Hb A1c IV. METABOLISME LEMAK Cholesterol Total HDL dan LDL Tryglycerida HDL ApoAI Apo B LP (a) V.

ELEKTROLIT DAN GAS DARAH Natrium (Na) Kalium (K) Chorida (Cl) Calssium Ion Phosfor Magnesium Analisa Gas Darah Calsium Total

Rp 172,000

1 2 3 4 5 6 7

Rp 25,645 Rp 11,4425 Rp 43,200 Rp 35,000 Rp 172,500 Rp 138,000 Rp 230,000

1 2 3 4 5 6 7 8

Rp 52,000 Rp 52,000 Rp 31,740 Rp 95,000 Rp 51,750 Rp 51,750 Rp 103,500 Rp 52,000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

VII. SEROLOGI/IMUNOLOGI/PERTANDA TUMOR Widal Rp 49,450 VDRL Kwalitatif Rp 57,500 VDRL Kwantitatif Rp 115,000 TPHA Kwalitatif Rp 66,125 TPHA Kwantitatif Rp 115,000 Ig M / Ig G Anti Texoplasma Rp 345,000 Ig M / Ig G Anti Rubella Rp 230,000 Ig M / Ig G Anti CMV Rp 230,000 Ig M / Ig G Anti Chlamydia Rp 690,000 Ig M + Ig G Anti Dengue Rp 275,000 Ig M HSV II Rp 253,000 Ig G HSV II Rp 253,000 HIV TITER (Metode Elisa) Rp 316,250 Dengue NS I AG Rp 379,500 Ig M Salmonella Rp 192,500 Dengue Duo Rp 440,000 Ig G Anti CMV Rp 253,000 Ig M Anti CMV Rp 302,500 Ig M ACA Rp 440,000 SGOT SGPT Rp 25,760 Rp 25,760

LDH Total Protein Albumin Globulin Gamma GT SPE Cholinesterase HBsAG Anti HBs Anti HBc Anti HBc Ig M Hbe Ag Anti Hbe Ig M Anti HAV Ig G Anti HAV Anti HCV Ig M Anti HCV Alfa Feto Protein HBV DNA PCR (Kwantitatif) HCV RNA PCR (Kwantitatif) IX. HEMATOLOGI KHUSUS Golongan Darah Rhesus Faktor Trombosit Masa Bekuan Remple Beede Masa Pendarahan Retraksi Bekuan Retokulosit Hematokrit Malaria Mikrofilaria Menilai B M P MCV MCH MCHC Comb Test Sperma Analisis Troponin T Troponin T + CKMB XI. Hormon

Rp 55,200 Rp 36,000 Rp 17,250 Rp 17,250 Rp 46,000 Rp 132,000 Rp 88,000 Rp 86,000 Rp 100,000 Rp 198,375 Rp 345,000 Rp 250,000 Rp 250,000 Rp 264,500 Rp 277,750 Rp 231,450 Rp 690,000 Rp 198,500 Rp 2,200,000 Rp 2,200,000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Rp 10,350 Rp 15,525 Rp 10,580 Rp 7,475 Rp 9,775 Rp 7,475 Rp 7,475 Rp 9,890 Rp 13,800 Rp 14,720 Rp 21,620 Rp 166,750 Rp 23,000 Rp 23,000 Rp 23,000 Rp 25,300 Rp 41,400 Rp 253,000 Rp 368,000

1 2 3 4 5 6 7 8 9

LH FSH Prolactin Testosteron Estradiol Progesteron Cortisol Beta HCG Serum Beta HCG Urine XIII. Profil Lipid T3 T4 TSH Free T4 Free T3 XIV. Mikro Biologi Kultur Kultur Darah Kultur Urine Kultur Feaces kultur Sputum Kultur PUS Kultur Sekret Kultur Throastswab Kultur BTA Kultur Cairan Otak Sputum BTA Gram Trichomonas Jamur/Spora Gonorrhoe ICT TB XIV. Profil Pankreas Amylase Darah Lipase Darah Amilase Urine Ca IG G Ca 153 PSA PAP SCC

Rp 195,500 Rp 195,500 Rp 195,000 Rp 230,000 Rp 258,000 Rp 258,750 Rp 253,000 Rp 230,000 Rp 143,750

1 2 3 4 5

Rp 138,000 Rp 138,000 Rp 143,750 Rp 230,000 Rp 275,000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Rp 231,725 Rp 231,725 Rp 231,725 Rp 231,725 Rp 231,725 Rp 231,725 Rp 231,725 Rp 231,725 Rp 231,725 Rp 26,450 Rp 66,125 Rp 66,125 Rp 66,125 Rp 66,125 Rp 132,250

1 2 3 4 5 6 7 8

Rp 132,250 Rp 132,250 Rp 158,700 Rp 385,000 Rp 380,000 Rp 290,000 Rp 290,000 Rp 400,000

1 2 3 4 5

XVI. Protein Serum C3+C4 Ig A Ig E Ig G Ig M XVII. Analisa Cairan Cairan Ascites Liquor Cerebrospinal Cairan Pleura Cairan Synovial XVII. Test Narkoba Methamphetomin Opiat THC Cocain

Rp 550,000 Rp 275,000 Rp 187,500 Rp 275,000 Rp 275,000

1 2 3 4

Rp 302,500 Rp 165,000 Rp 165,000 Rp 165,000

1 2 3 4

Rp 66,000 Rp 66,000 Rp 66,000 Rp 66,000

TARIF PEMERIKSAAN RADIOLOGI No item-item Pemeriksaan BONE (tulang-tulang) 1 Schedel (Tulang Tengkorak) 2 Basic Cranii (Tulang Dasar Tengkorak) 3 Mandibula ( Tulang rongga Bawah) 4 Maxilla 5 SPN (Tulang rongga Muka) 6 Clavicula (Tulang selangka) 7 Scapula (Tulang belikat) 8 Costae (Tulang Tiga) 9 Humerus (tulang Lengan Atas) 10 Antebrachi (Tulang Lengan Bawah) 11 Mastoid (1 Posisi) 12 Manus (Tulang Tangan) 13 Pelvis (Tulang Panggul) 14 Femur (Tulang Paha) 15 Cruris (Tulang Tungkai Bawah) 16 Pedis (Tulang Kaki) Collumna Vertebralis (Tulang Belakang) A. Vertebrae Cervicalis AP + L (Ruas tulang Leher) A. Vertebrae Cervicalis AP + L + OBL (Ruas Tulang leher) Vertebrae Thoracalis (Ruas Tulang Dada) Vertebrae Thoracalis (Ruas Tulang Dada) OBL Vertebrae Lumbalis (Ruas Tulang Belakang) Vertebrae Lumbalis (Ruas Tulang Belakang) OBL Vertebrae Sacralis (Ruas Tulang Bokong) Vertebrae Coccygeus (Ruas Tulang Ekor) Articulatio (Persendian Tulang-Tulang) Articulatio Mandibula (Persendian Tulang rahang) Articulatio Humeri (Persendian Tulang Bahu) Articulatio Cubiti ( Persendian Tulang siku) Articulatio Radiocarpalia ( Persendian Tulang Tangan) Articulatio Coxae (Persendian Tulang Panggul) Articulatio Genu (Persendian Tulang Lutut) Articula Talo-Cruralis/ Unkle Joint Thorax PA/L Thorax PA/ Lateral (Foto Analisa Jantung) Thorax Doorlighting (Pemeriksaan Rongga Dada) (Fluoroscopy dengan TV System) Tanpa Film Tarif Rp 115,000 Rp 115,000 Rp 115,000 Rp 115,000 Rp 115,000 Rp 92,000 Rp 92,000 Rp 92,000 Rp 92,000 Rp 92,000 Rp 115,000 Rp 92,000 Rp 103,500 Rp 103,500 Rp 92,000 Rp 92,000

1 2 3 4 5 6 7 8

Rp 138,000 Rp 161,000 Rp 126,000 Rp 161,000 Rp 161,000 Rp 161,000 Rp 138,000 Rp 138,000

1 2 3 4 5 6 7

Rp 115,000 Rp 92,000 Rp 92,000 Rp 92,000 Rp 103,000 Rp 92,000 Rp 92,000 Rp 120,000 Rp 230,000 Rp 103,500

1 2 3 4 5

Disgestive System (Saluran pencernaan) Oesophagus Double Contras (Saluran Makanan Atas) MDF Double Contras (Lambung dan Usus Halus) Colon In Loop (Usus Besar) Follow Though (Usus Kecil) Appendix (Usus Buntu) Kidneys & Urinaria Tract (Ginjal dan saluran Air Seni) BNO (Perut Polos) BNO / I V P ( Ginjal Dan Air Seni) BNO / I V P ( Ginjal Dan Air Seni) / Contars Non Ionic Cistografi Cistografi + Contras Blass (Kandungan Kemih) Abdomen 2 Posisi AP/Lateral Abdomen 3 Posisi AP/Lateral Pelvimetery (Ukuran Panggul Wanita Hamil) MRI NEVRO Brain Brain+Contras Paranasal Sinus Paranasal Sinus+Contras Orbita Orbita+ Contras Temporal Bone Temporal Bone + Contras MRI SPINE Cervical Cervical+Contras Thoracal Thoracal+Contras Lumbal Lumbal+Contras MRI BODY Extremitas

Rp 184,000 Rp 287,500 Rp 287,500 Rp 287,500 Rp 287,500

1 2 3 4 5 6 7 8 9

Rp 103,500 Rp 517,500 Rp 632,500 Rp 500,000 Rp 1,035,000 Rp 86,250 Rp 195,500 Rp 304,750 Rp 172,500

1 2 3 4 5 6 7 8

Rp 1,980,000 Rp 2,860,000 Rp 1,980,000 Rp 2,860,000 Rp 1,980,000 Rp 2,860,000 Rp 1,980,000 Rp 2,860,000

1 2 3 4 5 6

Rp 1,980,000 Rp 2,860,000 Rp 1,980,000 Rp 2,860,000 Rp 1,840,000 Rp 2,530,000