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id_tindakan kode_tm

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1911 TM1910

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1973 TM1972

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1980 TM1979

1981 TM1980

1986 TM1981

1987 TM1982

1988 TM1983

Page 17
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nama_tindakan harga ANAK

KARTU PASIEN 8250

BUKU PASIEN 27500

BIAYA ADMINISTRASI RS 20900

ADMINISTRASI TANPA BUKU 29150

UANG MUKA SUITE ROOM 9500000

UANG MUKA SVIP ROOM 8100000

UANG MUKA VIP ROOM 7250000

UANG MUKA KELAS 1 4250000

UANG MUKA KELAS 2 2550000

UANG MUKA KELAS 3A 2550000

UANG MUKA RAWAT INTENSIF (ICU) 8000000

UANG MUKA RAWAT PERINA 3500000

REGISTRASI BAYI 16500

KAMAR PERAWATAN SUITE ROOM 1430000

KAMAR PERAWATAN SVIP ROOM 1078000

KAMAR PERAWATAN VIP ROOM 990000

KAMAR PERAWATAN KELAS 1 605000

KAMAR PERAWATAN KELAS 2 363000

KAMAR PERAWATAN KELAS 3 220000

KONSULTASI DOKTER UMUM 50000

KONSULTASI DOKTER SPESIALIS 121000 1

KONSULTASI DOKTER SUB SPESIALIS/KONSULTASI 137500

AFF DRAIN SELANG (ANGKATAN DRAIN) 44000

BILAS LAMBUNG 88000

BUKA GIPS 1 SISI (IGD) 99000

BUKA GIPS 2 SISI (IGD) 165000

CIRCUMCISI / SUNAT 440000

CLISMA, KOREK SKIBALA 41800 1

DEBRIDEMENT RINGAN (IGD) 88000

DEBRIDEMENT SEDANG (IGD) 115500

Page 18
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DEBRIDEMENT BERAT (IGD) 147400

DILATASI PREPUTIUM 44000

EKSPLORASI VULNUS PUNCTUM 36300

EKTIRPASI LIPOMA / KISTA / CLAVUS / NEVUS 99000

EKSTRASI CORPUS ALIENUM 49500

EKSTRASI KUKU 69300

GANTI VERBAND (TINDAKAN DOKTER) 33000

HECTING 1-3 (IGD) 49500

HECTING 4-6 (IGD) 82500

HECTING 7-10 (IGD) 132000

HECTING 11-15 (IGD) 137500

HECTING 15-20 (IGD) 165000

HECTING >20 (IGD) 192500

INCISI ABSES 1 / < 10CM 41800

INCISI ABSES > 1 / > 10CM 99000

INJEKSI INTRALASI KELOID 38500

INTUBASI / ETT / RESUSITASI 159500

IRIGASI TELINGA / MATA 29700

KOMPRESI JANTUNG PARU (CPR) 82500 1

MINI WSD 176000

OBSERVASI > 3 JAM 33600

OBSERVASI 3 - 6 JAM 78000

PASANG CATHERER 55000

PASANG INFUS DEWASA 18700

PASANG IV LINE INTRA OSSEUS (IGD) 110000

PASANG IV LINE VENA JUGULARIS (IGD) 110000

PASANG IV LINE VENA SECTIE (IGD) 214500

PASANG IV LINE PERCUTANEUS CATETER (IGD) 275000

PASANG IV LINE VENA SENTRAL (CVC) (IGD) 275000

PASANG NASOGASTRIC TUBE (NGT) 30800 1

PASANG RANSEL VERBAND 55000

Page 19
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PASANG SPALK / BIDAI 35200 1

PASANG BALON CATETHER 330000

PASANG TAMPON HIDUNG 18700 1

PASANG UMBILICAL CATETER / UMBILICAL LINE 181500

COMBUSITO RINGAN 137500

COMBUSITO SEDANG 165000

COMBUSITO BERAT 192500

COMBUSITO LUTUT 137500

COMBUSITO PLUERA 220000

COMBUSITO PERICARDIAL 275000

REPOSISI LUKSASI MANDIBULA 137500

REPOSISI DENDI TERTUTUP 40700

SUNTIK / SKIN TEST (igd) 23100 1

TINDIK JARUM (IGD) 44000

TINDIK ALAT (IGD) 55000

BIOPSIS 236500

GANTI VERBAND 38500

PASANG IMPLANT / NORPLANT 165000

AFF IMPLANT / NORPLANT 165000

AFF DAN PASANG IMPLANT / NORPLANT 275000

PASANG IUD 115500

AFF IUD (CABUT) 115500

AFF DAN PASANG IUD 151800

KOLPOSKOPI 311300

KOLPOSKOPI + BIOPSIS 588500

PAPSMEAR 148500

PAPSMEAR DNA HC2 385000

PASANG LAMINARIA 148500

PUNGSI DOUGLASH 286000

SUNTIK / SKIN TEST 28600 1

TAMPON VAGINA 165000

Page 20
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VAGINAL TOILET 220000

KOMPRESI JANTUNG PARU (CPR) 448800 1

PASANG IV LINE INTRA OSSEUS (anak) 149600 1
PASANG IV LINE VENA JUGULARIS (anak) 158400 1
PASANG IV LINE VENA SECTIE (anak) 440000 1
PASANG IV LINE PERCUTANEUS CATETER (anak) 440000 1
PASANG IV LINE VENA SENTRAL (CVC) (anak) 422400 1
PASANG NASOGASTRIC TUBE (NGT) 44000 1
PASANG UMBILICAL CATETER / UMBILICAL LINE 308000

SURFAKTAN 193600

SURFAKTAN + ETT 387200

PUNGSI LUMBAL 233200

SUNTIK IMUNISASI 22880

TINDIK JARUM (anak) 52800

TINDIK ALAT (anak) 96800

TRANFUSI TUKAR 1 822800

TRANFUSI TUKAR 2 536800

TRANFUSI TUKAR 3 396000

WSD 330000

AFF DRAIN SELANG (ANGKATAN DRAIN) 66000

CIRCUMCISI (ANASTESI LOKAL) 715000

DEBRIDEMENT RINGAN 137500 1

DEBRIDEMENT SEDANG 154000 1
DEBRIDEMENT BERAT 176000 1
DILATASI PREPUTIUM 77000

EKSPLORASI VULNUS PUNCTUM 165000

EKTIRPASI LIPOMA / KISTA / CLAVUS / NEVUS 280500

EKSTRAKSI CORPUS ALIENUM 165000

EKSTRAKSI KUKU 220000

GANTI VERBAND 38500

PASANG GIPS 616000

Page 21
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PASANG GIPS + REPOSISI 1001000

PASANG GIPS BAYI 825000

PASANG GIPS BAYI + REPOSISI 1650000

BUKA GIPS 1 SISI 198000

BUKA GIPS 2 SISI 330000

HECTING 1-3 93500

HECTING 4-6 165000

HECTING 7-10 264000

HECTING 11-15 286000

HECTING 15-20 302500

HECTING >20 330000

HECTING AFF 1-3 60500

HECTING AFF 4-6 88000

HECTING AFF 7-10 115500

HECTING AFF 11-15 121000

HECTING AFF 15-20 132000

HECTING AFF >20 143000

INCISI ABSES = 1 / < 10CM 137500

INCISI ABSES > 1 / > 10CM 242000

INJEKSI INTRALASI KELOID 137500

INJEKSI INTRATEKAL 330000

INTUBASI 297000

KOMPRESI JANTUNG PARU (CPR) 330000 1

PASANG BOUGIE 165000

PASANG CATHERER 121000 1

PASANG IV LINE INTRA OSSEUS 187000

PASANG IV LINE VENA JUGULARIS 198000

PASANG IV LINE VENA SECTIE 550000

PASANG IV LINE PERCUTANEUS CATETER 550000

PASANG IV LINE VENA SENTRAL (CVC) 660000

PASANG NASOGASTRIC TUBE (NGT) 55000 1

Page 22
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PASANG RANSEL VERBAND 88000

PASANG SKIN TRACTION 55000

PASANG SPALK / BIDAI 88000

PASANG UMBILICAL CATETER / UMBILICAL LINE 385000

COMBUSITO RINGAN 165000

COMBUSITO SEDANG 220000

COMBUSITO BERAT 275000

PUNGSI SUPRA PUBLIC 82500

PUNGSI HEMATOMA 137500

PUNGSI LUTUT 165000

PUNGSI PUNGSI ABDOMEN (ASCITES/BUICK) 220000

PUNGSI PLEURA 247500

PUNGSI LUMBAL 291500

PUNGSI STERNUM (BONE MARROW) 302500

PUNGSI PERICARDIAL 220000

REPOSISI LUKSASI MANDIBULA 220000

REPOSISI SENDI TERTUTUP 275000

RESERPLASTY 297000

SUNTIK 28600 1
WSD 412500

AERONAB (FILTER NEBULIZER) 82500 1

BLUE LIGHT 93500

BUBBLE C-PAP 297000

DISPOSIBLE / DILUAR ALAT SIRKUIT 121000

CTG 1 KALI 74800

CTG 2 KALI 148500

CTG 3 KALI 209000

CTG > 3 KALI/HARI 231000

COUVE 74800

DEFIBLILATOR 203500

ECHOCARDIOGRAPHY 467500

Page 23
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EKG 74800

KONSUL BACA EKG 33000

EEG 247500

EEG + BRAIN MAPPING 440000

INFUSE PUMP PER JAM 27500 1

INFUSE PUMP > 4 JAM 99000 1
INCUBATOR 187000

TINDAKAN MEDIS OPERATIF GOL 1 DAN 2 1100000

TINDAKAN MEDIS OPERATIF GOL 3 DAN 4 1760000

LARYNGOSCOPE DIRECT 176000

MONITOR 176000 1
MONITOR PERINA (LEVEL 2) 88000

NEBULIZER 82500 1
OKSIGEN / JAM 33000 1
OKSIGEN / 14 JAM 176000 1
POMPA ELEKTRIK (BREAST PUMP) 23100

PULSE SUSU ELEKTRIK 66000

SYRINGE PUMP 93500

USG KEPALA 2D 165000

USG LEHER 3D 275000

USG THORAX 3D 275000

USG JANTUNG 165000

USG ABDOMEN 275000

USG 2D (ALAT 3D) 82500

USG 3D / 4D 242000

USG KEBIDANAN 55000

USG TRANSVAGINAL 93500

USG TESTIS 3D 78100

USG EKSTREMITAS 3D 330000

USG KULIT 165000

USG PRINT / LEMBAR 5500

Page 24
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VENTILATOR 495000

ALKES NEBULIZER 22500 1

VISIT (suite) by phone 83600 1
VISIT (svip) by phone 69630 1
VISIT (vip) by phone 58080 1
VISIT (utama) by phone 58080 1
VISIT (kls1) by phone 48400 1
VISIT (kls2) by phone 43560 1
VISIT (kls3) by phone 39160 1
VISIT (suite) 209000 1
VISIT (svip) 174240 1
VISIT (vip) 145200 1
VISIT (utama) 135300 1
VISIT (kls1) 121000 1
VISIT (kls2) 108900 1
VISIT (kls3) 98010 1
ABDOMEN 3 POSISI 371000

ABDOMEN POLOS 130000

APPENDICOGRAM 400000

BNO-IVP 1138500

ABDOMEN 2 POSISI 241640

VET. LUMBOSACRAL AP / LAT 251900

VET. LUMBOSACRAL AP / LAT / OBL 262900

VET. CERVICAL AP / LAT 251900

VET. CERVICAL AP / LAT / OBL 387200

VET. THORACOLUMBAL AP / LAT 251900

VET. THORACOLUMBAL AP / LAT / OBL 324500

PELVIS AP / LAT 211200

PELVIS AP / LAT / OBL 245300

LUMBAL AP / LAT 214500

LUMBAL AP / LAT / OBL 251900

Page 25
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SACRAL AP / LAT 171600

SACRAL AP / LAT / OBL 262900

COCYGEUS AP / LAT 171600

COXAE AP 148500

COXAE AP / LAT 171600

COXAE AP / LAT / OBL 262900

HUMERUS AP / LAT 148500

HUMERUS BILATERAL 223300

MANUS AP / LAT 148500

ANTEBRACHII AP / LAT 135300

DIGITI AP / LAT 148500

DIGITI BILATERAL 190300

WRIST JOINT AP / LAT 148500

WRIST JOIN BILATERAL 223300

ANTEBRACHII BILATERAL 223300

ARTIC CUBITI AP / LAT 148500

ARTIC CUBITI BILATERAL 223300

ANKLE AP/ LAT 148500

ART GENU AP/ LAT 148500

CALCANEUS AP/ LAT 192500

CALCANEUS BILATERAL 258500

CRURIS AP/ LAT 148500

FEMUR AP/ LAT 148500

PEDIS AP/ LAT 148500

FEMUR BELATERAL 262900

ART GENU BILATERAL 223300

CRURIS BILATERAL 223300

PEDIS BILATERAL 223300

ANKLE BILATERAL 223300

CRANIUM 154000

MANDIBULA 234300

Page 26
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MASTOID 214500

ORBITA 206800

OS NASAL 198000

SPN 2 POSISI 234800

TMJ (TEMPOROMANDIBULAJOINT) 148500

SPN 3 POSISI 227700

TMJ OPEN & CLOSE MOUTH 247500

ELBOW JOINT AP/LAT 192500

ELBOW JOINT BILATERAL 258500

CLAVICULA 136400

SCAPULA 136400

SHOULDER 170500

STRENUM 154500

THORAX LAT 126500

THORAX AP / PA 135300

THORAX AP / LAT 247500

TORAX ANAK 135000

COSTEA 143000

SHOULDER BILATERAL 200200

CLAVICULA BILATERAL 171600

SCAPULA BILATERAL 171600

TENS 50050

DIATHERMY 91050

EXERCISE 100100

NEBULIZER (fisio) 100100

ULTRASOUND 57200

PARAFINBATH 50050

INFRA RED 42900

MANIPULASI (MASSAGE) 143000

MANUAL TERAPI 143000

LASER 143000

Page 27
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TENS (kls1) 77000

DIATHERMY (kls1) 77000

EXERCISE (kls1) 112000

NEBULIZER (kls1) 119000 1

ULTRASOUND (kls1) 84000

PARAFINBATH (kls1) 77000

INFRA RED (kls1) 70000

TENS (kls2) 63000

DIATHERMY (kls2) 63000

EXERCISE (kls2) 91000

NEBULIZER (kls2) 105000 1

ULTRASOUND (kls2) 70000 1
PARAFINBATH (kls2) 63000

INFRA RED (kls2) 56000 1

TENS (kls3) 49000

DIATHERMY (kls3) 49000

EXERCISE (kls3) 70000

NEBULIZER (kls3) 91000 1

ULTRASOUND (kls3) 56000

PARAFINBATH (kls3) 49000

INFRA RED (kls3) 42000 1

TENS (vip) 91000

DIATHERMY (vip) 91000

EXERCISE (vip) 133000 1

NEBULIZER (vip) 119000 1
ULTRASOUND (vip) 98000 1
PARAFINBATH (vip) 91000

INFRA RED (vip) 91000 1

BHP USG ABDOMEN / USG 2D 6875

BHP CTG 17875

BHP EKG 37125

Page 28
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BHP AFF HECTING (ANGKAT/BUKA JAHITAN) 21725

BHP HECTING KECIL (3-5 JAHITAN) 41112

BHP HECTING SEDANG (5-10 JAHITAN) 62837

BHP HECTING BESAR (>10 JAHITAN) 69850

BHP GANTI VERBAND (GV) KECIL 29975 1

BHP GANTI VERBAND (GV) SEDANG DAN BESAR 43037 1
BHP LUKA BAKAR RINGAN 25162

BHP LUKA BAKAR SEDANG 39600

BHP LUKA BAKAR BERAT 82325

BHP VULVA HYGIENE 23925

BHP PASANG IUD 32175

BHP PAPSMEAR 47437

BHP SUNTIK IMUNISASI 10038

BHP PASANG CATHETER 26675 1

BHP PASANG NGT / OGT 9350 1
BHP PASANG INFUS DEWASA 10725

BHP PASANG INFUS ANAK 40975 1

BHP CUKUR 11550

BHP NEBULIZER 22550 1

BHP USG TRANSVAGINAL 23100

PASANG INFUS ANAK 27500 1

JASA PARAMEDIS 11000 1
INSPEKULO 27500

BHP INSPEKULO 23925

BHP VT 23925

BHP AVV IUD 32175

WONT TOILET (WT) (igd) 44000

NEOPUFF 165000 1
BHP AFF IUD 32175

JASA DOKTER NEBULIZER (igd) 27500

BIAYA SC + STERIL (suite) 5527500

Page 29
 Sheet1

BIAYA SC + STERIL (svip) 4576000

BIAYA SC + STERIL (vip) 3826900

BIAYA SC + STERIL (kls1) 3619000

BIAYA SC + STERIL (kls2) 3151225

BIAYA SC + STERIL (kls3) 2727725

INDUKSI (suite) 1425600

INDUKSI (svip) 1211650

INDUKSI (vip) 1111550

INDUKSI (utama) 975150

INDUKSI (kls1) 840950

INDUKSI (ksl2) 657250

INDUKSI (kls3) 470250

ALAT VAKUM 220000

VAKUM (suite) 1425600

VAKUM (svip) 1211650

VAKUM (vip) 1111550

VAKUM (utama) 975150

VAKUM (kls1) 840950

VAKUM (kls2) 657250

VAKUM (kls3) 470250

BHP GANTI VERBAN (poli) 43038

KONSULTASI GIGI (anak) 90000

KONSULTASI GIGI (dewasa) 90000

OBAT TANPA TINDAKAN GIGI 120000

PERAWATAN ULKUS/INFEKSI/RADANG/DRAINASE 160000

BONGKAR TAMBALAN 150000

POLISHING/ GRINDING 100000

EUGENOL + TS 150000

PULPCAPPING TS 200000

DEVITAL + EUGENOL + TS 200000

ROCKLESS TS 200000

Page 30
 Sheet1

3MIX + TS 150000

TAMBAL COMPOSITE PERMANEN KECIL (anak) 200000

TAMBAL COMPOSITE PERMANEN SEDANG (anak) 250000

TAMBAL COMPOSITE PERMANEN BESAR (anak) 300000

TAMBAL COMPOSITE PERMANEN KECIL (dewasa) 250000

TAMBAL COMPOSITE PERMANEN SEDANG (dewasa) 300000

TAMBAL COMPOSITE PERMANEN BESAR (dewasa) 400000

TAMBAL GIC PERMANEN KECIL (anak) 150000

TAMBAL GIC PERMANEN SEDANG (anak) 200000

TAMBAL GIC PERMANEN BESAR (anak) 250000

TAMBAL GIC PERMANEN KECIL (dewasa) 200000

TAMBAL GIC PERMANEN SEDANG (dewasa) 250000

TAMBAL GIC PERMANEN BESAR (dewasa) 300000

PSA I/C (anak) 50000

PSA M (anak) 100000

PSA I/C (dewasa) 100000

PSA P (dewasa) 125000

PSA M (dewasa) 150000

PENGISIAN I/ C (anak) 100000

PENGISIAN M (anak) 150000

PENGISIAN I/ C (dewasa) 150000

PENGISIAN P (dewasa) 175000

PENGISIAN M (dewasa) 200000

SCALLING KALKULUS TYPE 1 (anak) 125000

SCALLING KALKULUS TYPE 2 (anak) 150000

SCALLING KALKULUS TYPE 3 (anak) 200000

SCALLING KALKULUS TYPE 1 (dewasa) 250000

SCALLING KALKULUS TYPE 2 (dewasa) 350000

SCALLING KALKULUS TYPE 3 (dewasa) 450000

CURRETAGE/ ROOT PLANNING PER GIGI 150000

SPLINTING PER REGIO 400000

Page 31
 Sheet1

OCCLUSAL ADJUSTMENT PER GIGI 100000

CABUT GIGI SULUNG TOPIKAL 150000

CABUT GIGI SULUNG CITOJEK 200000

CABUT GIGI DEWASA KASUS 1 250000

CABUT GIGI DEWASA KASUS 2 350000

CABUT GIGI DEWASA KASUS 3 450000

CABUT GIGI KOMPILASI KOMPLIKASI 600000

CABUT GIGI OLEH SP.BM 1500000

GIGI IMPAKSI OLEH DOKTER GIGI 2000000

GIGI IMPAKSI OLEH SPESIALIS BEDAH MULUT 3500000

ALVEOLECTOMY PER REGIO 500000

GINGIVECTOMY PER GIGI 250000

INSISI ABSES INTRAORAL 250000

KONTROL PASCA BEDAH (ANGKAT HECTING) 200000

HOME BLEACHING 2500000

IN OFFICE BLEACHING 3000000

APLIKASI DENGAN FLOUR PER KUNJUNGAN 250000

DIRECT LABIAL VENEER PER 1 GIGI 550000

INDIRECT LANIAL VENEER PER 1 GIGI PORCELAIN EMAX 3200000

CETAK ALGINATE RA & RB 250000

CETAK DOUBLE IMPRESSION RA & RB 300000

ALAT ORTHO CEKAT BAHAN METAL KASUS RINGAN 5500000

ALAT ORTHO CEKAT BAHAN METAL KASUS SEDANG 7500000

ALAT ORTHO CEKAT BAHAN METAL KASUS SULIT 8500000

ALAT ORTHO CEKAT BAHAN CERAMIC KASUS RINGAN 9500000

ALAT ORTHO CEKAT BAHAN CERAMIC KASUS SEDANG 11000000

ALAT ORTHO CEKAT BAHAN CERAMIC KASUS SULIT 13000000

ALAT ORTHO CEKAT BAHAN SAPHIRE KASUS RINGAN 13500000

ALAT ORTHO CEKAT BAHAN SAPHIRE KASUS SEDANG 15000000

ALAT ORTHO CEKAT BAHAN SAPHIRE KASUS SULIT 16000000

ALAT ORTHO CEKAT DAMOND METAL 22000000

Page 32
 Sheet1

ALAT ORTHO LEPASAN RA & RB 2000000

PINDAH KONTROL ORTHO 2500000

KONTROL BRACKET 250000

RECEMENT 1 BRACKET/BUCCAL TUBE 80000

GANTI 1 BRACKET 140000

GANTI 1 BUCCAL TUBE 180000

RETAINER VACUUM PER RAHANG 1500000

BUKA BRACKET PER RAHANG 200000

WIRE PER RAHANG 150000

GTSL KERANGKA AKRILIK (PAKE KAWAT)+ 1 GIGI PERTAMA 1100000

GTSL VALPLAST (TIDAK PAKE KAWAT) + 1 GIGI PERTAMA (BILATERAL) 1750000

GTSL VERTEX THERMOSEN/FRS +1 GIGI PERTAMA (BILATERAL) 1850000

GTSL VALPLAST (TIDAK PAKE KAWAT) + 1 GIGI PERTAMA (SADDLE) 1500000

GTSL VERTEX THERMOSEN/FRS +1 GIGI PERTAMA (SADDLE) 1650000

GIGI KEDUA DAN SETERUSNYA 180000

GTP AKRILIK PER RAHANG 3300000

GTP VALPLAST PER RAHANG 3000000

GTP KERANGKA LOGAMPER RAHANG 2300000

KONTROL PASCA INSERSI 150000

REPARASI PROTESA PATAH/RETAK + 1GIGI PERTAMA 550000

REPARASI PROTESA PATAH/RETAK + 1GIGI PERTAMA (HEAD CURING) 700000

REBASING PER RAHANG 650000

SENDOK CETAK INDIVIDUAL 500000

BONGKAR/ BUKA CROWN PER-1 UNIT 250000

INLAY/ONLAY METAL 1150000

INLAY/ONLAY ALL PORCELAIN EMAX 3000000

INLAY/ONLAY ALL PORCELINE ZIRCONE 4500000

PROVISORIS 150000

NIGHT GUARD 1200000

HAWLEY RETAINER PER RAHANG 1300000

CENGKRAM/KAWAT 140000

Page 33
 Sheet1

INVISIBLE RETAINER PER RAHANG 1800000

JACKET/BRIDGE CROWN PFM (PORCELAIN FUSED METAL) 2000000

JACKET/BRIDGE CROEN EMAX 3000000

JACKET/BRIDGE CROWN ZICRONE 4500000

JACKET/BRIDGE CROWN METAL PER 1 GIGI 1400000

JACKET/BRIDGE CROWN ACRYLIC PER 1 GIGI 850000

PIN CORE METAL/ POST CORE 2000000

PIN FIBER CORE 600000

BREAST CARE 33000

VISIT (perina) 137500

VISIT (nicu/picu) 187500

VISIT (vk/ok) 108900

VISIT HCU

VISIT DOKTER UMUM 1

Page 34
 Sheet1

IGD IBU PICU NICU HCU PERINA BAYI POLI VK OK ADM DEPOSIT

1
1 1 1 1 1 1 1 1 1 1

1 1 1 1 1
1 1 1 1 1
1
1
1 1
1 1 1 1 1
1
1
Page 35
 Sheet1

1
1
1

1 1
1 1 1 1 1 1
1
1
1
1
1
1
1
1
1
1 1 1 1 1
1
1 1 1 1 1 1 1 1 1 1

1
1
1 1 1 1 1 1 1
1 1 1 1 1
1 1 1 1 1 1
1 1 1 1 1 1
1 1 1 1 1
1 1 1 1 1 1
1 1 1 1 1
1 1 1 1

Page 36
 Sheet1

1 1 1 1 1
1
1 1 1
1 1
1
1
1
1
1
1
1
1
1 1 1 1 1 1
1 1
1
1
1 1
1
1
1
1 1
1 1
1 1
1
1
1
1
1
1 1
1 1 1 1 1 1 1
1 1
Page 37
 Sheet1

1 1 1
1 1 1 1 1 1 1 1 1
1 1
1 1
1 1
1 1
1 1 1
1 1 1 1 1 1 1 1
1 1 1
1
1
1
1 1 1
1 1
1
1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1
1 1 1
1 1 1
1 1 1
1 1
1
1

1 1
1 1 1

Page 38
 Sheet1

1
1
1
1
1
1
1
1
1
1
1
1
1 1
1 1
1 1 1
1
1 1 1 1
1 1 1 1 1 1 1 1 1

1 1 1 1 1 1 1 1
1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1 1 1 1 1
Page 39
 Sheet1

1
1 1
1 1
1 1
1 1

1 1 1 1 1 1 1 1 1 1
1 1
1 1 1 1 1 1 1 1
1 1
1 1
1
1
1
1
1

Page 40
 Sheet1

1 1 1 1 1
1 1 1 1 1

1 1 1 1 1 1
1 1 1 1 1 1
1 1
1
1
1 1 1 1
1 1 1 1 1 1 1
1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1
1 1 1 1
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1
1
1
1 1 1
1 1 1

1
Page 41
 Sheet1

1 1 1
1 1 1 1 1 1 1 1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
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1 1
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1
1
1
1
1
1
1
1
1
1
1
Page 42
Sheet1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
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1
1
1
Page 43
Sheet1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
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1
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1
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Page 44
 Sheet1

1
1 1

1
1

1
1

1
1
1

1
1 1 1
1 1 1
1 1
Page 45
 Sheet1

1 1
1 1
1 1
1 1
1 1 1
1 1
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1 1
1 1
1 1 1 1
1 1
1
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1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1
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1 1 1 1 1 1 1 1 1
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1 1 1 1 1 1 1 1 1 1
1 1 1 1
1 1 1 1
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1

Page 46
 Sheet1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
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1 1
1
1
1
1
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Page 47
Sheet1

1
1
1
1
1
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1
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1
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Page 48
 Sheet1

1
1
1
1
1
1
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1
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Page 49
Sheet1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
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1
1
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1
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1
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1
Page 50
 Sheet1

1
1
1
1
1
1
1
1
1 1 1
1
1 1
1
1
1 1 1 1 1 1 1 1

Page 51