No Code Deskripsi Jumlah ALOS Subtotal R Subtotal INA-CBG

1 88.76 Diagnostic 39 - 9,445,500 20,997,600

2 93.94 Respirator 34 - 6,300,200 10,550,200
3 87:44:00 Routine che 21 - 4,132,996 4,292,700
4 89:52:00 Electrocar 14 - 2,585,000 3,245,400
5 88.75 Diagnostic 10 - 2,035,000 5,384,000
6 87.79 Other x-ray 5- 975 993.1
7 88.79 Other diag 2- 520 1,076,800
8 93.96 Other oxyg 2- 215 620.6
9 87.75 Percutane 1- 245 520.4
10 93:57:00 Applicatio 1- 200 180.3
11 57.94 Insertion o 1- 170 338.1