Tarif Layanan (Tindakan & Akomodasi)

Akomodasi
Nama Kelas Biaya
Kelas 3 150,000
Kelas 3 Infection Centre 216,000
Kelas 2 180,000
HCU / Intermediate 300,000
Intensif Care 540,000
Kelas 2 Infection Centre 270,000
HCU Infection Centre 360,000
Kelas 1 240,000
Kelas 1 Infection Centre 324,000
VIP 500,000
VIP Intensive Care 720,000
VIP Infection Centre 500,000
CVCU (VIP) 720,000
VIP A 550,000
Super VIP B 720,000
Super VIP A 770,000
Super VIP Intensif Care 970,000
CVCU (SUPER VIP) 970,000
Super VIP 770,000
Tindakan
Nama Tindakan Tarif Kelas 3 Tarif Kelas 2 Tarif Kelas 1 Tarif VIP Tarif VIP B Tarif VIP A Tarif SUPERVIP
Laser V Beam 250,000 250,000 250,000 250,000 0 0 0
17-OH Progesteron (LC-MS/MS) (P) 900,000 900,000 900,000 900,000 900,000 900,000 900,000
Abdominopelvic amputation 9,282,099 9,282,099 9,282,099 9,282,099 9,282,099 9,282,099 9,282,099
Abdominoperineal Pull - Through / Malformasi 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Abdominoperineal Pull-Throug/ Swenson 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Abdominorectal Pull - Through/Swenson Procedure 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Ablatio Retina 10,926,000 10,926,000 10,926,000 10,926,000 10,926,000 10,926,000 10,926,000
Absebt Pulmonary Valve Syndrome Repair/ dengan atau tanpa MOF/ CABG High Risk/Operasi Mitral Valve Repair (MVR)/ Atrial Valve Repair (AVR) / Aortic Repair + PS 59,550,000 59,550,000 59,550,000 59,550,000 59,550,000 59,550,000 59,550,000
Absisi Corpus Alinun 150,000 150,000 150,000 150,000 677,500 677,500 677,500
ACA IgG 438,000 438,000 438,000 438,000 438,000 438,000 438,000
ACA IgG (P) 671,000 671,000 671,000 671,000 671,000 671,000 671,000
ACA IgM 438,000 438,000 438,000 438,000 438,000 438,000 438,000
ACA IgM (P) 690,000 690,000 690,000 690,000 690,000 690,000 690,000
Achillotenotomy 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Activated Clotting Time 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Acute Pain Service + Anastesi 734,000 734,000 734,000 734,000 734,000 734,000 734,000
Adductor tenotomy of hip 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Adenoidektomi 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Adenolisis 6,350,000 6,350,000 6,350,000 6,350,000 6,350,000 6,350,000 6,350,000
Adesolisis 5,931,446 5,931,446 5,931,446 5,931,446 5,931,446 5,931,446 5,931,446
ADL (Activity of Daily Living) 22,800 22,800 22,800 22,800 35,000 35,000 35,000
Administrasi Home Care 100,000 100,000 100,000 100,000 100,000 100,000 100,000
Administrasi Penyerahan Jenazah 120,000 120,000 120,000 120,000 120,000 120,000 120,000
Adrenalektomi Abdominotorakal 10,320,000 10,320,000 10,320,000 10,320,000 10,320,000 10,320,000 10,320,000
Adult Complex Repair/ Operation/ Alcapa Repair + MOF/ Off Pump/ Aneurysmectomy / Arterial Switch Opeartion/ AVR-MVR + MOF/ CABG + MVR / CABG + AVR/ Congenital Heart Complex Repair/ Damuskez/ Noorwood Operation/ Senning Operation / TVR/AV Replacement + MV Repair + TV Repair/ Repair L'etage Ventrikuler 90,000,000 90,000,000 90,000,000 90,000,000 90,000,000 90,000,000 90,000,000
Advancement of pedicle graft 10,925,000 10,925,000 10,925,000 10,925,000 10,925,000 10,925,000 10,925,000
Advancement of tendon 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000
Advancement of tendon of hand 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000
Aff DJ Stent 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Aff DJ Stent (ESWL) 2,500,000 2,500,000 2,500,000 2,500,000 2,500,000 2,500,000 2,500,000
Aff Double Lumen 217,000 217,000 217,000 217,000 0 0 0
Aff Drain 83,000 83,000 83,000 83,000 125,000 125,000 125,000
Aff Hecting 35,000 35,000 35,000 35,000 53,000 53,000 53,000
AFO (Biasa) 961,000 961,000 961,000 961,000 1,442,000 1,442,000 1,442,000
AFO (Khusus) 2,850,000 2,850,000 2,850,000 2,850,000 4,275,000 4,275,000 4,275,000
AFO (Standar) 1,556,000 1,556,000 1,556,000 1,556,000 2,334,000 2,334,000 2,334,000
AFP _ 245,000 245,000 245,000 245,000 245,000 245,000 245,000
Agregasi Trombosit _ 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Air Plumbage ( Bedah Paru/ Thorax ) 21,102,000 21,102,000 21,102,000 21,102,000 21,102,000 21,102,000 21,102,000
Akupuntur ( 4 x Tindakan ) 250,000 250,000 250,000 250,000 0 0 0
Albumin Urine 30,000 30,000 30,000 30,000 30,000 30,000 30,000
Albumin _ 32,000 32,000 32,000 32,000 32,000 32,000 32,000
Alkali Fosfatase _ 37,000 37,000 37,000 37,000 37,000 37,000 37,000
Allergi Test/Patch Test 66,000 66,000 66,000 66,000 0 0 0
ALPACA Repair/AP Window+MOF/AVSD Repair/BCPS On Off Pump + MOF/Corctasio Aorta+MOF 49,550,000 49,550,000 49,550,000 49,550,000 49,550,000 49,550,000 49,550,000
Alveolar Bone Graft 9,550,000 9,550,000 9,550,000 9,550,000 9,550,000 9,550,000 9,550,000
Alveolectomi 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Alveolektomi 2 Regio dengan Anastesi Lokal 0 0 0 0 1,015,000 1,015,000 1,015,000
Alveolektomi per Regio dengan Anastesi Lokal 270,000 270,000 270,000 270,000 0 0 0
Ambil Bahan Kultur/Biopsi/Swab/Kerokan 66,000 66,000 66,000 66,000 66,000 66,000 66,000
Ambulance Jenasah Makassar (Tamalanrea) - BTN Antara 182,000 182,000 182,000 182,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - BTP 157,000 157,000 157,000 157,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Bulurokeng 282,000 282,000 282,000 282,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - BUNG 135,000 135,000 135,000 135,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Cendrawasih 282,000 282,000 282,000 282,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Galangan Kapal 257,000 257,000 257,000 257,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Jl. Sunu 257,000 257,000 257,000 257,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Jl.Abd.Dg.Sirua 162,000 162,000 162,000 162,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Jl.Pettarani 245,000 245,000 245,000 245,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Minasa Upa 232,000 232,000 232,000 232,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Pampang 206,000 206,000 206,000 206,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Panaikang 170,000 170,000 170,000 170,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Panakkukang 195,000 195,000 195,000 195,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Pannampu 282,000 282,000 282,000 282,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Perumahan Dosen 132,000 132,000 132,000 132,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Perumnas Antang 206,000 206,000 206,000 206,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Perumnas Sudiang 232,000 232,000 232,000 232,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Rappokalling 220,000 220,000 220,000 220,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Samata (Gowa) 257,000 257,000 257,000 257,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Somba Opu 257,000 257,000 257,000 257,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Sultan Alauddin 257,000 257,000 257,000 257,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Tala' Salapang 270,000 270,000 270,000 270,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Tello 160,000 160,000 160,000 160,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Teuku Umar 232,000 232,000 232,000 232,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Tol Jl.Ir.Sutami 245,000 245,000 245,000 245,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Ujung Tanah 282,000 282,000 282,000 282,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Unhas 127,000 127,000 127,000 127,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Veteran Selatan 270,000 270,000 270,000 270,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Veteran Utara 230,000 230,000 230,000 230,000 0 0 0
Ambulance Jenasah Makassar (Tamalanrea) - Wesabbe 127,000 127,000 127,000 127,000 0 0 0
Ambulance Jenasah Makassar - Ampana (Sul-Teng) 9,500,000 9,500,000 9,500,000 9,500,000 0 0 0
Ambulance Jenasah Makassar - Bantaeng (Banyorang) 1,550,000 1,550,000 1,550,000 1,550,000 0 0 0
Ambulance Jenasah Makassar - Bantaeng (Kota) 1,400,000 1,400,000 1,400,000 1,400,000 0 0 0
Ambulance Jenasah Makassar - Barru (Kota) 1,200,000 1,200,000 1,200,000 1,200,000 0 0 0
Ambulance Jenasah Makassar - Barru (Mangkoso) 1,300,000 1,300,000 1,300,000 1,300,000 0 0 0
Ambulance Jenasah Makassar - Barru (Palandro) 1,350,000 1,350,000 1,350,000 1,350,000 0 0 0
Ambulance Jenasah Makassar - Barru (Pekkae) 1,135,000 1,135,000 1,135,000 1,135,000 0 0 0
Ambulance Jenasah Makassar - Barru (Takkalasi) 1,250,000 1,250,000 1,250,000 1,250,000 0 0 0
Ambulance Jenasah Makassar - Bone (Bontocani) 1,400,000 1,400,000 1,400,000 1,400,000 0 0 0
Ambulance Jenasah Makassar - Bone (Camming) 1,500,000 1,500,000 1,500,000 1,500,000 0 0 0
Ambulance Jenasah Makassar - Bone (Cenrana) 2,500,000 2,500,000 2,500,000 2,500,000 0 0 0
Ambulance Jenasah Makassar - Bone (Cina) 2,000,000 2,000,000 2,000,000 2,000,000 0 0 0
Ambulance Jenasah Makassar - Bone (Kajuara) 2,000,000 2,000,000 2,000,000 2,000,000 0 0 0
Ambulance Jenasah Makassar - Bone (Koppe) 1,760,000 1,760,000 1,760,000 1,760,000 0 0 0
Ambulance Jenasah Makassar - Bone (Kota) 1,500,000 1,500,000 1,500,000 1,500,000 0 0 0
Ambulance Jenasah Makassar - Bone (Lamuru) 1,600,000 1,600,000 1,600,000 1,600,000 0 0 0
Ambulance Jenasah Makassar - Bone (Lapri) 1,495,000 1,495,000 1,495,000 1,495,000 0 0 0
Ambulance Jenasah Makassar - Bone (Lempangeng) 1,750,000 1,750,000 1,750,000 1,750,000 0 0 0
Ambulance Jenasah Makassar - Bone (Limpoe) 2,000,000 2,000,000 2,000,000 2,000,000 0 0 0
Ambulance Jenasah Makassar - Bone (Mare) 2,200,000 2,200,000 2,200,000 2,200,000 0 0 0
Ambulance Jenasah Makassar - Bone (Palattea) 1,600,000 1,600,000 1,600,000 1,600,000 0 0 0
Ambulance Jenasah Makassar - Bone (Pompanua) 2,350,000 2,350,000 2,350,000 2,350,000 0 0 0
Ambulance Jenasah Makassar - Bone (Solo) 2,350,000 2,350,000 2,350,000 2,350,000 0 0 0
Ambulance Jenasah Makassar - Bone (Tonra) 2,200,000 2,200,000 2,200,000 2,200,000 0 0 0
Ambulance Jenasah Makassar - Bulukumba (Bira) 2,375,000 2,375,000 2,375,000 2,375,000 0 0 0
Ambulance Jenasah Makassar - Bulukumba (Kajang) 2,350,000 2,350,000 2,350,000 2,350,000 0 0 0
Ambulance Jenasah Makassar - Bulukumba (Kota) 1,700,000 1,700,000 1,700,000 1,700,000 0 0 0
Ambulance Jenasah Makassar - Bulukumba (Tanete) 1,750,000 1,750,000 1,750,000 1,750,000 0 0 0
Ambulance Jenasah Makassar - Bunta (Sul-Teng) 9,730,000 9,730,000 9,730,000 9,730,000 0 0 0
Ambulance Jenasah Makassar - Enrekang (Baraka) 2,300,000 2,300,000 2,300,000 2,300,000 0 0 0
Ambulance Jenasah Makassar - Enrekang (Baroko) 2,300,000 2,300,000 2,300,000 2,300,000 0 0 0
Ambulance Jenasah Makassar - Enrekang (Cakke) 2,300,000 2,300,000 2,300,000 2,300,000 0 0 0
Ambulance Jenasah Makassar - Enrekang (Kalosi) 2,300,000 2,300,000 2,300,000 2,300,000 0 0 0
Ambulance Jenasah Makassar - Enrekang (Kota) 1,950,000 1,950,000 1,950,000 1,950,000 0 0 0
Ambulance Jenasah Makassar - Enrekang (Malua) 2,350,000 2,350,000 2,350,000 2,350,000 0 0 0
Ambulance Jenasah Makassar - Enrekang (Marowanging) 1,850,000 1,850,000 1,850,000 1,850,000 0 0 0
Ambulance Jenasah Makassar - Enrekang (Sudu) 2,400,000 2,400,000 2,400,000 2,400,000 0 0 0
Ambulance Jenasah Makassar - Gowa (Barombong) 395,000 395,000 395,000 395,000 0 0 0
Ambulance Jenasah Makassar - Gowa (Bili-Bili) 557,000 557,000 557,000 557,000 0 0 0
Ambulance Jenasah Makassar - Gowa (Galesong Selatan) 657,000 657,000 657,000 657,000 0 0 0
Ambulance Jenasah Makassar - Gowa (Galesong Utara) 495,000 495,000 495,000 495,000 0 0 0
Ambulance Jenasah Makassar - Gowa (Limbung) 457,000 457,000 457,000 457,000 0 0 0
Ambulance Jenasah Makassar - Gowa (Malakaji) 1,357,000 1,357,000 1,357,000 1,357,000 0 0 0
Ambulance Jenasah Makassar - Gowa (Malino Kota) 1,100,000 1,100,000 1,100,000 1,100,000 0 0 0
Ambulance Jenasah Makassar - Gowa (Pallangga) 410,000 410,000 410,000 410,000 0 0 0
Ambulance Jenasah Makassar - Gowa (S.Minasa) 345,000 345,000 345,000 345,000 0 0 0
Ambulance Jenasah Makassar - Gowa (Sapaiya) 1,050,000 1,050,000 1,050,000 1,050,000 0 0 0
Ambulance Jenasah Makassar - Gowa (Tombolo) 1,370,000 1,370,000 1,370,000 1,370,000 0 0 0
Ambulance Jenasah Makassar - Jeneponto (Allu) 950,000 950,000 950,000 950,000 0 0 0
Ambulance Jenasah Makassar - Jeneponto (Kota) 1,000,000 1,000,000 1,000,000 1,000,000 0 0 0
Ambulance Jenasah Makassar - Jeneponto (Tamalatea) 980,000 980,000 980,000 980,000 0 0 0
Ambulance Jenasah Makassar - Kolonodale (Sul-Teng) 8,500,000 8,500,000 8,500,000 8,500,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Belopa) 2,550,000 2,550,000 2,550,000 2,550,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Bone-Bone) 3,736,000 3,736,000 3,736,000 3,736,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Bua) 3,100,000 3,100,000 3,100,000 3,100,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Kota Palopo) 3,245,000 3,245,000 3,245,000 3,245,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Larompong) 2,520,000 2,520,000 2,520,000 2,520,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Malangke) 4,000,000 4,000,000 4,000,000 4,000,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Malili) 5,750,000 5,750,000 5,750,000 5,750,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Mangkutana) 5,500,000 5,500,000 5,500,000 5,500,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Masamba) 3,520,000 3,520,000 3,520,000 3,520,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Padang Sappa) 2,987,000 2,987,000 2,987,000 2,987,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Ponrang) 2,885,000 2,885,000 2,885,000 2,885,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Sabbang) 3,500,000 3,500,000 3,500,000 3,500,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Soroako) 6,000,000 6,000,000 6,000,000 6,000,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Suli) 2,539,000 2,539,000 2,539,000 2,539,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Wasinrang) 3,258,000 3,258,000 3,258,000 3,258,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Wasponda) 5,860,000 5,860,000 5,860,000 5,860,000 0 0 0
Ambulance Jenasah Makassar - Luwu (Wotu) 3,835,000 3,835,000 3,835,000 3,835,000 0 0 0
Ambulance Jenasah Makassar - Luwuk (Sul-Teng) 11,500,000 11,500,000 11,500,000 11,500,000 0 0 0
Ambulance Jenasah Makassar - Majene (Kota) 3,510,000 3,510,000 3,510,000 3,510,000 0 0 0
Ambulance Jenasah Makassar - Majene (Malunda) 3,525,000 3,525,000 3,525,000 3,525,000 0 0 0
Ambulance Jenasah Makassar - Majene (Pambuang) 2,985,000 2,985,000 2,985,000 2,985,000 0 0 0
Ambulance Jenasah Makassar - Majene (Tappalang) 3,675,000 3,675,000 3,675,000 3,675,000 0 0 0
Ambulance Jenasah Makassar - Mamuju (Budong-Budong) 5,350,000 5,350,000 5,350,000 5,350,000 0 0 0
Ambulance Jenasah Makassar - Mamuju (Kaluku) 4,650,000 4,650,000 4,650,000 4,650,000 0 0 0
Ambulance Jenasah Makassar - Mamuju (Kota) 4,500,000 4,500,000 4,500,000 4,500,000 0 0 0
Ambulance Jenasah Makassar - Mamuju (Pasangkayu) 6,250,000 6,250,000 6,250,000 6,250,000 0 0 0
Ambulance Jenasah Makassar - Mamuju (Tarailu) 4,900,000 4,900,000 4,900,000 4,900,000 0 0 0
Ambulance Jenasah Makassar - Mamuju (Tikke) 5,800,000 5,800,000 5,800,000 5,800,000 0 0 0
Ambulance Jenasah Makassar - Mamuju (Topoyo) 5,250,000 5,250,000 5,250,000 5,250,000 0 0 0
Ambulance Jenasah Makassar - Maros (Bandara) 295,000 295,000 295,000 295,000 0 0 0
Ambulance Jenasah Makassar - Maros (Bantimurung) 700,000 700,000 700,000 700,000 0 0 0
Ambulance Jenasah Makassar - Maros (Camba) 850,000 850,000 850,000 850,000 0 0 0
Ambulance Jenasah Makassar - Maros (Carangki) 445,000 445,000 445,000 445,000 0 0 0
Ambulance Jenasah Makassar - Maros (Cenrana) 800,000 800,000 800,000 800,000 0 0 0
Ambulance Jenasah Makassar - Maros (Kaemba) 420,000 420,000 420,000 420,000 0 0 0
Ambulance Jenasah Makassar - Maros (Kota) 445,000 445,000 445,000 445,000 0 0 0
Ambulance Jenasah Makassar - Maros (Pattene) 357,000 357,000 357,000 357,000 0 0 0
Ambulance Jenasah Makassar - Maros (Sipur) 510,000 510,000 510,000 510,000 0 0 0
Ambulance Jenasah Makassar - Maros (Tambua) 520,000 520,000 520,000 520,000 0 0 0
Ambulance Jenasah Makassar - Maros (Tanralili) 457,000 457,000 457,000 457,000 0 0 0
Ambulance Jenasah Makassar - Maros (Tompo Bulu) 1,000,000 1,000,000 1,000,000 1,000,000 0 0 0
Ambulance Jenasah Makassar - Morowali (Bungku) 9,500,000 9,500,000 9,500,000 9,500,000 0 0 0
Ambulance Jenasah Makassar - Palu (Sul-Teng) 12,350,000 12,350,000 12,350,000 12,350,000 0 0 0
Ambulance Jenasah Makassar - Pangemana (Sul-Teng) 10,000,000 10,000,000 10,000,000 10,000,000 0 0 0
Ambulance Jenasah Makassar - Pangkep (Balocci) 950,000 950,000 950,000 950,000 0 0 0
Ambulance Jenasah Makassar - Pangkep (Bungoro) 750,000 750,000 750,000 750,000 0 0 0
Ambulance Jenasah Makassar - Pangkep (Kota) 650,000 650,000 650,000 650,000 0 0 0
Ambulance Jenasah Makassar - Pangkep (Labakkang) 800,000 800,000 800,000 800,000 0 0 0
Ambulance Jenasah Makassar - Pangkep (Ma'rang) 950,000 950,000 950,000 950,000 0 0 0
Ambulance Jenasah Makassar - Pangkep (Mangdalle) 1,100,000 1,100,000 1,100,000 1,100,000 0 0 0
Ambulance Jenasah Makassar - Pangkep (Sigeri) 1,050,000 1,050,000 1,050,000 1,050,000 0 0 0
Ambulance Jenasah Makassar - Pangkep (Tondongkura) 960,000 960,000 960,000 960,000 0 0 0
Ambulance Jenasah Makassar - Pare-Pare (Kariango) 1,600,000 1,600,000 1,600,000 1,600,000 0 0 0
Ambulance Jenasah Makassar - Pare-Pare (Kota) 1,500,000 1,500,000 1,500,000 1,500,000 0 0 0
Ambulance Jenasah Makassar - Parigi (Sul-Teng) 13,000,000 13,000,000 13,000,000 13,000,000 0 0 0
Ambulance Jenasah Makassar - Pendolo (Sul-Teng) 6,500,000 6,500,000 6,500,000 6,500,000 0 0 0
Ambulance Jenasah Makassar - Pinrang (Batu Lappa) 2,250,000 2,250,000 2,250,000 2,250,000 0 0 0
Ambulance Jenasah Makassar - Pinrang (Benteng) 1,936,000 1,936,000 1,936,000 1,936,000 0 0 0
Ambulance Jenasah Makassar - Pinrang (Bungi) 1,900,000 1,900,000 1,900,000 1,900,000 0 0 0
Ambulance Jenasah Makassar - Pinrang (Kariango) 1,845,000 1,845,000 1,845,000 1,845,000 0 0 0
Ambulance Jenasah Makassar - Pinrang (Kota) 1,750,000 1,750,000 1,750,000 1,750,000 0 0 0
Ambulance Jenasah Makassar - Pinrang (Langnga) 1,850,000 1,850,000 1,850,000 1,850,000 0 0 0
Ambulance Jenasah Makassar - Pinrang (Pekkabata) 1,850,000 1,850,000 1,850,000 1,850,000 0 0 0
Ambulance Jenasah Makassar - Pinrang (Suppa) 1,600,000 1,600,000 1,600,000 1,600,000 0 0 0
Ambulance Jenasah Makassar - Polman (Campalagian) 2,456,000 2,456,000 2,456,000 2,456,000 0 0 0
Ambulance Jenasah Makassar - Polman (Mamasa) 2,570,000 2,570,000 2,570,000 2,570,000 0 0 0
Ambulance Jenasah Makassar - Polman (Mambi) 2,530,000 2,530,000 2,530,000 2,530,000 0 0 0
Ambulance Jenasah Makassar - Polman (Manding) 2,490,000 2,490,000 2,490,000 2,490,000 0 0 0
Ambulance Jenasah Makassar - Polman (Messawa) 2,440,000 2,440,000 2,440,000 2,440,000 0 0 0
Ambulance Jenasah Makassar - Polman (Nosu) 2,526,000 2,526,000 2,526,000 2,526,000 0 0 0
Ambulance Jenasah Makassar - Polman (Palatikan) 2,500,000 2,500,000 2,500,000 2,500,000 0 0 0
Ambulance Jenasah Makassar - Polman (Pembusuang) 2,470,000 2,470,000 2,470,000 2,470,000 0 0 0
Ambulance Jenasah Makassar - Polman (Polewali) 2,450,000 2,450,000 2,450,000 2,450,000 0 0 0
Ambulance Jenasah Makassar - Polman (Sumarorong) 2,485,000 2,485,000 2,485,000 2,485,000 0 0 0
Ambulance Jenasah Makassar - Polman (Tinambung) 2,490,000 2,490,000 2,490,000 2,490,000 0 0 0
Ambulance Jenasah Makassar - Polman (Wonomulyo) 2,580,000 2,580,000 2,580,000 2,580,000 0 0 0
Ambulance Jenasah Makassar - Poso (Sul-Teng) 8,000,000 8,000,000 8,000,000 8,000,000 0 0 0
Ambulance Jenasah Makassar - Selayar 7,000,000 7,000,000 7,000,000 7,000,000 0 0 0
Ambulance Jenasah Makassar - Sidrap (Amparita) 1,720,000 1,720,000 1,720,000 1,720,000 0 0 0
Ambulance Jenasah Makassar - Sidrap (Belokka) 1,650,000 1,650,000 1,650,000 1,650,000 0 0 0
Ambulance Jenasah Makassar - Sidrap (Pangkaje'ne) 1,700,000 1,700,000 1,700,000 1,700,000 0 0 0
Ambulance Jenasah Makassar - Sidrap (Rappang) 1,800,000 1,800,000 1,800,000 1,800,000 0 0 0
Ambulance Jenasah Makassar - Sidrap (Tanru Tedong) 1,750,000 1,750,000 1,750,000 1,750,000 0 0 0
Ambulance Jenasah Makassar - Sinjai (Bikeru) 1,900,000 1,900,000 1,900,000 1,900,000 0 0 0
Ambulance Jenasah Makassar - Sinjai (Bulupoddo) 1,900,000 1,900,000 1,900,000 1,900,000 0 0 0
Ambulance Jenasah Makassar - Sinjai (Kota) 1,800,000 1,800,000 1,800,000 1,800,000 0 0 0
Ambulance Jenasah Makassar - Sinjai (Manimpahoi) 2,100,000 2,100,000 2,100,000 2,100,000 0 0 0
Ambulance Jenasah Makassar - Sinjai (Manipi) 1,500,000 1,500,000 1,500,000 1,500,000 0 0 0
Ambulance Jenasah Makassar - Sinjai (Songi) 1,910,000 1,910,000 1,910,000 1,910,000 0 0 0
Ambulance Jenasah Makassar - Sinjai (Timur) 2,200,000 2,200,000 2,200,000 2,200,000 0 0 0
Ambulance Jenasah Makassar - Soppeng (Batu-Batu) 1,850,000 1,850,000 1,850,000 1,850,000 0 0 0
Ambulance Jenasah Makassar - Soppeng (Cabengge) 1,800,000 1,800,000 1,800,000 1,800,000 0 0 0
Ambulance Jenasah Makassar - Soppeng (Cangadi) 1,775,000 1,775,000 1,775,000 1,775,000 0 0 0
Ambulance Jenasah Makassar - Soppeng (Kota) 1,800,000 1,800,000 1,800,000 1,800,000 0 0 0
Ambulance Jenasah Makassar - Soppeng (Takkalala) 1,700,000 1,700,000 1,700,000 1,700,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Bau-Bau) 13,500,000 13,500,000 13,500,000 13,500,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Boepinang) 9,000,000 9,000,000 9,000,000 9,000,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Buton) 13,750,000 13,750,000 13,750,000 13,750,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Kendari Kota) 12,500,000 12,500,000 12,500,000 12,500,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Kolaka Kota) 10,500,000 10,500,000 10,500,000 10,500,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Kolaka Utara) 10,000,000 10,000,000 10,000,000 10,000,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Lambuya) 8,750,000 8,750,000 8,750,000 8,750,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Pomala) 8,500,000 8,500,000 8,500,000 8,500,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Raha + Peri) 12,500,000 12,500,000 12,500,000 12,500,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Rate-Rate) 8,500,000 8,500,000 8,500,000 8,500,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Torobulu) 12,000,000 12,000,000 12,000,000 12,000,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Unaha) 9,000,000 9,000,000 9,000,000 9,000,000 0 0 0
Ambulance Jenasah Makassar - SulTra (Wamengkoli + Peri) 13,000,000 13,000,000 13,000,000 13,000,000 0 0 0
Ambulance Jenasah Makassar - Takalar (Cikoang) 850,000 850,000 850,000 850,000 0 0 0
Ambulance Jenasah makassar - Takalar (Lama) 732,000 732,000 732,000 732,000 0 0 0
Ambulance Jenasah Makassar - Takalar (Lengkese) 782,000 782,000 782,000 782,000 0 0 0
Ambulance Jenasah Makassar - Takalar (Pabrik Gula) 632,000 632,000 632,000 632,000 0 0 0
Ambulance Jenasah Makassar - Takalar Gowa 710,000 710,000 710,000 710,000 0 0 0
Ambulance Jenasah Makassar - Tator (Batu-Tomenga) 3,000,000 3,000,000 3,000,000 3,000,000 0 0 0
Ambulance Jenasah Makassar - Tator (Bua Kayu) 2,500,000 2,500,000 2,500,000 2,500,000 0 0 0
Ambulance Jenasah Makassar - Tator (Kota Makale) 2,520,000 2,520,000 2,520,000 2,520,000 0 0 0
Ambulance Jenasah Makassar - Tator (Madandang) 2,525,000 2,525,000 2,525,000 2,525,000 0 0 0
Ambulance Jenasah Makassar - Tator (Nanggala) 2,575,000 2,575,000 2,575,000 2,575,000 0 0 0
Ambulance Jenasah Makassar - Tator (Pangngala) 2,895,000 2,895,000 2,895,000 2,895,000 0 0 0
Ambulance Jenasah Makassar - Tator (Rante Tayo) 2,645,000 2,645,000 2,645,000 2,645,000 0 0 0
Ambulance Jenasah Makassar - Tator (Rantepao) 2,570,000 2,570,000 2,570,000 2,570,000 0 0 0
Ambulance Jenasah Makassar - Tator (Rembon) 2,630,000 2,630,000 2,630,000 2,630,000 0 0 0
Ambulance Jenasah Makassar - Tator (Sa'dan) 3,000,000 3,000,000 3,000,000 3,000,000 0 0 0
Ambulance Jenasah Makassar - Tentena (Sul-Teng) 7,500,000 7,500,000 7,500,000 7,500,000 0 0 0
Ambulance Jenasah Makassar - Toli-toli (Sul-Teng) 15,000,000 15,000,000 15,000,000 15,000,000 0 0 0
Ambulance Jenasah Makassar - Wajo (Ana Banua) 1,765,000 1,765,000 1,765,000 1,765,000 0 0 0
Ambulance Jenasah Makassar - Wajo (Atapange) 1,770,000 1,770,000 1,770,000 1,770,000 0 0 0
Ambulance Jenasah Makassar - Wajo (Belawa) 1,775,000 1,775,000 1,775,000 1,775,000 0 0 0
Ambulance Jenasah Makassar - Wajo (Kera) 2,350,000 2,350,000 2,350,000 2,350,000 0 0 0
Ambulance Jenasah Makassar - Wajo (Kota Sengkang) 1,720,000 1,720,000 1,720,000 1,720,000 0 0 0
Ambulance Jenasah Makassar - Wajo (Siwa) 2,450,000 2,450,000 2,450,000 2,450,000 0 0 0
Ambulance Jenasah Makassar - Wajo (Tanasitolo) 1,755,000 1,755,000 1,755,000 1,755,000 0 0 0
Ambulance Jenasah Makassar - Wajo (Tarun Pekkae) 1,735,000 1,735,000 1,735,000 1,735,000 0 0 0
Ambulance Ke Bandara Sultan Hasanuddin (Event) 311,000 311,000 311,000 311,000 311,000 311,000 311,000
Ambulance Ke Lapangan Karebosi (Event) 266,000 266,000 266,000 266,000 266,000 266,000 266,000
Ambulance Ke Pantai Losari (Event) 295,000 295,000 295,000 295,000 295,000 295,000 295,000
Ambulance Ke RS Akademi Jaury 275,000 275,000 275,000 275,000 275,000 275,000 275,000
Ambulance Ke RS Dr. Tadjuddin Chalid 200,000 200,000 200,000 200,000 200,000 200,000 200,000
Ambulance Ke RS Ibnu Sina YW - UMI 209,000 209,000 209,000 209,000 209,000 209,000 209,000
Ambulance Ke RS Stella Maris 289,000 289,000 289,000 289,000 289,000 289,000 289,000
Ambulance Ke RSB Budi Mulia I 253,000 253,000 253,000 253,000 253,000 253,000 253,000
Ambulance Ke RSB Bunda 262,000 262,000 262,000 262,000 262,000 262,000 262,000
Ambulance Ke RSB GIA Lestari 244,000 244,000 244,000 244,000 244,000 244,000 244,000
Ambulance Ke RSB Masyita 176,000 176,000 176,000 176,000 176,000 176,000 176,000
Ambulance Ke RSB Restu 302,000 302,000 302,000 302,000 302,000 302,000 302,000
Ambulance Ke RSB Siti Fatimah 299,000 299,000 299,000 299,000 299,000 299,000 299,000
Ambulance Ke RSIA Bahagia 304,000 304,000 304,000 304,000 304,000 304,000 304,000
Ambulance Ke RSIA Elim 283,000 283,000 283,000 283,000 283,000 283,000 283,000
Ambulance Ke RSIA Pertiwi 271,000 271,000 271,000 271,000 271,000 271,000 271,000
Ambulance Ke RSIA Sitti Khadijah 269,000 269,000 269,000 269,000 269,000 269,000 269,000
Ambulance Ke RSIA Sitti Khadijah III 280,000 280,000 280,000 280,000 280,000 280,000 280,000
Ambulance Ke RSU Islam Faisal 281,000 281,000 281,000 281,000 281,000 281,000 281,000
Ambulance Ke RSU Labuang Baji 310,000 310,000 310,000 310,000 310,000 310,000 310,000
Ambulance Ke RSU Luramay 274,000 274,000 274,000 274,000 274,000 274,000 274,000
Ambulance Ke RSU Sayang Rakyat 305,000 305,000 305,000 305,000 305,000 305,000 305,000
Ambulance Ke RSUD Daya Makassar 186,000 186,000 186,000 186,000 186,000 186,000 186,000
Ambulance Ke Rumah Sakit 45',0);?> 233,000 233,000 233,000 233,000 233,000 233,000 233,000
Ambulance Ke Rumah Sakit Awal Bros 233,000 233,000 233,000 233,000 233,000 233,000 233,000
Ambulance Ke Rumah Sakit Hikmah 292,000 292,000 292,000 292,000 292,000 292,000 292,000
Ambulance Ke Rumah Sakit Jiwa 290,000 290,000 290,000 290,000 290,000 290,000 290,000
Ambulance Ke Rumah Sakit Mitra Husada 293,000 293,000 293,000 293,000 293,000 293,000 293,000
Ambulance Ke Rumah Sakit Umum Haji 320,000 320,000 320,000 320,000 320,000 320,000 320,000
Ambulance Ke Rumah Sakit Unhas 114,000 114,000 114,000 114,000 114,000 114,000 114,000
Ambulance Ke Siloam Hospitals 313,000 313,000 313,000 313,000 313,000 313,000 313,000
Ambulation and Gait Training 70,000 70,000 70,000 70,000 105,000 105,000 105,000
Amilase Darah 80,000 80,000 80,000 80,000 80,000 80,000 80,000
Amilase Urine 32,000 32,000 32,000 32,000 32,000 32,000 32,000
Aminophylin 41,000 41,000 41,000 41,000 41,000 41,000 41,000
Amniocentesis / CVS / Chordocentesis 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Amnioinfusi Trans Abdominal Dengan Anastesi Lokal 426,000 426,000 426,000 426,000 0 0 0
Amnioreduksi Dengan Anastesi Lokal 432,000 432,000 432,000 432,000 0 0 0
Amnioskopy dan Amniosintesis tranpag 88,000 88,000 88,000 88,000 0 0 0
Amputasi Jari (Multiple) (Bedah Plastik) 5,019,743 5,019,743 5,019,743 5,019,743 5,019,743 5,019,743 5,019,743
Amputation above knee 6,354,000 6,354,000 6,354,000 6,354,000 6,354,000 6,354,000 6,354,000
Amputation and disarticulation of finger 9,282,099 9,282,099 9,282,099 9,282,099 9,282,099 9,282,099 9,282,099
Amputation and disarticulation of thumb 9,282,099 9,282,099 9,282,099 9,282,099 9,282,099 9,282,099 9,282,099
Amputation of ankle through malleoli of tibia and fibula 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099
Amputation of toe 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099
Amputation through foot 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099
Amputation through forearm 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099
Amputation through hand 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099
Amputation through humerus 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099 5,244,099
Amylase Pancreatic (P) 305,000 305,000 305,000 305,000 305,000 305,000 305,000
Amylase Pancreatic Urine (P) 305,000 305,000 305,000 305,000 305,000 305,000 305,000
ANA (IF) & ANA Profile (P) 1,356,000 1,356,000 1,356,000 1,356,000 1,356,000 1,356,000 1,356,000
ANA (IF) (P) 620,000 620,000 620,000 620,000 620,000 620,000 620,000
ANA - IF 800,000 800,000 800,000 800,000 800,000 800,000 800,000
ANA Profile (P) 985,000 985,000 985,000 985,000 985,000 985,000 985,000
ANA Titrasi 200,000 200,000 200,000 200,000 200,000 200,000 200,000
Analisa Batu Empedu (P) 110,000 110,000 110,000 110,000 110,000 110,000 110,000
Analisa Batu Ginjal (P) 292,000 292,000 292,000 292,000 292,000 292,000 292,000
Analisa Batu _ 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Analisa Cairan Asites 280,000 280,000 280,000 280,000 280,000 280,000 280,000
Analisa Cairan Lain 200,000 200,000 200,000 200,000 200,000 200,000 200,000
Analisa Cairan Otak 200,000 200,000 200,000 200,000 200,000 200,000 200,000
Analisa Cairan Pleura 200,000 200,000 200,000 200,000 200,000 200,000 200,000
Analisa Cairan Sendi 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Analisa Faeces _ 70,000 70,000 70,000 70,000 70,000 70,000 70,000
Analisa Gas Darah 280,000 280,000 280,000 280,000 280,000 280,000 280,000
Analisa Gas Darah Plus Elektrolit (POCT) 350,000 350,000 350,000 350,000 350,000 350,000 350,000
Analisa Kromosom (P) 1,980,000 1,980,000 1,980,000 1,980,000 1,980,000 1,980,000 1,980,000
Analisa Sperma _ 200,000 200,000 200,000 200,000 200,000 200,000 200,000
Analisis Status Alergi 100,000 100,000 100,000 100,000 0 0 0
Anasthesi/Trepanasi/Eksterpasi Saluran Akar (Gigi Anterior/Akar Tunggal) 0 0 0 0 262,000 262,000 262,000
Anasthesi/Trepanasi/Eksterpasi Saluran Akar (Gigi Posterior/Akar Jamak) 0 0 0 0 280,000 280,000 280,000
Anastomosis end to end ureter 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
ANCA 221,000 221,000 221,000 221,000 221,000 221,000 221,000
Anca (P) 595,000 595,000 595,000 595,000 595,000 595,000 595,000
Aneurisma Aorta 4,860,000 4,860,000 4,860,000 4,860,000 4,860,000 4,860,000 4,860,000
Angiofibroma Nasofaring 5,773,712 5,773,712 5,773,712 5,773,712 5,773,712 5,773,712 5,773,712
Angiografi Coroner/Cerebral + Anestesi 5,324,718 5,324,718 5,324,718 5,324,718 5,324,718 5,324,718 5,324,718
Angiografi Koroner 4,442,718 4,442,718 4,442,718 4,442,718 4,442,718 4,442,718 4,442,718
Angiografi Perifer/Vaskuler/Arteriografy 4,582,688 4,582,688 4,582,688 4,582,688 4,582,688 4,582,688 4,582,688
Angiography arteri abdominal 6,431,386 6,431,386 6,431,386 6,431,386 6,431,386 6,431,386 6,431,386
Angiography pada extremitas 6,428,236 6,428,236 6,428,236 6,428,236 6,428,236 6,428,236 6,428,236
Angioplasti : A. Carotis 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000
Angioplasti : A. Renalis 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000
Angioplasti : Dialisis Graft 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000
Angioplasti : Extremitas Inf/Sup 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000
Angioplasti : Intrakranial 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000
Angioplasti : Vasospasme Intracranial 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000
Angkat Arch Bar 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Angkat K - Wire 70,000 70,000 70,000 70,000 70,000 70,000 70,000
Angkat Silikon ( Hidung/Dagu ) 0 0 0 0 4,000,000 4,000,000 4,000,000
Ankle fusion 17,935,044 17,935,044 17,935,044 17,935,044 17,935,044 17,935,044 17,935,044
Anoplasty/Limited PSARP/repair anoplasty 7,802,000 7,802,000 7,802,000 7,802,000 7,802,000 7,802,000 7,802,000
Anterio/Posterior Sklerotomi 4,913,000 4,913,000 4,913,000 4,913,000 4,913,000 4,913,000 4,913,000
Anti - HAV IgM (P) 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Anti Amuba 188,000 188,000 188,000 188,000 0 0 0
Anti Chikungunya 235,000 235,000 235,000 235,000 235,000 235,000 235,000
Anti CMV IgG _ 280,000 280,000 280,000 280,000 280,000 280,000 280,000
Anti CMV IgM _ 280,000 280,000 280,000 280,000 280,000 280,000 280,000
Anti Faktor Xa 225,000 225,000 225,000 225,000 225,000 225,000 225,000
Anti HAV IgM _ 220,000 220,000 220,000 220,000 220,000 220,000 220,000
Anti HAV Total 188,000 188,000 188,000 188,000 0 0 0
Anti HBc IgM _ 107,000 107,000 107,000 107,000 107,000 107,000 107,000
Anti HBc Total 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Anti HBe (Elisa Vidas) 425,000 425,000 425,000 425,000 425,000 425,000 425,000
Anti Hbe (P) 490,000 490,000 490,000 490,000 490,000 490,000 490,000
Anti HBs _ 175,000 175,000 175,000 175,000 175,000 175,000 175,000
Anti HCV (Elisa) _ 280,000 280,000 280,000 280,000 280,000 280,000 280,000
Anti HCV (ICT) 98,000 98,000 98,000 98,000 98,000 98,000 98,000
Anti Helicobacter Pylori IgG 81,000 81,000 81,000 81,000 0 0 0
Anti Helicobacter Pylori IgM 81,000 81,000 81,000 81,000 0 0 0
Anti HIV (Elisa) _ 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Anti HIV (ICT) 133,000 133,000 133,000 133,000 133,000 133,000 133,000
Anti HSV IgG _ 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Anti HSV IgM _ 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Anti HSV II IgG 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Anti HSV II IgM 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Anti Influenza A-B 313,000 313,000 313,000 313,000 313,000 313,000 313,000
Anti Jamur Intra Bladder 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Anti Japanese B Encephalitis 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Anti Kappa 74,000 74,000 74,000 74,000 0 0 0
Anti Lamda 74,000 74,000 74,000 74,000 0 0 0
Anti Leptospira 188,000 188,000 188,000 188,000 0 0 0
Anti Rubella IgG _ 275,000 275,000 275,000 275,000 275,000 275,000 275,000
Anti Rubella IgM _ 275,000 275,000 275,000 275,000 275,000 275,000 275,000
Anti TB 188,000 188,000 188,000 188,000 188,000 188,000 188,000
Anti Toxoplasma IgG _ 255,000 255,000 255,000 255,000 255,000 255,000 255,000
Anti Toxoplasma IgM _ 255,000 255,000 255,000 255,000 255,000 255,000 255,000
Anti-CCP IgG (P) 665,000 665,000 665,000 665,000 665,000 665,000 665,000
Anti-ds-DNA-NcX (P) 509,000 509,000 509,000 509,000 509,000 509,000 509,000
Anti-EBV VCA IgG (P) 650,000 650,000 650,000 650,000 650,000 650,000 650,000
Anti-EBV VCA IgM (P) 650,000 650,000 650,000 650,000 650,000 650,000 650,000
Anti-HAV (P) 463,000 463,000 463,000 463,000 463,000 463,000 463,000
Anti-HBc 249,000 249,000 249,000 249,000 249,000 249,000 249,000
Anti-HBc IgM 443,000 443,000 443,000 443,000 443,000 443,000 443,000
Anti-HBc IgM (P) 486,000 486,000 486,000 486,000 486,000 486,000 486,000
Anti-HBe 490,000 490,000 490,000 490,000 490,000 490,000 490,000
Anti-HBs 140,000 140,000 140,000 140,000 140,000 140,000 140,000
Anti-HSV 1 IgG (P) 335,000 335,000 335,000 335,000 335,000 335,000 335,000
Anti-HSV 1 IgM (P) 335,000 335,000 335,000 335,000 335,000 335,000 335,000
Antibodi Malaria 188,000 188,000 188,000 188,000 188,000 188,000 188,000
Antigen Malaria 150,000 150,000 150,000 150,000 150,000 150,000 150,000
Antigen Tuberkulosa 200,000 200,000 200,000 200,000 200,000 200,000 200,000
AP Window/ASD Primum/Extirpasi Tumor Tanpa Komplikasi/Repair PAPVD 42,350,000 42,350,000 42,350,000 42,350,000 42,350,000 42,350,000 42,350,000
Apek Reseksi (Gigi) 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Apek Reseksi Anasthesi Bedah 0 0 0 0 1,000,000 1,000,000 1,000,000
Apeks Reseksi / Apikoektomy per Gigi dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Apeksifikasi 0 0 0 0 450,000 450,000 450,000
Apendektomi Akut 4,137,279 4,137,279 4,137,279 4,137,279 4,137,279 4,137,279 4,137,279
Apendektomi Laparaskopi 10,850,000 10,850,000 10,850,000 10,850,000 10,850,000 10,850,000 10,850,000
Apendektomi Perforata 5,004,189 5,004,189 5,004,189 5,004,189 5,004,189 5,004,189 5,004,189
Appendectomy Simple 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Appendicitis Test 78,000 78,000 78,000 78,000 0 0 0
Application of external fixation device, carpals and metacarpals 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815
Application of external fixation device, femur 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815
Application of external fixation device, humerus 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815
Application of external fixation device, radius and ulna 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815
Application of external fixation device, tarsals and metatarsals 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815 4,767,815
Application of external fixation device, tibia and fibula 17,936,491 17,936,491 17,936,491 17,936,491 17,936,491 17,936,491 17,936,491
Application of external fixation device, unspecified site 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000
Application of neck support 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000
Application of other cast 2,900,182 2,900,182 2,900,182 2,900,182 2,900,182 2,900,182 2,900,182
Application of plaster jacket 4,017,182 4,017,182 4,017,182 4,017,182 4,017,182 4,017,182 4,017,182
Application of splint 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000
APTT _ 110,000 110,000 110,000 110,000 110,000 110,000 110,000
Arch Support 22,800 22,800 22,800 22,800 28,500 28,500 28,500
Argon Laser/Kenon 6,233,000 6,233,000 6,233,000 6,233,000 6,233,000 6,233,000 6,233,000
Arm Sling (Biasa) 399,000 399,000 399,000 399,000 599,000 599,000 599,000
Arm Sling (Khusus) 1,500,000 1,500,000 1,500,000 1,500,000 2,250,000 2,250,000 2,250,000
Arteri Carotis 4,860,000 4,860,000 4,860,000 4,860,000 4,860,000 4,860,000 4,860,000
Arteri Renalis Stenosis 4,816,000 4,816,000 4,816,000 4,816,000 4,816,000 4,816,000 4,816,000
Arterial Chemoterapi Embolisation (TACE) 9,037,000 9,037,000 9,037,000 9,037,000 9,037,000 9,037,000 9,037,000
Arteriography 4,582,688 4,582,688 4,582,688 4,582,688 4,582,688 4,582,688 4,582,688
Arthrocentesis 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Arthrodesis of elbow 5,619,121 5,619,121 5,619,121 5,619,121 5,619,121 5,619,121 5,619,121
Arthrodesis of hip 3,856,600 3,856,600 3,856,600 3,856,600 3,856,600 3,856,600 3,856,600
Arthrodesis of knee 17,930,044 17,930,044 17,930,044 17,930,044 17,930,044 17,930,044 17,930,044
Arthrodesis of shoulder 5,619,121 5,619,121 5,619,121 5,619,121 5,619,121 5,619,121 5,619,121
Arthroplasty of carpocarpal or carpometacarpal joint with implant 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000
Arthroplasty of carpocarpal or carpometacarpal joint without implant 8,488,000 8,488,000 8,488,000 8,488,000 8,488,000 8,488,000 8,488,000
Arthroplasty of metacarpophalangeal and interphalangeal joint with implant 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000
Arthroplasty of metacarpophalangeal and interphalangeal joint without implant 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000
Arthroscopy of ankle 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Arthroscopy of elbow 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Arthroscopy of foot and toe 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Arthroscopy of hand and finger 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Arthroscopy of hip 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Arthroscopy of knee 16,585,212 16,585,212 16,585,212 16,585,212 16,585,212 16,585,212 16,585,212
Arthroscopy of shoulder 16,585,212 16,585,212 16,585,212 16,585,212 16,585,212 16,585,212 16,585,212
Arthroscopy of wrist 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Arthrosplasty (Op.Gigi) 2,960,000 2,960,000 2,960,000 2,960,000 2,960,000 2,960,000 2,960,000
Asam Empedu 33,000 33,000 33,000 33,000 33,000 33,000 33,000
Asam Folat 181,000 181,000 181,000 181,000 181,000 181,000 181,000
Asam Laktat 115,000 115,000 115,000 115,000 115,000 115,000 115,000
Asam Urat (Urine) 30,000 30,000 30,000 30,000 30,000 30,000 30,000
Asam Urat _ 32,000 32,000 32,000 32,000 32,000 32,000 32,000
Ascites Test 78,000 78,000 78,000 78,000 0 0 0
ASD Closure+PFO Creation+TV Repair (TAP DE VEGA) 41,950,000 41,950,000 41,950,000 41,950,000 41,950,000 41,950,000 41,950,000
ASD+MOF/CABG/Total Koreksi+AV Repair/PV Repair/Total Koreksi TOF+PDA Ligasi/Ligasi Ventricle Duuct 48,350,000 48,350,000 48,350,000 48,350,000 48,350,000 48,350,000 48,350,000
ASD+Reseksi Infudibular 45,150,000 45,150,000 45,150,000 45,150,000 45,150,000 45,150,000 45,150,000
Asisted Exercise 70,000 70,000 70,000 70,000 105,000 105,000 105,000
Aspirasi Biopsi 140,000 140,000 140,000 140,000 166,000 166,000 166,000
Aspirasi Cairan Pericard / Pleura 53,000 53,000 53,000 53,000 53,000 53,000 53,000
Aspirasi Hemarthrosis 66,000 66,000 66,000 66,000 0 0 0
Aspirasi Jarum 49,000 49,000 49,000 49,000 74,000 74,000 74,000
Aspirasi Kista 675,000 675,000 675,000 675,000 0 0 0
Aspirasi Kista / Eksisi dengan Lokal Anastesi 0 0 0 0 675,000 675,000 675,000
Aspirasi Pneumotoraks 250,000 250,000 250,000 250,000 0 0 0
Aspirasi sendi 135,000 135,000 135,000 135,000 135,000 135,000 135,000
Aspirasi SST dan Evaluasi _ 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Aspiration of bursa of hand 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000
Aspiration of other soft tissue 3,856,600 3,856,600 3,856,600 3,856,600 3,856,600 3,856,600 3,856,600
Aspiration of other soft tissue of hand 3,856,600 3,856,600 3,856,600 3,856,600 3,856,600 3,856,600 3,856,600
Assay Faktor VIII 309,000 309,000 309,000 309,000 0 0 0
Assesment ADHD 75,000 75,000 75,000 75,000 75,000 75,000 75,000
Assesment Analysis Behavior 78,000 78,000 78,000 78,000 117,000 117,000 117,000
Assesment Autisme 75,000 75,000 75,000 75,000 75,000 75,000 75,000
Assesment Autisme CARS 220,000 220,000 220,000 220,000 330,000 330,000 330,000
Assesment Corners 50,000 50,000 50,000 50,000 50,000 50,000 50,000
Assesment dan Check Out Oetotis & Prostesis 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Dekondisi 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Diet DM asupan Oral 78,000 78,000 78,000 78,000 117,000 117,000 117,000
Assesment DSM IV untuk Autisme 150,000 150,000 150,000 150,000 225,000 225,000 225,000
Assesment DSM IV untuk GPPH 150,000 150,000 150,000 150,000 225,000 225,000 225,000
Assesment Edukasi Pengaturan Diet Dengan Dosis Insulin 120,000 120,000 120,000 120,000 180,000 180,000 180,000
Assesment Evaluasi Autis-CHAT 220,000 220,000 220,000 220,000 330,000 330,000 330,000
Assesment Evaluasi Hiperaktivitas GPPH 220,000 220,000 220,000 220,000 330,000 330,000 330,000
Assesment Fleksibilitas dan Lingkup Gerak 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Fungsi Berkemih 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Fungsi Defekasi 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Fungsi Eksekusi Gerak 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Fungsi Kardiorespirasi 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Fungsi Komunikasi 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Fungsi lokomotor 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Fungsi Memori 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Fungsi Menelan 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Integrasi Sensori Motor 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Kebugaran 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Kekuatan Otot 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Kemampuan Fungsional dan Perawatan Diri 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Keseimbangan Statik dan Dinamik 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Kontrol Postural 78,000 78,000 78,000 78,000 117,000 117,000 117,000
Assesment meningeal Sign 78,000 78,000 78,000 78,000 117,000 117,000 117,000
Assesment Motorik Halus 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Nervus Cranialis (Saraf Anak) 100,000 100,000 100,000 100,000 150,000 150,000 150,000
Assesment Nervus Cranialis (Tumbuh Kembang Anak) 78,000 78,000 78,000 78,000 117,000 117,000 117,000
Assesment Nyeri 103,000 103,000 103,000 103,000 155,000 155,000 155,000
Assesment Parental Education 100,000 100,000 100,000 100,000 150,000 150,000 150,000
Assesment Pendengaran Manual 78,000 78,000 78,000 78,000 117,000 117,000 117,000
Assesment Perawakan Pendek 120,000 120,000 120,000 120,000 0 0 0
Assesment Perkembangan kognitif CAT-CLAMPS 270,000 270,000 270,000 270,000 405,000 405,000 405,000
Assesment Perkembangan Umum 170,000 170,000 170,000 170,000 255,000 255,000 255,000
Assesment Pertumbuhan 78,000 78,000 78,000 78,000 117,000 117,000 117,000
Assesment Pola Jalan 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Postur 78,000 78,000 78,000 78,000 117,000 117,000 117,000
Assesment Postur Kontrol 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Reflex Fisiologis 80,000 80,000 80,000 80,000 120,000 120,000 120,000
Assesment Reflex Patologis 80,000 80,000 80,000 80,000 120,000 120,000 120,000
Assesment Sensibilitas 78,000 78,000 78,000 78,000 117,000 117,000 117,000
Assesment Sensibilitas (Rehabilitasi Medik) 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Assesment Sistem Saraf Otonom 78,000 78,000 78,000 78,000 117,000 117,000 117,000
Assesment Skiring masalah mental emosional 220,000 220,000 220,000 220,000 330,000 330,000 330,000
Assesment Waktu Pendarahan 78,000 78,000 78,000 78,000 117,000 117,000 117,000
ASTO _ 165,000 165,000 165,000 165,000 165,000 165,000 165,000
Astresia Esofagus 9,464,367 9,464,367 9,464,367 9,464,367 9,464,367 9,464,367 9,464,367
Asuhan Nutrisi Pediatric 150,000 150,000 150,000 150,000 225,000 225,000 225,000
Atlas-axis spinal fusion 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000
Attachment of pedicle or flap graft to hand 10,925,000 10,925,000 10,925,000 10,925,000 10,925,000 10,925,000 10,925,000
Attachment of pedicle or flap graft to other sites 10,925,000 10,925,000 10,925,000 10,925,000 10,925,000 10,925,000 10,925,000
Audiometri 150,000 150,000 150,000 150,000 225,000 225,000 225,000
Autis/Anak (1 Jam) 200,000 200,000 200,000 200,000 200,000 200,000 200,000
AV Replacement (AVR) 65,150,000 65,150,000 65,150,000 65,150,000 65,150,000 65,150,000 65,150,000
AV Shunt dengan graft vena/sintetis 15,450,000 15,450,000 15,450,000 15,450,000 15,450,000 15,450,000 15,450,000
BAS / Pemasangan Coil + Anastesi 49,334,000 49,334,000 49,334,000 49,334,000 49,334,000 49,334,000 49,334,000
BAS di Cath Lab / Pemasangan Coil 38,935,861 38,935,861 38,935,861 38,935,861 38,935,861 38,935,861 38,935,861
BCPS + PA Banding 31,950,000 31,950,000 31,950,000 31,950,000 31,950,000 31,950,000 31,950,000
BCPS Bilateral+Mitral Cleft repair 39,150,000 39,150,000 39,150,000 39,150,000 39,150,000 39,150,000 39,150,000
BCPS On Pump atau off Pump/Repair Fistula Coroner/Repair Vascular ring 38,350,000 38,350,000 38,350,000 38,350,000 38,350,000 38,350,000 38,350,000
BCPS+Ligasi BT Shunt 38,750,000 38,750,000 38,750,000 38,750,000 38,750,000 38,750,000 38,750,000
BCPS+PDA Ligasi 38,990,000 38,990,000 38,990,000 38,990,000 38,990,000 38,990,000 38,990,000
BCR - ABL 2,800,000 2,800,000 2,800,000 2,800,000 2,800,000 2,800,000 2,800,000
BCR-ABL Kualitatif (P) 1,050,000 1,050,000 1,050,000 1,050,000 1,050,000 1,050,000 1,050,000
Bedah Beku (Besar) 750,000 750,000 750,000 750,000 1,125,000 1,125,000 1,125,000
Bedah Beku (Kecil) 210,000 210,000 210,000 210,000 315,000 315,000 315,000
Bedah Beku (Sedang) 470,000 470,000 470,000 470,000 705,000 705,000 705,000
Bedah Laparoskopi Anak 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Bedah Listrik 66,000 66,000 66,000 66,000 0 0 0
Bedah Skapel 250,000 250,000 250,000 250,000 0 0 0
Belah Dagu 0 0 0 0 5,097,390 5,097,390 5,097,390
Belloq Tampon 50,000 50,000 50,000 50,000 75,000 75,000 75,000
Belloque Tampon Dalam Narkose 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Bentall/Ross Procedure/Eksisi Sub Aortic Stenosis + VSD Closure + PDA Ligasi + Epicardial PPM/ Rastelli With Contegra / Operasi Jantung Terbuka dengan dua Katup dan Pacu Jantung Temporer 79,550,000 79,550,000 79,550,000 79,550,000 79,550,000 79,550,000 79,550,000
Beta HCG Kwantitatif 244,000 244,000 244,000 244,000 244,000 244,000 244,000
Beta 2 Glycoprotein 1 (B2GP-1) 563,000 563,000 563,000 563,000 563,000 563,000 563,000
Biakan dan Resistensi (Medium Cair) 500,000 500,000 500,000 500,000 500,000 500,000 500,000
Biakan dan Resistensi (Medium Padat) 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Biakan dan Resistensi TB (medium Padat OAT Lini 1-2) 438,000 438,000 438,000 438,000 438,000 438,000 438,000
Biakan Salmonela Shigela (Biakan SS) 88,000 88,000 88,000 88,000 88,000 88,000 88,000
Bilas Lambung 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Bilirubin Direk _ 32,000 32,000 32,000 32,000 32,000 32,000 32,000
Bilirubin Indirect 25,000 25,000 25,000 25,000 25,000 25,000 25,000
Bilirubin Total _ 32,000 32,000 32,000 32,000 32,000 32,000 32,000
Biofeed Back 28,800 28,800 28,800 28,800 36,000 36,000 36,000
Biometri 78,000 78,000 78,000 78,000 117,000 117,000 117,000
Biopsi Aspirasi transtorakal dengan tuntutan CT - SCAN 540,000 540,000 540,000 540,000 810,000 810,000 810,000
Biopsi Aspirasi transtorakal dengan tuntutan USG 318,000 318,000 318,000 318,000 477,000 477,000 477,000
Biopsi ca. penis & kel. inguinal 2,500,000 2,500,000 2,500,000 2,500,000 2,500,000 2,500,000 2,500,000
Biopsi Cerviks - Pasang Tampon 250,000 250,000 250,000 250,000 0 0 0
Biopsi Core 675,000 675,000 675,000 675,000 0 0 0
Biopsi dalam Narkose Umum 3,431,074 3,431,074 3,431,074 3,431,074 3,431,074 3,431,074 3,431,074
Biopsi Eksisi Kelenjar Getah Bening dengan Anastesi Umum 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000
Biopsi Eksisional dalam Narkose 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Biopsi Ekstirpasi dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Biopsi Endoskopi 250,000 250,000 250,000 250,000 0 0 0
Biopsi Ginjal 222,000 222,000 222,000 222,000 222,000 222,000 222,000
Biopsi Ginjal perkutan 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Biopsi Ginjal Terbuka 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Biopsi Hippfaring Onko 250,000 250,000 250,000 250,000 0 0 0
Biopsi Incisional dalam Narkose 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Biopsi Insisi Dengan Lokal Anastesi 675,000 675,000 675,000 675,000 675,000 675,000 675,000
Biopsi Insisi Tumor dengan Anastesi Umum 3,431,074 3,431,074 3,431,074 3,431,074 3,431,074 3,431,074 3,431,074
Biopsi Insisional Tumor Leher Onko 250,000 250,000 250,000 250,000 0 0 0
Biopsi Jaringan 479,000 479,000 479,000 479,000 479,000 479,000 479,000
Biopsi Jaringan + Anastesi 1,217,000 1,217,000 1,217,000 1,217,000 1,217,000 1,217,000 1,217,000
Biopsi Jaringan + Anastesi (OK Obgyn) 1,423,000 1,423,000 1,423,000 1,423,000 1,423,000 1,423,000 1,423,000
Biopsi Jaringan Besar 800,000 800,000 800,000 800,000 800,000 800,000 800,000
Biopsi Jaringan Kecil 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Biopsi Jaringan Sedang 600,000 600,000 600,000 600,000 600,000 600,000 600,000
Biopsi Jarum 63,000 63,000 63,000 63,000 95,000 95,000 95,000
Biopsi Jarum Halus 675,000 675,000 675,000 675,000 0 0 0
Biopsi khusus (Hati, Ginjal, Gaster, Colon, Esofagus) 1-2 Jaringan 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Biopsi khusus (Hati, Ginjal, Gaster, Colon, Esofagus) 3-4 Jaringan 600,000 600,000 600,000 600,000 600,000 600,000 600,000
Biopsi khusus (Hati, Ginjal, Gaster, Colon, Esofagus) Lebih dari 4 Jaringan 800,000 800,000 800,000 800,000 800,000 800,000 800,000
Biopsi Kista 0 0 0 0 675,000 675,000 675,000
Biopsi Kulit (Besar) 560,000 560,000 560,000 560,000 840,000 840,000 840,000
Biopsi Kulit (Sedang) 480,000 480,000 480,000 480,000 720,000 720,000 720,000
Biopsi Lidah Palatum Onko 250,000 250,000 250,000 250,000 0 0 0
Biopsi Nasofaring Fiber Onko 250,000 250,000 250,000 250,000 0 0 0
Biopsi Nasofaring Rigid Onko 250,000 250,000 250,000 250,000 0 0 0
Biopsi Penis 675,000 675,000 675,000 675,000 0 0 0
Biopsi Permukaan 120,000 120,000 120,000 120,000 120,000 120,000 120,000
Biopsi Prostat 3,796,000 3,796,000 3,796,000 3,796,000 3,796,000 3,796,000 3,796,000
Biopsi Prostat (ESWL) 2,500,000 2,500,000 2,500,000 2,500,000 2,500,000 2,500,000 2,500,000
Biopsi rectum full thicknesis 3,431,074 3,431,074 3,431,074 3,431,074 3,431,074 3,431,074 3,431,074
Biopsi Saraf Kutaneus/Otot (Bedah Syaraf) 5,334,000 5,334,000 5,334,000 5,334,000 5,334,000 5,334,000 5,334,000
Biopsi Sinus Maksila Onko 250,000 250,000 250,000 250,000 0 0 0
Biopsi Telinga 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Biopsi Testis 3,806,011 3,806,011 3,806,011 3,806,011 3,806,011 3,806,011 3,806,011
Biopsi Tumor Hidung Onko 250,000 250,000 250,000 250,000 375,000 375,000 375,000
Biopsi Tumor Hidung. Lidah. Nasofaring THT 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Biopsi Tumor Kelopak 675,000 675,000 675,000 675,000 0 0 0
Biopsi Tumor Oral Cavity LF 250,000 250,000 250,000 250,000 375,000 375,000 375,000
Biopsi Tumor Orbita 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Biopsi Vertebra (1 Level) 3,532,812 3,532,812 3,532,812 3,532,812 3,532,812 3,532,812 3,532,812
Biopsi/Proof Laparatomy 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Biopsy of bone 9,190,468 9,190,468 9,190,468 9,190,468 9,190,468 9,190,468 9,190,468
Biopsy of bone marrow 2,998,053 2,998,053 2,998,053 2,998,053 2,998,053 2,998,053 2,998,053
Biopsy of carpals and metacarpals 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000
Biopsy of femur 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000
Biopsy of humerus 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000
Biopsy of joint structure of ankle 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Biopsy of joint structure of elbow 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Biopsy of joint structure of foot and toe 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Biopsy of joint structure of hand and finger 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Biopsy of joint structure of hip 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Biopsy of joint structure of knee 2,888,053 2,888,053 2,888,053 2,888,053 2,888,053 2,888,053 2,888,053
Biopsy of joint structure of shoulder 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Biopsy of joint structure of wrist 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Biopsy of joint structure, unspecified site 2,998,053 2,998,053 2,998,053 2,998,053 2,998,053 2,998,053 2,998,053
Biopsy of other bone, except facial bone 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000
Biopsy of patella 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000
Biopsy of radius and ulna 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000
Biopsy of scapula, clavicle, and thorax (ribs and sternum) 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000
Biopsy of soft tissue 3,864,200 3,864,200 3,864,200 3,864,200 3,864,200 3,864,200 3,864,200
Biopsy of spinal cord or spinal meninges 21,867,928 21,867,928 21,867,928 21,867,928 21,867,928 21,867,928 21,867,928
Biopsy of tarsals and metatarsals 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000
Biopsy of tibia and fibula 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000 5,202,000
Biotrainer 43,200 43,200 43,200 43,200 54,000 54,000 54,000
Blaas Functie 87,000 87,000 87,000 87,000 87,000 87,000 87,000
Bladder Neck Incision 6,923,000 6,923,000 6,923,000 6,923,000 6,923,000 6,923,000 6,923,000
Blandder Training 78,000 78,000 78,000 78,000 0 0 0
Blanket 46,000 46,000 46,000 46,000 46,000 46,000 46,000
Blanket Rol 46,000 46,000 46,000 46,000 46,000 46,000 46,000
Blanoplasty 0 0 0 0 2,000,000 2,000,000 2,000,000
Bleaching eksternal 0 0 0 0 2,500,000 2,500,000 2,500,000
Bleaching Internal 0 0 0 0 400,000 400,000 400,000
Blenharroplastik Atas 0 0 0 0 4,550,000 4,550,000 4,550,000
Blenharroplastik Bawah ( Kantong Mata ) 0 0 0 0 5,600,000 5,600,000 5,600,000
Blok Resectie 2,960,000 2,960,000 2,960,000 2,960,000 2,960,000 2,960,000 2,960,000
Blok Saraf Tepi (Bedah Syaraf) 5,304,000 5,304,000 5,304,000 5,304,000 5,304,000 5,304,000 5,304,000
Blowing Exercise Meter 39,600 39,600 39,600 39,600 55,000 55,000 60,000
BMP (Bone Morrow Fucture) 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000
BNO - IVP 375,000 375,000 375,000 375,000 375,000 375,000 375,000
Body Jacket 5,500,000 5,500,000 5,500,000 5,500,000 8,250,000 8,250,000 8,250,000
Bone graft of carpals and metacarpals 13,304,994 13,304,994 13,304,994 13,304,994 13,304,994 13,304,994 13,304,994
Bone graft of femur 13,154,994 13,154,994 13,154,994 13,154,994 13,154,994 13,154,994 13,154,994
Bone graft of humerus 13,254,994 13,254,994 13,254,994 13,254,994 13,254,994 13,254,994 13,254,994
Bone graft of patella 23,004,994 23,004,994 23,004,994 23,004,994 23,004,994 23,004,994 23,004,994
Bone graft of radius and ulna 13,254,994 13,254,994 13,254,994 13,254,994 13,254,994 13,254,994 13,254,994
Bone graft of scapula, clavicle, and thorax (ribs and sternum) 6,504,994 6,504,994 6,504,994 6,504,994 6,504,994 6,504,994 6,504,994
Bone graft of tarsals and metatarsals 8,504,994 8,504,994 8,504,994 8,504,994 8,504,994 8,504,994 8,504,994
Bone graft of tibia and fibula 23,004,994 23,004,994 23,004,994 23,004,994 23,004,994 23,004,994 23,004,994
Bone graft scapula, clavicle and thorax (ribs and sternum) 6,504,994 6,504,994 6,504,994 6,504,994 6,504,994 6,504,994 6,504,994
Bone Survey 450,000 450,000 450,000 450,000 450,000 450,000 450,000
Boston Brace 5,000,000 5,000,000 5,000,000 5,000,000 7,500,000 7,500,000 7,500,000
Bouginasi/Dilatasi Urethra (ESWL) 740,000 740,000 740,000 740,000 740,000 740,000 740,000
Brachytherapi - Base Of Tounge (1 X Tindakan + 4X Penyinaran + 1X Anestesi) 19,000,000 19,000,000 19,000,000 19,000,000 19,000,000 19,000,000 19,000,000
Brachytherapi - Base Of Tounge (1 X Tindakan + 4X Penyinaran + 1X Anestesi) + Anastesi 23,560,000 23,560,000 23,560,000 23,560,000 23,560,000 23,560,000 23,560,000
Brachytherapi - Base Of Tounge (1 X Tindakan + 6X Penyinaran + 1X Anestesi) 23,000,000 23,000,000 23,000,000 23,000,000 23,000,000 23,000,000 23,000,000
Brachytherapi - Base Of Tounge (1 X Tindakan + 6X Penyinaran + 1X Anestesi) + Anastesi 28,520,000 28,520,000 28,520,000 28,520,000 28,520,000 28,520,000 28,520,000
Brachytherapi - Cervix Implantas (1 X Tindakan + 2X Penyinaran + 1X Anestesi) 11,000,000 11,000,000 11,000,000 11,000,000 11,000,000 11,000,000 11,000,000
Brachytherapi - Cervix Implantas (1 X Tindakan + 2X Penyinaran + 1X Anestesi) + Anastesi 13,640,000 13,640,000 13,640,000 13,640,000 13,640,000 13,640,000 13,640,000
Brachytherapi - Cervix Implantas (1 X Tindakan + 4X Penyinaran + 1X Anestesi) 13,000,000 13,000,000 13,000,000 13,000,000 13,000,000 13,000,000 13,000,000
Brachytherapi - Cervix Implantas (1 X Tindakan + 4X Penyinaran + 1X Anestesi) + Anastesi 16,120,000 16,120,000 16,120,000 16,120,000 16,120,000 16,120,000 16,120,000
Brachytherapi - Cervix Implantas (1 X Tindakan + 6X Penyinaran + 1X Anestesi) 16,000,000 16,000,000 16,000,000 16,000,000 16,000,000 16,000,000 16,000,000
Brachytherapi - Cervix Implantas (1 X Tindakan + 6X Penyinaran + 1X Anestesi) + Anastesi 19,840,000 19,840,000 19,840,000 19,840,000 19,840,000 19,840,000 19,840,000
Brachytherapi - Cervix Intrakaviter Lengkap ( 2X Tindakan + 2X Penyinaran + 2X Anestesi ) 16,000,000 16,000,000 16,000,000 16,000,000 0 0 0
Brachytherapi - Cervix Intrakaviter Lengkap ( 2X Tindakan + 2X Penyinaran + 2X Anestesi ) + Anastesi 19,840,000 19,840,000 19,840,000 19,840,000 19,840,000 19,840,000 19,840,000
Brachytherapi - Cervix Intrakaviter Lengkap ( 3X Tindakan + 3X Penyinaran + 3X Anestesi ) 21,000,000 21,000,000 21,000,000 21,000,000 0 0 0
Brachytherapi - Cervix Intrakaviter Lengkap ( 3X Tindakan + 3X Penyinaran + 3X Anestesi ) + Anastesi 26,040,000 26,040,000 26,040,000 26,040,000 26,040,000 26,040,000 26,040,000
Brachytherapi - Kulit (1 X Tindakan + 2X Penyinaran + 1X Anestesi) 6,000,000 6,000,000 6,000,000 6,000,000 6,000,000 6,000,000 6,000,000
Brachytherapi - Kulit (1 X Tindakan + 2X Penyinaran + 1X Anestesi) + Anastesi 7,440,000 7,440,000 7,440,000 7,440,000 7,440,000 7,440,000 7,440,000
Brachytherapi - Kulit (1 X Tindakan + 3X Penyinaran + 1X Anestesi) 9,000,000 9,000,000 9,000,000 9,000,000 9,000,000 9,000,000 9,000,000
Brachytherapi - Kulit (1 X Tindakan + 3X Penyinaran + 1X Anestesi) + Anastesi 11,160,000 11,160,000 11,160,000 11,160,000 11,160,000 11,160,000 11,160,000
Brachytherapi - Lidah Anterior (1 X Tindakan + 4X Penyinaran + 1X Anestesi) 13,000,000 13,000,000 13,000,000 13,000,000 13,000,000 13,000,000 13,000,000
Brachytherapi - Lidah Anterior (1 X Tindakan + 4X Penyinaran + 1X Anestesi) + Anastesi 16,840,000 16,840,000 16,840,000 16,840,000 16,840,000 16,840,000 16,840,000
Brachytherapi - Lidah Anterior (1 X Tindakan + 6X Penyinaran + 1X Anestesi) 19,000,000 19,000,000 19,000,000 19,000,000 19,000,000 19,000,000 19,000,000
Brachytherapi - Lidah Anterior (1 X Tindakan + 6X Penyinaran + 1X Anestesi) + Anastesi 23,560,000 23,560,000 23,560,000 23,560,000 23,560,000 23,560,000 23,560,000
Brachytherapi - Nasofaring Intralumen (1 X Tindakan + 4X Penyinaran + 1X Anestesi) 12,000,000 12,000,000 12,000,000 12,000,000 12,000,000 12,000,000 12,000,000
Brachytherapi - Nasofaring Intralumen (1 X Tindakan + 4X Penyinaran + 1X Anestesi) + Anastesi 14,880,000 14,880,000 14,880,000 14,880,000 14,880,000 14,880,000 14,880,000
Brachytherapi - Nasofaring Intralumen (1 X Tindakan + 6X Penyinaran + 1X Anestesi) 15,000,000 15,000,000 15,000,000 15,000,000 15,000,000 15,000,000 15,000,000
Brachytherapi - Nasofaring Intralumen (1 X Tindakan + 6X Penyinaran + 1X Anestesi) + Anastesi 18,600,000 18,600,000 18,600,000 18,600,000 18,600,000 18,600,000 18,600,000
Brachytherapi - Ovoid ( 2X Tindakan + 2X Penyinaran + 2X Anestesi ) 10,000,000 10,000,000 10,000,000 10,000,000 0 0 0
Brachytherapi - Ovoid ( 2X Tindakan + 2X Penyinaran + 2X Anestesi ) + Anastesi 12,400,000 12,400,000 12,400,000 12,400,000 12,400,000 12,400,000 12,400,000
Brachytherapi - Ovoid ( 3X Tindakan + 3X Penyinaran + 3X Anestesi ) 16,000,000 16,000,000 16,000,000 16,000,000 0 0 0
Brachytherapi - Ovoid ( 3X Tindakan + 3X Penyinaran + 3X Anestesi ) + Anastesi 19,840,000 19,840,000 19,840,000 19,840,000 19,840,000 19,840,000 19,840,000
Brachytherapi - Payudara (1 X Tindakan + 1X Penyinaran + 1X Anestesi) 6,000,000 6,000,000 6,000,000 6,000,000 6,000,000 6,000,000 6,000,000
Brachytherapi - Payudara (1 X Tindakan + 1X Penyinaran + 1X Anestesi) + Anastesi 7,440,000 7,440,000 7,440,000 7,440,000 7,440,000 7,440,000 7,440,000
Brachytherapi - Payudara (1 X Tindakan + 2X Penyinaran + 1X Anestesi) 9,000,000 9,000,000 9,000,000 9,000,000 9,000,000 9,000,000 9,000,000
Brachytherapi - Payudara (1 X Tindakan + 2X Penyinaran + 1X Anestesi) + Anastesi 11,160,000 11,160,000 11,160,000 11,160,000 11,160,000 11,160,000 11,160,000
Brachytherapi - Perineal Implantasi (1 X Tindakan + 1X Penyinaran + 1X Anestesi) 10,000,000 10,000,000 10,000,000 10,000,000 0 0 0
Brachytherapi - Perineal Implantasi (1 X Tindakan + 1X Penyinaran + 1X Anestesi) + Anastesi 12,400,000 12,400,000 12,400,000 12,400,000 12,400,000 12,400,000 12,400,000
Brachytherapi - Perineal Implantasi (1 X Tindakan + 2X Penyinaran + 1X Anestesi) 11,000,000 11,000,000 11,000,000 11,000,000 0 0 0
Brachytherapi - Perineal Implantasi (1 X Tindakan + 2X Penyinaran + 1X Anestesi) + Anastesi 13,640,000 13,640,000 13,640,000 13,640,000 13,640,000 13,640,000 13,640,000
Brachytherapi - Perineal Implantasi (1X Tindakan + 3X Penyinaran + 1X Anestesi) 12,000,000 12,000,000 12,000,000 12,000,000 0 0 0
Brachytherapi - Perineal Implantasi (1X Tindakan + 3X Penyinaran + 1X Anestesi) + Anastesi 14,880,000 14,880,000 14,880,000 14,880,000 14,880,000 14,880,000 14,880,000
Brachytherapi - Radiasi Interna ( Terapi Iodium SO/2000/150 mCi ) 919,000 919,000 919,000 919,000 919,000 919,000 919,000
Brachytherapi - Radiasi Interna ( Terapi Samarium 50 mCi ) 788,000 788,000 788,000 788,000 788,000 788,000 788,000
Break up Time 33,000 33,000 33,000 33,000 50,000 50,000 50,000
Breakfast Paket C 55,000 55,000 55,000 55,000 55,000 55,000 55,000
Breast Conserving Surgery 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Breathing Exercise 70,000 70,000 70,000 70,000 105,000 105,000 105,000
Brock + BT Shunt / ASD Closure + PDA Ligasi 40,350,000 40,350,000 40,350,000 40,350,000 40,350,000 40,350,000 40,350,000
Brock/BT Shunt/Coarctasio Aorta/PA Banding/Sling/Unifokalisasi 29,950,000 29,950,000 29,950,000 29,950,000 29,950,000 29,950,000 29,950,000
Bronchoskopi Toileting dan Lavage 587,000 587,000 587,000 587,000 587,000 587,000 587,000
Bronchospirometri 187,000 187,000 187,000 187,000 187,000 187,000 187,000
broncoskopi 900,000 900,000 900,000 900,000 900,000 900,000 900,000
Bronkoskopi Bilasan 805,000 805,000 805,000 805,000 805,000 805,000 805,000
Bronkoskopi Bilasan + Anastesi 1,585,000 1,585,000 1,585,000 1,585,000 1,585,000 1,585,000 1,585,000
Bronkoskopi Diagnostik 805,000 805,000 805,000 805,000 805,000 805,000 805,000
Bronkoskopi Diagnostik + Anastesi 1,585,000 1,585,000 1,585,000 1,585,000 1,585,000 1,585,000 1,585,000
Bronkoskopi Sikatan 805,000 805,000 805,000 805,000 805,000 805,000 805,000
Bronkoskopi Sikatan + Anastesi 1,585,000 1,585,000 1,585,000 1,585,000 1,585,000 1,585,000 1,585,000
Bronschoscopy (COT) 5,656,405 5,656,405 5,656,405 5,656,405 5,656,405 5,656,405 5,656,405
Brushing melalui Bronchoschopy 188,000 188,000 188,000 188,000 188,000 188,000 188,000
BSEF/FESS 1 : Mini 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
BSEF/FESS 2 : Mini+Maksila/etmoid 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
BSEF/FESS 3: Mini+Frontal/Sfenoid 5,850,000 5,850,000 5,850,000 5,850,000 5,850,000 5,850,000 5,850,000
BSEF/FESS 4 : Mini+maksila/etmoid+frontal/sfenoid 5,850,000 5,850,000 5,850,000 5,850,000 5,850,000 5,850,000 5,850,000
BSEF/FESS lanjut : Ekstirpasi Tumor.Penutupan defek intrakranial 5,850,000 5,850,000 5,850,000 5,850,000 5,850,000 5,850,000 5,850,000
BT Shunt+Ligasi MAPCA 36,190,000 36,190,000 36,190,000 36,190,000 36,190,000 36,190,000 36,190,000
BTA 1X Biakan Resistensi Medium Cair OAT Lini 1',0);?> 438,000 438,000 438,000 438,000 438,000 438,000 438,000
BTA 1X Biakan Resistensi Medium Cair OAT Lini 2',0);?> 500,000 500,000 500,000 500,000 500,000 500,000 500,000
BTA 3X Biakan Medium Cair 375,000 375,000 375,000 375,000 375,000 375,000 375,000
BTA 3X Biakan Medium Padat 188,000 188,000 188,000 188,000 188,000 188,000 188,000
Buka / Pasang Pesarium 116,000 116,000 116,000 116,000 174,000 174,000 174,000
Buka Gips 69,000 69,000 69,000 69,000 0 0 0
Buka Jahitan (Poli Jantung) 150,000 150,000 150,000 150,000 225,000 225,000 225,000
Buka Obtorator 55,000 55,000 55,000 55,000 65,000 65,000 65,000
Buka Tampon / Kassa Kamicetin 140,000 140,000 140,000 140,000 166,000 166,000 166,000
Buka Wiring dengan Anastesi Lokal 270,000 270,000 270,000 270,000 319,000 319,000 319,000
Buku ICV 25,000 25,000 25,000 25,000 25,000 25,000 25,000
Bunionectomy with soft tissue correction and arthrodesis 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000
Bunionectomy with soft tissue correction and osteotomy of the first metatarsal 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000
Bursectomy of hand 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Bursotomy 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Bursotomy of hand 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000
Businasi 308,000 308,000 308,000 308,000 462,000 462,000 462,000
Businasi Hurtz (akhalasia) 966,000 966,000 966,000 966,000 966,000 966,000 966,000
Businasi Urethra 308,000 308,000 308,000 308,000 0 0 0
Butterfly Bath 98,400 98,400 98,400 98,400 123,000 123,000 123,000
C3 Komplemen (P) 500,000 500,000 500,000 500,000 500,000 500,000 500,000
C4 Komplemen (P) 500,000 500,000 500,000 500,000 500,000 500,000 500,000
CA 12-5 _ 265,000 265,000 265,000 265,000 265,000 265,000 265,000
CA 15-3 _ 350,000 350,000 350,000 350,000 350,000 350,000 350,000
CA 19-9 _ 300,000 300,000 300,000 300,000 300,000 300,000 300,000
CABG Lima + TV Repair/TAP DE VEGA + TPM + PPM/Endovasculer Stent Aorta 104,350,000 104,350,000 104,350,000 104,350,000 104,350,000 104,350,000 104,350,000
CABG Lima+Repair Aneurysme Artery Coroner 65,950,000 65,950,000 65,950,000 65,950,000 65,950,000 65,950,000 65,950,000
CABG+DVR 80,350,000 80,350,000 80,350,000 80,350,000 80,350,000 80,350,000 80,350,000
Cabut atau Tambal Gigi Tanpa Komplikasi 66,000 66,000 66,000 66,000 0 0 0
Cabut DJ Stent 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000
Cabut Gigi tetap dengan Komplikasi/Penyulit 66,000 66,000 66,000 66,000 0 0 0
Cabut IUD dengan Penyulit 173,000 173,000 173,000 173,000 260,000 260,000 260,000
Cabut Susut dengan Penyulit 253,000 253,000 253,000 253,000 380,000 380,000 380,000
Calcium Ion 45,000 45,000 45,000 45,000 45,000 45,000 45,000
Caldwell Luc Anthrostomi 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Calsium _ 35,000 35,000 35,000 35,000 35,000 35,000 35,000
Cantharidin < 5 Lesi / > 5 Lesi 66,000 66,000 66,000 66,000 0 0 0
Cardio Toco Graphy (CTG)/Kebidanan 299,000 299,000 299,000 299,000 0 0 0
Carotid Doppler 725,000 725,000 725,000 725,000 1,088,000 1,088,000 1,088,000
Carotid Duplex Doppler 400,000 400,000 400,000 400,000 0 0 0
Carporadial fusion 5,596,121 5,596,121 5,596,121 5,596,121 5,596,121 5,596,121 5,596,121
Catherisasi pada Retensi Urin 56,000 56,000 56,000 56,000 84,000 84,000 84,000
CEA _ 280,000 280,000 280,000 280,000 280,000 280,000 280,000
Cek GDS 15,000 15,000 15,000 15,000 15,000 15,000 15,000
Cek Permanent Pace Maker 75,000 75,000 75,000 75,000 113,000 113,000 113,000
Chairback (Biasa) 1,320,000 1,320,000 1,320,000 1,320,000 1,980,000 1,980,000 1,980,000
Chairback (Khusus) 2,850,000 2,850,000 2,850,000 2,850,000 4,275,000 4,275,000 4,275,000
Chemo surgery Podophyllin 66,000 66,000 66,000 66,000 0 0 0
Chemo surgery TCAA 66,000 66,000 66,000 66,000 99,000 99,000 99,000
ChemoEmbolisasi pada Hepatoma/tumor lain 24,883,390 24,883,390 24,883,390 24,883,390 24,883,390 24,883,390 24,883,390
Chest Port 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000
Chest Re Open Rekonstruksi 14,750,000 14,750,000 14,750,000 14,750,000 14,750,000 14,750,000 14,750,000
Cholinesterase 30,000 30,000 30,000 30,000 30,000 30,000 30,000
Cimino (Bedah Vaskuler) 4,784,000 4,784,000 4,784,000 4,784,000 4,784,000 4,784,000 4,784,000
Circumsisi bayi dan anak dengan anastesi umum 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000
CK _ 65,000 65,000 65,000 65,000 65,000 65,000 65,000
CK-MB _ 65,000 65,000 65,000 65,000 65,000 65,000 65,000
Clinical Kaustik 66,000 66,000 66,000 66,000 0 0 0
Closed Reduction dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Closed reduction of dislocation of ankle 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000
Closed reduction of dislocation of elbow 2,799,523 2,799,523 2,799,523 2,799,523 2,799,523 2,799,523 2,799,523
Closed reduction of dislocation of foot and toe 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000
Closed reduction of dislocation of hand and finger 2,799,523 2,799,523 2,799,523 2,799,523 2,799,523 2,799,523 2,799,523
Closed reduction of dislocation of hip 3,899,523 3,899,523 3,899,523 3,899,523 3,899,523 3,899,523 3,899,523
Closed reduction of dislocation of knee 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000
Closed reduction of dislocation of shoulder 2,849,523 2,849,523 2,849,523 2,849,523 2,849,523 2,849,523 2,849,523
Closed reduction of dislocation of wrist 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000
Closed reduction of fracture with internal fixation, carpals and metacarpals 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Closed reduction of fracture with internal fixation, femur 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Closed reduction of fracture with internal fixation, humerus 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Closed reduction of fracture with internal fixation, phalanges of foot 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Closed reduction of fracture with internal fixation, radius and ulna 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Closed reduction of fracture with internal fixation, tarsals and metatarsals 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Closed reduction of fracture with internal fixation, tibia and fibula 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Closed reduction of fracture with internal fixation,phalanges of hand 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Closed reduction of fracture without internal fixation, carpals and metacarpals 2,963,182 2,963,182 2,963,182 2,963,182 2,963,182 2,963,182 2,963,182
Closed reduction of fracture without internal fixation, femur 2,963,182 2,963,182 2,963,182 2,963,182 2,963,182 2,963,182 2,963,182
Closed reduction of fracture without internal fixation, humerus 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000
Closed reduction of fracture without internal fixation, phalanges of foot 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000
Closed reduction of fracture without internal fixation, phalanges of hand 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000
Closed reduction of fracture without internal fixation, radius and ulna 2,963,182 2,963,182 2,963,182 2,963,182 2,963,182 2,963,182 2,963,182
Closed reduction of fracture without internal fixation, tarsals and metatarsals 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000
Closed reduction of fracture without internal fixation, tibia and fibula 2,963,182 2,963,182 2,963,182 2,963,182 2,963,182 2,963,182 2,963,182
Closed reduction of separated epiphysis of femur 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000
Closed reduction of separated epiphysis of humerus 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000
Closed reduction of separated epiphysis of radius and ulna 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000
Closed reduction of separated epiphysis of tibia and fibula 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000 4,375,000
Coartasio Aorta Repair+PDA Ligasi+PA Banding 31,630,000 31,630,000 31,630,000 31,630,000 31,630,000 31,630,000 31,630,000
Cock Up Splint (Biasa) 1,800,000 1,800,000 1,800,000 1,800,000 2,700,000 2,700,000 2,700,000
Cock Up Splint (Standar/Khusus) 2,500,000 2,500,000 2,500,000 2,500,000 3,750,000 3,750,000 3,750,000
Colon - Inloop 500,000 500,000 500,000 500,000 500,000 500,000 500,000
Combination Therapi 43,200 43,200 43,200 43,200 54,000 54,000 54,000
Complicated Functional Neuro (P.Paraverteb/Visceral Blok) 9,094,887 9,094,887 9,094,887 9,094,887 9,094,887 9,094,887 9,094,887
Complicated Functional Neuro (Percuteneus Kordotomi) 11,110,887 11,110,887 11,110,887 11,110,887 11,110,887 11,110,887 11,110,887
Complicated Functional Neuro (Stereotaxy Kompleks) 14,736,887 14,736,887 14,736,887 14,736,887 14,736,887 14,736,887 14,736,887
Complicated Functional Neuro (Stereotaxy sederhana) 13,306,887 13,306,887 13,306,887 13,306,887 13,306,887 13,306,887 13,306,887
Comprehensive Geriatric Assesment (CGA) 66,000 66,000 66,000 66,000 66,000 66,000 66,000
Computer Spech Therapi 39,600 39,600 39,600 39,600 49,500 49,500 49,500
Condylotomy Mandibula 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Cone Biopsi/ Konisasi/ LETZ 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Congenital Formix Plastik/ Rekst Soket Berat 4,675,000 4,675,000 4,675,000 4,675,000 4,675,000 4,675,000 4,675,000
Cool Box (1X Pengiriman Darah) 10,000 10,000 10,000 10,000 10,000 10,000 10,000
Coombs' Test _ 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Cor Analysa 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Corangiography + TPM 7,033,000 7,033,000 7,033,000 7,033,000 7,033,000 7,033,000 7,033,000
Corangiography+Arteriografy/Corangiography+Katerisasi 9,200,000 9,200,000 9,200,000 9,200,000 9,200,000 9,200,000 9,200,000
Core Build-up Composite 0 0 0 0 500,000 500,000 500,000
Core Build-up Glass lonomer 0 0 0 0 350,000 350,000 350,000
Core Build-up Glass lonomer Pengambilan 2/3 Guttap 0 0 0 0 385,000 385,000 385,000
Corpus Alinium Cornea 250,000 250,000 250,000 250,000 0 0 0
Correction of syndactyly 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000
Cortisol (P) 448,000 448,000 448,000 448,000 448,000 448,000 448,000
Coustik Hidung 36,000 36,000 36,000 36,000 0 0 0
CPM 42,000 42,000 42,000 42,000 52,500 52,500 52,500
Cranial or peripheral nerve graft 11,682,099 11,682,099 11,682,099 11,682,099 11,682,099 11,682,099 11,682,099
Croos Insisi 44,000 44,000 44,000 44,000 66,000 66,000 66,000
Cross Leg Flap 8,950,000 8,950,000 8,950,000 8,950,000 8,950,000 8,950,000 8,950,000
Cross Matching 170,000 170,000 170,000 170,000 170,000 170,000 170,000
Crown & Bridge (Acrylic per unit) 295,000 295,000 295,000 295,000 445,000 445,000 445,000
Crown & Bridge (Porcelain per unit) 765,000 765,000 765,000 765,000 1,150,000 1,150,000 1,150,000
CRP Kuantitatif 130,000 130,000 130,000 130,000 130,000 130,000 130,000
CRRT (Continous Renal Replacement Therapy) 7,729,700 7,729,700 7,729,700 7,729,700 7,729,700 7,729,700 7,729,700
CRT / ICD 81,550,000 81,550,000 81,550,000 81,550,000 81,550,000 81,550,000 81,550,000
Cryo Jet 75,000 75,000 75,000 75,000 112,500 112,500 112,500
Cryo Therapi 43,200 43,200 43,200 43,200 54,000 54,000 54,000
Cryoglobulin 25,000 25,000 25,000 25,000 0 0 0
CT Abdomen Atas/Bawah ( Dengan Kontras ) 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000
CT Abdomen Atas/Bawah ( Dengan Kontras ) + Anestesi 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000
CT Abdomen Atas/Bawah ( Dengan Kontras ) Rujukan Luar 0 0 0 1,500,000 1,500,000 1,500,000 1,500,000
CT Abdomen Atas/Bawah ( Tanpa Kontras ) 875,000 875,000 875,000 875,000 875,000 875,000 875,000
CT Abdomen Atas/Bawah ( Tanpa Kontras ) + Anestesi 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000
CT Abdomen Atas/Bawah ( Tanpa Kontras ) Rujukan Luar 0 0 0 875,000 875,000 875,000 875,000
CT Cervical ( Dengan Kontras ) 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000
CT Cervical ( Dengan Kontras ) + Anestesi 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000
CT Cervical ( Tanpa Kontras ) 800,000 800,000 800,000 800,000 800,000 800,000 800,000
CT Cervical ( Tanpa Kontras ) + Anestesi 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000
CT Ekstremitas Atas/Bawah ( Dengan Kontras ) 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000
CT Ekstremitas Atas/Bawah ( Dengan Kontras ) + Anestesi 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000
CT Ekstremitas Atas/Bawah ( Tanpa Kontras ) 875,000 875,000 875,000 875,000 875,000 875,000 875,000
CT Ekstremitas Atas/Bawah ( Tanpa Kontras ) + Anestesi 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000
CT Kepala ( Dengan Kontras ) 900,000 900,000 900,000 900,000 900,000 900,000 900,000
CT Kepala ( Dengan Kontras ) + Anestesi 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000
CT Kepala ( Tanpa Kontras ) 750,000 750,000 750,000 750,000 750,000 750,000 750,000
CT Kepala ( Tanpa Kontras ) + Anestesi 910,000 910,000 910,000 910,000 910,000 910,000 910,000
CT Lumbal ( Dengan Kontras ) 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000
CT Lumbal ( Dengan Kontras ) + Anestesi 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000
CT Lumbal ( Tanpa Kontras ) 875,000 875,000 875,000 875,000 875,000 875,000 875,000
CT Lumbal ( Tanpa Kontras ) + Anestesi 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000
CT Mastoid ( Dengan Kontras ) 900,000 900,000 900,000 900,000 900,000 900,000 900,000
CT Mastoid ( Dengan Kontras ) + Anestesi 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000
CT Mastoid ( Tanpa Kontras ) 750,000 750,000 750,000 750,000 750,000 750,000 750,000
CT Mastoid ( Tanpa Kontras ) + Anestesi 910,000 910,000 910,000 910,000 910,000 910,000 910,000
CT Nasofaring ( Dengan Kontras ) 900,000 900,000 900,000 900,000 900,000 900,000 900,000
CT Nasofaring ( Dengan Kontras ) + Anestesi 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000
CT Nasofaring ( Tanpa Kontras ) 750,000 750,000 750,000 750,000 750,000 750,000 750,000
CT Nasofaring ( Tanpa Kontras ) + Anestesi 910,000 910,000 910,000 910,000 910,000 910,000 910,000
CT Pelvis ( Dengan Kontras ) 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000
CT Pelvis ( Dengan Kontras ) + Anestesi 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000
CT Pelvis ( Tanpa Kontras ) 875,000 875,000 875,000 875,000 875,000 875,000 875,000
CT Pelvis ( Tanpa Kontras ) + Anestesi 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000
CT Scan Simulator dengan kontras 1,671,000 1,671,000 1,671,000 1,671,000 1,671,000 1,671,000 1,671,000
CT Scan Simulator tanpa kontras 1,671,000 1,671,000 1,671,000 1,671,000 1,671,000 1,671,000 1,671,000
CT Sinus Paranasal ( Dengan Kontras ) 900,000 900,000 900,000 900,000 900,000 900,000 900,000
CT Sinus Paranasal ( Dengan Kontras ) + Anestesi 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000
CT Sinus Paranasal ( Tanpa Kontras ) 750,000 750,000 750,000 750,000 750,000 750,000 750,000
CT Sinus Paranasal ( Tanpa Kontras ) + Anestesi 910,000 910,000 910,000 910,000 910,000 910,000 910,000
CT Thoracal ( Dengan Kontras ) 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000
CT Thoracal ( Dengan Kontras ) + Anestesi 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000
CT Thoracal ( Tanpa Kontras ) 875,000 875,000 875,000 875,000 875,000 875,000 875,000
CT Thoracal ( Tanpa Kontras ) + Anestesi 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000
CT Thoraks ( Dengan Kontras ) 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000 1,500,000
CT Thoraks ( Dengan Kontras ) + Anestesi 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000 1,780,000
CT Thoraks ( Tanpa Kontras ) 875,000 875,000 875,000 875,000 875,000 875,000 875,000
CT Thoraks ( Tanpa Kontras ) + Anestesi 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000 1,075,000
CT Tyroid/Leher ( Dengan Kontras ) 900,000 900,000 900,000 900,000 900,000 900,000 900,000
CT Tyroid/Leher ( Dengan Kontras ) (Rujukan Luar) 900,000 900,000 900,000 900,000 900,000 900,000 900,000
CT Tyroid/Leher ( Dengan Kontras ) + Anestesi 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000 1,080,000
CT Tyroid/Leher ( Tanpa Kontras ) 750,000 750,000 750,000 750,000 750,000 750,000 750,000
CT Tyroid/Leher ( Tanpa Kontras ) (Rujukan Luar) 750,000 750,000 750,000 750,000 750,000 750,000 750,000
CT Tyroid/Leher ( Tanpa Kontras ) + Anestesi 910,000 910,000 910,000 910,000 910,000 910,000 910,000
CT Whole Abdomen ( Dengan Kontras ) 2,375,000 2,375,000 2,375,000 2,375,000 2,375,000 2,375,000 2,375,000
CT Whole Abdomen ( Dengan Kontras ) + Anestesi 2,805,000 2,805,000 2,805,000 2,805,000 2,805,000 2,805,000 2,805,000
CT Whole Abdomen ( Tanpa Kontras ) 1,250,000 1,250,000 1,250,000 1,250,000 1,250,000 1,250,000 1,250,000
CT Whole Abdomen ( Tanpa Kontras ) + Anestesi 1,490,000 1,490,000 1,490,000 1,490,000 1,490,000 1,490,000 1,490,000
CT Whole Body ( Tanpa kontras ) 1,250,000 1,250,000 1,250,000 1,250,000 1,250,000 1,250,000 1,250,000
CT Whole Body ( Tanpa kontras ) + Anestesi 1,490,000 1,490,000 1,490,000 1,490,000 1,490,000 1,490,000 1,490,000
CT Whole Body (Dengan Kontras) 2,375,000 2,375,000 2,375,000 2,375,000 2,375,000 2,375,000 2,375,000
CT Whole Body (Dengan Kontras) + Anestesi 2,805,000 2,805,000 2,805,000 2,805,000 2,805,000 2,805,000 2,805,000
CT. Abdomen Full (Rujukan Luar) 0 0 0 572,000 572,000 572,000 572,000
CT. Abdomen Lower / Pelvis (Dengan Contras) 1,250,000 1,250,000 1,250,000 1,250,000 1,250,000 1,250,000 1,250,000
CT. Kepala (Dengan Contras) 900,000 900,000 900,000 900,000 900,000 900,000 900,000
CT. Scan Lumbal Sacral (Dengan Contras) 1,250,000 1,250,000 1,250,000 1,250,000 1,250,000 1,250,000 1,250,000
Cuci Canule 38,000 38,000 38,000 38,000 57,000 57,000 57,000
Cuci Lambung 121,000 121,000 121,000 121,000 181,500 181,500 181,500
Curretage pada rentensi plasenta / Mola Pertama 352,000 352,000 352,000 352,000 352,000 352,000 352,000
Custom Post/Saluran Akar 0 0 0 0 500,000 500,000 500,000
Cutting and preparation of pedicle grafts or flaps 10,925,000 10,925,000 10,925,000 10,925,000 10,925,000 10,925,000 10,925,000
Cyclodia Termi 4,011,743 4,011,743 4,011,743 4,011,743 4,011,743 4,011,743 4,011,743
Cyclodialysa 3,997,000 3,997,000 3,997,000 3,997,000 3,997,000 3,997,000 3,997,000
Cyfra 21-1 _ 588,000 588,000 588,000 588,000 588,000 588,000 588,000
Cyro Surgery Besar 155,000 155,000 155,000 155,000 233,000 233,000 233,000
Cyro Surgery Ringan 90,000 90,000 90,000 90,000 135,000 135,000 135,000
Cysjejunostomi 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Cystoscopy biopsi (ESWL) 2,500,000 2,500,000 2,500,000 2,500,000 2,500,000 2,500,000 2,500,000
D Dimer _ 450,000 450,000 450,000 450,000 450,000 450,000 450,000
Dacryo Cysto Rhinostomi 11,581,770 11,581,770 11,581,770 11,581,770 11,581,770 11,581,770 11,581,770
Daptone (Doppler) 57,000 57,000 57,000 57,000 0 0 0
Darah Lengkap 62,000 62,000 62,000 62,000 62,000 62,000 62,000
Darah Per Bag ( BDRS ) 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Darah Per Bag (PMI) 325,000 325,000 325,000 325,000 325,000 325,000 325,000
Darah Per Bag (PMI) A,B,O,AB,Rhesus -- Afaresis 3,500,000 3,500,000 3,500,000 3,500,000 3,500,000 3,500,000 3,500,000
Darah Per Bag (PMI) A,B,O,AB,Rhesus -- FFP 325,000 325,000 325,000 325,000 325,000 325,000 325,000
Darah Per Bag (PMI) A,B,O,AB,Rhesus -- PRC 325,000 325,000 325,000 325,000 325,000 325,000 325,000
Darah Per Bag (PMI) A,B,O,AB,Rhesus -- WB 325,000 325,000 325,000 325,000 325,000 325,000 325,000
Darah Per Bag (PMI) A,B,O,AB,Rhesus -- WE 475,000 475,000 475,000 475,000 475,000 475,000 475,000
Darah Per Bag (UTD Provinsi Sul-Sel) 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Darah Per Bag (UTD Provinsi Sul-Sel) (Tindakan Cross Matching dan Golongan Darah) 310,000 310,000 310,000 310,000 310,000 310,000 310,000
Darah Perifer Lengkap Serial 68,000 68,000 68,000 68,000 68,000 68,000 68,000
Darah Rutin 0 0 0 0 60,000 60,000 60,000
Daye Test 100,000 100,000 100,000 100,000 150,000 150,000 150,000
DCR + Silikon Tube 8,350,000 8,350,000 8,350,000 8,350,000 8,350,000 8,350,000 8,350,000
Debridemen Luka dengan Anastesi Lokal 270,000 270,000 270,000 270,000 319,000 319,000 319,000
Debridement and anterior fusion in TB spine 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Debridement dengan falp 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Debridement dengan Skingarfting Kecil 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Debridement dengan Skingarfting Luas 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Debridement of nail, nail bed, or nail fold 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000
Debridement of open fracture of carpals and metacarpals 11,516,003 11,516,003 11,516,003 11,516,003 11,516,003 11,516,003 11,516,003
Debridement of open fracture of femur 11,116,003 11,116,003 11,116,003 11,116,003 11,116,003 11,116,003 11,116,003
Debridement of open fracture of humerus 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000
Debridement of open fracture of phalanges of foot 6,486,003 6,486,003 6,486,003 6,486,003 6,486,003 6,486,003 6,486,003
Debridement of open fracture of phalanges of hand 11,516,003 11,516,003 11,516,003 11,516,003 11,516,003 11,516,003 11,516,003
Debridement of open fracture of radius and ulna 11,516,003 11,516,003 11,516,003 11,516,003 11,516,003 11,516,003 11,516,003
Debridement of open fracture of tarsals and metatarsals 6,486,003 6,486,003 6,486,003 6,486,003 6,486,003 6,486,003 6,486,003
Debridement of open fracture of tibia and fibula 23,016,003 23,016,003 23,016,003 23,016,003 23,016,003 23,016,003 23,016,003
Debridement Pada Luka Bakar < 40% 5,579,641 5,579,641 5,579,641 5,579,641 5,579,641 5,579,641 5,579,641
Debridement Pada Luka Bakar > 40% 6,348,641 6,348,641 6,348,641 6,348,641 6,348,641 6,348,641 6,348,641
Debridement Ulang Vaskuler/ Debridement dng amputasi mayor 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Debridement Ulang Vaskuler/Debridement Dengan Amputasi Mayor/Minor 5,516,000 5,683,000 5,850,000 6,016,000 6,183,000 6,183,000 6,183,000
Debridement/EmbolisasiSederhana/Op.JantungTertutup/PTA/TAI 13,150,000 13,150,000 13,150,000 13,150,000 13,150,000 13,150,000 13,150,000
Debulking 6,917,222 6,917,222 6,917,222 6,917,222 6,917,222 6,917,222 6,917,222
Defibrilator 1,067,000 1,067,000 1,067,000 1,067,000 1,067,000 1,067,000 1,067,000
Deflasi dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Dekanulasi 250,000 250,000 250,000 250,000 0 0 0
Dekompresi orbita 6,357,000 6,357,000 6,357,000 6,357,000 6,357,000 6,357,000 6,357,000
Dekompresi Syaraf Tepi 5,382,587 5,382,587 5,382,587 5,382,587 5,382,587 5,382,587 5,382,587
Dekompresia Fasialis 5,482,645 5,482,645 5,482,645 5,482,645 5,482,645 5,482,645 5,482,645
Delayed suture of flexor tendon of hand 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000
Delayed suture of other tendon of hand 9,682,099 9,682,099 9,682,099 9,682,099 9,682,099 9,682,099 9,682,099
Delayed suture of tendon 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000
Dengue NS1 _ 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Denis Brown 3,800,000 3,800,000 3,800,000 3,800,000 5,700,000 5,700,000 5,700,000
Dental Rontgen Foto (Non Rujukan) 0 0 0 0 50,000 50,000 50,000
Dermabrasi (Luas) 598,000 598,000 598,000 598,000 495,000 495,000 495,000
Dermabrasi (Sedikit) 282,000 282,000 282,000 282,000 237,000 237,000 237,000
Dermaroller 0 0 0 0 500,000 500,000 500,000
Deroofing/unroofing kista 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Deseksi Kelenjar Inguinal 5,299,955 5,299,955 5,299,955 5,299,955 5,299,955 5,299,955 5,299,955
Detorsi testis + Orchidopexy 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462
DHF IGg/IgM (ICT) 220,000 220,000 220,000 220,000 220,000 220,000 220,000
Dialisis Peritoneal 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Diathermy 75,000 75,000 75,000 75,000 112,500 112,500 112,500
Dietary Survielance and Councelling pada Penyakit Khusus 100,000 100,000 100,000 100,000 125,000 125,000 125,000
Dietary Survielance and Councelling pada Weight Management 100,000 100,000 100,000 100,000 125,000 125,000 125,000
Dikortikasi ( Bedah Paru/Thorax) 21,102,000 21,102,000 21,102,000 21,102,000 21,102,000 21,102,000 21,102,000
Dilatasi Phimosis 66,000 66,000 66,000 66,000 0 0 0
Direct Veneer/(Composite) 0 0 0 0 500,000 500,000 500,000
Disarticulation of ankle 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099
Disarticulation of elbow 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099
Disarticulation of hip 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099
Disarticulation of knee 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099
Disarticulation of shoulder 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099
Disarticulation of wrist 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099 5,247,099
Diseksi KGB Pelvis 7,885,000 7,885,000 7,885,000 7,885,000 7,885,000 7,885,000 7,885,000
Diseksi Leher Radikal Modifikasi/Fungsional 4,599,000 4,599,000 4,599,000 4,599,000 4,599,000 4,599,000 4,599,000
Divertikulektomi 6,923,213 6,923,213 6,923,213 6,923,213 6,923,213 6,923,213 6,923,213
Divertikulektomi Vesika 8,215,530 8,215,530 8,215,530 8,215,530 8,215,530 8,215,530 8,215,530
Divertikulum uretra 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Division of joint capsule, ligament, or cartilage of ankle 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000
Division of joint capsule, ligament, or cartilage of elbow 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000
Division of joint capsule, ligament, or cartilage of foot and toe 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000
Division of joint capsule, ligament, or cartilage of hand and finger 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000
Division of joint capsule, ligament, or cartilage of hip 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000
Division of joint capsule, ligament, or cartilage of knee 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000
Division of joint capsule, ligament, or cartilage of shoulder 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000
Division of joint capsule, ligament, or cartilage of wrist 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000
Dorsal and dorsolumbar fusion, anterior technique 9,957,600 9,957,600 9,957,600 9,957,600 9,957,600 9,957,600 9,957,600
Dorsal and dorsolumbar fusion, posterior technique 9,957,600 9,957,600 9,957,600 9,957,600 9,957,600 9,957,600 9,957,600
Double Lumen Catheter 4,784,000 4,784,000 4,784,000 4,784,000 4,784,000 4,784,000 4,784,000
Drainage Kista Pankreas 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Drainage Periureter 5,132,887 5,132,887 5,132,887 5,132,887 5,132,887 5,132,887 5,132,887
Drainase Pus Pada Tuboovarial Abses Dengan Punksi Doglasi 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Dry Needling 250,000 250,000 250,000 250,000 99,000 99,000 99,000
Ductulography 375,000 375,000 375,000 375,000 375,000 375,000 375,000
Duedenoduodenostomi /Duodenojejunostomi 9,464,367 9,464,367 9,464,367 9,464,367 9,464,367 9,464,367 9,464,367
Ebstein(TV)Anomali Repair/TAPVD 53,150,000 53,150,000 53,150,000 53,150,000 53,150,000 53,150,000 53,150,000
Echo Anak 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Echo Dewasa 300,000 300,000 300,000 300,000 300,000 300,000 300,000
Echocardiography 0 0 0 563,000 563,000 563,000 563,000
Edema Test 78,000 78,000 78,000 78,000 0 0 0
Edukasi Keluarga 75,000 75,000 75,000 75,000 0 0 0
Edukasi Kemotherapi 100,000 100,000 100,000 100,000 100,000 100,000 100,000
EEG 695,000 695,000 695,000 695,000 1,043,000 1,043,000 1,043,000
EKG/Elektrokardiografi 73,000 73,000 73,000 73,000 110,000 110,000 110,000
Eksenterasi 12,661,000 12,661,000 12,661,000 12,661,000 12,661,000 12,661,000 12,661,000
Eksisi / Ekstirpasi Salolith dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Eksisi / Esterpasi 80,000 80,000 80,000 80,000 80,000 80,000 80,000
Eksisi Angiofibroma Nasofaring 6,350,000 6,350,000 6,350,000 6,350,000 6,350,000 6,350,000 6,350,000
Eksisi Baker Cyst 5,008,000 5,008,000 5,008,000 5,008,000 5,008,000 5,008,000 5,008,000
Eksisi Basalioma 1,350,000 1,350,000 1,350,000 1,350,000 2,025,000 2,025,000 2,025,000
Eksisi Biopsy dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Eksisi Ca Laring dengan Laser 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Eksisi Chalazion/Hordeolum 675,000 675,000 675,000 675,000 0 0 0
Eksisi Chodee 5,149,000 5,149,000 5,149,000 5,149,000 5,149,000 5,149,000 5,149,000
Eksisi Chordae Hyspospadia 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Eksisi Clavus 250,000 250,000 250,000 250,000 375,000 375,000 375,000
Eksisi Condiloma Accuminata 66,000 66,000 66,000 66,000 0 0 0
Eksisi Dengan Lokal Anastesi 675,000 675,000 675,000 675,000 0 0 0
Eksisi Denture Hyperplasia dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Eksisi FAM < 5cm 2,623,437 2,623,437 2,623,437 2,623,437 2,623,437 2,623,437 2,623,437
Eksisi FAM > 5cm 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Eksisi Fibroma 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Eksisi Fistel Preauricular 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Eksisi Giant Nevus (tampa skin graft) 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Eksisi Giant Nevus + skin graft 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Eksisi Granuloma 250,000 250,000 250,000 250,000 0 0 0
Eksisi Granuloma (Poli Mata) 675,000 675,000 675,000 675,000 0 0 0
Eksisi Granuloma Pyogenikum 250,000 250,000 250,000 250,000 0 0 0
Eksisi Granuloma/Granuloma Hibilical/Hemanioma Kecil 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000
Eksisi Gynecomastie 4,995,000 4,995,000 4,995,000 4,995,000 4,995,000 4,995,000 4,995,000
Eksisi Heangiona Luas 6,792,089 6,792,089 6,792,089 6,792,089 6,792,089 6,792,089 6,792,089
Eksisi Hemangioma Besar skingraft STSG/FTSG 5,634,913 5,634,913 5,634,913 5,634,913 5,634,913 5,634,913 5,634,913
Eksisi Hemangioma Besar/Multiple 5,634,913 5,634,913 5,634,913 5,634,913 5,634,913 5,634,913 5,634,913
Eksisi Hemangioma Kecil 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Eksisi Hemangioma Sedang 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Eksisi Higroma 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Eksisi Higroma Pada Anak 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462
Eksisi Hygroma Colli/Axilla Neonatus 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Eksisi Hygroma/Lympohagioma Simple 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Eksisi Kelenjar Liur Submandibula 3,887,600 3,887,600 3,887,600 3,887,600 3,887,600 3,887,600 3,887,600
Eksisi Keloid < 5 cm 66,000 66,000 66,000 66,000 0 0 0
Eksisi Kista Brachialis 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Eksisi Kista Branchiogenik 3,936,000 3,936,000 3,936,000 3,936,000 3,936,000 3,936,000 3,936,000
Eksisi Kista Bronchial 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462
Eksisi Kista Duktus Kholedukhus 17,350,000 17,350,000 17,350,000 17,350,000 17,350,000 17,350,000 17,350,000
Eksisi Kista Duktus Triglosus 5,059,548 5,059,548 5,059,548 5,059,548 5,059,548 5,059,548 5,059,548
Eksisi Kista Saluran Empedu 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Eksisi Kista Tiroglosus 3,892,000 3,892,000 3,892,000 3,892,000 3,892,000 3,892,000 3,892,000
Eksisi Kista Urachus 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462
Eksisi Limfedema + skin graft (charles prosedur) 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Eksisi Luas Lokal 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Eksisi Luas Radikal + Rekontruksi 5,336,807 5,336,807 5,336,807 5,336,807 5,336,807 5,336,807 5,336,807
Eksisi Mammae Aberran (Klp. III) 4,518,992 4,518,992 4,518,992 4,518,992 4,518,992 4,518,992 4,518,992
Eksisi Multiple FAM 4,527,541 4,527,541 4,527,541 4,527,541 4,527,541 4,527,541 4,527,541
Eksisi Neuroblastoma 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Eksisi Neurofibroma Multiple 4,990,913 4,990,913 4,990,913 4,990,913 4,990,913 4,990,913 4,990,913
Eksisi Pterigium Bare Sklera 675,000 675,000 675,000 675,000 0 0 0
Eksisi Skin Grafting 250,000 250,000 250,000 250,000 0 0 0
Eksisi Syringoma 66,000 66,000 66,000 66,000 0 0 0
Eksisi Tatto (Besar) 2,350,000 2,350,000 2,350,000 2,350,000 3,525,000 3,525,000 3,525,000
Eksisi Tatto (Lokal) 600,000 600,000 600,000 600,000 900,000 900,000 900,000
Eksisi Tatto (Sedang) 2,000,000 2,000,000 2,000,000 2,000,000 3,000,000 3,000,000 3,000,000
Eksisi Teratoma Ovarium 12,022,946 12,022,946 12,022,946 12,022,946 12,022,946 12,022,946 12,022,946
Eksisi Teratoma Retroperitoneal 6,151,418 6,151,418 6,151,418 6,151,418 6,151,418 6,151,418 6,151,418
Eksisi Teratoma Sacrococcygeal 11,130,825 11,130,825 11,130,825 11,130,825 11,130,825 11,130,825 11,130,825
Eksisi Torus Palatinus / Mansibularis dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Eksisi Tragus Acsesories 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Eksisi Tumor Adneksa Kecil 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Eksisi Tumor Adneksa Sedang 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Eksisi Veruka Vulgaris 66,000 66,000 66,000 66,000 0 0 0
Eksisi Webbed Penis 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Eksisi Xantelasma 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Eksisi Xantelasma (Besar) 2,350,000 2,350,000 2,350,000 2,350,000 3,525,000 3,525,000 3,525,000
Eksisi Xantelasma (Sedang) 2,000,000 2,000,000 2,000,000 2,000,000 3,000,000 3,000,000 3,000,000
Eksisi Xantoma 250,000 250,000 250,000 250,000 0 0 0
Eksisi/Ekstirpasi Tumor Jinak Kulit (Besar) 1,450,000 1,450,000 1,450,000 1,450,000 2,175,000 2,175,000 2,175,000
Eksisi/Ekstirpasi Tumor Jinak Kulit (Kecil) 700,000 700,000 700,000 700,000 1,050,000 1,050,000 1,050,000
Eksisi/Ekstirpasi Tumor Jinak Kulit (Sedang) 1,200,000 1,200,000 1,200,000 1,200,000 1,800,000 1,800,000 1,800,000
Eksisi/Esterpasi 80,000 80,000 80,000 80,000 0 0 0
Eksisi/Konisasi 6,074,400 6,074,400 6,074,400 6,074,400 6,074,400 6,074,400 6,074,400
Eksisi/Limfangioma Simple 4,986,687 4,986,687 4,986,687 4,986,687 4,986,687 4,986,687 4,986,687
Eksisi/Reduksi Neurofibroma Kompleks 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Eksoftalmometri 30,000 30,000 30,000 30,000 45,000 45,000 45,000
Eksplorasi Abses Mandibula 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Eksplorasi Abses Multiple ( Bedah Vaskuler ) 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Eksplorasi Abses Multiple THT 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Eksplorasi Abses Parafaringeal 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Eksplorasi Kista Branchial 5,767,645 5,767,645 5,767,645 5,767,645 5,767,645 5,767,645 5,767,645
Eksplorasi Kista Ductus Tiroglosus 5,767,645 5,767,645 5,767,645 5,767,645 5,767,645 5,767,645 5,767,645
Eksplorasi Kista Tiroid 5,788,179 5,788,179 5,788,179 5,788,179 5,788,179 5,788,179 5,788,179
Eksplorasi Kolekdokus 4,406,075 4,406,075 4,406,075 4,406,075 4,406,075 4,406,075 4,406,075
Eksplorasi Luka 60,000 60,000 60,000 60,000 99,000 99,000 99,000
Eksplorasi Nasofaring 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Eksterpasi / Biopsi Polip Serviks Kacil < 1/2',0);?> 135,000 135,000 135,000 135,000 135,000 135,000 135,000
Eksterpasi dan Kuretase 840,000 840,000 840,000 840,000 840,000 840,000 840,000
Eksterpasi Fistel Preaurikuler 4,530,362 4,530,362 4,530,362 4,530,362 4,530,362 4,530,362 4,530,362
Eksterpasi Kista Ateroma/Lipoma Ganglion < 2cm 250,000 250,000 250,000 250,000 0 0 0
Eksterpasi Kista Bartholin 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Eksterpasi Limpoma, ganglion kista epidermoid, neurolibroma sactase 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000
Eksterpasi Miom Geburt 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Ekstipasi Adenomiosis 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Ekstipasi Tumor Scalp/Cranium 5,586,887 5,586,887 5,586,887 5,586,887 5,586,887 5,586,887 5,586,887
Ekstirpasi Corpus Alienum 150,000 150,000 150,000 150,000 225,000 225,000 225,000
Ekstirpasi Fibroma 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Ekstirpasi Kista Ateroma / Lipoma / Ganglion > 2cm 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Ekstirpasi Kista Epidermoid 250,000 250,000 250,000 250,000 0 0 0
Ekstirpasi Kuku 0 0 0 0 750,000 750,000 750,000
Ekstirpasi Papiloma 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Ekstirpasi Preaurikuler Fistel THT 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Ekstirpasi Tumor Ganas Adnesa + Rekonstruksi 12,350,000 12,350,000 12,350,000 12,350,000 12,350,000 12,350,000 12,350,000
Ekstirpasi Tumor Jinak 250,000 250,000 250,000 250,000 0 0 0
Ekstirpasi Tumor Jinak Kel.Liur THT 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Ekstirpasi Tumor Jinak Kulit 0 < 3cm (Lipoma,Atheroma,dll) 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Ekstirpasi Tumor Jinak Kulit > 3cm (Lipoma. Atheroma.dll) 750,000 750,000 750,000 750,000 4,920,000 4,920,000 4,920,000
Ekstirpasi Tumor Jinak Lain > 5 cm 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Ekstirpasi Tumor Jinak Sinonasal Oral Cavity 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Ekstirpasi Tumor Jinak THT 675,000 675,000 675,000 675,000 0 0 0
Ekstrackel benda asing dengan anastesi umum 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000
Ekstraksi / Operasi (Alveolectomy pr Kwadran) 180,000 180,000 180,000 180,000 270,000 270,000 270,000
Ekstraksi / Operasi (Epulis) 165,000 165,000 165,000 165,000 248,000 248,000 248,000
Ekstraksi / Operasi (Fraktur Rahang) 450,000 450,000 450,000 450,000 675,000 675,000 675,000
Ekstraksi / Operasi (Gigi Permanent Komplikasi) 200,000 200,000 200,000 200,000 300,000 300,000 300,000
Ekstraksi / Operasi (Gigi Permanent Normal) 105,000 105,000 105,000 105,000 158,000 158,000 158,000
Ekstraksi / Operasi (Gigi Sulung / Chloraethyl) 70,000 70,000 70,000 70,000 110,000 110,000 110,000
Ekstraksi / Operasi (Gigi Sulung / Citoject) 75,000 75,000 75,000 75,000 115,000 115,000 115,000
Ekstraksi / Operasi (Incisi Abses) 250,000 250,000 250,000 250,000 375,000 375,000 375,000
Ekstraksi / Operasi (Kista) 330,000 330,000 330,000 330,000 495,000 495,000 495,000
Ekstraksi / Operasi (Mucocele) 350,000 350,000 350,000 350,000 525,000 525,000 525,000
Ekstraksi / Operasi (Odontektomi Dengan komplikasi) 455,000 455,000 455,000 455,000 685,000 685,000 685,000
Ekstraksi / Operasi (Odontektomi Tanpa komplikasi) 325,000 325,000 325,000 325,000 488,000 488,000 488,000
Ekstraksi Batu 5,625,000 5,625,000 5,625,000 5,625,000 5,625,000 5,625,000 5,625,000
Ekstraksi Benda Asing 552,000 552,000 552,000 552,000 552,000 552,000 552,000
Ekstraksi Benda Asing + Anastesi 1,247,000 1,247,000 1,247,000 1,247,000 1,247,000 1,247,000 1,247,000
Ekstraksi Benda Asing dengan Penyulit 250,000 250,000 250,000 250,000 0 0 0
Ekstraksi benda asing disaluran cerna bagian atas/bawah 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Ekstraksi Comedo 130,000 130,000 130,000 130,000 195,000 195,000 195,000
Ekstraksi Corpus Alienum 59,000 59,000 59,000 59,000 0 0 0
Ekstraksi Corpus Aliineum Cornea 250,000 250,000 250,000 250,000 0 0 0
Ekstraksi Gigi / Fragmen Gigi Penyulit dengan Anastesi 270,000 270,000 270,000 270,000 319,000 319,000 319,000
Ekstraksi jaringan granulasi pada telinga 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Ekstraksi Kolesteatom Eksterna 250,000 250,000 250,000 250,000 0 0 0
Ekstraksi korpus alineum cavum nasi 0 0 0 0 84,000 84,000 84,000
Ekstraksi Kuku 250,000 250,000 250,000 250,000 375,000 375,000 375,000
Ekstraksi Kuku Berat (Besar) 317,000 317,000 317,000 317,000 476,000 476,000 476,000
Ekstraksi Kuku Sederhana (Sedang) 190,000 190,000 190,000 190,000 285,000 285,000 285,000
Ekstraksi Linear 4,866,237 4,866,237 4,866,237 4,866,237 4,866,237 4,866,237 4,866,237
Ekstraksi Per Gigi dengan Anastesi Lokal 140,000 140,000 140,000 140,000 166,000 166,000 166,000
Ekstraksi polip hidung ( polipektomi simpleks) 100,000 100,000 100,000 100,000 150,000 150,000 150,000
Ekstraksi Serumen Dengan Penyulit 66,000 66,000 66,000 66,000 0 0 0
Ekstraksi Serumen Telinga 26,000 26,000 26,000 26,000 39,000 39,000 39,000
Elbow Brace (Biasa) 1,500,000 1,500,000 1,500,000 1,500,000 2,250,000 2,250,000 2,250,000
Elbow Brace (Khusus) 2,750,000 2,750,000 2,750,000 2,750,000 4,125,000 4,125,000 4,125,000
Elektrikal Stimulasi 75,000 75,000 75,000 75,000 112,500 112,500 112,500
Elektro Couter Besar 385,000 385,000 385,000 385,000 578,000 578,000 578,000
Elektro Couter Kecil 222,000 222,000 222,000 222,000 333,000 333,000 333,000
Elektro Couter Sedang 302,000 302,000 302,000 302,000 453,000 453,000 453,000
Elektro Physiologi Study (EP Study) 15,350,000 15,350,000 15,350,000 15,350,000 15,350,000 15,350,000 15,350,000
Elektro Physiologi Study (EP Study) + Ablasi 36,350,000 36,350,000 36,350,000 36,350,000 36,350,000 36,350,000 36,350,000
Elektrofulgurasi 66,000 66,000 66,000 66,000 0 0 0
Elektrokauter Keratosis Seboroik 710,000 710,000 710,000 710,000 1,065,000 1,065,000 1,065,000
Elektrolit Urine 24 Jam 100,000 100,000 100,000 100,000 100,000 100,000 100,000
Elektrolit _ 120,000 120,000 120,000 120,000 120,000 120,000 120,000
ElimInasi Fokus Infeksi Digigi/Perio 250,000 250,000 250,000 250,000 0 0 0
Embolektomi/Pleurodesis/RedoOperationForStopBleeding/Thoracotomi 13,550,000 13,550,000 13,550,000 13,550,000 13,550,000 13,550,000 13,550,000
Embolisasi dengan Spongiostan (Preop) 16,309,000 16,309,000 16,309,000 16,309,000 16,309,000 16,309,000 16,309,000
Embolisasi pada perdarahan intraabdominal/extremitas yang menggunakan coil 20,044,886 20,044,886 20,044,886 20,044,886 20,044,886 20,044,886 20,044,886
Embolisasi pada perdarahan intraabdominal/extremitas yang menggunakan gel foam 19,975,590 19,975,590 19,975,590 19,975,590 19,975,590 19,975,590 19,975,590
Embolisasi pada tumor intraabdominal / extremitas yang menggunakan gel foam 19,975,590 19,975,590 19,975,590 19,975,590 19,975,590 19,975,590 19,975,590
Embolisasi pada tumor intraabdominal / extremitas yang menggunakan PVA 21,161,761 21,161,761 21,161,761 21,161,761 21,161,761 21,161,761 21,161,761
Embriotomi (Eviserasi /punksi) 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000
Embriotomi (Kranioklasi) 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000
Embriotomi (Perforasi + Dekapitasi) 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000
EMG 568,000 568,000 568,000 568,000 852,000 852,000 852,000
Endodontic One Visit Gigi Anterior (Akar Tunggal) 0 0 0 0 1,500,000 1,500,000 1,500,000
Endodontic One Visit Gigi Posterior (Akar Jamak) 0 0 0 0 1,750,000 1,750,000 1,750,000
Endodontik Anterior 66,000 66,000 66,000 66,000 0 0 0
Endodontik Posterior/Pulpotomi 66,000 66,000 66,000 66,000 0 0 0
Endorectal pull-through/ soave Boley 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Endoscopy teurapeutic (BA) 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
enucleatie kista 2,510,000 2,510,000 2,510,000 2,510,000 2,510,000 2,510,000 2,510,000
Enucleatie Kista D 42',0);?> 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Enukleasi + DFG 6,822,174 6,822,174 6,822,174 6,822,174 6,822,174 6,822,174 6,822,174
Enukleasi Besar dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Enukleasi Kecil dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Enukleasi Kista Ginjal 6,926,000 6,926,000 6,926,000 6,926,000 6,926,000 6,926,000 6,926,000
Enukleasi Milia 66,000 66,000 66,000 66,000 0 0 0
Enukleasi Mol 66,000 66,000 66,000 66,000 0 0 0
Enukleasi Moluskum Banyak (Besar) 152,000 152,000 152,000 152,000 228,000 228,000 228,000
Enukleasi Moluskum Sedikit (Sedang) 111,000 111,000 111,000 111,000 167,000 167,000 167,000
Epicardial Permanen Pace Maker(Microny)/PDA=MOF/Pengangkatan Embolusi(Device Embolusi) dengan CPB)/PS Repair 33,550,000 33,550,000 33,550,000 33,550,000 33,550,000 33,550,000 33,550,000
Epidimovasostomi/Epididimovasostomi 10,320,000 10,320,000 10,320,000 10,320,000 10,320,000 10,320,000 10,320,000
Epidural Steroid Cateter 765,000 765,000 765,000 765,000 765,000 765,000 765,000
Epidural Steroid Injection 633,000 633,000 633,000 633,000 0 0 0
Epilasi Bulu Mata 84,000 84,000 84,000 84,000 126,000 126,000 126,000
Episiotomi + Jahitan Perineum 120,000 120,000 120,000 120,000 120,000 120,000 120,000
ERCP (Endoscopy Retrograde Cholangio Pankreatografi) 5,020,000 5,020,000 5,020,000 5,020,000 5,020,000 5,020,000 5,020,000
ERCP + Extraksi Batu Inci Lithotriptor 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000
ERCP Biopsy 6,860,000 6,860,000 6,860,000 6,860,000 6,860,000 6,860,000 6,860,000
ERCP Litotripsi Mechanical 14,126,000 14,126,000 14,126,000 14,126,000 14,126,000 14,126,000 14,126,000
ERCP NBD (Nasobiliary Drainage) 7,378,000 7,378,000 7,378,000 7,378,000 7,378,000 7,378,000 7,378,000
ERCP Sphincterotome 9,114,000 9,114,000 9,114,000 9,114,000 9,114,000 9,114,000 9,114,000
ERCP Stent (Drainase Bilier) 8,960,000 8,960,000 8,960,000 8,960,000 8,960,000 8,960,000 8,960,000
ERCP(Endoscopy Retrograde Cholangio Pankreatografi) (Rujukan Luar) 38,680,000 38,680,000 38,680,000 38,680,000 38,680,000 38,680,000 38,680,000
Eritrosit Cuci (WE) Perkantong 475,000 475,000 475,000 475,000 475,000 475,000 475,000
Esofagogastroduodenoskopi Diagnostik (GEH) 2,120,000 2,120,000 2,120,000 2,120,000 2,120,000 2,120,000 2,120,000
Esofagogastroduodenoskopi Diagnostik (GEH) + Anastesi 3,155,000 3,155,000 3,155,000 3,155,000 3,155,000 3,155,000 3,155,000
Esofagomyotomi 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Esofagoskopi Diagnostik 875,000 875,000 875,000 875,000 875,000 875,000 875,000
Esofagoskopi Diagnostik + Anastesi 1,752,000 1,752,000 1,752,000 1,752,000 1,752,000 1,752,000 1,752,000
Esofagostomi + Gastrotomi (Atresia Esophagus) 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Esoghageal Replacement Procedure (Transposisi Kolon, Transposisi gaster, gastric Pull-up) 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Esophagoscopy 5,647,645 5,647,645 5,647,645 5,647,645 5,647,645 5,647,645 5,647,645
ESST 1 (Paket 12X Tindakan) 0 0 0 0 34,183,000 34,183,000 34,183,000
ESST 1/2 (Paket 6X Tindakan) 0 0 0 0 22,674,000 22,674,000 22,674,000
Estradiol 263,000 263,000 263,000 263,000 263,000 263,000 263,000
Estradiol (P) 422,000 422,000 422,000 422,000 422,000 422,000 422,000
ESWL FASE I 7,841,000 7,841,000 7,841,000 7,841,000 7,841,000 7,841,000 7,841,000
ESWL FASE II 7,000,000 7,000,000 7,000,000 7,000,000 7,000,000 7,000,000 7,000,000
ESWL Prostatron 5,376,000 5,376,000 5,376,000 5,376,000 5,376,000 5,376,000 5,376,000
Ethmoidektomi (Intranasal) 5,827,645 5,827,645 5,827,645 5,827,645 5,827,645 5,827,645 5,827,645
Evakuasi Bekuan Darah (Clot) 4,442,187 4,442,187 4,442,187 4,442,187 4,442,187 4,442,187 4,442,187
Evaluasi SST _ 600,000 600,000 600,000 600,000 600,000 600,000 600,000
Eviserasi + DFG 6,904,436 6,904,436 6,904,436 6,904,436 6,904,436 6,904,436 6,904,436
Excisi Biopsi 77,000 77,000 77,000 77,000 77,000 77,000 77,000
Excision of bone for graft, carpus and metacarpus 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000
Excision of bone for graft, femur 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000
Excision of bone for graft, humerus 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000
Excision of bone for graft, patella 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000
Excision of bone for graft, radius and ulna 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000
Excision of bone for graft, scapula, clavicle, and thorax (ribs and sternum) 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000
Excision of bone for graft, tarsals and metatarsals 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000
Excision of bone for graft, tibia and fibula 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000
Excision of intervertebral disc 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000
Excision of lesion of muscle 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Excision of lesion of muscle of hand 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Excision of lesion of other soft tissue 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Excision of lesion of tendon sheath 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Excision of lesion of tendon sheath of hand 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Excision of muscle or fascia for graft 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000
Excision of muscle or fascia of hand for graft 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Excision of other lesion of soft tissue of hand 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Excision of semilunar cartilage of knee 16,485,212 16,485,212 16,485,212 16,485,212 16,485,212 16,485,212 16,485,212
Excision of skin for graft 7,522,000 7,522,000 7,522,000 7,522,000 7,522,000 7,522,000 7,522,000
Excision of tendon of hand for graft 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Excision or correction of bunionette 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000 6,600,000
Excisional debridement of wound, infection, or burn 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000
Excohliasi 2,510,000 2,510,000 2,510,000 2,510,000 2,510,000 2,510,000 2,510,000
Exercise / Latihan Wicara 22,800 22,800 22,800 22,800 28,500 28,500 28,500
Exercise Not Elshewhere Classified 70,000 70,000 70,000 70,000 105,000 105,000 105,000
Exercise Therapi ( Latihan ) 56,400 56,400 56,400 56,400 70,500 70,500 70,500
Exflorasi Vagina 5,979,000 5,979,000 5,979,000 5,979,000 5,979,000 5,979,000 5,979,000
Explorasi Testis Mikro Surgery 7,777,000 7,777,000 7,777,000 7,777,000 7,777,000 7,777,000 7,777,000
Exploration of tendon sheath 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000 9,390,000
Exploration of tendon sheath of hand 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000
Exposure Mahkota Gigi Terpendam dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Extended Pyelolithektomi (Gilverne) 7,214,004 7,214,004 7,214,004 7,214,004 7,214,004 7,214,004 7,214,004
Exterpasi / Eksisi Kecil 283,000 283,000 283,000 283,000 425,000 425,000 425,000
Exterpasi Besar / Eksisi 386,000 386,000 386,000 386,000 579,000 579,000 579,000
Extirpasi Polip 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Extirpasi Polip Cavum Nasi 4,532,000 4,532,000 4,532,000 4,532,000 4,532,000 4,532,000 4,532,000
Extirpasi Tumor 2,510,000 2,510,000 2,510,000 2,510,000 2,510,000 2,510,000 2,510,000
Extirpatie Plunging Ranula 2,960,000 2,960,000 2,960,000 2,960,000 2,960,000 2,960,000 2,960,000
Extraksi Kalium Oxalat 66,000 66,000 66,000 66,000 0 0 0
Extubasi 700,000 700,000 700,000 700,000 700,000 700,000 700,000
Eye Reflex Test 78,000 78,000 78,000 78,000 0 0 0
FAAL Paru 150,000 150,000 150,000 150,000 225,000 225,000 225,000
Facet Blok (1 Level/Multilevel) 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Facial 65,000 65,000 65,000 65,000 98,000 98,000 98,000
Facialis Parase 73,000 73,000 73,000 73,000 110,000 110,000 110,000
Faktor IX (P) 416,000 416,000 416,000 416,000 416,000 416,000 416,000
Faktor VIII (P) 416,000 416,000 416,000 416,000 416,000 416,000 416,000
Family Therapi 33,000 33,000 33,000 33,000 50,000 50,000 50,000
Faradic / Galvanic 45,600 45,600 45,600 45,600 57,000 57,000 57,000
Fare Head Flap 5,482,645 5,482,645 5,482,645 5,482,645 5,482,645 5,482,645 5,482,645
Faringotomi 5,482,645 5,482,645 5,482,645 5,482,645 5,482,645 5,482,645 5,482,645
Fasciotomy 6,424,400 6,424,400 6,424,400 6,424,400 6,424,400 6,424,400 6,424,400
Fasciotomy of hand 9,282,099 9,282,099 9,282,099 9,282,099 9,282,099 9,282,099 9,282,099
Fe (Besi) _ 45,000 45,000 45,000 45,000 45,000 45,000 45,000
Feeding Tube 36,000 36,000 36,000 36,000 0 0 0
Feeling AHA / TCA 200,000 200,000 200,000 200,000 230,000 230,000 230,000
Ferritine _ 230,000 230,000 230,000 230,000 230,000 230,000 230,000
Fetocide Dengan Anastesi Lokal 396,000 396,000 396,000 396,000 0 0 0
Fiber Post/buah 0 0 0 0 500,000 500,000 500,000
Fibrinogen _ 200,000 200,000 200,000 200,000 200,000 200,000 200,000
Fibro Adenom Mamae 3,444,000 3,444,000 3,444,000 3,444,000 3,444,000 3,444,000 3,444,000
Fibro Adenoma ( Fibroma ) 0 0 0 0 3,000,000 3,000,000 3,000,000
Fibro Adenoma ( Fibroma Multi ) 0 0 0 0 4,000,000 4,000,000 4,000,000
Fibro Adenoma > Tumor (Besar) 480,000 480,000 480,000 480,000 720,000 720,000 720,000
Fibroadenoma (Mammae) / Biji (Sedang) 157,000 157,000 157,000 157,000 0 0 0
Fibroscan 832,000 832,000 832,000 832,000 832,000 832,000 832,000
Filaria 27,500 27,500 27,500 27,500 27,500 27,500 27,500
Fine Needle Aspirasi (FNA) 145,000 145,000 145,000 145,000 145,000 145,000 145,000
Fine Needle Aspiration Biopsi (FNAB) Guided USG 250,000 250,000 250,000 250,000 0 0 0
Finger Insole 163,000 163,000 163,000 163,000 245,000 245,000 245,000
Finger reattachment 10,675,000 10,675,000 10,675,000 10,675,000 10,675,000 10,675,000 10,675,000
Finger Splint 316,000 316,000 316,000 316,000 474,000 474,000 474,000
Fisioterapi Dengan Alat (4x Tindakan) 250,000 250,000 250,000 250,000 99,000 99,000 99,000
Fistula Eterovesika 6,925,000 6,925,000 6,925,000 6,925,000 6,925,000 6,925,000 6,925,000
Fistulectomi 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Fistulectomy Perianal 4,962,559 4,962,559 4,962,559 4,962,559 4,962,559 4,962,559 4,962,559
Fistulektomi / Repair Fistel Uretra 4,442,187 4,442,187 4,442,187 4,442,187 4,442,187 4,442,187 4,442,187
Fistulektomi/Fistula Ani 4,183,286 4,183,286 4,183,286 4,183,286 4,183,286 4,183,286 4,183,286
Fistulografi 500,000 500,000 500,000 500,000 500,000 500,000 500,000
Five-in-one repair of knee 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000 8,105,000
Flebektomi 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Flexible Endoscopy Evaluation Of Swallowing (FEES) 1,077,000 1,077,000 1,077,000 1,077,000 1,077,000 1,077,000 1,077,000
Flourocences Insitu Hybridization 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000
Fontan/Kawashima/Penutupan VSD tanpa Pembedahan Dgn Menggunakan Device (AMVO)/Repair Aneuryema Of Sinus Valsava 68,031,954 68,031,954 68,031,954 68,031,954 68,031,954 68,031,954 68,031,954
Fontan/Kawashima/Penutupan VSD tanpa Pembedahan Dgn Menggunakan Device (AMVO)/Repair Aneuryema Of Sinus Valsava + Anastesi 77,790,699 77,790,699 77,790,699 77,790,699 77,790,699 77,790,699 77,790,699
Foot reattachment 10,675,000 10,675,000 10,675,000 10,675,000 10,675,000 10,675,000 10,675,000
Foot Splint (Biasa) 1,500,000 1,500,000 1,500,000 1,500,000 2,250,000 2,250,000 2,250,000
Foot Splint Orfit 3,500,000 3,500,000 3,500,000 3,500,000 5,250,000 5,250,000 5,250,000
Fore Head flap (Bedah Plastik) 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Forearm Crutches (Biasa) 170,000 170,000 170,000 170,000 255,000 255,000 255,000
Forearm Crutches (Standar) 385,000 385,000 385,000 385,000 578,000 578,000 578,000
Forearm, wrist, or hand reattachment 10,675,000 10,675,000 10,675,000 10,675,000 10,675,000 10,675,000 10,675,000
Forehead Flap THT 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Fosfatase Asam 75,000 75,000 75,000 75,000 75,000 75,000 75,000
Fosfor Anorganik (P) 98,000 98,000 98,000 98,000 98,000 98,000 98,000
Fosfor Anorganik Urine (P) 98,000 98,000 98,000 98,000 98,000 98,000 98,000
Foto Abdomen (1 Posisi/2 Posisi/BNO/Foto polos Abdomen) 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Abdomen 3 Posisi 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Foto Abdomen Invertogram 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Adenoid 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Ankle Joint AP + Lateral D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Ankle Joint AP + Lateral D/S 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Ankle Joint Mortise View 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Ankle/Ankle Bilateral (AP/Lat/Keduanya) 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Ante Brachii/Ante Brachii Bilateral 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Antebrachi AP + Lateral D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Antebrachi AP + Lateral D/S 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Basis Kranii 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Bone Age 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Cephalo 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Cervical AP + Lateral + Obliq 3 Posisi 200,000 200,000 200,000 200,000 200,000 200,000 200,000
Foto Cervical Open Mouth 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Clavicula D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Clavicula D/S 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Costae 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Coxae 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Cruris AP + Lateral D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Cruris AP + Lateral D/S 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Cubiti/Cubiti Bilateral 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Femur Ap + Lateral D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Femur Ap + Lateral D/S 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Fundus 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Foto Genu AP + Lateral & Sky Line View D+S 200,000 200,000 200,000 200,000 200,000 200,000 200,000
Foto Genu AP + Lateral & Sky Line View D/S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Genu/Knee Joint AP + Lateral D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Genu/Knee Joint AP + Lateral D/S 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Humerus D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Humerus D/S 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Jaringan Lunak 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Kepala AP + Lateral 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Kepala Water Position 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Koagulasi (acc) 3,760,000 3,760,000 3,760,000 3,760,000 3,760,000 3,760,000 3,760,000
Foto Koagulasi Laser 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Foto Koagulasi Laser (rujukan luar) 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000
Foto Kolumna Vertebralis 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Leher AP + Lateral 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Lumbal AP + Lateral 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Lumbal Dynamic 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Lumbosakral AP + Lateral 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Lumbosakral AP + Lateral + Obliq 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Mandibula / Rahang AP + Lateral 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Mandibula / Rahang AP + Lateral (Rujukan Luar) 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Manus AP + Obliq D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Manus AP + Obliq D/S 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Mastoid 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Metacarpai/Tangan 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Orbita 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Os Nasal 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Pedis AP + Obliq D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Pedis AP + Obliq D/S 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Pelvis/Panggul AP 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Pelvis/Panggul Inlet + outlet AP 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Polos Abdomen 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Radius/Ulna (AP/Lat/Keduanya) 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Rheese 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Sakrum AP + Lateral 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Scapula AP + Lateral D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Scapula AP + Lateral D/S 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Schedel (AP/Lat/Keduanya) (evaluasi adenoid) 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Sendi Bahu / Shoulder Joint D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Sendi Bahu / Shoulder Joint D/S 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Sendi Siku / Elbow Joint D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Sendi Siku / Elbow Joint D/S 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Sinus Adenoid 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Sinus Paranasal 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Stenvers 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Temporomandibular Joint (TMJ) 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Thoracal (AP/Lat/Keduanya) 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Thoracal AP/Lat/Obi 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Thoraco Lumbal AP/Lat/Obi 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Thorakal AP + Lateral 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Thoraks Lateral 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Thoraks PA/AP 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Thoraks PA/AP + Lateral 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto Thoraks RLD 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Top Lordotik 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Foto Wrist Joint AP + Lateral D+S 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Foto Wrist Joint AP + Lateral D/S 160,000 160,000 160,000 160,000 160,000 160,000 160,000
Foto X-RAY C ARM/Flouroscopy 350,000 350,000 350,000 350,000 350,000 350,000 350,000
Foto X-RAY C ARM/Flouroscopy (Rujukan Luar) 1,320,000 1,320,000 1,320,000 1,320,000 1,320,000 1,320,000 1,320,000
Four Poster Cervical Orthosis 2,850,000 2,850,000 2,850,000 2,850,000 4,275,000 4,275,000 4,275,000
Fraktur Maksila/Zygoma 6,168,740 6,168,740 6,168,740 6,168,740 6,168,740 6,168,740 6,168,740
Fraktur Muka Multiple (Tanpa Miniplate Screw) 9,451,305 9,451,305 9,451,305 9,451,305 9,451,305 9,451,305 9,451,305
Fraktur Rahang 2,960,000 2,960,000 2,960,000 2,960,000 2,960,000 2,960,000 2,960,000
Fraktur Rahang Sederhana 6,281,000 6,281,000 6,281,000 6,281,000 6,281,000 6,281,000 6,281,000
Fraktur Sederhana os Nassal + Lokal 5,108,000 5,108,000 5,108,000 5,108,000 5,108,000 5,108,000 5,108,000
Fraktur Sederhana os Nassal + Naskosa Umum 5,107,800 5,107,800 5,107,800 5,107,800 5,107,800 5,107,800 5,107,800
Fraktur Tripodo/Multiple 6,913,000 6,913,000 6,913,000 6,913,000 6,913,000 6,913,000 6,913,000
Free Field Test 73,000 73,000 73,000 73,000 110,000 110,000 110,000
Free Flap Surgery (Bedah Plastik) 39,655,772 39,655,772 39,655,772 39,655,772 39,655,772 39,655,772 39,655,772
Free skin graft 9,182,099 9,182,099 9,182,099 9,182,099 9,182,099 9,182,099 9,182,099
Free skin graft, not otherwise specified 6,528,000 6,528,000 6,528,000 6,528,000 6,528,000 6,528,000 6,528,000
Free T3',0);?> 181,000 181,000 181,000 181,000 0 0 0
Frenectomi 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Frenektomi dengan Anastesi Lokal 0 0 0 0 1,015,000 1,015,000 1,015,000
Fronto-Orbital Advancement Pada Craniosynostosis 22,016,772 22,016,772 22,016,772 22,016,772 22,016,772 22,016,772 22,016,772
Frosen Section (Potongan Beku) VC 900,000 900,000 900,000 900,000 900,000 900,000 900,000
Fruktosamin 84,000 84,000 84,000 84,000 84,000 84,000 84,000
FSH 200,000 200,000 200,000 200,000 200,000 200,000 200,000
FSH (P) 352,000 352,000 352,000 352,000 352,000 352,000 352,000
FT4 _ 210,000 210,000 210,000 210,000 210,000 210,000 210,000
Full-thickness skin graft to hand 6,528,000 6,528,000 6,528,000 6,528,000 6,528,000 6,528,000 6,528,000
Full-thickness skin graft to other sites 6,528,000 6,528,000 6,528,000 6,528,000 6,528,000 6,528,000 6,528,000
Functie Pericard 351,000 351,000 351,000 351,000 351,000 351,000 351,000
Functie Pertitoneum 87,000 87,000 87,000 87,000 87,000 87,000 87,000
Function Evaluation 70,000 70,000 70,000 70,000 105,000 105,000 105,000
Fundoplikasi Gaster 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Funduscopy 80,000 80,000 80,000 80,000 120,000 120,000 120,000
Funduscopy Direct 54,000 54,000 54,000 54,000 81,000 81,000 81,000
Funduscopy Indirect 58,000 58,000 58,000 58,000 87,000 87,000 87,000
Fungsional Endoscopy Sinus Surgery (FESS) 4,243,393 4,243,393 4,243,393 4,243,393 4,243,393 4,243,393 4,243,393
Fusi Korpus Vertebra Approach Anterior (Bedah Syaraf) 6,760,638 6,760,638 6,760,638 6,760,638 6,760,638 6,760,638 6,760,638
Fusi Korpus Vertebra Approach Posterior (Bedah Syaraf) 10,705,638 10,705,638 10,705,638 10,705,638 10,705,638 10,705,638 10,705,638
Fusion or refusion of 2-3 vertebrae 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000
Fusion or refusion of 4-8 vertebrae 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000
Fusion or refusion of 9 or more vertebrae 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000
Gali Kubur Dalam Kota 6,000,000 6,000,000 6,000,000 6,000,000 6,000,000 6,000,000 6,000,000
Gali Kubur Luar Kota 11,000,000 11,000,000 11,000,000 11,000,000 11,000,000 11,000,000 11,000,000
Gambaran Darah tepi * _ 190,000 190,000 190,000 190,000 190,000 190,000 190,000
Gamma GT _ 40,000 40,000 40,000 40,000 40,000 40,000 40,000
Ganti Colostomy Bag 308,000 308,000 308,000 308,000 462,000 462,000 462,000
Ganti Drain 55,000 55,000 55,000 55,000 65,000 65,000 65,000
Ganti Kanule 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Ganti Kawat IMF 55,000 55,000 55,000 55,000 65,000 65,000 65,000
Ganti Nefrostomi 675,000 675,000 675,000 675,000 0 0 0
Ganti Provox 250,000 250,000 250,000 250,000 0 0 0
Ganti Rubber Elastik IMF 55,000 55,000 55,000 55,000 65,000 65,000 65,000
Ganti Verban (Intensif) 83,000 83,000 83,000 83,000 83,000 83,000 83,000
Ganti Verban Besar (Poli Gigi) 122,000 122,000 122,000 122,000 134,000 134,000 134,000
Ganti Verban Kecil (Poli Gigi) 99,000 99,000 99,000 99,000 109,000 109,000 109,000
Ganti Verband 83,000 83,000 83,000 83,000 125,000 125,000 125,000
Ganti Verband (Radiotherapi) 83,000 83,000 83,000 83,000 83,000 83,000 83,000
Ganti Verband Pasien (Besar) 64,000 64,000 64,000 64,000 0 0 0
Ganti Verband Pasien (Kecil) 52,000 52,000 52,000 52,000 52,000 52,000 52,000
Gasterctomi (Blroth 1 dan 2) 5,982,388 5,982,388 5,982,388 5,982,388 5,982,388 5,982,388 5,982,388
Gastrectomi ( Bilroth 1 dan 2 ) 5,982,389 5,982,389 5,982,389 5,982,389 5,982,389 5,982,389 5,982,389
Gastroduodenoskopi 4,995,000 4,995,000 4,995,000 4,995,000 4,995,000 4,995,000 4,995,000
Gastroduodenoskopi Besar 4,995,000 4,995,000 4,995,000 4,995,000 4,995,000 4,995,000 4,995,000
Gastrostomi Pada Neonatus 8,164,502 8,164,502 8,164,502 8,164,502 8,164,502 8,164,502 8,164,502
Genitoplasty (Clitoroplasty, vaginoplasty) 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000 6,175,000
Gigi Tiruan Immediate Koreksi Posisi Protesa Delapan Gigi/Lebih 3,090,000 3,090,000 3,090,000 3,090,000 0 0 0
Gigi Tiruan Immediate Koreksi Posisi Protesa Dua Gigi 970,000 970,000 970,000 970,000 0 0 0
Gigi Tiruan Immediate Koreksi Posisi Protesa Empat Gigi 1,560,000 1,560,000 1,560,000 1,560,000 0 0 0
Gigi Tiruan Immediate Koreksi Posisi Protesa Enam Gigi 2,150,000 2,150,000 2,150,000 2,150,000 0 0 0
Gigi Tiruan Immediate Koreksi Posisi Protesa Lima Gigi 1,860,000 1,860,000 1,860,000 1,860,000 0 0 0
Gigi Tiruan Immediate Koreksi Posisi Protesa Penuh 7,000,000 7,000,000 7,000,000 7,000,000 0 0 0
Gigi Tiruan Immediate Koreksi Posisi Protesa Satu Gigi 600,000 600,000 600,000 600,000 0 0 0
Gigi Tiruan Immediate Koreksi Posisi Protesa Satu Rahang 3,740,000 3,740,000 3,740,000 3,740,000 0 0 0
Gigi Tiruan Immediate Koreksi Posisi Protesa Tiga Gigi 1,200,000 1,200,000 1,200,000 1,200,000 0 0 0
Gigi Tiruan Immediate Koreksi Posisi Protesa Tujuh Gigi 2,295,000 2,295,000 2,295,000 2,295,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Delapan/Lebih/Satu Rahang 1,240,000 1,240,000 1,240,000 1,240,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Dua Gigi 370,000 370,000 370,000 370,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Empat Gigi 560,000 560,000 560,000 560,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Enam Gigi 725,000 725,000 725,000 725,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Lima Gigi 650,000 650,000 650,000 650,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Penuh Flabby Ridge 4,000,000 4,000,000 4,000,000 4,000,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Penuh Flat Rata 3,500,000 3,500,000 3,500,000 3,500,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Penuh Rahang Atas dan Bawah Biasa 2,500,000 2,500,000 2,500,000 2,500,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Satu Gigi 300,000 300,000 300,000 300,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Satu Rahang Dengan Flabby Ridge 2,000,000 2,000,000 2,000,000 2,000,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Satu Rahang Dengan Flat Rata 1,700,000 1,700,000 1,700,000 1,700,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Tiga Gigi 465,000 465,000 465,000 465,000 0 0 0
Gigi Tiruan Lepasan Akrilik Protesa Tujuh Gigi 820,000 820,000 820,000 820,000 0 0 0
Gigi Tiruan Lepasan Immediate Penuh Immediate 4,000,000 4,000,000 4,000,000 4,000,000 0 0 0
Gigi Tiruan Lepasan Immediate Satu Rahang Immediate 2,240,000 2,240,000 2,240,000 2,240,000 0 0 0
Gigi Tiruan Lepasan Immediate/Segera Protesa Delapan/Lebih/Satu Rahang 1,740,000 1,740,000 1,740,000 1,740,000 0 0 0
Gigi Tiruan Lepasan Immediate/Segera Protesa Dua Gigi 670,000 670,000 670,000 670,000 0 0 0
Gigi Tiruan Lepasan Immediate/Segera Protesa Empat Gigi 1,060,000 1,060,000 1,060,000 1,060,000 0 0 0
Gigi Tiruan Lepasan Immediate/Segera Protesa Enam Gigi 1,425,000 1,425,000 1,425,000 1,425,000 0 0 0
Gigi Tiruan Lepasan Immediate/Segera Protesa Lima Gigi 1,250,000 1,250,000 1,250,000 1,250,000 0 0 0
Gigi Tiruan Lepasan Immediate/Segera Protesa Satu Gigi 550,000 550,000 550,000 550,000 0 0 0
Gigi Tiruan Lepasan Immediate/Segera Protesa Tiga Gigi 865,000 865,000 865,000 865,000 0 0 0
Gigi Tiruan Lepasan Immediate/Segera Protesa Tujuh Gigi 1,620,000 1,620,000 1,620,000 1,620,000 0 0 0
Gigi Tiruan Overdenture Protesa Delapan/Lebih/Satu Rahang 1,280,000 1,280,000 1,280,000 1,280,000 0 0 0
Gigi Tiruan Overdenture Protesa Dua Gigi 575,000 575,000 575,000 575,000 0 0 0
Gigi Tiruan Overdenture Protesa Empat Gigi 800,000 800,000 800,000 800,000 0 0 0
Gigi Tiruan Overdenture Protesa Enam Gigi 1,040,000 1,040,000 1,040,000 1,040,000 0 0 0
Gigi Tiruan Overdenture Protesa Lima Gigi 920,000 920,000 920,000 920,000 0 0 0
Gigi Tiruan Overdenture Protesa Penuh Rahang Atas dan Bawah Biasa 2,500,000 2,500,000 2,500,000 2,500,000 0 0 0
Gigi Tiruan Overdenture Protesa Satu Gigi 475,000 475,000 475,000 475,000 0 0 0
Gigi Tiruan Overdenture Protesa Tiga Gigi 680,000 680,000 680,000 680,000 0 0 0
Gigi Tiruan Overdenture Protesa Tujuh Gigi 1,160,000 1,160,000 1,160,000 1,160,000 0 0 0
Gingivectomy 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Gingivektomi / Gingivoplasty per Region dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Globulin _ 32,000 32,000 32,000 32,000 32,000 32,000 32,000
Glosektomi Total 4,903,089 4,903,089 4,903,089 4,903,089 4,903,089 4,903,089 4,903,089
Glosektomi Totalis 4,659,000 4,659,000 4,659,000 4,659,000 4,659,000 4,659,000 4,659,000
Glukose 2 Jam PP _ 28,000 28,000 28,000 28,000 28,000 28,000 28,000
Glukose Puasa _ 28,000 28,000 28,000 28,000 28,000 28,000 28,000
Glukose Sewaktu (Rapid) 30,000 30,000 30,000 30,000 30,000 30,000 30,000
Glukose Sewaktu _ 28,000 28,000 28,000 28,000 28,000 28,000 28,000
Glukose Strip 30,000 30,000 30,000 30,000 30,000 30,000 30,000
Glukose Toleransi _ 40,000 40,000 40,000 40,000 40,000 40,000 40,000
Golongan Darah ABO, Rhesus 95,000 95,000 95,000 95,000 95,000 95,000 95,000
Gonioplasty 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Goniotomi 4,235,000 4,235,000 4,235,000 4,235,000 4,235,000 4,235,000 4,235,000
Goniotomi + anastesi 4,889,000 4,889,000 4,889,000 4,889,000 4,889,000 4,889,000 4,889,000
GOT _ 33,000 33,000 33,000 33,000 33,000 33,000 33,000
GPT _ 33,000 33,000 33,000 33,000 33,000 33,000 33,000
Graf Vena Membuat A Vistula 4,860,000 4,860,000 4,860,000 4,860,000 4,860,000 4,860,000 4,860,000
Graft Gingival dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Graft of muscle or fascia 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000
Grafting Pada Arterial Insufisiensi (Bedah Vaskuler) 4,860,000 4,860,000 4,860,000 4,860,000 4,860,000 4,860,000 4,860,000
Grinding Gigi 55,000 55,000 55,000 55,000 65,000 65,000 65,000
Group Therapi 39,600 39,600 39,600 39,600 49,500 49,500 49,500
Group Therapi (Terapi Kelompok) Fisioterapi 22,800 22,800 22,800 22,800 28,500 28,500 28,500
Group Therapi (Terapi Kelompok)Okupasi Terapi 22,800 22,800 22,800 22,800 28,500 28,500 28,500
Group Therapi (Terapi Kelompok)Terapi Wicara 39,600 42,570 42,570 42,570 49,500 49,500 49,500
Growth Hormone 347,000 347,000 347,000 347,000 347,000 347,000 347,000
Gula Darah 2 Jam Puasa Strip 30,000 30,000 30,000 30,000 30,000 30,000 30,000
Gula Puasa Strip 30,000 30,000 30,000 30,000 30,000 30,000 30,000
GV Laparotomi Anak 24,000 24,000 24,000 24,000 0 0 0
Gymnic Ball (Fisioterapi) 33,000 33,000 33,000 33,000 28,500 28,500 28,500
Gymnic Ball (Okupasi Terapi) 33,000 33,000 33,000 33,000 41,250 41,250 41,250
Ham's Test 31,000 31,000 31,000 31,000 0 0 0
Hang Sling Set 33,000 33,000 33,000 33,000 41,250 41,250 41,250
HBA 1c _ 175,000 175,000 175,000 175,000 175,000 175,000 175,000
Hbe Ag 425,000 425,000 425,000 425,000 425,000 425,000 425,000
HBe Ag (P) 389,000 389,000 389,000 389,000 389,000 389,000 389,000
HBs Ag (Elisa) _ 128,000 128,000 128,000 128,000 128,000 128,000 128,000
HBs Ag (ICT) 72,000 72,000 72,000 72,000 72,000 72,000 72,000
HBsAg Konfirmasi (Elisa) 350,000 350,000 350,000 350,000 350,000 350,000 350,000
HBsAg Kuantitatif (P) 314,000 314,000 314,000 314,000 314,000 314,000 314,000
HBV DNA 2,000,000 2,000,000 2,000,000 2,000,000 2,000,000 2,000,000 2,000,000
HBv DNA (P) 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000
HBV-DNA (Real Time PCR) (P) 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000 1,800,000
HCV RNA 2,300,000 2,300,000 2,300,000 2,300,000 2,300,000 2,300,000 2,300,000
HCV-RNA (Real Time PCR) & HCV Genotipe (P) 4,600,000 4,600,000 4,600,000 4,600,000 4,600,000 4,600,000 4,600,000
HCV-RNA (Real Time PCR) (P) 2,300,000 2,300,000 2,300,000 2,300,000 2,300,000 2,300,000 2,300,000
Head Box 190,000 190,000 190,000 190,000 190,000 190,000 190,000
Hecting 5 cm 113,000 113,000 113,000 113,000 0 0 0
Hemangioma 787,000 787,000 787,000 787,000 0 0 0
Hemangioma (OK Minor) 0 0 0 0 4,000,000 4,000,000 4,000,000
Hematologi Rutin Automatik _ 100,000 100,000 100,000 100,000 100,000 100,000 100,000
Hemiglosektomi + RND 5,077,000 5,077,000 5,077,000 5,077,000 5,077,000 5,077,000 5,077,000
Hemiglosektomi THT 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Hemiglosektomi/Eksisi Tumor Lidah 3,968,000 3,968,000 3,968,000 3,968,000 3,968,000 3,968,000 3,968,000
Hemimandibulektomi 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Hemipelvektomi 6,414,000 6,414,000 6,414,000 6,414,000 6,414,000 6,414,000 6,414,000
Hemiseksi Gigi dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Hemiseksi/Bikuspidasi 0 0 0 0 1,750,000 1,750,000 1,750,000
Hemmimandibulektomi 4,442,187 4,442,187 4,442,187 4,442,187 4,442,187 4,442,187 4,442,187
Hemodialisa 1,300,000 1,300,000 1,300,000 1,300,000 1,300,000 1,300,000 1,300,000
Hemoroidektomi 4,347,979 4,347,979 4,347,979 4,347,979 4,347,979 4,347,979 4,347,979
Hemosiderin 24,000 24,000 24,000 24,000 24,000 24,000 24,000
Hemostasis Saluran Cerna Bagian Atas/Bawah 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Hernia Incarcerata 4,255,565 4,255,565 4,255,565 4,255,565 4,255,565 4,255,565 4,255,565
Herniatomi 4,515,165 4,515,165 4,515,165 4,515,165 4,515,165 4,515,165 4,515,165
Herniatomi Bilateral 4,491,877 4,491,877 4,491,877 4,491,877 4,491,877 4,491,877 4,491,877
Hernioraphi 4,515,165 4,515,165 4,515,165 4,515,165 4,515,165 4,515,165 4,515,165
Herniotomi Bilateral 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462
Herniotomi hernia inkarserata/strangulate 5,782,479 5,782,479 5,782,479 5,782,479 5,782,479 5,782,479 5,782,479
Herniotomi Unilateral 5,070,446 5,070,446 5,070,446 5,070,446 5,070,446 5,070,446 5,070,446
Herniotomy + Laparatomy + Reseksi 6,851,507 6,851,507 6,851,507 6,851,507 6,851,507 6,851,507 6,851,507
Hidrasi Alkalinisasi (hari) 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Hidrokel per Inguinal/Ligasi Tinggi 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Hidrokel per scrotal 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Hidroterapi 250,000 250,000 250,000 250,000 99,000 99,000 99,000
Higroma Colli/Limfangioma Besar 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462 6,238,462
Hip Bone Densitometry 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Hiperexention Brace Khusus 2,800,000 2,800,000 2,800,000 2,800,000 4,200,000 4,200,000 4,200,000
Histerectomi Trans Vaginal / Trans Abdominal et SOB 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Histerectomy Radikal 6,929,993 6,929,993 6,929,993 6,929,993 6,929,993 6,929,993 6,929,993
HIV VIRAL LOAD 2,000,000 2,000,000 2,000,000 2,000,000 2,000,000 2,000,000 2,000,000
Holter 516,000 516,000 516,000 516,000 774,000 774,000 774,000
Holter Monitor 516,000 516,000 516,000 516,000 774,000 774,000 774,000
Horsesche Kidney Koreksi 7,885,000 7,885,000 7,885,000 7,885,000 7,885,000 7,885,000 7,885,000
Hot Pack 22,800 22,800 22,800 22,800 28,500 28,500 28,500
HPV 1,700,000 1,700,000 1,700,000 1,700,000 1,700,000 1,700,000 1,700,000
Hs Troponin I 400,000 400,000 400,000 400,000 400,000 400,000 400,000
HSV II IgM 125,000 125,000 125,000 125,000 125,000 125,000 125,000
Hydro Therapi 91,200 91,200 91,200 91,200 114,000 114,000 114,000
hydrotubasi / Eksterpasi Polip Cerviks tanpa Anastesi 250,000 250,000 250,000 250,000 0 0 0
Hysterectomy Supravaginal 7,850,000 7,850,000 7,850,000 7,850,000 7,850,000 7,850,000 7,850,000
Hysterosalpingografi ( HSG ) 600,000 600,000 600,000 600,000 600,000 600,000 600,000
Hystrectomy Partial 6,292,709 6,292,709 6,292,709 6,292,709 6,292,709 6,292,709 6,292,709
Hystrectomy Total 6,273,291 6,273,291 6,273,291 6,273,291 6,273,291 6,273,291 6,273,291
I V P 750,000 750,000 750,000 750,000 750,000 750,000 750,000
ICCE/ECCE (tidak termasuk IOL) (acc) 4,276,711 4,276,711 4,276,711 4,276,711 4,276,711 4,276,711 4,276,711
IgA / IgG / IgM 96,000 96,000 96,000 96,000 96,000 96,000 96,000
IgE Total (P) 320,000 320,000 320,000 320,000 320,000 320,000 320,000
IgE _ 119,000 119,000 119,000 119,000 119,000 119,000 119,000
IgM Salmonella (TF Semikuantitatif) 250,000 250,000 250,000 250,000 250,000 250,000 250,000
IHC (Immunohistochemistry) - AE1/AE3 (Cytokeratin) 500,000 500,000 500,000 500,000 500,000 500,000 500,000
IHC (Immunohistochemistry) - CD 117',0);?> 500,000 500,000 500,000 500,000 500,000 500,000 500,000
IHC (Immunohistochemistry) - CD20',0);?> 500,000 500,000 500,000 500,000 500,000 500,000 500,000
IHC (Immunohistochemistry) - Ki67',0);?> 500,000 500,000 500,000 500,000 500,000 500,000 500,000
IHC (Immunohistochemistry) - LCA (CD45) 500,000 500,000 500,000 500,000 500,000 500,000 500,000
IHC (Immunohistochemistry) - S100',0);?> 500,000 500,000 500,000 500,000 500,000 500,000 500,000
IHC (Immunohistochemistry) - Vimentin 500,000 500,000 500,000 500,000 500,000 500,000 500,000
IHC (Immunohistochemistry) ER, PR, HER-2',0);?> 1,200,000 1,200,000 1,200,000 1,200,000 1,200,000 1,200,000 1,200,000
IHC Paket Payudara (ER-PR,Crb/HER 2, Topo, P53) 1,200,000 1,200,000 1,200,000 1,200,000 1,200,000 1,200,000 1,200,000
Ileal Condoit (Bricker)/Operasi 10,230,000 10,230,000 10,230,000 10,230,000 10,230,000 10,230,000 10,230,000
Immunoterapi 120,000 120,000 120,000 120,000 180,000 180,000 180,000
Immunotyping (P) 800,000 800,000 800,000 800,000 800,000 800,000 800,000
Implant Kokhlea 23,550,000 23,550,000 23,550,000 23,550,000 23,550,000 23,550,000 23,550,000
Implantasi Koklea 13,850,000 13,850,000 13,850,000 13,850,000 13,850,000 13,850,000 13,850,000
Imunisasi / Vaksinasi 45,000 45,000 45,000 45,000 68,000 68,000 68,000
Imunisasi Mandiri 45,000 45,000 45,000 45,000 68,000 68,000 68,000
Imuno Elektroforesis Anti IgG / IgA / IgM 96,000 96,000 96,000 96,000 96,000 96,000 96,000
Imuno Elektroforesis Whole Anti Serum 96,000 96,000 96,000 96,000 96,000 96,000 96,000
Imunohistokimia (IHC) )Per antibodi 500,000 500,000 500,000 500,000 500,000 500,000 500,000
Incisi (Tutup Lubang Telinga) 47,000 47,000 47,000 47,000 350,000 350,000 350,000
Incisi Ganed 120,000 120,000 120,000 120,000 0 0 0
Incision and drainage of palmar or thenar space 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000 11,196,000
Incubator 88,000 88,000 88,000 88,000 88,000 88,000 88,000
Indirect Veneer/Porcelain 0 0 0 0 500,000 500,000 500,000
Induksi Partus 300,000 300,000 300,000 300,000 300,000 300,000 300,000
Infant Warmer 66,000 66,000 66,000 66,000 66,000 66,000 66,000
Infra Red Rays 22,800 22,800 22,800 22,800 28,500 28,500 28,500
Infusion Pump 60,000 60,000 60,000 60,000 60,000 60,000 60,000
Inhalasi 60,000 60,000 60,000 60,000 0 0 0
Inisiasi Dini Menyusui (IDM) 10,000 10,000 10,000 10,000 10,000 10,000 10,000
Injection of anaesthetic into spinal canal for analgesia 5,115,554 5,115,554 5,115,554 5,115,554 5,115,554 5,115,554 5,115,554
Injection of other agent, except neurolytic 3,215,554 3,215,554 3,215,554 3,215,554 3,215,554 3,215,554 3,215,554
Injection of therapeutic agent into joint or ligament 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000
Injection of therapeutic substance into bursa of hand 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000
Injection of therapeutic substance into joint or ligament 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000 5,752,000
Injection of therapeutic substance into tendon of hand 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000 3,125,000
Injeksi (Suntik) 30,000 30,000 30,000 30,000 30,000 30,000 30,000
Injeksi (Suntik) II Dst 25,000 25,000 25,000 25,000 37,500 37,500 37,500
Injeksi Antibiotik 0 0 0 0 30,000 30,000 30,000
Injeksi Botulinum Toxin Phenol 250,000 250,000 250,000 250,000 99,000 99,000 99,000
Injeksi Deferoxamine 60,000 60,000 60,000 60,000 60,000 60,000 60,000
Injeksi Eritropoietin 60,000 60,000 60,000 60,000 60,000 60,000 60,000
Injeksi Gonadotropin Releasing Hormone Analog (GnRH Analog/Leuprorelin Asetat) 90,000 90,000 90,000 90,000 0 0 0
Injeksi Granulocyt Colony Stimulating Faktor 60,000 60,000 60,000 60,000 60,000 60,000 60,000
Injeksi Haemoroid (Termasuk Obat) 675,000 675,000 675,000 675,000 0 0 0
Injeksi HCG Test 90,000 90,000 90,000 90,000 135,000 135,000 135,000
Injeksi Hormon Testosteron (Sustanon) 90,000 90,000 90,000 90,000 0 0 0
Injeksi Intraartikuler 200,000 200,000 200,000 200,000 300,000 300,000 300,000
Injeksi Kenacort Intralesi 97,000 97,000 97,000 97,000 146,000 146,000 146,000
Injeksi Kenacort THT 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Injeksi Lokal Syaraf (Sederhana) 162,000 162,000 162,000 162,000 243,000 243,000 243,000
Injeksi MTPS ( Injeksi Triger Ponit ) 250,000 250,000 250,000 250,000 99,000 99,000 99,000
Injeksi Sensitivity Spinal Segmental 250,000 250,000 250,000 250,000 99,000 99,000 99,000
Injeksi Varises (Termasuk Obat) 675,000 675,000 675,000 675,000 0 0 0
Injeksi Zoledronic Acid (ZOMETA) 90,000 90,000 90,000 90,000 0 0 0
INR 110,000 110,000 110,000 110,000 110,000 110,000 110,000
Inseminasi Intra Urine 250,000 250,000 250,000 250,000 0 0 0
Insersi DJ Stent 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Insersi Kateter Double Lumen : Semi Permanen 3,438,000 3,438,000 3,438,000 3,438,000 5,157,000 5,157,000 5,157,000
Insersi Kateter Double Lumen : Temporer 1,688,000 1,688,000 1,688,000 1,688,000 2,532,000 2,532,000 2,532,000
Insersie Inlay/Onlay 0 0 0 0 350,000 350,000 350,000
Insersie Jacket Crown PFM/All porcelain 0 0 0 0 450,000 450,000 450,000
Insersie Veneer Porcelain 0 0 0 0 300,000 300,000 300,000
Insertion of interbody spinal fusion device 9,016,000 9,016,000 9,016,000 9,016,000 9,016,000 9,016,000 9,016,000
Insertion of other spinal device 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000 2,350,000
Insisi + eskplorasi abses septi 47,000 47,000 47,000 47,000 71,000 71,000 71,000
Insisi Abses 250,000 250,000 250,000 250,000 375,000 375,000 375,000
Insisi Abses (Hepatoma Septum Nasi/Peritonsil) 250,000 250,000 250,000 250,000 375,000 375,000 375,000
Insisi Abses Peri Tonsiler 250,000 250,000 250,000 250,000 0 0 0
Insisi Abses Perineum 675,000 675,000 675,000 675,000 0 0 0
Insisi Abses Single dengan Anastesi Lokal 270,000 270,000 270,000 270,000 319,000 319,000 319,000
Insisi Abses Skrotum 675,000 675,000 675,000 675,000 0 0 0
Insisi Abses Sub Madibula 250,000 250,000 250,000 250,000 375,000 375,000 375,000
Insisi Biopsy dengan Anastesi Lokal 270,000 270,000 270,000 270,000 319,000 319,000 319,000
Insisi Drainase Multiple dengan Anastesi Lokal 860,000 860,000 860,000 860,000 1,015,000 1,015,000 1,015,000
Insisi Furunkel 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Insisi hematoma Vulva 107,000 107,000 107,000 107,000 161,000 161,000 161,000
Insisi Kalazion / Hordeolun 153,000 153,000 153,000 153,000 230,000 230,000 230,000
Insisi Mucocele 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Insisi Tongue Tie 4,995,000 4,995,000 4,995,000 4,995,000 4,995,000 4,995,000 4,995,000
Insisi/drainase abses dengan anastesi umum 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000 2,159,000
Insisional Biopsi Kelenjar Leher 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Inspekulo 83,000 83,000 83,000 83,000 125,000 125,000 125,000
Inspekulo (Apusan servix) 30,000 30,000 30,000 30,000 0 0 0
Inspekulo (Kultur cairan servix) 30,000 30,000 30,000 30,000 0 0 0
Inspekulo (Test KOH) 30,000 30,000 30,000 30,000 0 0 0
Inspirasi 250,000 250,000 250,000 250,000 375,000 375,000 375,000
Interferensi 75,000 75,000 75,000 75,000 112,500 112,500 112,500
Intermiten Positive Pressure Breathing (IPPB) 66,000 66,000 66,000 66,000 0 0 0
Internal fixation of bone without fracture reduction on femur 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Internal fixation of bone without fracture reduction on humerus 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Internal fixation of bone without fracture reduction on patella 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Internal fixation of bone without fracture reduction on radius and ulna 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Internal fixation of bone without fracture reduction on scapula, clavicle, and thorax (ribs and sternum) 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Internal fixation of bone without fracture reduction on tarsals and metatarsals 4,804,456 4,804,456 4,804,456 4,804,456 4,804,456 4,804,456 4,804,456
Internal fixation of bone without fracture reduction on tibia and fibula 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Internal fixation of bone without fracture reductionon carpals and metacarpals 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000 5,828,000
Internal fixation of patella without fracture reduction 18,596,121 18,596,121 18,596,121 18,596,121 18,596,121 18,596,121 18,596,121
Internal Urethrotomi ( Sachse ) 7,458,259 7,458,259 7,458,259 7,458,259 7,458,259 7,458,259 7,458,259
interphalangeal fusion 5,561,121 5,561,121 5,561,121 5,561,121 5,561,121 5,561,121 5,561,121
Interthoracoscapular amputation 5,997,200 5,997,200 5,997,200 5,997,200 5,997,200 5,997,200 5,997,200
Intervertebral chemonucleolysis 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000 14,020,000
Intra Dermal Test THT 250,000 250,000 250,000 250,000 375,000 375,000 375,000
Intra-Aortic Balloon Pump (IABP) + Anestesi 17,198,000 17,198,000 17,198,000 17,198,000 17,198,000 17,198,000 17,198,000
Intubasi 695,684 695,684 695,684 695,684 695,684 695,684 695,684
Intubasi Double Lumen Tube 1,130,000 1,130,000 1,130,000 1,130,000 1,130,000 1,130,000 1,130,000
Irigasi Hidung/sinus paranasalis 36,000 36,000 36,000 36,000 54,000 54,000 54,000
Irigasi Kandung Kemih 25,000 25,000 25,000 25,000 0 0 0
Irigasi Luka Operasi / Spooling 55,000 55,000 55,000 55,000 65,000 65,000 65,000
Irigasi Sinus/DAWO 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000 2,850,000
Irigasi Telinga 55,000 55,000 55,000 55,000 83,000 83,000 83,000
Iscole 87,000 87,000 87,000 87,000 131,000 131,000 131,000
ISH per PROBE Inditu Hibridization 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000
Isonom Station ( Cybex ) 87,600 87,600 87,600 87,600 109,500 109,500 109,500
Isthmolobektomi 4,488,256 4,488,256 4,488,256 4,488,256 4,488,256 4,488,256 4,488,256
Isthobektomi 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
IV Cavagram 2,000,000 2,000,000 2,000,000 2,000,000 2,000,000 2,000,000 2,000,000
IVC Filter 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000 14,450,000
Jacket Crown/gigi porcelain preparasi jacket 0 0 0 0 650,000 650,000 650,000
Jahit Dehisensi Luka 163,000 163,000 163,000 163,000 245,000 245,000 245,000
Jahit Luka 76,000 76,000 76,000 76,000 0 0 0
Jahitan Perineum tingkat 1 & 2',0);?> 60,000 60,000 60,000 60,000 60,000 60,000 60,000
Jahitan Perineum tingkat 3 & 4',0);?> 600,000 600,000 600,000 600,000 600,000 600,000 600,000
Jamur 30,000 30,000 30,000 30,000 30,000 30,000 30,000
Jarak sampai 7 Km (dalam kota) 80,000 80,000 80,000 80,000 80,000 80,000 80,000
Jewett Brace (Biasa) 1,320,000 1,320,000 1,320,000 1,320,000 1,980,000 1,980,000 1,980,000
Jewett Brace (Khusus) 1,600,000 1,600,000 1,600,000 1,600,000 2,400,000 2,400,000 2,400,000
Johanson 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Johanson 1',0);?> 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
KAFO (Biasa) 3,500,000 3,500,000 3,500,000 3,500,000 5,250,000 5,250,000 5,250,000
KAFO (Khusus) 5,000,000 5,000,000 5,000,000 5,000,000 7,500,000 7,500,000 7,500,000
Kalibrasi Uretra 675,000 675,000 675,000 675,000 0 0 0
Kalporeksis 5,840,933 5,840,933 5,840,933 5,840,933 5,840,933 5,840,933 5,840,933
Kalsium Darah 45,000 45,000 45,000 45,000 45,000 45,000 45,000
Kalsium Urine 45,000 45,000 45,000 45,000 45,000 45,000 45,000
Kanaloplasti/ Pengangkatan massa tulang 6,050,000 6,050,000 6,050,000 6,050,000 6,050,000 6,050,000 6,050,000
Kapsulektomi Posterior 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
karcis 10,000 10,000 10,000 10,000 10,000 10,000 10,000
Karcis (ODC) 9,000 9,000 9,000 9,000 0 0 0
Kardiotokografi (KTG) 299,000 299,000 299,000 299,000 449,000 449,000 449,000
Kardioversi 1,076,000 1,076,000 1,076,000 1,076,000 1,076,000 1,076,000 1,076,000
Katerisasi Urethra 39,000 39,000 39,000 39,000 0 0 0
Kateterisasi Anak 4,120,000 4,120,000 4,120,000 4,120,000 4,120,000 4,120,000 4,120,000
Kaustik 66,000 66,000 66,000 66,000 0 0 0
Kaustik Faring 66,000 66,000 66,000 66,000 25,000 25,000 25,000
Kaustik hidung ( AgNO3, tricolor acetat) 36,000 36,000 36,000 36,000 54,000 54,000 54,000
Kaustik telinga (AgNo3,albotyl) 18,000 18,000 18,000 18,000 27,000 27,000 27,000
Kauter Albotil/Cauter Podofiline 66,000 66,000 66,000 66,000 0 0 0
Kauterisasi 675,000 675,000 675,000 675,000 0 0 0
Kehamilan Ektopik Terganggu (KET) 6,119,720 6,119,720 6,119,720 6,119,720 6,119,720 6,119,720 6,119,720
kelainan jari / ektremitas sederhana 5,175,000 5,175,000 5,175,000 5,175,000 5,175,000 5,175,000 5,175,000
Kelasi Besi Suntik 66,000 66,000 66,000 66,000 99,000 99,000 99,000
Kemotherapi + Anestesi 700,000 700,000 700,000 700,000 700,000 700,000 700,000
Kemotherapy Ca Paru 410,000 410,000 410,000 410,000 0 0 0
Keratometry 73,000 73,000 73,000 73,000 110,000 110,000 110,000
Keratoplasti 11,350,000 11,350,000 11,350,000 11,350,000 11,350,000 11,350,000 11,350,000
Keratoplastie Lamelar 4,093,930 4,093,930 4,093,930 4,093,930 4,093,930 4,093,930 4,093,930
Khemoterapy 410,000 410,000 410,000 410,000 410,000 410,000 410,000
Khordectomi 5,646,937 5,646,937 5,646,937 5,646,937 5,646,937 5,646,937 5,646,937
Khordektomy pada Hyspopadia 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
KHS ( Konduksi Hantaran Safar ) 62,400 62,400 62,400 62,400 78,000 78,000 78,000
Kindwall (2 Jam) 300,000 300,000 300,000 300,000 300,000 300,000 300,000
Kistektomi 6,165,762 6,165,762 6,165,762 6,165,762 6,165,762 6,165,762 6,165,762
Klisma 66,000 66,000 66,000 66,000 66,000 66,000 66,000
Klisma (Intensif) 66,000 66,000 66,000 66,000 66,000 66,000 66,000
Knee Brace (Biasa) 1,650,000 1,650,000 1,650,000 1,650,000 2,475,000 2,475,000 2,475,000
Knee Brace (Khusus) 2,500,000 2,500,000 2,500,000 2,500,000 3,750,000 3,750,000 3,750,000
Knight Taylor 3,000,000 3,000,000 3,000,000 3,000,000 4,500,000 4,500,000 4,500,000
KOH 33,000 33,000 33,000 33,000 50,000 50,000 50,000
Koledoko Jejunostomi 5,240,302 5,240,302 5,240,302 5,240,302 5,240,302 5,240,302 5,240,302
Kolesistektomi 4,342,099 4,342,099 4,342,099 4,342,099 4,342,099 4,342,099 4,342,099
Kolesterol HDL _ 60,000 60,000 60,000 60,000 60,000 60,000 60,000
Kolesterol LDL (Direk) _ 100,000 100,000 100,000 100,000 100,000 100,000 100,000
Kolesterol Total _ 45,000 45,000 45,000 45,000 45,000 45,000 45,000
Kolonoskopi 2,065,000 2,065,000 2,065,000 2,065,000 2,065,000 2,065,000 2,065,000
Kolonoskopi + Anastesi 3,102,000 3,102,000 3,102,000 3,102,000 3,102,000 3,102,000 3,102,000
Kolonoskopy 5,026,784 5,026,784 5,026,784 5,026,784 5,026,784 5,026,784 5,026,784
Kolostomi 4,160,391 4,160,391 4,160,391 4,160,391 4,160,391 4,160,391 4,160,391
Kolostomi Neonatus/Ikostomi/Jejunostomi 7,801,000 7,801,000 7,801,000 7,801,000 7,801,000 7,801,000 7,801,000
Kolostomi/ikostomi/kemonostomi pada anak 7,801,000 7,801,000 7,801,000 7,801,000 7,801,000 7,801,000 7,801,000
Kolpoperineorafi 675,000 675,000 675,000 675,000 1,013,000 1,013,000 1,013,000
Kolposkopi dan Biopsi 396,000 396,000 396,000 396,000 210,000 210,000 210,000
Komplemen C3',0);?> 70,000 70,000 70,000 70,000 70,000 70,000 70,000
Komplemen C4',0);?> 70,000 70,000 70,000 70,000 70,000 70,000 70,000
Komponen Trombosit Apheresis Per Bag (PMI) 3,500,000 3,500,000 3,500,000 3,500,000 3,500,000 3,500,000 3,500,000
Kompresi Bimanual interna& eksterna 180,000 180,000 180,000 180,000 180,000 180,000 180,000
Konkoplasti 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Konseling oleh Psikolog 130,000 130,000 130,000 130,000 0 0 0
Konsul Dokter 52,000 52,000 52,000 52,000 0 0 0
Konsul dr Ahli Alergi Imunologi Anak (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Anak (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Anastesi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Bedah Anak (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Bedah Digestive (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Bedah Gastroentrohepatologi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Bedah Orthopedi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Bedah Plastik (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Bedah Saraf (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Bedah Thorax & Vask. (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Bedah Tumor (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Bedah Umum (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Bedah Urologi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Cardiologi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Endokrin (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Forensik (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Gastroentrohepatologi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Geriatri (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Gigi dan Mulut (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Ginjal Hipertensi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Gizi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Hematologi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Hiperbarik (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Infection Center (IRNA) 86,400 108,000 129,600 150,000 150,000 150,000 288,000
Konsul dr Ahli Infeksi Tropis (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Jiwa (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Kulkel (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Mata (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Nefrologi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Neurologi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli NICU (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Obgyn (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Ongko Obgyn ( IRNA ) 41,200 51,400 84,000 120,000 150,000 210,000 288,000
Konsul dr Ahli Onkology (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Patologi Klinik (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Penyakit Dalam (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Penyakit Tropis (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli PICU (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Psikiatri (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Pulmonologi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Radiologi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Radiotherapi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Respiriology Anak ( IRNA) 41,200 51,400 84,000 120,000 150,000 210,000 288,000
Konsul dr Ahli Rheumatologi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli Saraf (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Ahli THT (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Fisiotherapi (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsul dr Rehab Medik (IRNA) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsultasi Dokter ( Rehab Medik ) 62,400 62,400 62,400 62,400 99,000 99,000 99,000
Konsultasi Dokter Ahli (IRNA PCC) 50,000 60,000 96,000 150,000 150,000 150,000 288,000
Konsultasi Dokter Ahli (IRNA PCC) Super VIP B 0 0 0 0 0 0 228,000
Kontraktur + STSG 6,421,000 6,421,000 6,421,000 6,421,000 6,421,000 6,421,000 6,421,000
Kontrol Protesa 42,000 42,000 42,000 42,000 75,000 75,000 75,000
Koreksi + Rekonstruksi Ptosis 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000 4,850,000
Koreksi Atresia Ani 5,225,000 5,225,000 5,225,000 5,225,000 5,225,000 5,225,000 5,225,000
Koreksi ektropion / entropion 4,515,574 4,515,574 4,515,574 4,515,574 4,515,574 4,515,574 4,515,574
Koreksi ektropion / entropion ( Anak ) 4,380,574 4,380,574 4,380,574 4,380,574 4,380,574 4,380,574 4,380,574
Koreksi Impresif Fraktur Sederhana 5,108,156 5,108,156 5,108,156 5,108,156 5,108,156 5,108,156 5,108,156
Koreksi Priapismus 5,151,000 5,151,000 5,151,000 5,151,000 5,151,000 5,151,000 5,151,000
Koreksi Simblefaron Berat 11,350,000 11,350,000 11,350,000 11,350,000 11,350,000 11,350,000 11,350,000
Koreksi Symblepharon 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000 3,850,000
Korset (Biasa) 366,000 366,000 366,000 366,000 549,000 549,000 549,000
Korset (Standar) 507,000 507,000 507,000 507,000 761,000 761,000 761,000
Kranioplasti/Koreksi Fraktur 9,775,887 9,775,887 9,775,887 9,775,887 9,775,887 9,775,887 9,775,887
Kraniotomi + Endoskopi 11,992,025 11,992,025 11,992,025 11,992,025 11,992,025 11,992,025 11,992,025
Kraniotomi+Bedah Mikro 11,775,887 11,775,887 11,775,887 11,775,887 11,775,887 11,775,887 11,775,887
Kraniotomi/Trepanasi Konvensional 10,554,887 10,554,887 10,554,887 10,554,887 10,554,887 10,554,887 10,554,887
Kreatinin Klrens _ 92,000 92,000 92,000 92,000 92,000 92,000 92,000
Kreatinin Urine 30,000 30,000 30,000 30,000 30,000 30,000 30,000
Kreatinin _ 35,000 35,000 35,000 35,000 35,000 35,000 35,000
Kruk Aluminium 271,000 271,000 271,000 271,000 407,000 407,000 407,000
Kuldosintesis 120,000 120,000 120,000 120,000 120,000 120,000 120,000
Kultur & Sensitivity OAT 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Kultur dan Sensitivitas Jamur 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Kultur dan Sensitivitas Manual 250,000 250,000 250,000 250,000 250,000 250,000 250,000
Kultur dan Sensitivitas Otomatis 380,000 380,000 380,000 380,000 380,000 380,000 380,000
Kulture jamur 54,000 54,000 54,000 54,000 81,000 81,000 81,000
Kunjungan Rumah Analis Laboratorium ( Home Care ) 100,000 100,000 100,000 100,000 100,000 0 0
Kunjungan Rumah Dokter ( Home Care ) 100,000 100,000 100,000 100,000 100,000 0 0
Kunjungan Rumah Dokter Spesialis ( Home Care ) 200,000 200,000 200,000 200,000 200,000 0 0
Kunjungan Rumah Fisioterapis ( Home Care ) 100,000 100,000 100,000 100,000 100,000 0 0
Kunjungan Rumah Ners ( Perawat ) ( Home Care ) 100,000 100,000 100,000 100,000 100,000 0 0
Kunjungan Rumah Nutrisionis ( Home Care ) 100,000 100,000 100,000 100,000 100,000 0 0
Kuretase 140,000 140,000 140,000 140,000 166,000 166,000 166,000
Kuretase Abortus Inkomplitus/ rest plasenta 600,000 600,000 600,000 600,000 600,000 600,000 600,000
Kuretase dengan PUD / Polip 5,680,221 5,680,221 5,680,221 5,680,221 5,680,221 5,680,221 5,680,221
Kuretase Diagnostik 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Kuretase molahidatidosa 720,000 720,000 720,000 720,000 720,000 720,000 720,000
Kuretase Percobaan 400,000 400,000 400,000 400,000 400,000 400,000 400,000
Kuretase Plasenta Retensio 720,000 720,000 720,000 720,000 720,000 720,000 720,000
Kuretase plasenta/molahidatidosa anastesi 1,423,000 1,423,000 1,423,000 1,423,000 1,423,000