| NO | BIAYA TINDAKAN UMUM | UMUM | PEGAWAI DAN PENSIUNAN ITB | KELUARGA PEGAWAI | MAHASISWA S1, S2 DAN S3 |
|---|---|---|---|---|---|
| U-1 | Spooling atau Irigasi Kotoran Telinga (Kiri dan atau Kanan) | 150,000 | Subsidi | Subsidi | Subsidi |
| U-2 | Cauter | 350,000 | Subsidi | Subsidi | Subsidi |
| U-3 | Angkat kuku tanpa kesulitan (ekstirpasi) | 100,000 | Subsidi | Subsidi | Subsidi |
| U-4 | Angkat kuku dengan kesulitan (ekstirpasi) | 300,000 | Subsidi | Subsidi | Subsidi |
| U-5 | Hecting (jahit luka) 1-7 | 250,000 | Subsidi | Subsidi | Subsidi |
| U-6 | Hecting (jahit luka) 8-10 | 300,000 | Subsidi | Subsidi | Subsidi |
| U-7 | Hecting (jahit luka) >11 | 500,000 | Subsidi | Subsidi | Subsidi |
| U-8 | Perawatan luka kecil | 75,000 | Subsidi | Subsidi | Subsidi |
| U-9 | Perawatan luka sedang | 200,000 | Subsidi | Subsidi | Subsidi |
| U-10 | Perawatan luka besar | 300,000 | Subsidi | Subsidi | Subsidi |
| U-11 | Perawatan luka dengan kesulitan | 400,000 | Subsidi | Subsidi | Subsidi |
| U-12 | Nebulizer | 75,000 | Subsidi | Subsidi | Subsidi |
| U-13 | Observasi/ per jam | 125,000 | Subsidi | Subsidi | Subsidi |
| U-14 | Up hecting 1-5 | 30,000 | Subsidi | Subsidi | Subsidi |
| U-15 | Up hecting 6-10 | 50,000 | Subsidi | Subsidi | Subsidi |
| U-16 | Up hecting >11 | 70,000 | Subsidi | Subsidi | Subsidi |
| U-17 | Bidai (excl. Tensocrept) | 75,000 | Subsidi | Subsidi | Subsidi |
| U-18 | Rapid Antigen | 90,000 | Subsidi | Subsidi | Subsidi |
| NO | BIAYA TINDAKAN LAINNYA DAN PENUNJANG | UMUM | PEGAWAI ITB DAN PENSIUNAN | KELUARGA PEGAWAI | MAHASISWA S1, S2 DAN S3 |
|---|---|---|---|---|---|
| 1 | ECG | 75,000 | Subsidi | Subsidi | Subsidi |
| 2 | KB | 30,000 | Subsidi | Subsidi | Subsidi |
| 3 | Gula darah sewaktu | 25,000 | Subsidi | Subsidi | Subsidi |
| 4 | Kolesterol sewaktu | 25,000 | Subsidi | Subsidi | Subsidi |
| 5 | Cek kehamilan | 32,000 | Subsidi | Subsidi | Subsidi |
| 6 | Pasang IUD (Cu T) | 750,000 | Subsidi | Subsidi | Subsidi |
| 7 | Pasang IUD (Biasa ) | 450,000 | Subsidi | Subsidi | Subsidi |
| 8 | Injeksi | 25,000 | Subsidi | Subsidi | Subsidi |
| 9 | Korpus Alenium | 50,000 | Subsidi | Subsidi | Subsidi |
| 10 | Asam Urat sewaktu | 20,000 | Subsidi | Subsidi | Subsidi |
- Subsidi sesuai kategori pasien (yaitu kategori Pegawai ITB, Pegawai UPT Layanan Kesehatan, Keluarga Pegawai ITB, Pensiunan ITB, Mahasiswa ITB reguler/internasional (S1, S2 dan S3)) berdasarkan rujukan dokter UPT Layanan Kesehatan ITB.
- Subsidi tindakan Poli Umum dibatasi dalam sekali kunjungan adalah sebesar Rp. 250.000 (Dua Ratus Lima Puluh Ribu Rupiah)
- Subsidi Obat untuk Mahasiswa (S1, S2, & S3) sebesar Rp. 50.000,- per kunjungan.
- Subsidi Obat untuk Pegawai ITB sebesar Rp. 55.000,- per kunjungan atau Rp. 400.000,-per tahun.
- Subsidi Obat untuk Keluarga Pegawai ITB sebesar
- Rp. 35.000,- per kunjungan atau Rp. 250.000,-per tahun.