| No | Nama Layanan | Tarif | Jenis Pemeriksaan |
|---|---|---|---|
| 1901 | Reposisi Iris | Rp2.813.000 | Prosedur Non Bedah |
| 1902 | Retcam + Narkose | Rp2.813.000 | Prosedur Non Bedah |
| 1903 | Yag Laser | Rp2.813.000 | Prosedur Non Bedah |
| 1904 | Foto Koagulasi (acc) | Rp3.760.000 | Prosedur Non Bedah |
| 1905 | Biopsi Tumor orbita | Rp4.070.000 | Prosedur Non Bedah |
| 1906 | Eksisi tumor adneksa sedang | Rp4.070.000 | Prosedur Non Bedah |
| 1907 | Koreksi Symblepharon | Rp4.070.000 | Prosedur Non Bedah |
| 1908 | Pthisis bulbi (Graft Mukosa Bibir) | Rp4.070.000 | Prosedur Non Bedah |
| 1909 | Repair Ruptur Palpebra Transkanal | Rp4.070.000 | Prosedur Non Bedah |
| 1910 | Tindakan Congenital Fornix Plastik | Rp4.070.000 | Prosedur Non Bedah |
