| No | Nama Layanan | Tarif | Jenis Pemeriksaan |
|---|---|---|---|
| 1951 | Ptosis | Rp15.200.000 | Prosedur Non Bedah |
| 1952 | Ptosis + Anastesi | Rp15.200.000 | Prosedur Non Bedah |
| 1953 | Rekonstruksi orbita kongenital | Rp16.313.000 | Prosedur Non Bedah |
| 1954 | Rekontruksi Kelopak Berat | Rp15.200.000 | Prosedur Non Bedah |
| 1955 | Rekontruksi Orbita Congenital | Rp15.200.000 | Prosedur Non Bedah |
| 1956 | Rekontruksi Saket Berat | Rp15.200.000 | Prosedur Non Bedah |
| 1957 | Scheral Buckel + Cyro + C3F8 | Rp15.200.000 | Prosedur Non Bedah |
| 1958 | Strabismus 3-4 Otot | Rp15.200.000 | Prosedur Non Bedah |
| 1959 | Syndroma blefarophimosis | Rp15.200.000 | Prosedur Non Bedah |
| 1960 | Trabekulektomi+ECCE /Phacoemulsifikasi | Rp15.200.000 | Prosedur Non Bedah |
