Tarif Pemeriksaan Laboratorium Klinik Prodia

Berlaku Mulai 1 Januari 2020

TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
1 11-Deoxycortisol, LC/MS/MS, serum 2,070,000
2 17-Hydroxyprogesterone 1,028,000
3 17-Ketosteroid 240,000
4 17-OH Kortikosteroid (Urin 24 jam) 240,000
5 17-OH Progesterone (LC-MS/MS) 1,028,000
6 17-OH Progesteron Neonatus 150,000
7 21 - Hydroxylase Antibody 2,229,000
8 5' Nucleotidase 820,000
9 5-HIAA 132,000
10 96 Food Allergy IgA 3,718,000
11 ACA IgG 875,000
12 ACA IgM 875,000
13 Acetylcholine Receptor Antibodies (ACAB) 2,043,000
14 Acetylcholine Receptor Blocking Autoabs 1,257,000
15 Acetylcholine Receptor Modulating Antibody 2,217,000
16 ACTH 1,439,000
17 ACTH,Plasma 922,000
18 Activated Protein C Resistance 1,450,000
19 ADAMTS13 Activity with Reflex to Inhibitor 17,028,000
20 Adenosine Deaminase (ADA) , Cairan Pleura 477,000
21 Adenosine Deaminase (ADA) , CSF 477,000
22 Adenosine Deaminase (ADA) ,Ascites 477,000
23 Adenovirus AB 897,000
24 Adiponektin 901,000
25 Adrenocotex Stress Profile 4,046,000
26 AFP 419,000
27 Agregasi Trombosit 465,000
28 Agregasi Trombosit (TAT) 465,000
29 Albumin 98,000
30 Albumin Urin Kuantitatif 168,000
31 Albumin Urin Kuantitatif (dalam waktu tertentu) 168,000
32 Aldolase 810,000
33 Aldosteron 2,003,000
34 Aldosterone Urine 1,323,000
35 Aldosterone, Urine 2,384,000
36 Aldosterone/Plasma Renin Activity Ratio 2,066,000
37 Alkaline Phosphatase Isoenzymes 1,233,000
38 Alkaline Phosphatase, Bone Specifc 1,323,000
39 Alkohol/Ethanol Kuantitatif Urine 420,000
40 Alkohol/Ethanol Kuantitatif Whole Blood 480,000
41 Alpha - HBDH 530,000
42 Alpha-1-Acid Glycoprotein 1,156,000
43 Alpha-1-Antitrypsin, Quantitative (Quest) 935,000
44 Alpha-2-Macroglobulin 1,615,000
45 Aluminium 132,000
46 AMA dan ASMA IF 1,614,000
47 Amikacin 1,136,000
48 Amino Acid Analysis, LC/MS, Plasma 4,161,000
49 Amino Profile-19 1,900,000
50 Amino Profile-Metabolic 1,200,000
51 Amino Profile-Nutrition 1,200,000
52 Amniotic Fluid AFP 518,000
53 Amonia Darah 626,000
54 Amphetamin Kualitatif Urine 66,000
55 Amphetamin Kuantitatif Serum 480,000
56 Amphetamin Kuantitatif Urine 420,000
57 Amphetamine 175,000
58 Amylase Pancreatic 420,000
59 Amylase Pancreatic Urin 410,000
60 Amylase Pancreatic Urin 24 Jam 410,000
61 ANA (IF) 805,000
62 ANA Profile 1,267,000
63 Analisa Batu Empedu 120,000
64 Analisa Batu Ginjal (FTIR) 301,000
65 Analisa Cairan Asites 650,000
66 Analisa Cairan Otak 638,000
67 Analisa DNA 5 Alfa Reductase 2,750,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
68 Analisa DNA Achondroplasia 1,100,000
69 Analisa DNA Alpha Tahap 1 1,650,000
70 Analisa DNA Androgen Receptor 3,850,000
71 Analisa DNA Beta Thalasemia Tahap 1 2,200,000
72 Analisa DNA Hypochondroplasia 1,650,000
73 Analisa DNA Prader Willi 3,267,000
74 Analisa DNA SMA 4,400,000
75 Analisa DNA Thalassemia 3,300,000
76 Analisa Faeces 270,000
77 Analisa Gas Darah (RE) 358,000
78 Analisa Gas Darah 365,000
79 Analisa Gen DNA SRY 1,100,000
80 Analisa Gen P ( Anti Viral Tenofovir & Etacafier ) 2,200,000
81 Analisa Hb (HPLC) 625,000
82 Analisa Kromosom 1,980,000
83 Analisa Kromosom Cairan Amnion 2,750,000
84 Analisa Kromosom Cairan CVS 2,750,000
85 Analisa Kromosom Cairan Kuretase 2,750,000
86 Analisa Kromosom Darah 1,760,000
87 Analisa Kromosom Jaringan Kuretase 2,750,000
88 Analisa Kromosom Jaringan Plasenta 2,750,000
89 Analisa Kromosom Philadelpia 1,760,000
90 Analisa Sperma 445,000
91 Anaplastic Limpoma Kinase (ALK) 798,000
92 ANCA (IF) 450,000
93 ANCA (IF) 450,000
94 Androstenedione, LC/MSMS 1,492,000
95 Angiotensin Converting Enzyme 832,000
96 Angiotensin II 1,605,000
97 Anion GAP 1,716,000
98 Anti B2 Glikoprotein 1 IgG dan IgM 1,130,000
99 Anti EBV CA IgM 1,320,000
100 Anti HDV Total 1,679,000
101 Anti HEV IgM 2,601,000
102 Anti Mitochondrial Antibody (AMA M2) 947,000
103 Anti Mullerian Hormone (AMH) 736,000
104 Anti-Acetylcholine Receptor (Binding) 1,200,000
105 Anti-Amoeba 480,000
106 Anti-Beta2-Glikoprotein 1 1,130,000
107 Antibodi Filariasis 300,000
108 Antibodi Leptospira 120,000
109 Antibodi Sperma 605,000
110 Antibodi Trombosit 420,000
111 Anti-CCP IgG 880,000
112 Anti-Chikungunya IgM 420,000
113 Anti-Chlamydia trachomatis IgG 885,000
114 Anti-Chlamydia trachomatis IgM 885,000
115 Anti-CMV IgG 380,000
116 Anti-CMV IgM 520,000
117 Anti-Dengue IgG & IgM 585,000
118 Anti-dsDNA-NcX 670,000
119 Anti-EBV EA IgM 1,350,000
120 Anti-EBV VCA IgM 1,180,000
121 Anti-Extractable Nuclear Antigen Identification 1,640,000
122 Antigen Filariasis 300,000
123 Antigenemia-CMV 454,000
124 Anti-H. Pylori IgG 806,000
125 Anti-HAV IgG 565,000
126 Anti-HAV IgM 525,000
127 Anti-HBc 440,000
128 Anti-HBc IgM 680,000
129 Anti-HBe 720,000
130 Anti-HBs 226,000
131 Anti-HBs pasca vaksinasi 393,000
132 Anti-HCV 531,000
133 Anti-HIV 490,000
134 Anti-HIV (RE) 489,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
135 Anti-HIV 3 metode 761,000
136 Anti-HIV Konfirmasi 687,000
137 Anti-HSV1 IgG 445,000
138 Anti-HSV1 IgM 445,000
139 Anti-HSV2 IgG 426,000
140 Anti-HSV2 IgM 426,000
141 Anti-Rubella IgG 403,000
142 Anti-Rubella IgM 509,000
143 Anti-Salmonella typhi IgM 368,000
144 Anti-Skeletal Muscle Antibody 1,224,000
145 Anti-Tiroglobulin 463,000
146 Anti-Toxoplasma IgG 376,000
147 Anti-Toxoplasma IgM 376,000
148 Anti-TPO 981,000
149 AP Test 901,000
150 Apo-A1 387,000
151 Apo-B 250,000
152 APOE-Genotipe 2,000,000
153 APTT 215,000
154 Aquaporin-4 (AQP) Antibodies 3,555,000
155 Arsenic (As) Urine 1,294,000
156 Arsenic 24 Hour Urine 829,000
157 Asam Arachidonic (AA) 231,000
158 Asam Folat 1,011,000
159 Asam Laktat 651,000
160 Asam Urat 73,000
161 Asam Urat Urin 73,000
162 Asam Urat Urin 24 jam 73,000
163 ASTO 142,000
164 AT III (RE) 520,000
165 AT III 291,000
166 Aviditas Anti-CMV IgG 587,000
167 Aviditas Anti-Toxoplasma IgG 587,000
168 Badan Inklusi HbH 154,000
169 Barbiturat Kualitatif Urine 66,000
170 Barbiturat Kuantitatif Serum 480,000
171 Barbiturat Kuantitatif Urine 420,000
172 B-Cell Lymphoproliverative Disease 990,000
173 BCR ABL 1,226,000
174 BCR-ABL Kuantitatif p210 3,710,000
175 Benzene Metabolite S Phenyl Mercapturic Acid 880,000
176 Benzodiazepin Kualitatif Urine 66,000
177 Benzodiazepin Kuantitatif Serum 480,000
178 Benzodiazepin Kuantitatif Urine 420,000
179 Benzodiazepine 212,000
180 Besi 213,000
181 Beta 2-Microglobulin 928,000
182 Beta-2-Microglobulin, Urine 1,328,000
183 B-HCG 667,000
184 Bikarbonat 315,000
185 Bilasan bronkus 360,000
186 Bilirubin (Total/Direk/Indirek) 168,000
187 Bilirubin Direk 84,000
188 Bilirubin Total 84,000
189 Bilirubin Total (Neonatus) 173,000
190 BK Virus DNA, Quantitative, Real-Time PCR 2,878,000
191 BTA (Mikroskopik) 105,000
192 BTA Mikroskopik (Sputum 1) 105,000
193 BTA Mikroskopik (Sputum 2) 105,000
194 BTA Mikroskopik (Sputum 3) 105,000
195 Bullous Pemphigoid (Bp 180) Antibody 3,457,000
196 C1 Esterase Inhibitor, Functional 1,861,000
197 C1 Esterase Inhibitor, Protein 1,178,000
198 C3 Komplemen 643,000
199 C4 Komplemen 643,000
200 CA 125 770,000
201 CA 15-3 775,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
202 CA 19-9 789,000
203 CA 27.29,CSF (17419X) 946,000
204 CA 72-4 1,059,000
205 Caffein Plasma EDTA 480,000
206 Caffein Urine 480,000
207 Calcitonin 892,000
208 Calcium 132,000
209 Calcium Ion 375,000
210 Calcium Urin 132,000
211 Calcium Urin 24 jam 132,000
212 Calsium Ion 375,000
213 Campylobacter Jejuni Antibody 1,279,000
214 Cannabis 212,000
215 Cannabis Kuantitatif Serum 480,000
216 Cannabis Kuantitatif Urine 420,000
217 Carbamazepin 1,188,000
218 Cardiolipin Antibody IgA 1,107,000
219 CArisk 2.0 10,000,000
220 CArisk 2.0 (Add-on) 8,000,000
221 Carotene 1,323,000
222 Catecholamin Fractionated Urine Random 1,619,000
223 Catecholamines Fractionated Plasma 1,480,000
224 Catecholamines, Fractionated 24 Hr Urine 1,210,000
225 CD 117 798,000
226 CD 133 825,000
227 CD 14 / CD 20 300,000
228 CD 34 715,000
229 Cd, Blood 377,000
230 CEA 387,000
231 Ceruloplasmin 841,000
232 CHE 197,000
233 Chlamydia and Chlamydophila Antibody Panel 1 (IgG) 1,528,000
234 Chlamydia Pneumoniae IgG,IgM & IgA ABS 2,177,000
235 Chlamydophila Pneumoniae Antibody (IgM) 1,124,000
236 Chlorida 148,000
237 Chlorida Urin 148,000
238 Cholesterol HDL 84,000
239 Cholesterol LDL Direk 129,000
240 Cholesterol Total 63,000
241 Chrome (Cr) 132,000
242 Chromium (Urine) 151,000
243 Chromogranin - A 2,004,000
244 Circulating Tumor Cell (CTC) 14,842,000
245 CISH ( Chromogen In Situ Hybridization) 3,174,000
246 Citrate, Urine 1,476,000
247 CK 244,000
248 CK-MB (Massa) 504,000
249 Clomipramine 1,196,000
250 Clonazepam 1,141,000
251 Clostridium Difficile (GDH) 424,000
252 Clostridium Difficile (Toksin A/B) 689,000
253 CMV-DNA (Real Time PCR) 1,426,000
254 CMV-DNA, Cairan amnion (Real Time PCR) 1,426,000
255 CMV-DNA, Urin (Real Time PCR) 1,426,000
256 Co, Serum 377,000
257 Cocain Kualitatif Urine 66,000
258 Cocaine 176,000
259 Cocaine Kuantitatif Serum 480,000
260 Cocaine Kuantitatif Urine 420,000
261 Cold Agglutinins 1,068,000
262 Complement , Total (CH50) 1,320,000
263 Complement Componen C1Q 1,595,000
264 Complement Component C2 1,374,000
265 Complement Component C5 2,820,000
266 Coombs' Test 480,000
267 Copeptin 2,503,000
268 Copper ,24-Hour Urine 1,377,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
269 Cortisol 607,000
270 Cortisol Free, 24 hr urine 1,109,000
271 Cortisol Saliva 3,272,000
272 Cortisol Serum Pagi 607,000
273 Cortisol Serum Random 607,000
274 Cortisol Serum Sore 607,000
275 Cortisol Free Serum 1,670,000
276 Cotinine 124,000
277 Cotinine Kuantitatif Urine 480,000
278 Cow's Milk (f2) IgE 1,045,000
279 Coxsackie A Ab Panel Serum 1,540,000
280 C-Peptide 530,000
281 C-Peptide 2 jam PP 530,000
282 CRP Kualitatif 240,000
283 Cryptococcal Antigen, Latex Screen W/Reflex To Titer 2,205,000
284 Cryptococcus Antibody 1,341,000
285 CT/NG-DNA (Real Time PCR) 1,430,000
286 CTx (C-Telopeptide) 553,000
287 Cu, Serum 377,000
288 VASKULArisk 7,000,000
289 Cyclospora 300,000
290 Cyclosporin Parent 1,489,000
291 Cyfra 21-1 572,000
292 CYP2C19-Genotipe*2,*3 615,000
293 Cystatin-C 386,000
294 Cysticercus IgG Antibody, Western Blot 1,834,000
295 Cytokeratin 798,000
296 Cytomegalovirus Antibody (IGG) 1,696,000
297 Cytopathology 353,000
298 Darah Samar 207,000
299 D-Dimer 892,000
300 Dengue NS1 Antigen 467,000
301 Dengue Virus RNA, Qualitative Real-time PCR 7,693,000
302 Dexametason 480,000
303 DHEA-S 831,000
304 DHT Saliva 3,377,000
305 DIArisk 7,000,000
306 DIArisk (Add on) 5,000,000
307 Diazepam Serum 480,000
308 Diazepam Urine 480,000
309 Digoxin 1,125,000
310 Dihydrotestosterone 1,476,000
311 Diseksi janin 1,076,000
312 DMD (Duthenne Muscular Distropin) 4,400,000
313 Dnase-B Antibody 930,000
314 Donor, HTLV-I/II Antibody Screen 1,998,000
315 Echinococcus Antibody (IgG) EIA With Reflex to Western Blot 2,410,000
316 Eipstein-Bar Virus (PCR) 715,000
317 Elektroforesis Protein (Urine) 420,000
318 Endomysial Antibody Screen (IgA), With Reflex To Titer 1,413,000
319 Endomysial Igg Antibody Screen And Titer 1,338,000
320 Entamoeba Histolytica IgG, ELISA 953,000
321 Eosinofil Absolut 102,000
322 Epinephrine 1,460,000
323 Epstein Bar Virus DNA, Quantitative RT PCR 4,590,000
324 Epstein-Barr Virus Capsid Ag(VCA) IgG Abs 869,000
325 Epstein-Barr Virus Early Antigen D Antibody (IgG) 815,000
326 Epstein-Barr Virus Early Antigen IgA Antibodi 878,000
327 Epstein-Barr Virus Early Antigen IgG 1,350,000
328 Epstein-Barr Virus Nuclear Ag (EBNA) IgG Abs 930,000
329 Epstein-Barr Virus Viral Capsid Ag(VCA)IgM Abs 936,000
330 Epstein-Barr Virus Viral Capsid Antigen (VCA) Antibody (IgA) 878,000
331 ER (Estrogen Receptor) 930,000
332 Erythropoietin 1,163,000
333 Estradiol 560,000
334 Estradiol 560,000
335 Estriol, LC/MS/MS, Serum 1,538,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
336 Estroge Metabolite Comprehensive 5,739,000
337 Estrogen Receptor (ER) 930,000
338 Estrogen Receptor (ER) 930,000
339 Estrogen Total 1,776,000
340 Estrone 1,345,000
341 Everolimus 2,303,000
342 Extractable Nuclear Antigen (ENA) IgG Auto Abs 1,270,000
343 Factor IX 1,892,000
344 Factor V (Leiden) Mutation Analysis 3,330,000
345 Factor VII Assay 2,157,000
346 Factor VIII 1,892,000
347 Factor VIII Inhibitor Assay 2,159,000
348 Factor XI Activity, Clotting 1,866,000
349 Factor XII Activity, Clotting 1,866,000
350 Faeces Parasit Lengkap 264,000
351 Faeces Rutin 112,000
352 Faktor IX 378,000
353 Faktor VIII 378,000
354 Fatty Acid PROfile 1,113,000
355 Fe, Serum 377,000
356 Fecal Calprotectin 744,000
357 Ferritin 342,000
358 Fibrinogen 342,000
359 Fibrinogen Degradation Product (FDP) 1,685,000
360 FISH 5,280,000
361 FISH Kromosom 21 1,650,000
362 Fish SRY 1,980,000
363 Fish X,Y 1,980,000
364 Fistula 764,000
365 FNA extra paru 381,000
366 Fosfatase Alkali 102,000
367 Fosfor Anorganik 135,000
368 Fosfor Anorganik Urin 135,000
369 Fragile X (Molekular Gen FMR-1) 1,540,000
370 Fragile X (Sitogenetika) 1,870,000
371 Fragmentasi DNA Sperma 2,449,000
372 Free Light Chain 552,000
373 Free PSA 964,000
374 Fructosamine 921,000
375 FSH 479,000
376 FSH 479,000
377 FT3 510,000
378 FT4 420,000
379 FTA-ABS 966,000
380 G6PD 288,000
381 G6PD Neonatus 95,000
382 Gabapentin 1,590,000
383 Galactomanan 1,485,000
384 Gambaran Darah Tepi 234,000
385 Gambaran Sumsum Tulang 1,003,000
386 Gamma GT 122,000
387 Ganglioside GM-1 Antibodies (IgG&IgM) 2,171,000
388 Gastrin 1,116,000
389 Giardia Lamblia Abs IgG/IgA/IgM 1,586,000
390 Gingiva 779,000
391 Gliadin (Deamidated Peptide) Antibody (IgG, IgA) 1,581,000
392 Glomerular Basement Membrane Antibody (IgG) 2,410,000
393 Glucagon 3,492,000
394 Glukosa 1 Jam PP 42,000
395 Glukosa 2 jam PP 42,000
396 Glukosa 2 Jam PP 42,000
397 Glukosa Jam 11.00 42,000
398 Glukosa Jam 16.00 42,000
399 Glukosa Puasa 42,000
400 Glukosa Puasa 42,000
401 Glukosa Sewaktu 42,000
402 Glukosa Sewaktu I 42,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
403 Glukosa Sewaktu II 42,000
404 Glukosa Sewaktu III 42,000
405 Glukosa Sewaktu IV 42,000
406 Glutamic Acid Decarboxylase-65 Antibody 1,822,000
407 Glycated Albumin 201,000
408 Golongan Darah A, B, O dan Rhesus 84,000
409 Golongan darah A, B, O, dan Rh Konfirmasi 72,000
410 GOT 67,000
411 GPT 67,000
412 Growth Hormon Stimulation 1 608,000
413 Growth Hormon Stimulation 2 608,000
414 Growth Hormon Stimulation 3 608,000
415 Growth Hormon Stimulation 4 608,000
416 Growth Hormon Stimulation 5 608,000
417 Growth Hormon Stimulation 6 608,000
418 Growth Hormone 608,000
419 GTT 1 Jam 41,000
420 GTT 1 Jam 41,000
421 GTT 2 Jam 41,000
422 GTT 2 Jam PP 41,000
423 GTT Puasa 41,000
424 GTT Puasa 41,000
425 Haemophilus Influenzae B IgG Antibodies 1,365,000
426 Haptoglobin 856,000
427 HbA1c 195,000
428 HBeAg 609,000
429 HBsAg 204,000
430 HBsAg (Imunokromatografi) 204,000
431 HBsAg Konfirmasi 1,045,000
432 HBsAg Kuantitatif 467,000
433 HBV Genotipe 3,594,000
434 HBV-DNA 2,104,000
435 HCV - Genotipe (Sequencing) 4,686,000
436 HCV-RNA (Real Time PCR) 2,903,000
437 HE4 585,000
438 Hematologi Lengkap 132,000
439 Hematologi Rutin 111,000
440 Hemoglobin 85,000
441 Hepatitis D Antibody, Total 1,363,000
442 Hepatitis D Virus (HDV) Antibody Panel,EIA 3,441,000
443 Hepatitis D Virus (HDV) IgM Antibody 1,439,000
444 Hepatitis E Antibodies (IgG, IgM) 2,954,000
445 Hepatitis E Antibody (IgG) 1,737,000
446 Hepatitis E Antibody (IgM) 1,589,000
447 HER2 930,000
448 HER2 930,000
449 HER2 (human epidermal growth factor receptor 2) 930,000
450 Herpes Virus-6, Human IgG & IgM ABS 2,048,000
451 Hg, Blood 377,000
452 Histone Antibodies 1,660,000
453 HIV-1 Genotype 7,848,000
454 HIV-1-RNA (Real Time PCR) 1,638,000
455 HLA - A, B, DR, DQ 5,117,000
456 HLA - C 1,679,000
457 HLA A DQ High ress 2,137,000
458 HLA- A,B 2,867,000
459 HLA B DQ High ress 2,137,000
460 HLA-A,B,DR 4,554,000
461 HLA-ABC 3,742,000
462 HLA-B27 2,554,000
463 HLA-DR 2,554,000
464 Homa-B -
465 Homa-IR -
466 Homocysteine 760,000
467 Homovanillic Acid (HVA), random urine 2,487,000
468 HpSA 292,000
469 HPV Genotipe 1,590,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
470 HPV-DNA High Risk (HC) 695,000
471 hs Troponin T 420,000
472 hs-CRP 335,000
473 hs-Troponin I (Kuantitatif) 811,000
474 HSV (PCR) 715,000
475 Hydroxytryptamine,5-(Serotonin) 1,493,000
476 Hyperinsulin 6,135,000
477 IFN-Gamma Release Assay (IGRA) 1,010,000
478 IgA 590,000
479 IgE Atopy (Panel Indonesia) 1,870,000
480 IgE Atopy (panel pediatri) 1,670,000
481 IgE Spesifik Bulu Ayam 578,000
482 IgE Spesifik Cokelat 673,000
483 IgE Spesifik Daging Ayam 673,000
484 IgE Spesifik Daging Babi 393,000
485 IgE Spesifik Daging Kambing 578,000
486 IgE Spesifik Daging Sapi 393,000
487 IgE Spesifik Debu Rumah 673,000
488 IgE Spesifik Epitel Anjing 721,000
489 IgE Spesifik Epitel Kucing 721,000
490 IgE Spesifik Epitel Tikus 721,000
491 IgE Spesifik Gandum 366,000
492 IgE Spesifik Ikan 673,000
493 IgE Spesifik Ikan Cod 686,000
494 IgE Spesifik Jamur Aspergillus 721,000
495 IgE Spesifik Jamur Penicillin 721,000
496 IgE Spesifik Kacang 673,000
497 IgE Spesifik Kacang Kedelai 366,000
498 IgE Spesifik Kapuk 673,000
499 IgE Spesifik Kecoa 673,000
500 IgE Spesifik Kepiting 673,000
501 IgE Spesifik Kerang 673,000
502 IgE Spesifik Kotoran Burung 393,000
503 IgE Spesifik Kuning Telur 673,000
504 IgE Spesifik Lobster 578,000
505 IgE Spesifik Mucor 366,000
506 IgE Spesifik Nasi 366,000
507 IgE Spesifik Orange 366,000
508 IgE Spesifik Pisang 578,000
509 IgE Spesifik Putih Telur 673,000
510 IgE Spesifik Serpihan Kulit Kuda 366,000
511 IgE Spesifik Strawberry 366,000
512 IgE Spesifik Susu 673,000
513 IgE Spesifik Susu Sapi 366,000
514 IgE Spesifik Susu Soya 366,000
515 IgE Spesifik Tomat 366,000
516 IgE Spesifik Tuna 366,000
517 IgE Spesifik Tungau Debu Rumah 673,000
518 IgE Spesifik Udang 673,000
519 IgE Total 485,000
520 IGF BP3 998,000
521 IGF-1 995,000
522 IGF-2 1,423,000
523 IgG 661,000
524 IgG Food Sensitivity Profile 8,130,000
525 IgG Subclass 4 1,413,000
526 IgM 661,000
527 Immature Platelet Fraction (IPF) 81,000
528 Immune Status Panel-MMR 1,473,000
529 ImmuneRisk 7,000,000
530 Immunofiksasi -
531 IgG total w/ Subclass 1,2,3&4 2,212,000
532 Immunohistokimia CD 30 980,000
533 Immunohistokimia EMA 850,000
534 Immunologi Seluler 680,000
535 Immunotyping 1,114,000
536 Imunoelektroforesis (IgG, IgA, IgM, Kappa-Lambda) 982,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
537 Imunofiksasi Serum 599,000
538 Imunofiksasi Urine 825,000
539 Imunohistokimia (CD-20) 798,000
540 IMUNOHISTOKIMIA (PANEL LIMFOMA & CYTOKERATIN) 3,548,000
541 Imunohistokimia CD 15 798,000
542 Imunohistokimia CD3 798,000
543 Imunohistokimia CD68 798,000
544 Imunohistokimia CK 19 798,000
545 Imunohistokimia CK 20 -
546 Imunohistokimia CK 7 798,000
547 Imunohistokimia C-KIT 798,000
548 Imunohistokimia Glypican-3 798,000
549 Imunohistokimia HMB-45 798,000
550 Imunohistokimia Kappa 798,000
551 Imunohistokimia Lamda 798,000
552 Imunohistokimia p53 798,000
553 Imunohistokimia p63 798,000
554 Imunohistokimia S 100 798,000
555 Imunohistokimia SMA 798,000
556 Inhibin A 2,019,000
557 Inhibin B 2,773,000
558 Insulin 1 Jam PP 508,000
559 Insulin 2 jam PP 508,000
560 Insulin Autoantibody 1,167,000
561 Insulin Puasa 508,000
562 Insulin Puasa (Westerindo) 544,000
563 Insulin Sewaktu 508,000
564 Interleukin - 6 (IL-6), Serum 1,554,000
565 Interleukin 2 3,475,000
566 Interleukin 6 935,000
567 Interleukin-1 Beta 4,031,000
568 Interleukin-10 (IL 10) 2,682,000
569 Interleukin-2 Receptor Alpha Chain (IL-2RA/CD25), Soluable 2,700,000
570 Intrinsic Factor Blocking Antibody 1,685,000
571 Iodine 24 Hour Urine 1,394,000
572 Islet Cell Antibody Screen with Reflex to Titer 3,142,000
573 IT Ratio 160,000
574 Jamur Mikroskopis 125,000
575 JC Polyoma Virus DNA Quantitative 5,237,000
576 JO-1 Antibody 1,231,000
577 Kalium 148,000
578 Kalium (Urin 24 jam) 148,000
579 Kantung hidrokel 764,000
580 Kerokan Mandibula 764,000
581 Keton Darah 138,000
582 Ki67 921,000
583 Ki67 921,000
584 Kista Duktus Lacrimal 764,000
585 Kista Duktus Tiroglosus 764,000
586 Kista Ovarium (k) 764,000
587 Kista Ovarium (b) 1,803,000
588 Kista Ovarium (s) 1,076,000
589 Kista Popliteal 764,000
590 Kolostomi Stoma 764,000
591 Kondiloma 764,000
592 Konsultasi GP 124,000
593 Konsultasi Spesialis 252,000
594 Konsultasi Spesialis Gizi 252,000
595 Konsultasi Spesialis Olahraga 252,000
596 KRAS Mutation Analysis 6,941,000
597 Kreatinin 68,000
598 Kreatinin Clearance 176,000
599 Kreatinin Urin 68,000
600 Kreatinin Urin 24 Jam 68,000
601 Kultur & Resistensi Jamur 605,000
602 Kultur Anaerob 770,000
603 Kultur BTA 825,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
604 Kultur BTA (RE) 318,000
605 KULTUR BTA + RESISTENSI LINI 2 378,000
606 Kultur Cairan Tubuh 581,000
607 Kultur Darah 499,000
608 Kultur Darah 581,000
609 Kultur Diphteri 540,000
610 Kultur Feces 606,000
611 Kultur Gall 489,000
612 Kultur GO 423,000
613 Kultur Lain-lain 621,000
614 Kultur Lain-lain 621,000
615 Kultur Lain-lain 621,000
616 Kultur Lain-lain 621,000
617 Kultur Lain-lain 621,000
618 Kultur Swab Rektal 490,000
619 Kultur Urin 606,000
620 Kultur Vibrio 581,000
621 Kuretase endometrial 764,000
622 Kuretase endoserviks 764,000
623 Lamotrigine 1,085,000
624 LCA (Leukocyte Common Antigen) 798,000
625 LDH 161,000
626 Lead (Pb) Darah 985,000
627 Lead, 24-Hour Urine 829,000
628 Lead, Random Urine 1,649,000
629 LED 59,000
630 Legionella Antigen, EIA, Urine 2,410,000
631 Leiomioma, Tanpa Uterus 764,000
632 Leptin 1,866,000
633 Leptospira IgM 114,000
634 Leukemia Phenotyping 990,000
635 Levetiracetam 1,276,000
636 LH 464,000
637 LH 464,000
638 Lipase 295,000
639 Listeria Antibody 1,740,000
640 Lithium 1,417,000
641 Lithium 1,035,000
642 Liver - Kidney Microsome ( LKM-1 ) IgG Autoabs 870,000
643 Lobektomi paru-paru kanan 1,076,000
644 Lobektomi paru-paru kiri 1,076,000
645 Lobektomi tiroid kanan 1,803,000
646 Lobektomi tiroid kiri 1,803,000
647 Lp(a) 497,000
648 Lupus Antikoagulan 571,000
649 Lyme Disease Antibodies (IgG,IgM), Immunoblot 2,614,000
650 Lymphocyte Subset ( CD4,CD8,CD 19,NK ) 480,000
651 Lysozyme (Muramidase) 1,205,000
652 M Band Quantitative 1,298,000
653 M2PK (Multilab) 627,000
654 M2PK (RS Dharmais) 540,000
655 Magnesium 140,000
656 Magnesium (Urin 24 jam) 140,000
657 Magnesium Urin 140,000
658 Malaria (Mikroskopik) 131,000
659 Malaria Antigen 263,000
660 Massa Auricular 764,000
661 MDMA Kualitatif 66,000
662 MDMA Kuantitatif 420,000
663 Measles IgG 480,000
664 Measles IgM 480,000
665 Meatus Akustikus 764,000
666 Melatonin Saliva 3,377,000
667 Mercury, 24 Hour Urine 1,283,000
668 Merkuri (Hg) Urine 733,000
669 Merkury (Hg) Wholeblood 733,000
670 Metadone Kualitatif Urine 66,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
671 Metadone Kuantitatif Serum 480,000
672 Metadone Kuantitatif Urine 420,000
673 Metanephrines, Fractionated 24 hr Urine 1,268,000
674 Metanephrines, Fractionated Urine Random 1,268,000
675 Metanephrines, Fractionated,Free LC/MS/MS,Plasma 1,753,000
676 Methamphetamine 212,000
677 Methamphetamine Kualitatif Urine 66,000
678 Methamphetamine Kuantitatif Serum 480,000
679 Methamphetamine Kuantitatif Urine 420,000
680 Methaqualone Kualitatif 66,000
681 Methaqualone Kuantitatif Urin 420,000
682 Methotrexate 1,615,000
683 Methylenetetrahydrofolate Reductase (MTHFR) Variant 1,657,000
684 Methylmalonic Acid 1,685,000
685 Mikrofilaria (mikroskopik) 131,000
686 Minimal Residual Disease 990,000
687 Mn, Serum 377,000
688 Modified Harvard Step Test 132,000
689 Morphine (Opiat) 212,000
690 Morphine Kuantitatif Urine 420,000
691 MS AFP 475,000
692 MTB-DNA (Real Time PCR) 1,272,000
693 MTB-PCR JARINGAN 715,000
694 MTHFR, DNA Mutation Analysis 3,757,000
695 Mumps IgG Antibodies 870,000
696 Mumps IgM Antibodies 1,348,000
697 Musk Antibody Test 15,678,000
698 Mutasi EGFR Jaringan Blok 3,061,000
699 Mutasi EGFR Jaringan Baru 3,061,000
700 Mutasi EGFR Sitologi 3,061,000
701 Mutasi EGFR ctDNA 5,300,000
702 Mutasi JAK2V617F 779,000
703 Mutasi KRAS 2,640,000
704 Mycophenolic acid 1,747,000
705 Mycoplasma IgG & IgM Ab 880,000
706 Mycoplasma IgG Ab 480,000
707 Mycoplasma IgM Ab 480,000
708 Mycoplasma pneumoniae antibody IgG 797,000
709 Mycoplasma Pneumoniae IgG & IgM ABS 996,000
710 Mycoplasma Pneumoniae IgM Abs 966,000
711 Myelin Antibody ( IGG ), IFA 1,685,000
712 Myelin Associated Glycoprotein (MAG)-SGPG Antibody IgM 2,048,000
713 Myelin Basic Protein 1,685,000
714 Myeloperoxidase Antibody 1,226,000
715 Myeloperoxidase Antibody & Proteinase-3 Antibody 1,162,000
716 Myoglobin, Serum 960,000
717 Na, K, Cl 386,000
718 Natrium 148,000
719 Natrium Urin 148,000
720 Neuromyelitis Optica / Aquaporin 4 IgG 5,396,000
721 Neutrofil Alkaline Phosphatase (NAP) 420,000
722 Nikotin 480,000
723 NMDA Receptor Antibody, CSF 3,278,000
724 NMDA Receptor Antibody, Serum 3,278,000
725 N-MID Osteocalcin 587,000
726 NSE 926,000
727 NT-Pro BNP 803,000
728 Oligoclonal Bands IgG 2,410,000
729 Omega PROfile 890,000
730 OncoPrecise 5,563,000
731 Opiat Kualitatif Urin 66,000
732 Opiat Kuantitatif Serum 480,000
733 Opiat Kuantitatif Urine 420,000
734 Organic Acids Serum 6,035,000
735 Osmolalitas Serum 125,000
736 Osmolalitas Urine 125,000
737 Ovarium disertai tuba falopi neoplastik kanan 1,803,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
738 Ovarium disertai tuba falopi neoplastik kiri 1,803,000
739 Ovarium disertai tuba falopi non neoplastik kanan 1,803,000
740 Ovarium disertai tuba falopi non neoplastik kiri 1,803,000
741 Oxalate, Urine 1,600,000
742 Oxcarbazepine Metabolite 1,473,000
743 Oxycarbazepine Metabolite 3,489,000
744 Oxycodone 480,000
745 P53 Oncoprotein, IHC With Interpretation 3,489,000
746 Paket Imunohistokimia 2,750,000
747 Pan-ANCA Plus 3,455,000
748 Pancreatic Elastase 1,801,000
749 Panel Anti Aging, Serum & Whole Blood 1,503,000
750 Panel Limfoma 2,750,000
751 Panel Nutrisi dan Logam Berat 1,503,000
752 Panel Nutrisi dan Logam Berat, Serum & Whole Blood 1,503,000
753 Panel Nutrisi, Serum 1,503,000
754 Panel Nutrisi, Urine 1,503,000
755 Panel Toksik, Serum & Whole Blood 1,503,000
756 Panel Toksik, Urine 1,503,000
757 Panel Vitamin B1 dan B6, LC-MS/MS 600,000
758 Parainfluenza Ab, Serum 2,858,000
759 Parvovirus B-19 Antibody (IgM) 940,000
760 Parvovirus B19 IgG & IgM ABS 1,595,000
761 Patologi Anatomi Besar 1,040,000
762 Patologi Anatomi Kecil 578,000
763 Patologi Anatomi Sedang 809,000
764 Payudara kanan dengan tanda batas pemotongan 1,803,000
765 Payudara kiri dengan tanda batas pemotongan 1,803,000
766 Pb, Blood 377,000
767 PCP Pneumocitis Carini Pneumonia 240,000
768 Phencyclidine Kualitatif Urine 66,000
769 Phencyclidine Kuantitatif Serum 480,000
770 Phencyclidine Kuantitatif Urine 420,000
771 Phenobarbital 2,014,000
772 Phenylalanine (PKU) 2,986,000
773 Phenylalanine and Tyrosine 2,193,000
774 Phenytoin 1,085,000
775 Phospholipids 1,273,000
776 Plasminogen Activator Inhibitor (PAI-1) 2,095,000
777 Plasminogen Activity 2,555,000
778 Platelet Activating Factor (PAF) 210,000
779 Platelet Function Test Anti P2Y12 2,120,000
780 Platelet Function Test Aspirin 2,120,000
781 PNH (Paroxysmal Nocturnal Hemoglobinuria)/ CD55,CD59 880,000
782 Poliovirus AB Neutralization 2,619,000
783 Polip pada telinga 764,000
784 Porphyrins, Fractionated Random Urine(Quest) 1,415,000
785 Porphyrins, Total, Plasma 1,595,000
786 Prealbumin (Transthyretin) 1,272,000
787 Pregnenolone 3,573,000
788 Pregnenolone 1,323,000
789 Prenatal Diagnosis Thalassemia 6,918,000
790 Pro Healthy Gut 668,000
791 Pro-Breast Cancer 1 1,579,000
792 Pro-Breast Cancer 1 1,579,000
793 Pro-Breast Cancer 2 2,094,000
794 Pro-Breast Cancer 2 2,094,000
795 Pro-Breast Cancer 3 3,061,000
796 Pro Cancer-breast 3 3,061,000
797 Procalcitonin (PCT) 1,215,000
798 Procollagen Type-1 N Terminal Propeptide (P1NP) 3,746,000
799 Prodia Nutrigenomic (PNG) 7,000,000
800 Prodia Nutrigenomics (Add On) 5,000,000
801 PWG 25,000,000
802 Progesteron 590,000
803 Progesteron Receptor 930,000
804 Progesteron Receptor (PR) 930,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
805 Progesteron Receptor (PR) 930,000
806 Proinsulin 1,700,000
807 Prolactin 430,000
808 Proliferating Cell Nuclear Ag Autoabs 946,000
809 Propoxyphene Kualitatif Urine 66,000
810 Propoxyphene Kuantitatif Serum 480,000
811 Propoxyphene Kuantitatif Urine 420,000
812 ProSafe 7,400,000
813 Proses slide HE 454,000
814 Prostaglandin D2 (PG-D2), Urine 6,216,000
815 Prostate Health Index 2,421,000
816 Protein C (RE) 979,000
817 Protein C 979,000
818 Protein Elektroforesis Capillary 295,000
819 Protein Elektroforesis Gel Agarosa 295,000
820 Protein S (RE) 1,325,000
821 Protein S 1,325,000
822 Protein Total 97,000
823 Protein Total (Urin 24 jam) 225,000
824 Protein Total (Urin sewaktu) 225,000
825 Protein Total, Albumin , Globulin 194,000
826 PSA 500,000
827 Psikologi 292,000
828 PTH Intact 815,000
829 Questassured(TM)25-Hydroxyvitamin D(D2,D3) 1,207,000
830 Rasio Albumin - Kreatinin Urin Sewaktu 176,000
831 Rasio Protein Total/Kreatinin (Urin Sewaktu) 225,000
832 Ratio Etil Kolanolon / Androsterone 480,000
833 Registrasi Baru 44,000
834 Renin Activity Plasma,LC/MS/MS 1,327,000
835 Reseksi esofagus 764,000
836 Reseksi ginjal kanan 1,076,000
837 Reseksi ginjal kiri 1,076,000
838 Reseksi kandung kemih 1,803,000
839 Reseksi Kolon 1,803,000
840 Reseksi laring 1,803,000
841 Reseksi perut 1,803,000
842 Reseksi radikal prostat 1,803,000
843 Reseksi regional kelenjar getah bening 1,803,000
844 Reseksi segmental kolon (Non tumor) 1,076,000
845 Reseksi segmental tumor kolon (tumor) 1,803,000
846 Reseksi sendi 764,000
847 Reseksi tumor lidah 1,803,000
848 Reseksi tumor pada usus halus 1,803,000
849 Reseksi tumor perut 1,803,000
850 Reseksi tumor tonsil 1,803,000
851 Reseksi usus halus 1,803,000
852 Reseksi vulva 1,076,000
853 Respiratory Syncytial Virus Antibody 1,413,000
854 Retikulosit 138,000
855 Retikulosit (Otomatis) 138,000
856 Retraksi Bekuan 101,000
857 Review Patologi 437,000
858 Review Patologi OncoPrecise 437,000
859 RF 160,000
860 Rhesus Genotype 461,000
861 Rickettsia (RMSF) Antibodies (IgG, IgM) with Reflex to Titers 6,145,000
862 Ristocetin Cofactor 2,421,000
863 ROMA 1,285,000
864 Rotavirus Antigen 365,000
865 rT3 3,573,000
866 Rubella PCR 770,000
867 Rumpel Leede 34,000
868 Saccharomyces cerevisiae Antibodies (ASCA) (IgG, IgA) 1,685,000
869 Salmonella Typhi PCR 600,000
870 Saraf simpatik 764,000
871 SCC 736,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
872 Schistosoma IgG Serum 1,250,000
873 Scl-70 Antibody 779,000
874 Se, Serum 377,000
875 Sekuensing Alpha Thalasemia Teknik MLPA 4,400,000
876 Sekuensing Beta Thalassemia 1,650,000
877 Sel-LE 155,000
878 Serologi Jamur Aspergillosis 300,000
879 Serologi Jamur Candidiasis 300,000
880 Serologi Jamur Kriptokokosis 300,000
881 Rasio sFlT-1/PlGF 1,800,000
882 SHBG 1,539,000
883 Sikatan esofagus 360,000
884 Single Antigen Antibody Identification Class I & II 7,305,000
885 Sirolimus 1,464,000
886 Sitologi aspirasi 360,000
887 Sitologi Aspirasi kista payudara kanan 360,000
888 Sitologi Aspirasi kista payudara kiri 360,000
889 Sitologi bilasan buli-buli 360,000
890 Sitologi Cairan Abdomen 208,000
891 Sitologi Cairan Ascites 360,000
892 Sitologi Cairan asites 360,000
893 Sitologi Cairan Cerebrospinal 360,000
894 Sitologi Cairan kista ovarium 360,000
895 Sitologi Cairan perikardial 360,000
896 Sitologi Cairan peritoneal 360,000
897 Sitologi Cairan Pleura (RE) 360,000
898 Sitologi Cairan pleura 360,000
899 Sitologi cairan pus 360,000
900 Sitologi Cairan Sendi 342,000
901 Sitologi Cairan Tubuh Lainnya II 373,000
902 Sitologi Cairan Tubuh Lainnya I 373,000
903 Sitologi endobronkial 360,000
904 SITOLOGI SERVIKS BERBASIS CAIRAN 469,000
905 Sitologi Serviks Berbasis Cairan (RE) 469,000
906 Sitologi Serviks Berbasis Cairan (SSBC) 469,000
907 Sitologi Sikatan bronkus 360,000
908 Sitologi Sputum (RE) 360,000
909 Sitologi Sputum 360,000
910 Sitologi urine 764,000
911 Sjogren's Antibody (SS-A) 1,233,000
912 Sjogren's Antibody (SS-B) 1,407,000
913 Skin & Hair GENOMICS 7,000,000
914 Sm Antibody 1,141,000
915 Small-Dense-LDL 683,000
916 Smooth Muscle total Autoabs 888,000
917 Soluble Liver Antigen (SLA) Autoabs 1,431,000
918 Soluble Transferrin Receptor 1,550,000
919 sPMA (Urine) 650,000
920 SRP Autoantibodies 3,089,000
921 ST2 668,000
922 Status Anti oksidan Total 1,000,000
923 Stero Pro (LC-MS/MS) 1,589,000
924 Streptococcus pneumoniae Antibody (IgG) (14 Serotype) , MAID 2,274,000
925 Striated Muscle Antibody With Reflex To Titer 2,031,000
926 Striational Total Autoabs 870,000
927 Strongyloides IgG Antibody 1,487,000
928 Subtipe Limfosit (CD4 & CD8) 267,000
929 T3 (Total) 343,000
930 T4 (Total) 343,000
931 Tacrolimus 989,000
932 TBG 1,344,000
933 TB-PCR 564,000
934 TEG 649,000
935 Telomere Analysis 15,869,000
936 Tes Kehamilan 142,000
937 Testosteron 540,000
938 Testosteron Free & Total 1,323,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
939 Testosterone, Free 1,857,000
940 Theophyllin 1,802,000
941 Thrombotest Owren 317,000
942 Thyroid Autoantibodies 1,274,000
943 Thyroid-Stimulating Immunoglobulin ( TSI ), Serum 2,762,000
944 Timbal (Pb) Urine 936,000
945 Tindakan bedah minor (Ringan) 235,000
946 Tindakan inhalasi/sesak 155,000
947 Tindakan penanganan luka bakar (Ringan) 118,000
948 Tindakan penanganan sincope (Berat) 235,000
949 Tiroglobulin 661,000
950 Tissue Transglutaminase Antibody (IgA) 1,141,000
951 Tissue Transglutaminase Antibody (IgG, IgA) 1,685,000
952 Tissue Transglutaminase Antibody IgG 1,141,000
953 Toluene 715,000
954 Topiramate 1,086,000
955 Toxoplasma Gondii IgA Antibody 1,308,000
956 Toxoplasma PCR 715,000
957 TPHA 208,000
958 TRAb 596,000
959 Transbronkial aspirasi tumor 360,000
960 Transferrin 477,000
961 Transtorakal aspirasi tumor 360,000
962 Treponema Pallidum Ab 1,124,000
963 Trichomonas Mikroskopis 125,000
964 Trigliserida 68,000
965 Triple Cardiac Marker 1,406,000
966 Troponin I 811,000
967 Troponin I Kualitatif 811,000
968 Troponin T 240,000
969 Trypanosoma cruzi Antibody, IgG 4,950,000
970 Tryptase 2,598,000
971 TSH Neonatus 95,000
972 TSHs 332,000
973 UEI 68,000
974 UIBC 189,000
975 Urea Breath Test (UBT) 1,803,000
976 Urine Rutin 68,000
977 Urine Rutine (Flow Cytometry) 111,000
978 Valproic Acid 1,051,000
979 Valproic Acid 991,000
980 Vancomycin 1,086,000
981 Varicella Zoster Virus IgM 1,489,000
982 Varicella-Zoster Virus Antibody (IgM) 1,042,000
983 Vascular Endothelial Growth Factor (VEGF),Elisa 2,784,000
984 VDRL/RPR 130,000
985 Very Long Chain Fatty Acids 2,398,000
986 Virus Zika (ZIKV) 2,200,000
987 Viskositas Darah 198,000
988 Viskositas Plasma 164,000
989 Vitamin A & E 615,000
990 Vitamin B1 (Thiamine),LC/MS/MS 441,000
991 Vitamin B12 1,010,000
992 Vitamin B12 Binding Capacity 1,482,000
993 Vitamin B2 ( Riboflavin) 1,696,000
994 Vitamin B7 (Biotin) 1,634,000
995 Vitamin C, LC/MS/MS 1,805,000
996 Vitamin D 25-OH Total 416,000
997 Vitamin D,1,25-Dihiydroxy, LC/MS/MS 1,685,000
998 Vitamin K1 2,021,000
999 VMA Urine 108,000
1000 Von Willebrand Factor Antigen 2,245,000
1001 Waktu Pembekuan 72,000
1002 Waktu Perdarahan 72,000
1003 Waktu Perdarahan 72,000
1004 Waktu Protrombin 324,000
1005 Waktu Protrombin 324,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019
 Tarif Pemeriksaan Laboratorium Klinik Prodia
Berlaku Mulai 1 Januari 2020
TARIF A 2020 N L Sulampua -
No NAMA TES
MKS,PNK,KDI (Med A)
1006 Waktu Trombin 377,000
1007 Warfarin IndivTest 2,000,000
1008 WASHING SPERMA 2,305,000
1009 WIDAL 230,000
1010 Xylene 715,000
1011 Yersinia enterocolitica Antibodies (IgG,IgA) 3,723,000
1012 Zn, Serum 377,000
1013 Zonisamide 1,250,000
1014 Proteinase-3 Antibody 1,536,000
1015 Interferon-Gamma (IFN-y) Serum 4,185,000
1016 NBS-Amino Acid (LC-MS/MS) 490,000
1017 Prodia PULS Cardiac Test 4,160,000
1018 PIVKA 400,000
1019 NeuroGENOMICS 7,000,000
1020 Eye GENOMICS 7,000,000
1021 ADMA-SDMA 390,000
1022 Lymphoma Panel 1,000,000
1023 Carrier screening 5,000,000
1024 Organic Urine Acid 300,000
1025 Very Long Fatty Acid 300,000
1026 Acylcarnitin 300,000
1027 PDL-1 1,800,000
1028 Cortisol Saliva 400,000
1029 Carisk hereditary (Hi penetrance) 15,000,000
1030 Free testosterone & bio 400,000
1031 SportDNA 7,000,000

Revisi 00-2020
Dikeluarkan 01 Oktober 2019