NAMA TARIF KODE JENIS TARIF

Masa Perdarahan / BT LAB01004 NON OPERATIF

Masa Pembekuan / CT LAB01005 NON OPERATIF
GRUP TARIF DK KOMPONEN TARIF LAYANAN
SEDERHANA DOKTER LAB LABORATORIUM
SEDERHANA DOKTER LAB LABORATORIUM
Uraian

HEMATOLOGI

Darah Lengkap / DPL Darah Lengkap / DPL

Darah Rutin Darah Rutin

LED LED

HITUNG JENIS Hitung Jenis

Masa Perdarahan / BT Masa Perdarahan / BT

Masa Pembekuan / CT Masa Pembekuan / CT

GOLONGAN DARAH/RH Golongan darah/RH

GAMBARAN DARAH TEPI (GDT) #N/A

D Dimer #N/A

#N/A

#N/A

KIMIA KLINIK #N/A

BILIRUBIN TOTAL Bilirubin Total

BILIRUBIN DIREK #N/A

BILIRUBIN INDIREK #N/A

SGOT SGOT

SGPT SGPT

KOLESTEROL Kolesterol

LIPID TOTAL #N/A

TRIGLISERIDA #N/A

HDL KOLESTEROL DIREK #N/A

LDL KOLESTEROL DIREK #N/A

UREUM Ureum
KREATININ #N/A

ASAM URAT Asam Urat

GLUKOSA PUASA #N/A

GLUKOSA 2 PP #N/A

GLUKOSA SEWAKTU #N/A

GLUKOSA TOLERANSI TEST #N/A

HBA1C #N/A

ELEKTROLIT #N/A

#N/A

#N/A

IMMUNOSEROLOGI #N/A

WIDAL Widal

HBSAG RAPID HbsAg Rapid

ANTI DENGUE IGG/IGM #N/A

IGM ANTI SALMONELLA (TUBEX TF) #N/A

CRP KUANTITATIF (HJ) #N/A

NS-1 #N/A

#N/A

#N/A

Uraian #N/A

#N/A

BAKTERIOLOGI #N/A

PEWARNAAN GRAM #N/A

PEWARNAAN BTA #N/A

#N/A

URINALISA #N/A

URINE LENGKAP Urine lengkap

TES PACK #N/A

PROTEIN URINE Protein urine

KETON URINE #N/A

REDUKSI URINE Reduksi Urine

SEDIMEN URINE #N/A

#N/A

FAECES #N/A

FAECES LENGKAP Faeces Lengkap

ANALISA FAECES LENGKAP Analisa Faeces Lengkap

#N/A

#N/A

LAIN - LAIN #N/A

ANALISA SPERMA Analisa Sperma

KETON DARAH Keton Darah

TROPONIN
CKMB
 10%

DR RS DR
VIP A 6% 94% VIP B 6%
dr rs dr

LAB01001 242,394 14,544 227,850 226,536 13,592

LAB01007 196,877 11,813 185,065 183,997 11,040

LAB01002 91,574 5,494 86,080 85,583 5,135

LAB01003 91,574 5,494 86,080 85,583 5,135

LAB01004 45,573 2,734 42,839 38,720 2,323

LAB01005 45,573 2,734 42,839 47,916 2,875

LAB01006 109,946 6,597 103,349 102,753 6,165

#N/A 366,439 21,986 344,453 342,466 20,548

613,800 36,828 576,972 574,200 34,452

#NAME?

141,951 8,517 133,434 120,389 7,223

141,951 8,517 133,434 120,389 7,223

163,247 9,795 153,452 96,594 5,796

103,964 6,238 97,727 97,163 5,830

103,964 6,238 97,727 97,163 5,830

123,903 7,434 116,469 115,797 6,948

112,639 6,758 105,881 105,270 6,316

125,327 7,520 117,807 117,128 7,028

271,524 16,291 255,233 239,580 14,375

271,524 16,291 255,233 239,580 14,375

103,537 6,212 97,325 96,764 5,806

103,537 6,212 97,325 96,764 5,806

101,116 6,067 95,049 94,501 5,670

69,386 4,163 65,222 64,846 3,891

69,386 4,163 65,222 64,846 3,891

69,386 4,163 65,222 64,846 3,891

324,161 19,450 304,711 302,954 18,177

392,294 23,538 368,756 403,293 24,198

445,765 26,746 419,019 416,603 24,996

164,919 9,895 155,024 160,552 9,633

206,932 12,416 194,516 193,394 11,604

400,477 24,029 376,448 374,277 22,457

427,963 25,678 402,285 399,966 23,998

400,807 24,048 376,758 366,201 21,972

505,723 30,343 475,379 472,638 28,358

VVIP VIP B
dr rs dr

104,107 6,246 97,860 97,296 5,838

104,107 6,246 97,860 97,296 5,838

95,419 5,725 89,694 89,177 5,351

101,910 6,115 95,795 95,243 5,715

62,663 3,760 58,904 58,564 3,514

68,645 4,119 64,526 64,154 3,849

62,663 3,760 58,904 58,564 3,514

68,645 4,119 64,526 64,154 3,849

181,582 10,895 170,687 169,703 10,182

333,968 20,038 313,930 312,120 18,727

367,954 22,077 345,877 378,270 22,696

62,405 3,744 58,660 64,154 3,849

55%
 RS DR RS DR RS DR
94% Utama 6% 94% Kls I 6% 94% Kls II 6%
rs dr rs dr rs dr

212,944 190,981 11,459 179,522 178,487 10,709 167,778 159,720 9,583

172,958 155,519 9,331 146,188 145,345 8,721 136,624 120,274 7,216

80,448 66,030 3,962 62,068 67,881 4,073 63,808 56,023 3,361

80,448 72,633 4,358 68,275 61,710 3,703 58,007 56,023 3,361

36,397 32,368 1,942 30,425 33,275 1,997 31,279 27,830 1,670

45,041 40,019 2,401 37,618 37,401 2,244 35,157 31,218 1,873

96,588 86,874 5,212 81,662 81,191 4,871 76,320 67,276 4,037

321,918 289,107 17,346 271,760 270,193 16,212 253,981 223,850 13,431

539,748 554,400 33,264 521,136 534,600 32,076 502,524 495,000 29,700

113,166 120,389 7,223 113,166 102,420 6,145 96,275 76,472 4,588

113,166 120,389 7,223 113,166 102,420 6,145 96,275 76,472 4,588

90,798 74,303 4,458 69,845 62,884 3,773 59,111 52,151 3,129

91,333 95,033 5,702 89,331 90,508 5,430 85,078 75,262 4,516

91,333 95,033 5,702 89,331 90,508 5,430 85,078 75,262 4,516

108,849 113,202 6,792 106,409 107,811 6,469 101,342 79,860 4,792

98,954 102,911 6,175 96,736 98,010 5,881 92,129 72,600 4,356

110,100 114,599 6,876 107,723 109,142 6,549 102,593 81,191 4,871

225,205 239,580 14,375 225,205 215,755 12,945 202,810 188,070 11,284

225,205 239,580 14,375 225,205 215,755 12,945 202,810 188,070 11,284

90,958 95,033 5,702 89,331 90,508 5,430 85,078 67,216 4,033

 90,958 95,033 5,702 89,331 90,508 5,430 85,078 67,216 4,033

88,831 92,238 5,534 86,704 87,846 5,271 82,575 65,219 3,913

60,956 63,393 3,804 59,589 60,374 3,622 56,752 44,722 2,683

60,956 63,393 3,804 59,589 60,374 3,622 56,752 44,722 2,683

60,956 63,393 3,804 59,589 60,374 3,622 56,752 44,722 2,683

284,777 296,164 17,770 278,394 282,061 16,924 265,137 208,934 12,536

379,095 394,109 23,647 370,463 375,342 22,521 352,821 278,179 16,691

391,607 406,967 24,418 382,549 387,587 23,255 364,332 287,496 17,250

150,919 150,935 9,056 141,879 143,748 8,625 135,123 106,374 6,382

181,791 189,089 11,345 177,743 180,084 10,805 169,279 133,366 8,002

351,821 366,158 21,969 344,189 348,722 20,923 327,799 258,214 15,493

375,968 391,314 23,479 367,835 372,680 22,361 350,319 276,183 16,571

344,229 348,898 20,934 327,964 331,595 19,896 311,699 319,759 19,186

444,280 462,030 27,722 434,308 440,029 26,402 413,627 326,095 19,566

VIP C Kls I Kls II

rs dr rs dr rs dr

91,458 95,033 5,702 89,331 90,508 5,430 85,078 69,212 4,153

91,458 95,033 5,702 89,331 90,508 5,430 85,078 69,212 4,153

83,826 87,347 5,241 82,106 83,188 4,991 78,196 61,492 3,690

 89,528 94,576 5,675 88,901 90,072 5,404 84,668 65,685 3,941

55,050 57,300 3,438 53,862 54,571 3,274 51,297 40,063 2,404

60,305 62,890 3,773 59,116 59,895 3,594 56,301 44,589 2,675

55,050 57,300 3,438 53,862 54,571 3,274 51,297 40,063 2,404

60,305 62,890 3,773 59,116 59,895 3,594 56,301 44,589 2,675

159,520 166,308 9,979 156,330 158,389 9,503 148,886 117,128 7,028

293,392 305,365 18,322 287,043 290,824 17,449 273,374 215,622 12,937

355,574 369,792 22,188 347,604 352,183 21,131 331,052 260,876 15,653

60,305 62,890 3,773 59,116 59,895 3,594 56,301 44,322 2,659

45% 35% 25%

RS DR RS DR RS
94% Kls III 6% 94% BPJS 6% 94%
rs dr rs

150,137 133,233 7,994 125,239

113,058 107,332 6,440 100,892

52,662 50,046 3,003 47,043

52,662 50,046 3,003 47,043

26,160 24,624 1,477 23,146

29,345 27,951 1,677 26,274

63,239 60,028 3,602 56,426

210,419 199,916 11,995 187,921

465,300 455,400 27,324 428,076

71,884 68,280 4,097 64,183

71,884 68,280 4,097 64,183

49,022 46,580 2,795 43,785

70,746 67,216 4,033 63,183

70,746 67,216 4,033 63,183

75,068 71,874 4,312 67,562

68,244 65,340 3,920 61,420 62,370 3,742 58,628 56700

76,320 72,540 4,352 68,187

176,786 167,706 10,062 157,644

176,786 167,706 10,062 157,644

63,183 60,561 3,634 56,927

 63,183 60,561 3,634 56,927

61,306 58,564 3,514 55,050

42,038 40,249 2,415 37,834

42,038 40,249 2,415 37,834

42,038 40,249 2,415 37,834

196,398 188,040 11,282 176,758

261,488 250,228 15,014 235,214

270,246 258,480 15,509 242,971

99,991 95,832 5,750 90,082

125,364 120,056 7,203 112,853

242,721 232,393 13,944 218,449

259,612 248,232 14,894 233,338

300,574 319,759 19,186 300,574

306,529 293,486 17,609 275,876

Kls III
rs dr rs

65,059 61,892 3,713 58,178

65,059 61,892 3,713 58,178

57,803 55,902 3,354 52,548

 61,744 59,116 3,547 55,569

37,659 36,070 2,164 33,906

41,913 39,930 2,396 37,534

37,659 36,070 2,164 33,906

41,913 39,930 2,396 37,534

110,100 105,149 6,309 98,840

202,685 193,794 11,628 182,166

245,223 234,788 14,087 220,701

41,663 39,930 2,396 37,534

15%