DAFTAR HARGA

NO. JENIS PEMERIKSAAN HARGA

1. HEMATOLOGI - HEMOSTASIS
Hematologi Lengkap (Hemoglobin, Eritrosit,
1 Hematokrit, Nilai MC, Leukosit, Hitung Jenis, Rp 120,000
Laju Endap Darah, Trombosit)
Cell dyn (Hemoglobin, Eritrosit,
2 Hematokrit, Nilai MC, Leukosit, Hitung Jenis, Rp 100,000
Trombosit)
3 Hemoglobin Rp 80,000
4 Eritrosit Rp 80,000
5 Hematokrit Rp 80,000
6 Nilai - nilai MC Rp 80,000
7 Leukosit Rp 80,000
8 Hitung Jenis Rp 80,000
9 Laju Endap Darah Rp 49,500
10 Trombosit Rp 80,000
11 Retikulosit Rp 75,000
12 Jumlah Eosinofil Rp 80,000
13 Morfologi Sediaan Apus Darah Tepi Rp 212,000
HEMOSTASIS
14 Waktu perdarahan Rp 60,000
15 Waktu pembekuan Rp 60,000
16 Waktu protrombin (PT) Rp 290,000
17 aPTT Rp 195,000
18 Fibrinogen Rp 298,000
19 Agregasi Thrombosit Rp 425,000
20 Serum Iron Rp 160,000
21 TIBC Rp 170,000
22 Feritin Rp 290,000
23 Sel LE Rp 130,000
24 Golongan darah (+ Rh) Rp 70,000
2. IMMUNOLOGI
Hepatitis
25 anti HAV Total Rp 535,000
26 anti HAV IgM Rp 475,000
27 HBsAg Kualitatif Rp 180,000
28 HBsAg Kuantitatif Rp 420,000
29 anti HBs Rp 203,000
30 anti HBc total Rp 395,000
31 HBeAg Rp 512,000
32 anti HBe Rp 647,000
33 anti HCV Rp 481,000
Penanda Tumor
34 AFP Rp 380,000
35 CEA Rp 350,000
36 PSA Rp 455,000
37 Free PSA Rp 881,000
38 CA 15-3 Rp 700,000
39 CA 125 Rp 700,000
40 CA 19-9 Rp 720,000
41 B - hCG Rp 600,000
STD
42 VDRL Rp 115,000
43 TPHA Rp 187,000
44 anti HIV Rp 438,000
TORCH
45 anti Toxoplasma IgG Rp 333,000
NO. JENIS PEMERIKSAAN HARGA
46 anti Toxoplasma IgM Rp 333,000
47 anti Rubella IgG Rp 360,000
48 anti Rubella IgM Rp 440,000
49 anti CMV IgG Rp 340,000
50 anti CMV IgM Rp 460,000
Infeksi Salmonella
51 Widal slide test Rp 190,000
52 anti Salmonella typhi IgM Rapid Rp 300,000
53 Tubex TF/Anti Salmonella typhi IgM Rp 333,000
Infeksi Dengue
54 Dengue NS1Ag Rp 420,000
55 anti Dengue Rapid IgG & IgM Rp 528,000
Infeksi Lain
56 anti Chikungunya IgM Rapid Rp 350,000
57 anti Malaria falciparum (ICT malaria) Rp 400,000
Tiroid
58 T3 Rp 312,000
59 FT3 Rp 457,000
60 T4 Rp 300,000
61 FT4 Rp 355,000
62 TSHs Rp 286,000
Hormon
63 LH Rp 401,000
64 FSH Rp 417,000
65 Prolactin Rp 385,000
66 Estradiol Rp 502,000
67 Progesteron Rp 528,000
68 Testosteron Rp 484,000
Lain-lain
69 ASTO Kualitatif Rp 128,000
70 ASTO Semi Kuantitatif Rp 330,000
71 CRP kualitatif Rp 217,000
72 CRP kuantitatif Rp 300,000
Alergi
73 IgE total Rp 425,000
3. KIMIA
FAAL HATI
74 Protein total Rp 88,000
75 Albumin / Globulin Rp 88,000
76 Bilirubin total Rp 76,000
77 Direk / Indirek Rp 76,000
78 SGOT/AST Rp 60,500
79 SGPT/ALT Rp 60,500
80 Gamma GT Rp 110,000
81 Fosfatase alkali Rp 92,000
82 Cholinesterase / CHE Rp 178,000
FAAL GINJAL
83 Ureum Rp 61,000
84 Urea N Rp 61,000
85 Kreatinin Rp 62,000
86 Bersihan kreatinin / Kreatinin klirens Rp 150,000
87 Asam urat Rp 65,000
88 Cystatin C Rp 350,000
DIABETES
89 Glukosa puasa Rp 38,000
90 Glukosa urine puasa Rp 33,000
NO. JENIS PEMERIKSAAN HARGA
95 Glukosa 2 jpp Rp 38,000
96 Glukosa urine 2 jpp Rp 33,000
97 Glukosa sewaktu / ad random Rp 38,000
98 Glukosa urine sewaktu / ad random Rp 33,000
99 GTT (3x) Rp 213,000
100 Glukosa Kurva Harian Rp 284,000
101 HbA1C (HPLC) Rp 198,000
PROFIL LIPID
102 Kolesterol total Rp 57,000
103 Trigliserida Rp 61,000
104 Kolesterol HDL direk Rp 76,000
105 Kolesterol LDL direk Rp 117,000
106 Apo A -1 Rp 345,000
107 Apo B Rp 225,000
108 Lp (a) Rp 440,000
109 Small Dense LDL Rp 342,000
PROFIL JANTUNG
110 CK Rp 220,000
111 CK - MB Rp 450,000
112 hs - CRP Rp 300,000
113 Troponin T Rp 380,000
114 Homosistein Rp 682,000
ELEKTROLIT
115 Natrium/Sodium Rp 133,000
116 Kalium/Potassium Rp 133,000
117 Chlorida Rp 133,000
118 Calcium Rp 120,000
119 Fosfor anorganik Rp 121,000
120 Magnesium Rp 126,500
121 Calsium Ion Rp 319,000
PANKREAS
122 Lipase Rp 267,000
123 à Pancreatic Amylase Rp 350,000
URINALISIS
124 Urine rutin Rp 62,500
125 Glukosa Red Rp 33,000
126 Protein ESBACH Rp 65,000
127 Protein Bence - Jones Rp 99,000
128 Mikroalbuminuri Rp 190,000
129 Ratio Albumin/Kreatinin Rp 190,000
KEHAMILAN
130 á - hCG test Pack Rp 132,000
NARKOBA
131 Opiat Rp 155,000
132 Amphetamine Rp 155,000
133 Metamphetamine Rp 155,000
134 Tetrahidrocannabinoid (THC) Rp 155,000
135 Coccain Rp 155,000
136 Benzodiazepine/Diazepam Rp 155,000
FAESES
137 Faeces Rutin Rp 101,000
138 Pencernaan Rp 77,000
139 Sterkobilin Rp 77,000
140 Darah samar Rp 188,000
141 pH Rp 77,000
ANALISIS
142 Sperma Rp 385,000
NO. JENIS PEMERIKSAAN HARGA
Thorax
143 Thorax AP (DXR) Rp 236,500
JANTUNG
EKG
144 E K G Resting Rp 135,000
145 Treadmill Rp 688,000

Jakarta, 25 Juni 2018

Mengetahui,

Jacquelin Lam
081221817780