DAFTAR HARGA PEMERIKSAAN LABORATORIUM

HEMATOLOGI Tarif Peserta Tarif Umum Tarif BPJS

Darah lengkap Rp 60,000 Rp 60,000 Rp 60,000
Darah Rutin Rp 50,000 Rp 50,000 Rp 50,000
Hemoglobin Rp 22,000 Rp 22,000 Rp 22,000
Leukosit Rp 22,000 Rp 22,000 Rp 22,000
Diff Rp 22,000 Rp 22,000 Rp 22,000
Trombosit Rp 25,000 Rp 25,000 Rp 25,000
Eritrosit Rp 22,000 Rp 22,000 Rp 22,000
Hematokrit Rp 22,000 Rp 22,000 Rp 22,000
Retikulosit Rp 22,000 Rp 22,000 Rp 22,000
Eosionofil Rp 22,000 Rp 22,000 Rp 22,000
Gambaran Darah Tepi Rp 125,000 Rp 125,000 Rp 125,000
MCV,MCH,MCHC @ Rp 15,000 Rp 15,000 Rp 15,000
Golongan Darah Rp 20,000 Rp 20,000 Rp 20,000
Malaria Rp 135,000 Rp 135,000 Rp 135,000
Filaria Rp 30,000 Rp 30,000 Rp 30,000
Masa Pendarahan Rp 15,000 Rp 15,000 Rp 15,000
Masa Pembekuan Rp 15,000 Rp 15,000 Rp 15,000
PT Rp 160,000 Rp 160,000 Rp 160,000
APTT Rp 160,000 Rp 160,000 Rp 160,000
D.Dimer Rp 340,000 Rp 340,000 Rp 340,000
Fibrinogen Rp 155,000 Rp 155,000 Rp 155,000
INR - - -
SEL LE Rp 70,000 Rp 70,000 Rp 70,000
Reaksi LE Rp 70,000 Rp 70,000 Rp 70,000
HB.Elektroforesa Rp 335,000 Rp 335,000 Rp 335,000
SI Rp 125,000 Rp 125,000 Rp 125,000
TIBC Rp 125,000 Rp 125,000 Rp 125,000
Comm'bs Test Rp 150,000 Rp 150,000 Rp 150,000
G6 PD Rp 230,000 Rp 230,000 Rp 230,000
Feritin Rp 250,000 Rp 250,000 Rp 250,000
hb.HPLC Rp 445,000 Rp 445,000 Rp 445,000
URINE
Darah samar Rp 50,000 Rp 50,000 Rp 50,000
Lengkap Rp 30,000 Rp 30,000 Rp 30,000
PP Test - Rp 20,000 Rp 20,000
HCG Latex - - -

NARKOBA
Amphetamin - Rp 40,000 Rp 40,000
Morfin - Rp 40,000 Rp 40,000
Mariyuana - Rp 40,000 Rp 40,000
Cocain - Rp 40,000 Rp 40,000
Methamphetamin - Rp 40,000 Rp 40,000
Benzodiazepin - Rp 40,000 Rp 40,000
DAFTAR HARGA PEMERIKSAAN LABORATORIUM

MIKROBIOLOGI Tarif Peserta Tarif Umum Tarif BPJS

Gram Rp 80,000 Rp 80,000 Rp 80,000
Secret Mata Rp 80,000 Rp 80,000 Rp 80,000
Seret Uretha Rp 80,000 Rp 80,000 Rp 80,000
BTA SPUTUM 1 X Rp 30,000 Rp 30,000 Rp 30,000

ELEKTROLIT
Natrium Rp 80,000 Rp 80,000 Rp 80,000
Kalium Rp 80,000 Rp 80,000 Rp 80,000
Chlorida Rp 80,000 Rp 80,000 Rp 80,000
Calsium Rp 80,000 Rp 80,000 Rp 80,000
Phospor Rp 30,000 Rp 30,000 Rp 30,000
Magnesium Rp 30,000 Rp 30,000 Rp 30,000

ENDOKRIN
TSH Rp 240,000 Rp 240,000 Rp 240,000
T3 Rp 169,000 Rp 169,000 Rp 169,000
T4 Rp 165,000 Rp 165,000 Rp 165,000
T3 UPTAKE Rp 295,000 Rp 295,000 Rp 295,000
Fti Rp 1,080,000 Rp 1,080,000 Rp 1,080,000
FsH Rp 310,000 Rp 310,000 Rp 310,000
Free T4 Rp 288,000 Rp 288,000 Rp 288,000
LH Rp 292,000 Rp 292,000 Rp 292,000
PROLAKTIN Rp 215,000 Rp 215,000 Rp 215,000
ESTRADIOL Rp 240,000 Rp 240,000 Rp 240,000
PROGRESTERON Rp 250,000 Rp 250,000 Rp 250,000
TESTOTERON Rp 415,000 Rp 415,000 Rp 415,000
Tiroglubulin Rp 615,000 Rp 615,000 Rp 615,000

TORCH
Toxoplasma IgG Rp 237,000 Rp 237,000 Rp 237,000
Toxoplasma IgM Rp 237,000 Rp 237,000 Rp 237,000
Rubella IgG Rp 254,000 Rp 254,000 Rp 254,000
Rubella IgM Rp 317,000 Rp 317,000 Rp 317,000
CMV IgG Rp 240,000 Rp 240,000 Rp 240,000
CMV IgM Rp 328,000 Rp 328,000 Rp 328,000
HSV 1 IgG Rp 261,000 Rp 261,000 Rp 261,000
HSV 1 IgM Rp 261,000 Rp 261,000 Rp 261,000
HSV 2 IgG Rp 245,000 Rp 245,000 Rp 245,000
HSV 2 IgM Rp 245,000 Rp 245,000 Rp 245,000
IgG Toxo Aviditas Rp 395,000 Rp 395,000 Rp 395,000

PANKREAS
Lipase Rp 150,000 Rp 150,000 Rp 150,000
Amilase Rp 150,000 Rp 150,000 Rp 150,000
N LABORATORIUM

DIABETES Tarif Peserta Tarif Umum Tarif BPJS

Gula Darah Puasa Rp 25,000 Rp 25,000 Rp 25,000
Gula Darah 2 jam PP Rp 25,000 Rp 25,000 Rp 25,000
Gula Darah Sewaktu Rp 25,000 Rp 25,000 Rp 20,000
GTT Rp 80,000 Rp 80,000 Rp 80,000
Hb.A1c Rp 235,000 Rp 235,000 Rp 235,000

FUNGSI HATI
Protein Total Rp 30,000 Rp 30,000 Rp 30,000
Albumin Rp 30,000 Rp 30,000 Rp 30,000
Globulin Rp 20,000 Rp 20,000 Rp 20,000
Bilirubin Lengkap Rp 55,000 Rp 55,000 Rp 55,000
SGOT Rp 28,000 Rp 28,000 Rp 28,000
SGPT Rp 35,000 Rp 35,000 Rp 35,000
Alkaliphospatase Rp 35,000 Rp 35,000 Rp 35,000
Gamma GT Rp 35,000 Rp 35,000 Rp 35,000
LDH Rp 50,000 Rp 50,000 Rp 50,000
Cholinesterase Rp 120,000 Rp 120,000 Rp 120,000
TTT/Kunkel Rp 78,000 Rp 78,000 Rp 78,000
Elektroforesa Protein Rp 150,000 Rp 150,000 Rp 150,000
Asam Empedu Rp 335,000 Rp 335,000 Rp 335,000

FUNGSI GINJAL
Ureum Rp 28,000 Rp 28,000 Rp 28,000
Creatinin Rp 28,000 Rp 28,000 Rp 28,000
Asam Urat Rp 30,000 Rp 30,000 Rp 30,000
Clearence Ureum Rp 80,000 Rp 80,000 Rp 80,000
Asam Fosfatase Rp 80,000 Rp 80,000 Rp 80,000

LEMAK
Cholesterol Rp 28,000 Rp 28,000 Rp 28,000
Trigliserida Rp 28,000 Rp 28,000 Rp 28,000
HDL Rp 40,000 Rp 40,000 Rp 40,000
LDL Rp 25,000 Rp 25,000 Rp 25,000
Beta Lipoprotein Rp 100,000 Rp 100,000 Rp 100,000
Lipid Total Rp 75,000 Rp 75,000 Rp 75,000
LP(a) Rp 250,000 Rp 250,000 Rp 250,000

JANTUNG
CK Rp 198,000 Rp 198,000 Rp 198,000
CK-MB Rp 198,000 Rp 198,000 Rp 198,000
 LDH Rp 90,000 Rp 90,000 Rp 90,000
SGPT Rp 30,000 Rp 30,000 Rp 30,000
HBDH Rp 120,000 Rp 120,000 Rp 120,000
hs-CRP Rp 270,000 Rp 270,000 Rp 270,000
Troponin I Rp 395,000 Rp 395,000 Rp 395,000
Troponin T Rp 270,000 Rp 270,000 Rp 270,000
N LABORATORIUM

TUMOR MARKER Tarif Peserta Tarif Umum Tarif BPJS

AFP Rp 295,000
CEA Rp 295,000
Ca. 19-9 Rp 560,000
Ca.125 Rp 544,000
C.15-3 (Payudara) Rp 509,000
PSA Rp 363,000
NSE Rp 609,500

IMUNO SEROLOGI
Widal Rp 55,000 Rp 55,000 Rp 55,000
Anti Salmonella Thyphi IgM Rp 295,000 Rp 295,000 Rp 295,000
Tubex Rp 270,000 Rp 270,000 Rp 270,000
VDRL Rp 60,000 Rp 60,000 Rp 60,000
TPHA Rp 60,000 Rp 60,000 Rp 60,000
HbsAg Kualitalif Rp 55,000 Rp 55,000 Rp 55,000
HbsAg Kuanitatif Rp 145,000 Rp 145,000 Rp 145,000
Anti Hbs Rp 90,000 Rp 90,000 Rp 90,000
Anti HBc Rp 210,000 Rp 210,000 Rp 210,000
Anti HBc IgM Rp 365,000 Rp 365,000 Rp 365,000
HbeAg Rp 295,000 Rp 295,000 Rp 295,000
Anti HAV Rp 398,000
Anti HAV IgM Rp 280,000 Rp 280,000 Rp 280,000
Anti HCV Rp 150,000 Rp 150,000 Rp 150,000
Anti HIV Rp 150,000 Rp 150,000 Rp 150,000
ASTO Kualitatf Rp 95,000 Rp 95,000 Rp 95,000
ASTO Kuantitaif Rp 165,000 Rp 165,000 Rp 165,000
CRP Kualitatif Rp 120,000 Rp 120,000 Rp 120,000
CRP Kuantitif Rp 225,000 Rp 225,000 Rp 225,000
RF Rp 80,000 Rp 80,000 Rp 80,000
RF Kuantitatif Rp 155,000 Rp 155,000 Rp 155,000
C-3 Komplemen Rp 415,000 Rp 415,000 Rp 415,000
C-4 Complemen Rp 415,000 Rp 415,000 Rp 415,000
IgE Rp 288,000 Rp 288,000 Rp 288,000
Dengue Blot IgG/IgM Rp 185,000 Rp 185,000 Rp 185,000
PAP TB Rp 120,000 Rp 120,000 Rp 120,000
Serologi Amuba Rp 285,000 Rp 285,000 Rp 285,000
NS1 Rp 260,000 Rp 260,000 Rp 260,000
LAIN-LAIN
Analisa Sperma Rp 60,000 Rp 60,000 Rp 60,000
Analisa Batu Rp 145,000 Rp 145,000 Rp 145,000
Test Rivalta Rp 40,000 Rp 40,000 Rp 40,000
Kultur Pus Rp 34,000 Rp 34,000 Rp 34,000
 DAFTAR HARGA PEMERIKSAAN LABORATORIU

HEMATOLOGI Tarif Peserta Tarif Umum Tarif BPJS

Darah lengkap Rp 69,000 Rp 69,000 Rp 69,000
Darah Rutin Rp 57,000 Rp 57,000 Rp 57,000
Hemoglobin Rp 25,000 Rp 25,000 Rp 25,000
Leukosit Rp 25,000 Rp 25,000 Rp 25,000
Diff Rp 25,000 Rp 25,000 Rp 25,000
Trombosit Rp 29,000 Rp 29,000 Rp 29,000
Eritrosit Rp 25,000 Rp 25,000 Rp 25,000
Hematokrit Rp 25,000 Rp 25,000 Rp 25,000
Retikulosit Rp 25,000 Rp 25,000 Rp 25,000
Eosionofil Rp 25,000 Rp 25,000 Rp 25,000
Gambaran Darah Tepi Rp 144,000 Rp 144,000 Rp 144,000
MCV,MCH,MCHC @ Rp 17,000 Rp 17,000 Rp 17,000
Golongan Darah Rp 23,000 Rp 23,000 Rp 23,000
Malaria Rp 155,000 Rp 155,000 Rp 155,000
Filaria Rp 34,000 Rp 34,000 Rp 34,000
Masa Pendarahan Rp 17,000 Rp 17,000 Rp 17,000
Masa Pembekuan Rp 17,000 Rp 17,000 Rp 17,000
PT Rp 184,000 Rp 184,000 Rp 184,000
APTT Rp 184,000 Rp 184,000 Rp 184,000
D.Dimer Rp 391,000 Rp 391,000 Rp 391,000
Fibrinogen Rp 178,000 Rp 178,000 Rp 178,000
INR
SEL LE Rp 80,000 Rp 80,000 Rp 80,000
Reaksi LE Rp 80,000 Rp 80,000 Rp 80,000
HB.Elektroforesa Rp 385,000 Rp 385,000 Rp 385,000
SI Rp 144,000 Rp 144,000 Rp 144,000
TIBC Rp 144,000 Rp 144,000 Rp 144,000
Comm'bs Test Rp 172,000 Rp 172,000 Rp 172,000
G6 PD Rp 264,000 Rp 264,000 Rp 264,000
Feritin Rp 287,000 Rp 287,000 Rp 287,000
hb.HPLC Rp 512,000 Rp 512,000 Rp 512,000
URINE
Darah samar Rp 57,000 Rp 57,000 Rp 57,000
Lengkap Rp 34,000 Rp 34,000 Rp 34,000
PP Test Rp 23,000 Rp 23,000
HCG Latex

NARKOBA
Amphetamin Rp 46,000 Rp 46,000
Morfin Rp 46,000 Rp 46,000
Mariyuana Rp 46,000 Rp 46,000
Cocain Rp 46,000 Rp 46,000
Methamphetamin Rp 46,000 Rp 46,000
Benzodiazepin Rp 46,000 Rp 46,000

DAFTAR HARGA PEMERIKSAAN LABORATORIU

MIKROBIOLOGI Tarif Peserta Tarif Umum Tarif BPJS
Gram Rp 92,000 Rp 92,000 Rp 92,000
Secret Mata Rp 92,000 Rp 92,000 Rp 92,000
Seret Uretha Rp 92,000 Rp 92,000 Rp 92,000
BTA SPUTUM 1 X Rp 34,000 Rp 34,000 Rp 34,000

ELEKTROLIT
Natrium Rp 92,000 Rp 92,000 Rp 92,000
Kalium Rp 92,000 Rp 92,000 Rp 92,000
Chlorida Rp 92,000 Rp 92,000 Rp 92,000
Calsium Rp 92,000 Rp 92,000 Rp 92,000
Phospor Rp 34,000 Rp 34,000 Rp 34,000
Magnesium Rp 34,000 Rp 34,000 Rp 34,000

ENDOKRIN
TSH Rp 276,000 Rp 276,000 Rp 276,000
T3 Rp 194,000 Rp 194,000 Rp 194,000
T4 Rp 190,000 Rp 190,000 Rp 190,000
T3 UPTAKE Rp 339,000 Rp 339,000 Rp 339,000
Fti Rp 1,242,000 Rp 1,242,000 Rp 1,242,000
FsH Rp 356,000 Rp 356,000 Rp 356,000
Free T4 Rp 331,000 Rp 331,000 Rp 331,000
LH Rp 336,000 Rp 336,000 Rp 336,000
PROLAKTIN Rp 247,000 Rp 247,000 Rp 247,000
ESTRADIOL Rp 276,000 Rp 276,000 Rp 276,000
PROGRESTERON Rp 287,000 Rp 287,000 Rp 287,000
TESTOTERON Rp 477,000 Rp 477,000 Rp 477,000
Tiroglubulin Rp 707,000 Rp 707,000 Rp 707,000

TORCH
Toxoplasma IgG Rp 272,000 Rp 272,000 Rp 272,000
Toxoplasma IgM Rp 272,000 Rp 272,000 Rp 272,000
Rubella IgG Rp 292,000 Rp 292,000 Rp 292,000
Rubella IgM Rp 364,000 Rp 364,000 Rp 364,000
CMV IgG Rp 276,000 Rp 276,000 Rp 276,000
CMV IgM Rp 377,000 Rp 377,000 Rp 377,000
HSV 1 IgG Rp 300,000 Rp 300,000 Rp 300,000
HSV 1 IgM Rp 300,000 Rp 300,000 Rp 300,000
HSV 2 IgG Rp 282,000 Rp 282,000 Rp 282,000
HSV 2 IgM Rp 282,000 Rp 282,000 Rp 282,000
IgG Toxo Aviditas Rp 454,000 Rp 454,000 Rp 454,000

PANKREAS
Lipase Rp 172,000 Rp 172,000 Rp 172,000
Amilase Rp 172,000 Rp 172,000 Rp 172,000
MERIKSAAN LABORATORIUM

DIABETES Tarif Peserta Tarif Umum Tarif BPJS

Gula Darah Puasa Rp 29,000 Rp 29,000 Rp 28,750
Gula Darah 2 jam PP Rp 29,000 Rp 29,000 Rp 28,750
Gula Darah Sewaktu Rp 29,000 Rp 29,000 Rp 23,000
GTT Rp 92,000 Rp 92,000 Rp 92,000
Hb.A1c Rp 270,000 Rp 270,000 Rp 270,250

FUNGSI HATI
Protein Total Rp 34,000 Rp 34,000 Rp 34,000
Albumin Rp 34,000 Rp 34,000 Rp 34,000
Globulin Rp 23,000 Rp 23,000 Rp 23,000
Bilirubin Lengkap Rp 63,000 Rp 63,000 Rp 63,000
SGOT Rp 32,000 Rp 32,000 Rp 32,000
SGPT Rp 40,000 Rp 40,000 Rp 40,000
Alkaliphospatase Rp 40,000 Rp 40,000 Rp 40,000
Gamma GT Rp 40,000 Rp 40,000 Rp 40,000
LDH Rp 57,000 Rp 57,000 Rp 57,000
Cholinesterase Rp 138,000 Rp 138,000 Rp 138,000
TTT/Kunkel Rp 90,000 Rp 90,000 Rp 90,000
Elektroforesa Protein Rp 172,000 Rp 172,000 Rp 172,000
Asam Empedu Rp 385,000 Rp 385,000 Rp 385,000

FUNGSI GINJAL
Ureum Rp 32,000 Rp 32,000 Rp 32,000
Creatinin Rp 32,000 Rp 32,000 Rp 32,000
Asam Urat Rp 34,000 Rp 34,000 Rp 34,000
Clearence Ureum Rp 92,000 Rp 92,000 Rp 92,000
Asam Fosfatase Rp 92,000 Rp 92,000 Rp 92,000

LEMAK
Cholesterol Rp 32,000 Rp 32,000 Rp 32,000
Trigliserida Rp 32,000 Rp 32,000 Rp 32,000
HDL Rp 46,000 Rp 46,000 Rp 46,000
LDL Rp 29,000 Rp 29,000 Rp 29,000
Beta Lipoprotein Rp 115,000 Rp 115,000 Rp 115,000
Lipid Total Rp 86,000 Rp 86,000 Rp 86,000
LP(a) Rp 287,000 Rp 287,000 Rp 287,000

JANTUNG
CK Rp 228,000 Rp 228,000 Rp 228,000
CK-MB Rp 228,000 Rp 228,000 Rp 228,000
LDH Rp 103,000 Rp 103,000 Rp 103,000
 SGPT Rp 34,000 Rp 34,000 Rp 34,000
HBDH Rp 138,000 Rp 138,000 Rp 138,000
hs-CRP Rp 310,000 Rp 310,000 Rp 310,000
Troponin I Rp 454,000 Rp 454,000 Rp 454,000
Troponin T Rp 310,000 Rp 310,000 Rp 310,000

MERIKSAAN LABORATORIUM
TUMOR MARKER Tarif Peserta Tarif Umum Tarif BPJS
AFP Rp 339,000
CEA Rp 339,000
Ca. 19-9 Rp 644,000
Ca.125 Rp 626,000
C.15-3 (Payudara) Rp 585,000
PSA Rp 417,000
NSE Rp 700,000

IMUNO SEROLOGI
Widal Rp 63,000 Rp 63,000 Rp 63,000
Anti Salmonella Thyphi IgM Rp 339,000 Rp 339,000 Rp 339,000
Tubex Rp 310,000 Rp 310,000 Rp 310,000
VDRL Rp 69,000 Rp 69,000 Rp 69,000
TPHA Rp 69,000 Rp 69,000 Rp 69,000
HbsAg Kualitalif Rp 63,000 Rp 63,000 Rp 63,000
HbsAg Kuanitatif Rp 166,000 Rp 166,000 Rp 166,000
Anti Hbs Rp 103,000 Rp 103,000 Rp 103,000
Anti HBc Rp 241,000 Rp 241,000 Rp 241,000
Anti HBc IgM Rp 420,000 Rp 420,000 Rp 420,000
HbeAg Rp 339,000 Rp 339,000 Rp 339,000
Anti HAV Rp 458,000
Anti HAV IgM Rp 322,000 Rp 322,000 Rp 322,000
Anti HCV Rp 172,000 Rp 172,000 Rp 172,000
Anti HIV Rp 172,000 Rp 172,000 Rp 172,000
ASTO Kualitatf Rp 109,000 Rp 109,000 Rp 109,000
ASTO Kuantitaif Rp 190,000 Rp 190,000 Rp 190,000
CRP Kualitatif Rp 138,000 Rp 138,000 Rp 138,000
CRP Kuantitif Rp 259,000 Rp 259,000 Rp 259,000
RF Rp 92,000 Rp 92,000 Rp 92,000
RF Kuantitatif Rp 178,000 Rp 178,000 Rp 178,000
C-3 Komplemen Rp 477,000 Rp 477,000 Rp 477,000
C-4 Complemen Rp 477,000 Rp 477,000 Rp 477,000
IgE Rp 331,000 Rp 331,000 Rp 331,000
Dengue Blot IgG/IgM Rp 213,000 Rp 213,000 Rp 213,000
PAP TB Rp 138,000 Rp 138,000 Rp 138,000
Serologi Amuba Rp 328,000 Rp 328,000 Rp 328,000
NS1 Rp 299,000 Rp 299,000 Rp 299,000
 LAIN-LAIN
Analisa Sperma Rp 69,000 Rp 69,000 Rp 69,000
Analisa Batu Rp 167,000 Rp 167,000 Rp 167,000
Test Rivalta Rp 46,000 Rp 46,000 Rp 46,000
Kultur Pus Rp 39,000 Rp 39,000 Rp 39,000