| 1 |
Ambulance Jenazah Tamalanrea - Bantaeng(Uluere) |
620,000 |
| 2 |
Ambulance Jenazah Tamalanrea - Bulukumba(Tanete) |
760,000 |
| 3 |
Ambulance Medik Tamalanrea - Bantaeng (Bantaeng Kota) |
1,570,000 |
| 4 |
Ambulance Medik Tamalanrea - Selayar (Selayar) |
3,240,000 |
| 5 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 10 kali datang dalam 2 bulan) - Terapi Ke 10 |
0 |
| 6 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 10 kali datang dalam 2 bulan) - Terapi Ke 9 |
0 |
| 7 |
Laser V Beam |
250,000 |
| 8 |
17-OH Progesteron (LC-MS/MS) (P) |
900,000 |
| 9 |
25-OH VITAMIN D TOTAL/ VITAMIN D |
571,000 |
| 10 |
A-V shunt brachiocephalica (Cubiti) |
29,153,000 |
| 11 |
A-V Shunt dengan graft vena/sintetis |
51,764,000 |
| 12 |
A-V shunt dengan transposisi basilika |
29,153,000 |
| 13 |
A-V Shunt radial (Brescia Cimino) |
7,390,000 |
| 14 |
Abdominal packing pada perdarahan |
10,753,000 |
| 15 |
Abdominal trauma (Multiple organ repair) |
17,539,000 |
| 16 |
Abdominopelvic amputation |
9,282,099 |
| 17 |
Abdominoperineal Pull - Through / Malformasi |
6,175,000 |
| 18 |
Abdominoperineal Pull Through (Malformasi Anorectal) |
32,364,000 |
| 19 |
Abdominoperineal Pull-Throug/ Swenson |
6,175,000 |
| 20 |
Abdominorectal Pull - Through/Swenson Procedure |
6,175,000 |
| 21 |
Abdominorectal Pull Through (Swenson Procedure) |
44,624,000 |
| 22 |
Ablasi gingiva per gigi |
308,000 |
| 23 |
Ablasi gingiva per regio |
1,821,000 |
| 24 |
Ablasi transkutan vena (skin laser, radiofrekuensi, etc) |
21,640,000 |
| 25 |
Ablatio Retina |
10,926,000 |
| 26 |
Above elbow / below elbow amputation |
18,043,000 |
| 27 |
Above knee / Below knee amputation |
18,043,000 |
| 28 |
ABPM (Ambulatory Blood Pressure Monitoring) |
322,001 |
| 29 |
ABR Bone |
1,106,000 |
| 30 |
ABR Click |
1,106,000 |
| 31 |
ABR dengan sedasi |
1,106,000 |
| 32 |
ABR Skrining |
1,106,000 |
| 33 |
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 |
| 34 |
Absisi Corpus Alinun |
150,000 |
| 35 |
ACA IgG |
438,000 |
| 36 |
ACA IgG (P) |
671,000 |
| 37 |
ACA IgM |
438,000 |
| 38 |
ACA IgM (P) |
690,000 |
| 39 |
Acceptance and Commitment Therapy (ACT) pada dewasa |
300,000 |
| 40 |
Acceptance and Commitment Therapy (ACT) pada lansia |
300,000 |
| 41 |
Achillotenotomy |
9,390,000 |
| 42 |
ACT (ACTIVATE CLOTTING TIME) |
461,000 |
| 43 |
Activated Clotting Time |
400,000 |
| 44 |
Acute Pain Service |
0 |
| 45 |
Adaptasi Aktifitas Sehari-hari |
170,000 |
| 46 |
Adductor tenotomy of hip |
9,390,000 |
| 47 |
Adenoidektomi |
3,850,000 |
| 48 |
Adenoidektomi endoskopik |
7,450,000 |
| 49 |
Adenolisis |
6,350,000 |
| 50 |
Adesolisis |
5,931,446 |
| 51 |
Adhesiolisis intraluminal vagina |
19,424,000 |
| 52 |
Adhesiolisis per laparatomi |
13,421,000 |
| 53 |
Adhesiolisis per laparoskopi tingkat 1 |
17,651,000 |
| 54 |
Adhesiolisis per laparoskopi tingkat 2 (dengan penyulit, perlekatan hebat) |
19,424,000 |
| 55 |
ADL (Activity of Daily Living) |
22,800 |
| 56 |
Administrasi Home Care |
100,000 |
| 57 |
Administrasi Penyerahan Jenazah |
120,000 |
| 58 |
Administrasi Penyerahan Jenazah |
140,000 |
| 59 |
Adrenalektomi |
23,492,000 |
| 60 |
Adrenalektomi Abdominotorakal |
10,320,000 |
| 61 |
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 |
90,000,000 |
| 62 |
Advanced Hemodinamik Invasive Monitoring (EV1000) pasien dewasa |
4,612,000 |
| 63 |
Advanced Hemodinamik Invasive Monitoring (EV1000) pasien neonatus |
4,612,000 |
| 64 |
Advanced Hemodinamik Invasive Monitoring (EV1000) pasien pediatrik |
4,612,000 |
| 65 |
Advanced Hemodinamik Invasive Monitoring (Hemosphere) pasien dewasa |
4,612,000 |
| 66 |
Advanced Hemodinamik Invasive Monitoring (Hemosphere) pasien neonatus |
4,612,000 |
| 67 |
Advanced Hemodinamik Invasive Monitoring (Hemosphere) pasien pediatrik |
4,612,000 |
| 68 |
Advanced Hemodinamik Invasive Monitoring (lainnya) |
4,612,000 |
| 69 |
Advanced Hemodinamik Invasive Monitoring (lainnya) pasien dewasa |
4,612,000 |
| 70 |
Advanced Hemodinamik Invasive Monitoring (lainnya) pasien neonatus |
4,612,000 |
| 71 |
Advanced Hemodinamik Invasive Monitoring (lainnya) pasien pediatrik |
4,612,000 |
| 72 |
Advanced Hemodinamik Invasive Monitoring (LIDCO) |
4,612,000 |
| 73 |
Advanced Hemodinamik Invasive Monitoring (LIDCO) pasien dewasa |
4,612,000 |
| 74 |
Advanced Hemodinamik Invasive Monitoring (LIDCO) pasien neonatus |
4,612,000 |
| 75 |
Advanced Hemodinamik Invasive Monitoring (LIDCO) pasien pediatrik |
4,612,000 |
| 76 |
Advanced Hemodinamik Invasive Monitoring (Mostcare) |
4,612,000 |
| 77 |
Advanced Hemodinamik Invasive Monitoring (Mostcare) pasien dewasa |
4,612,000 |
| 78 |
Advanced Hemodinamik Invasive Monitoring (Mostcare) pasien neonatus |
4,612,000 |
| 79 |
Advanced Hemodinamik Invasive Monitoring (Mostcare) pasien pediatrik |
4,612,000 |
| 80 |
Advanced Hemodinamik Invasive Monitoring (PICCO) pasien dewasa |
4,612,000 |
| 81 |
Advanced Hemodinamik Invasive Monitoring (PICCO) pasien neonatus |
4,612,000 |
| 82 |
Advanced Hemodinamik Invasive Monitoring (PICCO) pasien pediatrik |
4,612,000 |
| 83 |
Advanced Hemodinamik Invasive Monitoring (PICCO) tanpa CVC / ABP |
4,612,000 |
| 84 |
Advanced Hemodinamik Non-Invasive Monitoring (ICON) |
3,642,000 |
| 85 |
Advanced Hemodinamik Non-Invasive Monitoring (ICON) pasien dewasa |
3,642,000 |
| 86 |
Advanced Hemodinamik Non-Invasive Monitoring (ICON) pasien neonatus |
3,642,000 |
| 87 |
Advanced Hemodinamik Non-Invasive Monitoring (ICON) pasien pediatrik |
3,642,000 |
| 88 |
Advanced Hemodinamik Non-Invasive Monitoring (lainnya) |
3,642,000 |
| 89 |
Advanced Hemodinamik Non-Invasive Monitoring (lainnya) pasien dewasa |
3,642,000 |
| 90 |
Advanced Hemodinamik Non-Invasive Monitoring (lainnya) pasien neonatus |
3,642,000 |
| 91 |
Advanced Hemodinamik Non-Invasive Monitoring (lainnya) pasien pediatrik |
3,642,000 |
| 92 |
Advanced Hemodinamik Non-Invasive Monitoring (USCOM) |
3,642,000 |
| 93 |
Advanced Hemodinamik Non-Invasive Monitoring (USCOM) pasien dewasa |
3,642,000 |
| 94 |
Advanced Hemodinamik Non-Invasive Monitoring (USCOM) pasien neonatus |
3,642,000 |
| 95 |
Advanced Hemodinamik Non-Invasive Monitoring (USCOM) pasien pediatrik |
3,642,000 |
| 96 |
Advancement of pedicle graft |
10,925,000 |
| 97 |
Advancement of tendon |
11,196,000 |
| 98 |
Advancement of tendon of hand |
11,196,000 |
| 99 |
Aff CVC |
0 |
| 100 |
Aff DJ Local |
2,933,000 |
| 101 |
Aff DJ Narkose |
3,409,000 |
| 102 |
Aff DJ Stent |
2,850,000 |
| 103 |
Aff DJ Stent |
3,409,000 |
| 104 |
Aff DJ Stent (ESWL) |
2,500,000 |
| 105 |
Aff DJ Stent (ESWL) (Sore) |
3,750,000 |
| 106 |
Aff Double Lumen |
217,000 |
| 107 |
Aff Drain |
83,000 |
| 108 |
Aff Drain pasca operasi |
116,000 |
| 109 |
Aff Epidural Kateter |
0 |
| 110 |
Aff External Ventricular Drainage / Lumbal Drain |
713,000 |
| 111 |
Aff Hecting |
72,000 |
| 112 |
Aff Infus |
0 |
| 113 |
Aff Infus Neonatus (Intensif) |
0 |
| 114 |
Aff Infus Sulit + Anastesi |
0 |
| 115 |
Aff kateter |
65,000 |
| 116 |
Aff Kateter Per Flouroskopi |
1,499,000 |
| 117 |
Aff Kateter Urine |
0 |
| 118 |
Aff Nefrostomi (Lokal) |
116,000 |
| 119 |
Aff NGT |
82,000 |
| 120 |
Aff or Repair pleural drain |
713,000 |
| 121 |
Aff pigtail |
560,000 |
| 122 |
Aff-ORIF Fraktur Rahang Kompleks/Wajah Multiple |
4,597,500 |
| 123 |
Aff-ORIF Fraktur Rahang Sederhana |
2,670,000 |
| 124 |
Aff/Insersi drain abses subkutis |
713,000 |
| 125 |
AFO (Biasa) |
961,000 |
| 126 |
AFO (Khusus) |
2,850,000 |
| 127 |
AFO (Standar) |
1,556,000 |
| 128 |
AFP |
300,000 |
| 129 |
AFP _ |
245,000 |
| 130 |
Agregasi Trombosit _ |
400,000 |
| 131 |
AGREGASI TROMBOSIT (ADP)/ TAT |
381,000 |
| 132 |
Ahmed Implant Lokal |
25,636,000 |
| 133 |
Ahmed Implant narkose |
26,693,000 |
| 134 |
Air Plumbage ( Bedah Paru/ Thorax ) |
21,102,000 |
| 135 |
Airway Metalic Stenting + Rigid Bronkoskopi dengan Anastesi |
13,284,000 |
| 136 |
Airway Silicon Stenting + Rigid Bronkoskopi dengan Anastesi |
13,284,000 |
| 137 |
Aktivator |
1,812,000 |
| 138 |
Akupresur Badan |
374,000 |
| 139 |
Akupunktur Anestesi |
993,000 |
| 140 |
Akupunktur Cupping |
156,000 |
| 141 |
Akupunktur Fertilitas |
824,001 |
| 142 |
Akupunktur Kecantikan |
307,000 |
| 143 |
Akupunktur Kepala |
486,000 |
| 144 |
Akupunktur Laser Intraarticular |
228,000 |
| 145 |
Akupunktur Laser Portable |
307,000 |
| 146 |
Akupunktur Manual Tubuh 1 posisi |
551,000 |
| 147 |
Akupunktur Manual Tubuh 2 posisi |
755,001 |
| 148 |
Akupunktur Obesitas |
228,000 |
| 149 |
Akupunktur Tanam Benang |
500,000 |
| 150 |
Akupuntur ( 4 x Tindakan ) |
250,000 |
| 151 |
Akupuntur (Elektro + Termal) |
120,000 |
| 152 |
Akupuntur Estetika |
125,000 |
| 153 |
Akupuntur Laser Pen |
100,000 |
| 154 |
Akupuntur Mikro |
100,000 |
| 155 |
Akupuntur Tanam Benang |
150,000 |
| 156 |
Alat Orthodonsia cekat ceramic 1 rahang (RA/RB saja) |
4,893,000 |
| 157 |
Alat Orthodonsia cekat ceramic 2 rahang (RA dan RB) |
8,890,000 |
| 158 |
Alat Orthodonsia cekat metal 1 rahang (RA/RB saja) |
3,030,000 |
| 159 |
Alat Orthodonsia cekat metal 1/4 rahang (RA dan RB) |
1,910,000 |
| 160 |
Alat Orthodonsia cekat metal 2 rahang (RA dan RB) |
5,614,000 |
| 161 |
Alat Orthodonsia cekat self ligating ceramic 2 rahang (RA dan RB) |
13,200,000 |
| 162 |
Alat Orthodonsia cekat self ligating metal 2 rahang (RA dan RB) |
11,474,000 |
| 163 |
Albumin |
32,000 |
| 164 |
ALBUMIN (ALB) |
46,000 |
| 165 |
ALBUMIN (URIN) |
79,000 |
| 166 |
Albumin Urine |
30,000 |
| 167 |
Alkali Fosfatase |
37,000 |
| 168 |
Allergi Test/Patch Test |
66,000 |
| 169 |
Allograft/Xenograft/Transplantasi Kulit |
8,889,000 |
| 170 |
ALND (Diseksi Axilla) |
18,522,000 |
| 171 |
ALPACA Repair/AP Window+MOF/AVSD Repair/BCPS On Off Pump + MOF/Corctasio Aorta+MOF |
49,550,000 |
| 172 |
Alveolar Bone Graft |
9,550,000 |
| 173 |
Alveolar Ridge augmentasi |
6,351,000 |
| 174 |
Alveolectomi |
9,168,000 |
| 175 |
Alveolektomi 2 Regio dengan Anastesi Lokal |
0 |
| 176 |
Alveolektomi per regio |
1,119,000 |
| 177 |
Alveolektomi Per Regio dengan Anastesi Lokal |
1,119,000 |
| 178 |
Alveolektomi per segmen rahang |
8,552,000 |
| 179 |
Ambil Bahan Kultur (asal spesimen) |
99,000 |
| 180 |
Ambil Bahan Kultur/Biopsi/Swab/Kerokan |
66,000 |
| 181 |
Ambulance Jenasah Tamalanrea - Makassar (Galangan Kapal) |
104,000 |
| 182 |
Ambulance Jenasah Tamalanrea - Makassar (Pannampu) |
114,000 |
| 183 |
Ambulance Jenasah Tamalanrea - Makassar (Sekitaran tanjung) |
142,000 |
| 184 |
Ambulance Jenasah Tamalanrea - Makassar (Teuku Umar) |
94,000 |
| 185 |
Ambulance Jenasah Tamalanrea - Makassar (Ujung Tanah) |
114,000 |
| 186 |
Ambulance Jenazah Tamalanrea - Bantaeng (Bantaeng Kota) |
560,000 |
| 187 |
Ambulance Jenazah Tamalanrea - Bantaeng (Eremerasa) |
600,000 |
| 188 |
Ambulance Jenazah Tamalanrea - Bantaeng (Gantarangkeke) |
640,000 |
| 189 |
Ambulance Jenazah Tamalanrea - Bantaeng(Banyorang) |
680,000 |
| 190 |
Ambulance Jenazah Tamalanrea - Bantaeng(Pajukukang) |
600,000 |
| 191 |
Ambulance Jenazah Tamalanrea - Bantaeng(Tompobulu) |
822,000 |
| 192 |
Ambulance Jenazah Tamalanrea - Barru (Barru Kota) |
480,000 |
| 193 |
Ambulance Jenazah Tamalanrea - Barru (Bojo) |
560,000 |
| 194 |
Ambulance Jenazah Tamalanrea - Barru (Bulu dua) |
660,000 |
| 195 |
Ambulance Jenazah Tamalanrea - Barru (Gattareng) |
800,000 |
| 196 |
Ambulance Jenazah Tamalanrea - Barru (Mangkoso) |
520,000 |
| 197 |
Ambulance Jenazah Tamalanrea - Barru (Palandro) |
540,000 |
| 198 |
Ambulance Jenazah Tamalanrea - Barru (Pekkae) |
454,000 |
| 199 |
Ambulance Jenazah Tamalanrea - Barru (Ralla/Tanete Riaja) |
502,000 |
| 200 |
Ambulance Jenazah Tamalanrea - Barru (Takkalasi) |
500,000 |
| 201 |
Ambulance Jenazah Tamalanrea - Bone (Bone Kota) |
760,000 |
| 202 |
Ambulance Jenazah Tamalanrea - Bone (Bontocani) |
800,000 |
| 203 |
Ambulance Jenazah Tamalanrea - Bone (Cakke) |
920,000 |
| 204 |
Ambulance Jenazah Tamalanrea - Bone (Camming) |
660,000 |
| 205 |
Ambulance Jenazah Tamalanrea - Bone (Cenrana) |
1,000,000 |
| 206 |
Ambulance Jenazah Tamalanrea - Bone (Cina) |
800,000 |
| 207 |
Ambulance Jenazah Tamalanrea - Bone (Kajuara) |
800,000 |
| 208 |
Ambulance Jenazah Tamalanrea - Bone (Koppe) |
704,000 |
| 209 |
Ambulance Jenazah Tamalanrea - Bone (Lamuru Ulam) |
800,000 |
| 210 |
Ambulance Jenazah Tamalanrea - Bone (Lapri) |
598,000 |
| 211 |
Ambulance Jenazah Tamalanrea - Bone (Lempangeng) |
700,000 |
| 212 |
Ambulance Jenazah Tamalanrea - Bone (Limpoe) |
800,000 |
| 213 |
Ambulance Jenazah Tamalanrea - Bone (Mare) |
880,000 |
| 214 |
Ambulance Jenazah Tamalanrea - Bone (Palattae) |
700,000 |
| 215 |
Ambulance Jenazah Tamalanrea - Bone (Pompanua) |
940,000 |
| 216 |
Ambulance Jenazah Tamalanrea - Bone (Solo) |
940,000 |
| 217 |
Ambulance Jenazah Tamalanrea - Bone (Tonra) |
880,000 |
| 218 |
Ambulance Jenazah Tamalanrea - Bulukumba(Bira) |
950,000 |
| 219 |
Ambulance Jenazah Tamalanrea - Bulukumba(Bulukumba Kota) |
680,000 |
| 220 |
Ambulance Jenazah Tamalanrea - Bulukumba(Kajang) |
940,000 |
| 221 |
Ambulance Jenazah Tamalanrea - Bulukumba(Tanaberu) |
760,000 |
| 222 |
Ambulance Jenazah Tamalanrea - Enrekang (Baraka) |
960,000 |
| 223 |
Ambulance Jenazah Tamalanrea - Enrekang (Baroko) |
960,000 |
| 224 |
Ambulance Jenazah Tamalanrea - Enrekang (Enrekang Kota) |
780,000 |
| 225 |
Ambulance Jenazah Tamalanrea - Enrekang (Kalosi) |
920,000 |
| 226 |
Ambulance Jenazah Tamalanrea - Enrekang (Malua) |
940,000 |
| 227 |
Ambulance Jenazah Tamalanrea - Enrekang (Moroanging) |
740,000 |
| 228 |
Ambulance Jenazah Tamalanrea - Enrekang (Sudu) |
960,000 |
| 229 |
Ambulance Jenazah Tamalanrea - Gowa (Barombong) |
158,000 |
| 230 |
Ambulance Jenazah Tamalanrea - Gowa (Bili-Bili) |
224,000 |
| 231 |
Ambulance Jenazah Tamalanrea - Gowa (Bontonompo) |
248,000 |
| 232 |
Ambulance Jenazah Tamalanrea - Gowa (Limbung) |
184,000 |
| 233 |
Ambulance Jenazah Tamalanrea - Gowa (Malakaji) |
600,000 |
| 234 |
Ambulance Jenazah Tamalanrea - Gowa (Malino) |
520,000 |
| 235 |
Ambulance Jenazah Tamalanrea - Gowa (Pallangga) |
164,000 |
| 236 |
Ambulance Jenazah Tamalanrea - Gowa (Samata) |
104,000 |
| 237 |
Ambulance Jenazah Tamalanrea - Gowa (Sapaiya) |
480,000 |
| 238 |
Ambulance Jenazah Tamalanrea - Gowa (Sungguminasa) |
138,000 |
| 239 |
Ambulance Jenazah Tamalanrea - Gowa (Tombolo Pao) |
620,000 |
| 240 |
Ambulance Jenazah Tamalanrea - Jeneponto (ALLU) |
380,000 |
| 241 |
Ambulance Jenazah Tamalanrea - Jeneponto (Batang) |
500,000 |
| 242 |
Ambulance Jenazah Tamalanrea - Jeneponto (Jeneponto Kota) |
480,000 |
| 243 |
Ambulance Jenazah Tamalanrea - Jeneponto (Kapita) |
448,000 |
| 244 |
Ambulance Jenazah Tamalanrea - Jeneponto (Kelara) |
500,000 |
| 245 |
Ambulance Jenazah Tamalanrea - Jeneponto (Rumbia) |
520,000 |
| 246 |
Ambulance Jenazah Tamalanrea - Jeneponto (Tamalatea) |
440,000 |
| 247 |
Ambulance Jenazah Tamalanrea - Jeneponto (Tarowang) |
520,000 |
| 248 |
Ambulance Jenazah Tamalanrea - Luwu (Belopa) |
1,100,000 |
| 249 |
Ambulance Jenazah Tamalanrea - Luwu (Bone-bone) |
1,496,000 |
| 250 |
Ambulance Jenazah Tamalanrea - Luwu (Bua) |
1,240,000 |
| 251 |
Ambulance Jenazah Tamalanrea - Luwu (Kota Palopo) |
1,298,000 |
| 252 |
Ambulance Jenazah Tamalanrea - Luwu (Larompong) |
1,040,000 |
| 253 |
Ambulance Jenazah Tamalanrea - Luwu (Malili) |
2,300,000 |
| 254 |
Ambulance Jenazah Tamalanrea - Luwu (Mallangke) |
1,600,000 |
| 255 |
Ambulance Jenazah Tamalanrea - Luwu (Mangkutana) |
2,200,000 |
| 256 |
Ambulance Jenazah Tamalanrea - Luwu (Masamba) |
1,460,000 |
| 257 |
Ambulance Jenazah Tamalanrea - Luwu (Padang Sappa) |
1,196,000 |
| 258 |
Ambulance Jenazah Tamalanrea - Luwu (Ponrang) |
1,154,000 |
| 259 |
Ambulance Jenazah Tamalanrea - Luwu (Sa'bang) |
1,400,000 |
| 260 |
Ambulance Jenazah Tamalanrea - Luwu (Soroako) |
2,400,000 |
| 261 |
Ambulance Jenazah Tamalanrea - Luwu (Suli) |
1,060,000 |
| 262 |
Ambulance Jenazah Tamalanrea - Luwu (Walenrang / Lamasi) |
1,340,000 |
| 263 |
Ambulance Jenazah Tamalanrea - Luwu (Wasuponda) |
2,344,000 |
| 264 |
Ambulance Jenazah Tamalanrea - Luwu (Wotu) |
1,534,000 |
| 265 |
Ambulance Jenazah Tamalanrea - Majene (Majene Kota) |
1,404,000 |
| 266 |
Ambulance Jenazah Tamalanrea - Majene (Malunda) |
1,720,000 |
| 267 |
Ambulance Jenazah Tamalanrea - Majene (Pamboang) |
1,440,000 |
| 268 |
Ambulance Jenazah Tamalanrea - Majene (Sendana) |
1,678,000 |
| 269 |
Ambulance Jenazah Tamalanrea - Majene (Tappalang) |
1,760,000 |
| 270 |
Ambulance Jenazah Tamalanrea - Makassar (BTN Antara) |
74,000 |
| 271 |
Ambulance Jenazah Tamalanrea - Makassar (BTP) |
64,000 |
| 272 |
Ambulance Jenazah Tamalanrea - Makassar (Bulurokeng) |
114,000 |
| 273 |
Ambulance Jenazah Tamalanrea - Makassar (Cendrawasih) |
114,000 |
| 274 |
Ambulance Jenazah Tamalanrea - Makassar (Jalan Bung) |
54,000 |
| 275 |
Ambulance Jenazah Tamalanrea - Makassar (Jalan Sunu) |
104,000 |
| 276 |
Ambulance Jenazah Tamalanrea - Makassar (Jl. Abd. Dg. Sirua) |
66,000 |
| 277 |
Ambulance Jenazah Tamalanrea - Makassar (Jl. Pettarani) |
98,000 |
| 278 |
Ambulance Jenazah Tamalanrea - Makassar (Minasa Upa) |
94,000 |
| 279 |
Ambulance Jenazah Tamalanrea - Makassar (Paccerakkang) |
78,000 |
| 280 |
Ambulance Jenazah Tamalanrea - Makassar (Pampang) |
84,000 |
| 281 |
Ambulance Jenazah Tamalanrea - Makassar (Panaikang) |
68,000 |
| 282 |
Ambulance Jenazah Tamalanrea - Makassar (Panakkukang) |
76,000 |
| 283 |
Ambulance Jenazah Tamalanrea - Makassar (Perumahan Dosen) |
54,000 |
| 284 |
Ambulance Jenazah Tamalanrea - Makassar (Perumnas Antang) |
84,000 |
| 285 |
Ambulance Jenazah Tamalanrea - Makassar (Perumnas Sudiang) |
94,000 |
| 286 |
Ambulance Jenazah Tamalanrea - Makassar (Rappokalling) |
88,000 |
| 287 |
Ambulance Jenazah Tamalanrea - Makassar (Somba Upu) |
104,000 |
| 288 |
Ambulance Jenazah Tamalanrea - Makassar (Sultan Alauddin) |
104,000 |
| 289 |
Ambulance Jenazah Tamalanrea - Makassar (Tala Salapang) |
108,000 |
| 290 |
Ambulance Jenazah Tamalanrea - Makassar (Tello) |
64,000 |
| 291 |
Ambulance Jenazah Tamalanrea - Makassar (Toll/ Jl. Ir. Sutami) |
98,000 |
| 292 |
Ambulance Jenazah Tamalanrea - Makassar (Unhas) |
52,000 |
| 293 |
Ambulance Jenazah Tamalanrea - Makassar (Veteran Selatan) |
108,000 |
| 294 |
Ambulance Jenazah Tamalanrea - Makassar (Veteran Utara) |
92,000 |
| 295 |
Ambulance Jenazah Tamalanrea - Makassar (Wesabbe) |
52,000 |
| 296 |
Ambulance Jenazah Tamalanrea - Mamuju (Budong-budong) |
2,240,000 |
| 297 |
Ambulance Jenazah Tamalanrea - Mamuju (Kaluku/Tasiu) |
1,860,000 |
| 298 |
Ambulance Jenazah Tamalanrea - Mamuju (Mamuju Kota) |
1,800,000 |
| 299 |
Ambulance Jenazah Tamalanrea - Mamuju (Pasang Kayu) |
2,500,000 |
| 300 |
Ambulance Jenazah Tamalanrea - Mamuju (Tarailu) |
2,100,000 |
| 301 |
Ambulance Jenazah Tamalanrea - Mamuju (Tikke) |
2,400,000 |
| 302 |
Ambulance Jenazah Tamalanrea - Mamuju (Tobadak) |
2,400,000 |
| 303 |
Ambulance Jenazah Tamalanrea - Mamuju (Topoyo) |
2,200,000 |
| 304 |
Ambulance Jenazah Tamalanrea - Maros (Bandara) |
118,000 |
| 305 |
Ambulance Jenazah Tamalanrea - Maros (Bantimurung) |
280,000 |
| 306 |
Ambulance Jenazah Tamalanrea - Maros (Camba) |
380,000 |
| 307 |
Ambulance Jenazah Tamalanrea - Maros (Carangki) |
200,000 |
| 308 |
Ambulance Jenazah Tamalanrea - Maros (Cenrana) |
360,000 |
| 309 |
Ambulance Jenazah Tamalanrea - Maros (Kaemba) |
168,000 |
| 310 |
Ambulance Jenazah Tamalanrea - Maros (Maros Kota) |
220,000 |
| 311 |
Ambulance Jenazah Tamalanrea - Maros (Pattene) |
144,000 |
| 312 |
Ambulance Jenazah Tamalanrea - Maros (Sipur) |
204,000 |
| 313 |
Ambulance Jenazah Tamalanrea - Maros (Tambua) |
260,000 |
| 314 |
Ambulance Jenazah Tamalanrea - Maros (Tanralili) |
220,000 |
| 315 |
Ambulance Jenazah Tamalanrea - Maros (Tompobulu) |
440,000 |
| 316 |
Ambulance Jenazah Tamalanrea - Pangkep (Balocci) |
380,000 |
| 317 |
Ambulance Jenazah Tamalanrea - Pangkep (Bungoro) |
300,000 |
| 318 |
Ambulance Jenazah Tamalanrea - Pangkep (La'bakkang) |
320,000 |
| 319 |
Ambulance Jenazah Tamalanrea - Pangkep (Ma'rang) |
380,000 |
| 320 |
Ambulance Jenazah Tamalanrea - Pangkep (Mandalle) |
440,000 |
| 321 |
Ambulance Jenazah Tamalanrea - Pangkep (Pangkep Kota) |
280,000 |
| 322 |
Ambulance Jenazah Tamalanrea - Pangkep (Segeri Kota) |
420,000 |
| 323 |
Ambulance Jenazah Tamalanrea - Pangkep (Tompubulu) |
520,000 |
| 324 |
Ambulance Jenazah Tamalanrea - Pangkep (Tondong Kura) |
520,000 |
| 325 |
Ambulance Jenazah Tamalanrea - Pare-Pare (Kariango) |
640,000 |
| 326 |
Ambulance Jenazah Tamalanrea - Pare-Pare (Pare-Pare Kota) |
600,000 |
| 327 |
Ambulance Jenazah Tamalanrea - Pinrang (Bakaru) |
920,000 |
| 328 |
Ambulance Jenazah Tamalanrea - Pinrang (Batu Lappa) |
900,000 |
| 329 |
Ambulance Jenazah Tamalanrea - Pinrang (Benteng) |
840,000 |
| 330 |
Ambulance Jenazah Tamalanrea - Pinrang (Bungi) |
940,000 |
| 331 |
Ambulance Jenazah Tamalanrea - Pinrang (Kariango) |
920,000 |
| 332 |
Ambulance Jenazah Tamalanrea - Pinrang (Langnga) |
740,000 |
| 333 |
Ambulance Jenazah Tamalanrea - Pinrang (Pekkabata/Paria) |
740,000 |
| 334 |
Ambulance Jenazah Tamalanrea - Pinrang (Pinrang Kota) |
700,000 |
| 335 |
Ambulance Jenazah Tamalanrea - Pinrang (Suppa) |
640,000 |
| 336 |
Ambulance Jenazah Tamalanrea - Polman (Wonomulyo) |
1,040,000 |
| 337 |
Ambulance Jenazah Tamalanrea - Polman (Campalagian) |
1,100,000 |
| 338 |
Ambulance Jenazah Tamalanrea - Polman (Mamasa Kota) |
1,400,000 |
| 339 |
Ambulance Jenazah Tamalanrea - Polman (Mambi) |
1,400,000 |
| 340 |
Ambulance Jenazah Tamalanrea - Polman (Manding) |
996,000 |
| 341 |
Ambulance Jenazah Tamalanrea - Polman (Mapilli) |
1,200,000 |
| 342 |
Ambulance Jenazah Tamalanrea - Polman (Messawa) |
1,200,000 |
| 343 |
Ambulance Jenazah Tamalanrea - Polman (Nosu) |
1,200,000 |
| 344 |
Ambulance Jenazah Tamalanrea - Polman (Palatikan) |
1,080,000 |
| 345 |
Ambulance Jenazah Tamalanrea - Polman (Pambusuang) |
1,160,000 |
| 346 |
Ambulance Jenazah Tamalanrea - Polman (Polewali-Polman Kota) |
980,000 |
| 347 |
Ambulance Jenazah Tamalanrea - Polman (Sumarorong) |
1,200,000 |
| 348 |
Ambulance Jenazah Tamalanrea - Polman (Tinambung) |
1,200,000 |
| 349 |
Ambulance Jenazah Tamalanrea - Selayar |
2,800,000 |
| 350 |
Ambulance Jenazah Tamalanrea - Sidrap (Amparita) |
720,000 |
| 351 |
Ambulance Jenazah Tamalanrea - Sidrap (Belokka) |
740,000 |
| 352 |
Ambulance Jenazah Tamalanrea - Sidrap (Pangkaje'ne) |
680,000 |
| 353 |
Ambulance Jenazah Tamalanrea - Sidrap (Rappang) |
720,000 |
| 354 |
Ambulance Jenazah Tamalanrea - Sidrap (Tanru Tedong) |
740,000 |
| 355 |
Ambulance Jenazah Tamalanrea - Sinjai (Bikeru) |
760,000 |
| 356 |
Ambulance Jenazah Tamalanrea - Sinjai (Bulupoddo) |
760,000 |
| 357 |
Ambulance Jenazah Tamalanrea - Sinjai (Manimpahoi) |
840,000 |
| 358 |
Ambulance Jenazah Tamalanrea - Sinjai (Manipi) |
640,000 |
| 359 |
Ambulance Jenazah Tamalanrea - Sinjai (Sinjai Kota) |
760,000 |
| 360 |
Ambulance Jenazah Tamalanrea - Sinjai (Sinjai Timur) |
880,000 |
| 361 |
Ambulance Jenazah Tamalanrea - Sinjai (Songing) |
764,000 |
| 362 |
Ambulance Jenazah Tamalanrea - Soppeng(Batu-batu) |
740,000 |
| 363 |
Ambulance Jenazah Tamalanrea - Soppeng(Ca'benge) |
720,000 |
| 364 |
Ambulance Jenazah Tamalanrea - Soppeng(Cangadi) |
710,000 |
| 365 |
Ambulance Jenazah Tamalanrea - Soppeng(Leworeng) |
742,000 |
| 366 |
Ambulance Jenazah Tamalanrea - Soppeng(Soppeng Kota) |
720,000 |
| 367 |
Ambulance Jenazah Tamalanrea - Soppeng(Takalalla) |
680,000 |
| 368 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Ampana) |
3,800,000 |
| 369 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Bunta) |
3,892,000 |
| 370 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Kolongdale) |
3,400,000 |
| 371 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Luwuk Kota) |
4,600,000 |
| 372 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Morowali (Bungku)) |
3,800,000 |
| 373 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Morowali Selatan) |
4,968,000 |
| 374 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Pagimana) |
4,000,000 |
| 375 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Palu Kota) |
5,000,000 |
| 376 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Parigi) |
5,200,000 |
| 377 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Pendolo) |
2,600,000 |
| 378 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Poso Kota) |
3,200,000 |
| 379 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Tentena) |
3,000,000 |
| 380 |
Ambulance Jenazah Tamalanrea - Sulawesi Tengah (Toli-toli) |
6,000,000 |
| 381 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Bau-Bau) |
5,400,000 |
| 382 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Boepinang) |
4,600,000 |
| 383 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Buton) |
5,500,000 |
| 384 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Kendari kota) |
5,000,000 |
| 385 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Kolaka Kota) |
4,200,000 |
| 386 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Kolaka Utara) |
4,000,000 |
| 387 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Lambuya) |
4,400,000 |
| 388 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Pomala) |
4,400,000 |
| 389 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Raha + (Peri)) |
5,400,000 |
| 390 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Rate-rate) |
4,400,000 |
| 391 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Torobulu) |
4,800,000 |
| 392 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Unaaha) |
4,600,000 |
| 393 |
Ambulance Jenazah Tamalanrea - Sulawesi Tenggara (Wamengkoli + (Peri)) |
5,400,000 |
| 394 |
Ambulance Jenazah Tamalanrea - Takalar (Cikowang) |
340,000 |
| 395 |
Ambulance Jenazah Tamalanrea - Takalar (Galesong Selatan) |
300,000 |
| 396 |
Ambulance Jenazah Tamalanrea - Takalar (Galesong Utara) |
240,000 |
| 397 |
Ambulance Jenazah Tamalanrea - Takalar (Lantang) |
332,000 |
| 398 |
Ambulance Jenazah Tamalanrea - Takalar (Lengkese) |
314,000 |
| 399 |
Ambulance Jenazah Tamalanrea - Takalar (Pabrik Gula Takalar) |
280,000 |
| 400 |
Ambulance Jenazah Tamalanrea - Takalar (Takalar Kota) |
300,000 |
| 401 |
Ambulance Jenazah Tamalanrea - Takalar (Takalar Lama) |
320,000 |
| 402 |
Ambulance Jenazah Tamalanrea - Tator (Batu-Tumonga) |
1,200,000 |
| 403 |
Ambulance Jenazah Tamalanrea - Tator (Bua Kayu) |
1,000,000 |
| 404 |
Ambulance Jenazah Tamalanrea - Tator (Kota Makale) |
1,008,000 |
| 405 |
Ambulance Jenazah Tamalanrea - Tator (Kota Rantepao) |
1,080,000 |
| 406 |
Ambulance Jenazah Tamalanrea - Tator (Madandan) |
1,080,000 |
| 407 |
Ambulance Jenazah Tamalanrea - Tator (Nanggala) |
1,080,000 |
| 408 |
Ambulance Jenazah Tamalanrea - Tator (Pangngala) |
1,280,000 |
| 409 |
Ambulance Jenazah Tamalanrea - Tator (Rante Tayo) |
1,058,000 |
| 410 |
Ambulance Jenazah Tamalanrea - Tator (Rembon) |
1,080,000 |
| 411 |
Ambulance Jenazah Tamalanrea - Tator (Sa'dan) |
1,200,000 |
| 412 |
Ambulance Jenazah Tamalanrea - Wajo (Ana Banua) |
760,000 |
| 413 |
Ambulance Jenazah Tamalanrea - Wajo (Atapange) |
860,000 |
| 414 |
Ambulance Jenazah Tamalanrea - Wajo (Belawa) |
800,000 |
| 415 |
Ambulance Jenazah Tamalanrea - Wajo (Kera) |
940,000 |
| 416 |
Ambulance Jenazah Tamalanrea - Wajo (Sengkang Kota) |
840,000 |
| 417 |
Ambulance Jenazah Tamalanrea - Wajo (Siwa) |
980,000 |
| 418 |
Ambulance Jenazah Tamalanrea - Wajo (Tanasitolo) |
800,000 |
| 419 |
Ambulance Jenazah Tamalanrea - Wajo (Terumpekkae) |
840,000 |
| 420 |
Ambulance Ke Bandara Sultan Hasanuddin (Event) |
311,000 |
| 421 |
Ambulance Ke Lapangan Karebosi (Event) |
266,000 |
| 422 |
Ambulance Ke Pantai Losari (Event) |
295,000 |
| 423 |
Ambulance Ke RS Akademi Jaury |
275,000 |
| 424 |
Ambulance Ke RS Dr. Tadjuddin Chalid |
200,000 |
| 425 |
Ambulance Ke RS Ibnu Sina YW - UMI |
209,000 |
| 426 |
Ambulance Ke RS Stella Maris |
289,000 |
| 427 |
Ambulance Ke RSB Budi Mulia I |
253,000 |
| 428 |
Ambulance Ke RSB Bunda |
262,000 |
| 429 |
Ambulance Ke RSB GIA Lestari |
244,000 |
| 430 |
Ambulance Ke RSB Masyita |
176,000 |
| 431 |
Ambulance Ke RSB Restu |
302,000 |
| 432 |
Ambulance Ke RSB Siti Fatimah |
299,000 |
| 433 |
Ambulance Ke RSIA Bahagia |
304,000 |
| 434 |
Ambulance Ke RSIA Elim |
283,000 |
| 435 |
Ambulance Ke RSIA Pertiwi |
271,000 |
| 436 |
Ambulance Ke RSIA Sitti Khadijah |
269,000 |
| 437 |
Ambulance Ke RSIA Sitti Khadijah III |
280,000 |
| 438 |
Ambulance Ke RSU Islam Faisal |
281,000 |
| 439 |
Ambulance Ke RSU Labuang Baji |
310,000 |
| 440 |
Ambulance Ke RSU Luramay |
274,000 |
| 441 |
Ambulance Ke RSU Sayang Rakyat |
305,000 |
| 442 |
Ambulance Ke RSUD Daya Makassar |
186,000 |
| 443 |
Ambulance Ke Rumah Sakit 45 |
233,000 |
| 444 |
Ambulance Ke Rumah Sakit Awal Bros |
233,000 |
| 445 |
Ambulance Ke Rumah Sakit Hikmah |
292,000 |
| 446 |
Ambulance Ke Rumah Sakit Jiwa |
290,000 |
| 447 |
Ambulance Ke Rumah Sakit Mitra Husada |
293,000 |
| 448 |
Ambulance Ke Rumah Sakit Umum Haji |
320,000 |
| 449 |
Ambulance Ke Rumah Sakit Unhas |
114,000 |
| 450 |
Ambulance Ke Siloam Hospitals |
313,000 |
| 451 |
Ambulance Medik + Pendamping (Dokter Spesialis) |
1,000,000 |
| 452 |
Ambulance Medik + Pendamping (Dokter Umum) |
500,000 |
| 453 |
Ambulance Medik + Pendamping (Perawat) |
250,000 |
| 454 |
Ambulance Medik Siaga (< 8Jam) |
2,460,000 |
| 455 |
Ambulance Medik Siaga (16 < 24 Jam) |
6,640,000 |
| 456 |
Ambulance Medik Siaga (8 < 16 Jam) |
4,670,000 |
| 457 |
Ambulance Medik Tamalanrea - Bantaeng (Banyorang) |
1,800,000 |
| 458 |
Ambulance Medik Tamalanrea - Bantaeng (Eremerasa) |
1,650,000 |
| 459 |
Ambulance Medik Tamalanrea - Bantaeng (Gantarangkeke) |
1,800,000 |
| 460 |
Ambulance Medik Tamalanrea - Bantaeng (Gattarengkeke) |
1,800,000 |
| 461 |
Ambulance Medik Tamalanrea - Bantaeng (Pajukukang) |
1,680,000 |
| 462 |
Ambulance Medik Tamalanrea - Bantaeng (Tompobulu) |
1,980,000 |
| 463 |
Ambulance Medik Tamalanrea - Bantaeng (Tompobulu) |
1,980,000 |
| 464 |
Ambulance Medik Tamalanrea - Bantaeng (Uluere) |
1,570,000 |
| 465 |
Ambulance Medik Tamalanrea - Bantaeng (Ulurere) |
1,570,000 |
| 466 |
Ambulance Medik Tamalanrea - Bone (Bone Kota) |
2,190,000 |
| 467 |
Ambulance Medik Tamalanrea - Bone (Bontocani) |
1,200,000 |
| 468 |
Ambulance Medik Tamalanrea - Bone (Cakke) |
2,310,000 |
| 469 |
Ambulance Medik Tamalanrea - Bone (Camming) |
1,520,000 |
| 470 |
Ambulance Medik Tamalanrea - Bone (Cenrana) |
2,500,000 |
| 471 |
Ambulance Medik Tamalanrea - Bone (Cina) |
2,270,000 |
| 472 |
Ambulance Medik Tamalanrea - Bone (Kajuara) |
2,000,000 |
| 473 |
Ambulance Medik Tamalanrea - Bone (Koppe) |
1,650,000 |
| 474 |
Ambulance Medik Tamalanrea - Bone (Lamuru Ulam) |
1,620,000 |
| 475 |
Ambulance Medik Tamalanrea - Bone (Lapri) |
1,410,000 |
| 476 |
Ambulance Medik Tamalanrea - Bone (Lempangeng) |
2,040,000 |
| 477 |
Ambulance Medik Tamalanrea - Bone (Limpoe) |
1,620,000 |
| 478 |
Ambulance Medik Tamalanrea - Bone (Mare) |
2,230,000 |
| 479 |
Ambulance Medik Tamalanrea - Bone (Palattae) |
1,650,000 |
| 480 |
Ambulance Medik Tamalanrea - Bone (Pallattae) |
1,650,000 |
| 481 |
Ambulance Medik Tamalanrea - Bone (Pompanua) |
2,360,000 |
| 482 |
Ambulance Medik Tamalanrea - Bone (Solo) |
2,370,000 |
| 483 |
Ambulance Medik Tamalanrea - Bone (Tonra) |
2,120,000 |
| 484 |
Ambulance Medik Tamalanrea - Bulukumba (Bira) |
2,450,000 |
| 485 |
Ambulance Medik Tamalanrea - Bulukumba (Bulukumba Kota) |
2,120,000 |
| 486 |
Ambulance Medik Tamalanrea - Bulukumba (Bulukumba Kota) |
2,120,000 |
| 487 |
Ambulance Medik Tamalanrea - Bulukumba (Kajang) |
2,410,000 |
| 488 |
Ambulance Medik Tamalanrea - Bulukumba (Tanaberu) |
2,310,000 |
| 489 |
Ambulance Medik Tamalanrea - Bulukumba (Tanete) |
2,140,000 |
| 490 |
Ambulance Medik Tamalanrea - Enrekang (Baraka) |
3,130,000 |
| 491 |
Ambulance Medik Tamalanrea - Enrekang (Baroko) |
3,310,000 |
| 492 |
Ambulance Medik Tamalanrea - Enrekang (Enrekang Kota) |
2,740,000 |
| 493 |
Ambulance Medik Tamalanrea - Enrekang (Kalosi) |
3,150,000 |
| 494 |
Ambulance Medik Tamalanrea - Enrekang (Malua) |
3,180,000 |
| 495 |
Ambulance Medik Tamalanrea - Enrekang (Moroanging) |
2,420,000 |
| 496 |
Ambulance Medik Tamalanrea - Enrekang (Sudu) |
3,200,000 |
| 497 |
Ambulance Medik Tamalanrea - Gowa (Barombong) |
400,000 |
| 498 |
Ambulance Medik Tamalanrea - Gowa (Bili-Bili) |
560,000 |
| 499 |
Ambulance Medik Tamalanrea - Gowa (Bontonompo) |
620,000 |
| 500 |
Ambulance Medik Tamalanrea - Gowa (Limbung) |
470,000 |
| 501 |
Ambulance Medik Tamalanrea - Gowa (Malakaji) |
1,520,000 |
| 502 |
Ambulance Medik Tamalanrea - Gowa (Malino) |
1,090,000 |
| 503 |
Ambulance Medik Tamalanrea - Gowa (Pallangga) |
420,000 |
| 504 |
Ambulance Medik Tamalanrea - Gowa (Samata) |
250,000 |
| 505 |
Ambulance Medik Tamalanrea - Gowa (Sapaya) |
1,070,000 |
| 506 |
Ambulance Medik Tamalanrea - Gowa (Sungguminasa) |
330,000 |
| 507 |
Ambulance Medik Tamalanrea - Gowa (Tombolo Pao) |
1,460,000 |
| 508 |
Ambulance Medik Tamalanrea - Jeneponto (Allu) |
930,000 |
| 509 |
Ambulance Medik Tamalanrea - Jeneponto (Batang) |
1,350,000 |
| 510 |
Ambulance Medik Tamalanrea - Jeneponto (Jeneponto Kota) |
1,210,000 |
| 511 |
Ambulance Medik Tamalanrea - Jeneponto (Kapita') |
1,170,000 |
| 512 |
Ambulance Medik Tamalanrea - Jeneponto (Kelara) |
1,450,000 |
| 513 |
Ambulance Medik Tamalanrea - Jeneponto (Rumbia) |
1,400,000 |
| 514 |
Ambulance Medik Tamalanrea - Jeneponto (Tamalatea) |
1,110,000 |
| 515 |
Ambulance Medik Tamalanrea - Jeneponto (Tarowang) |
1,390,000 |
| 516 |
Ambulance Medik Tamalanrea - Luwu (Belopa) |
3,830,000 |
| 517 |
Ambulance Medik Tamalanrea - Luwu (Bone-Bone) |
5,830,000 |
| 518 |
Ambulance Medik Tamalanrea - Luwu (Bua) |
4,390,000 |
| 519 |
Ambulance Medik Tamalanrea - Luwu (Kota Palopo) |
4,634,792 |
| 520 |
Ambulance Medik Tamalanrea - Luwu (Larompong) |
3,640,000 |
| 521 |
Ambulance Medik Tamalanrea - Luwu (Malili) |
6,770,000 |
| 522 |
Ambulance Medik Tamalanrea - Luwu (Mallangke) |
5,640,000 |
| 523 |
Ambulance Medik Tamalanrea - Luwu (Mangkutana) |
7,700,000 |
| 524 |
Ambulance Medik Tamalanrea - Luwu (Masamba) |
5,450,000 |
| 525 |
Ambulance Medik Tamalanrea - Luwu (Padang Sappa) |
4,120,000 |
| 526 |
Ambulance Medik Tamalanrea - Luwu (Ponrang) |
4,170,000 |
| 527 |
Ambulance Medik Tamalanrea - Luwu (Sa'bang) |
5,300,000 |
| 528 |
Ambulance Medik Tamalanrea - Luwu (Soroako) |
7,500,000 |
| 529 |
Ambulance Medik Tamalanrea - Luwu (Suli) |
3,790,000 |
| 530 |
Ambulance Medik Tamalanrea - Luwu (Walenrang/Lamasi) |
4,880,000 |
| 531 |
Ambulance Medik Tamalanrea - Luwu (Wasuponda) |
7,190,000 |
| 532 |
Ambulance Medik Tamalanrea - Luwu (Wotu) |
6,280,000 |
| 533 |
Ambulance Medik Tamalanrea - Majene (Majene Kota) |
3,720,000 |
| 534 |
Ambulance Medik Tamalanrea - Majene (Malunda) |
4,830,000 |
| 535 |
Ambulance Medik Tamalanrea - Majene (Pamboang) |
3,910,000 |
| 536 |
Ambulance Medik Tamalanrea - Majene (Sandana) |
4,160,000 |
| 537 |
Ambulance Medik Tamalanrea - Makassar (BTN Antara) |
100,000 |
| 538 |
Ambulance Medik Tamalanrea - Makassar (BTP) |
90,000 |
| 539 |
Ambulance Medik Tamalanrea - Makassar (Bulurokeng) |
270,000 |
| 540 |
Ambulance Medik Tamalanrea - Makassar (Cendrawasih) |
280,000 |
| 541 |
Ambulance Medik Tamalanrea - Makassar (Galangan Kapal) |
250,000 |
| 542 |
Ambulance Medik Tamalanrea - Makassar (Jalan Bung) |
80,000 |
| 543 |
Ambulance Medik Tamalanrea - Makassar (Jalan Sunu) |
230,000 |
| 544 |
Ambulance Medik Tamalanrea - Makassar (Jl. Abd. Dg. Sirua) |
150,000 |
| 545 |
Ambulance Medik Tamalanrea - Makassar (Jl. Pettarani) |
210,000 |
| 546 |
Ambulance Medik Tamalanrea - Makassar (Minasa Upa) |
230,000 |
| 547 |
Ambulance Medik Tamalanrea - Makassar (Paccerakkang) |
130,000 |
| 548 |
Ambulance Medik Tamalanrea - Makassar (Pampang) |
180,000 |
| 549 |
Ambulance Medik Tamalanrea - Makassar (Panaikang) |
140,000 |
| 550 |
Ambulance Medik Tamalanrea - Makassar (Panakukkang) |
170,000 |
| 551 |
Ambulance Medik Tamalanrea - Makassar (Pannampu) |
270,000 |
| 552 |
Ambulance Medik Tamalanrea - Makassar (Perumahan Dosen) |
70,000 |
| 553 |
Ambulance Medik Tamalanrea - Makassar (Perumnas Antang) |
180,000 |
| 554 |
Ambulance Medik Tamalanrea - Makassar (Perumnas Sudiang) |
200,000 |
| 555 |
Ambulance Medik Tamalanrea - Makassar (Rappokalling) |
200,000 |
| 556 |
Ambulance Medik Tamalanrea - Makassar (Sekitaran Tanjung) |
350,000 |
| 557 |
Ambulance Medik Tamalanrea - Makassar (Sombo Upu) |
230,000 |
| 558 |
Ambulance Medik Tamalanrea - Makassar (Sultan Alauddin) |
230,000 |
| 559 |
Ambulance Medik Tamalanrea - Makassar (Tala'Salapang) |
250,000 |
| 560 |
Ambulance Medik Tamalanrea - Makassar (Tello) |
120,000 |
| 561 |
Ambulance Medik Tamalanrea - Makassar (Teuku Umar) |
210,000 |
| 562 |
Ambulance Medik Tamalanrea - Makassar (Tol / Jl.Ir.Sutami) |
210,000 |
| 563 |
Ambulance Medik Tamalanrea - Makassar (Ujung Tanah) |
280,000 |
| 564 |
Ambulance Medik Tamalanrea - Makassar (Unhas) |
80,000 |
| 565 |
Ambulance Medik Tamalanrea - Makassar (Veteran Selatan) |
250,000 |
| 566 |
Ambulance Medik Tamalanrea - Makassar (Veteran Utara) |
210,000 |
| 567 |
Ambulance Medik Tamalanrea - Makassar (Wesabbe) |
50,000 |
| 568 |
Ambulance Medik Tamalanrea - Mamuju (Budong-Budong) |
6,710,000 |
| 569 |
Ambulance Medik Tamalanrea - Mamuju (Kaluku/Tasiu) |
5,910,000 |
| 570 |
Ambulance Medik Tamalanrea - Mamuju (Mamuju Kota) |
5,200,000 |
| 571 |
Ambulance Medik Tamalanrea - Mamuju (Pasang Kayu) |
8,910,000 |
| 572 |
Ambulance Medik Tamalanrea - Mamuju (Tappalang) |
5,060,000 |
| 573 |
Ambulance Medik Tamalanrea - Mamuju (Tarailu) |
6,440,000 |
| 574 |
Ambulance Medik Tamalanrea - Mamuju (Tikke) |
8,620,000 |
| 575 |
Ambulance Medik Tamalanrea - Mamuju (Tobadak) |
7,090,000 |
| 576 |
Ambulance Medik Tamalanrea - Mamuju (Topoyo) |
6,940,000 |
| 577 |
Ambulance Medik Tamalanrea - Maros (Bandara) |
240,000 |
| 578 |
Ambulance Medik Tamalanrea - Maros (Bantimurung) |
720,000 |
| 579 |
Ambulance Medik Tamalanrea - Maros (Camba) |
1,160,000 |
| 580 |
Ambulance Medik Tamalanrea - Maros (Carangki) |
440,000 |
| 581 |
Ambulance Medik Tamalanrea - Maros (Cenrana) |
2,500,000 |
| 582 |
Ambulance Medik Tamalanrea - Maros (Kaemba) |
330,000 |
| 583 |
Ambulance Medik Tamalanrea - Maros (Maros Kota) |
560,000 |
| 584 |
Ambulance Medik Tamalanrea - Maros (Pattene) |
320,000 |
| 585 |
Ambulance Medik Tamalanrea - Maros (Sipur) |
490,000 |
| 586 |
Ambulance Medik Tamalanrea - Maros (Tambua) |
450,000 |
| 587 |
Ambulance Medik Tamalanrea - Maros (Tanralili) |
450,000 |
| 588 |
Ambulance Medik Tamalanrea - Maros (Tompobulu) |
850,000 |
| 589 |
Ambulance Medik Tamalanrea - Pangkep (Balocci) |
950,000 |
| 590 |
Ambulance Medik Tamalanrea - Pangkep (Bungoro) |
770,000 |
| 591 |
Ambulance Medik Tamalanrea - Pangkep (Labakkang) |
890,000 |
| 592 |
Ambulance Medik Tamalanrea - Pangkep (Mandalle) |
1,210,000 |
| 593 |
Ambulance Medik Tamalanrea - Pangkep (Marang) |
970,000 |
| 594 |
Ambulance Medik Tamalanrea - Pangkep (Pangkep Kota) |
720,000 |
| 595 |
Ambulance Medik Tamalanrea - Pangkep (Segeri Kota) |
1,090,000 |
| 596 |
Ambulance Medik Tamalanrea - Pangkep (Tompobulu) |
1,300,000 |
| 597 |
Ambulance Medik Tamalanrea - Pangkep (Tondong Kura) |
1,360,000 |
| 598 |
Ambulance Medik Tamalanrea - Pare-Pare (Kariango) |
2,070,000 |
| 599 |
Ambulance Medik Tamalanrea - Pare-Pare (Pare-Pare Kota) |
1,870,000 |
| 600 |
Ambulance Medik Tamalanrea - Pinrang (Bakaru) |
3,080,000 |
| 601 |
Ambulance Medik Tamalanrea - Pinrang (Batu Lappa) |
2,550,000 |
| 602 |
Ambulance Medik Tamalanrea - Pinrang (Benteng) |
2,360,000 |
| 603 |
Ambulance Medik Tamalanrea - Pinrang (Bungi) |
1,209,800 |
| 604 |
Ambulance Medik Tamalanrea - Pinrang (Kariango) |
2,970,000 |
| 605 |
Ambulance Medik Tamalanrea - Pinrang (Langnga) |
2,270,000 |
| 606 |
Ambulance Medik Tamalanrea - Pinrang (Pekkabata/Paria) |
2,470,000 |
| 607 |
Ambulance Medik Tamalanrea - Pinrang (Pinrang Kota) |
2,220,000 |
| 608 |
Ambulance Medik Tamalanrea - Pinrang (Suppa) |
1,970,000 |
| 609 |
Ambulance Medik Tamalanrea - Polman (Campalagian) |
3,430,000 |
| 610 |
Ambulance Medik Tamalanrea - Polman (Mamasa Kota) |
4,070,000 |
| 611 |
Ambulance Medik Tamalanrea - Polman (Mambi) |
4,270,000 |
| 612 |
Ambulance Medik Tamalanrea - Polman (Manding) |
3,110,000 |
| 613 |
Ambulance Medik Tamalanrea - Polman (Mapili) |
3,300,000 |
| 614 |
Ambulance Medik Tamalanrea - Polman (Nosu) |
3,880,000 |
| 615 |
Ambulance Medik Tamalanrea - Polman (Palatikang) |
4,260,000 |
| 616 |
Ambulance Medik Tamalanrea - Polman (Pambusuang) |
3,540,000 |
| 617 |
Ambulance Medik Tamalanrea - Polman (Polman Kota) |
3,050,000 |
| 618 |
Ambulance Medik Tamalanrea - Polman (Sumarorong) |
3,670,000 |
| 619 |
Ambulance Medik Tamalanrea - Polman (Tinambung) |
3,620,000 |
| 620 |
Ambulance Medik Tamalanrea - Polman (Wonomulyo) |
3,250,000 |
| 621 |
Ambulance Medik Tamalanrea - Sidrap (Amparita) |
2,360,000 |
| 622 |
Ambulance Medik Tamalanrea - Sidrap (Belokka) |
2,410,000 |
| 623 |
Ambulance Medik Tamalanrea - Sidrap (Pangkaje'ne) |
2,180,000 |
| 624 |
Ambulance Medik Tamalanrea - Sidrap (Rappang) |
2,270,000 |
| 625 |
Ambulance Medik Tamalanrea - Sidrap (Tanru Tedong) |
2,490,000 |
| 626 |
Ambulance Medik Tamalanrea - Sinjai (Bikeru) |
2,140,000 |
| 627 |
Ambulance Medik Tamalanrea - Sinjai (Bulupoddo) |
2,000,000 |
| 628 |
Ambulance Medik Tamalanrea - Sinjai (Manimpahoi) |
2,300,000 |
| 629 |
Ambulance Medik Tamalanrea - Sinjai (Manipi) |
1,550,000 |
| 630 |
Ambulance Medik Tamalanrea - Sinjai (Sinjai Kota) |
2,140,000 |
| 631 |
Ambulance Medik Tamalanrea - Sinjai (Sinjai Timur) |
2,320,000 |
| 632 |
Ambulance Medik Tamalanrea - Sinjai (Songing) |
2,020,000 |
| 633 |
Ambulance Medik Tamalanrea - Soppeng (Batu-Batu) |
2,030,000 |
| 634 |
Ambulance Medik Tamalanrea - Soppeng (Cabenge) |
1,970,000 |
| 635 |
Ambulance Medik Tamalanrea - Soppeng (Cangadi) |
1,880,000 |
| 636 |
Ambulance Medik Tamalanrea - Soppeng (Leworeng) |
1,890,000 |
| 637 |
Ambulance Medik Tamalanrea - Soppeng (Soppeng Kota) |
1,930,000 |
| 638 |
Ambulance Medik Tamalanrea - Soppeng (Takalalla) |
1,750,000 |
| 639 |
Ambulance Medik Tamalanrea - Sul-Teng (Ampana) |
10,580,000 |
| 640 |
Ambulance Medik Tamalanrea - Sul-Teng (Bunta) |
11,740,000 |
| 641 |
Ambulance Medik Tamalanrea - Sul-Teng (Kolongdale) |
9,090,000 |
| 642 |
Ambulance Medik Tamalanrea - Sul-Teng (Luwuk Kota) |
13,440,000 |
| 643 |
Ambulance Medik Tamalanrea - Sul-Teng (Marowali Selatan) |
12,500,000 |
| 644 |
Ambulance Medik Tamalanrea - Sul-Teng (Marowali/Bungku) |
10,170,000 |
| 645 |
Ambulance Medik Tamalanrea - Sul-Teng (Pagimana) |
12,670,000 |
| 646 |
Ambulance Medik Tamalanrea - Sul-Teng (Palu Kota) |
11,490,000 |
| 647 |
Ambulance Medik Tamalanrea - Sul-Teng (Parigi) |
13,440,000 |
| 648 |
Ambulance Medik Tamalanrea - Sul-Teng (Pendolo) |
7,320,000 |
| 649 |
Ambulance Medik Tamalanrea - Sul-Teng (Poso Kota) |
8,860,000 |
| 650 |
Ambulance Medik Tamalanrea - Sul-Teng (Tentena) |
8,220,000 |
| 651 |
Ambulance Medik Tamalanrea - Sul-Teng (Toli-Toli) |
14,110,000 |
| 652 |
Ambulance Medik Tamalanrea - Sul-Tra (Bau-Bau) |
8,300,000 |
| 653 |
Ambulance Medik Tamalanrea - Sul-Tra (Boepinang) |
5,290,000 |
| 654 |
Ambulance Medik Tamalanrea - Sul-Tra (Buton) |
8,800,000 |
| 655 |
Ambulance Medik Tamalanrea - Sul-Tra (Kendari Kota) |
6,090,000 |
| 656 |
Ambulance Medik Tamalanrea - Sul-Tra (Kolaka Kota) |
4,060,000 |
| 657 |
Ambulance Medik Tamalanrea - Sul-Tra (Kolaka Utara) |
4,410,000 |
| 658 |
Ambulance Medik Tamalanrea - Sul-Tra (Lambuya) |
5,080,000 |
| 659 |
Ambulance Medik Tamalanrea - Sul-Tra (Pomala) |
4,230,000 |
| 660 |
Ambulance Medik Tamalanrea - Sul-Tra (Raha + (Peri)) |
7,340,000 |
| 661 |
Ambulance Medik Tamalanrea - Sul-Tra (Rate-Rate) |
4,710,000 |
| 662 |
Ambulance Medik Tamalanrea - Sul-Tra (Torobulu) |
6,360,000 |
| 663 |
Ambulance Medik Tamalanrea - Sul-Tra (Unaaha) |
5,270,000 |
| 664 |
Ambulance Medik Tamalanrea - Sul-Tra (Wamengkoli +(Peri)) |
8,620,000 |
| 665 |
Ambulance Medik Tamalanrea - Takalar (Cikowang) |
1,010,000 |
| 666 |
Ambulance Medik Tamalanrea - Takalar (Galesong Selatan) |
800,000 |
| 667 |
Ambulance Medik Tamalanrea - Takalar (Galesong Utara) |
610,000 |
| 668 |
Ambulance Medik Tamalanrea - Takalar (Lantang) |
850,000 |
| 669 |
Ambulance Medik Tamalanrea - Takalar (Lengkese) |
890,000 |
| 670 |
Ambulance Medik Tamalanrea - Takalar (Pabrik Gula Takalar) |
710,000 |
| 671 |
Ambulance Medik Tamalanrea - Takalar (Takalar Kota) |
800,000 |
| 672 |
Ambulance Medik Tamalanrea - Takalar (Takalar Lama) |
850,000 |
| 673 |
Ambulance Medik Tamalanrea - Tator (Batu Tumonga) |
4,030,000 |
| 674 |
Ambulance Medik Tamalanrea - Tator (Bua Kayu) |
3,560,000 |
| 675 |
Ambulance Medik Tamalanrea - Tator (Kota Makale) |
3,670,000 |
| 676 |
Ambulance Medik Tamalanrea - Tator (Kota Rantepao) |
3,890,000 |
| 677 |
Ambulance Medik Tamalanrea - Tator (Madandan) |
3,840,000 |
| 678 |
Ambulance Medik Tamalanrea - Tator (Nanggala) |
3,950,000 |
| 679 |
Ambulance Medik Tamalanrea - Tator (Pangngala) |
4,140,000 |
| 680 |
Ambulance Medik Tamalanrea - Tator (Rante Tayo) |
3,780,000 |
| 681 |
Ambulance Medik Tamalanrea - Tator (Rembon) |
3,810,000 |
| 682 |
Ambulance Medik Tamalanrea - Tator (Sadan) |
4,060,000 |
| 683 |
Ambulance Medik Tamalanrea - Wajo (Ana Banua) |
2,600,000 |
| 684 |
Ambulance Medik Tamalanrea - Wajo (Atapange) |
2,720,000 |
| 685 |
Ambulance Medik Tamalanrea - Wajo (Belawa) |
2,530,000 |
| 686 |
Ambulance Medik Tamalanrea - Wajo (Kera) |
3,060,000 |
| 687 |
Ambulance Medik Tamalanrea - Wajo (Sengkang Kota) |
2,360,000 |
| 688 |
Ambulance Medik Tamalanrea - Wajo (Siwa) |
3,300,000 |
| 689 |
Ambulance Medik Tamalanrea - Wajo (Tanasitolo) |
2,440,000 |
| 690 |
Ambulance Medik Tamalanrea - Wajo (Terumpekkae) |
2,690,000 |
| 691 |
Ambulance/Kendaraan Dinas Milik RS (>10 - 15 km) |
30,000 |
| 692 |
Ambulance/Kendaraan Dinas Milik RS (>15 - 20 km) |
40,000 |
| 693 |
Ambulance/Kendaraan Dinas Milik RS (>20 - 25 km) |
45,000 |
| 694 |
Ambulance/Kendaraan Dinas Milik RS (>25 km) |
66,000 |
| 695 |
Ambulance/Kendaraan Dinas Milik RS (>5 - 10 km) |
20,000 |
| 696 |
Ambulance/Kendaraan Dinas Milik RS (0 - 5 km) |
10,000 |
| 697 |
Ambulation and Gait Training |
70,000 |
| 698 |
Ambulatory chest drainage |
713,000 |
| 699 |
Ambulatory monitoring of blood pressure (ABPM) |
322,001 |
| 700 |
AMILASE DARAH |
167,000 |
| 701 |
Amilase Darah |
80,000 |
| 702 |
Amilase Urine |
32,000 |
| 703 |
Amniocentesis (di rawat jalan) |
2,782,000 |
| 704 |
Amniocentesis (di ruang bersalin) |
2,782,000 |
| 705 |
Amniocentesis / CVS / Chordocentesis |
250,000 |
| 706 |
Amnioinfusi pervaginam |
2,782,000 |
| 707 |
Amnioinfusi Trans Abdominal Dengan Anastesi Lokal |
426,000 |
| 708 |
Amnioinfusi transabdominal |
2,782,000 |
| 709 |
Amnion Membrane Transplant lokal |
5,095,000 |
| 710 |
Amnion Membrane Transplant narkose |
8,883,000 |
| 711 |
Amnioreduksi (di ruang bersalin) |
2,378,000 |
| 712 |
Amnioreduksi (di ruang operasi) |
2,378,000 |
| 713 |
Amnioreduksi Dengan Anastesi Lokal |
432,000 |
| 714 |
Amnioskopy dan Amniosintesis tranpag |
88,000 |
| 715 |
Amputasi + STSG |
25,706,000 |
| 716 |
Amputasi above elbow |
14,222,000 |
| 717 |
Amputasi above knee |
13,489,999 |
| 718 |
Amputasi below elbow |
14,222,000 |
| 719 |
Amputasi below knee |
13,734,000 |
| 720 |
Amputasi digiti |
13,576,000 |
| 721 |
Amputasi Jari (Multiple) (Bedah Plastik) |
5,019,743 |
| 722 |
Amputasi Komplek, GA |
21,334,000 |
| 723 |
Amputasi Mayor kaki diabetik atau kasus vaskular |
25,603,000 |
| 724 |
Amputasi Sederhana, GA |
14,222,000 |
| 725 |
Amputasi serviks (Manchester Forthegill) |
20,530,000 |
| 726 |
Amputasi serviks (Manchester Forthegill) + Kolporafi anterior (KA) + Kolpoperineorafi |
35,930,000 |
| 727 |
Amputasi transmetetarsal/lischfranc/chopart/syme |
25,603,000 |
| 728 |
Amputation / disarticulation of finger (Single) |
12,937,000 |
| 729 |
Amputation / disarticulation of toe (Single) |
13,576,000 |
| 730 |
Amputation above knee |
6,354,000 |
| 731 |
Amputation and disarticulation of finger |
9,282,099 |
| 732 |
Amputation and disarticulation of thumb |
9,282,099 |
| 733 |
Amputation for Polydactily |
18,043,000 |
| 734 |
Amputation of ankle through malleoli of tibia and fibula |
5,244,099 |
| 735 |
Amputation of toe |
5,244,099 |
| 736 |
Amputation through foot |
5,244,099 |
| 737 |
Amputation through forearm |
5,244,099 |
| 738 |
Amputation through hand |
5,244,099 |
| 739 |
Amputation through humerus |
5,244,099 |
| 740 |
Amputation with soft tissue reconstruction for Polydactily |
18,043,000 |
| 741 |
Amylase Pancreatic (P) |
305,000 |
| 742 |
Amylase Pancreatic Urine (P) |
305,000 |
| 743 |
ANA - IF |
800,000 |
| 744 |
ANA (IF) (P) |
620,000 |
| 745 |
ANA (IF) & ANA Profile (P) |
1,356,000 |
| 746 |
ANA IF |
895,000 |
| 747 |
ANA PROFILE |
1,583,000 |
| 748 |
ANA Profile (P) |
985,000 |
| 749 |
ANA Profile (P) |
985,000 |
| 750 |
Anal Dilatasi |
414,000 |
| 751 |
Analisa Batu _ |
250,000 |
| 752 |
Analisa Batu Empedu (P) |
110,000 |
| 753 |
Analisa Batu Ginjal (P) |
292,000 |
| 754 |
Analisa Cairan Asites |
280,000 |
| 755 |
ANALISA CAIRAN ASITES/PERITONEAL |
252,000 |
| 756 |
Analisa cairan dialisis peritoneal/CAPD |
129,000 |
| 757 |
Analisa Cairan Lain |
200,000 |
| 758 |
ANALISA CAIRAN OTAK |
264,000 |
| 759 |
Analisa Cairan Otak |
200,000 |
| 760 |
Analisa Cairan Pleura |
200,000 |
| 761 |
ANALISA CAIRAN PLEURA |
262,000 |
| 762 |
ANALISA CAIRAN SENDI |
262,000 |
| 763 |
Analisa Cairan Sendi |
250,000 |
| 764 |
ANALISA CAIRAN TUBUH LAINNYA |
262,000 |
| 765 |
Analisa Cetakan/Model Gigi |
250,000 |
| 766 |
Analisa Cetakan/Model Gigi (Eksekutif) |
0 |
| 767 |
Analisa Faeces _ |
70,000 |
| 768 |
ANALISA FESES/TELUR CACING |
63,000 |
| 769 |
ANALISA GAS DARAH |
222,000 |
| 770 |
Analisa Gas Darah |
280,000 |
| 771 |
Analisa Gas Darah Plus Elektrolit (POCT) |
350,000 |
| 772 |
ANALISA HB / HB ELEKTROFORESA |
370,000 |
| 773 |
Analisa Kromosom (P) |
1,980,000 |
| 774 |
Analisa Sefalometri |
500,000 |
| 775 |
Analisa Sefalometri (Eksekutif) |
0 |
| 776 |
ANALISA SPERMA |
200,000 |
| 777 |
Analisa Sperma _ |
200,000 |
| 778 |
Analisis cairan sendi |
262,000 |
| 779 |
Analisis Status Alergi |
100,000 |
| 780 |
Anasthesi/Trepanasi/Eksterpasi Saluran Akar (Gigi Anterior/Akar Tunggal) |
0 |
| 781 |
Anasthesi/Trepanasi/Eksterpasi Saluran Akar (Gigi Posterior/Akar Jamak) |
0 |
| 782 |
Anastomosis end to end ureter |
4,850,000 |
| 783 |
Anastomosis Saraf Asesorius-fasialis |
15,526,000 |
| 784 |
Anastomosis Saraf Asesorius-hipoglosus |
15,526,000 |
| 785 |
Anastomosis Saraf Hipoglosus-fasialis |
15,526,000 |
| 786 |
Anastomosis usus dengan stapler |
42,058,000 |
| 787 |
ANCA |
221,000 |
| 788 |
Anca (P) |
595,000 |
| 789 |
Anel Lakrimalis / Anel Test |
245,000 |
| 790 |
Anestesi Epidural |
984,000 |
| 791 |
Anestesi Epidural Anak |
1,231,000 |
| 792 |
Anestesi Epidural Cervical |
1,097,000 |
| 793 |
Anestesi Epidural Lumbal |
1,097,000 |
| 794 |
Anestesi Epidural Torakal |
984,000 |
| 795 |
Anestesi Kaudal |
984,000 |
| 796 |
Anestesi Spinal |
327,000 |
| 797 |
Anestesi Spinal pada SC |
327,000 |
| 798 |
Anestesi Spinal Pediatrik |
393,000 |
| 799 |
Anestesi Umum : ETT dewasa |
1,078,000 |
| 800 |
Anestesi Umum : ETT dewasa bedah saraf |
1,078,000 |
| 801 |
Anestesi Umum : ETT dewasa transplan ginjal donor |
1,078,000 |
| 802 |
Anestesi Umum : ETT dewasa transplan ginjal resipien |
1,078,000 |
| 803 |
Anestesi Umum : ETT dewasa transplan hepar donor |
1,078,000 |
| 804 |
Anestesi Umum : ETT dewasa transplan hepar resipien |
1,078,000 |
| 805 |
Anestesi Umum : ETT Double Lumen Anak |
1,914,000 |
| 806 |
Anestesi Umum : ETT Double Lumen dewasa |
1,594,000 |
| 807 |
Anestesi Umum : ETT Neonatus / Pediatrik Transplan ginjal |
1,078,000 |
| 808 |
Anestesi Umum : ETT Neonatus / Pediatrik Transplan hepar |
1,078,000 |
| 809 |
Anestesi Umum Kembar siam |
1,691,000 |
| 810 |
Anestesi Umum LMA dewasa |
938,000 |
| 811 |
Anestesi Umum LMA Neonatus / Pediatrik |
1,127,000 |
| 812 |
Anestesi Umum untuk 1 jenis operasi |
1,279,000 |
| 813 |
Aneurisma Aorta |
4,860,000 |
| 814 |
Angio & Stenting A. Vertebralis |
9,024,000 |
| 815 |
Angiofibroma Nasofaring |
5,773,712 |
| 816 |
Angiografi - Spinal |
8,050,000 |
| 817 |
Angiografi - Spinal dengan Anestesi |
9,888,000 |
| 818 |
Angiografi 4 vessel - Craniocervical |
7,972,000 |
| 819 |
Angiografi 4 vessel - Craniocervical dengan Anestesi |
9,283,000 |
| 820 |
Angiografi 4 vessels - Craniocervical Kasus Kompleks |
10,048,000 |
| 821 |
Angiografi 4 vessels - Craniocervical Kasus Kompleks dengan anestesi |
11,460,900 |
| 822 |
Angiografi 6 vessel - Craniocervical |
9,024,000 |
| 823 |
Angiografi 6 vessel - Craniocervical dengan Anestesi |
11,703,000 |
| 824 |
Angiografi Coroner/Cerebral + Anestesi |
5,324,718 |
| 825 |
Angiografi Diagnostik Craniospinal Kasus Simpel |
6,889,000 |
| 826 |
Angiografi Diagnostik Craniospinal Kasus Simpel dengan anestesi |
8,088,000 |
| 827 |
Angiografi diagnostik kompleks |
17,886,000 |
| 828 |
Angiografi diagnostik sederhana |
11,923,000 |
| 829 |
Angiografi Koroner |
4,442,718 |
| 830 |
Angiografi Perifer/Vaskuler/Arteriografy |
4,582,688 |
| 831 |
Angiografi Superselektif |
9,283,000 |
| 832 |
Angiografi Superselektif Kasus Kompleks |
9,024,000 |
| 833 |
Angiografi Superselektif Kasus Kompleks dengan anestesi |
10,487,000 |
| 834 |
Angiografi Superselektif Kasus Simpel |
8,497,000 |
| 835 |
Angiografi Superselektif Kasus Simpel dengan anestesi |
9,893,000 |
| 836 |
Angiografi, Angioplasty dan Catheter Directed Thrombolysis 1 ekstremitas Kasus Simpel |
53,575,000 |
| 837 |
Angiografi, Trombektomi (Combination of Stent Retrievers + Peripheral Aspiration Catheters - Low Specification) Dengan Angioplasty 1 Ekstremitas Kasus Simpel |
33,280,000 |
| 838 |
Angiografi, Trombektomi (Stent Retrievers) Tanpa Angioplasty 1 Ekstremitas/Perifer Kasus Kompleks |
33,280,000 |
| 839 |
Angiografi, Trombektomi (Stent Retrievers) Tanpa Angioplasty 1 Ekstremitas/Perifer Kasus Simpel |
32,011,000 |
| 840 |
Angiografi, Trombektomi (Stent Retrievers) Tanpa Angioplasty 1 Ekstremitas/Perifer Kasus Simpel dengan anestesi |
35,298,000 |
| 841 |
Angiography arteri abdominal |
6,431,386 |
| 842 |
Angiography Arteri Abdominal + Anastesi |
9,820,000 |
| 843 |
Angiography cerebral |
6,428,236 |
| 844 |
Angiography Cerebral + Anastesi |
9,820,000 |
| 845 |
Angiography pada extremitas |
6,428,236 |
| 846 |
Angiography Pada Extremitas + Anastesi |
9,820,000 |
| 847 |
Angioplasti : A. Carotis |
14,450,000 |
| 848 |
Angioplasti : A. Carotis + Anastesi |
18,950,000 |
| 849 |
Angioplasti : A. Renalis |
14,450,000 |
| 850 |
Angioplasti : A. Renalis + Anastesi |
18,950,000 |
| 851 |
Angioplasti : Dialisis Graft |
14,450,000 |
| 852 |
Angioplasti : Dialisis Graft + Anastesi |
18,950,000 |
| 853 |
Angioplasti : Extremitas Inf/Sup |
14,450,000 |
| 854 |
Angioplasti : Extremitas Inf/Sup + Anastesi |
18,950,000 |
| 855 |
Angioplasti : Intrakranial |
14,450,000 |
| 856 |
Angioplasti : Intrakranial + Anastesi |
18,950,000 |
| 857 |
Angioplasti : Vasospasme Intracranial |
14,450,000 |
| 858 |
Angioplasti : Vasospasme Intracranial + Anastesi |
18,950,000 |
| 859 |
Angioplasti + Stenting Carotis |
50,380,000 |
| 860 |
Angioplasti + Stenting Intrakranial |
9,104,000 |
| 861 |
Angioplasti + Stenting Intrakranial Kasus Simpel dengan anestesi |
9,104,000 |
| 862 |
Angioplasti A. Vertebralis |
37,432,000 |
| 863 |
Angioplasti Carotis |
37,432,000 |
| 864 |
Angioplasti Intrakranial |
53,265,000 |
| 865 |
Angioplasty/Percutaneous Transluminal (Ballon) Multipel Vessel + Penyulit |
56,705,000 |
| 866 |
Angioplasty/Percutaneous Transluminal (Ballon) Singel Vessel |
43,410,000 |
| 867 |
Angioplasty/Percutaneous Transluminal (Ballon) Singel Vessel + Penyulit |
46,655,000 |
| 868 |
Angioplasty/percutaneus transluminal ( ballon ) singel vessel (Eksekutif) |
0 |
| 869 |
Angioplasty/percutaneus transluminal ( ballon ) singel vessel + penyulit (Eksekutif) |
0 |
| 870 |
Angioplasty/percutaneus transluminal ( ballon )Multipel vessel + penyulit (Eksekutif) |
0 |
| 871 |
Angkat Arch Bar |
6,476,000 |
| 872 |
Angkat jahit pleural catheter |
217,000 |
| 873 |
Angkat jahit WSD/ pigtail |
560,000 |
| 874 |
Angkat jahitan besar ( > 15 jahitan) |
217,000 |
| 875 |
Angkat Jahitan Kecil (1-7 jahitan) |
119,000 |
| 876 |
Angkat Jahitan Kornea |
74,000 |
| 877 |
Angkat Jahitan lokal |
1,548,000 |
| 878 |
Angkat Jahitan narkose |
2,079,000 |
| 879 |
Angkat Jahitan Palpebra |
74,000 |
| 880 |
Angkat Jahitan Sedang (8-15 jahitan) |
167,000 |
| 881 |
Angkat K - Wire |
70,000 |
| 882 |
Angkat Kanul Trakeostomi + tutup trakeostomi |
6,979,000 |
| 883 |
Angkat kateter Tenckhoff |
7,270,000 |
| 884 |
Angkat stapler |
217,000 |
| 885 |
Angkat Tampon Hidung Anterior |
272,000 |
| 886 |
Angkat Tampon Hidung Posterior |
300,000 |
| 887 |
Ankle fusion |
17,935,044 |
| 888 |
Ankylosis Release, GA |
3,147,000 |
| 889 |
Anoplasty kompleks |
21,174,000 |
| 890 |
Anoplasty sederhana |
7,270,000 |
| 891 |
Anoplasty/Limited PSARP/repair anoplasty |
7,802,000 |
| 892 |
Anoskopi disertai interpretasi dan relevansi |
200,000 |
| 893 |
Antegard Pyelography (APG) |
1,531,000 |
| 894 |
Anterio/Posterior Sklerotomi |
4,913,000 |
| 895 |
Anterior - lateral approach (Dekompresi radiks dan medulla spinalis) lumbal |
37,385,000 |
| 896 |
Anterior - lateral approach (Dekompresi radiks dan medulla spinalis) thorakal |
37,385,000 |
| 897 |
Anterior approach (Dekompresi radiks dan medulla spinalis) servikal |
37,385,000 |
| 898 |
Anterior approach (Dekompresi radiks) lumbal |
37,385,000 |
| 899 |
Anterior bite riser dengan tambalan |
270,000 |
| 900 |
Anterior bite riser plat |
820,000 |
| 901 |
Anterior cervical corpectomy & fusi (ACCF): - Fusi distractable anterior spacer -Fusi Autograft -Fusi Plate and screw |
37,385,000 |
| 902 |
Anterior cervical disc artroplasty |
37,385,000 |
| 903 |
Anterior Cervical Discectomy and Fusion (ACDF) (multiple) |
32,404,000 |
| 904 |
Anterior Cervical Discectomy and Fusion (ACDF) (single) |
32,868,000 |
| 905 |
Anterior cervical diskectomy& fusi (ACDF) : - Fusi Cage - Fusi Plate and screw |
37,385,000 |
| 906 |
Anterior discectomy / release for Scoliosis |
34,119,000 |
| 907 |
Anterior lumbar interbody fusion (ALIF) |
27,360,000 |
| 908 |
Anterior or posterior instrumented spinal fusion |
34,119,000 |
| 909 |
Anti - HAV IgM (P) |
400,000 |
| 910 |
Anti Amuba |
188,000 |
| 911 |
Anti Chikungunya |
235,000 |
| 912 |
Anti CMV IgG |
280,000 |
| 913 |
ANTI CMV IgG |
338,000 |
| 914 |
ANTI CMV IgM |
457,000 |
| 915 |
Anti CMV IgM |
280,000 |
| 916 |
ANTI DENGUE IgG + IgM |
246,000 |
| 917 |
Anti Faktor Xa |
225,000 |
| 918 |
Anti HAV IgM |
220,000 |
| 919 |
ANTI HAV IgM |
724,000 |
| 920 |
Anti HAV Total |
188,000 |
| 921 |
Anti HBc IgM |
107,000 |
| 922 |
ANTI HBC IgM |
518,000 |
| 923 |
ANTI HBC TOTAL |
363,000 |
| 924 |
Anti HBc Total |
250,000 |
| 925 |
ANTI HBE |
497,000 |
| 926 |
Anti HBe |
425,000 |
| 927 |
Anti Hbe (P) |
490,000 |
| 928 |
ANTI HBS |
305,000 |
| 929 |
Anti HBs |
175,000 |
| 930 |
Anti HCV (CMIA) |
280,000 |
| 931 |
Anti HCV (ICT) |
98,000 |
| 932 |
ANTI HCV METODE CMIA |
411,000 |
| 933 |
ANTI HCV METODE ICT |
156,000 |
| 934 |
Anti Helicobacter Pylori IgG |
81,000 |
| 935 |
Anti Helicobacter Pylori IgM |
81,000 |
| 936 |
Anti HEV IgM |
737,000 |
| 937 |
Anti HEV IgM |
650,000 |
| 938 |
Anti HIV (CMIA) |
473,000 |
| 939 |
Anti HIV (CMIA) |
400,000 |
| 940 |
Anti HIV (ICT) |
133,000 |
| 941 |
ANTI HIV PENYARING/ HIV SCREENING (ICT) |
158,000 |
| 942 |
ANTI HSV I IgG |
634,000 |
| 943 |
ANTI HSV I IgG |
634,000 |
| 944 |
Anti HSV IgG |
125,000 |
| 945 |
Anti HSV IgM |
125,000 |
| 946 |
ANTI HSV II IgG |
634,000 |
| 947 |
ANTI HSV II IgG |
634,000 |
| 948 |
Anti HSV II IgM |
125,000 |
| 949 |
Anti Influenza A-B |
313,000 |
| 950 |
Anti Jamur Intra Bladder |
66,000 |
| 951 |
Anti Japanese B Encephalitis |
250,000 |
| 952 |
Anti Kappa |
74,000 |
| 953 |
Anti Lamda |
74,000 |
| 954 |
Anti Leptospira |
188,000 |
| 955 |
ANTI LEPTOSPIRA IgG/IgM |
232,000 |
| 956 |
ANTI RUBELA IgM |
366,000 |
| 957 |
ANTI RUBELLA IgG |
300,000 |
| 958 |
Anti Rubella IgG |
275,000 |
| 959 |
Anti Rubella IgM |
275,000 |
| 960 |
ANTI SALMONELLA IgM / TUBEX TF |
300,000 |
| 961 |
Anti TB |
188,000 |
| 962 |
Anti Toxoplasma IgG |
255,000 |
| 963 |
ANTI TOXOPLASMA IgG |
353,000 |
| 964 |
ANTI TOXOPLASMA IgM |
420,000 |
| 965 |
Anti Toxoplasma IgM |
255,000 |
| 966 |
Anti-CCP IgG (P) |
665,000 |
| 967 |
Anti-ds-DNA-NcX (P) |
509,000 |
| 968 |
Anti-EBV VCA IgG (P) |
950,000 |
| 969 |
Anti-EBV VCA IgG (P) |
950,000 |
| 970 |
Anti-EBV VCA IgM (P) |
950,000 |
| 971 |
Anti-EBV VCA IgM (P) |
950,000 |
| 972 |
Anti-HAV (P) |
463,000 |
| 973 |
Anti-HBc |
249,000 |
| 974 |
Anti-HBc IgM |
443,000 |
| 975 |
Anti-HBc IgM (P) |
486,000 |
| 976 |
Anti-HBs |
140,000 |
| 977 |
Anti-HSV 1 IgG (P) |
585,000 |
| 978 |
Anti-HSV 1 IgG (P) |
585,000 |
| 979 |
Anti-HSV 1 IgM (P) |
335,000 |
| 980 |
Anti-HSV 1/2 IgM (P) |
565,000 |
| 981 |
Anti-HSV 1/2 IgM (P) |
565,000 |
| 982 |
Anti-HSV2 IgG |
560,000 |
| 983 |
ANTIBODI KUANTITATIF SARS COV-2 |
350,000 |
| 984 |
Antibodi Malaria |
188,000 |
| 985 |
Antigen Malaria |
150,000 |
| 986 |
Antigen Tuberkulosa |
200,000 |
| 987 |
Anuskopi |
414,000 |
| 988 |
Aorta Valve Repair (AVr) |
118,384,000 |
| 989 |
Aorta Valve Replacement (AVR) |
118,384,000 |
| 990 |
Aortografi |
11,924,000 |
| 991 |
Aortography ( Arteriography of aorta and aortic arch/ arteriography of spinal + Dengan penyulit + anestesi general (Eksekutif) |
0 |
| 992 |
Aortography ( Arteriography of aorta and aortic arch/ arteriography of spinal + Dengan penyulit + anestesi lokal (Eksekutif) |
0 |
| 993 |
Aortography ( Arteriography of aorta and aortic arch/ arteriography of spinal + tanpa penyulit + anestesi lokal (Eksekutif) |
0 |
| 994 |
Aortography (Arteriography Of Aorta and Aortic Arch/Arteriography Of Spinal) + Dengan Penyulit + Anastesi General |
16,545,000 |
| 995 |
Aortography (Arteriography Of Aorta and Aortic Arch/Arteriography Of Spinal) + Dengan Penyulit + Anastesi Lokal |
12,515,000 |
| 996 |
Aortography (Arteriography Of Aorta and Aortic Arch/Arteriography Of Spinal) + Tanpa Penyulit + Anastesi Lokal |
10,000,000 |
| 997 |
AP Window/ASD Primum/Extirpasi Tumor Tanpa Komplikasi/Repair PAPVD |
42,350,000 |
| 998 |
APD Petugas |
160,000 |
| 999 |
Apek Reseksi (Gigi) |
2,850,000 |
| 1000 |
Apek Reseksi Anasthesi Bedah |
0 |
| 1001 |
Apeks reseksi |
1,729,000 |
| 1002 |
Apeks Reseksi (MTA/Biodentine-membrane-bone graft) |
1,440,000 |
| 1003 |
Apeks Reseksi / Apikoektomy per Gigi dengan Anastesi Lokal |
860,000 |
| 1004 |
Apeksifikasi |
0 |
| 1005 |
Apendektomi Akut |
4,137,279 |
| 1006 |
Apendektomi Laparaskopi |
10,850,000 |
| 1007 |
Apendektomi Perforata |
5,004,189 |
| 1008 |
Apikoektomi |
1,723,000 |
| 1009 |
Aplication of skeletal traction for Fracture of femur / pelvis |
12,413,000 |
| 1010 |
Aplikasi Casting Lain |
225,000 |
| 1011 |
Aplikasi KOH |
129,000 |
| 1012 |
Aplikasi TCA 90% / Fenol / Podofilin >10 lesi |
398,000 |
| 1013 |
Aplikasi TCA 90% / Fenol / Podofilin 1-5 lesi |
204,000 |
| 1014 |
Aplikasi TCA 90% / Fenol / Podofilin 6-10 lesi |
307,000 |
| 1015 |
Appendectomy Simple |
3,850,000 |
| 1016 |
Appendektomi pada keganasan ginekologi |
18,392,000 |
| 1017 |
Appendektomi pada keganasan ginekologi per laparoskopi |
18,392,000 |
| 1018 |
Appendektomi Terbuka |
12,375,000 |
| 1019 |
Appendicitis Test |
78,000 |
| 1020 |
Appendicography |
1,145,000 |
| 1021 |
Application of axial traction or external fixation device for Simple vertebral fracture / dislocation / deformity |
10,778,000 |
| 1022 |
Application of external fixation device, carpals and metacarpals |
4,767,815 |
| 1023 |
Application of external fixation device, femur |
4,767,815 |
| 1024 |
Application of external fixation device, humerus |
4,767,815 |
| 1025 |
Application of external fixation device, radius and ulna |
4,767,815 |
| 1026 |
Application of external fixation device, tarsals and metatarsals |
4,767,815 |
| 1027 |
Application of external fixation device, tibia and fibula |
17,936,491 |
| 1028 |
Application of external fixation device, unspecified site |
2,350,000 |
| 1029 |
Application of external fixation for Pelvic fracture |
17,616,000 |
| 1030 |
Application of neck support |
2,350,000 |
| 1031 |
Application of other cast |
2,900,182 |
| 1032 |
Application of plaster jacket |
4,017,182 |
| 1033 |
Application of splint |
2,350,000 |
| 1034 |
APTT |
152,000 |
| 1035 |
APTT _ |
110,000 |
| 1036 |
Aqueous Tap |
4,966,000 |
| 1037 |
Arch Support |
22,800 |
| 1038 |
Argon Laser/Kenon |
6,233,000 |
| 1039 |
Argon Plasma Coagualation |
9,590,000 |
| 1040 |
Argon Plasma Coagulation |
9,175,000 |
| 1041 |
Argon Plasma Coagulation (Sore) |
14,380,000 |
| 1042 |
Argon Plasma Coagulation dengan sedasi |
10,465,000 |
| 1043 |
Arhtroscopic debridement & loose bodies removal for Joint arthritis |
33,975,000 |
| 1044 |
Arhtroscopic diagnostic / biopsy for Joint Arthritis / Capsulitis |
14,550,000 |
| 1045 |
Aritenoidektomi |
10,855,000 |
| 1046 |
Arm Sling (Biasa) |
399,000 |
| 1047 |
Arm Sling (Khusus) |
1,500,000 |
| 1048 |
Art Therapy pada anak dan remaja |
200,000 |
| 1049 |
Art therapy pada dewasa |
200,000 |
| 1050 |
Art therapy pada lansia |
200,000 |
| 1051 |
Arteri Carotis |
4,860,000 |
| 1052 |
Arteri Renalis Stenosis |
4,816,000 |
| 1053 |
Arterial Chemoterapi Embolisation (TACE) |
9,037,000 |
| 1054 |
Arterial occlusion - sacrifice |
63,564,000 |
| 1055 |
Arteriografi Kasus Kompleks |
12,094,000 |
| 1056 |
Arteriografi Kasus Kompleks dengan anestesi |
10,511,000 |
| 1057 |
Arteriografi Kasus Simpel |
8,672,000 |
| 1058 |
Arteriografi Kasus Simpel dengan anestesi |
9,880,000 |
| 1059 |
Arteriografi Pulmonal |
11,924,000 |
| 1060 |
Arteriografi: imaging intravaskular (IVUS/OCT) |
51,959,000 |
| 1061 |
Arteriografi: Physiologic study (IFR/FFR) |
118,384,000 |
| 1062 |
Arteriography |
4,582,688 |
| 1063 |
Arteriography + Anastesi |
10,210,400 |
| 1064 |
Arteriography of cerebral Arteries + Dengan penyulit + 3 Dimensi + Anestesi General (Eksekutif) |
0 |
| 1065 |
Arteriography Of Cerebral Arteries + Dengan Penyulit + 3 Dimensi + Anastesi General |
21,905,000 |
| 1066 |
Arteriography Of Cerebral Arteries + Dengan Penyulit + 3 Dimensi + Anastesi Lokal |
17,020,000 |
| 1067 |
Arteriography of cerebral Arteries + Dengan penyulit + 3 Dimensi + Anestesi lokal (Eksekutif) |
0 |
| 1068 |
Arteriography Of Cerebral Arteries + Dengan Penyulit + Anastesi General |
17,120,000 |
| 1069 |
Arteriography Of Cerebral Arteries + Dengan Penyulit + Anastesi Lokal |
13,060,000 |
| 1070 |
Arteriography of cerebral Arteries + Dengan penyulit + Anestesi General (Eksekutif) |
0 |
| 1071 |
Arteriography of cerebral Arteries + Dengan penyulit + Anestesi lokal (Eksekutif) |
0 |
| 1072 |
Arteriography of cerebral Arteries + Dengan penyulit + Balloon oculusion test + Anestesi lokal (Eksekutif) |
0 |
| 1073 |
Arteriography Of Cerebral Arteries + Dengan Penyulit + Balloon Oculusion Test + Anastesi Lokal |
67,770,000 |
| 1074 |
Arteriography of cerebral Arteries + Dengan penyulit + Wada test/intracarotid amobarbital test + Anestesi lokal (Eksekutif) |
0 |
| 1075 |
Arteriography Of Cerebral Arteries + Dengan Penyulit + Wada Test/Intracarotid Amobarbital Test + Anastesi Lokal |
23,530,000 |
| 1076 |
Arteriography of cerebral Arteries + Tanpa penyulit + 3 Dimensi + Anestesi lokal (Eksekutif) |
0 |
| 1077 |
Arteriography Of Cerebral Arteries + Tanpa Penyulit + 3 Dimensi + Anastesi Lokal |
14,560,000 |
| 1078 |
Arteriography Of Cerebral Arteries + Tanpa Penyulit + Anastesi Lokal |
10,240,000 |
| 1079 |
Arteriography of cerebral Arteries + tanpa penyulit + Anestesi lokal (Eksekutif) |
0 |
| 1080 |
Arteriography of cerebral Arteries + Tanpa penyulit + Balloon oculusion test + Anestesi lokal (Eksekutif) |
0 |
| 1081 |
Arteriography Of Cerebral Arteries + Tanpa Penyulit + Balloon Oculusion Test + Anastesi Lokal |
52,980,000 |
| 1082 |
Arteriography of cerebral Arteries + Tanpa penyulit + Wada test/intracarotid amobarbital test + Anestesi lokal (Eksekutif) |
0 |
| 1083 |
Arteriography Of Cerebral Arteries + Tanpa Penyulit + Wada Test/Intracarotid Amobarbital Test + Anastesi Lokal |
22,000,000 |
| 1084 |
Arteriovenous shunt dengan graft/AV graft untuk hemodialisis |
51,764,000 |
| 1085 |
Arthoscopic bankart repair for Reccurent shoulder dislocation |
32,821,000 |
| 1086 |
Arthrocentesis |
5,752,000 |
| 1087 |
Arthrocentesis TMJ guided USG |
15,538,000 |
| 1088 |
Arthrodesis of elbow |
5,619,121 |
| 1089 |
Arthrodesis of hip |
3,856,600 |
| 1090 |
Arthrodesis of knee |
17,930,044 |
| 1091 |
Arthrodesis of shoulder |
5,619,121 |
| 1092 |
Arthrodhesis for Large joint destruction / infection /injury/deformity |
17,686,000 |
| 1093 |
Arthrodhesis for Small joint arthritis/ destruction / infection /injury/deformity |
15,857,000 |
| 1094 |
Arthrography |
1,670,000 |
| 1095 |
Arthroplasty of carpocarpal or carpometacarpal joint with implant |
8,105,000 |
| 1096 |
Arthroplasty of carpocarpal or carpometacarpal joint without implant |
8,488,000 |
| 1097 |
Arthroplasty of metacarpophalangeal and interphalangeal joint with implant |
8,105,000 |
| 1098 |
Arthroplasty of metacarpophalangeal and interphalangeal joint without implant |
8,105,000 |
| 1099 |
Arthroscopic Cartilage Repair and Cartilage Engineering Procedures (Hip/Knee/Ankle/Shoulder/Wrist) |
44,536,000 |
| 1100 |
Arthroscopic Ganglion Excision |
12,203,000 |
| 1101 |
Arthroscopic ligament reconstruction for Patellar ligament injury |
23,914,000 |
| 1102 |
Arthroscopic meniscus repair for Knee meniscus injury |
23,914,000 |
| 1103 |
Arthroscopic Menisectomy for Knee meniscus injury |
23,914,000 |
| 1104 |
Arthroscopic plica release for Knee plica syndrome |
23,914,000 |
| 1105 |
Arthroscopic reconstruction for Knee ligament injury |
33,975,000 |
| 1106 |
Arthroscopic release / reconstruction for Joint impingement |
23,914,000 |
| 1107 |
Arthroscopic release for Peripheral nerve entrapment |
23,914,000 |
| 1108 |
Arthroscopic repair for Rotator cuff injury |
23,914,000 |
| 1109 |
Arthroscopic Shoulder - Acromioplasty |
23,914,000 |
| 1110 |
Arthroscopic Shoulder - Biceps tenotomy |
23,914,000 |
| 1111 |
Arthroscopic Shoulder - Capsular release for shoulder stiffness / frozen shoulder |
23,914,000 |
| 1112 |
Arthroscopic Shoulder - Labral Repair |
23,914,000 |
| 1113 |
Arthroscopy Ankle - Calcaneoplasty |
34,285,000 |
| 1114 |
Arthroscopy Ankle - Excision os Trigonum |
34,285,000 |
| 1115 |
Arthroscopy Ankle - Ligament repair / reconstruction for ankle ligament injury |
23,914,000 |
| 1116 |
Arthroscopy Ankle - Osteoplasty for Impingement |
34,285,000 |
| 1117 |
Arthroscopy CMC / PIP joint |
23,914,000 |
| 1118 |
Arthroscopy Elbow - Reconstruction |
23,914,000 |
| 1119 |
Arthroscopy Hip - Deep gluteal syndrome release |
34,597,000 |
| 1120 |
Arthroscopy Hip - Extra Articular Impingement release |
34,597,000 |
| 1121 |
Arthroscopy Hip - Gluteus Medius Repair |
23,914,000 |
| 1122 |
Arthroscopy Hip - Labral debridement |
23,914,000 |
| 1123 |
Arthroscopy Hip - Labral Reconstruction |
23,914,000 |
| 1124 |
Arthroscopy Hip - Labral Repair |
23,914,000 |
| 1125 |
Arthroscopy Hip - Osteoplasty for intraarticular impingement (femoroplasty / acetabuloplasty) |
34,597,000 |
| 1126 |
Arthroscopy Hip - Proximal hamstring tendon repair |
34,597,000 |
| 1127 |
Arthroscopy of ankle |
5,752,000 |
| 1128 |
Arthroscopy of elbow |
5,752,000 |
| 1129 |
Arthroscopy of foot and toe |
5,752,000 |
| 1130 |
Arthroscopy of hand and finger |
5,752,000 |
| 1131 |
Arthroscopy of hip |
5,752,000 |
| 1132 |
Arthroscopy of knee |
16,585,212 |
| 1133 |
Arthroscopy of shoulder |
16,585,212 |
| 1134 |
Arthroscopy of wrist |
5,752,000 |
| 1135 |
Arthroscopy Subtalar joint |
23,914,000 |
| 1136 |
Arthroscopy TMJ kompleks |
15,538,000 |
| 1137 |
Arthroscopy TMJ Simpel |
11,655,000 |
| 1138 |
Arthroscopy Wrist - ARIF for carpal fractures |
23,914,000 |
| 1139 |
Arthroscopy Wrist - carpal ligament repair / reconstruction |
23,914,000 |
| 1140 |
Arthroscopy Wrist - DRUJ reconstruction |
23,914,000 |
| 1141 |
Arthroscopy Wrist - Rekonstruction of carpal bone with bone grafting |
23,914,000 |
| 1142 |
Arthroscopy Wrist - TFCC repair |
23,914,000 |
| 1143 |
Arthrosplasty (Op.Gigi) |
2,960,000 |
| 1144 |
Asam Empedu |
33,000 |
| 1145 |
Asam Laktat |
115,000 |
| 1146 |
Asam Urat |
32,000 |
| 1147 |
Asam Urat (Urine) |
30,000 |
| 1148 |
ASAM URAT DARAH |
56,000 |
| 1149 |
ASAM URAT URIN |
53,000 |
| 1150 |
Ascites Test |
78,000 |
| 1151 |
ASD Closure |
112,316,000 |
| 1152 |
ASD Closure (MICS) |
112,316,000 |
| 1153 |
ASD Closure + AVR |
133,995,000 |
| 1154 |
ASD Closure + DVR |
133,995,000 |
| 1155 |
ASD Closure + MVr |
133,995,000 |
| 1156 |
ASD closure + Operasi katup jantung dua katup |
219,293,000 |
| 1157 |
ASD closure + Operasi katup jantung satu katup |
180,340,000 |
| 1158 |
ASD closure + Single Valve Procedure |
112,316,000 |
| 1159 |
ASD closure complex |
133,995,000 |
| 1160 |
ASD Closure dengan Tata Laksana PH |
112,316,000 |
| 1161 |
ASD closure simple |
112,316,000 |
| 1162 |
ASD Closure tanpa Tata Laksana PH |
112,316,000 |
| 1163 |
ASD Closure, PV repair |
133,995,000 |
| 1164 |
ASD Closure, TVr |
133,995,000 |
| 1165 |
ASD Closure, TVr + Penutupan PFO |
165,447,000 |
| 1166 |
ASD Closure+PFO Creation+TV Repair (TAP DE VEGA) |
41,950,000 |
| 1167 |
ASD+MOF/CABG/Total Koreksi+AV Repair/PV Repair/Total Koreksi TOF+PDA Ligasi/Ligasi Ventricle Duuct |
48,350,000 |
| 1168 |
ASD+Reseksi Infudibular |
45,150,000 |
| 1169 |
Asesmen Akupunktur Abdomen |
284,001 |
| 1170 |
Asesmen Akupunktur Kulit Kepala |
284,001 |
| 1171 |
Asesmen Algometer |
284,001 |
| 1172 |
Asesmen Dekondisi |
125,000 |
| 1173 |
Asesmen Fungsi Berkemih |
220,000 |
| 1174 |
Asesmen Fungsi Eksekusi |
224,000 |
| 1175 |
Asesmen Fungsi Kelainan Tungkai / Kaki |
224,000 |
| 1176 |
Asesmen Fungsi Komunikasi |
224,000 |
| 1177 |
Asesmen Fungsi Lokomotor |
224,000 |
| 1178 |
Asesmen Fungsi Makan dan Menelan |
224,000 |
| 1179 |
Asesmen Fungsi Paru |
191,000 |
| 1180 |
Asesmen Fungsi Postur / Kontrol Postur |
284,001 |
| 1181 |
Asesmen Fungsi Seksual |
224,000 |
| 1182 |
Asesmen Fungsi Tangan |
224,000 |
| 1183 |
Asesmen INMAS |
284,001 |
| 1184 |
Asesmen Kapasitas Fungsional Return To Activities |
75,000 |
| 1185 |
Asesmen Kapasitas Fungsional Return To Work |
78,001 |
| 1186 |
Asesmen Kemampuan Fungsional Perawatan Diri / ADL-IADL |
200,000 |
| 1187 |
Asesmen Kesiapan sekolah |
296,000 |
| 1188 |
Asesmen Kesulitan belajar pada anak dan remaja |
296,000 |
| 1189 |
Asesmen Kualitas Hidup |
224,000 |
| 1190 |
Asesmen Monitoring Hipoventilasi |
125,000 |
| 1191 |
Asesmen Paliatif |
120,000 |
| 1192 |
Asesmen Persiapan Bersekolah |
75,000 |
| 1193 |
Asesmen Sensasi Penjaruman |
284,001 |
| 1194 |
Asesmen Tes gambar |
296,000 |
| 1195 |
Asesmen ulang dokter Spesialis Gizi Klinik |
130,000 |
| 1196 |
Asesmen Vascular Autonomic Signal Auriculo |
284,001 |
| 1197 |
Asisted Exercise |
70,000 |
| 1198 |
Aspirasi + Injeksi Ethanol Tiroid dengan Panduan USG |
1,064,000 |
| 1199 |
Aspirasi abses hati |
3,766,000 |
| 1200 |
Aspirasi Abses Hati Percutaneus |
3,580,000 |
| 1201 |
Aspirasi Abses Hati Percutaneus (Sore) |
5,370,000 |
| 1202 |
Aspirasi Abses Kepala Leher |
818,000 |
| 1203 |
Aspirasi Abses/Kista |
747,000 |
| 1204 |
Aspirasi Biopsi |
140,000 |
| 1205 |
Aspirasi Biopsi |
175,000 |
| 1206 |
Aspirasi Bula |
200,000 |
| 1207 |
Aspirasi Bursa |
249,000 |
| 1208 |
Aspirasi Bursa Pada Tangan |
336,000 |
| 1209 |
Aspirasi Bursa Pada Tangan Berpandu USG |
654,000 |
| 1210 |
Aspirasi Cairan Pericard / Pleura |
53,000 |
| 1211 |
Aspirasi efusi pleura tanpa USG |
125,000 |
| 1212 |
Aspirasi Hemarthrosis |
66,000 |
| 1213 |
Aspirasi Hipopion + Injeksi Intracameral (Tanpa Obat) lokal |
4,549,000 |
| 1214 |
Aspirasi Hipopion + Injeksi Intracameral (Tanpa Obat) narkose |
7,574,000 |
| 1215 |
Aspirasi Irigasi Sisa Korteks lokal |
6,068,000 |
| 1216 |
Aspirasi Irigasi Sisa Korteks narkose |
3,229,000 |
| 1217 |
Aspirasi Jarum |
49,000 |
| 1218 |
Aspirasi Kista |
675,000 |
| 1219 |
Aspirasi kista |
747,000 |
| 1220 |
Aspirasi kista dengan USG |
1,267,000 |
| 1221 |
Aspirasi Kista hati |
747,000 |
| 1222 |
Aspirasi Kista Kasus Kompleks |
5,767,000 |
| 1223 |
Aspirasi Kista Kasus Kompleks dengan anestesi |
6,828,000 |
| 1224 |
Aspirasi kista payudara |
747,000 |
| 1225 |
Aspirasi kista payudara dengan USG |
1,267,000 |
| 1226 |
Aspirasi kista tanpa USG |
747,000 |
| 1227 |
Aspirasi Kista Tiroid |
1,064,000 |
| 1228 |
Aspirasi Pada Soft Tissue Lain |
250,000 |
| 1229 |
Aspirasi pneumotoraks / Lung |
1,121,000 |
| 1230 |
Aspirasi Pseudokista |
747,000 |
| 1231 |
Aspirasi Sendi |
163,000 |
| 1232 |
Aspirasi sendi |
135,000 |
| 1233 |
Aspirasi Sendi Berpandu USG |
367,000 |
| 1234 |
Aspirasi Soft Tissue pada Tangan dengan USG |
589,000 |
| 1235 |
Aspirasi SST dan Evaluasi |
250,000 |
| 1236 |
Aspirasi sumsum tulang |
1,224,000 |
| 1237 |
Aspirasi sumsum tulang pasien dewasa |
1,224,000 |
| 1238 |
Aspirasi sumsum tulang pasien neonatus |
1,536,999 |
| 1239 |
Aspirasi sumsum tulang pasien pediatrik |
1,536,999 |
| 1240 |
Aspirasi supra Pubik |
1,566,000 |
| 1241 |
Aspiration of bursa of hand |
3,125,000 |
| 1242 |
Aspiration of other soft tissue |
3,856,600 |
| 1243 |
Aspiration of other soft tissue of hand |
3,856,600 |
| 1244 |
Assesmen awal dokter Spesialis Gizi Klinik |
150,000 |
| 1245 |
Assesmen disfagia |
86,000 |
| 1246 |
Assesment ADHD |
75,000 |
| 1247 |
Assesment Analysis Behavior |
78,000 |
| 1248 |
Assesment Autisme CARS |
220,000 |
| 1249 |
Assesment CAPD |
350,000 |
| 1250 |
Assesment Corners |
50,000 |
| 1251 |
Assesment dan Check Out Oetotis & Prostesis |
66,000 |
| 1252 |
Assesment Dekondisi |
66,000 |
| 1253 |
Assesment Diet DM asupan Oral |
78,000 |
| 1254 |
Assesment DSM IV untuk Autisme |
150,000 |
| 1255 |
Assesment DSM IV untuk GPPH |
150,000 |
| 1256 |
Assesment Edukasi Pengaturan Diet Dengan Dosis Insulin |
120,000 |
| 1257 |
Assesment Evaluasi Autis-CHAT |
220,000 |
| 1258 |
Assesment Evaluasi Hiperaktivitas GPPH |
220,000 |
| 1259 |
Assesment Fleksibilitas dan Lingkup Gerak |
66,000 |
| 1260 |
Assesment Fungsi Berkemih |
66,000 |
| 1261 |
Assesment Fungsi Defekasi |
66,000 |
| 1262 |
Assesment Fungsi Eksekusi Gerak |
66,000 |
| 1263 |
Assesment Fungsi Kardiorespirasi |
66,000 |
| 1264 |
Assesment Fungsi Komunikasi |
66,000 |
| 1265 |
Assesment Fungsi lokomotor |
66,000 |
| 1266 |
Assesment Fungsi Memori |
66,000 |
| 1267 |
Assesment Fungsi Menelan |
66,000 |
| 1268 |
Assesment Integrasi Sensori Motor |
66,000 |
| 1269 |
Assesment Kebugaran |
66,000 |
| 1270 |
Assesment Kekuatan Otot |
66,000 |
| 1271 |
Assesment Kemampuan Fungsional dan Perawatan Diri |
66,000 |
| 1272 |
Assesment Keseimbangan Statik dan Dinamik |
66,000 |
| 1273 |
Assesment Kontrol Postural |
78,000 |
| 1274 |
Assesment meningeal Sign |
78,000 |
| 1275 |
Assesment Motorik Halus |
66,000 |
| 1276 |
Assesment Nervus Cranialis (Saraf Anak) |
100,000 |
| 1277 |
Assesment Nervus Cranialis (Tumbuh Kembang Anak) |
78,000 |
| 1278 |
Assesment Nyeri |
0 |
| 1279 |
Assesment Nyeri (RJ) |
0 |
| 1280 |
Assesment Parental Education |
100,000 |
| 1281 |
Assesment Pendengaran Manual |
78,000 |
| 1282 |
Assesment Perawakan Pendek |
120,000 |
| 1283 |
Assesment Perkembangan (Perkembangan Psikologis) |
100,000 |
| 1284 |
Assesment Perkembangan (Perkembangan Psikologis) (Eksekutif) |
0 |
| 1285 |
Assesment Perkembangan kognitif CAT-CLAMPS |
270,000 |
| 1286 |
Assesment Perkembangan Umum |
170,000 |
| 1287 |
Assesment Pertumbuhan |
78,000 |
| 1288 |
Assesment Pola Jalan |
66,000 |
| 1289 |
Assesment Postur |
78,000 |
| 1290 |
Assesment Postur Kontrol |
66,000 |
| 1291 |
Assesment Reflex Fisiologis |
80,000 |
| 1292 |
Assesment Reflex Patologis |
80,000 |
| 1293 |
Assesment Sensibilitas |
78,000 |
| 1294 |
Assesment Sensibilitas (Rehabilitasi Medik) |
66,000 |
| 1295 |
Assesment Sistem Saraf Otonom |
78,000 |
| 1296 |
Assesment Skrining masalah mental emosional |
220,000 |
| 1297 |
Assesment Status Nutrisi |
65,000 |
| 1298 |
Assesment Waktu Pendarahan |
78,000 |
| 1299 |
Assisted Exercise in Pool |
134,000 |
| 1300 |
ASSR |
1,106,000 |
| 1301 |
ASSR dengan Anestesi |
2,800,000 |
| 1302 |
ASTO _ |
165,000 |
| 1303 |
ASTO KUANTITATIF |
176,000 |
| 1304 |
Astresia Esofagus |
9,464,367 |
| 1305 |
Asuhan Keperawatan Berat (Malam) |
0 |
| 1306 |
Asuhan Keperawatan Berat (Pagi) |
315,000 |
| 1307 |
Asuhan Keperawatan Berat (Sore) |
0 |
| 1308 |
Asuhan Keperawatan Minimal (Malam) |
0 |
| 1309 |
Asuhan Keperawatan Minimal (Pagi) |
50,000 |
| 1310 |
Asuhan Keperawatan Minimal (Sore) |
0 |
| 1311 |
Asuhan Keperawatan Ringan (Malam) |
0 |
| 1312 |
Asuhan Keperawatan Ringan (Pagi) |
130,000 |
| 1313 |
Asuhan Keperawatan Ringan (Sore) |
0 |
| 1314 |
Asuhan Keperawatan Sedang (Malam) |
0 |
| 1315 |
Asuhan Keperawatan Sedang (Pagi) |
215,000 |
| 1316 |
Asuhan Keperawatan Sedang (Sore) |
0 |
| 1317 |
Asuhan Keperawatan Total (Malam) |
0 |
| 1318 |
Asuhan Keperawatan Total (Pagi) |
420,000 |
| 1319 |
Asuhan Keperawatan Total (Sore) |
0 |
| 1320 |
Asuhan nutrisi enteral dasar |
224,000 |
| 1321 |
Asuhan nutrisi enteral khusus |
281,000 |
| 1322 |
Asuhan nutrisi parenteral |
225,000 |
| 1323 |
Asuhan Nutrisi Pediatric |
150,000 |
| 1324 |
Atikotomi |
13,988,000 |
| 1325 |
Atlas-axis spinal fusion |
14,020,000 |
| 1326 |
Attachment of Pedicle or Flap Graft pada Bibir & Mulut |
17,778,000 |
| 1327 |
Attachment of pedicle or flap graft to hand |
10,925,000 |
| 1328 |
Attachment of pedicle or flap graft to other sites |
10,925,000 |
| 1329 |
Atticoantrostomi / Mastoidektomi Modifikasi |
16,945,000 |
| 1330 |
Audiometri |
150,000 |
| 1331 |
Audiometri ( DPRD ) |
225,000 |
| 1332 |
Audiometri Nada Murni |
282,000 |
| 1333 |
Audiometri Tes Gliserol |
282,000 |
| 1334 |
Audometri Tutur |
282,000 |
| 1335 |
Augmentasi alveolar per kwardant dengan allograft |
6,403,000 |
| 1336 |
Augmentasi Bokong dengan Fat Transfer |
6,061,000 |
| 1337 |
Augmentasi Buli |
27,117,000 |
| 1338 |
Augmentasi Filler 1 (<0.5 mL) |
2,461,000 |
| 1339 |
Augmentasi Filler 2 (0.5 - 1 mL) |
3,481,000 |
| 1340 |
Augmentasi Filler 3 (>1 mL) |
4,981,000 |
| 1341 |
Augmentasi Hipotrofi Lemak akibat Bawaan atau Bekas Sedot Lemak Lalu 1 (kecil) dengan Fat Transfer |
3,748,000 |
| 1342 |
Augmentasi Hipotrofi Lemak akibat Bawaan atau Bekas Sedot Lemak Lalu 2 (besar) dengan Fat Transfer |
4,500,000 |
| 1343 |
Augmentasi Mammae |
19,625,000 |
| 1344 |
Augmentasi Payudara dengan Fat Transfer |
4,081,000 |
| 1345 |
Augmentasi Wajah/Area Kecil (dahi/pelipis/pipi 1 area/dagu/solabial kan kiri) dengan Fat Transfer |
5,131,000 |
| 1346 |
Augmented Urethroplasty |
27,117,000 |
| 1347 |
Aurikulopasti Mikrotia Tahap 1 |
15,827,000 |
| 1348 |
Aurikulopasti Mikrotia Tahap 2 |
15,827,000 |
| 1349 |
Aurikulopasti Mikrotia Tahap 3 |
15,827,000 |
| 1350 |
Aurikulopasti Rekontruksi |
15,827,000 |
| 1351 |
Automated Breast Scanner |
1,163,000 |
| 1352 |
Automated Breast Scanner + USG Mammae |
1,537,000 |
| 1353 |
Autorefraktometri |
71,000 |
| 1354 |
AV Replacement (AVR) |
65,150,000 |
| 1355 |
AV shunt brachio-sefalika/basilika |
29,153,000 |
| 1356 |
AV Shunt dengan graft vena/sintetis |
15,450,000 |
| 1357 |
AV shunt radio/ulnar-sefalika |
29,153,000 |
| 1358 |
AVM Angiografi + Embolisasi Kasus Kompleks |
31,608,000 |
| 1359 |
AVM Angiografi + Embolisasi Kasus Kompleks dengan anestesi |
36,810,000 |
| 1360 |
AVM Angiografi + Embolisasi Kasus Simpel |
25,197,000 |
| 1361 |
AVM Angiografi + Embolisasi Kasus Simpel dengan anestesi |
29,585,000 |
| 1362 |
AVM Angiografi Selektif Kasus Kompleks |
9,982,000 |
| 1363 |
AVM Angiografi Selektif Kasus Kompleks dengan anestesi |
11,423,000 |
| 1364 |
AVM Angiografi Selektif Kasus Simpel |
8,317,000 |
| 1365 |
AVM Angiografi Selektif Kasus Simpel dengan anestesi |
9,517,000 |
| 1366 |
AVR, Reseksi SAS, VSD |
133,995,000 |
| 1367 |
Babygram di NICU |
341,000 |
| 1368 |
Baca Foto Intra dan Ekstra Oral |
150,000 |
| 1369 |
Baca Foto Intra dan Ekstra Oral (Eksekutif) |
0 |
| 1370 |
Back Up BTKV prosedur < 3 jam |
8,199,000 |
| 1371 |
Back Up BTKV prosedur > 3 jam |
12,300,000 |
| 1372 |
Ballon test occlusion |
42,884,000 |
| 1373 |
Balloon Atrial Septostomy (BAS) (Bedside) |
50,948,000 |
| 1374 |
Balon dilatasi saluran nafas |
12,974,000 |
| 1375 |
Band Ligation / Ligasi VE |
8,335,000 |
| 1376 |
BAS / Pemasangan Coil + Anastesi |
49,334,000 |
| 1377 |
BAS di Cath Lab / Pemasangan Coil |
38,935,861 |
| 1378 |
BCPS (bidirectional cavopulmonary shunt) |
51,733,000 |
| 1379 |
BCPS + PA Banding |
31,950,000 |
| 1380 |
BCPS Bilateral+Mitral Cleft repair |
39,150,000 |
| 1381 |
BCPS On Pump atau off Pump/Repair Fistula Coroner/Repair Vascular ring |
38,350,000 |
| 1382 |
BCPS/Kawashima dengan CPB |
126,378,000 |
| 1383 |
BCPS/Kawashima tanpa CPB |
51,733,000 |
| 1384 |
BCPS+Ligasi BT Shunt |
38,750,000 |
| 1385 |
BCPS+PDA Ligasi |
38,990,000 |
| 1386 |
BCR - ABL |
2,800,000 |
| 1387 |
BCR ABL KUANTITATIF |
2,800,000 |
| 1388 |
BCR-ABL Kualitatif (P) |
1,050,000 |
| 1389 |
BCS Non Palpable dengan Tuntutan USG |
18,522,000 |
| 1390 |
BCT / SNLP + STEM SEL ADSRC |
20,681,000 |
| 1391 |
Bedah Beku (Besar) |
750,000 |
| 1392 |
Bedah Beku (Kecil) |
250,000 |
| 1393 |
Bedah Beku (Sedang) |
470,000 |
| 1394 |
Bedah Beku 1 (ringan, <5 lesi, atau 1 regio tubuh) |
641,000 |
| 1395 |
Bedah Beku 2 (sedang, 5-10 lesi, atau >1 regio tubuh) |
835,000 |
| 1396 |
Bedah Beku 3 (berat, >10 lesi, atau multipel regio tubuh) |
962,000 |
| 1397 |
Bedah Eksisi Fusiformis/Elips/Elips Modifikasi/Marsupialisasi 1 (ringan, ?5 cm) dengan PA |
1,059,000 |
| 1398 |
Bedah Eksisi Fusiformis/Elips/Elips Modifikasi/Marsupialisasi 1 (ringan, ?5 cm) tanpa PA |
902,000 |
| 1399 |
Bedah Eksisi Fusiformis/Elips/Elips Modifikasi/Marsupialisasi 2 (sedang, 6-10 cm) dengan PA |
1,143,000 |
| 1400 |
Bedah Eksisi Fusiformis/Elips/Elips Modifikasi/Marsupialisasi 2 (sedang, 6-10 cm) tanpa PA |
921,000 |
| 1401 |
Bedah Eksisi Fusiformis/Elips/Elips Modifikasi/Marsupialisasi 3 (berat) / Z-plasty (>10 cm) dengan PA |
2,274,000 |
| 1402 |
Bedah Eksisi Fusiformis/Elips/Elips Modifikasi/Marsupialisasi 3 (berat) / Z-plasty (>10 cm) tanpa PA |
1,522,000 |
| 1403 |
Bedah Flap 1 (advancement/ bilobed/ rotation/ transposition/ island) (kecil) (tingkat kesulitan ringan) |
3,500,000 |
| 1404 |
Bedah Flap 2 (advancement/ bilobed/ rotation/ transposition/ island) (sedang) (tingkat kesulitan sedang) |
4,900,000 |
| 1405 |
Bedah Flap 3 (advancement/ bilobed/ rotation/ transposition/ island) (besar) (tingkat kesulitan berat) |
5,968,000 |
| 1406 |
Bedah Flap 4 (advancement/ bilobed/ rotation/ transposition/ island) (tingkat kesulitan khusus) |
7,351,000 |
| 1407 |
Bedah Kimia Dalam 1 |
511,000 |
| 1408 |
Bedah Kimia Dalam 2 |
589,000 |
| 1409 |
Bedah Kimia Dalam 3 |
685,000 |
| 1410 |
Bedah Kimia Medium 1 |
411,000 |
| 1411 |
Bedah Kimia Medium 2 |
475,000 |
| 1412 |
Bedah Kimia Medium 3 |
572,000 |
| 1413 |
Bedah Kimia Superfisial 1 |
134,000 |
| 1414 |
Bedah Kimia Superfisial 2 |
411,000 |
| 1415 |
Bedah Kimia Superfisial 3 |
475,000 |
| 1416 |
Bedah Kuku/Removal of Nail, Nailbed, or Nail Fold 1 (Ringan/1 kuku/teknik mudah) |
1,485,000 |
| 1417 |
Bedah Kuku/Removal of Nail, Nailbed, or Nail Fold 2 (Sedang/2 kuku/teknik sulit) |
1,932,000 |
| 1418 |
Bedah Kuku/Removal of Nail, Nailbed, or Nail Fold 3 (Berat/lebih dari 2 kuku/teknik sulit) |
2,260,000 |
| 1419 |
Bedah Laparoskopi anak |
32,096,000 |
| 1420 |
Bedah Laparoskopi Anak |
6,175,000 |
| 1421 |
Bedah Listrik |
66,000 |
| 1422 |
Bedah Listrik 1 (ringan, <5 lesi, atau 1 regio tubuh) |
389,000 |
| 1423 |
Bedah Listrik 2 (sedang, 5-10 lesi, atau >1 regio tubuh) |
484,000 |
| 1424 |
Bedah Listrik 3 (berat, >10 lesi, atau multipel regio tubuh) |
722,000 |
| 1425 |
Bedah Listrik 4 (Genitalia, Sedang) |
899,999 |
| 1426 |
Bedah Listrik 5 (Genitalia, Berat) |
1,123,000 |
| 1427 |
BEDAH MIKRO, GA |
11,286,000 |
| 1428 |
Bedah Mohs 1 (T1 atau 1-2 layer) |
2,562,000 |
| 1429 |
Bedah Mohs 2 (T2 atau 2-4 layer) |
4,574,000 |
| 1430 |
Bedah Mohs 3 (>T2 atau >4 layer) |
6,732,000 |
| 1431 |
Bedah Skapel |
250,000 |
| 1432 |
Belloq Tampon |
50,000 |
| 1433 |
Belloque Tampon Dalam Narkose |
2,850,000 |
| 1434 |
Benda Asing Dengan Penyulit |
379,000 |
| 1435 |
Bentall Procedure |
112,316,000 |
| 1436 |
Bentall Procedure, CABG |
159,957,000 |
| 1437 |
Bentall, Hemi Arch |
112,317,000 |
| 1438 |
Bentall, Partial Arch Repl, CABG |
112,317,000 |
| 1439 |
Bentall, Total Arch |
112,316,000 |
| 1440 |
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 |
| 1441 |
BERA |
1,106,000 |
| 1442 |
BERA dengan Anestesi |
2,800,000 |
| 1443 |
BERA Tone Burst |
1,106,000 |
| 1444 |
BERSIHAN KREATININ / KLIRENS KREATININ |
92,000 |
| 1445 |
Beta HCG Kwantitatif |
244,000 |
| 1446 |
Beta 2 Glycoprotein 1 (B2GP-1) |
563,000 |
| 1447 |
BETA HCG (KUANTITATIF) |
690,000 |
| 1448 |
BETA HCG KUALITATIF (ICT) URIN |
80,000 |
| 1449 |
BIAKAN AEROB ASPIRAT DAN UJI KEPEKAAN |
844,000 |
| 1450 |
BIAKAN AEROB CAIRAN OTAK DAN UJI KEPEKAAN |
844,000 |
| 1451 |
BIAKAN AEROB CAIRAN PERIKARDIUM DAN UJI KEPEKAAN |
844,000 |
| 1452 |
BIAKAN AEROB CAIRAN PERITONEAL DAN UJI KEPEKAAN |
844,000 |
| 1453 |
BIAKAN AEROB CAIRAN PERITONEAL DIALISIS (CAPD) DAN UJI KEPEKAAN |
844,000 |
| 1454 |
BIAKAN AEROB CAIRAN PLEURA DAN UJI KEPEKAAN |
844,000 |
| 1455 |
BIAKAN AEROB CAIRAN SINOVIAL DAN UJI KEPEKAAN |
844,000 |
| 1456 |
BIAKAN AEROB CAIRAN SUMSUM TULANG DAN UJI KEPEKAAN |
844,000 |
| 1457 |
BIAKAN AEROB DARAH DAN UJI KEPEKAAN |
844,000 |
| 1458 |
BIAKAN AEROB JARINGAN DAN UJI KEPEKAAN |
825,000 |
| 1459 |
BIAKAN AEROB KATETER INTRAVASKULAR DAN UJI KEPEKAAN |
825,000 |
| 1460 |
BIAKAN AEROB LAIN-LAIN DAN UJI KEPEKAAN |
825,000 |
| 1461 |
BIAKAN AEROB PUS DAN UJI KEPEKAAN |
825,000 |
| 1462 |
BIAKAN AEROB SALURAN NAFAS BAWAH DAN UJI KEPEKAAN |
825,000 |
| 1463 |
BIAKAN AEROB SPUTUM DAN UJI KEPEKAAN |
825,000 |
| 1464 |
BIAKAN AEROB SWAB DASAR LUKA DAN UJI KEPEKAAN |
825,000 |
| 1465 |
BIAKAN AEROB TINJA DAN UJI KEPEKAAN |
825,000 |
| 1466 |
BIAKAN AEROB URINE DAN UJI KEPEKAAN |
825,000 |
| 1467 |
Biakan dan Resistensi TB (medium Padat OAT Lini 1-2) |
438,000 |
| 1468 |
BIAKAN JAMUR ASPIRAT TRAKEAL |
324,000 |
| 1469 |
BIAKAN JAMUR ASPIRAT TRAKEAL DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1470 |
BIAKAN JAMUR BILASAN BRONKUS |
324,000 |
| 1471 |
BIAKAN JAMUR BILASAN BRONKUS DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1472 |
BIAKAN JAMUR BRONCHOALVEOLAR LAVAGE |
324,000 |
| 1473 |
BIAKAN JAMUR BRONCHOALVEOLAR LAVAGE DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1474 |
BIAKAN JAMUR CAIRAN ASCITES |
324,000 |
| 1475 |
BIAKAN JAMUR CAIRAN ASCITES DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1476 |
BIAKAN JAMUR CAIRAN OTAK |
324,000 |
| 1477 |
BIAKAN JAMUR CAIRAN OTAK DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1478 |
BIAKAN JAMUR CAIRAN PERIKARDIAL |
324,000 |
| 1479 |
BIAKAN JAMUR CAIRAN PERIKARDIAL DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1480 |
BIAKAN JAMUR CAIRAN PERITONEAL DAN DIALISIS |
324,000 |
| 1481 |
BIAKAN JAMUR CAIRAN PERITONEAL DAN DIALISIS DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1482 |
BIAKAN JAMUR CAIRAN PLEURA |
324,000 |
| 1483 |
BIAKAN JAMUR CAIRAN PLEURA DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1484 |
BIAKAN JAMUR CAIRAN SINOVIAL |
324,000 |
| 1485 |
BIAKAN JAMUR CAIRAN SINOVIAL DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1486 |
BIAKAN JAMUR CAIRAN TUBUH LAINNYA |
324,000 |
| 1487 |
BIAKAN JAMUR CAIRAN TUBUH LAINNYA DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1488 |
BIAKAN JAMUR FESES |
324,000 |
| 1489 |
BIAKAN JAMUR FESES DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1490 |
BIAKAN JAMUR GENITAL PRIA |
324,000 |
| 1491 |
BIAKAN JAMUR GENITAL PRIA DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1492 |
BIAKAN JAMUR GENITAL WANITA |
324,000 |
| 1493 |
BIAKAN JAMUR GENITAL WANITA DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1494 |
BIAKAN JAMUR ISOLAT DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1495 |
BIAKAN JAMUR JARINGAN |
324,000 |
| 1496 |
BIAKAN JAMUR JARINGAN DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1497 |
BIAKAN JAMUR KORNEA/KONJUNGTIVA/VITREOUS |
324,000 |
| 1498 |
BIAKAN JAMUR KORNEA/KONJUNGTIVA/VITREOUS DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1499 |
BIAKAN JAMUR KUKU |
324,000 |
| 1500 |
BIAKAN JAMUR KUKU DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1501 |
BIAKAN JAMUR KULIT |
324,000 |
| 1502 |
BIAKAN JAMUR KULIT DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1503 |
BIAKAN JAMUR LAIN-LAINNYA |
324,000 |
| 1504 |
BIAKAN JAMUR LAIN-LAINNYA DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1505 |
BIAKAN JAMUR LUKA |
324,000 |
| 1506 |
BIAKAN JAMUR LUKA BAKAR |
324,000 |
| 1507 |
BIAKAN JAMUR LUKA/LUKA BAKAR DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1508 |
BIAKAN JAMUR MULUT |
324,000 |
| 1509 |
BIAKAN JAMUR MULUT DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1510 |
BIAKAN JAMUR RAMBUT |
324,000 |
| 1511 |
BIAKAN JAMUR RAMBUT DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1512 |
BIAKAN JAMUR SPESIMEN KLINIS |
324,000 |
| 1513 |
BIAKAN JAMUR SPESIMEN KLINIS DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1514 |
BIAKAN JAMUR SPUTUM |
324,000 |
| 1515 |
BIAKAN JAMUR SPUTUM DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1516 |
BIAKAN JAMUR URINE |
324,000 |
| 1517 |
BIAKAN JAMUR URINE DAN UJI KEPEKAAN ANTIJAMUR |
579,000 |
| 1518 |
BIAKAN M. TUBERCULOSIS + DST LINI 1 DENGAN MEDIA CAIR (MGIT) SPESIMEN EKSTRA PARU |
770,000 |
| 1519 |
BIAKAN M. TUBERCULOSIS + DST LINI 1 DENGAN MEDIA CAIR (MGIT) SPESIMEN PARU |
770,000 |
| 1520 |
Biakan Salmonela Shigela (Biakan SS) |
88,000 |
| 1521 |
Bilas Lambung |
66,000 |
| 1522 |
Bilas lambung |
118,000 |
| 1523 |
Bilas lambung neonatus |
117,000 |
| 1524 |
Bilateral breast implant |
20,681,000 |
| 1525 |
Bilateral extended radical mastectomy |
20,681,000 |
| 1526 |
Bilateral extended simple mastectomy |
20,681,000 |
| 1527 |
Bilateral radical mastectomy |
20,681,000 |
| 1528 |
Bilateral reduction mammoplasty |
20,681,000 |
| 1529 |
Bilateral simple mastectomy |
20,681,000 |
| 1530 |
Bilateral subcutaneous mammectomy |
12,850,000 |
| 1531 |
Biliodigestif double bypass |
15,091,000 |
| 1532 |
Bilirubin Direk |
32,000 |
| 1533 |
BILIRUBIN DIREK |
72,000 |
| 1534 |
Bilirubin Indirect |
25,000 |
| 1535 |
BILIRUBIN INDIREK |
72,000 |
| 1536 |
BILIRUBIN TOTAL |
71,000 |
| 1537 |
Bilirubin Total |
32,000 |
| 1538 |
Bioelectrical Impedence Analysis (BIA) |
300,000 |
| 1539 |
Biofeed Back |
28,800 |
| 1540 |
Biofeedback |
274,001 |
| 1541 |
Biometri |
450,000 |
| 1542 |
Biometri Kontak |
511,000 |
| 1543 |
Biopsi Aspirasi transtorakal dengan tuntutan CT - SCAN |
540,000 |
| 1544 |
Biopsi Aspirasi transtorakal dengan tuntutan USG |
318,000 |
| 1545 |
Biopsi ca. penis & kel. inguinal |
2,500,000 |
| 1546 |
Biopsi Ca. Penis & Kel. Inguinal (Sore) |
3,750,000 |
| 1547 |
Biopsi Cerviks - Pasang Tampon |
250,000 |
| 1548 |
Biopsi Core |
675,000 |
| 1549 |
Biopsi cubit (oral cancer) |
7,588,000 |
| 1550 |
Biopsi dalam Narkose Umum |
3,431,074 |
| 1551 |
Biopsi dengan USG guided |
1,952,000 |
| 1552 |
Biopsi Ductus Biliaris |
1,300,000 |
| 1553 |
Biopsi Ductus Biliaris |
1,300,000 |
| 1554 |
Biopsi Ductus Biliaris (Poli Sore) |
1,950,000 |
| 1555 |
Biopsi Eksisi - Op |
8,199,000 |
| 1556 |
Biopsi eksisi < 3 cm |
609,000 |
| 1557 |
Biopsi eksisi > 3 cm |
765,000 |
| 1558 |
Biopsi Eksisi Berat |
1,500,000 |
| 1559 |
Biopsi Eksisi Kelenjar Getah Bening dengan Anastesi Umum |
2,159,000 |
| 1560 |
Biopsi Eksisi Ringan |
800,000 |
| 1561 |
Biopsi Eksisi Rongga Mulut |
9,449,000 |
| 1562 |
Biopsi Eksisi Sedang |
1,200,000 |
| 1563 |
Biopsi Eksisional dalam Narkose |
2,850,000 |
| 1564 |
Biopsi Ekstirpasi dengan Anastesi Lokal |
860,000 |
| 1565 |
Biopsi endometrium (office) dengan Pipelle |
3,685,000 |
| 1566 |
Biopsi Endoskopi |
811,000 |
| 1567 |
Biopsi Endoskopi |
250,000 |
| 1568 |
Biopsi Faring (Nasofaring,orofaring, hipofaring) dengan/tanpa endoskopi |
9,966,000 |
| 1569 |
Biopsi Ginjal |
222,000 |
| 1570 |
Biopsi Ginjal |
1,840,000 |
| 1571 |
Biopsi ginjal (open) |
8,955,000 |
| 1572 |
Biopsi Ginjal Hemodialisa |
5,200,000 |
| 1573 |
Biopsi Ginjal perkutan |
3,850,000 |
| 1574 |
Biopsi Ginjal Perkutan |
7,331,000 |
| 1575 |
Biopsi Ginjal Terbuka |
7,331,000 |
| 1576 |
Biopsi Ginjal Terbuka |
4,850,000 |
| 1577 |
Biopsi hati |
8,750,000 |
| 1578 |
Biopsi Hati Percutaneus |
8,170,000 |
| 1579 |
Biopsi Hati Percutaneus |
8,750,000 |
| 1580 |
Biopsi Hati Percutaneus (Sore) |
12,250,000 |
| 1581 |
Biopsi hepar |
13,420,000 |
| 1582 |
Biopsi Hidung (dengan dan tanpa guiding endoskopi) |
9,854,000 |
| 1583 |
Biopsi Hippfaring Onko |
250,000 |
| 1584 |
Biopsi Incisional dalam Narkose |
2,850,000 |
| 1585 |
Biopsi Insisi |
271,000 |
| 1586 |
Biopsi Insisi (OK) |
8,199,000 |
| 1587 |
Biopsi Insisi Dengan Lokal Anastesi |
675,000 |
| 1588 |
Biopsi insisi kelopak Lokal |
6,985,000 |
| 1589 |
Biopsi insisi kelopak Narkose |
8,199,000 |
| 1590 |
Biopsi insisi konjungtiva Lokal |
6,985,000 |
| 1591 |
Biopsi insisi konjungtiva Narkose |
8,199,000 |
| 1592 |
Biopsi insisi orbita Lokal |
6,995,000 |
| 1593 |
Biopsi insisi orbita Narkose |
8,199,000 |
| 1594 |
Biopsi Insisi Tumor dengan Anastesi Umum |
3,431,074 |
| 1595 |
Biopsi Insisional Tumor Leher Onko |
250,000 |
| 1596 |
Biopsi Jaringan |
146,000 |
| 1597 |
Biopsi Jaringan |
112,000 |
| 1598 |
Biopsi Jaringan (Gastro) |
479,000 |
| 1599 |
Biopsi Jaringan + Anastesi |
1,217,000 |
| 1600 |
Biopsi Jaringan + Anastesi |
1,382,000 |
| 1601 |
Biopsi Jaringan + Anastesi (OK Obgyn) |
1,423,000 |
| 1602 |
Biopsi Jaringan Besar |
800,000 |
| 1603 |
Biopsi Jaringan Kecil |
400,000 |
| 1604 |
Biopsi Jaringan Saluran Cerna Perendoskopi |
655,000 |
| 1605 |
Biopsi Jaringan Saluran Cerna Perendoskopi |
734,000 |
| 1606 |
Biopsi Jaringan Saluran Cerna Perendoskopi (Sore) |
980,000 |
| 1607 |
Biopsi Jaringan Sedang |
600,000 |
| 1608 |
Biopsi Jarum |
63,000 |
| 1609 |
Biopsi Jarum Halus |
675,000 |
| 1610 |
Biopsi Kanker Laring |
10,650,000 |
| 1611 |
Biopsi Kelenjar Hipofisis Transsfenoid |
14,461,000 |
| 1612 |
Biopsi kelenjar limfe pelvik/ paraaorta per laparoskopi |
20,359,000 |
| 1613 |
Biopsi kelenjar limfe pelvik/ paraaorta per laparotomi |
16,289,000 |
| 1614 |
Biopsi kelenjar limfe superfisial |
20,359,000 |
| 1615 |
Biopsi Kelenjar Paratiroid |
8,199,000 |
| 1616 |
Biopsi KGB |
414,000 |
| 1617 |
Biopsi khusus (Hati, Ginjal, Gaster, Colon, Esofagus) 1-2 Jaringan |
400,000 |
| 1618 |
Biopsi khusus (Hati, Ginjal, Gaster, Colon, Esofagus) 3-4 Jaringan |
600,000 |
| 1619 |
Biopsi khusus (Hati, Ginjal, Gaster, Colon, Esofagus) Lebih dari 4 Jaringan |
800,000 |
| 1620 |
Biopsi Kulit (Besar) |
560,000 |
| 1621 |
Biopsi Kulit (Sedang) |
480,000 |
| 1622 |
Biopsi Lidah |
6,009,000 |
| 1623 |
Biopsi Lidah Palatum |
306,000 |
| 1624 |
Biopsi Lidah Palatum Onko |
250,000 |
| 1625 |
Biopsi Lokal |
7,345,000 |
| 1626 |
Biopsi Mukosa Buli Narkose |
7,588,000 |
| 1627 |
Biopsi Nasofaring Fiber Onko |
250,000 |
| 1628 |
Biopsi Nasofaring Rigid |
956,000 |
| 1629 |
Biopsi Nasofaring Rigid Onko |
250,000 |
| 1630 |
Biopsi Neoplasma Bronkus dengan Endoskopi kaku |
7,803,000 |
| 1631 |
Biopsi Neoplasma Kelenjar Liur |
10,854,000 |
| 1632 |
Biopsi Neoplasma Laring dengan Mikrolaring |
11,276,000 |
| 1633 |
Biopsi Neoplasma Sinonasal app Bucogingival |
9,449,000 |
| 1634 |
Biopsi Neoplasma Trakea dengan Endoskopi kaku |
10,475,000 |
| 1635 |
Biopsi ovarium per laparoskopi |
20,359,000 |
| 1636 |
Biopsi Penis |
675,000 |
| 1637 |
Biopsi Penis Lokal |
5,620,000 |
| 1638 |
Biopsi Penis Narkose |
6,403,000 |
| 1639 |
Biopsi per endoskopi |
811,000 |
| 1640 |
Biopsi peritoneum |
16,289,000 |
| 1641 |
Biopsi peritoneum/nodul tumor per laparoskopi |
20,359,000 |
| 1642 |
Biopsi perlaparatomi |
18,679,000 |
| 1643 |
Biopsi Permukaan |
120,000 |
| 1644 |
Biopsi pleura |
1,121,000 |
| 1645 |
Biopsi pleura tertutup |
1,235,000 |
| 1646 |
Biopsi Plong 1 (1-2 titik) |
700,000 |
| 1647 |
Biopsi Plong 2 (3-5 titik) |
961,000 |
| 1648 |
Biopsi Plong 3 (>5 titik) |
1,281,000 |
| 1649 |
Biopsi Prostat |
3,796,000 |
| 1650 |
Biopsi Prostat (ESWL) |
2,500,000 |
| 1651 |
Biopsi Prostat (ESWL) (Sore) |
3,750,000 |
| 1652 |
Biopsi Prostat (Narkose) |
5,822,000 |
| 1653 |
Biopsi Prostat Lokal |
2,990,000 |
| 1654 |
Biopsi prostat robotik |
17,377,000 |
| 1655 |
Biopsi rectum full thicknesis |
3,431,074 |
| 1656 |
Biopsi rektum "Full thickness" |
17,140,000 |
| 1657 |
Biopsi Saraf Kutaneus / Otot |
55,602,000 |
| 1658 |
Biopsi Saraf Kutaneus/Otot (Bedah Syaraf) |
5,334,000 |
| 1659 |
Biopsi sentinel kelenjar limfe pelvik/ paraaorta per laparoskopi |
20,359,000 |
| 1660 |
Biopsi sentinel kelenjar limfe pelvik/ paraaorta per laparotomi |
16,289,000 |
| 1661 |
Biopsi Sinus Maksila |
811,000 |
| 1662 |
Biopsi Sinus Maksila Onko |
250,000 |
| 1663 |
Biopsi Telinga |
2,850,000 |
| 1664 |
Biopsi Telinga Luar |
5,188,000 |
| 1665 |
Biopsi telinga tengah dan dalam dengan Mikroskop |
13,988,000 |
| 1666 |
Biopsi Tepi Fistel Narkose |
8,199,000 |
| 1667 |
Biopsi Terbuka Laring atau Trakea dengan Laringofisure/trakeofisure |
13,289,000 |
| 1668 |
Biopsi Testis |
8,199,000 |
| 1669 |
Biopsi Testis |
3,806,011 |
| 1670 |
Biopsi Tumor Hidung Onko |
250,000 |
| 1671 |
Biopsi Tumor Hidung. Lidah. Nasofaring THT |
2,850,000 |
| 1672 |
Biopsi tumor hipofaring |
811,000 |
| 1673 |
Biopsi Tumor Kavumnasi |
811,000 |
| 1674 |
Biopsi Tumor Kelopak |
675,000 |
| 1675 |
Biopsi tumor oral cavity |
811,000 |
| 1676 |
Biopsi Tumor Oral Cavity LF |
250,000 |
| 1677 |
Biopsi Tumor Orbita |
3,850,000 |
| 1678 |
Biopsi Vertebra (1 Level) |
3,532,812 |
| 1679 |
Biopsi, GA |
7,331,000 |
| 1680 |
Biopsi/Eksisi KGB, Lipoma. Ateroma, ganglion |
10,498,000 |
| 1681 |
Biopsi/Proof Laparatomy |
4,850,000 |
| 1682 |
Biopsy of bone |
9,190,468 |
| 1683 |
Biopsy of bone marrow |
2,998,053 |
| 1684 |
Biopsy of carpals and metacarpals |
5,202,000 |
| 1685 |
Biopsy of femur |
5,202,000 |
| 1686 |
Biopsy of humerus |
5,202,000 |
| 1687 |
Biopsy of joint structure of ankle |
5,752,000 |
| 1688 |
Biopsy of joint structure of elbow |
5,752,000 |
| 1689 |
Biopsy of joint structure of foot and toe |
5,752,000 |
| 1690 |
Biopsy of joint structure of hand and finger |
5,752,000 |
| 1691 |
Biopsy of joint structure of hip |
5,752,000 |
| 1692 |
Biopsy of joint structure of knee |
2,888,053 |
| 1693 |
Biopsy of joint structure of shoulder |
5,752,000 |
| 1694 |
Biopsy of joint structure of wrist |
5,752,000 |
| 1695 |
Biopsy of joint structure, unspecified site |
2,998,053 |
| 1696 |
Biopsy of other bone, except facial bone |
5,202,000 |
| 1697 |
Biopsy of patella |
5,202,000 |
| 1698 |
Biopsy of radius and ulna |
5,202,000 |
| 1699 |
Biopsy of scapula, clavicle, and thorax (ribs and sternum) |
5,202,000 |
| 1700 |
Biopsy of soft tissue |
3,864,200 |
| 1701 |
Biopsy of spinal cord or spinal meninges |
21,867,928 |
| 1702 |
Biopsy of tarsals and metatarsals |
5,202,000 |
| 1703 |
Biopsy of tibia and fibula |
5,202,000 |
| 1704 |
Biotrainer |
43,200 |
| 1705 |
Bishoop koop procedure |
17,316,000 |
| 1706 |
Blaas Functie |
87,000 |
| 1707 |
Bladder Neck Incision |
6,923,000 |
| 1708 |
Bladder neck reconstruction |
25,429,000 |
| 1709 |
Bladder Training |
78,000 |
| 1710 |
Bladder training |
270,000 |
| 1711 |
Blanket |
46,000 |
| 1712 |
Blanket Rol |
46,000 |
| 1713 |
Blanket warmer/ Matras cooling |
91,000 |
| 1714 |
Bleaching eksternal |
3,500,000 |
| 1715 |
Bleaching eksternal (Eksekutif) |
0 |
| 1716 |
Bleaching Internal |
550,000 |
| 1717 |
Bleaching Internal (Eksekutif)) |
0 |
| 1718 |
Blefaroplasti Lokal |
7,940,001 |
| 1719 |
Blefaroplasti Narkose |
9,320,001 |
| 1720 |
Blepharo Plasty Bawah |
16,331,000 |
| 1721 |
Blepharolasty + Temporal Lift, LA |
14,707,000 |
| 1722 |
Blind BAL prosedural |
6,046,500 |
| 1723 |
Blink reflex |
753,000 |
| 1724 |
Block Genicular dengan panduan USG |
317,000 |
| 1725 |
Blok Epidural |
633,000 |
| 1726 |
Blok Resectie |
2,960,000 |
| 1727 |
Blok saraf perifer |
503,000 |
| 1728 |
Blok saraf perifer kontinyu |
1,570,000 |
| 1729 |
Blok Saraf Tepi |
16,900,000 |
| 1730 |
Blok Saraf Tepi |
5,954,000 |
| 1731 |
Blok Saraf Trigeminal dengan penuntun C-Arm Fluoroskopi |
5,791,000 |
| 1732 |
Blood warmer |
175,000 |
| 1733 |
Blood warmer pasien dewasa |
175,000 |
| 1734 |
Blood warmer pasien neonatus |
175,000 |
| 1735 |
Blood warmer pediatrik |
175,000 |
| 1736 |
Blowing Exercise Meter |
39,600 |
| 1737 |
BMD (Bone Mineral Densitometry) dan BMH (Bone Metabolic Health)/ Total body Composition |
703,000 |
| 1738 |
BMD (Bone Mineral Densitometry) Implant Orthopedic Series |
703,000 |
| 1739 |
BMD (Bone Mineral Density) Anak |
405,000 |
| 1740 |
BMD (Bone Mineral Density) Vertebral Mophometry |
405,000 |
| 1741 |
BMP (Bone Morrow Fucture) |
1,000,000 |
| 1742 |
BMP (TINDAKAN) |
1,461,000 |
| 1743 |
BNI (narkose) |
9,340,000 |
| 1744 |
BNO - IVP |
375,000 |
| 1745 |
BOA/VRA |
282,000 |
| 1746 |
Boari Flap |
14,055,000 |
| 1747 |
Body cast for Simple vertebral fracture / dislocation / deformity |
16,353,000 |
| 1748 |
Body Countouring - Abdominoplasty Assisted With Liposuction, GA |
16,331,000 |
| 1749 |
Body Countouring - Abdominoplasty, GA |
16,331,000 |
| 1750 |
Body Countouring - Liposuction > 2 Aesthetic Area, GA |
14,550,000 |
| 1751 |
Body Countouring - Liposuction 1aesthetic Area, LA |
16,330,000 |
| 1752 |
Body Countouring - Liposuction 2 Aesthetic Area, LA |
20,650,000 |
| 1753 |
Body Countouring - Suction Assisted Lipectomy, GA |
14,550,000 |
| 1754 |
Body Jacket |
5,500,000 |
| 1755 |
Bone graft defek tulang alveolar per segmen |
15,538,000 |
| 1756 |
Bone graft of carpals and metacarpals |
13,304,994 |
| 1757 |
Bone graft of femur |
13,154,994 |
| 1758 |
Bone graft of humerus |
13,254,994 |
| 1759 |
Bone graft of patella |
23,004,994 |
| 1760 |
Bone graft of radius and ulna |
13,254,994 |
| 1761 |
Bone graft of scapula, clavicle, and thorax (ribs and sternum) |
6,504,994 |
| 1762 |
Bone graft of tarsals and metatarsals |
8,504,994 |
| 1763 |
Bone graft of tibia and fibula |
23,004,994 |
| 1764 |
Bone graft per regio gigi Op |
15,538,000 |
| 1765 |
Bone graft scapula, clavicle and thorax (ribs and sternum) |
6,504,994 |
| 1766 |
Bone lengthening for Limb length inequality |
24,064,000 |
| 1767 |
Bone marrow biopsy dengan penyulit |
1,536,999 |
| 1768 |
Bone marrow biopsy tanpa penyulit |
1,224,000 |
| 1769 |
Bone marrow puncture dengan penyulit |
1,536,999 |
| 1770 |
Bone marrow puncture tanpa penyulit |
1,224,000 |
| 1771 |
Bone Mineral Density (BMD) Dewasa 3 sites |
405,000 |
| 1772 |
Bone procedure for Cerebral palsy |
23,914,000 |
| 1773 |
Bone procedure for Congenital deformity |
23,914,000 |
| 1774 |
Bone procedure for Finger and Hand deformity |
23,914,000 |
| 1775 |
Bone procedure for Foot / Ankle Deformity |
23,914,000 |
| 1776 |
Bone procedure for Hand & forearm deformity |
23,914,000 |
| 1777 |
Bone procedure for Sprain / dislocation of ligaments and tendons |
23,914,000 |
| 1778 |
Bone Procedure for Stiffness / spastic / contracture joint lower extremity |
23,914,000 |
| 1779 |
Bone Procedure for Stiffness / spastic / contracture joint of upper extremity |
23,914,000 |
| 1780 |
Bone reconstruction for Neglected Case |
23,914,000 |
| 1781 |
Bone reconstruction with stem cell therapy for Non union / bone defect / Pseudoarthrosis |
19,788,000 |
| 1782 |
Bone spacer application for Bone defect |
19,788,000 |
| 1783 |
Bone Survey |
450,000 |
| 1784 |
Bone transport - Illizarov/ monopolar exfix/ bipolar exfix |
12,299,000 |
| 1785 |
Bongkar Crown/pin per Unit |
338,000 |
| 1786 |
Bongkar Prothesa kompleks per unit |
775,000 |
| 1787 |
Bongkar Prothesa sederhana per unit |
567,000 |
| 1788 |
Bony and soft tissue procedure for MPFL reconstruction |
23,914,000 |
| 1789 |
Boston Brace |
5,000,000 |
| 1790 |
Botox injection |
752,000 |
| 1791 |
Botox injection for Cerebral palsy |
12,638,000 |
| 1792 |
Botulinum toxin injection ( 26 - 50 iu) |
3,464,000 |
| 1793 |
Botulinum toxin injection ( 51 – 100 iu) |
4,464,000 |
| 1794 |
Botulinum toxin injection (< 10 iu) |
1,864,000 |
| 1795 |
Botulinum toxin injection 10 – 25 iu |
2,464,000 |
| 1796 |
Botulinum toxin injection guided EMG |
1,943,201 |
| 1797 |
Botulinum toxin injection guided USG |
1,903,101 |
| 1798 |
Bouginasi/ Dilatasi Urethra (ESWL) (Sore) |
1,110,000 |
| 1799 |
Bouginasi/Dilatasi Urethra (ESWL) |
740,000 |
| 1800 |
Boutonniere Deformity Repair, GA |
11,105,000 |
| 1801 |
Brachytherapi - Base Of Tounge (1 X Tindakan + 4X Penyinaran + 1X Anestesi) |
19,000,000 |
| 1802 |
Brachytherapi - Base Of Tounge (1 X Tindakan + 4X Penyinaran + 1X Anestesi) + Anastesi |
23,560,000 |
| 1803 |
Brachytherapi - Base Of Tounge (1 X Tindakan + 6X Penyinaran + 1X Anestesi) |
23,000,000 |
| 1804 |
Brachytherapi - Base Of Tounge (1 X Tindakan + 6X Penyinaran + 1X Anestesi) + Anastesi |
28,520,000 |
| 1805 |
Brachytherapi - Cervix Implantas (1 X Tindakan + 2X Penyinaran + 1X Anestesi) |
11,000,000 |
| 1806 |
Brachytherapi - Cervix Implantas (1 X Tindakan + 2X Penyinaran + 1X Anestesi) + Anastesi |
13,640,000 |
| 1807 |
Brachytherapi - Cervix Implantas (1 X Tindakan + 4X Penyinaran + 1X Anestesi) |
13,000,000 |
| 1808 |
Brachytherapi - Cervix Implantas (1 X Tindakan + 4X Penyinaran + 1X Anestesi) + Anastesi |
16,120,000 |
| 1809 |
Brachytherapi - Cervix Implantas (1 X Tindakan + 6X Penyinaran + 1X Anestesi) |
16,000,000 |
| 1810 |
Brachytherapi - Cervix Implantas (1 X Tindakan + 6X Penyinaran + 1X Anestesi) + Anastesi |
19,840,000 |
| 1811 |
Brachytherapi - Cervix Intrakaviter Lengkap ( 2X Tindakan + 2X Penyinaran + 2X Anestesi ) |
16,000,000 |
| 1812 |
Brachytherapi - Cervix Intrakaviter Lengkap ( 2X Tindakan + 2X Penyinaran + 2X Anestesi ) + Anastesi |
19,840,000 |
| 1813 |
Brachytherapi - Cervix Intrakaviter Lengkap ( 3X Tindakan + 3X Penyinaran + 3X Anestesi ) |
21,000,000 |
| 1814 |
Brachytherapi - Cervix Intrakaviter Lengkap ( 3X Tindakan + 3X Penyinaran + 3X Anestesi ) + Anastesi |
26,040,000 |
| 1815 |
Brachytherapi - Kulit (1 X Tindakan + 2X Penyinaran + 1X Anestesi) |
6,000,000 |
| 1816 |
Brachytherapi - Kulit (1 X Tindakan + 2X Penyinaran + 1X Anestesi) + Anastesi |
7,440,000 |
| 1817 |
Brachytherapi - Kulit (1 X Tindakan + 3X Penyinaran + 1X Anestesi) |
9,000,000 |
| 1818 |
Brachytherapi - Kulit (1 X Tindakan + 3X Penyinaran + 1X Anestesi) + Anastesi |
11,160,000 |
| 1819 |
Brachytherapi - Lidah Anterior (1 X Tindakan + 4X Penyinaran + 1X Anestesi) |
13,000,000 |
| 1820 |
Brachytherapi - Lidah Anterior (1 X Tindakan + 4X Penyinaran + 1X Anestesi) + Anastesi |
16,840,000 |
| 1821 |
Brachytherapi - Lidah Anterior (1 X Tindakan + 6X Penyinaran + 1X Anestesi) |
19,000,000 |
| 1822 |
Brachytherapi - Lidah Anterior (1 X Tindakan + 6X Penyinaran + 1X Anestesi) + Anastesi |
23,560,000 |
| 1823 |
Brachytherapi - Nasofaring Intralumen (1 X Tindakan + 4X Penyinaran + 1X Anestesi) |
12,000,000 |
| 1824 |
Brachytherapi - Nasofaring Intralumen (1 X Tindakan + 4X Penyinaran + 1X Anestesi) + Anastesi |
14,880,000 |
| 1825 |
Brachytherapi - Nasofaring Intralumen (1 X Tindakan + 6X Penyinaran + 1X Anestesi) |
15,000,000 |
| 1826 |
Brachytherapi - Nasofaring Intralumen (1 X Tindakan + 6X Penyinaran + 1X Anestesi) + Anastesi |
18,600,000 |
| 1827 |
Brachytherapi - Ovoid ( 2X Tindakan + 2X Penyinaran + 2X Anestesi ) |
10,000,000 |
| 1828 |
Brachytherapi - Ovoid ( 2X Tindakan + 2X Penyinaran + 2X Anestesi ) + Anastesi |
12,400,000 |
| 1829 |
Brachytherapi - Ovoid ( 3X Tindakan + 3X Penyinaran + 3X Anestesi ) |
16,000,000 |
| 1830 |
Brachytherapi - Ovoid ( 3X Tindakan + 3X Penyinaran + 3X Anestesi ) + Anastesi |
19,840,000 |
| 1831 |
Brachytherapi - Payudara (1 X Tindakan + 1X Penyinaran + 1X Anestesi) |
6,000,000 |
| 1832 |
Brachytherapi - Payudara (1 X Tindakan + 1X Penyinaran + 1X Anestesi) + Anastesi |
7,440,000 |
| 1833 |
Brachytherapi - Payudara (1 X Tindakan + 2X Penyinaran + 1X Anestesi) |
9,000,000 |
| 1834 |
Brachytherapi - Payudara (1 X Tindakan + 2X Penyinaran + 1X Anestesi) + Anastesi |
11,160,000 |
| 1835 |
Brachytherapi - Perineal Implantasi (1 X Tindakan + 1X Penyinaran + 1X Anestesi) |
10,000,000 |
| 1836 |
Brachytherapi - Perineal Implantasi (1 X Tindakan + 1X Penyinaran + 1X Anestesi) + Anastesi |
12,400,000 |
| 1837 |
Brachytherapi - Perineal Implantasi (1 X Tindakan + 2X Penyinaran + 1X Anestesi) |
11,000,000 |
| 1838 |
Brachytherapi - Perineal Implantasi (1 X Tindakan + 2X Penyinaran + 1X Anestesi) + Anastesi |
13,640,000 |
| 1839 |
Brachytherapi - Perineal Implantasi (1X Tindakan + 3X Penyinaran + 1X Anestesi) |
12,000,000 |
| 1840 |
Brachytherapi - Perineal Implantasi (1X Tindakan + 3X Penyinaran + 1X Anestesi) + Anastesi |
14,880,000 |
| 1841 |
Brachytherapi - Radiasi Interna ( Terapi Iodium SO/2000/150 mCi ) |
919,000 |
| 1842 |
Brachytherapi - Radiasi Interna ( Terapi Samarium 50 mCi ) |
788,000 |
| 1843 |
Brain Dymic mind conditioning (Hyptherapy) |
499,000 |
| 1844 |
Brain Evoked Response Activity |
1,106,000 |
| 1845 |
Brain mapping |
1,308,000 |
| 1846 |
Brainstem Auditory Evoked Potential (BAEP). |
1,696,000 |
| 1847 |
Brainstem Evoked Response Audiometry (BERA) |
880,000 |
| 1848 |
Brakhiterapi interstitial |
39,553,000 |
| 1849 |
Brakhiterapi intrakaviter hybrid |
32,961,000 |
| 1850 |
Brakhiterapi intrakaviter lengkap |
28,135,000 |
| 1851 |
Brakhiterapi intrakaviter sederhana |
22,125,000 |
| 1852 |
Brakhiterapi superfisial / mould |
2,483,000 |
| 1853 |
Branched EVAR |
176,779,000 |
| 1854 |
Branched TEVAR |
176,779,000 |
| 1855 |
Break up Time |
33,000 |
| 1856 |
Breakfast (Cek-Up) |
70,000 |
| 1857 |
Breakfast Paket C |
55,000 |
| 1858 |
Breast Augmentation, GA |
14,550,000 |
| 1859 |
Breast Conserving Surgery |
4,850,000 |
| 1860 |
Breast Conserving Treatment |
18,522,000 |
| 1861 |
Breast Reduction Assisted With Liposuction, GA |
14,550,000 |
| 1862 |
Breast Reduction, GA |
14,550,000 |
| 1863 |
Breathing Exercise |
70,000 |
| 1864 |
Bristow / letarjet procedure for Recurrent shoulder dislocation |
23,914,000 |
| 1865 |
Brock + BT Shunt / ASD Closure + PDA Ligasi |
40,350,000 |
| 1866 |
Brock/BT Shunt/Coarctasio Aorta/PA Banding/Sling/Unifokalisasi |
29,950,000 |
| 1867 |
Bronchoscopy Navigation |
1,533,000 |
| 1868 |
Bronchoskopi Toileting dan Lavage |
587,000 |
| 1869 |
Bronchoskopy Fleksibel Transnasal + Ekstraksi benda asing Bronkus dengan anestesi |
3,620,000 |
| 1870 |
Bronchospirometri I |
250,000 |
| 1871 |
Bronchospirometri I (Eksekutif) |
0 |
| 1872 |
Bronchospirometri II |
250,000 |
| 1873 |
Bronchospirometri II (Eksekutif) |
0 |
| 1874 |
broncoskopi |
900,000 |
| 1875 |
Bronkoskopi + Argon Plasma Coagulation (APC) dengan Anestesi |
9,590,000 |
| 1876 |
Bronkoskopi + BAL |
4,621,000 |
| 1877 |
Bronkoskopi + BAL dengan anestesi |
5,455,000 |
| 1878 |
Bronkoskopi + BAL dengan sedasi |
5,350,000 |
| 1879 |
Bronkoskopi + Balon dilatasi saluran nafas dengan Anestesi |
13,519,000 |
| 1880 |
Bronkoskopi + Bronchial Toilette |
1,533,000 |
| 1881 |
Bronkoskopi + Bronkial Toilette |
4,621,000 |
| 1882 |
Bronkoskopi + Brushing |
4,621,000 |
| 1883 |
Bronkoskopi + Brushing + Biopsi |
7,316,000 |
| 1884 |
Bronkoskopi + Brushing + Biopsi dengan anestesi |
8,433,000 |
| 1885 |
Bronkoskopi + Brushing + Biopsi dengan sedasi |
7,316,000 |
| 1886 |
Bronkoskopi + Brushing dengan anestesi |
5,455,000 |
| 1887 |
Bronkoskopi + Brushing dengan sedasi |
5,350,000 |
| 1888 |
Bronkoskopi + Cryobiopsy |
9,230,000 |
| 1889 |
Bronkoskopi + Cryobiopsy Endobronchial dengan Anestesi |
10,539,000 |
| 1890 |
Bronkoskopi + Cryobiopsy/Cryoteraphy + Argon Plasma Coagulation (APC) dengan anestesi |
11,823,000 |
| 1891 |
Bronkoskopi + Ekstraksi Benda Asing dengan Anestesi |
7,316,000 |
| 1892 |
Bronkoskopi + Injeksi Intra Lesi Endoluminal dengan anestesi |
7,316,000 |
| 1893 |
Bronkoskopi + Laser, elektrokauter (fleksibel dan rigid) |
7,263,000 |
| 1894 |
Bronkoskopi + TBLB guided Fluroskopi |
8,047,900 |
| 1895 |
Bronkoskopi + TBLB guided Fluroskopi dengan anestesi |
9,239,000 |
| 1896 |
Bronkoskopi + TBNA Konvensional |
7,316,000 |
| 1897 |
Bronkoskopi + TBNA Konvensional dengan anestesi |
8,432,000 |
| 1898 |
Bronkoskopi + TBNA Konvensional dengan sedasi |
8,378,000 |
| 1899 |
Bronkoskopi + Whole lung lavage |
4,621,000 |
| 1900 |
Bronkoskopi Bilasan |
805,000 |
| 1901 |
Bronkoskopi Bilasan + Anastesi |
1,585,000 |
| 1902 |
Bronkoskopi Bronchial Toilette |
1,533,000 |
| 1903 |
Bronkoskopi dengan penggunaan Methylen Blue atau pewarnaan lain |
1,533,000 |
| 1904 |
Bronkoskopi diagnostic |
1,533,000 |
| 1905 |
Bronkoskopi Diagnostik |
805,000 |
| 1906 |
Bronkoskopi Diagnostik + Anastesi |
1,585,000 |
| 1907 |
Bronkoskopi diagnostik dan terapeutik oleh DPJP intensivist |
4,653,000 |
| 1908 |
Bronkoskopi diagnostik kaku |
7,653,000 |
| 1909 |
Bronkoskopi diagnostik pasien dewasa |
1,533,000 |
| 1910 |
Bronkoskopi diagnostik pasien neonatus |
1,533,000 |
| 1911 |
Bronkoskopi diagnostik pediatrik |
1,533,000 |
| 1912 |
Bronkoskopi emergency |
1,533,000 |
| 1913 |
Bronkoskopi fleksibel + pemasangan stent jenis lain |
11,763,000 |
| 1914 |
Bronkoskopi fleksibel + pemasangan stent jenis lain dengan anestesi |
13,520,000 |
| 1915 |
Bronkoskopi Fleksibel Diagnostik |
7,653,000 |
| 1916 |
Bronkoskopi guiding ETT (intubasi sulit) |
2,253,000 |
| 1917 |
Bronkoskopi pasca bedah |
1,533,000 |
| 1918 |
Bronkoskopi pra bedah |
1,533,000 |
| 1919 |
Bronkoskopi Sikatan |
805,000 |
| 1920 |
Bronkoskopi Sikatan + Anastesi |
1,585,000 |
| 1921 |
Bronkoskopi terapeutik (injeksi, dilatasi, dll) |
1,533,000 |
| 1922 |
Bronkoskopi therapautic pasien dewasa |
1,533,000 |
| 1923 |
Bronkoskopi therapeutic |
1,533,000 |
| 1924 |
Bronkoskopi therapeutic pasien neonatus |
1,533,000 |
| 1925 |
Bronkoskopi therapeutic pediatrik |
1,533,000 |
| 1926 |
Bronkoskopi+Balon Dilatasi Saluran Nafas Dengan Anestesi |
13,247,000 |
| 1927 |
Bronschoscopy (COT) |
5,656,405 |
| 1928 |
Brushing melalui Bronchoschopy |
188,000 |
| 1929 |
BSEF/FESS 1 : Mini |
4,850,000 |
| 1930 |
BSEF/FESS 1: Unsinektomi(antrostomi intranasal) dan pelebaran ostium sinus maksilaris |
7,021,000 |
| 1931 |
BSEF/FESS 2 : Mini+Maksila/etmoid |
4,850,000 |
| 1932 |
BSEF/FESS 2: Unsinektomi(antrostomi intranasal) ,pelebaran ostium sinus maksilaris dan etmoidektomi |
10,498,000 |
| 1933 |
BSEF/FESS 3: Mini+Frontal/Sfenoid |
5,850,000 |
| 1934 |
BSEF/FESS 3: Unsinektomi(antrostomi intranasal) ,pelebaran ostium sinus maksilaris, etmoidektomi, dan sinusektomi sinus frontal/sfenoidektomi |
16,257,000 |
| 1935 |
BSEF/FESS 4 : Mini+maksila/etmoid+frontal/sfenoid |
5,850,000 |
| 1936 |
BSEF/FESS 4(Full House FESS): Unsinektomi(antrostomi intranasal) ,pelebaran ostium sinus maksilaris, etmoidektomi, sinusektomi sinus frontal dan sfenoidektomi |
16,257,000 |
| 1937 |
BSEF/FESS lanjut : Ekstirpasi Tumor.Penutupan defek intrakranial |
5,850,000 |
| 1938 |
BSEF/FESS Lanjutan: dekompresi orbita, dekompresi n. opticus, endoscopic skull base surgery) |
16,257,000 |
| 1939 |
BT shunt + PA banding |
133,139,000 |
| 1940 |
BT shunt dengan CPB |
110,750,000 |
| 1941 |
BT Shunt tanpa CPB |
51,733,000 |
| 1942 |
BT Shunt+Ligasi MAPCA |
36,190,000 |
| 1943 |
BTA 1X Biakan Resistensi Medium Cair OAT Lini 1 |
438,000 |
| 1944 |
BTA 1X Biakan Resistensi Medium Cair OAT Lini 2 |
500,000 |
| 1945 |
BTA 3X Biakan Medium Cair |
375,000 |
| 1946 |
BTA 3X Biakan Medium Padat |
188,000 |
| 1947 |
Buccal Fat Pad Removal |
14,550,000 |
| 1948 |
Buccal Mucosal Graft |
8,517,000 |
| 1949 |
Buka / Pasang Pesarium |
116,000 |
| 1950 |
Buka Arch Bar (OK) |
5,465,000 |
| 1951 |
Buka body jacket |
156,000 |
| 1952 |
Buka Fiksasi /Archbar |
314,000 |
| 1953 |
Buka Gips |
69,000 |
| 1954 |
Buka gips atas lutut |
214,000 |
| 1955 |
Buka Gips atas siku |
214,000 |
| 1956 |
Buka Gips bawah lutut |
214,000 |
| 1957 |
Buka Gips bawah siku |
214,000 |
| 1958 |
Buka hip-spica |
214,000 |
| 1959 |
Buka IDW (Bedah Mulut) |
935,000 |
| 1960 |
Buka Jahitan (Poli Jantung) |
150,000 |
| 1961 |
Buka Obtorator |
55,000 |
| 1962 |
Buka pack ikamicetine /gingival |
5,843,000 |
| 1963 |
Buka Tampon / Kassa Kamicetin |
140,000 |
| 1964 |
Buka Wiring Dengan Anastesi Lokal (Bedah Mulut) |
393,000 |
| 1965 |
Buku ICV |
25,000 |
| 1966 |
Bunionectomy with soft tissue correction and arthrodesis |
6,600,000 |
| 1967 |
Bunionectomy with soft tissue correction and osteotomy of the first metatarsal |
6,600,000 |
| 1968 |
Buried Dermal Flap (Thompson Procedure), GA |
14,550,000 |
| 1969 |
Burrhole drainase subdural |
25,091,000 |
| 1970 |
Bursectomy of hand |
9,390,000 |
| 1971 |
Bursotomy |
9,390,000 |
| 1972 |
Bursotomy of hand |
11,196,000 |
| 1973 |
Businasi |
308,000 |
| 1974 |
Businasi |
4,273,000 |
| 1975 |
Businasi anorektal |
414,000 |
| 1976 |
Businasi Hurtz (Akalasia) |
7,133,000 |
| 1977 |
Businasi Hurtz (akhalasia) |
966,000 |
| 1978 |
Businasi Hurtz Esofagus + anastesi |
8,040,000 |
| 1979 |
Businasi Hurtz Esofagus + Anastesi (Sore) |
12,060,000 |
| 1980 |
Businasi Urethra |
308,000 |
| 1981 |
Businasi uretra |
414,000 |
| 1982 |
Businasi vagina |
414,000 |
| 1983 |
Butterfly Bath |
98,400 |
| 1984 |
C-Arm Guided Intraoperatif |
775,000 |
| 1985 |
C-Arm Guided Intraoperatif dengan Kontras |
1,486,000 |
| 1986 |
C-Arm Guided Non-Operatif |
775,000 |
| 1987 |
C-Arm Guided Non-Operatif dengan Kontras |
1,486,000 |
| 1988 |
C1-C2 fusion |
33,404,000 |
| 1989 |
C3 |
243,000 |
| 1990 |
C3 Komplemen (P) |
828,000 |
| 1991 |
C4 |
483,000 |
| 1992 |
C4 Complement |
483,000 |
| 1993 |
C4 Komplemen (P) |
828,000 |
| 1994 |
CA 12-5 _ |
265,000 |
| 1995 |
CA 125 |
816,000 |
| 1996 |
CA 15-3 |
811,000 |
| 1997 |
CA 15-3 _ |
350,000 |
| 1998 |
CA 19-9 |
839,000 |
| 1999 |
CA 19-9 _ |
300,000 |
| 2000 |
CABG |
113,462,000 |
| 2001 |
CABG (Eksekutif) |
0 |
| 2002 |
CABG + ASD Closure |
133,995,000 |
| 2003 |
CABG + Double Valve Repair/Replacement |
118,995,000 |
| 2004 |
CABG + IVS Ruptur |
118,995,000 |
| 2005 |
CABG + IVS Ruptur, TVr |
118,995,000 |
| 2006 |
CABG + MVR (Eksekutif) |
0 |
| 2007 |
CABG + MVR + Repair (Eksekutif) |
0 |
| 2008 |
CABG + Repair (Eksekutif) |
0 |
| 2009 |
CABG + Repair Fistel Artery Coroner ke Paru |
133,995,000 |
| 2010 |
CABG + Single Valve Repair/Replacement |
133,995,000 |
| 2011 |
CABG + Triple Valve Repair/Replacement |
147,397,000 |
| 2012 |
CABG + VSD Closure |
133,995,000 |
| 2013 |
CABG dengan Carotid Endarterectomy |
133,995,000 |
| 2014 |
CABG dengan MOF (Multi Organ Failure) |
133,995,000 |
| 2015 |
CABG Lima + TV Repair/TAP DE VEGA + TPM + PPM/Endovasculer Stent Aorta |
104,350,000 |
| 2016 |
CABG Lima+Repair Aneurysme Artery Coroner |
65,950,000 |
| 2017 |
CABG reoperatif/redo |
118,995,000 |
| 2018 |
CABG+DVR |
80,350,000 |
| 2019 |
Cabut chest tube / drain toraks |
713,000 |
| 2020 |
Cabut chest tube drain/WSD |
713,000 |
| 2021 |
Cabut DJ Stent |
3,125,000 |
| 2022 |
Cabut Drain Abdomen |
116,000 |
| 2023 |
Cabut Drain Bilier |
116,000 |
| 2024 |
Cabut Drain T-Tube |
116,000 |
| 2025 |
Cabut Gigi Tetap dengan Komplikasi |
1,028,000 |
| 2026 |
Cabut Gigi Tetap dengan Penyulit |
839,000 |
| 2027 |
Cabut IUD dengan Penyulit |
173,000 |
| 2028 |
Cabut K-wire / pin dengan anestesi lokal |
179,000 |
| 2029 |
Cabut Susut dengan Penyulit |
253,000 |
| 2030 |
Cabut trakeostomi |
286,000 |
| 2031 |
Calcium intraarterial stimulation |
345,000 |
| 2032 |
Caldwell Luc (insisi Bucoginggival,) |
7,021,000 |
| 2033 |
Caldwell LUC Anthrostomi |
13,142,000 |
| 2034 |
Caldwell Luc Anthrostomi |
3,850,000 |
| 2035 |
Calsium _ |
35,000 |
| 2036 |
CALSIUM DARAH/ KALSIUM |
90,000 |
| 2037 |
Canaloplasty |
11,482,000 |
| 2038 |
Cancellous / Non Vascularized Bone graft for Bone Defect <2cm / Non union |
19,788,000 |
| 2039 |
Cancellous / Non Vascularized Bone graft for Bone Defect > 2cm / Non union |
21,768,000 |
| 2040 |
Cantharidin < 5 Lesi / > 5 Lesi |
66,000 |
| 2041 |
CAPD Perlaparoskopik |
15,032,000 |
| 2042 |
Capsulotomi Posterior |
2,500,000 |
| 2043 |
Captopril Challenge Test |
345,000 |
| 2044 |
Cardio Toco Graphy (CTG)/Kebidanan |
299,000 |
| 2045 |
Cardiopulmonary exercise test |
161,000 |
| 2046 |
Carotid Dopler |
1,260,000 |
| 2047 |
Carotid Doppler |
725,000 |
| 2048 |
Carotid Duplex Doppler |
400,000 |
| 2049 |
Carotid/Vertebral Arteri Stenting |
79,223,000 |
| 2050 |
Carotid/Vertebral Arteri Stenting dengan Anestesi |
13,988,000 |
| 2051 |
Carpal Tunnel Syndrome Manual (tanpa panduan) |
281,000 |
| 2052 |
Carpal Tunnel Syndrome USG |
595,000 |
| 2053 |
Carporadial fusion |
5,596,121 |
| 2054 |
Casting dan Serial Splinting |
228,000 |
| 2055 |
Casting Pembuatan Ortosis Prostesis |
309,000 |
| 2056 |
Catherisasi pada Retensi Urin |
56,000 |
| 2057 |
CD 4 |
387,000 |
| 2058 |
CEA |
337,000 |
| 2059 |
CEA _ |
280,000 |
| 2060 |
Cek GDS |
15,000 |
| 2061 |
Cek Permanent Pace Maker |
75,000 |
| 2062 |
Cerebral Monitoring |
1,206,000 |
| 2063 |
Cerebral Monitoring lainnya pasien dewasa |
1,206,000 |
| 2064 |
Cerebral Monitoring lainnya pasien neonatus |
1,206,000 |
| 2065 |
Cerebral Monitoring lainnya pasien pediatrik |
1,206,000 |
| 2066 |
Cervical Facet Joint Injection C ARM |
5,929,000 |
| 2067 |
Cervical Facet Joint Injection C-Arm ? 2 (Eksekutif) |
0 |
| 2068 |
Cervical Facet Joint Injection C-Arm <= 2 |
7,910,000 |
| 2069 |
Cervical Facet Joint Injection C-Arm > 2 |
7,910,000 |
| 2070 |
Cervical Facet Joint Injection C-Arm > 2 (Eksekutif) |
0 |
| 2071 |
Cervical Interlaminar Injection C ARM |
4,561,000 |
| 2072 |
Cervical Interlaminar Injection C-Arm |
8,200,000 |
| 2073 |
Cervical Interlaminar Injection C-Arm (Eksekutif) |
0 |
| 2074 |
Cervical medial branch block |
5,929,000 |
| 2075 |
Cervical Medial Branch Block Injection C-Arm ? 2 (Eksekutif) |
0 |
| 2076 |
Cervical Medial Branch Block Injection C-Arm <= 2 |
7,910,000 |
| 2077 |
Cervical Medial Branch Block Injection C-Arm > 2 |
8,200,000 |
| 2078 |
Cervical Medial Branch Block Injection C-Arm > 2 (Eksekutif) |
0 |
| 2079 |
Cervical Medial Branch Injection C ARM |
5,929,000 |
| 2080 |
Cervical Medial Branch Injection USG |
3,755,000 |
| 2081 |
Cervical Sympathetic Injection C ARM |
10,708,000 |
| 2082 |
Cervicotomy + Sternotomi + Debridement |
37,385,000 |
| 2083 |
Cervicotomy + Total Laringektomi |
54,581,000 |
| 2084 |
Cetak alginate |
321,000 |
| 2085 |
Cetak Double Impression |
754,000 |
| 2086 |
Cetak Film Ukuran Besar |
70,000 |
| 2087 |
Cetak Film Ukuran Kecil |
50,000 |
| 2088 |
Cetak Prothesa Ekstra Oral Alginate |
1,296,000 |
| 2089 |
Cetak Prothesa Ekstra Oral Double Impression |
1,408,000 |
| 2090 |
CGM real time |
345,000 |
| 2091 |
Chairback (Biasa) |
1,320,000 |
| 2092 |
Chairback (Khusus) |
2,850,000 |
| 2093 |
Chemo surgery Podophyllin |
66,000 |
| 2094 |
Chemo surgery TCAA |
66,000 |
| 2095 |
ChemoEmbolisasi pada Hepatoma/tumor lain |
24,883,390 |
| 2096 |
ChemoEmbolisasi pada Hepatoma/tumor lain + Anastesi |
45,450,000 |
| 2097 |
Chest Port |
14,450,000 |
| 2098 |
Chest Port + Anastesi |
18,950,000 |
| 2099 |
Chest Re Open Rekonstruksi |
14,750,000 |
| 2100 |
Chest tube + WSD pasien dewasa |
2,058,000 |
| 2101 |
Chest tube + WSD pasien neonatus |
2,058,000 |
| 2102 |
Chest tube + WSD pasien pediatrik |
2,058,000 |
| 2103 |
Chest Tube Seldinger + Ambulatory Chest Drainage |
5,529,000 |
| 2104 |
Cholangiografi T. Tube |
1,345,000 |
| 2105 |
Choledochojejunostomy roux en y |
19,235,000 |
| 2106 |
CHOLESTEROL HDL / HDL KOLESTEROL |
105,000 |
| 2107 |
CHOLESTEROL LDL / LDL KOLESTEROL DIREK |
139,000 |
| 2108 |
CHOLESTEROL TOTAL / KOLESTEROL TOTAL |
72,000 |
| 2109 |
Chordee Excision + Urethroplasty 1 Tahap, GA |
12,758,000 |
| 2110 |
CIC (Continuous Intermittent Catheterization) |
339,000 |
| 2111 |
Cimino (Bedah Vaskuler) |
4,784,000 |
| 2112 |
CIMT (Constraint movement therapy) |
149,000 |
| 2113 |
Circumferential Wiring + Archbarr, GA |
19,617,000 |
| 2114 |
Circumsisi bayi dan anak dengan anastesi umum |
2,159,000 |
| 2115 |
Circumsisi, LA |
5,198,000 |
| 2116 |
CK |
160,000 |
| 2117 |
CK _ |
65,000 |
| 2118 |
CK-MB _ |
65,000 |
| 2119 |
CKMB |
138,000 |
| 2120 |
Clinical Kaustik |
66,000 |
| 2121 |
Clinical staging (karsinoma serviks) |
290,000 |
| 2122 |
Clip Feeder to Fisutulous Point (Microsurgery) |
25,091,000 |
| 2123 |
Clip Over The Scope |
11,633,000 |
| 2124 |
Clip Over The Scope |
11,420,000 |
| 2125 |
Clip Over The Scope (Poli Sore) |
17,130,000 |
| 2126 |
Clisma Neonatus |
120,000 |
| 2127 |
Closed reduction & Casting for Closed fracture (All) |
20,272,000 |
| 2128 |
Closed reduction & casting for congenital knee dislocation |
12,528,000 |
| 2129 |
Closed reduction & fixation for Acquired Joint dislocation (Acute) |
12,054,000 |
| 2130 |
Closed reduction & simple wire pinning for Closed periarticular fracture |
15,436,000 |
| 2131 |
Closed Reduction + Archbarr, GA |
19,617,000 |
| 2132 |
Closed Reduction + Bandage, GA |
19,617,000 |
| 2133 |
Closed Reduction + Imf(Eyelet), GA |
19,617,000 |
| 2134 |
Closed Reduction dengan Anastesi Lokal |
860,000 |
| 2135 |
Closed reduction fraktur mandibula simple |
10,094,000 |
| 2136 |
Closed reduction fraktur simple mandibula |
10,094,000 |
| 2137 |
Closed reduction maksilla / mandibula dengan IMF/Archbar dan suspensi transmandibula/transzigomatik/ piriform / infraobita |
15,585,000 |
| 2138 |
Closed reduction of complex MCP/PIP/DIP joint dislocation under general anesthesia |
11,042,000 |
| 2139 |
Closed reduction of dislocation of ankle |
4,375,000 |
| 2140 |
Closed reduction of dislocation of elbow |
2,799,523 |
| 2141 |
Closed reduction of dislocation of foot and toe |
4,375,000 |
| 2142 |
Closed reduction of dislocation of hand and finger |
2,799,523 |
| 2143 |
Closed reduction of dislocation of hip |
3,899,523 |
| 2144 |
Closed reduction of dislocation of knee |
4,375,000 |
| 2145 |
Closed reduction of dislocation of shoulder |
2,849,523 |
| 2146 |
Closed reduction of dislocation of wrist |
4,375,000 |
| 2147 |
Closed reduction of fracture with internal fixation, carpals and metacarpals |
5,828,000 |
| 2148 |
Closed reduction of fracture with internal fixation, femur |
5,828,000 |
| 2149 |
Closed reduction of fracture with internal fixation, humerus |
5,828,000 |
| 2150 |
Closed reduction of fracture with internal fixation, phalanges of foot |
5,828,000 |
| 2151 |
Closed reduction of fracture with internal fixation, radius and ulna |
5,828,000 |
| 2152 |
Closed reduction of fracture with internal fixation, tarsals and metatarsals |
5,828,000 |
| 2153 |
Closed reduction of fracture with internal fixation, tibia and fibula |
5,828,000 |
| 2154 |
Closed reduction of fracture with internal fixation,phalanges of hand |
5,828,000 |
| 2155 |
Closed reduction of fracture without internal fixation, carpals and metacarpals |
2,963,182 |
| 2156 |
Closed reduction of fracture without internal fixation, femur |
2,963,182 |
| 2157 |
Closed reduction of fracture without internal fixation, humerus |
4,375,000 |
| 2158 |
Closed reduction of fracture without internal fixation, phalanges of foot |
4,375,000 |
| 2159 |
Closed reduction of fracture without internal fixation, phalanges of hand |
4,375,000 |
| 2160 |
Closed reduction of fracture without internal fixation, radius and ulna |
2,963,182 |
| 2161 |
Closed reduction of fracture without internal fixation, tarsals and metatarsals |
4,375,000 |
| 2162 |
Closed reduction of fracture without internal fixation, tibia and fibula |
2,963,182 |
| 2163 |
Closed reduction of separated epiphysis of femur |
4,375,000 |
| 2164 |
Closed reduction of separated epiphysis of humerus |
4,375,000 |
| 2165 |
Closed reduction of separated epiphysis of radius and ulna |
4,375,000 |
| 2166 |
Closed reduction of separated epiphysis of tibia and fibula |
4,375,000 |
| 2167 |
Closed Reduction With Splint, GA |
19,617,000 |
| 2168 |
Closed reduction, arthrogram & Hemispica for DDH |
15,436,000 |
| 2169 |
Closed reduction. percutaneous fixation for SCFE |
12,528,000 |
| 2170 |
Closed Septoplasty/ Septoplasti endoskopik |
10,390,000 |
| 2171 |
Coarctatio Aorta repair dengan CPB |
126,320,000 |
| 2172 |
Coarctatio Aorta repair tanpa CPB |
94,623,000 |
| 2173 |
Coarctatio aorta stenting transkateter + anestesi |
81,631,000 |
| 2174 |
Coartasio Aorta Repair+PDA Ligasi+PA Banding |
31,630,000 |
| 2175 |
Cock Up Splint (Biasa) |
1,800,000 |
| 2176 |
Cock Up Splint (Standar/Khusus) |
2,500,000 |
| 2177 |
Cognitive behavioral therapy untuk gangguan tidur insomnia |
250,000 |
| 2178 |
Cognitive Behaviour Therapy |
190,000 |
| 2179 |
Cognitive Behaviour Therapy (Eksekutif) |
0 |
| 2180 |
Cognitive-Behavioral Therapy pada anak dan remaja |
250,000 |
| 2181 |
Cognitive-Behavioral Therapy pada dewasa |
250,000 |
| 2182 |
Cognitive-Behavioral Therapy pada Gangguan Penggunaan Zat/Adiksi perilaku |
250,000 |
| 2183 |
Cognitive-Behavioral Therapy pada lansia |
250,000 |
| 2184 |
Coiling Aneurisma (stent-assisted atau balloon-asisted) |
114,393,000 |
| 2185 |
Coiling Aneurisma kompleks |
21,234,000 |
| 2186 |
Coiling Aneurisma Multiple |
21,234,000 |
| 2187 |
Coiling Aneurisma simpel |
16,990,000 |
| 2188 |
Colling Aneurisma Intrakranial |
114,393,000 |
| 2189 |
Colok dubur (rectal touche) |
109,000 |
| 2190 |
Colon - Inloop |
500,000 |
| 2191 |
Colon in Loop |
1,289,000 |
| 2192 |
Colon in Loop Releasae Intususepsi |
1,476,000 |
| 2193 |
Colonoscopic dilatation (+stent insertion) |
32,511,000 |
| 2194 |
Combination Therapi |
43,200 |
| 2195 |
Combined anterior and posterior sacrectomy with lumbosacral reconstruction |
11,070,000 |
| 2196 |
Commissuroplasty - Composite Flap(Microsurgery), GA |
22,616,000 |
| 2197 |
Commissuroplasty - Direct Closure, LA |
19,913,000 |
| 2198 |
Commissuroplasty - Ear Cartilage Graft, LA |
10,482,000 |
| 2199 |
Commissuroplasty - Gastro Omental Free Flap(Microsurgery), GA |
11,749,000 |
| 2200 |
Commissuroplasty - Jejunal Free Autograft (Microsurgery), GA |
11,749,000 |
| 2201 |
Commissuroplasty - Regional Flap, LA |
10,482,000 |
| 2202 |
Commissuroplasty - Skin Flap Lokal, LA |
10,482,000 |
| 2203 |
Commissuroplasty - Skin Graft, GA |
11,749,000 |
| 2204 |
Commissuroplasty, LA |
10,482,000 |
| 2205 |
Complicated Functional Neuro (P.Paraverteb/Visceral Blok) |
9,094,887 |
| 2206 |
Complicated Functional Neuro (Percuteneus Kordotomi) |
11,110,887 |
| 2207 |
Complicated Functional Neuro (Stereotaxy Kompleks) |
14,736,887 |
| 2208 |
Complicated Functional Neuro (Stereotaxy sederhana) |
13,306,887 |
| 2209 |
Complicated Functional Neuro P.Paraverteb / Visceral Block Kasus Simpel |
4,049,000 |
| 2210 |
Complicated Functional Neuro P.Paraverteb / Visceral Block Kasus Simpel dengan anestesi |
4,110,000 |
| 2211 |
Complicated Total Ankle Arthroplasty |
34,638,000 |
| 2212 |
Complicated Total Elbow Arthroplasty |
34,638,000 |
| 2213 |
Complicated Total Hip Arthroplasty |
34,638,000 |
| 2214 |
Complicated Total Knee Arthroplasty |
34,638,000 |
| 2215 |
Complicated Total Shoulder Arthroplasty |
33,100,000 |
| 2216 |
Complicated Total Wrist Arthroplasty |
34,638,000 |
| 2217 |
Composite Besar |
421,000 |
| 2218 |
Composite Kecil |
386,000 |
| 2219 |
Comprehensive Geriatric Assesment (CGA) |
66,000 |
| 2220 |
Computer Spech Therapi |
39,600 |
| 2221 |
Conchal Graft |
15,827,000 |
| 2222 |
Condilectomy bilateral |
22,985,000 |
| 2223 |
Condilectomy unilateral |
15,538,000 |
| 2224 |
Condylotomy Mandibula |
4,850,000 |
| 2225 |
Cone Biopsi/ Konisasi/ LETZ |
2,850,000 |
| 2226 |
Congenital Formix Plastik/ Rekst Soket Berat |
4,675,000 |
| 2227 |
Congenital Knee dislocation - Reconstruction |
23,914,000 |
| 2228 |
Congenital pseudo arthrosis tibia reconstruction - Intramedullary pin/ Exfix/ Illizarov |
30,873,000 |
| 2229 |
Contingency Management |
250,000 |
| 2230 |
continuous glucose monitoring (CGM) konvensional |
345,000 |
| 2231 |
Contouring gigi dengan composite resin |
387,000 |
| 2232 |
Control perdarahan |
7,919,000 |
| 2233 |
Cool Box (1X Pengiriman Darah) |
10,000 |
| 2234 |
COOMBS TEST |
238,000 |
| 2235 |
Coombs' Test _ |
160,000 |
| 2236 |
Cor Analysa |
400,000 |
| 2237 |
Corangiography + TPM |
7,033,000 |
| 2238 |
Corangiography+Arteriografy/Corangiography+Katerisasi |
9,200,000 |
| 2239 |
Core biopsi |
1,503,000 |
| 2240 |
Core Biopsi (CT guided) |
1,656,000 |
| 2241 |
Core Biopsi (USG guided) |
1,952,000 |
| 2242 |
Core Biopsy Adenoma Paratiroid |
1,655,000 |
| 2243 |
Core Biopsy Kelenjar Getah Bening Leher |
1,655,000 |
| 2244 |
Core biopsy of extremity |
11,307,000 |
| 2245 |
Core Biopsy Tiroid |
1,655,000 |
| 2246 |
Core Build-up Composite |
0 |
| 2247 |
Core Build-up Glass lonomer |
0 |
| 2248 |
Core Build-up Glass lonomer Pengambilan 2/3 Guttap |
0 |
| 2249 |
Corneal Fluorescein Test |
36,000 |
| 2250 |
Coronoidectomy bilateral |
15,538,000 |
| 2251 |
Coronoidektomi unilateral |
17,039,000 |
| 2252 |
Corpus Alinium Cornea |
250,000 |
| 2253 |
Correction of syndactyly |
6,600,000 |
| 2254 |
Correction with bone procedure for CTEV |
23,914,000 |
| 2255 |
Corrective osteotomy & fixation for Bone deformity |
23,914,000 |
| 2256 |
Cortisol (P) |
448,000 |
| 2257 |
Costal Graft |
11,744,000 |
| 2258 |
Countouring Of The Arm, LA |
14,707,000 |
| 2259 |
Countouring Of The Thigh, LA |
14,707,000 |
| 2260 |
Countouring Of The Thrunk, LA |
14,707,000 |
| 2261 |
Coustik Hidung |
36,000 |
| 2262 |
CPM |
42,000 |
| 2263 |
Cranial or peripheral nerve graft |
11,682,099 |
| 2264 |
Crimpable Hook |
153,000 |
| 2265 |
Crisis Intervention |
100,000 |
| 2266 |
Crisis Intervention ( Eksekutif ) |
0 |
| 2267 |
Croos Insisi |
44,000 |
| 2268 |
Cross Leg Flap |
8,950,000 |
| 2269 |
Cross Match |
0 |
| 2270 |
CROSS MATCH/UJI SILANG SERASI |
97,000 |
| 2271 |
Cross Matching |
170,000 |
| 2272 |
Cross-Facial Verve Graft, GA |
16,331,000 |
| 2273 |
CROSSMATCH (CDC)/ HLA CROSSMATCH |
1,751,000 |
| 2274 |
CROSSMATCH (CDC)/HLA CROSSMATCH |
1,751,000 |
| 2275 |
Crown & Bridge (Acrylic per unit) |
295,000 |
| 2276 |
Crown & Bridge (Porcelain per unit) |
765,000 |
| 2277 |
CRP (KUANTITATIF) |
167,000 |
| 2278 |
CRP Kuantitatif |
130,000 |
| 2279 |
CRRT (Continous Renal Replacement Therapy) |
33,720,000 |
| 2280 |
CRT / ICD |
81,550,000 |
| 2281 |
CRT D dengan anestesi |
132,179,000 |
| 2282 |
CRT P dengan anestesi |
132,179,000 |
| 2283 |
CRT-D |
127,732,000 |
| 2284 |
CRT-P |
127,732,000 |
| 2285 |
Cryballoon Ablation AF |
80,894,000 |
| 2286 |
Cryballoon Ablation AF + ICE |
83,541,000 |
| 2287 |
Cryballoon Ablation AF + Trans Esofageal Ekokardiografi (TEE) + Anestesi |
83,541,000 |
| 2288 |
Cryo Jet |
75,000 |
| 2289 |
Cryo Therapi |
43,200 |
| 2290 |
Cryoglobulin |
25,000 |
| 2291 |
Cryoteraphy TBLB |
3,899,000 |
| 2292 |
Cryoteraphy TBLB dengan Anastesi |
4,307,000 |
| 2293 |
CRYOTHERAPY |
2,292,000 |
| 2294 |
CRYOTHERAPY dengan sedasi |
2,925,000 |
| 2295 |
Cryotherapy single use (1.1 mm) |
3,564,000 |
| 2296 |
Cryotherapy single use (1.1 mm) dengan Anastesi |
3,938,000 |
| 2297 |
Cryotherapy single use (1.7 mm) dengan Anastesi |
4,727,000 |
| 2298 |
CT Scan Angiografi Abdomen |
3,765,000 |
| 2299 |
CT Scan Angiografi Abdomen dengan anestesi |
4,829,001 |
| 2300 |
CT Scan Angiografi Aorta Lengkap (Arkus s/d Iliaka) |
3,765,000 |
| 2301 |
CT Scan Angiografi Aorta Lengkap (Arkus s/d Iliaka) dengan anestesi |
4,829,001 |
| 2302 |
CT Scan Angiografi Aorta Torakalis |
3,765,000 |
| 2303 |
CT Scan Angiografi Aorta Torakalis dengan anestesi |
4,829,001 |
| 2304 |
CT Scan Angiografi Aorta Toraks - Abdomen |
3,765,000 |
| 2305 |
CT Scan Angiografi Aorta Toraks - Abdomen dengan anestesi |
4,829,001 |
| 2306 |
CT Scan Angiografi Carotis |
3,765,000 |
| 2307 |
CT Scan Angiografi Carotis dengan anestesi |
4,829,001 |
| 2308 |
CT Scan Angiografi Cerebral |
3,765,000 |
| 2309 |
CT Scan Angiografi Cerebral - Carotis |
3,765,000 |
| 2310 |
CT Scan Angiografi Cerebral - Carotis dengan anestesi |
4,829,001 |
| 2311 |
CT Scan Angiografi Cerebral dengan anestesi |
4,829,001 |
| 2312 |
CT Scan Angiografi Coroner |
3,765,000 |
| 2313 |
CT Scan Angiografi Coroner dengan anestesi |
4,829,001 |
| 2314 |
CT Scan Angiografi Ekstremitas Inferior |
3,765,000 |
| 2315 |
CT Scan Angiografi Ekstremitas Inferior dengan anestesi |
4,829,001 |
| 2316 |
CT Scan Angiografi Ekstremitas Superior |
3,765,000 |
| 2317 |
CT Scan Angiografi Ekstremitas Superior dengan anestesi |
4,829,001 |
| 2318 |
CT Scan Angiografi Iliaka |
3,765,000 |
| 2319 |
CT Scan Angiografi Iliaka dengan anestesi |
4,829,001 |
| 2320 |
CT Scan Angiografi Pulmonal |
3,765,000 |
| 2321 |
CT Scan Angiografi Pulmonal dengan anestesi |
4,829,001 |
| 2322 |
CT Scan Cysternography |
2,139,000 |
| 2323 |
CT Scan Cysternography dengan anestesi |
3,033,001 |
| 2324 |
CT Scan Cystography |
2,903,000 |
| 2325 |
CT Scan Cystography dengan anestesi |
3,877,001 |
| 2326 |
CT Scan Dental Cone Beam (CBCT) |
2,139,000 |
| 2327 |
CT Scan Dental Cone Beam (CBCT) dengan anestesi |
3,033,001 |
| 2328 |
CT Scan Fistulografi |
2,903,000 |
| 2329 |
CT Scan Fistulografi dengan anestesi |
3,877,001 |
| 2330 |
CT Scan Guided |
1,700,000 |
| 2331 |
CT Scan Guided + Biopsi (Tindakan oleh DPJP Radiologi) |
2,879,000 |
| 2332 |
CT Scan Guided + Biopsi (Tindakan oleh DPJP Radiologi) dengan anestesi |
2,879,000 |
| 2333 |
CT Scan Guided + Core Biopsy (Tindakan oleh DPJP Radiologi) |
1,952,000 |
| 2334 |
CT Scan Guided + Core Biopsy (Tindakan oleh DPJP Radiologi) dengan anestesi |
2,879,000 |
| 2335 |
CT Scan Guided Biopsy Kasus Kompleks |
5,767,000 |
| 2336 |
CT Scan Guided Biopsy Kasus Kompleks dengan anestesi |
6,828,000 |
| 2337 |
CT Scan Guided Biopsy Kasus Simpel |
4,869,000 |
| 2338 |
CT Scan Guided Biopsy Kasus Simpel dengan anestesi |
5,819,000 |
| 2339 |
CT Scan Guided dengan anestesi |
2,547,000 |
| 2340 |
CT Scan Guided Percutaneus Cryosurgery Argonhelium |
1,700,000 |
| 2341 |
CT Scan Guided Percutaneus Cryosurgery Argonhelium dengan anestesi |
2,547,000 |
| 2342 |
CT Scan Kontras Abdomen Lengkap |
3,765,000 |
| 2343 |
CT Scan Kontras Abdomen Lengkap + Virtual Colonoscopy |
3,765,000 |
| 2344 |
CT Scan Kontras Abdomen Lengkap + Virtual Colonoscopy dengan anestesi |
4,829,001 |
| 2345 |
CT Scan Kontras Abdomen Lengkap + Volumetri + Virtual Colonoscopy |
3,765,000 |
| 2346 |
CT Scan Kontras Abdomen Lengkap + Volumetri + Virtual Colonoscopy dengan anestesi |
4,829,001 |
| 2347 |
CT Scan Kontras Abdomen Lengkap dengan anestesi |
4,829,001 |
| 2348 |
CT Scan Kontras Antebrachii |
3,014,000 |
| 2349 |
CT Scan Kontras Antebrachii dengan anestesi |
4,000,001 |
| 2350 |
CT Scan Kontras Bahu |
3,014,000 |
| 2351 |
CT Scan Kontras Bahu dengan anestesi |
4,000,001 |
| 2352 |
CT Scan Kontras Cardiac (Calcium Scoring dan Angiografi Coroner) |
3,765,000 |
| 2353 |
CT Scan Kontras Cardiac (Calcium Scoring dan Angiografi Coroner) dan evaluasi Late Iodine Enhancement (LIE) |
3,765,000 |
| 2354 |
CT Scan Kontras Cardiac (Calcium Scoring dan Angiografi Coroner) dan evaluasi Late Iodine Enhancement (LIE) dengan anestesi |
4,829,001 |
| 2355 |
CT Scan Kontras Cardiac (Calcium Scoring dan Angiografi Coroner) dengan anestesi |
4,829,001 |
| 2356 |
CT Scan Kontras Cardiac dengan Stress Perfusion |
3,765,000 |
| 2357 |
CT Scan Kontras Cardiac dengan Stress Perfusion dengan anestesi |
4,829,001 |
| 2358 |
CT Scan Kontras Cardiac dengan Stress Test dan evaluasi Late Iodine Enhancement (LIE) |
3,765,000 |
| 2359 |
CT Scan Kontras Cardiac dengan Stress Test dan evaluasi Late Iodine Enhancement (LIE) dengan anestesi |
4,829,001 |
| 2360 |
CT Scan Kontras Cardiac Pediatrik |
3,765,000 |
| 2361 |
CT Scan Kontras Cardiac Pediatrik dengan anestesi |
4,829,001 |
| 2362 |
CT Scan Kontras Cardiac untuk Prosedur Intervensi |
3,765,000 |
| 2363 |
CT Scan Kontras Cardiac untuk Prosedur Intervensi dengan anestesi |
4,829,001 |
| 2364 |
CT Scan Kontras Cruris |
3,014,000 |
| 2365 |
CT Scan Kontras Cruris dengan anestesi |
4,000,001 |
| 2366 |
CT Scan Kontras Cubiti |
3,014,000 |
| 2367 |
CT Scan Kontras Cubiti dengan anestesi |
4,000,001 |
| 2368 |
CT Scan Kontras Cystography |
3,765,000 |
| 2369 |
CT Scan Kontras Cystography dengan anestesi |
4,829,001 |
| 2370 |
CT Scan Kontras Enterography |
3,765,000 |
| 2371 |
CT Scan Kontras Enterography dengan anestesi |
4,829,001 |
| 2372 |
CT Scan Kontras Esophagography |
3,317,000 |
| 2373 |
CT Scan Kontras Esophagography dengan anestesi |
4,402,000 |
| 2374 |
CT Scan Kontras Femur |
3,014,000 |
| 2375 |
CT Scan Kontras Femur dengan anestesi |
4,000,001 |
| 2376 |
CT Scan Kontras Fistulografi |
3,765,000 |
| 2377 |
CT Scan Kontras Fistulografi dengan anestesi |
4,829,001 |
| 2378 |
CT Scan Kontras Genu |
3,014,000 |
| 2379 |
CT Scan Kontras Genu dengan anestesi |
4,000,001 |
| 2380 |
CT Scan Kontras Guided |
3,765,000 |
| 2381 |
CT Scan Kontras Guided dengan anestesi |
4,829,001 |
| 2382 |
CT Scan Kontras Guided Percutaneus Cryosurgery Argonhelium |
3,765,000 |
| 2383 |
CT Scan Kontras Guided Percutaneus Cryosurgery Argonhelium dengan anestesi |
4,829,001 |
| 2384 |
CT Scan Kontras High Resolution Mastoid |
3,014,000 |
| 2385 |
CT Scan Kontras High Resolution Mastoid dengan anestesi |
4,000,001 |
| 2386 |
CT Scan Kontras Humerus |
3,014,000 |
| 2387 |
CT Scan Kontras Humerus dengan anestesi |
4,000,001 |
| 2388 |
CT Scan Kontras Leher (Faring-Laring) |
3,014,000 |
| 2389 |
CT Scan Kontras Leher (Faring-Laring) dengan anestesi |
4,000,001 |
| 2390 |
CT Scan Kontras Manus |
3,014,000 |
| 2391 |
CT Scan Kontras Manus dengan anestesi |
4,000,001 |
| 2392 |
CT Scan Kontras Multifase Abdomen Atas |
3,765,000 |
| 2393 |
CT Scan Kontras Multifase Abdomen Atas dengan anestesi |
4,829,001 |
| 2394 |
CT Scan Kontras Multifase Abdomen Lengkap |
3,765,000 |
| 2395 |
CT Scan Kontras Multifase Abdomen Lengkap + Volumetri |
3,765,000 |
| 2396 |
CT Scan Kontras Multifase Abdomen Lengkap + Volumetri dengan anestesi |
4,829,001 |
| 2397 |
CT Scan Kontras Multifase Abdomen Lengkap dengan anestesi |
4,829,001 |
| 2398 |
CT Scan Kontras Multifase Urografi |
3,765,000 |
| 2399 |
CT Scan Kontras Multifase Urografi dengan anestesi |
4,829,001 |
| 2400 |
CT Scan Kontras Orbita |
3,014,000 |
| 2401 |
CT Scan Kontras Orbita dengan anestesi |
4,000,001 |
| 2402 |
CT Scan Kontras Os. Temporal |
3,014,000 |
| 2403 |
CT Scan Kontras Os. Temporal dengan anestesi |
4,000,001 |
| 2404 |
CT Scan Kontras Otak |
3,342,000 |
| 2405 |
CT Scan Kontras Otak dengan anestesi |
4,362,001 |
| 2406 |
CT Scan Kontras Pedis |
3,014,000 |
| 2407 |
CT Scan Kontras Pedis dengan anestesi |
4,000,001 |
| 2408 |
CT Scan Kontras Perfusi |
3,014,000 |
| 2409 |
CT Scan Kontras Perfusi dengan anestesi |
4,000,001 |
| 2410 |
CT Scan Kontras Pergelangan Kaki |
3,014,000 |
| 2411 |
CT Scan Kontras Pergelangan Kaki dengan anestesi |
4,000,001 |
| 2412 |
CT Scan Kontras Pergelangan Tangan |
3,014,000 |
| 2413 |
CT Scan Kontras Pergelangan Tangan dengan anestesi |
4,000,001 |
| 2414 |
CT Scan Kontras Peritoneography |
3,765,000 |
| 2415 |
CT Scan Kontras Peritoneography dengan anestesi |
4,829,001 |
| 2416 |
CT Scan Kontras Sinus Paranasal |
3,014,000 |
| 2417 |
CT Scan Kontras Sinus Paranasal dengan anestesi |
4,000,001 |
| 2418 |
CT Scan Kontras Thorax |
3,765,000 |
| 2419 |
CT Scan Kontras Thorax + Biopsi (Tindakan oleh DPJP Radiologi) |
3,765,000 |
| 2420 |
CT Scan Kontras Thorax + Biopsi (Tindakan oleh DPJP Radiologi) dengan anestesi |
4,829,001 |
| 2421 |
CT Scan Kontras Thorax + Virtual Bronchoscopy |
3,765,000 |
| 2422 |
CT Scan Kontras Thorax + Virtual Bronchoscopy dengan anestesi |
4,829,001 |
| 2423 |
CT Scan Kontras Thorax + Volumetri |
3,765,000 |
| 2424 |
CT Scan Kontras Thorax + Volumetri dengan anestesi |
4,829,001 |
| 2425 |
CT Scan Kontras Thorax dengan anestesi |
4,829,001 |
| 2426 |
CT Scan Kontras Thorax Lung Point / Navigasi |
3,765,000 |
| 2427 |
CT Scan Kontras Thorax Lung Point / Navigasi dengan anestesi |
4,829,001 |
| 2428 |
CT Scan Kontras Triple Rule Out (Pulmonal - Cardiac - Aorta) |
3,765,000 |
| 2429 |
CT Scan Kontras Triple Rule Out (Pulmonal - Cardiac - Aorta) dengan anestesi |
4,829,001 |
| 2430 |
CT Scan Kontras Vertebra Cervical |
3,014,000 |
| 2431 |
CT Scan Kontras Vertebra Cervical + Thoracal |
3,317,000 |
| 2432 |
CT Scan Kontras Vertebra Cervical + Thoracal dengan anestesi |
4,402,000 |
| 2433 |
CT Scan Kontras Vertebra Cervical dengan anestesi |
4,000,001 |
| 2434 |
CT Scan Kontras Vertebra Lengkap (Wholespine) |
3,317,000 |
| 2435 |
CT Scan Kontras Vertebra Lengkap (Wholespine) dengan anestesi |
4,402,000 |
| 2436 |
CT Scan Kontras Vertebra Lumbal |
3,014,000 |
| 2437 |
CT Scan Kontras Vertebra Lumbal dengan anestesi |
4,000,001 |
| 2438 |
CT Scan Kontras Vertebra Thoracal |
3,014,000 |
| 2439 |
CT Scan Kontras Vertebra Thoracal + Lumbal |
3,317,000 |
| 2440 |
CT Scan Kontras Vertebra Thoracal + Lumbal dengan anestesi |
4,402,000 |
| 2441 |
CT Scan Kontras Vertebra Thoracal dengan anestesi |
4,000,001 |
| 2442 |
CT Scan Kontras Wajah / Craniofacial |
3,014,000 |
| 2443 |
CT Scan Kontras Wajah / Craniofacial dengan anestesi |
4,000,001 |
| 2444 |
CT Scan Myelography |
2,139,000 |
| 2445 |
CT Scan Myelography dengan anestesi |
3,033,001 |
| 2446 |
CT Scan Non Kontras Abdomen Lengkap |
2,903,000 |
| 2447 |
CT Scan Non Kontras Abdomen Lengkap + Virtual Colonoscopy |
3,194,000 |
| 2448 |
CT Scan Non Kontras Abdomen Lengkap + Virtual Colonoscopy dengan anestesi |
4,265,000 |
| 2449 |
CT Scan Non Kontras Abdomen Lengkap dengan anestesi |
3,877,001 |
| 2450 |
CT Scan Non Kontras Antebrachii |
2,139,000 |
| 2451 |
CT Scan Non Kontras Antebrachii dengan anestesi |
3,033,001 |
| 2452 |
CT Scan Non Kontras Bahu |
2,139,000 |
| 2453 |
CT Scan Non Kontras Bahu dengan anestesi |
3,033,001 |
| 2454 |
CT Scan Non Kontras Cardiac (Calcium Scoring) |
2,521,000 |
| 2455 |
CT Scan Non Kontras Cardiac (Calcium Scoring) dengan anestesi |
3,455,001 |
| 2456 |
CT Scan Non Kontras Cardiac Pediatrik |
3,026,000 |
| 2457 |
CT Scan Non Kontras Cardiac Pediatrik dengan anestesi |
4,147,000 |
| 2458 |
CT Scan Non Kontras Cruris |
2,139,000 |
| 2459 |
CT Scan Non Kontras Cruris dengan anestesi |
3,033,001 |
| 2460 |
CT Scan Non Kontras Cubiti |
2,139,000 |
| 2461 |
CT Scan Non Kontras Cubiti dengan anestesi |
3,033,001 |
| 2462 |
CT Scan Non Kontras Esophagography |
2,521,000 |
| 2463 |
CT Scan Non Kontras Esophagography dengan anestesi |
3,455,001 |
| 2464 |
CT Scan Non Kontras Femur |
2,139,000 |
| 2465 |
CT Scan Non Kontras Femur dengan anestesi |
3,033,001 |
| 2466 |
CT Scan Non Kontras Genu |
2,139,000 |
| 2467 |
CT Scan Non Kontras Genu dengan anestesi |
3,033,001 |
| 2468 |
CT Scan Non Kontras High Resolution Mastoid |
2,139,000 |
| 2469 |
CT Scan Non Kontras High Resolution Mastoid dengan anestesi |
3,033,001 |
| 2470 |
CT Scan Non Kontras Humerus |
2,139,000 |
| 2471 |
CT Scan Non Kontras Humerus dengan anestesi |
3,033,001 |
| 2472 |
CT Scan Non Kontras Leher (Faring-Laring) |
2,139,000 |
| 2473 |
CT Scan Non Kontras Leher (Faring-Laring) dengan anestesi |
3,033,001 |
| 2474 |
CT Scan Non Kontras Manus |
2,139,000 |
| 2475 |
CT Scan Non Kontras Manus dengan anestesi |
3,033,001 |
| 2476 |
CT Scan Non Kontras Orbita |
2,139,000 |
| 2477 |
CT Scan Non Kontras Orbita dengan anestesi |
3,033,001 |
| 2478 |
CT Scan Non Kontras Os. Temporal |
2,139,000 |
| 2479 |
CT Scan Non Kontras Os. Temporal dengan anestesi |
3,033,001 |
| 2480 |
CT Scan Non Kontras Otak |
2,139,000 |
| 2481 |
CT Scan Non Kontras Otak dengan anestesi |
3,033,001 |
| 2482 |
CT Scan Non Kontras Pedis |
2,139,000 |
| 2483 |
CT Scan Non Kontras Pedis dengan anestesi |
3,033,001 |
| 2484 |
CT Scan Non Kontras Pergelangan Kaki |
2,139,000 |
| 2485 |
CT Scan Non Kontras Pergelangan Kaki dengan anestesi |
3,033,001 |
| 2486 |
CT Scan Non Kontras Pergelangan Tangan |
2,139,000 |
| 2487 |
CT Scan Non Kontras Pergelangan Tangan dengan anestesi |
3,033,001 |
| 2488 |
CT Scan Non Kontras Sinus Paranasal |
2,139,000 |
| 2489 |
CT Scan Non Kontras Sinus Paranasal dengan anestesi |
3,033,001 |
| 2490 |
CT Scan Non Kontras Thorax |
2,521,000 |
| 2491 |
CT Scan Non Kontras Thorax + Guiding CT |
2,521,000 |
| 2492 |
CT Scan Non Kontras Thorax + Guiding CT dengan anestesi |
3,455,001 |
| 2493 |
CT Scan Non Kontras Thorax + Virtual Bronchoscopy |
3,026,000 |
| 2494 |
CT Scan Non Kontras Thorax + Virtual Bronchoscopy dengan anestesi |
4,147,000 |
| 2495 |
CT Scan Non Kontras Thorax + Volumetri |
2,521,000 |
| 2496 |
CT Scan Non Kontras Thorax + Volumetri dengan anestesi |
3,455,001 |
| 2497 |
CT Scan Non Kontras Thorax dengan anestesi |
3,455,001 |
| 2498 |
CT Scan Non Kontras Torakoabdominal |
2,903,000 |
| 2499 |
CT Scan Non Kontras Torakoabdominal dengan anestesi |
3,877,001 |
| 2500 |
CT Scan Non Kontras Trauma Kepala |
2,681,000 |
| 2501 |
CT Scan Non Kontras Trauma Kepala dengan anestesi |
3,632,001 |
| 2502 |
CT Scan Non Kontras Vertebra Cervical |
2,139,000 |
| 2503 |
CT Scan Non Kontras Vertebra Cervical + Thoracal |
2,521,000 |
| 2504 |
CT Scan Non Kontras Vertebra Cervical + Thoracal dengan anestesi |
3,455,001 |
| 2505 |
CT Scan Non Kontras Vertebra Cervical dengan anestesi |
3,033,001 |
| 2506 |
CT Scan Non Kontras Vertebra Lengkap (wholespine) |
2,676,000 |
| 2507 |
CT Scan Non Kontras Vertebra Lengkap (wholespine) dengan anestesi |
3,794,000 |
| 2508 |
CT Scan Non Kontras Vertebra Lumbal |
2,139,000 |
| 2509 |
CT Scan Non Kontras Vertebra Lumbal dengan anestesi |
3,033,001 |
| 2510 |
CT Scan Non Kontras Vertebra Thoracal |
2,139,000 |
| 2511 |
CT Scan Non Kontras Vertebra Thoracal + Lumbal |
2,521,000 |
| 2512 |
CT Scan Non Kontras Vertebra Thoracal + Lumbal dengan anestesi |
3,455,001 |
| 2513 |
CT Scan Non Kontras Vertebra Thoracal dengan anestesi |
3,033,001 |
| 2514 |
CT Scan Non Kontras Wajah / Craniofacial |
2,139,000 |
| 2515 |
CT Scan Non Kontras Wajah / Craniofacial dengan anestesi |
3,033,001 |
| 2516 |
CT Scan Panoramik |
2,139,000 |
| 2517 |
CT Scan Panoramik dengan anestesi |
3,033,001 |
| 2518 |
CT Scan Peritoneography |
2,903,000 |
| 2519 |
CT Scan Peritoneography dengan anestesi |
3,877,001 |
| 2520 |
CT Scan Searching Stone (Traktus Urinarius) |
2,903,000 |
| 2521 |
CT Scan Searching Stone (Traktus Urinarius) dengan anestesi |
3,877,001 |
| 2522 |
CT Scan Simulator dengan kontras |
1,671,000 |
| 2523 |
CT Scan Simulator tanpa kontras |
1,671,000 |
| 2524 |
CT Scan Venografi Ekstremitas Inferior |
3,765,000 |
| 2525 |
CT Scan Venografi Ekstremitas Inferior dengan anestesi |
4,829,001 |
| 2526 |
CT Scan Venografi Ekstremitas Superior |
3,765,000 |
| 2527 |
CT Scan Venografi Ekstremitas Superior dengan anestesi |
4,829,001 |
| 2528 |
CT Simulator 3D-kompleks |
3,351,000 |
| 2529 |
CT Simulator 3D-sederhana |
2,234,000 |
| 2530 |
CT. Abdomen Full (Rujukan Luar) |
0 |
| 2531 |
CT. Kepala (Dengan Contras) |
900,000 |
| 2532 |
CTG (kardio tokografi) |
611,000 |
| 2533 |
Cuci Canule |
38,000 |
| 2534 |
Cuci Lambung |
121,000 |
| 2535 |
Cuci Trakea dan Bronkus (Termasuk Bronkoalveolar lavage dengan bronkoskopi fleksibel) |
8,200,000 |
| 2536 |
Curetase gigi |
337,000 |
| 2537 |
Curettage and bone graft for Large sized benign bone tumor (>10cm) |
25,883,000 |
| 2538 |
Curettage and bone graft for Small / medium sized benign bone tumor (<10cm) |
25,883,000 |
| 2539 |
Curretage pada rentensi plasenta / Mola Pertama |
352,000 |
| 2540 |
Custom Post/Saluran Akar |
0 |
| 2541 |
Cutting and preparation of pedicle grafts or flaps |
10,925,000 |
| 2542 |
CVP Akses Vaskuler |
2,540,000 |
| 2543 |
CVP Akses Vaskuler dengan USG |
2,540,000 |
| 2544 |
CVVH/CVVHD/CVVHDF/SCUF harian pasien dewasa |
30,671,000 |
| 2545 |
CVVH/CVVHD/CVVHDF/SCUF harian pasien neonatus |
30,671,000 |
| 2546 |
CVVH/CVVHD/CVVHDF/SCUF harian pasien pediatrik |
30,671,000 |
| 2547 |
Cyclocryo lokal |
7,284,001 |
| 2548 |
Cyclocryo narkose |
8,130,001 |
| 2549 |
Cyclodia Termi |
4,011,743 |
| 2550 |
Cyclodialysa |
3,997,000 |
| 2551 |
Cyfra 21-1 _ |
588,000 |
| 2552 |
Cyro Surgery Besar |
155,000 |
| 2553 |
Cyro Surgery Ringan |
90,000 |
| 2554 |
Cysjejunostomi |
6,175,000 |
| 2555 |
Cystography |
1,289,000 |
| 2556 |
Cystojejenostomi |
17,539,000 |
| 2557 |
Cystojejunostomi anastomosis roux en y |
18,995,000 |
| 2558 |
cystoscopic uretrocele/PUV excision |
2,628,000 |
| 2559 |
Cystoscopy biopsi (ESWL) |
2,500,000 |
| 2560 |
Cystoscopy Biopsi (ESWL) (Sore) |
3,750,000 |
| 2561 |
Cytomegalovirus (CMV) PCR |
1,200,000 |
| 2562 |
Cytoreductive Nefrektomi |
23,363,000 |
| 2563 |
D Dimer _ |
450,000 |
| 2564 |
D-DIMER/D-DIMER KUANTITATIF |
560,000 |
| 2565 |
Dacriocystography |
1,289,000 |
| 2566 |
Dacryo Cysto Rhinostomi |
11,581,770 |
| 2567 |
Dakriosistorinostomi (DCR) bilateral |
12,668,000 |
| 2568 |
Dakriosistorinostomi (DCR) unilateral |
11,904,000 |
| 2569 |
Daptone (Doppler) |
57,000 |
| 2570 |
Darah Droping ke BDRS 2024 |
490,000 |
| 2571 |
Darah Lengkap |
62,000 |
| 2572 |
Darah Per Bag ( BDRS ) |
400,000 |
| 2573 |
Darah Per Bag (PMI) |
325,000 |
| 2574 |
Darah Per Bag (PMI) |
490,000 |
| 2575 |
Darah Per Bag (PMI) 2024 |
490,000 |
| 2576 |
Darah Per Bag (PMI) A,B,O,AB,Rhesus -- Afaresis |
3,500,000 |
| 2577 |
Darah Per Bag (PMI) A,B,O,AB,Rhesus -- FFP |
325,000 |
| 2578 |
Darah Per Bag (PMI) A,B,O,AB,Rhesus -- FFP |
325,000 |
| 2579 |
Darah Per Bag (PMI) A,B,O,AB,Rhesus -- WB |
325,000 |
| 2580 |
Darah Per Bag (PMI) A,B,O,AB,Rhesus -- WE |
475,000 |
| 2581 |
Darah Per Bag (UTD Provinsi Sul-Sel) |
250,000 |
| 2582 |
Darah Per Bag (UTD Provinsi Sul-Sel) |
490,000 |
| 2583 |
Darah Per Bag (UTD Provinsi Sul-Sel) (Tindakan Cross Matching dan Golongan Darah) |
310,000 |
| 2584 |
Darah Per Bag (UTD Provinsi Sul-Sel) (Tindakan Cross Matching dan Golongan Darah) 2024 |
490,000 |
| 2585 |
Darah Per Bag (UTD Provinsi Sul-Sel) 2024 |
490,000 |
| 2586 |
Darah Per Bag (UTD Provinsi Sul-Sel) Tindakan Cross Matching dan Golongan Darah) |
490,000 |
| 2587 |
Darah Per Bag Persiapan |
0 |
| 2588 |
Darah Perifer Lengkap Serial |
68,000 |
| 2589 |
DARAH PRC LEUKODEPLETED |
124,000 |
| 2590 |
Darah Rutin |
0 |
| 2591 |
Daye Test |
100,000 |
| 2592 |
DCR + Silikon Tube |
8,350,000 |
| 2593 |
De Quervain Syndrome Manual (tanpa panduan) |
281,000 |
| 2594 |
De Quervain Syndrome USG |
595,000 |
| 2595 |
Debonding |
600,000 |
| 2596 |
Debonding (Eksekutif) |
0 |
| 2597 |
Debonding bracket per gigi |
660,000 |
| 2598 |
Debridemen Dan Nekrotomi Dekubitus, LA |
14,707,000 |
| 2599 |
Debridemen gangren Fournier |
13,397,000 |
| 2600 |
Debridemen Intra Oral / Ekstra Oral dengan General Anestesi |
9,220,000 |
| 2601 |
Debridemen luka anak |
839,000 |
| 2602 |
Debridemen Luka Dengan Anastesi Lokal (Bedah Mulut) |
794,000 |
| 2603 |
Debridemen luka luas (1 regio tubuh atau lebih) |
2,103,000 |
| 2604 |
Debridement & application of external fixation for Open fracture GA III of long bone (Single) |
17,616,000 |
| 2605 |
Debridement & application of Joint spanning external fixation for Open fracture of periarticular / intra articular |
17,616,000 |
| 2606 |
Debridement & external splinting for Open fracture GA I-II of long bone (Single) |
12,860,000 |
| 2607 |
Debridement & ORIF for Open Fracture GA I-II of shaft long bone (Single) |
23,824,000 |
| 2608 |
Debridement & Primary Suture for Open wound (<10cm without skin loss) |
11,575,500 |
| 2609 |
Debridement & Primary Suture for Open wound (>10cm without skin loss) |
12,860,000 |
| 2610 |
Debridement + Jahit luka |
12,860,000 |
| 2611 |
Debridement + STSG |
25,708,000 |
| 2612 |
Debridement and anterior fusion in TB spine |
4,850,000 |
| 2613 |
Debridement and decompression for Specific / pyogenic spondylitis |
18,437,000 |
| 2614 |
Debridement angkat graft perifer |
12,837,000 |
| 2615 |
Debridement dan evakuasi hematom |
12,837,000 |
| 2616 |
Debridement dan tutup defek kaki diabetik/CVI sederhana |
12,032,000 |
| 2617 |
Debridement dan tutup defek pada gangren diabetik |
12,032,000 |
| 2618 |
Debridement dengan alat khusus |
10,906,000 |
| 2619 |
Debridement dengan amputasi minor kaki diabetik |
25,603,000 |
| 2620 |
Debridement dengan falp |
4,850,000 |
| 2621 |
Debridement dengan Skingarfting Kecil |
3,850,000 |
| 2622 |
Debridement dengan Skingarfting Luas |
4,850,000 |
| 2623 |
Debridement eksisi gangren/ulkus diabetik |
12,032,000 |
| 2624 |
Debridement eksisi kompleks |
10,906,000 |
| 2625 |
Debridement eksisi sederhana |
7,270,000 |
| 2626 |
Debridement for Diabetic Foot |
17,616,000 |
| 2627 |
Debridement for Necrotic tissue (Multiple) |
17,616,000 |
| 2628 |
Debridement for Necrotic tissue (Single) |
12,032,000 |
| 2629 |
Debridement for Open fracture GA I-II |
12,860,000 |
| 2630 |
Debridement for total joint arthroplasty with implant retention (modular part exchange) |
16,353,000 |
| 2631 |
Debridement Hecting besar - Op |
5,270,000 |
| 2632 |
Debridement Hecting kecil-Op |
3,688,000 |
| 2633 |
Debridement kompleks |
10,905,000 |
| 2634 |
Debridement Luka Bakar Fase Akut <15%, GA |
9,744,000 |
| 2635 |
Debridement Luka Bakar Fase Akut <15%, LA |
8,380,000 |
| 2636 |
Debridement luka besar ( > 10 cm) |
701,000 |
| 2637 |
Debridement luka kecil (< 6 cm) |
481,000 |
| 2638 |
Debridement luka neonatus |
839,000 |
| 2639 |
Debridement luka sedang (6 cm - 10 cm) |
561,001 |
| 2640 |
Debridement of nail, nail bed, or nail fold |
3,125,000 |
| 2641 |
Debridement of open fracture of carpals and metacarpals |
11,516,003 |
| 2642 |
Debridement of open fracture of femur |
11,116,003 |
| 2643 |
Debridement of open fracture of humerus |
3,125,000 |
| 2644 |
Debridement of open fracture of phalanges of foot |
6,486,003 |
| 2645 |
Debridement of open fracture of phalanges of hand |
11,516,003 |
| 2646 |
Debridement of open fracture of radius and ulna |
11,516,003 |
| 2647 |
Debridement of open fracture of tarsals and metatarsals |
6,486,003 |
| 2648 |
Debridement of open fracture of tibia and fibula |
23,016,003 |
| 2649 |
Debridement only anterior / posterior for Specific / pyogenic spondylitis |
17,616,000 |
| 2650 |
Debridement or abcess drainage for Finger infection |
11,482,000 |
| 2651 |
Debridement Pada Luka Bakar < 40% |
5,579,641 |
| 2652 |
Debridement Pada Luka Bakar > 40% |
6,348,641 |
| 2653 |
Debridement rawat luka |
561,001 |
| 2654 |
Debridement Ringan (Lokal) |
481,000 |
| 2655 |
Debridement sederhana |
7,270,000 |
| 2656 |
Debridement Tajam pada Luka Besar dengan Bius Lokal ( > 11 cm) |
767,000 |
| 2657 |
Debridement Tajam pada Luka Besar tanpa Bius Lokal ( > 11 cm) |
588,000 |
| 2658 |
Debridement Tajam pada Luka Kecil dengan Bius Lokal (< 5 cm) |
577,000 |
| 2659 |
Debridement Tajam pada Luka Kecil tanpa Bius Lokal (< 5 cm) |
481,000 |
| 2660 |
Debridement Tajam pada Luka Sedang dengan Bius Lokal (6 cm - 10 cm) |
674,000 |
| 2661 |
Debridement Tajam pada Luka Sedang tanpa Bius Lokal (6 cm - 10 cm) |
561,001 |
| 2662 |
Debridement Ulang Vaskuler/ Debridement dng amputasi mayor |
2,850,000 |
| 2663 |
Debridement. saucerization & sequestrectomy for Chronic osteomyelitis |
10,676,000 |
| 2664 |
Debridement/EmbolisasiSederhana/Op.JantungTertutup/PTA/TAI |
13,150,000 |
| 2665 |
Debulking |
16,124,000 |
| 2666 |
Debulking |
6,917,222 |
| 2667 |
Debulking atau Surgical staging pada keganasan ginekologi lainnya per laparoskopi |
18,442,000 |
| 2668 |
Debulking for Macrodactily |
16,124,000 |
| 2669 |
Debulking karsinoma endometrium per laparoskopi |
18,442,000 |
| 2670 |
Debulking karsinoma endometrium per laparotomi |
17,442,000 |
| 2671 |
Debulking karsinoma ovarium per laparoskopi |
18,442,000 |
| 2672 |
Debulking karsinoma ovarium per laparotomi |
17,442,000 |
| 2673 |
Debulking karsinoma serviks |
17,442,000 |
| 2674 |
Debulking keganasan ginekologi lainnya per laparotomi |
17,442,000 |
| 2675 |
Debulking tumor |
20,048,000 |
| 2676 |
Decompression Endolympatic Sac Exposure |
12,668,000 |
| 2677 |
Decompression only (laminectomy or laminotomy) (Single) for Compression of spinal cord or nerve root |
34,582,000 |
| 2678 |
Defibrilasi |
934,000 |
| 2679 |
Defibrilator |
1,067,000 |
| 2680 |
Deflasi dengan Anastesi Lokal |
860,000 |
| 2681 |
Deformity correction (multiple) for Spinal deformity |
34,119,000 |
| 2682 |
Dekanulasi |
250,000 |
| 2683 |
Dekanulasi Trakeostomi |
379,000 |
| 2684 |
Dekompresi (laminektomi konvensional) |
37,385,000 |
| 2685 |
Dekompresi dan stablisasi anterior approach bila terdapat instabilitas (auto/allo bonegraft, implant -spine instrumentasi) |
37,385,000 |
| 2686 |
Dekompresi foramen magnum |
27,360,000 |
| 2687 |
Dekompresi laminektomi konvensional |
30,703,000 |
| 2688 |
Dekompresi medulla spinalis dengan fiksasi atlanto-axial : Pasang odontoid screw |
37,385,000 |
| 2689 |
Dekompresi medulla spinalis dengan fusi instrumentasi atlanto-axial esensial |
37,385,000 |
| 2690 |
Dekompresi medulla spinalis dengan fusi intrumentasi atlanto-axial advance/kompleks |
37,385,000 |
| 2691 |
Dekompresi orbita |
6,357,000 |
| 2692 |
Dekompresi Saraf Fasialis |
22,801,000 |
| 2693 |
Dekompresi Saraf Optikus |
15,526,000 |
| 2694 |
Dekompresi Syaraf Tepi |
5,382,587 |
| 2695 |
Dekompresia Fasialis |
5,482,645 |
| 2696 |
Dekortifikasi |
12,175,000 |
| 2697 |
Delayed suture of flexor tendon of hand |
11,196,000 |
| 2698 |
Delayed suture of other tendon of hand |
9,682,099 |
| 2699 |
Delayed suture of tendon |
11,196,000 |
| 2700 |
Denervasi / Blok Facet Perkutan |
361,000 |
| 2701 |
DENGUE NS-1 |
544,000 |
| 2702 |
Dengue NS1 _ |
250,000 |
| 2703 |
Denis Brown |
3,800,000 |
| 2704 |
Dental Rontgen Foto (Non Rujukan) |
0 |
| 2705 |
Dermabrasi |
204,000 |
| 2706 |
Dermabrasi (Luas) |
598,000 |
| 2707 |
Dermabrasi (Sedikit) |
282,000 |
| 2708 |
Dermabrasi Berat |
642,000 |
| 2709 |
Dermabrasi Ringan |
331,000 |
| 2710 |
Dermabrasi Sedang |
464,000 |
| 2711 |
Dermaroller |
0 |
| 2712 |
Dermoskopi 1 (1-2 lesi) |
154,000 |
| 2713 |
Dermoskopi 2 (3-5 lesi) |
192,000 |
| 2714 |
Dermoskopi 3 (>5 lesi) |
269,000 |
| 2715 |
Dermoskopi 4 (whole body + skin imaging) |
307,000 |
| 2716 |
Deroofing/unroofing kista |
4,850,000 |
| 2717 |
Derotational osteotomy with/out acetabulopasty for Perthes disease |
23,914,000 |
| 2718 |
Deseksi Kelenjar Inguinal |
5,299,955 |
| 2719 |
Desensitisasi obat level I (durasi 12 jam) |
121,000 |
| 2720 |
Desensitisasi obat level II (durasi 24 jam) |
200,000 |
| 2721 |
Desinfektan Jenazah |
100,000 |
| 2722 |
Desinfektan Jenazah |
100,000 |
| 2723 |
Desinfektan Mobil Jenazah |
100,000 |
| 2724 |
Desinfektan Mobil Jenazah |
100,000 |
| 2725 |
Desmopresin (DDAVP) test |
345,000 |
| 2726 |
Destruksi Saraf Perifer Berpandu USG Dengan Agen Neurolitik |
623,000 |
| 2727 |
Destruksi Saraf Perifer Berpandu USG Dengan Cryoanalgesia |
830,000 |
| 2728 |
Destruksi Saraf Perifer Berpandu USG Dengan Radiofrequency Ablation |
830,000 |
| 2729 |
Detorsi testis + Orchidopexy |
6,238,462 |
| 2730 |
Detorsi testis + orchidopexy |
7,257,000 |
| 2731 |
Devitalisasi / Sterilisasi |
162,000 |
| 2732 |
Devitalisasi Saluran Akar Dengan Anastesi |
210,000 |
| 2733 |
Devitalisasi Saluran Akar Dengan Anastesi (Eksekutif) |
0 |
| 2734 |
Devitalisasi Saluran Akar Dengan Arsen |
210,000 |
| 2735 |
Devitalisasi Saluran Akar Dengan Arsen (Eksekutif) |
0 |
| 2736 |
DHF IGg/IgM (ICT) |
220,000 |
| 2737 |
Dialectical Behavioral Therapy pada anak dan remaja |
350,000 |
| 2738 |
Dialectical Behavioral Therapy pada dewasa |
350,000 |
| 2739 |
Dialectical Behavioral Therapy pada Gangguan Penggunaan Zat/Adiksi perilaku |
350,000 |
| 2740 |
Dialectical Behavioral Therapy pada lansia |
350,000 |
| 2741 |
Dialisis Peritoneal |
66,000 |
| 2742 |
Diaphgramatic stripping karsinoma ovarium |
10,949,000 |
| 2743 |
Diathermy |
75,000 |
| 2744 |
Dietary Survielance and Councelling pada Penyakit Khusus |
100,000 |
| 2745 |
Dietary Survielance and Councelling pada Weight Management |
100,000 |
| 2746 |
Digital Stimulasi Rectal |
199,000 |
| 2747 |
Dignity Therapy |
300,000 |
| 2748 |
Dikortikasi ( Bedah Paru/Thorax) |
21,102,000 |
| 2749 |
Dilatasi (dengan balon) Esofagus/Gaster/Duodenum/Colon/Rektosigmoid/Bilier |
17,610,000 |
| 2750 |
Dilatasi (Dengan Balon) Esofagus/Gaster/Duodenum/Colon/Rektosigmoid/Bilier (Sore) |
17,610,000 |
| 2751 |
Dilatasi Duktus Frontonasal bilateral perendoskopi |
10,390,000 |
| 2752 |
Dilatasi Duktus Frontonasal perendoskopi |
10,390,000 |
| 2753 |
Dilatasi esofagus |
3,274,000 |
| 2754 |
Dilatasi Katup Mitral (Balon Mitral Valvulotomy / Valvuloplasty) Dengan Trans Esofageal Ekokardiografi (TEE) Guiding Dan Anestesi |
89,437,000 |
| 2755 |
Dilatasi Katup Pulmonal (Balon Pulmonal Valvotomy) pada Critical Pulmonary Stenosis + anestesi |
89,437,000 |
| 2756 |
Dilatasi Katup Pulmonal (Balon Pulmonal Valvulotomy / Valvuloplasty) Dengan Anestesi |
89,437,000 |
| 2757 |
Dilatasi Phimosis |
66,000 |
| 2758 |
Dilatasi Punctum |
59,000 |
| 2759 |
Dilatasi striktur esofagus dengan dilator balon |
21,290,000 |
| 2760 |
Dilatasi striktur pilorus, duodenum, jejunum, ileum dan kolon |
17,990,000 |
| 2761 |
Dilatasi/ Kalibrasi Uretra Lokal |
2,920,000 |
| 2762 |
Dilatasi/ Kalibrasi Uretra Narkose |
6,813,000 |
| 2763 |
Direct Catheter Thrombolytic (CDT) |
26,604,000 |
| 2764 |
Direct Veneer/(Composite) |
0 |
| 2765 |
Disarticulation of ankle |
5,247,099 |
| 2766 |
Disarticulation of elbow |
5,247,099 |
| 2767 |
Disarticulation of hip |
5,247,099 |
| 2768 |
Disarticulation of knee |
5,247,099 |
| 2769 |
Disarticulation of shoulder |
5,247,099 |
| 2770 |
Disarticulation of wrist |
5,247,099 |
| 2771 |
Discography (Multiple) for Chronic back pain / leg pain |
13,462,000 |
| 2772 |
Discography (Single) for Chronic back pain / leg pain |
12,638,000 |
| 2773 |
Disekectomy lumbal (minimal invasive/endoscopic) |
27,360,000 |
| 2774 |
Disekectomy lumbal (open surgery) |
37,385,000 |
| 2775 |
Disekectomy torakal (minimal invasive/endoscopic) |
27,360,000 |
| 2776 |
Disekectomy torakal (open surgery) |
37,385,000 |
| 2777 |
Diseksi Kelenjar Getah Bening Inguinal |
20,681,000 |
| 2778 |
Diseksi kelenjar inguinal |
21,301,000 |
| 2779 |
Diseksi kelenjar limfe pelvik/ paraaorta (node debulking) |
20,359,000 |
| 2780 |
Diseksi KGB Deep |
17,094,000 |
| 2781 |
Diseksi KGB Pelvis |
7,885,000 |
| 2782 |
Diseksi KGB Superfisial |
17,999,000 |
| 2783 |
Diseksi Leher Bilateral |
28,193,000 |
| 2784 |
Diseksi leher posteralateral ( 1 sisi ) |
18,522,000 |
| 2785 |
Diseksi leher radikal klasik ( 1 sisi ) |
20,048,000 |
| 2786 |
Diseksi Leher Radikal Modifikasi |
33,156,000 |
| 2787 |
Diseksi leher radikal modifikasi/fungsional |
33,156,000 |
| 2788 |
Diseksi Leher Radikal Modifikasi/Fungsional |
4,599,000 |
| 2789 |
Diseksi Leher Selektif |
18,193,000 |
| 2790 |
Diseksi leher supra omohyoid ( 1 sisi ) |
18,522,000 |
| 2791 |
Diseksi leher upper neck ( 1 sisi ) |
18,522,000 |
| 2792 |
Disektomi TMJ |
15,538,000 |
| 2793 |
Disk arthroplasty |
27,360,000 |
| 2794 |
Distant Flap for Soft tissue defect |
34,463,001 |
| 2795 |
Divertikulektomi |
6,923,213 |
| 2796 |
Divertikulektomi Faring |
10,586,000 |
| 2797 |
Divertikulektomi Vesika |
8,215,530 |
| 2798 |
Divertikulektomi vesika narkose |
13,040,000 |
| 2799 |
Divertikulum uretra |
4,850,000 |
| 2800 |
Division of joint capsule, ligament, or cartilage of ankle |
8,105,000 |
| 2801 |
Division of joint capsule, ligament, or cartilage of elbow |
8,105,000 |
| 2802 |
Division of joint capsule, ligament, or cartilage of foot and toe |
8,105,000 |
| 2803 |
Division of joint capsule, ligament, or cartilage of hand and finger |
8,105,000 |
| 2804 |
Division of joint capsule, ligament, or cartilage of hip |
8,105,000 |
| 2805 |
Division of joint capsule, ligament, or cartilage of knee |
8,105,000 |
| 2806 |
Division of joint capsule, ligament, or cartilage of shoulder |
8,105,000 |
| 2807 |
Division of joint capsule, ligament, or cartilage of wrist |
8,105,000 |
| 2808 |
Division Of Trigeminal Nerve (Retrogasserian Neurotomy) With Fluoroscopy Guided |
354,000 |
| 2809 |
Division Of Trigeminal Nerve (Retrogasserian Neurotomy) With USG Guided |
364,000 |
| 2810 |
Dokumentasi Wajah |
300,000 |
| 2811 |
DOLV repair |
112,316,000 |
| 2812 |
Donor Ginjal LLDN |
166,000,000 |
| 2813 |
Donor Transplant dengan operasi terbuka (Khusus III+khusus II) |
83,365,000 |
| 2814 |
Dorsal and dorsolumbar fusion, anterior technique |
9,957,600 |
| 2815 |
Dorsal and dorsolumbar fusion, posterior technique |
9,957,600 |
| 2816 |
Dorsumsisi Lokal |
4,012,000 |
| 2817 |
Dorsumsisi Narkose |
4,870,000 |
| 2818 |
DORV/DOLV repair (intraventricular tunelling) |
112,317,000 |
| 2819 |
Double curve correction for scoliosis |
35,012,000 |
| 2820 |
Double Lumen Catheter |
4,784,000 |
| 2821 |
Double pelvic osteotomy and internal or external fixation for Symphysiolysis |
12,528,000 |
| 2822 |
Double Rotation Skin Flap, LA |
19,533,000 |
| 2823 |
Double Valve Repair (DVr) |
154,434,000 |
| 2824 |
Double Valve Replacement (DVR) |
167,901,000 |
| 2825 |
DPOAE 11 Frekuensi |
281,000 |
| 2826 |
DPOAE Diagnostic |
281,000 |
| 2827 |
DPOAE Skrining |
281,000 |
| 2828 |
Drainage Asites Percutaneus |
21,853,000 |
| 2829 |
Drainage Asites Percutaneus (Sore) |
28,000,000 |
| 2830 |
Drainage Internal Pankreaas |
9,590,000 |
| 2831 |
Drainage Internal Pankreaas (Sore) |
14,380,000 |
| 2832 |
Drainage Kista Pankreas |
3,850,000 |
| 2833 |
Drainage Periureter |
5,132,887 |
| 2834 |
Drainage periureter (narkose) |
9,284,000 |
| 2835 |
Drainase abscess hati |
7,850,000 |
| 2836 |
Drainase Abses Perinefrik/ Paranefrik Narkose |
13,421,000 |
| 2837 |
Drainase abses serebri |
25,091,000 |
| 2838 |
Drainase Eksternal Kasus Kompleks |
5,767,000 |
| 2839 |
Drainase Eksternal Kasus Kompleks dengan anestesi |
6,921,000 |
| 2840 |
Drainase Eksternal Kasus Simpel |
6,821,000 |
| 2841 |
Drainase Pus Pada Tuboovarial Abses Dengan Punksi Doglasi |
2,850,000 |
| 2842 |
Drainase urinoma |
1,181,000 |
| 2843 |
Drainase Urinoma Narkose |
13,859,000 |
| 2844 |
Dry Needling |
250,000 |
| 2845 |
Dry needling (paket 1) |
219,000 |
| 2846 |
Dry needling (paket 2) |
335,000 |
| 2847 |
Dry needling (paket 3) |
434,000 |
| 2848 |
DSA (Digital Substracting Angiogram) Craniocervical Kasus Kompleks |
7,972,000 |
| 2849 |
DSA (Digital Substracting Angiogram) Craniocervical Kasus Kompleks dengan anestesi |
9,305,000 |
| 2850 |
DSA (Digital Substracting Angiogram) Craniocervical Kasus Simpel |
6,846,000 |
| 2851 |
DSA (Digital Substracting Angiogram) Craniocervical Kasus Simpel dengan anestesi |
8,040,000 |
| 2852 |
DSA (Digital Substracting Angiogram) Diagnostik Kasus Kompleks |
8,553,000 |
| 2853 |
DSA (Digital Substracting Angiogram) Diagnostik Kasus Simpel |
8,672,000 |
| 2854 |
DSA (Digital Substracting Angiogram) Diagnostik Kasus Simpel dengan anestesi |
10,091,000 |
| 2855 |
DSA (Digital Substracting Angiogram) Spinal Kasus Kompleks |
7,972,000 |
| 2856 |
DSA (Digital Substracting Angiogram) Spinal Kasus Kompleks dengan anestesi |
9,305,000 |
| 2857 |
DSA (Digital Substracting Angiogram) Spinal Kasus Simpel |
6,846,000 |
| 2858 |
DSA (Digital Substracting Angiogram) Spinal Kasus Simpel dengan anestesi |
8,040,000 |
| 2859 |
DSA/ HLA ANTIBODY |
21,880,000 |
| 2860 |
Ductulografi |
1,289,000 |
| 2861 |
Ductulography |
375,000 |
| 2862 |
Duedenoduodenostomi /Duodenojejunostomi |
9,464,367 |
| 2863 |
Duhamel-Adang procedure |
32,364,000 |
| 2864 |
Duhamel-Martin procedure |
32,364,000 |
| 2865 |
Duodenoduodenostomi/duodenojejunostomi |
22,542,000 |
| 2866 |
Dural Repair |
23,914,000 |
| 2867 |
DXA Total Body Composition |
703,000 |
| 2868 |
Ear Toilet Pasca Operasi |
562,000 |
| 2869 |
Ebstein(TV)Anomali Repair/TAPVD |
53,150,000 |
| 2870 |
Echo Anak |
400,000 |
| 2871 |
Echo Dewasa |
300,000 |
| 2872 |
ECHO Fungsional Neonatus |
571,000 |
| 2873 |
Echocardiography |
0 |
| 2874 |
Echocardiography hemodynamic pasien dewasa |
774,000 |
| 2875 |
Echocardiography hemodynamic pasien neonatus |
774,000 |
| 2876 |
Echocardiography hemodynamic pasien pediatrik |
774,000 |
| 2877 |
ECP (External Counter pulsation) paket 35x kedatangan |
25,590,001 |
| 2878 |
ECP (External Counter pulsation) paket 5x kedatangan |
3,412,000 |
| 2879 |
ECP (External Counter pulsation) per-kedatangan |
853,000 |
| 2880 |
Edema Test |
78,000 |
| 2881 |
Educational therapy terkait gizi |
133,000 |
| 2882 |
Edukasi Gizi |
120,000 |
| 2883 |
Edukasi Keluarga |
0 |
| 2884 |
Edukasi Keluarga (RJ) |
0 |
| 2885 |
Edukasi Kemotherapi |
100,000 |
| 2886 |
Edukasi Kesehatan Individu |
71,000 |
| 2887 |
Edukasi Kesehatan Kelompok / Komunitas |
210,000 |
| 2888 |
Edukasi penyakit kompleks paru antara lain terdiri dari TB RO, terapi inhalasi |
351,000 |
| 2889 |
EEG - Anak |
960,000 |
| 2890 |
EEG rutin |
906,000 |
| 2891 |
EGD dengan Hemospray |
18,210,000 |
| 2892 |
EGD Dengan Hemospray (Sore) |
18,210,000 |
| 2893 |
EGFR Mutasi |
1,620,000 |
| 2894 |
EKG/Elektrokardiografi |
73,000 |
| 2895 |
Ekokardiografi Transesofageal (TEE) dengan anestesi |
1,518,000 |
| 2896 |
Ekokardiografi Transesofageal (TEE) Lanjut (strain / 3D/ Evaluasi RV) |
1,562,000 |
| 2897 |
Ekokardiografi Transesofageal (TEE) lanjut + bubble test |
1,947,000 |
| 2898 |
Ekokardiografi Transesofageal (TEE) pada prosedur bedah/non bedah |
1,200,000 |
| 2899 |
Ekokardiografi Transesofageal (TEE) Standar |
1,200,000 |
| 2900 |
Ekokardiografi Transtorakal (TTE) dengan bubble test |
1,191,000 |
| 2901 |
Ekokardiografi Transtorakal (TTE) Lanjut (strain / 3D/ Evaluasi RV) |
1,296,000 |
| 2902 |
Ekokardiografi Transtorakal (TTE) pada prosedur intervensi bedah/non bedah |
822,000 |
| 2903 |
Ekokardiografi Transtorakal (TTE) Standar |
822,000 |
| 2904 |
Eksenterasi |
12,661,000 |
| 2905 |
Eksenterasi kompleks |
13,549,000 |
| 2906 |
Eksenterasi ringan |
10,837,000 |
| 2907 |
eksisi / destruksi lesi lain dari telinga luar |
9,083,000 |
| 2908 |
Eksisi / Ekstirpasi Salolith dengan Anastesi Lokal |
860,000 |
| 2909 |
Eksisi / Esterpasi |
80,000 |
| 2910 |
Eksisi & rekonstruksi vaskuler pada malformasi vaskuler |
55,602,000 |
| 2911 |
Eksisi Angiofibroma Nasofaring |
6,350,000 |
| 2912 |
Eksisi atau dekstruksi lesi vagina |
14,283,000 |
| 2913 |
Eksisi Baker Cyst |
5,008,000 |
| 2914 |
Eksisi Baker Cyst ? 3cm |
11,316,000 |
| 2915 |
Eksisi Baker Cyst > 3cm |
11,316,000 |
| 2916 |
Eksisi Basalioma |
1,350,000 |
| 2917 |
Eksisi Basalioma Dengan Skin Flap, LA |
1,157,000 |
| 2918 |
Eksisi besar > 6 cm |
8,261,000 |
| 2919 |
Eksisi Biopsy dengan Anastesi Lokal |
860,000 |
| 2920 |
Eksisi Ca Laring dengan Laser |
3,850,000 |
| 2921 |
Eksisi Chalazion/Hordeolum |
675,000 |
| 2922 |
Eksisi Chodee |
5,149,000 |
| 2923 |
Eksisi Chordae Hyspospadia |
4,850,000 |
| 2924 |
Eksisi Clavus |
250,000 |
| 2925 |
Eksisi Condiloma Accuminata |
66,000 |
| 2926 |
Eksisi condiloma komplek |
15,380,000 |
| 2927 |
Eksisi dan ligasi malformasi vaskular kompleks |
69,504,000 |
| 2928 |
Eksisi dan ligasi malformasi vaskular sederhana |
55,602,000 |
| 2929 |
Eksisi dan rekonstruksi limfedema |
21,420,000 |
| 2930 |
Eksisi Dengan Lokal Anastesi |
675,000 |
| 2931 |
Eksisi Denture Hyperplasia dengan Anastesi Lokal |
860,000 |
| 2932 |
Eksisi Divertikel Uretra |
11,687,000 |
| 2933 |
Eksisi Divertikulum Esofagus |
7,075,000 |
| 2934 |
Eksisi Duktus Tiroglosus |
9,496,000 |
| 2935 |
Eksisi FAM ? 3cm |
7,166,000 |
| 2936 |
Eksisi FAM < 5cm |
2,623,437 |
| 2937 |
Eksisi FAM > 5cm |
2,850,000 |
| 2938 |
Eksisi FAM >3cm |
10,804,000 |
| 2939 |
Eksisi FAM Multiple |
14,482,000 |
| 2940 |
Eksisi Fibroma |
2,850,000 |
| 2941 |
Eksisi Fistel / Abses Preauricular |
9,083,000 |
| 2942 |
Eksisi Fistel Preauricular |
2,850,000 |
| 2943 |
Eksisi Fistel Preaurikula |
9,449,000 |
| 2944 |
Eksisi Fistel Preaurikula, LA |
7,788,000 |
| 2945 |
Eksisi Ganglion |
9,450,000 |
| 2946 |
Eksisi Giant Nevus (tampa skin graft) |
2,850,000 |
| 2947 |
Eksisi Giant Nevus + skin graft |
4,850,000 |
| 2948 |
Eksisi Granuloma |
250,000 |
| 2949 |
Eksisi Granuloma (Poli Mata) |
675,000 |
| 2950 |
Eksisi Granuloma Pyogenikum |
250,000 |
| 2951 |
Eksisi granuloma umbilikal |
48,553,000 |
| 2952 |
Eksisi Granuloma/Granuloma Hibilical/Hemanioma Kecil |
2,159,000 |
| 2953 |
Eksisi Gynecomastie |
4,995,000 |
| 2954 |
Eksisi Haemangioma Dengan Composite Flap, GA |
13,664,000 |
| 2955 |
Eksisi Haemangioma Dengan Composite Flap, LA |
11,893,000 |
| 2956 |
Eksisi Haemangioma Dengan Simple Advancement Flap, GA |
13,664,000 |
| 2957 |
Eksisi Haemangioma Dengan Simple Advancement Flap, LA |
11,893,000 |
| 2958 |
Eksisi Haemangioma Dengan Skin Flap Lokal, LA |
11,893,000 |
| 2959 |
Eksisi Haemangioma Dengan Skin Flap, GA |
13,664,000 |
| 2960 |
Eksisi Haemangioma Dengan Skingrafting, GA |
13,664,000 |
| 2961 |
Eksisi Haemangioma Dengan Skingrafting, LA |
11,893,000 |
| 2962 |
Eksisi Heangiona Luas |
6,792,089 |
| 2963 |
Eksisi Hemangioma < 3 cm |
8,076,000 |
| 2964 |
Eksisi Hemangioma > 3 cm |
11,309,000 |
| 2965 |
Eksisi Hemangioma Besar skingraft STSG/FTSG |
5,634,913 |
| 2966 |
Eksisi Hemangioma Besar/Multiple |
5,634,913 |
| 2967 |
Eksisi hemangioma besar/multiple |
14,313,000 |
| 2968 |
Eksisi hemangioma dengan skin graft STSG/FTSG |
25,706,000 |
| 2969 |
Eksisi Hemangioma Kecil |
2,850,000 |
| 2970 |
Eksisi hemangioma kompleks |
11,309,000 |
| 2971 |
Eksisi Hemangioma Sedang |
3,850,000 |
| 2972 |
Eksisi hemangioma sederhana |
8,076,000 |
| 2973 |
Eksisi Higroma |
4,850,000 |
| 2974 |
Eksisi higroma colli/limfangioma kompleks |
21,659,000 |
| 2975 |
Eksisi higroma colli/limfangioma simple |
17,327,000 |
| 2976 |
Eksisi Higroma Pada Anak |
6,238,462 |
| 2977 |
Eksisi Hygroma Colli/Axilla Neonatus |
6,175,000 |
| 2978 |
Eksisi hygroma colli/axilla pada neonatus |
21,421,000 |
| 2979 |
Eksisi Hygroma/Lympohagioma Simple |
3,850,000 |
| 2980 |
Eksisi Intrakeloidal + Jahit Primer, LA |
11,893,000 |
| 2981 |
Eksisi Intrakeloidal Diluar Wajah, LA |
11,893,000 |
| 2982 |
Eksisi Intrakeloidal Wajah, LA |
11,893,000 |
| 2983 |
Eksisi Karunkula |
6,844,000 |
| 2984 |
Eksisi Karunkula Narkose |
8,030,000 |
| 2985 |
Eksisi kelenjar getah bening/Limfadenektomi |
14,148,000 |
| 2986 |
Eksisi kelenjar getah bening/Limfadenektomi kompleks |
16,975,000 |
| 2987 |
Eksisi kelenjar getah bening/Limfadenektomi simple |
11,316,000 |
| 2988 |
Eksisi kelenjar limfe lain |
20,359,000 |
| 2989 |
Eksisi kelenjar limfe regional |
20,359,000 |
| 2990 |
Eksisi kelenjar liur submandibula |
11,316,000 |
| 2991 |
Eksisi Kelenjar Liur Submandibula |
3,887,600 |
| 2992 |
Eksisi Keloid + Skin Grafting - Komplek, GA |
19,542,000 |
| 2993 |
Eksisi Keloid + Skin Grafting - Revisi Dengan Multiple Z Plast, GA |
19,542,000 |
| 2994 |
Eksisi Keloid + Skin Grafting - Revisi Dengan Simple Advancement, GA |
19,542,000 |
| 2995 |
Eksisi Keloid + Skin Grafting - Revisi Dengan Single Z Plasty, GA |
19,542,000 |
| 2996 |
Eksisi Keloid + Skin Grafting , GA |
19,542,000 |
| 2997 |
Eksisi Keloid + Skin Grafting, LA |
17,159,000 |
| 2998 |
Eksisi Keloid < 5 cm |
66,000 |
| 2999 |
Eksisi Keloid Dengan Flap, LA |
18,015,000 |
| 3000 |
Eksisi kista Bartholin |
8,874,000 |
| 3001 |
Eksisi Kista Brachialis |
3,850,000 |
| 3002 |
Eksisi kista brachiogenik simple |
11,316,000 |
| 3003 |
Eksisi kista branchial kompleks |
13,667,000 |
| 3004 |
Eksisi kista branchial simple |
9,110,000 |
| 3005 |
Eksisi Kista Branchiogenik |
3,936,000 |
| 3006 |
Eksisi Kista Bronchial |
6,238,462 |
| 3007 |
Eksisi Kista Dermoid, LA |
18,015,000 |
| 3008 |
Eksisi Kista Duktus Kholedukhus |
17,350,000 |
| 3009 |
Eksisi kista duktus tiroglosus |
11,316,000 |
| 3010 |
Eksisi Kista Duktus Triglosus |
5,059,548 |
| 3011 |
Eksisi kista Gartner, Skene |
1,230,000 |
| 3012 |
Eksisi kista saluran empedu |
28,626,000 |
| 3013 |
Eksisi Kista Saluran Empedu |
6,175,000 |
| 3014 |
Eksisi Kista Tiroglosus |
3,892,000 |
| 3015 |
Eksisi Kista Urachus |
6,238,462 |
| 3016 |
Eksisi kista urachus |
14,313,000 |
| 3017 |
Eksisi Lesi di Faring, Tonsil dan Adenoid |
12,503,000 |
| 3018 |
Eksisi Lesi Hidung |
8,869,000 |
| 3019 |
Eksisi lesi jinak kulit |
604,000 |
| 3020 |
Eksisi lesi jinak perianal |
1,024,999 |
| 3021 |
Eksisi Lesi Laring (Papiloma, Nodul) dengan mikrolaring |
11,346,000 |
| 3022 |
Eksisi Lesi Liang Telinga |
9,083,000 |
| 3023 |
Eksisi Lesi Neoplasma Palatum Durum |
9,449,000 |
| 3024 |
Eksisi lesi perianal (skin tag, haematoma, viral warts etc) |
9,449,000 |
| 3025 |
Eksisi lesi telinga tengah dengan mikroskop |
13,988,000 |
| 3026 |
Eksisi Lesi Trakea |
11,390,000 |
| 3027 |
Eksisi ligasi dan rekonstruksi malformasi vaskuler sederhana |
55,602,000 |
| 3028 |
Eksisi Ligasi pseudoaneurisma kompleks |
14,313,000 |
| 3029 |
Eksisi Limfangioma |
13,667,000 |
| 3030 |
Eksisi limfangioma kompleks |
21,419,000 |
| 3031 |
Eksisi Limfangioma leher |
18,193,000 |
| 3032 |
Eksisi limfangioma sederhana |
16,475,000 |
| 3033 |
Eksisi limfedema |
16,475,000 |
| 3034 |
Eksisi Limfedema + skin graft (charles prosedur) |
4,850,000 |
| 3035 |
Eksisi limfedema kompleks |
21,419,000 |
| 3036 |
Eksisi limfedema sederhana |
16,475,000 |
| 3037 |
Eksisi Lokal < 3 cm |
5,232,000 |
| 3038 |
Eksisi Lokal > 3 cm |
8,988,000 |
| 3039 |
Eksisi luas |
10,982,000 |
| 3040 |
Eksisi Luas dan Rekonstruksi Malformasi vaskular Kompleks (tanpa graft) |
16,895,000 |
| 3041 |
Eksisi Luas Liang Telinga |
8,869,000 |
| 3042 |
Eksisi Luas Lokal |
4,850,000 |
| 3043 |
Eksisi luas malformasi vaskuler |
16,996,000 |
| 3044 |
Eksisi Luas Neoplasma Palatum Durum |
20,130,000 |
| 3045 |
Eksisi luas radikal + Rekonstruksi |
27,955,000 |
| 3046 |
Eksisi Luas Radikal + Rekontruksi |
5,336,807 |
| 3047 |
Eksisi luas tumor rongga mulut |
15,861,000 |
| 3048 |
Eksisi luas Tumor Tonsil, Orofaring |
17,935,000 |
| 3049 |
Eksisi Mamaria Aberant ? 3cm |
7,230,000 |
| 3050 |
Eksisi Mamaria Aberant > 3cm |
11,316,000 |
| 3051 |
Eksisi Mammae Aberran (Klp. III) |
4,518,992 |
| 3052 |
Eksisi massa kepala leher |
9,125,000 |
| 3053 |
Eksisi Mucocele |
1,798,000 |
| 3054 |
Eksisi Multiple FAM |
4,527,541 |
| 3055 |
Eksisi neoplasma kulit kepala dan leher |
18,193,000 |
| 3056 |
Eksisi Neoplasma Laring dengan Laser |
33,156,000 |
| 3057 |
Eksisi Neuroblastoma |
21,301,000 |
| 3058 |
Eksisi Neuroblastoma |
6,175,000 |
| 3059 |
Eksisi Neurofibroma Multiple |
4,990,913 |
| 3060 |
Eksisi neurofibroma simpel |
18,522,000 |
| 3061 |
Eksisi Neuroma Akustik |
12,668,000 |
| 3062 |
Eksisi Nevus |
507,000 |
| 3063 |
Eksisi Nevus Diluar Wajah Multiple, LA |
9,167,000 |
| 3064 |
Eksisi Nevus Diluar Wajah Simple, LA |
6,878,000 |
| 3065 |
Eksisi Nevus Wajah Multiple , LA |
9,167,000 |
| 3066 |
Eksisi Nevus Wajah Simple , LA |
6,878,000 |
| 3067 |
Eksisi Papiloma |
11,316,000 |
| 3068 |
Eksisi Parsial Kelenjar Hipofisis Transsfenoid |
15,827,000 |
| 3069 |
Eksisi pibrosis (narkose) |
9,650,000 |
| 3070 |
Eksisi Polidaktili Simple Dewasa, LA |
17,666,000 |
| 3071 |
Eksisi Polydactyly Complex, GA |
19,541,000 |
| 3072 |
Eksisi Poydactyly Simple, GA |
19,541,000 |
| 3073 |
Eksisi pseudoaneurisma kompleks |
13,627,000 |
| 3074 |
Eksisi pseudoaneurisma sederhana |
9,083,000 |
| 3075 |
Eksisi Pterigium Bare Sklera |
675,000 |
| 3076 |
Eksisi Remant Duktus |
22,689,000 |
| 3077 |
Eksisi septum uterus |
20,321,000 |
| 3078 |
Eksisi septum vagina |
20,321,000 |
| 3079 |
Eksisi Skin Grafting |
250,000 |
| 3080 |
Eksisi soft tissue tumor/ mucocele/ epulis/ fibroma/ lipoma < 3 CM |
55,602,000 |
| 3081 |
Eksisi Syringoma |
66,000 |
| 3082 |
Eksisi Tag Tonsil |
9,449,000 |
| 3083 |
Eksisi Tatto (Besar) |
2,350,000 |
| 3084 |
Eksisi Tatto (Lokal) |
600,000 |
| 3085 |
Eksisi Tatto (Sedang) |
2,000,000 |
| 3086 |
Eksisi teratoma ovarium |
21,343,000 |
| 3087 |
Eksisi Teratoma Ovarium |
12,022,946 |
| 3088 |
Eksisi Teratoma Retroperitoneal |
6,151,418 |
| 3089 |
Eksisi teratoma retroperitoneal |
20,572,000 |
| 3090 |
Eksisi teratoma sacrococcygeal |
15,607,000 |
| 3091 |
Eksisi Teratoma Sacrococcygeal |
11,130,825 |
| 3092 |
Eksisi Tiroid Lingual |
9,496,000 |
| 3093 |
Eksisi Tonsil Lingual |
9,841,000 |
| 3094 |
Eksisi Torus Palatinus / Mansibularis dengan Anastesi Lokal |
860,000 |
| 3095 |
Eksisi Total Kelenjar Hipofisis Transsfenoid |
16,578,000 |
| 3096 |
Eksisi Tragus Acsesories |
2,850,000 |
| 3097 |
Eksisi tumor <3 cm |
8,565,000 |
| 3098 |
Eksisi Tumor Adneksa Kecil |
2,850,000 |
| 3099 |
Eksisi Tumor Adneksa Sedang |
3,850,000 |
| 3100 |
Eksisi Tumor Jinak |
13,667,000 |
| 3101 |
Eksisi Tumor Jinak Sinonasal |
11,316,000 |
| 3102 |
Eksisi Tumor Kulit dan jaringan lunak <4 Lokasi |
20,683,000 |
| 3103 |
Eksisi Tumor kulit dan jaringan lunak> 10 Lokasi |
25,386,000 |
| 3104 |
Eksisi Tumor Rongga Mulut Mandibula (Pull-Through) |
20,681,000 |
| 3105 |
Eksisi Tumor Scalp |
9,839,000 |
| 3106 |
Eksisi tumor ukuran 3-6 cm |
10,232,000 |
| 3107 |
Eksisi Uvula |
8,199,000 |
| 3108 |
Eksisi veruka |
282,000 |
| 3109 |
Eksisi Veruka Vulgaris |
66,000 |
| 3110 |
Eksisi vulva |
13,367,000 |
| 3111 |
Eksisi Webbed Penis |
8,869,000 |
| 3112 |
Eksisi Webbed Penis |
4,850,000 |
| 3113 |
Eksisi Xantelasma |
2,850,000 |
| 3114 |
Eksisi Xantelasma |
1,811,000 |
| 3115 |
Eksisi Xantelasma (Besar) |
2,350,000 |
| 3116 |
Eksisi Xantelasma (Sedang) |
2,000,000 |
| 3117 |
Eksisi Xantoma |
250,000 |
| 3118 |
Eksisi, flap |
10,982,000 |
| 3119 |
Eksisi, Jahit primer |
14,313,000 |
| 3120 |
Eksisi, rekonstruksi |
14,313,000 |
| 3121 |
Eksisi, rekonstruksi dengan flap/implant |
32,929,000 |
| 3122 |
Eksisi, rekonstruksi dengan skin graft |
21,301,000 |
| 3123 |
Eksisi, skin graft |
14,313,000 |
| 3124 |
Eksisi/ Ekstirpasi luas tumor kelopak kecil (<5 mm) dan rekonstruksi kelopak sederhana |
8,199,000 |
| 3125 |
Eksisi/ Ekstirpasi tumor kelopak besar (>5 mm) dan rekonstruksi kelopak kompleks |
12,299,000 |
| 3126 |
Eksisi/ Ekstirpasi tumor kelopak besar (>5 mm)Lokal |
6,995,000 |
| 3127 |
Eksisi/ Ekstirpasi tumor kelopak besar (>5 mm)Narkosa |
8,199,000 |
| 3128 |
Eksisi/ Ekstirpasi tumor kelopak kecil (<5 mm) Lokal |
3,498,000 |
| 3129 |
Eksisi/ Ekstirpasi tumor kelopak kecil (<5 mm) Narkosa |
4,100,000 |
| 3130 |
Eksisi/ Ekstirpasi tumor konjungtiva besar (keterlibatan >1 clock hour) Lokal |
6,995,000 |
| 3131 |
Eksisi/ Ekstirpasi tumor konjungtiva besar (keterlibatan >1 clock hour) Narkose |
6,995,000 |
| 3132 |
Eksisi/ Ekstirpasi tumor konjungtiva kecil (keterlibatan < 1 clock hour) Lokal |
3,498,000 |
| 3133 |
Eksisi/ Ekstirpasi tumor konjungtiva kecil (keterlibatan < 1 clock hour) Narkose |
4,100,000 |
| 3134 |
Eksisi/Ekstirpasi (Poliklinik) |
207,000 |
| 3135 |
Eksisi/Ekstirpasi < 3cm |
11,658,000 |
| 3136 |
Eksisi/Ekstirpasi > 3cm |
10,804,000 |
| 3137 |
Eksisi/Ekstirpasi Tumor Jinak Kulit (Besar) |
1,450,000 |
| 3138 |
Eksisi/Ekstirpasi Tumor Jinak Kulit (Kecil) |
700,000 |
| 3139 |
Eksisi/Ekstirpasi Tumor Jinak Kulit (Sedang) |
1,200,000 |
| 3140 |
Eksisi/Esterpasi |
80,000 |
| 3141 |
Eksisi/insisi Tumor Konjungtiva |
590,000 |
| 3142 |
Eksisi/insisi Tumor Palpebra |
507,000 |
| 3143 |
Eksisi/Konisasi |
6,074,400 |
| 3144 |
Eksisi/Limfangioma Simple |
4,986,687 |
| 3145 |
Eksisi/Reduksi Neurofibroma Kompleks |
4,850,000 |
| 3146 |
Eksoftalmometri |
30,000 |
| 3147 |
Eksplorasi & rekonstruksi vaskuler pada trauma vaskuler akut |
16,895,000 |
| 3148 |
Eksplorasi Abses Intra Oral/ Ekstra Oral |
9,309,000 |
| 3149 |
Eksplorasi Abses Mandibula |
3,850,000 |
| 3150 |
Eksplorasi Abses Multiple ( Bedah Vaskuler ) |
3,850,000 |
| 3151 |
Eksplorasi Abses Multiple THT |
4,850,000 |
| 3152 |
Eksplorasi Abses Parafaringeal |
3,850,000 |
| 3153 |
Eksplorasi CBD - Pasang T-Tube |
14,865,000 |
| 3154 |
Eksplorasi CBD + bypass Biliodigestif |
19,064,000 |
| 3155 |
Eksplorasi dan jahit hematom vagina |
12,837,000 |
| 3156 |
Eksplorasi dan jahit hematom vulva |
12,837,000 |
| 3157 |
Eksplorasi dan ligasi tinggi vena ovarica pada PCS |
16,895,000 |
| 3158 |
Eksplorasi dan rekonstruksi vena cava dengan graft sintesis |
37,385,000 |
| 3159 |
Eksplorasi dan rekonstruksi vena iliaka dengan graft sintesis |
16,895,000 |
| 3160 |
Eksplorasi dan Reparasi Trauma Saraf Kranial/Perifer |
15,526,000 |
| 3161 |
Eksplorasi debridement |
6,270,000 |
| 3162 |
Eksplorasi kehamilan ektopik terganggu per laparotomi |
23,640,000 |
| 3163 |
Eksplorasi Kista Branchial |
5,767,645 |
| 3164 |
Eksplorasi Kista Ductus Tiroglosus |
5,767,645 |
| 3165 |
Eksplorasi Kista Tiroid |
5,788,179 |
| 3166 |
Eksplorasi Kolekdokus |
4,406,075 |
| 3167 |
Eksplorasi Luka |
60,000 |
| 3168 |
Eksplorasi Multiple Abses |
10,678,000 |
| 3169 |
Eksplorasi Nasofaring |
3,850,000 |
| 3170 |
Eksplorasi testis (mikro surgery) narkose |
20,005,000 |
| 3171 |
Eksplorasi vaskular ekstremitas |
16,895,000 |
| 3172 |
Eksplorasi vaskular intra-abdomen |
16,895,000 |
| 3173 |
Eksplorasi vaskular leher |
16,895,000 |
| 3174 |
Eksplorasi vaskuler ekstremitas tanpa rekonstruksi |
16,895,000 |
| 3175 |
Eksplorasi vaskuler intraabdomen tanpa rekonstruksi |
16,895,000 |
| 3176 |
Eksplorasi vaskuler leher tanpa rekonstruksi |
16,895,000 |
| 3177 |
Eksterpasi / Biopsi Polip Serviks Kacil < 1/2 |
135,000 |
| 3178 |
Eksterpasi dan Kuretase |
840,000 |
| 3179 |
Eksterpasi Fistel Preaurikuler |
4,530,362 |
| 3180 |
Eksterpasi Kista Ateroma/Lipoma Ganglion < 2cm |
250,000 |
| 3181 |
Eksterpasi Kista Bartholin |
2,850,000 |
| 3182 |
Eksterpasi Limpoma, ganglion kista epidermoid, neurolibroma sactase |
2,159,000 |
| 3183 |
Eksterpasi Miom Geburt |
2,850,000 |
| 3184 |
Eksterpasi Tumor Jinak, Diluar Wajah ,La |
17,666,000 |
| 3185 |
Eksterpasi Tumor Scalp / Cranium Ligasi Carotis Ext / Int |
29,833,000 |
| 3186 |
Ekstipasi Adenomiosis |
4,850,000 |
| 3187 |
Ekstipasi Tumor Scalp/Cranium |
5,586,887 |
| 3188 |
Ekstirpasi / Enukleasi ukuran 3-6 cm |
8,821,000 |
| 3189 |
Ekstirpasi / Marsupialisasi Ranula |
9,461,000 |
| 3190 |
Ekstirpasi & Rekonstruksi Silikonoma |
13,303,000 |
| 3191 |
Ekstirpasi angiofibroma dengan Endoskopi |
23,870,000 |
| 3192 |
Ekstirpasi Angiofibroma Nasofaring |
22,130,000 |
| 3193 |
Ekstirpasi biopsi / Enukleasi biopsi < 3 cm |
6,418,000 |
| 3194 |
Ekstirpasi Corpus Alienum |
150,000 |
| 3195 |
Ekstirpasi dan kuretase mioma geburt |
12,287,000 |
| 3196 |
Ekstirpasi Fibroma |
2,850,000 |
| 3197 |
Ekstirpasi Kelenjar Sublingual Parsial |
8,199,000 |
| 3198 |
Ekstirpasi Kelenjar Sublingual Total |
8,199,000 |
| 3199 |
Ekstirpasi Kelenjar Submandibula Parsial |
25,572,000 |
| 3200 |
Ekstirpasi Kelenjar Submandibula Total |
11,500,000 |
| 3201 |
Ekstirpasi Kista Ateroma / Lipoma / Ganglion > 2cm |
2,850,000 |
| 3202 |
Ekstirpasi kista brakial/ Penutupan Fistel Celah Brakial |
7,736,000 |
| 3203 |
Ekstirpasi Kista Epidermoid |
250,000 |
| 3204 |
Ekstirpasi kista odontogenik di maksila |
20,130,000 |
| 3205 |
Ekstirpasi kista odontogenik di mandibula |
20,130,000 |
| 3206 |
Ekstirpasi lesi jinak |
1,321,000 |
| 3207 |
Ekstirpasi Massa Sinonasal dengan Pendekatan Endoskopi |
9,449,000 |
| 3208 |
Ekstirpasi mucocele |
13,715,000 |
| 3209 |
Ekstirpasi Mucocele dengan Anastesi Lokal |
1,798,000 |
| 3210 |
Ekstirpasi Neoplasma Telinga |
16,945,000 |
| 3211 |
Ekstirpasi Odontoma |
9,070,000 |
| 3212 |
Ekstirpasi Papiloma |
3,850,000 |
| 3213 |
Ekstirpasi Papiloma / Kista |
604,000 |
| 3214 |
Ekstirpasi Plunging Ranula |
2,485,000 |
| 3215 |
Ekstirpasi Preaurikuler Fistel THT |
4,850,000 |
| 3216 |
Ekstirpasi Ranula Dengan Anastesi Lokal |
2,485,000 |
| 3217 |
Ekstirpasi Silikonoma Nasal |
13,303,000 |
| 3218 |
Ekstirpasi Silikonoma wajah |
13,303,000 |
| 3219 |
Ekstirpasi Tumor Ganas Adnesa + Rekonstruksi |
12,350,000 |
| 3220 |
Ekstirpasi Tumor Jinak |
250,000 |
| 3221 |
Ekstirpasi Tumor Jinak |
1,022,000 |
| 3222 |
Ekstirpasi Tumor Jinak Kel.Liur THT |
4,850,000 |
| 3223 |
Ekstirpasi tumor jinak kulit ?>3 cm (Limpoma, atheroma, dll) |
17,778,000 |
| 3224 |
Ekstirpasi tumor jinak kulit ?3 cm (Limpoma, atheroma, dll) |
13,336,000 |
| 3225 |
Ekstirpasi Tumor Jinak Kulit > 3 cm ( lipoma,atheroma dll) |
17,778,000 |
| 3226 |
Ekstirpasi Tumor Jinak Kulit 0 < 3cm (Lipoma,Atheroma,dll) |
2,850,000 |
| 3227 |
Ekstirpasi tumor jinak kulit wajah |
17,778,000 |
| 3228 |
Ekstirpasi Tumor Jinak Kulit Wajah, GA |
17,778,000 |
| 3229 |
Ekstirpasi Tumor Jinak Kulit Wajah, LA |
15,578,000 |
| 3230 |
Ekstirpasi Tumor Jinak Lain > 5 cm |
3,850,000 |
| 3231 |
Ekstirpasi Tumor Jinak Sinonasal Oral Cavity |
3,850,000 |
| 3232 |
Ekstirpasi Tumor Jinak THT |
675,000 |
| 3233 |
Ekstirpasi tumor jinak vagina |
4,686,000 |
| 3234 |
Ekstirpasi tumor kecil |
9,500,000 |
| 3235 |
Ekstrackel benda asing dengan anastesi umum |
2,159,000 |
| 3236 |
Ekstraksi / Operasi (Alveolectomy pr Kwadran) |
180,000 |
| 3237 |
Ekstraksi / Operasi (Epulis) |
165,000 |
| 3238 |
Ekstraksi / Operasi (Fraktur Rahang) |
450,000 |
| 3239 |
Ekstraksi / Operasi (Gigi Permanent Komplikasi) |
200,000 |
| 3240 |
Ekstraksi / Operasi (Gigi Permanent Normal) |
105,000 |
| 3241 |
Ekstraksi / Operasi (Gigi Sulung / Chloraethyl) |
70,000 |
| 3242 |
Ekstraksi / Operasi (Gigi Sulung / Citoject) |
75,000 |
| 3243 |
Ekstraksi / Operasi (Incisi Abses) |
250,000 |
| 3244 |
Ekstraksi / Operasi (Kista) |
330,000 |
| 3245 |
Ekstraksi / Operasi (Mucocele) |
350,000 |
| 3246 |
Ekstraksi / Operasi (Odontektomi Dengan komplikasi) |
455,000 |
| 3247 |
Ekstraksi / Operasi (Odontektomi Tanpa komplikasi) |
325,000 |
| 3248 |
Ekstraksi Batu |
4,850,000 |
| 3249 |
Ekstraksi Batu Dengan Basket |
17,023,000 |
| 3250 |
Ekstraksi Batu dengan Basket/Balon |
11,530,000 |
| 3251 |
Ekstraksi Batu Dengan Basket/Balon (Sore) |
17,290,000 |
| 3252 |
Ekstraksi Benda Asing |
700,000 |
| 3253 |
Ekstraksi Benda Asing |
552,000 |
| 3254 |
Ekstraksi Benda Asing + Anastesi |
1,334,000 |
| 3255 |
Ekstraksi Benda Asing + Anastesi |
1,247,000 |
| 3256 |
Ekstraksi Benda Asing Bronkus dengan penyulit |
14,460,000 |
| 3257 |
Ekstraksi Benda Asing Bronkus tanpa penyulit |
12,495,000 |
| 3258 |
Ekstraksi Benda Asing Daerah Hidung |
124,000 |
| 3259 |
Ekstraksi benda asing dengan anestesi lokal |
735,000 |
| 3260 |
Ekstraksi Benda Asing dengan Penyulit |
250,000 |
| 3261 |
Ekstraksi Benda asing Dengan RFL |
956,000 |
| 3262 |
Ekstraksi benda asing di saluran cerna bagian atas |
4,748,000 |
| 3263 |
Ekstraksi benda asing di saluran cerna bagian bawah |
4,629,000 |
| 3264 |
Ekstraksi benda asing disaluran cerna bagian atas/bawah |
2,850,000 |
| 3265 |
Ekstraksi Benda Asing esofagus dengan penyulit |
12,128,000 |
| 3266 |
Ekstraksi Benda Asing esofagus tanpa penyulit |
9,083,000 |
| 3267 |
Ekstraksi Benda Asing Laring dengan mikrolaring |
7,030,000 |
| 3268 |
Ekstraksi benda asing muskuloskeletal dengan panduan USG |
291,000 |
| 3269 |
Ekstraksi Benda Asing operatif (Telinga, Hidung dan Faring) dengan endoskopi |
8,439,000 |
| 3270 |
Ekstraksi Benda Asing operatif (Telinga/Hidung/faring) |
7,030,000 |
| 3271 |
Ekstraksi benda asing saluran cerna |
4,630,000 |
| 3272 |
Ekstraksi Benda Asing Saluran Cerna + Anastesi |
4,270,000 |
| 3273 |
Ekstraksi Benda Asing Saluran Cerna + Anastesi (Sore) |
6,400,000 |
| 3274 |
Ekstraksi Benda Asing Trakea app bronkoskopi fleksibel |
9,640,000 |
| 3275 |
Ekstraksi Comedo |
130,000 |
| 3276 |
Ekstraksi Corpus Alienum |
59,000 |
| 3277 |
Ekstraksi Corpus Alienum Cornea |
204,000 |
| 3278 |
Ekstraksi Corpus Alienum, GA |
6,585,000 |
| 3279 |
Ekstraksi Corpus Alienum, LA |
5,441,000 |
| 3280 |
Ekstraksi Corpus Aliineum Cornea |
250,000 |
| 3281 |
Ekstraksi Gigi / Fragmen Gigi Penyulit dengan Anastesi |
270,000 |
| 3282 |
Ekstraksi jaringan Granulasi |
379,000 |
| 3283 |
Ekstraksi jaringan granulasi pada telinga |
66,000 |
| 3284 |
Ekstraksi katarak+IOL+PPC+Vitrektomi anterior |
28,506,000 |
| 3285 |
Ekstraksi katarak+IOL+PPC+Vitrektomi anterior pars plana |
26,573,000 |
| 3286 |
Ekstraksi katarak+PPC+Vitrektomi anterior |
26,370,000 |
| 3287 |
Ekstraksi Kolesteatom Eksterna |
250,000 |
| 3288 |
Ekstraksi kolesteatoma Eksterna |
568,000 |
| 3289 |
Ekstraksi korpus alineum cavum nasi |
0 |
| 3290 |
Ekstraksi Kuku |
250,000 |
| 3291 |
Ekstraksi kuku |
481,000 |
| 3292 |
Ekstraksi Kuku Berat (Besar) |
317,000 |
| 3293 |
Ekstraksi Kuku Sederhana (Sedang) |
190,000 |
| 3294 |
Ekstraksi Linear |
4,866,237 |
| 3295 |
Ekstraksi Per Gigi dengan Anastesi Lokal |
140,000 |
| 3296 |
Ekstraksi polip hidung ( polipektomi simpleks) |
100,000 |
| 3297 |
Ekstraksi Serumen |
379,000 |
| 3298 |
Ekstraksi serumen dengan penyulit |
872,000 |
| 3299 |
Ekstraksi Serumen Dengan Penyulit |
66,000 |
| 3300 |
Ekstraksi Serumen Telinga |
26,000 |
| 3301 |
Ekstraksi Stent Migrasi |
3,610,000 |
| 3302 |
Ekstraksi Stent Migrasi |
3,979,000 |
| 3303 |
Ekstraksi Stent Migrasi (Sore) |
5,410,000 |
| 3304 |
Ekstraksi Stent Non-Migrasi |
3,700,000 |
| 3305 |
Ekstraksi Stent Non-Migrasi |
3,892,000 |
| 3306 |
Ekstraksi Stent Non-Migrasi (Sore) |
5,550,000 |
| 3307 |
Ekstrasi Komedo 1 |
154,000 |
| 3308 |
Ekstrasi Komedo 1 |
150,000 |
| 3309 |
Ekstrasi Komedo 2 |
210,000 |
| 3310 |
Ekstrasi Komedo 2 |
192,000 |
| 3311 |
Ekstrasi Komedo 3 |
231,000 |
| 3312 |
Ekstrasi Komedo 3 |
255,000 |
| 3313 |
Ekstremitas Angiografi dengan balon (1 balon) (+ Radiografer) |
21,516,000 |
| 3314 |
Ekstremitas Angiografi dengan balon + stent (1 balon, 1 stent) + Radiografer |
20,273,000 |
| 3315 |
Ekstremitas Angiografi sederhana |
9,355,000 |
| 3316 |
Ekstremitas Angiografi selektif (+ Radiografer) |
17,155,000 |
| 3317 |
Ekstubasi |
1,061,001 |
| 3318 |
Ekstubasi dengan Penyulit |
1,274,000 |
| 3319 |
Ekstubasi dengan penyulit pasien pediatrik |
1,274,000 |
| 3320 |
Ekstubasi dewasa dengan penyulit pasien dewasa |
1,274,000 |
| 3321 |
Ekstubasi dewasa pasien dewasa |
1,061,001 |
| 3322 |
Ekstubasi Neonatus |
1,061,001 |
| 3323 |
Ekstubasi neonatus / pediatrik |
1,061,001 |
| 3324 |
Ekstubasi pasien neonatus dengan penyulit pasien neonatus |
1,274,000 |
| 3325 |
Ekstubasi pasien neonatus pasien neonatus |
1,061,001 |
| 3326 |
Ekstubasi pasien pediatrik |
1,061,001 |
| 3327 |
Ekstubasi pediatrik dengan penyulit |
1,274,000 |
| 3328 |
Ektirpasi Aterom Diluar Wajah, LA |
17,666,000 |
| 3329 |
Ektirpasi Aterom Wajah, LA |
17,666,000 |
| 3330 |
Ektirpasi Lipoma Diluar Wajah, LA |
17,666,000 |
| 3331 |
Ektirpasi Lipoma Wajah, LA |
17,666,000 |
| 3332 |
Ektirpasi tumor parafaring |
20,130,000 |
| 3333 |
Elbow Brace (Biasa) |
1,500,000 |
| 3334 |
Elbow Brace (Khusus) |
2,750,000 |
| 3335 |
Elbow disarticulation |
18,043,000 |
| 3336 |
Electroencephalography (EEG) |
780,000 |
| 3337 |
Electromyography (EMG) |
930,000 |
| 3338 |
Electromyography (EMG) 1 ekstremitas dengan needle. |
2,992,000 |
| 3339 |
Electromyography (EMG) 2 ekstremitas dengan needle. |
3,105,000 |
| 3340 |
Electromyography (EMG) 3 ekstremitas dengan needle. |
3,650,000 |
| 3341 |
Electrophyisiology Study |
29,913,000 |
| 3342 |
Electrophyisiology Study + Radiofrequency Ablasi (Konvensional Non Irrigation) |
83,354,000 |
| 3343 |
Electrophyisiology Study + Radiofrequency Ablasi EP 3D AF + Trans Esofageal Ekokardiografi (TEE) (Non Irrigation) |
128,612,000 |
| 3344 |
Electrophyisiology Study + Radiofrequency Ablasi EP 3D Non AF + Trans Esofageal Ekokardiografi (TEE) (Non Irrigation) |
114,123,000 |
| 3345 |
Elektrikal Stimulasi |
75,000 |
| 3346 |
Elektro Couter Besar |
385,000 |
| 3347 |
Elektro Couter Kecil |
222,000 |
| 3348 |
Elektro Couter Sedang |
302,000 |
| 3349 |
Elektro Physiologi Study (EP Study) |
15,350,000 |
| 3350 |
Elektro Physiologi Study (EP Study) + Ablasi |
36,350,000 |
| 3351 |
Elektroakupunktur |
438,001 |
| 3352 |
Elektroensefalografi bedside |
873,000 |
| 3353 |
Elektroensefalografi digital rutin (termasuk aEEG) |
873,000 |
| 3354 |
Elektroensefalografi long term |
873,000 |
| 3355 |
Elektroensefalografi video |
873,000 |
| 3356 |
ELEKTROFORESIS PROTEIN (SPE) |
270,000 |
| 3357 |
Elektrofulgurasi |
66,000 |
| 3358 |
Elektrokardiografi (EKG) |
129,000 |
| 3359 |
Elektrokardiografi (ERIA) |
129,000 |
| 3360 |
Elektrokauter Keratosis Seboroik |
710,000 |
| 3361 |
Elektrolit _ |
120,000 |
| 3362 |
ELEKTROLIT DARAH (NA, K, CL) |
233,000 |
| 3363 |
ELEKTROLIT URIN (NA, K, CL) 24 JAM |
233,000 |
| 3364 |
Elektrolit Urine 24 Jam |
100,000 |
| 3365 |
Elektromiografi jarum |
1,800,000 |
| 3366 |
Elektromiografi spasmofilia |
1,800,000 |
| 3367 |
Elevasi Plong 1-5 titik |
1,000,000 |
| 3368 |
Elevasi Plong 6-10 titik |
1,500,000 |
| 3369 |
Embolektomi |
26,604,000 |
| 3370 |
Embolektomi/Pleurodesis/RedoOperationForStopBleeding/Thoracotomi |
13,550,000 |
| 3371 |
Embolisasi AVF Kompleks |
83,231,000 |
| 3372 |
Embolisasi AVF Simple |
77,513,000 |
| 3373 |
Embolisasi Ballon |
42,884,000 |
| 3374 |
Embolisasi Brain AVM Kompleks |
34,760,000 |
| 3375 |
Embolisasi Brain AVM Kompleks kombinasi intraarterial -transvena |
38,684,000 |
| 3376 |
Embolisasi brain AVM kompleks kombinasi transarterial-transvena |
38,684,000 |
| 3377 |
Embolisasi brain AVM kompleks transarterial |
83,221,000 |
| 3378 |
Embolisasi brain AVM simpel |
80,936,000 |
| 3379 |
Embolisasi CCF Kompleks - balloning / coil |
83,231,000 |
| 3380 |
Embolisasi CCF Simple - balllooning |
77,513,000 |
| 3381 |
Embolisasi dengan coil |
85,771,000 |
| 3382 |
Embolisasi dengan gelatine foam |
85,771,000 |
| 3383 |
Embolisasi dengan liquid embolic adhesive material (NBCA, etc) |
85,771,000 |
| 3384 |
Embolisasi dengan liquid embolic non-adhesive material (Onyx, etc) |
85,771,000 |
| 3385 |
Embolisasi dengan Spongiostan (Preop) |
16,309,000 |
| 3386 |
Embolisasi dengan Spongiostan (Preop) + Anastesi |
33,450,000 |
| 3387 |
Embolisasi dengan vascular plug/balloon occluder |
85,771,000 |
| 3388 |
Embolisasi Onyx |
82,311,000 |
| 3389 |
Embolisasi pada Perdarahan Intraabdominal / Extermitas yang Menggunakan Gel Foam + Anastesi |
26,610,000 |
| 3390 |
Embolisasi pada Perdarahan Intraabdominal / Extremitas yang Menggunakan Coil + Anastesi |
26,900,000 |
| 3391 |
Embolisasi pada perdarahan intraabdominal/extremitas yang menggunakan coil |
20,044,886 |
| 3392 |
Embolisasi pada perdarahan intraabdominal/extremitas yang menggunakan gel foam |
19,975,590 |
| 3393 |
Embolisasi pada tumor intraabdominal / extremitas yang menggunakan gel foam |
19,975,590 |
| 3394 |
Embolisasi pada Tumor Intraabdominal / Extremitas yang Menggunakan Gel Foam + Anastesi |
26,610,000 |
| 3395 |
Embolisasi pada tumor intraabdominal / extremitas yang menggunakan PVA |
21,161,761 |
| 3396 |
Embolisasi pada tumor intraabdominal / extremitas yang menggunakan PVA + Anastesi |
31,750,000 |
| 3397 |
Embolisasi Perdarahan dengan Coil Kasus Kompleks |
37,309,000 |
| 3398 |
Embolisasi Perdarahan dengan Coil Kasus Kompleks dengan anestesi |
41,906,000 |
| 3399 |
Embolisasi Pre-Operatif Kasus Kompleks |
43,046,000 |
| 3400 |
Embolisasi Pre-Operatif Kasus Kompleks dengan anestesi |
47,793,000 |
| 3401 |
Embolisasi Pre-Operatif Kasus Simpel |
35,217,000 |
| 3402 |
Embolisasi Pre-Operatif Kasus Simpel dengan anestesi |
39,906,000 |
| 3403 |
Embolisasi spinal AVM/AVF |
83,221,000 |
| 3404 |
Embolisasi Spinal Kompleks |
48,456,000 |
| 3405 |
Embolisasi Spinal simpel |
37,680,000 |
| 3406 |
Embolisasi Tumor Kompleks |
51,543,000 |
| 3407 |
Embolisasi Tumor Simple |
50,829,000 |
| 3408 |
Embolo-sclerotherapy pada malformasi vaskular |
80,936,000 |
| 3409 |
Embriotomi (Eviserasi /punksi) |
1,800,000 |
| 3410 |
Embriotomi (Kranioklasi) |
1,800,000 |
| 3411 |
Embriotomi (Perforasi + Dekapitasi) |
1,800,000 |
| 3412 |
EMG - Anak |
1,100,000 |
| 3413 |
EMG Single Fiber |
980,000 |
| 3414 |
Eminektomi artikularis |
15,538,000 |
| 3415 |
End of life care |
347,000 |
| 3416 |
Endodontic One Visit Gigi Anterior (Akar Tunggal) |
0 |
| 3417 |
Endodontic One Visit Gigi Posterior (Akar Jamak) |
0 |
| 3418 |
Endopyelolitotomi interna |
15,421,000 |
| 3419 |
Endorectal pull through (Soave-bolley procedure) |
44,624,000 |
| 3420 |
Endorectal pull-through/ soave Boley |
6,175,000 |
| 3421 |
Endoscopic discectomy (single) Intervertebral disc herniation |
35,012,000 |
| 3422 |
Endoscopic Mucosal Resection (EMR) |
5,918,000 |
| 3423 |
Endoscopic Mucosal Resection (EMR) |
5,900,000 |
| 3424 |
Endoscopic Mucosal Resection (EMR) (Sore) |
8,850,000 |
| 3425 |
Endoscopic Papillary Balloon Dilatation (EPBD) / Endoscopic Papillary Large Balloon Dilatation (EPLBD) |
9,340,000 |
| 3426 |
Endoscopic Papillary Balloon Dilatation (EPBD) / Endoscopic Papillary Large Balloon Dilatation (EPLBD) |
10,700,000 |
| 3427 |
Endoscopic Papillary Balloon Dilatation (EPBD) / Endoscopic Papillary Large Balloon Dilatation (EPLBD) (Sore) |
14,010,000 |
| 3428 |
ENDOSCOPIC RECONSTRUCTIVE SURGERY, GA |
14,650,000 |
| 3429 |
Endoscopic spinal decompression for Spinal stenosis |
35,012,000 |
| 3430 |
Endoscopic Submucosal Disection (ESD) |
26,640,000 |
| 3431 |
Endoscopic Submucosal Disection (ESD) (Sore) |
39,960,000 |
| 3432 |
Endoscopic Submucosal Dissection (Esd) |
27,022,000 |
| 3433 |
Endoscopic submucosal dissection (ESD) Saluran Cerna Bagian Bawah |
27,022,000 |
| 3434 |
Endoscopic Third Ventriculostomy (ETV) |
21,960,000 |
| 3435 |
Endoscopic Ultrasound (EUS) Diagnostik |
2,780,000 |
| 3436 |
Endoscopic Ultrasound (EUS) Diagnostik (Sore) |
4,170,000 |
| 3437 |
Endoscopic ultrasound diagnostik |
2,991,000 |
| 3438 |
Endoscopic ultrasound-guided fine needle aspiration/biopsy |
27,242,000 |
| 3439 |
Endoscopic ultrasound-guided gastrojejunostomy |
34,417,000 |
| 3440 |
Endoscopy Nasofaring |
481,000 |
| 3441 |
Endoscopy Retrograde Cholangio Pankreatografi (ERCP) Diagnostik |
15,890,000 |
| 3442 |
Endoscopy Retrograde Cholangio Pankreatografi (ERCP) Diagnostik (Sore) |
23,830,000 |
| 3443 |
Endoscopy teurapeutic (BA) |
6,175,000 |
| 3444 |
Endoskopi + argon plasma coagulation |
9,590,000 |
| 3445 |
Endoskopi ERCP |
16,999,000 |
| 3446 |
Endoskopi Evakuasi ICH |
25,091,000 |
| 3447 |
Endoskopi hemostasis saluran cerna bagian atas |
3,741,000 |
| 3448 |
Endoskopi hemostasis saluran cerna bagian bawah |
3,741,000 |
| 3449 |
Endoskopi Telinga |
818,000 |
| 3450 |
Endoskopi tiroidektomi bilateral |
23,473,000 |
| 3451 |
Endoskopi tiroidektomi unilateral |
23,473,000 |
| 3452 |
Endovascular Aneurysm Repair (EVAR) aorto-iliaka kompleks |
176,779,000 |
| 3453 |
Endovascular Aneurysm Repair (EVAR) aorto-iliaka sederhana |
149,093,000 |
| 3454 |
Endovascular Aortic Repair (EVAR) |
158,000,000 |
| 3455 |
Endovascular Coiling Of Aneurysm Using ? 3 Bare Coiling + GA (Eksekutif) |
0 |
| 3456 |
Endovascular Coiling Of Aneurysm Using <= 3 Bare Coiling + GA |
106,680,000 |
| 3457 |
Endovascular Coiling Of Aneurysm Using > 3 Bare Coiling + GA (Eksekutif) |
0 |
| 3458 |
Endovascular Coiling Of Aneurysm Using > 3 Bare Coiling + GA |
155,225,000 |
| 3459 |
Endovascular Coiling Of Aneurysm Using Balloon Assited > 3 Coiling + GA (Eksekutif) |
0 |
| 3460 |
Endovascular Coiling Of Aneurysm Using Balloon Assited ? 3 Coiling + GA (Eksekutif) |
0 |
| 3461 |
Endovascular Coiling Of Aneurysm Using Balloon Assited <= 3 Coiling + GA |
153,015,000 |
| 3462 |
Endovascular Coiling Of Aneurysm Using Balloon Assited > 3 Coiling + GA |
197,745,000 |
| 3463 |
Endovascular Coiling Of Aneurysm Using Flow Diverter/Stent Graft/Endovascular Graft + GA |
293,805,000 |
| 3464 |
Endovascular Coiling Of Aneurysm Using Flow Diverter/Stent Graft/Endovascular Graft + GA (Eksekutif) |
0 |
| 3465 |
Endovascular Coiling Of Aneurysm Using Stent Assited > 3 Coiling + GA (Eksekutif) |
0 |
| 3466 |
Endovascular Coiling Of Aneurysm Using Stent Assited ? 3 Coiling + GA (Eksekutif) |
0 |
| 3467 |
Endovascular Coiling Of Aneurysm Using Stent Assited <= 3 Coiling + GA |
202,025,000 |
| 3468 |
Endovascular Coiling Of Aneurysm Using Stent Assited > 3 Coiling + GA |
242,685,000 |
| 3469 |
Endovascular Occlusion Of Carotic Cavernous Fistula Using > 3 Coil + GA (Eksekutif) |
0 |
| 3470 |
Endovascular Occlusion Of Carotic Cavernous Fistula Using ? 3 Coil + GA (Eksekutif) |
0 |
| 3471 |
Endovascular Occlusion Of Carotic Cavernous Fistula Using <= 3 Coil + GA |
104,640,000 |
| 3472 |
Endovascular Occlusion Of Carotic Cavernous Fistula Using > 3 Coil + GA |
155,525,000 |
| 3473 |
Endovascular Occlusion Of Carotic Cavernous Fistula With Parent Artery Sacrifice Using ? 3 Coil + GA (Eksekutif) |
0 |
| 3474 |
Endovascular Occlusion Of Carotic Cavernous Fistula With Parent Artery Sacrifice Using <= 3 Coil + GA |
105,075,000 |
| 3475 |
Endovascular Occlusion Of Carotic Cavernous Fistula With Parent Artery Sacrifice Using > 3 Coil + GA |
155,525,000 |
| 3476 |
Endovascular Occlusion Of Carotic Cavernous Fistula With Parent Artery Sacrifice Using > 3 Coil + GA (Eksekutif) |
0 |
| 3477 |
Endovascular Occlusion Of Carotid Cavernous Fistula Using Detachable Balloon (Goldbal) + GA (Eksekutif) |
0 |
| 3478 |
Endovascular Occlusion Of Carotid Cavernous Fistula Using Detachable Baloon (Goldbal) + GA |
68,095,000 |
| 3479 |
Endovascular Occlusion Of Carotid Cavernous Fistula Using Liquid Embolization + GA |
131,685,000 |
| 3480 |
Endovascular Occlusion Of Carotid Cavernous Fistula Using Liquid Embolization + GA (Eksekutif) |
0 |
| 3481 |
Endovascular Occlusion Of Ccf Using Flow Diverter + GA |
293,375,000 |
| 3482 |
Endovascular Occlusion Of Ccf Using Flow Diverter + GA (Eksekutif) |
0 |
| 3483 |
Endovascular Occlusion Of Head And Neck Tumour Using Coil ? 3 + GA (Eksekutif) |
0 |
| 3484 |
Endovascular Occlusion Of Head And Neck Tumour Using Coil ? 3 + Penyulit + GA (Eksekutif) |
0 |
| 3485 |
Endovascular Occlusion Of Head And Neck Tumour Using Coil <= 3 + GA |
97,775,000 |
| 3486 |
Endovascular Occlusion Of Head And Neck Tumour Using Coil <= 3 + Penyulit + GA |
146,415,000 |
| 3487 |
Endovascular Occlusion Of Head And Neck Tumour Using Coil > 3 + GA |
150,800,000 |
| 3488 |
Endovascular Occlusion Of Head And Neck Tumour Using Coil > 3 + GA (Eksekutif) |
0 |
| 3489 |
Endovascular Occlusion Of Head And Neck Tumour Using Coil > 3 + Penyulit + GA |
152,075,000 |
| 3490 |
Endovascular Occlusion Of Head And Neck Tumour Using Coil > 3 + Penyulit + GA (Eksekutif) |
0 |
| 3491 |
Endovascular Occlusion Of Head And Neck Tumour Using Liquid Embolization ? 3 + GA (Eksekutif) |
0 |
| 3492 |
Endovascular Occlusion Of Head And Neck Tumour Using Liquid Embolization ? 3 + Penyulit + GA (Eksekutif) |
0 |
| 3493 |
Endovascular Occlusion Of Head And Neck Tumour Using Liquid Embolization <= 3 + GA |
138,065,000 |
| 3494 |
Endovascular Occlusion Of Head And Neck Tumour Using Liquid Embolization <= 3 + Penyulit + GA |
141,775,000 |
| 3495 |
Endovascular Occlusion Of Head And Neck Tumour Using Liquid Embolization > 3 + GA |
203,710,000 |
| 3496 |
Endovascular Occlusion Of Head And Neck Tumour Using Liquid Embolization > 3 + GA (Eksekutif) |
0 |
| 3497 |
Endovascular Occlusion Of Head And Neck Tumour Using Liquid Embolization > 3 + Penyulit + GA |
215,190,000 |
| 3498 |
Endovascular Occlusion Of Head And Neck Tumour Using Liquid Embolization > 3 + Penyulit + GA (Eksekutif) |
0 |
| 3499 |
Endovascular Occlusion Of Head And Neck Tumour Using Particle ? 3 + GA (Eksekutif) |
0 |
| 3500 |
Endovascular Occlusion Of Head And Neck Tumour Using Particle + Penyulit + GA |
98,885,000 |
| 3501 |
Endovascular Occlusion Of Head And Neck Tumour Using Particle + Penyulit + GA (Eksekutif) |
0 |
| 3502 |
Endovascular Occlusion Of Head And Neck Tumour Using Particle <= 3 + GA |
96,140,000 |
| 3503 |
Endovascular Occlusion Of Head And Neck Tumour Using Particle > 3 + GA |
129,645,000 |
| 3504 |
Endovascular Occlusion Of Head And Neck Tumour Using Particle > 3 + GA (Eksekutif) |
0 |
| 3505 |
Endovascular thrombectomy menggunakan aspiration thrombectomy |
20,131,000 |
| 3506 |
Enema/spooling/irigasi rektal/stoma |
253,000 |
| 3507 |
enucleatie kista |
2,510,000 |
| 3508 |
Enucleatie Kista D 42 |
4,850,000 |
| 3509 |
Enukleasi (PO) |
10,215,000 |
| 3510 |
Enukleasi + DFG |
6,822,174 |
| 3511 |
Enukleasi Besar dengan Anastesi Lokal |
860,000 |
| 3512 |
Enukleasi DFG + Retcam |
10,215,000 |
| 3513 |
Enukleasi Kecil dengan Anastesi Lokal |
860,000 |
| 3514 |
Enukleasi Kista |
2,488,000 |
| 3515 |
Enukleasi Kista Dental dengan Anastesi Lokal |
2,488,000 |
| 3516 |
Enukleasi kista gigi kecil |
6,403,000 |
| 3517 |
Enukleasi Kista Ginjal |
6,926,000 |
| 3518 |
Enukleasi Kista Odontogenik / Nonodontogenik |
9,461,000 |
| 3519 |
Enukleasi kista sedang |
8,821,000 |
| 3520 |
Enukleasi Milia |
66,000 |
| 3521 |
Enukleasi Mol |
66,000 |
| 3522 |
Enukleasi Moluskum / Milia / Tumor Jinak Lainnya 1 |
368,000 |
| 3523 |
Enukleasi Moluskum / Milia / Tumor Jinak Lainnya 2 |
552,000 |
| 3524 |
Enukleasi Moluskum / Milia / Tumor Jinak Lainnya 3 |
664,000 |
| 3525 |
Enukleasi Moluskum Banyak (Besar) |
152,000 |
| 3526 |
Enukleasi Moluskum Sedikit (Sedang) |
111,000 |
| 3527 |
Enukleasi prostat dengan laser |
15,300,000 |
| 3528 |
Enukleasi prostat dengan monopolar/ bipolar |
13,490,000 |
| 3529 |
Enukleasi Ranula |
9,461,000 |
| 3530 |
Enukleasi/ Eviserasi |
9,379,000 |
| 3531 |
Enukleasi/ Eviserasi with Ball Orbital Implant |
9,533,000 |
| 3532 |
Enukleasi/ Eviserasi with DFG |
9,663,000 |
| 3533 |
Enukleasi/ Eviserasi with Orbital Implant |
9,533,000 |
| 3534 |
Epicardial Permanen Pace Maker(Microny)/PDA=MOF/Pengangkatan Embolusi(Device Embolusi) dengan CPB)/PS Repair |
33,550,000 |
| 3535 |
Epidermal Graft / Suction Blister 1 (ringan atau hanya 1 regio tubuh) |
2,200,000 |
| 3536 |
Epidermal Graft / Suction Blister 2 (berat atau lebih dari 1 regio) |
3,420,000 |
| 3537 |
Epidermal Thinning |
744,000 |
| 3538 |
Epididimimovasostomi narkose |
9,280,000 |
| 3539 |
Epidimovasostomi/Epididimovasostomi |
10,320,000 |
| 3540 |
Epidural Block for Chronic back pain / leg pain |
12,638,000 |
| 3541 |
Epidural bolus hari 1 |
796,000 |
| 3542 |
Epidural bolus setelah hari 1 |
638,000 |
| 3543 |
Epidural catheter analgesia |
703,000 |
| 3544 |
Epidural kontinu |
796,000 |
| 3545 |
Epidural kontinu setelah hari 1 |
638,000 |
| 3546 |
Epidural Steroid Cateter |
765,000 |
| 3547 |
Epidural Steroid Injection |
633,000 |
| 3548 |
Epidurolysis for Chronic back pain / leg pain |
12,638,000 |
| 3549 |
Epilasi bulu mata |
96,000 |
| 3550 |
Epilasi Bulu Mata |
84,000 |
| 3551 |
Episiotomi + Jahitan Perineum |
120,000 |
| 3552 |
ERCP (Endoscopy Retrograde Cholangio Pankreatografi) - sulit |
21,547,000 |
| 3553 |
ERCP + ekstraksi batu sederhana |
7,733,000 |
| 3554 |
ERCP + Extraksi Batu Inci Lithotriptor |
3,125,000 |
| 3555 |
ERCP + sfingterotomi |
5,991,000 |
| 3556 |
ERCP + sfingterotomi + pemasangan stent |
7,100,000 |
| 3557 |
ERCP Biopsy |
6,860,000 |
| 3558 |
ERCP Biopsy |
6,860,000 |
| 3559 |
ERCP Biopsy Intraductal / Cytology Brush |
1,399,000 |
| 3560 |
ERCP Biopsy Intraductal / Cytology Brush (Sore) |
1,180,000 |
| 3561 |
ERCP Biopsy Intraductal /Cytology Brush |
790,000 |
| 3562 |
ERCP Litotripsi Mechanical |
14,126,000 |
| 3563 |
ERCP Litotripsi Mechanical |
14,126,000 |
| 3564 |
ERCP Litotripsi Mechanical - Large stone |
8,188,000 |
| 3565 |
ERCP Litotripsi Mechanical - Large Stone |
8,230,000 |
| 3566 |
ERCP Litotripsi Mechanical - Large Stone (Sore) |
12,340,000 |
| 3567 |
ERCP Litotripsi Mechanical - Prosedur Soehendra |
5,110,000 |
| 3568 |
ERCP Litotripsi Mechanical - Prosedur Soehendra |
5,630,000 |
| 3569 |
ERCP Litotripsi Mechanical - Prosedur Soehendra (Sore) |
7,660,000 |
| 3570 |
ERCP Litotripsi Mechanical - Small Stone |
7,140,000 |
| 3571 |
ERCP Litotripsi Mechanical - Small Stone |
7,140,000 |
| 3572 |
ERCP Litotripsi Mechanical - Small Stone (Sore) |
10,700,000 |
| 3573 |
ERCP NBD (Nasobiliary Drainage) |
7,378,000 |
| 3574 |
ERCP NBD (Nasobiliary Drainage) |
7,445,000 |
| 3575 |
ERCP Plastic Stent (Drainase Internal Bilier) |
7,100,000 |
| 3576 |
ERCP Plastic Stent (Drainase Internal Bilier) (Sore) |
10,640,000 |
| 3577 |
ERCP Sphincterotome / Precut |
6,160,000 |
| 3578 |
ERCP Sphincterotome / Precut |
6,160,000 |
| 3579 |
ERCP Sphincterotome / Precut (Sore) |
9,240,000 |
| 3580 |
ERCP Stent (Drainase Bilier) |
8,960,000 |
| 3581 |
ERCP Stent (Drainase Bilier) |
9,041,000 |
| 3582 |
ERCP(Endoscopy Retrograde Cholangio Pankreatografi) (Rujukan Luar) |
38,680,000 |
| 3583 |
ERCP+ekstraksi batu sulit |
11,601,000 |
| 3584 |
Ergocycle Stress Test |
749,000 |
| 3585 |
Ergocycle Stress Test dengan CPET (Cardio Pulmonary Exercise Test) |
1,300,000 |
| 3586 |
Eritrosit Cuci (WE) Perkantong |
475,000 |
| 3587 |
Esofageal Manometri dengan esofagoskopi fleksibel |
6,479,000 |
| 3588 |
Esofagogastroduodenoskopi |
2,174,000 |
| 3589 |
Esofagogastroduodenoskopi Dengan Anastesi |
2,792,000 |
| 3590 |
Esofagogastroduodenoskopi Diagnostik (GEH) |
2,120,000 |
| 3591 |
Esofagogastroduodenoskopi Diagnostik (GEH) (Sore) |
3,180,000 |
| 3592 |
Esofagogastroduodenoskopi Diagnostik (GEH) + Anastesi |
3,155,000 |
| 3593 |
Esofagogastroduodenoskopi Diagnostik (GEH) + Anastesi (Sore) |
4,320,000 |
| 3594 |
Esofagomyotomi |
6,175,000 |
| 3595 |
Esofagomyotomi (Operasi Heller) |
17,957,000 |
| 3596 |
Esofagoskopi Diagnostik |
875,000 |
| 3597 |
Esofagoskopi Diagnostik + Anastesi |
1,752,000 |
| 3598 |
Esofagoskopi kaku diagnostik |
7,249,000 |
| 3599 |
Esofagoskopi terapeutik (Eksisi, Varises, Injeksi, businasi, dll) |
7,075,000 |
| 3600 |
Esofagostomi |
24,639,000 |
| 3601 |
Esofagostomi + gastrostomi (atreswia esofagus) |
18,315,000 |
| 3602 |
Esofagostomi + Gastrotomi (Atresia Esophagus) |
6,175,000 |
| 3603 |
Esoghageal Replacement Procedure (Transposisi Kolon, Transposisi gaster, gastric Pull-up) |
6,175,000 |
| 3604 |
Esophagography |
1,145,000 |
| 3605 |
Esophagoscopy |
5,647,645 |
| 3606 |
Esophagus replacement procedure |
31,081,000 |
| 3607 |
Estradiol |
263,000 |
| 3608 |
Estradiol (P) |
422,000 |
| 3609 |
ESWL |
7,850,000 |
| 3610 |
ESWL FASE I |
7,841,000 |
| 3611 |
ESWL Fase I (Sore) |
11,470,000 |
| 3612 |
ESWL FASE II |
7,000,000 |
| 3613 |
ESWL Fase II (Sore) |
10,160,000 |
| 3614 |
ESWL Prostatron |
5,376,000 |
| 3615 |
ESWL Prostatron (Sore) |
8,070,000 |
| 3616 |
ESWL ULANG |
7,850,000 |
| 3617 |
ESWT disfungsi ereksi awal (4 sesi) |
10,181,000 |
| 3618 |
ESWT Disfungsi Ereksi Awal (4 Sesi) |
10,181,000 |
| 3619 |
ESWT Disfungsi Ereksi Lanjutan (2 Sesi Lanjutan) |
5,467,000 |
| 3620 |
ESWT disfungsi ereksi lanjutan (2 sesi lanjutan) |
5,467,000 |
| 3621 |
ESWT peyronie disease (3 sesi) |
8,482,000 |
| 3622 |
ESWT Peyronie Disease (3 Sesi) |
7,918,000 |
| 3623 |
ESWT Urologi ( 1 sesi) |
3,580,000 |
| 3624 |
ESWT Urologi ( 6 sesi) |
14,145,000 |
| 3625 |
ESWT Urologi (1 Sesi) |
2,828,000 |
| 3626 |
ESWT Urologi (6 Sesi) |
14,145,000 |
| 3627 |
Ethmoidektomi (Intranasal) |
5,827,645 |
| 3628 |
Etmoidektomi Eksternal bilateral |
10,498,000 |
| 3629 |
Etmoidektomi Eksternal unilateral |
8,199,000 |
| 3630 |
EUS Abiasi Trunkus Coeliacus (Sore) |
3,870,000 |
| 3631 |
Eus Ablasi Trunkus Coeliacus |
2,580,000 |
| 3632 |
Eus Biopsi Fine Needle Aspiration |
27,460,000 |
| 3633 |
EUS Biopsi Fine Needle Aspiration (Sore) |
41,190,000 |
| 3634 |
Eus Gastro Jejenal Bypass (Hot axios stent) |
101,070,000 |
| 3635 |
EUS Gastro Jejenal Bypass (Hot Axios Stent) (Sore) |
151,600,000 |
| 3636 |
Eus Kanulasi Rendervous |
9,310,000 |
| 3637 |
EUS Kanulasi Rendervous (Sore) |
13,960,000 |
| 3638 |
Eus Stent Biliogastric (Plastic Stent) |
44,070,000 |
| 3639 |
Eus Stent Biliogastric (Plastic Stent) |
42,870,000 |
| 3640 |
EUS Stent Biliogastric (Plastic Stent) (Sore) |
66,100,000 |
| 3641 |
Evakuasi Bekuan Darah (Clot) |
4,442,187 |
| 3642 |
Evakuasi feses |
7,849,000 |
| 3643 |
Evakuasi Hematom |
334,000 |
| 3644 |
Evakuasi Hematoma - Op |
8,557,000 |
| 3645 |
Evakuasi Silicon Oil + Endolaser Lokal |
26,697,000 |
| 3646 |
Evakuasi Silicon Oil + Endolaser Narkose |
30,187,000 |
| 3647 |
Evaluasi Kemampuan Intelektual |
147,000 |
| 3648 |
Evaluasi Orthotik |
166,000 |
| 3649 |
Evaluasi Prosthetik |
166,000 |
| 3650 |
Evaluasi SST |
600,000 |
| 3651 |
EVAR + Branched Devices |
176,779,000 |
| 3652 |
EVAR + Chimney ± Intra-aorta Imaging |
176,779,000 |
| 3653 |
EVAR + Coilling ± Intra-aorta Imaging |
176,779,000 |
| 3654 |
EVAR + CUFF Extension ± Intra-aorta Imaging |
176,779,000 |
| 3655 |
EVAR + Endo anchor ± Intra-aorta Imaging |
176,779,000 |
| 3656 |
EVAR + Multiple Stiff Wire Technique |
176,779,000 |
| 3657 |
Evar Aorta abdominalis sederhana (+ Radiografer) |
132,585,000 |
| 3658 |
EVAR Customized Device (B-EVAR) ± Intra-aorta Imaging |
176,779,000 |
| 3659 |
EVAR Cut Down/dengan pembedahan |
176,779,000 |
| 3660 |
EVAR dengan Proglide (tanpa pembedahan) - Kompleks |
176,779,000 |
| 3661 |
EVAR Fenestrated ± Intra-aorta Imaging |
176,779,000 |
| 3662 |
EVAR kompleks (+ Radiografer) |
176,779,000 |
| 3663 |
Eviserasi + DFG |
6,904,436 |
| 3664 |
EVLT dengan multiple flebektomi 1 ekstremitas |
19,546,000 |
| 3665 |
Examination under anesthesia |
6,073,000 |
| 3666 |
Excisi Biopsi |
77,000 |
| 3667 |
Excision (Multiple) for Malignancy |
23,914,000 |
| 3668 |
Excision / Resection for Bone / Soft tissue tumor in difficult site (Scapula. pelvic. spine. deep muscles. or complex neurovascular area) with reconstruction |
17,403,000 |
| 3669 |
Excision for Ganglion / Wart/ Nevus/ Clavus |
10,677,000 |
| 3670 |
Excision of bone for graft, carpus and metacarpus |
6,600,000 |
| 3671 |
Excision of bone for graft, femur |
6,600,000 |
| 3672 |
Excision of bone for graft, humerus |
6,600,000 |
| 3673 |
Excision of bone for graft, patella |
6,600,000 |
| 3674 |
Excision of bone for graft, radius and ulna |
6,600,000 |
| 3675 |
Excision of bone for graft, scapula, clavicle, and thorax (ribs and sternum) |
6,600,000 |
| 3676 |
Excision of bone for graft, tarsals and metatarsals |
6,600,000 |
| 3677 |
Excision of bone for graft, tibia and fibula |
6,600,000 |
| 3678 |
Excision of intervertebral disc |
14,020,000 |
| 3679 |
Excision of lesion of muscle |
9,390,000 |
| 3680 |
Excision of lesion of muscle of hand |
9,390,000 |
| 3681 |
Excision of lesion of other soft tissue |
9,390,000 |
| 3682 |
Excision of lesion of tendon sheath |
9,390,000 |
| 3683 |
Excision of lesion of tendon sheath of hand |
9,390,000 |
| 3684 |
Excision of morton neuroma |
14,392,000 |
| 3685 |
Excision of muscle or fascia for graft |
11,196,000 |
| 3686 |
Excision of muscle or fascia of hand for graft |
9,390,000 |
| 3687 |
Excision of other lesion of soft tissue of hand |
9,390,000 |
| 3688 |
Excision of semilunar cartilage of knee |
16,485,212 |
| 3689 |
Excision of skin for graft |
7,522,000 |
| 3690 |
Excision of spine tumor (extradura / intradura) |
15,989,000 |
| 3691 |
Excision of tendon of hand for graft |
9,390,000 |
| 3692 |
Excision or correction of bunionette |
6,600,000 |
| 3693 |
Excisional Debridement / Nekrotomi/ Eskarektomi (Kategori Tindakan Disamakan) |
17,616,000 |
| 3694 |
Excisional Debridement + STSG + Amputasi |
25,706,000 |
| 3695 |
Excisional debridement of wound, infection, or burn |
2,350,000 |
| 3696 |
Excohliasi |
2,510,000 |
| 3697 |
Exercise / Latihan Wicara |
22,800 |
| 3698 |
Exercise challenge test |
250,000 |
| 3699 |
Exercise Not Elshewhere Classified |
70,000 |
| 3700 |
Exercise stress echocardiography dengan Treadmill |
749,000 |
| 3701 |
Exercise Therapi ( Latihan ) |
56,400 |
| 3702 |
Exflorasi Vagina |
5,979,000 |
| 3703 |
Expertise untuk Kepentingan Khusus |
191,000 |
| 3704 |
Explorasi Arteri Femoralis |
16,895,000 |
| 3705 |
Explorasi Testis Mikro Surgery |
7,777,000 |
| 3706 |
Exploration & extraction (open) for Foreign body |
13,060,000 |
| 3707 |
Exploration of tendon sheath |
9,390,000 |
| 3708 |
Exploration of tendon sheath of hand |
11,196,000 |
| 3709 |
Exposure Mahkota Gigi Terpendam dengan Anastesi Lokal |
860,000 |
| 3710 |
Ext. Pyelolitotomi (narkose) |
11,810,000 |
| 3711 |
Extended lobektomi hepar |
31,082,000 |
| 3712 |
Extended Pyelolithektomi (Gilverne) |
7,214,004 |
| 3713 |
External bleaching |
3,757,000 |
| 3714 |
EXTERNAL DCR+SIL TUBE Lokal |
10,316,000 |
| 3715 |
EXTERNAL DCR+SIL TUBE Narkose |
11,904,000 |
| 3716 |
External ventricular drainage (EVD) |
13,326,000 |
| 3717 |
Exterpasi / Eksisi Kecil |
283,000 |
| 3718 |
Exterpasi Besar / Eksisi |
386,000 |
| 3719 |
Extirpasi / Enukleasi besar > 6 cm |
6,408,000 |
| 3720 |
Extirpasi corpus alienum intra oral |
4,157,000 |
| 3721 |
Extirpasi plunging ranula |
12,175,000 |
| 3722 |
Extirpasi Polip |
2,850,000 |
| 3723 |
Extirpasi Polip Cavum Nasi |
4,532,000 |
| 3724 |
Extirpasi Tumor |
2,510,000 |
| 3725 |
Extraction/ Follicular Unit Extraction (FUE) pada alopesia sikatrikal 1 |
9,981,000 |
| 3726 |
Extraction/ Follicular Unit Extraction (FUE) pada alopesia sikatrikal 2 |
19,962,000 |
| 3727 |
Extraction/ Follicular Unit Extraction (FUE) pada alopesia sikatrikal 3 |
29,943,000 |
| 3728 |
Extraksi corpus alienum dengan Cald well luck |
9,281,000 |
| 3729 |
Extraksi gigi 1-5 |
14,250,000 |
| 3730 |
Extraksi gigi anak |
8,821,000 |
| 3731 |
Extraksi gigi dengan komplikasi |
8,821,000 |
| 3732 |
Extraksi gigi dewasa |
8,821,000 |
| 3733 |
Extraksi Kalium Oxalat |
66,000 |
| 3734 |
Extubasi |
700,000 |
| 3735 |
Eye Movement Desensitization and Reprocessing pada anak dan remaja |
250,000 |
| 3736 |
Eye Movement Desensitization and Reprocessing pada dewasa |
250,000 |
| 3737 |
Eye Movement Desensitization and Reprocessing pada lansia |
250,000 |
| 3738 |
Eye Reflex Test |
78,000 |
| 3739 |
FAAL Paru |
150,000 |
| 3740 |
Face Lift Mini |
22,616,000 |
| 3741 |
Face Lift, GA |
22,616,000 |
| 3742 |
Facebow transfer |
1,607,000 |
| 3743 |
Facelift (mini-facelift) |
3,741,000 |
| 3744 |
Facet block (Multiple) for Chronic back pain / leg pain |
12,641,000 |
| 3745 |
Facet block (Single) for Chronic back pain / leg pain |
12,641,000 |
| 3746 |
Facet Blok (1 Level/Multilevel) |
3,850,000 |
| 3747 |
Facial |
65,000 |
| 3748 |
Facial Bone Countouring - Angle Reshaping, GA |
22,616,000 |
| 3749 |
Facial Bone Countouring - Genioplasty With Silicone Implant, GA |
22,616,000 |
| 3750 |
Facial Bone Countouring - Malarplasty With Silicone Implant, GA |
22,616,000 |
| 3751 |
Facial Bone Countouring - Osseous Genioplasty, GA |
22,616,000 |
| 3752 |
Facial Bone Countouring - Osseous Malarplasty, GA |
22,616,000 |
| 3753 |
Facial Bone Countouring - Split Mandible Osteotomy, GA |
22,616,000 |
| 3754 |
Facial Medik |
184,000 |
| 3755 |
Facial Rejuvenation - Classical Facelift, GA |
22,616,000 |
| 3756 |
Facial Rejuvenation - Mini Facelift, LA |
19,913,000 |
| 3757 |
Facial Rejuvenation - Thread Facelift, LA |
19,913,000 |
| 3758 |
Facial Sling Dengan Alograft, GA |
22,616,000 |
| 3759 |
Facialis Parase |
73,000 |
| 3760 |
Faktor IX (P) |
416,000 |
| 3761 |
Faktor VIII |
382,000 |
| 3762 |
FAKTOR VIII |
382,000 |
| 3763 |
Faktor VIII (P) |
416,000 |
| 3764 |
Family Meeting pasien dewasa |
547,000 |
| 3765 |
Family Meeting pasien neonatus multidisiplin |
547,000 |
| 3766 |
Family Meeting pasien pediatrik |
547,000 |
| 3767 |
Family Therapi |
33,000 |
| 3768 |
Faradic / Galvanic |
45,600 |
| 3769 |
Fare Head Flap |
5,482,645 |
| 3770 |
Faringektomi |
18,502,000 |
| 3771 |
Faringoplasti |
24,639,000 |
| 3772 |
Faringotomi |
15,502,000 |
| 3773 |
Faringotomi |
5,482,645 |
| 3774 |
Farmakopunktur Analgesia |
228,000 |
| 3775 |
Farmakopunktur Anestesi Lokal |
378,000 |
| 3776 |
Farmakopunktur Obesitas |
228,000 |
| 3777 |
Farmakopunktur PRP Dengan Panduan USG |
700,000 |
| 3778 |
Farmakopunktur PRP Tanpa Panduan USG |
228,000 |
| 3779 |
Farmakopuntur |
105,000 |
| 3780 |
Fasalata Graft Lokal |
12,418,000 |
| 3781 |
Fasalata Graft Narkose |
14,250,000 |
| 3782 |
Fasciocutaneus Flap, GA |
22,616,000 |
| 3783 |
Fasciotomi dekompresi |
8,107,000 |
| 3784 |
Fasciotomy |
6,424,400 |
| 3785 |
Fasciotomy Burned Compartement Syndrome, GA |
8,107,000 |
| 3786 |
Fasciotomy of hand |
9,282,099 |
| 3787 |
Fascitis Plantaris manual (tanpa panduan) |
281,000 |
| 3788 |
Fascitis Plantaris USG |
595,000 |
| 3789 |
Fasiotomi |
8,107,000 |
| 3790 |
Fat Myringoplasty |
1,321,000 |
| 3791 |
Fe (Besi) _ |
45,000 |
| 3792 |
FE (SI)/BESI |
104,000 |
| 3793 |
Feeding plate |
1,257,000 |
| 3794 |
Feeding Tube |
36,000 |
| 3795 |
Feeling AHA / TCA |
200,000 |
| 3796 |
FEES |
720,000 |
| 3797 |
Femoral Entrapment manual (tanpa panduan) |
281,000 |
| 3798 |
Femoral Entrapment USG |
595,000 |
| 3799 |
Femoral osteotomy and fixation for LCPD |
23,728,000 |
| 3800 |
Fenestrasi Telinga Dalam |
14,568,000 |
| 3801 |
Fenestrasi Telinga Dalam bilateral |
17,568,000 |
| 3802 |
FERRITIN |
303,000 |
| 3803 |
Ferritine _ |
230,000 |
| 3804 |
Fetocide Dengan Anastesi Lokal |
396,000 |
| 3805 |
Fiber Optic Laryngoscopy (FOL) |
250,000 |
| 3806 |
Fiber Post/buah |
0 |
| 3807 |
Fibre Optic Bronkoskopi |
4,653,000 |
| 3808 |
Fibrilitik Intra Pleural |
2,120,000 |
| 3809 |
FIBRINOGEN |
247,000 |
| 3810 |
Fibrinogen _ |
200,000 |
| 3811 |
Fibro Adenom Mamae |
3,444,000 |
| 3812 |
Fibro Adenoma > Tumor (Besar) |
480,000 |
| 3813 |
Fibroadenoma (Mammae) / Biji (Sedang) |
157,000 |
| 3814 |
Fibroscan |
1,040,000 |
| 3815 |
Fibroscan |
1,079,000 |
| 3816 |
Fibroscan (Sore) |
1,560,000 |
| 3817 |
Fiksasi |
193,000 |
| 3818 |
Fiksasi (Eksekutif) |
0 |
| 3819 |
Fiksasi Archbar Per Rahang |
1,784,000 |
| 3820 |
Fiksasi Composte Wiring Per Rahang |
1,567,000 |
| 3821 |
Fiksasi sakrospinosus (suspensi vagina per vaginam) |
8,965,000 |
| 3822 |
Fiksasi Wiring Per Regio (Segmen) |
1,227,000 |
| 3823 |
Fiksasi/ Wire Satu Gigi |
298,000 |
| 3824 |
Filaria |
27,500 |
| 3825 |
Fine Needle Aspirasi (FNA) |
145,000 |
| 3826 |
Finger Insole |
163,000 |
| 3827 |
Finger reattachment |
10,675,000 |
| 3828 |
Finger Splint |
316,000 |
| 3829 |
Finger Tip Injury Repair - Composite Graft, LA |
7,434,000 |
| 3830 |
Finger Tip Injury Repair - Skin Flap Lokal, LA |
7,434,000 |
| 3831 |
Finger Tip Injury Repair - Skin Grafting, LA |
7,434,000 |
| 3832 |
Finger Tip Injury Repair - Toe Transfer, GA |
8,443,000 |
| 3833 |
Fisioterapi Dengan Alat (4x Tindakan) |
250,000 |
| 3834 |
Fistula enterovesika (nakose) |
16,955,000 |
| 3835 |
Fistula Eterovesika |
6,925,000 |
| 3836 |
Fistulectomi |
2,850,000 |
| 3837 |
Fistulectomy Perianal |
4,962,559 |
| 3838 |
Fistulektomi / Repair Fistel Uretra |
4,442,187 |
| 3839 |
Fistulektomi Kompleks |
18,442,000 |
| 3840 |
Fistulektomi Nasolabial/ Nasofaringeal/ Oronasal |
12,294,000 |
| 3841 |
Fistulektomi Pediatrik |
18,442,000 |
| 3842 |
Fistulektomi Sederhana |
12,294,000 |
| 3843 |
Fistulektomi/Fistula Ani |
4,183,286 |
| 3844 |
Fistulografi |
500,000 |
| 3845 |
Fistulography |
1,289,000 |
| 3846 |
Fistulorafi |
13,306,000 |
| 3847 |
Fitting Alat Bantu Ambulasi |
203,000 |
| 3848 |
Fitting Ortosis (Spinal, AGB, AGA) |
241,000 |
| 3849 |
Fitting Ortosis (Spinal, Anggota Gerak Atas, Anggota Gerak Bawah) |
203,000 |
| 3850 |
Fitting Ortosis Leher |
203,000 |
| 3851 |
Fitting Ortosis Leher |
100,000 |
| 3852 |
Fitting Prostesis Atas Lutut |
203,000 |
| 3853 |
Fitting Prostesis Bawah Lutut |
203,000 |
| 3854 |
Fitting Prostesis Bawah Lutut |
241,000 |
| 3855 |
Fitting Prostesis Kaki Atas Lutut |
241,000 |
| 3856 |
Fitting Prostesis Kaki, Not Otherwise Specified |
203,000 |
| 3857 |
Fitting Prostesis Kaki, Nit Otherwise Specified |
241,000 |
| 3858 |
Fitting Prostesis Lengan Atas dan Bahu |
241,000 |
| 3859 |
Fitting Prostesis Lengan Atas dan Bahu |
203,000 |
| 3860 |
Fitting Prostesis Lengan Bawah dan Tangan |
203,000 |
| 3861 |
Fitting Prostesis Lengan Bawah dan Tangan |
241,000 |
| 3862 |
Fitting Prostesis Lengan, Tidak Pada Lengan Spesifik |
241,000 |
| 3863 |
Fitting Prostesis Lengan, Tidak pada Lengan Spesifik |
203,000 |
| 3864 |
Fitting Protesa |
203,000 |
| 3865 |
Five-in-one repair of knee |
8,105,000 |
| 3866 |
Fixed retainer 1 rahang |
1,238,000 |
| 3867 |
Fixed retainer 2 rahang |
2,413,000 |
| 3868 |
Flap kompleks (Tumor) |
9,839,000 |
| 3869 |
Flap kompleks 2 (myocutan flap, keystone flap di atas 2 sisi) |
24,639,000 |
| 3870 |
Flap Konjungtiva lokal |
4,874,000 |
| 3871 |
Flap Konjungtiva narkose |
5,856,000 |
| 3872 |
Flap kulit sederhana |
10,070,000 |
| 3873 |
Flap kulit sederhana (Tumor) |
10,804,000 |
| 3874 |
Flap kulit sederhana 1 (advancement) |
16,973,000 |
| 3875 |
Flap kulit sederhana 2 (pedicled skin flap, keystone flap) |
13,715,000 |
| 3876 |
Flebektomi |
2,850,000 |
| 3877 |
Flebektomi 1 tungkai kompleks |
9,421,000 |
| 3878 |
Flebektomi 1 tungkai sederhana |
7,849,000 |
| 3879 |
Flebektomi 2 tungkai kompleks |
11,306,000 |
| 3880 |
Flebektomi 2 tungkai sederhana |
9,421,000 |
| 3881 |
FLEBOTOMI |
436,000 |
| 3882 |
Flexi Denture * |
1,147,000 |
| 3883 |
Flexible Endoscopy Evaluation Of Swallowing (FEES) |
1,077,000 |
| 3884 |
Flourocences Insitu Hybridization |
3,125,000 |
| 3885 |
Flow Diverter Intrakranial |
41,145,000 |
| 3886 |
Flow Diverter Stent |
41,145,000 |
| 3887 |
Fludrocortisone Suppression Test |
345,000 |
| 3888 |
Fluoroscopy |
775,000 |
| 3889 |
Fluoroscopy + Anestesi |
1,057,000 |
| 3890 |
Fluoroscopy dengan Kontras |
1,486,000 |
| 3891 |
Flushing cellsite |
280,000 |
| 3892 |
Flusing CAPD |
855,000 |
| 3893 |
FNAB dengan USG Guided |
891,000 |
| 3894 |
FNAB limfadenopati usg guided |
891,000 |
| 3895 |
FNAB tanpa panduan USG |
785,000 |
| 3896 |
FNAB tanpa USG Guided |
785,000 |
| 3897 |
FNAB/ Aspirasi Jarum halus KGB |
785,000 |
| 3898 |
Follicular Unit Transplantation (FUT) 1 |
4,001,000 |
| 3899 |
Follicular Unit Transplantation (FUT) 2 |
5,004,000 |
| 3900 |
Follicular Unit Transplantation (FUT) 3 |
7,005,000 |
| 3901 |
Follow Through |
1,445,000 |
| 3902 |
Fontan/Kawashima/Penutupan VSD tanpa Pembedahan Dgn Menggunakan Device (AMVO)/Repair Aneuryema Of Sinus Valsava |
68,031,954 |
| 3903 |
Fontan/Kawashima/Penutupan VSD tanpa Pembedahan Dgn Menggunakan Device (AMVO)/Repair Aneuryema Of Sinus Valsava + Anastesi |
77,790,699 |
| 3904 |
Foot Glove Prosthesis |
18,630,000 |
| 3905 |
Foot reattachment |
10,675,000 |
| 3906 |
Foot Splint (Biasa) |
1,500,000 |
| 3907 |
Foot Splint Orfit |
3,500,000 |
| 3908 |
Foramen Magnum Decompression |
28,718,000 |
| 3909 |
Foraminal / Nerve Root Block (Multiple) for Chronic back pain / leg pain |
9,448,000 |
| 3910 |
Foraminal / Nerve Root Block (Single) for Chronic back pain / leg pain |
11,057,000 |
| 3911 |
Fore Head flap (Bedah Plastik) |
4,850,000 |
| 3912 |
Forearm Crutches (Biasa) |
170,000 |
| 3913 |
Forearm Crutches (Standar) |
385,000 |
| 3914 |
Forearm, wrist, or hand reattachment |
10,675,000 |
| 3915 |
Forehead Flap THT |
4,850,000 |
| 3916 |
forequarter amputation |
14,629,000 |
| 3917 |
Fosfat Inorganik/Phosphat Anorganik/Fosfor Darah |
195,000 |
| 3918 |
FOSFATASE ALKALI/ ALKALI FOSFATASE |
71,000 |
| 3919 |
Fosfor |
195,000 |
| 3920 |
Fosfor Anorganik (P) |
98,000 |
| 3921 |
Fosfor Anorganik Urine (P) |
98,000 |
| 3922 |
Foto Abdomen (1 Posisi/2 Posisi/BNO/Foto polos Abdomen) |
125,000 |
| 3923 |
Foto Abdomen 3 Posisi |
250,000 |
| 3924 |
Foto Abdomen Invertogram |
160,000 |
| 3925 |
Foto Adenoid |
125,000 |
| 3926 |
Foto Ankle Joint AP + Lateral D/S |
160,000 |
| 3927 |
Foto Ankle Joint AP + Lateral D+S |
180,000 |
| 3928 |
Foto Ankle Joint Mortise View |
125,000 |
| 3929 |
Foto Ankle/Ankle Bilateral (AP/Lat/Keduanya) |
125,000 |
| 3930 |
Foto Ante Brachii/Ante Brachii Bilateral |
125,000 |
| 3931 |
Foto Antebrachi AP + Lateral D/S |
160,000 |
| 3932 |
Foto Antebrachi AP + Lateral D+S |
180,000 |
| 3933 |
Foto Basis Kranii |
125,000 |
| 3934 |
Foto Bone Age |
125,000 |
| 3935 |
Foto Cephalo |
125,000 |
| 3936 |
Foto Cervical AP + Lateral + Obliq 3 Posisi |
200,000 |
| 3937 |
Foto Cervical Open Mouth |
125,000 |
| 3938 |
Foto Clavicula D/S |
125,000 |
| 3939 |
Foto Clavicula D+S |
180,000 |
| 3940 |
Foto Costae |
125,000 |
| 3941 |
Foto Coxae |
125,000 |
| 3942 |
Foto Cruris AP + Lateral D/S |
160,000 |
| 3943 |
Foto Cruris AP + Lateral D+S |
180,000 |
| 3944 |
Foto Cubiti/Cubiti Bilateral |
125,000 |
| 3945 |
Foto Femur Ap + Lateral D/S |
160,000 |
| 3946 |
Foto Femur Ap + Lateral D+S |
180,000 |
| 3947 |
Foto Fundus |
250,000 |
| 3948 |
Foto Fundus |
313,000 |
| 3949 |
Foto Genu AP + Lateral & Sky Line View D/S |
180,000 |
| 3950 |
Foto Genu AP + Lateral & Sky Line View D+S |
200,000 |
| 3951 |
Foto Genu/Knee Joint AP + Lateral D/S |
160,000 |
| 3952 |
Foto Genu/Knee Joint AP + Lateral D+S |
180,000 |
| 3953 |
Foto Humerus D/S |
160,000 |
| 3954 |
Foto Humerus D+S |
180,000 |
| 3955 |
Foto Jaringan Lunak |
125,000 |
| 3956 |
Foto Kepala AP + Lateral |
160,000 |
| 3957 |
Foto Kepala Water Position |
125,000 |
| 3958 |
Foto Koagulasi (acc) |
3,760,000 |
| 3959 |
Foto Koagulasi Laser |
2,850,000 |
| 3960 |
Foto Koagulasi Laser (rujukan luar) |
3,125,000 |
| 3961 |
Foto Kolumna Vertebralis |
125,000 |
| 3962 |
Foto Leher AP + Lateral |
160,000 |
| 3963 |
Foto Lumbal AP + Lateral |
160,000 |
| 3964 |
Foto Lumbal Dynamic |
160,000 |
| 3965 |
Foto Lumbosakral AP + Lateral |
160,000 |
| 3966 |
Foto Lumbosakral AP + Lateral + Obliq |
180,000 |
| 3967 |
Foto Mandibula / Rahang AP + Lateral |
160,000 |
| 3968 |
Foto Mandibula / Rahang AP + Lateral (Rujukan Luar) |
160,000 |
| 3969 |
Foto Manus AP + Obliq D/S |
160,000 |
| 3970 |
Foto Manus AP + Obliq D+S |
180,000 |
| 3971 |
Foto Mastoid |
160,000 |
| 3972 |
Foto Metacarpai/Tangan |
125,000 |
| 3973 |
Foto Orbita |
160,000 |
| 3974 |
Foto Os Nasal |
125,000 |
| 3975 |
Foto Pedis AP + Obliq D/S |
160,000 |
| 3976 |
Foto Pedis AP + Obliq D+S |
180,000 |
| 3977 |
Foto Pelvis/Panggul AP |
125,000 |
| 3978 |
Foto Pelvis/Panggul Inlet + outlet AP |
180,000 |
| 3979 |
Foto Polos Abdomen |
125,000 |
| 3980 |
Foto Radius/Ulna (AP/Lat/Keduanya) |
125,000 |
| 3981 |
Foto Rheese |
125,000 |
| 3982 |
Foto Sakrum AP + Lateral |
160,000 |
| 3983 |
Foto Scapula AP + Lateral D/S |
160,000 |
| 3984 |
Foto Scapula AP + Lateral D+S |
180,000 |
| 3985 |
Foto Schedel (AP/Lat/Keduanya) (evaluasi adenoid) |
125,000 |
| 3986 |
Foto Sendi Bahu / Shoulder Joint D/S |
160,000 |
| 3987 |
Foto Sendi Bahu / Shoulder Joint D+S |
180,000 |
| 3988 |
Foto Sendi Siku / Elbow Joint D/S |
160,000 |
| 3989 |
Foto Sendi Siku / Elbow Joint D+S |
180,000 |
| 3990 |
Foto Sinus Adenoid |
125,000 |
| 3991 |
Foto Sinus Paranasal |
160,000 |
| 3992 |
Foto Stenvers |
125,000 |
| 3993 |
Foto Temporomandibular Joint (TMJ) |
180,000 |
| 3994 |
Foto Thoracal (AP/Lat/Keduanya) |
125,000 |
| 3995 |
Foto Thoracal AP/Lat/Obi |
125,000 |
| 3996 |
Foto Thoraco Lumbal AP/Lat/Obi |
125,000 |
| 3997 |
Foto Thorakal AP + Lateral |
160,000 |
| 3998 |
Foto Thoraks Lateral |
125,000 |
| 3999 |
Foto Thoraks PA/AP |
125,000 |
| 4000 |
Foto Thoraks PA/AP + Lateral |
160,000 |
| 4001 |
Foto Thoraks RLD |
125,000 |
| 4002 |
Foto Top Lordotik |
125,000 |
| 4003 |
Foto Wrist Joint AP + Lateral D/S |
160,000 |
| 4004 |
Foto Wrist Joint AP + Lateral D+S |
180,000 |
| 4005 |
Foto X-RAY C ARM/Flouroscopy |
350,000 |
| 4006 |
Foto X-RAY C ARM/Flouroscopy (Rujukan Luar) |
1,320,000 |
| 4007 |
Fotokoagulasi Laser |
2,500,000 |
| 4008 |
Fototerapi 1 (1-2 lesi) |
50,000 |
| 4009 |
Fototerapi 2 (= 3 lesi) |
70,000 |
| 4010 |
Fototerapi 3 (Whole Body) |
89,000 |
| 4011 |
Four Poster Cervical Orthosis |
2,850,000 |
| 4012 |
Fraktur Dan Dislokasi - Orif Dengan Miniplate, GA |
29,374,000 |
| 4013 |
Fraktur Dan Dislokasi - Pemasangan Intramedulary Wire, LA |
12,650,000 |
| 4014 |
Fraktur Maksila/Zygoma |
6,168,740 |
| 4015 |
Fraktur Muka Multiple (Tanpa Miniplate Screw) |
9,451,305 |
| 4016 |
Fraktur Rahang |
2,960,000 |
| 4017 |
Fraktur Rahang Sederhana |
6,281,000 |
| 4018 |
Fraktur Sederhana os Nassal + Lokal |
5,108,000 |
| 4019 |
Fraktur Sederhana os Nassal + Naskosa Umum |
5,107,800 |
| 4020 |
Fraktur Tripodo/Multiple |
6,913,000 |
| 4021 |
Free Fibular Flap /Fff(Microsurgery) |
32,311,000 |
| 4022 |
Free Field Test |
73,000 |
| 4023 |
Free Field Test |
282,000 |
| 4024 |
Free flap |
23,250,000 |
| 4025 |
Free Flap Surgery |
39,655,772 |
| 4026 |
Free skin graft |
9,182,099 |
| 4027 |
Free skin graft, not otherwise specified |
6,528,000 |
| 4028 |
Free T3 |
181,000 |
| 4029 |
FREE T4/ FT4 |
277,000 |
| 4030 |
Frenectomi |
2,850,000 |
| 4031 |
Frenectomy |
1,536,000 |
| 4032 |
Frenektomi (Bedah Mulut) |
1,464,000 |
| 4033 |
Frenektomi dengan Anastesi Lokal |
0 |
| 4034 |
Frenektomi lingualis / labialis |
8,261,000 |
| 4035 |
FRESH FROZEN PLASMA (FFP) |
573,000 |
| 4036 |
Fresh Frozen Plasma (FFP) NAT |
740,000 |
| 4037 |
Fresh Frozen Plasma (FFP) NAT skrining antibodi |
740,000 |
| 4038 |
Fresh Frozen Plasma (FFP) skrining antibodi |
490,000 |
| 4039 |
Fronto-Orbital Advancement Pada Craniosynostosis |
22,016,772 |
| 4040 |
Frontoetmoidektomi Eksternal |
10,498,000 |
| 4041 |
Frontozygomaticomaxillary Suspension, GA |
20,578,000 |
| 4042 |
Frosen Section (Potongan Beku) VC |
900,000 |
| 4043 |
Fruktosamin |
84,000 |
| 4044 |
FSH |
200,000 |
| 4045 |
FSH (P) |
352,000 |
| 4046 |
FT4 _ |
210,000 |
| 4047 |
Full Thickness Skin Graft (FTSG) |
21,420,000 |
| 4048 |
Full Thickness Skin Graft (Ftsg) Daerah Diluar Wajah, GA |
21,420,000 |
| 4049 |
Full Thickness Skin Graft (Ftsg) Daerah Diluar Wajah, LA |
18,841,000 |
| 4050 |
Full Thickness Skin Graft (Ftsg) Pada Wajah, GA |
21,420,000 |
| 4051 |
Full Thickness Skin Graft (Ftsg) Pada Wajah, LA |
18,841,000 |
| 4052 |
Full thickness skin graft for skin defect |
21,420,000 |
| 4053 |
Full-thickness skin graft to hand |
6,528,000 |
| 4054 |
Full-thickness skin graft to other sites |
6,528,000 |
| 4055 |
Functie Pericard |
351,000 |
| 4056 |
Functie Pertitoneum |
87,000 |
| 4057 |
Function Evaluation |
70,000 |
| 4058 |
Functional Echocardiography pasien neonatus |
774,000 |
| 4059 |
Functional TCD |
850,000 |
| 4060 |
Fundoplikasi gaster |
18,554,000 |
| 4061 |
Fundoplikasi Gaster |
6,175,000 |
| 4062 |
Funduscopy |
80,000 |
| 4063 |
Funduscopy Direct |
54,000 |
| 4064 |
Funduscopy Direct ( DPRD ) |
120,000 |
| 4065 |
Funduscopy Indirect |
58,000 |
| 4066 |
Funduskopi Direk |
99,000 |
| 4067 |
Funduskopi indirek |
137,000 |
| 4068 |
Fungsi luhur bedside |
499,000 |
| 4069 |
Fungsi luhur diagnostic |
499,000 |
| 4070 |
Fungsi luhur global (MMSE, MOCA, VCAT) |
499,000 |
| 4071 |
Fungsi luhur legal |
499,000 |
| 4072 |
Fungsi luhur okupasional |
499,000 |
| 4073 |
Fungsi luhur terapeutik |
564,000 |
| 4074 |
Fungsional Endoscopy Sinus Surgery (FESS) |
4,243,393 |
| 4075 |
Fusi dan instrumentasi lumbal (open surgery) |
37,385,000 |
| 4076 |
Fusi dan Instrumentasi Lumbosacroiliac |
50,395,000 |
| 4077 |
Fusi dan instrumentasi servikal advance/kompleks posterior approach |
37,385,000 |
| 4078 |
Fusi dan instrumentasi servikal esensial, posterior approach |
37,385,000 |
| 4079 |
Fusi dan instrumetasi torakal : - Fusi autograft - Fusi cage -Fusi distractable anterior spacer -fusi plate and screw |
37,385,000 |
| 4080 |
Fusi instrumentasi servikal anterior -Fusi cage - Fusi plate and screw - Fusi autograft -Fusi distratable anterior spacer |
37,385,000 |
| 4081 |
Fusi Korpus Vertebra Approach Anterior (Bedah Syaraf) |
6,760,638 |
| 4082 |
Fusi Korpus Vertebra Approach Posterior (Bedah Syaraf) |
10,705,638 |
| 4083 |
Fusion or refusion of 2-3 vertebrae |
14,020,000 |
| 4084 |
Fusion or refusion of 4-8 vertebrae |
14,020,000 |
| 4085 |
Fusion or refusion of 9 or more vertebrae |
14,020,000 |
| 4086 |
Gali Kubur Dalam Kota |
6,000,000 |
| 4087 |
Gali Kubur Luar Kota |
11,000,000 |
| 4088 |
GAMBARAN DARAH TEPI (TANPA HEMATOLOGI ANALYZER) |
198,000 |
| 4089 |
Gambaran Darah tepi * _ |
190,000 |
| 4090 |
GAMBARAN SUMSUM TULANG LENGKAP |
660,000 |
| 4091 |
GAMMA GT |
90,000 |
| 4092 |
Gamma GT |
40,000 |
| 4093 |
Ganglionektomi Sfenopalatina bilateral |
18,802,000 |
| 4094 |
Ganglionektomi Sfenopalatina unilateral Perendoskopi |
14,461,000 |
| 4095 |
Ganti / Rawat Colostomy (RJ) |
67,050 |
| 4096 |
Ganti Arch wire NiTi (1 Rahang) |
130,000 |
| 4097 |
Ganti Arch wire NiTi (2 Rahang) |
153,000 |
| 4098 |
Ganti Arch wire SS (1 Rahang) |
115,000 |
| 4099 |
Ganti Arch wire SS (2 Rahang) |
130,000 |
| 4100 |
Ganti Balutan ( Dlm Narkose ) |
6,467,000 |
| 4101 |
Ganti Balutan Besar ( > 11cm ) |
136,000 |
| 4102 |
Ganti Balutan Besar ( > 11cm ) pasien dewasa |
136,000 |
| 4103 |
Ganti Balutan Besar ( > 11cm ) pasien neonatus |
136,000 |
| 4104 |
Ganti Balutan daerah Mata |
89,000 |
| 4105 |
Ganti Balutan Kecil (< 5 cm) |
103,000 |
| 4106 |
Ganti Balutan Kecil (< 5 cm) pasien dewasa |
103,000 |
| 4107 |
Ganti Balutan Kecil (< 5 cm) pasien neonatus |
103,000 |
| 4108 |
Ganti Balutan Kecil (< 5 cm) pasien pediatrik |
103,000 |
| 4109 |
Ganti balutan luka luas (1 regio tubuh atau lebih) |
421,000 |
| 4110 |
Ganti Balutan Sedang ( 6 cm - 10 cm ) |
128,000 |
| 4111 |
Ganti Balutan Sedang ( 6 cm - 10 cm ) pasien dewasa |
128,000 |
| 4112 |
Ganti Balutan Sedang ( 6 cm - 10 cm ) pasien neonatus |
128,000 |
| 4113 |
Ganti Balutan Sedang ( 6 cm - 10 cm ) pasien pediatrik |
128,000 |
| 4114 |
Ganti band baru |
192,000 |
| 4115 |
Ganti bracket baru |
115,000 |
| 4116 |
Ganti Colostomy Bag |
0 |
| 4117 |
Ganti Cuci Kanul |
568,000 |
| 4118 |
Ganti Drain |
55,000 |
| 4119 |
Ganti Kanule |
250,000 |
| 4120 |
Ganti kateter |
321,000 |
| 4121 |
Ganti kateter gastrostomi |
261,000 |
| 4122 |
Ganti Kawat IMF |
55,000 |
| 4123 |
Ganti Nefrostomi |
675,000 |
| 4124 |
Ganti Nefrostomi (Lokal) Nop |
797,000 |
| 4125 |
Ganti Nefrostomi Lokal |
8,251,000 |
| 4126 |
Ganti nefrostomi perkutan |
9,210,000 |
| 4127 |
Ganti Provok |
577,000 |
| 4128 |
Ganti Provox |
250,000 |
| 4129 |
Ganti Rubber Elastik IMF |
55,000 |
| 4130 |
Ganti Sistostomi (Lokal) |
321,000 |
| 4131 |
Ganti Verban |
168,000 |
| 4132 |
Ganti Verban (Intensif) |
83,000 |
| 4133 |
Ganti Verban Besar |
231,000 |
| 4134 |
Ganti Verban Besar (Poli Gigi) |
122,000 |
| 4135 |
Ganti verban Kecil |
116,000 |
| 4136 |
Ganti Verban Kecil (Poli Gigi) |
99,000 |
| 4137 |
Ganti Verband |
83,000 |
| 4138 |
Ganti Verband (Radiotherapi) |
83,000 |
| 4139 |
Ganti Verband Pasien (Besar) |
64,000 |
| 4140 |
Ganti Verband Pasien (Kecil) |
52,000 |
| 4141 |
Gap arthoplasty TMJ |
15,538,000 |
| 4142 |
Gas-Fluid Exchange (GFX)/ Drainage subretinal Fluid Lokal |
4,162,000 |
| 4143 |
Gas-Fluid Exchange (GFX)/ Drainage subretinal Fluid Narkose |
6,310,000 |
| 4144 |
Gasterctomi (Blroth 1 dan 2) |
5,982,388 |
| 4145 |
Gastrectomi ( Bilroth 1 dan 2 ) |
5,982,389 |
| 4146 |
Gastrektomi Distal + Diseksi KGB D1 |
18,315,000 |
| 4147 |
Gastrektomi parsial dengan anastomosis (Bilroth I & II) |
18,315,000 |
| 4148 |
Gastrektomi proksimal + Diseksi KGB D1 |
18,315,000 |
| 4149 |
Gastrektomi total (Diseksi KGB D1) |
18,315,000 |
| 4150 |
Gastrektomi total (Diseksi KGB D2) |
18,315,000 |
| 4151 |
Gastrektomi total+ esofagektomi (Diseksi KGB D1) |
31,082,000 |
| 4152 |
Gastric analysis dan interpretasi gastric residual volume |
122,000 |
| 4153 |
Gastroduodenoskopi |
10,153,000 |
| 4154 |
Gastroduodenoskopi |
4,995,000 |
| 4155 |
Gastroduodenoskopi Besar |
4,995,000 |
| 4156 |
Gastroscopy / Esofagogastroduodescopy EGD |
18,720,000 |
| 4157 |
Gastrostomi |
10,153,000 |
| 4158 |
Gastrostomi anak |
13,142,000 |
| 4159 |
Gastrostomi neonatus |
10,153,000 |
| 4160 |
Gastrostomi Pada Neonatus |
8,164,502 |
| 4161 |
GCSF drip intravena |
1,400,000 |
| 4162 |
GCSF subkutan |
920,000 |
| 4163 |
Genioplasty |
18,017,000 |
| 4164 |
Genital Aesthetic Surgery - Hymenoplasty, LA |
25,773,000 |
| 4165 |
Genital Aesthetic Surgery - Labiaplasty, LA |
25,773,000 |
| 4166 |
Genital Aesthetic Surgery - Vaginoplasty, GA |
28,333,000 |
| 4167 |
Genital hygiene pasien pediatrik |
20,000 |
| 4168 |
Genitography |
1,289,000 |
| 4169 |
Genitoplasty (Clitoroplasty, vaginoplasty) |
6,175,000 |
| 4170 |
GIC besar |
115,000 |
| 4171 |
GIC kecil |
77,000 |
| 4172 |
Gigi Tiruan Immediate Koreksi Posisi Protesa Delapan Gigi/Lebih |
3,090,000 |
| 4173 |
Gigi Tiruan Immediate Koreksi Posisi Protesa Dua Gigi |
970,000 |
| 4174 |
Gigi Tiruan Immediate Koreksi Posisi Protesa Empat Gigi |
1,560,000 |
| 4175 |
Gigi Tiruan Immediate Koreksi Posisi Protesa Enam Gigi |
2,150,000 |
| 4176 |
Gigi Tiruan Immediate Koreksi Posisi Protesa Lima Gigi |
1,860,000 |
| 4177 |
Gigi Tiruan Immediate Koreksi Posisi Protesa Penuh |
7,000,000 |
| 4178 |
Gigi Tiruan Immediate Koreksi Posisi Protesa Satu Gigi |
600,000 |
| 4179 |
Gigi Tiruan Immediate Koreksi Posisi Protesa Satu Rahang |
3,740,000 |
| 4180 |
Gigi Tiruan Immediate Koreksi Posisi Protesa Tiga Gigi |
1,200,000 |
| 4181 |
Gigi Tiruan Immediate Koreksi Posisi Protesa Tujuh Gigi |
2,295,000 |
| 4182 |
Gigi Tiruan Lepasan Akrilik Protesa Delapan/Lebih/Satu Rahang |
1,240,000 |
| 4183 |
Gigi Tiruan Lepasan Akrilik Protesa Dua Gigi |
370,000 |
| 4184 |
Gigi Tiruan Lepasan Akrilik Protesa Empat Gigi |
560,000 |
| 4185 |
Gigi Tiruan Lepasan Akrilik Protesa Enam Gigi |
725,000 |
| 4186 |
Gigi Tiruan Lepasan Akrilik Protesa Lima Gigi |
650,000 |
| 4187 |
Gigi Tiruan Lepasan Akrilik Protesa Penuh Flabby Ridge |
4,000,000 |
| 4188 |
Gigi Tiruan Lepasan Akrilik Protesa Penuh Flat Rata |
3,500,000 |
| 4189 |
Gigi Tiruan Lepasan Akrilik Protesa Penuh Rahang Atas dan Bawah Biasa |
2,500,000 |
| 4190 |
Gigi Tiruan Lepasan Akrilik Protesa Satu Gigi |
300,000 |
| 4191 |
Gigi Tiruan Lepasan Akrilik Protesa Satu Rahang Dengan Flabby Ridge |
2,000,000 |
| 4192 |
Gigi Tiruan Lepasan Akrilik Protesa Satu Rahang Dengan Flat Rata |
1,700,000 |
| 4193 |
Gigi Tiruan Lepasan Akrilik Protesa Tiga Gigi |
465,000 |
| 4194 |
Gigi Tiruan Lepasan Akrilik Protesa Tujuh Gigi |
820,000 |
| 4195 |
Gigi Tiruan Lepasan Immediate Penuh Immediate |
4,000,000 |
| 4196 |
Gigi Tiruan Lepasan Immediate Satu Rahang Immediate |
2,240,000 |
| 4197 |
Gigi Tiruan Lepasan Immediate/Segera Protesa Delapan/Lebih/Satu Rahang |
1,740,000 |
| 4198 |
Gigi Tiruan Lepasan Immediate/Segera Protesa Dua Gigi |
670,000 |
| 4199 |
Gigi Tiruan Lepasan Immediate/Segera Protesa Empat Gigi |
1,060,000 |
| 4200 |
Gigi Tiruan Lepasan Immediate/Segera Protesa Enam Gigi |
1,425,000 |
| 4201 |
Gigi Tiruan Lepasan Immediate/Segera Protesa Lima Gigi |
1,250,000 |
| 4202 |
Gigi Tiruan Lepasan Immediate/Segera Protesa Satu Gigi |
550,000 |
| 4203 |
Gigi Tiruan Lepasan Immediate/Segera Protesa Tiga Gigi |
865,000 |
| 4204 |
Gigi Tiruan Lepasan Immediate/Segera Protesa Tujuh Gigi |
1,620,000 |
| 4205 |
Gigi Tiruan Overdenture Protesa Delapan/Lebih/Satu Rahang |
1,280,000 |
| 4206 |
Gigi Tiruan Overdenture Protesa Dua Gigi |
575,000 |
| 4207 |
Gigi Tiruan Overdenture Protesa Empat Gigi |
800,000 |
| 4208 |
Gigi Tiruan Overdenture Protesa Enam Gigi |
1,040,000 |
| 4209 |
Gigi Tiruan Overdenture Protesa Lima Gigi |
920,000 |
| 4210 |
Gigi Tiruan Overdenture Protesa Penuh Rahang Atas dan Bawah Biasa |
2,500,000 |
| 4211 |
Gigi Tiruan Overdenture Protesa Satu Gigi |
475,000 |
| 4212 |
Gigi Tiruan Overdenture Protesa Tiga Gigi |
680,000 |
| 4213 |
Gigi Tiruan Overdenture Protesa Tujuh Gigi |
1,160,000 |
| 4214 |
Gingivectomi per regio |
2,698,000 |
| 4215 |
Gingivectomy |
2,850,000 |
| 4216 |
Gingivektomi / Gingivoplasty per Region dengan Anastesi Lokal |
860,000 |
| 4217 |
Glanduloplasty |
9,210,000 |
| 4218 |
GLIKO HB (HBA1C) |
309,000 |
| 4219 |
Globulin |
32,000 |
| 4220 |
GLOBULIN+PROT. TOTAL+ALBUMIN |
37,000 |
| 4221 |
Glosektomi Parsial / Hemiglosektomi |
23,473,000 |
| 4222 |
Glosektomi Total |
4,903,089 |
| 4223 |
Glosektomi Totalis |
4,659,000 |
| 4224 |
Glosektomi totalis |
23,473,000 |
| 4225 |
Glukokortikoid Pulse Therapy |
329,000 |
| 4226 |
GLUKOSA 2 JAM PP |
46,000 |
| 4227 |
GLUKOSA 2 PP + URIN GLUKOSA CARIK CELUP |
50,000 |
| 4228 |
GLUKOSA PUASA |
46,000 |
| 4229 |
GLUKOSA PUASA + URIN GLUKOSA CARIK CELUP |
50,000 |
| 4230 |
GLUKOSA SEWAKTU |
51,000 |
| 4231 |
Glukose 2 Jam PP |
28,000 |
| 4232 |
Glukose Puasa |
28,000 |
| 4233 |
Glukose Sewaktu |
28,000 |
| 4234 |
Glukose Sewaktu (Rapid) |
30,000 |
| 4235 |
Glukose Strip |
30,000 |
| 4236 |
Glukose Toleransi |
40,000 |
| 4237 |
Gnathoplasty |
9,054,000 |
| 4238 |
Gnathoplasty disertai Bone graft celah alveolar |
15,058,000 |
| 4239 |
Golfer Elbow Manual (tanpa panduan) |
281,000 |
| 4240 |
Golfer Elbow USG |
595,000 |
| 4241 |
Golongan Darah ABO, Rhesus |
95,000 |
| 4242 |
GOLONGAN DARAH/ GOL.DARAH (ABO) + RHESUS |
163,000 |
| 4243 |
Goniometri |
114,000 |
| 4244 |
Gonioplasty |
2,850,000 |
| 4245 |
Goniotomi |
4,235,000 |
| 4246 |
Goniotomi + anastesi |
4,889,000 |
| 4247 |
GOT |
33,000 |
| 4248 |
GPT |
33,000 |
| 4249 |
Graf Vena Membuat A Vistula |
4,860,000 |
| 4250 |
Graft Gingival dengan Anastesi Lokal |
860,000 |
| 4251 |
Graft of muscle or fascia |
11,196,000 |
| 4252 |
Graft Saraf Kranial / Perifer unilateral |
15,526,000 |
| 4253 |
Grafting Pada Arterial Insufisiensi (Bedah Vaskuler) |
4,860,000 |
| 4254 |
Grinding Gigi |
55,000 |
| 4255 |
Grinding Prothesa kompleks |
512,000 |
| 4256 |
Grinding Prothesa sederhana |
257,000 |
| 4257 |
Group Therapi |
39,600 |
| 4258 |
Group Therapi (Terapi Kelompok) Fisioterapi |
22,800 |
| 4259 |
Group Therapi (Terapi Kelompok)Okupasi Terapi |
22,800 |
| 4260 |
Group Therapi (Terapi Kelompok)Terapi Wicara |
42,570 |
| 4261 |
Growing Rod Procedures for Scoliosis |
34,119,000 |
| 4262 |
Growth Hormon |
464,000 |
| 4263 |
Growth Hormone |
347,000 |
| 4264 |
Gula Darah 2 Jam Puasa Strip |
30,000 |
| 4265 |
Gula Puasa Strip |
30,000 |
| 4266 |
Guyon Syndrome Manual (tanpa panduan) |
281,000 |
| 4267 |
Guyon Syndrome USG |
595,000 |
| 4268 |
GV Laparotomi Anak |
24,000 |
| 4269 |
Gymnic Ball (Fisioterapi) |
33,000 |
| 4270 |
Gymnic Ball (Okupasi Terapi) |
33,000 |
| 4271 |
Haemoroidektomi Konvesional |
9,271,000 |
| 4272 |
Ham's Test |
31,000 |
| 4273 |
Hamstring release |
15,058,000 |
| 4274 |
Hang Sling Set |
33,000 |
| 4275 |
HBA 1c |
175,000 |
| 4276 |
Hbe Ag |
425,000 |
| 4277 |
HBe Ag (P) |
389,000 |
| 4278 |
HBeAg |
505,000 |
| 4279 |
HBs Ag (Elisa) |
128,000 |
| 4280 |
HBs Ag (ICT) |
72,000 |
| 4281 |
HBsAg (CMIA) |
128,000 |
| 4282 |
HBsAg CMIA/ECLIA |
218,000 |
| 4283 |
HBsAg Confirmatory |
545,000 |
| 4284 |
HBsAg ICT |
89,000 |
| 4285 |
HBsAg Konfirmasi (CMIA) |
350,000 |
| 4286 |
HBsAg Konfirmasi (Elisa) |
350,000 |
| 4287 |
HBsAg Kuantitatif (P) |
314,000 |
| 4288 |
HBV DNA |
2,000,000 |
| 4289 |
HBv DNA (P) |
1,800,000 |
| 4290 |
HBV DNA VIRAL LOAD |
1,678,000 |
| 4291 |
HBV-DNA (Real Time PCR) (P) |
1,800,000 |
| 4292 |
HCV RNA |
2,300,000 |
| 4293 |
HCV RNA / VIRAL LOAD HCV |
2,032,000 |
| 4294 |
HCV-RNA (Real Time PCR) (P) |
2,300,000 |
| 4295 |
HCV-RNA (Real Time PCR) & HCV Genotipe (P) |
4,600,000 |
| 4296 |
HD Sled di ruang intensif pasien dewasa |
2,370,000 |
| 4297 |
HD Sled di ruang intensif pasien neonatus |
2,370,000 |
| 4298 |
HD Sled di ruang intensif pasien pediatrik |
2,370,000 |
| 4299 |
Head Box |
190,000 |
| 4300 |
Hecting 5 cm |
113,000 |
| 4301 |
Hecting Kelenjar Tiroid |
4,546,000 |
| 4302 |
Hecting Laserasi Bibir |
5,556,000 |
| 4303 |
Hecting Laserasi Faring |
5,556,000 |
| 4304 |
Hecting Laserasi Hidung |
7,223,000 |
| 4305 |
Hecting Laserasi Kelenjar Liur |
5,556,000 |
| 4306 |
Hecting Laserasi Lidah |
5,556,000 |
| 4307 |
Hecting Laserasi Mulut |
5,556,000 |
| 4308 |
Hecting Laserasi Palatum |
5,556,000 |
| 4309 |
Hemangioma (OK Minor) |
0 |
| 4310 |
HEMATOLOGI LENGKAP + LED |
81,000 |
| 4311 |
HEMATOLOGI LENGKAP TANPA LED + I/T RATIO |
197,000 |
| 4312 |
HEMATOLOGI RUTIN + HITUNG RETIKULOSIT + RET-HE |
145,000 |
| 4313 |
HEMATOLOGI RUTIN + LED |
151,000 |
| 4314 |
Hematologi Rutin Automatik |
100,000 |
| 4315 |
Hemi/Epiphyseodesis Multiple |
24,064,000 |
| 4316 |
Hemi/Epiphyseodesis Single |
12,805,000 |
| 4317 |
Hemiarthroplasty for Bone / Soft tissue tumor with pathological fracture |
23,981,000 |
| 4318 |
Hemiarthroplasty for Hip fracture / arthritis |
23,981,000 |
| 4319 |
Hemifrenektomi |
22,030,000 |
| 4320 |
Hemiglosektomi |
23,473,000 |
| 4321 |
Hemiglosektomi + RND |
5,077,000 |
| 4322 |
Hemiglosektomi THT |
4,850,000 |
| 4323 |
Hemiglosektomi/Eksisi Tumor Lidah |
3,968,000 |
| 4324 |
Hemihamate Arthroplasty / Volar Plate Arthroplasty |
25,266,000 |
| 4325 |
Hemikolektomi kanan, kiri, reseksi transversum |
23,961,000 |
| 4326 |
Hemikordektomi |
10,390,000 |
| 4327 |
Hemimaksilektomi/ hemimandibulektomi |
15,224,000 |
| 4328 |
Hemimandibulektomi |
4,850,000 |
| 4329 |
Hemipelvectomy |
13,306,000 |
| 4330 |
Hemipelvektomi |
6,414,000 |
| 4331 |
Hemiseksi gigi / amputasi akar gigi |
4,750,000 |
| 4332 |
Hemiseksi Gigi dengan Anastesi Lokal |
860,000 |
| 4333 |
Hemiseksi/Bikuspidasi |
0 |
| 4334 |
Hemmimandibulektomi |
4,442,187 |
| 4335 |
Hemodialisa |
1,300,000 |
| 4336 |
Hemodialisa |
1,837,000 |
| 4337 |
Hemodialisis Cito |
2,298,000 |
| 4338 |
Hemodialisis di ruang intensif pasien dewasa |
1,837,000 |
| 4339 |
Hemodialisis di ruang intensif pasien neonatus |
1,837,000 |
| 4340 |
Hemodialisis di ruang intensif pasien pediatrik |
1,837,000 |
| 4341 |
Hemoroidektomi |
4,347,979 |
| 4342 |
Hemoroidektomi (variants) |
10,412,000 |
| 4343 |
Hemosiderin |
24,000 |
| 4344 |
Hemostasis Saluran Cerna Bagian Atas/Bawah |
2,850,000 |
| 4345 |
Hemostatis dengan hemoclip |
2,590,000 |
| 4346 |
Hemostatis Dengan Hemoclip (Sore) |
2,590,000 |
| 4347 |
Hepatektomi kanan |
20,010,000 |
| 4348 |
Hepatektomi kiri |
20,010,000 |
| 4349 |
Hernia Bilateral |
12,236,000 |
| 4350 |
Hernia Incarcerata |
4,255,565 |
| 4351 |
Hernia insisional |
16,659,000 |
| 4352 |
Hernia permagna |
16,659,000 |
| 4353 |
Hernia Residif |
13,422,000 |
| 4354 |
Herniatomi |
4,515,165 |
| 4355 |
Herniatomi Bilateral |
4,491,877 |
| 4356 |
Hernioplasti dengan mesh |
7,387,000 |
| 4357 |
Hernioraphi |
4,515,165 |
| 4358 |
Herniotomi bilateral |
25,806,000 |
| 4359 |
Herniotomi Bilateral |
6,238,462 |
| 4360 |
Herniotomi hernia inkarserata/strangulate |
5,782,479 |
| 4361 |
Herniotomi pada hernia strangulata |
13,422,000 |
| 4362 |
Herniotomi Umbilikalis |
16,659,000 |
| 4363 |
Herniotomi unilateral |
18,065,000 |
| 4364 |
Herniotomi Unilateral |
5,070,446 |
| 4365 |
Herniotomy + Laparatomy + Reseksi |
6,851,507 |
| 4366 |
Herniotomy + laparotomy + reseksi + anastomosis |
21,320,000 |
| 4367 |
HFO setting harian |
127,000 |
| 4368 |
HFOV pasien neonatus |
2,204,000 |
| 4369 |
HFOV pasien pediatrik |
2,204,000 |
| 4370 |
HFOV setting harian |
127,000 |
| 4371 |
HFOV setting harian oleh DPJP pasien dewasa |
127,000 |
| 4372 |
HFOV setting harian oleh DPJP pasien neonatus |
127,000 |
| 4373 |
HFOV setting harian oleh DPJP pasien pediatrik |
127,000 |
| 4374 |
Hidrasi Alkalinisasi (hari) |
66,000 |
| 4375 |
Hidrokel ligasi tinggi narkose |
11,429,000 |
| 4376 |
Hidrokel per Inguinal/Ligasi Tinggi |
4,850,000 |
| 4377 |
Hidrokel per scrotal |
3,850,000 |
| 4378 |
Hidrokelektomi (narkose) |
7,693,000 |
| 4379 |
Hidroterapi |
250,000 |
| 4380 |
Hidrotubasi |
4,110,000 |
| 4381 |
High Flow Nasal Canule (Per Hari) |
1,500,000 |
| 4382 |
High Intensity Laser Therapy |
525,000 |
| 4383 |
High Resolution Anoskopi disertai interpretasi dan relevansi |
300,000 |
| 4384 |
Higroma colli/limfangioma besar |
18,017,000 |
| 4385 |
Higroma Colli/Limfangioma Besar |
6,238,462 |
| 4386 |
Hip Bone Densitometry |
250,000 |
| 4387 |
Hip disarticulation |
14,091,000 |
| 4388 |
Hiperexention Brace Khusus |
2,800,000 |
| 4389 |
Hipnoterapi pada anak dan remaja |
300,000 |
| 4390 |
Hipnoterapi pada dewasa |
300,000 |
| 4391 |
Hipnoterapi pada lansia |
300,000 |
| 4392 |
Hipnotherapy |
100,000 |
| 4393 |
Hipnotherapy ( Eksekutif ) |
0 |
| 4394 |
Histerectomi Trans Vaginal / Trans Abdominal et SOB |
2,850,000 |
| 4395 |
Histerectomy Radikal |
6,929,993 |
| 4396 |
Histerektomi radikal + limfadenektomi para aorta per laparoskopi |
23,640,000 |
| 4397 |
Histerektomi radikal + limfadenektomi para aorta per laparotomi |
21,489,000 |
| 4398 |
Histerektomi radikal per laparoskopi |
24,588,000 |
| 4399 |
Histerektomi radikal per laparoskopi dengan penyulit |
30,737,000 |
| 4400 |
Histerektomi radikal per laparotomi |
22,131,000 |
| 4401 |
Histerektomi radikal per laparotomi dengan penyulit |
27,665,000 |
| 4402 |
Histerektomi subtotal per laparotomi |
13,091,000 |
| 4403 |
Histerektomi tipe 2 |
13,091,000 |
| 4404 |
Histerektomi tipe 2 per laparoskopi |
22,590,000 |
| 4405 |
Histerektomi total pada keganasan per laparoskopi (TLH) |
22,590,000 |
| 4406 |
Histerektomi total pada keganasan per laparoskopi (TLH) dengan penyulit |
22,590,000 |
| 4407 |
Histerektomi total pada keganasan per laparotomi |
13,091,000 |
| 4408 |
Histerektomi total pada keganasan per laparotomi dengan penyulit |
13,091,000 |
| 4409 |
Histerektomi total per laparoskopi (TLH) |
22,635,000 |
| 4410 |
Histerektomi total per laparoskopi (TLH) dengan penyulit |
28,296,000 |
| 4411 |
Histerektomi total per laparotomi |
20,374,000 |
| 4412 |
Histerektomi total per laparotomi dengan penyulit |
25,470,000 |
| 4413 |
Histerektomi total salpingo ooforektomi bilateral pada keganasan per laparoskopi |
19,637,000 |
| 4414 |
Histerektomi total salpingo ooforektomi bilateral pada keganasan per laparoskopi dengan penyulit |
24,549,000 |
| 4415 |
Histerektomi total salpingo ooforektomi bilateral pada keganasan per laparotomi |
13,091,000 |
| 4416 |
Histerektomi total salpingo ooforektomi bilateral pada keganasan per laparotomi dengan penyulit |
16,366,001 |
| 4417 |
Histerektomi total salpingo ooforektomi bilateral per laparoskopi |
20,576,000 |
| 4418 |
Histerektomi total salpingo ooforektomi bilateral per laparoskopi dengan penyulit |
26,750,000 |
| 4419 |
Histerektomi total salpingo ooforektomi bilateral per laparotomi |
17,819,000 |
| 4420 |
Histerektomi total salpingo ooforektomi bilateral per laparotomi dengan penyulit |
23,165,000 |
| 4421 |
Histerektomi total transvaginal (non prolaps) |
21,463,000 |
| 4422 |
Histerektomi total transvaginal (prolaps uteri) |
21,463,000 |
| 4423 |
Histerektomi total tranvaginal dibantu laparoskopi (LAVH) |
22,590,000 |
| 4424 |
Histeropeksi sakrospinosus (suspensi dan fiksasi uterus per vaginam) |
22,590,000 |
| 4425 |
Histerosalphingography (HSG) |
1,145,000 |
| 4426 |
Histeroskopi operatif pada kasus keganasan |
16,366,001 |
| 4427 |
Histeroskopi operatif tingkat 1 (Sterilisasi, Polip ringan, ROPC) |
14,742,000 |
| 4428 |
Histeroskopi operatif tingkat 2 (Polip besar, ROPC dg penyulit, adhesi ringan, Mioma<2 cm, Ablasi Endometrium) |
17,819,000 |
| 4429 |
Histeroskopi operatif tingkat 3 (Mioma>2 cm, Intrauterin Adhesion berat, malformasi uterus) |
23,165,000 |
| 4430 |
Histerotomi |
17,623,000 |
| 4431 |
Histopatologi Anatomi |
1,175,000 |
| 4432 |
HIV VIRAL LOAD |
2,000,000 |
| 4433 |
HLA TYPING |
15,761,000 |
| 4434 |
Hoffmann s Reflex Electromyography Examination |
1,800,000 |
| 4435 |
Holter |
516,000 |
| 4436 |
Holter Monitor |
516,000 |
| 4437 |
Holter monitor 12 lead 24 jam |
778,000 |
| 4438 |
Holter monitor 12 lead 48 jam |
1,169,000 |
| 4439 |
Holter monitor 12 lead 72 jam |
1,753,001 |
| 4440 |
Holter monitor minimal lead 24 jam |
622,000 |
| 4441 |
Holter monitor minimal lead 48 jam |
934,000 |
| 4442 |
Holter monitor minimal lead 72 jam |
1,402,000 |
| 4443 |
Home Care dan Home Visit Spesialis |
400,000 |
| 4444 |
Homecare/ Asuhan perawatan rumah Analis Laboratorium |
150,000 |
| 4445 |
Homecare/ Asuhan perawatan rumah Dokter |
300,000 |
| 4446 |
Homecare/ Asuhan perawatan rumah Fisioterapis |
200,000 |
| 4447 |
Homecare/ Asuhan perawatan rumah Perawat |
150,000 |
| 4448 |
Horsesche Kidney Koreksi |
7,885,000 |
| 4449 |
Hot Pack |
22,800 |
| 4450 |
HPV |
1,700,000 |
| 4451 |
HRCT ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 4452 |
HRCT ( Tanpa Kontras ) + Anastesi |
3,090,000 |
| 4453 |
HRCT (Dengan Kontras) |
5,100,000 |
| 4454 |
HRCT (Tanpa Kontras) |
2,200,000 |
| 4455 |
HRCT Scan Kontras Thorax |
3,765,000 |
| 4456 |
HRCT Scan Kontras Thorax + Volumetri |
3,765,000 |
| 4457 |
HRCT Scan Kontras Thorax + Volumetri dengan anestesi |
4,829,001 |
| 4458 |
HRCT Scan Kontras Thorax dengan anestesi |
4,829,001 |
| 4459 |
HRCT Scan Non Kontras Thorax |
2,521,000 |
| 4460 |
HRCT Scan Non Kontras Thorax dengan anestesi |
3,455,001 |
| 4461 |
HS TROPONIN I |
498,000 |
| 4462 |
Hs Troponin I |
400,000 |
| 4463 |
HSV II IgM |
125,000 |
| 4464 |
Hydro Therapi |
91,200 |
| 4465 |
hydrotubasi / Eksterpasi Polip Cerviks tanpa Anastesi |
250,000 |
| 4466 |
Hyperbarik Tabel 5 US Navy |
650,000 |
| 4467 |
Hyperbarik Tabel 6 A US Navy |
1,593,000 |
| 4468 |
Hyperbarik Tabel 6 US Navy |
1,593,000 |
| 4469 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter |
345,000 |
| 4470 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Kelompok I; 8 Orang) |
2,400,000 |
| 4471 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Kelompok II; 5 Orang) |
1,600,000 |
| 4472 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 10 kali datang dalam 2 bulan) |
2,700,000 |
| 4473 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 10 kali datang dalam 2 bulan) - Terapi Ke 2 |
0 |
| 4474 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 10 kali datang dalam 2 bulan) - Terapi Ke 3 |
0 |
| 4475 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 10 kali datang dalam 2 bulan) - Terapi Ke 4 |
0 |
| 4476 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 10 kali datang dalam 2 bulan) - Terapi Ke 5 |
0 |
| 4477 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 10 kali datang dalam 2 bulan) - Terapi Ke 6 |
0 |
| 4478 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 10 kali datang dalam 2 bulan) - Terapi Ke 7 |
0 |
| 4479 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 10 kali datang dalam 2 bulan) - Terapi Ke 8 |
0 |
| 4480 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 3 kali datang dalam 1 bulan) |
960,000 |
| 4481 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 3 kali datang dalam 1 bulan) - Terapi Ke 2 |
0 |
| 4482 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 3 kali datang dalam 1 bulan) - Terapi Ke 3 |
0 |
| 4483 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 5 kali datang dalam 1 bulan) |
1,500,000 |
| 4484 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 5 kali datang dalam 1 bulan) - Terapi Ke 2 |
0 |
| 4485 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 5 kali datang dalam 1 bulan) - Terapi Ke 3 |
0 |
| 4486 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 5 kali datang dalam 1 bulan) - Terapi Ke 4 |
0 |
| 4487 |
Hyperbarik Tabel 9 Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 5 kali datang dalam 1 bulan) - Terapi Ke 5 |
0 |
| 4488 |
Hyperbarik Tabel Autis |
300,000 |
| 4489 |
Hyperbarik Washing Out Silent Bubbles |
650,000 |
| 4490 |
Hysterectomy Supravaginal |
7,850,000 |
| 4491 |
Hysterosalpingografi ( HSG ) |
600,000 |
| 4492 |
Hystrectomy Partial |
6,292,709 |
| 4493 |
Hystrectomy Total |
6,273,291 |
| 4494 |
I V P |
750,000 |
| 4495 |
ICCE / ECCE / SICS / SCLERAL FIKSASI lokal |
8,816,000 |
| 4496 |
ICCE / ECCE / SICS / SCLERAL FIKSASI narkose |
10,230,000 |
| 4497 |
ICCE/ECCE (tidak termasuk IOL) (acc) |
4,276,711 |
| 4498 |
ICCE/ECCE/SICS/SEKUNDER IMPLANT lokal |
8,178,000 |
| 4499 |
ICCE/ECCE/SICS/SEKUNDER IMPLANT narkose |
9,519,000 |
| 4500 |
ICD Single Chamber |
130,633,000 |
| 4501 |
Ice pack test |
300,000 |
| 4502 |
Identifikasi Jenazah Pembusukan Lanjut |
1,079,000 |
| 4503 |
Identifikasi Jenazah Utuh |
1,079,000 |
| 4504 |
IDW |
9,111,000 |
| 4505 |
IFN-Gamma Release Assay ( IGRA ) (P) |
1,414,000 |
| 4506 |
IFN-Gamma Release Assay ( IGRA ) (P) |
1,414,000 |
| 4507 |
IgA / IgG / IgM |
96,000 |
| 4508 |
IgE _ |
119,000 |
| 4509 |
IgE KUANTITATIF TOTAL |
337,000 |
| 4510 |
IgE Total (P) |
320,000 |
| 4511 |
IgM Salmonella (TF Semikuantitatif) |
250,000 |
| 4512 |
IHC (Immunohistochemistry) - AE1/AE3 (Cytokeratin) |
650,000 |
| 4513 |
IHC (Immunohistochemistry) - Calretinin |
650,000 |
| 4514 |
IHC (Immunohistochemistry) - CD 117 |
650,000 |
| 4515 |
IHC (Immunohistochemistry) - CD20 |
650,000 |
| 4516 |
IHC (Immunohistochemistry) - CD3 |
650,000 |
| 4517 |
IHC (Immunohistochemistry) - Chromogranin |
650,000 |
| 4518 |
IHC (Immunohistochemistry) - ER |
650,000 |
| 4519 |
IHC (Immunohistochemistry) - ER, PR, HER-2 |
1,350,000 |
| 4520 |
IHC (Immunohistochemistry) - ER, PR, HER-2, Ki67 |
1,700,000 |
| 4521 |
IHC (Immunohistochemistry) - HER-2 |
650,000 |
| 4522 |
IHC (Immunohistochemistry) - Ki67 |
650,000 |
| 4523 |
IHC (Immunohistochemistry) - LCA (CD45) |
650,000 |
| 4524 |
IHC (Immunohistochemistry) - PR |
650,000 |
| 4525 |
IHC (Immunohistochemistry) - S100 |
650,000 |
| 4526 |
IHC (Immunohistochemistry) - Synaptophisin |
650,000 |
| 4527 |
IHC (Immunohistochemistry) - TTF1 |
650,000 |
| 4528 |
IHC (Immunohistochemistry) - Vimentin |
650,000 |
| 4529 |
Ileal Condoit (Bricker)/Operasi |
10,230,000 |
| 4530 |
Ileal Conduit |
26,873,000 |
| 4531 |
Immunoterapi |
120,000 |
| 4532 |
Immunotyping (P) |
800,000 |
| 4533 |
Immunotyping (P) |
800,000 |
| 4534 |
Implan Koklea bilateral |
25,408,000 |
| 4535 |
Implan Koklea unilateral |
20,638,000 |
| 4536 |
Implant Artificial Sfingter |
22,030,000 |
| 4537 |
Implant removal of spinal implants |
11,174,000 |
| 4538 |
Implant Tahap 1 Pemasangan Fixture per unit |
4,021,000 |
| 4539 |
Implant Tahap 2 Abutment Custom per unit |
11,003,000 |
| 4540 |
Implant Tahap 2 Abutment per unit |
11,003,000 |
| 4541 |
Implant Tahap 3 Crown Dental per unit |
3,199,000 |
| 4542 |
Implantasi Koklea |
13,850,000 |
| 4543 |
Implantation Or Replacement Of Peripheral Neurostimulator Lead(s) |
2,209,000 |
| 4544 |
Implantation Or Replacement Of Spinal Neurostimulator Lead(s) |
472,000 |
| 4545 |
Imunisasi / Vaksinasi |
45,000 |
| 4546 |
Imunisasi Mandiri |
45,000 |
| 4547 |
Imuno Elektroforesis Anti IgG / IgA / IgM |
96,000 |
| 4548 |
Imuno Elektroforesis Whole Anti Serum |
96,000 |
| 4549 |
Imunohistokimia (IHC) )Per antibodi |
650,000 |
| 4550 |
Imunoterapi Oral |
343,885 |
| 4551 |
Imunoterapi oral |
230,000 |
| 4552 |
Imunoterapi subkutan |
250,000 |
| 4553 |
Imunoterapi Subkutan |
343,885 |
| 4554 |
Imunoterapi sublingual |
230,000 |
| 4555 |
Incisi (Tutup Lubang Telinga) |
47,000 |
| 4556 |
Incisi Abses |
1,026,000 |
| 4557 |
Incisi Abses Intraoral |
1,026,000 |
| 4558 |
Incisi drainage abses multiple/kompleks |
10,753,000 |
| 4559 |
Incisi Ganed |
120,000 |
| 4560 |
Incision and drainage of palmar or thenar space |
11,196,000 |
| 4561 |
Incision. excision and division of bone procedure |
12,994,000 |
| 4562 |
Inclined Bite Plane |
245,000 |
| 4563 |
Incubator |
88,000 |
| 4564 |
Incubator |
88,000 |
| 4565 |
Indirect Veneer/Porcelain |
0 |
| 4566 |
Induksi Partus |
300,000 |
| 4567 |
Induksi sputum |
357,000 |
| 4568 |
Indwelling pleural catheter |
9,444,000 |
| 4569 |
Indwelling Pleural Catheter + Ambulatory Chest Drainage |
12,566,000 |
| 4570 |
Indwelling Pleural Catheter + Ambulatory Chest Drainage dengan anestesi |
14,162,000 |
| 4571 |
Indwelling Pleural Catheter dengan Anestesi |
10,781,000 |
| 4572 |
Infant Flow CPAP pasien neonatus |
720,000 |
| 4573 |
Infant Flow SIPAP pasien neonatus |
2,204,000 |
| 4574 |
Infant pulmonary function test |
207,000 |
| 4575 |
Infant Warmer |
66,000 |
| 4576 |
Infant Warmer |
66,000 |
| 4577 |
Infra Red (IR) |
135,000 |
| 4578 |
Infra Red Rays |
22,800 |
| 4579 |
infus bisphosphonate |
2,382,000 |
| 4580 |
Infus drip coagulation concentrate (aPCC) |
431,000 |
| 4581 |
infus perifer |
199,000 |
| 4582 |
Infus pump |
111,000 |
| 4583 |
Infus Pump pasien dewasa |
111,000 |
| 4584 |
Infus Pump pasien neonatus |
111,000 |
| 4585 |
Infus Pump pasien pediatrik |
111,000 |
| 4586 |
Infus stem cell |
2,500,000 |
| 4587 |
Infus Suplemen Besi Intravena |
50,000 |
| 4588 |
Infus Zometa/Bonefos |
79,000 |
| 4589 |
Infusion Intra arterial/intravenous enzimes trombolitik ( streptocinase ) (tissue plasminogen aktifator/TPA)+ Anestesi General + Intrakranial (Eksekutif) |
0 |
| 4590 |
Infusion Intra arterial/intravenous enzimes trombolitik ( streptocinase ) (tissue plasminogen aktifator/TPA)+ Anestesi General + Penyulit +Intrakranial (Eksekutif) |
0 |
| 4591 |
Infusion Intra arterial/intravenous enzimes trombolitik ( streptocinase ) (tissue plasminogen aktifator/TPA)+ Anestesi lokal + Dengan penyulit + Intrakranial (Eksekutif) |
0 |
| 4592 |
Infusion Intra arterial/intravenous enzimes trombolitik ( streptocinase ) (tissue plasminogen aktifator/TPA)+ Anestesi lokal + Intrakranial (Eksekutif) |
0 |
| 4593 |
Infusion Intra Arterial/Intravenous Enzimes Trombolitik (Streptocinase) (Tissue Plasminogen Aktifator/TPA) + Anastesi General + Intrakranial |
49,485,000 |
| 4594 |
Infusion Intra Arterial/Intravenous Enzimes Trombolitik (Streptocinase) (Tissue Plasminogen Aktifator/TPA) + Anastesi General + Penyulit + Intrakranial |
52,295,000 |
| 4595 |
Infusion Intra Arterial/Intravenous Enzimes Trombolitik (Streptocinase) (Tissue Plasminogen Aktifator/TPA) + Anastesi Lokal + Dengan Penyulit + Intrakranial |
42,570,000 |
| 4596 |
Infusion Intra Arterial/Intravenous Enzimes Trombolitik (Streptocinase) (Tissue Plasminogen Aktifator/TPA) + Anastesi Lokal + Intrakranial |
40,060,000 |
| 4597 |
Infusion Pump |
60,000 |
| 4598 |
Inhalasi |
60,000 |
| 4599 |
Inhalasi pasien dewasa |
161,000 |
| 4600 |
Inhalasi pasien neonatus |
161,000 |
| 4601 |
Inhalasi pasien pediatrik |
161,000 |
| 4602 |
Inisiasi Dini Menyusui (IDM) |
10,000 |
| 4603 |
Injection of anaesthetic into spinal canal for analgesia |
5,115,554 |
| 4604 |
Injection of other agent, except neurolytic |
3,215,554 |
| 4605 |
Injection of other agent, except neurolytic |
4,961,000 |
| 4606 |
Injection of steroid |
449,000 |
| 4607 |
Injection of Steroid |
251,889 |
| 4608 |
Injection of therapeutic agent into joint or ligament |
2,350,000 |
| 4609 |
Injection of therapeutic substance into bursa of hand |
3,125,000 |
| 4610 |
Injection of therapeutic substance into joint or ligament |
5,752,000 |
| 4611 |
Injection of therapeutic substance into tendon of hand |
3,125,000 |
| 4612 |
Injection or infusion of thrombolytic agent (rTPA) |
42,714,000 |
| 4613 |
Injeksi (Suntik) |
0 |
| 4614 |
Injeksi (Suntik) |
38,000 |
| 4615 |
Injeksi (Suntik) II Dst |
0 |
| 4616 |
Injeksi Agen Lain Ke Dalam Canalis Spinalis |
319,000 |
| 4617 |
Injeksi agen sklerotik |
6,089,000 |
| 4618 |
Injeksi Anestesi Ke Dalam Canalis Spinalis Untuk Analgesia |
406,000 |
| 4619 |
Injeksi Anestesi Ke Saraf Simpatetik Untuk Analgesia Berpandu Fluoroscopy |
375,000 |
| 4620 |
Injeksi Anestesi Ke Saraf Simpatetik Untuk Analgesia Berpandu USG |
417,000 |
| 4621 |
Injeksi Antibiotik |
0 |
| 4622 |
Injeksi Bahan Skleroterapi 1 |
1,433,000 |
| 4623 |
Injeksi Bahan Skleroterapi 2 |
2,894,000 |
| 4624 |
Injeksi Bahan Skleroterapi 3 |
4,970,000 |
| 4625 |
Injeksi BOTOX dengan panduan USG |
752,000 |
| 4626 |
Injeksi BOTOX tanpa panduan USG |
752,000 |
| 4627 |
Injeksi Botulinum Toxin Phenol |
250,000 |
| 4628 |
Injeksi bulking agent/botox/PRP intravesika |
6,450,000 |
| 4629 |
Injeksi caudal epidural dengan panduan USG |
1,241,000 |
| 4630 |
Injeksi Deferoxamine |
60,000 |
| 4631 |
Injeksi Eritropoeitin |
86,000 |
| 4632 |
Injeksi Eritropoietin |
60,000 |
| 4633 |
Injeksi facet joint dengan panduan USG |
317,000 |
| 4634 |
Injeksi ganglion impar dengan panduan USG |
417,000 |
| 4635 |
Injeksi Gonadotropin Releasing Hormone Analog (GnRH Analog/Leuprorelin Asetat) |
90,000 |
| 4636 |
Injeksi Granulocyt Colony Stimulating Faktor |
60,000 |
| 4637 |
Injeksi Haemangioma Dengan Skleroting Agent Atau Triamcinolon Acetonid, GA |
6,766,000 |
| 4638 |
Injeksi Haemangioma Dengan Skleroting Agent Atau Triamcinolon Acetonid, LA |
5,711,000 |
| 4639 |
Injeksi Haemoroid (Termasuk Obat) |
675,000 |
| 4640 |
Injeksi HCG Test |
90,000 |
| 4641 |
Injeksi Heparin/Antibiotik Intra Peritoneal |
0 |
| 4642 |
Injeksi Hormon Testosteron (Sustanon) |
90,000 |
| 4643 |
Injeksi intraarticular dengan panduan USG |
478,000 |
| 4644 |
Injeksi intraartikular dengan panduan USG |
478,000 |
| 4645 |
Injeksi intraartikular sendi besar |
441,000 |
| 4646 |
Injeksi intraartikular sendi kecil |
333,000 |
| 4647 |
Injeksi Intraartikuler |
200,000 |
| 4648 |
Injeksi intracaversa |
169,000 |
| 4649 |
Injeksi Intrakameral / COA / Bubble |
2,329,000 |
| 4650 |
Injeksi Intrakameral / COA / Bubble Tanpa Obat Lokal |
3,276,000 |
| 4651 |
Injeksi Intrakameral / COA / Bubble Tanpa Obat Narkose |
4,048,000 |
| 4652 |
Injeksi intralesi |
430,000 |
| 4653 |
Injeksi intralesi triamsinolon |
371,000 |
| 4654 |
Injeksi intralesional (tendon sheath / tendon insertion / nervecompression) |
97,000 |
| 4655 |
Injeksi Intralesional (tendon sheath/tendon insertion/ligamen/bursa/nerve compression) dengan panduan USG |
317,000 |
| 4656 |
Injeksi Intrastromal Kornea |
1,911,000 |
| 4657 |
Injeksi Intrastromal Kornea Tanpa Obat Lokal |
3,104,000 |
| 4658 |
Injeksi Intrastromal Kornea Tanpa Obat Narkose |
3,856,000 |
| 4659 |
Injeksi Intratechal |
1,461,000 |
| 4660 |
Injeksi Intratimpanik |
74,000 |
| 4661 |
Injeksi Intravitreal |
3,256,000 |
| 4662 |
Injeksi Intravitreal Tanpa Obat Lokal |
4,708,000 |
| 4663 |
Injeksi Intravitreal Tanpa Obat Narkose |
5,646,000 |
| 4664 |
Injeksi intravitreal untuk ROP pasien dewasa |
3,256,000 |
| 4665 |
Injeksi intravitreal untuk ROP pasien neonatus |
3,256,000 |
| 4666 |
Injeksi IV/IM (Suntik) (RJ) |
21,885 |
| 4667 |
Injeksi IV/IM (Suntik) II Dst (RJ) |
25,000 |
| 4668 |
Injeksi IVIG |
737,000 |
| 4669 |
Injeksi Keloid (kortikosteroid / kortikosteroid + 5 FU atau obat lainnya) Besar |
449,000 |
| 4670 |
Injeksi Keloid (kortikosteroid / kortikosteroid + 5 FU atau obat lainnya) Kecil |
449,000 |
| 4671 |
Injeksi Keloid (kortikosteroid / kortikosteroid + 5 FU atau obat lainnya) Sedang |
449,000 |
| 4672 |
Injeksi kemoterapi IM/IV |
3,289,000 |
| 4673 |
Injeksi Kenacort |
129,000 |
| 4674 |
Injeksi Kenacort Intralesi |
97,000 |
| 4675 |
Injeksi Kenacort THT |
66,000 |
| 4676 |
Injeksi Kenacort/ triamsilon |
478,000 |
| 4677 |
Injeksi Khusus Saraf Guiding USG |
670,000 |
| 4678 |
Injeksi Kortikosteroid Intra Lesi (Kil) I |
449,000 |
| 4679 |
Injeksi Kortikosteroid Intra Lesi (Kil) II |
449,000 |
| 4680 |
Injeksi Kortikosteroid Intra Lesi (Kil) III |
449,000 |
| 4681 |
Injeksi Kortikosteroid Intra Lesi (Kil) IV |
449,000 |
| 4682 |
Injeksi Kortikosteroid Intra Lesi (Kil) Kuku I ? 3 kuku |
449,000 |
| 4683 |
Injeksi Kortikosteroid Intra Lesi (Kil) Kuku II > 3 kuku |
449,000 |
| 4684 |
Injeksi Lain Ke Saraf Simpatetik Berpandu Fluoroscopy |
297,000 |
| 4685 |
Injeksi Lain Ke Saraf Simpatetik Berpandu USG |
654,000 |
| 4686 |
Injeksi laring dengan mikrolaringoskopi |
9,653,000 |
| 4687 |
Injeksi Lokal Anestesi Blok Saraf Perifer |
446,000 |
| 4688 |
Injeksi Lokal Anestesi Blok Saraf Perifer Dengan Botox |
1,896,000 |
| 4689 |
Injeksi Lokal Lain Ke Soft Tissue Di Area Tangan |
446,000 |
| 4690 |
Injeksi Lokal Lain Ke Soft Tissue Di Area Tangan Berpandu USG |
654,000 |
| 4691 |
Injeksi lokal muskuloskeletal dan saraf |
760,000 |
| 4692 |
Injeksi Lokal Substansi Teurapeutik Ke Soft Tissue Lain |
446,000 |
| 4693 |
Injeksi Lokal Syaraf (Sederhana) |
162,000 |
| 4694 |
Injeksi MTPS ( Injeksi Triger Ponit ) |
250,000 |
| 4695 |
Injeksi Neurolisis Ke Saraf Simpatetik Berpandu Fluoroscopy |
654,000 |
| 4696 |
Injeksi Neurolisis Ke Saraf Simpatetik Berpandu USG |
653,000 |
| 4697 |
Injeksi Obat anti hemofilia |
221,000 |
| 4698 |
Injeksi Obat Biologik |
200,000 |
| 4699 |
Injeksi Obat kemo dan Th/Hormonal |
762,000 |
| 4700 |
Injeksi Obat Khusus Faktor Pembekuan (FVIII/FIX/VWF/rVIIa) IV tanpa obat*** |
264,000 |
| 4701 |
Injeksi Obat Khusus GCSF |
314,000 |
| 4702 |
Injeksi Obat subkutan |
314,000 |
| 4703 |
Injeksi obat untuk efek samping kemoterapi |
660,000 |
| 4704 |
Injeksi Penisilin |
187,000 |
| 4705 |
Injeksi periartikular dengan panduan USG |
783,000 |
| 4706 |
Injeksi periartikuler |
310,000 |
| 4707 |
Injeksi Piriformis dengan panduan USG |
417,000 |
| 4708 |
Injeksi Platelet Rich Plasma (PRP) dengan panduan USG |
2,020,000 |
| 4709 |
Injeksi PRP |
1,500,000 |
| 4710 |
Injeksi Sacroiliac dengan panduan USG |
1,280,000 |
| 4711 |
Injeksi Saraf Lain, Kecuali Agen Neurolisis |
436,000 |
| 4712 |
Injeksi Saraf Perifer (N. Occipital, Suprascapular, Lateral Femoral Cutaneus, Dll) Single Shot dengan Catheter Continue tanpa penuntun USG |
1,570,000 |
| 4713 |
Injeksi Saraf Perifer (N. Occipital, Suprascapularteral Femoral Cutaneus, Dll) Single Shot dengan Catheter Continue Guided USG |
1,570,000 |
| 4714 |
Injeksi Saraf Perifer (N. Occipital, Suprascapularteral Femoral Cutaneus, Dll) Single Shot tanpa Catheter Continue |
503,000 |
| 4715 |
Injeksi Saraf Perifer (N. Occipital, Suprascapularteral Femoral Cutaneus, Dll) Single Shot tanpa Catheter Continue Guiding USG |
503,000 |
| 4716 |
Injeksi Saraf Perifer, Tidak Spesifik Lainnya Dengan BMC |
446,000 |
| 4717 |
Injeksi Saraf Perifer, Tidak Spesifik Lainnya Dengan Cryotherapy |
447,000 |
| 4718 |
Injeksi Saraf Perifer, Tidak Spesifik Lainnya Dengan PRP |
332,000 |
| 4719 |
Injeksi Saraf Perifer, Tidak Spesifik Lainnya Dengan Radiofrequency |
436,000 |
| 4720 |
Injeksi Saraf Perifer, Tidak Spesifik Lainnya Dengan Stem Cell |
396,000 |
| 4721 |
Injeksi Saraf Perifer, Tidak Spesifik Lainnya Dengan Triamcinolone |
446,000 |
| 4722 |
Injeksi Sendi Facet Kasus Simpel |
4,049,000 |
| 4723 |
Injeksi Sendi Kasus Simple |
6,822,000 |
| 4724 |
Injeksi Sendi Sacroiliaca Kasus Simpel |
3,037,000 |
| 4725 |
Injeksi Sensitivity Spinal Segmental |
250,000 |
| 4726 |
Injeksi Skleroterapi Komplek (dengan anestesi umum) |
8,122,000 |
| 4727 |
Injeksi Skleroterapi Simple (dengan anestesi umum) |
6,766,000 |
| 4728 |
Injeksi Skleroting Agent, LA |
5,711,000 |
| 4729 |
Injeksi Steroid Intralesi Besar |
449,000 |
| 4730 |
Injeksi Steroid Intralesi Kecil |
449,000 |
| 4731 |
Injeksi Substansi Teurapetik Ke Dalam Bursa |
446,000 |
| 4732 |
Injeksi Substansi Teurapetik Ke Dalam Bursa Berpandu USG |
654,000 |
| 4733 |
Injeksi Substansi Teurapetik Ke Dalam Sendi Dan Ligamen |
446,000 |
| 4734 |
Injeksi Substansi Teurapetik Ke Dalam Sendi Dan Ligamen Berpandu USG |
654,000 |
| 4735 |
Injeksi Substansi Teurapetik Ke Dalam Sendi Tangan |
446,000 |
| 4736 |
Injeksi Substansi Teurapetik Ke Dalam Sendi Tangan Berpandu USG |
654,000 |
| 4737 |
Injeksi Substansi Teurapetik Ke Dalam Sendi Temporomandibular |
364,000 |
| 4738 |
Injeksi Substansi Teurapetik Ke Dalam Sendi Temporomandibular Dengan PRP |
296,000 |
| 4739 |
Injeksi Substansi Teurapeutik Ke Dalam Tendon |
446,000 |
| 4740 |
Injeksi Substansi Teurapeutik Lain Ke Dalam Bursa |
446,000 |
| 4741 |
Injeksi Subtenon/ Sclera Tanpa Obat Lokal |
2,984,000 |
| 4742 |
Injeksi Subtenon/ Sclera Tanpa Obat Narkose |
3,722,000 |
| 4743 |
Injeksi Subtenon/Sclera |
1,626,000 |
| 4744 |
Injeksi Telinga Dalam |
1,055,000 |
| 4745 |
Injeksi Tender Point |
245,000 |
| 4746 |
Injeksi Toksin Botulinum 1 (?25 unit) |
2,464,000 |
| 4747 |
Injeksi Toksin Botulinum 2 (26-50 unit) |
3,464,000 |
| 4748 |
Injeksi Toksin Botulinum 3 (51-100 unit) |
4,464,000 |
| 4749 |
Injeksi Toksin Botulinum 4 (100-200 unit) |
9,547,999 |
| 4750 |
Injeksi Vaksin HPV |
2,225,000 |
| 4751 |
Injeksi Varises (Termasuk Obat) |
675,000 |
| 4752 |
Injeksi Vitamin C |
300,000 |
| 4753 |
Injeksi zoladex |
314,000 |
| 4754 |
Injeksi Zoledronic Acid (ZOMETA) |
90,000 |
| 4755 |
Inlay Full Porcelain (belum termasuk laboratorium) |
4,655,000 |
| 4756 |
INR |
110,000 |
| 4757 |
Inseminasi Intra Urine |
250,000 |
| 4758 |
Insentive spirometri training |
230,001 |
| 4759 |
Insersi CDL hemodialisis semi-permanen/long-term/CDL Tunnelling |
8,400,000 |
| 4760 |
Insersi CDL hemodialisis temporer/short-term |
6,827,000 |
| 4761 |
Insersi chest tube / drain toraks bedside dengan anestesi lokal |
2,458,000 |
| 4762 |
Insersi chest tube + WSD |
2,058,000 |
| 4763 |
Insersi DJ Stent |
4,850,000 |
| 4764 |
Insersi Heimlich Valve |
3,190,000 |
| 4765 |
Insersi Implan Sintetik di Wajah |
10,235,000 |
| 4766 |
Insersi Indweling Pleural Catheter (IPC) |
10,781,000 |
| 4767 |
Insersi Jacket Crown / Full Crown Dengan PFM |
550,000 |
| 4768 |
Insersi Jacket Crown / Full Crown Dengan PFM (Eksekutif) |
0 |
| 4769 |
Insersi Kateter Double Lumen : Semi Permanen |
3,438,000 |
| 4770 |
Insersi Kateter Double Lumen : Temporer |
1,688,000 |
| 4771 |
Insersi Kateter Ke Canalis Spinalis Untuk Infus Teurapetik Atau Paliatif |
703,000 |
| 4772 |
Insersi Obturator Bayi |
1,344,000 |
| 4773 |
Insersi Obturator Dewasa |
1,133,000 |
| 4774 |
Insersi Pasak Custom |
890,000 |
| 4775 |
Insersi Pasak Custom (Eksekutif) |
0 |
| 4776 |
Insersi Pasak Fiber Post |
1,200,000 |
| 4777 |
Insersi Pasak Fiber Post (Eksekutif) |
0 |
| 4778 |
Insersi Peripherally Inserted Central Catheter (PICC) |
3,487,000 |
| 4779 |
Insersi UK |
8,961,000 |
| 4780 |
Insersi Veneer Indirect |
1,100,000 |
| 4781 |
Insersi Veneer Indirect (Eksekutif) |
1,270,000 |
| 4782 |
Insersie Inlay/Onlay |
0 |
| 4783 |
Insersie Jacket Crown PFM/All porcelain |
0 |
| 4784 |
Insersie Veneer Porcelain |
0 |
| 4785 |
Insertion of interbody spinal fusion device |
9,016,000 |
| 4786 |
Insertion of other spinal device |
2,350,000 |
| 4787 |
Insertion of Totally Implantable Infusion Pump |
75,000 |
| 4788 |
Insertion Or Replacement Of Dual Array Neurostimulator Pulse Generator, Not Specified As Rechargeable Pulse Generator (Dual Array, Dual Channel) For Intracranial, Spinal And Peripheral Neurostimulator |
475,000 |
| 4789 |
Insertion Or Replacement Of Dual Array Rechargeable Neurostimulator Pulse Generator |
486,000 |
| 4790 |
Insertion Or Replacement Of Other Neurostimulator Pulse Generator (Kecuali, Single Dan Dual Array Neurostimulator) |
467,000 |
| 4791 |
Insertion Or Replacement Of Single Array Neurostimulator Pulse Generator, Not Specified As Rechargeable Pulse Generator (Single Array, Single Channel) For Intracranial, Spinal And Peripheral Neurostimulator |
512,000 |
| 4792 |
Insertion Or Replacement Of Single Array Rechargeable Neurostimulator Pulse Generator |
462,000 |
| 4793 |
Insertion Or Replacement Of Skeletal Muscle Stimulator (Implantation, Insertion, Placement, Or Replacement Of Skeletal Muscle: Electrodes, Stimulator) |
81,000 |
| 4794 |
Insici Abses Ekstraoral |
1,026,000 |
| 4795 |
Insisi + eskplorasi abses septi |
47,000 |
| 4796 |
Insisi Abses |
250,000 |
| 4797 |
Insisi Abses (Hepatoma Septum Nasi/Peritonsil) |
250,000 |
| 4798 |
Insisi Abses < 3 cm |
575,000 |
| 4799 |
Insisi Abses > 3 cm |
692,000 |
| 4800 |
Insisi abses Extra oral |
692,000 |
| 4801 |
Insisi abses intra oral |
575,000 |
| 4802 |
Insisi Abses Peri Tonsiler |
250,000 |
| 4803 |
Insisi Abses Perianal |
10,753,000 |
| 4804 |
Insisi Abses Perineum |
675,000 |
| 4805 |
Insisi Abses Single dengan Anastesi Lokal |
270,000 |
| 4806 |
Insisi Abses Skrotum |
675,000 |
| 4807 |
Insisi Abses Sub Madibula |
250,000 |
| 4808 |
Insisi adhesi labia |
13,367,000 |
| 4809 |
Insisi Biopsy dengan Anastesi Lokal |
270,000 |
| 4810 |
Insisi dan Kompresi Pseudokista / Hematoma/Perikondritis Aurikula |
9,083,000 |
| 4811 |
Insisi Drainage Abses |
1,548,000 |
| 4812 |
Insisi Drainage Abses Narkose |
6,834,000 |
| 4813 |
Insisi Drainase abses CAE (Liang Telinga) |
5,307,000 |
| 4814 |
Insisi Drainase Abses Kelenjar Liur |
12,553,000 |
| 4815 |
Insisi Drainase Abses Leher |
923,000 |
| 4816 |
Insisi Drainase Abses Parafaring/Retrofaring |
11,482,000 |
| 4817 |
Insisi Drainase Abses Peritonsil |
1,548,000 |
| 4818 |
Insisi Drainase Abses Retroaurikula |
1,548,000 |
| 4819 |
Insisi Drainase Abses ruang leher ( Submandibula / Submental/ Temporal/ Buccal) |
8,703,000 |
| 4820 |
Insisi Drainase Angina Ludovici |
7,803,000 |
| 4821 |
Insisi drainase dan debridement abses |
11,482,000 |
| 4822 |
Insisi drainase multipe abses flegmon/ submandibula |
12,702,000 |
| 4823 |
Insisi Drainase Multiple dengan Anastesi Lokal |
860,000 |
| 4824 |
Insisi drainase/debridement abses |
11,482,000 |
| 4825 |
Insisi drainase/debridement eksisi abses kompleks |
14,354,000 |
| 4826 |
Insisi drainase/debridement eksisi abses sederhana |
11,482,000 |
| 4827 |
Insisi Drainege/Eksplorasi Abses Multipel |
10,753,000 |
| 4828 |
Insisi Furunkel |
66,000 |
| 4829 |
Insisi hematoma Vulva |
107,000 |
| 4830 |
Insisi Hordeolum/Kalazion/Granuloma/ Abses |
861,000 |
| 4831 |
Insisi Kalazion / Hordeolun |
153,000 |
| 4832 |
Insisi Lain dari telinga Luar |
9,083,000 |
| 4833 |
Insisi Mucocele |
2,850,000 |
| 4834 |
Insisi Palatum |
7,307,000 |
| 4835 |
Insisi Tongue Tie |
8,245,000 |
| 4836 |
Insisi tongue tie |
8,245,000 |
| 4837 |
Insisi Web Esofagus |
8,289,000 |
| 4838 |
Insisi, Eksisi dan Destruksi dari telinga dalam |
25,742,000 |
| 4839 |
Insisi/drainase abses dengan anastesi umum |
2,159,000 |
| 4840 |
Insisional Biopsi Kelenjar Leher |
6,366,000 |
| 4841 |
Insisional Biopsi Kelenjar Leher |
2,850,000 |
| 4842 |
Inspekulo |
83,000 |
| 4843 |
Inspekulo (Apusan servix) |
30,000 |
| 4844 |
Inspekulo (Kultur cairan servix) |
30,000 |
| 4845 |
Inspekulo (Test KOH) |
30,000 |
| 4846 |
Inspirasi |
250,000 |
| 4847 |
Instilasi kandung kemih |
21,504,000 |
| 4848 |
Instilasi obat (Diluar kemoterapi) |
38,000 |
| 4849 |
Intensed Pulse Light/Energy Based Devices Lainnya 1 |
1,000,000 |
| 4850 |
Intensed Pulse Light/Energy Based Devices Lainnya 2 |
1,500,000 |
| 4851 |
Intensed Pulse Light/Energy Based Devices Lainnya 3 |
2,000,000 |
| 4852 |
Interbody fusion for Spinal Instability |
34,582,000 |
| 4853 |
Intercalary resection |
24,064,000 |
| 4854 |
Intercostal block |
1,240,000 |
| 4855 |
Intercostal neurolysis |
1,698,000 |
| 4856 |
Intercostal radiofrequency |
1,746,000 |
| 4857 |
Interferensi |
75,000 |
| 4858 |
Interleukin 6 (IL-6) (P) |
335,000 |
| 4859 |
Interleukin 6 (IL-6) (P) |
335,000 |
| 4860 |
Intermaksilari Fixation |
16,332,000 |
| 4861 |
Intermiten Positive Pressure Breathing (IPPB) |
66,000 |
| 4862 |
Internal bleaching |
850,000 |
| 4863 |
Internal fixation of bone without fracture reduction on femur |
5,828,000 |
| 4864 |
Internal fixation of bone without fracture reduction on humerus |
5,828,000 |
| 4865 |
Internal fixation of bone without fracture reduction on patella |
5,828,000 |
| 4866 |
Internal fixation of bone without fracture reduction on radius and ulna |
5,828,000 |
| 4867 |
Internal fixation of bone without fracture reduction on scapula, clavicle, and thorax (ribs and sternum) |
5,828,000 |
| 4868 |
Internal fixation of bone without fracture reduction on tarsals and metatarsals |
4,804,456 |
| 4869 |
Internal fixation of bone without fracture reduction on tibia and fibula |
5,828,000 |
| 4870 |
Internal fixation of bone without fracture reductionon carpals and metacarpals |
5,828,000 |
| 4871 |
Internal fixation of patella without fracture reduction |
18,596,121 |
| 4872 |
Internal Urethrotomi ( Sachse ) |
7,458,259 |
| 4873 |
interphalangeal fusion |
5,561,121 |
| 4874 |
Interpretasi bone mass densitometry |
138,000 |
| 4875 |
Interpretasi dan Pembacaan Hasil Mantoux |
155,000 |
| 4876 |
Interpretasi dan penentuan turn-over protein |
99,000 |
| 4877 |
Interpretasi dan tatalaksana albumin |
42,000 |
| 4878 |
Interpretasi dan tatalaksana gangguan elektrolit |
129,000 |
| 4879 |
Interpretasi dan tatalaksana gangguan mikronutrien |
129,000 |
| 4880 |
Interpretasi dan tatalaksana laboratorium hormon |
219,000 |
| 4881 |
Interpretasi dan tatalaksana laboratorium mineral |
219,000 |
| 4882 |
Interpretasi dan tatalaksana laboratorium nutrigenomik dan yang terkait gen |
221,000 |
| 4883 |
Interpretasi dan tatalaksana laboratorium profil asam amino |
219,000 |
| 4884 |
Interpretasi dan tatalaksana laboratorium profil asam lemak |
219,000 |
| 4885 |
Interpretasi dan tatalaksana laboratorium vitamin |
129,000 |
| 4886 |
Interpretasi histokimia (1 jenis pulasan) |
604,000 |
| 4887 |
Interpretasi komposisi tubuh dengan alat bioelectrical impedance analysis |
138,000 |
| 4888 |
Interpretasi komposisi tubuh dengan bioelectrical impedance analysis pada pasien bedridden |
138,000 |
| 4889 |
Interpretasi komposisi tubuh DEXA/densitometri |
221,000 |
| 4890 |
Interpretasi komposisi tubuh musculoskeletal MRI/USG |
138,000 |
| 4891 |
Interpretasi pengukuran kebutuhan energi dengan kalorimetri indirek |
247,000 |
| 4892 |
Interpretasi penilaian respons alergi terhadap makanan |
219,000 |
| 4893 |
Interpretasi status anti-oksidan |
82,000 |
| 4894 |
Interpretasi status hiperkatabolisme |
82,000 |
| 4895 |
Interpretasi status pencernaan dan mikrobiota usus |
82,000 |
| 4896 |
Interthoracoscapular amputation |
5,997,200 |
| 4897 |
Intervensi Keluarga |
350,000 |
| 4898 |
Intervensi Krisis |
350,000 |
| 4899 |
Intervensi singkat (Brief Intervention) pada Gangguan Penggunaan Zat/Adiksi perilaku |
250,000 |
| 4900 |
Intervertebral chemonucleolysis |
14,020,000 |
| 4901 |
Intra Arterial Cerebral Stem Cell |
8,672,000 |
| 4902 |
Intra Arterial Mekanical Trombektomi Using Aspirasi Device |
41,690,000 |
| 4903 |
Intra Arterial mekanical trombektomi using aspirasi device (Eksekutif) |
0 |
| 4904 |
Intra Arterial Mekanical Trombektomi Using Aspirasi Device + Penyulit |
45,295,000 |
| 4905 |
Intra Arterial mekanical trombektomi using aspirasi device + Penyulit (Eksekutif) |
0 |
| 4906 |
Intra Arterial Mekanical Trombektomi Using Stent Retriever |
96,925,000 |
| 4907 |
Intra Arterial mekanical trombektomi using stent retriever (Eksekutif) |
0 |
| 4908 |
Intra Arterial Mekanical Trombektomi Using Stent Retriever + Penyulit |
102,660,000 |
| 4909 |
Intra Arterial mekanical trombektomi using stent retriever + penyulit (Eksekutif) |
0 |
| 4910 |
Intra Dermal Test THT |
250,000 |
| 4911 |
Intra-Aortic Balloon Pump (IABP) + Anestesi |
17,198,000 |
| 4912 |
Intraarticular steroid injection |
449,000 |
| 4913 |
Intraartikuler 1 Manual (tanpa panduan) |
333,000 |
| 4914 |
Intraartikuler 1 USG |
478,000 |
| 4915 |
Intraartikuler 2 Manual (tanpa panduan) |
441,000 |
| 4916 |
Intraartikuler 2 USG |
616,000 |
| 4917 |
Intralesional stem cell injection for Spinal cord injury |
11,174,000 |
| 4918 |
Intratechal analgesia |
406,000 |
| 4919 |
Intrauterine Bigatti Shaver (IBS) per histeroskopi |
23,165,000 |
| 4920 |
Intubasi |
1,077,000 |
| 4921 |
Intubasi |
847,000 |
| 4922 |
Intubasi dengan Bronkoskopi Fleksibel |
12,553,000 |
| 4923 |
Intubasi dengan penyulit pasien dewasa |
1,293,000 |
| 4924 |
Intubasi dengan penyulit pasien neonatus |
1,293,000 |
| 4925 |
Intubasi dengan penyulit pasien pediatrik |
1,293,000 |
| 4926 |
Intubasi dengan Videolaryngoscopy pasien dewasa |
1,293,000 |
| 4927 |
Intubasi dengan Videolaryngoscopy pasien neonatus |
1,293,000 |
| 4928 |
Intubasi dengan Videolaryngoscopy pasien pediatrik |
1,293,000 |
| 4929 |
Intubasi Double Lumen |
1,872,000 |
| 4930 |
Intubasi Double Lumen pasien dewasa |
1,872,000 |
| 4931 |
Intubasi Double Lumen pasien neonatus |
1,872,000 |
| 4932 |
Intubasi Double Lumen pasien pediatrik |
1,872,000 |
| 4933 |
Intubasi Double Lumen Tube |
1,130,000 |
| 4934 |
Intubasi Neonatus |
1,376,000 |
| 4935 |
Intubasi pasien dewasa |
1,077,000 |
| 4936 |
Intubasi pasien neonatus |
1,077,000 |
| 4937 |
Intubasi pasien pediatrik |
1,077,000 |
| 4938 |
Intubasi/SGA |
1,077,000 |
| 4939 |
Invertogram / Knee Chest |
221,000 |
| 4940 |
Ioid + Archbarr Fraktur 1 Sisi, GA |
17,778,000 |
| 4941 |
Ioid+ Archbarr Fraktur 2 Sisi, GA |
25,403,000 |
| 4942 |
IOM HNP Lumbal Sakral |
16,100,000 |
| 4943 |
IOM HNP Servikal |
15,400,000 |
| 4944 |
IOM Pleksus Brachialis/N. Fasialis |
15,400,000 |
| 4945 |
IOM Skoliosis |
20,650,000 |
| 4946 |
IOM Tumor Fosa anterior kortikal mapping |
20,650,000 |
| 4947 |
IOM Tumor Fosa Posterior |
25,850,000 |
| 4948 |
IOM Tumor Medula Spinalis |
20,650,000 |
| 4949 |
Iontophoresis |
166,000 |
| 4950 |
Iridektomi Lokal |
3,962,000 |
| 4951 |
Iridektomi Narkose |
4,690,000 |
| 4952 |
Iridoplasty komplek |
3,207,000 |
| 4953 |
Iridoplasty simple |
2,855,000 |
| 4954 |
Irigasi Hidung |
367,000 |
| 4955 |
Irigasi Hidung/sinus paranasalis |
36,000 |
| 4956 |
Irigasi Kandung Kemih |
25,000 |
| 4957 |
Irigasi Liang Telinga |
379,000 |
| 4958 |
Irigasi Luka Operasi / Spooling |
55,000 |
| 4959 |
Irigasi Sinus |
129,000 |
| 4960 |
Irigasi Sinus/DAWO |
2,850,000 |
| 4961 |
Irigasi Telinga |
55,000 |
| 4962 |
Irigasi Telinga ( DPRD ) |
83,000 |
| 4963 |
Irigasi vagina |
241,000 |
| 4964 |
Iscole |
87,000 |
| 4965 |
ISH per PROBE Inditu Hibridization |
1,000,000 |
| 4966 |
Ismusectomy tiroid |
23,389,000 |
| 4967 |
Isonom Station ( Cybex ) |
87,600 |
| 4968 |
Isthmolobektomi |
4,488,256 |
| 4969 |
Isthmolobektomi |
9,337,000 |
| 4970 |
Isthobektomi |
4,850,000 |
| 4971 |
IV Cavagram |
2,000,000 |
| 4972 |
IV Cavagram + Anastesi |
3,610,000 |
| 4973 |
IV kontinu hari 1 |
796,000 |
| 4974 |
IV kontinu setelah hari 1 |
638,000 |
| 4975 |
IVC Filter |
14,450,000 |
| 4976 |
IVC Filter + Anastesi |
18,950,000 |
| 4977 |
IVUS (Intra-vascular ultra sound) |
33,270,000 |
| 4978 |
Jacket Crown/gigi porcelain preparasi jacket |
0 |
| 4979 |
Jahit Dehisensi Luka |
163,000 |
| 4980 |
Jahit Dehisensi Luka (Poli) |
163,000 |
| 4981 |
Jahit Hemostasis (bleeding control) dengan anestesi lokal |
233,000 |
| 4982 |
Jahit hepar & hemositasis |
13,420,000 |
| 4983 |
Jahit kompresi uterus (contoh: B-Lynch) |
14,725,000 |
| 4984 |
Jahit Luka |
76,000 |
| 4985 |
Jahit luka besar ( > 15 jahitan) |
330,000 |
| 4986 |
Jahit Luka Dengan Endoskopi/Microskopik |
5,556,000 |
| 4987 |
Jahit Luka Di Wajah Daerah Estetik Unit, GA |
18,019,000 |
| 4988 |
Jahit Luka Di Wajah Daerah Estetik Unit, LA |
15,794,000 |
| 4989 |
Jahit Luka Di Wajah Dengan Kerusakan Komplek, GA |
13,664,000 |
| 4990 |
Jahit Luka Di Wajah Dengan Kerusakan Komplek, LA |
12,248,000 |
| 4991 |
Jahit Luka Di Wajah Dengan Kerusakan Sedang, GA |
10,250,000 |
| 4992 |
Jahit Luka Di Wajah Dengan Kerusakan Sedang, LA |
9,187,000 |
| 4993 |
Jahit luka kecil (1-7 jahitan) |
167,000 |
| 4994 |
Jahit Luka Kepala Leher |
300,000 |
| 4995 |
Jahit luka sedang (8-15 jahitan) |
233,000 |
| 4996 |
Jahit Palpebra Ringan |
861,000 |
| 4997 |
Jahitan Perineum tingkat 1 & 2 |
60,000 |
| 4998 |
Jahitan Perineum tingkat 3 & 4 |
600,000 |
| 4999 |
Jamur |
30,000 |
| 5000 |
Jarak sampai 7 Km (dalam kota) |
80,000 |
| 5001 |
Jejunostomi |
17,158,000 |
| 5002 |
Jejunostomy feeding tube |
13,420,000 |
| 5003 |
Jewett Brace (Biasa) |
1,320,000 |
| 5004 |
Jewett Brace (Khusus) |
1,600,000 |
| 5005 |
Johanson |
4,850,000 |
| 5006 |
Johanson 1 |
4,850,000 |
| 5007 |
Joint debridement + resection arthroplasty |
33,975,000 |
| 5008 |
KAFO (Biasa) |
3,500,000 |
| 5009 |
KAFO (Khusus) |
5,000,000 |
| 5010 |
Kalibrasi Uretra |
675,000 |
| 5011 |
Kalorimetri direk pasien dewasa |
850,000 |
| 5012 |
Kalorimetri direk pasien pediatrik |
850,000 |
| 5013 |
Kalorimetri indirek |
850,000 |
| 5014 |
Kalorimetri indirek pasien dewasa |
850,000 |
| 5015 |
Kalorimetri indirek pasien neonatus |
850,000 |
| 5016 |
Kalorimetri indirek pasien pediatrik |
850,000 |
| 5017 |
Kalporeksis |
5,840,933 |
| 5018 |
Kalsium Darah |
45,000 |
| 5019 |
Kalsium Urine |
45,000 |
| 5020 |
Kanaloplasti/ Pengangkatan massa tulang |
6,050,000 |
| 5021 |
Kantong Jenazah |
100,000 |
| 5022 |
Kantong Jenazah |
100,000 |
| 5023 |
Kantopeksi Lokal |
5,026,000 |
| 5024 |
Kantopeksi Narkose |
7,325,000 |
| 5025 |
Kanulasi ECMO VA/VV |
127,578,000 |
| 5026 |
Kapsulektomi Posterior |
4,850,000 |
| 5027 |
karcis |
10,000 |
| 5028 |
Karcis (ODC) |
9,000 |
| 5029 |
Kardiotokografi (KTG) |
299,000 |
| 5030 |
Kardioversi |
1,076,000 |
| 5031 |
Kardioversi |
1,404,000 |
| 5032 |
Kardioversi Anak Dengan Anestesi |
1,850,000 |
| 5033 |
Kardioversi Anak Emergensi |
1,404,000 |
| 5034 |
Kardioversi Dengan Anestesi |
1,951,000 |
| 5035 |
Karet Intra Oral |
77,000 |
| 5036 |
Karotis Angiografi (+ Radiografer) |
23,940,000 |
| 5037 |
Karotis Angiografi dengan balon (1 balon) (+ Radiografer) |
47,880,000 |
| 5038 |
Karotis Angiografi dengan balon+stent (1 balon, 1 stent) (+Radiografer) |
47,880,000 |
| 5039 |
Kasai prosedur |
53,435,000 |
| 5040 |
Katerisasi Urethra |
39,000 |
| 5041 |
Kateterisasi Anak |
4,120,000 |
| 5042 |
Kateterisasi jantung kanan dan kiri dengan termodilusi |
14,465,000 |
| 5043 |
Kateterisasi Jantung Kanan dan Kiri PJB kompleks dengan angiography dengan anestesi |
21,743,000 |
| 5044 |
Kateterisasi Jantung Kanan dan Kiri PJB kompleks dengan angiography tanpa anestesi |
19,142,000 |
| 5045 |
Kateterisasi Jantung Kanan dan Kiri PJB kompleks tanpa angiography dengan anestesi |
19,988,000 |
| 5046 |
Kateterisasi Jantung Kanan dan Kiri PJB kompleks tanpa angiography tanpa anestesi |
17,569,000 |
| 5047 |
Kateterisasi Jantung Kanan dan Kiri PJB Simpel (ASD, VSD, PDA, Post Device Closure) dengan angiography dengan anestesi |
27,812,000 |
| 5048 |
Kateterisasi Jantung Kanan dan Kiri PJB Simpel (ASD, VSD, PDA, Post Device Closure) tanpa angiography dengan anestesi |
21,743,000 |
| 5049 |
Kateterisasi Jantung Kanan dan Kiri PJB Simpel (ASD, VSD, PDA, Post Device Closure) tanpa angiography tanpa anestesi |
19,142,000 |
| 5050 |
Kaustik |
66,000 |
| 5051 |
Kaustik Faring |
213,000 |
| 5052 |
Kaustik Faring |
66,000 |
| 5053 |
Kaustik hidung ( AgNO3, tricolor acetat) |
36,000 |
| 5054 |
Kaustik telinga (AgNo3,albotyl) |
18,000 |
| 5055 |
Kauter Albotil/Cauter Podofiline |
66,000 |
| 5056 |
Kauteriasasi Hidung |
281,000 |
| 5057 |
Kauterisasi |
675,000 |
| 5058 |
Kauterisasi |
675,000 |
| 5059 |
Kauterisasi kondiloma akuminata |
9,443,000 |
| 5060 |
Kecepatan Hantar Saraf (KHS) 1 ekstremitas dan late response. |
929,000 |
| 5061 |
Kecepatan Hantar Saraf (KHS) 1 ekstremitas. |
929,000 |
| 5062 |
Kecepatan Hantar Saraf (KHS) 2 ekstremitas dan late response. |
1,057,000 |
| 5063 |
Kecepatan Hantar Saraf (KHS) 2 ekstremitas. |
1,057,000 |
| 5064 |
Kecepatan Hantar Saraf (KHS) 3 ekstremitas dan late response. |
1,186,000 |
| 5065 |
Kecepatan Hantar Saraf (KHS) 3 ekstremitas. |
1,186,000 |
| 5066 |
Kehamilan Ektopik Terganggu (KET) |
6,119,720 |
| 5067 |
kelainan jari / ektremitas sederhana |
5,175,000 |
| 5068 |
Kelainan umbilikus |
13,667,000 |
| 5069 |
Kelainan usus (invaginasi, trombosis, divertikulitis) |
18,392,000 |
| 5070 |
Kelasi besi intravena |
247,000 |
| 5071 |
Kelasi besi subkutan |
141,000 |
| 5072 |
Kelasi Besi Suntik |
66,000 |
| 5073 |
KELOPAK BERAT Lokal |
7,972,000 |
| 5074 |
KELOPAK BERAT Narkose |
9,289,000 |
| 5075 |
KELOPAK SEDANG II Lokal |
7,722,001 |
| 5076 |
KELOPAK SEDANG II Narkose |
9,010,001 |
| 5077 |
Kemoterapi intratekal (Injection other agent into spinal canal, caudal epidural) |
4,311,000 |
| 5078 |
Kemoterapi Intratekal Anak |
1,460,000 |
| 5079 |
Kemoterapi Intratekal Anak dengan Anestesi |
1,998,000 |
| 5080 |
Kemoterapi Intratekal Dewasa |
1,135,000 |
| 5081 |
Kemoterapi Intratekal Dewasa dengan Anestesi |
1,620,000 |
| 5082 |
Kemoterapi Intravena Anak |
660,000 |
| 5083 |
Kemoterapi Intravena Dewasa |
540,000 |
| 5084 |
Kemotherapy Ca Paru |
410,000 |
| 5085 |
Kendaraan Pribadi Milik Petugas |
0 |
| 5086 |
Keratometri |
49,000 |
| 5087 |
Keratometry |
73,000 |
| 5088 |
Keratoplasti |
11,350,000 |
| 5089 |
Keratoplastie Lamelar |
4,093,930 |
| 5090 |
Keratoplasty lamelar posterior lokal |
8,343,000 |
| 5091 |
Khordectomi |
5,646,937 |
| 5092 |
Khordektomy pada Hyspopadia |
4,850,000 |
| 5093 |
KHS ( Konduksi Hantaran Safar ) |
62,400 |
| 5094 |
Kistektomi |
6,165,762 |
| 5095 |
Kistektomi per laparoskopi |
14,720,000 |
| 5096 |
Kistektomi per laparoskopi dengan penyulit |
18,401,000 |
| 5097 |
Kistektomi per laparotomi |
13,379,000 |
| 5098 |
Kistektomi per laparotomi dengan penyulit |
16,726,000 |
| 5099 |
Kistektomi/ eksisi lokal ovarium per laparoskopi |
14,721,000 |
| 5100 |
Kistektomi/ eksisi lokal ovarium per laparotomi |
13,379,000 |
| 5101 |
Kistektomi/ eksisi lokal ovarium per laparotomi dengan penyulit |
16,726,000 |
| 5102 |
Klinik Memori |
390,000 |
| 5103 |
Klisma |
66,000 |
| 5104 |
Knee Brace (Biasa) |
1,650,000 |
| 5105 |
Knee Brace (Khusus) |
2,500,000 |
| 5106 |
Knee disarticulation |
18,043,000 |
| 5107 |
Knight Taylor |
3,000,000 |
| 5108 |
Koagulasi tali pusat bipolar per fetoskopi |
4,870,000 |
| 5109 |
KOH |
33,000 |
| 5110 |
Kolangiografi intra operasi kasai prosedur |
130,643,000 |
| 5111 |
Koledoko Jejunostomi |
5,240,302 |
| 5112 |
Koledoskopi |
16,659,000 |
| 5113 |
Kolesistektomi |
4,342,099 |
| 5114 |
Kolesistektomi radikal |
10,331,000 |
| 5115 |
Kolesistektomi terbuka |
9,735,000 |
| 5116 |
Kolesistostomi |
4,100,000 |
| 5117 |
Kolesterol HDL |
60,000 |
| 5118 |
Kolesterol LDL (Direk) |
100,000 |
| 5119 |
Kolesterol Total |
45,000 |
| 5120 |
Kolonoskopi |
2,360,000 |
| 5121 |
Kolonoskopi |
2,866,000 |
| 5122 |
Kolonoskopi (Sore) |
3,540,000 |
| 5123 |
Kolonoskopi + Anastesi |
3,150,000 |
| 5124 |
Kolonoskopi + Anastesi (Sore) |
4,720,000 |
| 5125 |
Kolonoskopi biopsi |
11,923,000 |
| 5126 |
Kolonoskopi dekompres |
11,923,000 |
| 5127 |
Kolonoskopi Dengan Anastesi |
3,390,000 |
| 5128 |
Kolonoskopi hemostasis |
11,923,000 |
| 5129 |
Kolonoskopi polipektomi |
7,702,000 |
| 5130 |
Kolonoskopi reseksi endomukosal |
11,923,000 |
| 5131 |
Kolonoskopi sten |
11,923,000 |
| 5132 |
Kolonoskopy |
5,026,784 |
| 5133 |
Kolostomi |
4,160,391 |
| 5134 |
Kolostomi |
10,885,000 |
| 5135 |
Kolostomi anak |
16,328,000 |
| 5136 |
Kolostomi neonatus |
16,326,000 |
| 5137 |
Kolostomi Neonatus/Ikostomi/Jejunostomi |
7,801,000 |
| 5138 |
Kolostomi/ikostomi/kemonostomi pada anak |
7,801,000 |
| 5139 |
Kolotomi |
130,643,000 |
| 5140 |
Kolpokleisis parsial (Le Fort) |
18,549,000 |
| 5141 |
Kolpokleisis total |
20,678,000 |
| 5142 |
Kolpoperineorafi |
20,530,000 |
| 5143 |
Kolpoperineorafi |
675,000 |
| 5144 |
Kolporafi anterior (KA) |
20,530,000 |
| 5145 |
Kolporafi anterior dengan mesh |
18,654,000 |
| 5146 |
Kolporafi posterior |
20,530,000 |
| 5147 |
Kolporafi posterior dengan mesh |
18,654,000 |
| 5148 |
Kolposkopi dan Biopsi |
396,000 |
| 5149 |
Kolposkopi dan biopsi (di rawat jalan) |
856,000 |
| 5150 |
Kolposkopi dan biopsi (di ruang operasi) |
856,000 |
| 5151 |
Kolposuspensi Burch |
23,294,000 |
| 5152 |
Kommisuroplasty bilateral |
18,017,000 |
| 5153 |
Kommisuroplasty unilateral |
14,070,000 |
| 5154 |
Komplemen C3 |
70,000 |
| 5155 |
Komponen Trombosit Apheresis Per Bag (PMI) |
3,500,000 |
| 5156 |
Kompresi Bimanual interna& eksterna |
180,000 |
| 5157 |
Kompresi Regio Inguinal, Ekstremitas Atas dan Bawah dengan Bandaging |
154,000 |
| 5158 |
Kompresi Regio Inguinal, Ekstremitas Atas dan Bawah dengan Intermittent Pressure |
154,000 |
| 5159 |
Konisasi serviks (cold knife) |
19,527,000 |
| 5160 |
Konisasi serviks (electrosurgery) |
19,527,000 |
| 5161 |
Konkoplasti |
4,850,000 |
| 5162 |
Konkotomi |
7,432,000 |
| 5163 |
Konseling CAPD |
420,000 |
| 5164 |
Konseling dan Edukasi Pasien Dialisis Peritoneal |
466,000 |
| 5165 |
Konseling end of life pasien dewasa |
225,000 |
| 5166 |
Konseling end of life pasien neonatus |
225,000 |
| 5167 |
Konseling end of life pasien pediatrik |
225,000 |
| 5168 |
Konseling genetik |
225,000 |
| 5169 |
Konseling Individu |
150,000 |
| 5170 |
Konseling Kelompok (> 5 orang) |
300,000 |
| 5171 |
Konseling Keluarga (2-3 orang) |
300,000 |
| 5172 |
Konseling keluarga / Intervensi keluarga |
120,000 |
| 5173 |
Konseling Keluarga Berencana |
95,000 |
| 5174 |
Konseling Lainnya (Family Meeting) |
547,000 |
| 5175 |
Konseling lainnya pasien dewasa |
225,000 |
| 5176 |
Konseling lainnya pasien neonatus |
225,000 |
| 5177 |
Konseling lainnya pasien pediatrik |
225,000 |
| 5178 |
Konseling oleh Psikolog |
130,000 |
| 5179 |
Konseling Perawatan dan Pencegahan IMS |
200,000 |
| 5180 |
Konseling Psikolog / Psikoterapi |
250,000 |
| 5181 |
Konsul Dokter |
52,000 |
| 5182 |
Konsul dr Ahli Alergi Imunologi Anak (IRNA) |
60,000 |
| 5183 |
Konsul dr Ahli Anak (IRNA) |
60,000 |
| 5184 |
Konsul dr Ahli Anastesi (IRNA) |
60,000 |
| 5185 |
Konsul dr Ahli Bedah Anak (IRNA) |
60,000 |
| 5186 |
Konsul dr Ahli Bedah Digestive (IRNA) |
60,000 |
| 5187 |
Konsul dr Ahli Bedah Gastroentrohepatologi (IRNA) |
60,000 |
| 5188 |
Konsul dr Ahli Bedah Orthopedi (IRNA) |
60,000 |
| 5189 |
Konsul dr Ahli Bedah Plastik (IRNA) |
60,000 |
| 5190 |
Konsul dr Ahli Bedah Saraf (IRNA) |
60,000 |
| 5191 |
Konsul dr Ahli Bedah Thorax & Vask. (IRNA) |
60,000 |
| 5192 |
Konsul dr Ahli Bedah Tumor (IRNA) |
60,000 |
| 5193 |
Konsul dr Ahli Bedah Umum (IRNA) |
60,000 |
| 5194 |
Konsul dr Ahli Bedah Urologi (IRNA) |
60,000 |
| 5195 |
Konsul dr Ahli Cardiologi (IRNA) |
60,000 |
| 5196 |
Konsul dr Ahli Endokrin (IRNA) |
60,000 |
| 5197 |
Konsul dr Ahli Forensik (IRNA) |
60,000 |
| 5198 |
Konsul dr Ahli Gastroentrohepatologi (IRNA) |
60,000 |
| 5199 |
Konsul dr Ahli Geriatri (IRNA) |
60,000 |
| 5200 |
Konsul dr Ahli Gigi dan Mulut (IRNA) |
60,000 |
| 5201 |
Konsul dr Ahli Ginjal Hipertensi (IRNA) |
60,000 |
| 5202 |
Konsul dr Ahli Gizi (IRNA) |
60,000 |
| 5203 |
Konsul dr Ahli Hematologi (IRNA) |
60,000 |
| 5204 |
Konsul dr Ahli Hiperbarik (IRNA) |
60,000 |
| 5205 |
Konsul dr Ahli Infection Center (IRNA) |
108,000 |
| 5206 |
Konsul dr Ahli Infeksi Tropis (IRNA) |
60,000 |
| 5207 |
Konsul dr Ahli Jiwa (IRNA) |
60,000 |
| 5208 |
Konsul dr Ahli Kulkel (IRNA) |
60,000 |
| 5209 |
Konsul dr Ahli Mata (IRNA) |
60,000 |
| 5210 |
Konsul dr Ahli Nefrologi (IRNA) |
60,000 |
| 5211 |
Konsul dr Ahli Neurologi (IRNA) |
60,000 |
| 5212 |
Konsul dr Ahli NICU (IRNA) |
60,000 |
| 5213 |
Konsul dr Ahli Obgyn (IRNA) |
60,000 |
| 5214 |
Konsul dr Ahli Ongko Obgyn ( IRNA ) |
51,400 |
| 5215 |
Konsul dr Ahli Onkology (IRNA) |
60,000 |
| 5216 |
Konsul dr Ahli Patologi Klinik (IRNA) |
60,000 |
| 5217 |
Konsul dr Ahli Penyakit Dalam (IRNA) |
60,000 |
| 5218 |
Konsul dr Ahli Penyakit Tropis (IRNA) |
60,000 |
| 5219 |
Konsul dr Ahli PICU (IRNA) |
60,000 |
| 5220 |
Konsul dr Ahli Psikiatri (IRNA) |
60,000 |
| 5221 |
Konsul dr Ahli Pulmonologi (IRNA) |
60,000 |
| 5222 |
Konsul dr Ahli Radiologi (IRNA) |
60,000 |
| 5223 |
Konsul dr Ahli Radiologi Intervensi (IRNA) |
60,000 |
| 5224 |
Konsul dr Ahli Radiotherapi (IRNA) |
60,000 |
| 5225 |
Konsul dr Ahli Respiriology Anak ( IRNA) |
51,400 |
| 5226 |
Konsul dr Ahli Rheumatologi (IRNA) |
60,000 |
| 5227 |
Konsul dr Ahli Saraf (IRNA) |
60,000 |
| 5228 |
Konsul dr Ahli THT (IRNA) |
60,000 |
| 5229 |
Konsul dr Fisiotherapi (IRNA) |
60,000 |
| 5230 |
Konsul dr Rehab Medik (IRNA) |
60,000 |
| 5231 |
Konsultasi Ahli Psikiatri |
150,000 |
| 5232 |
Konsultasi Ahli Psikiatri ( Eksekutif ) |
0 |
| 5233 |
Konsultasi dan Konseling Komperehensif Disorder of Sex Development (DSD) |
1,041,000 |
| 5234 |
Konsultasi dan Konseling Komperehensif DM (Inisial) |
300,000 |
| 5235 |
Konsultasi dan Konseling Komprehensif DM (Lanjutan) |
300,000 |
| 5236 |
Konsultasi dan Konseling Nutrisi pada DM |
300,000 |
| 5237 |
Konsultasi Dokter ( Rehab Medik ) |
62,400 |
| 5238 |
Konsultasi Dokter (Pemeriksaan Kedokteran Fisik dan Rehabilitasi Komprehensif) |
120,000 |
| 5239 |
Konsultasi Dokter Ahli (IRNA PCC) |
60,000 |
| 5240 |
Konsultasi Dokter Ahli Rawat Inap |
70,000 |
| 5241 |
Konsultasi Dokter Hiperbarik |
120,000 |
| 5242 |
Konsultasi Etik Medikolegal/Jam |
301,000 |
| 5243 |
Konsultasi evaluasi ketepatan penggunaan antimikroba golongan reserve |
133,000 |
| 5244 |
Konsultasi Gizi |
120,000 |
| 5245 |
Konsultasi infeksi hasil kultur bakteri MDR |
133,000 |
| 5246 |
Konsultasi infeksi pada pasien khusus (transplan, keganasan, autoimun, geriatri, imukompromais, perawatan intensif, konsultasi perjalanan/wisata) |
650,000 |
| 5247 |
Konsultasi manajemen nyeri |
120,000 |
| 5248 |
Konsultasi Psikologi |
240,000 |
| 5249 |
Konsultasi Psikologi ( DPRD ) |
135,000 |
| 5250 |
Kontraktur + STSG |
6,421,000 |
| 5251 |
Kontraktur Tangan Dan Jari, GA |
17,019,000 |
| 5252 |
Kontraktur Tangan Dan Jari, LA |
14,898,000 |
| 5253 |
Kontrol / Cek / Reposisi PTBD Kasus Simpel |
6,683,000 |
| 5254 |
Kontrol Epistaksis dengan Eksisi Mukosa Hidung dan Graft kulit ke Septum & Dinding Lateral Hidung |
7,935,000 |
| 5255 |
Kontrol Epistaksis dengan Kauterisasi per endsokopi |
4,546,000 |
| 5256 |
Kontrol Epistaksis dengan Ligasi Arteri Etmoid / Sfenopalatina |
7,935,000 |
| 5257 |
Kontrol Epistaksis dengan Ligasi Arteri Maksilaris Transantral |
7,935,000 |
| 5258 |
Kontrol Epistaksis dengan pemasangan tampon (anterior/posterior) |
10,230,000 |
| 5259 |
Kontrol Feeding Plate |
281,000 |
| 5260 |
Kontrol NAM |
284,000 |
| 5261 |
Kontrol Orthodonsia |
200,000 |
| 5262 |
Kontrol perdarahan |
7,919,000 |
| 5263 |
Kontrol Perdarahan Pasca Tonsilektomi & Adenoidektomi |
10,553,000 |
| 5264 |
Kontrol Protesa |
42,000 |
| 5265 |
Kontrol Prothesa Akrilik |
447,000 |
| 5266 |
Kontrol Prothesa maxillofacial kompleks |
314,000 |
| 5267 |
Kontrol Prothesa maxillofacial sederhana |
220,000 |
| 5268 |
Konversi EVD menjadi VP Shunt |
21,960,000 |
| 5269 |
Korangiografi |
11,834,000 |
| 5270 |
Korangiografi + Arteriografi |
19,790,000 |
| 5271 |
Korangiografi + IABP dengan anestesi dan ventilator |
41,328,000 |
| 5272 |
Korangiografi + TPM |
15,223,000 |
| 5273 |
Kordektomi plica vocalis |
12,353,000 |
| 5274 |
Kordosentesis (di ruang bersalin) |
1,474,000 |
| 5275 |
Kordosentesis (di ruang operasi) |
1,474,000 |
| 5276 |
Koreksi + Rekonstruksi Ptosis |
4,850,000 |
| 5277 |
Koreksi Atresia Ani |
5,225,000 |
| 5278 |
Koreksi ektropion / entropion |
4,515,574 |
| 5279 |
Koreksi ektropion / entropion ( Anak ) |
4,380,574 |
| 5280 |
Koreksi Elektrolit |
130,000 |
| 5281 |
Koreksi fraktur impresi |
36,880,000 |
| 5282 |
Koreksi gangguan elektrolit dan asam basa bed side (critical care) pasien dewasa |
129,000 |
| 5283 |
Koreksi gangguan elektrolit dan asam basa bed side (critical care) pasien neonatus |
129,000 |
| 5284 |
Koreksi gangguan elektrolit dan asam basa bed side (critical care) pasien pediatrik |
129,000 |
| 5285 |
Koreksi hipokalemia |
636,000 |
| 5286 |
Koreksi hiponatremia |
2,586,000 |
| 5287 |
Koreksi Impresif Fraktur Sederhana |
5,108,156 |
| 5288 |
Koreksi Magnesium |
130,000 |
| 5289 |
Koreksi Manual Lain pada Deformitas (Manipulasi TMJ, Spine) |
409,000 |
| 5290 |
Koreksi pria prismus (winter prosedur narkose) |
10,306,000 |
| 5291 |
Koreksi Priapismus |
5,151,000 |
| 5292 |
Koreksi Simblefaron Berat |
11,350,000 |
| 5293 |
Koreksi Symblepharon |
3,850,000 |
| 5294 |
Koreksi Vitamin |
130,000 |
| 5295 |
Kornea Tattoo lokal |
6,684,000 |
| 5296 |
Kornea Tattoo narkose |
7,852,000 |
| 5297 |
Koronektomi mahkota gigi impaksi 1-2 gigi |
8,821,000 |
| 5298 |
Korset (Biasa) |
366,000 |
| 5299 |
Korset (Standar) |
507,000 |
| 5300 |
Kraniektomi dekompresi |
25,091,000 |
| 5301 |
Kraniektomi Dekompresi + Evakuasi ICH |
25,091,000 |
| 5302 |
Kraniektomi dekompresi evakuasi hematom |
25,091,000 |
| 5303 |
Kranioplasti/Koreksi Fraktur |
9,775,887 |
| 5304 |
Kranioplasti/rekonstruksi (autograft maupun implant) |
50,847,000 |
| 5305 |
Kraniotomi + Endoskopi |
11,992,025 |
| 5306 |
Kraniotomi bedah mikro 1 |
65,237,000 |
| 5307 |
Kraniotomi bedah mikro 2 |
66,285,000 |
| 5308 |
Kraniotomi bedah mikro 3 |
67,168,000 |
| 5309 |
Kraniotomi bedah mikro 4 |
72,029,000 |
| 5310 |
Kraniotomi Biopsi |
28,807,000 |
| 5311 |
Kraniotomi Bypass / Anastomosis Carotid - Vertebral |
28,807,000 |
| 5312 |
Kraniotomi Bypass / Anastomosis STA- MCA- ACA |
28,807,000 |
| 5313 |
Kraniotomi Clipping Aneurisma |
28,807,000 |
| 5314 |
Kraniotomi Eksisi abses serebri |
28,807,000 |
| 5315 |
Kraniotomi Eksisi Cavernoma |
28,807,000 |
| 5316 |
Kraniotomi evakuasi hematoma |
28,807,000 |
| 5317 |
Kraniotomi Evakuasi ICH |
28,807,000 |
| 5318 |
Kraniotomi Lobektomi |
13,095,000 |
| 5319 |
Kraniotomi Micosurgery epilepsi |
72,029,000 |
| 5320 |
Kraniotomi Removal Tumor |
23,445,000 |
| 5321 |
Kraniotomi removal tumor mikro kompleks 1 |
65,237,000 |
| 5322 |
Kraniotomi removal tumor mikro kompleks 2 |
66,285,000 |
| 5323 |
Kraniotomi removal tumor mikro kompleks 3 |
67,168,000 |
| 5324 |
Kraniotomi removal tumor mikro kompleks 4 |
72,029,000 |
| 5325 |
Kraniotomi Repair Fistula |
25,091,000 |
| 5326 |
Kraniotomi Reseksi AVM |
25,091,000 |
| 5327 |
Kraniotomi Wrapping, Coagulation, Suture Aneurisma |
25,091,000 |
| 5328 |
Kraniotomi/Trepanasi Konvensional |
10,554,887 |
| 5329 |
Kraniotomi+Bedah Mikro |
11,775,887 |
| 5330 |
Kreatinin |
35,000 |
| 5331 |
KREATININ DARAH |
77,000 |
| 5332 |
Kreatinin Klrens |
92,000 |
| 5333 |
KREATININ URIN |
70,000 |
| 5334 |
Kreatinin Urine |
30,000 |
| 5335 |
Kruk Aluminium |
271,000 |
| 5336 |
Kuldosentesis (pungsi kavum Douglassi) |
224,000 |
| 5337 |
Kuldosintesis |
120,000 |
| 5338 |
Kultur & Sensitivity OAT |
400,000 |
| 5339 |
KULTUR DAN RESISTENSI JAMUR NON KAPANG |
579,000 |
| 5340 |
Kultur dan Sensitivitas Jamur |
400,000 |
| 5341 |
Kultur dan Sensitivitas Manual |
250,000 |
| 5342 |
Kultur dan Sensitivitas Obat Medium Cair |
500,000 |
| 5343 |
Kultur dan Sensitivitas Obat Medium Padat |
400,000 |
| 5344 |
Kultur dan Sensitivitas Otomatis |
380,000 |
| 5345 |
Kulture jamur |
54,000 |
| 5346 |
Kunjungan Rumah Analis Laboratorium ( Home Care ) |
100,000 |
| 5347 |
Kunjungan Rumah Dokter ( Home Care ) |
200,000 |
| 5348 |
Kunjungan Rumah Dokter Spesialis ( Home Care ) |
300,000 |
| 5349 |
Kunjungan Rumah Fisioterapis ( Home Care ) |
150,000 |
| 5350 |
Kunjungan Rumah Ners ( Perawat ) ( Home Care ) |
100,000 |
| 5351 |
Kunjungan Rumah Nutrisionis ( Home Care ) |
100,000 |
| 5352 |
Kuret per gigi |
198,000 |
| 5353 |
Kuret per regio |
1,386,000 |
| 5354 |
Kuretase |
140,000 |
| 5355 |
Kuretase Abortus Inkomplitus/ rest plasenta |
600,000 |
| 5356 |
Kuretase dengan PUD / Polip |
5,680,221 |
| 5357 |
Kuretase Diagnostik |
400,000 |
| 5358 |
Kuretase JAringan Granulasi CAE |
2,616,000 |
| 5359 |
Kuretase molahidatidosa |
720,000 |
| 5360 |
Kuretase Percobaan |
400,000 |
| 5361 |
Kuretase Plasenta Retensio |
720,000 |
| 5362 |
Kuretase plasenta/molahidatidosa anastesi |
1,423,000 |
| 5363 |
Kuretase/Dilatasi Kuretase dengan Narkose |
6,165,762 |
| 5364 |
Kyphoplasty |
11,566,000 |
| 5365 |
Kyphoplasty / vertebroplasty for pathological fracture |
25,507,000 |
| 5366 |
Labia mayora plasti |
11,425,000 |
| 5367 |
Labia minora plasti |
26,144,000 |
| 5368 |
Labial augmentation |
26,144,000 |
| 5369 |
Labial Veneer Direct |
1,197,000 |
| 5370 |
Labial Veneer Indirect* |
1,796,000 |
| 5371 |
Labio Plasty |
11,557,000 |
| 5372 |
Labiopalatoplasti Bilateral |
6,866,000 |
| 5373 |
labioplasti |
787,000 |
| 5374 |
Labioplasti Bilateral |
6,761,255 |
| 5375 |
Labioplasti pada Celah Bibir bilateral |
11,557,000 |
| 5376 |
Labioplasti pada Celah Bibir unilateral |
9,211,000 |
| 5377 |
Labioplasti Unilateral |
5,163,000 |
| 5378 |
Labioplasty Unilateral Dengan Nasoplasty, Ga |
12,429,000 |
| 5379 |
Labioplasty Unilateral Dengan Nasoplasty, LA |
14,707,000 |
| 5380 |
Labioplasty Vulva-Vagina |
4,344,000 |
| 5381 |
Labirintectomy Transmastoid |
12,668,000 |
| 5382 |
LACTAT/ LAKTAT (ASAM LAKTAT) |
145,000 |
| 5383 |
Ladd s procedure |
37,825,000 |
| 5384 |
Ladds Procedure |
9,464,367 |
| 5385 |
Laju Endap Darah Automotik |
30,000 |
| 5386 |
LAJU ENDAP DARAH/ LED |
59,000 |
| 5387 |
Laktat Darah |
50,000 |
| 5388 |
Laminektomi foraminostomy |
27,360,000 |
| 5389 |
Laminektomi Kompleks (Bedah Syaraf) |
9,331,885 |
| 5390 |
Laminektomi Oklusi Fistula (Microsurgery) |
37,385,000 |
| 5391 |
Laminektomi Removal tumor intradura |
37,385,000 |
| 5392 |
Laminektomi Removal Tumor Intradura ekstramedulla komplreks |
56,078,000 |
| 5393 |
Laminektomi Removal Tumor Intradura ekstramedulla simple |
37,385,000 |
| 5394 |
Laminektomi Removal Tumor Intramedulla |
56,078,000 |
| 5395 |
Laminektomi Reseksi AVM Spinal |
37,385,000 |
| 5396 |
Laminektomi Sederhana (Bedah Syaraf) |
7,459,885 |
| 5397 |
Laminektomi servikal |
37,385,000 |
| 5398 |
Laminektomy dekompresi lumbal |
37,385,000 |
| 5399 |
Laminektomy dekompresi thorakal |
37,385,000 |
| 5400 |
Laminoplasti servikal |
37,385,000 |
| 5401 |
laminoplasty for Cervical myelopathy |
29,404,000 |
| 5402 |
Laparascopy Kompleks |
15,350,000 |
| 5403 |
Laparascopy Operatif |
6,607,809 |
| 5404 |
Laparascopy Operatif (ODC) |
4,260,000 |
| 5405 |
Laparascopy Operatif Hitroscopy |
6,607,809 |
| 5406 |
Laparascopy Simple |
13,350,000 |
| 5407 |
Laparaskopi diagnostik |
14,500,000 |
| 5408 |
Laparaskopi fundoplikasi |
18,554,000 |
| 5409 |
Laparaskopi R end Y Gastric bypass |
16,609,000 |
| 5410 |
Laparaskopik Kolesistektomi |
6,377,211 |
| 5411 |
Laparatomi + Apendoktomi apendix perforasi |
9,464,367 |
| 5412 |
Laparatomi + Appendektomi pada APP perforasi |
42,326,000 |
| 5413 |
Laparatomi + Milking / reseksi pada invaginasi |
42,058,000 |
| 5414 |
Laparatomi + Milking / Reseksi pada Invaginasi |
9,464,367 |
| 5415 |
Laparatomi + Reksisi Usus Halus / Kolon |
6,173,139 |
| 5416 |
Laparatomi + reseksi invaginasi |
6,175,000 |
| 5417 |
Laparatomi + reseksi usus halus/kolon |
50,597,000 |
| 5418 |
Laparatomi Biopsi Terbuka |
15,069,000 |
| 5419 |
Laparatomi Eksplorasi |
19,119,000 |
| 5420 |
Laparatomi Eksplorasi |
4,377,586 |
| 5421 |
Laparatomi FC |
6,286,074 |
| 5422 |
Laparatomi fundoplikasi |
18,554,000 |
| 5423 |
Laparatomi pada perforasi usus |
6,175,000 |
| 5424 |
Laparatomi pada perforasi usus |
42,326,000 |
| 5425 |
Laparatomi pada Peritonitis Neonatal |
6,175,000 |
| 5426 |
Laparatomi pada peritonitis neonatus |
26,079,000 |
| 5427 |
Laparatomi pada Trauma Abdomen |
15,749,000 |
| 5428 |
Laparatomi pada Trauma Abdomen |
6,181,401 |
| 5429 |
Laparatomi R end Y Gastric bypass |
16,370,000 |
| 5430 |
Laparatomy + Reseksi Usus pada Anak |
11,350,000 |
| 5431 |
Laparatomy pada Perforasi Usus pada Anak |
7,758,000 |
| 5432 |
Laparatomy Percobaan |
6,058,221 |
| 5433 |
Laparoscopy kasai procedure |
16,101,000 |
| 5434 |
Laparoskopi Adrenalektomi |
26,460,000 |
| 5435 |
Laparoskopi biopsi |
15,066,000 |
| 5436 |
Laparoskopi Biopsi Gonad |
18,640,000 |
| 5437 |
Laparoskopi Diseksi Kelenjar Getah Bening Pelvis |
18,640,000 |
| 5438 |
Laparoskopi Eksisi kista duktus koledokus |
22,521,000 |
| 5439 |
Laparoskopi Eksisi Remnant Duktus Mulleri |
18,640,000 |
| 5440 |
Laparoskopi eksplorasi |
11,797,000 |
| 5441 |
Laparoskopi eksplorasi CBD |
25,653,000 |
| 5442 |
Laparoskopi eksplorasi pada KET (kehamilan ektopik terganggu) |
19,592,000 |
| 5443 |
Laparoskopi gastrektomi distal |
17,412,000 |
| 5444 |
Laparoskopi Gonadektomi |
16,199,000 |
| 5445 |
Laparoskopi herniotomi |
33,179,000 |
| 5446 |
Laparoskopi insersi Tenckhoff catheter |
15,110,000 |
| 5447 |
Laparoskopi intrauterin |
12,350,000 |
| 5448 |
Laparoskopi Koledokolitotomi |
14,829,000 |
| 5449 |
Laparoskopi Nefrouretrektomi |
43,490,000 |
| 5450 |
Laparoskopi Orchidopeksi |
18,640,000 |
| 5451 |
Laparoskopi Pankreatektomi |
30,561,000 |
| 5452 |
Laparoskopi psoas hitch/boari flap unilateral |
34,600,000 |
| 5453 |
Laparoskopi Reimplantasi Ureter |
34,600,000 |
| 5454 |
Laparoskopi Repair Fistel |
26,961,000 |
| 5455 |
Laparoskopi repair hernia bilateral |
17,903,000 |
| 5456 |
Laparoskopi repair hernia unilateral |
17,664,000 |
| 5457 |
Laparoskopi Reseksi hepar |
18,726,000 |
| 5458 |
Laparoskopi Simple Prostatektomi |
15,479,000 |
| 5459 |
Laparoskopi Sistektomi Radikal |
26,961,000 |
| 5460 |
Laparoskopi splenektomi |
16,011,000 |
| 5461 |
Laparoskopi ultra low resection (ULAR) |
33,179,000 |
| 5462 |
Laparoskopi Unroofing kista hati |
13,943,000 |
| 5463 |
Laparoskopik Anterior Reseksi |
33,179,000 |
| 5464 |
Laparoskopik Appendektomi |
18,392,000 |
| 5465 |
Laparoskopik Diagnostik/Biopsi |
15,429,000 |
| 5466 |
Laparoskopik fundoplikasi gaster + Repair hiatal hernia (anak) |
27,834,000 |
| 5467 |
Laparoskopik Gastrektomi |
33,179,000 |
| 5468 |
Laparoskopik inguinal lymphadenectomy |
15,066,000 |
| 5469 |
Laparoskopik Kolektomi |
33,179,000 |
| 5470 |
Laparoskopik Kolesistektomi |
13,005,000 |
| 5471 |
Laparoskopik Miles/ LAR |
34,409,000 |
| 5472 |
Laparoskopik orchiectomy |
12,130,000 |
| 5473 |
Laparoskopik repair hernia insisional |
17,461,000 |
| 5474 |
Laparoskopik Reseksi Hati |
14,540,000 |
| 5475 |
Laparoskopik retropertinoeal lymph node dissection |
15,066,000 |
| 5476 |
Laparotomi Biopsi Diagnostik |
15,069,000 |
| 5477 |
Laparotomi eksplorasi CBD + kolesistektomi |
25,653,000 |
| 5478 |
Laparotomi eksplorasi ginekologi |
10,000,000 |
| 5479 |
Laparotomi eksplorasi KET (kehamilan ektopik terganggu) |
11,090,000 |
| 5480 |
Laparotomi eksplorasi KET (kehamilan ektopik terganggu) dengan penyulit |
13,861,000 |
| 5481 |
Laparotomi kelainan esofagus distal (striktur) |
14,070,000 |
| 5482 |
Laparotomi kelainan esofagus distal (tumor) |
14,070,000 |
| 5483 |
Laparotomi obstruksi usus |
24,215,000 |
| 5484 |
Laparotomi Reseksi Anastomosis Biasa |
42,326,000 |
| 5485 |
Laparotomi Tumor Intra Abdomen |
49,574,000 |
| 5486 |
Laparotomi Tumor Retroperitoneal |
21,344,000 |
| 5487 |
Laparotomi ultra low resection (ULAR) |
26,545,000 |
| 5488 |
LAR Terbuka |
25,304,000 |
| 5489 |
Laringektomi |
3,781,100 |
| 5490 |
Laringektomi Parsial |
21,425,000 |
| 5491 |
Laringektomi Total |
33,156,000 |
| 5492 |
Laringgofisure |
3,850,000 |
| 5493 |
Laringo Fisur/Eksplorasi Laring |
5,482,645 |
| 5494 |
Laringofisure |
12,401,000 |
| 5495 |
Laringoskopi |
7,653,000 |
| 5496 |
Laringoskopi dengan Ekstirpasi |
3,850,000 |
| 5497 |
Laringoskopi fleksibel diagnostik |
6,156,000 |
| 5498 |
Laringoskopi Kaku |
828,000 |
| 5499 |
Laringoskopi kaku diagnostik |
7,653,000 |
| 5500 |
Laser Ablatif 1 |
1,500,000 |
| 5501 |
Laser Ablatif 2 |
2,000,000 |
| 5502 |
Laser Ablatif 3 |
2,000,000 |
| 5503 |
Laser Barrage / Laser Retinopexy |
2,939,000 |
| 5504 |
Laser CO2 |
1,000,000 |
| 5505 |
Laser Erbium & Tatto Besar |
0 |
| 5506 |
Laser Erbium & Tatto Kecil |
0 |
| 5507 |
Laser Erbium & Tatto Sedang |
0 |
| 5508 |
Laser Fokal / Grid Retina |
2,939,000 |
| 5509 |
Laser Indirect Ophthalmoscopy (LIO) |
2,939,000 |
| 5510 |
Laser Iridotomi Perifer |
2,850,000 |
| 5511 |
Laser Nd-YAG (Capsulotomy Posterior) |
2,529,000 |
| 5512 |
Laser Nd-YAG Hyaloidotomy |
2,529,000 |
| 5513 |
Laser Pan Retinal Photocoagulation (PRP) (Argon Laser) |
2,939,000 |
| 5514 |
Laser Peremajaan/Photorejuvenation 1 |
2,000,000 |
| 5515 |
Laser Peremajaan/Photorejuvenation 2 |
2,500,000 |
| 5516 |
Laser Peremajaan/Photorejuvenation 3 |
3,000,000 |
| 5517 |
Laser Perifer Iridektomi (LPI) |
1,249,000 |
| 5518 |
Laser Pigmentasi 1 |
1,500,000 |
| 5519 |
Laser Pigmentasi 2 |
2,000,000 |
| 5520 |
Laser Pigmentasi 3 |
2,500,000 |
| 5521 |
Laser Skar 1 |
1,500,000 |
| 5522 |
Laser Skar 2 |
2,000,000 |
| 5523 |
Laser Skar 3 |
2,500,000 |
| 5524 |
Laser Therapy |
72,600 |
| 5525 |
Laser Vaskular 1 |
1,500,000 |
| 5526 |
Laser Vaskular 2 |
2,000,000 |
| 5527 |
Laser Vaskular 3 |
2,500,000 |
| 5528 |
Lateral Tarsal Strip Lokal |
7,132,000 |
| 5529 |
Lateral Tarsal Strip Narkose |
8,352,000 |
| 5530 |
Latihan Aktif Lainnya (Latihan Koordinasi, Ketangkasan, Daya Ledak (Power), Daya Tahan, Latihan Kontrol Postur, Stabilisasi Postur, Developmental Activities Training, Motor Training, Movement Pattern Training, Latihan Neuromusculer re-learning, Tekni |
209,000 |
| 5531 |
Latihan Ambulasi dan Gait Training |
159,000 |
| 5532 |
Latihan Ambulasi Risiko Tinggi pada Pasien Rawat Jalan |
159,000 |
| 5533 |
Latihan Augmentative and Alternative Communication (AAC) |
150,000 |
| 5534 |
Latihan Bicara Esofageal |
141,000 |
| 5535 |
Latihan dengan Virtual Reality |
253,000 |
| 5536 |
Latihan Ekstrimitas Atas dengan Robotic System |
125,000 |
| 5537 |
Latihan Ekstrimitas Bawah dengan Robotic System |
125,000 |
| 5538 |
Latihan Fungsional Return to Work dan Return to Activities |
239,000 |
| 5539 |
Latihan Jalan Menggunakan Orthosis, Prosthesis, dan Alat Bantu Jalan |
72,000 |
| 5540 |
Latihan Kebugaran Kardiorespirasi Risiko Tinggi dengan Treadmill atau Ergocycle |
749,000 |
| 5541 |
Latihan Kebugaran Kardiorespirasi Risiko Tinggi tanpa Alat |
521,000 |
| 5542 |
Latihan Ketahanan Kardiorespirasi dengan Ergocycle (Arm/Leg) |
158,000 |
| 5543 |
Latihan Ketahanan Kardiorespirasi dengan Treadmill |
749,000 |
| 5544 |
Latihan Ketahanan Kardiorespirasi Menggunakan Oksigen |
148,000 |
| 5545 |
Latihan Khusus (PNF, NDT, DNS, MRP, GMI, MRT, Mulligan Concept, Movement, System Impairment Exercise, Feldenkrais Method, Biofeedback Exercise, Sling Exercise Therapy, Bobath, Scoliosis, Osteoporosis) |
125,000 |
| 5546 |
Latihan Kombinasi |
125,000 |
| 5547 |
Latihan Lingkup Gerak Sendi (Tanpa dan Dengan Ortosis, Assistive, Adaptive, Prostesis dan Alat Lainnya) |
125,000 |
| 5548 |
Latihan Mobilisasi Pasien Rawat Inap dan Pasien Kritis |
155,000 |
| 5549 |
Latihan mobilisasi pra / pasca operasi |
210,000 |
| 5550 |
Latihan Pasif lainnya (CPM, dll) |
90,000 |
| 5551 |
Latihan Penguatan Otot dengan alat (NK Table/Leg Press/EN Tree dsb) |
125,000 |
| 5552 |
Latihan Penguatan Otot Tanpa Alat (Theraband, dumble) |
125,000 |
| 5553 |
Latihan Peregangan Otot atau Tendon (Aktif) |
148,000 |
| 5554 |
Latihan Pernafasan |
100,000 |
| 5555 |
Latihan Pernapasan dengan Incentive Spirometer, IMT, EMT |
125,000 |
| 5556 |
Latihan Prenatal |
225,000 |
| 5557 |
Latisimus Dorsi Flap |
4,850,000 |
| 5558 |
Latissimus dorsi myocutaneous flap |
2,382,099 |
| 5559 |
Layanan Asesmen Psikologis CPPDS |
296,000 |
| 5560 |
Layanan Sosial Medis (Konsultasi, Bimbingan, Asesmen dan Intervensi Sosial Medis) |
164,000 |
| 5561 |
Layanan Telemedicine Spesialis |
150,000 |
| 5562 |
LDH |
40,000 |
| 5563 |
LDH |
100,000 |
| 5564 |
Le Fort I Osteotomy, GA |
16,331,000 |
| 5565 |
Le-ford Advancement Surgery |
9,556,772 |
| 5566 |
Legalisir Surat Keterangan Kematian (10 Lbr) |
20,000 |
| 5567 |
Legallisir Surat Kematian /10 lmbr |
20,000 |
| 5568 |
Lepas AKDR/ IUD per histeroskopi |
8,366,000 |
| 5569 |
Lepas AKDR/ IUD per laparoskopi |
9,515,000 |
| 5570 |
Lepas balon endotrakea per fetoskopi |
23,750,000 |
| 5571 |
Lepas Drain |
116,000 |
| 5572 |
Lepas implant (susuk kontrasepsi) dengan penyulit |
935,000 |
| 5573 |
Lepas pessarium |
546,000 |
| 5574 |
Lepas/ pasang kateter Folley |
256,000 |
| 5575 |
Lepto Dipstick _ |
135,000 |
| 5576 |
Leptospira IgM |
200,000 |
| 5577 |
Leucodepleted |
650,000 |
| 5578 |
Leukaferesis terapi |
6,048,000 |
| 5579 |
Leukemia Phenotyping (P) |
715,000 |
| 5580 |
LEUKIMIA PHENOTYPING/ IMUNOFENOTYPING |
3,150,000 |
| 5581 |
LEUKIMIA PHENOTYPING/ IMUNOFENOTYPING |
3,150,000 |
| 5582 |
Leukoferesis |
2,260,000 |
| 5583 |
Levator reseksi Lokal |
4,835,000 |
| 5584 |
Levator reseksi Narkose |
5,811,000 |
| 5585 |
LH |
200,000 |
| 5586 |
LH (P) |
338,000 |
| 5587 |
Liberation for Joint Stiffness |
24,208,000 |
| 5588 |
Ligasi A.Karotis Eksterna |
4,850,000 |
| 5589 |
Ligasi arteri hipogastrika per laparotomi |
13,709,000 |
| 5590 |
Ligasi Arteri Karotis Eksterna |
25,671,000 |
| 5591 |
Ligasi Arteri Profunda + Eksisi Biopsi |
24,572,000 |
| 5592 |
Ligasi arteri uterina/hipogastrika per laparoskopi |
18,008,000 |
| 5593 |
Ligasi arteri uterina/hipogastrika per laparotomi |
12,004,000 |
| 5594 |
Ligasi cabang Draining Vein AV Shunt |
17,783,000 |
| 5595 |
Ligasi cabang draining vein AV shunt hemodialisis |
29,153,000 |
| 5596 |
Ligasi dan pemotongan tuba Falopii bilateral per laparoskopi |
18,008,000 |
| 5597 |
Ligasi dan pemotongan tuba Falopii bilateral per laparotomi |
12,004,000 |
| 5598 |
Ligasi Hemorhoid + Anastesi (Sore) |
7,180,000 |
| 5599 |
Ligasi Hemorrhoid + Anastesi |
7,180,000 |
| 5600 |
Ligasi Hemorrhoid + Anastesi |
7,549,000 |
| 5601 |
Ligasi MAPCA |
75,329,000 |
| 5602 |
Ligasi Pembuluh Darah Tiroid |
25,572,000 |
| 5603 |
Ligasi tinggi |
8,606,000 |
| 5604 |
Ligasi Tinggi hidrokel pada anak |
4,967,567 |
| 5605 |
Ligasi tinggi perlaparoskopi |
33,179,000 |
| 5606 |
Ligasi varises esofagus |
10,366,000 |
| 5607 |
Ligasi Varises SCBA |
7,580,000 |
| 5608 |
Ligasi Varises SCBA (Sore) |
7,580,000 |
| 5609 |
Ligasi Varises SCBA + Anastesi |
10,100,000 |
| 5610 |
Ligasi Varises SCBA + Anastesi (Sore) |
10,100,000 |
| 5611 |
Ligasi vena spermatika (mikro surgery narkose) |
26,961,000 |
| 5612 |
Light Emitting Diode 1 |
1,500,000 |
| 5613 |
Light Emitting Diode 2 |
2,000,000 |
| 5614 |
Light Emitting Diode 3 |
2,500,000 |
| 5615 |
Limb lengthening procedures, carpals and metacarpals |
6,600,000 |
| 5616 |
Limb lengthening procedures, femur |
6,600,000 |
| 5617 |
Limb lengthening procedures, humerus |
6,600,000 |
| 5618 |
Limb lengthening procedures, radius and ulna |
6,600,000 |
| 5619 |
Limb lengthening procedures, tarsals and metatarsals |
6,600,000 |
| 5620 |
Limb lengthening procedures, tibia and fibula |
6,600,000 |
| 5621 |
Limb salvage surgery: (stage 2) for Bone / Soft tissue tumor |
32,889,000 |
| 5622 |
Limb salvage surgery: reconstruction with arthrodhesis for Periarticular Bone / Soft tissue tumor |
32,911,000 |
| 5623 |
Limb salvage surgery: reconstruction with endoprosthesis |
32,911,000 |
| 5624 |
Limb salvage surgery: reconstruction with non vascularized bone / soft tissue graft for Bone / Soft tissue tumor of upper extremity |
37,692,000 |
| 5625 |
Limb salvage surgery: reconstruction with non vascularized bone graft for Bone / Soft tissue tumor of lower extremity |
37,692,000 |
| 5626 |
Limb salvage surgery: reconstruction with vascularized bone / soft tissue graft for Bone / Soft tissue tumor |
32,889,000 |
| 5627 |
Limb salvage surgery: stage 1 for Bone / Soft tissue tumor |
32,889,000 |
| 5628 |
Limb shortening procedures, carpals and metacarpals |
6,600,000 |
| 5629 |
Limb shortening procedures, femur |
6,600,000 |
| 5630 |
Limb shortening procedures, humerus |
6,600,000 |
| 5631 |
Limb shortening procedures, radius and ulna |
6,600,000 |
| 5632 |
Limb shortening procedures, tarsals and metatarsals |
6,600,000 |
| 5633 |
Limb shortening procedures, tibia and fibula |
6,600,000 |
| 5634 |
limbal stem cell graft lokal |
8,955,000 |
| 5635 |
limbal stem cell graft narkose |
9,995,000 |
| 5636 |
Limfadenektomi Ileoinguinal |
7,885,000 |
| 5637 |
Limfadenektomi Multiple |
12,638,000 |
| 5638 |
Limfadenektomi pelvik/ paraaorta per laparoskopi |
24,354,000 |
| 5639 |
Limfadenektomi pelvik/ paraaorta per laparotomi |
19,484,000 |
| 5640 |
Limfadenektomi radikal KGB inguinal bilateral |
23,370,000 |
| 5641 |
Limfadenektomi radikal KGB inguinal per laparoskopi |
23,370,000 |
| 5642 |
Limfadenektomi radikal KGB inguinal unilateral |
17,530,000 |
| 5643 |
Limfadenektomi Retroperitoneal |
7,885,000 |
| 5644 |
Lingual arch |
608,000 |
| 5645 |
Lingual button |
230,000 |
| 5646 |
Lip Bumper |
1,812,000 |
| 5647 |
Lip Mucosa Graft Lokal |
7,280,000 |
| 5648 |
Lip Mucosa Graft Narkose |
8,517,000 |
| 5649 |
Lipase (P) |
225,000 |
| 5650 |
Lipase Darah |
80,000 |
| 5651 |
LIPASE DARAH |
216,000 |
| 5652 |
Lipase Urine |
63,000 |
| 5653 |
Lipokuretase untuk Hiperhidrosis Aksila Kanan Kiri |
4,000,000 |
| 5654 |
Lipoma Besar (Lipoma + Kista) |
480,000 |
| 5655 |
Lipoma Kecil ( Lipoma + Kista ) |
157,000 |
| 5656 |
Lipoma Sedang (Lipoma + Kista) |
400,000 |
| 5657 |
Liposuction Dada/ Punggung/ Tungkai Kanan dan Kiri |
4,000,000 |
| 5658 |
Liposuction Lengan Atas Kanan dan Kiri |
3,500,000 |
| 5659 |
Liposuction Perut Atas/ Perut Bawah/ Pinggang/ Pinggul |
4,000,000 |
| 5660 |
Liposuction Wajah Area Kecil (1 pipi/ double chin), termasuk Buccal Fat Removal |
1,534,000 |
| 5661 |
Liquid Embolization for occlusion for atriovenous fistula ? 3 Feeder (Eksekutif) |
0 |
| 5662 |
Liquid Embolization for occlusion for atriovenous fistula ? 3 Feeder + Penyulit (Eksekutif) |
0 |
| 5663 |
Liquid Embolization For Occlusion For Atriovenous Fistula <= 3 Feeder |
138,110,000 |
| 5664 |
Liquid Embolization For Occlusion For Atriovenous Fistula <= 3 Feeder + Penyulit |
141,815,000 |
| 5665 |
Liquid Embolization For Occlusion For Atriovenous Fistula > 3 Feeder |
203,710,000 |
| 5666 |
Liquid Embolization for occlusion for atriovenous fistula > 3 Feeder (Eksekutif) |
0 |
| 5667 |
Liquid Embolization For Occlusion For Atriovenous Fistula > 3 Feeder + Penyulit |
213,465,000 |
| 5668 |
Liquid Embolization for occlusion for atriovenous fistula > 3 Feeder + Penyulit (Eksekutif) |
0 |
| 5669 |
Liquid Embolization for occlusion for atriovenous Malformation ? 3 freder + penyulit (Eksekutif) |
0 |
| 5670 |
Liquid Embolization for occlusion for atriovenous Malformation ? 3 freder (Eksekutif) |
0 |
| 5671 |
Liquid Embolization For Occlusion For Atriovenous Malformation <= 3 Freder |
138,110,000 |
| 5672 |
Liquid Embolization For Occlusion For Atriovenous Malformation <= 3 Freder + Penyulit |
141,815,000 |
| 5673 |
Liquid Embolization For Occlusion For Atriovenous Malformation > 3 Freder + Penyulit |
232,870,000 |
| 5674 |
Liquid Embolization for occlusion for atriovenous Malformation > 3 freder + penyulit (Eksekutif) |
0 |
| 5675 |
Lithiasis |
250,000 |
| 5676 |
Lithotripsi Batu Buli (Narkose) |
9,215,000 |
| 5677 |
Litotripsi dengan EHL |
3,860,000 |
| 5678 |
Litotripsi Dengan EHL |
4,159,000 |
| 5679 |
Litotripsi dengan EHL (Sore) |
5,790,000 |
| 5680 |
Litotripsi dengan Laser |
5,810,000 |
| 5681 |
Litotripsi Dengan Laser |
5,912,000 |
| 5682 |
Litotripsi dengan Laser (Sore) |
8,710,000 |
| 5683 |
Litrotipasi/litotripsi |
7,160,799 |
| 5684 |
Lobektomi ( Bedah Paru/ Thorax ) |
21,102,000 |
| 5685 |
Lobektomi tiroid |
11,131,000 |
| 5686 |
Lobektomi Tiroid |
4,850,000 |
| 5687 |
Lobulaplasti (1Telinga / 2Telinga) |
2,850,000 |
| 5688 |
Local excision of lesion or tissue of carpals and metacarpals |
3,125,000 |
| 5689 |
Local excision of lesion or tissue of femur |
3,125,000 |
| 5690 |
Local excision of lesion or tissue of humerus |
3,125,000 |
| 5691 |
Local excision of lesion or tissue of patella |
3,125,000 |
| 5692 |
Local excision of lesion or tissue of radius and ulna |
3,125,000 |
| 5693 |
Local excision of lesion or tissue of scapula, clavicle, and thorax (ribs and sternum) |
3,125,000 |
| 5694 |
Local excision of lesion or tissue of tarsals and metatarsals |
3,125,000 |
| 5695 |
Local excision of lesion or tissue of tibia and fibula |
3,125,000 |
| 5696 |
Lokal Chemoterapi pada Hepatoma / tumor-tumor Metastasi Lain + Anastesi |
45,450,000 |
| 5697 |
Lokal Chemoterapi pada tumor-tumor Extremitas + Anastesi |
45,450,000 |
| 5698 |
Lokal chemotherapi pada Hepatoma/tumor-tumor metastasi lain |
24,883,390 |
| 5699 |
Lokal chemotherapi pada tumor-tumor extremitas |
24,883,390 |
| 5700 |
Lokal Flap pada Wajah |
17,778,000 |
| 5701 |
Longitudinal Nefrolithotomi (Kadet) |
7,885,000 |
| 5702 |
Longitudinal nefrolothotomi |
12,160,000 |
| 5703 |
Lontophoresis |
72,600 |
| 5704 |
Lopografi |
500,000 |
| 5705 |
Lopography |
1,417,000 |
| 5706 |
Low level laser therapy kasus kompleks |
525,000 |
| 5707 |
Low level laser therapy kasus sederhana |
349,000 |
| 5708 |
Lower leg or ankle reattachment |
10,675,000 |
| 5709 |
LRI ( Limbal relaxing Incision ) lokal |
12,975,000 |
| 5710 |
LRI ( Limbal relaxing Incision ) narkose |
16,341,000 |
| 5711 |
Luka Bakar Berat Umum |
581,730 |
| 5712 |
Luka Bakar Ringan Umum |
245,000 |
| 5713 |
Luka Bakar Sedang Umum |
480,000 |
| 5714 |
Lumbal Bone Densitometry |
250,000 |
| 5715 |
Lumbal Facet Joint Injection USG |
2,891,000 |
| 5716 |
Lumbal medial branch block |
5,075,000 |
| 5717 |
Lumbal Pungsi |
564,000 |
| 5718 |
Lumbal Pungsi Neonatus |
564,000 |
| 5719 |
Lumbar and lumbosacral fusion, anterior technique |
14,020,000 |
| 5720 |
Lumbar and lumbosacral fusion, lateral transverse process technique |
14,020,000 |
| 5721 |
Lumbar and lumbosacral fusion, posterior technique |
14,020,000 |
| 5722 |
Lumbar disk artroplasty |
37,385,000 |
| 5723 |
Lumbar Facet Joint Injection C ARM |
5,075,000 |
| 5724 |
Lumbar Facet Joint Injection C-Arm ? 2 (Eksekutif) |
0 |
| 5725 |
Lumbar Facet Joint Injection C-Arm <= 2 |
5,550,000 |
| 5726 |
Lumbar Facet Joint Injection C-Arm > 2 |
7,910,000 |
| 5727 |
Lumbar Facet Joint Injection C-Arm > 2 (Eksekutif) |
0 |
| 5728 |
Lumbar foraminostomy |
37,385,000 |
| 5729 |
Lumbar Interlaminar Injection C-Arm (Eksekutif) |
0 |
| 5730 |
Lumbar Interlaminar Injection C ARM |
4,547,000 |
| 5731 |
Lumbar Interlaminar Injection C-Arm |
8,165,000 |
| 5732 |
Lumbar Interlaminar Injection USG |
2,891,000 |
| 5733 |
Lumbar Intradiscal Injection C ARM |
5,075,000 |
| 5734 |
Lumbar Medial Branch Block Injection C-Arm ? 2 (Eksekutif) |
0 |
| 5735 |
Lumbar Medial Branch Block Injection C-Arm <= 2 |
8,715,000 |
| 5736 |
Lumbar Medial Branch Block Injection C-Arm > 2 |
8,200,000 |
| 5737 |
Lumbar Medial Branch Block Injection C-Arm > 2 (Eksekutif) |
0 |
| 5738 |
Lumbar Median Branch Injection C ARM |
5,075,000 |
| 5739 |
Lumbar Median Branch Injection USG |
2,891,000 |
| 5740 |
Lumbar Sympathetic Injection C ARM |
10,708,000 |
| 5741 |
Lumbar Transforaminal Injection C-Arm ? 2 (Eksekutif) |
0 |
| 5742 |
Lumbar Transforaminal Injection C-Arm > 2 (Eksekutif) |
0 |
| 5743 |
Lumbar Transforaminal Injection C ARM |
5,264,000 |
| 5744 |
Lumbar Transforaminal Injection C-Arm <= 2 |
8,165,000 |
| 5745 |
Lumbar Transforaminal Injection C-Arm > 2 |
7,910,000 |
| 5746 |
Lumbar Transforaminal Injection USG |
2,891,000 |
| 5747 |
Lumbosacroillac fixation |
27,360,000 |
| 5748 |
Lung Recruitment ICU/HCU/ICCU pasien dewasa |
1,085,000 |
| 5749 |
Lung recruitment manuver |
1,085,000 |
| 5750 |
Lung Recruitment pasien pediatrik |
1,085,000 |
| 5751 |
Lung volume recruitment therapy (air stacking, chest expansion, incentive spirometry, segmental breathing) |
147,000 |
| 5752 |
Lysis of adhesions of hand |
3,125,000 |
| 5753 |
Lysis Of Adhesions Of Muscle, Tendon, Fascia And Bursa |
414,000 |
| 5754 |
Magnesium Darah |
37,000 |
| 5755 |
MAGNESIUM TOTAL |
83,000 |
| 5756 |
Magneto Therapy |
72,600 |
| 5757 |
Mahkota All Porcelain* |
765,000 |
| 5758 |
Mahkota Metal* |
657,000 |
| 5759 |
Mahkota Porcelain Fused to Metal (PFM) |
549,999 |
| 5760 |
Mahkota Sementara Direct |
804,000 |
| 5761 |
Mahkota Sementara In Direct* |
967,000 |
| 5762 |
Makan dan Snack |
300,000 |
| 5763 |
Maksilektomi Parsial |
22,092,000 |
| 5764 |
Maksilektomi Partialis |
4,850,000 |
| 5765 |
Maksilektomi totalis |
14,714,000 |
| 5766 |
Maksilektomi Totalis |
5,393,089 |
| 5767 |
Malaria Mikroskopik |
120,000 |
| 5768 |
MALARIA MIKROSKOPIK |
119,000 |
| 5769 |
Mammografi + Ultrasonografi Mammae |
921,000 |
| 5770 |
Mammography dan USG (Rujukan Luar) |
250,000 |
| 5771 |
Mammography Digital |
350,000 |
| 5772 |
Mammography Digital (Rujukan Luar) |
350,000 |
| 5773 |
Mamografi |
352,000 |
| 5774 |
Mamografi DBT (Digital Breast Tomosyntesis) |
600,000 |
| 5775 |
Mamografi stereotactic biopsy / guided localization |
703,000 |
| 5776 |
Managemen Laktasi |
100,000 |
| 5777 |
Managemen terapi oksigen jangka panjang |
141,000 |
| 5778 |
Manajemen Ekstrapiramidal Sindrom ( EPS ) ( Eksekutif ) |
0 |
| 5779 |
Manajemen Ekstrapiramidal Sindrom (EPS) |
250,000 |
| 5780 |
Manajemen Gaduh Gelisah |
750,000 |
| 5781 |
Manajemen Gaduh Gelisah |
275,000 |
| 5782 |
Manajemen Gaduh Gelisah ( Eksekutif ) |
0 |
| 5783 |
Manajemen nutrisi enteral |
129,000 |
| 5784 |
Manajemen nutrisi parenteral |
225,000 |
| 5785 |
Manajemen nutrisi parenteral compounding |
238,000 |
| 5786 |
Manajemen Nyeri Akupunktur Intervensi Dengan Panduan USG |
633,000 |
| 5787 |
Manajemen Nyeri Akupunktur Intervensi Tanpa Panduan USG |
161,000 |
| 5788 |
Manajemen PCA IV / PCA epidural |
638,000 |
| 5789 |
Manajemen perioperatif pada pasien geriatri |
720,000 |
| 5790 |
Manajemen Psikologis Pasca Bencana (Crisis intervention) |
257,000 |
| 5791 |
Manajemen Resiko Bunuh Diri |
196,000 |
| 5792 |
Manajemen Resiko Bunuh Diri ( Eksekutif ) |
0 |
| 5793 |
Manajemen Risiko Bunuh Diri |
500,000 |
| 5794 |
Mandi Jenazah Infeksi |
500,000 |
| 5795 |
Mandi Jenazah Non Infeksi |
350,000 |
| 5796 |
Mandibula kompleks |
23,473,000 |
| 5797 |
Mandibula sederhana |
17,607,001 |
| 5798 |
Mandibular Distraction, GA |
16,331,000 |
| 5799 |
Mandibular Reconst With Non Vascularized Bone Graft, GA |
16,331,000 |
| 5800 |
Mandibular Reconst With Tmj Plate Rekonstruction, GA |
16,331,000 |
| 5801 |
Mandibular Reconst With Vascularized Bone Graft(Mikro) - Defek Boyd T, GA |
16,331,000 |
| 5802 |
Mandibular recontruction with non vascularized bone graft |
15,538,000 |
| 5803 |
Mandibular recontruction with plate recontruction |
15,538,000 |
| 5804 |
Mandibular recontruction with vascularized bone graft |
15,538,000 |
| 5805 |
Mandibulektomi |
13,950,000 |
| 5806 |
Mandibulektomi dengan rekonstruksi |
26,912,000 |
| 5807 |
Mandibulektomi dengan rekonstruksi (Bone Graft) |
28,092,000 |
| 5808 |
Mandibulektomi dengan rekonstruksi (Plate and Screw) |
35,202,000 |
| 5809 |
Mandibulektomi marginalis |
13,808,000 |
| 5810 |
Mandibulektomi Marginalis |
4,018,158 |
| 5811 |
Mandibulektomi Parsial THT |
4,850,000 |
| 5812 |
Mandibulektomi partialis |
13,808,000 |
| 5813 |
Mandibulektomi Partialis dengan Rekontruksi |
5,111,414 |
| 5814 |
Mandibulektomi Total |
13,105,000 |
| 5815 |
Mandibulektomi Total + Rekonstruksi |
19,278,000 |
| 5816 |
Mandibulektomi Totalis |
5,443,284 |
| 5817 |
Mandibulektomi totalis + rekonstruksi |
28,092,000 |
| 5818 |
Manipulasi Ekstrimitas |
150,000 |
| 5819 |
Manipulasi Lainnya Pada Sendi Temporomandibular |
346,000 |
| 5820 |
Manipulasi sendi |
150,000 |
| 5821 |
Manipulasi sendi dengan anestesi lokal |
150,000 |
| 5822 |
Manipulation Temporomandibular Joint |
70,000 |
| 5823 |
Mantoux Test |
80,000 |
| 5824 |
Mantoux test |
200,000 |
| 5825 |
Manual and Mekanikal Traction |
70,000 |
| 5826 |
Manual Plasenta |
444,000 |
| 5827 |
Manual Plasenta |
300,000 |
| 5828 |
Manual Test Kekuatan Otot |
70,000 |
| 5829 |
Manual Test Tonus Otot |
80,000 |
| 5830 |
Manual Testing Of Muscle Function |
70,000 |
| 5831 |
Mapping Implan Koklea Komunitas |
250,000 |
| 5832 |
Mapping implant koklea |
584,000 |
| 5833 |
Marginal Excision for Large sized benign soft tissue tumor (diameter >10cm) |
19,593,000 |
| 5834 |
Marginal Excision for Medium sized benign soft tissue tumor (diameter 5-10cm) |
13,061,000 |
| 5835 |
Marginal Excsion for Small sized benign soft tissue tumor (diameter <5cm) |
13,061,000 |
| 5836 |
Marking USG |
896,000 |
| 5837 |
Marsupialisasi |
8,846,000 |
| 5838 |
Marsupialisasi Abses Bartholin |
2,850,000 |
| 5839 |
Marsupialisasi (Partch Prosedur) dengan Anastesi Lokal |
860,000 |
| 5840 |
Marsupialisasi Kista Bartholini |
675,000 |
| 5841 |
Marsupialisasi Kista Dental dengan Anastesi Lokal |
2,493,000 |
| 5842 |
Marsupialisasi Kista Kelenjar Liur |
8,199,000 |
| 5843 |
Marsupialisasi Kista Laring dengan mikrolaringoskopi |
15,305,000 |
| 5844 |
Marsupialisasi Ranula |
2,510,000 |
| 5845 |
Marsupialisasi ranula / kista |
8,821,000 |
| 5846 |
Marsupialisasi ranula besar |
8,845,000 |
| 5847 |
Marsupialisasi/ekstirpasi/fenestrasi (kraniotomi/mikroskopik/endoskopik) kista arachnoid |
21,960,000 |
| 5848 |
Masa Lisis Euglobin |
63,000 |
| 5849 |
MASA PEMBEKUAN LEE & WHITE/ WAKTU PEMBEKUAN |
39,000 |
| 5850 |
MASA PENDARAHAN IVY/ WAKTU PERDARAHAN |
36,000 |
| 5851 |
Masase Prostate |
675,000 |
| 5852 |
Masilektomi Partialis |
4,027,668 |
| 5853 |
Massage |
36,000 |
| 5854 |
Massage |
89,000 |
| 5855 |
Massage Prostat |
200,000 |
| 5856 |
Mastektomi + SLND |
35,981,000 |
| 5857 |
Mastektomi completion |
35,671,000 |
| 5858 |
Mastektomi Radikal |
5,087,253 |
| 5859 |
Mastektomi radikal klasik |
17,432,000 |
| 5860 |
Mastektomi radikal modifikasi |
21,301,000 |
| 5861 |
Mastektomi Radikal Modifikasi (Skin Sparing M, Nipple Sparing M) |
18,263,000 |
| 5862 |
Mastektomi Simple |
4,009,175 |
| 5863 |
Mastektomi simpleks |
11,855,000 |
| 5864 |
Mastektomi Simpleks |
7,350,000 |
| 5865 |
Mastektomi Subkutaneus |
4,396,100 |
| 5866 |
Mastektomi subkutaneus |
13,537,000 |
| 5867 |
Mastoidektomi modified |
18,945,000 |
| 5868 |
Mastoidektomi Radikal |
5,278,621 |
| 5869 |
Mastoidektomi Radikal dengan Penyulit |
5,850,000 |
| 5870 |
Mastoidektomi Radikal dgn Penyulit |
19,801,000 |
| 5871 |
Mastoidektomi Radikal/ Canal Wall Down |
18,945,000 |
| 5872 |
Mastoidektomi Revisi |
16,945,000 |
| 5873 |
Mastoidektomi Sederhana |
4,850,000 |
| 5874 |
Mastoidektomi Sederhana/Canal Wall Up |
11,482,000 |
| 5875 |
Mastopexy, GA |
16,331,000 |
| 5876 |
Maxilla reconstruction with plate |
15,538,000 |
| 5877 |
Maxilla reconstruction with vascularized bone graft |
15,538,000 |
| 5878 |
Maxillary Reconst,With Non Vascularized Bone Graft, GA |
16,332,000 |
| 5879 |
Maxillary Reconst,With Vascularized Bone Graft(Mikro), GA |
16,331,000 |
| 5880 |
MD (Maag Deudenum) |
500,000 |
| 5881 |
Meatatomi (ESWL) |
2,500,000 |
| 5882 |
Meatatomi (ESWL) (Sore) |
3,750,000 |
| 5883 |
Meatoplasti |
3,850,000 |
| 5884 |
Meatoplasty Lokal |
10,287,000 |
| 5885 |
Meatoplasty Narkose |
11,482,000 |
| 5886 |
Meatotomi |
3,796,000 |
| 5887 |
Meatotomi Non Operatif |
4,125,000 |
| 5888 |
Meatotomi Operatif |
11,482,000 |
| 5889 |
Meatotomy Lokal |
10,287,000 |
| 5890 |
Meatotomy Narkose |
11,482,000 |
| 5891 |
Medial branch block (Multiple) for Chronic back pain / leg pain |
12,641,000 |
| 5892 |
Medial branch block (Single) for Chronic back pain / leg pain |
11,174,000 |
| 5893 |
Medial wall and orbital floor fracture/naso orbital fracture |
11,842,000 |
| 5894 |
Mediastinoskopi |
22,350,000 |
| 5895 |
Mediastinostomi |
15,429,000 |
| 5896 |
Medikasi Saluran Akar Dengan Cresophene/CHKM (Akar Jamak) |
450,000 |
| 5897 |
Medikasi Saluran Akar Dengan Cresophene/CHKM (Akar Jamak) (Eksekutif) |
0 |
| 5898 |
Medikasi Saluran Akar Dengan Cresophene/CHKM (Akar Tunggal) |
280,000 |
| 5899 |
Medikasi Saluran Akar Dengan Cresophene/CHKM (Akar Tunggal) (Eksekutif) |
0 |
| 5900 |
Medikasi Saluran Akar Dengan Ultracal (Akar Jamak) |
620,000 |
| 5901 |
Medikasi Saluran Akar Dengan Ultracal (Akar Jamak) (Eksekutif) |
0 |
| 5902 |
Medikasi Saluran Akar Dengan Ultracal (Akar Tunggal) |
370,000 |
| 5903 |
Medikasi Saluran Akar Dengan Ultracal (Akar Tunggal) (Eksekutif) |
0 |
| 5904 |
Medikasi Saluran Akar/Ganti Obat |
0 |
| 5905 |
Mega Kolon Hierchprung |
7,827,722 |
| 5906 |
Meibografi |
283,000 |
| 5907 |
Melakukan Nekrotomi Luas, GA |
12,859,000 |
| 5908 |
Melakukan Nekrotomi Sedang, LA |
11,505,000 |
| 5909 |
Melakukan Tindakan Terapi Aktivitas Kelompok (TAK) |
300,000 |
| 5910 |
Melepas Alat Imobilisasi Eksternal |
156,000 |
| 5911 |
Memandikan Larutan PK |
135,000 |
| 5912 |
Membebaskan Perlekatan Atau Dekompresi Ganglion Atau Saraf Perifer Lain |
300,000 |
| 5913 |
Membuka / Melepas Casting |
30,000 |
| 5914 |
Mengumbah Lambung |
124,000 |
| 5915 |
Menilai Pertumbuhan |
78,000 |
| 5916 |
Menyambung/ repair pleksus |
17,384,000 |
| 5917 |
Menyambung/ repair saraf |
17,384,000 |
| 5918 |
MESA-TESA (narkose) |
13,207,000 |
| 5919 |
Message Perineum |
11,000 |
| 5920 |
Metacarpocarpal fusion |
5,596,121 |
| 5921 |
Metacarpophalangeal fusion |
5,596,121 |
| 5922 |
Metatarsophalangeal fusion |
5,476,800 |
| 5923 |
Metode dredging |
17,618,000 |
| 5924 |
Micro Curatage tanpa Anastesi |
250,000 |
| 5925 |
Micro Wave Diathemi |
39,600 |
| 5926 |
Micro Wave Diathermy (MWD) |
115,000 |
| 5927 |
Microalbumin |
0 |
| 5928 |
Microneedling 1 (lokasi terbatas di wajah) |
1,000,000 |
| 5929 |
Microneedling 2 (seluruh wajah) |
1,500,000 |
| 5930 |
Microneedling 3 (di luar wajah) |
2,000,000 |
| 5931 |
Microscopic discectomy (single) for Intervertebral disc herniation |
34,582,000 |
| 5932 |
Microtia Tahap Ii |
15,322,000 |
| 5933 |
Midfasial Degloving |
22,286,000 |
| 5934 |
Midline Glosectomy |
29,193,000 |
| 5935 |
Midtarsal fusion |
5,476,800 |
| 5936 |
Mikro Dermabrasi Diamond |
0 |
| 5937 |
Mikro Dermabrasi Kristal |
0 |
| 5938 |
Mikro Kuret Untuk Deteksi Duulasi |
198,000 |
| 5939 |
Mikroakupunktur 1 (Short; 20 menit) |
598,000 |
| 5940 |
Mikroakupunktur 2 (Moderate; 45 menit) |
670,000 |
| 5941 |
Mikroakupunktur 3 (Long; 60 menit) |
741,000 |
| 5942 |
MIKROALBUMINURIA/ ALBUMIN URIN KUANTITATIF |
256,000 |
| 5943 |
Mikrodermabrasi |
500,000 |
| 5944 |
Mikrokuretase untuk deteksi ovulasi |
360,000 |
| 5945 |
Mikrosurgen Ligasi Vena Spermatika |
7,777,000 |
| 5946 |
Mikulitz procedure |
7,810,000 |
| 5947 |
Miles Operation |
6,244,888 |
| 5948 |
Miles procedure / abdomino perineal resection |
34,409,000 |
| 5949 |
Miles/APR terbuka |
25,810,000 |
| 5950 |
Mindfulness-based therapy pada anak dan remaja |
300,000 |
| 5951 |
Mindfulness-based therapy pada dewasa |
300,000 |
| 5952 |
Mindfulness-based therapy pada lansia |
300,000 |
| 5953 |
Mini Laparotomy |
675,000 |
| 5954 |
Minimal invasive osteosynthesis image guided for Closed fracture |
9,841,000 |
| 5955 |
Minimal invasive spine surgery / endoscopic surgery lumbal |
27,360,000 |
| 5956 |
Minimal invasive spine surgery / endoscopic surgery servikal |
52,945,000 |
| 5957 |
Minimal invasive spine surgery / endoscopic surgery thorakal |
47,589,000 |
| 5958 |
Minimal/Limited PSARP |
14,027,000 |
| 5959 |
MIOGLOBIN URIN |
500,000 |
| 5960 |
Miomektomi multipel per laparotomi |
13,984,000 |
| 5961 |
Miomektomi multipel per laparotomi dengan penyulit |
17,134,000 |
| 5962 |
Miomektomi per laparoskopi dengan jahit |
17,134,000 |
| 5963 |
Miomektomi per laparoskopi dengan penyulit |
17,134,000 |
| 5964 |
Miomektomi per laparoskopi tanpa jahit |
17,134,000 |
| 5965 |
Miomektomi per laparotomi |
17,134,000 |
| 5966 |
Miomektomi simpel per laparotomi |
17,134,000 |
| 5967 |
Miomektomi transvaginal |
17,134,000 |
| 5968 |
Miotomi Krikofaring |
10,985,000 |
| 5969 |
Miotomi spasme esofagus |
8,208,000 |
| 5970 |
Miringoplasti |
4,850,000 |
| 5971 |
Miringotomi |
5,320,000 |
| 5972 |
Mitral Valve repair (MVr) |
148,602,000 |
| 5973 |
Mitrofanoff |
23,445,000 |
| 5974 |
MMK/ Sling uretra |
4,850,000 |
| 5975 |
MMPI |
0 |
| 5976 |
MMPI Umum |
212,000 |
| 5977 |
MMPI Umum ( Eksekutif ) |
0 |
| 5978 |
Mobilisasi Sendi Lainnya |
115,000 |
| 5979 |
Mobilisasi Spine |
98,000 |
| 5980 |
Mobilization Of Other Joint |
70,000 |
| 5981 |
Mobilization Of Spine |
70,000 |
| 5982 |
Mobilization under GA for Joint stiffness |
15,058,000 |
| 5983 |
Model kerja Orthodonsia |
192,000 |
| 5984 |
Model Kerja per Rahang |
192,000 |
| 5985 |
Model studi Orthodonsia |
192,000 |
| 5986 |
Moderate soket rekonstruktion (NARKOSE) |
10,506,000 |
| 5987 |
Monitor dan tatalaksana harian ventilator pasien neonatus |
720,000 |
| 5988 |
Monitor dan tatalaksana harian ventilator pasien pediatrik |
720,000 |
| 5989 |
Monitoring dan tatalaksana ECMO pasien dewasa |
778,000 |
| 5990 |
Monitoring dan tatalaksana ECMO pasien neonatus |
778,000 |
| 5991 |
Monitoring dan tatalaksana ECMO pasien pediatrik |
778,000 |
| 5992 |
Monitoring ekstra pasca anestesi |
216,000 |
| 5993 |
Monitoring End tidal CO2 Harian oleh DPJP pasien dewasa |
300,000 |
| 5994 |
Monitoring End tidal CO2 Harian oleh DPJP pasien neonatus |
300,000 |
| 5995 |
Monitoring End tidal CO2 Harian oleh DPJP pasien pediatrik |
300,000 |
| 5996 |
Monitoring harian IABP |
228,000 |
| 5997 |
Monitoring harian IABP pasien dewasa |
228,000 |
| 5998 |
Monitoring harian IABP pasien neonatus |
228,000 |
| 5999 |
Monitoring harian IABP pasien pediatrik |
228,000 |
| 6000 |
Monitoring harian SwanGanz pasien dewasa |
120,000 |
| 6001 |
Monitoring harian SwanGanz pasien neonatus |
120,000 |
| 6002 |
Monitoring harian SwanGanz pasien pediatrik |
120,000 |
| 6003 |
Monitoring Hemodinamik invasive harian oleh DPJP |
200,000 |
| 6004 |
Monitoring Hemodinamik Non Invasive Harian oleh DPJP |
200,000 |
| 6005 |
Monitoring pacu jantung transkutan pasien dewasa |
347,000 |
| 6006 |
Monitoring pacu jantung transkutan pasien neonatus |
347,000 |
| 6007 |
Monitoring pacu jantung transkutan pasien pediatrik |
347,000 |
| 6008 |
Monitoring pacu jantung transvena pasien dewasa |
347,000 |
| 6009 |
Monitoring pacu jantung transvena pasien neonatus |
347,000 |
| 6010 |
Monitoring pacu jantung transvena pasien pediatrik |
347,000 |
| 6011 |
Monitoring terapi intensif serangan asma |
586,000 |
| 6012 |
Monitoring tindakan peritoneal dialisa akut pasien dewasa |
120,000 |
| 6013 |
Monitoring tindakan peritoneal dialisa akut pasien neonatus |
120,000 |
| 6014 |
Monitoring tindakan peritoneal dialisa akut pasien pediatrik |
120,000 |
| 6015 |
Monitoring transfusi masif |
265,500 |
| 6016 |
Monitoring trombolisis intravena |
337,000 |
| 6017 |
Monti Procedure |
23,445,000 |
| 6018 |
Montou Test |
72,000 |
| 6019 |
Morfologi Sumsum Tulang |
1,461,000 |
| 6020 |
Motivational Enhancement Therapy |
250,000 |
| 6021 |
Motivational Interviewing |
250,000 |
| 6022 |
Motor Evoked Potential (MEP) dengan Transcranial Magnetic Stimulation (TMS) ekstremitas atas dan bawah. |
1,955,000 |
| 6023 |
Motor Evoked Potential (MEP) dengan Transcranial Magnetic Stimulation (TMS) ekstremitas atas. |
1,955,000 |
| 6024 |
Motor Evoked Potential (MEP) dengan Transcranial Magnetic Stimulation (TMS) ekstremitas bawah. |
1,955,000 |
| 6025 |
MPPI |
104,000 |
| 6026 |
MR Non Kontras 4D Flow Brain |
5,823,000 |
| 6027 |
MR Non Kontras 4D Flow Brain dengan anestesi |
7,104,001 |
| 6028 |
MRA Kontras Aorta Abdominalis |
7,594,000 |
| 6029 |
MRA Kontras Aorta Abdominalis dengan anestesi |
9,060,001 |
| 6030 |
MRA Kontras Aorta Lengkap (Arkus Aorta s/d Bifurkasio) |
10,254,000 |
| 6031 |
MRA Kontras Aorta Lengkap (Arkus Aorta s/d Bifurkasio) dengan anestesi |
12,233,001 |
| 6032 |
MRA Kontras Aorta Torakalis |
7,594,000 |
| 6033 |
MRA Kontras Aorta Torakalis dengan anestesi |
9,060,001 |
| 6034 |
MRA Kontras Arteri Pulmonalis |
7,594,000 |
| 6035 |
MRA Kontras Arteri Pulmonalis dengan anestesi |
9,060,001 |
| 6036 |
MRA Kontras Ekstremitas Bawah |
7,594,000 |
| 6037 |
MRA Kontras Ekstremitas Bawah dengan anestesi |
9,060,001 |
| 6038 |
MRA Kontras Extremitas Atas |
7,594,000 |
| 6039 |
MRA Kontras Extremitas Atas dengan anestesi |
9,060,001 |
| 6040 |
MRA Kontras Karotis |
7,594,000 |
| 6041 |
MRA Kontras Karotis dengan anestesi |
9,060,001 |
| 6042 |
MRA Kontras Otak |
7,594,000 |
| 6043 |
MRA Kontras Otak dengan anestesi |
9,060,001 |
| 6044 |
MRA Kontras Pelvis |
7,594,000 |
| 6045 |
MRA Kontras Pelvis dengan anestesi |
9,060,001 |
| 6046 |
MRA Kontras Spinal |
7,594,000 |
| 6047 |
MRA Kontras Spinal dengan anestesi |
9,060,001 |
| 6048 |
MRA Non Kontras Aorta Abdominalis |
7,784,000 |
| 6049 |
MRA Non Kontras Aorta Abdominalis dengan anestesi |
8,752,000 |
| 6050 |
MRA Non Kontras Aorta Lengkap (Arkus Aorta s/d Bifurkasio) |
10,121,000 |
| 6051 |
MRA Non Kontras Aorta Lengkap (Arkus Aorta s/d Bifurkasio) dengan anestesi |
11,380,000 |
| 6052 |
MRA Non Kontras Aorta Torakalis |
7,784,000 |
| 6053 |
MRA Non Kontras Aorta Torakalis dengan anestesi |
8,752,000 |
| 6054 |
MRA Non Kontras Ekstremitas Inferior |
5,720,000 |
| 6055 |
MRA Non Kontras Ekstremitas Inferior Bilateral |
6,865,000 |
| 6056 |
MRA Non Kontras Ekstremitas Inferior Bilateral dengan anestesi |
8,390,000 |
| 6057 |
MRA Non Kontras Ekstremitas Inferior dengan anestesi |
6,990,001 |
| 6058 |
MRA Non Kontras Ekstremitas Superior |
5,720,000 |
| 6059 |
MRA Non Kontras Ekstremitas Superior Bilateral |
6,865,000 |
| 6060 |
MRA Non Kontras Ekstremitas Superior Bilateral dengan anestesi |
8,390,000 |
| 6061 |
MRA Non Kontras Ekstremitas Superior dengan anestesi |
6,990,001 |
| 6062 |
MRA Non Kontras Karotis |
5,720,000 |
| 6063 |
MRA Non Kontras Karotis dengan anestesi |
6,990,001 |
| 6064 |
MRA Non Kontras Otak |
5,720,000 |
| 6065 |
MRA Non Kontras Otak dengan anestesi |
6,990,001 |
| 6066 |
MRA Non Kontras Pelvis |
7,784,000 |
| 6067 |
MRA Non Kontras Pelvis dengan anestesi |
8,752,000 |
| 6068 |
MRI Ankle Joint ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6069 |
MRI Ankle Joint (Dengan Kontras) |
5,100,000 |
| 6070 |
MRI Ankle Joint (Dengan Kontras) + Anastesi |
6,240,000 |
| 6071 |
MRI Ankle Joint (Tanpa Kontras) |
3,900,000 |
| 6072 |
MRI Ankle Joint Bilateral ( Tanpa Kontras ) + Anastesi |
6,420,000 |
| 6073 |
MRI Ankle Joint Bilateral (Dengan Kontras) |
6,300,000 |
| 6074 |
MRI Ankle Joint Bilateral (Dengan Kontras) + Anastesi |
7,550,000 |
| 6075 |
MRI Ankle Joint Bilateral (Tanpa Kontras) |
5,200,000 |
| 6076 |
MRI Arthrography |
5,996,000 |
| 6077 |
MRI Arthrography dengan anestesi |
7,295,000 |
| 6078 |
MRI Brain ( Dengan Kontras ) |
5,100,000 |
| 6079 |
MRI Brain ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6080 |
MRI Brain ( Tanpa Kontras ) |
3,900,000 |
| 6081 |
MRI Brain ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6082 |
MRI Brain + Diffusion + Perfusion + Spektroscopy |
6,300,000 |
| 6083 |
MRI Brain + Diffusion + Perfusion + Spektroscopy + Anastesi |
7,550,000 |
| 6084 |
MRI Brain + Kontras + Tractografi |
5,700,000 |
| 6085 |
MRI Brain + Kontras + Tractografi + Anastesi |
6,890,000 |
| 6086 |
MRI Brain + MRA ( Dengan Kontras ) |
1,900,000 |
| 6087 |
MRI Brain + MRA ( Dengan Kontras )(rujukan luar) |
1,900,000 |
| 6088 |
MRI Brain + MRA ( Tanpa Kontras ) |
1,500,000 |
| 6089 |
MRI Brain + MRA + Venograf + Diffusion (Tanpa Kontras) |
4,900,000 |
| 6090 |
MRI Brain + MRA + Venografi ( Dengan Kontras ) |
6,300,000 |
| 6091 |
MRI Brain + MRA + Venografi ( Dengan Kontras ) + Anastesi |
7,550,000 |
| 6092 |
MRI Brain + MRA + Venografi ( Dengan Kontras )(rujukan luar) |
1,900,000 |
| 6093 |
MRI Brain + MRA + Venografi ( Tanpa Kontras ) + Anastesi |
6,760,000 |
| 6094 |
MRI Brain + MRA + Venografi ( Tanpa Kontras )(rujukan luar) |
1,500,000 |
| 6095 |
MRI Brain + MRA + Venografi (Tanpa Kontras) |
5,500,000 |
| 6096 |
MRI Brain + MRA + Venografi + Diffusion ( Dengan Kontras ) + Anastesi |
6,350,000 |
| 6097 |
MRI Brain + MRA + Venografi + Diffusion ( Tanpa Kontras ) + Anastesi |
6,050,000 |
| 6098 |
MRI Brain + MRA + Venografi + Diffusion (Dengan Kontras) |
5,200,000 |
| 6099 |
MRI Brain + MRA Carotis (Tanpa Kontras) |
4,900,000 |
| 6100 |
MRI Brain + MRA Carotis ( Dengan Kontras ) + Anastesi |
7,440,000 |
| 6101 |
MRI Brain + MRA Carotis ( Tanpa Kontras ) + Anastesi |
6,030,000 |
| 6102 |
MRI Brain + MRA Carotis (Dengan Kontras) |
6,200,000 |
| 6103 |
MRI Cardiac ( Dengan Kontras ) + Anastesi |
7,440,000 |
| 6104 |
MRI Cardiac ( Tanpa Kontras ) + Anastesi |
5,590,000 |
| 6105 |
MRI Cardiac (Dengan Kontras) |
6,200,000 |
| 6106 |
MRI Cardiac (Tanpa Kontras) |
4,500,000 |
| 6107 |
MRI Cruris ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6108 |
MRI Cruris (Dengan Kontras) |
5,100,000 |
| 6109 |
MRI Cruris (Dengan Kontras) + Anastesi |
6,240,000 |
| 6110 |
MRI Cruris (Tanpa Kontras) |
3,900,000 |
| 6111 |
MRI Cruris Bilateral ( Tanpa Kontras ) + Anastesi |
6,420,000 |
| 6112 |
MRI Cruris Bilateral (Dengan Kontras) |
6,300,000 |
| 6113 |
MRI Cruris Bilateral (Dengan Kontras) + Anastesi |
7,550,000 |
| 6114 |
MRI Cruris Bilateral (Tanpa Kontras) |
5,200,000 |
| 6115 |
MRI Defekografi |
5,420,000 |
| 6116 |
MRI Defekografi dengan anestesi |
6,658,001 |
| 6117 |
MRI Elbow ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6118 |
MRI Elbow ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6119 |
MRI Elbow (Dengan Kontras) |
5,100,000 |
| 6120 |
MRI Elbow (Dengan Kontras)(rujukan luar) |
1,900,000 |
| 6121 |
MRI Elbow (Tanpa Kontras) |
3,900,000 |
| 6122 |
MRI Elbow (Tanpa Kontras)(rujukan luar) |
1,350,000 |
| 6123 |
MRI Elbow Bilateral ( Dengan Kontras ) + Anastesi |
7,550,000 |
| 6124 |
MRI Elbow Bilateral ( Tanpa Kontras ) + Anastesi |
6,420,000 |
| 6125 |
MRI Elbow Bilateral (Dengan Kontras) |
6,300,000 |
| 6126 |
MRI Elbow Bilateral (Tanpa Kontras) |
5,200,000 |
| 6127 |
MRI Femur ( Dengan Kontras) + Anastesi |
6,240,000 |
| 6128 |
MRI Femur ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6129 |
MRI Femur (Dengan Kontras) |
5,100,000 |
| 6130 |
MRI Femur (Tanpa Kontras) |
3,900,000 |
| 6131 |
MRI Femur Bilateral ( Tanpa Kontras ) + Anastesi |
6,420,000 |
| 6132 |
MRI Femur Bilateral (Dengan Kontras) |
6,300,000 |
| 6133 |
MRI Femur Bilateral (Dengan Kontras) + Anastesi |
7,550,000 |
| 6134 |
MRI Femur Bilateral (Tanpa Kontras) |
5,200,000 |
| 6135 |
MRI Genu ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6136 |
MRI Genu ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6137 |
MRI Genu ( Tanpa Kontras) |
3,900,000 |
| 6138 |
MRI Genu (Dengan Kontras) |
5,100,000 |
| 6139 |
MRI Genu Bilateral ( Tanpa Kontras ) + Anastesi |
6,420,000 |
| 6140 |
MRI Genu Bilateral (Dengan Kontras) |
6,300,000 |
| 6141 |
MRI Genu Bilateral (Dengan Kontras) + Anastesi |
7,550,000 |
| 6142 |
MRI Genu Bilateral (Tanpa Kontras) |
5,200,000 |
| 6143 |
MRI Ginekologis ( Dengan Kontras ) + Anastesi |
6,780,000 |
| 6144 |
MRI Ginekologis ( Tanpa Kontras ) + Anastesi |
5,590,000 |
| 6145 |
MRI Ginekologis (Dengan Kontras) |
5,600,000 |
| 6146 |
MRI Ginekologis (Tanpa Kontras) |
4,500,000 |
| 6147 |
MRI Ginekologis + Diffusion ( Dengan Kontras ) + Anastesi |
6,350,000 |
| 6148 |
MRI Ginekologis + Diffusion ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6149 |
MRI Ginekologis + Diffusion (Dengan Kontras) |
5,200,000 |
| 6150 |
MRI Ginekologis + Diffusion (Tanpa Kontras) |
3,900,000 |
| 6151 |
MRI Ginjal + Diffusion ( Dengan Kontras ) + Anastesi |
6,350,000 |
| 6152 |
MRI Ginjal + Diffusion ( Tanpa Kontras ) + Anastesi |
5,950,000 |
| 6153 |
MRI Ginjal + Diffusion (Dengan Kontras) |
5,200,000 |
| 6154 |
MRI Ginjal + Diffusion (Tanpa Kontras) |
4,800,000 |
| 6155 |
MRI Hepar Fat Fraction |
5,420,000 |
| 6156 |
MRI Hepar Fat Fraction dengan anestesi |
6,658,001 |
| 6157 |
MRI Hip Joint ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6158 |
MRI Hip Joint (Dengan Kontras) |
5,100,000 |
| 6159 |
MRI Hip Joint (Dengan Kontras) + Anastesi |
6,240,000 |
| 6160 |
MRI Hip Joint (Tanpa Kontras) |
3,900,000 |
| 6161 |
MRI Humerus ( Tanpa Kontras ) |
3,900,000 |
| 6162 |
MRI Humerus ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6163 |
MRI Humerus (Dengan Kontras) |
5,100,000 |
| 6164 |
MRI Humerus (Dengan Kontras) + Anastesi |
6,240,000 |
| 6165 |
MRI Humerus Bilateral ( Tanpa Kontras ) |
5,200,000 |
| 6166 |
MRI Humerus Bilateral ( Tanpa Kontras ) + Anastesi |
6,420,000 |
| 6167 |
MRI Humerus Bilateral (Dengan Kontras) |
6,300,000 |
| 6168 |
MRI Humerus Bilateral (Dengan Kontras) + Anastesi |
7,550,000 |
| 6169 |
MRI Kontras 4D Flow Brain |
5,825,000 |
| 6170 |
MRI Kontras 4D Flow Brain dengan anestesi |
7,106,001 |
| 6171 |
MRI Kontras Abdomen Atas |
6,917,000 |
| 6172 |
MRI Kontras Abdomen Atas + MRCP |
7,456,000 |
| 6173 |
MRI Kontras Abdomen Atas + MRCP dengan anestesi |
8,908,001 |
| 6174 |
MRI Kontras Abdomen Atas dengan anestesi |
8,312,001 |
| 6175 |
MRI Kontras Abdomen Bawah |
6,917,000 |
| 6176 |
MRI Kontras Abdomen Bawah dengan anestesi |
8,312,001 |
| 6177 |
MRI Kontras Abdomen Lengkap (Abdomen Atas + Pelvis) |
8,648,000 |
| 6178 |
MRI Kontras Abdomen Lengkap (Abdomen Atas + Pelvis) dengan anestesi |
10,392,000 |
| 6179 |
MRI Kontras Antebrachii |
5,828,000 |
| 6180 |
MRI Kontras Antebrachii Bilateral |
6,994,000 |
| 6181 |
MRI Kontras Antebrachii Bilateral dengan anestesi |
8,532,001 |
| 6182 |
MRI Kontras Antebrachii dengan anestesi |
7,109,001 |
| 6183 |
MRI Kontras Bahu |
5,828,000 |
| 6184 |
MRI Kontras Bahu Bilateral |
6,994,000 |
| 6185 |
MRI Kontras Bahu Bilateral dengan anestesi |
8,532,001 |
| 6186 |
MRI Kontras Bahu dengan anestesi |
7,109,001 |
| 6187 |
MRI Kontras Cardiac |
7,594,000 |
| 6188 |
MRI Kontras Cardiac dengan anestesi |
9,060,001 |
| 6189 |
MRI Kontras Cardiac dengan Stress Perfusion |
7,594,000 |
| 6190 |
MRI Kontras Cardiac dengan Stress Perfusion dengan anestesi |
9,060,001 |
| 6191 |
MRI Kontras Cardiac Pediatrik |
7,594,000 |
| 6192 |
MRI Kontras Cardiac Pediatrik dengan anestesi |
9,060,001 |
| 6193 |
MRI Kontras Cardiac Rest |
7,594,000 |
| 6194 |
MRI Kontras Cardiac Rest dengan anestesi |
9,060,001 |
| 6195 |
MRI Kontras Cardiac Stress Test |
7,594,000 |
| 6196 |
MRI Kontras Cardiac Stress Test dengan anestesi |
9,060,001 |
| 6197 |
MRI Kontras Cartigram + Genu |
5,828,000 |
| 6198 |
MRI Kontras Cartigram + Genu Bilateral |
6,994,000 |
| 6199 |
MRI Kontras Cartigram + Genu Bilateral dengan anestesi |
8,532,001 |
| 6200 |
MRI Kontras Cartigram + Genu dengan anestesi |
7,109,001 |
| 6201 |
MRI Kontras Clavikula |
5,828,000 |
| 6202 |
MRI Kontras Clavikula Bilateral |
6,994,000 |
| 6203 |
MRI Kontras Clavikula Bilateral dengan anestesi |
8,532,001 |
| 6204 |
MRI Kontras Clavikula dengan anestesi |
7,109,001 |
| 6205 |
MRI Kontras Cruris |
5,828,000 |
| 6206 |
MRI Kontras Cruris Bilateral |
6,994,000 |
| 6207 |
MRI Kontras Cruris Bilateral dengan anestesi |
8,532,001 |
| 6208 |
MRI Kontras Cruris dengan anestesi |
7,109,001 |
| 6209 |
MRI Kontras Cubiti |
5,828,000 |
| 6210 |
MRI Kontras Cubiti Bilateral |
6,994,000 |
| 6211 |
MRI Kontras Cubiti Bilateral dengan anestesi |
8,532,001 |
| 6212 |
MRI Kontras Cubiti dengan anestesi |
7,109,001 |
| 6213 |
MRI Kontras Cysternography |
5,825,000 |
| 6214 |
MRI Kontras Cysternography dengan anestesi |
7,106,001 |
| 6215 |
MRI Kontras Dinamik Hipofisis |
7,283,000 |
| 6216 |
MRI Kontras Dinamik Hipofisis dengan anestesi |
8,884,000 |
| 6217 |
MRI Kontras Dinamik Multifase Abdomen Atas |
6,917,000 |
| 6218 |
MRI Kontras Dinamik Multifase Abdomen Atas + MRCP |
7,456,000 |
| 6219 |
MRI Kontras Dinamik Multifase Abdomen Atas + MRCP dengan anestesi |
8,908,001 |
| 6220 |
MRI Kontras Dinamik Multifase Abdomen Atas dengan anestesi |
8,312,001 |
| 6221 |
MRI Kontras Dinamik Multiparametrik Payudara |
7,594,000 |
| 6222 |
MRI Kontras Dinamik Multiparametrik Payudara dengan anestesi |
9,060,001 |
| 6223 |
MRI Kontras Dinamik Multiparametrik Prostat |
7,456,000 |
| 6224 |
MRI Kontras Dinamik Multiparametrik Prostat dengan anestesi |
8,908,001 |
| 6225 |
MRI Kontras Enterography |
6,917,000 |
| 6226 |
MRI Kontras Enterography dengan anestesi |
8,312,001 |
| 6227 |
MRI Kontras Femur |
5,828,000 |
| 6228 |
MRI Kontras Femur Bilateral |
6,994,000 |
| 6229 |
MRI Kontras Femur Bilateral dengan anestesi |
8,532,001 |
| 6230 |
MRI Kontras Femur dengan anestesi |
7,109,001 |
| 6231 |
MRI Kontras Fistula perianal |
6,917,000 |
| 6232 |
MRI Kontras Fistula perianal dengan anestesi |
8,312,001 |
| 6233 |
MRI Kontras Genu |
5,828,000 |
| 6234 |
MRI Kontras Genu Bilateral |
6,994,000 |
| 6235 |
MRI Kontras Genu Bilateral dengan anestesi |
8,532,001 |
| 6236 |
MRI Kontras Genu dengan anestesi |
7,109,001 |
| 6237 |
MRI Kontras Hepatobiliaris Abdomen Atas |
6,917,000 |
| 6238 |
MRI Kontras Hepatobiliaris Abdomen Atas dengan anestesi |
8,312,001 |
| 6239 |
MRI Kontras Hepatobiliaris Abdomen Lengkap |
8,648,000 |
| 6240 |
MRI Kontras Hepatobiliaris Abdomen Lengkap dengan anestesi |
10,392,000 |
| 6241 |
MRI Kontras Humerus |
5,828,000 |
| 6242 |
MRI Kontras Humerus Bilateral |
6,994,000 |
| 6243 |
MRI Kontras Humerus Bilateral dengan anestesi |
8,532,001 |
| 6244 |
MRI Kontras Humerus dengan anestesi |
7,109,001 |
| 6245 |
MRI Kontras Koklea + DTI |
5,825,000 |
| 6246 |
MRI Kontras Koklea + DTI dengan anestesi |
7,106,001 |
| 6247 |
MRI Kontras Leher (Faring-Laring) |
5,825,000 |
| 6248 |
MRI Kontras Leher (Faring-Laring) dengan anestesi |
7,106,001 |
| 6249 |
MRI Kontras Leher Pleksus Brachialis |
5,828,000 |
| 6250 |
MRI Kontras Leher Pleksus Brachialis dengan anestesi |
7,109,001 |
| 6251 |
MRI Kontras Manus |
5,828,000 |
| 6252 |
MRI Kontras Manus Bilateral |
6,994,000 |
| 6253 |
MRI Kontras Manus Bilateral dengan anestesi |
8,532,001 |
| 6254 |
MRI Kontras Manus dengan anestesi |
7,109,001 |
| 6255 |
MRI Kontras Mastoid |
5,825,000 |
| 6256 |
MRI Kontras Mastoid dengan anestesi |
7,106,001 |
| 6257 |
MRI Kontras Nervus Kranial |
5,825,000 |
| 6258 |
MRI Kontras Nervus Kranial dengan anestesi |
7,106,001 |
| 6259 |
MRI Kontras Orbita |
5,825,000 |
| 6260 |
MRI Kontras Orbita dengan anestesi |
7,106,001 |
| 6261 |
MRI Kontras Otak |
5,825,000 |
| 6262 |
MRI Kontras Otak - Epilepsi |
5,825,000 |
| 6263 |
MRI Kontras Otak - Epilepsi dengan anestesi |
7,106,001 |
| 6264 |
MRI Kontras Otak - Parkinson |
5,825,000 |
| 6265 |
MRI Kontras Otak - Parkinson dengan anestesi |
7,106,001 |
| 6266 |
MRI Kontras Otak + DTI |
5,825,000 |
| 6267 |
MRI Kontras Otak + DTI dengan anestesi |
7,106,001 |
| 6268 |
MRI Kontras Otak + MRA |
7,283,000 |
| 6269 |
MRI Kontras Otak + MRA + MRV |
7,283,000 |
| 6270 |
MRI Kontras Otak + MRA + MRV dengan anestesi |
8,884,000 |
| 6271 |
MRI Kontras Otak + MRA dengan anestesi |
8,884,000 |
| 6272 |
MRI Kontras Otak + MRS |
7,283,000 |
| 6273 |
MRI Kontras Otak + MRS dengan anestesi |
8,884,000 |
| 6274 |
MRI Kontras Otak + Perfusi |
7,283,000 |
| 6275 |
MRI Kontras Otak + Perfusi dengan anestesi |
8,884,000 |
| 6276 |
MRI Kontras Otak dengan anestesi |
7,106,001 |
| 6277 |
MRI Kontras Otak Fungsional |
7,283,000 |
| 6278 |
MRI Kontras Otak Fungsional dengan anestesi |
8,884,000 |
| 6279 |
MRI Kontras Otak Navigasi |
5,825,000 |
| 6280 |
MRI Kontras Otak Navigasi dengan anestesi |
7,106,001 |
| 6281 |
MRI Kontras Pedis |
5,828,000 |
| 6282 |
MRI Kontras Pedis Bilateral |
6,994,000 |
| 6283 |
MRI Kontras Pedis Bilateral dengan anestesi |
8,532,001 |
| 6284 |
MRI Kontras Pedis dengan anestesi |
7,109,001 |
| 6285 |
MRI Kontras Pergelangan Kaki |
5,828,000 |
| 6286 |
MRI Kontras Pergelangan Kaki Bilateral |
6,994,000 |
| 6287 |
MRI Kontras Pergelangan Kaki Bilateral dengan anestesi |
8,532,001 |
| 6288 |
MRI Kontras Pergelangan Kaki dengan anestesi |
7,109,001 |
| 6289 |
MRI Kontras Pergelangan Tangan |
5,828,000 |
| 6290 |
MRI Kontras Pergelangan Tangan Bilateral |
6,994,000 |
| 6291 |
MRI Kontras Pergelangan Tangan Bilateral dengan anestesi |
8,532,001 |
| 6292 |
MRI Kontras Pergelangan Tangan dengan anestesi |
7,109,001 |
| 6293 |
MRI Kontras Sendi Panggul (hip) - 1 sendi |
5,828,000 |
| 6294 |
MRI Kontras Sendi Panggul (hip) - 1 sendi dengan anestesi |
7,109,001 |
| 6295 |
MRI Kontras Sendi Panggul bilateral (hip bilateral) |
6,994,000 |
| 6296 |
MRI Kontras Sendi Panggul bilateral (hip bilateral) dengan anestesi |
8,532,001 |
| 6297 |
MRI Kontras Sendi Sakroiliaka |
5,828,000 |
| 6298 |
MRI Kontras Sendi Sakroiliaka dengan anestesi |
7,109,001 |
| 6299 |
MRI Kontras Sinus Paranasal |
5,825,000 |
| 6300 |
MRI Kontras Sinus Paranasal dengan anestesi |
7,106,001 |
| 6301 |
MRI Kontras Spine + DTI |
5,825,000 |
| 6302 |
MRI Kontras Spine + DTI dengan anestesi |
7,106,001 |
| 6303 |
MRI Kontras Temporo Mandibula |
5,825,000 |
| 6304 |
MRI Kontras Temporo Mandibula dengan anestesi |
7,106,001 |
| 6305 |
MRI Kontras Thorax/Paru |
5,828,000 |
| 6306 |
MRI Kontras Thorax/Paru dengan anestesi |
7,109,001 |
| 6307 |
MRI Kontras Tulang Pelvis |
5,828,000 |
| 6308 |
MRI Kontras Tulang Pelvis dengan anestesi |
7,109,001 |
| 6309 |
MRI Kontras Urografi |
6,917,000 |
| 6310 |
MRI Kontras Urografi dengan anestesi |
8,312,001 |
| 6311 |
MRI Kontras Vertebra Cervikal + Thoracal |
6,994,000 |
| 6312 |
MRI Kontras Vertebra Cervikal + Thoracal dengan anestesi |
8,532,001 |
| 6313 |
MRI Kontras Vertebra Lengkap (wholespine) |
8,737,000 |
| 6314 |
MRI Kontras Vertebra Lengkap (wholespine) dengan anestesi |
10,325,001 |
| 6315 |
MRI Kontras Vertebra Lumbal |
5,828,000 |
| 6316 |
MRI Kontras Vertebra Lumbal dengan anestesi |
7,109,001 |
| 6317 |
MRI Kontras Vertebra Thoracal |
5,828,000 |
| 6318 |
MRI Kontras Vertebra Thoracal + Lumbal |
6,994,000 |
| 6319 |
MRI Kontras Vertebra Thoracal + Lumbal dengan anestesi |
8,532,001 |
| 6320 |
MRI Kontras Vertebra Thoracal dengan anestesi |
7,109,001 |
| 6321 |
MRI Kontras Vessel Wall Imaging |
5,825,000 |
| 6322 |
MRI Kontras Vessel Wall Imaging dengan anestesi |
7,106,001 |
| 6323 |
MRI Kontras Vetebra Cervikal |
5,828,000 |
| 6324 |
MRI Kontras Vetebra Cervikal dengan anestesi |
7,109,001 |
| 6325 |
MRI Leher ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6326 |
MRI Leher ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6327 |
MRI Leher (Dengan Kontras) |
5,100,000 |
| 6328 |
MRI Leher (Tanpa Kontras) |
3,900,000 |
| 6329 |
MRI Liver + Diffusion ( Dengan Kontras ) + Anastesi |
6,350,000 |
| 6330 |
MRI Liver + Diffusion ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6331 |
MRI Liver + Diffusion (Dengan Kontras) |
5,200,000 |
| 6332 |
MRI Liver + Diffusion (Tanpa Kontras) |
3,900,000 |
| 6333 |
MRI Lumbosakral ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6334 |
MRI Lumbosakral ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6335 |
MRI Lumbosakral (Dengan Kontras) |
5,100,000 |
| 6336 |
MRI Lumbosakral (Tanpa Kontras) |
3,900,000 |
| 6337 |
MRI Mamae ( Dengan Kontras ) + Anastesi |
6,780,000 |
| 6338 |
MRI Mamae ( Tanpa Kontras ) + Anastesi |
5,830,000 |
| 6339 |
MRI Mamae (Dengan Kontras) |
5,600,000 |
| 6340 |
MRI Mamae (Tanpa Kontras) |
4,700,000 |
| 6341 |
MRI Manus ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6342 |
MRI Manus ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6343 |
MRI Manus (Dengan Kontras) |
5,100,000 |
| 6344 |
MRI Manus (Tanpa Kontras) |
3,900,000 |
| 6345 |
MRI Manus Bilateral ( Dengan Kontras ) + Anastesi |
7,550,000 |
| 6346 |
MRI Manus Bilateral ( Tanpa Kontras ) + Anastesi |
6,420,000 |
| 6347 |
MRI Manus Bilateral (Dengan Kontras) |
6,300,000 |
| 6348 |
MRI Manus Bilateral (Tanpa Kontras) |
5,200,000 |
| 6349 |
MRI MRCP ( Tanpa Kontras ) + Anastesi |
6,030,000 |
| 6350 |
MRI MRCP (Dengan Kontras) |
5,300,000 |
| 6351 |
MRI MRCP (Dengan Kontras) + Anastesi |
6,460,000 |
| 6352 |
MRI MRCP (Tanpa Kontras) |
4,900,000 |
| 6353 |
MRI Nasofaring ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6354 |
MRI Nasofaring ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6355 |
MRI Nasofaring (Dengan Kontras) |
5,100,000 |
| 6356 |
MRI Nasofaring (Tanpa Kontras) |
3,900,000 |
| 6357 |
MRI Non Kontras (synthetic / DWI & FLAIR) |
4,456,000 |
| 6358 |
MRI Non Kontras (synthetic / DWI & FLAIR) + MRA |
4,456,000 |
| 6359 |
MRI Non Kontras (synthetic / DWI & FLAIR) + MRA dengan anestesi |
5,593,001 |
| 6360 |
MRI Non Kontras (synthetic / DWI & FLAIR) dengan anestesi |
5,593,001 |
| 6361 |
MRI Non Kontras Abdomen Atas |
5,420,000 |
| 6362 |
MRI Non Kontras Abdomen Atas + MRCP |
5,996,000 |
| 6363 |
MRI Non Kontras Abdomen Atas + MRCP dengan anestesi |
7,295,000 |
| 6364 |
MRI Non Kontras Abdomen Atas dengan anestesi |
6,658,001 |
| 6365 |
MRI Non Kontras Abdomen Bawah |
5,420,000 |
| 6366 |
MRI Non Kontras Abdomen Bawah dengan anestesi |
6,658,001 |
| 6367 |
MRI Non Kontras Abdomen Lengkap (Abdomen Atas + Pelvis) |
7,318,000 |
| 6368 |
MRI Non Kontras Abdomen Lengkap (Abdomen Atas + Pelvis) dengan anestesi |
8,737,001 |
| 6369 |
MRI Non Kontras Antebrachii |
4,456,000 |
| 6370 |
MRI Non Kontras Antebrachii Bilateral |
5,349,000 |
| 6371 |
MRI Non Kontras Antebrachii Bilateral dengan anestesi |
6,714,000 |
| 6372 |
MRI Non Kontras Antebrachii dengan anestesi |
5,593,001 |
| 6373 |
MRI Non Kontras Bahu |
4,456,000 |
| 6374 |
MRI Non Kontras Bahu Bilateral |
5,349,000 |
| 6375 |
MRI Non Kontras Bahu Bilateral dengan anestesi |
6,714,000 |
| 6376 |
MRI Non Kontras Bahu dengan anestesi |
5,593,001 |
| 6377 |
MRI Non Kontras Cardiac |
5,996,000 |
| 6378 |
MRI Non Kontras Cardiac dengan anestesi |
7,295,000 |
| 6379 |
MRI Non Kontras Cardiac Pediatrik |
5,996,000 |
| 6380 |
MRI Non Kontras Cardiac Pediatrik dengan anestesi |
7,295,000 |
| 6381 |
MRI Non Kontras Cardiac Rest |
5,996,000 |
| 6382 |
MRI Non Kontras Cardiac Rest dengan anestesi |
7,295,000 |
| 6383 |
MRI Non Kontras Cardiac Stress Test |
5,996,000 |
| 6384 |
MRI Non Kontras Cardiac Stress Test dengan anestesi |
7,295,000 |
| 6385 |
MRI Non Kontras Cartigram + Genu |
4,456,000 |
| 6386 |
MRI Non Kontras Cartigram + Genu Biateral |
5,349,000 |
| 6387 |
MRI Non Kontras Cartigram + Genu Biateral dengan anestesi |
6,714,000 |
| 6388 |
MRI Non Kontras Cartigram + Genu dengan anestesi |
5,593,001 |
| 6389 |
MRI Non Kontras Clavikula |
4,456,000 |
| 6390 |
MRI Non Kontras Clavikula Bilateral |
5,349,000 |
| 6391 |
MRI Non Kontras Clavikula Bilateral dengan anestesi |
6,714,000 |
| 6392 |
MRI Non Kontras Clavikula dengan anestesi |
5,593,001 |
| 6393 |
MRI Non Kontras Cruris |
4,456,000 |
| 6394 |
MRI Non Kontras Cruris Bilateral |
5,349,000 |
| 6395 |
MRI Non Kontras Cruris Bilateral dengan anestesi |
6,714,000 |
| 6396 |
MRI Non Kontras Cruris dengan anestesi |
5,593,001 |
| 6397 |
MRI Non Kontras Cubiti |
4,456,000 |
| 6398 |
MRI Non Kontras Cubiti Bilateral |
5,349,000 |
| 6399 |
MRI Non Kontras Cubiti Bilateral dengan anestesi |
6,714,000 |
| 6400 |
MRI Non Kontras Cubiti dengan anestesi |
5,593,001 |
| 6401 |
MRI Non Kontras Cysternography |
4,456,000 |
| 6402 |
MRI Non Kontras Cysternography dengan anestesi |
5,593,001 |
| 6403 |
MRI Non Kontras DTI Pleksus Lumbal |
5,823,000 |
| 6404 |
MRI Non Kontras DTI Pleksus Lumbal dengan anestesi |
7,104,001 |
| 6405 |
MRI Non Kontras DTI Plexus Brachialis |
5,823,000 |
| 6406 |
MRI Non Kontras DTI Plexus Brachialis dengan anestesi |
7,104,001 |
| 6407 |
MRI Non Kontras Enterography |
5,420,000 |
| 6408 |
MRI Non Kontras Enterography dengan anestesi |
6,658,001 |
| 6409 |
MRI Non Kontras Femur |
4,456,000 |
| 6410 |
MRI Non Kontras Femur Bilateral |
5,349,000 |
| 6411 |
MRI Non Kontras Femur Bilateral dengan anestesi |
6,714,000 |
| 6412 |
MRI Non Kontras Femur dengan anestesi |
5,593,001 |
| 6413 |
MRI Non Kontras Fetus |
5,420,000 |
| 6414 |
MRI Non Kontras Fetus dengan anestesi |
6,658,001 |
| 6415 |
MRI Non Kontras Fistula perianal |
5,420,000 |
| 6416 |
MRI Non Kontras Fistula perianal dengan anestesi |
6,658,001 |
| 6417 |
MRI Non Kontras Genu |
4,456,000 |
| 6418 |
MRI Non Kontras Genu Bilateral |
5,349,000 |
| 6419 |
MRI Non Kontras Genu Bilateral dengan anestesi |
6,714,000 |
| 6420 |
MRI Non Kontras Genu dengan anestesi |
5,593,001 |
| 6421 |
MRI Non Kontras Humerus |
4,456,000 |
| 6422 |
MRI Non Kontras Humerus Bilateral |
5,349,000 |
| 6423 |
MRI Non Kontras Humerus Bilateral dengan anestesi |
6,714,000 |
| 6424 |
MRI Non Kontras Humerus dengan anestesi |
5,593,001 |
| 6425 |
MRI Non Kontras Koklea + DTI |
4,456,000 |
| 6426 |
MRI Non Kontras Koklea + DTI dengan anestesi |
5,593,001 |
| 6427 |
MRI Non Kontras Leher (Faring-Laring) |
4,456,000 |
| 6428 |
MRI Non Kontras Leher (Faring-Laring) dengan anestesi |
5,593,001 |
| 6429 |
MRI Non Kontras Leher Pleksus Brachialis |
4,456,000 |
| 6430 |
MRI Non Kontras Leher Pleksus Brachialis dengan anestesi |
5,593,001 |
| 6431 |
MRI Non Kontras Manus |
4,456,000 |
| 6432 |
MRI Non Kontras Manus Bilateral |
5,349,000 |
| 6433 |
MRI Non Kontras Manus Bilateral dengan anestesi |
6,714,000 |
| 6434 |
MRI Non Kontras Manus dengan anestesi |
5,593,001 |
| 6435 |
MRI Non Kontras Mastoid |
4,456,000 |
| 6436 |
MRI Non Kontras Mastoid dengan anestesi |
5,593,001 |
| 6437 |
MRI Non Kontras Nervus Kranial |
4,456,000 |
| 6438 |
MRI Non Kontras Nervus Kranial dengan anestesi |
5,593,001 |
| 6439 |
MRI Non Kontras Obstetri / Plasenta |
5,420,000 |
| 6440 |
MRI Non Kontras Obstetri / Plasenta dengan anestesi |
6,658,001 |
| 6441 |
MRI Non Kontras Orbita |
4,456,000 |
| 6442 |
MRI Non Kontras Orbita dengan anestesi |
5,593,001 |
| 6443 |
MRI Non Kontras Otak |
4,456,000 |
| 6444 |
MRI Non Kontras Otak - Epilepsi |
4,456,000 |
| 6445 |
MRI Non Kontras Otak - Epilepsi dengan anestesi |
5,593,001 |
| 6446 |
MRI Non Kontras Otak - Parkinson |
4,456,000 |
| 6447 |
MRI Non Kontras Otak - Parkinson dengan anestesi |
5,593,001 |
| 6448 |
MRI Non Kontras Otak + DTI |
5,823,000 |
| 6449 |
MRI Non Kontras Otak + DTI dengan anestesi |
7,104,001 |
| 6450 |
MRI Non Kontras Otak + MRA |
4,456,000 |
| 6451 |
MRI Non Kontras Otak + MRA + MRV |
5,823,000 |
| 6452 |
MRI Non Kontras Otak + MRA + MRV dengan anestesi |
7,104,001 |
| 6453 |
MRI Non Kontras Otak + MRA dengan anestesi |
5,593,001 |
| 6454 |
MRI Non Kontras Otak + MRS |
5,823,000 |
| 6455 |
MRI Non Kontras Otak + MRS dengan anestesi |
7,104,001 |
| 6456 |
MRI Non Kontras Otak + Perfusi |
5,823,000 |
| 6457 |
MRI Non Kontras Otak + Perfusi dengan anestesi |
7,104,001 |
| 6458 |
MRI Non Kontras Otak dengan anestesi |
5,593,001 |
| 6459 |
MRI Non Kontras Otak Fungsional |
5,823,000 |
| 6460 |
MRI Non Kontras Otak Fungsional dengan anestesi |
7,104,001 |
| 6461 |
MRI Non Kontras Payudara |
5,996,000 |
| 6462 |
MRI Non Kontras Payudara dengan anestesi |
7,295,000 |
| 6463 |
MRI Non Kontras Pedis |
4,456,000 |
| 6464 |
MRI Non Kontras Pedis Bilateral |
5,349,000 |
| 6465 |
MRI Non Kontras Pedis Bilateral dengan anestesi |
6,714,000 |
| 6466 |
MRI Non Kontras Pedis dengan anestesi |
5,593,001 |
| 6467 |
MRI Non Kontras Pergelangan Kaki |
4,456,000 |
| 6468 |
MRI Non Kontras Pergelangan Kaki Bilateral |
5,349,000 |
| 6469 |
MRI Non Kontras Pergelangan Kaki Bilateral dengan anestesi |
6,714,000 |
| 6470 |
MRI Non Kontras Pergelangan Kaki dengan anestesi |
5,593,001 |
| 6471 |
MRI Non Kontras Pergelangan Tangan |
4,456,000 |
| 6472 |
MRI Non Kontras Pergelangan Tangan Bilateral |
5,349,000 |
| 6473 |
MRI Non Kontras Pergelangan Tangan Bilateral dengan anestesi |
6,714,000 |
| 6474 |
MRI Non Kontras Pergelangan Tangan dengan anestesi |
5,593,001 |
| 6475 |
MRI Non Kontras Phalang Manus |
4,456,000 |
| 6476 |
MRI Non Kontras Phalang Manus dengan anestesi |
5,593,001 |
| 6477 |
MRI Non Kontras Phalang Pedis |
4,456,000 |
| 6478 |
MRI Non Kontras Phalang Pedis dengan anestesi |
5,593,001 |
| 6479 |
MRI Non Kontras Prostat |
5,420,000 |
| 6480 |
MRI Non Kontras Prostat dengan anestesi |
6,658,001 |
| 6481 |
MRI Non Kontras Sendi Panggul (hip) - 1 sendi |
4,456,000 |
| 6482 |
MRI Non Kontras Sendi Panggul (hip) - 1 sendi dengan anestesi |
5,593,001 |
| 6483 |
MRI Non Kontras Sendi Panggul bilateral (hip bilateral) |
6,685,000 |
| 6484 |
MRI Non Kontras Sendi Panggul bilateral (hip bilateral) dengan anestesi |
8,389,999 |
| 6485 |
MRI Non Kontras Sendi Sakroiliaka |
4,456,000 |
| 6486 |
MRI Non Kontras Sendi Sakroiliaka dengan anestesi |
5,593,001 |
| 6487 |
MRI Non Kontras Sinus Pranasal |
4,456,000 |
| 6488 |
MRI Non Kontras Sinus Pranasal dengan anestesi |
5,593,001 |
| 6489 |
MRI Non Kontras Spine + DTI |
5,823,000 |
| 6490 |
MRI Non Kontras Spine + DTI dengan anestesi |
7,104,001 |
| 6491 |
MRI Non Kontras Tempora Mandibula |
4,456,000 |
| 6492 |
MRI Non Kontras Tempora Mandibula dengan anestesi |
5,593,001 |
| 6493 |
MRI Non Kontras Thorax/Paru |
4,456,000 |
| 6494 |
MRI Non Kontras Thorax/Paru dengan anestesi |
5,593,001 |
| 6495 |
MRI Non Kontras Tulang Pelvis |
4,456,000 |
| 6496 |
MRI Non Kontras Tulang Pelvis dengan anestesi |
5,593,001 |
| 6497 |
MRI Non Kontras Urografi |
5,420,000 |
| 6498 |
MRI Non Kontras Urografi dengan anestesi |
6,658,001 |
| 6499 |
MRI Non Kontras Vertebra Cervical + Thoracal |
4,456,000 |
| 6500 |
MRI Non Kontras Vertebra Cervical + Thoracal dengan anestesi |
5,593,001 |
| 6501 |
MRI Non Kontras Vertebra Lengkap (Wholespine) |
5,823,000 |
| 6502 |
MRI Non Kontras Vertebra Lengkap (Wholespine) dengan anestesi |
7,104,001 |
| 6503 |
MRI Non Kontras Vertebra Lumbal |
4,456,000 |
| 6504 |
MRI Non Kontras Vertebra Lumbal dengan anestesi |
5,593,001 |
| 6505 |
MRI Non Kontras Vertebra Thoracal |
4,456,000 |
| 6506 |
MRI Non Kontras Vertebra Thoracal + Lumbal |
5,823,000 |
| 6507 |
MRI Non Kontras Vertebra Thoracal + Lumbal dengan anestesi |
7,104,001 |
| 6508 |
MRI Non Kontras Vertebra Thoracal dengan anestesi |
5,593,001 |
| 6509 |
MRI Non Kontras Vessel Wall Imaging |
5,823,000 |
| 6510 |
MRI Non Kontras Vessel Wall Imaging dengan anestesi |
7,104,001 |
| 6511 |
MRI Non Kontras Vetebra Cervical |
4,456,000 |
| 6512 |
MRI Non Kontras Vetebra Cervical dengan anestesi |
5,593,001 |
| 6513 |
MRI Orbita ( Dengan Kontras ) + Anastesi |
6,350,000 |
| 6514 |
MRI Orbita ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6515 |
MRI Orbita (Dengan Kontras) |
5,200,000 |
| 6516 |
MRI Orbita (Tanpa Kontras) |
3,900,000 |
| 6517 |
MRI Pedis ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6518 |
MRI Pedis ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6519 |
MRI Pedis (Dengan Kontras) |
5,100,000 |
| 6520 |
MRI Pedis (Tanpa Kontras) |
3,900,000 |
| 6521 |
MRI Pedis Bilateral ( Dengan Kontras ) + Anastesi |
7,550,000 |
| 6522 |
MRI Pedis Bilateral ( Tanpa Kontras ) + Anastesi |
6,420,000 |
| 6523 |
MRI Pedis Bilateral (Dengan Kontras) |
6,300,000 |
| 6524 |
MRI Pedis Bilateral (Tanpa Kontras) |
5,200,000 |
| 6525 |
MRI Pelvis ( Dengan Kontras )(rujukan luar) |
1,900,000 |
| 6526 |
MRI Pelvis ( Tanpa Kontras ) |
4,500,000 |
| 6527 |
MRI Pelvis ( Tanpa Kontras ) + Anastesi |
5,590,000 |
| 6528 |
MRI Pelvis ( Tanpa Kontras )(rujukan luar) |
1,350,000 |
| 6529 |
MRI Pelvis (Dengan Kontras) |
5,100,000 |
| 6530 |
MRI Pelvis (Dengan Kontras) + Anastesi |
6,240,000 |
| 6531 |
MRI Plexus Brachialis ( Dengan Kontras ) + Anastesi |
6,780,000 |
| 6532 |
MRI Plexus Brachialis ( Tanpa Kontras ) + Anastesi |
5,950,000 |
| 6533 |
MRI Plexus Brachialis (Dengan Kontras) |
5,600,000 |
| 6534 |
MRI Plexus Brachialis (Tanpa Kontras) |
4,800,000 |
| 6535 |
MRI Prostat + Diffusion ( Dengan Kontras ) + Anastesi |
6,350,000 |
| 6536 |
MRI Prostat + Diffusion ( Tanpa Kontras ) + Anastesi |
5,950,000 |
| 6537 |
MRI Prostat + Diffusion (Dengan Kontras) |
5,200,000 |
| 6538 |
MRI Prostat + Diffusion (Tanpa Kontras) |
4,800,000 |
| 6539 |
MRI Prostat Dynamic Kontras + Perfusion + Diffusion |
5,700,000 |
| 6540 |
MRI Prostat Dynamic Kontras + Perfusion + Diffusion + Anastesi |
6,890,000 |
| 6541 |
MRI Sella Tursika Dynamic Kontras + Diffusion |
5,700,000 |
| 6542 |
MRI Sella Tursika Dynamic Kontras + Diffusion + Anastesi |
6,890,000 |
| 6543 |
MRI Servikal ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6544 |
MRI Servikal ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6545 |
MRI Servikal (Dengan Kontras) |
5,100,000 |
| 6546 |
MRI Servikal (Tanpa Kontras) |
3,900,000 |
| 6547 |
MRI Shoulder ( Tanpa Kontras ) |
3,900,000 |
| 6548 |
MRI Shoulder ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6549 |
MRI Shoulder (Dengan Kontras) |
5,100,000 |
| 6550 |
MRI Shoulder (Dengan Kontras) + Anastesi |
6,240,000 |
| 6551 |
MRI Shoulder Bilateral ( Tanpa Kontras ) |
5,200,000 |
| 6552 |
MRI Shoulder Bilateral ( Tanpa Kontras ) + Anastesi |
6,420,000 |
| 6553 |
MRI Shoulder Bilateral (Dengan Kontras) |
6,300,000 |
| 6554 |
MRI Shoulder Bilateral (Dengan Kontras) + Anastesi |
7,550,000 |
| 6555 |
MRI Sinus Paranasal ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6556 |
MRI Sinus Paranasal ( Tanpa Kontras ) + Anastesi |
6,220,000 |
| 6557 |
MRI Sinus Paranasal (Dengan Kontras) |
5,100,000 |
| 6558 |
MRI Sinus Paranasal (Tanpa Kontras) |
5,000,000 |
| 6559 |
MRI T2* 1 organ |
4,456,000 |
| 6560 |
MRI T2* 1 organ dengan anestesi |
5,593,001 |
| 6561 |
MRI T2* 2 organ |
5,570,000 |
| 6562 |
MRI T2* 2 organ dengan anestesi |
6,992,001 |
| 6563 |
MRI T2* 3 organ |
7,437,000 |
| 6564 |
MRI T2* 3 organ dengan anestesi |
9,089,001 |
| 6565 |
MRI T2* Hepar |
5,720,000 |
| 6566 |
MRI T2* Hepar + Jantung + Pankreas |
7,437,000 |
| 6567 |
MRI T2* Hepar + Jantung + Pankreas dengan anestesi |
9,089,001 |
| 6568 |
MRI T2* Hepar dengan anestesi |
6,990,001 |
| 6569 |
MRI T2* Hipofisis |
5,720,000 |
| 6570 |
MRI T2* Hipofisis dengan anestesi |
6,990,001 |
| 6571 |
MRI T2* Jantung |
5,720,000 |
| 6572 |
MRI T2* Jantung dengan anestesi |
6,990,001 |
| 6573 |
MRI Thoracal ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6574 |
MRI Thoracal ( Tanpa Kontras ) + Anastesi |
4,940,000 |
| 6575 |
MRI Thoracal (Dengan Kontras) |
5,100,000 |
| 6576 |
MRI Thoracal (Dengan Kontras)(rujukan luar) |
1,900,000 |
| 6577 |
MRI Thoracal (Tanpa Kontras) |
3,900,000 |
| 6578 |
MRI Thoracal (Tanpa Kontras)(rujukan luar) |
1,350,000 |
| 6579 |
MRI Thoraks ( Dengan Kontras ) + Anastesi |
6,350,000 |
| 6580 |
MRI Thoraks ( Tanpa Kontras ) + Anastesi |
6,560,000 |
| 6581 |
MRI Thoraks (Dengan Kontras) |
5,200,000 |
| 6582 |
MRI Thoraks (Tanpa Kontras) |
5,300,000 |
| 6583 |
MRI Thoraks + Diffusion ( Dengan Kontras ) + Anastesi |
6,780,000 |
| 6584 |
MRI Thoraks + Diffusion ( Tanpa Kontras ) + Anastesi |
5,950,000 |
| 6585 |
MRI Thoraks + Diffusion (Dengan Kontras) |
5,600,000 |
| 6586 |
MRI Thoraks + Diffusion (Tanpa Kontras) |
4,800,000 |
| 6587 |
MRI Total Spine ( Dengan Kontras ) + Anastesi |
7,550,000 |
| 6588 |
MRI Total Spine ( Tanpa Kontras ) + Anastesi |
6,420,000 |
| 6589 |
MRI Total Spine (Dengan Kontras) |
6,300,000 |
| 6590 |
MRI Total Spine (Tanpa Kontras) |
5,200,000 |
| 6591 |
MRI Upper Abdomen ( Tanpa Kontras ) + Anastesi |
5,830,000 |
| 6592 |
MRI Upper Abdomen (Dengan Kontras) |
5,300,000 |
| 6593 |
MRI Upper Abdomen (Dengan Kontras) + Anastesi |
6,460,000 |
| 6594 |
MRI Upper Abdomen (Tanpa Kontras) |
4,700,000 |
| 6595 |
MRI Upper Abdomen Dynamic Kontras |
5,700,000 |
| 6596 |
MRI Upper Abdomen Dynamic Kontras + Anastesi |
6,890,000 |
| 6597 |
MRI Urografi ( Tanpa Kontras ) + Anastesi |
6,030,000 |
| 6598 |
MRI Urografi (Dengan Kontras) |
5,300,000 |
| 6599 |
MRI Urografi (Dengan Kontras) + Anastesi |
6,460,000 |
| 6600 |
MRI Urografi (Tanpa Kontras) |
4,900,000 |
| 6601 |
MRI Whole Body ( Dengan Kontras ) + Anastesi |
7,440,000 |
| 6602 |
MRI Whole Body ( Tanpa Kontras ) + Anastesi |
5,590,000 |
| 6603 |
MRI Whole Body (Dengan Kontras) |
6,200,000 |
| 6604 |
MRI Whole Body (Tanpa Kontras) |
4,500,000 |
| 6605 |
MRI Whole Body DWI |
5,349,000 |
| 6606 |
MRI Whole Body DWI dengan anestesi |
6,714,000 |
| 6607 |
MSCT Ankle ( Dengan Kontras ) + Anastesi |
6,460,000 |
| 6608 |
MSCT Ankle ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6609 |
MSCT Ankle (Dengan Kontras) |
5,300,000 |
| 6610 |
MSCT Ankle (Tanpa Kontras) |
2,100,000 |
| 6611 |
MSCT Antebrachi ( Dengan Kontras ) + Anastesi |
4,720,000 |
| 6612 |
MSCT Antebrachi ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6613 |
MSCT Antebrachi (Dengan Kontras) |
3,700,000 |
| 6614 |
MSCT Antebrachi (Tanpa Kontras) |
2,100,000 |
| 6615 |
MSCT Biopsi + Film Non Kontras |
1,000,000 |
| 6616 |
MSCT Biopsi Non Kontras |
850,000 |
| 6617 |
MSCT Brain ( Dengan Kontras ) + Anastesi |
4,500,000 |
| 6618 |
MSCT Brain ( Tanpa Kontras ) + Anastesi |
2,550,000 |
| 6619 |
MSCT Brain (Dengan Kontras) |
3,500,000 |
| 6620 |
MSCT Brain (Tanpa Kontras) |
1,700,000 |
| 6621 |
MSCT Calsium Score ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6622 |
MSCT Calsium Score ( Tanpa Kontras ) + Anastesi |
2,870,000 |
| 6623 |
MSCT Calsium Score (Dengan Kontras) |
5,100,000 |
| 6624 |
MSCT Calsium Score (Tanpa Kontras) |
2,000,000 |
| 6625 |
MSCT Cerebral Carotis |
6,300,000 |
| 6626 |
MSCT Cruris ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6627 |
MSCT Cruris ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6628 |
MSCT Cruris (Dengan Kontras) |
5,100,000 |
| 6629 |
MSCT Cruris (Tanpa Kontras) |
2,100,000 |
| 6630 |
MSCT Ekstremitas (Dengan Kontras) |
2,300,000 |
| 6631 |
MSCT Ekstremitas (Non Kontras) |
1,500,000 |
| 6632 |
MSCT Ekstremitas Superior |
2,900,000 |
| 6633 |
MSCT Elbow ( Dengan Kontras ) + Anastesi |
4,720,000 |
| 6634 |
MSCT Elbow ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6635 |
MSCT Elbow (Dengan Kontras) |
3,700,000 |
| 6636 |
MSCT Elbow (Tanpa Kontras) |
2,100,000 |
| 6637 |
MSCT Elbow Bilateral ( Dengan Kontras ) + Anastesi |
4,720,000 |
| 6638 |
MSCT Elbow Bilateral ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6639 |
MSCT Elbow Bilateral (Dengan Kontras) |
3,700,000 |
| 6640 |
MSCT Elbow Bilateral (Tanpa Kontras) |
2,100,000 |
| 6641 |
MSCT Femur ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6642 |
MSCT Femur ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6643 |
MSCT Femur (Dengan Kontras) |
5,100,000 |
| 6644 |
MSCT Femur (Tanpa Kontras) |
2,100,000 |
| 6645 |
MSCT Genu ( Dengan Kontras ) + Anastesi |
7,550,000 |
| 6646 |
MSCT Genu ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6647 |
MSCT Genu (Dengan Kontras) |
6,300,000 |
| 6648 |
MSCT Genu (Tanpa Kontras) |
2,100,000 |
| 6649 |
MSCT Humerus ( Dengan Kontras ) + Anastesi |
4,720,000 |
| 6650 |
MSCT Humerus ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6651 |
MSCT Humerus (Dengan Kontras) |
3,700,000 |
| 6652 |
MSCT Humerus (Tanpa Kontras) |
2,100,000 |
| 6653 |
MSCT Kepala (Dengan Kontras) |
1,700,000 |
| 6654 |
MSCT Kepala 3 Dimensi ( Dengan Kontras ) + Anastesi |
4,720,000 |
| 6655 |
MSCT Kepala 3 Dimensi ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6656 |
MSCT Kepala 3 Dimensi (Dengan Kontras) |
3,700,000 |
| 6657 |
MSCT Kepala 3 Dimensi (Tanpa Kontras) |
2,100,000 |
| 6658 |
MSCT Laring ( Dengan Kontras ) + Anastesi |
4,610,000 |
| 6659 |
MSCT Laring ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6660 |
MSCT Laring (Dengan Kontras) |
3,600,000 |
| 6661 |
MSCT Laring (Tanpa Kontras) |
2,100,000 |
| 6662 |
MSCT Leher ( Dengan Kontras ) + Anastesi |
4,610,000 |
| 6663 |
MSCT Leher ( Tanpa Kontras ) + Anastesi |
2,550,000 |
| 6664 |
MSCT Leher (Dengan Kontras) |
3,600,000 |
| 6665 |
MSCT Leher (Tanpa Kontras) |
1,700,000 |
| 6666 |
MSCT Lower Abdomen ( Dengan Kontras ) + Anastesi |
5,040,000 |
| 6667 |
MSCT Lower Abdomen ( Tanpa Kontras ) + Anastesi |
3,090,000 |
| 6668 |
MSCT Lower Abdomen (Dengan Kontras) |
4,000,000 |
| 6669 |
MSCT Lower Abdomen (Tanpa Kontras) |
2,200,000 |
| 6670 |
MSCT Lumbosakral ( Dengan Kontras ) + Anastesi |
4,720,000 |
| 6671 |
MSCT Lumbosakral (Dengan Kontras) |
3,700,000 |
| 6672 |
MSCT Lumbosakral (Tanpa Kontras ) + Anastesi |
3,410,000 |
| 6673 |
MSCT Lumbosakral (Tanpa Kontras) |
2,500,000 |
| 6674 |
MSCT Manus ( Dengan Kontras ) + Anastesi |
4,720,000 |
| 6675 |
MSCT Manus ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6676 |
MSCT Manus (Dengan Kontras) |
3,700,000 |
| 6677 |
MSCT Manus (Tanpa Kontras) |
2,100,000 |
| 6678 |
MSCT Mastoid ( Dengan Kontras ) + Anastesi |
4,500,000 |
| 6679 |
MSCT Mastoid ( Tanpa Kontras ) + Anastesi |
2,550,000 |
| 6680 |
MSCT Mastoid (Dengan Kontras) |
3,500,000 |
| 6681 |
MSCT Mastoid (Tanpa Kontras) |
1,700,000 |
| 6682 |
MSCT Nasofaring ( Dengan Kontras ) + Anastesi |
4,500,000 |
| 6683 |
MSCT Nasofaring ( Tanpa Kontras ) + Anastesi |
2,550,000 |
| 6684 |
MSCT Nasofaring (Dengan Kontras) |
3,500,000 |
| 6685 |
MSCT Nasofaring (Tanpa Kontras) |
1,700,000 |
| 6686 |
MSCT Pedis ( Dengan Kontras ) + Anastesi |
6,460,000 |
| 6687 |
MSCT Pedis ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6688 |
MSCT Pedis (Dengan Kontras) |
5,300,000 |
| 6689 |
MSCT Pedis (Tanpa Kontras) |
2,100,000 |
| 6690 |
MSCT Pelvis ( Dengan Kontras ) + Anastesi |
4,720,000 |
| 6691 |
MSCT Pelvis ( Tanpa Kontras ) + Anastesi |
3,090,000 |
| 6692 |
MSCT Pelvis (Dengan Kontras) |
3,700,000 |
| 6693 |
MSCT Pelvis (Tanpa Kontras) |
2,200,000 |
| 6694 |
MSCT Servikal ( Dengan Kontras ) + Anastesi |
4,720,000 |
| 6695 |
MSCT Servikal ( Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6696 |
MSCT Servikal (Dengan Kontras) |
3,700,000 |
| 6697 |
MSCT Servikal (Tanpa Kontras) |
2,100,000 |
| 6698 |
MSCT Sinus (Dengan Kontras) |
1,700,000 |
| 6699 |
MSCT Sinus Paranasal ( Dengan Kontras ) + Anastesi |
4,500,000 |
| 6700 |
MSCT Sinus Paranasal (Dengan Kontras) |
3,500,000 |
| 6701 |
MSCT Sinus Paranasal (Tanpa Kontras ) + Anastesi |
2,550,000 |
| 6702 |
MSCT Sinus Paranasal (Tanpa Kontras) |
1,700,000 |
| 6703 |
MSCT Thoraco-Abdominal ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6704 |
MSCT Thoraco-Abdominal ( Tanpa Kontras ) + Anastesi |
4,500,000 |
| 6705 |
MSCT Thoraco-Abdominal (Dengan Kontras) |
5,100,000 |
| 6706 |
MSCT Thoraco-Abdominal (Tanpa Kontras) |
3,500,000 |
| 6707 |
MSCT Thorakal ( Dengan Kontras ) + Anastesi |
4,720,000 |
| 6708 |
MSCT Thorakal ( Tanpa Kontras ) + Anastesi |
3,410,000 |
| 6709 |
MSCT Thorakal (Dengan Kontras) |
3,700,000 |
| 6710 |
MSCT Thorakal (Tanpa Kontras) |
2,500,000 |
| 6711 |
MSCT Thoraks ( Dengan Kontras ) + Anastesi |
6,240,000 |
| 6712 |
MSCT Thoraks ( Tanpa Kontras ) + Anastesi |
3,200,000 |
| 6713 |
MSCT Thoraks (Dengan Kontras) |
5,100,000 |
| 6714 |
MSCT Thoraks (Tanpa Kontras) |
2,300,000 |
| 6715 |
MSCT Total Spine ( Dengan Kontras ) + Anastesi |
4,720,000 |
| 6716 |
MSCT Total Spine (Dengan Kontras) |
3,700,000 |
| 6717 |
MSCT Total Spine (Tanpa Kontras ) + Anastesi |
2,980,000 |
| 6718 |
MSCT Total Spine (Tanpa Kontras) |
2,100,000 |
| 6719 |
MSCT Tyroid ( Dengan Kontras ) + Anastesi |
4,610,000 |
| 6720 |
MSCT Tyroid ( Tanpa Kontras ) + Anastesi |
2,870,000 |
| 6721 |
MSCT Tyroid (Dengan Kontras) |
3,600,000 |
| 6722 |
MSCT Tyroid (Tanpa Kontras) |
2,000,000 |
| 6723 |
MSCT Upper Abdomen ( Dengan Kontras ) + Anastesi |
5,040,000 |
| 6724 |
MSCT Upper Abdomen ( Tanpa Kontras ) + Anastesi |
3,090,000 |
| 6725 |
MSCT Upper Abdomen (Dengan Kontras) |
4,000,000 |
| 6726 |
MSCT Upper Abdomen (Tanpa Kontras) |
2,200,000 |
| 6727 |
MSCT Virtual Colonoscopy ( Dengan Kontras ) + Anastesi |
6,460,000 |
| 6728 |
MSCT Virtual Colonoscopy ( Tanpa Kontras ) + Anastesi |
3,410,000 |
| 6729 |
MSCT Virtual Colonoscopy (Dengan Kontras) |
5,300,000 |
| 6730 |
MSCT Virtual Colonoscopy (Tanpa Kontras) |
2,500,000 |
| 6731 |
MSCT Virtual Colonoscopy Non Kontras |
1,650,000 |
| 6732 |
MSCT Whole Abdomen ( Dengan Kontras ) + Anastesi |
6,890,000 |
| 6733 |
MSCT Whole Abdomen ( Tanpa Kontras ) + Anastesi |
3,640,000 |
| 6734 |
MSCT Whole Abdomen (Dengan Kontras) |
5,700,000 |
| 6735 |
MSCT Whole Abdomen (Tanpa Kontras) |
2,700,000 |
| 6736 |
MSCTA Cerebral |
2,219,800 |
| 6737 |
MSCTA Perfusion |
1,419,800 |
| 6738 |
MSCTA Brain Perfusion |
6,300,000 |
| 6739 |
MSCTA Brain Perfusion + Anastesi |
7,550,000 |
| 6740 |
MSCTA Cardiac |
6,300,000 |
| 6741 |
MSCTA Cardiac + Anastesi |
7,550,000 |
| 6742 |
MSCTA Cardiac + Functional |
5,100,000 |
| 6743 |
MSCTA Cardiac + Functional + Anastesi |
6,240,000 |
| 6744 |
MSCTA Cerebral |
5,100,000 |
| 6745 |
MSCTA Cerebral + Anastesi |
6,240,000 |
| 6746 |
MSCTA Cerebral Carotis + Anastesi |
7,550,000 |
| 6747 |
MSCTA Dental |
6,300,000 |
| 6748 |
MSCTA Dental + Anastesi |
7,550,000 |
| 6749 |
MSCTA Dynamic 2 Phase Liver |
5,100,000 |
| 6750 |
MSCTA Dynamic 2 Phase Liver + Anastesi |
6,240,000 |
| 6751 |
MSCTA Dynamic 3 Phase Liver |
6,300,000 |
| 6752 |
MSCTA Dynamic 3 Phase Liver + Anastesi |
7,550,000 |
| 6753 |
MSCTA Ekstremitas Atas |
5,100,000 |
| 6754 |
MSCTA Ekstremitas Atas + Anastesi |
6,240,000 |
| 6755 |
MSCTA Pulmunal |
5,100,000 |
| 6756 |
MSCTA Pulmunal + Anastesi |
6,240,000 |
| 6757 |
MSCTA Renal |
5,100,000 |
| 6758 |
MSCTA Renal + Anastesi |
6,240,000 |
| 6759 |
MSCTA Run Off / Ekstremitas Inferior |
6,300,000 |
| 6760 |
MSCTA Run Off / Ekstremitas Inferior + Anastesi |
7,550,000 |
| 6761 |
MSCTA Thoracal |
6,300,000 |
| 6762 |
MSCTA Thoracal + Abdominal |
5,100,000 |
| 6763 |
MSCTA Thoracal + Abdominal + Anastesi |
6,240,000 |
| 6764 |
MSCTA Thoracal + Anastesi |
7,550,000 |
| 6765 |
MSCTA Whole Body |
5,100,000 |
| 6766 |
MSCTA Whole Body + Anastesi |
6,240,000 |
| 6767 |
Multi - Slici Scanning |
4,000,000 |
| 6768 |
Multi-Discipline surgery: Mastectomy + Rekonstruksi dinding dada |
26,038,000 |
| 6769 |
Multi-Discipline surgery: Tirioid + Sternotomi |
37,385,000 |
| 6770 |
Multi-Discipline surgery: Wide eksisi Oncoplasty + Vascular Rekonstruction |
26,038,000 |
| 6771 |
MULTIDRUG TEST SCREEN 3 PARAMETER (AMP, METH, THC) |
254,000 |
| 6772 |
MULTIDRUG TEST SCREEN 5 PARAMETER (AMP, METH, THC, MORP, BENZ) |
300,000 |
| 6773 |
MULTIDRUG TEST SCREEN 6 PARAMETER (AMP, METH, THC, MORP, BENZ, COC) |
368,000 |
| 6774 |
MULTIDRUG TEST SCREEN 7 PARAMETER (AMP, METH, THC, MORP, BENZ, COC), SOMA |
475,000 |
| 6775 |
Multipel anastomosis usus |
18,315,000 |
| 6776 |
Multiple Ekstraksi |
9,334,000 |
| 6777 |
Multiple Ekstraksi dengan General Anastesi |
6,000,000 |
| 6778 |
Muscle Plombage ( Bedah Paru/ Thorax ) |
21,102,000 |
| 6779 |
Muscle Test |
22,800 |
| 6780 |
Muscle transfer or transplantation |
11,196,000 |
| 6781 |
Muscle, Tendon, fascia or bursa injection |
1,240,000 |
| 6782 |
MVr + Closure ASD, VSD |
133,995,000 |
| 6783 |
MVR + TVR |
133,995,000 |
| 6784 |
MVr + TVr + Exterpasi Myxoma |
133,995,000 |
| 6785 |
Myelography |
500,000 |
| 6786 |
Myelography Cervical |
1,417,000 |
| 6787 |
Myelography Lumbal |
1,417,000 |
| 6788 |
Myelography Thoracal |
1,417,000 |
| 6789 |
Myocutaneus Flap/Pectoral Mayor |
5,393,089 |
| 6790 |
Myofascial triggerpoint injection |
798,000 |
| 6791 |
Myoglobin _ |
500,000 |
| 6792 |
Myomectomy |
6,083,892 |
| 6793 |
Myotomy |
9,390,000 |
| 6794 |
Myotomy of hand |
11,196,000 |
| 6795 |
Naevus Pigmatosus |
66,000 |
| 6796 |
Nasal Kanul oksigen pasien dewasa |
243,000 |
| 6797 |
Nasal Kanul oksigen pasien neonatus |
242,000 |
| 6798 |
Nasal Kanul oksigen pasien pediatrik |
243,000 |
| 6799 |
Nasalance (Komunitas) |
66,000 |
| 6800 |
Naso alveolar molding (NAM) |
1,070,000 |
| 6801 |
Naso orbital fracture with complete rhinoplasty |
11,881,000 |
| 6802 |
Naso orbital fracture with DCR |
9,465,000 |
| 6803 |
Nasoendoscopy-set |
800,000 |
| 6804 |
Nasoendoskopi dengan Fiber |
481,000 |
| 6805 |
Nasoendoskopi Dengan Fiber |
250,000 |
| 6806 |
Nasoendoskopi dengan Fiber + Anestesi |
1,109,000 |
| 6807 |
Nasoendoskopi dengan Tindakan Sederhana |
430,000 |
| 6808 |
Nasoendoskopi Rigid |
409,000 |
| 6809 |
Nasoendoskopi/Nasoendoskopi dengan Tindakan |
250,000 |
| 6810 |
Nasoendoskopilaryng Rigid |
250,000 |
| 6811 |
Nasofaring BSO Onko |
250,000 |
| 6812 |
Nasofaringoskopi |
250,000 |
| 6813 |
Nasofaringoskopi |
481,000 |
| 6814 |
Nasopharyngolaryngeal (NPL) - Endoscopy |
1,177,000 |
| 6815 |
Nasopharyngolaryngeal (NPL) - Endoscopy + Anastesi |
1,935,000 |
| 6816 |
Near total tiroidektomi |
18,522,000 |
| 6817 |
Near Total Tiroidektomi |
4,850,000 |
| 6818 |
Nebulasi/Therapi Inhalasi |
66,000 |
| 6819 |
Nebulisasi dengan chest fisioterapi |
178,000 |
| 6820 |
Nebulizer I |
175,000 |
| 6821 |
Nebulizer II |
91,000 |
| 6822 |
Necototomi (ESWL) |
2,500,000 |
| 6823 |
Necototomi (ESWL) (Sore) |
3,750,000 |
| 6824 |
Necrotomi |
125,000 |
| 6825 |
Needle crycothyrotomy |
396,000 |
| 6826 |
Needle crycothyrotomy pasien dewasa |
396,000 |
| 6827 |
Needle crycothyrotomy pasien neonatus |
396,000 |
| 6828 |
Needle crycothyrotomy pasien pediatrik |
396,000 |
| 6829 |
Needle decompression pada tension pneumotoraks |
320,000 |
| 6830 |
Needle Thoracostomy |
923,000 |
| 6831 |
Needle torakostomi |
300,000 |
| 6832 |
Needle torakostomi pasien dewasa |
300,000 |
| 6833 |
Needle torakostomi pasien neonatus |
300,000 |
| 6834 |
Needle torakostomi pasien pediatrik |
300,000 |
| 6835 |
Nefrectomi Partial |
6,122,557 |
| 6836 |
Nefrektomi Partikal / Partial |
7,567,078 |
| 6837 |
Nefreuretektomi Parsial |
10,325,221 |
| 6838 |
Nefro Ureterektomi |
10,325,221 |
| 6839 |
Nefropeksi |
15,248,000 |
| 6840 |
Nefropeksi/Renopeksi |
4,850,000 |
| 6841 |
Nefropexie |
6,928,435 |
| 6842 |
Nefrostomi |
6,928,435 |
| 6843 |
Nefrostomi Percutan |
7,525,000 |
| 6844 |
Nefrostomi Percutan (ESWL) |
2,500,000 |
| 6845 |
Nefrostomi Percutan (ESWL) (Sore) |
3,750,000 |
| 6846 |
Nefrostomi perkutan (bius) |
13,281,000 |
| 6847 |
Nefrostomi perkutan Lokal |
5,581,000 |
| 6848 |
Nefrostomi terbuka/ permanen |
11,486,000 |
| 6849 |
NefrostomiTerbuka/Permanen |
4,850,000 |
| 6850 |
Nefrostomy open/perkutan (anak) |
8,063,000 |
| 6851 |
Nefrouretectomy Tumor Wilms |
14,350,000 |
| 6852 |
Nefroureterectomy tumor wilms |
22,234,000 |
| 6853 |
Nefroureterektomi |
20,350,000 |
| 6854 |
Nefrrektomi partial/Simple nefrektomi |
20,350,000 |
| 6855 |
Nefus Sedang, xantoma Crac Revisi |
300,000 |
| 6856 |
Nefus yang diwajah |
600,000 |
| 6857 |
Nekretomi |
66,000 |
| 6858 |
Nekropsi sederhana |
2,209,000 |
| 6859 |
Nekrotomi |
324,000 |
| 6860 |
Nekrotomi dan ganti balutan |
324,000 |
| 6861 |
Nekrotomi debridement |
11,457,000 |
| 6862 |
Nekrotomi debridement besar |
6,270,000 |
| 6863 |
Nekrotomi debridement kecil |
6,270,000 |
| 6864 |
Nekrotomi dengan Anastesi Lokal |
270,000 |
| 6865 |
Nekrotomi lokal |
6,253,000 |
| 6866 |
Nekrotomi narkose |
9,968,000 |
| 6867 |
Neobladder |
25,429,000 |
| 6868 |
Nerve procedure for Brachial plexus injury |
33,285,000 |
| 6869 |
Neurektomi / Neurolise |
21,523,000 |
| 6870 |
Neurektomi Posterior bilateral |
21,523,000 |
| 6871 |
Neurektomi Posterior unilateral |
15,526,000 |
| 6872 |
Neurodevelopment Test |
100,000 |
| 6873 |
Neurofeedback - Anak |
840,000 |
| 6874 |
Neurofeedback pada anak dan remaja |
878,000 |
| 6875 |
Neurofeedback pada dewasa |
878,000 |
| 6876 |
Neurofeedback pada lansia |
878,000 |
| 6877 |
Neuroktomi Saraf Vidian |
5,482,645 |
| 6878 |
Neuroktomi/ Neurolise |
7,308,000 |
| 6879 |
Neurolisis (Kimiawi) Saraf Perifer (Fenol, Alkohol) |
503,000 |
| 6880 |
Neurolysis only for Brachial plexus injury |
33,285,000 |
| 6881 |
Neuromuscular tapping (<2.5 m) |
128,000 |
| 6882 |
Neuromuscular tapping (> 2.5 m) |
174,000 |
| 6883 |
Neuromusculoskeletal Taping |
263,000 |
| 6884 |
Neuroplasti/Anastomosis/Eksplorasi (N.Cranialis/Spinalis Perifer) |
10,803,887 |
| 6885 |
Neuroplasti/Anastomosis/Eksplorasi (Plexus Brakhialis/Lumbalis Sacralis) |
13,351,887 |
| 6886 |
Neuroplasty/Anastomosis/Explorasi Bedah mikro Bedah Konvensional |
27,942,000 |
| 6887 |
Neuroplasty/Anastomosis/Explorasi Bedah mikro N.Cranialis/Spinalis Perifer |
52,654,000 |
| 6888 |
Neuroplasty/Anastomosis/Explorasi Bedah mikro Plexus Brachialis/LbSacralis |
17,384,000 |
| 6889 |
Night Care |
225,000 |
| 6890 |
Nipple Areola Complex Reconstruction, LA |
22,442,000 |
| 6891 |
Nitrogen Cair |
66,000 |
| 6892 |
NMES (Neuromuscular Electrical Stimulation) |
275,000 |
| 6893 |
NO - Funduskopi |
226,000 |
| 6894 |
Non-Invasive Ventilation (Per Hari) |
2,000,000 |
| 6895 |
Nonexcisional debridement of wound, infection, or burn |
2,350,000 |
| 6896 |
Nonoperative removal of therapeutic device from head and neck |
4,375,000 |
| 6897 |
NOT Pemeriksaan Vertigo |
351,000 |
| 6898 |
Novel treatment subkutan tidak termasuk obat |
494,000 |
| 6899 |
NRM oksigen pasien dewasa |
242,000 |
| 6900 |
NRM oksigen pasien pediatrik |
242,000 |
| 6901 |
NT- PROBNP |
899,000 |
| 6902 |
Nt-proBNP |
800,000 |
| 6903 |
OAE (Oto Acoustik Emission) |
200,000 |
| 6904 |
OAE dengan Sedasi |
281,000 |
| 6905 |
Obliterasi mastoid/penutupan fistel mastoid |
16,945,000 |
| 6906 |
Observasi (dr. Obs ) |
23,000 |
| 6907 |
Observasi Kecerdasan (Komunitas) |
66,000 |
| 6908 |
Obturasi (Pengisian Saluran Akar) Gigi Anterior (Akar Tunggal) |
0 |
| 6909 |
Obturasi (Pengisian Saluran Akar) Gigi Posterior (Akar Jamak) |
0 |
| 6910 |
Obturasi Atau Pengisian Saluran Akar (Akar Jamak) |
1,200,000 |
| 6911 |
Obturasi Atau Pengisian Saluran Akar (Akar Jamak) (Eksekutif) |
0 |
| 6912 |
Obturasi Atau Pengisian Saluran Akar (Akar Tunggal) |
760,000 |
| 6913 |
Obturasi Atau Pengisian Saluran Akar (Akar Tunggal) (Eksekutif) |
0 |
| 6914 |
Obturator |
2,510,000 |
| 6915 |
Obturator + gigi |
4,068,000 |
| 6916 |
Obturator Bootle Feeding pada bayi |
1,692,000 |
| 6917 |
Obturator Intermediate |
1,400,000 |
| 6918 |
Obturator Sementara |
500,000 |
| 6919 |
Obturator/ hotzplate/ oklusal splint |
13,148,000 |
| 6920 |
Occipital Nerve Injection (Local anesthetics) |
798,000 |
| 6921 |
Occipital Nerve Injection (steroids) |
449,000 |
| 6922 |
Occipitocervical fusion |
32,404,000 |
| 6923 |
OCT Scan Anterior Segment |
654,000 |
| 6924 |
OCT Scan Posterior Segment |
654,000 |
| 6925 |
ODC Paket A |
3,182,000 |
| 6926 |
ODC Paket B |
4,250,000 |
| 6927 |
ODC Paket C |
8,150,000 |
| 6928 |
ODC Umum ( > 6 jam ) |
156,000 |
| 6929 |
Odentectomy > 2 elemen dengan narkose |
2,725,000 |
| 6930 |
Odontectomy Berat Per Gigi |
2,436,000 |
| 6931 |
Odontectomy Lebih dari 2 elemen |
2,880,000 |
| 6932 |
Odontectomy Ringan Per Gigi |
1,491,000 |
| 6933 |
Odontectomy Sedang Per Gigi |
1,993,000 |
| 6934 |
Odontektomi dengan Anastesi Lokal |
1,000,000 |
| 6935 |
Odontektomi dengan General Anastesi |
9,334,000 |
| 6936 |
Odontektomi M3 IMP Kls I |
1,491,000 |
| 6937 |
Odontektomi M3 IMP Kls II |
1,993,000 |
| 6938 |
Odontektomi M3 IMP Kls III |
2,436,000 |
| 6939 |
Odontektomi palatal per gigi |
8,821,000 |
| 6940 |
Oesophagigrafi |
400,000 |
| 6941 |
Oesophago Maag Duodenum (OMD) |
1,289,000 |
| 6942 |
Oklusi tuba anestesi lokal per laparoskopi (LOTAL) |
2,478,000 |
| 6943 |
Omentektomi infrakolik |
19,523,000 |
| 6944 |
Omentektomi infrakolik per laparoskopi |
21,422,000 |
| 6945 |
Omentektomi infrakolik per robotic assisted laparoscopy |
42,750,000 |
| 6946 |
Omentektomi suprakolik |
21,422,000 |
| 6947 |
Omentektomi suprakolik per laparoskopi |
22,372,000 |
| 6948 |
Omentumpexi ( Bedah Paru / Thorax ) |
21,102,000 |
| 6949 |
Onestage Labiopalatopalsty |
18,511,000 |
| 6950 |
Onlay Full Porcelain (belum termasuk laboratorium) |
4,655,000 |
| 6951 |
Ooforektomi bilateral pada kasus keganasan per laparoskopi |
20,565,000 |
| 6952 |
Ooforektomi bilateral pada kasus keganasan per laparoskopi dengan penyulit |
25,708,000 |
| 6953 |
Ooforektomi bilateral pada kasus keganasan per laparotomi |
16,454,000 |
| 6954 |
Ooforektomi bilateral pada kasus keganasan per laparotomi dengan penyulit |
20,572,000 |
| 6955 |
Ooforektomi bilateral per laparoskopi |
17,343,000 |
| 6956 |
Ooforektomi bilateral per laparoskopi dengan penyulit |
21,682,001 |
| 6957 |
Ooforektomi bilateral per laparotomi |
14,288,000 |
| 6958 |
Ooforektomi per laparoskopi |
14,773,000 |
| 6959 |
Ooforektomi unilateral pada kasus keganasan per laparoskopi |
13,709,000 |
| 6960 |
Ooforektomi unilateral pada kasus keganasan per laparoskopi dengan penyulit |
17,138,001 |
| 6961 |
Ooforektomi unilateral pada kasus keganasan per laparotomi |
10,969,000 |
| 6962 |
Ooforektomi unilateral pada kasus keganasan per laparotomi dengan penyulit |
13,714,000 |
| 6963 |
Open / closed reduction with internal fixation for Other pathological fracture (except malignancy) |
23,646,000 |
| 6964 |
Open / mini open reconstruction for Rotator cuff injury |
23,913,000 |
| 6965 |
Open achilles tendon lengthening (single) for CTEV |
15,058,000 |
| 6966 |
Open arthrotomy & debridement for Joint infection (acute) |
17,616,000 |
| 6967 |
Open arthrotomy. debridement & joint release for Joint infection (chronic) |
33,975,000 |
| 6968 |
Open Biopsy of extremity |
11,306,000 |
| 6969 |
Open chest exploration/rescucitation/tamponade release dengan CPB |
112,316,000 |
| 6970 |
Open chest exploration/rescucitation/tamponade release tanpa CPB |
51,733,000 |
| 6971 |
Open coil spring (1 Gigi) |
50,000 |
| 6972 |
Open coil spring (2 s/d 4 Gigi) |
150,000 |
| 6973 |
Open discectomy (Multiple) for Intervertebral disc herniation |
34,119,000 |
| 6974 |
Open discectomy (single) for Intervertebral disc herniation |
32,889,000 |
| 6975 |
Open ligament reconstruction for AC joint instability |
23,914,000 |
| 6976 |
Open ligament reconstruction for ATFL / Deltoid injury |
23,914,000 |
| 6977 |
Open ligament reconstruction for elbow instability |
23,914,000 |
| 6978 |
Open ligament reconstruction for MCL / LCL injury |
23,914,000 |
| 6979 |
Open Radikal Nefrektomi |
20,124,000 |
| 6980 |
Open reconstruction of Distal radioulnar joint/DRUJ |
23,914,000 |
| 6981 |
Open reduction & ligament reconstruction for Neglected joint dislocation |
23,914,000 |
| 6982 |
Open reduction and fixation for Neglected joint dislocation |
23,914,000 |
| 6983 |
Open reduction and internal fixation for SCFE |
23,728,000 |
| 6984 |
Open Reduction and soft tissue procedure for DDH |
23,728,000 |
| 6985 |
Open reduction dan stabilisation of spinal Fracture |
4,850,000 |
| 6986 |
Open reduction for Vertebral fracture / dislocation with stabilization/fusion |
36,895,000 |
| 6987 |
Open reduction of dislocation of ankle |
22,971,664 |
| 6988 |
Open reduction of dislocation of elbow |
11,203,072 |
| 6989 |
Open reduction of dislocation of foot and toe |
8,831,664 |
| 6990 |
Open reduction of dislocation of hip |
9,133,709 |
| 6991 |
Open reduction of dislocation of knee |
22,938,709 |
| 6992 |
Open reduction of dislocation of shoulder |
9,238,709 |
| 6993 |
Open reduction of dislocation of wrist |
8,521,664 |
| 6994 |
Open reduction of fracture of other specified bone, except facial bones, with internal fixation |
4,835,044 |
| 6995 |
Open reduction of fracture with internal fixation, carpals and metacarpals |
4,835,044 |
| 6996 |
Open reduction of fracture with internal fixation, femur |
7,090,400 |
| 6997 |
Open reduction of fracture with internal fixation, humerus |
3,405,196 |
| 6998 |
Open reduction of fracture with internal fixation, other specified bone |
4,835,044 |
| 6999 |
Open reduction of fracture with internal fixation, phalanges of foot |
9,351,000 |
| 7000 |
Open reduction of fracture with internal fixation, phalanges of hand |
4,835,044 |
| 7001 |
Open reduction of fracture with internal fixation, radius and ulna |
5,611,121 |
| 7002 |
Open reduction of fracture with internal fixation, tarsals and metatarsals |
7,090,400 |
| 7003 |
Open reduction of fracture with internal fixation, tibia and fibula |
18,115,044 |
| 7004 |
Open reduction of separated epiphysis of femur |
4,515,044 |
| 7005 |
Open reduction of separated epiphysis of humerus |
9,351,000 |
| 7006 |
Open reduction of separated epiphysis of radius and ulna |
9,351,000 |
| 7007 |
Open reduction of separated epiphysis of tibia and fibula |
9,351,000 |
| 7008 |
Open Reduction With Implant And Septoplasty, LA |
19,913,000 |
| 7009 |
Open reduction with soft tissue and bone procedure for DDH |
23,728,000 |
| 7010 |
Open Reduction With Wire/Titanium Implant, GA |
26,912,000 |
| 7011 |
Open Renal Biopsi |
5,352,084 |
| 7012 |
Open repair aneurisma aortoiliaka kompleks dengan graft |
13,327,000 |
| 7013 |
Open repair aneurisma aortoiliaka sederhana dengan graft |
8,884,000 |
| 7014 |
Open Septorhinoplasty |
10,390,000 |
| 7015 |
Open Synovectomy |
17,616,000 |
| 7016 |
Operasi ASD (Eksekutif) |
0 |
| 7017 |
Operasi Commando |
6,350,000 |
| 7018 |
Operasi Commando |
24,639,000 |
| 7019 |
Operasi endoskopik kompleks 1 |
21,960,000 |
| 7020 |
Operasi endoskopik kompleks 2 |
21,960,000 |
| 7021 |
Operasi Gigi Berat |
26,630,000 |
| 7022 |
Operasi Gigi Ringan |
16,090,000 |
| 7023 |
Operasi Gigi Sedang |
21,320,000 |
| 7024 |
Operasi Hernia dengan Komplikasi |
6,595,462 |
| 7025 |
Operasi Hernia Dengan Komplikasi (Hernia Incarcerata) |
7,350,000 |
| 7026 |
Operasi Hernia tanpa Komplikasi |
6,599,674 |
| 7027 |
Operasi Hirschsprung Dewasa + rekonstruksi |
18,315,000 |
| 7028 |
Operasi Hydrokel |
6,588,140 |
| 7029 |
Operasi Hypospadia/Kordectomy |
8,183,889 |
| 7030 |
Operasi Jantung Terbuka Dengan Pacu Jantung Temporer/Penutupan PDA Tanpa Pembedahan dengan menggunakan Device ADO/Plug Ocluder/PDA+PA Banding/Corangiography + IABP (Intra Aortic Ballon Pump) |
25,950,000 |
| 7031 |
Operasi Jantung Terbuka dengan Pacu Jantung Temporer/TOF |
53,295,000 |
| 7032 |
Operasi Jantung Terbuka Dengan satu Katup dan Pacu Jantung Temporer / TOF+MOF |
57,950,000 |
| 7033 |
Operasi Jantung Terbuka dua Katup |
91,711,314 |
| 7034 |
Operasi Jantung Terbuka satu Katup |
73,450,000 |
| 7035 |
Operasi Jantung Terbuka Standar/ASD |
53,295,000 |
| 7036 |
Operasi Jantung Terbuka Standar/VSD/ASD Closure+Reseksi Infudibulum + Transanular Patch/Repair Left Ventricle Out Flow Track + VSD Closure |
29,240,000 |
| 7037 |
Operasi Jantung Tertutup/PDA |
37,705,000 |
| 7038 |
Operasi Kasai |
17,350,000 |
| 7039 |
Operasi katup jantung dua katup |
186,527,000 |
| 7040 |
Operasi katup jantung dua katup reoperatif/redo |
186,527,000 |
| 7041 |
Operasi katup jantung satu katup |
144,180,000 |
| 7042 |
Operasi katup jantung satu katup reoperatif/redo |
144,180,000 |
| 7043 |
Operasi katup jantung tiga katup |
206,793,000 |
| 7044 |
Operasi katup jantung tiga katup reoperatif/redo |
206,793,000 |
| 7045 |
Operasi klitoris |
17,623,000 |
| 7046 |
Operasi Konvensional plexus Brakhialias /Lumbalis / Sacralis / Cranialis / Spinalis perifer |
9,392,000 |
| 7047 |
Operasi Koreksi Stress Incontinence |
19,671,000 |
| 7048 |
Operasi Laringcopi biopsi |
4,375,000 |
| 7049 |
Operasi Manchester Fortegil |
6,115,000 |
| 7050 |
Operasi micro Plexus Brakhialis /Lumbalis Sacralis |
11,941,616 |
| 7051 |
Operasi Mikrotia |
6,821,000 |
| 7052 |
Operasi pada pericardium tanpa CPB |
37,385,000 |
| 7053 |
Operasi pada tumor/vegetasi intrakardiak |
144,180,000 |
| 7054 |
Operasi pada tumor/vegetasi intrakardiak + Operasi katup jantung dua katup |
203,921,001 |
| 7055 |
Operasi pada tumor/vegetasi intrakardiak + Operasi katup jantung satu katup |
193,150,000 |
| 7056 |
Operasi Pasang Kateter Tenckhoff untuk CAPD |
3,850,000 |
| 7057 |
Operasi Perineum |
6,073,000 |
| 7058 |
Operasi Peyronie |
6,928,435 |
| 7059 |
Operasi priapismus (prosedur winter) |
3,850,000 |
| 7060 |
Operasi Prosthesis Penis |
23,260,000 |
| 7061 |
Operasi Rekonstruksi : Genitalia Eksterna Dan Sekitarnya, GA |
18,019,000 |
| 7062 |
Operasi Rekonstruksi : Hidung, GA |
17,778,000 |
| 7063 |
Operasi Rekonstruksi : Hidung, LA |
15,578,000 |
| 7064 |
Operasi Rekonstruksi : Palpebra, GA |
17,778,000 |
| 7065 |
Operasi Rekonstruksi : Palpebra, LA |
13,473,000 |
| 7066 |
Operasi Rekonstruksi : Payudara Dan Sekitarnya, GA |
17,778,000 |
| 7067 |
Operasi Rekonstruksi : Tangan Dan Jari Jari, GA |
14,225,000 |
| 7068 |
Operasi Rekonstruksi : Tangan Dan Jari Jari, LA |
12,465,000 |
| 7069 |
Operasi Rekonstruksi : Telinga, GA |
17,778,000 |
| 7070 |
Operasi Rekonstruksi : Telinga, LA |
13,823,000 |
| 7071 |
Operasi Rekonstruksi : Wajah, GA |
17,778,000 |
| 7072 |
Operasi Rekonstruksi : Wajah, LA |
13,473,000 |
| 7073 |
Operasi Repair Bull Trauma |
4,850,000 |
| 7074 |
Operasi Sistokel |
19,863,000 |
| 7075 |
Operasi Skin Flap Yang Lain Yang Lebih Komplek, GA |
16,331,000 |
| 7076 |
Operasi Skin Flap Yang Lain Yang Lebih Komplek, LA |
14,707,000 |
| 7077 |
Operasi Spinal deformity (Skoliosis, kifosis, kifoskoliosis, lordosis) reallignment, dekompresi dan fusi |
37,385,000 |
| 7078 |
Operasi Tuba Eustachius |
7,653,000 |
| 7079 |
Operasi Tumor Ganas Ovarium |
6,526,000 |
| 7080 |
Operasi Tumor Jinak Ovarium |
6,073,000 |
| 7081 |
Operasi Tumor Pembuluh Darah |
4,850,000 |
| 7082 |
Operasi Tumor Spinal Daerah Kraniospinal |
13,194,095 |
| 7083 |
Operasi uroginekologi lain |
16,754,000 |
| 7084 |
Operasi Usus (Duhamel) |
6,509,511 |
| 7085 |
Operasi Vaskuler Tehnik Operasi Khusus |
4,884,949 |
| 7086 |
Operasi VSD (Eksekutif) |
0 |
| 7087 |
Operculectomy |
8,614,000 |
| 7088 |
Operculectomy Per Regio |
997,000 |
| 7089 |
Operkulektomi |
997,000 |
| 7090 |
Operkulektomi dengan Anastesi Lokal |
270,000 |
| 7091 |
Ophorektomi Bilateral (Onkology) |
3,939,234 |
| 7092 |
Opponens plasty for Thumb Paralysis |
23,728,000 |
| 7093 |
Ops, Rekonstruksi : Defek/ Kelainan Muka, GA |
16,331,000 |
| 7094 |
Ops, Rekonstruksi : Defek/ Kelainan Muka, LA |
14,707,000 |
| 7095 |
Ops,Rek, : Defek/Kelainan Tubuh Yang Lain, GA |
16,331,000 |
| 7096 |
Ops,Rek, : Defek/Kelainan Tubuh Yang Lain, LA |
14,707,000 |
| 7097 |
Optical Coherence Tomography |
600,000 |
| 7098 |
Oral Diagnosa |
0 |
| 7099 |
Oral Hygiene |
20,000 |
| 7100 |
Oral hygiene di ICU/HCU/ICCU pasien dewasa |
20,000 |
| 7101 |
Oral hygiene di pasien pediatrik |
20,000 |
| 7102 |
Oral prep / mouth prep pada pasien Komorbid medis berat |
6,380,000 |
| 7103 |
Oral preparasi besar pd psn behavior disorders |
14,287,000 |
| 7104 |
Oral preparasi kecil pd pasien dgn behavior disorders |
7,326,000 |
| 7105 |
Orbiotomi Anterior |
4,850,000 |
| 7106 |
Orbital Bone And Eye Socket Reconstruction, GA |
22,616,000 |
| 7107 |
orbital floor fracture |
9,158,000 |
| 7108 |
Orbitotomi Anterior |
8,135,000 |
| 7109 |
Orbitotomi anterior dan eksisi tumor kompleks |
8,498,000 |
| 7110 |
Orbitotomi anterior dan ekstirpasi tumor |
8,498,000 |
| 7111 |
Orbitotomi Lateral |
6,830,745 |
| 7112 |
Orbitotomi lateral dan eksisi tumor |
9,510,000 |
| 7113 |
Orbitotomi lateral dan eksisi tumor kompleks |
9,995,000 |
| 7114 |
Orchidectomy pada anak |
4,966,754 |
| 7115 |
Orchidectomy/Orchidopexy Unilateral |
7,165,911 |
| 7116 |
Orchidektomi Ligasi Tinggi |
6,869,778 |
| 7117 |
Orchidektomi ligasi tinggi/ hernia ligasi tinggi |
9,176,000 |
| 7118 |
Orchidektomi local |
7,871,000 |
| 7119 |
Orchidektomi narkose |
9,176,000 |
| 7120 |
Orchidektomi Subkapsuler |
5,137,089 |
| 7121 |
Orchidektomi/orchidektomi subkapsuler |
3,850,000 |
| 7122 |
Orchidopexi |
7,165,911 |
| 7123 |
Orchidopexy bilateral |
9,176,000 |
| 7124 |
Orchidopexy lokal |
7,871,000 |
| 7125 |
Orchidopexy narkose |
9,176,000 |
| 7126 |
ORIF (Single) for Bone / Soft tissue tumor with pathological fracture |
16,232,000 |
| 7127 |
ORIF / Minimal invasive osteosyntesis with image guided for Complex fracture of irregular bone (scapula/pelvis/ sacrum/acetabulum) |
23,914,000 |
| 7128 |
ORIF / Minimal invasive osteosyntesis with image guided for Simple fracture of irregular bone (scapula/pelvis/ sacrum/acetabulum) |
16,659,000 |
| 7129 |
ORIF & Bone graft for Non union / bone defect / Pseudoarthrosis |
15,403,000 |
| 7130 |
Orif + Orbital Wall Reconstruction Dengan Ribs Bone Graft, GA |
22,616,000 |
| 7131 |
Orif + Orbital Wall Reconstruction Dengan Silicon Plate, GA |
28,440,000 |
| 7132 |
Orif + Titanium Mini Plate Approach Ektra Oral 1 Sisi, GA |
28,440,000 |
| 7133 |
Orif + Titanium Mini Plate Approach Ektra Oral 2 Sisi, GA |
34,132,000 |
| 7134 |
ORIF AC Joint dislocation |
23,532,000 |
| 7135 |
ORIF Clavicle fracture |
23,532,000 |
| 7136 |
Orif Dengan 1 Approach |
12,433,000 |
| 7137 |
Orif Dengan 2 Approach |
15,538,000 |
| 7138 |
Orif Dengan 3 Approach |
15,538,000 |
| 7139 |
ORIF dengan bucco-ginggival Approach |
15,538,000 |
| 7140 |
Orif Dengan Ginggivo-Bucal Approach, GA |
28,440,000 |
| 7141 |
Orif Dengan Infraciliar Approach, GA |
28,440,000 |
| 7142 |
Orif Dengan Transconjunctival Approach, GA |
28,440,000 |
| 7143 |
ORIF for Closed intra articular fracture |
16,659,000 |
| 7144 |
ORIF for Complex small bone fracture or dislocation of foot |
23,532,000 |
| 7145 |
ORIF for Complex small bone fracture or dislocation of Foot & Ankle |
23,532,000 |
| 7146 |
ORIF for Complex small bone fracture or dislocation of Hand |
23,914,000 |
| 7147 |
ORIF for Complex small bone fracture or dislocation of Wrist & Hand |
23,914,000 |
| 7148 |
ORIF for Periprosthetic Fracture |
23,914,000 |
| 7149 |
ORIF for Salter Harris fracture |
23,728,000 |
| 7150 |
ORIF fraktur angulus mandibula |
15,538,000 |
| 7151 |
ORIF fraktur bilateral kondilus mandibula |
15,538,000 |
| 7152 |
ORIF fraktur blow out/ blow orbita |
15,538,000 |
| 7153 |
ORIF fraktur maksila lefort I |
15,538,000 |
| 7154 |
ORIF fraktur maksila Lefort II |
15,538,000 |
| 7155 |
ORIF Fraktur maksila Lefort III |
15,538,000 |
| 7156 |
ORIF fraktur maksila multiple |
15,538,000 |
| 7157 |
ORIF Fraktur mandibula multiple |
15,538,000 |
| 7158 |
ORIF Fraktur Panfasial |
15,538,000 |
| 7159 |
Orif Fraktur Parasimfisis Mandibula |
28,440,000 |
| 7160 |
ORIF fraktur ramus mandibula |
15,538,000 |
| 7161 |
ORIF fraktur symphisis mandibula |
15,538,000 |
| 7162 |
ORIF Fraktur unilateral maksila / zygoma/orbita |
15,538,000 |
| 7163 |
ORIF Fraktur Unilateral TMJ/ kondilus |
15,538,000 |
| 7164 |
ORIF Fraktur wajah multiple |
15,538,000 |
| 7165 |
ORIF Humerus - Intercondyler |
23,728,000 |
| 7166 |
ORIF Humerus - Proximal/supracondyler |
23,728,000 |
| 7167 |
ORIF Humerus - Shaft - plate |
23,728,000 |
| 7168 |
ORIF Olecranon - Plate and screw/shortening |
23,728,000 |
| 7169 |
ORIF Olecranon - Tension band wiring |
23,532,000 |
| 7170 |
Orif Pan Facial Fractur |
28,440,000 |
| 7171 |
ORIF Proximal Radius including radial head |
23,533,000 |
| 7172 |
ORIF Radius and/or Ulna |
23,349,000 |
| 7173 |
ORIF SC dislocation |
24,597,000 |
| 7174 |
Orif Untuk Fraktur Le Fort I, GA |
28,440,000 |
| 7175 |
Orif Untuk Fraktur Le Fort Ii, GA |
16,659,000 |
| 7176 |
Orif Untuk Fraktur Le Fort Iii Bicoronal Approach, GA |
18,327,000 |
| 7177 |
Orif Untuk Fraktur Le Fort Iii, GA |
16,659,000 |
| 7178 |
ORIF/CRIF Distal femur fracture |
23,728,000 |
| 7179 |
ORIF/CRIF distal tibia fracture |
23,728,000 |
| 7180 |
ORIF/CRIF Femoral neck fracture |
23,728,000 |
| 7181 |
ORIF/CRIF Femoral shaft fracture |
23,728,000 |
| 7182 |
ORIF/CRIF for pediatric femoral shaft fracture |
23,728,000 |
| 7183 |
ORIF/CRIF for pediatric humerus fracture |
23,728,000 |
| 7184 |
ORIF/CRIF for pediatric radius and/or ulna fracture |
23,349,000 |
| 7185 |
ORIF/CRIF for pediatric supracondyler humerus fracture |
23,728,000 |
| 7186 |
ORIF/CRIF for pediatric tibia shaft fracture |
23,728,000 |
| 7187 |
ORIF/CRIF Intertrochanter fracture |
23,728,000 |
| 7188 |
ORIF/CRIF Proximal tibia fracture |
23,728,000 |
| 7189 |
ORIF/CRIF Subtrochanter fracture |
23,728,000 |
| 7190 |
ORIF/CRIF tibia shaft fracture |
23,728,000 |
| 7191 |
ORIF/CRPP for pediatric lateral condyle fracture |
23,728,000 |
| 7192 |
ORIF/MIPO for Closed shaft fracture of long bone |
23,728,000 |
| 7193 |
Orkhidektomi extended |
4,850,000 |
| 7194 |
Orkhidopeksi Per Laparaskopi |
6,478,211 |
| 7195 |
Orthodentic Fixed (Ceramic Bracket) Control Orthodentic |
0 |
| 7196 |
Orthodentic Fixed (Ceramic Bracket) Rahang Atas / Rahang Bawah |
0 |
| 7197 |
Orthodentic Fixed (Ceramic Bracket) Rahang Atas + Rahang Bawah |
0 |
| 7198 |
Orthodentic Fixed (Control Orthodontik) |
56,000 |
| 7199 |
Orthodentic Fixed (Metal Bracket) Control Orthodentic |
0 |
| 7200 |
Orthodentic Fixed (Metal Bracket) Rahang Atas / Rahang Bawah |
0 |
| 7201 |
Orthodentic Fixed (Metal Bracket) Rahang Atas + Rahang Bawah |
0 |
| 7202 |
Orthodontik Fixed (Rahang atas / bawah) |
3,478,000 |
| 7203 |
Orthodontik Fixed (Rahang atas + bawah) |
5,040,000 |
| 7204 |
Orthognathic surgery pada maksilla |
15,694,000 |
| 7205 |
Orthognathic surgery pada mandibula |
15,694,000 |
| 7206 |
Orthognatic Surgery |
8,888,772 |
| 7207 |
Orthopedic Shoes |
3,000,000 |
| 7208 |
Orthoplasty |
9,242,000 |
| 7209 |
Oscilometri |
900,000 |
| 7210 |
Osseointegrated Mandibular Implant - Close Primary, GA |
15,694,000 |
| 7211 |
Osseointegrated Mandibular Implant - Distant/Free Flap, GA |
22,616,000 |
| 7212 |
Osseointegrated Mandibular Implant, GA |
22,616,000 |
| 7213 |
Ossiculoplasty Bilateral |
16,870,000 |
| 7214 |
Ossiculoplasty Tahap II Bilateral |
16,870,000 |
| 7215 |
Ossiculoplasty Tahap II Unilateral |
13,988,000 |
| 7216 |
Ossiculoplasty Unilateral |
13,988,000 |
| 7217 |
Osteodistraksi alveolar 1 segmen |
18,017,000 |
| 7218 |
Osteodistraksi maksilla |
22,800,000 |
| 7219 |
Osteodistraksi mandibula |
22,800,000 |
| 7220 |
Osteotomi Medialis |
10,498,000 |
| 7221 |
Osteotomi Paramedial/Lateral |
10,498,000 |
| 7222 |
Osteotomi Percutaneus |
10,498,000 |
| 7223 |
Osteotomi premaksilla |
14,070,000 |
| 7224 |
Osteotomi, fusi dan instrumentasi spinal kompleks |
30,096,000 |
| 7225 |
Osteotomy & Gradual correction for Bone deformity |
24,597,000 |
| 7226 |
Osteotomy and intramedullary telescoping rod for osteogenesis imperfecta |
24,597,000 |
| 7227 |
Osteotomy around the elbow |
24,597,000 |
| 7228 |
Osteotomy around the Hip (Subtrochnateric Valgus Osteotomy), Rekonstruksi proximal femoral focal deficiency |
25,027,000 |
| 7229 |
Osteotomy around the knee (HTO & DFO) |
24,064,000 |
| 7230 |
Osteotomy around the shoulder |
24,064,000 |
| 7231 |
Other Active Musculoskeletal Exercise |
70,000 |
| 7232 |
Other amputation below knee |
5,242,099 |
| 7233 |
Other and unspecified repair of the anulus fibrosus |
14,020,000 |
| 7234 |
Other anstomosis of cranial or peripheral nerve |
11,582,099 |
| 7235 |
Other bunionectomy with soft tissue correction |
6,600,000 |
| 7236 |
Other cervical fusion, anterior technique |
14,020,000 |
| 7237 |
Other cervical fusion, posterior technique |
14,020,000 |
| 7238 |
Other change in muscle or tendon length |
11,196,000 |
| 7239 |
Other change in muscle or tendon length of hand |
11,196,000 |
| 7240 |
Other destruction of intervertebral disc |
14,020,000 |
| 7241 |
Other Destruction Of Intervertebral Disc (Prosedur PLDD) |
1,221,000 |
| 7242 |
Other diagnostic procedures on joint structures |
5,752,000 |
| 7243 |
Other diagnostic procedures on muscle, tendon, fascia, and bursa, including that of hand |
5,202,000 |
| 7244 |
Other division of carpals and metacarpals |
10,675,000 |
| 7245 |
Other division of soft tissue |
9,390,000 |
| 7246 |
Other division of soft tissue of hand |
9,390,000 |
| 7247 |
Other excision of ankle joint |
8,105,000 |
| 7248 |
Other excision of elbow joint |
8,105,000 |
| 7249 |
Other excision of hip joint |
8,105,000 |
| 7250 |
Other excision of joint of foot and toe |
8,105,000 |
| 7251 |
Other excision of joint of hand and finger |
8,105,000 |
| 7252 |
Other excision of knee joint |
8,105,000 |
| 7253 |
Other excision of shoulder joint |
8,105,000 |
| 7254 |
Other excision of soft tissue |
11,196,000 |
| 7255 |
Other excision of soft tissue of hand |
9,390,000 |
| 7256 |
Other excision of wrist joint |
8,105,000 |
| 7257 |
Other excision, fusion, and repair of toes |
6,600,000 |
| 7258 |
Other exploration and decompresion of spinal canal |
31,267,928 |
| 7259 |
Other fasciectomy |
11,196,000 |
| 7260 |
Other fasciectomy of hand |
9,390,000 |
| 7261 |
Other fusion of foot |
5,476,800 |
| 7262 |
Other hand muscle transfer or transplantation |
11,196,000 |
| 7263 |
Other hand muscle transposition |
11,196,000 |
| 7264 |
Other hand tendon transfer or transplantation |
11,196,000 |
| 7265 |
Other hand tendon transposition |
11,196,000 |
| 7266 |
Other Hydrotherapy |
147,000 |
| 7267 |
Other Immobilization,pressure,and attention to wound |
2,350,000 |
| 7268 |
Other incision of soft tissue |
9,390,000 |
| 7269 |
Other incision of soft tissue of hand |
11,196,000 |
| 7270 |
Other injection of locally-acting therapeutic substance into soft tissue |
3,125,000 |
| 7271 |
Other local excision or destruction of lesion of ankle joint |
8,105,000 |
| 7272 |
Other local excision or destruction of lesion of elbow joint |
8,105,000 |
| 7273 |
Other local excision or destruction of lesion of hip joint |
8,105,000 |
| 7274 |
Other local excision or destruction of lesion of joint of foot and toe |
8,105,000 |
| 7275 |
Other local excision or destruction of lesion of joint of hand and finger |
8,105,000 |
| 7276 |
Other local excision or destruction of lesion of knee joint |
8,105,000 |
| 7277 |
Other local excision or destruction of lesion of shoulder joint |
8,105,000 |
| 7278 |
Other local excision or destruction of lesion of wrist joint |
8,105,000 |
| 7279 |
Other local excision or destruction of lesion or tissue of skin and |
3,125,000 |
| 7280 |
Other muscle transposition |
11,196,000 |
| 7281 |
Other myectomy |
11,196,000 |
| 7282 |
Other myectomy of hand |
9,390,000 |
| 7283 |
Other nonoperative replacements |
4,375,000 |
| 7284 |
Other operations on joint structures |
5,752,000 |
| 7285 |
Other operations on muscle, tendon, and fascia of hand |
3,125,000 |
| 7286 |
Other partial ostectomy carpals and metacarpals |
4,632,099 |
| 7287 |
Other partial ostectomy humerus |
4,632,099 |
| 7288 |
Other partial ostectomy of carpals and metacarpals |
6,600,000 |
| 7289 |
Other partial ostectomy of femur |
4,342,099 |
| 7290 |
Other partial ostectomy of humerus |
6,600,000 |
| 7291 |
Other partial ostectomy of patella |
18,432,099 |
| 7292 |
Other partial ostectomy of radius and ulna |
6,600,000 |
| 7293 |
Other partial ostectomy of scapula, clavicle, and thorax (ribs and sternum) |
6,600,000 |
| 7294 |
Other partial ostectomy of tarsals and metatarsals |
4,739,600 |
| 7295 |
Other partial ostectomy of tibia and fibula |
18,432,099 |
| 7296 |
Other partial ostectomy radius and ulna |
4,662,099 |
| 7297 |
Other partial ostectomy scapula, clavicle, and thorax (rib and sternum) |
6,600,000 |
| 7298 |
Other Passive Musculoskeletal Exercise |
70,000 |
| 7299 |
Other peripheral nerve or ganglion decompression or lysis of adhesions |
11,604,994 |
| 7300 |
Other plastic operations on fascia |
11,196,000 |
| 7301 |
Other plastic operations on hand |
10,675,000 |
| 7302 |
Other plastic operations on muscle |
11,196,000 |
| 7303 |
Other plastic operations on tendon |
11,196,000 |
| 7304 |
Other reconstruction of thumb |
10,675,000 |
| 7305 |
Other repair and reconstruction of skin and subcutaneous tissue |
4,739,600 |
| 7306 |
Other repair of elbow |
8,105,000 |
| 7307 |
Other repair of hand, fingers, and wrist |
8,105,000 |
| 7308 |
Other repair of joint |
5,752,000 |
| 7309 |
Other repair of knee |
16,585,212 |
| 7310 |
Other repair of shoulder |
8,105,000 |
| 7311 |
Other repair of the collateral ligaments |
17,985,212 |
| 7312 |
Other repair of the cruciate ligaments |
17,985,212 |
| 7313 |
Other skin graft to hand |
6,528,000 |
| 7314 |
Other suture of flexor tendon of hand |
11,196,000 |
| 7315 |
Other suture of muscle or fascia |
11,196,000 |
| 7316 |
Other suture of other tendon of hand |
11,196,000 |
| 7317 |
Other suture of tendon |
11,196,000 |
| 7318 |
Other tendon transposition |
11,196,000 |
| 7319 |
Other tenodesis of hand |
10,675,000 |
| 7320 |
Other tenonectomy |
11,196,000 |
| 7321 |
Other tenonectomy of hand |
6,883,430 |
| 7322 |
Other tenoplasty of hand |
10,675,000 |
| 7323 |
Other tenotomy |
9,390,000 |
| 7324 |
Otis (narkose) |
8,208,000 |
| 7325 |
Otomikroskopi |
73,000 |
| 7326 |
Otomikroskopi Diagnostik |
379,000 |
| 7327 |
Otoplasty |
11,572,000 |
| 7328 |
Otoplasty THT |
4,850,000 |
| 7329 |
Oval Fat Body |
25,000 |
| 7330 |
Ovarian drilling per laparoskopi |
17,638,000 |
| 7331 |
Overhecting |
217,000 |
| 7332 |
P300 evoked response potential. |
1,696,000 |
| 7333 |
PA Banding + BT shunt |
51,733,000 |
| 7334 |
PA banding dengan CPB |
112,316,000 |
| 7335 |
PA Banding tanpa CPB |
51,733,000 |
| 7336 |
PA Potong Beku (VC) Besar |
875,000 |
| 7337 |
PA Potong Beku (VC) Kecil |
438,000 |
| 7338 |
PACKED RED CELL (PRC) |
490,000 |
| 7339 |
Packed Red Cell (PRC) Leuko depletet /reduksi NAT skrining antibodi |
1,025,000 |
| 7340 |
Packed Red Cell (PRC) Leuko depletet /reduksi NAT |
1,025,000 |
| 7341 |
Packed Red Cell (PRC) Leuko depletet /reduksi skrining antibodi |
850,000 |
| 7342 |
Packed Red Cell (PRC) Leuko depletet/reduksi |
850,000 |
| 7343 |
Packed Red Cell (PRC) NAT |
740,000 |
| 7344 |
Packed Red Cell (PRC) NAT skrining antibodi |
740,000 |
| 7345 |
Packed Red Cell (PRC) skrining antibodi |
490,000 |
| 7346 |
Pain intervention - image guided radiofrequency (multiple) for Chronic pain (except spine) |
12,638,000 |
| 7347 |
Pain intervention - image guided radiofrequency (single) for Chronic pain (except spine) |
11,174,000 |
| 7348 |
Pain intervention - image guided selective nerve block (multiple) for Chronic pain (except spine) |
12,638,000 |
| 7349 |
Pain intervention - image guided selective nerve block (single) for Chronic pain (except spine) |
11,174,000 |
| 7350 |
Pain Management |
100,000 |
| 7351 |
Paket Advokasi Donor Transplantasi Organ oleh Tim Advokasi |
15,100,000 |
| 7352 |
Paket Eksternal kelas manajemen stress (Maks 20 orang) |
5,000,000 |
| 7353 |
Paket Eksternal kelas manajemen stress bagi lansia (Maks 20 orang) |
5,000,000 |
| 7354 |
Paket Hormonal |
500,000 |
| 7355 |
Paket Limfoma Kasus Sukar |
1,500,000 |
| 7356 |
Paket OK Gigi Anak Berat (› 10 gigi) |
5,430,000 |
| 7357 |
Paket OK Gigi Anak Berat dengan penyulit |
5,930,000 |
| 7358 |
Paket OK Gigi Anak Ringan (1-5 gigi) |
4,150,000 |
| 7359 |
Paket OK Gigi Anak Sedang (1 - 10 gigi) |
4,825,000 |
| 7360 |
Paket Perawatan Luka (Konsultasi + Tindakan) |
440,000 |
| 7361 |
Paket PTCA + 1 Stent DES dengan IMAGING INTRAKORONER |
99,657,000 |
| 7362 |
PAKET PTCA + 1 STENT DES dengan IMAGING INTRAKORONER dengan anestesi dan ventilator |
103,618,000 |
| 7363 |
PAKET PTCA + 1 STENT DES dengan IMAGING INTRAKORONER dengan anestesi dan ventilator Kompleks |
109,822,000 |
| 7364 |
Paket PTCA + 1 Stent DES dengan IMAGING INTRAKORONER Kompleks |
104,777,000 |
| 7365 |
Paket PTCA + 1 Stent DES Dengan Uji Fungsional |
99,657,000 |
| 7366 |
PAKET PTCA + 1 STENT DES DENGAN UJI FUNGSIONAL dengan anestesi dan ventilator |
103,618,000 |
| 7367 |
PAKET PTCA + 1 STENT DES DENGAN UJI FUNGSIONAL dengan anestesi dan ventilator Kompleks |
109,822,000 |
| 7368 |
Paket PTCA + 1 Stent DES Dengan Uji Fungsional Kompleks |
104,777,000 |
| 7369 |
Paket PTCA + 2 Stent DES dengan IMAGING INTRAKORONER |
105,587,000 |
| 7370 |
PAKET PTCA + 2 STENT DES dengan IMAGING INTRAKORONER dengan anestesi dan ventilator |
110,737,000 |
| 7371 |
PAKET PTCA + 2 STENT DES dengan IMAGING INTRAKORONER dengan anestesi dan ventilator Kompleks |
119,077,000 |
| 7372 |
Paket PTCA + 2 Stent DES dengan IMAGING INTRAKORONER Kompleks |
112,487,000 |
| 7373 |
Paket PTCA + 2 Stent DES dengan Imaging Intrakoroner Kompleks |
68,900,000 |
| 7374 |
Paket PTCA + 2 Stent DES Dengan Uji Fungsional |
105,587,000 |
| 7375 |
PAKET PTCA + 2 STENT DES DENGAN UJI FUNGSIONAL dengan anestesi dan ventilator |
110,737,000 |
| 7376 |
PAKET PTCA + 2 STENT DES DENGAN UJI FUNGSIONAL dengan anestesi dan ventilator Kompleks |
119,077,000 |
| 7377 |
Paket PTCA + 2 Stent DES Dengan Uji Fungsional Kompleks |
112,487,000 |
| 7378 |
Paket PTCA + 3 Stent DES dengan IMAGING INTRAKORONER |
109,082,000 |
| 7379 |
PAKET PTCA + 3 STENT DES dengan IMAGING INTRAKORONER dengan anestesi dan ventilator |
114,232,000 |
| 7380 |
PAKET PTCA + 3 STENT DES dengan IMAGING INTRAKORONER dengan anestesi dan ventilator Kompleks |
122,572,000 |
| 7381 |
Paket PTCA + 3 Stent DES dengan IMAGING INTRAKORONER Kompleks |
115,982,000 |
| 7382 |
Paket PTCA + 3 Stent DES Dengan Uji Fungsional |
109,082,000 |
| 7383 |
PAKET PTCA + 3 STENT DES DENGAN UJI FUNGSIONAL dengan anestesi dan ventilator |
114,232,000 |
| 7384 |
PAKET PTCA + 3 STENT DES DENGAN UJI FUNGSIONAL dengan anestesi dan ventilator Kompleks |
122,572,000 |
| 7385 |
Paket PTCA + 3 Stent DES Dengan Uji Fungsional Kompleks |
115,982,000 |
| 7386 |
Paket PTCA + 4 Stent DES dengan IMAGING INTRAKORONER |
112,577,000 |
| 7387 |
PAKET PTCA + 4 STENT DES dengan IMAGING INTRAKORONER dengan anestesi dan ventilator |
117,727,000 |
| 7388 |
PAKET PTCA + 4 STENT DES dengan IMAGING INTRAKORONER dengan anestesi dan ventilator Kompleks |
126,067,000 |
| 7389 |
Paket PTCA + 4 Stent DES dengan IMAGING INTRAKORONER Kompleks |
119,477,000 |
| 7390 |
Paket PTCA + 4 Stent DES Dengan Uji Fungsional |
112,577,000 |
| 7391 |
PAKET PTCA + 4 STENT DES DENGAN UJI FUNGSIONAL dengan anestesi dan ventilator |
117,727,000 |
| 7392 |
PAKET PTCA + 4 STENT DES DENGAN UJI FUNGSIONAL dengan anestesi dan ventilator Kompleks |
126,067,000 |
| 7393 |
Paket PTCA + 4 Stent DES Dengan Uji Fungsional Kompleks |
119,477,000 |
| 7394 |
Paket Radiasi Eksterna 3D |
31,200,000 |
| 7395 |
Paket Radiasi Eksterna 3D Kompleks |
40,560,000 |
| 7396 |
Paket Radiasi Eksterna IMRT |
53,263,000 |
| 7397 |
Paket Radiasi Eksterna Konvensional |
26,318,000 |
| 7398 |
Paket Radiasi Eksterna Konvensional Kompleks |
31,582,000 |
| 7399 |
Paket Rehab Jantung fase 2 / 3, 12x pertemuan (full telemetri) |
15,910,000 |
| 7400 |
Paket Rehab Jantung fase 2 / 3, 12x pertemuan (tanpa telemetri) |
4,940,001 |
| 7401 |
Paket Rehab Jantung fase 2 / 3, 12x pertemuan (telemetri awal akhir saja) |
6,586,500 |
| 7402 |
Paket Rehab Jantung fase 2 / 3, 6x pertemuan (full telemetri) |
8,449,000 |
| 7403 |
Paket Rehab Jantung fase 2 / 3, 6x pertemuan (tanpa telemetri) |
2,964,000 |
| 7404 |
Paket Rehab Jantung fase 2 / 3, 6x pertemuan (telemetri awal akhir saja) |
4,609,000 |
| 7405 |
PAKET SCREENING TRANSPLANTASI GINJAL (HLA TYPING. DSA/ HLA ANTIBODY, CROSSMATCH (CDC)/ HLA CROSSMATCH) ) |
32,765,000 |
| 7406 |
Paket Sputum 3x Serial |
359,000 |
| 7407 |
Paket Tes Kepribadian 1 |
296,000 |
| 7408 |
Paket Tes Kepribadian 2 |
385,000 |
| 7409 |
Paket Uji Urtikaria |
1,500,000 |
| 7410 |
Palato Plasty |
7,235,000 |
| 7411 |
Palatoplasti |
6,794,335 |
| 7412 |
Palatoplasti pada Celah Palatum |
7,235,000 |
| 7413 |
Palatoplasty bilateral/ complete |
10,878,000 |
| 7414 |
Palatoplasty Dengan Implan Palatum ( Pilar Implant) |
18,522,000 |
| 7415 |
Palatoplasty unilateral/ incomplete |
9,211,000 |
| 7416 |
PAN Endoskopi (Triple Endoskopi) |
14,461,000 |
| 7417 |
Panel IMS/Venereologik Pria |
100,000 |
| 7418 |
Panel IMS/Venereologik Wanita dengan Spekulum |
151,000 |
| 7419 |
Panel IMS/Venereologik Wanita tanpa Spekulum |
100,000 |
| 7420 |
Panendoskopi (Eksplorasi NF.Laringoskopi.Esofagoskopi.Bronkoskopi dengan Biopsi) |
4,850,000 |
| 7421 |
Pankreaktektomi |
6,482,351 |
| 7422 |
Pankreatektomi distal |
20,066,000 |
| 7423 |
Pankreatektomi duodenal preserving |
13,045,000 |
| 7424 |
Pankreatektomi total |
13,045,000 |
| 7425 |
Pankreatikojejunostomy |
33,321,000 |
| 7426 |
Panoramic |
125,000 |
| 7427 |
PAP / Vaginal Smer |
81,000 |
| 7428 |
Pap Smear |
81,000 |
| 7429 |
Paper Patch Therapy |
0 |
| 7430 |
Papsmear berbasis cairan |
316,000 |
| 7431 |
Papsmear konvensional |
114,000 |
| 7432 |
Paracervical block |
4,049,000 |
| 7433 |
Parafin Bath |
33,000 |
| 7434 |
Parafin Bath |
125,000 |
| 7435 |
Parametrektomi per laparoskopi |
27,123,000 |
| 7436 |
Parametrektomi per laparotomi |
26,173,000 |
| 7437 |
Parasentase Telinga |
66,000 |
| 7438 |
Parasentesa |
4,850,000 |
| 7439 |
Parasentese ( I/A Koagulum / Aspirasi sisa korteks) |
6,068,000 |
| 7440 |
Parasentesis (pungsi asites) |
1,371,000 |
| 7441 |
Parasintesis |
60,000 |
| 7442 |
Parasintesis/Miringotomi |
319,000 |
| 7443 |
Paratiroidektomi Partial |
15,020,000 |
| 7444 |
Paratiroidektomi Total |
14,711,000 |
| 7445 |
Paravin |
75,000 |
| 7446 |
Parotidektomi |
3,933,656 |
| 7447 |
Parotidektomi (THT) |
5,482,645 |
| 7448 |
Parotidektomi Parsial |
11,554,000 |
| 7449 |
Parotidektomi radikal |
15,854,000 |
| 7450 |
Parotidektomi Radikal + mandibulektomi |
5,077,000 |
| 7451 |
Parotidektomi superfisialis |
11,316,000 |
| 7452 |
Parotidektomi totalis |
11,316,000 |
| 7453 |
Parotidektomy Total / Radikal dengan + Diseksi Leher Radikal |
17,277,000 |
| 7454 |
Partial hip replacement |
5,661,098 |
| 7455 |
Partial Knee Replacement / Arthroplasty |
33,805,000 |
| 7456 |
Partial laringektomi |
21,425,000 |
| 7457 |
Partial shoulder replacement |
8,105,000 |
| 7458 |
Partus Fisiologi (Anak) |
127,500 |
| 7459 |
Partus Fisiologi (Obgyn) |
672,500 |
| 7460 |
Partus Letak Bokong (Anak) |
203,750 |
| 7461 |
Partus Letak Bokong (Obgyn) |
996,250 |
| 7462 |
Partus normal + infeksi menular (hiv-aids, hepatitis) |
1,542,000 |
| 7463 |
Pasang / Cabut IUD |
103,000 |
| 7464 |
Pasang / Cabut Pesarium |
116,000 |
| 7465 |
Pasang / Cabut Susut KB |
127,000 |
| 7466 |
Pasang Akses port celsite |
9,150,000 |
| 7467 |
Pasang akses vena |
22,616,000 |
| 7468 |
Pasang Albumin |
37,000 |
| 7469 |
Pasang Archbarr 1 Sisi, LA |
10,231,000 |
| 7470 |
Pasang Archbarr 2 Sisi, LA |
14,324,000 |
| 7471 |
Pasang Arterial Line Intra Arterial Pressure (IAP) |
2,906,000 |
| 7472 |
Pasang atau lepas AKDR/ IUD |
566,000 |
| 7473 |
Pasang atau lepas implant (susuk kontrasepsi) |
778,000 |
| 7474 |
Pasang atau lepas tampon vaginal |
171,000 |
| 7475 |
Pasang Back Slab |
75,000 |
| 7476 |
Pasang Balon Kateter |
337,000 |
| 7477 |
Pasang band lepas |
77,000 |
| 7478 |
Pasang bracket lepas |
77,000 |
| 7479 |
Pasang Catheter Epidural |
900,000 |
| 7480 |
Pasang Catheter Dokter |
200,000 |
| 7481 |
Pasang Catheter Dokter (RJ) |
82,600 |
| 7482 |
Pasang Catheter Perawat |
0 |
| 7483 |
Pasang Catheter Perawat (RJ) |
82,600 |
| 7484 |
Pasang Central Venous Catheter (CVC) |
2,915,000 |
| 7485 |
Pasang Central Venous Catheter Dengan USG Guided |
2,923,000 |
| 7486 |
Pasang Central Venous Catheter Untuk HD |
2,061,000 |
| 7487 |
Pasang Central Venous Catheter Untuk HD Dengan USG Guided |
2,070,000 |
| 7488 |
Pasang chemoport (celsite port a cath) |
5,912,000 |
| 7489 |
Pasang Coba GTSL Gigi RA dan RB |
450,000 |
| 7490 |
Pasang CVP |
290,000 |
| 7491 |
Pasang DJ Local/Ganti DJ stent lokal |
8,310,000 |
| 7492 |
Pasang DJ Narkose/Ganti DJ Stent narkose |
9,235,000 |
| 7493 |
Pasang drain |
8,320,000 |
| 7494 |
Pasang Folley Catheter |
256,000 |
| 7495 |
Pasang Folley Catheter kompleks pasien dewasa |
385,000 |
| 7496 |
Pasang Folley Catheter kompleks pasien neonatus |
385,000 |
| 7497 |
Pasang Folley Catheter kompleks pasien pediatrik |
385,000 |
| 7498 |
Pasang Folley Catheter sederhana pasien dewasa |
256,000 |
| 7499 |
Pasang Folley Catheter sederhana pasien neonatus |
256,000 |
| 7500 |
Pasang Folley Catheter sederhana pasien pediatrik |
256,000 |
| 7501 |
Pasang Gips Tanpa Narcose (Aff Hecting) |
35,000 |
| 7502 |
Pasang Gips Tanpa Narcose (Aspirasi sendi) |
135,000 |
| 7503 |
Pasang Gips Tanpa Narcose (Body Jaket Gips) |
56,000 |
| 7504 |
Pasang Gips Tanpa Narcose (Buka Gips) |
69,000 |
| 7505 |
Pasang Gips Tanpa Narcose (Cabut K. Wire) |
69,000 |
| 7506 |
Pasang Gips Tanpa Narcose (Cabut Screw) |
74,000 |
| 7507 |
Pasang Gips Tanpa Narcose (Cabut Wire) |
69,000 |
| 7508 |
Pasang Gips Tanpa Narcose (Fore Arm Slab) |
52,000 |
| 7509 |
Pasang Gips Tanpa Narcose (Long Arm Plester) |
56,000 |
| 7510 |
Pasang Gips Tanpa Narcose (Long Leg Plester) |
56,000 |
| 7511 |
Pasang Gips Tanpa Narcose (Pasang Body Cast) |
106,000 |
| 7512 |
Pasang Gips Tanpa Narcose (Sarmento Plester) |
56,000 |
| 7513 |
Pasang Gips Tanpa Narcose (Short Leg Plester) |
56,000 |
| 7514 |
Pasang Gips Tanpa Narcose (Spica Gips) |
56,000 |
| 7515 |
Pasang Gips Tanpa Narcose (U - Slab) |
52,000 |
| 7516 |
Pasang Gips Tanpa Narcose (Uip Gips) |
56,000 |
| 7517 |
Pasang Gudel |
90,000 |
| 7518 |
Pasang implant (susuk kontrasepsi) |
778,000 |
| 7519 |
Pasang Infus |
150,000 |
| 7520 |
Pasang Infus |
0 |
| 7521 |
Pasang Infus (RJ) |
25,600 |
| 7522 |
Pasang Infus dengan penyulit pasien dewasa |
189,000 |
| 7523 |
Pasang Infus dengan penyulit pasien neonatus |
226,001 |
| 7524 |
Pasang Infus dengan penyulit pasien pediatrik |
189,000 |
| 7525 |
Pasang Infus Neonatus (Intensif) |
75,000 |
| 7526 |
Pasang Infus Sulit + Anastesi |
326,000 |
| 7527 |
Pasang Infus tanpa penyulit pasien dewasa |
150,000 |
| 7528 |
Pasang Infus tanpa penyulit pasien neonatus |
180,000 |
| 7529 |
Pasang Infus tanpa penyulit pasien pediatrik |
150,000 |
| 7530 |
Pasang Kateter dengan Mandrain |
675,000 |
| 7531 |
Pasang kateter dengan mandrain |
797,000 |
| 7532 |
Pasang Kateter tenchoff untuk CAPD Narkose |
7,852,000 |
| 7533 |
Pasang Kateter Urin ( Home Care ) |
50,000 |
| 7534 |
Pasang laminaria |
803,000 |
| 7535 |
Pasang Laminaria/Folley Catheter |
250,000 |
| 7536 |
Pasang Lmainaria Stift |
250,000 |
| 7537 |
Pasang Maag Slang Dokter |
154,000 |
| 7538 |
Pasang Maag Slang Perawat |
154,000 |
| 7539 |
Pasang Mitellah |
75,000 |
| 7540 |
Pasang Monitor |
0 |
| 7541 |
Pasang Monitor (RJ) |
0 |
| 7542 |
Pasang Monitoring Invasif Kontinyu (PICCO2) |
4,412,000 |
| 7543 |
Pasang Necloler |
75,000 |
| 7544 |
Pasang Nefrostomi (Lokal) |
1,791,000 |
| 7545 |
Pasang Neopuff |
110,000 |
| 7546 |
Pasang NGT |
182,000 |
| 7547 |
Pasang NGT kompleks pasien dewasa |
248,000 |
| 7548 |
Pasang NGT kompleks pasien neonatus |
248,000 |
| 7549 |
Pasang NGT kompleks pasien pediatrik |
248,000 |
| 7550 |
Pasang NGT sederhana pasien dewasa |
182,000 |
| 7551 |
Pasang NGT sederhana pasien neonatus |
182,000 |
| 7552 |
Pasang NGT sederhana pasien pediatrik |
182,000 |
| 7553 |
Pasang NGT sulit |
248,000 |
| 7554 |
Pasang NGT Sulit + Anastesi |
297,000 |
| 7555 |
Pasang O2 |
0 |
| 7556 |
Pasang O2 (RJ) |
22,500 |
| 7557 |
Pasang OGT |
34,000 |
| 7558 |
Pasang PD Catheter |
1,220,000 |
| 7559 |
Pasang Periheral Insertion Central Catheter (PICC) |
1,298,000 |
| 7560 |
Pasang Pulmonari Arteri Catheter (Swan-Gans) |
5,655,000 |
| 7561 |
Pasang Saturasi |
0 |
| 7562 |
Pasang Saturasi (RJ) |
0 |
| 7563 |
Pasang Skeletal Traction |
78,000 |
| 7564 |
Pasang Skin Traksi |
47,000 |
| 7565 |
Pasang Stent Metal Esofagus |
44,530,000 |
| 7566 |
Pasang Tampon |
471,000 |
| 7567 |
Pasang Traksi Vertebra (Tulang Belakang) |
675,000 |
| 7568 |
Pasang Transfusi |
95,000 |
| 7569 |
Pasang Transfusi Albumin |
86,000 |
| 7570 |
Pasang Trombolitik (Intensif) |
103,000 |
| 7571 |
Pasang Umbilical Catheter |
136,000 |
| 7572 |
Pasang WSD |
1,300,000 |
| 7573 |
Pasang WSD (CathLab) |
1,300,000 |
| 7574 |
Pasang/Angkat Jahit |
66,000 |
| 7575 |
Pasang/Buka Gips Sirkular |
250,000 |
| 7576 |
Pasang/Buka Tampon Vagina |
66,000 |
| 7577 |
Pasang/cabut susuk KB/Inplan |
127,000 |
| 7578 |
Patch Test Diagnostik (Gendang Telinga) |
66,000 |
| 7579 |
Patellar stabilization |
8,105,000 |
| 7580 |
Patellectomy for Articular bone /soft tissue tumor |
23,532,000 |
| 7581 |
PCNL (narkose) |
18,401,000 |
| 7582 |
PCNL Dengan Laser |
23,368,000 |
| 7583 |
PCR CMV |
966,000 |
| 7584 |
PCR EBV ( Eipstein-Bar Virus ) (P) |
934,000 |
| 7585 |
PCR EBV ( Eipstein-Bar Virus ) (P) |
934,000 |
| 7586 |
PCR HIV (VIRAL LOAD) |
2,000,000 |
| 7587 |
PDA Ligasi |
15,550,000 |
| 7588 |
PDA Ligasi (off CPB) |
56,373,000 |
| 7589 |
PDA Ligasi on CPB |
90,199,000 |
| 7590 |
PDA Stenting / BT Shunt Stenting + anestesi |
51,733,000 |
| 7591 |
PDT |
13,712,000 |
| 7592 |
Peak Flow Meter |
46,200 |
| 7593 |
Peak Flow Rate (PFR) |
73,000 |
| 7594 |
PEAK NASAL INSPIRATORY FLOWMETRI ( PNIF) |
282,000 |
| 7595 |
Pediatric Auto Ref |
71,000 |
| 7596 |
Pedicle grafts or flaps |
13,154,994 |
| 7597 |
Pedicle or flap graft, not otherwise specified |
13,154,994 |
| 7598 |
Peeling Kimia (Deep) |
320,000 |
| 7599 |
Peeling Kimia (Superficial) |
200,000 |
| 7600 |
Peeling Kimiawi Dalam |
165,000 |
| 7601 |
Peeling Kimiawi Superfisial |
90,000 |
| 7602 |
PEG di ICU/HCU/ICCU pasien dewasa |
10,497,000 |
| 7603 |
PEG di NICU pasien neonatus |
10,497,000 |
| 7604 |
PEG di PICU pasien pediatrik |
10,497,000 |
| 7605 |
Pelacakan Sindrom |
90,000 |
| 7606 |
Pelatihan Autis |
60,000 |
| 7607 |
Pelayanan Etikomedikolegal Forensik (Advokasi Transplantasi Organ) |
2,151,000 |
| 7608 |
Pelayanan Etikomedikolegal Forensik Advokasi Transplantasi Organ |
2,151,000 |
| 7609 |
Pelayanan Psikiatrik Kompleks |
800,000 |
| 7610 |
Pelayanan Psikiatrik Simpel |
600,000 |
| 7611 |
Pelepasan (aff) atau repair Chest tube/pleural drain |
713,000 |
| 7612 |
Pelepasan (Aff) Small Pleural Catheter (<=16 Fr) |
713,000 |
| 7613 |
Pelepasan catheter jugular bulb pasien dewasa |
778,000 |
| 7614 |
Pelepasan catheter jugular bulb pasien neonatus |
778,000 |
| 7615 |
Pelepasan catheter jugular bulb pasien pediatrik |
778,000 |
| 7616 |
Pelepasan ECMO pasien dewasa |
778,000 |
| 7617 |
Pelepasan ECMO pasien neonatus |
778,000 |
| 7618 |
Pelepasan ECMO pasien pediatrik |
778,000 |
| 7619 |
Pelepasan Gromet |
5,188,000 |
| 7620 |
Pelepasan IABP pasien dewasa |
228,000 |
| 7621 |
Pelepasan IABP pasien neonatus |
228,000 |
| 7622 |
Pelepasan IABP pasien pediatrik |
228,000 |
| 7623 |
Pelepasan kateter peritoneal dialisa akut pasien dewasa |
120,000 |
| 7624 |
Pelepasan kateter peritoneal dialisa akut pasien neonatus |
120,000 |
| 7625 |
Pelepasan kateter peritoneal dialisa akut pasien pediatrik |
120,000 |
| 7626 |
Pelepasan Mini Screw |
200,000 |
| 7627 |
Pelepasan Mini Screw (Eksekutif) |
0 |
| 7628 |
Pelepasan Negative Pressure Wound Therapy (NPWT) |
370,000 |
| 7629 |
Pelepasan NGT/OGT |
107,000 |
| 7630 |
Pelepasan pacu jantung transkutan pasien dewasa |
795,000 |
| 7631 |
Pelepasan pacu jantung transkutan pasien neonatus |
795,000 |
| 7632 |
Pelepasan pacu jantung transkutan pasien pediatrik |
795,000 |
| 7633 |
Pelepasan pacu jantung transvena pasien dewasa |
795,000 |
| 7634 |
Pelepasan pacu jantung transvena pasien neonatus |
795,000 |
| 7635 |
Pelepasan pacu jantung transvena pasien pediatrik |
795,000 |
| 7636 |
Pelepasan Peripheral Insertion Central Catheter (PICC) |
200,000 |
| 7637 |
Pelepasan sistostomi |
116,000 |
| 7638 |
Pelepasan SwanGanz pasien dewasa |
120,000 |
| 7639 |
Pelepasan SwanGanz pasien neonatus |
120,000 |
| 7640 |
Pelepasan SwanGanz pasien pediatrik |
120,000 |
| 7641 |
Pelepasan Synechia Vaginalis |
120,000 |
| 7642 |
Pelipektomi |
4,310,000 |
| 7643 |
Pelipektomi + Anastesi |
5,750,000 |
| 7644 |
Pelvic resection |
24,141,999 |
| 7645 |
Pelvimetri |
745,000 |
| 7646 |
Pelvimetri dengan Sonde |
745,000 |
| 7647 |
Pem Psikotest MMPI 2 |
276,000 |
| 7648 |
Pemanatuan catheter jugular bulb pasien dewasa |
281,000 |
| 7649 |
Pemanatuan catheter jugular bulb pasien neonatus |
281,000 |
| 7650 |
Pemanatuan catheter jugular bulb pasien pediatrik |
281,000 |
| 7651 |
Pemantauan aEEG pasien dewasa |
906,000 |
| 7652 |
Pemantauan aEEG pasien neonatus |
906,000 |
| 7653 |
Pemantauan aEEG pasien pediatrik |
906,000 |
| 7654 |
Pemantauan BIS pasien dewasa |
1,206,000 |
| 7655 |
Pemantauan BIS pasien pediatrik |
1,206,000 |
| 7656 |
Pemantauan EEG pasien dewasa |
906,000 |
| 7657 |
Pemantauan EEG pasien neonatus |
906,000 |
| 7658 |
Pemantauan EEG pasien pediatrik |
906,000 |
| 7659 |
Pemantauan NIRS pasien dewasa |
1,206,000 |
| 7660 |
Pemantauan NIRS pasien neonatus |
1,206,000 |
| 7661 |
Pemantauan NIRS pasien pediatrik |
1,206,000 |
| 7662 |
Pemantauan oleh Tim Terapi Gizi |
120,000 |
| 7663 |
Pemantauan TCD |
364,000 |
| 7664 |
Pemantauan TCD pasien dewasa |
364,000 |
| 7665 |
Pemantauan TCD pasien neonatus |
364,000 |
| 7666 |
Pemantauan TCD pasien pediatrik |
364,000 |
| 7667 |
Pemantauan transcutaneous bilirubinometry pasien neonatus |
200,000 |
| 7668 |
Pemantauan transcutaneous bilirubinometry pasien pediatrik |
200,000 |
| 7669 |
Pemantauan transcutaneous CO2 pasien dewasa |
200,000 |
| 7670 |
Pemantauan transcutaneous CO2 pasien neonatus |
200,000 |
| 7671 |
Pemantauan transcutaneous CO2 pasien pediatrik |
200,000 |
| 7672 |
Pemantauan transcutaneous SpMet pasien dewasa |
200,000 |
| 7673 |
Pemantauan transcutaneous SpMet pasien neonatus |
200,000 |
| 7674 |
Pemantauan transcutaneous SpMet pasien pediatrik |
200,000 |
| 7675 |
Pemantuan harian home ventilator |
196,000 |
| 7676 |
Pemasangan / Penggantian Pack / Kassa Kemicitine |
270,000 |
| 7677 |
Pemasangan Abutmen |
860,000 |
| 7678 |
Pemasangan akses arteri (Arterial Line) |
2,349,000 |
| 7679 |
Pemasangan akses intraoseus |
2,991,000 |
| 7680 |
Pemasangan Akses Intraoseus pasien dewasa |
2,991,000 |
| 7681 |
Pemasangan Akses Intraoseus pasien neonatus |
2,991,000 |
| 7682 |
Pemasangan Akses Intraoseus pasien pediatrik |
2,991,000 |
| 7683 |
Pemasangan akses vena dengan penyulit |
206,000 |
| 7684 |
Pemasangan akses vena femoralis pasien dewasa |
3,000,000 |
| 7685 |
Pemasangan akses vena femoralis pasien neonatus |
3,000,000 |
| 7686 |
Pemasangan akses vena femoralis pasien pediatrik |
3,000,000 |
| 7687 |
Pemasangan Ambulatory Chest Drainage |
5,529,000 |
| 7688 |
Pemasangan Amplitude EEG |
873,000 |
| 7689 |
Pemasangan Arteri Line |
2,349,000 |
| 7690 |
Pemasangan Arteri Line |
930,000 |
| 7691 |
Pemasangan Arteri Line dengan bantuan USG oleh DPJP |
2,585,900 |
| 7692 |
Pemasangan Arteri Line dengan penyulit |
3,524,000 |
| 7693 |
Pemasangan Arteri Line oleh DPJP pasien dewasa |
2,349,000 |
| 7694 |
Pemasangan Arteri Line oleh DPJP pasien neonatus |
2,349,000 |
| 7695 |
Pemasangan arteri Umbilical pasien neonatus |
1,448,000 |
| 7696 |
Pemasangan Balon Mitral |
24,475,000 |
| 7697 |
Pemasangan bandage |
294,000 |
| 7698 |
Pemasangan Belog Tampon |
66,000 |
| 7699 |
Pemasangan Bite Riser |
270,000 |
| 7700 |
Pemasangan body jacket |
6,814,000 |
| 7701 |
Pemasangan Bone Anchored Hearing Aid (BAHA) |
20,638,000 |
| 7702 |
Pemasangan Button |
300,000 |
| 7703 |
Pemasangan Button (Eksekutif) |
340,000 |
| 7704 |
Pemasangan catheter jugular bulb pasien dewasa |
1,361,000 |
| 7705 |
Pemasangan catheter jugular bulb pasien neonatus |
1,361,000 |
| 7706 |
Pemasangan catheter jugular bulb pasien pediatrik |
1,361,000 |
| 7707 |
Pemasangan Cell saver (Perfusi) |
17,924,000 |
| 7708 |
Pemasangan Cimino |
5,000,000 |
| 7709 |
Pemasangan Continuous Suction |
1,078,000 |
| 7710 |
Pemasangan CPAP |
720,000 |
| 7711 |
Pemasangan CPAP |
229,000 |
| 7712 |
Pemasangan CRRT (CVVH, CVVHD, CVVHDF) |
30,671,000 |
| 7713 |
Pemasangan CVC |
3,000,000 |
| 7714 |
Pemasangan CVC dengan penyulit |
3,900,000 |
| 7715 |
Pemasangan CVC dengan USG |
3,281,000 |
| 7716 |
Pemasangan CVC dengan USG pasien dewasa |
3,281,000 |
| 7717 |
Pemasangan CVC dengan USG pasien neonatus |
3,281,000 |
| 7718 |
Pemasangan CVC dengan USG pasien pediatrik |
3,281,000 |
| 7719 |
Pemasangan CVC tanpa USG pasien dewasa |
3,000,000 |
| 7720 |
Pemasangan CVC tanpa USG pasien neonatus |
3,000,000 |
| 7721 |
Pemasangan CVC tanpa USG pasien pediatrik |
3,000,000 |
| 7722 |
Pemasangan dan pemantauan BIA pasien dewasa |
300,000 |
| 7723 |
Pemasangan dan pemantauan BIA pasien neonatus |
300,000 |
| 7724 |
Pemasangan dan pemantauan BIA pasien pediatrik |
300,000 |
| 7725 |
Pemasangan dan setting awal ventilator |
720,000 |
| 7726 |
Pemasangan Defibrilator pada Anak |
326,000 |
| 7727 |
Pemasangan Dental Implant 1 Gigi dengan Anastesi Lokal |
0 |
| 7728 |
Pemasangan Dental Implant 2 Gigi dengan Anastesi Lokal |
0 |
| 7729 |
Pemasangan Dental Implant 3 Gigi dengan Anastesi Lokal |
0 |
| 7730 |
Pemasangan drain bedside |
923,000 |
| 7731 |
Pemasangan drain bedside dengan anastesi lokal |
923,000 |
| 7732 |
Pemasangan drain bilier (PTBD) dengan anestesi lokal |
17,741,000 |
| 7733 |
Pemasangan drain dengan anastesi lokal |
923,000 |
| 7734 |
Pemasangan ECMO pasien dewasa |
127,578,000 |
| 7735 |
Pemasangan ECMO pasien neonatus |
127,578,000 |
| 7736 |
Pemasangan ECMO pasien pediatrik |
127,578,000 |
| 7737 |
Pemasangan Ekspansi Rahang |
1,500,000 |
| 7738 |
Pemasangan Ekspansi Rahang (Eksekutif) |
0 |
| 7739 |
Pemasangan Elastik |
50,000 |
| 7740 |
Pemasangan Elastik (Eksekutif) |
0 |
| 7741 |
Pemasangan Fiksasi Interna |
24,500,000 |
| 7742 |
Pemasangan Fiksasi Interna |
6,882,000 |
| 7743 |
Pemasangan Flocare |
2,850,000 |
| 7744 |
Pemasangan gips |
1,000,000 |
| 7745 |
Pemasangan Gips atas lutut tanpa reposisi |
1,028,000 |
| 7746 |
Pemasangan Gips atas siku tanpa reposisi |
1,088,000 |
| 7747 |
Pemasangan Gips bawah lutut tanpa reposisi |
927,000 |
| 7748 |
Pemasangan Gips bawah siku tanpa reposisi |
1,225,000 |
| 7749 |
Pemasangan Gips Telinga |
114,000 |
| 7750 |
Pemasangan Gromet 1 TELINGA |
6,657,000 |
| 7751 |
Pemasangan Gromet 2 TELINGA |
7,395,000 |
| 7752 |
Pemasangan Grommet dgn Narkose (Diluar Alkes Gromet) |
2,850,000 |
| 7753 |
Pemasangan GWT/Halo Traction lokal |
25,001,000 |
| 7754 |
Pemasangan HFNC |
1,440,000 |
| 7755 |
Pemasangan HFOV |
2,204,000 |
| 7756 |
Pemasangan High Flow Nasal Cannul |
1,440,000 |
| 7757 |
Pemasangan hip spica |
738,000 |
| 7758 |
Pemasangan HNFC / HFOT pasien neonatus |
2,204,000 |
| 7759 |
Pemasangan HNFC / HFOT pasien pediatrik |
2,204,000 |
| 7760 |
Pemasangan IABP pasien dewasa |
32,187,000 |
| 7761 |
Pemasangan IABP pasien neonatus |
32,187,000 |
| 7762 |
Pemasangan IABP pasien pediatrik |
32,187,000 |
| 7763 |
Pemasangan ICP monitoring catherter |
25,091,000 |
| 7764 |
Pemasangan IMF rubber elastik / wire |
10,094,000 |
| 7765 |
Pemasangan insulin pump |
303,000 |
| 7766 |
Pemasangan Kateter (ESWL) |
740,000 |
| 7767 |
Pemasangan Kateter (ESWL) (Sore) |
1,110,000 |
| 7768 |
Pemasangan kateter peritoneal dialisa akut pasien dewasa |
825,000 |
| 7769 |
Pemasangan kateter peritoneal dialisa akut pasien neonatus |
825,000 |
| 7770 |
Pemasangan kateter peritoneal dialisa akut pasien pediatrik |
825,000 |
| 7771 |
Pemasangan kateter peritoneal dialysis |
825,000 |
| 7772 |
Pemasangan kateter ureter (ESWL) |
2,500,000 |
| 7773 |
Pemasangan Kateter Ureter (ESWL) (Sore) |
3,750,000 |
| 7774 |
Pemasangan kateter urin |
175,000 |
| 7775 |
Pemasangan Kembali Molar Band |
70,000 |
| 7776 |
Pemasangan Kembali Molar Band (Eksekutif) |
70,000 |
| 7777 |
Pemasangan Kruk |
99,000 |
| 7778 |
Pemasangan Lingual Bar |
1,100,000 |
| 7779 |
Pemasangan Lingual Bar (Eksekutif) |
0 |
| 7780 |
Pemasangan Long Line |
210,000 |
| 7781 |
Pemasangan Mahkota Implant |
860,000 |
| 7782 |
Pemasangan Mini Screw |
1,500,000 |
| 7783 |
Pemasangan Mini Screw (Eksekutif) |
1,770,000 |
| 7784 |
Pemasangan Nasal HFO pasien neonatus |
2,681,000 |
| 7785 |
Pemasangan nasojejunal feeding tube (NJFT) |
500,000 |
| 7786 |
Pemasangan Negative Pressure Wound Therapy (NPWT) |
1,833,000 |
| 7787 |
Pemasangan NGT |
0 |
| 7788 |
Pemasangan NGT (RJ) |
33,400 |
| 7789 |
Pemasangan NGT Neonatus |
334,000 |
| 7790 |
Pemasangan Nitric Oxide (NOxBOXi) |
4,000,000 |
| 7791 |
Pemasangan NIV |
720,000 |
| 7792 |
Pemasangan NIV dengan NAVA pasien pediatrik |
721,000 |
| 7793 |
Pemasangan NIV pasien dewasa |
720,000 |
| 7794 |
Pemasangan NIV pasien neonatus |
720,000 |
| 7795 |
Pemasangan NIV+ NAVA pasien neonatus |
720,000 |
| 7796 |
Pemasangan NIV+ NAVA pasien pediatrik |
720,000 |
| 7797 |
Pemasangan non invasive respiratory support lainnya |
400,000 |
| 7798 |
Pemasangan non invasive respiratory support lainnya pasien dewasa |
400,000 |
| 7799 |
Pemasangan Non-invasive respiratory support |
720,000 |
| 7800 |
Pemasangan oropharyngeal airway |
184,000 |
| 7801 |
Pemasangan pacu jantung transkutan pasien dewasa |
3,389,000 |
| 7802 |
Pemasangan pacu jantung transkutan pasien neonatus |
3,389,000 |
| 7803 |
Pemasangan pacu jantung transkutan pasien pediatrik |
3,389,000 |
| 7804 |
Pemasangan pacu jantung transvena pasien dewasa |
3,389,000 |
| 7805 |
Pemasangan pacu jantung transvena pasien neonatus |
3,389,000 |
| 7806 |
Pemasangan pacu jantung transvena pasien pediatrik |
3,389,000 |
| 7807 |
Pemasangan pasak post core |
964,000 |
| 7808 |
Pemasangan PCA CADD |
307,000 |
| 7809 |
Pemasangan PDT terencana dan emergency pasien dewasa |
13,712,000 |
| 7810 |
Pemasangan PDT terencana dan emergency pasien neonatus |
13,712,000 |
| 7811 |
Pemasangan PDT terencana dan emergency pasien pediatrik |
13,712,000 |
| 7812 |
Pemasangan Peripherally Inserted Central Catheter (PICC) |
3,487,000 |
| 7813 |
Pemasangan Peritoneal Dialisis Akut |
825,000 |
| 7814 |
Pemasangan PICC dengan USG |
4,186,000 |
| 7815 |
Pemasangan PICC neonatus |
3,487,000 |
| 7816 |
Pemasangan PICC pasien dewasa |
3,487,000 |
| 7817 |
Pemasangan PICC pasien neonatus |
3,487,000 |
| 7818 |
Pemasangan PICC pasien pediatrik |
3,487,000 |
| 7819 |
Pemasangan PICC pediatrik |
3,487,000 |
| 7820 |
Pemasangan pigtail asites |
1,371,000 |
| 7821 |
Pemasangan Pilar Implant/Somnoplasty |
2,850,000 |
| 7822 |
Pemasangan Pintasan VA/VP Shunt |
7,337,579 |
| 7823 |
Pemasangan Pipa Shepard |
3,850,000 |
| 7824 |
Pemasangan port access needle/surecan |
722,000 |
| 7825 |
Pemasangan rectal tube |
74,000 |
| 7826 |
Pemasangan rectal tube neonatus |
74,000 |
| 7827 |
Pemasangan Retainer Bening Satu Rahang |
400,000 |
| 7828 |
Pemasangan Retainer Bening Satu Rahang (Eksekutif) |
0 |
| 7829 |
Pemasangan Retainer Cekat Satu Rahang |
1,000,000 |
| 7830 |
Pemasangan Retainer Cekat Satu Rahang (Eksekutif) |
0 |
| 7831 |
Pemasangan Retainer Plat Satu Rahang |
400,000 |
| 7832 |
Pemasangan Retainer Plat Satu Rahang (Eksekutif) |
0 |
| 7833 |
Pemasangan Separator Per Set |
100,000 |
| 7834 |
Pemasangan Separator Per Set (Eksekutif) |
0 |
| 7835 |
Pemasangan SILO bag |
13,420,000 |
| 7836 |
Pemasangan Sistostomi Perkutan (Lokal) |
3,400,000 |
| 7837 |
Pemasangan Slab / splint |
879,000 |
| 7838 |
Pemasangan Stent Metal Bilier |
42,590,000 |
| 7839 |
Pemasangan Stent Metal Bilier (Sore) |
42,590,000 |
| 7840 |
Pemasangan Stent Metal Esofagus/ Gaster/ Duodenum/ Colon/ Rektosigmoid (Sore) |
55,760,000 |
| 7841 |
Pemasangan Stent Metal Esofagus/Gaster/Duodenum/Colon/Rektosigmoid |
37,180,000 |
| 7842 |
Pemasangan stent metal saluran cerna bagian atas |
38,596,000 |
| 7843 |
Pemasangan stent metal saluran cerna bagian bawah |
38,596,000 |
| 7844 |
Pemasangan Stent Non Vascular |
3,000,000 |
| 7845 |
Pemasangan Stent Non Vascular + Anastesi |
4,790,000 |
| 7846 |
Pemasangan Stent Non Vaskular (dengan stent) Kasus Simpel |
32,578,000 |
| 7847 |
Pemasangan Stent Non Vaskular (dengan stent) Kasus Simpel dengan anestesi |
36,942,000 |
| 7848 |
Pemasangan SwanGanz Kateter pasien dewasa |
8,125,000 |
| 7849 |
Pemasangan SwanGanz Kateter pasien neonatus |
8,125,000 |
| 7850 |
Pemasangan SwanGanz Kateter pasien pediatrik |
8,125,000 |
| 7851 |
Pemasangan Swans Ganz |
8,125,000 |
| 7852 |
Pemasangan T Tube |
3,850,000 |
| 7853 |
Pemasangan T-Tube / Ganti T Stent |
11,655,000 |
| 7854 |
Pemasangan Tampon Hidung Anterior |
207,000 |
| 7855 |
Pemasangan Tampon Hidung Posterior |
379,000 |
| 7856 |
Pemasangan Tampon Telinga |
207,000 |
| 7857 |
Pemasangan TIPS |
14,450,000 |
| 7858 |
Pemasangan TIPS + Anastesi |
18,950,000 |
| 7859 |
Pemasangan total contact cast |
221,000 |
| 7860 |
Pemasangan TPA |
100,000 |
| 7861 |
Pemasangan TPA (Eksekutif) |
0 |
| 7862 |
Pemasangan TPM transkutan |
8,921,000 |
| 7863 |
Pemasangan TPM transvena |
8,329,000 |
| 7864 |
Pemasangan TPM transvena dengan anestesi |
9,706,000 |
| 7865 |
Pemasangan Traksi Cervical / dan pemasangan HaloVest |
23,445,000 |
| 7866 |
Pemasangan Traksi Cervical/ dan Pemasangan Halovest |
5,926,089 |
| 7867 |
Pemasangan Traksi Servikal |
6,116,000 |
| 7868 |
Pemasangan Umbilical Neonatus |
1,206,000 |
| 7869 |
Pemasangan Vena Dalam |
451,000 |
| 7870 |
Pemasangan vena Umbilical pasien neonatus |
1,206,000 |
| 7871 |
Pemasangan ventilator awal |
720,000 |
| 7872 |
Pemasangan Ventilator Non-Invasif/CPAP |
720,000 |
| 7873 |
Pemasangan zygoma implant per buah |
15,538,000 |
| 7874 |
Pemasangan/penggantian Negative Pressure Wound Therapy (NPWT) pasien dewasa |
1,833,000 |
| 7875 |
Pemasangan/penggantian Negative Pressure Wound Therapy (NPWT) pasien neonatus |
1,833,000 |
| 7876 |
Pemasangan/penggantian Negative Pressure Wound Therapy (NPWT) pasien pediatrik |
1,833,000 |
| 7877 |
Pembacaan slide PA disertai interpretasi dan relevansi DVE |
227,000 |
| 7878 |
Pembedahan Forequarter (Bedah Onkology) |
6,472,000 |
| 7879 |
Pembedahan Forequater |
12,937,000 |
| 7880 |
Pembedahan perforasi tukak peptik |
15,000,000 |
| 7881 |
Pembentukan vagina/neovagina |
13,233,000 |
| 7882 |
Pembentukan vagina/neovagina dengan graft |
19,850,000 |
| 7883 |
Pembentukan vagina/neovagina dengan graft bowel |
19,850,000 |
| 7884 |
Pemberian antibiotik intraventrikel |
34,000 |
| 7885 |
Pemberian Enteral Nutrisi |
85,000 |
| 7886 |
Pemberian immunoglobulin (IVIg) neonatus |
737,000 |
| 7887 |
Pemberian Immunonutrisi |
225,000 |
| 7888 |
Pemberian Imunosupresan Intravena Rawat Jalan (Siklosfosfamid) |
463,000 |
| 7889 |
Pemberian imunoterapi (dan steroid) |
449,000 |
| 7890 |
Pemberian Keterangan Ahli di dalam pengadilan |
750,000 |
| 7891 |
Pemberian Keterangan Ahli di luar pengadilan |
750,000 |
| 7892 |
Pemberian Nutrisi Via NGT |
0 |
| 7893 |
Pemberian Nutrisi Via NGT (RJ) |
39,360 |
| 7894 |
Pemberian Obat Via Rectal |
77,000 |
| 7895 |
Pemberian Parental Nutrisi/Total Parental Nutrisi |
225,000 |
| 7896 |
Pemberian Parenteral Nutrisi / Total Parenteral Nutrisi |
225,000 |
| 7897 |
Pemberian Siklofosfamid |
631,000 |
| 7898 |
Pemberian Sitotastika |
250,000 |
| 7899 |
Pemberian Sonde |
25,000 |
| 7900 |
Pemberian Surfaktan |
653,000 |
| 7901 |
Pemberian Surfaktan |
349,000 |
| 7902 |
Pemberian Surfaktan pasien neonatus |
1,800,000 |
| 7903 |
Pemberian terapi DMARD biologik (intravena) |
661,000 |
| 7904 |
Pemberian terapi DMARD biologik (subkutan) |
314,000 |
| 7905 |
Pemberian Terapi Parentral Nutrisi Harian |
225,000 |
| 7906 |
Pemberian Terapi Parentral Nutrisi Harian pasien pediatrik |
225,000 |
| 7907 |
Pemberian Tetes Mata |
40,000 |
| 7908 |
Pembersihan Karang Gigi (Banyak 1/2 Rahang) |
70,000 |
| 7909 |
Pembersihan Karang Gigi (Rahang Bawah + Rahang Atas) |
140,000 |
| 7910 |
Pembersihan Karang Gigi RA/RB (Kronis) |
670,000 |
| 7911 |
Pembersihan Karang Gigi RA/RB (Kronis) (Eksekutif) |
0 |
| 7912 |
Pembersihan Karang Gigi RA/RB (Simple) |
540,000 |
| 7913 |
Pembersihan Karang Gigi RA/RB (Simple) (Eksekutif) |
600,000 |
| 7914 |
Pembuatan blok parafin dan slide HE jaringan besar (diameter terbesar 6-10 cm/ volume maksimal 50 cc) tanpa interpretasi |
778,000 |
| 7915 |
Pembuatan blok parafin dan slide HE jaringan kecil (diameter terbesar ? 2cm/ volume maksimal 5 cc) tanpa interpretasi |
499,000 |
| 7916 |
Pembuatan blok parafin dan slide HE jaringan khusus (diameter terbesar > 10 cm/ volumen maksimal > 50 cc) tanpa interpretasi |
934,000 |
| 7917 |
Pembuatan blok parafin dan slide HE jaringan sedang (diameter terbesar 3-5cm/ volume maksimal 25 cc) tanpa interpretasi |
599,000 |
| 7918 |
Pembuatan Cervical Collar Semi Rigid |
179,000 |
| 7919 |
Pembuatan Cervical Collar Soft |
264,000 |
| 7920 |
Pembuatan CTO Cervical Thoracal Ortosis |
776,000 |
| 7921 |
Pembuatan Individual Tray Akrilik per Rahang |
1,254,000 |
| 7922 |
Pembuatan Jadwal Makan |
50,000 |
| 7923 |
Pembuatan LS Korset (LSO Semi Rigid) |
136,000 |
| 7924 |
Pembuatan LSO (F-E-L) Kontrol, Knight Brace |
1,053,000 |
| 7925 |
Pembuatan LSO (F-E) Kontrol , Chairback |
1,477,000 |
| 7926 |
Pembuatan LSO Flexion- Lateral- Rotary (F-L-R) Control Orthosis (Cowhorn Brace) |
759,000 |
| 7927 |
Pembuatan LSO Jacket, Boston Overlap |
1,141,000 |
| 7928 |
Pembuatan meal plan |
50,000 |
| 7929 |
Pembuatan Prostesis Atas Siku / Disartikulasi Siku / Pas Siku Khusus Fungsional |
2,151,000 |
| 7930 |
Pembuatan Prostesis Atas Siku / Disartikulasi Siku/ Pas Siku Kosmetik |
3,617,000 |
| 7931 |
Pembuatan Prostesis Bawah Lutut |
4,483,000 |
| 7932 |
Pembuatan Prostesis Bawah Lutut Komponen Foot Khusus |
4,868,000 |
| 7933 |
Pembuatan Prostesis Bawah Lutut Komponen Khusus |
12,003,000 |
| 7934 |
Pembuatan Prostesis Bawah Lutut/Tengah Lutut + Korset Paha Besar/paha kecil |
4,769,000 |
| 7935 |
Pembuatan Prostesis Bawah Siku Fungsional |
1,782,000 |
| 7936 |
Pembuatan Prostesis Bawah Siku Kosmetik |
2,454,000 |
| 7937 |
Pembuatan Prostesis Chopart Biasa |
1,704,000 |
| 7938 |
Pembuatan Prostesis Chopart Biasa |
2,474,000 |
| 7939 |
Pembuatan Prostesis Chopart Khusus |
2,184,000 |
| 7940 |
Pembuatan Prostesis Disartikulasi Bahu Khusus Fungsional |
2,772,000 |
| 7941 |
Pembuatan Prostesis Disartikulasi Bahu Kosmetik |
2,772,000 |
| 7942 |
Pembuatan Prostesis Disartikulasi Pergelangan Tangan Kosmetik |
4,689,000 |
| 7943 |
Pembuatan Prostesis Disartikulasi Pergelangan Tangan Kosmetik Khusus |
4,689,000 |
| 7944 |
Pembuatan Prostesis Pas Panggul Fungsional |
4,689,000 |
| 7945 |
Pembuatan Prostesis Pas Panggul Khusus Fungsional |
4,689,000 |
| 7946 |
Pembuatan Prostesis Pas Panggul Kosmetik |
4,689,000 |
| 7947 |
Pembuatan Prostesis Sebagian Jari Kosmetik |
2,220,000 |
| 7948 |
Pembuatan Prostesis Sebagian Tangan Kosmetik |
4,689,000 |
| 7949 |
Pembuatan protesa atas lutut / Tengah lutut fungsional, khusus fungsional |
4,612,000 |
| 7950 |
Pembuatan protesa atas lutut / Tengah lutut khusus fungsional |
4,612,000 |
| 7951 |
Pembuatan protesa atas lutut / tengah lutut khusus kosmetik |
4,612,000 |
| 7952 |
Pembuatan Sacroiliac Corset |
385,000 |
| 7953 |
Pembuatan Single Lateral-Upright Metal KAFO / Scott-Craig Metal KAFO with Drop Ring Lock (Dengan Sepatu / Tanpa Sepatu) |
1,400,000 |
| 7954 |
Pembuatan Single Upright Metal KAFO with Swiss Lock (Dengan Sepatu / Tanpa Sepatu) |
1,400,000 |
| 7955 |
Pembuatan Single Upright Plastic HKAFO with Swiss Lock |
1,400,000 |
| 7956 |
Pembuatan slide HE (per slide) |
250,000 |
| 7957 |
Pembuatan slide sitologi ginekologi konvensional tanpa interpretasi |
1,027,000 |
| 7958 |
Pembuatan slide sitologi ginekologi LBC tanpa interpretasi |
477,000 |
| 7959 |
Pembuatan slide sitologi non ginekologi tanpa interpretasi (> 15 slides) |
593,000 |
| 7960 |
Pembuatan slide sitologi non ginekologi tanpa interpretasi (< 5 slides) |
351,000 |
| 7961 |
Pembuatan slide sitologi non ginekologi tanpa interpretasi (5-15 slides) |
498,000 |
| 7962 |
Pembuatan Soft Cervical Collar (Zimmer Collar) |
235,000 |
| 7963 |
Pembuatan Thermoplastic Insert (University of California Biomechanics Laboratory (UCBL), Heel Cup, Sesamoid Insert, Metatarsal Insert, Longitudinal Arch Insert) |
284,000 |
| 7964 |
Pembuatan TLS Corset |
385,000 |
| 7965 |
Pembuatan TLS Korset (TLSO Semi Rigid) |
186,000 |
| 7966 |
Pembuatan TLSO (F-E-L) Control Ortosis, Knight Taylor Brace |
1,056,000 |
| 7967 |
Pembuatan TLSO (F-E-L) Flexion – Extension – Lateral Control Orthosis (Knight Taylor Brace) |
861,000 |
| 7968 |
Pembuatan TLSO (F-E) Control Ortosis, Taylor Brace |
1,027,000 |
| 7969 |
Pembuatan TLSO Flexion (F) Control Orthosis |
569,000 |
| 7970 |
Pembuatan TLSO Flexion- Extension (F-E) Control Orthosis (Taylor Brace) |
759,000 |
| 7971 |
Pembuatan TLSO Flexion- Extension- Lateral- Rotary (F-E-L-R) Control Orthosis (TLS jacket) |
759,000 |
| 7972 |
Pembuatan TLSO Hyperextension Brace (Jewwet) |
1,027,000 |
| 7973 |
Pembuatan TLSO Scoliotic Brace (Muenster), TLSO Scoliotic Brace Under Arm Brace (Boston) |
759,000 |
| 7974 |
Pembuatan unstained slide (per slide) |
25,000 |
| 7975 |
Pembuatan Unstained Slide (per slide) Imunohistokimia |
240,000 |
| 7976 |
Pembuatan unstained slide poly-L-lysine (per slide) |
150,000 |
| 7977 |
Pembukaan lubang hidung THT |
3,850,000 |
| 7978 |
Pembukaan obturator/nostril retainer |
2,375,000 |
| 7979 |
Pemeriksaan Adekusi Kt/v CAPD |
1,450,000 |
| 7980 |
Pemeriksaan Antropometri Dokter |
126,000 |
| 7981 |
Pemeriksaan Antropometri Paramedis |
126,000 |
| 7982 |
Pemeriksaan APE / PFR |
207,000 |
| 7983 |
Pemeriksaan Bimanual Vagina |
100,000 |
| 7984 |
Pemeriksaan Bioimpedance Analysis |
300,000 |
| 7985 |
Pemeriksaan Biothesiometer |
345,000 |
| 7986 |
Pemeriksaan body composition analysis menggunakan metode BIA |
300,000 |
| 7987 |
Pemeriksaan Body/Fat Composition |
150,000 |
| 7988 |
Pemeriksaan Cairan Aspirasi (FNAB) Deep (Guidance) |
750,000 |
| 7989 |
Pemeriksaan Cairan Aspirasi (FNAB) superfisial |
500,000 |
| 7990 |
Pemeriksaan Cairan Prostat (Massage Prostat) |
135,000 |
| 7991 |
Pemeriksaan Candidiasis Vaginalis (Flour Albus) |
115,000 |
| 7992 |
Pemeriksaan Combs test/Pemeriksaan Inkompatibel |
238,000 |
| 7993 |
Pemeriksaan Crossmatch/uji silang serasi |
97,000 |
| 7994 |
Pemeriksaan Dalam Jenazah |
2,209,000 |
| 7995 |
Pemeriksaan dalam jenazah (dalam jam kerja) |
2,209,000 |
| 7996 |
Pemeriksaan dalam jenazah (diluar jam kerja) |
2,209,000 |
| 7997 |
Pemeriksaan Dalam Jenazah dugaan pidana penganiayaan ringan (dengan rekonstruksi berat) |
3,154,000 |
| 7998 |
Pemeriksaan Dalam Jenazah dugaan pidana penganiayaan ringan (dengan rekonstruksi sedang) |
3,154,000 |
| 7999 |
Pemeriksaan Dalam Jenazah dugaan pidana penganiayaan ringan (tanpa rekonstruksi - rekonstruksi ringan) |
3,154,000 |
| 8000 |
Pemeriksaan Dalam Jenazah kasus Aborsi |
2,209,000 |
| 8001 |
Pemeriksaan Dalam Jenazah kasus Infanticide |
2,209,000 |
| 8002 |
Pemeriksaan Dalam Jenazah kasus Intoksikasi |
2,209,000 |
| 8003 |
Pemeriksaan Dalam Jenazah kasus Kejahatan Seksual |
2,209,000 |
| 8004 |
Pemeriksaan Dalam Jenazah WNA |
3,716,000 |
| 8005 |
Pemeriksaan Dalam Jenazah-Virtual |
3,234,000 |
| 8006 |
Pemeriksaan dengan Lampu Wood |
100,000 |
| 8007 |
Pemeriksaan deteksi mutasi EGFR |
2,500,000 |
| 8008 |
Pemeriksaan diagnostik kelainan muskular Compount Muscle Action Potential |
300,000 |
| 8009 |
Pemeriksaan diagnostik kelainan perkembangan Hummer Smith Infant Neurological Examination |
300,000 |
| 8010 |
Pemeriksaan diagnostik spinal atrofi Hammersmith Functional Motor Scale Expanded-HMFSE |
300,000 |
| 8011 |
Pemeriksaan diagnostik untuk distropi muskular (Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders CHOP-inten) |
300,000 |
| 8012 |
Pemeriksaan Dokter ( Pemeriksaan fisik )(Home Care) |
52,000 |
| 8013 |
Pemeriksaan Easy Nogal Secret Hidung |
100,000 |
| 8014 |
Pemeriksaan ELEKTROFISIOLOGI N. FASIALIS |
282,000 |
| 8015 |
Pemeriksaan Fasialis |
300,000 |
| 8016 |
Pemeriksaan Fisik / Konsultasi Dokter Ahli ( DPRD ) |
135,000 |
| 8017 |
Pemeriksaan Fisik / Konsultasi Dokter Spesialis |
250,000 |
| 8018 |
Pemeriksaan Fisik / Konsultasi Dokter Spesialis ( diluar jam kerja ) |
350,000 |
| 8019 |
Pemeriksaan Fisik / Konsultasi Dokter Sub Spesialis/Konsultan |
300,000 |
| 8020 |
Pemeriksaan Fisik / Konsultasi Dokter Sub Spesialis/Konsultan ( diluar jam kerja ) |
400,000 |
| 8021 |
Pemeriksaan Fisik / Konsultasi Professor ( Guru Besar ) |
650,000 |
| 8022 |
Pemeriksaan Fisik & Konsultasi Dokter Ahli |
120,000 |
| 8023 |
Pemeriksaan Fisik & Konsultasi Dokter Spesialis (diluar jam kerja) (Poli Eksekutif) |
350,000 |
| 8024 |
Pemeriksaan Fisik & Konsultasi Dokter Spesialis (Poli Eksekutif) |
250,000 |
| 8025 |
Pemeriksaan Fisik & Konsultasi Dokter Sub Spesialis/Konsultan (diluar jam kerja) (Poli Eksekutif) |
400,000 |
| 8026 |
Pemeriksaan Fisik & Konsultasi Dokter Sub Spesialis/Konsultan (Poli Eksekutif) |
300,000 |
| 8027 |
Pemeriksaan Fisik & Konsultasi Dokter Umum |
90,000 |
| 8028 |
Pemeriksaan Fisik & Konsultasi Professor (Guru Besar) (Poli Eksekutif) |
650,000 |
| 8029 |
Pemeriksaan Fisik dan Konsultasi Dokter Ahli |
120,000 |
| 8030 |
Pemeriksaan Fisik dan Konsultasi Dokter Umum |
90,000 |
| 8031 |
Pemeriksaan fisik terkait gizi |
86,000 |
| 8032 |
Pemeriksaan Fisik Vaginal dengan Speculum |
47,000 |
| 8033 |
Pemeriksaan Fisik/Konsultasi dr. Ahli (Poli Sore) |
300,000 |
| 8034 |
Pemeriksaan Forensik Korban Hidup dugaan kejahatan seksual |
753,000 |
| 8035 |
Pemeriksaan Forensik Korban Hidup dugaan keracunan |
753,000 |
| 8036 |
Pemeriksaan Forensik Korban Hidup dugaan pidana KDRT |
753,000 |
| 8037 |
Pemeriksaan Forensik Korban Hidup dugaan pidana kejahatan khusus |
753,000 |
| 8038 |
Pemeriksaan Forensik Korban Hidup dugaan pidana lalu lintas |
753,000 |
| 8039 |
Pemeriksaan Forensik Korban Hidup dugaan pidana penganiayaan anak |
753,000 |
| 8040 |
Pemeriksaan Forensik Korban Hidup dugaan pidana umum penganiayaan |
753,000 |
| 8041 |
Pemeriksaan Forensik Tahanan |
815,000 |
| 8042 |
Pemeriksaan Funduskopi |
137,000 |
| 8043 |
Pemeriksaan garpu tala |
20,000 |
| 8044 |
Pemeriksaan golongan darah |
47,000 |
| 8045 |
Pemeriksaan golongan darah konfirmasi |
163,000 |
| 8046 |
Pemeriksaan Gram |
95,000 |
| 8047 |
Pemeriksaan Hb |
51,001 |
| 8048 |
Pemeriksaan Hertel |
41,000 |
| 8049 |
Pemeriksaan histokimia ginjal |
1,003,000 |
| 8050 |
Pemeriksaan histokimia non-perak |
603,000 |
| 8051 |
Pemeriksaan histokimia Perak |
604,000 |
| 8052 |
Pemeriksaan histopatologi biopsi ginjal |
847,000 |
| 8053 |
Pemeriksaan histopatologi biopsi esofagus/gaster/colon/kulit |
1,003,000 |
| 8054 |
Pemeriksaan histopatologi biopsi hati |
703,000 |
| 8055 |
Pemeriksaan histopatologi biopsi paket inflammatory bowel disease (IBD) |
1,004,000 |
| 8056 |
Pemeriksaan histopatologi jaringan besar (diameter terbesar 6-10 cm/ volume maksimal 50 cc) |
1,003,000 |
| 8057 |
Pemeriksaan histopatologi jaringan Hirschsprung |
1,009,000 |
| 8058 |
Pemeriksaan histopatologi jaringan kecil (diameter terbesar ? 2 cm/ volume maksimal 5 cc) |
664,000 |
| 8059 |
Pemeriksaan histopatologi jaringan khusus (diameter terbesar > 10 cm/ volume maksimal > 50 cc) |
1,175,000 |
| 8060 |
Pemeriksaan histopatologi jaringan khusus transplantasi |
2,913,000 |
| 8061 |
Pemeriksaan histopatologi jaringan sedang (diameter terbesar 3-5 cm/ volume maksimal 25 cc) |
836,000 |
| 8062 |
Pemeriksaan histopatologi surgical staging |
1,412,000 |
| 8063 |
Pemeriksaan impedans |
73,000 |
| 8064 |
Pemeriksaan Imunofluoresensi (IF) ginjal |
2,723,000 |
| 8065 |
Pemeriksaan Imunofluoresensi (IF) Ginjal |
2,717,000 |
| 8066 |
Pemeriksaan imunohistokimia paket limfoma dasar |
841,000 |
| 8067 |
Pemeriksaan imunohistokimia paket prognostik payudara (ER, PR,HER2 & Ki67) |
2,600,000 |
| 8068 |
Pemeriksaan imunohistokimia per antibody |
909,000 |
| 8069 |
Pemeriksaan Inspekulo |
186,000 |
| 8070 |
Pemeriksaan Kalorimetri Indirect |
855,000 |
| 8071 |
Pemeriksaan Kampimetri (Humphrey) |
317,000 |
| 8072 |
Pemeriksaan Kerangka |
2,209,000 |
| 8073 |
Pemeriksaan Kesehatan ( Khusus ) |
35,000 |
| 8074 |
Pemeriksaan Kesehatan (CPNS) |
45,000 |
| 8075 |
Pemeriksaan Keseimbangan dengan Frenzel |
282,000 |
| 8076 |
Pemeriksaan Keseimbangan Sederhana |
157,000 |
| 8077 |
Pemeriksaan Kesembingan dengan VHIT |
282,000 |
| 8078 |
Pemeriksaan klasifikasi palsi serebral menurut Gross Motor Function Classification System, Manual Ability Classification System (MACS), Communication Function Classification System (CFCS) |
300,000 |
| 8079 |
Pemeriksaan Klinis Neurologi umum |
340,000 |
| 8080 |
Pemeriksaan KOH dan Interpretasi |
99,000 |
| 8081 |
Pemeriksaan Kondiloma (As. Asetat) |
95,000 |
| 8082 |
Pemeriksaan koordinasi dan keseimbangan dengan 6 Minutes Walking Test |
258,001 |
| 8083 |
Pemeriksaan Korban Kekerasan Sexual (Korban Hidup) + VER |
250,000 |
| 8084 |
Pemeriksaan Korban Keracunan (Korban Hidup) + VER |
250,000 |
| 8085 |
Pemeriksaan Korban Perlukaan (Korban Hidup) + VER |
250,000 |
| 8086 |
Pemeriksaan Kt/V Pasien Dialisis Peritoneal |
1,615,000 |
| 8087 |
Pemeriksaan Lampu Wood |
105,000 |
| 8088 |
Pemeriksaan Lapangan Pandang Humphrey |
250,000 |
| 8089 |
Pemeriksaan Lapangan Pandang Humphrey (Eksekutif) |
0 |
| 8090 |
Pemeriksaan Limfadenopati |
96,000 |
| 8091 |
Pemeriksaan luar jenazah (dalam jam kerja) |
1,079,000 |
| 8092 |
Pemeriksaan luar jenazah (diluar jam kerja) |
1,079,000 |
| 8093 |
Pemeriksaan Luar Jenazah dugaan pidana penganiayaan ringan (dengan rekonstruksi berat) |
1,072,000 |
| 8094 |
Pemeriksaan Luar Jenazah dugaan pidana penganiayaan ringan (dengan rekonstruksi sedang) |
815,000 |
| 8095 |
Pemeriksaan Luar Jenazah dugaan pidana penganiayaan ringan (tanpa rekonstruksi - rekonstruksi ringan) |
516,000 |
| 8096 |
Pemeriksaan Luar Jenazah Jenazah Pembusukan Lanjut |
1,072,000 |
| 8097 |
Pemeriksaan Luar Jenazah kasus Aborsi |
1,072,000 |
| 8098 |
Pemeriksaan Luar Jenazah kasus Infanticide |
1,072,000 |
| 8099 |
Pemeriksaan Luar Jenazah kasus Intoksikasi |
1,072,000 |
| 8100 |
Pemeriksaan Luar Jenazah kasus Kejahatan Seksual |
1,072,000 |
| 8101 |
Pemeriksaan Luar Jenazah kasus Sudden Natural Death |
1,769,000 |
| 8102 |
Pemeriksaan Luar Jenazah kasus Suddent Unnatural Death |
1,769,000 |
| 8103 |
Pemeriksaan Luar Jenazah kasus Undetermined Death |
1,769,000 |
| 8104 |
Pemeriksaan Luar Jenazah WNA |
1,850,000 |
| 8105 |
Pemeriksaan Luar Jenazah WNA |
1,100,000 |
| 8106 |
Pemeriksaan mati batang otak pasien dewasa |
326,000 |
| 8107 |
Pemeriksaan mati batang otak pasien neonatus |
326,000 |
| 8108 |
Pemeriksaan mati batang otak pasien pediatrik |
326,000 |
| 8109 |
Pemeriksaan Morfologi Darah Tepi |
198,000 |
| 8110 |
Pemeriksaan Motorik Saraf Wajah |
300,000 |
| 8111 |
Pemeriksaan OAE |
281,000 |
| 8112 |
Pemeriksaan Orchidometer |
345,000 |
| 8113 |
Pemeriksaan paket biopsi khusus ginjal (histopatologi + histokimia) |
2,913,000 |
| 8114 |
Pemeriksaan penentuan mati batang otak |
326,000 |
| 8115 |
Pemeriksaan performa fisik ( TUTG, SPPB) |
211,000 |
| 8116 |
Pemeriksaan Peritoneal Equilibration Test (PET) |
1,900,001 |
| 8117 |
Pemeriksaan PET |
1,670,000 |
| 8118 |
Pemeriksaan pH Vagina |
100,000 |
| 8119 |
Pemeriksaan Potongan Tubuh (>1 Body Parts) |
2,209,000 |
| 8120 |
Pemeriksaan Potongan Tubuh (1 Body Parts, kecuali kepala) |
2,209,000 |
| 8121 |
Pemeriksaan Potongan Tubuh (1 Body Parts, kepala) |
2,209,000 |
| 8122 |
Pemeriksaan Psikiatrik pada Orangtua |
200,000 |
| 8123 |
Pemeriksaan Psikologi Pada Kasus Psikiatri Forensik |
250,000 |
| 8124 |
Pemeriksaan Sarcoptei Scabies |
115,000 |
| 8125 |
Pemeriksaan Scoliosis Program |
350,000 |
| 8126 |
Pemeriksaan Sediaan Basah |
178,001 |
| 8127 |
Pemeriksaan sitologi kiriman slides aspirasi (< 5 slides) |
593,000 |
| 8128 |
Pemeriksaan sitologi kiriman slides aspirasi (5-15 slides) |
703,000 |
| 8129 |
Pemeriksaan sitologi kiriman slides sikatan (< 5 slides) |
593,000 |
| 8130 |
Pemeriksaan sitologi kiriman slides sikatan (5-15 slides) |
703,000 |
| 8131 |
Pemeriksaan sitologi BAL analisis seluler |
594,000 |
| 8132 |
Pemeriksaan sitologi bilasan bronkus |
594,000 |
| 8133 |
Pemeriksaan sitologi bilasan peritoneum |
594,000 |
| 8134 |
Pemeriksaan sitologi blok sel |
1,178,000 |
| 8135 |
Pemeriksaan sitologi cairan pleura |
594,000 |
| 8136 |
Pemeriksaan sitologi cairan tubuh - asites |
593,000 |
| 8137 |
Pemeriksaan sitologi cairan tubuh - kista |
593,000 |
| 8138 |
Pemeriksaan sitologi cairan tubuh - LCS |
409,000 |
| 8139 |
Pemeriksaan sitologi cairan tubuh - perikardium |
593,000 |
| 8140 |
Pemeriksaan sitologi cairan tubuh - urin |
593,000 |
| 8141 |
Pemeriksaan sitologi FNAB radiologi guided deep (tindakan + interpretasi) |
891,000 |
| 8142 |
Pemeriksaan sitologi FNAB tanpa radiologi guided/swab/scrapping/smear (tindakan + interpretasi) |
785,000 |
| 8143 |
Pemeriksaan sitologi kiriman slides aspirasi (> 15 slides) |
785,000 |
| 8144 |
Pemeriksaan sitologi kiriman slides sikatan (> 15 slides) |
847,000 |
| 8145 |
Pemeriksaan sitologi LBC non ginekologi |
1,178,000 |
| 8146 |
Pemeriksaan sitologi pap smear konvensional (interpretasi) |
207,000 |
| 8147 |
Pemeriksaan sitologi pap smear konvensional (tindakan + interpretasi) |
312,000 |
| 8148 |
Pemeriksaan sitologi pap smear LBC (interpretasi) |
593,000 |
| 8149 |
Pemeriksaan sitologi pap smear LBC (tindakan + interpretasi) |
785,000 |
| 8150 |
Pemeriksaan sitologi sputum |
593,000 |
| 8151 |
Pemeriksaan SMA independence scale-upper limb module (SMAIS-ULM) |
300,000 |
| 8152 |
Pemeriksaan Standardized Skin Surface Biopsy dengan Sianoakrilat |
200,000 |
| 8153 |
Pemeriksaan Status Mental |
150,000 |
| 8154 |
Pemeriksaan Status Mental ( Eksekutif ) |
0 |
| 8155 |
Pemeriksaan status mental geriatri |
151,000 |
| 8156 |
Pemeriksaan status nutrisi geriatri |
99,000 |
| 8157 |
Pemeriksaan Strabismus |
103,000 |
| 8158 |
Pemeriksaan TCM |
25,000 |
| 8159 |
Pemeriksaan Tekanan Intraokuler |
78,000 |
| 8160 |
Pemeriksaan test Synacthen |
200,000 |
| 8161 |
Pemeriksaan tinggi lutut |
74,001 |
| 8162 |
Pemeriksaan Tiroid |
80,000 |
| 8163 |
Pemeriksaan Trichomoniasis |
115,000 |
| 8164 |
Pemeriksaan Umum Psikiatri / Wawancara Psikiatri Terstruktur |
150,000 |
| 8165 |
Pemeriksaan Umum Psikiatri / Wawancara Psikiatri Terstruktur ( Eksekutif ) |
0 |
| 8166 |
Pemeriksaan Umum Psikiatri pada anak dan remaja |
200,000 |
| 8167 |
Pemeriksaan Umum Psikiatri pada dewasa |
200,000 |
| 8168 |
Pemeriksaan Umum Psikiatri pada lansia |
200,000 |
| 8169 |
Pemeriksaan vagina lain |
103,000 |
| 8170 |
Pemeriksaan Vaginal Touche |
200,000 |
| 8171 |
Pemeriksaan Warna Ishihara |
0 |
| 8172 |
Pemeriksaan Warna Ishihara |
75,000 |
| 8173 |
Pemisahan kembar siam |
11,179,000 |
| 8174 |
Pemolesan Prothesa per Rahang |
303,000 |
| 8175 |
Pemulasaran Jenazah |
550,000 |
| 8176 |
Pemulasaran Jenazah |
550,000 |
| 8177 |
Penambahan Elemen* akrilik |
364,000 |
| 8178 |
Penambahan Pontik Per Pontik |
860,000 |
| 8179 |
Penambalan Gigi Sementara |
0 |
| 8180 |
Penanganan Dehisensi / Freshening dan Jahit Ulang 1 (kecil, 60 menit) |
300,000 |
| 8181 |
Penanganan Dehisensi / Freshening dan Jahit Ulang 2 (besar, 90 menit) |
500,000 |
| 8182 |
Penanganan Hematoma (buka jahitan) |
251,000 |
| 8183 |
Penanganan Hematoma Sederhana (punksi) |
151,000 |
| 8184 |
Penanganan Manipulatif Osteopatik (pada Persendian) untuk Mobilisasi Umum |
156,000 |
| 8185 |
Pencabutan WSD |
180,000 |
| 8186 |
Pencabutan Akses intraoseus |
451,000 |
| 8187 |
Pencabutan Akses intraoseus pasien dewasa |
451,000 |
| 8188 |
Pencabutan Akses intraoseus pasien neonatus |
451,000 |
| 8189 |
Pencabutan Akses intraoseus pasien pediatrik |
451,000 |
| 8190 |
Pencabutan arteri line |
778,000 |
| 8191 |
Pencabutan arteri line pasien dewasa |
778,000 |
| 8192 |
Pencabutan arteri line pasien neonatus |
778,000 |
| 8193 |
Pencabutan arteri line pasien pediatrik |
778,000 |
| 8194 |
Pencabutan arteri Umbilical pasien neonatus |
300,000 |
| 8195 |
Pencabutan CDL semi permanen/long-term |
706,000 |
| 8196 |
Pencabutan CDL Temporer/short-term |
706,000 |
| 8197 |
Pencabutan chest tube / WSD pasien dewasa |
549,000 |
| 8198 |
Pencabutan chest tube / WSD pasien neonatus |
549,000 |
| 8199 |
Pencabutan chest tube / WSD pasien pediatrik |
549,000 |
| 8200 |
Pencabutan CVC |
266,000 |
| 8201 |
Pencabutan CVC pasien dewasa |
266,000 |
| 8202 |
Pencabutan CVC pasien neonatus |
266,000 |
| 8203 |
Pencabutan CVC pasien pediatrik |
266,000 |
| 8204 |
Pencabutan dengan suntik (pedodonsia) |
580,000 |
| 8205 |
Pencabutan drain pasien dewasa |
116,000 |
| 8206 |
Pencabutan drain pasien neonatus |
116,000 |
| 8207 |
Pencabutan drain pasien pediatrik |
116,000 |
| 8208 |
Pencabutan epidural |
103,000 |
| 8209 |
Pencabutan gigi dan dengan komplikasi |
2,850,000 |
| 8210 |
Pencabutan gigi dengan komplikasi |
1,028,000 |
| 8211 |
Pencabutan Gigi Tanpa Komplikasi |
393,000 |
| 8212 |
Pencabutan Gigi tanpa komplikasi/penyulit |
393,001 |
| 8213 |
Pencabutan jahitan pasien dewasa |
167,000 |
| 8214 |
Pencabutan jahitan pasien neonatus |
167,000 |
| 8215 |
Pencabutan jahitan pasien pediatrik |
167,000 |
| 8216 |
Pencabutan nefrostomi bilateral |
116,000 |
| 8217 |
Pencabutan nefrostomi unilateral |
116,000 |
| 8218 |
Pencabutan PICC |
680,000 |
| 8219 |
Pencabutan PICC pasien dewasa |
680,000 |
| 8220 |
Pencabutan PICC pasien neonatus |
680,000 |
| 8221 |
Pencabutan PICC pasien pediatrik |
680,000 |
| 8222 |
Pencabutan tanpa suntik (pedodonsia) |
332,000 |
| 8223 |
Pencabutan vena Umbilical pasien neonatus |
300,000 |
| 8224 |
Pencampuran Nutrisi Parental |
48,000 |
| 8225 |
Pencampuran Obat Sitostatika |
195,000 |
| 8226 |
Pencetakan Alginat Per Rahang |
140,000 |
| 8227 |
Pencetakan Double Impression |
270,000 |
| 8228 |
Pencetakan Gigi RA dan RB |
250,000 |
| 8229 |
Pencetakan Gigi RA dan RB (Eksekutif) |
0 |
| 8230 |
Pendampingan Anestesi |
981,000 |
| 8231 |
Pendampingan Bronkoskopi |
1,294,000 |
| 8232 |
Pendampingan masa akhir kehidupan |
300,000 |
| 8233 |
Penektomi |
18,130,000 |
| 8234 |
Penektomi |
5,173,218 |
| 8235 |
Penektomi Parsial |
4,850,000 |
| 8236 |
Penentuan Kebutuhan Energi Basal |
65,000 |
| 8237 |
Penetapan Gigit/Gigitan Malam RA dan RB |
304,000 |
| 8238 |
Pengambilan 2/3 Guttap |
0 |
| 8239 |
Pengambilan Apusan Kulit/Rambut/Kuku untuk Bahan Pemeriksaan (Gram, PCR, Kultur) |
113,000 |
| 8240 |
Pengambilan Foto Berbagai Posisi untuk Layanan Kosmestik |
451,000 |
| 8241 |
Pengambilan Foto dengan Skin Imaging |
351,000 |
| 8242 |
Pengambilan Kerokan Kuku untuk Bahan Pemeriksaan (KOH, PCR, Kultur) |
113,000 |
| 8243 |
Pengambilan Kerokan Kulit untuk Bahan Pemeriksaan (KOH, PCR, Kultur) |
113,000 |
| 8244 |
Pengambilan Kerokan Rambut untuk Bahan Pemeriksaan (KOH, PCR, Kultur) |
113,000 |
| 8245 |
Pengambilan Kultur |
66,000 |
| 8246 |
Pengambilan Kultur Cairan CAPD |
116,000 |
| 8247 |
PENGAMBILAN SAMPEL ASPIRAT TRACHEA |
113,000 |
| 8248 |
PENGAMBILAN SAMPEL BTA KULIT (LEPRA) |
113,000 |
| 8249 |
Pengambilan Sampel Darah |
31,000 |
| 8250 |
Pengambilan Sampel Darah |
57,000 |
| 8251 |
Pengambilan Sampel Darah dan Serum |
0 |
| 8252 |
Pengambilan Sampel darah Keadaan Sulit ( Pasien Luka Bakar, Pasien Udema, Pasien Kemoterapi) |
105,000 |
| 8253 |
PENGAMBILAN SAMPEL KEROKAN KULIT |
113,000 |
| 8254 |
PENGAMBILAN SAMPEL KEROKAN KULIT (SKIN SCAPING UNTUK SKABIES) |
113,000 |
| 8255 |
PENGAMBILAN SAMPEL KEROKAN REKTUM (RECTAL SCRAPING) |
113,000 |
| 8256 |
PENGAMBILAN SAMPEL MASSAGE PROSTAT |
113,000 |
| 8257 |
PENGAMBILAN SAMPEL SCRAPING KORNEA |
113,000 |
| 8258 |
Pengambilan Sampel Sputum |
79,000 |
| 8259 |
Pengambilan Sampel Sputum |
0 |
| 8260 |
PENGAMBILAN SAMPEL SWAB CERVIX/VAGINA/URETHRA |
113,000 |
| 8261 |
PENGAMBILAN SAMPEL SWAB HIDUNG |
113,000 |
| 8262 |
PENGAMBILAN SAMPEL SWAB KONJUNGTIVA |
113,000 |
| 8263 |
PENGAMBILAN SAMPEL SWAB NASOFARING |
113,000 |
| 8264 |
Pengambilan Sampel Swab Nasofaring dan Orofaring |
100,000 |
| 8265 |
PENGAMBILAN SAMPEL SWAB NASOFARING-OROFARING |
113,000 |
| 8266 |
PENGAMBILAN SAMPEL SWAB OROFARING |
113,000 |
| 8267 |
PENGAMBILAN SAMPEL SWAB REKTAL |
113,000 |
| 8268 |
Pengambilan Spesimen untuk Tzank Smear |
251,000 |
| 8269 |
Pengangkatan Alat Fiksasi Mandibula |
3,409,000 |
| 8270 |
Pengangkatan Alat Terapeutik di Kepala Leher |
3,409,000 |
| 8271 |
Pengangkatan benda asing |
23,445,000 |
| 8272 |
Pengangkatan Bite Riser |
140,000 |
| 8273 |
Pengangkatan Fibro Adenom Mamae |
2,850,000 |
| 8274 |
Pengangkatan IMF |
9,006,000 |
| 8275 |
Pengangkatan Jaringan (Debridement) |
577,000 |
| 8276 |
Pengangkatan Neuro Fibroma |
250,000 |
| 8277 |
Pengangkatan Nevus Margo Palpebra |
675,000 |
| 8278 |
Pengangkatan Pack |
140,000 |
| 8279 |
Pengangkatan Skin Tag |
250,000 |
| 8280 |
Pengangkatan Tandur Kulit |
250,000 |
| 8281 |
Pengantaran Jenasah Melalui Laut |
1,750,000 |
| 8282 |
Pengantaran Jenasah Melalui Penerbangan |
2,750,000 |
| 8283 |
Pengasahan gigi untuk reshaping gigi |
230,000 |
| 8284 |
Pengaturan Diet |
100,000 |
| 8285 |
Pengaturan Non Invasive Ventilation (BiPAP, NIPPV) |
123,000 |
| 8286 |
Pengawetan Jenazah |
1,331,000 |
| 8287 |
Pengawetan Jenazah Pasca Autopsi |
1,692,000 |
| 8288 |
Pengawetan Jenazah Pasca Otopsi |
1,500,000 |
| 8289 |
Pengawetan Jenazah WNA |
2,272,000 |
| 8290 |
Pengawetan jenazah WNA Infeksi ( HIV, AIDS) |
3,800,000 |
| 8291 |
Pengawetan jenazah WNA Non Infeksi |
2,000,000 |
| 8292 |
Pengecatan Gram |
30,000 |
| 8293 |
Pengelolaan bereavement pada keluarga |
200,000 |
| 8294 |
Pengelolaan CRRT harian |
2,259,000 |
| 8295 |
Pengelolaan ECMO harian |
778,000 |
| 8296 |
Pengelolaan Hemodinamik Non-Invasif |
128,000 |
| 8297 |
Pengelolaan Ventilator harian |
127,000 |
| 8298 |
Pengelolaan ventilator non-invasif/CPAP harian |
127,000 |
| 8299 |
Penggantian Archwire NiTi (1 Rahang) |
170,000 |
| 8300 |
Penggantian Archwire NiTi (1 Rahang) (Eksekutif) |
0 |
| 8301 |
Penggantian Archwire NiTi (2 Rahang) |
200,000 |
| 8302 |
Penggantian Archwire NiTi (2 Rahang) (Eksekutif) |
240,000 |
| 8303 |
Penggantian Archwire SS (1 Rahang) |
150,000 |
| 8304 |
Penggantian Archwire SS (1 Rahang) (Eksekutif) |
0 |
| 8305 |
Penggantian Archwire SS (2 Rahang) |
170,000 |
| 8306 |
Penggantian Archwire SS (2 Rahang) (Eksekutif) |
0 |
| 8307 |
Penggantian Bracket |
150,000 |
| 8308 |
Penggantian Bracket (Eksekutif) |
0 |
| 8309 |
Penggantian Buccal Tube |
200,000 |
| 8310 |
Penggantian Buccal Tube (Eksekutif) |
0 |
| 8311 |
Penggantian kanul trakeostomi |
971,000 |
| 8312 |
Penggantian kanul trakeostomi pasien dewasa |
1,262,000 |
| 8313 |
Penggantian kanul trakeostomi pasien neonatus |
971,000 |
| 8314 |
Penggantian kanul trakeostomi pasien pediatrik |
971,000 |
| 8315 |
Penggantian Kateter Dialisis |
3,000,000 |
| 8316 |
Penggantian Kateter Dialisis (dengan kateter) Kasus Kompleks |
6,427,000 |
| 8317 |
Penggantian Kateter Dialisis (dengan kateter) Kasus Kompleks dengan anestesi |
7,657,000 |
| 8318 |
Penggantian Kateter Dialisis (dengan kateter) Kasus Simpel |
5,141,000 |
| 8319 |
Penggantian Kateter Dialisis (dengan kateter) Kasus Simpel dengan anestesi |
6,126,000 |
| 8320 |
Penggantian Kateter Dialisis + Anastesi |
4,790,000 |
| 8321 |
Penggantian Molar Band |
250,000 |
| 8322 |
Penggantian Molar Band (Eksekutif) |
0 |
| 8323 |
Penggantian nefrostomi bilateral |
797,000 |
| 8324 |
Penggantian nefrostomi unilateral |
797,000 |
| 8325 |
Penggantian Open/Close Coil Spring (1 Gigi) |
50,000 |
| 8326 |
Penggantian Open/Close Coil Spring (1 Gigi) (Eksekutif) |
0 |
| 8327 |
Penggantian Open/Close Coil Spring (2 s/d 4 Gigi) |
150,000 |
| 8328 |
Penggantian Open/Close Coil Spring (2 s/d 4 Gigi) (Eksekutif) |
170,000 |
| 8329 |
Penggantian Stent Laring / Trakea |
11,655,000 |
| 8330 |
Penggantian tabung chest tube pasien dewasa |
3,190,000 |
| 8331 |
Penggantian tabung chest tube pasien neonatus |
3,190,000 |
| 8332 |
Penggantian tabung chest tube pasien pediatrik |
3,190,000 |
| 8333 |
Penggantian tabung Water Sealed Drainege (WSD) |
547,000 |
| 8334 |
Penggantian Transfer Set Kateter Dialisis Peritoneal CAPD |
540,000 |
| 8335 |
Penggunaan Defibrilator / kardioversi |
1,404,000 |
| 8336 |
Penggunaan Kamar Pendingin |
300,000 |
| 8337 |
Penggunaan Nitrit Oxide |
14,000,000 |
| 8338 |
Penggunaan Ruang Inap Keluarga Duka |
150,000 |
| 8339 |
Penggunaan Ruangan VIP |
150,000 |
| 8340 |
Penggunaan Rumah Duka |
100,000 |
| 8341 |
Penggunaan Rumah Duka Ruangan VIP/hari |
1,520,000 |
| 8342 |
Pengisian 1 Saluran Akar |
760,000 |
| 8343 |
Pengisian 2 Saluran Akar |
1,200,000 |
| 8344 |
Pengisian 3 Saluran Akar/Lebih |
1,560,000 |
| 8345 |
Pengkajian Frailty |
179,000 |
| 8346 |
Pengkajian Fungsi Kognitif (Pepisan Demensia) |
100,000 |
| 8347 |
Pengkajian paripurna pasien geriatri |
138,000 |
| 8348 |
Pengkajian Sarkopenia |
138,000 |
| 8349 |
Pengkajian Status Gizi |
65,000 |
| 8350 |
Pengobatan Epistaksis |
66,000 |
| 8351 |
Pengukuran |
70,000 |
| 8352 |
Pengukuran & Interpretasi BIA Bedridden/Fat Composition |
300,000 |
| 8353 |
Pengukuran Ankle Brachial Index (ABI) |
28,000 |
| 8354 |
Pengukuran Berat Badan (Bb) |
0 |
| 8355 |
Pengukuran Berat Badan (Bb) (RJ) |
0 |
| 8356 |
Pengukuran dan interpretasi antropometri khusus (berat badan estimasi, berat badan koreksi, berat badan adjusted) |
92,001 |
| 8357 |
Pengukuran indeks massa tubuh |
50,000 |
| 8358 |
Pengukuran Kelenjar Tiroid |
65,000 |
| 8359 |
Pengukuran knee height |
74,001 |
| 8360 |
Pengukuran lingkar betis (calf circumference) |
27,000 |
| 8361 |
Pengukuran Lingkar Lengan Atas (LLA) |
54,000 |
| 8362 |
Pengukuran lingkar pinggang/panggul |
27,000 |
| 8363 |
Pengukuran MUAC (Mid Upper Arm Circumference) atau Lingkar Lengan Atas |
40,001 |
| 8364 |
Pengukuran Ortosis / Prostesis |
184,000 |
| 8365 |
Pengukuran panjang lengan (armspan/demispan) |
39,001 |
| 8366 |
Pengukuran Panjang Lengan (Demispan) |
40,000 |
| 8367 |
Pengukuran Panjang Penis |
65,000 |
| 8368 |
Pengukuran paparan Radiasi |
504,000 |
| 8369 |
Pengukuran tebal lipatan kulit |
41,001 |
| 8370 |
Pengukuran Tebal Lipatan Kulit (TLK) |
40,000 |
| 8371 |
Pengukuran Tinggi Badan (Tb) / Pengukuran Panjang Badan (Pb) |
0 |
| 8372 |
Pengukuran Tinggi Badan (Tb) / Pengukuran Panjang Badan (Pb) (RJ) |
0 |
| 8373 |
Pengukuran Tinggi Lutut (Knee High) |
75,000 |
| 8374 |
Pengukuran Vas |
70,000 |
| 8375 |
Pengurangan bite riser |
127,000 |
| 8376 |
Pengurangan Bite Riser |
140,000 |
| 8377 |
Penilaian awal pasien infeksi emerging dan re-emerging |
288,000 |
| 8378 |
Penilaian derajat dehidrasi |
99,000 |
| 8379 |
Penilaian Status Pubertas |
78,000 |
| 8380 |
Penile Length Test |
78,000 |
| 8381 |
Penjahitan < 10 Jahitan |
140,000 |
| 8382 |
Penjahitan > 10 Jahitan |
270,000 |
| 8383 |
Penjahitan rekonstruksi robekan vulva atau perineum lama |
12,027,000 |
| 8384 |
Penutupan ASD tanpa Pembedahan dengan menggunakan Device (ASO)/ Penutupan PFO tanpa Pembedahan dengan Device (PFO Ocluder)/PTA Carotis dengan Stent |
80,200,082 |
| 8385 |
Penutupan ASD tanpa Pembedahan dengan menggunakan Device (ASO)/ Penutupan PFO tanpa Pembedahan dengan Device (PFO Ocluder)/PTA Carotis dengan Stent + Anastesi |
92,563,349 |
| 8386 |
Penutupan ASD transkateter dengan device (implantasi occluder) dengan anestesi |
52,739,000 |
| 8387 |
Penutupan Defek Hernia Diafragmatika |
9,464,367 |
| 8388 |
Penutupan defek hernia diafragmatika |
31,134,000 |
| 8389 |
Penutupan Fistel area maksilofacial |
7,075,000 |
| 8390 |
Penutupan Fistel Celah Brakial bilateral |
8,978,000 |
| 8391 |
Penutupan Fistel Celah Brakial unilateral |
8,978,000 |
| 8392 |
Penutupan Fistel Faring |
8,978,000 |
| 8393 |
Penutupan Fistel Laring |
24,156,000 |
| 8394 |
Penutupan Fistel Mulut |
5,556,000 |
| 8395 |
Penutupan Fistel Trakeoesofagus |
9,853,000 |
| 8396 |
Penutupan fistula extra oral besar |
15,538,000 |
| 8397 |
Penutupan Fistula Extra Oral dengan Anastesia Lokal |
860,000 |
| 8398 |
Penutupan fistula extra oral kecil |
15,538,000 |
| 8399 |
Penutupan Fistula Oro Antral dengan Anastesia Lokal |
860,000 |
| 8400 |
Penutupan Fistula Oroantral |
7,000,000 |
| 8401 |
Penutupan fistula oroantral besar |
15,908,000 |
| 8402 |
Penutupan fistula oroantral kecil |
15,908,000 |
| 8403 |
Penutupan VSD transkateter dengan device (implantasi occluder) dengan anestesi |
65,542,000 |
| 8404 |
Penutupan/repair bocoran likuor serebrospinal |
25,091,000 |
| 8405 |
Penyadapan Jantung |
39,915,008 |
| 8406 |
Penyadapan Jantung + Anastesi |
43,630,247 |
| 8407 |
Penyakit Pembuluh Darah Perifer |
4,842,820 |
| 8408 |
Penyelesaian Problem RS |
33,000 |
| 8409 |
Penyusunan Gigi Anterior RA dan RB |
1,549,000 |
| 8410 |
Penyusunan Gigi Posterior RA dan RB |
1,997,000 |
| 8411 |
Per Oral Endoscopic Mucosectomy (POEM) |
34,420,000 |
| 8412 |
Per Oral Endoscopic Mucosectomy (POEM) (Sore) |
51,630,000 |
| 8413 |
Per oral endoscopic myotomy (POEM) |
34,429,000 |
| 8414 |
Perasi Peyronie |
14,302,000 |
| 8415 |
Perawatan Bayi Lahir dengan Sectio Caesaria |
489,000 |
| 8416 |
Perawatan CAPD |
654,000 |
| 8417 |
Perawatan CAPD Kronik |
606,000 |
| 8418 |
Perawatan CDL temporer dan semipermanen |
342,000 |
| 8419 |
Perawatan celsite (termasuk flushing chemo port) |
337,000 |
| 8420 |
Perawatan chemoport |
442,000 |
| 8421 |
Perawatan Chemoport dengan Komplikasi |
442,000 |
| 8422 |
Perawatan chest tube drain/WSD |
547,000 |
| 8423 |
Perawatan Chest tube/pleural catheter |
547,000 |
| 8424 |
Perawatan Cranule |
72,000 |
| 8425 |
Perawatan Cranule Trachea |
72,000 |
| 8426 |
Perawatan Cranule WSD |
72,000 |
| 8427 |
Perawatan CVC |
125,000 |
| 8428 |
Perawatan drain |
116,000 |
| 8429 |
Perawatan Exit Site |
164,000 |
| 8430 |
Perawatan Exit Site Kateter Dialisis Peritoneal |
181,000 |
| 8431 |
Perawatan Fixed Orthodonti Metal Bracket Dua Rahang |
7,340,000 |
| 8432 |
Perawatan Fixed Orthodonti Metal Bracket Dua Rahang (Eksekutif) |
0 |
| 8433 |
Perawatan Fixed Orthodonti Metal Bracket Satu Rahang |
3,950,000 |
| 8434 |
Perawatan Fixed Orthodonti Metal Bracket Satu Rahang (Eksekutif) |
0 |
| 8435 |
Perawatan Fixed Orthodonti Metal Bracket Seperempat Rahang |
2,490,000 |
| 8436 |
Perawatan Fixed Orthodonti Metal Bracket Seperempat Rahang (Eksekutif) |
0 |
| 8437 |
Perawatan Fixed Orthodonti Porcelain Bracket Dua Rahang |
12,390,000 |
| 8438 |
Perawatan Fixed Orthodonti Porcelain Bracket Dua Rahang (Eksekutif) |
0 |
| 8439 |
Perawatan Fixed Orthodonti Porcelain Bracket Satu Rahang |
6,380,000 |
| 8440 |
Perawatan Fixed Orthodonti Porcelain Bracket Satu Rahang (Eksekutif) |
0 |
| 8441 |
Perawatan Fixed Orthodonti Self Ligating Bracket |
14,960,000 |
| 8442 |
Perawatan Fixed Orthodonti Self Ligating Bracket (Eksekutif) |
0 |
| 8443 |
Perawatan luka bakar dengan sedasi |
958,000 |
| 8444 |
Perawatan luka bakar di wajah |
699,000 |
| 8445 |
Perawatan luka bakar tanpa sedasi dengan atau tanpa STSG |
699,000 |
| 8446 |
Perawatan luka besar (laparatomi) |
370,000 |
| 8447 |
Perawatan luka kecil (Sirkumsisi, luka paska PCNL) |
114,000 |
| 8448 |
Perawatan luka khusus (Hypospadia, flap) |
231,000 |
| 8449 |
Perawatan Luka Perineum |
10,000 |
| 8450 |
Perawatan Payudara |
10,000 |
| 8451 |
Perawatan Pengawetan jenazah + Jenazah Infeksi ( HIV, AIDS) |
2,268,000 |
| 8452 |
Perawatan Pengawetan jenazah + Jenazah Non Infeksi |
900,000 |
| 8453 |
Perawatan PICC |
127,000 |
| 8454 |
Perawatan Pulpa Capping |
70,000 |
| 8455 |
Perawatan Rumah 24 Jam/3 Shift (Home Care) |
850,000 |
| 8456 |
Perawatan Rumah 24 Jam/3 Shift (Home Care) |
750,000 |
| 8457 |
Perawatan Rumah Shift Pagi (Home Care) |
250,000 |
| 8458 |
Perawatan Rumah Shift Pagi (Home Care) |
350,000 |
| 8459 |
Perawatan Rumah Shift Sore (Home Care) |
350,000 |
| 8460 |
Perawatan Rumah Shift Sore (Home Care) |
250,000 |
| 8461 |
Perawatan Saluran Akar |
60,000 |
| 8462 |
Perawatan Saluran Akar Dengan One Visit (Akar Jamak) |
2,800,000 |
| 8463 |
Perawatan Saluran Akar Dengan One Visit (Akar Jamak) (Eksekutif) |
0 |
| 8464 |
Perawatan Saluran Akar Dengan One Visit (Akar Tunggal) |
1,870,000 |
| 8465 |
Perawatan Saluran Akar Dengan One Visit (Akar Tunggal) (Eksekutif) |
0 |
| 8466 |
Perawatan stoma |
137,000 |
| 8467 |
Perawatan Tali Pusat |
34,000 |
| 8468 |
Perawatan Tali Pusat |
23,000 |
| 8469 |
Perawatan TMD kompleks |
332,001 |
| 8470 |
Perawatan TMD sedang |
242,001 |
| 8471 |
Perawatan trakeostomi |
286,000 |
| 8472 |
Percutaneous achilles tenotomy (single) for CTEV |
13,734,000 |
| 8473 |
Percutaneous Arterial Mechanical Thrombectomy + Lytic Therapy |
21,890,000 |
| 8474 |
Percutaneous Cholangioscopy Kasus Simpel |
19,717,000 |
| 8475 |
Percutaneous Cholangioscopy Kasus Simpel dengan anestesi |
20,387,000 |
| 8476 |
Percutaneous closure 1 akses vaskular pada tindakan endovaskular |
33,088,000 |
| 8477 |
Percutaneous closure 2 akses atau lebih pada tindakan endovaskular |
49,633,000 |
| 8478 |
Percutaneous Dilatation Trakeostomi (PDT) |
3,588,000 |
| 8479 |
Percutaneous endoscopic gastrostomy (PEG) |
10,497,000 |
| 8480 |
Percutaneous Endoscopic Gastrostomy (PEG) |
8,730,000 |
| 8481 |
Percutaneous Endoscopic Gastrostomy (PEG) / Colostomy (PEC) |
9,620,000 |
| 8482 |
Percutaneous Endoscopic Gastrostomy (PEG)/ Colostomy (PEC) (Sore) |
14,430,000 |
| 8483 |
Percutaneous endoscopic jejunostomy (PEJ) |
10,370,000 |
| 8484 |
Percutaneous Intra Arterial Thrombolysis (PIAT) |
21,890,000 |
| 8485 |
Percutaneous Mitral Commissurotomy Transvenous (PTMC)/Baloon Mitral Valvotomy (BMV) |
13,110,000 |
| 8486 |
Percutaneous Nephrolithostripst (PNCL) |
11,245,000 |
| 8487 |
Percutaneous Transhepatic Biliary Drainage |
18,320,000 |
| 8488 |
Percutaneous Transluminal Angioplasty (PTA) : POBA |
21,438,000 |
| 8489 |
Percutaneous Transluminal Angioplasty (PTA) : POBA + DCB |
33,088,000 |
| 8490 |
Percutaneous Transluminal Angioplasty (PTA) : POBA + Intra-arterial imaging |
54,777,001 |
| 8491 |
Percutaneous Transluminal Angioplasty (PTA) : POBA + Stent |
65,721,000 |
| 8492 |
Percutaneous Transluminal Angioplasty (PTA) dengan 1 balon |
47,088,000 |
| 8493 |
Percutaneous Transluminal Angioplasty (PTA) dengan 1 bare stent |
47,088,000 |
| 8494 |
Percutaneous Transluminal Angioplasty (PTA) dengan 1 drug-eluting/covered stent |
47,088,000 |
| 8495 |
Percutaneous Transluminal Angioplasty (PTA) dengan 2 balon |
83,534,000 |
| 8496 |
Percutaneous Transluminal Angioplasty (PTA) dengan 2 bare stent |
64,257,000 |
| 8497 |
Percutaneous Transluminal Angioplasty (PTA) dengan 3 balon |
82,008,000 |
| 8498 |
Percutaneous Transluminal Angioplasty (PTA) dengan 3 bare stent |
82,008,000 |
| 8499 |
Percutaneous Transluminal Angioplasty (PTA) dengan 3 drug-eluting/covered stent |
82,008,000 |
| 8500 |
Percutaneous Transluminal Angioplasty (PTA) dengan 4 atau lebih bare stent |
123,637,000 |
| 8501 |
Percutaneous Transluminal Angioplasty (PTA) dengan 4 atau lebih drug-eluting/covered stent |
123,637,000 |
| 8502 |
Percutaneous Transluminal Angioplasty (PTA) dengan 4 balon atau lebih |
123,637,000 |
| 8503 |
Percutaneous Transluminal Angioplasty (PTV) : POBA |
21,438,000 |
| 8504 |
Percutaneous Transluminal Angioplasty (PTV) : POBA + DCB |
33,088,000 |
| 8505 |
Percutaneous Transluminal Angioplasty (PTV) : POBA + Intra-venous imaging |
54,777,001 |
| 8506 |
Percutaneous Transluminal Angioplasty (PTV) : POBA + Stent |
65,721,000 |
| 8507 |
Percutaneous Venous Mechanical Thrombectomy + Lytic Therapy |
20,958,000 |
| 8508 |
Percutaneous vertebroplasty |
14,020,000 |
| 8509 |
Percutaneouscopy Vesikolithotripsi |
20,896,000 |
| 8510 |
Percutaneus closure 1 akses pada tindakan endovaskular |
37,657,000 |
| 8511 |
Percutaneus drainage |
4,766,000 |
| 8512 |
Percutaneus Insertion Of Extracranial Carotid Arteri Stent |
76,740,000 |
| 8513 |
Percutaneus Insertion of extracranial carotid arteri stent (Eksekutif) |
0 |
| 8514 |
Percutaneus Insertion Of Extracranial Carotid Arteri Stent + Penyulit |
82,575,000 |
| 8515 |
Percutaneus Insertion of extracranial carotid arteri stent + penyulit (Eksekutif) |
0 |
| 8516 |
Percutaneus Insertion Of Intracranial Carotid Arteri Stent |
76,740,000 |
| 8517 |
Percutaneus Insertion of intracranial carotid arteri stent (Eksekutif) |
0 |
| 8518 |
Percutaneus Insertion Of Intracranial Carotid Arteri Stent + Penyulit |
82,575,000 |
| 8519 |
Percutaneus Insertion of intracranial carotid arteri stent + penyulit (Eksekutif) |
0 |
| 8520 |
Percutaneus Pulmonary Angioplasty (Pulmonary PTA) pada stenosis perifer pulmonal + anestesi |
61,167,000 |
| 8521 |
Percutaneus Pulmonary Intervensi dengan stent (Pulmonary PTA dengan stent) pada stenosis perifer pulmonal + anestesi |
61,167,000 |
| 8522 |
Percutaneus Trans Biliary Duct. (PTBD) |
18,866,131 |
| 8523 |
Percutaneus Trans Biliary Duct. (PTBD) + Anastesi |
24,950,000 |
| 8524 |
Percutaneus Transhepatic Biliary Drainage (Sore) |
21,250,000 |
| 8525 |
Percutanous decompression and steroid injection for Benign bone tumor |
14,621,000 |
| 8526 |
Perekaman EKG pasien dewasa |
129,000 |
| 8527 |
Perekaman EKG pasien neonatus |
129,000 |
| 8528 |
Perekaman EKG pasien pediatrik |
129,000 |
| 8529 |
Pergantian Cairan CAPD |
415,000 |
| 8530 |
Pergantian Transfer Set |
528,000 |
| 8531 |
Perhitungan Total Parenteral Nutrition |
400,000 |
| 8532 |
Pericardial Sintesis (Tapping) |
36,691,997 |
| 8533 |
Pericardial Sintesis (Tapping) + Anastesi |
39,735,130 |
| 8534 |
Pericardial Window |
12,005,000 |
| 8535 |
Pericardiectomy dengan CPB |
146,011,000 |
| 8536 |
Pericardiectomy tanpa CPB |
22,350,000 |
| 8537 |
Pericardiosintesis |
19,450,000 |
| 8538 |
Pericardiosintesis / Pilkasi Diafragma |
12,530,000 |
| 8539 |
Pericardiostomy |
8,799,000 |
| 8540 |
Perifer kontinu hari 1 |
796,000 |
| 8541 |
Perifer kontinu setelah hari 1 |
638,000 |
| 8542 |
Perikardiosentesis |
6,765,000 |
| 8543 |
Perikardiosintesis+ anestesi |
8,799,000 |
| 8544 |
Periksa Dalam Jenazah + VER |
3,000,000 |
| 8545 |
Periksa Dalam Jenazah WNA |
4,230,000 |
| 8546 |
Periksa Luar Jenazah + VER |
500,000 |
| 8547 |
Perimetri |
36,000 |
| 8548 |
Perineoplasti |
13,429,000 |
| 8549 |
Perineostomi |
16,450,000 |
| 8550 |
Periokardiosentesis pasien dewasa |
6,765,000 |
| 8551 |
Periokardiosentesis pasien neonatus |
6,765,000 |
| 8552 |
Periokardiosentesis pasien pediatrik |
6,765,000 |
| 8553 |
periosteal graft lokal |
33,088,000 |
| 8554 |
periosteal graft narkose |
37,696,000 |
| 8555 |
Peripheral Embolization |
27,679,000 |
| 8556 |
Peripheral Nerve Entrapment |
1,051,000 |
| 8557 |
Peripheral nerve injection (steroid) |
449,000 |
| 8558 |
Peripheral nerve injection analgesia |
349,000 |
| 8559 |
Peritonektomi parsial |
19,148,000 |
| 8560 |
Peritonektomi parsial per laparoskopi |
20,098,000 |
| 8561 |
Peritonektomi total |
23,879,000 |
| 8562 |
Perkutaneus Gastrostomi / Pemasangan PEG |
14,450,000 |
| 8563 |
Perkutaneus Gastrostomi / Pemasangan PEG + Anastesi |
18,950,000 |
| 8564 |
Peroneal Entrapment manual (tanpa panduan) |
281,000 |
| 8565 |
Peroneal Entrapment USG |
595,000 |
| 8566 |
Persalinan normal |
3,874,000 |
| 8567 |
Persalinan per vaginam pada riwayat SC / Vaginal birth after Cesarean Section (VBAC) |
5,036,000 |
| 8568 |
Persalinan sungsang per vaginam (Bracht, Burn Marshall) |
5,036,000 |
| 8569 |
Persalinan sungsang per vaginam (Klasik/Deventer, Muller, Lovset, Mauriceau) |
5,036,000 |
| 8570 |
Persiapan terapi kanker pada usia lanjut |
720,000 |
| 8571 |
Peti Jenazah |
1,750,000 |
| 8572 |
Peti Jenazah |
1,750,000 |
| 8573 |
Petrosectomy |
34,742,000 |
| 8574 |
Pewarnaan dan Interpretasi Pewarnaan Basil Tahan Asam |
100,000 |
| 8575 |
Pewarnaan dan Interpretasi Pewarnaan Gram |
100,000 |
| 8576 |
Pewarnaan dan Interpretasi Tzank Smear |
151,000 |
| 8577 |
PEWARNAAN JAMUR |
80,000 |
| 8578 |
Pewarnaan Khusus Histokimia - PAS |
600,000 |
| 8579 |
Pewarnaan Khusus Histokimia - Trichrome Masson |
600,000 |
| 8580 |
pH-metri impedance |
350,000 |
| 8581 |
Phaco + IOL premium local |
9,605,000 |
| 8582 |
Phaco + IOL premium narkose |
11,112,000 |
| 8583 |
Phaco + IOL standard dengan penyulit |
11,418,000 |
| 8584 |
Phaco + IOL standard lokal |
11,418,000 |
| 8585 |
Phaco + IOL standard narkose |
13,135,000 |
| 8586 |
Phacoemulsifikasi |
6,850,000 |
| 8587 |
Pharingoplasty |
4,850,000 |
| 8588 |
Pharyngeal Flap |
5,482,645 |
| 8589 |
Pharyngoplasty, GA |
22,616,000 |
| 8590 |
Philadelphia Collar |
950,000 |
| 8591 |
Phlebotomi Terapi |
436,000 |
| 8592 |
Phonophoresis |
72,600 |
| 8593 |
Phosphat Darah |
31,000 |
| 8594 |
Phosphat Urine |
31,000 |
| 8595 |
Phototherapy |
60,000 |
| 8596 |
PICC |
3,487,000 |
| 8597 |
Pick Up 1a |
350,000 |
| 8598 |
Pick Up 1b |
450,000 |
| 8599 |
Pick Up 2a |
450,000 |
| 8600 |
Pick Up 2b |
550,000 |
| 8601 |
Pick Up 3a |
450,000 |
| 8602 |
Pick Up 4a |
550,000 |
| 8603 |
Pick Up 4b |
650,000 |
| 8604 |
Pielokalikotomi |
16,450,000 |
| 8605 |
Pielolitotomi |
4,850,000 |
| 8606 |
Pijat Bayi prematur (high risik) |
171,000 |
| 8607 |
Pilkasi Diafragma |
6,175,000 |
| 8608 |
Piriformis Syndrom C -Arm Bilateral (Eksekutif) |
0 |
| 8609 |
Piriformis Syndrom C -Arm Unilateral (Eksekutif) |
0 |
| 8610 |
Piriformis Syndrom C-Arm Billateral |
7,910,000 |
| 8611 |
Piriformis Syndrom C-Arm Unilateral |
8,715,000 |
| 8612 |
Piriformis Syndrome USG |
595,000 |
| 8613 |
Plano Test (HCG) |
25,000 |
| 8614 |
Plasma Konvalesen (PK) |
2,186,000 |
| 8615 |
Plasma Konvalesen (PK) NAT |
2,436,000 |
| 8616 |
Plasma Konvalesen (PK) NAT skrining antibodi |
2,436,000 |
| 8617 |
Plasma Konvalesen (PK) skrining antibodi |
2,186,000 |
| 8618 |
Plasmaferesis |
2,259,000 |
| 8619 |
Plasmaferesis (Hemato) |
2,259,000 |
| 8620 |
Plasmaferesis CRRT |
2,259,000 |
| 8621 |
Plasmaferesis pasien dewasa |
2,259,000 |
| 8622 |
Plasmaferesis pasien neonatus |
2,259,000 |
| 8623 |
Plasmaferesis pasien pediatrik |
2,259,000 |
| 8624 |
Plaster aplication of extremity & spine |
3,850,000 |
| 8625 |
Plastic operation on hand with graft of muscle or fascia |
10,675,000 |
| 8626 |
Plastic operation on hand with other graft or implant |
10,675,000 |
| 8627 |
Plastik Erat |
260,000 |
| 8628 |
Plastik Erat |
260,000 |
| 8629 |
PLATELET RICH PLASMA |
600,000 |
| 8630 |
Play Audiometry |
282,000 |
| 8631 |
Play Terapi |
40,000 |
| 8632 |
Plebography Bilateral |
718,000 |
| 8633 |
Plebography Bilateral + Anastesi |
2,730,000 |
| 8634 |
Plebography Unilateral |
555,000 |
| 8635 |
Plebography Unilateral + Anastesi |
2,100,000 |
| 8636 |
Plebotomi Tarapeutik |
600,000 |
| 8637 |
Plebotomi Terapi |
436,000 |
| 8638 |
Pleno Tim Hasil MCU |
1,000,000 |
| 8639 |
Pleurodesis |
1,714,000 |
| 8640 |
Pleurodesis |
675,000 |
| 8641 |
Pleurodesis Bleomycin |
1,714,000 |
| 8642 |
Pleurodesis Doksisiklin |
1,714,000 |
| 8643 |
Pleurofibrosis |
7,030,000 |
| 8644 |
Pleuroodesis Talc |
1,509,000 |
| 8645 |
Plikasi sub uretro-vesika |
11,530,000 |
| 8646 |
PMK Intermitten |
54,000 |
| 8647 |
PMK Kontinue |
54,000 |
| 8648 |
Pnemonektomi ( Bedah Paru/ Thorax ) |
21,102,000 |
| 8649 |
Pneumatic Displacement |
3,075,000 |
| 8650 |
Pneumatic Retinopexy Lokal |
5,415,000 |
| 8651 |
Pneumatic Retinopexy Narkose |
6,435,000 |
| 8652 |
POCT - GLUKOSA |
57,000 |
| 8653 |
POCT Pemeriksaan Elektrolit pasien dewasa |
233,000 |
| 8654 |
POCT Pemeriksaan Elektrolit pasien neonatus |
233,000 |
| 8655 |
POCT Pemeriksaan Elektrolit pasien pediatrik |
233,000 |
| 8656 |
POCT Pemeriksaan gula darah pasien dewasa |
140,000 |
| 8657 |
POCT Pemeriksaan gula darah pasien neonatus |
140,000 |
| 8658 |
POCT Pemeriksaan gula darah pasien pediatrik |
140,000 |
| 8659 |
POCT Pemeriksaan ISTAT |
500,000 |
| 8660 |
POCT Pemeriksaan ISTAT pasien dewasa |
500,000 |
| 8661 |
POCT Pemeriksaan ISTAT pasien neonatus |
500,000 |
| 8662 |
POCT Pemeriksaan ISTAT pasien pediatrik |
500,000 |
| 8663 |
POCT Pemeriksaan Laktat pasien dewasa |
145,000 |
| 8664 |
POCT Pemeriksaan Laktat pasien neonatus |
145,000 |
| 8665 |
POCT Pemeriksaan Laktat pasien pediatrik |
145,000 |
| 8666 |
POCUS / Hemodynamic echocardiography |
774,000 |
| 8667 |
Podopilin 25% 1-5 Lesi |
66,000 |
| 8668 |
Podopilin 35% 1-5 Lesi |
66,000 |
| 8669 |
Point of Care USG abdomen |
774,000 |
| 8670 |
Point of Care USG abdomen pasien dewasa |
774,000 |
| 8671 |
Point of Care USG abdomen pasien neonatus |
774,000 |
| 8672 |
Point of Care USG abdomen pasien pediatrik |
774,000 |
| 8673 |
Point of Care USG airway pasien dewasa |
774,000 |
| 8674 |
Point of Care USG airway pasien neonatus |
774,000 |
| 8675 |
Point of Care USG airway pasien pediatrik |
774,000 |
| 8676 |
Point of Care USG doppler cranial |
774,000 |
| 8677 |
Point of Care USG doppler cranial pasien dewasa |
774,000 |
| 8678 |
Point of Care USG doppler cranial pasien neonatus |
774,000 |
| 8679 |
Point of Care USG doppler cranial pasien pediatrik |
774,000 |
| 8680 |
Point of Care USG doppler cranial/vascular/jantung/paru/abdomen/airway |
774,000 |
| 8681 |
Point of Care USG functional haemodynamic assessment |
774,000 |
| 8682 |
Point of Care USG functional haemodynamic assessment pasien dewasa |
774,000 |
| 8683 |
Point of Care USG functional haemodynamic assessment pasien neonatus |
774,000 |
| 8684 |
Point of Care USG functional haemodynamic assessment pasien pediatrik |
774,000 |
| 8685 |
Point of Care USG jantung |
774,000 |
| 8686 |
Point of Care USG jantung pasien dewasa |
774,000 |
| 8687 |
Point of Care USG jantung pasien neonatus |
774,000 |
| 8688 |
Point of Care USG jantung pasien pediatrik |
774,000 |
| 8689 |
Point of Care USG paru pasien dewasa |
774,000 |
| 8690 |
Point of Care USG paru pasien neonatus |
774,000 |
| 8691 |
Point of Care USG paru pasien pediatrik |
774,000 |
| 8692 |
Point of Care USG pasien dewasa |
774,000 |
| 8693 |
Point of Care USG pasien neonatus |
774,000 |
| 8694 |
Point of Care USG pasien pediatrik |
774,000 |
| 8695 |
Point of Care USG vascular pasien dewasa |
774,000 |
| 8696 |
Point of Care USG vascular pasien neonatus |
774,000 |
| 8697 |
Point of Care USG vascular pasien pediatrik |
774,000 |
| 8698 |
Poligrafi |
1,413,000 |
| 8699 |
Poliklinik CAPD |
350,000 |
| 8700 |
Polipektomi |
7,702,000 |
| 8701 |
Polipektomi |
5,420,000 |
| 8702 |
Polipektomi (Sore) |
5,420,000 |
| 8703 |
Polipektomi + Anastesi |
7,230,000 |
| 8704 |
Polipektomi + Anastesi (Sore) |
7,230,000 |
| 8705 |
Polipektomi Endometrium |
7,702,000 |
| 8706 |
Polipektomi Endoskopik Sederhana |
430,000 |
| 8707 |
Polipektomi nasal bilateral |
7,702,000 |
| 8708 |
Polipektomi nasal dengan endoskopi |
7,702,000 |
| 8709 |
Polipektomi rektum |
7,702,000 |
| 8710 |
Polipektomi saluran cerna bagian atas |
5,462,000 |
| 8711 |
Polipektomi Saluran Cerna Bagian Atas/Bawah |
2,850,000 |
| 8712 |
Polipektomi saluran cerna bagian bawah |
5,462,000 |
| 8713 |
Polipektomi sederhana per endoskopi |
7,702,000 |
| 8714 |
Polipektomi Serviks |
7,702,000 |
| 8715 |
Polis Tambalan |
36,000 |
| 8716 |
Polisomnografi (PSG) |
3,550,000 |
| 8717 |
Polisomnografi/Sleep lab study |
1,570,000 |
| 8718 |
Pollicization operation carrying over nerves and blood supply |
10,675,000 |
| 8719 |
Polypectomy Rectum |
3,850,000 |
| 8720 |
Popliteal Entrapment manual (tanpa panduan) |
281,000 |
| 8721 |
Popliteal Entrapment USG |
595,000 |
| 8722 |
Poroentrostomi (Operasi Kasal) |
6,175,000 |
| 8723 |
Portoenterostomi (Operasi Kassai) |
28,917,000 |
| 8724 |
Posterior approach (dekompresi Radiks dan Medulla spinalis) lumbal |
37,385,000 |
| 8725 |
Posterior approach (dekompresi Radiks dan Medulla spinalis) servikal |
37,385,000 |
| 8726 |
Posterior approach (dekompresi Radiks dan Medulla spinalis) thorakal |
37,385,000 |
| 8727 |
Posterior bite riser dengan tambalan composite |
270,000 |
| 8728 |
Posterior bite riser plat |
820,000 |
| 8729 |
Posterior dan lateral lumbar interbody fusion (PLIF) -minimal invasive |
27,360,000 |
| 8730 |
Posterior dan lateral lumbar interbody fusion (PLIF) -open surgery |
27,360,000 |
| 8731 |
Posterior foraminotomy servikal |
37,385,000 |
| 8732 |
Postero Sagital Anorecto Vagino Urethra Plasty (PSARPUV) |
17,350,000 |
| 8733 |
Postero Sagital Anorectoplaty / PSARP |
32,161,000 |
| 8734 |
Postero Sagittal Anorectolasty / PSARP |
9,464,367 |
| 8735 |
Postero Sagittal/Anorectovaginorethroplasty |
6,138,408 |
| 8736 |
Posterolateral fusion for Spinal Instability |
34,119,000 |
| 8737 |
Posteromedial soft tisue release (single) for CTEV |
24,239,000 |
| 8738 |
Posteromedial soft tisue release for non CTEV case |
24,208,000 |
| 8739 |
Posterosagital anorectovaginourethroplasty/PSARVUP |
27,117,000 |
| 8740 |
Posturografi |
282,000 |
| 8741 |
Potong Stump (Rectum) |
4,978,718 |
| 8742 |
Potong flap |
7,841,000 |
| 8743 |
Potong Flap (Bedah Onkology) |
3,573,535 |
| 8744 |
Potong stump |
7,682,000 |
| 8745 |
PPD Tes |
66,000 |
| 8746 |
PPH Haemoroidektomi/Haemoroidektomi dengan stapler (II) |
10,316,000 |
| 8747 |
PPM (Permanent Pace Maker) |
9,896,883 |
| 8748 |
PPM Double Chamber |
34,454,000 |
| 8749 |
PPM Double Chamber |
87,519,000 |
| 8750 |
PPM DOUBLE CHAMBER dengan anestesi |
98,301,000 |
| 8751 |
PPM Single Chamber |
42,646,000 |
| 8752 |
PPM SINGLE CHAMBER dengan anestesi |
47,901,000 |
| 8753 |
Prefabricated post logam/buah |
0 |
| 8754 |
Premedikasi |
227,000 |
| 8755 |
Preparasi dan Pencetakan Onlay / Jacket Crown / Full Crown |
750,000 |
| 8756 |
Preparasi dan Pencetakan Onlay / Jacket Crown / Full Crown (Eksekutif) |
0 |
| 8757 |
Preparasi dan Pencetakan Veneer Indirect |
1,070,000 |
| 8758 |
Preparasi dan Pencetakan Veneer Indirect (Eksekutif) |
0 |
| 8759 |
Preparasi Inlay Cetak Double Impression |
0 |
| 8760 |
Preparasi Onlay Cetak Double Impression |
0 |
| 8761 |
Preparasi Produk Regenerasi Jaringan (fat/PRP/PRFM/etc) |
8,889,000 |
| 8762 |
Preparasi Saluran Akar Dengan Hand Use Protaper (Akar Jamak) |
1,590,000 |
| 8763 |
Preparasi Saluran Akar Dengan Hand Use Protaper (Akar Jamak) (Eksekutif) |
0 |
| 8764 |
Preparasi Saluran Akar Dengan Hand Use Protaper (Akar Tunggal) |
770,000 |
| 8765 |
Preparasi Saluran Akar Dengan Hand Use Protaper (Akar Tunggal) (Eksekutif) |
0 |
| 8766 |
Preparasi Saluran Akar Dengan Protaper Rotary Instrumen (Akar Jamak) |
1,330,000 |
| 8767 |
Preparasi Saluran Akar Dengan Protaper Rotary Instrumen (Akar Jamak) (Eksekutif) |
0 |
| 8768 |
Preparasi Saluran Akar Dengan Protaper Rotary Instrumen (Akar Tunggal) |
1,080,000 |
| 8769 |
Preparasi Saluran Akar Dengan Protaper Rotary Instrumen (Akar Tunggal) (Eksekutif) |
0 |
| 8770 |
Preparasi Saluran Akar Gigi anterior/Akar Tunggal Dengan Rotary/Manual Protaper |
0 |
| 8771 |
Preparasi Saluran Akar Gigi Posterior/Akar Jamak Dengan Rotary/Manual Protaper |
0 |
| 8772 |
Press needle |
741,000 |
| 8773 |
Prick Test (Ingestan) |
136,000 |
| 8774 |
Prick Test (Rinala) |
136,000 |
| 8775 |
Primary Endoscopic Realignment urethra pasca trauma |
13,652,000 |
| 8776 |
Primary PCI |
11,175,225 |
| 8777 |
Primary repair for Arterial injury |
23,914,000 |
| 8778 |
Primary repair for Large tendon rupture (quadriceps/ patellar/ achilles tendon) |
23,914,000 |
| 8779 |
Primary repair for Nail bed laceration (Multiple) |
11,980,000 |
| 8780 |
Primary repair for Nail bed laceration (Single) |
11,980,000 |
| 8781 |
Primary repair for Nerve injury |
23,914,000 |
| 8782 |
Primary stump closure for Traumatic amputation of finger and hand |
17,616,000 |
| 8783 |
Primary stump closure for Traumatic amputation of upper or lower extremities |
18,043,000 |
| 8784 |
Primary Total Ankle Arthroplasty |
34,638,000 |
| 8785 |
Primary Total Elbow Arthroplasty for Elbow arthritis |
34,638,000 |
| 8786 |
Primary Total Hip Arthroplasty |
34,638,000 |
| 8787 |
Primary Total Joint Arthroplasty for Wrist/MCP/IP/CMC |
34,638,000 |
| 8788 |
Primary Total Knee Arthroplasty |
34,638,000 |
| 8789 |
Primary/Early PCI 1 STENT DES |
56,767,000 |
| 8790 |
Primary/Early PCI 2 STENT DES |
70,959,000 |
| 8791 |
Probing Saluran Liur |
4,546,000 |
| 8792 |
Probing with/ without Infracturing Concha with Endoscopy Narkose |
4,802,000 |
| 8793 |
Problem Solving Therapy (Individual) |
150,000 |
| 8794 |
Problem Solving Therapy (Kelompok) |
300,000 |
| 8795 |
Problem Solving Therapy pada dewasa |
150,000 |
| 8796 |
Problem Solving Therapy pada lansia |
150,000 |
| 8797 |
PROCALCITONIN (PCT) |
820,000 |
| 8798 |
Produk Apharesis |
4,000,000 |
| 8799 |
Progesteron _ |
269,000 |
| 8800 |
Progesteron (P) |
445,000 |
| 8801 |
Program Berhenti Merokok |
146,000 |
| 8802 |
Program inisiasi terapi insulin pada pasien baru DM |
300,000 |
| 8803 |
Program Keterampilan Hidup Harian (Kelompok) |
300,000 |
| 8804 |
Program Pemanfaatan Waktu Luang & Rekreasi (Kelompok) |
300,000 |
| 8805 |
Programming PPM/ILR |
109,000 |
| 8806 |
Prokalsitonin |
660,000 |
| 8807 |
Prolactin (P) |
325,000 |
| 8808 |
Prolactine |
200,000 |
| 8809 |
Prolaktin _ |
200,000 |
| 8810 |
Prolonged Exposure Therapy pada anak dan remaja |
250,000 |
| 8811 |
Prolonged Exposure Therapy pada dewasa |
250,000 |
| 8812 |
Prolonged Exposure Therapy pada lansia |
250,000 |
| 8813 |
Pronto Etmoidektomi (Ekstranasal) |
5,482,645 |
| 8814 |
Proof laparatomy/biopsi per laparatomy |
6,175,000 |
| 8815 |
Proof Pungsi |
564,000 |
| 8816 |
Proptosis |
41,000 |
| 8817 |
Prosedur Diskectomy (PELD) |
1,238,000 |
| 8818 |
Prosedur konservatif pada inversio uteri (reposisi) |
25,429,000 |
| 8819 |
Prosedur operatif pada inversio uteri ginekologi / kronis per abdominam |
25,429,000 |
| 8820 |
Prosedur operatif pada inversio uteri ginekologi / kronis per vaginam |
25,429,000 |
| 8821 |
Prosedur Pemasangan atau Fitting Prostesis Kaki |
239,000 |
| 8822 |
Prosedur Pemasangan atau Fitting Prostesis Kaki, Tidak Spesifik Lainnya |
203,000 |
| 8823 |
Prosedur sterotaktik : implant deep brain stimulation |
37,385,000 |
| 8824 |
Prosedur Tiersch (Prolapsus Recti) |
6,238,462 |
| 8825 |
Prosedur Tiersch pada prolap rekti |
7,681,000 |
| 8826 |
Prosedur whipple |
21,482,000 |
| 8827 |
Prosedur Winter (Priapismus) Narkose |
6,230,000 |
| 8828 |
Prostatektomi Retropubik |
13,200,000 |
| 8829 |
Prostatektomi Retropubik |
7,252,252 |
| 8830 |
Prostatektomi terbuka |
4,850,000 |
| 8831 |
Prostatektomi terbuka dan sectio Alta |
4,850,000 |
| 8832 |
Prosthetic removal and bone spacer for Infected arthroplasty |
21,399,000 |
| 8833 |
Prostigmin test |
300,000 |
| 8834 |
Protein Bence Jones (P) |
70,000 |
| 8835 |
Protein C |
313,000 |
| 8836 |
Protein Electrophoresis (P) |
195,000 |
| 8837 |
Protein Electrophoresis (P) |
195,000 |
| 8838 |
Protein Esbach _ |
30,000 |
| 8839 |
Protein Kuantitatif Urine |
65,000 |
| 8840 |
Protein S |
313,000 |
| 8841 |
Protein Total |
32,000 |
| 8842 |
PROTEIN TOTAL/ TOTAL PROTEIN (DARAH) |
77,000 |
| 8843 |
Protesa 1 Gigi |
413,000 |
| 8844 |
Protesa 2 Gigi |
328,000 |
| 8845 |
Protesa 3 Gigi |
380,000 |
| 8846 |
Protesa 4 Gigi |
465,000 |
| 8847 |
Protesa 5 Gigi |
568,000 |
| 8848 |
Protesa 6 Gigi |
661,000 |
| 8849 |
Protesa 7 Gigi |
723,000 |
| 8850 |
Protesa Atas Lutut (Khusus) |
27,000,000 |
| 8851 |
Protesa Atas Lutut (Standar) |
19,500,000 |
| 8852 |
Protesa Atas Siku (Standar) |
16,700,000 |
| 8853 |
Protesa Bawah Siku (Khusus) |
19,000,000 |
| 8854 |
Protesa Bawah Siku (Standar) |
11,050,000 |
| 8855 |
Protesa Full Denture |
1,576,000 |
| 8856 |
Protesa Lebih dari 7 Gigi=1/2 Full |
761,000 |
| 8857 |
Protesa Opturator |
600,000 |
| 8858 |
Prothesa Ekstra Oral Hidung |
1,786,000 |
| 8859 |
Prothesa Ekstra Oral Mata |
1,664,000 |
| 8860 |
Prothesa Ekstra Oral Telinga |
2,011,000 |
| 8861 |
Prothesa Ektra Oral Wajah |
2,011,000 |
| 8862 |
Protokol pemberian asam zoledronat pada Osteogenesis Imperfecta |
600,000 |
| 8863 |
Protokol pemberian asam zoledronat pada osteoporosis sekunder |
500,000 |
| 8864 |
Provocative Test Brugada Sindrome |
1,799,000 |
| 8865 |
Provokasi histamin |
395,000 |
| 8866 |
Provokasi Vaksin |
395,000 |
| 8867 |
PRP (Platelet Rich Plasma) |
600,000 |
| 8868 |
PRP injection |
332,000 |
| 8869 |
PRP TERAPI SEL |
700,000 |
| 8870 |
PRPP Injection C ARM |
4,049,000 |
| 8871 |
PRPP Injection manual (tanpa panduan) |
1,500,000 |
| 8872 |
PRPP Injection servikal C ARM |
4,049,000 |
| 8873 |
PRPP Injection servikal USG |
2,853,000 |
| 8874 |
PRPP Injection thorakal C ARM |
4,049,000 |
| 8875 |
PRPP Injection thorakal USG |
2,853,000 |
| 8876 |
PRPP Injection USG |
2,853,000 |
| 8877 |
PRR Tipe B |
600,000 |
| 8878 |
PRR Tipe C |
750,001 |
| 8879 |
PS1.5 Ventrikular Repair/RVOT Repair/AVR+VSD Closure+ASD Closure |
45,950,000 |
| 8880 |
PSA |
6,331,000 |
| 8881 |
PSA _ |
265,000 |
| 8882 |
PSA 1 Saluran Akar Gigi Decidui |
481,000 |
| 8883 |
PSA 1 Saluran Akar Gigi Permanen |
391,000 |
| 8884 |
PSA 2 atau 3 Saluran Akar Gigi Decidui |
566,000 |
| 8885 |
PSA 2 Saluran Akar Gigi Permanen |
485,000 |
| 8886 |
PSA 3 Saluran Akar Gigi Permanen |
574,000 |
| 8887 |
PSA One Visit 1 Saluran akar |
1,236,000 |
| 8888 |
PSA One Visit 2 Saluran akar |
2,139,000 |
| 8889 |
PSA One Visit 3 atau lebih Saluran akar |
3,211,000 |
| 8890 |
PSA TOTAL |
393,000 |
| 8891 |
PSARP + laparotomy |
33,942,000 |
| 8892 |
PSARP Laparatomi |
6,118,524 |
| 8893 |
Pseudokista THT |
250,000 |
| 8894 |
PSG |
3,550,000 |
| 8895 |
Psikiatri Forensik 1 (SKKJ administratif umum, psikoedukasi medikolegal) |
350,000 |
| 8896 |
Psikiatri Forensik 1 (SKKJ administratif umum, psikoedukasi medikolegal) (Online) |
500,000 |
| 8897 |
Psikiatri Forensik 2 (Visum et repertum psychiatricum dan SKKJ Kecakapan Mental Kasus Simpel, konsultasi medikolegal) |
580,000 |
| 8898 |
Psikiatri Forensik 3 (Visum et repertum psychiatricum dan SKKJ kecakapan mental kasus kompleks) |
940,000 |
| 8899 |
Psikiatri Forensik 4 (Visum et repertum psychiatricum dan SKKJ kecakapan mental kasus kompleks dengan penyulit) |
1,450,000 |
| 8900 |
Psikoanalisis (Psychoanalysis) |
257,000 |
| 8901 |
Psikoanalisis pada anak dan remaja |
350,000 |
| 8902 |
Psikoanalisis pada dewasa |
350,000 |
| 8903 |
Psikoanalisis pada lansia |
350,000 |
| 8904 |
Psikodrama |
300,000 |
| 8905 |
Psikoedukasi Kelompok (>5 orang) |
300,000 |
| 8906 |
Psikoedukasi Keluarga |
150,000 |
| 8907 |
Psikoedukasi Keluarga ( Eksekutif ) |
0 |
| 8908 |
Psikoedukasi Keluarga (2-3 orang) |
300,000 |
| 8909 |
Psikometri Individu ( Geriatric Depression Scale / GDS 15 / 30) ( Eksekutif ) |
0 |
| 8910 |
Psikometri Individu (Abberant Behaviour Checklist Irritability) |
100,000 |
| 8911 |
Psikometri Individu (Abberant Behaviour Checklist Irritability) ( Eksekutif ) |
0 |
| 8912 |
Psikometri Individu (Abbreviated Conners Rating Scale) |
100,000 |
| 8913 |
Psikometri Individu (Abbreviated Conners Rating Scale) ( Eksekutif ) |
0 |
| 8914 |
Psikometri Individu (Activity Daily Living / Barthel Index / IADL / FAQ ( Eksekutif ) |
0 |
| 8915 |
Psikometri Individu (Activity Daily Living / Barthel Index / IADL / FAQ) |
100,000 |
| 8916 |
Psikometri Individu (Addiction Severity Index) |
100,000 |
| 8917 |
Psikometri Individu (Addiction Severity Index) ( Eksekutif ) |
0 |
| 8918 |
Psikometri Individu (Brief Psyciatric Rating Scale) |
100,000 |
| 8919 |
Psikometri Individu (Brief Psyciatric Rating Scale) ( Eksekutif ) |
0 |
| 8920 |
Psikometri Individu (Child Depresi Inventory / Berrige House Depression Screening Questionare) |
100,000 |
| 8921 |
Psikometri Individu (Clinical Dementia Rating Scale) |
100,000 |
| 8922 |
Psikometri Individu (Clinical Dementia Rating Scale) ( Eksekutif ) |
0 |
| 8923 |
Psikometri Individu (Clinical Global Impression Scale) |
100,000 |
| 8924 |
Psikometri Individu (Clinical Global Impression Scale) ( Eksekutif ) |
0 |
| 8925 |
Psikometri Individu (Confussion Assesment Methode) |
100,000 |
| 8926 |
Psikometri Individu (Confussion Assesment Methode) ( Eksekutif ) |
0 |
| 8927 |
Psikometri Individu (CSRS / Skala Bunuh Diri) |
100,000 |
| 8928 |
Psikometri Individu (CSRS / Skala Bunuh Diri) ( Eksekutif ) |
0 |
| 8929 |
Psikometri Individu (Ekstrapiramidal Sympton Rating Scale / SAS) |
100,000 |
| 8930 |
Psikometri Individu (Ekstrapiramidal Sympton Rating Scale / SAS) ( Eksekutif ) |
0 |
| 8931 |
Psikometri Individu (Geriatric Depression Scale / GDS 15 / 30) |
100,000 |
| 8932 |
Psikometri Individu (HARS / GAD-7) |
100,000 |
| 8933 |
Psikometri Individu (HARS / GAD-7) ( Eksekutif ) |
0 |
| 8934 |
Psikometri Individu (HDRS / BDI / MADRS / PHQ-9) |
100,000 |
| 8935 |
Psikometri Individu (HDRS / BDI /MADRS / PHQ-9) ( Eksekutif ) |
0 |
| 8936 |
Psikometri Individu (HDRS/HARS Mini Metal) |
32,000 |
| 8937 |
Psikometri Individu (Insomnia Rating Scale ) ( Eksekutif ) |
0 |
| 8938 |
Psikometri Individu (Insomnia Rating Scale) |
100,000 |
| 8939 |
Psikometri Individu (Kuesioner Kekuatan dan Kesulitan Pada Anak) |
100,000 |
| 8940 |
Psikometri Individu (Kuesioner Kekuatan dan Kesulitan Pada Anak) ( Eksekutif ) |
0 |
| 8941 |
Psikometri Individu (Mini-Mental State Examination / MMSE) |
100,000 |
| 8942 |
Psikometri Individu (Mini-Mental State Examination / MMSE) ( Eksekutif ) |
0 |
| 8943 |
Psikometri Individu (Montreal Cognitive Assesment / MoCA-INA) |
100,000 |
| 8944 |
Psikometri Individu (Montreal Cognitive Assesment / MoCA-INA) (Eksekutif ) |
0 |
| 8945 |
Psikometri Individu (PANSS EC) |
100,000 |
| 8946 |
Psikometri Individu (PANSS EC) ( Eksekutif ) |
0 |
| 8947 |
Psikometri Individu (PANSS) |
100,000 |
| 8948 |
Psikometri Individu (PANSS) ( Eksekutif ) |
0 |
| 8949 |
Psikometri Individu (Pemeriksaan Mini Cognitif dan Clock Drawing Test / CDT ( Eksekutif ) |
0 |
| 8950 |
Psikometri Individu (Pemeriksaan Mini Cognitif dan Clock Drawing Test / CDT ) |
100,000 |
| 8951 |
Psikometri Individu (Penilaian Resiko Jatuh Pada Lansia) |
100,000 |
| 8952 |
Psikometri Individu (Penilaian Resiko Jatuh Pada Lansia) ( Eksekutif ) |
0 |
| 8953 |
Psikometri Individu (Score Iskemik Haschinski) |
100,000 |
| 8954 |
Psikometri Individu (Score Iskemik Haschinski) ( Eksekutif ) |
0 |
| 8955 |
Psikometri Individu (Shild Depresi Inventory / Berriga House Depression Screening Questionare ) ( Eksekutif ) |
0 |
| 8956 |
Psikometri Individu (Status Psikiatri Anak & Remaja) |
100,000 |
| 8957 |
Psikometri Individu (Status Psikiatri Anak & Remaja) ( Eksekutif ) |
0 |
| 8958 |
Psikometri Individu (Warteg HTP Rorschach ( Eksekutif ) |
150,000 |
| 8959 |
Psikometri Individu (Warteg HTP Rorschach) |
100,000 |
| 8960 |
Psikometri Individu (Yale Brown Obsessive Compulsive Scale) |
100,000 |
| 8961 |
Psikometri Individu (Yale Brown Obsessive Compulsive Scale) ( Eksekutif ) |
150,000 |
| 8962 |
Psikometri Individu (Young Mania Rating Scale) |
100,000 |
| 8963 |
Psikometri Individu (Young Mania Rating Scale) ( Eksekutif ) |
0 |
| 8964 |
Psikometri MMPI ( Pasien ) ( Eksekutif ) |
0 |
| 8965 |
Psikometri MMPI (Pasien) |
212,000 |
| 8966 |
Psikoterapi Bermain (Play psychotherapy) |
59,000 |
| 8967 |
Psikoterapi I |
40,000 |
| 8968 |
Psikoterapi I (psikoterapi suportif dan psikoedukasi) |
150,000 |
| 8969 |
Psikoterapi II |
65,000 |
| 8970 |
Psikoterapi II (dengan Konseling Keluarga) |
200,000 |
| 8971 |
Psikoterapi Individual Lainnya (Other Individual Psychotherapy) |
125,000 |
| 8972 |
Psikoterapi Individual oleh Psikiater anak |
150,000 |
| 8973 |
Psikoterapi Keluarga / Family Therapy |
190,000 |
| 8974 |
Psikoterapi Keluarga / Family Therapy ( Eksekutif ) |
0 |
| 8975 |
Psikoterapi Psikodinamik |
350,000 |
| 8976 |
Psikoterapi Psikodinamik |
190,000 |
| 8977 |
Psikoterapi Psikodinamik ( Eksekutif ) |
0 |
| 8978 |
Psikoterapi Psikodinamik pada dewasa |
350,000 |
| 8979 |
Psikoterapi Psikodinamik pada Gangguan Penggunaan Zat/Adiksi perilaku |
350,000 |
| 8980 |
Psikoterapi Psikodinamik pada lansia |
350,000 |
| 8981 |
Psikoterapi Suportif |
100,000 |
| 8982 |
Psikoterapi Suportif ( Eksekutif ) |
0 |
| 8983 |
Psikoterapi Suportif Kelompok (>5 orang) |
250,000 |
| 8984 |
Psikoterapi Suportif Keluarga (2-3 orang) |
250,000 |
| 8985 |
Psikoterapi Suportif pada anak |
150,000 |
| 8986 |
Psikoterapi Suportif pada orangtua |
150,000 |
| 8987 |
Psikoterapi Verbal Supportif (Supportive Verbal Psychotherapy) |
150,000 |
| 8988 |
Psikoterapi/psikoedukasi pada DM |
341,000 |
| 8989 |
Psoas Histch/Boari Flap |
6,943,000 |
| 8990 |
Psoas Hitch |
25,429,000 |
| 8991 |
PT + INR |
184,000 |
| 8992 |
PTA / ANGIOPLASTY / VENOPLASTY |
33,088,000 |
| 8993 |
PTA + 1 Buah (Sub Clavia, Femoralis, Renalis) |
19,490,000 |
| 8994 |
PTA + 2 Stent |
45,300,000 |
| 8995 |
PTA Carotis Tanpa Stent |
16,010,000 |
| 8996 |
PTB Prothesis (Khusus) |
20,000,000 |
| 8997 |
PTB Prothesis (Standar) |
9,800,000 |
| 8998 |
PTBD (Percutaneous Biliary Drainage) |
12,086,000 |
| 8999 |
PTBD (Percutaneous Transhepatic Biliary Drainage) + kateter Kasus Kompleks |
20,356,001 |
| 9000 |
PTBD (Percutaneous Transhepatic Biliary Drainage) + kateter Kasus Kompleks dengan anestesi |
22,903,001 |
| 9001 |
PTBD (Percutaneous Transhepatic Biliary Drainage) + kateter Kasus Simpel |
16,284,000 |
| 9002 |
PTBD (Percutaneous Transhepatic Biliary Drainage) + kateter Kasus Simpel dengan anestesi |
18,320,000 |
| 9003 |
PTC (Percutaneous Transhepatic Cholangiography) Kasus Simpel |
5,639,000 |
| 9004 |
PTC (Percutaneous Transhepatic Cholangiography) Kasus Simpel dengan anestesi |
6,334,000 |
| 9005 |
PTCA |
69,285,000 |
| 9006 |
PTCA |
11,011,434 |
| 9007 |
PTCA + TPM |
12,820,000 |
| 9008 |
PTCA 1 STENT DES DENGAN IMAGING INTRAKORONER + ATEREKTOMI dengan anestesi dan ventilator |
144,263,000 |
| 9009 |
PTCA 1 STENT DES DENGAN IMAGING INTRAKORONER + ATEREKTOMI dengan anestesi dan ventilator Kompleks |
157,050,000 |
| 9010 |
PTCA 1 Stent DES Dengan Uji Fungsional + Aterektomi |
136,154,000 |
| 9011 |
PTCA 1 STENT DES DENGAN UJI FUNGSIONAL + ATEREKTOMI dengan anestesi dan ventilator |
144,263,000 |
| 9012 |
PTCA 1 STENT DES DENGAN UJI FUNGSIONAL + ATEREKTOMI dengan anestesi dan ventilator Kompleks |
157,050,000 |
| 9013 |
PTCA 1 Stent DES Dengan Uji Fungsional + Aterektomi Kompleks |
146,613,000 |
| 9014 |
PTCA 1 Stent DESDengan Imaging Intrakoroner + Aterektomi |
136,154,000 |
| 9015 |
PTCA 1 Stent DESDengan Imaging Intrakoroner + Aterektomi Kompleks |
146,613,000 |
| 9016 |
PTCA 1STENT DES |
77,462,000 |
| 9017 |
PTCA 1STENT DES dengan anestesi dan ventilator |
81,367,000 |
| 9018 |
PTCA 1STENT DES dengan anestesi dan ventilator Kompleks |
87,513,000 |
| 9019 |
PTCA 1STENT DES Kompleks |
82,541,000 |
| 9020 |
PTCA 2 Stent DES Dengan Imaging Intrakoroner + Aterektomi |
139,649,000 |
| 9021 |
PTCA 2 STENT DES DENGAN IMAGING INTRAKORONER + ATEREKTOMI dengan anestesi dan ventilator |
147,758,000 |
| 9022 |
PTCA 2 STENT DES DENGAN IMAGING INTRAKORONER + ATEREKTOMI dengan anestesi dan ventilator Kompleks |
160,545,000 |
| 9023 |
PTCA 2 Stent DES Dengan Imaging Intrakoroner + Aterektomi Kompleks |
150,108,000 |
| 9024 |
PTCA 2 Stent DES dengan Uji Fungsional + Aterektomi |
139,649,000 |
| 9025 |
PTCA 2 STENT DES DENGAN UJI FUNGSIONAL + ATEREKTOMI dengan anestesi dan ventilator |
147,758,000 |
| 9026 |
PTCA 2 STENT DES DENGAN UJI FUNGSIONAL + ATEREKTOMI dengan anestesi dan ventilator Kompleks |
160,545,000 |
| 9027 |
PTCA 2 Stent DES dengan Uji Fungsional + Aterektomi Kompleks |
150,108,000 |
| 9028 |
PTCA 2STENT DES |
88,028,000 |
| 9029 |
PTCA 2STENT DES dengan anestesi dan ventilator |
93,562,000 |
| 9030 |
PTCA 2STENT DES dengan anestesi dan ventilator Kompleks |
102,318,000 |
| 9031 |
PTCA 2STENT DES Kompleks |
95,228,000 |
| 9032 |
PTCA 3 Stent DES Dengan Imaging Intrakoroner + Aterektomi |
143,144,000 |
| 9033 |
PTCA 3 STENT DES DENGAN IMAGING INTRAKORONER + ATEREKTOMI dengan anestesi dan ventilator |
151,253,000 |
| 9034 |
PTCA 3 STENT DES DENGAN IMAGING INTRAKORONER + ATEREKTOMI dengan anestesi dan ventilator Kompleks |
164,040,000 |
| 9035 |
PTCA 3 Stent DES Dengan Imaging Intrakoroner + Aterektomi Kompleks |
153,603,000 |
| 9036 |
PTCA 3 Stent DES dengan Uji Fungsional + Aterektomi |
143,144,000 |
| 9037 |
PTCA 3 STENT DES DENGAN UJI FUNGSIONAL + ATEREKTOMI dengan anestesi dan ventilator |
151,253,000 |
| 9038 |
PTCA 3 STENT DES DENGAN UJI FUNGSIONAL + ATEREKTOMI dengan anestesi dan ventilator Kompleks |
164,040,000 |
| 9039 |
PTCA 3 Stent DES dengan Uji Fungsional + Aterektomi Kompleks |
153,603,000 |
| 9040 |
PTCA 3STENT DES |
91,523,000 |
| 9041 |
PTCA 3STENT DES dengan anestesi dan ventilator |
94,491,000 |
| 9042 |
PTCA 3STENT DES dengan anestesi dan ventilator Kompleks |
102,477,000 |
| 9043 |
PTCA 3STENT DES Kompleks |
98,723,000 |
| 9044 |
PTCA 4 Stent Des Dengan Imaging Intrakoroner + Aterektomi |
146,639,000 |
| 9045 |
PTCA 4 STENT DES DENGAN IMAGING INTRAKORONER + ATEREKTOMI dengan anestesi dan ventilator |
154,748,000 |
| 9046 |
PTCA 4 STENT DES DENGAN IMAGING INTRAKORONER + ATEREKTOMI dengan anestesi dan ventilator Kompleks |
167,535,000 |
| 9047 |
PTCA 4 Stent Des Dengan Imaging Intrakoroner + Aterektomi Kompleks |
157,098,000 |
| 9048 |
PTCA 4 Stent DES dengan Uji Fungsional + Aterektomi |
146,639,000 |
| 9049 |
PTCA 4 STENT DES DENGAN UJI FUNGSIONAL + ATEREKTOMI dengan anestesi dan ventilator |
154,748,000 |
| 9050 |
PTCA 4 STENT DES DENGAN UJI FUNGSIONAL + ATEREKTOMI dengan anestesi dan ventilator Kompleks |
167,535,000 |
| 9051 |
PTCA 4 Stent DES dengan Uji Fungsional + Aterektomi Kompleks |
157,098,000 |
| 9052 |
PTCA 4STENT DES |
95,018,000 |
| 9053 |
PTCA 4STENT DES dengan anestesi dan ventilator |
99,895,000 |
| 9054 |
PTCA 4STENT DES dengan anestesi dan ventilator Kompleks |
108,454,000 |
| 9055 |
PTCA 4STENT DES Kompleks |
102,218,000 |
| 9056 |
PTCA dengan anestesi dan ventilator |
72,206,000 |
| 9057 |
PTCA dengan anestesi dan ventilator Kompleks |
72,978,000 |
| 9058 |
PTCA Kompleks |
72,958,000 |
| 9059 |
PTCA+1 Stent BMS |
11,093,434 |
| 9060 |
PTCA+1 Stent DES |
11,149,852 |
| 9061 |
PTCA+1 Stent DES+1 BMS |
11,166,852 |
| 9062 |
PTCA+2 Stent BMS |
11,110,434 |
| 9063 |
PTCA+2 Stent DES |
11,223,270 |
| 9064 |
PTCA+2 Stent DES+1 BMS |
11,305,270 |
| 9065 |
PTCA+3 Stent DES |
11,361,688 |
| 9066 |
Pterigium + CLG |
2,850,000 |
| 9067 |
Pterigium Plasty lokal |
7,151,000 |
| 9068 |
Pterigium Plasty narkose |
8,373,000 |
| 9069 |
PTH intact (P) |
608,000 |
| 9070 |
Pthisis Bulbi (Graft Mukosa Bibir) |
3,850,000 |
| 9071 |
PTMC/BMV |
84,247,000 |
| 9072 |
PTMC/BMV + ANESTESI |
89,437,000 |
| 9073 |
Ptosis |
5,586,093 |
| 9074 |
Ptosis + anastesi |
6,823,000 |
| 9075 |
Puberty Test |
78,000 |
| 9076 |
PULASAN GRAM LAIN-LAIN |
112,000 |
| 9077 |
Pulasan imunohistokimia paket prognostik payudara (ER, PR,HER2 & Ki67) tanpa interpretasi |
2,000,000 |
| 9078 |
Pulasan imunohistokimia per antibodi tanpa interpretasi |
603,000 |
| 9079 |
PULASAN TAHAN ASAM LAIN-LAIN |
72,000 |
| 9080 |
PULASAN TAHAN ASAM LAIN-LAIN II |
81,000 |
| 9081 |
PULASAN TAHAN ASAM LAIN-LAIN III |
92,000 |
| 9082 |
PULASAN TAHAN ASAM SPUTUM |
72,000 |
| 9083 |
PULASAN TAHAN ASAM SPUTUM II |
81,000 |
| 9084 |
PULASAN TAHAN ASAM SPUTUM III |
92,000 |
| 9085 |
Pull Through (Soave.Duhamel.Sewnson) |
9,464,367 |
| 9086 |
Pulmonal Valve Replacement |
55,550,000 |
| 9087 |
Pulmonary artery repair kompleks/redo |
27,679,000 |
| 9088 |
Pulmonary Valve repair (PVr) |
121,838,000 |
| 9089 |
Pulmonary Valve Replacement (PVR) |
134,500,000 |
| 9090 |
Pulp Capping |
500,000 |
| 9091 |
Pulp Capping |
464,000 |
| 9092 |
Pulp Capping (Eksekutif) |
0 |
| 9093 |
Pulse Oxymeter |
63,000 |
| 9094 |
Punch biopsi |
2,475,000 |
| 9095 |
Punch Graft Vitiligo 1-5 titik |
600,000 |
| 9096 |
Punch Graft Vitiligo 6-10 titik |
1,000,000 |
| 9097 |
Punctie + Kenacort (0.5/1/2cc) Sendi Besar |
325,000 |
| 9098 |
Punctie + Kenacort (0.5/1/2cc) Sendi Kecil |
320,000 |
| 9099 |
Punctie Ascites |
675,000 |
| 9100 |
Punctie Ascites (Endoscopy) |
1,200,000 |
| 9101 |
Punctie Ascites (Endoscopy) (Sore) |
1,800,000 |
| 9102 |
Punctie Capung Duglasi |
142,000 |
| 9103 |
Punctie Lumbal |
242,000 |
| 9104 |
Punctie Pertitoneum |
87,000 |
| 9105 |
Punctie Pleura |
675,000 |
| 9106 |
Punctie Sendi Besar |
300,000 |
| 9107 |
Punctie Sendi Kecil |
295,000 |
| 9108 |
Pungsi Arteri |
2,631,000 |
| 9109 |
Pungsi arteri pasien dewasa |
2,631,000 |
| 9110 |
Pungsi arteri pasien neonatus |
2,631,000 |
| 9111 |
Pungsi arteri pasien pediatrik |
2,631,000 |
| 9112 |
Pungsi ascites intermittent pasien dewasa |
1,371,000 |
| 9113 |
Pungsi ascites intermittent pasien neonatus |
1,371,000 |
| 9114 |
Pungsi ascites intermittent pasien pediatrik |
1,371,000 |
| 9115 |
Pungsi ascites kontinu pasien dewasa |
1,371,000 |
| 9116 |
Pungsi ascites kontinu pasien neonatus |
1,371,000 |
| 9117 |
Pungsi ascites kontinu pasien pediatrik |
1,371,000 |
| 9118 |
Pungsi Cairan - via VP shunt/Omaya |
564,000 |
| 9119 |
Pungsi cairan pleura |
1,261,000 |
| 9120 |
Pungsi Pleura / Torakosintesis |
1,261,000 |
| 9121 |
Pungsi Pleura / Torakosintesis pasien dewasa |
1,261,000 |
| 9122 |
Pungsi Pleura / Torakosintesis pasien neonatus |
1,261,000 |
| 9123 |
Pungsi Pleura / Torakosintesis pasien pediatrik |
1,261,000 |
| 9124 |
Pungsi Pleura Emergency pada Neonatus |
1,578,000 |
| 9125 |
Pungsi Pleura/ Torakosentesis |
1,261,000 |
| 9126 |
Pungsi sendi besar |
417,000 |
| 9127 |
Pungsi sendi kecil |
402,000 |
| 9128 |
Pungsi Subgaleal |
1,371,000 |
| 9129 |
Pungsi Ventrikel |
12,740,000 |
| 9130 |
Punksi / Irigasi Pleura |
675,000 |
| 9131 |
Punksi Acites/Punksi Pleura |
0 |
| 9132 |
Punksi Batu |
66,000 |
| 9133 |
Punksi Cairan Otak |
4,892,887 |
| 9134 |
Punksi Hematoma Telinga |
66,000 |
| 9135 |
Punksi kista ginjal (bius) |
14,516,000 |
| 9136 |
Punksi Kista Ginjal Lokal |
8,822,000 |
| 9137 |
Punksi Sumsum Tulang |
250,000 |
| 9138 |
Puntie Pertitoneum |
87,000 |
| 9139 |
Pupiloplasty |
9,519,000 |
| 9140 |
PVR + TVR + Infidibulectomy |
43,850,000 |
| 9141 |
Pyelolithotomi |
6,911,502 |
| 9142 |
Pyelolitotomi |
11,848,000 |
| 9143 |
Pyeloplasty |
15,720,000 |
| 9144 |
Pyeloplasty |
6,499,717 |
| 9145 |
Pyeloplasty per laparoskopi |
20,765,000 |
| 9146 |
Pyloromiotomi (operasi fredet-ramstedt) |
9,464,367 |
| 9147 |
Pyloromyotomi (Operasi Fredet Ramstedt) |
18,019,000 |
| 9148 |
Quad Helix |
1,151,000 |
| 9149 |
Quadricepsplasty |
11,196,000 |
| 9150 |
R end Y Gastric bypass revisi |
16,011,000 |
| 9151 |
R.P.G ( Retrograde Pyelografi ) |
450,000 |
| 9152 |
Radial Head Excision |
24,767,000 |
| 9153 |
Radial Head Replacement |
25,231,000 |
| 9154 |
Radiasi Eksterna - CT Simulator / 3 D - Kuratif Definitif |
21,250,000 |
| 9155 |
Radiasi Eksterna - CT Simulator / 3 D - Kuratif Booster |
2,500,000 |
| 9156 |
Radiasi Eksterna - CT Simulator / 3 D - Kuratif Booster (rujukan luar) |
500,000 |
| 9157 |
Radiasi Eksterna - CT Simulator / 3 D - Kuratif Booster + Anastesi |
3,100,000 |
| 9158 |
Radiasi Eksterna - CT Simulator / 3 D - Kuratif Definitif (rujukan luar) |
607,150 |
| 9159 |
Radiasi Eksterna - CT Simulator / 3 D - Kuratif Definitif + Anastesi |
26,350,000 |
| 9160 |
Radiasi Eksterna - IMRT / IGRT - Kuratif Booster |
4,375,000 |
| 9161 |
Radiasi Eksterna - IMRT / IGRT - Kuratif Booster (rujukan luar) |
875,000 |
| 9162 |
Radiasi Eksterna - IMRT / IGRT - Kuratif Booster + Anastesi |
5,425,000 |
| 9163 |
Radiasi Eksterna - IMRT / IGRT - Kuratif Defenitif + Anastesi |
31,000,000 |
| 9164 |
Radiasi Eksterna - IMRT / IGRT - Kuratif Definitif |
25,000,000 |
| 9165 |
Radiasi Eksterna - IMRT / IGRT - Kuratif Definitif (rujukan luar ) |
714,300 |
| 9166 |
Radiasi Eksterna - Paket I (Pesawat + Simulator) - Paliatif |
8,800,000 |
| 9167 |
Radiasi Eksterna - Paket I (Pesawat + Simulator) - Kuratif Adjuvant |
10,800,000 |
| 9168 |
Radiasi Eksterna - Paket I (Pesawat + Simulator) - Kuratif Adjuvant (rujukan luar) |
432,000 |
| 9169 |
Radiasi Eksterna - Paket I (Pesawat + Simulator) - Kuratif Adjuvant + Anastesi |
12,960,000 |
| 9170 |
Radiasi Eksterna - Paket I (Pesawat + Simulator) - Kuratif Defenitif |
11,500,000 |
| 9171 |
Radiasi Eksterna - Paket I (Pesawat + Simulator) - Kuratif Defenitif (rujukan luar) |
328,600 |
| 9172 |
Radiasi Eksterna - Paket I (Pesawat + Simulator) - Kuratif Defenitif + Anastesi |
14,020,000 |
| 9173 |
Radiasi Eksterna - Paket I (Pesawat + Simulator) - Paliatif (rujukan luar) |
1,760,000 |
| 9174 |
Radiasi Eksterna - Paket I (Pesawat + Simulator) - Paliatif + Anastesi |
10,120,000 |
| 9175 |
Radiasi Eksterna - Paket II (Theartment Planning System) TPS + Simulator - Kuratif Adjuvant |
12,500,000 |
| 9176 |
Radiasi Eksterna - Paket II (Theartment Planning System) TPS + Simulator - Kuratif Adjuvant (rujukan luar) |
500,000 |
| 9177 |
Radiasi Eksterna - Paket II (Theartment Planning System) TPS + Simulator - Kuratif Adjuvant + Anastesi |
15,020,000 |
| 9178 |
Radiasi Eksterna - Paket II (Theartment Planning System) TPS + Simulator - Kuratif Defenitif |
13,300,000 |
| 9179 |
Radiasi Eksterna - Paket II (Theartment Planning System) TPS + Simulator - Kuratif Defenitif (rujukan luar) |
380,000 |
| 9180 |
Radiasi Eksterna - Paket II (Theartment Planning System) TPS + Simulator - Kuratif Defenitif + Anastesi |
16,180,000 |
| 9181 |
Radiasi Eksterna - Paket II (Theartment Planning System) TPS + Simulator - Paliatif |
11,000,000 |
| 9182 |
Radiasi Eksterna - Paket II (Theartment Planning System) TPS + Simulator - Paliatif (rujukan luar) |
2,200,000 |
| 9183 |
Radiasi Eksterna - Paket II (Theartment Planning System) TPS + Simulator - Paliatif + Anastesi |
13,520,000 |
| 9184 |
Radiasi Eksterna - Paket II (Theartment Planning System) TPS + Simulator - Radiokastrasi/Non Keganasan |
8,600,000 |
| 9185 |
Radiasi Eksterna - Paket II (Theartment Planning System) TPS + Simulator - Radiokastrasi/Non Keganasan (rujukan luar) |
1,720,000 |
| 9186 |
Radiasi Eksterna - Paket II (Theartment Planning System) TPS + Simulator - Radiokastrasi/Non Keganasan + Anastesi |
9,800,000 |
| 9187 |
Radiasi Eksterna - Paket III ( Pesawat + Simulator + Treatmen Planning System (TPS) + Alat Bantu) - Paliatif |
8,750,000 |
| 9188 |
Radiasi Eksterna - Paket III ( Pesawat + Simulator + Treatmen Planning System (TPS) + Alat Bantu) - Paliatif (rujukan luar) |
1,750,000 |
| 9189 |
Radiasi Eksterna - Paket III ( Pesawat + Simulator + Treatmen Planning System (TPS)+Alat Bantu) - Kuratif Adjuvant |
12,500,000 |
| 9190 |
Radiasi Eksterna - Paket III ( Pesawat + Simulator + Treatmen Planning System (TPS)+Alat Bantu) - Kuratif Adjuvant (rujukan luar) |
500,000 |
| 9191 |
Radiasi Eksterna - Paket III ( Pesawat + Simulator + Treatmen Planning System (TPS)+Alat Bantu) - Kuratif Adjuvant + Anastesi |
15,380,000 |
| 9192 |
Radiasi Eksterna - Paket III ( Pesawat + Simulator + Treatmen Planning System (TPS)+Alat Bantu) - Kuratif Defenitif |
15,000,000 |
| 9193 |
Radiasi Eksterna - Paket III ( Pesawat + Simulator + Treatmen Planning System (TPS)+Alat Bantu) - Kuratif Defenitif (rujukan luar) |
428,600 |
| 9194 |
Radiasi Eksterna - Paket III ( Pesawat + Simulator + Treatmen Planning System (TPS)+Alat Bantu) - Kuratif Defenitif + Anastesi |
17,040,000 |
| 9195 |
Radiasi Eksterna - Paket III ( Pesawat + Simulator + Treatmen Planning System (TPS)+Alat Bantu) - Paliatif + Anastesi |
10,790,000 |
| 9196 |
Radiasi Eksterna - Stereotactic Radiosurgery (SRS) - Kuratif Booster + SRS Headfix / Alat Surgery |
9,375,000 |
| 9197 |
Radiasi Eksterna - Stereotactic Radiosurgery (SRS) - Kuratif Booster + SRS Headfix / Alat Surgery (rujukan luar) |
9,375,000 |
| 9198 |
Radiasi Eksterna - Stereotactic Radiosurgery (SRS) - Kuratif Booster + SRS Headfix / Alat Surgery + Anastesi |
11,625,000 |
| 9199 |
Radiasi Eksterna - Stereotactic Radiosurgery (SRS) - Kuratif Definitif + SRS Headfix / Alat Surgery |
31,250,000 |
| 9200 |
Radiasi Eksterna - Stereotactic Radiosurgery (SRS) - Kuratif Definitif + SRS Headfix / Alat Surgery (rujukan luar) |
31,250,000 |
| 9201 |
Radiasi Eksterna - Stereotactic Radiosurgery (SRS) - Kuratif Definitif + SRS Headfix / Alat Surgery + Anastesi |
38,750,000 |
| 9202 |
Radiasi Eksterna - Stereotactic Radiotherapy (SRT) - Kuratif Booster + SRT Headfix / Bodfix |
9,375,000 |
| 9203 |
Radiasi Eksterna - Stereotactic Radiotherapy (SRT) - Kuratif Booster + SRT Headfix / Bodfix (rujukan luar) |
1,875,000 |
| 9204 |
Radiasi Eksterna - Stereotactic Radiotherapy (SRT) - Kuratif Booster + SRT Headfix / Bodfix + Anastesi |
11,625,000 |
| 9205 |
Radiasi Eksterna - Stereotactic Radiotherapy (SRT) - Kuratif Definitif + SRT Headfix / Bodfix |
31,250,000 |
| 9206 |
Radiasi Eksterna - Stereotactic Radiotherapy (SRT) - Kuratif Definitif + SRT Headfix / Bodfix (rujukan luar) |
6,250,000 |
| 9207 |
Radiasi Eksterna - Stereotactic Radiotherapy (SRT) - Kuratif Definitif + SRT Headfix / Bodfix + Anastesi |
38,750,000 |
| 9208 |
Radiasi Eksterna 2D/3D |
1,275,000 |
| 9209 |
Radiasi Eksterna 3D 1 x radiasi |
1,154,000 |
| 9210 |
Radiasi Eksterna IMRT 1 x radiasi |
1,154,000 |
| 9211 |
Radiasi Eksterna IMRT/VMAT |
1,453,000 |
| 9212 |
Radical Excision for Malignant Soft tissue Tumor |
27,328,000 |
| 9213 |
Radical excision of skin lesion |
3,125,000 |
| 9214 |
Radikal Cystektomi |
11,981,598 |
| 9215 |
Radikal Neck Desection |
4,063,694 |
| 9216 |
Radikal Nefrektomi per laparoskopi |
31,425,000 |
| 9217 |
Radikal Nefroktomi |
9,356,913 |
| 9218 |
Radikal Prostatektomi |
11,130,825 |
| 9219 |
Radikal Prostatektomi |
22,190,000 |
| 9220 |
Radikal Prostatektomi per laparoskopi |
27,667,000 |
| 9221 |
Radikal sistektomi |
22,190,000 |
| 9222 |
Radioderm |
0 |
| 9223 |
Radiofrekuensi + PTBV |
23,550,000 |
| 9224 |
Radiofrekuensi lumbosacral C ARM |
4,049,000 |
| 9225 |
Radiofrekuensi servikal C ARM |
4,049,000 |
| 9226 |
Radiofrekuensi thorakal C ARM |
4,049,000 |
| 9227 |
Radiofrequency 1 |
764,000 |
| 9228 |
Radiofrequency 2 |
1,136,000 |
| 9229 |
Radiofrequency 3 |
1,521,000 |
| 9230 |
Radiofrequency Ablation |
29,940,000 |
| 9231 |
Radiofrequency Ablation (RFA) |
30,056,000 |
| 9232 |
Radiofrequency Ablation (Sore) |
36,250,000 |
| 9233 |
Radiofrequency Ablation 3D AF |
104,405,000 |
| 9234 |
Radiofrequency Ablation 3D AF + ANESTESI |
108,614,000 |
| 9235 |
Radiofrequency Ablation 3D AF + ICE |
130,917,000 |
| 9236 |
Radiofrequency Ablation 3D AF + ICE + ANESTESI |
119,477,000 |
| 9237 |
Radiofrequency Ablation 3D AF + TEE + ANESTESI |
132,293,000 |
| 9238 |
Radiofrequency Ablation 3D Non AF |
75,839,000 |
| 9239 |
Radiofrequency Ablation 3D Non AF + Anestesi |
80,394,000 |
| 9240 |
Radiofrequency Ablation 3D Non AF + Transeptal |
83,424,000 |
| 9241 |
Radiofrequency Ablation 3D NonAF + Transeptal + Anestesi |
104,168,000 |
| 9242 |
Radiofrequency Ablation Non 3D Irrigation |
125,372,000 |
| 9243 |
Radiofrequency Ablation Non 3D Irrigation + Anestesi |
137,306,000 |
| 9244 |
Radiofrequency Ablation Non 3D Irrigation + Transeptal |
137,910,000 |
| 9245 |
Radiofrequency Ablation Non 3D Non Irrigation + Transeptal + Anestesi |
151,038,000 |
| 9246 |
Radiografi Abdomen 2 proyeksi |
405,000 |
| 9247 |
Radiografi Abdomen 3 proyeksi |
470,000 |
| 9248 |
Radiografi Abdomen Polos (BNO) |
251,000 |
| 9249 |
Radiografi Abdomen Polos dengan Sonde (BNO dengan Sonde) |
251,000 |
| 9250 |
Radiografi Antebrachii 2 proyeksi |
405,000 |
| 9251 |
Radiografi Antebrachii 3 proyeksi |
447,000 |
| 9252 |
Radiografi Antebrachii Bilateral 2 proyeksi |
492,000 |
| 9253 |
Radiografi Antebrachii Bilateral 3 proyeksi |
543,000 |
| 9254 |
Radiografi Babygram |
378,000 |
| 9255 |
Radiografi Bahu 2 proyeksi |
405,000 |
| 9256 |
Radiografi Bahu 3 proyeksi |
447,000 |
| 9257 |
Radiografi Bahu 4 proyeksi |
494,000 |
| 9258 |
Radiografi Bahu 5 proyeksi |
545,000 |
| 9259 |
Radiografi Bahu 6 proyeksi |
601,000 |
| 9260 |
Radiografi Bahu Bilateral 2 proyeksi |
492,000 |
| 9261 |
Radiografi Bahu Bilateral 3 proyeksi |
543,000 |
| 9262 |
Radiografi Bahu Bilateral 4 proyeksi |
598,000 |
| 9263 |
Radiografi Bahu Bilateral 5 proyeksi |
659,000 |
| 9264 |
Radiografi Bahu Bilateral 6 proyeksi |
726,000 |
| 9265 |
Radiografi Basis Kranii |
405,000 |
| 9266 |
Radiografi Bone Age |
251,000 |
| 9267 |
Radiografi Calcaneus 2 proyeksi |
405,000 |
| 9268 |
Radiografi Calcaneus Bilateral 2 proyeksi |
484,000 |
| 9269 |
Radiografi Cephalometri |
405,000 |
| 9270 |
Radiografi Clavicula |
251,000 |
| 9271 |
Radiografi Clavicula Bilateral |
302,000 |
| 9272 |
Radiografi Comberg |
405,000 |
| 9273 |
Radiografi Costa |
405,000 |
| 9274 |
Radiografi Coxae 1 proyeksi |
251,000 |
| 9275 |
Radiografi Coxae 2 proyeksi |
405,000 |
| 9276 |
Radiografi Coxae 3 proyeksi |
447,000 |
| 9277 |
Radiografi Coxae 4 proyeksi |
494,000 |
| 9278 |
Radiografi Coxae Bilateral 1 proyeksi |
302,000 |
| 9279 |
Radiografi Coxae Bilateral 2 proyeksi |
492,000 |
| 9280 |
Radiografi Coxae Bilateral 3 proyeksi |
543,000 |
| 9281 |
Radiografi Coxae Bilateral 4 proyeksi |
598,000 |
| 9282 |
Radiografi Cranium 1 proyeksi |
251,000 |
| 9283 |
Radiografi Cranium 2 proyeksi (AP & Lateral ) |
405,000 |
| 9284 |
Radiografi Cranium 3 proyeksi (AP & Lateral & Towne) |
405,000 |
| 9285 |
Radiografi Cruris 2 proyeksi |
405,000 |
| 9286 |
Radiografi Cruris 3 proyeksi |
447,000 |
| 9287 |
Radiografi Cruris Bilateral 2 proyeksi |
484,000 |
| 9288 |
Radiografi Cruris Bilateral 3 proyeksi |
543,000 |
| 9289 |
Radiografi Cubiti 2 proyeksi |
405,000 |
| 9290 |
Radiografi Cubiti 3 proyeksi |
447,000 |
| 9291 |
Radiografi Cubiti 4 proyeksi |
494,000 |
| 9292 |
Radiografi Cubiti Bilateral 2 proyeksi |
492,000 |
| 9293 |
Radiografi Cubiti Bilateral 3 proyeksi |
543,000 |
| 9294 |
Radiografi Cubiti Bilateral 4 proyeksi |
598,000 |
| 9295 |
Radiografi Dental Intra Oral (1 gigi) |
251,000 |
| 9296 |
Radiografi Femur 2 proyeksi |
405,000 |
| 9297 |
Radiografi Femur 3 proyeksi |
447,000 |
| 9298 |
Radiografi Femur 4 proyeksi |
494,000 |
| 9299 |
Radiografi Femur Bilateral 2 proyeksi |
492,000 |
| 9300 |
Radiografi Femur Bilateral 3 proyeksi |
543,000 |
| 9301 |
Radiografi Femur Bilateral 4 proyeksi |
598,000 |
| 9302 |
Radiografi Foramen Opticum (Proyeksi Rheese) |
405,000 |
| 9303 |
Radiografi Genu 2 proyeksi |
405,000 |
| 9304 |
Radiografi Genu 3 proyeksi |
447,000 |
| 9305 |
Radiografi Genu 4 proyeksi |
494,000 |
| 9306 |
Radiografi Genu 5 proyeksi |
545,000 |
| 9307 |
Radiografi Genu 6 proyeksi |
601,000 |
| 9308 |
Radiografi Genu Bilateral 2 proyeksi |
492,000 |
| 9309 |
Radiografi Genu Bilateral 3 proyeksi |
543,000 |
| 9310 |
Radiografi Genu Bilateral 4 proyeksi |
598,000 |
| 9311 |
Radiografi Genu Bilateral 5 proyeksi |
659,000 |
| 9312 |
Radiografi Genu Bilateral 6 proyeksi |
726,000 |
| 9313 |
Radiografi Humerus 2 proyeksi |
405,000 |
| 9314 |
Radiografi Humerus 3 proyeksi |
447,000 |
| 9315 |
Radiografi Humerus 4 proyeksi |
494,000 |
| 9316 |
Radiografi Humerus Bilateral 2 proyeksi |
484,000 |
| 9317 |
Radiografi Humerus Bilateral 3 proyeksi |
543,000 |
| 9318 |
Radiografi Humerus Bilateral 4 proyeksi |
598,000 |
| 9319 |
Radiografi Leher (Jaringan Lunak) |
484,000 |
| 9320 |
Radiografi Mandibula |
405,000 |
| 9321 |
Radiografi Manus 2 proyeksi |
405,000 |
| 9322 |
Radiografi Manus 3 proyeksi |
447,000 |
| 9323 |
Radiografi Manus Bilateral 2 proyeksi |
484,000 |
| 9324 |
Radiografi Manus Bilateral 3 proyeksi |
543,000 |
| 9325 |
Radiografi Mastoid |
405,000 |
| 9326 |
Radiografi Occlusal 3D Rahang Atas |
405,000 |
| 9327 |
Radiografi Occlusal 3D Rahang Bawah |
405,000 |
| 9328 |
Radiografi Orbita |
405,000 |
| 9329 |
Radiografi Os Nasal |
251,000 |
| 9330 |
Radiografi Os Temporal (Proyeksi Stenvers) |
405,000 |
| 9331 |
Radiografi Panoramic dengan Tomografi |
600,000 |
| 9332 |
Radiografi Panoramik |
251,000 |
| 9333 |
Radiografi Panoramik 3D |
484,000 |
| 9334 |
Radiografi Pedis 2 proyeksi |
405,000 |
| 9335 |
Radiografi Pedis 3 proyeksi |
447,000 |
| 9336 |
Radiografi Pedis Bilateral 2 proyeksi |
484,000 |
| 9337 |
Radiografi Pedis Bilateral 3 proyeksi |
543,000 |
| 9338 |
Radiografi Pelvis 1 proyeksi |
251,000 |
| 9339 |
Radiografi Pelvis 2 proyeksi |
302,000 |
| 9340 |
Radiografi Pelvis 3 proyeksi |
363,000 |
| 9341 |
Radiografi Pelvis 4 proyeksi |
437,000 |
| 9342 |
Radiografi Pergelangan Kaki 1 proyeksi |
251,000 |
| 9343 |
Radiografi Pergelangan Kaki 2 proyeksi |
405,000 |
| 9344 |
Radiografi Pergelangan Kaki 3 proyeksi |
447,000 |
| 9345 |
Radiografi Pergelangan Kaki Bilateral 1 proyeksi |
302,000 |
| 9346 |
Radiografi Pergelangan Kaki Bilateral 2 proyeksi |
492,000 |
| 9347 |
Radiografi Pergelangan Kaki Bilateral 3 proyeksi |
543,000 |
| 9348 |
Radiografi Pergelangan Tangan 2 proyeksi |
405,000 |
| 9349 |
Radiografi Pergelangan Tangan 3 proyeksi |
447,000 |
| 9350 |
Radiografi Pergelangan Tangan 4 proyeksi |
494,000 |
| 9351 |
Radiografi Pergelangan Tangan Bilateral 2 proyeksi |
484,000 |
| 9352 |
Radiografi Pergelangan Tangan Bilateral 3 proyeksi |
543,000 |
| 9353 |
Radiografi Pergelangan Tangan Bilateral 4 proyeksi |
598,000 |
| 9354 |
Radiografi Proyeksi Waters |
405,000 |
| 9355 |
Radiografi Sakrum 2 proyeksi |
484,000 |
| 9356 |
Radiografi Scapula |
405,000 |
| 9357 |
Radiografi Scapula Bilateral |
484,000 |
| 9358 |
Radiografi Sendi Sakroiliaka |
251,000 |
| 9359 |
Radiografi Sendi Temporo Mandibula |
405,000 |
| 9360 |
Radiografi Sendi Temporo Mandibula dengan Pesawat Panoramic |
405,000 |
| 9361 |
Radiografi Sinus Adenoid |
405,000 |
| 9362 |
Radiografi Sinus Paranasal 3 proyeksi (AP & Waters & Lateral) |
484,000 |
| 9363 |
Radiografi Sternum |
405,000 |
| 9364 |
Radiografi Survei Skeletal (Bone survey) |
1,098,000 |
| 9365 |
Radiografi Thorax 1 proyeksi (AP/PA/Lateral/Top) |
251,000 |
| 9366 |
Radiografi Thorax 2 proyeksi (AP/PA & Lateral) |
405,000 |
| 9367 |
Radiografi Thorax 2 proyeksi (AP/PA & Top Lordotik) |
405,000 |
| 9368 |
Radiografi Thorax CITO (on site radiography) |
405,000 |
| 9369 |
Radiografi Vertebra C1-C2 |
251,000 |
| 9370 |
Radiografi Vertebra Cervical 2 proyeksi |
405,000 |
| 9371 |
Radiografi Vertebra Cervical 4 proyeksi |
527,000 |
| 9372 |
Radiografi Vertebra Cervical 6 proyeksi |
687,000 |
| 9373 |
Radiografi Vertebra Lengkap (Wholespine) |
688,000 |
| 9374 |
Radiografi Vertebra Lumbal 2 proyeksi |
405,000 |
| 9375 |
Radiografi Vertebra Lumbal 4 proyeksi |
527,000 |
| 9376 |
Radiografi Vertebra Lumbal Dinamik |
484,000 |
| 9377 |
Radiografi Vertebra Thoracal 2 proyeksi |
405,000 |
| 9378 |
Rail Roding |
14,360,000 |
| 9379 |
Rangsang Termal |
436,000 |
| 9380 |
Rapid palatal expansion |
1,500,000 |
| 9381 |
Rasio IT |
190,000 |
| 9382 |
Rawat Colostomy |
0 |
| 9383 |
Rawat Luka (THT) |
105,000 |
| 9384 |
Rawat Luka Berat |
110,000 |
| 9385 |
Rawat luka besar (>10 cm) |
370,000 |
| 9386 |
Rawat luka dekubitus , luka kecil (< 5 cm) |
125,000 |
| 9387 |
Rawat luka dekubitus , luka sedang (6 cm - 10 cm) |
231,000 |
| 9388 |
Rawat luka kecil (< 6 cm) |
125,000 |
| 9389 |
Rawat luka perineum dan vagina |
154,000 |
| 9390 |
Rawat Luka Ringan |
47,000 |
| 9391 |
Rawat Luka Sedang |
76,000 |
| 9392 |
Rawat luka sedang (6 cm - 10 cm) |
231,000 |
| 9393 |
Rawat Stoma Trakeostomi |
185,000 |
| 9394 |
Rawat Traechestomy |
190,000 |
| 9395 |
Ray Amputation of hand |
18,043,000 |
| 9396 |
Ray amputation of toes |
13,576,000 |
| 9397 |
Re-treatment Saluran Akar Jamak |
1,400,000 |
| 9398 |
Re-treatment Saluran Akar Jamak (Eksekutif) |
0 |
| 9399 |
Re-treatment Saluran Akar Tunggal |
1,100,000 |
| 9400 |
Re-treatment Saluran Akar Tunggal (Eksekutif) |
0 |
| 9401 |
Real Time - PCR Covid-19 (Untuk Perjalanan) |
295,000 |
| 9402 |
REAL-TIME PCR SARS COV2 (PROGRAM) |
631,000 |
| 9403 |
REAL-TIME PCR SARS-COV2 |
631,000 |
| 9404 |
Reapir Komplikasi AV Shunt |
2,850,000 |
| 9405 |
Reattachment of extremity |
2,350,000 |
| 9406 |
Reattachment of muscle |
11,196,000 |
| 9407 |
Reattachment of muscle of hand |
11,196,000 |
| 9408 |
Reattachment of tendon |
11,196,000 |
| 9409 |
Reattachment of tendon of hand |
11,196,000 |
| 9410 |
Rebase |
1,786,000 |
| 9411 |
Rebonding Per Bracket |
150,000 |
| 9412 |
Rebonding Per Bracket (Eksekutif) |
0 |
| 9413 |
Recession of tendon |
11,196,000 |
| 9414 |
Recession of tendon of hand |
11,196,000 |
| 9415 |
Reconstruction Anterior |
4,375,000 |
| 9416 |
Reconstruction for Bone / Soft tissue tumor |
34,638,000 |
| 9417 |
Reconstruction for Tenosynovitis / tendon entrapment |
23,914,000 |
| 9418 |
Reconstruction of Blount s disease with Physeal Bar Resection |
23,914,000 |
| 9419 |
Reconstruction of muscle and tendon |
3,271,994 |
| 9420 |
Reconstruction of thumb |
5,561,121 |
| 9421 |
Reconstruction post tumor berat |
10,679,000 |
| 9422 |
Reconstruction post tumor sedang |
7,926,000 |
| 9423 |
Reconstruction procedure for Hallux Valgus |
24,768,000 |
| 9424 |
Reconstruction procedure for Large tendon rupture (quadriceps/ patellar. achilles tendon) |
23,914,000 |
| 9425 |
Reconstruction procedure for Large tendon rupture / Avulsion (quadriceps/ patellar. achilles tendon) |
23,914,000 |
| 9426 |
Recreation Therapy (Play Therapy) |
170,000 |
| 9427 |
Rectal / Vaginal Toucher |
77,000 |
| 9428 |
Rectal Toucher |
77,000 |
| 9429 |
Rectorectal pull-through/duhamel procedure |
6,175,000 |
| 9430 |
Redebridement |
7,270,000 |
| 9431 |
Redo BT Shunt / Redo PS Repair / VSD + PS Repair |
48,750,000 |
| 9432 |
Redo thoracotomy |
13,608,000 |
| 9433 |
Reduksi (ORIF) Fraktur Maksila |
16,332,000 |
| 9434 |
Reduksi (ORIF) Fraktur Malar dan Zigoma |
16,332,000 |
| 9435 |
Reduksi (ORIF) Fraktur Mandibula |
16,332,000 |
| 9436 |
Reduksi dan fiksasi Fraktur dentoalveolar |
6,465,000 |
| 9437 |
Reduksi dasar lidah dengan Radiofrekuensi |
10,230,000 |
| 9438 |
Reduksi Faktur Nasal Terbuka |
7,899,000 |
| 9439 |
Reduksi fraktur nasal tertutup |
7,931,000 |
| 9440 |
Reduksi Konka dengan Kauter |
7,075,000 |
| 9441 |
Reduksi Konka dengan RDF (radiofrekuensi)/Coblation |
7,075,000 |
| 9442 |
Reduksi Payudara |
21,425,000 |
| 9443 |
Reduksi torus |
8,968,000 |
| 9444 |
Reduksi tuberositas |
5,821,000 |
| 9445 |
Reduksi tuberositas maxilla |
8,968,000 |
| 9446 |
Refraksi Subjektif |
84,000 |
| 9447 |
Refraktometri |
25,000 |
| 9448 |
Refrakturing |
9,054,000 |
| 9449 |
Refusion of atlas-axis spine |
10,791,458 |
| 9450 |
Refusion of dorsal and dorolumbarspine, anterior technique |
14,020,000 |
| 9451 |
Refusion of dorsal and dorolumbarspine, posterior technique |
14,020,000 |
| 9452 |
Refusion of lumbar and lumbosacral spine, anterior technique |
14,020,000 |
| 9453 |
Refusion of lumbar and lumbosacral spine, lateral transverse technique |
14,020,000 |
| 9454 |
Refusion of lumbar and lumbosacral spine, posterior technique |
14,020,000 |
| 9455 |
Refusion of other cervical spine, anterior technique |
14,020,000 |
| 9456 |
Refusion of other cervical spine, posterior technique |
14,020,000 |
| 9457 |
Refusion of spine, NEC |
14,020,000 |
| 9458 |
Regional Flap |
5,011,958 |
| 9459 |
Regional flap for Soft tissue defect |
23,914,000 |
| 9460 |
Regional Flap luas |
17,778,000 |
| 9461 |
Regional Flap tidak luas |
12,889,000 |
| 9462 |
Regional Flap Tidak Luas THT |
4,850,000 |
| 9463 |
Rehabilitasi Medik Fase II dan Fase III |
200,000 |
| 9464 |
Rehabilitasi Pre-Vokasional & Rehabilitasi Okupasi |
117,000 |
| 9465 |
Rehabilitasi Sosial |
33,000 |
| 9466 |
Rehidrasi Pada Dehidrasi Berat |
200,000 |
| 9467 |
Rehidrasi Pada Dehidrasi Ringan/Sedang |
168,000 |
| 9468 |
Reimplantasi gigi |
7,125,000 |
| 9469 |
Reimplantasi Gigi Asli dengan Anastesi Lokal |
860,000 |
| 9470 |
Reimplantasi Ureter |
6,175,000 |
| 9471 |
Reimplantasi ureter |
14,055,000 |
| 9472 |
Reinervasi N Laringeus |
20,578,000 |
| 9473 |
Rekanalisasi Central Line |
3,000,000 |
| 9474 |
Rekanalisasi Central Line + Anastesi |
4,790,000 |
| 9475 |
Rekanalisasi Ruptura / Transkanal |
4,392,000 |
| 9476 |
Rekanalisasi Saluran Kelenjar Saliva |
3,762,000 |
| 9477 |
Rekanalisasi Tuba Fallopi Kasus Simpel dengan anestesi |
4,597,000 |
| 9478 |
Rekanulasi Trakeostomi |
971,000 |
| 9479 |
Rekons defek / kelainan tubuh yang simple |
3,850,000 |
| 9480 |
Rekonstruksi (ORIF) Fraktur Condylus |
16,332,000 |
| 9481 |
Rekonstruksi Ala Nasi |
10,390,000 |
| 9482 |
Rekonstruksi avulsi auricula bilateral |
11,118,000 |
| 9483 |
Rekonstruksi avulsi auricula unilateral |
11,482,000 |
| 9484 |
Rekonstruksi avulsi kulit |
4,850,000 |
| 9485 |
Rekonstruksi bibir besar / sekunder |
9,054,000 |
| 9486 |
Rekonstruksi bibir kecil |
8,681,000 |
| 9487 |
Rekonstruksi cedera CBD (traumatik atau iatrogenik) |
32,161,000 |
| 9488 |
Rekonstruksi Chronic Mallet Finger, Swan Neck, Boutenniere |
23,914,000 |
| 9489 |
Rekonstruksi Club hand |
4,850,000 |
| 9490 |
Rekonstruksi Craniosinostosis |
4,850,000 |
| 9491 |
Rekonstruksi dan reposisi Temporo Mandibular Join |
14,650,000 |
| 9492 |
Rekonstruksi defek dengan flap jauh |
4,850,000 |
| 9493 |
Rekonstruksi defek dengan flap lokal |
4,850,000 |
| 9494 |
Rekonstruksi defek dinding abdomen |
19,986,000 |
| 9495 |
Rekonstruksi defek wajah |
17,778,000 |
| 9496 |
Rekonstruksi Defek/Kelainan Tubuh Yang Kompleks |
5,394,025 |
| 9497 |
Rekonstruksi Degloving Injury |
8,888,772 |
| 9498 |
Rekonstruksi Dengan Composite Flap (Microsurgery), GA |
30,842,000 |
| 9499 |
Rekonstruksi Dengan Free Vascularized Bone Graft, GA |
23,961,000 |
| 9500 |
Rekonstruksi dengan LD flap |
23,473,000 |
| 9501 |
Rekonstruksi Dengan Menggunakan Tissue Expantion, GA |
23,961,000 |
| 9502 |
Rekonstruksi Dengan Musculocutaneus Flap, GA |
16,331,000 |
| 9503 |
Rekonstruksi Dengan Skin Flap Komplek, GA |
25,429,000 |
| 9504 |
Rekonstruksi Dengan Skin Flap Komplek, LA |
22,433,000 |
| 9505 |
Rekonstruksi Dengan Skin Flap Lokal, GA |
20,346,000 |
| 9506 |
Rekonstruksi Dengan Skin Flap Lokal, LA |
17,948,000 |
| 9507 |
Rekonstruksi Dengan Skin Grafting, GA |
25,429,000 |
| 9508 |
Rekonstruksi Dengan Skin Grafting, LA |
22,433,000 |
| 9509 |
Rekonstruksi Dengan Tissue Expantion+Skin Flap, GA |
16,331,000 |
| 9510 |
Rekonstruksi Duktus Lacrimalis / Stenosis Sederhana |
4,850,000 |
| 9511 |
Rekonstruksi Epispadia |
25,429,000 |
| 9512 |
Rekonstruksi fistel penyulit post operasi esofagus |
23,156,000 |
| 9513 |
Rekonstruksi Flap Pasca Mastektomi |
20,681,000 |
| 9514 |
Rekonstruksi Flaps |
23,473,000 |
| 9515 |
Rekonstruksi Fraktur Muka Dengan Palte Screw THT |
8,850,000 |
| 9516 |
Rekonstruksi Fraktur NasoOrbitoEtmoid |
14,650,000 |
| 9517 |
Rekonstruksi Fraktur Orbita/Blow Out unilateral |
16,332,000 |
| 9518 |
Rekonstruksi Fraktur Orbito Zigomaticomaksilaricompleks |
14,650,000 |
| 9519 |
Rekonstruksi Fraktur Palatum Durum |
9,449,000 |
| 9520 |
Rekonstruksi Fraktur Rahang THT |
4,850,000 |
| 9521 |
Rekonstruksi Fraktur Rima Orbita bilateral |
16,332,000 |
| 9522 |
Rekonstruksi Fraktur Rima Orbita unilateral |
16,332,000 |
| 9523 |
Rekonstruksi FTSG |
19,280,000 |
| 9524 |
Rekonstruksi Gigantomastia |
4,850,000 |
| 9525 |
Rekonstruksi gingival besar |
15,224,000 |
| 9526 |
Rekonstruksi hard tissue dengan vaskularisasi osteokutaneus graft |
15,538,000 |
| 9527 |
Rekonstruksi hemangioma kompleks |
23,914,000 |
| 9528 |
Rekonstruksi hemangioma sederhana |
11,642,000 |
| 9529 |
Rekonstruksi hidung dengan defek |
20,650,000 |
| 9530 |
Rekonstruksi Hidung Dengan Defek THT |
7,850,000 |
| 9531 |
Rekonstruksi Hidung Dgn Facial Cleft (Bius) |
10,885,000 |
| 9532 |
Rekonstruksi Horse-Shoe Kidney |
25,429,000 |
| 9533 |
Rekonstruksi Ibu Jari - Bone Graft + Myocutaneus Free Flap, GA |
16,331,000 |
| 9534 |
Rekonstruksi Ibu Jari - Bone Graft + Regional Flap, GA |
16,331,000 |
| 9535 |
Rekonstruksi Ibu Jari - Deepening First Digital Web Space, LA |
14,707,000 |
| 9536 |
Rekonstruksi Ibu Jari - Policization, GA |
16,331,000 |
| 9537 |
Rekonstruksi Ibu Jari - Toe To Thumb Transfer, GA |
16,331,000 |
| 9538 |
Rekonstruksi Jenazah Tk.Berat |
1,000,000 |
| 9539 |
Rekonstruksi Jenazah Tk.Ringan |
500,000 |
| 9540 |
Rekonstruksi Jenazah Tk.Sedang |
750,000 |
| 9541 |
Rekonstruksi Karotid body tumor |
8,685,000 |
| 9542 |
Rekonstruksi Kelainan Craniofacial Congenila |
4,850,000 |
| 9543 |
Rekonstruksi Kelainan Genetalia Eksterna Yang Lain, GA |
16,331,000 |
| 9544 |
Rekonstruksi Kelainan Genetalia Eksterna Yang Lain, LA |
14,707,000 |
| 9545 |
Rekonstruksi kelainan jari (polidaktil simple) |
2,850,000 |
| 9546 |
Rekonstruksi Kelainan Mata/kontraktur palpebra |
4,850,000 |
| 9547 |
Rekonstruksi Kelainan Telinga Yang Lain, GA |
16,331,000 |
| 9548 |
Rekonstruksi Kelainan Telinga Yang Lain, LA |
14,707,000 |
| 9549 |
Rekonstruksi kerusakan katup vena dalam tungkai pada DVT kronik/CVI |
9,517,000 |
| 9550 |
Rekonstruksi kompleks arteri ekstremitas pada CLI dengan graft |
27,699,000 |
| 9551 |
Rekonstruksi komplikasi A-V shunt (pseudoaneurisma) A-V shunt dengan graft vena / sintetis |
27,699,000 |
| 9552 |
Rekonstruksi komplikasi pasca trauma (A-V fistula/pseudoaneurisma) |
8,343,000 |
| 9553 |
Rekonstruksi komplikasi pseudoaneurisma repair primer |
19,281,000 |
| 9554 |
Rekonstruksi Kontraktur Difus |
4,850,000 |
| 9555 |
Rekonstruksi Kontraktur Kompleks (Bedah THT) |
4,850,000 |
| 9556 |
Rekonstruksi koreksi Camplodactyl/Clinidactyl |
4,850,000 |
| 9557 |
Rekonstruksi koreksi Makrodactyl |
4,850,000 |
| 9558 |
Rekonstruksi kraniofasial (melibatkan rekonstruksi supraorbital rim) |
25,091,000 |
| 9559 |
Rekonstruksi Lidah |
8,654,000 |
| 9560 |
Rekonstruksi limfangioma kompleks |
20,131,000 |
| 9561 |
Rekonstruksi limfangioma sederhana |
16,475,000 |
| 9562 |
Rekonstruksi limfedema |
36,125,000 |
| 9563 |
Rekonstruksi limfedema kompleks |
9,054,000 |
| 9564 |
Rekonstruksi limfedema sederhana |
15,463,000 |
| 9565 |
Rekonstruksi malformasi vaskular kompleks |
66,724,000 |
| 9566 |
Rekonstruksi malformasi vaskular sederhana |
55,602,000 |
| 9567 |
Rekonstruksi Mammae dengan miocutaneus |
4,850,000 |
| 9568 |
Rekonstruksi Mandibula Dengan Costochondral Graft, GA |
21,478,000 |
| 9569 |
Rekonstruksi mandibula kompleks |
14,650,000 |
| 9570 |
Rekonstruksi Mandibula THT |
7,850,000 |
| 9571 |
Rekonstruksi Mayor |
7,750,000 |
| 9572 |
Rekonstruksi Meningo Encephalocele Anterior (MEA) |
4,850,000 |
| 9573 |
Rekonstruksi Meningokel Kranial (Anterior/ Posterior) |
7,667,000 |
| 9574 |
Rekonstruksi Meningokel Spina Bifida |
7,662,000 |
| 9575 |
Rekonstruksi mukosa bukal besar |
15,224,000 |
| 9576 |
Rekonstruksi myelomeningocele |
37,385,000 |
| 9577 |
Rekonstruksi orbita kongenital |
6,823,000 |
| 9578 |
Rekonstruksi pada total laringesofagektomi |
13,045,000 |
| 9579 |
Rekonstruksi Palpebra Inferior |
10,070,000 |
| 9580 |
Rekonstruksi Palpebra Superior |
10,070,000 |
| 9581 |
Rekonstruksi Panfacial Fraktur |
16,578,000 |
| 9582 |
Rekonstruksi penis (anak) |
16,123,000 |
| 9583 |
Rekonstruksi Plate & Screw |
23,473,000 |
| 9584 |
Rekonstruksi pseudoaneurisma/fistula arteri-vena kompleks |
66,724,000 |
| 9585 |
Rekonstruksi pseudoaneurisma/fistula arteri-vena sederhana |
55,602,000 |
| 9586 |
Rekonstruksi Pulley Tendon |
4,375,000 |
| 9587 |
Rekonstruksi Renovaskular |
25,429,000 |
| 9588 |
Rekonstruksi Repair Tendon Complikate |
4,850,000 |
| 9589 |
Rekonstruksi Rima Orbitha |
16,331,000 |
| 9590 |
Rekonstruksi Ring Avulsion |
4,850,000 |
| 9591 |
Rekonstruksi Sedang (STSG.FTSG.Flap Lokal) |
4,850,000 |
| 9592 |
Rekonstruksi sindaktili |
16,331,000 |
| 9593 |
Rekonstruksi sinus urogenital |
25,429,000 |
| 9594 |
Rekonstruksi Soft Tissue Dan Tulang, GA |
16,331,000 |
| 9595 |
Rekonstruksi soft tissue dengan vaskularisasi soft tissue graft |
15,538,000 |
| 9596 |
Rekonstruksi Soft Tissue Yang Lain, GA |
16,331,000 |
| 9597 |
Rekonstruksi Softtissue Pada Hipertelorism, GA |
16,331,000 |
| 9598 |
Rekonstruksi Softtissue Pada Hipertelorism, LA |
14,707,000 |
| 9599 |
Rekonstruksi spinal meningocele |
37,385,000 |
| 9600 |
Rekonstruksi striktur CBD |
32,161,000 |
| 9601 |
Rekonstruksi STSG |
19,280,000 |
| 9602 |
Rekonstruksi Telinga |
9,950,000 |
| 9603 |
Rekonstruksi Telinga - Elevasi Flap Daun Telinga + Skin Graft, GA |
16,331,000 |
| 9604 |
Rekonstruksi Telinga - Operasi Insersi Graft Tulang Rawan, GA |
16,331,000 |
| 9605 |
Rekonstruksi Telinga - Repair Lobulus Dan Kelainan Penyerta, GA |
16,331,000 |
| 9606 |
Rekonstruksi Telinga - Repair Lobulus Dan Kelainan Penyerta, LA |
14,707,000 |
| 9607 |
Rekonstruksi Telinga ( Microtia ) Tahap I |
14,225,000 |
| 9608 |
Rekonstruksi Telinga ( Tahap 1/ tahap 2 ) |
9,950,000 |
| 9609 |
Rekonstruksi tip nasal |
10,390,000 |
| 9610 |
Rekonstruksi Trakea dan Konstruksi Laring |
20,578,000 |
| 9611 |
Rekonstruksi Transposisi Penokrotal |
25,429,000 |
| 9612 |
Rekonstruksi Trauma Leher |
20,578,000 |
| 9613 |
Rekonstruksi Tripod Fraktur |
14,650,000 |
| 9614 |
Rekonstruksi tuba per laparoskopi |
15,516,000 |
| 9615 |
Rekonstruksi tumor simple |
17,696,000 |
| 9616 |
Rekonstruksi tutup defek spina bifida |
37,385,000 |
| 9617 |
Rekonstruksi Ulkus Decubitus dengan Flap |
4,850,000 |
| 9618 |
Rekonstruksi uretra |
12,027,000 |
| 9619 |
Rekonstruksi urogenital dengan menggunakan flap |
25,429,000 |
| 9620 |
Rekonstruksi Urogenitalia |
12,327,000 |
| 9621 |
Rekonstruksi uterus (metroplasti) per laparoskopi |
21,023,000 |
| 9622 |
Rekonstruksi uterus (termasuk metroplasti) per laparotomi |
18,860,000 |
| 9623 |
Rekonstruksi Vagina |
4,377,586 |
| 9624 |
Rekonstruksi vagina pada kanker ginekologi |
12,027,000 |
| 9625 |
Rekonstruksi Vaskular arteri inomiata atau subklavia dengan graft sintesis |
27,699,000 |
| 9626 |
Rekonstruksi vaskuler aneurisma perifer |
8,344,000 |
| 9627 |
Rekonstruksi vaskuler arteri tungkai / lengan pada Chronic Limb Ischemic |
6,366,000 |
| 9628 |
Rekonstruksi Vaskuler Sederhana |
2,850,000 |
| 9629 |
Rekonstruksi Vermilion, GA |
18,019,000 |
| 9630 |
Rekonstruksi Vesika narkose |
14,629,000 |
| 9631 |
Rekonstruksi vesika urinaria |
12,027,000 |
| 9632 |
Rekonstruksi/bypass aorto-iliaka-femoral dengan graft |
16,895,000 |
| 9633 |
Rekonstruksi/bypass aorto-subklavia-karotis dengan graft |
16,895,000 |
| 9634 |
Rekonstruksi/bypass arteri intra-abdominal (aortosoeliakus/aortomesenterik/etc) |
16,895,000 |
| 9635 |
Rekonstruksi/bypass vaskular perifer ekstra-anatomikal (aksila-brachial/aksila-femoral/femoral-femoral/femoropopliteal/femorotibial/etc) |
16,895,000 |
| 9636 |
Rekonstruksi/Flap |
250,000 |
| 9637 |
Rekontruksi Blassemeck / Bladder Neck |
6,925,000 |
| 9638 |
Rekontruksi fasial cleft unilateral |
15,224,000 |
| 9639 |
Rekontruksi fraktur dentoalveolar |
10,094,000 |
| 9640 |
Rekontruksi Kelopak Berat |
6,849,023 |
| 9641 |
Rekontruksi komplex Naso labio gnatho palato schisis |
15,538,000 |
| 9642 |
Rekontruksi lidah kecil / reduksi lidah |
7,792,000 |
| 9643 |
Rekontruksi mikrovaskular |
15,538,000 |
| 9644 |
Rekontruksi Orbita Congenital |
6,823,000 |
| 9645 |
Rekontruksi penutupan defek kulit kecil |
7,766,000 |
| 9646 |
Rekontruksi penutupan defek mukosa dan otot kecil |
5,709,000 |
| 9647 |
Rekontruksi Renovaskuler |
8,011,000 |
| 9648 |
Rekontruksi Saket Berat |
6,944,450 |
| 9649 |
Rekontruksi sekunder labioplasty |
19,561,000 |
| 9650 |
Rekontruksi sekunder palatoplasty |
10,878,000 |
| 9651 |
Rekontruksi Vesika |
6,925,000 |
| 9652 |
Rekontruksi vulva pasca radikal vulvektomi |
12,027,000 |
| 9653 |
Rekostruksi Softtissue Dan Tulang Pada Hipertelorism, GA |
18,019,000 |
| 9654 |
Relaparotomi |
21,504,000 |
| 9655 |
Relaxation of scar or web contracture of skin |
6,600,000 |
| 9656 |
Release Burried Penis, GA |
18,019,000 |
| 9657 |
Release Burried Penis, LA |
15,794,000 |
| 9658 |
Release chordae + urethroplasty |
16,959,000 |
| 9659 |
Release cordeae /eksisi chorde |
12,354,000 |
| 9660 |
Release Ekstropion, GA |
18,019,000 |
| 9661 |
Release Ekstropion, LA |
15,794,000 |
| 9662 |
Release entrapment syndrome : dekompresi (bedah terbuka) |
17,895,000 |
| 9663 |
Release for Compartment Syndrome |
10,540,000 |
| 9664 |
Release for Peripheral nerve entrapment |
12,476,000 |
| 9665 |
Release for Polidactyli (complex/ >1) |
23,709,000 |
| 9666 |
Release for Ring Constriction |
12,476,000 |
| 9667 |
Release for Syndactily (complex) |
23,709,000 |
| 9668 |
Release for Syndactily (Simple) |
10,393,000 |
| 9669 |
Release for Tenosynovitis / tendon entrapment (single) |
14,550,000 |
| 9670 |
Release konstraktur post NOMA luas |
18,017,000 |
| 9671 |
Release Kontraktur |
11,810,000 |
| 9672 |
Release Kontraktur |
3,850,000 |
| 9673 |
Release Kontraktur + Flap |
6,388,884 |
| 9674 |
Release Kontraktur + Split Thickness Skin Graft |
27,327,000 |
| 9675 |
Release Kontraktur Dengan Dermagram, LA |
15,794,000 |
| 9676 |
Release Kontraktur Dengan Free Flap, GA |
32,929,000 |
| 9677 |
Release Kontraktur Dengan Skin Flap, GA |
32,929,000 |
| 9678 |
Release Kontraktur Dengan Skin Flap, LA |
29,153,000 |
| 9679 |
Release Kontraktur Dengan Skingraft, GA |
32,929,000 |
| 9680 |
Release Kontraktur Dengan Skingraft, LA |
29,153,000 |
| 9681 |
Release Kontraktur Dengan Z Plasty, GA |
18,019,000 |
| 9682 |
Release Kontraktur Dengan Z Plasty, LA |
15,794,000 |
| 9683 |
Release Kontraktur Kompleks + STSG |
6,789,135 |
| 9684 |
Release Kontraktur Leher, GA |
18,019,000 |
| 9685 |
Release Kontraktur Leher, LA |
15,794,000 |
| 9686 |
Release Kontraktur Linier, GA |
18,019,000 |
| 9687 |
Release Kontraktur Linier, LA |
15,794,000 |
| 9688 |
Release kontraktur post NOMA kecil |
18,948,000 |
| 9689 |
Release of Carpal Tunnel |
9,036,000 |
| 9690 |
Release of carpal tunnel |
6,455,000 |
| 9691 |
Release of clubfoot, not elsewhere classified |
11,947,140 |
| 9692 |
Release of tarsal tunnel |
6,455,000 |
| 9693 |
Release of Tarsal Tunnel |
9,036,000 |
| 9694 |
Release sinechia vulva |
10,650,000 |
| 9695 |
Release Sinekhia Vulva |
4,991,000 |
| 9696 |
Release sinekhia vulva Op |
10,650,000 |
| 9697 |
Release Syndacil Kompleks |
4,850,000 |
| 9698 |
Release tethered cord |
37,385,000 |
| 9699 |
Release Thoracic Outlet Syndrome (TOS) |
31,134,000 |
| 9700 |
Release Tongue Tie |
2,850,000 |
| 9701 |
Release torticolis - unipolar/ bipolar |
15,058,000 |
| 9702 |
Release trigger finger percutaneous dengan anestesi lokal |
281,000 |
| 9703 |
Release Vagina Acreta, GA |
18,019,000 |
| 9704 |
Release Vagina Acreta, LA |
15,794,000 |
| 9705 |
Reline |
1,786,000 |
| 9706 |
Remedial Teaching |
60,000 |
| 9707 |
Removable retaine 1 rahang (RA/RB saja) |
391,000 |
| 9708 |
Removable retainer RA dan RB |
594,000 |
| 9709 |
Removal benda asing |
700,000 |
| 9710 |
Removal implant/ screw & plate dgn > 3 approach |
11,801,000 |
| 9711 |
Removal implant/ screw & plate dgn 1 approuch |
9,108,000 |
| 9712 |
Removal implant/ screw & plate dgn 2 approuch |
10,203,000 |
| 9713 |
Removal implant/ screw & plate dgn 3 approach |
11,088,000 |
| 9714 |
Removal Of Abdominal Wall Sutures |
353,000 |
| 9715 |
Removal of external immobilization device |
2,350,000 |
| 9716 |
Removal of foreign body from foot without incision |
3,125,000 |
| 9717 |
Removal of foreign body from hand without incision |
3,125,000 |
| 9718 |
Removal of foreign body from spinal canal |
14,020,000 |
| 9719 |
Removal of foreign body without incision from lower limb, except foot |
3,125,000 |
| 9720 |
Removal of foreign body without incision from upper limb, except hand |
3,125,000 |
| 9721 |
Removal of foreign body, not otherwise specified |
2,350,000 |
| 9722 |
Removal of implanted device from carpals and metacarpals |
4,952,586 |
| 9723 |
Removal of implanted device from femur |
3,814,600 |
| 9724 |
Removal of implanted device from humerus |
5,078,000 |
| 9725 |
Removal of implanted device from patella |
3,814,600 |
| 9726 |
Removal of implanted device from radius and ulna |
3,814,600 |
| 9727 |
Removal of implanted device from scapula, clavicle, and thorax (ribs and sternum) |
6,154,994 |
| 9728 |
Removal of implanted device from tarsal and metatarsals |
3,814,600 |
| 9729 |
Removal of implanted device from tibia and fibula |
3,814,600 |
| 9730 |
Removal of implanted device, unspesified site |
2,350,000 |
| 9731 |
Removal of nail, nailbed, or nail fold |
2,350,000 |
| 9732 |
Removal of Orthopaedic Implant in extremities |
11,174,000 |
| 9733 |
Removal Of Other Device From Abdomen |
345,000 |
| 9734 |
Removal of other device from trunk |
4,375,000 |
| 9735 |
Removal of other foreign body without incision from head and neck |
3,125,000 |
| 9736 |
Removal Of Other Therapeutic Device |
339,000 |
| 9737 |
Removal Of Packing From Trunk, Not Elsewhere Classified |
353,000 |
| 9738 |
Removal Of Peripheral Neurostimulator Lead(s) |
392,000 |
| 9739 |
Removal Of Spinal Neurostimulator Lead(s) |
392,000 |
| 9740 |
Removal Of Sutures From Trunk, Not Elsewhere Classified |
362,000 |
| 9741 |
Removal Tumor Saraf Tepi |
16,900,000 |
| 9742 |
Removal wire per rahang |
900,000 |
| 9743 |
Remove plate/screw/quick fix |
19,779,000 |
| 9744 |
Remove Wiring / Splinting |
7,676,000 |
| 9745 |
Reopening of laminectomy site |
14,020,000 |
| 9746 |
Repair / Rekonstruksi gingival besar |
8,261,000 |
| 9747 |
Repair /Reconstruction mukosa bukal kecil |
9,054,000 |
| 9748 |
Repair /Rekonstruksi/ Reduksi lidah besar |
15,224,000 |
| 9749 |
Repair ALCAPA/coronary artery |
113,462,000 |
| 9750 |
Repair Atresia Koana bilateral |
10,390,000 |
| 9751 |
Repair Atresia Koana unilateral |
6,366,000 |
| 9752 |
Repair AVSD dengan prosedur katup jantung |
144,180,000 |
| 9753 |
Repair AVSD tanpa prosedur katup jantung |
112,316,000 |
| 9754 |
Repair Bibir Dengan - Estlander Flap, GA |
18,019,000 |
| 9755 |
Repair Bibir Dengan Bernard-Burows Flap, GA |
13,664,000 |
| 9756 |
Repair Bibir Dengan Karapandzic Methode, GA |
13,664,000 |
| 9757 |
Repair bifid scrotum |
4,879,000 |
| 9758 |
Repair bladder extrophy |
4,879,000 |
| 9759 |
Repair bladder extrophy (BA) |
6,175,000 |
| 9760 |
Repair Blepharoptosis, GA |
13,664,000 |
| 9761 |
Repair Blepharoptosis, LA |
12,248,000 |
| 9762 |
Repair Camptodactyly, GA |
13,664,000 |
| 9763 |
Repair Cleft Ear Lobe, LA |
12,248,000 |
| 9764 |
Repair Clinodactyly, GA |
13,664,000 |
| 9765 |
Repair cloacal |
6,175,000 |
| 9766 |
Repair Creeple Hypospadia, GA |
13,664,000 |
| 9767 |
Repair defek dinding abdomen |
42,326,000 |
| 9768 |
Repair Defek Dinding Perut |
9,464,367 |
| 9769 |
Repair defek dinding perut (omphalocele/gastroschizis) |
7,925,000 |
| 9770 |
Repair defek hernia umbilikalis |
8,017,000 |
| 9771 |
Repair Defek Hernia Umbilikalis |
5,008,000 |
| 9772 |
Repair Ductus Nasolacrimalis, GA |
13,664,000 |
| 9773 |
Repair Ductus Parotis, GA |
13,664,000 |
| 9774 |
Repair Epispadia, GA |
13,664,000 |
| 9775 |
Repair esofagostomi |
23,367,000 |
| 9776 |
Repair Fistel |
6,054,980 |
| 9777 |
Repair fistel |
17,812,000 |
| 9778 |
Repair Fistel Intra Oral / Ekstra Oral |
9,312,000 |
| 9779 |
Repair Fistel Palatum Dengan Bucal Atau Lingual Flap, GA |
13,664,000 |
| 9780 |
Repair Fistel Palatum, GA |
13,664,000 |
| 9781 |
Repair Fistel Recto-vaginal |
6,175,000 |
| 9782 |
Repair fistel rectovaginal |
17,812,000 |
| 9783 |
Repair Fistel Urethra Complex, GA |
13,664,000 |
| 9784 |
Repair Fistel Urethra Pascauretroplasti |
5,193,000 |
| 9785 |
Repair Fistel Urethra Sederhana, GA |
13,664,000 |
| 9786 |
Repair fistel uretrokutan |
18,050,000 |
| 9787 |
Repair fistel vesico vagina |
14,606,000 |
| 9788 |
Repair fistel vesiko vaginal komplek |
15,673,000 |
| 9789 |
Repair Fistel Vesikokutan |
9,679,000 |
| 9790 |
Repair Fistel Vesikokutan |
4,850,000 |
| 9791 |
Repair Fistel Vesikorektal |
9,429,000 |
| 9792 |
Repair fistula coroner dengan CPB |
113,462,000 |
| 9793 |
Repair fistula coroner tanpa CPB |
90,771,000 |
| 9794 |
Repair fistula enterovesika |
9,679,000 |
| 9795 |
Repair Fistula rcto Vaginal |
6,238,462 |
| 9796 |
Repair fistula urethrokutan |
17,812,000 |
| 9797 |
Repair for Tendon injury (?8) |
14,550,000 |
| 9798 |
Repair fraktur penis |
13,200,000 |
| 9799 |
Repair gastrostomi |
10,659,000 |
| 9800 |
Repair Hernia Insisional |
13,091,000 |
| 9801 |
Repair hiatal hernia (anak) |
26,600,000 |
| 9802 |
Repair Involutional Ptosis, GA |
13,664,000 |
| 9803 |
Repair Involutional Ptosis, LA |
12,248,000 |
| 9804 |
Repair Kornea lokal |
7,456,000 |
| 9805 |
Repair Kornea narkose |
8,845,000 |
| 9806 |
Repair luka kompleks pd wajah |
9,054,000 |
| 9807 |
Repair Luka Pada Wajah Kompleks |
6,767,221 |
| 9808 |
Repair Luka Pada Wajah melibatkan saraf ducyus lakrimal/kelenjar liur |
4,850,000 |
| 9809 |
Repair luka pada wajah simple |
9,054,000 |
| 9810 |
Repair Luka Robek Sederhana Pada Wajah |
5,193,000 |
| 9811 |
Repair microsurgery for nerve injury |
23,914,000 |
| 9812 |
Repair Muscle/Tendon |
5,121,824 |
| 9813 |
Repair of claw toe |
6,600,000 |
| 9814 |
Repair of cleft hand |
10,675,000 |
| 9815 |
Repair of hammer toe |
6,600,000 |
| 9816 |
Repair of macrodactyly |
10,675,000 |
| 9817 |
Repair of mallet finger |
10,675,000 |
| 9818 |
Repair of recurrent dislocation of shoulder |
8,105,000 |
| 9819 |
Repair of the anulus fibrosus with graft or prosthesis |
14,020,000 |
| 9820 |
Repair omfalokel |
17,812,000 |
| 9821 |
Repair Palpebra Dengan Hard Palate Mucosal Graft, GA |
13,664,000 |
| 9822 |
Repair Palpebra Dengan Local Skin Flap, GA |
13,664,000 |
| 9823 |
Repair Palpebra Dengan Local Skin Flap, LA |
12,248,000 |
| 9824 |
Repair Palpebra Dengan Oral Mucosal Graft, GA |
13,664,000 |
| 9825 |
Repair Palpebra Dengan Posterior Lamellar Reconstruction, GA |
13,664,000 |
| 9826 |
Repair Palpebra Dengan Septal Chondromucosal Graft, GA |
13,664,000 |
| 9827 |
Repair Palpebra Dengan Skin Flap Regional, LA |
12,248,000 |
| 9828 |
Repair Palpebra Dengan Skin Graft, LA |
12,248,000 |
| 9829 |
Repair Palpebra Dengan Sliding Transconjunctival Flap, LA |
12,248,000 |
| 9830 |
Repair Palpebra Dengan Tarsoconjunctival Graft, GA |
13,664,000 |
| 9831 |
Repair Palpebra Komplek, GA |
13,664,000 |
| 9832 |
Repair Palpebra Simple, LA |
12,248,000 |
| 9833 |
Repair Perforasi Septum Hidung |
10,390,000 |
| 9834 |
repair perforasi uterus |
15,348,000 |
| 9835 |
Repair perineum |
14,029,000 |
| 9836 |
Repair Perinium Grade III - IV Pasca Persalinan |
2,850,000 |
| 9837 |
Repair Polysyndactyly, GA |
13,664,000 |
| 9838 |
Repair PSARP |
17,812,000 |
| 9839 |
Repair Pseudo Aneurysm |
9,104,000 |
| 9840 |
Repair Pulmonary Vein dengan tatalaksana PH |
126,841,000 |
| 9841 |
Repair Ruptur Korneosklera |
4,850,000 |
| 9842 |
Repair Ruptur Palpebra Simpel |
2,850,000 |
| 9843 |
Repair Ruptur Palpebra Transkanal |
3,850,000 |
| 9844 |
Repair RVOTO + BT shunt |
100,860,000 |
| 9845 |
Repair RVOTO dengan CPB |
117,601,000 |
| 9846 |
Repair RVOTO tanpa CPB |
98,765,000 |
| 9847 |
Repair Sklera lokal |
7,030,000 |
| 9848 |
Repair Sklera narkose |
8,237,000 |
| 9849 |
Repair Soft Tissue Komplek, LA |
12,248,000 |
| 9850 |
Repair Soft Tisue Simple, LA |
12,248,000 |
| 9851 |
Repair Stenosis Subglotis dengan mikrolaring |
16,553,000 |
| 9852 |
Repair Stenosis Trakea dengan bronkoskopi |
15,653,000 |
| 9853 |
Repair stoma |
19,986,000 |
| 9854 |
Repair Stoma / Revisi Laringostomi |
11,118,000 |
| 9855 |
Repair Symbrachydactyly, GA |
13,664,000 |
| 9856 |
Repair Tendon Ekstensor Tangan Multiple, GA |
14,550,000 |
| 9857 |
Repair Tendon Ekstensor Tangan Tunggal, LA |
10,572,000 |
| 9858 |
Repair Tendon Fleksor Tangan Multipel+ Pulley Reconst,, GA |
17,462,000 |
| 9859 |
Repair Tendon Fleksor Tangan Multiple, GA |
14,550,000 |
| 9860 |
Repair Tendon Fleksor Tangan Tunggal + Pulley Reconst,, GA |
12,134,000 |
| 9861 |
Repair Tendon Fleksor Tangan Tunggal, LA |
10,572,000 |
| 9862 |
Repair Tendon Jari (Bedah Plastik) |
6,883,430 |
| 9863 |
Repair Trauma Amputasi Jari |
91,000 |
| 9864 |
Repair Trauma Buli-buli |
17,212,000 |
| 9865 |
Repair Trauma Telinga Komplek, GA |
13,664,000 |
| 9866 |
Repair Trauma Telinga Simple, LA |
12,248,000 |
| 9867 |
Repair trauma uretra |
17,212,000 |
| 9868 |
Repair Tube narkose |
3,845,000 |
| 9869 |
repair ureter |
17,812,000 |
| 9870 |
Repair vagina |
17,812,000 |
| 9871 |
Repair vesica |
17,812,000 |
| 9872 |
Repair Vesico Vagina Fistel Complex |
9,464,367 |
| 9873 |
Repair VP Shunt |
5,010,202 |
| 9874 |
Repair with graft for Arterial injury |
23,914,000 |
| 9875 |
Repair with graft for Nerve injury |
23,914,000 |
| 9876 |
Repair with graft for Tendon injury / entrapment |
17,460,000 |
| 9877 |
Repair WSD |
180,000 |
| 9878 |
Repalatoplasty, GA |
7,235,000 |
| 9879 |
Reparasi Fistel Esofagus |
26,382,000 |
| 9880 |
Reparasi Fistel Kebocoran LCS |
13,191,000 |
| 9881 |
Reparasi fistula ano-perineal |
13,191,000 |
| 9882 |
Reparasi fistula rekto-vagina per laparoskopi |
21,888,000 |
| 9883 |
Reparasi fistula rekto-vagina per laparotomi |
17,514,000 |
| 9884 |
Reparasi fistula rekto-vagina transvaginal |
13,191,000 |
| 9885 |
Reparasi fistula uretro-kutan |
18,544,000 |
| 9886 |
Reparasi fistula urogenital dengan graft |
21,394,000 |
| 9887 |
Reparasi fistula urogenital kompleks |
19,494,000 |
| 9888 |
Reparasi Fistula Vesiko Vaginal |
6,968,000 |
| 9889 |
Reparasi fistula vesiko-vagina dengan graft |
21,394,000 |
| 9890 |
Reparasi fistula vesiko-vagina per laparoskopi |
21,888,000 |
| 9891 |
Reparasi fistula vesiko-vagina per laparotomi |
17,514,000 |
| 9892 |
Reparasi fistula vesiko-vagina transvaginal |
13,191,000 |
| 9893 |
Reparasi Fraktur Laring |
20,578,000 |
| 9894 |
Reparasi Kawat |
770,000 |
| 9895 |
Reparasi Kebocoran LCS dengan Graft Abdomen |
14,461,000 |
| 9896 |
Reparasi Kompleks |
770,000 |
| 9897 |
Reparasi laserasi kandung kemih |
17,212,000 |
| 9898 |
Reparasi laserasi rektum |
11,894,000 |
| 9899 |
Reparasi laserasi uretra |
19,494,000 |
| 9900 |
Reparasi Oval/Round Window |
17,568,000 |
| 9901 |
Reparasi Patah |
770,000 |
| 9902 |
Reparasi Ringan (<25%) Ortosis |
291,000 |
| 9903 |
Reparasi Ringan (<25%) Prostesis |
344,000 |
| 9904 |
Reparasi ruptura perineum lama |
12,331,000 |
| 9905 |
Reparasi Sedang (25-60%) Ortosis |
357,000 |
| 9906 |
Reparasi Sedang (25-60%) Prostesis |
484,000 |
| 9907 |
Reparasi Striktur Esofagus |
8,085,000 |
| 9908 |
Reparasi vesika urinaria kasus obsgin |
15,694,000 |
| 9909 |
Repeititve Nerve Stimulation |
1,800,000 |
| 9910 |
Repetitive nerve stimulation (RNS). |
1,621,000 |
| 9911 |
repetitive Transcranial Magnetic Stimulation (terapeutik) |
712,000 |
| 9912 |
Replacement of cast on lower limb |
4,375,000 |
| 9913 |
Replacement of cast on upper limb |
4,375,000 |
| 9914 |
Replacement of other cast |
4,375,000 |
| 9915 |
Replacement of other device for musculoskeletal immobilization |
4,375,000 |
| 9916 |
Replacement PPM dengan ekstraksi lead dan upgrade device |
80,214,000 |
| 9917 |
Replacement PPM Dual Chamber dengan Ekstraksi Lead |
80,214,000 |
| 9918 |
Replacement PPM dual chamber dengan ekstraksi lead + anestesi |
101,605,000 |
| 9919 |
Replacement PPM single chamber dengan ekstraksi lead |
38,254,000 |
| 9920 |
Replacement PPM single chamber dengan ekstraksi lead + anestesi |
48,456,000 |
| 9921 |
Replacement PPM tanpa ekstraksi lead |
80,214,000 |
| 9922 |
Replacement PPM tanpa ekstraksi lead dan upgrade device |
80,214,000 |
| 9923 |
Replantasi |
39,652,089 |
| 9924 |
Replantasi gigi |
3,720,000 |
| 9925 |
Replantasi gigi multipel |
8,687,000 |
| 9926 |
Replantasi Jari Multiple, GA |
49,681,000 |
| 9927 |
Replantasi Jari Tunggal |
38,115,000 |
| 9928 |
Replantasi Jari Tunggal, GA |
38,115,000 |
| 9929 |
Replantation for Ring avulsion or traumatic amputaton of finger and hand (single) |
36,161,000 |
| 9930 |
Reposisi / Fiksasi Fr.Maksila & Mandibula |
9,350,000 |
| 9931 |
Reposisi / Fiksasi Fr.Naso Orbita Edmoe (NOE) |
9,350,000 |
| 9932 |
Reposisi & Fiksasi Fr. Naso Orbita Edmoe (NOE) |
11,250,000 |
| 9933 |
Reposisi & Fiksasi Fraktur Tunggal Tulang Wajah |
4,850,000 |
| 9934 |
Reposisi CDL |
480,000 |
| 9935 |
Reposisi chest tube / WSD pasien dewasa |
549,000 |
| 9936 |
Reposisi chest tube / WSD pasien neonatus |
549,000 |
| 9937 |
Reposisi chest tube / WSD pasien pediatrik |
549,000 |
| 9938 |
Reposisi CRT |
6,749,000 |
| 9939 |
Reposisi CVC |
941,000 |
| 9940 |
Reposisi CVC pasien dewasa |
941,000 |
| 9941 |
Reposisi CVC pasien neonatus |
941,000 |
| 9942 |
Reposisi CVC pasien pediatrik |
941,000 |
| 9943 |
Reposisi dan pemasangan gips atas lutut dengan lokal anestesi |
221,000 |
| 9944 |
Reposisi dan pemasangan gips atas siku dengan lokal anestesi |
294,000 |
| 9945 |
Reposisi dan pemasangan gips bawah lutut dengan lokal anestesi |
927,000 |
| 9946 |
Reposisi dan Pemasangan Gips bawah siku dengan lokal anestesi |
849,000 |
| 9947 |
Reposisi dengan Anestesi Lokal |
675,000 |
| 9948 |
Reposisi Disc TMJ Manual |
1,470,000 |
| 9949 |
Reposisi dislokasi Temporo mandibula (TMJ) |
9,982,000 |
| 9950 |
Reposisi Dislokasi Tmj, GA |
9,448,000 |
| 9951 |
Reposisi Fraktur Mandibula Multiple/ Kompleks |
6,767,221 |
| 9952 |
Reposisi Fraktur Mandibula Sederhana |
4,850,000 |
| 9953 |
Reposisi Fraktur Os Maksila Le Fort |
14,650,000 |
| 9954 |
Reposisi Fraktur Rahang Simple |
4,850,000 |
| 9955 |
Reposisi fraktur sederhana os nassal |
2,850,000 |
| 9956 |
Reposisi Hidung |
418,000 |
| 9957 |
Reposisi Hidung THT |
250,000 |
| 9958 |
Reposisi ICD |
6,749,000 |
| 9959 |
Reposisi IOL |
2,850,000 |
| 9960 |
Reposisi IOL lokal |
6,620,000 |
| 9961 |
Reposisi IOL narkose |
7,780,000 |
| 9962 |
Reposisi Iris |
2,850,000 |
| 9963 |
Reposisi kateter peritoneal dialisa akut pasien dewasa |
120,000 |
| 9964 |
Reposisi kateter peritoneal dialisa akut pasien neonatus |
120,000 |
| 9965 |
Reposisi kateter peritoneal dialisa akut pasien pediatrik |
120,000 |
| 9966 |
Reposisi Luksasi Rahang |
270,000 |
| 9967 |
Reposisi Luksasi Rahang Berat |
860,000 |
| 9968 |
Reposisi pacu jantung transvena pasien dewasa |
795,000 |
| 9969 |
Reposisi pacu jantung transvena pasien neonatus |
795,000 |
| 9970 |
Reposisi pacu jantung transvena pasien pediatrik |
795,000 |
| 9971 |
Reposisi PICC |
127,000 |
| 9972 |
Reposisi PICC pasien dewasa |
941,000 |
| 9973 |
Reposisi PICC pasien neonatus |
941,000 |
| 9974 |
Reposisi PICC pasien pediatrik |
941,000 |
| 9975 |
Reposisi PPM |
6,750,000 |
| 9976 |
Reposisi PPM |
6,750,000 |
| 9977 |
REPOSISI PPM / CRT / ICD dengan anestesi |
9,920,000 |
| 9978 |
Reposisi Terbuka dan Fiksasi |
4,375,000 |
| 9979 |
Reposisi TMJ (Bedah Mulut) |
1,470,000 |
| 9980 |
Reposisi TMJ dengan manual |
3,797,000 |
| 9981 |
Reposisi TPM |
1,945,000 |
| 9982 |
Reposisi TPM |
2,547,000 |
| 9983 |
Reposisi Trauma Hidung sederhana |
250,000 |
| 9984 |
Reposisi-fixasi (fraktur rahang simple mandibula/maksila) dengan pemasangan IDW |
10,094,000 |
| 9985 |
Reposisi/ Fiksasi Fr. Orbita |
9,950,000 |
| 9986 |
Reprogram Pacemaker |
221,000 |
| 9987 |
Resectie Rahang |
4,442,187 |
| 9988 |
Reseksi + anastomosis esofagus |
30,484,000 |
| 9989 |
Reseksi + Anastomosis Esophagos |
6,180,370 |
| 9990 |
Reseksi Adenomiosis |
6,323,408 |
| 9991 |
Reseksi Adenomiosis (simpel) per laparotomi |
15,694,000 |
| 9992 |
Reseksi Adenomiosis (teknik Osada) per laparotomi |
17,702,000 |
| 9993 |
Reseksi adenomiosis per laparoskopi |
18,654,000 |
| 9994 |
Reseksi adenomiosis per laparoskopi dengan penyulit |
23,318,000 |
| 9995 |
Reseksi adenomiosis per laparotomi |
21,023,000 |
| 9996 |
Reseksi Anastomosis |
4,455,809 |
| 9997 |
Reseksi Anastomosis Atresia usus,duplikasi |
6,136,962 |
| 9998 |
Reseksi anastomosis pada atresia usus, duplikasi |
22,485,000 |
| 9999 |
Reseksi Anastomosis Urethra |
27,117,000 |
| 10000 |
Reseksi anterior reh bein |
6,175,000 |
| 10001 |
Reseksi Anterior Terbuka |
42,864,000 |
| 10002 |
Reseksi cele anterior |
37,385,000 |
| 10003 |
Reseksi cele konveksitas |
37,385,000 |
| 10004 |
Reseksi cele per endoksopik |
50,068,000 |
| 10005 |
Reseksi cele transkranial |
37,385,000 |
| 10006 |
Reseksi cele transkranial dengani rekonstruksi supraorbital rim |
37,385,000 |
| 10007 |
Reseksi dan Anastomosis Ureter |
14,055,000 |
| 10008 |
Reseksi deep infiltrating endometriosis (DIE) tingkat 1 per laparotomi |
16,754,000 |
| 10009 |
Reseksi deep infiltrating endometriosis (DIE) tingkat 2 per laparotomi |
17,702,000 |
| 10010 |
Reseksi Esofagus |
34,621,000 |
| 10011 |
Reseksi Esofagus & Rekonstruksi |
30,842,000 |
| 10012 |
Reseksi Esofagus + Interposisi Kolon |
7,131,625 |
| 10013 |
Reseksi esofagus dan anastomosis |
13,045,000 |
| 10014 |
Reseksi gaster |
10,331,000 |
| 10015 |
Reseksi Gaster |
6,175,000 |
| 10016 |
Reseksi Gaster Parsial |
18,315,000 |
| 10017 |
Reseksi Hepar |
6,171,198 |
| 10018 |
Reseksi hepar (operasi terbuka) |
14,406,000 |
| 10019 |
Reseksi hepar (tumor, trauma) |
18,734,000 |
| 10020 |
Reseksi Klatskin dan rekonstruksi |
32,161,000 |
| 10021 |
Reseksi Klatskin dan rekonstruksi + hepatektomi |
13,045,000 |
| 10022 |
Reseksi Marginal |
14,255,000 |
| 10023 |
Reseksi marginal mandibula / maksilla kecil |
13,642,000 |
| 10024 |
Reseksi marginal mandibula / maksilla luas |
15,224,000 |
| 10025 |
Reseksi Partial Vesika |
6,942,000 |
| 10026 |
Reseksi partial vesika (narkose) |
12,697,000 |
| 10027 |
Reseksi paru dengan lokalisasi tumor (image guided, dye) |
31,134,000 |
| 10028 |
Reseksi Reduksi |
6,894,000 |
| 10029 |
Reseksi segmental mandibula / maksilla kecil |
12,175,000 |
| 10030 |
Reseksi Sigmoid / Hartman procedure |
47,480,000 |
| 10031 |
Reseksi Trachea ( Bedah Paru / Thorax ) |
21,102,000 |
| 10032 |
Reseksi Urachus (narkose) |
20,225,000 |
| 10033 |
Reseksi uterus tingkat 1 (adenomiosis, skar operasi) per laparoskopi |
16,754,000 |
| 10034 |
Reseksi uterus tingkat 1 (adenomiosis, skar operasi) per laparotomi |
16,754,000 |
| 10035 |
Reseksi uterus tingkat 2 (adenomiosis, skar operasi) per laparoskopi |
17,702,000 |
| 10036 |
Reseksi uterus tingkat 2 (adenomiosis, skar operasi) per laparotomi |
17,702,000 |
| 10037 |
Reseksi+anastomosis esofagus |
30,484,000 |
| 10038 |
Reshape Mahkota Gigi |
450,000 |
| 10039 |
Reshape Mahkota Gigi (Eksekutif) |
0 |
| 10040 |
Reshaping luas tulang wajah |
9,054,000 |
| 10041 |
Reshaping maksilla / mandibula |
15,224,000 |
| 10042 |
Reshaping Untuk Torus (Op.Gigi) |
2,510,000 |
| 10043 |
Reshaping untuk Torus/Tumor Tulang |
4,757,000 |
| 10044 |
Resipien Transplan Ginjal |
101,660,000 |
| 10045 |
Resisted exe |
70,000 |
| 10046 |
RESTORASI - BESAR - Veneer Direct |
1,200,000 |
| 10047 |
RESTORASI - KHUSUS - Mahkota Jaket Full Porcelain (belum termasuk laboratorium) |
4,964,000 |
| 10048 |
RESTORASI - KHUSUS - Mahkota Jaket PFM (belum termasuk laboratorium) |
3,292,000 |
| 10049 |
RESTORASI - KHUSUS - Veneer Indirect (belum termasuk laboratorium) |
5,558,000 |
| 10050 |
Restorasi dengan Composite Besar |
600,000 |
| 10051 |
Restorasi dengan Composite Besar (Eksekutif) |
0 |
| 10052 |
Restorasi dengan Composite Kecil |
480,000 |
| 10053 |
Restorasi dengan Composite Kecil (Eksekutif) |
0 |
| 10054 |
Restorasi Gigi Dengan Glass Lonomer (Fuji IX) |
520,000 |
| 10055 |
Restorasi Gigi Dengan Glass Lonomer (Fuji IX) (Eksekutif) |
0 |
| 10056 |
Resurgical debridement |
12,920,000 |
| 10057 |
Resusitasi cairan |
92,000 |
| 10058 |
Resusitasi cairan pada pemberian kemoterapi |
92,000 |
| 10059 |
Resusitasi dan stabilisasi pasien dewasa |
1,178,000 |
| 10060 |
Resusitasi dan stabilisasi pasien neonatus (per bayi)) |
1,178,000 |
| 10061 |
Resusitasi dan stabilisasi pasien pediatrik |
1,178,000 |
| 10062 |
Resusitasi jantung paru |
1,010,000 |
| 10063 |
Resusitasi Jantung Paru ( RJP) |
931,000 |
| 10064 |
Resusitasi Syok |
750,000 |
| 10065 |
Retcam + Narkose |
2,850,000 |
| 10066 |
RETCAM ODS |
6,897,000 |
| 10067 |
RetCam ODS + Cryotherapy OD/OS |
8,362,000 |
| 10068 |
RetCam ODS + Cryotherapy ODS |
9,870,000 |
| 10069 |
RetCam ODS + Injeksi Avastine ODS |
8,560,000 |
| 10070 |
RetCam ODS+ Injeksi Avastine OD/OS |
7,978,000 |
| 10071 |
RetCam ODS+LIO OD/OS |
10,841,000 |
| 10072 |
RetCam ODS+LIO ODS |
10,841,000 |
| 10073 |
RetCam+LIO+Cryotherapy |
10,841,000 |
| 10074 |
Retightening PA Banding |
15,352,000 |
| 10075 |
Retikulosit Otomatik + Hematologi Rutin |
150,000 |
| 10076 |
Retreatment 1 saluran akar |
892,000 |
| 10077 |
Retreatment 2 saluran akar |
1,124,000 |
| 10078 |
Retreatment 3 saluran akar/lebih |
1,353,000 |
| 10079 |
Retrograde Intubation |
1,077,000 |
| 10080 |
Retrograde Intubation pasien dewasa |
1,077,000 |
| 10081 |
Retrograde Intubation pasien neonatus |
1,077,000 |
| 10082 |
Retrograde Intubation pasien pediatrik |
1,077,000 |
| 10083 |
Retroperitoneal Lymph Node Dissection |
10,005,000 |
| 10084 |
Retroperitoneoskopik Heminefrektomi |
15,030,000 |
| 10085 |
Retroperitoneum, pengangkatan tumor |
22,616,000 |
| 10086 |
Retroperitoneum, trauma |
22,616,000 |
| 10087 |
Retrorectal pull through (duhamel procedure) |
44,624,000 |
| 10088 |
Reverse Hartman |
22,616,000 |
| 10089 |
Review blok/slide (>15 blok/slide) |
400,000 |
| 10090 |
Review blok/slide (1-2 blok/slide) |
250,000 |
| 10091 |
Review blok/slide (3-15 blok/slide) |
350,000 |
| 10092 |
Review slide sitologi (< 5 slides) |
250,000 |
| 10093 |
Review slide sitologi (> 15 slides) |
400,000 |
| 10094 |
Review slide sitologi (5-15 slides) |
350,000 |
| 10095 |
Revisi Cuping Telinga |
2,000,000 |
| 10096 |
Revisi Dengan Flap Jauh, GA |
16,331,000 |
| 10097 |
Revisi Dengan Flap Lokal, GA |
16,331,000 |
| 10098 |
Revisi Dengan Flap Lokal, LA |
14,707,000 |
| 10099 |
Revisi Dengan Multiple Z Plasty/W Plasty, GA |
16,331,000 |
| 10100 |
Revisi Dengan Multiple Z Plasty/W Plasty, LA |
14,707,000 |
| 10101 |
Revisi Dengan Simple Z Plasty, GA |
16,331,000 |
| 10102 |
Revisi Dengan Simple Z Plasty, LA |
14,707,000 |
| 10103 |
Revisi Fenestrasi Telinga Dalam |
17,568,000 |
| 10104 |
revisi Fistula Trakeoesofagus |
33,156,000 |
| 10105 |
Revisi Iridektomi / Bleb lokal |
9,196,000 |
| 10106 |
Revisi Iridektomi / Bleb narkose |
10,655,000 |
| 10107 |
Revisi Jaringan Parut THT |
250,000 |
| 10108 |
Revisi Labioplasty, LA |
16,331,000 |
| 10109 |
Revisi Lesi Hidung (Sinekia, Pelebaran Ostium) |
5,307,000 |
| 10110 |
Revisi Nefrostomi Lokal |
5,901,000 |
| 10111 |
Revisi Operasi Saraf Kranial / Perifer |
15,526,000 |
| 10112 |
Revisi Palatoplasti pada Celah Palatum |
7,235,000 |
| 10113 |
Revisi Parut |
4,546,000 |
| 10114 |
Revisi Parut Dengan Simple Advancement Flap, GA |
16,331,000 |
| 10115 |
Revisi Parut Dengan Simple Advancement Flap, LA |
14,707,000 |
| 10116 |
Revisi Parut Per Biji |
66,000 |
| 10117 |
Revisi Parut THT |
2,850,000 |
| 10118 |
Revisi Parut Wajah, LA |
14,707,000 |
| 10119 |
Revisi Parut, GA |
16,331,000 |
| 10120 |
Revisi Parut, LA |
14,707,000 |
| 10121 |
Revisi shunt |
21,960,000 |
| 10122 |
Revisi Skar 1 (kecil, panjang hingga 3 cm) |
800,000 |
| 10123 |
Revisi Skar 2 (sedang, panjang hingga 6 cm) |
1,000,000 |
| 10124 |
Revisi Skar 3 (besar, panjang hingga 12 cm) |
1,200,000 |
| 10125 |
Revisi Stump, LA |
14,707,000 |
| 10126 |
Revision of Hemiarthroplasty |
33,415,000 |
| 10127 |
Revision of joint replacement of upper extremity |
5,752,000 |
| 10128 |
Revision of monoplanar / biplanar / ring external fixator |
33,415,000 |
| 10129 |
Revision of Total Hip Arthroplasty |
34,176,000 |
| 10130 |
Revision of Total Knee Arthroplasty |
34,176,000 |
| 10131 |
Revision of Total Shoulder Arthroplasty |
34,140,000 |
| 10132 |
Revisis Parut Diluar Wajah, LA |
14,707,000 |
| 10133 |
Rewiring Sternum |
3,850,000 |
| 10134 |
RF _ |
100,000 |
| 10135 |
RF Dasar Lidah THT |
4,850,000 |
| 10136 |
RFA tiroid |
8,246,000 |
| 10137 |
RHEUMATOID FACTOR (RF) KUANTITATIF |
190,000 |
| 10138 |
Rhino Plasty ( Lokal ) |
14,215,000 |
| 10139 |
Rhino Plasty dengan anestesi |
16,257,000 |
| 10140 |
Rhinoplasty With Silicone Implant, LA |
14,707,000 |
| 10141 |
Rhizotomi |
5,943,000 |
| 10142 |
Rifaringolaringoskopi Fleksibel |
971,000 |
| 10143 |
Rigde Augmentasi dengan Anastesi Lokal |
860,000 |
| 10144 |
Rigid Endoskopi ( Naso endoskopi ) |
258,000 |
| 10145 |
Rinofaringolaringoskopi |
781,000 |
| 10146 |
Rinoplasti Augmentasi |
16,397,000 |
| 10147 |
Rinoplasti Revisi |
11,286,000 |
| 10148 |
Rinoplasty dgn Augmentasi Tulang Rawan THT |
8,350,000 |
| 10149 |
Rinoplasty THT |
4,850,000 |
| 10150 |
Rinotomi Lateralis |
7,850,000 |
| 10151 |
RIRS |
11,011,000 |
| 10152 |
Ritidectomy |
16,397,000 |
| 10153 |
RND bilateral |
17,277,000 |
| 10154 |
Robekan Porsio + Jahitan |
600,000 |
| 10155 |
Roda Dua (>10 - 15 km) |
6,000 |
| 10156 |
Roda Dua (>15 - 20 km) |
8,000 |
| 10157 |
Roda Dua (>20 - 25 km) |
10,000 |
| 10158 |
Roda Dua (>25 km) |
15,000 |
| 10159 |
Roda Dua (>5 - 10 km) |
4,000 |
| 10160 |
Roda Dua (0 - 5 km) |
2,000 |
| 10161 |
Rong Of Motion Testing |
70,000 |
| 10162 |
Rontgen (Poli Jantung) |
75,000 |
| 10163 |
Root planing berat |
1,994,000 |
| 10164 |
Root planing sedang |
1,330,000 |
| 10165 |
Ross Procedure |
127,703,000 |
| 10166 |
Rotational Flap |
15,230,000 |
| 10167 |
Rotator cuff repair |
11,196,000 |
| 10168 |
Rozerplasty |
686,000 |
| 10169 |
RPG |
740,000 |
| 10170 |
RPG (Sore) |
1,110,000 |
| 10171 |
RPG Local |
6,531,000 |
| 10172 |
RPG Narkose |
7,681,000 |
| 10173 |
RPLND |
12,022,946 |
| 10174 |
Ruptur Palpebra Moderate |
4,850,000 |
| 10175 |
RVOT stenting perkutan + anestesi |
53,158,000 |
| 10176 |
S Gene Target Failure (SGTF) SARS CoV-2 |
1,100,000 |
| 10177 |
Sach Foot |
5,500,000 |
| 10178 |
Sachse (narkose) |
14,350,000 |
| 10179 |
Sacral Epidural Injection C ARM |
5,075,000 |
| 10180 |
Sacral Epidural Injection C-Arm |
8,715,000 |
| 10181 |
Sacral Epidural Injection C-Arm (Eksekutif) |
0 |
| 10182 |
Sacral Epidural Injection manual (tanpa panduan) |
7,495,900 |
| 10183 |
Sacroiliac joint block |
1,280,000 |
| 10184 |
Sacroiliac Joint Disorde C-Arm Bilateral (Eksekutif) |
0 |
| 10185 |
Sacroiliac Joint Disorde C-Arm Billateral |
7,910,000 |
| 10186 |
Sacroiliac Joint Disorde C-Arm Unilateral |
8,715,000 |
| 10187 |
Sacroiliac Joint Disorde C-Arm Unilateral (Eksekutif) |
0 |
| 10188 |
Sacroiliac Joint Dysfunction USG |
1,280,000 |
| 10189 |
Sacroiliac joint injection |
3,037,000 |
| 10190 |
Sacroiliac joint radio frequency |
1,280,000 |
| 10191 |
Sakral neuromodulasi |
6,450,000 |
| 10192 |
Sakral-histeropeksi (suspensi dan fiksasi uterus pada sakrum) per laparoskopi |
19,034,000 |
| 10193 |
Sakral-histeropeksi (suspensi dan fiksasi uterus pada sakrum) per laparotomi |
18,654,000 |
| 10194 |
Sakral-kolpopeksi (suspensi dan fiksasi vagina pada sakrum) per laparoskopi |
19,034,000 |
| 10195 |
Sakral-kolpopeksi (suspensi dan fiksasi vagina pada sakrum) per laparotomi |
18,654,000 |
| 10196 |
Salfingektomi per vaginam |
14,773,000 |
| 10197 |
Salfingoovarektomi per vaginam |
16,673,000 |
| 10198 |
Saline infusion sonography (SIS) |
774,000 |
| 10199 |
Saline Infusion Test |
233,000 |
| 10200 |
Salphingo Oophorektomi Bilateral |
4,850,000 |
| 10201 |
Salphingo Oophorektomi Unilateral |
3,850,000 |
| 10202 |
Salpingektomi per laparoskopi |
14,358,000 |
| 10203 |
Salpingektomi per laparoskopi dengan penyulit |
17,949,000 |
| 10204 |
Salpingektomi per laparotomi |
12,924,000 |
| 10205 |
Salpingo ooforektomi per laparoskopi |
19,213,000 |
| 10206 |
Salpingo ooforektomi per laparotomi |
19,213,000 |
| 10207 |
Salpingo Ophorectomy Bilateral |
6,095,575 |
| 10208 |
Salpingo Ovarektomi/Unilateral |
6,094,334 |
| 10209 |
Salpingo-ooforektomi bilateral pada kasus keganasan per laparoskopi |
23,379,000 |
| 10210 |
Salpingo-ooforektomi bilateral pada kasus keganasan per laparoskopi dengan penyulit |
29,224,000 |
| 10211 |
Salpingo-ooforektomi bilateral pada kasus keganasan per laparotomi |
21,043,000 |
| 10212 |
Salpingo-ooforektomi bilateral pada kasus keganasan per laparotomi dengan penyulit |
26,304,000 |
| 10213 |
Salpingo-ooforektomi per laparoskopi |
21,817,000 |
| 10214 |
Salpingo-ooforektomi per laparoskopi dengan penyulit |
27,273,000 |
| 10215 |
Salpingo-ooforektomi per laparotomi |
19,831,000 |
| 10216 |
Salpingo-ooforektomi per laparotomi dengan penyulit |
24,793,000 |
| 10217 |
Salpingo-ooforektomi unilateral pada kasus keganasan per laparoskopi |
15,585,000 |
| 10218 |
Salpingo-ooforektomi unilateral pada kasus keganasan per laparoskopi dengan penyulit |
19,483,000 |
| 10219 |
Salpingo-ooforektomi unilateral pada kasus keganasan per laparotomi |
14,029,000 |
| 10220 |
Salpingo-ooforektomi unilateral pada kasus keganasan per laparotomi dengan penyulit |
17,539,000 |
| 10221 |
Salpingorafi per laparoskopi |
16,754,000 |
| 10222 |
Salpingorafi per laparotomi |
14,854,000 |
| 10223 |
Salvaging Operasi Mikro |
42,591,000 |
| 10224 |
Santuli prosedur |
17,539,000 |
| 10225 |
Saturasi Oksigen |
0 |
| 10226 |
Saturasi Oksigen (RJ) |
0 |
| 10227 |
Savariy Bougie |
2,850,000 |
| 10228 |
SC dengan B Lynch |
6,458,138 |
| 10229 |
SC dengan HT subtotal |
6,881,118 |
| 10230 |
SC dengan Ligasi Arteri Uterine |
6,764,059 |
| 10231 |
SC dengan SO ( Torsi Kista) - COT |
6,844,000 |
| 10232 |
Scaling berat |
600,000 |
| 10233 |
Scaling komplikasi |
800,000 |
| 10234 |
Scaling penyulit |
800,000 |
| 10235 |
Scaling ringan |
300,000 |
| 10236 |
Scaling sedang |
400,000 |
| 10237 |
Scalpel crycothyrotomy |
396,000 |
| 10238 |
Scalpel crycothyrotomy pasien dewasa |
396,000 |
| 10239 |
Scalpel crycothyrotomy pasien neonatus |
396,000 |
| 10240 |
Scalpel crycothyrotomy pasien pediatrik |
396,000 |
| 10241 |
Scanogram (Radiografi Long Leg) |
484,000 |
| 10242 |
Sceral Buckling |
4,850,000 |
| 10243 |
Scheral Buckel + Cryo + C3F8 |
7,850,000 |
| 10244 |
Schlera Buckle Lokal |
25,353,000 |
| 10245 |
Schlera Buckle Narkose |
28,687,000 |
| 10246 |
Schrimer Test |
20,000 |
| 10247 |
Scintigraphy TL 120 |
4,000,000 |
| 10248 |
Scoliosis correction for severe curve (>70o) |
35,014,000 |
| 10249 |
Scoliosis Program |
484,000 |
| 10250 |
Scraping Cornea |
161,000 |
| 10251 |
scrapping kornea / keratektomi superfisial lokal |
6,610,000 |
| 10252 |
scrapping kornea / keratektomi superfisial narkose |
7,769,000 |
| 10253 |
Screening & Tatalaksana Gizi Anak |
100,000 |
| 10254 |
SCREENING ANTIBODI DARAH PASIEN |
152,000 |
| 10255 |
Screening Pendonor |
45,450,000 |
| 10256 |
Screening Resipien |
55,000,000 |
| 10257 |
Screening ROP |
137,000 |
| 10258 |
Scrotoplasty |
9,242,000 |
| 10259 |
Scrotoplasty + Chordectomy |
6,175,000 |
| 10260 |
Scrotoplasty+chordectomy |
16,959,000 |
| 10261 |
Secondary Hechting, LA |
14,707,000 |
| 10262 |
Secondary Lip Repair , GA |
16,331,000 |
| 10263 |
Secondary Repair Labioplasty, LA |
14,707,000 |
| 10264 |
Secondary Rhynoplasty, LA |
14,707,000 |
| 10265 |
Sectio Alta (narkose) |
7,492,000 |
| 10266 |
Sedasi paliatif |
1,234,000 |
| 10267 |
Sedasi sedang > 3 jam |
949,000 |
| 10268 |
Sedasi sedang 1-3 jam |
792,000 |
| 10269 |
Sedasi Sedang Anak |
632,000 |
| 10270 |
Sediaan Langsung Pewarnaan BTA |
30,000 |
| 10271 |
Sediment Urine _ |
22,000 |
| 10272 |
Segmented Orthognathic surgery maksilla |
15,694,000 |
| 10273 |
Segmented Orthognathic surgery mandibula |
15,694,000 |
| 10274 |
Segmentektomi |
12,178,000 |
| 10275 |
Segmentektomi |
3,573,535 |
| 10276 |
Segmentektomi ( Bedah Paru/Thorax ) |
21,102,000 |
| 10277 |
Segmentektomi hepar |
30,485,000 |
| 10278 |
Seksio En Caul |
6,458,138 |
| 10279 |
Seksio sesarea |
10,543,000 |
| 10280 |
Seksio sesarea dan adhesiolisis |
17,254,000 |
| 10281 |
Seksio sesarea dan histerektomi |
27,404,000 |
| 10282 |
Seksio sesarea dan histerektomi pada akreta |
18,269,000 |
| 10283 |
Seksio sesarea dan histerektomi total |
25,647,000 |
| 10284 |
Seksio sesarea dan kistektomi |
18,652,000 |
| 10285 |
Seksio sesarea dan kompresi uterus |
20,342,000 |
| 10286 |
Seksio sesarea dan ligasi arteri uterina/ hipogastrika |
14,358,000 |
| 10287 |
Seksio sesarea dan miomektomi |
17,134,000 |
| 10288 |
Seksio sesarea dan reseksi plasenta akreta (konservasi uterus) |
20,565,000 |
| 10289 |
Seksio sesarea dan reseksi vesika urinaria |
21,137,000 |
| 10290 |
Seksio sesarea dan salpingektomi |
19,632,000 |
| 10291 |
Seksio sesarea dan salpingo-oofrektomi |
25,104,000 |
| 10292 |
Seksio sesarea dengan kontrasepsi (IUD / sterilisasi) |
15,221,000 |
| 10293 |
Seksio sesarea kehamilan multipel >2 |
15,221,000 |
| 10294 |
Seksio sesarea pada bekas seksio/ penyulit obstetrik |
15,221,000 |
| 10295 |
Seksio sesarea pada kehamilan multipel |
15,221,000 |
| 10296 |
Seksio sesarea pada penyulit di bidang Fetomaternal |
15,815,000 |
| 10297 |
Seksio Sesaria |
5,605,334 |
| 10298 |
SEL LE |
124,000 |
| 10299 |
Sel LE _ |
120,000 |
| 10300 |
Selective neck diseksi (SND) |
22,800,000 |
| 10301 |
Selective rhizotomy for Cerebral Palsy |
12,641,000 |
| 10302 |
Seluruh Tindakan USG selain di Ruang Radiologi (RJ) |
0 |
| 10303 |
Sementasi Resin Base per gigi |
298,000 |
| 10304 |
Semi Open Reduction (Gillies Procedure), GA |
16,331,000 |
| 10305 |
Senam ( Stroke / Hamil / Asma ) |
22,800 |
| 10306 |
Separasi |
77,000 |
| 10307 |
Separasi Complete Syndacttly, GA |
16,331,000 |
| 10308 |
Separasi Complex Syndactyly, LA |
14,707,000 |
| 10309 |
Separasi Syndactyly, GA |
16,331,000 |
| 10310 |
Septectomi (potong septum) |
7,681,000 |
| 10311 |
Septectomy (Potong Septum) |
5,031,000 |
| 10312 |
Septoplasti |
4,850,000 |
| 10313 |
Septoplasti dengan Endoskopik |
9,640,000 |
| 10314 |
Septoplasty ec trauma hidung |
4,850,000 |
| 10315 |
Septorinoplasty THT |
7,850,000 |
| 10316 |
Septum Reseksi |
3,850,000 |
| 10317 |
Sequesterectomy |
11,023,000 |
| 10318 |
Sequesterectomy kecil |
10,676,000 |
| 10319 |
Sequesterektomi Per Regio Berat |
2,500,000 |
| 10320 |
Sequesterektomi Per Regio Ringan |
1,980,000 |
| 10321 |
Serial Ekstraksi |
9,334,000 |
| 10322 |
Serial plaster / ponseti (<3bln) (Single) |
228,000 |
| 10323 |
Serial plaster / ponseti (>4th / relaps) (Single) |
228,000 |
| 10324 |
Serial plaster / ponseti (1th - 4th) (Single) |
228,000 |
| 10325 |
Serial plaster / ponseti (3bln - 1th) (Single) |
228,000 |
| 10326 |
Serklase abdominal |
9,816,000 |
| 10327 |
Serklase serviks |
9,816,000 |
| 10328 |
SEROLOGI FILARIA (ICT) |
72,000 |
| 10329 |
SEROLOGI MALARIA (RAPID TEST) |
192,000 |
| 10330 |
SERUM ASCITES ALBUMIN GRADIEN (SAAG) |
186,000 |
| 10331 |
Serum Autotest |
66,000 |
| 10332 |
Service Cost Darah Aferesis (Tromboferesis) |
3,500,000 |
| 10333 |
Setting harian Advanced Mechanical Ventilation pasien dewasa (Cth: NAVA) |
127,000 |
| 10334 |
Setting harian HNFC / HFOT pasien dewasa |
1,085,000 |
| 10335 |
Setting harian HNFC / HFOT pasien neonatus |
1,085,000 |
| 10336 |
Setting harian HNFC / HFOT pasien pediatrik |
1,085,000 |
| 10337 |
Setting harian Nasal HFO pasien neonatus |
127,000 |
| 10338 |
Setting harian NIV pasien dewasa |
127,000 |
| 10339 |
Setting harian NIV pasien neonatus |
127,000 |
| 10340 |
Setting harian NIV pasien pediatrik |
127,000 |
| 10341 |
Setting harian NIV+ NAVA pasien neonatus |
127,000 |
| 10342 |
Setting harian NIV+ NAVA pasien pediatrik |
127,000 |
| 10343 |
Setting HFNC harian |
127,000 |
| 10344 |
Setting NIV harian |
127,000 |
| 10345 |
Setting NIV Inisial |
127,000 |
| 10346 |
Setting Tekanan VP shunt |
127,000 |
| 10347 |
Setting ventilator |
127,000 |
| 10348 |
Setting ventilator harian |
1,085,000 |
| 10349 |
Setting ventilator harian pasien dewasa |
1,085,000 |
| 10350 |
Setting ventilator harian pasien neonatus |
1,085,000 |
| 10351 |
Setting ventilator harian pasien pediatrik |
1,085,000 |
| 10352 |
Setting Ventilator Mekanik harian |
127,000 |
| 10353 |
Setting Ventilator Mekanik Inisial |
127,000 |
| 10354 |
Severe soket rekonstruktion |
10,694,000 |
| 10355 |
Sfenoidektomi (FESS) |
10,498,000 |
| 10356 |
Sfingteroplasti dan rekonstruksi vagina pada ruptur perineum total lama |
17,594,000 |
| 10357 |
Sfingterorafi |
18,544,000 |
| 10358 |
SGOT (AST) |
78,000 |
| 10359 |
SGPT (ALT) |
78,000 |
| 10360 |
Shigella Antigen |
235,000 |
| 10361 |
Short Wave Diathermi |
39,600 |
| 10362 |
Short Wave Diathermy (SWD) |
115,000 |
| 10363 |
Shoulder disarticulation |
14,629,000 |
| 10364 |
Shoulder hemiarthroplasty |
34,602,000 |
| 10365 |
Shunt Endolimfatik |
12,668,000 |
| 10366 |
Shunt removal |
21,960,000 |
| 10367 |
Shunting Femoralis ( Bedah Vaskuler) |
4,860,000 |
| 10368 |
Shunting Poplitea/Tibialis ( Bedah Vaskuler) |
4,860,000 |
| 10369 |
Shunting Splenorea |
4,816,000 |
| 10370 |
Shunting Splenorea (Vaskuler) |
4,816,000 |
| 10371 |
Shunting Syringomelia |
18,271,000 |
| 10372 |
SI Joint Fusion |
27,360,000 |
| 10373 |
SI Joint Injection |
27,360,000 |
| 10374 |
Sialendoskopi Diagnostik |
6,546,000 |
| 10375 |
Sialendoskopi Terapeutik |
5,450,000 |
| 10376 |
Sialoadenektomi /Eksisi kelenjar saliva submandibula/ submental per sisi |
12,702,000 |
| 10377 |
Sialoduktoplasty / Sialoduktektomi |
12,702,000 |
| 10378 |
Sialoendoscopy kompleks |
22,165,000 |
| 10379 |
Sialoendoscopy simple |
18,986,000 |
| 10380 |
Sialografi |
375,000 |
| 10381 |
Sialography |
1,531,000 |
| 10382 |
Sialolithectomy / Extirpasi Sialolith (Batu Kelenjar Liur) |
9,476,000 |
| 10383 |
Sialolithektomi besar |
12,702,000 |
| 10384 |
Sialometri |
384,000 |
| 10385 |
Sikatan Ductus Biliaris |
2,780,000 |
| 10386 |
Sikatan Ductus Biliaris (Sore) |
4,170,000 |
| 10387 |
Sikatan Duktus Biliaris |
2,922,000 |
| 10388 |
Simpatektomi |
4,816,000 |
| 10389 |
Simpatektomi laparoskopi |
31,134,000 |
| 10390 |
Simpatektomi perifer |
31,134,000 |
| 10391 |
Simpatektomi torakoskopi |
31,134,000 |
| 10392 |
Simple Advancement Flap, LA |
14,707,000 |
| 10393 |
Simple Functional N Surgery (Percutaneus Facet Denevation dll) |
5,852,000 |
| 10394 |
Simple Functional N Surgery (Percutaneus Rhizotomy/PRGR) |
5,813,000 |
| 10395 |
Simple Functional Nsurgery Perc Facet Denervation dll |
11,929,000 |
| 10396 |
Simple Functional Nsurgery Percutaneus Rhizotomy / PRGR |
6,604,000 |
| 10397 |
Simple Mask oksigen pasien dewasa |
242,000 |
| 10398 |
Simple Mask oksigen pasien pediatrik |
242,000 |
| 10399 |
Simple nefrektomi per laparoskopi |
25,653,000 |
| 10400 |
Simple Ocular Motility Evaluation |
103,000 |
| 10401 |
Simulasi menurut usia |
150,000 |
| 10402 |
Single curve correction for scoliosis |
35,014,000 |
| 10403 |
Single Fiber Electromyography |
1,800,000 |
| 10404 |
Single Fiber Electromyography (sf-EMG) dengan needle. |
2,645,000 |
| 10405 |
single pulse Transcranial Magnetic Stimulation (diagnostik) |
712,000 |
| 10406 |
Single Rotation/ Transposition Skin Flap, GA |
16,331,000 |
| 10407 |
Single Rotation/ Transposition Skin Flap, LA |
14,707,000 |
| 10408 |
Sinus Lifting |
9,500,000 |
| 10409 |
Sinus Lifting dengan Anastesi Lokal |
860,000 |
| 10410 |
Sinus lifting dengan pembukaan Caldwel Lac |
15,224,000 |
| 10411 |
Sinusektomi Sinus Frontal (FESS) |
10,498,000 |
| 10412 |
Sinuskopi Diagnostik |
379,000 |
| 10413 |
Sinuskopi/Sinoskopi Dengan Tindakan |
2,850,000 |
| 10414 |
Sirklase |
5,950,000 |
| 10415 |
Sirkumsisi ( Sunat ) |
200,000 |
| 10416 |
Sirkumsisi ( Umur diatas 6 tahun ) (ESWL) |
2,500,000 |
| 10417 |
Sirkumsisi (Umur diatas 6 Tahun) (ESWL) (Sore) |
3,750,000 |
| 10418 |
Sirkumsisi dengan anestesi lokal |
1,403,001 |
| 10419 |
Sirkumsisi dengan Phymosis |
3,812,293 |
| 10420 |
Sirkumsisi Narkose |
5,802,000 |
| 10421 |
Sirkumsisi pada Phymosis dengan Narkose |
3,812,293 |
| 10422 |
Sistektomi Parsial |
16,230,000 |
| 10423 |
SISTOGRAFI |
1,629,000 |
| 10424 |
Sistoplasti Reduksi |
6,941,000 |
| 10425 |
Sistoskopi |
3,930,682 |
| 10426 |
Sistoskopi - VCUG Narkose |
6,300,000 |
| 10427 |
Sistoskopi (ESWL) |
2,500,000 |
| 10428 |
Sistoskopi (ESWL) (Sore) |
3,750,000 |
| 10429 |
Sistoskopi dan Evakuasi Clot/ Bekuan Darah |
15,245,000 |
| 10430 |
Sistoskopi diagnostik |
2,628,000 |
| 10431 |
Sistoskopi fleksibel (lokal) |
2,628,000 |
| 10432 |
Sistoskopi Local |
4,533,000 |
| 10433 |
Sistoskopi n-flexible (Lokal) |
3,400,000 |
| 10434 |
Sistoskopi Narkose |
7,588,000 |
| 10435 |
Sistoskopi ODS |
3,850,000 |
| 10436 |
Sistoskopi operatif |
7,588,000 |
| 10437 |
Sistostomi |
3,864,658 |
| 10438 |
Sistostomi lokal |
6,656,000 |
| 10439 |
Sistostomi Narkose |
7,820,000 |
| 10440 |
Sistostomi perkutan |
3,850,000 |
| 10441 |
Sistostomi Perkutan (ESWL) |
2,500,000 |
| 10442 |
Sistostomi Perkutan (ESWL) (Sore) |
3,750,000 |
| 10443 |
Sistostomi Terbuka Narkose |
10,200,000 |
| 10444 |
Sistouretrografi Bipolar |
1,499,000 |
| 10445 |
Sitologi (Sputum, Sikatan, Bilasan) |
140,000 |
| 10446 |
Sitologi 3x Serial |
96,000 |
| 10447 |
Sitologi Bone Marrow Punction (BMP) Biopsi |
191,000 |
| 10448 |
Sitologi Cairan Efusi, ascites, sputum, urin |
400,000 |
| 10449 |
Sitologi Pap Smear |
150,000 |
| 10450 |
Sitostomi terbuka |
3,850,000 |
| 10451 |
Six Minute Walking Test |
165,000 |
| 10452 |
Size reduction plastic operation |
6,600,000 |
| 10453 |
SKBN |
38,000 |
| 10454 |
Skeletal traction and Other traction |
2,350,000 |
| 10455 |
Skeletal Traction lokal |
174,000 |
| 10456 |
Skin And Fascial Grafts, LA |
14,707,000 |
| 10457 |
Skin Booster 1 (1 vial) |
1,500,000 |
| 10458 |
Skin Booster 2 (2-3 vial) |
2,500,000 |
| 10459 |
Skin Booster 3 (?4 vial) |
4,000,000 |
| 10460 |
Skin Flap |
559,000 |
| 10461 |
Skin Flap Komplek Lebih Dari Satu Flap, GA |
10,236,000 |
| 10462 |
Skin Flap Komplek, GA |
10,236,000 |
| 10463 |
Skin Flap Lokal Komplek, GA |
10,236,000 |
| 10464 |
Skin Flap Lokal Komplek, LA |
9,086,000 |
| 10465 |
Skin Flap Lokal Sederhana, GA |
10,236,000 |
| 10466 |
Skin Flap Lokal Sederhana, LA |
9,086,000 |
| 10467 |
Skin Flap Sederhana , LA |
9,170,000 |
| 10468 |
Skin Graft |
560,000 |
| 10469 |
Skin Graft 1 (kecil) |
841,001 |
| 10470 |
Skin Graft 2 (sedang) |
1,012,999 |
| 10471 |
Skin Graft 3 (besar)/ Graft Kartilago |
1,215,000 |
| 10472 |
Skin Grafting Dengan Luas Sedang, GA |
10,236,000 |
| 10473 |
Skin Grafting Yang Luas, GA |
26,870,000 |
| 10474 |
Skin Laser Treatment |
4,850,000 |
| 10475 |
Skin Prick Test THT |
250,000 |
| 10476 |
Skin Test |
32,000 |
| 10477 |
Skin Traction |
47,000 |
| 10478 |
Skin Traction |
267,000 |
| 10479 |
Skingrafting yang Luas |
7,587,525 |
| 10480 |
Skingrafting Yang Tidak Luas |
6,777,729 |
| 10481 |
Skingrafting Yang Tidak Luas THT |
3,850,000 |
| 10482 |
Skleroterapi 1 Kasus Simpel |
1,433,000 |
| 10483 |
Skleroterapi 2 Kasus Kompleks |
4,341,000 |
| 10484 |
Skleroterapi 2 Kasus Simpel |
2,894,000 |
| 10485 |
Skleroterapi dengan pembiusan umum |
6,766,000 |
| 10486 |
Skleroterapi Hemorhoid |
1,430,000 |
| 10487 |
Skleroterapi Hemorhoid (Sore) |
11,900,000 |
| 10488 |
Skleroterapi Hemoroid |
2,513,000 |
| 10489 |
Skleroterapi varises esofagus |
14,799,000 |
| 10490 |
Skleroterapi Varises Esofagus |
2,850,000 |
| 10491 |
Skleroterapi Varises SCBA |
6,296,000 |
| 10492 |
Skleroterapi Varises SCBA + Anastesi |
14,570,000 |
| 10493 |
Skleroterapi Varises SCBA + Anastesi (sore) |
21,850,000 |
| 10494 |
Sklerotomi posterior lokal |
7,093,000 |
| 10495 |
Sklerotomi posterior narkose |
8,308,000 |
| 10496 |
Skrining Antibodi |
600,000 |
| 10497 |
Skrining kelainan perkembangan anak |
120,000 |
| 10498 |
Skrotoplasti |
6,238,462 |
| 10499 |
SLED |
2,370,000 |
| 10500 |
Sleep Endoscopy (DISE) |
5,929,000 |
| 10501 |
Sleep study |
300,000 |
| 10502 |
Sleepnasoendoskopi |
675,000 |
| 10503 |
Slevece Lobektomi ( Bedah Paru / Thorax ) |
21,102,000 |
| 10504 |
Slit Lamp Examination |
73,000 |
| 10505 |
Slitlamp Examination |
90,000 |
| 10506 |
Social Skills Training (Kelompok) |
300,000 |
| 10507 |
Soft Collar |
145,000 |
| 10508 |
Soft Liner |
354,000 |
| 10509 |
Soft Tissue Interpositional Arthroplasty for Shoulder, Elbow, Wrist, Finger |
23,914,000 |
| 10510 |
Soft tissue procedure (Multiple) for Cerebral palsy |
23,914,000 |
| 10511 |
Soft tissue procedure (Single) for Cerebral palsy |
23,914,000 |
| 10512 |
Soft tissue procedure for Brachial plexus injury |
23,914,000 |
| 10513 |
Soft tissue procedure for Congenital deformity |
23,914,000 |
| 10514 |
Soft tissue procedure for Finger & hand deformity |
23,914,000 |
| 10515 |
Soft tissue procedure for Foot / Ankle Deformity |
23,914,000 |
| 10516 |
Soft tissue procedure for Hand & forearm deformity |
23,914,000 |
| 10517 |
Soft tissue procedure for MPFL reconstruction |
23,914,000 |
| 10518 |
Soft tissue procedure for Muscle transfer/transplantation/free functional transfer/transposition |
23,914,000 |
| 10519 |
Soft tissue procedure for Sprain / dislocation of ligaments and tendons |
23,913,000 |
| 10520 |
Soft Tissue Rekonstruksi, LA |
9,086,000 |
| 10521 |
Soft tissue release / reconstruction (single joint) for Stiffness / spastic / contracture joint |
23,914,000 |
| 10522 |
Soft tissue release for knee dislocation |
24,433,000 |
| 10523 |
Soft tissue release for Stiffness / spastic / joint contracture of hand & forearm |
23,914,000 |
| 10524 |
Solarium/Photo Therapi |
66,000 |
| 10525 |
Solonektomi |
4,816,000 |
| 10526 |
Solux |
140,000 |
| 10527 |
Somato-sensory Evoked Potential (SSEP) ekstremitas atas dan bawah. |
2,545,000 |
| 10528 |
Somato-sensory Evoked Potential (SSEP) ekstremitas atas. |
1,696,000 |
| 10529 |
Somato-sensory Evoked Potential (SSEP) ekstremitas bawah. |
1,696,000 |
| 10530 |
Somato-sensory Evoked Potential (SSEP) pudendal. |
2,520,000 |
| 10531 |
Somnoplasty |
2,850,000 |
| 10532 |
Sondage Canalculi Lacrimalis |
250,000 |
| 10533 |
Sonopunktur |
161,000 |
| 10534 |
Space Regainer |
809,000 |
| 10535 |
Speak Audio Meter |
48,300 |
| 10536 |
Specular Microscope |
400,000 |
| 10537 |
Speech Assement (Komunitas) |
66,000 |
| 10538 |
Speech Assesment |
282,000 |
| 10539 |
Speech Audiometri |
73,000 |
| 10540 |
Spektrum Plasenta Akreta, Prosedur konservasi uterus / reseksi (ligasi neovaskularisasi uterus, histerotomi / histerorafi), SUMPUC (Surabaya Modification Procedure of Uterine conservation), OSCS (One Step Conservative Surgery) |
27,404,000 |
| 10541 |
Spektrum plasenta akreta, Prosedur radikal uterus (devaskularisasi pelvis, ligasi neovaskularisasi uterus, histerektomi), dengan atau tanpa mengambil implantasi plasenta pada organ sekitar |
27,404,000 |
| 10542 |
Spermatocele |
5,134,089 |
| 10543 |
Spermatokel (ESWL) |
2,500,000 |
| 10544 |
Spermatokel (ESWL) (Sore) |
3,750,000 |
| 10545 |
Spermatokel narkose |
6,713,000 |
| 10546 |
Spermatokelektomi |
3,850,000 |
| 10547 |
Sphincterotomy |
19,281,000 |
| 10548 |
Sphincterotomy / Lynn Procedure |
5,008,000 |
| 10549 |
Spinal Implant removal and revision |
11,770,000 |
| 10550 |
Spinal intratechal catheter |
703,000 |
| 10551 |
Spinal osteotomy (multiple) for Spinal deformity |
36,228,000 |
| 10552 |
Spinal osteotomy (single) for Spinal deformity |
34,261,000 |
| 10553 |
Spingterektomi lateral |
6,766,000 |
| 10554 |
Spirometer |
142,000 |
| 10555 |
Spirometri |
230,001 |
| 10556 |
Spirometri |
138,000 |
| 10557 |
Spirometri dengan bronkodilator |
230,001 |
| 10558 |
Spleenektomi |
7,367,878 |
| 10559 |
Splenectomy pda trauma |
6,622,000 |
| 10560 |
Splenektomi |
17,019,000 |
| 10561 |
Splenektomi (Bedah Vaskuler) |
4,850,000 |
| 10562 |
Splenektomi (Thalasemia, hipersplenisme) |
11,981,598 |
| 10563 |
Splenektomi dan Ligasi vv coronaria serta Splenorenal Shunt |
19,913,000 |
| 10564 |
Splenektomi ec hipertensi portal/kelainan hematologi lain |
17,019,000 |
| 10565 |
Splenektomi ec.Hipertensi Portal/ Kelainan Hematologi lain |
14,690,000 |
| 10566 |
Splenektomi pada metastasis keganasan ginekologi |
21,280,000 |
| 10567 |
Splenektomi pada thalasemia, hipersplenisme |
18,891,000 |
| 10568 |
Splenektomi pada trauma |
19,249,000 |
| 10569 |
Splenektomi Partial |
6,331,000 |
| 10570 |
Splenektomi, Ligasi vv coronaria serta Splenorenal shunt pada hipertensi porta |
19,913,000 |
| 10571 |
Splinting dengan Anastesi Lokal |
270,000 |
| 10572 |
Splinting gigi / interdental wiring per rahang |
8,568,000 |
| 10573 |
Splinting Per Gigi |
298,000 |
| 10574 |
Splintography |
1,531,000 |
| 10575 |
Split Thickness Skin Graft (>10x20cm) Luas Dengan Perawatan Khusus, GA |
25,706,000 |
| 10576 |
Split Thickness Skin Graft (>10x20cm) Luas, GA |
21,420,000 |
| 10577 |
Split Thickness Skin Graft (10 X 20cm) Sederhana, GA |
17,140,000 |
| 10578 |
Split Thickness Skin Graft (10 X 20cm) Sederhana, LA |
15,005,000 |
| 10579 |
Split thickness skin graft dengan anastesi lokal |
842,001 |
| 10580 |
Spool Slang WSD |
26,000 |
| 10581 |
Spooling / Irigasi Bola Mata |
132,000 |
| 10582 |
Spooling Blast |
308,000 |
| 10583 |
Spooling Bola Mata |
42,000 |
| 10584 |
Spooling Catheter |
308,000 |
| 10585 |
Spooling Chest tube/Pleural Catheter |
493,000 |
| 10586 |
Spooling Colostomy |
308,000 |
| 10587 |
Spooling Double Lumen |
338,000 |
| 10588 |
Spooling Intoksikasi |
40,000 |
| 10589 |
Spooling kateter |
207,000 |
| 10590 |
Spooling kateter gastrostomi/feeding enterostomi |
207,000 |
| 10591 |
Spooling kateter urin |
187,000 |
| 10592 |
Spooling Rectal |
253,000 |
| 10593 |
Spooling Serumen Telinga |
66,000 |
| 10594 |
Spooling Sinus |
43,000 |
| 10595 |
Spooling Telinga |
45,000 |
| 10596 |
Spooling/irigasi |
188,000 |
| 10597 |
Spot Fluoroscopic |
484,000 |
| 10598 |
Spray & Stretch |
250,000 |
| 10599 |
Sputum 1x Sikatan |
223,000 |
| 10600 |
Sputum BTA 1 X (Pewarnaan) |
35,000 |
| 10601 |
Sputum BTA 3 X (Pewarnaan) |
65,000 |
| 10602 |
Spy Glass Diagnostik |
6,980,000 |
| 10603 |
Spy Glass Diagnostik (Sore) |
10,470,000 |
| 10604 |
Squesterektomi per Rahang dengan Anastesi Lokal |
1,500,000 |
| 10605 |
Sretching Of Fascia |
70,000 |
| 10606 |
Stabilisasi fusi dengan instrumentasi spinal torakal atas |
37,385,000 |
| 10607 |
Stabilisasi fusi dengan instrumentasi spinal torakal bawah |
37,385,000 |
| 10608 |
Stabilisasi posterior approach lumbal, torakal, cervical (wiring dan hartziel) bila terdapat instabilitas (auto/allo bonegraft, implant-spine instrumentasi) |
37,385,000 |
| 10609 |
Stabilisasi/fiksasi sternum |
37,385,000 |
| 10610 |
Stabilisasi/fiksasi sternum + debridement |
37,385,000 |
| 10611 |
Standard EVAR (1 Main Body Stent Graft + 2 Limb Extension) |
176,779,000 |
| 10612 |
Standard EVAR + Intra-aorta Imaging |
176,779,000 |
| 10613 |
Standard EVAR + PTA |
187,135,000 |
| 10614 |
Standard TEVAR (1 Stent Graft) |
176,779,000 |
| 10615 |
Standard TEVAR + Intra-aorta Imaging |
176,779,000 |
| 10616 |
Standard TEVAR + PTA |
187,135,000 |
| 10617 |
Stapedektomi |
13,988,000 |
| 10618 |
Stapedektomi |
4,046,000 |
| 10619 |
Stapedektomi dengan replacement dari inkus |
13,988,000 |
| 10620 |
Stapedektomi Revisi bilateral |
16,568,000 |
| 10621 |
Stapedektomi Revisi unilateral |
16,945,000 |
| 10622 |
Stapled Transanal Rectalis Resection (STARR) |
18,892,000 |
| 10623 |
Status hidrasi (urine specific gravity) |
78,000 |
| 10624 |
STE Hemorroid |
660,000 |
| 10625 |
STE Hemorroid + Anastesi |
1,422,000 |
| 10626 |
STE Hemorroid + Anastesi |
1,584,000 |
| 10627 |
Stellate ganglion block |
1,240,000 |
| 10628 |
Stellate Ganglion Block |
177,000 |
| 10629 |
Stem cell intramuskular |
8,672,000 |
| 10630 |
Stem cell intratekal |
8,672,000 |
| 10631 |
Stem cell intravena |
8,672,000 |
| 10632 |
Stemsel ADSRC Pasca Lumpectomy |
9,674,000 |
| 10633 |
Stenting duodenum |
39,065,000 |
| 10634 |
Sterilisasi per laparoskopi |
9,025,000 |
| 10635 |
Sternotomi + Biopsi |
37,385,000 |
| 10636 |
Sternotomi + Bypass Graft Vena |
37,385,000 |
| 10637 |
Sternotomi + Debridement |
37,385,000 |
| 10638 |
Sternotomi + Eksisi Tumor Mediastinum |
37,385,000 |
| 10639 |
Sternotomi + Perikardiektomi |
37,385,000 |
| 10640 |
Sternotomi + Rekonstruksi Dinding Dada |
37,385,000 |
| 10641 |
Sternotomi + Repair jantung |
37,385,000 |
| 10642 |
Sternotomi + Timektomi |
37,385,000 |
| 10643 |
Sternotomi eksplorasi dengan CPB |
112,316,000 |
| 10644 |
Sternotomi/Torakotomi eksplorasi tanpa CPB |
22,350,000 |
| 10645 |
Stick / Cane |
142,000 |
| 10646 |
Stimulasi Memori |
370,000 |
| 10647 |
Stimulasi otot |
6,766,000 |
| 10648 |
Strabismus |
5,122,073 |
| 10649 |
Strabismus 1 Narkose |
7,322,000 |
| 10650 |
Strabismus 2 Lokal |
6,641,000 |
| 10651 |
Strabismus 2 Narkose |
7,803,000 |
| 10652 |
Strabismus 3 |
10,144,000 |
| 10653 |
Strabismus 3-4 Otot |
8,350,000 |
| 10654 |
Strabismus 4 |
10,848,000 |
| 10655 |
Strapping |
156,000 |
| 10656 |
Streching Of Muscle Or Tendon |
70,000 |
| 10657 |
Stress Management |
33,000 |
| 10658 |
Stress Treadmill Dobutamin |
300,000 |
| 10659 |
Strest Echo Dobutamin |
656,000 |
| 10660 |
Stretching Fascia |
147,000 |
| 10661 |
Stripping 2 tungkai, debridement, dan ligasi vena perforantes |
16,424,000 |
| 10662 |
Stripping Per Gigi |
300,000 |
| 10663 |
Stripping Per Gigi (Eksekutif) |
0 |
| 10664 |
Stripping varises 1 tungkai dengan flebektomi |
11,306,000 |
| 10665 |
Stripping varises 1 tungkai kompleks (flebektomi/debridement ulkus vena) |
13,570,000 |
| 10666 |
Stripping varises 1 tungkai sederhana |
10,949,000 |
| 10667 |
Stripping varises 1 tungkai, debridement ligasi vena perforantes/penyulit |
8,697,000 |
| 10668 |
Stripping varises 2 tungkai dengan flebektomi |
13,570,000 |
| 10669 |
Stripping Varises 2 tungkai dengan multipel flebektomi |
4,842,820 |
| 10670 |
Stripping Varises 2 tungkai kompleks (flebektomi/debridement ulkus vena) |
16,286,000 |
| 10671 |
Stripping Varises 2 tungkai sederhana |
14,277,000 |
| 10672 |
Stripping vena dan ligasi tinggi 1 tungkai kompleks |
13,335,000 |
| 10673 |
Stripping vena dan ligasi tinggi 1 tungkai sederhana |
10,949,000 |
| 10674 |
Stripping vena dan ligasi tinggi 2 tungkai kompleks |
16,424,000 |
| 10675 |
Stripping vena dan ligasi tinggi 2 tungkai sederhana |
14,277,000 |
| 10676 |
Stump closure with local flap for Traumatic amputation of upper or lower extremities |
12,859,000 |
| 10677 |
Submukosa Reseksi (SMR) Septum Nasal |
7,432,000 |
| 10678 |
Suboccipital Decompression (tonsil lobectomy/ dekompresi duroplasty/ Cervical Decompression) for chiari malformation |
37,385,000 |
| 10679 |
Subsisi 1 |
500,000 |
| 10680 |
Subsisi 2 |
800,000 |
| 10681 |
Subsisi 3 |
1,200,000 |
| 10682 |
Subtalar fusion |
3,856,600 |
| 10683 |
Subtalar joint arthroereisis |
5,476,800 |
| 10684 |
Subtipe Limfosit : CD4 _ |
317,000 |
| 10685 |
Suction |
73,000 |
| 10686 |
Suction biopsy |
74,000 |
| 10687 |
Suction Blister Grafting |
250,000 |
| 10688 |
Suction Neonatus |
74,000 |
| 10689 |
Sudase Ureter |
2,500,000 |
| 10690 |
Sudase Ureter (Sore) |
3,750,000 |
| 10691 |
Suntik scleroting agent |
7,007,000 |
| 10692 |
Suntikan Intralesi |
430,000 |
| 10693 |
Supra Scapular C ARM |
5,075,000 |
| 10694 |
Supraglotoplasty |
10,254,000 |
| 10695 |
Supramalleolar Orthosis (Nancy Hilton, Supramalleolar Orthosis) |
520,000 |
| 10696 |
Suquestractomy |
2,510,000 |
| 10697 |
Surface Electromyography 1 channel. |
1,303,000 |
| 10698 |
Surgical hip dislocation |
11,162,000 |
| 10699 |
Surgical Staging (Bedah Obgyn) |
6,559,543 |
| 10700 |
Surgical staging karsinoma endometrium per laparoskopi |
21,234,000 |
| 10701 |
Surgical staging karsinoma endometrium per laparoskopi dengan penyulit |
21,234,000 |
| 10702 |
Surgical staging karsinoma endometrium per laparotomi |
21,234,000 |
| 10703 |
Surgical staging karsinoma endometrium per laparotomi dengan penyulit |
21,234,000 |
| 10704 |
Surgical staging karsinoma ovarium per laparoskopi |
21,234,000 |
| 10705 |
Surgical staging karsinoma ovarium per laparoskopi dengan penyulit |
21,234,000 |
| 10706 |
Surgical staging karsinoma ovarium per laparotomi |
21,234,000 |
| 10707 |
Surgical staging karsinoma ovarium per laparotomi dengan penyulit |
21,234,000 |
| 10708 |
Surgical staging pada keganasan ginekologi lainnya |
21,234,000 |
| 10709 |
Survey dan Block Out Model Kerja per rahang |
147,001 |
| 10710 |
Suspensi parauretra pada inkontinensia per laparotomi |
13,486,000 |
| 10711 |
Suspensi parauretra pada inkontinensia TOT (trans obturator tape) |
10,787,000 |
| 10712 |
Suspensi parauretra pada inkontinensia TVT (trans vaginal tape) |
10,787,000 |
| 10713 |
Suture of artery |
28,004,994 |
| 10714 |
Suture of capsule or ligament of ankle and foot |
5,752,000 |
| 10715 |
Suture of capsule or ligament of other lower extremity |
5,752,000 |
| 10716 |
Suture of capsule or ligament of upper extremity |
5,752,000 |
| 10717 |
Suture of muscle or fascia of hand |
11,196,000 |
| 10718 |
Suture of muscle, tendon, and fascia |
4,891,625 |
| 10719 |
Suture of tendon sheath |
11,196,000 |
| 10720 |
Suture of tendon sheath of hand |
11,196,000 |
| 10721 |
Suturectomy per endoskopik |
21,960,000 |
| 10722 |
Suturectomy simple |
21,960,000 |
| 10723 |
Swab Discar Lesi |
66,000 |
| 10724 |
Swab Konjungtiva |
96,000 |
| 10725 |
Swab luka |
100,000 |
| 10726 |
SWT (Shock Wave Therapy) |
2,765,000 |
| 10727 |
Symblepharon |
3,851,142 |
| 10728 |
Symblepharon + anastesi |
3,724,142 |
| 10729 |
Symne Protesis (Biasa) |
3,200,000 |
| 10730 |
Symne Protesis (Khusus) |
13,000,000 |
| 10731 |
Symne Protesis (Standar) |
6,000,000 |
| 10732 |
Sympathetic skin response |
682,000 |
| 10733 |
Syndroma Blefarophimosis |
11,350,000 |
| 10734 |
Synovectomy |
13,254,994 |
| 10735 |
Synovectomy for Articular bone /soft tissue tumor |
17,616,000 |
| 10736 |
Synovectomy of ankle |
5,474,000 |
| 10737 |
Synovectomy of elbow |
5,474,000 |
| 10738 |
Synovectomy of foot and toe |
5,474,000 |
| 10739 |
Synovectomy of hand and finger |
5,474,000 |
| 10740 |
Synovectomy of hip |
5,474,000 |
| 10741 |
Synovectomy of knee |
26,604,994 |
| 10742 |
Synovectomy of shoulder |
13,054,994 |
| 10743 |
Synovectomy of wrist |
5,474,000 |
| 10744 |
Syringe Pump |
0 |
| 10745 |
Syringe pump |
69,000 |
| 10746 |
Syringe Pump (RJ) |
68,000 |
| 10747 |
syringe pump pada neonatus |
69,000 |
| 10748 |
T - Tube Cholangiografi |
400,000 |
| 10749 |
T Cel dan B Cel |
69,000 |
| 10750 |
T3 |
140,000 |
| 10751 |
T3 |
219,000 |
| 10752 |
T3 (Total) (P) |
256,000 |
| 10753 |
T3 Up Take |
75,000 |
| 10754 |
T4 |
140,000 |
| 10755 |
T4 (Total) (P) |
256,000 |
| 10756 |
Tabel 5 US Navy |
650,000 |
| 10757 |
Tabel 6 A US Navy |
2,965,000 |
| 10758 |
Tabel 6 US Navy |
2,965,000 |
| 10759 |
Tabel 9 / Pengobatan Penyakit Klinis Guritno 14 Meter |
345,000 |
| 10760 |
Tabel 9 / Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Kelompok I; 8 Orang) |
300,000 |
| 10761 |
Tabel 9 / Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Kelompok II; 5 Orang) |
320,000 |
| 10762 |
Tabel 9 / Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 3 kali datang dalam 1 bulan) - Terapi Ke 1 |
960,000 |
| 10763 |
Tabel 9 / Pengobatan Penyakit Klinis Guritno 14 Meter (Paket Sehat 5 kali datang dalam 1 bulan) - Terapi Ke 1 |
1,500,000 |
| 10764 |
Tabel Autis |
300,000 |
| 10765 |
TACE (Trans-Arterial Chemo-Embolization) Hepatoma Kasus Kompleks |
39,451,000 |
| 10766 |
TACE (Trans-Arterial Chemo-Embolization) Hepatoma Kasus Kompleks dengan anestesi |
44,838,000 |
| 10767 |
TACE (Trans-Arterial Chemo-Embolization) Hepatoma Kasus Simpel |
26,300,000 |
| 10768 |
TACE (Trans-Arterial Chemo-Embolization) Hepatoma Kasus Simpel dengan anestesi |
29,891,000 |
| 10769 |
TACE (Trans-Arterial Chemo-Embolization) Kasus Kompleks |
39,451,000 |
| 10770 |
TACE (Trans-Arterial Chemo-Embolization) Kasus Kompleks dengan anestesi |
45,471,000 |
| 10771 |
TACE (Trans-Arterial Chemo-Embolization) Kasus Simpel |
26,300,000 |
| 10772 |
TACE (Trans-Arterial Chemo-Embolization) Kasus Simpel dengan anestesi |
30,313,000 |
| 10773 |
TACE (Trans-Arterial Chemo-Embolization) Malignansi Non Hepatoma Kasus Kompleks |
39,451,000 |
| 10774 |
TACE (Trans-Arterial Chemo-Embolization) Malignansi Non Hepatoma Kasus Kompleks dengan anestesi |
45,472,000 |
| 10775 |
TACE (Trans-Arterial Chemo-Embolization) Malignanzi Non Hepatoma Kasus Simpel |
26,300,000 |
| 10776 |
TACE (Trans-Arterial Chemo-Embolization) Malignanzi Non Hepatoma Kasus Simpel dengan anestesi |
30,313,000 |
| 10777 |
TACI (Trans-Arterial Chemo-Infusion) Hepatoma Kasus Kompleks |
39,451,000 |
| 10778 |
TACI (Trans-Arterial Chemo-Infusion) Hepatoma Kasus Kompleks dengan anestesi |
45,472,000 |
| 10779 |
TACI (Trans-Arterial Chemo-Infusion) Hepatoma Kasus Simpel |
26,300,000 |
| 10780 |
TACI (Trans-Arterial Chemo-Infusion) Hepatoma Kasus Simpel dengan anestesi |
30,313,000 |
| 10781 |
TACI (Trans-Arterial Chemo-Infusion) Kasus Kompleks |
39,451,000 |
| 10782 |
TACI (Trans-Arterial Chemo-Infusion) Kasus Kompleks dengan anestesi |
45,472,000 |
| 10783 |
TACI (Trans-Arterial Chemo-Infusion) Kasus Simpel |
26,300,000 |
| 10784 |
TACI (Trans-Arterial Chemo-Infusion) Kasus Simpel dengan anestesi |
30,313,000 |
| 10785 |
TACI (Trans-Arterial Chemo-Infusion) Malignansi Non Hepatoma Kasus Kompleks |
39,451,000 |
| 10786 |
TACI (Trans-Arterial Chemo-Infusion) Malignansi Non Hepatoma Kasus Kompleks dengan anestesi |
45,472,000 |
| 10787 |
TACI (Trans-Arterial Chemo-Infusion) Malignansi Non Hepatoma Kasus Simpel |
26,300,000 |
| 10788 |
TACI (Trans-Arterial Chemo-Infusion) Malignansi Non Hepatoma Kasus Simpel dengan anestesi |
30,313,000 |
| 10789 |
Tacrolimus |
1,975,000 |
| 10790 |
TACROLIMUS |
1,975,000 |
| 10791 |
TAE (Trans-Arterial Embolization) Bronchial Kasus Kompleks |
44,741,000 |
| 10792 |
TAE (Trans-Arterial Embolization) Bronchial Kasus Kompleks dengan anestesi |
51,321,000 |
| 10793 |
TAE (Trans-Arterial Embolization) Bronchial Kasus Simpel |
35,367,000 |
| 10794 |
TAE (Trans-Arterial Embolization) Bronchial Kasus Simpel dengan anestesi |
40,642,000 |
| 10795 |
TAE (Trans-Arterial Embolization) Hepatoma Kasus Kompleks |
44,741,000 |
| 10796 |
TAE (Trans-Arterial Embolization) Hepatoma Kasus Kompleks dengan anestesi |
51,321,000 |
| 10797 |
TAE (Trans-Arterial Embolization) Hepatoma Kasus Simpel |
33,694,000 |
| 10798 |
TAE (Trans-Arterial Embolization) Hepatoma Kasus Simpel dengan anestesi |
38,735,000 |
| 10799 |
TAE (Trans-Arterial Embolization) Kasus Kompleks |
47,129,000 |
| 10800 |
TAE (Trans-Arterial Embolization) Kasus Kompleks dengan anestesi |
54,041,000 |
| 10801 |
TAE (Trans-Arterial Embolization) Kasus Simpel |
35,217,000 |
| 10802 |
TAE (Trans-Arterial Embolization) Kasus Simpel dengan anestesi |
40,471,000 |
| 10803 |
TAE (Trans-Arterial Embolization) Malignansi Non Hepatoma Kasus Kompleks |
47,129,000 |
| 10804 |
TAE (Trans-Arterial Embolization) Malignansi Non Hepatoma Kasus Kompleks dengan anestesi |
54,041,000 |
| 10805 |
TAE (Trans-Arterial Embolization) Malignansi Non Hepatoma Kasus Simpel |
35,217,000 |
| 10806 |
TAE (Trans-Arterial Embolization) Malignansi Non Hepatoma Kasus Simpel dengan anestesi |
40,471,000 |
| 10807 |
TAE (Trans-Arterial Embolization) Mioma Uteri Kasus Kompleks |
47,129,000 |
| 10808 |
TAE (Trans-Arterial Embolization) Mioma Uteri Kasus Kompleks dengan anestesi |
54,041,000 |
| 10809 |
TAE (Trans-Arterial Embolization) Mioma Uteri Kasus Simpel |
35,217,000 |
| 10810 |
TAE (Trans-Arterial Embolization) Mioma Uteri Kasus Simpel dengan anestesi |
40,471,000 |
| 10811 |
TAE (Trans-Arterial Embolization) OA Genu Kasus Kompleks |
34,046,000 |
| 10812 |
TAE (Trans-Arterial Embolization) OA Genu Kasus Kompleks dengan anestesi |
39,137,000 |
| 10813 |
TAE (Trans-Arterial Embolization) OA Genu Kasus Simpel |
29,384,000 |
| 10814 |
TAE (Trans-Arterial Embolization) OA Genu Kasus Simpel dengan anestesi |
33,826,000 |
| 10815 |
TAE BPH ((Trans-Arterial Embolization of Benign Prostatic Hyperplasia) Kasus Kompleks |
47,129,000 |
| 10816 |
TAE BPH ((Trans-Arterial Embolization of Benign Prostatic Hyperplasia) Kasus Kompleks dengan anestesi |
54,041,000 |
| 10817 |
TAE BPH (Trans-Arterial Embolization of Benign Prostatic Hyperplasia) Kasus Simpel |
35,217,000 |
| 10818 |
TAE BPH (Trans-Arterial Embolization of Benign Prostatic Hyperplasia) Kasus Simpel dengan anestesi |
40,471,000 |
| 10819 |
Tailoring Ureter |
25,429,000 |
| 10820 |
Tambalan Sementara |
114,000 |
| 10821 |
Tambalan/Restorasi Amalgam |
0 |
| 10822 |
Tampon Bellogue |
120,000 |
| 10823 |
Tampon Boor Zulf Covu Nasi |
42,000 |
| 10824 |
Tampon Burowi/ telinga |
14,000 |
| 10825 |
Tampon cavum nasi ( boorzalf) |
42,000 |
| 10826 |
Tampon Cavum Nasi (Lidokain + Efedrin) |
31,000 |
| 10827 |
Tampon Hidung |
14,000 |
| 10828 |
Tampon Mata |
14,000 |
| 10829 |
Tampon utero-vagina |
70,000 |
| 10830 |
Tampon Vagina |
66,000 |
| 10831 |
Tanam Benang 1 |
4,000,000 |
| 10832 |
Tanam Benang 2 |
6,000,000 |
| 10833 |
Tanam Benang 3 |
6,980,000 |
| 10834 |
Tapping & Strapping |
250,000 |
| 10835 |
Target Temperature Management Harian (terapi hipotermia) |
151,000 |
| 10836 |
Tarsal Tunnel Syndrome manual (tanpa panduan) |
281,000 |
| 10837 |
Tarsal Tunnel Syndrome USG |
595,000 |
| 10838 |
Tarsometatarsal fusion |
5,476,800 |
| 10839 |
Tata laksana dan monitoring nyeri berkala |
161,000 |
| 10840 |
Tata laksana dan pemantauan tekanan intrakranial |
300,000 |
| 10841 |
Tatalaksana dan monitoring harian hiperleukositosis |
337,000 |
| 10842 |
Tatalaksana dan monitoring harian tumor lysis syndrome |
337,000 |
| 10843 |
Tatalaksana dan Monitoring Hemodinamik Invasive Harian oleh DPJP pasien dewasa |
200,000 |
| 10844 |
Tatalaksana dan Monitoring Hemodinamik Invasive Harian oleh DPJP pasien neonatus |
200,000 |
| 10845 |
Tatalaksana dan Monitoring Hemodinamik Invasive Harian oleh DPJP pasien pediatrik |
200,000 |
| 10846 |
Tatalaksana dan Monitoring Hemodinamik Non Invasive Harian oleh DPJP pasien dewasa |
200,000 |
| 10847 |
Tatalaksana dan Monitoring Hemodinamik Non Invasive Harian oleh DPJP pasien neonatus |
200,000 |
| 10848 |
Tatalaksana dan Monitoring Hemodinamik Non Invasive Harian oleh DPJP pasien pediatrik |
200,000 |
| 10849 |
Tatalaksana Gangguan Artikulasi |
176,000 |
| 10850 |
Tatalaksana Gangguan Bahasa Tidak Spesifik (Termasuk Disleksia, Dispraksia) |
191,000 |
| 10851 |
Tatalaksana Gangguan Berbahasa |
146,000 |
| 10852 |
Tatalaksana Gangguan Fonasi / Produksi Suara |
263,000 |
| 10853 |
Tatalaksana Gangguan Kelancaran Bicara |
141,000 |
| 10854 |
Tatalaksana Gangguan Makan dan Menelan |
224,000 |
| 10855 |
Tatalaksana Gangguan Proses Bicara pada Kelainan Kraniofacial |
191,000 |
| 10856 |
Tatalaksana gizi di ICU/HCU/ICCU pasien dewasa (lihat tindakan gizi) |
150,000 |
| 10857 |
Tatalaksana gizi di NICU pasien neonatus (lihat tindakan gizi) |
150,000 |
| 10858 |
Tatalaksana gizi di PICU pasien pediatrik |
150,000 |
| 10859 |
Tatalaksana imunonutrisi |
219,000 |
| 10860 |
Tatalaksana jalan nafas sulit dengan alat lainnya |
809,000 |
| 10861 |
Tatalaksana jalan nafas sulit dengan alat lainnya pasien dewasa |
809,000 |
| 10862 |
Tatalaksana jalan nafas sulit dengan alat lainnya pasien neonatus |
809,000 |
| 10863 |
Tatalaksana jalan nafas sulit dengan alat lainnya pasien pediatrik |
809,000 |
| 10864 |
Tatalaksana Jenazah dari Dalam RS |
275,000 |
| 10865 |
Tatalaksana Keterlambatan Bahasa Bicara |
141,000 |
| 10866 |
Tatalaksana nutrisi bariatrik |
128,000 |
| 10867 |
Tatalaksana nutrisi homecare |
128,000 |
| 10868 |
Tatalaksana nutrisi paliatif |
128,000 |
| 10869 |
Tatalaksana nutrisi perioperatif |
128,000 |
| 10870 |
Tatalaksana nutrisi transplantasi organ |
128,000 |
| 10871 |
Tatalaksana pangan fungsional dan nutraceutical |
203,000 |
| 10872 |
Tatalaksana sedasi kontinu (critical care / emergency / Early Warning System) |
1,241,000 |
| 10873 |
Tatalaksana sedasi kontinu (critical care) pasien dewasa |
1,241,000 |
| 10874 |
Tatalaksana sedasi kontinu (critical care) pasien neonatus |
1,241,000 |
| 10875 |
Tatalaksana sedasi kontinu (critical care) pasien pediatrik |
1,241,000 |
| 10876 |
Tatalaksana Total Parenteral Nutrition (TPN) di ICU/HCU/ICCU pasien dewasa |
225,000 |
| 10877 |
Tatalaksana Total Parenteral Nutrition (TPN) di NICU Pasien neonatus |
225,000 |
| 10878 |
Tatalaksana Total Parenteral Nutrition (TPN) di PICU pasien pediatrik |
225,000 |
| 10879 |
TAVI |
121,011,000 |
| 10880 |
Taylor Brace (Biasa) |
1,320,000 |
| 10881 |
Taylor Brace (Khusus) |
2,850,000 |
| 10882 |
TCA Cross 90-100% |
251,000 |
| 10883 |
TCD (Transcranial Doppler) |
850,000 |
| 10884 |
TCM MTB/RIF ULTRA (PROGRAM) |
577,000 |
| 10885 |
TCM MTB/XDR (PROGRAM) |
577,000 |
| 10886 |
TCM Mycobacterium Tuberculosa (Genexpert Tb) |
2,000,000 |
| 10887 |
TCM SARS-COV-2 |
770,001 |
| 10888 |
Tears Break Up Time (TBUT) |
44,000 |
| 10889 |
TEAS (Transcutaneous Electrical Acupoint Stimulation) |
249,000 |
| 10890 |
TEE |
1,200,000 |
| 10891 |
TEE intraoperatif |
2,475,000 |
| 10892 |
TEE pasien dewasa |
1,200,000 |
| 10893 |
TEE pasien neonatus |
1,200,000 |
| 10894 |
TEE pasien pediatrik |
1,200,000 |
| 10895 |
Telemedicine |
150,000 |
| 10896 |
Telemetri kardiak |
1,097,000 |
| 10897 |
Temporal Bone Resection |
19,801,000 |
| 10898 |
Temporal Bone Resection |
5,393,089 |
| 10899 |
Temporary anchorage device |
2,071,000 |
| 10900 |
Temporomandibular joint injection |
1,240,000 |
| 10901 |
Tendinitis Bicipitalis Manual (tanpa panduan) |
281,000 |
| 10902 |
Tendinitis Bicipitalis USG |
595,000 |
| 10903 |
Tendinitis Patella manual (tanpa panduan) |
281,000 |
| 10904 |
Tendinitis Patella USG |
595,000 |
| 10905 |
Tendon graft |
11,196,000 |
| 10906 |
Tendon pulley reconstruction |
13,754,994 |
| 10907 |
Tendon Repair, LA |
13,141,000 |
| 10908 |
Tendon Transfer Ekstremitas Bawah Pada Kasus Neuromuskular Anak |
3,532,812 |
| 10909 |
Tendon Transfer for Lower Extremity (Soft Tissue /Nerve Problem, Multiple) |
19,751,000 |
| 10910 |
Tendon Transfer for Lower Extremity (Soft Tissue /Nerve Problem, Single) |
19,752,000 |
| 10911 |
Tendon Transfer for lower Extremity Problems |
19,751,000 |
| 10912 |
Tendon Transfer for stiffness/spastic/contracure joint |
23,914,000 |
| 10913 |
Tendon transfer for Upper Extremity (Soft Tissue / Nerve Problem, Multiple) |
19,752,000 |
| 10914 |
Tendon transfer for Upper Extremity (Soft Tissue / Nerve Problem, Single) |
19,752,000 |
| 10915 |
Tendon Transfer for Upper Extremity Problems |
19,751,000 |
| 10916 |
Tendon Transfer Multiple, GA |
33,975,000 |
| 10917 |
Tendon transfer or transplantation |
7,533,800 |
| 10918 |
Tendon Transfer Tunggal, GA |
33,975,000 |
| 10919 |
Tendoplasty, GA |
33,975,000 |
| 10920 |
Tennis Elbow Manual (tanpa panduan) |
281,000 |
| 10921 |
Tennis Elbow USG |
595,000 |
| 10922 |
Tenolysis for Tendon adhesion/ entrapment (single) |
21,296,000 |
| 10923 |
Tenotomy for Tendinitis / tendon contracture |
21,296,000 |
| 10924 |
Tenotomy of hand |
9,390,000 |
| 10925 |
Tens |
39,600 |
| 10926 |
Terapi / Latihan Neuromuscular Activation System |
172,000 |
| 10927 |
Terapi Aferesis |
5,000,000 |
| 10928 |
Terapi Aktivitas Kelompok |
300,000 |
| 10929 |
Terapi Aktivitas Kelompok ( Eksekutif ) |
0 |
| 10930 |
Terapi antibiotik intraperitoneal |
206,000 |
| 10931 |
Terapi antikoagulan subkutan |
431,000 |
| 10932 |
Terapi Bermain pada Anak (Play Therapy) |
300,000 |
| 10933 |
Terapi besi intravena |
247,000 |
| 10934 |
Terapi besi subkutan |
141,000 |
| 10935 |
Terapi Bicara |
282,000 |
| 10936 |
Terapi Bicara Komunitas ( Paket 4x Datang ) |
250,000 |
| 10937 |
Terapi Biofeedback |
274,001 |
| 10938 |
Terapi CPA Pulse |
66,000 |
| 10939 |
Terapi dan monitoring antikoagulan pasien dewasa |
400,000 |
| 10940 |
Terapi dan monitoring antikoagulan pasien neonatus |
400,000 |
| 10941 |
Terapi dan monitoring antikoagulan pasien pediatrik |
400,000 |
| 10942 |
Terapi Derivat Sel Punca / Secretome / Exosome / Growth Factor 1 |
2,500,000 |
| 10943 |
Terapi Derivat Sel Punca / Secretome / Exosome / Growth Factor 2 |
3,500,000 |
| 10944 |
Terapi Derivat Sel Punca / Secretome / Exosome / Growth Factor 3 |
5,000,000 |
| 10945 |
Terapi Diet Alergi |
100,000 |
| 10946 |
Terapi Diet DM |
78,000 |
| 10947 |
Terapi Diet Sindroma Nefrotik & Gnaps |
78,000 |
| 10948 |
Terapi Dingin |
125,000 |
| 10949 |
Terapi Edukasi (Care Giver) |
521,000 |
| 10950 |
Terapi Edukasi (Care Giver) pada lansia |
100,000 |
| 10951 |
Terapi Edukasi Anak Berkebutuhan Khusus |
165,000 |
| 10952 |
Terapi emfisema subkutis |
200,000 |
| 10953 |
Terapi fibrinolitik pasien dewasa |
142,000 |
| 10954 |
Terapi fibrinolitik pasien neonatus |
142,000 |
| 10955 |
Terapi fibrinolitik pasien pediatrik |
142,000 |
| 10956 |
Terapi High Intensity Focused Ultrasound (HIFU) 1 |
1,500,000 |
| 10957 |
Terapi High Intensity Focused Ultrasound (HIFU) 2 |
2,000,000 |
| 10958 |
Terapi High Intensity Focused Ultrasound (HIFU) 3 |
2,500,000 |
| 10959 |
Terapi hipotermia pasien dewasa |
151,000 |
| 10960 |
Terapi hipotermia pasien neonatus |
151,000 |
| 10961 |
Terapi hipotermia pasien pediatrik |
151,000 |
| 10962 |
Terapi imunosupresan intravena |
463,000 |
| 10963 |
Terapi infus n kemoterapi |
660,000 |
| 10964 |
Terapi inhalasi |
104,000 |
| 10965 |
Terapi Inhalasi (Nebulizer) |
178,000 |
| 10966 |
Terapi Injeksi Long Acting |
100,000 |
| 10967 |
Terapi Injeksi Long Acting ( Eksekutif ) |
0 |
| 10968 |
Terapi Kateterisasi Intermiten Berkala atau Clean Intermittent Catheterization (CIC) |
339,000 |
| 10969 |
Terapi Kelompok |
75,000 |
| 10970 |
Terapi Kelompok Lainnya (Other Group Therapy) |
255,000 |
| 10971 |
Terapi kelompok pada anak dan remaja |
300,000 |
| 10972 |
Terapi kelompok pada dewasa |
300,000 |
| 10973 |
Terapi kelompok pada Gangguan Penggunaan Zat/Adiksi Perilaku |
300,000 |
| 10974 |
Terapi kelompok pada lansia |
300,000 |
| 10975 |
Terapi Keluarga |
350,000 |
| 10976 |
Terapi Keluarga (Family therapy) |
106,000 |
| 10977 |
Terapi latihan kebugaran kardiorespirasi tanpa alat dengan pemantauan kardiovaskular (per-kedatangan) |
521,000 |
| 10978 |
Terapi Marital |
300,000 |
| 10979 |
Terapi Modifikasi Prilaku |
250,000 |
| 10980 |
Terapi Musik (Individu & Grup) |
125,000 |
| 10981 |
Terapi musik pada anak dan remaja |
200,000 |
| 10982 |
Terapi musik pada dewasa |
200,000 |
| 10983 |
Terapi musik pada lansia |
200,000 |
| 10984 |
Terapi Neurostimulasi Fungsi Berkemih dan Defekasi |
125,000 |
| 10985 |
Terapi Neurostimulasi Fungsi Menelan |
125,000 |
| 10986 |
Terapi Neurostimulasi Fungsi Otot |
125,000 |
| 10987 |
Terapi Nyeri |
386,000 |
| 10988 |
Terapi Oksigen |
90,000 |
| 10989 |
Terapi Oksigen |
150,000 |
| 10990 |
Terapi Oksigen dengan nasal kanul dan mask |
107,000 |
| 10991 |
Terapi Okupasi Audiovisual Sensori Terintegrasi (Snoezelen) |
125,000 |
| 10992 |
Terapi okupasi neurorestorasi (neurofasilitasi) |
129,000 |
| 10993 |
Terapi Okupasi Penanganan Gangguan Persepsi Kognisi, Sensori Integrasi |
135,000 |
| 10994 |
Terapi Perilaku |
109,000 |
| 10995 |
Terapi Perilaku |
100,000 |
| 10996 |
Terapi Perilaku ( Eksekutif ) |
0 |
| 10997 |
Terapi perilaku korban kekerasan anak |
251,000 |
| 10998 |
Terapi Plasma Exchange |
5,000,000 |
| 10999 |
Terapi Plasmaferesis/Leukoferesis/Tromboferesis |
3,300,000 |
| 11000 |
Terapi Platelet Rich Fibrin (PRF) |
1,000,000 |
| 11001 |
Terapi Platelet Rich Plasma (PRP) (automated) |
1,500,000 |
| 11002 |
Terapi Platelet Rich Plasma (PRP) (manual) |
700,000 |
| 11003 |
TERAPI REHABILITASI VESTIBULER(VRT) |
282,000 |
| 11004 |
Terapi reposisi otolit |
379,000 |
| 11005 |
Terapi Sel Punca Mesenkimal / Sel Punca Lainnya 1 |
3,000,000 |
| 11006 |
Terapi Sel Punca Mesenkimal / Sel Punca Lainnya 2 |
4,000,000 |
| 11007 |
Terapi Sel Punca Mesenkimal / Sel Punca Lainnya 3 |
5,000,000 |
| 11008 |
Terapi Sklerosing |
5,193,000 |
| 11009 |
Terapi stimulasi taktil dan kinestetik bayi (infant massage) |
188,000 |
| 11010 |
Terapi Transcranial Magnetic Stimulation (TMS) |
1,955,000 |
| 11011 |
Terminalization for Ring avulsion or traumatic amputaton of finger and hand |
18,043,000 |
| 11012 |
Tes Alergi Asthma |
323,000 |
| 11013 |
Tes Amin |
100,000 |
| 11014 |
Tes Anel |
234,000 |
| 11015 |
Tes Antibodi Covid - 19 Metode Rapid Test |
130,000 |
| 11016 |
Tes Antibodi Covid-19 (IgG dan IgM) |
350,000 |
| 11017 |
Tes Antigen Covid-19 Metode Rapid Tes |
109,000 |
| 11018 |
Tes Asam Asetat |
130,001 |
| 11019 |
Tes Bakat ( GABT Paket ) |
60,000 |
| 11020 |
Tes Berjalan 6 menit |
258,001 |
| 11021 |
Tes Cepat Molekuler RT-PCR Covid-19 |
750,000 |
| 11022 |
Tes dan Evaluasi Psikologis Lainnnya (Penulusuran Minat dan Bakat) |
125,000 |
| 11023 |
Tes Deprivasi Air |
121,000 |
| 11024 |
Tes Elektroforesis Hb |
370,000 |
| 11025 |
Tes Elektroforesis Protein |
270,000 |
| 11026 |
Tes Feming |
33,000 |
| 11027 |
Tes Fluoresin |
29,000 |
| 11028 |
Tes Fungsi Kortikal Luhur (Pasien Baru) |
261,000 |
| 11029 |
Tes Fungsi Kortikal Luhur (Pasien Lama) |
153,000 |
| 11030 |
Tes Fungsi Tuba |
110,000 |
| 11031 |
Tes Intelegensi |
75,000 |
| 11032 |
Tes Inteligensi (IQ) |
200,000 |
| 11033 |
Tes IQ / Raven Test |
100,000 |
| 11034 |
Tes IQ / Raven Test ( Eksekutif ) |
0 |
| 11035 |
Tes Kalori |
282,000 |
| 11036 |
Tes Kepribadian |
50,000 |
| 11037 |
Tes Kepribadian |
224,000 |
| 11038 |
Tes Minat Bakat Anak dan Remaja |
296,000 |
| 11039 |
Tes Minat Bakat Dewasa |
296,000 |
| 11040 |
Tes MMPI, Print grafik MMPI dan Pembuatan hasil |
350,000 |
| 11041 |
Tes Mutasi KRAS |
2,338,000 |
| 11042 |
Tes Narkoba ( 3 Jenis Obat ) |
255,000 |
| 11043 |
Tes Narkoba ( 5 Jenis Obat ) |
300,000 |
| 11044 |
Tes Narkoba ( 6 Jenis Obat ) |
368,000 |
| 11045 |
Tes Narkoba ( 7 Jenis Obat ) |
475,000 |
| 11046 |
Tes Neuropati Garpu Tala |
121,000 |
| 11047 |
Tes Perspirasi |
150,000 |
| 11048 |
Tes Provokasi Bronkus |
323,000 |
| 11049 |
Tes Psikolog (Komunitas) |
66,000 |
| 11050 |
Tes Rose Bengal |
33,000 |
| 11051 |
Tes RT-PCR Covid-19 dengan Viral Respiratory Infection (10 Virus VRI) |
4,000,000 |
| 11052 |
Tes sakarin |
71,000 |
| 11053 |
TES SAL (sensorineural acquity level) |
282,000 |
| 11054 |
Tes Schirmen |
33,000 |
| 11055 |
Tes Schirmer |
65,000 |
| 11056 |
TES TOLERANSI GLUKOSA ORAL (2X SAMPLING)/OGTT |
157,000 |
| 11057 |
TES TOPOGRAFI N. FASIALIS |
300,000 |
| 11058 |
Tes Vestibuler |
90,000 |
| 11059 |
TES VISUAL DINAMIC ACQUTY (VDA) |
300,000 |
| 11060 |
Test Impedance Implan koklea (NRT+ Impedance + E SRT) |
1,055,000 |
| 11061 |
Test Intelegensi WAIS |
60,000 |
| 11062 |
Test Intelegensi WISC/SPPSI |
60,000 |
| 11063 |
Test Kepribadian EPPS |
33,000 |
| 11064 |
Test Kepribadian Grafis |
33,000 |
| 11065 |
Test Meningeal Sign |
78,000 |
| 11066 |
Test Nervus Cranialis (Saraf - Anak) |
100,000 |
| 11067 |
Test Nervus Cranialis (Tumbuh Kembang - Anak) |
78,000 |
| 11068 |
Test Pendengaran Manual |
78,000 |
| 11069 |
Test Perkembangan |
33,000 |
| 11070 |
Test Perkembangan Kognitif CAT-CLAMPS |
270,000 |
| 11071 |
Test Personal Sosial |
100,000 |
| 11072 |
Test Reflex Fisiologis |
80,000 |
| 11073 |
Test Reflex Patologis |
80,000 |
| 11074 |
Test Sensibilitas |
78,000 |
| 11075 |
Test Sisi / Decay |
73,000 |
| 11076 |
Test Sisi Decay |
282,000 |
| 11077 |
Test Sistem Saraf Otonom |
78,000 |
| 11078 |
Test Skiring Masalah Mental Emosional |
220,000 |
| 11079 |
Test Sniffin |
651,800 |
| 11080 |
Test Tanda - Tanda Vital (RJ) |
0 |
| 11081 |
Test Tanda-tanda Vital |
0 |
| 11082 |
Test Tempel Slektif |
73,000 |
| 11083 |
Test Waktu Pendarahan |
78,000 |
| 11084 |
Testosteron (P) |
400,000 |
| 11085 |
Testoteron _ |
288,000 |
| 11086 |
TEVAR + Chimney + Fenestrated |
176,779,000 |
| 11087 |
TEVAR + Chimney ± Intra-aorta Imaging |
176,779,000 |
| 11088 |
TEVAR + Coilling ± Intra-aorta Imaging |
176,779,000 |
| 11089 |
TEVAR + CUFF Extension ± Intra-aorta Imaging |
176,779,000 |
| 11090 |
TEVAR + Multiple Stiff Wire Technique |
176,779,000 |
| 11091 |
TEVAR Customized Device (Scallop) ± Intra-aorta Imaging |
176,779,000 |
| 11092 |
TEVAR Fenestrated ± Intra-aorta Imaging |
176,779,000 |
| 11093 |
Therapeutic Plasma Exchange |
6,209,000 |
| 11094 |
Therapi Afasia Anak |
39,600 |
| 11095 |
Therapi Afasia Dewasa |
39,600 |
| 11096 |
Therapi Bermain |
25,200 |
| 11097 |
Therapi Delayed Speech (Okupasi Terapi) |
39,600 |
| 11098 |
Therapi Delayed Speech (Terapi Wicara) |
39,600 |
| 11099 |
Therapi Dimensia |
39,600 |
| 11100 |
Therapi Disatria |
39,600 |
| 11101 |
Therapi Disaudia |
39,600 |
| 11102 |
Therapi Disfagia |
39,600 |
| 11103 |
Therapi Disglosia |
39,600 |
| 11104 |
Therapi Inderek / Konsultasi |
39,600 |
| 11105 |
Therapi Irama Kelancaran |
39,600 |
| 11106 |
Therapi Kreativitas |
39,600 |
| 11107 |
Thigh reattachment |
7,676,900 |
| 11108 |
Thoracal Interlaminar Injection C-Arm (Eksekutif) |
0 |
| 11109 |
Thoracal Medial Branch Block Injection C-Arm ? 2 (Eksekutif) |
0 |
| 11110 |
Thoracal Medial Branch Block Injection C-Arm > 2 (Eksekutif) |
0 |
| 11111 |
Thoracal corpectomy |
37,385,000 |
| 11112 |
Thoracal Facet Joint Injection C-Arm <= 2 |
8,715,000 |
| 11113 |
Thoracal Facet Joint Injection C-Arm > 2 |
6,660,000 |
| 11114 |
Thoracal Facet Jonit Injection C-Arm ? 2 (Eksekutif) |
0 |
| 11115 |
Thoracal Facet Jonit Injection C-Arm > 2 (Eksekutif) |
0 |
| 11116 |
Thoracal Interlaminar Injection C-Arm |
8,715,000 |
| 11117 |
Thoracal Medial Branch Block Injection C-Arm <= 2 |
8,715,000 |
| 11118 |
Thoracal Medial Branch Block Injection C-Arm > 2 |
6,660,000 |
| 11119 |
Thoracal Transforaminal Injection C-Arm ? 2 (Eksekutif) |
0 |
| 11120 |
Thoracal Transforaminal Injection C-Arm <= 2 |
10,610,000 |
| 11121 |
Thoracal Transforaminal Injection C-Arm > 2 |
7,910,000 |
| 11122 |
Thoracal Transforaminal Injection C-Arm > 2 (Eksekutif) |
0 |
| 11123 |
Thoracic Drainase Kasus Simpel |
6,822,000 |
| 11124 |
Thoracic Endovascular Aortic Repair (TEVAR) |
158,000,000 |
| 11125 |
Thoracic Facet Joint Injection USG |
2,891,000 |
| 11126 |
Thoraco-abdominal Aortic Replacement |
156,779,000 |
| 11127 |
Thoracotomi + anastomosis esofagus |
31,134,000 |
| 11128 |
Thoracotomy + Gastrostomi |
31,134,000 |
| 11129 |
Thorakal Facet Joint Injection C ARM |
5,075,000 |
| 11130 |
Thorakal Facet Joint Injection USG |
2,891,000 |
| 11131 |
Thorakal Interlaminar Injection C ARM |
4,547,000 |
| 11132 |
Thorakal Interlaminar Injection USG |
2,891,000 |
| 11133 |
Thorakal Median Branch Injection C ARM |
5,075,000 |
| 11134 |
Thorakal Median Branch Injection USG |
2,891,000 |
| 11135 |
Thorakal Transforaminal Injection C ARM |
5,929,000 |
| 11136 |
Thorakal Transforaminal Injection USG |
2,891,000 |
| 11137 |
Thorasic Endovascular Aortic Repair (TEVAR) kompleks |
176,779,000 |
| 11138 |
Thorasic Endovascular Aortic Repair (TEVAR) sederhana |
148,532,000 |
| 11139 |
Thrombine Time (TT) |
200,000 |
| 11140 |
Thromboplastin Generation Time (TGT) |
115,000 |
| 11141 |
Thrombotest |
113,000 |
| 11142 |
Thumb reattachment |
10,675,000 |
| 11143 |
Thyroidektomi completion |
18,522,000 |
| 11144 |
TIBC |
192,000 |
| 11145 |
TIBC _ |
90,000 |
| 11146 |
Tibial Entrapment manual (tanpa panduan) |
281,000 |
| 11147 |
Tibial Entrapment USG |
595,000 |
| 11148 |
Tilt Table Test |
731,000 |
| 11149 |
Tilt-Table Test (Kardiovaskular) |
731,000 |
| 11150 |
Tilting Table (Fisioterapi) |
39,600 |
| 11151 |
Tilting Table (Okupasi Terapi) |
60,000 |
| 11152 |
Timpametri |
430,000 |
| 11153 |
Timpametri High Frequensi |
430,000 |
| 11154 |
Timpano Plastik |
4,593,472 |
| 11155 |
Timpanometri |
150,000 |
| 11156 |
Timpanoplasti Revisi bilateral |
16,945,000 |
| 11157 |
Timpanoplasti Revisi unilateral |
13,988,000 |
| 11158 |
Timpanoplasti tipe I/ Miringoplasti |
12,255,000 |
| 11159 |
Timpanoplasti tipe II |
12,255,000 |
| 11160 |
Timpanoplasty tipe III |
12,255,000 |
| 11161 |
Timpanoplasty tipe IV |
13,988,000 |
| 11162 |
Timpanoplasty tipe V |
13,988,000 |
| 11163 |
Tind. Akupuntur, Tind TDP, Tind Cupping |
55,000 |
| 11164 |
Tindakan (monitor SPO2 - saturasi) |
45,000 |
| 11165 |
Tindakan Analisis Asupan ( Food Recall 24 Jam dan Riwayat Asupan) |
100,000 |
| 11166 |
Tindakan Analisis Asupan (Food Recall 24 Jam dan Riwayat Asupan) |
86,000 |
| 11167 |
Tindakan Anoscopy |
66,000 |
| 11168 |
Tindakan Ballon Detachable |
12,950,000 |
| 11169 |
Tindakan Ballon Detachable + Anastesi |
43,270,000 |
| 11170 |
Tindakan Balloning Dilatator |
18,350,000 |
| 11171 |
Tindakan Balloning Dilatator + Anastesi |
63,850,000 |
| 11172 |
Tindakan Bedah Flap |
250,000 |
| 11173 |
Tindakan Biopsi |
143,000 |
| 11174 |
Tindakan CABG |
67,000,000 |
| 11175 |
Tindakan CABG High Risk/MVR/AVR |
75,600,000 |
| 11176 |
Tindakan Coiling |
17,350,000 |
| 11177 |
Tindakan Coiling + Anastesi |
58,650,000 |
| 11178 |
Tindakan Congenital Fornix Plastik |
4,375,000 |
| 11179 |
Tindakan defibrilasi |
1,404,000 |
| 11180 |
Tindakan defibrilasi pasien dewasa |
1,404,000 |
| 11181 |
Tindakan defibrilasi pasien neonatus |
1,404,000 |
| 11182 |
Tindakan defibrilasi pasien pediatrik |
1,404,000 |
| 11183 |
Tindakan Dekompresi Fasialis |
9,350,000 |
| 11184 |
Tindakan Dermabrasi |
250,000 |
| 11185 |
Tindakan embolisasi+angiografi (endoleak) (+Radiografer) |
19,913,000 |
| 11186 |
Tindakan Embolisasio dengan Bead Block |
11,283,000 |
| 11187 |
Tindakan Embolisasio dengan Bead Block + Anastesi |
32,440,000 |
| 11188 |
Tindakan Embolisasio dengan Gel Foam |
6,683,000 |
| 11189 |
Tindakan Embolisasio dengan Gel Foam + Anastesi |
22,520,000 |
| 11190 |
Tindakan IABP |
32,187,000 |
| 11191 |
Tindakan imunisasi biasa (PedSos) |
100,000 |
| 11192 |
Tindakan imunisasi pada kondisi penyakit khusus (HIV, atresia bilier, hemofilia, dll) |
100,000 |
| 11193 |
Tindakan injeksi GnRH analog / Leuprorelin acetate (Tapros®) |
241,000 |
| 11194 |
Tindakan injeksi testosteron ester (Sustanon®) |
241,000 |
| 11195 |
Tindakan kardioversi |
1,404,000 |
| 11196 |
Tindakan kardioversi pasien dewasa |
1,404,000 |
| 11197 |
Tindakan kardioversi pasien neonatus |
1,404,000 |
| 11198 |
Tindakan kardioversi pasien pediatrik |
1,404,000 |
| 11199 |
Tindakan lumbal pungsi pasien dewasa |
564,000 |
| 11200 |
Tindakan lumbal pungsi pasien neonatus |
564,000 |
| 11201 |
Tindakan lumbal pungsi pasien pediatrik |
564,000 |
| 11202 |
Tindakan Manual Plasenta |
2,850,000 |
| 11203 |
Tindakan Menghentikan Perdarahan (elektrokoagulasi, ligasi arteri) Rumit |
500,000 |
| 11204 |
Tindakan Menghentikan Perdarahan (elektrokoagulasi, ligasi arteri) Sederhana |
300,000 |
| 11205 |
Tindakan MVR/AVR |
75,600,000 |
| 11206 |
Tindakan Pada Keratosis Seboroika |
675,000 |
| 11207 |
Tindakan pemberian dan pemantauan antidifteri serum |
389,000 |
| 11208 |
Tindakan pengukuran kebutuhan energi dengan kalorimetri indirek |
850,000 |
| 11209 |
Tindakan pengukuran komposisi tubuh dengan alat bioelectrical impedance alysis |
300,000 |
| 11210 |
Tindakan Pharyngeal Flap |
4,850,000 |
| 11211 |
Tindakan potong beku dengan batas sayatan di dalam jam kerja |
2,270,000 |
| 11212 |
Tindakan potong beku tanpa batas sayatan di dalam jam kerja |
1,725,000 |
| 11213 |
Tindakan Resusitasi |
66,000 |
| 11214 |
Tindakan Roser Plasty |
675,000 |
| 11215 |
Tindakan sedasi / pendampingan anestesi di dalam kamar operasi 1-3 jam tanpa penyulit |
654,000 |
| 11216 |
Tindakan sedasi / pendampingan anestesi di luar kamar operasi <1 jam dengan penyulit |
410,000 |
| 11217 |
Tindakan sedasi / pendampingan anestesi di luar kamar operasi <1 jam tanpa penyulit |
327,000 |
| 11218 |
Tindakan sedasi / pendampingan anestesi di luar kamar operasi >3 jam dengan penyulit |
1,227,000 |
| 11219 |
Tindakan sedasi / pendampingan anestesi di luar kamar operasi >3 jam tanpa penyulit |
981,000 |
| 11220 |
Tindakan sedasi / pendampingan anestesi di luar kamar operasi 1-3 jam tanpa penyulit |
654,000 |
| 11221 |
Tindakan sedasi / pendampingan anestesi pada tindakan jalan nafas <1 jam dengan penyulit |
410,000 |
| 11222 |
Tindakan sedasi / pendampingan anestesi pada tindakan jalan nafas <1 jam tanpa penyulit |
327,000 |
| 11223 |
Tindakan sedasi / pendampingan anestesi pada tindakan jalan nafas >3 jam dengan penyulit |
1,227,000 |
| 11224 |
Tindakan sedasi / pendampingan anestesi pada tindakan jalan nafas >3 jam tanpa penyulit |
981,000 |
| 11225 |
Tindakan sedasi / pendampingan anestesi pada tindakan jalan nafas 1-3 jam dengan penyulit |
818,000 |
| 11226 |
Tindakan sedasi / pendampingan anestesi pada tindakan jalan nafas 1-3 jam tanpa penyulit |
654,000 |
| 11227 |
Tindakan Sedasi Dalam |
949,000 |
| 11228 |
Tindakan Sedasi Dalam pasien dewasa |
949,000 |
| 11229 |
Tindakan Sedasi Dalam pasien neonatus |
949,000 |
| 11230 |
Tindakan Sedasi Dalam pasien pediatrik |
949,000 |
| 11231 |
Tindakan Sedasi prosedural |
949,000 |
| 11232 |
Tindakan Sedasi prosedural pasien dewasa |
949,000 |
| 11233 |
Tindakan Sedasi prosedural pasien neonatus |
949,000 |
| 11234 |
Tindakan Sedasi prosedural pasien pediatrik |
949,000 |
| 11235 |
Tindakan Sedasi Ringan pasien dewasa |
421,000 |
| 11236 |
Tindakan Sedasi Ringan pasien neonatus |
421,000 |
| 11237 |
Tindakan Sedasi Ringan pasien pediatrik |
421,000 |
| 11238 |
Tindakan Sedasi Sedang <1 jam |
632,000 |
| 11239 |
Tindakan Sedasi Sedang pasien dewasa |
632,000 |
| 11240 |
Tindakan Sedasi Sedang pasien neonatus |
632,000 |
| 11241 |
Tindakan Sedasi Sedang pasien pediatrik |
632,000 |
| 11242 |
Tindakan Stenting |
25,350,000 |
| 11243 |
Tindakan Stenting + Anastesi |
85,250,000 |
| 11244 |
Tindakan Trans Arterial Chemoterapi Infunsion (TACI/E) |
6,435,000 |
| 11245 |
Tindakan Transfusi Darah (Poliklinik - Rawat Inap) |
66,000 |
| 11246 |
Tindakan Trombolis |
18,050,000 |
| 11247 |
Tindakan Trombolis + Anastesi |
63,790,000 |
| 11248 |
Tindakan uji stimulasi HCG |
241,000 |
| 11249 |
Tindakan USG di Ruang Perawatan |
0 |
| 11250 |
Tindih Telinga (Pemasangan Anting) |
170,000 |
| 11251 |
Tindik Telinga |
108,000 |
| 11252 |
Tirodektomi |
4,850,000 |
| 11253 |
Tirodektomi Total |
4,527,541 |
| 11254 |
Tiroidektomi subtotalis |
18,522,000 |
| 11255 |
Tiroidektomi THT |
4,850,000 |
| 11256 |
Tissue Expantion, GA |
23,914,000 |
| 11257 |
Titrasi vasopresor dan inotropik kontinu bed side (critical care) |
424,000 |
| 11258 |
Titrasi vasopresor dan inotropik kontinu bed side (critical care) pasien dewasa |
424,000 |
| 11259 |
Titrasi vasopresor dan inotropik kontinu bed side (critical care) pasien neonatus |
424,000 |
| 11260 |
Titrasi vasopresor dan inotropik kontinu bed side (critical care) pasien pediatrik |
424,000 |
| 11261 |
TMD Devices Kompleks |
2,450,000 |
| 11262 |
TMD Devices Sedang |
1,937,000 |
| 11263 |
TNE (Transnasal Esofagoscopy) + Biopsi |
3,017,000 |
| 11264 |
Toe reattachment |
10,675,000 |
| 11265 |
TOF Low Risk/ASD Closure+MV Repair/Cleft Repair/VSD+PDA Division+Coarctasio Repair/VSD Closure+AV Repair/MV Repair |
44,350,000 |
| 11266 |
ToF repair complex |
140,398,000 |
| 11267 |
ToF repair simple |
75,328,000 |
| 11268 |
Toilet Hidung |
95,000 |
| 11269 |
Toilet Telinga |
272,000 |
| 11270 |
Toilet Telinga |
65,000 |
| 11271 |
Tonografi |
73,000 |
| 11272 |
Tonometri |
14,000 |
| 11273 |
Tonometri non Kontak |
78,000 |
| 11274 |
Tonsilektomi |
9,021,000 |
| 11275 |
Tonsilektomi |
4,549,405 |
| 11276 |
Tonsilektomi dan Adenoidektomi dengan Coblation |
10,935,000 |
| 11277 |
Tonsilektomi dengan Adenoidektomi (perendoskopi) |
10,436,000 |
| 11278 |
Tonsilo Edenoidectomi |
3,850,000 |
| 11279 |
Topikal Aplikasi Fluor per rahang |
345,000 |
| 11280 |
Toracotomi + Anastomosis Esophagus |
6,124,671 |
| 11281 |
Torakocentesis tanpa USG |
3,190,000 |
| 11282 |
Torakoplasti |
34,668,000 |
| 11283 |
Torakoplasty ( Bedah Paru/ Thorax ) |
21,102,000 |
| 11284 |
Torakosentesis/ pleural tap efusi pleura |
458,000 |
| 11285 |
Torakoskopi |
14,611,000 |
| 11286 |
Torakoskopi single port flexrigid dan rigid + brushing + forceps biopsi |
7,253,000 |
| 11287 |
Torakoskopi single port flexrigid dan rigid + brushing + forceps biopsi + cryobiopsy |
9,430,000 |
| 11288 |
Torakoskopi single port flexrigid dan rigid + cuci rongga pleura |
8,089,000 |
| 11289 |
Torakoskopi single port flexrigid dan rigid + pleurodesis |
8,204,000 |
| 11290 |
Torakotomi (Paket A Bedah Paru) |
19,450,000 |
| 11291 |
Torakotomi /Mediastinostomi + Biopsi Chamberlains |
31,134,000 |
| 11292 |
Torakotomi + Air Plombage |
31,134,000 |
| 11293 |
Torakotomi + Anastomosis Esofagus |
31,134,000 |
| 11294 |
Torakotomi + Bullaectomy |
31,134,000 |
| 11295 |
Torakotomi + Debridement |
31,134,000 |
| 11296 |
Torakotomi + Debridement + Drainase Abses Hepar |
31,134,000 |
| 11297 |
Torakotomi + Dekortikasi |
31,134,000 |
| 11298 |
Torakotomi + Eksisi Tumor Mediastinum |
55,439,000 |
| 11299 |
Torakotomi + Ekstraksi Benda Asing |
31,134,000 |
| 11300 |
Torakotomi + Eloeser Window |
31,134,000 |
| 11301 |
Torakotomi + Esofagektomi (Tumor) |
32,685,000 |
| 11302 |
Torakotomi + esofagomyotomi |
31,134,000 |
| 11303 |
Torakotomi + Esofagomyotomi (Operasi Heller) |
31,134,000 |
| 11304 |
Torakotomi + Fiksasi Iga |
35,909,000 |
| 11305 |
Torakotomi + Gastrostomi |
31,134,000 |
| 11306 |
Torakotomi + gastrostomi (atresia esofagus) |
31,134,000 |
| 11307 |
Torakotomi + Hemostasis |
31,134,000 |
| 11308 |
Torakotomi + Lobektomi |
31,134,000 |
| 11309 |
Torakotomi + Muscle Plumbage |
31,134,000 |
| 11310 |
Torakotomi + Pericardial Window |
31,134,000 |
| 11311 |
Torakotomi + Pleurectomy |
31,134,000 |
| 11312 |
Torakotomi + Plikasi Diafragma |
31,134,000 |
| 11313 |
Torakotomi + Pneumektomi |
31,134,000 |
| 11314 |
Torakotomi + Rekonstruksi Dinding Dada |
31,134,000 |
| 11315 |
Torakotomi + Repair Bronchus |
31,134,000 |
| 11316 |
Torakotomi + Repair Diafragma |
31,134,000 |
| 11317 |
Torakotomi + Repair Duktus Torasikus |
31,134,000 |
| 11318 |
Torakotomi + Repair Fistula Bronchopleura |
31,134,000 |
| 11319 |
Torakotomi + Repair Hernia Diafragma dengan Mesh Graft |
31,134,000 |
| 11320 |
Torakotomi + Repair paru |
31,134,000 |
| 11321 |
Torakotomi + Repair Trakea |
31,134,000 |
| 11322 |
Torakotomi + Reseksi dan/atau Anastomosis Esofagus |
31,134,000 |
| 11323 |
Torakotomi + Segmentektomi atau Wedge Ressection |
31,134,000 |
| 11324 |
Torakotomi + Simpatektomi Torakal |
38,920,000 |
| 11325 |
Torakotomi + Sleeve Lobektomi |
31,134,000 |
| 11326 |
Torakotomi + Sleeve Pneumektomi |
31,134,000 |
| 11327 |
Torsio Testis |
5,134,089 |
| 11328 |
Torsio testis (narkose) |
10,346,000 |
| 11329 |
Total Arch Replacement |
127,703,000 |
| 11330 |
Total Cranial Vault Reconstruction, GA |
19,617,000 |
| 11331 |
Total disc replacement (multiple) |
34,663,001 |
| 11332 |
Total disc replacement (single) |
24,318,000 |
| 11333 |
Total elbow replacement |
8,105,000 |
| 11334 |
Total Face Lift |
19,617,000 |
| 11335 |
Total hip replacement |
5,741,098 |
| 11336 |
Total Joint Replacement for Bone / Soft tissue tumor with pathological fracture |
25,267,000 |
| 11337 |
Total knee replacement |
5,741,098 |
| 11338 |
Total laringektomi |
33,156,000 |
| 11339 |
Total ostectomy of carpals and metacarpals |
6,600,000 |
| 11340 |
Total ostectomy of femur |
6,600,000 |
| 11341 |
Total ostectomy of humerus |
6,600,000 |
| 11342 |
Total ostectomy of patella |
6,600,000 |
| 11343 |
Total ostectomy of radius and ulna |
6,600,000 |
| 11344 |
Total ostectomy of scapula, clavicle, and thorax (ribs and sternum) |
6,600,000 |
| 11345 |
Total ostectomy of tarsals and metatarsals |
6,600,000 |
| 11346 |
Total ostectomy of tibia and fibula |
6,600,000 |
| 11347 |
Total Penektomi |
14,200,000 |
| 11348 |
Total Penektomi + Perineostomi |
23,550,000 |
| 11349 |
Total Shoulder Arthoplasty |
24,506,000 |
| 11350 |
Total shoulder replacement |
8,105,000 |
| 11351 |
Total Thyroidektomy + CND atau extended (ukuran >10cm) |
21,301,000 |
| 11352 |
Total Thyroidektomy + Trakeostomi |
27,691,000 |
| 11353 |
Total tiroidektomi |
18,522,000 |
| 11354 |
Total tiroidektomi + Berrypicking (limfadenektomi) |
21,301,000 |
| 11355 |
Total wrist replacement |
8,105,000 |
| 11356 |
Touch Massage |
150,000 |
| 11357 |
Touch Therapy |
150,000 |
| 11358 |
TPE pasien dewasa |
6,209,000 |
| 11359 |
TPE pasien neonatus |
6,209,000 |
| 11360 |
TPE pasien pediatrik |
6,209,000 |
| 11361 |
TPHA |
172,000 |
| 11362 |
TPM (Temporary Pace Maker) |
3,682,250 |
| 11363 |
TRAb (P) |
1,164,000 |
| 11364 |
Trabekulektomi |
6,260,937 |
| 11365 |
Trabekulektomi +ECCE/ Phacoemulsifikasi |
7,850,000 |
| 11366 |
Trabekulo-Trabekulektomi + MMU lokal |
6,706,999 |
| 11367 |
Trabekulo-Trabekulektomi + MMU narkose |
7,420,000 |
| 11368 |
Trabekulotomi + Phaco + IOL premium local |
12,960,001 |
| 11369 |
Trabekulotomi + Phaco + IOL premium narkose |
14,825,000 |
| 11370 |
Trabekulotomi + Phaco + IOL standard dengan penyulit |
15,129,000 |
| 11371 |
Trabekulotomi + Phaco + IOL standard narkose |
16,848,000 |
| 11372 |
Tracheoplasty anterior |
16,578,000 |
| 11373 |
Tracheostomi |
3,900,504 |
| 11374 |
Tracheostomi (CathLab) |
1,945,000 |
| 11375 |
Tracheostomi elektif |
7,622,000 |
| 11376 |
Tracheostomy dengan Penyulit + Tumor Regio Leher |
18,522,000 |
| 11377 |
Tracheostomy pasien dewasa |
6,979,000 |
| 11378 |
Tracheostomy pasien neonatus |
6,979,000 |
| 11379 |
Tracheostomy pasien pediatrik |
6,979,000 |
| 11380 |
Training CAPD : Perawatan Exit Site |
150,000 |
| 11381 |
Training CAPD : Training Ganti Cairan |
1,050,000 |
| 11382 |
Training khusus persiapan homecare |
250,000 |
| 11383 |
Training Pasien Dialisis Peritoneal |
1,114,000 |
| 11384 |
Trakbekulektomi |
4,488,393 |
| 11385 |
Trakeo-Bronkoskopi melalui Stoma (bronkoskopi fleksibel) |
6,385,000 |
| 11386 |
Trakeoplasi ( Bedah Paru / Thorax ) |
21,102,000 |
| 11387 |
Trakeoskopi |
8,555,000 |
| 11388 |
Trakeostomi |
6,979,000 |
| 11389 |
Trakeostomi Cito |
7,521,000 |
| 11390 |
Trakeostomi dengan Penyulit |
8,377,000 |
| 11391 |
Trakestomi dengan penyulit |
3,850,000 |
| 11392 |
Trakhelektomi parsial |
17,281,000 |
| 11393 |
Trakhelektomi per laparoskopi |
17,702,000 |
| 11394 |
Trakhelektomi per laparotomi |
15,804,000 |
| 11395 |
Trakhelektomi radikal per laparoskopi |
20,552,000 |
| 11396 |
Trakhelektomi radikal per laparotomi karsinoma serviks |
18,654,000 |
| 11397 |
Trakhelektomi radikal transvaginal |
20,552,000 |
| 11398 |
Trakhelektomi transvaginal |
18,654,000 |
| 11399 |
Traksi |
33,000 |
| 11400 |
Traksi Cervical / Lumbal |
158,000 |
| 11401 |
Traksi servikal |
8,314,000 |
| 11402 |
Tram Flap |
4,850,000 |
| 11403 |
Trancheostomi |
5,676,074 |
| 11404 |
Tranfusi Tukar Neonatus |
614,000 |
| 11405 |
Trans Esophageal Echocardiogram (TEE) |
1,800,000 |
| 11406 |
Trans Esophageal Echocardiogram (TEE) + Anastesi |
2,500,000 |
| 11407 |
Trans Nasal Esofagoskopi (TNE) |
3,017,000 |
| 11408 |
Transactional analysis pada dewasa |
200,000 |
| 11409 |
Transanal mucosektomy |
32,364,000 |
| 11410 |
Transanal pull through |
44,624,000 |
| 11411 |
Transcatheter Mitral Valve Repair/Replacement |
162,430,000 |
| 11412 |
Transcleral Cyclophotocoagulation (TCP) narkose |
8,130,001 |
| 11413 |
Transcranial Direct Current Stimulation (TDCS) |
499,000 |
| 11414 |
Transcranial Doppler |
850,000 |
| 11415 |
Transcranial Doppler(TCD) |
850,000 |
| 11416 |
Transcranial Magnetic Stimulation (TMS) |
520,000 |
| 11417 |
Transcranial magnetic stimulation (TMS) pada anak dan remaja |
1,955,000 |
| 11418 |
Transcranial magnetic stimulation (TMS) pada dewasa |
1,955,000 |
| 11419 |
Transcranial magnetic stimulation (TMS) pada kasus adiksi |
1,955,000 |
| 11420 |
Transcranial magnetic stimulation (TMS) pada lansia |
1,955,000 |
| 11421 |
Transcutaneous Electrical Nerve Stimulation (TENS), NMES, Electrical Stimulation (ES), FES |
125,000 |
| 11422 |
Transcutaneus Elektric Nerve Stimulation |
253,000 |
| 11423 |
Transeksi Esofagus |
4,399,600 |
| 11424 |
Transfer of finger, except thumb |
10,675,000 |
| 11425 |
TRANSFERIN |
187,000 |
| 11426 |
Transferrin |
124,000 |
| 11427 |
Transforaminal Nerve Block Kasus Simpel |
7,064,000 |
| 11428 |
Transfusi Darah Dengan Filter |
330,000 |
| 11429 |
Transfusi darah dengan filter pasien dewasa |
330,000 |
| 11430 |
Transfusi darah dengan filter pasien neonatus |
330,000 |
| 11431 |
Transfusi Darah Dengan Filter Pasien Pediatrik |
330,000 |
| 11432 |
Transfusi Darah Tanpa Filter |
193,000 |
| 11433 |
Transfusi darah tanpa filter pasien dewasa |
193,000 |
| 11434 |
Transfusi darah tanpa filter pasien neonatus |
193,000 |
| 11435 |
Transfusi Darah Tanpa Filter Pasien Pediatrik |
193,000 |
| 11436 |
Transfusi Faktor Pembekuan |
102,000 |
| 11437 |
Transfusi sel darah irradiated |
276,000 |
| 11438 |
Transfusi Tukar |
307,000 |
| 11439 |
Transfusi tukar pasien neonatus |
614,000 |
| 11440 |
Transfusi tukar pasien pediatrik |
614,000 |
| 11441 |
Transjuguler Liver Biopsi |
14,450,000 |
| 11442 |
Transjuguler Liver Biopsi + Anastesi |
18,950,000 |
| 11443 |
Transnasal Esofagoskopi |
1,961,000 |
| 11444 |
Transpedicular biopsy (Multiple) |
15,352,000 |
| 11445 |
Transpedicular biopsy (single) |
15,352,000 |
| 11446 |
Transplantasi dental implant per gigi |
15,224,000 |
| 11447 |
Transplantasi Ginjal Resipien |
55,000,000 |
| 11448 |
Transplantasi Organ (Pendonor) |
11,300,000 |
| 11449 |
Transplantasi Organ (Penerima) |
95,800,000 |
| 11450 |
Transplantation of muscle and tendon of hand |
13,754,994 |
| 11451 |
Transplantation Penis, GA |
15,352,000 |
| 11452 |
Transport Mobil Jenazah |
500,000 |
| 11453 |
Transposisi fistula brachio-basilika |
29,153,000 |
| 11454 |
Transposisi jejunum |
13,045,000 |
| 11455 |
Transposisi kolon |
32,364,000 |
| 11456 |
Transposisi ovarium per laparoskopi |
14,854,000 |
| 11457 |
Transposisi ovarium per laparotomi |
12,004,000 |
| 11458 |
Transposisi Saraf Kranial / Perifer |
15,526,000 |
| 11459 |
Transposition for Peripheral nerve entrapment |
12,476,000 |
| 11460 |
Transthoracal Needle aspiration (TTNA) belum termasuk needle) Blind |
446,000 |
| 11461 |
Transthoracal Needle aspiration (TTNA) belum termasuk needle) CT guided |
672,000 |
| 11462 |
Transthoracal Needle aspiration (TTNA) belum termasuk needle) USG guided |
672,000 |
| 11463 |
Transthoracal Needle aspiration (TTNA) dengan transtorakal biopsi (TTB) belum termasuk needle) Blind |
892,000 |
| 11464 |
Transthoracal Needle aspiration (TTNA) dengan transtorakal biopsi (TTB) belum termasuk needle) USG guided |
1,343,000 |
| 11465 |
Tranvesal cordotomy plica vocalis |
11,286,000 |
| 11466 |
Trauma Ginjal |
17,865,000 |
| 11467 |
Trauma jaringan lunak wajah sederhana |
2,850,000 |
| 11468 |
Trauma Kompleks Jaringan Lunak Wajah |
5,075,000 |
| 11469 |
Treadment ESMR |
20,000,000 |
| 11470 |
Treadmill Exercice |
105,600 |
| 11471 |
Treadmill Stress Test |
749,000 |
| 11472 |
Treadmill Stress Test dengan CPET (Cardio Pulmonary Exercise Test) |
1,300,000 |
| 11473 |
Treadmill Test |
400,000 |
| 11474 |
Treatment Planning System 2 D |
2,405,000 |
| 11475 |
Treatment Planning System 3 D |
3,554,000 |
| 11476 |
Treatment Planning System Brakhiterapi 3D |
6,661,000 |
| 11477 |
Treatment Planning System IMRT kompleks |
5,827,000 |
| 11478 |
Treatment Planning System IMRT sederhana |
4,100,000 |
| 11479 |
Tree Imirror Guinoscopy |
20,000 |
| 11480 |
Trepanasi |
298,000 |
| 11481 |
Trepanasi Gigi |
140,000 |
| 11482 |
Trepanasi Sinus Frontalis bilateral |
13,650,000 |
| 11483 |
Trepanasi Sinus Frontalis Unilateral |
10,498,000 |
| 11484 |
Treponema Pallidum Haemagglutination Assay (TPHA) |
145,000 |
| 11485 |
Triad knee repair |
8,105,000 |
| 11486 |
Triage (dr. Triage ) |
18,000 |
| 11487 |
Triage (ODC) |
22,500 |
| 11488 |
Trial Aspiraction / Fungsi Percobaan |
75,000 |
| 11489 |
Tricuspid Valve repair (TVr) |
162,430,000 |
| 11490 |
Tricuspid Valve Replacement (TVR) |
162,430,000 |
| 11491 |
Tridenelisis |
4,047,000 |
| 11492 |
Trigeminal ganglion injection |
1,240,000 |
| 11493 |
Trigger Finger manual (tanpa panduan) |
281,000 |
| 11494 |
Trigger Finger USG |
595,000 |
| 11495 |
Trigger point deafferentation and injection |
281,000 |
| 11496 |
Trigger Point Injection |
245,000 |
| 11497 |
Trigger Point Injection |
68,000 |
| 11498 |
Trigger Point Injection Kelas 1 |
281,000 |
| 11499 |
Trigger Point Injection Kelas 2&3 |
281,000 |
| 11500 |
Trigger Point Injection VIP |
281,000 |
| 11501 |
Trigger Point Manual (tanpa panduan) |
281,000 |
| 11502 |
Trigger Point USG |
953,000 |
| 11503 |
Trigliserida |
40,000 |
| 11504 |
TRIGLISERIDA |
73,000 |
| 11505 |
Trikeopitelioma |
250,000 |
| 11506 |
Triple arthrodesis |
18,465,044 |
| 11507 |
Triple Prosedur Keratoplasti dengan Glaukoma |
6,927,026 |
| 11508 |
Trochanteric transfer |
23,914,000 |
| 11509 |
Trombektomi 1 ekstremitas |
32,011,000 |
| 11510 |
Trombektomi 1 ekstremitas dengan angiojet |
32,011,000 |
| 11511 |
Trombektomi 1 ekstremitas superior |
32,011,000 |
| 11512 |
Trombektomi 2 ekstremitas |
41,616,000 |
| 11513 |
Trombektomi 2 ekstremitas dengan angiojet |
41,616,000 |
| 11514 |
Trombektomi aorta |
32,011,000 |
| 11515 |
Trombektomi arteri 1 ekstremitas inferior |
32,011,000 |
| 11516 |
Trombektomi arteri intra-abdominal |
32,011,000 |
| 11517 |
Trombektomi arteri intra-torakal |
32,011,000 |
| 11518 |
Trombektomi Kasus Kompleks |
41,616,000 |
| 11519 |
Trombektomi Kasus Kompleks dengan anestesi |
46,770,000 |
| 11520 |
Trombektomi Kasus Simpel |
32,011,000 |
| 11521 |
Trombektomi Kasus Simpel dengan anestesi |
36,057,000 |
| 11522 |
Trombektomi Stroke |
35,727,000 |
| 11523 |
Trombektomi vena 1 ekstremitas inferior |
32,011,000 |
| 11524 |
Trombektomi vena intra-abdominal |
32,011,000 |
| 11525 |
Trombektomi/Lysis dengan Catheter For Vein |
2,850,000 |
| 11526 |
Trombolisis : Dialisis Graf |
14,450,000 |
| 11527 |
Trombolisis : Dialisis Graf + Anastesi |
18,950,000 |
| 11528 |
Trombolisis : Extremitas Inferior |
14,450,000 |
| 11529 |
Trombolisis : Extremitas Inferior + Anastesi |
18,950,000 |
| 11530 |
Trombolisis : Stroke |
14,450,000 |
| 11531 |
Trombolisis : Stroke + Anastesi |
18,950,000 |
| 11532 |
Trombolisis : Trombosis Intrakranial |
14,450,000 |
| 11533 |
Trombolisis : Trombosis Intrakranial + Anastesi |
18,950,000 |
| 11534 |
Trombolisis Intraarteri |
42,714,000 |
| 11535 |
Trombolisis Intrasinus |
45,135,000 |
| 11536 |
Trombopheresis |
2,260,000 |
| 11537 |
Tromboreduction Terapi |
6,048,000 |
| 11538 |
Trombosis intravena |
337,000 |
| 11539 |
Trombosit (manual) |
490,000 |
| 11540 |
Trombosit (manual) Leuko depletet /reduksi NAT |
1,025,000 |
| 11541 |
Trombosit (manual) Leuko depletet /reduksi NAT skrining antibodi |
1,025,000 |
| 11542 |
Trombosit (manual) Leuko depletet/reduksi |
850,000 |
| 11543 |
Trombosit (manual) Leuko depletet/reduksi skrining antibodi |
850,000 |
| 11544 |
Trombosit (manual) NAT |
740,000 |
| 11545 |
Trombosit (manual) NAT skrining antibodi |
740,000 |
| 11546 |
Trombosit (manual) skrining antibodi |
490,000 |
| 11547 |
Trombosit apheresis |
4,000,000 |
| 11548 |
Trombosit Apheresis 2024 |
4,560,000 |
| 11549 |
Trombosit apheresis Leuko depletet NAT skrining antibodi |
4,610,000 |
| 11550 |
Trombosit apheresis Leuko depletet skrining antibodi |
4,360,000 |
| 11551 |
Trombosit apheresis Leuko depletet/reduksi |
4,360,000 |
| 11552 |
Trombosit apheresis Leuko depletet/reduksi NAT |
4,610,000 |
| 11553 |
Trombosit apheresis NAT |
4,250,000 |
| 11554 |
Trombosit apheresis NAT skrining antibodi |
4,250,000 |
| 11555 |
Trombosit apheresis skrining antibodi |
4,000,000 |
| 11556 |
Trombosit pooling |
2,940,000 |
| 11557 |
Trombosit pooling Leuko depletet NAT skrining antibodi |
6,150,000 |
| 11558 |
Trombosit pooling Leuko depletet skrining antibodi |
5,100,000 |
| 11559 |
Trombosit pooling Leuko depletet/reduksi |
5,100,000 |
| 11560 |
Trombosit pooling Leuko depletet/reduksi NAT |
6,150,000 |
| 11561 |
Trombosit pooling NAT |
3,115,000 |
| 11562 |
Trombosit pooling NAT skrining antibodi |
3,115,000 |
| 11563 |
Trombosit pooling skrining antibodi |
2,940,000 |
| 11564 |
Troponin I |
350,000 |
| 11565 |
TROPONIN I |
498,000 |
| 11566 |
Troponin T |
220,000 |
| 11567 |
Trust Taus |
1,000,000 |
| 11568 |
Trust Taus (Sore) |
1,500,000 |
| 11569 |
TSH ( Dried Blood Spot ) dengan BMHP |
70,500 |
| 11570 |
TSH ( Dried Blood Spot ) tanpa BMHP |
60,000 |
| 11571 |
TSH NEONATUS KEMENKES / SKRINING HIPOTIROID KONGENITAL |
60,000 |
| 11572 |
TSH NEONATUS KEMENKES / SKRINING HIPOTIROID KONGENITAL (DENGAN BMHP) |
70,500 |
| 11573 |
TSHs |
180,000 |
| 11574 |
TT (MASA TROMBIN ) |
200,000 |
| 11575 |
TTNS |
250,000 |
| 11576 |
Tuba Plasty |
2,850,000 |
| 11577 |
Tubektomi |
5,716,458 |
| 11578 |
Tubektomi interval |
11,473,000 |
| 11579 |
Tubektomi postpartum |
11,473,000 |
| 11580 |
Tuberculin Test |
75,000 |
| 11581 |
Tumor Ganas/ Adnesa Luas Rekontruksi |
3,902,175 |
| 11582 |
Tumor Pembuluh Darah |
5,396,887 |
| 11583 |
Tumor Spinal Daerah Cervikal (Bedah Syaraf) |
9,482,094 |
| 11584 |
Tumor Spinal Daerah Torakolumbal (Bedah Syaraf) |
7,917,094 |
| 11585 |
Tumpatan Amalgan |
110,000 |
| 11586 |
Tumpatan Glassionomer |
90,000 |
| 11587 |
Tumpatan komposit / L Curing Besar |
200,000 |
| 11588 |
Tumpatan Komposit / L. Curing kecil |
140,000 |
| 11589 |
Tumpatan Komposit Silikat |
70,000 |
| 11590 |
TUR BULI (narkose) |
17,865,000 |
| 11591 |
Tur Dengan Laser |
17,865,000 |
| 11592 |
TUR Prostat |
8,838,281 |
| 11593 |
Tur Prostat (Narkose) |
11,651,000 |
| 11594 |
TUR Tumor Buli-Buli |
9,133,281 |
| 11595 |
Turbinektomi |
4,514,000 |
| 11596 |
Turbinoplasty |
2,850,000 |
| 11597 |
Turbinoplasty |
7,432,000 |
| 11598 |
Tutup Defek Primer |
18,395,000 |
| 11599 |
Tutup Kolostomi Laparotomi |
47,005,000 |
| 11600 |
Tutup santuli |
22,843,000 |
| 11601 |
Tutup stoma |
47,362,000 |
| 11602 |
TV repair, VSD closure |
75,329,000 |
| 11603 |
TVP/TMP |
4,850,000 |
| 11604 |
Uji depresi anak CDI |
200,000 |
| 11605 |
Uji Desensitisasi Obat |
464,000 |
| 11606 |
Uji diagnostik gangguan neurodevelopmental DSM-V/DC 0-5 |
251,000 |
| 11607 |
Uji fasting-induced hypoglycemia pada hipoglikemia persisten |
751,000 |
| 11608 |
Uji Fungsi Agility / Ketangkasan |
224,000 |
| 11609 |
Uji Fungsi Berkemih Dengan Elektromyogram |
225,000 |
| 11610 |
Uji Fungsi Berkemih Dengan Sistometri Sederhana |
225,000 |
| 11611 |
Uji Fungsi Berkemih Dengan Urodinamik Gambaran Tekanan Uretra (Uretral Pressure Profile / UPP) |
225,000 |
| 11612 |
Uji Fungsi Berkemih Dengan Urodinamik Sistometrogram |
225,000 |
| 11613 |
Uji Fungsi Berkemih Dengan Urodinamik Uroflometri |
225,000 |
| 11614 |
Uji Fungsi Defekasi Dengan Bowel Diary Dan Anorectal Manometry / Pressure Biofeedback |
128,000 |
| 11615 |
Uji fungsi Feeding Disorders |
200,000 |
| 11616 |
Uji Fungsi Kapasitas Fungsional Sistem Neuromuskular |
225,000 |
| 11617 |
Uji Fungsi Kebugaran Kardiorespirasi Dengan Analisis Gas |
557,000 |
| 11618 |
Uji fungsi kebugaran kardiorespirasi dengan Armcycle |
557,000 |
| 11619 |
Uji Fungsi Kebugaran Kardiorespirasi Dengan Ergocycle (Termasuk Arm Ergocycle) |
557,000 |
| 11620 |
Uji Fungsi Kebugaran Kardiorespirasi Dengan Treadmill |
749,000 |
| 11621 |
Uji Fungsi Kebugaran Kardiorespirasi di Lapangan |
557,000 |
| 11622 |
Uji Fungsi Kekuatan Otot dengan MMT pada Kasus Kompleks/Pinchmeter/Dinamometer |
224,000 |
| 11623 |
Uji Fungsi Kelenturan Tubuh (Flexibility), Koordinasi dan Daya Ledak Otot |
224,000 |
| 11624 |
Uji Fungsi Keseimbangan tanpa Alat |
78,001 |
| 11625 |
Uji Fungsi Kognisi/Fungsi Luhur |
224,000 |
| 11626 |
Uji fungsi kognitif anak Mullen |
300,000 |
| 11627 |
Uji Fungsi Lingkup Gerak Sendi dan Fleksibilitas pada Kasus Kompleks (Multisendi) |
224,000 |
| 11628 |
Uji Fungsi Menelan dan Bicara dengan Fiberoptic Endoscopic Evaluation of Swallowing Study (FEES) |
648,000 |
| 11629 |
Uji fungsi motorik Cerebral Palsy |
151,000 |
| 11630 |
Uji fungsi Neurodevelopmental SINDA |
341,000 |
| 11631 |
Uji fungsi paru / spirometri anak |
230,001 |
| 11632 |
Uji fungsi paru pre- dan post- bronkodilator anak |
531,000 |
| 11633 |
Uji Fungsi Performa Saraf dan Otot dengan EMG |
391,000 |
| 11634 |
Uji Fungsi Performa Saraf dan Otot dengan Surface EMG |
209,000 |
| 11635 |
Uji Fungsi Pola Jalan Dengan Gait Analysis (Instrumental) |
88,000 |
| 11636 |
Uji Fungsi Pola Jalan Dengan Gait Analysis (Observasional) |
224,000 |
| 11637 |
Uji Fungsi Postur / Kontrol Postur Computerized |
224,000 |
| 11638 |
Uji Fungsi Sensori Integrasi Dan Praksis |
224,000 |
| 11639 |
Uji gangguan cemas anak DASS 21 |
200,000 |
| 11640 |
Uji gangguan paparan screen time |
200,000 |
| 11641 |
Uji gangguan perilaku autisme MCHATR/F |
140,000 |
| 11642 |
Uji gangguan perilaku hiperaktivitas Conners ASQ, ACRS |
188,000 |
| 11643 |
Uji gangguan psikososial SDQ, PSC-17, SCARED |
200,000 |
| 11644 |
Uji gangguan psikososial terkait perundungan Olweus |
200,000 |
| 11645 |
Uji gangguan sensoris Sensory Profile |
300,000 |
| 11646 |
Uji gangguan tidur anak SDSC |
300,000 |
| 11647 |
Uji haus (water deprivation test) (15jam / 8 jam) |
500,000 |
| 11648 |
Uji Iritasi / Repeated Open Aplication Test |
500,000 |
| 11649 |
Uji Jalan 6 menit |
258,001 |
| 11650 |
Uji Jalan 6 Menit dengan pemantauan kardiovaskular |
258,001 |
| 11651 |
Uji Kekuatan Genggam Tangan Dengan Handgrip Dynamometer |
75,000 |
| 11652 |
Uji kekuatan genggaman tangan dengan Handgrip Dymometer |
75,001 |
| 11653 |
Uji kekuatan genggaman tangan dengan Handgrip Dynamometer |
75,001 |
| 11654 |
Uji Kemampuan Bahasa Capute Scale |
341,000 |
| 11655 |
Uji Kompetensi 1 (rekrutmen/ laik kerja) |
300,000 |
| 11656 |
Uji Kompetensi 2 (laik studi) |
300,000 |
| 11657 |
Uji kualitas hidup PedsQL |
251,000 |
| 11658 |
Uji Neurokognitif |
250,000 |
| 11659 |
Uji Patergi |
186,000 |
| 11660 |
Uji Penghidu Alkohol |
300,000 |
| 11661 |
Uji Penisilin |
66,000 |
| 11662 |
Uji Penisilin I |
430,000 |
| 11663 |
Uji Penisilin Ulang |
308,001 |
| 11664 |
Uji Perkembangan Denver |
341,000 |
| 11665 |
Uji perkembangan khusus BSID III |
400,000 |
| 11666 |
Uji pewarnaan metilen biru pada fistula (office) |
557,000 |
| 11667 |
Uji Provokasi Bronkus (Astograph) |
464,000 |
| 11668 |
Uji Provokasi Fisik |
464,000 |
| 11669 |
Uji Provokasi Makanan/ Obat Level I (Durasi 4 Jam) |
290,500 |
| 11670 |
Uji Provokasi Makanan/ Obat Level II (Durasi 6 Jam) |
371,000 |
| 11671 |
Uji provokasi makanan/obat level I (durasi 4 jam) |
395,000 |
| 11672 |
Uji provokasi makanan/obat level II (durasi 6 jam) |
494,000 |
| 11673 |
Uji Provokasi Obat |
464,000 |
| 11674 |
Uji Provokasi Obat |
66,000 |
| 11675 |
Uji Psikometrik |
120,000 |
| 11676 |
Uji psikososial remaja HEEADSSS |
251,000 |
| 11677 |
Uji Serum Autolog |
494,000 |
| 11678 |
Uji stimulasi adrenocorticotropin hormone (ACTH) |
751,000 |
| 11679 |
Uji stimulasi gonadotropin releasing hormone (GnRH) |
751,000 |
| 11680 |
Uji stimulasi hormon pertumbuhan (clonidine test) |
751,000 |
| 11681 |
Uji Supresi Deksametason Dosis Rendah |
395,000 |
| 11682 |
Uji Supresi Deksametason Dosis Tinggi |
514,000 |
| 11683 |
Uji Tempel Obat |
464,000 |
| 11684 |
Uji Tempel Standar |
464,000 |
| 11685 |
Uji Tusuk Obat |
464,000 |
| 11686 |
Uji Tusuk Obat |
66,000 |
| 11687 |
Uji Tusuk Standar |
66,000 |
| 11688 |
Uji Tusuk Standar (Skin Prick Test) |
395,000 |
| 11689 |
Ultra Sound Diathermi |
75,000 |
| 11690 |
Ultrasonografi neuromuskular |
761,000 |
| 11691 |
Ultrasound Diathermy (USD) |
115,000 |
| 11692 |
Ultrasound-Guided Procedure |
166,000 |
| 11693 |
Unifokalisasi MAPCA |
75,328,000 |
| 11694 |
Unilateral breast implant |
33,572,000 |
| 11695 |
Unilateral extended radical mastectomy |
20,681,000 |
| 11696 |
Unilateral extended simple mastectomy |
18,522,000 |
| 11697 |
Unilateral reduction mammoplasty |
43,571,000 |
| 11698 |
Unilateral subcutaneous mammectomy with synchronous implant |
20,681,000 |
| 11699 |
Unilateral Total TMJ replacement |
27,229,000 |
| 11700 |
Unroofing kista ginjal per laparoskopi |
17,865,000 |
| 11701 |
Unroofing kista hati |
9,176,000 |
| 11702 |
Unroofing kista higroma |
49,574,000 |
| 11703 |
Unroofing/Deroofing Kista Ginjal |
17,865,000 |
| 11704 |
Upper arm reattachment |
10,675,000 |
| 11705 |
Upper GI endoscopy (ekstraksi corpus alienum) |
10,803,000 |
| 11706 |
Urea Klirens |
33,000 |
| 11707 |
Urea N Urine (P) |
52,000 |
| 11708 |
Uretero Sigmoidostomi |
8,164,502 |
| 11709 |
Uretero Ureterostomi |
7,802,000 |
| 11710 |
Uretero Uretrostomi narkose |
17,865,000 |
| 11711 |
Ureterocutaneostomy |
14,055,000 |
| 11712 |
Ureterocutanneostomi |
7,801,000 |
| 11713 |
Ureterolithotomi |
8,740,947 |
| 11714 |
Ureterolithotomi proksimal |
4,850,000 |
| 11715 |
Ureterolitotomi (narkose) |
17,865,000 |
| 11716 |
Ureterolitotomi Distal |
17,865,000 |
| 11717 |
Ureterolitotomi per laparoskopi |
22,316,000 |
| 11718 |
Ureterolysis |
11,623,000 |
| 11719 |
Ureterolysis |
5,133,934 |
| 11720 |
Ureteroplasty + Buccal Mucosal Graft |
22,124,000 |
| 11721 |
Ureterostomi |
5,905,186 |
| 11722 |
Ureterostomi (narkose) |
17,865,000 |
| 11723 |
Uretetoneo Cystosthomi |
8,185,000 |
| 11724 |
Urethocystography |
525,000 |
| 11725 |
Urethrektomi |
7,758,000 |
| 11726 |
Urethrocystogram |
1,562,000 |
| 11727 |
Urethrocystogram bipolar |
1,499,000 |
| 11728 |
Urethrography |
1,289,000 |
| 11729 |
Urethrography pericatheter |
1,289,000 |
| 11730 |
Urethroplasty |
7,144,677 |
| 11731 |
Urethroplasty |
9,206,000 |
| 11732 |
Uretrografi |
450,000 |
| 11733 |
Uretrografi |
1,504,000 |
| 11734 |
Uretrokele |
11,623,000 |
| 11735 |
Uretroplasti (Bedah Plastik) |
7,603,306 |
| 11736 |
Uretroplasty |
7,921,000 |
| 11737 |
Uretrosistografi Narkose |
4,140,000 |
| 11738 |
Uretrosistoskopi Narkose |
5,903,000 |
| 11739 |
Uretroskopi Narkose |
5,903,000 |
| 11740 |
Urettroskopi/uretrosistoskopi |
3,850,000 |
| 11741 |
Ureum |
40,000 |
| 11742 |
UREUM DARAH/ BUN DARAH |
86,000 |
| 11743 |
UREUM URIN/ BUN URIN |
83,000 |
| 11744 |
Ureum Urine (UUN) |
60,000 |
| 11745 |
Urin Kehamilan (HCG) _ |
50,000 |
| 11746 |
Urina Infiltrate Superficial |
2,500,000 |
| 11747 |
Urina Infiltrate Superficial (Sore) |
3,750,000 |
| 11748 |
URINALISIS (AUTOMATIK) |
227,000 |
| 11749 |
Urine 4 Porsi/Kurve Harian |
31,000 |
| 11750 |
Urine Lengkap |
25,000 |
| 11751 |
Urine Rutin |
50,000 |
| 11752 |
Urine Serial 3x |
107,000 |
| 11753 |
Urodimik |
12,436,000 |
| 11754 |
Urodinamik |
7,100,000 |
| 11755 |
UROFLOWMETRI |
500,000 |
| 11756 |
Uroflowmetri |
724,000 |
| 11757 |
Uroflowmetri (Sore) |
750,000 |
| 11758 |
Uroginekologi biofeedback |
3,344,000 |
| 11759 |
Urografi Intravena (BNO - IVP) |
1,531,000 |
| 11760 |
URS |
7,921,000 |
| 11761 |
URS (narkose) |
21,590,000 |
| 11762 |
URS dengan Laser |
22,765,000 |
| 11763 |
Usap tenggorok/nasofaring |
207,000 |
| 11764 |
USG (Ultrasonograpi) Abdominal |
227,000 |
| 11765 |
USG (Ultrasonograpi) Doppler |
250,000 |
| 11766 |
USG (Ultrasonograpi) Transvaginal |
251,000 |
| 11767 |
USG 4D |
580,000 |
| 11768 |
USG abdomen |
745,000 |
| 11769 |
USG Abdomen (Kertas) |
77,000 |
| 11770 |
USG Abdomen (Polaroid Berwarna) |
117,000 |
| 11771 |
USG Abdomen (Polaroid Tidak Berwarna) |
114,000 |
| 11772 |
USG Abdomen Atas |
745,000 |
| 11773 |
USG Abdomen Atas ( Upper ) |
225,000 |
| 11774 |
USG Abdomen Atas + Bawah (Whole Abdomen) |
250,000 |
| 11775 |
USG Abdomen Bawah |
745,000 |
| 11776 |
USG Abdomen Bawah ( Lower ) |
225,000 |
| 11777 |
USG Abdomen Bayi |
775,000 |
| 11778 |
USG Abdomen Bayi 2 Fase |
1,163,000 |
| 11779 |
USG Abdomen Lengkap |
1,119,000 |
| 11780 |
USG Abdomen/Prostat |
250,000 |
| 11781 |
USG Ankle |
163,000 |
| 11782 |
USG Ankle Bilateral |
200,000 |
| 11783 |
USG Appendiks |
200,000 |
| 11784 |
USG Appendiks |
745,000 |
| 11785 |
USG Axilla |
896,000 |
| 11786 |
USG Bahu |
745,000 |
| 11787 |
USG Bahu |
163,000 |
| 11788 |
USG Bahu Bilateral |
200,000 |
| 11789 |
USG Bahu Bilateral |
896,000 |
| 11790 |
USG Bayi |
250,000 |
| 11791 |
USG Bedside |
1,077,000 |
| 11792 |
USG Cardia |
375,000 |
| 11793 |
USG Cimino |
375,000 |
| 11794 |
USG Colli |
745,000 |
| 11795 |
USG Colour Doppler 3 Dimensi |
125,000 |
| 11796 |
USG Cubiti |
745,000 |
| 11797 |
USG Cubiti Bilateral |
896,000 |
| 11798 |
USG Dopler Vaskuler |
254,000 |
| 11799 |
USG Doppler |
350,000 |
| 11800 |
USG Doppler Abdomen Bayi |
1,670,000 |
| 11801 |
USG Doppler Akses Dialisis |
1,260,000 |
| 11802 |
USG Doppler Aorta Abdominal |
1,260,000 |
| 11803 |
USG Doppler Arkus Aorta – Carotis - Vertebralis |
1,260,000 |
| 11804 |
USG Doppler Arteri dan Vena Ekstremitas Inferior Bilateral |
1,890,000 |
| 11805 |
USG Doppler Arteri dan Vena Ekstremitas Superior |
1,260,000 |
| 11806 |
USG Doppler Arteri dan Vena Ekstremitas Superior Bilateral |
1,890,000 |
| 11807 |
USG Doppler Arteri Ekstremitas Inferior |
1,260,000 |
| 11808 |
USG Doppler Arteri Ekstremitas Inferior Bilateral |
1,890,000 |
| 11809 |
USG Doppler Arteri Ekstremitas Superior |
1,260,000 |
| 11810 |
USG Doppler Arteri Ekstremitas Superior Bilateral |
1,513,000 |
| 11811 |
USG Doppler Arteri Renalis |
1,260,000 |
| 11812 |
USG Doppler Carotis - Vertebral - Jugular |
1,670,000 |
| 11813 |
USG Doppler Carotis - Vertebral - Jugular Bilateral |
2,006,000 |
| 11814 |
USG Doppler Carotis/TCD (Trans Cranial Doppler) |
375,000 |
| 11815 |
USG Doppler Diagnostik |
390,000 |
| 11816 |
USG Doppler Extremitas |
350,000 |
| 11817 |
USG Doppler Extremitas Atas : Bilateral |
1,260,000 |
| 11818 |
USG Doppler Extremitas Atas : Unilateral |
1,260,000 |
| 11819 |
USG Doppler Extremitas Bawah: Bilateral |
1,260,000 |
| 11820 |
USG Doppler Extremitas Bawah: Unilateral |
1,260,000 |
| 11821 |
USG Doppler Jaringan lunak/Superficial |
896,000 |
| 11822 |
USG Doppler Obstetri |
1,670,000 |
| 11823 |
USG Doppler Testis |
375,000 |
| 11824 |
USG Doppler Transcranial |
936,000 |
| 11825 |
USG Doppler Vaskular 1 Organ |
1,670,000 |
| 11826 |
USG Doppler Vaskular Ginjal |
1,670,000 |
| 11827 |
USG Doppler Vaskular Hepar |
1,670,000 |
| 11828 |
USG Doppler Vaskular Penis |
1,670,000 |
| 11829 |
USG Doppler Vaskular Testis |
1,670,000 |
| 11830 |
USG Doppler Vena Ekstremitas Inferior |
1,260,000 |
| 11831 |
USG Doppler Vena Ekstremitas Inferior Bilateral |
1,890,000 |
| 11832 |
USG Doppler Vena Ekstremitas Superior |
1,260,000 |
| 11833 |
USG Doppler Vena Ekstremitas Superior Bilateral |
1,513,000 |
| 11834 |
USG Elbow |
163,000 |
| 11835 |
USG Genitalia Interna |
745,000 |
| 11836 |
USG Genu |
745,000 |
| 11837 |
USG Genu |
163,000 |
| 11838 |
USG Genu Bilateral |
200,000 |
| 11839 |
USG Genu Bilateral |
896,000 |
| 11840 |
USG Ginekologi |
227,000 |
| 11841 |
USG Ginekologi Spesialistik |
934,000 |
| 11842 |
USG Ginjal |
303,000 |
| 11843 |
USG Ginjal, Buli-Buli dan Prostat |
200,000 |
| 11844 |
USG Guide Injeksi dan Pungsi |
295,000 |
| 11845 |
USG Guided + Core Biopsy |
1,952,000 |
| 11846 |
USG Guided + Needle Aspiration Biopsy |
1,952,000 |
| 11847 |
USG Guided + Sclerotheraphy |
1,952,000 |
| 11848 |
USG Guided Aspirasi |
896,000 |
| 11849 |
USG Guided Aspirasi Abses Hepar |
896,000 |
| 11850 |
USG Guided Aspirasi Hepatoma |
896,000 |
| 11851 |
USG Guided Aspirasi Kista Hepar |
1,267,000 |
| 11852 |
USG Guided Aspirasi Limpa |
896,000 |
| 11853 |
USG Guided Aspirasi Pankreas |
896,000 |
| 11854 |
USG Guided Biopsi |
1,952,000 |
| 11855 |
USG Guided Biopsi Organ Dalam |
1,952,000 |
| 11856 |
USG Guided Biopsi Organ Superfisial |
1,952,000 |
| 11857 |
USG Guided Biopsi Tulang |
1,952,000 |
| 11858 |
USG Guided intraoperatif |
896,000 |
| 11859 |
USG Guided Localization Mammae |
896,000 |
| 11860 |
USG Guided Mammae |
896,000 |
| 11861 |
USG Guided non operatif |
896,000 |
| 11862 |
USG Guided Pungsi Ascites |
896,000 |
| 11863 |
USG Guided Pungsi Efusi Pleura |
1,578,000 |
| 11864 |
USG Guiding |
350,000 |
| 11865 |
USG Hepar + Elastografi |
745,000 |
| 11866 |
USG Hepatopankreatobilier |
540,000 |
| 11867 |
USG Hepatopankreatobilier (Sore) |
810,000 |
| 11868 |
USG Inguinal |
896,000 |
| 11869 |
USG Intravagina |
225,000 |
| 11870 |
USG Jaras Saraf Perifer |
896,000 |
| 11871 |
USG Jaringan Lunak/Superficial |
896,000 |
| 11872 |
USG Jaringan Lunak/Superficial + Elastografi |
896,000 |
| 11873 |
USG Kandungan |
200,000 |
| 11874 |
USG Kandungan (Polaroid Berwarna) |
111,000 |
| 11875 |
USG Kasus Cito |
1,077,000 |
| 11876 |
USG Kepala |
1,307,000 |
| 11877 |
USG Kepala |
250,000 |
| 11878 |
USG Kepala Bayi |
1,109,000 |
| 11879 |
USG Leher |
110,000 |
| 11880 |
USG Leher + Elastografi |
1,670,000 |
| 11881 |
USG Leher Lengkap |
1,670,000 |
| 11882 |
USG Lengan |
896,000 |
| 11883 |
USG Lengan |
163,000 |
| 11884 |
USG Lengan Bilateral |
200,000 |
| 11885 |
USG Lengan Bilateral |
1,077,000 |
| 11886 |
USG Mamma ( Payudara ) |
250,000 |
| 11887 |
USG Mammae |
745,000 |
| 11888 |
USG Mammae + Elastografi |
1,163,000 |
| 11889 |
USG Mata |
224,000 |
| 11890 |
USG Mata |
200,000 |
| 11891 |
USG Mata ( Poli/Irna ) |
103,000 |
| 11892 |
USG Musculosckletal Lain |
163,000 |
| 11893 |
USG Musculosckletal Lain Bilateral |
200,000 |
| 11894 |
USG Musculoskeletal |
600,000 |
| 11895 |
USG Musculus Sceletal Ankle |
250,000 |
| 11896 |
USG Musculus Sceletal Antebrachii |
250,000 |
| 11897 |
USG Musculus Sceletal Elbow |
250,000 |
| 11898 |
USG Musculus Sceletal Genu |
250,000 |
| 11899 |
USG Musculus Sceletal Shoulder |
250,000 |
| 11900 |
USG Musculus Sceletal Wrist |
250,000 |
| 11901 |
USG Muskuloskeletal |
760,000 |
| 11902 |
USG Muskuloskeletal + Elastografi |
745,000 |
| 11903 |
USG Muskuloskeletal Lain |
745,000 |
| 11904 |
USG Muskuloskeletal Lain Bilateral |
896,000 |
| 11905 |
USG Neuromuscular |
761,000 |
| 11906 |
USG Obstetri |
227,000 |
| 11907 |
USG Obstetri 3D / 4D |
745,000 |
| 11908 |
USG Obstetri Ginekologi 2 Dimensi |
289,000 |
| 11909 |
USG Obstetri Spesialistik |
289,000 |
| 11910 |
USG Parotid |
745,000 |
| 11911 |
USG Pedis |
163,000 |
| 11912 |
USG Pedis Bilateral |
200,000 |
| 11913 |
USG Pelvis |
200,000 |
| 11914 |
USG Penis |
745,000 |
| 11915 |
USG Pergelangan Kaki |
745,000 |
| 11916 |
USG Pergelangan Kaki Bilateral |
896,000 |
| 11917 |
USG Plantar Pedis |
745,000 |
| 11918 |
USG Plexus Brachialis |
745,000 |
| 11919 |
USG Plexus Brachialis Bilateral |
896,000 |
| 11920 |
USG PROSTAT (Transrectal) |
290,000 |
| 11921 |
USG Prostat Transperineal |
290,000 |
| 11922 |
USG Prostat transtabdominal |
290,000 |
| 11923 |
USG Screening Limfo Nodi (Colli, Axilla, Inguinal) |
896,000 |
| 11924 |
USG Sendi Kecil |
745,000 |
| 11925 |
USG Sendi Panggul Bayi (1 sisi) |
775,000 |
| 11926 |
USG Sendi Panggul Bayi (bilateral) |
931,000 |
| 11927 |
USG soft tissue |
653,000 |
| 11928 |
USG Soft Tissue |
200,000 |
| 11929 |
USG Submandibula |
745,000 |
| 11930 |
USG Tendon Achilles |
745,000 |
| 11931 |
USG TESTIS |
745,000 |
| 11932 |
USG Testis |
225,000 |
| 11933 |
USG Thorax |
200,000 |
| 11934 |
USG Thorax |
745,000 |
| 11935 |
USG Thorax/Colli |
745,000 |
| 11936 |
USG Thyroid |
745,000 |
| 11937 |
USG Thyroid |
200,000 |
| 11938 |
USG toraks/Colli |
745,000 |
| 11939 |
USG Tractus Urinarius |
290,000 |
| 11940 |
USG Traktus Urinarius |
745,000 |
| 11941 |
USG Transrectal (Prostat) |
745,000 |
| 11942 |
USG Transvaginal |
330,000 |
| 11943 |
USG Urologi |
200,000 |
| 11944 |
USG Vaskular (Akses Hemodialisis) |
1,670,000 |
| 11945 |
USG Whole Abdomen |
250,000 |
| 11946 |
USG Wrist |
163,000 |
| 11947 |
USG Wrist |
745,000 |
| 11948 |
USG Wrist Bilateral |
896,000 |
| 11949 |
USG Wrist Bilateral |
200,000 |
| 11950 |
Uvulopharingopalatoplasty/UVPPP |
10,021,000 |
| 11951 |
Uvuloplasty |
8,436,000 |
| 11952 |
Vaccum asstisted breast excision |
14,539,000 |
| 11953 |
Vacum Unit |
39,600 |
| 11954 |
Vaginektomi parsial |
17,210,000 |
| 11955 |
Vaginektomi radikal |
23,322,000 |
| 11956 |
Vaginektomi total |
30,923,000 |
| 11957 |
Vaginoplasti Pullthrough per laparoskopi |
15,277,000 |
| 11958 |
Vagotomy |
9,176,000 |
| 11959 |
Vaksin Rabies |
92,000 |
| 11960 |
Vaksinasi |
58,000 |
| 11961 |
Vaksinasi Meningitis |
280,000 |
| 11962 |
Vaksinasi Rabies |
92,000 |
| 11963 |
Vakum Ekstraksi |
1,800,000 |
| 11964 |
Valve Dual Replace (Eksekutif) |
0 |
| 11965 |
Valve Repair (Eksekutif) |
0 |
| 11966 |
Valve Replace (Eksekutif) |
0 |
| 11967 |
Valve Replace + Repair (Eksekutif) |
0 |
| 11968 |
Valvuloplasti stenosis aorta kritis janin perkutaneus |
15,277,000 |
| 11969 |
Varikokelektomi (Palomo) |
3,850,000 |
| 11970 |
Varikokelektomi (Palomo) Narkose |
7,950,000 |
| 11971 |
Vascularized bone graft for Bone defect |
19,788,000 |
| 11972 |
Vasektomi |
2,850,000 |
| 11973 |
Vasektomi (ESWL) |
2,500,000 |
| 11974 |
Vasektomi (ESWL) (Sore) |
3,750,000 |
| 11975 |
Vasektomi (local) |
2,678,000 |
| 11976 |
Vasektomi Dengan Narkose |
4,646,000 |
| 11977 |
Vasektomi dengan Narkose |
2,850,000 |
| 11978 |
Vaskuler Dopler 1 Tungkai |
364,000 |
| 11979 |
Vaskuler Dopler 2 Tungkai |
660,000 |
| 11980 |
Vasografi |
5,149,000 |
| 11981 |
Vasografi (narkose) |
6,350,000 |
| 11982 |
Vasovasostomi |
25,429,000 |
| 11983 |
VATS + Biopsi Chamberlains |
55,439,000 |
| 11984 |
VATS + Bullaectomi |
31,134,000 |
| 11985 |
VATS + Cervicotomy + Plikasi diafragma |
31,134,000 |
| 11986 |
VATS + Cryosurgery / Ablation / RFA |
31,134,000 |
| 11987 |
VATS + Debridement |
31,134,000 |
| 11988 |
VATS + Debridement + Drainase Abses Hepar |
31,134,000 |
| 11989 |
VATS + Debulking Tumor |
31,134,000 |
| 11990 |
VATS + Dekortikasi |
31,134,000 |
| 11991 |
VATS + Diagnostik dengan dye |
31,134,000 |
| 11992 |
VATS + Eksisi Baji Paru/ wedge ressection |
31,134,000 |
| 11993 |
VATS + Eksisi Tumor Mediastinum |
55,439,000 |
| 11994 |
VATS + Ekstraksi Benda Asing |
31,134,000 |
| 11995 |
VATS + esofagomyotomi |
31,134,000 |
| 11996 |
VATS + Esofagomyotomi (Operasi Heller) |
31,134,000 |
| 11997 |
VATS + Esofagostomi + gastrostomi (atresia esofagus) |
31,134,000 |
| 11998 |
VATS + Gastrostomi |
31,134,000 |
| 11999 |
VATS + gastrostomi (atresia esofagus) |
31,134,000 |
| 12000 |
VATS + Hemostasis |
31,134,000 |
| 12001 |
VATS + Lobektomi |
31,134,000 |
| 12002 |
VATS + Lung Volume Reduction Surgery (LVRS) |
31,134,000 |
| 12003 |
VATS + Pericardial Window |
31,134,000 |
| 12004 |
VATS + Pleurectomy |
31,134,000 |
| 12005 |
VATS + Pleurodesis |
31,134,000 |
| 12006 |
VATS + Plikasi Diafragma |
31,134,000 |
| 12007 |
VATS + Pneumonectomy |
31,134,000 |
| 12008 |
VATS + Repair Bronchus |
31,134,000 |
| 12009 |
VATS + Repair Diafragma |
31,134,000 |
| 12010 |
VATS + Repair Ductus Thoracicus |
31,134,000 |
| 12011 |
VATS + Repair Duktus Torasikus |
31,134,000 |
| 12012 |
VATS + Repair Fistula Bronchopleura |
31,134,000 |
| 12013 |
VATS + Repair Parenkim Paru |
31,134,000 |
| 12014 |
VATS + Repair paru |
31,134,000 |
| 12015 |
VATS + Repair Trakea |
31,134,000 |
| 12016 |
VATS + Reseksi dan/atau Anastomosis Esofagus |
31,134,000 |
| 12017 |
VATS + Segmentectomy |
31,134,000 |
| 12018 |
VATS + Segmentectomy dengan dye |
31,134,000 |
| 12019 |
VATS + Sleeve Lobektomi |
31,134,000 |
| 12020 |
VATS + Sleeve Pneumektomi |
31,134,000 |
| 12021 |
VATS + Thymectomy |
31,134,000 |
| 12022 |
VATS + Uni / Bilateral Thoracic Sympathetocctomy (Bilateral ETS) |
31,134,000 |
| 12023 |
VATS Biopsi |
31,134,000 |
| 12024 |
VATS Diagnostik |
31,134,000 |
| 12025 |
VATS IORT |
31,134,000 |
| 12026 |
VATS+ Eksisi Tumor Mediastinum |
31,134,000 |
| 12027 |
VCUG (narcose) |
8,760,000 |
| 12028 |
VCUG local |
7,498,000 |
| 12029 |
VDRL |
40,000 |
| 12030 |
VDRL |
100,000 |
| 12031 |
Veloplasty |
9,054,000 |
| 12032 |
Vena Seksi |
396,000 |
| 12033 |
Vena Seksi |
344,000 |
| 12034 |
Vena seksi dan pasang akses vaskuler |
2,967,000 |
| 12035 |
Venaseksi Anastesi Anak |
66,000 |
| 12036 |
Venografi |
11,924,000 |
| 12037 |
Venografi Kasus Kompleks |
8,365,000 |
| 12038 |
Venografi Kasus Kompleks dengan anestesi |
9,531,000 |
| 12039 |
Venografi Kasus Simpel |
6,669,000 |
| 12040 |
Venografi Kasus Simpel dengan anestesi |
7,598,000 |
| 12041 |
Ventilator |
572,000 |
| 12042 |
Ventriculoatrial shunt |
21,960,000 |
| 12043 |
Ventrikuloperitoneal shunt |
21,960,000 |
| 12044 |
Ventrikuloperitoneal shunt/cyst - peritoneal shunt |
21,960,000 |
| 12045 |
Ventrikulostomi / VE Drainage |
8,615,000 |
| 12046 |
Ventrikulostomi/VE Drainage |
4,084,000 |
| 12047 |
Vericocele/Palomo |
5,149,000 |
| 12048 |
Versi ekstraksi janin gemelli 2 |
5,905,000 |
| 12049 |
Vertebroplasty lumbal |
37,385,000 |
| 12050 |
Vertebroplasty servikal |
37,385,000 |
| 12051 |
Vertebroplasty thorakal |
37,385,000 |
| 12052 |
Vertrikel Tap |
250,000 |
| 12053 |
Very High Dose Glukokortikoid Therapy |
329,000 |
| 12054 |
Vesicolithotomi (Sectio Alta) |
5,346,294 |
| 12055 |
Vesiko litotomi pada prolaps organ panggul |
11,080,001 |
| 12056 |
Vestibular Evoked Myogenic Potential (VEMP). |
1,696,000 |
| 12057 |
Vestibuloplasti > 1 segmen |
9,915,000 |
| 12058 |
Vestibuloplasty 1 segmen |
8,261,000 |
| 12059 |
Vestibuloplasty Per Regio dengan Anastesi Lokal |
860,000 |
| 12060 |
Video Urodinamik |
16,575,000 |
| 12061 |
Videofluoroscopic Swallow Study (VFSS) |
1,145,000 |
| 12062 |
Videolaryngoscopy |
461,000 |
| 12063 |
Videourodimik Lokal |
16,899,000 |
| 12064 |
Videourodinamik Lokal |
16,899,000 |
| 12065 |
Vidiourodinamik Bius |
19,252,000 |
| 12066 |
Virna Implant lokal |
13,861,000 |
| 12067 |
Virna Implant narkose |
15,861,000 |
| 12068 |
Viseral Angiografi (+ Radiografer) |
9,809,000 |
| 12069 |
Viseral Angiografi dengan balon (1 balon) (+ Radiografer) |
26,771,000 |
| 12070 |
Viseral Angiografi dengan balon + stent (1 balon, 1 stent) + Radiografer |
27,219,000 |
| 12071 |
Visite Dokter dan Perawat |
120,000 |
| 12072 |
Visite Dokter dan Perawat (HCU) |
200,000 |
| 12073 |
Visite Dokter dan Perawat (PJT) |
120,000 |
| 12074 |
Visite Dokter & perawat (Super Vip A) |
102,800 |
| 12075 |
Visite Dokter & Perawat Bayi |
60,000 |
| 12076 |
Visite Dokter dan Perawat |
200,000 |
| 12077 |
Visite Dokter dan Perawat (CVCU PJT) |
360,000 |
| 12078 |
Visite Dokter dan Perawat (HCU Infection Center) |
240,000 |
| 12079 |
Visite Dokter dan Perawat (Infection Center) |
250,000 |
| 12080 |
Visite dokter perawat HCU bayi |
100,000 |
| 12081 |
Visite Dokter Perawat Intensif (ICCU/CVCU) |
360,000 |
| 12082 |
Visite Dokter Perawat Intensif (NICU, PICU, ICU, Brain) |
360,000 |
| 12083 |
Visite Rawat Bersama |
60,000 |
| 12084 |
Visite Rawat Bersama |
225,000 |
| 12085 |
Visite Rawat Bersama (CVCU PJT) |
216,000 |
| 12086 |
Visite Rawat Bersama (HCU Infection Center) |
144,000 |
| 12087 |
Visite Rawat Bersama (HCU) |
120,000 |
| 12088 |
Visite Rawat Bersama (Infection Center) |
108,000 |
| 12089 |
Visite Rawat Bersama (Intensif) |
216,000 |
| 12090 |
Visual Evoked Potential (VEP) |
1,696,000 |
| 12091 |
Visum Et Repertum |
28,000 |
| 12092 |
Visus / Refraksi |
73,000 |
| 12093 |
Visus / Refraksi ( DPRD ) |
110,000 |
| 12094 |
Vitamin D |
650,000 |
| 12095 |
Vitrectomi Posterior Complex + Macular surgery Local |
26,650,000 |
| 12096 |
Vitrectomi Posterior Complex + Macular surgery Narkose |
30,135,000 |
| 12097 |
Vitrectomy Posterior Complex + Heavy fluid |
28,083,000 |
| 12098 |
Vitrectomy Posterior Complex + Macular surgery + Heavy fluid |
35,100,000 |
| 12099 |
Vitrektomi |
12,103,000 |
| 12100 |
Vitrektomi + Endo Laser + SB + Silikon Oil/Gas |
19,350,000 |
| 12101 |
Vitrektomi Anterior lokal |
21,131,000 |
| 12102 |
Vitrektomi Anterior narkose |
23,975,000 |
| 12103 |
Vitrektomi Posterior Complex Lokal |
31,099,000 |
| 12104 |
Vitrektomi Posterior Complex Narkose |
35,100,000 |
| 12105 |
Vitrektomi Posterior simple Lokal |
22,546,000 |
| 12106 |
Vitrektomi Posterior simple Narkose |
25,554,000 |
| 12107 |
Vitreus /Aqueous Tap lokal |
6,755,000 |
| 12108 |
Vitreus /Aqueous Tap narkose |
7,931,000 |
| 12109 |
VMA Urine (P) |
99,000 |
| 12110 |
Voiding Cystourethrogram (VCUG) |
1,289,000 |
| 12111 |
VSD closure + AVR |
75,329,000 |
| 12112 |
VSD closure + AVR + Repair SAS |
75,329,000 |
| 12113 |
VSD closure + AVr/repair sinus valsava |
75,329,000 |
| 12114 |
VSD closure + Operasi katup jantung satu katup |
158,600,000 |
| 12115 |
VSD closure + repair coarctatio aorta/IAA |
75,329,000 |
| 12116 |
VSD closure + Repair Pulmonary Artery |
75,329,000 |
| 12117 |
VSD closure + repair RVOTO/LVOTO |
75,329,000 |
| 12118 |
VSD closure + repair RVOTO/LVOTO + Operasi katup jantung satu katup |
174,460,000 |
| 12119 |
VSD closure + Repair SAS |
75,329,000 |
| 12120 |
VSD closure complex |
87,767,000 |
| 12121 |
VSD closure Repair + IAA/Coarctatio Aorta |
75,329,000 |
| 12122 |
VSD closure simple |
74,007,000 |
| 12123 |
VSD Closure+Reroute PAPVD+TV Repair |
51,550,000 |
| 12124 |
VSD+MOF(<10 Hari Perawatan) |
51,150,000 |
| 12125 |
Vulgurasi urethra (narkose) |
14,500,000 |
| 12126 |
Vulvektomi |
18,145,000 |
| 12127 |
Vulvektomi |
6,490,781 |
| 12128 |
Vulvektomi radikal |
20,530,000 |
| 12129 |
Vulvektomi total |
21,422,000 |
| 12130 |
WADA Test |
41,429,000 |
| 12131 |
Waktu Bekuan _ |
15,000 |
| 12132 |
Waktu Pendarahan _ |
15,000 |
| 12133 |
Waktu Prothtrombine (PT) _ |
180,000 |
| 12134 |
WALANT - Peripheral Nerve Decompression, ORIF Hand, Ligament Reconstruction, Tendon repair |
26,222,000 |
| 12135 |
Washing melalui Bronchoschopy |
188,000 |
| 12136 |
Water Drinking Test |
66,000 |
| 12137 |
Water soluble contrast enema |
1,289,000 |
| 12138 |
Wawancara Sosial |
22,800 |
| 12139 |
Wawancara Test |
0 |
| 12140 |
Wedge osteotomy of carpals and metacarpals |
6,600,000 |
| 12141 |
Wedge osteotomy of femur |
6,600,000 |
| 12142 |
Wedge osteotomy of humerus |
6,600,000 |
| 12143 |
Wedge osteotomy of patella |
6,600,000 |
| 12144 |
Wedge osteotomy of radius and ulna |
6,600,000 |
| 12145 |
Wedge osteotomy of scapula, clavicle, and thorax (ribs and sternum) |
6,600,000 |
| 12146 |
Wedge osteotomy of tarsals and metatarsals |
6,600,000 |
| 12147 |
Wedge osteotomy of tibia and fibula |
6,600,000 |
| 12148 |
Whipple s Procedure (P3D) |
30,842,000 |
| 12149 |
Whirlpool Treatment |
134,000 |
| 12150 |
Whirpoll |
39,600 |
| 12151 |
Whole Blood (WB) |
490,000 |
| 12152 |
Whole Blood (WB) Leuko depletet |
850,000 |
| 12153 |
Whole Blood (WB) Leuko depletet /reduksi skrining antibodi |
850,000 |
| 12154 |
Whole Blood (WB) NAT |
740,000 |
| 12155 |
Whole Blood (WB) NAT skrining antibodi |
740,000 |
| 12156 |
Whole Blood (WB) skrining antibodi |
490,000 |
| 12157 |
Whole Blood (WB)Leuko depletet /reduksi NAT skrining antibodi |
1,025,000 |
| 12158 |
Whole Blood (WB)Leuko depletet NAT |
1,025,000 |
| 12159 |
Whole Body Bone Densitometry |
300,000 |
| 12160 |
WIDAL |
147,000 |
| 12161 |
Widal _ |
60,000 |
| 12162 |
Wide eksisi |
14,313,000 |
| 12163 |
Wide Eksisi |
9,461,000 |
| 12164 |
Wide Eksisi + Diseksi Axilla |
17,094,000 |
| 12165 |
Wide Eksisi + Diseksi Fungsional |
17,094,000 |
| 12166 |
Wide Eksisi + Flap |
17,094,000 |
| 12167 |
Wide Eksisi + Limfadenektomi |
16,874,000 |
| 12168 |
Wide Eksisi Ca. Kulit + Diseksi KGB Superfisial |
16,874,000 |
| 12169 |
Wide Eksisi dan Reconstruction Oncoplasty |
29,970,000 |
| 12170 |
Wide Eksisi Tumor |
15,500,000 |
| 12171 |
Wide eksisi tumor tonsil.orofaring |
4,850,000 |
| 12172 |
Wide Excision for Bone / Soft tissue tumor |
23,914,000 |
| 12173 |
Wide Excision for Bone / Soft tissue tumor / + Reconstruction |
40,333,000 |
| 12174 |
Windowing / Operkulektomi /exposure impaksi |
1,380,000 |
| 12175 |
Windowing Exposure |
7,750,000 |
| 12176 |
Wire Splint per gigi |
230,000 |
| 12177 |
Wire Splint per rahang |
1,202,000 |
| 12178 |
Wire Splint per regio |
943,000 |
| 12179 |
Wiring dengan Anastesi Lokal |
860,000 |
| 12180 |
Wiring Per Rahang Dengan Anastesi Lokal |
0 |
| 12181 |
Wound Toilet |
111,000 |
| 12182 |
Wound Toilet Besar (Post Eksenterasi) |
224,000 |
| 12183 |
Wrist Splint (Biasa) |
1,500,000 |
| 12184 |
Wrist Splint (Khusus) |
2,500,000 |
| 12185 |
WSD Chest Tube Konvensional |
2,058,000 |
| 12186 |
WSD Chest Tube Seldinger |
3,088,000 |
| 12187 |
Yag Laser |
2,850,000 |
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