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Daftar Tarif Laboratorium Klinik Utama Kedungdoro

Berlaku Per 1 Maret 2016


Untuk Rumah Sakit

HEMATOLOGI

NO NAMA TEST ( Bhs Inggris )* BAHAN STABILITAS METODE HARI KERJA HASIL
1 ABO Group and Rh Type 1,0 mL darah EDTA 14 hari 2-8°C Agglutinasi Tiap hari 1 hari
2 Activated Partial Thromboplastin Time (APTT) 1,0 mL plasma sitras (1:9) Fresh < 4 jam 20-25°C Optic Tiap hari 1 hari
3 Antithrombin III (AT III) 2,0 ml Plasma Citrat (1:9) <4 jam 2-8°C, bulanan dibekukan Chromogenic Assay Tiap hari<jam 9 Besoknya
4 Blood Smear (Blood Film) 1,0 mL darah EDTA Fresh MGG Tiap hari 1 hari
5 Blood Viscosity 2,0 mL darah EDTA 6 jam 18-25°C, 2 hari 2-8°C Viscometer ( CP ) Tiap hari 1 hari
6 CD 4 Cell count , screening test 1 subset 2.0 mL darah EDTA Fresh (tidak lisis,tidak Fresh Indirect counting Tiap hari 1 hari
lipemik,tidak ikterus)
7 CD 4 Cell count , confirmation test 3 subsets 2.0 mL darah EDTA Fresh (tidak lisis,tidak Fresh Cytometer (FACS Calibur) Senin-Jumat <jam 09 1 hari
lipemik,tidak ikterus)
8 Coombs' Direct Anti Human Globulin ( IgG & C3c ) 2,0 mL darah EDTA Fresh < 24 jam Agglutinasi Tiap hari 1 hari
9 Coombs' Indirect Anti Human Globulin (IgG & C3c) 1.0 ml serum, 2,0 ml EDTA < 24 jam Agglutinasi Tiap hari 2 hari
10 D-dimer, see FDP 0,5 mL Plasma sitrat (1:9) Fresh < 8 jam 15-25°C, 2 bulan -20°C Latex Turbidimetry Tiap hari 1 hari
Immunoassay
11 Eosinophil Count, see IgE total 1,0 mL darah EDTA Fresh Flowcytometry Tiap hari 1 hari
12 Erythrocyte Sedimentation Rate (ESR), 2,0 mL darah EDTA Fresh Westergren Modifikasi Tiap hari 1 hari
see CRP quantitative
13 Ferritin 0,5 mL serum 7 hari 2-8°C , 12 bulan -20°C ECLIA Tiap hari 1 hari
14 Fibrinogen 1,0 mL plasma sitras (1:9) Fresh 8 jam 20- 25°C Optic Tiap hari 1 hari
15 Fibrinogen Degradation Product (FDP ), see D-dimer 0,5 mL plasma sitras (1:9) Fresh 8 jam 20- 25°C Latex Turbidimetry Tiap hari 1 hari
Hyperfibrinolysis secunder DIC 2 bulan -20°C Immunoassay

16 Folate/Folic acid 1,0 serum ( terlindung dari cahaya ) 2 jam 20-25°C, 2 hari 2-8°C ECLIA Sabtu Rabu

17 Full Blood Count (FBC), 5 Dif 2,0 mL darah EDTA Fresh Flowcytometry Sysmex Tiap hari 1 hari
18 Glucose-6 Phosphate Dehydrogenase (G6PD), quantitation 1,0 mL darah EDTA 7 hari 2-8°C Kinetik Tiap hari 1 hari
(U/g Hb)
19 Glucose-6 Phosphate Dehydrogenase (G6PD) neonatal, 1,0 mL darah EDTA 7 hari 2-8°C Kinetik Tiap hari 1 hari
quantitation (U/g Hb)
20 Haemoglobin electrophoresis 2,0 mL darah EDTA 4 hari 2-8°C HPLC Tiap hari selasa,
kamis,sabtu

21 Haemoglobin Analysis Panel ( Hb Electrophoresis, FBC, 2 x 2,0 mL darah EDTA 4 hari 2-8°C HPLC, flow cytometry, New Tiap hari selasa,
Blood film, HbH inclusion body) Methylene Blue kamis,sabtu

Contact Person : Ibu Kori


1/19
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Daftar Tarif Laboratorium Klinik Utama Kedungdoro
Berlaku Per 1 Maret 2016
Untuk Rumah Sakit

22 Haptoglobin (Intra Vascular Hemolysis) 0,5 mL serum 2 hari 2-8°C Laser Nephelometry Tiap hari 1 hari

23 HbA2, see HbA2 & HbF screening,HPLC method 2,0 ml darah EDTA 4 hari 2-8°C HPLC Tiap hari selasa,
24 HbF, see HbA2 & HbF screening,HPLC method 2,0 mL darah EDTA 4 hari 2-8°C HPLC Tiap hari kamis,sabtu
selasa,
kamis,sabtu

25 HbH, see Hb electrophoresis/Hb HPLC: Thalassemia &Hb 3,0 mL darah EDTA Fresh New Methylene Blue Tiap hari 1 hari
pathi screening

26 Iron (Fe/SI) 0,5 mL serum 7 hari 2-8°C Ferrozine Tiap hari 1 hari
27 Plasma Viscosity 1,0 mL plasma sitras (1:9) 6 jam 18-25°C, 2 hari 2-8°C Viscometer ( CP ) Tiap hari 1 hari
28 Platelet Aggregation (ADP 0,5/2,5uM,Coll,Epi) 10,0 mL darah sitras (1:9) Fresh < 2 jam Platelet aggregation Tiap hari 1 hari
29 Prothrombine Time ( PT ) 1,0 mL plasma sitras (1:9) Fresh < 4 jam 20-25°C Optic Tiap hari 1 hari
30 Reticulocyte 1,0 mL darah EDTA Fresh Miller/ New Methylene Blue Tiap hari 1 hari

31 Thalassemia panel (Hb Electrophoresis, FBC, Blood film, SI, 2 x 2,0 mL darah EDTA 4 hari 2-8°C HPLC, flow cytometry, New Tiap hari selasa,
TIBC, Ferritin ) Methylene Blue kamis,sabtu

32 Thrombine Time (TT) 1,0 mL plasma sitras (1:9) Fresh < 8 jam 20-25°C Optic Tiap hari 1 hari
33 TIBC 0,5 mL serum 7 hari 2-8°C Ferrozine Tiap hari 1 hari
34 Transferrin 0,5 mL serum 2 hari,2-8°C Laser Nephelometry Tiap hari 1 hari
35 Transferrin Saturation 2,0 mL serum 7 hari 2-8°C Ferrozine Tiap hari 1 hari
36 Trombotes / INR / PT 1,0 mL plasma sitras (1:9) Fresh < 4 jam 20-25°C Optic Tiap hari 1 hari
37 Vitamin B12 1,5 mL serum 2 jam 20-25°C,2 hari 2-8°C ECLIA Selasa 1 minggu

KIMIA KLINIK

38 Acid Phosphatase 0,5 mL serum 3 hari 2-8°C Enzymatic Tiap hari 1 hari
39 Adiponectin 0,5 mL serum 2 hari 2-8°C, 1 tahun -20°C EIA Tiap hari 1 minggu
40 Ammonia (NH3) 0,5 ml Plasma EDTA Fresh (Darah EDTA Fresh (2 jam 4° C) Enzymatic UV Tiap hari 1 hari
langsung disentrifus)
41 Amylase pancreatic 0,5 mL serum 7 hari 20-25°C, 7 hari 2-8°C, 1 th -20°C Enzymatic Tiap hari 1 hari
42 Apolipoprotein A1 0,5 mL serum 2 minggu 2-10°C Immunoturbidimetry Tiap hari 1 hari
43 Apolipoprotein B 0,5 mL serum 2 minggu 2-10°C Immunoturbidimetry Tiap hari 1 hari
44 Calcium 0,5 mL serum 7 hari 20-25°C, 3 minggu 2-8°C Photometric Tiap hari 1 hari

Contact Person : Ibu Kori


2/19
031-5312981,5322565
www.labkedungdoro.com
081331395079
Daftar Tarif Laboratorium Klinik Utama Kedungdoro
Berlaku Per 1 Maret 2016
Untuk Rumah Sakit

45 Calcium Ion 0,5 mL serum 24 jam 2-8°C ISE Tiap hari 1 hari
46 Carbon Dioxide (CO2) / Bicarbonate 0,5 mL serum 1 hari 2-8°C Enzimatik Tiap hari 1 hari
47 Chloride (Cl) 0,5 mL serum 24 jam 2-8°C, 3 minggu -20°C ISE Tiap hari 1 hari

48 Cholinesterase (CHE) 0,5 mL serum 14 hari 2-8°C , 6 bulan -20°C Fotometrik kinetik Tiap hari 1 hari
49 Creatinine ,eGFR MDRD 0,5 mL serum ( data : umur, L/P ) 7 hari 2 - 8°C Kinetik Tiap hari 1 hari

< 3 bulan -20°C


50 Creatinine Clearance Test (CCT) 0,5 mL serum, 5 mL Urine 24 jam.Volume 2 hari 2-8°C Kinetik Tiap hari 1 hari
urine 24 jam, TB & BB
51 Cystatin C, eGFR 1,0 mL serum ( data : umur, L/P ) 12 hari 2-8°C Latex Agg. Immunoassay Tiap hari 1 hari
52 Glycated Albumin 1,0 mL serum 7 hari 2-8°C Enzimatik Tiap hari 1 hari
53 Haemoglobin A1c,glycated (HbA1c) 2,0 mL darah EDTA 4 hari 2-8°C HPLC Tiap hari 1 hari
54 Low-Density Lipoprotein,small dense ( Direct sd-LDL), 1,0 mL serum 3 hari pd 2-8°C Uji direk homogenous Tiap hari 1 hari
mg/dL dengan presipitasi Heparin-
Mg

55 Low-Density Lipoprotein,small dense ( Indirect sd-LDL) - 1.0 mL serum < 1 minggu 2-10°C, > 1 minggu -20°C Immunoturbidimetry Tiap hari 1 hari
LDL / ApoB ratio
56 Lipase 0,5 mL serum 1 hari 15-25°C, 5 hari 2-8°C, 1 th -20°C Enzymatic Tiap hari 1 hari
57 Lipoprotein (a) / Lp(a) 0,5 mL serum < 2 minggu 2-10°C, > 2 minggu pd -20°C Latex Agglutination Tiap hari 1 hari
Immunoturbidimetric
58 Magnesium 0,5 mL serum 7 hari 2-8°C Photometric Tiap hari 1 hari
59 Phosphate (PO4) 0,5 mL serum 7 hari , 4-25°C, 3 bulan -20°C UV-endpoint Tiap hari 1 hari
60 Potassium (K) 0,5 mL serum 24 jam 2-8°C, 1 minggu -20°C ISE Tiap hari 1 hari
61 pH 0,5 mL serum Tiap hari 1 hari
62 Sodium (Na) 0,5 mL serum 24 jam 2-8°C, 1 minggu -20°C ISE Tiap hari 1 hari

IMMUNO SEROLOGI

63 Amoebiasis Serology 0,5 mL serum 5 hari 2-8°C ,3 bulan -20°C ELISA Tiap hari 1 hari
64 Anti Chikungunya IgM 0,5 mL serum 2 minggu 2-8°C , Sandwich Immunoassay Tiap hari 1 hari
>2 minggu -20°C

Contact Person : Ibu Kori


3/19
031-5312981,5322565
www.labkedungdoro.com
081331395079
Daftar Tarif Laboratorium Klinik Utama Kedungdoro
Berlaku Per 1 Maret 2016
Untuk Rumah Sakit

65 Anti Chlamydia Trachomatis IgG 0,5 mL serum 5 hari 2-8°C EIA Selasa,Jumat Rabu,Sabtu
66 Anti Chlamydia Trachomatis IgM 0,5 mL serum 5 hari 2-8°C EIA Selasa,Jumat Rabu,Sabtu
67 Anti Dengue IgG ELISA 0,5 mL serum 24 jam 2-8°C, 2 hari -20°C ELISA Tiap hari 1 hari

68 Anti Dengue IgM ELISA 0,5 mL serum 24 jam 2-8°C, 2 hari -20°C ELISA Tiap hari 1 hari
69 Anti Dengue IgG 0,5 mL serum 3 hari 2 - 8°C Sandwich Immunoassay Tiap hari 1 hari
70 Anti Dengue IgM 0,5 mL serum 3 hari 2 - 8°C Sandwich Immunoassay Tiap hari 1 hari
71 Anti Dengue IgG,IgM 0,5 mL serum 3 hari 2 - 8°C Sandwich Immunoassay Tiap hari 1 hari
72 Anti Helicobacter IgG (CIM),Children/Adult PPV 89% 0,5 mL serum 2 hari 2-8°C Sandwich Immunoassay Tiap hari 1 hari
against conserve Ag's : Vac,Cag,urease sub unit
73 Anti Human Immunodeficiency Virus Antibody 0,5 mL serum 10 hari 2-8°C ECLIA Tiap hari 1 hari
(Anti HIV)
74 Anti Human Immunodeficiency Virus Antibody (Anti HIV) 0,5 mL serum 7 hari 2-8°C ELFA Tiap hari 1 hari
DUO Ultra, (p24 Ag & Ab)
75 Anti Human Immunodeficiency Virus Antibody 0,5 mL serum 7 hari 2-8°C Western Blot Tiap hari 1 minggu
(Anti HIV)1&2 CombFirm test: Western Blot
76 Anti MCV, specific markers for Rheumatoid Arthritis 1,0 mL darah EDTA Fresh Sandwich Immunoassay Tiap hari 1 hari
77 Anti Mycoplasma pneumoniae IgM 1,0 ml serum 5 hari 2-8°C EIA Tiap hari 1 hari
78 Anti Streptolysin O (ASO),kadar (IU/mL) 0,5 mL serum 3 hari 2-8°C Nephelometry Tiap hari 1 hari
79 Anti-Cyclic Citrulinated Peptide (Anti-CCP) 1,0 mL serum 3 hari 2-8°C, 1 bulan -20°C ECLIA Tiap hari Besoknya
80 C-Reactive Protein (CRP),qualitative 0,5 mL serum 2 hari 2-8°C Latex Agg. Tiap hari 1 hari
Immunoturbidimetric
81 C-Reactive Protein (CRP),quantitative 0,5 mL serum 7 hari 2-8°C Latex Tiap hari 1 hari
Agg.Immunoturbidimetric
82 C-Reactive Protein,High Sensitivity (Hs CRP) 0,5 mL serum 14 hari 2-8°C Latex Tiap hari 1 hari
Agg.Immunoturbidimetry
83 Dengue NS1 Antigen 0,5 mL serum 24 jam suhu 2-8°C, 2 hari -20°C ELISA Tiap hari 1 hari
84 Gamma Globulin 0,5 mL serum 7 hari 2-8°C Hidragel Tiap hari 1 hari
85 Helicobacter pylori IgM ( ELISA ) 0,5 mL serum 7 hari 2-8°C, > 7 hari-20°C EIA Tiap hari < jam 10 1 hari
86 IgE Atopic panel (21 allergens) 2,0 mL serum 3 hari 2-8°C, 3 bulan -20°C Immunoblotting Tiap hari 1 minggu
87 IgE South East Asia cuisine ( 20 allergens) 2,0 mL serum 3 hari 2-8°C, 3 bulan -20°C Immunoblotting 3 x seminggu 1 minggu
88 IgE Pediatric panel (27 allergens) 2,0 mL serum 3 hari 2-8°C, 3 bulan -20°C Immunoblotting 3 x seminggu 1 minggu
89 IgE Respiratory / Breathing Panel ( 20 allergens) 2,0 mL serum 3 hari 2-8°C, 3 bulan -20°C Immunoblotting 3 x seminggu 1 minggu
90 IgE specific, beef meat, pork meat & chicken meat 3,0 mL serum 3 hari 2-8°C, 3 bulan -20°C Chemiluminescence 2 x seminggu 1 minggu
Immunoassay

Contact Person : Ibu Kori


4/19
031-5312981,5322565
www.labkedungdoro.com
081331395079
Daftar Tarif Laboratorium Klinik Utama Kedungdoro
Berlaku Per 1 Maret 2016
Untuk Rumah Sakit

91 IgE specific, clams, sea fish, shrimp, prawn, lobster & crab 3,0 mL serum 3 hari 2-8°C, 3 bulan -20°C Chemiluminescence 2 x seminggu 2 hari
92 IgE specific cow milk, egg white & egg yolk 3,0 mL serum 3 hari 2-8°C, 3 bulan -20°C Immunoassay
Chemiluminescence 2 x seminggu 2 hari
93 IgE specific, flour, rice, sesame oil & soya bean 3,0 mL serum 3 hari 2-8°C, 3 bulan -20°C Immunoassay
Chemiluminescence 2 x seminggu 2 hari
Immunoassay

94 IgE specific, peanut & hazelnut 3,0 mL serum 3 hari 2-8°C, 3 bulan -20°C Chemiluminescence 2 x seminggu 2 hari
Immunoassay
95 IgE specific,Chocolate & Mono Sodium Glutamate 3,0 mL serum 3 hari 2-8°C, 3 bulan -20°C Chemiluminescence 2 x seminggu 2 hari
Immunoassay
96 IgM Rheumatoid Factor (IgM RF). 0,5 mL serum 14 hari 2-8°C ELISA Tiap hari Besoknya
97 Immunoglobulin A (IgA) 0,5 mL serum 2 hari,2-8°C Laser Nephelometry Tiap hari 1 hari
98 Immunoglobulin E (IgE) 0,5 mL serum 7 hari,2-8° / 6 bulan -20°C ECLIA Tiap hari 1 hari
99 Immunoglobulin G (IgG) 0,5 mL serum 2 hari 2-8°C Laser Nephelometry Tiap hari 1 hari
100 Immunoglobulin M (IgM) 0,5 mL serum 2 hari 2-8°C Laser Nephelometry Tiap hari 1 hari
101 Malaria, ICT (Ag detection) 1,0 mL darah EDTA 2 hari 2-8°C Sandwich Immunoassay Tiap hari 1 hari
102 Malaria,Thick Film 2,0 mL darah EDTA 2 hari 2-8°C Giemsa Tiap hari 1 hari
103 Prealbumin (Transthyretin) 0,5 mL serum 2 hari 2-8°C Laser Nephelometry Tiap hari 1 hari
104 Procalcitonin 0,5 mL serum 24 jam 2-8°C / 3 bulan -20°C ECLIA Tiap hari 1 hari
105 Protein Electrophoresis,Serum 0,5 mL serum 7 hari 2-8°C Hydragel Tiap hari Besoknya
106 Rose Waaler 0,5 mL serum 2 hari 2-8°C Agglutinasi Tiap hari 1 hari
107 Rheumatoid Factor (RF) 0,5 mL serum 2 hari 2-8°C Nephelometry Tiap hari 1 hari
108 Salmonella typhi, IgM (IPS 0,9 ) 0,5 mL serum 3 hari 2-8°C IMBI Tiap hari 1 hari
109 Treponema Pallidum Haemagglutination (TPHA) 0,5 mL serum 7 hari 2-8°C,3 bulan -20°C IHA Tiap hari 1 hari
110 Tuberculosis (TB),ICT 0,5 mL serum 3 hari 2-8 °C Sandwich immunoassay Tiap hari 1 hari
112 VDRL for syphilis 0,5 mL serum 7 hari 2-8°C, 3 bulan -20°C Agglutinasi Tiap hari 1 hari
113 Vitamin D3 total, 25-Hydroxy,screening for osteoporosis 0,5 mL serum 4 hari 2-8°C, 8 jam 18-25°C, ECLIA Tiap hari 1 hari
risk 4 minggu -20°C

TORCH

Contact Person : Ibu Kori


5/19
031-5312981,5322565
www.labkedungdoro.com
081331395079
Daftar Tarif Laboratorium Klinik Utama Kedungdoro
Berlaku Per 1 Maret 2016
Untuk Rumah Sakit

114 Cytomegalovirus (CMV) IgG Antibody 0,5 mL serum 7 hari 2-8°C , 6 bulan -20°C ELFA / ECLIA Tiap hari 1 hari
115 Cytomegalovirus (CMV) IgG Avidity 0,5 mL serum 5 hari 2-8°C, 6 bulan -20°C ELFA / ECLIA Tiap hari 1 hari
116 Cytomegalovirus (CMV) IgM Antibody 0,5 mL serum 5 hari 2-8°C, 6 bulan -20°C ELFA / ECLIA Tiap hari 1 hari
117 Herpes Simplex IgG (HSV IgG ) Virus 1 0,5 mL serum ≤ 24 jam 2-8°C, Lebih panjang,-20°C EIA Tiap hari 1 hari
118 Herpes Simplex IgG (HSV IgG ) Virus 2 0,5 mL serum ≤ 24 jam 2-8°C bulanan,-20°C EIA Tiap hari 1 hari
119 Herpes Simplex IgM (HSV IgM ) Virus 1 0,5 mL serum ≤ 24 jam 2-8°C bulanan,-20°C EIA Tiap hari 1 hari
120 Herpes Simplex IgM (HSV IgM) Virus 2 0,5 mL serum ≤ 24 jam 2-8°C bulanan,-20°C EIA Tiap hari 1 hari
121 Rubella IgG 0,5 mL serum 14 hari 2-8°C, > 14 hari -20°C ECLIA / ELFA Tiap hari 1 hari
122 Rubella IgM 0,5 mL serum 14 hari 2-8°C, >14 hari -20°C ECLIA / ELFA Tiap hari 1 hari
123 Toxoplasma IgG 0,5 mL serum 7 hari 2-8°C , 3 bulan -20°C ECLIA / ELFA Tiap hari 1 hari
124 Toxoplasma IgG Avidity 0,5 mL serum 5 hari 2-8°C, 3 bulan -20°C ECLIA / ELFA Tiap hari Besoknya
125 Toxoplasma IgM 0,5 mL serum 7 hari 2-8°C , 3 bulan -20°C ECLIA / ELFA Tiap hari 1 hari
126 Toxoplasma IHA 0,5 mL serum 7 hari 2-8°C, > 7 hari -10°C IHA Tiap hari 1 hari

HEPATITIS

127 Anti-Hepatitis A Antibody (Anti HAV),IgM 0,5 mL serum 7 hari 2-8°C , 3 bulan -20°C ECLIA / CMIA Tiap hari 1 hari
128 Anti-Hepatitis A Antibody (Anti HAV),Total 0,5 mL serum 7 hari 2-8°C, 3 bulan -20°C ECLIA / CMIA Tiap hari 1 hari
129 Anti-Hepatitis B Core Antibody (Anti HBc),IgM 0,5 mL serum 6 hari 2-8°C, 3 bulan - 20°C ECLIA / CMIA Tiap hari 1 hari
130 Anti-Hepatitis B Core Antibody (Anti HBc),Total 0,5 mL serum 5 hari 2 - 8°C, 3 bulan - 20°C ECLIA / CMIA Tiap hari 1 hari
131 Anti-Hepatitis B Surface Antibody (Anti-HBs) 0,5 mL serum 6 hari 2-8°C, 3 bulan -20°C ECLIA Tiap hari 1 hari
132 Anti-Hepatitis C Antibody (Anti HCV) 0,5 mL serum 7 hari 2-8°C, 3 bulan -20°C ECLIA / CMIA Tiap hari 1 hari
133 Anti Hepatitis B e Antibody (Anti-HBe) 0,5 mL serum 5 hari 2-8°C, 3 bulan -20°C ECLIA / CMIA Tiap hari 1 hari
134 Hepatitis B e Antigen (HBe Ag) 0,5 mL serum 7 hari 2-8°C, 3 bulan -20°C ECLIA / CMIA Tiap hari 1 hari
135 Hepatitis B Surface Antigen (HBs Ag II),mutant 0,5 mL serum 5 hari 2-8°C, 3 bulan-20°C ECLIA / CMIA Tiap hari 1 hari
136 Hepatitis B Surface Antigen (HBs Ag) Titer Iu/mL 0,5 mL serum 5 hari 2-8°C , 3 bulan -20°C ECLIA Tiap hari 2 hari

HORMON

Contact Person : Ibu Kori


6/19
031-5312981,5322565
www.labkedungdoro.com
081331395079
Daftar Tarif Laboratorium Klinik Utama Kedungdoro
Berlaku Per 1 Maret 2016
Untuk Rumah Sakit

137 Adrenocorticotrophic Hormone (ACTH) 1,0 mL plasma EDTA, beku 1 bulan -20°C Chem.EIA Tiap hari 1 hari
138 Aldosterone 1,0 mL serum /plasma EDTA,Heparin serum : 12 jam 2-8°C 2 bln -20°C CLIA Tiap hari 1 hari
plasma : 24 jam 2-8°C ,2 bln -20°C
139 Amenorrhoea (FSH,LH,E2,& Prolactin) 2,0 mL serum 2 hari 2-8°C CHEM.EIA/ ELFA Tiap hari 1 hari
140 Cortisol 0,5 mL serum (pagi / sore) 5 hari 2- 8°C / 3 bulan -20°C CHEM.EIA Tiap hari 1 hari
141 C-Peptide 2 hour post pandrial 0,5 mL serum 4 jam 15-25°C , 24 jam 2-8°C ECLIA Tiap hari 1 hari
142 C-Peptide fasting 0,5 mL serum 4 jam 15-25°C , 24 jam 2-8°C ECLIA Tiap hari 1 hari
143 Dehydroepiandrosterone Sulphate (DHEAS) 3,0 mL serum 7 hari 2-8°C Chem.EIA Tiap hari
144 Estradiol (E2) 0,5 mL serum 2 hari 2-8°C Chem.EIA/ELFA Tiap hari 1 hari

145 Follicle Stimulating Hormone (FSH) 0,5 mL serum 2 hari 2-8°C, 1 bulan -25°C Chem.EIA/ELFA Tiap hari 1 hari
146 Growth Hormone 0,5 mL serum 8 jam 2-8°C,2 bulan-20°C Chem.IA Tiap hari 1 hari
147 Homa B 0.5 mL serum + 0,5 ml Plasma NaF 1 hari 20-25°C, ECLIA, GOD-PAP Tiap hari 1 hari
148 Homa IR 0.5 mL serum + 0,5 ml Plasma NaF 7
1 hari
hari 4-8°C
20-25°C,7 hari 4-8°C ECLIA, GOD-PAP Tiap hari 1 hari
149 Insulin 0,5 mL serum ( Puasa / 2 jam PP ) 24 jam 2-8°C,6 bulan -20°C ECLIA Tiap hari 1 hari
150 Insulin-like Growth Factor 1(IGF1) 0,5 mL serum 12 jam 2-8°C,12 bulan-20°C Chemiluminescence Rabu
151 Luteinising Hormone (LH) 0,5 mL serum 2 hari 2-8°C Chem.IA/ELFA Tiap hari 1 hari
152 Progesterone 0,5 mL serum 24 jam 2-8°C Chem.EIA/ELFA Tiap hari 1 hari
153 Prolactin 0,5 mL serum 2 hari 2-8°C, 1 bulan -25°C Chem.IA/ELFA Tiap hari 1 hari
154 Sex Hormone Binding Globulin (SHBG) Serum 3,0 mL 7 hari 2-8°C, 2 bln -20°C Chem.IA Tiap hari 1 hari
155 Testosterone 0,5 mL serum 7 hari 2-8°C Chem.EIA Tiap hari 1 hari
156 Testosterone,Free 0,5 mL serum 12 jam 2-8°C, 30 hari -20°C CLIA Tiap hari 1 hari

TIROID

157 Anti-Thyroid Peroxidase (TPO) 1,0 mL serum 3 hari 2-8°C, 1 bulan -20°C EIA Tiap hari 1 hari
158 Anti Thyroglobulin 1,0 mL serum 5 hari 2-8°C, 1 bulan -20°C EIA Tiap hari 1 hari
159 FT4I (T4/TBK) 0,5 mL serum 7 hari 2-8°C, 1 bulan -20°C ECLIA Tiap hari 1 hari
160 Parathyroid Hormone,Intact (iPTH) 0.5 mL serum 8 jam 15-25°C, 2 hari 2-8°C, 6 bulan -20°C ECLIA Tiap hari 1 hari
161 TBK/T Uptake 0,5 mL serum 8 hari 2-8°C, 3 bulan -20°C ECLIA Tiap hari 1 hari

Contact Person : Ibu Kori


7/19
031-5312981,5322565
www.labkedungdoro.com
081331395079
Daftar Tarif Laboratorium Klinik Utama Kedungdoro
Berlaku Per 1 Maret 2016
Untuk Rumah Sakit

162 Triiodothyronine (T3),Total 0,5 mL serum 7 hari 2-8°C , 1 bulan -20°C ECLIA / CMIA Tiap hari 1 hari
163 Thyroglobulin 0,5 mL serum 3 hari 2-8°C Chem.IA Tiap hari 1 hari
164 Thyroxine (T4),Total 0,5 mL serum 7 hari 2-8°C , 2 bulan -20°C ECLIA Tiap hari 1 hari
165 Thyroxine,Free (Free T4) 0,5 mL serum 7 hari 2-8°C , 1 bulan -20°C ECLIA / CMIA Tiap hari 1 hari
166 Triiodothyronine,Free (Free T3) 0,5 mL serum 7 hari 2-8°C , 1 bulan -20°C ECLIA / CMIA Tiap hari 1 hari
167 TSH Receptor Antibody (TRAb) 0,5 mL serum 3 hari 2-8°C, 1 bulan -20°C ECLIA / CMIA Jum'at Sabtu
168 TSH Sensitif 0,5 mL serum 7 hari 2-8°C , 1 bulan -20°C ECLIA Tiap hari 1 hari
169 TSH neonatal 0,5 mL serum/ whole blood on filter paper 7 hari 2-8°C . 1 bulan -20°C ECLIA Tiap hari 1 hari

AUTOIMMUNE

170 Anti Cardiolipin Antibody,IgG (ACA IgG) 0,5 mL serum 5 hari 2 - 8°C, 6 bulan - 20°C EIA Senin,Kamis Selasa,Jum'at
171 Anti Cardiolipin Antibody,IgM (ACA IgM) 0.5 mL serum 5 hari 2 - 8°C, 6 bulan - 20°C EIA Senin,Kamis Selasa,Jum'at
172 Anti Nuclear Antibody (ANA) - Profile 3 Euroline, 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
173 confirmation test
Anti Nuclear Antibody (ANA), Anti Ku 0,5 mL serum 14 hari 2-8°C IFA,HEP-2 Cells sabtu, rabu senin, kamis
174 Anti Nuclear Antibody (ANA), Anti Nuclear dots 0,5 mL serum 14 hari 2-8°C IFA,HEP-2 Cells sabtu, rabu senin, kamis
175 Anti Nuclear Antibody (ANA Profile ), CENP B 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
176 Anti Nuclear Antibody (ANA Profile ), dsDNA 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
177 Anti Nuclear Antibody (ANA Profile ), histones 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
178 Anti Nuclear Antibody (ANA Profile ), Jo-1 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
179 Anti Nuclear Antibody (ANA Profile ), nRNP/Sm 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
180 Anti Nuclear Antibody (ANA Profile ), nucleosomes 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
181 Anti Nuclear Antibody (ANA Profile ), Ribosomal P-proteins 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu

182 Anti Nuclear Antibody (ANA Profile ), Ro-52 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
183 Anti Nuclear Antibody (ANA Profile ), Scl-70 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
184 Anti Nuclear Antibody (ANA Profile ), Sm 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
185 Anti Nuclear Antibody (ANA Profile ), SS-A (Ro) 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
186 Anti Nuclear Antibody (ANA Profile ), SS-B (La) 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
187 Anti Nuclear Antibody (ANA Profile ), PCNA 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu

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8/19
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Untuk Rumah Sakit

188 Anti Nuclear Antibody (ANA Profile ), PM-Scl 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
189 Anti Nuclear Antibody (ANA Profile ), AMA-M2 0,5 mL serum 14 hari 2-8°C Immunoblotting Tiap hari 2 minggu
190 Anti Nuclear Antibody (ANA), Anti F-actin 0,5 mL serum
191 Anti Nuclear Antibody (ANA), Anti Few Nuclear dots 0,5 mL serum 14 hari 2-8°C IFA,HEP-2 Cells sabtu, rabu senin, kamis
192 Anti Nuclear Antibody (ANA), Anti Fibrillarin / anti 0,5 mL serum 14 hari 2-8°C IFA,HEP-2 Cells sabtu, rabu senin, kamis
Nucleolar Clumpy
193 Anti Nuclear Antibody (ANA), Anti Golgi Apparatus 0,5 mL serum 14 hari 2-8°C IFA,HEP-2 Cells sabtu, rabu senin, kamis
194 Anti Nuclear Antibody (ANA), Anti Lysosomes 0,5 mL serum 14 hari 2-8°C IFA,HEP-2 Cells sabtu, rabu senin, kamis
195 Anti Nuclear Antibody (ANA), Anti Nuclear Membrane 0,5 mL serum 14 hari 2-8°C IFA,HEP-2 Cells sabtu, rabu senin, kamis
196 Anti Nuclear Antibody (ANA), Anti RNA Polymerase 0,5 mL serum 14 hari 2-8°C IFA,HEP-2 Cells sabtu, rabu senin, kamis
197 Anti Nuclear Antibody (ANA), Anti Vimentin 0,5 mL serum 14 hari 2-8°C IFA,HEP-2 Cells sabtu, rabu senin, kamis
198 Anti Nuclear Antibody (ANA), Detect , Screening test 0,5 mL serum 5 hari 2 - 8°C, bulanan - 20°C EIA senin,kamis selasa,jumat
199 Anti Nuclear Antibody (ANA), IFA 0,5 mL serum 14 hari 2-8°C IFA,HEP-2 Cells sabtu, rabu senin, kamis
200 Anti Nuclear Cytoplasm Antibody (ANCA) screen hs 0.5 mL serum 5 hari 2 - 8°C, 6 bulan - 20°C EIA Selasa, jum'at Rabu,Sabtu
201 Anti-ds-DNA, Screen 0,5 mL serum 5 hari 2 - 8°C, bulanan - 20°C EIA senin,kamis selasa,jumat
202 Antiphospholipid Antibody (APL/APS) - ACA & Lupus 1,0 mL plasma sitras & 0,5 mL serum plasma sitras : < 8 jam. ELISA & Optic Senin,Kamis Selasa,Jum'at
Anticoagulant. Dx Antiphospholipid Syndrome (APS) Serum : 5 hari 2 - 8°C , 6 bulan -20°C
203 Anti-Smooth Muscle Antibody (ASMA/SMA) 0,5 mL serum 14 hari 2-8°C IFA,HEP-2 Cells sabtu,rabu senin, kamis
204 Anti Mitochondrial Antibody (AMA) 0,5 mL serum 14 hari 2-8°C IFA,HEP-2 Cells sabtu,rabu senin, kamis
205 Complement 3 (C3) 0,5 mL serum 2 hari 2-8°C Laser Nephelometry Tiap hari 1 hari
206 Complement 4 (C4) 0,5 mL serum 2 hari 2-8°C Laser Nephelometry Tiap hari 1 hari
207 Lupus Anticoagulant ( LA 1& LA II ) 0,5 mL Plasma citras (1:9) Fresh < 8 jam Optic Tiap hari 1 hari
208 Lupus Erythematosus (LE) test 0,5 mL serum 14 hari 2-8°C IIFT sabtu, rabu senin, kamis

PENANDA TUMOR

209 Alphafetoprotein (AFP) 0,5 mL serum 7 hari 2-8°C / 12 bulan-20°C ECLIA Tiap hari 1 hari
210 Beta HCG Serum 0.5 mL serum / 1,0 ml urine 7 hari 2-8°C, 12 bln -20°C ECLIA Tiap hari 1 hari
211 Beta-2 Microglobulin 0.5 mL serum 7 hari 2-8°C, 2 bulan -20°C Fluorosence enzyme Tiap hari 1 hari
immunoassay
212 CA 125 0,5 mL serum 5 hari 2-8°C, 3 bulan -20°C ECLIA / Fluorosence enzyme Tiap hari 1 hari
immunoassay

Contact Person : Ibu Kori


9/19
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213 CA 15-3 0,5 mL serum 5 hari 2-8°C , 12 bulan -20°C ECLIA Tiap hari 1 hari
214 CA 19-9 0,5 mL serum 7 hari 2-8°C , 3 bulan -20°C ECLIA Tiap hari 1 hari
215 CA 72-4 0,5 mL serum 5 hari 2-8°C , 3 bulan -20°C EIA Jum'at 1 minggu
216 Calcitonin (Tumour Marker) 1,0 mL serum Kirim beku Chem.IA
217 Carcinoembryonic Antigen (CEA) 0,5 mL serum 7 hari 2-8°C ECLIA Tiap hari 1 hari
218 Cyfra 21-1 1,0 mL serum 24 jam 2-8 °C Selasa
219 Human Epididymis Protein (HE4) 0,5 mL serum Fresh < 2 jam EIA Rabu
220 Neuron-Specific Enolase (NSE) 0,5 mL serum 24 jam 2-8°C , 6 jam -25°C ECLIA Tiap hari 1 hari
221 Nuclear Matrix Protein 22 (NMP 22) 10 mL urin dlm tabung plastik
222 Prostate Specific Antigen (PSA) 0,5 mL serum 5 hari 2-8°C, 3 bln -20°C ECLIA / CHEM.IA Tiap hari 1 hari
223 Prostate Specific Antigen (PSA),Free 0,5 mL serum 24 jam 2-8°C , >24 jam -20°C CMIA / Chem.EIA Tiap hari 1 hari
224 Squamous Cell Carcinoma (SCC) 0.5 mL serum 7 hari 2-8°C,> 7 hari,-20°C CMIA Tiap hari 1 hari

JANTUNG

225 Creatine Kinase (CK) 0,5 mL Serum 2 hari 20-25°C, 7 hari 4-8°C DGKC Tiap hari 1 hari
226 Creatine Kinase-MB (CKMB), Activity 0,5 mL Serum 2 hari 20-25°C, 7 hari 4-8°C DGKC Tiap hari 1 hari
227 Homocysteine 0,5 mL serum 14 hari 2-8°C, 3 bulan -20°C CMIA Tiap hari 1 hari
228 Lactate Dehydrogenase (LDH) 0,5 mL Serum , 5,0 mL cairan pleura 4 hari 20-25°C, 6 minggu 4-8°C DGKC Tiap hari 1 hari
229 NT-pro Brain Natriuretic Peptide (NT-Pro BNP) 0,5 mL Serum 6 hari 2-8°C, 3 hari 20 - 25°C ECLIA Tiap hari 1 hari
230 Troponin I 0,5 mL Serum 1 hari 2-8°C, 12 bulan -20°C Quantitatif Immunofluorecence Tiap hari 1 hari
assay

231 Troponin T hs 0,5 mL serum 1 hari 2 - 8°C, 12 bulan -20°C ECLIA Tiap hari 2 hari
1 th pd -20°C

` MICROBIOLOGY

232 Culture & Sensitivity, Tuberculosis (TB) Sputum di tempat steril 3 hari di media transport 2-8°C Konvensional Tiap hari 3 bulan
233 Culture, Blood Aerobic 5,0 cc darah dalam media aerob (HIB) 3 hari di media transport 2-8°C Konvensional Tiap hari 5-7 hari
234 Culture, Blood Anaerobic 5,0 cc darah dalam media anaerob (thio) 3 hari di media transport 2-8°C Konvensional Tiap hari 5-7 hari
235 Culture, Blood Anaerobic & Aerobic masing- masing 5,0 mL dalam media 3 hari di media transport 2-8°C Konvensional Tiap hari 5-7 hari
transport

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236 Culture, Usap Tenggorok / Usap hidung selain C.diphteriae Usap tenggorok/ usap hidung dalam media 3 hari di media transport 2-8°C Konvensional Tiap hari 4-5 hari
transport
237 Culture, Usap Tenggorok / Usap hidung C.diphteriae Usap tenggorok/ usap hidung dalam media 3 hari di media transport 2-8°C Konvensional Tiap hari 4-7 hari
transport
238 Toxigenitas C.diphtheriae Test Usap tenggorok/ usap hidung dalam media 3 hari di media transport 2-8°C Konvensional Tiap hari
transport
239 Culture, CSF Aerobic 1,0 mL CSF dalam media transport fresh Konvensional Tiap hari 5-7 hari
240 Culture, Faeces Faeces ( tempat steril ) 1 hari di media transport 2-8°C Konvensional Tiap hari 5-7 hari
241 Culture, Jamur Sesuai bahan 3 hari di media transport 2-8°C Konvensional Tiap hari 2 - 3 minggu
242 Culture, Gall 5,0 cc darah dalam media aerob (HIB) 3 hari di media transport 2-8°C Konvensional Tiap hari 3-5 hari
243 Culture, Pleura Cairan pleura dalam media TSB 3 hari di media transport 2-8°C Konvensional Tiap hari 5-7 hari
244 Culture, Pus / Exudat Aerobic 3,0 cc pus / Exudat dalam media transport 3 hari di media transport 2-8°C Konvensional Tiap hari 5-7 hari

245 Culture, Pus / Exudat Anaerobic 3,0 cc pus / Exudat dalam media transport 3 hari di media transport 2-8°C Konvensional Tiap hari 5-7 hari

246 Culture, Pus / Exudat Aerobic & Anaerobic 3,0 mL dalam media transport 3 hari di media transport 2-8°C Konvensional Tiap hari 5-7 hari
247 Culture, Sputum Sputum di tempat steril 3 hari di media transport 2-8°C Konvensional Tiap hari 5-7 hari
248 Culture, Urethra Swab swab urethra dalam media transport 3 hari di media transport 2-8°C Konvensional Tiap hari 4-5 hari
249 Culture, Urine Fresh Urine (tempat steril) 1 hari di media transport 2-8°C Konvensional Tiap hari 5-7 hari
250 Culture, Vagina Swab swab vagina dalam media transport 3 hari di media transport 2-8°C Konvensional Tiap hari 4-5 hari
251 Methicillin-Resistant Staphylococcus aureus (MRSA) Sesuai bahan 1 hari 2-8°C Konvensional Tiap hari 5 - 7 hari
252 Methicillin-Resistant Staphylococcus aureus, Confirmation Sesuai bahan 1 hari 2-8°C Konvensional Tiap hari 5 - 7 hari
253 Ziehl-Neelsen Stain for acid fast organisms,see TB Antigen Sputum Fresh Ziehl-Neelsen Tiap hari 1 hari

URINE

254 Albumin,urine (microalbumin)-quantitative 10,0 mL Urine fresh Fresh Latex immunoturbidimetric Tiap hari 1 hari
assay
255 Albumin/Creatinine Ratio 10,0 mL Urine Fresh Fresh Latex immunoturbidimetric Tiap hari 1 hari
assay
256 Chloride, Urine 10,0 mL Urine 24 jam ( Volume ) /sesaat Fresh ISE Tiap hari 1 hari
257 Calcium Urine 10,0 mL Urine 24 jam Fresh Photometric Tiap hari 1 hari
258 Creatinine Urine 5,0 mL Urine 24 jam ( Volume urine , BB ) 6 hari 4 - 8 °C, 2 hari pd 20-25°C Kinetik Tiap hari 1 hari
6 hari pd 4-8°C

Contact Person : Ibu Kori


11/19
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259 Eosinophil, urine staining (Hansel's) 10,0 mL Urine Fresh Fresh Hansels's stain Tiap hari 1 hari
260 Esbach, see Protein Total,urine quantitative 20,0 mL Urine 24 Jam Fresh Presipitasi Tiap hari 2 hari
261 Glomerular Bleeding, Special Microscopy : G1 cells 20,0 mL Urine Fresh Fresh 4 jam suhu ruang Phase Contrast Tiap hari Besoknya
262 IgA Nephropathy Panel ( IgA, C3, UL, Glomerular Bleeding, 10,0 mL urine fresh dan 0,5 mL serum dan see IgA,C3,Glomerular bleeding,Total protein Laser Nephelometry, Tiap hari Besoknya
Total Protein urine) urine 24 jam urine Refrectometry, Phase
Contrast, & Biuret

263 Oval fat bodies 10,0 mL urine Fresh Phase Contrast Tiap hari 1 hari
264 Phosphate (PO4),Urine 5,0 mL Urine 24 jam ( Volume urine ) 2 hari 20-25°C pd pH<5 Photometric Tiap hari 1 hari
265 Potassium (K), Urine 10,0 mL Urine 24 jam / sesaat Fresh ISE Tiap hari 1 hari
266 Sodium,Urine 10,0 mL Urine 24 jam / sesaat Fresh ISE Tiap hari 1 hari
267 Urea Nitrogen Urine 5,0 mL Urine 24 jam ( Volume urine ) 6 hari 4 - 8 °C, 2 hari 20-25°C Urease GLDH : Enzimatic UV Tiap hari 1 hari
Test
268 Uric acid,urine 5,0 mL Urine 24 jam ( Volume urine ) 4 hari 20-25°C Enzimatic photometric Tiap hari 1 hari
(TBHBA)
269 Urine Microscopy . Urinary sediment, Acute Kidney Injury/ 10 mL urine fresh/ urine dgn pengawet 3 bulan pd 18-25°C jika diawetkan dengan Mikroskop fase kontras Tiap hari 1 hari
Acute Tubular Necrosis Glutaraldehyde/ formaldehyde Glutaraldehyde /formaldehyde

FAECES

270 Clini Test Faeces Fresh Tiap hari Besoknya


271 Faecal Occult Blood (FOB) Faeces Fresh Fresh Sandwich Immunoassay Tiap hari 1 hari
272 Floating Test Faeces Fresh Tiap hari Besoknya
273 Helicobacter pylori Stool Antigen (HpSA),see anti H.pylori Faeces Fresh Sandwich Immunoassay Tiap hari 1 hari
IgG (CIM)

DRUG ABUSE

274 Amphetamine 5,0 mL urine fresh 2 hari 2-8°C Sandwich Immunoassay Tiap hari 1 hari
275 Benzodiazepine 5,0 mL urine fresh 2 hari 2-8°C Sandwich Immunoassay Tiap hari 1 hari
276 Coccaine 5,0 mL urine fresh 2 hari 2-8°C Sandwich Immunoassay Tiap hari 1 hari

Contact Person : Ibu Kori


12/19
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277 Marijuana ( THC ) 5,0 mL urine fresh 2 hari 2-8°C Sandwich Immunoassay Tiap hari 1 hari
278 Methamphetamine 5,0 mL urine fresh 2 hari 2-8°C Sandwich Immunoassay Tiap hari 1 hari
279 Opiate 5,0 mL urine fresh 2 hari 2-8°C Sandwich Immunoassay Tiap hari 1 hari

DRUG MONITORING

280 Carbamazepine 1,0 mL serum 1 hari 2-8°C Chem.EIA Tiap hari


281 Cyclosporin Parent 3,0 mL darah EDTA 7 hari 2-8 °C FPIA Tiap hari
282 Digoxin 0,5 mL serum 24 jam 2- 8 °C , 7 hari < -10 °C FPIA Tiap hari
283 Lithium 0,5 mL urine 8 jam 18 - 25 °C, 2 hari 2-8°C ISE Senin s/d Sabtu
284 Theophyllin 0,5 mL plasma/serum. Jgn menggunakan 1 hari 2-8°C , 7 hari -20°C FPIA Tiap hari
tabung SST

PCR

285 Chlamydia Trachomatis,PCR qualitative 3 ,0 mL darah EDTA & 2,0 mL urine 2 minggu -20°C, > 2 minggu -80°C PCR 3 x seminggu 4 hari
286 Cytomegalovirus (CMV),PCR 3,0 mL serum 2 minggu -20°C PCR Tiap hari 5 hari
287 Dengue Virus RNA (RT-PCR) 1,0 mL serum >1 2minggu
minggu -80°Cbulanan -80°C
-20°C, Real Time RT PCR Tiap hari 1 minggu
288 HBV DNA Genotype *& HBV DNA Quantitative 2 ,0 mL serum , Fresh steril 2 minggu -20°C, > 2 minggu -80°C Real Time PCR Tiap hari 7 - 10 hari
HBV DNA Quantitative (transport pd 4°C) Cobas Taqman 48 ROCHE
minimum 103 IU/mL
289 HBV DNA,qualitative 2 ,0 mL serum , Fresh, steril 2 minggu -20°C, > 2 minggu -80°C Real Time PCR Tiap hari 7 - 10 hari
sensitivity : 2 IU/mL (transport pd 4°C) Cobas Taqman 48 ROCHE
290 HBV DNA,quantitative (Viral load) 2 ,0 mL serum , Fresh , steril 2 minggu -20°C, > 2 minggu -80°C Real Time PCR Tiap hari 7 - 10 hari
sensitivity : 6 IU/mL (transport pd 4°C) Cobas Taqman 48 ROCHE
291 HCV RNA Genotype * & HCV RNA Quantitative 2 ,0 mL serum , Fresh, steril 2 minggu -20°C, > 2 minggu -80°C Real Time PCR Tiap hari 7 - 10 hari
HCV RNA quantitative minimum (transport pd 4°C) Cobas Taqman 48 ROCHE
104 IU/mL
292 HCV RNA,qualitative 2 ,0 mL serum , Fresh, steril 2 minggu -20°C,> 2 minggu -80°C Reverse Trancription PCR Tiap hari 7 - 10 hari
sensitivity : 50 IU/mL (transport pd 4°C) ( RT PCR )

Contact Person : Ibu Kori


13/19
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293 HCV RNA,quantitative (Viral load ) 2 ,0 mL serum , Fresh, steril 2 minggu -20°C, > 2 minggu -80°C Real Time PCR Tiap hari 7 - 10 hari
sensitivity : 25 IU /mL (transport pd 4°C) Cobas Taqman 48
ROCHE
294 HIV RNA (Viral Load), sensitivity : 20 cp/mL 2.0 mL darah EDTA 2 minggu -20°C, > 2 minggu -80°C Real Time RT PCR Tiap hari 1 bulan
295 Herpes Simplex Virus (HSV),PCR qualitative 3,0 mL serum steril, Fresh 2 minggu -20°C, > minggu -80°C Real Time PCR Tiap hari 4-5 hari
(transport pd 4°C) Cobas Taqman 48 ROCHE
296 Human Papiloma Virus (HPV) DNA screening DNA PAP Cervical Sampler 2 minggu suhu kamar,3 bulan -20 °C PCR Jumat 5 hari
297 Salmonella typhi,PCR 3 mL darah EDTA 6 hari 2-8°C PCR Tiap hari 7 - 10 hari
298 Tuberculosis (TB),PCR (TB Milier / TB diluar paru ) 2,0 mL darah EDTA ( 2 tabung ) 1 minggu 4-8°C PCR Tiap hari 3 hari
299 IGRA (T-SPOT-TB) 0 -2 th : 1 tabung heparin 4cc < 6 jam suhu ruang T-SPOT-TB ( Elispot ) Tiap hari 2 - 3 hari
> 2 th, 2 tabung heparin 4cc
300 PCR TB NAT + ADA 1,0 mL sputum,cairan pleura, CSF, 2 hari 2-8°C PCR + Spectrophotometry Tiap hari 2 hari
C.peritonial, Ascites

LAIN- LAIN

301 Adenosine Deaminase (ADA) 1,0 ml serum, C.pleura, CSF, C.peritonial, 2 hari 2-8°C Spectrophotometry / Tiap hari 1 hari
Ascites Colorimetric
302 Alpha 1-Acid Glycoprotein 2 x 0,5 mL serum Kirim beku Nephelometry 2 x seminggu
303 Alpha-1-Antitrypsin (AAT) 3,0 mL serum 3 hari 4-8°C, 2 bulan -20°C Immunoturbidimetry 1 x seminggu
304 Alpha 2-Macroglobulin 0,5 mL serum Kirim beku Nephelometry 2 x seminggu
305 Analisa Cairan ( Ascites, Pleura ) 2,0 ml cairan ( ascites, pleura ) Tiap hari Besoknya
306 Angiotensin Converting Enzyme (ACE) 2 x 0,5 mL serum Kirim beku Kinetik Spectrophotometry 2 x seminggu
307 Anti-Glutamic Acid Decarboxylase (GAD) 3,0 mL serum bulanan -20°C Enzyme Immunoassay (EIA) 1 x 2 minggu
308 Anti EBV EA IgA 0,5 mL serum 14 hari 2-8°C,6 bulan -20°C Immunofluorescence 1 x seminggu
309 Anti EBV EA IgG 1,0 mL serum 14 hari 2-8°C,6 bulan -20°C EIA 1 x seminggu
310 Anti EBV EA IgM 3,0 mL serum 14 hari 2-8°C,6 bulan -20°C EIA 1 x seminggu
311 Anti EBV VCA IgA 0,5 mL serum 14 hari 2-8°C,6 bulan -20°C Immunofluorescence Kamis

Contact Person : Ibu Kori


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312 Anti EBV VCA IgG 1,0 mL serum 14 hari 2-8°C,6 bulan -20°C EIA 1 x seminggu
313 Anti EBV VCA IgM 1,0 mL serum 14 hari 2-8°C,6 bulan -20°C EIA 1 x seminggu
314 Anti Leptospira IgM 1,0 mL serum 4 hari 2-8°C MAT Senin s/d Jumat
315 Anti Mycoplasma IgG 2 x 1,0 mL serum Kirim beku EIA 2 x seminggu
316 Anti Mycoplasma IgM 2 x 1,0 mL serum Kirim beku EIA 2 x seminggu
317 Anti Parietal Sel 1,0 mL serum 14 hari 2-8°C EIA 1 x seminggu
318 Ceruloplasmin 0,5 mL serum 5 hari 2-8°C , 3 bulan-20°C Nephelometry 2 x seminggu
319 Catecholamine Fractionated
320 Faecal Elastase-1 3 hari 2-8°C,1 tahun -20°C EIA 1 x 2 minggu
321 ICA (Islet Cell Autoantibodies) 2 x 0,5 mL serum kirim beku IFA Tiap hari 1 bulan
322 N-MID Osteocalcin
323 Protein C 3,0 mL p.sitras segera sentrifus 2 minggu -20°C EIA 2 x seminggu
324 Protein S 3,0 mL p.sitras segera sentrifus 2 minggu -20°C EIA 2 x seminggu
325 Renin 2 x 1,0 mL Plasma EDTA Bekukan secepatnya Radio Immunoassay 1 x seminggu
326 Sperm Analysis Sperma Fresh < 2 jam Tiap hari <jam 9 1 hari
327 Stone Analysis (Semi quantitative ), urinary tract Batu Ginjal, Batu Empedu 2 minggu 2-8°C Semiquantitative Tiap hari Besoknya
328 Tacrolymus 3,0 mL darah EDTA 14 hari 2-8 °C MEIA Tiap hari
329 Total Oxidant Status 1,0 mL serum 36 jam 2-8°C, 14 hari -20°C Kolorimetri Tiap hari <jam 9 Jumat

PATOLOGI ANATOMI

NO NAMA TEST KETERANGANGAN HARI KERJA HASIL


330 Biopsi / Kuret ( < 3 cm ) Bahan biopsi organ permukaan dan tumor s/d 3 cm : Tiap hari 4 - 5 hari
a. Biopsi kecil cervix
b. Kerokan endometrium maximal 5 cc
c. Biopsi kecil kulit, pleura, FOB paru, nasopharynx
d. Tumor - tumor kecil Fibro Adenoma 1 - 3 buah, appendix, kelenjar getah bening kecil
e. Kecil - kecil maximum 3 ( tiga ) potong s/d 3 cm, dan lain-lain
331 Bahan Operasi Sedang ( 3 - 10 cm ) Bahan biopsi organ dalam dan tumor 3 s/d 10 cm :
a. Biopsi organ dalam : Otak, hati, dan lain-lain
b. Biopsi tulang (perlu dekalsifikasi)

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c. Kandung empedu dan limpa


d. Fibro Adenoma / Tumor mamma : lebih dari 3 cm atau kecil-kecil 3 - 6 potong
e. Prostat maximal 3 potong : TUR Prostat/ buli maximal 40 gram
f. Sediaan kecil dalam 2 tempat terpisah : FAM kiri & kanan, polyp cervix & kerokan, nasopharynx kanan & kiri
g. Kehamilan ectopic, tumor ovarium sedang, kista coklat
h.Thyroid maximum 2 lobus
i. Bola mata
j. Tumor testis <--> 3 s/d 10 cm
k. Beberapa potong Hemorrhoid
332 Bahan Operasi Besar ( > 10 cm ) Jaringan berbagai organ dan tumor > 10 cm : Tiap hari 4 - 5 hari
a. Bahan TAH / TAH - BSO
b. Reseksi usus maximal 10 cm, ginjal, paru, dan lain-lain
c. Potongan tulang
d. Tumor besar ovarium, Sarcoma, potongan rahang
e. Tumor dengan radicalistas : Basalioma, Melanoma
f. Bahan kecil dalam 4 (empat) tempat sediaan
g. Simple Mastectomi
333 Bahan Khusus a. Sediaan extra besar dari ovarium, potongan kaki, sarcoma, dan lain-lain Tiap hari 4 - 5 hari
b. Mastectomi dengan kelenjar terpisah ( Radikal )
c. Sediaan -sediaan kecil dalam 5 (lima) botol terpisah / lebih
d. Operasi kandungan Wartheim ( TAH-BSO + vag.Cupf + kelenjar )
e. Reseksi usus > 10 cm
334 Biopsi Usus/Gaster/endoskopi : 1 bahan Bila 2 botol terpisah ditambah Rp 200,000,- dan seterusnya Tiap hari 4 - 5 hari
( dengan / tanpa H.Pylori )
335 PAP Smear ( Slide ) Slide yang sudah di fiksasi Tiap hari 3 - 4 hari
336 Sitologi Sputum Sputum + Alkohol 70% ( 1 : 1 ). Bila 2 bahan ditambah Rp 100.000,- dan seterusnya Tiap hari 3 - 4 hari
337 Sitologi Bronchial Brushing Bila 2 bahan ditambah Rp 100,000,- dan seterusnya Tiap hari 3 - 4 hari
338 Sitologi Bronchial Washing Bila 2 bahan ditambah Rp 100,000,- dan seterusnya Tiap hari 3 - 4 hari
339 Sitologi Urine / cairan tubuh lain 3 ml Urine / cairan tubuh lain + 3 ml alkohol 70%. Bila 2 bahan ditambah Rp 100.000,- dan seterusnya Tiap hari 3 - 4 hari

Catatan :
1. Tarif berlaku sampai akhir bulan Pebruari tahun 2017
2. Diskon berlaku …... %
3. Hasil selesai sesuai jadwal, apabila sample diterima sebelum jam 12.00 WIB

Contact Person : Ibu Kori


16/19
031-5312981,5322565
www.labkedungdoro.com
081331395079
Daftar Tarif Laboratorium Klinik Utama Kedungdoro
Berlaku Per 1 Maret 2016
Untuk Rumah Sakit

4. * : Hubungi petugas Laboratorium Kedungdoro


JAMINAN MUTU HASIL
Metode & Alat
Ada 15 kelompok metode yang dipakai untuk penggunaan alat otomatis yang jumlahnya telah mencapai 27 unit, dengan harapan dapat menjadi laboratorium rujukan yang terpercaya.

IPAL : Waste Water Treatment Plant Anaerobic-Biofiltration, Physical & Chemical (Ion Exchange)

Supervisi oleh
Dokter Spesialis Patologi Klinik, Konsultan (Indonesian College of Clinical Pathologist)
Medical Scientist ( Bachelor of Applied Science)

Kendali Mutu ( QC) & Pemantapan Mutu QA/EQA (External Quality Assesment)
EQA : Program Nasional Pemantapan Mutu Eksternal (PNME) oleh Depkes, Meliputi Kimia Klinik, Hematologi, Koagulasi, Imunologi & Urine
IEQA : International External Quality Assesment. Ber-sertifikat RIQAS(UK), EQAS(USA), dan RCPA QAP (AUS) : 2003 s/d 2015

Implementasi
KAN ISO 15189 & MS ISO 15189 (termasuk Ethics in Laboratory Medicine )

Updated 27 Januari 2016

Contact Person : Ibu Kori


17/19
031-5312981,5322565
www.labkedungdoro.com
081331395079
DAFTAR HARGA UNTUK RS BAPTISBERLAKU PER 01 OKTOBER 2008
DAFTAR HARGA UNTUK RS BAPTISBERLAKU PER 01 OKTOBER 2008