REKAPITULASI DATA REVISI RAWAT JALAN KASU

RS. BUDI KEMULIAAN

No Tgl. Masuk No. RM Nama Pasien No. SEP

1 5 Jan 2017 39 45 41 KHAVITA LIYENITA PURBA 0407R00201170000889

2 6 Jan 2017 10 45 18 MAWATI SIAHAAN 0407R00201170001122
3 10 Jan 2017 35 72 41 SURIYATI 0407R00201170001898
4 16 Jan 2017 40 37 55 EMA 0407R00201170003030
5 16 Jan 2017 09 96 32 BUGARI RAJA GUK GUK 0407R00201170003123
6 19 Jan 2017 24 42 84 DEVIE CHRISWINA RACHMAULI PURBA 0407R00201170003887
7 23 Jan 2017 31 66 56 NURHALIZA OKTAVIA 0407R00201170004537
8 24 Jan 2017 40 41 65 TAN MOI KIA 0407R00201170004716
9 25 Jan 2017 04 70 25 MUNAWAR 0407R00201170005036
10 27 Jan 2017 40 41 65 TAN MOI KIA 0407R00201170005549
11 5 Jan 2017 30 01 74 SITI FATIMAH 0407R00201170000893
12 6 Jan 2017 13 76 12 MARMILA 0407R00201170001184
13 13 Jan 2017 40 09 47 TANIAH 0407R00201170002609
14 18 Jan 2017 28 81 41 HARIYOS 0407R00201170003669
15 13 Jan 2017 40 36 02 DINDA NURUL AWALYAH 0407R00201170002575
16 3 Jan 2017 40 24 87 MASLINA 0407R00201170000310
17 3 Jan 2017 40 28 86 FAHLI 0407R00201170000348
18 4 Jan 2017 40 29 44 APRIZQIE AKBAR 0407R00201170000516
19 5 Jan 2017 40 08 79 NURLINA ANSARI 0407R00201170000749
20 6 Jan 2017 14 60 18 TRI UTAMI 0407R00201170001064
21 7 Jan 2017 40 11 09 NOPEL HASUDUNGAN SINAGA 0407R00201170001270
22 11 Jan 2017 40 34 19 RAJA DICA MERIANTI 0407R00201170001964
23 12 Jan 2017 40 11 09 NOPEL HASUDUNGAN SINAGA 0407R00201170002229
24 14 Jan 2017 40 36 34 HERLIN MARTHA . R 0407R00201170002696
25 14 Jan 2017 40 30 45 NURHASAN 0407R00201170002707
26 19 Jan 2017 03 25 36 MERY TONTEY 0407R00201170003795
27 20 Jan 2017 38 08 72 NURTI ANGGUN SP LIMBONG 0407R00201170003987
28 20 Jan 2017 40 40 78 GAGARIN TUA BELA 0407R00201170004023
29 23 Jan 2017 36 82 00 SYARONY 0407R00201170004472
30 26 Jan 2017 31 66 56 NURHALIZA OKTAVIA 0407R00201170005329
31 27 Jan 2017 29 89 67 BUNGA NARITA SETYADI 0407R00201170005520
32 30 Jan 2017 09 28 27 IIN KARLINAWATI 0407R00201170005752
33 31 Jan 2017 40 48 12 ERWIN, A.MD 0407R00201170006243
34 6 Jan 2017 38 25 67 AHMAD BONAYA 0407R00201170001129
35 13 Jan 2017 40 31 15 TJOEN HIANG 0407R00201170002572
36 16 Jan 2017 40 16 91 WARINO 0407R00201170003088
37 16 Jan 2017 08 54 58 MASYITAH 0407R00201170003101
38 16 Jan 2017 40 26 31 SYAMSIAH 0407R00201170003124
TOTAL
DATA REVISI RAWAT JALAN KASUS BEDAH BULAN JANUARI 2017
RS. BUDI KEMULIAAN BATAM

DPJP SMF INACBG Tarif RS Tarif Awal Revisi I Selisih

Dr. APRIL, SpB BEDAH Z-3-27-0 Rp 166,500 Rp 211,300 Rp 211,300 Rp -

Dr. APRIL, SpB BEDAH Q-5-18-0 Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Dr. APRIL, SpB BEDAH Q-5-44-0 Rp 100,000 Rp 194,700 Rp 194,700 Rp -
Dr. APRIL, SpB BEDAH Q-5-44-0 Rp 98,500 Rp 194,700 Rp 194,700 Rp -
Dr. APRIL, SpB BEDAH Z-3-23-0 Rp 570,500 Rp 599,600 Rp 599,600 Rp -
Dr. APRIL, SpB BEDAH Q-5-25-0 Rp 100,000 Rp 155,800 Rp 155,800 Rp -
Dr. APRIL, SpB BEDAH Q-5-44-0 Rp 235,500 Rp 194,700 Rp 194,700 Rp -
Dr. APRIL, SpB BEDAH Q-5-42-0 Rp 160,000 Rp 196,200 Rp 196,200 Rp -
Dr. APRIL, SpB BEDAH Q-5-18-0 Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Dr. APRIL, SpB BEDAH Q-5-42-0 Rp 179,500 Rp 196,200 Rp 196,200 Rp -
Dr. ASMOJI, SpB BEDAH Q-5-18-0 Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Dr. ASMOJI, SpB BEDAH Q-5-44-0 Rp 102,000 Rp 194,700 Rp 194,700 Rp -
Dr. ASMOJI, SpB BEDAH Q-5-44-0 Rp 95,500 Rp 194,700 Rp 194,700 Rp -
Dr. ASMOJI, SpB BEDAH Q-5-42-0 Rp 126,500 Rp 196,200 Rp 196,200 Rp -
Dr. ISMANTORO, SpB BEDAH Q-5-44-0 Rp 85,000 Rp 194,700 Rp 194,700 Rp -
Dr. TAMSIL, SpB BEDAH Q-5-18-0 Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Dr. TAMSIL, SpB BEDAH Q-5-41-0 Rp 194,000 Rp 310,800 Rp 310,800 Rp -
Dr. TAMSIL, SpB BEDAH Z-3-23-0 Rp 435,000 Rp 599,600 Rp 599,600 Rp -
Dr. TAMSIL, SpB BEDAH Q-5-44-0 Rp 88,500 Rp 194,700 Rp 194,700 Rp -
Dr. TAMSIL, SpB BEDAH Q-5-18-0 Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Dr. TAMSIL, SpB BEDAH Q-5-31-0 Rp 123,500 Rp 148,800 Rp 148,800 Rp -
Dr. TAMSIL, SpB BEDAH Q-5-44-0 Rp 1,285,000 Rp 194,700 Rp 194,700 Rp -
Dr. TAMSIL, SpB BEDAH M-3-15-0 Rp 163,500 Rp 295,800 Rp 295,800 Rp -
Dr. TAMSIL, SpB BEDAH Q-5-25-0 Rp 94,000 Rp 281,400 Rp 155,800 Rp (125,600)
Dr. TAMSIL, SpB BEDAH Q-5-44-0 Rp 114,500 Rp 194,700 Rp 194,700 Rp -
Dr. TAMSIL, SpB BEDAH Q-5-18-0 Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Dr. TAMSIL, SpB BEDAH Q-5-44-0 Rp 88,000 Rp 194,700 Rp 194,700 Rp -
Dr. TAMSIL, SpB BEDAH Q-5-18-0 Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Dr. TAMSIL, SpB BEDAH Q-5-18-0 Rp 85,000 Rp 269,200 Rp 151,100 Rp (118,100)
Dr. TAMSIL, SpB BEDAH Q-5-44-0 Rp 123,500 Rp 194,700 Rp 194,700 Rp -
Dr. TAMSIL, SpB BEDAH Q-5-18-0 Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Dr. TAMSIL, SpB BEDAH Q-5-44-0 Rp 99,500 Rp 194,700 Rp 194,700 Rp -
Dr. TAMSIL, SpB BEDAH Q-5-44-0 Rp 85,000 Rp 194,700 Rp 194,700 Rp -
Dr. VICTOR JESRON NABABEDAH T Q-5-18-0 Rp 85,000 Rp 281,400 Rp 151,100 Rp (130,300)
Dr. VICTOR JESRON NABABEDAH T Q-5-18-0 Rp 85,000 Rp 281,400 Rp 151,100 Rp (130,300)
Dr. VICTOR JESRON NABABEDAH T Z-3-27-0 Rp 150,000 Rp 211,300 Rp 211,300 Rp -
Dr. VICTOR JESRON NABABEDAH T Z-3-27-0 Rp 165,000 Rp 361,000 Rp 211,300 Rp (149,700)
Dr. VICTOR JESRON NABABEDAH T Q-5-44-0 Rp 94,500 Rp 281,400 Rp 194,700 Rp (86,700)
Rp 6,258,000 Rp 8,748,100 Rp 7,876,600 Rp (871,500)
 Keterangan

Konfirmasi
Kode Konsling
Konfirmasi
Konfirmasi
Konfirmasi
1 Episode ranap 27-1-17
Konfirmasi
Konfirmasi
Konfirmasi
Konfirmasi
Konfirmasi
Konfirmasi
1 Episode ranap 19-1-17
Konfirmasi
1 Episode ranap 17-1-17
Konfirmasi
Konfirmasi
Konfirmasi
Konfirmasi
Kode Konsling
Konfirmasi
1 Episode ranap 23-1-17
Konfirmasi
Kode dx
Konfirmasi
Konfirmasi
Konfirmasi
Konfirmasi
Kode Konsling
Konfirmasi
Kode Konsling
Konfirmasi
Konfirmasi
Kode Konsling
Kode Konsling
TTD
Kode Kontrol
Kode Kontrol
 Data
DPJP Count - INACBG Sum - Tarif Awal Sum - Revisi I
Dr. APRIL, SpB 10 Rp 2,289,000 Rp 2,245,400
Dr. ASMOJI, SpB 4 Rp 736,700 Rp 736,700
Dr. ISMANTORO, SpB 1 Rp 194,700 Rp 194,700
Dr. TAMSIL, SpB 18 Rp 4,111,200 Rp 3,780,300
Dr. VICTOR JESRON NABABAN, Sp.BTKV 5 Rp 1,416,500 Rp 919,500
Total Result 38 Rp 8,748,100 Rp 7,876,600
Sum - Selisih
Rp (43,600)
Rp -
Rp -
Rp (330,900)
Rp (497,000)
Rp (871,500)
 REKAPITULASI DATA REVISI RAWAT JALAN K
RS. BUDI KEMULIA

No Tgl. Masuk No. RM Nama Pasien No. SEP

1 4 Feb 2017 31 63 37 SALMAH 0407R00202170000927

2 6 Feb 2017 40 50 01 ANTONIUS ERIKSON SIMANJUNTAK 0407R00202170001220
3 6 Feb 2017 40 00 22 M. ALFIN ROMMADHON USKA 0407R00202170001263
4 16 Feb 2017 08 02 98 SAMADI 0407R00202170003593
5 17 Feb 2017 04 68 70 GRACE DWI ANANDA SITOMPUL 0407R00202170003870
6 18 Feb 2017 31 64 31 MICHELLE GRETHA WELLY BANJARNAHOR 0407R00202170004129
7 20 Feb 2017 40 61 14 MONALISA ANGRAINI H 0407R00202170004427
8 27 Feb 2017 08 02 98 SAMADI 0407R00202170005984
9 13 Feb 2017 40 56 74 ASNAWATI 0407R00202170002901
10 13 Feb 2017 40 57 08 SUGITO 0407R00202170002990
11 16 Feb 2017 26 99 45 JONEPI 0407R00202170003647
12 28 Feb 2017 40 65 52 YUES AGUS SETIAWAN 0407R00202170006401
13 10 Feb 2017 39 84 10 ERIK SUTEJA 0407R00202170002436
14 20 Feb 2017 39 84 10 ERIK SUTEJA 0407R00202170004479
15 27 Feb 2017 40 65 34 ANDI FARDANSYAH 0407R00202170006007
16 27 Feb 2017 11 12 47 AKBARUL YAMIN 0407R00202170006086
17 27 Feb 2017 07 26 94 MEGA HERWINA 0407R00202170006095
18 4 Feb 2017 17 95 18 HARDI MURDIONO 0407R00202170000853
19 6 Feb 2017 13 82 34 YURNITA 0407R00202170001137
20 8 Feb 2017 14 78 56 SAMIDI 0407R00202170001719
21 8 Feb 2017 39 16 05 EUIS MARLIYANI EKAWATI 0407R00202170001822
22 10 Feb 2017 40 54 87 DR. ELLY 0407R00202170002264
23 10 Feb 2017 29 10 88 LUDIA LEPPANG 0407R00202170002315
24 11 Feb 2017 16 64 58 KLARA SINAGA 0407R00202170002501
25 11 Feb 2017 40 55 45 FEBRI TOGU PARULIAN SIAHAAN 0407R00202170002506
26 11 Feb 2017 40 55 46 HALILAH 0407R00202170002511
27 11 Feb 2017 25 05 71 DASWAR FITRA PRAJA 0407R00202170002563
28 11 Feb 2017 40 55 88 SAMINAH 0407R00202170002660
29 13 Feb 2017 40 56 64 SUSANTI 0407R00202170002861
30 13 Feb 2017 23 20 15 ASWATI 0407R00202170002871
31 16 Feb 2017 25 57 97 SIIN 0407R00202170003463
32 16 Feb 2017 40 58 46 AHMAD DJADI 0407R00202170003464
33 16 Feb 2017 40 56 55 CHAFIDZ DHARMAWAN 0407R00202170003513
34 17 Feb 2017 40 55 45 FEBRI TOGU PARULIAN SIAHAAN 0407R00202170003729
35 20 Feb 2017 40 59 07 MUHNAN 0407R00202170004320
36 20 Feb 2017 15 96 14 ASWIZAR SARI 0407R00202170004328
37 21 Feb 2017 30 46 64 FAKHRY WISTARA PRAYATA 0407R00202170004774
38 23 Feb 2017 40 62 98 JANNER MARPAUNG 0407R00202170005255
39 23 Feb 2017 30 46 64 FAKHRY WISTARA PRAYATA 0407R00202170005328
40 24 Feb 2017 40 63 49 WALUYO 0407R00202170005414
41 24 Feb 2017 40 57 58 W. KRISTOPER SITANGGANG 0407R00202170005448
42 25 Feb 2017 37 28 68 FAQIH KHAIRUL GHAZALI 0407R00202170005598
43 25 Feb 2017 05 60 11 SURYA NINGSIH 0407R00202170005634
44 25 Feb 2017 02 22 61 SITI KHOFSOH 0407R00202170005697
45 25 Feb 2017 31 65 07 DUDUNG HENDARMAN YUSUP 0407R00202170005713
46 25 Feb 2017 40 64 21 TRI HARIYADI 0407R00202170005721
47 25 Feb 2017 39 98 51 NADILA PUTRI SEPTIA 0407R00202170005799
48 27 Feb 2017 40 64 97 CAESILLIA RIJANTI 0407R00202170005854
49 27 Feb 2017 37 51 17 YANTI 0407R00202170005953
50 27 Feb 2017 32 63 76 AYUDYA NURRAHIMA WIDYAKENCANA 0407R00202170005992
51 28 Feb 2017 32 86 02 YENI WISMITA 0407R00202170006190
52 28 Feb 2017 32 63 76 AYUDYA NURRAHIMA WIDYAKENCANA 0407R00202170006299
53 28 Feb 2017 22 02 99 DEWI SETIANI FUTHERI 0407R00202170006312
54 28 Feb 2017 16 26 63 HAZIM MAHFUZHI 0407R00202170006378
55 20 Feb 2017 40 46 66 NIRMAYA SARI DEWI PURBA 0407R00202170006413
56 25 Feb 2017 02 85 65 SITI HASNAH 0407R00202170006431
57 6 Feb 2017 30 80 11 R ASNIYAH WATI 0407R00202170001238
58 13 Feb 2017 40 56 84 DIAN WULANDARY 0407R00202170002930
59 27 Feb 2017 04 01 55 MARYAM ASIAH 0407R00202170005988
60 27 Feb 2017 27 85 60 NADIAR 0407R00202170006032
61 27 Feb 2017 08 54 58 MASYITAH 0407R00202170006039
62 27 Feb 2017 40 48 49 LE KIOK 0407R00202170006052
63 27 Feb 2017 40 57 51 MAUIDLOTUN KHASANAH 0407R00202170006058
64 16 Feb 2017 12 87 37 ANDRI ASPAYOGI 0407R00202170006412
TOTAL
SI DATA REVISI RAWAT JALAN KASUS BEDAH BULAN FEBRUARI 2017
RS. BUDI KEMULIAAN BATAM

INACBG DPJP SMF Tarif RS Tarif Awal Revisi I Selisih

Q-5-44-0 Dr. APRIL, SpB BEDAH Rp 108,500 Rp 194,700 Rp 194,700 Rp -

Z-3-23-0 Dr. APRIL, SpB BEDAH Rp 446,500 Rp 599,600 Rp 599,600 Rp -
Z-3-27-0 Dr. APRIL, SpB BEDAH Rp 135,000 Rp 211,300 Rp 211,300 Rp -
Q-5-18-0 Dr. APRIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Z-3-23-0 Dr. APRIL, SpB BEDAH Rp 435,000 Rp 194,700 Rp 599,600 Rp 404,900
Q-5-44-0 Dr. APRIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 194,700 Rp -
Q-5-44-0 Dr. APRIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 194,700 Rp -
Q-5-18-0 Dr. APRIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-18-0 Dr. ASMOJI, SpB BEDAH Rp 85,000 Rp 273,700 Rp 151,100 Rp (122,600)
Q-5-18-0 Dr. ASMOJI, SpB BEDAH Rp 85,000 Rp 269,200 Rp 151,100 Rp (118,100)
Q-5-25-0 Dr. ASMOJI, SpB BEDAH Rp 142,500 Rp 155,800 Rp 155,800 Rp -
Q-5-18-0 Dr. ASMOJI, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-18-0 Dr. ISMANTORO, SpB BEDAH Rp 85,000 Rp 148,800 Rp 151,100 Rp 2,300
Q-5-44-0 Dr. ISMANTORO, SpB BEDAH Rp 190,000 Rp 194,700 Rp 194,700 Rp -
Q-5-18-0 Dr. ISMANTORO, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
L-3-12-0 Dr. ISMANTORO, SpB BEDAH Rp 910,080 Rp 434,800 Rp 219,800 Rp (215,000)
Q-5-44-0 Dr. ISMANTORO, SpB BEDAH Rp 1,705,000 Rp 194,700 Rp 194,700 Rp -
Z-3-27-0 Dr. TAMSIL, SpB BEDAH Rp 158,000 Rp 211,300 Rp 211,300 Rp -
Z-3-23-0 Dr. TAMSIL, SpB BEDAH Rp 438,500 Rp 269,200 Rp 599,600 Rp 330,400
Z-3-23-0 Dr. TAMSIL, SpB BEDAH Rp 300,000 Rp 599,600 Rp 599,600 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Z-3-23-0 Dr. TAMSIL, SpB BEDAH Rp 365,000 Rp 194,700 Rp 599,600 Rp 404,900
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Z-3-23-0 Dr. TAMSIL, SpB BEDAH Rp 379,000 Rp 599,600 Rp 599,600 Rp -
Z-3-23-0 Dr. TAMSIL, SpB BEDAH Rp 300,000 Rp 151,100 Rp 599,600 Rp 448,500
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Z-3-23-0 Dr. TAMSIL, SpB BEDAH Rp 300,000 Rp 194,700 Rp 599,600 Rp 404,900
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 95,500 Rp 269,200 Rp 194,700 Rp (74,500)
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 88,500 Rp 194,700 Rp 194,700 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-25-0 Dr. TAMSIL, SpB BEDAH Rp 89,500 Rp 155,800 Rp 155,800 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 129,500 Rp 194,700 Rp 194,700 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 233,500 Rp 194,700 Rp 194,700 Rp -
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 143,500 Rp 194,700 Rp 194,700 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Z-3-23-0 Dr. TAMSIL, SpB BEDAH Rp 300,000 Rp 194,700 Rp 599,600 Rp 404,900
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 198,500 Rp 194,700 Rp 194,700 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-42-0 Dr. TAMSIL, SpB BEDAH Rp 134,000 Rp 196,200 Rp 196,200 Rp -
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 211,500 Rp 194,700 Rp 194,700 Rp -
Z-3-23-0 Dr. TAMSIL, SpB BEDAH Rp 434,000 Rp 599,600 Rp 599,600 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-18-0 Dr. VICTOR JESRON NABABEDAH TORRp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-18-0 Dr. VICTOR JESRON NABABEDAH TORRp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-18-0 Dr. VICTOR JESRON NABABEDAH TORRp 85,000 Rp 281,400 Rp 151,100 Rp (130,300)
Z-3-27-0 Dr. VICTOR JESRON NABABEDAH TORRp 190,000 Rp 211,300 Rp 211,300 Rp -
Q-5-18-0 Dr. VICTOR JESRON NABABEDAH TORRp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-18-0 Dr. VICTOR JESRON NABABEDAH TORRp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-18-0 Dr. VICTOR JESRON NABABEDAH TORRp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Z-3-24-0 Dr. VICTOR JESRON NABABEDAH TORRp 790,000 Rp 751,300 Rp 751,300 Rp -
Rp 12,411,080 Rp 14,714,300 Rp 15,582,600 Rp 868,300
 Keterangan

1 episode ranap tgl 8-2-17

1 episode ranap tgl 1-3-17
1 episode ranap tgl 7-2-17
1 Episode ranap tgl 1-3-17
tambah hasil USG
Konfirmasi
1 Episode Ranap tgl 2-3-17
Kode Konsling
Kode Konsling
Kode Konsling
1 episode ranap tgl 22-2-17
1 episode ranap tgl 1-3-17
Kode Konsling
Konfirmasi
Konfirmasi
Ganti Kode Tindakan
Konfirmasi
Konfirmasi
tambah hasil USG
Konfirmasi
Kode Konsling
tambah hasil USG
Kode Konsling
Kode Konsling
Konfirmasi
tambah hasil USG
Kode Konsling
Kode Konsling
Kode Konsling
tambah hasil USG
1 episode ranap tgl 20-2-17
1 episode ranap tgl 20-2-17

Konfirmasi
1 Episode Ranap tgl 25-2-17
Konfirmasi
Kode Konsling
Konfirmasi
Kode Konsling
Konfirmasi
Konfirmasi
Kode Konsling
Kode Konsling
Kode Konsling
Kode Konsling
Kode Konsling
Kode Konsling
tambah hasil USG
Kode Konsling
Konfirmasi
1 episode ranap tgl 3-3-17
Konfirmasi
Konfirmasi
Konfirmasi
Klaim Susulan Hasil USG
SEP Ulang
1 episode ranap tgl 8-2-17
Kode Konsling
Kode Konsling
Konfirmasi
Kode Konsling
Kode Konsling
Kode Konsling
Klaim Susulan Hasil USG
 REKAPITULASI DATA REVISI RAWAT
RS. BUDI K

No Tgl. Masuk No. RM Nama Pasien No. SEP

1 27 Mar 2017 39 65 52 PATIMAH 0407R00203170005468

2 29 Mar 2017 39 65 52 PATIMAH 0407R00203170006035
3 15 Mar 2017 13 80 84 TALITHA FARRELIA NUR FIRDAUS 0407R00203170006902
4 16 Mar 2017 40 59 00 MICHAEL BRIAN BHAYU NAINGGOLAN 0407R00203170003731
5 6 Mar 2017 40 50 72 ACHMAD BICHAER 0407R00203170001236
6 4 Mar 2017 09 24 80 SITI NGAISAH 0407R00203170000870
7 6 Mar 2017 37 51 17 YANTI 0407R00203170001045
8 6 Mar 2017 15 58 24 SYARFRIAN 0407R00203170001093
9 6 Mar 2017 40 46 75 DEWI NURAENI 0407R00203170001115
10 8 Mar 2017 13 13 26 JUGUR BR SINAGA 0407R00203170001685
11 9 Mar 2017 32 86 02 YENI WISMITA 0407R00203170001923
12 9 Mar 2017 00 69 43 FARRASZ ALVENDRI 0407R00203170002097
13 11 Mar 2017 31 64 31 MICHELLE GRETHA WELLY BANJARNAHOR 0407R00203170002473
14 11 Mar 2017 40 70 73 SITI IMROATUL MAIMUNAH 0407R00203170002512
15 14 Mar 2017 40 74 85 MAYA ANGELINA PUTRI 0407R00203170003027
16 1 Mar 2017 40 35 48 ALPIYAH 0407R00203170000213
TOTAL
PITULASI DATA REVISI RAWAT JALAN KASUS BEDAH BULAN MARET 2017
RS. BUDI KEMULIAAN BATAM

INACBG DPJP SMF Tarif RS Tarif Awal Revisi I

Q-5-18-0 Dr. APRIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100

Q-5-18-0 Dr. APRIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100
Q-5-44-0 Dr. APRIL, SpB BEDAH Rp 117,000 Rp 194,700 Rp 194,700
Q-5-31-0 Dr. ASMOJI, SpB BEDAH Rp 89,500 Rp 148,800 Rp 148,800
Q-5-31-0 Dr. ISMANTORO, SpB BEDAH Rp 558,000 Rp 148,800 Rp 148,800
Z-3-23-0 Dr. TAMSIL, SpB BEDAH Rp 300,000 Rp 151,100 Rp 599,600
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100
Z-3-23-0 Dr. TAMSIL, SpB BEDAH Rp 581,000 Rp 562,300 Rp 599,600
Z-3-23-0 Dr. TAMSIL, SpB BEDAH Rp 300,000 Rp 151,100 Rp 599,600
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 190,000 Rp 194,700 Rp 194,700
Z-3-23-0 Dr. TAMSIL, SpB BEDAH Rp 378,500 Rp 211,300 Rp 599,600
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 143,500 Rp 194,700 Rp 194,700
Q-5-42-0 Dr. TAMSIL, SpB BEDAH Rp 193,500 Rp 196,200 Rp 196,200
Q-5-18-0 Dr. VICTOR JESRON NABABAN, Sp.BTKV BEDAH TORRp 85,000 Rp 151,100 Rp 151,100
Rp 3,361,000 Rp 3,103,900 Rp 4,382,900
 Selisih Keterangan

Rp - Konfirmasi
Rp - 1 Episode tgl 27/3 Rajal
Rp - 1 Episode Ranap tgl 20/3
Rp - Konfirmasi
Rp - Konfirmasi
Rp 448,500 Tambah hasil USG
Rp (43,600) Kode Konsling
Rp 37,300 Tambah hasil USG
Rp 448,500 Tambah hasil USG
Rp - Konfirmasi
Rp 388,300 Tambah hasil USG
Rp - 1 Episode Ranap tgl 11/3
Rp - 1 Episode Ranap tgl 14/3
Rp - 1 Episode Ranap tgl 15/3
Rp - Konfirmasi
Rp - 1 Episode Ranap tgl 3/3
Rp 1,279,000
 REKAPITULASI DATA REVISI RAWAT JALAN K
RS. BUDI KEMULIAA

No Tgl. Masuk No. RM Nama Pasien No. SEP

1 6 Apr 2017 40 73 24 CHICHA MEILIANTI 0407R00204170001306

2 10 Apr 2017 40 91 53 RAHAYU 0407R00204170001965
3 10 Apr 2017 36 14 05 NESSA 0407R00204170002045
4 13 Apr 2017 18 21 09 ZEFIN ADEGIO 0407R00204170003014
5 15 Apr 2017 40 93 81 ARDIANSYAH PUTRA 0407R00204170003304
6 18 Apr 2017 40 52 54 ZAILANI 0407R00204170003931
7 4 Apr 2017 03 75 06 YULIA ASTUTI 0407R00204170000764
8 6 Apr 2017 01 78 69 PAULINUS HARIS SHERWANI 0407R00204170001338
9 6 Apr 2017 40 89 48 NANANG HERMANTO 0407R00204170001343
10 13 Apr 2017 40 93 95 DIMAS AGUNG WISNU W 0407R00204170003034
11 13 Apr 2017 19 74 38 YUSNIMAR 0407R00204170003037
12 18 Apr 2017 26 08 11 SRIYONO 0407R00204170003991
13 7 Apr 2017 30 24 01 ADE BENNY NUSANTARA 0407R00204170001592
14 1 Apr 2017 36 29 11 GIOK AI 0407R00204170000145
15 4 Apr 2017 40 87 84 AINI RUKMAYASARI 0407R00204170000746
16 11 Apr 2017 40 44 37 JANSEN SEMBIRING 0407R00204170002245
17 12 Apr 2017 15 95 93 PUTRI JUNE PRAWARA SARI 0407R00204170002513
18 12 Apr 2017 31 64 31 MICHELLE GRETHA WELLY BANJARNAHOR 0407R00204170002560
19 13 Apr 2017 40 93 43 KHAIDIR 0407R00204170002772
20 13 Apr 2017 40 91 98 RUSPERINA SITUMORANG 0407R00204170002827
21 13 Apr 2017 40 93 03 RASIDIN 0407R00204170002879
22 13 Apr 2017 05 18 51 MARKISA DAHLIA, ST 0407R00204170002890
23 13 Apr 2017 40 75 05 ERIK GUNADI 0407R00204170002913
24 17 Apr 2017 40 95 22 ZILFIA ADRIANTI 0407R00204170003382
25 18 Apr 2017 36 49 58 SUHARYATI 0407R00204170003782
26 18 Apr 2017 16 29 54 SYAMDIRGA RIYADI 0407R00204170003845
TOTAL
DATA REVISI RAWAT JALAN KASUS BEDAH BULAN APRIL 2017
RS. BUDI KEMULIAAN BATAM

INACBG DPJP SMF Tarif RS Tarif Awal Revisi I Selisih

Q-5-18-0 Dr. APRIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -

Q-5-44-0 Dr. APRIL, SpB BEDAH Rp 136,000 Rp 194,700 Rp 194,700 Rp -
Q-5-44-0 Dr. APRIL, SpB BEDAH Rp 87,500 Rp 194,700 Rp 194,700 Rp -
Q-5-18-0 Dr. APRIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-31-0 Dr. APRIL, SpB BEDAH Rp 190,000 Rp 148,800 Rp 148,800 Rp -
Q-5-25-0 Dr. APRIL, SpB BEDAH Rp 85,000 Rp 155,800 Rp 155,800 Rp -
Q-5-18-0 Dr. ASMOJI, SpB BEDAH Rp 85,000 Rp 194,700 Rp 151,100 Rp (43,600)
Q-5-44-0 Dr. ASMOJI, SpB BEDAH Rp 94,000 Rp 194,700 Rp 194,700 Rp -
Q-5-18-0 Dr. ASMOJI, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-18-0 Dr. ASMOJI, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-44-0 Dr. ASMOJI, SpB BEDAH Rp 85,000 Rp 194,700 Rp 194,700 Rp -
Q-5-44-0 Dr. ASMOJI, SpB BEDAH Rp 98,000 Rp 194,700 Rp 194,700 Rp -
Q-5-31-0 Dr. ISMANTORO, SpB BEDAH Rp 420,000 Rp 148,800 Rp 148,800 Rp -
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 176,500 Rp 196,200 Rp 194,700 Rp (1,500)
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 95,000 Rp 194,700 Rp 194,700 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 1,187,500 Rp 194,700 Rp 194,700 Rp -
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 194,700 Rp 194,700 Rp -
Q-5-25-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 155,800 Rp 155,800 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Q-5-44-0 Dr. TAMSIL, SpB BEDAH Rp 95,500 Rp 194,700 Rp 194,700 Rp -
Q-5-18-0 Dr. TAMSIL, SpB BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp -
Rp 3,940,000 Rp 4,414,500 Rp 4,369,400 Rp (45,100)
 Keterangan

Konfirmasi
1 episode ranap tgl 11-4-17
1 episode ranap tgl 11-4-17
Konfirmasi
Konfirmasi
1 episode ranap tgl 19-4-17
1 episode ranap tgl 10-4-17
1 episode ranap tgl 11-4-17
1 episode ranap tgl 10-4-17
1 episode ranap tgl 20-4-17
1 episode ranap tgl 17-4-17
1 episode ranap tgl 19-4-17
konfirmasi
Kode Kontrol
1 episode ranap tgl 5-4-17
1 episode ranap tgl 17-4-17
1 episode rajal tgl 15-4-17
1 episode ranap tgl 15-4-17
1 episode ranap tgl 17-4-17
1 Episode Op tgl 17-4-17
Konfirmasi
1 episode ranap tgl 18-4-17
1 episode ranap tgl 15-4-17
Konfirmasi
Konfirmasi
1 Episode Ranap 20-4-17
 REKAPITULASI DATA REVISI RAWAT JALAN KASUS BE
RS. BUDI KEMULIAAN BATAM

No Tgl. Masuk No. RM Nama Pasien No. SEP INACBG

1 5/9/2017 40 91 50 AMAN SITINJAK 0407R00205170002022 Q-5-18-0

2 5/16/2017 41 06 20 SUYANTO 0407R00205170003561 Q-5-18-0
3 5/20/2017 40 56 49 ITA ANANDA 0407R00205170004527 Q-5-18-0
4 5/22/2017 17 86 23 TOGI ROBERTO SITUMORANG 0407R00205170004772 Z-3-26-0
5 5/24/2017 13 10 91 SYLVIA FITRIANA 0407R00205170005346 Q-5-18-0
6 5/2/2017 28 00 41 IRSYADULHALIM 0407R00205170000387 Q-5-18-0
7 5/2/2017 41 04 60 SANTI FITRIYENI 0407R00205170000405 Q-5-18-0
8 5/5/2017 39 68 67 EMILIA KONTESA 0407R00205170001294 Z-3-23-0
9 5/5/2017 39 22 99 DIANDRA REZKY AGUSTINA 0407R00205170001298 Q-5-42-0
10 5/10/2017 17 28 62 DIMAS ABI ARSY BUANA 0407R00205170002344 Q-5-18-0
11 5/31/2017 33 13 32 RAMOT RYANTO TAMBUNAN 0407R00205170006699 Q-5-44-0
12 5/2/2017 41 04 11 ANDINDA PUTRI ARIANTI 0407R00205170000230 Q-5-18-0
13 5/3/2017 29 68 85 MIKO MARENDRA 0407R00205170000510 Q-5-18-0
14 5/5/2017 13 04 22 RAMLET E SIHOTANG 0407R00205170001139 Z-3-23-0
15 5/6/2017 15 90 08 SUHARTY 0407R00205170001334 Z-3-27-0
16 5/6/2017 41 06 15 AURA JOANA SYIFA 0407R00205170001406 Q-5-42-0
17 5/6/2017 40 96 45 SISRI PUTRI RAHMADANI 0407R00205170001449 Q-5-18-0
18 5/13/2017 41 11 34 UMMU HABIBAH 0407R00205170002882 Z-3-23-0
19 5/19/2017 40 98 35 WENNI SURYANA 0407R00205170004252 Q-5-18-0
20 5/19/2017 26 08 11 SRIYONO 0407R00205170004280 Q-5-44-0
21 5/27/2017 41 18 54 YOHANNES PUTRA DAVERLI SILAEN 0407R00205170005802 Q-5-44-0
22 5/27/2017 41 18 87 AGUSRYADY PUTRA 0407R00205170005805 Z-3-23-0
23 5/27/2017 41 18 89 MASAYU MIMA 0407R00205170005812 Q-5-18-0
24 5/30/2017 32 33 69 ERNAWATI SIMANJUNTAK 0407R00205170006271 Q-5-44-0
25 5/30/2017 39 32 18 ELLI ERAWATI 0407R00205170006344 Z-3-23-0
TOTAL
I RAWAT JALAN KASUS BEDAH BULAN MEI 2017
BUDI KEMULIAAN BATAM

DPJP SMF Tarif RS Tarif Awal Revisi I Selisih Keterangan

Dr. APRIL, BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp - 1 Episode

Dr. APRIL, BEDAH Rp 165,000 Rp 335,100 Rp 335,100 Rp - Konfirmasi ke dokter
Dr. APRIL, BEDAH Rp 697,500 Rp 148,800 Rp 148,800 Rp - Purifikasi Ulang
Dr. APRIL, BEDAH Rp 160,000 Rp 335,100 Rp 335,100 Rp - Konfirmasi ke dokter
Dr. APRIL, BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp - 1 Episode
Dr. ASMOJIBEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp - Konfirmasi
Dr. ASMOJIBEDAH Rp 305,000 Rp 194,700 Rp 194,700 Rp - Purifikasi Ulang
Dr. ASMOJIBEDAH Rp 190,000 Rp 194,700 Rp 194,700 Rp - Konfirmasi ke dokter
Dr. ASMOJIBEDAH Rp 148,000 Rp 310,800 Rp 194,700 Rp (116,100) Kode Kontrol
Dr. ASMOJIBEDAH Rp 154,000 Rp 194,700 Rp 194,700 Rp - Purifikasi Ulang
Dr. ISMAN BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp - 1 Episode
Dr. TAMSILBEDAH Rp 272,500 Rp 304,800 Rp 304,800 Rp - Purifikasi Ulang
Dr. TAMSILBEDAH Rp 273,500 Rp 304,800 Rp 304,800 Rp - Purifikasi Ulang
Dr. TAMSILBEDAH Rp 293,500 Rp 304,800 Rp 304,800 Rp - Purifikasi Ulang
Dr. TAMSILBEDAH Rp 190,000 Rp 194,700 Rp 194,700 Rp - Purifikasi Ulang
Dr. TAMSILBEDAH Rp 402,500 Rp 599,600 Rp 599,600 Rp - Konfirmasi ke dokter
Dr. TAMSILBEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp - Konfirmasi ke dokter
Dr. TAMSILBEDAH Rp 165,000 Rp 335,100 Rp 335,100 Rp - 1 Episode
Dr. TAMSILBEDAH Rp 204,500 Rp 194,700 Rp 194,700 Rp - Purifikasi Ulang
Dr. TAMSILBEDAH Rp 160,000 Rp 335,100 Rp 335,100 Rp - 1 Episode
Dr. TAMSILBEDAH Rp 154,200 Rp 336,100 Rp 336,100 Rp - Konfirmasi ke dokter
Dr. TAMSILBEDAH Rp 276,500 Rp 194,700 Rp 194,700 Rp - Purifikasi Ulang
Dr. TAMSILBEDAH Rp 231,000 Rp 194,700 Rp 194,700 Rp - Purifikasi Ulang
Dr. TAMSILBEDAH Rp 1,074,500 Rp 194,700 Rp 194,700 Rp - Purifikasi Ulang
Dr. TAMSILBEDAH Rp 95,000 Rp 194,700 Rp 194,700 Rp - Salah Cetak SEP(Ranap)
Rp 6,037,200 Rp 6,157,900 Rp 6,041,800 Rp (116,100)
 REKAPITULASI DATA REVISI RAWAT JALAN KASUS BEDA
RS. BUDI KEMULIAAN BATAM

No Tgl. Masuk No. RM Nama Pasien No. SEP INACBG

1 6/20/2017 41 16 97 KRISTINA HUTABARAT 0407R00206170003980 Q-5-18-0

2 6/22/2017 41 31 57 ADIANSYAH PUTERA 0407R00206170004626 Q-5-44-0
3 6/29/2017 11 88 34 SYARIPAH MAISYARAH 0407R00206170005179 Q-5-28-0
4 6/30/2017 40 27 67 ADE HANDAYANI 0407R00206170005285 Q-5-44-0
5 6/19/2017 13 82 10 ERNI YUSNITA 0407R00206170003745 Z-3-23-0
6 6/20/2017 41 22 83 IRAWATI 0407R00206170004099 Z-3-27-0
7 6/6/2017 41 23 59 HARYONO 0407R00206170001038 Q-5-32-0
8 6/10/2017 41 07 39 RENNI 0407R00206170001921 Q-5-18-0
9 6/14/2017 28 76 15 ARNOLY INDRA RURU 0407R00206170002735 Q-5-18-0
10 6/16/2017 41 28 49 GUSNAR ALI PULUNGAN 0407R00206170003157 Q-5-18-0
11 6/16/2017 32 82 98 DINI ARIANI 0407R00206170003170 Z-3-23-0
12 6/17/2017 41 29 10 SITI ALFIANA 0407R00206170003463 Q-5-44-0
13 6/17/2017 41 29 11 BAHRUL ULUM 0407R00206170003470 Q-5-18-0
14 6/19/2017 19 09 99 JUNAIDA NOVAWATI RUMAPEA 0407R00206170003705 Q-5-18-0
15 6/19/2017 41 29 11 BAHRUL ULUM 0407R00206170003738 Q-5-18-0
TOTAL
SI RAWAT JALAN KASUS BEDAH BULAN JUNI 2017
BUDI KEMULIAAN BATAM

DPJP SMF Tarif RS Tarif Awal Revisi I Selisih Keterangan

Dr. APRIL, BEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp - Purifikasi Ulang

Dr. APRIL, BEDAH Rp 374,500 Rp 194,700 Rp 194,700 Rp - Purifikasi Ulang
Dr. APRIL, BEDAH Rp 126,000 Rp 197,900 Rp 197,900 Rp - Konfirmasi Trauma
Dr. APRIL, BEDAH Rp 156,000 Rp 599,600 Rp 194,700 Rp (404,900) Hapus Kode Tindakan
Dr. ASMOJIBEDAH Rp 300,000 Rp 599,600 Rp 599,600 Rp - Ganti Kode Tindakan
Dr. ASMOJIBEDAH Rp 226,500 Rp 211,300 Rp 211,300 Rp - Purifikasi Ulang
Dr. TAMSILBEDAH Rp 236,000 Rp 269,200 Rp 269,200 Rp - Konfirmasi
Dr. TAMSILBEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp - 1 Episode
Dr. TAMSILBEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp - 1 Episode
Dr. TAMSILBEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp - Purifikasi Ulang
Dr. TAMSILBEDAH Rp 474,500 Rp 599,600 Rp 599,600 Rp - Konfirmasi Trauma
Dr. TAMSILBEDAH Rp 85,000 Rp 194,700 Rp 194,700 Rp - 1 Episode
Dr. TAMSILBEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp - Konfirmasi
Dr. TAMSILBEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp - 1 Episode
Dr. TAMSILBEDAH Rp 85,000 Rp 151,100 Rp 151,100 Rp - 1 Episode
Rp 2,573,500 Rp 3,924,300 Rp 3,519,400 Rp (404,900)