KLINIK SEHAT AL WUSTHO

Jl Raya Cisinga, Kp. Warung Waru

Desa Cisaruni Kec. Padakembang
Kab. Tasikmalaya
NO PEMERIKSAAN HARGA (Rp) NO PEMERIKSAAN HARGA (Rp)
HEMATOLOGI URINALISA
1 Hematologi lengkap 65,000 1 Urine lengkap 25,000
2 Hematologi rutin 55,000 2 Protein urine (Kualitatif) 16,000
3 Hemoglobin 15,000 3 Protein urine (Kuantitif) 62,000
4 Leukosit 15,000 4 Glukosa urin 10,000
5 Eritrosit 15,000 5 Urobilin urine 10,000
6 Trombosit 20,000 6 Bilirubin urine 10,000
7 Hematokrit 15,000 7 Sedimen urine 10,000
8 Hitung jenis 20,000 8 Berat jenis urine 12,500
9 MCV, MCH, MCHC 18,000 9 pH 6,000
10 LED 18,000 10 Mikroalbumin urine 155,000
11 Golongan darah ABO/Rhesus 20,000 11 Protein esbach 75,000
12 Waktu Perdarahan BT 15,000 12 Kehamilan biasa 58,000
13 Waktu Pembekuan CT 15,000 FAECES
14 Eosinofil 53,000 1 Faeces rutin 35,000
15 Retikulosis 72,000 2 Lemak 35,000
16 Paket hapusan darah 237,000 3 Darah samar (OCCULT BLOOD) 128,000
17 Faal hemostatis 490,000 4 Analisa faeces lengkap 160,000
18 PPT 204,000 FAAL GINJAL
19 APTT 146,000 1 Urenum (BUN) 25,000
20 Fibrinogen 235,000 2 Creatinin 25,000
21 Trombin time 225,000 3 Asam urat 25,000
22 Agregasi trombosit (TAT) 325,000 4 Creatinin clearance 125,000
23 Viskositas darah 90,000 LEMAK
24 Viskositas Plasma 90,000 1 Cholesterol total 25,000
25 Serum Iron 115,000 2 Trigliserida 25,000
26 TIBC 165,000 3 HDL Cholesterol 30,000
27 Ferritin 255,000 4 LDL Cholesterol 35,000
28 Transferin 280,000 5 Lipid total 86,000
29 GEPD 308,000 FAAL HATI
30 Sel Le 85,000 1 Albumin 30,000
31 Malaria - ICT 260,000 2 Globulin 30,000
32 Malaria 72,000 3 Total protein 30,000
33 Trombo test owren 236,000 4 SGOT 23,000
34 INR 210,000 5 SGPT 23,000
35 Hb Elektroforesis 368,000 6 Gamma GT 50,000
36 CD 4 285,000 7 Alkali phoosphates 50,000
37 Asam polat 640,000 8 Bilirubin total 28,000
DIABETES MELITUS 9 Bilirubin direk 28,000
1 Glukosa puasa 15000 10 Bilirubin indirek 28,000
2 Glukosa 2 jam PP 15000 11 Gamma globuluin 280,000
3 Glukosa sewaktu 15000
4 HBA1c 228000
 NO PEMERIKSAAN HARGA (Rp) NO PEMERIKSAAN HARGA (Rp)
IMUNO SEROLOGI BIO MOLEKULER
1 HBs Ag 85,000 1 HCV RNA Kuantitatif 3,000,000
2 HBs Ag (elisa) 325,000 2 PCR HBV DNA Kuantitatif 2,650,000
3 Anti HBs 115,000 3 PCR M Tuberculosis 880,000
4 Anti HBs (elisa) 254,000 FAAL JANTUNG
5 Anti HBc 305,000 1 CK/ CPK 148,000
6 igM Anti HBc 545,000 2 CKMB 300,000
7 Hbe Ag 430,000 3 LDH 108,000
8 Anti Hbe 526,000 4 hs-CRP 258,000
9 Anti HAV 430,000 KIMIA LAIN
10 igM Anti HAV 385,000 1 Amylase 170,000
11 Anti HVC 420,000 2 P-Amylase 192,000
12 igM anti HCV 520,000 3 Lipase 198,000
13 igG anti DHF/ Dengue 275,000 4 Acid Phospatase 355,000
14 igM anti DHF/ Dengue 275,000 HORMON ENDOKRINOLOGI
15 igG anti Toxoplasma 230,000 1 T-3 225,000
16 igM anti Toxoplasma 230,000 2 T-4 225,000
17 igG Toxo Aviditas 510,000 3 TSH-s 238,000
18 igG anti Rubella 260,000 4 Free T-3 360,000
19 igM anti Rubella 300,000 5 Free T-4 305,000
20 igG anti CMV 230,000 6 LH 327,000
21 igG anti CMV 310,000 7 FSH 327,000
22 lgG anti HSV2 255,000 8 Prolaktin 324,000
23 lgG anti HSV2 255,000 9 Testosteron 362,000
24 lgG anti HSV1 275,000 10 Progresteron 425,000
25 lgM anti HVS1 290,000 11 Beta HCG Kuantitatif 458,000
26 TPHA 100,000 12 Insulin 345,000
27 VDRL 75,000 13 C-Peptide 345,000
28 Widal 60,000 PETANDA TUMOR
29 Rheumatoid Faktor (RF) 96,000 1 AFP 312,000
30 Rf Kuantitatif 255,000 2 CEA 290,000
31 CRP Kualitatif 135,000 3 Ca 125 573,000
32 CRF Kuantitatif 260,000 4 PSA Total 385,000
33 ASTRO Kualitatif 95,000 5 CA 15-3 550,000
34 ASTRO Kuantitatif 252,000 6 Ca 19-9 592,000
35 Seramoeba 380,000 7 Ca 72-4 732,000
36 C- 3 Komplemen 460,000 8 Free PSA 560,000
37 C - 4 Komplemen 460,000 LAIN - LAIN
38 Tubex 275,000 1 N-Mid Osteocalsin 650,000
39 Anti MTB (ICT TB) 264,000 2 B-Crosslaps/ C- Tx 750,000
40 lgG H. Pylori 528,000 3 Papsmear 140,000
41 lgM H. Pylori 528,000
42 Anti Ds DNA 485,000
43 ANA Test 488,000
44 ACA lgG 576,000
45 ACA lgM 576,000
46 Anti HIV 320,000
 NO PEMERIKSAAN HARGA (Rp) NO PEMERIKSAAN HARGA (Rp)
NARKOBA ALERGI
1 Amphetamine 70,000 1 lgE Atopy (Panel) 1,400,000
2 Methampetamine 70,000 2 lgE Rast Daging Ayam 415,000
3 Cocaine 70,000 3 lgE Rast Kepiting 415,000
4 Cannabinoid 70,000 4 lgE Rast Udang 415,000
5 Opiate/ Morphine 70,000 5 lgE Rast Kerang 415,000
6 Benzodiazepine 70,000 6 lgE Rast Daging Sapi 415,000
ELEKTROLIT 7 lgE Rast Kacang 415,000
1 Natrium 92,000 8 lgE Rast Coklat 415,000
2 Kalium 92,000 9 lgE Rast Putih Telur 415,000
3 Chlorida 92,000 10 lgE Rast Kuning Telur 415,000
4 Calsium 92,000 11 lgE Rast Debu Rumah 415,000
5 Fosfor Anorganik 92,000 12 lgE Rast Tungau 415,000
6 Natrium urine 92,000 13 lgE Rast Ikan 415,000
7 Kalium urine 92,000 14 lgE Rast Kecoa 425,000
8 Chlorida urine 92,000 15 lgE Rast Bulu Ayam 570,000
9 Calsium ion 245,000 16 lgE Rast Epitel Anjing 480,000
10 Magnesium 92,000 17 lgE Rast Epitel Kucing 480,000
18 lgE Rast Epitel Tikus 515,000
19 lgE Rast Gandum 480,000
 KLINIK SEHAT AL WUSTHO
Jl Raya Cisinga, Kp. Warung Waru
Desa Cisaruni Kec. Padakembang
Kab. Tasikmalaya
NO PEMERIKSAAN HARGA (Rp) NO PEMERIKSAAN HARGA (Rp)
HEMATOLOGI URINALISA
1 Hematologi lengkap 75,000 1 Urine lengkap 35,000
2 Hematologi rutin 65,000 2 Protein urine (Kualitatif) 26,000
3 Hemoglobin 25,000 3 Protein urine (Kuantitif) 62,000
4 Leukosit 25,000 4 Glukosa urin 20,000
5 Eritrosit 25,000 5 Urobilin urine 20,000
6 Trombosit 30,000 6 Bilirubin urine 20,000
7 Hematokrit 25,000 7 Sedimen urine 20,000
8 Hitung jenis 30,000 8 Berat jenis urine 22,500
9 MCV, MCH, MCHC 28,000 9 pH 16,000
10 LED 28,000 10 Mikroalbumin urine 155,000
11 Golongan darah ABO/Rhesus 35,000 11 Protein esbach 75,000
12 Waktu Perdarahan BT 25,000 12 Kehamilan biasa 68,000
13 Waktu Pembekuan CT 25,000 FAECES
14 Eosinofil 63,000 1 Faeces rutin 45,000
15 Retikulosis 82,000 2 Lemak 35,000
16 Paket hapusan darah 237,000 3 Darah samar (OCCULT BLOOD) 128,000
17 Faal hemostatis 490,000 4 Analisa faeces lengkap 160,000
18 PPT 204,000 FAAL GINJAL
19 APTT 146,000 1 Urenum (BUN) 35,000
20 Fibrinogen 235,000 2 Creatinin 35,000
21 Trombin time 225,000 3 Asam urat 35,000
22 Agregasi trombosit (TAT) 325,000 4 Creatinin clearance 125,000
23 Viskositas darah 90,000 LEMAK
24 Viskositas Plasma 90,000 1 Cholesterol total 35,000
25 Serum Iron 115,000 2 Trigliserida 35,000
26 TIBC 165,000 3 HDL Cholesterol 40,000
27 Ferritin 255,000 4 LDL Cholesterol 45,000
28 Transferin 280,000 5 Lipid total 86,000
29 GEPD 308,000 FAAL HATI
30 Sel Le 85,000 1 Albumin 40,000
31 Malaria - ICT 260,000 2 Globulin 40,000
32 Malaria 72,000 3 Total protein 40,000
33 Trombo test owren 236,000 4 SGOT 33,000
34 INR 210,000 5 SGPT 33,000
35 Hb Elektroforesis 368,000 6 Gamma GT 60,000
36 CD 4 285,000 7 Alkali phoosphates 50,000
37 Asam polat 640,000 8 Bilirubin total 38,000
DIABETES MELITUS 9 Bilirubin direk 38,000
1 Glukosa puasa 25000 10 Bilirubin indirek 38,000
2 Glukosa 2 jam PP 25000 11 Gamma globuluin 280,000
3 Glukosa sewaktu 25000 BIO MOLEKULER
4 HBA1c 228000 1 HCV RNA Kuantitatif 3,000,000
NARKOBA 2 PCR HBV DNA Kuantitatif 2,650,000
1 Amphetamine 70,000 3 PCR M Tuberculosis 880,000
2 Methampetamine 70,000 FAAL JANTUNG
3 Cocaine 70,000 1 CK/ CPK 148,000
4 Cannabinoid 70,000 2 CKMB 300,000
5 Opiate/ Morphine 70,000 3 LDH 108,000
6 Benzodiazepine 70,000 4 hs-CRP 258,000
NO PEMERIKSAAN HARGA (Rp) NO PEMERIKSAAN HARGA (Rp)
IMUNO SEROLOGI KIMIA LAIN
1 HBs Ag 85,000 1 Amylase 170,000
2 HBs Ag (elisa) 325,000 2 P-Amylase 192,000
3 Anti HBs 115,000 3 Lipase 198,000
4 Anti HBs (elisa) 254,000 4 Acid Phospatase 355,000
5 Anti HBc 305,000 HORMON ENDOKRINOLOGI
6 igM Anti HBc 545,000 1 T-3 225,000
7 Hbe Ag 430,000 2 T-4 225,000
8 Anti Hbe 526,000 3 TSH-s 238,000
9 Anti HAV 430,000 4 Free T-3 360,000
10 igM Anti HAV 385,000 5 Free T-4 305,000
11 Anti HVC 420,000 6 LH 327,000
12 igM anti HCV 520,000 7 FSH 327,000
13 igG anti DHF/ Dengue 275,000 8 Prolaktin 324,000
14 igM anti DHF/ Dengue 275,000 9 Testosteron 362,000
15 igG anti Toxoplasma 230,000 10 Progresteron 425,000
16 igM anti Toxoplasma 230,000 11 Beta HCG Kuantitatif 458,000
17 igG Toxo Aviditas 510,000 12 Insulin 345,000
18 igG anti Rubella 260,000 13 C-Peptide 345,000
19 igM anti Rubella 300,000 PETANDA TUMOR
20 igG anti CMV 230,000 1 AFP 312,000
21 igG anti CMV 310,000 2 CEA 290,000
22 lgG anti HSV2 255,000 3 Ca 125 573,000
23 lgG anti HSV2 255,000 4 PSA Total 385,000
24 lgG anti HSV1 275,000 5 CA 15-3 550,000
25 lgM anti HVS1 290,000 6 Ca 19-9 592,000
26 TPHA 100,000 7 Ca 72-4 732,000
27 VDRL 75,000 8 Free PSA 560,000
28 Widal 70,000 LAIN - LAIN
29 Rheumatoid Faktor (RF) 96,000 1 N-Mid Osteocalsin 650,000
30 Rf Kuantitatif 255,000 2 B-Crosslaps/ C- Tx 750,000
31 CRP Kualitatif 135,000 3 Papsmear 140,000
32 CRF Kuantitatif 260,000 ALERGI
33 ASTRO Kualitatif 95,000 1 lgE Atopy (Panel) 1,400,000
34 ASTRO Kuantitatif 252,000 2 lgE Rast Daging Ayam 415,000
35 Seramoeba 380,000 3 lgE Rast Kepiting 415,000
36 C- 3 Komplemen 460,000 4 lgE Rast Udang 415,000
37 C - 4 Komplemen 460,000 5 lgE Rast Kerang 415,000
38 Tubex 275,000 6 lgE Rast Daging Sapi 415,000
39 Anti MTB (ICT TB) 264,000 7 lgE Rast Kacang 415,000
40 lgG H. Pylori 528,000 8 lgE Rast Coklat 415,000
41 lgM H. Pylori 528,000 9 lgE Rast Putih Telur 415,000
42 Anti Ds DNA 485,000 10 lgE Rast Kuning Telur 415,000
43 ANA Test 488,000 11 lgE Rast Debu Rumah 415,000
44 ACA lgG 576,000 12 lgE Rast Tungau 415,000
45 ACA lgM 576,000 13 lgE Rast Ikan 415,000
46 Anti HIV 320,000 14 lgE Rast Kecoa 425,000
ELEKTROLIT 15 lgE Rast Bulu Ayam 570,000
1 Natrium 92,000 16 lgE Rast Epitel Anjing 480,000
2 Kalium 92,000 17 lgE Rast Epitel Kucing 480,000
3 Chlorida 92,000 18 lgE Rast Epitel Tikus 515,000
4 Calsium 92,000 19 lgE Rast Gandum 480,000
5 Fosfor Anorganik 92,000
6 Natrium urine 92,000
7 Kalium urine 92,000
8 Chlorida urine 92,000
9 Calsium ion 245,000
10 Magnesium 92,000
 DAFTAR HARGA LABORATORIUM
UPTD PUSKESMAS DTP TINEWATI
Jl Raya Barat Singaparna
NO PEMERIKSAAN HARGA (Rp)
URINE
1 Albumin/ Protein 2,500
2 Reduksi 2,500
3 Urobulin 2,500
4 Sedimen 2,500
5 Bilirubin 2,500
6 Keasaman/ pH 2,500
7 Berat Jenis 2,500
8 Urine Rutin 15,000
9 Protein Urune ( Kebidanan ) 10,000
FAECES
1 Rutin 15,000
2 Garam Penuh 25,000
3 Benzidin Test 25,000
4 Telor Cacing 10,000
HEMATOLOGI
1 Haemoglobin 10,000
2 Haemoglobin ( Kebidanan ) 15,000
3 Leukosit 10,000
4 Hitungan Jenis 10,000
5 Laju Endapan Darah/ BSE 10,000
6 Eritrosit 10,000
7 Trombosit 10,000
8 Waktu Pendarahan 7,500
9 Waktu Pembekuan 7,500
10 Morfologi Eritrosit/ Leukosit 50,000
11 Jumlah Eosinofil 17,000
12 Reticulosit 10,000
MIKROBIOLOGI DAN PARASITOLOGI
1 Preparat Malaria 15,000
2 Preparat BTA 15,000
3 Preparat Jamur 10,000
4 Preparat Dipteri 20,000
5 Pewarnaan Gram 10,000
SEROLOGI
1 Widal 20,000
2 Kehamilan/ PP Test 20,000
3 Golongan Darah 8,000
4 Dengue Blot 200,000
5 HbSag 60,000
BIO KIMIA/ KIMIA DARAH
1 Glukosa Puasa/ 2 Jam PP 15000
2 Glukosa Sewaktu 15000
3 Kolesterol 20000
4 Trigliserida 25000
5 HDL Cholesterol dan LDL Cholesterol 30000
6 Asam Urat/ Uric Acid 20,000
7 Ureum 20,000
8 Creatinin 20,000
9 Protein Total, Albumin, Globulin 50,000
10 SGOT 21,000
11 SGPT 21,000
12 Bilirubin Total, Direc, Indirect 40,000
13 Narkoba/ Nafza 90,000
14 CK - MB 110,000