Data Peserta Agustus

DATA PESERTA TERDAFTAR DI FASILITAS KESEHATAN TINGKAT PERTAMA
BULAN JANUARI 2020

BPJS KESEHATAN KCU SURABAYA
KAP JUMLAH PESERTA

KODE BULAN JANUARI 2020
NO KANTOR CABANG NAMA FASKES
FASKES
NON PBI PBI TOTAL
1 2 3 4 5 6 7=5+6
139 KOTA SURABAYA 02170004 Siwalankerto 8,601 4,037 12,638
140 KOTA SURABAYA 02170005 Balas Klumprik 3,744 3,643 7,387
141 KOTA SURABAYA 02170006 Keputih 6,849 10,668 17,517
142 KOTA SURABAYA 02170007 Bangkingan 2,972 4,595 7,567
143 KOTA SURABAYA 02170008 Made 4,579 6,924 11,503
144 KOTA SURABAYA 02170105 Morokrembangan 3,905 20,729 24,634
145 KOTA SURABAYA 02170106 Tambak Wedi 3,220 7,976 11,196
146 KOTA SURABAYA 02170107 Bulak Banteng 4,439 12,688 17,127
147 KOTA SURABAYA 02170108 Kalijudan 6,476 9,017 15,493
148 KOTA SURABAYA 13010101 Pegirian 7,008 25,895 32,903
149 KOTA SURABAYA 13010102 Wonokusumo 8,167 39,600 47,767
150 KOTA SURABAYA 13010103 Sidotopo 4,230 29,424 33,654
151 KOTA SURABAYA 13010201 Perak Timur 9,805 30,318 40,123
152 KOTA SURABAYA 13010301 Tanjungsari 5,114 7,144 12,258
153 KOTA SURABAYA 13010302 Manukan Kulon 23,836 15,071 38,907
154 KOTA SURABAYA 13010303 Simomulyo 16,940 20,358 37,298
155 KOTA SURABAYA 13010304 Asemrowo 5,596 21,759 27,355
156 KOTA SURABAYA 13010305 Balongsari 9,142 13,461 22,603
157 KOTA SURABAYA 13010401 Sememi 13,166 19,748 32,914
158 KOTA SURABAYA 13010402 Benowo 12,034 18,036 30,070
159 KOTA SURABAYA 13010501 Krembangan Selatan 8,880 16,870 25,750
160 KOTA SURABAYA 13010502 Dupak 7,169 11,198 18,367
161 KOTA SURABAYA 13010601 Tembok Dukuh 10,073 22,371 32,444
162 KOTA SURABAYA 13010602 Gundih 4,830 15,368 20,198
163 KOTA SURABAYA 13010701 Tambak Rejo 9,126 27,961 37,087

164 KOTA SURABAYA 13010702 Simolawang 4,222 27,689 31,911
165 KOTA SURABAYA 13010801 Rangkah 9,653 25,075 34,728
166 KOTA SURABAYA 13010802 Pacar Keling 11,132 21,561 32,693
167 KOTA SURABAYA 13010803 Gading 5,933 32,371 38,304
168 KOTA SURABAYA 13010901 Pucang Sewu 18,181 15,277 33,458
169 KOTA SURABAYA 13010902 Mojo 15,213 21,308 36,521
170 KOTA SURABAYA 13011001 Kalirungkut 13,438 12,019 25,457
171 KOTA SURABAYA 13011002 Tenggilis 11,862 10,695 22,557
172 KOTA SURABAYA 13011003 Gunung Anyar 8,276 11,321 19,597
173 KOTA SURABAYA 13011004 Medokan Ayu 13,086 13,399 26,485
174 KOTA SURABAYA 13011101 Menur 12,618 10,019 22,637
175 KOTA SURABAYA 13011102 Mulyorejo 11,921 8,902 20,823
176 KOTA SURABAYA 13011103 Klampis Ngasem 9,043 6,932 15,975
177 KOTA SURABAYA 13011201 Tanah Kali Kedinding 12,395 24,913 37,308
178 KOTA SURABAYA 13011202 Sidotopo Wetan 10,003 24,613 34,616
179 KOTA SURABAYA 13011203 Kenjeran 6,545 15,980 22,525
180 KOTA SURABAYA 13011301 Jagir 18,629 19,352 37,981
181 KOTA SURABAYA 13011302 Wonokromo 13,109 13,781 26,890
182 KOTA SURABAYA 13011303 Ngagel Rejo 9,561 14,557 24,118
183 KOTA SURABAYA 13011401 Peneleh 6,251 15,688 21,939
184 KOTA SURABAYA 13011402 Ketabang 6,496 7,712 14,208
185 KOTA SURABAYA 13011501 Kedungdoro 13,296 18,717 32,013
186 KOTA SURABAYA 13011502 Dr. Soetomo 7,348 18,667 26,015
187 KOTA SURABAYA 13011601 Sawahan 16,285 17,287 33,572

188 KOTA SURABAYA 13011602 Putat Jaya 8,705 17,319 26,024
189 KOTA SURABAYA 13011603 Banyu Urip 11,473 23,732 35,205
190 KOTA SURABAYA 13011604 Pakis 9,043 11,505 20,548
191 KOTA SURABAYA 13011701 Gayungan 16,800 7,448 24,248
192 KOTA SURABAYA 13011702 Jemursari 8,005 4,483 12,488
193 KOTA SURABAYA 13011703 Kebonsari 11,545 11,863 23,408
194 KOTA SURABAYA 13011704 Sidosermo 6,681 9,075 15,756
195 KOTA SURABAYA 13011801 Kedurus 14,305 13,208 27,513
196 KOTA SURABAYA 13011802 Dukuh Kupang 15,639 12,522 28,161
197 KOTA SURABAYA 13011803 Wiyung 14,165 11,183 25,348

198 KOTA SURABAYA 13011901 Jeruk 6,945 7,536 14,481
199 KOTA SURABAYA 13011902 Lidah Kulon 8,308 6,519 14,827
200 KOTA SURABAYA 13011903 Lontar 6,131 7,612 13,743
201 KOTA SURABAYA 02170903 Sawah Pulo 1,857 21,282 23,139
TOTAL PUSKESMAS KOTA SURABAYA ### ### ###

KAPITASI BULAN JANUARI 2020
KAPITASI SUSULAN BULA
% BIAYA PER KAP JUMLAH PESERTA
BIAYA PER
PENYES JIWA BIAYA KAPITASI
JIWA
UAIAN PENYESUAIAN
NON PBI PBI TOTAL
14=12+1
8 9 10-=8*9 11=7*10 12 13
3
Rp 6,000 95.00% Rp 5,700 Rp 72,036,600 24 10 34
Rp 6,000 95.00% Rp 5,700 Rp 42,105,900 18 15 33
Rp 6,000 95.00% Rp 5,700 Rp 99,846,900 32 26 58
Rp 6,000 95.00% Rp 5,700 Rp 43,131,900 13 3 16
Rp 6,000 95.00% Rp 5,700 Rp 65,567,100 36 10 46
Rp 6,000 95.00% Rp 5,700 Rp 140,413,800 12 28 40
Rp 6,000 95.00% Rp 5,700 Rp 63,817,200 21 16 37
Rp 6,000 95.00% Rp 5,700 Rp 97,623,900 24 36 60
Rp 6,000 90.00% Rp 5,400 Rp 83,662,200 32 2 34
Rp 6,000 95.00% Rp 5,700 Rp 187,547,100 25 26 51
Rp 6,000 95.00% Rp 5,700 Rp 272,271,900 33 43 76
Rp 6,000 95.00% Rp 5,700 Rp 191,827,800 26 29 55
Rp 6,000 95.00% Rp 5,700 Rp 228,701,100 36 43 79
Rp 6,000 95.00% Rp 5,700 Rp 69,870,600 27 36 63
Rp 6,000 95.00% Rp 5,700 Rp 221,769,900 61 - 61
Rp 6,000 95.00% Rp 5,700 Rp 212,598,600 62 - 62
Rp 6,000 95.00% Rp 5,700 Rp 155,923,500 14 23 37
Rp 6,000 95.00% Rp 5,700 Rp 128,837,100 24 21 45
Rp 6,000 95.00% Rp 5,700 Rp 187,609,800 34 11 45
Rp 6,000 95.00% Rp 5,700 Rp 171,399,000 48 11 59
Rp 6,000 95.00% Rp 5,700 Rp 146,775,000 15 9 24
Rp 6,000 95.00% Rp 5,700 Rp 104,691,900 31 7 38
Rp 6,000 95.00% Rp 5,700 Rp 184,930,800 25 28 53
Rp 6,000 95.00% Rp 5,700 Rp 115,128,600 24 8 32
Rp 6,000 95.00% Rp 5,700 Rp 211,395,900 40 7 47

Rp 6,000 95.00% Rp 5,700 Rp 181,892,700 6 35 41
Rp 6,000 95.00% Rp 5,700 Rp 197,949,600 25 5 30
Rp 6,000 95.00% Rp 5,700 Rp 186,350,100 18 - 18
Rp 6,000 100.00% Rp 6,000 Rp 229,824,000 21 45 66
Rp 6,000 95.00% Rp 5,700 Rp 190,710,600 23 22 45
Rp 6,000 95.00% Rp 5,700 Rp 208,169,700 36 10 46
Rp 6,000 95.00% Rp 5,700 Rp 145,104,900 48 12 60
Rp 6,000 95.00% Rp 5,700 Rp 128,574,900 39 25 64
Rp 6,000 95.00% Rp 5,700 Rp 111,702,900 37 11 48
Rp 6,000 95.00% Rp 5,700 Rp 150,964,500 44 4 48
Rp 6,000 95.00% Rp 5,700 Rp 129,030,900 47 3 50
Rp 6,000 95.00% Rp 5,700 Rp 118,691,100 41 14 55
Rp 6,000 95.00% Rp 5,700 Rp 91,057,500 33 7 40
Rp 6,000 95.00% Rp 5,700 Rp 212,655,600 40 20 60
Rp 6,000 95.00% Rp 5,700 Rp 197,311,200 45 48 93
Rp 6,000 95.00% Rp 5,700 Rp 128,392,500 19 9 28
Rp 6,000 95.00% Rp 5,700 Rp 216,491,700 50 - 50
Rp 6,000 95.00% Rp 5,700 Rp 153,273,000 31 40 71
Rp 6,000 95.00% Rp 5,700 Rp 137,472,600 17 - 17
Rp 6,000 95.00% Rp 5,700 Rp 125,052,300 31 10 41
Rp 6,000 95.00% Rp 5,700 Rp 80,985,600 7 4 11
Rp 6,000 95.00% Rp 5,700 Rp 182,474,100 30 23 53
Rp 6,000 95.00% Rp 5,700 Rp 148,285,500 18 - 18
Rp 6,000 95.00% Rp 5,700 Rp 191,360,400 40 26 66

Rp 6,000 100.00% Rp 6,000 Rp 156,144,000 46 17 63
Rp 6,000 95.00% Rp 5,700 Rp 200,668,500 44 9 53
Rp 6,000 95.00% Rp 5,700 Rp 117,123,600 7 3 10
Rp 6,000 90.00% Rp 5,400 Rp 130,939,200 33 11 44
Rp 6,000 95.00% Rp 5,700 Rp 71,181,600 20 6 26
Rp 6,000 95.00% Rp 5,700 Rp 133,425,600 38 18 56
Rp 6,000 95.00% Rp 5,700 Rp 89,809,200 18 4 22
Rp 6,000 95.00% Rp 5,700 Rp 156,824,100 31 5 36
Rp 6,000 95.00% Rp 5,700 Rp 160,517,700 38 15 53
Rp 6,000 95.00% Rp 5,700 Rp 144,483,600 41 - 41

Rp 6,000 90.00% Rp 5,400 Rp 78,197,400 47 13 60
Rp 6,000 95.00% Rp 5,700 Rp 84,513,900 16 - 16
Rp 6,000 95.00% Rp 5,700 Rp 78,335,100 41 - 41
Rp 6,000 95.00% Rp 5,700 Rp 131,892,300 7 27 34
Rp 9,077,317,800 1,910 949 2,859

TOTAL
KAPITASI SUSULAN BULAN DESEMBER 2019 KAPITASI YANG
PESERTA
BIAYA PER DIBAYARKAN
% BULAN
BIAYA PER JIWA BIAYA BULAN JANUARI
PENYES JANUARI
JIWA PENYESUAI KAPITASI 2020
UAIAN 2020
AN
15 16 17=15*16 18=14*17 19=7+14 20=11+18
Rp 6,000 95.00% Rp 5,700 Rp 193,800 12,672 Rp 72,230,400
Rp 6,000 95.00% Rp 5,700 Rp 188,100 7,420 Rp 42,294,000
Rp 6,000 95.00% Rp 5,700 Rp 330,600 17,575 Rp 100,177,500
Rp 6,000 95.00% Rp 5,700 Rp 91,200 7,583 Rp 43,223,100
Rp 6,000 95.00% Rp 5,700 Rp 262,200 11,549 Rp 65,829,300
Rp 6,000 95.00% Rp 5,700 Rp 228,000 24,674 Rp 140,641,800
Rp 6,000 90.00% Rp 5,400 Rp 199,800 11,233 Rp 64,017,000
Rp 6,000 95.00% Rp 5,700 Rp 342,000 17,187 Rp 97,965,900
Rp 6,000 95.00% Rp 5,700 Rp 193,800 15,527 Rp 83,856,000
Rp 6,000 95.00% Rp 5,700 Rp 290,700 32,954 Rp 187,837,800
Rp 6,000 95.00% Rp 5,700 Rp 433,200 47,843 Rp 272,705,100
Rp 6,000 95.00% Rp 5,700 Rp 313,500 33,709 Rp 192,141,300
Rp 6,000 95.00% Rp 5,700 Rp 450,300 40,202 Rp 229,151,400
Rp 6,000 95.00% Rp 5,700 Rp 359,100 12,321 Rp 70,229,700
Rp 6,000 95.00% Rp 5,700 Rp 347,700 38,968 Rp 222,117,600
Rp 6,000 95.00% Rp 5,700 Rp 353,400 37,360 Rp 212,952,000
Rp 6,000 95.00% Rp 5,700 Rp 210,900 27,392 Rp 156,134,400
Rp 6,000 95.00% Rp 5,700 Rp 256,500 22,648 Rp 129,093,600
Rp 6,000 95.00% Rp 5,700 Rp 256,500 32,959 Rp 187,866,300
Rp 6,000 95.00% Rp 5,700 Rp 336,300 30,129 Rp 171,735,300
Rp 6,000 95.00% Rp 5,700 Rp 136,800 25,774 Rp 146,911,800
Rp 6,000 95.00% Rp 5,700 Rp 216,600 18,405 Rp 104,908,500
Rp 6,000 95.00% Rp 5,700 Rp 302,100 32,497 Rp 185,232,900
Rp 6,000 95.00% Rp 5,700 Rp 182,400 20,230 Rp 115,311,000
Rp 6,000 95.00% Rp 5,700 Rp 267,900 37,134 Rp 211,663,800

Rp 6,000 95.00% Rp 5,700 Rp 233,700 31,952 Rp 182,126,400
Rp 6,000 95.00% Rp 5,700 Rp 171,000 34,758 Rp 198,120,600
Rp 6,000 95.00% Rp 5,700 Rp 102,600 32,711 Rp 186,452,700
Rp 6,000 100.00% Rp 6,000 Rp 396,000 38,370 Rp 230,220,000
Rp 6,000 95.00% Rp 5,700 Rp 256,500 33,503 Rp 190,967,100
Rp 6,000 95.00% Rp 5,700 Rp 262,200 36,567 Rp 208,431,900
Rp 6,000 95.00% Rp 5,700 Rp 342,000 25,517 Rp 145,446,900
Rp 6,000 95.00% Rp 5,700 Rp 364,800 22,621 Rp 128,939,700
Rp 6,000 95.00% Rp 5,700 Rp 273,600 19,645 Rp 111,976,500
Rp 6,000 95.00% Rp 5,700 Rp 273,600 26,533 Rp 151,238,100
Rp 6,000 95.00% Rp 5,700 Rp 285,000 22,687 Rp 129,315,900
Rp 6,000 95.00% Rp 5,700 Rp 313,500 20,878 Rp 119,004,600
Rp 6,000 95.00% Rp 5,700 Rp 228,000 16,015 Rp 91,285,500
Rp 6,000 95.00% Rp 5,700 Rp 342,000 37,368 Rp 212,997,600
Rp 6,000 95.00% Rp 5,700 Rp 530,100 34,709 Rp 197,841,300
Rp 6,000 90.00% Rp 5,400 Rp 151,200 22,553 Rp 128,543,700
Rp 6,000 95.00% Rp 5,700 Rp 285,000 38,031 Rp 216,776,700
Rp 6,000 95.00% Rp 5,700 Rp 404,700 26,961 Rp 153,677,700
Rp 6,000 95.00% Rp 5,700 Rp 96,900 24,135 Rp 137,569,500
Rp 6,000 95.00% Rp 5,700 Rp 233,700 21,980 Rp 125,286,000
Rp 6,000 95.00% Rp 5,700 Rp 62,700 14,219 Rp 81,048,300
Rp 6,000 95.00% Rp 5,700 Rp 302,100 32,066 Rp 182,776,200
Rp 6,000 95.00% Rp 5,700 Rp 102,600 26,033 Rp 148,388,100
Rp 6,000 95.00% Rp 5,700 Rp 376,200 33,638 Rp 191,736,600

Rp 6,000 95.00% Rp 5,700 Rp 359,100 26,087 Rp 156,503,100
Rp 6,000 95.00% Rp 5,700 Rp 302,100 35,258 Rp 200,970,600
Rp 6,000 95.00% Rp 5,700 Rp 57,000 20,558 Rp 117,180,600
Rp 6,000 95.00% Rp 5,700 Rp 250,800 24,292 Rp 131,190,000
Rp 6,000 95.00% Rp 5,700 Rp 148,200 12,514 Rp 71,329,800
Rp 6,000 95.00% Rp 5,700 Rp 319,200 23,464 Rp 133,744,800
Rp 6,000 95.00% Rp 5,700 Rp 125,400 15,778 Rp 89,934,600
Rp 6,000 95.00% Rp 5,700 Rp 205,200 27,549 Rp 157,029,300
Rp 6,000 95.00% Rp 5,700 Rp 302,100 28,214 Rp 160,819,800
Rp 6,000 95.00% Rp 5,700 Rp 233,700 25,389 Rp 144,717,300

Rp 6,000 95.00% Rp 5,700 Rp 342,000 14,541 Rp 78,539,400
Rp 6,000 90.00% Rp 5,400 Rp 86,400 14,843 Rp 84,600,300
Rp 6,000 95.00% Rp 5,700 Rp 233,700 13,784 Rp 78,568,800
Rp 6,000 95.00% Rp 5,700 Rp 193,800 23,173 Rp 132,086,100
### ### Rp 9,093,609,600

BULAN FEBRUARI 2020
KAP JUMLAH PESERTA BULAN

KODE FEBRUARI 2020
FASKES
NON PBI PBI
1 2 3 4 5 6
138 KOTA SURABAYA 02170004 Siwalankerto 8,846 3,528
139 KOTA SURABAYA 02170005 Balas Klumprik 3,768 3,294
140 KOTA SURABAYA 02170006 Keputih 7,233 9,392
141 KOTA SURABAYA 02170007 Bangkingan 3,032 3,438
142 KOTA SURABAYA 02170008 Made 4,633 6,013
143 KOTA SURABAYA 02170105 Morokrembangan 4,040 12,769
144 KOTA SURABAYA 02170106 Tambak Wedi 3,619 6,290

145 KOTA SURABAYA 02170107 Bulak Banteng 4,686 10,961
146 KOTA SURABAYA 02170108 Kalijudan 6,583 7,357
147 KOTA SURABAYA 13010101 Pegirian 7,254 21,854
148 KOTA SURABAYA 13010102 Wonokusumo 8,542 28,841
149 KOTA SURABAYA 13010103 Sidotopo 4,381 21,384
150 KOTA SURABAYA 13010201 Perak Timur 9,888 26,150
151 KOTA SURABAYA 13010301 Tanjungsari 5,231 6,073
152 KOTA SURABAYA 13010302 Manukan Kulon 24,180 11,171
153 KOTA SURABAYA 13010303 Simomulyo 17,277 17,772
154 KOTA SURABAYA 13010304 Asemrowo 5,787 15,442
155 KOTA SURABAYA 13010305 Balongsari 9,405 10,334
156 KOTA SURABAYA 13010401 Sememi 13,745 13,227
157 KOTA SURABAYA 13010402 Benowo 12,707 11,709
158 KOTA SURABAYA 13010501 Krembangan Selatan 8,941 12,054
159 KOTA SURABAYA 13010502 Dupak 7,409 7,517
160 KOTA SURABAYA 13010601 Tembok Dukuh 10,162 17,941
161 KOTA SURABAYA 13010602 Gundih 4,864 13,392

162 KOTA SURABAYA 13010701 Tambak Rejo 9,386 22,258
163 KOTA SURABAYA 13010702 Simolawang 4,334 23,629
164 KOTA SURABAYA 13010801 Rangkah 9,882 18,898
165 KOTA SURABAYA 13010802 Pacar Keling 11,449 15,897
166 KOTA SURABAYA 13010803 Gading 6,089 26,103
167 KOTA SURABAYA 13010901 Pucang Sewu 18,247 10,458
168 KOTA SURABAYA 13010902 Mojo 15,689 16,638
169 KOTA SURABAYA 13011001 Kalirungkut 13,775 10,633
170 KOTA SURABAYA 13011002 Tenggilis 12,118 8,027
171 KOTA SURABAYA 13011003 Gunung Anyar 8,457 8,788
172 KOTA SURABAYA 13011004 Medokan Ayu 13,346 11,356
173 KOTA SURABAYA 13011101 Menur 12,807 8,548
174 KOTA SURABAYA 13011102 Mulyorejo 12,204 7,351
175 KOTA SURABAYA 13011103 Klampis Ngasem 9,216 6,176
176 KOTA SURABAYA 13011201 Tanah Kali Kedinding 12,871 17,194
177 KOTA SURABAYA 13011202 Sidotopo Wetan 10,576 18,775
178 KOTA SURABAYA 13011203 Kenjeran 6,873 12,590
179 KOTA SURABAYA 13011301 Jagir 18,967 15,428
180 KOTA SURABAYA 13011302 Wonokromo 13,315 11,094
181 KOTA SURABAYA 13011303 Ngagel Rejo 9,933 11,294
182 KOTA SURABAYA 13011401 Peneleh 6,344 10,695
183 KOTA SURABAYA 13011402 Ketabang 7,119 6,122
184 KOTA SURABAYA 13011501 Kedungdoro 13,243 14,042
185 KOTA SURABAYA 13011502 Dr. Soetomo 7,516 13,599

186 KOTA SURABAYA 13011601 Sawahan 16,390 13,703
187 KOTA SURABAYA 13011602 Putat Jaya 9,026 12,747
188 KOTA SURABAYA 13011603 Banyu Urip 11,704 17,283
189 KOTA SURABAYA 13011604 Pakis 9,098 7,516
190 KOTA SURABAYA 13011701 Gayungan 17,155 6,336
191 KOTA SURABAYA 13011702 Jemursari 8,075 3,749
192 KOTA SURABAYA 13011703 Kebonsari 11,873 10,474
193 KOTA SURABAYA 13011704 Sidosermo 6,840 7,602
194 KOTA SURABAYA 13011801 Kedurus 14,488 10,329
195 KOTA SURABAYA 13011802 Dukuh Kupang 15,622 9,476

196 KOTA SURABAYA 13011803 Wiyung 14,371 7,881
197 KOTA SURABAYA 13011901 Jeruk 6,989 5,768
198 KOTA SURABAYA 13011902 Lidah Kulon 8,478 4,451
199 KOTA SURABAYA 13011903 Lontar 6,245 5,126
200 KOTA SURABAYA 02170903 Sawah Pulo 1,900 15,961
TOTAL PUSKESMAS KOTA SURABAYA 618,223 761,898

KAPITASI BULAN FEBRUARI 2020
H PESERTA BULAN KAPITA

BIAYA
RUARI 2020 BIAYA KAP JUMLAH PESERTA
PER JIWA
PER % PENYESUAIAN BIAYA KAPITASI
PENYESU
JIWA
TOTAL AIAN NON PBI
7=5+6 8 9 10-=8*9 11=7*10 12
12,374 ### 100.00% Rp 6,000 Rp 74,244,000 45
7,062 ### 100.00% Rp 6,000 Rp 42,372,000 4
16,625 ### 100.00% Rp 6,000 Rp 99,750,000 49
6,470 ### 100.00% Rp 6,000 Rp 38,820,000 7
10,646 ### 100.00% Rp 6,000 Rp 63,876,000 37
16,809 ### 95.00% Rp 5,700 Rp 95,811,300 18
9,909 ### 95.00% Rp 5,700 Rp 56,481,300 22

15,647 ### 100.00% Rp 6,000 Rp 93,882,000 31
13,940 ### 100.00% Rp 6,000 Rp 83,640,000 18
29,108 ### 100.00% Rp 6,000 Rp 174,648,000 11
37,383 ### 100.00% Rp 6,000 Rp 224,298,000 20
25,765 ### 95.00% Rp 5,700 Rp 146,860,500 26
36,038 ### 95.00% Rp 5,700 Rp 205,416,600 48
11,304 ### 95.00% Rp 5,700 Rp 64,432,800 24
35,351 ### 100.00% Rp 6,000 Rp 212,106,000 67
35,049 ### 100.00% Rp 6,000 Rp 210,294,000 93
21,229 ### 95.00% Rp 5,700 Rp 121,005,300 48
19,739 ### 100.00% Rp 6,000 Rp 118,434,000 93
26,972 ### 100.00% Rp 6,000 Rp 161,832,000 43
24,416 ### 100.00% Rp 6,000 Rp 146,496,000 40
20,995 ### 100.00% Rp 6,000 Rp 125,970,000 13
14,926 ### 100.00% Rp 6,000 Rp 89,556,000 30
28,103 ### 100.00% Rp 6,000 Rp 168,618,000 24
18,256 ### 95.00% Rp 5,700 Rp 104,059,200 31

31,644 ### 100.00% Rp 6,000 Rp 189,864,000 33
27,963 ### 100.00% Rp 6,000 Rp 167,778,000 11
28,780 ### 100.00% Rp 6,000 Rp 172,680,000 16
27,346 ### 100.00% Rp 6,000 Rp 164,076,000 23
32,192 ### 100.00% Rp 6,000 Rp 193,152,000 29
28,705 ### 100.00% Rp 6,000 Rp 172,230,000 41
32,327 ### 95.00% Rp 5,700 Rp 184,263,900 35
24,408 ### 95.00% Rp 5,700 Rp 139,125,600 52
20,145 ### 100.00% Rp 6,000 Rp 120,870,000 42
17,245 ### 100.00% Rp 6,000 Rp 103,470,000 31
24,702 ### 95.00% Rp 5,700 Rp 140,801,400 56
21,355 ### 100.00% Rp 6,000 Rp 128,130,000 20
19,555 ### 100.00% Rp 6,000 Rp 117,330,000 37
15,392 ### 95.00% Rp 5,700 Rp 87,734,400 51
30,065 ### 95.00% Rp 5,700 Rp 171,370,500 42
29,351 ### 100.00% Rp 6,000 Rp 176,106,000 27
19,463 ### 95.00% Rp 5,700 Rp 110,939,100 19
34,395 ### 100.00% Rp 6,000 Rp 206,370,000 56
24,409 ### 100.00% Rp 6,000 Rp 146,454,000 37
21,227 ### 100.00% Rp 6,000 Rp 127,362,000 33
17,039 ### 95.00% Rp 5,700 Rp 97,122,300 18
13,241 ### 95.00% Rp 5,700 Rp 75,473,700 22
27,285 ### 95.00% Rp 5,700 Rp 155,524,500 43
21,115 ### 100.00% Rp 6,000 Rp 126,690,000 22

30,093 ### 100.00% Rp 6,000 Rp 180,558,000 46
21,773 ### 100.00% Rp 6,000 Rp 130,638,000 18
28,987 ### 95.00% Rp 5,700 Rp 165,225,900 45
16,614 ### 100.00% Rp 6,000 Rp 99,684,000 21
23,491 ### 100.00% Rp 6,000 Rp 140,946,000 41
11,824 ### 100.00% Rp 6,000 Rp 70,944,000 15
22,347 ### 100.00% Rp 6,000 Rp 134,082,000 34
14,442 ### 100.00% Rp 6,000 Rp 86,652,000 27
24,817 ### 100.00% Rp 6,000 Rp 148,902,000 37
25,098 ### 95.00% Rp 5,700 Rp 143,058,600 69

22,252 ### 100.00% Rp 6,000 Rp 133,512,000 43
12,757 ### 100.00% Rp 6,000 Rp 76,542,000 16
12,929 ### 95.00% Rp 5,700 Rp 73,695,300 33
11,371 ### 100.00% Rp 6,000 Rp 68,226,000 35
17,861 ### 95.00% Rp 5,700 Rp 101,807,700 9
1,380,121 Rp 8,152,293,900 2,127

BRUARI 2020
KAPITASI SUSULAN BULAN JANUARI 2019
BIAYA
KAP JUMLAH PESERTA BIAYA % PER
PER PENYES JIWA BIAYA KAPITASI
PBI SUSULA TOTAL JIWA UAIAN PENYES
N PPNPN UAIAN
15=12+1 18=16*1
13 14 16 17 19=15*18
3+14 7
327 5 377 ### 95.00% ### Rp 2,148,900
137 - 141 ### 95.00% ### Rp 803,700
432 2 483 ### 95.00% ### Rp 2,753,100
113 7 127 ### 95.00% ### Rp 723,900
190 2 229 ### 95.00% ### Rp 1,305,300
231 8 257 ### 95.00% ### Rp 1,464,900
442 7 471 ### 95.00% ### Rp 2,684,700

379 21 431 ### 95.00% ### Rp 2,456,700
259 1 278 ### 90.00% ### Rp 1,501,200
385 7 403 ### 95.00% ### Rp 2,297,100
518 13 551 ### 95.00% ### Rp 3,140,700
242 22 290 ### 95.00% ### Rp 1,653,000
287 4 339 ### 95.00% ### Rp 1,932,300
198 - 222 ### 95.00% ### Rp 1,265,400
755 - 822 ### 95.00% ### Rp 4,685,400
798 12 903 ### 95.00% ### Rp 5,147,100
252 2 302 ### 95.00% ### Rp 1,721,400
365 5 463 ### 95.00% ### Rp 2,639,100
824 1 868 ### 95.00% ### Rp 4,947,600
876 2 918 ### 95.00% ### Rp 5,232,600
337 - 350 ### 95.00% ### Rp 1,995,000
480 - 510 ### 95.00% ### Rp 2,907,000
319 3 346 ### 95.00% ### Rp 1,972,200
184 1 216 ### 95.00% ### Rp 1,231,200

460 7 500 ### 95.00% ### Rp 2,850,000
237 5 253 ### 95.00% ### Rp 1,442,100
535 19 570 ### 95.00% ### Rp 3,249,000
551 4 578 ### 95.00% ### Rp 3,294,600
294 8 331 ### 100.00% ### Rp 1,986,000
470 3 514 ### 95.00% ### Rp 2,929,800
711 5 751 ### 95.00% ### Rp 4,280,700
509 11 572 ### 95.00% ### Rp 3,260,400
433 4 479 ### 95.00% ### Rp 2,730,300
331 - 362 ### 95.00% ### Rp 2,063,400
572 1 629 ### 95.00% ### Rp 3,585,300
410 4 434 ### 95.00% ### Rp 2,473,800
501 4 542 ### 95.00% ### Rp 3,089,400
343 - 394 ### 95.00% ### Rp 2,245,800
778 8 828 ### 95.00% ### Rp 4,719,600
780 13 820 ### 95.00% ### Rp 4,674,000
473 4 496 ### 95.00% ### Rp 2,827,200
749 9 814 ### 95.00% ### Rp 4,639,800
425 3 465 ### 95.00% ### Rp 2,650,500
518 - 551 ### 95.00% ### Rp 3,140,700
279 2 299 ### 95.00% ### Rp 1,704,300
657 - 679 ### 95.00% ### Rp 3,870,300
258 12 313 ### 95.00% ### Rp 1,784,100
332 - 354 ### 95.00% ### Rp 2,017,800

448 5 499 ### 95.00% ### Rp 2,844,300
581 8 607 ### 100.00% ### Rp 3,642,000
484 2 531 ### 95.00% ### Rp 3,026,700
284 4 309 ### 95.00% ### Rp 1,761,300
672 3 716 ### 90.00% ### Rp 3,866,400
242 - 257 ### 95.00% ### Rp 1,464,900
483 1 518 ### 95.00% ### Rp 2,952,600
232 - 259 ### 95.00% ### Rp 1,476,300
441 - 478 ### 95.00% ### Rp 2,724,600
440 8 517 ### 95.00% ### Rp 2,946,900

446 8 497 ### 95.00% ### Rp 2,832,900
187 1 204 ### 90.00% ### Rp 1,101,600
290 2 325 ### 95.00% ### Rp 1,852,500
222 1 258 ### 95.00% ### Rp 1,470,600
89 12 110 ### 95.00% ### Rp 627,000
26,477 306 28,910 Rp 164,709,000

TOTAL
PESERTA KAPITASI YANG
BULAN DIBAYARKAN BULAN
FEBRUARI FEBRUARI 2020
2020
20=7+15 21=11+19
12,751 Rp 76,392,900
7,203 Rp 43,175,700
17,108 Rp 102,503,100
6,597 Rp 39,543,900
10,875 Rp 65,181,300
17,066 Rp 97,276,200
10,380 Rp 59,166,000
16,078 Rp 96,338,700
14,218 Rp 85,141,200
29,511 Rp 176,945,100
37,934 Rp 227,438,700
26,055 Rp 148,513,500
36,377 Rp 207,348,900
11,526 Rp 65,698,200
36,173 Rp 216,791,400
35,952 Rp 215,441,100
21,531 Rp 122,726,700
20,202 Rp 121,073,100
27,840 Rp 166,779,600
25,334 Rp 151,728,600
21,345 Rp 127,965,000
15,436 Rp 92,463,000
28,449 Rp 170,590,200
18,472 Rp 105,290,400
32,144 Rp 192,714,000
28,216 Rp 169,220,100
29,350 Rp 175,929,000
27,924 Rp 167,370,600
32,523 Rp 195,138,000
29,219 Rp 175,159,800
33,078 Rp 188,544,600
24,980 Rp 142,386,000
20,624 Rp 123,600,300
17,607 Rp 105,533,400
25,331 Rp 144,386,700
21,789 Rp 130,603,800
20,097 Rp 120,419,400
15,786 Rp 89,980,200
30,893 Rp 176,090,100
30,171 Rp 180,780,000
19,959 Rp 113,766,300
35,209 Rp 211,009,800
24,874 Rp 149,104,500
21,778 Rp 130,502,700
17,338 Rp 98,826,600
13,920 Rp 79,344,000
27,598 Rp 157,308,600
21,469 Rp 128,707,800
30,592 Rp 183,402,300
22,380 Rp 134,280,000
29,518 Rp 168,252,600
16,923 Rp 101,445,300
24,207 Rp 144,812,400
12,081 Rp 72,408,900
22,865 Rp 137,034,600
14,701 Rp 88,128,300
25,295 Rp 151,626,600
25,615 Rp 146,005,500
22,749 Rp 136,344,900
12,961 Rp 77,643,600
13,254 Rp 75,547,800
11,629 Rp 69,696,600
17,971 Rp 102,434,700
1,409,031 Rp 8,317,002,900
BULAN MARET 2020
KAP JUMLAH PESERTA

KODE BULAN MARET 2020
FASKES
NON PBI PBI TOTAL
1 2 3 4 5 6 7=5+6
140 KOTA SURABAYA 02170004 Siwalankerto 8,863 3,231 12,094
141 KOTA SURABAYA 02170005 Balas Klumprik 3,804 3,096 6,900
142 KOTA SURABAYA 02170006 Keputih 7,309 8,649 15,958
143 KOTA SURABAYA 02170007 Bangkingan 2,998 3,330 6,328
144 KOTA SURABAYA 02170008 Made 4,618 6,020 10,638
145 KOTA SURABAYA 02170105 Morokrembangan 4,068 12,655 16,723
146 KOTA SURABAYA 02170106 Tambak Wedi 3,633 6,149 9,782

147 KOTA SURABAYA 02170107 Bulak Banteng 4,680 10,842 15,522
148 KOTA SURABAYA 02170108 Kalijudan 6,598 7,258 13,856
149 KOTA SURABAYA 13010101 Pegirian 7,286 21,851 29,137
150 KOTA SURABAYA 13010102 Wonokusumo 8,547 27,787 36,334
151 KOTA SURABAYA 13010103 Sidotopo 4,493 20,259 24,752
152 KOTA SURABAYA 13010201 Perak Timur 9,916 25,242 35,158
153 KOTA SURABAYA 13010301 Tanjungsari 5,266 5,674 10,940
154 KOTA SURABAYA 13010302 Manukan Kulon 24,198 10,917 35,115
155 KOTA SURABAYA 13010303 Simomulyo 17,313 16,942 34,255
156 KOTA SURABAYA 13010304 Asemrowo 5,709 15,350 21,059
157 KOTA SURABAYA 13010305 Balongsari 9,536 10,088 19,624
158 KOTA SURABAYA 13010401 Sememi 13,783 12,604 26,387
159 KOTA SURABAYA 13010402 Benowo 12,696 11,761 24,457
160 KOTA SURABAYA 13010501 Krembangan Selatan 8,954 11,791 20,745
161 KOTA SURABAYA 13010502 Dupak 7,376 6,991 14,367
162 KOTA SURABAYA 13010601 Tembok Dukuh 10,151 17,569 27,720
163 KOTA SURABAYA 13010602 Gundih 4,887 12,526 17,413

164 KOTA SURABAYA 13010701 Tambak Rejo 9,374 21,687 31,061
165 KOTA SURABAYA 13010702 Simolawang 4,394 23,077 27,471
166 KOTA SURABAYA 13010801 Rangkah 9,984 18,652 28,636
167 KOTA SURABAYA 13010802 Pacar Keling 11,528 15,435 26,963
168 KOTA SURABAYA 13010803 Gading 6,109 24,816 30,925
169 KOTA SURABAYA 13010901 Pucang Sewu 18,313 9,785 28,098
170 KOTA SURABAYA 13010902 Mojo 15,721 16,247 31,968
171 KOTA SURABAYA 13011001 Kalirungkut 13,727 9,392 23,119
172 KOTA SURABAYA 13011002 Tenggilis 12,200 8,105 20,305
173 KOTA SURABAYA 13011003 Gunung Anyar 8,410 8,605 17,015
174 KOTA SURABAYA 13011004 Medokan Ayu 13,465 11,066 24,531
175 KOTA SURABAYA 13011101 Menur 12,741 8,171 20,912
176 KOTA SURABAYA 13011102 Mulyorejo 12,194 7,342 19,536
177 KOTA SURABAYA 13011103 Klampis Ngasem 9,127 6,020 15,147
178 KOTA SURABAYA 13011201 Tanah Kali Kedinding 12,952 16,772 29,724
179 KOTA SURABAYA 13011202 Sidotopo Wetan 10,627 17,760 28,387
180 KOTA SURABAYA 13011203 Kenjeran 6,872 12,424 19,296
181 KOTA SURABAYA 13011301 Jagir 18,946 14,939 33,885
182 KOTA SURABAYA 13011302 Wonokromo 13,251 10,704 23,955
183 KOTA SURABAYA 13011303 Ngagel Rejo 10,032 10,560 20,592
184 KOTA SURABAYA 13011401 Peneleh 6,408 10,631 17,039
185 KOTA SURABAYA 13011402 Ketabang 7,187 5,912 13,099
186 KOTA SURABAYA 13011501 Kedungdoro 13,253 13,706 26,959
187 KOTA SURABAYA 13011502 Dr. Soetomo 7,558 13,026 20,584

188 KOTA SURABAYA 13011601 Sawahan 16,299 13,070 29,369
189 KOTA SURABAYA 13011602 Putat Jaya 9,121 12,495 21,616
190 KOTA SURABAYA 13011603 Banyu Urip 11,727 16,811 28,538
191 KOTA SURABAYA 13011604 Pakis 9,185 7,094 16,279
192 KOTA SURABAYA 13011701 Gayungan 17,244 5,851 23,095
193 KOTA SURABAYA 13011702 Jemursari 8,071 3,652 11,723
194 KOTA SURABAYA 13011703 Kebonsari 11,900 10,172 22,072
195 KOTA SURABAYA 13011704 Sidosermo 6,708 7,407 14,115
196 KOTA SURABAYA 13011801 Kedurus 14,592 9,760 24,352
197 KOTA SURABAYA 13011802 Dukuh Kupang 15,731 9,071 24,802

198 KOTA SURABAYA 13011803 Wiyung 14,362 7,493 21,855
199 KOTA SURABAYA 13011901 Jeruk 6,967 5,572 12,539
200 KOTA SURABAYA 13011902 Lidah Kulon 8,458 4,295 12,753
201 KOTA SURABAYA 13011903 Lontar 6,255 5,098 11,353
202 KOTA SURABAYA 02170903 Sawah Pulo 1,945 15,814 17,759
TOTAL PUSKESMAS KOTA SURABAYA ### ### ###

KAPITASI BULAN MARET 2020
KAPITASI SUSULAN B
% BIAYA PER KAP JUMLAH PESERTA
BIAYA PER
PENYESUAI JIWA BIAYA KAPITASI
JIWA
AN PENYESUAIAN
NON PBI PBI TOTAL
15=12+1
8 9 10-=8*9 11=7*10 12 13
3+14
Rp 6,000 100.00% Rp 6,000 Rp 72,564,000 39 - 39
Rp 6,000 100.00% Rp 6,000 Rp 41,400,000 4 - 4
Rp 6,000 100.00% Rp 6,000 Rp 95,748,000 38 - 38
Rp 6,000 100.00% Rp 6,000 Rp 37,968,000 10 - 10
Rp 6,000 100.00% Rp 6,000 Rp 63,828,000 30 - 30
Rp 6,000 100.00% Rp 6,000 Rp 100,338,000 34 - 34
Rp 6,000 100.00% Rp 6,000 Rp 58,692,000 6 - 6

Rp 6,000 100.00% Rp 6,000 Rp 93,132,000 20 - 20
Rp 6,000 100.00% Rp 6,000 Rp 83,136,000 21 - 21
Rp 6,000 100.00% Rp 6,000 Rp 174,822,000 14 - 14
Rp 6,000 100.00% Rp 6,000 Rp 218,004,000 25 - 25
Rp 6,000 95.00% Rp 5,700 Rp 141,086,400 11 - 11
Rp 6,000 100.00% Rp 6,000 Rp 210,948,000 27 - 27
Rp 6,000 100.00% Rp 6,000 Rp 65,640,000 11 - 11
Rp 6,000 100.00% Rp 6,000 Rp 210,690,000 38 - 38
Rp 6,000 100.00% Rp 6,000 Rp 205,530,000 51 - 51
Rp 6,000 100.00% Rp 6,000 Rp 126,354,000 14 - 14
Rp 6,000 100.00% Rp 6,000 Rp 117,744,000 33 - 33
Rp 6,000 100.00% Rp 6,000 Rp 158,322,000 34 - 34
Rp 6,000 100.00% Rp 6,000 Rp 146,742,000 42 - 42
Rp 6,000 100.00% Rp 6,000 Rp 124,470,000 9 - 9
Rp 6,000 100.00% Rp 6,000 Rp 86,202,000 22 - 22
Rp 6,000 100.00% Rp 6,000 Rp 166,320,000 20 - 20
Rp 6,000 100.00% Rp 6,000 Rp 104,478,000 12 - 12

Rp 6,000 100.00% Rp 6,000 Rp 186,366,000 25 - 25
Rp 6,000 95.00% Rp 5,700 Rp 156,584,700 16 - 16
Rp 6,000 100.00% Rp 6,000 Rp 171,816,000 23 - 23
Rp 6,000 100.00% Rp 6,000 Rp 161,778,000 39 - 39
Rp 6,000 100.00% Rp 6,000 Rp 185,550,000 40 - 40
Rp 6,000 100.00% Rp 6,000 Rp 168,588,000 33 - 33
Rp 6,000 100.00% Rp 6,000 Rp 191,808,000 46 - 46
Rp 6,000 100.00% Rp 6,000 Rp 138,714,000 27 - 27
Rp 6,000 100.00% Rp 6,000 Rp 121,830,000 30 - 30
Rp 6,000 100.00% Rp 6,000 Rp 102,090,000 19 - 19
Rp 6,000 100.00% Rp 6,000 Rp 147,186,000 29 - 29
Rp 6,000 100.00% Rp 6,000 Rp 125,472,000 49 - 49
Rp 6,000 100.00% Rp 6,000 Rp 117,216,000 33 - 33
Rp 6,000 100.00% Rp 6,000 Rp 90,882,000 37 - 37
Rp 6,000 100.00% Rp 6,000 Rp 178,344,000 53 - 53
Rp 6,000 100.00% Rp 6,000 Rp 170,322,000 23 - 23
Rp 6,000 100.00% Rp 6,000 Rp 115,776,000 23 - 23
Rp 6,000 100.00% Rp 6,000 Rp 203,310,000 69 - 69
Rp 6,000 100.00% Rp 6,000 Rp 143,730,000 36 - 36
Rp 6,000 100.00% Rp 6,000 Rp 123,552,000 20 - 20
Rp 6,000 100.00% Rp 6,000 Rp 102,234,000 13 - 13
Rp 6,000 100.00% Rp 6,000 Rp 78,594,000 9 - 9
Rp 6,000 100.00% Rp 6,000 Rp 161,754,000 20 - 20
Rp 6,000 100.00% Rp 6,000 Rp 123,504,000 21 - 21

Rp 6,000 100.00% Rp 6,000 Rp 176,214,000 15 - 15
Rp 6,000 100.00% Rp 6,000 Rp 129,696,000 18 - 18
Rp 6,000 100.00% Rp 6,000 Rp 171,228,000 28 - 28
Rp 6,000 100.00% Rp 6,000 Rp 97,674,000 23 - 23
Rp 6,000 100.00% Rp 6,000 Rp 138,570,000 37 - 37
Rp 6,000 100.00% Rp 6,000 Rp 70,338,000 20 - 20
Rp 6,000 100.00% Rp 6,000 Rp 132,432,000 36 - 36
Rp 6,000 100.00% Rp 6,000 Rp 84,690,000 9 - 9
Rp 6,000 100.00% Rp 6,000 Rp 146,112,000 36 - 36
Rp 6,000 100.00% Rp 6,000 Rp 148,812,000 43 - 43

Rp 6,000 100.00% Rp 6,000 Rp 131,130,000 30 - 30
Rp 6,000 100.00% Rp 6,000 Rp 75,234,000 38 - 38
Rp 6,000 95.00% Rp 5,700 Rp 72,692,100 22 - 22
Rp 6,000 100.00% Rp 6,000 Rp 68,118,000 32 - 32
Rp 6,000 100.00% Rp 6,000 Rp 106,554,000 6 - 6
Rp 8,120,653,200 1,691 - 1,691

KAPITASI SUSULAN BULAN FEBRUARI 2020 TOTAL
BIAYA PER PESERTA
% BULAN
BIAYA PER JIWA BIAYA
PENYESUAIA MARET 2020
JIWA PENYESUAIA KAPITASI
N
N
16 17 18=16*17 19=15*18 20=7+15
Rp 6,000 100.00% Rp 6,000 Rp 234,000 12,133
Rp 6,000 100.00% Rp 6,000 Rp 24,000 6,904
Rp 6,000 100.00% Rp 6,000 Rp 228,000 15,996
Rp 6,000 100.00% Rp 6,000 Rp 60,000 6,338
Rp 6,000 100.00% Rp 6,000 Rp 180,000 10,668
Rp 6,000 95.00% Rp 5,700 Rp 193,800 16,757
Rp 6,000 95.00% Rp 5,700 Rp 34,200 9,788

Rp 6,000 100.00% Rp 6,000 Rp 120,000 15,542
Rp 6,000 100.00% Rp 6,000 Rp 126,000 13,877
Rp 6,000 100.00% Rp 6,000 Rp 84,000 29,151
Rp 6,000 100.00% Rp 6,000 Rp 150,000 36,359
Rp 6,000 95.00% Rp 5,700 Rp 62,700 24,763
Rp 6,000 95.00% Rp 5,700 Rp 153,900 35,185
Rp 6,000 95.00% Rp 5,700 Rp 62,700 10,951
Rp 6,000 100.00% Rp 6,000 Rp 228,000 35,153
Rp 6,000 100.00% Rp 6,000 Rp 306,000 34,306
Rp 6,000 95.00% Rp 5,700 Rp 79,800 21,073
Rp 6,000 100.00% Rp 6,000 Rp 198,000 19,657
Rp 6,000 100.00% Rp 6,000 Rp 204,000 26,421
Rp 6,000 100.00% Rp 6,000 Rp 252,000 24,499
Rp 6,000 100.00% Rp 6,000 Rp 54,000 20,754
Rp 6,000 100.00% Rp 6,000 Rp 132,000 14,389
Rp 6,000 100.00% Rp 6,000 Rp 120,000 27,740
Rp 6,000 95.00% Rp 5,700 Rp 68,400 17,425

Rp 6,000 100.00% Rp 6,000 Rp 150,000 31,086
Rp 6,000 100.00% Rp 6,000 Rp 96,000 27,487
Rp 6,000 100.00% Rp 6,000 Rp 138,000 28,659
Rp 6,000 100.00% Rp 6,000 Rp 234,000 27,002
Rp 6,000 100.00% Rp 6,000 Rp 240,000 30,965
Rp 6,000 100.00% Rp 6,000 Rp 198,000 28,131
Rp 6,000 95.00% Rp 5,700 Rp 262,200 32,014
Rp 6,000 95.00% Rp 5,700 Rp 153,900 23,146
Rp 6,000 100.00% Rp 6,000 Rp 180,000 20,335
Rp 6,000 100.00% Rp 6,000 Rp 114,000 17,034
Rp 6,000 95.00% Rp 5,700 Rp 165,300 24,560
Rp 6,000 100.00% Rp 6,000 Rp 294,000 20,961
Rp 6,000 100.00% Rp 6,000 Rp 198,000 19,569
Rp 6,000 95.00% Rp 5,700 Rp 210,900 15,184
Rp 6,000 95.00% Rp 5,700 Rp 302,100 29,777
Rp 6,000 100.00% Rp 6,000 Rp 138,000 28,410
Rp 6,000 95.00% Rp 5,700 Rp 131,100 19,319
Rp 6,000 100.00% Rp 6,000 Rp 414,000 33,954
Rp 6,000 100.00% Rp 6,000 Rp 216,000 23,991
Rp 6,000 100.00% Rp 6,000 Rp 120,000 20,612
Rp 6,000 95.00% Rp 5,700 Rp 74,100 17,052
Rp 6,000 95.00% Rp 5,700 Rp 51,300 13,108
Rp 6,000 95.00% Rp 5,700 Rp 114,000 26,979
Rp 6,000 100.00% Rp 6,000 Rp 126,000 20,605

Rp 6,000 100.00% Rp 6,000 Rp 90,000 29,384
Rp 6,000 100.00% Rp 6,000 Rp 108,000 21,634
Rp 6,000 95.00% Rp 5,700 Rp 159,600 28,566
Rp 6,000 100.00% Rp 6,000 Rp 138,000 16,302
Rp 6,000 100.00% Rp 6,000 Rp 222,000 23,132
Rp 6,000 100.00% Rp 6,000 Rp 120,000 11,743
Rp 6,000 100.00% Rp 6,000 Rp 216,000 22,108
Rp 6,000 100.00% Rp 6,000 Rp 54,000 14,124
Rp 6,000 100.00% Rp 6,000 Rp 216,000 24,388
Rp 6,000 95.00% Rp 5,700 Rp 245,100 24,845

Rp 6,000 100.00% Rp 6,000 Rp 180,000 21,885
Rp 6,000 100.00% Rp 6,000 Rp 228,000 12,577
Rp 6,000 95.00% Rp 5,700 Rp 125,400 12,775
Rp 6,000 100.00% Rp 6,000 Rp 192,000 11,385
Rp 6,000 95.00% Rp 5,700 Rp 34,200 17,765
Rp10,004,700 1,358,382
KAPITASI YANG
DIBAYARKAN BULAN
MARET 2020
21=11+19
Rp 72,798,000
Rp 41,424,000
Rp 95,976,000
Rp 38,028,000
Rp 64,008,000
Rp 100,531,800
Rp 58,726,200
Rp 93,252,000
Rp 83,262,000
Rp 174,906,000
Rp 218,154,000
Rp 141,149,100
Rp 211,101,900
Rp 65,702,700
Rp 210,918,000
Rp 205,836,000
Rp 126,433,800
Rp 117,942,000
Rp 158,526,000
Rp 146,994,000
Rp 124,524,000
Rp 86,334,000
Rp 166,440,000
Rp 104,546,400
Rp 186,516,000
Rp 156,680,700
Rp 171,954,000
Rp 162,012,000
Rp 185,790,000
Rp 168,786,000
Rp 192,070,200
Rp 138,867,900
Rp 122,010,000
Rp 102,204,000
Rp 147,351,300
Rp 125,766,000
Rp 117,414,000
Rp 91,092,900
Rp 178,646,100
Rp 170,460,000
Rp 115,907,100
Rp 203,724,000
Rp 143,946,000
Rp 123,672,000
Rp 102,308,100
Rp 78,645,300
Rp 161,868,000
Rp 123,630,000
Rp 176,304,000
Rp 129,804,000
Rp 171,387,600
Rp 97,812,000
Rp 138,792,000
Rp 70,458,000
Rp 132,648,000
Rp 84,744,000
Rp 146,328,000
Rp 149,057,100
Rp 131,310,000
Rp 75,462,000
Rp 72,817,500
Rp 68,310,000
Rp 106,588,200
Rp 8,130,657,900
BULAN APRIL 2020
KAPITASI BULAN APRIL 2020
KAP JUMLAH PESERTA BULAN KAPITASI SUSULAN BULAN MARET 2020

APRIL 2020 KAP JUMLAH PESERTA
KODE BIAYA PER
NO KANTOR CABANG NAMA FASKES BIAYA PER BIAYA PER
FASKES % PENYESUAIAN JIWA BIAYA KAPITASI BIAYA PER
JIWA Non Pengalihan % PENYESUAIAN JIWA
PENYESUAIAN Pengalihan PBI Non Pengalihan JIWA
NON PBI PBI TOTAL NON PBI Migrasi PBI JK PBI JK (NON Total PENYESUAIAN
JK tahap 1 PBI JK (PBI)
PBI)
1 2 3 4 5 6 7=5+6 8 9 10-=8*9 11=7*10 12 13 14 15 16 17=12+13+14+15+ 18 19 20

16
1 KOTA SURABAYA 02170004 Siwalankerto 8,818 3,661 12,479 Rp 6,000 100.00% Rp 6,000 Rp 74,874,000 40 1 - - 3 44 Rp 6,000 100.00% Rp 6,000
2 KOTA SURABAYA 02170005 Balas Klumprik 3,738 3,460 7,198 Rp 6,000 100.00% Rp 6,000 Rp 43,188,000 5 - - - - 5 Rp 6,000 100.00% Rp 6,000
3 KOTA SURABAYA 02170006 Keputih 7,240 9,896 17,136 Rp 6,000 100.00% Rp 6,000 Rp 102,816,000 29 - - - - 29 Rp 6,000 100.00% Rp 6,000
4 KOTA SURABAYA 02170007 Bangkingan 3,039 4,113 7,152 Rp 6,000 100.00% Rp 6,000 Rp 42,912,000 16 1 2 - - 19 Rp 6,000 100.00% Rp 6,000
5 KOTA SURABAYA 02170008 Made 4,621 6,699 11,320 Rp 6,000 100.00% Rp 6,000 Rp 67,920,000 25 - 3 - - 28 Rp 6,000 100.00% Rp 6,000
6 KOTA SURABAYA 02170105 Morokrembangan 4,055 18,929 22,984 Rp 6,000 100.00% Rp 6,000 Rp 137,904,000 9 11 4 - 3 27 Rp 6,000 100.00% Rp 6,000
7 KOTA SURABAYA 02170106 Tambak Wedi 3,567 7,452 11,019 Rp 6,000 100.00% Rp 6,000 Rp 66,114,000 8 - 1 - - 9 Rp 6,000 100.00% Rp 6,000
8 KOTA SURABAYA 02170107 Bulak Banteng 4,690 13,192 17,882 Rp 6,000 100.00% Rp 6,000 Rp 107,292,000 19 - - - - 19 Rp 6,000 100.00% Rp 6,000
9 KOTA SURABAYA 02170108 Kalijudan 6,589 8,533 15,122 Rp 6,000 100.00% Rp 6,000 Rp 90,732,000 43 - 2 1 1 47 Rp 6,000 100.00% Rp 6,000
10 KOTA SURABAYA 13010101 Pegirian 7,181 25,524 32,705 Rp 6,000 100.00% Rp 6,000 Rp 196,230,000 11 3 2 - 4 20 Rp 6,000 100.00% Rp 6,000
11 KOTA SURABAYA 13010102 Wonokusumo 8,588 35,297 43,885 Rp 6,000 100.00% Rp 6,000 Rp 263,310,000 23 - 1 - 1 25 Rp 6,000 100.00% Rp 6,000
12 KOTA SURABAYA 13010103 Sidotopo 4,431 24,530 28,961 Rp 6,000 95.00% Rp 5,700 Rp 165,077,700 15 6 - - 1 22 Rp 6,000 95.00% Rp 5,700
13 KOTA SURABAYA 13010201 Perak Timur 9,954 30,072 40,026 Rp 6,000 100.00% Rp 6,000 Rp 240,156,000 23 11 1 - - 35 Rp 6,000 100.00% Rp 6,000
14 KOTA SURABAYA 13010301 Tanjungsari 5,294 7,007 12,301 Rp 6,000 100.00% Rp 6,000 Rp 73,806,000 21 - 4 - 1 26 Rp 6,000 100.00% Rp 6,000
15 KOTA SURABAYA 13010302 Manukan Kulon 24,219 14,125 38,344 Rp 6,000 100.00% Rp 6,000 Rp 230,064,000 52 - 5 - - 57 Rp 6,000 100.00% Rp 6,000
16 KOTA SURABAYA 13010303 Simomulyo 17,263 20,136 37,399 Rp 6,000 100.00% Rp 6,000 Rp 224,394,000 60 6 5 1 5 77 Rp 6,000 100.00% Rp 6,000
17 KOTA SURABAYA 13010304 Asemrowo 5,760 18,473 24,233 Rp 6,000 100.00% Rp 6,000 Rp 145,398,000 12 4 - - 1 17 Rp 6,000 100.00% Rp 6,000
18 KOTA SURABAYA 13010305 Balongsari 9,581 12,273 21,854 Rp 6,000 100.00% Rp 6,000 Rp 131,124,000 26 5 5 - - 36 Rp 6,000 100.00% Rp 6,000
19 KOTA SURABAYA 13010401 Sememi 13,743 16,699 30,442 Rp 6,000 100.00% Rp 6,000 Rp 182,652,000 58 1 4 - - 63 Rp 6,000 100.00% Rp 6,000
20 KOTA SURABAYA 13010402 Benowo 12,808 16,077 28,885 Rp 6,000 100.00% Rp 6,000 Rp 173,310,000 42 2 - - 5 49 Rp 6,000 100.00% Rp 6,000
21 KOTA SURABAYA 13010501 Krembangan Selatan 8,895 15,427 24,322 Rp 6,000 100.00% Rp 6,000 Rp 145,932,000 34 - - - - 34 Rp 6,000 100.00% Rp 6,000
22 KOTA SURABAYA 13010502 Dupak 7,447 9,438 16,885 Rp 6,000 100.00% Rp 6,000 Rp 101,310,000 15 - 1 1 - 17 Rp 6,000 100.00% Rp 6,000
23 KOTA SURABAYA 13010601 Tembok Dukuh 10,193 21,781 31,974 Rp 6,000 100.00% Rp 6,000 Rp 191,844,000 21 5 3 - 1 30 Rp 6,000 100.00% Rp 6,000
24 KOTA SURABAYA 13010602 Gundih 4,902 14,026 18,928 Rp 6,000 100.00% Rp 6,000 Rp 113,568,000 13 - 2 - 1 16 Rp 6,000 100.00% Rp 6,000
25 KOTA SURABAYA 13010701 Tambak Rejo 9,399 26,789 36,188 Rp 6,000 100.00% Rp 6,000 Rp 217,128,000 31 - 3 - - 34 Rp 6,000 100.00% Rp 6,000
26 KOTA SURABAYA 13010702 Simolawang 4,335 26,393 30,728 Rp 6,000 95.00% Rp 5,700 Rp 175,149,600 20 5 1 - 1 27 Rp 6,000 95.00% Rp 5,700
27 KOTA SURABAYA 13010801 Rangkah 9,897 23,710 33,607 Rp 6,000 100.00% Rp 6,000 Rp 201,642,000 33 - 18 1 2 54 Rp 6,000 100.00% Rp 6,000
28 KOTA SURABAYA 13010802 Pacar Keling 11,459 21,288 32,747 Rp 6,000 100.00% Rp 6,000 Rp 196,482,000 22 - - 3 3 28 Rp 6,000 100.00% Rp 6,000
29 KOTA SURABAYA 13010803 Gading 6,097 29,094 35,191 Rp 6,000 100.00% Rp 6,000 Rp 211,146,000 22 17 4 - 2 45 Rp 6,000 100.00% Rp 6,000
30 KOTA SURABAYA 13010901 Pucang Sewu 18,271 11,603 29,874 Rp 6,000 100.00% Rp 6,000 Rp 179,244,000 47 6 - - - 53 Rp 6,000 100.00% Rp 6,000
31 KOTA SURABAYA 13010902 Mojo 15,612 18,920 34,532 Rp 6,000 100.00% Rp 6,000 Rp 207,192,000 29 - 2 - 3 34 Rp 6,000 100.00% Rp 6,000
32 KOTA SURABAYA 13011001 Kalirungkut 13,678 10,631 24,309 Rp 6,000 100.00% Rp 6,000 Rp 145,854,000 38 3 - - 2 43 Rp 6,000 100.00% Rp 6,000
33 KOTA SURABAYA 13011002 Tenggilis 12,199 10,681 22,880 Rp 6,000 100.00% Rp 6,000 Rp 137,280,000 42 - - 1 5 48 Rp 6,000 100.00% Rp 6,000
34 KOTA SURABAYA 13011003 Gunung Anyar 8,384 10,559 18,943 Rp 6,000 100.00% Rp 6,000 Rp 113,658,000 43 4 - 1 2 50 Rp 6,000 100.00% Rp 6,000
35 KOTA SURABAYA 13011004 Medokan Ayu 13,513 12,902 26,415 Rp 6,000 100.00% Rp 6,000 Rp 158,490,000 57 - 5 1 1 64 Rp 6,000 100.00% Rp 6,000
36 KOTA SURABAYA 13011101 Menur 12,707 9,663 22,370 Rp 6,000 100.00% Rp 6,000 Rp 134,220,000 64 2 - - - 66 Rp 6,000 100.00% Rp 6,000
37 KOTA SURABAYA 13011102 Mulyorejo 12,139 9,418 21,557 Rp 6,000 100.00% Rp 6,000 Rp 129,342,000 31 1 3 - - 35 Rp 6,000 100.00% Rp 6,000
38 KOTA SURABAYA 13011103 Klampis Ngasem 9,228 6,862 16,090 Rp 6,000 100.00% Rp 6,000 Rp 96,540,000 26 - - - 3 29 Rp 6,000 100.00% Rp 6,000
39 KOTA SURABAYA 13011201 Tanah Kali Kedinding 12,846 20,864 33,710 Rp 6,000 100.00% Rp 6,000 Rp 202,260,000 38 1 7 - 2 48 Rp 6,000 100.00% Rp 6,000
40 KOTA SURABAYA 13011202 Sidotopo Wetan 10,627 22,311 32,938 Rp 6,000 100.00% Rp 6,000 Rp 197,628,000 60 4 1 - 1 66 Rp 6,000 100.00% Rp 6,000
41 KOTA SURABAYA 13011203 Kenjeran 6,864 14,317 21,181 Rp 6,000 100.00% Rp 6,000 Rp 127,086,000 30 3 1 - 4 38 Rp 6,000 100.00% Rp 6,000
42 KOTA SURABAYA 13011301 Jagir 18,895 18,294 37,189 Rp 6,000 100.00% Rp 6,000 Rp 223,134,000 43 - 1 - 2 46 Rp 6,000 100.00% Rp 6,000
43 KOTA SURABAYA 13011302 Wonokromo 13,270 12,225 25,495 Rp 6,000 100.00% Rp 6,000 Rp 152,970,000 40 1 9 - 2 52 Rp 6,000 100.00% Rp 6,000
44 KOTA SURABAYA 13011303 Ngagel Rejo 10,093 12,652 22,745 Rp 6,000 100.00% Rp 6,000 Rp 136,470,000 43 - 4 8 3 58 Rp 6,000 100.00% Rp 6,000
45 KOTA SURABAYA 13011401 Peneleh 6,373 14,170 20,543 Rp 6,000 100.00% Rp 6,000 Rp 123,258,000 19 - - - 5 24 Rp 6,000 100.00% Rp 6,000
46 KOTA SURABAYA 13011402 Ketabang 7,168 7,039 14,207 Rp 6,000 100.00% Rp 6,000 Rp 85,242,000 20 - - - 3 23 Rp 6,000 100.00% Rp 6,000
47 KOTA SURABAYA 13011501 Kedungdoro 13,157 16,314 29,471 Rp 6,000 100.00% Rp 6,000 Rp 176,826,000 27 4 - - 5 36 Rp 6,000 100.00% Rp 6,000
48 KOTA SURABAYA 13011502 Dr. Soetomo 7,606 15,749 23,355 Rp 6,000 100.00% Rp 6,000 Rp 140,130,000 33 - - - 6 39 Rp 6,000 100.00% Rp 6,000
49 KOTA SURABAYA 13011601 Sawahan 16,279 14,362 30,641 Rp 6,000 100.00% Rp 6,000 Rp 183,846,000 54 10 7 2 1 74 Rp 6,000 100.00% Rp 6,000
50 KOTA SURABAYA 13011602 Putat Jaya 9,094 15,542 24,636 Rp 6,000 100.00% Rp 6,000 Rp 147,816,000 19 - 2 1 1 23 Rp 6,000 100.00% Rp 6,000
51 KOTA SURABAYA 13011603 Banyu Urip 11,733 21,520 33,253 Rp 6,000 100.00% Rp 6,000 Rp 199,518,000 33 - 3 - - 36 Rp 6,000 100.00% Rp 6,000
52 KOTA SURABAYA 13011604 Pakis 9,062 9,336 18,398 Rp 6,000 100.00% Rp 6,000 Rp 110,388,000 30 - 1 - 2 33 Rp 6,000 100.00% Rp 6,000
53 KOTA SURABAYA 13011701 Gayungan 17,162 7,442 24,604 Rp 6,000 100.00% Rp 6,000 Rp 147,624,000 35 - 2 - - 37 Rp 6,000 100.00% Rp 6,000
54 KOTA SURABAYA 13011702 Jemursari 8,045 4,339 12,384 Rp 6,000 100.00% Rp 6,000 Rp 74,304,000 29 - - - 1 30 Rp 6,000 100.00% Rp 6,000
KAPITASI BULAN APRIL 2020
KAP JUMLAH PESERTA BULAN KAPITASI SUSULAN BULAN MARET 2020

APRIL 2020 KAP JUMLAH PESERTA
KODE BIAYA PER
NO KANTOR CABANG NAMA FASKES BIAYA PER BIAYA PER
FASKES % PENYESUAIAN JIWA BIAYA KAPITASI BIAYA PER
JIWA Non Pengalihan % PENYESUAIAN JIWA
PENYESUAIAN Pengalihan PBI Non Pengalihan JIWA
NON PBI PBI TOTAL NON PBI Migrasi PBI JK PBI JK (NON Total PENYESUAIAN
JK tahap 1 PBI JK (PBI)
PBI)
1 2 3 4 5 6 7=5+6 8 9 10-=8*9 11=7*10 12 13 14 15 16 17=12+13+14+15+ 18 19 20

16
55 KOTA SURABAYA 13011703 Kebonsari 11,987 11,813 23,800 Rp 6,000 100.00% Rp 6,000 Rp 142,800,000 44 1 - - - 45 Rp 6,000 100.00% Rp 6,000
56 KOTA SURABAYA 13011704 Sidosermo 6,748 8,427 15,175 Rp 6,000 100.00% Rp 6,000 Rp 91,050,000 14 1 - - 2 17 Rp 6,000 100.00% Rp 6,000
57 KOTA SURABAYA 13011801 Kedurus 14,558 11,926 26,484 Rp 6,000 100.00% Rp 6,000 Rp 158,904,000 43 1 1 1 - 46 Rp 6,000 100.00% Rp 6,000
58 KOTA SURABAYA 13011802 Dukuh Kupang 15,622 11,130 26,752 Rp 6,000 100.00% Rp 6,000 Rp 160,512,000 43 - 5 - 1 49 Rp 6,000 100.00% Rp 6,000
59 KOTA SURABAYA 13011803 Wiyung 14,226 10,169 24,395 Rp 6,000 100.00% Rp 6,000 Rp 146,370,000 37 - 4 1 3 45 Rp 6,000 100.00% Rp 6,000
60 KOTA SURABAYA 13011901 Jeruk 7,009 6,792 13,801 Rp 6,000 100.00% Rp 6,000 Rp 82,806,000 16 - 1 - - 17 Rp 6,000 100.00% Rp 6,000
61 KOTA SURABAYA 13011902 Lidah Kulon 8,460 5,517 13,977 Rp 6,000 95.00% Rp 5,700 Rp 79,668,900 21 2 2 - - 25 Rp 6,000 95.00% Rp 5,700
62 KOTA SURABAYA 13011903 Lontar 6,273 7,234 13,507 Rp 6,000 100.00% Rp 6,000 Rp 81,042,000 35 - - - 5 40 Rp 6,000 100.00% Rp 6,000
63 KOTA SURABAYA 02170903 Sawah Pulo 1,947 19,401 21,348 Rp 6,000 100.00% Rp 6,000 Rp 128,088,000 1 - - 2 3 6 Rp 6,000 100.00% Rp 6,000
TOTAL PUSKESMAS KOTA SURABAYA 618,638 904,218 1,522,856 Rp 9,115,036,200 1,932 122 132 25 103 2,314
TOTAL KAPITASI YANG
PESERTA BULAN DIBAYARKAN BULAN
BIAYA APRIL 2020 APRIL 2020
KAPITASI
21=17*20 22=7+17 23=11+21
Rp 264,000 12,523 Rp 75,138,000
Rp 30,000 7,203 Rp 43,218,000
Rp 174,000 17,165 Rp 102,990,000
Rp 114,000 7,171 Rp 43,026,000

Rp 168,000 11,348 Rp 68,088,000
Rp 162,000 23,011 Rp 138,066,000
Rp 54,000 11,028 Rp 66,168,000

Rp 114,000 17,901 Rp 107,406,000
Rp 282,000 15,169 Rp 91,014,000
Rp 120,000 32,725 Rp 196,350,000
Rp 150,000 43,910 Rp 263,460,000

Rp 125,400 28,983 Rp 165,203,100
Rp 210,000 40,061 Rp 240,366,000
Rp 156,000 12,327 Rp 73,962,000

Rp 342,000 38,401 Rp 230,406,000
Rp 462,000 37,476 Rp 224,856,000
Rp 102,000 24,250 Rp 145,500,000

Rp 216,000 21,890 Rp 131,340,000
Rp 378,000 30,505 Rp 183,030,000
Rp 294,000 28,934 Rp 173,604,000

Rp 204,000 24,356 Rp 146,136,000
Rp 102,000 16,902 Rp 101,412,000

Rp 180,000 32,004 Rp 192,024,000
Rp 96,000 18,944 Rp 113,664,000
Rp 204,000 36,222 Rp 217,332,000

Rp 153,900 30,755 Rp 175,303,500
Rp 324,000 33,661 Rp 201,966,000
Rp 168,000 32,775 Rp 196,650,000

Rp 270,000 35,236 Rp 211,416,000
Rp 318,000 29,927 Rp 179,562,000
Rp 204,000 34,566 Rp 207,396,000

Rp 258,000 24,352 Rp 146,112,000
Rp 288,000 22,928 Rp 137,568,000
Rp 300,000 18,993 Rp 113,958,000
Rp 384,000 26,479 Rp 158,874,000

Rp 396,000 22,436 Rp 134,616,000
Rp 210,000 21,592 Rp 129,552,000
Rp 174,000 16,119 Rp 96,714,000

Rp 288,000 33,758 Rp 202,548,000
Rp 396,000 33,004 Rp 198,024,000
Rp 228,000 21,219 Rp 127,314,000
Rp 276,000 37,235 Rp 223,410,000
Rp 312,000 25,547 Rp 153,282,000
Rp 348,000 22,803 Rp 136,818,000

Rp 144,000 20,567 Rp 123,402,000
Rp 138,000 14,230 Rp 85,380,000

Rp 216,000 29,507 Rp 177,042,000
Rp 234,000 23,394 Rp 140,364,000
Rp 444,000 30,715 Rp 184,290,000

Rp 138,000 24,659 Rp 147,954,000
Rp 216,000 33,289 Rp 199,734,000
Rp 198,000 18,431 Rp 110,586,000

Rp 222,000 24,641 Rp 147,846,000
Rp 180,000 12,414 Rp 74,484,000

TOTAL KAPITASI YANG
PESERTA BULAN DIBAYARKAN BULAN
BIAYA APRIL 2020 APRIL 2020
KAPITASI
21=17*20 22=7+17 23=11+21
Rp 270,000 23,845 Rp 143,070,000

Rp 102,000 15,192 Rp 91,152,000
Rp 276,000 26,530 Rp 159,180,000
Rp 294,000 26,801 Rp 160,806,000

Rp 270,000 24,440 Rp 146,640,000
Rp 102,000 13,818 Rp 82,908,000
Rp 142,500 14,002 Rp 79,811,400

Rp 240,000 13,547 Rp 81,282,000
Rp 36,000 21,354 Rp 128,124,000
Rp 13,861,800 1,525,170 Rp 9,128,898,000

BULAN MEI 2020
KAPITASI BULAN MEI 2020

KAP JUMLAH PESERTA BULAN MEI KAPITASI SUSULAN BULAN APRIL 2020
2020 KAP JUMLAH PESERTA
KODE BIAYA
NO KANTOR CABANG NAMA FASKES % BIAYA PER
FASKES BIAYA PER JIWA
PENYESU BIAYA KAPITASI JIWA
PER JIWA PENYESUA BIAYA PER JIWA % PENYESUAIAN
AIAN Migrasi Susulan PENYESUAI
NON PBI PBI TOTAL IAN NON PBI Total
PBI JK TNI AN
1 2 3 4 5 6 7=5+6 8 9 10-=8*9 11=7*10 12 13 14 15=12+13 18 19 20

+14
1 KOTA SURABAYA 02170004 Siwalankerto 8,500 3,849 12,349 Rp 6,000 100.00% Rp 6,000 Rp 74,094,000 22 - 4 26 Rp 6,000 100.00% Rp 6,000
2 KOTA SURABAYA 02170005 Balas Klumprik 3,640 3,612 7,252 Rp 6,000 100.00% Rp 6,000 Rp 43,512,000 3 - 4 7 Rp 6,000 100.00% Rp 6,000
3 KOTA SURABAYA 02170006 Keputih 6,976 9,250 16,226 Rp 6,000 100.00% Rp 6,000 Rp 97,356,000 28 - 5 33 Rp 6,000 100.00% Rp 6,000
4 KOTA SURABAYA 02170007 Bangkingan 2,936 4,114 7,050 Rp 6,000 100.00% Rp 6,000 Rp 42,300,000 6 - 1 7 Rp 6,000 100.00% Rp 6,000
5 KOTA SURABAYA 02170008 Made 4,479 6,557 11,036 Rp 6,000 100.00% Rp 6,000 Rp 66,216,000 17 - 2 19 Rp 6,000 100.00% Rp 6,000
6 KOTA SURABAYA 02170105 Morokrembangan 3,887 18,634 22,521 Rp 6,000 100.00% Rp 6,000 Rp 135,126,000 12 - 1 13 Rp 6,000 100.00% Rp 6,000
7 KOTA SURABAYA 02170106 Tambak Wedi 3,436 7,379 10,815 Rp 6,000 100.00% Rp 6,000 Rp 64,890,000 20 - 1 21 Rp 6,000 100.00% Rp 6,000
8 KOTA SURABAYA 02170107 Bulak Banteng 4,545 12,713 17,258 Rp 6,000 100.00% Rp 6,000 Rp 103,548,000 18 - - 18 Rp 6,000 100.00% Rp 6,000
9 KOTA SURABAYA 02170108 Kalijudan 6,355 9,295 15,650 Rp 6,000 100.00% Rp 6,000 Rp 93,900,000 26 - - 26 Rp 6,000 100.00% Rp 6,000
10 KOTA SURABAYA 13010101 Pegirian 6,934 24,728 31,662 Rp 6,000 100.00% Rp 6,000 Rp 189,972,000 31 1 1 33 Rp 6,000 100.00% Rp 6,000
11 KOTA SURABAYA 13010102 Wonokusumo 8,239 33,475 41,714 Rp 6,000 100.00% Rp 6,000 Rp 250,284,000 11 - 3 14 Rp 6,000 100.00% Rp 6,000
12 KOTA SURABAYA 13010103 Sidotopo 4,219 22,367 26,586 Rp 6,000 95.00% Rp 5,700 Rp 151,540,200 20 - - 20 Rp 6,000 95.00% Rp 5,700
13 KOTA SURABAYA 13010201 Perak Timur 9,534 29,119 38,653 Rp 6,000 100.00% Rp 6,000 Rp 231,918,000 25 1 6 32 Rp 6,000 100.00% Rp 6,000
14 KOTA SURABAYA 13010301 Tanjungsari 5,079 7,133 12,212 Rp 6,000 100.00% Rp 6,000 Rp 73,272,000 2 - - 2 Rp 6,000 100.00% Rp 6,000
15 KOTA SURABAYA 13010302 Manukan Kulon 23,279 14,692 37,971 Rp 6,000 100.00% Rp 6,000 Rp 227,826,000 62 - 1 63 Rp 6,000 100.00% Rp 6,000
16 KOTA SURABAYA 13010303 Simomulyo 16,444 20,079 36,523 Rp 6,000 100.00% Rp 6,000 Rp 219,138,000 25 1 - 26 Rp 6,000 100.00% Rp 6,000
17 KOTA SURABAYA 13010304 Asemrowo 5,536 19,067 24,603 Rp 6,000 100.00% Rp 6,000 Rp 147,618,000 16 - - 16 Rp 6,000 100.00% Rp 6,000
18 KOTA SURABAYA 13010305 Balongsari 9,077 11,213 20,290 Rp 6,000 100.00% Rp 6,000 Rp 121,740,000 21 1 - 22 Rp 6,000 100.00% Rp 6,000
19 KOTA SURABAYA 13010401 Sememi 13,209 17,385 30,594 Rp 6,000 100.00% Rp 6,000 Rp 183,564,000 15 - 1 16 Rp 6,000 100.00% Rp 6,000
20 KOTA SURABAYA 13010402 Benowo 12,333 16,534 28,867 Rp 6,000 100.00% Rp 6,000 Rp 173,202,000 44 - 6 50 Rp 6,000 100.00% Rp 6,000
21 KOTA SURABAYA 13010501 Krembangan Selatan 8,734 15,579 24,313 Rp 6,000 100.00% Rp 6,000 Rp 145,878,000 16 - - 16 Rp 6,000 100.00% Rp 6,000
22 KOTA SURABAYA 13010502 Dupak 7,099 9,223 16,322 Rp 6,000 100.00% Rp 6,000 Rp 97,932,000 14 - - 14 Rp 6,000 100.00% Rp 6,000
23 KOTA SURABAYA 13010601 Tembok Dukuh 9,847 20,978 30,825 Rp 6,000 100.00% Rp 6,000 Rp 184,950,000 7 - - 7 Rp 6,000 100.00% Rp 6,000
24 KOTA SURABAYA 13010602 Gundih 4,681 14,325 19,006 Rp 6,000 100.00% Rp 6,000 Rp 114,036,000 4 - - 4 Rp 6,000 100.00% Rp 6,000
25 KOTA SURABAYA 13010701 Tambak Rejo 8,944 26,407 35,351 Rp 6,000 100.00% Rp 6,000 Rp 212,106,000 28 - - 28 Rp 6,000 100.00% Rp 6,000
26 KOTA SURABAYA 13010702 Simolawang 4,199 25,007 29,206 Rp 6,000 95.00% Rp 5,700 Rp 166,474,200 5 - 1 6 Rp 6,000 95.00% Rp 5,700
27 KOTA SURABAYA 13010801 Rangkah 9,596 23,620 33,216 Rp 6,000 100.00% Rp 6,000 Rp 199,296,000 13 - - 13 Rp 6,000 100.00% Rp 6,000
28 KOTA SURABAYA 13010802 Pacar Keling 11,050 20,732 31,782 Rp 6,000 100.00% Rp 6,000 Rp 190,692,000 23 - 2 25 Rp 6,000 100.00% Rp 6,000
29 KOTA SURABAYA 13010803 Gading 5,819 29,543 35,362 Rp 6,000 100.00% Rp 6,000 Rp 212,172,000 9 1 - 10 Rp 6,000 100.00% Rp 6,000
30 KOTA SURABAYA 13010901 Pucang Sewu 17,711 12,865 30,576 Rp 6,000 100.00% Rp 6,000 Rp 183,456,000 43 - 2 45 Rp 6,000 100.00% Rp 6,000
31 KOTA SURABAYA 13010902 Mojo 15,150 19,878 35,028 Rp 6,000 100.00% Rp 6,000 Rp 210,168,000 27 - 1 28 Rp 6,000 100.00% Rp 6,000
32 KOTA SURABAYA 13011001 Kalirungkut 13,191 10,417 23,608 Rp 6,000 100.00% Rp 6,000 Rp 141,648,000 20 - 5 25 Rp 6,000 100.00% Rp 6,000
33 KOTA SURABAYA 13011002 Tenggilis 11,840 11,173 23,013 Rp 6,000 100.00% Rp 6,000 Rp 138,078,000 19 1 - 20 Rp 6,000 100.00% Rp 6,000
34 KOTA SURABAYA 13011003 Gunung Anyar 8,075 11,090 19,165 Rp 6,000 100.00% Rp 6,000 Rp 114,990,000 11 1 1 13 Rp 6,000 100.00% Rp 6,000
35 KOTA SURABAYA 13011004 Medokan Ayu 13,115 13,126 26,241 Rp 6,000 100.00% Rp 6,000 Rp 157,446,000 41 - 1 42 Rp 6,000 100.00% Rp 6,000
36 KOTA SURABAYA 13011101 Menur 12,150 10,151 22,301 Rp 6,000 100.00% Rp 6,000 Rp 133,806,000 36 1 - 37 Rp 6,000 100.00% Rp 6,000
37 KOTA SURABAYA 13011102 Mulyorejo 11,711 10,039 21,750 Rp 6,000 100.00% Rp 6,000 Rp 130,500,000 43 - 9 52 Rp 6,000 100.00% Rp 6,000
38 KOTA SURABAYA 13011103 Klampis Ngasem 8,889 7,010 15,899 Rp 6,000 100.00% Rp 6,000 Rp 95,394,000 23 - 2 25 Rp 6,000 100.00% Rp 6,000
39 KOTA SURABAYA 13011201 Tanah Kali Kedinding 12,358 21,195 33,553 Rp 6,000 100.00% Rp 6,000 Rp 201,318,000 24 1 1 26 Rp 6,000 100.00% Rp 6,000
40 KOTA SURABAYA 13011202 Sidotopo Wetan 10,164 22,035 32,199 Rp 6,000 100.00% Rp 6,000 Rp 193,194,000 23 - - 23 Rp 6,000 100.00% Rp 6,000
KAPITASI BULAN MEI 2020
KAP JUMLAH PESERTA BULAN MEI KAPITASI SUSULAN BULAN APRIL 2020
KODE BIAYA
FASKES BIAYA PER JIWA
PENYESU BIAYA KAPITASI JIWA
PER JIWA PENYESUA BIAYA PER JIWA % PENYESUAIAN
AIAN Migrasi Susulan PENYESUAI
NON PBI PBI TOTAL IAN NON PBI Total
PBI JK TNI AN
1 2 3 4 5 6 7=5+6 8 9 10-=8*9 11=7*10 12 13 14 15=12+13 18 19 20

+14
41 KOTA SURABAYA 13011203 Kenjeran 6,555 15,249 21,804 Rp 6,000 100.00% Rp 6,000 Rp 130,824,000 22 - 1 23 Rp 6,000 100.00% Rp 6,000
42 KOTA SURABAYA 13011301 Jagir 18,173 18,266 36,439 Rp 6,000 100.00% Rp 6,000 Rp 218,634,000 28 - 4 32 Rp 6,000 100.00% Rp 6,000
43 KOTA SURABAYA 13011302 Wonokromo 12,732 12,091 24,823 Rp 6,000 100.00% Rp 6,000 Rp 148,938,000 27 2 7 36 Rp 6,000 100.00% Rp 6,000
44 KOTA SURABAYA 13011303 Ngagel Rejo 9,683 13,768 23,451 Rp 6,000 100.00% Rp 6,000 Rp 140,706,000 16 - - 16 Rp 6,000 100.00% Rp 6,000
45 KOTA SURABAYA 13011401 Peneleh 5,995 14,777 20,772 Rp 6,000 100.00% Rp 6,000 Rp 124,632,000 10 - - 10 Rp 6,000 100.00% Rp 6,000
46 KOTA SURABAYA 13011402 Ketabang 6,785 7,271 14,056 Rp 6,000 100.00% Rp 6,000 Rp 84,336,000 11 - - 11 Rp 6,000 100.00% Rp 6,000
47 KOTA SURABAYA 13011501 Kedungdoro 12,542 16,591 29,133 Rp 6,000 100.00% Rp 6,000 Rp 174,798,000 17 - - 17 Rp 6,000 100.00% Rp 6,000
48 KOTA SURABAYA 13011502 Dr. Soetomo 7,381 16,244 23,625 Rp 6,000 100.00% Rp 6,000 Rp 141,750,000 17 - - 17 Rp 6,000 100.00% Rp 6,000
49 KOTA SURABAYA 13011601 Sawahan 15,467 15,224 30,691 Rp 6,000 100.00% Rp 6,000 Rp 184,146,000 28 1 1 30 Rp 6,000 100.00% Rp 6,000
50 KOTA SURABAYA 13011602 Putat Jaya 8,691 15,898 24,589 Rp 6,000 100.00% Rp 6,000 Rp 147,534,000 23 - 3 26 Rp 6,000 100.00% Rp 6,000
51 KOTA SURABAYA 13011603 Banyu Urip 11,084 21,355 32,439 Rp 6,000 100.00% Rp 6,000 Rp 194,634,000 19 - 3 22 Rp 6,000 100.00% Rp 6,000
52 KOTA SURABAYA 13011604 Pakis 8,685 9,818 18,503 Rp 6,000 100.00% Rp 6,000 Rp 111,018,000 9 - - 9 Rp 6,000 100.00% Rp 6,000
53 KOTA SURABAYA 13011701 Gayungan 16,641 8,211 24,852 Rp 6,000 100.00% Rp 6,000 Rp 149,112,000 18 - - 18 Rp 6,000 100.00% Rp 6,000
54 KOTA SURABAYA 13011702 Jemursari 7,695 4,914 12,609 Rp 6,000 100.00% Rp 6,000 Rp 75,654,000 13 - 1 14 Rp 6,000 100.00% Rp 6,000
55 KOTA SURABAYA 13011703 Kebonsari 11,555 12,084 23,639 Rp 6,000 100.00% Rp 6,000 Rp 141,834,000 20 1 3 24 Rp 6,000 100.00% Rp 6,000
56 KOTA SURABAYA 13011704 Sidosermo 6,340 9,094 15,434 Rp 6,000 100.00% Rp 6,000 Rp 92,604,000 15 - - 15 Rp 6,000 100.00% Rp 6,000
57 KOTA SURABAYA 13011801 Kedurus 14,080 13,021 27,101 Rp 6,000 100.00% Rp 6,000 Rp 162,606,000 28 - - 28 Rp 6,000 100.00% Rp 6,000
58 KOTA SURABAYA 13011802 Dukuh Kupang 14,660 11,925 26,585 Rp 6,000 100.00% Rp 6,000 Rp 159,510,000 34 - - 34 Rp 6,000 100.00% Rp 6,000
59 KOTA SURABAYA 13011803 Wiyung 13,588 11,096 24,684 Rp 6,000 100.00% Rp 6,000 Rp 148,104,000 24 - 2 26 Rp 6,000 100.00% Rp 6,000
60 KOTA SURABAYA 13011901 Jeruk 6,760 6,636 13,396 Rp 6,000 100.00% Rp 6,000 Rp 80,376,000 22 - - 22 Rp 6,000 100.00% Rp 6,000
61 KOTA SURABAYA 13011902 Lidah Kulon 8,107 5,993 14,100 Rp 6,000 95.00% Rp 5,700 Rp 80,370,000 11 - - 11 Rp 6,000 95.00% Rp 5,700
62 KOTA SURABAYA 13011903 Lontar 5,943 8,571 14,514 Rp 6,000 100.00% Rp 6,000 Rp 87,084,000 17 - 2 19 Rp 6,000 100.00% Rp 6,000
63 KOTA SURABAYA 02170903 Sawah Pulo 1,849 17,091 18,940 Rp 6,000 100.00% Rp 6,000 Rp 113,640,000 6 - - 6 Rp 6,000 100.00% Rp 6,000
TOTAL PUSKESMAS KOTA SURABAYA 593,951 910,776 1,504,727 Rp 9,007,394,400 1,288 13 88 1,389
20
TOTAL
KAPITASI YANG
PESERTA
DIBAYARKAN BULAN
BULAN MEI
BIAYA KAPITASI MEI 2020
2020
21=17*20 22=7+17 23=11+21
Rp 156,000 12,375 Rp 74,250,000
Rp 42,000 7,259 Rp 43,554,000

Rp 198,000 16,259 Rp 97,554,000
Rp 42,000 7,057 Rp 42,342,000

Rp 114,000 11,055 Rp 66,330,000
Rp 78,000 22,534 Rp 135,204,000

Rp 126,000 10,836 Rp 65,016,000
Rp 108,000 17,276 Rp 103,656,000

Rp 156,000 15,676 Rp 94,056,000
Rp 198,000 31,695 Rp 190,170,000

Rp 84,000 41,728 Rp 250,368,000
Rp 114,000 26,606 Rp 151,654,200
Rp 192,000 38,685 Rp 232,110,000
Rp 12,000 12,214 Rp 73,284,000

Rp 378,000 38,034 Rp 228,204,000
Rp 156,000 36,549 Rp 219,294,000

Rp 96,000 24,619 Rp 147,714,000
Rp 132,000 20,312 Rp 121,872,000

Rp 96,000 30,610 Rp 183,660,000
Rp 300,000 28,917 Rp 173,502,000
Rp 96,000 24,329 Rp 145,974,000

Rp 84,000 16,336 Rp 98,016,000
Rp 42,000 30,832 Rp 184,992,000

Rp 24,000 19,010 Rp 114,060,000
Rp 168,000 35,379 Rp 212,274,000

Rp 34,200 29,212 Rp 166,508,400
Rp 78,000 33,229 Rp 199,374,000

Rp 150,000 31,807 Rp 190,842,000
Rp 60,000 35,372 Rp 212,232,000
Rp 270,000 30,621 Rp 183,726,000
Rp 168,000 35,056 Rp 210,336,000

Rp 150,000 23,633 Rp 141,798,000
Rp 120,000 23,033 Rp 138,198,000

Rp 78,000 19,178 Rp 115,068,000
Rp 252,000 26,283 Rp 157,698,000
Rp 222,000 22,338 Rp 134,028,000
Rp 312,000 21,802 Rp 130,812,000
Rp 150,000 15,924 Rp 95,544,000
Rp 156,000 33,579 Rp 201,474,000

Rp 138,000 32,222 Rp 193,332,000
20
TOTAL
KAPITASI YANG
PESERTA
DIBAYARKAN BULAN
BULAN MEI
BIAYA KAPITASI MEI 2020
2020
21=17*20 22=7+17 23=11+21
Rp 138,000 21,827 Rp 130,962,000
Rp 192,000 36,471 Rp 218,826,000

Rp 216,000 24,859 Rp 149,154,000
Rp 96,000 23,467 Rp 140,802,000
Rp 60,000 20,782 Rp 124,692,000
Rp 66,000 14,067 Rp 84,402,000

Rp 102,000 29,150 Rp 174,900,000
Rp 102,000 23,642 Rp 141,852,000

Rp 180,000 30,721 Rp 184,326,000
Rp 156,000 24,615 Rp 147,690,000

Rp 132,000 32,461 Rp 194,766,000
Rp 54,000 18,512 Rp 111,072,000
Rp 108,000 24,870 Rp 149,220,000
Rp 84,000 12,623 Rp 75,738,000

Rp 144,000 23,663 Rp 141,978,000
Rp 90,000 15,449 Rp 92,694,000

Rp 168,000 27,129 Rp 162,774,000
Rp 204,000 26,619 Rp 159,714,000

Rp 156,000 24,710 Rp 148,260,000
Rp 132,000 13,418 Rp 80,508,000

Rp 62,700 14,111 Rp 80,432,700
Rp 114,000 14,533 Rp 87,198,000
Rp 36,000 18,946 Rp 113,676,000

Rp 8,322,900 1,506,116 Rp 9,015,717,300
BULAN Juni 2020
KAPITASI BULAN Juni 2020

KAP JUMLAH PESERTA BULAN Juni KAPITASI SUSULAN BULAN Mei 2020
KODE BIAYA PER
FASKES BIAYA JIWA %
PENYESUAI BIAYA KAPITASI BIAYA JIWA
PER JIWA PENYESUAI Susulan PENYESUA
AN PER JIWA PENYESUAIA
NON PBI PBI TOTAL AN NON PBI PBI PD Total IAN
PEMDA N
1 2 3 4 5 6 7=5+6 8 9 10-=8*9 11=7*10 12 13 14 15=12+13 18 19 20

+14
1 KOTA SURABAYA 02170004 Siwalankerto 8,694 3,982 12,676 Rp 6,000 100.00% Rp 6,000 Rp 76,056,000 31 - 4 35 Rp 6,000 100.00% Rp 6,000
2 KOTA SURABAYA 02170005 Balas Klumprik 3,735 3,791 7,526 Rp 6,000 100.00% Rp 6,000 Rp 45,156,000 4 - - 4 Rp 6,000 100.00% Rp 6,000
3 KOTA SURABAYA 02170006 Keputih 7,156 9,942 17,098 Rp 6,000 100.00% Rp 6,000 Rp 102,588,000 16 - 9 25 Rp 6,000 100.00% Rp 6,000
4 KOTA SURABAYA 02170007 Bangkingan 2,980 4,245 7,225 Rp 6,000 100.00% Rp 6,000 Rp 43,350,000 7 - 16 23 Rp 6,000 100.00% Rp 6,000
5 KOTA SURABAYA 02170008 Made 4,638 6,817 11,455 Rp 6,000 100.00% Rp 6,000 Rp 68,730,000 13 - 23 36 Rp 6,000 100.00% Rp 6,000
6 KOTA SURABAYA 02170105 Morokrembangan 3,939 19,323 23,262 Rp 6,000 100.00% Rp 6,000 Rp 139,572,000 5 - - 5 Rp 6,000 100.00% Rp 6,000
7 KOTA SURABAYA 02170106 Tambak Wedi 3,480 7,724 11,204 Rp 6,000 100.00% Rp 6,000 Rp 67,224,000 9 - - 9 Rp 6,000 100.00% Rp 6,000
8 KOTA SURABAYA 02170107 Bulak Banteng 4,559 13,266 17,825 Rp 6,000 100.00% Rp 6,000 Rp 106,950,000 10 - - 10 Rp 6,000 100.00% Rp 6,000
9 KOTA SURABAYA 02170108 Kalijudan 6,514 9,742 16,256 Rp 6,000 100.00% Rp 6,000 Rp 97,536,000 28 - 2 30 Rp 6,000 100.00% Rp 6,000
10 KOTA SURABAYA 13010101 Pegirian 7,003 27,906 34,909 Rp 6,000 100.00% Rp 6,000 Rp 209,454,000 13 - 1 14 Rp 6,000 100.00% Rp 6,000
11 KOTA SURABAYA 13010102 Wonokusumo 8,253 35,036 43,289 Rp 6,000 100.00% Rp 6,000 Rp 259,734,000 23 - 3 26 Rp 6,000 100.00% Rp 6,000
12 KOTA SURABAYA 13010103 Sidotopo 4,278 21,485 25,763 Rp 6,000 95.00% Rp 5,700 Rp 146,849,100 9 - - 9 Rp 6,000 95.00% Rp 5,700
13 KOTA SURABAYA 13010201 Perak Timur 9,703 30,799 40,502 Rp 6,000 100.00% Rp 6,000 Rp 243,012,000 18 - - 18 Rp 6,000 100.00% Rp 6,000
14 KOTA SURABAYA 13010301 Tanjungsari 5,138 7,453 12,591 Rp 6,000 100.00% Rp 6,000 Rp 75,546,000 21 - 2 23 Rp 6,000 100.00% Rp 6,000
15 KOTA SURABAYA 13010302 Manukan Kulon 23,826 15,275 39,101 Rp 6,000 100.00% Rp 6,000 Rp 234,606,000 37 - 7 44 Rp 6,000 100.00% Rp 6,000
16 KOTA SURABAYA 13010303 Simomulyo 16,807 21,178 37,985 Rp 6,000 100.00% Rp 6,000 Rp 227,910,000 51 - 8 59 Rp 6,000 100.00% Rp 6,000
17 KOTA SURABAYA 13010304 Asemrowo 5,603 19,593 25,196 Rp 6,000 100.00% Rp 6,000 Rp 151,176,000 28 - - 28 Rp 6,000 100.00% Rp 6,000
18 KOTA SURABAYA 13010305 Balongsari 9,280 11,617 20,897 Rp 6,000 100.00% Rp 6,000 Rp 125,382,000 41 - 14 55 Rp 6,000 100.00% Rp 6,000
19 KOTA SURABAYA 13010401 Sememi 13,674 18,134 31,808 Rp 6,000 100.00% Rp 6,000 Rp 190,848,000 30 - 9 39 Rp 6,000 100.00% Rp 6,000
20 KOTA SURABAYA 13010402 Benowo 12,527 17,023 29,550 Rp 6,000 100.00% Rp 6,000 Rp 177,300,000 37 - 3 40 Rp 6,000 100.00% Rp 6,000
21 KOTA SURABAYA 13010501 Krembangan Selatan 8,812 16,202 25,014 Rp 6,000 100.00% Rp 6,000 Rp 150,084,000 13 - 6 19 Rp 6,000 100.00% Rp 6,000
22 KOTA SURABAYA 13010502 Dupak 7,236 9,560 16,796 Rp 6,000 100.00% Rp 6,000 Rp 100,776,000 25 - - 25 Rp 6,000 100.00% Rp 6,000
23 KOTA SURABAYA 13010601 Tembok Dukuh 9,970 21,832 31,802 Rp 6,000 100.00% Rp 6,000 Rp 190,812,000 19 - - 19 Rp 6,000 100.00% Rp 6,000
24 KOTA SURABAYA 13010602 Gundih 4,733 14,918 19,651 Rp 6,000 100.00% Rp 6,000 Rp 117,906,000 12 - 3 15 Rp 6,000 100.00% Rp 6,000
25 KOTA SURABAYA 13010701 Tambak Rejo 9,113 27,266 36,379 Rp 6,000 100.00% Rp 6,000 Rp 218,274,000 24 - 7 31 Rp 6,000 100.00% Rp 6,000
26 KOTA SURABAYA 13010702 Simolawang 4,286 25,683 29,969 Rp 6,000 95.00% Rp 5,700 Rp 170,823,300 9 - 1 10 Rp 6,000 95.00% Rp 5,700
27 KOTA SURABAYA 13010801 Rangkah 9,751 24,536 34,287 Rp 6,000 100.00% Rp 6,000 Rp 205,722,000 28 - 1 29 Rp 6,000 100.00% Rp 6,000
28 KOTA SURABAYA 13010802 Pacar Keling 11,081 21,438 32,519 Rp 6,000 100.00% Rp 6,000 Rp 195,114,000 14 - 2 16 Rp 6,000 100.00% Rp 6,000
29 KOTA SURABAYA 13010803 Gading 5,977 30,568 36,545 Rp 6,000 100.00% Rp 6,000 Rp 219,270,000 16 - 7 23 Rp 6,000 100.00% Rp 6,000
30 KOTA SURABAYA 13010901 Pucang Sewu 18,077 13,559 31,636 Rp 6,000 100.00% Rp 6,000 Rp 189,816,000 24 - - 24 Rp 6,000 100.00% Rp 6,000
31 KOTA SURABAYA 13010902 Mojo 15,315 20,591 35,906 Rp 6,000 100.00% Rp 6,000 Rp 215,436,000 31 - - 31 Rp 6,000 100.00% Rp 6,000
32 KOTA SURABAYA 13011001 Kalirungkut 13,473 10,896 24,369 Rp 6,000 100.00% Rp 6,000 Rp 146,214,000 29 - 10 39 Rp 6,000 100.00% Rp 6,000
33 KOTA SURABAYA 13011002 Tenggilis 12,189 11,790 23,979 Rp 6,000 100.00% Rp 6,000 Rp 143,874,000 34 - 6 40 Rp 6,000 100.00% Rp 6,000
34 KOTA SURABAYA 13011003 Gunung Anyar 8,311 11,491 19,802 Rp 6,000 100.00% Rp 6,000 Rp 118,812,000 22 - 3 25 Rp 6,000 100.00% Rp 6,000
35 KOTA SURABAYA 13011004 Medokan Ayu 13,403 13,635 27,038 Rp 6,000 100.00% Rp 6,000 Rp 162,228,000 27 - 4 31 Rp 6,000 100.00% Rp 6,000
36 KOTA SURABAYA 13011101 Menur 12,508 10,657 23,165 Rp 6,000 100.00% Rp 6,000 Rp 138,990,000 30 - 1 31 Rp 6,000 100.00% Rp 6,000
37 KOTA SURABAYA 13011102 Mulyorejo 11,872 10,483 22,355 Rp 6,000 100.00% Rp 6,000 Rp 134,130,000 25 - 3 28 Rp 6,000 100.00% Rp 6,000
KAPITASI BULAN Juni 2020
KAP JUMLAH PESERTA BULAN Juni KAPITASI SUSULAN BULAN Mei 2020
KODE BIAYA PER
FASKES BIAYA JIWA %
PENYESUAI BIAYA KAPITASI BIAYA JIWA
PER JIWA PENYESUAI Susulan PENYESUA
AN PER JIWA PENYESUAIA
NON PBI PBI TOTAL AN NON PBI PBI PD Total IAN
PEMDA N
1 2 3 4 5 6 7=5+6 8 9 10-=8*9 11=7*10 12 13 14 15=12+13 18 19 20

+14
38 KOTA SURABAYA 13011103 Klampis Ngasem 9,091 7,267 16,358 Rp 6,000 100.00% Rp 6,000 Rp 98,148,000 28 - 3 31 Rp 6,000 100.00% Rp 6,000
39 KOTA SURABAYA 13011201 Tanah Kali Kedinding 12,601 22,092 34,693 Rp 6,000 100.00% Rp 6,000 Rp 208,158,000 25 - 1 26 Rp 6,000 100.00% Rp 6,000
40 KOTA SURABAYA 13011202 Sidotopo Wetan 10,382 23,191 33,573 Rp 6,000 100.00% Rp 6,000 Rp 201,438,000 30 - 1 31 Rp 6,000 100.00% Rp 6,000
41 KOTA SURABAYA 13011203 Kenjeran 6,633 15,800 22,433 Rp 6,000 100.00% Rp 6,000 Rp 134,598,000 22 - 14 36 Rp 6,000 100.00% Rp 6,000
42 KOTA SURABAYA 13011301 Jagir 18,527 18,974 37,501 Rp 6,000 100.00% Rp 6,000 Rp 225,006,000 39 - 3 42 Rp 6,000 100.00% Rp 6,000
43 KOTA SURABAYA 13011302 Wonokromo 12,888 13,274 26,162 Rp 6,000 100.00% Rp 6,000 Rp 156,972,000 34 - 3 37 Rp 6,000 100.00% Rp 6,000
44 KOTA SURABAYA 13011303 Ngagel Rejo 9,834 14,445 24,279 Rp 6,000 100.00% Rp 6,000 Rp 145,674,000 26 - 1 27 Rp 6,000 100.00% Rp 6,000
45 KOTA SURABAYA 13011401 Peneleh 6,188 15,301 21,489 Rp 6,000 100.00% Rp 6,000 Rp 128,934,000 17 - 1 18 Rp 6,000 100.00% Rp 6,000
46 KOTA SURABAYA 13011402 Ketabang 7,047 7,458 14,505 Rp 6,000 100.00% Rp 6,000 Rp 87,030,000 17 - - 17 Rp 6,000 100.00% Rp 6,000
47 KOTA SURABAYA 13011501 Kedungdoro 12,573 17,155 29,728 Rp 6,000 100.00% Rp 6,000 Rp 178,368,000 14 - 4 18 Rp 6,000 100.00% Rp 6,000
48 KOTA SURABAYA 13011502 Dr. Soetomo 7,545 16,812 24,357 Rp 6,000 100.00% Rp 6,000 Rp 146,142,000 21 - 8 29 Rp 6,000 100.00% Rp 6,000
49 KOTA SURABAYA 13011601 Sawahan 15,957 16,048 32,005 Rp 6,000 100.00% Rp 6,000 Rp 192,030,000 38 - 1 39 Rp 6,000 100.00% Rp 6,000
50 KOTA SURABAYA 13011602 Putat Jaya 8,853 16,529 25,382 Rp 6,000 100.00% Rp 6,000 Rp 152,292,000 19 - - 19 Rp 6,000 100.00% Rp 6,000
51 KOTA SURABAYA 13011603 Banyu Urip 11,341 22,341 33,682 Rp 6,000 100.00% Rp 6,000 Rp 202,092,000 37 - 3 40 Rp 6,000 100.00% Rp 6,000
52 KOTA SURABAYA 13011604 Pakis 8,865 10,356 19,221 Rp 6,000 100.00% Rp 6,000 Rp 115,326,000 13 - - 13 Rp 6,000 100.00% Rp 6,000
53 KOTA SURABAYA 13011701 Gayungan 16,947 8,581 25,528 Rp 6,000 100.00% Rp 6,000 Rp 153,168,000 23 - 9 32 Rp 6,000 100.00% Rp 6,000
54 KOTA SURABAYA 13011702 Jemursari 7,870 5,125 12,995 Rp 6,000 100.00% Rp 6,000 Rp 77,970,000 8 - - 8 Rp 6,000 100.00% Rp 6,000
55 KOTA SURABAYA 13011703 Kebonsari 11,803 12,691 24,494 Rp 6,000 100.00% Rp 6,000 Rp 146,964,000 19 - 2 21 Rp 6,000 100.00% Rp 6,000
56 KOTA SURABAYA 13011704 Sidosermo 6,611 9,440 16,051 Rp 6,000 100.00% Rp 6,000 Rp 96,306,000 7 - 3 10 Rp 6,000 100.00% Rp 6,000
57 KOTA SURABAYA 13011801 Kedurus 14,429 13,894 28,323 Rp 6,000 100.00% Rp 6,000 Rp 169,938,000 33 - - 33 Rp 6,000 100.00% Rp 6,000
58 KOTA SURABAYA 13011802 Dukuh Kupang 15,166 12,462 27,628 Rp 6,000 100.00% Rp 6,000 Rp 165,768,000 41 - 7 48 Rp 6,000 100.00% Rp 6,000
59 KOTA SURABAYA 13011803 Wiyung 13,930 11,645 25,575 Rp 6,000 100.00% Rp 6,000 Rp 153,450,000 31 - 1 32 Rp 6,000 100.00% Rp 6,000
60 KOTA SURABAYA 13011901 Jeruk 6,908 6,866 13,774 Rp 6,000 100.00% Rp 6,000 Rp 82,644,000 17 - 5 22 Rp 6,000 100.00% Rp 6,000
61 KOTA SURABAYA 13011902 Lidah Kulon 8,321 6,312 14,633 Rp 6,000 95.00% Rp 5,700 Rp 83,408,100 11 - 1 12 Rp 6,000 95.00% Rp 5,700
62 KOTA SURABAYA 13011903 Lontar 6,200 8,776 14,976 Rp 6,000 100.00% Rp 6,000 Rp 89,856,000 18 - 2 20 Rp 6,000 100.00% Rp 6,000
63 KOTA SURABAYA 02170903 Sawah Pulo 1,880 17,563 19,443 Rp 6,000 100.00% Rp 6,000 Rp 116,658,000 3 - - 3 Rp 6,000 100.00% Rp 6,000
TOTAL PUSKESMAS KOTA SURABAYA 606,284 949,834 1,556,118 Rp 9,315,598,500 1,404 - 228 1,632
ei 2020
TOTAL
KAPITASI YANG
PESERTA
DIBAYARKAN BULAN
BULAN Juni
BIAYA KAPITASI Juni 2020
2020
21=17*20 22=7+17 23=11+21
Rp 210,000 12,711 Rp 76,266,000
Rp 24,000 7,530 Rp 45,180,000
Rp 150,000 17,123 Rp 102,738,000
Rp 138,000 7,248 Rp 43,488,000
Rp 216,000 11,491 Rp 68,946,000
Rp 30,000 23,267 Rp 139,602,000
Rp 54,000 11,213 Rp 67,278,000
Rp 60,000 17,835 Rp 107,010,000
Rp 180,000 16,286 Rp 97,716,000
Rp 84,000 34,923 Rp 209,538,000

Rp 156,000 43,315 Rp 259,890,000
Rp 51,300 25,772 Rp 146,900,400
Rp 108,000 40,520 Rp 243,120,000
Rp 138,000 12,614 Rp 75,684,000
Rp 264,000 39,145 Rp 234,870,000

Rp 354,000 38,044 Rp 228,264,000
Rp 168,000 25,224 Rp 151,344,000

Rp 330,000 20,952 Rp 125,712,000
Rp 234,000 31,847 Rp 191,082,000

Rp 240,000 29,590 Rp 177,540,000
Rp 114,000 25,033 Rp 150,198,000

Rp 150,000 16,821 Rp 100,926,000
Rp 114,000 31,821 Rp 190,926,000
Rp 90,000 19,666 Rp 117,996,000
Rp 186,000 36,410 Rp 218,460,000
Rp 57,000 29,979 Rp 170,880,300
Rp 174,000 34,316 Rp 205,896,000

Rp 96,000 32,535 Rp 195,210,000
Rp 138,000 36,568 Rp 219,408,000
Rp 144,000 31,660 Rp 189,960,000
Rp 186,000 35,937 Rp 215,622,000
Rp 234,000 24,408 Rp 146,448,000
Rp 240,000 24,019 Rp 144,114,000
Rp 150,000 19,827 Rp 118,962,000
Rp 186,000 27,069 Rp 162,414,000
Rp 186,000 23,196 Rp 139,176,000

Rp 168,000 22,383 Rp 134,298,000
ei 2020
TOTAL
KAPITASI YANG
PESERTA
DIBAYARKAN BULAN
BULAN Juni
BIAYA KAPITASI Juni 2020
2020
21=17*20 22=7+17 23=11+21
Rp 186,000 16,389 Rp 98,334,000
Rp 156,000 34,719 Rp 208,314,000
Rp 186,000 33,604 Rp 201,624,000
Rp 216,000 22,469 Rp 134,814,000
Rp 252,000 37,543 Rp 225,258,000
Rp 222,000 26,199 Rp 157,194,000
Rp 162,000 24,306 Rp 145,836,000
Rp 108,000 21,507 Rp 129,042,000
Rp 102,000 14,522 Rp 87,132,000
Rp 108,000 29,746 Rp 178,476,000
Rp 174,000 24,386 Rp 146,316,000
Rp 234,000 32,044 Rp 192,264,000
Rp 114,000 25,401 Rp 152,406,000
Rp 240,000 33,722 Rp 202,332,000
Rp 78,000 19,234 Rp 115,404,000
Rp 192,000 25,560 Rp 153,360,000
Rp 48,000 13,003 Rp 78,018,000
Rp 126,000 24,515 Rp 147,090,000

Rp 60,000 16,061 Rp 96,366,000
Rp 198,000 28,356 Rp 170,136,000

Rp 288,000 27,676 Rp 166,056,000
Rp 192,000 25,607 Rp 153,642,000

Rp 132,000 13,796 Rp 82,776,000
Rp 68,400 14,645 Rp 83,476,500

Rp 120,000 14,996 Rp 89,976,000
Rp 18,000 19,446 Rp 116,676,000
Rp 9,782,700 1,557,750 Rp 9,325,381,200

BULAN JULI 2020
KAPITASI BULAN Juli 2020
KAP JUMLAH PESERTA BULAN Juli KAPITASI SUSULAN BULAN Juni 2020
NO KANTOR CABANG KODE FASKES NAMA FASKES % BIAYA PER BIAYA PER
BIAYA PER %
PENYESUAIA JIWA BIAYA KAPITASI BIAYA JIWA
JIWA PENYESU
N PENYESUAIAN PER JIWA PENYESUAI
NON PBI PBI TOTAL NON PBI PBI Total AIAN
AN
1 2 3 4 5 6 7=5+6 8 9 10-=8*9 11=7*10 12 13 15=12+13 18 19 20

+14
1 KOTA SURABAYA 02170004 Siwalankerto 8,706 4,095 12,801 Rp 6,000 100.00% Rp 6,000 Rp 76,806,000 35 - 35 Rp 6,000 100.00% Rp 6,000
2 KOTA SURABAYA 02170005 Balas Klumprik 3,759 3,947 7,706 Rp 6,000 100.00% Rp 6,000 Rp 46,236,000 5 - 5 Rp 6,000 100.00% Rp 6,000
3 KOTA SURABAYA 02170006 Keputih 7,019 10,386 17,405 Rp 6,000 100.00% Rp 6,000 Rp 104,430,000 11 - 11 Rp 6,000 100.00% Rp 6,000
4 KOTA SURABAYA 02170007 Bangkingan 3,007 4,357 7,364 Rp 6,000 100.00% Rp 6,000 Rp 44,184,000 1 - 1 Rp 6,000 100.00% Rp 6,000
5 KOTA SURABAYA 02170008 Made 4,592 7,055 11,647 Rp 6,000 100.00% Rp 6,000 Rp 69,882,000 16 - 16 Rp 6,000 100.00% Rp 6,000
6 KOTA SURABAYA 02170105 Morokrembangan 3,891 21,596 25,487 Rp 6,000 100.00% Rp 6,000 Rp 152,922,000 16 - 16 Rp 6,000 100.00% Rp 6,000
7 KOTA SURABAYA 02170106 Tambak Wedi 3,434 8,424 11,858 Rp 6,000 100.00% Rp 6,000 Rp 71,148,000 14 - 14 Rp 6,000 100.00% Rp 6,000
8 KOTA SURABAYA 02170107 Bulak Banteng 4,555 14,747 19,302 Rp 6,000 100.00% Rp 6,000 Rp 115,812,000 29 - 29 Rp 6,000 100.00% Rp 6,000
9 KOTA SURABAYA 02170108 Kalijudan 6,455 10,361 16,816 Rp 6,000 100.00% Rp 6,000 Rp 100,896,000 19 - 19 Rp 6,000 100.00% Rp 6,000
10 KOTA SURABAYA 13010101 Pegirian 6,908 28,746 35,654 Rp 6,000 100.00% Rp 6,000 Rp 213,924,000 11 - 11 Rp 6,000 100.00% Rp 6,000
11 KOTA SURABAYA 13010102 Wonokusumo 8,183 36,328 44,511 Rp 6,000 100.00% Rp 6,000 Rp 267,066,000 3 - 3 Rp 6,000 100.00% Rp 6,000
12 KOTA SURABAYA 13010103 Sidotopo 4,229 22,904 27,133 Rp 6,000 95.00% Rp 5,700 Rp 154,658,100 8 - 8 Rp 6,000 95.00% Rp 5,700
13 KOTA SURABAYA 13010201 Perak Timur 9,479 32,652 42,131 Rp 6,000 100.00% Rp 6,000 Rp 252,786,000 4 - 4 Rp 6,000 100.00% Rp 6,000
14 KOTA SURABAYA 13010301 Tanjungsari 5,047 7,714 12,761 Rp 6,000 100.00% Rp 6,000 Rp 76,566,000 8 - 8 Rp 6,000 100.00% Rp 6,000
15 KOTA SURABAYA 13010302 Manukan Kulon 23,698 15,937 39,635 Rp 6,000 100.00% Rp 6,000 Rp 237,810,000 12 - 12 Rp 6,000 100.00% Rp 6,000
16 KOTA SURABAYA 13010303 Simomulyo 16,616 22,745 39,361 Rp 6,000 100.00% Rp 6,000 Rp 236,166,000 41 - 41 Rp 6,000 100.00% Rp 6,000
17 KOTA SURABAYA 13010304 Asemrowo 5,511 20,234 25,745 Rp 6,000 100.00% Rp 6,000 Rp 154,470,000 11 - 11 Rp 6,000 100.00% Rp 6,000
18 KOTA SURABAYA 13010305 Balongsari 9,203 11,992 21,195 Rp 6,000 100.00% Rp 6,000 Rp 127,170,000 15 - 15 Rp 6,000 100.00% Rp 6,000
19 KOTA SURABAYA 13010401 Sememi 13,470 19,504 32,974 Rp 6,000 100.00% Rp 6,000 Rp 197,844,000 13 - 13 Rp 6,000 100.00% Rp 6,000
20 KOTA SURABAYA 13010402 Benowo 12,417 18,205 30,622 Rp 6,000 100.00% Rp 6,000 Rp 183,732,000 23 - 23 Rp 6,000 100.00% Rp 6,000
21 KOTA SURABAYA 13010501 Krembangan Selatan 8,713 17,383 26,096 Rp 6,000 100.00% Rp 6,000 Rp 156,576,000 12 - 12 Rp 6,000 100.00% Rp 6,000
22 KOTA SURABAYA 13010502 Dupak 7,114 10,079 17,193 Rp 6,000 100.00% Rp 6,000 Rp 103,158,000 9 - 9 Rp 6,000 100.00% Rp 6,000
23 KOTA SURABAYA 13010601 Tembok Dukuh 9,893 22,882 32,775 Rp 6,000 100.00% Rp 6,000 Rp 196,650,000 17 - 17 Rp 6,000 100.00% Rp 6,000
24 KOTA SURABAYA 13010602 Gundih 4,696 15,509 20,205 Rp 6,000 100.00% Rp 6,000 Rp 121,230,000 13 - 13 Rp 6,000 100.00% Rp 6,000
25 KOTA SURABAYA 13010701 Tambak Rejo 9,054 28,291 37,345 Rp 6,000 100.00% Rp 6,000 Rp 224,070,000 18 - 18 Rp 6,000 100.00% Rp 6,000
26 KOTA SURABAYA 13010702 Simolawang 4,218 26,201 30,419 Rp 6,000 95.00% Rp 5,700 Rp 173,388,300 10 - 10 Rp 6,000 95.00% Rp 5,700
27 KOTA SURABAYA 13010801 Rangkah 9,765 26,257 36,022 Rp 6,000 100.00% Rp 6,000 Rp 216,132,000 10 - 10 Rp 6,000 100.00% Rp 6,000
28 KOTA SURABAYA 13010802 Pacar Keling 11,185 22,277 33,462 Rp 6,000 100.00% Rp 6,000 Rp 200,772,000 14 - 14 Rp 6,000 100.00% Rp 6,000
29 KOTA SURABAYA 13010803 Gading 5,931 31,715 37,646 Rp 6,000 100.00% Rp 6,000 Rp 225,876,000 24 - 24 Rp 6,000 100.00% Rp 6,000
30 KOTA SURABAYA 13010901 Pucang Sewu 17,896 14,720 32,616 Rp 6,000 100.00% Rp 6,000 Rp 195,696,000 12 - 12 Rp 6,000 100.00% Rp 6,000
31 KOTA SURABAYA 13010902 Mojo 15,261 21,932 37,193 Rp 6,000 100.00% Rp 6,000 Rp 223,158,000 22 - 22 Rp 6,000 100.00% Rp 6,000
32 KOTA SURABAYA 13011001 Kalirungkut 13,384 11,526 24,910 Rp 6,000 100.00% Rp 6,000 Rp 149,460,000 24 - 24 Rp 6,000 100.00% Rp 6,000
33 KOTA SURABAYA 13011002 Tenggilis 12,008 12,436 24,444 Rp 6,000 100.00% Rp 6,000 Rp 146,664,000 30 - 30 Rp 6,000 100.00% Rp 6,000
34 KOTA SURABAYA 13011003 Gunung Anyar 8,198 11,928 20,126 Rp 6,000 100.00% Rp 6,000 Rp 120,756,000 4 - 4 Rp 6,000 100.00% Rp 6,000
35 KOTA SURABAYA 13011004 Medokan Ayu 13,343 14,178 27,521 Rp 6,000 100.00% Rp 6,000 Rp 165,126,000 46 - 46 Rp 6,000 100.00% Rp 6,000
36 KOTA SURABAYA 13011101 Menur 12,322 11,002 23,324 Rp 6,000 100.00% Rp 6,000 Rp 139,944,000 30 - 30 Rp 6,000 100.00% Rp 6,000
37 KOTA SURABAYA 13011102 Mulyorejo 11,725 11,253 22,978 Rp 6,000 100.00% Rp 6,000 Rp 137,868,000 30 - 30 Rp 6,000 100.00% Rp 6,000
38 KOTA SURABAYA 13011103 Klampis Ngasem 8,990 7,676 16,666 Rp 6,000 100.00% Rp 6,000 Rp 99,996,000 22 - 22 Rp 6,000 100.00% Rp 6,000
KAPITASI BULAN Juli 2020
KAP JUMLAH PESERTA BULAN Juli KAPITASI SUSULAN BULAN Juni 2020
NO KANTOR CABANG KODE FASKES NAMA FASKES % BIAYA PER BIAYA PER
BIAYA PER %
PENYESUAIA JIWA BIAYA KAPITASI BIAYA JIWA
JIWA PENYESU
N PENYESUAIAN PER JIWA PENYESUAI
NON PBI PBI TOTAL NON PBI PBI Total AIAN
AN
1 2 3 4 5 6 7=5+6 8 9 10-=8*9 11=7*10 12 13 15=12+13 18 19 20

+14
39 KOTA SURABAYA 13011201 Tanah Kali Kedinding 12,393 24,581 36,974 Rp 6,000 100.00% Rp 6,000 Rp 221,844,000 26 - 26 Rp 6,000 100.00% Rp 6,000
40 KOTA SURABAYA 13011202 Sidotopo Wetan 10,182 25,117 35,299 Rp 6,000 100.00% Rp 6,000 Rp 211,794,000 21 - 21 Rp 6,000 100.00% Rp 6,000
41 KOTA SURABAYA 13011203 Kenjeran 6,450 17,221 23,671 Rp 6,000 100.00% Rp 6,000 Rp 142,026,000 11 - 11 Rp 6,000 100.00% Rp 6,000
42 KOTA SURABAYA 13011301 Jagir 18,261 20,056 38,317 Rp 6,000 100.00% Rp 6,000 Rp 229,902,000 25 - 25 Rp 6,000 100.00% Rp 6,000
43 KOTA SURABAYA 13011302 Wonokromo 12,858 14,144 27,002 Rp 6,000 100.00% Rp 6,000 Rp 162,012,000 31 - 31 Rp 6,000 100.00% Rp 6,000
44 KOTA SURABAYA 13011303 Ngagel Rejo 9,774 15,039 24,813 Rp 6,000 100.00% Rp 6,000 Rp 148,878,000 15 - 15 Rp 6,000 100.00% Rp 6,000
45 KOTA SURABAYA 13011401 Peneleh 6,092 16,329 22,421 Rp 6,000 100.00% Rp 6,000 Rp 134,526,000 6 - 6 Rp 6,000 100.00% Rp 6,000
46 KOTA SURABAYA 13011402 Ketabang 6,983 7,770 14,753 Rp 6,000 100.00% Rp 6,000 Rp 88,518,000 2 - 2 Rp 6,000 100.00% Rp 6,000
47 KOTA SURABAYA 13011501 Kedungdoro 12,506 18,086 30,592 Rp 6,000 100.00% Rp 6,000 Rp 183,552,000 6 - 6 Rp 6,000 100.00% Rp 6,000
48 KOTA SURABAYA 13011502 Dr. Soetomo 7,427 18,068 25,495 Rp 6,000 100.00% Rp 6,000 Rp 152,970,000 12 - 12 Rp 6,000 100.00% Rp 6,000
49 KOTA SURABAYA 13011601 Sawahan 15,661 17,029 32,690 Rp 6,000 100.00% Rp 6,000 Rp 196,140,000 15 - 15 Rp 6,000 100.00% Rp 6,000
50 KOTA SURABAYA 13011602 Putat Jaya 8,714 17,365 26,079 Rp 6,000 100.00% Rp 6,000 Rp 156,474,000 15 - 15 Rp 6,000 100.00% Rp 6,000
51 KOTA SURABAYA 13011603 Banyu Urip 11,150 23,991 35,141 Rp 6,000 100.00% Rp 6,000 Rp 210,846,000 14 - 14 Rp 6,000 100.00% Rp 6,000
52 KOTA SURABAYA 13011604 Pakis 8,633 10,809 19,442 Rp 6,000 100.00% Rp 6,000 Rp 116,652,000 5 - 5 Rp 6,000 100.00% Rp 6,000
53 KOTA SURABAYA 13011701 Gayungan 16,806 8,906 25,712 Rp 6,000 100.00% Rp 6,000 Rp 154,272,000 16 - 16 Rp 6,000 100.00% Rp 6,000
54 KOTA SURABAYA 13011702 Jemursari 7,742 5,245 12,987 Rp 6,000 100.00% Rp 6,000 Rp 77,922,000 16 - 16 Rp 6,000 100.00% Rp 6,000
55 KOTA SURABAYA 13011703 Kebonsari 11,694 13,599 25,293 Rp 6,000 100.00% Rp 6,000 Rp 151,758,000 14 - 14 Rp 6,000 100.00% Rp 6,000
56 KOTA SURABAYA 13011704 Sidosermo 6,494 9,785 16,279 Rp 6,000 100.00% Rp 6,000 Rp 97,674,000 13 - 13 Rp 6,000 100.00% Rp 6,000
57 KOTA SURABAYA 13011801 Kedurus 14,270 15,162 29,432 Rp 6,000 100.00% Rp 6,000 Rp 176,592,000 16 - 16 Rp 6,000 100.00% Rp 6,000
58 KOTA SURABAYA 13011802 Dukuh Kupang 15,071 13,239 28,310 Rp 6,000 100.00% Rp 6,000 Rp 169,860,000 24 - 24 Rp 6,000 100.00% Rp 6,000
59 KOTA SURABAYA 13011803 Wiyung 13,762 12,600 26,362 Rp 6,000 100.00% Rp 6,000 Rp 158,172,000 24 - 24 Rp 6,000 100.00% Rp 6,000
60 KOTA SURABAYA 13011901 Jeruk 6,783 7,185 13,968 Rp 6,000 100.00% Rp 6,000 Rp 83,808,000 17 - 17 Rp 6,000 100.00% Rp 6,000
61 KOTA SURABAYA 13011902 Lidah Kulon 8,313 6,656 14,969 Rp 6,000 95.00% Rp 5,700 Rp 85,323,300 4 - 4 Rp 6,000 95.00% Rp 5,700
62 KOTA SURABAYA 13011903 Lontar 6,047 9,639 15,686 Rp 6,000 100.00% Rp 6,000 Rp 94,116,000 14 - 14 Rp 6,000 100.00% Rp 6,000
63 KOTA SURABAYA 02170903 Sawah Pulo 1,865 18,313 20,178 Rp 6,000 100.00% Rp 6,000 Rp 121,068,000 4 - 4 Rp 6,000 100.00% Rp 6,000
TOTAL PUSKESMAS KOTA SURABAYA 599,806 1,005,108 1,604,914 Rp 9,607,727,700 1,008 - 1,008
ULAN Juni 2020
TOTAL
KAPITASI YANG
PESERTA
DIBAYARKAN BULAN
BULAN Juli
BIAYA KAPITASI Juli 2020
2020
21=17*20 22=7+17 23=11+21
Rp 210,000 12,836 Rp 77,016,000
Rp 30,000 7,711 Rp 46,266,000
Rp 66,000 17,416 Rp 104,496,000

Rp 6,000 7,365 Rp 44,190,000
Rp 96,000 11,663 Rp 69,978,000

Rp 96,000 25,503 Rp 153,018,000
Rp 84,000 11,872 Rp 71,232,000
Rp 174,000 19,331 Rp 115,986,000
Rp 114,000 16,835 Rp 101,010,000
Rp 66,000 35,665 Rp 213,990,000
Rp 18,000 44,514 Rp 267,084,000
Rp 45,600 27,141 Rp 154,703,700
Rp 24,000 42,135 Rp 252,810,000

Rp 48,000 12,769 Rp 76,614,000
Rp 72,000 39,647 Rp 237,882,000

Rp 246,000 39,402 Rp 236,412,000
Rp 66,000 25,756 Rp 154,536,000
Rp 90,000 21,210 Rp 127,260,000
Rp 78,000 32,987 Rp 197,922,000
Rp 138,000 30,645 Rp 183,870,000
Rp 72,000 26,108 Rp 156,648,000
Rp 54,000 17,202 Rp 103,212,000
Rp 102,000 32,792 Rp 196,752,000
Rp 78,000 20,218 Rp 121,308,000
Rp 108,000 37,363 Rp 224,178,000
Rp 57,000 30,429 Rp 173,445,300
Rp 60,000 36,032 Rp 216,192,000
Rp 84,000 33,476 Rp 200,856,000
Rp 144,000 37,670 Rp 226,020,000
Rp 72,000 32,628 Rp 195,768,000
Rp 132,000 37,215 Rp 223,290,000
Rp 144,000 24,934 Rp 149,604,000
Rp 180,000 24,474 Rp 146,844,000
Rp 24,000 20,130 Rp 120,780,000
Rp 276,000 27,567 Rp 165,402,000

Rp 180,000 23,354 Rp 140,124,000
Rp 180,000 23,008 Rp 138,048,000

Rp 132,000 16,688 Rp 100,128,000
ULAN Juni 2020
TOTAL
KAPITASI YANG
PESERTA
DIBAYARKAN BULAN
BULAN Juli
BIAYA KAPITASI Juli 2020
2020
21=17*20 22=7+17 23=11+21
Rp 156,000 37,000 Rp 222,000,000
Rp 126,000 35,320 Rp 211,920,000

Rp 66,000 23,682 Rp 142,092,000
Rp 150,000 38,342 Rp 230,052,000

Rp 186,000 27,033 Rp 162,198,000
Rp 90,000 24,828 Rp 148,968,000

Rp 36,000 22,427 Rp 134,562,000
Rp 12,000 14,755 Rp 88,530,000

Rp 36,000 30,598 Rp 183,588,000
Rp 72,000 25,507 Rp 153,042,000

Rp 90,000 32,705 Rp 196,230,000
Rp 90,000 26,094 Rp 156,564,000

Rp 84,000 35,155 Rp 210,930,000
Rp 30,000 19,447 Rp 116,682,000

Rp 96,000 25,728 Rp 154,368,000
Rp 96,000 13,003 Rp 78,018,000

Rp 84,000 25,307 Rp 151,842,000
Rp 78,000 16,292 Rp 97,752,000

Rp 96,000 29,448 Rp 176,688,000
Rp 144,000 28,334 Rp 170,004,000

Rp 144,000 26,386 Rp 158,316,000
Rp 102,000 13,985 Rp 83,910,000

Rp 22,800 14,973 Rp 85,346,100
Rp 84,000 15,700 Rp 94,200,000

Rp 24,000 20,182 Rp 121,092,000
Rp 6,041,400 1,605,922 Rp 9,613,769,100

BULAN AGUSTUS 2020
KAPITASI BULAN AGUSTUS 2020
KAP JUMLAH PESERTA BULAN KAPITASI SUSULAN BULAN JULI 2020

AGUSTUS 2020 KAP JUMLAH PESERTA
KODE BIAYA PER BIAYA PER
NO KANTOR CABANG NAMA FASKES BIAYA PER % %
FASKES JIWA BIAYA KAPITASI BIAYA PER JIWA
JIWA PENYESUAIAN PENYESUAI
PENYESUAIAN JIWA PENYESUAI
NON PBI PBI TOTAL NON PBI PBI Total AN
AN
1 2 3 4 5 6 7=5+6 8 9 10-=8*9 11=7*10 12 13 15=12+13+14 18 19 20

1 KOTA SURABAYA 02170004 Siwalankerto 8,542 4,144 12,686 Rp 6,000 100.00% Rp 6,000 Rp 76,116,000 11 - 11 Rp 6,000 100.00% Rp 6,000
2 KOTA SURABAYA 02170005 Balas Klumprik 3,704 3,972 7,676 Rp 6,000 100.00% Rp 6,000 Rp 46,056,000 6 - 6 Rp 6,000 100.00% Rp 6,000
3 KOTA SURABAYA 02170006 Keputih 6,935 10,468 17,403 Rp 6,000 100.00% Rp 6,000 Rp 104,418,000 15 - 15 Rp 6,000 100.00% Rp 6,000
4 KOTA SURABAYA 02170007 Bangkingan 2,989 4,381 7,370 Rp 6,000 100.00% Rp 6,000 Rp 44,220,000 4 - 4 Rp 6,000 100.00% Rp 6,000
5 KOTA SURABAYA 02170008 Made 4,532 7,005 11,537 Rp 6,000 100.00% Rp 6,000 Rp 69,222,000 18 - 18 Rp 6,000 100.00% Rp 6,000
6 KOTA SURABAYA 02170105 Morokrembangan 3,738 22,003 25,741 Rp 6,000 100.00% Rp 6,000 Rp 154,446,000 8 - 8 Rp 6,000 100.00% Rp 6,000
7 KOTA SURABAYA 02170106 Tambak Wedi 3,396 8,530 11,926 Rp 6,000 100.00% Rp 6,000 Rp 71,556,000 4 - 4 Rp 6,000 100.00% Rp 6,000
8 KOTA SURABAYA 02170107 Bulak Banteng 4,484 14,954 19,438 Rp 6,000 100.00% Rp 6,000 Rp 116,628,000 12 - 12 Rp 6,000 100.00% Rp 6,000
9 KOTA SURABAYA 02170108 Kalijudan 6,340 10,429 16,769 Rp 6,000 100.00% Rp 6,000 Rp 100,614,000 12 - 12 Rp 6,000 100.00% Rp 6,000
10 KOTA SURABAYA 13010101 Pegirian 6,823 28,822 35,645 Rp 6,000 100.00% Rp 6,000 Rp 213,870,000 14 - 14 Rp 6,000 100.00% Rp 6,000
11 KOTA SURABAYA 13010102 Wonokusumo 8,072 36,427 44,499 Rp 6,000 100.00% Rp 6,000 Rp 266,994,000 15 - 15 Rp 6,000 100.00% Rp 6,000
12 KOTA SURABAYA 13010103 Sidotopo 4,132 23,325 27,457 Rp 6,000 95.00% Rp 5,700 Rp 156,504,900 10 - 10 Rp 6,000 95.00% Rp 5,700
13 KOTA SURABAYA 13010201 Perak Timur 9,353 32,976 42,329 Rp 6,000 100.00% Rp 6,000 Rp 253,974,000 26 - 26 Rp 6,000 100.00% Rp 6,000
14 KOTA SURABAYA 13010301 Tanjungsari 5,012 7,740 12,752 Rp 6,000 100.00% Rp 6,000 Rp 76,512,000 19 - 19 Rp 6,000 100.00% Rp 6,000
15 KOTA SURABAYA 13010302 Manukan Kulon 22,604 16,174 38,778 Rp 6,000 100.00% Rp 6,000 Rp 232,668,000 15 - 15 Rp 6,000 100.00% Rp 6,000
16 KOTA SURABAYA 13010303 Simomulyo 16,453 23,163 39,616 Rp 6,000 100.00% Rp 6,000 Rp 237,696,000 40 - 40 Rp 6,000 100.00% Rp 6,000
17 KOTA SURABAYA 13010304 Asemrowo 5,373 20,318 25,691 Rp 6,000 100.00% Rp 6,000 Rp 154,146,000 9 - 9 Rp 6,000 100.00% Rp 6,000
18 KOTA SURABAYA 13010305 Balongsari 8,976 12,051 21,027 Rp 6,000 100.00% Rp 6,000 Rp 126,162,000 19 - 19 Rp 6,000 100.00% Rp 6,000
19 KOTA SURABAYA 13010401 Sememi 13,379 19,775 33,154 Rp 6,000 100.00% Rp 6,000 Rp 198,924,000 34 - 34 Rp 6,000 100.00% Rp 6,000
20 KOTA SURABAYA 13010402 Benowo 12,259 18,488 30,747 Rp 6,000 100.00% Rp 6,000 Rp 184,482,000 28 - 28 Rp 6,000 100.00% Rp 6,000
21 KOTA SURABAYA 13010501 Krembangan Selatan 7,922 17,547 25,469 Rp 6,000 100.00% Rp 6,000 Rp 152,814,000 10 - 10 Rp 6,000 100.00% Rp 6,000
22 KOTA SURABAYA 13010502 Dupak 7,014 10,119 17,133 Rp 6,000 100.00% Rp 6,000 Rp 102,798,000 12 - 12 Rp 6,000 100.00% Rp 6,000
23 KOTA SURABAYA 13010601 Tembok Dukuh 9,233 23,057 32,290 Rp 6,000 100.00% Rp 6,000 Rp 193,740,000 5 - 5 Rp 6,000 100.00% Rp 6,000
24 KOTA SURABAYA 13010602 Gundih 4,647 15,679 20,326 Rp 6,000 100.00% Rp 6,000 Rp 121,956,000 23 - 23 Rp 6,000 100.00% Rp 6,000
25 KOTA SURABAYA 13010701 Tambak Rejo 8,803 28,378 37,181 Rp 6,000 100.00% Rp 6,000 Rp 223,086,000 13 - 13 Rp 6,000 100.00% Rp 6,000
26 KOTA SURABAYA 13010702 Simolawang 4,097 26,284 30,381 Rp 6,000 95.00% Rp 5,700 Rp 173,171,700 13 - 13 Rp 6,000 95.00% Rp 5,700
27 KOTA SURABAYA 13010801 Rangkah 9,294 26,568 35,862 Rp 6,000 100.00% Rp 6,000 Rp 215,172,000 10 - 10 Rp 6,000 100.00% Rp 6,000
28 KOTA SURABAYA 13010802 Pacar Keling 10,996 22,353 33,349 Rp 6,000 100.00% Rp 6,000 Rp 200,094,000 16 - 16 Rp 6,000 100.00% Rp 6,000
29 KOTA SURABAYA 13010803 Gading 5,864 32,005 37,869 Rp 6,000 100.00% Rp 6,000 Rp 227,214,000 8 - 8 Rp 6,000 100.00% Rp 6,000
30 KOTA SURABAYA 13010901 Pucang Sewu 16,978 14,923 31,901 Rp 6,000 100.00% Rp 6,000 Rp 191,406,000 26 - 26 Rp 6,000 100.00% Rp 6,000
31 KOTA SURABAYA 13010902 Mojo 14,719 22,176 36,895 Rp 6,000 100.00% Rp 6,000 Rp 221,370,000 21 - 21 Rp 6,000 100.00% Rp 6,000
32 KOTA SURABAYA 13011001 Kalirungkut 13,177 11,605 24,782 Rp 6,000 100.00% Rp 6,000 Rp 148,692,000 23 - 23 Rp 6,000 100.00% Rp 6,000
33 KOTA SURABAYA 13011002 Tenggilis 11,712 12,650 24,362 Rp 6,000 100.00% Rp 6,000 Rp 146,172,000 26 - 26 Rp 6,000 100.00% Rp 6,000
34 KOTA SURABAYA 13011003 Gunung Anyar 8,107 11,994 20,101 Rp 6,000 100.00% Rp 6,000 Rp 120,606,000 18 - 18 Rp 6,000 100.00% Rp 6,000
35 KOTA SURABAYA 13011004 Medokan Ayu 13,264 14,252 27,516 Rp 6,000 100.00% Rp 6,000 Rp 165,096,000 16 - 16 Rp 6,000 100.00% Rp 6,000
36 KOTA SURABAYA 13011101 Menur 12,033 11,172 23,205 Rp 6,000 100.00% Rp 6,000 Rp 139,230,000 37 - 37 Rp 6,000 100.00% Rp 6,000
37 KOTA SURABAYA 13011102 Mulyorejo 11,632 11,387 23,019 Rp 6,000 100.00% Rp 6,000 Rp 138,114,000 24 - 24 Rp 6,000 100.00% Rp 6,000
38 KOTA SURABAYA 13011103 Klampis Ngasem 8,829 7,809 16,638 Rp 6,000 100.00% Rp 6,000 Rp 99,828,000 18 - 18 Rp 6,000 100.00% Rp 6,000
39 KOTA SURABAYA 13011201 Tanah Kali Kedinding 12,001 24,782 36,783 Rp 6,000 100.00% Rp 6,000 Rp 220,698,000 27 - 27 Rp 6,000 100.00% Rp 6,000
40 KOTA SURABAYA 13011202 Sidotopo Wetan 10,068 25,403 35,471 Rp 6,000 100.00% Rp 6,000 Rp 212,826,000 22 - 22 Rp 6,000 100.00% Rp 6,000
41 KOTA SURABAYA 13011203 Kenjeran 6,231 17,462 23,693 Rp 6,000 100.00% Rp 6,000 Rp 142,158,000 21 - 21 Rp 6,000 100.00% Rp 6,000
KAPITASI BULAN AGUSTUS 2020
KAP JUMLAH PESERTA BULAN KAPITASI SUSULAN BULAN JULI 2020

AGUSTUS 2020 KAP JUMLAH PESERTA
KODE BIAYA PER BIAYA PER
NO KANTOR CABANG NAMA FASKES BIAYA PER %
FASKES JIWA BIAYA KAPITASI %
JIWA PENYESUAIAN BIAYA PER JIWA
PENYESUAIAN PENYESUAI
NON PBI PBI TOTAL NON PBI PBI Total JIWA PENYESUAI
AN
AN
1 2 3 4 5 6 7=5+6 8 9 10-=8*9 11=7*10 12 13 15=12+13+14 18 19 20

42 KOTA SURABAYA 13011301 Jagir 17,351 20,416 37,767 Rp 6,000 100.00% Rp 6,000 Rp 226,602,000 20 - 20 Rp 6,000 100.00% Rp 6,000
43 KOTA SURABAYA 13011302 Wonokromo 11,823 14,389 26,212 Rp 6,000 100.00% Rp 6,000 Rp 157,272,000 30 - 30 Rp 6,000 100.00% Rp 6,000
44 KOTA SURABAYA 13011303 Ngagel Rejo 9,640 15,242 24,882 Rp 6,000 100.00% Rp 6,000 Rp 149,292,000 28 - 28 Rp 6,000 100.00% Rp 6,000
45 KOTA SURABAYA 13011401 Peneleh 5,946 16,477 22,423 Rp 6,000 100.00% Rp 6,000 Rp 134,538,000 7 - 7 Rp 6,000 100.00% Rp 6,000
46 KOTA SURABAYA 13011402 Ketabang 6,857 7,815 14,672 Rp 6,000 100.00% Rp 6,000 Rp 88,032,000 10 - 10 Rp 6,000 100.00% Rp 6,000
47 KOTA SURABAYA 13011501 Kedungdoro 12,295 18,424 30,719 Rp 6,000 100.00% Rp 6,000 Rp 184,314,000 17 - 17 Rp 6,000 100.00% Rp 6,000
48 KOTA SURABAYA 13011502 Dr. Soetomo 7,310 18,359 25,669 Rp 6,000 100.00% Rp 6,000 Rp 154,014,000 10 - 10 Rp 6,000 100.00% Rp 6,000
49 KOTA SURABAYA 13011601 Sawahan 15,402 17,247 32,649 Rp 6,000 100.00% Rp 6,000 Rp 195,894,000 8 - 8 Rp 6,000 100.00% Rp 6,000
50 KOTA SURABAYA 13011602 Putat Jaya 8,676 17,689 26,365 Rp 6,000 100.00% Rp 6,000 Rp 158,190,000 23 - 23 Rp 6,000 100.00% Rp 6,000
51 KOTA SURABAYA 13011603 Banyu Urip 10,576 24,500 35,076 Rp 6,000 100.00% Rp 6,000 Rp 210,456,000 24 - 24 Rp 6,000 100.00% Rp 6,000
52 KOTA SURABAYA 13011604 Pakis 8,411 10,962 19,373 Rp 6,000 100.00% Rp 6,000 Rp 116,238,000 14 - 14 Rp 6,000 100.00% Rp 6,000
53 KOTA SURABAYA 13011701 Gayungan 16,635 8,953 25,588 Rp 6,000 100.00% Rp 6,000 Rp 153,528,000 22 - 22 Rp 6,000 100.00% Rp 6,000
54 KOTA SURABAYA 13011702 Jemursari 7,426 5,296 12,722 Rp 6,000 100.00% Rp 6,000 Rp 76,332,000 10 - 10 Rp 6,000 100.00% Rp 6,000
55 KOTA SURABAYA 13011703 Kebonsari 11,373 13,673 25,046 Rp 6,000 100.00% Rp 6,000 Rp 150,276,000 6 - 6 Rp 6,000 100.00% Rp 6,000
56 KOTA SURABAYA 13011704 Sidosermo 6,219 9,901 16,120 Rp 6,000 100.00% Rp 6,000 Rp 96,720,000 22 - 22 Rp 6,000 100.00% Rp 6,000
57 KOTA SURABAYA 13011801 Kedurus 14,176 15,391 29,567 Rp 6,000 100.00% Rp 6,000 Rp 177,402,000 30 - 30 Rp 6,000 100.00% Rp 6,000
58 KOTA SURABAYA 13011802 Dukuh Kupang 14,817 13,345 28,162 Rp 6,000 100.00% Rp 6,000 Rp 168,972,000 59 - 59 Rp 6,000 100.00% Rp 6,000
59 KOTA SURABAYA 13011803 Wiyung 13,610 12,765 26,375 Rp 6,000 100.00% Rp 6,000 Rp 158,250,000 29 - 29 Rp 6,000 100.00% Rp 6,000
60 KOTA SURABAYA 13011901 Jeruk 6,717 7,207 13,924 Rp 6,000 100.00% Rp 6,000 Rp 83,544,000 12 - 12 Rp 6,000 100.00% Rp 6,000
61 KOTA SURABAYA 13011902 Lidah Kulon 8,000 6,696 14,696 Rp 6,000 95.00% Rp 5,700 Rp 83,767,200 12 - 12 Rp 6,000 95.00% Rp 5,700
62 KOTA SURABAYA 13011903 Lontar 5,945 9,867 15,812 Rp 6,000 100.00% Rp 6,000 Rp 94,872,000 18 - 18 Rp 6,000 100.00% Rp 6,000
63 KOTA SURABAYA 02170903 Sawah Pulo 1,688 18,451 20,139 Rp 6,000 100.00% Rp 6,000 Rp 120,834,000 6 - 6 Rp 6,000 100.00% Rp 6,000
TOTAL PUSKESMAS KOTA SURABAYA 584,610 1,015,815 1,600,425 Rp 9,580,789,800 1,125 - 1,125
TOTAL
BIAYA KAPITASI AGUSTUS AGUSTUS 2020
2020
21=17*20 22=7+17 23=11+21

Rp 66,000 12,697 Rp 76,182,000
Rp 36,000 7,682 Rp 46,092,000
Rp 90,000 17,418 Rp 104,508,000
Rp 24,000 7,374 Rp 44,244,000
Rp 108,000 11,555 Rp 69,330,000
Rp 48,000 25,749 Rp 154,494,000

Rp 24,000 11,930 Rp 71,580,000
Rp 72,000 19,450 Rp 116,700,000
Rp 72,000 16,781 Rp 100,686,000
Rp 84,000 35,659 Rp 213,954,000
Rp 90,000 44,514 Rp 267,084,000
Rp 57,000 27,467 Rp 156,561,900
Rp 156,000 42,355 Rp 254,130,000

Rp 114,000 12,771 Rp 76,626,000
Rp 90,000 38,793 Rp 232,758,000
Rp 240,000 39,656 Rp 237,936,000
Rp 54,000 25,700 Rp 154,200,000
Rp 114,000 21,046 Rp 126,276,000
Rp 204,000 33,188 Rp 199,128,000

Rp 168,000 30,775 Rp 184,650,000
Rp 60,000 25,479 Rp 152,874,000
Rp 72,000 17,145 Rp 102,870,000
Rp 30,000 32,295 Rp 193,770,000

Rp 138,000 20,349 Rp 122,094,000
Rp 78,000 37,194 Rp 223,164,000

Rp 74,100 30,394 Rp 173,245,800
Rp 60,000 35,872 Rp 215,232,000
Rp 96,000 33,365 Rp 200,190,000
Rp 48,000 37,877 Rp 227,262,000
Rp 156,000 31,927 Rp 191,562,000

Rp 126,000 36,916 Rp 221,496,000
Rp 138,000 24,805 Rp 148,830,000

Rp 156,000 24,388 Rp 146,328,000
Rp 108,000 20,119 Rp 120,714,000
Rp 96,000 27,532 Rp 165,192,000
Rp 222,000 23,242 Rp 139,452,000

Rp 144,000 23,043 Rp 138,258,000
Rp 108,000 16,656 Rp 99,936,000
Rp 162,000 36,810 Rp 220,860,000
Rp 132,000 35,493 Rp 212,958,000
Rp 126,000 23,714 Rp 142,284,000

TOTAL
BIAYA KAPITASI AGUSTUS AGUSTUS 2020
2020
21=17*20 22=7+17 23=11+21

Rp 120,000 37,787 Rp 226,722,000
Rp 180,000 26,242 Rp 157,452,000
Rp 168,000 24,910 Rp 149,460,000

Rp 42,000 22,430 Rp 134,580,000
Rp 60,000 14,682 Rp 88,092,000

Rp 102,000 30,736 Rp 184,416,000
Rp 60,000 25,679 Rp 154,074,000
Rp 48,000 32,657 Rp 195,942,000
Rp 138,000 26,388 Rp 158,328,000

Rp 144,000 35,100 Rp 210,600,000
Rp 84,000 19,387 Rp 116,322,000
Rp 132,000 25,610 Rp 153,660,000
Rp 60,000 12,732 Rp 76,392,000
Rp 36,000 25,052 Rp 150,312,000
Rp 132,000 16,142 Rp 96,852,000

Rp 180,000 29,597 Rp 177,582,000
Rp 354,000 28,221 Rp 169,326,000
Rp 174,000 26,404 Rp 158,424,000
Rp 72,000 13,936 Rp 83,616,000
Rp 68,400 14,708 Rp 83,835,600
Rp 108,000 15,830 Rp 94,980,000
Rp 36,000 20,145 Rp 120,870,000

Rp 6,739,500 1,601,550 Rp 9,587,529,300

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DATA PESERTA TERDAFTAR DI FASILITAS KESEHATAN TINGKAT PERTAMA

BULAN JANUARI 2020

KAP JUMLAH PESERTA

NON PBI PBI TOTAL

139 KOTA SURABAYA 02170004 Siwalankerto 8,601 4,037 12,638

140 KOTA SURABAYA 02170005 Balas Klumprik 3,744 3,643 7,387

141 KOTA SURABAYA 02170006 Keputih 6,849 10,668 17,517

142 KOTA SURABAYA 02170007 Bangkingan 2,972 4,595 7,567

143 KOTA SURABAYA 02170008 Made 4,579 6,924 11,503

144 KOTA SURABAYA 02170105 Morokrembangan 3,905 20,729 24,634

145 KOTA SURABAYA 02170106 Tambak Wedi 3,220 7,976 11,196

146 KOTA SURABAYA 02170107 Bulak Banteng 4,439 12,688 17,127

147 KOTA SURABAYA 02170108 Kalijudan 6,476 9,017 15,493

148 KOTA SURABAYA 13010101 Pegirian 7,008 25,895 32,903

149 KOTA SURABAYA 13010102 Wonokusumo 8,167 39,600 47,767

150 KOTA SURABAYA 13010103 Sidotopo 4,230 29,424 33,654

151 KOTA SURABAYA 13010201 Perak Timur 9,805 30,318 40,123

152 KOTA SURABAYA 13010301 Tanjungsari 5,114 7,144 12,258

153 KOTA SURABAYA 13010302 Manukan Kulon 23,836 15,071 38,907

154 KOTA SURABAYA 13010303 Simomulyo 16,940 20,358 37,298

155 KOTA SURABAYA 13010304 Asemrowo 5,596 21,759 27,355

156 KOTA SURABAYA 13010305 Balongsari 9,142 13,461 22,603

157 KOTA SURABAYA 13010401 Sememi 13,166 19,748 32,914

158 KOTA SURABAYA 13010402 Benowo 12,034 18,036 30,070

159 KOTA SURABAYA 13010501 Krembangan Selatan 8,880 16,870 25,750

160 KOTA SURABAYA 13010502 Dupak 7,169 11,198 18,367

161 KOTA SURABAYA 13010601 Tembok Dukuh 10,073 22,371 32,444

162 KOTA SURABAYA 13010602 Gundih 4,830 15,368 20,198

163 KOTA SURABAYA 13010701 Tambak Rejo 9,126 27,961 37,087

165 KOTA SURABAYA 13010801 Rangkah 9,653 25,075 34,728

166 KOTA SURABAYA 13010802 Pacar Keling 11,132 21,561 32,693

167 KOTA SURABAYA 13010803 Gading 5,933 32,371 38,304

168 KOTA SURABAYA 13010901 Pucang Sewu 18,181 15,277 33,458

169 KOTA SURABAYA 13010902 Mojo 15,213 21,308 36,521

170 KOTA SURABAYA 13011001 Kalirungkut 13,438 12,019 25,457

171 KOTA SURABAYA 13011002 Tenggilis 11,862 10,695 22,557

172 KOTA SURABAYA 13011003 Gunung Anyar 8,276 11,321 19,597

173 KOTA SURABAYA 13011004 Medokan Ayu 13,086 13,399 26,485

174 KOTA SURABAYA 13011101 Menur 12,618 10,019 22,637

175 KOTA SURABAYA 13011102 Mulyorejo 11,921 8,902 20,823

176 KOTA SURABAYA 13011103 Klampis Ngasem 9,043 6,932 15,975

178 KOTA SURABAYA 13011202 Sidotopo Wetan 10,003 24,613 34,616

179 KOTA SURABAYA 13011203 Kenjeran 6,545 15,980 22,525

180 KOTA SURABAYA 13011301 Jagir 18,629 19,352 37,981

181 KOTA SURABAYA 13011302 Wonokromo 13,109 13,781 26,890

182 KOTA SURABAYA 13011303 Ngagel Rejo 9,561 14,557 24,118

183 KOTA SURABAYA 13011401 Peneleh 6,251 15,688 21,939

184 KOTA SURABAYA 13011402 Ketabang 6,496 7,712 14,208

185 KOTA SURABAYA 13011501 Kedungdoro 13,296 18,717 32,013

186 KOTA SURABAYA 13011502 Dr. Soetomo 7,348 18,667 26,015

187 KOTA SURABAYA 13011601 Sawahan 16,285 17,287 33,572

189 KOTA SURABAYA 13011603 Banyu Urip 11,473 23,732 35,205

190 KOTA SURABAYA 13011604 Pakis 9,043 11,505 20,548

191 KOTA SURABAYA 13011701 Gayungan 16,800 7,448 24,248

192 KOTA SURABAYA 13011702 Jemursari 8,005 4,483 12,488

193 KOTA SURABAYA 13011703 Kebonsari 11,545 11,863 23,408

194 KOTA SURABAYA 13011704 Sidosermo 6,681 9,075 15,756

195 KOTA SURABAYA 13011801 Kedurus 14,305 13,208 27,513

196 KOTA SURABAYA 13011802 Dukuh Kupang 15,639 12,522 28,161

197 KOTA SURABAYA 13011803 Wiyung 14,165 11,183 25,348

199 KOTA SURABAYA 13011902 Lidah Kulon 8,308 6,519 14,827

200 KOTA SURABAYA 13011903 Lontar 6,131 7,612 13,743