| 2151 | 
          Sequesterektomy dengan Narkose | 
          Rp4.888.000 | 
          Prosedur Non Bedah | 
        
              
          | 2152 | 
          Skingrafting yang tidak luas (Bedah Orthopedi) | 
          Rp5.967.000 | 
          Prosedur Non Bedah | 
        
              
          | 2153 | 
          Tendor transfer ekstremitas bawah pada kasus Neuromuskular anak | 
          Rp4.000.000 | 
          Prosedur Non Bedah | 
        
              
          | 2154 | 
          Total joiny Arthroplasty | 
          Rp4.000.000 | 
          Prosedur Non Bedah | 
        
              
          | 2155 | 
          Total Knee/Shoulder Replacement | 
          Rp4.000.000 | 
          Prosedur Non Bedah | 
        
              
          | 2156 | 
          Total Patellectomy dan Rekonstruksi | 
          Rp4.000.000 | 
          Prosedur Non Bedah | 
        
              
          | 2157 | 
          Transfer Jari. deformity. instrinsic muscle | 
          Rp4.000.000 | 
          Prosedur Non Bedah | 
        
              
          | 2158 | 
          Acetabuloplasty (salter InnominatPemberton.Dega) pada kasus panggul | 
          Rp6.600.000 | 
          Prosedur Non Bedah | 
        
              
          | 2159 | 
          Alat transverse fusion | 
          Rp6.600.000 | 
          Prosedur Non Bedah | 
        
              
          | 2160 | 
          Amputasi Jari (Multiple) | 
          Rp6.600.000 | 
          Prosedur Non Bedah |