DAFTAR HARGA

LABORATORIUM KLINIK KIMIA FARMA

Berlaku Mulai 1 April 2018

NO JENIS TEST KFD 2018

HEMATOLOGI
1 Hematologi Lengkap 115,000
2 Hematologi Rutin 105,000
3 Hemoglobin 55,000
4 LED 44,000
5 Lekosit 55,000
6 Hitung Jenis 55,000
7 Hematokrit 55,000
8 Eritrosit 55,000
9 Trombosit 50,000
10 Nilai Eritrosit (MCV, MCH, MCHC) 50,000
11 Hitung Eosinofil 50,000
12 Retikulosit 130,000
13 Retikulosit Absolut 130,000
14 Golongan Darah (ABO-Rh) 70,000
15 Coomb's Test (PMI) 575,000
16 G6PD 300,000
17 G6PD Neonatus 160,000
18 Resistensi Osmotik 110,000
19 LE Reaksi 110,000
20 Sel LE 135,000
21 Serum Iron (SI) 170,000
22 TIBC 170,000
23 Indeks Malaria 100,000
24 Ferritin 325,000
25 Transferin 500,000
26 Vitamin B12 865,000
27 Asam Folat 950,000
28 Elektroforesa HB 600,000
29 Malaria Slide Mikroskopis 110,000
30 ICT Malaria Pf/Pv 350,000
31 Filaria Mikroskopis 120,000
32 Gambaran Darah Tepi 215,000
 HEMOSTASIS
1 Rumple Leede 35,000
2 Ms Pendarahan 55,000
3 Ms Pembekuan 55,000
4 Ms.Protrombin & INR 310,000
5 Ms Trombin 380,000
6 Ms Tromboplastatin (APTT) 225,000
7 Retraksi Bekuan 210,000
8 Fibrinogen 320,000
9 D-Dimer Kuantitatif 795,000
10 AT III 485,000
11 Agregasi Trombosit (TAT) 450,000
12 Protein S 925,000
13 Protein C 925,000
14 Viskositas Darah 265,000
15 ACA IgG 810,000
16 ACA IgM 830,000

KIMIA KLINIK
TES FUNGSI HATI
1 Protein Total 80,000
2 Albumin 80,000
3 Prot. Total, Albumin dan Globulin 160,000
4 Protein Elektroforesa 330,000
5 Bilirubin Total 70,000
6 Bilirubin direk 70,000
7 Bilirubin Total Direk,Indirek 140,000
8 SGPT (ALT) 60,000
9 SGOT (AST) 60,000
10 SGOT dan SGPT 120,000
11 Gamma GT (GGT) 95,000
12 Fosfatase Alkali 80,000
13 Cholinesterase 185,000
14 Asam Empedu Puasa 980,000

TES FUNGSI GINJAL

1 Ureum 60,000
2 Creatinin 60,000
3 Asam urat 60,000
4 Creatinin Clearance 150,000
5 Cystatin C 365,000

DIABETES MILITUS
1 Glukosa Puasa 45,000
2 Glukosa 2 Jam PP 45,000
3 Glukosa sewaktu 45,000
4 Tes Toleransi Glukosa 5x 225,000
5 Tes Toleransi Glukosa 3x 135,000
6 Kurva Harian (4x) 180,000
7 HbA1c 195,000
8 Insulin 475,000

PROFIL LEMAK
1 Kolesterol total 60,000
2 Kolesterol HDL 65,000
3 Kolesterol HDL Direk 80,000
4 Kolest.LDL direk 110,000
5 Small Dense LDL 360,000
6 Trigliserida 60,000
7 Lipid total 125,000
8 Apo A1 350,000
9 Apo B 235,000
10 Lp (a) 465,000

CARDIO MARKER
1 CK 230,000
2 CK - MB 480,000
3 GLDH
4 LDH 150,000
5 Troponin I Kuantitatif 770,000
6 Homocysteine 760,000
7 CRP Kuantitatif 330,000
8 CRP Kualitatif 210,000
9 hs CRP 305,000

PANKREAS
1 Amilase Pankreatic 390,000
2 Lipase 290,000
3 Fosfatase Asam 320,000
4 Fosfatase Asam Prostat 390,000

ELEKTROLIT
1 Natrium 135,000
2 Kalium 135,000
3 Chlorida 135,000
4 Paket Na, K, Cl 405,000
5 Calcium Ion 365,000
6 Calcium Total 130,000
 7 Magnesium Total 130,000
8 Fosfor Anorganik 125,000
9 Analisa Gas Darah 530,000
10 C-Peptide 500,000

URINALISA
1 Urine Lengkap 60,000
2 Glukosa 35,000
3 Albumin/Globulin 35,000
4 Sedimen 40,000
5 Keton 35,000
6 Protein Urine 24 Jam 220,000
7 Protein Urine Bencejones 150,000
8 Na/K/Cl Urine 420,000
9 Mikro Albumin Kuantitatif 240,000
10 Test Pack 95,000
11 Tes Kehamilan EIA 105,000

NARKOTEST
1 Morfine/Opiat 135,000
2 Amphetamin/Shabu-shabu 135,000
3 Mariyuana/THC 135,000
4 Benzoadiazepin 135,000
5 Cocaine 135,000
6 Drug 3 Parameter 405,000

FAECES
1 Faeces Rutin 85,000
2 Darah samar 180,000
3 Analisa Faeses Lengkap 300,000

CAIRAN TUBUH
1 Analisa Batu Ginjal 310,000
2 Analisa Batu Empedu 300,000
3 Analisa Sperma 330,000

IMUNOLOGI
HEPATITIS
1 Anti HAV (Ig M) 490,000
2 Anti HAV (Total) 550,000
3 HBsAg (ECLIA) 180,000
4 HBsAg (Kuantitatif) 440,000
5 HBsAg Konfirmasi 980,000
6 HBsAg rapid ( screening ) 135,000
 7 Anti HBs 210,000
8 Anti HBc Total 405,000
9 Anti HBc Ig M 640,000
10 Hbe Ag 515,000
11 Anti HBe 680,000
12 HBV DNA (Kualitatif) 1,985,000
14 HBV DNA (Kuantitatif) voucher Heplav & Ricovir 1,100,000
15 HBV DNA (Kuantitatif) Regular 1,850,000
16 HCV RNA (Kuantitatif) 2,550,000
17 HCV RNA Genotype 4,000,000
18 Anti HCV total Kuantitatif 500,000
19 Anti HCV total Kualitatif 395,000

IMUNOLOGI LAIN
20 Anti Dengue Ig G/M 480,000
21 Dengue NS1 430,000
22 Anti HIV 385,000
23 HIV-1 RNA PCR 900,000
24 Anti HIV (Konfirmasi RSCM) 900,000
25 CD4 350,000
26 CD8 265,000
27 Chikungunya IgM 370,000

TORCH
1 Anti TOXO Ig G 330,000
2 Anti TOXO Ig M 330,000
3 IgG Toxo Aviditas 550,000
4 Anti Rubella Ig G 370,000
5 Anti Rubella Ig M 460,000
6 Anti CMV Ig G 350,000
7 Anti CMV Ig M 470,000
8 IgG CMV Aviditas 550,000
9 Anti HSV I Ig G 400,000
10 Anti HSV I Ig M 400,000
11 Anti HSV II Ig G 375,000
12 Anti HSV II Ig M 375,000
13 Anti Chlamydia Ig G 835,000
14 Anti Chlamydia Ig M 835,000
15 Ig G 620,000
16 Ig M 620,000
17 Ig A 610,000
18 Komplemen C3 625,000
19 Komplemen C4 625,000
20 ANA 770,000
21 Anti ds-DNA 630,000
22 Anti Smoot Muscle Ab (SMA)

SEROLOGI
1 Widal 125,000
2 Anti Salmonella Typhi IgM / Tubek 325,000
3 TPHA 170,000
4 VDRL/RPR 105,000
5 ASTO Kuantitatif (Semi) 250,000
6 ASTO Kualitatif 140,000
7 RF Kuantitatif (semi) 250,000
8 RF Kualitatif 140,000
9 IDT/Seramoeba 500,000
10 Anti TB-Ig G 330,000
11 Helicobacter Pylori Ig G 740,000
12 Helicobacter Pylori Ig M 610,000

HORMON
ENDOKRINOLOGI
1 T3 Total 310,000
2 T4 Total 310,000
3 Free T4 380,000
4 Free T3 480,000
5 TSH Sensitif 300,000
6 TSH Neonatus (kit insert) 150,000
7 T Uptake 620,000
8 Free T4 Index 520,000
9 Cortisol 570,000
10 Growth Hormon Basal 580,000
11 Growth Hormon Exerc. 580,000

FERTILITAS
1 LH 420,000
2 FSH 435,000
3 Prolaktin 400,000
4 Testosteron 500,000
5 Estradiol 525,000
6 Progesteron 535,000
7 B-HCG kuantitatif 640,000

TUMOR MARKER
1 AFP (Hati) 400,000
2 CEA 370,000
3 Ca 72-4 (Paru-paru) 1,000,000
 4 Cyfra 21.1 710,000
5 CA 15-3 (Payudara) 700,000
6 CA 19-9 (Pankreas) 755,000
7 CA 125 (Ovarium) 700,000
8 PSA (Prostat) 470,000
9 Free PSA 910,000
10 SCC (Cervix) 690,000
11 NSE 850,000

ALERGI TEST
1 Ig E Total 420,000
2 Ig E Spesifik Debu Rumah 630,000
3 Ig E Spesifik Tungau Debu Rumah 630,000
4 Ig E Spesifik Bulu Ayam 580,000
5 Ig E Spesifik Kapuk 630,000
6 Ig E Spesifik Epithel Anjing 675,000
7 Ig E Spesifik Epithel Kucing 675,000
8 Ig E Spesifik Epithel Tikus 675,000
9 IgE Spesifik Kecoa 630,000
10 IgE Spesifik Coklat 630,000
11 Ig E Spesifik Daging Ayam 630,000
12 Ig E Spesifik Daging Sapi 610,000
13 Ig E Spesifik Daging Kambing 580,000
14 Ig E Spesifik Daging Ikan 625,000
15 Ig E Spesifik Jamur Aspergillus 675,000
16 Ig E Spesifik Jamur Penicillin 675,000
17 IgE Spesifik Kacang-kacangan 625,000
18 IgE Spesifik Udang 630,000
19 IgE Spesifik Kepiting 630,000
20 IgE Spesifik Kerang 630,000
21 IgE Spesifik Kuning Telur 630,000
22 IgE Spesifik Putih Telur 630,000
23 IgE Spesifik Susu 630,000
24 IgE Spesifik Gandum 600,000
25 IgE Spesifik Jamur Mucor 600,000
26 IgE Spesifik Kotoran Burung 600,000
27 IgE Spesifik Bulu Ayam 600,000
28 IgE Atopy 1,755,000

TEST DRUG MONITORING (TDM)

1 Cyclosporin 1,400,000
2 Teofilin 1,550,000
3 Dilantin/Phenytoin 1,020,000
4 Digoxin 1,060,000
5 Phenobarbital 1,700,000
6 Carbamazepin 1,120,000

MIKROBIOLOGI
1 Pew.Gram 90,000
2 Pew.Neisser 90,000
3 Pew.BTA 90,000
4 Pewarnaan GO 90,000
5 Trichomonas 90,000
6 Candida 90,000
7 Jamur / Spora 90,000
8 Biakan BTA 785,000

KULTUR DAN RESISTENSI

1 Darah (Vitec) 465,000
Darah (manual) 400,000
2 Urine (Vitec) 560,000
Urine (manual) 445,000
3 Sputum (Vitec) 455,000
Sputum (manual) 380,000
4 Hapus Tenggorokan (Vitec) 455,000
Hapus Tenggorokan (manual) 380,000
5 Hapus Luka (Vitec) 455,000
Hapus Luka (manual) 380,000
7 Pus (Vitec) 455,000
Pus (manual) 380,000
8 C. Pleura / C. Pericard (Vitec) 560,000
C. Pleura / C. Pericard (manual) 380,000
9 C. Peritonium (Vitec) 560,000
C. Peritonium (manual) 385,000
10 L Cerebrospinal (Vitec) 545,000
L Cerebrospinal (Vitec) 385,000
11 Faeses (vitec) 560,000
Faeses (manual) 380,000
12 Gall (Vitec) 455,000
Gall (manual) 390,000
13 Jamur (Vitec) 455,000
Jamur (Manual) 380,000
14 Rectal Swab (Vitec) 455,000
Rectal Swab ( Manual) 380,000

BIOMOLEKULER (PCR)
1 PCR Myco.TB 690,000
2 PCR S.Typhi 700,000
3 PCR Dengue 725,000
4 PCR Malaria 605,000
5 HPV DNA Genotyping 900,000
6 HPV DNA Genotyping + LBC 1,300,000
7 EGFR (tissue) 2,800,000
8 EGFR (plasma) 2,800,000
9 NutrigenMe 10,000,000

SITOLOGI
1 PA Jaringan Kecil 935,000
2 PA Jaringan Sedang 1,425,000
3 PA Jaringan Besar 1,650,000
4 Pap's Smear 225,000
5 LBC (Liquid Base Cytologi) 450,000

NON LAB / LAIN - LAIN

1 Thorax PA 190,000
2 EKG 120,000
3 Audiometri 160,000
4 Spirometri 160,000
5 Treadmill 600,000
6 USG Abdomen 575,000