jasperreports - data jenis perawatan
DESCRIPTION
Data Keperawatan dan jenis perawatan yang dilakukan dirumah sakitTRANSCRIPT
-
DATA
TIND
AKAN/PERAW
ATAN/TAG
IHAN
RS.AVECIENA
MED
IKAKaw
asanKom
ersialSEKUM
PUL,M
ARTAPU
RA,Kalim
antanSelatan
E-mail:
info@rsavm
.com0511-4721555
KodeN
AMA
PERAWATAN
/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
A.I.1KonsultasiICU
Non
emergensi(Pertam
aKali)
-Rp
0.00Rp
200,000.00Rp
0.00Rp
200,000.00Rp
0.00A.I.2
KonsultasiICUEm
ergensi(Pertama
Kali)-
Rp0.00
Rp200,000.00
Rp0.00
Rp200,000.00
Rp0.00
A.I.3KonsultasiICU
Perhari(FollowU
p)-
Rp0.00
Rp200,000.00
Rp0.00
Rp200,000.00
Rp0.00
A.II.1KonsultasiICU
Non
emergensi(Pertam
aKali)
-Rp
0.00Rp
170,000.00Rp
0.00Rp
170,000.00Rp
0.00A.II.2
KonsultasiICUEm
ergensi(Pertama
Kali)-
Rp0.00
Rp170,000.00
Rp0.00
Rp170,000.00
Rp0.00
A.II.3KonsultasiICU
Perhari(FollowU
p)-
Rp0.00
Rp170,000.00
Rp0.00
Rp170,000.00
Rp0.00
A.III.1KonsultasiICU
Non
emergensi(Pertam
aKali)
-Rp
0.00Rp
144,500.00Rp
0.00Rp
144,500.00Rp
0.00A.III.2
KonsultasiICUEm
ergensi(Pertama
Kali)-
Rp0.00
Rp144,500.00
Rp0.00
Rp144,500.00
Rp0.00
A.III.3KonsultasiICU
Perhari(FollowU
p)-
Rp0.00
Rp144,500.00
Rp0.00
Rp144,500.00
Rp0.00
A.OD
C.1KonsultasiICU
Non
emergensi(Pertam
aKali)
-Rp
0.00Rp
122,825.00Rp
0.00Rp
122,825.00Rp
0.00A.O
DC.2
KonsultasiICUEm
ergensi(Pertama
Kali)-
Rp0.00
Rp122,825.00
Rp0.00
Rp122,825.00
Rp0.00
A.OD
C.3KonsultasiICU
Perhari(FollowU
p)-
Rp0.00
Rp122,825.00
Rp0.00
Rp122,825.00
Rp0.00
A.VIP.1KonsultasiICU
Non
emergensi(Pertam
aKali)
-Rp
0.00Rp
230,000.00Rp
0.00Rp
230,000.00Rp
0.00A.VIP.2
KonsultasiICUEm
ergensi(Pertama
Kali)-
Rp0.00
Rp230,000.00
Rp0.00
Rp230,000.00
Rp0.00
A.VIP.3KonsultasiICU
Perhari(FollowU
p)-
Rp0.00
Rp230,000.00
Rp0.00
Rp230,000.00
Rp0.00
A.VVIP.1KonsultasiICU
Non
emergensi(Pertam
aKali)
-Rp
0.00Rp
264,500.00Rp
0.00Rp
264,500.00Rp
0.00A.VVIP.2
KonsultasiICUEm
ergensi(Pertama
Kali)-
Rp0.00
Rp264,500.00
Rp0.00
Rp264,500.00
Rp0.00
A.VVIP.3KonsultasiICU
Perhari(FollowU
p)-
Rp0.00
Rp264,500.00
Rp0.00
Rp264,500.00
Rp0.00
BU.I.1
AmputasiAbove
Knee-
Rp0.00
Rp3,100,000.00
Rp0.00
Rp3,100,000.00
Rp0.00
BU.I.10
Bilateralrepairof
indirectinguinalhernia
-Rp
0.00Rp
2,900,000.00Rp
0.00Rp
2,900,000.00Rp
0.00BU
.I.11Bilateralsim
plem
astectomy
-Rp
0.00Rp
3,300,000.00Rp
0.00Rp
3,300,000.00Rp
0.00BU
.I.12Cholecystectom
y-
Rp0.00
Rp3,700,000.00
Rp0.00
Rp3,700,000.00
Rp0.00
BU.I.13
Choledochoplasty-
Rp0.00
Rp4,300,000.00
Rp0.00
Rp4,300,000.00
Rp0.00
BU.I.14
Combustio
(LukaBakar)
-Rp
0.00Rp
2,200,000.00Rp
0.00Rp
2,200,000.00Rp
0.00BU
.I.15Com
pletethyroidectom
y-
Rp0.00
Rp3,700,000.00
Rp0.00
Rp3,700,000.00
Rp0.00
BU.I.16
Debridem
entM
ediastinum(Sternotom
i)-
Rp0.00
Rp3,100,000.00
Rp0.00
Rp3,100,000.00
Rp0.00
BU.I.17
FrakturCruris
-Rp
0.00Rp
3,500,000.00Rp
0.00Rp
3,500,000.00Rp
0.00BU
.I.18Fraktur
Femur
-Rp
0.00Rp
2,800,000.00Rp
0.00Rp
2,800,000.00Rp
0.00BU
.I.19Fraktur
Hum
erus-
Rp0.00
Rp2,400,000.00
Rp0.00
Rp2,400,000.00
Rp0.00
BU.I.2
AmputasiBelow
Knee-
Rp0.00
Rp3,100,000.00
Rp0.00
Rp3,100,000.00
Rp0.00
BU.I.20
FrakturKlavikula
-Rp
0.00Rp
2,700,000.00Rp
0.00Rp
2,700,000.00Rp
0.00BU
.I.21InsisiAbses
denganAnastesiLokal
-Rp
0.00Rp
1,300,000.00Rp
0.00Rp
1,300,000.00Rp
0.00BU
.I.22Pem
asanganPeritonealSialysis
(PD)
Catheter(diluar
alat)-
Rp0.00
Rp2,300,000.00
Rp0.00
Rp2,300,000.00
Rp0.00
BU.I.23
Pleurodesis-
Rp0.00
Rp1,200,000.00
Rp0.00
Rp1,200,000.00
Rp0.00
BU.I.24
TiroidektomiSubtotal,TotalN
odulTiroid-
Rp0.00
Rp2,400,000.00
Rp0.00
Rp2,400,000.00
Rp0.00
BU.I.25
TotalSplenectomy
-Rp
0.00Rp
3,400,000.00Rp
0.00Rp
3,400,000.00Rp
0.00BU
.I.3Am
putasiJari(Phalangs-
Traumatik)
-Rp
0.00Rp
1,300,000.00Rp
0.00Rp
1,300,000.00Rp
0.00BU
.I.4Arteriovenous
shunt(AV
Shunt)brakiosefalika
-Rp
0.00Rp
2,700,000.00Rp
0.00Rp
2,700,000.00Rp
0.00
52Page
1of
3/23/158:08
AM
-
KodeN
AMA
PERAWATAN
/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BU.I.5
Arteriovenousshunt
(AVShunt)
radiosefalika-
Rp0.00
Rp2,700,000.00
Rp0.00
Rp2,700,000.00
Rp0.00
BU.I.6
BatuSaluran
Kemih
-Rp
0.00Rp
2,700,000.00Rp
0.00Rp
2,700,000.00Rp
0.00BU
.I.7Bilateralexcision
ofectopic
breasttissue
(mam
aaberans)
-Rp
0.00Rp
3,100,000.00Rp
0.00Rp
3,100,000.00Rp
0.00BU
.I.8Bilateralradicalm
astectomy
-Rp
0.00Rp
5,000,000.00Rp
0.00Rp
5,000,000.00Rp
0.00BU
.I.9Bilateralrepair
ofdirect
inguinalhernia-
Rp0.00
Rp2,900,000.00
Rp0.00
Rp2,900,000.00
Rp0.00
BU.II.1
AmputasiAbove
Knee-
Rp0.00
Rp2,635,000.00
Rp0.00
Rp2,635,000.00
Rp0.00
BU.II.10
Bilateralrepairof
indirectinguinalhernia
-Rp
0.00Rp
2,465,000.00Rp
0.00Rp
2,465,000.00Rp
0.00BU
.II.11Bilateralsim
plem
astectomy
-Rp
0.00Rp
2,805,000.00Rp
0.00Rp
2,805,000.00Rp
0.00BU
.II.12Cholecystectom
y-
Rp0.00
Rp3,145,000.00
Rp0.00
Rp3,145,000.00
Rp0.00
BU.II.13
Choledochoplasty-
Rp0.00
Rp3,655,000.00
Rp0.00
Rp3,655,000.00
Rp0.00
BU.II.14
Combustio
(LukaBakar)
-Rp
0.00Rp
1,870,000.00Rp
0.00Rp
1,870,000.00Rp
0.00BU
.II.15Com
pletethyroidectom
y-
Rp0.00
Rp3,145,000.00
Rp0.00
Rp3,145,000.00
Rp0.00
BU.II.16
Debridem
entM
ediastinum(Sternotom
i)-
Rp0.00
Rp2,635,000.00
Rp0.00
Rp2,635,000.00
Rp0.00
BU.II.17
FrakturCruris
-Rp
0.00Rp
2,975,000.00Rp
0.00Rp
2,975,000.00Rp
0.00BU
.II.18Fraktur
Femur
-Rp
0.00Rp
2,380,000.00Rp
0.00Rp
2,380,000.00Rp
0.00BU
.II.19Fraktur
Hum
erus-
Rp0.00
Rp2,040,000.00
Rp0.00
Rp2,040,000.00
Rp0.00
BU.II.2
AmputasiBelow
Knee-
Rp0.00
Rp2,635,000.00
Rp0.00
Rp2,635,000.00
Rp0.00
BU.II.20
FrakturKlavikula
-Rp
0.00Rp
2,295,000.00Rp
0.00Rp
2,295,000.00Rp
0.00BU
.II.21InsisiAbses
denganAnastesiLokal
-Rp
0.00Rp
1,105,000.00Rp
0.00Rp
1,105,000.00Rp
0.00BU
.II.22Pem
asanganPeritonealSialysis
(PD)
Catheter(diluar
alat)-
Rp0.00
Rp1,955,000.00
Rp0.00
Rp1,955,000.00
Rp0.00
BU.II.23
Pleurodesis-
Rp0.00
Rp1,020,000.00
Rp0.00
Rp1,020,000.00
Rp0.00
BU.II.24
TiroidektomiSubtotal,TotalN
odulTiroid-
Rp0.00
Rp2,040,000.00
Rp0.00
Rp2,040,000.00
Rp0.00
BU.II.25
TotalSplenectomy
-Rp
0.00Rp
2,890,000.00Rp
0.00Rp
2,890,000.00Rp
0.00BU
.II.3Am
putasiJari(Phalangs-
Traumatik)
-Rp
0.00Rp
1,105,000.00Rp
0.00Rp
1,105,000.00Rp
0.00BU
.II.4Arteriovenous
shunt(AV
Shunt)brakiosefalika
-Rp
0.00Rp
2,295,000.00Rp
0.00Rp
2,295,000.00Rp
0.00BU
.II.5Arteriovenous
shunt(AV
Shunt)radiosefalika
-Rp
0.00Rp
2,295,000.00Rp
0.00Rp
2,295,000.00Rp
0.00BU
.II.6Batu
SaluranKem
ih-
Rp0.00
Rp2,295,000.00
Rp0.00
Rp2,295,000.00
Rp0.00
BU.II.7
Bilateralexcisionof
ectopicbreast
tissue(m
ama
aberans)-
Rp0.00
Rp2,635,000.00
Rp0.00
Rp2,635,000.00
Rp0.00
BU.II.8
Bilateralradicalmastectom
y-
Rp0.00
Rp4,250,000.00
Rp0.00
Rp4,250,000.00
Rp0.00
BU.II.9
Bilateralrepairof
directinguinalhernia
-Rp
0.00Rp
2,465,000.00Rp
0.00Rp
2,465,000.00Rp
0.00BU
.III.1Am
putasiAboveKnee
-Rp
0.00Rp
2,239,750.00Rp
0.00Rp
2,239,750.00Rp
0.00BU
.III.10Bilateralrepair
ofindirect
inguinalhernia-
Rp0.00
Rp2,095,250.00
Rp0.00
Rp2,095,250.00
Rp0.00
BU.III.11
Bilateralsimple
mastectom
y-
Rp0.00
Rp2,384,250.00
Rp0.00
Rp2,384,250.00
Rp0.00
BU.III.12
Cholecystectomy
-Rp
0.00Rp
2,673,250.00Rp
0.00Rp
2,673,250.00Rp
0.00BU
.III.13Choledochoplasty
-Rp
0.00Rp
3,106,750.00Rp
0.00Rp
3,106,750.00Rp
0.00BU
.III.14Com
bustio(Luka
Bakar)-
Rp0.00
Rp1,589,500.00
Rp0.00
Rp1,589,500.00
Rp0.00
BU.III.15
Complete
thyroidectomy
-Rp
0.00Rp
2,673,250.00Rp
0.00Rp
2,673,250.00Rp
0.00BU
.III.16D
ebridement
Mediastinum
(Sternotomi)
-Rp
0.00Rp
2,239,750.00Rp
0.00Rp
2,239,750.00Rp
0.00BU
.III.17Fraktur
Cruris-
Rp0.00
Rp2,528,750.00
Rp0.00
Rp2,528,750.00
Rp0.00
BU.III.18
FrakturFem
ur-
Rp0.00
Rp2,023,000.00
Rp0.00
Rp2,023,000.00
Rp0.00
BU.III.19
FrakturH
umerus
-Rp
0.00Rp
1,734,000.00Rp
0.00Rp
1,734,000.00Rp
0.00BU
.III.2Am
putasiBelowKnee
-Rp
0.00Rp
2,239,750.00Rp
0.00Rp
2,239,750.00Rp
0.00BU
.III.20Fraktur
Klavikula-
Rp0.00
Rp1,950,750.00
Rp0.00
Rp1,950,750.00
Rp0.00
BU.III.21
InsisiAbsesdengan
AnastesiLokal-
Rp0.00
Rp939,250.00
Rp0.00
Rp939,250.00
Rp0.00
BU.III.22
Pemasangan
PeritonealSialysis(PD
)Catheter
(diluaralat)
-Rp
0.00Rp
1,661,750.00Rp
0.00Rp
1,661,750.00Rp
0.00BU
.III.23Pleurodesis
-Rp
0.00Rp
867,000.00Rp
0.00Rp
867,000.00Rp
0.00
52Page
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AM
-
KodeN
AMA
PERAWATAN
/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BU.III.24
TiroidektomiSubtotal,TotalN
odulTiroid-
Rp0.00
Rp1,734,000.00
Rp0.00
Rp1,734,000.00
Rp0.00
BU.III.25
TotalSplenectomy
-Rp
0.00Rp
2,456,500.00Rp
0.00Rp
2,456,500.00Rp
0.00BU
.III.3Am
putasiJari(Phalangs-
Traumatik)
-Rp
0.00Rp
939,250.00Rp
0.00Rp
939,250.00Rp
0.00BU
.III.4Arteriovenous
shunt(AV
Shunt)brakiosefalika
-Rp
0.00Rp
1,950,750.00Rp
0.00Rp
1,950,750.00Rp
0.00BU
.III.5Arteriovenous
shunt(AV
Shunt)radiosefalika
-Rp
0.00Rp
1,950,750.00Rp
0.00Rp
1,950,750.00Rp
0.00BU
.III.6Batu
SaluranKem
ih-
Rp0.00
Rp1,950,750.00
Rp0.00
Rp1,950,750.00
Rp0.00
BU.III.7
Bilateralexcisionof
ectopicbreast
tissue(m
ama
aberans)-
Rp0.00
Rp2,239,750.00
Rp0.00
Rp2,239,750.00
Rp0.00
BU.III.8
Bilateralradicalmastectom
y-
Rp0.00
Rp3,612,500.00
Rp0.00
Rp3,612,500.00
Rp0.00
BU.III.9
Bilateralrepairof
directinguinalhernia
-Rp
0.00Rp
2,095,250.00Rp
0.00Rp
2,095,250.00Rp
0.00BU
.OD
C.1Am
putasiAboveKnee
-Rp
0.00Rp
1,903,787.50Rp
0.00Rp
1,903,787.50Rp
0.00BU
.OD
C.10Bilateralrepair
ofindirect
inguinalhernia-
Rp0.00
Rp1,780,962.50
Rp0.00
Rp1,780,962.50
Rp0.00
BU.O
DC.11
Bilateralsimple
mastectom
y-
Rp0.00
Rp2,026,612.50
Rp0.00
Rp2,026,612.50
Rp0.00
BU.O
DC.12
Cholecystectomy
-Rp
0.00Rp
2,272,262.50Rp
0.00Rp
2,272,262.50Rp
0.00BU
.OD
C.13Choledochoplasty
-Rp
0.00Rp
2,640,737.50Rp
0.00Rp
2,640,737.50Rp
0.00BU
.OD
C.14Com
bustio(Luka
Bakar)-
Rp0.00
Rp1,351,075.00
Rp0.00
Rp1,351,075.00
Rp0.00
BU.O
DC.15
Complete
thyroidectomy
-Rp
0.00Rp
2,272,262.50Rp
0.00Rp
2,272,262.50Rp
0.00BU
.OD
C.16D
ebridement
Mediastinum
(Sternotomi)
-Rp
0.00Rp
1,903,787.50Rp
0.00Rp
1,903,787.50Rp
0.00BU
.OD
C.17Fraktur
Cruris-
Rp0.00
Rp2,149,437.50
Rp0.00
Rp2,149,437.50
Rp0.00
BU.O
DC.18
FrakturFem
ur-
Rp0.00
Rp1,719,550.00
Rp0.00
Rp1,719,550.00
Rp0.00
BU.O
DC.19
FrakturH
umerus
-Rp
0.00Rp
1,473,900.00Rp
0.00Rp
1,473,900.00Rp
0.00BU
.OD
C.2Am
putasiBelowKnee
-Rp
0.00Rp
1,903,787.50Rp
0.00Rp
1,903,787.50Rp
0.00BU
.OD
C.20Fraktur
Klavikula-
Rp0.00
Rp1,658,137.50
Rp0.00
Rp1,658,137.50
Rp0.00
BU.O
DC.21
InsisiAbsesdengan
AnastesiLokal-
Rp0.00
Rp798,362.50
Rp0.00
Rp798,362.50
Rp0.00
BU.O
DC.22
Pemasangan
PeritonealSialysis(PD
)Catheter
(diluaralat)
-Rp
0.00Rp
1,412,487.50Rp
0.00Rp
1,412,487.50Rp
0.00BU
.OD
C.23Pleurodesis
-Rp
0.00Rp
736,950.00Rp
0.00Rp
736,950.00Rp
0.00BU
.OD
C.24Tiroidektom
iSubtotal,TotalNodulTiroid
-Rp
0.00Rp
1,473,900.00Rp
0.00Rp
1,473,900.00Rp
0.00BU
.OD
C.25TotalSplenectom
y-
Rp0.00
Rp2,088,025.00
Rp0.00
Rp2,088,025.00
Rp0.00
BU.O
DC.3
AmputasiJari(Phalangs
-Traum
atik)-
Rp0.00
Rp798,362.50
Rp0.00
Rp798,362.50
Rp0.00
BU.O
DC.4
Arteriovenousshunt
(AVShunt)
brakiosefalika-
Rp0.00
Rp1,658,137.50
Rp0.00
Rp1,658,137.50
Rp0.00
BU.O
DC.5
Arteriovenousshunt
(AVShunt)
radiosefalika-
Rp0.00
Rp1,658,137.50
Rp0.00
Rp1,658,137.50
Rp0.00
BU.O
DC.6
BatuSaluran
Kemih
-Rp
0.00Rp
1,658,137.50Rp
0.00Rp
1,658,137.50Rp
0.00BU
.OD
C.7Bilateralexcision
ofectopic
breasttissue
(mam
aaberans)
-Rp
0.00Rp
1,903,787.50Rp
0.00Rp
1,903,787.50Rp
0.00BU
.OD
C.8Bilateralradicalm
astectomy
-Rp
0.00Rp
3,070,625.00Rp
0.00Rp
3,070,625.00Rp
0.00BU
.OD
C.9Bilateralrepair
ofdirect
inguinalhernia-
Rp0.00
Rp1,780,962.50
Rp0.00
Rp1,780,962.50
Rp0.00
BU.VIP.1
AmputasiAbove
Knee-
Rp0.00
Rp3,565,000.00
Rp0.00
Rp3,565,000.00
Rp0.00
BU.VIP.10
Bilateralrepairof
indirectinguinalhernia
-Rp
0.00Rp
3,335,000.00Rp
0.00Rp
3,335,000.00Rp
0.00BU
.VIP.11Bilateralsim
plem
astectomy
-Rp
0.00Rp
3,795,000.00Rp
0.00Rp
3,795,000.00Rp
0.00BU
.VIP.12Cholecystectom
y-
Rp0.00
Rp4,255,000.00
Rp0.00
Rp4,255,000.00
Rp0.00
BU.VIP.13
Choledochoplasty-
Rp0.00
Rp4,945,000.00
Rp0.00
Rp4,945,000.00
Rp0.00
BU.VIP.14
Combustio
(LukaBakar)
-Rp
0.00Rp
2,530,000.00Rp
0.00Rp
2,530,000.00Rp
0.00BU
.VIP.15Com
pletethyroidectom
y-
Rp0.00
Rp4,255,000.00
Rp0.00
Rp4,255,000.00
Rp0.00
BU.VIP.16
Debridem
entM
ediastinum(Sternotom
i)-
Rp0.00
Rp3,565,000.00
Rp0.00
Rp3,565,000.00
Rp0.00
BU.VIP.17
FrakturCruris
-Rp
0.00Rp
4,025,000.00Rp
0.00Rp
4,025,000.00Rp
0.00BU
.VIP.18Fraktur
Femur
-Rp
0.00Rp
3,220,000.00Rp
0.00Rp
3,220,000.00Rp
0.00BU
.VIP.19Fraktur
Hum
erus-
Rp0.00
Rp2,760,000.00
Rp0.00
Rp2,760,000.00
Rp0.00
BU.VIP.2
AmputasiBelow
Knee-
Rp0.00
Rp3,565,000.00
Rp0.00
Rp3,565,000.00
Rp0.00
52Page
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KodeN
AMA
PERAWATAN
/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BU.VIP.20
FrakturKlavikula
-Rp
0.00Rp
3,105,000.00Rp
0.00Rp
3,105,000.00Rp
0.00BU
.VIP.21InsisiAbses
denganAnastesiLokal
-Rp
0.00Rp
1,495,000.00Rp
0.00Rp
1,495,000.00Rp
0.00BU
.VIP.22Pem
asanganPeritonealSialysis
(PD)
Catheter(diluar
alat)-
Rp0.00
Rp2,645,000.00
Rp0.00
Rp2,645,000.00
Rp0.00
BU.VIP.23
Pleurodesis-
Rp0.00
Rp1,380,000.00
Rp0.00
Rp1,380,000.00
Rp0.00
BU.VIP.24
TiroidektomiSubtotal,TotalN
odulTiroid-
Rp0.00
Rp2,760,000.00
Rp0.00
Rp2,760,000.00
Rp0.00
BU.VIP.25
TotalSplenectomy
-Rp
0.00Rp
3,910,000.00Rp
0.00Rp
3,910,000.00Rp
0.00BU
.VIP.3Am
putasiJari(Phalangs-
Traumatik)
-Rp
0.00Rp
1,495,000.00Rp
0.00Rp
1,495,000.00Rp
0.00BU
.VIP.4Arteriovenous
shunt(AV
Shunt)brakiosefalika
-Rp
0.00Rp
3,105,000.00Rp
0.00Rp
3,105,000.00Rp
0.00BU
.VIP.5Arteriovenous
shunt(AV
Shunt)radiosefalika
-Rp
0.00Rp
3,105,000.00Rp
0.00Rp
3,105,000.00Rp
0.00BU
.VIP.6Batu
SaluranKem
ih-
Rp0.00
Rp3,105,000.00
Rp0.00
Rp3,105,000.00
Rp0.00
BU.VIP.7
Bilateralexcisionof
ectopicbreast
tissue(m
ama
aberans)-
Rp0.00
Rp3,565,000.00
Rp0.00
Rp3,565,000.00
Rp0.00
BU.VIP.8
Bilateralradicalmastectom
y-
Rp0.00
Rp5,750,000.00
Rp0.00
Rp5,750,000.00
Rp0.00
BU.VIP.9
Bilateralrepairof
directinguinalhernia
-Rp
0.00Rp
3,335,000.00Rp
0.00Rp
3,335,000.00Rp
0.00BU
.VVIP.1Am
putasiAboveKnee
-Rp
0.00Rp
4,099,750.00Rp
0.00Rp
4,099,750.00Rp
0.00BU
.VVIP.10Bilateralrepair
ofindirect
inguinalhernia-
Rp0.00
Rp3,835,250.00
Rp0.00
Rp3,835,250.00
Rp0.00
BU.VVIP.11
Bilateralsimple
mastectom
y-
Rp0.00
Rp4,364,250.00
Rp0.00
Rp4,364,250.00
Rp0.00
BU.VVIP.12
Cholecystectomy
-Rp
0.00Rp
4,893,250.00Rp
0.00Rp
4,893,250.00Rp
0.00BU
.VVIP.13Choledochoplasty
-Rp
0.00Rp
5,686,750.00Rp
0.00Rp
5,686,750.00Rp
0.00BU
.VVIP.14Com
bustio(Luka
Bakar)-
Rp0.00
Rp2,909,500.00
Rp0.00
Rp2,909,500.00
Rp0.00
BU.VVIP.15
Complete
thyroidectomy
-Rp
0.00Rp
4,893,250.00Rp
0.00Rp
4,893,250.00Rp
0.00BU
.VVIP.16D
ebridement
Mediastinum
(Sternotomi)
-Rp
0.00Rp
4,099,750.00Rp
0.00Rp
4,099,750.00Rp
0.00BU
.VVIP.17Fraktur
Cruris-
Rp0.00
Rp4,628,750.00
Rp0.00
Rp4,628,750.00
Rp0.00
BU.VVIP.18
FrakturFem
ur-
Rp0.00
Rp3,703,000.00
Rp0.00
Rp3,703,000.00
Rp0.00
BU.VVIP.19
FrakturH
umerus
-Rp
0.00Rp
3,174,000.00Rp
0.00Rp
3,174,000.00Rp
0.00BU
.VVIP.2Am
putasiBelowKnee
-Rp
0.00Rp
4,099,750.00Rp
0.00Rp
4,099,750.00Rp
0.00BU
.VVIP.20Fraktur
Klavikula-
Rp0.00
Rp3,570,750.00
Rp0.00
Rp3,570,750.00
Rp0.00
BU.VVIP.21
InsisiAbsesdengan
AnastesiLokal-
Rp0.00
Rp1,719,250.00
Rp0.00
Rp1,719,250.00
Rp0.00
BU.VVIP.22
Pemasangan
PeritonealSialysis(PD
)Catheter
(diluaralat)
-Rp
0.00Rp
3,041,750.00Rp
0.00Rp
3,041,750.00Rp
0.00BU
.VVIP.23Pleurodesis
-Rp
0.00Rp
1,587,000.00Rp
0.00Rp
1,587,000.00Rp
0.00BU
.VVIP.24Tiroidektom
iSubtotal,TotalNodulTiroid
-Rp
0.00Rp
3,174,000.00Rp
0.00Rp
3,174,000.00Rp
0.00BU
.VVIP.25TotalSplenectom
y-
Rp0.00
Rp4,496,500.00
Rp0.00
Rp4,496,500.00
Rp0.00
BU.VVIP.3
AmputasiJari(Phalangs
-Traum
atik)-
Rp0.00
Rp1,719,250.00
Rp0.00
Rp1,719,250.00
Rp0.00
BU.VVIP.4
Arteriovenousshunt
(AVShunt)
brakiosefalika-
Rp0.00
Rp3,570,750.00
Rp0.00
Rp3,570,750.00
Rp0.00
BU.VVIP.5
Arteriovenousshunt
(AVShunt)
radiosefalika-
Rp0.00
Rp3,570,750.00
Rp0.00
Rp3,570,750.00
Rp0.00
BU.VVIP.6
BatuSaluran
Kemih
-Rp
0.00Rp
3,570,750.00Rp
0.00Rp
3,570,750.00Rp
0.00BU
.VVIP.7Bilateralexcision
ofectopic
breasttissue
(mam
aaberans)
-Rp
0.00Rp
4,099,750.00Rp
0.00Rp
4,099,750.00Rp
0.00BU
.VVIP.8Bilateralradicalm
astectomy
-Rp
0.00Rp
6,612,500.00Rp
0.00Rp
6,612,500.00Rp
0.00BU
.VVIP.9Bilateralrepair
ofdirect
inguinalhernia-
Rp0.00
Rp3,835,250.00
Rp0.00
Rp3,835,250.00
Rp0.00
BUR.I.1
BiopsiGinjalTerbuka
-Rp
0.00Rp
3,600,000.00Rp
0.00Rp
3,600,000.00Rp
0.00BU
R.I.10RPG
,UR
Sdiagnostik
-Rp
0.00Rp
3,500,000.00Rp
0.00Rp
3,500,000.00Rp
0.00BU
R.I.100Skrotoplasti
-Rp
0.00Rp
3,000,000.00Rp
0.00Rp
3,000,000.00Rp
0.00BU
R.I.101Sperm
atokelektomi
-Rp
0.00Rp
2,900,000.00Rp
0.00Rp
2,900,000.00Rp
0.00BU
R.I.102Varikokelektom
i(Palomo)
-Rp
0.00Rp
2,200,000.00Rp
0.00Rp
2,200,000.00Rp
0.00BU
R.I.103Vasektom
i(anastesilokal)-
Rp0.00
Rp2,200,000.00
Rp0.00
Rp2,200,000.00
Rp0.00
BUR.I.104
Vasektomi(narkose)
-Rp
0.00Rp
2,800,000.00Rp
0.00Rp
2,800,000.00Rp
0.00BU
R.I.105Vasoepididim
ostomi
-Rp
0.00Rp
4,100,000.00Rp
0.00Rp
4,100,000.00Rp
0.00
52Page
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KodeN
AMA
PERAWATAN
/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BUR.I.106
Vasografi-
Rp0.00
Rp2,100,000.00
Rp0.00
Rp2,100,000.00
Rp0.00
BUR.I.107
EksisiWebbed
Penis-
Rp0.00
Rp3,400,000.00
Rp0.00
Rp3,400,000.00
Rp0.00
BUR.I.108
BurriedPenis
-Rp
0.00Rp
2,900,000.00Rp
0.00Rp
2,900,000.00Rp
0.00BU
R.I.109D
iseksiKelenjarG
etahBening
Pelvis-
Rp0.00
Rp3,500,000.00
Rp0.00
Rp3,500,000.00
Rp0.00
BUR.I.11
TailoringU
reter-
Rp0.00
Rp3,800,000.00
Rp0.00
Rp3,800,000.00
Rp0.00
BUR.I.110
DiseksiKelenjar
Getah
Beningper
laparaskopi-
Rp0.00
Rp4,500,000.00
Rp0.00
Rp4,500,000.00
Rp0.00
BUR.I.111
ESWL
-Rp
0.00Rp
2,400,000.00Rp
0.00Rp
2,400,000.00Rp
0.00BU
R.I.112H
olmium
YaGlaser
-Rp
0.00Rp
3,900,000.00Rp
0.00Rp
3,900,000.00Rp
0.00BU
R.I.113Kauterisasi
-Rp
0.00Rp
2,000,000.00Rp
0.00Rp
2,000,000.00Rp
0.00BU
R.I.114Laparotom
iEksplorasi-
Rp0.00
Rp3,600,000.00
Rp0.00
Rp3,600,000.00
Rp0.00
BUR.I.115
Limfadenektom
iRetroperitoneal,R
PLND
-Rp
0.00Rp
3,600,000.00Rp
0.00Rp
3,600,000.00Rp
0.00BU
R.I.116M
MK,sling
uretra-
Rp0.00
Rp2,900,000.00
Rp0.00
Rp2,900,000.00
Rp0.00
BUR.I.117
OperasiSistokel
-Rp
0.00Rp
3,000,000.00Rp
0.00Rp
3,000,000.00Rp
0.00BU
R.I.118O
perasiUrakhus,R
eseksiUrakhus
-Rp
0.00Rp
3,000,000.00Rp
0.00Rp
3,000,000.00Rp
0.00BU
R.I.119Pasang
KateterTenckhoff
untukCAPD
-Rp
0.00Rp
2,300,000.00Rp
0.00Rp
2,300,000.00Rp
0.00BU
R.I.12Transuretero-uterostom
i-
Rp0.00
Rp3,800,000.00
Rp0.00
Rp3,800,000.00
Rp0.00
BUR.I.120
CabutKateter
Tenckhoffuntuk
CAPD-
Rp0.00
Rp2,200,000.00
Rp0.00
Rp2,200,000.00
Rp0.00
BUR.I.121
Punksidansklerosing
kistaginjal
-Rp
0.00Rp
2,200,000.00Rp
0.00Rp
2,200,000.00Rp
0.00BU
R.I.122Tindakan
pembedahan
testisuntuk
pengambilan
spermatozoa
(TESA,TESE,PESA,MESA)
-Rp
0.00Rp
3,700,000.00Rp
0.00Rp
3,700,000.00Rp
0.00
BUR.I.123
Konsultasi,Visite-
Rp0.00
Rp500,000.00
Rp0.00
Rp500,000.00
Rp0.00
BUR.I.13
Ureterolithotom
iproksimal
-Rp
0.00Rp
3,500,000.00Rp
0.00Rp
3,500,000.00Rp
0.00BU
R.I.14U
reterolithotomidistal
-Rp
0.00Rp
3,800,000.00Rp
0.00Rp
3,800,000.00Rp
0.00BU
R.I.15U
retorolisis-
Rp0.00
Rp3,500,000.00
Rp0.00
Rp3,500,000.00
Rp0.00
BUR.I.16
Ureterostom
i-
Rp0.00
Rp3,600,000.00
Rp0.00
Rp3,600,000.00
Rp0.00
BUR.I.17
Ureterouretostom
i-
Rp0.00
Rp3,800,000.00
Rp0.00
Rp3,800,000.00
Rp0.00
BUR.I.18
UR
S,Lithotripsi-
Rp0.00
Rp3,800,000.00
Rp0.00
Rp3,800,000.00
Rp0.00
BUR.I.19
Ureterolitotom
iproksimalper
laparoskopik-
Rp0.00
Rp4,500,000.00
Rp0.00
Rp4,500,000.00
Rp0.00
BUR.I.2
Nefrektom
i-
Rp0.00
Rp3,800,000.00
Rp0.00
Rp3,800,000.00
Rp0.00
BUR.I.20
AugmentasiBuli
-Rp
0.00Rp
7,600,000.00Rp
0.00Rp
7,600,000.00Rp
0.00BU
R.I.21Bladder
neckR
ekonstruksi-
Rp0.00
Rp4,900,000.00
Rp0.00
Rp4,900,000.00
Rp0.00
BUR.I.22
Divertikulektom
ibuli-
Rp0.00
Rp3,200,000.00
Rp0.00
Rp3,200,000.00
Rp0.00
BUR.I.23
Divertikulektom
ibuliperlaparoskopi
-Rp
0.00Rp
4,900,000.00Rp
0.00Rp
4,900,000.00Rp
0.00BU
R.I.24Ekstrofibulirekonstruksi
-Rp
0.00Rp
7,600,000.00Rp
0.00Rp
7,600,000.00Rp
0.00BU
R.I.25Evakuasibekuan
darah(Clot)
-Rp
0.00Rp
3,500,000.00Rp
0.00Rp
3,500,000.00Rp
0.00BU
R.I.26Litholapaksi
-Rp
0.00Rp
3,600,000.00Rp
0.00Rp
3,600,000.00Rp
0.00BU
R.I.27Lithotripsi
-Rp
0.00Rp
3,600,000.00Rp
0.00Rp
3,600,000.00Rp
0.00BU
R.I.28N
eobladder-
Rp0.00
Rp7,600,000.00
Rp0.00
Rp7,600,000.00
Rp0.00
BUR.I.29
PsoasH
itch,BoariFlap-
Rp0.00
Rp3,800,000.00
Rp0.00
Rp3,800,000.00
Rp0.00
BUR.I.3
Anastomosis
endto
endureter
-Rp
0.00Rp
3,600,000.00Rp
0.00Rp
3,600,000.00Rp
0.00BU
R.I.30R
epairFistelEnterovesika
-Rp
0.00Rp
7,600,000.00Rp
0.00Rp
7,600,000.00Rp
0.00BU
R.I.31R
epairFistelVesikokutan
-Rp
0.00Rp
3,800,000.00Rp
0.00Rp
3,800,000.00Rp
0.00BU
R.I.32R
apairFistelVesikorektal
-Rp
0.00Rp
7,600,000.00Rp
0.00Rp
7,600,000.00Rp
0.00BU
R.I.33R
epairFistelVesikovagina
-Rp
0.00Rp
3,800,000.00Rp
0.00Rp
3,800,000.00Rp
0.00BU
R.I.34R
epairFistelVesikovagina
kompleks
-Rp
0.00Rp
4,900,000.00Rp
0.00Rp
4,900,000.00Rp
0.00BU
R.I.35Sectio
Alta,Vesikolithoyomi
-Rp
0.00Rp
3,000,000.00Rp
0.00Rp
3,000,000.00Rp
0.00
52Page
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AMA
PERAWATAN
/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BUR.I.36
SistokopiOD
S-
Rp0.00
Rp2,800,000.00
Rp0.00
Rp2,800,000.00
Rp0.00
BUR.I.37
Sistokopi-
Rp0.00
Rp2,200,000.00
Rp0.00
Rp2,200,000.00
Rp0.00
BUR.I.38
Sistostomiperkutan
-Rp
0.00Rp
2,200,000.00Rp
0.00Rp
2,200,000.00Rp
0.00BU
R.I.39Sistostom
iterbuka-
Rp0.00
Rp2,900,000.00
Rp0.00
Rp2,900,000.00
Rp0.00
BUR.I.4
CabutD
JStent
-Rp
0.00Rp
2,100,000.00Rp
0.00Rp
2,100,000.00Rp
0.00BU
R.I.40Sistektom
itotal,radikal-
Rp0.00
Rp5,800,000.00
Rp0.00
Rp5,800,000.00
Rp0.00
BUR.I.41
Sistektomiparsial,sistoplastireduksi
-Rp
0.00Rp
3,800,000.00Rp
0.00Rp
3,800,000.00Rp
0.00BU
R.I.42Sistektom
iperlaparaskopi
-Rp
0.00Rp
4,900,000.00Rp
0.00Rp
4,900,000.00Rp
0.00BU
R.I.43TU
RTum
orBuli
-Rp
0.00Rp
3,700,000.00Rp
0.00Rp
3,700,000.00Rp
0.00BU
R.I.44O
perasiRepairBU
LITraum
a-
Rp0.00
Rp3,000,000.00
Rp0.00
Rp3,000,000.00
Rp0.00
BUR.I.45
Businasi,DilatasiU
retra-
Rp0.00
Rp2,100,000.00
Rp0.00
Rp2,100,000.00
Rp0.00
BUR.I.46
Divertikulum
uretra-
Rp0.00
Rp2,400,000.00
Rp0.00
Rp2,400,000.00
Rp0.00
BUR.I.47
Epispadia-
Rp0.00
Rp6,800,000.00
Rp0.00
Rp6,800,000.00
Rp0.00
BUR.I.48
Fistulektomi,R
epairFistelU
retra-
Rp0.00
Rp2,400,000.00
Rp0.00
Rp2,400,000.00
Rp0.00
BUR.I.49
UretroplastriH
ipospadia-
Rp0.00
Rp2,600,000.00
Rp0.00
Rp2,600,000.00
Rp0.00
BUR.I.5
Drainase
Periureter-
Rp0.00
Rp2,200,000.00
Rp0.00
Rp2,200,000.00
Rp0.00
BUR.I.50
Hispospadia
Subkoronal-
Rp0.00
Rp3,800,000.00
Rp0.00
Rp3,800,000.00
Rp0.00
BUR.I.51
InsisiPosteriorU
rethralValve-
Rp0.00
Rp3,400,000.00
Rp0.00
Rp3,400,000.00
Rp0.00
BUR.I.52
Uretrotom
iInterna(Sachse)
-Rp
0.00Rp
2,800,000.00Rp
0.00Rp
2,800,000.00Rp
0.00BU
R.I.53Johanson
I-
Rp0.00
Rp2,900,000.00
Rp0.00
Rp2,900,000.00
Rp0.00
BUR.I.54
JohansonII
-Rp
0.00Rp
3,200,000.00Rp
0.00Rp
3,200,000.00Rp
0.00BU
R.I.55KalibrasiU
retra-
Rp0.00
Rp2,100,000.00
Rp0.00
Rp2,100,000.00
Rp0.00
BUR.I.56
Meatotom
i-
Rp0.00
Rp2,100,000.00
Rp0.00
Rp2,100,000.00
Rp0.00
BUR.I.57
Meatoplasti
-Rp
0.00Rp
2,200,000.00Rp
0.00Rp
2,200,000.00Rp
0.00BU
R.I.58Pasang
Kateter-
Rp0.00
Rp2,100,000.00
Rp0.00
Rp2,100,000.00
Rp0.00
BUR.I.59
PasangKateter
denganM
andrain-
Rp0.00
Rp2,100,000.00
Rp0.00
Rp2,100,000.00
Rp0.00
BUR.I.6
EkstraksiBatu-
Rp0.00
Rp2,800,000.00
Rp0.00
Rp2,800,000.00
Rp0.00
BUR.I.60
Railroading
Ruptur
Uretra
-Rp
0.00Rp
3,600,000.00Rp
0.00Rp
3,600,000.00Rp
0.00BU
R.I.61PER
(Primary
EndoscopicRealignm
ent)-
Rp0.00
Rp3,500,000.00
Rp0.00
Rp3,500,000.00
Rp0.00
BUR.I.62
Reseksi-Anastom
osisU
retra-
Rp0.00
Rp3,600,000.00
Rp0.00
Rp3,600,000.00
Rp0.00
BUR.I.63
Uretroskopi,U
retrosistoskopi-
Rp0.00
Rp2,100,000.00
Rp0.00
Rp2,100,000.00
Rp0.00
BUR.I.64
UretroplastiBukalG
raf-
Rp0.00
Rp4,000,000.00
Rp0.00
Rp4,000,000.00
Rp0.00
BUR.I.65
Uretrotom
iEksterna-
Rp0.00
Rp2,300,000.00
Rp0.00
Rp2,300,000.00
Rp0.00
BUR.I.66
BiopsiProstrat-
Rp0.00
Rp2,100,000.00
Rp0.00
Rp2,100,000.00
Rp0.00
BUR.I.67
Masasae
Prostrat-
Rp0.00
Rp2,100,000.00
Rp0.00
Rp2,100,000.00
Rp0.00
BUR.I.68
ProstatektomiTerbuka
-Rp
0.00Rp
2,700,000.00Rp
0.00Rp
2,700,000.00Rp
0.00BU
R.I.69Prostatektom
iRetropublik-
Rp0.00
Rp3,000,000.00
Rp0.00
Rp3,000,000.00
Rp0.00
BUR.I.7
InsersiDJ
Stent-
Rp0.00
Rp3,400,000.00
Rp0.00
Rp3,400,000.00
Rp0.00
BUR.I.70
Prostatektomiradikal
-Rp
0.00Rp
5,800,000.00Rp
0.00Rp
5,800,000.00Rp
0.00BU
R.I.71TU
RProstat,TU
IP,BNI
-Rp
0.00Rp
3,700,000.00Rp
0.00Rp
3,700,000.00Rp
0.00BU
R.I.72TVP,TM
P-
Rp0.00
Rp2,800,000.00
Rp0.00
Rp2,800,000.00
Rp0.00
BUR.I.73
LaparoskopikR
adikalProstatektomi
-Rp
0.00Rp
6,600,000.00Rp
0.00Rp
6,600,000.00Rp
0.00BU
R.I.74BiopsiPenis
-Rp
0.00Rp
2,100,000.00Rp
0.00Rp
2,100,000.00Rp
0.00BU
R.I.75BiopsiTestis
-Rp
0.00Rp
2,100,000.00Rp
0.00Rp
2,100,000.00Rp
0.00BU
R.I.76D
iseksiKelenjarG
etahBening
-Rp
0.00Rp
3,000,000.00Rp
0.00Rp
3,000,000.00Rp
0.00BU
R.I.77Sirkum
sisi,Dorsum
sisi-
Rp0.00
Rp1,100,000.00
Rp0.00
Rp1,100,000.00
Rp0.00
52Page
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KodeN
AMA
PERAWATAN
/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BUR.I.78
EksisiChordae,Chordektomi
-Rp
0.00Rp
3,000,000.00Rp
0.00Rp
3,000,000.00Rp
0.00BU
R.I.79EksisiPlaque
(PeyronieD
isease)-
Rp0.00
Rp2,800,000.00
Rp0.00
Rp2,800,000.00
Rp0.00
BUR.I.8
Reim
plantasiureterunilateral,U
reteroneosistostomi
-Rp
0.00Rp
3,600,000.00Rp
0.00Rp
3,600,000.00Rp
0.00BU
R.I.80EksplorasiTestis
(Microsurgery)
-Rp
0.00Rp
3,900,000.00Rp
0.00Rp
3,900,000.00Rp
0.00BU
R.I.81EksisiFibrom
a,RekonstruksiPenis
-Rp
0.00Rp
3,000,000.00Rp
0.00Rp
3,000,000.00Rp
0.00BU
R.I.82Funikokelektom
i-
Rp0.00
Rp2,900,000.00
Rp0.00
Rp2,900,000.00
Rp0.00
BUR.I.83
Hidrokelper
skrotal-
Rp0.00
Rp2,900,000.00
Rp0.00
Rp2,900,000.00
Rp0.00
BUR.I.84
Hidrokelper
ingunial,Ligasitinggi-
Rp0.00
Rp3,600,000.00
Rp0.00
Rp3,600,000.00
Rp0.00
BUR.I.85
InsisiAbsesPerineum
-Rp
0.00Rp
2,100,000.00Rp
0.00Rp
2,100,000.00Rp
0.00BU
R.I.86O
perasiPriapismus
(ProsedurW
inter)-
Rp0.00
Rp3,300,000.00
Rp0.00
Rp3,300,000.00
Rp0.00
BUR.I.87
KoreksiPriapismus
-Rp
0.00Rp
3,000,000.00Rp
0.00Rp
3,000,000.00Rp
0.00BU
R.I.88Ligasiv.Sperm
atikaInterna
(Microsurgery)
-Rp
0.00Rp
2,900,000.00Rp
0.00Rp
2,900,000.00Rp
0.00BU
R.I.89Lim
fadenektomiilioinguinal
-Rp
0.00Rp
3,000,000.00Rp
0.00Rp
3,000,000.00Rp
0.00BU
R.I.9R
eimplantasiureter
bilateral-
Rp0.00
Rp4,000,000.00
Rp0.00
Rp4,000,000.00
Rp0.00
BUR.I.90
Orkhidektom
i-
Rp0.00
Rp2,800,000.00
Rp0.00
Rp2,800,000.00
Rp0.00
BUR.I.91
Orkhidektom
iExtended-
Rp0.00
Rp2,800,000.00
Rp0.00
Rp2,800,000.00
Rp0.00
BUR.I.92
Orkhidektom
iLigasiTinggi-
Rp0.00
Rp2,900,000.00
Rp0.00
Rp2,900,000.00
Rp0.00
BUR.I.93
Orkhidektom
iSubkapsuler-
Rp0.00
Rp2,800,000.00
Rp0.00
Rp2,800,000.00
Rp0.00
BUR.I.94
Orkhidopeksi(Torsio
Testis)-
Rp0.00
Rp3,200,000.00
Rp0.00
Rp3,200,000.00
Rp0.00
BUR.I.95
Orkhidopeksi(U
DT)
-Rp
0.00Rp
3,600,000.00Rp
0.00Rp
3,600,000.00Rp
0.00BU
R.I.96O
rkhidopeksiperlaparaskopi
-Rp
0.00Rp
4,500,000.00Rp
0.00Rp
4,500,000.00Rp
0.00BU
R.I.97Penektom
iParsial-
Rp0.00
Rp2,900,000.00
Rp0.00
Rp2,900,000.00
Rp0.00
BUR.I.98
Penektomitotal,am
putasipenis-
Rp0.00
Rp3,000,000.00
Rp0.00
Rp3,000,000.00
Rp0.00
BUR.I.99
Reparasipenis
-Rp
0.00Rp
3,000,000.00Rp
0.00Rp
3,000,000.00Rp
0.00BU
R.II.1BiopsiG
injalTerbuka-
Rp0.00
Rp3,060,000.00
Rp0.00
Rp3,060,000.00
Rp0.00
BUR.II.10
RPG,U
RS
diagnostik-
Rp0.00
Rp2,975,000.00
Rp0.00
Rp2,975,000.00
Rp0.00
BUR.II.100
Skrotoplasti-
Rp0.00
Rp2,550,000.00
Rp0.00
Rp2,550,000.00
Rp0.00
BUR.II.101
Spermatokelektom
i-
Rp0.00
Rp2,465,000.00
Rp0.00
Rp2,465,000.00
Rp0.00
BUR.II.102
Varikokelektomi(Palom
o)-
Rp0.00
Rp1,870,000.00
Rp0.00
Rp1,870,000.00
Rp0.00
BUR.II.103
Vasektomi(anastesilokal)
-Rp
0.00Rp
1,870,000.00Rp
0.00Rp
1,870,000.00Rp
0.00BU
R.II.104Vasektom
i(narkose)-
Rp0.00
Rp2,380,000.00
Rp0.00
Rp2,380,000.00
Rp0.00
BUR.II.105
Vasoepididimostom
i-
Rp0.00
Rp3,485,000.00
Rp0.00
Rp3,485,000.00
Rp0.00
BUR.II.106
Vasografi-
Rp0.00
Rp1,785,000.00
Rp0.00
Rp1,785,000.00
Rp0.00
BUR.II.107
EksisiWebbed
Penis-
Rp0.00
Rp2,890,000.00
Rp0.00
Rp2,890,000.00
Rp0.00
BUR.II.108
BurriedPenis
-Rp
0.00Rp
2,465,000.00Rp
0.00Rp
2,465,000.00Rp
0.00BU
R.II.109D
iseksiKelenjarG
etahBening
Pelvis-
Rp0.00
Rp2,975,000.00
Rp0.00
Rp2,975,000.00
Rp0.00
BUR.II.11
TailoringU
reter-
Rp0.00
Rp3,230,000.00
Rp0.00
Rp3,230,000.00
Rp0.00
BUR.II.110
DiseksiKelenjar
Getah
Beningper
laparaskopi-
Rp0.00
Rp3,825,000.00
Rp0.00
Rp3,825,000.00
Rp0.00
BUR.II.111
ESWL
-Rp
0.00Rp
2,040,000.00Rp
0.00Rp
2,040,000.00Rp
0.00BU
R.II.112H
olmium
YaGlaser
-Rp
0.00Rp
3,315,000.00Rp
0.00Rp
3,315,000.00Rp
0.00BU
R.II.113Kauterisasi
-Rp
0.00Rp
1,700,000.00Rp
0.00Rp
1,700,000.00Rp
0.00BU
R.II.114Laparotom
iEksplorasi-
Rp0.00
Rp3,060,000.00
Rp0.00
Rp3,060,000.00
Rp0.00
BUR.II.115
Limfadenektom
iRetroperitoneal,R
PLND
-Rp
0.00Rp
3,060,000.00Rp
0.00Rp
3,060,000.00Rp
0.00BU
R.II.116M
MK,sling
uretra-
Rp0.00
Rp2,465,000.00
Rp0.00
Rp2,465,000.00
Rp0.00
BUR.II.117
OperasiSistokel
-Rp
0.00Rp
2,550,000.00Rp
0.00Rp
2,550,000.00Rp
0.00BU
R.II.118O
perasiUrakhus,R
eseksiUrakhus
-Rp
0.00Rp
2,550,000.00Rp
0.00Rp
2,550,000.00Rp
0.00
52Page
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KodeN
AMA
PERAWATAN
/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BUR.II.119
PasangKateter
Tenckhoffuntuk
CAPD-
Rp0.00
Rp1,955,000.00
Rp0.00
Rp1,955,000.00
Rp0.00
BUR.II.12
Transuretero-uterostomi
-Rp
0.00Rp
3,230,000.00Rp
0.00Rp
3,230,000.00Rp
0.00BU
R.II.120Cabut
KateterTenckhoff
untukCAPD
-Rp
0.00Rp
1,870,000.00Rp
0.00Rp
1,870,000.00Rp
0.00BU
R.II.121Punksidan
sklerosingkista
ginjal-
Rp0.00
Rp1,870,000.00
Rp0.00
Rp1,870,000.00
Rp0.00
BUR.II.122
Tindakanpem
bedahantestis
untukpengam
bilansperm
atozoa(TESA,TESE,PESA,M
ESA)-
Rp0.00
Rp3,145,000.00
Rp0.00
Rp3,145,000.00
Rp0.00
BUR.II.123
Konsultasi,Visite-
Rp0.00
Rp425,000.00
Rp0.00
Rp425,000.00
Rp0.00
BUR.II.13
Ureterolithotom
iproksimal
-Rp
0.00Rp
2,975,000.00Rp
0.00Rp
2,975,000.00Rp
0.00BU
R.II.14U
reterolithotomidistal
-Rp
0.00Rp
3,230,000.00Rp
0.00Rp
3,230,000.00Rp
0.00BU
R.II.15U
retorolisis-
Rp0.00
Rp2,975,000.00
Rp0.00
Rp2,975,000.00
Rp0.00
BUR.II.16
Ureterostom
i-
Rp0.00
Rp3,060,000.00
Rp0.00
Rp3,060,000.00
Rp0.00
BUR.II.17
Ureterouretostom
i-
Rp0.00
Rp3,230,000.00
Rp0.00
Rp3,230,000.00
Rp0.00
BUR.II.18
UR
S,Lithotripsi-
Rp0.00
Rp3,230,000.00
Rp0.00
Rp3,230,000.00
Rp0.00
BUR.II.19
Ureterolitotom
iproksimalper
laparoskopik-
Rp0.00
Rp3,825,000.00
Rp0.00
Rp3,825,000.00
Rp0.00
BUR.II.2
Nefrektom
i-
Rp0.00
Rp3,230,000.00
Rp0.00
Rp3,230,000.00
Rp0.00
BUR.II.20
AugmentasiBuli
-Rp
0.00Rp
6,460,000.00Rp
0.00Rp
6,460,000.00Rp
0.00BU
R.II.21Bladder
neckR
ekonstruksi-
Rp0.00
Rp4,165,000.00
Rp0.00
Rp4,165,000.00
Rp0.00
BUR.II.22
Divertikulektom
ibuli-
Rp0.00
Rp2,720,000.00
Rp0.00
Rp2,720,000.00
Rp0.00
BUR.II.23
Divertikulektom
ibuliperlaparoskopi
-Rp
0.00Rp
4,165,000.00Rp
0.00Rp
4,165,000.00Rp
0.00BU
R.II.24Ekstrofibulirekonstruksi
-Rp
0.00Rp
6,460,000.00Rp
0.00Rp
6,460,000.00Rp
0.00BU
R.II.25Evakuasibekuan
darah(Clot)
-Rp
0.00Rp
2,975,000.00Rp
0.00Rp
2,975,000.00Rp
0.00BU
R.II.26Litholapaksi
-Rp
0.00Rp
3,060,000.00Rp
0.00Rp
3,060,000.00Rp
0.00BU
R.II.27Lithotripsi
-Rp
0.00Rp
3,060,000.00Rp
0.00Rp
3,060,000.00Rp
0.00BU
R.II.28N
eobladder-
Rp0.00
Rp6,460,000.00
Rp0.00
Rp6,460,000.00
Rp0.00
BUR.II.29
PsoasH
itch,BoariFlap-
Rp0.00
Rp3,230,000.00
Rp0.00
Rp3,230,000.00
Rp0.00
BUR.II.3
Anastomosis
endto
endureter
-Rp
0.00Rp
3,060,000.00Rp
0.00Rp
3,060,000.00Rp
0.00BU
R.II.30R
epairFistelEnterovesika
-Rp
0.00Rp
6,460,000.00Rp
0.00Rp
6,460,000.00Rp
0.00BU
R.II.31R
epairFistelVesikokutan
-Rp
0.00Rp
3,230,000.00Rp
0.00Rp
3,230,000.00Rp
0.00BU
R.II.32R
apairFistelVesikorektal
-Rp
0.00Rp
6,460,000.00Rp
0.00Rp
6,460,000.00Rp
0.00BU
R.II.33R
epairFistelVesikovagina
-Rp
0.00Rp
3,230,000.00Rp
0.00Rp
3,230,000.00Rp
0.00BU
R.II.34R
epairFistelVesikovagina
kompleks
-Rp
0.00Rp
4,165,000.00Rp
0.00Rp
4,165,000.00Rp
0.00BU
R.II.35Sectio
Alta,Vesikolithoyomi
-Rp
0.00Rp
2,550,000.00Rp
0.00Rp
2,550,000.00Rp
0.00BU
R.II.36SistokopiO
DS
-Rp
0.00Rp
2,380,000.00Rp
0.00Rp
2,380,000.00Rp
0.00BU
R.II.37Sistokopi
-Rp
0.00Rp
1,870,000.00Rp
0.00Rp
1,870,000.00Rp
0.00BU
R.II.38Sistostom
iperkutan-
Rp0.00
Rp1,870,000.00
Rp0.00
Rp1,870,000.00
Rp0.00
BUR.II.39
Sistostomiterbuka
-Rp
0.00Rp
2,465,000.00Rp
0.00Rp
2,465,000.00Rp
0.00BU
R.II.4Cabut
DJ
Stent-
Rp0.00
Rp1,785,000.00
Rp0.00
Rp1,785,000.00
Rp0.00
BUR.II.40
Sistektomitotal,radikal
-Rp
0.00Rp
4,930,000.00Rp
0.00Rp
4,930,000.00Rp
0.00BU
R.II.41Sistektom
iparsial,sistoplastireduksi-
Rp0.00
Rp3,230,000.00
Rp0.00
Rp3,230,000.00
Rp0.00
BUR.II.42
Sistektomiper
laparaskopi-
Rp0.00
Rp4,165,000.00
Rp0.00
Rp4,165,000.00
Rp0.00
BUR.II.43
TUR
Tumor
Buli-
Rp0.00
Rp3,145,000.00
Rp0.00
Rp3,145,000.00
Rp0.00
BUR.II.44
OperasiRepair
BULI
Trauma
-Rp
0.00Rp
2,550,000.00Rp
0.00Rp
2,550,000.00Rp
0.00BU
R.II.45Businasi,D
ilatasiUretra
-Rp
0.00Rp
1,785,000.00Rp
0.00Rp
1,785,000.00Rp
0.00BU
R.II.46D
ivertikulumuretra
-Rp
0.00Rp
2,040,000.00Rp
0.00Rp
2,040,000.00Rp
0.00BU
R.II.47Epispadia
-Rp
0.00Rp
5,780,000.00Rp
0.00Rp
5,780,000.00Rp
0.00BU
R.II.48Fistulektom
i,Repair
FistelUretra
-Rp
0.00Rp
2,040,000.00Rp
0.00Rp
2,040,000.00Rp
0.00
52Page
8of
3/23/158:08
AM
-
KodeN
AMA
PERAWATAN
/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BUR.II.49
UretroplastriH
ipospadia-
Rp0.00
Rp2,210,000.00
Rp0.00
Rp2,210,000.00
Rp0.00
BUR.II.5
Drainase
Periureter-
Rp0.00
Rp1,870,000.00
Rp0.00
Rp1,870,000.00
Rp0.00
BUR.II.50
Hispospadia
Subkoronal-
Rp0.00
Rp3,230,000.00
Rp0.00
Rp3,230,000.00
Rp0.00
BUR.II.51
InsisiPosteriorU
rethralValve-
Rp0.00
Rp2,890,000.00
Rp0.00
Rp2,890,000.00
Rp0.00
BUR.II.52
Uretrotom
iInterna(Sachse)
-Rp
0.00Rp
2,380,000.00Rp
0.00Rp
2,380,000.00Rp
0.00BU
R.II.53Johanson
I-
Rp0.00
Rp2,465,000.00
Rp0.00
Rp2,465,000.00
Rp0.00
BUR.II.54
JohansonII
-Rp
0.00Rp
2,720,000.00Rp
0.00Rp
2,720,000.00Rp
0.00BU
R.II.55KalibrasiU
retra-
Rp0.00
Rp1,785,000.00
Rp0.00
Rp1,785,000.00
Rp0.00
BUR.II.56
Meatotom
i-
Rp0.00
Rp1,785,000.00
Rp0.00
Rp1,785,000.00
Rp0.00
BUR.II.57
Meatoplasti
-Rp
0.00Rp
1,870,000.00Rp
0.00Rp
1,870,000.00Rp
0.00BU
R.II.58Pasang
Kateter-
Rp0.00
Rp1,785,000.00
Rp0.00
Rp1,785,000.00
Rp0.00
BUR.II.59
PasangKateter
denganM
andrain-
Rp0.00
Rp1,785,000.00
Rp0.00
Rp1,785,000.00
Rp0.00
BUR.II.6
EkstraksiBatu-
Rp0.00
Rp2,380,000.00
Rp0.00
Rp2,380,000.00
Rp0.00
BUR.II.60
Railroading
Ruptur
Uretra
-Rp
0.00Rp
3,060,000.00Rp
0.00Rp
3,060,000.00Rp
0.00BU
R.II.61PER
(Primary
EndoscopicRealignm
ent)-
Rp0.00
Rp2,975,000.00
Rp0.00
Rp2,975,000.00
Rp0.00
BUR.II.62
Reseksi-Anastom
osisU
retra-
Rp0.00
Rp3,060,000.00
Rp0.00
Rp3,060,000.00
Rp0.00
BUR.II.63
Uretroskopi,U
retrosistoskopi-
Rp0.00
Rp1,785,000.00
Rp0.00
Rp1,785,000.00
Rp0.00
BUR.II.64
UretroplastiBukalG
raf-
Rp0.00
Rp3,400,000.00
Rp0.00
Rp3,400,000.00
Rp0.00
BUR.II.65
Uretrotom
iEksterna-
Rp0.00
Rp1,955,000.00
Rp0.00
Rp1,955,000.00
Rp0.00
BUR.II.66
BiopsiProstrat-
Rp0.00
Rp1,785,000.00
Rp0.00
Rp1,785,000.00
Rp0.00
BUR.II.67
Masasae
Prostrat-
Rp0.00
Rp1,785,000.00
Rp0.00
Rp1,785,000.00
Rp0.00
BUR.II.68
ProstatektomiTerbuka
-Rp
0.00Rp
2,295,000.00Rp
0.00Rp
2,295,000.00Rp
0.00BU
R.II.69Prostatektom
iRetropublik-
Rp0.00
Rp2,550,000.00
Rp0.00
Rp2,550,000.00
Rp0.00
BUR.II.7
InsersiDJ
Stent-
Rp0.00
Rp2,890,000.00
Rp0.00
Rp2,890,000.00
Rp0.00
BUR.II.70
Prostatektomiradikal
-Rp
0.00Rp
4,930,000.00Rp
0.00Rp
4,930,000.00Rp
0.00BU
R.II.71TU
RProstat,TU
IP,BNI
-Rp
0.00Rp
3,145,000.00Rp
0.00Rp
3,145,000.00Rp
0.00BU
R.II.72TVP,TM
P-
Rp0.00
Rp2,380,000.00
Rp0.00
Rp2,380,000.00
Rp0.00
BUR.II.73
LaparoskopikR
adikalProstatektomi
-Rp
0.00Rp
5,610,000.00Rp
0.00Rp
5,610,000.00Rp
0.00BU
R.II.74BiopsiPenis
-Rp
0.00Rp
1,785,000.00Rp
0.00Rp
1,785,000.00Rp
0.00BU
R.II.75BiopsiTestis
-Rp
0.00Rp
1,785,000.00Rp
0.00Rp
1,785,000.00Rp
0.00BU
R.II.76D
iseksiKelenjarG
etahBening
-Rp
0.00Rp
2,550,000.00Rp
0.00Rp
2,550,000.00Rp
0.00BU
R.II.77Sirkum
sisi,Dorsum
sisi-
Rp0.00
Rp935,000.00
Rp0.00
Rp935,000.00
Rp0.00
BUR.II.78
EksisiChordae,Chordektomi
-Rp
0.00Rp
2,550,000.00Rp
0.00Rp
2,550,000.00Rp
0.00BU
R.II.79EksisiPlaque
(PeyronieD
isease)-
Rp0.00
Rp2,380,000.00
Rp0.00
Rp2,380,000.00
Rp0.00
BUR.II.8
Reim
plantasiureterunilateral,U
reteroneosistostomi
-Rp
0.00Rp
3,060,000.00Rp
0.00Rp
3,060,000.00Rp
0.00BU
R.II.80EksplorasiTestis
(Microsurgery)
-Rp
0.00Rp
3,315,000.00Rp
0.00Rp
3,315,000.00Rp
0.00BU
R.II.81EksisiFibrom
a,RekonstruksiPenis
-Rp
0.00Rp
2,550,000.00Rp
0.00Rp
2,550,000.00Rp
0.00BU
R.II.82Funikokelektom
i-
Rp0.00
Rp2,465,000.00
Rp0.00
Rp2,465,000.00
Rp0.00
BUR.II.83
Hidrokelper
skrotal-
Rp0.00
Rp2,465,000.00
Rp0.00
Rp2,465,000.00
Rp0.00
BUR.II.84
Hidrokelper
ingunial,Ligasitinggi-
Rp0.00
Rp3,060,000.00
Rp0.00
Rp3,060,000.00
Rp0.00
BUR.II.85
InsisiAbsesPerineum
-Rp
0.00Rp
1,785,000.00Rp
0.00Rp
1,785,000.00Rp
0.00BU
R.II.86O
perasiPriapismus
(ProsedurW
inter)-
Rp0.00
Rp2,805,000.00
Rp0.00
Rp2,805,000.00
Rp0.00
BUR.II.87
KoreksiPriapismus
-Rp
0.00Rp
2,550,000.00Rp
0.00Rp
2,550,000.00Rp
0.00BU
R.II.88Ligasiv.Sperm
atikaInterna
(Microsurgery)
-Rp
0.00Rp
2,465,000.00Rp
0.00Rp
2,465,000.00Rp
0.00BU
R.II.89Lim
fadenektomiilioinguinal
-Rp
0.00Rp
2,550,000.00Rp
0.00Rp
2,550,000.00Rp
0.00BU
R.II.9R
eimplantasiureter
bilateral-
Rp0.00
Rp3,400,000.00
Rp0.00
Rp3,400,000.00
Rp0.00
52Page
9of
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AM
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KodeN
AMA
PERAWATAN
/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BUR.II.90
Orkhidektom
i-
Rp0.00
Rp2,380,000.00
Rp0.00
Rp2,380,000.00
Rp0.00
BUR.II.91
Orkhidektom
iExtended-
Rp0.00
Rp2,380,000.00
Rp0.00
Rp2,380,000.00
Rp0.00
BUR.II.92
Orkhidektom
iLigasiTinggi-
Rp0.00
Rp2,465,000.00
Rp0.00
Rp2,465,000.00
Rp0.00
BUR.II.93
Orkhidektom
iSubkapsuler-
Rp0.00
Rp2,380,000.00
Rp0.00
Rp2,380,000.00
Rp0.00
BUR.II.94
Orkhidopeksi(Torsio
Testis)-
Rp0.00
Rp2,720,000.00
Rp0.00
Rp2,720,000.00
Rp0.00
BUR.II.95
Orkhidopeksi(U
DT)
-Rp
0.00Rp
3,060,000.00Rp
0.00Rp
3,060,000.00Rp
0.00BU
R.II.96O
rkhidopeksiperlaparaskopi
-Rp
0.00Rp
3,825,000.00Rp
0.00Rp
3,825,000.00Rp
0.00BU
R.II.97Penektom
iParsial-
Rp0.00
Rp2,465,000.00
Rp0.00
Rp2,465,000.00
Rp0.00
BUR.II.98
Penektomitotal,am
putasipenis-
Rp0.00
Rp2,550,000.00
Rp0.00
Rp2,550,000.00
Rp0.00
BUR.II.99
Reparasipenis
-Rp
0.00Rp
2,550,000.00Rp
0.00Rp
2,550,000.00Rp
0.00BU
R.III.1BiopsiG
injalTerbuka-
Rp0.00
Rp2,601,000.00
Rp0.00
Rp2,601,000.00
Rp0.00
BUR.III.10
RPG,U
RS
diagnostik-
Rp0.00
Rp2,528,750.00
Rp0.00
Rp2,528,750.00
Rp0.00
BUR.III.100
Skrotoplasti-
Rp0.00
Rp2,167,500.00
Rp0.00
Rp2,167,500.00
Rp0.00
BUR.III.101
Spermatokelektom
i-
Rp0.00
Rp2,095,250.00
Rp0.00
Rp2,095,250.00
Rp0.00
BUR.III.102
Varikokelektomi(Palom
o)-
Rp0.00
Rp1,589,500.00
Rp0.00
Rp1,589,500.00
Rp0.00
BUR.III.103
Vasektomi(anastesilokal)
-Rp
0.00Rp
1,589,500.00Rp
0.00Rp
1,589,500.00Rp
0.00BU
R.III.104Vasektom
i(narkose)-
Rp0.00
Rp2,023,000.00
Rp0.00
Rp2,023,000.00
Rp0.00
BUR.III.105
Vasoepididimostom
i-
Rp0.00
Rp2,962,250.00
Rp0.00
Rp2,962,250.00
Rp0.00
BUR.III.106
Vasografi-
Rp0.00
Rp1,517,250.00
Rp0.00
Rp1,517,250.00
Rp0.00
BUR.III.107
EksisiWebbed
Penis-
Rp0.00
Rp2,456,500.00
Rp0.00
Rp2,456,500.00
Rp0.00
BUR.III.108
BurriedPenis
-Rp
0.00Rp
2,095,250.00Rp
0.00Rp
2,095,250.00Rp
0.00BU
R.III.109D
iseksiKelenjarG
etahBening
Pelvis-
Rp0.00
Rp2,528,750.00
Rp0.00
Rp2,528,750.00
Rp0.00
BUR.III.11
TailoringU
reter-
Rp0.00
Rp2,745,500.00
Rp0.00
Rp2,745,500.00
Rp0.00
BUR.III.110
DiseksiKelenjar
Getah
Beningper
laparaskopi-
Rp0.00
Rp3,251,250.00
Rp0.00
Rp3,251,250.00
Rp0.00
BUR.III.111
ESWL
-Rp
0.00Rp
1,734,000.00Rp
0.00Rp
1,734,000.00Rp
0.00BU
R.III.112H
olmium
YaGlaser
-Rp
0.00Rp
2,817,750.00Rp
0.00Rp
2,817,750.00Rp
0.00BU
R.III.113Kauterisasi
-Rp
0.00Rp
1,445,000.00Rp
0.00Rp
1,445,000.00Rp
0.00BU
R.III.114Laparotom
iEksplorasi-
Rp0.00
Rp2,601,000.00
Rp0.00
Rp2,601,000.00
Rp0.00
BUR.III.115
Limfadenektom
iRetroperitoneal,R
PLND
-Rp
0.00Rp
2,601,000.00Rp
0.00Rp
2,601,000.00Rp
0.00BU
R.III.116M
MK,sling
uretra-
Rp0.00
Rp2,095,250.00
Rp0.00
Rp2,095,250.00
Rp0.00
BUR.III.117
OperasiSistokel
-Rp
0.00Rp
2,167,500.00Rp
0.00Rp
2,167,500.00Rp
0.00BU
R.III.118O
perasiUrakhus,R
eseksiUrakhus
-Rp
0.00Rp
2,167,500.00Rp
0.00Rp
2,167,500.00Rp
0.00BU
R.III.119Pasang
KateterTenckhoff
untukCAPD
-Rp
0.00Rp
1,661,750.00Rp
0.00Rp
1,661,750.00Rp
0.00BU
R.III.12Transuretero-uterostom
i-
Rp0.00
Rp2,745,500.00
Rp0.00
Rp2,745,500.00
Rp0.00
BUR.III.120
CabutKateter
Tenckhoffuntuk
CAPD-
Rp0.00
Rp1,589,500.00
Rp0.00
Rp1,589,500.00
Rp0.00
BUR.III.121
Punksidansklerosing
kistaginjal
-Rp
0.00Rp
1,589,500.00Rp
0.00Rp
1,589,500.00Rp
0.00BU
R.III.122Tindakan
pembedahan
testisuntuk
pengambilan
spermatozoa
(TESA,TESE,PESA,MESA)
-Rp
0.00Rp
2,673,250.00Rp
0.00Rp
2,673,250.00Rp
0.00
BUR.III.123
Konsultasi,Visite-
Rp0.00
Rp361,250.00
Rp0.00
Rp361,250.00
Rp0.00
BUR.III.13
Ureterolithotom
iproksimal
-Rp
0.00Rp
2,528,750.00Rp
0.00Rp
2,528,750.00Rp
0.00BU
R.III.14U
reterolithotomidistal
-Rp
0.00Rp
2,745,500.00Rp
0.00Rp
2,745,500.00Rp
0.00BU
R.III.15U
retorolisis-
Rp0.00
Rp2,528,750.00
Rp0.00
Rp2,528,750.00
Rp0.00
BUR.III.16
Ureterostom
i-
Rp0.00
Rp2,601,000.00
Rp0.00
Rp2,601,000.00
Rp0.00
BUR.III.17
Ureterouretostom
i-
Rp0.00
Rp2,745,500.00
Rp0.00
Rp2,745,500.00
Rp0.00
BUR.III.18
UR
S,Lithotripsi-
Rp0.00
Rp2,745,500.00
Rp0.00
Rp2,745,500.00
Rp0.00
BUR.III.19
Ureterolitotom
iproksimalper
laparoskopik-
Rp0.00
Rp3,251,250.00
Rp0.00
Rp3,251,250.00
Rp0.00
52Page
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KodeN
AMA
PERAWATAN
/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BUR.III.2
Nefrektom
i-
Rp0.00
Rp2,745,500.00
Rp0.00
Rp2,745,500.00
Rp0.00
BUR.III.20
AugmentasiBuli
-Rp
0.00Rp
5,491,000.00Rp
0.00Rp
5,491,000.00Rp
0.00BU
R.III.21Bladder
neckR
ekonstruksi-
Rp0.00
Rp3,540,250.00
Rp0.00
Rp3,540,250.00
Rp0.00
BUR.III.22
Divertikulektom
ibuli-
Rp0.00
Rp2,312,000.00
Rp0.00
Rp2,312,000.00
Rp0.00
BUR.III.23
Divertikulektom
ibuliperlaparoskopi
-Rp
0.00Rp
3,540,250.00Rp
0.00Rp
3,540,250.00Rp
0.00BU
R.III.24Ekstrofibulirekonstruksi
-Rp
0.00Rp
5,491,000.00Rp
0.00Rp
5,491,000.00Rp
0.00BU
R.III.25Evakuasibekuan
darah(Clot)
-Rp
0.00Rp
2,528,750.00Rp
0.00Rp
2,528,750.00Rp
0.00BU
R.III.26Litholapaksi
-Rp
0.00Rp
2,601,000.00Rp
0.00Rp
2,601,000.00Rp
0.00BU
R.III.27Lithotripsi
-Rp
0.00Rp
2,601,000.00Rp
0.00Rp
2,601,000.00Rp
0.00BU
R.III.28N
eobladder-
Rp0.00
Rp5,491,000.00
Rp0.00
Rp5,491,000.00
Rp0.00
BUR.III.29
PsoasH
itch,BoariFlap-
Rp0.00
Rp2,745,500.00
Rp0.00
Rp2,745,500.00
Rp0.00
BUR.III.3
Anastomosis
endto
endureter
-Rp
0.00Rp
2,601,000.00Rp
0.00Rp
2,601,000.00Rp
0.00BU
R.III.30R
epairFistelEnterovesika
-Rp
0.00Rp
5,491,000.00Rp
0.00Rp
5,491,000.00Rp
0.00BU
R.III.31R
epairFistelVesikokutan
-Rp
0.00Rp
2,745,500.00Rp
0.00Rp
2,745,500.00Rp
0.00BU
R.III.32R
apairFistelVesikorektal
-Rp
0.00Rp
5,491,000.00Rp
0.00Rp
5,491,000.00Rp
0.00BU
R.III.33R
epairFistelVesikovagina
-Rp
0.00Rp
2,745,500.00Rp
0.00Rp
2,745,500.00Rp
0.00BU
R.III.34R
epairFistelVesikovagina
kompleks
-Rp
0.00Rp
3,540,250.00Rp
0.00Rp
3,540,250.00Rp
0.00BU
R.III.35Sectio
Alta,Vesikolithoyomi
-Rp
0.00Rp
2,167,500.00Rp
0.00Rp
2,167,500.00Rp
0.00BU
R.III.36SistokopiO
DS
-Rp
0.00Rp
2,023,000.00Rp
0.00Rp
2,023,000.00Rp
0.00BU
R.III.37Sistokopi
-Rp
0.00Rp
1,589,500.00Rp
0.00Rp
1,589,500.00Rp
0.00BU
R.III.38Sistostom
iperkutan-
Rp0.00
Rp1,589,500.00
Rp0.00
Rp1,589,500.00
Rp0.00
BUR.III.39
Sistostomiterbuka
-Rp
0.00Rp
2,095,250.00Rp
0.00Rp
2,095,250.00Rp
0.00BU
R.III.4Cabut
DJ
Stent-
Rp0.00
Rp1,517,250.00
Rp0.00
Rp1,517,250.00
Rp0.00
BUR.III.40
Sistektomitotal,radikal
-Rp
0.00Rp
4,190,500.00Rp
0.00Rp
4,190,500.00Rp
0.00BU
R.III.41Sistektom
iparsial,sistoplastireduksi-
Rp0.00
Rp2,745,500.00
Rp0.00
Rp2,745,500.00
Rp0.00
BUR.III.42
Sistektomiper
laparaskopi-
Rp0.00
Rp3,540,250.00
Rp0.00
Rp3,540,250.00
Rp0.00
BUR.III.43
TUR
Tumor
Buli-
Rp0.00
Rp2,673,250.00
Rp0.00
Rp2,673,250.00
Rp0.00
BUR.III.44
OperasiRepair
BULI
Trauma
-Rp
0.00Rp
2,167,500.00Rp
0.00Rp
2,167,500.00Rp
0.00BU
R.III.45Businasi,D
ilatasiUretra
-Rp
0.00Rp
1,517,250.00Rp
0.00Rp
1,517,250.00Rp
0.00BU
R.III.46D
ivertikulumuretra
-Rp
0.00Rp
1,734,000.00Rp
0.00Rp
1,734,000.00Rp
0.00BU
R.III.47Epispadia
-Rp
0.00Rp
4,913,000.00Rp
0.00Rp
4,913,000.00Rp
0.00BU
R.III.48Fistulektom
i,Repair
FistelUretra
-Rp
0.00Rp
1,734,000.00Rp
0.00Rp
1,734,000.00Rp
0.00BU
R.III.49U
retroplastriHipospadia
-Rp
0.00Rp
1,878,500.00Rp
0.00Rp
1,878,500.00Rp
0.00BU
R.III.5D
rainasePeriureter
-Rp
0.00Rp
1,589,500.00Rp
0.00Rp
1,589,500.00Rp
0.00BU
R.III.50H
ispospadiaSubkoronal
-Rp
0.00Rp
2,745,500.00Rp
0.00Rp
2,745,500.00Rp
0.00BU
R.III.51InsisiPosterior
UrethralValve
-Rp
0.00Rp
2,456,500.00Rp
0.00Rp
2,456,500.00Rp
0.00BU
R.III.52U
retrotomiInterna
(Sachse)-
Rp0.00
Rp2,023,000.00
Rp0.00
Rp2,023,000.00
Rp0.00
BUR.III.53
JohansonI
-Rp
0.00Rp
2,095,250.00Rp
0.00Rp
2,095,250.00Rp
0.00BU
R.III.54Johanson
II-
Rp0.00
Rp2,312,000.00
Rp0.00
Rp2,312,000.00
Rp0.00
BUR.III.55
KalibrasiUretra
-Rp
0.00Rp
1,517,250.00Rp
0.00Rp
1,517,250.00Rp
0.00BU
R.III.56M
eatotomi
-Rp
0.00Rp
1,517,250.00Rp
0.00Rp
1,517,250.00Rp
0.00BU
R.III.57M
eatoplasti-
Rp0.00
Rp1,589,500.00
Rp0.00
Rp1,589,500.00
Rp0.00
BUR.III.58
PasangKateter
-Rp
0.00Rp
1,517,250.00Rp
0.00Rp
1,517,250.00Rp
0.00BU
R.III.59Pasang
Kateterdengan
Mandrain
-Rp
0.00Rp
1,517,250.00Rp
0.00Rp
1,517,250.00Rp
0.00BU
R.III.6EkstraksiBatu
-Rp
0.00Rp
2,023,000.00Rp
0.00Rp
2,023,000.00Rp
0.00BU
R.III.60R
ailroadingR
upturU
retra-
Rp0.00
Rp2,601,000.00
Rp0.00
Rp2,601,000.00
Rp0.00
52Page
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KodeN
AMA
PERAWATAN
/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BUR.III.61
PER(Prim
aryEndoscopic
Realignment)
-Rp
0.00Rp
2,528,750.00Rp
0.00Rp
2,528,750.00Rp
0.00BU
R.III.62R
eseksi-Anastomosis
Uretra
-Rp
0.00Rp
2,601,000.00Rp
0.00Rp
2,601,000.00Rp
0.00BU
R.III.63U
retroskopi,Uretrosistoskopi
-Rp
0.00Rp
1,517,250.00Rp
0.00Rp
1,517,250.00Rp
0.00BU
R.III.64U
retroplastiBukalGraf
-Rp
0.00Rp
2,890,000.00Rp
0.00Rp
2,890,000.00Rp
0.00BU
R.III.65U
retrotomiEksterna
-Rp
0.00Rp
1,661,750.00Rp
0.00Rp
1,661,750.00Rp
0.00BU
R.III.66BiopsiProstrat
-Rp
0.00Rp
1,517,250.00Rp
0.00Rp
1,517,250.00Rp
0.00BU
R.III.67M
asasaeProstrat
-Rp
0.00Rp
1,517,250.00Rp
0.00Rp
1,517,250.00Rp
0.00BU
R.III.68Prostatektom
iTerbuka-
Rp0.00
Rp1,950,750.00
Rp0.00
Rp1,950,750.00
Rp0.00
BUR.III.69
ProstatektomiRetropublik
-Rp
0.00Rp
2,167,500.00Rp
0.00Rp
2,167,500.00Rp
0.00BU
R.III.7InsersiD
JStent
-Rp
0.00Rp
2,456,500.00Rp
0.00Rp
2,456,500.00Rp
0.00BU
R.III.70Prostatektom
iradikal-
Rp0.00
Rp4,190,500.00
Rp0.00
Rp4,190,500.00
Rp0.00
BUR.III.71
TUR
Prostat,TUIP,BN
I-
Rp0.00
Rp2,673,250.00
Rp0.00
Rp2,673,250.00
Rp0.00
BUR.III.72
TVP,TMP
-Rp
0.00Rp
2,023,000.00Rp
0.00Rp
2,023,000.00Rp
0.00BU
R.III.73Laparoskopik
RadikalProstatektom
i-
Rp0.00
Rp4,768,500.00
Rp0.00
Rp4,768,500.00
Rp0.00
BUR.III.74
BiopsiPenis-
Rp0.00
Rp1,517,250.00
Rp0.00
Rp1,517,250.00
Rp0.00
BUR.III.75
BiopsiTestis-
Rp0.00
Rp1,517,250.00
Rp0.00
Rp1,517,250.00
Rp0.00
BUR.III.76
DiseksiKelenjar
Getah
Bening-
Rp0.00
Rp2,167,500.00
Rp0.00
Rp2,167,500.00
Rp0.00
BUR.III.77
Sirkumsisi,D
orsumsisi
-Rp
0.00Rp
794,750.00Rp
0.00Rp
794,750.00Rp
0.00BU
R.III.78EksisiChordae,Chordektom
i-
Rp0.00
Rp2,167,500.00
Rp0.00
Rp2,167,500.00
Rp0.00
BUR.III.79
EksisiPlaque(Peyronie
Disease)
-Rp
0.00Rp
2,023,000.00Rp
0.00Rp
2,023,000.00Rp
0.00BU
R.III.8R
eimplantasiureter
unilateral,Ureteroneosistostom
i-
Rp0.00
Rp2,601,000.00
Rp0.00
Rp2,601,000.00
Rp0.00
BUR.III.80
EksplorasiTestis(M
icrosurgery)-
Rp0.00
Rp2,817,750.00
Rp0.00
Rp2,817,750.00
Rp0.00
BUR.III.81
EksisiFibroma,R
ekonstruksiPenis-
Rp0.00
Rp2,167,500.00
Rp0.00
Rp2,167,500.00
Rp0.00
BUR.III.82
Funikokelektomi
-Rp
0.00Rp
2,095,250.00Rp
0.00Rp
2,095,250.00Rp
0.00BU
R.III.83H
idrokelperskrotal
-Rp
0.00Rp
2,095,250.00Rp
0.00Rp
2,095,250.00Rp
0.00BU
R.III.84H
idrokelperingunial,Ligasitinggi
-Rp
0.00Rp
2,601,000.00Rp
0.00Rp
2,601,000.00Rp
0.00BU
R.III.85InsisiAbses
Perineum-
Rp0.00
Rp1,517,250.00
Rp0.00
Rp1,517,250.00
Rp0.00
BUR.III.86
OperasiPriapism
us(Prosedur
Winter)
-Rp
0.00Rp
2,384,250.00Rp
0.00Rp
2,384,250.00Rp
0.00BU
R.III.87KoreksiPriapism
us-
Rp0.00
Rp2,167,500.00
Rp0.00
Rp2,167,500.00
Rp0.00
BUR.III.88
Ligasiv.Spermatika
Interna(M
icrosurgery)-
Rp0.00
Rp2,095,250.00
Rp0.00
Rp2,095,250.00
Rp0.00
BUR.III.89
Limfadenektom
iilioinguinal-
Rp0.00
Rp2,167,500.00
Rp0.00
Rp2,167,500.00
Rp0.00
BUR.III.9
Reim
plantasiureterbilateral
-Rp
0.00Rp
2,890,000.00Rp
0.00Rp
2,890,000.00Rp
0.00BU
R.III.90O
rkhidektomi
-Rp
0.00Rp
2,023,000.00Rp
0.00Rp
2,023,000.00Rp
0.00BU
R.III.91O
rkhidektomiExtended
-Rp
0.00Rp
2,023,000.00Rp
0.00Rp
2,023,000.00Rp
0.00BU
R.III.92O
rkhidektomiLigasiTinggi
-Rp
0.00Rp
2,095,250.00Rp
0.00Rp
2,095,250.00Rp
0.00BU
R.III.93O
rkhidektomiSubkapsuler
-Rp
0.00Rp
2,023,000.00Rp
0.00Rp
2,023,000.00Rp
0.00BU
R.III.94O
rkhidopeksi(TorsioTestis)
-Rp
0.00Rp
2,312,000.00Rp
0.00Rp
2,312,000.00Rp
0.00BU
R.III.95O
rkhidopeksi(UD
T)-
Rp0.00
Rp2,601,000.00
Rp0.00
Rp2,601,000.00
Rp0.00
BUR.III.96
Orkhidopeksiper
laparaskopi-
Rp0.00
Rp3,251,250.00
Rp0.00
Rp3,251,250.00
Rp0.00
BUR.III.97
PenektomiParsial
-Rp
0.00Rp
2,095,250.00Rp
0.00Rp
2,095,250.00Rp
0.00BU
R.III.98Penektom
itotal,amputasipenis
-Rp
0.00Rp
2,167,500.00Rp
0.00Rp
2,167,500.00Rp
0.00BU
R.III.99R
eparasipenis-
Rp0.00
Rp2,167,500.00
Rp0.00
Rp2,167,500.00
Rp0.00
BUR
.OD
C.1BiopsiG
injalTerbuka-
Rp0.00
Rp2,210,850.00
Rp0.00
Rp2,210,850.00
Rp0.00
BUR.O
DC.10
RPG,U
RS
diagnostik-
Rp0.00
Rp2,149,437.50
Rp0.00
Rp2,149,437.50
Rp0.00
BUR.O
DC.100
Skrotoplasti-
Rp0.00
Rp1,842,375.00
Rp0.00
Rp1,842,375.00
Rp0.00
BUR.O
DC.101
Spermatokelektom
i-
Rp0.00
Rp1,780,962.50
Rp0.00
Rp1,780,962.50
Rp0.00
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AMA
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/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BUR.O
DC.102
Varikokelektomi(Palom
o)-
Rp0.00
Rp1,351,075.00
Rp0.00
Rp1,351,075.00
Rp0.00
BUR.O
DC.103
Vasektomi(anastesilokal)
-Rp
0.00Rp
1,351,075.00Rp
0.00Rp
1,351,075.00Rp
0.00BU
R.OD
C.104Vasektom
i(narkose)-
Rp0.00
Rp1,719,550.00
Rp0.00
Rp1,719,550.00
Rp0.00
BUR.O
DC.105
Vasoepididimostom
i-
Rp0.00
Rp2,517,912.50
Rp0.00
Rp2,517,912.50
Rp0.00
BUR.O
DC.106
Vasografi-
Rp0.00
Rp1,289,662.50
Rp0.00
Rp1,289,662.50
Rp0.00
BUR.O
DC.107
EksisiWebbed
Penis-
Rp0.00
Rp2,088,025.00
Rp0.00
Rp2,088,025.00
Rp0.00
BUR.O
DC.108
BurriedPenis
-Rp
0.00Rp
1,780,962.50Rp
0.00Rp
1,780,962.50Rp
0.00BU
R.OD
C.109D
iseksiKelenjarG
etahBening
Pelvis-
Rp0.00
Rp2,149,437.50
Rp0.00
Rp2,149,437.50
Rp0.00
BUR.O
DC.11
TailoringU
reter-
Rp0.00
Rp2,333,675.00
Rp0.00
Rp2,333,675.00
Rp0.00
BUR.O
DC.110
DiseksiKelenjar
Getah
Beningper
laparaskopi-
Rp0.00
Rp2,763,562.50
Rp0.00
Rp2,763,562.50
Rp0.00
BUR.O
DC.111
ESWL
-Rp
0.00Rp
1,473,900.00Rp
0.00Rp
1,473,900.00Rp
0.00BU
R.OD
C.112H
olmium
YaGlaser
-Rp
0.00Rp
2,395,087.50Rp
0.00Rp
2,395,087.50Rp
0.00BU
R.OD
C.113Kauterisasi
-Rp
0.00Rp
1,228,250.00Rp
0.00Rp
1,228,250.00Rp
0.00BU
R.OD
C.114Laparotom
iEksplorasi-
Rp0.00
Rp2,210,850.00
Rp0.00
Rp2,210,850.00
Rp0.00
BUR.O
DC.115
Limfadenektom
iRetroperitoneal,R
PLND
-Rp
0.00Rp
2,210,850.00Rp
0.00Rp
2,210,850.00Rp
0.00BU
R.OD
C.116M
MK,sling
uretra-
Rp0.00
Rp1,780,962.50
Rp0.00
Rp1,780,962.50
Rp0.00
BUR.O
DC.117
OperasiSistokel
-Rp
0.00Rp
1,842,375.00Rp
0.00Rp
1,842,375.00Rp
0.00BU
R.OD
C.118O
perasiUrakhus,R
eseksiUrakhus
-Rp
0.00Rp
1,842,375.00Rp
0.00Rp
1,842,375.00Rp
0.00BU
R.OD
C.119Pasang
KateterTenckhoff
untukCAPD
-Rp
0.00Rp
1,412,487.50Rp
0.00Rp
1,412,487.50Rp
0.00BU
R.OD
C.12Transuretero-uterostom
i-
Rp0.00
Rp2,333,675.00
Rp0.00
Rp2,333,675.00
Rp0.00
BUR.O
DC.120
CabutKateter
Tenckhoffuntuk
CAPD-
Rp0.00
Rp1,351,075.00
Rp0.00
Rp1,351,075.00
Rp0.00
BUR.O
DC.121
Punksidansklerosing
kistaginjal
-Rp
0.00Rp
1,351,075.00Rp
0.00Rp
1,351,075.00Rp
0.00BU
R.OD
C.122Tindakan
pembedahan
testisuntuk
pengambilan
spermatozoa
(TESA,TESE,PESA,MESA)
-Rp
0.00Rp
2,272,262.50Rp
0.00Rp
2,272,262.50Rp
0.00
BUR.O
DC.123
Konsultasi,Visite-
Rp0.00
Rp307,062.50
Rp0.00
Rp307,062.50
Rp0.00
BUR.O
DC.13
Ureterolithotom
iproksimal
-Rp
0.00Rp
2,149,437.50Rp
0.00Rp
2,149,437.50Rp
0.00BU
R.OD
C.14U
reterolithotomidistal
-Rp
0.00Rp
2,333,675.00Rp
0.00Rp
2,333,675.00Rp
0.00BU
R.OD
C.15U
retorolisis-
Rp0.00
Rp2,149,437.50
Rp0.00
Rp2,149,437.50
Rp0.00
BUR.O
DC.16
Ureterostom
i-
Rp0.00
Rp2,210,850.00
Rp0.00
Rp2,210,850.00
Rp0.00
BUR.O
DC.17
Ureterouretostom
i-
Rp0.00
Rp2,333,675.00
Rp0.00
Rp2,333,675.00
Rp0.00
BUR.O
DC.18
UR
S,Lithotripsi-
Rp0.00
Rp2,333,675.00
Rp0.00
Rp2,333,675.00
Rp0.00
BUR.O
DC.19
Ureterolitotom
iproksimalper
laparoskopik-
Rp0.00
Rp2,763,562.50
Rp0.00
Rp2,763,562.50
Rp0.00
BUR
.OD
C.2N
efrektomi
-Rp
0.00Rp
2,333,675.00Rp
0.00Rp
2,333,675.00Rp
0.00BU
R.OD
C.20Augm
entasiBuli-
Rp0.00
Rp4,667,350.00
Rp0.00
Rp4,667,350.00
Rp0.00
BUR.O
DC.21
Bladderneck
Rekonstruksi
-Rp
0.00Rp
3,009,212.50Rp
0.00Rp
3,009,212.50Rp
0.00BU
R.OD
C.22D
ivertikulektomibuli
-Rp
0.00Rp
1,965,200.00Rp
0.00Rp
1,965,200.00Rp
0.00BU
R.OD
C.23D
ivertikulektomibuliper
laparoskopi-
Rp0.00
Rp3,009,212.50
Rp0.00
Rp3,009,212.50
Rp0.00
BUR.O
DC.24
Ekstrofibulirekonstruksi-
Rp0.00
Rp4,667,350.00
Rp0.00
Rp4,667,350.00
Rp0.00
BUR.O
DC.25
Evakuasibekuandarah
(Clot)-
Rp0.00
Rp2,149,437.50
Rp0.00
Rp2,149,437.50
Rp0.00
BUR.O
DC.26
Litholapaksi-
Rp0.00
Rp2,210,850.00
Rp0.00
Rp2,210,850.00
Rp0.00
BUR.O
DC.27
Lithotripsi-
Rp0.00
Rp2,210,850.00
Rp0.00
Rp2,210,850.00
Rp0.00
BUR.O
DC.28
Neobladder
-Rp
0.00Rp
4,667,350.00Rp
0.00Rp
4,667,350.00Rp
0.00BU
R.OD
C.29Psoas
Hitch,BoariFlap
-Rp
0.00Rp
2,333,675.00Rp
0.00Rp
2,333,675.00Rp
0.00BU
R.O
DC.3
Anastomosis
endto
endureter
-Rp
0.00Rp
2,210,850.00Rp
0.00Rp
2,210,850.00Rp
0.00BU
R.OD
C.30R
epairFistelEnterovesika
-Rp
0.00Rp
4,667,350.00Rp
0.00Rp
4,667,350.00Rp
0.00BU
R.OD
C.31R
epairFistelVesikokutan
-Rp
0.00Rp
2,333,675.00Rp
0.00Rp
2,333,675.00Rp
0.00
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/TIND
AKAN/TAG
IHAN
KATEGO
RIM
ATERIALTRF.TN
DKAN
DR
TRF.TND
KANPR
TOTAL
BAYARD
RTO
TALBAYAR
PR
BUR.O
DC.32
Rapair
FistelVesikorektal-
Rp0.00
Rp4,667,350.00
Rp0.00
Rp4,667,350.00
Rp0.00
BUR.O
DC.33
Repair
FistelVesikovagina-
Rp0.00
Rp2,333,675.00
Rp0.00
Rp2,333,675.00
Rp0.00
BUR.O
DC.34
Repair
FistelVesikovaginakom
pleks-
Rp0.00
Rp3,009,212.50
Rp0.00
Rp3,009,212.50
Rp0.00
BUR.O
DC.35
SectioAlta,Vesikolithoyom
i-
Rp0.00
Rp1,842,375.00
Rp0.00
Rp1,842,375.00
Rp0.00
BUR.O
DC.36
SistokopiOD
S-
Rp0.00
Rp1,719,550.00
Rp0.00
Rp1,719,550.00
Rp0.00
BUR.O
DC.37
Sistokopi-
Rp0.00
Rp1,351,075.00
Rp0.00
Rp1,351,075.00
Rp0.00
BUR.O
DC.38
Sistostomiperkutan
-Rp
0.00Rp
1,351,075.00Rp
0.00Rp
1,351,075.00Rp
0.00BU
R.OD
C.39Sistostom
iterbuka-
Rp0.00
Rp1,780,962.50
Rp0.00
Rp1,780,962.50
Rp0.00
BUR
.OD
C.4Cabut
DJ
Stent-
Rp0.00
Rp1,289,662.50
Rp0.00
Rp1,289,662.50
Rp0.00
BUR.O
DC.40
Sistektomitotal,radikal
-Rp
0.00Rp
3,561,925.00Rp
0.00Rp
3,561,925.00Rp
0.00BU
R.OD
C.41Sistektom
iparsial,sistoplastireduksi-
Rp0.00
Rp2,333,675.00
Rp0.00
Rp2,333,675.00
Rp0.00
BUR.O
DC.42
Sistektomiper
laparaskopi-
Rp0.00
Rp3,009,212.50
Rp0.00
Rp3,009,212.50
Rp0.00
BUR.O
DC.43
TUR
Tumor
Buli-
Rp0.00
Rp2,272,262.50
Rp0.00
Rp2,272,262.50
Rp0.00
BUR.O
DC.44
OperasiRepair
BULI
Trauma
-Rp
0.00Rp
1,842,375.00Rp
0.00Rp
1,842,375.00Rp
0.00BU
R.OD
C.45Businasi,D
ilatasiUretra
-Rp
0.00Rp
1,289,662.50Rp
0.00Rp
1,289,662.50Rp
0.00BU
R.OD
C.46D
ivertikulumuretra
-Rp
0.00Rp
1,473,900.00Rp
0.00Rp
1,473,900.00Rp
0.00BU
R.OD
C.47Epispadia
-Rp
0.00Rp
4,176,050.00Rp
0.00Rp
4,176,050.00Rp
0.00BU
R.OD
C.48Fistulektom
i,Repair
FistelUretra
-Rp
0.00Rp
1,473,900.00Rp
0.00Rp
1,473,900.00Rp
0.00BU
R.OD
C.49U
retroplastriHipospadia
-Rp
0.00Rp
1,596,725.00Rp
0.00Rp
1,596,725.00Rp
0.00BU
R.O
DC.5
Drainase
Periureter-
Rp0.00
Rp1,351,075.00
Rp0.00
Rp1,351,075.00
Rp0.00
BUR.O
DC.50
Hispospadia
Subkoronal-
Rp0.00
Rp2,333,675.00
Rp0.00
Rp2,333,675.00
Rp0.00
BUR.O
DC.51
InsisiPosteriorU
rethralValve-
Rp0.00
Rp2,088,025.00
Rp0.00
Rp2,088,025.00
Rp0.00
BUR.O
DC.52
Uretrotom
iInterna(Sachse)
-Rp
0.00Rp
1,719,550.00Rp
0.00Rp
1,719,550.00Rp
0.00BU
R.OD
C.53Johanson
I-
Rp0.00
Rp1,780,962.50
Rp0.00
Rp1,780,962.50
Rp0.00
BUR.O
DC.54
JohansonII
-Rp
0.00Rp
1,965,200.00Rp
0.00Rp
1,965,200.00Rp
0.00BU
R.OD
C.55KalibrasiU
retra-
Rp0.00
Rp1,289,662.50
Rp0.00
Rp1,289,662.50
Rp0.00
BUR.O
DC.56
Meatotom
i-
Rp0.00
Rp1,289,662.50
Rp0.00
Rp1,289,662.50
Rp0.00
BUR.O
DC.57
Meatoplasti
-Rp
0.00Rp
1,351,075.00Rp
0.00Rp
1,351,075.00Rp
0.00BU
R.OD
C.58Pasang
Kateter-
Rp0.00
Rp1,289,662.50
Rp0.00
Rp1,289,662.50
Rp0.00
BUR.O
DC.59
PasangKateter
denganM
andrain-
Rp0.00
Rp1,289,662.50
Rp0.00
Rp1,289,662.50
Rp0.00
BUR
.OD
C.6EkstraksiBatu
-Rp
0.00Rp
1,719,550.00Rp
0.00Rp
1,719,550.00Rp
0.00BU
R.OD
C.60R
ailroadingR
upturU
retra-
Rp0.00
Rp2,210,850.00
Rp0.00
Rp2,210,850.00
Rp0.00
BUR.O
DC.61
PER(Prim
aryEndoscopic
Realignment)
-Rp
0.00Rp
2,149,437.50Rp
0.00Rp
2,149,437.50Rp
0.00BU
R.OD
C.62R
eseksi-Anastomosis
Uretra
-Rp
0.00Rp
2,210,850.00Rp
0.00Rp
2,210,850.00Rp
0.00BU
R.OD
C.63U
retroskopi,Uretrosistoskopi
-Rp
0.00Rp
1,289,662.50Rp
0.00Rp
1,289,662.50Rp
0.00BU
R.OD
C.64U
retroplastiBukalGraf
-Rp
0.00Rp
2,456,500.00Rp
0.00Rp
2,456,500.00Rp
0.00BU
R.OD
C.65U
retrotomiEksterna
-Rp
0.00Rp
1,412,487.50Rp
0.00Rp
1,412,487.50Rp
0.00BU
R.OD
C.66BiopsiProstrat
-Rp
0.00Rp
1,289,662.50Rp
0.00Rp
1,289,662.50Rp
0.00BU
R.OD
C.67M
asasaeProstrat
-Rp
0.00Rp
1,289,662.50Rp
0.00Rp
1,289,662.50Rp
0.00BU
R.OD
C.68Prostatektom
iTerbuka-
Rp0.00
Rp1,658,137.50
Rp0.00
Rp1,658,137.50
Rp0.00
BU