No. | RINCIAN OBJEK | BESARAN TARIF (RP) |
1 | Pemeriksaan Laboratorium Klinik | |
| Albumin Darah | 40.000 |
| Alkali Phospatase | 40.000 |
| Bilirubin Direct | 30.000 |
| Bilirubin Total | 45.000 |
| BUN | 30.000 |
| BSN | 30.000 |
| SGOT | 40.000 |
| SGPT | 40.000 |
| S.Creatinin | 45.000 |
| HDL-Cholesterol | 30.000 |
| LDL-Cholesterol | 40.000 |
| Total Cholesterol | 40.000 |
| Total Protein | 40.000 |
| Trigliserida | 50.000 |
| Glukosa | 40.000 |
| HbA1C | 150.000 |
| Asam Urat | 45.000 |
| Cholesterol (Stik POCT) | 30.000 |
| Glukosa (Stik POCT) | 25.000 |
| Asam Urat (Stik POCT) | 30.000 |
| Hb {Stik POCT) | 15.000 |
| Golongan Darah | 20.000 |
| Trombosit | 30.000 |
| Darah Lengkap | 70.000 |
| Anti HBs | 45.000 |
| Anti HBs dengan ELISA | 120.000 |
| HbsAg (Rapid Test) | 45.000 |
| HbsAg dengan ELISA | 150.000 |
| HIV (Rapid Test) | 40.000 |
| Anti HIV Kuantitatif dengan ELISA | 200.000 |
| DHF (Rapid Test) | 120.000 |
| Anti Dengue IgG/IgM | 150.000 |
| NS1 Anti Dengue | 175.000 |
| Masa Perdarahan | 10.000 |
| Masa Pembekuan | 10.000 |
| Pengecatan Gram | 30.000 |
| Pengecatan Giemsa | 30.000 |
| Widal | 40.000 |
| VDRL | 25.000 |
| Mantoux Test | 80.000 |
| Urine 10 Parameter | 25.000 |
| Urine 3 Parameter | 10.000 |
| Sedimen Urine | 10.000 |
| Tes Kehamilan | 20.000 |
| Faeces Lengkap | 20.000 |
| ||
2 | Narkoba | |
| 3 Parameter | 150.000 |
| 5 Parameter | 200.000 |
| ||
3 | Pemeriksaan Bakteri Klinik dan Parasitologi | |
| Pemeriksaan Sifilis | 40.000 |
| Pemeriksaan jamur | 40.000 |
| Pemeriksaan GO | 40.000 |
| Pemeriksaan VDRL | 25.000 |
| Kultur PUS + Sensitifity Test | 150.000 |
| Kultur Sputum + Sensitifity Test | 150.000 |
| Kultur Darah + Sensitifity Test | 150.000 |
| Kultur BTA + + Sensitifity Test | 225.000 |
| Sputum BTA | 20.000 |
| Benzidin Tes | 15.000 |
| Malaria Mikroskopis | 30.000 |
| ||
4 | Pemeriksaan Sampel Mikrobiologi Lingkungan | |
| MPN Coli Form | 55.000 |
| MPN Coli Tinja | 55.000 |
| Total Coliform (CFU) | 100.000 |
| Angka Kuman E.Coli (CFU) | 100.000 |
| Angka Kuman | 105.000 |
| E.Coli | 25.000 |
| Salmonella | 25.000 |
| Vibrio Cholera | 25.000 |
| Staphylococcus Aureus | 25.000 |
| Shigela | 25.000 |
| Streptococcus Pyogenes | 25.000 |
| Streptococcus Aureus | 25.000 |
| Pseudomonas | 25.000 |
| Udara Ruangan | 110.000 |
| Swab Alat Medis | 110.000 |
| Swab Linen Steril | 110.000 |
| Angka Kuman/ Usap Alat Makan | 110.000 |
| Swab Lantai | 110.000 |
| Swab Dinding | 110.000 |
| ||
5 | Pemerikasan Kimia Kesehatan | |
| FISIKA |
|
| Temperatur | 10.000 |
| Residu Terlarut | 55.000 |
| Residu Tersuspensi | 55.000 |
| Daya Hantar listrik | 34.000 |
| Warna | 55.000 |
| Kekeruhan | 34.000 |
| Bau | 10.000 |
| Rasa | 10.000 |
|
| |
| KIMIA AN ORGANIK |
|
| Ph | 24.000 |
| DO | 20.000 |
| BOD | 70.000 |
| COD | 110.000 |
| Total Phospat | 110.000 |
| NO3-N | 56.000 |
| NH3-N | 65.000 |
| NO2-N | 120.000 |
| Sianida | 50.000 |
| Sulfat | 50.000 |
| Belerang (H2S) | 50.000 |
| Fluorida | 50.000 |
| Cholrida | 50.000 |
| Arsen | 150.000 |
| Kobalt | 150.000 |
| Barium | 150.000 |
| Boron | 150.000 |
| Selenium | 150.000 |
| Chromium | 150.000 |
| Tembaga | 150.000 |
| Besi | 150.000 |
| Timbal | 150.000 |
| Mangan | 150.000 |
| Air Raksa | 150.000 |
| Seng | 150.000 |
| Kesadahan (CaCO3) | 29.000 |
| Sisa Chlor | 35.000 |
| Salinitas | 35.000 |
| KMnO4 | 35.000 |
|
| |
| KIMIA ORGANIK |
|
| Minyak Dan Lemak | 120.000 |
| Detrergen | 50.000 |
| Aldrin/Dieldrin | 150.000 |
| Chlordane | 150.000 |
| DDT | 150.000 |
| Hepataclor | 150.000 |
| Lindane | 150.000 |
| Methocyclor | 150.000 |
| Endrine | 150.000 |
| Toxapen | 150.000 |
| ||
6 | PEMERIKSAAN KIMIA PANGAN LAINNYA | |
| Identifikasi Boraks | 70.000 |
| Identifikasi Formalin | 70.000 |
| Identifikasi Methanil Yellow | 70.000 |
| Identifikasi Rhodamin | 70.000 |
| Penetapan Kadar Pemanis | 650.000 |
| Penetapan Kadar Pewarna | 650.000 |
| Penetapan Kadar Air | 70.000 |
| ||
7 | UDARA AMBIENT | |
| NO2 | 120.000 |
| NOX | 120.000 |
| SO2 | 120.000 |
| CO | 120.000 |
| Kebisingan | 50.000 |
