| No | Nama Layanan | Tarif | Jenis Pemeriksaan |
|---|---|---|---|
| 1211 | Partus Distokia Bahu (Rawat Inap) | Rp3.180.000 | Prosedur Bedah |
| 1212 | Partus Versi Ekstrasi (Rawat Inap) | Rp3.342.000 | Prosedur Bedah |
| 1213 | Embriotomi (Rawat Inap) | Rp2.475.000 | Prosedur Bedah |
| 1214 | Partus Gemeli dengan Penyulit (Rawat Inap) | Rp4.455.000 | Prosedur Bedah |
| 1215 | IT Ratio | Rp32.000 | Laboratorium |
| 1216 | KED / LED / BBS | Rp63.000 | Laboratorium |
| 1217 | Jumlah Trombosit | Rp80.000 | Laboratorium |
| 1218 | Malaria | Rp45.000 | Laboratorium |
| 1219 | Reticulocyt (AR) | Rp68.000 | Laboratorium |
| 1220 | LPB ( Limposit Plasma Biru ) | Rp15.000 | Laboratorium |
