| POLI MATA | PEMERIKSAAN DOKTER SPESIALIS | 60,000 |
| PEMERIKSAAN TTV | 7,500 | |
| TONOMETRY | 10,000 | |
| BIOMETRI MATA | 50,000 | |
| OPERASI MATA PHACO | 6,000,000 | |
| OPERASI MATA SICS | 4,000,000 | |
| OPERASI MATA PTERIGIUM + GRAFT | 1,500,000 | |
| EKSTIRPASI CORPUS ALINEUM KONJUNGTIVA | 90,000 | |
| EKSTIRPASI CORPUS ALINEUM KORNEA | 90,000 | |
| TRABEKULEKTOMI | 2,000,000 | |
| SCRAPPING KORNEA | 70,000 | |
| INSISI HORDEOLUM | 227,000 | |
| INSISI KHALAZION | 227,000 | |
| POLI THT | PEMERIKSAAN DOKTER SPESIALIS | 60,000 |
| PEMERIKSAAN TTV | 7,500 | |
| EKSTIRPASI CORPUS ALINEUM | 40,000 | |
| EKSTRAKSI HEWAN TELINGAN | 100,000 | |
| IRIGASI TELINGA | 70,000 | |
| PEMERIKSAAAN POLI THT | 20,000 | |
| POLI PARU | PEMERIKSAAN DOKTER SPESIALIS | 60,000 |
| PEMERIKSAAN TTV | 7,500 | |
| POLI ANAK | PEMERIKSAAN DOKTER SPESIALIS | 60,000 |
| PEMERIKSAAN TTV | 7,500 | |
| NEBULIZER | 40,000 | |
| IMUNISASI | 20,000 | |
| MANTOUX TEST | 100,000 | |
| TINDIK BAYI | 35,000 | |
| POLI PENYAKIT DALAM | PEMERIKSAAN DOKTER SPESIALIS | 60,000 |
| PEMERIKSAAN TTV | 7,500 | |
| USG POLI DALAM | 100,000 | |
| EKG | 35,000 | |
| POLI KANDUNGAN | PEMERIKSAAN TTV | 7,500 |
| PEMERIKSAAN DAN KONSUL DOKTER SPESIALIS | 60,000 | |
| USG KB DAN KD | 75,000 | |
| DOPPLER | 15,000 | |
| NST | 325,000 | |
| PERAWATAN LUKA OPERASI | 43,000 | |
| PERAWATAN LUKA 0-5 cm | 30,000 | |
| ANGKAT JAHIT POST OPERASI | 15,000 | |
| ANGKAT JAHITAN 1-5 | 15,000 | |
| VULVA HYGIENE | 10,000 | |
| PASANG PESARIUM | 50,000 | |
| PASANG TAMPON | 15,000 | |
| PASANG KATETER | 25,000 | |
| LEPAS KATETER | 10,000 | |
| AFF TAMPON VAGINA | 20,000 | |
| AFF PESARIUM | 50,000 | |
| PASANG IUD | 80,000 | |
| LEPAS IUD | 85,000 | |
| PASANG IMPLANT | 75,000 | |
| LEPAS IMPLANT | 80,000 | |
| INJEKSI IV, IM, SC | 4,000 | |
| JAHIT PERINEUM | 150,000 | |
| INSISI KECIL | 125,000 | |
| INSPECULO | 95,000 | |
| POLI GIGI | PEMERIKSAAN POLI GIGI | 20,000 |
| PEMBERSIHAN KARANG GIGI / RAHANG | 70,000 | |
| PERAWATAN MUMIFIKASI | 65,000 | |
| TAMBALAN SEMENTARA | 20,000 | |
| TUMPATAN LIGHT CURING BESAR | 125,000 | |
| TAMBALAN COMPOSITE | 100,000 | |
| TUMPATAN LIGHT CURING KECIL | 75,000 | |
| TAMBALAN GIC | 50,000 | |
| EKSTRAKSI GIGI SULUNG | 30,000 | |
| EKSTRAKSI GIGI PERMANEN | 50,000 | |
| EKSTRAKSI GIGI PERMANEN DENGAN PENYULIT | 75,000 | |
| EKSTRAKSI KOMPLIKASI GIGI PERMANEN | 250,000 | |
| ODENTECTOMY | 350,000 | |
| ODENTECTOMY SEDERHANA | 275,000 | |
| ODENTECTOMY DENGAN PENYULIT | 420,000 | |
| POLI JANTUNG | PEMERIKSAAN DOKTER SPESIALIS | 60,000 |
| PEMERIKSAAN TTV | 7,500 | |
| EKG | 35,000 | |
| ECHO | 300,000 | |
| POLI UROLOGI | PEMERIKSAAN DOKTER SPESIALIS | 60,000 |
| PEMERIKSAAN TTV | 7,500 | |
| LEPAS KATETER | 30,000 | |
| RAWAT LUKA | 30,000 | |
| POLI SYARAF | PEMERIKSAAN DOKTER SPESIALIS | 60,000 |
| PEMERIKSAAN POLI SYARAF / NEUROLOGI | 20,000 | |
| INJEKSI INTRA ALTIKULER | 50,000 | |
| INJEKSI IM | 4,000 | |
| LABORATORIUM | DARAH LENGKAP | 48,875 |
| GOLONGAN DARAH | 2,156 | |
| URIC ACID | 24,438 | |
| URINE LENGKAP | 28,750 | |
| SGOT | 25,875 | |
| SGPT | 25,875 | |
| GLUKOSA DARAH | 17,250 | |
| CHOLESTEROL | 27,500 | |
| PLANO TEST | 28,750 | |
| NARKOBA 5 CHANEL | 112,500 | |
| NARKOBA 6 CHANEL | 187,500 | |
| TRIGLISERIDA | 27,500 | |
| UREA NITROGEN | 23,750 | |
| LDL CHOLESTEROL | 27,500 | |
| KREATININ | 23,000 | |
| HIV | 179,688 | |
| HBs-Ag | 86,250 | |
| RADIOLOGI | ANGKLE 1 POSISI | 82,000 |
| ANGKLE 2 POSISI | 164,000 | |
| ANTEBRACHII 1 POSISI | 82,000 | |
| ANTEBRACHII 2 POSISI | 164,000 | |
| BOF ANAK 1 POSISI | 88,000 | |
| BOF ANAK 2 POSISI | 176,000 | |
| BOF DEWASA 1 POSISI | 94,750 | |
| BOF DEWASA 2 POSISI | 189,500 | |
| CRURIS 1 POSISI | 91,000 | |
| CRURIS 2 POSISI | 182,000 | |
| FEMUR 1 POSISI | 91,000 | |
| FEMUR 2 POSISI | 182,000 | |
| GENU 1 POSISI | 82,000 | |
| GENU 2 POSISI | 164,000 | |
| HIP JOIN 1 POSISI | 82,000 | |
| HIP JOIN 2 POSISI | 164,000 | |
| HUMERUS 1 POSISI | 92,000 | |
| HUMERUS 2 POSISI | 184,000 | |
| MANUS 1 POSISI | 82,000 | |
| MANUS 2 POSISI | 164,000 | |
| PEDIS 1 POSISI | 82,000 | |
| PEDIS 2 POSISI | 164,000 | |
| PELVIS ANAK 1 POSISI | 88,000 | |
| PELVIS ANAK 2 POSISI | 176,000 | |
| PELVIS DEWASA 1 POSISI | 94,750 | |
| PELVIS DEWASA 2 POSISI | 189,500 | |
| SHOULDER 1 POSISI | 80,000 | |
| SHOULDER 2 POSISI | 160,000 | |
| SKULL ANAK 1 POSISI | 77,500 | |
| SKULL ANAK 2 POSISI | 155,000 | |
| SKULL DEWASA 1 POSISI | 88,000 | |
| SKULL DEWASA 2 POSISI | 176,000 | |
| THORACOLUMBAL ANAK 1 POSISI | 91,000 | |
| THORACOLUMBAL ANAK 2 POSISI | 182,000 | |
| THORACOLUMBAL DEWASA 1 POSISI | 94,750 | |
| THORACOLUMBAL DEWASA 2 POSISI | 189,500 | |
| THORAX ANAK 1 POSISI | 71,750 | |
| THORAX ANAK 2 POSISI | 143,500 | |
| THORAX DEWASA 1 POSISI | 88,000 | |
| THORAX DEWASA 2 POSISI | 176,000 | |
| USG ABDOMEN | 230,000 | |
| WRIST 1 POSISI | 66,000 | |
| WRIST 2 POSISI | 132,000 | |
