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KODE PEMERIKSAAN LABORATORIUM

Kode Pemeriksaan Harga 2013


J1 Sperma (#) 225,000
J2 Batu ginjal 242,000
J3 Batu Empedu 184,000
J4 Papsmear 110,000
G2 Pencernaan 27,000
G3 Darah Samar 108,000
G4 Lemak 52,000
FRN1 MAKROSKOPIK -
FRN2 Warna -
FRN3 Konsistensi -
FRN4 MIKROSKOPIK -
FRN6 Sisa Pencernaan -
FRN5 Telur Cacing -
FRN7 Lekosit -
FRN8 Eritrosit -
FRN9 Sel Epitel -
A10 Laju Endap Darah 27,500
A12 Eosinofil 51,000
A14 Gambaran Sed, apus darah tepi 143,000
A15 Gambaran Sed, apus sumsum tulang 440,000
A16 TIBC 104,000
A17 Ferritin 198,000
A18 Trombotest Owren 180,000
A20 Waktu Pembekuan 35,500
A22 APTT (activated) 126,500
A23 Fibrinogen 198,000
A24 Rektraksi Bekuan 40,000
A25 Viskositas Darah 151,000
A26 Coombs test 360,000
A27 Rumpell Leede 17,600
A28 Resistensi Osmotik/Hemolisis 60,000
A29 G6-PD 167,000
A30 Hb Elektoforesis 691,000
A31 Rhesus Factor -
A32 Cross Match Major/Minor -
A33 Ham 38,500
A34 Sel LE 52,000
A35 Golongan Darah (ABO) 46,000
A4 Hemoglobin 48,000
A5 Eritrosit 52,000
A6 Lekosit 52,000
A7 Hematokrit 52,000

Page 1 of 18
Kode Pemeriksaan Harga 2013
A9 Trombosit 48,000
A8b MCH -
A8a MCV -
A8c MCHC -
A10b LED Jam 2 -
A11a Limfosit -
A11b Monosit -
A11c Neutrofil -
A11e Basofil -
A17A Fe Serum 105,000
A10a LED Jam 1 -
A13 Retikulosit 70,000
A21a Hasil Dalam INR -
A38 D-Dimer 531,000
A21 Waktu Protrombin 181,000
a19 Waktu Pendarahan 35,500
A20K Waktu Pembekuan 33,000
a19K Waktu Pendarahan 33,000
B10 HCV RNA KUALITATIF 2,350,000
B11A Anti HAV 340,000
B12 Anti HAV IgM 310,000
B14 CEA 230,000
B15 PSA total 315,000
B16 Free PSA 630,000
B18 Ca 125 470,000
B19 Ca 15-3 440,000
B2 Anti HBs Titer 200,000
B20 Ca 19-9 480,000
B21 SCC 420,000
B22 NSE 528,000
B24 Malaria 57,500
B25 Anti Amuba 310,000
B26a Anti Dengue Elisa IgG 1,500,000
B26b Anti Dengue Elisa IgM 1,550,000
B28 ICT-TB 275,000
B29 Anti H Pylorl IgG 435,000
B30 VDRL 59,000
B31 TPHA 92,000
B33 GO (Mikroskopik) 52,000
B34g Anti Toxoplasma IgG 222,000
B35 Anti Rubella (IgG) 240,000
B36 Anti Rubella (IgM) 306,000
B37 Anti CMV (IgG) 225,000
B38 Anti CMV (IgM) 315,000

Page 2 of 18
Kode Pemeriksaan Harga 2013
B39 Anti HSV 2 (IgG) 230,000
B4 Anti HBc IgM 443,000
B40 Anti HSV 2 (IgM) 230,000
B41 Anti HSV 1 (IgG) 247,000
B42 Anti HSV 1 (IgM) 247,000
B43 T3 185,000
B44 Free T3 290,000
B45 T4 185,000
B46 Free T4 245,000
B47 TSHS 194,000
B48 LH (#) 265,000
B49 FSH (#) 269,000
B5 HBe Ag 347,000
B50 Prolactin ( # *) 250,000
B51 Estrodiol 330,000
B52 Testosteron 300,000
B53 Progesteron 335,000
B54 Calcitonin 1,350,000
B55 Cartisol ( # * ) 326,000
B56 ASTO 78,000
B57 ANA 518,000
B58 LE Test 95,000
B59 RF 81,000
B6 Anti HBe 427,000
B60 AMA 99,000
B61 SMA 99,000
B62 C3 Komplemen 334,000
B63 Anti-ds DNA 390,000
B64 IGE Total 265,000
B65 IgG 359,000
B65A IgA 346,000
B65B IgM 366,000
B66A CRP Kualitatif 116,000
B66b Crp Kuantitatif 214,000
B7 HBV DNA Kuantitatif 2,500,000
B8 ANTI HCV 346,500
B9 ANTI HCV IgM 1,050,000
J10 Pap Smear (Check Up) 110,000
wdl2 Salmonella Parathypi AH -
wdl1 Salmonella Thypi H -
wdl3 Salmonella Parathypi BH -
wdl4 Salmonella Parathypi CH -
wdl5 Salmonella Thypi O -
wdl6 Salmonella Parathypi AO -

Page 3 of 18
Kode Pemeriksaan Harga 2013
wdl7 Salmonella Parathypi BO -
wdl8 Salmonella Parathypi CO -
drp1 Anti Dengue IgG -
drp2 Anti Dengue IgM -
b32a Anti HIV 1 300,000
b32b Anti HIV 2 -
B34m Anti Toxoplasma IgM 222,000
B1a HBsAg -
B1b -
B7A -
B7B -
B41a -
B7D -
B7E -
b3A -
B3 Anti HBc Total 249,000
B13 A- Fetoprotein (AFP) 245,000
B34M1 -
B34G1 -
B351 -
B36a -
B37A -
B38A -
b352 -
b36B -
b37B -
b38B -
b34MB -
B34GB -
b9a -
B42a -
B39a -
B40a -
B39b -
B40b -
B41b -
B42b -
B67 hs-CRP 181,500
b6a -
b63a -
b63b -
b63c -
B65C IgE Atopy 832,000
B11B -

Page 4 of 18
Kode Pemeriksaan Harga 2013
B10B HCV RNA KUANTITATIF 2,538,000
B49a -
B49b -
B49c -
B49d -
B49e -
B68 Anti CCP Igg 440,000
B34G2 -
B69 Anti Tyroglobulin 269,000
B62a C4 Komplemen 367,000
B23A Anti Salmonella Typhi (IgM) 214,000
B27A Dengue Rapid NS1 Antigen 295,000
B70 Tubex 198,000
B23B Anti Salmonella Typhi (IgG) 253,000
B71a Anti Immunoglobulin IgA 374,000
B71b Anti Immunoglubulin IgG 374,000
B71c Anti Immunologiglobulin IgM 374,000
B2K Anti Hbs Titer 185,000
B8K ANTI HCV 315,000
E1 Plano Test 72,000
C1 SGOT (AST) 38,000
C10 Protein Total 49,000
C11 Protein Elektroforesis 176,000
C12a Albumin -
C13 Asam Empedu 618,000
C14 Ureum/Urea N (*) 38,000
C15 Kreatinin 38,000
C16 Klirens Urea (~) 80,000
C17 Klirens Kreatinin (~) 84,000
C18 Asam Urat (*) 41,000
C19 Mikroalbuminuri (MAU) 110,000
C2 SGPT (ALT) 38,000
C20 Glukosa puasa 25,000
C21 Glukosa 2 jam PP 25,000
C22 Glukosa Sewaktu 25,000
C24 Kurva harian (4X) 83,000
C25 Glycosilated Hb (HbA1c) 180,000
C26 Fruktosamin 550,000
C27 Insulin (*) 281,000
C28 C-Peptide (*) 306,000
C29 SGOT (AST) 35,000
C3 Gamma-GT 71,000
C30 SGPT (ALT) 35,000
C31 LDH 82,000

Page 5 of 18
Kode Pemeriksaan Harga 2013
C32 CK 124,000
C33 CK-MB 295,000
C34 Homocysteine (*) 475,000
C35 Amilase 206,000
C36 Lipase 163,000
C37 Kolesterol Total 39,000
C38 Trigliserida 40,000
C39 Kolesterol HDL 50,000
C4 Fosfatase Alkali (AP) 58,000
C40 Kolesterol LDL 80,000
C41 Kolesterol LDL direk 80,000
C42 Apo A1 (*) 214,000
C43 Apo B (*) 155,000
C44 Lp A (*) 280,000
C45 Natrium 77,000
C46 Kalium 77,000
C47 Klorida 77,000
C48 Kalsium 60,000
C49 Fosfor Anorganik 67,000
C5 LAP -
C50 Bikarbonat (Enzymatik) 350,000
C51 Magnesium 71,000
C6 Cholinesterase (Che) 104,000
C7 GLDH 396,000
C9 Bilirubin Total 47,000
c8b Bilirubin Indirec -
C12b Globulin -
c8a Bilirubin Direc -
B22a B-HCG 297,000
C21K Glukosa 2 jam PP 23,000
C20K Glukosa Puasa 23,000
C15K Kreatinin 35,000
C14K Ureum/Urea N (*) -
C22K Glukosa Sewaktu 23,000
C1K SGOT (AST) 35,000
C2K SGPT (ALT) 35,000
C18K Asam Urat (*) 38,000
C37K Kolesterol Total 36,000
C38K Trigliserida 37,000
C39K Kolesterol HDL 46,000
C41K Kolesterol LDL Direk 73,000
C4K Fosfatase Alkali (AP) 53,000
C31 LDH 75,000
C14A Urea N Urine 40,000

Page 6 of 18
Kode Pemeriksaan Harga 2013
I1 Jumlah Sel 57,000
I2 Hitung jenis 57,000
I3 Nonne/Pandy 27,000
I4 Rivalta 18,000
I5 Protein 27,000
I6 Glukosa 27,000
I7 PA/Sitologi Cairan 82,000
H10 Kultur Difteria 165,000
H11 Kultur jamur 302,000
bt5 BTA ( Sewaktu ) -
H2 BTA (Mikroskopik) 53,000
H3 GO (Mikroskopik) 51,000
H4 Diphteria ( Mikroskopik) 60,000
H5 Fungi (Mikroskopik) 60,000
H6 Candida (Mikroskopik) 60,000
H6A Clamydia (Mikroskopik) 43,000
H6B Trichomonas Vaginalis(Mikroskopik) 43,500
H7 Kultur Gal 297,000
H8 Kultur BTA 242,000
H9 Kultur GO 330,000
bt Bahan -
bt1 BTA -
bt2 BTA 1 X -
bt3 BTA 2 X -
bt4 BTA 3 X -
bt6 BTA ( Pagi ) -
gr Bahan -
gr1 Basil Gram (-) -
gr2 Basil Gram (+) -
gr3 Coccus Gram (-) -
gr4 Coccus Gram (+) -
h13 Kultur dan Resistensi 290,000
bt10 Bahan : Sputum -
bt11 Pengecatan BTA -
H12 Uji Kepekatan Obat 148,500
F1 Methamphetamine (MET) 63,000
F2 Marijuana (THc) / Canabinoid 63,000
F3 Morphine (MOR) / Heroin / Opiate 63,000
F4 Coccain 63,000
F6 Benzodiazepine / Diazepam 63,000
F5 Amphetamine 72,000
F7 Opiatest 93,500
F8 Cannabis 60,500
A1 Hematologi rutin 68,000

Page 7 of 18
Kode Pemeriksaan Harga 2013
B23 Widal 95,000
D1 Urine Rutin 38,000
A2 Hematologi Lengkap 80,000
B27 Dengue Rapid 295,000
C8 Bilirubin Direct / Indirec 47,000
c23 GTTO 210,000
d6 Sedimen 25,000
G1 FAECES RUTIN 51,000
b32 Anti HIV 1 & 2 300,000
B1 HBsAg 124,000
H2 BTA (Mikrobiologi) 53,000
B7 HBV DNA Kuantitatif 2,750,000
b3 Anti HBc Total 249,000
B34M Anti Toxoplasma IgM 222,000
B34G Anti Toxoplasma IgG 222,000
B36 Anti Rubella IgM 305,000
B37 Anti CMV IgG 225,000
B38 Anti CMV IgM 315,000
b9 Anti HCV IgM 1,155,000
B41 Anti HSV 1 IgG 247,000
B42 Anti HSV 1 IgM 247,000
B39 Anti HSV 2 IgG 230,000
B40 Anti HSV 2 IgM 230,000
b6 Anti HBeAG 427,000
b63 Anti-ds DNA 396,000
B49 FSH 269,000
B11 Anti HAV 344,000
A8 Nilai Nilai MC 63,000
C12 Albumin/Globulin 51,000
A4 Hemoglobin 48,000
E1 Plano Test 72,000
A14a Gambaran Sed, apus darah tepi + Hematologi Lengkap 193,000
A2K Hematologi Lengkap 73,000
B1K HBsAg 113,000
B23K Widal 87,000
D1-K Urine Rutin 35,000
A1K Hematologi rutin 61,000
H1 Pengecatan gram Preparat 60,000
URN5a Calsium Oxalat -
URN3 Sel Epitel -
URN4 Bakteri -
URN5 Kristal -
URN1 Lekosit -
URN2 Eritrosit -

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Kode Pemeriksaan Harga 2013
URN5b Urat Amorf -
URN5c Uric acid -
URN5d Tripel Phosfat -
URN6 Hialin -
URN7 Granula -
J5 Biopsy Jarum Halus (FNA) 330,000
J6 Biopsi Calring 275,000
J7 Pemeriksaan PA Jaringan 330,000
D2 Glukosa 25,000
D3 Protein 25,000
D4 Bilirubin 25,000
D5 Keton 25,000
D7 Protein Esbach (~) -
D8 Protein Bence Jones 64,000
D1D CLARITY -
D1E SG -
D1F PH -
D1K LEU -
D1H NIT -
D1C PRO -
D1J GLU -
D1I KET -
D1A UBG -
D1B BIL -
D1G ERY -
URN5e Phosfat Amorf -
D1L COLOR -
a11 Hitung Jenis Leukosit 52,000

Page 9 of 18
KODE PEMERIKSAAN LABORATORIUM

Kode Pemeriksaan Harga 2013 KREDIT 2014 TUNAI


J1 Sperma (#) 225,000 270,000 2
J2 Batu ginjal 242,000 290,400 2
J3 Batu Empedu 184,000 220,800 2
J4 Papsmear 110,000 132,000 1
G2 Pencernaan 27,000 32,400
G3 Darah Samar 108,000 129,600 1
G4 Lemak 52,000 62,400
FRN1 MAKROSKOPIK -
FRN2 Warna -
FRN3 Konsistensi -
FRN4 MIKROSKOPIK -
FRN6 Sisa Pencernaan -
FRN5 Telur Cacing -
FRN7 Lekosit -
FRN8 Eritrosit -
FRN9 Sel Epitel -
A10 Laju Endap Darah 27,500 35,000
A12 Eosinofil 51,000 61,200
A14 Gambaran Sed, apus darah tepi 143,000 171,600 1
A15 Gambaran Sed, apus sumsum tulang 440,000 550,000 5
A16 TIBC 104,000 125,000 1
A17 Ferritin 198,000 237,000 2
A18 Trombotest Owren 180,000 216,000 2
A20 Waktu Pembekuan 35,500 42,600
A22 APTT (activated) 126,500 151,000 1
A23 Fibrinogen 198,000 235,000 2
A24 Rektraksi Bekuan 40,000 50,000
A25 Viskositas Darah 151,000 181,000 1
A26 Coombs test 360,000 430,000 4
A27 Rumpell Leede 17,600 220,000
A28 Resistensi Osmotik/Hemolisis 60,000 75,000
A29 G6-PD 167,000 200,000 1
A30 Hb Elektoforesis 691,000 829,000 8
A31 Rhesus Factor - -
A32 Cross Match Major/Minor - -
A33 Ham 38,500 46,000
A34 Sel LE 52,000 62,400
A35 Golongan Darah (ABO) 46,000 55,200
A4 Hemoglobin 48,000 57,600
A5 Eritrosit 52,000 62,000
A6 Lekosit 52,000 62,000
A7 Hematokrit 52,000 62,000

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Kode Pemeriksaan Harga 2013 KREDIT 2014 TUNAI
A9 Trombosit 48,000 57,600
A8b MCH - -
A8a MCV - -
A8c MCHC - -
A10b LED Jam 2 - -
A11a Limfosit - -
A11b Monosit - -
A11c Neutrofil - -
A11e Basofil - -
A17A Fe Serum 105,000 126,000 1
A10a LED Jam 1 - -
A13 Retikulosit 70,000 84,000
A21a Hasil Dalam INR - -
A38 D-Dimer 531,000 637,200 6
A21 Waktu Protrombin 181,000 217,200 2
a19 Waktu Pendarahan 35,500 42,600
A20K Waktu Pembekuan 33,000 39,600
a19K Waktu Pendarahan 33,000 39,600
B10 HCV RNA KUALITATIF 2,350,000 2,820,000 2,8
B11A Anti HAV 340,000 408,000 3
B12 Anti HAV IgM 310,000 372,000 3
B14 CEA 230,000 276,000 2
B15 PSA total 315,000 378,000 3
B16 Free PSA 630,000 730,000 7
B18 Ca 125 470,000 564,000 5
B19 Ca 15-3 440,000 528,000 5
B2 Anti HBs Titer 200,000 240,000 2
B20 Ca 19-9 480,000 576,000 5
B21 SCC 420,000 504,000 5
B22 NSE 528,000 633,600 6
B24 Malaria 57,500 69,000
B25 Anti Amuba 310,000 372,000 3
B26a Anti Dengue Elisa IgG 1,500,000 1,800,000 1,8
B26b Anti Dengue Elisa IgM 1,550,000 1,860,000 1,8
B28 ICT-TB 275,000 330,000 3
B29 Anti H Pylorl IgG 435,000 500,000 4
B30 VDRL 59,000 70,800
B31 TPHA 92,000 110,400 1
B33 GO (Mikroskopik) 52,000 62,400
B34g Anti Toxoplasma IgG 222,000 266,400 2
B35 Anti Rubella (IgG) 240,000 288,000 2
B36 Anti Rubella (IgM) 306,000 367,200 3
B37 Anti CMV (IgG) 225,000 270,000 2
B38 Anti CMV (IgM) 315,000 378,000 3

Page 11 of 18
Kode Pemeriksaan Harga 2013 KREDIT 2014 TUNAI
B39 Anti HSV 2 (IgG) 230,000 276,000 2
B4 Anti HBc IgM 443,000 531,600 5
B40 Anti HSV 2 (IgM) 230,000 276,000 2
B41 Anti HSV 1 (IgG) 247,000 296,400 2
B42 Anti HSV 1 (IgM) 247,000 296,400 2
B43 T3 185,000 222,000 2
B44 Free T3 290,000 348,000
B45 T4 185,000 222,000 2
B46 Free T4 245,000 290,000 2
B47 TSHS 194,000 232,800 2
B48 LH (#) 265,000 318,000 3
B49 FSH (#) 269,000 322,800 3
B5 HBe Ag 347,000 416,400 4
B50 Prolactin ( # *) 250,000 300,000 3
B51 Estrodiol 330,000 396,000 3
B52 Testosteron 300,000 360,000 3
B53 Progesteron 335,000 402,000 4
B54 Calcitonin 1,350,000 1,620,000 1,6
B55 Cartisol ( # * ) 326,000 391,200 3
B56 ASTO 78,000 93,600
B57 ANA 518,000 621,600 6
B58 LE Test 95,000 114,000 1
B59 RF 81,000 97,200
B6 Anti HBe 427,000 512,400 5
B60 AMA 99,000 118,800 1
B61 SMA 99,000 118,800 1
B62 C3 Komplemen 334,000 400,800 4
B63 Anti-ds DNA 390,000 468,000 4
B64 IGE Total 265,000 318,000 3
B65 IgG 359,000 430,800 4
B65A IgA 346,000 415,200 4
B65B IgM 366,000 439,200 4
B66A CRP Kualitatif 116,000 139,200 1
B66b Crp Kuantitatif 214,000 256,800 2
B7 HBV DNA Kuantitatif 2,500,000 3,000,000 3,0
B8 ANTI HCV 346,500 415,800 4
B9 ANTI HCV IgM 1,050,000 1,260,000 1,2
J10 Pap Smear (Check Up) 110,000 135,000 1
wdl2 Salmonella Parathypi AH - -
wdl1 Salmonella Thypi H - -
wdl3 Salmonella Parathypi BH - -
wdl4 Salmonella Parathypi CH - -
wdl5 Salmonella Thypi O - -
wdl6 Salmonella Parathypi AO - -

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Kode Pemeriksaan Harga 2013 KREDIT 2014 TUNAI
wdl7 Salmonella Parathypi BO - -
wdl8 Salmonella Parathypi CO - -
drp1 Anti Dengue IgG - -
drp2 Anti Dengue IgM - -
b32a Anti HIV 1 300,000 360,000 3
b32b Anti HIV 2 - -
B34m Anti Toxoplasma IgM 222,000 266,400 2,6
B1a HBsAg - -
B1b - -
B7A - -
B7B - -
B41a - -
B7D - -
B7E - -
b3A - -
B3 Anti HBc Total 249,000 298,800 2
B13 A- Fetoprotein (AFP) 245,000 294,000 2
B34M1 - -
B34G1 - -
B351 - -
B36a - -
B37A - -
B38A - -
b352 - -
b36B - -
b37B - -
b38B - -
b34MB - -
B34GB - -
b9a - -
B42a - -
B39a - -
B40a - -
B39b - -
B40b - -
B41b - -
B42b - -
B67 hs-CRP 181,500 217,800 2
b6a - -
b63a - -
b63b - -
b63c - -
B65C IgE Atopy 832,000 998,400 9
B11B - -

Page 13 of 18
Kode Pemeriksaan Harga 2013 KREDIT 2014 TUNAI
B10B HCV RNA KUANTITATIF 2,538,000 3,045,600 3,0
B49a - -
B49b - -
B49c - -
B49d - -
B49e - -
B68 Anti CCP Igg 440,000 528,000 5
B34G2 - -
B69 Anti Tyroglobulin 269,000 322,800 3
B62a C4 Komplemen 367,000 440,400 4
B23A Anti Salmonella Typhi (IgM) 214,000 256,800 2
B27A Dengue Rapid NS1 Antigen 295,000 354,000 3
B70 Tubex 198,000 237,600 2
B23B Anti Salmonella Typhi (IgG) 253,000 303,000 3
B71a Anti Immunoglobulin IgA 374,000 448,800 4
B71b Anti Immunoglubulin IgG 374,000 448,800 4
B71c Anti Immunologiglobulin IgM 374,000 448,800 4
B2K Anti Hbs Titer 185,000 222,000 2
B8K ANTI HCV 315,000 378,000 3
E1 Plano Test 72,000 86,400
C1 SGOT (AST) 38,000 45,600
C10 Protein Total 49,000 58,800
C11 Protein Elektroforesis 176,000 211,200 2
C12a Albumin - -
C13 Asam Empedu 618,000 741,600 7
C14 Ureum/Urea N (*) 38,000 45,600
C15 Kreatinin 38,000 45,600
C16 Klirens Urea (~) 80,000 95,000
C17 Klirens Kreatinin (~) 84,000 100,000
C18 Asam Urat (*) 41,000 49,000
C19 Mikroalbuminuri (MAU) 110,000 132,000 1
C2 SGPT (ALT) 38,000 45,600
C20 Glukosa puasa 25,000 30,000
C21 Glukosa 2 jam PP 25,000 30,000
C22 Glukosa Sewaktu 25,000 30,000
C24 Kurva harian (4X) 83,000 99,600
C25 Glycosilated Hb (HbA1c) 180,000 216,000 2
C26 Fruktosamin 550,000 660,000 6
C27 Insulin (*) 281,000 337,200 3
C28 C-Peptide (*) 306,000 367,200 3
C29 SGOT (AST) 35,000 42,000
C3 Gamma-GT 71,000 85,200
C30 SGPT (ALT) 35,000 42,000
C31 LDH 82,000 98,400

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Kode Pemeriksaan Harga 2013 KREDIT 2014 TUNAI
C32 CK 124,000 148,800 1
C33 CK-MB 295,000 354,000 3
C34 Homocysteine (*) 475,000 570,000 5
C35 Amilase 206,000 247,200 2
C36 Lipase 163,000 195,600 1
C37 Kolesterol Total 39,000 46,800
C38 Trigliserida 40,000 48,000
C39 Kolesterol HDL 50,000 60,000
C4 Fosfatase Alkali (AP) 58,000 69,600
C40 Kolesterol LDL 80,000 96,000
C41 Kolesterol LDL direk 80,000 96,000
C42 Apo A1 (*) 214,000 256,800 2
C43 Apo B (*) 155,000 186,000 1
C44 Lp A (*) 280,000 336,000 3
C45 Natrium 77,000 92,400
C46 Kalium 77,000 92,400
C47 Klorida 77,000 92,400
C48 Kalsium 60,000 72,000
C49 Fosfor Anorganik 67,000 80,400
C5 LAP - -
C50 Bikarbonat (Enzymatik) 350,000 420,000 4
C51 Magnesium 71,000 85,200
C6 Cholinesterase (Che) 104,000 124,800 1
C7 GLDH 396,000 475,200 4
C9 Bilirubin Total 47,000 56,400
c8b Bilirubin Indirec - -
C12b Globulin - -
c8a Bilirubin Direc - -
B22a B-HCG 297,000 356,400 3
C21K Glukosa 2 jam PP 23,000 27,600
C20K Glukosa Puasa 23,000 27,600
C15K Kreatinin 35,000 42,000
C14K Ureum/Urea N (*) - -
C22K Glukosa Sewaktu 23,000 27,600
C1K SGOT (AST) 35,000 42,000
C2K SGPT (ALT) 35,000 42,000
C18K Asam Urat (*) 38,000 45,600
C37K Kolesterol Total 36,000 43,200
C38K Trigliserida 37,000 44,400
C39K Kolesterol HDL 46,000 55,200
C41K Kolesterol LDL Direk 73,000 87,600
C4K Fosfatase Alkali (AP) 53,000 63,600
C31 LDH 75,000 90,000
C14A Urea N Urine 40,000 48,000

Page 15 of 18
Kode Pemeriksaan Harga 2013 KREDIT 2014 TUNAI
I1 Jumlah Sel 57,000 68,400
I2 Hitung jenis 57,000 68,400
I3 Nonne/Pandy 27,000 32,400
I4 Rivalta 18,000 21,600
I5 Protein 27,000 32,400
I6 Glukosa 27,000 32,400
I7 PA/Sitologi Cairan 82,000 98,400
H10 Kultur Difteria 165,000 198,000 1
H11 Kultur jamur 302,000 362,400 3
bt5 BTA ( Sewaktu ) - -
H2 BTA (Mikroskopik) 53,000 63,600
H3 GO (Mikroskopik) 51,000 61,200
H4 Diphteria ( Mikroskopik) 60,000 72,000
H5 Fungi (Mikroskopik) 60,000 72,000
H6 Candida (Mikroskopik) 60,000 72,000
H6A Clamydia (Mikroskopik) 43,000 51,600
H6B Trichomonas Vaginalis(Mikroskopik) 43,500 52,200
H7 Kultur Gal 297,000 356,400 3
H8 Kultur BTA 242,000 290,400 2
H9 Kultur GO 330,000 396,000 3
bt Bahan - -
bt1 BTA - -
bt2 BTA 1 X - -
bt3 BTA 2 X - -
bt4 BTA 3 X - -
bt6 BTA ( Pagi ) - -
gr Bahan - -
gr1 Basil Gram (-) - -
gr2 Basil Gram (+) - -
gr3 Coccus Gram (-) - -
gr4 Coccus Gram (+) - -
h13 Kultur dan Resistensi 290,000 348,000 3
bt10 Bahan : Sputum - -
bt11 Pengecatan BTA - -
H12 Uji Kepekatan Obat 148,500 178,200 1
F1 Methamphetamine (MET) 63,000 75,600
F2 Marijuana (THc) / Canabinoid 63,000 75,600
F3 Morphine (MOR) / Heroin / Opiate 63,000 75,600
F4 Coccain 63,000 75,600
F6 Benzodiazepine / Diazepam 63,000 75,600
F5 Amphetamine 72,000 86,400
F7 Opiatest 93,500 112,200 1
F8 Cannabis 60,500 72,600
A1 Hematologi rutin 68,000 81,600

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Kode Pemeriksaan Harga 2013 KREDIT 2014 TUNAI
B23 Widal 95,000 114,000 1
D1 Urine Rutin 38,000 45,600
A2 Hematologi Lengkap 80,000 96,000
B27 Dengue Rapid 295,000 354,000 3
C8 Bilirubin Direct / Indirec 47,000 56,400
c23 GTTO 210,000 252,000 2
d6 Sedimen 25,000 30,000
G1 FAECES RUTIN 51,000 61,200
b32 Anti HIV 1 & 2 300,000 360,000 3
B1 HBsAg 124,000 148,800 1
H2 BTA (Mikrobiologi) 53,000 63,600
B7 HBV DNA Kuantitatif 2,750,000 3,300,000 3,3
b3 Anti HBc Total 249,000 298,800 2
B34M Anti Toxoplasma IgM 222,000 266,400 2
B34G Anti Toxoplasma IgG 222,000 266,400 2
B36 Anti Rubella IgM 305,000 366,000 3
B37 Anti CMV IgG 225,000 270,000 2
B38 Anti CMV IgM 315,000 378,000 3
b9 Anti HCV IgM 1,155,000 1,386,000 1,3
B41 Anti HSV 1 IgG 247,000 296,400 2
B42 Anti HSV 1 IgM 247,000 296,400 2
B39 Anti HSV 2 IgG 230,000 276,000 2
B40 Anti HSV 2 IgM 230,000 276,000 2
b6 Anti HBeAG 427,000 512,400 5
b63 Anti-ds DNA 396,000 475,200 4
B49 FSH 269,000 322,800 3
B11 Anti HAV 344,000 412,800 4
A8 Nilai Nilai MC 63,000 75,600
C12 Albumin/Globulin 51,000 61,200
A4 Hemoglobin 48,000 57,600
E1 Plano Test 72,000 86,400
A14a Gambaran Sed, apus darah tepi + Hematologi Lengkap 193,000 231,600 2
A2K Hematologi Lengkap 73,000 87,600
B1K HBsAg 113,000 135,600 1
B23K Widal 87,000 104,400 1
D1-K Urine Rutin 35,000 42,000
A1K Hematologi rutin 61,000 73,200
H1 Pengecatan gram Preparat 60,000 72,000
URN5a Calsium Oxalat - -
URN3 Sel Epitel - -
URN4 Bakteri - -
URN5 Kristal - -
URN1 Lekosit - -
URN2 Eritrosit - -

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Kode Pemeriksaan Harga 2013 KREDIT 2014 TUNAI
URN5b Urat Amorf - -
URN5c Uric acid - -
URN5d Tripel Phosfat - -
URN6 Hialin - -
URN7 Granula - -
J5 Biopsy Jarum Halus (FNA) 330,000 396,000 3
J6 Biopsi Calring 275,000 330,000 3
J7 Pemeriksaan PA Jaringan 330,000 396,000 3
D2 Glukosa 25,000 30,000
D3 Protein 25,000 30,000
D4 Bilirubin 25,000 30,000
D5 Keton 25,000 30,000
D7 Protein Esbach (~) - -
D8 Protein Bence Jones 64,000 76,800
D1D CLARITY - -
D1E SG - -
D1F PH - -
D1K LEU - -
D1H NIT - -
D1C PRO - -
D1J GLU - -
D1I KET - -
D1A UBG - -
D1B BIL - -
D1G ERY - -
URN5e Phosfat Amorf - -
D1L COLOR - -
a11 Hitung Jenis Leukosit 52,000 62,400

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