| No | Nama Layanan | Tarif | Jenis Pemeriksaan |
|---|---|---|---|
| 1061 | BERA (Rawat Jalan) | Rp549.000 | Prosedur Bedah |
| 1062 | ASSR (Rawat Jalan) | Rp549.000 | Prosedur Bedah |
| 1063 | BERA. ASSR (Rawat Jalan) | Rp738.000 | Prosedur Bedah |
| 1064 | Nasolaryngo Endoskopi (Rawat Jalan) | Rp100.000 | Prosedur Bedah |
| 1065 | OAE (Rawat Jalan) | Rp182.000 | Prosedur Bedah |
| 1066 | Therapi Surfaktan (Rawat Jalan) | Rp365.000 | Prosedur Bedah |
| 1067 | Pasang CVP Pediatric (Rawat Jalan.Rawat Inap) | Rp1.336.000 | Prosedur Bedah |
| 1068 | Tranfusi Tukar (IGD) | Rp202.000 | Prosedur Bedah |
| 1069 | SUPER VIP (Gabung) | Rp500.000 | Prosedur Bedah |
| 1070 | Akomodasi IGD ( >6 Jam) | Rp140.000 | Prosedur Bedah |
