Lahoratnrinm Klint, SAM HUSADA J, Veteran No, $5 ~ 57 Velp/Fax. (0388) 328470 NGANIUR 2 Momplovidi No. $Telp. (USA) O87466 Fa. (0984) O72E raegorn No. 3 Te £86242 KERTOSONO DAFTAR HARGA SAM HUSADA TAHUN 2023 HEMATOLOGI SAM, Oe Darah Lengkap 3 diff 110 000, 66 000 [Darah Lengkap 5 diff 445.000 87.000. [Retikulosit 390-009, 54.000 Hitung Jenis. 90,000. 54.000 |Hapusan Darah 175.000. "705.000. IEosinofil 90.000 54 000. Faal Hemostasis 325.000. 795 000, \Waktu Perdarahan 35.000. 21,000, Waktu Pembekuan 35.000, 21.000 PPT 750.000 {90.000 KPPT 150.000 90,000 [Gol Darah ABO+ Rho D. 20.000, 48,000 Rho D. 45,000. 27-000. URINE ‘SAM. a0% (Urine Lengkap 65.000, 39,000. [Mikroalbumin Urine. 7200-000 720.000 [Protein Urine Bence Jones. 60.000 36.000 ‘TES KEHAMILAN. ‘SAM ai [Plano Test 45,000 27.000 ELEKTROLIT. ‘SAM. 4% Natrium, Kalium, Clonda 305,000, 213.500 [Magnesium 195.000 100.000 [Phospor 195.000 7100000 (Co 2 | Bicarbonat 7230.00. 174.000 ‘JANTUNG: ‘SAM 0% ECG 75.000 ‘50,000. TAINTAIN ‘SAM. 40% [Analisa Batu 525,000, 315,000 [Analisa Sperma 160.000 708.000 PAP Smear 795 000 117.000 ‘GLUKOSA, SAM a [Giukosa Puasa 40000, 24,000 [Glukosa Zipp 40.000. 24.000. [Glukosa Ad Random 40.000. 24.000 ict 225.000. 700,000. HbATC 215,000. 729,000 FAECES, ‘SAM Wi [Faeces Rutin 70,000, 42,000 LEMAK. ‘SAM. a0% [Cholesterol Total 70,000. 35,000 [Trialiserida 80,000, “40.000 Paket Profil Lioid 305.000. 752.500 HDL Direct-Cholesterol 150.000. 60.000 LDL Direct-Cholesterol 150.000. 60.000 [Apolipo Protein At 395.000 237,000. [Apolipo Protein B. ‘385.000 231,000) FAAL HATI ‘SAM. Oy, Bilirubin total 57,000. 34,200 Bilirubin direct 57,000, 34.200, SGOT. 47.000. 28.200 SGPT. 47.000 28.200 /Alkali phospatase 57.000 34.200 Gamma GT 87.000 52.200. bumin: ‘57.000 34.200 [Globulin 50.000. "30.000 Total Protein 57.000. 34.200. Elektroforesis Protein 550,000. 330,000 [Amylase 495.000 297.000, Lipase 435.000 264.000. © Dipindai dengan CamScannerLabaratorinm Klinik SAM HUSADA AL Veteran No, 35 — 37 Yelp/Fax, (0358) 328470 NGANJUK Pusat: JL Monginsidi No. $ Telp. (0354) 687466 Fax. (0354) 699928 Cabang : JL Diponegoro No, 3 Telp/Fas. (0358) 556242 KERTOSONO FAAL GINJAL = ‘SAM. 40%, (Urea (BUN) 52.000 31.200 [Creatinin 52.000 31.200 Uric Acie 62.000 31,000. (Clear Creatinin 704.000 62.400 IMMUNO-SEROLOGY ‘SAM. a fg E Total 440,000 264.000 lg G Toxoplasmosis 430,000 215.000 ig M Toxoplasmosis. 430,000 215.000 IMMUNO-SEROLOGY. ‘SAM. 40% fa G Rubella 430,000 215,000. Iq M Rubella 625.000 312.500. la G CMV 530.000 316.000. lq MCMV, 650.000 390,000 IVORL 85.000 42.500 ITPHA 765.000 82.500 Widal (8 strainy 415.000 69.000 Hibs Ag (Elfa ) 250.000 725.000 Hibs Ab/Anti Hbs (Eta) [285,000 198.500 [Anti Hbc 465.000 279.000. fa M Anti HBC 630.000 378.000. Hibe Ag 635.000 381,000 Hbe Ab 635.000. 381.000 [Anti HOV {610.000 366.000 lq M Anti HAV "590.000 295.000. [Anti HAV 630,000 315.000 LE Test, "780,000. 474.000 IANA Test "760,000. 456.000 RA Test 120.000 72,000. Csic 4s @ 700,000, 420.000 lg M Anti S. Thypi [372.000 223.200 ICRP Kuantitatif 410.000. 246.000. ‘Anti Hbs Titer (Ela) 285,000 174.000, [Anti Hbe 635,000 350,000 lig G fg M Aca (1564) = = HIV (Elisa 225,000 735,000 [Anti ds DNA 750,000 450,000, iq G HSV 1 Kult 450,000. 225.000 lg M HSV Kulit 450.000. 225.000 FNAB 490,000 400,000. widity 19. Toxo, 820.000 450.000 ig G HSV 2 Kelamin 450.000. 225.000 ig M HSV 2 Kelamin “460.000 230,000. IMMUNO-SEROLOGY ‘SAM 40% bs Ag Chromatograf = ICT Malaria 385.000 231,000 HBV DNA. 3.500.000 2,300,000 Iq GBM DAF 350,000 200,000. ICT Tuberculosis 315,000 157.500 TUMOR MARKER. ‘SAM 0%. CEA 250,000. 187.500, ICA 125 700.000 310.000, CA 15.3 (Elta) 640,000. 320.000 PSA (Eclia) 530,000 270,000 Free PSA (Ecia) 575.000 310,000 |AFP (Eclia) 445.000 215.000. [Beta HCG (Ecla) 520.000 260.000 HORMON ‘SAM. a0% TSH/TSHS. 425,000 185,000, [r-3 Total 395.000 140,000. T4 Total 395,000 "130.000. (Free T 3 575,000 299.000 Free T4 415.000 180.000 © Dipindai dengan CamScannerMorin Kline SAM HUSADA JL. Veteran No. 35 ~ 37 Yelp/ax, (0358) 328470 NGANJUK Pusat: Jl. Monginsidi No, § Telp. (0354) 687466 Fax. (0388) 699928 {Cabang £ SL Diponegoo Ne-3 TelpFax, (1358) 586242 KERTOSONO iH 350,000 300,000 FSH 645.000. 290.000 Prolakiin 610,000 300,000. Estradiol 680.000 340.000. Estriol Free / Total o Corisol E0000 310000 MIKROBIOLOGY ‘SAM 40° feria 110000 35,000, /Pewarnaan ZN 85.000 51,000, |[Pewarnaan Neisser = [Pewarnaan Gram 85.000. 51,000, Sitologi Pap Smear 185.000, 105.000 X-RAY. SAM (= 25% ) ‘Manus Dex (Ap/Lat ) 275.000 206.250. Manus Sin ( Ap/Lat ) 275.000 206.250. Wist Dex ( Ap/Lat 275,000 206.250 Wrist Sin (Ap/Lat 275,000 206.250 | Antebrachi Dex (Ap/Lat ) 325.000 243.750. “Antebrachi Sin (Ap/Lat ) 325,000 243.750 X-RAY. SAM (25%) Cubii Dax( AprLat 325,000 243,750 Cubiti Sin ( Ap/Lat ) 325.000 243.750 Humerus Dex (Ap/Lat ) 325.000 243.750 Humerus Sin ( Ap/Lat ) 325.000 243.750 ‘Shoulder Joint Dex (AprLat) 325,000 | 243.750 ‘Shoulder Joint Sin ( Ap/Lat ) 325.000 243.750 Pedis Dex ( Ap/Lat) 325.000 243.750 Pedis Sin ( Ap/Lat ) 325.000 243.750 Ankle Dex {Ap/Lal) 325,000 243-750 ‘Ankle Sin ( Ap/Lat ) 325,000 243.750 Calcaneus Dex (Ap/Lat) 300,000 225,000 Coleaneus Sin (Ap/tat) 300,000 225,000 ‘Cruris Dex (Ap/Lat ) 350.000 262.500 Cruris Sin (Ap/Lat) 350,000 262.500 Genu Dex ( Ap/Lat ) 325.000 243.750. Genu Sin (Ap/Lat) 325.000 243.750 Femur Dex ( Ap/Lat ) 350.000 262.500 Femur Sin ( Ap/Lat ) 350.000. 262.500. Elbow Dex ( Ap/Lat ) 325.000 243.750 Elbow Sin ( ApiLat ) 325.000 243.750 Clavicula Dex ( Ap/Lat ) 475.000 131,250 Ciavicula Sin ( Ap/Lat ) 475.000 131.250 ‘Scapula Dex (Ap) 200.000 450.000 ‘Scapula Sin (Ap ) ‘200.000 150.000, ‘Scapula Ap/Lat 300.000 225.000 ‘Thorax PA 475.000 431.250 Thorax Lat 475,000 131.250 Thorax PA & Lat 325.000 243.750. BOF / BNO 175.000 431.250 LLD 175.000 131.250 Pelvis 175.000 131.250 BOF+LD 325,000 243.750 BOF 3 posis 475,000 356.250 Standart Scolosi 00.000 750 000 Vert. Cervical (ApiLat) 300.000 225,000, © Dipindai dengan CamScannerVaboratoriam Klinik SAM HUSADA I, Veteran No. 35 ~ 37 'Yelp/Kax. (0358) 328470 NGANJUK Pusat: Jl Monginsii No. Seip, (0354) 687466 Fas (0354) 699928 Cabang : IL Diponegoro No. 3 Telp/Fax. (0388) 56242 KERTOSONO Vert, Cervical Ap&Lat&Obiq O] 450.000, 337.500 Vert. Thoracolumbal Ap/Lat 325.000 243,750 Vert. Thoracalis Ap/Lat 325.000, 243.750 Vert. Thoracalis Oblq Dex/Sin 325,000 243.750 Vert. Lumbosacral Ap/Lat 325,000 243.750, Vert. Lumbosacral Obig Dexia 325.000 243.750, ‘Sinus Paranasalis / Waters 175.000 131.250 Nasal Ap/Lat 175.000, 131.250 Nasal Ap & Lat 275.000 206.250) Mastoid AP/Lat 175,000 131.250 Mastoid AP&Lat 300,000 225.000, ‘Skull Ap/Lat 175.000 131.250 ‘Skull Ap&Lat 300.000 225.000 Mandibula Apalat "300.000 225.000, TMJ Dew/Sin 300,000 225.000, TMJ Dex&Sin “450.000 337.500, X-RAY ‘SAM. (25%) ‘Gesophagograf 1,350,000 | 7.012.500, Farinfo-Oesophagografi 1.750.000 |___ 1.312.500 UGI 4,800,000 | 1.425.000 Colon in Loop 2.000.000 | ~1.500.000 Barium Follow Throught 2.250.000 | 1.687.500 ‘Appendicogram 1.350.000 |__1.012.500 Uretrocystography 1.650.000 | 1.237.500 Ureterography 7.400.000 | 1.050.000 Cystograph 7.450.000 | 1.087.500 IVP lop 30cc 7.800.000 | 1.350.000 HSG 4.650.000 | 1.237.500 Fistulography 7.350.000 | 1.012.500 UsG ‘SAM (25%) USG Coll 575,000 431,250 USG Thyroid {600.000 “450,000 USG Musculus {800.000 600.000 USG Mammae Dex/Sin 750.000 ‘562.500, USG Thorax 450,000 337.500 USG Upper Abdomen 600,000 450.000, [USG Lower Abdomen [525.000 [393.750 | USG Abdomen Total 800.000 600.000, USG Urologi 350.000 262.500 USG Kandungan 525.000 393.750 USG Inguinal 575.000 431.250 USG Testis 600.000, 450,000 USG Trans Vagina 575,000 431.250 Mengetahui, © 3 Antorti, Ama Manager © Dipindai dengan CamScanner