jasperreports - data jenis perawatan

52
DATA TINDAKAN/PERAWATAN/TAGIHAN RS. AVECIENA MEDIKA Kawasan Komersial SEKUMPUL, MARTAPURA, Kalimantan Selatan E-mail : [email protected] 0511-4721555 Kode NAMA PERAWATAN/TINDAKAN/TAGIHAN KATEGORI MATERIAL TRF.TNDKAN DR TRF.TNDKAN PR TOTAL BAYAR DR TOTAL BAYAR PR A.I.1 Konsultasi ICU Non emergensi (Pertama Kali) - Rp 0.00 Rp 200,000.00 Rp 0.00 Rp 200,000.00 Rp 0.00 A.I.2 Konsultasi ICU Emergensi (Pertama Kali) - Rp 0.00 Rp 200,000.00 Rp 0.00 Rp 200,000.00 Rp 0.00 A.I.3 Konsultasi ICU Perhari (Follow Up) - Rp 0.00 Rp 200,000.00 Rp 0.00 Rp 200,000.00 Rp 0.00 A.II.1 Konsultasi ICU Non emergensi (Pertama Kali) - Rp 0.00 Rp 170,000.00 Rp 0.00 Rp 170,000.00 Rp 0.00 A.II.2 Konsultasi ICU Emergensi (Pertama Kali) - Rp 0.00 Rp 170,000.00 Rp 0.00 Rp 170,000.00 Rp 0.00 A.II.3 Konsultasi ICU Perhari (Follow Up) - Rp 0.00 Rp 170,000.00 Rp 0.00 Rp 170,000.00 Rp 0.00 A.III.1 Konsultasi ICU Non emergensi (Pertama Kali) - Rp 0.00 Rp 144,500.00 Rp 0.00 Rp 144,500.00 Rp 0.00 A.III.2 Konsultasi ICU Emergensi (Pertama Kali) - Rp 0.00 Rp 144,500.00 Rp 0.00 Rp 144,500.00 Rp 0.00 A.III.3 Konsultasi ICU Perhari (Follow Up) - Rp 0.00 Rp 144,500.00 Rp 0.00 Rp 144,500.00 Rp 0.00 A.ODC.1 Konsultasi ICU Non emergensi (Pertama Kali) - Rp 0.00 Rp 122,825.00 Rp 0.00 Rp 122,825.00 Rp 0.00 A.ODC.2 Konsultasi ICU Emergensi (Pertama Kali) - Rp 0.00 Rp 122,825.00 Rp 0.00 Rp 122,825.00 Rp 0.00 A.ODC.3 Konsultasi ICU Perhari (Follow Up) - Rp 0.00 Rp 122,825.00 Rp 0.00 Rp 122,825.00 Rp 0.00 A.VIP.1 Konsultasi ICU Non emergensi (Pertama Kali) - Rp 0.00 Rp 230,000.00 Rp 0.00 Rp 230,000.00 Rp 0.00 A.VIP.2 Konsultasi ICU Emergensi (Pertama Kali) - Rp 0.00 Rp 230,000.00 Rp 0.00 Rp 230,000.00 Rp 0.00 A.VIP.3 Konsultasi ICU Perhari (Follow Up) - Rp 0.00 Rp 230,000.00 Rp 0.00 Rp 230,000.00 Rp 0.00 A.VVIP.1 Konsultasi ICU Non emergensi (Pertama Kali) - Rp 0.00 Rp 264,500.00 Rp 0.00 Rp 264,500.00 Rp 0.00 A.VVIP.2 Konsultasi ICU Emergensi (Pertama Kali) - Rp 0.00 Rp 264,500.00 Rp 0.00 Rp 264,500.00 Rp 0.00 A.VVIP.3 Konsultasi ICU Perhari (Follow Up) - Rp 0.00 Rp 264,500.00 Rp 0.00 Rp 264,500.00 Rp 0.00 BU.I.1 Amputasi Above Knee - Rp 0.00 Rp 3,100,000.00 Rp 0.00 Rp 3,100,000.00 Rp 0.00 BU.I.10 Bilateral repair of indirect inguinal hernia - Rp 0.00 Rp 2,900,000.00 Rp 0.00 Rp 2,900,000.00 Rp 0.00 BU.I.11 Bilateral simple mastectomy - Rp 0.00 Rp 3,300,000.00 Rp 0.00 Rp 3,300,000.00 Rp 0.00 BU.I.12 Cholecystectomy - Rp 0.00 Rp 3,700,000.00 Rp 0.00 Rp 3,700,000.00 Rp 0.00 BU.I.13 Choledochoplasty - Rp 0.00 Rp 4,300,000.00 Rp 0.00 Rp 4,300,000.00 Rp 0.00 BU.I.14 Combustio (Luka Bakar) - Rp 0.00 Rp 2,200,000.00 Rp 0.00 Rp 2,200,000.00 Rp 0.00 BU.I.15 Complete thyroidectomy - Rp 0.00 Rp 3,700,000.00 Rp 0.00 Rp 3,700,000.00 Rp 0.00 BU.I.16 Debridement Mediastinum (Sternotomi) - Rp 0.00 Rp 3,100,000.00 Rp 0.00 Rp 3,100,000.00 Rp 0.00 BU.I.17 Fraktur Cruris - Rp 0.00 Rp 3,500,000.00 Rp 0.00 Rp 3,500,000.00 Rp 0.00 BU.I.18 Fraktur Femur - Rp 0.00 Rp 2,800,000.00 Rp 0.00 Rp 2,800,000.00 Rp 0.00 BU.I.19 Fraktur Humerus - Rp 0.00 Rp 2,400,000.00 Rp 0.00 Rp 2,400,000.00 Rp 0.00 BU.I.2 Amputasi Below Knee - Rp 0.00 Rp 3,100,000.00 Rp 0.00 Rp 3,100,000.00 Rp 0.00 BU.I.20 Fraktur Klavikula - Rp 0.00 Rp 2,700,000.00 Rp 0.00 Rp 2,700,000.00 Rp 0.00 BU.I.21 Insisi Abses dengan Anastesi Lokal - Rp 0.00 Rp 1,300,000.00 Rp 0.00 Rp 1,300,000.00 Rp 0.00 BU.I.22 Pemasangan Peritoneal Sialysis (PD) Catheter (diluar alat) - Rp 0.00 Rp 2,300,000.00 Rp 0.00 Rp 2,300,000.00 Rp 0.00 BU.I.23 Pleurodesis - Rp 0.00 Rp 1,200,000.00 Rp 0.00 Rp 1,200,000.00 Rp 0.00 BU.I.24 Tiroidektomi Subtotal,Total Nodul Tiroid - Rp 0.00 Rp 2,400,000.00 Rp 0.00 Rp 2,400,000.00 Rp 0.00 BU.I.25 Total Splenectomy - Rp 0.00 Rp 3,400,000.00 Rp 0.00 Rp 3,400,000.00 Rp 0.00 BU.I.3 Amputasi Jari (Phalangs - Traumatik) - Rp 0.00 Rp 1,300,000.00 Rp 0.00 Rp 1,300,000.00 Rp 0.00 BU.I.4 Arteriovenous shunt (AV Shunt) brakiosefalika - Rp 0.00 Rp 2,700,000.00 Rp 0.00 Rp 2,700,000.00 Rp 0.00 52 Page 1 of 3/23/15 8:08 AM

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  • 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

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    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

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    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

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    /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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  • KodeN

    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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    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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    AM

  • 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

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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.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

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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.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

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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.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

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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.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

    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.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

    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.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