| No | Nama Layanan | Tarif | Jenis Pemeriksaan |
|---|---|---|---|
| 2251 | Eksisi Limfedema + skin graft (charles Prosedur) | Rp6.600.000 | Prosedur Non Bedah |
| 2252 | Fore Head flap | Rp6.600.000 | Prosedur Non Bedah |
| 2253 | Fraktur Maksila/Zygoma | Rp8.256.000 | Prosedur Non Bedah |
| 2254 | Fraktur Rahang Sederhana | Rp6.600.000 | Prosedur Non Bedah |
| 2255 | Kontraktur + STSG | Rp6.994.000 | Prosedur Non Bedah |
| 2256 | Koreksi + rekonstruksi Ptosis | Rp6.600.000 | Prosedur Non Bedah |
| 2257 | Labiopalatoplasti Bilateral (Bedah Plastik) | Rp7.844.000 | Prosedur Non Bedah |
| 2258 | Labioplasti Bilateral (Besar) | Rp6.789.000 | Prosedur Non Bedah |
| 2259 | Latisimus Dorsi Flap | Rp6.600.000 | Prosedur Non Bedah |
| 2260 | Operasi Mikrotia | Rp7.804.000 | Prosedur Non Bedah |
