| No | Nama Layanan | Tarif | Jenis Pemeriksaan |
|---|---|---|---|
| 2291 | Salvaging Operasi Mikro | Rp39.997.000 | Prosedur Non Bedah |
| 2292 | Tram Flap | Rp6.600.000 | Prosedur Non Bedah |
| 2293 | Trauma kompleks jaringan lunak wajah | Rp6.600.000 | Prosedur Non Bedah |
| 2294 | Uretroplasti | Rp8.242.000 | Prosedur Non Bedah |
| 2295 | Alveolar Bone Graft | Rp15.200.000 | Prosedur Non Bedah |
| 2296 | Cross Leg flap | Rp15.200.000 | Prosedur Non Bedah |
| 2297 | Fraktur Muka Multiple (Tanpa Miniplate Screw) | Rp15.200.000 | Prosedur Non Bedah |
| 2298 | Fronto-Orbital Advancement Pada Craniosynostosis | Rp20.768.000 | Prosedur Non Bedah |
| 2299 | Le-ford Advancement Surgery | Rp15.200.000 | Prosedur Non Bedah |
| 2300 | Mandibulektomi | Rp15.300.000 | Prosedur Non Bedah |
