LAMPIRAN SK KEPALA UPTD LABORATORIUM KESEHATAN DAERAH KOTA SAMARINDA

NOMOR: 188/TU.SK./05 /100.02.28

TENTANG BIAYA PEMERIKSAAN LABORATORIUM

No

Jenis Pemeriksaan

 Tarif

HEMATOLOGI

1

Darah Lengkap

 Rp             60,000

2

Laju Endap Darah

 Rp             25,000

3

Hitung Eosinofil

 Rp             20,000

4

Hitung Retikulosit

 Rp             20,000

5

Diff Count

 Rp             10,000

6

Masa Perdarahan

 Rp             15,000

7

Masa Pembekuan

 Rp             15,000

8

Morfologi Darah Tepi

 Rp             75,000

9

Fibrinogem

 Rp          200,000

10

Thrombine Time

 Rp          200,000

11

Golongan Darah

 Rp             15,000

12

INR

 Rp             80,000

13

APTT

 Rp          100,000

14

Coombs

 Rp          500,000

15

PTT

 Rp          100,000

KIMIA DARAH

1

Glukosa Sewaktu

 Rp             23,000

2

Glukosa 2 jam PP

 Rp             23,000

3

Glukosa Puasa

 Rp             23,000

4

Ureum

 Rp             32,000

5

SGOT

 Rp             30,000

6

SGPT

 Rp             30,000

7

Asam Urat

 Rp             32,000

8

Kolestrol Total

 Rp             25,000

9

Trigliserida

 Rp             32,000

10

HDL Kolestrol

 Rp             35,000

11

LDL Kolestrol

 Rp             20,000

12

Natrium

 Rp             60,000

13

Kalium

 Rp             60,000

14

Calsium

 Rp             60,000

15

Cloride

 Rp          100,000

16

Magnesium

 Rp             95,000

17

CK-NAC

 Rp             80,000

18

Bilirubin Total

 Rp             18,000

19

Bilirubin Direct

 Rp             18,000

20

Bilirubin Indirect

 Rp             18,000

21

Alkali Phospate

 Rp             28,000

22

Gamma GT

 Rp             30,000

23

CK-MB

 Rp          110,000

24

GTT

 Rp          100,000

25

Troponin

 Rp          300,000

26

Cholinesterase

 Rp          125,000

27

Fe Serum

 Rp             75,000

28

Total Protein

 Rp             20,000

29

Albumin

 Rp             22,000

30

Globulin

 Rp             21,000

31

Asam urat Stik

 Rp             25,000

32

Kolestrol total stik

 Rp             25,000

33

Glukosa Stik

 Rp             25,000

34

TIBC

 Rp             80,000

35

HBA1C

 Rp          150,000

URINALISA

1

Urine Lengkap

 Rp             30,000

2

Tes Kehamilan

 Rp             20,000

3

Narkoba 5 Parameter

 Rp          170,000

4

Amphetamine

 Rp             55,000

5

Metamphetamine

 Rp             55,000

6

Morfin

 Rp             55,000

7

Benzodiazepine

 Rp             55,000

8

Mariyuana

 Rp             55,000

9

Cocain

 Rp             55,000

MIKROBIOLOGI

1

KOH

 Rp             15,000

2

C. Diphteria stain

 Rp             23,000

3

MPN Coliform

 Rp             60,000

4

MPN E. Coli (Fecal Coli)

 Rp             60,000

5

Angka Kuman (ALT)

 Rp             41,000

6

Salmonella

 Rp             63,000

7

Shiegella

 Rp             63,000

8

E.Coli

 Rp             63,000

9

Stapylococcus

 Rp             63,000

10

Mikrobiologi Udara

 Rp             63,000

11

Uji Sterilitas

 Rp             65,000

12

Urine Cultur

 Rp             80,000

13

Sekret Cultur

 Rp             80,000

14

BTA Cultur

 Rp             80,000

15

Darah Cultur

 Rp             80,000

16

Pus Cultur

 Rp             80,000

17

Gall Cultur

 Rp             80,000

18

LCS Cultur

 Rp             80,000

19

Feces Cultur

 Rp             80,000

20

Media transport (swab + amies Agar)

 Rp             27,000

21

Culture C Diphteri

 Rp          150,000

22

Stapylococcus Cultur

 Rp             87,000

23

Streptococcus Cultur

 Rp             87,000

24

Vibrio Cholera

 Rp             87,000

25

Legionella

 Rp          405,000

26

Koliform

 Rp             63,000

27

Kultur Umum

 Rp             77,000

28

Pseudomonas Aeruginosa

 Rp             63,000

29

Heterotropik Plate Count

 Rp             63,000

30

Bacillus cereus

 Rp             63,000

IMUNOLOGI

1

Widal

 Rp             40,000

2

Tubex

 Rp          110,000

3

ASTO /ASO

 Rp             35,000

4

VDRL

 Rp             35,000

5

Rematoid Factor

 Rp             35,000

6

CRP

 Rp             35,000

7

HBs Ag Strips

 Rp             36,000

8

HBs Ag

 Rp          125,000

9

Anti HBs

 Rp          150,000

10

AHBs Strip

 Rp             50,000

11

CEA

 Rp          200,000

12

AFP

 Rp          160,000

13

T3

 Rp          175,000

14

T4

 Rp          125,000

15

TSH

 Rp          135,000

16

Free T3

 Rp          275,000

17

Free T4

 Rp          205,000

18

Ig E

 Rp          173,000

19

Toxo Ig G

 Rp          200,000

20

Toxo Ig M

 Rp          200,000

21

Rubella IgG

 Rp          195,000

22

Rubella IgM

 Rp          220,000

23

CMV IgG

 Rp          220,000

24

CMV IgM

 Rp          250,000

25

HSV IgG

 Rp          194,000

26

HSV IgM

 Rp          194,000

27

Hb e Ag

 Rp          238,000

28

AHBe

 Rp          238,000

29

TPSA

 Rp          236,000

30

Anti HAV IgM

 Rp          236,000

31

AHCP Kualitatif

 Rp             87,000

32

AHIV Kualitatif

 Rp             90,000

33

Anti TB (ICT)

 Rp          125,000

34

Anti Dengue IgG, IgM

 Rp          175,000

35

Anti Salmonella IgM

 Rp          180,000

36

Alpha Amilase

 Rp          160,000

37

ICT Malaria

 Rp          170,000

38

Antigen

 Rp          100,000

BIO MOLEKULAR

1

PCR

 Rp          300,000

MIKROSKOPIS

1

Gram

 Rp             20,000

2

BTA

 Rp             20,000

3

Malaria

 Rp             25,000

4

Filaria

 Rp             25,000

5

Feces Rutin

 Rp             25,000

6

Darah Samar

 Rp             65,000

KIMIA / FISIKA

1

Air Raksa

 Rp          120,000

2

Arsen

 Rp             63,000

3

Bau

 Rp             15,000

4

Besi

 Rp             52,000

5

Florida

 Rp             32,000

6

Jumlah zat Padat Terlarut

 Rp             26,500

7

Kadmium

 Rp             70,000

8

Kekeruhan

 Rp             17,500

9

Kesadahan

 Rp             47,000

10

Klorida

 Rp             53,000

11

Kromium Valensi

 Rp             54,000

12

Mangan

 Rp             52,000

13

Nitrat

 Rp             37,000

14

Nitrit

 Rp             37,000

15

pH

 Rp             20,000

16

Rasa

 Rp             14,000

17

Selenium

 Rp             63,000

18

Seng

 Rp             52,000

19

Sianida

 Rp             46,000

20

Sulfat

 Rp             51,700

21

Tembaga

 Rp             43,000

22

Timbal

 Rp             65,000

23

Warna

 Rp             14,000

24

Zat Organik

 Rp             30,000

MIKROBIOLOGI AIR

1

MPN Total Coliform

 Rp          100,000

2

MPN Fecal Coliform

 Rp          101,000

3

MPN E. Coli

 Rp          120,000

MIKROBIOLOGI MAKANAN

1

Angka Kuman E.Coli

 Rp          126,000

2

Salmonella

 Rp             92,500

3

Shigella

 Rp             94,000

4

Staphylococcus

 Rp             97,000

5

E.Coli

 Rp             99,000

KIMIA MAKANAN

1

Borax

 Rp             55,000

2

Formalin

 Rp          105,000

3

Siklamat

 Rp             51,000

4

Rhodamin

 Rp             40,000

5

Cyanida

 Rp             51,000

6

Nitrit

 Rp             37,000

7

Lodat

 Rp             41,000

8

Peroksida

 Rp             55,000

9

Hypoklorit

 Rp             41,000

10

Methil Yellow

 Rp             31,000

11

Benzoat

 Rp             37,000

SURAT KETERANGAN

12

Surat Keterangan Kehamilan

 Rp             35,000

13

Surat Keterangan Kesehatan

 Rp             35,000