Laboratorium Diagnostik Hayam Wuruk

Jl. Hayam Wuruk No. 53, Telp. (0354) 681123, 682110 Fax. Bagian Patologi Anatomi (0341) 403782
Layanan Konsumen 08883338731, 081334263813

Tagihan Pemeriksaan Patologi Anatomi Bedah Sentral RS. Muhammadiyah

Periode Maret 2023

Sediaan Reg Nama Nama Diagnosa Jumlah

No.
diterima PA penderita dokter Klinis (Rp)
1 01/04/23 K.230615 Tn. Parnyoto Dr. Ardian Bayu, SpU BPH 280,000
2 K.230616 Ny. Siti Zaenab Dr. Ardian Bayu, SpU Cystitis 170,000
3 K.230617 Ny. Wijiati Dr. Heru T., SpoG AUB 210,000
4 K.230618 Ny. Anggun Suastika Dr. Nikmah E., SpOG AUB 170,000
5 K.230619 Ny. Nurul Hidayah Dr. Fitrah K., SpB Tumor Mamma 210,000
6 K.230620 Ny. Sunarti Dr. Fitrah K., SpB Tumor Phylloides 280,000
7 05/04/23 K.230639 Ny. Siti Marokah Dr. Heru T., SpoG Kista Ovarii (Kista Coklat) 280,000
8 K.230640 Tn. Abdul Salam Dr. Ardian Bayu, SpU BPH 280,000
9 K.230641 Tn. Suprianto Dr. Ardian Bayu, SpU BPH 280,000
10 K.230642 Tn. M. Sarwan Dr. Ardian Bayu, SpU BPH 280,000
11 K.230643 Ny. Nila Rosita D. Dr. S. Vika, SpOG DUB 170,000
12 K.230644 Ny. Boniyem Dr. S. Vika, SpOG Endometrium Ca 170,000
13 K.230645 Ny. Lilik Isnaini Dr. S. Vika, SpOG DUB 170,000
14 K.230646 Tn. Wagiman Dr. Ardian Bayu, SpU BPH 280,000
15 08/04/23 K.230664 Ny. Nur Kasanah Dr. Nikmah E., SpOG Massa Labia 210,000
16 K.230665 Ny. Kayatun Dr. Fitrah K., SpB Susp Tumor Mamma 210,000
17 K.230666 Ny. Munawaroh Dr. Fitrah K., SpB Susp Tumor Mamma 210,000
18 12/04/23 K.230673 Ny. Amelia Dr. Fitrah K., SpB Lymphadenopaty Femur 210,000
19 K.230674 Ny. Ariani Ningsih Dr. Ardian Bayu, SpU Cystitis 170,000
20 K.230675 Ny. Widarti Dr. Ardian Bayu, SpU BPH 280,000
21 K.230676 Tn. Parji Dr. Ardian Bayu, SpU BPH 280,000
22 K.230677 Tn. Kusno Dr. Ardian Bayu, SpU BPH 280,000
23 K.230678 Tn. Ponidi Dr. Ardian Bayu, SpU BPH 280,000
24 K.230679 Tn. M. Lukman Hakim Dr. Ardian Bayu, SpU ISK 170,000
25 K.230680 Tn. Misdi Dr. Ardian Bayu, SpU BPH 280,000
26 K.230681 Ny. Dewi Anggarwati Dr. S. Vika, SpOG Adenomyosis (5 blok) 340,000
27 K.230682 Tn. Subandi Dr. Fitrah K., SpB Susp Ca Recti 210,000
28 15/04/23 K.230699 Tn. Mukarom Dr. Wahyu Aji, SpOT Soft Tissue Tumor 210,000
29 K.230700 Tn. Lavi Budiawan Dr. Fitrah K., SpB Granuloma 210,000
30 K.230701 Nn. Riesna Fanania Dr. Darwan, SpM Lipoma Palpebra 170,000
31 26/04/23 K.230720 Tn. Ilyas Dr. Ardian Bayu, SpU BPH 280,000
32 K.230721 Tn. Sya'ya Dr. Ardian Bayu, SpU BPH 280,000
33 K.230722 Ny. Siti Juwariyah Dr. Heru T., SpoG Kista Ovarii (6 blok) 400,000
34 K.230723 Ny. Fina Dwiyanti Dr. Heru T., SpoG Kista Ovarii 280,000
35 K.230724 Ny. Elyn Novita L. Dr. Edy S., SpB Abscess Mamma 170,000
36 K.230725 Ny. Muhibatul Mila Dr. Nikmah E., SpOG Myoma Uteri 280,000
37 K.230726 Ny. Siti Umayyatus Dr. Nikmah E., SpOG Kista Tuba 280,000
8,920,000

892000
8,028,000
Malang,

Nonny Yogha Pupita. SE,Ak

1
2
3
4
5
6
7
 Laboratorium Diagnostik Hayam Wuruk
Jl. Hayam Wuruk No. 53, Telp. (0354) 681123, 682110 Fax. Bagian Patologi Anatomi (0341) 403782
Layanan Konsumen 08883338731, 081334263813

Tagihan Pemeriksaan Patologi Anatomi RSI Aisyiyah Nganjuk Periode April 2023

Sediaan Reg Nama Nama Diagnosa Jumlah

No.
diterima PA penderita dokter Klinis (Rp)
1 01/04/23 K.230606 Tarmono Dr. Puruhito, SpU Susp Ca Buli 285,000
2 05/04/23 K.230636 Mujiono Dr. Puruhito, SpU Susp Ca Buli 285,000
3 08/04/23 K.230656 Ahmat Nuril Dr. Dwanda Y., SpB Cholesistitis 285,000
4 K.230657 Marijo Dr. Puruhito, SpU Susp Ca Penis 175,000
5 K.230658 Yadi Dr. Puruhito, SpU BPH 285,000
6 26/04/23 K.230710 Warijo Dr. Puruhito, SpU BPH 285,000
7 K.230711 Basiran Dr. Puruhito, SpU BPH 285,000
1,885,000
188,500
1,696,500
Malang,

Nonny Yogha Pupita. SE,Ak

 Page 3

Tagihan Pemeriksaan Patologi Anatomi Bedah Sentral RS. Bhayangkara Nganjuk

Periode April 2023

Sediaan Reg Nama Nama Diagnosa Jumlah

No.
diterima PA penderita dokter Klinis (Rp)
1 01/04/23 K.230611 Ny. Nana Susiana Dr. Elyani, SpOG Cystoma Ovarii 280,000
2 K.230612 Ny. Nining Kurnia Dr. Sonia R., SpOG Kista Bartholine 280,000
3 K.230613 Ny. Denti Liantina Dr. Gazali R., SpOG Kista Terplintir 280,000
4 K.230614 Tn. Parso Santoso Dr. Rahmad K., SpU BPH 280,000
5 05/04/23 K.230638 Ny. Munik Dr. Elyani, SpOG PUA DD: Malignancy 165,000
6 08/04/23 K.230662 Ny. Dilem Dr. Elyani, SpOG Susp Ca cx 165,000
7 K.230663 Tn. Pargi Dr. Rahmad K., SpU BPH 280,000
8 26/04/23 K.230718 Ny. Desy Alanuarita B Dr. Elyani, SpOG KET 280,000
9 K.230719 Tn. Saelan Dr. Rahmad K., SpU BPH 280,000
2,290,000

2,290,000

No. Sediaan Reg Nama Nama Diagnosa Jumlah

diterima PA penderita dokter Klinis
1 10/12/22 K.222016 Ny. Karni Rahayu Dr. Sonia R., SpOG Pap Smear 0
0

2,290,000

Sediaan Reg Nama Nama Diagnosa Jumlah

No.
diterima PA penderita dokter Klinis (Rp)

1 04/11/15 Ny. Nita Dwi Jayanti Dr. Elyani,SpOG Pap Smear Kolektif 45,000
2 Ny. Diana M Dr. Elyani,SpOG Pap Smear Kolektif 45,000
3 Ny. Sri Sunarsih Dr. Elyani,SpOG Pap Smear Kolektif 45,000
4 Ny. Tanti S Dr. Elyani,SpOG Pap Smear Kolektif 45,000
5 Ny. Dewi E Dr. Elyani,SpOG Pap Smear Kolektif 45,000
6 Ny. Sumini Dr. Elyani,SpOG Pap Smear Kolektif 45,000
7 Ny. Tumini Dr. Elyani,SpOG Pap Smear Kolektif 45,000
8 Ny. Lukarnani Dr. Elyani,SpOG Pap Smear Kolektif 45,000
9 Ny. Dyah Yuni P Dr. Elyani,SpOG Pap Smear Kolektif 45,000
10 Ny. Sumesri Dr. Elyani,SpOG Pap Smear Kolektif 45,000
11 Ny. Parasiningsih Dr. Elyani,SpOG Pap Smear Kolektif 45,000
12 Ny. Lilis M. Dr. Elyani,SpOG Pap Smear Kolektif 45,000
13 Ny. Sri Wahyuni Dr. Elyani,SpOG Pap Smear Kolektif 45,000
14 Ny. Katini Dr. Elyani,SpOG Pap Smear Kolektif 45,000
15 Ny. Budi U Dr. Elyani,SpOG Pap Smear Kolektif 45,000
16 Ny. Yatik Dr. Elyani,SpOG Pap Smear Kolektif 45,000
17 Ny. Sri Yuliningsih Dr. Elyani,SpOG Pap Smear Kolektif 45,000
18 Ny. Susanti Dr. Elyani,SpOG Pap Smear Kolektif 45,000
19 Ny. Sunarsih Dr. Elyani,SpOG Pap Smear Kolektif 45,000
20 Ny. Jumiati Dr. Elyani,SpOG Pap Smear Kolektif 45,000
 Page 4

40000
40000
40000
40000
40000
40000
40000
40000
40000
40000
40000
40000
40000
40000
40000
40000
40000
40000
40000
40000
800000
 Tagihan Pemeriksaan Patologi Anatomi RS DKT
Periode April 2023

Sediaan Reg Nama Nama Diagnosa Jumlah

No.
diterima PA penderita dokter Klinis (Rp)
1 1-Apr-23 K.230609 Ny. Riani Dr. Sulung M., SpOG Adenomyosis
2 K.230610 Ny. Anggun F. Dr. Ririen Indah, SpOG Kista Coklat Bilateral
3 5-Apr-23 K.230637 Ny. Rika Melani Dr. Sulung M., SpOG Kista
4 8-Apr-23 K.230659 Ny. Sunarti Dr. Sulung M., SpOG Adenomyosis (5 blok)
5 K.230660 Ny. Krisminarsih Dr. Ardi P., SpOG Post Menopause Bleeding
6 K.230661 Ny. Purwanti Dr. Ardi P., SpOG DUB
7 12-Apr-23 K.230670 Ny. Renita Afriska Dr. Ardi P., SpOG Myoma Uteri
8 K.230671 Ny. Nur Indah N. Dr. Ririen Indah, SpOG Myoma Uteri
9 K.230672 Ny. Dwi Sulistiyowati Dr. Sulung M., SpOG Kista Ovarii
10 15-Apr-23 K.230698 Tn. Suparlan Dr. Riyadi W., SpB Soft Tissue Tumor Paha
11 26-Apr-23 K.230713 Ny. Marsinah Dr. Sulung M., SpOG Adenomyosis (5 blok)
12 K.230714 Nn. Nurul Farida Dr. Riyadi W., SpB Tumor Mammae
13 K.230715 An. M. Farel A. Dr. Riyadi W., SpB Polip Recti
14 K.230716 Nn. Eka Fitri N. R. Dr. Riyadi W., SpB Tumor Mammae
15 K.230717 Ny. Siti Masruroh Dr. Ririen Indah, SpOG Kista Coklat pada Tuba
0
 Laboratorium Diagnostik Hayam Wuruk
Jl. Hayam Wuruk No. 53, Telp. (0354) 681123, 682110 Fax. Bagian Patologi Anatomi (0341) 403782
Layanan Konsumen 08883338731, 081334263813

Tagihan Pemeriksaan Patologi Anatomi RSUD Kertosono

Periode April 2023

Sediaan Reg Nama Nama Diagnosa Jumlah

No.
diterima PA penderita dokter Klinis (Rp)
1 01/04/23 K.230607 Nn. Puji Rahayu Dr. R. Imam Mujajirin, SpB Tumor Mamma 220,000
2 K.230608 Agung Wijoyo Dr. Woro Safitri, SpTHT-KL Tumor Cavum Nasi 220,000
3 05/04/23 K.230633 Tn. Sungkono Dr. Ardian Bayu, SpU BPH 290,000
4 K.230634 Ny. Suci Dr. IPK Yudasmara, SpOG TOA 290,000
5 K.230635 Tn. Mustajib Dr. R. Imam Mujajirin, SpB Susp Perforasi Gaster 180,000
6 08/04/23 K.230654 Ny. Satinem Dr. R. Imam Mujajirin, SpB Tumor Colli 180,000
7 K.230655 Tn. Ponimin Dr. Ardian Bayu, SpU BPH 290,000
8 12/04/23 K.230668 Tn. Saifur Rohman Dr. Ardian Bayu, SpU BPH 290,000
9 K.230669 Ny. Listiyani Dr. Sunarman, SpB Tumor Mamma (5 blok) 350,000
10 15/04/23 K.230693 Tn. Subani Dr. R. Imam Mujajirin, SpB Perforasi Gaster 180,000
11 K.230694 An. Jihan Ghaitsa Dr. R. Imam Mujajirin, SpB Tumor Colli 180,000
12 K.230695 Tn. Sipin Dr. R. Imam Mujajirin, SpB Melanoma Manus (D) 220,000
13 K.230696 Tn. Sukiswo Dr. Ardian Bayu, SpU BPH 290,000
14 26/04/23 K.230707 Ny. Nunuk Ekowati Dr. Sunarman, SpB Tumor Mamma 290,000
15 K.230708 Nn. Armiatin A. N. Dr. Sunarman, SpB FAM 220,000
16 K.230709 Tn. Satimin Dr. Ardian Bayu, SpU BPH 290,000
3,980,000

398000
3,582,000
Malang,

Nonny Yogha Pupita. SE,Ak

1
2
3
4
5
6
7
 Laboratorium Diagnostik Hayam Wuruk
Jl. Hayam Wuruk No. 53, Telp. (0354) 681123, 682110 Fax. Bagian Patologi Anatomi (0341) 403782
Layanan Konsumen 08883338731, 081334263813

bpjs
bpjs
 Laboratorium Diagnostik Hayam Wuruk
Jl. Hayam Wuruk No. 53, Telp. (0354) 681123, 682110 Fax. Bagian Patologi Anatomi (0341) 403782
Layanan Konsumen 08883338731, 081334263813

Tagihan Pemeriksaan Patologi Anatomi RS Ratih Periode April 2023

Sediaan Reg Nama Nama Diagnosa Jumlah

No.
diterima PA penderita dokter Klinis (Rp)
1 15-Apr-23 K.230697 Ny. Indraini Dr. Jody H., SpB Tumor R Inguinal
2 26-Apr-23 K.230712 Ny. Imas Candra Dr. Jody H., SpB Susp Limfoma Maligna
-
0
0

Malang,

Nonny Yogha Pupita. SE,Ak

 Laboratorium Diagnostik Hayam Wuruk
Jl. Hayam Wuruk No. 53, Telp. (0354) 681123, 682110 Fax. Bagian Patologi Anatomi (0341) 403782
Layanan Konsumen 08883338731, 081334263813

Tagihan Pemeriksaan Patologi Anatomi RS Melinda Periode Juni 2022

Sediaan Reg Nama Nama Diagnosa Jumlah

No.
diterima PA penderita dokter Klinis (Rp)
1 8/6/2022 K.221008 Ny. Titis Gya Dr. Dibya A. Iskandar, SpOG Pap Smear
2 K.221009 Ny. Naning Juwanti Dr. Dibya A. Iskandar, SpOG Pap Smear
3 K.221010 Ny. Puryati Dr. Dibya A. Iskandar, SpOG Pap Smear
4 K.221011 Ny. Nabila Hatmani Dr. Dibya A. Iskandar, SpOG Pap Smear
5 K.221012 Ny. Ersi Sukirno Dr. Dibya A. Iskandar, SpOG Pap Smear
-
0
0

Malang,

Nonny Yogha Pupita. SE,Ak