NO	JENIS PELAYANAN	BIAYA
	UGD	TARIF BANTUL	TARIF LUAR BANTUL
1	PERAWATAN LUKA
	KECIL	Rp         16,350	Rp                     22,000
	SEDANG	Rp         33,500	Rp                     33,500
	BESAR	Rp         56,000	Rp                     56,000
2	HECTING / JAHIT LUKA
	1-5	Rp         39,050	Rp                     61,500
	6-10	Rp         58,600	Rp                     87,500
	setelah jahitan 10	@ 5000	@ 5000
3	Ambil Jahitan	Rp         16,550	Rp                     19,000
4	Tindik per tindik	Rp            6,400	Rp                     21,700
	KIA
1	Pasang IUD	Rp         26,250	Rp                     76,800
2	Kontrol IUD	Rp         25,750	Rp                     37,500
3	Pelepasan IUD	Rp         25,750	Rp                     50,300
4	IVA	Rp         25,500	Rp                     29,200
5	Suntik KB	Rp            5,800	Rp                     11,400
6	Papsmear	Rp         21,500	Rp                     86,900
	GIGI
1	Pembersihan karang gigi per regio ( scalling)	Rp         13,750	Rp                     39,500
2	Tumpatan GIC 1 Permukaan	Rp         24,300	Rp                     49,500
3	Tumpatan GIC 2 Permukaan	Rp         24,300	Rp                     64,500
4	Tumpatan GIC lebih dari 2 Permukaan	Rp         24,300	Rp                     70,000
5	Pencabutan gigi decidui dengan citoject	Rp         10,600	Rp                     28,500
6	Pencabutan gigi decidui dengan topikal anestesi	Rp         10,600	Rp                     20,000
7	Pencabutan gigi dewasa dg spuit dispossible	Rp         12,100	Rp                     22,500
8	Pencabutan gigi dewasa dg spuit dispossible dg penyulit	Rp         29,350	Rp                     75,500
9	Pencabutan gigi dewasa dengan citoject	Rp         29,350	Rp                     50,000
10	Pencabutan gigi dewasa dengan citoject dg penyulit	Rp         29,350	Rp                     90,000
	LABORATORIUM
1	Cek Darah Lengkap Otomatis	Rp         40,000	Rp                     40,000
2	Glukosa Stik	Rp         12,450	Rp                     15,000
3	Asam Urat Stik	Rp         18,950	Rp                     20,000
4	Kolesterol Stik	Rp         24,350	Rp                     25,000
5	Trigliserid Stik	Rp         27,700	Rp                     30,000
6	Urin Lengkap	Rp         20,000	Rp                     20,000
7	Sampling darah kapiler	Rp            2,000	Rp                        2,000
8	Sampling darah vena	Rp            5,000	Rp                        5,000
9	Narkoba  / Benzodiazepine	Rp         24,350	Rp                     30,000
10	Narkoba  / Amphetamine	Rp         24,350	Rp                     30,000
	FISIOTERAPI
1	Terapi Latihan
	Kecil	Rp            5,500	Rp                        8,000
	Sedang	Rp            9,200	Rp                     12,000
	Besar	Rp         10,700	Rp                     17,000
2	Infra Red	Rp            7,150	Rp                        9,000
3	TENS	Rp            6,200	Rp                     10,000
4	Massage Bayi	Rp            2,950	Rp                     12,000
	LAIN-LAIN
1	Surat Sehat	Rp            5,000	Rp                        7,500
2	Cek Buta Warna	Rp            5,000	Rp                        5,000
3	Konseling	Rp            5,000	Rp                        5,000
4	Retribusi Rawat Jalan	Rp            5,500	Rp                        9,000
5	Retribusi UGD	Rp         11,000	Rp                     18,000