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[749,"TUL/URS","350000.0","6430000.0"], [750,"Retroperitoneal","350000.0","6430000.0"], [751,"Lymphadenektomi","350000.0","6430000.0"], [752,"Radical prostatektomi","350000.0","6430000.0"], [753,"Operasi tumor supra renalis","350000.0","6430000.0"], [754,"Augmentasi bladder","350000.0","6430000.0"], [755,"Bivalve nefrolitotomi","350000.0","6430000.0"], [756,"Coffey prosedur","350000.0","6430000.0"], [757,"TUUC (Trans Uretero Ureteral Cutaneostomy)","350000.0","6430000.0"], [758,"Breaker Prosedur","350000.0","6430000.0"], [759,"Nefrektomi donor cangkok ginjal","350000.0","6430000.0"], [760,"(TURP) & Litotripsi","350000.0","6430000.0"], [761,"Koreksi Horseshoe Kidney","350000.0","6430000.0"], [762,"Nefroureteroktomi","350000.0","6430000.0"], [763,"Deroofing Kista Ginjal Per Laparoskopi","350000.0","6430000.0"], [764,"Diseksi Kelenjar Getah Bening Pelvis Per Laparoskopi","350000.0","6430000.0"], [765,"Eksplorasi Testis (Microsurgery)","350000.0","6430000.0"], [766,"Laparoskopi 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Pemasangan Intramedulary Wire, La","350000.0","1870000.0"], [811,"Fraktur Dan Dislokasi - Pemasangan Splint Tangan, La","350000.0","1870000.0"], [812,"Incisi Absces Perikondritis, Ga","350000.0","1870000.0"], [813,"Injeksi Haemangioma Dengan Skleroting Agent Atau Triamcinolon Acetonid, La","350000.0","1870000.0"], [814,"Injeksi Skleroting Agent, La","350000.0","1870000.0"], [815,"Jahit Luka Di Wajah Dengan Kerusakan Sedang, Ga","350000.0","1870000.0"], [816,"Jahit Luka Di Wajah Dengan Kerusakan Sedang, La","350000.0","1870000.0"], [817,"Lobuloplasty, La","350000.0","1870000.0"], [818,"Melakukan Nekrotomi Sedang, La","350000.0","1870000.0"], [819,"Rouzerplasty, La","350000.0","1870000.0"], [820,"Simple Advancement Flap (Flap Kulit Sederhana), La","350000.0","1870000.0"], [821,"","",""], [822,"BESAR","",""], [823,"Amputasi Sederhana, Ga","350000.0","3400000.0"], [824,"Boutonnniere Deformity Repair, La","350000.0","3400000.0"], [825,"Debridement Luka Bakar Fase Akut 15 - 30 %, Ga","350000.0","3400000.0"], [826,"Eksisi Fistel Preaurikula, La","350000.0","3400000.0"], [827,"Eksisi Intrakeloidal + Jahit Primer, La","350000.0","3400000.0"], [828,"Eksisi Keloid + Skin Grafting, La","350000.0","3400000.0"], [829,"Eksisi Polidaktili Simple Dewasa, La","350000.0","3400000.0"], [830,"Ekstirpasi Tumor Jinak Kulit Diluar Wajah, Ga","350000.0","3400000.0"], [831,"Escharectomy Dengan Tangensial Eksisi, Ga","350000.0","3400000.0"], [832,"Fasciotomy Burned Compartement Syndrome, Ga","350000.0","3400000.0"], [833,"Finger Tip Injury Repair - Composite Graft, La","350000.0","3400000.0"], [834,"Finger Tip Injury Repair - Skin Flap Lokal, La","350000.0","3400000.0"], [835,"Finger Tip Injury Repair - Skin Grafting, La","350000.0","3400000.0"], [836,"Full Thickness Skin Graft (Ftsg) Daerah Diluar Wajah, La","350000.0","3400000.0"], [837,"Full Thickness Skin Graft (Ftsg) Pada Wajah, La","350000.0","3400000.0"], [838,"Injeksi Haemangioma Dengan Skleroting Agent Atau Triamcinolon Acetonid, Ga","350000.0","3400000.0"], [839,"Insersi Tulang Rawan Telinga Akibat Avulsi Telinga, La","350000.0","3400000.0"], [840,"Ioid + Archbarr Fraktur 1 Sisi, Ga","350000.0","3400000.0"], [841,"Ioid + Archbarr Fraktur 2 Sisi, Ga","350000.0","3400000.0"], [842,"Ioid + Imf(Eyelet) Fraktur 1 Sisi, Ga","350000.0","3400000.0"], [843,"Jahit Luka Di Wajah Daerah Estetik Unit, La","350000.0","3400000.0"], [844,"Jahit Luka Di Wajah Dengan Kerusakan Komplek, La","350000.0","3400000.0"], [845,"Kontraktur Tangan Dan Jari, La","350000.0","3400000.0"], [846,"Labioplasty Pada Microform, La","350000.0","3400000.0"], [847,"Labioplasty Sumbing Bibir Unilateral, Ga","350000.0","3400000.0"], [848,"Mallet Finger Repair, La","350000.0","3400000.0"], [849,"Melakukan Nekrotomi Luas, Ga","350000.0","3400000.0"], [850,"Pasang Archbarr 1 Sisi, La","350000.0","3400000.0"], [851,"Pasang Archbarr 2 Sisi, La","350000.0","3400000.0"], [852,"Release Kontraktur Dengan Dermagram, La","350000.0","3400000.0"], [853,"Repair Cleft Ear Lobe, La","350000.0","3400000.0"], [854,"Repair Trauma Telinga Simple, La","350000.0","3400000.0"], [855,"Revisi Dengan Simple Z Plasty, La","350000.0","3400000.0"], [856,"Revisi Labioplasty, La","350000.0","3400000.0"], [857,"Revisi Parut Dengan Simple Advancement Flap, La","350000.0","3400000.0"], [858,"Revisi Parut, La","350000.0","3400000.0"], [859,"Revisi Stump, La","350000.0","3400000.0"], [860,"Revisis Parutdiluar Wajah, La","350000.0","3400000.0"], [861,"Rhynophyma Repair, La","350000.0","3400000.0"], [862,"Simple Advancement Flap, La","350000.0","3400000.0"], [863,"Skin Flap Lokal Sederhana, La","350000.0","3400000.0"], [864,"Skin Flap Sederhana , La","350000.0","3400000.0"], [865,"Split Thickness Skin Graft (Stsg) Sederhana, La","350000.0","3400000.0"], [866,"Surgical Debridement/Sharp Debridement, Ga","350000.0","3400000.0"], [867,"","",""], [868,"KHUSUS","",""], [869,"Alveolar Bone Graft Dengan Allograft, Ga","350000.0","6430000.0"], [870,"Amputasi Komplek, Ga","350000.0","6430000.0"], [871,"Chordee Excision, Ga","350000.0","6430000.0"], [872,"Circumferential Wiring + Archbarr, Ga","350000.0","6430000.0"], [873,"Closed Recuction + Imf(Eyelet), Ga","350000.0","6430000.0"], [874,"Closed Reduction + Archbarr, Ga","350000.0","6430000.0"], [875,"Commissuroplasty - Direct Closure, La","350000.0","6430000.0"], [876,"Commissuroplasty - Ear Cartilage Graft, La","350000.0","6430000.0"], [877,"Commissuroplasty - Regional Flap, La","350000.0","6430000.0"], [878,"Commissuroplasty - Skin Flap Lokal, La","350000.0","6430000.0"], [879,"Commissuroplasty, La","350000.0","6430000.0"], [880,"Debridement Luka Bakar Fase Akut > 30 %, Ga","350000.0","6430000.0"], [881,"Double Rotation Skin Flap, La","350000.0","6430000.0"], [882,"Eksisi Basalioma Dengan Skin Flap, La","350000.0","6430000.0"], [883,"Eksisi Haemangioma Dengan Composite Flap, La","350000.0","6430000.0"], [884,"Eksisi Haemangioma Dengan Simple Advancement Flap, La","350000.0","6430000.0"], [885,"Eksisi Haemangioma Dengan Skin Flap Lokal, La","350000.0","6430000.0"], [886,"Eksisi Haemangioma Dengan Skingrafting, La","350000.0","6430000.0"], [887,"Eksisi Keloid + Skin Grafting - Revisi Dengan Multiple Z Plast, Ga","350000.0","6430000.0"], [888,"Eksisi Keloid + Skin Grafting - Revisi Dengan Simple Advancement, Ga","350000.0","6430000.0"], [889,"Eksisi Keloid + Skin Grafting - 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Rekonstruksi : Defek/ Kelainan Muka, La","350000.0","6430000.0"], [900,"Ops.Rek. : Defak/Kelainan Tubuh Yang Lain, La","350000.0","6430000.0"], [901,"Orbital Bone And Eye Socket Reconstruction, Ga","350000.0","6430000.0"], [902,"Orif + Orbital Wall Reconstruction Dengan Ribs Bone Graft, Ga","350000.0","6430000.0"], [903,"Rekonstruksi Dengan Skin Flap Komplek, La","350000.0","6430000.0"], [904,"Rekonstruksi Dengan Skin Grafting, La","350000.0","6430000.0"], [905,"Rekonstruksi Kelainan Genetalia Eksterna Yang Lain, La","350000.0","6430000.0"], [906,"Rekonstruksi Kelainan Telinga Yang Lain, La","350000.0","6430000.0"], [907,"Rekonstruksi Softtissue Pada Hipertelorism, La","350000.0","6430000.0"], [908,"Rekonstruksi Telinga - Repair Lobulus Dan Kelainan Penyerta, La","350000.0","6430000.0"], [909,"Rekonstruksi Vermilion, Ga","350000.0","6430000.0"], [910,"Release Burried Penis, La","350000.0","6430000.0"], [911,"Release Burried Penis, Ga","350000.0","6430000.0"], [912,"Release Ekstropion, La","350000.0","6430000.0"], [913,"Release Ekstropion, Ga","350000.0","6430000.0"], [914,"Release Kontraktur Dengan Skin Flap, La","350000.0","6430000.0"], [915,"Release Kontraktur Dengan Skingraft, La","350000.0","6430000.0"], [916,"Release Kontraktur Dengan Z Plasty, La","350000.0","6430000.0"], [917,"Release Kontraktur Leher, La","350000.0","6430000.0"], [918,"Release Kontraktur Linier, La","350000.0","6430000.0"], [919,"Release Vagina Acreta, La","350000.0","6430000.0"], [920,"Repair Palpebra Dengan Local Skin Flap, La","350000.0","6430000.0"], [921,"Repair Palpebra Simple, La","350000.0","6430000.0"], [922,"Repair Soft Tissue Komplek, La","350000.0","6430000.0"], [923,"Repair Softtisue Simple, La","350000.0","6430000.0"], [924,"Repair Tendon Ekstensor Tangan Tunggal, La","350000.0","6430000.0"], [925,"Repair Tendon Fleksor Tangan Tunggal, La","350000.0","6430000.0"], [926,"Reposisi Dislokasi Tmj, Ga","350000.0","6430000.0"], [927,"Revisi Dengan Multiple Z Plasty/W Plasty, La","350000.0","6430000.0"], [928,"Revisi Dengan Flap Lokal, La","350000.0","6430000.0"], [929,"Revisi Dengan Simple Z Plasty, Ga","350000.0","6430000.0"], [930,"Revisi Parut Dengan Simple Advancement Flap, Ga","350000.0","6430000.0"], [931,"Revisi Parut Wajah, La","350000.0","6430000.0"], [932,"Revisi Parut, Ga","350000.0","6430000.0"], [933,"Nailbed Reconstruction, Ga","350000.0","6430000.0"], [934,"Secondary Repair Labioplasty, La","350000.0","6430000.0"], [935,"Secondary Rhynoplasty, La","350000.0","6430000.0"], [936,"Semi Open Reduction (Gillies Procedure), Ga","350000.0","6430000.0"], [937,"Single Rotation/ Transposition Skin Flap, Ga","350000.0","6430000.0"], [938,"Single Rotation/ Transposition Skin Flap, La","350000.0","6430000.0"], [939,"Skin And Fascial Grafts, La","350000.0","6430000.0"], [940,"Skin Flap Lokal Komplek, La","350000.0","6430000.0"], [941,"Skin Flap Lokal Sederhana, Ga","350000.0","6430000.0"], [942,"Soft Tissue Rekonstruksi, La","350000.0","6430000.0"], [943,"Split Thickness Skin Graft (Stsg) Sederhana, Ga","350000.0","6430000.0"], [944,"Stiff Finger Joint - Capsuloyomy-Tenolysis, La","350000.0","6430000.0"], [945,"Stiff Finger Joint - Volar Plate Release, La","350000.0","6430000.0"], [946,"Tangensial Eksisi Dini Dengan Skin Grafting , La","350000.0","6430000.0"], [947,"Tendon Repair, La","350000.0","6430000.0"], [948,"Commissuroplasty - Skin Graft, Ga","350000.0","6430000.0"], [949,"Distant Flap, Ga","350000.0","6430000.0"], [950,"Double Rotation Skin Flap, Ga","350000.0","6430000.0"], [951,"Eksisi Haemangioma Dengan Simple Advancement Flap, Ga","350000.0","6430000.0"], [952,"Eksisi Haemangioma Dengan Skin Flap, Ga","350000.0","6430000.0"], [953,"Eksisi Haemangioma Dengan Skingrafting, Ga","350000.0","6430000.0"], [954,"Eksisi Keloid + Skin Grafting - Komplek, Ga","350000.0","6430000.0"], [955,"Eksisi Polydactyly Complex, Ga","350000.0","6430000.0"], [956,"Eksisi Poydactyly Simple, Ga","350000.0","6430000.0"], [957,"Eksisi Rinofima, Ga","350000.0","6430000.0"], [958,"Fasciocutaneus Flap, Ga","350000.0","6430000.0"], [959,"Full Thickness Skin Graft (Ftsg) Daerah Diluar Wajah, Ga","350000.0","6430000.0"], [960,"Full Thickness Skin Graft (Ftsg) Pada Wajah, Ga","350000.0","6430000.0"], [961,"Jahit Luka Di Wajah Daerah Estetik Unit, Ga","350000.0","6430000.0"], [962,"Labioplasty Bilateral, Ga","350000.0","6430000.0"], [963,"Operasi Rekonstruksi : Palpebra, La","350000.0","6430000.0"], [964,"Orif + Titanium Mini Plate Approach Ektra Oral 1 Sisi, Ga","350000.0","6430000.0"], [965,"Orif Dengan 1 Approach, Ga","350000.0","6430000.0"], [966,"Orif Dengan Ginggivo-Bucal Approach, Ga","350000.0","6430000.0"], [967,"Orif Dengan Infraciliar Approach, Ga","350000.0","6430000.0"], [968,"Orif Dengan Transconjunctival Approach, Ga","350000.0","6430000.0"], [969,"Orif Untuk Fraktur Le Fort I, Ga","350000.0","6430000.0"], [970,"Palatoplasty Complete, Ga","350000.0","6430000.0"], [971,"Palatoplasty Incomplete, Ga","350000.0","6430000.0"], [972,"Reconstruction Of Central Ray Deficiency, Ga","350000.0","6430000.0"], [973,"Reconstruction Of Radial Ray Deficiency, Ga","350000.0","6430000.0"], [974,"Rekonstruksi Dengan Menggunakan Tissue Expantion, Ga","350000.0","6430000.0"], [975,"Rekonstruksi Dengan Skin Flap Lokal, La","350000.0","6430000.0"], [976,"Rekonstruksi Dengan Skin Grafting, Ga","350000.0","6430000.0"], [977,"Rekonstruksi Kelainan Telinga Yang Lain, Ga","350000.0","6430000.0"], [978,"Release Kontraktur Dengan Skin Flap, Ga","350000.0","6430000.0"], [979,"Release Kontraktur Dengan Z Plasty, Ga","350000.0","6430000.0"], [980,"Repair Palpebra Dengan Oral Mucosal Graft, Ga","350000.0","6430000.0"], [981,"Repair Palpebra Dengan Posterior Lamellar Reconstruction, Ga","350000.0","6430000.0"], [982,"Repair Trauma Telinga Komplek, Ga","350000.0","6430000.0"], [983,"Secondary Lip Repair , Ga","350000.0","6430000.0"], [984,"Separasi Complete Syndacttly, Ga","350000.0","6430000.0"], [985,"Separasi Syndactyly, Ga","350000.0","6430000.0"], [986,"Skin Flap Lokal Komplek, Ga","350000.0","6430000.0"], [987,"Skingrafting Yang Sederhana, Ga","350000.0","6430000.0"], [988,"Split Thickness Skin Graft (Stsg) Luas, Ga","350000.0","6430000.0"], [989,"Tangensial Eksisi Dini Dengan Skin Grafting, Ga","350000.0","6430000.0"], [990,"Ankylosis Release, Ga","350000.0","6430000.0"], [991,"Bedah Mikro, Ga","350000.0","6430000.0"], [992,"Buried Dermal Flap (Thompson Procedure), Ga","350000.0","6430000.0"], [993,"Chordee Excision + Urethroplasty 1 Tahap, Ga","350000.0","6430000.0"], [994,"Commissuroplasty - Composite Flap(Microsurgery), Ga","350000.0","6430000.0"], [995,"Commissuroplasty - Gastro Omental Free Flap(Microsurgery), Ga","350000.0","6430000.0"], [996,"Commissuroplasty - Jejunal Free Autograft (Microsurgery), Ga","350000.0","6430000.0"], [997,"Cross-Facial Verve Graft, Ga","350000.0","6430000.0"], [998,"Eksisi Haemangioma Dengan Composite Flap, Ga","350000.0","6430000.0"], [999,"Endoscopic Reconstructive Surgery, Ga","350000.0","6430000.0"], [1000,"Facial Sling Dengan Alograft, Ga","350000.0","6430000.0"], [1001,"Finger Tip Injury Repair - Neurovascular Island/Distant Flap, Ga","350000.0","6430000.0"], [1002,"Finger Tip Injury Repair - Toe Transfer, Ga","350000.0","6430000.0"], [1003,"Fraktur Dan Dislokasi - Orif Dengan Miniplate, Ga","350000.0","6430000.0"], [1004,"Free Flap, Ga","350000.0","6430000.0"], [1005,"Free Gracillis Transfer, Ga","350000.0","6430000.0"], [1006,"Frontozygomaticomaxillary Suspension, Ga","350000.0","6430000.0"], [1007,"Jahit Luka Di Wajah Dengan Kerusakan Komplek, Ga","350000.0","6430000.0"], [1008,"Kontraktur Tangan Dan Jari, Ga","350000.0","6430000.0"], [1009,"Le Fort I Osteotomy, Ga","350000.0","6430000.0"], [1010,"Mandibular Distraction, Ga","350000.0","6430000.0"], [1011,"Mandibular Reconst With Non Vascularized Bone Graft, Ga","350000.0","6430000.0"], [1012,"Mandibular Reconst With Tmj Plate Rekonstruction, Ga","350000.0","6430000.0"], [1013,"Mandibular Reconst With Vascularized Bone Graft(Mikro) - Defek Boyd T, Ga","350000.0","6430000.0"], [1014,"Mastopexy, Ga","350000.0","6430000.0"], [1015,"Maxillary Reconst.With Non Vascularized Bone Graft, Ga","350000.0","6430000.0"], [1016,"Maxillary Reconst.With Vascularized Bone Graft(Mikro), Ga","350000.0","6430000.0"], [1017,"Medial/Lateral Canthoplasty, Ga","350000.0","6430000.0"], [1018,"Musculocutaneus Flap, Ga","350000.0","6430000.0"], [1019,"Myocutaneus Flap, Ga","350000.0","6430000.0"], [1020,"Omental Flap, Ga","350000.0","6430000.0"], [1021,"Open Reduction With Implant And Septoplasty, La","350000.0","6430000.0"], [1022,"Open Reduction With Wire/Titanium Implant, Ga","350000.0","6430000.0"], [1023,"Operasi Bedah Mikro Yang Lain, Ga","350000.0","6430000.0"], [1024,"Operasi Rekonstruksi : Hidung, La","350000.0","6430000.0"], [1025,"Operasi Rekonstruksi : Hidung, Ga","350000.0","6430000.0"], [1026,"Operasi Rekonstruksi : Palpebra, Ga","350000.0","6430000.0"], [1027,"Operasi Rekonstruksi : Telinga, Ga","350000.0","6430000.0"], [1028,"Operasi Rekonstruksi : Wajah, Ga","350000.0","6430000.0"], [1029,"Operasi Rekonstruksi : Wajah, Ga","350000.0","6430000.0"], [1030,"Operasi Rekonstruksi : Payudara Dan Sekitarnya, Ga","350000.0","6430000.0"], [1031,"Operasi Rekonstruksi : Bokong, Ga","350000.0","6430000.0"], [1032,"Operasi Rekonstruksi : Genitalia Eksterna Dan Sekitarnya, Ga","350000.0","6430000.0"], [1033,"Operasi Skin Flap Yang Lain Yang Lebih Komplek, Ga","350000.0","6430000.0"], [1034,"Ops. Rekonstruksi : Defek/ Kelainan Muka, Ga","350000.0","6430000.0"], [1035,"Ops.Rek. : Defak/Kelainan Tubuh Yang Lain, Ga","350000.0","6430000.0"], [1036,"Orif + Orbital Wall Reconstruction Dengan Silicon Plate, Ga","350000.0","6430000.0"], [1037,"Orif + Titanium Mini Plate Approach Ektra Oral 2 Sisi, Ga","350000.0","6430000.0"], [1038,"Orif Dengan 2 Approach, Ga","350000.0","6430000.0"], [1039,"Orif Dengan 3 Approach, Ga","350000.0","6430000.0"], [1040,"Orif Untuk Fraktur Le Fort Ii, Ga","350000.0","6430000.0"], [1041,"Orif Untuk Fraktur Le Fort Iii Bicoronal Approach, Ga","350000.0","6430000.0"], [1042,"Osseointegrated Mandibular Implant - Close Primary, Ga","350000.0","6430000.0"], [1043,"Osseointegrated Mandibular Implant - Distant/Free Flap, Ga","350000.0","6430000.0"], [1044,"Osseointegrated Mandibular Implant, Ga","350000.0","6430000.0"], [1045,"Pharyngoplasty, Ga","350000.0","6430000.0"], [1046,"Primary/Secondary Repair Nerve Injury (Bedah Mikro), Ga","350000.0","6430000.0"], [1047,"Rekonstruksi Dengan Composite Flap (Microsurgery), Ga","350000.0","6430000.0"], [1048,"Rekonstruksi Dengan Composite Flap (Microsurgery), Ga","350000.0","6430000.0"], [1049,"Rekonstruksi Dengan Free Vascularized Bone Graft, Ga","350000.0","6430000.0"], [1050,"Rekonstruksi Dengan Muscle Flap Dengan Skin Graft, Ga","350000.0","6430000.0"], [1051,"Rekonstruksi Dengan Musculocutaneus Flap, Ga","350000.0","6430000.0"], [1052,"Rekonstruksi Dengan Skin Flap Komplek, Ga","350000.0","6430000.0"], [1053,"Rekonstruksi Dengan Skin Flap Lokal, Ga","350000.0","6430000.0"], [1054,"Rekonstruksi Dengan Tissue Expantion+Skin Flap, Ga","350000.0","6430000.0"], [1055,"Rekonstruksi Ibu Jari - Bone Graft + Myocutaneus Free Flap, Ga","350000.0","6430000.0"], [1056,"Rekonstruksi Ibu Jari - Bone Graft + Regional Flap, Ga","350000.0","6430000.0"], [1057,"Rekonstruksi Ibu Jari - Deepening First Digital Web Space, La","350000.0","6430000.0"], [1058,"Rekonstruksi Ibu Jari - Policization, Ga","350000.0","6430000.0"], [1059,"Rekonstruksi Ibu Jari - Toe To Thumb Transfer, Ga","350000.0","6430000.0"], [1060,"Rekonstruksi Kelainan Genetalia Eksterna Yang Lain, Ga","350000.0","6430000.0"], [1061,"Rekonstruksi Mandibula Dengan Costochondral Graft, Ga","350000.0","6430000.0"], [1062,"Rekonstruksi Soft Tissue Dan Tulang, Ga","350000.0","6430000.0"], [1063,"Rekonstruksi Soft Tissue Yang Lain, Ga","350000.0","6430000.0"], [1064,"Rekonstruksi Softtissue Pada Hipertelorism, Ga","350000.0","6430000.0"], [1065,"Rekonstruksi Telinga - Elevasi Flap Daun Telinga + Skin Graft, Ga","350000.0","6430000.0"], [1066,"Rekonstruksi Telinga - Operasi Insersi Graft Tulang Rawan, Ga","350000.0","6430000.0"], [1067,"Rekonstruksi Telinga - Repair Lobulus Dan Kelainan Penyerta, Ga","350000.0","6430000.0"], [1068,"Rekostruksi Softtissue Dan Tulang Pada Hipertelorism, Ga","350000.0","6430000.0"], [1069,"Release Kontraktur Dengan Free Flap, Ga","350000.0","6430000.0"], [1070,"Release Kontraktur Dengan Skingraft, Ga","350000.0","6430000.0"], [1071,"Release Kontraktur Leher, Ga","350000.0","6430000.0"], [1072,"Release Kontraktur Linier, Ga","350000.0","6430000.0"], [1073,"Release Vagina Acreta, Ga","350000.0","6430000.0"], [1074,"Repair Blepharoptosis, La","350000.0","6430000.0"], [1075,"Repair Blepharoptosis, Ga","350000.0","6430000.0"], [1076,"Repair Bibir Dengan - Estlander Flap, Ga","350000.0","6430000.0"], [1077,"Repair Bibir Dengan Bernard-Burows Flap, Ga","350000.0","6430000.0"], [1078,"Repair Bibir Dengan Karapandzic Methode, Ga","350000.0","6430000.0"], [1079,"Repair Camptodactyly, Ga","350000.0","6430000.0"], [1080,"Repair Clinodactyly, Ga","350000.0","6430000.0"], [1081,"Repair Creeple Hypospadia, Ga","350000.0","6430000.0"], [1082,"Repair Ductus Nasolacrimalis, Ga","350000.0","6430000.0"], [1083,"Repair Ductus Parotis, Ga","350000.0","6430000.0"], [1084,"Repair Epispadia, Ga","350000.0","6430000.0"], [1085,"Repair Fistel Palatum Dengan Bucal Atau Lingual Flap, Ga","350000.0","6430000.0"], [1086,"Repair Fistel Palatum, Ga","350000.0","6430000.0"], [1087,"Repair Fistel Urethra Complex, Ga","350000.0","6430000.0"], [1088,"Repair Fistel Urethra Sederhana, Ga","350000.0","6430000.0"], [1089,"Repair Involutional Ptosis, La","350000.0","6430000.0"], [1090,"Repair Involutional Ptosis, Ga","350000.0","6430000.0"], [1091,"Repair Palpebra Dengan Tarsoconjunctival Graft, Ga","350000.0","6430000.0"], [1092,"Repair Palpebra Dengan Hard Palate Mucosal Graft, Ga","350000.0","6430000.0"], [1093,"Repair Palpebra Dengan Local Skin Flap, Ga","350000.0","6430000.0"], [1094,"Repair Palpebra Dengan Septal Chondromucosal Graft, Ga","350000.0","6430000.0"], [1095,"Repair Palpebra Dengan Skin Flap Regional, La","350000.0","6430000.0"], [1096,"Repair Palpebra Dengan Skin Graft, La","350000.0","6430000.0"], [1097,"Repair Palpebra Dengan Sliding Transconjunctival Flap, La","350000.0","6430000.0"], [1098,"Repair Palpebra Komplek, Ga","350000.0","6430000.0"], [1099,"Repair Polysyndactyly, Ga","350000.0","6430000.0"], [1100,"Repair Syaraf Tepi, Ga","350000.0","6430000.0"], [1101,"Repair Symbrachydactyly, Ga","350000.0","6430000.0"], [1102,"Repair Tendon Ekstensor Tangan Multiple, Ga","350000.0","6430000.0"], [1103,"Repair Tendon Fleksor Tangan Multipel+ Pulley Reconst., Ga","350000.0","6430000.0"], [1104,"Repair Tendon Fleksor Tangan Multiple, Ga","350000.0","6430000.0"], [1105,"Repair Tendon Fleksor Tangan Tunggal + Pulley Reconst., Ga","350000.0","6430000.0"], [1106,"Repalatoplasty, Ga","350000.0","6430000.0"], [1107,"Replantasi Jari Multiple, Ga","350000.0","6430000.0"], [1108,"Replantasi Jari Tunggal, Ga","350000.0","6430000.0"], [1109,"Reseksi Rahang, Ga","350000.0","6430000.0"], [1110,"Restorasi Dan Rekonstruksi Softissue+ Bone Dengan Multiple Approach, Ga","350000.0","6430000.0"], [1111,"Revaskularisasi Jari Multiple, Ga","350000.0","6430000.0"], [1112,"Revaskularisasi Jari Tunggal, Ga","350000.0","6430000.0"], [1113,"Revisi Dengan Multiple Z Plasty/W Plasty, Ga","350000.0","6430000.0"], [1114,"Revisi Dengan Flap Jauh, Ga","350000.0","6430000.0"], [1115,"Revisi Dengan Flap Lokal, Ga","350000.0","6430000.0"], [1116,"Separasi Complex Syndactyly, Ga","350000.0","6430000.0"], [1117,"Skin Flap Komplek Lebih Dari Satu Flap, Ga","350000.0","6430000.0"], [1118,"Skin Flap Komplek, Ga","350000.0","6430000.0"], [1119,"Skin Grafting Yang Luas, Ga","350000.0","6430000.0"], [1120,"Skin Grafting Dengan Luas Sedang, Ga","350000.0","6430000.0"], [1121,"Split Thickness Skin Graft (Stsg) Luas Dengan Perawatan Khusus, Ga","350000.0","6430000.0"], [1122,"Staged Subcutaneous Excision Underneath Flaps, Ga","350000.0","6430000.0"], [1123,"Stiff Finger Joint - Finger Arthoplasty With Silicone Implant, Ga","350000.0","6430000.0"], [1124,"Stiff Finger Joint - Finger Arthoplasty With Titanium Implant, Ga","350000.0","6430000.0"], [1125,"Supraorbital Bone Reconstruction, Ga","350000.0","6430000.0"], [1126,"Temporalis Muscle Fascia Transfer, Ga","350000.0","6430000.0"], [1127,"Tendon Transfer Multiple, Ga","350000.0","6430000.0"], [1128,"Tendon Transfer Tunggal, Ga","350000.0","6430000.0"], [1129,"Tendoplasty, Ga","350000.0","6430000.0"], [1130,"Tissue Expantion, Ga","350000.0","6430000.0"], [1131,"Tmj Arthroscopy And Treatment, Ga","350000.0","6430000.0"], [1132,"Tmj Arthrotomy, Ga","350000.0","6430000.0"], [1133,"Tmj Lavage Dengan C-Arm, Ga","350000.0","6430000.0"], [1134,"Total Cranial Vault Reconstruction, Ga","350000.0","6430000.0"], [1135,"Total Joint Repl With Vascularized Bone Graft, Ga","350000.0","6430000.0"], [1136,"Total Joint Replacement With Implant, Ga","350000.0","6430000.0"], [1137,"Total Skin And Subcutaneous Tissue Excision Dg Skingraft (Charles), Ga","350000.0","6430000.0"], [1138,"Transeksual Female To Male, Ga","350000.0","6430000.0"], [1139,"Transeksual Male To Female, Ga","350000.0","6430000.0"], [1140,"Transplatation Penis, Ga","350000.0","6430000.0"], [1141,"Urethroplasty, Ga","350000.0","6430000.0"], [1142,"Facial Bone Countouring - Angle Reshaping, Ga","350000.0","6430000.0"], [1143,"Facial Bone Countouring - Genioplasty With Silicone Implant, Ga","350000.0","6430000.0"], [1144,"Facial Bone Countouring - Malarplasty With Silicone Implant, Ga","350000.0","6430000.0"], [1145,"Facial Bone Countouring - Osseous Genioplasty, Ga","350000.0","6430000.0"], [1146,"Facial Bone Countouring - Osseous Malarplasty, Ga","350000.0","6430000.0"], [1147,"Facial Bone Countouring - Split Mandible Osteotomy, Ga","350000.0","6430000.0"], [1148,"Orif Untuk Fraktur Le Fort Iii, Ga","350000.0","6430000.0"], [1149,"Biopsi, La","350000.0","6430000.0"], [1150,"Incisi Absces Perikondritis, La","350000.0","6430000.0"], [1151,"Incisi Abscess, La, La","350000.0","6430000.0"], [1152,"Kauterisasi Lesi Kulit Jinak, La","350000.0","6430000.0"], [1153,"Kauterisasi Papiloma Kulit , La","350000.0","6430000.0"], [1154,"Secondary Hechting, La","350000.0","6430000.0"], [1155,"","",""], [1156,"DOKTER BEDAH THORAX / VASKULAR","",""], [1157,"JENIS PELAYANAN","JS","TARIF"], [1158,"KECIL","",""], [1159,"Pasang jarum Jet Can","350000.0","1110000.0"], [1160,"Amputasi 1 digiti","350000.0","1110000.0"], [1161,"","",""], [1162,"BESAR","",""], [1163,"Biopsi scalen","350000.0","1870000.0"], [1164,"Debridement luas","350000.0","1870000.0"], [1165,"Extirpasi hemangioma simple","350000.0","1870000.0"], [1166,"Embolectomi (kh1)","350000.0","1870000.0"], [1167,"Pemasangan akses vena port (VAP)","350000.0","1870000.0"], [1168,"Removal VAP","350000.0","1870000.0"], [1169,"Amputasi below knee","350000.0","1870000.0"], [1170,"Amputasi above knee (kh 1)","350000.0","1870000.0"], [1171,"Amputasi lengan","350000.0","1870000.0"], [1172,"HD Cath ( open method )","350000.0","1870000.0"], [1173,"","",""], [1174,"KHUSUS","",""], [1175,"Torakotomisimpatektomi","350000.0","3400000.0"], [1176,"Torakotomi biopsy","350000.0","3400000.0"], [1177,"Torakotomi window","350000.0","3400000.0"], [1178,"Ligasiarterikarotis","350000.0","3400000.0"], [1179,"End arterectomi","350000.0","3400000.0"], [1180,"Stripping + Extraksibabcock","350000.0","3400000.0"], [1181,"Embolectomi + Amputasi (kh2)","350000.0","3400000.0"], [1182,"Extirpasihemangioma duplex/kompleks","350000.0","3400000.0"], [1183,"Repair arteri perifer tanpa graf","350000.0","3400000.0"], [1184,"Repair AV fistula (kh2)","350000.0","3400000.0"], [1185,"Eksisi tumor dinding dada ","350000.0","3400000.0"], [1186,"AV Shunt radialis","350000.0","3400000.0"], [1187,"Stripping simple","350000.0","3400000.0"], [1188,"Simpatektomi lumbal/abdominal","350000.0","3400000.0"], [1189,"Reseksi tumor pleura","350000.0","3400000.0"], [1190,"Torakotomi simple","350000.0","3400000.0"], [1191,"Torakotomi dekortikasi","350000.0","3400000.0"], [1192,"Torakotomi reseksi kosta / Sternum","350000.0","3400000.0"], [1193,"Torakotomi ORIF kosta","350000.0","3400000.0"], [1194,"Torakotomi segmentektomi (kh3)","350000.0","3400000.0"], [1195,"Torakotomi removal korpal","350000.0","3400000.0"], [1196,"Torakotomi Repair hernia diafragmatika (kh3)","350000.0","3400000.0"], [1197,"Simpatektomi duplex","350000.0","3400000.0"], [1198,"AV shunt cubiti","350000.0","3400000.0"], [1199,"Reseksi aneurisma arteri perifer","350000.0","3400000.0"], [1200,"Stripping duplex / komplex","350000.0","3400000.0"], [1201,"Repair arteri dengan graf","350000.0","3400000.0"], [1202,"Torakoscopi Biopsi","350000.0","3400000.0"], [1203,"Torakoscopi Evakuasi","350000.0","3400000.0"], [1204,"Torakoscopi Tutup Vistel","350000.0","3400000.0"], [1205,"Pneumektomi","350000.0","3400000.0"], [1206,"Rekonstruksi aneurisma aorta abdominalis per laparotomi","350000.0","3400000.0"], [1207,"Rekonstruksi aneurisma aorta abdominalis suprarenal per laparotomi","350000.0","3400000.0"], [1208,"Rekonstruksi aneurisma arteri iliaka per laparotomi","350000.0","3400000.0"], [1209,"Reseksi tumor oesophagus + Rekonstruksi dengan conduid","350000.0","3400000.0"], [1210,"Rekonstruksi dinding dada","350000.0","3400000.0"], [1211,"Torakotomi Lobektomi","350000.0","3400000.0"], [1212,"Reseksi tumor mediastinum","350000.0","3400000.0"], [1213,"Reseksi tumor paru","350000.0","3400000.0"], [1214,"Torakotomi dekortikasi dan plumbage","350000.0","3400000.0"], [1215,"By pass arterifemoralis","350000.0","3400000.0"], [1216,"Repair perforasi oesophagus","350000.0","3400000.0"], [1217,"Repair bronchus","350000.0","3400000.0"], [1218,"Repair trachea","350000.0","3400000.0"], [1219,"Splenorenal shunt","350000.0","3400000.0"], [1220,"Toracoskopi Reseksi paru","350000.0","3400000.0"], [1221,"Toracoskopi Simpatektomi ","350000.0","3400000.0"], [1222,"Toracoskopi Pengambilan Korpal intra parenchym Paru","350000.0","3400000.0"], [1223,"Toracoskopi Ligasi arteri","350000.0","3400000.0"], [1224,"","",""], [1225,"DOKTER BEDAH ANAK","",""], [1226,"JENIS PELAYANAN","JS","TARIF"], [1227,"KECIL","",""], [1228,"Insisi dan drainase abses","350000.0","1110000.0"], [1229,"Aplikasi silversulfadiazin, betadin, merkurokroom, antibiotika topikal pada omphalocele","350000.0","1110000.0"], [1230,"Sirkumsisi Lokal","350000.0","1110000.0"], [1231,"","",""], [1232,"SEDANG ","",""], [1233,"Eksisi Kista dermoid","350000.0","1870000.0"], [1234,"Skleroterapi lymphangioma dengan injeksi bleomycin, OK 432","350000.0","1870000.0"], [1235,"Eksisi, biopsi lymphadenopaty","350000.0","1870000.0"], [1236,"Eksisi biopsi soft tissue tumor leher, dinding perut","350000.0","1870000.0"], [1237,"Eksisi tongue tie","350000.0","1870000.0"], [1238,"eksisi granuloma umbilikal","350000.0","1870000.0"], [1239,"Release synechia","350000.0","1870000.0"], [1240,"Insisi imperforate hymen","350000.0","1870000.0"], [1241,"","",""], [1242,"BESAR ","",""], [1243,"Eksisi preauricular remnant/ extratragus","350000.0","3400000.0"], [1244,"Eksisi kista, fistula branchial ( I, II, III )","350000.0","3400000.0"], [1245,"Eksisi Kista, fistula thyroglosus","350000.0","3400000.0"], [1246,"Eksisi lymphangioma","350000.0","3400000.0"], [1247,"Lobektomi thyroid","350000.0","3400000.0"], [1248,"Eksisi, marsupialisasi ranula","350000.0","3400000.0"], [1249,"Eksisi epignagthus","350000.0","3400000.0"], [1250,"Gastrostomi","350000.0","3400000.0"], [1251,"esofagostomi","350000.0","3400000.0"], [1252,"Subkutaneus mastektomi ginekomastia","350000.0","3400000.0"], [1253,"Herniotomi umbilikal","350000.0","3400000.0"], [1254,"tutup defek dinding perut dengan silo","350000.0","3400000.0"], [1255,"Fundoplikasi","350000.0","3400000.0"], [1256,"Pyloromiotomy","350000.0","3400000.0"], [1257,"Liver biopsi","350000.0","3400000.0"], [1258,"Appendektomi ","350000.0","3400000.0"], [1259,"Eksisi tumor, biopsy neuroblastoma, teratoma, rabdomyosarkoma","350000.0","3400000.0"], [1260,"Sphincterotomi anal, stretching anal","350000.0","3400000.0"], [1261,"Thiersch procedure","350000.0","3400000.0"], [1262,"Herniotorni, ligasi tinggi proc. vaginalis","350000.0","3400000.0"], [1263,"Detorsio testis, orkhidopeksi, orkhidektomi","350000.0","3400000.0"], [1264,"Eksisi kista baker's","350000.0","3400000.0"], [1265,"Koreksi polidaktili","350000.0","3400000.0"], [1266,"","",""], [1267,"KHUSUS ","",""], [1268,"Lengthening m. sternokleidomastoideus","350000.0","6430000.0"], [1269,"Thorakotomi Reseksi anastomosis esophagus","350000.0","6430000.0"], [1270,"Esofagomyotomi achalasia","350000.0","6430000.0"], [1271,"Thorakotomi tutup defek diafragma kongenital","350000.0","6430000.0"], [1272,"Laparotomi tutup defek diafragma kongenital","350000.0","6430000.0"], [1273,"Thorakotomy Plikasi diafragma ","350000.0","6430000.0"], [1274,"Laparotomi plikasi diafragma","350000.0","6430000.0"], [1275,"Eksisi sinus, fistula dan kista omphalomesenterikus","350000.0","6430000.0"], [1276,"Eksisi sinus, fistula dan kista urakhus","350000.0","6430000.0"], [1277,"Repair dinding perut (abdominal closure) gastroskisis dan omphalokel","350000.0","6430000.0"], [1278,"Abdominoplasty, urine diversion, orkhidopeksi pada prune belly syndrome","350000.0","6430000.0"], [1279,"Gatropexy, reduction of valvulus, gastrostomi pada gangguan rotasi usus kongenital","350000.0","6430000.0"], [1280,"Eksisi diafragma, mocosal ablation pada gastric diafragma atau pre antral web","350000.0","6430000.0"], [1281,"Closure of perforation, gastrostomi","350000.0","6430000.0"], [1282,"Foreign bodies and bezoar extraction per endoskopi, laparotomi","350000.0","6430000.0"], [1283,"Ablasio duplikasi gastrointestinal","350000.0","6430000.0"], [1284,"Duodenoduodenostomy, duodenojejunostomy","350000.0","6430000.0"], [1285,"Reseksi pankreas","350000.0","6430000.0"], [1286,"Kistojejunostomi R&Y, pada pseudokista pankreas ","350000.0","6430000.0"], [1287,"Hepatikojejunostomi R&Y pada kista duktus koledukus","350000.0","6430000.0"], [1288,"Hepaticojejunostomy, portoenterostomy (Kasai)","350000.0","6430000.0"], [1289,"Kholedokholitotomi, kholesistektomi","350000.0","6430000.0"], [1290,"Total splenectomy, ","350000.0","6430000.0"], [1291,"Partial splenectomy","350000.0","6430000.0"], [1292,"Splenoraphy","350000.0","6430000.0"], [1293,"Reseksi anastomosis, ileostomi (Bishop­Koop/ Santulli, Mickulicz) pada obstruksi usus halus kongenital","350000.0","6430000.0"], [1294,"Intraperitoneal lavage","350000.0","6430000.0"], [1295,"Reduksi volvulus, Ladd procedure, appendeektomi","350000.0","6430000.0"], [1296,"Wedge resection, reseksi anastomosis","350000.0","6430000.0"], [1297,"Reduksi intususepsi per laparotomi","350000.0","6430000.0"], [1298,"Reseksi anatomosis usus","350000.0","6430000.0"], [1299,"Eksisi kista oinentum, mesenterial","350000.0","6430000.0"], [1300,"Pull-through procedure (Swenson, Soave, Duhamel, transanal), myektomi (Lynn) ","350000.0","6430000.0"], [1301,"PSRHD ","350000.0","6430000.0"], [1302,"Nefrektomi total","350000.0","6430000.0"], [1303,"Nefrektomi parsial","350000.0","6430000.0"], [1304,"Pyeloplasti","350000.0","6430000.0"], [1305,"Reimplantasi ureter, tapering, plikasi„ folding.","350000.0","6430000.0"], [1306,"Eksisi ureterocele","350000.0","6430000.0"], [1307,"Augmentation cystoplasty pada neurogenik bladder","350000.0","6430000.0"], [1308,"Release chordee","350000.0","6430000.0"], [1309,"Urethroplasty","350000.0","6430000.0"], [1310,"Scrotoplasty","350000.0","6430000.0"], [1311,"Vaginoplasty, urethroplasty pada sinus urogenitalis","350000.0","6430000.0"], [1312,"Koreksi polidaktili","350000.0","6430000.0"], [1313,"Koreksi syndaktili","350000.0","6430000.0"], [1314,"Kholesistektomi","350000.0","6430000.0"], [1315,"esophageal replacement (colon, gastric tube, jejenum, gastric pull-up)","350000.0","6430000.0"], [1316,"thorakoskopi Reseksi anastomosis esophagus","350000.0","6430000.0"], [1317,"Intestinal lengthening,","350000.0","6430000.0"], [1318,"laparoskopi tutup defek diafragma kongenital","350000.0","6430000.0"], [1319,"Reseksi liver, lobektomi, ","350000.0","6430000.0"], [1320,"Reduksi intususepsi per laparoskopy","350000.0","6430000.0"], [1321,"laparoskopy appendektomy","350000.0","6430000.0"], [1322,"PSARP (postero sagital anorectoplasti)","350000.0","6430000.0"], [1323,"PSARUVP (posterosagital anorecto uretero vagino plasty","350000.0","6430000.0"], [1324,"ASARP (anterosagital anorecto plasty)","350000.0","6430000.0"], [1325,"abdominosakroperineal pulltrough","350000.0","6430000.0"], [1326,"laparoskopi Fundoplikasi","350000.0","6430000.0"], [1327,"laparoskopy assisted pulltrough","350000.0","6430000.0"], [1328,"Genitoplasty, clitoral reduction, vaginoplasty, urethroplasty pada ambigous genital","350000.0","6430000.0"], [1329,"Rectal closure, bladder closure, kolostomi, anorektoplasti, epispadia repair, continent surgery pada cloaca extrofia","350000.0","6430000.0"], [1330,"Bladder closure, epispadia repair, continent surgery","350000.0","6430000.0"], [1331,"Valve ablation pada posyterior uretral valve","350000.0","6430000.0"], [1332,"laparoskopi herniotomi","350000.0","6430000.0"], [1333,"laparoskopy pyeloplasty","350000.0","6430000.0"], [1334,"laparoskopy reseksi usus","350000.0","6430000.0"], [1335,"laparoskopi pyloromyotomi","350000.0","6430000.0"], [1336,"laparoskopy splenektomi","350000.0","6430000.0"], [1337,"laparoskopi kolesistektomi","350000.0","6430000.0"], [1338,"thorakostomi koreksi pectus exavatus","350000.0","6430000.0"], [1339,"intestinal transplantation","350000.0","6430000.0"], [1340,"Twin separation surgery","350000.0","6430000.0"], [1341,"Liver transplantation","350000.0","6430000.0"], [1342,"","",""], [1343,"DOKTER BEDAH TUMOR","",""], [1344,"JENIS PELAYANAN","JS","TARIF"], [1345,"KECIL","",""], [1346,"Alligator biopsi","350000.0","1110000.0"], [1347,"Katerisasi papilom","350000.0","1110000.0"], [1348,"Cabut kuku","350000.0","1110000.0"], [1349,"Biopsi, La","350000.0","1110000.0"], [1350,"Incisi Absces Perikondritis, La","350000.0","1110000.0"], [1351,"Incisi Abscess, La, La","350000.0","1110000.0"], [1352,"Kauterisasi Lesi Kulit Jinak, La","350000.0","1110000.0"], [1353,"Kauterisasi Papiloma Kulit , La","350000.0","1110000.0"], [1354,"Secondary Hechting, La","350000.0","1110000.0"], [1355,"Sirkumsisi Lokal","350000.0","1110000.0"], [1356,"Eksisi Veruka, La","350000.0","1110000.0"], [1357,"Eksterpasi Tumor Jinak, Diluar Wajah ,La","350000.0","1110000.0"], [1358,"Ektirpasi Aterom Diluar Wajah, La","350000.0","1110000.0"], [1359,"Ektirpasi Lipoma Diluar Wajah, La","350000.0","1110000.0"], [1360,"","",""], [1361,"SEDANG","",""], [1362,"Eksisi papiloma GA","350000.0","1870000.0"], [1363,"Eksisi atheroma GA","350000.0","1870000.0"], [1364,"Debridement GA","350000.0","1870000.0"], [1365,"Rehecting","350000.0","1870000.0"], [1366,"Incisi abses GA","350000.0","1870000.0"], [1367,"","",""], [1368,"BESAR","",""], [1369,"Eksisi papiloma multipel","350000.0","3400000.0"], [1370,"Eksisi atheroma multipel","350000.0","3400000.0"], [1371,"Biopsi dengan generalanestesi","350000.0","3400000.0"], [1372,"Limfadenektomi dengan general anestesi","350000.0","3400000.0"], [1373,"Eksisi FAM single ","350000.0","3400000.0"], [1374,"Eksisi Mastopati single ","350000.0","3400000.0"], [1375,"Subcutan mastektomi unilateral","350000.0","3400000.0"], [1376,"Rekonstruksi nipple areolar complek unilateral","350000.0","3400000.0"], [1377,"Eksisi tumor < 5cm","350000.0","3400000.0"], [1378,"STSG/FTSG < 5cm","350000.0","3400000.0"], [1379,"CWL procedure","350000.0","3400000.0"], [1380,"Eksisi baker's cyst unilateral","350000.0","3400000.0"], [1381,"Debridement +rehecting","350000.0","3400000.0"], [1382,"","",""], [1383,"KHUSUS ","",""], [1384,"Simple mastektomi ","350000.0","6430000.0"], [1385,"Eksisi FAM multiple / bilateral","350000.0","6430000.0"], [1386,"Eksisi Mastopati multipel / bilateral","350000.0","6430000.0"], [1387,"Rekonstruksi nipple areoler complek bilateral","350000.0","6430000.0"], [1388,"Subcutan mastektomi bilateral","350000.0","6430000.0"], [1389,"Istmolobektomi tiroid","350000.0","6430000.0"], [1390,"Hemiglosektomi","350000.0","6430000.0"], [1391,"Radikal Neck Dissection unilateral","350000.0","6430000.0"], [1392,"Inguinal dissection unilateral ","350000.0","6430000.0"], [1393,"Axillary dissection unilateral ","350000.0","6430000.0"], [1394,"Eksisi luas tumor ≥ 5cm","350000.0","6430000.0"], [1395,"Guttering abses","350000.0","6430000.0"], [1396,"Eksisi mama acessories unilateral","350000.0","6430000.0"], [1397,"Eksisi tumor submandibula unilateral","350000.0","6430000.0"], [1398,"Core biopsi","350000.0","6430000.0"], [1399,"Parsial / Hemimandibulektomi","350000.0","6430000.0"], [1400,"Parotidektomi unilateral","350000.0","6430000.0"], [1401,"Maxillektomi unilateral","350000.0","6430000.0"], [1402,"Delay rekonstruksi maxilla/mandibulla","350000.0","6430000.0"], [1403,"Delay rekonstruksi payudara unilateral (Flap/implant)","350000.0","6430000.0"], [1404,"STSG/FTSG ≥ 5cm","350000.0","6430000.0"], [1405,"Amputasi ","350000.0","6430000.0"], [1406,"Reanimasi N7 unilateral","350000.0","6430000.0"], [1407,"Eksisi tumor intraoral unilateral","350000.0","6430000.0"], [1408,"Cystrunk procedure","350000.0","6430000.0"], [1409,"Tracheostomi tumor headneck","350000.0","6430000.0"], [1410,"Eksisi baker's cyst bilateral","350000.0","6430000.0"], [1411,"(Modified) Radikal Mastektomi ","350000.0","6430000.0"], [1412,"BCT (Breast Concerving Treatment) ","350000.0","6430000.0"], [1413,"Skin/NAC sparing mastektomi","350000.0","6430000.0"], [1414,"Eksisi FAM multiple dan bilateral","350000.0","6430000.0"], [1415,"Eksisi Mastopati multipel dan bilateral","350000.0","6430000.0"], [1416,"Subtotal/neartotal/total tiroidektomi","350000.0","6430000.0"], [1417,"Hemiglosektomi+Radikal Neck dissection unilateral","350000.0","6430000.0"], [1418,"Eksisi mama acessories bilateral","350000.0","6430000.0"], [1419,"Eksisi tumor submandibula bilateral","350000.0","6430000.0"], [1420,"Hemimandibulektomi +reconstruksi(implant/FLAP)","350000.0","6430000.0"], [1421,"Total mandibulektomi","350000.0","6430000.0"], [1422,"Parotidektomi unilateral +neck disection","350000.0","6430000.0"], [1423,"Maxillektomi + rekonstruksi (Implant/FLAP)","350000.0","6430000.0"], [1424,"Maksilektomi bilateral","350000.0","6430000.0"], [1425,"Delay rekonstruksi payudara bilateral (Flap/implant)","350000.0","6430000.0"], [1426,"Pasang/lepas Port A Cath/VAP/Cell Side","350000.0","6430000.0"], [1427,"Eksisi tumor intraoral bilateral","350000.0","6430000.0"], [1428,"Eksisi tumor intraoral unilateral +neck dissection","350000.0","6430000.0"], [1429,"Rekonstruksi hidung, bibir dengan flap/implant","350000.0","6430000.0"], [1430,"Eksisi luas tumor ≥ 5cm +FLAP/graft","350000.0","6430000.0"], [1431,"Muscle Group Excision","350000.0","6430000.0"], [1432,"Debulking Tumor","350000.0","6430000.0"], [1433,"(Modified) Radikal Mastektomi+rekonstruksi payudara dengan implant/ flap","350000.0","6430000.0"], [1434,"Skin/NAC sparing mastektomi +rekonstruksi implant/flap","350000.0","6430000.0"], [1435,"Total tiroidektomi + Neck dissection unilateral ","350000.0","6430000.0"], [1436,"Hemiglosektomi+Radikal Neck dissection bilateral","350000.0","6430000.0"], [1437,"Endoskopi tiroidektomi","350000.0","6430000.0"], [1438,"Sentinel node biopsi","350000.0","6430000.0"], [1439,"Total mandibulektomi +rekonstruksi implant/ FLAP","350000.0","6430000.0"], [1440,"Total maksilektomi +rekonstruksi implant/FLAP","350000.0","6430000.0"], [1441,"Hemipelvektomi","350000.0","6430000.0"], [1442,"Fore quarter amputasi","350000.0","6430000.0"], [1443,"Hind quarter amputasi","350000.0","6430000.0"], [1444,"Parotidektomi bilateral +rekonstruksi flap","350000.0","6430000.0"], [1445,"Parotidektomi bilateral +neck dissection","350000.0","6430000.0"], [1446,"Distant/ microsurgery flap (TRAM, LD, Gluteal,forearm, costa, fibula,pectoralis )","350000.0","6430000.0"], [1447,"","",""], [1448,"DOKTER BEDAH SARAF","",""], [1449,"JENIS PELAYANAN","JS","TARIF"], [1450,"KECIL","",""], [1451,"Blok saraf perifer (Pain Management Sederhana)","350000.0","1110000.0"], [1452,"Punctie subgaleal hematom","350000.0","1110000.0"], [1453,"Pemasangan Cervical Traksi / Halo Cast","350000.0","1110000.0"], [1454,"Punctie Ventrikel","350000.0","1110000.0"], [1455,"Biopsi saraf perifer 1 (ICD 9 CM 04)","350000.0","1110000.0"], [1456,"Punctie Kranial 1 (IC 9 CM 01.0)","350000.0","1110000.0"], [1457,"Ventrikulo Shunt (ICD 9 CM No 02.3)","350000.0","1110000.0"], [1458,"","",""], [1459,"SEDANG","",""], [1460,"Ekstirpasi eksostosis tulang","350000.0","1870000.0"], [1461,"Eksternal ventrikulostomi","350000.0","1870000.0"], [1462,"Ekstirpasi kista dermoid/epidermoid cranium","350000.0","1870000.0"], [1463,"Kranioplasty (Other Operation On Skull, Brain and Meninges (ICD 9 CM No 02.00)","350000.0","1870000.0"], [1464,"Punctie Kranial 1 (ICD 9 CM 01.1)","350000.0","1870000.0"], [1465,"","",""], [1466,"BESAR","",""], [1467,"Koreksi depressed frakture simple ( lama operasi < 1 jam )","350000.0","3400000.0"], [1468,"Saraf perifer : Dekompresi saraf perifer tanpa anastomosis ( dekompresi tunnel syndrome )","350000.0","3400000.0"], [1469,"Simple functional neurosurgery : Percutaneus Facet Denervation, Percutaneus Rhizotomi","350000.0","3400000.0"], [1470,"Vaskuler surgery : ligasi karotis pada fistula karotikocavernosa","350000.0","3400000.0"], [1471,"Operasi tulang belakang /Laminektomi 1 (ICD 9 CM 03.0)","350000.0","3400000.0"], [1472,"Kraniotomi dan Kraniektomi 1 (ICD 9 CM 01.2)","350000.0","3400000.0"], [1473,"Repair Meningocele dan Spina Bifida (ICD 9 CM 02.1)","350000.0","3400000.0"], [1474,"Operasi Saraf Perifer 2 (ICD 9 CM 04.5)","350000.0","3400000.0"], [1475,"","",""], [1476,"KHUSUS","",""], [1477,"Craniotomi/Kraniektomi neoplasma/ proses desak ruang : Neoplasma ekstra aksial supra tentorial : meningiomakonveksitas, Sitoreduksi/Ekstirpasi tumor superfisial ","350000.0","6430000.0"], [1478,"Endoskopic surgery","350000.0","6430000.0"], [1479,"Stereotaktic surgery","350000.0","6430000.0"], [1480,"Functional neurosurgery complicated : Kordotomi,Para vertebral /Visceral Blok / Simpatektomi","350000.0","6430000.0"], [1481,"Kraniotomi Osteoma / Fibrous dysplasia","350000.0","6430000.0"], [1482,"Kranioplasty defek kranium","350000.0","6430000.0"], [1483,"Ekstirpasi cele (meningoencefalocele Anterior / Posterior . Lumbalis (Spina Bifida)","350000.0","6430000.0"], [1484,"Koreksi depressed fraktur non complicated ( laserasi durameter . Duraplasty / duraraphy)","350000.0","6430000.0"], [1485,"Spinal Surgery : Laminektomi dekompresi tanpa fiksasi : Kanal stenosis, Hernia Nukleus Polposus","350000.0","6430000.0"], [1486,"Kranitomi epidural hematom supra tentorial, Burrhole kraniektomi subdural hematom kronis","350000.0","6430000.0"], [1487,"Pemasangan pintasan LCS : Ventrikulo peritoneal shunt (VP Shunt)","350000.0","6430000.0"], [1488,"Saraf perifer : Eksplorasi dengan neuroplasty / anastomosis saraf perifer","350000.0","6430000.0"], [1489,"Kraniotomi dan Kraniektomi 2 (ICD 9 CM 01.2)","350000.0","6430000.0"], [1490,"Operasi Saraf Perifer 3 (ICD 9 CM 04.4","350000.0","6430000.0"], [1491,"Operasi tulang belakang /Laminektomi 2 (ICD 9 CM 03.5)","350000.0","6430000.0"], [1492,"Craniotomi/Kraniektomi neoplasma/ proses desak ruang : Neoplasma skullbase : Giant meningioma supratentorial Sfenoid ridge, Olfactory groove, Sagital, Torcular Tumor infra tentorial : Meningioma Cerebellopontine angle tumor,Medullobiastoma Sito reduksi / ekstirpasi deep seated tumor","350000.0","6430000.0"], [1493,"Koreksi/Rekonstruksi likworhoe, complicated depressed frakture (laserasi serebri dengan reseksi serebri)","350000.0","6430000.0"], [1494,"Vaskuler surgery : Eksisi AVM, Aneurysma, Evakuasi perdarahan stroke","350000.0","6430000.0"], [1495,"Kraniotomi dekompresi duraplasty Subdural hemato aku, Kraniotomi Epidural hematom supra dan atau Kraniektomi suboccipital Epidural Hematomi","350000.0","6430000.0"], [1496,"Epileptic Surgery","350000.0","6430000.0"], [1497,"Spinal Surgery Anterior/Posterior Fusion /Fixation, Laminektomi ekstirpasi tumor spinal","350000.0","6430000.0"], [1498,"Pemasangan pintasan LCS : Atrio ventrikular shunt (AV Shunt)","350000.0","6430000.0"], [1499,"Saraf perifer : Eksplorasi dengan neuroplasty/transposisi/anastomosis saraf","350000.0","6430000.0"], [1500,"Endovaskuler DSA Serebral Diagnostik","350000.0","6430000.0"], [1501,"Endovaskuler Coiling 1","350000.0","6430000.0"], [1502,"Endovaskuler Coiling 2","350000.0","6430000.0"], [1503,"Endovaskuler Coiling 3","350000.0","6430000.0"], [1504,"Endovaskuler Baloning 1","350000.0","6430000.0"], [1505,"Endovaskuler Baloning 2","350000.0","6430000.0"], [1506,"Endovaskuler Embolisasi 1","350000.0","6430000.0"], [1507,"Endovaskuler Embolisasi 2","350000.0","6430000.0"], [1508,"Endovaskuler Embolisasi 3","350000.0","6430000.0"], [1509,"Endovaskuler Trombolysis","350000.0","6430000.0"], [1510,"Endovaskuler Trombus Removal Ischemic Stroke","350000.0","6430000.0"], [1511,"Endovaskuler Carotid Arterial Stenting CAS","350000.0","6430000.0"], [1512,"","",""], [1513,"DOKTER BEDAH ORTHOPEDI","",""], [1514,"JENIS PELAYANAN","JS","TARIF"], [1515,"KECIL","",""], [1516,"Release 1 Trigger Finger","350000.0","1110000.0"], [1517,"Amputasi 1 jari","350000.0","1110000.0"], [1518,"Atrodisis 1 jari","350000.0","1110000.0"], [1519,"Excisi Ganglion carpi","350000.0","1110000.0"], [1520,"","",""], [1521,"SEDANG ","",""], [1522,"Amputasi 2 jari","350000.0","1870000.0"], [1523,"Atrodisis 2 jari","350000.0","1870000.0"], [1524,"Skin Grafting","350000.0","1870000.0"], [1525,"Operasi arteri dengan tuntunan Arthroskopi","350000.0","1870000.0"], [1526,"ORIF 1 jari","350000.0","1870000.0"], [1527,"ORIF 1 metatarsal","350000.0","1870000.0"], [1528,"ORIF 1 metacarpal","350000.0","1870000.0"], [1529,"Debridement open fraktur","350000.0","1870000.0"], [1530,"Release > 2 trigger finger","350000.0","1870000.0"], [1531,"Blind External Fixasi","350000.0","1870000.0"], [1532,"Discografi","350000.0","1870000.0"], [1533,"Facet Vertebra Block dengan Fluoroscopy","350000.0","1870000.0"], [1534,"Cabut inplant","350000.0","1870000.0"], [1535,"","",""], [1536,"BESAR ","",""], [1537,"Amputasi > 2 jari","350000.0","3400000.0"], [1538,"Amputasi pergelangan tangan","350000.0","3400000.0"], [1539,"Amputasi lengan bawah","350000.0","3400000.0"], [1540,"Amputasi lengan atas","350000.0","3400000.0"], [1541,"Amputasi pergelangan kaki","350000.0","3400000.0"], [1542,"Amputasi tungkai bawah","350000.0","3400000.0"], [1543,"Amputasi pedis","350000.0","3400000.0"], [1544,"Amputasi siku","350000.0","3400000.0"], [1545,"Amputasi paha","350000.0","3400000.0"], [1546,"Amputasi lutut","350000.0","3400000.0"], [1547,"Atrodesis > 2 jari","350000.0","3400000.0"], [1548,"Atrodesis pergelangan tangan","350000.0","3400000.0"], [1549,"Atrodesis sendi siku","350000.0","3400000.0"], [1550,"Atrodesis sendi ankle","350000.0","3400000.0"], [1551,"Atrodesis sendi lutut","350000.0","3400000.0"], [1552,"ORIF","350000.0","3400000.0"], [1553,"Fasciotomy ","350000.0","3400000.0"], [1554,"Arthrotomy + pinning","350000.0","3400000.0"], [1555,"Squesterectomy","350000.0","3400000.0"], [1556,"Arthrotomy + Debridement","350000.0","3400000.0"], [1557,"Reposisi + pinning + pasang gip","350000.0","3400000.0"], [1558,"Debridement + Reposisi + Pinning + pasang gip","350000.0","3400000.0"], [1559,"Cabut wire dalam kulit dengan fluoroscopy","350000.0","3400000.0"], [1560,"ORIF tibia Simple","350000.0","3400000.0"], [1561,"ORIF Humerus Simple","350000.0","3400000.0"], [1562,"Nailing femur Simple","350000.0","3400000.0"], [1563,"ORIF Fibula Simple","350000.0","3400000.0"], [1564,"ORIF 1 malleollus","350000.0","3400000.0"], [1565,"ORIF Radius Simple","350000.0","3400000.0"], [1566,"ORIF Ulna Simple","350000.0","3400000.0"], [1567,"ORIF > 2 jari","350000.0","3400000.0"], [1568,"ORIF > 2 Metatarsal","350000.0","3400000.0"], [1569,"ORIF > 2 Metacarpal","350000.0","3400000.0"], [1570,"ORIF Radius Distal","350000.0","3400000.0"], [1571,"ORIF Femur Simple","350000.0","3400000.0"], [1572,"ORIF Clauvicula","350000.0","3400000.0"], [1573,"Debridement open fractore + ORIF tersebut diatas","350000.0","3400000.0"], [1574,"ORIF Olecranon","350000.0","3400000.0"], [1575,"ORIF Patella","350000.0","3400000.0"], [1576,"Instra Discal Elektrotermal terapy","350000.0","3400000.0"], [1577,"Tenoraphy > 2 Tendo","350000.0","3400000.0"], [1578,"Neuraraphy > 2 Nervus","350000.0","3400000.0"], [1579,"Excisi Tumor Jinak Tulang","350000.0","3400000.0"], [1580,"External Fixasi + Reposisi terbuka","350000.0","3400000.0"], [1581,"Minimal Invasive percutaneus Osteosynthesis","350000.0","3400000.0"], [1582,"Release 1 Syndactyli","350000.0","3400000.0"], [1583,"External Fixasi + Reposisi terbuka","350000.0","3400000.0"], [1584,"Minimal Invasive percutaneus Osteosynthesis","350000.0","3400000.0"], [1585,"Excisi Ganglion Poplitea","350000.0","3400000.0"], [1586,"Tenoraphy 1 Tendo","350000.0","3400000.0"], [1587,"Neuraraphy 1 Nervus","350000.0","3400000.0"], [1588," Release compressi saraf perifer","350000.0","3400000.0"], [1589,"Neulolysis/Neurectomy dengan Fluoroscopy","350000.0","3400000.0"], [1590,"","",""], [1591,"KHUSUS ","",""], [1592,"Semua rekonstruksi","350000.0","6430000.0"], [1593,"ORIF Tibia + Fibula","350000.0","6430000.0"], [1594,"ORIF Malleolus Lateralis + Medialis","350000.0","6430000.0"], [1595,"ORIF Radius + ULNA","350000.0","6430000.0"], [1596,"ORIF Intercondiler Humeri","350000.0","6430000.0"], [1597,"ORIF Intercondiler Femur","350000.0","6430000.0"], [1598,"ORIF Intertroohanter Femur","350000.0","6430000.0"], [1599,"Release CTEV","350000.0","6430000.0"], [1600,"ORIF > 2 Metacarpal","350000.0","6430000.0"], [1601,"Debridement open fracture + ORIF tersebut diatas","350000.0","6430000.0"], [1602,"Rekonstruksi Blast Injury","350000.0","6430000.0"], [1603,"Rekonstruksi Tendo/","350000.0","6430000.0"], [1604,"ORIF 1 Condilus Humeri","350000.0","6430000.0"], [1605,"ORIF Collum humeri","350000.0","6430000.0"], [1606,"ORIF Caput Humeri","350000.0","6430000.0"], [1607,"ORIF Caput Femur","350000.0","6430000.0"], [1608,"Release Contractur 1 sendi","350000.0","6430000.0"], [1609,"ORIF tibia Kominutif","350000.0","6430000.0"], [1610,"ORIF Humerus Kominutif","350000.0","6430000.0"], [1611,"Nailing femur Kominutif","350000.0","6430000.0"], [1612,"ORIF Fibula Kominutif","350000.0","6430000.0"], [1613,"ORIF Ankle","350000.0","6430000.0"], [1614,"ORIF Radius Kominutif","350000.0","6430000.0"], [1615,"ORIF Ulna Kominutif","350000.0","6430000.0"], [1616,"ORIF Femur Kominutif","350000.0","6430000.0"], [1617,"Myocutan free vascularizeo flapping","350000.0","6430000.0"], [1618,"Free vascularizeo bone grafting","350000.0","6430000.0"], [1619,"Arthroscopy + Rekonstruksi sendi","350000.0","6430000.0"], [1620,"Rekonstruksi ligament/tendo sendi bahu","350000.0","6430000.0"], [1621,"Shish kebab nailling + osteotomy","350000.0","6430000.0"], [1622,"Rekonstruksi Negleted Fraktur dan / atau Dislocasi","350000.0","6430000.0"], [1623,"Triple Arthrodesis","350000.0","6430000.0"], [1624,"Hemi Arthroplasty","350000.0","6430000.0"], [1625,"Arthrodesis sendi coxae","350000.0","6430000.0"], [1626,"Arthrodesis sendi bahu","350000.0","6430000.0"], [1627,"Release Contracture> 2 sendi","350000.0","6430000.0"], [1628,"Release contracture + Ostetomy + ORIF","350000.0","6430000.0"], [1629,"ORIF Malunion Fracture","350000.0","6430000.0"], [1630,"ORIF Nonunion Fracture","350000.0","6430000.0"], [1631,"High Tibial Osteotomy","350000.0","6430000.0"], [1632,"Supra condiler osteotomy","350000.0","6430000.0"], [1633,"Varus/Valgus osteotomy","350000.0","6430000.0"], [1634,"ORIF Pelvis","350000.0","6430000.0"], [1635,"Excisi tumor jinak tulang + Rekonstruksi dengan Inplant/Bonecement.","350000.0","6430000.0"], [1636,"Excisi tumor ganas tulang+ Rekonstruksi + Inplant /Bonecement","350000.0","6430000.0"], [1637,"External Fixasi + Reposisi terbuka Cominnutive Fracture Dekat Sendi","350000.0","6430000.0"], [1638,"French Osteotomy","350000.0","6430000.0"], [1639,"Ligament > 2 Jari","350000.0","6430000.0"], [1640,"Ilizarof Procedure","350000.0","6430000.0"], [1641,"Release Syndactily > 2","350000.0","6430000.0"], [1642,"Tendon Transfer 1-2 tendon","350000.0","6430000.0"], [1643,"Rekonstruksi Ligamen/Tendo sendi Ankle","350000.0","6430000.0"], [1644,"Release 1 Syndactyli","350000.0","6430000.0"], [1645,"Release Ring Contriction Syndrome","350000.0","6430000.0"], [1646,"Rekonstruksi Ligament/Tendo 1 Jari","350000.0","6430000.0"], [1647,"Achiles Tendo Lengtening","350000.0","6430000.0"], [1648,"Myocutan flapping","350000.0","6430000.0"], [1649,"Meniscectomy","350000.0","6430000.0"], [1650,"Reattachment osteochondritis","350000.0","6430000.0"], [1651,"Cabut inplant tulang belakang","350000.0","6430000.0"], [1652,"Explorasi plexus Brachialis","350000.0","6430000.0"], [1653,"Debridement + Tenoraphy + Neuroraphy + Anas-tomose Vasculer.","350000.0","6430000.0"], [1654,"Rekonstruksi Ligamen/Tendo sendi lutut","350000.0","6430000.0"], [1655,"Tendon Transfer > 3 Tendon","350000.0","6430000.0"], [1656,"Rekonstruksi Club Hand","350000.0","6430000.0"], [1657,"Krukenberg Procedure","350000.0","6430000.0"], [1658,"Juvara Procedure","350000.0","6430000.0"], [1659,"Hand Surgery Rekonstruksi","350000.0","6430000.0"], [1660,"Rekonstruksi Tulang pelvis","350000.0","6430000.0"], [1661,"Total knee replacement","350000.0","6430000.0"], [1662,"Total hip replacement","350000.0","6430000.0"], [1663,"Kyphoplasty","350000.0","6430000.0"], [1664,"Vertebroplasty","350000.0","6430000.0"], [1665,"Micro Discectomy","350000.0","6430000.0"], [1666,"Replantasi","350000.0","6430000.0"], [1667,"Operasi tulang belakang dengan pasang instrument","350000.0","6430000.0"], [1668,"Operasi tulang belakang dengan tuntunan endoscopy","350000.0","6430000.0"], [1669,"Mikro surgery dengan mikroskop","350000.0","6430000.0"], [1670,"Calotaxis/Lenghtening dengan Inplant/External fixasi","350000.0","6430000.0"], [1671,"","",""], [1672,"DOKTER MATA","",""], [1673,"JENIS PELAYANAN","JS","TARIF"], [1674,"KECIL","",""], [1675,"Epilasi","350000.0","1110000.0"], [1676,"","",""], [1677,"SEDANG ","",""], [1678,"Anestesi Injeksi Subkonjungtiva","350000.0","1870000.0"], [1679,"Anestesi Injeksi Retrobulbar/Parabulbar","350000.0","1870000.0"], [1680,"Amotio Corpal Konjungtiva","350000.0","1870000.0"], [1681,"Irigasi Mata","350000.0","1870000.0"], [1682,"Aff Hecting Palpebra","350000.0","1870000.0"], [1683,"Ganti Tampon","350000.0","1870000.0"], [1684,"Toilet Luka","350000.0","1870000.0"], [1685,"","",""], [1686,"BESAR ","",""], [1687,"Injeksi Intravitreal","350000.0","3400000.0"], [1688,"Amotio Corpal Kornea","350000.0","3400000.0"], [1689,"Anel Test","350000.0","3400000.0"], [1690,"Ekskokleasi Hordeolum/Kalazion","350000.0","3400000.0"], [1691,"Eksisi Pterigium Bare Sclera","350000.0","3400000.0"], [1692,"Eksisi Pterigium McReynold","350000.0","3400000.0"], [1693,"Eksisi Pterigium Autograf dengan Jahitan","350000.0","3400000.0"], [1694,"Sondasi","350000.0","3400000.0"], [1695,"Ekstirpasi Kista Konjungtiva","350000.0","3400000.0"], [1696,"Biopsi ","350000.0","3400000.0"], [1697,"Tarsorafi","350000.0","3400000.0"], [1698,"Parasentesis ","350000.0","3400000.0"], [1699,"Amotio Lithiasis","350000.0","3400000.0"], [1700,"Eksisi Granuloma","350000.0","3400000.0"], [1701,"Ekstirpasi Nevus","350000.0","3400000.0"], [1702,"Repair Palpebra","350000.0","3400000.0"], [1703,"Iridektomi Perifer","350000.0","3400000.0"], [1704,"Cyclocryotherapy (CCT)","350000.0","3400000.0"], [1705,"Eksisi Tumor Konjungtiva","350000.0","3400000.0"], [1706,"SBL Tarsotomi","350000.0","3400000.0"], [1707,"Transplantasi Membran Amnion","350000.0","3400000.0"], [1708,"Transplantasi Stem Cell","350000.0","3400000.0"], [1709,"Flap Konjungtiva","350000.0","3400000.0"], [1710,"Repair Entropion/Ektropion","350000.0","3400000.0"], [1711,"Repair Kornea","350000.0","3400000.0"], [1712,"Eviserasi","350000.0","3400000.0"], [1713,"Enukleasi","350000.0","3400000.0"], [1714,"Eksenterasi","350000.0","3400000.0"], [1715,"Dermo-Fat Graft (DFG)","350000.0","3400000.0"], [1716,"Repair Avulsi Kanalis Lacrimalis","350000.0","3400000.0"], [1717,"ICCE","350000.0","3400000.0"], [1718,"Laser Retina","350000.0","3400000.0"], [1719,"Laser Iridotomi","350000.0","3400000.0"], [1720,"Laser Kapsulotomi PCO","350000.0","3400000.0"], [1721,"Aff Hecting Kornea","350000.0","3400000.0"], [1722,"Fundus Florescein Angiography (FFA)","350000.0","3400000.0"], [1723,"","",""], [1724,"","",""], [1725,"KHUSUS ","",""], [1726,"Eksisi Pterigium dengan Fibrin Glue","350000.0","6430000.0"], [1727,"ECCE + IOL","350000.0","6430000.0"], [1728,"SICS + IOL","350000.0","6430000.0"], [1729,"Implantasi IOL Sekunder","350000.0","6430000.0"], [1730,"Trabekulektomi","350000.0","6430000.0"], [1731,"Orbitotomi Anterior","350000.0","6430000.0"], [1732,"Repair Ptosis","350000.0","6430000.0"], [1733,"Eksisi Luas (Wide Excision)","350000.0","6430000.0"], [1734,"Scleral Buckle","350000.0","6430000.0"], [1735,"Dekompresi Orbita","350000.0","6430000.0"], [1736,"Repair Strabismus","350000.0","6430000.0"], [1737,"Blefaroplasti","350000.0","6430000.0"], [1738,"Evakuasi Silicon Oil","350000.0","6430000.0"], [1739,"Combined Trabekulektomi + ECCE + IOL","350000.0","6430000.0"], [1740,"Combined Trabekulektomi + SICS + IOL","350000.0","6430000.0"], [1741,"Keratoplasti","350000.0","6430000.0"], [1742,"Phacoemulsification + IOL","350000.0","6430000.0"], [1743,"Combined Trabeklektomi + Phaco + IOL","350000.0","6430000.0"], [1744,"Vitrectomy","350000.0","6430000.0"], [1745,"Darcryocystorhynostomy (DCR)","350000.0","6430000.0"], [1746,"","350000.0","6430000.0"], [1747,"","",""], [1748,"DOKTER SPESIALIS OBSTETRI DAN GINEKOLOGI","",""], [1749,"JENIS PELAYANAN","JS","TARIF"], [1750,"KECIL","",""], [1751,"Closed/transuretral biopsy of bladder","350000.0","1110000.0"], [1752,"Culdotomy","350000.0","1110000.0"], [1753,"Diagnostic procedures on vulva (biopsi vulva)","350000.0","1110000.0"], [1754,"Percutaneus aspiration of bartholin's gland (cyst)","350000.0","1110000.0"], [1755,"Incision of Bartholin's gland (cyst)/ insisi abses bartolin","350000.0","1110000.0"], [1756,"Excision or other destruction of Bartholin's","350000.0","1110000.0"], [1757,"Suture of laceration of vulva and perineum","350000.0","1110000.0"], [1758,"Repair of other current obstetric laceration (episioperineoraphy, perineorafi ruptur perineum grade 1-2)","350000.0","1110000.0"], [1759,"","",""], [1760,"SEDANG ","",""], [1761,"Other excision or destruction lession of uterus (pedunculata myoma)","350000.0","1870000.0"], [1762,"Reclosure of postoperative disruption of abdominal wall","350000.0","1870000.0"], [1763,"Transuretral cystoscopy","350000.0","1870000.0"], [1764,"Bilateral endoscopic destruction or occlusion of fallopian tubes (laparoscopic MOW)","350000.0","1870000.0"], [1765,"Other bilateral destruction or occlusion of fallopian tubes (Sterilisasi minilaparotomi)","350000.0","1870000.0"], [1766,"unilateral destruction or occlusion of fallopian tube","350000.0","1870000.0"], [1767,"Repair of internal cervical os (cerclage of isthmus uteri, shirodcard operation)","350000.0","1870000.0"], [1768,"Dilation and curettage of uterus (for termination of pregnancy or following delivery or abortion, Diagnostic Currettage)","350000.0","1870000.0"], [1769,"Aspiration curettage of uterus","350000.0","1870000.0"], [1770,"Incision of vulva and perineum (Labia & vulva adhesion, enlargement introitus)","350000.0","1870000.0"], [1771,"Removal of cerclage material from cervix","350000.0","1870000.0"], [1772,"Hymenotomy","350000.0","1870000.0"], [1773,"Suture of laceration of vagina","350000.0","1870000.0"], [1774,"Marsupialization of Bartholin's gland (cyst)","350000.0","1870000.0"], [1775,"Pubiotomy to assist delivery","350000.0","1870000.0"], [1776,"Repair of current obstetric laceration of cervic","350000.0","1870000.0"], [1777,"Repair of current obstetric laceration of rectum and spincter ani (Ruptur perineum grade 3 & 4)","350000.0","1870000.0"], [1778,"","",""], [1779,"BESAR ","",""], [1780,"Cesarean section and removal of fetus","350000.0","3400000.0"], [1781,"Exploratory laparotomy","350000.0","3400000.0"], [1782,"Reopening of recent laparotomy site","350000.0","3400000.0"], [1783,"Other Laparotomy ( drainase of intraperitoneal abses or hematom/TOA)","350000.0","3400000.0"], [1784,"Delayed closure of granulating abdominal wound","350000.0","3400000.0"], [1785,"Oophorotomy","350000.0","3400000.0"], [1786,"Diagnostic procedures on ovaries (aspirasi biopsi, biopsi)","350000.0","3400000.0"], [1787,"Local excision or destruction of ovarian lesion or tissue (cystectomy)","350000.0","3400000.0"], [1788,"Unilateral oophorectomy","350000.0","3400000.0"], [1789,"Unilateral salpingo-oophorectomy","350000.0","3400000.0"], [1790,"Bilateral oophorectomy","350000.0","3400000.0"], [1791,"Bilateral salpingo-oophorectomy","350000.0","3400000.0"], [1792,"Repair of ovary","350000.0","3400000.0"], [1793,"Lysis of adhesions of ovary and fallopian tube","350000.0","3400000.0"], [1794,"Manual rupture of ovarian cyst","350000.0","3400000.0"], [1795,"Release of torsion of ovary","350000.0","3400000.0"], [1796,"Salpingotomy and salpingostomy","350000.0","3400000.0"], [1797,"Diagnostic procedures on fallopian tubes (biopsy of fallopian tube)","350000.0","3400000.0"], [1798,"Total unilateral salpingectomy","350000.0","3400000.0"], [1799,"Total bilateral salpingectomy","350000.0","3400000.0"], [1800,"Other salpingectomy (cautherization, coagulation, electrocoagulation, excision)","350000.0","3400000.0"], [1801,"Aspiration of fallopian tubes","350000.0","3400000.0"], [1802,"Burying of fimbriae in uterine wall","350000.0","3400000.0"], [1803,"Hysterotomy","350000.0","3400000.0"], [1804,"Open biopsy of uterine ligament","350000.0","3400000.0"], [1805,"Other excision or destruction lession of uterus (uterine myomectomy)","350000.0","3400000.0"], [1806,"Subtotal abdominal hysterectomy","350000.0","3400000.0"], [1807,"Excision or destruction of lesion or tissue of uterus and supporting structures","350000.0","3400000.0"], [1808,"Uterine repair (hysteroraphy non obstetric)","350000.0","3400000.0"], [1809,"Caesarean section of unspecified type ( Hysterotomy to terminate pregnancy)","350000.0","3400000.0"], [1810,"Repair of current obstetric laceration of uterus","350000.0","3400000.0"], [1811,"Repair of other current obstetric laceration (Blader and uretra)","350000.0","3400000.0"], [1812,"Lysis of intraluminal adhesions of vagina","350000.0","3400000.0"], [1813,"Other vaginotomy (vaginal septum/eksisi septum vaginal, drainase hematom of vaginal cuff)","350000.0","3400000.0"], [1814,"Other repair of vagina (Colpoperineoplasty, Repair old obstetric laceration of vagina)","350000.0","3400000.0"], [1815,"","",""], [1816,"KHUSUS ","",""], [1817,"Insufflation of fallopian tube (hydrotubasi)","350000.0","6430000.0"], [1818,"Conization of cervix excluding electrical/cryo","350000.0","6430000.0"], [1819,"Amputation of cervix (fortegil operation)","350000.0","6430000.0"], [1820,"Closed biopsy of uterine ligament (laparoscopy biopsy of uterine ligament)","350000.0","6430000.0"], [1821,"Closed biopsy of uterus (laparoscopy or hysteroscopy)","350000.0","6430000.0"], [1822,"Devision of endometrial synechia","350000.0","6430000.0"], [1823,"Total abdominal hysterectomy","350000.0","6430000.0"], [1824,"Vaginal hysterectomy (prolaps uteri)","350000.0","6430000.0"], [1825,"Other local excision or destruction of vulva and perineum","350000.0","6430000.0"], [1826,"Operations on clitoris","350000.0","6430000.0"], [1827,"Hymenoraphy","350000.0","6430000.0"], [1828,"Other repair of vulva and perineum (repair of old obstetric laceration of vulva or perineum)","350000.0","6430000.0"], [1829,"Caeraean section with previous C-section or complicated pregnancy","350000.0","6430000.0"], [1830,"Levator muscle operation for urethrovesical suspension","350000.0","6430000.0"], [1831,"Other ( TOT, TVT-O, TVT)","350000.0","6430000.0"], [1832,"Other and unspecific hysterectomy (Caesarean Hysterectomi)","350000.0","6430000.0"], [1833,"Other repair of urinary bladder (repair fistula involving bladder and instestin/ rectovesikovaginal, vesicosigmoidovaginal)","350000.0","6430000.0"], [1834,"Repair of other fistula of bladder (cervicovesical, uretroperineovesical, uterovesical, vaginovesical)","350000.0","6430000.0"], [1835,"Other repair of bladder (repair of old obstetric laceration of bladder)","350000.0","6430000.0"], [1836,"Plication of uretrovesical junction (Kelly Kenedy operation on uretra, Kelly stoeckel operation)","350000.0","6430000.0"], [1837,"Suprapubic sling operation (Goebel-Frangenheim-Stoeckel urethrovesical suspension, Millin-Read uretrovesical suspension, Oxford operation for urinary incontinence, urethrocystopexy by suprapubic suspension, purandare)","350000.0","6430000.0"], [1838,"Retropubic uretral suspension (Marshall-Marchetti-Krantz operation, Suture of periurethral tissue to symphysis pubis)","350000.0","6430000.0"], [1839,"Paraurethral suspension","350000.0","6430000.0"], [1840,"Repair of fallopian tube","350000.0","6430000.0"], [1841,"Removal of prosthesis of fallopian tube","350000.0","6430000.0"], [1842,"Hysteroscopy diagnostic","350000.0","6430000.0"], [1843,"Incisin or excision of congernital uterus (Jones operation)","350000.0","6430000.0"], [1844,"Vaginal hysterectomy (nondescent, exclude myoma)","350000.0","6430000.0"], [1845,"Repair of uterine supporting structures (watkin procedure, manchester operation, plication ligament)","350000.0","6430000.0"], [1846,"Obliteration and total excision of vagina:Vaginectomy (lefort operation & vaginectomy)/kolpokleisis","350000.0","6430000.0"], [1847,"Vaginal construction and reconstruction (neovagina)","350000.0","6430000.0"], [1848,"Obliteration of vaginal vault","350000.0","6430000.0"], [1849,"Other vulvectomy (unilateral & bilateral vulvectomy/vulvektomi sederhana)","350000.0","6430000.0"], [1850,"Removal of extratubal of ectopic pregnancy (abdonimal pregnancy)","350000.0","6430000.0"], [1851,"Repair of rectovaginal fistule","350000.0","6430000.0"], [1852,"Vaginal suspension and fixation (Burch suspension)","350000.0","6430000.0"], [1853,"Repair of fistula of vulva or perineum","350000.0","6430000.0"], [1854,"Amnioscopy (fetoscopy, laparoamnioscopy)","350000.0","6430000.0"], [1855,"Other and unspecific hysterectomy (AVRUEL operation)","350000.0","6430000.0"], [1856,"Laparoscopy","350000.0","6430000.0"], [1857,"Closured of other fistula of ureter (vesicoureterovaginal fistulectomy)","350000.0","6430000.0"], [1858,"Cystouretroplasty and plastic repair of bladder neck (plication of spincter of urinary bladder, VY plasty of bladder neck)","350000.0","6430000.0"], [1859,"Aspiration of ovary (OPU)","350000.0","6430000.0"], [1860,"Transplantation of ovary","350000.0","6430000.0"], [1861,"Ovarian denervation","350000.0","6430000.0"], [1862,"Implantation or replacement of prothesis of fallopian tube","350000.0","6430000.0"], [1863,"Vaginal hysterectomy (laparoscopically assisted vaginal)","350000.0","6430000.0"], [1864,"Vaginal hysterectomy (nondescent due to myoma)","350000.0","6430000.0"], [1865,"Radical abdominal hysterectomy (wertheim, POA)","350000.0","6430000.0"], [1866,"Radical vaginal hysterectomy","350000.0","6430000.0"], [1867,"Pelvic eviceration","350000.0","6430000.0"], [1868,"Paracervical uterine denervation","350000.0","6430000.0"], [1869,"Local excision or destruction of vagina and rectouterine pouch (hymenectomy, endometrectomy of cul de sac)","350000.0","6430000.0"], [1870,"Repair of cystocele and rectocele","350000.0","6430000.0"], [1871,"Radical vulvectomy","350000.0","6430000.0"], [1872,"Other intrauterine operations on fetus and amnion","350000.0","6430000.0"], [1873,"Other operation on cervix and uterus (Hysteroscopy therapetic)","350000.0","6430000.0"], [1874,"Repair of colovaginal fistule","350000.0","6430000.0"], [1875,"Repair of other vaginoenteric fistule","350000.0","6430000.0"], [1876,"Correction of fetal defect","350000.0","6430000.0"], [1877,"","",""], [1878,"DOKTER SPESIALIS THT","",""], [1879,"JENIS PELAYANAN","JS","TARIF"], [1880,"KECIL","",""], [1881,"Insisi Abses (septum, furunkel, tonsil peritonsil, preauricula)","350000.0","1110000.0"], [1882,"Explorasi Nashofarinx","350000.0","1110000.0"], [1883,"Extirpasi (kista, atheroma, granuloma, papiloma)","350000.0","1110000.0"], [1884,"Extraksi benda asing (telinga, hidung, orofaring)","350000.0","1110000.0"], [1885,"Evakuasi serumen/ kolesteatoma dengan penyakit","350000.0","1110000.0"], [1886,"Insisi hematoma telinga (othematoma/pseudocyst)","350000.0","1110000.0"], [1887,"Penggantian arteficial laring (provox) esofagus (NGT)","350000.0","1110000.0"], [1888,"Parasentesis","350000.0","1110000.0"], [1889,"Biopsi tumor (telinga, hidung, orofaring)","350000.0","1110000.0"], [1890,"Biopsi insisi tumor leher","350000.0","1110000.0"], [1891,"","",""], [1892,"SEDANG ","",""], [1893,"Miringotomi","350000.0","1870000.0"], [1894,"Pemasangan Grommet","350000.0","1870000.0"], [1895,"Extraksi benda asing telinga dengan penyulit","350000.0","1870000.0"], [1896,"Extraksi kolesteatoma dengan penyulit","350000.0","1870000.0"], [1897,"Extirpasi fistel preaurikuler","350000.0","1870000.0"], [1898,"Reposisi fraktur os nasal","350000.0","1870000.0"], [1899,"Extraksi polip nasal","350000.0","1870000.0"], [1900,"Irigasi sinus","350000.0","1870000.0"], [1901,"Sinuskopi diagnostik","350000.0","1870000.0"], [1902,"Extraksi benda asing hidung dengan penyulit","350000.0","1870000.0"], [1903,"Konkotomi","350000.0","1870000.0"], [1904,"Antrostomi Intranasal","350000.0","1870000.0"], [1905,"Trakeostomi elektif","350000.0","1870000.0"], [1906,"Pasang dan ganti stent laring","350000.0","1870000.0"], [1907,"Laringoskopi diagnostik","350000.0","1870000.0"], [1908,"Intubasi dengan 'flexible Bronchoscopy)","350000.0","1870000.0"], [1909,"Explorasi abses submandibula","350000.0","1870000.0"], [1910,"Adenoidektomi","350000.0","1870000.0"], [1911,"Sialendoskopi diagnostik","350000.0","1870000.0"], [1912,"Reposisi fraktur arkus Zygomatikus","350000.0","1870000.0"], [1913,"Esofaguskopi diagnostik","350000.0","1870000.0"], [1914,"Multple explorasi biopsi tumor","350000.0","1870000.0"], [1915,"Insisi biopsi kelenjar leher","350000.0","1870000.0"], [1916,"Extirpasi tumor jinak sinunasal, kavitas oral","350000.0","1870000.0"], [1917,"Extirpasi tumor jinak kelenjar liur","350000.0","1870000.0"], [1918,"","",""], [1919,"BESAR ","",""], [1920,"Miringoplasti","350000.0","3400000.0"], [1921,"Kanaloplasti","350000.0","3400000.0"], [1922,"Timpanoplasti","350000.0","3400000.0"], [1923,"Meatoplasti","350000.0","3400000.0"], [1924,"Mastoidektomi sederhana","350000.0","3400000.0"], [1925,"Septum reseksi","350000.0","3400000.0"], [1926,"Turbinoplasti","350000.0","3400000.0"], [1927,"Septoplasti","350000.0","3400000.0"], [1928,"Rinoplasti","350000.0","3400000.0"], [1929,"Antrostomi extranasal (Caldwell Luc)","350000.0","3400000.0"], [1930,"Sinuskopi dengan tindakan","350000.0","3400000.0"], [1931,"Fronto ethmoidektomi external","350000.0","3400000.0"], [1932,"Tonsillo adenoidektomi","350000.0","3400000.0"], [1933,"Trakeostomi emergensi dengan penyulit","350000.0","3400000.0"], [1934,"Laryngoskopi dengan tindakan","350000.0","3400000.0"], [1935,"Explorasi abses parafaring, retrofaring","350000.0","3400000.0"], [1936,"Explorasi abses multiple","350000.0","3400000.0"], [1937,"Rekakeaonstruksi fraktur laring-trakea","350000.0","3400000.0"], [1938,"Bedah mikro laring","350000.0","3400000.0"], [1939,"Esofaguskopi dengan tindakan/penyulit","350000.0","3400000.0"], [1940,"Sialendoskopi terapi/dilatasi","350000.0","3400000.0"], [1941,"Labioplasti","350000.0","3400000.0"], [1942,"Palatoplasti","350000.0","3400000.0"], [1943,"Faringeal flap","350000.0","3400000.0"], [1944,"Forehead flap","350000.0","3400000.0"], [1945,"Laringofisur","350000.0","3400000.0"], [1946,"Operasi tumor kelenjar liur","350000.0","3400000.0"], [1947,"Laringektomi parsial","350000.0","3400000.0"], [1948,"Tiroidektomi subtotal","350000.0","3400000.0"], [1949,"Parotidektomi superfisial","350000.0","3400000.0"], [1950,"Hemiglosektomi","350000.0","3400000.0"], [1951,"Wide eksisi tumor tonsil, orofaring","350000.0","3400000.0"], [1952,"Ligasi a. karatis externa","350000.0","3400000.0"], [1953,"Extirpasi Angiofibroma Nasofaring","350000.0","3400000.0"], [1954,"Maxilektomi parsial","350000.0","3400000.0"], [1955,"Mandibulektomi parsial","350000.0","3400000.0"], [1956,"Mini FESS","350000.0","3400000.0"], [1957,"Uvulo-Palatofaringoplasti (UPPP)","350000.0","3400000.0"], [1958,"","",""], [1959,"KHUSUS","",""], [1960,"Maxilektomi total","350000.0","6430000.0"], [1961,"Mandibulektomi total","350000.0","6430000.0"], [1962,"Laringektomi total + Deseksi Leher","350000.0","6430000.0"], [1963,"Tiroidektomi total","350000.0","6430000.0"], [1964,"Parotidektomi total","350000.0","6430000.0"], [1965,"Hemiglosektomi + Deseksi Leher","350000.0","6430000.0"], [1966,"Deseksi Leher Radikal","350000.0","6430000.0"], [1967,"Timpano- Mastoidektomi","350000.0","6430000.0"], [1968,"Mastoidektomi Modifikasi Radikal","350000.0","6430000.0"], [1969,"Mastoidektomi Radikal","350000.0","6430000.0"], [1970,"Osikuloplasti","350000.0","6430000.0"], [1971,"Stapedektomi","350000.0","6430000.0"], [1972,"Dekompresi nervus fasialis","350000.0","6430000.0"], [1973,"Reseksi tulang temporal","350000.0","6430000.0"], [1974,"Septorinoplasti","350000.0","6430000.0"], [1975,"Rinoplasti augmentasi","350000.0","6430000.0"], [1976,"FESS (funtional endoscopy sinus surgery)","350000.0","6430000.0"], [1977,"ESS (endoscopy sinus surgery)","350000.0","6430000.0"], [1978,"Otoplasti","350000.0","6430000.0"], [1979,"Implan Koklea","350000.0","6430000.0"], [1980,"Rekonstruksi fraktur rahang/wajah","350000.0","6430000.0"], [1981,"Rekonstruksi telinga, mikrotia + aural atresia)","350000.0","6430000.0"], [1982,"","",""], [1983,"DOKTER SPESIALIS PARU","",""], [1984,"JENIS PELAYANAN","JS","TARIF"], [1985,"KECIL","",""], [1986,"Aspirasi/incisi abses paru","350000.0","1110000.0"], [1987,"Aspirasi/incisi empyema","350000.0","1110000.0"], [1988,"Pungsi pleura / needle thoraccoentesis evakuasi ","350000.0","1110000.0"], [1989,"Pungsi pleura / needle thoraccoentesis evakuasi emergensi/cito","350000.0","1110000.0"], [1990,"Pemasangan mini WSD","350000.0","1110000.0"], [1991,"Injeksi intra vacum pleura","350000.0","1110000.0"], [1992,"","",""], [1993,"SEDANG","",""], [1994,"Transthoracal needle aspiration/ TTNA","350000.0","1870000.0"], [1995,"Transthoracal biopsy/ TTB","350000.0","1870000.0"], [1996,"Transbronchial needle aspiration/biopsi (TBNA/TBNB)","350000.0","1870000.0"], [1997,"Pleurodesis","350000.0","1870000.0"], [1998,"","",""], [1999,"BESAR","",""], [2000,"Biopsi pleura","350000.0","3400000.0"], [2001,"Pemasangan WSD /tube thoracocentesis WSD dg lokal anestesi (OPERATIF)","350000.0","3400000.0"], [2002,"Pemasangan WSD /tube thoracocentesis WSD dg lokal anestesi emergensi/cito (OPERATIF)","350000.0","3400000.0"], [2003,"","",""], [2004,"TABEL 15.","",""], [2005,"PELAYANAN TINDAKAN PERSALINAN","",""], [2006,"","",""], [2007,"JENIS PELAYANAN","JS","TARIF"], [2008,"PERSALINAN TANPA PENYULIT (NORMAL)","300000.0","1163000.0"], [2009,"PERSALINAN DENGAN PENYULIT PER VAGINAM","602000.0","2092000.0"], [2010,"INDUKSI PERSALINAN (PARTUS GAGAL)","20000.0","71000.0"], [2011,"","",""], [2012,"TABEL 16.","",""], [2013,"PELAYANAN ASUHAN KEPERAWATAN ","",""], [2014,"","",""], [2015,"JENIS PELAYANAN","JS","TARIF"], [2016,"ASKEP PASIEN SELF CARE","10000.0","50000.0"], [2017,"ASKEP PASIEN PARSIAL CARE","10000.0","90000.0"], [2018,"ASKEP PADA PASIEN TOTAL CARE","10000.0","130000.0"], [2019,"ASKEP PADA PASIEN INTENSIVE CARE","10000.0","160000.0"], [2020,"","",""], [2021,"TABEL 17.","",""], [2022,"PELAYANAN ANESTESI ","",""], [2023,"","",""], [2024,"JENIS TINDAKAN","JS","TARIF"], [2025,"TINDAKAN MEDIK ANESTESI KECIL","350000.0","730000.0"], [2026,"TINDAKAN MEDIK ANESTESI SEDANG ","350000.0","1110000.0"], [2027,"TINDAKAN MEDIK ANESTESI BESAR ","350000.0","1870000.0"], [2028,"TINDAKAN MEDIK ANESTESI KHUSUS","350000.0","3390000.0"], [2029,"","",""], [2030,"TABEL 18.","",""], [2031,"PELAYANAN DIKLAT ","",""], [2032,"","",""], [2033,"JENIS PELAYANAN","JS","TARIF "], [2034,"PRAKTEK DAN PENELITIAN TENAGA KEPERAWATAN / KEBIDANAN : ","",""], [2035,"Profesi / orang / minggu","60000.0","150000.0"], [2036,"Sarjana / orang / minggu","40000.0","100000.0"], [2037,"Diploma / orang / minggu","30000.0","75000.0"], [2038,"PRAKTEK DAN PENELITIAN TENAGA KESEHATAN LAIN : ","",""], [2039,"Profesi / orang / minggu","60000.0","150000.0"], [2040,"Sarjana / orang / minggu","40000.0","100000.0"], [2041,"Diploma / orang / minggu","30000.0","75000.0"], [2042,"PRAKTEK DAN PENELITIAN TENAGA NON KESEHATAN : ","",""], [2043,"SLTA sederajat / orang / minggu","16000.0","40000.0"], [2044,"Diploma / orang / minggu","20000.0","50000.0"], [2045,"Diploma IV atau S1 / orang / minggu","30000.0","75000.0"], [2046,"S2 / orang / minggu","60000.0","150000.0"], [2047,"Penelitian DIII / orang / paket","50000.0","125000.0"], [2048,"Penelitian S1 / orang / paket","80000.0","200000.0"], [2049,"Penelitian S2 / orang / paket","100000.0","250000.0"], [2050,"Uji Validitas","20000.0","50000.0"], [2051,"Job Training Keterampilan Khusus (peminatan) / paket 3 bln","1000000.0","2500000.0"], [2052,"Job Training perawat dan bidan / paket 3 bln","480000.0","1200000.0"], [2053,"Job Training tenaga kesehatan lain (gizi, farmasi, radiologi, fisioterapi dll) / paket 3 bln","360000.0","900000.0"], [2054,"Job Training tenaga non kesehatan (akuntansi, IT, dll) / paket 3 bln","300000.0","750000.0"], [2055,"Kunjungan siswa SLTA / hari / orang / tempat","8000.0","20000.0"], [2056,"Kunjungan mahasiswa DIII / hari / orang / tempat","10000.0","25000.0"], [2057,"Kunjungan mahasiswa DIV atau S1 / hari / orang / tempat","12000.0","30000.0"], [2058,"Kunjungan mahasiswa S2 / hari / orang / tempat","14000.0","35000.0"], [2059,"Kunjungan / hari (pegawai atau peserta diklat) / orang / tempat","24000.0","60000.0"], [2060,"Kunjungan dari RS lain / paket / kunjungan / orang","100000.0","250000.0"], [2061,"","",""], [2062,"","",""], [2063,"TABEL 19.","",""], [2064,"SEWA LAHAN","",""], [2065,"","",""], [2066,"JENIS PELAYANAN","JS","TARIF "], [2067,"RUANG PERTEMUAN","",""], [2068,"Sewa Ruang Pertemuan/Aula ( paket/hari ) kapasitas max 25 orang ","250000.0","250000.0"], [2069,"Sewa Ruang Pertemuan/Aula ( paket/hari ) kapasitas max 75 orang ","750000.0","750000.0"], [2070,"Sewa Ruang Pertemuan/Aula ( paket/hari ) kapasitas max 150 orang ","1000000.0","1000000.0"], [2071,"Biaya Tambahan Fasilitas & Penyiapannya bila diperlukan","0.0","0.0"], [2072,"Proses alih media arsip ke video / disk","150000.0","150000.0"], [2073,"Sewa Tempat dan Bangunan","0.0","0.0"], [2074,"Areal 1 / M2 / Bln","70000.0","70000.0"], [2075,"Areal 2 / M2 / Bln","50000.0","50000.0"], [2076,"","",""], [2077,"CATATAN SEWA LAHAN: ","",""], [2078,"Area 1 adalah untuk area bisnis yang berada di lokasi strategis ","",""], [2079,"Area 2 adalah untuk area non bisnis ","",""], [2080,"","",""], [2081,"TABEL 20.","",""], [2082,"PELAYANAN HIV-AIDS","",""], [2083,"","",""], [2084,"JENIS PELAYANAN","JS","TARIF "], [2085,"Staging klinis ODHA","6000.0","24000.0"], [2086,"Paket VCT Mobile (per kunjungan / org)*","75000.0","108000.0"], [2087,"Paket in house Training HIV-AIDS**","150000.0","2650000.0"], [2088,"Konseling Pelayanan HIV-AIDS","6000.0","41000.0"], [2089,"","",""], [2090,"CATATAN : ","",""], [2091,"Paket VCT Mobile adalah konseling dan pemeriksaan HIV di RS / klinik swasta di Kota Cilacap","",""], [2092,"Paket in house training HIV-AIDS adalah pemberian training, meliputi KIE dasar HIV-AIDS, pemeriksaan, pengelolaan kasus, perawatan, dukungan dan pengobatan ODHA","",""], [2093,"","",""], [2094,"","",""], [2095,"TABEL 21.","",""], [2096,"PELAYANAN HOME CARE","",""], [2097,"","",""], [2098,"JENIS PELAYANAN ","JS","TARIF"], [2099,"PELAYANAN MEDIS :","0.0",""], [2100,"Pemeriksaan dokter umum","20000.0","110000.0"], [2101,"Pemeriksaan dokter Spesialis","25000.0","185000.0"], [2102,"Konsultasi dokter Spesialis","15000.0","90000.0"], [2103,"Tindakan Medis :","",""], [2104," Plebotomi","24000.0","74000.0"], [2105," Pungsi","24000.0","74000.0"], [2106," Tranfusi Albumin","3000.0","14000.0"], [2107," Tranfusi Darah","11000.0","86000.0"], [2108," Nebulizer ","12000.0","22000.0"], [2109," Pemberian obat Suppositoria","3000.0","7000.0"], [2110," Lepas dan atau pasang canul Tracheostomy oleh dokter","6000.0","56000.0"], [2111," Tindakan Akupunktur","10000.0","60000.0"], [2112,"","",""], [2113,"PELAYANAN KEPERAWATAN :","0.0","0.0"], [2114,"Kunjungan Perawat / Bidan","7000.0","70000.0"], [2115,"Tindakan Keperawatan :","0.0","0.0"], [2116,"Perawatan Luka :","0.0","0.0"], [2117," PLK Kecil","3000.0","9000.0"], [2118," PLK Sedang","3000.0","11000.0"], [2119," PLK Besar","4000.0","14000.0"], [2120,"Pasang NGT/SONDE","4000.0","16000.0"], [2121,"Pasang DC","4000.0","15000.0"], [2122,"Pasang Infus","4000.0","15000.0"], [2123,"Injeksi :","3000.0","12000.0"], [2124,"Suction Sputum","3000.0","7000.0"], [2125,"Manual faeces","3000.0","12000.0"], [2126,"Lavement","3000.0","14000.0"], [2127,"Memandikan pasien","3000.0","14000.0"], [2128,"Mencuci rambut","3000.0","14000.0"], [2129,"Periksa Gula Darah Manual","8000.0","13000.0"], [2130,"Bantuan Pernapasan/RJP","34000.0","44000.0"], [2131,"Oral Higiene","1000.0","6000.0"], [2132,"Vulva Higiene","1000.0","6000.0"], [2133,"Pembersihan telinga","1000.0","6000.0"], [2134,"Evakuasi Serumen prop oleh dokter","2000.0","12000.0"], [2135,"Menunggu pasien oleh perawat / bidan","",""], [2136," Pukul 07.00 - 14.00","6000.0","44000.0"], [2137," Pukul 14.00 - 21.00","6000.0","44000.0"], [2138," Pukul 21.00 - 07.00","8000.0","58000.0"], [2139,"","",""], [2140,"PEMERIKSAAN PENUNJANG ","",""], [2141,"EKG ","23000.0","53000.0"], [2142,"Ambil lab :","",""], [2143," Sampel darah, urin, dan tinja","4000.0","21000.0"], [2144," Sampel darah","3000.0","14000.0"], [2145," Sampel urin / tinja","3000.0","9000.0"], [2146,"","",""], [2147,"REHABILITASI MEDIS","",""], [2148,"Kunjungan Fisioterapi ","18000.0","68000.0"], [2149,"Okupasiterapi","18000.0","68000.0"], [2150,"Terapi Wicara","20000.0","95000.0"], [2151,"","",""], [2152,"PELAYANAN AHLI GIZI","",""], [2153,"Kunjungan Ahli Gizi","","40000.0"], [2154,"Penyusunan menu makanan","14000.0","59000.0"], [2155,"","",""], [2156,"","",""], [2157,"PELAYANAN PSIKOLOGI","",""], [2158,"Kunjungan Psikolog","25000.0","150000.0"], [2159,"","",""], [2160,"PELAYANAN TRANSPORTASI (AMBULANCE)","",""], [2161,"Transportasi / Ambulance Dalam Kota","87500.0","87500.0"], [2162,"Supir ","0.0","35000.0"], [2163,"","",""], [2164,"Transportasi / Ambulance Luar Kota","",""], [2165,"Supir (1500 / km)","",""], [2166,"Biaya BBM (6000/km)","",""], [2167,"","",""], [2168,"SEWA 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[2528,"BRONKOSKOPI + BIOPSI JARUM + FORCEP + BRUSHING","578000.0","2078000.0"], [2529,"BRONKOSKOPI TERAPI (PENGAMBILAN BENDA ASING, BRONCHIAL TOILET, STOP PERDARAHAN","578000.0","2078000.0"], [2530,"BRONKOSKOPI DENGAN GA","612000.0","1530000.0"], [2531,"","",""], [2532,"TABEL 25.","",""], [2533,"PELAYANAN TINDAKAN MEDIK NON OPERATIF","",""], [2534,"","",""], [2535,"JENIS PELAYANAN","JS","TARIF"], [2536,"KECIL","",""], [2537,"ASPIRASI HEMARTROSIS","17500.0","56000.0"], [2538,"ALLERGI TEST / PATCH TEST","17500.0","56000.0"], [2539,"BILAS LAMBUNG","17500.0","56000.0"], [2540,"DILATASI PHIMOSIS","17500.0","56000.0"], [2541,"EKSISI CLAVUS","17500.0","56000.0"], [2542,"EKSISI CONDILOMA ACCUMINATA","17500.0","56000.0"], [2543,"EKSISI GRANULOMA PYOGENIKUM","17500.0","56000.0"], [2544,"EKSISI KELOID < 5 CM","17500.0","56000.0"], [2545,"EKSISI SYRINGOMA","17500.0","56000.0"], [2546,"EKSISI VERUKA VULGARIS","17500.0","56000.0"], [2547,"EKSTRAKSI KALIUM OXALAT","17500.0","56000.0"], [2548,"EKTERPASI KISTA ATEROMA / LIPOMA / GANGLION < 2 CM","17500.0","56000.0"], [2549,"EKTRAKSI KUKU","17500.0","56000.0"], [2550,"EPILASI BULU MATA","17500.0","56000.0"], [2551,"FNA (FINE NEEDLE ASPIRATION)","17500.0","56000.0"], [2552,"INSISI FURUNKEL / ABSES","17500.0","56000.0"], [2553,"IPPB (INTERMITEN POSITIVE PRESSURE BREATHING)","17500.0","56000.0"], [2554,"IRIGASI TELINGA","17500.0","56000.0"], [2555,"KAUSTIK","17500.0","56000.0"], [2556,"LOBULAPLASTI 1 TELINGA","17500.0","56000.0"], [2557,"MANTOUX TEST/ IMUNISASI","17500.0","56000.0"], [2558,"NEKROTOMI","17500.0","56000.0"], [2559,"PAPSMEAR (PENGAMBILAN SEKRET)","17500.0","56000.0"], [2560,"PARASENTENSE TELINGA","17500.0","56000.0"], [2561,"PEMASANGAN / ANGKAT IMPLANT / IUD","17500.0","56000.0"], [2562,"PEMASANGAN / ANGKAT JAHIT SEDERHANA","17500.0","56000.0"], [2563,"PEMASANGAN INFUS UMBILICAL","17500.0","56000.0"], [2564,"PEMASANGAN PISARIUM","17500.0","56000.0"], [2565,"PEMASANGAN BELOG TAMPON","17500.0","56000.0"], 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ORAL","52000.0","129000.0"], [2623,"LOBULOPLASTI 2 TELINGA","52000.0","129000.0"], [2624,"PEMASANGAN / ANGKAT JAHIT LUKA BESAR / KOMPLEKS","52000.0","129000.0"], [2625,"PEMASANGAN / BUKA GIPS SIRKULAR","52000.0","129000.0"], [2626,"PEMBERIAN SITOSTATIKA","52000.0","129000.0"], [2627,"PENGANGKATAN NEURO FIBROMA","52000.0","129000.0"], [2628,"PENGANGKATAN NEVUS","52000.0","129000.0"], [2629,"PENGANGKATAN SKIN TAG","52000.0","129000.0"], [2630,"PENGANGKATAN TANDUR KULIT","52000.0","129000.0"], [2631,"TINDAKAN BEDAH BEKU","52000.0","129000.0"], [2632,"TINDAKAN BEDAH FLAP","52000.0","129000.0"], [2633,"TINDAKAN CRYOSURGERY","52000.0","129000.0"], [2634,"TINDAKAN DERMABRASI","52000.0","129000.0"], [2635,"TINDAKAN PUNKSI LUMBAL","52000.0","129000.0"], [2636,"REPOSISI DISLOKASI MANDIBULA","52000.0","129000.0"], [2637,"KEMOTHERAPI","52000.0","129000.0"], [2638,"PEMASANGAN SKIN TRAKSI","52000.0","129000.0"], [2639,"PHOTOTHERAPI","52000.0","129000.0"], [2640,"PUNGSI CAVUM 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(BRACHACEIA)","52000.0","129000.0"], [2657,"HIDROTUBASI","52000.0","129000.0"], [2658,"DILATASI SERVIK","52000.0","129000.0"], [2659,"INFANT WARMER","52000.0","129000.0"], [2660,"INCUBATOR","52000.0","129000.0"], [2661,"Perawatan luka/ganti balutan ( Lk > 10 cm )","52000.0","129000.0"], [2662,"Pemasangan NGT","52000.0","129000.0"], [2663,"Pemasanagan Oksigen RM - NRM","52000.0","129000.0"], [2664,"Cross Incisi","52000.0","129000.0"], [2665,"Perawatan luka bakar > 25%","52000.0","129000.0"], [2666,"Pemasangan Infus dengan penyulit","52000.0","129000.0"], [2667,"Pemasangan Syringe Pump","52000.0","129000.0"], [2668,"Pemasangan Infus Pump ","52000.0","129000.0"], [2669,"Tranfusi Darah ","52000.0","129000.0"], [2670,"Pemasangan Tampon Abses/Fistula","52000.0","129000.0"], [2671,"Perawatan Colostomi","52000.0","129000.0"], [2672,"Pemasangan OPA / Mayo Tube","52000.0","129000.0"], [2673,"Pengambilan sekret vaginal","52000.0","129000.0"], [2674,"Ekstubasi","52000.0","129000.0"], [2675,"Pemasangan Laminaria","52000.0","129000.0"], [2676,"Hecting Perineum > 10 jahitan","52000.0","129000.0"], [2677,"Perawatan Luka Ulkus/Gangren","52000.0","129000.0"], [2678,"Manual Placenta","52000.0","129000.0"], [2679,"Tindakan Scortsteen","52000.0","129000.0"], [2680,"Pemasangan Implant / IUD","52000.0","129000.0"], [2681,"Pemasangan Balon Cateter","52000.0","129000.0"], [2682,"Penanganan Perdarahan Ante - Post Partum","52000.0","129000.0"], [2683,"Resusitasi Jantung Paru Sederhana","52000.0","129000.0"], [2684,"Pemasangan Cateter Urine dgn penyulit","52000.0","129000.0"], [2685,"Perawatan AV Shunt","52000.0","129000.0"], [2686,"Bronchial Washing","52000.0","129000.0"], [2687,"Lavement / Pemberian Enema","52000.0","129000.0"], [2688,"Pemeriksaan Pulse Oxymetri","52000.0","129000.0"], [2689,"Pengambilan Corpus Alienum","52000.0","129000.0"], [2690,"Blass Punksi","52000.0","129000.0"], [2691,"","",""], [2692,"BESAR","",""], [2693,"EKSISI PTERGIUM","121000.0","275000.0"], 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