| 3501 | PACITAN | RS Umum Daerah dr. Darsono | Kelas C | 3/1 | 2/1 | 2/1 | 3/1 | 2/1 | 2/1 | 2/1 | 27/1 |
| 3502 | PONOROGO | RS Umum Daerah Dr. Harjono S. Kabupaten Ponorogo | Kelas B | 3/1 | 3/1 | 4/1 | 2/1 | 3/1 | 2/1 | 2/1 | 37/1 |
| 3502 | PONOROGO | RS Umum Daerah Bantarangin | Kelas D | 1/1 | 1/1 | 2/1 | 1/1 | 1/1 | 1/1 | 1/1 | 0/0 |
| 3503 | TRENGGALEK | RS Umum Daerah dr. Soedomo Trenggalek | Kelas B | 3/1 | 2/1 | 3/1 | 4/1 | 3/1 | 2/1 | 2/1 | 34/1 |
| 3503 | TRENGGALEK | RS Umum Daerah Panggul | Kelas D | 1/1 | 1/1 | 1/1 | 2/1 | 1/1 | 1/1 | 1/1 | 0/0 |
| 3504 | TULUNGAGUNG | RS Umum Daerah Dr. Iskak | Kelas A | 3/1 | 5/1 | 6/1 | 5/1 | 4/1 | 2/1 | 2/1 | 72/1 |
| 3504 | TULUNGAGUNG | RS Umum Daerah Campurdarat | Kelas C | 1/1 | 2/1 | 1/1 | 2/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3505 | BLITAR | RS Umum Daerah Ngudi Waluyo Wlingi | Kelas B | 2/1 | 2/1 | 3/1 | 6/1 | 2/1 | 2/1 | 1/1 | 39/1 |
| 3505 | BLITAR | RS Umum Daerah Srengat Kab. Blitar | Kelas C | 1/1 | 2/1 | 1/1 | 3/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3506 | KEDIRI | RS Umum Daerah Kabupaten Kediri | Kelas B | 2/1 | 3/1 | 4/1 | 4/1 | 3/1 | 1/1 | 2/1 | 36/1 |
| 3506 | KEDIRI | RS Umum Daerah Simpang Lima Gumul Kediri | Kelas C | 3/1 | 1/1 | 4/1 | 2/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3507 | MALANG | RS Umum Daerah Kanjuruhan Kepanjen Kab. Malang | Kelas B | 4/1 | 3/1 | 4/1 | 4/1 | 3/1 | 3/1 | 1/1 | 49/1 |
| 3507 | MALANG | RS Umum Daerah Lawang | Kelas C | 2/1 | 2/1 | 2/1 | 2/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3507 | MALANG | RS Umum Daerah Ngantang | Kelas D | 2/1 | 1/1 | 1/1 | 1/1 | 1/1 | 1/1 | 1/1 | 0/0 |
| 3508 | LUMAJANG | RS Umum Daerah Dr. Haryoto Kabupaten Lumajang | Kelas B | 4/1 | 2/1 | 2/1 | 6/1 | 2/1 | 3/1 | 2/1 | 39/1 |
| 3508 | LUMAJANG | RS Umum Daerah Pasirian Kabupaten Lumajang | Kelas C | 2/1 | 3/1 | 2/1 | 2/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3509 | JEMBER | RS Umum Daerah Dr. Soebandi Jember | Kelas B | 4/1 | 5/1 | 5/1 | 6/1 | 3/1 | 4/1 | 3/1 | 76/1 |
| 3509 | JEMBER | RS Daerah Kalisat Jember | Kelas C | 1/1 | 3/1 | 2/1 | 2/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3509 | JEMBER | RS Daerah Balung Jember | Kelas C | 2/1 | 3/1 | 2/1 | 5/1 | 1/1 | 2/1 | 1/1 | 0/0 |
| 3510 | BANYUWANGI | RS Umum Daerah Blambangan | Kelas B | 2/1 | 3/1 | 2/1 | 4/1 | 2/1 | 1/1 | 1/1 | 42/1 |
| 3510 | BANYUWANGI | RS Umum Daerah Genteng | Kelas C | 2/1 | 4/1 | 2/1 | 1/1 | 5/1 | 1/1 | 1/1 | 0/0 |
| 3511 | BONDOWOSO | RS Umum dr. H.Koesnadi Bondowoso | Kelas B | 3/1 | 2/1 | 3/1 | 3/1 | 2/1 | 3/1 | 1/1 | 43/1 |
| 3512 | SITUBONDO | RS Umum Daerah dr. Abdoer Rahem Situbondo | Kelas C | 2/1 | 2/1 | 2/1 | 4/1 | 2/1 | 1/1 | 1/1 | 35/1 |
| 3512 | SITUBONDO | RS Umum Daerah Besuki Kabupaten Situbondo | Kelas D | 1/1 | 1/1 | 1/1 | 2/1 | 1/1 | 1/1 | 1/1 | 0/0 |
| 3512 | SITUBONDO | RS Umum Daerah Asembagus Kabupaten Situbondo | Kelas D | 1/1 | 1/1 | 2/1 | 2/1 | 2/1 | 2/1 | 1/1 | 0/0 |
| 3513 | PROBOLINGGO | RS Umum Daerah Waluyo Jati Kraksaan | Kelas B | 2/1 | 3/1 | 4/1 | 4/1 | 4/1 | 3/1 | 2/1 | 31/1 |
| 3513 | PROBOLINGGO | RS Umum Daerah Tongas | Kelas C | 2/1 | 2/1 | 3/1 | 3/1 | 2/1 | 2/1 | 1/1 | 0/0 |
| 3514 | PASURUAN | RS Umum Daerah Bangil | Kelas B | 5/1 | 2/1 | 5/1 | 8/1 | 3/1 | 5/1 | 1/1 | 59/1 |
| 3514 | PASURUAN | RS Umum Daerah Grati | Kelas C | 3/1 | 2/1 | 3/1 | 3/1 | 3/1 | 3/1 | 1/1 | 0/0 |
| 3515 | SIDOARJO | RS Umum Daerah R. T. Notopuro Sidoarjo | Kelas A | 5/1 | 4/1 | 5/1 | 11/1 | 6/1 | 6/1 | 1/1 | 88/1 |
| 3515 | SIDOARJO | RS Umum Daerah Sidoarjo Barat | Kelas C | 2/1 | 2/1 | 2/1 | 3/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3516 | MOJOKERTO | RS Umum Daerah Sumberglagah | Kelas C | 2/1 | 2/1 | 2/1 | 2/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3516 | MOJOKERTO | RS Umum Daerah Prof. Dr. Soekandar | Kelas B | 3/1 | 2/1 | 4/1 | 5/1 | 4/1 | 1/1 | 2/1 | 46/1 |
| 3516 | MOJOKERTO | RS Umum Daerah Raden Achmad Basoeni | Kelas C | 3/1 | 2/1 | 2/1 | 3/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3517 | JOMBANG | RS Umum Daerah Kab. Jombang | Kelas B | 4/1 | 4/1 | 3/1 | 6/1 | 5/1 | 3/1 | 2/1 | 56/1 |
| 3517 | JOMBANG | RS Umum Daerah Ploso | Kelas C | 2/1 | 1/1 | 2/1 | 3/1 | 3/1 | 1/1 | 2/1 | 0/0 |
| 3518 | NGANJUK | RS Umum Daerah Nganjuk | Kelas B | 2/1 | 2/1 | 3/1 | 5/1 | 2/1 | 2/1 | 1/1 | 36/1 |
| 3518 | NGANJUK | RS Daerah Kertosono | Kelas C | 3/1 | 3/1 | 4/1 | 2/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3519 | MADIUN | RS Umum Daerah Dungus | Kelas C | 1/1 | 2/1 | 2/1 | 1/1 | 1/1 | 1/1 | 1/1 | 0/0 |
| 3519 | MADIUN | RS Umum Daerah Caruban | Kelas C | 3/1 | 2/1 | 2/1 | 4/1 | 2/1 | 0/1 | 1/1 | 26/1 |
| 3519 | MADIUN | RS Umum Daerah Dolopo | Kelas C | 2/1 | 1/1 | 2/1 | 2/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3520 | MAGETAN | RS Umum Daerah dr. Sayidiman Magetan | Kelas C | 3/1 | 2/1 | 3/1 | 4/1 | 2/1 | 2/1 | 2/1 | 34/1 |
| 3521 | NGAWI | RS Umum Daerah Dr. Soeroto Ngawi | Kelas C | 2/1 | 3/1 | 4/1 | 3/1 | 1/1 | 1/1 | 1/1 | 35/1 |
| 3521 | NGAWI | RS Umum Daerah Geneng | Kelas D | 1/1 | 2/1 | 1/1 | 2/1 | 1/1 | 1/1 | 2/1 | 0/0 |
| 3521 | NGAWI | RS Umum Daerah Mantingan | Kelas D | 1/1 | 1/1 | 1/1 | 2/1 | 1/1 | 1/1 | 1/1 | 0/0 |
| 3522 | BOJONEGORO | RS Umum Daerah Dr. R. Sosodoro Djatikoesoemo | Kelas B | 3/1 | 3/1 | 2/1 | 6/1 | 2/1 | 4/1 | 2/1 | 45/1 |
| 3522 | BOJONEGORO | RS Umum Daerah Sumberrejo | Kelas C | 2/1 | 2/1 | 2/1 | 2/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3522 | BOJONEGORO | RS umum Daerah Padangan | Kelas C | 1/1 | 2/1 | 3/1 | 2/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3522 | BOJONEGORO | RS Umum Daerah Kepohbaru | Kelas D | 1/1 | 1/1 | 1/1 | 1/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3522 | BOJONEGORO | (NONAKTIF) RS Umum Daerah Temayang | | 0/1 | 0/1 | 0/1 | 0/1 | 0/1 | 0/1 | 0/1 | 0/0 |
| 3523 | TUBAN | RS Umum Daerah Dr. R. Koesma Tuban | Kelas B | 4/1 | 3/1 | 4/1 | 4/1 | 4/1 | 4/1 | 2/1 | 51/1 |
| 3523 | TUBAN | RS Umum Daerah R. Ali Manshur | Kelas C | 2/1 | 2/1 | 3/1 | 3/1 | 3/1 | 2/1 | 2/1 | 0/0 |
| 3524 | LAMONGAN | RS Umum Daerah Dr. Soegiri Lamongan | Kelas B | 4/1 | 3/1 | 3/1 | 3/1 | 2/1 | 3/1 | 2/1 | 46/1 |
| 3524 | LAMONGAN | RS Umum Daerah Ngimbang | Kelas C | 1/1 | 2/1 | 2/1 | 4/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3524 | LAMONGAN | RS Umum Daerah Karangkembang | Kelas D | 1/1 | 1/1 | 1/1 | 2/1 | 1/1 | 1/1 | 2/1 | 0/0 |
| 3524 | LAMONGAN | RS Umum Daerah Ki Ageng Brondong | Kelas D | 1/1 | 1/1 | 1/1 | 2/1 | 1/1 | 0/1 | 1/1 | 0/0 |
| 3525 | GRESIK | RS Umum Daerah Ibnu Sina Kab. Gresik | Kelas B | 3/1 | 2/1 | 3/1 | 8/1 | 3/1 | 4/1 | 2/1 | 50/1 |
| 3525 | GRESIK | RS Umum Daerah Umar Mas'ud Bawean | Kelas D | 1/1 | 1/1 | 1/1 | 1/1 | 1/1 | 0/1 | 0/1 | 0/0 |
| 3525 | GRESIK | RS Umum Daerah Gresik Sehati | Kelas C | 1/1 | 1/1 | 1/1 | 1/1 | 1/1 | 0/1 | 1/1 | 0/0 |
| 3526 | BANGKALAN | RS Umum Daerah Syarifah Ambami Rato Ebu | Kelas B | 4/1 | 3/1 | 4/1 | 4/1 | 4/1 | 3/1 | 2/1 | 50/1 |
| 3527 | SAMPANG | RS Umum Daerah dr. Mohammad Zyn Kab. Sampang | Kelas B | 3/1 | 3/1 | 3/1 | 2/1 | 2/1 | 2/1 | 0/1 | 34/1 |
| 3527 | SAMPANG | RS Umum Daerah Ketapang | Kelas D | 2/1 | 1/1 | 2/1 | 1/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3528 | PAMEKASAN | RS Umum Daerah Dr. H. Slamet Martodirdjo Pamekasan | Kelas B | 2/1 | 4/1 | 3/1 | 4/1 | 3/1 | 3/1 | 2/1 | 39/1 |
| 3528 | PAMEKASAN | RS Umum Daerah Mohammad Noer Pamekasan | Kelas C | 2/1 | 3/1 | 2/1 | 2/1 | 2/1 | 3/1 | 1/1 | 0/0 |
| 3528 | PAMEKASAN | RS Umum Daerah Waru Pamekasan | Kelas D | 1/1 | 2/1 | 1/1 | 2/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3529 | SUMENEP | RS Umum Daerah dr. H. Moh. Anwar | Kelas B | 4/1 | 1/1 | 3/1 | 4/1 | 3/1 | 1/1 | 1/1 | 27/1 |
| 3529 | SUMENEP | RS Umum Daerah Abuya Kangean | Kelas D | 3/1 | 1/1 | 4/1 | 1/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3571 | KOTA KEDIRI | RS Umum Daerah Gambiran | Kelas B | 3/1 | 2/1 | 3/1 | 6/1 | 2/1 | 3/1 | 2/1 | 46/1 |
| 3571 | KOTA KEDIRI | RS Umum Daha Husada | Kelas D | 2/1 | 2/1 | 1/1 | 2/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3571 | KOTA KEDIRI | RS Umum Daerah Kilisuci | Kelas C | 1/1 | 1/1 | 2/1 | 2/1 | 1/1 | 1/1 | 1/1 | 0/0 |
| 3572 | KOTA BLITAR | RS Umum Daerah Mardi Waluyo | Kelas B | 3/1 | 2/1 | 3/1 | 4/1 | 2/1 | 2/1 | 2/1 | 39/1 |
| 3573 | KOTA MALANG | RS Umum Daerah Dr. Saiful Anwar | Kelas A | 3/1 | 1/1 | 6/1 | 11/1 | 4/1 | 3/1 | 3/1 | 221/1 |
| 3573 | KOTA MALANG | RS Umum Daerah Kota Malang | Kelas C | 3/1 | 1/1 | 2/1 | 3/1 | 1/1 | 2/1 | 1/1 | 20/1 |
| 3574 | KOTA PROBOLINGGO | RS Umum Daerah dr. Mohamad Saleh Kota Probolinggo | Kelas B | 3/1 | 3/1 | 3/1 | 5/1 | 2/1 | 3/1 | 1/1 | 34/1 |
| 3574 | KOTA PROBOLINGGO | RS Umum Daerah Ar Rozy | Kelas C | 1/1 | 3/1 | 1/1 | 3/1 | 1/1 | 1/1 | 1/1 | 0/0 |
| 3575 | KOTA PASURUAN | RS Umum Daerah Dr. R. Soedarsono Kota Pasuruan | Kelas C | 3/1 | 2/1 | 3/1 | 3/1 | 2/1 | 1/1 | 1/1 | 38/1 |
| 3576 | KOTA MOJOKERTO | RSUD dr. Wahidin Sudiro Husodo Kota Mojokerto | Kelas B | 4/1 | 3/1 | 3/1 | 3/1 | 3/1 | 2/1 | 2/1 | 48/1 |
| 3577 | KOTA MADIUN | RS Umum Daerah Dr. Soedono Madiun | Kelas B | 3/1 | 4/1 | 3/1 | 6/1 | 3/1 | 4/1 | 2/1 | 60/1 |
| 3577 | KOTA MADIUN | RS Umum Daerah Kota Madiun | Kelas C | 3/1 | 3/1 | 2/1 | 3/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3578 | KOTA SURABAYA | RS Umum Daerah Dr. Soetomo | Kelas A | 40/1 | 19/1 | 40/1 | 41/1 | 61/1 | 8/1 | 14/1 | 525/1 |
| 3578 | KOTA SURABAYA | RS Umum Daerah Bhakti Dharma Husada | Kelas B | 3/1 | 1/1 | 4/1 | 5/1 | 4/1 | 3/1 | 3/1 | 44/1 |
| 3578 | KOTA SURABAYA | RS Umum Daerah Husada Prima | Kelas C | 2/1 | 3/1 | 2/1 | 3/1 | 2/1 | 1/1 | 1/1 | 0/0 |
| 3578 | KOTA SURABAYA | RS Umum Daerah Haji Provinsi Jawa Timur | Kelas B | 2/1 | 3/1 | 4/1 | 5/1 | 5/1 | 3/1 | 3/1 | 0/0 |
| 3578 | KOTA SURABAYA | RS Umum Daerah dr. Mohamad Soewandhie | Kelas B | 7/1 | 7/1 | 4/1 | 11/1 | 5/1 | 3/1 | 2/1 | 0/0 |
| 3578 | KOTA SURABAYA | RSUP Surabaya | | 9/1 | 7/1 | 7/1 | 11/1 | 9/1 | 1/1 | 4/1 | 0/1 |
| 3578 | KOTA SURABAYA | RS Umum Daerah Eka Candrarini | Kelas C | 4/1 | 5/1 | 3/1 | 5/1 | 5/1 | 3/1 | 3/1 | 0/0 |
| 3579 | KOTA BATU | RS Umum Karsa Husada Kota Batu | Kelas B | 3/1 | 4/1 | 4/1 | 7/1 | 3/1 | 3/1 | 3/1 | 50/1 |