8 Agustus

NO TANGGAL MASUK TANGGAL KELUAR DIAGNOSATINDAKAN
1 8/2/2020 8/3/2020 A90 99.18;90.59 INFEKSI VI

2 8/26/2020 8/30/2020 P22.1;P03.99.18;90.59;87.44;93.96 NEONATAL,
3 8/27/2020 8/30/2020 A49.9;A09.99.18;90.59 PENYAKIT I
LAB 3
RO 1
1 8/2/2020 8/3/2020 A90 99.18;90.59 INFEKSI VI

2 8/26/2020 8/30/2020 P22.1;P03.99.18;90.59;87.44;93.96 NEONATAL,
3 8/27/2020 8/30/2020 A49.9;A09.99.18;90.59 PENYAKIT I
1 8/26/2020 8/30/2020 P22.1;P03.99.18;90.59;87.44;93.96 NEONATAL,

ANAK
TARIF INACBG TARIF RS NAMA USIA DPJP SEP

Rp 1,256,500 Rp 976,000 AL AZZAM 1 ANDAR, SP.0464R0060820V000007
Rp 3,492,300 Rp 1,479,500 BAYI NYON 0 ANDAR, SP.0464R0060820V001019
Rp 2,092,500 Rp 1,022,000 FIRZA PUTR 0 ANDAR, SP.0464R0060820V001111
Rp 6,841,300 Rp 3,477,500
Rp 1,256,500 Rp 976,000 AL AZZAM 1 ANDAR, SP.0464R0060820V000007

Rp 2,092,500 Rp 1,022,000 FIRZA PUTR 0 ANDAR, SP.0464R0060820V001111
Rp 6,841,300
NO TANGGAL MATANGGAL KEDIAGNOSA
0464R0060820V000007 1,256,500 1 7/26/2020 8/6/2020 N18.9;I11.
0464R0060820V001019 3,492,300 2 7/31/2020 8/1/2020 K56.7
0464R0060820V001111 2,092,500 3 8/2/2020 8/10/2020 E11.9;I10
4 8/9/2020 8/11/2020 K30;E86;I1
5 8/13/2020 8/15/2020 K30
6 8/16/2020 8/18/2020 A90;K30
7 8/18/2020 8/24/2020 E11.9;H81.
8 8/20/2020 8/22/2020 E11.9;I10
9 8/25/2020 8/27/2020 I49.9;I10
10 8/25/2020 8/27/2020 I10;K30
DALAM
TINDAKAN TARIF INACBG TARIF RS NAMA USIA DPJP SEP

99.18;90.59;89.52;87.44 TUMOR
Rp 2,146,800
GINJAL & SALURAN
Rp 4,477,000
URIN & GAGAL
WARNIATIGINJAL (RINGAN)
56 DIAH RAHM0464R0060
99.18;90.59;89.52;88.19 OBSTRUKSI
Rp 1,624,300
SALURAN RpGASTROINTESTINAL
865,000 ETI SULAST
(RINGAN) 47 DIAH RAHM 0464R0060
99.18;90.59;89.52 PENYAKIT
Rp 3,796,900
KENCING RpMANIS
3,974,000
& GANGGUAN
RUKASIHNUTRISI/ METABOLIK
63 DIAH RAHM
(RINGAN)
0464R0060
99.18;90.59;89.52 GANGGUAN
Rp 1,084,000
SISTEMRp
PENCERNAAN
964,500 LAIN-LAIN
EULIS SUHA(RINGAN)45 DIAH RAHM 0464R0060
99.18;90.59;89.52 GANGGUAN
Rp 1,084,000
SISTEMRp
PENCERNAAN
905,000 LAIN-LAIN
WIDA SULA (RINGAN)32 DIAH RAHM 0464R0060
99.18;90.59 INFEKSI
Rp 1,047,100
VIRAL & NON-BAKTERIAL
Rp 920,000
LAIN
RIYAN
(RINGAN)
SOP 33 DIAH RAHM0464R0060
99.18;90.59;89.52 PENYAKIT
Rp 3,164,100
KENCING RpMANIS
3,170,000
& GANGGUAN
SUHANAHNUTRISI/ METABOLIK
40 DIAH RAHM
(RINGAN)
0464R0060
99.18;90.59 PENYAKIT
Rp 3,164,100
KENCINGRp MANIS 923,500
& GANGGUAN
SITI MUNA
NUTRISI/ METABOLIK
48 DIAH RAHM
(RINGAN)
0464R0060
99.18;89.52;90.59 GANGGUAN
Rp 3,043,400
KONDUKSI
Rp &1,292,500
ARITMIA JANTUNG
HJ.HASANA (RINGAN)71 DIAH RAHM 0464R0060
99.18;89.52;90.59 HIPERTENSI
Rp 1,670,700
(RINGAN)
Rp 875,500 ATANG 74 DIAH RAHM0464R0060
Rp 21,825,400 Rp 18,367,000
LAB 10
RO 1
EKG 8
Rp 21,825,400
NO TANGGAL MATANGGAL KEDIAGNOSATINDAKAN
0464R0060720V001037
2,146,800 1 8/4/2020 8/5/2020 D17.0 86.3;99.18;90.59
0464R0060720V001256
1,624,300 2 8/4/2020 8/5/2020 M71.24 80.74;99.18;90.59;87.44
0464R0060820V000009
3,796,900 3 8/4/2020 8/5/2020 D24;I10 99.18;90.59;85.21
0464R0060820V000303
1,084,000 4 8/4/2020 8/5/2020 K61.0 99.18;90.59;49.01
0464R0060820V000601
1,084,000 5 8/6/2020 8/7/2020 D24 99.18;87.44;85.21;90.59
0464R0060820V000636
1,047,100 6 8/6/2020 8/8/2020 D24 85.12;99.18;90.59;87.44
0464R0060820V000709
3,164,100 7 8/6/2020 8/10/2020 K56.2 99.18;90.59
0464R0060820V000797
3,164,100 8 8/10/2020 8/16/2020 K56.0;A15.99.18;90.59;87.44;87.79
0464R0060820V000923
3,043,400 9 8/11/2020 8/12/2020 Q54.9 99.18;87.44;58.45;90.59
0464R0060820V000925
1,670,700 10 8/11/2020 8/12/2020 D24 85.21;99.18;90.59;87.44
11 8/11/2020 8/14/2020 E11.5 99.18;90.59;84.91;89.52
12 8/13/2020 8/15/2020 K40.9 53.04;99.18;90.59
13 Rp 44,056 Rp 44,057 M71.24 80.74;99.18;90.59;87.44
14 8/18/2020 8/19/2020 D18.0 86.3;99.18;90.59;87.44
15 8/23/2020 8/25/2020 D15.2 99.18;90.59;89.52
16 8/25/2020 8/28/2020 E04.9;E86 99.18;90.59;89.52
BEDAH

Rp 3,225,200 Rp 3,465,500 SRI SURYAT
### 32 DR. CITRA 0464R00600464R0060820V000083
3,225,200
Rp 5,449,400 Rp 3,649,000 ERNY MULY
### 46 DR. CITRA 0464R00600464R0060820V000143
5,449,400
Rp 5,080,900 Rp 3,922,500 ETIK ### 67 DR. CITRA 0464R00600464R0060820V000145
5,080,900
Rp 3,857,300 Rp 3,643,000 YULI ### 27 DR. CITRA 0464R00600464R0060820V000152
3,857,300
Rp 5,080,900 Rp 3,937,500 DEWI SANTI
### 17 DR. CITRA 0464R00600464R0060820V000257
5,080,900
Rp 4,234,100 Rp 3,720,000 SELLY SELV
### 26 DR. CITRA 0464R00600464R0060820V000258
4,234,100
Rp 1,624,300 Rp 1,305,500 KALEA FELI
### 3 DR. CITRA 0464R00600464R0060820V000288
1,624,300
Rp 1,624,300 Rp 1,741,500 SANDI MUL
### 15 DR. CITRA 0464R00600464R0060820V000384
1,624,300
Rp 5,053,000 Rp 3,460,500 HABSY ALI
### 5 DR. CITRA 0464R00600464R0060820V000459
5,053,000
Rp 5,080,900 Rp 3,967,500 NADYA ###AMAL 21 DR. CITRA 0464R00600464R0060820V000460
5,080,900
Rp 8,365,500 Rp 5,684,500 IYAM ### 55 DR. CITRA 0464R00600464R0060820V000469
8,365,500
Rp 4,741,200 Rp 4,296,000 UCE ERAW### 80 DR. CITRA 0464R00600464R0060820V000593
4,741,200
Rp 5,449,400 Rp 3,665,500 LILIS HENI
### Rp Rp5,449,400
45 DR. CITRA 0464R006 0464R0060820V000596
Rp 3,225,200 Rp 3,638,500 NISSA RISN
### 19 DR. CITRA 0464R00600464R0060820V000662
3,225,200
Rp 2,859,900 Rp 1,057,500 WATI ### 45 DR. CITRA 0464R00600464R0060820V000807
2,859,900
Rp 2,395,100 Rp 1,013,000 ODAH ### 66 DR. CITRA 0464R00600464R0060820V000958
2,395,100
Rp 67,346,600 Rp 52,167,500
LAB 16
RO Rp 7
thorax 5
ro prostat 1
ro urania sistem 1
Rp 67,346,600
OBGYN
NO TANGGAL MATANGGAL KEDIAGNOSATINDAKAN TARIF INACBG

1 8/3/2020 8/6/2020 O34.2;O13;74.4;99.18;90.59 Rp 4,293,500
2 8/3/2020 8/6/2020 O32.1;O82.74.4;99.18;90.59 Rp 5,152,300
3 8/3/2020 8/5/2020 O99.8;R50.99.18;90.59;93.96;88.78 Rp 1,899,900
4 8/3/2020 8/4/2020 O02.0 69.01;99.18;90.59 Rp 1,659,800
5 8/5/2020 8/6/2020 O73.0;O13;99.18;90.59;73.59;69.02 Rp 2,225,600
6 8/5/2020 8/8/2020 O61.9;O41.74.4;99.18;90.59 Rp 4,293,500
7 8/6/2020 8/7/2020 O32.1;O80.99.18;90.59;88.78;73.59 Rp 1,467,600
8 8/7/2020 8/8/2020 O13;O41.0;73.59;99.18;90.59 Rp 1,737,000
9 8/7/2020 8/8/2020 O42.9;O80.73.59;99.18;90.59 Rp 1,737,000
10 8/8/2020 8/9/2020 O42.9;O80.73.59;99.18;90.59 Rp 2,431,900
11 8/8/2020 8/10/2020 O13;O80.8;73.59;99.18;90.59 Rp 2,084,400
12 8/9/2020 8/10/2020 O10.9;O80.99.18;90.59;73.59 Rp 1,737,000
13 Rp 44,053 Rp 44,056 O41.0;O3674.4;99.18;90.59 Rp 4,293,500
14 8/10/2020 8/13/2020 O34.2;O82.99.18;74.4;90.59;88.78 Rp 6,011,000
15 8/10/2020 8/13/2020 O00.9 65.29;99.18;90.59 Rp 6,424,600
16 8/10/2020 8/12/2020 O41.0;O80.73.59;99.18;90.59 Rp 2,084,400
17 8/11/2020 8/12/2020 O02.0 69.01;90.59;99.18 Rp 1,383,100
18 8/11/2020 8/13/2020 O63.9 99.18;90.59 Rp 1,899,900
19 8/11/2020 8/15/2020 O41.0;O61.74.4;99.18;90.59;88.78 Rp 4,293,500
20 8/12/2020 8/14/2020 O02.0 69.01;99.18;90.59 Rp 1,383,100
21 Rp 44,055 Rp 44,058 O33.9;O9974.4;90.59;99.18 Rp 4,542,200
22 8/12/2020 8/15/2020 O32.1;O82.74.4;90.59;99.18 Rp 4,293,500
23 8/12/2020 8/15/2020 O32.1;O41.74.4;99.18;90.59 Rp 4,293,500
24 8/13/2020 8/14/2020 O41.0;O80.73.59;99.18;90.59;88.78 Rp 1,737,000
25 8/20/2020 8/20/2020 O14.1;O6899.18;90.59 Rp 2,540,600
26 8/23/2020 8/24/2020 O62.2;R50.99.18;90.59;73.59 Rp 1,467,600
27 8/24/2020 8/28/2020 O73.0 99.18;99.04;88.78;69.02;90.59 Rp 1,734,800
28 8/24/2020 8/27/2020 O34.2;O82.74.4;99.18;90.59 Rp 4,293,500
Rp 83,395,300
Rp 83,395,300
tindakan
LAB
TARIF RS NAMA USIA DPJP SEP NO
Rp 10,408,500 LINA SRI 39 DR. FATAL 0464R00600464R0060820V000076
4,293,500 1
Rp 10,945,500 SITI RODIA 24 DR. FATAL 0464R00600464R0060820V000077
5,152,300 2
Rp 848,500 DESI ANGG 16 DR. FATAL 0464R00600464R0060820V000079
1,899,900 3
Rp 3,565,500 INTAN TAN 35 DR. FATAL 0464R00600464R0060820V000081
1,659,800 4
Rp 4,343,000 CICA CAHY 23 DR. FATAL 0464R00600464R0060820V000154
2,225,600 5
Rp 10,273,500 RINA 24 DR. FATAL 0464R00600464R0060820V000201
4,293,500 6
Rp 2,478,500 TUTI SUMI 38 DR. FATAL 0464R00600464R0060820V000260
1,467,600 7
Rp 1,664,500 WIDA NIN 38 DR. FATAL 0464R00600464R0060820V000265
1,737,000 8
Rp 1,474,500 IKAH 28 DR. FATAL 0464R00600464R0060820V000290
1,737,000 9
Rp 2,032,500 FRISCA FE 26 DR. FATAL 0464R00600464R0060820V000301
2,431,900 10
Rp 2,159,500 AMALIA KA 25 DR. FATAL 0464R00600464R0060820V000302
2,084,400 11
Rp 1,516,500 ERNA 27 DR. FATAL 0464R00600464R0060820V000305
1,737,000 12
Rp 10,328,500 YANI ANG Rp Rp4,293,500
19 DR. FATAL 0464R006 0464R0060820V000379 13
Rp 11,339,500 RIKA PUTRI 35 DR. FATAL 0464R00600464R0060820V000380
6,011,000 14
Rp 10,995,500 ENUNG RO 46 DR. FATAL 0464R00600464R0060820V000381
6,424,600 15
Rp 1,631,500 SITI JULAE 31 DR. FATAL 0464R00600464R0060820V000382
2,084,400 16
Rp 3,355,500 ERNI 36 DR. FATAL 0464R00600464R0060820V000397
1,383,100 17
Rp 972,000 NURHASAN 36 DR. FATAL 0464R00600464R0060820V000462
1,899,900
Rp 10,538,500 DIANA MA 34 DR. FATAL 0464R00600464R0060820V000466
4,293,500
Rp 3,580,500 ATI KURNIA 32 DR. FATAL 0464R00600464R0060820V000530
1,383,100
Rp 10,200,000 PUTRI SAS Rp 19 DR. FATAL 0464R006 Rp4,542,200
0464R0060820V000531
Rp 10,105,000 KARMILA D 32 DR. FATAL 0464R00600464R0060820V000532
4,293,500
Rp 10,194,000 NENG SUMI 24 DR. FATAL 0464R00600464R0060820V000533
4,293,500
Rp 1,553,000 TINA WATI 24 DR. FATAL 0464R00600464R0060820V000632
1,737,000
Rp 863,500 YUNITA FIT 20 DR. FATAL 0464R00600464R0060820V000799
2,540,600
Rp 1,711,500 WIWIN 17 DR. FATAL 0464R00600464R0060820V000806
1,467,600
Rp 5,211,500 GUSMAYAN 36 DR. FATAL 0464R00600464R0060820V000877
1,734,800
Rp 10,379,000 LIDA MAUL 30 DR. FATAL 0464R00600464R0060820V000883
4,293,500
Rp 154,669,500
28
OBGYN
TANGGAL MATANGGAL KEDIAGNOSATINDAKAN TARIF INACBG TARIF RS

7/30/2020 8/1/2020 O60.0 99.18;90.59 Rp 1,427,900 Rp 950,000
7/31/2020 8/1/2020 O13;O80.8;99.18;90.59;73.59 Rp 1,737,000 Rp 1,606,500
8/1/2020 8/2/2020 O42.9;O13;73.59;99.18;90.59 Rp 1,737,000 Rp 1,488,000
8/3/2020 8/4/2020 O41.0;O80.99.18;73.59;90.59;88.78 Rp 1,737,000 Rp 1,683,000
8/10/2020 8/13/2020 O00.9 65.29;99.18;90.59;88.78 Rp 5,353,800 Rp 11,247,500
8/12/2020 8/14/2020 O34.2;O82.74.4;99.18;90.59 Rp 5,152,300 Rp 10,569,500
8/13/2020 8/16/2020 O99.5;O99.73.59;99.18;90.59;99.04 Rp 2,084,400 Rp 2,307,000
8/14/2020 8/15/2020 O13;O42.9;73.59;99.18;90.59 Rp 1,737,000 Rp 1,581,500
8/15/2020 8/16/2020 O63.0;O3099.18;90.59 Rp 1,899,900 Rp 852,000
8/16/2020 8/18/2020 O13;O99.5;73.59;99.18;90.59 Rp 1,737,000 Rp 1,620,000
8/17/2020 8/21/2020 O61.9;O82.74.4;99.18;90.59 Rp 4,293,500 Rp 10,497,500
8/19/2020 8/20/2020 O03.4 69.02;99.18;90.59;88.78 Rp 1,734,800 Rp 3,836,500
Rp 44,067 Rp 44,068 O60.0;O3499.18;90.59 Rp 1,427,900 Rp 967,000
8/26/2020 8/28/2020 O20.0 99.18;99.04;88.78;90.59 Rp 1,076,800 Rp 1,265,500
8/26/2020 8/28/2020 O62.2;O80.99.18;73.59;90.59 Rp 1,467,600 Rp 1,846,500
8/30/2020 8/31/2020 O42.9;O99.73.59;99.18;90.59 Rp 2,431,900 Rp 2,122,500
8/29/2020 8/30/2020 O32.2 99.18;90.59 Rp 1,899,900 Rp 827,000
Rp 38,935,700 Rp 55,267,500
tindakan
lab 17
Rp 38,935,700
NAMA USIA DPJP SEP NO TANGGAL MATANGGAL KE
IMAS SURY
### 23 EISEN HOW0464R00600464R0060720V001252
1,427,900 1 7/29/2020 8/2/2020
CICA SUGIA
### 25 EISEN HOW0464R00600464R0060720V001258
1,737,000 2 8/4/2020 8/6/2020
ENGKIB###
FIT 29 EISEN HOW0464R00600464R0060820V000003
1,737,000 3 8/8/2020 8/11/2020
MEISI AYU
### 21 EISEN HOW0464R00600464R0060820V000060
1,737,000 4 8/9/2020 8/11/2020
LINDA NUR
### 30 EISEN HOW0464R00600464R0060820V000377
5,353,800 5 8/12/2020 8/18/2020
RINI SOPIA
### 28 EISEN HOW0464R00600464R0060820V000528
5,152,300 6 8/12/2020 8/13/2020
NYI RADEN
### 21 EISEN HOW0464R00600464R0060820V000602
2,084,400 7 8/18/2020 8/22/2020
CICIN ADIS
### 21 EISEN HOW0464R00600464R0060820V000610
1,737,000 8 8/18/2020 8/22/2020
RAHMAWA### 22 EISEN HOW0464R00600464R0060820V000634
1,899,900 9 8/25/2020 8/27/2020
AISYAH### 35 EISEN HOW0464R00600464R0060820V000635
1,737,000 10 8/28/2020 8/30/2020
TIKA ARYA
### 19 EISEN HOW0464R00600464R0060820V000641
4,293,500
ENUNG###HE 40 EISEN HOW0464R00600464R0060820V000765
1,734,800
RIKA NUR
### Rp Rp1,427,900
25 EISEN HOW0464R006 0464R0060820V000823
SITI HAJAR
### 38 EISEN HOW0464R00600464R0060820V001017
1,076,800
NURHASAN
### 36 EISEN HOW0464R00600464R0060820V001022
1,467,600
TASYA ###
ALD 20 EISEN HOW0464R00600464R0060820V001164
2,431,900
FIFI MARY
### 35 EISEN HOW0464R00600464R0060820V001250
1,899,900
DALAM
DIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA

K80.8;B17.99.18;90.59;88.76 GANGGUANRp 2,720,800 Rp 1,487,500 ANIS 44
N17.9;E86 99.18;88.76;90.59 TUMOR GINRp 2,146,800 Rp 946,500 DEDEN RO 44
I10;K30;R099.18;90.59;89.52 HIPERTENS Rp 2,723,000 Rp 1,069,500 WIDY SAPU 52
A49.9;I25. 99.18;90.59;89.52 PENYAKIT I Rp 2,092,500 Rp 1,056,000 YAYAH YULI 45
J18.9;J45.999.18;90.59;87.44;89.52 SIMPLE PN Rp 3,799,100 Rp 3,253,000 AI RISMAW 64
K21.9 99.18;90.59 GANGGUANRp 2,679,900 Rp 951,500 ROSWATI 28
A49.9;K30;99.18;90.59;89.52 PENYAKIT I Rp 2,092,500 Rp 1,511,500 IMAS ENI 50
A18.3 99.18;90.59;87.44;88.76 GANGGUANRp 1,084,000 Rp 1,416,000 JAJANG SOL 22
A49.9;A09.99.18;90.59 PENYAKIT I Rp 2,092,500 Rp 988,500 RUSTINI 65
I10;E86 99.18;90.59;89.52 HIPERTENS Rp 2,338,900 Rp 1,608,500 LENA DANIA 53
Rp 23,770,000 Rp14,288,500
lab 10
ro 3
ekg 5
Rp 23,770,000
DPJP SEP NO TANGGAL MATANGGAL KEDIAGNOSA
HELENTINA0464R00600464R0060720V001212
2,720,800 1 7/21/2020 8/24/2020 P07.1;P07.
HELENTINA0464R00600464R0060820V000147
2,146,800 2 7/21/2020 8/15/2020 P07.1;P59.
HELENTINA0464R00600464R0060820V000300
2,723,000 3 8/3/2020 8/6/2020 N93.9;N89.
HELENTINA0464R00600464R0060820V000378
2,092,500 4 8/8/2020 8/13/2020 J18.0
HELENTINA0464R00600464R0060820V000535
3,799,100 5 8/8/2020 8/14/2020 P22.9;P59.
HELENTINA0464R00600464R0060820V000537
2,679,900
HELENTINA0464R00600464R0060820V000645
2,092,500
HELENTINA0464R00600464R0060820V000708
1,084,000
HELENTINA0464R00600464R0060820V000889
2,092,500
HELENTINA0464R00600464R0060820V001160
2,338,900
ANAK

99.18;90.59;87.44;93.35;93.96 NEONATAL,
Rp 8,879,400
BBL 1000
Rp -9,005,500
1499 GR TANPA
BAYI NYON
PROSEDUR MAYOR
0 HENNE
(BERAT)
GIYA
0464R0060
99.18;90.59 NEONATAL,
Rp 5,533,700
BBL 1000
Rp -1,969,000
1499 GR TANPA
BAYI NYON
PROSEDUR MAYOR
0 HENNE
(RINGAN)
GIYA
0464R0060
99.18;90.59;88.78 GANGGUAN
Rp 3,045,300
MENSTRUASI
Rp 1,639,000
& SISTEM
AMELIA
REPRODUKSI WANITA
14 HENNE
LAIN-LAIN
GIYA
0464R0060
(RINGAN)
99.18;87.44;93.94;90.59 SIMPLE
Rp 3,166,000
PNEUMONIARp &1,942,000
WHOOPING BAYI
COUGH
NYON(RINGAN)0 HENNE GIYA0464R0060
99.18;90.59;99.83 NEONATAL,
Rp 5,443,200
BBL 2000
Rp -3,826,500
2499 GR TANPA
BAYI NYON
PROSEDUR MAYOR
0 HENNE
(RINGAN)
GIYA
0464R0060
Rp 26,067,600 Rp18,382,000
lab 5
ro 1
Rp 26,067,600
NO TANGGAL MATANGGAL KEDIAGNOSATINDAKAN
0464R0060720V001029
8,879,400 1 8/4/2020 8/6/2020 J35.0;J35.199.18;90.59;28.3;87.44
0464R0060720V001030
5,533,700 2 8/6/2020 8/8/2020 J35.0;J35.128.3;99.18;90.59;87.44
0464R0060820V000073
3,045,300
0464R0060820V000298
3,166,000
0464R0060820V000465
5,443,200
THT

PROSEDUR Rp 2,839,400 Rp 3,726,000 ANNISYA YU 7 HENNY, DR.0464R00600464R0060820V000082
PROSEDUR Rp 3,407,300 Rp 4,318,000 MOCHAMAD 5 HENNY, DR.0464R00600464R0060820V000205
Rp 6,246,700 Rp 8,044,000
lab 2
ro 2
Rp 6,246,700 274,428,600
Rp 274,428,600
2,839,400
3,407,300
DALAM
NO TANGGAL TANGGAL DIAGNOSATINDAKAN TARIF INACBG TARIF RS

1 ### 8/1/2020 I11.9 99.18;90.59;89.52 HIPERTENS Rp 2,338,900 Rp 1,249,500
Rp 2,338,900
lab Rp 1
ekg Rp 1
NAMA USIA DPJP SEP
ACEP 2455 0464R0060720V001254 0464R0060720V001254 2,338,900
60 DIAH RAHM
ANAK
NO TANGGAL TANGGAL DIAGNOSATINDAKAN TARIF INACBG TARIF RS

1 8/8/2020 ### E86;P07.1 99.18;90.59 HIPOVOLEMRp 1,914,200 ###
Rp 1,914,200
lab 1
NAMA USIA DPJP SEP NO TANGGAL
MIRZA AL 50177 0464R00600464R0060820V000296
0 HENNE GIYA 1,914,200 ###
bedah
TANGGAL DIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA

### K40.4 99.18;90.59;53.04 PROSEDUR Rp 3,951,000 ### ANEN 46127 63
Rp 3,951,000
lab 1
DPJP SEP NO TANGGAL TANGGAL DIAGNOSA
DR. CITRA 0464R00600464R0060820V000704
3,951,000 ### ### A16.2;K21.
dalam
TINDAKAN TARIF INACBG TARIF RS NAMA USIA

99.18;89.52;87.44;93.94;90.59 PERADANGARp 3,799,700 ### WATI 13829 53
Rp 3,799,700
lab 1
ro 1
DPJP SEP
HELENTINA H. S, 0464R00600464R0060820V000881
3,799,700
12,003,800
Rp 12,003,800
UGD
NO TANGGAL MASUK DIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA

67 8/2/2020 Z09.8;K30 - Rp 176,200 Rp 20,000 DEDE JUM
###
68 8/3/2020 K30 - Rp 229,900 Rp 20,000 NURUL###FAD
15 8/3/2020 M54.16 - Rp 176,200 Rp 20,000 ENTANG ###
16 8/3/2020 D64.9;K92.- Rp 145,800 Rp 20,000 CICI SUMIA
###
17 8/4/2020 M54.16;J30- Rp 176,200 Rp 20,000 AMELIA###SA
29 8/1/2020 K35.8 - Rp 125,500 Rp 20,000 NUR ANGG
###
30 8/6/2020 A09.9;R11 - Rp 173,400 Rp 20,000 TENTI PUR
###
53 8/6/2020 I50.0 - Rp 494,800 Rp 20,000 SUSI MUST
###
31 8/7/2020 I25.1 - Rp 248,800 Rp 215,000 NONENG ###M
83 8/5/2020 H81.4;A09.- Rp 176,200 Rp 20,000 HENDRA ###S
32 8/5/2020 K30;I10 - Rp 229,900 Rp 20,000 CUCU SRI
###
33 8/5/2020 M54.66 - Rp 176,200 Rp 20,000 MAMAH ###
34 8/5/2020 K21.9 - Rp 229,900 Rp 20,000 UNTUNG ###S
1 8/11/2020 I21.9;K30;I- Rp 573,600 Rp 60,000 SITI MARI
###
2 8/11/2020 H81.4;K30;- Rp 176,200 Rp 20,000 NANI SUM
###
18 8/12/2020 I50.9;K30 - Rp 494,800 Rp 20,000 DAHLAN ###
35 8/13/2020 J18.9 93.94 Rp 292,900 Rp 20,000 BENNY###AUR
3 8/13/2020 Z09.8;A16.- Rp 176,200 Rp 25,000 ARSELY###
SY
36 8/13/2020 K21.9;R10.- Rp 229,900 Rp 20,000 KARWATI###
84 8/16/2020 R10.4 - Rp 125,500 Rp 20,000 MUHAMMAD
###
85 8/17/2020 R50.9;K30;- Rp 173,400 Rp 20,000 IMAS ENI
###
69 8/17/2020 K30 - Rp 229,900 Rp 20,000 ODID SUH
###
70 8/17/2020 R99 - Rp 176,200 Rp 20,000 ENTIN SUH
###
4 8/18/2020 A09.9;Z35.- Rp 173,400 Rp 20,000 SITA AULIA
###
86 8/12/2020 I10;I21.4;E- Rp 176,200 Rp 20,000 HERTY SUM049686.
37 8/18/2020 I10;R50.9 - Rp 176,200 Rp 20,000 O DENI###
87 8/19/2020 J44.9;K30;I93.94;93.96 Rp 292,900 Rp 20,000 DAHRI ###
38 8/17/2020 K21.9 - Rp 229,900 Rp 20,000 AGUS SOFI
###
39 8/17/2020 K30 - Rp 229,900 Rp 20,000 EUIS ###
40 8/13/2020 A09.9 - Rp 173,400 Rp 20,000 SUKANDA###
41 8/12/2020 J45.9 93.94 Rp 292,900 Rp 65,000 INA KUSTI
###
42 8/12/2020 A09.9 - Rp 173,400 Rp 20,000 SITI NURA
###
43 8/12/2020 A09.9;J06. - Rp 173,400 Rp 20,000 GILBY RAK
###
44 8/14/2020 K30;I10 - Rp 229,900 Rp 20,000 TUGIMAN###
54 8/15/2020 A09.9 - Rp 173,400 Rp 20,000 A. TARMIN
###
61 8/9/2020 K30;I11.9 - Rp 229,900 Rp 20,000 AI RISMAW
###
5 8/11/2020 J45.9 93.94 Rp 292,900 Rp 20,000 SAPNA###
PAU
19 8/10/2020 I63.9 - Rp 126,800 Rp 20,000 ELAS NURH
###
88 8/10/2020 I10 - Rp 176,200 Rp 20,000 ROSMIATI
###
20 8/18/2020 A01.0 - Rp 173,400 Rp 20,000 DESI.H###
89 8/7/2020 M54.16 - Rp 176,200 Rp 20,000 MAMAT ###
6 8/7/2020 I21.9 - Rp 573,600 Rp 20,000 ENDANG ###S
45 8/14/2020 K80.8;I10 - Rp 248,800 Rp 20,000 DEDE JUM###
46 8/13/2020 K30 - Rp 229,900 Rp 20,000 MAMAH ###
62 8/14/2020 R73.9;E11.- Rp 176,200 Rp 20,000 SITI AISAH
###
90 8/16/2020 N40 57.94 Rp 319,200 Rp 90,000 UHRI SUHE
###
71 8/17/2020 K30 - Rp 229,900 Rp 20,000 NYAI ###
47 8/17/2020 K30;Z34.9 - Rp 229,900 Rp 20,000 DEDEH### KUR
91 8/17/2020 A09.9 - Rp 173,400 Rp 20,000 ENJANG ###
H
92 8/19/2020 J35.0 - Rp 176,200 Rp 20,000 DHIANISA###
7 8/4/2020 K30 - Rp 229,900 Rp 20,000 IIS ###
55 8/20/2020 K21.9;I10 - Rp 229,900 Rp 20,000 AGUS SOFI
###
72 8/21/2020 K30;H81.4 - Rp 229,900 Rp 20,000 DARKI ###
73 8/21/2020 K30;A09.9 - Rp 229,900 Rp 20,000 PIPIN NUR
###
74 8/21/2020 J45.9 93.96 Rp 292,900 Rp 20,000 AI SARSIAH
###
21 8/22/2020 H81.4;I10 - Rp 176,200 Rp 20,000 APONG### RO
75 8/24/2020 K56.0 - Rp 125,500 Rp 20,000 ASEP SAEP
###
56 8/24/2020 I50.0 93.96 Rp 292,900 Rp 26,000 SARI ###
57 8/24/2020 R10.4 - Rp 125,500 Rp 20,000 ONIH ###
58 8/25/2020 I50.0 93.94 Rp 292,900 Rp 70,000 MAYA RUK###
59 8/25/2020 R10.4 93.96;90.59 Rp 292,900 Rp 81,000 M. NAUFAL
###
8 8/25/2020 B34.9;R50.- Rp 173,400 Rp 20,000 BAYI NY###RE
9 8/25/2020 I10 - Rp 176,200 Rp 20,000 HASNA### NU
80 8/26/2020 E86;K65.9 - Rp 342,900 Rp 25,000 NANI ###
48 8/27/2020 Z48.8;K35.- Rp 176,200 Rp 95,000 NUR ANGG###
63 8/19/2020 K30;I50.9 93.96 Rp 292,900 Rp 20,000 ENGKOS ###
K
93 8/25/2020 N40 - Rp 176,200 Rp 20,000 UHRI SUHE
###
10 8/25/2020 I50.9;J81 93.96 Rp 292,900 Rp 20,000 NANIN###ROH
11 8/25/2020 J90;A16.2 93.94 Rp 292,900 Rp 85,000 DEDE NURH
###
94 8/19/2020 I10 - Rp 176,200 Rp 20,000 RUKMINI ###H
95 8/21/2020 J45.9 93.94 Rp 292,900 Rp 65,000 SUWITA ###
96 8/25/2020 K30;A09.9;- Rp 229,900 Rp 20,000 ONIH KARN
###
12 8/26/2020 K30;E86 - Rp 229,900 Rp 20,000 EUIS ###
13 8/25/2020 S06.9 - Rp 175,000 Rp 20,000 SRI KARMI
###
49 8/26/2020 N40;R33 - Rp 176,200 Rp 20,000 TOGAR### SI
97 8/30/2020 H81.3;I10 - Rp 176,200 Rp 20,000 PIPIN SEMB
###
76 8/30/2020 K30 - Rp 229,900 Rp 20,000 NENDEN ###
77 8/30/2020 R50.9;J06. - Rp 173,400 Rp 20,000 SODIKIN ###
78 8/30/2020 K30;I10 - Rp 229,900 Rp 20,000 EMIN ###
79 8/30/2020 R56.0 - Rp 274,800 Rp 20,000 ROSA DWI 032848/005127
14 8/30/2020 K21.9;J44. - Rp 229,900 Rp 32,000 HENDRA ###Y
98 8/28/2020 I21.0;I10 93.96 Rp 292,900 Rp 44,000 EMAN ###SUH
99 8/28/2020 A09.9 - Rp 173,400 Rp 20,000 MULYANA ###
100 8/29/2020 I50.0;J81;J - Rp 494,800 Rp 20,000 AMSOR###
101 8/30/2020 J45.9;I10 93.96;93.94 Rp 292,900 Rp 89,000 LINDA ARIS
###
102 8/28/2020 O03.4 - Rp 171,300 Rp 20,000 DULIS ###
81 8/10/2020 R06.0;J45. 93.94 Rp 292,900 Rp 65,000 RISMAN ###
AB
103 8/7/2020 R18;K74.6 - Rp 125,500 Rp 20,000 DEDEH###
82 8/10/2020 R33;N20.0;- Rp 238,100 Rp 20,000 WAWAT ###
K
64 8/18/2020 H81.4;E11.- Rp 176,200 Rp 20,000 PINONDAN
###
65 8/9/2020 K30 - Rp 229,900 Rp 20,000 ADE UNAK
###
66 8/19/2020 I50.0 93.96 Rp 292,900 Rp 26,000 SILVIA AYU
###
22 8/31/2020 I50.0 93.96 Rp 292,900 Rp 44,000 IDI SUPARD
###
60 8/27/2020 R10.4 - Rp 125,500 Rp 20,000 YENIARTI
###D
50 8/26/2020 I50.0 - Rp 494,800 Rp 20,000 ASEP SUK
###
23 8/31/2020 F41.0 89.52;93.96 Rp 292,900 Rp 77,000 RANDI ###
RAM
24 8/31/2020 I50.0;J44.993.96 Rp 292,900 Rp 44,000 IWIS ###
25 8/31/2020 I21.0 89.52 Rp 573,600 Rp 65,000 ENDANG ###S
51 8/31/2020 J45.9 93.96;93.94 Rp 292,900 Rp 71,000 A SURYAN
###
52 8/31/2020 K30;H81.4 - Rp 229,900 Rp 20,000 ASEP RAH
###
26 8/31/2020 R10.4;B34.- Rp 125,500 Rp 20,000 LUKMAN ###N
104 8/10/2020 R11;M54.5- Rp 125,500 Rp 20,000 ANISAH###
27 8/31/2020 O21.1 - Rp 117,600 Rp 20,000 ENENG###RO
28 8/31/2020 B34.9 - Rp 173,400 Rp 20,000 WAFDA###SA
Rp 24,389,400 Rp 3,099,000
lab Rp 1
Rp 24,389,400
USIA DPJP SEP NO
54 DR.AMALI 0464R0060820V000010 0464R0060820V000467 573,600 1
37 DR.AMALI 0464R0060820V000011 0464R0060820V000468 176,200 2
61 ARI ARDIA 0464R0060820V000148 0464R0060820V000556 176,200 3
55 ARI ARDIA 0464R0060820V000149 0464R0060820V000712 173,400 4
19 ARI ARDIA 0464R0060820V000150 0464R0060820V000778 292,900 5
23 DR DWI PU0464R0060820V000151 0464R0060820V000784 573,600 6
55 DR DWI PU0464R0060820V000261 0464R0060820V000793 229,900 7
57 DR. DINDA0464R0060820V000262 0464R0060820V000959 173,400 8
67 DR DWI PU0464R0060820V000280 0464R0060820V000960 176,200 9
26 SUWANDA0464R0060820V000372 0464R0060820V001098 292,900 10
45 DR DWI PU0464R0060820V000373 0464R0060820V001099 292,900 11
49 DR DWI PU0464R0060820V000375 0464R0060820V001103 229,900 12
67 DR DWI PU0464R0060820V000376 0464R0060820V001104 175,000 13
73 ADITYA, DR0464R0060820V000467 0464R0060820V001171 229,900 14
63 ADITYA, DR0464R0060820V000468 0464R0060820V000148 176,200 15
52 ARI ARDIA 0464R0060820V000529 0464R0060820V000149 145,800 16
58 DR DWI PU0464R0060820V000538 0464R0060820V000150 176,200 17
1 ADITYA, DR0464R0060820V000556 0464R0060820V000529 494,800 18
48 DR DWI PU0464R0060820V000585 0464R0060820V000779 126,800 19
1 SUWANDA0464R0060820V000637 0464R0060820V000781 173,400 20
50 SUWANDA0464R0060820V000640 0464R0060820V000804 176,200 21
40 DR.AMALI 0464R0060820V000642 0464R0060820V001248 292,900 22
52 DR.AMALI 0464R0060820V000643 0464R0060820V001253 292,900 23
22 ADITYA, DR0464R0060820V000712 0464R0060820V001254 292,900 24
62 SUWANDA0464R0060820V000766 0464R0060820V001255 573,600 25
60 DR DWI PU0464R0060820V000767 0464R0060820V001259 125,500 26
78 SUWANDA0464R0060820V000768 0464R0060820V001261 117,600 27
44 DR DWI PU0464R0060820V000769 0464R0060820V001262 173,400 28
70 DR DWI PU0464R0060820V000770 0464R0060820V000151 125,500 29
56 DR DWI PU0464R0060820V000771 0464R0060820V000261 173,400 30
55 DR DWI PU0464R0060820V000772 0464R0060820V000280 248,800 31
26 DR DWI PU0464R0060820V000773 0464R0060820V000373 229,900 32
1 DR DWI PU0464R0060820V000774 0464R0060820V000375 176,200 33
42 DR DWI PU0464R0060820V000775 0464R0060820V000376 229,900 34
77 DR. DINDA0464R0060820V000776 0464R0060820V000538 292,900
64 DR. YAN A 0464R0060820V000777 0464R0060820V000585 229,900
16 ADITYA, DR0464R0060820V000778 0464R0060820V000767 176,200
54 ARI ARDIA 0464R0060820V000779 0464R0060820V000769 229,900
53 SUWANDA0464R0060820V000780 0464R0060820V000770 229,900
20 ARI ARDIA 0464R0060820V000781 0464R0060820V000771 173,400
34 SUWANDA0464R0060820V000783 0464R0060820V000772 292,900
66 ADITYA, DR0464R0060820V000784 0464R0060820V000773 173,400
54 DR DWI PU0464R0060820V000785 0464R0060820V000774 173,400
49 DR DWI PU0464R0060820V000786 0464R0060820V000775 229,900
68 DR. YAN A 0464R0060820V000787 0464R0060820V000785 248,800
65 SUWANDA0464R0060820V000788 0464R0060820V000786 229,900
56 DR.AMALI 0464R0060820V000789 0464R0060820V000790 229,900
38 DR DWI PU0464R0060820V000790 0464R0060820V001078 176,200
45 SUWANDA0464R0060820V000791 0464R0060820V001105 176,200
15 SUWANDA0464R0060820V000792 0464R0060820V001252 494,800
60 ADITYA, DR0464R0060820V000793 0464R0060820V001257 292,900
44 DR. DINDA0464R0060820V000800 0464R0060820V001258 229,900
44 DR.AMALI 0464R0060820V000801 0464R0060820V000262 494,800
42 DR.AMALI 0464R0060820V000802 0464R0060820V000776 173,400
32 DR.AMALI 0464R0060820V000803 0464R0060820V000800 229,900
62 ARI ARDIA 0464R0060820V000804 0464R0060820V000884 292,900
48 DR.AMALI 0464R0060820V000871 0464R0060820V000885 125,500
58 DR. DINDA0464R0060820V000884 0464R0060820V000886 292,900
48 DR. DINDA0464R0060820V000885 0464R0060820V000890 292,900
57 DR. DINDA0464R0060820V000886 0464R0060820V001251 125,500
15 DR. DINDA0464R0060820V000890 0464R0060820V000777 229,900
2 ADITYA, DR0464R0060820V000959 0464R0060820V000787 176,200
45 ADITYA, DR0464R0060820V000960 0464R0060820V001096 292,900
60 RIZKIA DR 0464R0060820V001020 0464R0060820V001235 176,200
23 DR DWI PU0464R0060820V001078 0464R0060820V001236 229,900
69 DR. YAN A 0464R0060820V001096 0464R0060820V001237 292,900
65 SUWANDA0464R0060820V001097 0464R0060820V000010 176,200
61 ADITYA, DR0464R0060820V001098 0464R0060820V000011 229,900
46 ADITYA, DR0464R0060820V001099 0464R0060820V000642 229,900
70 SUWANDA0464R0060820V001100 0464R0060820V000643 176,200
74 SUWANDA0464R0060820V001101 0464R0060820V000789 229,900
52 SUWANDA0464R0060820V001102 0464R0060820V000801 229,900
70 ADITYA, DR0464R0060820V001103 0464R0060820V000802 229,900
66 ADITYA, DR0464R0060820V001104 0464R0060820V000803 292,900
69 DR DWI PU0464R0060820V001105 0464R0060820V000871 125,500
59 SUWANDA0464R0060820V001163 0464R0060820V001165 229,900
43 DR.AMALI 0464R0060820V001165 0464R0060820V001166 173,400
49 DR.AMALI 0464R0060820V001166 0464R0060820V001169 229,900
73 DR.AMALI 0464R0060820V001169 0464R0060820V001170 274,800
3 DR.AMALI 0464R0060820V001170 0464R0060820V001020 342,900
45 ANDREY G 0464R0060820V001171 0464R0060820V001232 292,900
66 SUWANDA0464R0060820V001227 0464R0060820V001234 238,100
40 SUWANDA0464R0060820V001228 0464R0060820V000372 176,200
57 SUWANDA0464R0060820V001229 0464R0060820V000637 125,500
33 SUWANDA0464R0060820V001230 0464R0060820V000640 173,400
41 SUWANDA0464R0060820V001231 0464R0060820V000766 176,200
11 RIZKIA DR 0464R0060820V001232 0464R0060820V000768 292,900
54 SUWANDA0464R0060820V001233 0464R0060820V000780 176,200
47 RIZKIA DR 0464R0060820V001234 0464R0060820V000783 176,200
63 DR. YAN A 0464R0060820V001235 0464R0060820V000788 319,200
68 DR. YAN A 0464R0060820V001236 0464R0060820V000791 173,400
19 DR. YAN A 0464R0060820V001237 0464R0060820V000792 176,200
86 ARI ARDIA 0464R0060820V001248 0464R0060820V001097 176,200
41 DR. DINDA0464R0060820V001251 0464R0060820V001100 176,200
50 DR DWI PU0464R0060820V001252 0464R0060820V001101 292,900
31 ARI ARDIA 0464R0060820V001253 0464R0060820V001102 229,900
61 ARI ARDIA 0464R0060820V001254 0464R0060820V001163 176,200
66 ARI ARDIA 0464R0060820V001255 0464R0060820V001227 292,900
70 DR DWI PU0464R0060820V001257 0464R0060820V001228 173,400
30 DR DWI PU0464R0060820V001258 0464R0060820V001229 494,800
25 ARI ARDIA 0464R0060820V001259 0464R0060820V001230 292,900
75 SUWANDA0464R0060820V001260 0464R0060820V001231 171,300
25 ARI ARDIA 0464R0060820V001261 0464R0060820V001233 125,500
10 ARI ARDIA 0464R0060820V001262 0464R0060820V001260 125,500
ANAK
TANGGAL MADIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA

8/10/2020 Z71.9;D56.- KONSULTASRp 121,700 Rp 25,000 ALDI RAH 15769 8
8/10/2020 Z71.9;J45. - KONSULTASRp 121,700 Rp 25,000 AUFA TAUF 26066 9
8/10/2020 Z71.9;D55.- KONSULTASRp 121,700 Rp 25,000 RIFKI ALF 50530 8
8/10/2020 Z09.8;G40.- PENYAKIT KRp 176,200 Rp 25,000 MUHAMAD 13225 7
8/10/2020 Z03.0 - PENYAKIT KRp 176,200 Rp 25,000 RAMA 50459 16
8/10/2020 Z09.8;G40.- PENYAKIT KRp 176,200 Rp 25,000 MUHAMAD 41058 13
8/10/2020 Z71.9;G40.- KONSULTASRp 121,700 Rp 25,000 ALDIANSY 13278 16
8/10/2020 Z71.9;Q90.- KONSULTASRp 121,700 Rp 25,000 AZKA ALF 50453 0
8/13/2020 Z71.9;A16.- KONSULTASRp 121,700 Rp 25,000 M RIZAL R 49998 17
8/13/2020 Z71.9;B58.- KONSULTASRp 121,700 Rp 25,000 BAYI NYON 48726 0
8/13/2020 Z09.8;J45. - PENYAKIT KRp 176,200 Rp 25,000 RENDI REN 15299 4
8/13/2020 Z09.8;D56.- PENYAKIT KRp 176,200 Rp 25,000 MUHAMMAD 041884... 3
8/13/2020 Z09.8;D56.- PENYAKIT KRp 176,200 Rp 25,000 ASTRIA ALI 17638 8
8/13/2020 Z71.9;P07.- KONSULTASRp 121,700 Rp 25,000 MIRZA AL 50177 0
8/13/2020 Z71.9;G40.- KONSULTASRp 121,700 Rp 25,000 MEILIANI 50614 16
8/13/2020 Z71.9;R62.- KONSULTASRp 121,700 Rp 25,000 DEMIZA LO 38468 6
8/13/2020 Z71.9;D56.- KONSULTASRp 121,700 Rp 25,000 KUSNINA 25948 8
8/13/2020 Z71.9;A16.- KONSULTASRp 121,700 Rp 25,000 RAMA 50459 16
8/24/2020 R63.8 - PENYAKIT KRp 176,200 Rp 25,000 WIDYA AZ 50778 1
8/24/2020 Z71.9;F90. - KONSULTASRp 121,700 Rp 25,000 FIKRI ROY 28914 4
8/24/2020 Z09.8;J18. - PENYAKIT KRp 176,200 Rp 25,000 BAYI NYON 49638 0
8/24/2020 P07.1 - PENYAKIT KRp 176,200 Rp 25,000 BAYI NYON 50110 0
8/24/2020 Z71.9;Q21.- KONSULTASRp 121,700 Rp 25,000 NADINA D 40271 1
8/24/2020 Z71.9;G40.- KONSULTASRp 121,700 Rp 25,000 RAMA ARD 15797 13
8/24/2020 Z71.9;J45. - KONSULTASRp 121,700 Rp 25,000 MUHAMMAD 39489 3
8/24/2020 Z71.9;G40.- KONSULTASRp 121,700 Rp 25,000 KHAIRY DA 1578 2
8/24/2020 B15.9 - PENYAKIT ARp 173,400 Rp 25,000 GHANIA PU 50789 6
8/24/2020 Z71.9;C95.- KONSULTASRp 121,700 Rp 25,000 ALTHAF RI 50796 2
8/27/2020 Z71.9;D56.- KONSULTASRp 121,700 Rp 25,000 RIZKY AME 46624 16
8/27/2020 Z09.8;P07.- PENYAKIT KRp 176,200 Rp 25,000 BAYI NYON 50111 0
8/27/2020 Z71.9;A18.- KONSULTASRp 121,700 Rp 25,000 ERIK SETI 49091 14
8/27/2020 Z09.8;J45. - PENYAKIT KRp 176,200 Rp 25,000 BANYU MU 50072 8
8/27/2020 Z09.8;R05 87.44 PENYAKIT KRp 176,200 Rp 25,000 MUHAMMAD 50803 8
8/27/2020 Z09.8;A16.- PENYAKIT KRp 176,200 Rp 25,000 BAYI NY. 18216 2
Rp 4,898,000 Rp 850,000
ro 1
Rp 4,898,000
DPJP SEP NO TANGGAL MADIAGNOSA TINDAKAN
ANDAR, SP.0464R00600464R0060820V000308
121,700 1 8/3/2020 Z09.8;E11.9 -
ANDAR, SP.0464R00600464R0060820V000317
121,700 2 8/3/2020 Z09.8;E11.9 -
ANDAR, SP.0464R00600464R0060820V000331
121,700 3 8/3/2020 Z71.9;I64 -
ANDAR, SP.0464R00600464R0060820V000333
176,200 4 8/3/2020 Z09.8;E11.9 -
ANDAR, SP.0464R00600464R0060820V000338
176,200 5 8/3/2020 Z09.8;A16.2 -
ANDAR, SP.0464R00600464R0060820V000368
176,200 6 8/3/2020 Z71.9;I11.9 -
ANDAR, SP.0464R00600464R0060820V000369
121,700 7 8/3/2020 Z09.8;A19.8 87.44
ANDAR, SP.0464R00600464R0060820V000371
121,700 8 8/3/2020 Z09.8;I11.9 -
ANDAR, SP.0464R00600464R0060820V000540
121,700 9 8/3/2020 Z09.8;I11.9 -
ANDAR, SP.0464R00600464R0060820V000551
121,700 10 8/3/2020 Z71.9;J44.9 -
ANDAR, SP.0464R00600464R0060820V000560
176,200 11 8/3/2020 Z09.8;I11.9 -
ANDAR, SP.0464R00600464R0060820V000574
176,200 12 8/3/2020 Z09.8;I20.9 -
ANDAR, SP.0464R00600464R0060820V000580
176,200 13 8/3/2020 Z09.8;K30 88.76
ANDAR, SP.0464R00600464R0060820V000591
121,700 14 8/3/2020 Z09.8;E11.9 -
ANDAR, SP.0464R00600464R0060820V000592
121,700 15 8/3/2020 Z09.8;I50.9 -
ANDAR, SP.0464R00600464R0060820V000595
121,700 16 8/3/2020 Z09.8;K30 -
ANDAR, SP.0464R00600464R0060820V000597
121,700 17 8/3/2020 Z09.8;E05.9 -
ANDAR, SP.0464R00600464R0060820V000599
121,700 18 8/3/2020 Z09.8;K30 88.76
ANDAR, SP.0464R00600464R0060820V000833
176,200 19 8/3/2020 Z71.9;A16.2 -
ANDAR, SP.0464R00600464R0060820V000840
121,700 20 8/3/2020 Z71.9;N40 -
ANDAR, SP.0464R00600464R0060820V000844
176,200 21 8/3/2020 Z71.9;G40.9 -
ANDAR, SP.0464R00600464R0060820V000847
176,200 22 8/3/2020 Z71.9;J45.9 -
ANDAR, SP.0464R00600464R0060820V000851
121,700 23 8/3/2020 Z09.8;D64.9 -
ANDAR, SP.0464R00600464R0060820V000855
121,700 24 8/3/2020 Z71.9;G40.9 -
ANDAR, SP.0464R00600464R0060820V000861
121,700 25 8/3/2020 Z09.8;H10.9 -
ANDAR, SP.0464R00600464R0060820V000862
121,700 26 8/3/2020 Z71.9;A16.2 -
ANDAR, SP.0464R00600464R0060820V000864
173,400 27 8/3/2020 Z09.8;K30 -
ANDAR, SP.0464R00600464R0060820V000879
121,700 28 8/3/2020 Z09.8;E11.9 -
ANDAR, SP.0464R00600464R0060820V001028
121,700 29 8/3/2020 Z71.9;F20.9 -
ANDAR, SP.0464R00600464R0060820V001038
176,200 30 8/5/2020 Z09.8;J44.9 -
ANDAR, SP.0464R00600464R0060820V001042
121,700 31 8/5/2020 Z09.8;E11.9 -
ANDAR, SP.0464R00600464R0060820V001046
176,200 32 8/5/2020 Z09.8;E05.9 -
ANDAR, SP.0464R00600464R0060820V001052
176,200 33 8/5/2020 Z09.8;E11.9 -
ANDAR, SP.0464R00600464R0060820V001067
176,200 34 8/5/2020 Z09.8;I11.9 -
35 8/5/2020 Z09.8;J40 -
36 8/5/2020 Z71.9;A16.2 -
37 8/5/2020 Z09.8;E11.9 -
38 8/5/2020 Z09.8;J90 -
39 8/5/2020 Z71.9;F20.9 -
40 8/5/2020 Z09.8;D21.4 -
41 8/5/2020 Z09.8;K21.9 -
42 8/5/2020 Z71.9;N18.5 -
43 8/5/2020 Z71.9;G40.9 -
44 8/5/2020 Z09.8;A18.2 -
45 8/5/2020 Z09.8;J44.9 -
46 8/5/2020 Z09.8;E11.9 -
47 8/5/2020 Z71.9;M32.9 -
48 8/5/2020 Z09.8;J90 87.44
49 8/5/2020 Z71.9;K30 -
50 8/5/2020 Z71.9;C20 -
51 8/5/2020 Z71.9;C50.9 -
52 8/5/2020 Z71.9;M06.99 -
53 8/10/2020 Z09.8;E11.9 -
54 8/10/2020 Z09.8;E11.9 90.59
55 8/10/2020 Z09.8;E11.9 -
56 8/10/2020 Z09.8;E11.9 90.59
57 8/10/2020 Z09.8;E11.9 -
58 8/10/2020 Z09.8;E11.9 -
59 8/10/2020 Z97.5 88.79
60 8/10/2020 Z09.8;A16.2 -
61 8/10/2020 Z09.8;E11.9 -
62 8/10/2020 Z09.8;I10 -
63 8/10/2020 Z71.9;N18.5 -
64 8/10/2020 E11.9 -
65 8/10/2020 Z09.8;I20.9 -
66 8/10/2020 Z09.8;I25.1 -
67 8/10/2020 Z09.8;K21.9 -
68 8/10/2020 Z71.9;I69.4 -
69 8/10/2020 Z09.8;J44.9 -
70 8/10/2020 Z09.8;E78.0 -
71 8/10/2020 Z09.8;E11.9 -
72 8/10/2020 Z09.8;I11.9 -
73 8/10/2020 Z71.9;I25.1 -
74 8/10/2020 Z09.8;I50.9 -
75 8/10/2020 Z09.8;E11.9 -
76 8/10/2020 Z09.8;E11.9 90.59
77 8/10/2020 Z71.9;G40.9 -
78 8/10/2020 Z71.9;J44.9 -
79 8/10/2020 Z09.8;J44.9 -
80 8/10/2020 Z71.9;A16.2 -
81 8/10/2020 Z71.9;K74.6 -
82 8/10/2020 Z09.8;E11.9 -
83 8/12/2020 Z09.8;E11.9 90.59
84 8/12/2020 Z09.8;E11.9 90.59
85 8/12/2020 Z09.8;E11.9 -
86 8/12/2020 Z09.8;E11.9 90.59
87 8/12/2020 Z09.8;E11.9 90.59
88 8/12/2020 Z09.8;E11.9 90.59
89 8/12/2020 Z09.8;I50.9 -
90 8/12/2020 Z09.8;E11.9 90.59
91 8/12/2020 Z09.8;E11.9 -
92 8/12/2020 Z09.8;E11.9 90.59
93 8/12/2020 Z09.8;E11.9 90.59
94 8/12/2020 Z09.8;A16.2 -
95 8/12/2020 Z09.8;A18.2 -
96 8/12/2020 Z09.8;J44.9 -
97 8/12/2020 Z09.8;A18.8 -
98 8/12/2020 Z09.8;I10 -
99 8/12/2020 Z09.8;K30 -
100 8/12/2020 Z71.9;J90 -
101 8/12/2020 Z09.8;R51 -
102 8/12/2020 Z09.8;A18.2 -
103 8/12/2020 Z71.9;I64 -
104 8/12/2020 Z09.8;Z03.0 -
105 8/12/2020 Z71.9;J44.9 -
106 8/12/2020 Z09.8;E11.9 -
107 8/12/2020 Z09.8;A19.9 -
108 8/12/2020 Z09.8;K21.9 -
109 8/12/2020 Z09.8;I11.9 -
110 8/12/2020 Z09.8;I64 -
111 8/12/2020 Z09.8;E11.9 -
112 8/14/2020 Z09.8;A16.2 -
113 8/14/2020 Z09.8;E11.9 -
114 8/18/2020 Z09.8;I11.9 -
115 8/18/2020 Z09.8;E11.9 90.59
116 8/19/2020 Z09.8;E11.9 -
117 8/19/2020 Z09.8;E11.9 -
118 8/19/2020 Z09.8;E11.9 -
119 8/19/2020 Z09.8;E11.9 -
120 8/19/2020 Z09.8;E11.9 90.59
121 8/19/2020 Z09.8;E11.9 90.59
122 8/19/2020 Z09.8;E11.9 90.59
123 8/19/2020 Z09.8;J44.9 -
124 8/19/2020 Z09.8;E11.9 90.59
125 8/19/2020 Z09.8;I11.9 -
126 8/19/2020 Z09.8;E11.9 90.59
127 8/19/2020 Z09.8;E11.9 90.59
128 8/19/2020 Z09.8;J44.9 87.44
129 8/19/2020 Z09.8;K30 88.76
130 8/19/2020 Z09.8;K21.9 -
131 8/19/2020 Z09.8;E05.9 -
132 8/19/2020 Z09.8;A16.2 -
133 8/19/2020 Z09.8;M06.99 -
134 8/19/2020 Z09.8;N23 -
135 8/19/2020 Z09.8;E11.9 -
136 8/19/2020 Z09.8;E11.9 90.59
137 8/19/2020 Z09.7;E11.9 -
138 8/19/2020 Z09.8;J45.9 -
139 8/19/2020 Z09.8;E11.9 -
140 8/19/2020 Z09.8;N18.9 -
141 8/19/2020 Z09.8;M17.9;M5-
142 8/19/2020 Z09.8;A16.2 -
143 8/19/2020 Z09.8;I10;K30 -
144 8/19/2020 Z09.8;N18.9 -
145 8/19/2020 Z71.9;N18.5 -
146 8/19/2020 Z09.8;E11.9 -
147 8/19/2020 Z09.8;E11.9 -
148 8/19/2020 Z09.8;M10.99 -
149 8/23/2020 Z09.8;I50.9;J44. -
150 8/24/2020 Z09.8;I11.9;M17-
151 8/24/2020 Z09.8;I25.1 89.52;90.59
152 8/24/2020 Z09.8;E11.9 90.59
153 8/24/2020 Z09.8;E11.9 90.59
154 8/24/2020 Z09.8;E11.9 90.59
155 8/24/2020 Z09.8;I50.9 -
156 8/24/2020 Z09.8;I20.9 -
157 8/24/2020 Z09.8;I50.9 90.59
158 8/24/2020 Z09.8;E11.9 90.59
159 8/24/2020 Z09.8;E11.9 90.59
160 8/24/2020 Z09.8;E11.9 90.59
161 8/24/2020 Z09.8;E11.9;I69.90.59
162 8/24/2020 Z09.8;E11.9 90.59
163 8/24/2020 Z09.8;K30 -
164 8/24/2020 Z09.8;E11.9 90.59
165 8/24/2020 Z09.8;E11.9 90.59
166 8/24/2020 E04.9 -
167 8/24/2020 Z09.8;A18.2 -
168 8/24/2020 Z09.8;K30 -
169 8/24/2020 Z09.8;A18.2 -
170 8/24/2020 Z09.8;J44.9 -
171 8/24/2020 Z09.8;I25.1 -
172 8/24/2020 Z09.8;K30 -
173 8/24/2020 Z09.8;E11.9 -
174 8/24/2020 Z09.8;F41.9 -
175 8/24/2020 Z09.8;M54.5 -
176 8/24/2020 Z71.9;G30.9 -
177 8/24/2020 Z71.9;F20.9 -
178 8/24/2020 Z71.9;I25.1 -
179 8/24/2020 Z71.9;I50.9 -
180 8/24/2020 Z71.9;M32.9 -
181 8/24/2020 I10;M81.0 -
182 8/24/2020 Z71.9;C54.1 -
183 8/24/2020 Z71.9;C71.9 -
184 8/24/2020 Z71.9;J45.9 -
185 8/24/2020 Z09.8;A09.9 -
186 8/24/2020 Z09.8;E11.9 90.59
187 8/24/2020 Z09.8;A16.2 -
188 8/24/2020 Z71.9;I25.1 -
189 8/26/2020 Z09.8;I11.9 -
190 8/26/2020 Z09.8;E11.9 -
191 8/26/2020 Z09.8;E11.9 -
192 8/26/2020 Z09.8;E11.9 -
193 8/26/2020 Z09.8;E11.9 90.59
194 8/26/2020 Z09.8;E11.9 -
195 8/26/2020 Z09.8;E11.9 -
196 8/26/2020 Z09.8;J44.9 -
197 8/26/2020 Z09.8;E11.9 90.59
198 8/26/2020 Z09.8;E11.9 -
199 8/26/2020 Z09.8;I11.9 -
200 8/26/2020 Z09.8;I10 -
201 8/26/2020 Z09.8;E11.9 90.59
202 8/26/2020 Z09.8;I11.9 -
203 8/26/2020 Z09.8;J40 -
204 8/26/2020 Z71.9;I20.9 -
205 8/26/2020 Z09.8;J45.9 -
206 8/26/2020 Z71.9;F32.8 -
207 8/26/2020 Z71.9;D14.3 -
208 8/26/2020 Z71.9;J44.9 -
209 8/26/2020 Z09.8;E11.9 -
210 8/26/2020 Z09.8;H26.8 -
211 8/26/2020 Z09.8;M06.99 -
212 8/26/2020 Z09.8;N20.9 -
213 8/26/2020 Z09.8;E11.9 -
214 8/26/2020 Z09.8;A16.2 -
215 8/26/2020 Z09.8;I20.9 90.59
216 8/26/2020 Z09.8;M32.9 -
217 8/26/2020 Z71.9;G40.9 -
218 8/26/2020 Z71.9;C50.9 -
219 8/26/2020 Z09.8;E11.9 -
220 8/26/2020 Z09.8;K30 87.44
221 8/26/2020 Z71.9;E05.9 -
222 8/26/2020 Z71.9;N18.5 -
223 8/26/2020 Z71.9;G20 -
224 8/26/2020 Z71.9;I11.9 -
225 8/26/2020 Z09.8;E11.9 -
226 8/26/2020 Z09.8;J44.9 -
227 8/31/2020 Z09.8;E11.9 90.59
228 8/31/2020 Z09.8;I11.9 90.59
229 8/31/2020 Z09.8;E11.9 90.59
230 8/31/2020 Z09.8;E11.9 90.59
231 8/31/2020 Z09.8;E11.9 90.59
232 8/31/2020 Z09.8;E11.9 90.59
233 8/31/2020 Z09.8;E11.9 90.59
234 8/31/2020 Z09.8;E11.9 90.59
235 8/31/2020 Z09.8;E11.9 90.59
236 8/31/2020 Z09.8;E78.0 -
237 8/31/2020 Z09.8;J44.9 -
238 8/31/2020 Z09.8;E11.9 90.59
239 8/31/2020 Z09.8;E11.9 -
240 8/31/2020 Z09.8;N20.0 88.76
241 8/31/2020 Z09.8;I10;K30 -
242 8/31/2020 I10 -
243 8/31/2020 Z09.8;A16.2 -
244 8/31/2020 Z09.8;E11.9 -
245 8/31/2020 Z09.8;E11.9 90.59
246 8/31/2020 Z09.8;K30 -
247 8/31/2020 Z09.8;N18.9;E11-
248 8/31/2020 Z09.8;E11.9 89.52;90.59
249 8/31/2020 Z09.8;L04.9 -
250 8/31/2020 Z71.9;A16.2 -
251 8/31/2020 Z71.9;F33.9 -
252 8/31/2020 Z09.8;I50.9 -
253 8/31/2020 Z09.8;E11.9 -
254 8/31/2020 Z09.8;N40;N20. -
255 8/31/2020 Z71.9;F20.9 -
256 8/31/2020 Z71.9;N18.9 -
DALAM

PENYAKIT KRp 176,200 Rp 75,000 RIZKI ANDR
### 39 DIAH RAHM0464R00600464R0060820V000013
176,200
PENYAKIT KRp 176,200 Rp 60,000 POPOM###HA 65 DIAH RAHM0464R00600464R0060820V000014
176,200
KONSULTASRp 121,700 Rp 25,000 ACE JUWA
### 66 DIAH RAHM0464R00600464R0060820V000016
121,700
PENYAKIT KRp 176,200 Rp 85,000 R.DERA###
P 35 DIAH RAHM0464R00600464R0060820V000017
176,200
PENYAKIT KRp 176,200 Rp 45,000 AHMAD###TA 36 DIAH RAHM0464R00600464R0060820V000019
176,200
KONSULTASRp 121,700 Rp 25,000 TUTI SURYA
### 62 DIAH RAHM0464R00600464R0060820V000023
121,700
PENYAKIT KRp 176,200 Rp 90,000 TIARA RISZ
### 20 DIAH RAHM0464R00600464R0060820V000027
176,200
PENYAKIT KRp 176,200 Rp 25,000 OMAH### 65 DIAH RAHM0464R00600464R0060820V000028
176,200
PENYAKIT KRp 176,200 Rp 25,000 ANIH 031105..45 DIAH RAHM
0464R00600464R0060820V000030
176,200
KONSULTASRp 121,700 Rp 25,000 TETTY BIDA
### 77 DIAH RAHM0464R00600464R0060820V000033
121,700
PENYAKIT KRp 176,200 Rp 25,000 ULI ### 57 DIAH RAHM0464R00600464R0060820V000036
176,200
PENYAKIT KRp 176,200 Rp 25,000 PELLIS ###
SET 29 DIAH RAHM0464R00600464R0060820V000040
176,200
PROSEDUR Rp 508,200 Rp 169,000 H.MUHTAR
### 61 DIAH RAHM0464R00600464R0060820V000041
508,200
PENYAKIT KRp 176,200 Rp 25,000 AI MARYAT
### 62 DIAH RAHM0464R00600464R0060820V000043
176,200
PENYAKIT KRp 176,200 Rp 25,000 NANI ### 59 DIAH RAHM0464R00600464R0060820V000045
176,200
PENYAKIT KRp 176,200 Rp 25,000 AAN ### 63 DIAH RAHM0464R00600464R0060820V000047
176,200
PENYAKIT KRp 176,200 Rp 25,000 AI SUMIATI
### 26 DIAH RAHM0464R00600464R0060820V000049
176,200
PROSEDUR Rp 508,200 Rp 169,000 DEDE NURH
### 46 DIAH RAHM0464R00600464R0060820V000052
508,200
KONSULTASRp 121,700 Rp 25,000 TOTONG ### 47 DIAH RAHM0464R00600464R0060820V000053
121,700
KONSULTASRp 121,700 Rp 25,000 ASEP HIDA
### 60 DIAH RAHM0464R00600464R0060820V000055
121,700
KONSULTASRp 121,700 Rp 25,000 SATRIO W 011999.24 DIAH RAHM 0464R00600464R0060820V000056
121,700
KONSULTASRp 121,700 Rp 25,000 MAMAH ###
KO 44 DIAH RAHM0464R00600464R0060820V000057
121,700
PENYAKIT KRp 176,200 Rp 65,000 EMI WARH
### 50 DIAH RAHM0464R00600464R0060820V000062
176,200
KONSULTASRp 121,700 Rp 25,000 NENI HAND
### 31 DIAH RAHM0464R00600464R0060820V000063
121,700
PENYAKIT KRp 176,200 Rp 25,000 IWAN HER
### 50 DIAH RAHM0464R00600464R0060820V000066
176,200
KONSULTASRp 121,700 Rp 25,000 AGUS WAH
### 42 DIAH RAHM0464R00600464R0060820V000069
121,700
PENYAKIT KRp 176,200 Rp 25,000 ARIEF PUT
### 27 DIAH RAHM0464R00600464R0060820V000156
176,200
PENYAKIT KRp 176,200 Rp 90,000 WARNASIH
### 74 DIAH RAHM0464R00600464R0060820V000157
176,200
KONSULTASRp 121,700 Rp 25,000 YAYAN###
SOP 47 DIAH RAHM0464R00600464R0060820V000159
121,700
PENYAKIT KRp 176,200 Rp 25,000 IHO SARYA
### 79 DIAH RAHM0464R00600464R0060820V000161
176,200
PENYAKIT KRp 176,200 Rp 25,000 SUHARTINI
### 70 DIAH RAHM0464R00600464R0060820V000163
176,200
PENYAKIT KRp 176,200 Rp 25,000 NUNUNG ###A 56 DIAH RAHM0464R00600464R0060820V000167
176,200
PENYAKIT KRp 176,200 Rp 70,000 NANA RUK
### 72 DIAH RAHM0464R00600464R0060820V000169
176,200
PENYAKIT KRp 176,200 Rp 25,000 ACEP ### 60 DIAH RAHM0464R00600464R0060820V000170
176,200
PENYAKIT KRp 176,200 Rp 25,000 IWAN SET
### 50 DIAH RAHM0464R00600464R0060820V000172
176,200
KONSULTASRp 121,700 Rp 25,000 DADAN###KO 45 DIAH RAHM0464R00600464R0060820V000173
121,700
PENYAKIT KRp 176,200 Rp 45,000 YULI HARY
### 56 DIAH RAHM0464R00600464R0060820V000174
176,200
PENYAKIT KRp 176,200 Rp 25,000 DEDE NURH
### 46 DIAH RAHM0464R00600464R0060820V000178
176,200
KONSULTASRp 121,700 Rp 25,000 AGUS PRIA
### 67 DIAH RAHM0464R00600464R0060820V000184
121,700
PENYAKIT KRp 176,200 Rp 75,000 AYI ROSTIN
### 52 DIAH RAHM0464R00600464R0060820V000186
176,200
PENYAKIT KRp 176,200 Rp 155,000 EROS ### 0464R00600464R0060820V000188
60 DIAH RAHM 176,200
KONSULTASRp 121,700 Rp 25,000 ROHIDIN### 44 DIAH RAHM
0464R00600464R0060820V000189
121,700
KONSULTASRp 121,700 Rp 25,000 ENTIS TEDI
### 0464R00600464R0060820V000192
PENYAKIT KRp 176,200 Rp 25,000 ESTRIAWAT
### 0464R00600464R0060820V000194
PENYAKIT KRp 176,200 Rp 25,000 ASEP SUTR
### 0464R00600464R0060820V000196
PENYAKIT KRp 176,200 Rp 45,000 ETI SUSILA
### 57 DIAH RAHM
0464R00600464R0060820V000198
176,200
KONSULTASRp 121,700 Rp 25,000 SITI NAJIL
### 0464R00600464R0060820V000199
PENYAKIT KRp 176,200 Rp 90,000 YANTI SURT
### 0464R00600464R0060820V000200
KONSULTASRp 121,700 Rp 25,000 RUSLI MAN
### 0464R00600464R0060820V000309
KONSULTASRp 121,700 Rp 70,000 IIS ### 60 DIAH RAHM
0464R00600464R0060820V000311
121,700
KONSULTASRp 121,700 Rp 25,000 0464R00600464R0060820V000314
ELY SUSIL 001021.52 DIAH RAHM 121,700
KONSULTASRp 121,700 Rp 25,000 WATI ### 0464R00600464R0060820V000315
PENYAKIT KRp 176,200 Rp 70,000 SUMIYATI
### 0464R00600464R0060820V000318
PENYAKIT KRp 176,200 Rp 70,000 AI SUARSIH
### 63 DIAH RAHM
0464R00600464R0060820V000319
176,200
PENYAKIT KRp 176,200 Rp 60,000 RENI NUR
### 0464R00600464R0060820V000320
PENYAKIT KRp 176,200 Rp 135,000 OMAH### 0464R00600464R0060820V000322
PENYAKIT KRp 176,200 Rp 60,000 ONENG### 57 DIAH RAHM
0464R00600464R0060820V000323
176,200
PENYAKIT KRp 176,200 Rp 45,000 MIMIN###MIN 0464R00600464R0060820V000324
PROSEDUR Rp 508,200 Rp 105,000 IPAT ### 0464R00600464R0060820V000325
PENYAKIT KRp 176,200 Rp 25,000 ASEP NAN
### 0464R00600464R0060820V000327
PENYAKIT KRp 176,200 Rp 70,000 MASLAN ###S 59 DIAH RAHM
0464R00600464R0060820V000329
176,200
PENYAKIT KRp 176,200 Rp 115,000 PINONDAN
### 0464R00600464R0060820V000332
KONSULTASRp 121,700 Rp 25,000 ELA NURLA
### 0464R00600464R0060820V000334
PENYAKIT KRp 176,200 Rp 25,000 UKAS ### 0464R00600464R0060820V000335
PENYAKIT KRp 176,200 Rp 50,000 EUIS ROH
### 0464R00600464R0060820V000336
PENYAKIT KRp 176,200 Rp 45,000 WARNASIH
### 74 DIAH RAHM
0464R00600464R0060820V000337
176,200
PENYAKIT KRp 176,200 Rp 25,000 EROS ### 0464R00600464R0060820V000339
KONSULTASRp 121,700 Rp 25,000 ARIP RAH
### 0464R00600464R0060820V000344
PENYAKIT KRp 176,200 Rp 145,000 AAN ### 63 DIAH RAHM
0464R00600464R0060820V000352
176,200
PENYAKIT KRp 176,200 Rp 25,000 OOM GHO### 0464R00600464R0060820V000355
PENYAKIT KRp 176,200 Rp 60,000 LILIS SUMA
### 0464R00600464R0060820V000359
PENYAKIT KRp 176,200 Rp 25,000 ATIH DARY
### 0464R00600464R0060820V000361
KONSULTASRp 121,700 Rp 25,000 OCIH ### 54 DIAH RAHM
0464R00600464R0060820V000365
121,700
PENYAKIT KRp 176,200 Rp 25,000 E RUSYADI
### 0464R00600464R0060820V000366
PENYAKIT KRp 176,200 Rp 90,000 ETI ### 0464R00600464R0060820V000475
PENYAKIT KRp 176,200 Rp 45,000 PATIMAH### 0464R00600464R0060820V000482
KONSULTASRp 121,700 Rp 25,000 RIKA ISMA
### 20 DIAH RAHM
0464R00600464R0060820V000485
121,700
KONSULTASRp 121,700 Rp 25,000 KODARYATI
### 0464R00600464R0060820V000497
PENYAKIT KRp 176,200 Rp 25,000 SARIPUDIN
### 0464R00600464R0060820V000499
KONSULTASRp 121,700 Rp 25,000 TUTI CARYA
### 0464R00600464R0060820V000501
KONSULTASRp 121,700 Rp 25,000 ENDANG ### 39 DIAH RAHM
0464R00600464R0060820V000503
121,700
PENYAKIT KRp 176,200 Rp 25,000 ASEP WAH
### 0464R00600464R0060820V000505
PENYAKIT KRp 176,200 Rp 70,000 YAYAH###SIT 0464R00600464R0060820V000506
PENYAKIT KRp 176,200 Rp 45,000 SARWATI### 0464R00600464R0060820V000509
PENYAKIT KRp 176,200 Rp 45,000 JUARIAH### 54 DIAH RAHM
0464R00600464R0060820V000511
176,200
PENYAKIT KRp 176,200 Rp 45,000 SURYATI###S 0464R00600464R0060820V000512
PENYAKIT KRp 176,200 Rp 45,000 AHMAD SU010333.49 DIAH RAHM
0464R00600464R0060820V000514
176,200
PENYAKIT KRp 176,200 Rp 45,000 ENONG### SUK 0464R00600464R0060820V000515
PENYAKIT KRp 176,200 Rp 95,000 YULIANTI
### 0464R00600464R0060820V000516
PENYAKIT KRp 176,200 Rp 60,000 IMRON###ROS 0464R00600464R0060820V000518
PENYAKIT KRp 176,200 Rp 75,000 WATI ### 58 DIAH RAHM
0464R00600464R0060820V000519
176,200
PENYAKIT KRp 176,200 Rp 60,000 RINCEU### 0464R00600464R0060820V000520
PENYAKIT KRp 176,200 Rp 60,000 HALIM ###
FAD 0464R00600464R0060820V000521
PENYAKIT KRp 176,200 Rp 90,000 NANANG ###K 0464R00600464R0060820V000522
PENYAKIT KRp 176,200 Rp 25,000 AMALIA###ASF 26 DIAH RAHM
0464R00600464R0060820V000525
176,200
PENYAKIT KRp 176,200 Rp 25,000 CAHYAN ### 0464R00600464R0060820V000616
PENYAKIT KRp 176,200 Rp 25,000 WIWIN### 0464R00600464R0060820V000618
PENYAKIT KRp 176,200 Rp 95,000 IDAH ### 0464R00600464R0060820V000646
PENYAKIT KRp 176,200 Rp 105,000 DEDE NURH
### 46 DIAH RAHM
0464R00600464R0060820V000714
176,200
KONSULTASRp 121,700 Rp 25,000 TONI SUKM
### 0464R00600464R0060820V000715
PENYAKIT KRp 176,200 Rp 25,000 IHO SARYA
### 0464R00600464R0060820V000718
PENYAKIT KRp 176,200 Rp 40,000 ASEP ABR
### 27 DIAH RAHM
0464R00600464R0060820V000720
176,200
KONSULTASRp 121,700 Rp 25,000 ENGKOS ###K 0464R00600464R0060820V000727
PENYAKIT KRp 176,200 Rp 25,000 SAMIYEM### 0464R00600464R0060820V000729
KONSULTASRp 121,700 Rp 25,000 AEP A ### 0464R00600464R0060820V000736
PENYAKIT KRp 176,200 Rp 45,000 YEYET AST
### 45 DIAH RAHM
0464R00600464R0060820V000738
176,200
PENYAKIT KRp 176,200 Rp 25,000 AULIA NOV
### 0464R00600464R0060820V000740
PENYAKIT KRp 176,200 Rp 25,000 DEDEN###RO 0464R00600464R0060820V000742
PENYAKIT KRp 176,200 Rp 95,000 HJ SENIFA
### 0464R00600464R0060820V000743
PENYAKIT KRp 176,200 Rp 25,000 HENNY###KUS 0464R00600464R0060820V000744
PENYAKIT KRp 176,200 Rp 25,000 SAFRINO###A 57 DIAH RAHM
0464R00600464R0060820V000746
176,200
PENYAKIT KRp 176,200 Rp 45,000 ENDANG ###B 0464R00600464R0060820V000747
PENYAKIT KRp 176,200 Rp 45,000 RUKASIH### 0464R00600464R0060820V000748
PENYAKIT KRp 176,200 Rp 25,000 HJ. IMAS
###R 64 DIAH RAHM
0464R00600464R0060820V000750
176,200
PENYAKIT KRp 176,200 Rp 45,000 NUNUNG ### 0464R00600464R0060820V000753
PENYAKIT KRp 176,200 Rp 25,000 NANI SUW
### 0464R00600464R0060820V000754
PENYAKIT KRp 176,200 Rp 90,000 NONO ###
SU 0464R00600464R0060820V000755
PENYAKIT KRp 176,200 Rp 25,000 IMAS MUTI
### 49 DIAH RAHM
0464R00600464R0060820V000756
176,200
PENYAKIT KRp 176,200 Rp 45,000 AKMALUDI
### 0464R00600464R0060820V000757
PENYAKIT KRp 176,200 Rp 45,000 ENTJEP###
S 0464R00600464R0060820V000758
PENYAKIT KRp 176,200 Rp 45,000 NURILAM### 0464R00600464R0060820V000762
PENYAKIT KRp 176,200 Rp 75,000 ELIN HERL
### 55 DIAH RAHM
0464R00600464R0060820V000763
176,200
PENYAKIT KRp 176,200 Rp 120,000 UJU MARZU
### 0464R00600464R0060820V000805
PENYAKIT KRp 176,200 Rp 45,000 DJASIMAN
### 0464R00600464R0060820V000810
PENYAKIT KRp 176,200 Rp 25,000 LILIS NENG
### 0464R00600464R0060820V000819
PENYAKIT KRp 176,200 Rp 45,000 NANI SURY
### 55 DIAH RAHM
0464R00600464R0060820V000821
176,200
PENYAKIT KRp 176,200 Rp 90,000 DRS.H.MUS
### 0464R00600464R0060820V000834
PENYAKIT KRp 176,200 Rp 90,000 LILIS ROHA
### 0464R00600464R0060820V000841
PROSEDUR Rp 508,200 Rp 169,000 LIAN SITI
### 0464R00600464R0060820V000842
PENYAKIT KRp 176,200 Rp 25,000 ROSWATI### 28 DIAH RAHM
0464R00600464R0060820V000843
176,200
PENYAKIT KRp 176,200 Rp 25,000 EULIS HER
### 0464R00600464R0060820V000845
PENYAKIT KRp 176,200 Rp 25,000 SANDRA ###FE 21 DIAH RAHM
0464R00600464R0060820V000846
176,200
PENYAKIT KRp 176,200 Rp 25,000 NUNUNG ###N 0464R00600464R0060820V000848
PENYAKIT KRp 176,200 Rp 25,000 AGUS SUR
### 0464R00600464R0060820V000849
PENYAKIT KRp 176,200 Rp 120,000 RHA.SUMAN
### 0464R00600464R0060820V000850
PENYAKIT KRp 176,200 Rp 45,000 EULIS SUR
### 47 DIAH RAHM
0464R00600464R0060820V000852
176,200
PENYAKIT KRp 176,200 Rp 45,000 JAENUDIN
### 0464R00600464R0060820V000853
PENYAKIT KRp 176,200 Rp 25,000 NENENG ### H 0464R00600464R0060820V000854
PENYAKIT KRp 176,200 Rp 60,000 NUR SYARI
### 0464R00600464R0060820V000856
PENYAKIT KRp 176,200 Rp 25,000 ANDIN ###
SU 73 DIAH RAHM
0464R00600464R0060820V000857
176,200
PENYAKIT KRp 176,200 Rp 25,000 ENOK 037946../037916 0464R00600464R0060820V000858
PENYAKIT KRp 176,200 Rp 25,000 YOYOH### JU 0464R00600464R0060820V000859
PENYAKIT KRp 176,200 Rp 25,000 CUCU JUH
### 0464R00600464R0060820V000863
PENYAKIT KRp 176,200 Rp 25,000 ASIH SULA
### 61 DIAH RAHM
0464R00600464R0060820V000865
176,200
KONSULTASRp 121,700 Rp 25,000 NANANG ### 0464R00600464R0060820V000866
PENYAKIT KRp 176,200 Rp 60,000 TATANG ###H 0464R00600464R0060820V000867
PENYAKIT KRp 176,200 Rp 90,000 TANA ### 47 DIAH RAHM
0464R00600464R0060820V000868
176,200
PENYAKIT KRp 176,200 Rp 25,000 ACIH ### 0464R00600464R0060820V000874
PENYAKIT KRp 176,200 Rp 20,000 DAHRI ### 0464R00600464R0060820V000878
PENYAKIT KRp 176,200 Rp 25,000 JULAEHA### 0464R00600464R0060820V000962
PENYAKIT KRp 176,200 Rp 90,000 ANI MARYA
### 46 DIAH RAHM
0464R00600464R0060820V000963
176,200
PENYAKIT KRp 176,200 Rp 85,000 HJ. OTIH
### 0464R00600464R0060820V000967
PENYAKIT KRp 176,200 Rp 60,000 SANTI DIR
### 0464R00600464R0060820V000969
PENYAKIT KRp 176,200 Rp 45,000 IMAS MARY
### 0464R00600464R0060820V000971
PENYAKIT KRp 176,200 Rp 25,000 H.NONO ### W 0464R00600464R0060820V000972
PENYAKIT KRp 176,200 Rp 25,000 SUSI PUJIA
### 46 DIAH RAHM
0464R00600464R0060820V000973
176,200
PENYAKIT KRp 176,200 Rp 60,000 IIS AISAH
### 0464R00600464R0060820V000976
PENYAKIT KRp 176,200 Rp 45,000 CUCUN### RI 0464R00600464R0060820V000977
PENYAKIT KRp 176,200 Rp 45,000 JUJU ### 70 DIAH RAHM
0464R00600464R0060820V000979
176,200
PENYAKIT KRp 176,200 Rp 25,000 IKAH ### 0464R00600464R0060820V000982
PENYAKIT KRp 176,200 Rp 45,000 TUTTY ###
ROC 0464R00600464R0060820V000984
PENYAKIT KRp 176,200 Rp 60,000 AYI HARYAT
### 0464R00600464R0060820V000986
PENYAKIT KRp 176,200 Rp 25,000 YAYA OBAY
### 47 DIAH RAHM
0464R00600464R0060820V000987
176,200
PENYAKIT KRp 176,200 Rp 60,000 SITI AMIN
### 0464R00600464R0060820V000991
PENYAKIT KRp 176,200 Rp 70,000 DHINCE### N 0464R00600464R0060820V000993
PENYAKIT KRp 176,200 Rp 25,000 NURSIGIT
### 0464R00600464R0060820V000994
PENYAKIT KRp 176,200 Rp 25,000 IMAS TETI
### 38 DIAH RAHM
0464R00600464R0060820V000995
176,200
PENYAKIT KRp 176,200 Rp 25,000 RUKASIH### 0464R00600464R0060820V000996
PENYAKIT KRp 176,200 Rp 25,000 SRI NURAN
### 0464R00600464R0060820V000998
PENYAKIT KRp 176,200 Rp 25,000 TINI NURJA
### 0464R00600464R0060820V001000
PENYAKIT KRp 176,200 Rp 25,000 RUKASIH### 64 DIAH RAHM
0464R00600464R0060820V001001
176,200
PENYAKIT KRp 176,200 Rp 25,000 EULIS SUH
### 0464R00600464R0060820V001003
PENYAKIT KRp 176,200 Rp 25,000 NENENG ### SI 0464R00600464R0060820V001005
PENYAKIT KRp 176,200 Rp 25,000 NAJMUDDIN
### 0464R00600464R0060820V001006
PENYAKIT KRp 176,200 Rp 25,000 ADE SUMIA
### 56 DIAH RAHM
0464R00600464R0060820V001007
176,200
KONSULTASRp 121,700 Rp 25,000 YAYA ### 0464R00600464R0060820V001008
KONSULTASRp 121,700 Rp 25,000 M.H RAMD
### 39 DIAH RAHM
0464R00600464R0060820V001010
121,700
KONSULTASRp 121,700 Rp 25,000 AMAR ###
SUM 0464R00600464R0060820V001011
KONSULTASRp 121,700 Rp 25,000 YAYA SUKA
### 0464R00600464R0060820V001013
KONSULTASRp 121,700 Rp 25,000 YENI ### 0464R00600464R0060820V001014
PENYAKIT KRp 176,200 Rp 25,000 TOTO ABID
### 68 DIAH RAHM
0464R00600464R0060820V001016
176,200
KONSULTASRp 121,700 Rp 25,000 CUCU NUR
### 0464R00600464R0060820V001018
KONSULTASRp 121,700 Rp 25,000 SAUDAH ### 0464R00600464R0060820V001185
KONSULTASRp 121,700 Rp 25,000 ACIT ### 0464R00600464R0060820V001187
PENYAKIT KRp 176,200 Rp 25,000 SYAMSUDI
### 45 DIAH RAHM
0464R00600464R0060820V001191
176,200
PENYAKIT KRp 176,200 Rp 60,000 SARI ### 0464R00600464R0060820V001195
PENYAKIT KRp 176,200 Rp 25,000 UJANG###SU 0464R00600464R0060820V001198
KONSULTASRp 121,700 Rp 25,000 AHMAD### CU 0464R00600464R0060820V001199
PENYAKIT KRp 176,200 Rp 25,000 EUIS KARTI
### 65 DIAH RAHM
0464R00600464R0060820V001201
176,200
PENYAKIT KRp 176,200 Rp 125,000 ANANG### SO 0464R00600464R0060820V001204
PENYAKIT KRp 176,200 Rp 75,000 KOMARIAH
### 0464R00600464R0060820V001206
PENYAKIT KRp 176,200 Rp 45,000 ETI KARWA
### 55 DIAH RAHM
0464R00600464R0060820V001210
176,200
PENYAKIT KRp 176,200 Rp 45,000 UKA SUKAE
### 0464R00600464R0060820V001213
PENYAKIT KRp 176,200 Rp 85,000 ENOK EROS
### 0464R00600464R0060820V001216
PENYAKIT KRp 176,200 Rp 45,000 E. DEDEH
###S 0464R00600464R0060820V001217
PENYAKIT KRp 176,200 Rp 25,000 YOESOEF###S 62 DIAH RAHM
0464R00600464R0060820V001219
176,200
PENYAKIT KRp 176,200 Rp 60,000 SAEPUDIN
### 0464R00600464R0060820V001220
PENYAKIT KRp 176,200 Rp 45,000 UKAH ### 0464R00600464R0060820V001221
PENYAKIT KRp 176,200 Rp 95,000 ONENG### 0464R00600464R0060820V001223
PENYAKIT KRp 176,200 Rp 25,000 IDING ### 0464R00600464R0060820V000025
PENYAKIT KRp 176,200 Rp 90,000 ACIH ### 65 DIAH RAHM
0464R00600464R0060820V000195
176,200
PENYAKIT KRp 176,200 Rp 25,000 YAYAH###
RO 0464R00600464R0060820V000733
PENYAKIT KRp 176,200 Rp 25,000 SAEPUDIN
### 0464R00600464R0060820V001009
KONSULTASRp 121,700 Rp 25,000 IWAN SET
### 47 DIAH RAHM
0464R00600464R0060820V000039
121,700
PENYAKIT KRp 176,200 Rp 25,000 AI RISMAW
### 0464R00600464R0060820V000046
KONSULTASRp 121,700 Rp 25,000 ASEP ROH
### 0464R00600464R0060820V000735
KONSULTASRp 121,700 Rp 25,000 TATA ### 0464R00600464R0060820V001194
KONSULTASRp 121,700 Rp 25,000 JAKA NASU
### 51 DIAH RAHM
0464R00600464R0060820V000316
121,700
PENYAKIT KRp 176,200 Rp 60,000 UU SAEPUD
### 0464R00600464R0060820V000813
PENYAKIT KRp 176,200 Rp 45,000 MIMIN###SU 0464R00600464R0060820V001208
PENYAKIT KRp 176,200 Rp 100,000 NUNUNG ###N 0464R00600464R0060820V000310
PENYAKIT KRp 176,200 Rp 60,000 ASIH SULA
### 61 DIAH RAHM
0464R00600464R0060820V000313
176,200
PENYAKIT KRp 176,200 Rp 60,000 A. SUTISNA
### 0464R00600464R0060820V000348
PENYAKIT KRp 176,200 Rp 25,000 JAJANG###SO 0464R00600464R0060820V000471
PENYAKIT KRp 176,200 Rp 85,000 ANDJAR ###
AD 0464R00600464R0060820V000473
PENYAKIT KRp 176,200 Rp 25,000 RATIH PUR
### 37 DIAH RAHM
0464R00600464R0060820V000477
176,200
KONSULTASRp 121,700 Rp 25,000 SRI LESTAR
### 0464R00600464R0060820V000478
KONSULTASRp 121,700 Rp 25,000 IIS KOMAL
### 0464R00600464R0060820V000480
PENYAKIT KRp 176,200 Rp 65,000 CECEP ###
LIN 0464R00600464R0060820V000484
PENYAKIT KRp 176,200 Rp 90,000 YOYOH###JU 60 DIAH RAHM
0464R00600464R0060820V000487
176,200
KONSULTASRp 121,700 Rp 25,000 ANI ### 0464R00600464R0060820V000493
KONSULTASRp 121,700 Rp 25,000 AJANG### 60 DIAH RAHM
0464R00600464R0060820V000661
121,700
KONSULTASRp 121,700 Rp 25,000 HJ YATI###
R 0464R00600464R0060820V000722
KONSULTASRp 121,700 Rp 25,000 ONEH ### 0464R00600464R0060820V000724
PENYAKIT KRp 176,200 Rp 25,000 ANDI RUST
### 0464R00600464R0060820V000725
PENYAKIT KRp 176,200 Rp 25,000 MAMAH ### 67 DIAH RAHM
0464R00600464R0060820V000728
176,200
PENYAKIT KRp 176,200 Rp 45,000 TOTO SUMA
### 0464R00600464R0060820V000730
PENYAKIT KRp 176,200 Rp 60,000 HENDRA ### 0464R00600464R0060820V000732
PENYAKIT KRp 176,200 Rp 45,000 TATI ### 0464R00600464R0060820V000745
PENYAKIT KRp 176,200 Rp 45,000 EULIS ATIK
### 52 DIAH RAHM
0464R00600464R0060820V000814
176,200
PENYAKIT KRp 176,200 Rp 60,000 EUIS ROHA
### 0464R00600464R0060820V000816
PENYAKIT KRp 176,200 Rp 45,000 YUYUS ###
SRI 0464R00600464R0060820V000817
PENYAKIT KRp 176,200 Rp 45,000 SITI ROKA
### 0464R00600464R0060820V000825
PENYAKIT KRp 176,200 Rp 45,000 HJ.SHOLIH
### 65 DIAH RAHM
0464R00600464R0060820V000826
176,200
PENYAKIT KRp 176,200 Rp 45,000 EMAN ###
SUL 0464R00600464R0060820V000827
PENYAKIT KRp 176,200 Rp 25,000 ADE SUMIA
### 0464R00600464R0060820V000829
PENYAKIT KRp 176,200 Rp 25,000 DEDEH###JU 59 DIAH RAHM
0464R00600464R0060820V000831
176,200
PENYAKIT KRp 176,200 Rp 45,000 NIRA ROST
### 0464R00600464R0060820V000832
PENYAKIT KRp 176,200 Rp 25,000 OMAH### 0464R00600464R0060820V000836
PROSEDUR Rp 508,200 Rp 169,000 AGUS SUR
### 0464R00600464R0060820V000838
PENYAKIT KRp 176,200 Rp 25,000 WIDA SULA
### 32 DIAH RAHM
0464R00600464R0060820V000870
176,200
PENYAKIT KRp 176,200 Rp 25,000 ANI MARYA
### 0464R00600464R0060820V000970
PENYAKIT KRp 176,200 Rp 25,000 UKAS ### 0464R00600464R0060820V000974
PENYAKIT KRp 176,200 Rp 25,000 MAYA MAR
### 0464R00600464R0060820V000981
PENYAKIT KRp 176,200 Rp 45,000 SUHANAH### 0464R00600464R0060820V001004
PENYAKIT KRp 176,200 Rp 25,000 AHMAD### TA 36 DIAH RAHM
0464R00600464R0060820V001172
176,200
PENYAKIT KRp 176,200 Rp 25,000 JOEL MAR
### 0464R00600464R0060820V001173
PENYAKIT KRp 176,200 Rp 105,000 TATI SRI
###
M 0464R00600464R0060820V001175
PENYAKIT KRp 176,200 Rp 25,000 DEASY ###
R. 27 DIAH RAHM
0464R00600464R0060820V001177
176,200
KONSULTASRp 121,700 Rp 25,000 INTAN ###
PER 0464R00600464R0060820V001178
KONSULTASRp 121,700 Rp 25,000 HATMAN ###A 0464R00600464R0060820V001180
PENYAKIT KRp 176,200 Rp 70,000 YADI SUPRI
### 0464R00600464R0060820V001181
PENYAKIT KRp 176,200 Rp 25,000 NUNUNG ### 46 DIAH RAHM
0464R00600464R0060820V001182
176,200
PENYAKIT KRp 176,200 Rp 25,000 ACE JUWA
### 0464R00600464R0060820V001183
KONSULTASRp 121,700 Rp 25,000 CUCU SUTI
### 0464R00600464R0060820V001190
KONSULTASRp 121,700 Rp 25,000 PATMAN ### 0464R00600464R0060820V001203
Rp 43,878,700 Rp 11,556,000
lab 102
ro 14
usg 5
thorax 4
Rp 43,878,700
BEDAH
NO TANGGAL MADIAGNOSA TINDAKAN TARIF INACBG TARIF RS

1 8/3/2020 Z09.8;I11.9 - PENYAKIT KRp 176,200 Rp 25,000
3 8/4/2020 Z09.8;T81.4 - PENYAKIT KRp 176,200 Rp 95,000
4 8/4/2020 Z09.8;L89.9 - PENYAKIT KRp 176,200 Rp 95,000
5 8/4/2020 Z09.8;C73 - PENYAKIT KRp 176,200 Rp 25,000
6 8/4/2020 Z09.8;L04.9 - PENYAKIT KRp 176,200 Rp 95,000
7 8/4/2020 D21.9 - PENYAKIT KRp 176,200 Rp 25,000
8 8/4/2020 Z09.8;K80.8;K8- PENYAKIT KRp 176,200 Rp 25,000
9 8/4/2020 Z09.8;K40.9 - PENYAKIT KRp 176,200 Rp 25,000
10 8/4/2020 Z48.8;D24 - PENYAKIT KRp 176,200 Rp 95,000
11 8/4/2020 D24 - PENYAKIT KRp 176,200 Rp 25,000
12 8/6/2020 Z48.8;L97 - PENYAKIT KRp 176,200 Rp 95,000
14 8/6/2020 Z09.8;C56 - PENYAKIT KRp 176,200 Rp 25,000
15 8/6/2020 D24 88.73 PROSEDUR Rp 508,200 Rp 169,000
16 8/6/2020 Z09.8;D17.9 - PENYAKIT KRp 176,200 Rp 25,000
17 8/6/2020 Z09.8;L97;M86- PENYAKIT KRp 176,200 Rp 95,000
18 8/6/2020 Z09.8;Q26.9 - PENYAKIT KRp 176,200 Rp 25,000
19 8/6/2020 Z09.8;E04.9 - PENYAKIT KRp 176,200 Rp 25,000
20 8/11/2020 Z09.8;L04.9;E1- PENYAKIT KRp 176,200 Rp 25,000
21 8/11/2020 Z09.8;C50.9 - PENYAKIT KRp 176,200 Rp 25,000
23 8/11/2020 D24 - PENYAKIT KRp 176,200 Rp 25,000
24 8/11/2020 Z09.8;N60.1 - PENYAKIT KRp 176,200 Rp 25,000
27 8/11/2020 Z09.8;S43.0 - PENYAKIT KRp 176,200 Rp 25,000
29 8/11/2020 K60.3 - PENYAKIT KRp 176,200 Rp 25,000
30 8/11/2020 Z48.8;M71.24 - PENYAKIT KRp 176,200 Rp 95,000
33 8/11/2020 Z09.8;Q54.9 - PENYAKIT KRp 176,200 Rp 95,000
34 8/13/2020 Z09.8;L97 - PENYAKIT KRp 176,200 Rp 95,000
35 8/13/2020 Z71.9;D24 - KONSULTASRp 121,700 Rp 25,000
37 8/13/2020 Z48.8;E07.9 - PENYAKIT KRp 176,200 Rp 25,000
39 8/18/2020 Z48.8;R02 - PENYAKIT KRp 176,200 Rp 95,000
40 8/18/2020 Q54.9 - PENYAKIT KRp 176,200 Rp 25,000
47 8/18/2020 Z09.8;S07.9 - PENYAKIT KRp 176,200 Rp 95,000
49 8/25/2020 Z71.9;N40 - KONSULTASRp 121,700 Rp 25,000
54 8/25/2020 Z71.9;N20.1 - KONSULTASRp 121,700 Rp 25,000
55 8/27/2020 Z71.9;C85.9 - KONSULTASRp 121,700 Rp 25,000
57 8/27/2020 D21.9 - PENYAKIT KRp 176,200 Rp 25,000
58 8/27/2020 Z48.8;R02 - PENYAKIT KRp 176,200 Rp 95,000
59 8/27/2020 Z71.9;E04.9 - KONSULTASRp 121,700 Rp 25,000
Rp 10,807,700 ###
Rp 10,807,700
NAMA USIA DPJP SEP NO TANGGAL MADIAGNOSA
UCE ERAW 80 DR. CITRA 0464R00600464R0060820V000022
176,200 1 8/3/2020 Z09.8;N83.
NUNUNG NE 53 DR. CITRA 0464R00600464R0060820V000098
176,200 2 8/4/2020 Z34.9
FEBY ELNA 17 DR. CITRA 0464R00600464R0060820V000104
176,200 3 8/4/2020 N93.9
JAJANG KU 39 DR. CITRA 0464R00600464R0060820V000114
176,200 4 8/4/2020 Z34.9
EVI SUMIAT 32 DR. CITRA 0464R00600464R0060820V000117
176,200 5 8/4/2020 Z34.9
MOCHAMAD 17 DR. CITRA 0464R00600464R0060820V000127
176,200 6 8/4/2020 Z34.9
NISSA RISN 19 DR. CITRA 0464R00600464R0060820V000128
176,200 7 8/4/2020 Z34.9
WAHYU 51 DR. CITRA 0464R00600464R0060820V000130
176,200 8 8/4/2020 Z54.0;O02.
ANEN 63 DR. CITRA 0464R00600464R0060820V000132
176,200 9 8/6/2020 N83.2
TAMARA QA 18 DR. CITRA 0464R00600464R0060820V000133
176,200 10 8/6/2020 Z34.9
AI SARIPAH 29 DR. CITRA 0464R00600464R0060820V000142
176,200 11 8/6/2020 Z34.9
TATANG DA 54 DR. CITRA 0464R00600464R0060820V000207
176,200 12 8/6/2020 Z34.9
OKI SETIA 19 DR. CITRA 0464R00600464R0060820V000217
176,200 13 8/6/2020 Z34.9
AYI ROSTINI 52 DR. CITRA 0464R00600464R0060820V000221
176,200 14 8/6/2020 Z09.8;N93.
KARWATI 36 DR. CITRA 0464R00600464R0060820V000231
508,200 15 8/6/2020 Z34.9
OJANG SUP 52 DR. CITRA 0464R00600464R0060820V000236
176,200 16 8/6/2020 Z34.9
IYAM 55 DR. CITRA 0464R00600464R0060820V000239
176,200 17 8/6/2020 Z34.9
SITI AISYA 2 DR. CITRA 0464R00600464R0060820V000240
176,200 18 8/6/2020 Z34.9
NANANG S 45 DR. CITRA 0464R00600464R0060820V000246
176,200 19 8/6/2020 Z35.9;O13
WARNASIH 74 DR. CITRA 0464R00600464R0060820V000386
176,200 20 8/6/2020 Z34.9
HERNAWAT 51 DR. CITRA 0464R00600464R0060820V000394
176,200 21 8/6/2020 N92.6
NUNUNG NE 53 DR. CITRA 0464R00600464R0060820V000398
176,200 22 8/11/2020 Z34.9
NENG SANT 42 DR. CITRA 0464R00600464R0060820V000403
176,200 23 8/11/2020 Z54.0;O02.
176,200 24 8/11/2020 Z34.9
SELLY SELV 26 DR. CITRA 0464R00600464R0060820V000441
176,200 25 8/11/2020 Z48.0;O13
DEWI SANTI 17 DR. CITRA 0464R00600464R0060820V000442
176,200 26 8/11/2020 Z34.9
RIZAL NUG 26 DR. CITRA 0464R00600464R0060820V000449
176,200 27 8/11/2020 Z34.9
YANDI ARIP 37 DR. CITRA 0464R00600464R0060820V000450
176,200 28 8/11/2020 Z09.8;N91.
WARSA HID 53 DR. CITRA 0464R00600464R0060820V000453
176,200 29 8/11/2020 N83.2
ERNY MULY 46 DR. CITRA 0464R00600464R0060820V000458
176,200 30 8/11/2020 Z48.0;O61.
YULI 27 DR. CITRA 0464R00600464R0060820V000461
176,200 31 8/11/2020 Z34.9
OSIM 38 DR. CITRA 0464R00600464R0060820V000463
176,200 32 8/11/2020 Z34.9
MUHAMMAD 5 DR. CITRA 0464R00600464R0060820V000464
176,200 33 8/11/2020 Z34.9
TATANG DA 54 DR. CITRA 0464R00600464R0060820V000539
176,200 34 8/11/2020 Z34.9
ETIK 67 DR. CITRA 0464R00600464R0060820V000547
121,700 35 8/11/2020 Z48.0;O32.
SRI SURYAT 32 DR. CITRA 0464R00600464R0060820V000559
176,200 36 8/13/2020 Z09.8;O03.
ROHMAN M 65 DR. CITRA 0464R00600464R0060820V000566
176,200 37 8/13/2020 Z35.9
TATA PERM 56 DR. CITRA 0464R00600464R0060820V000582
176,200 38 8/13/2020 Z35.9
IYAM 55 DR. CITRA 0464R00600464R0060820V000658
176,200 39 8/13/2020 Z09.8;N92.
RIFQI MOC 9 DR. CITRA 0464R00600464R0060820V000663
176,200 40 8/13/2020 Z34.9
SUCI WULAN 32 DR. CITRA 0464R00600464R0060820V000666
176,200 41 8/13/2020 Z34.9
LILIS HENI 45 DR. CITRA 0464R00600464R0060820V000669
176,200 42 8/13/2020 Z09.8;N93.
NADYA AMAL 22 DR. CITRA 0464R00600464R0060820V000675
176,200 43 8/18/2020 Z34.9
ERNY MULY 46 DR. CITRA 0464R00600464R0060820V000678
176,200 44 8/18/2020 Z34.9;O34.
WARSA HID 53 DR. CITRA 0464R00600464R0060820V000682
176,200 45 8/18/2020 Z54.0;O00.
DEWI SANTI 17 DR. CITRA 0464R00600464R0060820V000705
176,200 46 8/18/2020 Z54.0;Z34.
DEPIKA DW 12 DR. CITRA 0464R00600464R0060820V000706
176,200 47 8/18/2020 Z54.0;O00.
DANIKA PEB 21 DR. CITRA 0464R00600464R0060820V000893
176,200 48 8/25/2020 Z09.8;N80.
ENDANG 61 DR. CITRA 0464R00600464R0060820V000937
121,700 49 8/25/2020 Z34.9
176,200 50 8/25/2020 Z34.9
BAMBANG 55 DR. CITRA 0464R00600464R0060820V000947
176,200 51 8/25/2020 Z34.9
NENG SANT 42 DR. CITRA 0464R00600464R0060820V000948
176,200 52 8/25/2020 Z34.9
SELLY SELV 26 DR. CITRA 0464R00600464R0060820V000950
176,200 53 8/25/2020 Z48.8
AYI RUSMA 58 DR. CITRA 0464R00600464R0060820V000956
121,700 54 8/25/2020 Z34.9
AHMAD 47 DR. CITRA 0464R00600464R0060820V001023
121,700 55 8/25/2020 Z71.9;C54.
ANEN 63 DR. CITRA 0464R00600464R0060820V001024
176,200 56 8/25/2020 Z34.9
UJANG RA 61 DR. CITRA 0464R00600464R0060820V001048
176,200 57 8/25/2020 Z34.9
IYAM 55 DR. CITRA 0464R00600464R0060820V001054
176,200 58 8/25/2020 Z34.9
MARINI 38 DR. CITRA 0464R00600464R0060820V001060
121,700 59 8/25/2020 Z34.9
NADYA AMAL 22 DR. CITRA 0464R00600464R0060820V001065
176,200 60 8/25/2020 Z34.9
NISSA RISN 19 DR. CITRA 0464R00600464R0060820V001081
176,200 61 8/25/2020 Z34.9
62 8/25/2020 Z34.9
63 8/27/2020 Z34.9
64 8/27/2020 Z34.9
65 8/27/2020 Z34.9
66 8/27/2020 Z34.9
67 8/27/2020 Z34.9
68 8/27/2020 Z48.8
69 8/27/2020 Z34.9
70 8/27/2020 Z09.8;N83.
71 8/27/2020 Z09.8;O20.
72 8/27/2020 Z34.8
73 8/27/2020 Z34.9
74 8/27/2020 Z34.9
75 8/27/2020 Z34.9
76 8/27/2020 Z34.9
77 8/18/2020 Z35.9
OBGYN

88.78 PROSEDUR Rp 281,500 Rp 105,000 FITRI MUKT 24 DR. FATAL 0464R00600464R0060820V000035
88.78 PROSEDUR Rp 281,500 Rp 105,000 AI SARSIAH 32 DR. FATAL 0464R00600464R0060820V000089
88.78 PROSEDUR Rp 281,500 Rp 105,000 DEVIA NU 14 DR. FATAL 0464R00600464R0060820V000091
88.78 PROSEDUR Rp 281,500 Rp 105,000 ANDINI 20 DR. FATAL 0464R00600464R0060820V000093
88.78 PROSEDUR Rp 281,500 Rp 105,000 IMAS SYAM 32 DR. FATAL 0464R00600464R0060820V000102
88.78 PROSEDUR Rp 281,500 Rp 105,000 TUTI SUMIN 38 DR. FATAL 0464R00600464R0060820V000107
- PENYAKIT KRp 176,200 Rp 25,000 WIDIYA SE 28 DR. FATAL 0464R00600464R0060820V000112
88.78 PROSEDUR Rp 281,500 Rp 105,000 JUWITA 31 DR. FATAL 0464R00600464R0060820V000116
88.78 PROSEDUR Rp 281,500 Rp 105,000 NENG TINI 48 DR. FATAL 0464R00600464R0060820V000206
88.78 PROSEDUR Rp 281,500 Rp 105,000 IMAS SURY 23 DR. FATAL 0464R00600464R0060820V000210
88.78 PROSEDUR Rp 281,500 Rp 105,000 FATISA HA 35 DR. FATAL 0464R00600464R0060820V000212
88.78 PROSEDUR Rp 281,500 Rp 105,000 DEDEH KUR 38 DR. FATAL 0464R00600464R0060820V000215
88.78 PROSEDUR Rp 281,500 Rp 105,000 GEBBY NAT 25 DR. FATAL 0464R00600464R0060820V000227
88.78 PROSEDUR Rp 281,500 Rp 105,000 RUHUL CHAI 42 DR. FATAL 0464R00600464R0060820V000233
88.78 PROSEDUR Rp 281,500 Rp 105,000 YANI ANGG 19 DR. FATAL 0464R00600464R0060820V000235
88.78 PROSEDUR Rp 281,500 Rp 105,000 SOVIYANI 28 DR. FATAL 0464R00600464R0060820V000238
88.78 PROSEDUR Rp 281,500 Rp 105,000 ERNI 36 DR. FATAL 0464R00600464R0060820V000242
88.78 PROSEDUR Rp 281,500 Rp 105,000 AUREILA FA 20 DR. FATAL 0464R00600464R0060820V000250
88.78 PROSEDUR Rp 281,500 Rp 25,000 CICA SUGIA 25 DR. FATAL 0464R00600464R0060820V000252
88.78 PROSEDUR Rp 281,500 Rp 105,000 WIDA NIN 38 DR. FATAL 0464R00600464R0060820V000254
88.78 PROSEDUR Rp 281,500 Rp 105,000 EGI DEWI E 29 DR. FATAL 0464R00600464R0060820V000259
88.78 PROSEDUR Rp 281,500 Rp 105,000 RINI SOPIAN 28 DR. FATAL 0464R00600464R0060820V000387
88.78 PROSEDUR Rp 281,500 Rp 105,000 INTAN TAN 35 DR. FATAL 0464R00600464R0060820V000392
88.78 PROSEDUR Rp 281,500 Rp 105,000 NENG SUMI 24 DR. FATAL 0464R00600464R0060820V000401
88.78 PROSEDUR Rp 281,500 Rp 105,000 LINA SRI W 39 DR. FATAL 0464R00600464R0060820V000405
88.78 PROSEDUR Rp 281,500 Rp 105,000 YANI MULY 30 DR. FATAL 0464R00600464R0060820V000407
88.78 PROSEDUR Rp 281,500 Rp 105,000 EVI RUSMIY 29 DR. FATAL 0464R00600464R0060820V000411
88.78 PROSEDUR Rp 281,500 Rp 105,000 NUROH NU 21 DR. FATAL 0464R00600464R0060820V000413
88.78 PROSEDUR Rp 281,500 Rp 105,000 FITRIA 44 DR. FATAL 0464R00600464R0060820V000422
88.78 PROSEDUR Rp 281,500 Rp 105,000 RINA 24 DR. FATAL 0464R00600464R0060820V000430
88.78 PROSEDUR Rp 281,500 Rp 105,000 RIKA NUR 25 DR. FATAL 0464R00600464R0060820V000433
88.78 PROSEDUR Rp 281,500 Rp 105,000 LIDA MAUL 30 DR. FATAL 0464R00600464R0060820V000437
88.78 PROSEDUR Rp 281,500 Rp 105,000 IMA AMALI 41 DR. FATAL 0464R00600464R0060820V000439
88.78 PROSEDUR Rp 281,500 Rp 105,000 TINI 29 DR. FATAL 0464R00600464R0060820V000444
88.78 PROSEDUR Rp 281,500 Rp 105,000 SITI RODIA 24 DR. FATAL 0464R00600464R0060820V000445
88.78 PROSEDUR Rp 281,500 Rp 105,000 AUREILA FA 20 DR. FATAL 0464R00600464R0060820V000543
88.78 PROSEDUR Rp 281,500 Rp 105,000 ELVA OKTA 30 DR. FATAL 0464R00600464R0060820V000549
88.78 PROSEDUR Rp 281,500 Rp 105,000 AMELIA AY 17 DR. FATAL 0464R00600464R0060820V000554
88.78 PROSEDUR Rp 281,500 Rp 105,000 TANTI DAHL 24 DR. FATAL 0464R00600464R0060820V000557
88.78 PROSEDUR Rp 281,500 Rp 105,000 RENI MAUL 24 DR. FATAL 0464R00600464R0060820V000561
88.78 PROSEDUR Rp 281,500 Rp 105,000 DEBORA 30 DR. FATAL 0464R00600464R0060820V000563
88.78 PROSEDUR Rp 281,500 Rp 105,000 AMELIA 14 DR. FATAL 0464R00600464R0060820V000569
88.78 PROSEDUR Rp 281,500 Rp 105,000 WIDA WULA 29 DR. FATAL 0464R00600464R0060820V000647
88.78 PROSEDUR Rp 281,500 Rp 105,000 FATISA HA 35 DR. FATAL 0464R00600464R0060820V000649
88.78 PROSEDUR Rp 281,500 Rp 105,000 LINDA NUR 30 DR. FATAL 0464R00600464R0060820V000651
88.78 PROSEDUR Rp 281,500 Rp 105,000 IMAS SURY 23 DR. FATAL 0464R00600464R0060820V000654
88.78 PROSEDUR Rp 281,500 Rp 105,000 ENUNG RO 46 DR. FATAL 0464R00600464R0060820V000679
88.78 PROSEDUR Rp 281,500 Rp 105,000 YAYAH KO 43 DR. FATAL 0464R00600464R0060820V000892
88.78 PROSEDUR Rp 281,500 Rp 105,000 RIFKA AGUS 30 DR. FATAL 0464R00600464R0060820V000895
88.78 PROSEDUR Rp 281,500 Rp 105,000 SUMIATI 30 DR. FATAL 0464R00600464R0060820V000897
88.78 PROSEDUR Rp 281,500 Rp 105,000 NOVIA AFRI 31 DR. FATAL 0464R00600464R0060820V000905
88.78 PROSEDUR Rp 281,500 Rp 105,000 SUSILAWAT 24 DR. FATAL 0464R00600464R0060820V000911
88.78 PROSEDUR Rp 281,500 Rp 105,000 ERNI 36 DR. FATAL 0464R00600464R0060820V000918
88.78 PROSEDUR Rp 281,500 Rp 105,000 DEDEH KUR 39 DR. FATAL 0464R00600464R0060820V000924
- KONSULTASRp 121,700 Rp 25,000 SUMIATI 54 DR. FATAL 0464R00600464R0060820V000926
88.78 PROSEDUR Rp 281,500 Rp 105,000 YULIANI M 27 DR. FATAL 0464R00600464R0060820V000929
88.78 PROSEDUR Rp 281,500 Rp 105,000 IMAS SYAM 33 DR. FATAL 0464R00600464R0060820V000930
88.78 PROSEDUR Rp 281,500 Rp 105,000 NURHAYATI 32 DR. FATAL 0464R00600464R0060820V000931
88.78 PROSEDUR Rp 281,500 Rp 105,000 RATNA KO 25 DR. FATAL 0464R00600464R0060820V000932
88.78 PROSEDUR Rp 281,500 Rp 105,000 EVI SUMIAT 32 DR. FATAL 0464R00600464R0060820V000939
88.78 PROSEDUR Rp 281,500 Rp 105,000 YANTI APRI 29 DR. FATAL 0464R00600464R0060820V000940
88.78 PROSEDUR Rp 281,500 Rp 105,000 NANI MARY 42 DR. FATAL 0464R00600464R0060820V000954
88.78 PROSEDUR Rp 281,500 Rp 105,000 AI HAYATI 36 DR. FATAL 0464R00600464R0060820V001026
88.78 PROSEDUR Rp 281,500 Rp 105,000 HJ ETI RO 58 DR. FATAL 0464R00600464R0060820V001027
88.78 PROSEDUR Rp 281,500 Rp 105,000 FITRI DAMA 34 DR. FATAL 0464R00600464R0060820V001031
88.78 PROSEDUR Rp 281,500 Rp 105,000 YULIA 35 DR. FATAL 0464R00600464R0060820V001037
88.78 PROSEDUR Rp 281,500 Rp 105,000 FENI SAPITR 21 DR. FATAL 0464R00600464R0060820V001040
88.78 PROSEDUR Rp 281,500 Rp 105,000 NENG SUMI 24 DR. FATAL 0464R00600464R0060820V001044
88.78 PROSEDUR Rp 281,500 Rp 105,000 WIDANINGS 25 DR. FATAL 0464R00600464R0060820V001051
88.78 PROSEDUR Rp 281,500 Rp 105,000 YATI LIWIN 45 DR. FATAL 0464R00600464R0060820V001057
88.78 PROSEDUR Rp 281,500 Rp 105,000 YANTI NUR 33 DR. FATAL 0464R00600464R0060820V001059
88.78 PROSEDUR Rp 281,500 Rp 105,000 FIFI MARYA 35 DR. FATAL 0464R00600464R0060820V001062
88.78 PROSEDUR Rp 281,500 Rp 105,000 HESTI 22 DR. FATAL 0464R00600464R0060820V001064
88.78 PROSEDUR Rp 281,500 Rp 105,000 YANTI MUL 38 DR. FATAL 0464R00600464R0060820V001069
88.78 PROSEDUR Rp 281,500 Rp 105,000 MIRA MIRA 39 DR. FATAL 0464R00600464R0060820V001077
88.78 PROSEDUR Rp 281,500 Rp 105,000 HANIAH 20 DR. FATAL 0464R00600464R0060820V001094
- PEMERIKS Rp 117,600 Rp 85,000 LILIS SETIA 20 DR. FATAL 0464R00600464R0060820V001264
Rp 21,246,500 ###
non tindakan
Rp 21,246,500
FISIO
NO TANGGAL MADIAGNOSATINDAKAN TARIF INACBG

281,500 1 8/10/2020 Z09.8;M54.93.34;93.13 PROSEDUR Rp 101,800
281,500 2 8/10/2020 Z09.8;M5493.01;89.32;93.13 PROSEDUR Rp 216,500
281,500 3 8/19/2020 Z09.8;M54.93.13;93.34;93.39 PROSEDUR Rp 101,800
281,500 4 8/24/2020 Z09.8;M54.93.13;93.34;93.39 PROSEDUR Rp 101,800
281,500 5 8/24/2020 Z09.8;M54.93.13;93.34;93.39 PROSEDUR Rp 101,800
281,500 6 8/31/2020 Z09.8;M54.93.39;93.31 PROSEDUR Rp 101,800
176,200 7 8/31/2020 Z09.8;M17.93.36;93.39;93.31 PROSEDUR Rp 130,200
281,500 8 8/3/2020 Z09.8;M54.93.04;89.32;93.13 PROSEDUR Rp 216,500
281,500 9 8/3/2020 Z09.8;M17.93.04;93.13;89.32 PROSEDUR Rp 216,500
281,500 10 8/3/2020 Z09.8;M5493.39;93.34 PROSEDUR Rp 101,800
281,500 11 8/3/2020 Z09.8;M1793.04;93.13 PROSEDUR Rp 101,800
281,500 12 8/3/2020 Z09.8;G56.93.05;93.13 PROSEDUR Rp 101,800
281,500 Rp 1,594,100
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
121,700
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
281,500
117,600
Rp 1,594,100
TARIF RS NAMA USIA DPJP SEP NO
Rp 141,000 EUIS ROHAE
### 57 DR. MUHA0464R00600464R0060820V000345
101,800 1
Rp 166,000 ANIH 031105..45 DR. MUHA0464R00600464R0060820V000346
216,500 2
### 57 DR. MUHA0464R00600464R0060820V000764
101,800 3
101,800 4
### 57 DR. MUHA0464R0060 0464R0060820V000822
101,800 5
101,800 6
Rp 141,000 ENOK 50 DR. MUHA0464R00600464R0060820V001184
037946../037916 130,200 7
### 57 DR. MUHA0464R00600464R0060820V000021
216,500 8
Rp 155,000 CICIH ### 51 DR. MUHA0464R0060 0464R0060820V000024
216,500 9
Rp 141,000 OMAH ### 60 DR. MUHA0464R00600464R0060820V000026
101,800 10
Rp 141,000 AISYAH### 67 DR. MUHA0464R00600464R0060820V000034
101,800 11
Rp 105,000 FEBBY AYU 015564.. 9 DR. MUHA0464R0060 0464R0060820V000059
101,800 12
Rp 1,709,000 13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
obgyn
TANGGAL MADIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA DPJP

8/3/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 CICA CAHYA 23 EISEN HOW
8/3/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 WIDA RAHA 32 EISEN HOW
8/4/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 SITI JULAE 31 EISEN HOW
8/5/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 RIKA PUTRI 35 EISEN HOW
8/5/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 KARMILA D 32 EISEN HOW
8/5/2020 Z48.8 88.79 PROSEDUR Rp 508,200 Rp 105,000 SITY JULAE 38 EISEN HOW
8/5/2020 Z09.8;N83.88.78 PROSEDUR Rp 281,500 Rp 105,000 TETI YATI 39 EISEN HOW
8/5/2020 Z35.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 EKOM KOM 30 EISEN HOW
8/5/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 ENUNG RO 46 EISEN HOW
8/5/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 ROSMAWAT 19 EISEN HOW
8/10/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 YUSY LUSIA 27 EISEN HOW
8/10/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 IZMA NURA 24 EISEN HOW
8/10/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 DEWI MARL 29 EISEN HOW
8/10/2020 Z09.8;D15.88.79 PROSEDUR Rp 508,200 Rp 105,000 AYI ROSTINI 52 EISEN HOW
8/10/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 DANING RIS 35 EISEN HOW
8/10/2020 Z48.8 88.79 PROSEDUR Rp 508,200 Rp 105,000 GUSMAYANT 36 EISEN HOW
8/12/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 YANTI NUR 33 EISEN HOW
8/12/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 130,000 NIKE JAYAN 32 EISEN HOW
8/12/2020 Z48.8 88.78 PROSEDUR Rp 281,500 Rp 105,000 ILAH HASTA 46 EISEN HOW
8/12/2020 Z48.8 88.79 PROSEDUR Rp 508,200 Rp 105,000 CUCU CAHY 35 EISEN HOW
8/12/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 THALIA JUL 21 EISEN HOW
8/12/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 WIDANINGS 25 EISEN HOW
8/12/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 115,000 HESTI 22 EISEN HOW
8/19/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 MELA YULY 30 EISEN HOW
8/19/2020 Z48.8 88.79 PROSEDUR Rp 508,200 Rp 105,000 RINI SOPIAN 28 EISEN HOW
8/19/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 FITRI FAUJI 23 EISEN HOW
8/24/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 DEWI MARL 29 EISEN HOW
8/24/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 SUSILAWAT 21 EISEN HOW
8/24/2020 O00.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 LINDA NUR 30 EISEN HOW
8/24/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 NIKE JAYAN 32 EISEN HOW
8/24/2020 C53.9 - PENYAKIT KRp 176,200 Rp 25,000 NANI SUMA 56 EISEN HOW
8/26/2020 Z48.8 88.78 PROSEDUR Rp 281,500 Rp 105,000 ATI KURNIA 32 EISEN HOW
8/26/2020 Z09.8;N92.88.78 PROSEDUR Rp 281,500 Rp 105,000 WINA TANI 30 EISEN HOW
8/26/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 AI ROBIAH 22 EISEN HOW
8/31/2020 N91.2 88.78 PROSEDUR Rp 281,500 Rp 105,000 NUR ASIAH 44 EISEN HOW
8/31/2020 Z34.9 88.78 PROSEDUR Rp 281,500 Rp 105,000 SOVIYANI 28 EISEN HOW
8/31/2020 Z48.0 88.78 PROSEDUR Rp 281,500 Rp 105,000 DEBORA 30 EISEN HOW
Rp 11,443,700 ###
non tindakan
Rp 11,443,700
SEP NO TANGGAL MADIAGNOSA TINDAKAN
0464R00600464R0060820V000018
281,500 1 8/3/2020 Z09.8;I20.9 -
0464R00600464R0060820V000054
281,500 2 8/4/2020 Z71.9;M54.5 -
0464R00600464R0060820V000109
281,500 3 8/4/2020 Z71.9;C50.9 -
0464R00600464R0060820V000155
281,500 4 8/4/2020 Z71.9;C92.1 -
0464R00600464R0060820V000158
281,500 5 8/4/2020 Z09.8;K21.9 90.59
0464R00600464R0060820V000164
508,200 6 8/4/2020 M17.9 -
0464R00600464R0060820V000166
281,500 7 8/4/2020 Z09.8;J20.9 -
0464R00600464R0060820V000168
281,500 8 8/4/2020 Z09.8;I49.3;M17.9 89.52
0464R00600464R0060820V000179
281,500 9 8/4/2020 Z09.8;J20.9 -
0464R00600464R0060820V000180
281,500 10 8/4/2020 Z71.9;R33 -
0464R00600464R0060820V000312
281,500 11 8/4/2020 Z09.8;E11.8 90.59
0464R00600464R0060820V000328
281,500 12 8/4/2020 Z09.8;E11.9;M17.9 -
0464R00600464R0060820V000330
281,500 13 8/4/2020 Z09.8;E11.8 90.59
0464R00600464R0060820V000340
508,200 14 8/4/2020 Z09.8;I50.9 -
0464R00600464R0060820V000342
281,500 15 8/4/2020 Z71.9;A16.2 -
0464R00600464R0060820V000354
508,200 16 8/4/2020 Z09.8;E11.9 90.59
0464R00600464R0060820V000472
281,500 17 8/4/2020 Z09.8;I20.9 90.59
0464R00600464R0060820V000479
281,500 18 8/4/2020 Z09.8;E04.9 -
0464R00600464R0060820V000481
281,500 19 8/4/2020 Z09.8;K80.8 -
0464R00600464R0060820V000483
508,200 20 8/4/2020 Z09.8;J45.9 -
0464R00600464R0060820V000486
281,500 21 8/4/2020 Z09.8;E11.8 -
0464R00600464R0060820V000488
281,500 22 8/4/2020 Z09.8;L04.9 -
0464R00600464R0060820V000500
281,500 23 8/4/2020 Z71.9;C85.1 -
0464R00600464R0060820V000713
281,500 24 8/4/2020 Z09.8;G47.0 -
0464R00600464R0060820V000716
508,200 25 8/4/2020 Z71.9;F33.9 -
0464R00600464R0060820V000717
281,500 26 8/4/2020 Z71.9;I25.1 -
0464R00600464R0060820V000811
281,500 27 8/4/2020 Z71.9;I25.1 -
0464R00600464R0060820V000812
281,500 28 8/5/2020 Z09.8;A16.2 -
0464R00600464R0060820V000815
281,500 29 8/6/2020 Z09.8;E11.9 90.59
0464R00600464R0060820V000818
281,500 30 8/6/2020 Z09.8;A16.2 -
0464R00600464R0060820V000839
176,200 31 8/6/2020 Z09.8;E11.9 90.59
0464R00600464R0060820V000964
281,500 32 8/6/2020 Z09.8;E11.9;I10 90.59
0464R00600464R0060820V000966
281,500 33 8/6/2020 Z71.9;I69.4 -
0464R00600464R0060820V000968
281,500 34 8/6/2020 E04.9 -
0464R00600464R0060820V001176
281,500 35 8/6/2020 Z71.9;D16.5 -
0464R00600464R0060820V001192
281,500 36 8/6/2020 Z09.8;E11.9 90.59
0464R00600464R0060820V001209
281,500 37 8/6/2020 Z09.8;E11.9;I10 90.59
38 8/6/2020 A16.2 -
39 8/6/2020 Z09.8;A16.2 -
40 8/6/2020 Z71.9;F20.9 -
41 8/6/2020 Z09.8;E04.9 -
42 8/6/2020 Z09.8;I50.9 -
43 8/6/2020 Z09.8;J44.9 -
44 8/6/2020 Z71.9;I11.9 -
45 8/6/2020 Z71.9;J44.9 -
46 8/6/2020 Z09.8;I47.1;K21.9 -
47 8/6/2020 Z09.8;K80.8 -
48 8/6/2020 Z09.8;K80.1 -
49 8/6/2020 Z71.9;F41.9 -
50 8/6/2020 Z09.8;E11.9 -
51 8/7/2020 Z09.8;I50.9 -
52 8/7/2020 Z09.8;E11.9;I25.1 -
53 8/7/2020 Z09.8;E11.9 -
54 8/7/2020 Z09.8;E11.9 -
55 8/7/2020 Z09.8;E11.9;I10 90.59
56 8/7/2020 Z09.8;E11.9 90.59
57 8/7/2020 E11.9;I10 90.59
58 8/7/2020 Z09.8;R18;D75.9 -
59 8/7/2020 Z71.9;F20.9 -
60 8/7/2020 Z09.8;E11.9 90.59
61 8/7/2020 Z09.8;E11.9 90.59
62 8/7/2020 Z09.8;K80.8 88.76
63 8/7/2020 Z09.8;E11.9 -
64 8/7/2020 Z09.8;A18.2 90.59
65 8/7/2020 Z71.9;K80.5 -
66 8/7/2020 Z09.8;D24 -
67 8/7/2020 Z03.0 -
68 8/7/2020 Z09.8;J44.9 -
69 8/7/2020 Z09.8;J18.9 -
70 8/11/2020 Z09.8;E11.9;I10 90.59
71 8/11/2020 Z09.8;I11.9 90.59
72 8/11/2020 Z09.8;E11.9 90.59
73 8/11/2020 Z09.8;J45.9 -
74 8/11/2020 Z09.8;I50.9 -
75 8/11/2020 Z09.8;I50.9;M17.9 -
76 8/11/2020 Z09.8;I11.9 -
77 8/11/2020 Z09.8;I11.9 -
78 8/11/2020 Z09.8;I11.9 -
79 8/11/2020 M54.5;K92.1 -
80 8/11/2020 Z09.8;I25.1 -
81 8/11/2020 Z09.8;J44.9 -
82 8/11/2020 Z71.9;G45.9 -
83 8/11/2020 Z09.8;E11.9 90.59
84 8/11/2020 Z09.8;I50.9;K30 -
85 8/11/2020 Z09.8;E11.9;I10 90.59
86 8/11/2020 Z71.9;F42.9 -
87 8/11/2020 Z71.9;F20.9 -
88 8/11/2020 Z71.9;G40.9 -
89 8/11/2020 Z09.8;E11.9 90.59
90 8/11/2020 Z09.8;K21.9;M54.5 -
91 8/11/2020 Z09.8;E11.9 90.59
92 8/11/2020 Z09.8;I50.9;M17.9 90.59
93 8/11/2020 G43.9 -
94 8/11/2020 Z09.8;K21.9 -
95 8/11/2020 Z71.9;I69.4 -
96 8/11/2020 Z71.9;F31.9 -
97 8/11/2020 Z71.9;F20.9 -
98 8/11/2020 Z71.9;G40.9 -
99 8/11/2020 Z71.9;E11.9 -
100 8/11/2020 Z71.9;G40.9 -
101 8/11/2020 Z09.8;K80.8 -
102 8/11/2020 Z71.9;B20.9 -
103 8/11/2020 Z09.8;B20.9 89.52
104 8/13/2020 Z09.8;A18.2 -
105 8/13/2020 Z09.8;E11.9 -
106 8/13/2020 Z09.8;E11.9;K30 -
107 8/13/2020 Z09.8;I50.9 -
108 8/13/2020 Z09.8;E11.9 -
109 8/13/2020 Z09.8;E11.9 -
110 8/13/2020 Z09.8;E11.9 -
111 8/13/2020 Z09.8;E11.9 -
112 8/13/2020 Z09.8;M54.5;M17.9 -
113 8/13/2020 Z09.8;J90 -
114 8/13/2020 Z09.8;J40 -
115 8/13/2020 Z09.8;I11.9 -
116 8/13/2020 Z09.8;I50.9;K30 -
117 8/13/2020 Z09.8;K31.9 -
118 8/13/2020 Z09.8;K21.9 -
119 8/13/2020 Z09.8;I50.9 -
120 8/13/2020 Z09.8;M54.5 -
121 8/13/2020 Z09.8;M54.5 87.44
122 8/13/2020 Z71.9;I64 -
123 8/13/2020 Z09.8;H26.9 -
124 8/13/2020 Z71.9;J45.9 -
125 8/13/2020 Z71.9;N18.5 -
126 8/13/2020 Z09.8;I10 -
127 8/13/2020 Z09.8;A16.2 -
128 8/13/2020 Z09.8;M30.0 -
129 8/13/2020 Z09.8;M17.9 88.27
130 8/13/2020 Z71.9;I25.1 -
131 8/13/2020 Z71.9;F20.9 -
132 8/13/2020 Z09.8;E11.9 -
133 8/13/2020 Z09.8;I11.9 -
134 8/14/2020 Z09.8;E11.9 -
135 8/14/2020 Z09.8;E11.9 90.59
136 8/14/2020 Z09.8;E11.9 90.59
137 8/14/2020 Z09.8;J44.9 -
138 8/14/2020 Z09.8;I50.9 -
139 8/14/2020 Z09.8;E11.9 -
140 8/14/2020 Z09.8;E11.9 90.59
141 8/14/2020 Z09.8;I50.9 -
142 8/14/2020 Z09.8;E11.9 -
143 8/14/2020 Z09.8;I50.9 -
144 8/14/2020 Z09.8;I50.9 -
145 8/14/2020 Z09.8;E11.9 -
146 8/14/2020 Z09.8;E11.9 90.59
147 8/14/2020 Z09.8;J90 -
148 8/14/2020 Z09.8;A49.9 -
149 8/14/2020 Z71.9;K80.8 -
150 8/14/2020 Z71.9;F20.9 -
151 8/14/2020 Z09.8;F20.9 -
152 8/14/2020 Z09.8;I50.9 -
153 8/14/2020 Z09.8;J44.9 -
154 8/18/2020 Z09.8;I50.9 90.59
155 8/18/2020 Z09.8;E11.9 90.59
156 8/18/2020 Z09.8;E11.9;I25.1 90.59
157 8/18/2020 Z09.8;E11.9 90.59
158 8/18/2020 Z09.8;E11.9 90.59
159 8/18/2020 Z09.8;I25.1 90.59
160 8/18/2020 Z09.8;M54.16 90.59
161 8/18/2020 Z09.8;K21.9;K80.8 -
162 8/18/2020 Z09.8;E11.9 90.59
163 8/18/2020 Z09.8;J20.9 90.59
164 8/18/2020 Z09.8;I25.1;I10 -
165 8/18/2020 Z09.8;M54.5 -
166 8/18/2020 Z71.9;F20.9 -
167 8/18/2020 Z09.8;I10 -
168 8/18/2020 Z71.9;I50.9 -
169 8/18/2020 Z09.8;I25.1;E11.9 -
170 8/18/2020 Z71.9;J44.9 -
171 8/18/2020 Z09.8;C18.9 -
172 8/18/2020 Z09.8;K21.9 -
173 8/18/2020 Z09.8;J20.9;K30 -
174 8/18/2020 Z09.8;I50.9 -
175 8/18/2020 Z71.9;A16.5 -
176 8/18/2020 Z71.9;J44.9 -
177 8/18/2020 Z71.9;C20 -
178 8/18/2020 Z71.9;F20.9 -
179 8/16/2020 I61.9 -
180 8/25/2020 Z09.8;E11.9 90.59
181 8/25/2020 Z09.8;E11.9 90.59
182 8/25/2020 Z09.8;I11.9 -
183 8/25/2020 Z09.8;I10 -
184 8/25/2020 Z09.8;E11.9 -
185 8/25/2020 Z09.8;E11.9 -
186 8/25/2020 Z09.8;E11.9 -
187 8/25/2020 Z09.8;E11.9 -
188 8/25/2020 Z09.8;E11.9 90.59
189 8/25/2020 Z09.8;E11.9 -
190 8/25/2020 Z09.8;K21.9 -
191 8/25/2020 Z09.8;E11.9 90.59
192 8/25/2020 Z09.8;I50.9 -
193 8/25/2020 Z09.8;E11.9 -
194 8/25/2020 Z09.8;E11.9 90.59
195 8/25/2020 Z09.8;E11.9 90.59
196 8/25/2020 Z09.8;E11.9 90.59
197 8/25/2020 Z09.8;E11.9 90.59
198 8/25/2020 Z09.8;E11.9 -
199 8/25/2020 Z09.8;I11.9 -
200 8/25/2020 Z71.9;I25.1 -
201 8/25/2020 Z71.9;N18.5 -
202 8/25/2020 Z71.9;J44.9 -
203 8/25/2020 Z09.8;M32.9 -
204 8/25/2020 Z71.9;F20.9 -
205 8/25/2020 Z71.9;J90 -
206 8/25/2020 Z71.9;E11.9 -
207 8/25/2020 Z71.9;D24 -
208 8/25/2020 Z71.9;D24 -
209 8/25/2020 Z71.9;N18.5 -
210 8/25/2020 Z71.9;I25.1 -
211 8/26/2020 Z09.8;E07.9 -
212 8/27/2020 Z09.8;E11.9 90.59
213 8/27/2020 Z09.8;E11.9 -
214 8/27/2020 Z09.8;E11.9 -
215 8/27/2020 Z09.8;E11.9 90.59
216 8/27/2020 Z09.8;M54.16 -
217 8/27/2020 Z09.8;E11.9 -
218 8/27/2020 Z09.8;J44.9 -
219 8/27/2020 Z09.8;E11.9 -
220 8/27/2020 Z09.8;E11.9 90.59
221 8/27/2020 Z09.8;I11.9 -
222 8/27/2020 Z09.8;E11.9 -
223 8/27/2020 Z09.8;E11.9 90.59
224 8/27/2020 Z09.8;E11.9 90.59
225 8/27/2020 Z09.8;E11.9 90.59
226 8/27/2020 Z71.9;G40.9 -
227 8/27/2020 Z09.8;I11.9 -
228 8/27/2020 Z09.8;I50.9 -
229 8/27/2020 Z09.8;N20.9 -
230 8/27/2020 Z09.8;E05.9 -
231 8/27/2020 Z09.8;M13.9 90.59
232 8/27/2020 Z71.9;M32.9 -
233 8/27/2020 Z09.8;J44.9 -
234 8/27/2020 Z09.8;J45.9 -
235 8/27/2020 Z09.8;E11.9 -
236 8/27/2020 Z09.8;E11.9 -
237 8/27/2020 Z09.8;E11.9 -
238 8/27/2020 Z09.8;I50.9 -
239 8/27/2020 Z09.8;K40.9 -
240 8/27/2020 Z71.9;G40.9 -
241 8/27/2020 Z71.9;G40.9 -
242 8/27/2020 Z71.9;I11.9 -
243 8/27/2020 Z71.9;N18.9 -
244 8/27/2020 Z09.8;E11.9 -
245 8/28/2020 Z09.8;E11.9 90.59
246 8/28/2020 Z09.8;E11.9 90.59
247 8/28/2020 Z09.8;M17.9 90.59
248 8/28/2020 Z09.8;E11.9 90.59
249 8/28/2020 Z09.8;E11.9 90.59
250 8/28/2020 Z09.8;J44.9 -
251 8/28/2020 Z09.8;E11.9 -
252 8/28/2020 Z09.8;E11.9 90.59
253 8/28/2020 Z09.8;E11.9 90.59
254 8/28/2020 Z71.9;C34.9 -
255 8/28/2020 I10 -
256 8/28/2020 Z09.8;E11.9;I10 90.59
257 8/28/2020 Z09.8;E11.9 90.59
258 8/28/2020 Z71.9;J44.9 -
259 8/28/2020 Z09.8;A16.2 -
260 8/28/2020 Z09.8;E05.9 -
261 8/28/2020 Z09.8;E11.9 90.59
262 8/28/2020 Z09.8;R10.4 -
263 8/28/2020 Z09.8;I25.1;I10 -
264 8/28/2020 Z09.8;E11.9 90.59
265 8/28/2020 Z09.8;E11.9 90.59
266 8/28/2020 Z09.8;A18.2 -
267 8/28/2020 Z09.8;E05.9 -
268 8/28/2020 Z09.8;J02.9 90.59
269 8/28/2020 Z09.8;E11.9;I10 90.59
270 8/28/2020 Z09.8;J02.9 -
271 8/28/2020 Z09.8;J44.9 -
272 8/28/2020 Z71.9;I25.1 -
273 8/28/2020 Z71.9;F20.9 -
274 8/28/2020 Z71.9;C34.9 -
275 8/28/2020 Z09.8;J44.9;I10 -
276 8/28/2020 Z09.8;R13 -
dalam

Rp 176,200 Rp 25,000 UMI SUMIA
### 36 HELENTINA0464R00600464R0060820V000037
176,200
Rp 121,700 Rp 25,000 SUPRIATN
### 65 HELENTINA0464R00600464R0060820V000087
121,700
Rp 121,700 Rp 25,000 IROS ### 50 HELENTINA0464R00600464R0060820V000088
121,700
Rp 121,700 Rp 25,000 IMAN GUN
### 24 HELENTINA0464R00600464R0060820V000090
121,700
Rp 176,200 Rp 55,000 TIA SOPIAN
### 28 HELENTINA0464R00600464R0060820V000092
176,200
Rp 176,200 Rp 25,000 ENTIN ### 54 HELENTINA0464R00600464R0060820V000094
176,200
Rp 176,200 Rp 25,000 ACIH ### 72 HELENTINA0464R00600464R0060820V000095
176,200
Rp 176,200 Rp 70,000 NINING###
NU 45 HELENTINA0464R00600464R0060820V000096
176,200
Rp 176,200 Rp 25,000 TUTI ### 48 HELENTINA0464R00600464R0060820V000097
176,200
Rp 121,700 Rp 25,000 OLIH HIDA
### 65 HELENTINA0464R00600464R0060820V000100
121,700
Rp 176,200 Rp 90,000 SITI KUSLI
### 60 HELENTINA0464R00600464R0060820V000101
176,200
Rp 176,200 Rp 25,000 ONENG### 63 HELENTINA0464R00600464R0060820V000103
176,200
Rp 176,200 Rp 45,000 OMAN ###
KU 67 HELENTINA0464R00600464R0060820V000105
176,200
Rp 176,200 Rp 25,000 YULIANTI
### 21 HELENTINA0464R00600464R0060820V000108
176,200
Rp 121,700 Rp 25,000 HOTIPAH### 66 HELENTINA0464R00600464R0060820V000110
121,700
Rp 176,200 Rp 45,000 UUM ### 62 HELENTINA0464R00600464R0060820V000111
176,200
Rp 176,200 Rp 55,000 LIAN SITI
### 39 HELENTINA0464R00600464R0060820V000113
176,200
Rp 176,200 Rp 25,000 SRI NUR###
D 48 HELENTINA0464R00600464R0060820V000115
176,200
Rp 176,200 Rp 25,000 IMAS SUMI
### 31 HELENTINA0464R00600464R0060820V000118
176,200
Rp 176,200 Rp 25,000 ANI SURYA
### 47 HELENTINA0464R00600464R0060820V000120
176,200
Rp 176,200 Rp 25,000 WIWI DARI
### 63 HELENTINA0464R00600464R0060820V000121
176,200
Rp 176,200 Rp 25,000 INDRI ASTU
### 22 HELENTINA0464R00600464R0060820V000124
176,200
Rp 121,700 Rp 25,000 ADE HIDAY
### 60 HELENTINA0464R00600464R0060820V000129
121,700
Rp 176,200 Rp 25,000 DADI ADIA
### 40 HELENTINA0464R00600464R0060820V000131
176,200
Rp 121,700 Rp 25,000 OMAN ###
KUS 48 HELENTINA0464R00600464R0060820V000134
121,700
Rp 121,700 Rp 25,000 TATI SURYA
### 62 HELENTINA0464R00600464R0060820V000135
121,700
Rp 121,700 Rp 25,000 DEDE KOM
### 48 HELENTINA0464R00600464R0060820V000139
121,700
Rp 176,200 Rp 25,000 HALIMAH### 45 HELENTINA0464R00600464R0060820V000165
176,200
Rp 176,200 Rp 65,000 RENI ADIST
### 21 HELENTINA0464R00600464R0060820V000209
176,200
Rp 176,200 Rp 25,000 LINA AZIZA
### 25 HELENTINA0464R00600464R0060820V000213
176,200
Rp 176,200 Rp 45,000 ROHMAH ### 64 HELENTINA0464R00600464R0060820V000214
176,200
Rp 176,200 Rp 60,000 YANI ### 52 HELENTINA0464R00600464R0060820V000216
176,200
Rp 121,700 Rp 25,000 EUTIK ### 64 HELENTINA0464R00600464R0060820V000218
121,700
Rp 176,200 Rp 25,000 RIBKA ELI
### 22 HELENTINA0464R00600464R0060820V000219
176,200
Rp 121,700 Rp 25,000 DEWI YUN
### 32 HELENTINA0464R00600464R0060820V000220
121,700
Rp 176,200 Rp 45,000 AI ROHAN
### 60 HELENTINA0464R00600464R0060820V000223
176,200
Rp 176,200 Rp 45,000 SARSIH### 50 HELENTINA0464R00600464R0060820V000224
176,200
Rp 176,200 Rp 25,000 TARYANA### 46 HELENTINA0464R00600464R0060820V000226
176,200
Rp 176,200 Rp 25,000 RATNASIH
### 66 HELENTINA0464R00600464R0060820V000228
176,200
Rp 121,700 Rp 25,000 MOHAMAD### 41 HELENTINA0464R00600464R0060820V000229
121,700
Rp 176,200 Rp 25,000 SURYATI ### 37 HELENTINA0464R00600464R0060820V000230
176,200
Rp 176,200 Rp 25,000 RUKMINI ### 57 HELENTINA0464R00600464R0060820V000232
176,200
Rp 176,200 Rp 25,000 AI RISMAW
### 64 HELENTINA0464R00600464R0060820V000234
176,200
Rp 121,700 Rp 25,000 ICANG ###
RU 55 HELENTINA0464R00600464R0060820V000237
121,700
Rp 121,700 Rp 25,000 CUCU ### 67 HELENTINA0464R00600464R0060820V000241
121,700
Rp 176,200 Rp 25,000 TINI NURJA
### 41 HELENTINA0464R00600464R0060820V000247
176,200
Rp 176,200 Rp 70,000 DEDE JUM### 54 HELENTINA0464R00600464R0060820V000249
176,200
Rp 176,200 Rp 25,000 ANIS ### 44 HELENTINA0464R00600464R0060820V000251
176,200
Rp 121,700 Rp 25,000 ROHATI### 53 HELENTINA0464R00600464R0060820V000253
121,700
Rp 176,200 Rp 25,000 NANA ### 60 HELENTINA0464R00600464R0060820V000255
176,200
Rp 176,200 Rp 25,000 HJ WASINI
### 75 HELENTINA0464R00600464R0060820V000266
176,200
Rp 176,200 Rp 25,000 SITI ANALI
### 54 HELENTINA0464R00600464R0060820V000267
176,200
Rp 176,200 Rp 25,000 HJ. SITI###
D 74 HELENTINA0464R00600464R0060820V000268
176,200
Rp 176,200 Rp 25,000 ROBBY###SET 41 HELENTINA0464R00600464R0060820V000269
176,200
Rp 176,200 Rp 45,000 NURHAYAT### 32 HELENTINA0464R00600464R0060820V000270
176,200
Rp 176,200 Rp 45,000 IJAH HADI
### 60 HELENTINA0464R00600464R0060820V000271
176,200
Rp 176,200 Rp 75,000 IMAS HODI
### 58 HELENTINA0464R00600464R0060820V000272
176,200
Rp 176,200 Rp 25,000 AHMAD### 52 HELENTINA0464R00600464R0060820V000274
176,200
Rp 121,700 Rp 25,000 ASIKIN### 39 HELENTINA0464R00600464R0060820V000276
121,700
Rp 176,200 Rp 45,000 YULIAH### 63 HELENTINA0464R00600464R0060820V000277
176,200
Rp 176,200 Rp 100,000 EUIS ### 39 HELENTINA0464R00600464R0060820V000278
176,200
Rp 508,200 Rp 169,000 IMAS SUMI
### 31 HELENTINA0464R00600464R0060820V000279
508,200
Rp 176,200 Rp 25,000 IYAM ### 55 HELENTINA0464R00600464R0060820V000282
176,200
Rp 176,200 Rp 105,000 SUTIJA###
DE 24 HELENTINA0464R00600464R0060820V000283
176,200
Rp 121,700 Rp 25,000 AI SARININ
### 40 HELENTINA0464R00600464R0060820V000285
121,700
Rp 176,200 Rp 25,000 EULIS PIAN
### 47 HELENTINA0464R00600464R0060820V000286
176,200
Rp 176,200 Rp 25,000 SARIPUDIN
### 54 HELENTINA0464R00600464R0060820V000287
176,200
Rp 176,200 Rp 25,000 MUHAMAD ### 51 HELENTINA0464R00600464R0060820V000291
176,200
Rp 176,200 Rp 25,000 SUSI MUST
### 57 HELENTINA0464R00600464R0060820V000292
176,200
Rp 176,200 Rp 85,000 EULIS ### 50 HELENTINA0464R00600464R0060820V000385
176,200
Rp 176,200 Rp 55,000 SRI ROHAE
### 64 HELENTINA0464R00600464R0060820V000388
176,200
Rp 176,200 Rp 45,000 ATIK KURN
### 61 HELENTINA0464R00600464R0060820V000389
176,200
Rp 176,200 Rp 25,000 ENTIN MAR
### 78 HELENTINA0464R00600464R0060820V000390
176,200
Rp 176,200 Rp 25,000 CICIH ### 51 HELENTINA0464R00600464R0060820V000391
176,200
Rp 176,200 Rp 25,000 YAYAH### 66 HELENTINA0464R00600464R0060820V000393
176,200
Rp 176,200 Rp 25,000 AAH ### 61 HELENTINA0464R00600464R0060820V000395
176,200
Rp 176,200 Rp 25,000 TINAH #S## 66 HELENTINA0464R00600464R0060820V000399
176,200
Rp 176,200 Rp 25,000 AI WANGSI
### 46 HELENTINA0464R00600464R0060820V000400
176,200
Rp 176,200 Rp 25,000 MAMAT ###
JU 54 HELENTINA0464R00600464R0060820V000402
176,200
Rp 176,200 Rp 25,000 RUDI CAH### 38 HELENTINA0464R00600464R0060820V000404
176,200
Rp 176,200 Rp 25,000 HALIMAH ### 62 HELENTINA0464R00600464R0060820V000406
176,200
Rp 121,700 Rp 25,000 IR DARMA### 65 HELENTINA0464R00600464R0060820V000408
121,700
Rp 176,200 Rp 45,000 DODI BAHA
### 54 HELENTINA0464R00600464R0060820V000409
176,200
Rp 176,200 Rp 25,000 OJA ### 75 HELENTINA0464R00600464R0060820V000410
176,200
Rp 176,200 Rp 60,000 ASNA SIMA
### 46 HELENTINA0464R00600464R0060820V000415
176,200
Rp 121,700 Rp 25,000 RINI MULY
### 28 HELENTINA0464R00600464R0060820V000416
121,700
Rp 121,700 Rp 25,000 JAJANG### N 33 HELENTINA0464R00600464R0060820V000417
121,700
Rp 121,700 Rp 25,000 ARIESZA ###
D 34 HELENTINA0464R00600464R0060820V000419
121,700
Rp 176,200 Rp 45,000 ROKAYAH ### 68 HELENTINA0464R00600464R0060820V000420
176,200
Rp 176,200 Rp 25,000 ALIS NURH
### 44 HELENTINA0464R00600464R0060820V000421
176,200
Rp 176,200 Rp 75,000 IYUS YUSR
### 69 HELENTINA0464R00600464R0060820V000425
176,200
Rp 176,200 Rp 75,000 TOTO KOK### 67 HELENTINA0464R00600464R0060820V000427
176,200
Rp 176,200 Rp 25,000 AGIAN### 29 HELENTINA0464R00600464R0060820V000429
176,200
### 41 HELENTINA0464R00600464R0060820V000432
176,200
121,700
Rp 121,700 Rp 25,000 YANA SUR### 37 HELENTINA0464R00600464R0060820V000435
121,700
Rp 121,700 Rp 25,000 RAHMAT ### 37 HELENTINA0464R00600464R0060820V000436
121,700
Rp 121,700 Rp 25,000 SITI KHODI
### 30 HELENTINA0464R00600464R0060820V000440
121,700
Rp 121,700 Rp 25,000 HARRY### KU 31 HELENTINA0464R00600464R0060820V000443
121,700
Rp 121,700 Rp 25,000 SAJAR RA### 24 HELENTINA0464R00600464R0060820V000446
121,700
Rp 176,200 Rp 25,000 DEDE JUM### 54 HELENTINA0464R00600464R0060820V000454
176,200
Rp 121,700 Rp 25,000 YOPI SUTR
### 32 HELENTINA0464R00600464R0060820V000456
121,700
Rp 176,200 Rp 70,000 ARIEF PUT
### 27 HELENTINA0464R00600464R0060820V000457
176,200
Rp 176,200 Rp 40,000 RUDI ### 44 HELENTINA0464R00600464R0060820V000541
176,200
Rp 176,200 Rp 60,000 ANENG### KAR 42 HELENTINA0464R00600464R0060820V000542
176,200
Rp 176,200 Rp 25,000 ANENG### KU 57 HELENTINA0464R00600464R0060820V000544
176,200
Rp 176,200 Rp 105,000 ENCAR### 76 HELENTINA0464R00600464R0060820V000545
176,200
Rp 176,200 Rp 25,000 TAMIM### SU 70 HELENTINA0464R00600464R0060820V000546
176,200
Rp 176,200 Rp 60,000 SITI AISAH
### 68 HELENTINA0464R00600464R0060820V000548
176,200
176,200
Rp 176,200 Rp 45,000 MAMAT HE002417.61 HELENTINA0464R00600464R0060820V000552
176,200
Rp 176,200 Rp 25,000 ITO SUMIA
### 75 HELENTINA0464R00600464R0060820V000555
176,200
Rp 176,200 Rp 25,000 ATIK SUHA
### 33 HELENTINA0464R00600464R0060820V000558
176,200
Rp 176,200 Rp 25,000 LILIS ROHA
### 50 HELENTINA0464R00600464R0060820V000562
176,200
Rp 176,200 Rp 25,000 ROBIAH### 75 HELENTINA0464R00600464R0060820V000564
176,200
Rp 176,200 Rp 25,000 DRA.H ###
NU 68 HELENTINA0464R00600464R0060820V000565
176,200
Rp 176,200 Rp 70,000 APONG### SA 42 HELENTINA0464R00600464R0060820V000567
176,200
Rp 176,200 Rp 25,000 PELLIS ###
SET 29 HELENTINA0464R00600464R0060820V000568
176,200
Rp 176,200 Rp 25,000 SUSI MUST
### 57 HELENTINA0464R00600464R0060820V000570
176,200
Rp 176,200 Rp 25,000 TUGIRAN ### 75 HELENTINA0464R00600464R0060820V000571
176,200
Rp 176,200 Rp 90,000 DEDEH### WID 52 HELENTINA0464R00600464R0060820V000572
176,200
Rp 121,700 Rp 25,000 ENDANG ###S 57 HELENTINA0464R00600464R0060820V000573
121,700
Rp 176,200 Rp 25,000 CECEP ###
LIN 56 HELENTINA0464R00600464R0060820V000575
176,200
Rp 121,700 Rp 25,000 ENOK ### 67 HELENTINA0464R00600464R0060820V000577
121,700
Rp 121,700 Rp 25,000 ATIKAH### 45 HELENTINA0464R00600464R0060820V000578
121,700
Rp 176,200 Rp 25,000 NANIH### 58 HELENTINA0464R00600464R0060820V000579
176,200
Rp 176,200 Rp 95,000 PUTRIANI### 30 HELENTINA0464R00600464R0060820V000581
176,200
Rp 176,200 Rp 50,000 SUPRIATN### 65 HELENTINA0464R00600464R0060820V000583
176,200
Rp 176,200 Rp 145,000 ENTIN ### 54 HELENTINA0464R00600464R0060820V000584
176,200
Rp 121,700 Rp 25,000 IDIN TARM
### 66 HELENTINA0464R00600464R0060820V000588
121,700
Rp 121,700 Rp 25,000 MULYATI### 21 HELENTINA0464R00600464R0060820V000589
121,700
Rp 176,200 Rp 25,000 IWAN HER
### 50 HELENTINA0464R0060 0464R0060820V000590
176,200
Rp 176,200 Rp 25,000 YATI ### 57 HELENTINA0464R00600464R0060820V000594
176,200
Rp 176,200 Rp 85,000 TITIN SUM024446..56 HELENTINA0464R00600464R0060820V000603
176,200
Rp 176,200 Rp 60,000 URPAN###YU 61 HELENTINA0464R00600464R0060820V000604
176,200
Rp 176,200 Rp 60,000 DEWI KURA
### 41 HELENTINA0464R0060 0464R0060820V000606
176,200
Rp 176,200 Rp 45,000 AISYAH### 67 HELENTINA0464R00600464R0060820V000607
176,200
Rp 176,200 Rp 25,000 EUIS KOMA
### 65 HELENTINA0464R00600464R0060820V000608
176,200
Rp 176,200 Rp 25,000 RAHMAT ### 65 HELENTINA0464R00600464R0060820V000609
176,200
Rp 176,200 Rp 85,000 INA MARLI
### 67 HELENTINA0464R0060 0464R0060820V000611
176,200
Rp 176,200 Rp 25,000 SUMIATI### 63 HELENTINA0464R00600464R0060820V000613
176,200
Rp 176,200 Rp 70,000 IMAS ### 60 HELENTINA0464R00600464R0060820V000615
176,200
Rp 176,200 Rp 25,000 MIRA ### 30 HELENTINA0464R00600464R0060820V000619
176,200
Rp 176,200 Rp 25,000 H. SUPARM
### 71 HELENTINA0464R0060 0464R0060820V000620
176,200
Rp 176,200 Rp 45,000 SUMARNA### 53 HELENTINA0464R00600464R0060820V000621
176,200
Rp 176,200 Rp 45,000 MIMIN###SU 62 HELENTINA0464R00600464R0060820V000622
176,200
Rp 176,200 Rp 25,000 ROHMAN ### 26 HELENTINA0464R0060 0464R0060820V000623
176,200
Rp 176,200 Rp 25,000 SITI NURA
### 26 HELENTINA0464R00600464R0060820V000624
176,200
Rp 121,700 Rp 25,000 TINI ASTRI
### 26 HELENTINA0464R00600464R0060820V000625
121,700
Rp 121,700 Rp 25,000 DUDU DU### 44 HELENTINA0464R00600464R0060820V000626
121,700
Rp 176,200 Rp 25,000 ASEP ROHE
### 38 HELENTINA0464R0060 0464R0060820V000627
176,200
Rp 176,200 Rp 25,000 SUTI RAHA
### 63 HELENTINA0464R00600464R0060820V000629
176,200
Rp 176,200 Rp 25,000 IWA GARN
### 62 HELENTINA0464R00600464R0060820V000631
176,200
Rp 176,200 Rp 45,000 JUARIAH### 51 HELENTINA0464R00600464R0060820V000648
176,200
Rp 176,200 Rp 45,000 TONI ### 51 HELENTINA0464R00600464R0060820V000650
176,200
Rp 176,200 Rp 60,000 NANDANG### 56 HELENTINA0464R0060 0464R0060820V000652
176,200
Rp 176,200 Rp 75,000 AMID SAEP024205.66 HELENTINA0464R00600464R0060820V000653
176,200
Rp 176,200 Rp 60,000 NONENG ### 59 HELENTINA0464R00600464R0060820V000655
176,200
Rp 176,200 Rp 100,000 YAYAN###
RO 63 HELENTINA0464R0060 0464R0060820V000657
176,200
Rp 176,200 Rp 70,000 ALIS NURH
### 44 HELENTINA0464R00600464R0060820V000660
176,200
### 41 HELENTINA0464R00600464R0060820V000664
176,200
Rp 176,200 Rp 75,000 NENI MARD
### 51 HELENTINA0464R00600464R0060820V000665
176,200
Rp 176,200 Rp 45,000 ASNA SIMA
### 46 HELENTINA0464R0060 0464R0060820V000668
176,200
Rp 176,200 Rp 25,000 YAYAH###
YUL 45 HELENTINA0464R00600464R0060820V000670
176,200
Rp 176,200 Rp 25,000 H. ENDANG
### 70 HELENTINA0464R00600464R0060820V000671
176,200
Rp 121,700 Rp 25,000 AE KOPWA
### 43 HELENTINA0464R00600464R0060820V000672
121,700
Rp 176,200 Rp 25,000 WIDY SAP
### 53 HELENTINA0464R0060 0464R0060820V000673
176,200
Rp 121,700 Rp 25,000 BUDIYANT
### 50 HELENTINA0464R00600464R0060820V000674
121,700
Rp 176,200 Rp 25,000 ROSYID###
NU 72 HELENTINA0464R00600464R0060820V000677
176,200
Rp 121,700 Rp 25,000 UNDANG ###H 79 HELENTINA0464R00600464R0060820V000680
121,700
Rp 176,200 Rp 25,000 NASUHI### 72 HELENTINA0464R0060 0464R0060820V000684
176,200
Rp 176,200 Rp 25,000 USEP HIDA
### 44 HELENTINA0464R00600464R0060820V000685
176,200
Rp 176,200 Rp 25,000 SAMIYEM### 39 HELENTINA0464R00600464R0060820V000686
176,200
Rp 176,200 Rp 25,000 AYAT HIDA
### 88 HELENTINA0464R00600464R0060820V000690
176,200
Rp 121,700 Rp 25,000 EDI ### 84 HELENTINA0464R0060 0464R0060820V000692
121,700
Rp 121,700 Rp 25,000 SUHMID ### 54 HELENTINA0464R00600464R0060820V000693
121,700
Rp 121,700 Rp 25,000 DENIH ###
WIY 47 HELENTINA0464R00600464R0060820V000694
121,700
Rp 121,700 Rp 25,000 YOGI OKTA
### 23 HELENTINA0464R00600464R0060820V000696
121,700
Rp 126,800 Rp 20,000 LILIS NURH
### 48 HELENTINA0464R00600464R0060820V000782
126,800
Rp 176,200 Rp 45,000 ROKAYAH### 64 HELENTINA0464R00600464R0060820V000894
176,200
Rp 176,200 Rp 45,000 A WANDA### 72 HELENTINA0464R00600464R0060820V000896
176,200
Rp 176,200 Rp 25,000 CUCU SUPR
### 44 HELENTINA0464R00600464R0060820V000898
176,200
Rp 176,200 Rp 25,000 TATI SUHA
### 42 HELENTINA0464R00600464R0060820V000899
176,200
Rp 176,200 Rp 85,000 DUDI SUH
### 67 HELENTINA0464R00600464R0060820V000900
176,200
Rp 176,200 Rp 60,000 MAMAN, ###S 80 HELENTINA0464R00600464R0060820V000901
176,200
Rp 176,200 Rp 60,000 TRIYADI### 60 HELENTINA0464R00600464R0060820V000903
176,200
Rp 176,200 Rp 45,000 NINAH### 72 HELENTINA0464R00600464R0060820V000906
176,200
Rp 176,200 Rp 45,000 ELIS SLIWA
### 52 HELENTINA0464R00600464R0060820V000907
176,200
Rp 176,200 Rp 25,000 DESKA ###
ARI 25 HELENTINA0464R00600464R0060820V000908
176,200
Rp 176,200 Rp 50,000 YATI ### 54 HELENTINA0464R00600464R0060820V000909
176,200
Rp 176,200 Rp 45,000 DENNY###RU 48 HELENTINA0464R00600464R0060820V000910
176,200
Rp 176,200 Rp 25,000 TATI ROHA
### 66 HELENTINA0464R00600464R0060820V000912
176,200
Rp 176,200 Rp 45,000 AYI ### 50 HELENTINA0464R00600464R0060820V000913
176,200
Rp 176,200 Rp 75,000 JUARIAH### 57 HELENTINA0464R00600464R0060820V000914
176,200
Rp 176,200 Rp 45,000 MAMAH ###
HA 64 HELENTINA0464R00600464R0060820V000915
176,200
Rp 176,200 Rp 75,000 MUSJAFAK
### 65 HELENTINA0464R00600464R0060820V000916
176,200
Rp 176,200 Rp 45,000 AYI RUKMA
### 62 HELENTINA0464R00600464R0060820V000919
176,200
Rp 176,200 Rp 45,000 ABDUROC### 54 HELENTINA0464R00600464R0060820V000921
176,200
Rp 176,200 Rp 45,000 IKA KARTIK
### 64 HELENTINA0464R00600464R0060820V000922
176,200
Rp 121,700 Rp 20,000 ENDANG ###T 60 HELENTINA0464R00600464R0060820V000934
121,700
Rp 121,700 Rp 25,000 EPON ### 66 HELENTINA0464R00600464R0060820V000936
121,700
Rp 121,700 Rp 25,000 EPON ### 54 HELENTINA0464R00600464R0060820V000938
121,700
Rp 176,200 Rp 25,000 DESY GUN
### 30 HELENTINA0464R00600464R0060820V000941
176,200
Rp 121,700 Rp 25,000 HENDRI HE012671.31 HELENTINA0464R00600464R0060820V000942
121,700
Rp 121,700 Rp 25,000 ADANG### 71 HELENTINA0464R00600464R0060820V000944
121,700
Rp 121,700 Rp 25,000 ANI JUHAN001481.84 HELENTINA0464R00600464R0060820V000945
121,700
Rp 121,700 Rp 25,000 OMON### RAS 71 HELENTINA0464R00600464R0060820V000946
121,700
Rp 121,700 Rp 25,000 ANI SUPAR
### 53 HELENTINA0464R00600464R0060820V000949
121,700
Rp 121,700 Rp 25,000 DANIAWAN
### 44 HELENTINA0464R00600464R0060820V000953
121,700
Rp 121,700 Rp 25,000 H. OCIM### 53 HELENTINA0464R00600464R0060820V000957
121,700
Rp 176,200 Rp 25,000 NONO ###
WA 34 HELENTINA0464R00600464R0060820V000989
176,200
Rp 176,200 Rp 45,000 NETTI PAN
### 55 HELENTINA0464R00600464R0060820V001025
176,200
Rp 176,200 Rp 25,000 AI RATNIN
### 64 HELENTINA0464R00600464R0060820V001029
176,200
Rp 176,200 Rp 135,000 HADIJAH### 66 HELENTINA0464R00600464R0060820V001030
176,200
Rp 176,200 Rp 105,000 PARTIAH 017308.66 HELENTINA0464R00600464R0060820V001032
176,200
Rp 176,200 Rp 25,000 ISKANDAR
### 56 HELENTINA0464R00600464R0060820V001033
176,200
Rp 176,200 Rp 45,000 SUYONO ### 64 HELENTINA0464R00600464R0060820V001035
176,200
Rp 176,200 Rp 25,000 SRI MULIA
### 63 HELENTINA0464R00600464R0060820V001036
176,200
Rp 176,200 Rp 45,000 KONIH ###
HE 79 HELENTINA0464R00600464R0060820V001039
176,200
Rp 176,200 Rp 45,000 ADE RAHM
### 60 HELENTINA0464R00600464R0060820V001041
176,200
Rp 176,200 Rp 55,000 E. RUSYATI
### 82 HELENTINA0464R00600464R0060820V001043
176,200
Rp 176,200 Rp 45,000 ONENG### NE 61 HELENTINA0464R0060 0464R0060820V001045
176,200
Rp 176,200 Rp 90,000 NURYETI### 62 HELENTINA0464R00600464R0060820V001047
176,200
Rp 176,200 Rp 45,000 ASEP HIDA
### 56 HELENTINA0464R00600464R0060820V001049
176,200
Rp 176,200 Rp 45,000 HJ.EUIS###
WI 62 HELENTINA0464R00600464R0060820V001050
176,200
Rp 121,700 Rp 25,000 FANNY###YUL 34 HELENTINA0464R0060 0464R0060820V001053
121,700
Rp 176,200 Rp 25,000 SITI ROHA
### 77 HELENTINA0464R00600464R0060820V001055
176,200
Rp 176,200 Rp 25,000 ASEP RAH 003954..58 HELENTINA0464R00600464R0060820V001056
176,200
Rp 176,200 Rp 25,000 ANWAR### EF 30 HELENTINA0464R00600464R0060820V001058
176,200
Rp 176,200 Rp 25,000 RINI ANGRA
### 33 HELENTINA0464R0060 0464R0060820V001063
176,200
Rp 176,200 Rp 60,000 NURLIATY
### 62 HELENTINA0464R00600464R0060820V001068
176,200
Rp 121,700 Rp 25,000 DWI MEIKA
### 43 HELENTINA0464R00600464R0060820V001071
121,700
Rp 176,200 Rp 25,000 SAING ###
BUD 53 HELENTINA0464R00600464R0060820V001073
176,200
Rp 176,200 Rp 25,000 HALIMAH### 45 HELENTINA0464R0060 0464R0060820V001074
176,200
Rp 176,200 Rp 25,000 KOSWARA### 60 HELENTINA0464R00600464R0060820V001076
176,200
Rp 176,200 Rp 60,000 RUHIYAT### 77 HELENTINA0464R00600464R0060820V001080
176,200
Rp 176,200 Rp 25,000 ASEP SODI
### 65 HELENTINA0464R0060 0464R0060820V001082
176,200
Rp 176,200 Rp 25,000 DODI BAHA
### 54 HELENTINA0464R00600464R0060820V001083
176,200
Rp 176,200 Rp 25,000 HOLILUDIN
### 70 HELENTINA0464R00600464R0060820V001084
176,200
Rp 121,700 Rp 25,000 RISKA DEW
### 23 HELENTINA0464R00600464R0060820V001086
121,700
Rp 121,700 Rp 25,000 DEDE NENG
### 58 HELENTINA0464R0060 0464R0060820V001087
121,700
Rp 121,700 Rp 25,000 MAMAN ###PE 71 HELENTINA0464R00600464R0060820V001090
121,700
Rp 121,700 Rp 25,000 NENI DARY
### 58 HELENTINA0464R00600464R0060820V001091
121,700
Rp 176,200 Rp 45,000 PUTRIANI
### 30 HELENTINA0464R00600464R0060820V001092
176,200
Rp 176,200 Rp 45,000 PARLAUNG
### 73 HELENTINA0464R00600464R0060820V001115
176,200
Rp 176,200 Rp 45,000 OMAH### 56 HELENTINA0464R0060 0464R0060820V001116
176,200
Rp 176,200 Rp 40,000 DEDEN###SU 56 HELENTINA0464R00600464R0060820V001117
176,200
Rp 176,200 Rp 60,000 ENTIN WA
### 65 HELENTINA0464R00600464R0060820V001118
176,200
Rp 176,200 Rp 55,000 SUSI SUMA
### 44 HELENTINA0464R0060 0464R0060820V001119
176,200
Rp 176,200 Rp 25,000 ATANG### 67 HELENTINA0464R00600464R0060820V001120
176,200
Rp 176,200 Rp 25,000 NANI SURY
### 51 HELENTINA0464R00600464R0060820V001121
176,200
Rp 176,200 Rp 45,000 RONI SUPR
### 43 HELENTINA0464R00600464R0060820V001123
176,200
Rp 176,200 Rp 105,000 ROKAYAH### 43 HELENTINA0464R0060 0464R0060820V001124
176,200
Rp 121,700 Rp 25,000 NANI SURY
### 47 HELENTINA0464R00600464R0060820V001125
121,700
Rp 176,200 Rp 25,000 KARWATI### 50 HELENTINA0464R00600464R0060820V001126
176,200
Rp 176,200 Rp 45,000 TATANG ### 53 HELENTINA0464R00600464R0060820V001127
176,200
Rp 176,200 Rp 75,000 NONENG ###S 60 HELENTINA0464R0060 0464R0060820V001128
176,200
Rp 121,700 Rp 25,000 BENNY###AUR 58 HELENTINA0464R00600464R0060820V001129
121,700
Rp 176,200 Rp 25,000 ONIH ### 73 HELENTINA0464R00600464R0060820V001131
176,200
Rp 176,200 Rp 25,000 NANI ### 59 HELENTINA0464R00600464R0060820V001132
176,200
Rp 176,200 Rp 75,000 WIWI SRI
### 55 HELENTINA0464R0060 0464R0060820V001134
176,200
Rp 176,200 Rp 25,000 ARIEF PUT
### 27 HELENTINA0464R00600464R0060820V001135
176,200
Rp 176,200 Rp 25,000 NASIH ### 68 HELENTINA0464R00600464R0060820V001136
176,200
Rp 176,200 Rp 45,000 MAEMUNA### 52 HELENTINA0464R00600464R0060820V001137
176,200
Rp 176,200 Rp 60,000 ENTIS AMI
### 53 HELENTINA0464R0060 0464R0060820V001139
176,200
Rp 176,200 Rp 25,000 AMANAH ### 56 HELENTINA0464R00600464R0060820V001140
176,200
Rp 176,200 Rp 25,000 SURYATI### 37 HELENTINA0464R00600464R0060820V001141
176,200
Rp 176,200 Rp 65,000 EULIS D###
KU 58 HELENTINA0464R00600464R0060820V001142
176,200
Rp 176,200 Rp 60,000 N.SUMINA
### 73 HELENTINA0464R00600464R0060820V001144
176,200
Rp 176,200 Rp 25,000 DEWI ### 29 HELENTINA0464R00600464R0060820V001145
176,200
Rp 176,200 Rp 25,000 EMI MARYA
### 70 HELENTINA0464R00600464R0060820V001146
176,200
Rp 121,700 Rp 25,000 SANUSI### 60 HELENTINA0464R00600464R0060820V001147
121,700
Rp 121,700 Rp 25,000 ENTIS ### 32 HELENTINA0464R00600464R0060820V001150
121,700
Rp 121,700 Rp 25,000 ROHAYA ### 54 HELENTINA0464R00600464R0060820V001151
121,700
Rp 176,200 Rp 25,000 ENTIN KART
### 48 HELENTINA0464R00600464R0060820V001153
176,200
Rp 176,200 Rp 25,000 SUTI RAHA
### 63 HELENTINA0464R00600464R0060820V001154
176,200
Rp 45,480,300 Rp 10,649,000
Rp 45,480,300
lab 92
ro 3
anak
NO TANGGAL MADIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA DPJP

1 8/3/2020 Z09.8;A18.- PENYAKIT
Rp 176,200
KRONIS KECIL
Rp LAIN-LAIN
25,000 RADITYA AR 4 HENNE GIYA
2 8/3/2020 Z09.8;A16.- PENYAKIT
Rp 176,200
KRONIS KECIL
Rp LAIN-LAIN
25,000 ALDIANSYA 5 HENNE GIYA
3 8/3/2020 Z09.8;Z03. - PENYAKIT
Rp 176,200
KRONIS KECIL
Rp LAIN-LAIN
25,000 NANDA SAB 15 HENNE GIYA
4 8/3/2020 Z09.8;N48.- PENYAKIT
Rp 176,200
KRONIS KECIL
Rp LAIN-LAIN
25,000 HABSY ALI 5 HENNE GIYA
5 8/3/2020 Z71.9;A16.- KONSULTASI
Rp 121,700
ATAU PEMERIKSAAN
Rp 25,000 FIANDRA
LAIN-LAIN
RI 15 HENNE GIYA
6 8/3/2020 Z71.9;C71.- KONSULTASI
Rp 121,700
ATAU PEMERIKSAAN
Rp 25,000 HARILAIN-LAIN
RUST 10 HENNE GIYA
7 8/6/2020 Z71.9;A16.- KONSULTASI
Rp 121,700
ATAU PEMERIKSAAN
Rp 25,000 SELLY
LAIN-LAIN
AGH 7 HENNE GIYA
8 8/6/2020 Z09.8;J41. - PENYAKIT
Rp 176,200
KRONIS KECIL
Rp LAIN-LAIN
25,000 BANYU MU 8 HENNE GIYA
9 8/6/2020 Z09.8;G40.- PENYAKIT
Rp 176,200
KRONIS KECIL
Rp LAIN-LAIN
25,000 ABIZAR HAF 2 HENNE GIYA
10 8/6/2020 Z71.9;G40.- KONSULTASI
Rp 121,700
ATAU PEMERIKSAAN
Rp 25,000 WIGITA
LAIN-LAIN
NA 6 HENNE GIYA
11 8/10/2020 Z71.9;M49- KONSULTASI
Rp 121,700
ATAU PEMERIKSAAN
Rp 25,000 REHAN
LAIN-LAIN
ALIF 17 HENNE GIYA
12 8/27/2020 L04.9 - PENYAKIT
Rp 173,400
AKUT KECIL
Rp LAIN-LAIN
25,000 CAHAYA RE 1 HENNE GIYA
13 8/31/2020 Z09.8;A18.- PENYAKIT
Rp 176,200
KRONIS KECIL
Rp LAIN-LAIN
25,000 AMANDA BI 12 HENNE GIYA
14 8/31/2020 Z09.8;R04.90.59 PENYAKIT
Rp 176,200
KRONIS KECIL
Rp LAIN-LAIN
60,000 BAYI NY RES 2 HENNE GIYA
15 8/31/2020 Z09.8;B15.- PENYAKIT
Rp 176,200
KRONIS KECIL
Rp LAIN-LAIN
25,000 GHANIA PU 6 HENNE GIYA
16 8/31/2020 Z09.8;A18.87.44;90.5PENYAKIT
Rp 176,200
KRONIS KECIL
Rp 155,000
LAIN-LAIN
CAHAYA RE 1 HENNE GIYA
17 8/31/2020 Z09.8;J40 - PENYAKIT
Rp 176,200
KRONIS KECIL
Rp LAIN-LAIN
90,000 MUHAMMAD 8 HENNE GIYA
18 8/31/2020 Z71.9;Q21.- KONSULTASI
Rp 121,700
ATAU PEMERIKSAAN
Rp 25,000 MUHAMMAD
LAIN-LAIN 7 HENNE GIYA
19 8/31/2020 Z09.8;G40.- PENYAKIT
Rp 176,200
KRONIS KECIL
Rp LAIN-LAIN
25,000 NAZWA SAL 5 HENNE GIYA
20 8/31/2020 Z03.0 - PENYAKIT
Rp 176,200
KRONIS KECIL
Rp LAIN-LAIN
25,000 GANYA AWI 1 HENNE GIYA
Rp 3,194,200 Rp 730,000
lab 2
ro 1
Rp 3,194,200
SEP NO TANGGAL MADIAGNOSATINDAKAN
0464R00600464R0060820V000032
176,200 1 8/3/2020 Z09.8;H65.- PENYAKIT K
0464R00600464R0060820V000038
176,200 2 8/3/2020 Z09.8;H92.- PENYAKIT K
0464R00600464R0060820V000044
176,200 3 8/3/2020 Z09.8;H72.- PENYAKIT K
0464R00600464R0060820V000048
176,200 4 8/3/2020 Z09.8;J32.0- PENYAKIT K
0464R00600464R0060820V000061
121,700 5 8/3/2020 Z09.8;H60.96.52 PROSEDUR
0464R00600464R0060820V000065
121,700 6 8/3/2020 Z09.8;J35.0- PENYAKIT K
0464R00600464R0060820V000208
121,700 7 8/3/2020 Z09.8;H61.96.52 PROSEDUR
0464R00600464R0060820V000211
176,200 8 8/3/2020 Z09.8;J32.0- PENYAKIT K
0464R00600464R0060820V000225
176,200 9 8/5/2020 Z09.8;J35.0- PENYAKIT K
0464R00600464R0060820V000244
121,700 10 8/5/2020 Z09.8;C31.- PENYAKIT K
0464R00600464R0060820V000357
121,700 11 8/5/2020 Z09.8;H72.- PENYAKIT K
0464R00600464R0060820V001075
173,400 12 8/5/2020 Z09.8;H66.- PENYAKIT K
0464R00600464R0060820V001186
176,200 13 8/5/2020 Z09.8;J31. - PENYAKIT K
0464R00600464R0060820V001188
176,200 14 8/10/2020 Z09.8;H65.- PENYAKIT K
0464R00600464R0060820V001193
176,200 15 8/10/2020 Z09.8;J32.0- PENYAKIT K
0464R00600464R0060820V001196
176,200 16 8/10/2020 Z09.8;M25- PENYAKIT K
0464R00600464R0060820V001197
176,200 17 8/10/2020 Z09.8;J30. - PENYAKIT K
0464R00600464R0060820V001212
121,700 18 8/10/2020 Z09.8;B37.96.52 PROSEDUR
0464R00600464R0060820V001214
176,200 19 8/10/2020 Z71.9;D17.- KONSULTAS
0464R00600464R0060820V001218
176,200 20 8/10/2020 Z09.8;J31. - PENYAKIT K
21 8/10/2020 Z09.8;B37.96.52 PROSEDUR
22 8/10/2020 Z09.8;J32.0- PENYAKIT K
23 8/10/2020 Z09.8;J00 - PENYAKIT K
24 8/10/2020 Z09.8;J35.0- PENYAKIT K
25 8/10/2020 Z09.8;H81.- PENYAKIT K
26 8/12/2020 Z09.8;J32. - PENYAKIT K
27 8/12/2020 Z09.8;J32.0- PENYAKIT K
28 8/12/2020 Z09.8;J32.0- PENYAKIT K
29 8/14/2020 Z09.8;H66.96.52 PROSEDUR
30 8/14/2020 Z09.8;J00 - PENYAKIT K
31 8/14/2020 Z09.8;H72.96.52 PROSEDUR
32 8/14/2020 Z09.8;J30. - PENYAKIT K
33 8/19/2020 Z09.8;H92.- PENYAKIT K
34 8/19/2020 Z09.8;J31. - PENYAKIT K
35 8/19/2020 Z09.8;J32.0- PENYAKIT K
36 8/19/2020 J32.0;J32.296.52 PROSEDUR
37 8/26/2020 Z09.8;J00 - PENYAKIT K
38 8/26/2020 Z09.8;J32.0- PENYAKIT K
39 8/26/2020 Z09.8;J31. - PENYAKIT K
40 8/26/2020 Z09.8;J32.0- PENYAKIT K
41 8/28/2020 H66.4;H72.96.52 PROSEDUR
42 8/28/2020 Z09.8;J32.0- PENYAKIT K
43 8/31/2020 J30.4 - PENYAKIT K
44 8/31/2020 R13;N18.9 - PENYAKIT A
45 8/31/2020 Z09.8;J32. - PENYAKIT K
46 8/31/2020 Z09.8;B36.96.52 PROSEDUR
tht

Rp 176,200 Rp 25,000 MUH AULIA 18 HENNY, DR.0464R00600464R0060820V000012
176,200
Rp 176,200 Rp 25,000 GUNAWAN 47 HENNY, DR.0464R00600464R0060820V000020
176,200
Rp 176,200 Rp 25,000 HJ SENIFAH 63 HENNY, DR.0464R00600464R0060820V000029
176,200
Rp 176,200 Rp 25,000 EULIS D KU 58 HENNY, DR.0464R00600464R0060820V000031
176,200
Rp 238,300 Rp 214,800 SYARIF 52 HENNY, DR.0464R00600464R0060820V000058
238,300
Rp 176,200 Rp 25,000 DZAMIR HA 3 HENNY, DR.0464R00600464R0060820V000067
176,200
Rp 238,300 Rp 214,800 SABILA LIS 14 HENNY, DR.0464R00600464R0060820V000068
238,300
Rp 176,200 Rp 25,000 LUCKY JIMM 39 HENNY, DR.0464R00600464R0060820V000070
176,200
Rp 176,200 Rp 25,000 YANI SURYA 40 HENNY, DR.0464R00600464R0060820V000175
176,200
Rp 176,200 Rp 25,000 AMINUDIN 51 HENNY, DR.0464R00600464R0060820V000176
176,200
Rp 176,200 Rp 214,800 ETI ROHAET 39 HENNY, DR.0464R00600464R0060820V000181
176,200
Rp 176,200 Rp 25,000 PERTIWI W 54 HENNY, DR.0464R00600464R0060820V000182
176,200
Rp 176,200 Rp 25,000 YUYUN NUR 53 HENNY, DR.0464R00600464R0060820V000197
176,200
Rp 176,200 Rp 25,000 MUH AULIA 18 HENNY, DR.0464R00600464R0060820V000306
176,200
Rp 176,200 Rp 25,000 PIRDA MIL 17 HENNY, DR.0464R00600464R0060820V000326
176,200
176,200
Rp 176,200 Rp 209,200 EULIS D KU 58 HENNY, DR.0464R00600464R0060820V000347
176,200
238,300
Rp 121,700 Rp 25,000 EMAS 49 HENNY, DR.0464R00600464R0060820V000350
121,700
176,200
Rp 238,300 Rp 214,800 TATANG DJ 70 HENNY, DR.0464R00600464R0060820V000353
238,300
Rp 176,200 Rp 25,000 WINDRI NO 14 HENNY, DR.0464R00600464R0060820V000360
176,200
Rp 176,200 Rp 25,000 LYDIA NUR 26 HENNY, DR.0464R00600464R0060820V000362
176,200
Rp 176,200 Rp 25,000 DZAMIR HA 3 HENNY, DR.0464R00600464R0060820V000363
176,200
Rp 176,200 Rp 25,000 NURELYA 48 HENNY, DR.0464R00600464R0060820V000367
176,200
Rp 176,200 Rp 25,000 PERTIWI W 54 HENNY, DR.0464R00600464R0060820V000474
176,200
176,200
176,200
Rp 238,300 Rp 214,800 SOERANTI 75 HENNY, DR.0464R00600464R0060820V000605
238,300
Rp 176,200 Rp 25,000 MOCHAMAD 5 HENNY, DR.0464R00600464R0060820V000614
176,200
Rp 238,300 Rp 214,800 ETI ROHAET 39 HENNY, DR.0464R00600464R0060820V000628
238,300
Rp 176,200 Rp 25,000 NAZWA SAL 5 HENNY, DR.0464R00600464R0060820V000630
176,200
176,200
176,200
176,200
Rp 238,300 Rp 214,800 RIAN TURM 24 HENNY, DR.0464R00600464R0060820V000761
238,300
Rp 176,200 Rp 25,000 MOCHAMAD 5 HENNY, DR.0464R00600464R0060820V000980
176,200
Rp 176,200 Rp 25,000 ASIPA RIYA 20 HENNY, DR.0464R00600464R0060820V000997
176,200
176,200
176,200
238,300
176,200
Rp 176,200 Rp 25,000 PIRDA MIL 17 HENNY, DR.0464R00600464R0060820V001189
176,200
Rp 173,400 Rp 25,000 SUTI RAHA 63 HENNY, DR.0464R00600464R0060820V001202
173,400
Rp 176,200 Rp 25,000 WINDRI NO 14 HENNY, DR.0464R00600464R0060820V001207
176,200
Rp 238,300 Rp 214,800 TUTIH SUTI 48 HENNY, DR.0464R00600464R0060820V001215
238,300
Rp 8,606,800 ###
tindakan
Rp 8,606,800
gigi
NO TANGGAL MADIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA

1 8/11/2020 K04.5 - GIGI DAN Rp 196,200 Rp 35,000 NANIH 58
2 8/11/2020 Z09.8;K12.- PENYAKIT KRp 176,200 Rp 35,000 NENENG K 47
3 8/11/2020 K01.1 - GIGI DAN Rp 196,200 Rp 35,000 ANISA MUJ 24
4 8/11/2020 K01.1 - GIGI DAN Rp 196,200 Rp 35,000 SYAH FITR 25
5 8/11/2020 K04.5 23.09 PROSEDUR Rp 269,500 Rp 165,000 NANANG K 64
6 8/19/2020 Z09.8;K04.23.49 PROSEDUR Rp 269,500 Rp 125,000 SERINA M 13
7 8/19/2020 Z71.9;K01.- KONSULTASRp 121,700 Rp 35,000 IIS SUGIAR 36
8 8/19/2020 Z09.8;K04.23.49 PROSEDUR Rp 269,500 Rp 105,000 AI ROHIMA 37
9 8/25/2020 Z09.8;K05.- PENYAKIT KRp 176,200 Rp 45,000 SITI SOLIH 29
10 8/25/2020 Z09.8;K08.23.49 PROSEDUR Rp 269,500 Rp 165,000 SITI AISYA 61
11 8/25/2020 Z71.9;K01.- KONSULTASRp 121,700 Rp 35,000 GILANG PR 27
12 8/25/2020 Z09.8;K04.23.49 PROSEDUR Rp 269,500 Rp 75,000 TRI SUGIH 30
Rp 2,531,900 Rp 890,000
Rp 2,531,900
DPJP SEP NO TANGGAL MADIAGNOSATINDAKAN
LOREN PA 0464R00600464R0060820V000418
196,200 1 8/4/2020 Z09.8;K04.23.2 PROSEDUR
LOREN PA 0464R00600464R0060820V000423
176,200 2 8/4/2020 K01.1 - GIGI DAN
LOREN PA 0464R00600464R0060820V000431
196,200 3 8/4/2020 Z09.8;K04.23.09 PROSEDUR
LOREN PA 0464R00600464R0060820V000438
196,200 4 8/4/2020 Z09.8;K04.- PENYAKIT K
LOREN PA 0464R00600464R0060820V000452
269,500 5 8/4/2020 Z09.8;K04.23.09 PROSEDUR
LOREN PA 0464R00600464R0060820V000721
269,500 6 8/12/2020 Z09.8;K01.- PENYAKIT K
LOREN PA 0464R00600464R0060820V000734
121,700 7 8/12/2020 Z09.8;K04.23.49 PROSEDUR
LOREN PA 0464R00600464R0060820V000760
269,500 8 8/12/2020 Z09.8;K04.- PENYAKIT K
LOREN PA 0464R00600464R0060820V000904
176,200 9 8/12/2020 Z71.9;K05.- KONSULTAS
LOREN PA 0464R00600464R0060820V000920
269,500 10 8/12/2020 Z09.8;K04.23.49;23.7PROSEDUR
LOREN PA 0464R00600464R0060820V000951
121,700 11 8/12/2020 Z71.9;K04.- KONSULTAS
LOREN PA 0464R00600464R0060820V000955
269,500 12 8/18/2020 K04.1 23.09 PROSEDUR
13 8/18/2020 K01.1 - GIGI DAN
14 8/18/2020 K04.1 23.09 PROSEDUR
15 8/18/2020 K04.1 - GIGI DAN
16 8/18/2020 Z09.8;K04.23.2 PROSEDUR
17 8/18/2020 Z09.8;K04.23.09 PROSEDUR
18 8/18/2020 Z09.8;K04.- PENYAKIT K
19 8/18/2020 K04.1 - GIGI DAN
20 8/18/2020 Z09.8;K04.- PENYAKIT K
21 8/18/2020 Z09.8;K04.23.09 PROSEDUR
22 8/18/2020 Z09.8;K04.23.09 PROSEDUR
gigi

Rp 269,500 Rp 105,000 SERINA M 13 M ARIF DR0464R00600464R0060820V000085
269,500
Rp 196,200 Rp 35,000 MARTIN NEL 26 M ARIF DR0464R00600464R0060820V000122
196,200
Rp 269,500 Rp 35,000 SITI AISYAH 61 M ARIF DR0464R00600464R0060820V000126
269,500
Rp 176,200 Rp 35,000 HILMAN ZU 26 M ARIF DR0464R00600464R0060820V000137
176,200
Rp 269,500 Rp 165,000 NENENG K 47 M ARIF DR0464R00600464R0060820V000138
269,500
176,200
Rp 269,500 Rp 105,000 AI ROHIMA 37 M ARIF DR0464R00600464R0060820V000494
269,500
Rp 176,200 Rp 35,000 SRI RAHAYU 36 M ARIF DR0464R00600464R0060820V000496
176,200
Rp 121,700 Rp 35,000 HARTINING 65 M ARIF DR0464R00600464R0060820V000507
121,700
Rp 269,500 Rp 105,000 SURYADI 36 M ARIF DR0464R00600464R0060820V000510
269,500
Rp 121,700 Rp 35,000 IGNATIUS 53 M ARIF DR0464R00600464R0060820V000524
121,700
Rp 269,500 Rp 115,000 RADEN KAL 10 M ARIF DR0464R00600464R0060820V000676
269,500
Rp 196,200 Rp 35,000 LALA ROML 28 M ARIF DR0464R00600464R0060820V000681
196,200
Rp 269,500 Rp 115,000 MUHAMMAD 9 M ARIF DR0464R00600464R0060820V000683
269,500
Rp 196,200 Rp 35,000 MARNI 40 M ARIF DR0464R00600464R0060820V000687
196,200
Rp 269,500 Rp 105,000 AULIA PUTR 23 M ARIF DR0464R00600464R0060820V000689
269,500
Rp 269,500 Rp 165,000 NENENG K 48 M ARIF DR0464R00600464R0060820V000691
269,500
Rp 176,200 Rp 35,000 IR. JAMES 49 M ARIF DR0464R00600464R0060820V000698
176,200
Rp 196,200 Rp 35,000 SULASTRI 41 M ARIF DR0464R00600464R0060820V000699
196,200
Rp 176,200 Rp 35,000 SRI RAHAYU 36 M ARIF DR0464R00600464R0060820V000700
176,200
Rp 269,500 Rp 165,000 HILMAN ZU 26 M ARIF DR0464R00600464R0060820V000701
269,500
269,500
Rp 4,873,700 ###
Rp 4,873,700
gigi
NO TANGGAL DIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA

1 8/5/2020 Z09.8;K04.23.71 PROSEDUR Rp 269,500 Rp 205,000 AULIA PUT 23
2 8/7/2020 K04.0 23.70 PROSEDUR Rp 269,500 Rp 115,000 AI ROHIMA 37
3 8/7/2020 K04.0 23.70 PROSEDUR Rp 269,500 Rp 105,000 DESI SUSA 26
4 ### K04.1 23.09 PROSEDUR Rp 269,500 Rp 140,000 IDA MELIN 12
5 ### Z09.8;K05.23.70 PROSEDUR Rp 269,500 Rp 215,000 ASIPA RIYA 20
6 ### Z09.8;K05.23.09 PROSEDUR Rp 269,500 Rp 165,000 AKMALUDI 65
7 ### Z09.8;K04.23.09 PROSEDUR Rp 269,500 Rp 315,000 WIWI KART 36
8 ### Z09.8;K04.23.70 PROSEDUR Rp 269,500 Rp 135,000 INTAN TAN 35
9 ### K04.5 23.09 PROSEDUR Rp 269,500 Rp 215,000 DUDUNG 65
10 ### K05.3 - GIGI DAN Rp 196,200 Rp 35,000 LIS ROHAET 54
Rp 2,621,700 Rp 1,645,000
Rp 2,621,700
DPJP SEP NO TANGGAL MADIAGNOSATINDAKAN
NUR R HID0464R00600464R0060820V000171
269,500 1 8/3/2020 Z09.8;H11.- PENYAKIT K
NUR R HID0464R00600464R0060820V000273
269,500 2 8/3/2020 Z71.9;H27.- KONSULTAS
NUR R HID0464R00600464R0060820V000284
269,500 3 8/5/2020 Z09.8;H26.- PENYAKIT K
NUR R HID0464R00600464R0060820V001112
269,500 4 8/5/2020 Z09.8;H40.- PENYAKIT K
NUR R HID0464R00600464R0060820V001113
269,500 5 8/5/2020 Z09.8;H52.- PENYAKIT K
NUR R HID0464R00600464R0060820V001114
269,500 6 8/5/2020 Z09.8;H26.- PENYAKIT K
NUR R HID0464R00600464R0060820V001138
269,500 7 8/5/2020 Z09.8;H26.- PENYAKIT K
NUR R HID0464R00600464R0060820V001143
269,500 8 8/5/2020 Z09.8;H26.- PENYAKIT K
NUR R HID0464R00600464R0060820V001149
269,500 9 8/5/2020 H11.0 11.39 PROSEDUR
NUR R HID0464R00600464R0060820V001152
196,200 10 8/5/2020 Z09.8;H26.- PENYAKIT K
11 8/10/2020 Z09.8;H52.- PENYAKIT K
12 8/10/2020 Z09.8;H11.- PENYAKIT K
13 8/12/2020 Z09.8;H25.- PENYAKIT K
14 8/12/2020 Z09.8;H25.- PENYAKIT K
15 8/12/2020 Z09.8;H00.- PENYAKIT K
16 8/12/2020 Z09.8;H40.- PENYAKIT K
17 8/12/2020 Z09.8;T15. - PENYAKIT K
18 8/19/2020 H26.9 - PENYAKIT K
19 8/19/2020 Z09.8;H25.- PENYAKIT K
20 8/19/2020 Z09.8;H40.- PENYAKIT K
21 8/19/2020 Z09.8;H02.- PENYAKIT K
22 8/19/2020 Z71.9;H44.- KONSULTAS
23 8/24/2020 H52.7 - PENYAKIT K
24 8/24/2020 Z09.8;H00.- PENYAKIT K
25 8/24/2020 Z09.8;H11.- PENYAKIT K
26 8/24/2020 Z09.8;H11.- PENYAKIT K
27 8/26/2020 Z09.8;H26.- PENYAKIT K
28 8/26/2020 Z71.9;H11.- KONSULTAS
29 8/26/2020 Z09.8;H10.- PENYAKIT K
30 8/26/2020 Z09.8;H16.- PENYAKIT K
31 8/26/2020 Z09.8;H25.- PENYAKIT K
32 8/26/2020 Z09.8;H26.- PENYAKIT K
33 8/26/2020 Z09.8;H52.- PENYAKIT K
34 8/26/2020 Z09.8;F95. - PENYAKIT K
35 8/31/2020 H53.0 - PENYAKIT K
36 8/31/2020 H52.4 - PENYAKIT K
37 8/31/2020 Z09.8;H16.- PENYAKIT K
mata

Rp 176,200 Rp 25,000 LILIS SUBA 0464R00600464R0060820V000042
51 SRI RAHAYU 176,200
Rp 121,700 Rp 25,000 SONENGSI 0464R00600464R0060820V000064
Rp 176,200 Rp 25,000 OMAN KU 0464R00600464R0060820V000160
Rp 176,200 Rp 25,000 WARTIKA 0464R00600464R0060820V000162
Rp 176,200 Rp 25,000 IWAN HER 50 SRI RAHAYU
0464R00600464R0060820V000183
176,200
Rp 176,200 Rp 25,000 ENTJENG 0464R00600464R0060820V000185
Rp 176,200 Rp 25,000 UHA SUHA 0464R00600464R0060820V000187
Rp 176,200 Rp 25,000 HJ. SUHAE 0464R00600464R0060820V000190
Rp 837,100 Rp 25,000 OON 60 SRI RAHAYU
0464R00600464R0060820V000191
837,100
Rp 176,200 Rp 25,000 DRS.MAHF 0464R00600464R0060820V000193
Rp 176,200 Rp 25,000 BAYU FIR 0464R00600464R0060820V000358
Rp 176,200 Rp 25,000 LILIS SUBA 51 SRI RAHAYU
0464R00600464R0060820V000364
176,200
Rp 176,200 Rp 25,000 ENGKOS K 0464R00600464R0060820V000490
Rp 176,200 Rp 25,000 ALIS MIATI 0464R00600464R0060820V000495
Rp 176,200 Rp 25,000 RADINKA A 0464R00600464R0060820V000498
Rp 176,200 Rp 25,000 YUYUN 39 SRI RAHAYU
0464R00600464R0060820V000502
176,200
Rp 176,200 Rp 25,000 GINANJAR 0464R00600464R0060820V000526
Rp 176,200 Rp 25,000 OMAH 0464R00600464R0060820V000719
Rp 176,200 Rp 25,000 CECEP LIN 0464R00600464R0060820V000723
Rp 176,200 Rp 25,000 WARTIKA 0464R00600464R0060820V000731
Rp 176,200 Rp 25,000 YATI HUSM 62 SRI RAHAYU
0464R00600464R0060820V000741
176,200
Rp 121,700 Rp 25,000 AJAT SUDR 0464R00600464R0060820V000759
Rp 176,200 Rp 25,000 KAYYASAH 0464R00600464R0060820V000828
Rp 176,200 Rp 25,000 TIKA KARTI 53 SRI RAHAYU
0464R00600464R0060820V000860
176,200
Rp 176,200 Rp 25,000 LILIS SUBA 0464R00600464R0060820V000869
Rp 176,200 Rp 25,000 OON 0464R00600464R0060820V000873
Rp 176,200 Rp 25,000 ATO FATAH 0464R00600464R0060820V000975
Rp 121,700 Rp 25,000 SAUDAH 48 SRI RAHAYU
0464R00600464R0060820V000978
121,700
Rp 176,200 Rp 25,000 AI ARYANTI 0464R00600464R0060820V000983
Rp 176,200 Rp 25,000 RINI 0464R00600464R0060820V000985
Rp 176,200 Rp 25,000 ALIS MIATI 0464R00600464R0060820V000988
Rp 176,200 Rp 25,000 YATI HUSM 62 SRI RAHAYU
0464R00600464R0060820V000990
176,200
Rp 176,200 Rp 25,000 SHELA MAU 0464R00600464R0060820V000992
Rp 176,200 Rp 25,000 ANI 0464R00600464R0060820V001012
Rp 176,200 Rp 25,000 MH ANDAR 0464R00600464R0060820V001200
Rp 176,200 Rp 25,000 ANNY HERY 54 SRI RAHAYU
0464R00600464R0060820V001205
176,200
Rp 176,200 Rp 25,000 RAKA SAM 0464R00600464R0060820V001222
Rp 7,016,800 Rp 925,000
Rp 7,016,800
gigi
NO TANGGAL DIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA

1 8/4/2020 Z09.8;K04.23.2 PROSEDUR Rp 269,500 Rp 365,000 IR. JAMES
2 8/4/2020 Z09.8;K04.23.71 PROSEDUR Rp 269,500 Rp 365,000 NIA KURNI
3 ### Z09.8;K04.23.71 PROSEDUR Rp 269,500 Rp 365,000 NURAENI
4 ### Z09.8;K04.23.71 PROSEDUR Rp 269,500 Rp 365,000 DESI SUSA
5 ### Z09.8;K04.23.71 PROSEDUR Rp 269,500 Rp 365,000 NIA KURNI
6 ### Z09.8;K04.23.49 PROSEDUR Rp 269,500 Rp 365,000 AI MULYAN
7 ### Z09.8;K04.- PENYAKIT KRp 176,200 Rp 365,000 MAULANA
8 ### Z09.8;K04.23.49 PROSEDUR Rp 269,500 Rp 365,000 RAIDA RA
9 ### Z09.8;K04.23.49 PROSEDUR Rp 269,500 Rp 365,000 AULIA PUT
10 ### Z09.8;K04.23.49 PROSEDUR Rp 269,500 Rp 356,000 NIA KURNI
Rp 2,601,700 Rp 3,641,000
Rp 2,601,700
USIA DPJP SEP
49 WIJOYO, D0464R00600464R0060820V000136
269,500
20 WIJOYO, D0464R00600464R0060820V000140
269,500
17 WIJOYO, D0464R00600464R0060820V000426
269,500
26 WIJOYO, D0464R00600464R0060820V000448
269,500
20 WIJOYO, D0464R00600464R0060820V000455
269,500
43 WIJOYO, D0464R00600464R0060820V000902
269,500
19 WIJOYO, D0464R00600464R0060820V000917
176,200
18 WIJOYO, D0464R00600464R0060820V000933
269,500
23 WIJOYO, D0464R00600464R0060820V000935
269,500
20 WIJOYO, D0464R00600464R0060820V000952
269,500
195,185,200
Rp 195,185,200
obgyn
NO TANGGAL DIAGNOSATINDAKAN TARIF INA TARIF RS NAMA

1 ### ### Z48.8 88.78 PROSEDUR Rp 281,500 Rp 105,000 TINI SETIA
Rp 281,500
tindakan
Rp 281,500
USIA DPJP SEP
49981 24 DR. FATAL 0464R0060820V000321 0464R0060820V000321 281,500
fisio
NO TANGGAL DIAGNOSATINDAKAN TARIF INA TARIF RS NAMA USIA

1 ### ### M17.0;R5293.13;93.3PROSEDUR Rp 101,800 Rp 141,000 ENOK 037946../
2 ### ### Z09.8;M54.93.13;93.3PROSEDUR Rp 101,800 Rp 166,000 H. ENDANG 23390
3 ### ### Z09.8;M54.93.13;93.3PROSEDUR Rp 101,800 Rp 191,000 IMAS MUTI 27324
4 ### ### M54.5;R5293.13;93.3PROSEDUR Rp 101,800 Rp 166,000 NANI SURY 42256
5 ### ### Z09.8;G51.93.13;93.3PROSEDUR Rp 101,800 Rp 141,000 FEBBY AYU015564..
Rp 509,000 Rp 805,000
Rp 509,000
DPJP SEP NO TANGGAL DIAGNOSATINDAKAN
50 DR. MUHA0464R00600464R0060820V000824
101,800 1 ### ### Z48.8
70 DR. MUHA0464R00600464R0060820V000830
101,800 2 ### ### Z48.8
49 DR. MUHA0464R00600464R0060820V000835
101,800
55 DR. MUHA0464R00600464R0060820V000837
101,800
9 DR. MUHA0464R00600464R0060820V000872
101,800
obgyn
TINDAKAN TARIF INA TARIF RS NAMA USIA DPJP SEP

88.78 PROSEDUR Rp 281,500 Rp 105,000 SOPI SELPI 50340 33 EISEN HOW0464R00600464R0060820V00035
88.78 PROSEDUR Rp 281,500 Rp 105,000 PUTRI SASA 50096 19 EISEN HOW0464R00600464R0060820V00110
Rp 563,000 Rp 210,000
tindakan
Rp 563,000
mata
NO TANGGAL DIAGNOSATINDAKAN TARIF INA TARIF RS NAMA

281,500 1 8/3/2020 8/3/2020 Z09.8;T15. 96.51 PROSEDUR Rp 200,600 Rp 79,000
281,500 Rp 200,600
Rp 200,600
USIA DPJP SEP
GINANJAR 50364 24 SRI RAHAYU, SP. 0464R00600464R0060820V000050
200,600
1,554,100
Rp 1,554,100

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NO TANGGAL MASUK TANGGAL KELUAR DIAGNOSATINDAKAN

1 8/2/2020 8/3/2020 A90 99.18;90.59 INFEKSI VI

1 8/2/2020 8/3/2020 A90 99.18;90.59 INFEKSI VI

1 8/26/2020 8/30/2020 P22.1;P03.99.18;90.59;87.44;93.96 NEONATAL,

TARIF INACBG TARIF RS NAMA USIA DPJP SEP

Rp 1,256,500 Rp 976,000 AL AZZAM 1 ANDAR, SP.0464R0060820V000007

Rp 3,492,300 Rp 1,479,500 BAYI NYON 0 ANDAR, SP.0464R0060820V001019

TINDAKAN TARIF INACBG TARIF RS NAMA USIA DPJP SEP

TARIF INACBG TARIF RS NAMA USIA DPJP SEP

NO TANGGAL MATANGGAL KEDIAGNOSATINDAKAN TARIF INACBG

TANGGAL MATANGGAL KEDIAGNOSATINDAKAN TARIF INACBG TARIF RS

DIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA

TINDAKAN TARIF INACBG TARIF RS NAMA USIA DPJP SEP

TARIF INACBG TARIF RS NAMA USIA DPJP SEP

NO TANGGAL TANGGAL DIAGNOSATINDAKAN TARIF INACBG TARIF RS

NO TANGGAL TANGGAL DIAGNOSATINDAKAN TARIF INACBG TARIF RS

TANGGAL DIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA

TINDAKAN TARIF INACBG TARIF RS NAMA USIA

NO TANGGAL MASUK DIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA

TANGGAL MADIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA

TARIF INACBG TARIF RS NAMA USIA DPJP SEP

NO TANGGAL MADIAGNOSA TINDAKAN TARIF INACBG TARIF RS

TINDAKAN TARIF INACBG TARIF RS NAMA USIA DPJP SEP

NO TANGGAL MADIAGNOSATINDAKAN TARIF INACBG

TANGGAL MADIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA DPJP

TARIF INACBG TARIF RS NAMA USIA DPJP SEP

NO TANGGAL MADIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA DPJP

TARIF INACBG TARIF RS NAMA USIA DPJP SEP

NO TANGGAL MADIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA

TARIF INACBG TARIF RS NAMA USIA DPJP SEP

NO TANGGAL DIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA USIA

TARIF INACBG TARIF RS NAMA USIA DPJP SEP

NO TANGGAL DIAGNOSATINDAKAN TARIF INACBG TARIF RS NAMA

NO TANGGAL DIAGNOSATINDAKAN TARIF INA TARIF RS NAMA

NO TANGGAL DIAGNOSATINDAKAN TARIF INA TARIF RS NAMA USIA

TINDAKAN TARIF INA TARIF RS NAMA USIA DPJP SEP

NO TANGGAL DIAGNOSATINDAKAN TARIF INA TARIF RS NAMA

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