| No | Nama Layanan | Tarif | Jenis Pemeriksaan |
|---|---|---|---|
| 4011 | Jahit <5 (Gigi & Mulut Rawat Jalan) | Rp113.500 | Keperawatan |
| 4012 | USG Transvaginal | Rp340.000 | Prosedur Non Bedah |
| 4013 | Kardiotofografi (NST) Tanpa OCT | Rp90.000 | Prosedur Non Bedah |
| 4014 | USG Transabdomen | Rp450.000 | Prosedur Non Bedah |
| 4015 | Curretage Diagnostik | Rp1.650.000 | Prosedur Non Bedah |
| 4016 | Pap Smear Liquid Base | Rp150.000 | Prosedur Non Bedah |
| 4017 | Pap Smear Konvensional | Rp70.000 | Prosedur Non Bedah |
| 4018 | Injeksi KB | Rp40.500 | Prosedur Non Bedah |
| 4019 | Lepas Implant (Rawat Jalan) | Rp112.500 | Prosedur Non Bedah |
| 4020 | Pasang Implant (Rawat Jalan) | Rp105.000 | Prosedur Non Bedah |
