Tumor Ganas Ovarium
2,115,000 Partus Abnormal Bayi Sungsang
2,120,000 Partus Abnormal ditolong Residen/Dokter Umum
2,375,000 Partus Abnormal ditolong Spesialis Jaga
2,675,000 Partus Abnormal Spesialis Khusus
1,045,000 Partus Kembar Ditolong Bidan Jaga
1,805,000 Partus Normal Bayi Kembar Oleh Spesialis
1,057,000 Partus Normal Bidan Khusus
1,307,000 Partus Normal Ditolong Residen/Dokter Umum
837,000 Partus Normal Ditolong Bidan Jaga
1,537,000 Partus Normal Ditolong Spesialis Jaga
1,837,000 Partus Normal Spesialis Khusus
410,000 Pasang/Buka Susuk KB
25,000 Pasang Infuse Umbilical (Rawat inap)
306,000 Pasang IUD Pasca Plasenta
91,000 Pasang KB
91,000 Pasang Tampon pada Vagina
67,000 Pasang/Lepas Pesarium
850,000 Perineorafi Anestesi Lokal
1,200,000 Perineorafi Anestesi Umum
675,000 Perineorafi Sub Total Anestesi lokal
1,000,000 Perineorafi Sub Total dengan Anestesi Umum
3,200,000 Persalinan Tanpa Nyeri
1,015,000 Placenta Manual Partus Luar
609,000 Repair Vagina dan Robekan Total Perinium
609,000 Repair Vagina dengan GA
8,650,000 Repair Velsco Vagina Fistel Kompleks
4,900,000 Reparasi Vistula Vesiko Vaginal
203,000 Resusitasi Bayi Baru Lahir
2,700,000 Salpingo-Ooporektomy Bilateral (Tind.Med.Bes.1)
2,025,000 Salpingo-Ooporektomy Unilateral
4,900,000 Salvagino Operasi Mikro
55,000 Screening Pendengaran pada Bayi
3,400,000 Seksio Sesarea
6,800,000 Seksio Sesarea + Histerektomi
3,550,000 Seksio Sesarea dengan Hamil Ganda
4,050,000 Seksio Sesarea dengan Hamil Ganda dengan Steril
4,000,000 Seksio Sesarea dengan Penyulit (Riwayat SC)
3,900,000 Seksio Sesarea dengan Steril
400,000 Tampon Uterus/Kondom Kateter
250,000 Tampon Vagina
3,800,000 Tindakan pada Kolpodeksis
20,000 Tindakan Pelayanan Gizi
2,350,000 Tubektomi
2,500,000 Turbinektomi/Konkotomi
70,000 USG 2D
500,000 USG 4 Dimensi
200,000 USG Organ
170,000 USG Transvaginal
67,000 Vaginal Swab
2,600,000 Vaginoplasti
100,000 Aspirasi Efusi Perikondrial
100,000 Audiometri (THT)
6,500,000 Bedah Sinus Endoskopik Fungsional (BSEF) Bilateral
5,000,000 Bedah Sinus Endoskopik Fungsional (BSEF) Unilateral
300,000 Beloq Tampon dengan Anestesi Lokal

2,200,000 Beloq Tampon dengan Anestesi Umum
250,000 Biopsi Sinus Maksila
200,000 Biopsi Tumor Hidung
2,000,000 Biopsi Tumor Hipofaring dengan Anestesi Umum
200,000 Biopsi Tumor Lidah/Palatum
200,000 Biopsi Tumor Nasofaring
4,225,000 Cadwell Luc Anthrostomi Bilateral
3,250,000 Cadwell Luc Anthrostomi Unilateral
2,500,000 Eksisi Ranula atau Kista pada Mukosa Mulut
3,250,000 Eksplorasi Abses Parafaringeal
500,000 Eksplorasi Abses Peritonsiler dengan Anestesi Lokal
2,100,000 Eksplorasi Abses Peritonsiler dengan Anestesi Umum
3,250,000 Eksplorasi Pre Aurikuler Fistel dengan Abses
4,225,000 Eksplorasi Tumor Jinak Kelenjar Liur
3,500,000 Ekstirpasi Papiloma Laring
180,000 Ekstirpasi Papiloma Mulut
250,000 Ekstirpasi Polip Nasi dengan Anestesi Lokal
2,250,000 Ekstirpasi Polip Nasi dengan Anestesi Umum
3,250,000 Ekstraksi Corpus Alienum Esofagus
100,000 Ekstraksi Corpus Alienum Hidung (Tindakan THT)
1,700,000 Ekstraksi Corpus Alienum Hidung dengan Anestesi Umum
100,000 Ekstraksi Corpus Alienum Telinga (Tindakan THT)

1,700,000 Ekstraksi Corpus Alienum Telingan dengan Anestesi Umum
100,000 Ekstraksi Corpus Alienum Tenggorokan (Tindakan THT)

250,000 Ekstraksi Jaringan Granulasi CAE
300,000 Ekstraksi Keratosis dengan Anestesi Lokal
1,700,000 Ekstraksi Keratosis dengan Anestesi Umum
50,000 Ekstraksi Serumen
100,000 Ekstraksi Serumen dengan Penyulit
4,225,000 Ekstraksi Sialolithiasis
50,000 Endoskopi Hidung
50,000 Endoskopi Telinga/Tenggorok
2,925,000 Fistulektomi Pre Aurikuler Bilateral
2,250,000 Fistulektomi Pre Aurikuler Unilateral
5,000,000 Hemimaksilektomi Partial
6,000,000 Hemimaksilektomi Total
250,000 Incisi Abses Leher Anestesi Lokal
1,500,000 Incisi Abses Leher dengan Anestesi Umum
250,000 Incisi Abses Preaurikula dengan Anestesi Lokal
250,000 Incisi Abses Retroaurikuler Anestesi Lokal
75,000 Irigasi Telinga
1,700,000 Irigrasi Sinus Maxilaris dengan Anestesi Umum
6,875,000 Laringektomi
200,000 Lepas Beloq Tampon
150,000 Lepas Tampon Hidung
5,000,000 Mastoidektomi Radikal
4,000,000 Mastoidektomi Simple
4,225,000 Otoplasti THT
150,000 Parasintesis Telinga Bilateral
75,000 Parasintesis Telinga Unilateral
400,000 Pemasangan Paper Patch Komprehensif
100,000 Pemasangan Paper Patch Sederhana
50,000 Pemasangan Tampon Telinga
400,000 Pemasangan Timpanic Tube dengan Anestesi Lokal
1,600,000 Pemasangan Timpanic Tube dengan Anestesi Umum
300,000 Pungsi Hematoma Telinga
100,000 Rawat Luka Post Op Mastoidektomi
100,000 Rawat Luka Post Op Sinus/Hidung
200,000 Rawat Stoma Trakeostomi
3,000,000 Rekonstruksi/flap
700,000 Repair Lobulus Telinga Bilateral dengan Anestesi Lokal
400,000 Repair Lobulus Telinga Unilateral dengan Anestesi Lokal
2,500,000 Reposisi Fraktur Os Nasal (Hidung)

4,225,000 Rinotomi Lateral
75,000 Screening OAE
4,225,000 Septoplasti
4,225,000 Septoplasti EC Trauma Hidung
7,500,000 Septorinoplasti THT
3,250,000 Septum Reseksi
100,000 Sinuskopi
300,000 Skin Prick Test Alergen Debu dan Makanan
200,000 Skin Prick Test Alergen Debu/Makanan
75,000 Timpanometri
3,000,000 Timpanoplasti Tipe I/Miringoplasti
3,000,000 Timpanoplasti Tipe II
4,000,000 Timpanoplasti Tipe III
6,000,000 Timpanoplasti Tipe IV
150,000 Tindakan Cuci Sinus (Perawatan)
50,000 Toilet Telinga
3,000,000 Tonsilektomi
3,250,000 Tonsilo Adenoidektomi
300,000 EEG
65,000 Facialis Parase
100,000 Pain Intervensi Ringan
200,000 Pemeriksaan Fungsi Luhur
40,000 Pemeriksaan Neuroligi Sederhana
80,000 Pemeriksaan Neuroopthalmologi
80,000 Tes Pembauan, Pengecapan
225,000 Tindakan Electro Convulsive Therapy (ECT)
60,000 Tindakan Roser Plasty
60,000 Anel Test
4,250,000 Anterior/Posterior Sklerotomi
135,000 Biometri
876,000 Biopsi Tumor Kelopak
4,250,000 Biopsi Tumor Orbita
800,000 Eksisi Chalazion/Hordiolum
30,000 Ekstraksi Corpus Alienum Conjungtiva
60,000 Ekstraksi Corpus Alienum Kornea
800,000 Ekstraksi Granuloma
3,500,000 Ekstraksi Katarak (SICS dan LOL) dengan Anestesi Lokal
4,050,000 Ekstraksi Katarak (SICS + LOL + PPC) Anak-Anak dengan Anestesi Umum
50,000 Ekstraksi Membran/Scrapping
800,000 Ekstraksi Nevus
675,000 Ekstraksi Tumor Kecil Palpebra
4,250,000 Ekstropion Siktratis/Entropion dengan Laser
30,000 Epilasi (Tindakan Mata)
100,000 Funduskopi Indirect
50,000 Gonioskopi
1,012,000 Incisi dan Kuretase Kalazion/Granuloma Anak-Anak dengan Anestesi Umum
1,350,000 Jahit Luka Kornea dan Repair Iris

2,700,000 Jahit Luka Korneo Sclera
500,000 Jahit Luka Palpebra Full Theckness
800,000 Kalazion Dewasa
4,250,000 Koreksi Strabismus
11,000,000 Koreksi Symbleparon Berat
3,250,000 Koreksi Symblepharon
2,200,000 Laser Iridotomi Perifer
70,000 Lepas Jahitan Palpebra < 3 Buah
150,000 Lepas Jahitan Palpebra > 3 Buah
300,000 Lithiasis
9,375,000 Operasi Ablatio Retina
4,250,000 Operasi Katarak ICCE/ECCE (Ekstraksi Katarak )
6,500,000 Operasi Phaceomulsifikasi + LOL
15,000 Pemeriksaan Visus
800,000 Pengangkatan Nevus Marga Palpebra
800,000 Pengangkatan Skin Tag
2,500,000 Pterigoplasti
1,500,000 Pterygium
9,375,000 Rekonstruksi Kelopak Mata Berat
4,250,000 Rekonstruksi Kelopak Mata/Kontraktur Palpebra
18,125,000 Rekonstruksi Orbita Conaenital
4,250,000 Repair Ruptur Kornea Sklera
2,200,000 Repair Ruptur Palpebra Simple
3,250,000 Repair Ruptur Palpebra Transkanal
2,350,000 Reposisi LOL
4,250,000 Ruptur Palpebra Moderat
30,000 Slit Lamp (Tindakan Mata)
70,000 Slit Lamp Examination
56,000 Sondage Canaliculi Lacrimaris
75,000 Spooling Bola Mata
8,000,000 Starbimus (3 - 4) Otot
15,000 Tes Ishihara (Buta Warna)
250,000 Tindakan Cryosurgery
20,000 Tonometri
6,000,000 Triple Produser Keratiplasti dengan Glaukoma
2,295,000 Doubel Lumen
90,000 Ganti Transfer Set
682,000 Hemodialisis Baru Bicarbonat
617,000 Hemodialisis Re-use Bicarbonat
52,000 Penggantian Cairan/Training
351,000 Kardiosintesis + Indwelling Kateter
351,000 Kardiosintesis Tanpa Indwelling Kateter
1,138,500 Kateterisasi Ka/Ki Tanpa Angio
1,138,500 Temporary Peacemaker
2,673,000 Kateterisasi Ka/Ki Angio Valvuler
3,071,700 Kateterisasi Ka/Ki dengan Angio
3,161,700 Penyadapan Angio Valvuler + Koroner
3,485,700 Koronarografo
3,539,700 Dilatasi Katup Mitral (BMW)
3,915,900 Jantung Anak Penyadapan (Diagnostik)
1,267,000 Anastesi Bronchoscopy
6,035,000 Biopsi Aspirasi Transthorakal
2,143,000 Biopsi Pleura
5,496,000 Bronchoscopy
6,600,000 Bronchoscopy dan Biopsi
1,044,000 Pleurodesis
1,573,000 Punksi Pleura
307,000 Spyrometri
609,000 WSD (Water Seal Drainage)
732,000 Endoskopi Atas
1,098,000 Endoskopi Bawah
976,000 Skleroterafi Ligasi 1 Ikatan
1,037,000 Skleroterafi Ligasi 2 Ikatan
1,464,000 Skleroterafi Ligasi Lebih dari 6 Ikatan
133,000 AFF Tampon Hidung
406,000 BMP (Bone Merrow Punctie)
55,000 Buka WSD
1,015,000 Debridemen Luka Kecil
253,500 Echo Cardiography (Tindakan Khusus ICU)
37,000 Extraksi Cerumen
2,500,000 Injeksi dengan Platelet Rich Plasma
400,000 Injeksi Intraartikuler dengan USG Guidance
102,000 Konsultasi Psikologi (Tindakan Khusus ICU)
18,000 Parasintesis (THT)
406,000 Pemasangan Epidural/Chateter
230,000 Pemasangan Swan Ganz Catheter
2,670,000 Perikardiosintesis Tanpa G A
25,000 Persiapan Pasien Pre Op
203,000 Punctie Cairan Sendi
74,000 Rehab Jantung
1,780,000 Repair Burst Abdoment/Dehiscensi/Luka
45,000 SWD (ICU)
55,000 Spooling Cateter Post Turp Bph
45,000 Traksi L/C
300,000 Allergi Test/Pateh Test/Prick Test
75,000 EKG Anak
160,000 Foto Terapi
200,000 Foto Terapi Double Lamp
15,000 Imunisasi
25,000 Konsultasi Dokter Gigi
30,000 Konsultasi Dokter Spesialis di IRD
145,000 Lumbal Pungsi
30,000 Pasang dan Lepas Kateter Bayi
100,000 Pasang Infus Anak (Tindakan Khusus Perinatologi)
150,000 Pasang Infus Bayi/Konsul
30,000 Pasang Monitor Per Hari
20,000 Pasang Tindik
150,000 Pasang/Lepas Infus Umbilikalis (Perinatologi)
125,000 Pemakaian C - PAP
140,000 Pemakaian Ventilator pada Bayi
25,000 Pengambilan Darah Bayi
20,000 Rectal Terapi
325,000 Resusitasi Bayi Asphiksia
25,000 Visite Ahli Gizi
25,000 Visite Dokter Umum
25,000 Asistensi Intra Operatif
37,000 Bandaging Khusus (Pembalut Khusus)
18,000 Buka Kateter
64,000 Cabut Gigi dengan Penyulit
38,000 Cabut Gigi Tetap dengan Lokal Anastesi (HCU)
406,000 Cauter Coloctomi
304,000 Chemoterapi
59,500 Ches Fisioterapi
25,000 Dekontiminasi Racun
18,000 Dressing Luka (Perawatan Luka)
200,000 Dryneeding
253,500 #N/A
25,000 Extubasi
55,000 Fiksasi pada Fraktur
203,000 Fnab Hati, Kelenjar
37,000 Funduskopi Direct
30,000 Galvanic/Faradic/Tens
55,000 #N/A
30,000 Heating Ir/Uv
507,000 Incisi dengan General Anastesi
406,000 Incisional Biopsi Kelenjar dengan Lokal Ans
25,000 Intubasi
30,000 Konsultasi Dokter Spesialis
67,000 Konsultasi Dokter Psychiatri
45,000 Konsultasi VCT
30,000 Massage/Vibrator
20,000 Melakukan Suction
20,000 Memberi Obat Injeksi
20,000 Memberi Tranfusi Darah
15,000 Merawat Catheter
15,000 Merawat Infus
15,000 Merawat NGT
15,000 Oksigenasi dengan Canula
20,000 Oksigenasi dengan Masker
25,000 Oksigenasi Rebreathing/Non Rebreathing
135,000 One Day Care
37,000 Pasang Bidai/Splint/Spalk
20,000 Pasang Infus Anak
25,000 Pasang Infus Bayi
20,000 Pasang Infus Dewasa
37,000 Pasang Kateter Folley Bag
20,000 #N/A
55,000 Pasang NGT
18,000 Pasang PASG
609,000 Pasang WSD
25,000 Pemasangan CPAP
406,000 Pemasangan CVP
20,000 Pemasangan Infusion Pump
20,000 Pemasangan Syring Pump
406,000 Pemasangan Ventilator
37,000 Pemeriksaan EKG
25,000 Pengambilan Spesimen Darah Anak/Bayi
15,000 Pengambilan Spesimen Darah Dewasa
18,000 Pengelolaan Jalan Napas/Nebulizer
26,000 Penyesuaian Gigitan
20,000 Premedikasi
207,000 Psikoterapi Suportif (Rawat inap)
203,000 Punctie Cairan Acites
133,000 Punctie Pleura
74,000 Rehab Paru
74,000 Rehab Stroke
20,000 Saturasi Oksigen
27,000 Toilet Hidung
609,000 Vena Sectie
25,000 Visite Dokter Residen
30,000 Visite Dokter Spesialis di Intermediate
25,000 Visite Dokter Umum di Intermediate
25,000 Visite Farmasi Klinis
91,000 WT dan HT Lebih dari 20 Jahitan
20,000 Zonde Feeding
75,000 Perawatan Jenazah
750,000 Bedah Jenazah
295,000 Konservasi Jenazah/Suntik Formalin
775,000 Konservasi Jenazah/Suntik Formalin di Luar Jam Kerja
200,000 Visum Mayat

250,000 Visum Mayat di Luar Jam Kerja
600,000 Otopsi di Dalam Jam Kerja
750,000 Otopsi di Luar Jam Kerja/Hari Libur
50,000 Penyimpanan Jenazah Tanpa Cooling/Hari
100,000 Penyimpanan Jenazah dengan Cooling/Hari
100,000 Mengeluarkan Bayi dari Jenazah Ibunya (Pelayanan Jenazah)
150,000 Mengeluarkan Bayi dari Jenazah Ibunya di Luar Jam Kerja
60,000 Penjahitan Jenazah < 25 Cm

90,000 Penjahitan Jenazah > 25 Cm
250,000 Penjahitan Jenazah > 100 Cm
165,000 ± 100 Ambulance Jenazah Kabupaten Buleleng
52,500 ± 35 Ambulance Jenazah Kabupaten Badung
105,000 ± 50 Ambulance Jenazah Kabupaten Tabanan
165,000 ± 100 Ambulance Jenazah Kabupaten Jembrana
52,500 ± 35 Ambulance Jenazah Kabupaten Gianyar
105,000 ± 50 Ambulance Jenazah Kabupaten Bangli
52,500 ± 35 Ambulance Jenazah Kabupaten Klungkung
138,750 ± 80 Ambulance Jenazah Kabupaten Karangasem
37,500 ± 15 Ambulance Jenazah Dalam Kota Denpasar
130,000 Small Film (1 Foto)
145,000 Small Film (2 Foto)
150,000 Medium Film (1 Foto)
165,000 Medium Film (2 Foto)
170,000 Large Film (1 Foto)
185,000 Large Film (2 Foto)
300,000 Mammografi
200,000 Panoramic
450,000 IVP
450,000 Colon In Loop/Barium Enema
400,000 Esopagografi/Barium Swallow
400,000 OMD / UGI (Upper GI Sudy)
400,000 Barium Follow Through
300,000 Uretrografi
300,000 Fistulogarafi
400,000 Bvcug
400,000 Cystografi
400,000 Caudografi/Myelografi
450,000 HSG
400,000 Cholangiografi
400,000 Sialografi
400,000 Retrograe Pyelografi (Rpg)
400,000 Antegrade Pyelografi (Apg)
400,000 Lopografi Proksimal/Distal
2,200,000 MRI Kepala Tanpa Kontras
2,500,000 MRI Kepala dengan Kontras
2,200,000 MRI Leher Tanpa Kontras
2,500,000 MRI Leher dengan Kontras
2,500,000 MRI Thorax Tanpa Kontras
3,000,000 MRI Thorax dengan Kontras
2,400,000 MRI Abdomen Atas Tanpa Kontras
2,500,000 MRI Abdomen Atas Tanpa Kontras + Mrcp
3,000,000 MRI Abdomen Atas dengan Kontras
2,400,000 MRI Abdomen Bawah Tanpa Kontras
2,500,000 MRI Abdomen Bawah dengan Kontras;
3,500,000 MRI Whole Abdomen (Atas+ Bawah) Tanpa Kontras
4,000,000 MRI Whole Abdomen (Atas+ Bawah) dengan Kontras
1,800,000 MRI Cervical Spine Tanpa Kontras
2,200,000 MRI Cervical Spine dengan Kontras
1,800,000 MRI Thoracal Spine Tanpa Kontras
2,200,000 MRI Thoracal Spine dengan Kontras
1,800,000 MRI Lumobosacral Spine Tanpa Kontras
2,200,000 MRI Lumbosacral Spine dengan Kontras
3,500,000 MRI Whole Spine Tanpa Kontras
4,000,000 MRI Whole Spine dengan Kontras
1,800,000 MRI Extremitas Tanpa Kontras
2,200,000 MRI Extremitas dengan Kontras
300,000 USG Abdomen Atas dan Bawah
150,000 USG Abdomen Atas
150,000 USG Abdomen Bawah
150,000 USG Pelvis/Gynaecology
150,000 USG Urologi
400,000 USG Doppler Testis
300,000 USG Tyroid
300,000 USG Mamma/Payudara
700,000 USG Doppler Vascular (1 Extremitas)
750,000 CT Scan Kepala Tanpa Kontras
1,000,000 CT Scan Kepala Dengan Kontras
750,000 CT Scan Leher/Colli Tanpa Kontras
1,000,000 CT Scan Leher/Colli Dengan Kontras
850,000 CT Scan Thorax Tanpa Kontras
1,200,000 CT Scan Thorax Dengan Kontras
900,000 CT Scan Abdomen Tanpa Kontras
1,200,000 CT Scan Abdomen Dengan Kontras
750,000 CT Scan Pelvis Tanpa Kontras
1,000,000 CT Scan Pelvis Dengan Kontras
750,000 CT Scan Cervical Spine
750,000 CT Scan Thoracal Spine
750,000 CT Scan Lumbosacral Spine
800,000 CT Scan Extremitas Tanpa Kontras
1,200,000 CT Scan Extremitas Dengan Kontras
3,500,000 Msct Cardiac
3,500,000 CT Angiografi
360,000 C-Arm
500,000 Tindakan Anastesi Diagnostik
40,000 Darah lengkap 3 diff
60,000 Darah lengkap 5 diff
13,400 LED
15,000 Golongan darah (ABO + Rhesus)
15,000 Hitung jenis leukosit
40,000 Platelet Antobodi
40,000 G6PD
120,000 CD-4
120,000 Hitung eosinofil
27,500 Hams test
27,500 Hb F
66,000 NAP
55,000 NSE
36,300 Pewarnaan Acid Phospatase
36,300 Pewarnaan Besi
36,300 Pewarnaan Sumsum Tulang
66,000 Serum Iron Binding Capacity (SIBC)
19,250 Sugar Water Test
108,900 Transferrin
192,500 Elektroforesis Hb
55,000 Retikulosit
60,000 Besi
60,000 Total Iron Binding Capacity (TIBC)
168,000 Feritin
60,000 Vitamin B12
60,000 Asam Folat
64,000 Gambaran Darah Tepi
140,000 Gambaran Sumsum Tulang
14,000 Masa Perdarahan (BT)
14,000 Masa Pembekuan (CT)
75,000 Masa Protrombin (PT)
75,000 APTT
64,000 Fibrinogen
64,000 Retraksi Bekuan
205,000 Agregasi Trombosit
259,000 D-dimer
198,000 Anti Faktor Xa
121,000 Anti Trombin III
275,000 Assay Faktor IX
272,250 Assay Faktor VIII
192,500 F.Von Willebrands
250,800 Inhibitor VIII
187,550 Lupus Anticoagulant
55,000 Masa Iisis Euglobin
101,200 Tromboplastin Generation Time (TGT)
99,000 Trombotest
19,000 Sel LE
19,000 IT Rasio
22,500 SGOT
22,500 SGPT
70,000 LDH
25,000 Bilirubin total
25,000 Bilirubin direk
25,000 Bilirubin indirek
55,000 Gamma GT
30,000 Alkali Phospat
25,000 Protein total
25,000 Albumin
25,000 Globulin
25,000 Glukosa sewaktu
25,000 Glukosa puasa
27,730 TTGO (5x GDS)
166,320 HBA1c
180,000 Insulin
180,000 C-peptide
30,000 Kolesterol total
58,000 Kolesterol HDL
60,000 Kolesterol LDL
35,000 Trigliserida
30,000 Apo A1
30,000 Apo B
80,000 CK-total
80,000 CK-MB
165,000 Troponin I
22,500 Ureum
30,000 Urea Clearance
22,500 Kreatinin
45,000 Kreatinin Clearance
28,000 Asam urat
120,000 Na, K, Cl (elektrolit darah)
66,000 Kalsium (Ca)
34,000 Fosfor
58,000 Magnesium
250,000 Analisa Gas Darah
205,000 CRP kualitatif
205,000 CRP kuantitatif
78,650 Alfa 1 Antitrifsin Kuantitatif
55,000 Alfa 2 makro Globulin Kuantitatif
176,000 ANA Titrasi
64,900 Anti Kappa
64,900 Anti Lamda
64,900 C3
64,900 C4
22,000 Cryoglobulin
84,700 IgA/IgG/IgM
227,200 IgE
84,700 Imuno Elektroforesis Anti IgA/IgG/IgM
84,700 Imuno Elektroforesis Whole Anti Serum
46,750 Smooth Muscle Antibody (SMA)
60,500 T Cel dan B Cel
75,000 HBsAg
75,000 HBsAg Elisa
98,000 Anti HBs
98,000 Anti HBs (Elisa)
160,000 Anti HCV
205,000 Anti HAV
200,000 Anti HBe
155,000 Anti HBc
55,000 Widal
160,000 IgM anti Salmonella (Tubex)
280,000 Anti Dengue IgM, IgG
185,000 NS1
240,000 Anti H Pylori IgG
71,500 Anti H Pylori IgM
25,000 Malaria
31,000 Filaria
55,000 Anti HIV (rapid)
55,000 HIV Western Blot*
225,000 Anti Rubella IgC
225,000 Anti Rubella IgM
200,000 Anti Toxoplasma IgG
200,000 Anti Toxoplasma IgM
110,000 Anti HSV I IgG
110,000 Anti HSV I IgM
110,000 Anti HSV II IgG
110,000 Anti HSV II IgM
165,000 Dengue Blot IgG
165,000 Dengue Blot IgM
110,000 HSV I IgG
110,000 HSV II IgM
47,500 ASTO
81,000 RF (Rheumatoid Factor)
400,000 ANA (IF)
750,000 ANA Profile
35,000 VDRL
51,000 TPHA
40,000 Urin lengkap (Rutin + Sedimen)
10,000 Reduksi urin
50,000 Protein Bence Jones
25,000 Tes Kehamilan (25 mIU/mL)
192,500 Beta HCG
16,500 Esbach
33,000 Hemosiderin
22,000 Oval Fat Body
22,000 Protein Kuantitatif
25,000 Lengkap (Rutin + pH + Reduksi)
30,000 Darah samar
100,000 Rectal Swab
- TIROID
156,000 FT3
146,000 FT4
116,000 TSHS
101,000 T3 Total
101,000 T4 Total
212,000 LH
212,000 FSH
228,000 Testosteron
236,500 Progesteron
176,000 Prolactine
231,000 Estradiol
86,900 Estrogen
175,000 BTA 1x
205,000 Anti Tb IgG (PAP TB)
200,000 AFP
200,000 CEA
320,000 CA 19-9
275,000 CA 125 II
275,000 CA 72-4
306,000 CA 15-3
189,000 Prostat Specific Antigen (PSA)
236,500 CA 12-5
82,500 MCA
200,000 Analisa cairan otak
63,000 Analisa sperma
100,000 Analisa cairan sendi
100,000 Analisa cairan tubuh lain (pleura/lain-lain)
37,000 Tes Narkoba per Parameter
37,000 Narkoba A mffetamin
37,000 Narkoba Canabis
37,000 Narkoba Opiat
37,000 Narkoba Barbiturat
37,000 Narkoba Benzodiazepine
39,000 Pewarnaan Gram
74,000 Jamur (KOH)
45,000 BTA
482,000 Biakan Aerob + Uji Kepekaan Konvensional
482,000 Kultur GO
1,650,000 Kultur Legionella
482,000 Grup B Streptococcus
450,000 Kultur TB Uji Kepekaan OAT Lini I
206,000 Kultur TB
160,000 Biaya pemeriksaan resitensi ke BBLK
120,000 Biaya pengiriman kultur TB ke BBLK
515,000 Kultur Darah (Biakan Aerob)
515,000 Kultur Urine (Biakan Aerob)
515,000 Kultur Feses
515,000 Kultur Cairan (Likuor serebrospinalis/Ascites/Pleura/lain-lain) (Biakan Aerob)
515,000 Kultur Pus/Dasarl luka/Jaringan (Biakan Aerob)

515,000 Kultur Sputum (Biakan Aerob)
515,000 Kultur Spesimen lainnya (Biakan Aerob)
321,000 Kultur jamur tanpa uji kepekaan
514,000 Kultur jamur dengan uji kepekaan
642,000 Skrining MRSA (tenggorokan,hidung, lipatan paha/ketiak)
482,000 Rectal Swab (Indentifikasi Otomatis Vitek)

578,000 Kultur Darah (Biakan Anaerob)
578,000 Kultur Urine (Biakan Anaerob)
578,000 Kultur Cairan (Likuor serebrospinalis/Ascites/Pleura/lain-lain) (Biakan Anaerob)
578,000 Kultur Pus/Dasarl luka/Jaringan (Biakan Anaerob)

578,000 Kultur Sputum (Biakan Anaerob)
578,000 Kultur Spesimen lainnya (Biakan Anaerob)
584,000 PCR TB
1,446,000 PCR RABIES
642,000 PCR GO
642,000 PCR Chlamydia
642,000 PCR Mycoplasma
642,000 PCR Ureaplasma
584,000 PCR Streptococcus
642,000 PCR Legionella
925,000 Kultur Ruangan
25,000 Jasa Pembacaan Kultur
300,000 PA Kecil (1-4 Blok)
300,000 Biopsi Endoscopy 1-2 Blok (Kategori Sedang)
437,500 Bone Marrow aspirasi
437,500 Bone Marrow biopsi
437,500 Biopsi Endoscopy 3 Blok (Kategori Canggih)
625,000 PA Sedang (5-8 Blok)
625,000 Ca Cervic Stadium IB Keatas (Kategori Canggih)
812,500 PA Besar (> 8 Blok)
812,500 Ca Cervic Stadium IA, insitu (Kategori Canggih)
75,000 Konsultasi Dokter (Tidak jadi FNAB)
150,000 Pap Smear-Kiriman Slide
150,000 Pap Smear-Diambil di Lab PA
180,000 Urine, Sputum dan Sitologi Eksfoliatif lainnya (Bronchoscopy, Bronchial washing)
200,000 FNAB-Kiriman Slide

250,000 Cell Blok
250,000 FNAB-Diambil di lab PA dan di ruangan (Superfisial)
300,000 Urine dan Sputum Seri 3 Kali
600,000 FNAB-FNAB Deep (diluar Lab PA)
425,000 Frozen Zection (FZ) Pemeriksaan 1-2 Blok
650,000 Frozen Zection (FZ) Pemeriksaan > 2 Blok
1,100,000 Frozen Zection (FZ) Dari Rumah Sakit Swasta Pemeriksaan 1-2 Blok
1,850,000 Frozen zection (FZ) dari Rumah Sakit Swasta Pemeriksaan > 2 Blok
60,000 1 jenis pemeriksaan (Kategori Kecil)

75,000 2 jenis pemeriksaan (Kategori Kecil)
545,000 3 Jenis pemeriksaan (Kategori Kecil)
280,000 Bone Marrow Aspirasi dan Biopsi (Histokimia)
350,000 Imunohistokimia 1 jenis pemeriksaan (Kategori Sedang)
700,000 Imunohistokimia 2 jenis pemeriksaan (Kategori Sedang)
1,100,000 Imunohistokimia 3 jenis pemeriksaan (Kategori Sedang)
1,200,000 Imunohistokimia > 3 jenis pemeriksaan (Kategori Sedang)
760,000 Otopsi bahan kecil (1 Organ)

1,500,000 Otopsi bahan sedang (2-3 Organ)
2,300,000 Otopsi bahan besar > 3 Organ
252,000 Pemeriksaan PA kecil ( 1-4 Blok)
403,000 Pemeriksaan PA sedang ( 5-8 Blok)
547,000 Pemeriksaan PA besar (> 8 Blok)
400,000 Ca Cervic Stadium IB keatas (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
525,000 Ca Cervic Stadium IA, insitu (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
252,000 Kulit
250,000 Biopsi Endoscopy 1-2 Blok (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
275,000 Biopsi Endoscopy 3 Blok (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
75,000 Pap Smear Kiriman - 1 Slide
80,000 Pap Smear Kiriman - 2 Slide
119,000 Urine, Sputum dan Sitilogi Eksfoliatif lain
119,000 Bronchoscopy, Broncial Washsing
325,000 FNAB-Tindakan langsung
40,000 1 Jenis Pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
60,000 2 jenis Pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
75,000 3 Jenis Pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
225,000 Imunohistokimia 1 jenis pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
705,000 Imunohistokimia > 3 jenis pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)
10,000 Konsultasi Farmasi Klinis Pasien Rawat Jalan

30,000 Visite Farmasi Klinis Pasien Rawat Inap
35,000 1. Tarif tidak termasuk obat, tindakan medik, tindakan medik gigi dan mulut, penunjang medik.
45,000
55,000 2. Untuk pasien asing yang tidak memiliki KITAS dikenakan tarif sebesar 1,5 kali dari tarif RS.
100,000
50,000 1. Tarif tidak termasuk obat, tindakan medik, tindakan medik gigi dan mulut, penunjang medik.
60,000
70,000 2. Untuk pasien asing yang tidak memiliki KITAS dikenakan tarif sebesar 1,5 kali dari tarif RS.
87,500
1. Tarif tidak termasuk obat,

75,000 tindakan medik, tindakan
90,000 medik gigi dan mulut,
100,000 penunjang medik.
2. Untuk pasien asing yang
100,000 tidak memiliki KITAS
110,000 dikenakan tarif sebesar
130,000 1,5 kali dari tarif RS.
160,000
175,000
185,000
600,000
700,000
900,000
1,000,000
2,500,000
3,000,000
525,000
600,000
525,000
600,000
orakoplasti + Omentumpexy

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2482 1941 FNAB-Kiriman Slide 120,000 80,000 200,000

1. PELAYANAN RAWAT JALAN

1. PELAYANAN INSTALASI GAWAT DARURAT

RI 1. PELAYANAN RAWAT INAP

1. Tarif tidak termasuk obat,

1 Jenis Pemeriksaan (Prosesing Tanpa Pembacaan Oleh Spesialis Patologi Anatomi)

Imunohistokimia 1 jenis pemeriksaan (Kategori Sedang)

Imunohistokimia 2 jenis pemeriksaan (Kategori Sedang)

Imunohistokimia 3 jenis pemeriksaan (Kategori Sedang)

Incisi Abces Peritonsil

1. PELAYANAN RAWAT JALAN

1. PELAYANAN INSTALASI GAWAT DARURAT

1. PELAYANAN RAWAT INAP

210,000 140,000 350,000

210,000 140,000 350,000

420,000 280,000 700,000

660,000 440,000 1,100,000

189,600 126,400 316,000

4,050,000 2,700,000 6,750,000

5,000 30,000 35,000 1.

30,000 20,000 50,000 1.

96,000 64,000 160,000

360,000 240,000 600,000

540,000 360,000 900,000

1,500,000 1,000,000 2,500,000

315,000 210,000 525,000

315,000 210,000 525,000

Kru atau kruris?

Lengan atau Lgn?

Wrsi atau wris?

Debri atau Debrid atau Debridemen atau Debridement?

Reg atau Regio?

Delatasi atau Dilatasi, Phimosis atau Phimosis

Tarif tidak termasuk obat,

Konsultasi Farmasi Klinis Pasien Rawat Jalan

1. PELAYANAN INSTALASI GAWAT DARURAT

1. PELAYANAN RAWAT INAP

210,000 140,000 350,000

4,050,000 2,700,000 6,750,000

246,000 164,000 410,000

312,000 208,000 520,000

423,000 282,000 705,000

6,000 4,000 10,000

30,000 20,000 50,000 1.

96,000 64,000 160,000

360,000 240,000 600,000

540,000 360,000 900,000

1,500,000 1,000,000 2,500,000

315,000 210,000 525,000

315,000 210,000 525,000

Tarif tidak termasuk obat,

300,000 Pencabutan Gigi dengan Komplikasi dan Open Method

50,000 Pencabutan Gigi dengan Topical Anestesi

140,000 Visum di Luar RS - TKP dengan Penggalian

265,000 IGD Pelayanan Ambulance Keperawatan Dalam Kota

25,000 Kumbah Lambung

250,000 Pemasangan Skin Traksi

750,000 Reposisi Long Leg dengan Anastesi Umum

280,000 Trocar Sistostomi

4,650,000 Angkat "Plate Screw" Fraktur Os Maksilofasial 3 tempat atau lebih