RSCA MEDAN

BUKU TARIF INSURANCE 2022

NO. KODE KETERANGAN

TARIF ADMINISTRASI
1 ACCAGOLD KARTU MEMBERSHIP CA GOLD
2 ACKIDS BIAYA PENDAFTARAN KARTU CA KIDS
3 ACLAUNDRY ADMIN CHARGES - LAUNDRY
4 ACPCOR1 ADMIN CHARGES - RAWAT INAP CORPORATE (1-5 HARI)
5 ACPCOR20 ADMIN CHARGES - RAWAT INAP CORPORATE (>20 HARI)
6 ACPCOR6 ADMIN CHARGES - RAWAT INAP CORPORATE (6-20 HARI)
7 ACRFOP ADMIN CHARGES - RAWAT JALAN ASURANSI
8 ACRGF ADMIN CHARGES - PENDAFTARAN RAWAT INAP
9 ACRGFC ADMIN CHARGES - PENDAFTARAN KUNJUNGAN PERTAMA
10 ACRGOPD BIAYA ADMINISTRASI RAWAT JALAN
11 ACSENAM BIAYA SENAM HAMIL
12 ACSINS ADMIN CHARGES - RAWAT INAP ASURANSI
13 ACREGIP2 BIAYA ADMIN – RAWAT INAP ASURANSI
14 ACAMBHOMECARE ADMIN CHARGES - AMBULANCE HOMECARE
15 ACHOMESWAB ADMIN PELAYANAN HOMECARE SWAB
16 ACRGOTC ADMIN CHARGES - PENDAFTARAN OTC
17 ACSTAMP BIAYA ADMIN - MATERAI
18 ACVENUS BIAYA PENDAFTARAN VENUS CARD

TARIF AMBULANCE
19 ACAMB ADMIN CHARGES - AMBULANCE < 7 KM
20 ACAMB7 ADMIN CHARGES - AMBULANCE 7-15 KM
21 ACAMB15 ADMIN CHARGES - AMBULANCE > 15 KM

TARIF KAMAR BEDAH & GAS MEDIK

22 ORCAROXY CARBON DIOXIDE CO2 ADULT
23 ORCAROXY-KID CARBON DIOXIDE CO2 KID
24 ORITROG NITROGEN GAS-N2
25 ORITROXY NITRO OXYGEN N2O ADULT
26 ORITROXY-KID NITRO OXYGEN N20 KID
27 ORMSR1 BIAYA KAMAR OPERASI MINOR INPATIENT
28 ORMSR2 BIAYA KAMAR OPERASI MINOR DAYCARE
29 ORO2CITY O2 PORTABLE WITHIN CITY
30 ORO2PORT OXYGEN PORTABLE WITH REGULATOR
31 OROXY1 OXYGEN
32 ORRADD OT ADDITIONAL 1/2 HR
33 ORRECV BIAYA KAMAR RECOVERY/HOUR
34 ORRUTAMA BIAYA KAMAR OPERASI UTAMA
35 ORRUTAMACITO OPERATING ROOM 1st HOUR (CITO)

TARIF KAMAR
36 RCDECHAIR BIAYA KAMAR - DECK CHAIR
37 RCDR BIAYA KAMAR BERSALIN
38 RCER1TO3 BED ANE < 3 HOURS
39 RCER3TO6 BED ANE 3 - 6 HOURS
40 RCLODGER BIAYA KAMAR - LODGER
41 RCMORTU MORTUARY ROOM (KAMAR MAYAT)
42 RCNC BIAYA KAMAR BOKS BAYI
43 RDAYCARE BIAYA KAMAR DAY CARE
44 RCBD6 BIAYA KAMAR 6 TEMPAT TIDUR
45 RCBD5 BIAYA KAMAR 5 TEMPAT TIDUR
46 RCBD4 BIAYA KAMAR 4 TEMPAT TIDUR
47 RCBD2 BIAYA KAMAR 2 TEMPAT TIDUR
48 RCBS1 BIAYA KAMAR SUPERIOR
49 RCBD1 BIAYA KAMAR DELUXE
50 RCPRE BIAYA KAMAR PREMIER
51 RCBDC BIAYA KAMAR DELUXE CLUB
52 RCBFC BIAYA KAMAR FAMILY CLUB
53 RCBDISO BIAYA KAMAR ISOLASI
54 RCBDISOICU BIAYA KAMAR ICU ISOLASI
55 RCBDNICU BIAYA KAMAR NICU
56 RCBDSBW BIAYA KAMAR BAYI SAKIT
57 RCBDHDU BIAYA KAMAR HDU
58 RCBDICU BIAYA KAMAR ICU
59 RCMATTRESS BIAYA KAMAR - MATRAS
60 RCOTH BIAYA KAMAR LAINNYA
 TARIF KONSULTASI DOKTER
61 SCOPDGP KONSULTASI GP VISITING OP
62 SCVGP4N6 KONSULTASI GP VISIT RUANGAN 4 DAN 6 BED
63 SCVGP1N2 KONSULTASI GP VISIT RUANGAN SVIP,VIP,DELUXE,SUPERIOR,2BED
64 SCGPFC KONSULTASI GP VISIT RUANGAN FAMILY CLUB
65 SCGPGC KONSULTASI GP GENERAL CLINIC

66 SCOPDSP1 KONSULTASI SPESIALIS OP 1

67 SCAIP4N6 KONSULTASI SPESIALIS 1 VISIT RUANGAN 4 DAN 6 BED
68 SCAIPVIP KONSULTASI SPESIALIS 1 VISIT RUANGAN VIP,DELUXE,SUPERIOR,2BEDDED
69 SCAIPICU KONSULTASI SPESIALIS 1 VISIT RUANGAN DC,SVIP, ICU/HDU/SBW/NICU
70 SCAIPFC KONSULTASI SPESIALIS 1 VISIT RUANGAN FAMILY CLUB
71 SCAIPISO DOCTOR VISIT RUANGAN ISOLATION 1
72 SCAOL1 KONSULTASI SPESIALIS ONLINE 1
73 SCAHOMECARE VISIT DOCTOR SPESIALIS HOMECARE

74 SCOPDSP2 KONSULTASI SPESIALIS OP 2

75 SCBIP4N6 KONSULTASI SPESIALIS 2 VISIT RUANGAN 4 DAN 6 BED
76 SCBIPVIP KONSULTASI SPESIALIS 2 VISIT RUANGAN VIP,DELUXE,SUPERIOR,2BEDDED
77 SCBIPICU KONSULTASI SPESIALIS 2 VISIT RUANGAN DC/SVIP, ICU/HDU/SBW/NICU
78 SCBIPFC KONSULTASI SPESIALIS 2 VISIT RUANGAN FAMILY CLUB
79 SCBIPISO DOCTOR VISIT RUANGAN ISOLATION 2
80 SCBOL1 KONSULTASI SPESIALIS ONLINE 1
81 SCBHOMECARE VISIT DOCTOR SPESIALIS HOMECARE

82 SCOPDSP3 KONSULTASI SPESIALIS OP 3

83 SCCIP4N6 KONSULTASI SPESIALIS 3 VISIT RUANGAN 4 DAN 6 BED
84 SCCIPVIP KONSULTASI SPESIALIS 3 VISIT RUANGAN VIP,DELUXE,SUPERIOR,2BEDDED
85 SCCIPICU KONSULTASI SPESIALIS 3 VISIT RUANGAN SVIP, ICU/HDU/SBW/NICU
86 SCCIPFC KONSULTASI SPESIALIS 3 VISIT RUANGAN FAMILY CLUB
87 SCCIPISO DOCTOR VISIT RUANGAN ISOLATION 3
88 SCCOL1 KONSULTASI SPESIALIS ONLINE 1
89 SCCOL2SS KONSULTASI SUB-SPESIALIS ONLINE
90 SCCHOMECARE VISIT DOCTOR SPESIALIS HOMECARE

91 SCOPDSP4 KONSULTASI SPESIALIS OP 4

92 SCDIP4N6 KONSULTASI SPESIALIS 4 VISIT RUANGAN 4 DAN 6 BED
93 SCDIPVIP KONSULTASI SPESIALIS 4 VISIT RUANGAN VIP,DELUXE,SUPERIOR,2BEDDED
94 SCDIPICU KONSULTASI SPESIALIS 4 VISIT RUANGAN SVIP, ICU/HDU/SBW/NICU
95 SCDIPISO DOCTOR VISIT RUANGAN ISOLATION 4
96 SCDOL2SS KONSULTASI SUB-SPESIALIS ONLINE

97 SCOPDSP5 KONSULTASI SPESIALIS OP 5

98 SCEIP4N6 KONSULTASI SPESIALIS 5 VISIT RUANGAN 4 DAN 6 BED
99 SCEIPVIP KONSULTASI SPESIALIS 5 VISIT RUANGAN VIP,DELUXE,SUPERIOR,2BEDDED
100 SCEIPICU KONSULTASI SPESIALIS 5 VISIT RUANGAN SVIP, ICU/HDU/SBW/NICU
101 SCEIPISO DOCTOR VISIT RUANGAN ISOLATION 5
102 SCEOL2SS KONSULTASI SUB-SPESIALIS ONLINE

TARIF KONSULTASI MO
103 MCDURMOV PRIVATE DUTY RMO (PERJALANAN DENGAN PESAWAT)
104 MCDURMOVA PRIVATE DUTY RMO LUAR KOTA PER JAM
105 MCMOIP3 KONSULTASI MO VISIT RUANGAN 4 DAN 6 BED
106 MCMOIP4 KONSULTASI MO VISIT RUANGAN VIP,DELUXE,SUPERIOR,2BEDDED
107 MCMOMCU PEMERIKSAAN DAN KOSULTASI RMO
108 MCRMO1 RMO FEE (07.00 - 21.00) OP
109 MCRMO2 RMO FEE (21.00 - 07.00) OP
110 MCRMOFEE PRIVATE DUTY RMO (DALAM KOTA)
111 MCRMOIP RMO FEE (07.00-21.00) IP
112 MCRMOIP2 RMO FEE (21.00-07.00) IP
113 MCIPISO DOCTOR VISIT RUANGAN ISOLATION
114 MCOL1 KONSULTASI MO ONLINE 1
115 MCHOMECARE VISIT DOCTOR MO HOMECARE

TARIF LABORATORIUM
116 LAAGD ANALISA GAS DARAH
117 LAALB ALBUMIN
118 LAALK ALKOHOL DALAM DARAH
119 LAALP FOSFATASE ALKALI (ALP)
120 LAAMYL AMILASE
121 LAAPHOS ACID PHOSPHATASE
122 LAAPOA APO - A1
123 LAAPOB APO - B
124 LABICAR BICARBONAT (BICARB)
125 LABILD BILIRUBIN DIRECT
126 LABILIND BILIRUBIN INDIRECT
 127 LABILT BILIRUBIN TOTAL
128 LABTEM ANALISA BATU EMPEDU
129 LACA CALCIUM
130 LACALION CALCIUM ION
131 LACARB CARBAMAZEPIN
132 LACHOL CHOLESTEROL TOTAL
133 LACHOLIN CHOLINESTERASE
134 LACKMB CK-MB
135 LACL CHLORIDA (CL)
136 LACPEP C-PEPTIDE
137 LACPK CPK/CK
138 LACREAT KREATININ
139 LACTH ACTH
140 LACTX CTX (BETA CROSLAPS)
141 LACYCLO CYCLOSPORIN
142 LACYSTC CYSTATIN C
143 LADIPON ADIPONEKTIN
144 LAEGFR EGFR (ESTIMATED GLOMEROLUS FILTRATE RATE)
145 LAELEKT PAKET NATRIUM, KALIUM, CHLORIDA
146 LAG2PP GLUKOSA 2 JAM PP
147 LAGDN GLUKOSA PUASA
148 LAGDNHBA PANEL GLUKOSA PUASA DAN HBA 1C
149 LAGDS GLUKOSA SEWAKTU (GLUCOSE RANDOM)
150 LAGDSHBA PANEL GLUKOSA SEWAKTU DAN HBA 1C
151 LAGDSTIK GLUCOTEST STRIP
152 LAGENE GENE EXPERT
153 LAGGT GAMMA GT (GGT)
154 LAGKH GLUCOTEST STRIP KURVA HARIAN 3X
155 LAGLOB GLOBULIN
156 LAGRAT PAKET TOTAL PROTEIN, ALBUMIN, GLOBULIN, A/G RATIO
157 LAGTT5 TES TOLERANSI GLUKOSA (GTT)
158 LAHBA HBA 1C
159 LAHDL HDL - CHOLESTEROL
160 LAHSCRP HSCRP
161 LAINS INSULIN
162 LAKAL KALIUM (K)
163 LAKRECLE KREATININ CLEARANCE
164 LALAC LACTATE
165 LALDH LDH
166 LALDL LDL - CHOLESTEROL
167 LALDLD LDL - CHOLESTEROL DIRECT
168 LALIP LIPASE
169 LALIPOA LIPOPROTEIN (A)
170 LAMAG MAGNESIUM
171 LAMAKUAL MIKRO ALBUMIN KUALITATIF
172 LAMON AMONIAK
173 LAMYOGL MYOGLOBIN
174 LANAT NATRIUM (NA)
175 LAOSMOS OSMOLARITAS SERUM
176 LAOSMOU OSMOLARITAS URIN
177 LAPCRERT PROTEIN CREATININ RATIO
178 LAPDL1 PDL 1
179 LAPHEN PHENYTOIN
180 LAPHENO PHENOBARBITAL
181 LAPHOS FOSFOR ANORGANIK (IN. PHOS)
182 LAPHOSU PHOSPOR URINE
183 LAPIVKA PIVKA TEST
184 LAPLU PLUMBUM
185 LAPORAT APO A1 / APO B RATIO
186 LAPROTC PROTEIN C
187 LAPROTS PROTEIN S
188 LASGOT SGOT
189 LASGPT SGPT
190 LATP TOTAL PROTEIN
191 LATPELEK PROTEIN ELEKTROFORESIS (SPE)
192 LATRIG TRIGLISERIDA (TG)
193 LAUA URIC ACID
194 LAUBT UBT (URE BREATH TEST)
195 LAUCRT ASAM URAT CREATININ RATIO
196 LAUREUM UREA (BUN)
197 LB6PD G-6PD (SCREENING)
198 LB6PDQ G 6 PD (QUANTITATIVE)
199 LBACT ACT-ACTIVATE CLOTING TIME
200 LBAGTROM AGREGASI THROMBOSIT
201 LBAPTT APTT (ACTIVATED PTT)
202 LBASFOL ASAM FOLATE
203 LBATIII AT III
204 LBATPO ANTI TPO
205 LBBT WAKTU PERDARAHAN (BT)
206 LBCD4 CD 4
207 LBCD8 CD 8
208 LBCLTR COULTER
209 LBCOLDAG COLD AGLUTININ
210 LBCT WAKTU PEMBEKUAN (CT)
211 LBDIM D-DIMER
212 LBDL01 DARAH LENGKAP (DARAH RUTIN,LED,RETIKULOSIT,IPF)
213 LBDLGOL DARAH LENGKAP DAN GOL DARAH
214 LBDR01 ROUTINE BLOOD (HB,WBC,RBC,HCT,PLT,NER,HITUNG JENIS)
215 LBEPINE EPINEPHRINE
216 LBFACT11 FACTOR XI
217 LBFACT8 FACTOR VIII
218 LBFACT9 FACTOR IX
219 LBFE FE SERUM (SERUM IRON)
220 LBFER FERRITIN
221 LBFERUR FERRITIN URINE
222 LBFIBRIN FIBRINOGEN
223 LBGOL GOL. DARAH A B O/RHESUS
224 LBHBH BADAN INKLUSI HBH
225 LBHELEK HB ELEKTROFORESIS
226 LBHHPLC ANALISA HB (HPLC)
227 LBHOM HOMOCYSTEIN
228 LBLE SEL LE
229 LBLED LED (LAJU ENDAP DARAH)
230 LBMALARI MALARIA
231 LBMALICT ICT MALARIA PV/PF (PLASMODIUM VIVAX/FALCIPARUM
232 LBMAPTT MIXED APTT
233 LBMDT GAMBARAN SED. DARAH TEPI (PBF)
234 LBMICROF MICROFILARIA
235 LBPT PT/INR
236 LBRCF RED CELL FOLATE
237 LBRET RETIKULOSIT (RETIC)
238 LBRISTO RISTOCETINE
239 LBTIBC TIBC
240 LBTRANS TRANSFERIN
241 LBTT THROMBIN TIME (TT)
242 LBUFFY BUFFY COAT STAINING
243 LBVIRAL VIRAL LOAD HIV
244 LBVISCD VISCOSITAS DARAH
245 LBVIT VIT. B12
246 LBVITD25 VIT D 25-OH
247 LBVWB VWF
248 LBWB WESTERN BLOT
249 LCADA ADA
250 LCFLUIDS FLUIDS (SPUTUM,URINE,WASHING,ETC)
251 LCFNA01A FINE NEEDLE ASPIRATION
252 LCHPV HPV- DNA
253 LCLIQ ANALISA CAIRAN LCS
254 LCPAPLIQA PAP SMEAR
255 LCSENDI ANALISA CAIRAN SENDI
256 LCSPERM ANALISA SPERMA
257 LDAMPHE SCREENING AMPHETAMIN
258 LDBARBIT BARBITURAT
259 LDBENZO SCREENING BENZOADIAZEPIN
260 LDCOCA SCREENING COCAINE
261 LDCOTINUR COTININ URINE
262 LDDIG DIGOXIN
263 LDHLA HLA-B27
264 LDMET SCREENING MET (SHABU-SHABU)
265 LDMETADH SCREENING METADHONE
266 LDOPIAT SCREENING OPIATE (MORPHINE)
267 LDPHENCY SCREENING PHENCYCLIDINE
268 LDPHENI PHENITOID
269 LDPROPOXY SCREENING PROPOXYPHENE
270 LDTACRO TACROLIMUS
271 LDTHC SCREENING THC / CANNABINOID (MARIJUANA)
272 LDTHEO THEOPHYLLIN
273 LDVALAC VALPORIC ACID
274 LEALDOS ALDOSTERON
275 LEAMH AMH (ANTI MULLERIAN HORMONE)
276 LEANTHYRO ANTI THYROGLOBULIN
277 LEATSHR ANTI TSH RECEPTOR
278 LEBHCG B-HCG QUANTITATIVE
279 LECALCI CALCITONIN
280 LECORT CORTISOL
281 LECORUR CORTISOL URINE
282 LEDHEAS DHEAS
283 LEESTRA ESTRADIOL
284 LEFRTESTO FREE TESTOSTERON
285 LEFRUKTO FRUKTOSAMIN
286 LEFSH FSH
287 LEFT3 FT3
288 LEFT4 FT 4
289 LEFT4TSH PANEL ENDOCRINE (FT4, TSH)
290 LEGLYALB GLYCATED ALBUMIN
291 LEGROW GROWTH HORMON
292 LEI5HIAA 5-HIAA
293 LEIGF IGF-1
294 LELH LH
295 LEPROCAL PRO CALCITONIN
296 LEPROG PROGESTERON
297 LEPROL PROLACTIN
298 LEPTHIN PTH INTACT
299 LESTRI ESTRIOL
300 LET3 T3
301 LET4 T4
302 LETEST TESTOSTERON
303 LETHYRO THYROGLOBULIN
304 LETRAB TRAB
305 LETSH TSH-S (THYROID STIMUL. HORMONE)
306 LETTG ANTI TTG
307 LFABOGR ABO/RH GROUPING
308 LFABOKELL ABO/RH, KELL GROUPING
309 LFABSID ANTIBODIES IDENTIFICATION
310 LFABSS ANTIBODIES SCREENING
311 LFBATYP RHESUS TYPING
312 LFCOMBTEST COOMBS TEST DIRECT/INDIRECT
313 LFCRMNR CROSS MATCH MINOR
314 LFCRMYR CROSS MATCH MAYOR
315 LFGOLN GOLONGAN DARAH NEONATUS
316 LFNAT NAT (NUCLEIC ACID TEST)
317 LFPLAGEL PLATELET GEL
318 LFPRECRYO PRE TRANSFUSION TESTING CRYO
319 LFPREFFP PRE TRANSFUSION TESTING FFP
320 LFPREFWB PRE TRANSFUSION TESTING FWB
321 LFPREPRC PRE TRANSFUSION TESTING PRC
322 LFPRETC PRE TRANSFUSION TESTING TC
323 LFTEG THROMBOELASTOGRAPH
324 LFTEGHPRN THROMBOELASTOGRAPH HEPARINASE
325 LFWRCNAT WRC NAT
326 LHCD 3W CD 3
327 LHCD117 CD 117
328 LHCD20 CD 20
329 LHE125 HE4+CA 125 (ROMA)
330 LHER ER (ESTROGEN RECEPTOR 301C)
331 LHFROZEN FROZEN SECTION
332 LHHER HER-2
333 LHKI67 KI 67
334 LHLARGEA LARGE SPECIMEN
335 LHMEDIUMA MEDIUM SPECIMEN
336 LHPANCYT CYTOKERATIN 20
337 LHPR PR (PROGESTERON RECEPTOR 302C)
338 LHSMALLA SMALL SPECIMEN
339 LHSTI hs-TROPONIN I
340 LHVIMEN VIMENTIN
341 LIACAIGG ACA IGG
342 LIACAIGM ACA IGM
343 LIACCP ANTI CCP IgG
344 LIADP ADENOSINE DISPHOSPHATE (ADP)
345 LIADSDNA ANTI DS DNA
346 LIAFP AFP
347 LIAHAVG ANTI HAV IgG
348 LIAHAVM IGM ANTI HAV
349 LIAHBCG ANTI HBC IGG
350 LIAHBCM ANTI HBC IGM
351 LIAHBE ANTI HBE
352 LIAHBS ANTI HBS
353 LIAHCV ANTI HCV
354 LIAHCVM IGM ANTI HCV
355 LIAMIKO ANTI MIKOPLASMA IgM
356 LIAMIKOG ANTI MIKOPLASMA IgG
357 LIANA ANA
358 LIANAIF ANA IF
359 LIANCA ANCA
360 LIANMCV ANTI MCV
361 LIANPRO ANA PROFILE
362 LIANTIJO ANTI JO-1
363 LIANTISCL ANTI SCL-70
364 LIANTISM ANTI SM
365 LIANTISSA ANTI SS-A (RO)
366 LIANTISSB ANTI SS-B (LA)
367 LIASTO ASTO (KUANTITATIF)
368 LIATOPY IGE ATOPY
369 LIB2GPIG B2GPI IGG
370 LIB2GPIM B2GPI IGM
371 LIB2MIC BETA2 MICROGLOBULIN
372 LIBCRABL BCR-ABL
373 LIC3 C-3 KOMPLEMEN
374 LIC4 C-4 KOMPLEMEN
375 LICA12 CA 125
376 LICA15 CA 15-3
377 LICA19 CA 19-9
378 LICA72 CA 72-4
379 LICEA CEA
380 LICGA CgA (CHROMOGRANIN A)
381 LICHIKM ANTI CHIKUNGUNYA IGM
382 LICHLAG CHLAMYDIA IGG
383 LICHLAM CHLAMYDIA IGM
384 LICHROM ANALISA CHROMOSOM
385 LICIFRA CYFRA 21-1
386 LICLOSD CLOSTRIDIUM DIFFICILE
387 LICMVG ANTI CMV IGG
388 LICMVGAV AV. ANTI CMV IGG
389 LICMVM ANTI CMV IGM
390 LICMVPCR CMV PCR
391 LICOMPACT TOTAL COMPLEMENT ACTIVITY
392 LICRP CRP (KUANTITATIF)
393 LIDHF ANTI DENGUE IGG/IGM
394 LIEBVEA ANTI EBV EA IGA
395 LIEBVVCA ANTI EBV VCA IGA
396 LIFPSA FREE PSA
397 LIGA IGA
398 LIGG IGG
399 LIGLIAD IgA ANTI GLIADIN
400 LIGM IGM
401 LIHANTA HANTA VIRUS
402 LIHBE HBE AG
403 LIHBS HBS AG
404 LIHBSAG HBS AG KUANTITATIF
405 LIHBSAGK HBS AG KONFIRMASI
406 LIHBVDNA HBV-DNA
407 LIHCVGEN HCV RNA GENOTYPE
408 LIHCVKT HCV RNA (KUANTITATIF)
409 LIHE4 HE4
410 LIHIV ANTI HIV
411 LIHIV1 HIV RNA KUANTITATIF
412 LIHIVKF HIV KONFIRMASI
413 LIHPILO ANTI HELICOBACTER IGG (H.PILORY)
414 LIHPILOM ANTI HELICOBACTER IGM (H. PILORY)
415 LIHPSA HPSA
416 LIHPVGEN HPV - GENOTYPE
417 LIHSV1G ANTI HSV 1 IGG
418 LIHSV1M ANTI HSV 1 IGM
419 LIHSV2G ANTI HSV 2 IGG
420 LIHSV2M ANTI HSV 2 IGM
421 LIIGE IGE TOTAL
422 LIIGRA IGRA
423 LILCA LCA
424 LILEPTGM LEPTOSPIRA IGM
425 LILETEST LE TEST
426 LINFLUA INFLU A
427 LINS1 NS 1 ANTIGEN
428 LINSE NSE
429 LINTPRO NT-PRO BNP
430 LIOSTEO N MID OSTEOCALCIN
431 LIP1NP AMYLASE
432 LIPAP PAP
433 LIPSA PSA
434 LIRF RF (REMATIC FACTOR)
435 LIRHEUM RHEUMACHEC
436 LIROTA ROTAVIRUS
437 LIRUBG ANTI RUBELLA IGG
438 LIRUBM ANTI RUBELLA IGM
439 LISALMOM SALMONELLA TYPHI IGM
440 LISCC SCC
441 LISERAM ANTI AMOEBA
442 LISLA SLA
443 LISTREPA STREPTO A
444 LITBA TB ANTIGEN
445 LITBICT ANTI M TBC
446 LITBPCR PCR-TB
447 LITEO TOTAL EOSINOFIL
448 LITOXG ANTI TOXO IGG
449 LITOXGAV AV. ANTI TOXO IGG
450 LITOXM ANTI TOXO IGM
451 LITPHA TPHA
452 LITSHN TSH NEONATUS
453 LIVDRL VDRL
454 LIWIDAL WIDAL
455 LIZIKA VIRUS ZIKA
456 LJACBAL ANALISA CAIRAN BAL
457 LJASCI ANALISA CAIRAN ASCITES
458 LJDIFF JML SEL/HITUNG JENIS (CELL COUNT)
459 LJGLUK GLUKOSA (GLUCOSE)
460 LJNON NONNE
461 LJPAN PANDY
462 LJPROT PROTEIN CAIRAN
463 LKCD10 CD 10
464 LKCD14 CD 14
465 LKCD30 CD 30
466 LKCD33 CD 33
467 LKCD34 CD 34
468 LKCD41 CD 41
469 LKCD5 CD 5
470 LKPHCTLK PAKET IHC TUMOR LYMPHOMA (CD 30, CD 20)
471 LKPHCTM PAKET IHC TUMOR MEDIASTINUM (CYTOKERATIN, VIMENTIN, CD 30)
472 LKPHCTP PAKET IHC TUMOR PAYUDARA (ER, PR, HER2, Ki67)
473 LMANSWAB KULTUR ANAL SWAB
474 LMJAR KULTUR & RESISTENSI JARINGAN
475 LMKAN KULTUR ANAEROB
476 LMKBTA KULTUR BTA (AFB CULTURE)
477 LMKCAND KULTUR CANDIDA
478 LMKFSS KULTUR FAECES (SALMONELLA-SHIGELLA)
479 LMKFVC KULTUR FAECES (VIBRIO CHOLERA)
480 LMKGALL GALL KULTUR (BILE CULTURE)
481 LMKKAT KULTUR KATETER
482 LMKNS KULTUR & RESISTENSI DIPHTERI (NOSE S)
483 LMKRBRON KULTUR & RESISTENSI BRONCHIAL WASHING
484 LMKRC KULTUR & RESISTENSI CAIRAN
485 LMKRCSF KULTUR & RESISTENSI CSF (CSF CULT.)
486 LMKRD KULTUR & RESISTENSI DARAH (BLD CULT)
487 LMKRF KULTUR & RESISTENSI FAECES(STL CULT)
488 LMKRGO KULTUR & RESISTENSI GO (GO CULT.)
489 LMKRJAM KULTUR & RESISTENSI JAMUR
490 LMKRPUS KULTUR & RESISTENSI PUS
491 LMKRSKR KULTUR & RESISTENSI SEKRET(FLD.CULT)
492 LMKRSPT KULTUR & RESISTENSI SPUTUM (SPT CULT)
493 LMKRTE KULTUR & RESISTENSI TRANSUDAT / EKSUDA
494 LMKRTGG KULTUR & RESISTENSI USAP TENGGOROK (THROAT SWAB)
495 LMKRU KULTUR & RESISTENSI URINE (UR. CULT)
496 LMPBTA01 PENGECATAN BTA (SPUTUM 3X)
497 LMPBTA02 PENGECATAN MYCOBACTERIUM LEPRAE
498 LMPBTA03 PENGECATAN BTA
499 LMPCAND CANDIDA
500 LMPDIPH PENGECATAN DIPHTERI
501 LMPGLG PGL 1 IGG
502 LMPGLM PGL 1 IGM
503 LMPGO GO (G.C.)
504 LMPGRAM PENGECATAN GRAM (GRAMS STAIN)
505 LMPJAM JAMUR / FUNGI
506 LMPTRICH TRICHOMONAS
507 LMRECSWAB KULTUR RECTAL SWAB
508 LOAINAB ANTI INSULIN ANTIBODI
509 LOAINFR ANTI INTRINSIK FAKTOR
510 LOALKSALV ALKOHOL SALIVA
511 LOAMA AMA
512 LOANDROS ANDROSTENEDION
513 LOBCAIRANT BTA CAIRAN/SPUTUM
514 LOBMP BONE MARROW PUNCTION (BMP)
515 LOBORGM BORRELIA IGG & IGM
516 LOC1Q ANTI C1Q
517 LOCRYPPO CRYPTOSPORIDIA
518 LOCYTOG CYTOLOGY GIEMSA
519 LOEPO EPO
520 LOGAST GASTRIN
521 LOGBM ANTI GBM
522 LOGIEMSA GIEMSA
523 LOGRAM GRAM
524 LOHBHK HBH KLEHAWER
525 LOHEBO HEINZ BODIES
526 LOHTLOV HTLV I/II
527 LOIGER IGE SPESIFIK
528 LOIL1 IL-1
529 LOIL6 IL-6
530 LOJAK2 JAK2
531 LOLKM ANTI LKM-1
532 LOLOEGIO U.LEGIONELLA
533 LOMJOF MORFOLOGI/JUMLAH SEL
534 LOMYOGUR MYOGLOBIN URINE
535 LOMYOSP MYOSITIS PANEL
536 LONGAL NGAL
537 LOPAS PAS
538 LOSHBG SHBG
539 LOSTEO OSTEOCALCIN
540 LOSUGWAT SUGAR WATER TEST
541 LOTNFA TNF ALPHA
542 LOTRFUR TRANSFERIN URINE
543 LOUPE UPE
544 LOVMAU VMA URINE
545 LPDHF1 PANEL DEMAM DENGUE (DARAH LENGKAP, DENGUE IGE & IGM, DENGUE NS1 AG)
546 LPDIAB2 PANEL DIABETES 2 (GDP, GD 2 JAM, HBA1C)
PAKET NARKOBA 5 TEST
547 LPDRUG (AMPHETAMIN,MORPHIN,CANABIS/THC/MARIJUANA,METHAMPHETAMIN,BENZODIAZE
PIN)
548 LPDRUG03 PAKET NARKOBA 3 TEST (AMPHETAMIN,MORPHIN,CANABIS/THC/MARIJUANA)
549 LPGIN1 PANEL GINJAL 1 (UREUM, KREATININ, URIC ACID)
550 LPGIN3 PANEL GINJAL 3 (UREUM, KREATININ, URIC ACID, CYSTATIN C)
551 LPLIP PANEL LIPID (CHOLESTEROL, HDL, LDL, TRIGLISERIDA)
552 LPLIV3 PANEL LIVER 3 (SGOT, SGPT, GGT, ALP, BILIRUBIN)
553 LPPOSTHD PAKET POST HD (UREUM CREATININ)
554 LPPREHD PAKET PRE HD (UREUM CREATININ)
555 LRATIO RATIO CHOLESTEROL
556 LRCDIFF C.DIFFICILE
557 LRDS DARAH SAMAR/BENZIDIN (O.B)
558 LRFAECES FAECES LENGKAP (FAEC
559 LRFECAL FECAL CALPROTECTIN
560 LSDL SMALL DENSE LDL
561 LSPLEU ANALISA CAIRAN PLEURA
562 LTTO THROMBOTEST OWREN
563 LUACR RATIO URINE ALBUMIN CREATININ
564 LUBAGIN ANALISA BATU GINJAL
565 LUBENCE PROTEIN BENCE JONES
566 LUCA CALSIUM URINE (URINE CA)
567 LUCL CHLORIDA URINE (URINE CL)
568 LUCREAT CREATININ URINE 24 JAM (UR. CREAT
569 LUESBA PROTEIN 24 JAM
570 LUHCG TEST PACK HCG
571 LUKUR KALIUM URINE (URINE KA)
572 LUMIKROO MIKRO ALBUMIN KUANTITATIF
573 LUNA NATRIUM URINE (URINE NA)
574 LUPROUR TOTAL PROTEIN URINE
575 LUUA ASAM URAT URINE 24 JAM
576 LUUL URINE LENGKAP (URINE FEME/URINE PANEL)
577 LUUR URINE RUTIN
578 LUUREUM UREUM URINE 24 JAM (URINE UREA)
579 LASD LUPUS ANTICOAGULANT (SCT & dRVVT)
580 LHCELLB CELL BLOCK
581 LIVZVG ANTI VZV IgG
582 LIVZVM ANTI VZV IgM
583 LOIMUN IMMUNOTYPING
584 LOTH LABORATORIUM LAINNYA
585 LOVITB1B6 VITAMIN B1 & B6
586 LLEUPHE LEUKEMIA PHENOTYPING
587 LOCOV RAPID TEST COVID 19 IGG IGM
588 LOCOVPCR SARS COV-2 REAL TIME PCR
589 LOANTIGEN RAPID ANTIGEN SARS COV-2
590 LOCOVID SARS-COV-2 IGG & IGM (CMIA)
591 LOCOVRNA2 SARS COV-2 RNA (INHOUSE)
592 LOCOVRNA3 SARS COV-2 RNA SAME DAY
593 LOCOVRNA4 SARS COV-2 RNA NEXT DAY
594 LOCOVRNA5 SARS COV-2 RNA THREE DAY
595 LOCOVRNA6 RESPIRATORY PANEL INCLUDE SARS COV-2
596 LOSABKU SARS-COV-2 ANTIBODI KUANTITATIF S (RBD)
597 LACOVPCR SWAB PCR CEPAT
598 LOITRATIO IT RATIO
599 LOLSCPER ANALISA CAIRAN PERIKAD
600 LHPROCORE PROSTATE & CORE BIOPSY SPECIMENT
601 LHSPECSP SPECIFIC SPECIMENT (MASTECTOMY, HEMICOLECTOMY)
602 LAATHALAB ANALISA THALASEMIA ALFA & BETHA
603 LOANTIPP PENDAMPING PASIEN RAPID ANTIGEN SARS COV-2

TARIF BDRS
604 LBCRYO30 CRYOPRECIPITATE 30 CC
605 LBDKPRC PRC DONOR KELUARGA
606 LBDKWB WB DONOR KELUARGA
607 LBFILPLAT FILTER PLATELET
608 LBFILREDC FILTER RED CELL
609 LBFP150 FRESH FROZEN PLASMA (FFP) 150CC
610 LBFP300 FRESH FROZEN PLASMA (FFP) 300CC
611 LBFPA700 FRESH FROZEN PLASMA (FFP) APHERESIS 700CC
612 LBFWB350 FWB 350CC - V
613 LBGC GRANULOCYTE COLLECTION
614 LBLMC LYMPHO MONO COLLECTION
615 LBPLABO BLOOD BAG/PLEBOTOMY
616 LBPRC175 PACKED RED CELLS (PRC) 175CC
617 LBSTEM STEM CELL COLLECTION
618 LBTC50 THROMBOCYTE CONCENTRATE (TC) 50 CC
619 LBTGR THERAPEUTIC GRANULOCYTE REDUCTION
620 LBTHROM1 THROMBOCYTE CONCENTRATE (TC)
621 LBTLMR THERAPEUTIC LYMPHO/MONO REDUCTION
622 LBTPE TPE (TERAPEUTIC PLASMA EXCHANGE)
623 LBTPR THERAPEUTIC PLATELET REDUCTION
624 LBVITAPH VIT. APHERESIS
625 LBWPRC WASHING PACKED RED CELLS

TARIF FISIOTERAPI
626 RHOTGYMEQUIP PHYSIO TREADMILL
627 RHOTQDB QUADRICEPS BENCH
628 RHOTSTABIC STATIC BICYCLE
629 RHPTAKMOV ACTIVE MOVEMENT/LATIHAN-LATIHAN AKTIF
630 RHPTBALEXER BALANCE EXERCISES/LATIHAN KESEIMBANGAN
631 RHPTBOEX BOBATH EXERCISES
632 RHPTCABG EXERCISE FOR POST OP CABG
633 RHPTCP BREATHING EXERSICES/LATIHAN PERNAFASAN
634 RHPTCPMH CPM (CONTINOUS PASSIVE MOVEMENTS) PER JAM
635 RHPTCPT CHEST PHYSIOTHERAPY
636 RHPTELESTIMF ELECTRICAL SIMULATION - FARADIC
637 RHPTELESTIMG ELECTRICAL SIMUL - GALVANIC
638 RHPTGENEXC GYMNASIUM EXERCISES
639 RHPTIFT INTERFERENTIAL THERAPY
640 RHPTIHSI INHALASI / NEBULIZER
641 RHPTIRR SINAR INFRA MERAH
642 RHPTKD ICE PACK / KOMPRES DINGIN
643 RHPTKP CORRECTION POSTURE/KOREKSI SIKAP TUBUH
644 RHPTKPNS HOT PACK / KOMPRES PANAS
645 RHPTKTP KINESIOTAPPING
646 RHPTLATJAL WALKING EXERCISE/LATIHAN BERJALAN
647 RHPTLATKOOR COORDINATION EXERCISES/LAT. KOORDINASI
648 RHPTMASS MASSAGE
649 RHPTMMT MUSCLE TEST/EVALUASI KEKUATAN OTOT
650 RHPTMNLDV MANUAL LUMPH DRAINASE VOLDER
651 RHPTMT15 PASSIVE JOINT MOBILIZATION/MANUAL THERAP
652 RHPTPASMOV PASSIVE MOVEMENT/LATIHAN PASIF
653 RHPTPBATH PARAFFIN BATH
654 RHPTPEKE PENINGKATAN KEKUATAN GERAKAN SENDI
655 RHPTPNF P.N.F (PROPIOCAPTURE NERO NUSCULAR FAC.)
656 RHPTPNMF PROPRIOCEPTOR NEURO MUSCULAR FASILITATIO
657 RHPTPODR POSTURAL DRAINAGE
658 RHPTRLT RED LASER THERAPY
659 RHPTSTRENG STRENGTHENING EXERCISES/PENGUATAN OTOT
660 RHPTSWD SHORTWAVE DIATHERMY
661 RHPTSWT SHOCK WAVE THERAPY
662 RHPTTC STATIC/INTERMITTEN CARVICAL TRACTION
663 RHPTTENS TENS (TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR)
664 RHPTTL STATIC/INTERMITTEN LUMBAR TRACTION
665 RHPTUST ULTRASOUND THERAPY
666 RHPTRT ROMBERG TEST
667 RHPTTFSSM TERAPI FISIK STIMULASI SENSORIK DAN MOTORIK
668 RHPTTWP TERAPI WICARA PSIKOLOGIS
669 RHPTSEN SENSORIS INTEGRITAS
670 RHPTOTH REHABILITASI LAINNYA

TARIF RADIOLOGI
671 RCARM C-ARM
672 RCCAD CT HEAD EXAMINATION WITH CONTRAST
673 RCCARD CTA CORONARY
674 RCCBRA CT SCAN ROUTINE BRAIN + IV CONTRAST
675 RCCBTH CT SCAN THORAX HRCT + IV CONTRAST
676 RCCFBS CT BODY EXAM WC
677 RCCLOW CT SCAN LOWER ABDOMEN + IV CONTRAST
678 RCCNAS CT SCAN NASOPHARYNX + IV CONTRAST
679 RCCNEC CT SCAN NECK + IV CONTRAST
680 RCCSEL CT SCAN SELLA TURSICA + IV CONTRAST
681 RCCULO CT SCAN ABDOMEN + IV CONTRAST
682 RCCUPP CT SCAN UPPER ABDOMEN + IV CONTRAST
683 RCOAOR CT ANGIO AORTA
684 RCOCER CT ANGIO CERVICAL
685 RCOCRA CT ANGIO CRANIAL
686 RCOLEX CT ANGIO LOWER EXTREMITY
687 RCOLOW CT ANGIO LOWER ABDOMEN
688 RCOTHO CT ANGIO THORAX
689 RCOUEX CT ANGIO UPPER EXTREMITY
690 RCOUPP CT ANGIO UPPER ABDOMEN
691 RCTALS CT CALCIUM SCORING
692 RCTANK CT SCAN ANKLE JOINT
693 RCTANK3D CT SCAN ANKLE JOINT 3D
694 RCTARS CT CARDIAC ANGIO CORONER + CALCIUM SCORING
695 RCTBIOP CT BIOPSY
696 RCTBMD CT BONE MINERAL DENSITY (BMD) OSTEO
697 RCTBPERC CT SCAN BRAIN PERFUSION
698 RCTBRA CT SCAN ROUTINE BRAIN
699 RCTBRA3D CT SCAN ROUTINE BRAIN 3D
700 RCTBTH CT SCAN THORAX
701 RCTBTH3D CT SCAN THORAX 3D
702 RCTCER CT SCAN CERVICAL
703 RCTCER3D CT SCAN CERVICAL SPINE 3D
704 RCTCUB CT SCAN CUBITI
705 RCTCUB3D CT SCAN CUBITI/ELBOW JOINT 3D
706 RCTDPE CT SCAN DIGITAL PELVIMETRY
707 RCTEXT CT SCAN EXTREMITAS LONG BONE
708 RCTEXT3D CT SCAN EXTREMITAS 3D
709 RCTFAB CT FACIAL BONE
710 RCTFAB3D CT FACIAL BONE 3D
711 RCTGEN CT SCAN GENU
712 RCTGEN3D CT SCAN GENU/KNEE 3D
713 RCTHIP CT SCAN HIP JOINT
714 RCTHIP3D CT SCAN HIP JOINT 3D
715 RCTINAC CT SCAN INNER AUDITORY CANAL
716 RCTL3PH CT SCAN LIVER 3 PHASE
717 RCTLOW CT SCAN LOWER ABDOMEN
718 RCTLOW3D CT SCAN LOWER ABDOMEN 3D
719 RCTLUM CT SCAN LUMBAL
720 RCTLUM3D CT SCAN LUMBAR SPINE 3D
721 RCTMAN CT MANDIBULA
722 RCTMAN3D CT MANDIBULA 3D
723 RCTMNS CT SCAN MANUS
724 RCTMNS3D CT SCAN MANUS 3D
725 RCTNAS CT SCAN NASOPHARYNX
726 RCTNAS3D CT SCAN NASOPHARYNX 3D
727 RCTNEC CT SCAN NECK
728 RCTNEC3D CT SCAN NECK 3D
729 RCTORB CT SCAN ORBITA
730 RCTORB3D CT SCAN ORBITA 3D
731 RCTPANO CT SCAN PANORAMIK (CBCT)
732 RCTPAR CT SCAN PARANASAL SINUS
733 RCTPAR3D CT SCAN PARANASAL SINUS 3D
734 RCTPEL3D CT SCAN PELVIS 3D
735 RCTPELV CT SCAN PELVIS
736 RCTSEL CT SCAN SELLA TURSICA
737 RCTSEL3D CT SCAN SELLA TURSICA 3D
738 RCTSHD CT SCAN SHOULDER JOINT
739 RCTSHD3D CT SCAN SHOULDER JOINT 3D
740 RCTTEM CT SCAN TEMPORAL BONE
741 RCTTEM3D CT SCAN TEMPORAL BONE 3D
742 RCTTHO CT SCAN THORACIC SPINE
743 RCTTHO3D CT SCAN THORACAL SPINE 3D
744 RCTULO CT SCAN UPPER + LOWER ABDOMEN
745 RCTULO3D CT SCAN UPPER + LOWER ABDOMEN 3D
746 RCTUPP CT SCAN UPPER ABDOMEN
747 RCTUPP3D CT SCAN UPPER ABDOMEN 3D
748 RCTWJN CT SCAN WRIST JOINT
749 RCTWJN3D CT SCAN WRIST JOINT 3D
750 RMAAOR MRA AORTA WITH CONTRAST
751 RMAARV MRA + MRV LOWER EXTREMITAS
752 RMABRA MRA BRAIN
753 RMABRAC MRA BRAIN WITH CONTRAST
754 RMABRAMS MRI + MRA/MRV BRAIN + SPECTROSCOPY
755 RMANEC MRA NECK
756 RMAPEL MRA PELVIS
757 RMAREN MRA RENAL
758 RMASUB MRA SUBCLAUIAN
759 RMCBRACS MRI BRAIN + IV CONTRAST + SPECTROSCOPY
760 RMCBRE MRI BREAST + IV CONTRAST
761 RMCCERC MRI CERVICAL SPINE + IV CONTRAST
762 RMCEXAM MRI ADDITIONAL EXAMINATION WITH CONTRAST
763 RMCLUMC MRI LUMBAR SPINE + IV CONTRAST
764 RMCTHSC MRI THORARIC SPINE + IV CONTRAST
765 RMCUABC MRI UPPER ABDOMEN + IV CONTRAST
766 RMMMUS MAMMOGRAPHY + USG BREAST
767 RMRANK MRI ANKLE JOINT
768 RMRBRA MRI BRAIN
769 RMRBRAM MRI BRAIN + MRA/MRV
770 RMRCER MRI CERVICAL SPINE
771 RMRCERMY MRI CERVICAL SPINE + MYELO
772 RMRCUB MRI CUBITI
773 RMREXT MRI EXTREMITIES LONG BONE
774 RMRGEN MRI GENU
775 RMRHIP MRI HIP JOINT
776 RMRLAB MRI LOWER ABDOMEN
777 RMRLMY MRI LUMBAL + MYELOGRAPHY
778 RMRLUM MRI LUMBAR SPINE
779 RMRMNS MRI MANUS
780 RMRMRCP MRI MRCP
781 RMRNAS MRI NASOPHARYNX
782 RMRNEC MRI NECK
783 RMRORB MRI ORBITA
784 RMRPAR MRI PARANASAL SINUS
785 RMRRU MRU / UROLOGI
786 RMRSEL MRI SELLA TURSICA
787 RMRSHD MRI SHOULDER JOINT
788 RMRSP MRI SPINE + SAGITAL VIEW
789 RMRSPEC MRI SPECTROSCOPY
790 RMRTEM MRI TEMPORAL BONE
791 RMRTHO MRI THORAX
792 RMRTHS MRI THORARIC SPINE
793 RMRTMJ MRI TEMPORO MANDIBULAR JOINT
794 RMRUAB MRI UPPER ABDOMEN
795 RMRULA MRI UPPER LOWER ABDOMEN
796 RMRWJN MRI WRIST JOINT
797 ROMBCCT KONSUL BACA FOTO CT-SCAN
798 ROMBCMR KONSUL BACA FOTO MRI
799 ROMBCUS KONSUL BACA FOTO USG
800 ROMBCXR KONSUL BACA FOTO X-RAY
801 ROMCD CETAK CD
802 ROMCONION CONTRAST NON IONIC WATER SOLUBLE
803 ROMENG REPORT IN ENGLISH
804 ROMFFB CHARGE X-RAY FILM
805 ROMFUS CETAK FILM USG (1 LEMBAR)
806 ROMRAD PRINT ULANG HASIL RADIOLOGI
807 RUSAPP USG APPENDIX
808 RUSBRS USG BREAST
809 RUSDOP USG DOPLER
810 RUSG-URO USG UROLOGY ITEM
811 RUSKID USG KIDNEY + BLADDER
812 RUSPEL USG PELVIS (LOWER ABDOMEN)
813 RUSSUP USG SUPERFICIAL
814 RUSTES USG TESTIS
815 RUSTHY USG THYROID
816 RUSULO USG UPPER & LOWER ABDOMEN
817 RUSVPP USG UPPER ABDOMEN (LIVER,GB,PANCREAS,KID
818 RXCAFOL X-RAY BA FOLLOW THROUGH
819 RXCAPP X-RAY APPENDIX
820 RXCB2V X-RAY BNO + IVP
821 RXCCOLO X-RAY COLON
822 RXCCYS X-RAY CYSTOGRAPHY (BLASS CONTRAST)
823 RXCESOF X-RAY ESOFAGOGRAM
824 RXCFIS X-RAY FISTULOGRAPHY
825 RXCGAL X-RAY GALACTOGRAPHY
826 RXCHYS X-RAY HYSTEROSALPINGOGRAPH (HSG)
827 RXCLOPO X-RAY LOPOGRAFI
828 RXCOMD X-RAY OMD
829 RXCONION X-RAY CONTRAST NON IONIC WATER SOLBLE
830 RXCRPG X-RAY RETROGRADE PYELOGRAPHY
831 RXCSOX X-RAY BA ESHOPHAGUS
832 RXCTUBE X-RAY T-TUBE CHOLANGIOGRAPHY
833 RXCURC X-RAY URETHROCYSTOGRAPHY
834 RXR3POS X-RAY ABDOMEN 3 POSISI
835 RXRABD X-RAY ANTEBRACHII DEXTRA
836 RXRABDPX X-RAY ANTEBRACHII DEXTRA MOBILE
837 RXRABS X-RAY ANTEBRACHII SINISTRA
838 RXRABSPX X-RAY ANTEBRACHII SINISTRA MOBILE
839 RXRAKD X-RAY ANKLE JOINT DEXTRA
840 RXRAKDPX X-RAY ANKLE JOINT DEXTRA MOBILE
841 RXRAKS X-RAY ANKLE JOINT SINISTRA
842 RXRAKSPX X-RAY ANKLE JOINT SINISTRA MOBILE
843 RXRATR X-RAY ATRISIANI (KNEE CHEST)
844 RXRATRPX X-RAY ATRISIANI (KNEE CHEST) MOBILE
845 RXRBABY X-RAY BABYGRAM FOTO
846 RXRBABYPX X-RAY BABYGRAM FOTO MOBILE
847 RXRBAGE X-RAY BONE AGE
848 RXRBNO X-RAY BNO
849 RXRBNOPX X-RAY BNO MOBILE
850 RXRCAD X-RAY CALCANEUS DEXTRA
851 RXRCAS X-RAY CALCANEUS SINISTRA
852 RXRCER X-RAY CERVICAL (AP+LATERAL)
853 RXRCERPX X-RAY CERVICAL (AP+LATERAL) MOBILE
854 RXRCLA X-RAY CLAVICULA
855 RXRCLAPX X-RAY CLAVICULA MOBILE
856 RXRCOB X-RAY CERVICAL (AP+LAT+OBLIQUE)
857 RXRCOBPX X-RAY CERVICAL (AP+LAT+OBLIQUE) MOBILE
858 RXRCRD X-RAY CRURIS DEXTRA
859 RXRCRDPX X-RAY CRURIS DEXTRA MOBILE
860 RXRCRS X-RAY CRURIS SINISTRA
861 RXRCRSPX X-RAY CRURIS SINISTRA (AP+LATERAL) MOBILE
862 RXRCUD X-RAY CUBITI DEXTRA
863 RXRCUDPX X-RAY CUBITI DEXTRA MOBILE
864 RXRCUS X-RAY CUBITI SINISTRA
865 RXRCUSPX X-RAY CUBITI SINISTRA MOBILE
866 RXRFED X-RAY FEMUR DEXTRA
867 RXRFEDPX X-RAY FEMUR DEXTRA MOBILE
868 RXRFES X-RAY FEMUR SINISTRA
869 RXRFESPX X-RAY FEMUR SINISTRA MOBILE
870 RXRGND X-RAY GENU DEXTRA
871 RXRGNDPX X-RAY GENU DEXTRA MOBILE
872 RXRGNS X-RAY GENU SINISTRA
873 RXRGNSPX X-RAY GENU SINISTRA MOBILE
874 RXRGSD X-RAY GENU DEXTRA + SKY LINE
875 RXRGSS X-RAY GENU SINISTRA + SKY LINE
876 RXRHUD X-RAY HUMERUS DEXTRA
877 RXRHUDPX X-RAY HUMERUS DEXTRA MOBILE
878 RXRHUS X-RAY HUMERUS SINISTRA
879 RXRHUSPX X-RAY HUMERUS SINISTRA MOBILE
880 RXRLOB X-RAY LUMBOSACRAL (AP+LAT+OBLIQUE)
881 RXRLOBPX X-RAY LUMBOSACRAL (AP+LATERAL+OBLIQUE) MOBILE
882 RXRLUM X-RAY LUMBOSACRAL (AP+LATERAL)
883 RXRLUMPX X-RAY LUMBOSACRAL (AP+LATERAL) MOBILE
884 RXRMAD X-RAY MASTOID DEXTRA
885 RXRMAN X-RAY MANDIBULA
886 RXRMANPX X-RAY MANDIBULA MOBILE
887 RXRMAS X-RAY MASTOID SINISTRA
888 RXRMND X-RAY MANUS DEXTRA
889 RXRMNDPX X-RAY MANUS DEXTRA MOBILE
890 RXRMNS X-RAY MANUS SINISTRA
891 RXRMNSPX X-RAY MANUS SINISTRA MOBILE
892 RXRNSL X-RAY OS. NASAL
893 RXRPAB X-RAY POLOS ABDOMEN
894 RXRPABPX X-RAY POLOS ABDOMEN MOBILE
895 RXRPDD X-RAY PEDIS DEXTRA
896 RXRPDDPX X-RAY PEDIS DEXTRA MOBILE
897 RXRPDS X-RAY PEDIS SINISTRA
898 RXRPDSPX X-RAY PEDIS SINISTRA MOBILE
899 RXRPEL X-RAY PELVIS
900 RXRPELPX X-RAY PELVIS MOBILE
901 RXRSCH X-RAY SKULL (SCHEDEL)
902 RXRSCHPX X-RAY SKULL (SCHEDEL) MOBILE
903 RXRSCOL X-RAY SCOLIOSIS PROGRAM
904 RXRSHD X-RAY SHOULDER JOINT
905 RXRSHYV X-RAY SHOULDER JOINT + Y VIEW
906 RXRSIN X-RAY SINUS SERIES (WATERS+LATERAL)
907 RXRSINPX X-RAY SINUS SERIES (WATERS+LATERAL) MOBILE
908 RXRTAP X-RAY THORACIC SPINE
909 RXRTAPPX X-RAY THORACAL (AP+LATERAL) MOBILE
910 RXRTLA X-RAY THORAX (PA + LAT)
911 RXRTLAPX X-RAY THORAX (PA+LATERAL) MOBILE
912 RXRTMJ X-RAY TEMPORO MANDIBULAR JOINT
913 RXRTPA X-RAY THORAX
914 RXRTPAB X-RAY THORAX PHOTO BESAR
915 RXRTPAPX X-RAY THORAX (PA) MOBILE
916 RXRWRD X-RAY WRIST JOINT DEXTRA
917 RXRWRDPX X-RAY WRIST DEXTRA MOBILE
918 RXRWRS X-RAY WRIST JOINT SINISTRA
919 RXRWRSPX X-RAY WRIST SINISTRA MOBILE
920 RXPHLEB X-RAY PHLEBOGRAPHY
921 RCTLUNG CT SCAN LUNG LOW DOSE
922 RMBRAC MRI BRAIN + IV CONTRAST
923 ROMNUCL NUCLEAR GAMMA CAMERA
924 ROMRADIOI RADIOTERAPI I (15X)
925 ROMRADIOII RADIOTERAPI II (30X)
926 ROMSIM SIMULATOR (PERSIAPAN RADIOTERAPI)
927 ROMOTH RADIOLOGI LAINNYA

TARIF PROSEDUR PERAWAT

928 NAFFCATH AFF CATHETER
929 NAFFHECT AFF HECTING NURSING
930 NAFFNGT AFF NGT
931 NAPRON1 PENGURUSAN APRON (ANTAR)
932 NAPRON2 PENGURUSAN APRON (JEMPUT)
933 NBLADWASH BLADDER WASHOUT (IRIGASI BLADDER)
934 NBLTRAN BLOOD TRANSFUSION
935 NCATH CATHETERIZATION
936 NCBLUE CODE BLUE
937 NCDRECORDING CD RECORDING PROCDR FOR PTCA
938 NCENVEN PROSEDUR CENTRAL VENOUS LINE
939 NCHEM<10 CHEMOTHERAPHY PROCEDURE > 5 HOURS
940 NCHEM<5 CHEMOTHERAPHY PROCEDURE 1-5 HOUR
941 NCHEPORT PROSEDUR CHEMOPORT
942 NCITY PRIVATE NURSE FEE (DALAM KOTA)
943 NDAYVERB GANTI VERBAND - PERAWAT
944 NECG ECG NURSING
945 NECP ECP NURSING
946 NEEG EEG NURSING
947 NENDINTU NURSING ENOTRACHEAL INTUBATATION
948 NFLI PRIVATE DUTY NURSING (PERJALANAN DENGAN PESAWAT)
949 NFLIPLUS PRIVATE DUTY NURSE LUAR KOTA (PER ADDTIONAL DAY)
950 NHAIR CUCI RAMBUT
951 NINJEC INJECTION MEDICATION
952 NIVCAN I.V. CANNULATION - PERAWAT
953 NLEPGIS PROSEDUR BUKA GIPS
954 NMEDROP EYE DROP PROCEDURE
955 NNASOINS NASO-GASTRIC TUBE INSERTION
956 NNEBUL NEBULIZER NURSING PROCEDURE
957 NORESUSC NURSE RESUSCITATION
958 NOTH KEPERAWATAN LAINNYA
959 NOTVERB GANTI VERBAND OR
960 NOXYTHE OXYGEN THERAPY
961 NPASGIPS PROSEDUR PASANG GIPS
962 NPNGT PROSEDUR PASANG NGT
963 NRECTWASH RECTAL/COLONIC WASHOUT
964 NROOM1 PRIVATE NURSE FEE DI ROOM (SHIFT I)
965 NROOM2 PRIVATE NURSE FEE DI ROOM (SHIFT II)
966 NROOM3 PRIVATE NURSE FEE DI ROOM (SHIFT III)
967 NSPIRO NURSING PROCEDURE SPIROMETRI
968 NSTOMWASH STOMACH WASHOUT/KUMBAH LAMBUNG
969 NSUCTION SUCTIONING CONTINUOUS
970 NSUCTION1 SUCTIONING IN ANE
971 NSURSTEP HEMOGLUCOTEST
972 NTREADMILL PROSEDUR PERAWAT TREADMILL
973 NWOUND WOUND CARE - PERAWAT
974 NVITAL NURSING CARE GENERAL
975 NVITAL-ANG FONDS NURSING ANGIO
976 NVITALANGCIT NVITAL NURSING ANGIO CITO
977 NVITAL-BABY NURSING CARE BABY
978 NVITAL-ICU NURSING CARE HDU/ICU/SBW/NICU
979 NVITAL-OT FONDS OT - INPATIENT
980 NVITALOTIP NVITAL OPERATING ROOM IP PRIVATE
981 NVITALOTOP NVITAL OPERATING ROOM OP PRIVATE
982 NVITAL-OTOUT FONDS OT - OUTPATIENT
983 NVITALISO NURSING CARE ISOLATION ROOM
984 NVITALISOICU NURSING CARE ISOLATION ICU ROOM
985 NVITALDAYCARE NURSING CARE DAYCARE

TARIF PERALATAN MEDIK

986 EQAQUATERM AQUATERM III EXTERNAL
987 EQARTHROSCOPY ARTHROSCOPY DIAGNOSTIC
988 EQAUDIO EHS-AUDIOMETRI
989 EQAUTOREF AUTOREFRAKSI EYE EQP
990 EQBASIC BASIC EMERGENCY KIT (PORT RESUSCITATOR)
991 EQBIOMET BIOMETRI EYE CHECK
992 EQBIOPROST INSTRUMENT BIOPSY
993 EQBLWARM BLOOD WARMER
994 EQBRONCHOS PERALATAN MEDIK BRONCHOSCOPY
995 EQCABGEQP CABG EQUIPMENT USE
996 EQCATHLAB-ANG CATH LAB-ANGIO EQUIPMENT USE
997 EQCPAP-DAY NCPAP EQUIPMENT USE
998 EQCTG CTG MONITORING - 1 HOUR
999 EQCTGOUTP CTG OUTPATIENT
1000 EQDECUBIBED TRIPLE BED/DECUBITUS BED
1001 EQDEFIBR DEFIBRILATOR
1002 EQDIATHERMY DIATHERMY - MONO/BI POLAR (W CABLE ONLY)
1003 EQDIAVALLAB DIATHERMY MACHINE VALLEYLAB
1004 EQDOPPL DOPPLER
1005 EQDRILL DRILL OTRHO
1006 EQECG12 12-LEAD ECG
1007 EQECGMON ECG/CARDIAC MONITORING (CONTINOUS)
1008 EQECHOCARD ECHO CARDIOGRAPHY (DIAGNOSTIC ULTRASOUND)
1009 EQEEGMON EEG-ELECTRO ENCEPHALO GRAPH
1010 EQEMERESCBOX EMERGENCY&RESCUE BOX
1011 EQENDOS EQP ENDOSCOPY
1012 EQENTCO2 ENDTIDAL CO2 (MONITORING)
1013 EQFORCDEL FORCEPS DELIVER
1014 EQGOMPUMP GOMCO PUMP
1015 EQHAEMO HAEMOTERM EQUIPMENT
1016 EQHARGENSYS HARMONIC GENERATOR SYSTEM
1017 EQHEADLI HEAD LIGHT
1018 EQHEAR EQUIPMENT HEARING IMPLANT CENTER (HOSPITAL)
1019 EQKHEAR1 EQP HEARING IMPLANT CENTER (MEDEL)
1020 EQKHEARH EQP HEARING IMPLANT CENTER (HOSPITAL)
1021 EQKMETLASER LASER METABOLIC SET (INTRA VENA, MULTI CHANNEL & OXYPEN)
1022 EQINFTRESU INFANT BLENDING / T- PIECE RESUSITATOR (FA:10H/5F/5493)
1023 EQINFUSPUMP INFUSION PUMP
1024 EQINSEMINATOR INSEMINATOR
1025 EQKECP EQP ECP (EXTERNAL COUNTER PULSATION) PT. SIMAK
1026 EQLASBIO LASER BIOLITEC LEONARDO DUAL 45
1027 EQMICENT MICROSCOPE ENT
1028 EQMICEYE MICROSCOPE EYE
1029 EQMICOPMI MICROSCOPE OPMI VARIO 700 ZEISS
1030 EQNEBULI NEBULIZER
1031 EQO2SAT SATURASI OXYGEN
1032 EQOTH PERALATAN RS LAINNYA
1033 EQOXYCHK OXYMETRI CHECK
1034 EQPACE PACE MAKER MACHINE
1035 EQPACER PACER (EXTERNAL)
1036 EQPBDRILL PNEUMATIC BONE DRILL
1037 EQPCNLSET PERCUTANEOUS NEPHROLITHOTOMY (PCNL) SET
1038 EQPHACO PHACO MACHINE
1039 EQPHOTO1 PHOTOTHERAPY SINGLE LIGHT
1040 EQPHOTO2 PHOTOTHERAPY-DOUBLE LIGHT
1041 EQPORTINC PORTABLE INCUBATOR
1042 EQSACHE SACHE (UROLOGY)
1043 EQSCOPE SCOPE LAPARASCOPY
1044 EQSETBASIC SET BASIC INSTRUMENT
1045 EQSETHYSTERE HYSTEROSCOPY SET 10K FLUID SYSTEM
1046 EQSETLAPARA LAPARASCOPIC SET
1047 EQSETLAPARMIS MIS LAPARASCOPY SET
1048 EQSETMAJOR SET MAJOR INSTRUMENT
1049 EQSETMINI SET MINI INSTRUMENT
1050 EQSISTOCOPY SISTOCOPY(UROLOGY)
1051 EQSPIRO SPIROMETRY
1052 EQSYRIPUMP SYRINGE PUMP
1053 EQTHERBLAN THERMAL BLANKET
1054 EQTONOME TONOMETER EYE EQP
1055 EQTOURNIQUET TOURNIQUET MACHINE
1056 EQTRDMILL TREADMILL
1057 EQTURP TUR (UROLOGY)
1058 EQURFLOW UROFLOWMETRY PORTABLE
1059 EQURS URS EQUIPMENT
1060 EQURSLASER URS LASER EQUIPMENT
1061 EQUSG4DGY USG 4D COLOR - GYNECOLOGY
1062 EQUSG4DGY1 USG 4 D COLOUR
1063 EQUSGBW-G USG B/W - GYNECOLOGY - EQUSGBW-G
1064 EQUSGBWGY USG B/W - GYNECOLOGY
1065 EQUSGBWGY1 USG BLACK / WHITE - GYNECOLOGY
1066 EQUSGEYE USG EYE
1067 EQUSGOTH BIAYA USG
1068 EQUSGTVBW USG TRANSVAGINAL BW - EQUSGTVBW
1069 EQUSGTVGBW USG TRANSVAGINAL BW
1070 EQUSGTVGC USG TRANSVAGINAL COLOR
1071 EQUSGURO ULTRASONOGRAPHY / USG UROLOGY TP
1072 EQUSGURO1 ULTRASONOGRAPHY / USG UROLOGY P
1073 EQUSG4D BIAYA USG 4D
1074 EQVACEXT VACCUM EXTRACTION
1075 EQVACUUM VACCUM MACHINE FOR TOP
1076 EQVENDAY VENTILATOR - 1 DAY
1077 EQHFNC HIGH FLOW NASAL CANNULA
1078 EQBIA BIO-ELECTRICAL IMPEDANCE ANALYSIS (BIA) - BODY MASS ANALYSIS

TARIF PERALATAN DOKTER

1079 EQDCBIOE PERALATAN DOKTER - THERAPY BIO E
1080 EQDCECG003 ECG DR. MASRUL LUBIS
1081 EQDCEYE004 LASER YAG CAPSULOTOMY UNILATERAL
1082 EQDCEYE005 LASER YAG CAPSULOTOMY BILATERAL ( 2 EYES)
1083 EQDCGLUC001 GLUCOTEST
1084 EQDCHOLTER001 HOLTER MONITORING PROCEDURE
1085 EQDCLASE001 LASER DR. M FAUZI NASUTION
1086 EQDCNASO001 NASO ENDOSCOPY THT
1087 EQDCSLIM001 SLIMMING MASTER DR. M FAUZI NASUTION
1088 EQDCSPIR002 SPIROMETRI PROF TAMSIL
1089 EQDCTHT001 ELECTRIC SUCTION TELINGA THT
1090 EQDCTHT002 EXTRACTIE CRUSTA THT
1091 EQDCTHT003 KAUSTIC STOMATITIS + BIOPSI THT
1092 EQDCTHT004 TEST ALERGI
1093 EQDCUSG005 USD 2D DR. M FAUZI NASUTION
1094 EQDCUSG006 USD 3D DR. M FAUZI NASUTION
1095 EQDCUSG007 USD 4D DR. M FAUZI NASUTION
1096 EQDCUSGSP DIAGNOSTIC ULTRASOUND SUPERFICIAL
1097 EQDCVASC001 VASCULAR ENDOSCOPY DR. M FAUZI NASUTION
1098 EQDMICLAR MICROLARINGOSCOPY PROF ABDUL RACHMAN

TARIF BIAYA ANESTESI

1099 SA0066A PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) - SA
1100 SA0066B PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) (1 VESSEL) - SA

1101 SA0066C PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) (2 VESSELS) - SA

1102 SA0066D PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) (>2 VESSELS) - SA

1103 SA0066E PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) (DES/BMS 1

STENT) - SA
1104 SA0066F PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) (DES/BMS 2
STENT) - SA
1105 SA0066G PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) (DES/BMS >2
STENT) - SA
1106 SA0066H PERCUTANEOUS TRANSLUMINAL COR ANGIOGRAPHY (F) - SA
1107 SA0070 REVISION OF HIP REPLACEMENT, BOTH ACETABULAR AND FEMORAL COMPONENTS -
SA
1108 SA0102 VENTRICULOPUNCTURE THROUGH PREVIOUSLY IMPLANTED CATHETER - SA
1109 SA0109 OTHER CRANIAL PUNCTURE - SA
1110 SA0113A CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF BRAIN (STEREOTIC) - SA
1111 SA0113B CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF BRAIN (DIAGNOSTIC) - SA
1112 SA0113C CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF BRAIN (EXPLORATORY BURRHOLE) -
SA
1113 SA0114 OPEN BIOPSY OF BRAIN - SA
1114 SA0121 INCISION AND DRAINAGE OF CRANIAL SINUS - SA
1115 SA0122A REMOVAL OF INTRACRANIAL NEUROSTIMULATOR LEAD(S) (BRAIN) - SA
1116 SA0122B REMOVAL OF INTRACRANIAL NEUROSTIMULATOR LEAD(S) (CARNIAL NERVE) - SA

1117 SA0124A OTHER CRANIOTOMY (EXPLORATORY OPEN CRANIOTOMY) - SA

1118 SA0124B OTHER CRANIOTOMY (EVACUATION OF EXTRADURAL HAEMATOMA) - SA
1119 SA0124C OTHER CRANIOTOMY (DECOMPRESSION OF CRANIAL NERVE (CRANIOTOMY)) - SA

1120 SA0124D OTHER CRANIOTOMY (CRANIOTOMY-POSTOPERATIVE HAEMORRHAGE) - SA

1121 SA0124E OTHER CRANIOTOMY (BURRHOLE FOR INTRACRANIAL INFECTION) - SA
1122 SA0131 INCISION OF CEREBRAL MENINGES - SA
1123 SA0151 EXCISION OF LESION OR TISSUE OF CEREBRAL MENINGES - SA
1124 SA0152 HEMISPHERECTOMY - SA
1125 SA0159A OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BRAIN - SA
1126 SA0159B OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BRAIN (ABCESS) - SA

1127 SA0159C OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BRAIN

(CEREBELLOPONTINE ANGLE TUMOUR) - SA
1128 SA0159D OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BRAIN (THERAPEUTIC
ENDOSCOPIC OP ON VENTRICLE OF BRAIN) - SA
1129 SA016 EXCISION OF LESION OF SKULL - SA
1130 SA0201 OPENING OF CRANIAL SUTURE - SA
1131 SA0202A ELEVATION OF SKULL FRACTURE FRAGMENTS (FORAMEN MAGNUM DECOMPRESSION)
- SA
1132 SA0202B ELEVATION OF SKULL FRACTURE FRAGMENTS - SA
1133 SA0206A OTHER CRANIAL OSTEOPLASTY (PLASTIC REPAIR CRANIUM) - SA
1134 SA0206B OTHER CRANIAL OSTEOPLASTY (REPAIR OF SKULL) - SA
1135 SA0206C OTHER CRANIAL OSTEOPLASTY (RECONSTRUCTIVE CRANIOPLASTY) - SA
1136 SA0212 OTHER REPAIR OF CEREBRAL MENINGES - SA
1137 SA0212A OTHER REPAIR OF CEREBRAL MENINGES (REPAIR OF DURA) - SA
1138 SA022A VENTRICULOSTOMY (CREATION OF VENTRICULOVASCULAR ANASTOMOSIS) - SA

1139 SA022B VENTRICULOSTOMY (VENTRICULOCISTERNAL INTUBATION) - SA

1140 SA0234 VENTRICULAR SHUNT TO ABDOMINAL CAVITY AND ORGANS - SA
1141 SA0241 IRRIGATION AND EXPLORATION OF VENTRICULAR SHUNT - SA
1142 SA0242 REPLACEMENT OF VENTRICULAR SHUNT (REVISION OF VENTRICULOPERITONEAL
SHUNT AT VENTRICULAR SITE) - SA
1143 SA0243 REMOVAL OF VENTRICULAR SHUNT - SA
1144 SA0293 IMPLANTATION OR REPLACEMENT OF INTRACRANIAL NEUROSTIMULATOR LEAD(S) -
SA
1145 SA0309 OTHER EXPLORATION AND DECOMPRESSION OF SPINAL CANAL - SA
1146 SA031 DIVISION OF INTRASPINAL NERVE ROOT - SA
1147 SA0331 SPINAL TAP - SA
1148 SA0339 OTHER DIAGNOSTIC PROCEDURES ON SPINAL CORD AND SPINAL CANAL
STRUCTURES - SA
1149 SA034 EXCISION OR DESTRUCTION OF LESION OF SPINAL CORD OR SPINAL MENINGES - SA

1150 SA0352 REPAIR OF SPINAL MYELOMENINGOCELE - SA

1151 SA0390 INSERTION OF CATHETER INTO SPINAL CANAL FOR INFUSION OF THERAPEUTIC OR
PALLIATIVE SUBSTANCES - SA
1152 SA0391A INJECTION OF ANESTHETIC INTO SPINAL CANAL FOR ANALGESIA
(CERVICAL/THORACIC) - SA
1153 SA0391B INJECTION OF ANESTHETIC INTO SPINAL CANAL FOR ANALGESIA (LUMBAL) - SA
1154 SA0396 PERCUTANEOUS DENERVATION OF FACET - SA
1155 SA0401 EXCISION OF ACOUSTIC NEUROMA - SA
1156 SA0404 BILATERAL POSTERIOR NASAL NEURECTOMY - SA
1157 SA0407A OTHER EXCISION OR AVULSION OF CRANIAL AND PERIPHERAL NERVE
(INTRACRANIAL TRANSECTION OF CRANIAL NERVE) - SA
1158 SA0407B OTHER EXCISION OR AVULSION OF CRANIAL AND PERIPHERAL NERVE (INCLUDE
EXCISION OF LESION ON CRANIAL NERVE) - SA
1159 SA0407C OTHER EXCISION OR AVULSION OF CRANIAL AND PERIPHERAL NERVES (MAJOR
NERVE) - SA
1160 SA0407D OTHER EXCISION OR AVULSION OF CRANIAL AND PERIPHERAL NERVES (EXCISION
OF LESION) - SA
1161 SA0407E OTHER EXCISION OR AVULSION OF CRANIAL AND PERIPHERAL NERVES
(TRANSECTION/EXCISION) - SA
1162 SA0411 CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF CRANIAL OR PERIPHERAL NERVE OR
GANGLION - SA
1163 SA0419A OTHER DIAGNOSTIC PROCEDURES ON CRANIAL AND PERIPHERAL NERVES AND
GANGLIA-EXPLORATION OF NERVE - SA
1164 SA042 DESTRUCTION OF CRANIAL AND PERIPHERAL NERVES - SA
1165 SA042A DESTRUCTION OF CRANIAL AND PERIPHERAL NERVES (INJ) - SA
1166 SA042B DESTRUCTION OF CRANIAL AND PERIPHERAL NERVES (RF) - SA
1167 SA043 SUTURE OF CRANIAL AND PERIPHERAL NERVES - SA
1168 SA0443A RELEASE OF CARPAL TUNNEL SYNDROME (ENDOSCOPIC) - SA
1169 SA0443B RELEASE OF CARPAL TUNNEL SYNDROME (ENDOSCOPIC BILATERAL) - SA
1170 SA0444 RELEASE OF TARSAL TUNNEL - SA
1171 SA0449 OTHER PERIPHERAL NERVE OR GANGLION DECOMPRESSION OR LYSIS OF
ADHESIONS - SA
1172 SA0449A OTHER PERIPHERAL NERVE OR GANGLION DECOMPRESSION OR LYSIS OF
ADHESIONS-DEEP - SA
1173 SA045 CRANIAL OR PERIPHERAL NERVE GRAFT - SA
1174 SA045A CRANIAL OR PERIPHERAL NERVE GRAFT (PRIMARY & 2ND) - SA
1175 SA045B CRANIAL OR PERIPHERAL NERVE GRAFT-COMPLEX - SA
1176 SA046A TRANSPOSITION OF CRANIAL AND PERIPHERAL NERVES (NEUROLYSIS) - SA
1177 SA046B TRANSPOSITION OF CRANIAL AND PERIPHERAL NERVES (SUBMUSCULAR) - SA
1178 SA0475A REVISION OF PREVIOUS REPAIR OF CRANIAL AND PERIPHERAL NERVES
(MICROSURGERY) - SA
1179 SA0475B REVISION OF PREVIOUS REPAIR OF CRANIAL AND PERIPHERAL NERVES (NON
MICROSURGERY) - SA
1180 SA0475C REVISION OF PREVIOUS REPAIR OF CRANIAL AND PERIPHERAL NERVES (RELEASE
PERIPHERAL NERVES) - SA
1181 SA0475D REVISION OF PREVIOUS REPAIR OF CRANIAL AND PERIPHERAL NERVES (2ND REPAIR
NERVE TRUNK) - SA
1182 SA0479A OTHER NEUROPLASTY REPAIR OF CRANIAL NERVE (INTRACRANIAL) - SA
1183 SA0479B OTHER NEUROPLASTY PRIMARY REPAIR PERIPHERAL NERVE W MICROSURGERY - SA

1184 SA0479C OTHER NEUROPLASTY PRIMARY REPAIR PERIPHERAL NERVE - SA

1185 SA0479D OTHER NEUROPLASTY PRIMARY REPAIR NERVE TRUNK - SA
1186 SA0481 INJECTION OF ANESTHETIC INTO PERIPHERAL NERVE FOR ANALGESIA - SA
1187 SA0492 IMPLANTATION OR REPLACEMENT OF PERIPHERAL NEUROSTIMULATOR LEAD(S) - SA

1188 SA0523 LUMBAR SYMPATHECTOMY - SA

1189 SA0523A LUMBAR SYMPATHECTOMY (LAPAROSCOPIC) - SA
1190 SA0524 PRESACRAL SYMPATHECTOMY - SA
1191 SA052A THORASCOPIC SYMPATHECTOMY - SA
1192 SA052B THORACIC SYMPATHECTOMY : DIAG.(LA UNDER X-RAY CTRL) - SA
1193 SA052C THORACIC SYMPATHECTOMY : THERAPEUTIC (NEUROLYTIC UNDER X-RAY CTRL) - SA

1194 SA0532 INJECTION OF NEUROLYTIC AGENT INTO SYMPATHETIC NERVE - SA

1195 SA0609 OTHER INCISION OF THYROID FIELD - SA
1196 SA0611A CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF THYROID GLAND (FNAB) - SA
1197 SA0611B CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF THYROID GLAND (NEEDLE BIOPSY) -
SA
1198 SA062A UNILATERAL THYROID LOBECTOMY (HEMI-THYROIDECTOMY) - SA
1199 SA062B UNILATERAL THYROID LOBECTOMY (ISTHMULOBECTOMY WITH FROZEN SECTION
EXCISION) - SA
1200 SA0631 EXCISION OF LESION OF THYROID - SA
1201 SA0639 OTHER PARTIAL THYROIDECTOMY - SA
1202 SA064A COMPLETE THYROIDECTOMY (TOTAL) - SA
1203 SA064B COMPLETE THYROIDECTOMY (BILATERAL SUBTOTAL) - SA
1204 SA064C COMPLETE THYROIDECTOMY + BERRYPICKING (LIFADENECTOMY) - SA
1205 SA067A EXCISION OF THYROGLOSSAL DUCT OR TRACT (THYROGLOSSAL CYST) - SA
1206 SA067B EXCISION OF THYROGLOSSAL DUCT OR TRACT (THYROGLOSSAL TRACT) - SA
1207 SA067C EXCISION OF THYROGLOSSAL DUCT OR TRACT (THYROGLOSSAL CYST ONCOLOGY) -
SA
1208 SA0681 COMPLETE PARATHYROIDECTOMY - SA
1209 SA0689 OTHER PARATHYROIDECTOMY - SA
1210 SA0695 PARATHYROID TISSUE REIMPLANTATION - SA
1211 SA0698 OTHER OPERATIONS ON THYROID (REGION) AND PARATHYROID - THYROID
ABERRANT - SA
1212 SA0698A OTHER OPERATIONS ON THYROID (REGION) AND PARATHYROID - ENDOSCOPIC - SA

1213 SA0729 OTHER PARTIAL ADRENALECTOMY - SA

1214 SA073 BILATERAL ADRENALECTOMY - SA
1215 SA0753 PARTIAL EXCISION OF PINEAL GLAND - SA
1216 SA0754 TOTAL EXCISION OF PINEAL GLAND - SA
1217 SA0761 PARTIAL EXCISION OF PITUITARY GLAND, TRANSFRONTAL APPROACH - SA
1218 SA0769 TOTAL EXCISION OF PITUITARY GLAND, UNSPECIFIED APPROACH -
HYPOPHYSECTOMY NOS - SA
1219 SA0780 THYMECTOMY, NOT OTHERWISE SPECIFIED - SA
1220 SA0811 BIOPSY OF EYELID - SA
1221 SA0822A EXCISION OF OTHER MINOR LESION OF EYEBROW - SA
1222 SA0822B EXCISION OF OTHER MINOR LESION OF CANTHUS - SA
1223 SA0825 DESTRUCTION OF LESION OF EYELID - SA
1224 SA0836 REPAIR OF BLEPHAROPTOSIS BY OTHER TECHNIQUES - SA
1225 SA0849 OTHER REPAIR OF ENTROPION OR ECTROPION - SA
1226 SA0851 CANTHOTOMY - SA
1227 SA0852A BLEPHARORRHAPHY (TARSORRHAPHY) - SA
1228 SA0852B BLEPHARORRHAPHY (TARSOMULLERECTOMY) - SA
1229 SA0859 CANTHOPLASTY / REPAIR OF EPICANTHAL / TELECANTHAL FOLD - SA
1230 SA0861 RECONSTRUCTION OF EYELID WITH SKIN FLAP OR GRAFT - SA
1231 SA0869A OTHER RECONSTRUCTION OF EYELID WITH FLAPS OR GRAFTS (TOTAL) - SA
1232 SA0869B OTHER RECONSTRUCTION OF EYELID WITH FLAPS OR GRAFTS (BILATERAL) - SA
1233 SA0881A LINEAR REPAIR OF LACERATION OF EYELID OR EYEBROW (SUTURE OF EYEBROW) -
SA
1234 SA0881B LINEAR REPAIR OF LACERATION OF EYELID OR EYEBROW (SUTURE OF EYELID
(LACERATION)) - SA
1235 SA0893 OTHER EPILATION OF EYELID - SA
1236 SA090A INCISION OF LACRIMAL GLAND (EYELID LESSION) - SA
1237 SA090B INCISION OF LACRIMAL GLAND (CONJUNCTIVAL CYST) - SA
1238 SA0912 BIOPSY OF LACRIMAL SAC - SA
1239 SA0943 PROBING OF NASOLACRIMAL DUCT (UNDER GA) - SA
1240 SA0944 INTUBATION OF NASOLACRIMAL DUCT - SA
1241 SA0949 OTHER MANIPULATION OF LACRIMAL PASSAGE - THAT WITH DILATION - SA
1242 SA0953 INCISION OF LACRIMAL SAC - SA
1243 SA096 EXCISION OF LACRIMAL SAC AND PASSAGE - SA
1244 SA0973 REPAIR OF CANALICULUS - SA
1245 SA0982 CONJUNCTIVOCYSTORHINOSTOMY - SA
1246 SA0983 CONJUNCTIVORHINOSTOMY WITH INSERTION OF TUBE OR STENT - SA
1247 SA100 REMOVAL OF EMBEDDED FOREIGN BODY FROM CONJUNCTIVA BY INCISION - SA
1248 SA1021 BIOPSY OF CONJUNCTIVA - SA
1249 SA1031 EXCISION OF LESION OR TISSUE OF CONJUNCTIVA - SA
1250 SA1032 DESTRUCTION OF LESION OF CONJUNCTIVA - SA
1251 SA1033 OTHER DESTRUCTIVE PROCEDURES ON CONJUNCTIVA - SA
1252 SA1044 OTHER FREE GRAFT TO CONJUNCTIVA - SA
1253 SA105 LYSIS OF ADHESIONS OF CONJUNCTIVA AND EYELID - SA
1254 SA106A REPAIR OF LACERATION OF CONJUNCTIVA (SUTURE) - SA
1255 SA106B REPAIR OF LACERATION OF CONJUNCTIVA (REMOVAL OF SUTURE) - SA
1256 SA1091 SUBCONJUNCTIVAL INJECTION - SA
1257 SA110 MAGNETIC REMOVAL OF EMBEDDED FOREIGN BODY FROM CORNEA - SA
1258 SA111 INCISION OF CORNEA - SA
1259 SA1121 SCRAPING OF CORNEA FOR SMEAR OR CULTURE - SA
1260 SA1143 CRYOTHERAPY OF CORNEAL LESION - SA
1261 SA1149 OTHER REMOVAL OR DESTRUCTION OF CORNEAL LESION - EXCISION OF CORNEA
NOS - SA
1262 SA1149A OTHER REMOVAL OR DESTRUCTION OF CORNEAL LESION-CHELATION - SA
1263 SA1151 SUTURE OF CORNEAL LACERATION - SA
1264 SA1152 REPAIR OF POSTOPERATIVE WOUND DEHISCENCE OF CORNEA - SA
1265 SA1159 OTHER REPAIR OF CORNEA (REMOVAL OF CORNEAL SUTURE) - SA
1266 SA1161 LAMELLAR KERATOPLASTY WITH AUTOGRAFT - SA
1267 SA1163 PENETRATING KERATOPLASTY WITH AUTOGRAFT - SA
1268 SA1191 TATTOOING OF CORNEA - SA
1269 SA1200A REMOVAL OF INTRAOCULAR FOREIGN BODY FROM ANTERIOR SEGMENT OF EYE -
IRIS - SA
1270 SA1200B REMOVAL OF INTRAOCULAR FOREIGN BODY FROM ANTERIOR SEGMENT OF EYE -
ANTERIOR CHAMBER - SA
1271 SA1212 OTHER IRIDOTOMY - IRIDOCYCLECTOMY - SA
1272 SA1212A OTHER IRIDOTOMY (LASER IRIDOTOMY) - SA
1273 SA1213 EXCISION OF PROLAPSED IRIS - SA
1274 SA1214 OTHER IRIDECTOMY - SA
1275 SA1242 EXCISION OF LESION OF IRIS - SA
1276 SA1252 GONIOTOMY WITHOUT GONIOPUNCTURE - SA
1277 SA1253 GONIOTOMY WITH GONIOPUNCTURE - SA
1278 SA1254 TRABECULOTOMY AB EXTERNO - SA
1279 SA1255 CYCLODIALYSIS - SA
1280 SA1264A TRABECULECTOMY AB EXTERNO (SURGICAL TRABECULECTOMY) - SA
1281 SA1264B TRABECULECTOMY AB EXTERNO (LASER TRABECULOPLASTY) - SA
1282 SA1272 CYCLOCRYOTHERAPY - SA
1283 SA1281 SUTURE OF LACERATION OF SCLERA - SA
1284 SA1284 EXCISION OR DESTRUCTION OF LESION OF SCLERA - SA
1285 SA1287 SCLERAL REINFORCEMENT WITH GRAFT - SA
1286 SA1291 THERAPEUTIC EVACUATION OF ANTERIOR CHAMBER - SA
1287 SA1292 INJECTION INTO ANTERIOR CHAMBER (IRRIGATION) - SA
1288 SA1299 OTHER OPERATIONS ON ANTERIOR CHAMBER - SA
1289 SA1370 INSERTION OF PSEUDOPHAKOS, NOT OTHERWISE SPECIFIED - SA
1290 SA1371 INSERTION OF INTRAOCULAR LENS PROSTHESIS AT TIME OF CATARACT
EXTRACTION, ONE-STAGE - SA
1291 SA138 REMOVAL OF IMPLANTED LENS - SA
1292 SA1402 REMOVAL OF FOREIGN BODY FROM POSTERIOR SEGMENT OF EYE WITHOUT USE OF
MAGNET - SA
1293 SA1419 OTHER DIAGNOSTIC PROCEDURES ON RETINA, CHOROID, VITREOUS, AND
POSTERIOR CHAMBER - SA
1294 SA1422 DESTRUCTION OF CHORIORETINAL LESION BY CRYOTHERAPY - SA
1295 SA1425 DESTRUCTION OF CHORIORETINAL LESION BY PHOTOCOAGULATION OF
UNSPECIFIED TYPE - SA
1296 SA1426 DESTRUCTION OF CHORIORETINAL LESION BY RADIATION THERAPY - SA
1297 SA1429 OTHER DESTRUCTION OF CHORIORETINAL LESION - DESTRUCTION OF LESION OF
RETINA AND CHOROID NOS - SA
1298 SA1441 SCLERAL BUCKLING WITH IMPLANT - SA
1299 SA1471 REMOVAL OF VITREOUS, ANTERIOR APPROACH - SA
1300 SA1471A REMOVAL OF VITREOUS, ANTERIOR APPROACH (VITRECTOMY PARS PLANA
APPROACH W INSERTION OF INT.TAMPONADE) - SA
1301 SA1479 OTHER OPERATIONS ON VITREOUS - SA
1302 SA1521 LENGTHENING PROCEDURE ON ONE EXTRAOCULAR MUSCLE - SA
1303 SA154A OTHER OPERATIONS ON TWO OR MORE EXTRAOCULAR MUSCLES, ONE OR BOTH
EYES (SQUINT) - SA
1304 SA154B OTHER OPERATIONS ON TWO OR MORE EXTRAOCULAR MUSCLES, ONE OR BOTH
EYES (SQUINT W ADJUSTABLE SUTURES) - SA
1305 SA155 TRANSPOSITION OF EXTRAOCULAR MUSCLES - SA
1306 SA156A REVISION OF EXTRAOCULAR MUSCLE SURGERY (REVISION OF SQUINT) - SA
1307 SA156B REVISION OF EXTRAOCULAR MUSCLE SURGERY (REVISION OF SQUINT W
ADJUSTABLE SUTURES) - SA
1308 SA1609 OTHER ORBITOTOMY - SA
1309 SA1609A OTHER ORBITOTOMY (EXPLORATION/REMOVAL OF FOREIGN BODY) - SA
1310 SA1623 BIOPSY OF EYEBALL AND ORBIT - SA
1311 SA1649 OTHER ENUCLEATION OF EYEBALL - SA
1312 SA1652 EXENTERATION OF ORBIT WITH THERAPEUTIC REMOVAL OF ORBITAL BONE - SA
1313 SA1659 OTHER EXENTERATION OF ORBIT / EVISCERATION OF ORBIT NOS - SA
1314 SA1666 OTHER REVISION OF EXENTERATION CAVITY - SA
1315 SA1691 RETROBULBAR INJECTION OF THERAPEUTIC AGENT - SA
1316 SA1692 EXCISION OF LESION OF ORBIT - SA
1317 SA1713 LAPAROSCOPIC REPAIR OF INGUINAL HERNIA WITH GRAFT OR PROSTHESIS, NOT
OTHERWISE SPECIFIED - SA
1318 SA1736 LAPAROSCOPIC SIGMOIDECTOMY - SA
1319 SA1739 OTHER LAPAROSCOPIC PARTIAL EXCISION OF LARGE INTESTINE - SA
1320 SA1762A LASER ASSISTED UVULOPALATOPLASTY - SA
1321 SA1762C LASER ASSISTED HEMICORDECTOMY - SA
1322 SA1762D LASER ASSISTED ARYTENOIDECTOMY - SA
1323 SA1762E LASER ASSISTED VOCAL CORD SURGERY - SA
1324 SA182 EXCISION OR DESTRUCTION OF LESION OF EXTERNAL EAR - SA
1325 SA1821 EXCISION OF PREAURICULAR SINUS - SA
1326 SA1829A EXCISION OR DESTRUCTION OF OTHER LESION OF EXTERNAL EAR (GRANULASI) - SA

1327 SA1829B EXCISION OR DESTRUCTION OF OTHER LESION OF EXTERNAL EAR (REMOVAL OF

EXOSTOSES FROM EAC) - SA
1328 SA1839 AMPUTATION OF EXTERNAL EAR - SA
1329 SA184 SUTURE OF LACERATION OF EXTERNAL EAR - SA
1330 SA185 SURGICAL CORRECTION OF PROMINENT EAR - SA
1331 SA186 RECONSTRUCTION OF EXTERNAL AUDITORY CANAL - SA
1332 SA186A RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (GRAFT) - SA
1333 SA186B RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (EAR) SA
1334 SA186C RECONSTRUCTION OF EXTERNAL AUDITORY CANAL - MEATOPLASTY SA
1335 SA1919 OTHER STAPEDECTOMY - SA
1336 SA193 OTHER OPERATIONS ON OSSICULAR CHAIN - OSSICULOPLASTY WITH/WITHOUT
TYMPANOPLASTY - SA
1337 SA194 MYRINGOPLASTY (TYMPANOPLASTY) SA

1338 SA194A MYRINGOPLASTY SA

1339 SA200 MYRINGOTOMY - SA
1340 SA2001 MYRINGOTOMY WITH INSERTION OF TUBE - SA
1341 SA2031 ELECTROCOCHLEOGRAPHY - TRANS TYMPANIC - SA
1342 SA2032 BIOPSY OF MIDDLE AND INNER EAR - SA
1343 SA2041 SIMPLE MASTOIDECTOMY - SA
1344 SA2042 RADICAL MASTOIDECTOMY - SA
1345 SA2049A OTHER MASTOIDECTOMY - PETROSECTOMY - SA
1346 SA2049B OTHER MASTOIDECTOMY - MODIFIED RADICAL MASTOIDECTOMY - SA
1347 SA2049C OTHER MASTOIDECTOMY - PETROSECTOMY (COMPLEX) - SA
1348 SA2051A EXCISION OF LESION OF MIDDLE EAR - POLYPECTOMY - SA
1349 SA2051B EXCISION OF LESION OF MIDDLE EAR -TUMOUR - SA
1350 SA2079 INCISION OF ENDOLYMPHATIC SAC - OPERATION(S) ENDOLYMPHATIC SAC - SA
1351 SA2079A LABYRINTHECTOMY (TRANSTYMPANIC) - MEMBRANOUS - SA
1352 SA2079B LABYRINTHECTOMY (TRANSTYMPANIC) - OSSEUS - SA
1353 SA2092 REVISION OF MASTOIDECTOMY - SA
1354 SA2097 IMPLANTATION OR REPLACEMENT OF COCHLEAR PROSTHETIC DEVICE, SINGLE
CHANNEL - SA
1355 SA2098 IMPLANTATION OR REPLACEMENT OF COCHLEAR PROSTHETIC DEVICE, MULTIPLE
CHANNEL - SA
1356 SA2101 CONTROL OF EPISTAXIS BY ANTERIOR NASAL PACKING - SA
1357 SA2102 CONTROL OF EPISTAXIS BY POSTERIOR (AND ANTERIOR) PACKING - SA
1358 SA2103 CONTROL OF EPISTAXIS BY CAUTERIZATION (AND PACKING) - SA
1359 SA2104 CONTROL OF EPISTAXIS BY LIGATION OF ETHMOIDAL ARTERIES - SA
1360 SA211 INCISION OF NOSE - SA
1361 SA211A INCISION OF NOSE (LATERAL RHINOTOMY INTO SINUS FOR MALIGNANCY) - SA
1362 SA2122 BIOPSY OF NOSE - SA
1363 SA2123 BIOPSY OF LESION OF TURBINATE OF NOSE - SA
1364 SA2129 OTHER DIAGNOSTIC PROCEDURE ON NOSE - VOCAL CORD (SLEEP ENDOSCOPY)
1365 SA213 LOCAL EXCISION OR DESTRUCTION OF LESION OF NOSE - SA
1366 SA2130 EXCISION OR DESTRUCTION OF LESION OF NOSE, NOT OTHERWISE SPECIFIED - SA

1367 SA2131A LOCAL EXCISION OR DESTRUCTION OF INTRANASAL LESION - POLYPECTOMY - SA

1368 SA2132 LOCAL EXCISION OR DESTRUCTION OF OTHER LESION OF NOSE - SA

1369 SA2132B LOCAL EXCISION OR DESTRUCTION OF OTHER LESION OF NOSE (INTERNAL) - SA

1370 SA214 RESECTION OF NOSE - AMPUTATION OF NOSE - SA

1371 SA215 SUBMUCOUS RESECTION OF NASAL SEPTUM - SA
1372 SA216 TURBINECTOMY - SA
1373 SA2161A TURBINECTOMY BY DIATHERMY OR CRYOSURGERY (DIATHERMY) - SA
1374 SA2161B TURBINECTOMY BY DIATHERMY OR CRYOSURGERY (CAUTERISATION) - SA

1375 SA2169 OTHER TURBINECTOMY - SA

1376 SA2169A QUILTING SUTURE OF NASAL SEPTUM - SA
1377 SA2169B BILATERAL TURBINOPLASTY - SA
1378 SA2169C REMOVAL OF BILATERAL TURBINATE BONE - SA
1379 SA2172A OPEN REDUCTION OF NASAL FRACTURE - OPEN FRACTURE - SA
1380 SA2172B OPEN REDUCTION OF NASAL FRACTURE - CLOSED FRACTURE - SA
1381 SA2184 REVISION RHINOPLASTY - RHINOSEPTOPLASTY - SA
1382 SA2184A REVISION OF RHINOSEPTOPLASTY - SEPTOPLASTY OF NOSE - SA
1383 SA2187 OTHER RHINOPLASTY, NOS - SA
1384 SA2188 OTHER SEPTOPLASTY - SA
1385 SA219 OTHER OPERATION ON NOSE - INTRANASAL ANTROSTOMY INCL.ENDOSCOPIC - SA

1386 SA2191 LYSIS OF ADHESIONS OF NOSE - SA

1387 SA2201 PUNCTURE OF NASAL SINUS FOR ASPIRATION OR LAVAGE - SA
1388 SA2219A OTHER DIAGNOSTIC PROCEDURES ON NASAL SINUSES - MINI FESS - SA
1389 SA2219B OTHER DIAGNOSTIC PROCEDURES ON NASAL SINUSES - ADVANCED FESS - SA
1390 SA2219C OTHER DIAGNOSTIC PROCEDURES ON NASAL SINUSES - SA
1391 SA222 INTRANASAL ANTROTOMY - SA
1392 SA2239 OTHER EXTERNAL MAXILLARY ANTROTOMY - SA
1393 SA2241 FRONTAL SINUSOTOMY - SA
1394 SA2261 EXCISION OF LESION OF MAXILLARY SINUS WITH CALDWELL-LUC APPROACH - SA

1395 SA2263 EXT FRONTOETHMOIDECTOMY - SA

1396 SA2263A INTRANASAL ETHMOIDECTOMY - SA
1397 SA2263B EXT ETHMOIDECTOMY INCLUDING ENDOSCOPIC - SA
1398 SA2263C TRANSANTRAL ETHMOIDECTOMY - SA
1399 SA2263D RADICAL FRONTOETHMOIDECTOMY - SA
1400 SA2271 CLOSURE OF NASAL SINUS FISTULA - SA
1401 SA2279 OTHER REPAIR OF NASAL SINUS - REPAIR OF BONE OF ACCESSORY SINUS - SA
1402 SA229 OTHER OPERATION ON NASAL SINUSES - ANTERIOR AND POSTERIOR OPENING INTO
FESS - SA
1403 SA229A OTHER OPERATION ON NASAL SINUSES - SPHENOID SINUS - SA
1404 SA229B OTHER OPERATION ON NASAL SINUSES - UNSPECIFIED - SA
1405 SA2319 OTHER SURGICAL EXTRACTION OF TOOTH - SA
1406 SA235 IMPLANTATION OF TOOTH - SA
1407 SA2373 APICOECTOMY - SA
1408 SA244A EXCISION OF DENTAL LESION OF JAW - SA
1409 SA244B EXCISION OF DENTAL LESION OF JAW - CYST - SA
1410 SA245 ALVEOLOPLASTY - SA
1411 SA245A ALVEOLECTOMY - SA

1412 SA246 EXPOSURE OF TOOTH - SA

1413 SA2501 OPEN/CLOSED [NEEDLE] BIOPSY OF TONGUE - SA
1414 SA251 EXCISION OR DESTRUCTION OF LESION OR TISSUE OF TONGUE - SA
1415 SA251A INSICION/EXCISION OF PAPILLOMA/FIBROMA - SA
1416 SA252 PARTIAL GLOSSECTOMY - SA
1417 SA252A PARTIAL GLOSSECTOMY (HEMIGLOSECTOMY) - SA
1418 SA253 COMPLETE GLOSSECTOMY - SA
1419 SA253A COMPLETE GLOSSECTOMY (COMPLEX) - SA
1420 SA2559A OTHER REPAIR AND PLASTIC OPERATIONS ON TONGUE (GLOSSOPLASTY/TONGUE
FLAP 1ST STAGE) - SA
1421 SA2559B OTHER REPAIR AND PLASTIC OPERATIONS ON TONGUE (GLOSSOPLASTY/TONGUE
FLAP 2ND STAGE) - SA
1422 SA2559C OTHER REPAIR AND PLASTIC OPERATIONS ON TONGUE (FUSION OF TONGUE TO LIP)
- SA
1423 SA2591 LINGUAL FRENOTOMY - SA
1424 SA2592 LINGUAL FRENECTOMY - SA
1425 SA2593 LYSIS OF ADHESIONS OF TONGUE - SA
1426 SA260 INCISION OF SALIVARY GLAND OR DUCT - SA
1427 SA2611 CLOSED [NEEDLE] BIOPSY OF SALIVARY GLAND OR DUCT - SA
1428 SA2621 MARSUPIALIZATION OF SALIVARY GLAND CYST - SA
1429 SA2629A OTHER EXCISION OF SALIVARY GLAND LESION - SIALOLITHIASIS PAROTID (OPEN) -
SA
1430 SA2629B OTHER EXCISION OF SALIVARY GLAND LESION - SIALOLITHIASIS SUBMANDIBULAR -
SA
1431 SA2629C OTHER EXCISION OF SALIVARY GLAND LESION - SIALOLITHIASIS PAROTID
(MANIPULATIVE) - SA
1432 SA2629D EXCISION OF LESION OF SALIVARY GLAND - PAROTID/SUBMANDIBULAR - SA
1433 SA2629E EXCISION OF LESION OF SALIVARY GLAND - SUBLINGUAL - SA
1434 SA2629F OTHER EXCISION OF SALIVARY GLAND LESION-STONE EXTRACTION WITH IMAGING -
SA
1435 SA2630 SIALOADENECTOMY, NOT OTHERWISE SPECIFIED - SA
1436 SA2630A SIALOADENECTOMY, NOT OTHERWISE SPECIFIED - PAROTID - SA
1437 SA2631 PARTIAL SIALOADENECTOMY - SA
1438 SA2631B SIALOADENECTOMY, NOT OTHERWISE SPECIFIED - SUBMANDIBULAR - SA
1439 SA2631C SIALOADENECTOMY, NOT OTHERWISE SPECIFIED - SUBLINGUAL - SA
1440 SA2632 COMPLETE SIALOADENECTOMY - SA
1441 SA2632A COMPLETE SIALOADENECTOMY (PAROTIDECTOMY) - SA
1442 SA2642 CLOSURE OF SALIVARY FISTULA - SA
1443 SA2649 OTHER REPAIR AND PLASTIC OPERATIONS ON SALIVARY GLAND OR DUCT -
TRANSPOSITION OF PAROTID/SUBMANDIBULAR DUCT - SA
1444 SA2699 OTHER OPERATIONS ON SALIVARY GLAND OR DUCT - SA
1445 SA2699LP OTHER OPERATIONS ON SALIVARY GLAND OR DUCT-LIGATION OF PAROTID - SA
1446 SA2699LS OTHER OPERATIONS ON SALIVARY GLAND OR DUCT-LIGATION OF SUBMANDIBULAR -
SA
1447 SA2699M OTHER OPERATIONS ON SALIVARY GLAND OR DUCT-SUBMANDIBULAR - SA
1448 SA270 INCISION ABSCESS AND DRAINAGE (ORAL SURGERY) - SA
1449 SA271 INCISION OF PALATE - SA
1450 SA2721 BIOPSY OF BONY PALATE - SA
1451 SA2722 BIOPSY OF UVULA AND SOFT PALATE - SA
1452 SA2723 BIOPSY OF LIP - SA
1453 SA2724 BIOPSY OF MOUTH, UNSPECIFIED STRUCTURE - SA
1454 SA2731 LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BONY PALATE
(MOUTH) - SA
1455 SA2731A LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BONY PALATE
(PALATE) - SA
1456 SA2731B LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BONY PALATE
(UNROOFING MAXILLA) - SA
1457 SA2742 WIDE EXCISION OF LESION OF LIP - SA
1458 SA2743 OTHER EXCISION OF LESION OR TISSUE OF LIP - SA
1459 SA2749 OTHER EXCISION OF MOUTH (EXCEPT TOUNGUE, UVULA, AND PALATE) - SA
1460 SA2749A OTHER EXCISION OF MOUTH (REMOVAL OF EXCESS MUCOSA) - SA
1461 SA2749B FRENULECTOMY - SA
1462 SA2751 SUTURE OF LACERATION OF LIP - SA
1463 SA2752 SUTURE OF LACERATION OF OTHER PART OF MOUTH - SA
1464 SA2754A REPAIR OF CLEFT LIP - PRIMARY - SA
1465 SA2754B REPAIR OF CLEFT LIP - REVISION - SA
1466 SA2755 FULL-THICKNESS SKIN GRAFT TO LIP AND MOUTH - SA
1467 SA2755A FULL-THICKNESS SKIN GRAFT TO LIP AND MOUTH - MOUTH - SA
1468 SA2757A ATTACHMENT OF PEDICLE OR FLAP GRAFT TO LIP AND MOUTH (MOUTH) - SA
1469 SA2757B ATTACHMENT OF PEDICLE OR FLAP GRAFT TO LIP AND MOUTH (LIP) - SA
1470 SA2759 OTHER PLASTIC REPAIR OF MOUTH - SA
1471 SA2759A OTHER PLASTIC REPAIR OF MOUTH - GRAFT MUCOSA TO MOUTH - SA
1472 SA2761 SUTURE OF LACERATION OF PALATE - SA

1473 SA2762 CORRECTION OF CLEFT PALATE - SA

1474 SA2763 REVISION OF CLEFT PALATE REPAIR - SA
1475 SA2769A OTHER PLASTIC REPAIR OF PALATE - FLAP OF PALATE - SA
1476 SA2769B OTHER PLASTIC REPAIR OF PALATE - FLAP OF SKIN - SA
1477 SA2779 OTHER OPERATIONS ON UVULA - SA
1478 SA2779A UVULOPALATOPLASTY - SA
1479 SA2792 INCISION/EXCISION OF PHLEGMON - SA
1480 SA2799 EXOSTOSIS (ORAL SURGERY) - SA
1481 SA280 INCISION AND DRAINAGE OF TONSIL AND PERITONSILLAR STRUCTURES - SA
1482 SA282 TONSILLECTOMY WITHOUT ADENOIDECTOMY - SA
1483 SA282A TONSILLECTOMY WITHOUT ADENOIDECTOMY - LINGUAL TONSIL - SA
1484 SA282B TONSILLECTOMY WITHOUT ADENOIDECTOMY - WITH COMPLICATION - SA
1485 SA282C TONSILLECTOMY WITHOUT ADENOIDECTOMY - COBLATION - SA
1486 SA282D TONSILLECTOMY WITHOUT ADENOIDECTOMY - THERMAL WELDING - SA
1487 SA283 TONSILLECTOMY WITH ADENOIDECTOMY - SA
1488 SA285 EXCISION (REDUCTION) OF LINGUAL TONSIL - SA
1489 SA286 ADENOIDECTOMY WITHOUT TONSILLECTOMY - SA
1490 SA2911 PHARYNGOSCOPY - THERAPEUTIC ENDOSCOPIC OPERATION ON PHARYNX - SA
1491 SA2912 PHARYNGEAL BIOPSY - DIAG.ENDOSCOPIC EXAM OF PHARYNX - SA
1492 SA292 EXCISION OF BRANCHIAL CLEFT CYST OR VESTIGE - SA
1493 SA2932 PHARYNGEAL DIVERTICULECTOMY - SA
1494 SA2933 PHARYNGECTOMY (PARTIAL) - SA
1495 SA2939A OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF PHARYNX - TOTAL
PHARYNGECTOMY - SA
1496 SA2939B OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF PHARYNX -
PHARYNGEAL POUCH - SA
1497 SA2939C OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF PHARYNX - OPEN
EXCISION - SA
1498 SA295 OTHER REPAIR OF PHARYNX - SA
1499 SA2952 CLOSURE OF BRANCHIAL CLEFT FISTULA - SA
1500 SA3009 OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF LARYNX - SA
1501 SA301 HEMILARYNGECTOMY - SA
1502 SA3022 VOCAL CORDECTOMY - SA
1503 SA303 COMPLETE LARYNGECTOMY - SA
1504 SA304 RADICAL LARYNGECTOMY - SA
1505 SA304A RADICAL LARYNGECTOMY (THYROIDECTOMY+RND) - SA
1506 SA310 INJECTION OF LARYNX - SA
1507 SA310A MEDIALIZATION OF VOCAL CORD WITH INJECTION FAT/OTHER MATERIAL - SA
1508 SA311 TEMPORARY TRACHEOSTOMY (MINI TRACHEOSTOMY) - SA
1509 SA311A TEMPORARY TRACHEOSTOMY-CITO - SA
1510 SA311B TEMPORARY TRACHEOSTOMY (ELECTIVE TRACHEOSTOMY) - SA
1511 SA3129 OTHER PERMANENT TRACHEOSTOMY - SA
1512 SA3143 CLOSED [ENDOSCOPIC] BIOPSY OF LARYNX - SA
1513 SA3144 CLOSED [ENDOSCOPIC] BIOPSY OF TRACHEA - SA
1514 SA3169 OTHER REPAIR OF LARYNX - SA
1515 SA3169B OPEN MEDIALIZATION OF VOCAL CORD - SA
1516 SA3169C OPEN MEDIALIZATION/LATERIZATION OF VOCAL CORD - SA
1517 SA3175A RECONSTRUCTION OF TRACHEA AND CONSTRUCTION OF ARTIFICIAL LARYNX-
EXCISION+RECONSTRUCTION - SA
1518 SA3175B RECONSTRUCTION OF TRACHEA AND CONSTRUCTION OF ARTIFICIAL LARYNX-
TRACHEOPLASTY - SA
1519 SA3175C RECONSTRUCTION OF TRACHEA AND CONSTRUCTION OF ARTIFICIAL LARYNX-
EXCISION+RECONSTRUCTION (COMPLEX) - SA
1520 SA3179 OTHER REPAIR AND PLASTIC OPERATIONS ON TRACHEA - SA
1521 SA3193 REPLACEMENT OF LARYNGEAL OR TRACHEAL STENT - SA
1522 SA321 OTHER EXCISION OF BRONCHUS - SA
1523 SA3228 ENDOSCOPIC EXCISION OR DESTRUCTION OF LESION OR TISSUE OF LUNG - SA
1524 SA3229 OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF LUNG - SA
1525 SA3239 OTHER AND UNSPECIFIED SEGMENTAL RESECTION OF LUNG - SA
1526 SA324 LOBECTOMY OF LUNG - SA
1527 SA3241 THORACOSCOPIC LOBECTOMY OF LUNG - SA
1528 SA3250 THORACOSCOPIC PNEUMONECTOMY - SA
1529 SA3259 OTHER AND UNSPECIFIED PNEUMONECTOMY - SA
1530 SA3320 THORACOSCOPIC LUNG BIOPSY - SA
1531 SA3323 OTHER BRONCHOSCOPY SA
1532 SA3324 CLOSED [ENDOSCOPIC] BIOPSY OF BRONCHUS - SA
1533 SA3324BL CLOSED [ENDOSCOPIC] BIOPSY OF BRONCHUS (BRONCHIAL LAVAGE) - SA
1534 SA3326 CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF LUNG - SA
1535 SA3326A CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF LUNG (CORE BIOPSY) - SA
1536 SA3327 CLOSED ENDOSCOPIC BIOPSY OF LUNG - SA
1537 SA3334 THORACOPLASTY - SA
1538 SA3391 BRONCHIAL DILATION - SA
1539 SA3402 EXPLORATORY THORACOTOMY - SA
1540 SA3402A EXPLORATORY THORACOTOMY (MEDIAN STERNOTOMY) - SA
1541 SA3404 INSERTION OF INTERCOSTAL CATHETER FOR DRAINAGE - SA
1542 SA3404A INSERTION OF INTERCOSTAL CATHETER FOR DRAINAGE (INSERTION TUBE DRAIN
PLEURAL CAVITY) - SA
1543 SA3404C INSERTION OF INTERCOSTAL CATHETER FOR DRAINAGE - COMPLEX - SA
1544 SA3409 OTHER INCISION OF PLEURA - OPEN CHEST DRAINAGE - SA
1545 SA3422 MEDIASTINOSCOPY - SA
1546 SA3423 BIOPSY OF CHEST WALL - SA
1547 SA3424 OTHER PLEURAL BIOPSY - SA
1548 SA343 EXCISION OR DESTRUCTION OF LESION OR TISSUE OF MEDIASTINUM - SA
1549 SA344 EXCISION OR DESTRUCTION OF LESION OF CHEST WALL - SA
1550 SA3451 DECORTICATION OF LUNG - SA
1551 SA3459 OTHER EXCISION OF PLEURA - SA
1552 SA3474 REPAIR OF PECTUS DEFORMITY - SA
1553 SA3484 OTHER REPAIR OF DIAPHRAGM - SA
1554 SA3492 INJECTION INTO THORACIC CAVITY - INTRODUCTION - SA
1555 SA3492A INJECTION INTO THORACIC CAVITY - PLEURODESIS - SA
1556 SA3501 CLOSED HEART VALVOTOMY, AORTIC VALVE - SA
1557 SA3502 CLOSED HEART VALVOTOMY, MITRAL VALVE - SA
1558 SA3510 OPEN HEART VALVULOPLASTY WITHOUT REPLACEMENT, UNSPECIFIED VALVE - SA

1559 SA3520 OPEN AND OTHER REPLACEMENT OF UNSPECIFIED HEART VALVE - SA

1560 SA3521 OPEN AND OTHER REPLACEMENT OF AORTIC VALVE WITH TISSUE GRAFT - SA
1561 SA3522 OPEN AND OTHER REPLACEMENT OF AORTIC VALVE - SA
1562 SA3523 OPEN AND OTHER REPLACEMENT OF MITRAL VALVE WITH TISSUE GRAFT - SA
1563 SA3524 OPEN AND OTHER REPLACEMENT OF MITRAL VALVE - SA
1564 SA3525 OPEN AND OTHER REPLACEMENT OF PULMONARY VALVE WITH TISSUE GRAFT - SA

1565 SA3527 OPEN AND OTHER REPLACEMENT OF TRICUSPID VALVE WITH TISSUE GRAFT - SA

1566 SA3539 OPERATIONS ON OTHER STRUCTURES ADJACENT TO VALVES OF HEART - SA

1567 SA3551 REPAIR OF ATRIAL SEPTAL DEFECT WITH PROSTHESIS, OPEN TECHNIQUE - SA
1568 SA3552 REPAIR OF ATRIAL SEPTAL DEFECT WITH PROSTHESIS, CLOSED TECHNIQUE - SA

1569 SA3554 REPAIR OF ENDOCARDIAL CUSHION DEFECT WITH PROSTHESIS - SA

1570 SA3571 OTHER AND UNSPECIFIED REPAIR OF ATRIAL SEPTAL DEFECT - SA
1571 SA3572 OTHER AND UNSPECIFIED REPAIR OF VENTRICULAR SEPTAL DEFECT - SA
1572 SA3573 OTHER AND UNSPECIFIED REPAIR OF ENDOCARDIAL CUSHION DEFECT - SA
1573 SA3581 TOTAL REPAIR OF TETRALOGY OF FALLOT - SA
1574 SA3582 TOTAL REPAIR OF TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION - SA
1575 SA3583 LIGATION OF CONNECTIONS BETWEEN AORTA AND PULMONARY ARTERY - SA
1576 SA3583A TOTAL REPAIR OF TRUNCUS ARTERIOSUS (CORRECTION) - SA
1577 SA3583B TOTAL REPAIR OF TRUNCUS ARTERIOSUS (CONNECTION TO PULMONARY ARTERY
FROM AORTA) - SA
1578 SA3584A TOTAL CORRECTION OF TRANSPOSITION OF GREAT VESSELS, NOT ELSEWHERE
CLASSIFIED - ARTERIAL SWITCH OPERATION [JATENE] - SA
1579 SA3584B TOTAL CORRECTION OF TRANSPOSITION OF GREAT VESSELS, NOT ELSEWHERE
CLASSIFIED - SA
1580 SA3592 CREATION OF CONDUIT BETWEEN RIGHT VENTRICLE AND PULMONARY ARTERY - SA

1581 SA3592A CREATION OF CONDUIT BETWEEN RIGHT VENTRICLE AND PULMONARY ARTERY -
CREATION VALVED CARDIAC CONDUIT - SA
1582 SA3593 CREATION OF CONDUIT BETWEEN LEFT VENTRICLE AND AORTA - SA
1583 SA3594 CREATION OF CONDUIT BETWEEN ATRIUM AND PULMONARY ARTERY - SA
1584 SA3595 REVISION OF CORRECTIVE PROCEDURE ON HEART / REPAIR OF PULMONARY ARTERY
- SA
1585 SA3595A REVISION OF CORRECTIVE PROCEDURE ON HEART / OPEN OPERATION ON
PULMONARY ARTERY - SA
1586 SA3595B REVISION OF CORRECTIVE PROCEDURE ON HEART - SA
1587 SA3596A PERCUTANEOUS VALVULOPLASTY (THERAPEUTIC TRANSLUMINAL OPERATIONS
SEPTUM HEART) - SA
1588 SA3596B PERCUTANEOUS VALVULOPLASTY (PERCUTANEOUS TRANSLUMINAL MITRAL
VALVULOTOMY) - SA
1589 SA3599 OTHER OPERATIONS ON VALVES OF HEART - SA
1590 SA3603 OPEN CHEST CORONARY ARTERY ANGIOPLASTY - SA
1591 SA3611 (AORTO)CORONARY BYPASS OF ONE CORONARY ARTERY - SA
1592 SA3699 OTHER OPERATIONS ON VESSELS OF HEART - SA
1593 SA370 PERICARDIOCENTESIS - SA
1594 SA370A PERICARDIOCENTESIS (DECOMPRESSION FO CARDIAC TAMPONADE) - SA
1595 SA3712 PERICARDIOTOMY - SA
1596 SA3723A COMBINED RIGHT AND LEFT HEART CARDIAC CATHETERIZATION (ADULT) - SA
1597 SA3723B COMBINED RIGHT AND LEFT HEART CARDIAC CATHETERIZATION (PAEDIATRIC) - SA

1598 SA3727 CARDIAC MAPPING - SA

1599 SA3727A CARDIAC MAPPING - MAP GUIDED SURG FOR VENTRICULAR ARRHYTHMIAS (W
MAPPING) - SA
1600 SA3731 PERICARDIECTOMY - SA
1601 SA3732 EXCISION OF ANEURYSM OF HEART - SA
1602 SA3733 EXCISION OR DESTRUCTION OF OTHER LESION OR TISSUE OF HEART, OPEN
APPROACH - SA
1603 SA3734 EXCISION OR DESTRUCTION OF OTHER LESION OR TISSUE OF HEART, OTHER
APPROACH - TRANSLUMINAL - SA
1604 SA3734A EXCISION OR DESTRUCTION OF OTHER LESION OR TISSUE OF HEART,OTHER
APPROACH-ABLATION AV NODE - SA
1605 SA3749 OTHER REPAIR OF HEART AND PERICARDIUM - SA
1606 SA3779A REVISION OR RELOCATION OF CARDIAC DEVICE POCKET (RESITTING OF IV CARDIAC
PACEMAKER SYSTEM) - SA
1607 SA3779B REVISION OR RELOCATION OF CARDIAC DEVICE POCKET (REMOVAL OF PACING
SYSTEM WITH BYPASS) - SA
1608 SA3779C REVISION OR RELOCATION OF CARDIAC DEVICE POCKET (REMOVAL OF PACING
SYSTEM W/O BYPASS) - SA
INSERTION, REVISION, REPLACEMENT, AND REMOVAL OF LEADS; INSERTION OF TEMPORARY
1609 SA377A PACEMAKER SYSTEM; OR REVISION OF CARDIAC DEVICE POCKET
(SINGLE CHAMBER) - SA
INSERTION, REVISION, REPLACEMENT, AND REMOVAL OF LEADS; INSERTION OF TEMPORARY
1610 SA377B PACEMAKER SYSTEM; OR REVISION OF CARDIAC DEVICE POCKET (DUAL
CHAMBER) - SA
REPLACEMENT OF ANY TYPE PACEMAKER DEVICE WITH SINGLE-CHAMBER DEVICE, NOT SPECIFIED AS
1611 SA3785 RATE RES / REPLACEMENT OF ANY TYPE PACEMAKER DEVICE
WITH DUAL-CHAMBER DEVICE - SA
1612 SA3787 REPLACEMENT OF ANY TYPE PACEMAKER DEVICE WITH DUAL-CHAMBER DEVICE - SA

1613 SA3794 IMPLANTATION OR REPLACEMENT OF AUTOMATIC CARDIOVERTER/DEFIBRILLATOR,

TOTAL SYSTEM [AICD] - SA
1614 SA3800 INCISION OF VESSEL - THROMBECTOMY - SA
1615 SA3800A INCISION OF VESSEL - THROMBECTOMY (OPEN) - SA
1616 SA3805 INCISION OF VESSEL (PULMONARY EMBOLECTOMY) - SA
1617 SA3810 ENDARTERECTOMY WITH GRAFT - UNSPESIFIED - SA
1618 SA3811 ENDARTERECTOMY (INTRACRANIAL VESSEL) - SA
1619 SA3812 ENDARTERECTOMY CAROTID - SA
1620 SA3814 ENDARTERECTOMY AORTA INCLUDE PATCH GRAFT - SA
1621 SA3815 ENDARTERECTOMY WITH GRAFT - SUBCLAVIA - SA
1622 SA3816 ENDARTERECTOMY ILIAC ARTERY INCLUDE PATCH GRAFT - SA
1623 SA3817 ENDARTERECTOMY RENAL ARTERY - SA
1624 SA3819 ENDARTERECTOMY FEMORAL ARTERY - SA
1625 SA3821 BIOPSY OF BLOOD VESSEL - SA
1626 SA3830 RESECTION OF VESSEL WITH ANASTOMOSIS - EXCISION OF ARETRIOVENOUS
MALFORMATION - SA
1627 SA3841 RESECTION OF VESSEL WITH REPLACEMENT (INTRACRANIAL VESSEL) - SA
1628 SA3844A RESECTION OF VESSEL WITH REPLACEMENT (AORTA) (REVISION OF PROSTHESIS
ABDOMINAL AORTA) - SA
1629 SA3844B RESECTION OF VESSEL WITH REPLACEMENT (AORTA) (OTHER OPEN OP VISCERAL
BRANCH ABDOMINAL AORTA) - SA
1630 SA3844C RESECTION OF VESSEL WITH REPLACEMENT (AORTA) (INFRARENAL ABDOMINAL
AORTIC ANEURYSM TUBE GRAFT) - SA
1631 SA3844D RESECTION OF VESSEL WITH REPLACEMENT (AORTA) (INFRARENAL ABDOMINAL
AORTIC ANEURYSM BIFURCATION GRAFT) - SA
1632 SA3845 RESECTION OF VESSEL WITH REPLACEMENT (OTHER THORACIC VESSELS) - SA
1633 SA3845A RESECTION OF VESSEL WITH REPLACEMENT - EMERGENCY REPLACE OF
ANEURYSMAL SEGMENT ARCH OF AORTA (ARCHUS/ASCENDING) - SA
1634 SA3845B RESECTION OF VESSEL WITH REPLACEMENT - PLAN REPLACE ANEURYSMAL SEGMENT
THORACIC AORTA - SA
1635 SA3845C RESECTION OF VESSEL WITH REPLACEMENT - PLAN REPLACE OF ANEURYSMAL
SEGMENT ASCENDING AORTA - SA
1636 SA3845D RESECTION OF VESSEL WITH REPLACEMENT - PLAN REPLACE OF ANEURYSMAL
SEGMENT ARCH AORTA - SA
1637 SA3850A LIGATION AND STRIPPING OF VARICOSE VEINS - RECURRENT - SA
1638 SA3850B LIGATION AND STRIPPING OF VARICOSE VEINS - RECURRENT BILATERAL / MULTI
PHLEBECTOMY - SA
1639 SA3859 LIGATION AND STRIPPING OF VARICOSE VEINS - SAPHENOUS VEINS - SA
1640 SA3859A LIGATION AND STRIPPING OF VARICOSE VEIN - SAPHENOUS VEINS UNILATERAL - SA

1641 SA3859B LIGATION AND STRIPPING OF VARICOSE VEIN - SAPHENOUS VEINS BILATERAL - SA

1642 SA3859C LIGATION AND STRIPPING OF VARICOSE VEINS - SAPHENOUS VEINS (COMPLEX) - SA

1643 SA3866 OTHER EXCISION OF VESSEL - ILLIAC ARTERY - SA

1644 SA3868 OTHER EXCISION OF VESSEL - VARICOSE VEIN LEG - SA
1645 SA387A INTERRUPTION OF THE VENA CAVA (PLICATION OF VENA CAVA) - SA
1646 SA387B INTERRUPTION OF THE VENA CAVA (REPAIR OF WOUND OF MAJOR ARTERY/VEIN OF
ABDOMEN) - SA
1647 SA3893 VENOUS CATHETERIZATION, NOT ELSEWHERE CLASSIFIED - SA
1648 SA3893A VENOUS CATHETERIZATION, NON TUNNELLED - SA
1649 SA3893B VENOUS CATHETERIZATION, TUNNELLED - SA
1650 SA3893C VENOUS CATHETERIZATION - INSERTION OF VENA CAVA FILTER - SA
1651 SA3893D VENOUS CATHETERIZATION, NOT ELSEWHERE CLASSIFIED / CVC - SA
1652 SA3893E VENOUS CATHETERIZATION, NOT ELSEWHERE CLASSIFIED / CHEMOPOT - SA
1653 SA3895B VENOUS CATHETERIZATION FOR RENAL DIALYSIS / DOUBLE OR TRIPLE LUMEN HD -
SA
1654 SA3895C VENOUS CATHERIZATION FOR RENAL DIALYSIS / TUNELLING - SA
1655 SA390A SYSTEMIC TO PULMONARY ARTERY SHUNT (CREATION OF SHUNT TO PULMONARY
ARTERY FR SUBCLAVIA ARTERY BY INTERPOS.TUBE PROS.) - SA
1656 SA390B SYSTEMIC TO PULMONARY ARTERY SHUNT (CONNECTION TO PULMONARY ARTERY
FR SUBCLAVIA ARTERY) - SA
1657 SA390C SYSTEMIC TO PULMONARY ARTERY SHUNT (REPAIR OF PULMONARY ARTERY) - SA

1658 SA390D SYSTEMIC TO PULMONARY ARTERY SHUNT (OPEN OPERATION ON PULMONARY

ARTERY) - SA
1659 SA390E SYSTEMIC TO PULMONARY ARTERY SHUNT (TRANSLUMINAL OPERATION ON
PULMONARY ARTERY) - SA
1660 SA390F SYSTEMIC TO PULMONARY ARTERY SHUNT (CONNECTION TO PULMONARY ARTERY
FROM AORTA) - SA
1661 SA391 INTRA-ABDOMINAL VENOUS SHUNT - SA
1662 SA391A INTRA ABDOMINAL VENOUS SHUNT (TRANSJUGULAR INTRAHEPATIC
PORTOSYSTEMIC SHUNT) - SA
1663 SA3922 AORTA-SUBCLAVIAN-CAROTID BYPASS - SA
1664 SA3922A AORTA-SUBCLAVIAN-CAROTID BYPASS (EXCISION OF INFECTED AORTIC GRAFT W
BYPASS) - SA
1665 SA3922B AORTA-SUBCLAVIAN-CAROTID BYPASS (BYPASS CAROTID ARTERY FR ARCH) - SA

1666 SA3925 AORTA-ILIAC-FEMORAL BYPASS - SA

1667 SA3925A AORTA-ILIAC-FEMORAL BYPASS (AORTO-ILIAC,AORTO-FEMORAL,ILEO-FEMORAL
BYPASS) - SA
1668 SA3925B AORTA-ILIAC-FEMORAL BYPASS (OPEN OPERATION ILIAC ARTERY) - SA
1669 SA3926 OTHER INTRA-ABDOMINAL VASCULAR SHUNT OR BYPASS - SA
1670 SA3927 ARTERIOVENOSTOMY FOR RENAL DIALYSIS - SA
1671 SA3929 OTHER (PERIPHERAL) VASCULAR SHUNT OR BYPASS - SA
1672 SA3929A OTHER (PERIPHERAL) VASCULAR SHUNT OR BYPASS - FEMORO-FEMORAL BYPASS -
SA
1673 SA3929B OTHER (PERIPHERAL) VASCULAR SHUNT OR BYPASS - FEMORO-POPLITEAL BYPASS
USING PROSTHESIS &/VEIN&/CUFF/PATCH - SA
1674 SA3929C OTHER (PERIPHERAL) VASCULAR SHUNT OR BYPASS - FEMORO-DISTAL CALF BYPASS
USING PROSTHESIS&/VEIN&/VEIN CUFF/PATCH - SA
1675 SA3929D OTHER (PERIPHERAL) VASCULAR SHUNT OR BYPASS -REVISION FEMORAL BYPASS
GRAFT - SA
1676 SA3930 SUTURE OF UNSPECIFIED BLOOD VESSEL - SA
1677 SA3949 OTHER REVISION OF VASCULAR PROCEDURE - SA
1678 SA3950A ANGIOPLASTY OR ATHERECTOMY OF OTHER NON CORONARY VESSEL(S) - INCLUDE
PTA NON CORONARY VESSEL - SA
1679 SA3950B PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) OF NON- CORONARY VESSELS -
FEMORAL ARTERY - SA
1680 SA3950C PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) OF NON- CORONARY VESSELS -
ILLIAC ARTERY - SA
1681 SA3950D PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) OF NON- CORONARY VESSELS -
RENAL ARTERY - SA
1682 SA3950E ANGIOPLASTY OR ATHERECTOMY OF OTHER NON CORONARY VESSEL(S) -
RECONSTRUCTION OF RENAL ARTERY - SA
1683 SA3951 CLIPPING OF ANEURYSM - SA
1684 SA3952 OTHER REPAIR OF ANEURYSM - POPLITEAL - SA
1685 SA3952A OTHER REPAIR OF ANEURYSM - REINFORCEMENT OF ANEURYSM OF CEREBRAL
ARTERY - SA
1686 SA3953 REPAIR OF ARTERIOVENOUS FISTULA - SA
1687 SA3953A REPAIR OF ARTERIOVENOUS FISTULA (CREATION ARTERIOVENOUS FISTULA
(INCLUDE SUBSEQUENT CLOSURE) - SA
1688 SA3953B REPAIR OF ARTERIOVENOUS FISTULA - OCCLUSION OF FISTULA UNDER IMAGING
CONTROL - SA
1689 SA3956A REPAIR OF BLOOD VESSEL WITH TISSUE PATCH GRAFT (MICRO-ARTERIAL/MICRO-
VENOUS GRAFT) - SA
1690 SA3956B REPAIR OF BLOOD VESSEL WITH TISSUE PATCH GRAFT (REPAIR ARTERY USE VEIN
GRAFT) - SA
1691 SA3958 REPAIR OF BLOOD VESSEL WITH UNSPECIFIED TYPE OF PATCH GRAFT - AORTA
ABDOMINALIS - SA
1692 SA3958A REPAIR OF BLOOD VESSEL WITH UNSPECIFIED TYPE OF PATCH GRAFT-AORTA
REPAIR - SA
1693 SA3959 OTHER REPAIR OF VESSEL - SA
1694 SA3959A OTHER REPAIR OF VESSEL -MICROSURGERY - SA
1695 SA3959B OTHER REPAIR OF VESSEL - ARTERIOPLASTY - SA
1696 SA397 ENDOVASCULLAR PROSEDURE ON VESSELS - EMBOLISATION OF ARTERY OF
INTERNAL NOSE - SA
1697 SA3979C OTHER ENDOVASCULAR PROCEDURES ON OTHER VESSELS (REPLACE THORACIC-
ABDOMINAL ANEURYSM) - SA
1698 SA3992 INJECTION OF SCLEROSING AGENT INTO VEIN - SA
1699 SA3997 OTHER PERFUSION - SA
1700 SA4011A BIOPSY OF LYMPHATIC STRUCTURE (CERVICAL, INGUINAL, AXILLARY) - SA
1701 SA4011B BIOPSY OF LYMPHATIC STRUCTURE (EXCISION BIOPSY LYMPH NODE) - SA
1702 SA4011C BIOPSY OF LYMPHATIC STRUCTURE - CERVICAL LYMPH NODE - SA
1703 SA4011D BIOPSY OF LYMPHATIC STRUCTURE - AXILLARY LYMPH NODE - SA
1704 SA4011E BIOPSY OF LYMPHATIC STRUCTURE - MAMMARY LYMPH NODE - SA
1705 SA402 SIMPLE EXCISION OF LYMPHATIC STRUCTURE - SA
1706 SA4021 EXCISION OF DEEP CERVICAL LYMPH NODE - SA
1707 SA4023 EXCISION OF AXILLARY LYMPH NODE - SA
1708 SA4024 EXCISION OF INGUINAL LYMPH NODE - SA
1709 SA4024A EXCISION OF INGUINAL LYMPH NODE (COMPLEX) - SA
1710 SA4029 SIMPLE EXCISION OF OTHER LYMPHATIC STRUCTURE - SA
1711 SA4029A SIMPLE EXCISION OF OTHER LYMPHATIC STRUCTURE (BLOK DISSECTION OF PELVIC
LYMPH NODES) - SA
1712 SA4029B SIMPLE EXCISION OF OTHER LYMPHATIC STRUCTURE (EXCISION CYSTIC HYGROMA) -
SA
1713 SA4029C SIMPLE EXCISION OF OTHER LYMPHATIC STRUCTURE (COMPLEX) - SA
1714 SA403 REGIONAL LYMPH NODE EXCISION - SA
1715 SA404 RADICAL EXCISION OF CERVICAL LYMPH NODES - CLYMPH NODE - SA
1716 SA4040 RADICAL NECK DISSECTION, NOT OTHERWISE SPECIFIED - SA
1717 SA4051 RADICAL EXCISION OF AXILLARY LYMPH NODES - SA
1718 SA4051A RADICAL EXCISION OF AXILLARY LYMPH NODES - AXILLARY LYMPH NODE - SA
1719 SA4052 RADICAL EXCISION OF PERIAORTIC LYMPH NODES - SA
1720 SA409 OTHER OPERATIONS ON LYMPHATIC STRUCTURES - SA
1721 SA409A RECONSTRUCTION LYMPH OEDEM WITH MIROSURGERY OPERATION - SA
1722 SA4131 BIOPSY OF BONE MARROW - SA
1723 SA415A SPLEENECTOMY-LAPAROSCOPIC - SA
1724 SA415B SPLEENECTOMY-OPEN - SA
1725 SA4219 OTHER EXTERNAL FISTULIZATION OF ESOPHAGUS - SA
1726 SA4232 LOCAL EXCISION OF OTHER LESION OR TISSUE OF ESOPHAGUS - SA
1727 SA4233 ENDOSCOPIC EXCISION OR DESTRUCTION OF LESION OR TISSUE OF ESOPHAGUS -
INJECTION SCLEROTHERAPY - SA
1728 SA4242 TOTAL ESOPHAGECTOMY - SA
1729 SA4242A TOTAL ESOPHAGECTOMY (COMPLEX) - SA
1730 SA4251 INTRATHORACIC ESOPHAGOESOPHAGOSTOMY - SA
1731 SA427 ESOPHAGOMYOTOMY - SA
1732 SA427A ESOPHAGOMYOTOMY (BYPASS OESOPHAGUS) - SA
1733 SA427B ESOPHAGOMYOTOMY (THORASCOPIC OESOPHAGOGASTRIC MYOTOMY) - SA
1734 SA4281 INSERTION OF PERMANENT TUBE INTO ESOPHAGUS - SA
1735 SA4283 CLOSURE OF ESOPHAGOSTOMY - SA
1736 SA4284 REPAIR OF ESOPHAGEAL FISTULA, NOT ELSEWHERE CLASSIFIED - SA
1737 SA4289 OTHER REPAIR OF ESOPHAGUS - SA
1738 SA4289A OTHER REPAIR OF ESOPHAGUS-TRANSTHORACIC - SA
1739 SA4289B OTHER REPAIR OF ESOPHAGUS-THORACOSCOPIC - SA
1740 SA4289C OTHER REPAIR OF ESOPHAGUS-TRANSABDOMINAL ANTI REFLUX - SA
1741 SA4289D OTHER REPAIR OF ESOPHAGUS-REVISION ANTI REFLUX OP - SA
1742 SA4289E OTHER REPAIR OF ESOPHAGUS-TRANSTHORACIC (COMPLEX) - SA
1743 SA4289F OTHER REPAIR OF ESOPHAGUS-THORACOSCOPIC EXTRA - SA
1744 SA4311 PERCUTANEOUS [ENDOSCOPIC] GASTROSTOMY - SA
1745 SA4319 OTHER GASTROSTOMY - SA
1746 SA4319C OTHER GASTROSTOMY (COMPLEX) - SA
1747 SA433 PYLOROMYOTOMY - SA
1748 SA435 PARTIAL GASTRECTOMY WITH ANASTOMOSIS TO ESOPHAGUS - SA
1749 SA436 PARTIAL GASTRECTOMY WITH ANASTOMOSIS TO DUODENUM - SA
1750 SA437 PARTIAL GASTRECTOMY WITH ANASTOMOSIS TO JEJUNUM - SA
1751 SA438 OTHER PARTIAL GASTRECTOMY - SA
1752 SA4381 PARTIAL GASTRECTOMY WITH JEJUNAL TRANSPOSITION - SA
1753 SA4389 OPEN AND OTHER PARTIAL GASTRECTOMY - SA
1754 SA4399 OTHER TOTAL GASTRECTOMY - SA
1755 SA4399A OTHER TOTAL GASTRECTOMY-OESOPHAGOGASTRECTOMY - SA
1756 SA4399C OTHER TOTAL GASTRECTOMY-OESOPHAGOGASTRECTOMY (COMPLEX) - SA
1757 SA4400 VAGOTOMY, NOT OTHERWISE SPECIFIED - SA
1758 SA4400L VAGOTOMY, NOS - LAPAROSCOPIC - SA
1759 SA4401 TRUNCAL VAGOTOMY - SA
1760 SA4402 HIGHLY SELECTIVE VAGOTOMY - SA
1761 SA4403 OTHER SELECTIVE VAGOTOMY - SA
1762 SA4403P OTHER SELECTIVE VAGOTOMY-WITH PYLOROPLASTY - SA
1763 SA4413 OTHER GASTROSCOPY A
1764 SA4413B GASTROSCOPY BIOPSY A
1765 SA4413L GASTROSCOPY LIGATIE VEG A
1766 SA4413S GASTROSCOPY SCLEROTHERAPY A
1767 SA442 PYLOROPLASTY - SA
1768 SA4429 OTHER PYLOROPLASTY - SA
1769 SA4432 PERCUTANEOUS [ENDOSCOPIC] GASTROJEJUNOSTOMY (BYPASS OF
DUODENUM/JEJUNUM) - SA
1770 SA4432A PERCUTANEOUS [ENDOSCOPIC] GASTROJEJUNOSTOMY - SA
1771 SA4438A LAPAROSCOPIC GASTROENTEROSTOMY - GASTRO-JEJUNOSTOMY - SA
1772 SA4438B LAPAROSCOPIC GASTROENTEROSTOMY -GASTROSTOMY/JEJUNOSTOMY - SA
1773 SA4439 OTHER GASTROENTEROSTOMY - SA
1774 SA4441 SUTURE OF GASTRIC ULCER SITE - SA
1775 SA4442 SUTURE OF DUODENAL ULCER SITE - SA
1776 SA4443 ENDOSCOPIC CONTROL OF GASTRIC OR DUODENAL BLEEDING - SA
1777 SA445 REVISION OF GASTRIC ANASTOMOSIS - SA
1778 SA4462 CLOSURE OF GASTROSTOMY - SA
1779 SA4465 ESOPHAGOGASTROPLASTY-HELLER"S OP - SA
1780 SA4468 LAPAROSCOPIC GASTROPLASTY - SA
1781 SA4469 OTHER REPAIR OF STOMACH - GASTROPLASTY - SA
1782 SA4499 GASTRIC OPERATION NEC - SA
1783 SA4512 ENDOSCOPY OF SMALL INTESTINE THROUGH ARTIFICIAL STOMA - SA
1784 SA4523 COLONOSCOPY A
1785 SA4523B COLONOSCOPY BIOPSY A
1786 SA4523P COLONOSCOPY POLIPECTOMY A
1787 SA4524 FLEXIBLE SIGMOIDOSCOPY A
1788 SA4531 OTHER LOCAL EXCISION OF LESION OF DUODENUM - SA
1789 SA4533A LOCAL EXCISION OF LESION OR TISSUE OF SMALL INTESTINE, EXCEPT DUODENUM -
EXCISION OF JEJUNUM - SA
1790 SA4533B LOCAL EXCISION OF LESION OR TISSUE OF SMALL INTESTINE, EXCEPT DUODENUM -
EXCISION OF LESION OF JEJUNUM - SA
1791 SA4534 OTHER DESTRUCTION OF LESION OF SMALL INTESTINE, EXCEPT DUODENUM-
LAPAROSCOPIC RESECTION OF SMALL INTESTINE - SA
1792 SA4541 EXCISION OF LESION OR TISSUE OF LARGE INTESTINE - SA
1793 SA4573 OPEN AND OTHER RIGHT HEMICOLECTOMY - SA
1794 SA4574 OPEN AND OTHER RESECTION OF TRANSVERSE COLON - SA
1795 SA4575 OPEN AND OTHER LEFT HEMICOLECTOMY - SA
1796 SA4575A OPEN AND OTHER LEFT HEMICOLECTOMY (REVERSAL OF HARTMANN"S PROCEDURE) -
SA
1797 SA4576 OPEN AND OTHER SIGMOIDECTOMY - SA
1798 SA4579 OTHER AND UNSPECIFIED PARTIAL EXCISION OF LARGE INTESTINE - SA
1799 SA4594 LARGE-TO-LARGE INTESTINAL ANASTOMOSIS - SA
1800 SA4595 ANASTOMOSIS TO ANUS - SA
1801 SA4603 EXTERIORIZATION OF LARGE INTESTINE - SA
1802 SA4610 COLOSTOMY, NOT OTHERWISE SPECIFIED - SA
1803 SA4610L COLOSTOMY, NOT OTHERWISE SPECIFIED -- LAPAROSCOPIC - SA
1804 SA4620 ILEOSTOMY, BYPASS OF IELUM - SA
1805 SA4620A ILEOSTOMY, NOT OTHERWISE SPECIFIED - SA
1806 SA4620B ILEOSTOMY, ATTENTION - SA
1807 SA4639 ENTEROSTOMY NEC - SA
1808 SA4651 CLOSURE OF STOMA OF SMALL INTESTINE - SA
1809 SA4652E CLOSURE OF STOMA OF LARGE INTESTINE-EXTRA PERITONEAL - SA
1810 SA4652I CLOSURE OF STOMA OF LARGE INTESTINE-INTRA PERITONEAL - SA
1811 SA4680 INTRA-ABDOMINAL MANIPULATION OF INTESTINE, NOT OTHERWISE SPECIFIED - SA

1812 SA4682 INTRA-ABDOMINAL MANIPULATION OF LARGE INTESTINE - SA

1813 SA4701 LAPAROSCOPIC APPENDECTOMY - SA
1814 SA4709 OTHER APPENDECTOMY - SA
1815 SA4709A OTHER APPENDECTOMY-COMPLICATION - SA
1816 SA472 DRAINAGE OF APPENDICEAL ABSCESS - SA
1817 SA480 PROCTOTOMY - SA
1818 SA4823 RIGID PROCTOSIGMOIDOSCOPY - SA
1819 SA4825 OPEN BIOPSY OF RECTUM - SA
1820 SA4835 LOCAL EXCISION OF RECTAL LESION OR TISSUE - SA
1821 SA4835A LOCAL EXCISION OF RECTAL LESION OR TISSUE (OPEN) - SA
1822 SA4842 LAPAROSCOPIC PULL-THROUGH RESECTION OF RECTUM - SA
1823 SA4849 OTHER PULL-THROUGH RESECTION OF RECTUM - SA
1824 SA4850 ABDOMINOPERINEAL RESECTION OF THE RECTUM, NOT OTHERWISE SPECIFIED - SA

1825 SA4861 TRANSSACRAL RECTOSIGMOIDECTOMY - SA

1826 SA4862 ANTERIOR RESECTION OF RECTUM WITH SYNCHRONOUS COLOSTOMY - SA
1827 SA4869 RECTAL RESECTION NEC - SA
1828 SA4876 OTHER PROCTOPEXY - SA
1829 SA4892 ANORECTAL MYECTOMY - SA
1830 SA4901 INCISION OF PERIANAL ABSCESS - SA
1831 SA4904 OTHER EXCISION OF PERIANAL TISSUE - SA
1832 SA4911 ANAL FISTULOTOMY - SA
1833 SA4912B ANAL FISTULECTOMY-LAY OPEN HIGH FISTULA - SA
1834 SA493 LOCAL EXCISION OR DESTRUCTION OF OTHER LESION OR TISSUE OF ANUS - SA
1835 SA4939 OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF ANUS - SA
1836 SA4941 REDUCTION OF HEMORRHOIDS - SA
1837 SA4942 INJECTION OF HEMORRHOIDS - SA
1838 SA4946S EXCISION OF HEMORRHOIDS-STAPPLER - SA
1839 SA4951 LEFT LATERAL ANAL SPHINCTEROTOMY - SA
1840 SA4971 SUTURE OF LACERATION OF ANUS - SA
1841 SA4973 CLOSURE OF ANAL FISTULA - SA
1842 SA4979 OTHER REPAIR OF ANAL SPHINCTER - SA
1843 SA5011 CLOSED (PERCUTANEOUS) [NEEDLE] BIOPSY OF LIVER - SA
1844 SA5012 OPEN BIOPSY OF LIVER - SA
1845 SA5014 LAPAROSCOPIC LIVER BIOPSY - SA
1846 SA5021 MARSUPIALIZATION OF LESION OF LIVER - SA
1847 SA5022 PARTIAL HEPATECTOMY - SA
1848 SA5022A PARTIAL HEPATECTOMY - HEMIHEPATECTOMY - SA
1849 SA5025 LAPAROSCOPIC ABLATION OF LIVER LESION OR TISSUE - SA
1850 SA5029 OTHER DESTRUCTION OF LESION OF LIVER - SA
1851 SA5069 OTHER REPAIR OF LIVER - SA
1852 SA510 CHOLECYSTOTOMY AND CHOLECYSTOSTOMY - SA
1853 SA5110 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY [ERCP] A
1854 SA5112 PERCUTANEOUS BIOPSY OF GALLBLADDER OR BILE DUCTS - SA
1855 SA5122 CHOLECYSTECTOMY - SA
1856 SA5123 LAPAROSCOPIC CHOLECYSTECTOMY - SA
1857 SA5123A LAPAROSCOPIC CHOLECYSTECTOMY-WITH CHOLANGIOGRAM - SA
1858 SA5135 OTHER GALLBLADDER ANASTOMOSIS - SA
1859 SA5136 CHOLEDOCHOENTEROSTOMY - SA
1860 SA5137 ANASTOMOSIS OF HEPATIC DUCT TO GASTROINTESTINAL TRACT - SA
1861 SA5139 OTHER BILE DUCT ANASTOMOSIS - SA
1862 SA5149 INCISION OF OTHER BILE DUCTS FOR RELIEF OF OBSTRUCTION - SA
1863 SA5151 EXPLORATION OF COMMON DUCT - SA
1864 SA5169 EXCISION OF OTHER BILE DUCT - SA
1865 SA5179 REPAIR OF OTHER BILE DUCTS - SA
1866 SA5182 PANCREATIC SPHINCTEROTOMY - SA
1867 SA5198 OTHER PERCUTANEOUS PROCEDURES ON BILIARY TRACT - SA
1868 SA5198A OTHER PERCUTANEOUS PROCEDURES ON BILIARY TRACT (DILATATION) - SA
1869 SA5199 BILIARY TRACT OP NEC - SA
1870 SA5199A OTHER. INSERTION OR REPLACEMENT OF BILLIARY TRACT PROSTHESIS (PLASTIC) -
SA
1871 SA5199B OTHER. INSERTION OR REPLACEMENT OF BILLIARY TRACT PROSTHESIS (METALLIC) -
SA
1872 SA5201 DRAINAGE OF PANCREATIC CYST BY CATHETER - SA
1873 SA5211 CLOSED [ASPIRATION] [NEEDLE] [PERCUTANEOUS] BIOPSY OF PANCREAS - SA
1874 SA5212 OPEN BIOPSY OF PANCREAS - SA
1875 SA522 LOCAL EXCISION OR DESTRUCTION OF PANCREAS AND PANCREATIC DUCT - SA
1876 SA5222 OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF PANCREAS OR
PANCREATIC DUCT - SA
1877 SA523 MARSUPIALIZATION OF PANCREATIC CYST - SA
1878 SA5252 DISTAL PANCREATECTOMY - SA
1879 SA526 TOTAL PANCREATECTOMY - SA
1880 SA526A TOTAL PANCREATECTOMY A - SA
1881 SA527 RADICAL PANCREATICODUODENECTOMY - SA
1882 SA5296 ANASTOMOSIS OF PANCREAS - SA
1883 SA5300 UNILATERAL REPAIR OF INGUINAL HERNIA, NOT OTHERWISE SPECIFIED - SA
1884 SA5300P UNILATERAL REPAIR OF INGUINAL HERNIA, NOT OTHERWISE SPECIFIED-PRIMARY -
SA
1885 SA5300R UNILATERAL REPAIR OF INGUINAL HERNIA, NOT OTHERWISE SPECIFIED-RECURRENT
- SA
1886 SA5310 BILATERAL REPAIR OF INGUINAL HERNIA, NOT OTHERWISE SPECIFIED - SA
1887 SA5310R BILATERAL REPAIR OF INGUINAL HERNIA, NOT OTHERWISE SPECIFIED - RECURRENT
HERNIA - SA
1888 SA5321 UNILATERAL REPAIR OF FEMORAL HERNIA WITH GRAFT OR PROSTHESIS - SA
1889 SA5321R UNILATERAL REPAIR OF FEMORAL HERNIA WITH GRAFT OR PROSTHESIS-RECURRENT
- SA
1890 SA5329 OTHER UNILATERAL FEMORAL HERNIORRHAPHY - SA
1891 SA5341 OTHER AND OPEN REPAIR OF UMBILICAL HERNIA WITH GRAFT OR PROSTHESIS - SA

1892 SA5351 INCISIONAL HERNIA REPAIR - SA

1893 SA5361 OTHER OPEN INCISIONAL HERNIA REPAIR WITH GRAFT OR PROSTHESIS - SA
1894 SA5369 OTHER AND OPEN REPAIR OF OTHER HERNIA OF ANTERIOR ABDOMINAL WALL WITH
GRAFT OR PROSTHESIS - SA
1895 SA5371 LAPAROSCOPIC REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH - SA

1896 SA5371R LAPAROSCOPIC REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH

(REPAIR) - SA
1897 SA5372 OTHER AND OPEN REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH - SA

1898 SA5372A OTHER AND OPEN REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH -
CONGENITAL - SA
1899 SA5372C OTHER AND OPEN REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH
(COMPLEX) - SA
1900 SA5375 REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH, NOT OTHERWISE
SPECIFIED - SA
1901 SA5375A REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH, NOT OTHERWISE
SPECIFIED (COMPLEX) - SA
1902 SA5380 REPAIR OF DIAPHRAGMATIC HERNIA WITH THORACIC APPROACH, NOT OTHERWISE
SPECIFIED - SA
1903 SA5381 PLICATION OF THE DIAPHRAGM - SA
1904 SA5381A PLICATION OF THE DIAPHRAGM (TRANSABDOMINAL ANTI-REFLUX OP) - SA
1905 SA5381R PLICATION OF THE DIAPHRAGM-REVISION - SA
1906 SA5411 EXPLORATORY LAPAROTOMY - SA
1907 SA5412 REOPENING OF RECENT LAPAROTOMY SITE - SA
1908 SA5419 OTHER LAPAROTOMY - SA
1909 SA544A EXCISION OR DESTRUCTION OF PERITONEAL TISSUE - OMENTUM - SA
1910 SA544B EXCISION OR DESTRUCTION OF PERITONEAL TISSUE - PRESACRAL TUMOUR - SA

1911 SA5451 LAPAROSCOPIC LYSIS OF PERITONEAL ADHESIONS - SA

1912 SA5459 OTHER LYSIS OF PERITONEAL ADHESIONS - SA
1913 SA5461 RECLOSURE OF POSTOPERATIVE DISRUPTION OF ABDOMINAL WALL - SA
1914 SA5491 PERCUTANEOUS ABDOMINAL DRAINAGE - SA
1915 SA5494 CREATION OF PERITONEOVASCULAR SHUNT - SA
1916 SA5494A CREATION OF PERITONEOVASCULAR SHUNT (COMPLEX) - SA
1917 SA5495 INCISION OF PERITONEUM - SA
1918 SA5496 INJECTION OF AIR INTO PERITONEAL CAVITY - SA
1919 SA5501 NEPHROTOMY - SA
1920 SA5501A NEPHROTOMY. NEPHROLITHOTOMY - SA
1921 SA5502 NEPHROSTOMY (PERCUTANEOUS INSERTION OF NEPHROSTOMY TUBE) SA
1922 SA5502A NEPHROSTOMY SA
1923 SA5503 PERCUTANEOUS NEPHROSTOMY WITHOUT FRAGMENTATION - SA
1924 SA5504 PERCUTANEOUS NEPHROSTOMY WITH FRAGMENTATION - SA
1925 SA5512 PYELOSTOMY (DRAINAGE OF PYONEPHROSIS/PERINEPHRIC ABSCESS) - SA
1926 SA5512A PYELOSTOMY (PERCUTANEOUS PYELYSIS) - SA
1927 SA5523 CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF KIDNEY - SA
1928 SA5523A CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF KIDNEY (DIAGNOSTIC ENDOSCOPIC
EXAM) - SA
1929 SA554 PARTIAL NEPHRECTOMY - SA
1930 SA5551 NEPHROURETERECTOMY - SA
1931 SA5551A NEPHROURETERECTOMY - NEPHRECTOMY + PERIRENAL TISSUE - SA
1932 SA5551B NEPHROURETERECTOMY - LAPAROSCOPIC NEPHRECTOMY - SA
1933 SA5553 REMOVAL OF TRANSPLANTED OR REJECTED KIDNEY - SA
1934 SA5554 BILATERAL NEPHRECTOMY - SA
1935 SA5569 OTHER KIDNEY TRANSPLANTATION - SA
1936 SA5581 SUTURE OF LACERATION OF KIDNEY - SA
1937 SA5589 RENAL REPAIR NEC - SA
1938 SA5599 RENAL OPERATION NEC - SA
1939 SA560 TRANSURETHRAL REMOVAL OF OBSTRUCTION FROM URETER AND RENAL PELVIS - SA

1940 SA561 URETERAL MEATOTOMY - SA

1941 SA562 URETEROTOMY - SA
1942 SA5631 URETEROSCOPY - SA
1943 SA564 URETERECTOMY - SA
1944 SA5651 FORMATION OF CUTANEOUS URETERO-ILEOSTOMY - ILEAL CONDUIT - SA
1945 SA5651A FORMATION OF CUTANEOUS URETERO-ILEOSTOMY - SA
1946 SA5671 URINARY DIVERSION TO INTESTINE - SA
1947 SA5674 URETERONEOCYSTOSTOMY - SA
1948 SA5679 URETERAL ANASTOMOSIS NEC - SA
1949 SA5683 CLOSURE OF URETEROSTOMY - SA
1950 SA5684 CLOSURE OF OTHER FISTULA OF URETER - SA
1951 SA5689 OTHER REPAIR OF URETER - SA
1952 SA570 TRANSURETHRAL CLEARANCE OF BLADDER - SA
1953 SA5717 PERCUTANEOUS CYSTOSTOMY - SA
1954 SA5718 OTHER SUPRAPUBIC CYSTOSTOMY - SA
1955 SA5718A PERCUTANEOUS CYSTOSTOMY + SUPRAPUBIC TUBE - SA
1956 SA5719 OTHER CYSTOTOMY - SA
1957 SA5719E TRANSURETHRAL CLEARANCE OF BLADDER-ENDOSCOPIC VESICO-LITHOTRIPSY - SA

1958 SA5731 CYSTOSCOPY THROUGH ARTIFICIAL STOMA - SA

1959 SA5733 CLOSED [TRANSURETHRAL] BIOPSY OF BLADDER - SA
1960 SA5749 OTHER TRANSURETHRAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF
BLADDER - SA
1961 SA5749A OTHER TRANSURETHRAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF
BLADDER - DIVERTICULECTOMY - SA
1962 SA5749B OTHER TRANSURETHRAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF
BLADDER - RESECTION - SA
1963 SA5749C OTHER TRANSURETHRAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF
BLADDER - DESTRUCTION - SA
1964 SA5749F OTHER TRANSURETHRAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF
BLADDER - FEMALE - SA
1965 SA5749M OTHER TRANSURETHRAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF
BLADDER - MALE - SA
1966 SA5759 OPEN EXCISION OR DESTRUCTION OF OTHER LESION OR TISSUE OF BLADDER - SA

1967 SA576 PARTIAL CYSTECTOMY - SA

1968 SA577 TOTAL CYSTECTOMY - SA
1969 SA5782 CLOSURE OF CYSTOSTOMY - SA
1970 SA5783 REPAIR OF FISTULA INVOLVING BLADDER AND INTESTINE - SA
1971 SA5784 REPAIR OF OTHER FISTULA OF BLADDER - SA
1972 SA5784A REPAIR OF OTHER FISTULA OF BLADDER - CUTANEOUS VESICAL FISTULA - SA
1973 SA5784B REPAIR OF OTHER FISTULA OF BLADDER - URETHRORECTAL FISTULA - SA
1974 SA5785 CYSTOURETHROPLASTY AND PLASTIC REPAIR OF BLADDER NECK - SA
1975 SA5787 RECONSTRUCTION OF URINARY BLADDER - UNILATERAL - SA
1976 SA5787A RECONSTRUCTION OF URINARY BLADDER - BILATERAL - SA
1977 SA5787B RECONSTRUCTION OF URINARY BLADDER (CONTINENT POUCH/NEO BLADDER) - SA

1978 SA5789 OTHER REPAIR OF BLADDER - SA

1979 SA5789A OTHER REPAIR OF BLADDER - ENDOSCOPIC ANTI-REFLUX PROCEDURE (AND
BILATERAL) - SA
1980 SA5789B OTHER REPAIR OF BLADDER - VAGINAL OPERATION FOR BLADDER - SA
1981 SA5789C OTHER REPAIR OF BLADDER (COMPLEX) - SA
1982 SA5791 SPHINCTEROTOMY OF BLADDER - SA
1983 SA5791A SPHINCTEROTOMY OF BLADDER (RESECTION OF BLADDER NECK) - SA
1984 SA5792 DILATION OF BLADDER NECK - SA
1985 SA580 URETHROTOMY - SA
1986 SA580A URETHROTOMY - INCLUDE CYSTOSCOPY - SA
1987 SA581 URETHRAL MEATOTOMY - SA
1988 SA581E URETHRAL MEATOTOMY - ENDOSCOPIC - SA
1989 SA5822 OTHER URETHROSCOPY - SA
1990 SA5831 ENDOSCOPIC EXCISION OR DESTRUCTION OF LESION OR TISSUE OF URETHRA - SA

1991 SA5839 OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF URETHRA - SA

1992 SA5839A OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF URETHRA -

URETHRECTOMY - SA
1993 SA5839B OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF URETHRA -
VALVE RESECTION - SA
1994 SA5839C OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF URETHRA -
DIVERTICULECTOMY - SA
1995 SA5839D OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF URETHRA -
PROLAPSE URETHRA - SA
1996 SA5843 CLOSURE OF OTHER FISTULA OF URETHRA - SA
1997 SA5843A CLOSURE OF OTHER FISTULA OF URETHRA - REPAIR OF URETHRO-VAGINAL FISTULA -
SA
1998 SA5845 REPAIR OF HYPOSPADIAS OR EPISPADIAS - SA
1999 SA5845EA REPAIR OF HYPOSPADIAS OR EPISPADIAS - GLANDULAR HYPOSPADIA - SA
2000 SA5845EB REPAIR OF HYPOSPADIAS OR EPISPADIAS - CORPORAL HYPOSPADIA - SA
2001 SA5845EC REPAIR OF HYPOSPADIAS OR EPISPADIAS - PERINEAL HYPOSPADIA - SA
2002 SA5846 OTHER RECONSTRUCTION OF URETHRA - SA
2003 SA5846A OTHER RECONSTRUCTION OF URETHRA-URETHROCELE - SA
2004 SA5846B OTHER RECONSTRUCTION OF URETHRA (COMPLEX) - SA
2005 SA5847 URETHRAL MEATOPLASTY - SA
2006 SA586 DILATION OF URETHRA - SA
2007 SA5900 RETROPERITONEAL DISSECTION, NOT OTHERWISE SPECIFIED - SA
2008 SA5902 OTHER LYSIS OF PERIRENAL OR PERIURETERAL ADHESIONS - SA
2009 SA5902B OTHER LYSIS OF PERIRENAL OR PERIURETERAL ADHESIONS - BILATERAL - SA
2010 SA594 SUPRAPUBIC SLING OPERATION - SA
2011 SA595 RETROPUBIC URETHRAL SUSPENSION - SA
2012 SA598 URETERAL CATHETERIZATION - SA
2013 SA598A URETERAL CATHETERIZATION - DRAINAGE OF KIDNEY - SA
2014 SA600 INCISION OF PROSTATE - SA
2015 SA6011 CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF PROSTATE - SA
2016 SA6012 OPEN BIOPSY OF PROSTATE - SA
2017 SA6018 OTHER DIAGNOSTIC PROCEDURES ON PROSTATE AND PERIPROSTATIC TISSUE - SA

2018 SA6029 OTHER TRANSURETHRAL PROSTATECTOMY - SA

2019 SA605 RADICAL PROSTATECTOMY - SA
2020 SA6061 LOCAL EXCISION OF LESION OF PROSTATE - SA
2021 SA6079 OTHER OPERATIONS ON SEMINAL VESICLES - SA
2022 SA6095 TRANSURETHRAL BALLOON DILATION OF THE PROSTATIC URETHRA - SA
2023 SA6096 TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE BY MICROWAVE
THERMOTHERAPY - SA
2024 SA6097 OTHER TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE BY OTHER
THERMOTHERAPY - SA
2025 SA612 EXCISION OF HYDROCELE (OF TUNICA VAGINALIS) - SA
2026 SA6212 OPEN BIOPSY OF TESTIS - SA
2027 SA6219 OTHER DIAGNOSTIC PROCEDURES ON TESTES - SA
2028 SA622 EXCISION OR DESTRUCTION OF TESTICULAR LESION - SA
2029 SA623 UNILATERAL ORCHIECTOMY - SA
2030 SA623L UNILATERAL ORCHIECTOMY - LAPAROSCOPIC - SA
2031 SA6241 REMOVAL OF BOTH TESTES AT SAME OPERATIVE EPISODE - SA
2032 SA625 ORCHIOPEXY - SA
2033 SA625A ORCHIOPEXY - MICROVASCULAR TRANSFER OF TESTIS TO SCROTUM - SA
2034 SA625B ORCHIOPEXY - BILATERAL FIXATION OF TESTIS - SA
2035 SA625C ORCHIOPEXY - ABDOMINAL UNDESCENDED TESTIS - SA
2036 SA625D ORCHIOPEXY - FIXATION OF TESTIS - SA
2037 SA627 INSERTION OF TESTICULAR PROSTHESIS - SA
2038 SA631 EXCISION OF VARICOCELE AND HYDROCELE OF SPERMATIC CORD - SA
2039 SA632 EXCISION OF CYST OF EPIDIDYMIS - SA
2040 SA634 EPIDIDYMECTOMY - SA
2041 SA634B EPIDIDYMECTOMY-BILATERAL - SA
2042 SA640 CIRCUMCISION - SA
2043 SA6411 BIOPSY OF PENIS - SA
2044 SA643 AMPUTATION OF PENIS - SA
2045 SA643P AMPUTATION OF PENIS-PARTIAL - SA
2046 SA6444 RECONSTRUCTION OF PENIS - SA
2047 SA6445 REPLANTATION OF PENIS - SA
2048 SA6449 OTHER REPAIR OF PENIS - SA
2049 SA6493 DIVISION OF PENILE ADHESIONS - SA
2050 SA6493P DIVISION OF PENILE ADHESIONS-PEYRONIE"S - SA
2051 SA6521 MARSUPIALIZATION OF OVARIAN CYST - SA
2052 SA6523 LAPAROSCOPIC MARSUPIALIZATION OF OVARIAN CYST - SA
2053 SA6525 OTHER LAPAROSCOPIC LOCAL EXCISION OR DESTRUCTION OF OVARY - SA
2054 SA6549 OTHER UNILATERAL SALPINGO-OOPHORECTOMY - SA
2055 SA6561 OTHER REMOVAL OF BOTH OVARIES AND TUBES AT SAME OPERATIVE EPISODE - SA

2056 SA6622A BILATERAL ENDOSCOPIC LIGATION AND DIVISION OF FALLOPIAN TUBES - SA

2057 SA6631 OTHER BILATERAL LIGATION AND CRUSHING OF FALLOPIAN TUBES / STERILIZATION
- SA
2058 SA6632A OTHER BILATERAL LIGATION AND DIVISION OF FALLOPIAN TUBES. POMEROY
OPERATION - SA
2059 SA6711 ENDOCERVICAL BIOPSY - SA
2060 SA6712 OTHER CERVICAL BIOPSY - SA
2061 SA6712C OTHER CERVICAL BIOPSY (COMPLEX) - SA
2062 SA672 CONIZATION OF CERVIX - SA
2063 SA6732 DESTRUCTION OF LESION OF CERVIX BY CAUTERIZATION - SA
2064 SA674 AMPUTATION OF CERVIX - SA
2065 SA6812 HYSTEROSCOPY - SA
2066 SA6813 OPEN BIOPSY OF UTERUS - SA
2067 SA6823 ENDOMETRIAL ABLATION - SA
2068 SA6829 OTHER EXCISION OR DESTRUCTION OF LESION OF UTERUS - SA
2069 SA6839 OTHER AND UNSPECIFIED SUBTOTAL ABDOMINAL HYSTERECTOMY - SA
2070 SA6849 OTHER AND UNSPECIFIED TOTAL ABDOMINAL HYSTERECTOMY - SA
2071 SA6849A OTHER AND UNSPECIFIED TOTAL ABDOMINAL HYSTERECTOMY + REMOVAL OF
ADNEXA - SA
2072 SA6849B OTHER AND UNSPECIFIED TOTAL ABDOMINAL HYSTERECTOMY + REMOVAL OF
ADNEXA (OVARIAN) - SA
2073 SA6851 LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY (LAVH) - SA
2074 SA6859 OTHER AND UNSPECIFIED VAGINAL HYSTERECTOMY - SA
2075 SA6869 OTHER AND UNSPECIFIED RADICAL ABDOMINAL HYSTERECTOMY - SA
2076 SA688 PELVIC EVISCERATION - SA
2077 SA688A PELVIC EVISCERATION - ANTERIOR/POSTERIOR - SA
2078 SA689 OTHER AND UNSPECIFIED HYSTERECTOMY - SA
2079 SA6902 DILATION AND CURETTAGE FOLLOWING DELIVERY OR ABORTION - SA
2080 SA6909 OTHER DILATION AND CURETTAGE - SA
2081 SA6922 OTHER UTERINE SUSPENSION - SA
2082 SA6923 VAGINAL REPAIR OF CHRONIC INVERSION OF UTERUS - SA
2083 SA6929 OTHER REPAIR OF UTERUS AND SUPPORTING STRUCTURES - SA
2084 SA6949 OTHER REPAIR OF UTERUS - SA
2085 SA7013 LYSIS OF INTRALUMINAL ADHESIONS OF VAGINA - SA
2086 SA7014 OTHER VAGINOTOMY - SA
2087 SA7033 EXCISION OR DESTRUCTION OF LESION OF VAGINA - SA
2088 SA7051 REPAIR OF CYSTOCELE - SA
2089 SA7051A REPAIR OF CYSTOCELE-CERVIX UTERI - SA
2090 SA7051B REPAIR OF CYSTOCELE-VAGINAL HYSTERECTOMY - SA
2091 SA7052 REPAIR OF RECTOCELE - SA
2092 SA7062 VAGINAL RECONSTRUCTION - SA
2093 SA7073 REPAIR OF RECTOVAGINAL FISTULA - SA
2094 SA708 OBLITERATION OF VAGINAL VAULT - SA
2095 SA7123 MARSUPIALIZATION OF BARTHOLIN"S GLAND (CYST) - SA
2096 SA7124 EXCISION OR OTHER DESTRUCTION OF BARTHOLIN"S GLAND (CYST) - SA
2097 SA713 OTHER LOCAL EXCISION OR DESTRUCTION OF VULVA AND PERINEUM - SA
2098 SA715 RADICAL VULVECTOMY - SA
2099 SA7161 UNILATERAL VULVECTOMY - SA
2100 SA7179 OTHER REPAIR OF VULVA AND PERINEUM - SA
2101 SA718 OTHER OPERATIONS ON VULVA - SA
2102 SA7279 OTHER VACUUM EXTRACTION - SA
2103 SA7359 OTHER MANUALLY ASSISTED DELIVERY - SA
2104 SA740 CLASSICAL CESAREAN SECTION - SA
2105 SA741 LOW CERVICAL CESAREAN SECTION - SA
2106 SA7411 LOW CERVICAL CESAREAN SECTION -OPERATOR KE-2 - SA
2107 SA741A LOW CERVICAL CESAREAN SECTION (2-4BED) - SA
2108 SA742 EXTRAPERITONEAL CESAREAN SECTION - SA
2109 SA743 REMOVAL OF EXTRATUBAL ECTOPIC PREGNANCY - SA
2110 SA744 CESAREAN SECTION OF OTHER SPECIFIED TYPE - SA
2111 SA744LC CESAREAN SECTION OF OTHER SPECIFIED TYPE - GEMILI - SA
2112 SA7491 HYSTEROTOMY TO TERMINATE PREGNANCY - SA
2113 SA7499 OTHER CESAREAN SECTION OF UNSPECIFIED TYPE - SA
2114 SA752 INTRAUTERINE TRANSFUSION - SA
2115 SA7562 REPAIR OF CURRENT OBSTETRIC LACERATION OF RECTUM AND SPHINCTER ANI - SA

2116 SA7569 REPAIR OF OTHER CURRENT OBSTETRIC LACERATION - SA

2117 SA7611 BIOPSY OF FACIAL BONE - SA
2118 SA762 LOCAL EXCISION OR DESTRUCTION OF LESION OF FACIAL BONE (EXCISION OF
MAXILLA) - SA
2119 SA762A LOCAL EXCISION OR DESTRUCTION OF LESION OF FACIAL BONE-EXTENSIVE
EXCISION MANDIBLE - SA
2120 SA762B LOCAL EXCISION OR DESTRUCTION OF LESION OF FACIAL BONE - FACIAL BONE
TUMOUR - SA
2121 SA762C LOCAL EXCISION OR DESTRUCTION OF LESION OF FACIAL BONE-TUMOUR - SA
2122 SA762D LOCAL EXCISION OR DESTRUCTION OF LESION OF FACIAL BONE (EXCISION OF
LESION OF JAW) - SA
2123 SA7631 PARTIAL MANDIBULECTOMY - SA
2124 SA7631A PARTIAL MANDIBULECTOMY-SEGMENTAL/MARGINAL - SA
2125 SA7631B PARTIAL MANDIBULECTOMY-WITH RECONSTRUCTION - SA
2126 SA7639 PARTIAL OSTECTOMY OF OTHER FACIAL BONE - SA
2127 SA7639A PARTIAL OSTECTOMY OF OTHER FACIAL BONE-HEMIMAXILLECTOMY - SA
2128 SA7639C PARTIAL OSTECTOMY OF OTHER FACIAL BONE-MAXILLECTOMY - SA
2129 SA7641 TOTAL MANDIBULECTOMY WITH SYNCHRONOUS RECONSTRUCTION - SA
2130 SA7642 OTHER TOTAL MANDIBULECTOMY - SA
2131 SA7643 OTHER RECONSTRUCTION OF MANDIBLE - SA
2132 SA7644 TOTAL OSTECTOMY OF OTHER FACIAL BONE WITH SYNCHRONOUS
RECONSTRUCTION - SA
2133 SA765 TEMPOROMANDIBULAR ARTHROPLASTY - SA
2134 SA7661 CLOSED OSTEOPLASTY [OSTEOTOMY] OF MANDIBULAR RAMUS - SA
2135 SA767 REDUCTION OF FACIAL FRACTURE. INCLUDES INTERNAL FIXATION - SA
2136 SA7670 REDUCTION OF FACIAL FRACTURE, NOT OTHERWISE SPECIFIED - SA
2137 SA7670A REDUCTION OF FACIAL FRACTURE, NOT OTHERWISE SPECIFIED- TRANS ORAL
SURGERY WITH POST. FIXATION - SA
2138 SA7671 CLOSED REDUCTION OF MALAR AND ZYGOMATIC FRACTURE - SA
2139 SA7672 OPEN REDUCTION OF MALAR AND ZYGOMATIC FRACTURE - SA
2140 SA7673 CLOSED REDUCTION OF MAXILLARY FRACTURE - SA
2141 SA7674 OPEN REDUCTION OF MAXILLARY FRACTURE - SA
2142 SA7675 CLOSED REDUCTION OF MANDIBULAR FRACTURE - SA
2143 SA7675A CLOSED REDUCTION OF MANDIBULAR FRACTURE (EXTRA) - SA
2144 SA7676 OPEN REDUCTION OF MANDIBULAR FRACTURE - SA
2145 SA7676A OPEN REDUCTION OF MANDIBULAR FRACTURE (RAISED WIRING MANDIBLE /
MAXILLA) - SA
2146 SA7677 OPEN REDUCTION OF ALVEOLAR FRACTURE - SA
2147 SA7679 OTHER OPEN REDUCTION OF FACIAL FRACTURE - SA
2148 SA7691 BONE GRAFT TO FACIAL BONE - SA
2149 SA7692 INSERTION OF SYNTHETIC IMPLANT IN FACIAL BONE - SA
2150 SA7693 CLOSED REDUCTION OF TEMPOROMANDIBULAR DISLOCATION - SA
2151 SA7695 OTHER MANIPULATION OF TEMPOROMANDIBULAR JOINT - SA
2152 SA7696 INJECTION OF THERAPEUTIC SUBSTANCE INTO TEMPOROMANDIBULAR JOINT - SA

2153 SA7697 REMOVAL OF INTERNAL FIXATION DEVICE FROM FACIAL BONE (FIXATOR MAXILLA) -
SA
2154 SA7700 SEQUESTRECTOMY UNSPECIFIED SITE - SA
2155 SA7720 WEDGE OSTEOTOMY-UNSPECIFIED SITE - SA
2156 SA7728 WEDGE OSTEOTOMY - TARSAL/METATARSAL - SA
2157 SA7728A WEDGE OSTEOTOMY - TARSAL/METATARSAL (CLOSING) - SA
2158 SA7740 BIOPSY OF BONE, UNSPECIFIED SITE - SA
2159 SA7751 BUNIONECTOMY WITH SOFT TISSUE CORRECTION AND OSTEOTOMY OF THE FIRST
METATARSAL - SA
2160 SA7751A BUNIONECTOMY WITH SOFT TISSUE CORRECTION AND OSTEOTOMY OF THE FIRST
METATARSAL (CORRECTION MINOR) - SA
2161 SA7751B BUNIONECTOMY WITH SOFT TISSUE CORRECTION AND OSTEOTOMY OF THE FIRST
METATARSAL - BILATERAL - SA
2162 SA7752 BUNIONECTOMY WITH SOFT TISSUE CORRECTION AND ARTHRODESIS - SA
2163 SA7753 OTHER BUNIONECTOMY WITH SOFT TISSUE CORRECTION - SA
2164 SA7753B OTHER BUNIONECTOMY WITH SOFT TISSUE CORRECTION - BILATERAL - SA
2165 SA7754 EXCISION OR CORRECTION OF BUNIONETTE - SA
2166 SA7754A EXCISION OR CORRECTION OF BUNIONETTE-SIMPLE BILATERAL - SA
2167 SA7754B EXCISION OR CORRECTION OF BUNIONETTE-BILATERAL - SA
2168 SA7757 REPAIR OF CLAW TOE - SA
2169 SA7759 OTHER BUNIONECTOMY - SA
2170 SA7759A OTHER BUNIONECTOMY-KELLER"S UNILATERAL - SA
2171 SA7759B OTHER BUNIONECTOMY-KELLER"S BILATERAL - SA
2172 SA776 LOCAL EXCISION OF LESION OR TISSUE OF BONE - SA
2173 SA7761 LOCAL EXCISION OF LESION OR TISSUE OF BONE-CLAVICLE - SA
2174 SA7769 LOCAL EXCISION OF LESION OR TISSUE OF BONE-PELVIS - SA
2175 SA7788 OTHER PARTIAL OSTECTOMY-TARSAL - SA
2176 SA7790 TOTAL OSTECTOMY-UNSPECIFIED SITE - SA
2177 SA7800 BONE GRAFT-UNSPECIFIED SITE - SA
2178 SA7800A BONE GRAFT-UNSPECIFIED SITE (COMPLEX) - SA
2179 SA7801 BONE GRAFT-CLAVICLE, SCAPULA - SA
2180 SA7804 BONE GRAFT-CARPAL - SA
2181 SA781 APPLICATION OF EXTERNAL FIXATOR DEVICE - SA
2182 SA7810 APPLICATION OF EXTERNAL FIXATOR DEVICE-UNSPECIFIED SITE - SA
2183 SA7820E LIMB SHORTENING PROCEDURES-UNSPECIFIED SITE, EPIPHYSIS - SA
2184 SA7829 LIMB SHORTENING PROCEDURES-PELVIC - SA
2185 SA7829H LIMB SHORTENING PROCEDURES-HIP - SA
2186 SA7850 INTERNAL FIXATION OF BONE WITHOUT FRACTURE REDUCTION-NAILLING - SA
2187 SA7850A INTERNAL FIXATION OF BONE WITHOUT FRACTURE REDUCTION-LOCKED
INTRAMEDULLARY NAILING - SA
2188 SA7850B INTERNAL FIXATION OF BONE WITHOUT FRACTURE REDUCTION-NAILLING
(MULTIPLE FRACTURE FIXATION) - SA
2189 SA7860F REMOVAL OF EXTERNAL IMMOBILIZATION DEVICE (EXTERNAL FIXATION FROM
BONE) - SA
2190 SA7860K REMOVAL OF IMPLANTED DEVICES FROM BONE-K-WIRE, UNSPECIFIED SITE - SA
2191 SA7860T REMOVAL OF EXTERNAL IMMOBILIZATION DEVICE (SKELETAL TRACTION FROM
BONE) - SA
2192 SA7900 CLOSED REDUCTION OF FRACTURE WITHOUT INTERNAL FIXATION-UNSPECIFIED
SITE - SA
2193 SA791 CLOSED REDUCTION OF FRACTURE WITH INTERNAL FIXATION - SA
2194 SA7930 OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION-UNSPECIFIED SITE - SA

2195 SA7931 OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION HUMERUS - SMALL BONE
- SA
2196 SA7931A OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION HUMERUS - LONG BONE -
SA
2197 SA7931C OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION HUMERUS (COMPLEX) -
SA
2198 SA7935 OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION-FEMUR - SA
2199 SA7939 OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION OTHER SPECIFIED BONE
- SA
2200 SA7939C OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION OTHER SPECIFIED BONE
(COMPLEX) - SA
2201 SA7980 OPEN REDUCTION OF DISLOCATION OF UNSPECIFIED SITE - SA
2202 SA7987 OPEN REDUCTION OF DISLOCATION OF ANKLE - SA
2203 SA8000 ARTHROTOMY FOR REMOVAL OF PROSTHESIS WITHOUT REPLACEMENT-UNSPECIFIED
SITE - SA
2204 SA8009 ARTHROTOMY FOR REMOVAL OF PROSTHESIS WITHOUT REPLACEMENT-SPINE - SA

2205 SA8020 ARTHROSCOPY - UNSPECIFIED SITE - SA

2206 SA8020A ARTHROSCOPY - UNSPECIFIED CAVITY UNILATERAL - SA
2207 SA8020B ARTHROSCOPY - UNSPECIFIED CAVITY BILATERAL - SA
2208 SA8020C ARTHROSCOPY - UNSPECIFIED CAVITY UNILATERAL (ARTICULAR CARTILAGE) - SA

2209 SA8021 ARTHROSCOPY - SHOULDER - SA

2210 SA8021R ARTHROSCOPY - REVISION SHOULDER - SA
2211 SA8026 ARTHROSCOPY - KNEE - SA
2212 SA8026A ARTHROSCOPY - KNEE EXTENSIVE - SA
2213 SA8026B ARTHROSCOPY - KNEE SEMILUNAR CARTILAGE - SA
2214 SA8026C ARTHROSCOPY - KNEE SEMILUNAR CARTILAGE BILATERAL - SA
2215 SA8030 BIOPSY OF JOINT STRUCTURE-UNSPECIFIED - SA
2216 SA8051 EXCISION OF INTERVERTEBRAL DISC - SA
2217 SA8051A EXCISION OF INTERVERTEBRAL DISC-POSTERIOR DECOMPRESSION W INSTRUMENT -
SA
2218 SA8051C EXCISION OF INTERVERTEBRAL DISC-CERVICAL - SA
2219 SA8051D EXCISION OF INTERVERTEBRAL DISC-CERVICAL WITH FUSION - SA
2220 SA8051E EXCISION OF INTERVERTEBRAL DISC-DISCECTOMY LASER - SA
2221 SA8051F EXCISION OF INTERVERTEBRAL DISC-ANTERIOR & POSTERIOR DECOMPRESSION W
INSTRUMENT - SA
2222 SA8051G EXCISION OF INTERVERTEBRAL DISC-OPEN DOOR LAMINOPLASTY CERVICAL REGION
(HIROBYASHI) - SA
2223 SA8052 INTERVERTEBRAL CHEMONUCLEOLYSIS - SA
2224 SA8054 OTHER AND UNSPECIFIED REPAIR OF THE ANULUS FIBROSUS - SA
2225 SA8054A OTHER AND UNSPECIFIED REPAIR OF THE ANULUS FIBROSUS (REVISION) - SA
2226 SA8059 OTHER DESTRUCTION OF INTERVERTEBRAL DISC - SA
2227 SA807 SYNOVECTOMY - SA
2228 SA8074 SYNOVECTOMY-HAND - SA
2229 SA8100 SPINAL FUSION, NOT OTHERWISE SPECIFIED - SA
2230 SA8100A SPINAL FUSION, NOS (PRIMARY POST/ANT DECOMPRESSION W FUSION) - SA
2231 SA8100B SPINAL FUSION, NOS (PRIMARY POST/ANT DECOMPRESSION W FUSION &
INSTRUMENT) - SA
2232 SA8100C SPINAL FUSION, NOS (PRIMARY POST/ANT. EXCISION DISC W FUSION AND OR
INSTRUMENT) - SA
2233 SA8100D SPINAL FUSION, NOS (COMBINED ANT. & POST. FUSION CERVICAL SPINE, W
INSTRUMENT) - SA
2234 SA8100E SPINAL FUSION, NOS (PRIMARY TRANSTHORACIC/POST./ANT.-LAT.EX. VERTEBRAL
DISC W FUSION) - SA
2235 SA8100F SPINAL FUSION, NOS (COMBINED ANT. & POST. DECOMPRESSION, W FUSION &
INSTRUMENT) - SA
2236 SA8100G SPINAL FUSION, NOS (REVISION POST. / ANT. DECOMPRESSION W FUSION) - SA

2237 SA8100H SPINAL FUSION, NOS (REVISION POST/ANT EXCISION INTERVERTEBRAL DISC W
FUSION AND/OR W INSTRUMENT) - SA
2238 SA8100I SPINAL FUSION, NOS (PRIMARY POST/ANT TRANSTHORACIC DECOMPRESSION W
FUSION AND/OR W INSTRUMENT) - SA
2239 SA8108 LUMBAR AND LUMBOSACRAL FUSION OF THE ANTERIOR COLUMN, POSTERIOR
TECHNIQUE - SA
2240 SA8115 TARSOMETATARSAL FUSION - SA
2241 SA8115B TARSOMETATARSAL FUSION-BILATERAL - SA
2242 SA8116 METATARSOPHALANGEAL FUSION - SA
2243 SA8120 ARTHRODESIS OF UNSPECIFIED JOINT - SA
2244 SA8126 METACARPOCARPAL FUSION - SA
2245 SA8128 INTERPHALANGEAL FUSION - SA
2246 SA8128B INTERPHALANGEAL FUSION-BILATERAL - SA
2247 SA8129 ARTHRODESIS OF OTHER SPECIFIED JOINTS - SA
2248 SA8129A ARTHRODESIS OF OTHER SPECIFIED JOINTS-TRIPLE FUSION - SA
2249 SA8144 PATELLAR STABILIZATION - SA
2250 SA8145 OTHER REPAIR OF THE CRUCIATE LIGAMENTS - SA
2251 SA8147 OTHER REPAIR OF KNEE - SA
2252 SA8149 OTHER REPAIR OF ANKLE - SA
2253 SA8149B OTHER REPAIR OF ANKLE-BILATERAL - SA
2254 SA8151 TOTAL HIP REPLACEMENT - SA
2255 SA8151A TOTAL HIP REPLACEMENT-BILATERAL - SA
2256 SA8153 REVISION OF HIP REPLACEMENT, NOT OTHERWISE SPECIFIED - SA
2257 SA8154 TOTAL KNEE REPLACEMENT - SA
2258 SA8154B TOTAL KNEE REPLACEMENT-BILATERAL - SA
2259 SA8154C TOTAL KNEE REPLACEMENT-UNICOMPARTMENTAL - SA
2260 SA8155 REVISION OF KNEE REPLACEMENT,NOT OTHERWISE SPECIFIED - SA
2261 SA8156 TOTAL ANKLE REPLACEMENT - SA
2262 SA8157 REPLACEMENT OF JOINT OF FOOT AND TOE - SA
2263 SA8159 REVISION OF JOINT REPLACEMENT OF LOWER EXTREMITY, NOT ELSEWHERE
CLASSIFIED - SA
2264 SA8165A PERCUTANEOUS VERTEBROPLASTY-CT GUIDE - SA
2265 SA8165B PERCUTANEOUS VERTEBROPLASTY-FLUOROSCOPICALLY GUIDE - SA
2266 SA8166A PERCUTANEOUS VERTEBRAL AUGMENTATION-POSTERIOR - SA
2267 SA8166B PERCUTANEOUS VERTEBRAL AUGMENTATION-ANTERIOR - SA
2268 SA8173 TOTAL WRIST REPLACEMENT - SA
2269 SA8179 OTHER REPAIR OF HAND, FINGERS AND WRIST - SA
2270 SA8180 OTHER TOTAL SHOULDER REPLACEMENT - SA
2271 SA8180R TOTAL SHOULDER REPLACEMENT-REVISION - SA
2272 SA8181 PARTIAL SHOULDER REPLACEMENT - SA
2273 SA8181R PARTIAL SHOULDER REPLACEMENT-REVISION - SA
2274 SA8184 TOTAL ELBOW REPLACEMENT - SA
2275 SA8184R TOTAL ELBOW REPLACEMENT-REVISION - SA
2276 SA8190S OTHER REPAIR OF JOINT-STABILIZATION - SA
2277 SA8191 ARTHROCENTESIS - SA
2278 SA8192 INJECTION OF THERAPEUTIC SUBSTANCE INTO JOINT OR LIGAMENT - SA
2279 SA8192A INJECTION OF THERAPEUTIC SUBSTANCE INTO JOINT OR LIGAMENT-FACET - SA
2280 SA8192X INJECTION OF THERAPEUTIC SUBSTANCE INTO JOINT OR LIGAMENT-XRAY - SA
2281 SA8193 SUTURE OF CAPSULE OR LIGAMENT OF UPPER EXTREMITY (ARCOMIOPLASTY) - SA
2282 SA8193A SUTURE OF CAPSULE OR LIGAMENT OF UPPER EXTREMITY (PRIMARY / SECONDARY) -
SA
2283 SA8196 OTHER REPAIR OF JOINT - SA
2284 SA8196A OTHER REPAIR OF JOINT (RECONSTRUCTION) - SA
2285 SA8201 EXPLORATION OF TENDON SHEATH OF HAND - SA
2286 SA8211 TENOTOMY OF HAND - SA
2287 SA8221 EXCISION OF LESION OF TENDON SHEATH OF HAND - SA
2288 SA8229 EXCISION OF OTHER LESION OF SOFT TISSUE OF HAND (FASCIA) - SA
2289 SA8229A EXCISION OF OTHER LESION OF SOFT TISSUE OF HAND (TENDON) - SA
2290 SA8233 OTHER TENONECTOMY OF HAND - SA
2291 SA8235 OTHER FASCIECTOMY OF HAND - SA
2292 SA8235A OTHER FASCIECTOMY OF HAND-DERMOFASCIECTOMY - SA
2293 SA8235B OTHER FASCIECTOMY OF HAND-MULTIPLE - SA
2294 SA8256 OTHER HAND TENDON TRANSFER OR TRANSPLANTATION - SA
2295 SA8261 POLLICIZATION OPERATION CARRYING OVER NERVES AND BLOOD SUPPLY - SA
2296 SA8279 PLASTIC OPERATION ON HAND WITH OTHER GRAFT OR IMPLANT - SA
2297 SA8279E PLASTIC OPERATION ON HAND WITH OTHER GRAFT OR IMPLANT-EXTENSOR - SA

2298 SA8279F PLASTIC OPERATION ON HAND WITH OTHER GRAFT OR IMPLANT-FLEXOR - SA

2299 SA8285 OTHER TENODESIS OF HAND - SA
2300 SA8286A OTHER TENOPLASTY OF HAND - WITH IMPLANT - SA
2301 SA8286C OTHER TENOPLASTY OF HAND - EXCLUDE FLEXOR - SA
2302 SA8302S MYOTOMY-SHOULDER - SA
2303 SA8303 BURSOTOMY - SA
2304 SA8313 OTHER TENOTOMY - SA
2305 SA8314 DUPUYTREN"S SUBCUTANEOUS FASCIOTOMY - SA
2306 SA8314A RELEASE FASCIOTOMY OF ANT./POST. COMPARTMENT OF LEG - SA
2307 SA8319 OTHER DIVISION OF SOFT TISSUE - SA
2308 SA8321 OPEN BIOPSY OF SOFT TISSUE - SA
2309 SA8321A OPEN BIOPSY OF SOFT TISSUE (ONCOLOGY) - SA
2310 SA8331 EXCISION OF LESION OF TENDON SHEATH - SA
2311 SA8343 EXCISION OF MUSCLE OR FASCIA FOR GRAFT - SA
2312 SA8344 OTHER FASCIECTOMY - SA
2313 SA835 BURSECTOMY - SA
2314 SA8363 ROTATOR CUFF REPAIR - SA
2315 SA8364A OTHER SUTURE OF TENDON-ACHILLORAPHY - SA
2316 SA8364B OTHER SUTURE OF TENDON-ACHILLORAPHY 2ND - SA
2317 SA837 RECONSTRUCTION OF MUSCLE AND TENDON - SA
2318 SA8375 TENDON TRANSFER OR TRANSPLANTATION - SA
2319 SA8375M TENDON TRANSFER OR TRANSPLANTATION-MULTIPLE - SA
2320 SA8388 OTHER PLASTIC OPERATIONS ON TENDON - SA
2321 SA8398 INJECTION OF LOCALLY-ACTING THERAPEUTIC SUBSTANCE INTO OTHER SOFT
TISSUE - SA
2322 SA8399 OTHER OPERATIONS ON MUSCLE, TENDON, FASCIA, AND BURSA - SA
2323 SA8400 UPPER LIMB AMPUTATION, NOT OTHERWISE SPECIFIED - SA
2324 SA8401 AMPUTATION AND DISARTICULATION OF FINGER - SA
2325 SA8403 AMPUTATION THROUGH HAND - SA
2326 SA8405 AMPUTATION THROUGH FOREARM - SA
2327 SA8409 INTERTHORACOSCAPULAR AMPUTATION - SA
2328 SA8411 AMPUTATION OF TOE - SA
2329 SA8412 AMPUTATION THROUGH FOOT - SA
2330 SA8418 DISARTICULATION OF HIP - SA
2331 SA8419 ABDOMINOPELVIC AMPUTATION - SA
2332 SA8422 FINGER REATTACHMENT - SA
2333 SA844 IMPLANTATION OR FITTING OF PROSTHETIC LIMB DEVICE - SA
2334 SA8440 IMPLANTATION OR FITTING OF PROSTHETIC LIMB DEVICE, NOT OTHERWISE
SPECIFIED - SA
2335 SA8440A IMPLANTATION OR FITTING OF PROSTHETIC LIMB DEVICE, NOT OTHERWISE
SPECIFIED - ARTHROPLASTY - SA
2336 SA8459 INSERTION OF OTHER SPINAL DEVICES - SA
2337 SA8460 INSERTION OF SPINAL DISC PROSTHESIS, NOT OTHERWISE SPECIFIED - SA
2338 SA8472 APPLICATION OF EXTERNAL FIXATOR DEVICE, RING SYSTEM - SA
2339 SA8472A APPLICATION OF EXTERNAL FIXATOR DEVICE, RING SYSTEM -- ADJUSTMENT - SA

2340 SA8481B REVISION OF INTERSPINOUS PROCESS DEVICE(S) - SA

2341 SA8481C REVISION OF INTERSPINOUS PROCESS DEVICE(S) (REVISION POST. AND OR ANT.
DECOMPRESSION + FUSION WITH / WITHOUT INSTRUMENT) - SA
2342 SA8491 AMPUTATION, NOT OTHERWISE SPECIFIED - SA
2343 SA8511 CLOSED (PERCUTANEOUS NEEDLE) BIOPSY OF BREAST - SA
2344 SA8512 OPEN BIOPSY OF BREAST - SA
2345 SA8521 LOCAL EXCISION OF LESION OF BREAST - WIDE LOCAL EXCISION - SA
2346 SA8521A LOCAL EXCISION OF LESION OF BREAST (MULTIPLE TUMOUR MAMMAE / BILATERAL) -
SA
2347 SA8521B LOCAL EXCISION OF LESION OF BREAST - SA
2348 SA8521D LOCAL EXCISION OF LESION OF BREAST - STEREOTACTIC/GUIDE WIRE EXCISION -
SA
2349 SA8521P LOCAL EXCISION OF LESION OF BREAST-PAPILOMA INTRADUCTAL - SA
2350 SA8522 RESECTION OF QUADRANT OF BREAST - SA
2351 SA8524 EXCISION OF ECTOPIC BREAST TISSUE - SA
2352 SA8525 EXCISION OF NIPPLE - SA
2353 SA8525A EXCISION OF NIPPLE - MICRODOCHOTOMY - SA
2354 SA8533 UNILATERAL SUBCUTANEOUS MAMMECTOMY WITH SYNCHRONOUS IMPLANT
(MAJOR) - SA
2355 SA8533A UNILATERAL SUBCUTANEOUS MAMMECTOMY WITH SYNCHRONOUS IMPLANT - SA

2356 SA8534 OTHER UNILATERAL SUBCUTANEOUS MAMMECTOMY - SA

2357 SA8541 UNILATERAL SIMPLE MASTECTOMY - SA
2358 SA8541A UNILATERAL SIMPLE MASTECTOMY (INCLUDE AXILLARY NODE BIOPSY) - SA
2359 SA8543 UNILATERAL EXTENDED SIMPLE MASTECTOMY - SA
2360 SA8543A UNILATERAL EXTENDED SIMPLE MASTECTOMY, MODIFIED RADICAL MASTECTOMY -
SA
2361 SA8545 UNILATERAL RADICAL MASTECTOMY - SA
2362 SA8553 UNILATERAL BREAST IMPLANT - SA
2363 SA8570 TOTAL RECONSTRUCTION OF BREAST, NOT OTHERWISE SPECIFIED - SA
2364 SA8570A TOTAL RECONSTRUCTION OF BREAST, USING LOCAL FLAP - SA
2365 SA8571 LATISSIMUS DORSI MYOCUTANEOUS FLAP (RECONSTRUCTION OF BREAST) - SA
2366 SA8572 TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS (TRAM) FLAP - SA
2367 SA8589 OTHER MAMMOPLASTY - SA
2368 SA8594 REMOVAL OF IMPLANT OF BREAST - SA
2369 SA8601A ASPIRATION OF SKIN AND SUBCUTANEOUS TISSUE - SA
2370 SA8601B ASPIRATION OF SKIN AND SUBCUTANEOUS TISSUE-DRAINAGE OF LESION - SA
2371 SA8601C ASPIRATION OF SKIN AND SUBCUTANEOUS TISSUE-DRAINAGE OF SUBCUTANEOUS
ABSCESS - SA
2372 SA8602 INJECTION OR TATTOOING OF SKIN LESION OR DEFECT - SA
2373 SA8603 INCISION OF PILONIDAL SINUS OR CYST - SA
2374 SA8604 OTHER INCISION WITH DRAINAGE OF SKIN AND SUBCUTANEOUS TISSUE - SA
2375 SA8604A OTHER INCISION WITH DRAINAGE OF SKIN AND SUBCUTANEOUS TISSUE (BREAST
ABSCESS) - SA
2376 SA8605 INCISION WITH REMOVAL OF FOREIGN BODY OR DEVICE FROM SKIN AND
SUBCUTANEOUS TISSUE - SA
2377 SA8607 INSERTION OF TOTALLY IMPLANTABLE VASCULAR ACCESS DEVICE [VAD] - SA
2378 SA8609A OTHER INCISION OF SKIN AND SUBCUTANEOUS TISSUE-ESCHAROTOMY <10% - SA

2379 SA8609B OTHER INCISION OF SKIN AND SUBCUTANEOUS TISSUE-ESCHAROTOMY >10% - SA

2380 SA8611 CLOSED BIOPSY OF SKIN AND SUBCUTANEOUS TISSUE - SA

2381 SA8619 OTHER DIAGNOSTIC PROCEDURES ON SKIN AND SUBCUTANEOUS TISSUE - SA
2382 SA862 EXCISION OR DESTRUCTION OF LESION OR TISSUE OF SKIN AND SUBCUTANEOUS
TISSUE - SA
2383 SA8621 EXCISION OF PILONIDAL CYST OR SINUS - SA
2384 SA8622 EXCISIONAL DEBRIDEMENT OF WOUND, INFECTION, OR BURN - SA
2385 SA8622A EXCISIONAL DEBRIDEMENT OF WOUND, INFECTION, OR BURN-<3 - SA
2386 SA8622B EXCISIONAL DEBRIDEMENT OF WOUND, INFECTION, OR BURN->3 - SA
2387 SA8622C EXCISIONAL DEBRIDEMENT OF WOUND, INFECTION, OR BURN (COCCYGEAL
PRESSURE ULCER EXCISION) - SA
2388 SA8622GA EXCISIONAL DEBRIDEMENT OF WOUND, INFECTION, OR BURN-GA - SA
2389 SA8623 REMOVAL OF NAIL, NAIL BED, OR NAIL FOLD - SA
2390 SA8624 CHEMOSURGERY OF SKIN - SA
2391 SA8625 DERMABRASION - SA
2392 SA8625A DERMABRASION-EXTENSIVE - SA
2393 SA8627 DEBRIDEMENT OF NAIL, NAIL BED, OR NAIL FOLD - SA
2394 SA863 OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF SKIN AND
SUBCUTANEOUS TISSUE - SA
2395 SA863A OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF SKIN AND
SUBCUTANEOUS TISSUE - >4 LESSION - SA
2396 SA863B OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF SKIN AND
SUBCUTANEOUS TISSUE (EXCISION OF HEMANGIOMA) - SA
2397 SA863L OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF SKIN AND
SUBCUTANEOUS TISSUE - LASER - SA
2398 SA863M OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF SKIN AND
SUBCUTANEOUS TISSUE-MULTIPLE - SA
2399 SA864 RADICAL EXCISION OF SKIN LESION - SA
2400 SA864A RADICAL EXCISION OF SKIN LESION (COMPLEX) - SA
2401 SA864B RADICAL EXCISION OF SKIN LESION (MALIGNANT MELANOMA EXCISION INCL
GRAFTING) - SA
2402 SA865 SUTURE OR OTHER CLOSURE OF SKIN AND SUBCUTANEOUS TISSUE - SA
2403 SA865A SUTURE OR OTHER CLOSURE OF SKIN AND SUBCUTANEOUS TISSUE (MALIGNANT
MELANOMA) - SA
2404 SA865S SUTURE OR OTHER CLOSURE OF SKIN AND SUBCUTANEOUS TISSUE-SECONDARY
SUTURE - SA
2405 SA8660 FREE SKIN GRAFT, NOT OTHERWISE SPECIFIED - SA
2406 SA8662L OTHER SKIN GRAFT TO HAND-LARGE - SA
2407 SA8662S OTHER SKIN GRAFT TO HAND-SMALL - SA
2408 SA8663 FULL-THICKNESS SKIN GRAFT TO OTHER SITES - SA
2409 SA8663A FULL-THICKNESS SKIN GRAFT TO OTHER SITES (SPLIT THICKNESS) - SA
2410 SA8663C FULL-THICKNESS SKIN GRAFT TO OTHER SITES (BUTTOCECTOMY) - SA
2411 SA8669 OTHER SKIN GRAFT TO OTHER SITES - SA
2412 SA8670 PEDICLE OR FLAP GRAFT, NOT OTHERWISE SPECIFIED - SA
2413 SA8670D PEDICLE OR FLAP GRAFT, NOT OTHERWISE SPECIFIED - DISTANT FLAP - SA
2414 SA8670L PEDICLE OR FLAP GRAFT, NOT OTHERWISE SPECIFIED - LARGE FOCAL FLAP - SA
2415 SA8670N PEDICLE OR FLAP GRAFT, NOT OTHERWISE SPECIFIED - NEUROVASCULAR ISLAND
FLAP - SA
2416 SA8670S PEDICLE OR FLAP GRAFT, NOT OTHERWISE SPECIFIED - SMALL LOCAL FLAP - SA
2417 SA8689 OTHER REPAIR AND RECONSTRUCTION OF SKIN AND SUBCUTANEOUS TISSUE - SA

2418 SA8693 INSERTION OF TISSUE EXPANDER - SA

2419 SA8774 RETROGRADE PYELOGRAM - SA
2420 SA8794 CONTRAST VASOGRAM - SA
2421 SA8860 PHLEBOGRAPHY USING CONTRAST MATERIAL, UNSPECIFIED SITE - SA
2422 SA8929 OTHER NONOPERATIVE GENITOURINARY SYSTEM MEASUREMENTS - SA
2423 SA9315 MOBILIZATION OF SPINE - SA
2424 SA9325 FORCED EXTENSION OF LIMB - SA
2425 SA9344 OTHER SKELETAL TRACTION - SA
2426 SA9351 APPLICATION OF PLASTER JACKET - SA
2427 SA9354 APPLICATION OF SPLINT - SA
2428 SA9354P APPLICATION OF SPLINT - PLASTER HIP - SA
2429 SA9357 APPLICATION OF OTHER WOUND DRESSING (EXTENSIVE DRESSING OF BURN OF
SKIN OR SUBCUTANEOUS TISSUE) - SA
2430 SA9512 FLUORESCEIN ANGIOGRAPHY OR ANGIOSCOPY OF EYE - SA
2431 SA9604 INSERTION OF ENDOTRACHEAL TUBE / INTUBASI - SA
2432 SA9604A RE - INSERTION OF ENDOTRACHEAL TUBE / RE-INTUBASI - SA
2433 SA9605 OTHER INTUBATION OF RESPIRATORY TRACT - SA
2434 SA9607 INSERTION OF OTHER (NASO-)GASTRIC TUBE - SA
2435 SA9607A INSERTION NASO GASTRIC TUBE - SA
2436 SA9622 DILATION OF RECTUM - SA
2437 SA9625 THERAPEUTIC DISTENTION OF BLADDER - SA
2438 SA9629 REDUCTION OF INTUSSUSCEPTION OF ALIMENTARY TRACT - SA
2439 SA9652 IRRIGATION OF EAR - SA
2440 SA967 OTHER CONTINUOUS INVASIVE MECHANICAL VENTILATION - SA
2441 SA9736 REMOVAL OF OTHER EXTERNAL MANDIBULAR FIXATION DEVICE - SA
2442 SA9762 REMOVAL OF URETEROSTOMY TUBE AND URETERAL CATHETER - SA
2443 SA9771 REMOVAL OF INTRAUTERINE CONTRACEPTIVE DEVICE - SA
2444 SA9788 REMOVAL OF EXTERNAL IMMOBILIZATION DEVICE - SA
2445 SA9811 REMOVAL OF INTRALUMINAL FOREIGN BODY FROM EAR WITHOUT INCISION - SA
2446 SA9812 REMOVAL OF INTRALUMINAL FOREIGN BODY FROM NOSE WITHOUT INCISION - SA

2447 SA9813 REMOVAL OF FOREIGN BODY OF PHARYNX - SA

2448 SA9851 EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY [ESWL] OF THE KIDNEY, URETER
AND/OR BLADDER - SA
2449 SA9851K EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY [ESWL] OF THE KIDNEY, URETER
AND/OR BLADDER - KIDNEY - SA
2450 SA9851U EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY [ESWL] OF THE KIDNEY, URETER
AND/OR BLADDER - URETER - SA
2451 SA9910 INJECTION OR INFUSION OF THROMBOLYTIC AGENT - SA
2452 SA9925 INJECTION OR INFUSION OF CANCER CHEMOTHERAPEUTIC SUBSTANCE - SA
2453 SA9929 INJECTION OR INFUSION OF OTHER THERAPEUTIC OR PROPHYLACTIC SUBSTANCE -
SA
2454 SA9960 CARDIOPULMONARY RESUSCITATION, NOT OTHERWISE SPECIFIED& RJPO /
DEFIBRILASI - SA
2455 SA1762B LASER ASSISTED TONSILECTOMY - SA
2456 SA3500 BALOON VALVULATION - SA
2457 SA3734B LASER VASCULAR THERAPY - SA
2458 SA4131A REDUCTION OF FRACTURE AND DISLOCATION APPLICATION OF CAST (GIPS < 2
SENDI) - SA
2459 SA6631A OTHER BILATERAL LIGATION AND CRUSHING OF FALLOPIAN TUBES / STERILIZATION
(PDP COVID) - SA
2460 SA6902A DILATION AND CURETTAGE FOLLOWING DELIVERY OR ABORTION (PDP COVID) - SA

2461 SA7279A OTHER VACUUM EXTRACTION (PDP COVID) - SA

2462 SA7359A OTHER MANUALLY ASSISTED DELIVERY (PDP COVID) - SA
2463 SA741B CESAREAN SECTION WITH COMPLICATION - SA
2464 SA741C CESAREAN SECTION OF OTHER UNSPECIFIED TYPE - SA
2465 SA743A REMOVAL OF EXTRATUBAL ECTOPIC PREGNANCY (PDP COVID) - SA
2466 SA744A CESAREAN SECTION OF OTHER SPECIFIED TYPE (PDP COVID) - SA
2467 SA8191A MILD ARTHROCENTESIS FOR THERAPEUTIC - SA
2468 SA8191B MODERATE ARTHROCENTESIS FOR THERAPEUTIC - SA
2469 SA8191C SEVERE ARTHROCENTESIS FOR THERAPEUTIC - SA
2470 SA8152 PARTIAL HIP REPLACEMENT - SA
2471 SA3009A ENDOSCOPIC VOCAL CORD SURGERY - SA
2472 SA5498A PERITONEAL DIALYSIS / INSERTION OF PERITONEAL DIALYSIS - SA
2473 SA7021 VAGINOSCOPY / VAGINAL EXAMINATION - SA
2474 SA743B LAPAROSCOPIC ECTOPIC PREGNANCY - SA
2475 SA295A OSA SURGERY - SA

TARIF BIAYA BEDAH

2476 SG0051 IMPLANTATION OF CARDIAC RESYNCHRONIZATION DEFIBRILLATOR
2477 SG0066B PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) (1 VESSEL)
2478 SG0066C PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) (2 VESSELS)
2479 SG0066D PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) (>2 VESSELS)

2480 SG0066E PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) (DES/BMS 1

STENT)
2481 SG0066F PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) (DES/BMS 2
STENT)
2482 SG0066G PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) (DES/BMS >2
STENT)
2483 SG0066H PERCUTANEOUS TRANSLUMINAL COR ANGIOGRAPHY (F)
2484 SG0066I PERCUTANEOUS TRANSLUMINAL COR ANGIOGRAPHY (R)
2485 SG0070 REVISION OF HIP REPLACEMENT, BOTH ACETABULAR AND FEMORAL COMPONENTS

2486 SG0102 VENTRICULOPUNCTURE THROUGH PREVIOUSLY IMPLANTED CATHETER

2487 SG0109 OTHER CRANIAL PUNCTURE
2488 SG0113A CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF BRAIN (STEREOTIC)
2489 SG0113B CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF BRAIN (DIAGNOSTIC)
2490 SG0113C CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF BRAIN (EXPLORATORY BURRHOLE)

2491 SG0114 OPEN BIOPSY OF BRAIN

2492 SG0121 INCISION AND DRAINAGE OF CRANIAL SINUS
2493 SG0122A REMOVAL OF INTRACRANIAL NEUROSTIMULATOR LEAD(S) (BRAIN)
2494 SG0122B REMOVAL OF INTRACRANIAL NEUROSTIMULATOR LEAD(S) (CARNIAL NERVE)
2495 SG0124A OTHER CRANIOTOMY (EXPLORATORY OPEN CRANIOTOMY)
2496 SG0124B OTHER CRANIOTOMY (EVACUATION OF EXTRADURAL HAEMATOMA)
2497 SG0124C OTHER CRANIOTOMY (DECOMPRESSION OF CRANIAL NERVE (CRANIOTOMY))
2498 SG0124D OTHER CRANIOTOMY (CRANIOTOMY-POSTOPERATIVE HAEMORRHAGE)
2499 SG0124E OTHER CRANIOTOMY (BURRHOLE FOR INTRACRANIAL INFECTION)
2500 SG0131 INCISION OF CEREBRAL MENINGES
2501 SG0151 EXCISION OF LESION OR TISSUE OF CEREBRAL MENINGES
2502 SG0152 HEMISPHERECTOMY
2503 SG0159A OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BRAIN
2504 SG0159B OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BRAIN (ABCESS)
2505 SG0159C OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BRAIN
(CEREBELLOPONTINE ANGLE TUMOUR)
2506 SG0159D OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BRAIN (THERAPEUTIC
ENDOSCOPIC OP ON VENTRICLE OF BRAIN)
2507 SG016 EXCISION OF LESION OF SKULL
2508 SG0201 OPENING OF CRANIAL SUTURE
2509 SG0202A ELEVATION OF SKULL FRACTURE FRAGMENTS (FORAMEN MAGNUM DECOMPRESSION)

2510 SG0202B ELEVATION OF SKULL FRACTURE FRAGMENTS

2511 SG0206A OTHER CRANIAL OSTEOPLASTY (PLASTIC REPAIR CRANIUM)
2512 SG0206B OTHER CRANIAL OSTEOPLASTY (REPAIR OF SKULL)
2513 SG0206C OTHER CRANIAL OSTEOPLASTY (RECONSTRUCTIVE CRANIOPLASTY)
2514 SG0212 OTHER REPAIR OF CEREBRAL MENINGES
2515 SG0212A OTHER REPAIR OF CEREBRAL MENINGES (REPAIR OF DURA)
2516 SG022A VENTRICULOSTOMY (CREATION OF VENTRICULOVASCULAR ANASTOMOSIS)
2517 SG022B VENTRICULOSTOMY (VENTRICULOCISTERNAL INTUBATION)
2518 SG0234 VENTRICULAR SHUNT TO ABDOMINAL CAVITY AND ORGANS
2519 SG0241 IRRIGATION AND EXPLORATION OF VENTRICULAR SHUNT
2520 SG0242 REPLACEMENT OF VENTRICULAR SHUNT (REVISION OF VENTRICULOPERITONEAL
SHUNT AT VENTRICULAR SITE)
2521 SG0243 REMOVAL OF VENTRICULAR SHUNT
2522 SG0293 IMPLANTATION OR REPLACEMENT OF INTRACRANIAL NEUROSTIMULATOR LEAD(S)

2523 SG0309 OTHER EXPLORATION AND DECOMPRESSION OF SPINAL CANAL

2524 SG031 DIVISION OF INTRASPINAL NERVE ROOT
2525 SG0331 SPINAL TAP
2526 SG0331A SPINAL TAP / LUMBAL PUNCTURE
2527 SG0339 OTHER DIAGNOSTIC PROCEDURES ON SPINAL CORD AND SPINAL CANAL
STRUCTURES
2528 SG034 EXCISION OR DESTRUCTION OF LESION OF SPINAL CORD OR SPINAL MENINGES
2529 SG0352 REPAIR OF SPINAL MYELOMENINGOCELE
2530 SG0390 INSERTION OF CATHETER INTO SPINAL CANAL FOR INFUSION OF THERAPEUTIC OR
PALLIATIVE SUBSTANCES
2531 SG0391A INJECTION OF ANESTHETIC INTO SPINAL CANAL FOR ANALGESIA
(CERVICAL/THORACIC)
2532 SG0391B INJECTION OF ANESTHETIC INTO SPINAL CANAL FOR ANALGESIA (LUMBAL)
2533 SG0396 PERCUTANEOUS DENERVATION OF FACET
2534 SG0401 EXCISION OF ACOUSTIC NEUROMA
2535 SG0407A OTHER EXCISION OR AVULSION OF CRANIAL AND PERIPHERAL NERVE
(INTRACRANIAL TRANSECTION OF CRANIAL NERVE)
2536 SG0407B OTHER EXCISION OR AVULSION OF CRANIAL AND PERIPHERAL NERVE (INCLUDE
EXCISION OF LESION ON CRANIAL NERVE)
2537 SG0407C OTHER EXCISION OR AVULSION OF CRANIAL AND PERIPHERAL NERVES (MAJOR
NERVE)
2538 SG0407D OTHER EXCISION OR AVULSION OF CRANIAL AND PERIPHERAL NERVES (EXCISION
OF LESION)
2539 SG0407E OTHER EXCISION OR AVULSION OF CRANIAL AND PERIPHERAL NERVES
(TRANSECTION/EXCISION)
2540 SG0411 CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF CRANIAL OR PERIPHERAL NERVE OR
GANGLION
2541 SG0419A OTHER DIAGNOSTIC PROCEDURES ON CRANIAL AND PERIPHERAL NERVES AND
GANGLIA-EXPLORATION OF NERVE
2542 SG042 DESTRUCTION OF CRANIAL AND PERIPHERAL NERVES
2543 SG042A DESTRUCTION OF CRANIAL AND PERIPHERAL NERVES (INJ)
2544 SG042B DESTRUCTION OF CRANIAL AND PERIPHERAL NERVES (RF)
2545 SG043 SUTURE OF CRANIAL AND PERIPHERAL NERVES
2546 SG0443A RELEASE OF CARPAL TUNNEL SYNDROME (ENDOSCOPIC)
2547 SG0443B RELEASE OF CARPAL TUNNEL SYNDROME (ENDOSCOPIC BILATERAL)
2548 SG0444 RELEASE OF TARSAL TUNNEL
2549 SG0449 OTHER PERIPHERAL NERVE OR GANGLION DECOMPRESSION OR LYSIS OF
ADHESIONS
2550 SG0449A OTHER PERIPHERAL NERVE OR GANGLION DECOMPRESSION OR LYSIS OF
ADHESIONS-DEEP
2551 SG045 CRANIAL OR PERIPHERAL NERVE GRAFT
2552 SG045A CRANIAL OR PERIPHERAL NERVE GRAFT (PRIMARY & 2ND)
2553 SG045B CRANIAL OR PERIPHERAL NERVE GRAFT-COMPLEX
2554 SG046A TRANSPOSITION OF CRANIAL AND PERIPHERAL NERVES (NEUROLYSIS)
2555 SG046B TRANSPOSITION OF CRANIAL AND PERIPHERAL NERVES (SUBMUSCULAR)
2556 SG0475A REVISION OF PREVIOUS REPAIR OF CRANIAL AND PERIPHERAL NERVES
(MICROSURGERY)
2557 SG0475B REVISION OF PREVIOUS REPAIR OF CRANIAL AND PERIPHERAL NERVES (NON
MICROSURGERY)
2558 SG0475C REVISION OF PREVIOUS REPAIR OF CRANIAL AND PERIPHERAL NERVES (RELEASE
PERIPHERAL NERVES)
2559 SG0475D REVISION OF PREVIOUS REPAIR OF CRANIAL AND PERIPHERAL NERVES (2ND REPAIR
NERVE TRUNK)
2560 SG0479A OTHER NEUROPLASTY REPAIR OF CRANIAL NERVE (INTRACRANIAL)
2561 SG0479B OTHER NEUROPLASTY PRIMARY REPAIR PERIPHERAL NERVE W MICROSURGERY
2562 SG0479C OTHER NEUROPLASTY PRIMARY REPAIR PERIPHERAL NERVE
2563 SG0479D OTHER NEUROPLASTY PRIMARY REPAIR NERVE TRUNK
2564 SG0481 INJECTION OF ANESTHETIC INTO PERIPHERAL NERVE FOR ANALGESIA
2565 SG0492 IMPLANTATION OR REPLACEMENT OF PERIPHERAL NEUROSTIMULATOR LEAD(S)
2566 SG0523 LUMBAR SYMPATHECTOMY
2567 SG0523A LUMBAR SYMPATHECTOMY (LAPAROSCOPIC)
2568 SG0524 PRESACRAL SYMPATHECTOMY
2569 SG052A THORASCOPIC SYMPATHECTOMY
2570 SG052B THORACIC SYMPATHECTOMY : DIAG.(LA UNDER X-RAY CTRL)
2571 SG052C THORACIC SYMPATHECTOMY : THERAPEUTIC (NEUROLYTIC UNDER X-RAY CTRL)
2572 SG0532 INJECTION OF NEUROLYTIC AGENT INTO SYMPATHETIC NERVE
2573 SG0609 OTHER INCISION OF THYROID FIELD
2574 SG0611A CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF THYROID GLAND (FNAB)
2575 SG0611B CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF THYROID GLAND (NEEDLE BIOPSY)

2576 SG062A UNILATERAL THYROID LOBECTOMY (HEMI-THYROIDECTOMY)

2577 SG062B UNILATERAL THYROID LOBECTOMY (ISTHMULOBECTOMY WITH FROZEN SECTION
EXCISION)
2578 SG0631 EXCISION OF LESION OF THYROID
2579 SG0639 OTHER PARTIAL THYROIDECTOMY
2580 SG064A COMPLETE THYROIDECTOMY (TOTAL)
2581 SG064B COMPLETE THYROIDECTOMY (BILATERAL SUBTOTAL)
2582 SG064C COMPLETE THYROIDECTOMY + BERRYPICKING (LIFADENECTOMY)
2583 SG067A EXCISION OF THYROGLOSSAL DUCT OR TRACT (THYROGLOSSAL CYST)
2584 SG067B EXCISION OF THYROGLOSSAL DUCT OR TRACT (THYROGLOSSAL TRACT)
2585 SG067C EXCISION OF THYROGLOSSAL DUCT OR TRACT (THYROGLOSSAL CYST ONCOLOGY)

2586 SG0681 COMPLETE PARATHYROIDECTOMY

2587 SG0689 OTHER PARATHYROIDECTOMY
2588 SG0695 PARATHYROID TISSUE REIMPLANTATION
2589 SG0698 OTHER OPERATIONS ON THYROID (REGION) AND PARATHYROID - THYROID
ABERRANT
2590 SG0698A OTHER OPERATIONS ON THYROID (REGION) AND PARATHYROID - ENDOSCOPIC
2591 SG0729 OTHER PARTIAL ADRENALECTOMY
2592 SG073 BILATERAL ADRENALECTOMY
2593 SG0753 PARTIAL EXCISION OF PINEAL GLAND
2594 SG0754 TOTAL EXCISION OF PINEAL GLAND
2595 SG0761 PARTIAL EXCISION OF PITUITARY GLAND, TRANSFRONTAL APPROACH
2596 SG0769 TOTAL EXCISION OF PITUITARY GLAND, UNSPECIFIED APPROACH -
HYPOPHYSECTOMY NOS
2597 SG0780 THYMECTOMY, NOT OTHERWISE SPECIFIED
2598 SG0811 BIOPSY OF EYELID
2599 SG0821 EXCISION OF CHALAZION
2600 SG0822A EXCISION OF OTHER MINOR LESION OF EYEBROW
2601 SG0822B EXCISION OF OTHER MINOR LESION OF CANTHUS
2602 SG0825 DESTRUCTION OF LESION OF EYELID
2603 SG0836 REPAIR OF BLEPHAROPTOSIS BY OTHER TECHNIQUES
2604 SG0849 OTHER REPAIR OF ENTROPION OR ECTROPION
2605 SG0851 CANTHOTOMY
2606 SG0852A BLEPHARORRHAPHY (TARSORRHAPHY)
2607 SG0852B BLEPHARORRHAPHY (TARSOMULLERECTOMY)
2608 SG0859 CANTHOPLASTY / REPAIR OF EPICANTHAL / TELECANTHAL FOLD
2609 SG0861 RECONSTRUCTION OF EYELID WITH SKIN FLAP OR GRAFT
2610 SG0869A OTHER RECONSTRUCTION OF EYELID WITH FLAPS OR GRAFTS (TOTAL)
2611 SG0869B OTHER RECONSTRUCTION OF EYELID WITH FLAPS OR GRAFTS (BILATERAL)
2612 SG0881A LINEAR REPAIR OF LACERATION OF EYELID OR EYEBROW (SUTURE OF EYEBROW)

2613 SG0881B LINEAR REPAIR OF LACERATION OF EYELID OR EYEBROW (SUTURE OF EYELID

(LACERATION))
2614 SG0893 OTHER EPILATION OF EYELID
2615 SG090A INCISION OF LACRIMAL GLAND (EYELID LESSION)
2616 SG090B INCISION OF LACRIMAL GLAND (CONJUNCTIVAL CYST)
2617 SG0912 BIOPSY OF LACRIMAL SAC
2618 SG0943 PROBING OF NASOLACRIMAL DUCT (UNDER GA)
2619 SG0944 INTUBATION OF NASOLACRIMAL DUCT
2620 SG0949 OTHER MANIPULATION OF LACRIMAL PASSAGE - THAT WITH DILATION
2621 SG0953 INCISION OF LACRIMAL SAC
2622 SG096 EXCISION OF LACRIMAL SAC AND PASSAGE
2623 SG0973 REPAIR OF CANALICULUS
2624 SG0982 CONJUNCTIVOCYSTORHINOSTOMY
2625 SG0983 CONJUNCTIVORHINOSTOMY WITH INSERTION OF TUBE OR STENT
2626 SG100 REMOVAL OF EMBEDDED FOREIGN BODY FROM CONJUNCTIVA BY INCISION
2627 SG1021 BIOPSY OF CONJUNCTIVA
2628 SG1031 EXCISION OF LESION OR TISSUE OF CONJUNCTIVA
2629 SG1032 DESTRUCTION OF LESION OF CONJUNCTIVA
2630 SG1033 OTHER DESTRUCTIVE PROCEDURES ON CONJUNCTIVA
2631 SG1044 OTHER FREE GRAFT TO CONJUNCTIVA
2632 SG105 LYSIS OF ADHESIONS OF CONJUNCTIVA AND EYELID
2633 SG106A REPAIR OF LACERATION OF CONJUNCTIVA (SUTURE)
2634 SG106B REPAIR OF LACERATION OF CONJUNCTIVA (REMOVAL OF SUTURE)
2635 SG1091 SUBCONJUNCTIVAL INJECTION
2636 SG110 MAGNETIC REMOVAL OF EMBEDDED FOREIGN BODY FROM CORNEA
2637 SG111 INCISION OF CORNEA
2638 SG1121 SCRAPING OF CORNEA FOR SMEAR OR CULTURE
2639 SG1143 CRYOTHERAPY OF CORNEAL LESION
2640 SG1149 OTHER REMOVAL OR DESTRUCTION OF CORNEAL LESION - EXCISION OF CORNEA
NOS
2641 SG1149A OTHER REMOVAL OR DESTRUCTION OF CORNEAL LESION-CHELATION
2642 SG1151 SUTURE OF CORNEAL LACERATION
2643 SG1152 REPAIR OF POSTOPERATIVE WOUND DEHISCENCE OF CORNEA
2644 SG1159 OTHER REPAIR OF CORNEA (REMOVAL OF CORNEAL SUTURE)
2645 SG1161 LAMELLAR KERATOPLASTY WITH AUTOGRAFT
2646 SG1163 PENETRATING KERATOPLASTY WITH AUTOGRAFT
2647 SG117 LASIK / OTHER RECONSTRUCTIVE AND REFRACTIVE SURGERY ON CORNEA
2648 SG1191 TATTOOING OF CORNEA
2649 SG1200A REMOVAL OF INTRAOCULAR FOREIGN BODY FROM ANTERIOR SEGMENT OF EYE -
IRIS
2650 SG1200B REMOVAL OF INTRAOCULAR FOREIGN BODY FROM ANTERIOR SEGMENT OF EYE -
ANTERIOR CHAMBER
2651 SG1212 OTHER IRIDOTOMY - IRIDOCYCLECTOMY
2652 SG1212A OTHER IRIDOTOMY (LASER IRIDOTOMY)
2653 SG1213 EXCISION OF PROLAPSED IRIS
2654 SG1214 OTHER IRIDECTOMY
2655 SG1242 EXCISION OF LESION OF IRIS
2656 SG1252 GONIOTOMY WITHOUT GONIOPUNCTURE
2657 SG1253 GONIOTOMY WITH GONIOPUNCTURE
2658 SG1254 TRABECULOTOMY AB EXTERNO
2659 SG1255 CYCLODIALYSIS
2660 SG1264A TRABECULECTOMY AB EXTERNO (SURGICAL TRABECULECTOMY)
2661 SG1264B TRABECULECTOMY AB EXTERNO (LASER TRABECULOPLASTY)
2662 SG1272 CYCLOCRYOTHERAPY
2663 SG1281 SUTURE OF LACERATION OF SCLERA
2664 SG1284 EXCISION OR DESTRUCTION OF LESION OF SCLERA
2665 SG1287 SCLERAL REINFORCEMENT WITH GRAFT
2666 SG1291 THERAPEUTIC EVACUATION OF ANTERIOR CHAMBER
2667 SG1292 INJECTION INTO ANTERIOR CHAMBER (IRRIGATION)
2668 SG1299 OTHER OPERATIONS ON ANTERIOR CHAMBER
2669 SG1370 INSERTION OF PSEUDOPHAKOS, NOT OTHERWISE SPECIFIED
2670 SG1371 INSERTION OF INTRAOCULAR LENS PROSTHESIS AT TIME OF CATARACT
EXTRACTION, ONE-STAGE
2671 SG138 REMOVAL OF IMPLANTED LENS
2672 SG1402 REMOVAL OF FOREIGN BODY FROM POSTERIOR SEGMENT OF EYE WITHOUT USE OF
MAGNET
2673 SG1419 OTHER DIAGNOSTIC PROCEDURES ON RETINA, CHOROID, VITREOUS, AND
POSTERIOR CHAMBER
2674 SG1422 DESTRUCTION OF CHORIORETINAL LESION BY CRYOTHERAPY
2675 SG1425 DESTRUCTION OF CHORIORETINAL LESION BY PHOTOCOAGULATION OF
UNSPECIFIED TYPE
2676 SG1426 DESTRUCTION OF CHORIORETINAL LESION BY RADIATION THERAPY
2677 SG1429 OTHER DESTRUCTION OF CHORIORETINAL LESION - DESTRUCTION OF LESION OF
RETINA AND CHOROID NOS
2678 SG1441 SCLERAL BUCKLING WITH IMPLANT
2679 SG1471 REMOVAL OF VITREOUS, ANTERIOR APPROACH
2680 SG1471A REMOVAL OF VITREOUS, ANTERIOR APPROACH (VITRECTOMY PARS PLANA
APPROACH W INSERTION OF INT.TAMPONADE)
022
TARIF INSURANCE 01 APR
SATUAN 2022

PIECE 50,000
PIECE 50,000
PIECE Variabel
PASIEN 165,375
PASIEN 496,125
PASIEN 275,100
PASIEN 66,150
PASIEN 181,125
PASIEN 47,250
KUNJUNGAN 52,500
KUNJUNGAN 31,500
PASIEN Variabel
PASIEN 1,050,000
PASIEN 603,750
KUNJUNGAN 210,000
PASIEN 10,500
PIECE 10,500
PIECE 50,000

% 380,846
% 830,760
% Variabel

LITER 174,631
LITER 122,262
LITER 75,059
LITER 279,227
LITER 227,005
JAM 866,502
JAM 565,110
TABUNG 261,870
TABUNG 1,429,932
LITER/MENIT 358
1/2 JAM 502,320
JAM 175,812
JAM 1,670,214
JAM 1,996,722

PIECE 107,640
HARI 908,500
HARI 95,920
HARI 167,860
PIECE 263,120
% 203,320
HARI 180,000
PROSEDUR 402,500
HARI 250,000
HARI 250,000
HARI 400,000
HARI 550,000
HARI 960,000
HARI 1,430,000
HARI 2,150,000
HARI 2,150,000
HARI 3,000,000
HARI 1,200,000
HARI 1,500,000
HARI 830,000
HARI 370,000
HARI 720,000
HARI 940,000
SET 29,900
% Variabel
KUNJUNGAN 242,550
KUNJUNGAN 242,550
KUNJUNGAN 291,060
KUNJUNGAN 305,613
KUNJUNGAN 173,250

KUNJUNGAN 181,913
KUNJUNGAN 181,913
KUNJUNGAN 200,162
KUNJUNGAN 240,125
KUNJUNGAN 253,050
KUNJUNGAN 519,750
KUNJUNGAN 196,350
KUNJUNGAN 483,000

KUNJUNGAN 242,550
KUNJUNGAN 242,550
KUNJUNGAN 266,805
KUNJUNGAN 320,166
KUNJUNGAN 338,100
KUNJUNGAN 519,750
KUNJUNGAN 196,350
KUNJUNGAN 483,000

KUNJUNGAN 303,188
KUNJUNGAN 303,188
KUNJUNGAN 333,564
KUNJUNGAN 400,208
KUNJUNGAN 422,100
KUNJUNGAN 519,750
KUNJUNGAN 196,350
KUNJUNGAN 288,750
KUNJUNGAN 483,000

KUNJUNGAN 485,100
KUNJUNGAN 485,100
KUNJUNGAN 533,610
KUNJUNGAN 640,332
KUNJUNGAN 519,750
KUNJUNGAN 288,750

KUNJUNGAN 727,650
KUNJUNGAN 727,650
KUNJUNGAN 727,650
KUNJUNGAN 727,650
KUNJUNGAN 519,750
KUNJUNGAN 288,750

PASIEN 10,117,800
JAM 830,760
KUNJUNGAN 164,824
KUNJUNGAN 197,789
KUNJUNGAN 138,500
KUNJUNGAN 110,849
KUNJUNGAN 166,152
PASIEN 242,466
KUNJUNGAN 138,500
KUNJUNGAN 166,152
KUNJUNGAN 313,950
KUNJUNGAN 75,348
KUNJUNGAN 241,500

TEST 621,013
TEST 181,196
TEST 1,083,180
TEST 179,592
TEST 515,352
TEST 1,418,550
TEST 832,650
TEST 597,450
TEST 554,400
TEST 143,172
TEST 139,608
TEST 139,608
TEST 270,443
TEST 219,851
TEST 578,925
TEST 3,435,600
TEST 121,800
TEST 452,550
TEST 845,544
TEST 260,463
TEST 1,215,900
TEST 401,016
TEST 175,560
TEST 5,515,650
TEST 1,383,900
TEST 3,958,500
TEST 914,550
TEST 1,139,639
TEST 166,597
TEST 604,440
TEST 69,888
TEST 81,984
TEST 477,344
TEST 81,984
TEST 477,344
TEST 69,888
TEST 199,710
TEST 207,480
TEST 209,496
TEST 180,399
TEST 403,137
TEST 438,816
TEST 394,800
TEST 153,552
TEST 699,300
TEST 979,729
TEST 249,480
TEST 355,950
TEST 554,400
TEST 273,320
TEST 189,672
TEST 212,352
TEST 561,704
TEST 1,124,550
TEST 246,030
TEST 370,235
TEST 1,384,530
TEST 1,151,420
TEST 249,480
TEST 1,202,875
TEST 506,730
TEST 449,411
TEST 4,053,357
TEST 2,699,550
TEST 5,492,550
TEST 215,376
TEST 354,816
TEST 1,329,216
TEST 663,894
TEST 1,221,413
TEST 1,723,145
TEST 1,723,145
TEST 129,528
TEST 129,528
TEST 169,680
TEST 779,940
TEST 123,816
TEST 123,816
TEST 3,512,250
TEST 449,411
TEST 136,080
TEST 268,061
TEST 1,017,030
TEST 398,832
TEST 1,066,800
TEST 425,301
TEST 1,827,630
TEST 1,261,260
TEST 2,583,000
TEST 95,592
TEST 726,495
TEST 597,660
TEST 987,005
TEST 236,486
TEST 95,592
TEST 1,605,033
TEST 434,448
TEST 438,816
TEST 197,568
TEST 709,459
TEST 4,626,815
TEST 2,668,050
TEST 3,057,810
TEST 325,248
TEST 608,160
TEST 966,389
TEST 633,672
TEST 180,880
TEST 269,577
TEST 1,461,600
TEST 1,169,595
TEST 1,882,650
TEST 276,334
TEST 137,697
TEST 199,584
TEST 958,487
TEST 382,872
TEST 347,088
TEST 199,584
TEST 569,501
TEST 2,035,514
TEST 363,321
TEST 827,789
TEST 339,192
TEST 1,336,650
TEST 643,228
TEST 897,456
TEST 3,713,441
TEST 681,219
TEST 1,825,530
TEST 904,176
TEST 3,882,706
TEST 3,459,456
TEST 922,530
TEST 499,442
TEST 878,772
TEST 1,663,200
TEST 1,141,541
TEST 259,783
TEST 1,046,472
TEST 813,624
TEST 219,408
TEST 361,200
TEST 229,320
TEST 229,320
TEST 1,072,418
TEST 3,277,050
TEST 4,731,284
TEST 229,320
TEST 226,265
TEST 229,320
TEST 225,398
TEST 2,159,561
TEST 225,398
TEST 1,787,415
TEST 229,320
TEST 4,952,850
TEST 2,919,782
TEST 3,524,598
TEST 5,512,642
TEST 1,295,390
TEST 2,194,211
TEST 1,148,616
TEST 3,713,441
TEST 1,297,800
TEST 8,017,144
TEST 1,984,500
TEST 1,245,300
TEST 3,787,418
TEST 2,208,245
TEST 809,760
TEST 895,440
TEST 743,904
TEST 1,326,024
TEST 510,300
TEST 1,196,811
TEST 294,698
TEST 2,824,500
TEST 799,680
TEST 2,037,700
TEST 1,165,290
TEST 775,656
TEST 2,189,250
TEST 917,532
TEST 570,360
TEST 570,360
TEST 1,051,365
TEST 1,379,700
* 1,237,530
TEST 582,456
TEST 1,371,447
TEST 93,581
TEST 233,756
TEST 701,138
TEST 93,581
TEST 93,581
TEST 1,034,544
TEST 78,094
TEST 78,094
TEST 134,138
TEST 1,357,067
TEST 1,432,200
TEST 389,550
TEST 389,550
TEST 545,213
PROSEDUR 545,213
TEST 389,550
TEST 1,495,331
TEST 1,884,881
TEST 1,562,715
TEST 798,875
TEST 1,857,413
TEST 798,875
TEST 2,460,465
TEST 797,496
TEST 2,910,749
TEST 797,496
TEST 1,196,328
TEST 1,802,205
TEST 1,017,631
TEST 1,198,313
TEST 797,496
TEST 659,220
TEST 1,694,602
TEST 987,005
TEST 1,747,935
TEST 1,747,935
TEST 2,048,550
TEST 616,943
TEST 1,507,800
TEST 743,904
TEST 1,086,792
TEST 997,474
TEST 753,816
TEST 1,266,048
TEST 1,294,104
TEST 697,872
TEST 1,019,439
TEST 1,649,550
TEST 2,918,055
TEST 2,842,166
TEST 1,487,115
TEST 1,547,175
TEST 1,899,975
TEST 695,079
TEST 1,967,308
TEST 1,480,421
TEST 1,184,510
TEST 1,048,682
TEST 987,005
TEST 987,005
TEST 624,120
TEST 3,381,357
TEST 1,840,020
TEST 1,840,020
TEST 2,588,040
TEST 2,216,655
TEST 1,595,265
TEST 1,508,010
TEST 1,391,712
TEST 1,373,904
TEST 1,434,786
TEST 2,368,800
TEST 697,872
TEST 8,692,992
TEST 697,872
TEST 1,935,150
TEST 1,935,150
TEST 5,202,005
TEST 1,966,650
TEST 1,371,447
TEST 715,512
TEST 1,000,944
TEST 990,696
TEST 2,508,487
TEST 1,579,694
TEST 660,240
TEST 1,076,712
TEST 2,689,360
TEST 2,282,222
TEST 2,097,365
TEST 1,196,811
TEST 1,408,050
TEST 1,192,653
TEST 1,248,613
TEST 1,820,684
TEST 1,034,880
TEST 353,136
TEST 841,129
TEST 1,883,616
TEST 4,559,730
TEST 9,457,718
TEST 5,832,225
TEST 1,634,850
TEST 943,152
TEST 2,881,321
TEST 1,421,616
TEST 1,329,888
TEST 1,136,283
TEST 513,167
TEST 2,673,074
TEST 969,360
TEST 973,560
TEST 848,820
TEST 848,820
TEST 833,616
TEST 2,282,700
TEST 1,637,386
TEST 2,418,050
TEST 945,945
TEST 1,064,102
TEST 833,616
TEST 1,739,603
TEST 1,933,050
TEST 1,371,447
TEST 477,593
TEST 839,050
TEST 969,192
TEST 624,120
TEST 2,317,392
TEST 615,025
TEST 697,872
TEST 883,512
TEST 717,864
TEST 1,690,500
TEST 891,545
TEST 874,046
TEST 1,466,042
TEST 468,552
TEST 468,552
TEST 1,794,555
TEST 179,592
TEST 654,192
TEST 1,346,100
TEST 654,192
TEST 339,192
TEST 364,300
TEST 239,400
TEST 349,104
TEST 4,835,754
TEST 1,774,584
TEST 1,046,472
TEST 199,584
TEST 78,222
TEST 99,960
TEST 99,960
TEST 370,235
TEST 1,418,918
TEST 3,546,947
TEST 1,198,313
TEST 1,196,328
TEST 1,557,171
TEST 3,546,947
TEST 1,418,918
TEST 1,794,576
TEST 3,189,984
TEST 3,123,665
TEST 997,080
TEST 1,113,836
TEST 1,878,135
TEST 1,627,500
TEST 1,056,888
TEST 1,058,657
TEST 1,056,888
TEST 1,056,888
TEST 1,234,262
TEST 1,056,888
TEST 1,153,984
TEST 1,058,657
TEST 1,244,284
TEST 1,148,957
TEST 1,046,016
TEST 1,089,916
TEST 1,058,657
TEST 1,088,752
TEST 1,058,657
TEST 1,164,021
TEST 1,056,888
TEST 1,058,657
TEST 998,684
TEST 419,544
TEST 133,749
TEST 139,854
TEST 159,779
TEST 129,696
TEST 867,300
TEST 867,300
TEST 159,779
TEST 159,779
TEST 169,931
TEST 159,779
TEST 997,080
TEST 2,394,488
TEST 2,758,140
TEST 411,296
TEST 2,916,165
TEST 3,287,765
TEST 455,175
TEST 520,926
TEST 6,021,650
TEST 2,051,453
TEST 1,418,918
TEST 827,789
TEST 2,731,633
TEST 2,650,032
TEST 1,418,918
TEST 472,973
TEST 485,625
TEST 945,945
TEST 709,459
TEST 3,791,403
TEST 3,986,850
TEST 2,908,348
TEST 2,985,990
TEST 3,289,671
TEST 1,371,447
TEST 898,648
TEST 851,351
TEST 1,151,420
TEST 3,045,562
TEST 1,579,694
TEST 827,789
TEST 3,824,100
TEST 1,324,150
TEST 205,821
TEST 2,955,645
TEST 1,336,624
TEST 750,540
TEST 242,550
TEST 1,885,420
TEST 555,234

TEST 1,033,657

TEST 638,064
TEST 359,016
TEST 1,285,360
TEST 544,320
TEST 817,656
TEST 239,676
TEST 239,676
* 119,784
TEST 1,192,653
TEST 243,907
TEST 141,845
TEST 1,648,500
TEST 708,766
TEST 1,046,472
TEST 483,194
TEST 553,350
TEST 771,136
TEST 308,558
TEST 235,100
TEST 262,994
TEST 180,600
TEST 428,715
TEST 215,376
TEST 262,994
TEST 411,296
TEST 309,750
TEST 172,904
TEST 180,600
TEST 165,984
TEST 119,784
TEST 139,440
TEST 5,037,816
TEST 1,336,650
TEST 1,593,900
TEST 1,793,400
TEST 1,911,814
PROSEDUR Variabel
TEST 1,081,080
TEST 3,998,400
TEST 150,000
TEST 26,000
TEST 109,000
TEST 400,000
TEST 4,200,000
TEST 1,325,000
TEST 300,000
TEST 900,000
TEST 3,000,000
TEST 288,750
TEST 750,000
TEST 156,450
TEST 1,005,900
TEST 4,252,500
TEST 3,236,100
TEST 6,375,600
TEST 109,000

* 541,800
* 812,700
* 812,700
* 620,025
* 620,025
* 602,044
BAG 2,558,456
* 4,020,319
* 677,250
* 8,126,606
* 8,126,606
* 150,544
* 737,494
* 8,126,606
* 541,800
* 8,126,606
* 5,492,944
* 8,126,606
* 8,126,606
* 8,126,606
* 602,044
* 225,750

PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 214,484
PROSEDUR 118,157
PROSEDUR 235,967
PROSEDUR 160,949
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 171,518
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 128,725
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 128,725
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 235,967
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 133,679
PROSEDUR 118,157
PROSEDUR 321,725
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 118,157
PROSEDUR 128,725
PROSEDUR 173,250
PROSEDUR 259,875
PROSEDUR 259,875
PROSEDUR 259,875
PROSEDUR Variabel

% 2,078,664
% 1,870,848
% 7,898,520
% 3,872,272
% 5,820,024
% 2,510,465
% 5,230,130
% 3,325,728
% 3,949,344
% 3,949,344
% 7,586,880
% 5,404,392
% 8,314,320
% 7,482,888
% 7,898,520
% 8,314,320
% 7,898,520
% 7,898,520
% 8,314,320
% 9,524,751
* 3,741,528
% 2,078,664
% 3,741,528
* 8,314,320
% 3,582,146
% 1,662,864
% 4,157,160
% 1,796,088
% 3,533,712
% 3,429,720
% 6,235,824
% 2,390,472
% 4,572,960
% 1,974,840
% 3,741,528
% 1,870,848
% 2,494,296
% 4,988,592
% 2,078,664
% 3,949,344
% 1,974,840
% 3,741,528
% 2,078,664
% 3,949,344
% 2,078,664
% 7,959,650
% 3,014,088
% 5,612,208
% 2,390,472
% 4,572,960
% 1,974,840
% 3,741,528
% 1,974,840
% 3,741,528
% 1,767,024
% 3,325,728
% 2,078,664
% 3,741,528
% 1,767,024
% 3,325,728
% 765,072
% 1,870,848
% 3,325,728
% 5,968,269
% 3,014,088
% 1,767,024
% 2,910,096
% 1,870,848
% 3,741,528
% 2,078,664
% 3,741,528
% 2,598,288
% 4,988,592
% 5,196,408
% 9,353,568
% 2,910,096
% 5,196,408
% 1,974,840
% 3,741,528
% 6,235,824
% 6,235,824
% 4,157,160
* 7,578,744
% 7,275,072
% 5,404,392
% 5,612,208
% 5,612,208
% 5,612,208
% 7,898,520
% 6,651,456
% 5,820,024
% 2,494,296
% 5,820,024
% 6,131,832
% 6,027,840
% 1,662,864
% 4,572,960
% 4,572,960
% 6,235,824
% 4,572,960
% 5,404,392
% 4,572,960
% 4,988,592
% 4,572,960
% 4,572,960
% 4,572,960
% 5,404,392
% 4,572,960
% 4,572,960
% 4,906,443
% 4,572,960
% 4,572,960
% 4,572,960
% 4,572,960
% 4,780,776
% 6,443,640
% 4,572,960
% 5,820,024
% 4,157,160
% 4,572,960
% 4,364,976
% 4,572,960
% 4,988,592
% 4,780,776
% 8,729,952
% 4,572,960
% 139,104
% 173,397
% 80,782
% 80,782
% 62,496
BOTOL 1,351,224
% 224,233
% 312,423
% 21,000
% 41,664
% 1,039,416
% 935,592
% 3,741,528
% 364,532
% 1,122,576
% 1,039,416
% 1,039,416
% 1,351,224
% 1,039,416
% 1,455,048
% 1,143,408
% 2,757,175
% 1,662,864
% 2,078,664
% 2,261,616
% 2,510,234
% 835,800
% 2,666,974
% 2,078,664
% 2,548,838
% 1,846,200
% 2,358,400
% 1,351,224
% 2,510,234
% 1,979,600
% 2,825,002
% 2,510,234
% 1,046,033
% 385,253
% 665,280
% 385,253
% 665,280
% 385,253
% 665,280
% 385,253
% 665,280
% 519,792
% 1,039,416
% 623,616
% 1,039,416
* 520,644
% 416,443
% 748,440
% 385,253
% 385,253
% 520,644
% 914,592
% 395,705
% 665,280
% 727,608
% 1,143,408
% 458,084
% 831,432
% 458,084
% 831,432
% 385,253
% 665,280
% 385,253
% 665,280
% 458,084
% 831,432
% 458,084
% 831,432
% 385,253
% 665,280
% 385,253
% 665,280
% 520,644
% 520,644
% 458,084
% 831,432
% 458,084
% 831,432
% 727,608
% 1,143,408
% 520,644
% 935,592
% 519,792
% 519,792
% 1,039,416
% 519,792
% 385,253
% 665,280
% 385,253
% 665,280
% 384,720
% 416,443
% 866,828
% 385,253
% 665,280
% 385,253
% 665,280
% 416,443
% 748,440
% 623,616
% 1,039,416
% 1,559,040
% 437,362
% 551,833
% 520,644
% 1,039,416
% 623,616
% 914,592
% 623,616
% 1,194,048
% 727,608
% 417,816
% 415,800
% 659,154
% 385,253
% 665,280
% 385,253
% 665,280
PEMAKAIAN 6,720,000
PEMAKAIAN 1,197,000
* 5,820,150
% Variabel
% Variabel
% Variabel
% Variabel
% Variabel

PROSEDUR 62,935
PROSEDUR 62,935
PROSEDUR 62,935
PROSEDUR 3,255,525
PROSEDUR 3,052,004
PROSEDUR 121,895
PROSEDUR 108,722
PROSEDUR 108,722
PROSEDUR 393,387
% 112,067
PROSEDUR 159,472
PROSEDUR 699,341
PROSEDUR 525,000
PROSEDUR 108,722
PASIEN 168,118
PROSEDUR 65,495
PROSEDUR 65,336
PROSEDUR 101,283
PROSEDUR 108,722
PROSEDUR 217,430
PASIEN 9,390,654
HARI 420,287
PROSEDUR 84,066
PROSEDUR 81,822
PROSEDUR 145,059
PROSEDUR 108,722
PROSEDUR 26,754
PROSEDUR 130,817
PROSEDUR 21,779
PROSEDUR 217,430
PROSEDUR Variabel
PROSEDUR 157,228
PROSEDUR 101,829
PROSEDUR 101,283
PROSEDUR 70,127
PROSEDUR 81,822
SHIFT 504,338
SHIFT 504,338
SHIFT 626,126
PROSEDUR 21,779
PROSEDUR 320,229
PROSEDUR 114,476
PROSEDUR 62,935
PROSEDUR 8,861
PROSEDUR 108,722
PROSEDUR 81,822
PROSEDUR 188,370
PROSEDUR 693,840
PROSEDUR 1,159,515
PROSEDUR 185,850
PROSEDUR 346,500
PROSEDUR 371,700
PROSEDUR 724,645
PROSEDUR 362,330
PROSEDUR 185,850
PROSEDUR 458,640
PROSEDUR 709,275
PROSEDUR 147,420

PEMAKAIAN 244,806
PEMAKAIAN 21,031,290
PEMAKAIAN 187,819
PEMAKAIAN 40,889
PEMAKAIAN 1,504,913
PEMAKAIAN 113,006
PEMAKAIAN 678,615
PEMAKAIAN 173,250
SET 1,053,544
PEMAKAIAN 22,573,688
PEMAKAIAN 6,094,988
PEMAKAIAN 587,536
PEMAKAIAN 571,211
PEMAKAIAN 244,806
PEMAKAIAN 204,084
PEMAKAIAN 326,404
PEMAKAIAN 489,613
PROSEDUR 571,211
PEMAKAIAN 408,015
PEMAKAIAN 1,632,020
PEMAKAIAN 171,448
PEMAKAIAN 1,468,825
PEMAKAIAN 1,187,654
PEMAKAIAN 1,354,577
PEMAKAIAN 3,762,281
PROSEDUR Variabel
PEMAKAIAN 150,544
PEMAKAIAN 203,306
PEMAKAIAN 138,812
PEMAKAIAN 816,017
PEMAKAIAN 571,211
PEMAKAIAN 326,404
PROSEDUR Variabel
PROSEDUR Variabel
PROSEDUR Variabel
PROSEDUR Variabel
PEMAKAIAN 233,146
PEMAKAIAN 204,084
PEMAKAIAN 329,306
PROSEDUR 500,588
PEMAKAIAN 3,672,055
PEMAKAIAN 376,294
PEMAKAIAN 408,015
PEMAKAIAN 3,753,652
PEMAKAIAN 163,209
PEMAKAIAN 110,212
PEMAKAIAN Variabel
PEMAKAIAN 179,534
PEMAKAIAN 2,031,750
PEMAKAIAN 2,031,750
PEMAKAIAN 8,901,291
PROSEDUR 5,664,204
PEMAKAIAN 2,448,036
PEMAKAIAN 179,534
PEMAKAIAN 326,404
PEMAKAIAN 326,404
PEMAKAIAN 3,160,369
PEMAKAIAN 816,017
PEMAKAIAN 420,525
PEMAKAIAN 3,264,039
PEMAKAIAN 3,264,039
PEMAKAIAN 4,855,631
PEMAKAIAN 225,750
PEMAKAIAN 219,188
PEMAKAIAN 3,264,039
PROSEDUR 146,883
PEMAKAIAN 204,084
PEMAKAIAN 326,404
PEMAKAIAN 40,889
PEMAKAIAN 326,404
PROSEDUR 1,142,421
PEMAKAIAN 4,288,652
PROSEDUR 846,838
PEMAKAIAN 2,937,635
PEMAKAIAN 5,394,680
PEMAKAIAN 816,017
PEMAKAIAN 416,339
PEMAKAIAN 542,931
PEMAKAIAN 489,613
PEMAKAIAN 277,555
PEMAKAIAN 341,513
PEMAKAIAN 244,806
PEMAKAIAN 571,211
PEMAKAIAN 489,613
PEMAKAIAN 602,044
PROSEDUR 285,682
PROSEDUR 408,015
PEMAKAIAN Variabel
PEMAKAIAN 244,806
PEMAKAIAN 244,806
PEMAKAIAN 1,413,825
PEMAKAIAN 962,850
PROSEDUR 426,563

PROSEDUR 657,956
PROSEDUR 229,908
PROSEDUR 2,361,387
PROSEDUR 4,719,755
PROSEDUR 31,878
PROSEDUR 3,146,504
PROSEDUR 15,666,588
PROSEDUR 158,424
PROSEDUR 949,578
PROSEDUR 316,607
PROSEDUR 79,333
PROSEDUR 158,424
PROSEDUR 237,515
PROSEDUR 554,001
PROSEDUR 474,910
PROSEDUR 791,396
PROSEDUR 1,266,185
PROSEDUR 767,970
PROSEDUR 3,165,099
PROSEDUR 3,968,087
PROSEDUR 2,561,591
PROSEDUR 4,562,297

PROSEDUR 5,131,634

PROSEDUR 5,703,264

PROSEDUR 6,842,178

PROSEDUR 7,983,628

PROSEDUR 8,563,832

PROSEDUR 1,737,472
PROSEDUR 6,327,421

PROSEDUR 1,441,634
PROSEDUR 1,330,907
PROSEDUR 5,752,651
PROSEDUR 2,561,591
PROSEDUR 3,063,307

PROSEDUR 4,851,373
PROSEDUR 1,946,007
PROSEDUR 3,118,973
PROSEDUR 2,744,527

PROSEDUR 6,480,290
PROSEDUR 6,703,557
PROSEDUR 9,863,585

PROSEDUR 4,664,331
PROSEDUR 5,811,335
PROSEDUR 7,376,135
PROSEDUR 6,902,674
PROSEDUR 11,989,751
PROSEDUR 9,222,523
PROSEDUR 6,168,272

PROSEDUR 9,863,585

PROSEDUR 3,734,073

PROSEDUR 3,118,973
PROSEDUR 6,045,349
PROSEDUR 6,327,421

PROSEDUR 6,194,596
PROSEDUR 6,881,180
PROSEDUR 5,239,584
PROSEDUR 3,934,156
PROSEDUR 3,337,651
PROSEDUR 6,703,557
PROSEDUR 3,118,973

PROSEDUR 4,851,373
PROSEDUR 6,114,418
PROSEDUR 1,355,057
PROSEDUR 2,744,527

PROSEDUR 2,495,299
PROSEDUR 3,118,973

PROSEDUR 5,754,462
PROSEDUR 4,720,480
PROSEDUR 702,765
PROSEDUR 3,293,336

PROSEDUR 6,902,674

PROSEDUR 5,231,132
PROSEDUR 3,934,156

PROSEDUR 880,268

PROSEDUR 699,988
PROSEDUR 1,946,007
PROSEDUR 9,863,585
PROSEDUR 3,316,640
PROSEDUR 7,235,340

PROSEDUR 8,517,705

PROSEDUR 1,946,007

PROSEDUR 1,577,116

PROSEDUR 1,255,921

PROSEDUR 1,255,921

PROSEDUR 3,351,658

PROSEDUR 7,235,340
PROSEDUR 1,407,100
PROSEDUR 2,598,782
PROSEDUR 3,354,314
PROSEDUR 1,360,370
PROSEDUR 2,278,794
PROSEDUR 2,278,794
PROSEDUR 1,255,921

PROSEDUR 1,255,921

PROSEDUR 1,577,116
PROSEDUR 3,765,951
PROSEDUR 5,666,918
PROSEDUR 1,577,116
PROSEDUR 2,744,527
PROSEDUR 3,378,585

PROSEDUR 1,688,206

PROSEDUR 2,468,734

PROSEDUR 2,184,126

PROSEDUR 4,208,500
PROSEDUR 2,969,122

PROSEDUR 1,360,370
PROSEDUR 1,577,116
PROSEDUR 540,839
PROSEDUR 2,969,122

PROSEDUR 1,577,116
PROSEDUR 2,973,227
PROSEDUR 2,468,734
PROSEDUR 3,910,368
PROSEDUR 1,577,116
PROSEDUR 2,278,794

PROSEDUR 2,108,295
PROSEDUR 1,120,560
PROSEDUR 457,401
PROSEDUR 839,937

PROSEDUR 3,216,659
PROSEDUR 7,712,906

PROSEDUR 1,865,346
PROSEDUR 3,216,659
PROSEDUR 3,216,659
PROSEDUR 3,216,659
PROSEDUR 10,190,093
PROSEDUR 1,455,521
PROSEDUR 1,865,346
PROSEDUR 7,712,906

PROSEDUR 3,934,156
PROSEDUR 3,934,156
PROSEDUR 2,561,591
PROSEDUR 3,609,459

PROSEDUR 10,190,093

PROSEDUR 2,598,782
PROSEDUR 2,793,068
PROSEDUR 8,517,705
PROSEDUR 8,517,705
PROSEDUR 7,235,340
PROSEDUR 7,235,340

PROSEDUR 3,378,585
PROSEDUR 669,438
PROSEDUR 699,988
PROSEDUR 1,455,521
PROSEDUR 585,638
PROSEDUR 2,561,591
PROSEDUR 1,688,206
PROSEDUR 910,334
PROSEDUR 1,255,921
PROSEDUR 2,561,591
PROSEDUR 1,407,100
PROSEDUR 1,455,521
PROSEDUR 2,630,177
PROSEDUR 4,208,500
PROSEDUR 457,401

PROSEDUR 590,588

PROSEDUR 639,975
PROSEDUR 540,839
PROSEDUR 495,558
PROSEDUR 540,839
PROSEDUR 457,401
PROSEDUR 3,216,659
PROSEDUR 457,401
PROSEDUR 540,839
PROSEDUR 1,455,521
PROSEDUR 1,455,521
PROSEDUR 3,476,272
PROSEDUR 2,969,122
PROSEDUR 540,839
PROSEDUR 495,558
PROSEDUR 698,780
PROSEDUR 495,558
PROSEDUR 839,937
PROSEDUR 1,407,100
PROSEDUR 495,558
PROSEDUR 698,780
PROSEDUR 495,558
PROSEDUR 495,558
PROSEDUR 590,588
PROSEDUR 590,588
PROSEDUR 590,588
PROSEDUR 495,558
PROSEDUR 698,780

PROSEDUR 880,268
PROSEDUR 1,621,914
PROSEDUR 839,937
PROSEDUR 495,558
PROSEDUR 2,896,913
PROSEDUR 2,896,913
PROSEDUR 880,268
PROSEDUR 2,287,247

PROSEDUR 1,407,100

PROSEDUR 2,896,913
PROSEDUR 1,407,100
PROSEDUR 2,744,527
PROSEDUR 1,407,100
PROSEDUR 2,287,247
PROSEDUR 2,744,527
PROSEDUR 2,744,527
PROSEDUR 1,407,100
PROSEDUR 2,134,860
PROSEDUR 2,474,288
PROSEDUR 1,455,521
PROSEDUR 1,407,100
PROSEDUR 1,056,442
PROSEDUR 880,268
PROSEDUR 2,184,126
PROSEDUR 1,455,521
PROSEDUR 698,780
PROSEDUR 2,184,126
PROSEDUR 2,134,860
PROSEDUR 2,134,860

PROSEDUR 1,621,914
PROSEDUR 1,255,921

PROSEDUR 2,598,782

PROSEDUR 1,455,521
PROSEDUR 1,455,521

PROSEDUR 1,455,521
PROSEDUR 2,598,782

PROSEDUR 2,910,920
PROSEDUR 2,134,860
PROSEDUR 3,111,728

PROSEDUR 4,359,558
PROSEDUR 1,621,914
PROSEDUR 2,630,177

PROSEDUR 3,609,459

PROSEDUR 2,561,591
PROSEDUR 3,351,658
PROSEDUR 4,208,500

PROSEDUR 1,621,914
PROSEDUR 2,287,247
PROSEDUR 1,407,100
PROSEDUR 2,845,353
PROSEDUR 2,793,068
PROSEDUR 2,845,353
PROSEDUR 2,793,068
PROSEDUR 495,558
PROSEDUR 2,287,247
PROSEDUR 2,453,640

PROSEDUR 3,091,200
PROSEDUR 4,657,328
PROSEDUR 4,663,969
PROSEDUR 6,218,625
PROSEDUR 4,663,969
PROSEDUR 4,663,969
PROSEDUR 831,847
PROSEDUR 1,514,205
PROSEDUR 880,268

PROSEDUR 2,134,860

PROSEDUR 1,899,035
PROSEDUR 590,588
PROSEDUR 590,588
PROSEDUR 3,278,121
PROSEDUR 4,208,500
PROSEDUR 2,599,385
PROSEDUR 1,899,398
PROSEDUR 2,969,122
PROSEDUR 3,278,604

PROSEDUR 3,326,421

PROSEDUR 2,474,651
PROSEDUR 450,760
PROSEDUR 1,255,921
PROSEDUR 1,601,266
PROSEDUR 2,134,860
PROSEDUR 3,351,658
PROSEDUR 4,324,541
PROSEDUR 4,359,558
PROSEDUR 3,991,874
PROSEDUR 5,231,132
PROSEDUR 910,334
PROSEDUR 2,969,122
PROSEDUR 2,599,385
PROSEDUR 2,897,517
PROSEDUR 3,008,245
PROSEDUR 2,474,651
PROSEDUR 5,828,844

PROSEDUR 8,294,801

PROSEDUR 457,401
PROSEDUR 762,295
PROSEDUR 457,401
PROSEDUR 1,621,914
PROSEDUR 590,588
PROSEDUR 2,774,956
PROSEDUR 540,839
PROSEDUR 540,839
PROSEDUR 672,578
PROSEDUR 492,419
PROSEDUR 699,988

PROSEDUR 831,847

PROSEDUR 457,401
PROSEDUR 590,588

PROSEDUR 1,899,035
PROSEDUR 1,760,414
PROSEDUR 880,268
PROSEDUR 590,588
PROSEDUR 540,839

PROSEDUR 1,899,035
PROSEDUR 2,072,915
PROSEDUR 3,316,640
PROSEDUR 2,072,915
PROSEDUR 3,766,313
PROSEDUR 3,421,210
PROSEDUR 3,118,973
PROSEDUR 1,760,777
PROSEDUR 2,474,288
PROSEDUR 1,621,914
PROSEDUR 1,047,023

PROSEDUR 540,839
PROSEDUR 669,438
PROSEDUR 2,690,189
PROSEDUR 6,263,786
PROSEDUR 381,691
PROSEDUR 2,134,860
PROSEDUR 5,051,818
PROSEDUR 839,937
PROSEDUR 1,513,722

PROSEDUR 2,599,385
PROSEDUR 1,407,100
PROSEDUR 2,037,898
PROSEDUR 1,899,398
PROSEDUR 3,174,518
PROSEDUR 1,946,007
PROSEDUR 3,459,246
PROSEDUR 2,412,344

PROSEDUR 1,047,023
PROSEDUR 1,047,023
PROSEDUR 1,756,792
PROSEDUR 2,411,861
PROSEDUR 1,389,108
PROSEDUR 1,688,206
PROSEDUR 1,255,921
PROSEDUR 1,865,346
PROSEDUR 1,859,067

PROSEDUR 1,946,007
PROSEDUR 495,558
PROSEDUR 1,255,921
PROSEDUR 2,481,292
PROSEDUR 3,118,973
PROSEDUR 5,051,818
PROSEDUR 3,609,459
PROSEDUR 7,712,906
PROSEDUR 2,561,591

PROSEDUR 1,455,521

PROSEDUR 3,118,973

PROSEDUR 698,780
PROSEDUR 698,780
PROSEDUR 495,558
PROSEDUR 590,588
PROSEDUR 839,937
PROSEDUR 2,578,375
PROSEDUR 1,255,921

PROSEDUR 1,056,442

PROSEDUR 1,056,442

PROSEDUR 1,688,206
PROSEDUR 590,588
PROSEDUR 1,144,348

PROSEDUR 5,051,818
PROSEDUR 2,744,527
PROSEDUR 4,208,500
PROSEDUR 1,865,346
PROSEDUR 1,455,521
PROSEDUR 5,231,132
PROSEDUR 8,895,653
PROSEDUR 1,255,921
PROSEDUR 1,688,206

PROSEDUR 590,588
PROSEDUR 698,780
PROSEDUR 698,780

PROSEDUR 698,780
PROSEDUR 1,859,067
PROSEDUR 756,982
PROSEDUR 698,780
PROSEDUR 698,780
PROSEDUR 756,982
PROSEDUR 585,638
PROSEDUR 910,334

PROSEDUR 1,255,921

PROSEDUR 7,712,906

PROSEDUR 1,255,921
PROSEDUR 1,455,521
PROSEDUR 839,937
PROSEDUR 1,255,921
PROSEDUR 1,859,067
PROSEDUR 756,982
PROSEDUR 910,334
PROSEDUR 2,561,591
PROSEDUR 3,118,973
PROSEDUR 1,455,521
PROSEDUR 1,455,521
PROSEDUR 2,598,782
PROSEDUR 2,969,122
PROSEDUR 1,688,206
PROSEDUR 1,255,921
PROSEDUR 910,334

PROSEDUR 3,351,658
PROSEDUR 2,278,794
PROSEDUR 1,946,007
PROSEDUR 2,744,527
PROSEDUR 1,056,442
PROSEDUR 1,793,621
PROSEDUR 2,481,292
PROSEDUR 2,481,292
PROSEDUR 457,401
PROSEDUR 1,455,521
PROSEDUR 1,255,921
PROSEDUR 4,448,068
PROSEDUR 4,102,602
PROSEDUR 3,766,313
PROSEDUR 1,594,504
PROSEDUR 1,345,155
PROSEDUR 756,982
PROSEDUR 700,471
PROSEDUR 700,471
PROSEDUR 1,622,276
PROSEDUR 2,287,247
PROSEDUR 3,351,658
PROSEDUR 7,235,340

PROSEDUR 2,287,247

PROSEDUR 880,268

PROSEDUR 2,599,385
PROSEDUR 2,474,651
PROSEDUR 1,829,000
PROSEDUR 3,118,973
PROSEDUR 2,774,956
PROSEDUR 3,734,073
PROSEDUR 4,359,558
PROSEDUR 10,190,093
PROSEDUR 1,519,639
PROSEDUR 4,145,831
PROSEDUR 839,937
PROSEDUR 5,051,818
PROSEDUR 1,971,968
PROSEDUR 1,513,722
PROSEDUR 910,334
PROSEDUR 1,056,442
PROSEDUR 4,359,558
PROSEDUR 6,218,625
PROSEDUR 6,218,625
PROSEDUR 4,359,558

PROSEDUR 2,774,956

PROSEDUR 5,231,132

PROSEDUR 2,561,591
PROSEDUR 1,255,921
PROSEDUR 7,712,906
PROSEDUR 1,455,521
PROSEDUR 4,208,500
PROSEDUR 7,959,116
PROSEDUR 5,231,132
PROSEDUR 2,744,527
PROSEDUR 2,744,527
PROSEDUR 5,231,132
PROSEDUR 839,937
PROSEDUR 384,830
PROSEDUR 1,455,521
PROSEDUR 1,255,921
PROSEDUR 698,780
PROSEDUR 1,120,560
PROSEDUR 1,455,521
PROSEDUR 3,934,156
PROSEDUR 1,455,521
PROSEDUR 2,661,692
PROSEDUR 1,688,206
PROSEDUR 839,937
PROSEDUR 1,164,513

PROSEDUR 1,971,968
PROSEDUR 2,278,794
PROSEDUR 1,946,007
PROSEDUR 839,937
PROSEDUR 3,934,156
PROSEDUR 1,946,007
PROSEDUR 3,476,272
PROSEDUR 4,208,500
PROSEDUR 3,609,459
PROSEDUR 4,208,500
PROSEDUR 4,208,500
PROSEDUR 630,919
PROSEDUR 1,120,560
PROSEDUR 6,327,421
PROSEDUR 6,327,421
PROSEDUR 9,369,596

PROSEDUR 9,369,596
PROSEDUR 9,369,596
PROSEDUR 25,661,790
PROSEDUR 9,369,596
PROSEDUR 9,369,596
PROSEDUR 9,369,596

PROSEDUR 9,369,596

PROSEDUR 9,369,596
PROSEDUR 5,231,132
PROSEDUR 4,208,500

PROSEDUR 9,369,596
PROSEDUR 9,369,596
PROSEDUR 9,369,596
PROSEDUR 9,369,596
PROSEDUR 9,369,596
PROSEDUR 9,369,596
PROSEDUR 7,227,008
PROSEDUR 6,327,421
PROSEDUR 7,959,116

PROSEDUR 9,979,867

PROSEDUR 9,369,596

PROSEDUR 7,959,116

PROSEDUR 9,369,596

PROSEDUR 9,369,596
PROSEDUR 9,369,596
PROSEDUR 10,701,952

PROSEDUR 5,975,072

PROSEDUR 7,227,008
PROSEDUR 4,208,500

PROSEDUR 9,979,867

PROSEDUR 3,934,156
PROSEDUR 9,369,596
PROSEDUR 9,369,596
PROSEDUR 9,369,596
PROSEDUR 1,946,007
PROSEDUR 3,351,658
PROSEDUR 1,946,007
PROSEDUR 1,946,007
PROSEDUR 2,278,794

PROSEDUR 2,278,794
PROSEDUR 3,934,156
PROSEDUR 5,231,132
PROSEDUR 7,235,340
PROSEDUR 9,369,596

PROSEDUR 6,327,421

PROSEDUR 3,476,272

PROSEDUR 9,369,596
PROSEDUR 1,946,007

PROSEDUR 6,327,421

PROSEDUR 839,937

PROSEDUR 2,278,794

PROSEDUR 3,118,973

PROSEDUR 2,561,591

PROSEDUR 2,561,591

PROSEDUR 5,231,132

PROSEDUR 2,598,782
PROSEDUR 3,734,073
PROSEDUR 7,959,116
PROSEDUR 3,747,839
PROSEDUR 7,959,116
PROSEDUR 6,327,421
PROSEDUR 7,959,116
PROSEDUR 6,327,421
PROSEDUR 5,231,132
PROSEDUR 6,327,421
PROSEDUR 4,208,500
PROSEDUR 839,937
PROSEDUR 9,369,596

PROSEDUR 8,517,705
PROSEDUR 6,327,421

PROSEDUR 7,959,116

PROSEDUR 6,327,421

PROSEDUR 7,959,116

PROSEDUR 9,369,596
PROSEDUR 9,369,596

PROSEDUR 9,369,596

PROSEDUR 6,327,421

PROSEDUR 9,369,596

PROSEDUR 3,118,973
PROSEDUR 5,231,132

PROSEDUR 3,118,973
PROSEDUR 1,946,007

PROSEDUR 3,118,973

PROSEDUR 5,231,132

PROSEDUR 5,231,132
PROSEDUR 1,056,442
PROSEDUR 3,351,658
PROSEDUR 3,118,973

PROSEDUR 1,056,442
PROSEDUR 880,751
PROSEDUR 1,407,100
PROSEDUR 1,622,276
PROSEDUR 2,374,187
PROSEDUR 4,746,924
PROSEDUR 2,374,187

PROSEDUR 1,318,711
PROSEDUR 6,327,421

PROSEDUR 7,959,116

PROSEDUR 9,369,596

PROSEDUR 5,231,132

PROSEDUR 3,934,156

PROSEDUR 7,959,116

PROSEDUR 6,327,421
PROSEDUR 3,507,184

PROSEDUR 4,208,500
PROSEDUR 9,369,596

PROSEDUR 6,327,421

PROSEDUR 6,327,421
PROSEDUR 6,327,421

PROSEDUR 5,231,132
PROSEDUR 3,118,973
PROSEDUR 1,946,007
PROSEDUR 4,208,500
PROSEDUR 4,208,500

PROSEDUR 5,231,132

PROSEDUR 5,231,132

PROSEDUR 3,934,156

PROSEDUR 3,118,973
PROSEDUR 5,231,132
PROSEDUR 1,946,007

PROSEDUR 2,278,794

PROSEDUR 1,946,007

PROSEDUR 2,278,794

PROSEDUR 6,327,421

PROSEDUR 7,959,116
PROSEDUR 5,231,132
PROSEDUR 7,959,116

PROSEDUR 4,208,500
PROSEDUR 1,946,007

PROSEDUR 2,599,385

PROSEDUR 6,327,421

PROSEDUR 3,934,156

PROSEDUR 3,118,973

PROSEDUR 6,327,421

PROSEDUR 5,231,132
PROSEDUR 3,934,156
PROSEDUR 3,351,658
PROSEDUR 1,622,276
PROSEDUR 9,369,596

PROSEDUR 474,065
PROSEDUR 3,934,156
PROSEDUR 639,975
PROSEDUR 968,174
PROSEDUR 492,419
PROSEDUR 679,340
PROSEDUR 1,109,451
PROSEDUR 2,578,375
PROSEDUR 4,208,500
PROSEDUR 2,561,591
PROSEDUR 2,561,591
PROSEDUR 8,895,653
PROSEDUR 3,573,596
PROSEDUR 2,969,122

PROSEDUR 2,278,794

PROSEDUR 7,712,906
PROSEDUR 698,780
PROSEDUR 3,507,184
PROSEDUR 8,895,653
PROSEDUR 8,895,653
PROSEDUR 2,134,860
PROSEDUR 3,734,073
PROSEDUR 3,351,658
PROSEDUR 29,020,331
PROSEDUR 910,334
PROSEDUR 3,353,348
PROSEDUR 2,661,692
PROSEDUR 6,327,421
PROSEDUR 2,744,527
PROSEDUR 1,455,521

PROSEDUR 7,235,340
PROSEDUR 9,369,596
PROSEDUR 5,752,651
PROSEDUR 3,216,659
PROSEDUR 3,609,459
PROSEDUR 3,378,585
PROSEDUR 1,899,398
PROSEDUR 3,118,973
PROSEDUR 5,051,818
PROSEDUR 3,934,156
PROSEDUR 4,359,558
PROSEDUR 3,742,646
PROSEDUR 3,506,822
PROSEDUR 4,707,922
PROSEDUR 5,231,132
PROSEDUR 4,208,500
PROSEDUR 2,134,860
PROSEDUR 2,561,591
PROSEDUR 3,573,596
PROSEDUR 2,630,177
PROSEDUR 2,793,068
PROSEDUR 2,793,068
PROSEDUR 2,793,068
PROSEDUR 2,793,068
PROSEDUR 2,793,068
PROSEDUR 2,793,068
PROSEDUR 4,208,500
PROSEDUR 7,235,340
PROSEDUR 7,959,116
PROSEDUR 2,969,122
PROSEDUR 3,326,421
PROSEDUR 2,474,288
PROSEDUR 2,969,122
PROSEDUR 3,326,421
PROSEDUR 2,598,782
PROSEDUR 384,830
PROSEDUR 384,830
PROSEDUR 384,830
PROSEDUR 384,830
PROSEDUR 2,630,177
PROSEDUR 3,118,973
PROSEDUR 2,630,177

PROSEDUR 2,599,385
PROSEDUR 3,506,822
PROSEDUR 3,307,705
PROSEDUR 2,598,782
PROSEDUR 2,630,177
PROSEDUR 2,630,177
PROSEDUR 3,091,200
PROSEDUR 2,793,068
PROSEDUR 2,278,794
PROSEDUR 2,772,420
PROSEDUR 2,793,068
PROSEDUR 2,744,527
PROSEDUR 2,630,177
PROSEDUR 699,988
PROSEDUR 384,830
PROSEDUR 384,830
PROSEDUR 384,830
PROSEDUR 384,830
PROSEDUR 2,793,068
PROSEDUR 2,598,782

PROSEDUR 3,007,762

PROSEDUR 3,091,200

PROSEDUR 2,561,591
PROSEDUR 2,896,913
PROSEDUR 2,896,913
PROSEDUR 2,896,913
PROSEDUR 4,707,922

PROSEDUR 2,896,913
PROSEDUR 2,770,971
PROSEDUR 5,683,099
PROSEDUR 5,752,651
PROSEDUR 2,561,591
PROSEDUR 2,969,122
PROSEDUR 3,326,421
PROSEDUR 2,630,177
PROSEDUR 2,630,177
PROSEDUR 1,899,035
PROSEDUR 2,134,860
PROSEDUR 2,519,932
PROSEDUR 1,865,346
PROSEDUR 2,287,247
PROSEDUR 2,630,177

PROSEDUR 2,969,122
PROSEDUR 2,564,368
PROSEDUR 1,899,035
PROSEDUR 2,994,238
PROSEDUR 1,899,035
PROSEDUR 5,752,651
PROSEDUR 474,065
PROSEDUR 590,588
PROSEDUR 1,784,202
PROSEDUR 2,598,782
PROSEDUR 6,237,704
PROSEDUR 5,752,651
PROSEDUR 5,752,651

PROSEDUR 2,474,288
PROSEDUR 5,752,651
PROSEDUR 3,278,121
PROSEDUR 2,630,177
PROSEDUR 540,839
PROSEDUR 699,988
PROSEDUR 590,588
PROSEDUR 1,255,921
PROSEDUR 1,899,035
PROSEDUR 540,839
PROSEDUR 540,839
PROSEDUR 474,065
PROSEDUR 474,065
PROSEDUR 1,912,801
PROSEDUR 590,588
PROSEDUR 1,865,346
PROSEDUR 1,255,921
PROSEDUR 1,899,035
PROSEDUR 669,438
PROSEDUR 2,278,794
PROSEDUR 1,865,346
PROSEDUR 1,575,667
PROSEDUR 4,707,922
PROSEDUR 7,235,340
PROSEDUR 2,661,692
PROSEDUR 4,208,500
PROSEDUR 3,609,459
PROSEDUR 2,287,247
PROSEDUR 1,922,219
PROSEDUR 1,455,521
PROSEDUR 3,379,320
PROSEDUR 3,308,550
PROSEDUR 3,278,121
PROSEDUR 3,351,658
PROSEDUR 3,118,973
PROSEDUR 4,208,500
PROSEDUR 3,476,272
PROSEDUR 3,118,973
PROSEDUR 2,969,122
PROSEDUR 3,118,973
PROSEDUR 3,476,272
PROSEDUR 3,118,973
PROSEDUR 1,829,000
PROSEDUR 3,351,658
PROSEDUR 3,118,973
PROSEDUR 2,287,247

PROSEDUR 2,897,517

PROSEDUR 2,969,122
PROSEDUR 2,278,794
PROSEDUR 2,969,122
PROSEDUR 2,969,122
PROSEDUR 2,969,122

PROSEDUR 2,969,122
PROSEDUR 3,934,156
PROSEDUR 6,327,421
PROSEDUR 5,752,651
PROSEDUR 6,327,421
PROSEDUR 3,934,156
PROSEDUR 2,744,527
PROSEDUR 1,688,206

PROSEDUR 2,744,527

PROSEDUR 2,744,527
PROSEDUR 4,208,500

PROSEDUR 1,455,521
PROSEDUR 2,278,794

PROSEDUR 2,744,527
PROSEDUR 1,455,521

PROSEDUR 1,946,007
PROSEDUR 2,744,527
PROSEDUR 1,946,007

PROSEDUR 3,506,822

PROSEDUR 4,208,500

PROSEDUR 3,506,822

PROSEDUR 3,934,156

PROSEDUR 4,208,500
PROSEDUR 2,598,782

PROSEDUR 3,118,973

PROSEDUR 3,351,658

PROSEDUR 3,476,272
PROSEDUR 4,208,500
PROSEDUR 5,231,132
PROSEDUR 5,231,132
PROSEDUR 2,561,591
PROSEDUR 2,561,591
PROSEDUR 2,744,527
PROSEDUR 2,578,133

PROSEDUR 1,829,000
PROSEDUR 2,278,794
PROSEDUR 1,865,346
PROSEDUR 457,401
PROSEDUR 1,946,007
PROSEDUR 2,495,299
PROSEDUR 1,688,206
PROSEDUR 1,688,206
PROSEDUR 3,476,272
PROSEDUR 4,359,558
PROSEDUR 2,561,591
PROSEDUR 1,622,276
PROSEDUR 8,553,930
PROSEDUR 4,989,994
PROSEDUR 2,910,920
PROSEDUR 3,278,604
PROSEDUR 1,351,555
PROSEDUR 2,969,122

PROSEDUR 3,576,253
PROSEDUR 3,825,602
PROSEDUR 4,989,994
PROSEDUR 4,989,994
PROSEDUR 3,825,602
PROSEDUR 6,503,354
PROSEDUR 7,852,252
PROSEDUR 4,075,313
PROSEDUR 3,576,253
PROSEDUR 3,576,253
PROSEDUR 3,278,604

PROSEDUR 1,912,801
PROSEDUR 3,576,253
PROSEDUR 1,580,255
PROSEDUR 3,077,193
PROSEDUR 5,239,584
PROSEDUR 3,908,919
PROSEDUR 4,740,645
PROSEDUR 4,407,979
PROSEDUR 3,118,973
PROSEDUR 3,118,973
PROSEDUR 3,825,602
PROSEDUR 4,208,500
PROSEDUR 2,910,920
PROSEDUR 762,295
PROSEDUR 1,663,573
PROSEDUR 1,144,348
PROSEDUR 2,910,920
PROSEDUR 3,118,973

PROSEDUR 990,995
PROSEDUR 1,455,521
PROSEDUR 3,576,253

PROSEDUR 3,077,193

PROSEDUR 3,576,253

PROSEDUR 1,846,509
PROSEDUR 1,144,348

PROSEDUR 2,910,920

PROSEDUR 2,744,527

PROSEDUR 2,969,122
PROSEDUR 6,327,421
PROSEDUR 1,360,370
PROSEDUR 3,905,417
PROSEDUR 3,243,587
PROSEDUR 3,077,193
PROSEDUR 2,561,591
PROSEDUR 2,561,591
PROSEDUR 4,208,500
PROSEDUR 5,231,132
PROSEDUR 6,327,421

PROSEDUR 2,973,227
PROSEDUR 1,946,007

PROSEDUR 3,077,193
PROSEDUR 3,908,919
PROSEDUR 1,688,206
PROSEDUR 2,578,133
PROSEDUR 1,171,154
PROSEDUR 623,795
PROSEDUR 2,278,794
PROSEDUR 699,988
PROSEDUR 1,688,206
PROSEDUR 590,588
PROSEDUR 2,910,920

PROSEDUR 831,847

PROSEDUR 3,118,973

PROSEDUR 2,278,794

PROSEDUR 1,688,206

PROSEDUR 669,438

PROSEDUR 1,580,255
PROSEDUR 2,994,238

PROSEDUR 3,609,459
PROSEDUR 2,411,861
PROSEDUR 2,744,527
PROSEDUR 3,077,193
PROSEDUR 3,118,973
PROSEDUR 2,561,591
PROSEDUR 3,576,253
PROSEDUR 2,079,194
PROSEDUR 457,401
PROSEDUR 3,934,156
PROSEDUR 3,118,973
PROSEDUR 3,734,073
PROSEDUR 3,077,193
PROSEDUR 3,077,193
PROSEDUR 1,455,521
PROSEDUR 2,910,920
PROSEDUR 1,946,007
PROSEDUR 590,588
PROSEDUR 1,360,370
PROSEDUR 1,360,370

PROSEDUR 2,969,122
PROSEDUR 4,407,979
PROSEDUR 2,969,122
PROSEDUR 2,278,794
PROSEDUR 2,744,527
PROSEDUR 2,278,794

PROSEDUR 2,278,794
PROSEDUR 2,245,588
PROSEDUR 699,988
PROSEDUR 1,688,206
PROSEDUR 880,268
PROSEDUR 1,946,007
PROSEDUR 4,225,043
PROSEDUR 3,118,973
PROSEDUR 1,455,521
PROSEDUR 4,075,313
PROSEDUR 2,561,591
PROSEDUR 2,278,794
PROSEDUR 2,661,692
PROSEDUR 2,910,920
PROSEDUR 1,360,370
PROSEDUR 1,946,007
PROSEDUR 2,561,591
PROSEDUR 1,946,007
PROSEDUR 1,056,442
PROSEDUR 590,588
PROSEDUR 3,118,973
PROSEDUR 2,278,794
PROSEDUR 2,561,591
PROSEDUR 3,118,973
PROSEDUR 2,278,794
PROSEDUR 590,588
PROSEDUR 2,910,920
PROSEDUR 2,564,368
PROSEDUR 2,278,794
PROSEDUR 2,744,527
PROSEDUR 2,278,794
PROSEDUR 2,969,122

PROSEDUR 1,546,928
PROSEDUR 1,546,928

PROSEDUR 1,546,928

PROSEDUR 540,839
PROSEDUR 831,847
PROSEDUR 1,120,560
PROSEDUR 1,514,205
PROSEDUR 1,164,513
PROSEDUR 2,278,794
PROSEDUR 1,360,370
PROSEDUR 590,588
PROSEDUR 2,578,133
PROSEDUR 2,969,122
PROSEDUR 3,243,587
PROSEDUR 3,243,587
PROSEDUR 3,243,587

PROSEDUR 4,208,500

PROSEDUR 3,576,253
PROSEDUR 3,576,253
PROSEDUR 6,327,421
PROSEDUR 5,752,651
PROSEDUR 7,235,340
PROSEDUR 3,642,665
PROSEDUR 1,580,255
PROSEDUR 756,982
PROSEDUR 1,946,007
PROSEDUR 1,580,255
PROSEDUR 1,946,007
PROSEDUR 2,578,133
PROSEDUR 970,347
PROSEDUR 1,247,468
PROSEDUR 1,513,722
PROSEDUR 2,910,920
PROSEDUR 3,492,815
PROSEDUR 3,609,459
PROSEDUR 2,561,591
PROSEDUR 4,324,541
PROSEDUR 3,825,602
PROSEDUR 2,744,527
PROSEDUR 1,514,205
PROSEDUR 1,514,205
PROSEDUR 784,271
PROSEDUR 4,208,500
PROSEDUR 2,598,782
PROSEDUR 1,164,513
PROSEDUR 880,268
PROSEDUR 2,495,299
PROSEDUR 2,278,794
PROSEDUR 2,789,929
PROSEDUR 2,789,929
PROSEDUR 2,789,929
PROSEDUR 2,789,929
PROSEDUR 2,789,929
PROSEDUR 2,744,527
PROSEDUR 2,789,929
PROSEDUR 2,789,929
PROSEDUR 2,789,929
PROSEDUR 2,789,929
PROSEDUR 1,580,255
PROSEDUR 3,160,631

PROSEDUR 2,774,956
PROSEDUR 639,975
PROSEDUR 2,474,288

PROSEDUR 3,476,272

PROSEDUR 3,934,156

PROSEDUR 7,712,906
PROSEDUR 1,688,206

PROSEDUR 8,895,653
PROSEDUR 7,712,906
PROSEDUR 10,190,093
PROSEDUR 1,395,025
PROSEDUR 3,734,073
PROSEDUR 8,895,653
PROSEDUR 10,190,093
PROSEDUR 5,051,818
PROSEDUR 8,895,653
PROSEDUR 3,934,156

PROSEDUR 2,973,227
PROSEDUR 1,829,000
PROSEDUR 1,351,917
PROSEDUR 1,247,468
PROSEDUR 8,682,650

PROSEDUR 1,577,116
PROSEDUR 2,468,734
PROSEDUR 1,351,555
PROSEDUR 1,971,968
PROSEDUR 1,171,154
PROSEDUR 1,577,116
PROSEDUR 1,688,206
PROSEDUR 1,971,968

PROSEDUR 1,144,348
PROSEDUR 1,946,007
PROSEDUR 1,946,007
PROSEDUR 3,351,658
PROSEDUR 1,144,348
PROSEDUR 639,975
PROSEDUR 582,136

PROSEDUR 910,334

PROSEDUR 2,108,295
PROSEDUR 3,216,659
PROSEDUR 1,255,921
PROSEDUR 2,561,591
PROSEDUR 1,056,442
PROSEDUR 2,973,227
PROSEDUR 2,278,794

PROSEDUR 4,208,500

PROSEDUR 1,829,000
PROSEDUR 2,108,295
PROSEDUR 3,118,973
PROSEDUR 1,144,348
PROSEDUR 1,688,206
PROSEDUR 3,609,459
PROSEDUR 1,946,007
PROSEDUR 2,774,956
PROSEDUR 1,829,000
PROSEDUR 2,744,527
PROSEDUR 1,395,025
PROSEDUR 2,278,794
PROSEDUR 2,278,794
PROSEDUR 2,744,527
PROSEDUR 3,910,368
PROSEDUR 2,468,734
PROSEDUR 10,190,093
PROSEDUR 2,278,794
PROSEDUR 2,973,227
PROSEDUR 880,751
PROSEDUR 2,774,956
PROSEDUR 1,829,000
PROSEDUR 5,231,132
PROSEDUR 3,631,073
PROSEDUR 910,334
PROSEDUR 2,770,971

PROSEDUR 3,351,658

PROSEDUR 910,334

PROSEDUR 2,108,295
PROSEDUR 639,975

PROSEDUR 1,144,348

PROSEDUR 2,108,295
PROSEDUR 3,216,659

PROSEDUR 2,108,295

PROSEDUR 2,973,227

PROSEDUR 4,208,500

PROSEDUR 3,631,073
PROSEDUR 2,108,295

PROSEDUR 4,208,500

PROSEDUR 2,973,227
PROSEDUR 2,744,527
PROSEDUR 1,829,000

PROSEDUR 2,962,481

PROSEDUR 1,255,921
PROSEDUR 2,973,227
PROSEDUR 4,559,158
PROSEDUR 1,829,000

PROSEDUR 2,973,227
PROSEDUR 3,765,951
PROSEDUR 1,144,348
PROSEDUR 3,118,973
PROSEDUR 2,973,227
PROSEDUR 4,208,500
PROSEDUR 1,255,921
PROSEDUR 3,118,973
PROSEDUR 5,050,007

PROSEDUR 4,208,500
PROSEDUR 5,231,132
PROSEDUR 4,559,158
PROSEDUR 7,593,122

PROSEDUR 5,754,462

PROSEDUR 2,194,873
PROSEDUR 4,171,671
PROSEDUR 4,839,781
PROSEDUR 3,742,646
PROSEDUR 2,278,794
PROSEDUR 3,476,272
PROSEDUR 4,208,500
PROSEDUR 5,231,132
PROSEDUR 5,754,462

PROSEDUR 5,231,132

PROSEDUR 8,682,650

PROSEDUR 4,839,781

PROSEDUR 9,550,721

PROSEDUR 7,593,122

PROSEDUR 6,902,674

PROSEDUR 6,902,674

PROSEDUR 4,171,671

PROSEDUR 1,395,025
PROSEDUR 2,561,591
PROSEDUR 2,278,794
PROSEDUR 1,829,000
PROSEDUR 1,395,025
PROSEDUR 1,395,025
PROSEDUR 2,561,591
PROSEDUR 2,774,956
PROSEDUR 2,744,527
PROSEDUR 3,609,459
PROSEDUR 4,045,246
PROSEDUR 1,577,116
PROSEDUR 3,476,272
PROSEDUR 5,231,132
PROSEDUR 5,666,918
PROSEDUR 6,327,421
PROSEDUR 4,261,751
PROSEDUR 5,666,918
PROSEDUR 6,327,421
PROSEDUR 4,261,751
PROSEDUR 6,327,421
PROSEDUR 5,231,132
PROSEDUR 3,476,272
PROSEDUR 6,327,421

PROSEDUR 4,559,158
PROSEDUR 3,378,585
PROSEDUR 8,682,650
PROSEDUR 10,221,005
PROSEDUR 6,861,498
PROSEDUR 2,969,122
PROSEDUR 5,231,132
PROSEDUR 6,327,421
PROSEDUR 3,631,073
PROSEDUR 4,045,246
PROSEDUR 5,231,132
PROSEDUR 6,327,421
PROSEDUR 2,468,734
PROSEDUR 474,065
PROSEDUR 910,334
PROSEDUR 474,065
PROSEDUR 551,103
PROSEDUR 2,468,734
PROSEDUR 3,934,156

PROSEDUR 2,468,734
PROSEDUR 4,261,751
PROSEDUR 1,395,025
PROSEDUR 551,103
PROSEDUR 1,056,442
PROSEDUR 582,136
PROSEDUR 1,056,442
PROSEDUR 1,255,921
PROSEDUR 1,829,000
PROSEDUR 3,118,973
PROSEDUR 2,774,956
PROSEDUR 2,774,956
PROSEDUR 4,359,558
PROSEDUR 2,108,295
PROSEDUR 1,255,921

PROSEDUR 2,774,956
PROSEDUR 2,468,734
PROSEDUR 2,973,227
PROSEDUR 1,577,116
PROSEDUR 3,118,973
PROSEDUR 1,056,442
PROSEDUR 1,829,000
PROSEDUR 910,334
PROSEDUR 2,561,591
PROSEDUR 2,108,295
PROSEDUR 699,988
PROSEDUR 1,120,560
PROSEDUR 1,395,025
PROSEDUR 1,395,025
PROSEDUR 1,056,442
PROSEDUR 1,056,442
PROSEDUR 3,118,973
PROSEDUR 1,247,468
PROSEDUR 2,744,527
PROSEDUR 2,774,956
PROSEDUR 1,395,025
PROSEDUR 2,278,794
PROSEDUR 2,744,527
PROSEDUR 474,065

PROSEDUR 699,988
PROSEDUR 7,712,906
PROSEDUR 1,577,116
PROSEDUR 1,577,116
PROSEDUR 2,468,734
PROSEDUR 10,190,093
PROSEDUR 1,395,025
PROSEDUR 3,216,659
PROSEDUR 8,895,653
PROSEDUR 10,190,093
PROSEDUR 1,395,025
PROSEDUR 6,327,421
PROSEDUR 3,378,585

PROSEDUR 3,631,073

PROSEDUR 6,902,674
PROSEDUR 3,378,585
PROSEDUR 6,327,421
PROSEDUR 2,561,591

PROSEDUR 7,593,122
PROSEDUR 7,593,122

PROSEDUR 5,051,818
PROSEDUR 450,760
PROSEDUR 1,121,043
PROSEDUR 1,971,968
PROSEDUR 5,051,818

PROSEDUR 1,351,917
PROSEDUR 2,218,178
PROSEDUR 5,051,818
PROSEDUR 1,802,073
PROSEDUR 5,051,818
PROSEDUR 1,109,451
PROSEDUR 1,351,917
PROSEDUR 5,051,818

PROSEDUR 2,703,351

PROSEDUR 8,895,653
PROSEDUR 5,051,818
PROSEDUR 2,218,178
PROSEDUR 8,895,653
PROSEDUR 2,703,351

PROSEDUR 2,924,807
PROSEDUR 1,802,073
PROSEDUR 10,190,093
PROSEDUR 2,931,931
PROSEDUR 3,604,146
PROSEDUR 5,752,651
PROSEDUR 8,895,653
PROSEDUR 1,247,831
PROSEDUR 474,065
PROSEDUR 540,839
PROSEDUR 910,334

PROSEDUR 474,065
PROSEDUR 1,575,667
PROSEDUR 474,065
PROSEDUR 1,109,451

PROSEDUR 1,056,442

PROSEDUR 1,455,521
PROSEDUR 1,865,346

PROSEDUR 2,561,591

PROSEDUR 474,065
PROSEDUR 1,971,968
PROSEDUR 2,578,375

PROSEDUR 699,988
PROSEDUR 756,982
PROSEDUR 590,588
PROSEDUR 1,455,521
PROSEDUR 1,255,921

PROSEDUR 1,056,442
PROSEDUR 1,056,442
PROSEDUR 3,609,459
PROSEDUR 910,334
PROSEDUR 1,455,521
PROSEDUR 756,982
PROSEDUR 474,065

PROSEDUR 1,455,521

PROSEDUR 5,051,818

PROSEDUR 1,164,513

PROSEDUR 7,712,906

PROSEDUR 1,455,521
PROSEDUR 8,895,653
PROSEDUR 3,118,973

PROSEDUR 1,865,346
PROSEDUR 2,598,782

PROSEDUR 540,839

PROSEDUR 4,882,285
PROSEDUR 2,474,288
PROSEDUR 1,395,025
PROSEDUR 1,688,206
PROSEDUR 7,712,906
PROSEDUR 8,895,653
PROSEDUR 10,190,093
PROSEDUR 1,971,968
PROSEDUR 2,630,177
PROSEDUR 2,561,591
PROSEDUR 3,476,272

PROSEDUR 2,561,591
PROSEDUR 10,190,093

PROSEDUR 1,865,346
PROSEDUR 1,688,206
PROSEDUR 990,995
PROSEDUR 639,975
PROSEDUR 699,988
PROSEDUR 1,091,942
PROSEDUR 756,982
PROSEDUR 1,180,211
PROSEDUR 590,588
PROSEDUR 474,065
PROSEDUR 910,334
PROSEDUR 756,982

PROSEDUR 457,401
PROSEDUR 2,374,187
PROSEDUR 2,374,187
PROSEDUR 2,134,860
PROSEDUR 2,630,177
PROSEDUR 1,581,946
PROSEDUR 540,839
PROSEDUR 1,171,154
PROSEDUR 699,988
PROSEDUR 450,760
PROSEDUR 791,033
PROSEDUR 910,334
PROSEDUR 1,580,255
PROSEDUR 183,661
PROSEDUR 1,056,442
PROSEDUR 623,795
PROSEDUR 381,691

PROSEDUR 621,863
PROSEDUR 3,243,587

PROSEDUR 2,561,591

PROSEDUR 1,688,206

PROSEDUR 2,108,295
PROSEDUR 1,120,560
PROSEDUR 1,455,521

PROSEDUR 791,033

PROSEDUR 4,663,969
PROSEDUR 9,576,683
PROSEDUR 4,650,807
PROSEDUR 527,315

PROSEDUR 3,093,736

PROSEDUR 3,160,148

PROSEDUR 4,990,356
PROSEDUR 4,557,226
PROSEDUR 5,579,495
PROSEDUR 4,557,226
PROSEDUR 5,488,933
PROSEDUR 5,579,495
PROSEDUR 829,190
PROSEDUR 1,243,725
PROSEDUR 1,658,381
PROSEDUR 4,261,751
PROSEDUR 4,609,500
PROSEDUR 1,582,350
PROSEDUR 105,000
PROSEDUR 3,018,750
PROSEDUR 5,120,850

PROSEDUR 31,648,696
PROSEDUR 13,686,409
PROSEDUR 15,394,659
PROSEDUR 17,109,551

PROSEDUR 20,526,172

PROSEDUR 23,950,763

PROSEDUR 25,691,253

PROSEDUR 5,212,415
PROSEDUR 5,876,661
PROSEDUR 18,982,021

PROSEDUR 4,324,541
PROSEDUR 3,992,357
PROSEDUR 17,257,590
PROSEDUR 7,684,530
PROSEDUR 9,189,800

PROSEDUR 14,553,877
PROSEDUR 5,837,780
PROSEDUR 9,356,555
PROSEDUR 8,233,460
PROSEDUR 19,440,629
PROSEDUR 20,110,550
PROSEDUR 29,590,754
PROSEDUR 13,992,993
PROSEDUR 17,433,885
PROSEDUR 22,128,162
PROSEDUR 20,707,780
PROSEDUR 35,969,131
PROSEDUR 27,667,206
PROSEDUR 18,504,575
PROSEDUR 29,590,754

PROSEDUR 11,201,978

PROSEDUR 9,356,555
PROSEDUR 18,135,926
PROSEDUR 18,982,021

PROSEDUR 18,583,787
PROSEDUR 20,643,299
PROSEDUR 15,718,752
PROSEDUR 11,801,984
PROSEDUR 10,012,952
PROSEDUR 20,110,550
PROSEDUR 9,356,555
PROSEDUR 14,553,877
PROSEDUR 18,343,133
PROSEDUR 4,064,928
PROSEDUR 8,233,460

PROSEDUR 7,485,534
PROSEDUR 9,356,555

PROSEDUR 17,263,024
PROSEDUR 14,161,198
PROSEDUR 2,107,933
PROSEDUR 949,699
PROSEDUR 9,879,765

PROSEDUR 20,707,780
PROSEDUR 15,693,274
PROSEDUR 11,801,984
PROSEDUR 2,640,440

PROSEDUR 2,099,843
PROSEDUR 5,837,780
PROSEDUR 29,590,754
PROSEDUR 21,705,899

PROSEDUR 25,552,874

PROSEDUR 5,837,780

PROSEDUR 4,730,864

PROSEDUR 3,767,762

PROSEDUR 3,767,762

PROSEDUR 10,054,611

PROSEDUR 21,705,899
PROSEDUR 4,221,058
PROSEDUR 7,796,224
PROSEDUR 10,062,701
PROSEDUR 4,081,109
PROSEDUR 6,835,899
PROSEDUR 6,835,899
PROSEDUR 3,767,762

PROSEDUR 3,767,762

PROSEDUR 4,730,864
PROSEDUR 11,297,491
PROSEDUR 17,000,634
PROSEDUR 4,730,864
PROSEDUR 8,233,460
PROSEDUR 10,135,393

PROSEDUR 5,064,376

PROSEDUR 7,406,201

PROSEDUR 6,552,137

PROSEDUR 12,625,137
PROSEDUR 8,907,245
PROSEDUR 4,081,109
PROSEDUR 4,730,864
PROSEDUR 1,622,276
PROSEDUR 8,907,245
PROSEDUR 4,730,864
PROSEDUR 8,919,440
PROSEDUR 7,406,201
PROSEDUR 11,730,621
PROSEDUR 4,730,864
PROSEDUR 6,835,899
PROSEDUR 6,324,764
PROSEDUR 3,361,439
PROSEDUR 1,372,082
PROSEDUR 2,519,449

PROSEDUR 9,649,857
PROSEDUR 23,138,357

PROSEDUR 5,595,676
PROSEDUR 9,649,857
PROSEDUR 9,649,857
PROSEDUR 9,649,857
PROSEDUR 30,570,036
PROSEDUR 4,366,199
PROSEDUR 5,595,676
PROSEDUR 23,138,357

PROSEDUR 11,801,984
PROSEDUR 11,801,984
PROSEDUR 7,684,530
PROSEDUR 10,828,015

PROSEDUR 30,570,036
PROSEDUR 7,796,224
PROSEDUR 8,378,601
PROSEDUR 25,552,874
PROSEDUR 25,552,874
PROSEDUR 21,705,899
PROSEDUR 21,705,899

PROSEDUR 10,135,393
PROSEDUR 2,008,314
PROSEDUR 3,956,012
PROSEDUR 2,099,843
PROSEDUR 4,366,199
PROSEDUR 1,756,792
PROSEDUR 7,684,530
PROSEDUR 5,064,376
PROSEDUR 2,730,641
PROSEDUR 3,767,762
PROSEDUR 7,684,530
PROSEDUR 4,221,058
PROSEDUR 4,366,199
PROSEDUR 7,890,409
PROSEDUR 12,625,137
PROSEDUR 1,372,082

PROSEDUR 1,771,644

PROSEDUR 1,919,563
PROSEDUR 1,622,276
PROSEDUR 1,486,433
PROSEDUR 1,622,276
PROSEDUR 1,372,082
PROSEDUR 9,649,857
PROSEDUR 1,372,082
PROSEDUR 1,622,276
PROSEDUR 4,366,199
PROSEDUR 4,366,199
PROSEDUR 10,428,574
PROSEDUR 8,907,245
PROSEDUR 1,622,276
PROSEDUR 1,486,433
PROSEDUR 2,095,737
PROSEDUR 1,486,433
PROSEDUR 2,519,449
PROSEDUR 4,221,058
PROSEDUR 1,486,433
PROSEDUR 2,095,737
PROSEDUR 1,486,433
PROSEDUR 1,486,433
PROSEDUR 1,771,644
PROSEDUR 1,771,644
PROSEDUR 1,771,644
PROSEDUR 1,486,433
PROSEDUR 2,095,737

PROSEDUR 2,640,440
PROSEDUR 4,865,380
PROSEDUR 2,519,449
PROSEDUR 1,486,433
PROSEDUR 8,690,740
PROSEDUR 8,690,740
* 36,709,208
PROSEDUR 2,640,440
PROSEDUR 6,861,498

PROSEDUR 4,221,058

PROSEDUR 8,690,740
PROSEDUR 4,221,058
PROSEDUR 8,233,460
PROSEDUR 4,221,058
PROSEDUR 6,861,498
PROSEDUR 8,233,460
PROSEDUR 8,233,460
PROSEDUR 4,221,058
PROSEDUR 6,404,097
PROSEDUR 7,422,382
PROSEDUR 4,366,199
PROSEDUR 4,221,058
PROSEDUR 3,169,084
PROSEDUR 2,640,440
PROSEDUR 6,552,137
PROSEDUR 4,366,199
PROSEDUR 2,095,737
PROSEDUR 6,552,137
PROSEDUR 6,404,097
PROSEDUR 6,404,097

PROSEDUR 4,865,380
PROSEDUR 3,767,762

PROSEDUR 7,796,224

PROSEDUR 4,366,199
PROSEDUR 4,366,199

PROSEDUR 4,366,199
PROSEDUR 7,796,224

PROSEDUR 8,732,399
PROSEDUR 6,404,097
PROSEDUR 9,334,941
NO. KODE KETERANGAN

2681 SG1479 OTHER OPERATIONS ON VITREOUS

2682 SG1521 LENGTHENING PROCEDURE ON ONE EXTRAOCULAR MUSCLE
2683 SG154A OTHER OPERATIONS ON TWO OR MORE EXTRAOCULAR MUSCLES, ONE OR BOTH
EYES (SQUINT)
2684 SG154B OTHER OPERATIONS ON TWO OR MORE EXTRAOCULAR MUSCLES, ONE OR BOTH
EYES (SQUINT W ADJUSTABLE SUTURES)
2685 SG155 TRANSPOSITION OF EXTRAOCULAR MUSCLES
2686 SG156A REVISION OF EXTRAOCULAR MUSCLE SURGERY (REVISION OF SQUINT)
2687 SG156B REVISION OF EXTRAOCULAR MUSCLE SURGERY (REVISION OF SQUINT W
ADJUSTABLE SUTURES)
2688 SG1609 OTHER ORBITOTOMY
2689 SG1609A OTHER ORBITOTOMY (EXPLORATION/REMOVAL OF FOREIGN BODY)
2690 SG1623 BIOPSY OF EYEBALL AND ORBIT
2691 SG1649 OTHER ENUCLEATION OF EYEBALL
2692 SG1652 EXENTERATION OF ORBIT WITH THERAPEUTIC REMOVAL OF ORBITAL BONE
2693 SG1659 OTHER EXENTERATION OF ORBIT / EVISCERATION OF ORBIT NOS
2694 SG1666 OTHER REVISION OF EXENTERATION CAVITY
2695 SG1691 RETROBULBAR INJECTION OF THERAPEUTIC AGENT
2696 SG1692 EXCISION OF LESION OF ORBIT
2697 SG1713 LAPAROSCOPIC REPAIR OF INGUINAL HERNIA WITH GRAFT OR PROSTHESIS, NOT
OTHERWISE SPECIFIED
2698 SG1736 LAPAROSCOPIC SIGMOIDECTOMY
2699 SG1739 OTHER LAPAROSCOPIC PARTIAL EXCISION OF LARGE INTESTINE
2700 SG182 EXCISION OR DESTRUCTION OF LESION OF EXTERNAL EAR
2701 SG1821 EXCISION OF PREAURICULAR SINUS
2702 SG1829A EXCISION OR DESTRUCTION OF OTHER LESION OF EXTERNAL EAR (GRANULASI)
2703 SG1829B EXCISION OR DESTRUCTION OF OTHER LESION OF EXTERNAL EAR (REMOVAL OF
EXOSTOSES FROM EAC)
2704 SG1839 AMPUTATION OF EXTERNAL EAR
2705 SG184 SUTURE OF LACERATION OF EXTERNAL EAR
2706 SG185 SURGICAL CORRECTION OF PROMINENT EAR
2707 SG186 RECONSTRUCTION OF EXTERNAL AUDITORY CANAL
2708 SG186A RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (GRAFT)
2709 SG186B RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (EAR)
2710 SG186C RECONSTRUCTION OF EXTERNAL AUDITORY CANAL - MEATOPLASTY
2711 SG1919 OTHER STAPEDECTOMY
2712 SG193 OTHER OPERATIONS ON OSSICULAR CHAIN - OSSICULOPLASTY WITH/WITHOUT
TYMPANOPLASTY
2713 SG194 MYRINGOPLASTY (TYMPANOPLASTY)
2714 SG194A MYRINGOPLASTY
2715 SG200 MYRINGOTOMY
2716 SG2001 MYRINGOTOMY WITH INSERTION OF TUBE
2717 SG2031 ELECTROCOCHLEOGRAPHY - TRANS TYMPANIC
2718 SG2032 BIOPSY OF MIDDLE AND INNER EAR
2719 SG2041 SIMPLE MASTOIDECTOMY
2720 SG2042 RADICAL MASTOIDECTOMY
2721 SG2049A OTHER MASTOIDECTOMY - PETROSECTOMY
2722 SG2049B OTHER MASTOIDECTOMY - MODIFIED RADICAL MASTOIDECTOMY
2723 SG2049C OTHER MASTOIDECTOMY - PETROSECTOMY (COMPLEX)
2724 SG2051A EXCISION OF LESION OF MIDDLE EAR - POLYPECTOMY
2725 SG2051B EXCISION OF LESION OF MIDDLE EAR -TUMOUR
2726 SG2079 INCISION OF ENDOLYMPHATIC SAC - OPERATION(S) ENDOLYMPHATIC SAC
2727 SG2079A LABYRINTHECTOMY (TRANSTYMPANIC) - MEMBRANOUS
2728 SG2079B LABYRINTHECTOMY (TRANSTYMPANIC) - OSSEUS
2729 SG2092 REVISION OF MASTOIDECTOMY
2730 SG2097 IMPLANTATION OR REPLACEMENT OF COCHLEAR PROSTHETIC DEVICE, SINGLE
CHANNEL
2731 SG2098 IMPLANTATION OR REPLACEMENT OF COCHLEAR PROSTHETIC DEVICE, MULTIPLE
CHANNEL
2732 SG2101 CONTROL OF EPISTAXIS BY ANTERIOR NASAL PACKING
2733 SG2102 CONTROL OF EPISTAXIS BY POSTERIOR (AND ANTERIOR) PACKING
2734 SG2103 CONTROL OF EPISTAXIS BY CAUTERIZATION (AND PACKING)
2735 SG2104 CONTROL OF EPISTAXIS BY LIGATION OF ETHMOIDAL ARTERIES
2736 SG211 INCISION OF NOSE
2737 SG211A INCISION OF NOSE (LATERAL RHINOTOMY INTO SINUS FOR MALIGNANCY)
2738 SG2121 RHINOSCOPY / NASOENDOSCOPY
2739 SG2122 BIOPSY OF NOSE
2740 SG2123 BIOPSY OF LESION OF TURBINATE OF NOSE
2741 SG2129 OTHER DIAGNOSTIC PROCEDURE ON NOSE - VOCAL CORD (SLEEP ENDOSCOPY)
2742 SG213 LOCAL EXCISION OR DESTRUCTION OF LESION OF NOSE
2743 SG2130 EXCISION OR DESTRUCTION OF LESION OF NOSE, NOT OTHERWISE SPECIFIED
2744 SG2131A LOCAL EXCISION OR DESTRUCTION OF INTRANASAL LESION - POLYPECTOMY
2745 SG2132 LOCAL EXCISION OR DESTRUCTION OF OTHER LESION OF NOSE
2746 SG2132A ENDOSCOPIC TUMOR RESSECTION OF SINUS OR PARANASAL
2747 SG2132B LOCAL EXCISION OR DESTRUCTION OF OTHER LESION OF NOSE (INTERNAL)
2748 SG214 RESECTION OF NOSE - AMPUTATION OF NOSE
2749 SG215 SUBMUCOUS RESECTION OF NASAL SEPTUM
2750 SG216 TURBINECTOMY
2751 SG2161A TURBINECTOMY BY DIATHERMY OR CRYOSURGERY (DIATHERMY)
2752 SG2161B TURBINECTOMY BY DIATHERMY OR CRYOSURGERY (CAUTERISATION)
2753 SG2169 OTHER TURBINECTOMY
2754 SG2172A OPEN REDUCTION OF NASAL FRACTURE - OPEN FRACTURE
2755 SG2172B OPEN REDUCTION OF NASAL FRACTURE - CLOSED FRACTURE
2756 SG2184 REVISION RHINOPLASTY - RHINOSEPTOPLASTY
2757 SG2184A REVISION OF RHINOSEPTOPLASTY - SEPTOPLASTY OF NOSE
2758 SG2187 OTHER RHINOPLASTY, NOS
2759 SG2188 OTHER SEPTOPLASTY
2760 SG219 OTHER OPERATION ON NOSE - INTRANASAL ANTROSTOMY INCL.ENDOSCOPIC
2761 SG2191 LYSIS OF ADHESIONS OF NOSE
2762 SG2201 PUNCTURE OF NASAL SINUS FOR ASPIRATION OR LAVAGE
2763 SG2219A OTHER DIAGNOSTIC PROCEDURES ON NASAL SINUSES - MINI FESS
2764 SG2219B OTHER DIAGNOSTIC PROCEDURES ON NASAL SINUSES - ADVANCED FESS
2765 SG2219C OTHER DIAGNOSTIC PROCEDURES ON NASAL SINUSES
 TARIF INSURANCE 01 APR
SATUAN 2022

PROSEDUR 13,078,312
PROSEDUR 4,865,380
PROSEDUR 7,890,409

PROSEDUR 10,828,015

PROSEDUR 7,684,530
PROSEDUR 10,054,611
PROSEDUR 12,625,137

PROSEDUR 4,865,380
PROSEDUR 6,861,498
PROSEDUR 4,221,058
PROSEDUR 8,536,059
PROSEDUR 8,378,601
PROSEDUR 8,536,059
PROSEDUR 8,378,601
PROSEDUR 1,486,433
PROSEDUR 6,861,498
PROSEDUR 7,360,437

PROSEDUR 9,273,238
PROSEDUR 13,971,620
PROSEDUR 2,495,299
PROSEDUR 4,542,494
PROSEDUR 2,640,440
PROSEDUR 6,404,097

PROSEDUR 5,696,623
PROSEDUR 1,771,644
PROSEDUR 1,771,644
PROSEDUR 9,834,122
PROSEDUR 12,625,137
PROSEDUR 7,797,673
PROSEDUR 5,697,830
PROSEDUR 8,907,245
PROSEDUR 9,835,450

PROSEDUR 9,979,263
PROSEDUR 7,423,589
PROSEDUR 1,351,917
PROSEDUR 3,767,762
PROSEDUR 4,803,435
PROSEDUR 6,404,097
PROSEDUR 10,054,611
PROSEDUR 12,973,501
PROSEDUR 13,078,312
PROSEDUR 11,975,381
PROSEDUR 15,693,274
PROSEDUR 2,730,641
PROSEDUR 8,907,245
PROSEDUR 7,797,673
PROSEDUR 8,692,068
PROSEDUR 9,024,251
PROSEDUR 7,423,589
PROSEDUR 17,486,170

PROSEDUR 24,884,160

PROSEDUR 1,372,082
PROSEDUR 2,286,764
PROSEDUR 1,372,082
PROSEDUR 4,865,380
PROSEDUR 1,771,644
PROSEDUR 8,324,867
PROSEDUR 232,082
PROSEDUR 1,622,276
PROSEDUR 1,622,276
PROSEDUR 2,017,733
PROSEDUR 1,477,014
PROSEDUR 2,099,843
PROSEDUR 2,495,299
PROSEDUR 1,372,082
* 15,364,109
PROSEDUR 1,771,644
PROSEDUR 5,696,623
PROSEDUR 5,280,881
PROSEDUR 2,640,440
PROSEDUR 1,771,644
PROSEDUR 1,622,276
PROSEDUR 5,696,623
PROSEDUR 11,298,819
PROSEDUR 8,955,786
PROSEDUR 9,356,555
PROSEDUR 5,282,330
PROSEDUR 7,422,382
PROSEDUR 4,865,380
PROSEDUR 3,140,949
PROSEDUR 1,622,276
PROSEDUR 2,008,314
PROSEDUR 8,070,568
PROSEDUR 18,790,994
PROSEDUR 1,144,831
NO. KODE KETERANGAN

2766 SG222 INTRANASAL ANTROTOMY

2767 SG2239 OTHER EXTERNAL MAXILLARY ANTROTOMY
2768 SG2241 FRONTAL SINUSOTOMY
2769 SG2261 EXCISION OF LESION OF MAXILLARY SINUS WITH CALDWELL-LUC APPROACH
2770 SG2263 EXT FRONTOETHMOIDECTOMY
2771 SG2263A INTRANASAL ETHMOIDECTOMY
2772 SG2263B EXT ETHMOIDECTOMY INCLUDING ENDOSCOPIC
2773 SG2263C TRANSANTRAL ETHMOIDECTOMY
2774 SG2263D RADICAL FRONTOETHMOIDECTOMY
2775 SG2271 CLOSURE OF NASAL SINUS FISTULA
2776 SG2279 OTHER REPAIR OF NASAL SINUS - REPAIR OF BONE OF ACCESSORY SINUS
2777 SG229 OTHER OPERATION ON NASAL SINUSES - ANTERIOR AND POSTERIOR OPENING INTO
FESS
2778 SG229A OTHER OPERATION ON NASAL SINUSES - SPHENOID SINUS
2779 SG229B OTHER OPERATION ON NASAL SINUSES - UNSPECIFIED
2780 SG2319 OTHER SURGICAL EXTRACTION OF TOOTH
2781 SG235 IMPLANTATION OF TOOTH
2782 SG2373 APICOECTOMY
2783 SG244A EXCISION OF DENTAL LESION OF JAW
2784 SG244B EXCISION OF DENTAL LESION OF JAW - CYST
2785 SG245 ALVEOLOPLASTY
2786 SG245A ALVEOLECTOMY
2787 SG246 EXPOSURE OF TOOTH
2788 SG2501 OPEN/CLOSED [NEEDLE] BIOPSY OF TONGUE
2789 SG251 EXCISION OR DESTRUCTION OF LESION OR TISSUE OF TONGUE
2790 SG251A INSICION/EXCISION OF PAPILLOMA/FIBROMA
2791 SG252 PARTIAL GLOSSECTOMY
2792 SG252A PARTIAL GLOSSECTOMY (HEMIGLOSECTOMY)
2793 SG253 COMPLETE GLOSSECTOMY
2794 SG253A COMPLETE GLOSSECTOMY (COMPLEX)
2795 SG2559A OTHER REPAIR AND PLASTIC OPERATIONS ON TONGUE (GLOSSOPLASTY/TONGUE
FLAP 1ST STAGE)
2796 SG2559B OTHER REPAIR AND PLASTIC OPERATIONS ON TONGUE (GLOSSOPLASTY/TONGUE
FLAP 2ND STAGE)
2797 SG2559C OTHER REPAIR AND PLASTIC OPERATIONS ON TONGUE (FUSION OF TONGUE TO LIP)

2798 SG2591 LINGUAL FRENOTOMY

2799 SG2592 LINGUAL FRENECTOMY
2800 SG2592A LINGUAL FRENECTOMY DI OPD
2801 SG2593 LYSIS OF ADHESIONS OF TONGUE
2802 SG260 INCISION OF SALIVARY GLAND OR DUCT
2803 SG2611 CLOSED [NEEDLE] BIOPSY OF SALIVARY GLAND OR DUCT
2804 SG2621 MARSUPIALIZATION OF SALIVARY GLAND CYST
2805 SG2629A OTHER EXCISION OF SALIVARY GLAND LESION - SIALOLITHIASIS PAROTID (OPEN)

2806 SG2629B OTHER EXCISION OF SALIVARY GLAND LESION - SIALOLITHIASIS SUBMANDIBULAR

2807 SG2629C OTHER EXCISION OF SALIVARY GLAND LESION - SIALOLITHIASIS PAROTID

(MANIPULATIVE)
2808 SG2629D EXCISION OF LESION OF SALIVARY GLAND - PAROTID/SUBMANDIBULAR
2809 SG2629E EXCISION OF LESION OF SALIVARY GLAND - SUBLINGUAL
2810 SG2629F OTHER EXCISION OF SALIVARY GLAND LESION-STONE EXTRACTION WITH IMAGING

2811 SG2630 SIALOADENECTOMY, NOT OTHERWISE SPECIFIED

2812 SG2630A SIALOADENECTOMY, NOT OTHERWISE SPECIFIED - PAROTID
2813 SG2631 PARTIAL SIALOADENECTOMY
2814 SG2631B SIALOADENECTOMY, NOT OTHERWISE SPECIFIED - SUBMANDIBULAR
2815 SG2631C SIALOADENECTOMY, NOT OTHERWISE SPECIFIED - SUBLINGUAL
2816 SG2632 COMPLETE SIALOADENECTOMY
2817 SG2632A COMPLETE SIALOADENECTOMY (PAROTIDECTOMY)
2818 SG2642 CLOSURE OF SALIVARY FISTULA
2819 SG2649 OTHER REPAIR AND PLASTIC OPERATIONS ON SALIVARY GLAND OR DUCT -
TRANSPOSITION OF PAROTID/SUBMANDIBULAR DUCT
2820 SG2699 OTHER OPERATIONS ON SALIVARY GLAND OR DUCT
2821 SG2699LP OTHER OPERATIONS ON SALIVARY GLAND OR DUCT-LIGATION OF PAROTID
2822 SG2699LS OTHER OPERATIONS ON SALIVARY GLAND OR DUCT-LIGATION OF SUBMANDIBULAR

2823 SG2699M OTHER OPERATIONS ON SALIVARY GLAND OR DUCT-SUBMANDIBULAR

2824 SG270 INCISION ABSCESS AND DRAINAGE (ORAL SURGERY)
2825 SG271 INCISION OF PALATE
2826 SG2721 BIOPSY OF BONY PALATE
2827 SG2722 BIOPSY OF UVULA AND SOFT PALATE
2828 SG2723 BIOPSY OF LIP
2829 SG2724 BIOPSY OF MOUTH, UNSPECIFIED STRUCTURE
2830 SG2731 LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BONY PALATE
(MOUTH)
2831 SG2731A LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BONY PALATE
(PALATE)
2832 SG2731B LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF BONY PALATE
(UNROOFING MAXILLA)
2833 SG2742 WIDE EXCISION OF LESION OF LIP
2834 SG2743 OTHER EXCISION OF LESION OR TISSUE OF LIP
2835 SG2749 OTHER EXCISION OF MOUTH (EXCEPT TOUNGUE, UVULA, AND PALATE)
2836 SG2749A OTHER EXCISION OF MOUTH (REMOVAL OF EXCESS MUCOSA)
2837 SG2749B FRENULECTOMY
2838 SG2751 SUTURE OF LACERATION OF LIP
2839 SG2752 SUTURE OF LACERATION OF OTHER PART OF MOUTH
2840 SG2754A REPAIR OF CLEFT LIP - PRIMARY
2841 SG2754B REPAIR OF CLEFT LIP - REVISION
2842 SG2755 FULL-THICKNESS SKIN GRAFT TO LIP AND MOUTH
2843 SG2755A FULL-THICKNESS SKIN GRAFT TO LIP AND MOUTH - MOUTH
2844 SG2757A ATTACHMENT OF PEDICLE OR FLAP GRAFT TO LIP AND MOUTH (MOUTH)
2845 SG2757B ATTACHMENT OF PEDICLE OR FLAP GRAFT TO LIP AND MOUTH (LIP)
2846 SG2759 OTHER PLASTIC REPAIR OF MOUTH
2847 SG2759A OTHER PLASTIC REPAIR OF MOUTH - GRAFT MUCOSA TO MOUTH
2848 SG2761 SUTURE OF LACERATION OF PALATE
2849 SG2762 CORRECTION OF CLEFT PALATE
2850 SG2763 REVISION OF CLEFT PALATE REPAIR
2851 SG2769A OTHER PLASTIC REPAIR OF PALATE - FLAP OF PALATE
2852 SG2769B OTHER PLASTIC REPAIR OF PALATE - FLAP OF SKIN
2853 SG2779 OTHER OPERATIONS ON UVULA
2854 SG2779A UVULOPALATOPLASTY
2855 SG2792 INCISION/EXCISION OF PHLEGMON
2856 SG2799 EXOSTOSIS (ORAL SURGERY)
2857 SG280 INCISION AND DRAINAGE OF TONSIL AND PERITONSILLAR STRUCTURES
2858 SG282 TONSILLECTOMY WITHOUT ADENOIDECTOMY
2859 SG282A TONSILLECTOMY WITHOUT ADENOIDECTOMY - LINGUAL TONSIL
2860 SG282B TONSILLECTOMY WITHOUT ADENOIDECTOMY - WITH COMPLICATION
2861 SG282C TONSILLECTOMY WITHOUT ADENOIDECTOMY - COBLATION
2862 SG282D TONSILLECTOMY WITHOUT ADENOIDECTOMY - THERMAL WELDING
2863 SG283 TONSILLECTOMY WITH ADENOIDECTOMY
2864 SG285 EXCISION (REDUCTION) OF LINGUAL TONSIL
2865 SG286 ADENOIDECTOMY WITHOUT TONSILLECTOMY
2866 SG2911 PHARYNGOSCOPY - THERAPEUTIC ENDOSCOPIC OPERATION ON PHARYNX
2867 SG2912 PHARYNGEAL BIOPSY - DIAG.ENDOSCOPIC EXAM OF PHARYNX
2868 SG292 EXCISION OF BRANCHIAL CLEFT CYST OR VESTIGE
2869 SG2932 PHARYNGEAL DIVERTICULECTOMY
2870 SG2933 PHARYNGECTOMY (PARTIAL)
2871 SG2939A OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF PHARYNX - TOTAL
PHARYNGECTOMY
2872 SG2939B OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF PHARYNX -
PHARYNGEAL POUCH
2873 SG2939C OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF PHARYNX - OPEN
EXCISION
2874 SG295 OTHER REPAIR OF PHARYNX
2875 SG2952 CLOSURE OF BRANCHIAL CLEFT FISTULA
2876 SG295A OSA SURGERY
2877 SG3009 OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF LARYNX
2878 SG3009A ENDOSCOPIC VOCAL CORD SURGERY
2879 SG3009B LASER PHONOSURGERY
2880 SG301 HEMILARYNGECTOMY
2881 SG3022 VOCAL CORDECTOMY
2882 SG3022A HEMICORDECTOMY
2883 SG303 COMPLETE LARYNGECTOMY
2884 SG304 RADICAL LARYNGECTOMY
2885 SG304A RADICAL LARYNGECTOMY (THYROIDECTOMY+RND)
2886 SG31 TYPE 1 TYROPLASTY
2887 SG310 INJECTION OF LARYNX
2888 SG311 TEMPORARY TRACHEOSTOMY (MINI TRACHEOSTOMY)
2889 SG311A TEMPORARY TRACHEOSTOMY-CITO
2890 SG311B TEMPORARY TRACHEOSTOMY (ELECTIVE TRACHEOSTOMY)
2891 SG3129 OTHER PERMANENT TRACHEOSTOMY
2892 SG3142 LARYNGOSCOPY AND OTHER TRACHEOSCOPY
2893 SG3142A LARYNGOSCOPE FLEXIBLE
2894 SG3143 CLOSED [ENDOSCOPIC] BIOPSY OF LARYNX
2895 SG3144 CLOSED [ENDOSCOPIC] BIOPSY OF TRACHEA
2896 SG3169 OTHER REPAIR OF LARYNX
2897 SG3169A ARITENOIDECTOMY/EPIGLOTOPEXY
2898 SG3175A RECONSTRUCTION OF TRACHEA AND CONSTRUCTION OF ARTIFICIAL LARYNX-
EXCISION+RECONSTRUCTION
2899 SG3175B RECONSTRUCTION OF TRACHEA AND CONSTRUCTION OF ARTIFICIAL LARYNX-
TRACHEOPLASTY
2900 SG3175C RECONSTRUCTION OF TRACHEA AND CONSTRUCTION OF ARTIFICIAL LARYNX-
EXCISION+RECONSTRUCTION (COMPLEX)
2901 SG3179 OTHER REPAIR AND PLASTIC OPERATIONS ON TRACHEA
2902 SG3193 REPLACEMENT OF LARYNGEAL OR TRACHEAL STENT
2903 SG321 OTHER EXCISION OF BRONCHUS
2904 SG3228 ENDOSCOPIC EXCISION OR DESTRUCTION OF LESION OR TISSUE OF LUNG
2905 SG3229 OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF LUNG
2906 SG3239 OTHER AND UNSPECIFIED SEGMENTAL RESECTION OF LUNG
2907 SG324 LOBECTOMY OF LUNG
2908 SG3241 THORACOSCOPIC LOBECTOMY OF LUNG
2909 SG3250 THORACOSCOPIC PNEUMONECTOMY
2910 SG3259 OTHER AND UNSPECIFIED PNEUMONECTOMY
2911 SG3320 THORACOSCOPIC LUNG BIOPSY
2912 SG3323 OTHER BRONCHOSCOPY
2913 SG3324 CLOSED [ENDOSCOPIC] BIOPSY OF BRONCHUS
2914 SG3324BL CLOSED [ENDOSCOPIC] BIOPSY OF BRONCHUS (BRONCHIAL LAVAGE)
2915 SG3326 CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF LUNG
2916 SG3326A CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF LUNG (CORE BIOPSY)
2917 SG3327 CLOSED ENDOSCOPIC BIOPSY OF LUNG
2918 SG3334 THORACOPLASTY
2919 SG3391 BRONCHIAL DILATION
2920 SG3402 EXPLORATORY THORACOTOMY
2921 SG3402A EXPLORATORY THORACOTOMY (MEDIAN STERNOTOMY)
2922 SG3404 INSERTION OF INTERCOSTAL CATHETER FOR DRAINAGE
2923 SG3404A INSERTION OF INTERCOSTAL CATHETER FOR DRAINAGE (INSERTION TUBE DRAIN
PLEURAL CAVITY)
2924 SG3404B INSERTION OF INTERCOSTAL CATHETER FOR DRAINAGE / PLEURA FLUID
2925 SG3404C INSERTION OF INTERCOSTAL CATHETER FOR DRAINAGE - COMPLEX
2926 SG3409 OTHER INCISION OF PLEURA - OPEN CHEST DRAINAGE
2927 SG3422 MEDIASTINOSCOPY
2928 SG3423 BIOPSY OF CHEST WALL
2929 SG3424 OTHER PLEURAL BIOPSY
2930 SG343 EXCISION OR DESTRUCTION OF LESION OR TISSUE OF MEDIASTINUM
2931 SG344 EXCISION OR DESTRUCTION OF LESION OF CHEST WALL
2932 SG3451 DECORTICATION OF LUNG
2933 SG3459 OTHER EXCISION OF PLEURA
2934 SG3474 REPAIR OF PECTUS DEFORMITY
2935 SG3484 OTHER REPAIR OF DIAPHRAGM
2936 SG3485 IMPLANTATION OF DIAPHRAGMATIC PACEMAKER
2937 SG3492 INJECTION INTO THORACIC CAVITY - INTRODUCTION
2938 SG3492A INJECTION INTO THORACIC CAVITY - PLEURODESIS
2939 SG3500 BALOON VALVULATION
2940 SG3501 CLOSED HEART VALVOTOMY, AORTIC VALVE
2941 SG3502 CLOSED HEART VALVOTOMY, MITRAL VALVE
2942 SG3510 OPEN HEART VALVULOPLASTY WITHOUT REPLACEMENT, UNSPECIFIED VALVE
2943 SG3520 OPEN AND OTHER REPLACEMENT OF UNSPECIFIED HEART VALVE
2944 SG3521 OPEN AND OTHER REPLACEMENT OF AORTIC VALVE WITH TISSUE GRAFT
2945 SG3522 OPEN AND OTHER REPLACEMENT OF AORTIC VALVE
2946 SG3523 OPEN AND OTHER REPLACEMENT OF MITRAL VALVE WITH TISSUE GRAFT
2947 SG3524 OPEN AND OTHER REPLACEMENT OF MITRAL VALVE
2948 SG3525 OPEN AND OTHER REPLACEMENT OF PULMONARY VALVE WITH TISSUE GRAFT
2949 SG3527 OPEN AND OTHER REPLACEMENT OF TRICUSPID VALVE WITH TISSUE GRAFT
2950 SG3539 OPERATIONS ON OTHER STRUCTURES ADJACENT TO VALVES OF HEART
2951 SG3551 REPAIR OF ATRIAL SEPTAL DEFECT WITH PROSTHESIS, OPEN TECHNIQUE
2952 SG3552 REPAIR OF ATRIAL SEPTAL DEFECT WITH PROSTHESIS, CLOSED TECHNIQUE
2953 SG3554 REPAIR OF ENDOCARDIAL CUSHION DEFECT WITH PROSTHESIS
2954 SG3571 OTHER AND UNSPECIFIED REPAIR OF ATRIAL SEPTAL DEFECT
2955 SG3572 OTHER AND UNSPECIFIED REPAIR OF VENTRICULAR SEPTAL DEFECT
2956 SG3573 OTHER AND UNSPECIFIED REPAIR OF ENDOCARDIAL CUSHION DEFECT
2957 SG3581 TOTAL REPAIR OF TETRALOGY OF FALLOT
2958 SG3582 TOTAL REPAIR OF TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION
2959 SG3583 LIGATION OF CONNECTIONS BETWEEN AORTA AND PULMONARY ARTERY
2960 SG3583A TOTAL REPAIR OF TRUNCUS ARTERIOSUS (CORRECTION)
2961 SG3583B TOTAL REPAIR OF TRUNCUS ARTERIOSUS (CONNECTION TO PULMONARY ARTERY
FROM AORTA)
2962 SG3584A TOTAL CORRECTION OF TRANSPOSITION OF GREAT VESSELS, NOT ELSEWHERE
CLASSIFIED - ARTERIAL SWITCH OPERATION [JATENE]
2963 SG3584B TOTAL CORRECTION OF TRANSPOSITION OF GREAT VESSELS, NOT ELSEWHERE
CLASSIFIED
2964 SG3592 CREATION OF CONDUIT BETWEEN RIGHT VENTRICLE AND PULMONARY ARTERY
2965 SG3592A CREATION OF CONDUIT BETWEEN RIGHT VENTRICLE AND PULMONARY ARTERY -
CREATION VALVED CARDIAC CONDUIT
2966 SG3593 CREATION OF CONDUIT BETWEEN LEFT VENTRICLE AND AORTA
2967 SG3594 CREATION OF CONDUIT BETWEEN ATRIUM AND PULMONARY ARTERY
2968 SG3595 REVISION OF CORRECTIVE PROCEDURE ON HEART / REPAIR OF PULMONARY ARTERY

2969 SG3595A REVISION OF CORRECTIVE PROCEDURE ON HEART / OPEN OPERATION ON

PULMONARY ARTERY
2970 SG3595B REVISION OF CORRECTIVE PROCEDURE ON HEART
2971 SG3596A PERCUTANEOUS VALVULOPLASTY (THERAPEUTIC TRANSLUMINAL OPERATIONS
SEPTUM HEART)
2972 SG3596B PERCUTANEOUS VALVULOPLASTY (PERCUTANEOUS TRANSLUMINAL MITRAL
VALVULOTOMY)
2973 SG3599 OTHER OPERATIONS ON VALVES OF HEART
2974 SG3603 OPEN CHEST CORONARY ARTERY ANGIOPLASTY
2975 SG3611 (AORTO)CORONARY BYPASS OF ONE CORONARY ARTERY
2976 SG3699 OTHER OPERATIONS ON VESSELS OF HEART
2977 SG370 PERICARDIOCENTESIS
2978 SG370A PERICARDIOCENTESIS (DECOMPRESSION FO CARDIAC TAMPONADE)
2979 SG370B PERICARDIAL PUNCTURE /TAP
2980 SG3712 PERICARDIOTOMY
2981 SG3721 LEFT/RIGHT HEART CARDIAC CATHETERIZATION / ADULT CARDIAC
CATHETERIZATION
2982 SG3722 LEFT/RIGHT HEART CARDIAC CATHETERIZATION/ PAEDIATRIC CARDIAC
CATHETERIZATION
2983 SG3723A COMBINED RIGHT AND LEFT HEART CARDIAC CATHETERIZATION (ADULT)
2984 SG3723B COMBINED RIGHT AND LEFT HEART CARDIAC CATHETERIZATION (PAEDIATRIC)
2985 SG3726 ELECTRO PHYSIOLOGY STUDY
2986 SG3726A ELECTRO PHYSIOLOGY STUDY & ABLATIO
2987 SG3727 CARDIAC MAPPING
2988 SG3727A CARDIAC MAPPING - MAP GUIDED SURG FOR VENTRICULAR ARRHYTHMIAS (W
MAPPING)
2989 SG3731 PERICARDIECTOMY
2990 SG3732 EXCISION OF ANEURYSM OF HEART
2991 SG3733 EXCISION OR DESTRUCTION OF OTHER LESION OR TISSUE OF HEART, OPEN
APPROACH
2992 SG3734 EXCISION OR DESTRUCTION OF OTHER LESION OR TISSUE OF HEART, OTHER
APPROACH - TRANSLUMINAL
2993 SG3734A EXCISION OR DESTRUCTION OF OTHER LESION OR TISSUE OF HEART,OTHER
APPROACH-ABLATION AV NODE
2994 SG3734B LASER VASCULAR THERAPY
2995 SG3749 OTHER REPAIR OF HEART AND PERICARDIUM
2996 SG3778 INSERTION OF TEMPORARY TRANSVENOUS PACEMAKER SYSTEM
2997 SG3779A REVISION OR RELOCATION OF CARDIAC DEVICE POCKET (RESITTING OF IV CARDIAC
PACEMAKER SYSTEM)
2998 SG3779B REVISION OR RELOCATION OF CARDIAC DEVICE POCKET (REMOVAL OF PACING
SYSTEM WITH BYPASS)
2999 SG3779C REVISION OR RELOCATION OF CARDIAC DEVICE POCKET (REMOVAL OF PACING
SYSTEM W/O BYPASS)
3000 SG3779D REPOSITION TEMPORARY PACEMAKER
INSERTION, REVISION, REPLACEMENT, AND REMOVAL OF LEADS; INSERTION OF
3001 SG377A TEMPORARY PACEMAKER SYSTEM; OR REVISION OF CARDIAC DEVICE POCKET (SINGLE CHAMBER)

INSERTION, REVISION, REPLACEMENT, AND REMOVAL OF LEADS; INSERTION OF TEMPORARY

3002 SG377B PACEMAKER SYSTEM; OR REVISION OF CARDIAC DEVICE POCKET (DUAL
CHAMBER)
REPLACEMENT OF ANY TYPE PACEMAKER DEVICE WITH SINGLE-CHAMBER DEVICE, NOT SPECIFIED AS
3003 SG3785 RATE RES / REPLACEMENT OF ANY TYPE PACEMAKER DEVICE
WITH DUAL-CHAMBER DEVICE
3004 SG3787 REPLACEMENT OF ANY TYPE PACEMAKER DEVICE WITH DUAL-CHAMBER DEVICE
3005 SG3794 IMPLANTATION OR REPLACEMENT OF AUTOMATIC CARDIOVERTER/DEFIBRILLATOR,
TOTAL SYSTEM [AICD]
3006 SG3800 INCISION OF VESSEL - THROMBECTOMY
3007 SG3800A INCISION OF VESSEL - THROMBECTOMY (OPEN)
3008 SG3805 INCISION OF VESSEL (PULMONARY EMBOLECTOMY)
3009 SG3810 ENDARTERECTOMY WITH GRAFT - UNSPESIFIED
3010 SG3811 ENDARTERECTOMY (INTRACRANIAL VESSEL)
3011 SG3812 ENDARTERECTOMY CAROTID
3012 SG3814 ENDARTERECTOMY AORTA INCLUDE PATCH GRAFT
3013 SG3815 ENDARTERECTOMY WITH GRAFT - SUBCLAVIA
3014 SG3816 ENDARTERECTOMY ILIAC ARTERY INCLUDE PATCH GRAFT
3015 SG3817 ENDARTERECTOMY RENAL ARTERY
3016 SG3819 ENDARTERECTOMY FEMORAL ARTERY
3017 SG3821 BIOPSY OF BLOOD VESSEL
3018 SG3830 RESECTION OF VESSEL WITH ANASTOMOSIS - EXCISION OF ARETRIOVENOUS
MALFORMATION
3019 SG3841 RESECTION OF VESSEL WITH REPLACEMENT (INTRACRANIAL VESSEL)
3020 SG3844A RESECTION OF VESSEL WITH REPLACEMENT (AORTA) (REVISION OF PROSTHESIS
ABDOMINAL AORTA)
3021 SG3844B RESECTION OF VESSEL WITH REPLACEMENT (AORTA) (OTHER OPEN OP VISCERAL
BRANCH ABDOMINAL AORTA)
3022 SG3844C RESECTION OF VESSEL WITH REPLACEMENT (AORTA) (INFRARENAL ABDOMINAL
AORTIC ANEURYSM TUBE GRAFT)
3023 SG3844D RESECTION OF VESSEL WITH REPLACEMENT (AORTA) (INFRARENAL ABDOMINAL
AORTIC ANEURYSM BIFURCATION GRAFT)
3024 SG3845 RESECTION OF VESSEL WITH REPLACEMENT (OTHER THORACIC VESSELS)
3025 SG3845A RESECTION OF VESSEL WITH REPLACEMENT - EMERGENCY REPLACE OF
ANEURYSMAL SEGMENT ARCH OF AORTA (ARCHUS/ASCENDING)
3026 SG3845B RESECTION OF VESSEL WITH REPLACEMENT - PLAN REPLACE ANEURYSMAL SEGMENT
THORACIC AORTA
3027 SG3845C RESECTION OF VESSEL WITH REPLACEMENT - PLAN REPLACE OF ANEURYSMAL
SEGMENT ASCENDING AORTA
3028 SG3845D RESECTION OF VESSEL WITH REPLACEMENT - PLAN REPLACE OF ANEURYSMAL
SEGMENT ARCH AORTA
3029 SG3850A LIGATION AND STRIPPING OF VARICOSE VEINS - RECURRENT
3030 SG3850B LIGATION AND STRIPPING OF VARICOSE VEINS - RECURRENT BILATERAL / MULTI
PHLEBECTOMY
3031 SG3859 LIGATION AND STRIPPING OF VARICOSE VEINS - SAPHENOUS VEINS
3032 SG3859A LIGATION AND STRIPPING OF VARICOSE VEIN - SAPHENOUS VEINS UNILATERAL
3033 SG3859B LIGATION AND STRIPPING OF VARICOSE VEIN - SAPHENOUS VEINS BILATERAL
3034 SG3859C LIGATION AND STRIPPING OF VARICOSE VEINS - SAPHENOUS VEINS (COMPLEX)
3035 SG3866 OTHER EXCISION OF VESSEL - ILLIAC ARTERY
3036 SG3868 OTHER EXCISION OF VESSEL - VARICOSE VEIN LEG
3037 SG387A INTERRUPTION OF THE VENA CAVA (PLICATION OF VENA CAVA)
3038 SG387B INTERRUPTION OF THE VENA CAVA (REPAIR OF WOUND OF MAJOR ARTERY/VEIN OF
ABDOMEN)
3039 SG3893 VENOUS CATHETERIZATION, NOT ELSEWHERE CLASSIFIED
3040 SG3893A VENOUS CATHETERIZATION, NON TUNNELLED
3041 SG3893B VENOUS CATHETERIZATION, TUNNELLED
3042 SG3893C VENOUS CATHETERIZATION - INSERTION OF VENA CAVA FILTER
3043 SG3895C VENOUS CATHERIZATION FOR RENAL DIALYSIS / TUNELLING
3044 SG390 SUBCLAVIAN- PULMONARY ANASTOMOSIS (GRAFT) / CREATION OF SHUNT TO
PULMONARY ARTERY FR SUBCLAVIA ARTERY BY INTERPOS.TUBE PROS.
3045 SG390A SYSTEMIC TO PULMONARY ARTERY SHUNT (CREATION OF SHUNT TO PULMONARY
ARTERY FR SUBCLAVIA ARTERY BY INTERPOS.TUBE PROS.)
3046 SG390B SYSTEMIC TO PULMONARY ARTERY SHUNT (CONNECTION TO PULMONARY ARTERY
FR SUBCLAVIA ARTERY)
3047 SG390C SYSTEMIC TO PULMONARY ARTERY SHUNT (REPAIR OF PULMONARY ARTERY)
3048 SG390D SYSTEMIC TO PULMONARY ARTERY SHUNT (OPEN OPERATION ON PULMONARY
ARTERY)
3049 SG390E SYSTEMIC TO PULMONARY ARTERY SHUNT (TRANSLUMINAL OPERATION ON
PULMONARY ARTERY)
3050 SG390F SYSTEMIC TO PULMONARY ARTERY SHUNT (CONNECTION TO PULMONARY ARTERY
FROM AORTA)
3051 SG391 INTRA-ABDOMINAL VENOUS SHUNT
3052 SG391A INTRA ABDOMINAL VENOUS SHUNT (TRANSJUGULAR INTRAHEPATIC
PORTOSYSTEMIC SHUNT)
3053 SG3922 AORTA-SUBCLAVIAN-CAROTID BYPASS
3054 SG3922A AORTA-SUBCLAVIAN-CAROTID BYPASS (EXCISION OF INFECTED AORTIC GRAFT W
BYPASS)
3055 SG3922B AORTA-SUBCLAVIAN-CAROTID BYPASS (BYPASS CAROTID ARTERY FR ARCH)
3056 SG3925 AORTA-ILIAC-FEMORAL BYPASS
3057 SG3925A AORTA-ILIAC-FEMORAL BYPASS (AORTO-ILIAC,AORTO-FEMORAL,ILEO-FEMORAL
BYPASS)
3058 SG3925B AORTA-ILIAC-FEMORAL BYPASS (OPEN OPERATION ILIAC ARTERY)
3059 SG3926 OTHER INTRA-ABDOMINAL VASCULAR SHUNT OR BYPASS
3060 SG3927 ARTERIOVENOSTOMY FOR RENAL DIALYSIS
3061 SG3929 OTHER (PERIPHERAL) VASCULAR SHUNT OR BYPASS
3062 SG3929A OTHER (PERIPHERAL) VASCULAR SHUNT OR BYPASS - FEMORO-FEMORAL BYPASS

3063 SG3929B OTHER (PERIPHERAL) VASCULAR SHUNT OR BYPASS - FEMORO-POPLITEAL BYPASS

USING PROSTHESIS &/VEIN&/CUFF/PATCH
3064 SG3929C OTHER (PERIPHERAL) VASCULAR SHUNT OR BYPASS - FEMORO-DISTAL CALF BYPASS
USING PROSTHESIS&/VEIN&/VEIN CUFF/PATCH
3065 SG3929D OTHER (PERIPHERAL) VASCULAR SHUNT OR BYPASS -REVISION FEMORAL BYPASS
GRAFT
3066 SG3930 SUTURE OF UNSPECIFIED BLOOD VESSEL
3067 SG3949 OTHER REVISION OF VASCULAR PROCEDURE
3068 SG395 OTHER REPAIR OF VESSELS / TRANSLUMINAL OPERATION ON PULMONARY ARTERY

3069 SG3950A ANGIOPLASTY OR ATHERECTOMY OF OTHER NON CORONARY VESSEL(S) - INCLUDE

PTA NON CORONARY VESSEL
3070 SG3950B PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) OF NON- CORONARY VESSELS -
FEMORAL ARTERY
3071 SG3950C PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) OF NON- CORONARY VESSELS -
ILLIAC ARTERY
3072 SG3950D PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA) OF NON- CORONARY VESSELS -
RENAL ARTERY
3073 SG3950E ANGIOPLASTY OR ATHERECTOMY OF OTHER NON CORONARY VESSEL(S) -
RECONSTRUCTION OF RENAL ARTERY
3074 SG3951 CLIPPING OF ANEURYSM
3075 SG3952 OTHER REPAIR OF ANEURYSM - POPLITEAL
3076 SG3952A OTHER REPAIR OF ANEURYSM - REINFORCEMENT OF ANEURYSM OF CEREBRAL
ARTERY
3077 SG3953 REPAIR OF ARTERIOVENOUS FISTULA
3078 SG3953A REPAIR OF ARTERIOVENOUS FISTULA (CREATION ARTERIOVENOUS FISTULA
(INCLUDE SUBSEQUENT CLOSURE)
3079 SG3953B REPAIR OF ARTERIOVENOUS FISTULA - OCCLUSION OF FISTULA UNDER IMAGING
CONTROL
3080 SG3956A REPAIR OF BLOOD VESSEL WITH TISSUE PATCH GRAFT (MICRO-ARTERIAL/MICRO-
VENOUS GRAFT)
3081 SG3956B REPAIR OF BLOOD VESSEL WITH TISSUE PATCH GRAFT (REPAIR ARTERY USE VEIN
GRAFT)
3082 SG3958 REPAIR OF BLOOD VESSEL WITH UNSPECIFIED TYPE OF PATCH GRAFT - AORTA
ABDOMINALIS
3083 SG3958A REPAIR OF BLOOD VESSEL WITH UNSPECIFIED TYPE OF PATCH GRAFT-AORTA
REPAIR
3084 SG3959 OTHER REPAIR OF VESSEL
3085 SG3959A OTHER REPAIR OF VESSEL -MICROSURGERY
3086 SG3959B OTHER REPAIR OF VESSEL - ARTERIOPLASTY
3087 SG3966 REVISION OR RELOCATION OF PACEMAKER POCKET / REMOVAL OF PACING SYSTEM
WITHOUT BYPASS
3088 SG397 ENDOVASCULLAR PROSEDURE ON VESSELS - EMBOLISATION OF ARTERY OF
INTERNAL NOSE
3089 SG3979C OTHER ENDOVASCULAR PROCEDURES ON OTHER VESSELS (REPLACE THORACIC-
ABDOMINAL ANEURYSM)
3090 SG3992 INJECTION OF SCLEROSING AGENT INTO VEIN
3091 SG3995 HEMODILUTION / HEMODIAFILTRATION
3092 SG3997 OTHER PERFUSION
3093 SG4011A BIOPSY OF LYMPHATIC STRUCTURE (CERVICAL, INGUINAL, AXILLARY)
3094 SG4011B BIOPSY OF LYMPHATIC STRUCTURE (EXCISION BIOPSY LYMPH NODE)
3095 SG4011C BIOPSY OF LYMPHATIC STRUCTURE - CERVICAL LYMPH NODE
3096 SG4011D BIOPSY OF LYMPHATIC STRUCTURE - AXILLARY LYMPH NODE
3097 SG4011E BIOPSY OF LYMPHATIC STRUCTURE - MAMMARY LYMPH NODE
3098 SG402 SIMPLE EXCISION OF LYMPHATIC STRUCTURE
3099 SG4021 EXCISION OF DEEP CERVICAL LYMPH NODE
3100 SG4023 EXCISION OF AXILLARY LYMPH NODE
3101 SG4024 EXCISION OF INGUINAL LYMPH NODE
3102 SG4024A EXCISION OF INGUINAL LYMPH NODE (COMPLEX)
3103 SG4029 SIMPLE EXCISION OF OTHER LYMPHATIC STRUCTURE
3104 SG4029A SIMPLE EXCISION OF OTHER LYMPHATIC STRUCTURE (BLOK DISSECTION OF PELVIC
LYMPH NODES)
3105 SG4029B SIMPLE EXCISION OF OTHER LYMPHATIC STRUCTURE (EXCISION CYSTIC HYGROMA)

3106 SG4029C SIMPLE EXCISION OF OTHER LYMPHATIC STRUCTURE (COMPLEX)

3107 SG403 REGIONAL LYMPH NODE EXCISION
3108 SG404 RADICAL EXCISION OF CERVICAL LYMPH NODES - CLYMPH NODE
3109 SG4040 RADICAL NECK DISSECTION, NOT OTHERWISE SPECIFIED
3110 SG4051 RADICAL EXCISION OF AXILLARY LYMPH NODES
3111 SG4051A RADICAL EXCISION OF AXILLARY LYMPH NODES - AXILLARY LYMPH NODE
3112 SG4052 RADICAL EXCISION OF PERIAORTIC LYMPH NODES
3113 SG409 OTHER OPERATIONS ON LYMPHATIC STRUCTURES
3114 SG4131 REDUCTION OF FRACTURE AND DISLOCATION. APPLICATION OF CAST ( GIPS >
SENDI )
3115 SG4131A REDUCTION OF FRACTURE AND DISLOCATION. APPLICATION OF CAST ( GIPS < 2
SENDI )
3116 SG4131B BONE MARROW PUNCTION
3117 SG415A SPLEENECTOMY-LAPAROSCOPIC
3118 SG415B SPLEENECTOMY-OPEN
3119 SG4219 OTHER EXTERNAL FISTULIZATION OF ESOPHAGUS
3120 SG4224 FEES (FIBREOPTIC ENDOSCOPIC EVALUATION OF SWALLOWING)
3121 SG4232 LOCAL EXCISION OF OTHER LESION OR TISSUE OF ESOPHAGUS
3122 SG4233 ENDOSCOPIC EXCISION OR DESTRUCTION OF LESION OR TISSUE OF ESOPHAGUS -
INJECTION SCLEROTHERAPY
3123 SG4242 TOTAL ESOPHAGECTOMY
3124 SG4242A TOTAL ESOPHAGECTOMY (COMPLEX)
3125 SG4251 INTRATHORACIC ESOPHAGOESOPHAGOSTOMY
3126 SG427 ESOPHAGOMYOTOMY
3127 SG427A ESOPHAGOMYOTOMY (BYPASS OESOPHAGUS)
3128 SG427B ESOPHAGOMYOTOMY (THORASCOPIC OESOPHAGOGASTRIC MYOTOMY)
3129 SG4281 INSERTION OF PERMANENT TUBE INTO ESOPHAGUS
3130 SG4283 CLOSURE OF ESOPHAGOSTOMY
3131 SG4284 REPAIR OF ESOPHAGEAL FISTULA, NOT ELSEWHERE CLASSIFIED
3132 SG4289 OTHER REPAIR OF ESOPHAGUS
3133 SG4289A OTHER REPAIR OF ESOPHAGUS-TRANSTHORACIC
3134 SG4289B OTHER REPAIR OF ESOPHAGUS-THORACOSCOPIC
3135 SG4289C OTHER REPAIR OF ESOPHAGUS-TRANSABDOMINAL ANTI REFLUX
3136 SG4289D OTHER REPAIR OF ESOPHAGUS-REVISION ANTI REFLUX OP
3137 SG4289E OTHER REPAIR OF ESOPHAGUS-TRANSTHORACIC (COMPLEX)
3138 SG4289F OTHER REPAIR OF ESOPHAGUS-THORACOSCOPIC EXTRA
3139 SG4311 PERCUTANEOUS [ENDOSCOPIC] GASTROSTOMY
3140 SG4319 OTHER GASTROSTOMY
3141 SG4319C OTHER GASTROSTOMY (COMPLEX)
3142 SG433 PYLOROMYOTOMY
3143 SG435 PARTIAL GASTRECTOMY WITH ANASTOMOSIS TO ESOPHAGUS
3144 SG436 PARTIAL GASTRECTOMY WITH ANASTOMOSIS TO DUODENUM
3145 SG437 PARTIAL GASTRECTOMY WITH ANASTOMOSIS TO JEJUNUM
3146 SG438 OTHER PARTIAL GASTRECTOMY
3147 SG4381 PARTIAL GASTRECTOMY WITH JEJUNAL TRANSPOSITION
3148 SG4389 OPEN AND OTHER PARTIAL GASTRECTOMY
3149 SG4399 OTHER TOTAL GASTRECTOMY
3150 SG4399A OTHER TOTAL GASTRECTOMY-OESOPHAGOGASTRECTOMY
3151 SG4399C OTHER TOTAL GASTRECTOMY-OESOPHAGOGASTRECTOMY (COMPLEX)
3152 SG4400 VAGOTOMY, NOT OTHERWISE SPECIFIED
3153 SG4400L VAGOTOMY, NOS - LAPAROSCOPIC
3154 SG4401 TRUNCAL VAGOTOMY
3155 SG4402 HIGHLY SELECTIVE VAGOTOMY
3156 SG4403 OTHER SELECTIVE VAGOTOMY
3157 SG4403P OTHER SELECTIVE VAGOTOMY-WITH PYLOROPLASTY
3158 SG4413 OTHER GASTROSCOPY
3159 SG4413B GASTROSCOPY BIOPSY
3160 SG4413L GASTROSCOPY LIGATIE VEG
3161 SG4413S GASTROSCOPY SCLEROTHERAPY
3162 SG442 PYLOROPLASTY
3163 SG4429 OTHER PYLOROPLASTY
3164 SG4432 PERCUTANEOUS [ENDOSCOPIC] GASTROJEJUNOSTOMY (BYPASS OF
DUODENUM/JEJUNUM)
3165 SG4432A PERCUTANEOUS [ENDOSCOPIC] GASTROJEJUNOSTOMY
3166 SG4438A LAPAROSCOPIC GASTROENTEROSTOMY - GASTRO-JEJUNOSTOMY
3167 SG4438B LAPAROSCOPIC GASTROENTEROSTOMY -GASTROSTOMY/JEJUNOSTOMY
3168 SG4439 OTHER GASTROENTEROSTOMY
3169 SG4441 SUTURE OF GASTRIC ULCER SITE
3170 SG4442 SUTURE OF DUODENAL ULCER SITE
3171 SG4443 ENDOSCOPIC CONTROL OF GASTRIC OR DUODENAL BLEEDING
3172 SG445 REVISION OF GASTRIC ANASTOMOSIS
3173 SG4462 CLOSURE OF GASTROSTOMY
3174 SG4465 ESOPHAGOGASTROPLASTY-HELLER"S OP
3175 SG4468 LAPAROSCOPIC GASTROPLASTY
3176 SG4469 OTHER REPAIR OF STOMACH - GASTROPLASTY
3177 SG4499 GASTRIC OPERATION NEC
3178 SG4512 ENDOSCOPY OF SMALL INTESTINE THROUGH ARTIFICIAL STOMA
3179 SG4523 COLONOSCOPY
3180 SG4523B COLONOSCOPY BIOPSY
3181 SG4523P COLONOSCOPY POLIPECTOMY
3182 SG4524 FLEXIBLE SIGMOIDOSCOPY
3183 SG4531 OTHER LOCAL EXCISION OF LESION OF DUODENUM
3184 SG4533A LOCAL EXCISION OF LESION OR TISSUE OF SMALL INTESTINE, EXCEPT DUODENUM -
EXCISION OF JEJUNUM
3185 SG4533B LOCAL EXCISION OF LESION OR TISSUE OF SMALL INTESTINE, EXCEPT DUODENUM -
EXCISION OF LESION OF JEJUNUM
3186 SG4534 OTHER DESTRUCTION OF LESION OF SMALL INTESTINE, EXCEPT DUODENUM-
LAPAROSCOPIC RESECTION OF SMALL INTESTINE
3187 SG4541 EXCISION OF LESION OR TISSUE OF LARGE INTESTINE
3188 SG4573 OPEN AND OTHER RIGHT HEMICOLECTOMY
3189 SG4574 OPEN AND OTHER RESECTION OF TRANSVERSE COLON
3190 SG4575 OPEN AND OTHER LEFT HEMICOLECTOMY
3191 SG4575A OPEN AND OTHER LEFT HEMICOLECTOMY (REVERSAL OF HARTMANN"S PROCEDURE)

3192 SG4576 OPEN AND OTHER SIGMOIDECTOMY

3193 SG4579 OTHER AND UNSPECIFIED PARTIAL EXCISION OF LARGE INTESTINE
3194 SG4594 LARGE-TO-LARGE INTESTINAL ANASTOMOSIS
3195 SG4595 ANASTOMOSIS TO ANUS
3196 SG4603 EXTERIORIZATION OF LARGE INTESTINE
3197 SG4610 COLOSTOMY, NOT OTHERWISE SPECIFIED
3198 SG4610L COLOSTOMY, NOT OTHERWISE SPECIFIED -- LAPAROSCOPIC
3199 SG4620 ILEOSTOMY, BYPASS OF IELUM
3200 SG4620A ILEOSTOMY, NOT OTHERWISE SPECIFIED
3201 SG4620B ILEOSTOMY, ATTENTION
3202 SG4639 ENTEROSTOMY NEC
3203 SG4651 CLOSURE OF STOMA OF SMALL INTESTINE
3204 SG4652E CLOSURE OF STOMA OF LARGE INTESTINE-EXTRA PERITONEAL
3205 SG4652I CLOSURE OF STOMA OF LARGE INTESTINE-INTRA PERITONEAL
3206 SG4680 INTRA-ABDOMINAL MANIPULATION OF INTESTINE, NOT OTHERWISE SPECIFIED
3207 SG4682 INTRA-ABDOMINAL MANIPULATION OF LARGE INTESTINE
3208 SG4701 LAPAROSCOPIC APPENDECTOMY
3209 SG4709 OTHER APPENDECTOMY
3210 SG4709A OTHER APPENDECTOMY-COMPLICATION
3211 SG472 DRAINAGE OF APPENDICEAL ABSCESS
3212 SG480 PROCTOTOMY
3213 SG4823 RIGID PROCTOSIGMOIDOSCOPY
3214 SG4825 OPEN BIOPSY OF RECTUM
3215 SG4835 LOCAL EXCISION OF RECTAL LESION OR TISSUE
3216 SG4835A LOCAL EXCISION OF RECTAL LESION OR TISSUE (OPEN)
3217 SG4842 LAPAROSCOPIC PULL-THROUGH RESECTION OF RECTUM
3218 SG4849 OTHER PULL-THROUGH RESECTION OF RECTUM
3219 SG4850 ABDOMINOPERINEAL RESECTION OF THE RECTUM, NOT OTHERWISE SPECIFIED
3220 SG4861 TRANSSACRAL RECTOSIGMOIDECTOMY
3221 SG4862 ANTERIOR RESECTION OF RECTUM WITH SYNCHRONOUS COLOSTOMY
3222 SG4869 RECTAL RESECTION NEC
3223 SG4876 OTHER PROCTOPEXY
3224 SG4892 ANORECTAL MYECTOMY
3225 SG4901 INCISION OF PERIANAL ABSCESS
3226 SG4904 OTHER EXCISION OF PERIANAL TISSUE
3227 SG4911 ANAL FISTULOTOMY
3228 SG4912B ANAL FISTULECTOMY-LAY OPEN HIGH FISTULA
3229 SG493 LOCAL EXCISION OR DESTRUCTION OF OTHER LESION OR TISSUE OF ANUS
3230 SG4939 OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF ANUS
3231 SG4941 REDUCTION OF HEMORRHOIDS
3232 SG4942 INJECTION OF HEMORRHOIDS
3233 SG4946S EXCISION OF HEMORRHOIDS-STAPPLER
3234 SG4951 LEFT LATERAL ANAL SPHINCTEROTOMY
3235 SG4971 SUTURE OF LACERATION OF ANUS
3236 SG4973 CLOSURE OF ANAL FISTULA
3237 SG4979 OTHER REPAIR OF ANAL SPHINCTER
3238 SG5011 CLOSED (PERCUTANEOUS) [NEEDLE] BIOPSY OF LIVER
3239 SG5012 OPEN BIOPSY OF LIVER
3240 SG5014 LAPAROSCOPIC LIVER BIOPSY
3241 SG5021 MARSUPIALIZATION OF LESION OF LIVER
3242 SG5022 PARTIAL HEPATECTOMY
3243 SG5022A PARTIAL HEPATECTOMY - HEMIHEPATECTOMY
3244 SG5025 LAPAROSCOPIC ABLATION OF LIVER LESION OR TISSUE
3245 SG5029 OTHER DESTRUCTION OF LESION OF LIVER
3246 SG5069 OTHER REPAIR OF LIVER
3247 SG510 CHOLECYSTOTOMY AND CHOLECYSTOSTOMY
3248 SG5110 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY [ERCP]
3249 SG5112 PERCUTANEOUS BIOPSY OF GALLBLADDER OR BILE DUCTS
3250 SG5122 CHOLECYSTECTOMY
3251 SG5123 LAPAROSCOPIC CHOLECYSTECTOMY
3252 SG5123A LAPAROSCOPIC CHOLECYSTECTOMY-WITH CHOLANGIOGRAM
3253 SG5135 OTHER GALLBLADDER ANASTOMOSIS
3254 SG5136 CHOLEDOCHOENTEROSTOMY
3255 SG5137 ANASTOMOSIS OF HEPATIC DUCT TO GASTROINTESTINAL TRACT
3256 SG5139 OTHER BILE DUCT ANASTOMOSIS
3257 SG5149 INCISION OF OTHER BILE DUCTS FOR RELIEF OF OBSTRUCTION
3258 SG5151 EXPLORATION OF COMMON DUCT
3259 SG5169 EXCISION OF OTHER BILE DUCT
3260 SG5179 REPAIR OF OTHER BILE DUCTS
3261 SG5182 PANCREATIC SPHINCTEROTOMY
3262 SG5198 OTHER PERCUTANEOUS PROCEDURES ON BILIARY TRACT
3263 SG5198A OTHER PERCUTANEOUS PROCEDURES ON BILIARY TRACT (DILATATION)
3264 SG5199 BILIARY TRACT OP NEC
3265 SG5199A OTHER. INSERTION OR REPLACEMENT OF BILLIARY TRACT PROSTHESIS (PLASTIC)

3266 SG5199B OTHER. INSERTION OR REPLACEMENT OF BILLIARY TRACT PROSTHESIS (METALLIC)

3267 SG5201 DRAINAGE OF PANCREATIC CYST BY CATHETER

3268 SG5211 CLOSED [ASPIRATION] [NEEDLE] [PERCUTANEOUS] BIOPSY OF PANCREAS
3269 SG5212 OPEN BIOPSY OF PANCREAS
3270 SG522 LOCAL EXCISION OR DESTRUCTION OF PANCREAS AND PANCREATIC DUCT
3271 SG5222 OTHER EXCISION OR DESTRUCTION OF LESION OR TISSUE OF PANCREAS OR
PANCREATIC DUCT
3272 SG523 MARSUPIALIZATION OF PANCREATIC CYST
3273 SG5252 DISTAL PANCREATECTOMY
3274 SG526 TOTAL PANCREATECTOMY
3275 SG526A TOTAL PANCREATECTOMY A
3276 SG527 RADICAL PANCREATICODUODENECTOMY
3277 SG5296 ANASTOMOSIS OF PANCREAS
3278 SG5300 UNILATERAL REPAIR OF INGUINAL HERNIA, NOT OTHERWISE SPECIFIED
3279 SG5300P UNILATERAL REPAIR OF INGUINAL HERNIA, NOT OTHERWISE SPECIFIED-PRIMARY

3280 SG5300R UNILATERAL REPAIR OF INGUINAL HERNIA, NOT OTHERWISE SPECIFIED-RECURRENT

3281 SG5310 BILATERAL REPAIR OF INGUINAL HERNIA, NOT OTHERWISE SPECIFIED

3282 SG5310R BILATERAL REPAIR OF INGUINAL HERNIA, NOT OTHERWISE SPECIFIED - RECURRENT
HERNIA
3283 SG5321 UNILATERAL REPAIR OF FEMORAL HERNIA WITH GRAFT OR PROSTHESIS
3284 SG5321R UNILATERAL REPAIR OF FEMORAL HERNIA WITH GRAFT OR PROSTHESIS-RECURRENT

3285 SG5329 OTHER UNILATERAL FEMORAL HERNIORRHAPHY

3286 SG5341 OTHER AND OPEN REPAIR OF UMBILICAL HERNIA WITH GRAFT OR PROSTHESIS
3287 SG5351 INCISIONAL HERNIA REPAIR
3288 SG5361 OTHER OPEN INCISIONAL HERNIA REPAIR WITH GRAFT OR PROSTHESIS
3289 SG5369 OTHER AND OPEN REPAIR OF OTHER HERNIA OF ANTERIOR ABDOMINAL WALL WITH
GRAFT OR PROSTHESIS
3290 SG5371 LAPAROSCOPIC REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH
3291 SG5371R LAPAROSCOPIC REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH
(REPAIR)
3292 SG5372 OTHER AND OPEN REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH
3293 SG5372A OTHER AND OPEN REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH -
CONGENITAL
3294 SG5372C OTHER AND OPEN REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH
(COMPLEX)
3295 SG5375 REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH, NOT OTHERWISE
SPECIFIED
3296 SG5375A REPAIR OF DIAPHRAGMATIC HERNIA, ABDOMINAL APPROACH, NOT OTHERWISE
SPECIFIED (COMPLEX)
3297 SG5380 REPAIR OF DIAPHRAGMATIC HERNIA WITH THORACIC APPROACH, NOT OTHERWISE
SPECIFIED
3298 SG5381 PLICATION OF THE DIAPHRAGM
3299 SG5381A PLICATION OF THE DIAPHRAGM (TRANSABDOMINAL ANTI-REFLUX OP)
3300 SG5381R PLICATION OF THE DIAPHRAGM-REVISION
3301 SG5411 EXPLORATORY LAPAROTOMY
3302 SG5412 REOPENING OF RECENT LAPAROTOMY SITE
3303 SG5419 OTHER LAPAROTOMY
3304 SG544A EXCISION OR DESTRUCTION OF PERITONEAL TISSUE - OMENTUM
3305 SG544B EXCISION OR DESTRUCTION OF PERITONEAL TISSUE - PRESACRAL TUMOUR
3306 SG5451 LAPAROSCOPIC LYSIS OF PERITONEAL ADHESIONS
3307 SG5459 OTHER LYSIS OF PERITONEAL ADHESIONS
3308 SG5461 RECLOSURE OF POSTOPERATIVE DISRUPTION OF ABDOMINAL WALL
3309 SG5491 PERCUTANEOUS ABDOMINAL DRAINAGE
3310 SG5494 CREATION OF PERITONEOVASCULAR SHUNT
3311 SG5494A CREATION OF PERITONEOVASCULAR SHUNT (COMPLEX)
3312 SG5495 INCISION OF PERITONEUM
3313 SG5496 INJECTION OF AIR INTO PERITONEAL CAVITY
3314 SG5498A PERITONEAL DIALYSIS / INSERTION OF PERITONEAL DIALYSIS
3315 SG5501 NEPHROTOMY
3316 SG5501A NEPHROTOMY. NEPHROLITHOTOMY
3317 SG5502 NEPHROSTOMY (PERCUTANEOUS INSERTION OF NEPHROSTOMY TUBE)
3318 SG5502A NEPHROSTOMY
3319 SG5503 PERCUTANEOUS NEPHROSTOMY WITHOUT FRAGMENTATION
3320 SG5504 PERCUTANEOUS NEPHROSTOMY WITH FRAGMENTATION
3321 SG5512 PYELOSTOMY (DRAINAGE OF PYONEPHROSIS/PERINEPHRIC ABSCESS)
3322 SG5512A PYELOSTOMY (PERCUTANEOUS PYELYSIS)
3323 SG5523 CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF KIDNEY
3324 SG5523A CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF KIDNEY (DIAGNOSTIC ENDOSCOPIC
EXAM)
3325 SG554 PARTIAL NEPHRECTOMY
3326 SG5551 NEPHROURETERECTOMY
3327 SG5551A NEPHROURETERECTOMY - NEPHRECTOMY + PERIRENAL TISSUE
3328 SG5551B NEPHROURETERECTOMY - LAPAROSCOPIC NEPHRECTOMY
3329 SG5553 REMOVAL OF TRANSPLANTED OR REJECTED KIDNEY
3330 SG5554 BILATERAL NEPHRECTOMY
3331 SG5569 OTHER KIDNEY TRANSPLANTATION
3332 SG5581 SUTURE OF LACERATION OF KIDNEY
3333 SG5589 RENAL REPAIR NEC
3334 SG5599 RENAL OPERATION NEC
3335 SG560 TRANSURETHRAL REMOVAL OF OBSTRUCTION FROM URETER AND RENAL PELVIS

3336 SG561 URETERAL MEATOTOMY

3337 SG5612A PHARYNGEAL BIOPSY
3338 SG562 URETEROTOMY
3339 SG5631 URETEROSCOPY
3340 SG564 URETERECTOMY
3341 SG5651 FORMATION OF CUTANEOUS URETERO-ILEOSTOMY - ILEAL CONDUIT
3342 SG5651A FORMATION OF CUTANEOUS URETERO-ILEOSTOMY
3343 SG5671 URINARY DIVERSION TO INTESTINE
3344 SG5674 URETERONEOCYSTOSTOMY
3345 SG5679 URETERAL ANASTOMOSIS NEC
3346 SG5683 CLOSURE OF URETEROSTOMY
3347 SG5684 CLOSURE OF OTHER FISTULA OF URETER
3348 SG5689 OTHER REPAIR OF URETER
3349 SG570 TRANSURETHRAL CLEARANCE OF BLADDER
3350 SG5717 PERCUTANEOUS CYSTOSTOMY
3351 SG5718 OTHER SUPRAPUBIC CYSTOSTOMY
3352 SG5718A PERCUTANEOUS CYSTOSTOMY + SUPRAPUBIC TUBE
3353 SG5719 OTHER CYSTOTOMY
3354 SG5719E TRANSURETHRAL CLEARANCE OF BLADDER-ENDOSCOPIC VESICO-LITHOTRIPSY
3355 SG5731 CYSTOSCOPY THROUGH ARTIFICIAL STOMA
3356 SG5733 CLOSED [TRANSURETHRAL] BIOPSY OF BLADDER
3357 SG5749 OTHER TRANSURETHRAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF
BLADDER
3358 SG5749A OTHER TRANSURETHRAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF
BLADDER - DIVERTICULECTOMY
3359 SG5749B OTHER TRANSURETHRAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF
BLADDER - RESECTION
3360 SG5749C OTHER TRANSURETHRAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF
BLADDER - DESTRUCTION
3361 SG5749F OTHER TRANSURETHRAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF
BLADDER - FEMALE
3362 SG5749M OTHER TRANSURETHRAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF
BLADDER - MALE
3363 SG5759 OPEN EXCISION OR DESTRUCTION OF OTHER LESION OR TISSUE OF BLADDER
3364 SG576 PARTIAL CYSTECTOMY
3365 SG577 TOTAL CYSTECTOMY
3366 SG5782 CLOSURE OF CYSTOSTOMY
3367 SG5783 REPAIR OF FISTULA INVOLVING BLADDER AND INTESTINE
3368 SG5784 REPAIR OF OTHER FISTULA OF BLADDER
3369 SG5784A REPAIR OF OTHER FISTULA OF BLADDER - CUTANEOUS VESICAL FISTULA
3370 SG5784B REPAIR OF OTHER FISTULA OF BLADDER - URETHRORECTAL FISTULA
3371 SG5785 CYSTOURETHROPLASTY AND PLASTIC REPAIR OF BLADDER NECK
3372 SG5787 RECONSTRUCTION OF URINARY BLADDER - UNILATERAL
3373 SG5787A RECONSTRUCTION OF URINARY BLADDER - BILATERAL
3374 SG5787B RECONSTRUCTION OF URINARY BLADDER (CONTINENT POUCH/NEO BLADDER)
3375 SG5789 OTHER REPAIR OF BLADDER
3376 SG5789A OTHER REPAIR OF BLADDER - ENDOSCOPIC ANTI-REFLUX PROCEDURE (AND
BILATERAL)
3377 SG5789B OTHER REPAIR OF BLADDER - VAGINAL OPERATION FOR BLADDER
3378 SG5789C OTHER REPAIR OF BLADDER (COMPLEX)
3379 SG5791 SPHINCTEROTOMY OF BLADDER
3380 SG5791A SPHINCTEROTOMY OF BLADDER (RESECTION OF BLADDER NECK)
3381 SG5792 DILATION OF BLADDER NECK
3382 SG5794 INSERTION OF INDWELLING URINARY CATHETER
3383 SG580 URETHROTOMY
3384 SG580A URETHROTOMY - INCLUDE CYSTOSCOPY
3385 SG581 URETHRAL MEATOTOMY
3386 SG581E URETHRAL MEATOTOMY - ENDOSCOPIC
3387 SG5822 OTHER URETHROSCOPY
3388 SG5831 ENDOSCOPIC EXCISION OR DESTRUCTION OF LESION OR TISSUE OF URETHRA
3389 SG5839 OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF URETHRA
3390 SG5839A OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF URETHRA -
URETHRECTOMY
3391 SG5839B OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF URETHRA -
VALVE RESECTION
3392 SG5839C OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF URETHRA -
DIVERTICULECTOMY
3393 SG5839D OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF URETHRA -
PROLAPSE URETHRA
3394 SG5843 CLOSURE OF OTHER FISTULA OF URETHRA
3395 SG5843A CLOSURE OF OTHER FISTULA OF URETHRA - REPAIR OF URETHRO-VAGINAL FISTULA

3396 SG5845 REPAIR OF HYPOSPADIAS OR EPISPADIAS

3397 SG5845EA REPAIR OF HYPOSPADIAS OR EPISPADIAS - GLANDULAR HYPOSPADIA
3398 SG5845EB REPAIR OF HYPOSPADIAS OR EPISPADIAS - CORPORAL HYPOSPADIA
3399 SG5845EC REPAIR OF HYPOSPADIAS OR EPISPADIAS - PERINEAL HYPOSPADIA
3400 SG5846 OTHER RECONSTRUCTION OF URETHRA
3401 SG5846A OTHER RECONSTRUCTION OF URETHRA-URETHROCELE
3402 SG5846B OTHER RECONSTRUCTION OF URETHRA (COMPLEX)
3403 SG5847 URETHRAL MEATOPLASTY
3404 SG586 DILATION OF URETHRA
3405 SG5900 RETROPERITONEAL DISSECTION, NOT OTHERWISE SPECIFIED
3406 SG5902 OTHER LYSIS OF PERIRENAL OR PERIURETERAL ADHESIONS
3407 SG5902B OTHER LYSIS OF PERIRENAL OR PERIURETERAL ADHESIONS - BILATERAL
3408 SG594 SUPRAPUBIC SLING OPERATION
3409 SG595 RETROPUBIC URETHRAL SUSPENSION
3410 SG598 URETERAL CATHETERIZATION
3411 SG598A URETERAL CATHETERIZATION - DRAINAGE OF KIDNEY
3412 SG600 INCISION OF PROSTATE
3413 SG6011 CLOSED [PERCUTANEOUS] [NEEDLE] BIOPSY OF PROSTATE
3414 SG6012 OPEN BIOPSY OF PROSTATE
3415 SG6018 OTHER DIAGNOSTIC PROCEDURES ON PROSTATE AND PERIPROSTATIC TISSUE
3416 SG6029 OTHER TRANSURETHRAL PROSTATECTOMY
3417 SG605 RADICAL PROSTATECTOMY
3418 SG6061 LOCAL EXCISION OF LESION OF PROSTATE
3419 SG6079 OTHER OPERATIONS ON SEMINAL VESICLES
3420 SG6095 TRANSURETHRAL BALLOON DILATION OF THE PROSTATIC URETHRA
3421 SG6096 TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE BY MICROWAVE
THERMOTHERAPY
3422 SG6097 OTHER TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE BY OTHER
THERMOTHERAPY
3423 SG612 EXCISION OF HYDROCELE (OF TUNICA VAGINALIS)
3424 SG6212 OPEN BIOPSY OF TESTIS
3425 SG6219 OTHER DIAGNOSTIC PROCEDURES ON TESTES
3426 SG622 EXCISION OR DESTRUCTION OF TESTICULAR LESION
3427 SG623 UNILATERAL ORCHIECTOMY
3428 SG623L UNILATERAL ORCHIECTOMY - LAPAROSCOPIC
3429 SG6241 REMOVAL OF BOTH TESTES AT SAME OPERATIVE EPISODE
3430 SG625 ORCHIOPEXY
3431 SG625A ORCHIOPEXY - MICROVASCULAR TRANSFER OF TESTIS TO SCROTUM
3432 SG625B ORCHIOPEXY - BILATERAL FIXATION OF TESTIS
3433 SG625C ORCHIOPEXY - ABDOMINAL UNDESCENDED TESTIS
3434 SG625D ORCHIOPEXY - FIXATION OF TESTIS
3435 SG627 INSERTION OF TESTICULAR PROSTHESIS
3436 SG631 EXCISION OF VARICOCELE AND HYDROCELE OF SPERMATIC CORD
3437 SG632 EXCISION OF CYST OF EPIDIDYMIS
3438 SG634 EPIDIDYMECTOMY
3439 SG634B EPIDIDYMECTOMY-BILATERAL
3440 SG640 CIRCUMCISION
3441 SG6411 BIOPSY OF PENIS
3442 SG643 AMPUTATION OF PENIS
3443 SG643P AMPUTATION OF PENIS-PARTIAL
3444 SG6444 RECONSTRUCTION OF PENIS
3445 SG6445 REPLANTATION OF PENIS
3446 SG6449 OTHER REPAIR OF PENIS
3447 SG6493 DIVISION OF PENILE ADHESIONS
3448 SG6493P DIVISION OF PENILE ADHESIONS-PEYRONIE"S
3449 SG6521 MARSUPIALIZATION OF OVARIAN CYST
3450 SG6523 LAPAROSCOPIC MARSUPIALIZATION OF OVARIAN CYST
3451 SG6525 OTHER LAPAROSCOPIC LOCAL EXCISION OR DESTRUCTION OF OVARY
3452 SG6549 OTHER UNILATERAL SALPINGO-OOPHORECTOMY
3453 SG6561 OTHER REMOVAL OF BOTH OVARIES AND TUBES AT SAME OPERATIVE EPISODE
3454 SG6622 BILATERAL ENDOSCOPIC LIGATION AND DIVISION OF FALLOPIAN TUBES
3455 SG6631 OTHER BILATERAL LIGATION AND CRUSHING OF FALLOPIAN TUBES / STERILIZATION

3456 SG6632 OTHER BILATERAL LIGATION AND DIVISION OF FALLOPIAN TUBES. POMEROY
OPERATION
3457 SG6711 ENDOCERVICAL BIOPSY
3458 SG6712 OTHER CERVICAL BIOPSY
3459 SG6712C OTHER CERVICAL BIOPSY (COMPLEX)
3460 SG672 CONIZATION OF CERVIX
3461 SG6732 DESTRUCTION OF LESION OF CERVIX BY CAUTERIZATION
3462 SG674 AMPUTATION OF CERVIX
3463 SG6812 HYSTEROSCOPY
3464 SG6813 OPEN BIOPSY OF UTERUS
3465 SG6823 ENDOMETRIAL ABLATION
3466 SG6829 OTHER EXCISION OR DESTRUCTION OF LESION OF UTERUS
3467 SG6839 OTHER AND UNSPECIFIED SUBTOTAL ABDOMINAL HYSTERECTOMY
3468 SG6849 OTHER AND UNSPECIFIED TOTAL ABDOMINAL HYSTERECTOMY
3469 SG6849A OTHER AND UNSPECIFIED TOTAL ABDOMINAL HYSTERECTOMY + REMOVAL OF
ADNEXA
3470 SG6849B OTHER AND UNSPECIFIED TOTAL ABDOMINAL HYSTERECTOMY + REMOVAL OF
ADNEXA (OVARIAN)
3471 SG6851 LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY (LAVH)
3472 SG6859 OTHER AND UNSPECIFIED VAGINAL HYSTERECTOMY
3473 SG6869 OTHER AND UNSPECIFIED RADICAL ABDOMINAL HYSTERECTOMY
3474 SG688 PELVIC EVISCERATION
3475 SG688A PELVIC EVISCERATION - ANTERIOR/POSTERIOR
3476 SG689 OTHER AND UNSPECIFIED HYSTERECTOMY
3477 SG6902 DILATION AND CURETTAGE FOLLOWING DELIVERY OR ABORTION
3478 SG6909 OTHER DILATION AND CURETTAGE
3479 SG6922 OTHER UTERINE SUSPENSION
3480 SG6923 VAGINAL REPAIR OF CHRONIC INVERSION OF UTERUS
3481 SG6929 OTHER REPAIR OF UTERUS AND SUPPORTING STRUCTURES
3482 SG6949 OTHER REPAIR OF UTERUS
3483 SG697 INSERTION OF INTRAUTERINE CONTRACEPTIVE DEVICE
3484 SG6993 INSERTION OF LAMINARIA
3485 SG7013 LYSIS OF INTRALUMINAL ADHESIONS OF VAGINA
3486 SG7014 OTHER VAGINOTOMY
3487 SG7021 VAGINOSCOPY / VAGINAL EXAMINATION
3488 SG7033 EXCISION OR DESTRUCTION OF LESION OF VAGINA
3489 SG7051 REPAIR OF CYSTOCELE
3490 SG7051A REPAIR OF CYSTOCELE-CERVIX UTERI
3491 SG7051B REPAIR OF CYSTOCELE-VAGINAL HYSTERECTOMY
3492 SG7052 COLPORRHAPHY/REPAIR OF RECTOCELE
3493 SG7062 VAGINAL RECONSTRUCTION
3494 SG7073 REPAIR OF RECTOVAGINAL FISTULA
3495 SG708 OBLITERATION OF VAGINAL VAULT
3496 SG7123 MARSUPIALIZATION OF BARTHOLIN"S GLAND (CYST)
3497 SG7124 EXCISION OR OTHER DESTRUCTION OF BARTHOLIN"S GLAND (CYST)
3498 SG713 OTHER LOCAL EXCISION OR DESTRUCTION OF VULVA AND PERINEUM
3499 SG715 RADICAL VULVECTOMY
3500 SG7161 UNILATERAL VULVECTOMY
3501 SG7179 OTHER REPAIR OF VULVA AND PERINEUM
3502 SG718 OTHER OPERATIONS ON VULVA
3503 SG7279 OTHER VACUUM EXTRACTION
3504 SG7359 OTHER MANUALLY ASSISTED DELIVERY
3505 SG740 CLASSICAL CESAREAN SECTION
3506 SG741 LOW CERVICAL CESAREAN SECTION
3507 SG7411 LOW CERVICAL CESAREAN SECTION -OPERATOR KE-2
3508 SG741A LOW CERVICAL CESAREAN SECTION (2-4BED)
3509 SG742 EXTRAPERITONEAL CESAREAN SECTION
3510 SG743 REMOVAL OF EXTRATUBAL ECTOPIC PREGNANCY
3511 SG744 CESAREAN SECTION OF OTHER SPECIFIED TYPE
3512 SG744LC CESAREAN SECTION OF OTHER SPECIFIED TYPE - GEMILI
3513 SG7491 HYSTEROTOMY TO TERMINATE PREGNANCY
3514 SG7499 OTHER CESAREAN SECTION OF UNSPECIFIED TYPE
3515 SG752 INTRAUTERINE TRANSFUSION
3516 SG7562 REPAIR OF CURRENT OBSTETRIC LACERATION OF RECTUM AND SPHINCTER ANI
3517 SG7569 REPAIR OF OTHER CURRENT OBSTETRIC LACERATION
3518 SG7611 BIOPSY OF FACIAL BONE
3519 SG762 LOCAL EXCISION OR DESTRUCTION OF LESION OF FACIAL BONE (EXCISION OF
MAXILLA)
3520 SG762A LOCAL EXCISION OR DESTRUCTION OF LESION OF FACIAL BONE-EXTENSIVE
EXCISION MANDIBLE
3521 SG762B LOCAL EXCISION OR DESTRUCTION OF LESION OF FACIAL BONE - FACIAL BONE
TUMOUR
3522 SG762C LOCAL EXCISION OR DESTRUCTION OF LESION OF FACIAL BONE-TUMOUR
3523 SG762D LOCAL EXCISION OR DESTRUCTION OF LESION OF FACIAL BONE (EXCISION OF
LESION OF JAW)
3524 SG7631 PARTIAL MANDIBULECTOMY
3525 SG7631A PARTIAL MANDIBULECTOMY-SEGMENTAL/MARGINAL
3526 SG7631B PARTIAL MANDIBULECTOMY-WITH RECONSTRUCTION
3527 SG7639 PARTIAL OSTECTOMY OF OTHER FACIAL BONE
3528 SG7639A PARTIAL OSTECTOMY OF OTHER FACIAL BONE-HEMIMAXILLECTOMY
3529 SG7639C PARTIAL OSTECTOMY OF OTHER FACIAL BONE-MAXILLECTOMY
3530 SG7641 TOTAL MANDIBULECTOMY WITH SYNCHRONOUS RECONSTRUCTION
3531 SG7642 OTHER TOTAL MANDIBULECTOMY
3532 SG7643 OTHER RECONSTRUCTION OF MANDIBLE
3533 SG7644 TOTAL OSTECTOMY OF OTHER FACIAL BONE WITH SYNCHRONOUS
RECONSTRUCTION
3534 SG765 TEMPOROMANDIBULAR ARTHROPLASTY
3535 SG7661 CLOSED OSTEOPLASTY [OSTEOTOMY] OF MANDIBULAR RAMUS
3536 SG767 REDUCTION OF FACIAL FRACTURE. INCLUDES INTERNAL FIXATION
3537 SG7670 REDUCTION OF FACIAL FRACTURE, NOT OTHERWISE SPECIFIED
3538 SG7670A REDUCTION OF FACIAL FRACTURE, NOT OTHERWISE SPECIFIED- TRANS ORAL
SURGERY WITH POST. FIXATION
3539 SG7671 CLOSED REDUCTION OF MALAR AND ZYGOMATIC FRACTURE
3540 SG7672 OPEN REDUCTION OF MALAR AND ZYGOMATIC FRACTURE
3541 SG7673 CLOSED REDUCTION OF MAXILLARY FRACTURE
3542 SG7674 OPEN REDUCTION OF MAXILLARY FRACTURE
3543 SG7675 CLOSED REDUCTION OF MANDIBULAR FRACTURE
3544 SG7675A CLOSED REDUCTION OF MANDIBULAR FRACTURE (EXTRA)
3545 SG7676 OPEN REDUCTION OF MANDIBULAR FRACTURE
3546 SG7676A OPEN REDUCTION OF MANDIBULAR FRACTURE (RAISED WIRING MANDIBLE /
MAXILLA)
3547 SG7677 OPEN REDUCTION OF ALVEOLAR FRACTURE
3548 SG7679 OTHER OPEN REDUCTION OF FACIAL FRACTURE
3549 SG7691 BONE GRAFT TO FACIAL BONE
3550 SG7692 INSERTION OF SYNTHETIC IMPLANT IN FACIAL BONE
3551 SG7693 CLOSED REDUCTION OF TEMPOROMANDIBULAR DISLOCATION
3552 SG7695 OTHER MANIPULATION OF TEMPOROMANDIBULAR JOINT
3553 SG7696 INJECTION OF THERAPEUTIC SUBSTANCE INTO TEMPOROMANDIBULAR JOINT
3554 SG7697 REMOVAL OF INTERNAL FIXATION DEVICE FROM FACIAL BONE (FIXATOR MAXILLA)

3555 SG7700 SEQUESTRECTOMY UNSPECIFIED SITE

3556 SG7720 WEDGE OSTEOTOMY-UNSPECIFIED SITE
3557 SG7728 WEDGE OSTEOTOMY - TARSAL/METATARSAL
3558 SG7728A WEDGE OSTEOTOMY - TARSAL/METATARSAL (CLOSING)
3559 SG7740 BIOPSY OF BONE, UNSPECIFIED SITE
3560 SG7751 BUNIONECTOMY WITH SOFT TISSUE CORRECTION AND OSTEOTOMY OF THE FIRST
METATARSAL
3561 SG7751A BUNIONECTOMY WITH SOFT TISSUE CORRECTION AND OSTEOTOMY OF THE FIRST
METATARSAL (CORRECTION MINOR)
3562 SG7751B BUNIONECTOMY WITH SOFT TISSUE CORRECTION AND OSTEOTOMY OF THE FIRST
METATARSAL - BILATERAL
3563 SG7752 BUNIONECTOMY WITH SOFT TISSUE CORRECTION AND ARTHRODESIS
3564 SG7753 OTHER BUNIONECTOMY WITH SOFT TISSUE CORRECTION
3565 SG7753B OTHER BUNIONECTOMY WITH SOFT TISSUE CORRECTION - BILATERAL
3566 SG7754 EXCISION OR CORRECTION OF BUNIONETTE
3567 SG7754A EXCISION OR CORRECTION OF BUNIONETTE-SIMPLE BILATERAL
3568 SG7754B EXCISION OR CORRECTION OF BUNIONETTE-BILATERAL
3569 SG7757 REPAIR OF CLAW TOE
3570 SG7759 OTHER BUNIONECTOMY
3571 SG7759A OTHER BUNIONECTOMY-KELLER"S UNILATERAL
3572 SG7759B OTHER BUNIONECTOMY-KELLER"S BILATERAL
3573 SG776 LOCAL EXCISION OF LESION OR TISSUE OF BONE
3574 SG7761 LOCAL EXCISION OF LESION OR TISSUE OF BONE-CLAVICLE
3575 SG7769 LOCAL EXCISION OF LESION OR TISSUE OF BONE-PELVIS
3576 SG7788 OTHER PARTIAL OSTECTOMY-TARSAL
3577 SG7790 TOTAL OSTECTOMY-UNSPECIFIED SITE
3578 SG7800 BONE GRAFT-UNSPECIFIED SITE
3579 SG7800A BONE GRAFT-UNSPECIFIED SITE (COMPLEX)
3580 SG7801 BONE GRAFT-CLAVICLE, SCAPULA
3581 SG7804 BONE GRAFT-CARPAL
3582 SG781 APPLICATION OF EXTERNAL FIXATOR DEVICE
3583 SG7810 APPLICATION OF EXTERNAL FIXATOR DEVICE-UNSPECIFIED SITE
3584 SG7820E LIMB SHORTENING PROCEDURES-UNSPECIFIED SITE, EPIPHYSIS
3585 SG7829 LIMB SHORTENING PROCEDURES-PELVIC
3586 SG7829H LIMB SHORTENING PROCEDURES-HIP
3587 SG7850 INTERNAL FIXATION OF BONE WITHOUT FRACTURE REDUCTION-NAILLING
3588 SG7850A INTERNAL FIXATION OF BONE WITHOUT FRACTURE REDUCTION-LOCKED
INTRAMEDULLARY NAILING
3589 SG7850B INTERNAL FIXATION OF BONE WITHOUT FRACTURE REDUCTION-NAILLING
(MULTIPLE FRACTURE FIXATION)
3590 SG7860F REMOVAL OF EXTERNAL IMMOBILIZATION DEVICE (EXTERNAL FIXATION FROM
BONE)
3591 SG7860K REMOVAL OF IMPLANTED DEVICES FROM BONE-K-WIRE, UNSPECIFIED SITE
3592 SG7860T REMOVAL OF EXTERNAL IMMOBILIZATION DEVICE (SKELETAL TRACTION FROM
BONE)
3593 SG7900 CLOSED REDUCTION OF FRACTURE WITHOUT INTERNAL FIXATION-UNSPECIFIED
SITE
3594 SG791 CLOSED REDUCTION OF FRACTURE WITH INTERNAL FIXATION
3595 SG7930 OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION-UNSPECIFIED SITE
3596 SG7931 OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION HUMERUS - SMALL BONE

3597 SG7931A OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION HUMERUS - LONG BONE

3598 SG7931C OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION HUMERUS (COMPLEX)

3599 SG7935 OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION-FEMUR

3600 SG7939 OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION OTHER SPECIFIED BONE

3601 SG7939C OPEN REDUCTION OF FRACTURE WITH INTERNAL FIXATION OTHER SPECIFIED BONE
(COMPLEX)
3602 SG7980 OPEN REDUCTION OF DISLOCATION OF UNSPECIFIED SITE
3603 SG7987 OPEN REDUCTION OF DISLOCATION OF ANKLE
3604 SG8000 ARTHROTOMY FOR REMOVAL OF PROSTHESIS WITHOUT REPLACEMENT-UNSPECIFIED
SITE
3605 SG8009 ARTHROTOMY FOR REMOVAL OF PROSTHESIS WITHOUT REPLACEMENT-SPINE
3606 SG8020 ARTHROSCOPY - UNSPECIFIED SITE
3607 SG8020A ARTHROSCOPY - UNSPECIFIED CAVITY UNILATERAL
3608 SG8020B ARTHROSCOPY - UNSPECIFIED CAVITY BILATERAL
3609 SG8020C ARTHROSCOPY - UNSPECIFIED CAVITY UNILATERAL (ARTICULAR CARTILAGE)
3610 SG8021 ARTHROSCOPY - SHOULDER
3611 SG8021R ARTHROSCOPY - REVISION SHOULDER
3612 SG8026 ARTHROSCOPY - KNEE
3613 SG8026A ARTHROSCOPY - KNEE EXTENSIVE
3614 SG8026B ARTHROSCOPY - KNEE SEMILUNAR CARTILAGE
3615 SG8026C ARTHROSCOPY - KNEE SEMILUNAR CARTILAGE BILATERAL
3616 SG8030 BIOPSY OF JOINT STRUCTURE-UNSPECIFIED
3617 SG8051 EXCISION OF INTERVERTEBRAL DISC
3618 SG8051A EXCISION OF INTERVERTEBRAL DISC-POSTERIOR DECOMPRESSION W INSTRUMENT

3619 SG8051C EXCISION OF INTERVERTEBRAL DISC-CERVICAL

3620 SG8051D EXCISION OF INTERVERTEBRAL DISC-CERVICAL WITH FUSION
3621 SG8051E EXCISION OF INTERVERTEBRAL DISC-DISCECTOMY LASER
3622 SG8051F EXCISION OF INTERVERTEBRAL DISC-ANTERIOR & POSTERIOR DECOMPRESSION W
INSTRUMENT
3623 SG8051G EXCISION OF INTERVERTEBRAL DISC-OPEN DOOR LAMINOPLASTY CERVICAL REGION
(HIROBYASHI)
3624 SG8052 INTERVERTEBRAL CHEMONUCLEOLYSIS
3625 SG8054 OTHER AND UNSPECIFIED REPAIR OF THE ANULUS FIBROSUS
3626 SG8054A OTHER AND UNSPECIFIED REPAIR OF THE ANULUS FIBROSUS (REVISION)
3627 SG8059 OTHER DESTRUCTION OF INTERVERTEBRAL DISC
3628 SG807 SYNOVECTOMY
3629 SG8074 SYNOVECTOMY-HAND
3630 SG8100 SPINAL FUSION, NOT OTHERWISE SPECIFIED
3631 SG8100A SPINAL FUSION, NOS (PRIMARY POST/ANT DECOMPRESSION W FUSION)
3632 SG8100B SPINAL FUSION, NOS (PRIMARY POST/ANT DECOMPRESSION W FUSION &
INSTRUMENT)
3633 SG8100C SPINAL FUSION, NOS (PRIMARY POST/ANT. EXCISION DISC W FUSION AND OR
INSTRUMENT)
3634 SG8100D SPINAL FUSION, NOS (COMBINED ANT. & POST. FUSION CERVICAL SPINE, W
INSTRUMENT)
3635 SG8100E SPINAL FUSION, NOS (PRIMARY TRANSTHORACIC/POST./ANT.-LAT.EX. VERTEBRAL
DISC W FUSION)
3636 SG8100F SPINAL FUSION, NOS (COMBINED ANT. & POST. DECOMPRESSION, W FUSION &
INSTRUMENT)
3637 SG8100G SPINAL FUSION, NOS (REVISION POST. / ANT. DECOMPRESSION W FUSION)
3638 SG8100H SPINAL FUSION, NOS (REVISION POST/ANT EXCISION INTERVERTEBRAL DISC W
FUSION AND/OR W INSTRUMENT)
3639 SG8100I SPINAL FUSION, NOS (PRIMARY POST/ANT TRANSTHORACIC DECOMPRESSION W
FUSION AND/OR W INSTRUMENT)
3640 SG8108 LUMBAR AND LUMBOSACRAL FUSION OF THE ANTERIOR COLUMN, POSTERIOR
TECHNIQUE
3641 SG8115 TARSOMETATARSAL FUSION
3642 SG8115B TARSOMETATARSAL FUSION-BILATERAL
3643 SG8116 METATARSOPHALANGEAL FUSION
3644 SG8120 ARTHRODESIS OF UNSPECIFIED JOINT
3645 SG8126 METACARPOCARPAL FUSION
3646 SG8128 INTERPHALANGEAL FUSION
3647 SG8128B INTERPHALANGEAL FUSION-BILATERAL
3648 SG8129 ARTHRODESIS OF OTHER SPECIFIED JOINTS
3649 SG8129A ARTHRODESIS OF OTHER SPECIFIED JOINTS-TRIPLE FUSION
3650 SG8144 PATELLAR STABILIZATION
3651 SG8145 OTHER REPAIR OF THE CRUCIATE LIGAMENTS
3652 SG8147 OTHER REPAIR OF KNEE
3653 SG8149 OTHER REPAIR OF ANKLE
3654 SG8149B OTHER REPAIR OF ANKLE-BILATERAL
3655 SG8151 TOTAL HIP REPLACEMENT
3656 SG8151A TOTAL HIP REPLACEMENT-BILATERAL
3657 SG8153 REVISION OF HIP REPLACEMENT, NOT OTHERWISE SPECIFIED
3658 SG8154 TOTAL KNEE REPLACEMENT
3659 SG8154B TOTAL KNEE REPLACEMENT-BILATERAL
3660 SG8154C TOTAL KNEE REPLACEMENT-UNICOMPARTMENTAL
3661 SG8155 REVISION OF KNEE REPLACEMENT,NOT OTHERWISE SPECIFIED
3662 SG8156 TOTAL ANKLE REPLACEMENT
3663 SG8157 REPLACEMENT OF JOINT OF FOOT AND TOE
3664 SG8159 REVISION OF JOINT REPLACEMENT OF LOWER EXTREMITY, NOT ELSEWHERE
CLASSIFIED
3665 SG8165A PERCUTANEOUS VERTEBROPLASTY-CT GUIDE
3666 SG8165B PERCUTANEOUS VERTEBROPLASTY-FLUOROSCOPICALLY GUIDE
3667 SG8166A PERCUTANEOUS VERTEBRAL AUGMENTATION-POSTERIOR
3668 SG8166B PERCUTANEOUS VERTEBRAL AUGMENTATION-ANTERIOR
3669 SG8173 TOTAL WRIST REPLACEMENT
3670 SG8179 OTHER REPAIR OF HAND, FINGERS AND WRIST
3671 SG8180 OTHER TOTAL SHOULDER REPLACEMENT
3672 SG8180R TOTAL SHOULDER REPLACEMENT-REVISION
3673 SG8181 PARTIAL SHOULDER REPLACEMENT
3674 SG8181R PARTIAL SHOULDER REPLACEMENT-REVISION
3675 SG8184 TOTAL ELBOW REPLACEMENT
3676 SG8184R TOTAL ELBOW REPLACEMENT-REVISION
3677 SG8190S OTHER REPAIR OF JOINT-STABILIZATION
3678 SG8191 ARTHROCENTESIS
3679 SG8192 INJECTION OF THERAPEUTIC SUBSTANCE INTO JOINT OR LIGAMENT
3680 SG8192A INJECTION OF THERAPEUTIC SUBSTANCE INTO JOINT OR LIGAMENT-FACET
3681 SG8192B INJEKSI INTRAARTIKULAR
3682 SG8192X INJECTION OF THERAPEUTIC SUBSTANCE INTO JOINT OR LIGAMENT-XRAY
3683 SG8193 SUTURE OF CAPSULE OR LIGAMENT OF UPPER EXTREMITY (ARCOMIOPLASTY)
3684 SG8193A SUTURE OF CAPSULE OR LIGAMENT OF UPPER EXTREMITY (PRIMARY / SECONDARY)

3685 SG8196 OTHER REPAIR OF JOINT

3686 SG8196A OTHER REPAIR OF JOINT (RECONSTRUCTION)
3687 SG8201 EXPLORATION OF TENDON SHEATH OF HAND
3688 SG8211 TENOTOMY OF HAND
3689 SG8221 EXCISION OF LESION OF TENDON SHEATH OF HAND
3690 SG8229 EXCISION OF OTHER LESION OF SOFT TISSUE OF HAND (FASCIA)
3691 SG8229A EXCISION OF OTHER LESION OF SOFT TISSUE OF HAND (TENDON)
3692 SG8233 OTHER TENONECTOMY OF HAND
3693 SG8235 OTHER FASCIECTOMY OF HAND
3694 SG8235A OTHER FASCIECTOMY OF HAND-DERMOFASCIECTOMY
3695 SG8235B OTHER FASCIECTOMY OF HAND-MULTIPLE
3696 SG8256 OTHER HAND TENDON TRANSFER OR TRANSPLANTATION
3697 SG8261 POLLICIZATION OPERATION CARRYING OVER NERVES AND BLOOD SUPPLY
3698 SG8279 PLASTIC OPERATION ON HAND WITH OTHER GRAFT OR IMPLANT
3699 SG8279E PLASTIC OPERATION ON HAND WITH OTHER GRAFT OR IMPLANT-EXTENSOR
3700 SG8279F PLASTIC OPERATION ON HAND WITH OTHER GRAFT OR IMPLANT-FLEXOR
3701 SG8285 OTHER TENODESIS OF HAND
3702 SG8286A OTHER TENOPLASTY OF HAND - WITH IMPLANT
3703 SG8286C OTHER TENOPLASTY OF HAND - EXCLUDE FLEXOR
3704 SG8302S MYOTOMY-SHOULDER
3705 SG8303 BURSOTOMY
3706 SG8313 OTHER TENOTOMY
3707 SG8314 DUPUYTREN"S SUBCUTANEOUS FASCIOTOMY
3708 SG8314A RELEASE FASCIOTOMY OF ANT./POST. COMPARTMENT OF LEG
3709 SG8319 OTHER DIVISION OF SOFT TISSUE
3710 SG8321 OPEN BIOPSY OF SOFT TISSUE
3711 SG8321A OPEN BIOPSY OF SOFT TISSUE (ONCOLOGY)
3712 SG8331 EXCISION OF LESION OF TENDON SHEATH
3713 SG8343 EXCISION OF MUSCLE OR FASCIA FOR GRAFT
3714 SG8344 OTHER FASCIECTOMY
3715 SG835 BURSECTOMY
3716 SG8363 ROTATOR CUFF REPAIR
3717 SG8364A OTHER SUTURE OF TENDON-ACHILLORAPHY
3718 SG8364B OTHER SUTURE OF TENDON-ACHILLORAPHY 2ND
3719 SG837 RECONSTRUCTION OF MUSCLE AND TENDON
3720 SG8375 TENDON TRANSFER OR TRANSPLANTATION
3721 SG8375M TENDON TRANSFER OR TRANSPLANTATION-MULTIPLE
3722 SG8388 OTHER PLASTIC OPERATIONS ON TENDON
3723 SG8398 INJECTION OF LOCALLY-ACTING THERAPEUTIC SUBSTANCE INTO OTHER SOFT
TISSUE
3724 SG8398A INJEKSI SOFT TISSUE
3725 SG8399 OTHER OPERATIONS ON MUSCLE, TENDON, FASCIA, AND BURSA
3726 SG8400 UPPER LIMB AMPUTATION, NOT OTHERWISE SPECIFIED
3727 SG8401 AMPUTATION AND DISARTICULATION OF FINGER
3728 SG8403 AMPUTATION THROUGH HAND
3729 SG8405 AMPUTATION THROUGH FOREARM
3730 SG8409 INTERTHORACOSCAPULAR AMPUTATION
3731 SG8411 AMPUTATION OF TOE
3732 SG8412 AMPUTATION THROUGH FOOT
3733 SG8418 DISARTICULATION OF HIP
3734 SG8419 ABDOMINOPELVIC AMPUTATION
3735 SG8422 FINGER REATTACHMENT
3736 SG844 IMPLANTATION OR FITTING OF PROSTHETIC LIMB DEVICE
3737 SG8440 IMPLANTATION OR FITTING OF PROSTHETIC LIMB DEVICE, NOT OTHERWISE
SPECIFIED
3738 SG8440A IMPLANTATION OR FITTING OF PROSTHETIC LIMB DEVICE, NOT OTHERWISE
SPECIFIED - ARTHROPLASTY
3739 SG8459 INSERTION OF OTHER SPINAL DEVICES
3740 SG8460 INSERTION OF SPINAL DISC PROSTHESIS, NOT OTHERWISE SPECIFIED
3741 SG8472 APPLICATION OF EXTERNAL FIXATOR DEVICE, RING SYSTEM
3742 SG8472A APPLICATION OF EXTERNAL FIXATOR DEVICE, RING SYSTEM -- ADJUSTMENT
3743 SG8481B REVISION OF INTERSPINOUS PROCESS DEVICE(S)
3744 SG8481C REVISION OF INTERSPINOUS PROCESS DEVICE(S) (REVISION POST. AND OR ANT.
DECOMPRESSION + FUSION WITH / WITHOUT INSTRUMENT)
3745 SG8491 AMPUTATION, NOT OTHERWISE SPECIFIED
3746 SG8511 CLOSED (PERCUTANEOUS NEEDLE) BIOPSY OF BREAST
3747 SG8512 OPEN BIOPSY OF BREAST
3748 SG8521 LOCAL EXCISION OF LESION OF BREAST - WIDE LOCAL EXCISION
3749 SG8521A LOCAL EXCISION OF LESION OF BREAST (MULTIPLE TUMOUR MAMMAE / BILATERAL)

3750 SG8521B LOCAL EXCISION OF LESION OF BREAST

3751 SG8521D LOCAL EXCISION OF LESION OF BREAST - STEREOTACTIC/GUIDE WIRE EXCISION

3752 SG8521P LOCAL EXCISION OF LESION OF BREAST-PAPILOMA INTRADUCTAL

3753 SG8522 RESECTION OF QUADRANT OF BREAST
3754 SG8524 EXCISION OF ECTOPIC BREAST TISSUE
3755 SG8525 EXCISION OF NIPPLE
3756 SG8525A EXCISION OF NIPPLE - MICRODOCHOTOMY
3757 SG8533 UNILATERAL SUBCUTANEOUS MAMMECTOMY WITH SYNCHRONOUS IMPLANT
(MAJOR)
3758 SG8533A UNILATERAL SUBCUTANEOUS MAMMECTOMY WITH SYNCHRONOUS IMPLANT
3759 SG8534 OTHER UNILATERAL SUBCUTANEOUS MAMMECTOMY
3760 SG8541 UNILATERAL SIMPLE MASTECTOMY
3761 SG8541A UNILATERAL SIMPLE MASTECTOMY (INCLUDE AXILLARY NODE BIOPSY)
3762 SG8543 UNILATERAL EXTENDED SIMPLE MASTECTOMY
3763 SG8543A UNILATERAL EXTENDED SIMPLE MASTECTOMY, MODIFIED RADICAL MASTECTOMY

3764 SG8545 UNILATERAL RADICAL MASTECTOMY

3765 SG8553 UNILATERAL BREAST IMPLANT
3766 SG8570 TOTAL RECONSTRUCTION OF BREAST, NOT OTHERWISE SPECIFIED
3767 SG8570A TOTAL RECONSTRUCTION OF BREAST, USING LOCAL FLAP
3768 SG8571 LATISSIMUS DORSI MYOCUTANEOUS FLAP (RECONSTRUCTION OF BREAST)
3769 SG8572 TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS (TRAM) FLAP
3770 SG8589 OTHER MAMMOPLASTY
3771 SG8594 REMOVAL OF IMPLANT OF BREAST
3772 SG8601A ASPIRATION OF SKIN AND SUBCUTANEOUS TISSUE
3773 SG8601B ASPIRATION OF SKIN AND SUBCUTANEOUS TISSUE-DRAINAGE OF LESION
3774 SG8601C ASPIRATION OF SKIN AND SUBCUTANEOUS TISSUE-DRAINAGE OF SUBCUTANEOUS
ABSCESS
3775 SG8602 INJECTION OR TATTOOING OF SKIN LESION OR DEFECT
3776 SG8603 INCISION OF PILONIDAL SINUS OR CYST
3777 SG8604 OTHER INCISION WITH DRAINAGE OF SKIN AND SUBCUTANEOUS TISSUE
3778 SG8604A OTHER INCISION WITH DRAINAGE OF SKIN AND SUBCUTANEOUS TISSUE (BREAST
ABSCESS)
3779 SG8605 INCISION WITH REMOVAL OF FOREIGN BODY OR DEVICE FROM SKIN AND
SUBCUTANEOUS TISSUE
3780 SG8605A INCISION WITH REMOVAL OF FOREIGN BODY OR DEVICE / AFF IMPLANT
3781 SG8605B INCISION OF SKIN AND SUBCUTANEOUS TISSUE / PASANG IMPLANT
3782 SG8607 INSERTION OF TOTALLY IMPLANTABLE VASCULAR ACCESS DEVICE [VAD]
3783 SG8609A OTHER INCISION OF SKIN AND SUBCUTANEOUS TISSUE-ESCHAROTOMY <10%
3784 SG8609B OTHER INCISION OF SKIN AND SUBCUTANEOUS TISSUE-ESCHAROTOMY >10%
3785 SG8611 CLOSED BIOPSY OF SKIN AND SUBCUTANEOUS TISSUE
3786 SG8619 OTHER DIAGNOSTIC PROCEDURES ON SKIN AND SUBCUTANEOUS TISSUE
3787 SG862 EXCISION OR DESTRUCTION OF LESION OR TISSUE OF SKIN AND SUBCUTANEOUS
TISSUE
3788 SG8621 EXCISION OF PILONIDAL CYST OR SINUS
3789 SG8622 EXCISIONAL DEBRIDEMENT OF WOUND, INFECTION, OR BURN
3790 SG8622A EXCISIONAL DEBRIDEMENT OF WOUND, INFECTION, OR BURN-<3
3791 SG8622B EXCISIONAL DEBRIDEMENT OF WOUND, INFECTION, OR BURN->3
3792 SG8622C EXCISIONAL DEBRIDEMENT OF WOUND, INFECTION, OR BURN (COCCYGEAL
PRESSURE ULCER EXCISION)
3793 SG8622GA EXCISIONAL DEBRIDEMENT OF WOUND, INFECTION, OR BURN-GA
3794 SG8623 REMOVAL OF NAIL, NAIL BED, OR NAIL FOLD
3795 SG8624 CHEMOSURGERY OF SKIN
3796 SG8625 DERMABRASION
3797 SG8625A DERMABRASION-EXTENSIVE
3798 SG8625C MICRO DERMABRASION DIAMOND
3799 SG8627 DEBRIDEMENT OF NAIL, NAIL BED, OR NAIL FOLD
3800 SG863 OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF SKIN AND
SUBCUTANEOUS TISSUE
3801 SG863A OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF SKIN AND
SUBCUTANEOUS TISSUE - >4 LESSION
3802 SG863B OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF SKIN AND
SUBCUTANEOUS TISSUE (EXCISION OF HEMANGIOMA)
3803 SG863L OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF SKIN AND
SUBCUTANEOUS TISSUE - LASER
3804 SG863M OTHER LOCAL EXCISION OR DESTRUCTION OF LESION OR TISSUE OF SKIN AND
SUBCUTANEOUS TISSUE-MULTIPLE
3805 SG864 RADICAL EXCISION OF SKIN LESION
3806 SG864A RADICAL EXCISION OF SKIN LESION (COMPLEX)
3807 SG864B RADICAL EXCISION OF SKIN LESION (MALIGNANT MELANOMA EXCISION INCL
GRAFTING)
3808 SG865 SUTURE OR OTHER CLOSURE OF SKIN AND SUBCUTANEOUS TISSUE
3809 SG865A SUTURE OR OTHER CLOSURE OF SKIN AND SUBCUTANEOUS TISSUE (MALIGNANT
MELANOMA)
3810 SG865S SUTURE OR OTHER CLOSURE OF SKIN AND SUBCUTANEOUS TISSUE-SECONDARY
SUTURE
3811 SG8660 FREE SKIN GRAFT, NOT OTHERWISE SPECIFIED
3812 SG8662L OTHER SKIN GRAFT TO HAND-LARGE
3813 SG8662S OTHER SKIN GRAFT TO HAND-SMALL
3814 SG8663 FULL-THICKNESS SKIN GRAFT TO OTHER SITES
3815 SG8663A FULL-THICKNESS SKIN GRAFT TO OTHER SITES (SPLIT THICKNESS)
3816 SG8663C FULL-THICKNESS SKIN GRAFT TO OTHER SITES (BUTTOCECTOMY)
3817 SG8669 OTHER SKIN GRAFT TO OTHER SITES
3818 SG8670 PEDICLE OR FLAP GRAFT, NOT OTHERWISE SPECIFIED
3819 SG8670D PEDICLE OR FLAP GRAFT, NOT OTHERWISE SPECIFIED - DISTANT FLAP
3820 SG8670L PEDICLE OR FLAP GRAFT, NOT OTHERWISE SPECIFIED - LARGE FOCAL FLAP
3821 SG8670N PEDICLE OR FLAP GRAFT, NOT OTHERWISE SPECIFIED - NEUROVASCULAR ISLAND
FLAP
3822 SG8670S PEDICLE OR FLAP GRAFT, NOT OTHERWISE SPECIFIED - SMALL LOCAL FLAP
3823 SG8683 LIPOSUCTION / TAMITA
3824 SG8689 OTHER REPAIR AND RECONSTRUCTION OF SKIN AND SUBCUTANEOUS TISSUE
3825 SG8693 INSERTION OF TISSUE EXPANDER
3826 SG8774 RETROGRADE PYELOGRAM
3827 SG8794 CONTRAST VASOGRAM
3828 SG8840 PERIPHERAL (EXTREMITY) ARTERIOGRAPHY
3829 SG8842A AORTOGRAPHY
3830 SG8856 CORONARY ARTERIOGRAPHY USING TWO CATHETERS
3831 SG8860 PHLEBOGRAPHY USING CONTRAST MATERIAL, UNSPECIFIED SITE
3832 SG8872 DIAGNOSTIC ULTRASOUND OF HEART
3833 SG8872A ADVANCED ECHOCARDIOGRAPHY
3834 SG8872C TRANSOESOPHAGEAL ECHO EXAM
3835 SG8873 DIAGNOSTIC ULTRASOUND OF OTHER SITES OF THORAX
3836 SG8876 DIAGNOSTIC ULTRA SOUND OF ABDOMINAL AND RETROPERITONEUM
3837 SG8877 DIAGNOSTIC ULTRASOUND OF PERIPHERAL VASCULAR SYSTEM / MAPPING VASCULAR
PERIFER
3838 SG8878 DIAGNOSTIC ULTRASOUND OF GRAVID UTERUS
3839 SG8878A DIAGNOSTIC ULTRASOUND OBGYN
3840 SG8879 USG MUSCULOSKELETAL DIAGNOSTIC
3841 SG8929 OTHER NONOPERATIVE GENITOURINARY SYSTEM MEASUREMENTS
3842 SG8941 CARDIOVASCULAR STRESS TEST USING TREADMILL
3843 SG8945 ARTIFICIAL PACEMAKER RATE CHECK
3844 SG8950 AMBULATORY CARDIAC MONITORING. ANALOG DEVICES [HOLTER- TYPE]
3845 SG8950A HOLTER READING
3846 SG8952 ELECTROCARDIOGRAPHY
3847 SG90 MICROSCOPIC EXAMINATION. CELL BLOCK AND PAPANICOLOU SMEAR
3848 SG9315 MOBILIZATION OF SPINE
3849 SG9325 FORCED EXTENSION OF LIMB
3850 SG9344 OTHER SKELETAL TRACTION
3851 SG9351 APPLICATION OF PLASTER JACKET
3852 SG9354 APPLICATION OF SPLINT
3853 SG9354P APPLICATION OF SPLINT - PLASTER HIP
3854 SG9357 APPLICATION OF OTHER WOUND DRESSING (EXTENSIVE DRESSING OF BURN OF
SKIN OR SUBCUTANEOUS TISSUE)
3855 SG9357A APPLICATION OF OTHER WOUND DRESSING MINOR
3856 SG9357B APPLICATION OF OTHER WOUND DRESSING MAYOR
3857 SG9433 BEHAVIOR THERAPY, DESENSITIZATION THERAPY
3858 SG9511 FUNDUS PHOTOGRAPHY
3859 SG9512 FLUORESCEIN ANGIOGRAPHY OR ANGIOSCOPY OF EYE
3860 SG9605 OTHER INTUBATION OF RESPIRATORY TRACT
3861 SG9607 INSERTION OF OTHER (NASO-)GASTRIC TUBE
3862 SG9622 DILATION OF RECTUM
3863 SG9625 THERAPEUTIC DISTENTION OF BLADDER
3864 SG9629 REDUCTION OF INTUSSUSCEPTION OF ALIMENTARY TRACT
3865 SG9652 IRRIGATION OF EAR
3866 SG9653A IRRIGATION OF NASAL PASSAGES
3867 SG9736 REMOVAL OF OTHER EXTERNAL MANDIBULAR FIXATION DEVICE
3868 SG9744 NON OPERATIVE REMOVAL OF HEART ASSIST SYSTEMINTRA- AORTIC BALLOON PUMP
(IABP) / PERCUTANEOUS TRANSLUMINAL BALLOON OPERATION AORTA
3869 SG9744A INSERTION OF IABP
3870 SG9762 REMOVAL OF URETEROSTOMY TUBE AND URETERAL CATHETER
3871 SG9764 REMOVAL OF OTHER URINARY DRAINAGE DEVICE. (URINARY CATHETER)
3872 SG9771 REMOVAL OF INTRAUTERINE CONTRACEPTIVE DEVICE
3873 SG9779 REMOVAL OF SUTURES / AFF HECTING
3874 SG9788 REMOVAL OF EXTERNAL IMMOBILIZATION DEVICE
3875 SG9788A REMOVAL OF EXTERNAL IMMOBILIZATION DEVICE / BUKA GIPS < 2 SENDI
3876 SG9788B REMOVAL OF EXTERNAL IMMOBILIZATION DEVICE / BUKA GIPS > 2 SENDI
3877 SG9811 REMOVAL OF INTRALUMINAL FOREIGN BODY FROM EAR WITHOUT INCISION
3878 SG9812 REMOVAL OF INTRALUMINAL FOREIGN BODY FROM NOSE WITHOUT INCISION
3879 SG9851 EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY [ESWL] OF THE KIDNEY, URETER
AND/OR BLADDER
3880 SG9851K EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY [ESWL] OF THE KIDNEY, URETER
AND/OR BLADDER - KIDNEY
3881 SG9851U EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY [ESWL] OF THE KIDNEY, URETER
AND/OR BLADDER - URETER
3882 SG9901 EXCHANGE TRANSFUSION
3883 SG9910 INJECTION OR INFUSION OF THROMBOLYTIC AGENT
3884 SG9925 INJECTION OR INFUSION OF CANCER CHEMOTHERAPEUTIC SUBSTANCE
3885 SG9929 INJECTION OR INFUSION OF OTHER THERAPEUTIC OR PROPHYLACTIC SUBSTANCE

3886 SG992A INJECTION OR INFUSION OF OTHER THERAPEUTIC OR PROPHYLACTIC SUBSTANCE

(VIT C)
3887 SG992B INJECTION OR INFUSION (VIT C) 10 X
3888 SG993 PROPHYLACTIC VACCINATION AND INOCULATION AGAINST CERTAIN BACTERIAL
DISEASES
3889 SG9962 OTHER ELECTRIC COUNTERSHOCK OF HEART (ECP)
3890 SG9962B DIRECT CURRENT SHOCK / CARDIOVERSION
3891 SG9979 OTHER. APHERESIS (HARVEST) OF STEM CELLS
3892 SG9992 OTHER ACUPUNCTURE
3893 SG4131C BONE MARROW PUNCTION (INTERPRETATION)
3894 SG0404 BILATERAL POSTERIOR NASAL NEURECTOMY
3895 SG1762A LASER ASSISTED UVULOPALATOPLASTY
3896 SG1762B LASER ASSISTED TONSILECTOMY
3897 SG1762C LASER ASSISTED HEMICORDECTOMY
3898 SG1762D LASER ASSISTED ARYTENOIDECTOMY
3899 SG1762E LASER ASSISTED VOCAL CORD SURGERY
3900 SG2169A QUILTING SUTURE OF NASAL SEPTUM
3901 SG2169B BILATERAL TURBINOPLASTY
3902 SG2169C REMOVAL OF BILATERAL TURBINATE BONE
3903 SG310A MEDIALIZATION OF VOCAL CORD WITH INJECTION FAT/OTHER MATERIAL
3904 SG3169B OPEN MEDIALIZATION OF VOCAL CORD
3905 SG3169C OPEN MEDIALIZATION/LATERIZATION OF VOCAL CORD
3906 SG409A RECONSTRUCTION LYMPH OEDEM WITH MIROSURGERY OPERATION
3907 SG9813 REMOVAL OF FOREIGN BODY OF PHARYNX
3908 SG2919 NASOPHARYNX AND THROAT SWAB
3909 SG6631A OTHER BILATERAL LIGATION AND CRUSHING OF FALLOPIAN TUBES / STERILIZATION
(PDP COVID)
3910 SG6902A DILATION AND CURETTAGE FOLLOWING DELIVERY OR ABORTION (PDP COVID)
3911 SG7279A OTHER VACUUM EXTRACTION (PDP COVID)
3912 SG7359A OTHER MANUALLY ASSISTED DELIVERY (PDP COVID)
3913 SG741B CESAREAN SECTION WITH COMPLICATION
3914 SG741C CESAREAN SECTION OF OTHER UNSPECIFIED TYPE
3915 SG743A REMOVAL OF EXTRATUBAL ECTOPIC PREGNANCY (PDP COVID)
3916 SG744A CESAREAN SECTION OF OTHER SPECIFIED TYPE (PDP COVID)
3917 SG8948 INTERROGATION OF REPROGRAM PACEMAKER
3918 SG8191A MILD ARTHROCENTESIS FOR THERAPEUTIC
3919 SG8191B MODERATE ARTHROCENTESIS FOR THERAPEUTIC
3920 SG8191C SEVERE ARTHROCENTESIS FOR THERAPEUTIC
3921 SG743B LAPAROSCOPIC ECTOPIC PREGNANCY
3922 SG8152 PARTIAL HIP REPLACEMENT

TARIF PROSEDUR RMO/MO

3923 MOAFFHECT AFF HECTING - MO
3924 MODAYBIG EXTERPATIE BESAR (DAY SURGERY) - MO
3925 MODAYBUGIPS BUKA GIPS - MO
3926 MODAYCORP CORPUS ALENEUM - MO
3927 MODAYMED EXTERPATIE SEDANG (DAY SURGERY) - MO
3928 MODAYSML EXTERPATIE KECIL (DAY SURGERY) - MO
3929 MODAYVERBA GANTI VERBAND - MO
3930 MOOTH MO PROSEDUR LAINNYA - MO
3931 MOSUT15 TOILET&SUTURES<15MIN - MO
3932 MOSUT30 TOILET&SUTURES>15MIN - MO
3933 MOSUTURE10 6-10 SUTURE/WOUND - MO
3934 MOSUTURE5 1-5 SUTURE/WOUND - MO
3935 MOWOUND WOUND CARE/WOUND TOILET WITHOUT SUTURE - MO

TARIF PROSEDUR SPESIALIS

3936 SCP HIFU TREATMENT PROCEDUR
3937 SCPABDTAP ABDOMINAL TAPPING
3938 SCPAFFHECT2 AFF HECTING SPESIALIS
3939 SCPAN0001 PENDAMPINGAN CT-SCAN
3940 SCPAN0002 PENDAMPINGAN CT-SCAN PASIEN HIGH RISK
3941 SCPAN0003 PENDAMPINGAN MRI
3942 SCPAN0004 PENDAMPINGAN MRI PASIEN HIGH RISK
3943 SCPAN0005 PENDAMPINGAN ESCORT PASIEN DALAM KOTA
3944 SCPAN0006 PENDAMPINGAN ESCORT PASIEN LUAR KOTA / NEGARA
3945 SCPARTLINE ARTERIAL LINE
3946 SCPARTPUNC ARTERIAL PUNCTURE
3947 SCPBONEXT BONE MARROW EXTRACTION
3948 SCPCATHROMBUS CORONARY SUCTION THROMBUS
3949 SCPCENVEN CENTRAL VENOUS LINE
3950 SCPCESARPAE1 HONOR DOKTER ANAK DI PROSEDUR CAESERIAN (KAMAR 2 DAN 4)
3951 SCPCESARPAE2 HONOR DOKTER ANAK DI PROSEDUR CAESERIAN (KAMAR 1 DAN VIP)
3952 SCPCESARPAEC1 HONOR DOKTER ANAK (CITO) DI PROSEDUR CAESERIAN (KAMAR 2 DAN 4)
3953 SCPCESARPAEC2 HONOR DOKTER ANAK (CITO) DI PROSEDUR CAESERIAN (KAMAR 1 DAN VIP)
3954 SCPCHEM CHEMOTHERAPHY PROCEDURE
3955 SCPCHESTTASP CHEST TUBE INSERTION SET
3956 SCPCURETTE KURET
3957 SCPCYSTABLAT CYST ABLATION UNDER IMAGING CONTROL
3958 SCPDAYADEN ADENOID
3959 SCPDAYBIG EXTERPATIE BESAR (DAY SURGERY)
3960 SCPDAYBUGIPS BUKA GIPS
3961 SCPDAYCORP CORPUS ALENEUM
3962 SCPDAYENDO D&C/ENDOMETRIUM BIOPSI
3963 SCPDAYMED EXTERPATIE SEDANG (DAY SURGERY)
3964 SCPDAYREP REPOSISI TERTUTUP/PASANG GIPS
3965 SCPDAYSIRC SIRCUMSISI
3966 SCPDAYSML EXTERPATIE KECIL (DAY SURGERY)
3967 SCPDAYTAMP PASAN TAMPON & CABUT
3968 SCPDAYTONSIL LOKAL TONSILECTOMIE
3969 SCPDAYVERBB GANTI VERBAND
3970 SCPDAYVERBC GANTI VERBAND MAJOR
3971 SCPDEN001 PEDIATRIC DENTAL - TREPANASI
3972 SCPDEN002 PEDIATRIC DENTAL - PEMERIKSAAN RA/RB
3973 SCPDEN003 PEDIATRIC DENTAL - PENAMBALAN GIC
3974 SCPDEN004 PEDIATRIC DENTAL - PENAMBALAN RESIT KOMPOSIT
3975 SCPDEN005 PEDIATRIC DENTAL - PERAWATAN SALURAN AKAR DEVIT
3976 SCPDEN006 PEDIATRIC DENTAL - PERAWATAN SALURAN AKAR GANTI OBAT
3977 SCPDEN007 PEDIATRIC DENTAL - PERAWATAN SALURAN AKAR PENGISIAN
3978 SCPDEN008 PEDIATRIC DENTAL - PENCABUTAN/EXODONTI GIGI PERISTENSI
3979 SCPDEN009 PEDIATRIC DENTAL - PENCABUTAN/EXODONTI GIGI DECIDUI+INJEKSI
3980 SCPDEN010 PEDIATRIC DENTAL - PENCABUTAN/EXODONTI GIGI DECIDUI+CLORETYL
3981 SCPDEN011 PEDIATRIC DENTAL - PENCABUTAN/EXODONTI SISA AKAR
3982 SCPDEN012 PEDIATRIC DENTAL - SKALING/TAF/POLISH
3983 SCPDEN013 BUKA ATAP PULP
3984 SCPDEN014 PERAWATAN ALAT MYOFUNCTIONL (QUAD HELIX)
3985 SCPDEN015 KONTROL RA/ RB + GANTI
3986 SCPDEN016 GANTI NITI / SS
3987 SCPDEN017 BLUSHING
3988 SCPDEN018 PASANG BRACKET LEPAS
3989 SCPDEN019 RETAINER 1 RAHANG
3990 SCPDEN020 BAND AND LOOP
3991 SCPDEN021 FINER REINFORCE
3992 SCPDEN022 REMOVABLE SM
3993 SCPDEN023 FISSURE SEALENT
3994 SCPDEN024 PREVENTIVE RESIN
3995 SCPDOAP DOCTOR FEE DONOR APHERESIS
3996 SCPDR0001 HIFU TREATMENT (PAKET 3X)
3997 SCPDR0002 RADIO FREKWENSI / TREATMENT
3998 SCPDR0003 ULTRASOUND CAVITASI
3999 SCPDR0004 AKUPUNTUR KESEHATAN (PAKET 10 X TREATMENT)
4000 SCPDR0005 ACNE PEELING
4001 SCPDR0006 GLOWING PEEL
4002 SCPDR0007 DERMAROLLER
4003 SCPDR0008 P R P ( PLATELET RICH PLASMA )
4004 SCPDR0009 TANAM BENANG / TANPA BENANG
4005 SCPDR0010 FILLER (TANPA FILLER SERUM)
4006 SCPDR0011 IPL/LASER
4007 SCPDR0012 INJEKSI ACNE PER AREA
4008 SCPDR0013 HAIRLOSS TREATMENT + AKUPUNTUR (16 X TREATMENT)
4009 SCPDR0014 HIFU TREATMENT 1 X PROSEDUR
4010 SCPDR0015 RADIO FREKWENSI / TREATMENT (PAKET 3 X)
4011 SCPDR0016 AKUPUNTUR KESEHATAN (PAKET 10 X TREATMENT)
4012 SCPDR0017 FCL NANO BIOLIGHT 1 X PROCEDUR
4013 SCPDR0018 FCL NANO BB GLOW 1 X PROSEDUR
4014 SCPDR0019 FCL NANO BB GLOW (PAKET 3 X)
4015 SCPDR0020 BASIC FACIAL TREATMENT
4016 SCPDR0021 WHITENING INJECTION
4017 SCPDR0022 WHITENING INJECTION PACKAGE (10 X)
4018 SCPEARSYR EARSYRINGING
4019 SCPENDINT ENOTRACHEAL INTUBATION
4020 SCPENT001 ADVANCE THERAPY BIO E ALERGY
4021 SCPEPIANE EPIDURAL ANESTHESIA
4022 SCPEYEFUNDUS INDIRECT FUNDUSCOPY
4023 SCPFINENEEDLE PROSEDUR FINE NEEDLE ASPIRATION
4024 SCPFNCYTO FINE NEEDLE ASPIRATION CYTOLOGY
4025 SCPFOREIGNBODY RETRIEVAL OF FOREIGN BODY UNDER X-RAY GUIDANCE
4026 SCPHCG UJI HCG
4027 SCPINJARTC INJEKSI INTRAARTICULER
4028 SCPINTRAMUS INJEKSI INTRAMUSCULARE
4029 SCPINTRAVENA INJEKSI INTRAVENA
4030 SCPINTUBASI TINDAKAN INTUBASI
4031 SCPIUDIN INSERTION IUD
4032 SCPIUDOUT PROSEDUR REMOVAL IUD
4033 SCPIVCAN I.V. CANNULATION
4034 SCPLCMASS PERCUTANEOUS LASER COAGULATION OF MASS
4035 SCPLUMBP LUMBAR PUNCTURE
4036 SCPMANTOUX MANTOUX TEST
4037 SCPNURSERY HONOR DOKTER ANAK VISIT NURSERY
4038 SCPON0001 MYELOPEROXIDASE STAIN
4039 SCPON0002 NITROBLUE TETRAZOLIUM STAIN
4040 SCPON0003 PERIODIC ACID SCHIFF STRAIN
4041 SCPON0004 SUDDEN BLACK
4042 SCPPA001 PROSEDUR FROZEN SECTION OPERATING ROOM
4043 SCPPAED0001 DEVELOPMENT TEST
4044 SCPPAPS PROSEDUR PAP SMEAR
4045 SCPPERDIAL PERITONEAL DIALYSIS
4046 SCPPIERC EAR PIERCING PROCEDURE PACKAGE
4047 SCPPK001 PROSEDURE THROMBOCYTE CONCENTRATE (TC)
4048 SCPPK002 PROSEDURE FRESH FROZEN PLASMA (FFP) 700 CC
4049 SCPPK003 PROCEDURE THERAPEUTIC PLATELET REDUCTION
4050 SCPPK004 PROCEDURE THERAPEUTIC LYMPHO/MONO REDUCTION
4051 SCPPK005 PROSEDUR THERAPEUTIC GRANULOCYTE REDUCTION
4052 SCPPK006 PROSEDUR LYMPHO MONO COLLECTION
4053 SCPPK007 PROSEDUR GRANULOCYTE COLLECTION
4054 SCPPK008 PROSEDUR PLATELET GEL
4055 SCPPPARIS PLASTER OF PARIS
4056 SCPPSY001 PEMERIKSAAN INTELEGENSI I (KLIEN TYPICAL)
4057 SCPPSY002 PEMERIKSAAN INTELEGENSI II (KLIEN TYPICAL/SN)
4058 SCPPSY003 DETEKSI PERKEMBANGAN
4059 SCPPSY004 LAPORAN HASIL PEMERIKSAAN I (BRIEF, MAX 3 HALAMAN)
4060 SCPPSY005 LAPORAN HASIL PEMERIKSAAN I (BRIEF, LEBIH DARI 3 HALAMAN)
4061 SCPSHAVPREP SHAVING/SKIN PREP
4062 SCPSUT15 TOILET&SUTURES<15MIN
4063 SCPSUT30 TOILET&SUTURES>15MIN
4064 SCPSUTURE10 6-10 SUTURE/WOUND
4065 SCPSUTURE5 1-5 SUTURE/WOUND
4066 SCPTHAP DOCTOR FEE THERAPEUTIC APHERESIS
4067 SCPUR0001 POST PCNL
4068 SCPVAGEXAM VAGINAL EXAMINATION
4069 SCPVAGWASH PROSEDUR VAGINAL WASHING
4070 SCPVAKSIN PROSEDUR INJEKSI
4071 SCPWOUND WOUND CARE
4072 SCPWOUNDH WOUND HEALING
4073 SCPCP0001 ANA IF (INTERPRETATION)
4074 SCPNEU0001 EEG INTERPRETATION
4075 SCPDENPED0001 PEMASANGAN BRACKET PERTAMA
4076 SCPDENPED0002 PEMASANGAN BRACKET KEDUA
4077 SCPLAC001 EKSTRAKSI NIPPLE CORE
4078 SCPLAC002 TRAINING PEMBERIAN ASI DENGAN CUP FEEDING
4079 SCPLAC003 TRAINING PERAH ASI
4080 SCPLAC004 TBML (THERAPEUTIC BREAST MASSAGE FOR LACTATION)
4081 SCPLAC005 TRAINING SUPLEMENTASI
4082 SCPLAC006 PIJAT OXITOCIN
4083 SCPLAC007 TRAINING RELAKTASI
4084 SCPDC0001 DIABETIC FOOD SCREENING
4085 SCPHV HOME VISIT SPECIALIST
4086 SCPINT0001 USG KIDNEY-BLADDER NEPHROLOGY
4087 SCPBIA BIA PROCEDURE
4088 SCPPED001 INJEKSI TESTOSTERON ESTER
4089 SCPPED002 INJEKSI GNRH AGONIST (LEUPRORELIN ACETATE)
4090 SCPPED003 UJI STIMULASI HORMON PERTUMBUHAN
4091 SCPPED004 UJI STIMULASI HCG
4092 SCPPED005 UJI HAUS (WATER DESMOPRESSIN TEST)/ UJI DESMOPRESSIN (DDAVP)
4093 SCPPED006 TERAPI ZOLEDRONIC ACID PADA OSTEOGENESIS IMPERFECTA
4094 SCPPED007 INISIASI TERAPI INSULIN PADA PASIEN BARU DM
4095 SCPDELPAEC1 HONOR DOKTER ANAK CITO DI PROSEDUR DELIVERY DENGAN RESIKO (KAMAR 2
DAN 4)
4096 SCPDELPAEC2 HONOR DOKTER ANAK CITO DI PROSEDUR DELIVERY DENGAN RESIKO (KAMAR 1
DAN VIP)
4097 SCPINT0002 USG WHOLE ABDOMEN

TARIF DENTAL
4098 DENJL11 KONSULTASI DRG
4099 DENJL12 IMPRESSION MODEL RA DAN RB (STUDY MODEL)
4100 DENJL21 PENAMBALAN SEMENTARA
4101 DENJL22 PENAMBALAN RESIN COMPOSITE (UMUM)
4102 DENJL221 PENAMBALAN RESIN COMPOSITE (CLASS 1, 2, 3 SMALL <1/2 MAHKOTA GIGI)
4103 DENJL222 PENAMBALAN RESIN COMPOSITE (CLASS 1, 2, 3 LARGE)
4104 DENJL223 PENAMBALAN RESIN COMPOSITE (CLASS 4 ANTERIOR COMPOSITE, CLOSED
DIASTEMA)
4105 DENJL224 PENAMBALAN RESIN COMPOSITE (POSTERIOR MOD)
4106 DENJL225 PENAMBALAN RESIN COMPOSITE (INLAY / OVERLAY COMPOSITE (DIRECT))
4107 DENJL23 POST REINFORCEMENT FIBER / LOGAM
4108 DENJL24 BUILD UP COMPOSITE FX > 1/2 MAHKOTA GIGI
4109 DENJL251 PERAWATAN SALURAN AKAR (OPEN ACCESS, GLIDE PATH, PULP REMOVAL,
PENGISIAN SALURAN AKAR (NORMAL CANAL))
4110 DENJL252 PERAWATAN SALURAN AKAR (OPEN ACCESS, GLIDE PATH, PULP REMOVAL,
PENGISIAN SALURAN AKAR (CURVED CANAL, S CANAL, C SHAPE CANAL))
4111 DENJL253 PENAMBALAN PERMANEN PSA
4112 DENJL31 PENCABUTAN GIGI SUSU
4113 DENJL32 PENCABUTAN GIGI TETAP
4114 DENJL33 PENCABUTAN GIGI TETAP DENGAN KOMPLIKASI (FX TERBUKA DAN FX TERTUTUP)

4115 DENJL34 INSISI ABSES/ FISTEL

4116 DENJL35 DRY SOCKET
4117 DENJL36 CURRETAGE PER GIGI
4118 DENJL37 ALVEOLEKTOMI PER KUADRAN
4119 DENJL38 OPERASI GIGI MIRING / TERPENDAM
4120 DENJL39 HECTING
4121 DENJL41 PEMBERSIHAN KARANG GIGI + FLUORIDASI TIAP RAHANG RA DAN RB (GINGIVITIS)

4122 DENJL42 PEMBERSIHAN KARANG GIGI + FLUORIDASI TIAP RAHANG RA DAN RB

(PERIODONTITIS)
4123 DENJL43 FIBER SPLINT UNTUK GIGI MOBILITY PER RAHANG
4124 DENJL511 GIGI TIRUAN PENUH AKRILIK 1 RAHANG
4125 DENJL512 GIGI TIRUAN PENUH AKRILIK 2 RAHANG
4126 DENJL513 GIGI TIRUAN PENUH VALPLAST 1 RAHANG
4127 DENJL514 GIGI TIRUAN PENUH VALPLAST 2 RAHANG
4128 DENJL515 GIGI TIRUAN PENUH KERANGKA LOGAM VITALIUM 1 RAHANG
4129 DENJL516 GIGI TIRUAN PENUH KERANGKA LOGAM VITALIUM 2 RAHANG
4130 DENJL521 GIGI TIRUAN SEBAGIAN LEPASAN AKRILIK
4131 DENJL522 GIGI TIRUAN SEBAGIAN LEPASAN VALPLAST
4132 DENJL523 GIGI TIRUAN SEBAGIAN LEPASAN LOGAM VITALIUM
4133 DENJL524 GIGI TIRUAN SEBAGIAN SADDLE VALPLAST
4134 DENJL525 GIGI TIRUAN SEBAGIAN SADDLE LOGAM
4135 DENJL531 GIGI TIRUAN CEKAT MARYLAND
4136 DENJL532 GIGI TIRUAN CEKAT PFM
4137 DENJL533 GIGI TIRUAN CEKAT ALL CERAMIC
4138 DENJL534 GIGI TIRUAN INLAY/ OVERLAY LOGAM
4139 DENJL535 GIGI TIRUAN INLAY/ OVERLAY COMPOSITE (INDIRECT)
4140 DENJL541 DENTURE REPAIR RELINING
4141 DENJL542 DENTURE REPAIR REBASING
4142 DENJL543 REPARASI PREOTESA RETAK
4143 DENJL544 DENTURE REPAIR PENAMBAHAN GIGI AKRILIK
4144 DENJL545 DENTURE REPAIR PENAMBAHAN GIGI AKRILIK + METAL SUPPORT
4145 DENJL551 TMD PROBLEM SPLINT REPOSISI
4146 DENJL552 TMD PROBLEM SPLINT STABILISASI
4147 DENJL553 TMD PROBLEM MOUTH GUARD ( BRUXISM)
4148 DENJL554 TMD PROBLEM NTSS
4149 DENJL61 INTRAORAL
4150 DENJL62 DIGITAL PANORAMIK

TARIF CSSD
4151 CSA00001 CATHERIZATION SET
4152 CSA00002 CHEST TUBE INSERTION SET/ WSD SET
4153 CSA00003 DELIVERY SET
4154 CSA00004 DRESSING SET
4155 CSA00005 AFF HECTING SET
4156 CSA00006 CIRCUMCISION SET
4157 CSA00007 EPIDURAL SET
4158 CSA00008 LUMBAR PUNCTURE SET
4159 CSA00009 STITCHING SET
4160 CSA00010 STOMACH WASHOUT SET/ KUMBAH LAMBUNG
4161 CSA00011 SUPPLEMENTARY UTENSIL SINGLE
4162 CSA00012 GALIPOT
4163 CSA00013 VULVA SWABBING SET
4164 CSA00014 TRACHEOSTOMIE SET
4165 CSA00015 SUCTION TUBING
4166 CSA00016 SILICONE MASK
4167 CSA00017 HARMONIC SCAPLE
4168 CSA00018 TISSUE FORCEPS
4169 CSA00019 SINGLE INSTRUMENT - SUCTION TUBE
4170 CSA00020 SCISSORS CURVE
4171 CSA00021 SINGLE INSTRUMENT - ORTHOPEDICS
4172 CSA00022 VASCULAR INSTRUMENT
4173 CSA00023 DISSECTING FORCEPS
4174 CSA00024 INSTRUMENT FOR PROCEDURE ASSISTANT
4175 CSA00025 NEEDLE HOLDER
4176 CSA00026 ARTHERY FORCEPS
4177 CSA00027 RETRACTOR
4178 CSA00028 RIGHT ANGLE FORCEPS
4179 CSA00029 BIAYA STERILISASI PERALATAN DOKTER
4180 CSA00030 INSTRUMENT STERRAD FOR LARGE SET
4181 CSA00031 OTHER SINGLE INSTRUMENT
4182 CSA00032 UROLOGY INSTRUMENT SET
4183 CSA00033 PCNL
4184 CSA00034 D & C DELIVERY SET
4185 CSA00035 HAAK SPOELLING SET
4186 CSA00036 CERVICAL CONE BIOPSY SET
4187 CSA00037 CVP SET
4188 CSA00038 LINEN X4
4189 CSA00039 LINEN X2
4190 CSA00040 DRESSING TRACHEOSTOMY SET
4191 CSD00001 COTTON TAPE
4192 CSD00002 KASA DEPPER 20 X 20
4193 CSD00003 VAGINAL ROLL
4194 CSD00004 TAMPON VAGINAL
4195 CSD00005 PLAIN GAUZE 10 X 10
4196 CSD00006 PLAIN GAUZE 7.5 X 7.5
4197 CSD00007 RYTEX GAUZE 10 X 10
4198 CSD00008 RYTEX LAPARASCOPY 10 X 10
4199 CSD00009 RYTEX LAPARASCOPY 5 X 5
4200 CSD00010 STICK RYTEX
4201 CSD00011 PEANUT LARGE
4202 CSD00012 PENNY TOWEL
4203 CSD00013 PEANUT SMALL
4204 CSD00014 SWAB STICK LARGE
4205 CSD00015 SWAB STICK SMALL
4206 CSD00016 EYE SPONGE
4207 CSD00017 PLAIN GAUZE 5 X 5
4208 CSD00018 SPALK PAEDIATRIC
4209 CSD00019 TAMPON HIDUNG
4210 CSD00020 PLAIN GAUZE 2 X 2 CM
4211 CSD00021 GLOVE STERILE
4212 CSD00022 COTTON BUD L
4213 CSD00023 PLAIN GAUZE 5 X 5 CM (OBSOLETE)
4214 CSD00024 COTTON SWABS SMALL
4215 CSL00001 ADULT VENTILATOR+TUBING+CONNECTOR(150CM)
4216 CSL00002 INFANT VENTILATOR+TUBING+CONNECTOR(150CM
4217 CSN00001 BASIC SET
4218 CSN00002 MINI SET
4219 CSN00003 MINI SURGERY SET
4220 CSN00004 LAPARATOMY SET
4221 CSN00005 MINI DELIVERY SET
4222 CSN00006 PLASTIC SET
4223 CSN00007 PREPARATION SET
4224 CSN00008 GASTRO INTESTINAL
4225 CSN00009 THIROID SET
4226 CSN00010 GALL BLADDER SET
4227 CSN00011 PAEDIATRIC SET
4228 CSN00012 PROSTATECTOMY SET
4229 CSN00013 AV FISTULA SET
4230 CSN00014 CRANIOTOMY SET
4231 CSN00015 BOR CRANIOTOMY ( AESCULAP)
4232 CSN00016 CERVIX SET
4233 CSN00017 D & C SET OT
4234 CSN00018 LSCS SET
4235 CSN00019 HYSTERECTOMIE SET
4236 CSN00020 HYSTERESCOPY SET
4237 CSN00021 VAGINAL HYSTERCTOMIE SET
4238 CSN00022 PPH SET
4239 CSN00023 LAPARASCOPY SET
4240 CSN00024 LAPARASCOPY (OLYMPUS)
4241 CSN00025 KUSHNER NAIL SET
4242 CSN00026 MENISECTOMY SET
4243 CSN00027 AO DHS/DCS INSTRUMENT SET
4244 CSN00028 STAPPLING SET
4245 CSN00029 CERVICAL FUSION SET
4246 CSN00030 BONE REDUCTION SET
4247 CSN00031 HAND SET
4248 CSN00032 LAMINECTOMY SET
4249 CSN00033 LARGE ORTHOPEDIC SET (BASIC ORTHO SET)
4250 CSN00034 SMALL ORTHOPEDIC SET (BASIC ORTHO SET)
4251 CSN00035 BOR TULANG ( BOJIN/AESCULAP)
4252 CSN00036 DHS SET
4253 CSN00037 MOORES THOMSON ARTOPLASTY
4254 CSN00038 BASIC NASAL PROSEDUR SET
4255 CSN00039 SET FESS INSTRUMENT
4256 CSN00040 TONSILECTOMY SET
4257 CSN00041 EUM MYRENGOTOMY SET
4258 CSN00042 CATARAC EXTRACTION SET
4259 CSN00043 PHACO SET
4260 CSN00044 PTERYGIUM
4261 CSN00045 LASIC SET
4262 CSN00046 EYE MUSCLE SET
4263 CSN00047 BASIN SET
4264 CSN00048 HEAD PACK
4265 CSN00049 GOWN
4266 CSN00050 LINEN ORTHO
4267 CSN00051 ABDOMINAL PACK
4268 CSN00052 LINEN JANTUNG
4269 CSN00053 LITHOTOMY PACK
4270 CSN00054 LINEN KATARAK
4271 CSN00055 MEDIUM ROUND HOLE
4272 CSN00056 TUR SET
4273 CSN00057 SACHE SET (UROLOGY)
4274 CSN00058 CYTOSCOPY SET
4275 CSN00059 LITHOTRIPSI
4276 CSN00060 ANGIO INSTRUMENT SET
4277 CSN00061 PPM SET
4278 CSN00062 TPM SET
4279 CSN00063 TEST LUNG
4280 CSN00064 BASIN CARDIAC SET
4281 CSN00065 BASIC INFANT CARDIAC SET
4282 CSN00066 CABG SET
4283 CSN00067 BASIN ADULT SET
4284 CSN00068 CORONARY SET
4285 CSN00069 VALVES SURGERY SET
4286 CSN00070 BASIC ARTHROSCOPY SET
4287 CSN00071 RE OPENING SET
4288 CSSA0041 INSTRUMENT STERRAD FOR SINGLE SET
4289 CSS000072 KASA LUKA BAKAR

TARIF LAIN-LAIN
4290 PMU1 BIAYA RACIKAN 1-30 PACK
4291 PMU2 BIAYA RACIKAN 30-60 PACK
4292 PMU3 BIAYA RACIKAN >60 PACKS
4293 MSMAPD2 MEDICAL SUPPLIES APD LEVEL 2
4294 MSMAPD3 MEDICAL SUPPLIES APD LEVEL 3
4295 MSMHOMECARE MEDICAL SUPPLIES HOMECARE
4296 MSMJEN1 PETI JENAZAH
4297 MSMJEN2 WRAPPING JENAZAH
4298 MSMISO MEDICAL SUPPLIES ISOLATION
4299 MSMISOER MEDICAL SUPPLIES ISOLATION EMERGENCY ROOM
4300 MSMORPPI MEDICAL SUPPLIES OPERATING ROOM PPI
 TARIF INSURANCE 01 APR
SATUAN 2022

PROSEDUR 6,404,097
PROSEDUR 15,155,333
PROSEDUR 2,519,449
PROSEDUR 4,541,045
PROSEDUR 7,797,673
PROSEDUR 4,221,058
PROSEDUR 6,113,573
PROSEDUR 5,697,830
PROSEDUR 9,523,311
PROSEDUR 5,837,780
PROSEDUR 10,377,497
PROSEDUR 7,236,668

PROSEDUR 3,140,949
PROSEDUR 3,140,949
PROSEDUR 5,270,255
PROSEDUR 7,235,340
PROSEDUR 4,167,203
PROSEDUR 5,064,376
PROSEDUR 3,767,762
PROSEDUR 5,595,676
PROSEDUR 5,577,201
PROSEDUR 5,837,780
PROSEDUR 1,486,433
PROSEDUR 3,767,762
PROSEDUR 7,443,755
PROSEDUR 9,356,555
PROSEDUR 15,155,333
PROSEDUR 10,828,015
PROSEDUR 23,138,357
PROSEDUR 7,684,530

PROSEDUR 4,366,199

PROSEDUR 9,356,555

PROSEDUR 2,095,737
PROSEDUR 2,095,737
PROSEDUR 791,033
PROSEDUR 1,486,433
PROSEDUR 1,771,644
PROSEDUR 2,519,449
PROSEDUR 7,734,279
PROSEDUR 3,767,762

PROSEDUR 3,169,084

PROSEDUR 3,169,084

PROSEDUR 5,064,376
PROSEDUR 1,771,644
PROSEDUR 3,432,802

PROSEDUR 15,155,333
PROSEDUR 8,233,460
PROSEDUR 12,625,137
PROSEDUR 5,595,676
PROSEDUR 4,366,199
PROSEDUR 15,693,274
PROSEDUR 26,686,595
PROSEDUR 3,767,762
PROSEDUR 5,064,376

PROSEDUR 1,771,644
PROSEDUR 2,095,737
PROSEDUR 2,095,737

PROSEDUR 2,095,737
PROSEDUR 5,577,201
PROSEDUR 2,270,704
PROSEDUR 2,095,737
PROSEDUR 2,095,737
PROSEDUR 2,270,704
PROSEDUR 1,756,792
PROSEDUR 2,730,641

PROSEDUR 3,767,762

PROSEDUR 23,138,357

PROSEDUR 3,767,762
PROSEDUR 4,366,199
PROSEDUR 2,519,449
PROSEDUR 3,767,762
PROSEDUR 5,577,201
PROSEDUR 2,270,704
PROSEDUR 2,730,641
PROSEDUR 7,684,530
PROSEDUR 9,356,555
PROSEDUR 4,366,199
PROSEDUR 4,366,199
PROSEDUR 7,796,224
PROSEDUR 8,907,245
PROSEDUR 5,064,376
PROSEDUR 3,767,762
PROSEDUR 2,730,641
PROSEDUR 10,054,611
PROSEDUR 6,835,899
PROSEDUR 5,837,780
PROSEDUR 8,233,460
PROSEDUR 3,169,084
PROSEDUR 5,380,379
PROSEDUR 7,443,755
PROSEDUR 7,443,755
PROSEDUR 1,372,082
PROSEDUR 4,366,199
PROSEDUR 3,767,762
PROSEDUR 13,344,083
PROSEDUR 12,307,565
PROSEDUR 11,298,819
PROSEDUR 4,783,270
PROSEDUR 4,035,344
PROSEDUR 2,270,704
PROSEDUR 2,101,171
PROSEDUR 2,101,171
PROSEDUR 4,866,708
PROSEDUR 6,861,498
PROSEDUR 10,054,611
PROSEDUR 21,705,899

PROSEDUR 6,861,498

PROSEDUR 2,640,440

PROSEDUR 7,797,673
PROSEDUR 7,423,589
* 15,364,109
PROSEDUR 5,486,759
* 13,828,411
* 15,364,109
PROSEDUR 9,356,555
PROSEDUR 8,324,867
* 15,364,109
PROSEDUR 11,201,978
PROSEDUR 13,078,312
PROSEDUR 30,570,036
* 15,364,109
PROSEDUR 4,558,554
PROSEDUR 2,519,449
PROSEDUR 15,155,333
PROSEDUR 5,915,784
PROSEDUR 4,541,045
PROSEDUR 474,910
* 846,337
PROSEDUR 2,730,641
PROSEDUR 3,169,084
PROSEDUR 13,078,312
* 15,364,109
PROSEDUR 13,078,312

PROSEDUR 8,324,867

PROSEDUR 15,693,274

PROSEDUR 7,684,530
PROSEDUR 3,767,762
PROSEDUR 23,138,357
PROSEDUR 4,366,199
PROSEDUR 12,625,137
PROSEDUR 23,876,864
PROSEDUR 15,693,274
PROSEDUR 8,233,460
PROSEDUR 8,233,460
PROSEDUR 15,693,274
PROSEDUR 2,519,449
PROSEDUR 1,729,865
PROSEDUR 4,366,199
PROSEDUR 3,767,762
PROSEDUR 2,095,737
PROSEDUR 3,361,439
PROSEDUR 4,366,199
PROSEDUR 11,801,984
PROSEDUR 4,366,199
PROSEDUR 7,984,473
PROSEDUR 5,064,376
PROSEDUR 2,519,449
PROSEDUR 3,493,418

PROSEDUR 1,581,946
PROSEDUR 5,915,784
PROSEDUR 6,835,899
PROSEDUR 5,837,780
PROSEDUR 2,519,449
PROSEDUR 11,801,984
PROSEDUR 5,837,780
PROSEDUR 10,428,574
PROSEDUR 12,625,137
PROSEDUR 10,828,015
PROSEDUR 12,625,137
PROSEDUR 12,625,137
PROSEDUR 14,603,747
PROSEDUR 1,892,756
PROSEDUR 3,361,439
PROSEDUR 28,730,048
PROSEDUR 18,982,021
PROSEDUR 18,982,021
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 76,985,008
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 15,693,274
PROSEDUR 12,625,137
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 22,331,264
PROSEDUR 18,982,021
PROSEDUR 23,876,864

PROSEDUR 29,939,117

PROSEDUR 28,108,547

PROSEDUR 23,876,864
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 33,069,078

PROSEDUR 18,462,796

PROSEDUR 22,331,264
PROSEDUR 12,625,137

PROSEDUR 29,939,117

PROSEDUR 11,801,984
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 28,108,547
PROSEDUR 5,837,780
PROSEDUR 10,054,611
PROSEDUR 5,876,661
PROSEDUR 5,837,780
PROSEDUR 6,868,139

PROSEDUR 6,868,139

PROSEDUR 5,837,780
PROSEDUR 6,835,899
PROSEDUR 20,924,647
PROSEDUR 26,190,071
PROSEDUR 6,835,899
PROSEDUR 11,801,984

PROSEDUR 15,693,274
PROSEDUR 21,705,899
PROSEDUR 28,108,547

PROSEDUR 18,982,021

PROSEDUR 10,428,574

PROSEDUR 13,952,180
PROSEDUR 28,108,547
PROSEDUR 3,843,110
PROSEDUR 5,837,780

PROSEDUR 18,982,021

PROSEDUR 2,519,449

PROSEDUR 4,570,750

PROSEDUR 6,835,899

PROSEDUR 9,356,555

PROSEDUR 7,684,530

PROSEDUR 7,684,530
PROSEDUR 15,693,274

PROSEDUR 7,796,224
PROSEDUR 11,201,978
PROSEDUR 23,876,864
PROSEDUR 11,243,395
PROSEDUR 23,876,864
PROSEDUR 18,982,021
PROSEDUR 23,876,864
PROSEDUR 18,982,021
PROSEDUR 15,693,274
PROSEDUR 18,982,021
PROSEDUR 12,625,137
PROSEDUR 2,519,449
PROSEDUR 28,108,547

PROSEDUR 25,552,874
PROSEDUR 18,982,021

PROSEDUR 23,876,864

PROSEDUR 18,982,021

PROSEDUR 23,876,864

PROSEDUR 28,108,547
PROSEDUR 28,108,547

PROSEDUR 28,108,547

PROSEDUR 18,982,021

PROSEDUR 28,108,547

PROSEDUR 9,356,555
PROSEDUR 15,693,274

PROSEDUR 9,356,555
PROSEDUR 5,837,780
PROSEDUR 9,356,555
PROSEDUR 15,693,274
PROSEDUR 15,693,274
PROSEDUR 3,169,084
PROSEDUR 10,054,611
PROSEDUR 9,356,555

PROSEDUR 3,169,084
PROSEDUR 2,641,889
PROSEDUR 4,221,058
PROSEDUR 4,866,708
PROSEDUR 3,956,012
PROSEDUR 22,331,264

PROSEDUR 18,982,021

PROSEDUR 23,876,864

PROSEDUR 28,108,547
PROSEDUR 15,693,274

PROSEDUR 11,801,984

PROSEDUR 23,876,864

PROSEDUR 18,982,021
PROSEDUR 10,521,431

PROSEDUR 12,625,137
PROSEDUR 28,108,547

PROSEDUR 18,982,021
PROSEDUR 18,982,021
PROSEDUR 18,982,021

PROSEDUR 15,693,274
PROSEDUR 9,356,555
PROSEDUR 5,837,780
PROSEDUR 12,625,137
PROSEDUR 12,625,137

PROSEDUR 15,693,274

PROSEDUR 15,693,274

PROSEDUR 11,801,984

PROSEDUR 9,356,555
PROSEDUR 15,693,274
PROSEDUR 13,884,077

PROSEDUR 5,837,780
PROSEDUR 6,835,899

PROSEDUR 5,837,780

PROSEDUR 6,835,899

PROSEDUR 18,982,021

PROSEDUR 23,876,864
PROSEDUR 15,693,274
PROSEDUR 23,876,864

PROSEDUR 12,625,137
PROSEDUR 5,837,780

PROSEDUR 7,797,673

PROSEDUR 18,982,021

PROSEDUR 11,801,984

PROSEDUR 9,356,555

PROSEDUR 18,982,021

PROSEDUR 15,693,274
PROSEDUR 11,801,984
PROSEDUR 10,054,611
PROSEDUR 6,128,304

PROSEDUR 4,866,708

PROSEDUR 28,108,547

PROSEDUR 1,421,952
PROSEDUR 791,033
PROSEDUR 11,801,984
PROSEDUR 1,919,563
PROSEDUR 2,904,158
PROSEDUR 1,477,014
PROSEDUR 2,037,898
PROSEDUR 3,327,870
PROSEDUR 7,734,279
PROSEDUR 12,625,137
PROSEDUR 7,684,530
PROSEDUR 7,684,530
PROSEDUR 26,686,595
PROSEDUR 10,720,427
PROSEDUR 8,907,245

PROSEDUR 6,835,899

PROSEDUR 23,138,357
PROSEDUR 2,095,737
PROSEDUR 10,521,431
PROSEDUR 26,686,595
PROSEDUR 26,686,595
PROSEDUR 6,404,097
PROSEDUR 11,201,978
PROSEDUR 10,054,611
PROSEDUR 2,730,641

PROSEDUR 1,581,946

* 1,921,012
PROSEDUR 10,060,045
PROSEDUR 7,984,473
PROSEDUR 18,982,021
* 1,153,163
PROSEDUR 8,233,460
PROSEDUR 4,366,199

PROSEDUR 21,705,899
PROSEDUR 28,108,547
PROSEDUR 17,257,590
PROSEDUR 9,649,857
PROSEDUR 10,828,015
PROSEDUR 10,135,393
PROSEDUR 5,697,830
PROSEDUR 9,356,555
PROSEDUR 15,155,333
PROSEDUR 11,801,984
PROSEDUR 13,078,312
PROSEDUR 11,227,577
PROSEDUR 10,520,102
PROSEDUR 14,123,524
PROSEDUR 15,693,274
PROSEDUR 12,625,137
PROSEDUR 6,404,097
PROSEDUR 7,684,530
PROSEDUR 10,720,427
PROSEDUR 7,890,409
PROSEDUR 8,378,601
PROSEDUR 8,378,601
PROSEDUR 8,378,601
PROSEDUR 8,378,601
PROSEDUR 8,378,601
PROSEDUR 8,378,601
PROSEDUR 12,625,137
PROSEDUR 21,705,899
PROSEDUR 23,876,864
PROSEDUR 8,907,245
PROSEDUR 9,979,263
PROSEDUR 7,422,382
PROSEDUR 8,907,245
PROSEDUR 9,979,263
PROSEDUR 7,796,224
PROSEDUR 1,537,510
PROSEDUR 1,602,111
PROSEDUR 1,440,789
PROSEDUR 1,729,865
PROSEDUR 7,890,409
PROSEDUR 9,356,555
PROSEDUR 7,890,409

PROSEDUR 7,797,673
PROSEDUR 10,520,102
PROSEDUR 9,922,873
PROSEDUR 7,796,224
PROSEDUR 7,890,409
PROSEDUR 7,890,409
PROSEDUR 9,273,238
PROSEDUR 8,378,601
PROSEDUR 6,835,899
PROSEDUR 8,316,777
PROSEDUR 8,378,601
PROSEDUR 8,233,460
PROSEDUR 7,890,409
PROSEDUR 2,099,843
PROSEDUR 2,305,601
PROSEDUR 2,467,043
PROSEDUR 2,017,733
PROSEDUR 960,566
PROSEDUR 8,378,601
PROSEDUR 7,796,224

PROSEDUR 9,023,044

PROSEDUR 9,273,238

PROSEDUR 7,684,530
PROSEDUR 8,690,740
PROSEDUR 8,690,740
PROSEDUR 8,690,740
PROSEDUR 14,123,524

PROSEDUR 8,690,740
PROSEDUR 8,312,672
PROSEDUR 17,049,176
PROSEDUR 17,257,590
PROSEDUR 7,684,530
PROSEDUR 8,907,245
PROSEDUR 9,979,263
PROSEDUR 7,890,409
PROSEDUR 7,890,409
PROSEDUR 5,696,623
PROSEDUR 6,404,097
PROSEDUR 7,559,433
PROSEDUR 5,595,676
PROSEDUR 6,861,498
PROSEDUR 7,890,409
PROSEDUR 8,907,245
PROSEDUR 7,692,620
PROSEDUR 5,696,623
PROSEDUR 8,982,593
PROSEDUR 5,696,623
PROSEDUR 17,257,590
PROSEDUR 1,421,952
PROSEDUR 1,771,644
PROSEDUR 5,352,244
PROSEDUR 7,796,224
PROSEDUR 18,712,990
PROSEDUR 17,257,590
PROSEDUR 17,257,590
PROSEDUR 7,422,382
PROSEDUR 17,257,590
PROSEDUR 9,834,122
PROSEDUR 7,890,409
PROSEDUR 1,622,276
PROSEDUR 2,099,843
PROSEDUR 1,771,644
PROSEDUR 3,767,762
PROSEDUR 5,696,623
PROSEDUR 1,622,276
PROSEDUR 1,622,276
PROSEDUR 1,421,952
PROSEDUR 1,421,952
PROSEDUR 5,738,282
PROSEDUR 1,771,644
PROSEDUR 5,595,676
PROSEDUR 3,767,762
PROSEDUR 5,696,623
PROSEDUR 2,008,314
PROSEDUR 6,835,899
PROSEDUR 5,595,676
PROSEDUR 4,726,759
PROSEDUR 14,123,524
PROSEDUR 21,705,899
PROSEDUR 7,984,473
PROSEDUR 12,625,137
PROSEDUR 10,828,015
PROSEDUR 6,861,498
PROSEDUR 6,725,534
PROSEDUR 4,366,199
PROSEDUR 10,134,558
PROSEDUR 9,925,529
PROSEDUR 9,834,122
PROSEDUR 10,054,611
PROSEDUR 9,356,555
PROSEDUR 12,625,137
PROSEDUR 10,428,574
PROSEDUR 9,356,555
PROSEDUR 8,907,245
PROSEDUR 9,356,555
PROSEDUR 10,428,574
PROSEDUR 9,356,555
PROSEDUR 5,486,759
PROSEDUR 10,054,611
PROSEDUR 9,356,555
PROSEDUR 6,861,498

PROSEDUR 8,692,068

PROSEDUR 8,907,245
PROSEDUR 6,835,899
PROSEDUR 8,907,245
PROSEDUR 8,907,245
PROSEDUR 8,907,245

PROSEDUR 8,907,245
PROSEDUR 11,801,984
PROSEDUR 18,982,021
PROSEDUR 17,257,590
PROSEDUR 18,982,021
PROSEDUR 11,801,984
PROSEDUR 8,233,460
PROSEDUR 5,064,376

PROSEDUR 8,233,460

PROSEDUR 8,233,460
PROSEDUR 12,625,137

PROSEDUR 4,366,199
PROSEDUR 6,835,899

PROSEDUR 8,233,460
PROSEDUR 4,366,199
PROSEDUR 5,837,780
PROSEDUR 8,233,460
PROSEDUR 5,837,780

PROSEDUR 10,520,102
PROSEDUR 12,625,137

PROSEDUR 10,520,102
PROSEDUR 11,801,984

PROSEDUR 12,625,137

PROSEDUR 7,796,224

PROSEDUR 9,356,555

PROSEDUR 10,054,611

PROSEDUR 10,428,574
PROSEDUR 12,625,137
PROSEDUR 15,693,274
PROSEDUR 15,693,274
PROSEDUR 7,684,530
PROSEDUR 7,684,530
PROSEDUR 8,233,460
PROSEDUR 7,734,279
PROSEDUR 5,486,759
PROSEDUR 6,835,899
PROSEDUR 5,595,676
PROSEDUR 1,372,082
PROSEDUR 5,837,780
PROSEDUR 7,485,534
PROSEDUR 5,064,376
PROSEDUR 5,064,376
PROSEDUR 4,746,924
PROSEDUR 10,428,574
PROSEDUR 13,078,312
PROSEDUR 7,684,530
PROSEDUR 4,866,708
PROSEDUR 25,661,549
PROSEDUR 14,969,619
PROSEDUR 8,732,399
PROSEDUR 9,835,450
PROSEDUR 4,054,302
PROSEDUR 8,907,245

PROSEDUR 10,728,517
PROSEDUR 11,476,442
PROSEDUR 14,969,619
PROSEDUR 14,969,619
PROSEDUR 11,476,442
PROSEDUR 19,509,819
PROSEDUR 23,556,635
PROSEDUR 12,225,575
PROSEDUR 10,728,517
PROSEDUR 10,728,517
PROSEDUR 9,835,450

PROSEDUR 5,738,282
PROSEDUR 1,186,490
PROSEDUR 10,728,517
PROSEDUR 4,740,283
PROSEDUR 9,231,458
PROSEDUR 15,718,752
PROSEDUR 11,726,636
PROSEDUR 14,221,694
PROSEDUR 13,223,695
PROSEDUR 9,356,555
PROSEDUR 9,356,555
PROSEDUR 11,476,442
PROSEDUR 12,625,137
PROSEDUR 8,732,399
PROSEDUR 2,286,764
PROSEDUR 4,990,356
PROSEDUR 3,432,802
PROSEDUR 8,732,399
PROSEDUR 9,356,555
PROSEDUR 2,972,744
PROSEDUR 4,366,199
PROSEDUR 10,728,517

PROSEDUR 9,231,458

PROSEDUR 10,728,517

PROSEDUR 5,539,165

PROSEDUR 3,432,802

PROSEDUR 8,732,399

PROSEDUR 8,233,460
PROSEDUR 8,907,245
PROSEDUR 18,982,021
PROSEDUR 4,081,109
PROSEDUR 11,715,769
PROSEDUR 9,730,518
PROSEDUR 9,231,458
PROSEDUR 7,684,530
PROSEDUR 7,684,530
PROSEDUR 12,625,137
PROSEDUR 15,693,274
PROSEDUR 18,982,021
PROSEDUR 8,919,440
PROSEDUR 5,837,780

PROSEDUR 9,231,458
PROSEDUR 11,726,636
PROSEDUR 5,064,376
PROSEDUR 7,734,279
PROSEDUR 3,513,463
PROSEDUR 791,033
PROSEDUR 1,871,142
PROSEDUR 6,835,899
PROSEDUR 2,099,843
PROSEDUR 5,064,376
PROSEDUR 1,771,644
PROSEDUR 8,732,399
PROSEDUR 2,495,299
PROSEDUR 9,356,555

PROSEDUR 6,835,899

PROSEDUR 5,064,376

PROSEDUR 2,008,314

PROSEDUR 4,740,283
PROSEDUR 8,982,593

PROSEDUR 10,828,015
PROSEDUR 7,235,340
PROSEDUR 8,233,460
PROSEDUR 9,231,458
PROSEDUR 9,356,555
PROSEDUR 7,684,530
PROSEDUR 10,728,517
PROSEDUR 6,237,341
PROSEDUR 1,372,082
PROSEDUR 11,801,984
PROSEDUR 9,356,555
PROSEDUR 11,201,978
PROSEDUR 9,231,458
PROSEDUR 9,231,458
PROSEDUR 4,366,199
PROSEDUR 8,732,399
PROSEDUR 5,837,780
PROSEDUR 1,771,644
PROSEDUR 4,081,109
PROSEDUR 4,081,109
PROSEDUR 8,907,245
PROSEDUR 13,223,695
PROSEDUR 8,907,245
PROSEDUR 6,835,899
PROSEDUR 8,233,460
PROSEDUR 6,835,899

PROSEDUR 6,835,899

PROSEDUR 6,736,401
PROSEDUR 2,099,843
PROSEDUR 5,064,376
PROSEDUR 2,640,440
PROSEDUR 5,837,780
PROSEDUR 12,674,886
PROSEDUR 9,356,555
PROSEDUR 4,366,199
PROSEDUR 12,225,575
PROSEDUR 7,684,530
PROSEDUR 6,835,899
PROSEDUR 7,984,473
PROSEDUR 8,732,399
PROSEDUR 4,081,109
PROSEDUR 5,837,780
PROSEDUR 7,684,530
PROSEDUR 5,837,780
PROSEDUR 3,169,084
PROSEDUR 1,771,644
PROSEDUR 9,356,555
PROSEDUR 6,835,899
PROSEDUR 7,684,530
PROSEDUR 9,356,555
PROSEDUR 6,835,899
PROSEDUR 1,771,644
PROSEDUR 8,732,399
PROSEDUR 7,692,620
PROSEDUR 6,835,899
PROSEDUR 8,233,460
PROSEDUR 6,835,899
PROSEDUR 8,907,245
PROSEDUR 5,447,636
PROSEDUR 4,640,664

PROSEDUR 4,640,664

PROSEDUR 1,622,276
PROSEDUR 2,495,299
PROSEDUR 3,361,439
PROSEDUR 4,542,494
PROSEDUR 3,493,418
PROSEDUR 6,835,899
PROSEDUR 4,081,109
PROSEDUR 1,771,644
PROSEDUR 7,734,279
PROSEDUR 8,907,245
PROSEDUR 9,730,518
PROSEDUR 9,730,518
PROSEDUR 9,730,518

PROSEDUR 12,625,137

PROSEDUR 10,728,517
PROSEDUR 10,728,517
PROSEDUR 18,982,021
PROSEDUR 17,257,590
PROSEDUR 21,705,899
PROSEDUR 10,927,634
PROSEDUR 4,740,283
PROSEDUR 2,270,704
PROSEDUR 5,837,780
PROSEDUR 4,740,283
PROSEDUR 5,837,780
PROSEDUR 7,734,279
PROSEDUR 550,862
PROSEDUR 791,758
PROSEDUR 2,910,920
PROSEDUR 3,742,163
PROSEDUR 316,244
PROSEDUR 4,541,045
PROSEDUR 8,732,399
PROSEDUR 10,478,323
PROSEDUR 10,828,015
PROSEDUR 7,684,530
PROSEDUR 12,973,501
PROSEDUR 11,476,442
PROSEDUR 8,233,460
PROSEDUR 4,542,494
PROSEDUR 4,542,494
PROSEDUR 2,352,693
PROSEDUR 12,625,137
PROSEDUR 7,796,224
PROSEDUR 3,493,418
PROSEDUR 2,640,440
PROSEDUR 7,485,534
PROSEDUR 6,835,899
PROSEDUR 8,369,303
PROSEDUR 8,369,303
PROSEDUR 8,369,303
PROSEDUR 8,369,303
PROSEDUR 8,369,303
PROSEDUR 8,233,460
PROSEDUR 8,369,303
PROSEDUR 8,369,303
PROSEDUR 8,369,303
PROSEDUR 8,369,303
PROSEDUR 4,740,283
PROSEDUR 9,481,652
PROSEDUR 8,324,867
PROSEDUR 1,919,563
PROSEDUR 7,422,382

PROSEDUR 10,428,574

PROSEDUR 11,801,984

PROSEDUR 23,138,357
PROSEDUR 5,064,376

PROSEDUR 26,686,595
PROSEDUR 23,138,357
PROSEDUR 30,570,036
PROSEDUR 4,184,712
PROSEDUR 11,201,978
PROSEDUR 26,686,595
PROSEDUR 30,570,036
PROSEDUR 15,155,333
PROSEDUR 26,686,595
PROSEDUR 11,801,984

PROSEDUR 8,919,440
PROSEDUR 5,486,759
PROSEDUR 4,055,510
PROSEDUR 3,742,163
PROSEDUR 26,047,707

PROSEDUR 4,730,864
PROSEDUR 7,406,201
PROSEDUR 4,054,302
PROSEDUR 5,915,784
PROSEDUR 3,513,463
PROSEDUR 4,730,864
PROSEDUR 5,064,376
PROSEDUR 5,915,784

PROSEDUR 3,432,802
PROSEDUR 5,837,780
PROSEDUR 5,837,780
PROSEDUR 10,054,611
PROSEDUR 3,432,802
PROSEDUR 1,919,563
PROSEDUR 1,746,045
PROSEDUR 2,730,641

PROSEDUR 6,324,764
PROSEDUR 9,649,857
PROSEDUR 3,767,762
PROSEDUR 7,684,530
PROSEDUR 3,169,084
PROSEDUR 8,919,440

PROSEDUR 6,835,899

PROSEDUR 12,625,137

PROSEDUR 5,486,759
PROSEDUR 6,324,764
PROSEDUR 9,356,555
PROSEDUR 3,432,802
PROSEDUR 5,064,376
PROSEDUR 10,828,015
PROSEDUR 5,837,780
PROSEDUR 8,324,867
PROSEDUR 5,486,759
PROSEDUR 8,233,460
PROSEDUR 4,184,712
PROSEDUR 6,835,899
PROSEDUR 6,835,899
PROSEDUR 8,233,460
PROSEDUR 11,730,621
PROSEDUR 7,406,201
PROSEDUR 30,570,036
PROSEDUR 6,835,899
PROSEDUR 8,919,440
PROSEDUR 2,641,889
PROSEDUR 8,324,867
PROSEDUR 5,486,759
PROSEDUR 15,693,274
PROSEDUR 10,892,616
PROSEDUR 2,730,641
PROSEDUR 8,312,672

PROSEDUR 10,054,611

PROSEDUR 2,730,641

PROSEDUR 6,324,764
PROSEDUR 1,919,563

PROSEDUR 3,432,802

PROSEDUR 6,324,764
PROSEDUR 9,649,857
PROSEDUR 6,324,764

PROSEDUR 8,919,440

PROSEDUR 12,625,137

PROSEDUR 10,892,616
PROSEDUR 6,324,764

PROSEDUR 12,625,137

PROSEDUR 8,919,440
PROSEDUR 8,233,460
PROSEDUR 5,486,759

PROSEDUR 8,887,200
PROSEDUR 3,767,762
PROSEDUR 8,919,440
PROSEDUR 13,676,990
PROSEDUR 5,486,759
PROSEDUR 8,919,440
PROSEDUR 11,297,491
PROSEDUR 3,432,802
PROSEDUR 9,356,555
PROSEDUR 8,919,440
PROSEDUR 12,625,137
PROSEDUR 3,767,762
PROSEDUR 9,356,555
PROSEDUR 15,149,778

PROSEDUR 12,625,137
PROSEDUR 15,693,274
PROSEDUR 13,676,990
PROSEDUR 22,779,246

PROSEDUR 17,263,024

PROSEDUR 6,584,377
PROSEDUR 12,514,892
PROSEDUR 14,519,101
PROSEDUR 11,227,577
PROSEDUR 6,835,899
PROSEDUR 10,428,574
PROSEDUR 12,625,137
PROSEDUR 15,693,274
PROSEDUR 17,263,024

PROSEDUR 15,693,274

PROSEDUR 26,047,707

PROSEDUR 14,519,101

PROSEDUR 28,651,922

PROSEDUR 22,779,246
PROSEDUR 20,707,780

PROSEDUR 20,707,780

PROSEDUR 12,514,892

PROSEDUR 4,184,712
PROSEDUR 7,684,530
PROSEDUR 6,835,899
PROSEDUR 5,486,759
PROSEDUR 4,184,712
PROSEDUR 4,184,712
PROSEDUR 7,684,530
PROSEDUR 8,324,867
PROSEDUR 8,233,460
PROSEDUR 10,828,015
PROSEDUR 12,135,496
PROSEDUR 4,730,864
PROSEDUR 10,428,574
PROSEDUR 15,693,274
PROSEDUR 17,000,634
PROSEDUR 18,982,021
PROSEDUR 12,785,252
PROSEDUR 17,000,634
PROSEDUR 18,982,021
PROSEDUR 12,785,252
PROSEDUR 18,982,021
PROSEDUR 15,693,274
PROSEDUR 10,428,574
PROSEDUR 18,982,021

PROSEDUR 13,676,990
PROSEDUR 10,135,393
PROSEDUR 26,047,707
PROSEDUR 30,662,772
PROSEDUR 20,584,011
PROSEDUR 8,907,245
PROSEDUR 15,693,274
PROSEDUR 18,982,021
PROSEDUR 10,892,616
PROSEDUR 12,135,496
PROSEDUR 15,693,274
PROSEDUR 18,982,021
PROSEDUR 7,406,201
PROSEDUR 1,421,952
PROSEDUR 2,730,641
PROSEDUR 1,421,952
* 769,298
PROSEDUR 1,653,188
PROSEDUR 7,406,201
PROSEDUR 11,801,984

PROSEDUR 7,406,201
PROSEDUR 12,785,252
PROSEDUR 4,184,712
PROSEDUR 1,653,188
PROSEDUR 3,169,084
PROSEDUR 1,746,045
PROSEDUR 3,169,084
PROSEDUR 3,767,762
PROSEDUR 5,486,759
PROSEDUR 9,356,555
PROSEDUR 8,324,867
PROSEDUR 8,324,867
PROSEDUR 13,078,312
PROSEDUR 6,324,764
PROSEDUR 3,767,762
PROSEDUR 8,324,867
PROSEDUR 7,406,201
PROSEDUR 8,919,440
PROSEDUR 4,730,864
PROSEDUR 9,356,555
PROSEDUR 3,169,084
PROSEDUR 5,486,759
PROSEDUR 2,730,641
PROSEDUR 7,684,530
PROSEDUR 6,324,764
PROSEDUR 2,099,843
PROSEDUR 3,361,439
PROSEDUR 4,184,712
PROSEDUR 4,184,712
PROSEDUR 3,169,084
PROSEDUR 3,169,084
PROSEDUR 9,356,555
PROSEDUR 3,742,163
PROSEDUR 8,233,460
PROSEDUR 8,324,867
PROSEDUR 4,184,712
PROSEDUR 6,835,899
PROSEDUR 8,233,460
PROSEDUR 1,421,952

* 615,101
PROSEDUR 2,099,843
PROSEDUR 23,138,357
PROSEDUR 4,730,864
PROSEDUR 4,730,864
PROSEDUR 7,406,201
PROSEDUR 30,570,036
PROSEDUR 4,184,712
PROSEDUR 9,649,857
PROSEDUR 26,686,595
PROSEDUR 30,570,036
PROSEDUR 4,184,712
PROSEDUR 18,982,021
PROSEDUR 10,135,393

PROSEDUR 10,892,616

PROSEDUR 20,707,780
PROSEDUR 10,135,393
PROSEDUR 18,982,021
PROSEDUR 7,684,530
PROSEDUR 22,779,246
PROSEDUR 22,779,246

PROSEDUR 15,155,333
PROSEDUR 1,351,917
PROSEDUR 3,362,767
PROSEDUR 5,915,784
PROSEDUR 15,155,333

PROSEDUR 4,055,510
PROSEDUR 6,654,291

PROSEDUR 15,155,333
PROSEDUR 5,405,978
PROSEDUR 15,155,333
PROSEDUR 3,327,870
PROSEDUR 4,055,510
PROSEDUR 15,155,333

PROSEDUR 8,109,691
PROSEDUR 26,686,595
PROSEDUR 15,155,333
PROSEDUR 6,654,291
PROSEDUR 26,686,595
PROSEDUR 8,109,691

PROSEDUR 8,774,057
PROSEDUR 5,405,978
PROSEDUR 30,570,036
PROSEDUR 8,795,672
PROSEDUR 10,811,955
PROSEDUR 17,257,590
PROSEDUR 26,686,595
PROSEDUR 3,743,492
PROSEDUR 1,421,952
PROSEDUR 1,622,276
PROSEDUR 2,730,641

PROSEDUR 1,421,952
PROSEDUR 4,726,759
PROSEDUR 1,421,952
PROSEDUR 3,327,870

PROSEDUR 3,169,084

PROSEDUR 791,033
PROSEDUR 554,243
PROSEDUR 4,366,199
PROSEDUR 5,595,676
PROSEDUR 7,684,530
PROSEDUR 1,421,952
PROSEDUR 5,915,784
PROSEDUR 7,734,279

PROSEDUR 2,099,843
PROSEDUR 2,270,704
PROSEDUR 1,771,644
PROSEDUR 4,366,199
PROSEDUR 3,767,762

PROSEDUR 3,169,084
PROSEDUR 3,169,084
PROSEDUR 10,828,015
PROSEDUR 2,730,641
PROSEDUR 4,366,199
PROSEDUR 470,804
PROSEDUR 2,270,704
PROSEDUR 1,421,952

PROSEDUR 4,366,199

PROSEDUR 15,155,333

PROSEDUR 3,493,418

PROSEDUR 23,138,357

PROSEDUR 4,366,199
PROSEDUR 26,686,595
PROSEDUR 9,356,555

PROSEDUR 5,595,676
PROSEDUR 7,796,224

PROSEDUR 1,622,276

PROSEDUR 14,646,734
PROSEDUR 7,422,382
PROSEDUR 4,184,712
PROSEDUR 5,064,376
PROSEDUR 23,138,357
PROSEDUR 26,686,595
PROSEDUR 30,570,036
PROSEDUR 5,915,784
PROSEDUR 7,890,409
PROSEDUR 7,684,530
PROSEDUR 10,428,574

PROSEDUR 7,684,530
* 4,664,090
PROSEDUR 30,570,036
PROSEDUR 5,595,676
PROSEDUR 5,064,376
PROSEDUR 2,972,744
PROSEDUR 5,876,661
PROSEDUR 3,567,800
PROSEDUR 1,729,865
PROSEDUR 1,919,563
PROSEDUR 316,244
PROSEDUR 1,958,927
PROSEDUR 2,742,474
PROSEDUR 791,033
PROSEDUR 1,076,124
PROSEDUR 791,033

PROSEDUR 395,577
PROSEDUR 434,070
PROSEDUR 538,062
PROSEDUR 2,099,843
PROSEDUR 316,244
PROSEDUR 13,884,077
PROSEDUR 474,910
PROSEDUR 653,016
PROSEDUR 316,244
PROSEDUR 316,244
PROSEDUR 3,275,465
PROSEDUR 2,270,704
PROSEDUR 3,540,390
PROSEDUR 1,771,644
PROSEDUR 1,421,952
PROSEDUR 2,730,641
PROSEDUR 2,270,704

PROSEDUR 158,907
PROSEDUR 316,244
PROSEDUR 791,033
PROSEDUR 618,844
PROSEDUR 1,372,082
PROSEDUR 6,404,097
PROSEDUR 7,890,409
PROSEDUR 1,622,276
PROSEDUR 3,513,463
PROSEDUR 2,099,843
PROSEDUR 1,351,917
PROSEDUR 949,578
PROSEDUR 2,730,641
PROSEDUR 9,040,553

PROSEDUR 3,567,800
PROSEDUR 4,740,283
PROSEDUR 316,244
PROSEDUR 550,862
PROSEDUR 316,244
PROSEDUR 3,169,084
PROSEDUR 791,033
PROSEDUR 1,186,490
PROSEDUR 1,871,142
PROSEDUR 1,144,831
PROSEDUR 9,730,518

PROSEDUR 7,684,530

PROSEDUR 5,064,376

PROSEDUR 7,911,902
PROSEDUR 6,324,764
PROSEDUR 3,361,439
PROSEDUR 4,366,199

PROSEDUR 624,278

PROSEDUR 4,747,407
PROSEDUR 236,791

PROSEDUR 189,819
PROSEDUR 1,958,927
PROSEDUR 7,911,902
PROSEDUR 295,958
PROSEDUR 1,166,083
PROSEDUR 9,949,800
PROSEDUR 13,991,906
PROSEDUR 13,991,906
PROSEDUR 18,655,875
PROSEDUR 13,991,906
PROSEDUR 13,991,906
PROSEDUR 6,218,625
PROSEDUR 9,949,800
PROSEDUR 6,218,625
PROSEDUR 12,437,250
PROSEDUR 18,655,875
PROSEDUR 18,655,875
PROSEDUR 87,060,750
PROSEDUR 1,865,588
PROSEDUR 932,794
PROSEDUR 9,281,207

PROSEDUR 9,480,445
PROSEDUR 14,971,068
PROSEDUR 13,671,677
PROSEDUR 16,738,486
PROSEDUR 13,671,677
PROSEDUR 16,466,798
PROSEDUR 16,738,486
PROSEDUR 1,492,470
PROSEDUR 2,487,450
PROSEDUR 3,731,175
PROSEDUR 4,974,900
PROSEDUR 9,056,250
PROSEDUR 12,785,252

PROSEDUR 58,695
PROSEDUR 480,207
PROSEDUR 167,486
PROSEDUR 320,229
PROSEDUR 407,453
PROSEDUR 320,229
PROSEDUR 61,016
PROSEDUR Variabel
PROSEDUR 121,895
PROSEDUR 121,895
PROSEDUR 370,461
PROSEDUR 211,712
PROSEDUR 76,304

PROSEDUR 1,114,386
PROSEDUR 118,346
PROSEDUR 68,250
PROSEDUR 894,212
PROSEDUR 1,788,287
PROSEDUR 894,212
PROSEDUR 1,788,287
PROSEDUR 1,788,287
PROSEDUR Variabel
PROSEDUR 118,346
PROSEDUR 118,346
PROSEDUR 118,346
PROSEDUR 3,801,389
PROSEDUR 118,346
PROSEDUR 456,183
PROSEDUR 608,244
PROSEDUR 912,366
PROSEDUR 1,064,427
PROSEDUR 2,280,915
PROSEDUR 118,346
PROSEDUR 311,084
PROSEDUR 4,113,428
PROSEDUR 311,084
PROSEDUR 559,923
PROSEDUR 195,195
PROSEDUR 373,328
PROSEDUR 466,557
PROSEDUR 475,020
PROSEDUR 254,573
PROSEDUR 311,084
PROSEDUR 373,328
PROSEDUR 59,241
PROSEDUR 466,557
PROSEDUR 71,117
PROSEDUR 228,228
PROSEDUR 304,122
PROSEDUR 304,122
PROSEDUR 380,153
PROSEDUR 532,214
PROSEDUR 304,122
PROSEDUR 304,122
PROSEDUR 380,153
PROSEDUR 380,153
PROSEDUR 456,183
PROSEDUR 380,153
PROSEDUR 380,153
PROSEDUR 532,214
PROSEDUR 154,791
PROSEDUR 4,625,985
PROSEDUR 462,872
PROSEDUR 385,476
PROSEDUR 230,822
PROSEDUR 154,791
PROSEDUR 1,541,768
PROSEDUR 1,541,768
PROSEDUR 1,541,768
PROSEDUR 3,084,491
PROSEDUR 385,476
PROSEDUR 770,952
PROSEDUR 684,275
PROSEDUR 3,041,084
PROSEDUR 1,292,519
PROSEDUR 304,122
PROSEDUR 3,041,084
PROSEDUR 684,275
PROSEDUR 532,214
PROSEDUR 1,520,610
PROSEDUR 2,280,915
PROSEDUR 3,041,084
PROSEDUR 3,041,084
PROSEDUR 912,366
PROSEDUR 456,183
PROSEDUR 6,082,167
PROSEDUR 1,292,519
PROSEDUR 3,041,084
PROSEDUR 288,561
PROSEDUR 458,913
PROSEDUR 1,573,163
PROSEDUR 3,932,429
PROSEDUR 247,202
PROSEDUR 556,101
PROSEDUR 5,189,457
PROSEDUR 73,983
PROSEDUR 118,346
PROSEDUR 771,225
PROSEDUR 118,346
PROSEDUR 444,717
PROSEDUR 532,214
PROSEDUR 1,115,615
PROSEDUR 5,552,684
PROSEDUR 268,496
PROSEDUR 536,855
PROSEDUR 179,088
PROSEDUR 269,315
PROSEDUR 2,313,402
PROSEDUR 327,737
PROSEDUR 262,353
PROSEDUR 88,725
PROSEDUR 12,745,142
PROSEDUR 118,346
PROSEDUR 536,855
KUNJUNGAN 131,313
PROSEDUR 395,577
PROSEDUR 447,174
PROSEDUR 447,174
PROSEDUR 447,311
PROSEDUR 1,788,287
PROSEDUR 797,297
PROSEDUR 327,737
PROSEDUR 73,983
PROSEDUR 197,789
PROSEDUR 716,352
PROSEDUR 716,352
PROSEDUR 8,943,890
PROSEDUR 716,352
PROSEDUR 8,943,890
PROSEDUR 8,943,890
PROSEDUR 8,943,890
PROSEDUR 536,855
PROSEDUR 118,346
PROSEDUR 133,907
PROSEDUR 267,677
PROSEDUR 89,817
PROSEDUR 179,634
PROSEDUR 447,174
PROSEDUR 73,983
PROSEDUR 141,960
PROSEDUR 141,960
PROSEDUR 431,886
PROSEDUR 246,929
PROSEDUR 7,710,749
PROSEDUR 447,174
PROSEDUR 118,346
PROSEDUR 262,353
PROSEDUR 228,092
PROSEDUR 88,725
PROSEDUR 231,504
PROSEDUR 439,394
PROSEDUR 379,607
PROSEDUR 7,029,750
PROSEDUR 14,059,500
PROSEDUR 177,450
PROSEDUR 106,050
PROSEDUR 106,050
PROSEDUR 106,050
PROSEDUR 130,200
PROSEDUR 106,050
PROSEDUR 106,050
PROCEDURES - SPECIA 117,600
KUNJUNGAN 424,242
PROSEDUR 208,950
PROSEDUR 121,212
PROSEDUR 294,000
PROSEDUR 323,400
PROSEDUR 883,050
PROSEDUR 323,400
PROSEDUR 588,000
PROSEDUR 588,000
PROSEDUR 411,600
PROSEDUR 899,000

PROSEDUR 1,136,000

PROSEDUR 352,800

PROSEDUR 203,826
PROSEDUR 407,531
PROSEDUR Variabel
PROSEDUR 475,393
PROSEDUR 475,393
PROSEDUR 679,098
PROSEDUR 1,018,647

PROSEDUR 1,018,647
PROSEDUR Variabel
PROSEDUR 1,018,647
PROSEDUR 1,018,647
PROSEDUR 2,716,392

PROSEDUR 3,395,369

PROSEDUR 2,037,294
PROSEDUR 284,981
PROSEDUR 475,393
PROSEDUR 679,098

PROSEDUR 339,549
PROSEDUR 271,688
PROSEDUR 135,844
PROSEDUR 2,037,294
PROSEDUR 5,093,114
PROSEDUR 135,844
PROSEDUR 475,393

PROSEDUR 679,098

PROSEDUR Variabel
PROSEDUR 6,790,739
PROSEDUR 13,581,477
PROSEDUR 6,790,739
PROSEDUR 13,581,477
PROSEDUR 7,469,837
PROSEDUR 14,939,673
PROSEDUR 4,753,565
PROSEDUR 5,432,663
PROSEDUR 6,790,739
PROSEDUR 4,074,467
PROSEDUR 4,074,467
PROSEDUR 4,753,565
PROSEDUR 4,753,565
PROSEDUR Variabel
PROSEDUR 3,395,369
PROSEDUR 2,716,392
PROSEDUR 814,942
PROSEDUR 814,942
PROSEDUR 679,098
PROSEDUR 679,098
PROSEDUR 950,786
PROSEDUR 5,432,663
PROSEDUR 5,432,663
PROSEDUR 2,037,294
PROSEDUR 1,358,196
PROSEDUR 271,688
PROSEDUR 475,393

SET 104,748
SET 174,631
SET 174,631
SET 104,748
SET 104,748
SET 174,631
SET 104,748
SET 174,631
SET 174,631
SET 174,631
SET 131,087
PIECE 69,883
SET 104,748
SET 261,870
PIECE 139,766
PIECE 178,133
PIECE 174,631
PIECE 139,766
PIECE 139,766
PIECE 139,766
PIECE 139,766
PIECE 139,766
PIECE 139,766
PIECE 139,766
PIECE 139,766
PIECE 139,766
PIECE 139,766
PIECE 139,766
PIECE 174,631
SET 523,740
PIECE 139,766
SET 174,631
SET 174,631
SET 506,384
SET 218,327
SET 497,705
SET 174,631
SET 87,392
SET 87,392
SET 104,748
SET 8,831
SET 52,374
SET 69,883
SET 69,883
SET 122,257
SET 87,392
SET 139,766
SET 122,257
SET 35,018
SET 139,766
SET 26,339
SET 174,631
SET 52,374
SET 26,339
SET 21,011
SET 17,509
SET 52,374
SET 35,018
SET 69,883
SET 35,018
SET 21,011
SET 17,509
SET 15,073
SET 21,011
SET 488,875
SET 488,875
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 261,870
SET 261,870
SET 261,870
SET 261,870
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 139,766
SET 139,766
SET 174,631
SET 139,766
SET 174,631
SET 139,766
SET 139,766
SET 104,748
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 174,631
SET 184,984

% 16,459
% 27,431
% 38,259
* 196,560
* 262,080
* 627,900
* 1,569,750
* 608,265
* 491,400
* 577,500
* 491,400