| No | Nama Layanan | Tarif | Jenis Pemeriksaan |
|---|---|---|---|
| 3281 | ASSR (Rawat Inap) | Rp824.000 | Prosedur Bedah |
| 3282 | ASSR (IGD) | Rp700.000 | Prosedur Bedah |
| 3283 | BERA.ASSR (Rawat Inap) | Rp1.107.000 | Prosedur Bedah |
| 3284 | BERA.ASSR (IGD) | Rp800.000 | Prosedur Bedah |
| 3285 | Nasolaryngo Endoskopi (Rawat Inap) | Rp150.000 | Prosedur Bedah |
| 3286 | Nasolaryngo Endoskopi (IGD) | Rp150.000 | Prosedur Bedah |
| 3287 | OAE (Rawat Inap) | Rp273.000 | Prosedur Bedah |
| 3288 | OAE (IGD) | Rp275.000 | Prosedur Bedah |
| 3289 | Therapi Surfaktan (Rawat Inap.PICU.NICU) | Rp548.000 | Prosedur Bedah |
| 3290 | Therapi Surfaktan (IGD) | Rp475.000 | Prosedur Bedah |
