NO TGL MASUK TGL KELUAR NAMA NO SEP

1 6/28/2019 7/1/2019 JAELANI 1321R0010619V013605

2 6/27/2019 7/1/2019 NGAKAN PUTU ADNY1321R0010619V013493
3 6/29/2019 7/3/2019 CHOIRUL ABADI 1321R0010619V013734
4 7/1/2019 7/4/2019 YUSA IRWAN 1321R0010719V000842
5 7/3/2019 7/5/2019 NURI SRI UTAMI 1321R0010719V002113
6 7/1/2019 7/5/2019 SUJARI 1321R0010719V000832
7 7/2/2019 7/6/2019 SAPARI 1321R0010719V000848
8 7/2/2019 7/6/2019 SIKIN 1321R0010719V001688
9 7/4/2019 7/7/2019 LAURINO ARTHUR P 1321R0010719V002975
10 7/2/2019 7/8/2019 MUFATICHAH 1321R0010719V001643
11 7/2/2019 7/9/2019 ISMI NGATENI 1321R0010719V001684
12 7/7/2019 7/11/2019 SUMININGSIH 1321R0010719V003774
13 7/8/2019 7/13/2019 DADI PRIBADI 1321R0010719V004733
14 7/11/2019 7/16/2019 KUSNADI 1321R0010719V007145
15 7/14/2019 7/17/2019 MOKHAMAD BISRI 1321R0010719V008132
16 7/16/2019 7/20/2019 AGUS DANU S 1321R0010719V010020
17 7/19/2019 7/22/2019 MARIYAH ULFAH 1321R0010719V012338
18 7/18/2019 7/22/2019 ASMANAH 1321R0010719V011063
19 7/14/2019 7/22/2019 NGADRI 1321R0010719V009015
20 7/20/2019 7/24/2019 ANAM 1321R0010719V012516
21 7/19/2019 7/24/2019 SAYEM 1321R0010719V012335
22 7/21/2019 7/24/2019 SEMIADI 1321R0010719V012552
23 7/26/2019 7/26/2019 SUMARTONO 1321R0010719V016644
24 7/24/2019 7/27/2019 SUMIARMO 1321R0010719V015163
25 7/22/2019 7/27/2019 SUMIATI 1321R0010719V013511
26 7/24/2019 7/27/2019 SUDJA'I 1321R0010719V014660
27 7/22/2019 7/29/2019 MAHMUD THOHARI 1321R0010719V012923
28 7/25/2019 7/29/2019 SULIYANTO 1321R0010719V015304
29 7/21/2019 7/31/2019 SUNARTO 1321R0010719V012583
 ICD 10 ICD 9 (DCA) ICD 9 (PCI) ICD 9 (PCI) ICD 9 (PCI) INACBG
I20.9;I25.2 88.57 I-1-15-I
I25.1;I50.9;E10.9 88.57 I-1-15-II
I21.0 88.57 I-1-15-I
I21.1;I49.3 88.57 36.07 I-1-40-III
I25.1;I25.2 88.57 I-1-15-I
I25.1;I95.9;I44.2;I50.9 88.57 36.07 88.72 I-1-40-II
I21.0;I25.2;E87.6 88.57 I-1-15-II
I25.1;I50.9 88.57 36.06 88.72 I-1-40-II
I21.1;I44.2;R57.0 88.57 36.06 I-1-40-III
I44.2;I25.1 88.57 39.64 I-1-06-I
I25.1;E10.9 88.57 36.07 I-1-40-I
I25.1;E11.9 88.57 I-1-15-I
I25.1;I95.9;R57.0;E10.9 88.57 36.07 99.05 38.93 I-1-40-III
I25.1 88.57 36.07 I-1-40-I
I21.0;I25.1;R31 88.57 I-1-15-I
I21.1;I25.1 88.57 I-1-15-I
I20.0;E11.9 88.57 I-1-15-I
I25.1;E11.9 88.57 36.07 I-1-40-I
I25.1;I95.9 88.57 36.06 I-1-40-I
I25.2 88.57 I-1-15-I
I25.1 88.57 36.07 I-1-40-I
I25.1 88.57 I-1-15-I
I25.1;I48 88.57 36.07 I-1-40-II
I25.1 88.57 36.07 I-1-40-I
I25.1;R31 88.57 36.07 I-1-40-I
I25.1 88.57 36.06 I-1-40-I
I25.1;E10.9;I50.9 88.57 36.07 I-1-40-II
I25.1;E10.9 88.57 36.07 I-1-40-I
I25.1;A41.9;E87.2;I47.2;R57.0 88.57 36.07 96.71 J-1-20-III
 SPESIAL PROSEDUR DESKRIPSI_INACBG TARIF INACBG
None KATETERISASI JANTUNG (RINGAN) Rp 6,172,100.00
None KATETERISASI JANTUNG (SEDANG) Rp 8,619,200.00
None KATETERISASI JANTUNG (RINGAN) Rp 6,172,100.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (BERAT) Rp 40,024,100.00
None KATETERISASI JANTUNG (RINGAN) Rp 6,172,100.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (SEDANG) Rp 24,971,400.00
None KATETERISASI JANTUNG (SEDANG) Rp 7,387,900.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (SEDANG) Rp 24,971,400.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (BERAT) Rp 33,353,400.00
None PROSEDUR KARDIOTORASIK LAIN (RINGAN) Rp 29,872,900.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (RINGAN) Rp 10,413,400.00
None KATETERISASI JANTUNG (RINGAN) Rp 6,172,100.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (BERAT) Rp 46,694,700.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (RINGAN) Rp 12,496,100.00
None KATETERISASI JANTUNG (RINGAN) Rp 6,172,100.00
None KATETERISASI JANTUNG (RINGAN) Rp 6,172,100.00
None KATETERISASI JANTUNG (RINGAN) Rp 6,172,100.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (RINGAN) Rp 10,413,400.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (RINGAN) Rp 10,413,400.00
None KATETERISASI JANTUNG (RINGAN) Rp 6,172,100.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (RINGAN) Rp 10,413,400.00
None KATETERISASI JANTUNG (RINGAN) Rp 4,408,700.00
None PROSEDUR KARDIOVASKULAR PERKUTAN (SEDANG) Rp 34,960,000.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (RINGAN) Rp 12,496,100.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (RINGAN) Rp 10,413,400.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (RINGAN) Rp 10,413,400.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (SEDANG) Rp 29,965,700.00
YY-02-III PROSEDUR KARDIOVASKULAR PERKUTAN (RINGAN) Rp 10,413,400.00
None PROSEDUR SISTEM PERNAFASAN NON-KOMPLEKS (BERAT) Rp 33,944,600.00
Rp 466,436,800.00
TOTAL INACBGS
NAMA TINDAKAN TARIF RS LOS ICU LOS TOTALVENTILATOR NO RM
- Rp 10,925,731.00 0 4 0 452590
- Rp 20,434,694.00 5 5 0 452563
- Rp 21,048,795.00 3 5 0 452714
PCI Rp 29,244,549.00 2 4 0 452964
- Rp 10,402,771.00 0 3 0 453080
PCI Rp 36,323,118.00 2 5 0 452960
- Rp 13,218,053.00 2 5 0 452972
PCI Rp 31,297,314.00 3 5 0 453098
PCI Rp 28,107,410.00 2 4 0 453263
- Rp 29,370,189.00 0 7 0 453073
PCI Rp 29,575,669.00 1 8 0 357830
- Rp 21,294,122.00 3 5 0 3045
PCI Rp 47,600,239.00 6 6 0 440433
PCI Rp 33,525,215.00 2 6 0 454082
- Rp 14,524,520.00 3 4 0 292015
- Rp 11,688,767.00 0 5 0 375919
- Rp 10,253,275.00 0 4 0 174131
PCI Rp 30,399,293.00 2 5 0 447938
PCI Rp 25,464,056.00 4 9 0 454348
- Rp 13,778,053.00 0 5 0 454971
PCI Rp 39,719,665.00 3 6 0 454893
- Rp 24,674,572.00 0 4 0 454996
- Rp 29,712,640.00 1 1 0 455629
PCI Rp 31,292,298.00 2 4 0 353098
PCI Rp 24,116,020.00 4 6 0 455145
PCI Rp 28,111,027.00 2 4 0 455312
PCI Rp 37,967,390.00 2 8 0 455041
PCI Rp 30,942,554.00 2 5 0 445867
- Rp 59,298,268.00 6 11 49 455034
Rp 774,310,267.00
TOTAL TARIF RS