| No | Nama Layanan | Tarif | Jenis Pemeriksaan |
|---|---|---|---|
| 1911 | Tindakan Cyclodia Terni | Rp4.070.000 | Prosedur Non Bedah |
| 1912 | Trabekulektomi (Sedang) | Rp4.070.000 | Prosedur Non Bedah |
| 1913 | ICCE / ECCE (tidak termasuk IOL) (acc) | Rp6.600.000 | Prosedur Non Bedah |
| 1914 | Anterio/Posterior Sklerotomi | Rp6.600.000 | Prosedur Non Bedah |
| 1915 | Argon Laser / Kenon | Rp6.825.000 | Prosedur Non Bedah |
| 1916 | Congenital Formix Plastik/Rekst Soket Berat | Rp6.600.000 | Prosedur Non Bedah |
| 1917 | Cyclodia Termi | Rp6.600.000 | Prosedur Non Bedah |
| 1918 | Cyclodialysa | Rp6.600.000 | Prosedur Non Bedah |
| 1919 | Ekstraksi Linear | Rp6.600.000 | Prosedur Non Bedah |
| 1920 | Goniotomi + anastesi | Rp6.600.000 | Prosedur Non Bedah |
