RS CITAMA Verifikasi Biaya Pelayanan

UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
Tingkat Pelayanan : RJTL
Tgl.Pelayanan : 01 Agustus 2017 s/d 31 Agustus 2017 Hal.1/119
No No.SEP Tgl. Verifikasi Biaya

Diajukan Disetujui
1 0117R00908170000001 23/08/2017 190,400 190,400
2 0117R00908170000002 23/08/2017 190,400 190,400
3 0117R00908170000003 23/08/2017 190,400 190,400
4 0117R00908170000004 23/08/2017 190,400 190,400
5 0117R00908170000005 23/08/2017 190,400 190,400
6 0117R00908170000006 23/08/2017 190,400 190,400
7 0117R00908170000007 23/08/2017 190,400 190,400
8 0117R00908170000008 23/08/2017 190,400 190,400
9 0117R00908170000009 23/08/2017 190,400 190,400
10 0117R00908170000010 23/08/2017 190,400 190,400
11 0117R00908170000011 23/08/2017 190,400 190,400
12 0117R00908170000012 23/08/2017 190,400 190,400
13 0117R00908170000013 23/08/2017 190,400 190,400
14 0117R00908170000014 23/08/2017 190,400 190,400
15 0117R00908170000015 23/08/2017 190,400 190,400
16 0117R00908170000016 23/08/2017 190,400 190,400
17 0117R00908170000017 23/08/2017 190,400 190,400
18 0117R00908170000018 23/08/2017 190,400 190,400
19 0117R00908170000019 23/08/2017 190,400 190,400
20 0117R00908170000020 23/08/2017 323,900 323,900
21 0117R00908170000021 23/08/2017 190,400 190,400
22 0117R00908170000022 23/08/2017 190,400 190,400
23 0117R00908170000024 23/08/2017 190,400 190,400
24 0117R00908170000025 23/08/2017 190,400 190,400
25 0117R00908170000026 23/08/2017 191,800 191,800
26 0117R00908170000027 23/08/2017 190,400 190,400
27 0117R00908170000028 23/08/2017 190,400 190,400
28 0117R00908170000029 23/08/2017 190,400 190,400
29 0117R00908170000030 23/08/2017 190,400 190,400
30 0117R00908170000031 23/08/2017 190,400 190,400
31 0117R00908170000032 23/08/2017 190,400 190,400
32 0117R00908170000033 23/08/2017 252,600 252,600
33 0117R00908170000034 23/08/2017 190,400 190,400
34 0117R00908170000035 23/08/2017 190,400 190,400
35 0117R00908170000036 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
36 0117R00908170000037 23/08/2017 190,400 190,400

37 0117R00908170000038 23/08/2017 190,400 190,400
38 0117R00908170000039 23/08/2017 190,400 190,400
39 0117R00908170000040 23/08/2017 190,400 190,400
40 0117R00908170000042 23/08/2017 191,800 191,800
41 0117R00908170000043 23/08/2017 190,400 190,400
42 0117R00908170000044 23/08/2017 190,400 190,400
43 0117R00908170000045 23/08/2017 190,400 190,400
44 0117R00908170000046 23/08/2017 190,400 190,400
45 0117R00908170000047 23/08/2017 298,000 298,000
46 0117R00908170000048 23/08/2017 190,400 190,400
47 0117R00908170000049 23/08/2017 190,400 190,400
48 0117R00908170000050 23/08/2017 190,400 190,400
49 0117R00908170000051 23/08/2017 190,400 190,400
50 0117R00908170000052 23/08/2017 190,400 190,400
51 0117R00908170000053 23/08/2017 190,400 190,400
52 0117R00908170000054 23/08/2017 190,400 190,400
53 0117R00908170000055 23/08/2017 190,400 190,400
54 0117R00908170000057 23/08/2017 190,400 190,400
55 0117R00908170000058 23/08/2017 190,400 190,400
56 0117R00908170000059 23/08/2017 132,900 132,900
57 0117R00908170000060 23/08/2017 190,400 190,400
58 0117R00908170000061 23/08/2017 190,400 190,400
59 0117R00908170000062 23/08/2017 190,400 190,400
60 0117R00908170000063 23/08/2017 190,400 190,400
61 0117R00908170000064 23/08/2017 190,400 190,400
62 0117R00908170000065 23/08/2017 190,400 190,400
63 0117R00908170000066 23/08/2017 190,400 190,400
64 0117R00908170000067 23/08/2017 190,400 190,400
65 0117R00908170000068 23/08/2017 190,400 190,400
66 0117R00908170000069 23/08/2017 190,400 190,400
67 0117R00908170000070 23/08/2017 190,400 190,400
68 0117R00908170000071 23/08/2017 190,400 190,400
69 0117R00908170000072 23/08/2017 190,400 190,400
70 0117R00908170000073 23/08/2017 190,400 190,400
71 0117R00908170000074 23/08/2017 267,800 267,800
72 0117R00908170000075 23/08/2017 298,000 298,000
73 0117R00908170000076 23/08/2017 193,100 193,100
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
74 0117R00908170000077 23/08/2017 190,400 190,400

75 0117R00908170000078 23/08/2017 190,400 190,400
76 0117R00908170000079 23/08/2017 190,400 190,400
77 0117R00908170000080 23/08/2017 190,400 190,400
78 0117R00908170000081 23/08/2017 190,400 190,400
79 0117R00908170000082 23/08/2017 190,400 190,400
80 0117R00908170000083 23/08/2017 190,400 190,400
81 0117R00908170000084 23/08/2017 112,800 112,800
82 0117R00908170000085 23/08/2017 190,400 190,400
83 0117R00908170000086 23/08/2017 190,400 190,400
84 0117R00908170000087 23/08/2017 190,400 190,400
85 0117R00908170000088 23/08/2017 298,000 298,000
86 0117R00908170000089 23/08/2017 190,400 190,400
87 0117R00908170000090 23/08/2017 190,400 190,400
88 0117R00908170000091 23/08/2017 190,400 190,400
89 0117R00908170000092 23/08/2017 190,400 190,400
90 0117R00908170000093 23/08/2017 190,400 190,400
91 0117R00908170000094 23/08/2017 190,400 190,400
92 0117R00908170000095 23/08/2017 576,900 576,900
93 0117R00908170000096 23/08/2017 298,000 298,000
94 0117R00908170000097 23/08/2017 190,400 190,400
95 0117R00908170000098 23/08/2017 311,300 311,300
96 0117R00908170000099 23/08/2017 112,800 112,800
97 0117R00908170000100 23/08/2017 190,400 190,400
98 0117R00908170000101 23/08/2017 112,800 112,800
99 0117R00908170000102 23/08/2017 190,400 190,400
100 0117R00908170000104 23/08/2017 298,000 298,000
101 0117R00908170000105 23/08/2017 190,400 190,400
102 0117R00908170000106 23/08/2017 190,400 190,400
103 0117R00908170000107 23/08/2017 311,300 311,300
104 0117R00908170000109 23/08/2017 190,400 190,400
105 0117R00908170000110 23/08/2017 190,400 190,400
106 0117R00908170000111 23/08/2017 311,300 311,300
107 0117R00908170000114 23/08/2017 190,400 190,400
108 0117R00908170000115 23/08/2017 576,900 576,900
109 0117R00908170000116 23/08/2017 311,300 311,300
110 0117R00908170000117 23/08/2017 112,800 112,800
111 0117R00908170000118 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
112 0117R00908170000119 23/08/2017 193,100 193,100

113 0117R00908170000120 23/08/2017 191,800 191,800
114 0117R00908170000121 23/08/2017 112,800 112,800
115 0117R00908170000122 23/08/2017 190,400 190,400
116 0117R00908170000124 23/08/2017 112,800 112,800
117 0117R00908170000125 23/08/2017 193,100 193,100
118 0117R00908170000126 23/08/2017 190,400 190,400
119 0117R00908170000128 23/08/2017 190,400 190,400
120 0117R00908170000129 23/08/2017 190,400 190,400
121 0117R00908170000130 23/08/2017 576,900 576,900
122 0117R00908170000131 23/08/2017 191,800 191,800
123 0117R00908170000132 23/08/2017 190,400 190,400
124 0117R00908170000133 23/08/2017 112,800 112,800
125 0117R00908170000134 23/08/2017 263,500 263,500
126 0117R00908170000135 23/08/2017 112,800 112,800
127 0117R00908170000136 23/08/2017 193,100 193,100
128 0117R00908170000137 23/08/2017 190,400 190,400
129 0117R00908170000138 23/08/2017 190,400 190,400
130 0117R00908170000139 23/08/2017 576,900 576,900
131 0117R00908170000140 23/08/2017 190,400 190,400
132 0117R00908170000142 23/08/2017 190,400 190,400
133 0117R00908170000143 23/08/2017 190,400 190,400
134 0117R00908170000144 23/08/2017 190,400 190,400
135 0117R00908170000145 23/08/2017 190,400 190,400
136 0117R00908170000146 23/08/2017 190,400 190,400
137 0117R00908170000148 23/08/2017 190,400 190,400
138 0117R00908170000149 23/08/2017 323,900 323,900
139 0117R00908170000150 23/08/2017 190,400 190,400
140 0117R00908170000152 23/08/2017 133,500 133,500
141 0117R00908170000153 23/08/2017 190,400 190,400
142 0117R00908170000154 23/08/2017 191,800 191,800
143 0117R00908170000155 23/08/2017 112,800 112,800
144 0117R00908170000156 23/08/2017 190,400 190,400
145 0117R00908170000157 23/08/2017 311,300 311,300
146 0117R00908170000158 23/08/2017 298,000 298,000
147 0117R00908170000159 23/08/2017 323,900 323,900
148 0117R00908170000160 23/08/2017 190,400 190,400
149 0117R00908170000161 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
150 0117R00908170000162 23/08/2017 112,800 112,800

151 0117R00908170000163 23/08/2017 190,400 190,400
152 0117R00908170000164 23/08/2017 190,400 190,400
153 0117R00908170000165 23/08/2017 190,400 190,400
154 0117R00908170000166 23/08/2017 215,000 215,000
155 0117R00908170000167 23/08/2017 193,100 193,100
156 0117R00908170000169 23/08/2017 190,400 190,400
157 0117R00908170000170 23/08/2017 193,100 193,100
158 0117R00908170000171 23/08/2017 112,800 112,800
159 0117R00908170000172 23/08/2017 311,300 311,300
160 0117R00908170000173 23/08/2017 190,400 190,400
161 0117R00908170000174 23/08/2017 193,100 193,100
162 0117R00908170000175 23/08/2017 112,800 112,800
163 0117R00908170000176 23/08/2017 311,300 311,300
164 0117R00908170000177 23/08/2017 190,400 190,400
165 0117R00908170000178 23/08/2017 190,400 190,400
166 0117R00908170000180 23/08/2017 190,400 190,400
167 0117R00908170000181 23/08/2017 112,800 112,800
168 0117R00908170000182 23/08/2017 190,400 190,400
169 0117R00908170000183 23/08/2017 191,800 191,800
170 0117R00908170000184 23/08/2017 190,400 190,400
171 0117R00908170000185 23/08/2017 190,400 190,400
172 0117R00908170000186 23/08/2017 190,400 190,400
173 0117R00908170000187 23/08/2017 190,400 190,400
174 0117R00908170000188 23/08/2017 112,800 112,800
175 0117R00908170000189 23/08/2017 112,800 112,800
176 0117R00908170000190 23/08/2017 193,100 193,100
177 0117R00908170000192 23/08/2017 310,100 310,100
178 0117R00908170000193 23/08/2017 112,800 112,800
179 0117R00908170000194 23/08/2017 298,000 298,000
180 0117R00908170000195 23/08/2017 112,800 112,800
181 0117R00908170000196 23/08/2017 308,800 308,800
182 0117R00908170000197 23/08/2017 190,400 190,400
183 0117R00908170000198 23/08/2017 190,400 190,400
184 0117R00908170000199 23/08/2017 190,400 190,400
185 0117R00908170000200 23/08/2017 190,400 190,400
186 0117R00908170000201 23/08/2017 112,800 112,800
187 0117R00908170000202 23/08/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
188 0117R00908170000203 23/08/2017 190,400 190,400

189 0117R00908170000204 23/08/2017 190,400 190,400
190 0117R00908170000205 23/08/2017 190,400 190,400
191 0117R00908170000206 23/08/2017 190,400 190,400
192 0117R00908170000207 23/08/2017 190,400 190,400
193 0117R00908170000208 23/08/2017 190,400 190,400
194 0117R00908170000209 23/08/2017 190,400 190,400
195 0117R00908170000210 23/08/2017 254,200 254,200
196 0117R00908170000211 23/08/2017 190,400 190,400
197 0117R00908170000212 23/08/2017 190,400 190,400
198 0117R00908170000213 23/08/2017 190,400 190,400
199 0117R00908170000214 23/08/2017 258,100 258,100
200 0117R00908170000215 23/08/2017 190,400 190,400
201 0117R00908170000216 23/08/2017 263,500 263,500
202 0117R00908170000217 23/08/2017 190,400 190,400
203 0117R00908170000218 23/08/2017 263,500 263,500
204 0117R00908170000219 23/08/2017 190,400 190,400
205 0117R00908170000220 23/08/2017 190,400 190,400
206 0117R00908170000221 23/08/2017 190,400 190,400
207 0117R00908170000222 23/08/2017 112,800 112,800
208 0117R00908170000223 23/08/2017 190,400 190,400
209 0117R00908170000224 23/08/2017 191,800 191,800
210 0117R00908170000225 23/08/2017 190,400 190,400
211 0117R00908170000226 23/08/2017 190,400 190,400
212 0117R00908170000227 23/08/2017 190,400 190,400
213 0117R00908170000228 23/08/2017 190,400 190,400
214 0117R00908170000231 23/08/2017 112,800 112,800
215 0117R00908170000232 23/08/2017 190,400 190,400
216 0117R00908170000233 23/08/2017 112,800 112,800
217 0117R00908170000234 23/08/2017 190,400 190,400
218 0117R00908170000235 23/08/2017 190,400 190,400
219 0117R00908170000236 23/08/2017 190,400 190,400
220 0117R00908170000237 23/08/2017 263,500 263,500
221 0117R00908170000238 23/08/2017 112,800 112,800
222 0117R00908170000239 23/08/2017 190,400 190,400
223 0117R00908170000240 23/08/2017 190,400 190,400
224 0117R00908170000241 23/08/2017 190,400 190,400
225 0117R00908170000242 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
226 0117R00908170000243 23/08/2017 190,400 190,400

227 0117R00908170000244 23/08/2017 190,400 190,400
228 0117R00908170000245 23/08/2017 190,400 190,400
229 0117R00908170000246 23/08/2017 190,400 190,400
230 0117R00908170000247 23/08/2017 190,400 190,400
231 0117R00908170000248 23/08/2017 191,800 191,800
232 0117R00908170000249 23/08/2017 112,800 112,800
233 0117R00908170000250 23/08/2017 311,300 311,300
234 0117R00908170000251 23/08/2017 112,800 112,800
235 0117R00908170000252 23/08/2017 190,400 190,400
236 0117R00908170000253 23/08/2017 323,900 323,900
237 0117R00908170000254 23/08/2017 190,400 190,400
238 0117R00908170000255 23/08/2017 202,100 202,100
239 0117R00908170000256 23/08/2017 190,400 190,400
240 0117R00908170000257 23/08/2017 191,800 191,800
241 0117R00908170000258 23/08/2017 190,400 190,400
242 0117R00908170000259 23/08/2017 190,400 190,400
243 0117R00908170000260 23/08/2017 190,400 190,400
244 0117R00908170000261 23/08/2017 190,400 190,400
245 0117R00908170000262 23/08/2017 190,400 190,400
246 0117R00908170000263 23/08/2017 190,400 190,400
247 0117R00908170000264 23/08/2017 190,400 190,400
248 0117R00908170000265 23/08/2017 190,400 190,400
249 0117R00908170000266 23/08/2017 190,400 190,400
250 0117R00908170000267 23/08/2017 190,400 190,400
251 0117R00908170000268 23/08/2017 190,400 190,400
252 0117R00908170000269 23/08/2017 190,400 190,400
253 0117R00908170000270 23/08/2017 190,400 190,400
254 0117R00908170000271 23/08/2017 190,400 190,400
255 0117R00908170000272 23/08/2017 190,400 190,400
256 0117R00908170000273 23/08/2017 190,400 190,400
257 0117R00908170000274 23/08/2017 263,500 263,500
258 0117R00908170000275 23/08/2017 311,300 311,300
259 0117R00908170000276 23/08/2017 190,400 190,400
260 0117R00908170000277 23/08/2017 190,400 190,400
261 0117R00908170000278 23/08/2017 190,400 190,400
262 0117R00908170000279 23/08/2017 190,400 190,400
263 0117R00908170000280 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
264 0117R00908170000281 23/08/2017 263,500 263,500

265 0117R00908170000282 23/08/2017 190,400 190,400
266 0117R00908170000283 23/08/2017 190,400 190,400
267 0117R00908170000284 23/08/2017 190,400 190,400
268 0117R00908170000285 23/08/2017 190,400 190,400
269 0117R00908170000286 23/08/2017 190,400 190,400
270 0117R00908170000287 23/08/2017 254,200 254,200
271 0117R00908170000288 23/08/2017 190,400 190,400
272 0117R00908170000289 23/08/2017 190,400 190,400
273 0117R00908170000291 23/08/2017 190,400 190,400
274 0117R00908170000292 23/08/2017 190,400 190,400
275 0117R00908170000294 23/08/2017 263,500 263,500
276 0117R00908170000295 23/08/2017 190,400 190,400
277 0117R00908170000296 23/08/2017 190,400 190,400
278 0117R00908170000297 23/08/2017 311,300 311,300
279 0117R00908170000298 23/08/2017 190,400 190,400
280 0117R00908170000299 23/08/2017 190,400 190,400
281 0117R00908170000300 23/08/2017 190,400 190,400
282 0117R00908170000301 23/08/2017 190,400 190,400
283 0117R00908170000302 23/08/2017 190,400 190,400
284 0117R00908170000303 23/08/2017 190,400 190,400
285 0117R00908170000304 23/08/2017 190,400 190,400
286 0117R00908170000305 23/08/2017 190,400 190,400
287 0117R00908170000306 23/08/2017 190,400 190,400
288 0117R00908170000307 23/08/2017 190,400 190,400
289 0117R00908170000308 23/08/2017 190,400 190,400
290 0117R00908170000309 23/08/2017 190,400 190,400
291 0117R00908170000310 23/08/2017 190,400 190,400
292 0117R00908170000311 23/08/2017 576,900 576,900
293 0117R00908170000312 23/08/2017 190,400 190,400
294 0117R00908170000313 23/08/2017 190,400 190,400
295 0117R00908170000314 23/08/2017 190,400 190,400
296 0117R00908170000315 23/08/2017 190,400 190,400
297 0117R00908170000316 23/08/2017 190,400 190,400
298 0117R00908170000317 23/08/2017 576,900 576,900
299 0117R00908170000318 23/08/2017 263,500 263,500
300 0117R00908170000320 23/08/2017 190,400 190,400
301 0117R00908170000321 23/08/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
302 0117R00908170000322 23/08/2017 112,800 112,800

303 0117R00908170000323 23/08/2017 112,800 112,800
304 0117R00908170000324 23/08/2017 576,900 576,900
305 0117R00908170000325 23/08/2017 191,800 191,800
306 0117R00908170000326 23/08/2017 576,900 576,900
307 0117R00908170000327 23/08/2017 190,400 190,400
308 0117R00908170000328 23/08/2017 190,400 190,400
309 0117R00908170000329 23/08/2017 190,400 190,400
310 0117R00908170000330 23/08/2017 190,400 190,400
311 0117R00908170000331 23/08/2017 112,800 112,800
312 0117R00908170000332 23/08/2017 263,500 263,500
313 0117R00908170000334 23/08/2017 190,400 190,400
314 0117R00908170000335 23/08/2017 193,100 193,100
315 0117R00908170000337 23/08/2017 311,300 311,300
316 0117R00908170000338 23/08/2017 190,400 190,400
317 0117R00908170000339 23/08/2017 576,900 576,900
318 0117R00908170000340 23/08/2017 112,800 112,800
319 0117R00908170000341 23/08/2017 190,400 190,400
320 0117R00908170000342 23/08/2017 191,800 191,800
321 0117R00908170000343 23/08/2017 323,900 323,900
322 0117R00908170000344 23/08/2017 191,800 191,800
323 0117R00908170000345 23/08/2017 112,800 112,800
324 0117R00908170000346 23/08/2017 190,400 190,400
325 0117R00908170000347 23/08/2017 191,800 191,800
326 0117R00908170000348 23/08/2017 190,400 190,400
327 0117R00908170000349 23/08/2017 190,400 190,400
328 0117R00908170000350 23/08/2017 112,800 112,800
329 0117R00908170000351 23/08/2017 190,400 190,400
330 0117R00908170000352 23/08/2017 190,400 190,400
331 0117R00908170000353 23/08/2017 275,100 275,100
332 0117R00908170000354 23/08/2017 190,400 190,400
333 0117R00908170000356 23/08/2017 191,800 191,800
334 0117R00908170000357 23/08/2017 112,800 112,800
335 0117R00908170000358 23/08/2017 112,800 112,800
336 0117R00908170000359 23/08/2017 311,300 311,300
337 0117R00908170000361 23/08/2017 190,400 190,400
338 0117R00908170000362 23/08/2017 190,400 190,400
339 0117R00908170000363 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
340 0117R00908170000364 23/08/2017 263,300 263,300

341 0117R00908170000365 23/08/2017 190,400 190,400
342 0117R00908170000366 23/08/2017 191,800 191,800
343 0117R00908170000367 23/08/2017 547,100 547,100
344 0117R00908170000368 23/08/2017 190,400 190,400
345 0117R00908170000369 23/08/2017 190,400 190,400
346 0117R00908170000370 23/08/2017 190,400 190,400
347 0117R00908170000372 23/08/2017 190,400 190,400
348 0117R00908170000373 23/08/2017 298,000 298,000
349 0117R00908170000375 23/08/2017 191,800 191,800
350 0117R00908170000376 23/08/2017 311,300 311,300
351 0117R00908170000377 23/08/2017 190,400 190,400
352 0117R00908170000378 23/08/2017 263,500 263,500
353 0117R00908170000379 23/08/2017 311,300 311,300
354 0117R00908170000380 23/08/2017 191,800 191,800
355 0117R00908170000381 23/08/2017 190,400 190,400
356 0117R00908170000382 23/08/2017 311,300 311,300
357 0117R00908170000383 23/08/2017 112,800 112,800
358 0117R00908170000384 23/08/2017 112,800 112,800
359 0117R00908170000385 23/08/2017 191,800 191,800
360 0117R00908170000386 23/08/2017 193,100 193,100
361 0117R00908170000387 23/08/2017 190,400 190,400
362 0117R00908170000388 23/08/2017 190,400 190,400
363 0117R00908170000389 23/08/2017 576,900 576,900
364 0117R00908170000391 23/08/2017 576,900 576,900
365 0117R00908170000392 23/08/2017 576,900 576,900
366 0117R00908170000393 23/08/2017 190,400 190,400
367 0117R00908170000394 23/08/2017 190,400 190,400
368 0117R00908170000395 23/08/2017 112,800 112,800
369 0117R00908170000396 23/08/2017 576,900 576,900
370 0117R00908170000397 23/08/2017 112,800 112,800
371 0117R00908170000398 23/08/2017 190,400 190,400
372 0117R00908170000399 23/08/2017 190,400 190,400
373 0117R00908170000400 23/08/2017 576,900 576,900
374 0117R00908170000401 23/08/2017 112,800 112,800
375 0117R00908170000402 23/08/2017 190,400 190,400
376 0117R00908170000403 23/08/2017 112,800 112,800
377 0117R00908170000404 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
378 0117R00908170000405 23/08/2017 215,000 215,000

379 0117R00908170000406 23/08/2017 190,400 190,400
380 0117R00908170000407 23/08/2017 576,900 576,900
381 0117R00908170000408 23/08/2017 576,900 576,900
382 0117R00908170000409 23/08/2017 311,300 311,300
383 0117R00908170000410 23/08/2017 263,500 263,500
384 0117R00908170000411 23/08/2017 190,400 190,400
385 0117R00908170000412 23/08/2017 112,800 112,800
386 0117R00908170000413 23/08/2017 112,800 112,800
387 0117R00908170000414 23/08/2017 191,800 191,800
388 0117R00908170000415 23/08/2017 191,800 191,800
389 0117R00908170000417 23/08/2017 190,400 190,400
390 0117R00908170000418 23/08/2017 112,800 112,800
391 0117R00908170000419 23/08/2017 191,800 191,800
392 0117R00908170000420 23/08/2017 190,400 190,400
393 0117R00908170000421 23/08/2017 191,800 191,800
394 0117R00908170000422 23/08/2017 191,800 191,800
395 0117R00908170000423 23/08/2017 190,400 190,400
396 0117R00908170000424 23/08/2017 311,300 311,300
397 0117R00908170000426 23/08/2017 190,400 190,400
398 0117R00908170000427 23/08/2017 190,400 190,400
399 0117R00908170000428 23/08/2017 112,800 112,800
400 0117R00908170000429 23/08/2017 112,800 112,800
401 0117R00908170000430 23/08/2017 193,100 193,100
402 0117R00908170000431 23/08/2017 191,800 191,800
403 0117R00908170000433 23/08/2017 193,100 193,100
404 0117R00908170000434 23/08/2017 323,900 323,900
405 0117R00908170000435 23/08/2017 112,800 112,800
406 0117R00908170000437 23/08/2017 311,300 311,300
407 0117R00908170000438 23/08/2017 112,800 112,800
408 0117R00908170000439 23/08/2017 461,900 461,900
409 0117R00908170000440 23/08/2017 191,800 191,800
410 0117R00908170000441 23/08/2017 311,300 311,300
411 0117R00908170000442 23/08/2017 112,800 112,800
412 0117R00908170000443 23/08/2017 323,900 323,900
413 0117R00908170000444 23/08/2017 112,800 112,800
414 0117R00908170000445 23/08/2017 112,800 112,800
415 0117R00908170000446 23/08/2017 311,300 311,300
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
416 0117R00908170000447 23/08/2017 190,400 190,400

417 0117R00908170000449 23/08/2017 190,400 190,400
418 0117R00908170000450 23/08/2017 112,800 112,800
419 0117R00908170000451 23/08/2017 193,100 193,100
420 0117R00908170000452 23/08/2017 112,800 112,800
421 0117R00908170000453 23/08/2017 311,300 311,300
422 0117R00908170000454 23/08/2017 112,800 112,800
423 0117R00908170000455 23/08/2017 311,300 311,300
424 0117R00908170000456 23/08/2017 311,300 311,300
425 0117R00908170000457 23/08/2017 254,200 254,200
426 0117R00908170000458 23/08/2017 112,800 112,800
427 0117R00908170000459 23/08/2017 112,800 112,800
428 0117R00908170000460 23/08/2017 311,300 311,300
429 0117R00908170000461 23/08/2017 190,400 190,400
430 0117R00908170000462 23/08/2017 323,900 323,900
431 0117R00908170000463 23/08/2017 112,800 112,800
432 0117R00908170000464 23/08/2017 190,400 190,400
433 0117R00908170000465 23/08/2017 112,800 112,800
434 0117R00908170000466 23/08/2017 215,000 215,000
435 0117R00908170000467 23/08/2017 323,900 323,900
436 0117R00908170000468 23/08/2017 190,400 190,400
437 0117R00908170000469 23/08/2017 190,400 190,400
438 0117R00908170000470 23/08/2017 112,800 112,800
439 0117R00908170000471 23/08/2017 191,800 191,800
440 0117R00908170000472 23/08/2017 191,800 191,800
441 0117R00908170000473 23/08/2017 190,400 190,400
442 0117R00908170000474 23/08/2017 191,800 191,800
443 0117R00908170000475 23/08/2017 311,300 311,300
444 0117R00908170000477 23/08/2017 323,900 323,900
445 0117R00908170000479 23/08/2017 191,800 191,800
446 0117R00908170000483 23/08/2017 191,800 191,800
447 0117R00908170000484 23/08/2017 142,400 142,400
448 0117R00908170000485 23/08/2017 133,500 133,500
449 0117R00908170000486 23/08/2017 634,300 634,300
450 0117R00908170000487 23/08/2017 215,000 215,000
451 0117R00908170000488 23/08/2017 112,800 112,800
452 0117R00908170000489 23/08/2017 190,400 190,400
453 0117R00908170000490 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
454 0117R00908170000491 23/08/2017 190,400 190,400

455 0117R00908170000492 23/08/2017 190,400 190,400
456 0117R00908170000493 23/08/2017 190,400 190,400
457 0117R00908170000494 23/08/2017 190,400 190,400
458 0117R00908170000495 23/08/2017 190,400 190,400
459 0117R00908170000496 23/08/2017 190,400 190,400
460 0117R00908170000497 23/08/2017 190,400 190,400
461 0117R00908170000498 23/08/2017 311,300 311,300
462 0117R00908170000499 23/08/2017 190,400 190,400
463 0117R00908170000501 23/08/2017 190,400 190,400
464 0117R00908170000502 23/08/2017 190,400 190,400
465 0117R00908170000503 23/08/2017 190,400 190,400
466 0117R00908170000505 23/08/2017 190,400 190,400
467 0117R00908170000509 23/08/2017 190,400 190,400
468 0117R00908170000511 23/08/2017 190,400 190,400
469 0117R00908170000512 23/08/2017 190,400 190,400
470 0117R00908170000513 23/08/2017 190,400 190,400
471 0117R00908170000514 23/08/2017 190,400 190,400
472 0117R00908170000515 23/08/2017 190,400 190,400
473 0117R00908170000516 23/08/2017 190,400 190,400
474 0117R00908170000518 23/08/2017 190,400 190,400
475 0117R00908170000519 23/08/2017 190,400 190,400
476 0117R00908170000520 23/08/2017 190,400 190,400
477 0117R00908170000521 23/08/2017 190,400 190,400
478 0117R00908170000522 23/08/2017 190,400 190,400
479 0117R00908170000523 23/08/2017 190,400 190,400
480 0117R00908170000524 23/08/2017 190,400 190,400
481 0117R00908170000525 23/08/2017 190,400 190,400
482 0117R00908170000526 23/08/2017 190,400 190,400
483 0117R00908170000527 23/08/2017 311,300 311,300
484 0117R00908170000528 23/08/2017 142,400 142,400
485 0117R00908170000529 23/08/2017 190,400 190,400
486 0117R00908170000530 23/08/2017 576,900 576,900
487 0117R00908170000531 23/08/2017 190,400 190,400
488 0117R00908170000532 23/08/2017 190,400 190,400
489 0117R00908170000533 23/08/2017 190,400 190,400
490 0117R00908170000534 23/08/2017 190,400 190,400
491 0117R00908170000535 23/08/2017 298,000 298,000
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
492 0117R00908170000536 23/08/2017 190,400 190,400

493 0117R00908170000537 23/08/2017 190,400 190,400
494 0117R00908170000538 23/08/2017 190,400 190,400
495 0117R00908170000539 23/08/2017 190,400 190,400
496 0117R00908170000540 23/08/2017 190,400 190,400
497 0117R00908170000541 23/08/2017 190,400 190,400
498 0117R00908170000542 23/08/2017 193,100 193,100
499 0117R00908170000543 23/08/2017 190,400 190,400
500 0117R00908170000544 23/08/2017 190,400 190,400
501 0117R00908170000545 23/08/2017 190,400 190,400
502 0117R00908170000546 23/08/2017 190,400 190,400
503 0117R00908170000547 23/08/2017 190,400 190,400
504 0117R00908170000549 23/08/2017 190,400 190,400
505 0117R00908170000550 23/08/2017 112,800 112,800
506 0117R00908170000551 23/08/2017 190,400 190,400
507 0117R00908170000553 23/08/2017 190,400 190,400
508 0117R00908170000554 23/08/2017 190,400 190,400
509 0117R00908170000555 23/08/2017 190,400 190,400
510 0117R00908170000556 23/08/2017 190,400 190,400
511 0117R00908170000557 23/08/2017 190,400 190,400
512 0117R00908170000558 23/08/2017 191,800 191,800
513 0117R00908170000559 23/08/2017 190,400 190,400
514 0117R00908170000560 23/08/2017 190,400 190,400
515 0117R00908170000561 23/08/2017 190,400 190,400
516 0117R00908170000562 23/08/2017 112,800 112,800
517 0117R00908170000563 23/08/2017 190,400 190,400
518 0117R00908170000564 23/08/2017 190,400 190,400
519 0117R00908170000565 23/08/2017 190,400 190,400
520 0117R00908170000566 23/08/2017 190,400 190,400
521 0117R00908170000567 23/08/2017 190,400 190,400
522 0117R00908170000568 23/08/2017 263,500 263,500
523 0117R00908170000569 23/08/2017 190,400 190,400
524 0117R00908170000570 23/08/2017 190,400 190,400
525 0117R00908170000571 23/08/2017 190,400 190,400
526 0117R00908170000572 23/08/2017 112,800 112,800
527 0117R00908170000573 23/08/2017 190,400 190,400
528 0117R00908170000575 23/08/2017 190,400 190,400
529 0117R00908170000576 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
530 0117R00908170000577 23/08/2017 191,800 191,800

531 0117R00908170000578 23/08/2017 112,800 112,800
532 0117R00908170000579 23/08/2017 298,000 298,000
533 0117R00908170000580 23/08/2017 190,400 190,400
534 0117R00908170000581 23/08/2017 190,400 190,400
535 0117R00908170000582 23/08/2017 190,400 190,400
536 0117R00908170000583 23/08/2017 190,400 190,400
537 0117R00908170000584 23/08/2017 190,400 190,400
538 0117R00908170000585 23/08/2017 190,400 190,400
539 0117R00908170000586 23/08/2017 190,400 190,400
540 0117R00908170000587 23/08/2017 190,400 190,400
541 0117R00908170000588 23/08/2017 298,000 298,000
542 0117R00908170000590 23/08/2017 298,000 298,000
543 0117R00908170000591 23/08/2017 112,800 112,800
544 0117R00908170000592 23/08/2017 263,500 263,500
545 0117R00908170000593 23/08/2017 323,900 323,900
546 0117R00908170000596 23/08/2017 323,900 323,900
547 0117R00908170000597 23/08/2017 133,500 133,500
548 0117R00908170000598 23/08/2017 112,800 112,800
549 0117R00908170000599 23/08/2017 190,400 190,400
550 0117R00908170000600 23/08/2017 191,800 191,800
551 0117R00908170000601 23/08/2017 190,400 190,400
552 0117R00908170000602 23/08/2017 190,400 190,400
553 0117R00908170000603 23/08/2017 190,400 190,400
554 0117R00908170000604 23/08/2017 190,400 190,400
555 0117R00908170000605 23/08/2017 323,900 323,900
556 0117R00908170000606 23/08/2017 298,000 298,000
557 0117R00908170000607 23/08/2017 190,400 190,400
558 0117R00908170000608 23/08/2017 112,800 112,800
559 0117R00908170000609 23/08/2017 190,400 190,400
560 0117R00908170000610 23/08/2017 193,100 193,100
561 0117R00908170000611 23/08/2017 190,400 190,400
562 0117R00908170000612 23/08/2017 190,400 190,400
563 0117R00908170000613 23/08/2017 190,400 190,400
564 0117R00908170000614 23/08/2017 190,400 190,400
565 0117R00908170000616 23/08/2017 190,400 190,400
566 0117R00908170000617 23/08/2017 190,400 190,400
567 0117R00908170000618 23/08/2017 298,000 298,000
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
568 0117R00908170000619 23/08/2017 190,400 190,400

569 0117R00908170000622 23/08/2017 190,400 190,400
570 0117R00908170000623 23/08/2017 190,400 190,400
571 0117R00908170000624 23/08/2017 132,900 132,900
572 0117R00908170000625 23/08/2017 191,800 191,800
573 0117R00908170000626 23/08/2017 190,400 190,400
574 0117R00908170000627 23/08/2017 190,400 190,400
575 0117R00908170000628 23/08/2017 190,400 190,400
576 0117R00908170000629 23/08/2017 190,400 190,400
577 0117R00908170000631 23/08/2017 190,400 190,400
578 0117R00908170000633 23/08/2017 190,400 190,400
579 0117R00908170000634 23/08/2017 190,400 190,400
580 0117R00908170000635 23/08/2017 112,800 112,800
581 0117R00908170000636 23/08/2017 112,800 112,800
582 0117R00908170000637 23/08/2017 112,800 112,800
583 0117R00908170000638 23/08/2017 190,400 190,400
584 0117R00908170000639 23/08/2017 112,800 112,800
585 0117R00908170000640 23/08/2017 311,300 311,300
586 0117R00908170000642 23/08/2017 190,400 190,400
587 0117R00908170000644 23/08/2017 190,400 190,400
588 0117R00908170000645 23/08/2017 190,400 190,400
589 0117R00908170000646 23/08/2017 298,000 298,000
590 0117R00908170000647 23/08/2017 190,400 190,400
591 0117R00908170000648 23/08/2017 112,800 112,800
592 0117R00908170000649 23/08/2017 190,400 190,400
593 0117R00908170000650 23/08/2017 112,800 112,800
594 0117R00908170000651 23/08/2017 190,400 190,400
595 0117R00908170000652 23/08/2017 190,400 190,400
596 0117R00908170000653 23/08/2017 263,500 263,500
597 0117R00908170000654 23/08/2017 190,400 190,400
598 0117R00908170000655 23/08/2017 190,400 190,400
599 0117R00908170000656 23/08/2017 298,000 298,000
600 0117R00908170000657 23/08/2017 576,900 576,900
601 0117R00908170000658 23/08/2017 190,400 190,400
602 0117R00908170000659 23/08/2017 576,900 576,900
603 0117R00908170000660 23/08/2017 190,400 190,400
604 0117R00908170000661 23/08/2017 190,400 190,400
605 0117R00908170000662 23/08/2017 191,800 191,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
606 0117R00908170000663 23/08/2017 190,400 190,400

607 0117R00908170000664 23/08/2017 190,400 190,400
608 0117R00908170000665 23/08/2017 323,900 323,900
609 0117R00908170000666 23/08/2017 133,500 133,500
610 0117R00908170000667 23/08/2017 190,400 190,400
611 0117R00908170000668 23/08/2017 190,400 190,400
612 0117R00908170000669 23/08/2017 190,400 190,400
613 0117R00908170000671 23/08/2017 263,500 263,500
614 0117R00908170000672 23/08/2017 190,400 190,400
615 0117R00908170000673 23/08/2017 112,800 112,800
616 0117R00908170000674 23/08/2017 263,500 263,500
617 0117R00908170000675 23/08/2017 190,400 190,400
618 0117R00908170000676 23/08/2017 190,400 190,400
619 0117R00908170000678 23/08/2017 190,400 190,400
620 0117R00908170000679 23/08/2017 190,400 190,400
621 0117R00908170000680 23/08/2017 190,400 190,400
622 0117R00908170000681 23/08/2017 190,400 190,400
623 0117R00908170000682 23/08/2017 112,800 112,800
624 0117R00908170000683 23/08/2017 142,400 142,400
625 0117R00908170000684 23/08/2017 112,800 112,800
626 0117R00908170000685 23/08/2017 190,400 190,400
627 0117R00908170000686 23/08/2017 311,300 311,300
628 0117R00908170000687 23/08/2017 190,400 190,400
629 0117R00908170000688 23/08/2017 461,900 461,900
630 0117R00908170000689 23/08/2017 190,400 190,400
631 0117R00908170000690 23/08/2017 308,800 308,800
632 0117R00908170000691 23/08/2017 263,500 263,500
633 0117R00908170000692 23/08/2017 193,100 193,100
634 0117R00908170000693 23/08/2017 190,400 190,400
635 0117R00908170000695 23/08/2017 263,500 263,500
636 0117R00908170000696 23/08/2017 190,400 190,400
637 0117R00908170000697 23/08/2017 576,900 576,900
638 0117R00908170000698 23/08/2017 112,800 112,800
639 0117R00908170000699 23/08/2017 190,400 190,400
640 0117R00908170000700 23/08/2017 112,800 112,800
641 0117R00908170000702 23/08/2017 112,800 112,800
642 0117R00908170000703 23/08/2017 193,100 193,100
643 0117R00908170000704 23/08/2017 311,300 311,300
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
644 0117R00908170000705 23/08/2017 133,500 133,500

645 0117R00908170000706 23/08/2017 190,400 190,400
646 0117R00908170000707 23/08/2017 576,900 576,900
647 0117R00908170000708 23/08/2017 576,900 576,900
648 0117R00908170000709 23/08/2017 311,300 311,300
649 0117R00908170000710 23/08/2017 190,400 190,400
650 0117R00908170000711 23/08/2017 190,400 190,400
651 0117R00908170000712 23/08/2017 576,900 576,900
652 0117R00908170000713 23/08/2017 133,500 133,500
653 0117R00908170000714 23/08/2017 190,400 190,400
654 0117R00908170000715 23/08/2017 323,900 323,900
655 0117R00908170000716 23/08/2017 142,400 142,400
656 0117R00908170000717 23/08/2017 190,400 190,400
657 0117R00908170000718 23/08/2017 190,400 190,400
658 0117R00908170000719 23/08/2017 190,400 190,400
659 0117R00908170000720 23/08/2017 190,400 190,400
660 0117R00908170000722 23/08/2017 190,400 190,400
661 0117R00908170000723 23/08/2017 112,800 112,800
662 0117R00908170000724 23/08/2017 190,400 190,400
663 0117R00908170000725 23/08/2017 190,400 190,400
664 0117R00908170000726 23/08/2017 190,400 190,400
665 0117R00908170000728 23/08/2017 190,400 190,400
666 0117R00908170000729 23/08/2017 263,500 263,500
667 0117R00908170000730 23/08/2017 190,400 190,400
668 0117R00908170000732 23/08/2017 190,400 190,400
669 0117R00908170000733 23/08/2017 576,900 576,900
670 0117R00908170000734 23/08/2017 190,400 190,400
671 0117R00908170000735 23/08/2017 190,400 190,400
672 0117R00908170000736 23/08/2017 190,400 190,400
673 0117R00908170000737 23/08/2017 190,400 190,400
674 0117R00908170000738 23/08/2017 190,400 190,400
675 0117R00908170000739 23/08/2017 190,400 190,400
676 0117R00908170000740 23/08/2017 190,400 190,400
677 0117R00908170000741 23/08/2017 190,400 190,400
678 0117R00908170000742 23/08/2017 190,400 190,400
679 0117R00908170000743 23/08/2017 190,400 190,400
680 0117R00908170000744 23/08/2017 190,400 190,400
681 0117R00908170000745 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
682 0117R00908170000746 23/08/2017 190,400 190,400

683 0117R00908170000747 23/08/2017 190,400 190,400
684 0117R00908170000748 23/08/2017 190,400 190,400
685 0117R00908170000749 23/08/2017 190,400 190,400
686 0117R00908170000750 23/08/2017 190,400 190,400
687 0117R00908170000751 23/08/2017 190,400 190,400
688 0117R00908170000752 23/08/2017 190,400 190,400
689 0117R00908170000753 23/08/2017 190,400 190,400
690 0117R00908170000755 23/08/2017 190,400 190,400
691 0117R00908170000756 23/08/2017 190,400 190,400
692 0117R00908170000757 23/08/2017 133,500 133,500
693 0117R00908170000758 23/08/2017 190,400 190,400
694 0117R00908170000759 23/08/2017 190,400 190,400
695 0117R00908170000760 23/08/2017 190,400 190,400
696 0117R00908170000761 23/08/2017 190,400 190,400
697 0117R00908170000762 23/08/2017 190,400 190,400
698 0117R00908170000763 23/08/2017 190,400 190,400
699 0117R00908170000764 23/08/2017 190,400 190,400
700 0117R00908170000765 23/08/2017 190,400 190,400
701 0117R00908170000766 23/08/2017 190,400 190,400
702 0117R00908170000767 23/08/2017 190,400 190,400
703 0117R00908170000768 23/08/2017 190,400 190,400
704 0117R00908170000770 23/08/2017 323,900 323,900
705 0117R00908170000771 23/08/2017 190,400 190,400
706 0117R00908170000772 23/08/2017 112,800 112,800
707 0117R00908170000773 23/08/2017 112,800 112,800
708 0117R00908170000774 23/08/2017 263,500 263,500
709 0117R00908170000775 23/08/2017 190,400 190,400
710 0117R00908170000776 23/08/2017 190,400 190,400
711 0117R00908170000777 23/08/2017 190,400 190,400
712 0117R00908170000779 23/08/2017 190,400 190,400
713 0117R00908170000780 23/08/2017 190,400 190,400
714 0117R00908170000781 23/08/2017 191,800 191,800
715 0117R00908170000783 23/08/2017 254,200 254,200
716 0117R00908170000784 23/08/2017 190,400 190,400
717 0117R00908170000785 23/08/2017 112,800 112,800
718 0117R00908170000786 23/08/2017 112,800 112,800
719 0117R00908170000787 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
720 0117R00908170000788 23/08/2017 190,400 190,400

721 0117R00908170000789 23/08/2017 190,400 190,400
722 0117R00908170000790 23/08/2017 112,800 112,800
723 0117R00908170000791 23/08/2017 190,400 190,400
724 0117R00908170000792 23/08/2017 112,800 112,800
725 0117R00908170000793 23/08/2017 191,800 191,800
726 0117R00908170000795 23/08/2017 190,400 190,400
727 0117R00908170000796 23/08/2017 112,800 112,800
728 0117R00908170000797 23/08/2017 190,400 190,400
729 0117R00908170000798 23/08/2017 190,400 190,400
730 0117R00908170000799 23/08/2017 191,800 191,800
731 0117R00908170000800 23/08/2017 190,400 190,400
732 0117R00908170000801 23/08/2017 112,800 112,800
733 0117R00908170000803 23/08/2017 193,100 193,100
734 0117R00908170000804 23/08/2017 190,400 190,400
735 0117R00908170000805 23/08/2017 190,400 190,400
736 0117R00908170000806 23/08/2017 123,900 123,900
737 0117R00908170000807 23/08/2017 190,400 190,400
738 0117R00908170000808 23/08/2017 190,400 190,400
739 0117R00908170000809 23/08/2017 190,400 190,400
740 0117R00908170000810 23/08/2017 190,400 190,400
741 0117R00908170000811 23/08/2017 190,400 190,400
742 0117R00908170000812 23/08/2017 311,300 311,300
743 0117R00908170000813 23/08/2017 190,400 190,400
744 0117R00908170000814 23/08/2017 112,800 112,800
745 0117R00908170000815 23/08/2017 190,400 190,400
746 0117R00908170000816 23/08/2017 112,800 112,800
747 0117R00908170000817 23/08/2017 190,400 190,400
748 0117R00908170000818 23/08/2017 190,400 190,400
749 0117R00908170000819 23/08/2017 190,400 190,400
750 0117R00908170000820 23/08/2017 190,400 190,400
751 0117R00908170000821 23/08/2017 254,200 254,200
752 0117R00908170000822 23/08/2017 191,800 191,800
753 0117R00908170000823 23/08/2017 311,300 311,300
754 0117R00908170000824 23/08/2017 263,500 263,500
755 0117R00908170000825 23/08/2017 190,400 190,400
756 0117R00908170000826 23/08/2017 254,200 254,200
757 0117R00908170000827 23/08/2017 263,500 263,500
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
758 0117R00908170000828 23/08/2017 190,400 190,400

759 0117R00908170000829 23/08/2017 311,300 311,300
760 0117R00908170000830 23/08/2017 191,800 191,800
761 0117R00908170000831 23/08/2017 190,400 190,400
762 0117R00908170000832 23/08/2017 190,400 190,400
763 0117R00908170000833 23/08/2017 191,800 191,800
764 0117R00908170000834 23/08/2017 263,500 263,500
765 0117R00908170000836 23/08/2017 112,800 112,800
766 0117R00908170000837 23/08/2017 190,400 190,400
767 0117R00908170000838 23/08/2017 190,400 190,400
768 0117R00908170000839 23/08/2017 190,400 190,400
769 0117R00908170000840 23/08/2017 461,900 461,900
770 0117R00908170000841 23/08/2017 190,400 190,400
771 0117R00908170000843 23/08/2017 190,400 190,400
772 0117R00908170000844 23/08/2017 191,800 191,800
773 0117R00908170000846 23/08/2017 190,400 190,400
774 0117R00908170000847 23/08/2017 190,400 190,400
775 0117R00908170000848 23/08/2017 112,800 112,800
776 0117R00908170000849 23/08/2017 190,400 190,400
777 0117R00908170000850 23/08/2017 189,400 189,400
778 0117R00908170000851 23/08/2017 254,200 254,200
779 0117R00908170000852 23/08/2017 190,400 190,400
780 0117R00908170000853 23/08/2017 193,100 193,100
781 0117R00908170000854 23/08/2017 576,900 576,900
782 0117R00908170000855 23/08/2017 190,400 190,400
783 0117R00908170000856 23/08/2017 190,400 190,400
784 0117R00908170000857 23/08/2017 190,400 190,400
785 0117R00908170000858 23/08/2017 190,400 190,400
786 0117R00908170000860 23/08/2017 190,400 190,400
787 0117R00908170000861 23/08/2017 112,800 112,800
788 0117R00908170000862 23/08/2017 112,800 112,800
789 0117R00908170000863 23/08/2017 323,900 323,900
790 0117R00908170000864 23/08/2017 190,400 190,400
791 0117R00908170000865 23/08/2017 112,800 112,800
792 0117R00908170000866 23/08/2017 190,400 190,400
793 0117R00908170000867 23/08/2017 576,900 576,900
794 0117R00908170000868 23/08/2017 112,800 112,800
795 0117R00908170000869 23/08/2017 576,900 576,900
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
796 0117R00908170000870 23/08/2017 263,500 263,500

797 0117R00908170000871 23/08/2017 190,400 190,400
798 0117R00908170000872 23/08/2017 576,900 576,900
799 0117R00908170000873 23/08/2017 323,900 323,900
800 0117R00908170000874 23/08/2017 190,400 190,400
801 0117R00908170000875 23/08/2017 254,200 254,200
802 0117R00908170000876 23/08/2017 112,800 112,800
803 0117R00908170000877 23/08/2017 576,900 576,900
804 0117R00908170000878 23/08/2017 190,400 190,400
805 0117R00908170000879 23/08/2017 576,900 576,900
806 0117R00908170000881 23/08/2017 190,400 190,400
807 0117R00908170000882 23/08/2017 112,800 112,800
808 0117R00908170000883 23/08/2017 190,400 190,400
809 0117R00908170000884 23/08/2017 112,800 112,800
810 0117R00908170000886 23/08/2017 191,800 191,800
811 0117R00908170000887 23/08/2017 190,400 190,400
812 0117R00908170000888 23/08/2017 254,200 254,200
813 0117R00908170000889 23/08/2017 311,300 311,300
814 0117R00908170000890 23/08/2017 190,400 190,400
815 0117R00908170000891 23/08/2017 112,800 112,800
816 0117R00908170000893 23/08/2017 190,400 190,400
817 0117R00908170000894 23/08/2017 191,800 191,800
818 0117R00908170000895 23/08/2017 190,400 190,400
819 0117R00908170000896 23/08/2017 254,200 254,200
820 0117R00908170000897 23/08/2017 190,400 190,400
821 0117R00908170000898 23/08/2017 191,800 191,800
822 0117R00908170000901 23/08/2017 190,400 190,400
823 0117R00908170000902 23/08/2017 311,300 311,300
824 0117R00908170000903 23/08/2017 112,800 112,800
825 0117R00908170000904 23/08/2017 190,400 190,400
826 0117R00908170000905 23/08/2017 190,400 190,400
827 0117R00908170000906 23/08/2017 132,900 132,900
828 0117R00908170000907 23/08/2017 112,800 112,800
829 0117R00908170000908 23/08/2017 191,800 191,800
830 0117R00908170000909 23/08/2017 311,300 311,300
831 0117R00908170000910 23/08/2017 193,100 193,100
832 0117R00908170000911 23/08/2017 191,800 191,800
833 0117R00908170000912 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
834 0117R00908170000913 23/08/2017 323,900 323,900

835 0117R00908170000914 23/08/2017 112,800 112,800
836 0117R00908170000915 23/08/2017 193,100 193,100
837 0117R00908170000917 23/08/2017 576,900 576,900
838 0117R00908170000918 23/08/2017 112,800 112,800
839 0117R00908170000919 23/08/2017 112,800 112,800
840 0117R00908170000920 23/08/2017 190,400 190,400
841 0117R00908170000921 23/08/2017 191,800 191,800
842 0117R00908170000922 23/08/2017 191,800 191,800
843 0117R00908170000923 23/08/2017 191,800 191,800
844 0117R00908170000924 23/08/2017 190,400 190,400
845 0117R00908170000926 23/08/2017 193,100 193,100
846 0117R00908170000927 23/08/2017 190,400 190,400
847 0117R00908170000928 23/08/2017 190,400 190,400
848 0117R00908170000929 23/08/2017 112,800 112,800
849 0117R00908170000930 23/08/2017 190,400 190,400
850 0117R00908170000931 23/08/2017 112,800 112,800
851 0117R00908170000932 23/08/2017 190,400 190,400
852 0117R00908170000933 23/08/2017 190,400 190,400
853 0117R00908170000934 23/08/2017 190,400 190,400
854 0117R00908170000935 23/08/2017 190,400 190,400
855 0117R00908170000936 23/08/2017 190,400 190,400
856 0117R00908170000937 23/08/2017 193,100 193,100
857 0117R00908170000938 23/08/2017 112,800 112,800
858 0117R00908170000939 23/08/2017 112,800 112,800
859 0117R00908170000940 23/08/2017 190,400 190,400
860 0117R00908170000941 23/08/2017 191,800 191,800
861 0117R00908170000942 23/08/2017 254,200 254,200
862 0117R00908170000944 23/08/2017 112,800 112,800
863 0117R00908170000945 23/08/2017 193,100 193,100
864 0117R00908170000946 23/08/2017 215,000 215,000
865 0117R00908170000948 23/08/2017 190,400 190,400
866 0117R00908170000949 23/08/2017 191,800 191,800
867 0117R00908170000950 23/08/2017 191,800 191,800
868 0117R00908170000951 23/08/2017 254,200 254,200
869 0117R00908170000952 23/08/2017 352,900 352,900
870 0117R00908170000954 23/08/2017 191,800 191,800
871 0117R00908170000956 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
872 0117R00908170000957 23/08/2017 191,800 191,800

873 0117R00908170000958 23/08/2017 190,400 190,400
874 0117R00908170000959 23/08/2017 323,900 323,900
875 0117R00908170000960 23/08/2017 191,800 191,800
876 0117R00908170000961 23/08/2017 254,200 254,200
877 0117R00908170000962 23/08/2017 190,400 190,400
878 0117R00908170000963 23/08/2017 190,400 190,400
879 0117R00908170000964 23/08/2017 190,400 190,400
880 0117R00908170000965 23/08/2017 190,400 190,400
881 0117R00908170000966 23/08/2017 190,400 190,400
882 0117R00908170000967 23/08/2017 190,400 190,400
883 0117R00908170000968 23/08/2017 190,400 190,400
884 0117R00908170000969 23/08/2017 190,400 190,400
885 0117R00908170000970 23/08/2017 190,400 190,400
886 0117R00908170000971 23/08/2017 190,400 190,400
887 0117R00908170000972 23/08/2017 190,400 190,400
888 0117R00908170000973 23/08/2017 190,400 190,400
889 0117R00908170000975 23/08/2017 190,400 190,400
890 0117R00908170000976 23/08/2017 190,400 190,400
891 0117R00908170000977 23/08/2017 190,400 190,400
892 0117R00908170000979 23/08/2017 190,400 190,400
893 0117R00908170000980 23/08/2017 190,400 190,400
894 0117R00908170000981 23/08/2017 190,400 190,400
895 0117R00908170000982 23/08/2017 191,800 191,800
896 0117R00908170000983 23/08/2017 190,400 190,400
897 0117R00908170000984 23/08/2017 190,400 190,400
898 0117R00908170000985 23/08/2017 190,400 190,400
899 0117R00908170000986 23/08/2017 190,400 190,400
900 0117R00908170000987 23/08/2017 190,400 190,400
901 0117R00908170000988 23/08/2017 190,400 190,400
902 0117R00908170000989 23/08/2017 190,400 190,400
903 0117R00908170000990 23/08/2017 190,400 190,400
904 0117R00908170000991 23/08/2017 190,400 190,400
905 0117R00908170000992 23/08/2017 190,400 190,400
906 0117R00908170000993 23/08/2017 190,400 190,400
907 0117R00908170000994 23/08/2017 190,400 190,400
908 0117R00908170000995 23/08/2017 190,400 190,400
909 0117R00908170000996 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
910 0117R00908170000997 23/08/2017 190,400 190,400

911 0117R00908170000998 23/08/2017 190,400 190,400
912 0117R00908170000999 23/08/2017 190,400 190,400
913 0117R00908170001000 23/08/2017 190,400 190,400
914 0117R00908170001001 23/08/2017 190,400 190,400
915 0117R00908170001002 23/08/2017 190,400 190,400
916 0117R00908170001003 23/08/2017 190,400 190,400
917 0117R00908170001004 23/08/2017 190,400 190,400
918 0117R00908170001005 23/08/2017 190,400 190,400
919 0117R00908170001006 23/08/2017 190,400 190,400
920 0117R00908170001007 23/08/2017 190,400 190,400
921 0117R00908170001008 23/08/2017 190,400 190,400
922 0117R00908170001009 23/08/2017 190,400 190,400
923 0117R00908170001010 23/08/2017 190,400 190,400
924 0117R00908170001011 23/08/2017 190,400 190,400
925 0117R00908170001012 23/08/2017 190,400 190,400
926 0117R00908170001013 23/08/2017 190,400 190,400
927 0117R00908170001014 23/08/2017 190,400 190,400
928 0117R00908170001015 23/08/2017 190,400 190,400
929 0117R00908170001016 23/08/2017 190,400 190,400
930 0117R00908170001017 23/08/2017 190,400 190,400
931 0117R00908170001018 23/08/2017 190,400 190,400
932 0117R00908170001019 23/08/2017 298,000 298,000
933 0117R00908170001020 23/08/2017 190,400 190,400
934 0117R00908170001021 23/08/2017 190,400 190,400
935 0117R00908170001022 23/08/2017 190,400 190,400
936 0117R00908170001023 23/08/2017 190,400 190,400
937 0117R00908170001024 23/08/2017 190,400 190,400
938 0117R00908170001025 23/08/2017 190,400 190,400
939 0117R00908170001026 23/08/2017 190,400 190,400
940 0117R00908170001027 23/08/2017 190,400 190,400
941 0117R00908170001028 23/08/2017 190,400 190,400
942 0117R00908170001029 23/08/2017 190,400 190,400
943 0117R00908170001030 23/08/2017 190,400 190,400
944 0117R00908170001031 23/08/2017 190,400 190,400
945 0117R00908170001032 23/08/2017 190,400 190,400
946 0117R00908170001033 23/08/2017 190,400 190,400
947 0117R00908170001034 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
948 0117R00908170001035 23/08/2017 190,400 190,400

949 0117R00908170001036 23/08/2017 112,800 112,800
950 0117R00908170001037 23/08/2017 323,900 323,900
951 0117R00908170001038 23/08/2017 323,900 323,900
952 0117R00908170001039 23/08/2017 191,800 191,800
953 0117R00908170001040 23/08/2017 190,400 190,400
954 0117R00908170001041 23/08/2017 190,400 190,400
955 0117R00908170001042 23/08/2017 298,000 298,000
956 0117R00908170001043 23/08/2017 190,400 190,400
957 0117R00908170001044 23/08/2017 190,400 190,400
958 0117R00908170001045 23/08/2017 190,400 190,400
959 0117R00908170001046 23/08/2017 190,400 190,400
960 0117R00908170001047 23/08/2017 190,400 190,400
961 0117R00908170001048 23/08/2017 190,400 190,400
962 0117R00908170001049 23/08/2017 190,400 190,400
963 0117R00908170001050 23/08/2017 190,400 190,400
964 0117R00908170001051 23/08/2017 190,400 190,400
965 0117R00908170001052 23/08/2017 190,400 190,400
966 0117R00908170001053 23/08/2017 112,800 112,800
967 0117R00908170001054 23/08/2017 190,400 190,400
968 0117R00908170001055 23/08/2017 190,400 190,400
969 0117R00908170001056 23/08/2017 190,400 190,400
970 0117R00908170001057 23/08/2017 190,400 190,400
971 0117R00908170001059 23/08/2017 190,400 190,400
972 0117R00908170001060 23/08/2017 112,800 112,800
973 0117R00908170001061 23/08/2017 190,400 190,400
974 0117R00908170001063 23/08/2017 112,800 112,800
975 0117R00908170001064 23/08/2017 190,400 190,400
976 0117R00908170001065 23/08/2017 190,400 190,400
977 0117R00908170001066 23/08/2017 190,400 190,400
978 0117R00908170001068 23/08/2017 112,800 112,800
979 0117R00908170001069 23/08/2017 190,400 190,400
980 0117R00908170001071 23/08/2017 190,400 190,400
981 0117R00908170001072 23/08/2017 190,400 190,400
982 0117R00908170001074 23/08/2017 190,400 190,400
983 0117R00908170001075 23/08/2017 190,400 190,400
984 0117R00908170001076 23/08/2017 112,800 112,800
985 0117R00908170001077 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
986 0117R00908170001079 23/08/2017 298,000 298,000

987 0117R00908170001080 23/08/2017 298,000 298,000
988 0117R00908170001081 23/08/2017 576,900 576,900
989 0117R00908170001082 23/08/2017 112,800 112,800
990 0117R00908170001083 23/08/2017 190,400 190,400
991 0117R00908170001084 23/08/2017 112,800 112,800
992 0117R00908170001086 23/08/2017 576,900 576,900
993 0117R00908170001087 23/08/2017 190,400 190,400
994 0117R00908170001088 23/08/2017 190,400 190,400
995 0117R00908170001089 23/08/2017 576,900 576,900
996 0117R00908170001091 23/08/2017 190,400 190,400
997 0117R00908170001093 23/08/2017 267,800 267,800
998 0117R00908170001094 23/08/2017 190,400 190,400
999 0117R00908170001095 23/08/2017 112,800 112,800
1000 0117R00908170001096 23/08/2017 190,400 190,400
1001 0117R00908170001098 23/08/2017 193,100 193,100
1002 0117R00908170001099 23/08/2017 311,300 311,300
1003 0117R00908170001100 23/08/2017 190,400 190,400
1004 0117R00908170001101 23/08/2017 190,400 190,400
1005 0117R00908170001102 23/08/2017 112,800 112,800
1006 0117R00908170001103 23/08/2017 190,400 190,400
1007 0117R00908170001104 23/08/2017 190,400 190,400
1008 0117R00908170001105 23/08/2017 190,400 190,400
1009 0117R00908170001106 23/08/2017 191,800 191,800
1010 0117R00908170001107 23/08/2017 190,400 190,400
1011 0117R00908170001108 23/08/2017 311,300 311,300
1012 0117R00908170001110 23/08/2017 190,400 190,400
1013 0117R00908170001112 23/08/2017 298,000 298,000
1014 0117R00908170001113 23/08/2017 193,100 193,100
1015 0117R00908170001114 23/08/2017 298,000 298,000
1016 0117R00908170001115 23/08/2017 190,400 190,400
1017 0117R00908170001116 23/08/2017 112,800 112,800
1018 0117R00908170001117 23/08/2017 190,400 190,400
1019 0117R00908170001119 23/08/2017 112,800 112,800
1020 0117R00908170001120 23/08/2017 323,900 323,900
1021 0117R00908170001122 23/08/2017 461,900 461,900
1022 0117R00908170001123 23/08/2017 190,400 190,400
1023 0117R00908170001124 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1024 0117R00908170001125 23/08/2017 190,400 190,400

1025 0117R00908170001126 23/08/2017 190,400 190,400
1026 0117R00908170001127 23/08/2017 190,400 190,400
1027 0117R00908170001128 23/08/2017 190,400 190,400
1028 0117R00908170001129 23/08/2017 190,400 190,400
1029 0117R00908170001130 23/08/2017 112,800 112,800
1030 0117R00908170001131 23/08/2017 190,400 190,400
1031 0117R00908170001132 23/08/2017 190,400 190,400
1032 0117R00908170001133 23/08/2017 190,400 190,400
1033 0117R00908170001134 23/08/2017 190,400 190,400
1034 0117R00908170001135 23/08/2017 190,400 190,400
1035 0117R00908170001136 23/08/2017 323,900 323,900
1036 0117R00908170001137 23/08/2017 112,800 112,800
1037 0117R00908170001138 23/08/2017 112,800 112,800
1038 0117R00908170001139 23/08/2017 112,800 112,800
1039 0117R00908170001140 23/08/2017 190,400 190,400
1040 0117R00908170001141 23/08/2017 190,400 190,400
1041 0117R00908170001143 23/08/2017 263,500 263,500
1042 0117R00908170001145 23/08/2017 311,300 311,300
1043 0117R00908170001146 23/08/2017 311,300 311,300
1044 0117R00908170001147 23/08/2017 311,300 311,300
1045 0117R00908170001148 23/08/2017 190,400 190,400
1046 0117R00908170001150 23/08/2017 190,400 190,400
1047 0117R00908170001151 23/08/2017 191,800 191,800
1048 0117R00908170001152 23/08/2017 254,200 254,200
1049 0117R00908170001153 23/08/2017 112,800 112,800
1050 0117R00908170001154 23/08/2017 193,100 193,100
1051 0117R00908170001155 23/08/2017 190,400 190,400
1052 0117R00908170001156 23/08/2017 190,400 190,400
1053 0117R00908170001157 23/08/2017 311,300 311,300
1054 0117R00908170001158 23/08/2017 190,400 190,400
1055 0117R00908170001159 23/08/2017 576,900 576,900
1056 0117R00908170001160 23/08/2017 112,800 112,800
1057 0117R00908170001161 23/08/2017 190,400 190,400
1058 0117R00908170001162 23/08/2017 112,800 112,800
1059 0117R00908170001163 23/08/2017 190,400 190,400
1060 0117R00908170001164 23/08/2017 190,400 190,400
1061 0117R00908170001165 23/08/2017 311,300 311,300
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1062 0117R00908170001166 23/08/2017 112,800 112,800

1063 0117R00908170001167 23/08/2017 112,800 112,800
1064 0117R00908170001168 23/08/2017 298,000 298,000
1065 0117R00908170001169 23/08/2017 190,400 190,400
1066 0117R00908170001170 23/08/2017 190,400 190,400
1067 0117R00908170001172 23/08/2017 190,400 190,400
1068 0117R00908170001173 23/08/2017 190,400 190,400
1069 0117R00908170001174 23/08/2017 112,800 112,800
1070 0117R00908170001175 23/08/2017 191,800 191,800
1071 0117R00908170001176 23/08/2017 190,400 190,400
1072 0117R00908170001177 23/08/2017 254,200 254,200
1073 0117R00908170001178 23/08/2017 267,800 267,800
1074 0117R00908170001179 23/08/2017 298,000 298,000
1075 0117R00908170001180 23/08/2017 112,800 112,800
1076 0117R00908170001181 23/08/2017 303,900 303,900
1077 0117R00908170001182 23/08/2017 193,100 193,100
1078 0117R00908170001183 23/08/2017 263,500 263,500
1079 0117R00908170001184 23/08/2017 190,400 190,400
1080 0117R00908170001185 23/08/2017 310,100 310,100
1081 0117R00908170001186 23/08/2017 311,300 311,300
1082 0117R00908170001187 23/08/2017 190,400 190,400
1083 0117R00908170001188 23/08/2017 190,400 190,400
1084 0117R00908170001189 23/08/2017 311,300 311,300
1085 0117R00908170001190 23/08/2017 112,800 112,800
1086 0117R00908170001191 23/08/2017 190,400 190,400
1087 0117R00908170001192 23/08/2017 143,900 143,900
1088 0117R00908170001193 23/08/2017 263,500 263,500
1089 0117R00908170001194 23/08/2017 112,800 112,800
1090 0117R00908170001195 23/08/2017 303,900 303,900
1091 0117R00908170001196 23/08/2017 193,100 193,100
1092 0117R00908170001198 23/08/2017 112,800 112,800
1093 0117R00908170001199 23/08/2017 112,800 112,800
1094 0117R00908170001200 23/08/2017 190,400 190,400
1095 0117R00908170001202 23/08/2017 254,200 254,200
1096 0117R00908170001203 23/08/2017 308,800 308,800
1097 0117R00908170001204 23/08/2017 112,800 112,800
1098 0117R00908170001205 23/08/2017 193,100 193,100
1099 0117R00908170001206 23/08/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1100 0117R00908170001207 23/08/2017 311,300 311,300

1101 0117R00908170001208 23/08/2017 190,400 190,400
1102 0117R00908170001209 23/08/2017 190,400 190,400
1103 0117R00908170001212 23/08/2017 190,400 190,400
1104 0117R00908170001213 23/08/2017 263,500 263,500
1105 0117R00908170001214 23/08/2017 112,800 112,800
1106 0117R00908170001215 23/08/2017 190,400 190,400
1107 0117R00908170001216 23/08/2017 190,400 190,400
1108 0117R00908170001217 23/08/2017 190,400 190,400
1109 0117R00908170001218 23/08/2017 190,400 190,400
1110 0117R00908170001219 23/08/2017 190,400 190,400
1111 0117R00908170001220 23/08/2017 190,400 190,400
1112 0117R00908170001221 23/08/2017 190,400 190,400
1113 0117R00908170001222 23/08/2017 190,400 190,400
1114 0117R00908170001223 23/08/2017 190,400 190,400
1115 0117R00908170001224 23/08/2017 193,100 193,100
1116 0117R00908170001226 23/08/2017 190,400 190,400
1117 0117R00908170001227 23/08/2017 191,800 191,800
1118 0117R00908170001228 23/08/2017 190,400 190,400
1119 0117R00908170001229 23/08/2017 112,800 112,800
1120 0117R00908170001230 23/08/2017 311,300 311,300
1121 0117R00908170001232 23/08/2017 112,800 112,800
1122 0117R00908170001233 23/08/2017 112,800 112,800
1123 0117R00908170001234 23/08/2017 112,800 112,800
1124 0117R00908170001235 23/08/2017 190,400 190,400
1125 0117R00908170001236 23/08/2017 191,800 191,800
1126 0117R00908170001237 23/08/2017 311,300 311,300
1127 0117R00908170001238 23/08/2017 112,800 112,800
1128 0117R00908170001239 23/08/2017 190,400 190,400
1129 0117R00908170001240 23/08/2017 190,400 190,400
1130 0117R00908170001241 23/08/2017 190,400 190,400
1131 0117R00908170001242 23/08/2017 190,400 190,400
1132 0117R00908170001243 23/08/2017 190,400 190,400
1133 0117R00908170001244 23/08/2017 112,800 112,800
1134 0117R00908170001245 23/08/2017 190,400 190,400
1135 0117R00908170001246 23/08/2017 190,400 190,400
1136 0117R00908170001247 23/08/2017 190,400 190,400
1137 0117R00908170001249 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1138 0117R00908170001250 23/08/2017 191,800 191,800

1139 0117R00908170001251 23/08/2017 576,900 576,900
1140 0117R00908170001252 23/08/2017 112,800 112,800
1141 0117R00908170001253 23/08/2017 254,200 254,200
1142 0117R00908170001254 23/08/2017 190,400 190,400
1143 0117R00908170001255 23/08/2017 190,400 190,400
1144 0117R00908170001259 23/08/2017 133,500 133,500
1145 0117R00908170001260 23/08/2017 112,800 112,800
1146 0117R00908170001261 23/08/2017 112,800 112,800
1147 0117R00908170001262 23/08/2017 547,100 547,100
1148 0117R00908170001264 23/08/2017 263,500 263,500
1149 0117R00908170001265 23/08/2017 298,000 298,000
1150 0117R00908170001266 23/08/2017 112,800 112,800
1151 0117R00908170001267 23/08/2017 190,400 190,400
1152 0117R00908170001268 23/08/2017 190,400 190,400
1153 0117R00908170001269 23/08/2017 190,400 190,400
1154 0117R00908170001270 23/08/2017 112,800 112,800
1155 0117R00908170001271 23/08/2017 190,400 190,400
1156 0117R00908170001272 23/08/2017 254,200 254,200
1157 0117R00908170001273 23/08/2017 190,400 190,400
1158 0117R00908170001274 23/08/2017 191,800 191,800
1159 0117R00908170001275 23/08/2017 263,500 263,500
1160 0117R00908170001276 23/08/2017 190,400 190,400
1161 0117R00908170001277 23/08/2017 263,500 263,500
1162 0117R00908170001278 23/08/2017 190,400 190,400
1163 0117R00908170001279 23/08/2017 190,400 190,400
1164 0117R00908170001280 23/08/2017 190,400 190,400
1165 0117R00908170001281 23/08/2017 112,800 112,800
1166 0117R00908170001282 23/08/2017 193,100 193,100
1167 0117R00908170001283 23/08/2017 263,500 263,500
1168 0117R00908170001284 23/08/2017 190,400 190,400
1169 0117R00908170001285 23/08/2017 190,400 190,400
1170 0117R00908170001286 23/08/2017 190,400 190,400
1171 0117R00908170001287 23/08/2017 112,800 112,800
1172 0117R00908170001288 23/08/2017 190,400 190,400
1173 0117R00908170001289 23/08/2017 190,400 190,400
1174 0117R00908170001291 23/08/2017 190,400 190,400
1175 0117R00908170001292 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1176 0117R00908170001293 23/08/2017 298,000 298,000

1177 0117R00908170001294 23/08/2017 190,400 190,400
1178 0117R00908170001295 23/08/2017 190,400 190,400
1179 0117R00908170001296 23/08/2017 190,400 190,400
1180 0117R00908170001297 23/08/2017 190,400 190,400
1181 0117R00908170001298 23/08/2017 112,800 112,800
1182 0117R00908170001299 23/08/2017 311,300 311,300
1183 0117R00908170001300 23/08/2017 190,400 190,400
1184 0117R00908170001301 23/08/2017 193,100 193,100
1185 0117R00908170001302 23/08/2017 298,000 298,000
1186 0117R00908170001303 23/08/2017 576,900 576,900
1187 0117R00908170001304 23/08/2017 298,000 298,000
1188 0117R00908170001305 23/08/2017 190,400 190,400
1189 0117R00908170001306 23/08/2017 190,400 190,400
1190 0117R00908170001307 23/08/2017 190,400 190,400
1191 0117R00908170001308 23/08/2017 190,400 190,400
1192 0117R00908170001310 23/08/2017 190,400 190,400
1193 0117R00908170001311 23/08/2017 311,300 311,300
1194 0117R00908170001313 23/08/2017 190,400 190,400
1195 0117R00908170001314 23/08/2017 263,500 263,500
1196 0117R00908170001315 23/08/2017 190,400 190,400
1197 0117R00908170001316 23/08/2017 263,500 263,500
1198 0117R00908170001317 23/08/2017 576,900 576,900
1199 0117R00908170001318 23/08/2017 190,400 190,400
1200 0117R00908170001319 23/08/2017 576,900 576,900
1201 0117R00908170001320 23/08/2017 190,400 190,400
1202 0117R00908170001321 23/08/2017 190,400 190,400
1203 0117R00908170001322 23/08/2017 190,400 190,400
1204 0117R00908170001323 23/08/2017 193,100 193,100
1205 0117R00908170001324 23/08/2017 190,400 190,400
1206 0117R00908170001325 23/08/2017 112,800 112,800
1207 0117R00908170001326 23/08/2017 190,400 190,400
1208 0117R00908170001327 23/08/2017 576,900 576,900
1209 0117R00908170001328 23/08/2017 190,400 190,400
1210 0117R00908170001329 23/08/2017 576,900 576,900
1211 0117R00908170001330 23/08/2017 190,400 190,400
1212 0117R00908170001331 23/08/2017 112,800 112,800
1213 0117R00908170001332 23/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1214 0117R00908170001333 23/08/2017 323,900 323,900

1215 0117R00908170001334 23/08/2017 190,400 190,400
1216 0117R00908170001335 23/08/2017 190,400 190,400
1217 0117R00908170001336 23/08/2017 267,800 267,800
1218 0117R00908170001337 23/08/2017 112,800 112,800
1219 0117R00908170001338 23/08/2017 112,800 112,800
1220 0117R00908170001339 23/08/2017 263,500 263,500
1221 0117R00908170001340 23/08/2017 190,400 190,400
1222 0117R00908170001341 23/08/2017 112,800 112,800
1223 0117R00908170001342 23/08/2017 190,400 190,400
1224 0117R00908170001343 23/08/2017 461,900 461,900
1225 0117R00908170001344 23/08/2017 323,900 323,900
1226 0117R00908170001345 23/08/2017 112,800 112,800
1227 0117R00908170001346 23/08/2017 112,800 112,800
1228 0117R00908170001347 23/08/2017 323,900 323,900
1229 0117R00908170001348 23/08/2017 735,800 735,800
1230 0117R00908170001349 23/08/2017 190,400 190,400
1231 0117R00908170001350 23/08/2017 190,400 190,400
1232 0117R00908170001351 23/08/2017 193,100 193,100
1233 0117R00908170001352 23/08/2017 190,400 190,400
1234 0117R00908170001353 23/08/2017 308,800 308,800
1235 0117R00908170001355 23/08/2017 112,800 112,800
1236 0117R00908170001356 23/08/2017 190,400 190,400
1237 0117R00908170001359 23/08/2017 323,900 323,900
1238 0117R00908170001361 23/08/2017 193,100 193,100
1239 0117R00908170001362 23/08/2017 112,800 112,800
1240 0117R00908170001364 23/08/2017 190,400 190,400
1241 0117R00908170001365 23/08/2017 576,900 576,900
1242 0117R00908170001366 23/08/2017 112,800 112,800
1243 0117R00908170001367 23/08/2017 190,400 190,400
1244 0117R00908170001368 23/08/2017 193,100 193,100
1245 0117R00908170001369 23/08/2017 323,900 323,900
1246 0117R00908170001371 23/08/2017 190,400 190,400
1247 0117R00908170001372 23/08/2017 190,400 190,400
1248 0117R00908170001374 23/08/2017 190,400 190,400
1249 0117R00908170001375 23/08/2017 190,400 190,400
1250 0117R00908170001377 23/08/2017 112,800 112,800
1251 0117R00908170001378 23/08/2017 254,200 254,200
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1252 0117R00908170001379 23/08/2017 112,800 112,800

1253 0117R00908170001380 23/08/2017 190,400 190,400
1254 0117R00908170001381 23/08/2017 112,800 112,800
1255 0117R00908170001382 23/08/2017 190,400 190,400
1256 0117R00908170001383 23/08/2017 112,800 112,800
1257 0117R00908170001384 23/08/2017 254,200 254,200
1258 0117R00908170001385 23/08/2017 190,400 190,400
1259 0117R00908170001386 23/08/2017 112,800 112,800
1260 0117R00908170001388 23/08/2017 191,800 191,800
1261 0117R00908170001389 23/08/2017 190,400 190,400
1262 0117R00908170001390 23/08/2017 190,400 190,400
1263 0117R00908170001391 23/08/2017 191,800 191,800
1264 0117R00908170001392 23/08/2017 254,200 254,200
1265 0117R00908170001394 23/08/2017 191,800 191,800
1266 0117R00908170001395 23/08/2017 191,800 191,800
1267 0117R00908170001397 23/08/2017 254,200 254,200
1268 0117R00908170001398 23/08/2017 191,800 191,800
1269 0117R00908170001400 23/08/2017 191,800 191,800
1270 0117R00908170001403 23/08/2017 191,800 191,800
1271 0117R00908170001405 23/08/2017 323,900 323,900
1272 0117R00908170001406 23/08/2017 191,800 191,800
1273 0117R00908170001407 23/08/2017 323,900 323,900
1274 0117R00908170001408 23/08/2017 190,400 190,400
1275 0117R00908170001409 23/08/2017 110,000 110,000
1276 0117R00908170001410 25/08/2017 190,400 190,400
1277 0117R00908170001411 25/08/2017 190,400 190,400
1278 0117R00908170001412 25/08/2017 190,400 190,400
1279 0117R00908170001413 25/08/2017 190,400 190,400
1280 0117R00908170001414 25/08/2017 190,400 190,400
1281 0117R00908170001416 25/08/2017 190,400 190,400
1282 0117R00908170001417 25/08/2017 190,400 190,400
1283 0117R00908170001418 25/08/2017 191,800 191,800
1284 0117R00908170001419 25/08/2017 191,800 191,800
1285 0117R00908170001420 25/08/2017 190,400 190,400
1286 0117R00908170001421 25/08/2017 217,000 217,000
1287 0117R00908170001422 25/08/2017 190,400 190,400
1288 0117R00908170001423 25/08/2017 190,400 190,400
1289 0117R00908170001424 25/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1290 0117R00908170001425 25/08/2017 190,400 190,400

1291 0117R00908170001426 25/08/2017 190,400 190,400
1292 0117R00908170001427 25/08/2017 190,400 190,400
1293 0117R00908170001428 25/08/2017 190,400 190,400
1294 0117R00908170001429 25/08/2017 190,400 190,400
1295 0117R00908170001430 25/08/2017 190,400 190,400
1296 0117R00908170001431 25/08/2017 190,400 190,400
1297 0117R00908170001432 25/08/2017 190,400 190,400
1298 0117R00908170001433 25/08/2017 190,400 190,400
1299 0117R00908170001434 25/08/2017 190,400 190,400
1300 0117R00908170001435 25/08/2017 112,800 112,800
1301 0117R00908170001436 25/08/2017 191,800 191,800
1302 0117R00908170001437 25/08/2017 190,400 190,400
1303 0117R00908170001439 25/08/2017 461,900 461,900
1304 0117R00908170001440 25/08/2017 190,400 190,400
1305 0117R00908170001441 25/08/2017 191,800 191,800
1306 0117R00908170001442 25/08/2017 190,400 190,400
1307 0117R00908170001443 25/08/2017 190,400 190,400
1308 0117R00908170001444 25/08/2017 190,400 190,400
1309 0117R00908170001445 25/08/2017 112,800 112,800
1310 0117R00908170001446 25/08/2017 191,800 191,800
1311 0117R00908170001447 25/08/2017 190,400 190,400
1312 0117R00908170001448 25/08/2017 190,400 190,400
1313 0117R00908170001449 25/08/2017 461,900 461,900
1314 0117R00908170001450 25/08/2017 112,800 112,800
1315 0117R00908170001451 25/08/2017 323,900 323,900
1316 0117R00908170001452 25/08/2017 112,800 112,800
1317 0117R00908170001454 25/08/2017 190,400 190,400
1318 0117R00908170001455 25/08/2017 190,400 190,400
1319 0117R00908170001456 25/08/2017 190,400 190,400
1320 0117R00908170001457 25/08/2017 193,100 193,100
1321 0117R00908170001458 25/08/2017 298,000 298,000
1322 0117R00908170001459 25/08/2017 190,400 190,400
1323 0117R00908170001461 25/08/2017 298,000 298,000
1324 0117R00908170001462 25/08/2017 190,400 190,400
1325 0117R00908170001463 25/08/2017 112,800 112,800
1326 0117R00908170001464 25/08/2017 190,400 190,400
1327 0117R00908170001465 25/08/2017 576,900 576,900
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1328 0117R00908170001466 25/08/2017 190,400 190,400

1329 0117R00908170001468 25/08/2017 190,400 190,400
1330 0117R00908170001469 25/08/2017 190,400 190,400
1331 0117R00908170001470 25/08/2017 112,800 112,800
1332 0117R00908170001471 25/08/2017 112,800 112,800
1333 0117R00908170001472 25/08/2017 190,400 190,400
1334 0117R00908170001473 25/08/2017 190,400 190,400
1335 0117R00908170001474 25/08/2017 190,400 190,400
1336 0117R00908170001475 25/08/2017 190,400 190,400
1337 0117R00908170001476 25/08/2017 191,800 191,800
1338 0117R00908170001477 25/08/2017 461,900 461,900
1339 0117R00908170001478 25/08/2017 190,400 190,400
1340 0117R00908170001480 25/08/2017 193,100 193,100
1341 0117R00908170001481 25/08/2017 191,800 191,800
1342 0117R00908170001483 25/08/2017 112,800 112,800
1343 0117R00908170001484 25/08/2017 298,000 298,000
1344 0117R00908170001485 25/08/2017 298,000 298,000
1345 0117R00908170001486 25/08/2017 112,800 112,800
1346 0117R00908170001487 25/08/2017 298,000 298,000
1347 0117R00908170001488 25/08/2017 190,400 190,400
1348 0117R00908170001489 25/08/2017 112,800 112,800
1349 0117R00908170001490 25/08/2017 190,400 190,400
1350 0117R00908170001491 25/08/2017 190,400 190,400
1351 0117R00908170001493 25/08/2017 112,800 112,800
1352 0117R00908170001494 25/08/2017 190,400 190,400
1353 0117R00908170001496 25/08/2017 190,400 190,400
1354 0117R00908170001497 25/08/2017 190,400 190,400
1355 0117R00908170001498 25/08/2017 190,400 190,400
1356 0117R00908170001499 25/08/2017 190,400 190,400
1357 0117R00908170001500 25/08/2017 190,400 190,400
1358 0117R00908170001501 25/08/2017 133,500 133,500
1359 0117R00908170001502 25/08/2017 190,400 190,400
1360 0117R00908170001503 25/08/2017 190,400 190,400
1361 0117R00908170001504 25/08/2017 298,000 298,000
1362 0117R00908170001505 25/08/2017 190,400 190,400
1363 0117R00908170001507 25/08/2017 190,400 190,400
1364 0117R00908170001508 25/08/2017 190,400 190,400
1365 0117R00908170001509 25/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1366 0117R00908170001511 25/08/2017 190,400 190,400

1367 0117R00908170001512 25/08/2017 254,200 254,200
1368 0117R00908170001513 25/08/2017 112,800 112,800
1369 0117R00908170001514 25/08/2017 190,400 190,400
1370 0117R00908170001516 25/08/2017 112,800 112,800
1371 0117R00908170001518 25/08/2017 311,300 311,300
1372 0117R00908170001519 25/08/2017 112,800 112,800
1373 0117R00908170001520 25/08/2017 190,400 190,400
1374 0117R00908170001521 25/08/2017 112,800 112,800
1375 0117R00908170001522 25/08/2017 190,400 190,400
1376 0117R00908170001523 25/08/2017 190,400 190,400
1377 0117R00908170001524 25/08/2017 190,400 190,400
1378 0117R00908170001525 25/08/2017 311,300 311,300
1379 0117R00908170001526 25/08/2017 190,400 190,400
1380 0117R00908170001527 25/08/2017 190,400 190,400
1381 0117R00908170001528 25/08/2017 190,400 190,400
1382 0117R00908170001529 25/08/2017 190,400 190,400
1383 0117R00908170001531 25/08/2017 190,400 190,400
1384 0117R00908170001533 25/08/2017 190,400 190,400
1385 0117R00908170001534 25/08/2017 190,400 190,400
1386 0117R00908170001535 25/08/2017 190,400 190,400
1387 0117R00908170001536 25/08/2017 190,400 190,400
1388 0117R00908170001537 25/08/2017 190,400 190,400
1389 0117R00908170001538 25/08/2017 190,400 190,400
1390 0117R00908170001539 25/08/2017 190,400 190,400
1391 0117R00908170001540 25/08/2017 190,400 190,400
1392 0117R00908170001541 25/08/2017 190,400 190,400
1393 0117R00908170001542 25/08/2017 190,400 190,400
1394 0117R00908170001543 25/08/2017 190,400 190,400
1395 0117R00908170001544 25/08/2017 190,400 190,400
1396 0117R00908170001545 25/08/2017 263,500 263,500
1397 0117R00908170001546 25/08/2017 112,800 112,800
1398 0117R00908170001547 25/08/2017 190,400 190,400
1399 0117R00908170001548 25/08/2017 190,400 190,400
1400 0117R00908170001549 25/08/2017 323,900 323,900
1401 0117R00908170001550 25/08/2017 190,400 190,400
1402 0117R00908170001551 25/08/2017 112,800 112,800
1403 0117R00908170001552 25/08/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1404 0117R00908170001553 25/08/2017 190,400 190,400

1405 0117R00908170001554 25/08/2017 190,400 190,400
1406 0117R00908170001555 25/08/2017 190,400 190,400
1407 0117R00908170001557 25/08/2017 191,800 191,800
1408 0117R00908170001558 25/08/2017 190,400 190,400
1409 0117R00908170001559 25/08/2017 190,400 190,400
1410 0117R00908170001560 25/08/2017 190,400 190,400
1411 0117R00908170001561 25/08/2017 190,400 190,400
1412 0117R00908170001563 25/08/2017 263,500 263,500
1413 0117R00908170001564 25/08/2017 191,800 191,800
1414 0117R00908170001565 25/08/2017 112,800 112,800
1415 0117R00908170001567 25/08/2017 190,400 190,400
1416 0117R00908170001568 25/08/2017 112,800 112,800
1417 0117R00908170001569 25/08/2017 190,400 190,400
1418 0117R00908170001570 25/08/2017 190,400 190,400
1419 0117R00908170001571 25/08/2017 112,800 112,800
1420 0117R00908170001572 25/08/2017 190,400 190,400
1421 0117R00908170001573 25/08/2017 190,400 190,400
1422 0117R00908170001574 25/08/2017 190,400 190,400
1423 0117R00908170001575 25/08/2017 112,800 112,800
1424 0117R00908170001576 25/08/2017 190,400 190,400
1425 0117R00908170001578 25/08/2017 112,800 112,800
1426 0117R00908170001579 25/08/2017 190,400 190,400
1427 0117R00908170001580 25/08/2017 190,400 190,400
1428 0117R00908170001581 25/08/2017 190,400 190,400
1429 0117R00908170001583 25/08/2017 258,100 258,100
1430 0117R00908170001584 25/08/2017 190,400 190,400
1431 0117R00908170001585 25/08/2017 112,800 112,800
1432 0117R00908170001586 25/08/2017 190,400 190,400
1433 0117R00908170001587 25/08/2017 190,400 190,400
1434 0117R00908170001588 25/08/2017 323,900 323,900
1435 0117R00908170001589 25/08/2017 191,800 191,800
1436 0117R00908170001591 25/08/2017 190,400 190,400
1437 0117R00908170001592 25/08/2017 298,000 298,000
1438 0117R00908170001593 25/08/2017 133,500 133,500
1439 0117R00908170001594 25/08/2017 190,400 190,400
1440 0117R00908170001596 25/08/2017 112,800 112,800
1441 0117R00908170001597 25/08/2017 191,800 191,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1442 0117R00908170001599 25/08/2017 190,400 190,400

1443 0117R00908170001600 25/08/2017 112,800 112,800
1444 0117R00908170001601 25/08/2017 112,800 112,800
1445 0117R00908170001603 25/08/2017 133,500 133,500
1446 0117R00908170001604 25/08/2017 190,400 190,400
1447 0117R00908170001605 25/08/2017 190,400 190,400
1448 0117R00908170001606 25/08/2017 263,500 263,500
1449 0117R00908170001607 25/08/2017 133,500 133,500
1450 0117R00908170001608 25/08/2017 190,400 190,400
1451 0117R00908170001609 25/08/2017 193,100 193,100
1452 0117R00908170001610 25/08/2017 112,800 112,800
1453 0117R00908170001611 25/08/2017 133,500 133,500
1454 0117R00908170001612 25/08/2017 190,400 190,400
1455 0117R00908170001613 25/08/2017 263,500 263,500
1456 0117R00908170001614 25/08/2017 190,400 190,400
1457 0117R00908170001615 25/08/2017 133,500 133,500
1458 0117R00908170001616 25/08/2017 112,800 112,800
1459 0117R00908170001618 25/08/2017 190,400 190,400
1460 0117R00908170001620 25/08/2017 190,400 190,400
1461 0117R00908170001621 25/08/2017 254,200 254,200
1462 0117R00908170001622 25/08/2017 263,500 263,500
1463 0117R00908170001623 25/08/2017 191,800 191,800
1464 0117R00908170001624 25/08/2017 112,800 112,800
1465 0117R00908170001625 25/08/2017 190,400 190,400
1466 0117R00908170001626 25/08/2017 190,400 190,400
1467 0117R00908170001627 25/08/2017 190,400 190,400
1468 0117R00908170001628 25/08/2017 190,400 190,400
1469 0117R00908170001629 25/08/2017 263,500 263,500
1470 0117R00908170001630 25/08/2017 190,400 190,400
1471 0117R00908170001631 25/08/2017 191,800 191,800
1472 0117R00908170001632 25/08/2017 190,400 190,400
1473 0117R00908170001633 25/08/2017 112,800 112,800
1474 0117R00908170001634 25/08/2017 190,400 190,400
1475 0117R00908170001635 25/08/2017 190,400 190,400
1476 0117R00908170001636 25/08/2017 190,400 190,400
1477 0117R00908170001638 25/08/2017 190,400 190,400
1478 0117R00908170001639 25/08/2017 190,400 190,400
1479 0117R00908170001640 25/08/2017 358,700 358,700
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1480 0117R00908170001641 25/08/2017 190,400 190,400

1481 0117R00908170001642 25/08/2017 190,400 190,400
1482 0117R00908170001644 25/08/2017 190,400 190,400
1483 0117R00908170001645 25/08/2017 190,400 190,400
1484 0117R00908170001646 25/08/2017 191,800 191,800
1485 0117R00908170001647 25/08/2017 190,400 190,400
1486 0117R00908170001648 25/08/2017 190,400 190,400
1487 0117R00908170001649 25/08/2017 190,400 190,400
1488 0117R00908170001650 25/08/2017 190,400 190,400
1489 0117R00908170001652 25/08/2017 112,800 112,800
1490 0117R00908170001653 25/08/2017 190,400 190,400
1491 0117R00908170001654 25/08/2017 112,800 112,800
1492 0117R00908170001655 25/08/2017 190,400 190,400
1493 0117R00908170001656 25/08/2017 190,400 190,400
1494 0117R00908170001657 25/08/2017 193,100 193,100
1495 0117R00908170001658 23/08/2017 112,800 112,800
1496 0117R00908170001659 25/08/2017 190,400 190,400
1497 0117R00908170001660 25/08/2017 190,400 190,400
1498 0117R00908170001661 25/08/2017 190,400 190,400
1499 0117R00908170001662 25/08/2017 112,800 112,800
1500 0117R00908170001663 25/08/2017 190,400 190,400
1501 0117R00908170001664 25/08/2017 112,800 112,800
1502 0117R00908170001665 25/08/2017 263,500 263,500
1503 0117R00908170001666 25/08/2017 190,400 190,400
1504 0117R00908170001667 25/08/2017 112,800 112,800
1505 0117R00908170001669 25/08/2017 190,400 190,400
1506 0117R00908170001670 25/08/2017 190,400 190,400
1507 0117R00908170001671 25/08/2017 190,400 190,400
1508 0117R00908170001672 25/08/2017 190,400 190,400
1509 0117R00908170001673 25/08/2017 112,800 112,800
1510 0117R00908170001674 25/08/2017 190,400 190,400
1511 0117R00908170001675 25/08/2017 190,400 190,400
1512 0117R00908170001676 25/08/2017 190,400 190,400
1513 0117R00908170001677 25/08/2017 311,300 311,300
1514 0117R00908170001679 25/08/2017 190,400 190,400
1515 0117R00908170001680 25/08/2017 112,800 112,800
1516 0117R00908170001681 25/08/2017 190,400 190,400
1517 0117R00908170001682 25/08/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1518 0117R00908170001683 25/08/2017 191,800 191,800

1519 0117R00908170001684 25/08/2017 112,800 112,800
1520 0117R00908170001685 25/08/2017 190,400 190,400
1521 0117R00908170001687 25/08/2017 112,800 112,800
1522 0117R00908170001689 25/08/2017 190,400 190,400
1523 0117R00908170001690 25/08/2017 263,500 263,500
1524 0117R00908170001691 25/08/2017 112,800 112,800
1525 0117R00908170001694 25/08/2017 190,400 190,400
1526 0117R00908170001695 25/08/2017 190,400 190,400
1527 0117R00908170001696 25/08/2017 190,400 190,400
1528 0117R00908170001697 25/08/2017 112,800 112,800
1529 0117R00908170001698 25/08/2017 112,800 112,800
1530 0117R00908170001700 25/08/2017 190,400 190,400
1531 0117R00908170001701 25/08/2017 263,500 263,500
1532 0117R00908170001703 25/08/2017 190,400 190,400
1533 0117R00908170001704 25/08/2017 263,500 263,500
1534 0117R00908170001705 25/08/2017 190,400 190,400
1535 0117R00908170001706 25/08/2017 190,400 190,400
1536 0117R00908170001707 25/08/2017 190,400 190,400
1537 0117R00908170001708 25/08/2017 190,400 190,400
1538 0117R00908170001709 25/08/2017 190,400 190,400
1539 0117R00908170001711 25/08/2017 254,200 254,200
1540 0117R00908170001714 25/08/2017 576,900 576,900
1541 0117R00908170001716 25/08/2017 112,800 112,800
1542 0117R00908170001717 25/08/2017 112,800 112,800
1543 0117R00908170001718 25/08/2017 263,500 263,500
1544 0117R00908170001719 25/08/2017 254,200 254,200
1545 0117R00908170001720 25/08/2017 576,900 576,900
1546 0117R00908170001721 25/08/2017 576,900 576,900
1547 0117R00908170001723 25/08/2017 112,800 112,800
1548 0117R00908170001724 25/08/2017 190,400 190,400
1549 0117R00908170001725 25/08/2017 576,900 576,900
1550 0117R00908170001726 25/08/2017 254,200 254,200
1551 0117R00908170001727 25/08/2017 576,900 576,900
1552 0117R00908170001728 25/08/2017 576,900 576,900
1553 0117R00908170001729 25/08/2017 190,400 190,400
1554 0117R00908170001730 25/08/2017 190,400 190,400
1555 0117R00908170001731 25/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1556 0117R00908170001732 25/08/2017 190,400 190,400

1557 0117R00908170001733 25/08/2017 263,500 263,500
1558 0117R00908170001735 25/08/2017 112,800 112,800
1559 0117R00908170001736 25/08/2017 112,800 112,800
1560 0117R00908170001737 25/08/2017 190,400 190,400
1561 0117R00908170001738 25/08/2017 133,500 133,500
1562 0117R00908170001739 25/08/2017 190,400 190,400
1563 0117R00908170001740 25/08/2017 112,800 112,800
1564 0117R00908170001741 25/08/2017 190,400 190,400
1565 0117R00908170001742 25/08/2017 323,900 323,900
1566 0117R00908170001743 25/08/2017 112,800 112,800
1567 0117R00908170001744 25/08/2017 190,400 190,400
1568 0117R00908170001745 25/08/2017 112,800 112,800
1569 0117R00908170001746 25/08/2017 112,800 112,800
1570 0117R00908170001748 25/08/2017 191,800 191,800
1571 0117R00908170001749 25/08/2017 112,800 112,800
1572 0117R00908170001750 25/08/2017 112,800 112,800
1573 0117R00908170001751 25/08/2017 191,800 191,800
1574 0117R00908170001752 25/08/2017 576,900 576,900
1575 0117R00908170001753 25/08/2017 323,900 323,900
1576 0117R00908170001754 25/08/2017 254,200 254,200
1577 0117R00908170001756 25/08/2017 190,400 190,400
1578 0117R00908170001757 25/08/2017 190,400 190,400
1579 0117R00908170001758 25/08/2017 191,800 191,800
1580 0117R00908170001759 25/08/2017 112,800 112,800
1581 0117R00908170001760 25/08/2017 190,400 190,400
1582 0117R00908170001761 25/08/2017 190,400 190,400
1583 0117R00908170001762 25/08/2017 190,400 190,400
1584 0117R00908170001763 25/08/2017 112,800 112,800
1585 0117R00908170001764 25/08/2017 112,800 112,800
1586 0117R00908170001765 25/08/2017 311,300 311,300
1587 0117R00908170001766 25/08/2017 190,400 190,400
1588 0117R00908170001767 25/08/2017 190,400 190,400
1589 0117R00908170001768 25/08/2017 190,400 190,400
1590 0117R00908170001769 25/08/2017 190,400 190,400
1591 0117R00908170001770 25/08/2017 191,800 191,800
1592 0117R00908170001771 25/08/2017 190,400 190,400
1593 0117R00908170001772 25/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1594 0117R00908170001773 25/08/2017 112,800 112,800

1595 0117R00908170001774 25/08/2017 311,300 311,300
1596 0117R00908170001775 25/08/2017 112,800 112,800
1597 0117R00908170001776 25/08/2017 112,800 112,800
1598 0117R00908170001777 25/08/2017 193,100 193,100
1599 0117R00908170001778 25/08/2017 190,400 190,400
1600 0117R00908170001779 25/08/2017 190,400 190,400
1601 0117R00908170001780 25/08/2017 190,400 190,400
1602 0117R00908170001781 25/08/2017 190,400 190,400
1603 0117R00908170001782 25/08/2017 193,100 193,100
1604 0117R00908170001783 25/08/2017 190,400 190,400
1605 0117R00908170001784 25/08/2017 112,800 112,800
1606 0117R00908170001785 25/08/2017 311,300 311,300
1607 0117R00908170001786 25/08/2017 190,400 190,400
1608 0117R00908170001787 25/08/2017 112,800 112,800
1609 0117R00908170001788 25/08/2017 323,900 323,900
1610 0117R00908170001789 25/08/2017 193,100 193,100
1611 0117R00908170001790 25/08/2017 576,900 576,900
1612 0117R00908170001791 25/08/2017 191,800 191,800
1613 0117R00908170001792 25/08/2017 576,900 576,900
1614 0117R00908170001793 25/08/2017 193,100 193,100
1615 0117R00908170001794 25/08/2017 193,100 193,100
1616 0117R00908170001795 25/08/2017 191,800 191,800
1617 0117R00908170001796 25/08/2017 191,800 191,800
1618 0117R00908170001797 25/08/2017 112,800 112,800
1619 0117R00908170001798 25/08/2017 190,400 190,400
1620 0117R00908170001799 25/08/2017 112,800 112,800
1621 0117R00908170001800 25/08/2017 576,900 576,900
1622 0117R00908170001801 25/08/2017 193,100 193,100
1623 0117R00908170001802 25/08/2017 547,100 547,100
1624 0117R00908170001803 25/08/2017 191,800 191,800
1625 0117R00908170001804 25/08/2017 323,900 323,900
1626 0117R00908170001805 25/08/2017 190,400 190,400
1627 0117R00908170001806 25/08/2017 311,300 311,300
1628 0117R00908170001807 25/08/2017 311,300 311,300
1629 0117R00908170001809 25/08/2017 323,900 323,900
1630 0117R00908170001810 25/08/2017 323,900 323,900
1631 0117R00908170001811 25/08/2017 254,200 254,200
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1632 0117R00908170001812 25/08/2017 191,800 191,800

1633 0117R00908170001813 25/08/2017 191,800 191,800
1634 0117R00908170001814 25/08/2017 323,900 323,900
1635 0117R00908170001818 25/08/2017 191,800 191,800
1636 0117R00908170001819 25/08/2017 191,800 191,800
1637 0117R00908170001821 25/08/2017 190,400 190,400
1638 0117R00908170001822 25/08/2017 254,200 254,200
1639 0117R00908170001823 25/08/2017 191,800 191,800
1640 0117R00908170001824 25/08/2017 190,400 190,400
1641 0117R00908170001825 25/08/2017 190,400 190,400
1642 0117R00908170001826 25/08/2017 190,400 190,400
1643 0117R00908170001827 25/08/2017 190,400 190,400
1644 0117R00908170001828 25/08/2017 190,400 190,400
1645 0117R00908170001829 25/08/2017 190,400 190,400
1646 0117R00908170001830 25/08/2017 190,400 190,400
1647 0117R00908170001831 25/08/2017 190,400 190,400
1648 0117R00908170001832 25/08/2017 190,400 190,400
1649 0117R00908170001833 25/08/2017 190,400 190,400
1650 0117R00908170001834 25/08/2017 190,400 190,400
1651 0117R00908170001835 25/08/2017 190,400 190,400
1652 0117R00908170001836 25/08/2017 190,400 190,400
1653 0117R00908170001837 25/08/2017 190,400 190,400
1654 0117R00908170001838 25/08/2017 190,400 190,400
1655 0117R00908170001839 25/08/2017 190,400 190,400
1656 0117R00908170001840 25/08/2017 190,400 190,400
1657 0117R00908170001841 25/08/2017 190,400 190,400
1658 0117R00908170001842 25/08/2017 190,400 190,400
1659 0117R00908170001843 25/08/2017 190,400 190,400
1660 0117R00908170001844 25/08/2017 303,900 303,900
1661 0117R00908170001845 25/08/2017 190,400 190,400
1662 0117R00908170001846 25/08/2017 190,400 190,400
1663 0117R00908170001847 25/08/2017 190,400 190,400
1664 0117R00908170001848 25/08/2017 190,400 190,400
1665 0117R00908170001849 25/08/2017 190,400 190,400
1666 0117R00908170001850 25/08/2017 190,400 190,400
1667 0117R00908170001851 25/08/2017 190,400 190,400
1668 0117R00908170001852 25/08/2017 190,400 190,400
1669 0117R00908170001853 25/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1670 0117R00908170001854 25/08/2017 190,400 190,400

1671 0117R00908170001855 25/08/2017 190,400 190,400
1672 0117R00908170001856 25/08/2017 190,400 190,400
1673 0117R00908170001857 25/08/2017 190,400 190,400
1674 0117R00908170001858 25/08/2017 190,400 190,400
1675 0117R00908170001859 25/08/2017 190,400 190,400
1676 0117R00908170001860 25/08/2017 190,400 190,400
1677 0117R00908170001861 25/08/2017 190,400 190,400
1678 0117R00908170001862 25/08/2017 190,400 190,400
1679 0117R00908170001863 25/08/2017 190,400 190,400
1680 0117R00908170001864 25/08/2017 190,400 190,400
1681 0117R00908170001865 25/08/2017 190,400 190,400
1682 0117R00908170001866 25/08/2017 311,300 311,300
1683 0117R00908170001867 25/08/2017 190,400 190,400
1684 0117R00908170001868 25/08/2017 190,400 190,400
1685 0117R00908170001869 25/08/2017 190,400 190,400
1686 0117R00908170001870 25/08/2017 190,400 190,400
1687 0117R00908170001871 25/08/2017 190,400 190,400
1688 0117R00908170001872 25/08/2017 190,400 190,400
1689 0117R00908170001873 25/08/2017 190,400 190,400
1690 0117R00908170001874 25/08/2017 190,400 190,400
1691 0117R00908170001875 25/08/2017 190,400 190,400
1692 0117R00908170001876 25/08/2017 190,400 190,400
1693 0117R00908170001877 25/08/2017 190,400 190,400
1694 0117R00908170001878 25/08/2017 190,400 190,400
1695 0117R00908170001879 25/08/2017 190,400 190,400
1696 0117R00908170001880 25/08/2017 190,400 190,400
1697 0117R00908170001881 25/08/2017 190,400 190,400
1698 0117R00908170001882 25/08/2017 576,900 576,900
1699 0117R00908170001883 25/08/2017 190,400 190,400
1700 0117R00908170001884 25/08/2017 190,400 190,400
1701 0117R00908170001885 25/08/2017 190,400 190,400
1702 0117R00908170001888 25/08/2017 190,400 190,400
1703 0117R00908170001889 25/08/2017 190,400 190,400
1704 0117R00908170001890 25/08/2017 323,900 323,900
1705 0117R00908170001892 25/08/2017 190,400 190,400
1706 0117R00908170001893 25/08/2017 190,400 190,400
1707 0117R00908170001894 25/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1708 0117R00908170001895 25/08/2017 190,400 190,400

1709 0117R00908170001896 25/08/2017 190,400 190,400
1710 0117R00908170001897 25/08/2017 190,400 190,400
1711 0117R00908170001898 25/08/2017 190,400 190,400
1712 0117R00908170001899 25/08/2017 190,400 190,400
1713 0117R00908170001900 25/08/2017 190,400 190,400
1714 0117R00908170001901 25/08/2017 190,400 190,400
1715 0117R00908170001902 25/08/2017 190,400 190,400
1716 0117R00908170001903 25/08/2017 190,400 190,400
1717 0117R00908170001904 25/08/2017 190,400 190,400
1718 0117R00908170001905 25/08/2017 190,400 190,400
1719 0117R00908170001906 25/08/2017 190,400 190,400
1720 0117R00908170001907 25/08/2017 190,400 190,400
1721 0117R00908170001908 25/08/2017 133,500 133,500
1722 0117R00908170001909 25/08/2017 190,400 190,400
1723 0117R00908170001910 25/08/2017 190,400 190,400
1724 0117R00908170001911 25/08/2017 190,400 190,400
1725 0117R00908170001912 25/08/2017 190,400 190,400
1726 0117R00908170001913 25/08/2017 190,400 190,400
1727 0117R00908170001914 25/08/2017 190,400 190,400
1728 0117R00908170001915 25/08/2017 190,400 190,400
1729 0117R00908170001916 25/08/2017 190,400 190,400
1730 0117R00908170001917 25/08/2017 190,400 190,400
1731 0117R00908170001918 25/08/2017 311,300 311,300
1732 0117R00908170001920 25/08/2017 254,200 254,200
1733 0117R00908170001921 25/08/2017 190,400 190,400
1734 0117R00908170001923 25/08/2017 190,400 190,400
1735 0117R00908170001924 25/08/2017 190,400 190,400
1736 0117R00908170001925 25/08/2017 311,300 311,300
1737 0117R00908170001926 25/08/2017 190,400 190,400
1738 0117R00908170001927 25/08/2017 215,000 215,000
1739 0117R00908170001931 25/08/2017 190,400 190,400
1740 0117R00908170001932 25/08/2017 190,400 190,400
1741 0117R00908170001933 25/08/2017 190,400 190,400
1742 0117R00908170001934 25/08/2017 112,800 112,800
1743 0117R00908170001935 25/08/2017 190,400 190,400
1744 0117R00908170001936 25/08/2017 190,400 190,400
1745 0117R00908170001937 25/08/2017 576,900 576,900
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1746 0117R00908170001938 25/08/2017 215,000 215,000

1747 0117R00908170001939 25/08/2017 298,000 298,000
1748 0117R00908170001940 25/08/2017 576,900 576,900
1749 0117R00908170001941 25/08/2017 323,900 323,900
1750 0117R00908170001942 25/08/2017 190,400 190,400
1751 0117R00908170001943 25/08/2017 190,400 190,400
1752 0117R00908170001944 25/08/2017 323,900 323,900
1753 0117R00908170001945 25/08/2017 190,400 190,400
1754 0117R00908170001946 25/08/2017 190,400 190,400
1755 0117R00908170001948 25/08/2017 190,400 190,400
1756 0117R00908170001949 25/08/2017 191,800 191,800
1757 0117R00908170001950 25/08/2017 311,300 311,300
1758 0117R00908170001951 25/08/2017 190,400 190,400
1759 0117R00908170001952 25/08/2017 190,400 190,400
1760 0117R00908170001953 25/08/2017 576,900 576,900
1761 0117R00908170001954 25/08/2017 190,400 190,400
1762 0117R00908170001955 25/08/2017 298,000 298,000
1763 0117R00908170001956 25/08/2017 190,400 190,400
1764 0117R00908170001957 25/08/2017 298,000 298,000
1765 0117R00908170001958 25/08/2017 190,400 190,400
1766 0117R00908170001959 25/08/2017 576,900 576,900
1767 0117R00908170001960 25/08/2017 190,400 190,400
1768 0117R00908170001961 25/08/2017 143,900 143,900
1769 0117R00908170001962 25/08/2017 298,000 298,000
1770 0117R00908170001963 25/08/2017 298,000 298,000
1771 0117R00908170001965 25/08/2017 190,400 190,400
1772 0117R00908170001966 25/08/2017 311,300 311,300
1773 0117R00908170001967 25/08/2017 576,900 576,900
1774 0117R00908170001968 25/08/2017 323,900 323,900
1775 0117R00908170001969 25/08/2017 311,300 311,300
1776 0117R00908170001970 25/08/2017 311,300 311,300
1777 0117R00908170001971 25/08/2017 190,400 190,400
1778 0117R00908170001973 25/08/2017 112,800 112,800
1779 0117R00908170001974 25/08/2017 190,400 190,400
1780 0117R00908170001975 25/08/2017 191,800 191,800
1781 0117R00908170001976 25/08/2017 190,400 190,400
1782 0117R00908170001977 25/08/2017 190,400 190,400
1783 0117R00908170001978 25/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1784 0117R00908170001979 25/08/2017 190,400 190,400

1785 0117R00908170001980 25/08/2017 311,300 311,300
1786 0117R00908170001981 25/08/2017 190,400 190,400
1787 0117R00908170001982 25/08/2017 576,900 576,900
1788 0117R00908170001983 25/08/2017 311,300 311,300
1789 0117R00908170001984 25/08/2017 190,400 190,400
1790 0117R00908170001985 25/08/2017 191,800 191,800
1791 0117R00908170001986 25/08/2017 190,400 190,400
1792 0117R00908170001987 25/08/2017 576,900 576,900
1793 0117R00908170001988 25/08/2017 298,000 298,000
1794 0117R00908170001989 25/08/2017 190,400 190,400
1795 0117R00908170001990 25/08/2017 112,800 112,800
1796 0117R00908170001991 25/08/2017 190,400 190,400
1797 0117R00908170001992 25/08/2017 190,400 190,400
1798 0117R00908170001993 25/08/2017 576,900 576,900
1799 0117R00908170001994 25/08/2017 112,800 112,800
1800 0117R00908170001995 25/08/2017 190,400 190,400
1801 0117R00908170001996 25/08/2017 193,100 193,100
1802 0117R00908170001997 25/08/2017 190,400 190,400
1803 0117R00908170001998 25/08/2017 576,900 576,900
1804 0117R00908170001999 25/08/2017 190,400 190,400
1805 0117R00908170002000 25/08/2017 191,800 191,800
1806 0117R00908170002001 25/08/2017 323,900 323,900
1807 0117R00908170002002 25/08/2017 112,800 112,800
1808 0117R00908170002003 25/08/2017 308,800 308,800
1809 0117R00908170002004 25/08/2017 112,800 112,800
1810 0117R00908170002005 25/08/2017 193,100 193,100
1811 0117R00908170002006 25/08/2017 112,800 112,800
1812 0117R00908170002007 25/08/2017 190,400 190,400
1813 0117R00908170002008 25/08/2017 190,400 190,400
1814 0117R00908170002009 25/08/2017 190,400 190,400
1815 0117R00908170002010 25/08/2017 190,400 190,400
1816 0117R00908170002011 25/08/2017 193,100 193,100
1817 0117R00908170002012 25/08/2017 190,400 190,400
1818 0117R00908170002013 25/08/2017 190,400 190,400
1819 0117R00908170002014 25/08/2017 190,400 190,400
1820 0117R00908170002015 25/08/2017 190,400 190,400
1821 0117R00908170002016 25/08/2017 311,300 311,300
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1822 0117R00908170002017 25/08/2017 323,900 323,900

1823 0117R00908170002018 25/08/2017 323,900 323,900
1824 0117R00908170002019 25/08/2017 311,300 311,300
1825 0117R00908170002021 25/08/2017 190,400 190,400
1826 0117R00908170002022 25/08/2017 323,900 323,900
1827 0117R00908170002023 25/08/2017 311,300 311,300
1828 0117R00908170002024 25/08/2017 190,400 190,400
1829 0117R00908170002025 25/08/2017 215,000 215,000
1830 0117R00908170002026 25/08/2017 311,300 311,300
1831 0117R00908170002027 25/08/2017 112,800 112,800
1832 0117R00908170002028 25/08/2017 190,400 190,400
1833 0117R00908170002029 25/08/2017 190,400 190,400
1834 0117R00908170002030 25/08/2017 215,000 215,000
1835 0117R00908170002031 25/08/2017 308,800 308,800
1836 0117R00908170002033 25/08/2017 112,800 112,800
1837 0117R00908170002034 25/08/2017 112,800 112,800
1838 0117R00908170002035 25/08/2017 191,800 191,800
1839 0117R00908170002036 25/08/2017 191,800 191,800
1840 0117R00908170002038 25/08/2017 190,400 190,400
1841 0117R00908170002039 25/08/2017 193,100 193,100
1842 0117R00908170002040 25/08/2017 190,400 190,400
1843 0117R00908170002041 25/08/2017 323,900 323,900
1844 0117R00908170002042 25/08/2017 112,800 112,800
1845 0117R00908170002044 25/08/2017 323,900 323,900
1846 0117R00908170002045 25/08/2017 190,400 190,400
1847 0117R00908170002047 25/08/2017 190,400 190,400
1848 0117R00908170002048 25/08/2017 190,400 190,400
1849 0117R00908170002049 25/08/2017 190,400 190,400
1850 0117R00908170002050 25/08/2017 191,800 191,800
1851 0117R00908170002051 25/08/2017 576,900 576,900
1852 0117R00908170002052 25/08/2017 191,800 191,800
1853 0117R00908170002053 25/08/2017 190,400 190,400
1854 0117R00908170002054 25/08/2017 190,400 190,400
1855 0117R00908170002055 25/08/2017 308,800 308,800
1856 0117R00908170002056 25/08/2017 190,400 190,400
1857 0117R00908170002057 25/08/2017 190,400 190,400
1858 0117R00908170002058 25/08/2017 190,400 190,400
1859 0117R00908170002059 25/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1860 0117R00908170002060 25/08/2017 190,400 190,400

1861 0117R00908170002061 25/08/2017 190,400 190,400
1862 0117R00908170002062 25/08/2017 190,400 190,400
1863 0117R00908170002063 25/08/2017 190,400 190,400
1864 0117R00908170002064 25/08/2017 190,400 190,400
1865 0117R00908170002065 25/08/2017 190,400 190,400
1866 0117R00908170002066 25/08/2017 190,400 190,400
1867 0117R00908170002067 25/08/2017 190,400 190,400
1868 0117R00908170002068 25/08/2017 190,400 190,400
1869 0117R00908170002069 25/08/2017 112,800 112,800
1870 0117R00908170002070 25/08/2017 112,800 112,800
1871 0117R00908170002071 25/08/2017 190,400 190,400
1872 0117R00908170002072 25/08/2017 190,400 190,400
1873 0117R00908170002073 25/08/2017 323,900 323,900
1874 0117R00908170002074 25/08/2017 190,400 190,400
1875 0117R00908170002075 25/08/2017 190,400 190,400
1876 0117R00908170002076 25/08/2017 190,400 190,400
1877 0117R00908170002080 25/08/2017 112,800 112,800
1878 0117R00908170002082 25/08/2017 112,800 112,800
1879 0117R00908170002083 25/08/2017 190,400 190,400
1880 0117R00908170002084 25/08/2017 323,900 323,900
1881 0117R00908170002085 25/08/2017 323,900 323,900
1882 0117R00908170002086 25/08/2017 112,800 112,800
1883 0117R00908170002087 25/08/2017 190,400 190,400
1884 0117R00908170002088 25/08/2017 112,800 112,800
1885 0117R00908170002089 25/08/2017 143,900 143,900
1886 0117R00908170002090 25/08/2017 191,800 191,800
1887 0117R00908170002091 25/08/2017 193,100 193,100
1888 0117R00908170002093 25/08/2017 323,900 323,900
1889 0117R00908170002094 25/08/2017 311,300 311,300
1890 0117R00908170002095 25/08/2017 112,800 112,800
1891 0117R00908170002096 25/08/2017 191,800 191,800
1892 0117R00908170002097 25/08/2017 191,800 191,800
1893 0117R00908170002098 25/08/2017 190,400 190,400
1894 0117R00908170002101 25/08/2017 112,800 112,800
1895 0117R00908170002102 25/08/2017 191,800 191,800
1896 0117R00908170002104 25/08/2017 323,900 323,900
1897 0117R00908170002105 25/08/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1898 0117R00908170002109 25/08/2017 191,800 191,800

1899 0117R00908170002110 25/08/2017 323,900 323,900
1900 0117R00908170002113 25/08/2017 190,400 190,400
1901 0117R00908170002117 25/08/2017 142,400 142,400
1902 0117R00908170002118 25/08/2017 254,200 254,200
1903 0117R00908170002119 25/08/2017 191,800 191,800
1904 0117R00908170002120 25/08/2017 191,800 191,800
1905 0117R00908170002121 25/08/2017 190,400 190,400
1906 0117R00908170002122 25/08/2017 191,800 191,800
1907 0117R00908170002123 25/08/2017 191,800 191,800
1908 0117R00908170002124 25/08/2017 190,400 190,400
1909 0117R00908170002127 25/08/2017 191,800 191,800
1910 0117R00908170002128 25/08/2017 254,200 254,200
1911 0117R00908170002129 25/08/2017 190,400 190,400
1912 0117R00908170002130 25/08/2017 190,400 190,400
1913 0117R00908170002134 25/08/2017 323,900 323,900
1914 0117R00908170002138 25/08/2017 191,800 191,800
1915 0117R00908170002142 25/08/2017 323,900 323,900
1916 0117R00908170002147 25/08/2017 190,400 190,400
1917 0117R00908170002148 25/08/2017 323,900 323,900
1918 0117R00908170002149 25/08/2017 193,100 193,100
1919 0117R00908170002150 25/08/2017 133,500 133,500
1920 0117R00908170002151 25/08/2017 323,900 323,900
1921 0117R00908170002152 25/08/2017 191,800 191,800
1922 0117R00908170002153 25/08/2017 142,400 142,400
1923 0117R00908170002154 25/08/2017 191,800 191,800
1924 0117R00908170002155 25/08/2017 193,100 193,100
1925 0117R00908170002156 25/08/2017 193,100 193,100
1926 0117R00908170002157 25/08/2017 190,400 190,400
1927 0117R00908170002159 25/08/2017 190,400 190,400
1928 0117R00908170002160 25/08/2017 193,100 193,100
1929 0117R00908170002161 25/08/2017 190,400 190,400
1930 0117R00908170002162 25/08/2017 190,400 190,400
1931 0117R00908170002163 25/08/2017 191,800 191,800
1932 0117R00908170002164 25/08/2017 323,900 323,900
1933 0117R00908170002167 25/08/2017 191,800 191,800
1934 0117R00908170002168 25/08/2017 190,400 190,400
1935 0117R00908170002169 25/08/2017 193,100 193,100
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1936 0117R00908170002170 25/08/2017 190,400 190,400

1937 0117R00908170002171 25/08/2017 190,400 190,400
1938 0117R00908170002172 25/08/2017 190,400 190,400
1939 0117R00908170002173 25/08/2017 190,400 190,400
1940 0117R00908170002174 25/08/2017 191,800 191,800
1941 0117R00908170002175 25/08/2017 191,800 191,800
1942 0117R00908170002176 25/08/2017 461,900 461,900
1943 0117R00908170002177 25/08/2017 193,100 193,100
1944 0117R00908170002178 25/08/2017 193,100 193,100
1945 0117R00908170002179 25/08/2017 190,400 190,400
1946 0117R00908170002180 25/08/2017 190,400 190,400
1947 0117R00908170002181 25/08/2017 190,400 190,400
1948 0117R00908170002182 25/08/2017 461,900 461,900
1949 0117R00908170002183 25/08/2017 323,900 323,900
1950 0117R00908170002184 25/08/2017 263,500 263,500
1951 0117R00908170002185 25/08/2017 254,200 254,200
1952 0117R00908170002186 25/08/2017 254,200 254,200
1953 0117R00908170002187 25/08/2017 190,400 190,400
1954 0117R00908170002189 25/08/2017 267,800 267,800
1955 0117R00908170002190 25/08/2017 191,800 191,800
1956 0117R00908170002193 25/08/2017 190,400 190,400
1957 0117R00908170002194 25/08/2017 191,800 191,800
1958 0117R00908170002196 25/08/2017 191,800 191,800
1959 0117R00908170002198 25/08/2017 190,400 190,400
1960 0117R00908170002199 25/08/2017 323,900 323,900
1961 0117R00908170002200 25/08/2017 191,800 191,800
1962 0117R00908170002202 25/08/2017 323,900 323,900
1963 0117R00908170002203 25/08/2017 132,900 132,900
1964 0117R00908170002204 25/08/2017 191,800 191,800
1965 0117R00908170002205 25/08/2017 191,800 191,800
1966 0117R00908170002206 25/08/2017 191,800 191,800
1967 0117R00908170002207 25/08/2017 132,900 132,900
1968 0117R00908170002209 25/08/2017 254,200 254,200
1969 0117R00908170002210 25/08/2017 191,800 191,800
1970 0117R00908170002211 25/08/2017 191,800 191,800
1971 0117R00908170002213 25/08/2017 132,900 132,900
1972 0117R00908170002214 25/08/2017 191,800 191,800
1973 0117R00908170002216 25/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
1974 0117R00908170002217 25/08/2017 191,800 191,800

1975 0117R00908170002218 25/08/2017 191,800 191,800
1976 0117R00908170002219 25/08/2017 190,400 190,400
1977 0117R00908170002220 25/08/2017 323,900 323,900
1978 0117R00908170002221 25/08/2017 191,800 191,800
1979 0117R00908170002222 25/08/2017 547,100 547,100
1980 0117R00908170002223 25/08/2017 190,400 190,400
1981 0117R00908170002224 25/08/2017 323,900 323,900
1982 0117R00908170002225 25/08/2017 191,800 191,800
1983 0117R00908170002226 25/08/2017 323,900 323,900
1984 0117R00908170002227 25/08/2017 275,100 275,100
1985 0117R00908170002228 25/08/2017 190,400 190,400
1986 0117R00908170002229 25/08/2017 190,400 190,400
1987 0117R00908170002230 25/08/2017 191,800 191,800
1988 0117R00908170002232 25/08/2017 191,800 191,800
1989 0117R00908170002233 25/08/2017 323,900 323,900
1990 0117R00908170002235 25/08/2017 191,800 191,800
1991 0117R00908170002236 25/08/2017 323,900 323,900
1992 0117R00908170002237 25/08/2017 190,400 190,400
1993 0117R00908170002239 25/08/2017 191,800 191,800
1994 0117R00908170002240 25/08/2017 272,600 272,600
1995 0117R00908170002241 25/08/2017 323,900 323,900
1996 0117R00908170002242 25/08/2017 191,800 191,800
1997 0117R00908170002243 25/08/2017 190,400 190,400
1998 0117R00908170002244 25/08/2017 254,200 254,200
1999 0117R00908170002246 25/08/2017 191,800 191,800
2000 0117R00908170002247 25/08/2017 191,800 191,800
2001 0117R00908170002248 25/08/2017 323,900 323,900
2002 0117R00908170002250 25/08/2017 191,800 191,800
2003 0117R00908170002253 25/08/2017 142,400 142,400
2004 0117R00908170002256 25/08/2017 263,300 263,300
2005 0117R00908170002258 25/08/2017 142,400 142,400
2006 0117R00908170002259 25/08/2017 191,800 191,800
2007 0117R00908170002261 25/08/2017 190,400 190,400
2008 0117R00908170002262 25/08/2017 254,200 254,200
2009 0117R00908170002263 25/08/2017 191,800 191,800
2010 0117R00908170002264 25/08/2017 191,800 191,800
2011 0117R00908170002265 25/08/2017 254,200 254,200
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2012 0117R00908170002266 25/08/2017 323,900 323,900

2013 0117R00908170002267 31/08/2017 190,400 190,400
2014 0117R00908170002271 31/08/2017 193,100 193,100
2015 0117R00908170002272 31/08/2017 190,400 190,400
2016 0117R00908170002273 31/08/2017 190,400 190,400
2017 0117R00908170002274 31/08/2017 190,400 190,400
2018 0117R00908170002275 31/08/2017 311,300 311,300
2019 0117R00908170002276 31/08/2017 311,300 311,300
2020 0117R00908170002277 31/08/2017 190,400 190,400
2021 0117R00908170002278 31/08/2017 190,400 190,400
2022 0117R00908170002279 31/08/2017 311,300 311,300
2023 0117R00908170002280 31/08/2017 190,400 190,400
2024 0117R00908170002281 31/08/2017 190,400 190,400
2025 0117R00908170002282 31/08/2017 190,400 190,400
2026 0117R00908170002283 31/08/2017 193,100 193,100
2027 0117R00908170002284 31/08/2017 190,400 190,400
2028 0117R00908170002285 31/08/2017 190,400 190,400
2029 0117R00908170002286 31/08/2017 190,400 190,400
2030 0117R00908170002287 31/08/2017 190,400 190,400
2031 0117R00908170002288 31/08/2017 190,400 190,400
2032 0117R00908170002289 31/08/2017 190,400 190,400
2033 0117R00908170002290 31/08/2017 190,400 190,400
2034 0117R00908170002291 31/08/2017 190,400 190,400
2035 0117R00908170002292 31/08/2017 190,400 190,400
2036 0117R00908170002293 31/08/2017 190,400 190,400
2037 0117R00908170002294 31/08/2017 190,400 190,400
2038 0117R00908170002295 31/08/2017 190,400 190,400
2039 0117R00908170002296 31/08/2017 298,000 298,000
2040 0117R00908170002297 31/08/2017 190,400 190,400
2041 0117R00908170002298 31/08/2017 112,800 112,800
2042 0117R00908170002299 31/08/2017 190,400 190,400
2043 0117R00908170002301 31/08/2017 190,400 190,400
2044 0117R00908170002302 31/08/2017 190,400 190,400
2045 0117R00908170002304 31/08/2017 190,400 190,400
2046 0117R00908170002305 31/08/2017 193,100 193,100
2047 0117R00908170002306 31/08/2017 323,900 323,900
2048 0117R00908170002308 31/08/2017 190,400 190,400
2049 0117R00908170002309 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2050 0117R00908170002310 31/08/2017 112,800 112,800

2051 0117R00908170002312 31/08/2017 190,400 190,400
2052 0117R00908170002313 31/08/2017 112,800 112,800
2053 0117R00908170002314 31/08/2017 190,400 190,400
2054 0117R00908170002315 31/08/2017 190,400 190,400
2055 0117R00908170002316 31/08/2017 190,400 190,400
2056 0117R00908170002317 31/08/2017 576,900 576,900
2057 0117R00908170002318 31/08/2017 298,000 298,000
2058 0117R00908170002319 31/08/2017 190,400 190,400
2059 0117R00908170002320 31/08/2017 190,400 190,400
2060 0117R00908170002321 31/08/2017 190,400 190,400
2061 0117R00908170002323 31/08/2017 112,800 112,800
2062 0117R00908170002324 31/08/2017 190,400 190,400
2063 0117R00908170002325 31/08/2017 190,400 190,400
2064 0117R00908170002326 31/08/2017 190,400 190,400
2065 0117R00908170002327 31/08/2017 190,400 190,400
2066 0117R00908170002329 31/08/2017 190,400 190,400
2067 0117R00908170002330 31/08/2017 190,400 190,400
2068 0117R00908170002331 31/08/2017 112,800 112,800
2069 0117R00908170002332 31/08/2017 190,400 190,400
2070 0117R00908170002333 31/08/2017 190,400 190,400
2071 0117R00908170002334 31/08/2017 190,400 190,400
2072 0117R00908170002335 31/08/2017 190,400 190,400
2073 0117R00908170002336 31/08/2017 190,400 190,400
2074 0117R00908170002339 31/08/2017 190,400 190,400
2075 0117R00908170002340 31/08/2017 112,800 112,800
2076 0117R00908170002341 31/08/2017 236,300 236,300
2077 0117R00908170002342 31/08/2017 311,300 311,300
2078 0117R00908170002343 31/08/2017 191,800 191,800
2079 0117R00908170002344 31/08/2017 190,400 190,400
2080 0117R00908170002345 31/08/2017 190,400 190,400
2081 0117R00908170002346 31/08/2017 142,400 142,400
2082 0117R00908170002347 31/08/2017 112,800 112,800
2083 0117R00908170002348 31/08/2017 190,400 190,400
2084 0117R00908170002349 31/08/2017 190,400 190,400
2085 0117R00908170002350 31/08/2017 190,400 190,400
2086 0117R00908170002351 31/08/2017 323,900 323,900
2087 0117R00908170002352 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2088 0117R00908170002353 31/08/2017 190,400 190,400

2089 0117R00908170002354 31/08/2017 190,400 190,400
2090 0117R00908170002355 31/08/2017 112,800 112,800
2091 0117R00908170002356 31/08/2017 190,400 190,400
2092 0117R00908170002358 31/08/2017 193,100 193,100
2093 0117R00908170002359 31/08/2017 190,400 190,400
2094 0117R00908170002360 31/08/2017 190,400 190,400
2095 0117R00908170002361 31/08/2017 190,400 190,400
2096 0117R00908170002362 31/08/2017 190,400 190,400
2097 0117R00908170002363 31/08/2017 190,400 190,400
2098 0117R00908170002364 31/08/2017 190,400 190,400
2099 0117R00908170002365 31/08/2017 190,400 190,400
2100 0117R00908170002367 31/08/2017 190,400 190,400
2101 0117R00908170002368 31/08/2017 190,400 190,400
2102 0117R00908170002370 31/08/2017 190,400 190,400
2103 0117R00908170002371 31/08/2017 298,000 298,000
2104 0117R00908170002372 31/08/2017 112,800 112,800
2105 0117R00908170002373 31/08/2017 190,400 190,400
2106 0117R00908170002374 31/08/2017 112,800 112,800
2107 0117R00908170002375 31/08/2017 190,400 190,400
2108 0117R00908170002376 31/08/2017 190,400 190,400
2109 0117R00908170002377 31/08/2017 193,100 193,100
2110 0117R00908170002380 31/08/2017 190,400 190,400
2111 0117R00908170002381 31/08/2017 112,800 112,800
2112 0117R00908170002382 31/08/2017 112,800 112,800
2113 0117R00908170002383 31/08/2017 112,800 112,800
2114 0117R00908170002384 31/08/2017 190,400 190,400
2115 0117R00908170002385 31/08/2017 190,400 190,400
2116 0117R00908170002386 31/08/2017 191,800 191,800
2117 0117R00908170002387 31/08/2017 190,400 190,400
2118 0117R00908170002388 31/08/2017 191,800 191,800
2119 0117R00908170002389 31/08/2017 190,400 190,400
2120 0117R00908170002391 31/08/2017 190,400 190,400
2121 0117R00908170002392 31/08/2017 190,400 190,400
2122 0117R00908170002393 31/08/2017 298,000 298,000
2123 0117R00908170002394 31/08/2017 190,400 190,400
2124 0117R00908170002395 31/08/2017 190,400 190,400
2125 0117R00908170002396 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2126 0117R00908170002397 31/08/2017 112,800 112,800

2127 0117R00908170002399 31/08/2017 112,800 112,800
2128 0117R00908170002400 31/08/2017 190,400 190,400
2129 0117R00908170002401 31/08/2017 112,800 112,800
2130 0117R00908170002402 31/08/2017 263,500 263,500
2131 0117R00908170002403 31/08/2017 258,100 258,100
2132 0117R00908170002404 31/08/2017 190,400 190,400
2133 0117R00908170002405 31/08/2017 190,400 190,400
2134 0117R00908170002406 31/08/2017 190,400 190,400
2135 0117R00908170002407 31/08/2017 190,400 190,400
2136 0117R00908170002408 31/08/2017 190,400 190,400
2137 0117R00908170002409 31/08/2017 190,400 190,400
2138 0117R00908170002410 31/08/2017 263,500 263,500
2139 0117R00908170002411 31/08/2017 133,500 133,500
2140 0117R00908170002412 31/08/2017 298,000 298,000
2141 0117R00908170002413 31/08/2017 190,400 190,400
2142 0117R00908170002414 31/08/2017 190,400 190,400
2143 0117R00908170002415 31/08/2017 311,300 311,300
2144 0117R00908170002416 31/08/2017 311,300 311,300
2145 0117R00908170002417 31/08/2017 190,400 190,400
2146 0117R00908170002418 31/08/2017 190,400 190,400
2147 0117R00908170002419 31/08/2017 191,800 191,800
2148 0117R00908170002420 31/08/2017 191,800 191,800
2149 0117R00908170002421 31/08/2017 190,400 190,400
2150 0117R00908170002422 31/08/2017 298,000 298,000
2151 0117R00908170002423 31/08/2017 190,400 190,400
2152 0117R00908170002424 31/08/2017 323,900 323,900
2153 0117R00908170002425 31/08/2017 193,100 193,100
2154 0117R00908170002426 31/08/2017 190,400 190,400
2155 0117R00908170002427 31/08/2017 190,400 190,400
2156 0117R00908170002428 31/08/2017 190,400 190,400
2157 0117R00908170002430 31/08/2017 190,400 190,400
2158 0117R00908170002432 31/08/2017 298,000 298,000
2159 0117R00908170002433 31/08/2017 352,900 352,900
2160 0117R00908170002434 31/08/2017 298,000 298,000
2161 0117R00908170002435 31/08/2017 112,800 112,800
2162 0117R00908170002436 31/08/2017 190,400 190,400
2163 0117R00908170002437 31/08/2017 323,900 323,900
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2164 0117R00908170002438 31/08/2017 112,800 112,800

2165 0117R00908170002439 31/08/2017 190,400 190,400
2166 0117R00908170002440 31/08/2017 190,400 190,400
2167 0117R00908170002441 31/08/2017 191,800 191,800
2168 0117R00908170002442 31/08/2017 298,000 298,000
2169 0117R00908170002443 31/08/2017 190,400 190,400
2170 0117R00908170002444 31/08/2017 190,400 190,400
2171 0117R00908170002445 31/08/2017 190,400 190,400
2172 0117R00908170002446 31/08/2017 190,400 190,400
2173 0117R00908170002447 31/08/2017 190,400 190,400
2174 0117R00908170002448 31/08/2017 190,400 190,400
2175 0117R00908170002449 31/08/2017 190,400 190,400
2176 0117R00908170002450 31/08/2017 190,400 190,400
2177 0117R00908170002451 31/08/2017 298,000 298,000
2178 0117R00908170002452 31/08/2017 298,000 298,000
2179 0117R00908170002453 31/08/2017 190,400 190,400
2180 0117R00908170002454 31/08/2017 311,300 311,300
2181 0117R00908170002456 31/08/2017 112,800 112,800
2182 0117R00908170002457 31/08/2017 190,400 190,400
2183 0117R00908170002458 31/08/2017 190,400 190,400
2184 0117R00908170002459 31/08/2017 263,500 263,500
2185 0117R00908170002460 31/08/2017 323,900 323,900
2186 0117R00908170002461 31/08/2017 190,400 190,400
2187 0117R00908170002462 31/08/2017 263,500 263,500
2188 0117R00908170002463 31/08/2017 112,800 112,800
2189 0117R00908170002464 31/08/2017 190,400 190,400
2190 0117R00908170002466 31/08/2017 190,400 190,400
2191 0117R00908170002467 31/08/2017 263,500 263,500
2192 0117R00908170002468 31/08/2017 190,400 190,400
2193 0117R00908170002469 31/08/2017 190,400 190,400
2194 0117R00908170002470 31/08/2017 190,400 190,400
2195 0117R00908170002471 31/08/2017 190,400 190,400
2196 0117R00908170002472 31/08/2017 190,400 190,400
2197 0117R00908170002473 31/08/2017 112,800 112,800
2198 0117R00908170002474 31/08/2017 190,400 190,400
2199 0117R00908170002475 31/08/2017 193,100 193,100
2200 0117R00908170002476 31/08/2017 190,400 190,400
2201 0117R00908170002477 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2202 0117R00908170002478 31/08/2017 254,200 254,200

2203 0117R00908170002479 31/08/2017 263,500 263,500
2204 0117R00908170002480 31/08/2017 112,800 112,800
2205 0117R00908170002481 31/08/2017 112,800 112,800
2206 0117R00908170002482 31/08/2017 190,400 190,400
2207 0117R00908170002483 31/08/2017 190,400 190,400
2208 0117R00908170002484 31/08/2017 190,400 190,400
2209 0117R00908170002485 31/08/2017 190,400 190,400
2210 0117R00908170002486 31/08/2017 190,400 190,400
2211 0117R00908170002487 31/08/2017 190,400 190,400
2212 0117R00908170002488 31/08/2017 461,900 461,900
2213 0117R00908170002490 31/08/2017 112,800 112,800
2214 0117R00908170002491 31/08/2017 190,400 190,400
2215 0117R00908170002492 31/08/2017 190,400 190,400
2216 0117R00908170002493 31/08/2017 576,900 576,900
2217 0117R00908170002494 31/08/2017 190,400 190,400
2218 0117R00908170002495 31/08/2017 191,800 191,800
2219 0117R00908170002496 31/08/2017 190,400 190,400
2220 0117R00908170002497 31/08/2017 112,800 112,800
2221 0117R00908170002498 31/08/2017 190,400 190,400
2222 0117R00908170002499 31/08/2017 190,400 190,400
2223 0117R00908170002500 31/08/2017 190,400 190,400
2224 0117R00908170002501 31/08/2017 190,400 190,400
2225 0117R00908170002502 31/08/2017 193,100 193,100
2226 0117R00908170002503 31/08/2017 190,400 190,400
2227 0117R00908170002504 31/08/2017 308,800 308,800
2228 0117R00908170002505 31/08/2017 576,900 576,900
2229 0117R00908170002507 31/08/2017 112,800 112,800
2230 0117R00908170002508 31/08/2017 193,100 193,100
2231 0117R00908170002509 31/08/2017 193,100 193,100
2232 0117R00908170002510 31/08/2017 308,800 308,800
2233 0117R00908170002511 31/08/2017 311,300 311,300
2234 0117R00908170002512 31/08/2017 263,500 263,500
2235 0117R00908170002513 31/08/2017 190,400 190,400
2236 0117R00908170002514 31/08/2017 461,900 461,900
2237 0117R00908170002516 31/08/2017 193,100 193,100
2238 0117R00908170002517 31/08/2017 190,400 190,400
2239 0117R00908170002518 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2240 0117R00908170002519 31/08/2017 576,900 576,900

2241 0117R00908170002520 31/08/2017 190,400 190,400
2242 0117R00908170002521 31/08/2017 190,400 190,400
2243 0117R00908170002522 31/08/2017 190,400 190,400
2244 0117R00908170002523 31/08/2017 190,400 190,400
2245 0117R00908170002524 31/08/2017 263,500 263,500
2246 0117R00908170002525 31/08/2017 132,900 132,900
2247 0117R00908170002526 31/08/2017 190,400 190,400
2248 0117R00908170002527 31/08/2017 190,400 190,400
2249 0117R00908170002528 31/08/2017 190,400 190,400
2250 0117R00908170002529 31/08/2017 190,400 190,400
2251 0117R00908170002530 31/08/2017 190,400 190,400
2252 0117R00908170002531 31/08/2017 190,400 190,400
2253 0117R00908170002532 31/08/2017 193,100 193,100
2254 0117R00908170002533 31/08/2017 267,800 267,800
2255 0117R00908170002534 31/08/2017 112,800 112,800
2256 0117R00908170002535 31/08/2017 263,500 263,500
2257 0117R00908170002538 31/08/2017 576,900 576,900
2258 0117R00908170002539 31/08/2017 190,400 190,400
2259 0117R00908170002540 31/08/2017 190,400 190,400
2260 0117R00908170002541 31/08/2017 190,400 190,400
2261 0117R00908170002544 31/08/2017 193,100 193,100
2262 0117R00908170002545 31/08/2017 190,400 190,400
2263 0117R00908170002546 31/08/2017 190,400 190,400
2264 0117R00908170002547 31/08/2017 254,200 254,200
2265 0117R00908170002548 31/08/2017 263,500 263,500
2266 0117R00908170002549 31/08/2017 263,500 263,500
2267 0117R00908170002550 31/08/2017 263,500 263,500
2268 0117R00908170002551 31/08/2017 190,400 190,400
2269 0117R00908170002552 31/08/2017 190,400 190,400
2270 0117R00908170002553 31/08/2017 576,900 576,900
2271 0117R00908170002554 31/08/2017 190,400 190,400
2272 0117R00908170002555 31/08/2017 190,400 190,400
2273 0117R00908170002556 31/08/2017 190,400 190,400
2274 0117R00908170002557 31/08/2017 190,400 190,400
2275 0117R00908170002558 31/08/2017 193,100 193,100
2276 0117R00908170002559 31/08/2017 311,300 311,300
2277 0117R00908170002560 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2278 0117R00908170002561 31/08/2017 190,400 190,400

2279 0117R00908170002562 31/08/2017 190,400 190,400
2280 0117R00908170002563 31/08/2017 263,500 263,500
2281 0117R00908170002564 31/08/2017 263,500 263,500
2282 0117R00908170002565 31/08/2017 190,400 190,400
2283 0117R00908170002566 31/08/2017 263,500 263,500
2284 0117R00908170002567 31/08/2017 190,400 190,400
2285 0117R00908170002568 31/08/2017 190,400 190,400
2286 0117R00908170002569 31/08/2017 190,400 190,400
2287 0117R00908170002570 31/08/2017 193,100 193,100
2288 0117R00908170002571 31/08/2017 190,400 190,400
2289 0117R00908170002572 31/08/2017 190,400 190,400
2290 0117R00908170002574 31/08/2017 112,800 112,800
2291 0117R00908170002576 25/08/2017 323,900 323,900
2292 0117R00908170002578 31/08/2017 190,400 190,400
2293 0117R00908170002579 31/08/2017 190,400 190,400
2294 0117R00908170002580 31/08/2017 190,400 190,400
2295 0117R00908170002581 31/08/2017 112,800 112,800
2296 0117R00908170002582 31/08/2017 191,800 191,800
2297 0117R00908170002584 31/08/2017 576,900 576,900
2298 0117R00908170002585 31/08/2017 263,500 263,500
2299 0117R00908170002586 31/08/2017 190,400 190,400
2300 0117R00908170002588 31/08/2017 112,800 112,800
2301 0117R00908170002590 31/08/2017 193,100 193,100
2302 0117R00908170002591 31/08/2017 190,400 190,400
2303 0117R00908170002592 31/08/2017 190,400 190,400
2304 0117R00908170002593 31/08/2017 190,400 190,400
2305 0117R00908170002594 31/08/2017 190,400 190,400
2306 0117R00908170002595 31/08/2017 190,400 190,400
2307 0117R00908170002596 31/08/2017 190,400 190,400
2308 0117R00908170002597 31/08/2017 190,400 190,400
2309 0117R00908170002599 31/08/2017 190,400 190,400
2310 0117R00908170002600 31/08/2017 112,800 112,800
2311 0117R00908170002601 31/08/2017 190,400 190,400
2312 0117R00908170002602 31/08/2017 190,400 190,400
2313 0117R00908170002603 31/08/2017 193,100 193,100
2314 0117R00908170002604 31/08/2017 547,100 547,100
2315 0117R00908170002605 31/08/2017 191,800 191,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2316 0117R00908170002606 31/08/2017 112,800 112,800

2317 0117R00908170002607 31/08/2017 112,800 112,800
2318 0117R00908170002608 31/08/2017 298,000 298,000
2319 0117R00908170002609 31/08/2017 112,800 112,800
2320 0117R00908170002611 31/08/2017 133,500 133,500
2321 0117R00908170002615 31/08/2017 190,400 190,400
2322 0117R00908170002617 31/08/2017 190,400 190,400
2323 0117R00908170002618 31/08/2017 190,400 190,400
2324 0117R00908170002619 31/08/2017 190,400 190,400
2325 0117R00908170002620 31/08/2017 215,000 215,000
2326 0117R00908170002621 31/08/2017 112,800 112,800
2327 0117R00908170002622 31/08/2017 190,400 190,400
2328 0117R00908170002623 31/08/2017 190,400 190,400
2329 0117R00908170002624 31/08/2017 190,400 190,400
2330 0117R00908170002625 31/08/2017 190,400 190,400
2331 0117R00908170002626 31/08/2017 190,400 190,400
2332 0117R00908170002627 31/08/2017 190,400 190,400
2333 0117R00908170002628 31/08/2017 190,400 190,400
2334 0117R00908170002629 31/08/2017 112,800 112,800
2335 0117R00908170002630 31/08/2017 263,500 263,500
2336 0117R00908170002631 31/08/2017 263,500 263,500
2337 0117R00908170002632 31/08/2017 190,400 190,400
2338 0117R00908170002633 31/08/2017 191,800 191,800
2339 0117R00908170002634 31/08/2017 263,500 263,500
2340 0117R00908170002635 31/08/2017 190,400 190,400
2341 0117R00908170002636 31/08/2017 190,400 190,400
2342 0117R00908170002637 31/08/2017 263,500 263,500
2343 0117R00908170002638 31/08/2017 190,400 190,400
2344 0117R00908170002639 25/08/2017 254,200 254,200
2345 0117R00908170002640 31/08/2017 263,500 263,500
2346 0117R00908170002641 31/08/2017 190,400 190,400
2347 0117R00908170002642 31/08/2017 190,400 190,400
2348 0117R00908170002643 31/08/2017 254,200 254,200
2349 0117R00908170002645 31/08/2017 190,400 190,400
2350 0117R00908170002646 31/08/2017 112,800 112,800
2351 0117R00908170002647 31/08/2017 142,400 142,400
2352 0117R00908170002648 31/08/2017 258,100 258,100
2353 0117R00908170002649 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2354 0117R00908170002650 31/08/2017 190,400 190,400

2355 0117R00908170002651 31/08/2017 112,800 112,800
2356 0117R00908170002652 31/08/2017 263,500 263,500
2357 0117R00908170002653 31/08/2017 112,800 112,800
2358 0117R00908170002654 31/08/2017 190,400 190,400
2359 0117R00908170002657 31/08/2017 190,400 190,400
2360 0117R00908170002658 31/08/2017 254,200 254,200
2361 0117R00908170002659 31/08/2017 215,000 215,000
2362 0117R00908170002660 31/08/2017 190,400 190,400
2363 0117R00908170002661 31/08/2017 190,400 190,400
2364 0117R00908170002662 31/08/2017 112,800 112,800
2365 0117R00908170002663 31/08/2017 190,400 190,400
2366 0117R00908170002664 31/08/2017 263,500 263,500
2367 0117R00908170002665 31/08/2017 190,400 190,400
2368 0117R00908170002666 31/08/2017 576,900 576,900
2369 0117R00908170002667 31/08/2017 190,400 190,400
2370 0117R00908170002668 31/08/2017 190,400 190,400
2371 0117R00908170002669 31/08/2017 263,500 263,500
2372 0117R00908170002671 31/08/2017 263,500 263,500
2373 0117R00908170002672 31/08/2017 311,300 311,300
2374 0117R00908170002673 31/08/2017 263,500 263,500
2375 0117R00908170002674 31/08/2017 193,100 193,100
2376 0117R00908170002675 31/08/2017 123,900 123,900
2377 0117R00908170002678 31/08/2017 311,300 311,300
2378 0117R00908170002679 31/08/2017 190,400 190,400
2379 0117R00908170002680 31/08/2017 190,400 190,400
2380 0117R00908170002681 31/08/2017 263,500 263,500
2381 0117R00908170002682 31/08/2017 191,800 191,800
2382 0117R00908170002683 31/08/2017 263,500 263,500
2383 0117R00908170002684 31/08/2017 190,400 190,400
2384 0117R00908170002685 31/08/2017 112,800 112,800
2385 0117R00908170002686 31/08/2017 193,100 193,100
2386 0117R00908170002687 31/08/2017 190,400 190,400
2387 0117R00908170002688 31/08/2017 193,100 193,100
2388 0117R00908170002689 31/08/2017 112,800 112,800
2389 0117R00908170002690 31/08/2017 267,800 267,800
2390 0117R00908170002691 31/08/2017 191,800 191,800
2391 0117R00908170002692 31/08/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2392 0117R00908170002693 31/08/2017 191,800 191,800

2393 0117R00908170002694 31/08/2017 112,800 112,800
2394 0117R00908170002695 31/08/2017 112,800 112,800
2395 0117R00908170002697 31/08/2017 193,100 193,100
2396 0117R00908170002698 31/08/2017 263,500 263,500
2397 0117R00908170002700 31/08/2017 193,100 193,100
2398 0117R00908170002701 31/08/2017 191,800 191,800
2399 0117R00908170002702 31/08/2017 123,900 123,900
2400 0117R00908170002703 31/08/2017 308,800 308,800
2401 0117R00908170002704 31/08/2017 112,800 112,800
2402 0117R00908170002707 31/08/2017 190,400 190,400
2403 0117R00908170002708 31/08/2017 263,500 263,500
2404 0117R00908170002709 31/08/2017 190,400 190,400
2405 0117R00908170002710 31/08/2017 190,400 190,400
2406 0117R00908170002711 31/08/2017 190,400 190,400
2407 0117R00908170002712 31/08/2017 263,500 263,500
2408 0117R00908170002713 31/08/2017 112,800 112,800
2409 0117R00908170002714 31/08/2017 193,100 193,100
2410 0117R00908170002715 31/08/2017 112,800 112,800
2411 0117R00908170002716 31/08/2017 190,400 190,400
2412 0117R00908170002717 31/08/2017 193,100 193,100
2413 0117R00908170002718 31/08/2017 191,800 191,800
2414 0117R00908170002719 31/08/2017 190,400 190,400
2415 0117R00908170002720 31/08/2017 298,000 298,000
2416 0117R00908170002721 31/08/2017 112,800 112,800
2417 0117R00908170002722 31/08/2017 576,900 576,900
2418 0117R00908170002723 31/08/2017 112,800 112,800
2419 0117R00908170002724 31/08/2017 191,800 191,800
2420 0117R00908170002726 31/08/2017 190,400 190,400
2421 0117R00908170002727 31/08/2017 112,800 112,800
2422 0117R00908170002728 31/08/2017 112,800 112,800
2423 0117R00908170002729 31/08/2017 323,900 323,900
2424 0117R00908170002732 31/08/2017 190,400 190,400
2425 0117R00908170002733 31/08/2017 112,800 112,800
2426 0117R00908170002734 31/08/2017 190,400 190,400
2427 0117R00908170002735 31/08/2017 190,400 190,400
2428 0117R00908170002736 31/08/2017 190,400 190,400
2429 0117R00908170002737 31/08/2017 576,900 576,900
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2430 0117R00908170002738 31/08/2017 190,400 190,400

2431 0117R00908170002740 31/08/2017 190,400 190,400
2432 0117R00908170002741 31/08/2017 190,400 190,400
2433 0117R00908170002742 31/08/2017 190,400 190,400
2434 0117R00908170002743 31/08/2017 275,100 275,100
2435 0117R00908170002744 31/08/2017 190,400 190,400
2436 0117R00908170002745 31/08/2017 190,400 190,400
2437 0117R00908170002746 31/08/2017 190,400 190,400
2438 0117R00908170002747 31/08/2017 191,800 191,800
2439 0117R00908170002748 31/08/2017 190,400 190,400
2440 0117R00908170002749 31/08/2017 191,800 191,800
2441 0117R00908170002750 31/08/2017 191,800 191,800
2442 0117R00908170002752 31/08/2017 112,800 112,800
2443 0117R00908170002753 31/08/2017 190,400 190,400
2444 0117R00908170002754 31/08/2017 190,400 190,400
2445 0117R00908170002755 31/08/2017 190,400 190,400
2446 0117R00908170002756 31/08/2017 191,800 191,800
2447 0117R00908170002757 31/08/2017 190,400 190,400
2448 0117R00908170002758 31/08/2017 193,100 193,100
2449 0117R00908170002759 31/08/2017 190,400 190,400
2450 0117R00908170002760 31/08/2017 112,800 112,800
2451 0117R00908170002762 31/08/2017 190,400 190,400
2452 0117R00908170002763 31/08/2017 190,400 190,400
2453 0117R00908170002764 31/08/2017 190,400 190,400
2454 0117R00908170002765 31/08/2017 190,400 190,400
2455 0117R00908170002766 31/08/2017 190,400 190,400
2456 0117R00908170002767 31/08/2017 190,400 190,400
2457 0117R00908170002768 31/08/2017 112,800 112,800
2458 0117R00908170002769 31/08/2017 308,800 308,800
2459 0117R00908170002770 31/08/2017 191,800 191,800
2460 0117R00908170002772 31/08/2017 190,400 190,400
2461 0117R00908170002773 31/08/2017 112,800 112,800
2462 0117R00908170002774 31/08/2017 190,400 190,400
2463 0117R00908170002775 31/08/2017 190,400 190,400
2464 0117R00908170002776 31/08/2017 311,300 311,300
2465 0117R00908170002777 31/08/2017 190,400 190,400
2466 0117R00908170002778 31/08/2017 190,400 190,400
2467 0117R00908170002779 31/08/2017 193,100 193,100
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2468 0117R00908170002780 31/08/2017 193,100 193,100

2469 0117R00908170002781 31/08/2017 190,400 190,400
2470 0117R00908170002782 31/08/2017 193,100 193,100
2471 0117R00908170002783 31/08/2017 215,000 215,000
2472 0117R00908170002784 31/08/2017 254,200 254,200
2473 0117R00908170002786 31/08/2017 112,800 112,800
2474 0117R00908170002787 31/08/2017 191,800 191,800
2475 0117R00908170002788 31/08/2017 193,100 193,100
2476 0117R00908170002789 31/08/2017 190,400 190,400
2477 0117R00908170002791 31/08/2017 190,400 190,400
2478 0117R00908170002792 31/08/2017 190,400 190,400
2479 0117R00908170002795 31/08/2017 190,400 190,400
2480 0117R00908170002797 31/08/2017 193,100 193,100
2481 0117R00908170002798 31/08/2017 215,000 215,000
2482 0117R00908170002800 31/08/2017 190,400 190,400
2483 0117R00908170002801 31/08/2017 311,300 311,300
2484 0117R00908170002802 31/08/2017 193,100 193,100
2485 0117R00908170002803 31/08/2017 576,900 576,900
2486 0117R00908170002806 31/08/2017 254,200 254,200
2487 0117R00908170002807 31/08/2017 191,800 191,800
2488 0117R00908170002809 31/08/2017 323,900 323,900
2489 0117R00908170002814 31/08/2017 190,400 190,400
2490 0117R00908170002815 31/08/2017 190,400 190,400
2491 0117R00908170002816 31/08/2017 190,400 190,400
2492 0117R00908170002817 31/08/2017 190,400 190,400
2493 0117R00908170002818 31/08/2017 190,400 190,400
2494 0117R00908170002819 31/08/2017 190,400 190,400
2495 0117R00908170002821 31/08/2017 190,400 190,400
2496 0117R00908170002822 31/08/2017 308,800 308,800
2497 0117R00908170002823 31/08/2017 190,400 190,400
2498 0117R00908170002824 31/08/2017 191,800 191,800
2499 0117R00908170002825 31/08/2017 190,400 190,400
2500 0117R00908170002826 31/08/2017 190,400 190,400
2501 0117R00908170002827 31/08/2017 190,400 190,400
2502 0117R00908170002828 31/08/2017 190,400 190,400
2503 0117R00908170002829 31/08/2017 190,400 190,400
2504 0117R00908170002830 31/08/2017 190,400 190,400
2505 0117R00908170002831 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2506 0117R00908170002832 31/08/2017 190,400 190,400

2507 0117R00908170002833 31/08/2017 190,400 190,400
2508 0117R00908170002834 31/08/2017 191,800 191,800
2509 0117R00908170002838 31/08/2017 190,400 190,400
2510 0117R00908170002839 31/08/2017 191,800 191,800
2511 0117R00908170002840 31/08/2017 298,000 298,000
2512 0117R00908170002841 31/08/2017 190,400 190,400
2513 0117R00908170002842 31/08/2017 190,400 190,400
2514 0117R00908170002843 31/08/2017 190,400 190,400
2515 0117R00908170002844 31/08/2017 191,800 191,800
2516 0117R00908170002845 31/08/2017 190,400 190,400
2517 0117R00908170002846 31/08/2017 190,400 190,400
2518 0117R00908170002847 31/08/2017 190,400 190,400
2519 0117R00908170002848 31/08/2017 190,400 190,400
2520 0117R00908170002849 31/08/2017 190,400 190,400
2521 0117R00908170002850 31/08/2017 190,400 190,400
2522 0117R00908170002851 31/08/2017 190,400 190,400
2523 0117R00908170002852 31/08/2017 190,400 190,400
2524 0117R00908170002853 31/08/2017 190,400 190,400
2525 0117R00908170002854 31/08/2017 190,400 190,400
2526 0117R00908170002855 31/08/2017 323,900 323,900
2527 0117R00908170002856 31/08/2017 190,400 190,400
2528 0117R00908170002857 31/08/2017 190,400 190,400
2529 0117R00908170002858 31/08/2017 190,400 190,400
2530 0117R00908170002859 31/08/2017 190,400 190,400
2531 0117R00908170002860 31/08/2017 190,400 190,400
2532 0117R00908170002861 31/08/2017 190,400 190,400
2533 0117R00908170002862 31/08/2017 190,400 190,400
2534 0117R00908170002863 31/08/2017 190,400 190,400
2535 0117R00908170002864 31/08/2017 190,400 190,400
2536 0117R00908170002865 31/08/2017 190,400 190,400
2537 0117R00908170002866 31/08/2017 190,400 190,400
2538 0117R00908170002867 31/08/2017 190,400 190,400
2539 0117R00908170002868 31/08/2017 190,400 190,400
2540 0117R00908170002869 31/08/2017 298,000 298,000
2541 0117R00908170002870 31/08/2017 112,800 112,800
2542 0117R00908170002871 31/08/2017 190,400 190,400
2543 0117R00908170002872 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2544 0117R00908170002873 31/08/2017 190,400 190,400

2545 0117R00908170002874 31/08/2017 190,400 190,400
2546 0117R00908170002875 31/08/2017 190,400 190,400
2547 0117R00908170002876 31/08/2017 298,000 298,000
2548 0117R00908170002877 31/08/2017 190,400 190,400
2549 0117R00908170002878 31/08/2017 254,200 254,200
2550 0117R00908170002879 31/08/2017 461,900 461,900
2551 0117R00908170002880 31/08/2017 190,400 190,400
2552 0117R00908170002881 31/08/2017 190,400 190,400
2553 0117R00908170002882 31/08/2017 190,400 190,400
2554 0117R00908170002883 31/08/2017 190,400 190,400
2555 0117R00908170002884 31/08/2017 190,400 190,400
2556 0117R00908170002885 31/08/2017 298,000 298,000
2557 0117R00908170002886 31/08/2017 190,400 190,400
2558 0117R00908170002888 31/08/2017 190,400 190,400
2559 0117R00908170002889 31/08/2017 323,900 323,900
2560 0117R00908170002890 31/08/2017 190,400 190,400
2561 0117R00908170002891 31/08/2017 190,400 190,400
2562 0117R00908170002892 31/08/2017 190,400 190,400
2563 0117R00908170002893 31/08/2017 190,400 190,400
2564 0117R00908170002894 31/08/2017 190,400 190,400
2565 0117R00908170002895 31/08/2017 112,800 112,800
2566 0117R00908170002896 31/08/2017 190,400 190,400
2567 0117R00908170002897 31/08/2017 190,400 190,400
2568 0117R00908170002898 31/08/2017 190,400 190,400
2569 0117R00908170002899 31/08/2017 193,100 193,100
2570 0117R00908170002900 31/08/2017 190,400 190,400
2571 0117R00908170002901 31/08/2017 190,400 190,400
2572 0117R00908170002902 31/08/2017 190,400 190,400
2573 0117R00908170002903 31/08/2017 190,400 190,400
2574 0117R00908170002905 31/08/2017 190,400 190,400
2575 0117R00908170002906 31/08/2017 112,800 112,800
2576 0117R00908170002907 31/08/2017 190,400 190,400
2577 0117R00908170002908 31/08/2017 112,800 112,800
2578 0117R00908170002909 31/08/2017 190,400 190,400
2579 0117R00908170002910 31/08/2017 190,400 190,400
2580 0117R00908170002911 31/08/2017 190,400 190,400
2581 0117R00908170002912 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2582 0117R00908170002913 31/08/2017 112,800 112,800

2583 0117R00908170002914 31/08/2017 190,400 190,400
2584 0117R00908170002915 31/08/2017 190,400 190,400
2585 0117R00908170002916 31/08/2017 190,400 190,400
2586 0117R00908170002917 31/08/2017 190,400 190,400
2587 0117R00908170002918 31/08/2017 112,800 112,800
2588 0117R00908170002919 31/08/2017 190,400 190,400
2589 0117R00908170002921 31/08/2017 190,400 190,400
2590 0117R00908170002922 31/08/2017 190,400 190,400
2591 0117R00908170002923 31/08/2017 190,400 190,400
2592 0117R00908170002924 31/08/2017 576,900 576,900
2593 0117R00908170002925 31/08/2017 190,400 190,400
2594 0117R00908170002926 31/08/2017 112,800 112,800
2595 0117R00908170002927 31/08/2017 190,400 190,400
2596 0117R00908170002928 31/08/2017 190,400 190,400
2597 0117R00908170002929 31/08/2017 190,400 190,400
2598 0117R00908170002930 31/08/2017 112,800 112,800
2599 0117R00908170002931 31/08/2017 190,400 190,400
2600 0117R00908170002932 31/08/2017 112,800 112,800
2601 0117R00908170002933 31/08/2017 190,400 190,400
2602 0117R00908170002934 31/08/2017 190,400 190,400
2603 0117R00908170002935 31/08/2017 190,400 190,400
2604 0117R00908170002936 31/08/2017 190,400 190,400
2605 0117R00908170002937 31/08/2017 112,800 112,800
2606 0117R00908170002938 31/08/2017 190,400 190,400
2607 0117R00908170002939 31/08/2017 190,400 190,400
2608 0117R00908170002940 31/08/2017 303,900 303,900
2609 0117R00908170002941 31/08/2017 323,900 323,900
2610 0117R00908170002942 31/08/2017 190,400 190,400
2611 0117R00908170002943 31/08/2017 112,800 112,800
2612 0117R00908170002944 31/08/2017 190,400 190,400
2613 0117R00908170002945 31/08/2017 461,900 461,900
2614 0117R00908170002946 31/08/2017 190,400 190,400
2615 0117R00908170002947 31/08/2017 190,400 190,400
2616 0117R00908170002948 31/08/2017 112,800 112,800
2617 0117R00908170002949 31/08/2017 190,400 190,400
2618 0117R00908170002950 31/08/2017 190,400 190,400
2619 0117R00908170002952 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2620 0117R00908170002953 31/08/2017 190,400 190,400

2621 0117R00908170002954 31/08/2017 190,400 190,400
2622 0117R00908170002955 31/08/2017 298,000 298,000
2623 0117R00908170002956 31/08/2017 190,400 190,400
2624 0117R00908170002957 31/08/2017 323,900 323,900
2625 0117R00908170002958 31/08/2017 576,900 576,900
2626 0117R00908170002959 31/08/2017 190,400 190,400
2627 0117R00908170002960 31/08/2017 190,400 190,400
2628 0117R00908170002961 31/08/2017 193,100 193,100
2629 0117R00908170002962 31/08/2017 190,400 190,400
2630 0117R00908170002963 31/08/2017 190,400 190,400
2631 0117R00908170002964 31/08/2017 112,800 112,800
2632 0117R00908170002965 31/08/2017 112,800 112,800
2633 0117R00908170002966 31/08/2017 190,400 190,400
2634 0117R00908170002968 31/08/2017 190,400 190,400
2635 0117R00908170002969 31/08/2017 190,400 190,400
2636 0117R00908170002970 31/08/2017 190,400 190,400
2637 0117R00908170002971 31/08/2017 190,400 190,400
2638 0117R00908170002972 31/08/2017 112,800 112,800
2639 0117R00908170002974 31/08/2017 190,400 190,400
2640 0117R00908170002976 31/08/2017 112,800 112,800
2641 0117R00908170002977 31/08/2017 190,400 190,400
2642 0117R00908170002978 31/08/2017 112,800 112,800
2643 0117R00908170002979 31/08/2017 190,400 190,400
2644 0117R00908170002980 31/08/2017 190,400 190,400
2645 0117R00908170002981 31/08/2017 190,400 190,400
2646 0117R00908170002982 31/08/2017 190,400 190,400
2647 0117R00908170002983 31/08/2017 190,400 190,400
2648 0117R00908170002984 31/08/2017 311,300 311,300
2649 0117R00908170002985 31/08/2017 190,400 190,400
2650 0117R00908170002986 31/08/2017 190,400 190,400
2651 0117R00908170002987 31/08/2017 191,800 191,800
2652 0117R00908170002988 31/08/2017 190,400 190,400
2653 0117R00908170002990 31/08/2017 258,100 258,100
2654 0117R00908170002991 31/08/2017 267,800 267,800
2655 0117R00908170002992 31/08/2017 323,900 323,900
2656 0117R00908170002993 31/08/2017 190,400 190,400
2657 0117R00908170002994 31/08/2017 323,900 323,900
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2658 0117R00908170002995 31/08/2017 112,800 112,800

2659 0117R00908170002996 31/08/2017 190,400 190,400
2660 0117R00908170002997 31/08/2017 190,400 190,400
2661 0117R00908170002998 31/08/2017 190,400 190,400
2662 0117R00908170002999 31/08/2017 190,400 190,400
2663 0117R00908170003000 31/08/2017 190,400 190,400
2664 0117R00908170003001 31/08/2017 112,800 112,800
2665 0117R00908170003002 31/08/2017 191,800 191,800
2666 0117R00908170003003 31/08/2017 112,800 112,800
2667 0117R00908170003004 31/08/2017 254,200 254,200
2668 0117R00908170003005 31/08/2017 258,100 258,100
2669 0117R00908170003006 31/08/2017 190,400 190,400
2670 0117R00908170003007 31/08/2017 190,400 190,400
2671 0117R00908170003009 31/08/2017 190,400 190,400
2672 0117R00908170003010 31/08/2017 190,400 190,400
2673 0117R00908170003011 31/08/2017 190,400 190,400
2674 0117R00908170003012 31/08/2017 263,500 263,500
2675 0117R00908170003013 31/08/2017 190,400 190,400
2676 0117R00908170003014 31/08/2017 112,800 112,800
2677 0117R00908170003015 31/08/2017 190,400 190,400
2678 0117R00908170003016 31/08/2017 254,200 254,200
2679 0117R00908170003017 31/08/2017 275,100 275,100
2680 0117R00908170003018 31/08/2017 190,400 190,400
2681 0117R00908170003019 31/08/2017 112,800 112,800
2682 0117R00908170003020 31/08/2017 191,800 191,800
2683 0117R00908170003021 31/08/2017 190,400 190,400
2684 0117R00908170003022 31/08/2017 298,000 298,000
2685 0117R00908170003023 31/08/2017 190,400 190,400
2686 0117R00908170003024 31/08/2017 190,400 190,400
2687 0117R00908170003025 31/08/2017 191,800 191,800
2688 0117R00908170003026 31/08/2017 298,000 298,000
2689 0117R00908170003027 31/08/2017 112,800 112,800
2690 0117R00908170003028 31/08/2017 112,800 112,800
2691 0117R00908170003029 31/08/2017 190,400 190,400
2692 0117R00908170003030 31/08/2017 190,400 190,400
2693 0117R00908170003031 31/08/2017 311,300 311,300
2694 0117R00908170003032 31/08/2017 190,400 190,400
2695 0117R00908170003033 31/08/2017 311,300 311,300
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2696 0117R00908170003034 31/08/2017 190,400 190,400

2697 0117R00908170003035 31/08/2017 190,400 190,400
2698 0117R00908170003036 31/08/2017 190,400 190,400
2699 0117R00908170003037 31/08/2017 263,500 263,500
2700 0117R00908170003038 31/08/2017 190,400 190,400
2701 0117R00908170003039 31/08/2017 190,400 190,400
2702 0117R00908170003040 31/08/2017 112,800 112,800
2703 0117R00908170003041 31/08/2017 190,400 190,400
2704 0117R00908170003042 31/08/2017 190,400 190,400
2705 0117R00908170003043 31/08/2017 112,800 112,800
2706 0117R00908170003044 31/08/2017 190,400 190,400
2707 0117R00908170003045 31/08/2017 190,400 190,400
2708 0117R00908170003046 31/08/2017 190,400 190,400
2709 0117R00908170003047 31/08/2017 190,400 190,400
2710 0117R00908170003048 31/08/2017 190,400 190,400
2711 0117R00908170003049 31/08/2017 190,400 190,400
2712 0117R00908170003050 31/08/2017 190,400 190,400
2713 0117R00908170003051 31/08/2017 190,400 190,400
2714 0117R00908170003052 31/08/2017 190,400 190,400
2715 0117R00908170003053 31/08/2017 190,400 190,400
2716 0117R00908170003055 31/08/2017 112,800 112,800
2717 0117R00908170003056 31/08/2017 190,400 190,400
2718 0117R00908170003057 31/08/2017 112,800 112,800
2719 0117R00908170003058 31/08/2017 190,400 190,400
2720 0117R00908170003059 31/08/2017 190,400 190,400
2721 0117R00908170003060 31/08/2017 190,400 190,400
2722 0117R00908170003061 31/08/2017 311,300 311,300
2723 0117R00908170003062 31/08/2017 311,300 311,300
2724 0117R00908170003063 31/08/2017 190,400 190,400
2725 0117R00908170003064 31/08/2017 190,400 190,400
2726 0117R00908170003065 31/08/2017 190,400 190,400
2727 0117R00908170003066 31/08/2017 190,400 190,400
2728 0117R00908170003067 31/08/2017 190,400 190,400
2729 0117R00908170003068 31/08/2017 190,400 190,400
2730 0117R00908170003069 31/08/2017 190,400 190,400
2731 0117R00908170003070 31/08/2017 190,400 190,400
2732 0117R00908170003071 31/08/2017 190,400 190,400
2733 0117R00908170003072 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2734 0117R00908170003073 31/08/2017 191,800 191,800

2735 0117R00908170003074 31/08/2017 298,000 298,000
2736 0117R00908170003075 31/08/2017 190,400 190,400
2737 0117R00908170003076 31/08/2017 190,400 190,400
2738 0117R00908170003077 31/08/2017 190,400 190,400
2739 0117R00908170003078 31/08/2017 190,400 190,400
2740 0117R00908170003079 31/08/2017 311,300 311,300
2741 0117R00908170003080 31/08/2017 311,300 311,300
2742 0117R00908170003081 31/08/2017 193,100 193,100
2743 0117R00908170003082 31/08/2017 190,400 190,400
2744 0117R00908170003083 31/08/2017 190,400 190,400
2745 0117R00908170003084 31/08/2017 190,400 190,400
2746 0117R00908170003085 31/08/2017 190,400 190,400
2747 0117R00908170003086 31/08/2017 190,400 190,400
2748 0117R00908170003087 31/08/2017 191,800 191,800
2749 0117R00908170003088 31/08/2017 275,100 275,100
2750 0117R00908170003089 31/08/2017 190,400 190,400
2751 0117R00908170003090 31/08/2017 190,400 190,400
2752 0117R00908170003091 31/08/2017 190,400 190,400
2753 0117R00908170003092 31/08/2017 190,400 190,400
2754 0117R00908170003093 31/08/2017 190,400 190,400
2755 0117R00908170003094 31/08/2017 193,100 193,100
2756 0117R00908170003095 31/08/2017 190,400 190,400
2757 0117R00908170003096 31/08/2017 190,400 190,400
2758 0117R00908170003097 31/08/2017 190,400 190,400
2759 0117R00908170003098 31/08/2017 190,400 190,400
2760 0117R00908170003099 31/08/2017 190,400 190,400
2761 0117R00908170003100 31/08/2017 190,400 190,400
2762 0117R00908170003101 31/08/2017 190,400 190,400
2763 0117R00908170003103 31/08/2017 190,400 190,400
2764 0117R00908170003104 31/08/2017 190,400 190,400
2765 0117R00908170003105 31/08/2017 190,400 190,400
2766 0117R00908170003106 31/08/2017 263,500 263,500
2767 0117R00908170003107 31/08/2017 190,400 190,400
2768 0117R00908170003108 31/08/2017 193,100 193,100
2769 0117R00908170003109 31/08/2017 190,400 190,400
2770 0117R00908170003110 31/08/2017 112,800 112,800
2771 0117R00908170003111 31/08/2017 323,900 323,900
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2772 0117R00908170003112 31/08/2017 112,800 112,800

2773 0117R00908170003113 31/08/2017 190,400 190,400
2774 0117R00908170003114 31/08/2017 576,900 576,900
2775 0117R00908170003115 31/08/2017 311,300 311,300
2776 0117R00908170003116 31/08/2017 190,400 190,400
2777 0117R00908170003117 31/08/2017 263,500 263,500
2778 0117R00908170003118 31/08/2017 190,400 190,400
2779 0117R00908170003119 31/08/2017 263,500 263,500
2780 0117R00908170003120 31/08/2017 190,400 190,400
2781 0117R00908170003121 31/08/2017 263,500 263,500
2782 0117R00908170003122 31/08/2017 311,300 311,300
2783 0117R00908170003123 31/08/2017 143,900 143,900
2784 0117R00908170003124 31/08/2017 112,800 112,800
2785 0117R00908170003125 31/08/2017 263,500 263,500
2786 0117R00908170003126 31/08/2017 190,400 190,400
2787 0117R00908170003127 31/08/2017 112,800 112,800
2788 0117R00908170003128 31/08/2017 190,400 190,400
2789 0117R00908170003129 31/08/2017 112,800 112,800
2790 0117R00908170003130 31/08/2017 112,800 112,800
2791 0117R00908170003131 31/08/2017 190,400 190,400
2792 0117R00908170003132 31/08/2017 190,400 190,400
2793 0117R00908170003133 31/08/2017 190,400 190,400
2794 0117R00908170003135 31/08/2017 191,800 191,800
2795 0117R00908170003136 31/08/2017 112,800 112,800
2796 0117R00908170003137 31/08/2017 193,100 193,100
2797 0117R00908170003138 31/08/2017 190,400 190,400
2798 0117R00908170003139 31/08/2017 298,000 298,000
2799 0117R00908170003140 31/08/2017 190,400 190,400
2800 0117R00908170003141 31/08/2017 190,400 190,400
2801 0117R00908170003142 31/08/2017 191,800 191,800
2802 0117R00908170003144 31/08/2017 254,200 254,200
2803 0117R00908170003145 31/08/2017 323,900 323,900
2804 0117R00908170003146 31/08/2017 112,800 112,800
2805 0117R00908170003147 31/08/2017 142,400 142,400
2806 0117R00908170003148 31/08/2017 190,400 190,400
2807 0117R00908170003149 31/08/2017 263,500 263,500
2808 0117R00908170003150 31/08/2017 190,400 190,400
2809 0117R00908170003151 31/08/2017 263,500 263,500
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2810 0117R00908170003152 31/08/2017 215,000 215,000

2811 0117R00908170003154 31/08/2017 258,100 258,100
2812 0117R00908170003155 31/08/2017 190,400 190,400
2813 0117R00908170003156 31/08/2017 275,900 275,900
2814 0117R00908170003157 31/08/2017 311,300 311,300
2815 0117R00908170003158 31/08/2017 263,500 263,500
2816 0117R00908170003159 31/08/2017 323,900 323,900
2817 0117R00908170003160 31/08/2017 190,400 190,400
2818 0117R00908170003163 31/08/2017 191,800 191,800
2819 0117R00908170003164 31/08/2017 461,900 461,900
2820 0117R00908170003165 31/08/2017 193,100 193,100
2821 0117R00908170003166 31/08/2017 143,900 143,900
2822 0117R00908170003167 31/08/2017 190,400 190,400
2823 0117R00908170003168 31/08/2017 190,400 190,400
2824 0117R00908170003169 31/08/2017 190,400 190,400
2825 0117R00908170003170 31/08/2017 190,400 190,400
2826 0117R00908170003171 31/08/2017 112,800 112,800
2827 0117R00908170003172 31/08/2017 263,500 263,500
2828 0117R00908170003173 31/08/2017 263,500 263,500
2829 0117R00908170003174 31/08/2017 263,500 263,500
2830 0117R00908170003175 31/08/2017 263,500 263,500
2831 0117R00908170003177 31/08/2017 267,800 267,800
2832 0117R00908170003178 31/08/2017 323,900 323,900
2833 0117R00908170003179 31/08/2017 576,900 576,900
2834 0117R00908170003180 31/08/2017 204,200 204,200
2835 0117R00908170003182 31/08/2017 112,800 112,800
2836 0117R00908170003183 31/08/2017 576,900 576,900
2837 0117R00908170003184 31/08/2017 112,800 112,800
2838 0117R00908170003185 31/08/2017 576,900 576,900
2839 0117R00908170003186 31/08/2017 190,400 190,400
2840 0117R00908170003187 31/08/2017 323,900 323,900
2841 0117R00908170003188 31/08/2017 576,900 576,900
2842 0117R00908170003189 31/08/2017 112,800 112,800
2843 0117R00908170003190 31/08/2017 190,400 190,400
2844 0117R00908170003191 31/08/2017 323,900 323,900
2845 0117R00908170003192 31/08/2017 263,500 263,500
2846 0117R00908170003193 31/08/2017 576,900 576,900
2847 0117R00908170003194 31/08/2017 576,900 576,900
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2848 0117R00908170003195 31/08/2017 190,400 190,400

2849 0117R00908170003196 31/08/2017 112,800 112,800
2850 0117R00908170003197 31/08/2017 190,400 190,400
2851 0117R00908170003198 31/08/2017 311,300 311,300
2852 0117R00908170003199 31/08/2017 267,800 267,800
2853 0117R00908170003200 31/08/2017 308,800 308,800
2854 0117R00908170003201 31/08/2017 263,500 263,500
2855 0117R00908170003203 31/08/2017 190,400 190,400
2856 0117R00908170003204 31/08/2017 190,400 190,400
2857 0117R00908170003205 31/08/2017 190,400 190,400
2858 0117R00908170003206 31/08/2017 190,400 190,400
2859 0117R00908170003207 31/08/2017 112,800 112,800
2860 0117R00908170003208 31/08/2017 190,400 190,400
2861 0117R00908170003210 31/08/2017 190,400 190,400
2862 0117R00908170003211 31/08/2017 190,400 190,400
2863 0117R00908170003212 31/08/2017 112,800 112,800
2864 0117R00908170003213 31/08/2017 190,400 190,400
2865 0117R00908170003214 31/08/2017 112,800 112,800
2866 0117R00908170003215 31/08/2017 267,800 267,800
2867 0117R00908170003217 31/08/2017 311,300 311,300
2868 0117R00908170003218 31/08/2017 191,800 191,800
2869 0117R00908170003219 31/08/2017 254,200 254,200
2870 0117R00908170003221 31/08/2017 190,400 190,400
2871 0117R00908170003222 31/08/2017 190,400 190,400
2872 0117R00908170003224 31/08/2017 311,300 311,300
2873 0117R00908170003225 31/08/2017 112,800 112,800
2874 0117R00908170003226 31/08/2017 191,800 191,800
2875 0117R00908170003227 31/08/2017 191,800 191,800
2876 0117R00908170003228 31/08/2017 311,300 311,300
2877 0117R00908170003230 31/08/2017 190,400 190,400
2878 0117R00908170003231 31/08/2017 323,900 323,900
2879 0117R00908170003232 31/08/2017 190,400 190,400
2880 0117R00908170003233 31/08/2017 112,800 112,800
2881 0117R00908170003235 31/08/2017 190,400 190,400
2882 0117R00908170003236 31/08/2017 112,800 112,800
2883 0117R00908170003238 31/08/2017 112,800 112,800
2884 0117R00908170003239 31/08/2017 112,800 112,800
2885 0117R00908170003240 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2886 0117R00908170003241 31/08/2017 112,800 112,800

2887 0117R00908170003242 31/08/2017 190,400 190,400
2888 0117R00908170003243 31/08/2017 190,400 190,400
2889 0117R00908170003244 31/08/2017 193,100 193,100
2890 0117R00908170003245 31/08/2017 190,400 190,400
2891 0117R00908170003246 31/08/2017 193,100 193,100
2892 0117R00908170003247 31/08/2017 311,300 311,300
2893 0117R00908170003248 31/08/2017 112,800 112,800
2894 0117R00908170003250 31/08/2017 311,300 311,300
2895 0117R00908170003251 31/08/2017 254,200 254,200
2896 0117R00908170003252 31/08/2017 112,800 112,800
2897 0117R00908170003253 31/08/2017 190,400 190,400
2898 0117R00908170003254 31/08/2017 190,400 190,400
2899 0117R00908170003255 31/08/2017 311,300 311,300
2900 0117R00908170003256 31/08/2017 190,400 190,400
2901 0117R00908170003257 31/08/2017 190,400 190,400
2902 0117R00908170003258 31/08/2017 311,300 311,300
2903 0117R00908170003260 31/08/2017 254,200 254,200
2904 0117R00908170003262 31/08/2017 191,800 191,800
2905 0117R00908170003265 31/08/2017 191,800 191,800
2906 0117R00908170003267 31/08/2017 190,400 190,400
2907 0117R00908170003268 31/08/2017 190,400 190,400
2908 0117R00908170003269 31/08/2017 254,200 254,200
2909 0117R00908170003270 31/08/2017 142,400 142,400
2910 0117R00908170003271 31/08/2017 191,800 191,800
2911 0117R00908170003272 31/08/2017 190,400 190,400
2912 0117R00908170003273 31/08/2017 193,100 193,100
2913 0117R00908170003275 31/08/2017 323,900 323,900
2914 0117R00908170003276 31/08/2017 193,100 193,100
2915 0117R00908170003278 31/08/2017 190,400 190,400
2916 0117R00908170003279 31/08/2017 191,800 191,800
2917 0117R00908170003280 31/08/2017 323,900 323,900
2918 0117R00908170003281 31/08/2017 191,800 191,800
2919 0117R00908170003282 31/08/2017 172,400 172,400
2920 0117R00908170003283 31/08/2017 190,400 190,400
2921 0117R00908170003284 31/08/2017 190,400 190,400
2922 0117R00908170003285 31/08/2017 263,300 263,300
2923 0117R00908170003286 31/08/2017 323,900 323,900
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2924 0117R00908170003287 31/08/2017 191,800 191,800

2925 0117R00908170003290 31/08/2017 323,900 323,900
2926 0117R00908170003292 31/08/2017 323,900 323,900
2927 0117R00908170003293 31/08/2017 190,400 190,400
2928 0117R00908170003294 31/08/2017 191,800 191,800
2929 0117R00908170003296 31/08/2017 190,400 190,400
2930 0117R00908170003297 31/08/2017 190,400 190,400
2931 0117R00908170003298 31/08/2017 190,400 190,400
2932 0117R00908170003299 31/08/2017 303,900 303,900
2933 0117R00908170003300 31/08/2017 190,400 190,400
2934 0117R00908170003301 31/08/2017 254,200 254,200
2935 0117R00908170003302 31/08/2017 190,400 190,400
2936 0117R00908170003303 31/08/2017 190,400 190,400
2937 0117R00908170003304 31/08/2017 190,400 190,400
2938 0117R00908170003305 31/08/2017 190,400 190,400
2939 0117R00908170003306 31/08/2017 142,400 142,400
2940 0117R00908170003308 31/08/2017 190,400 190,400
2941 0117R00908170003309 31/08/2017 190,400 190,400
2942 0117R00908170003310 31/08/2017 190,400 190,400
2943 0117R00908170003311 31/08/2017 190,400 190,400
2944 0117R00908170003312 31/08/2017 323,900 323,900
2945 0117R00908170003313 31/08/2017 323,900 323,900
2946 0117R00908170003314 31/08/2017 190,400 190,400
2947 0117R00908170003315 31/08/2017 190,400 190,400
2948 0117R00908170003316 31/08/2017 190,400 190,400
2949 0117R00908170003317 31/08/2017 190,400 190,400
2950 0117R00908170003319 31/08/2017 190,400 190,400
2951 0117R00908170003320 31/08/2017 193,100 193,100
2952 0117R00908170003321 31/08/2017 190,400 190,400
2953 0117R00908170003322 31/08/2017 190,400 190,400
2954 0117R00908170003324 31/08/2017 190,400 190,400
2955 0117R00908170003325 31/08/2017 190,400 190,400
2956 0117R00908170003326 31/08/2017 190,400 190,400
2957 0117R00908170003327 31/08/2017 190,400 190,400
2958 0117R00908170003328 31/08/2017 190,400 190,400
2959 0117R00908170003329 31/08/2017 190,400 190,400
2960 0117R00908170003330 31/08/2017 190,400 190,400
2961 0117R00908170003332 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
2962 0117R00908170003333 31/08/2017 190,400 190,400

2963 0117R00908170003334 31/08/2017 190,400 190,400
2964 0117R00908170003335 31/08/2017 190,400 190,400
2965 0117R00908170003336 31/08/2017 190,400 190,400
2966 0117R00908170003337 31/08/2017 298,000 298,000
2967 0117R00908170003338 31/08/2017 190,400 190,400
2968 0117R00908170003339 31/08/2017 190,400 190,400
2969 0117R00908170003340 31/08/2017 190,400 190,400
2970 0117R00908170003341 31/08/2017 190,400 190,400
2971 0117R00908170003342 31/08/2017 190,400 190,400
2972 0117R00908170003343 31/08/2017 190,400 190,400
2973 0117R00908170003344 31/08/2017 254,200 254,200
2974 0117R00908170003345 31/08/2017 254,200 254,200
2975 0117R00908170003346 31/08/2017 190,400 190,400
2976 0117R00908170003347 31/08/2017 190,400 190,400
2977 0117R00908170003348 31/08/2017 190,400 190,400
2978 0117R00908170003349 31/08/2017 190,400 190,400
2979 0117R00908170003350 31/08/2017 190,400 190,400
2980 0117R00908170003351 31/08/2017 190,400 190,400
2981 0117R00908170003352 31/08/2017 112,800 112,800
2982 0117R00908170003353 31/08/2017 190,400 190,400
2983 0117R00908170003354 31/08/2017 190,400 190,400
2984 0117R00908170003356 31/08/2017 190,400 190,400
2985 0117R00908170003357 31/08/2017 190,400 190,400
2986 0117R00908170003358 31/08/2017 191,800 191,800
2987 0117R00908170003359 31/08/2017 112,800 112,800
2988 0117R00908170003360 31/08/2017 576,900 576,900
2989 0117R00908170003361 31/08/2017 190,400 190,400
2990 0117R00908170003362 31/08/2017 263,500 263,500
2991 0117R00908170003364 31/08/2017 190,400 190,400
2992 0117R00908170003365 31/08/2017 190,400 190,400
2993 0117R00908170003366 31/08/2017 298,000 298,000
2994 0117R00908170003367 31/08/2017 112,800 112,800
2995 0117R00908170003368 31/08/2017 298,000 298,000
2996 0117R00908170003369 31/08/2017 190,400 190,400
2997 0117R00908170003370 31/08/2017 112,800 112,800
2998 0117R00908170003371 31/08/2017 190,400 190,400
2999 0117R00908170003372 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3000 0117R00908170003373 31/08/2017 112,800 112,800

3001 0117R00908170003374 31/08/2017 190,400 190,400
3002 0117R00908170003375 31/08/2017 190,400 190,400
3003 0117R00908170003376 31/08/2017 190,400 190,400
3004 0117R00908170003377 31/08/2017 190,400 190,400
3005 0117R00908170003378 31/08/2017 112,800 112,800
3006 0117R00908170003379 31/08/2017 190,400 190,400
3007 0117R00908170003380 31/08/2017 311,300 311,300
3008 0117R00908170003381 31/08/2017 190,400 190,400
3009 0117R00908170003383 31/08/2017 190,400 190,400
3010 0117R00908170003384 31/08/2017 190,400 190,400
3011 0117R00908170003385 31/08/2017 112,800 112,800
3012 0117R00908170003386 31/08/2017 298,000 298,000
3013 0117R00908170003387 31/08/2017 190,400 190,400
3014 0117R00908170003388 31/08/2017 298,000 298,000
3015 0117R00908170003389 31/08/2017 190,400 190,400
3016 0117R00908170003390 31/08/2017 190,400 190,400
3017 0117R00908170003391 31/08/2017 112,800 112,800
3018 0117R00908170003392 31/08/2017 112,800 112,800
3019 0117R00908170003393 31/08/2017 112,800 112,800
3020 0117R00908170003394 31/08/2017 298,000 298,000
3021 0117R00908170003395 31/08/2017 190,400 190,400
3022 0117R00908170003396 31/08/2017 190,400 190,400
3023 0117R00908170003397 31/08/2017 190,400 190,400
3024 0117R00908170003398 31/08/2017 190,400 190,400
3025 0117R00908170003399 31/08/2017 323,900 323,900
3026 0117R00908170003401 31/08/2017 204,200 204,200
3027 0117R00908170003403 31/08/2017 191,800 191,800
3028 0117R00908170003405 31/08/2017 190,400 190,400
3029 0117R00908170003406 31/08/2017 190,400 190,400
3030 0117R00908170003407 31/08/2017 132,900 132,900
3031 0117R00908170003408 31/08/2017 190,400 190,400
3032 0117R00908170003409 31/08/2017 190,400 190,400
3033 0117R00908170003410 31/08/2017 190,400 190,400
3034 0117R00908170003411 31/08/2017 112,800 112,800
3035 0117R00908170003412 31/08/2017 112,800 112,800
3036 0117R00908170003413 31/08/2017 190,400 190,400
3037 0117R00908170003414 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3038 0117R00908170003416 31/08/2017 112,800 112,800

3039 0117R00908170003417 31/08/2017 190,400 190,400
3040 0117R00908170003418 31/08/2017 191,800 191,800
3041 0117R00908170003419 31/08/2017 190,400 190,400
3042 0117R00908170003420 31/08/2017 190,400 190,400
3043 0117R00908170003421 31/08/2017 112,800 112,800
3044 0117R00908170003422 31/08/2017 190,400 190,400
3045 0117R00908170003423 31/08/2017 298,000 298,000
3046 0117R00908170003424 31/08/2017 112,800 112,800
3047 0117R00908170003425 31/08/2017 190,400 190,400
3048 0117R00908170003426 31/08/2017 190,400 190,400
3049 0117R00908170003430 31/08/2017 190,400 190,400
3050 0117R00908170003431 31/08/2017 191,800 191,800
3051 0117R00908170003432 31/08/2017 112,800 112,800
3052 0117R00908170003433 31/08/2017 461,900 461,900
3053 0117R00908170003434 31/08/2017 190,400 190,400
3054 0117R00908170003435 31/08/2017 191,800 191,800
3055 0117R00908170003436 31/08/2017 190,400 190,400
3056 0117R00908170003437 31/08/2017 190,400 190,400
3057 0117R00908170003439 31/08/2017 323,900 323,900
3058 0117R00908170003440 31/08/2017 190,400 190,400
3059 0117R00908170003441 31/08/2017 190,400 190,400
3060 0117R00908170003442 31/08/2017 190,400 190,400
3061 0117R00908170003443 31/08/2017 190,400 190,400
3062 0117R00908170003444 31/08/2017 190,400 190,400
3063 0117R00908170003445 31/08/2017 190,400 190,400
3064 0117R00908170003446 31/08/2017 190,400 190,400
3065 0117R00908170003447 31/08/2017 190,400 190,400
3066 0117R00908170003448 31/08/2017 112,800 112,800
3067 0117R00908170003450 31/08/2017 190,400 190,400
3068 0117R00908170003452 31/08/2017 190,400 190,400
3069 0117R00908170003454 31/08/2017 190,400 190,400
3070 0117R00908170003455 31/08/2017 132,900 132,900
3071 0117R00908170003457 31/08/2017 112,800 112,800
3072 0117R00908170003458 31/08/2017 190,400 190,400
3073 0117R00908170003459 31/08/2017 461,900 461,900
3074 0117R00908170003460 31/08/2017 190,400 190,400
3075 0117R00908170003461 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3076 0117R00908170003462 31/08/2017 311,300 311,300

3077 0117R00908170003463 31/08/2017 190,400 190,400
3078 0117R00908170003464 31/08/2017 323,900 323,900
3079 0117R00908170003465 31/08/2017 193,100 193,100
3080 0117R00908170003466 31/08/2017 190,400 190,400
3081 0117R00908170003467 31/08/2017 190,400 190,400
3082 0117R00908170003468 31/08/2017 263,500 263,500
3083 0117R00908170003470 31/08/2017 190,400 190,400
3084 0117R00908170003471 31/08/2017 132,900 132,900
3085 0117R00908170003472 31/08/2017 190,400 190,400
3086 0117R00908170003473 31/08/2017 190,400 190,400
3087 0117R00908170003474 31/08/2017 190,400 190,400
3088 0117R00908170003475 31/08/2017 323,900 323,900
3089 0117R00908170003476 31/08/2017 190,400 190,400
3090 0117R00908170003477 31/08/2017 112,800 112,800
3091 0117R00908170003479 31/08/2017 191,800 191,800
3092 0117R00908170003480 31/08/2017 190,400 190,400
3093 0117R00908170003482 31/08/2017 190,400 190,400
3094 0117R00908170003483 31/08/2017 190,400 190,400
3095 0117R00908170003484 31/08/2017 190,400 190,400
3096 0117R00908170003485 31/08/2017 190,400 190,400
3097 0117R00908170003486 31/08/2017 190,400 190,400
3098 0117R00908170003487 31/08/2017 112,800 112,800
3099 0117R00908170003488 31/08/2017 190,400 190,400
3100 0117R00908170003489 31/08/2017 112,800 112,800
3101 0117R00908170003490 31/08/2017 193,100 193,100
3102 0117R00908170003491 31/08/2017 112,800 112,800
3103 0117R00908170003492 31/08/2017 275,100 275,100
3104 0117R00908170003494 31/08/2017 190,400 190,400
3105 0117R00908170003495 31/08/2017 190,400 190,400
3106 0117R00908170003496 31/08/2017 190,400 190,400
3107 0117R00908170003497 31/08/2017 112,800 112,800
3108 0117R00908170003498 31/08/2017 190,400 190,400
3109 0117R00908170003499 31/08/2017 191,800 191,800
3110 0117R00908170003500 31/08/2017 190,400 190,400
3111 0117R00908170003501 31/08/2017 190,400 190,400
3112 0117R00908170003502 31/08/2017 112,800 112,800
3113 0117R00908170003503 31/08/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3114 0117R00908170003504 31/08/2017 263,500 263,500

3115 0117R00908170003506 31/08/2017 190,400 190,400
3116 0117R00908170003507 31/08/2017 263,500 263,500
3117 0117R00908170003508 31/08/2017 112,800 112,800
3118 0117R00908170003510 31/08/2017 112,800 112,800
3119 0117R00908170003511 31/08/2017 190,400 190,400
3120 0117R00908170003512 31/08/2017 190,400 190,400
3121 0117R00908170003513 31/08/2017 190,400 190,400
3122 0117R00908170003514 31/08/2017 190,400 190,400
3123 0117R00908170003515 31/08/2017 190,400 190,400
3124 0117R00908170003516 31/08/2017 323,900 323,900
3125 0117R00908170003517 31/08/2017 311,300 311,300
3126 0117R00908170003518 31/08/2017 190,400 190,400
3127 0117R00908170003519 31/08/2017 190,400 190,400
3128 0117R00908170003520 31/08/2017 190,400 190,400
3129 0117R00908170003522 31/08/2017 190,400 190,400
3130 0117R00908170003523 31/08/2017 263,500 263,500
3131 0117R00908170003524 31/08/2017 202,100 202,100
3132 0117R00908170003525 31/08/2017 263,500 263,500
3133 0117R00908170003526 31/08/2017 311,300 311,300
3134 0117R00908170003527 31/08/2017 190,400 190,400
3135 0117R00908170003528 31/08/2017 190,400 190,400
3136 0117R00908170003529 31/08/2017 190,400 190,400
3137 0117R00908170003530 31/08/2017 190,400 190,400
3138 0117R00908170003531 31/08/2017 190,400 190,400
3139 0117R00908170003532 31/08/2017 190,400 190,400
3140 0117R00908170003533 31/08/2017 311,300 311,300
3141 0117R00908170003534 31/08/2017 576,900 576,900
3142 0117R00908170003535 31/08/2017 190,400 190,400
3143 0117R00908170003536 31/08/2017 193,100 193,100
3144 0117R00908170003538 31/08/2017 190,400 190,400
3145 0117R00908170003539 31/08/2017 263,500 263,500
3146 0117R00908170003540 31/08/2017 190,400 190,400
3147 0117R00908170003541 31/08/2017 190,400 190,400
3148 0117R00908170003542 31/08/2017 190,400 190,400
3149 0117R00908170003544 31/08/2017 190,400 190,400
3150 0117R00908170003545 31/08/2017 190,400 190,400
3151 0117R00908170003547 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3152 0117R00908170003548 31/08/2017 254,200 254,200

3153 0117R00908170003550 31/08/2017 193,100 193,100
3154 0117R00908170003551 31/08/2017 190,400 190,400
3155 0117R00908170003552 31/08/2017 190,400 190,400
3156 0117R00908170003553 31/08/2017 576,900 576,900
3157 0117R00908170003554 31/08/2017 190,400 190,400
3158 0117R00908170003555 31/08/2017 190,400 190,400
3159 0117R00908170003556 31/08/2017 190,400 190,400
3160 0117R00908170003557 31/08/2017 190,400 190,400
3161 0117R00908170003558 31/08/2017 112,800 112,800
3162 0117R00908170003559 31/08/2017 190,400 190,400
3163 0117R00908170003560 31/08/2017 547,100 547,100
3164 0117R00908170003561 31/08/2017 190,400 190,400
3165 0117R00908170003562 31/08/2017 263,500 263,500
3166 0117R00908170003563 31/08/2017 190,400 190,400
3167 0117R00908170003564 31/08/2017 193,100 193,100
3168 0117R00908170003565 31/08/2017 190,400 190,400
3169 0117R00908170003567 31/08/2017 190,400 190,400
3170 0117R00908170003569 31/08/2017 190,400 190,400
3171 0117R00908170003571 31/08/2017 190,400 190,400
3172 0117R00908170003572 31/08/2017 190,400 190,400
3173 0117R00908170003573 31/08/2017 190,400 190,400
3174 0117R00908170003575 31/08/2017 190,400 190,400
3175 0117R00908170003576 31/08/2017 190,400 190,400
3176 0117R00908170003577 31/08/2017 190,400 190,400
3177 0117R00908170003578 31/08/2017 254,200 254,200
3178 0117R00908170003580 31/08/2017 112,800 112,800
3179 0117R00908170003581 31/08/2017 190,400 190,400
3180 0117R00908170003582 31/08/2017 190,400 190,400
3181 0117R00908170003583 31/08/2017 190,400 190,400
3182 0117R00908170003584 31/08/2017 190,400 190,400
3183 0117R00908170003585 31/08/2017 190,400 190,400
3184 0117R00908170003586 31/08/2017 190,400 190,400
3185 0117R00908170003587 31/08/2017 112,800 112,800
3186 0117R00908170003588 31/08/2017 190,400 190,400
3187 0117R00908170003590 31/08/2017 190,400 190,400
3188 0117R00908170003591 31/08/2017 190,400 190,400
3189 0117R00908170003593 31/08/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3190 0117R00908170003594 31/08/2017 112,800 112,800

3191 0117R00908170003595 31/08/2017 191,800 191,800
3192 0117R00908170003597 31/08/2017 190,400 190,400
3193 0117R00908170003601 31/08/2017 190,400 190,400
3194 0117R00908170003603 31/08/2017 190,400 190,400
3195 0117R00908170003604 31/08/2017 112,800 112,800
3196 0117R00908170003605 31/08/2017 190,400 190,400
3197 0117R00908170003606 31/08/2017 190,400 190,400
3198 0117R00908170003607 31/08/2017 112,800 112,800
3199 0117R00908170003612 31/08/2017 263,500 263,500
3200 0117R00908170003613 31/08/2017 190,400 190,400
3201 0117R00908170003614 31/08/2017 263,500 263,500
3202 0117R00908170003615 31/08/2017 190,400 190,400
3203 0117R00908170003616 31/08/2017 576,900 576,900
3204 0117R00908170003617 31/08/2017 190,400 190,400
3205 0117R00908170003618 31/08/2017 190,400 190,400
3206 0117R00908170003619 31/08/2017 190,400 190,400
3207 0117R00908170003620 31/08/2017 190,400 190,400
3208 0117R00908170003621 31/08/2017 190,400 190,400
3209 0117R00908170003622 31/08/2017 190,400 190,400
3210 0117R00908170003623 31/08/2017 190,400 190,400
3211 0117R00908170003624 31/08/2017 190,400 190,400
3212 0117R00908170003626 31/08/2017 190,400 190,400
3213 0117R00908170003627 31/08/2017 190,400 190,400
3214 0117R00908170003628 31/08/2017 190,400 190,400
3215 0117R00908170003629 31/08/2017 202,100 202,100
3216 0117R00908170003630 31/08/2017 190,400 190,400
3217 0117R00908170003631 31/08/2017 190,400 190,400
3218 0117R00908170003632 31/08/2017 190,400 190,400
3219 0117R00908170003633 31/08/2017 263,500 263,500
3220 0117R00908170003634 31/08/2017 190,400 190,400
3221 0117R00908170003635 31/08/2017 190,400 190,400
3222 0117R00908170003636 31/08/2017 190,400 190,400
3223 0117R00908170003637 31/08/2017 190,400 190,400
3224 0117R00908170003638 31/08/2017 191,800 191,800
3225 0117R00908170003639 31/08/2017 190,400 190,400
3226 0117R00908170003641 31/08/2017 112,800 112,800
3227 0117R00908170003643 31/08/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3228 0117R00908170003644 31/08/2017 298,000 298,000

3229 0117R00908170003647 31/08/2017 311,300 311,300
3230 0117R00908170003648 31/08/2017 298,000 298,000
3231 0117R00908170003649 31/08/2017 190,400 190,400
3232 0117R00908170003650 31/08/2017 190,400 190,400
3233 0117R00908170003651 31/08/2017 190,400 190,400
3234 0117R00908170003652 31/08/2017 190,400 190,400
3235 0117R00908170003653 31/08/2017 112,800 112,800
3236 0117R00908170003654 31/08/2017 112,800 112,800
3237 0117R00908170003656 31/08/2017 190,400 190,400
3238 0117R00908170003657 31/08/2017 133,500 133,500
3239 0117R00908170003659 31/08/2017 123,900 123,900
3240 0117R00908170003660 31/08/2017 202,100 202,100
3241 0117R00908170003661 31/08/2017 254,200 254,200
3242 0117R00908170003662 31/08/2017 202,100 202,100
3243 0117R00908170003663 31/08/2017 112,800 112,800
3244 0117R00908170003664 31/08/2017 190,400 190,400
3245 0117R00908170003665 31/08/2017 190,400 190,400
3246 0117R00908170003666 31/08/2017 112,800 112,800
3247 0117R00908170003667 31/08/2017 190,400 190,400
3248 0117R00908170003668 31/08/2017 190,400 190,400
3249 0117R00908170003669 31/08/2017 254,200 254,200
3250 0117R00908170003670 31/08/2017 112,800 112,800
3251 0117R00908170003671 31/08/2017 190,400 190,400
3252 0117R00908170003672 31/08/2017 311,300 311,300
3253 0117R00908170003673 31/08/2017 576,900 576,900
3254 0117R00908170003675 31/08/2017 190,400 190,400
3255 0117R00908170003676 31/08/2017 190,400 190,400
3256 0117R00908170003677 31/08/2017 311,300 311,300
3257 0117R00908170003678 31/08/2017 323,900 323,900
3258 0117R00908170003679 31/08/2017 190,400 190,400
3259 0117R00908170003681 31/08/2017 254,200 254,200
3260 0117R00908170003682 31/08/2017 254,200 254,200
3261 0117R00908170003683 31/08/2017 190,400 190,400
3262 0117R00908170003684 31/08/2017 576,900 576,900
3263 0117R00908170003685 31/08/2017 191,800 191,800
3264 0117R00908170003686 31/08/2017 112,800 112,800
3265 0117R00908170003687 31/08/2017 191,800 191,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3266 0117R00908170003688 31/08/2017 190,400 190,400

3267 0117R00908170003689 31/08/2017 190,400 190,400
3268 0117R00908170003690 31/08/2017 112,800 112,800
3269 0117R00908170003691 31/08/2017 190,400 190,400
3270 0117R00908170003692 31/08/2017 576,900 576,900
3271 0117R00908170003693 31/08/2017 190,400 190,400
3272 0117R00908170003695 31/08/2017 190,400 190,400
3273 0117R00908170003696 31/08/2017 190,400 190,400
3274 0117R00908170003697 31/08/2017 190,400 190,400
3275 0117R00908170003698 31/08/2017 190,400 190,400
3276 0117R00908170003699 31/08/2017 193,100 193,100
3277 0117R00908170003700 31/08/2017 190,400 190,400
3278 0117R00908170003701 31/08/2017 308,800 308,800
3279 0117R00908170003702 31/08/2017 112,800 112,800
3280 0117R00908170003703 31/08/2017 112,800 112,800
3281 0117R00908170003704 31/08/2017 112,800 112,800
3282 0117R00908170003705 31/08/2017 190,400 190,400
3283 0117R00908170003706 31/08/2017 190,400 190,400
3284 0117R00908170003707 31/08/2017 191,800 191,800
3285 0117R00908170003708 31/08/2017 254,200 254,200
3286 0117R00908170003709 31/08/2017 112,800 112,800
3287 0117R00908170003710 31/08/2017 190,400 190,400
3288 0117R00908170003711 31/08/2017 190,400 190,400
3289 0117R00908170003713 31/08/2017 193,100 193,100
3290 0117R00908170003714 31/08/2017 190,400 190,400
3291 0117R00908170003715 31/08/2017 254,200 254,200
3292 0117R00908170003716 31/08/2017 112,800 112,800
3293 0117R00908170003717 31/08/2017 190,400 190,400
3294 0117R00908170003719 31/08/2017 254,200 254,200
3295 0117R00908170003720 31/08/2017 112,800 112,800
3296 0117R00908170003721 31/08/2017 193,100 193,100
3297 0117R00908170003722 31/08/2017 323,900 323,900
3298 0117R00908170003723 31/08/2017 308,800 308,800
3299 0117R00908170003724 31/08/2017 112,800 112,800
3300 0117R00908170003728 31/08/2017 190,400 190,400
3301 0117R00908170003729 31/08/2017 189,400 189,400
3302 0117R00908170003730 31/08/2017 323,900 323,900
3303 0117R00908170003733 31/08/2017 311,300 311,300
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3304 0117R00908170003734 31/08/2017 576,900 576,900

3305 0117R00908170003735 31/08/2017 190,400 190,400
3306 0117R00908170003736 31/08/2017 191,800 191,800
3307 0117R00908170003737 31/08/2017 576,900 576,900
3308 0117R00908170003738 31/08/2017 190,400 190,400
3309 0117R00908170003739 31/08/2017 190,400 190,400
3310 0117R00908170003740 31/08/2017 112,800 112,800
3311 0117R00908170003741 31/08/2017 191,800 191,800
3312 0117R00908170003742 31/08/2017 190,400 190,400
3313 0117R00908170003743 31/08/2017 311,300 311,300
3314 0117R00908170003744 31/08/2017 190,400 190,400
3315 0117R00908170003746 31/08/2017 133,500 133,500
3316 0117R00908170003747 31/08/2017 112,800 112,800
3317 0117R00908170003748 31/08/2017 190,400 190,400
3318 0117R00908170003749 31/08/2017 112,800 112,800
3319 0117R00908170003750 31/08/2017 323,900 323,900
3320 0117R00908170003751 31/08/2017 190,400 190,400
3321 0117R00908170003752 31/08/2017 190,400 190,400
3322 0117R00908170003753 31/08/2017 191,800 191,800
3323 0117R00908170003754 31/08/2017 112,800 112,800
3324 0117R00908170003755 31/08/2017 190,400 190,400
3325 0117R00908170003756 31/08/2017 190,400 190,400
3326 0117R00908170003757 31/08/2017 258,100 258,100
3327 0117R00908170003758 31/08/2017 190,400 190,400
3328 0117R00908170003761 31/08/2017 190,400 190,400
3329 0117R00908170003762 31/08/2017 190,400 190,400
3330 0117R00908170003763 31/08/2017 112,800 112,800
3331 0117R00908170003764 31/08/2017 311,300 311,300
3332 0117R00908170003766 31/08/2017 190,400 190,400
3333 0117R00908170003767 31/08/2017 190,400 190,400
3334 0117R00908170003768 31/08/2017 190,400 190,400
3335 0117R00908170003769 31/08/2017 190,400 190,400
3336 0117R00908170003775 31/08/2017 190,400 190,400
3337 0117R00908170003776 05/09/2017 190,400 190,400
3338 0117R00908170003778 05/09/2017 190,400 190,400
3339 0117R00908170003780 05/09/2017 190,400 190,400
3340 0117R00908170003782 05/09/2017 190,400 190,400
3341 0117R00908170003783 05/09/2017 191,800 191,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3342 0117R00908170003784 05/09/2017 190,400 190,400

3343 0117R00908170003785 05/09/2017 190,400 190,400
3344 0117R00908170003786 05/09/2017 190,400 190,400
3345 0117R00908170003788 05/09/2017 190,400 190,400
3346 0117R00908170003789 05/09/2017 254,200 254,200
3347 0117R00908170003790 05/09/2017 190,400 190,400
3348 0117R00908170003791 05/09/2017 190,400 190,400
3349 0117R00908170003792 05/09/2017 190,400 190,400
3350 0117R00908170003793 05/09/2017 190,400 190,400
3351 0117R00908170003794 05/09/2017 190,400 190,400
3352 0117R00908170003795 05/09/2017 190,400 190,400
3353 0117R00908170003797 05/09/2017 110,000 110,000
3354 0117R00908170003798 05/09/2017 190,400 190,400
3355 0117R00908170003799 05/09/2017 190,400 190,400
3356 0117R00908170003800 05/09/2017 254,200 254,200
3357 0117R00908170003801 05/09/2017 191,800 191,800
3358 0117R00908170003802 05/09/2017 190,400 190,400
3359 0117R00908170003803 05/09/2017 190,400 190,400
3360 0117R00908170003804 05/09/2017 190,400 190,400
3361 0117R00908170003805 05/09/2017 190,400 190,400
3362 0117R00908170003806 05/09/2017 190,400 190,400
3363 0117R00908170003807 05/09/2017 191,800 191,800
3364 0117R00908170003808 05/09/2017 190,400 190,400
3365 0117R00908170003809 05/09/2017 193,100 193,100
3366 0117R00908170003810 05/09/2017 190,400 190,400
3367 0117R00908170003811 05/09/2017 190,400 190,400
3368 0117R00908170003812 05/09/2017 191,800 191,800
3369 0117R00908170003814 05/09/2017 190,400 190,400
3370 0117R00908170003816 05/09/2017 193,100 193,100
3371 0117R00908170003817 05/09/2017 190,400 190,400
3372 0117R00908170003818 05/09/2017 190,400 190,400
3373 0117R00908170003819 05/09/2017 323,900 323,900
3374 0117R00908170003820 05/09/2017 190,400 190,400
3375 0117R00908170003821 05/09/2017 190,400 190,400
3376 0117R00908170003822 05/09/2017 311,300 311,300
3377 0117R00908170003823 05/09/2017 193,100 193,100
3378 0117R00908170003825 05/09/2017 112,800 112,800
3379 0117R00908170003826 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3380 0117R00908170003827 05/09/2017 190,400 190,400

3381 0117R00908170003828 05/09/2017 190,400 190,400
3382 0117R00908170003829 05/09/2017 190,400 190,400
3383 0117R00908170003830 05/09/2017 190,400 190,400
3384 0117R00908170003831 05/09/2017 190,400 190,400
3385 0117R00908170003832 05/09/2017 190,400 190,400
3386 0117R00908170003833 05/09/2017 193,100 193,100
3387 0117R00908170003834 05/09/2017 190,400 190,400
3388 0117R00908170003835 05/09/2017 190,400 190,400
3389 0117R00908170003836 05/09/2017 190,400 190,400
3390 0117R00908170003837 05/09/2017 298,000 298,000
3391 0117R00908170003838 05/09/2017 190,400 190,400
3392 0117R00908170003839 05/09/2017 190,400 190,400
3393 0117R00908170003840 05/09/2017 298,000 298,000
3394 0117R00908170003841 05/09/2017 254,200 254,200
3395 0117R00908170003842 05/09/2017 190,400 190,400
3396 0117R00908170003843 05/09/2017 191,800 191,800
3397 0117R00908170003844 05/09/2017 193,100 193,100
3398 0117R00908170003845 05/09/2017 190,400 190,400
3399 0117R00908170003846 05/09/2017 190,400 190,400
3400 0117R00908170003847 05/09/2017 112,800 112,800
3401 0117R00908170003848 05/09/2017 190,400 190,400
3402 0117R00908170003849 05/09/2017 190,400 190,400
3403 0117R00908170003851 05/09/2017 142,400 142,400
3404 0117R00908170003852 05/09/2017 190,400 190,400
3405 0117R00908170003853 05/09/2017 190,400 190,400
3406 0117R00908170003854 05/09/2017 190,400 190,400
3407 0117R00908170003855 05/09/2017 190,400 190,400
3408 0117R00908170003856 05/09/2017 190,400 190,400
3409 0117R00908170003857 05/09/2017 190,400 190,400
3410 0117R00908170003858 05/09/2017 190,400 190,400
3411 0117R00908170003860 05/09/2017 190,400 190,400
3412 0117R00908170003862 05/09/2017 323,900 323,900
3413 0117R00908170003863 05/09/2017 190,400 190,400
3414 0117R00908170003864 05/09/2017 190,400 190,400
3415 0117R00908170003865 05/09/2017 112,800 112,800
3416 0117R00908170003866 05/09/2017 190,400 190,400
3417 0117R00908170003867 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3418 0117R00908170003868 05/09/2017 190,400 190,400

3419 0117R00908170003869 05/09/2017 576,900 576,900
3420 0117R00908170003870 05/09/2017 191,800 191,800
3421 0117R00908170003871 05/09/2017 190,400 190,400
3422 0117R00908170003872 05/09/2017 190,400 190,400
3423 0117R00908170003873 05/09/2017 190,400 190,400
3424 0117R00908170003874 05/09/2017 112,800 112,800
3425 0117R00908170003876 05/09/2017 190,400 190,400
3426 0117R00908170003877 05/09/2017 190,400 190,400
3427 0117R00908170003878 05/09/2017 298,000 298,000
3428 0117R00908170003879 05/09/2017 112,800 112,800
3429 0117R00908170003880 05/09/2017 190,400 190,400
3430 0117R00908170003881 05/09/2017 112,800 112,800
3431 0117R00908170003882 05/09/2017 298,000 298,000
3432 0117R00908170003883 05/09/2017 190,400 190,400
3433 0117R00908170003884 05/09/2017 190,400 190,400
3434 0117R00908170003885 05/09/2017 190,400 190,400
3435 0117R00908170003886 05/09/2017 190,400 190,400
3436 0117R00908170003888 05/09/2017 190,400 190,400
3437 0117R00908170003889 05/09/2017 190,400 190,400
3438 0117R00908170003890 05/09/2017 190,400 190,400
3439 0117R00908170003891 05/09/2017 576,900 576,900
3440 0117R00908170003892 05/09/2017 193,100 193,100
3441 0117R00908170003893 05/09/2017 190,400 190,400
3442 0117R00908170003894 05/09/2017 190,400 190,400
3443 0117R00908170003895 05/09/2017 311,300 311,300
3444 0117R00908170003896 05/09/2017 112,800 112,800
3445 0117R00908170003897 05/09/2017 112,800 112,800
3446 0117R00908170003898 05/09/2017 298,000 298,000
3447 0117R00908170003899 05/09/2017 190,400 190,400
3448 0117R00908170003900 05/09/2017 190,400 190,400
3449 0117R00908170003901 05/09/2017 190,400 190,400
3450 0117R00908170003902 05/09/2017 190,400 190,400
3451 0117R00908170003903 05/09/2017 190,400 190,400
3452 0117R00908170003904 05/09/2017 190,400 190,400
3453 0117R00908170003905 05/09/2017 190,400 190,400
3454 0117R00908170003906 05/09/2017 190,400 190,400
3455 0117R00908170003907 05/09/2017 193,100 193,100
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3456 0117R00908170003909 05/09/2017 263,500 263,500

3457 0117R00908170003910 05/09/2017 133,500 133,500
3458 0117R00908170003911 05/09/2017 298,000 298,000
3459 0117R00908170003912 05/09/2017 190,400 190,400
3460 0117R00908170003913 05/09/2017 190,400 190,400
3461 0117R00908170003914 05/09/2017 193,100 193,100
3462 0117R00908170003915 05/09/2017 190,400 190,400
3463 0117R00908170003916 05/09/2017 190,400 190,400
3464 0117R00908170003917 05/09/2017 190,400 190,400
3465 0117R00908170003918 05/09/2017 191,800 191,800
3466 0117R00908170003919 05/09/2017 576,900 576,900
3467 0117R00908170003920 05/09/2017 190,400 190,400
3468 0117R00908170003921 05/09/2017 190,400 190,400
3469 0117R00908170003922 05/09/2017 190,400 190,400
3470 0117R00908170003923 05/09/2017 190,400 190,400
3471 0117R00908170003924 05/09/2017 190,400 190,400
3472 0117R00908170003926 05/09/2017 112,800 112,800
3473 0117R00908170003927 05/09/2017 190,400 190,400
3474 0117R00908170003928 05/09/2017 311,300 311,300
3475 0117R00908170003929 05/09/2017 190,400 190,400
3476 0117R00908170003930 05/09/2017 112,800 112,800
3477 0117R00908170003931 05/09/2017 190,400 190,400
3478 0117R00908170003932 05/09/2017 193,100 193,100
3479 0117R00908170003933 05/09/2017 190,400 190,400
3480 0117R00908170003934 05/09/2017 190,400 190,400
3481 0117R00908170003935 05/09/2017 303,900 303,900
3482 0117R00908170003936 05/09/2017 190,400 190,400
3483 0117R00908170003937 05/09/2017 190,400 190,400
3484 0117R00908170003938 05/09/2017 576,900 576,900
3485 0117R00908170003939 05/09/2017 190,400 190,400
3486 0117R00908170003940 05/09/2017 190,400 190,400
3487 0117R00908170003941 05/09/2017 190,400 190,400
3488 0117R00908170003942 05/09/2017 193,100 193,100
3489 0117R00908170003943 05/09/2017 576,900 576,900
3490 0117R00908170003944 05/09/2017 112,800 112,800
3491 0117R00908170003945 05/09/2017 190,400 190,400
3492 0117R00908170003946 05/09/2017 311,300 311,300
3493 0117R00908170003947 05/09/2017 191,800 191,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3494 0117R00908170003948 05/09/2017 190,400 190,400

3495 0117R00908170003949 05/09/2017 190,400 190,400
3496 0117R00908170003950 05/09/2017 190,400 190,400
3497 0117R00908170003951 05/09/2017 190,400 190,400
3498 0117R00908170003952 05/09/2017 190,400 190,400
3499 0117R00908170003953 05/09/2017 190,400 190,400
3500 0117R00908170003954 05/09/2017 112,800 112,800
3501 0117R00908170003955 05/09/2017 311,300 311,300
3502 0117R00908170003956 05/09/2017 112,800 112,800
3503 0117R00908170003957 05/09/2017 190,400 190,400
3504 0117R00908170003958 05/09/2017 190,400 190,400
3505 0117R00908170003960 05/09/2017 190,400 190,400
3506 0117R00908170003961 05/09/2017 190,400 190,400
3507 0117R00908170003962 05/09/2017 190,400 190,400
3508 0117R00908170003964 05/09/2017 143,900 143,900
3509 0117R00908170003965 05/09/2017 112,800 112,800
3510 0117R00908170003966 05/09/2017 112,800 112,800
3511 0117R00908170003967 05/09/2017 190,400 190,400
3512 0117R00908170003968 05/09/2017 311,300 311,300
3513 0117R00908170003969 05/09/2017 191,800 191,800
3514 0117R00908170003970 05/09/2017 190,400 190,400
3515 0117R00908170003971 05/09/2017 190,400 190,400
3516 0117R00908170003972 05/09/2017 190,400 190,400
3517 0117R00908170003973 05/09/2017 190,400 190,400
3518 0117R00908170003974 05/09/2017 190,400 190,400
3519 0117R00908170003975 05/09/2017 190,400 190,400
3520 0117R00908170003976 05/09/2017 576,900 576,900
3521 0117R00908170003977 05/09/2017 190,400 190,400
3522 0117R00908170003978 05/09/2017 112,800 112,800
3523 0117R00908170003979 05/09/2017 190,400 190,400
3524 0117R00908170003980 05/09/2017 311,300 311,300
3525 0117R00908170003981 05/09/2017 311,300 311,300
3526 0117R00908170003982 05/09/2017 323,900 323,900
3527 0117R00908170003983 05/09/2017 190,400 190,400
3528 0117R00908170003984 05/09/2017 190,400 190,400
3529 0117R00908170003985 05/09/2017 190,400 190,400
3530 0117R00908170003986 05/09/2017 298,000 298,000
3531 0117R00908170003987 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3532 0117R00908170003988 05/09/2017 191,800 191,800

3533 0117R00908170003989 05/09/2017 190,400 190,400
3534 0117R00908170003990 05/09/2017 254,200 254,200
3535 0117R00908170003991 05/09/2017 263,500 263,500
3536 0117R00908170003992 05/09/2017 112,800 112,800
3537 0117R00908170003993 05/09/2017 576,900 576,900
3538 0117R00908170003994 05/09/2017 298,000 298,000
3539 0117R00908170003995 05/09/2017 461,900 461,900
3540 0117R00908170003996 05/09/2017 112,800 112,800
3541 0117R00908170003997 05/09/2017 190,400 190,400
3542 0117R00908170003998 05/09/2017 190,400 190,400
3543 0117R00908170003999 05/09/2017 323,900 323,900
3544 0117R00908170004000 05/09/2017 190,400 190,400
3545 0117R00908170004001 05/09/2017 112,800 112,800
3546 0117R00908170004002 05/09/2017 190,400 190,400
3547 0117R00908170004003 05/09/2017 298,000 298,000
3548 0117R00908170004004 05/09/2017 298,000 298,000
3549 0117R00908170004005 05/09/2017 298,000 298,000
3550 0117R00908170004006 05/09/2017 191,800 191,800
3551 0117R00908170004007 05/09/2017 190,400 190,400
3552 0117R00908170004008 05/09/2017 190,400 190,400
3553 0117R00908170004009 05/09/2017 190,400 190,400
3554 0117R00908170004010 05/09/2017 202,100 202,100
3555 0117R00908170004011 05/09/2017 190,400 190,400
3556 0117R00908170004012 05/09/2017 190,400 190,400
3557 0117R00908170004013 05/09/2017 254,200 254,200
3558 0117R00908170004014 05/09/2017 263,500 263,500
3559 0117R00908170004015 05/09/2017 190,400 190,400
3560 0117R00908170004017 05/09/2017 275,100 275,100
3561 0117R00908170004018 05/09/2017 190,400 190,400
3562 0117R00908170004019 05/09/2017 190,400 190,400
3563 0117R00908170004020 05/09/2017 190,400 190,400
3564 0117R00908170004021 05/09/2017 190,400 190,400
3565 0117R00908170004022 05/09/2017 112,800 112,800
3566 0117R00908170004023 05/09/2017 190,400 190,400
3567 0117R00908170004024 05/09/2017 461,900 461,900
3568 0117R00908170004025 05/09/2017 190,400 190,400
3569 0117R00908170004026 05/09/2017 263,500 263,500
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3570 0117R00908170004027 05/09/2017 254,200 254,200

3571 0117R00908170004028 05/09/2017 190,400 190,400
3572 0117R00908170004029 05/09/2017 254,200 254,200
3573 0117R00908170004030 05/09/2017 112,800 112,800
3574 0117R00908170004031 05/09/2017 190,400 190,400
3575 0117R00908170004032 05/09/2017 190,400 190,400
3576 0117R00908170004033 05/09/2017 190,400 190,400
3577 0117R00908170004034 05/09/2017 190,400 190,400
3578 0117R00908170004035 05/09/2017 112,800 112,800
3579 0117R00908170004036 05/09/2017 576,900 576,900
3580 0117R00908170004038 05/09/2017 190,400 190,400
3581 0117R00908170004039 05/09/2017 576,900 576,900
3582 0117R00908170004040 05/09/2017 254,200 254,200
3583 0117R00908170004041 05/09/2017 323,900 323,900
3584 0117R00908170004042 05/09/2017 190,400 190,400
3585 0117R00908170004043 05/09/2017 191,800 191,800
3586 0117R00908170004044 05/09/2017 190,400 190,400
3587 0117R00908170004045 05/09/2017 112,800 112,800
3588 0117R00908170004046 05/09/2017 112,800 112,800
3589 0117R00908170004047 05/09/2017 190,400 190,400
3590 0117R00908170004048 05/09/2017 112,800 112,800
3591 0117R00908170004050 05/09/2017 112,800 112,800
3592 0117R00908170004051 05/09/2017 190,400 190,400
3593 0117R00908170004052 05/09/2017 112,800 112,800
3594 0117R00908170004053 05/09/2017 190,400 190,400
3595 0117R00908170004055 05/09/2017 190,400 190,400
3596 0117R00908170004056 05/09/2017 254,200 254,200
3597 0117R00908170004059 05/09/2017 112,800 112,800
3598 0117R00908170004060 05/09/2017 190,400 190,400
3599 0117R00908170004061 05/09/2017 323,900 323,900
3600 0117R00908170004062 05/09/2017 190,400 190,400
3601 0117R00908170004063 05/09/2017 112,800 112,800
3602 0117R00908170004064 05/09/2017 311,300 311,300
3603 0117R00908170004065 05/09/2017 112,800 112,800
3604 0117R00908170004066 05/09/2017 190,400 190,400
3605 0117R00908170004067 05/09/2017 112,800 112,800
3606 0117R00908170004068 05/09/2017 576,900 576,900
3607 0117R00908170004069 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3608 0117R00908170004070 05/09/2017 143,900 143,900

3609 0117R00908170004072 05/09/2017 190,400 190,400
3610 0117R00908170004074 05/09/2017 190,400 190,400
3611 0117R00908170004076 05/09/2017 547,100 547,100
3612 0117R00908170004077 05/09/2017 190,400 190,400
3613 0117R00908170004078 05/09/2017 190,400 190,400
3614 0117R00908170004079 05/09/2017 190,400 190,400
3615 0117R00908170004080 05/09/2017 190,400 190,400
3616 0117R00908170004081 05/09/2017 298,000 298,000
3617 0117R00908170004082 05/09/2017 190,400 190,400
3618 0117R00908170004083 05/09/2017 112,800 112,800
3619 0117R00908170004084 05/09/2017 190,400 190,400
3620 0117R00908170004085 05/09/2017 112,800 112,800
3621 0117R00908170004086 05/09/2017 190,400 190,400
3622 0117R00908170004087 05/09/2017 190,400 190,400
3623 0117R00908170004088 05/09/2017 190,400 190,400
3624 0117R00908170004089 05/09/2017 191,800 191,800
3625 0117R00908170004090 05/09/2017 112,800 112,800
3626 0117R00908170004091 05/09/2017 190,400 190,400
3627 0117R00908170004092 05/09/2017 112,800 112,800
3628 0117R00908170004093 05/09/2017 190,400 190,400
3629 0117R00908170004094 05/09/2017 112,800 112,800
3630 0117R00908170004096 05/09/2017 190,400 190,400
3631 0117R00908170004097 05/09/2017 311,300 311,300
3632 0117R00908170004098 05/09/2017 190,400 190,400
3633 0117R00908170004099 05/09/2017 323,900 323,900
3634 0117R00908170004100 05/09/2017 112,800 112,800
3635 0117R00908170004101 05/09/2017 190,400 190,400
3636 0117R00908170004102 05/09/2017 576,900 576,900
3637 0117R00908170004103 05/09/2017 190,400 190,400
3638 0117R00908170004104 05/09/2017 576,900 576,900
3639 0117R00908170004105 05/09/2017 190,400 190,400
3640 0117R00908170004106 05/09/2017 311,300 311,300
3641 0117R00908170004107 05/09/2017 311,300 311,300
3642 0117R00908170004108 05/09/2017 298,000 298,000
3643 0117R00908170004109 05/09/2017 263,500 263,500
3644 0117R00908170004110 05/09/2017 576,900 576,900
3645 0117R00908170004111 05/09/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3646 0117R00908170004112 05/09/2017 112,800 112,800

3647 0117R00908170004113 05/09/2017 112,800 112,800
3648 0117R00908170004115 05/09/2017 263,500 263,500
3649 0117R00908170004116 05/09/2017 263,500 263,500
3650 0117R00908170004117 05/09/2017 311,300 311,300
3651 0117R00908170004118 05/09/2017 190,400 190,400
3652 0117R00908170004119 05/09/2017 190,400 190,400
3653 0117R00908170004120 05/09/2017 112,800 112,800
3654 0117R00908170004121 05/09/2017 190,400 190,400
3655 0117R00908170004122 05/09/2017 190,400 190,400
3656 0117R00908170004123 05/09/2017 190,400 190,400
3657 0117R00908170004124 05/09/2017 323,900 323,900
3658 0117R00908170004125 05/09/2017 190,400 190,400
3659 0117R00908170004126 05/09/2017 576,900 576,900
3660 0117R00908170004127 05/09/2017 190,400 190,400
3661 0117R00908170004128 05/09/2017 191,800 191,800
3662 0117R00908170004129 05/09/2017 190,400 190,400
3663 0117R00908170004130 05/09/2017 461,900 461,900
3664 0117R00908170004131 05/09/2017 576,900 576,900
3665 0117R00908170004132 05/09/2017 112,800 112,800
3666 0117R00908170004133 05/09/2017 112,800 112,800
3667 0117R00908170004134 05/09/2017 190,400 190,400
3668 0117R00908170004135 05/09/2017 112,800 112,800
3669 0117R00908170004136 05/09/2017 323,900 323,900
3670 0117R00908170004137 05/09/2017 191,800 191,800
3671 0117R00908170004138 05/09/2017 112,800 112,800
3672 0117R00908170004139 05/09/2017 267,800 267,800
3673 0117R00908170004140 05/09/2017 298,000 298,000
3674 0117R00908170004141 05/09/2017 190,400 190,400
3675 0117R00908170004143 05/09/2017 112,800 112,800
3676 0117R00908170004144 05/09/2017 323,900 323,900
3677 0117R00908170004145 05/09/2017 190,400 190,400
3678 0117R00908170004146 05/09/2017 112,800 112,800
3679 0117R00908170004148 05/09/2017 191,800 191,800
3680 0117R00908170004149 05/09/2017 112,800 112,800
3681 0117R00908170004150 05/09/2017 112,800 112,800
3682 0117R00908170004151 05/09/2017 190,400 190,400
3683 0117R00908170004152 05/09/2017 267,800 267,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3684 0117R00908170004154 05/09/2017 323,900 323,900

3685 0117R00908170004155 05/09/2017 190,400 190,400
3686 0117R00908170004156 05/09/2017 112,800 112,800
3687 0117R00908170004157 05/09/2017 323,900 323,900
3688 0117R00908170004158 05/09/2017 191,800 191,800
3689 0117R00908170004159 05/09/2017 323,900 323,900
3690 0117R00908170004160 05/09/2017 112,800 112,800
3691 0117R00908170004161 05/09/2017 190,400 190,400
3692 0117R00908170004162 05/09/2017 112,800 112,800
3693 0117R00908170004164 05/09/2017 112,800 112,800
3694 0117R00908170004167 05/09/2017 190,400 190,400
3695 0117R00908170004168 05/09/2017 190,400 190,400
3696 0117R00908170004169 05/09/2017 190,400 190,400
3697 0117R00908170004170 05/09/2017 193,100 193,100
3698 0117R00908170004171 05/09/2017 112,800 112,800
3699 0117R00908170004172 05/09/2017 190,400 190,400
3700 0117R00908170004174 05/09/2017 254,200 254,200
3701 0117R00908170004175 05/09/2017 190,400 190,400
3702 0117R00908170004176 05/09/2017 112,800 112,800
3703 0117R00908170004177 05/09/2017 190,400 190,400
3704 0117R00908170004178 05/09/2017 576,900 576,900
3705 0117R00908170004179 05/09/2017 191,800 191,800
3706 0117R00908170004181 05/09/2017 254,200 254,200
3707 0117R00908170004182 05/09/2017 112,800 112,800
3708 0117R00908170004183 05/09/2017 190,400 190,400
3709 0117R00908170004184 05/09/2017 190,400 190,400
3710 0117R00908170004185 05/09/2017 190,400 190,400
3711 0117R00908170004186 05/09/2017 190,400 190,400
3712 0117R00908170004187 05/09/2017 112,800 112,800
3713 0117R00908170004188 05/09/2017 190,400 190,400
3714 0117R00908170004189 05/09/2017 323,900 323,900
3715 0117R00908170004190 05/09/2017 190,400 190,400
3716 0117R00908170004191 05/09/2017 112,800 112,800
3717 0117R00908170004192 05/09/2017 190,400 190,400
3718 0117R00908170004193 05/09/2017 190,400 190,400
3719 0117R00908170004195 05/09/2017 311,300 311,300
3720 0117R00908170004196 05/09/2017 190,400 190,400
3721 0117R00908170004197 05/09/2017 323,900 323,900
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3722 0117R00908170004198 05/09/2017 193,100 193,100

3723 0117R00908170004199 05/09/2017 132,900 132,900
3724 0117R00908170004200 05/09/2017 323,900 323,900
3725 0117R00908170004201 05/09/2017 191,800 191,800
3726 0117R00908170004205 05/09/2017 323,900 323,900
3727 0117R00908170004207 05/09/2017 323,900 323,900
3728 0117R00908170004208 05/09/2017 323,900 323,900
3729 0117R00908170004210 05/09/2017 191,800 191,800
3730 0117R00908170004211 05/09/2017 190,400 190,400
3731 0117R00908170004213 05/09/2017 191,800 191,800
3732 0117R00908170004215 05/09/2017 217,000 217,000
3733 0117R00908170004216 05/09/2017 142,400 142,400
3734 0117R00908170004217 05/09/2017 142,400 142,400
3735 0117R00908170004218 05/09/2017 190,400 190,400
3736 0117R00908170004219 05/09/2017 190,400 190,400
3737 0117R00908170004220 05/09/2017 190,400 190,400
3738 0117R00908170004221 05/09/2017 190,400 190,400
3739 0117R00908170004222 05/09/2017 190,400 190,400
3740 0117R00908170004223 05/09/2017 190,400 190,400
3741 0117R00908170004224 05/09/2017 323,900 323,900
3742 0117R00908170004225 05/09/2017 193,100 193,100
3743 0117R00908170004226 05/09/2017 190,400 190,400
3744 0117R00908170004227 05/09/2017 190,400 190,400
3745 0117R00908170004229 05/09/2017 191,800 191,800
3746 0117R00908170004230 05/09/2017 190,400 190,400
3747 0117R00908170004232 05/09/2017 323,900 323,900
3748 0117R00908170004234 05/09/2017 142,400 142,400
3749 0117R00908170004235 05/09/2017 190,400 190,400
3750 0117R00908170004236 05/09/2017 323,900 323,900
3751 0117R00908170004237 05/09/2017 193,100 193,100
3752 0117R00908170004238 05/09/2017 263,500 263,500
3753 0117R00908170004239 05/09/2017 263,500 263,500
3754 0117R00908170004240 05/09/2017 190,400 190,400
3755 0117R00908170004242 05/09/2017 142,400 142,400
3756 0117R00908170004243 05/09/2017 190,400 190,400
3757 0117R00908170004244 05/09/2017 190,400 190,400
3758 0117R00908170004245 05/09/2017 311,300 311,300
3759 0117R00908170004246 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3760 0117R00908170004247 05/09/2017 190,400 190,400

3761 0117R00908170004248 05/09/2017 190,400 190,400
3762 0117R00908170004249 05/09/2017 190,400 190,400
3763 0117R00908170004250 05/09/2017 267,800 267,800
3764 0117R00908170004251 05/09/2017 190,400 190,400
3765 0117R00908170004252 05/09/2017 190,400 190,400
3766 0117R00908170004253 05/09/2017 190,400 190,400
3767 0117R00908170004254 05/09/2017 190,400 190,400
3768 0117R00908170004255 05/09/2017 576,900 576,900
3769 0117R00908170004256 05/09/2017 190,400 190,400
3770 0117R00908170004257 05/09/2017 190,400 190,400
3771 0117R00908170004258 05/09/2017 190,400 190,400
3772 0117R00908170004259 05/09/2017 190,400 190,400
3773 0117R00908170004260 05/09/2017 190,400 190,400
3774 0117R00908170004261 05/09/2017 190,400 190,400
3775 0117R00908170004262 05/09/2017 190,400 190,400
3776 0117R00908170004263 05/09/2017 190,400 190,400
3777 0117R00908170004264 05/09/2017 190,400 190,400
3778 0117R00908170004265 05/09/2017 190,400 190,400
3779 0117R00908170004266 05/09/2017 112,800 112,800
3780 0117R00908170004267 05/09/2017 190,400 190,400
3781 0117R00908170004269 05/09/2017 112,800 112,800
3782 0117R00908170004270 05/09/2017 190,400 190,400
3783 0117R00908170004271 05/09/2017 190,400 190,400
3784 0117R00908170004272 05/09/2017 308,800 308,800
3785 0117R00908170004273 05/09/2017 191,800 191,800
3786 0117R00908170004274 05/09/2017 190,400 190,400
3787 0117R00908170004275 05/09/2017 190,400 190,400
3788 0117R00908170004276 05/09/2017 191,800 191,800
3789 0117R00908170004277 05/09/2017 190,400 190,400
3790 0117R00908170004278 05/09/2017 190,400 190,400
3791 0117R00908170004279 05/09/2017 193,100 193,100
3792 0117R00908170004280 05/09/2017 308,800 308,800
3793 0117R00908170004281 05/09/2017 190,400 190,400
3794 0117R00908170004282 05/09/2017 190,400 190,400
3795 0117R00908170004283 05/09/2017 298,000 298,000
3796 0117R00908170004284 05/09/2017 323,900 323,900
3797 0117R00908170004285 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3798 0117R00908170004286 05/09/2017 298,000 298,000

3799 0117R00908170004287 05/09/2017 461,900 461,900
3800 0117R00908170004288 05/09/2017 190,400 190,400
3801 0117R00908170004289 05/09/2017 298,000 298,000
3802 0117R00908170004290 05/09/2017 190,400 190,400
3803 0117R00908170004291 05/09/2017 298,000 298,000
3804 0117R00908170004293 05/09/2017 190,400 190,400
3805 0117R00908170004294 05/09/2017 190,400 190,400
3806 0117R00908170004295 05/09/2017 190,400 190,400
3807 0117R00908170004296 05/09/2017 112,800 112,800
3808 0117R00908170004298 05/09/2017 190,400 190,400
3809 0117R00908170004299 05/09/2017 190,400 190,400
3810 0117R00908170004300 05/09/2017 190,400 190,400
3811 0117R00908170004301 05/09/2017 576,900 576,900
3812 0117R00908170004302 05/09/2017 190,400 190,400
3813 0117R00908170004303 05/09/2017 190,400 190,400
3814 0117R00908170004304 05/09/2017 190,400 190,400
3815 0117R00908170004305 05/09/2017 267,800 267,800
3816 0117R00908170004306 05/09/2017 190,400 190,400
3817 0117R00908170004307 05/09/2017 190,400 190,400
3818 0117R00908170004308 05/09/2017 112,800 112,800
3819 0117R00908170004309 05/09/2017 191,800 191,800
3820 0117R00908170004310 05/09/2017 112,800 112,800
3821 0117R00908170004311 05/09/2017 112,800 112,800
3822 0117R00908170004312 05/09/2017 191,800 191,800
3823 0117R00908170004313 05/09/2017 190,400 190,400
3824 0117R00908170004314 05/09/2017 190,400 190,400
3825 0117R00908170004315 05/09/2017 190,400 190,400
3826 0117R00908170004316 05/09/2017 323,900 323,900
3827 0117R00908170004317 05/09/2017 190,400 190,400
3828 0117R00908170004318 05/09/2017 323,900 323,900
3829 0117R00908170004319 05/09/2017 190,400 190,400
3830 0117R00908170004320 05/09/2017 190,400 190,400
3831 0117R00908170004321 05/09/2017 308,800 308,800
3832 0117R00908170004322 05/09/2017 190,400 190,400
3833 0117R00908170004323 05/09/2017 112,800 112,800
3834 0117R00908170004324 05/09/2017 112,800 112,800
3835 0117R00908170004325 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3836 0117R00908170004326 05/09/2017 190,400 190,400

3837 0117R00908170004327 05/09/2017 112,800 112,800
3838 0117R00908170004328 05/09/2017 190,400 190,400
3839 0117R00908170004329 05/09/2017 190,400 190,400
3840 0117R00908170004330 05/09/2017 190,400 190,400
3841 0117R00908170004331 05/09/2017 190,400 190,400
3842 0117R00908170004333 05/09/2017 190,400 190,400
3843 0117R00908170004334 05/09/2017 190,400 190,400
3844 0117R00908170004335 05/09/2017 190,400 190,400
3845 0117R00908170004336 05/09/2017 190,400 190,400
3846 0117R00908170004337 05/09/2017 191,800 191,800
3847 0117R00908170004338 05/09/2017 190,400 190,400
3848 0117R00908170004339 05/09/2017 263,500 263,500
3849 0117R00908170004340 05/09/2017 112,800 112,800
3850 0117R00908170004341 05/09/2017 190,400 190,400
3851 0117R00908170004342 05/09/2017 112,800 112,800
3852 0117R00908170004343 05/09/2017 190,400 190,400
3853 0117R00908170004344 05/09/2017 193,100 193,100
3854 0117R00908170004345 05/09/2017 190,400 190,400
3855 0117R00908170004346 05/09/2017 298,000 298,000
3856 0117R00908170004347 05/09/2017 112,800 112,800
3857 0117R00908170004348 05/09/2017 576,900 576,900
3858 0117R00908170004349 05/09/2017 254,200 254,200
3859 0117R00908170004350 05/09/2017 190,400 190,400
3860 0117R00908170004351 05/09/2017 190,400 190,400
3861 0117R00908170004352 05/09/2017 298,000 298,000
3862 0117R00908170004353 05/09/2017 190,400 190,400
3863 0117R00908170004354 05/09/2017 190,400 190,400
3864 0117R00908170004355 05/09/2017 190,400 190,400
3865 0117R00908170004356 05/09/2017 191,800 191,800
3866 0117R00908170004357 05/09/2017 112,800 112,800
3867 0117R00908170004358 05/09/2017 193,100 193,100
3868 0117R00908170004359 25/08/2017 193,100 193,100
3869 0117R00908170004360 05/09/2017 190,400 190,400
3870 0117R00908170004361 05/09/2017 190,400 190,400
3871 0117R00908170004362 05/09/2017 190,400 190,400
3872 0117R00908170004363 05/09/2017 190,400 190,400
3873 0117R00908170004364 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3874 0117R00908170004365 05/09/2017 112,800 112,800

3875 0117R00908170004366 05/09/2017 112,800 112,800
3876 0117R00908170004367 05/09/2017 112,800 112,800
3877 0117R00908170004368 05/09/2017 190,400 190,400
3878 0117R00908170004370 05/09/2017 190,400 190,400
3879 0117R00908170004372 05/09/2017 190,400 190,400
3880 0117R00908170004373 05/09/2017 190,400 190,400
3881 0117R00908170004374 05/09/2017 190,400 190,400
3882 0117R00908170004375 05/09/2017 190,400 190,400
3883 0117R00908170004376 05/09/2017 190,400 190,400
3884 0117R00908170004377 05/09/2017 263,500 263,500
3885 0117R00908170004378 05/09/2017 190,400 190,400
3886 0117R00908170004379 05/09/2017 190,400 190,400
3887 0117R00908170004380 05/09/2017 190,400 190,400
3888 0117R00908170004381 05/09/2017 576,900 576,900
3889 0117R00908170004382 05/09/2017 263,500 263,500
3890 0117R00908170004383 05/09/2017 263,500 263,500
3891 0117R00908170004384 05/09/2017 263,500 263,500
3892 0117R00908170004385 05/09/2017 190,400 190,400
3893 0117R00908170004386 05/09/2017 190,400 190,400
3894 0117R00908170004387 05/09/2017 112,800 112,800
3895 0117R00908170004388 05/09/2017 263,500 263,500
3896 0117R00908170004389 05/09/2017 190,400 190,400
3897 0117R00908170004390 05/09/2017 263,500 263,500
3898 0117R00908170004391 05/09/2017 311,300 311,300
3899 0117R00908170004392 05/09/2017 323,900 323,900
3900 0117R00908170004393 05/09/2017 190,400 190,400
3901 0117R00908170004394 05/09/2017 190,400 190,400
3902 0117R00908170004395 05/09/2017 133,500 133,500
3903 0117R00908170004396 05/09/2017 190,400 190,400
3904 0117R00908170004397 05/09/2017 576,900 576,900
3905 0117R00908170004398 05/09/2017 112,800 112,800
3906 0117R00908170004399 05/09/2017 112,800 112,800
3907 0117R00908170004400 05/09/2017 576,900 576,900
3908 0117R00908170004401 05/09/2017 190,400 190,400
3909 0117R00908170004402 05/09/2017 190,400 190,400
3910 0117R00908170004403 05/09/2017 190,400 190,400
3911 0117R00908170004404 05/09/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3912 0117R00908170004405 05/09/2017 190,400 190,400

3913 0117R00908170004406 05/09/2017 190,400 190,400
3914 0117R00908170004407 05/09/2017 190,400 190,400
3915 0117R00908170004408 05/09/2017 263,500 263,500
3916 0117R00908170004409 05/09/2017 190,400 190,400
3917 0117R00908170004410 05/09/2017 112,800 112,800
3918 0117R00908170004411 05/09/2017 267,800 267,800
3919 0117R00908170004412 05/09/2017 190,400 190,400
3920 0117R00908170004413 05/09/2017 190,400 190,400
3921 0117R00908170004414 05/09/2017 193,100 193,100
3922 0117R00908170004415 05/09/2017 190,400 190,400
3923 0117R00908170004416 05/09/2017 142,400 142,400
3924 0117R00908170004417 05/09/2017 190,400 190,400
3925 0117R00908170004418 05/09/2017 190,400 190,400
3926 0117R00908170004419 05/09/2017 190,400 190,400
3927 0117R00908170004420 05/09/2017 112,800 112,800
3928 0117R00908170004421 05/09/2017 263,500 263,500
3929 0117R00908170004422 05/09/2017 190,400 190,400
3930 0117R00908170004423 05/09/2017 311,300 311,300
3931 0117R00908170004424 05/09/2017 263,500 263,500
3932 0117R00908170004425 05/09/2017 190,400 190,400
3933 0117R00908170004426 05/09/2017 112,800 112,800
3934 0117R00908170004427 05/09/2017 275,100 275,100
3935 0117R00908170004428 05/09/2017 311,300 311,300
3936 0117R00908170004429 05/09/2017 112,800 112,800
3937 0117R00908170004430 05/09/2017 190,400 190,400
3938 0117R00908170004431 05/09/2017 190,400 190,400
3939 0117R00908170004433 05/09/2017 112,800 112,800
3940 0117R00908170004434 05/09/2017 190,400 190,400
3941 0117R00908170004435 05/09/2017 190,400 190,400
3942 0117R00908170004436 05/09/2017 112,800 112,800
3943 0117R00908170004437 05/09/2017 323,900 323,900
3944 0117R00908170004438 05/09/2017 190,400 190,400
3945 0117R00908170004439 05/09/2017 190,400 190,400
3946 0117R00908170004440 05/09/2017 112,800 112,800
3947 0117R00908170004441 05/09/2017 263,500 263,500
3948 0117R00908170004442 05/09/2017 190,400 190,400
3949 0117R00908170004443 05/09/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3950 0117R00908170004444 05/09/2017 112,800 112,800

3951 0117R00908170004445 05/09/2017 190,400 190,400
3952 0117R00908170004447 05/09/2017 190,400 190,400
3953 0117R00908170004448 05/09/2017 254,200 254,200
3954 0117R00908170004449 05/09/2017 263,500 263,500
3955 0117R00908170004450 05/09/2017 112,800 112,800
3956 0117R00908170004451 05/09/2017 190,400 190,400
3957 0117R00908170004452 05/09/2017 112,800 112,800
3958 0117R00908170004453 05/09/2017 190,400 190,400
3959 0117R00908170004454 05/09/2017 191,800 191,800
3960 0117R00908170004455 05/09/2017 190,400 190,400
3961 0117R00908170004456 05/09/2017 190,400 190,400
3962 0117R00908170004457 05/09/2017 190,400 190,400
3963 0117R00908170004458 05/09/2017 190,400 190,400
3964 0117R00908170004459 05/09/2017 263,500 263,500
3965 0117R00908170004460 05/09/2017 190,400 190,400
3966 0117R00908170004461 05/09/2017 311,300 311,300
3967 0117R00908170004462 05/09/2017 263,500 263,500
3968 0117R00908170004463 05/09/2017 190,400 190,400
3969 0117R00908170004464 05/09/2017 254,200 254,200
3970 0117R00908170004465 05/09/2017 112,800 112,800
3971 0117R00908170004466 05/09/2017 112,800 112,800
3972 0117R00908170004467 05/09/2017 190,400 190,400
3973 0117R00908170004468 05/09/2017 190,400 190,400
3974 0117R00908170004469 05/09/2017 112,800 112,800
3975 0117R00908170004470 05/09/2017 263,500 263,500
3976 0117R00908170004471 05/09/2017 190,400 190,400
3977 0117R00908170004472 05/09/2017 112,800 112,800
3978 0117R00908170004473 05/09/2017 190,400 190,400
3979 0117R00908170004474 05/09/2017 263,500 263,500
3980 0117R00908170004475 05/09/2017 263,500 263,500
3981 0117R00908170004476 05/09/2017 576,900 576,900
3982 0117R00908170004477 05/09/2017 190,400 190,400
3983 0117R00908170004478 05/09/2017 190,400 190,400
3984 0117R00908170004479 05/09/2017 190,400 190,400
3985 0117R00908170004480 05/09/2017 112,800 112,800
3986 0117R00908170004481 05/09/2017 190,400 190,400
3987 0117R00908170004482 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
3988 0117R00908170004483 05/09/2017 190,400 190,400

3989 0117R00908170004484 05/09/2017 190,400 190,400
3990 0117R00908170004485 05/09/2017 112,800 112,800
3991 0117R00908170004486 05/09/2017 190,400 190,400
3992 0117R00908170004489 05/09/2017 190,400 190,400
3993 0117R00908170004490 05/09/2017 112,800 112,800
3994 0117R00908170004491 05/09/2017 190,400 190,400
3995 0117R00908170004492 05/09/2017 263,500 263,500
3996 0117R00908170004493 05/09/2017 112,800 112,800
3997 0117R00908170004495 05/09/2017 112,800 112,800
3998 0117R00908170004496 05/09/2017 190,400 190,400
3999 0117R00908170004497 05/09/2017 112,800 112,800
4000 0117R00908170004498 05/09/2017 190,400 190,400
4001 0117R00908170004499 05/09/2017 190,400 190,400
4002 0117R00908170004501 05/09/2017 190,400 190,400
4003 0117R00908170004504 05/09/2017 254,200 254,200
4004 0117R00908170004505 05/09/2017 263,500 263,500
4005 0117R00908170004506 05/09/2017 190,400 190,400
4006 0117R00908170004507 05/09/2017 112,800 112,800
4007 0117R00908170004508 05/09/2017 323,900 323,900
4008 0117R00908170004509 05/09/2017 191,800 191,800
4009 0117R00908170004511 05/09/2017 190,400 190,400
4010 0117R00908170004512 05/09/2017 191,800 191,800
4011 0117R00908170004513 05/09/2017 263,500 263,500
4012 0117R00908170004514 05/09/2017 190,400 190,400
4013 0117R00908170004515 05/09/2017 190,400 190,400
4014 0117R00908170004516 05/09/2017 190,400 190,400
4015 0117R00908170004517 05/09/2017 112,800 112,800
4016 0117R00908170004518 05/09/2017 190,400 190,400
4017 0117R00908170004519 05/09/2017 263,500 263,500
4018 0117R00908170004520 05/09/2017 263,500 263,500
4019 0117R00908170004521 05/09/2017 190,400 190,400
4020 0117R00908170004522 05/09/2017 263,500 263,500
4021 0117R00908170004523 05/09/2017 193,500 193,500
4022 0117R00908170004524 05/09/2017 112,800 112,800
4023 0117R00908170004525 05/09/2017 112,800 112,800
4024 0117R00908170004526 05/09/2017 311,300 311,300
4025 0117R00908170004527 05/09/2017 112,800 112,800
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4026 0117R00908170004528 05/09/2017 190,400 190,400

4027 0117R00908170004529 05/09/2017 190,400 190,400
4028 0117R00908170004530 05/09/2017 190,400 190,400
4029 0117R00908170004531 05/09/2017 576,900 576,900
4030 0117R00908170004533 05/09/2017 263,500 263,500
4031 0117R00908170004534 05/09/2017 576,900 576,900
4032 0117R00908170004537 05/09/2017 263,500 263,500
4033 0117R00908170004538 05/09/2017 112,800 112,800
4034 0117R00908170004539 05/09/2017 190,400 190,400
4035 0117R00908170004541 05/09/2017 263,500 263,500
4036 0117R00908170004543 05/09/2017 190,400 190,400
4037 0117R00908170004544 05/09/2017 191,800 191,800
4038 0117R00908170004545 05/09/2017 576,900 576,900
4039 0117R00908170004546 05/09/2017 112,800 112,800
4040 0117R00908170004547 05/09/2017 190,400 190,400
4041 0117R00908170004548 05/09/2017 190,400 190,400
4042 0117R00908170004549 05/09/2017 112,800 112,800
4043 0117R00908170004550 05/09/2017 190,400 190,400
4044 0117R00908170004551 05/09/2017 112,800 112,800
4045 0117R00908170004552 05/09/2017 191,800 191,800
4046 0117R00908170004553 05/09/2017 112,800 112,800
4047 0117R00908170004554 05/09/2017 112,800 112,800
4048 0117R00908170004555 05/09/2017 190,400 190,400
4049 0117R00908170004556 05/09/2017 112,800 112,800
4050 0117R00908170004557 05/09/2017 190,400 190,400
4051 0117R00908170004558 05/09/2017 323,900 323,900
4052 0117R00908170004559 05/09/2017 190,400 190,400
4053 0117R00908170004560 05/09/2017 263,500 263,500
4054 0117R00908170004561 05/09/2017 190,400 190,400
4055 0117R00908170004562 05/09/2017 112,800 112,800
4056 0117R00908170004563 05/09/2017 190,400 190,400
4057 0117R00908170004564 05/09/2017 263,500 263,500
4058 0117R00908170004565 05/09/2017 112,800 112,800
4059 0117R00908170004566 05/09/2017 190,400 190,400
4060 0117R00908170004567 05/09/2017 112,800 112,800
4061 0117R00908170004568 05/09/2017 112,800 112,800
4062 0117R00908170004569 05/09/2017 112,800 112,800
4063 0117R00908170004570 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4064 0117R00908170004571 05/09/2017 190,400 190,400

4065 0117R00908170004572 05/09/2017 193,100 193,100
4066 0117R00908170004573 05/09/2017 112,800 112,800
4067 0117R00908170004574 05/09/2017 191,800 191,800
4068 0117R00908170004575 05/09/2017 190,400 190,400
4069 0117R00908170004576 05/09/2017 112,800 112,800
4070 0117R00908170004577 05/09/2017 112,800 112,800
4071 0117R00908170004578 05/09/2017 190,400 190,400
4072 0117R00908170004579 05/09/2017 193,100 193,100
4073 0117R00908170004580 05/09/2017 190,400 190,400
4074 0117R00908170004581 05/09/2017 311,300 311,300
4075 0117R00908170004582 05/09/2017 311,300 311,300
4076 0117R00908170004583 05/09/2017 323,900 323,900
4077 0117R00908170004584 05/09/2017 112,800 112,800
4078 0117R00908170004585 05/09/2017 112,800 112,800
4079 0117R00908170004586 05/09/2017 190,400 190,400
4080 0117R00908170004587 05/09/2017 112,800 112,800
4081 0117R00908170004588 05/09/2017 311,300 311,300
4082 0117R00908170004589 05/09/2017 190,400 190,400
4083 0117R00908170004590 05/09/2017 112,800 112,800
4084 0117R00908170004591 05/09/2017 191,800 191,800
4085 0117R00908170004592 05/09/2017 112,800 112,800
4086 0117R00908170004593 05/09/2017 190,400 190,400
4087 0117R00908170004594 05/09/2017 323,900 323,900
4088 0117R00908170004595 05/09/2017 112,800 112,800
4089 0117R00908170004596 05/09/2017 190,400 190,400
4090 0117R00908170004597 05/09/2017 193,100 193,100
4091 0117R00908170004598 05/09/2017 323,900 323,900
4092 0117R00908170004599 05/09/2017 191,800 191,800
4093 0117R00908170004601 05/09/2017 190,400 190,400
4094 0117R00908170004602 05/09/2017 215,000 215,000
4095 0117R00908170004603 05/09/2017 275,100 275,100
4096 0117R00908170004605 05/09/2017 143,900 143,900
4097 0117R00908170004606 05/09/2017 191,800 191,800
4098 0117R00908170004607 05/09/2017 323,900 323,900
4099 0117R00908170004608 05/09/2017 254,200 254,200
4100 0117R00908170004610 05/09/2017 191,800 191,800
4101 0117R00908170004611 05/09/2017 323,900 323,900
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4102 0117R00908170004612 05/09/2017 323,900 323,900

4103 0117R00908170004615 05/09/2017 190,400 190,400
4104 0117R00908170004616 05/09/2017 132,900 132,900
4105 0117R00908170004617 05/09/2017 190,400 190,400
4106 0117R00908170004618 05/09/2017 190,400 190,400
4107 0117R00908170004619 05/09/2017 190,400 190,400
4108 0117R00908170004620 05/09/2017 190,400 190,400
4109 0117R00908170004621 05/09/2017 190,400 190,400
4110 0117R00908170004622 05/09/2017 190,400 190,400
4111 0117R00908170004623 05/09/2017 190,400 190,400
4112 0117R00908170004625 05/09/2017 190,400 190,400
4113 0117R00908170004626 05/09/2017 190,400 190,400
4114 0117R00908170004627 05/09/2017 190,400 190,400
4115 0117R00908170004629 05/09/2017 190,400 190,400
4116 0117R00908170004630 05/09/2017 190,400 190,400
4117 0117R00908170004631 05/09/2017 190,400 190,400
4118 0117R00908170004632 05/09/2017 190,400 190,400
4119 0117R00908170004633 05/09/2017 190,400 190,400
4120 0117R00908170004634 05/09/2017 190,400 190,400
4121 0117R00908170004635 05/09/2017 190,400 190,400
4122 0117R00908170004636 05/09/2017 311,300 311,300
4123 0117R00908170004637 05/09/2017 190,400 190,400
4124 0117R00908170004638 05/09/2017 190,400 190,400
4125 0117R00908170004639 05/09/2017 190,400 190,400
4126 0117R00908170004640 05/09/2017 190,400 190,400
4127 0117R00908170004641 05/09/2017 142,400 142,400
4128 0117R00908170004642 05/09/2017 190,400 190,400
4129 0117R00908170004643 05/09/2017 190,400 190,400
4130 0117R00908170004645 05/09/2017 311,300 311,300
4131 0117R00908170004646 05/09/2017 190,400 190,400
4132 0117R00908170004647 05/09/2017 576,900 576,900
4133 0117R00908170004648 05/09/2017 190,400 190,400
4134 0117R00908170004649 05/09/2017 190,400 190,400
4135 0117R00908170004650 05/09/2017 190,400 190,400
4136 0117R00908170004651 05/09/2017 190,400 190,400
4137 0117R00908170004652 05/09/2017 190,400 190,400
4138 0117R00908170004655 05/09/2017 298,000 298,000
4139 0117R00908170004656 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4140 0117R00908170004657 05/09/2017 190,400 190,400

4141 0117R00908170004658 05/09/2017 576,900 576,900
4142 0117R00908170004659 05/09/2017 190,400 190,400
4143 0117R00908170004660 05/09/2017 254,200 254,200
4144 0117R00908170004661 05/09/2017 190,400 190,400
4145 0117R00908170004663 05/09/2017 190,400 190,400
4146 0117R00908170004664 05/09/2017 190,400 190,400
4147 0117R00908170004665 05/09/2017 190,400 190,400
4148 0117R00908170004666 05/09/2017 190,400 190,400
4149 0117R00908170004667 05/09/2017 190,400 190,400
4150 0117R00908170004668 05/09/2017 190,400 190,400
4151 0117R00908170004669 05/09/2017 190,400 190,400
4152 0117R00908170004670 05/09/2017 576,900 576,900
4153 0117R00908170004672 05/09/2017 190,400 190,400
4154 0117R00908170004673 05/09/2017 190,400 190,400
4155 0117R00908170004675 05/09/2017 190,400 190,400
4156 0117R00908170004676 05/09/2017 190,400 190,400
4157 0117R00908170004677 05/09/2017 190,400 190,400
4158 0117R00908170004678 05/09/2017 190,400 190,400
4159 0117R00908170004679 05/09/2017 298,000 298,000
4160 0117R00908170004680 05/09/2017 193,100 193,100
4161 0117R00908170004681 05/09/2017 190,400 190,400
4162 0117R00908170004682 05/09/2017 112,800 112,800
4163 0117R00908170004683 05/09/2017 323,900 323,900
4164 0117R00908170004684 05/09/2017 190,400 190,400
4165 0117R00908170004686 05/09/2017 323,900 323,900
4166 0117R00908170004687 05/09/2017 190,400 190,400
4167 0117R00908170004688 05/09/2017 190,400 190,400
4168 0117R00908170004689 05/09/2017 190,400 190,400
4169 0117R00908170004690 05/09/2017 190,400 190,400
4170 0117R00908170004691 05/09/2017 190,400 190,400
4171 0117R00908170004692 05/09/2017 190,400 190,400
4172 0117R00908170004693 05/09/2017 190,400 190,400
4173 0117R00908170004694 05/09/2017 190,400 190,400
4174 0117R00908170004695 05/09/2017 191,800 191,800
4175 0117R00908170004696 05/09/2017 112,800 112,800
4176 0117R00908170004697 05/09/2017 193,100 193,100
4177 0117R00908170004698 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4178 0117R00908170004699 05/09/2017 190,400 190,400

4179 0117R00908170004700 05/09/2017 298,000 298,000
4180 0117R00908170004701 05/09/2017 190,400 190,400
4181 0117R00908170004702 05/09/2017 298,000 298,000
4182 0117R00908170004703 05/09/2017 311,300 311,300
4183 0117R00908170004704 05/09/2017 311,300 311,300
4184 0117R00908170004705 05/09/2017 190,400 190,400
4185 0117R00908170004706 05/09/2017 190,400 190,400
4186 0117R00908170004707 05/09/2017 190,400 190,400
4187 0117R00908170004708 05/09/2017 193,100 193,100
4188 0117R00908170004709 05/09/2017 254,200 254,200
4189 0117R00908170004710 05/09/2017 112,800 112,800
4190 0117R00908170004711 05/09/2017 190,400 190,400
4191 0117R00908170004712 05/09/2017 190,400 190,400
4192 0117R00908170004713 05/09/2017 190,400 190,400
4193 0117R00908170004714 05/09/2017 190,400 190,400
4194 0117R00908170004715 05/09/2017 190,400 190,400
4195 0117R00908170004718 05/09/2017 190,400 190,400
4196 0117R00908170004719 05/09/2017 112,800 112,800
4197 0117R00908170004720 05/09/2017 311,300 311,300
4198 0117R00908170004721 05/09/2017 190,400 190,400
4199 0117R00908170004722 05/09/2017 323,900 323,900
4200 0117R00908170004723 05/09/2017 190,400 190,400
4201 0117R00908170004724 05/09/2017 190,400 190,400
4202 0117R00908170004725 05/09/2017 190,400 190,400
4203 0117R00908170004726 05/09/2017 190,400 190,400
4204 0117R00908170004727 05/09/2017 190,400 190,400
4205 0117R00908170004728 05/09/2017 190,400 190,400
4206 0117R00908170004729 05/09/2017 190,400 190,400
4207 0117R00908170004730 05/09/2017 190,400 190,400
4208 0117R00908170004731 05/09/2017 193,100 193,100
4209 0117R00908170004732 05/09/2017 112,800 112,800
4210 0117R00908170004733 05/09/2017 190,400 190,400
4211 0117R00908170004734 05/09/2017 311,300 311,300
4212 0117R00908170004735 05/09/2017 112,800 112,800
4213 0117R00908170004736 05/09/2017 190,400 190,400
4214 0117R00908170004737 05/09/2017 190,400 190,400
4215 0117R00908170004738 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4216 0117R00908170004739 05/09/2017 190,400 190,400

4217 0117R00908170004740 05/09/2017 190,400 190,400
4218 0117R00908170004741 05/09/2017 311,300 311,300
4219 0117R00908170004742 05/09/2017 190,400 190,400
4220 0117R00908170004743 05/09/2017 193,100 193,100
4221 0117R00908170004744 05/09/2017 112,800 112,800
4222 0117R00908170004745 05/09/2017 190,400 190,400
4223 0117R00908170004747 05/09/2017 190,400 190,400
4224 0117R00908170004748 05/09/2017 442,900 442,900
4225 0117R00908170004749 05/09/2017 112,800 112,800
4226 0117R00908170004750 05/09/2017 190,400 190,400
4227 0117R00908170004751 05/09/2017 190,400 190,400
4228 0117R00908170004752 05/09/2017 190,400 190,400
4229 0117R00908170004753 05/09/2017 190,400 190,400
4230 0117R00908170004754 05/09/2017 191,800 191,800
4231 0117R00908170004755 05/09/2017 190,400 190,400
4232 0117R00908170004756 05/09/2017 112,800 112,800
4233 0117R00908170004757 05/09/2017 123,900 123,900
4234 0117R00908170004758 05/09/2017 190,400 190,400
4235 0117R00908170004759 05/09/2017 190,400 190,400
4236 0117R00908170004760 05/09/2017 190,400 190,400
4237 0117R00908170004761 05/09/2017 190,400 190,400
4238 0117R00908170004763 05/09/2017 190,400 190,400
4239 0117R00908170004764 05/09/2017 138,100 138,100
4240 0117R00908170004765 05/09/2017 191,800 191,800
4241 0117R00908170004766 05/09/2017 190,400 190,400
4242 0117R00908170004767 05/09/2017 193,100 193,100
4243 0117R00908170004768 05/09/2017 193,100 193,100
4244 0117R00908170004769 05/09/2017 311,300 311,300
4245 0117R00908170004770 05/09/2017 191,800 191,800
4246 0117R00908170004771 05/09/2017 190,400 190,400
4247 0117R00908170004772 05/09/2017 190,400 190,400
4248 0117R00908170004773 05/09/2017 193,100 193,100
4249 0117R00908170004775 05/09/2017 190,400 190,400
4250 0117R00908170004776 05/09/2017 193,100 193,100
4251 0117R00908170004777 05/09/2017 190,400 190,400
4252 0117R00908170004778 05/09/2017 190,400 190,400
4253 0117R00908170004779 05/09/2017 254,200 254,200
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4254 0117R00908170004780 05/09/2017 190,400 190,400

4255 0117R00908170004781 05/09/2017 112,800 112,800
4256 0117R00908170004783 05/09/2017 190,400 190,400
4257 0117R00908170004784 05/09/2017 311,300 311,300
4258 0117R00908170004785 05/09/2017 204,200 204,200
4259 0117R00908170004786 05/09/2017 138,100 138,100
4260 0117R00908170004787 05/09/2017 576,900 576,900
4261 0117R00908170004788 05/09/2017 191,800 191,800
4262 0117R00908170004789 05/09/2017 202,100 202,100
4263 0117R00908170004790 05/09/2017 190,400 190,400
4264 0117R00908170004791 05/09/2017 190,400 190,400
4265 0117R00908170004792 05/09/2017 190,400 190,400
4266 0117R00908170004794 05/09/2017 576,900 576,900
4267 0117R00908170004795 05/09/2017 190,400 190,400
4268 0117R00908170004796 05/09/2017 190,400 190,400
4269 0117R00908170004798 05/09/2017 190,400 190,400
4270 0117R00908170004799 05/09/2017 576,900 576,900
4271 0117R00908170004800 05/09/2017 191,800 191,800
4272 0117R00908170004802 05/09/2017 190,400 190,400
4273 0117R00908170004803 05/09/2017 190,400 190,400
4274 0117R00908170004804 05/09/2017 190,400 190,400
4275 0117R00908170004805 05/09/2017 190,400 190,400
4276 0117R00908170004806 05/09/2017 190,400 190,400
4277 0117R00908170004807 05/09/2017 112,800 112,800
4278 0117R00908170004808 05/09/2017 323,900 323,900
4279 0117R00908170004809 05/09/2017 190,400 190,400
4280 0117R00908170004811 05/09/2017 190,400 190,400
4281 0117R00908170004812 05/09/2017 311,300 311,300
4282 0117R00908170004813 05/09/2017 190,400 190,400
4283 0117R00908170004814 05/09/2017 190,400 190,400
4284 0117R00908170004815 05/09/2017 190,400 190,400
4285 0117R00908170004816 05/09/2017 112,800 112,800
4286 0117R00908170004817 05/09/2017 190,400 190,400
4287 0117R00908170004818 05/09/2017 112,800 112,800
4288 0117R00908170004819 05/09/2017 190,400 190,400
4289 0117R00908170004820 05/09/2017 190,400 190,400
4290 0117R00908170004821 05/09/2017 133,500 133,500
4291 0117R00908170004822 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4292 0117R00908170004823 05/09/2017 112,800 112,800

4293 0117R00908170004824 05/09/2017 190,400 190,400
4294 0117R00908170004825 05/09/2017 190,400 190,400
4295 0117R00908170004827 05/09/2017 191,800 191,800
4296 0117R00908170004828 05/09/2017 190,400 190,400
4297 0117R00908170004829 05/09/2017 190,400 190,400
4298 0117R00908170004830 05/09/2017 190,400 190,400
4299 0117R00908170004831 05/09/2017 190,400 190,400
4300 0117R00908170004832 05/09/2017 132,900 132,900
4301 0117R00908170004833 05/09/2017 190,400 190,400
4302 0117R00908170004834 05/09/2017 112,800 112,800
4303 0117R00908170004835 05/09/2017 191,800 191,800
4304 0117R00908170004836 05/09/2017 190,400 190,400
4305 0117R00908170004837 05/09/2017 190,400 190,400
4306 0117R00908170004838 05/09/2017 193,100 193,100
4307 0117R00908170004839 05/09/2017 112,800 112,800
4308 0117R00908170004840 05/09/2017 190,400 190,400
4309 0117R00908170004841 05/09/2017 112,800 112,800
4310 0117R00908170004842 05/09/2017 112,800 112,800
4311 0117R00908170004843 05/09/2017 190,400 190,400
4312 0117R00908170004846 05/09/2017 190,400 190,400
4313 0117R00908170004847 05/09/2017 323,900 323,900
4314 0117R00908170004848 05/09/2017 190,400 190,400
4315 0117R00908170004849 05/09/2017 191,800 191,800
4316 0117R00908170004850 05/09/2017 112,800 112,800
4317 0117R00908170004851 05/09/2017 191,800 191,800
4318 0117R00908170004852 05/09/2017 190,400 190,400
4319 0117R00908170004853 05/09/2017 190,400 190,400
4320 0117R00908170004854 05/09/2017 190,400 190,400
4321 0117R00908170004855 05/09/2017 190,400 190,400
4322 0117R00908170004856 05/09/2017 190,400 190,400
4323 0117R00908170004857 05/09/2017 190,400 190,400
4324 0117R00908170004858 05/09/2017 190,400 190,400
4325 0117R00908170004860 05/09/2017 112,800 112,800
4326 0117R00908170004861 05/09/2017 254,200 254,200
4327 0117R00908170004862 05/09/2017 190,400 190,400
4328 0117R00908170004863 05/09/2017 190,400 190,400
4329 0117R00908170004864 05/09/2017 311,300 311,300
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4330 0117R00908170004865 05/09/2017 190,400 190,400

4331 0117R00908170004866 05/09/2017 190,400 190,400
4332 0117R00908170004867 05/09/2017 190,400 190,400
4333 0117R00908170004868 05/09/2017 576,900 576,900
4334 0117R00908170004869 05/09/2017 190,400 190,400
4335 0117R00908170004870 05/09/2017 190,400 190,400
4336 0117R00908170004871 05/09/2017 190,400 190,400
4337 0117R00908170004872 05/09/2017 190,400 190,400
4338 0117R00908170004873 05/09/2017 190,400 190,400
4339 0117R00908170004874 05/09/2017 323,900 323,900
4340 0117R00908170004875 05/09/2017 576,900 576,900
4341 0117R00908170004876 05/09/2017 190,400 190,400
4342 0117R00908170004877 05/09/2017 190,400 190,400
4343 0117R00908170004878 05/09/2017 311,300 311,300
4344 0117R00908170004879 05/09/2017 190,400 190,400
4345 0117R00908170004880 05/09/2017 190,400 190,400
4346 0117R00908170004881 05/09/2017 190,400 190,400
4347 0117R00908170004882 05/09/2017 190,400 190,400
4348 0117R00908170004883 05/09/2017 190,400 190,400
4349 0117R00908170004884 05/09/2017 190,400 190,400
4350 0117R00908170004885 05/09/2017 311,300 311,300
4351 0117R00908170004886 05/09/2017 190,400 190,400
4352 0117R00908170004887 05/09/2017 190,400 190,400
4353 0117R00908170004888 05/09/2017 190,400 190,400
4354 0117R00908170004889 05/09/2017 190,400 190,400
4355 0117R00908170004890 05/09/2017 190,400 190,400
4356 0117R00908170004891 05/09/2017 190,400 190,400
4357 0117R00908170004892 05/09/2017 190,400 190,400
4358 0117R00908170004893 05/09/2017 190,400 190,400
4359 0117R00908170004894 05/09/2017 190,400 190,400
4360 0117R00908170004895 05/09/2017 190,400 190,400
4361 0117R00908170004896 05/09/2017 190,400 190,400
4362 0117R00908170004897 05/09/2017 190,400 190,400
4363 0117R00908170004898 05/09/2017 190,400 190,400
4364 0117R00908170004899 05/09/2017 190,400 190,400
4365 0117R00908170004900 05/09/2017 190,400 190,400
4366 0117R00908170004901 05/09/2017 190,400 190,400
4367 0117R00908170004902 05/09/2017 190,400 190,400
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4368 0117R00908170004903 05/09/2017 576,900 576,900

4369 0117R00908170004904 05/09/2017 190,400 190,400
4370 0117R00908170004906 05/09/2017 576,900 576,900
4371 0117R00908170004907 05/09/2017 191,800 191,800
4372 0117R00908170004908 05/09/2017 190,400 190,400
4373 0117R00908170004909 05/09/2017 190,400 190,400
4374 0117R00908170004910 05/09/2017 112,800 112,800
4375 0117R00908170004911 05/09/2017 576,900 576,900
4376 0117R00908170004912 05/09/2017 112,800 112,800
4377 0117R00908170004913 05/09/2017 576,900 576,900
4378 0117R00908170004915 05/09/2017 191,800 191,800
4379 0117R00908170004916 05/09/2017 133,500 133,500
4380 0117R00908170004917 05/09/2017 323,900 323,900
4381 0117R00908170004919 05/09/2017 112,800 112,800
4382 0117R00908170004920 05/09/2017 576,900 576,900
4383 0117R00908170004921 05/09/2017 191,800 191,800
4384 0117R00908170004923 05/09/2017 191,800 191,800
4385 0117R00908170004924 05/09/2017 112,800 112,800
4386 0117R00908170004925 05/09/2017 323,900 323,900
4387 0117R00908170004926 05/09/2017 112,800 112,800
4388 0117R00908170004928 05/09/2017 298,000 298,000
4389 0117R00908170004929 05/09/2017 254,200 254,200
4390 0117R00908170004930 05/09/2017 191,800 191,800
4391 0117R00908170004931 05/09/2017 190,400 190,400
4392 0117R00908170004933 05/09/2017 191,800 191,800
4393 0117R00908170004934 05/09/2017 323,900 323,900
4394 0117R00908170004935 05/09/2017 191,800 191,800
4395 0117R00908170004936 05/09/2017 190,400 190,400
4396 0117R00908170004937 05/09/2017 275,100 275,100
4397 0117R00908170004938 05/09/2017 191,800 191,800
4398 0117R00908170004939 05/09/2017 254,200 254,200
4399 0117R00908170004940 05/09/2017 191,800 191,800
4400 0117R00908170004941 05/09/2017 142,400 142,400
4401 0117R00908170004942 05/09/2017 190,400 190,400
4402 0117R00908170004943 05/09/2017 191,800 191,800
4403 0117R00908170004944 05/09/2017 190,400 190,400
4404 0117R00908170004945 05/09/2017 323,900 323,900
4405 0117R00908170004947 05/09/2017 323,900 323,900
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4406 0117R00908170004948 05/09/2017 191,800 191,800

4407 0117R00908170004949 05/09/2017 112,800 112,800
4408 0117R00908170004950 05/09/2017 112,800 112,800
4409 0117R00908170004951 05/09/2017 112,800 112,800
4410 0117R00908170004952 05/09/2017 254,200 254,200
4411 0117R00908170004953 05/09/2017 191,800 191,800
4412 0117R00908170004956 05/09/2017 191,800 191,800
4413 0117R00908170004957 05/09/2017 323,900 323,900
4414 0117R00908170004958 05/09/2017 191,800 191,800
4415 0117R00908170004961 05/09/2017 191,800 191,800
4416 0117R00908170004964 05/09/2017 191,800 191,800
4417 0117R00908170004966 05/09/2017 191,800 191,800
4418 0117R00908170004967 05/09/2017 193,100 193,100
4419 0117R00908170004968 05/09/2017 193,100 193,100
4420 0117R00908170004969 05/09/2017 193,100 193,100
4421 0117R00908170004970 05/09/2017 190,400 190,400
4422 0117R00908170004971 05/09/2017 191,800 191,800
4423 0117R00908170004972 05/09/2017 142,400 142,400
4424 0117R00908170004973 05/09/2017 190,400 190,400
4425 0117R00908170004974 05/09/2017 143,900 143,900
4426 0117R00908170004975 05/09/2017 191,800 191,800
4427 0117R00908170004977 05/09/2017 190,400 190,400
4428 0117R00908170004979 05/09/2017 254,200 254,200
4429 0117R00908170004980 05/09/2017 193,100 193,100
4430 0117R00908170004981 05/09/2017 191,800 191,800
4431 0117R00908170004982 05/09/2017 193,100 193,100
4432 0117R00908170004983 05/09/2017 191,800 191,800
4433 0117R00908170004984 05/09/2017 193,100 193,100
4434 0117R00908170004985 05/09/2017 193,100 193,100
4435 0117R00908170004986 05/09/2017 323,900 323,900
4436 0117R00908170004987 05/09/2017 190,400 190,400
4437 0117R00908170004988 05/09/2017 190,400 190,400
4438 0117R00908170004989 05/09/2017 254,200 254,200
4439 0117R00908170004990 05/09/2017 267,800 267,800
4440 0117R00908170004991 05/09/2017 191,800 191,800
4441 0117R00908170004992 05/09/2017 193,100 193,100
4442 0117R00908170004993 05/09/2017 190,400 190,400
4443 0117R00908170004995 05/09/2017 193,100 193,100
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4444 0117R00908170004996 05/09/2017 193,100 193,100

4445 0117R00908170004997 05/09/2017 323,900 323,900
4446 0117R00908170004998 05/09/2017 254,200 254,200
4447 0117R00908170004999 05/09/2017 461,900 461,900
4448 0117R00908170005001 05/09/2017 323,900 323,900
4449 0117R00908170005002 05/09/2017 461,900 461,900
4450 0117R00908170005003 05/09/2017 190,400 190,400
4451 0117R00908170005004 05/09/2017 190,400 190,400
4452 0117R00908170005005 05/09/2017 547,100 547,100
4453 0117R00908170005006 05/09/2017 190,400 190,400
4454 0117R00908170005007 05/09/2017 461,900 461,900
4455 0117R00908170005008 05/09/2017 461,900 461,900
4456 0117R00908170005009 05/09/2017 254,200 254,200
4457 0117R00908170005011 05/09/2017 191,800 191,800
4458 0117R00908170005012 05/09/2017 190,400 190,400
4459 0117R00908170005013 05/09/2017 191,800 191,800
4460 0117R00908170005014 05/09/2017 323,900 323,900
4461 0117R00908170005015 05/09/2017 190,400 190,400
4462 0117R00908170005016 05/09/2017 190,400 190,400
4463 0117R00908170005017 05/09/2017 190,400 190,400
4464 0117R00908170005018 05/09/2017 379,200 379,200
4465 0117R00908170005019 05/09/2017 191,800 191,800
4466 0117R00908170005020 05/09/2017 323,900 323,900
4467 0117R00908170005021 05/09/2017 190,400 190,400
4468 0117R00908170005022 05/09/2017 190,400 190,400
4469 0117R00908170005024 05/09/2017 263,300 263,300
4470 0117R00908170005025 05/09/2017 191,800 191,800
4471 0117R00908170005026 05/09/2017 323,900 323,900
4472 0117R00908170005027 05/09/2017 191,800 191,800
4473 0117R00908170005028 05/09/2017 190,400 190,400
4474 0117R00908170005029 05/09/2017 254,200 254,200
4475 0117R00908170005030 05/09/2017 190,400 190,400
4476 0117R00908170005031 05/09/2017 191,800 191,800
4477 0117R00908170005032 05/09/2017 254,200 254,200
4478 0117R00908170005033 05/09/2017 190,400 190,400
4479 0117R00908170005034 05/09/2017 191,800 191,800
4480 0117R00908170005035 05/09/2017 191,800 191,800
4481 0117R00908170005036 05/09/2017 254,200 254,200
UMPAN BALIK HASIL
VERIFIKASI
Nama RS : RS CITAMA
4482 0117R00908170005037 05/09/2017 254,200 254,200

4483 0117R00908170005038 05/09/2017 191,800 191,800
4484 0117R00908170005039 05/09/2017 323,900 323,900
4485 0117R00908170005040 05/09/2017 215,000 215,000
4486 0117R00908170005041 05/09/2017 191,800 191,800
4487 0117R00908170005042 05/09/2017 191,800 191,800
4488 0117R00908170005043 05/09/2017 190,400 190,400
4489 0117R00908170005044 05/09/2017 215,000 215,000
4490 0117R00908170005046 05/09/2017 191,800 191,800
4491 0117R00908170005047 05/09/2017 190,400 190,400
4492 0117R00908170005049 05/09/2017 323,900 323,900
4493 0117R00908170005050 05/09/2017 190,400 190,400
4494 0117R00908170005051 05/09/2017 323,900 323,900
4495 0117R00908170005052 05/09/2017 191,800 191,800
4496 0117R00908170005053 05/09/2017 142,400 142,400
4497 0117R00908170005054 05/09/2017 191,800 191,800
4498 0117R00908170005055 05/09/2017 191,800 191,800
4499 0117R00908170005056 05/09/2017 191,800 191,800
4500 0117R00908170005057 05/09/2017 191,800 191,800
4501 0117R00908170005058 05/09/2017 323,900 323,900
4502 0117R00908170005059 05/09/2017 323,900 323,900
4503 0117R00908170005061 05/09/2017 323,900 323,900
4504 0117R00908170005843 05/09/2017 190,400 190,400
4505 0117R00908170010171 31/08/2017 311,300 311,300
TOTAL 947,482,600 947,482,600
RESUME
Total : 947,482,600
Bea.Diajukan
Total : 947,482,600
Bea.Disetujui
Menyetujui Mengetahui
Direktur RS BPJS KESEHATAN
dr. Yohannes Febru Nainggolan, drg. Andina Rahmayani

MARS

RS CITAMA Verifikasi Biaya Pelayanan

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UMPAN BALIK HASIL

No No.SEP Tgl. Verifikasi Biaya

36 0117R00908170000037 23/08/2017 190,400 190,400

74 0117R00908170000077 23/08/2017 190,400 190,400

112 0117R00908170000119 23/08/2017 193,100 193,100

150 0117R00908170000162 23/08/2017 112,800 112,800

188 0117R00908170000203 23/08/2017 190,400 190,400

226 0117R00908170000243 23/08/2017 190,400 190,400

264 0117R00908170000281 23/08/2017 263,500 263,500

302 0117R00908170000322 23/08/2017 112,800 112,800

340 0117R00908170000364 23/08/2017 263,300 263,300

378 0117R00908170000405 23/08/2017 215,000 215,000

416 0117R00908170000447 23/08/2017 190,400 190,400

454 0117R00908170000491 23/08/2017 190,400 190,400

492 0117R00908170000536 23/08/2017 190,400 190,400

530 0117R00908170000577 23/08/2017 191,800 191,800

568 0117R00908170000619 23/08/2017 190,400 190,400

606 0117R00908170000663 23/08/2017 190,400 190,400

644 0117R00908170000705 23/08/2017 133,500 133,500

682 0117R00908170000746 23/08/2017 190,400 190,400

720 0117R00908170000788 23/08/2017 190,400 190,400

758 0117R00908170000828 23/08/2017 190,400 190,400

796 0117R00908170000870 23/08/2017 263,500 263,500

834 0117R00908170000913 23/08/2017 323,900 323,900

872 0117R00908170000957 23/08/2017 191,800 191,800

910 0117R00908170000997 23/08/2017 190,400 190,400

948 0117R00908170001035 23/08/2017 190,400 190,400

986 0117R00908170001079 23/08/2017 298,000 298,000

1024 0117R00908170001125 23/08/2017 190,400 190,400

1062 0117R00908170001166 23/08/2017 112,800 112,800

1100 0117R00908170001207 23/08/2017 311,300 311,300

1138 0117R00908170001250 23/08/2017 191,800 191,800

1176 0117R00908170001293 23/08/2017 298,000 298,000

1214 0117R00908170001333 23/08/2017 323,900 323,900

1252 0117R00908170001379 23/08/2017 112,800 112,800

1290 0117R00908170001425 25/08/2017 190,400 190,400

1328 0117R00908170001466 25/08/2017 190,400 190,400

1366 0117R00908170001511 25/08/2017 190,400 190,400

1404 0117R00908170001553 25/08/2017 190,400 190,400

1442 0117R00908170001599 25/08/2017 190,400 190,400

1480 0117R00908170001641 25/08/2017 190,400 190,400

1518 0117R00908170001683 25/08/2017 191,800 191,800

1556 0117R00908170001732 25/08/2017 190,400 190,400

1594 0117R00908170001773 25/08/2017 112,800 112,800

1632 0117R00908170001812 25/08/2017 191,800 191,800

1670 0117R00908170001854 25/08/2017 190,400 190,400

1708 0117R00908170001895 25/08/2017 190,400 190,400

1746 0117R00908170001938 25/08/2017 215,000 215,000

1784 0117R00908170001979 25/08/2017 190,400 190,400

1822 0117R00908170002017 25/08/2017 323,900 323,900

1860 0117R00908170002060 25/08/2017 190,400 190,400

1898 0117R00908170002109 25/08/2017 191,800 191,800

1936 0117R00908170002170 25/08/2017 190,400 190,400

1974 0117R00908170002217 25/08/2017 191,800 191,800

2012 0117R00908170002266 25/08/2017 323,900 323,900

2050 0117R00908170002310 31/08/2017 112,800 112,800

2088 0117R00908170002353 31/08/2017 190,400 190,400

2126 0117R00908170002397 31/08/2017 112,800 112,800

2164 0117R00908170002438 31/08/2017 112,800 112,800

2202 0117R00908170002478 31/08/2017 254,200 254,200

2240 0117R00908170002519 31/08/2017 576,900 576,900

2278 0117R00908170002561 31/08/2017 190,400 190,400

2316 0117R00908170002606 31/08/2017 112,800 112,800