Page 21 - TARIF BPJS (Update Nov 2017)

PEMERIKSAAN LABORATORIUM

2017
HEMATOLOGI 2015
Jasa Medis Biaya Sarana Total Tarif
1 D-Dimer 305,000 4,680 300,320 305,000
2 Gambaran Darah Tepi 110,000 35,940 74,060 110,000
3 Gol Darah ABO 18,500 3,480 15,020 18,500
4 Gol Darah Rhesus 21,000 4,680 16,320 21,000
5 Hema Automatik : 3 diff 40,000 5,880 34,120 40,000
6 Hema Automatik : 5 diff 70,000 5,820 64,180 70,000
7 Hematokrit 10,000 2,340 7,660 10,000
8 Hemoglobin 30,000 2,340 27,660 30,000
9 Hitung Eosinofil 40,000 4,620 35,380 40,000
10 Hitung Jenis Lekosit 40,000 3,480 36,520 40,000
11 INR 1 35,000 4,680 30,320 35,000
12 INR 2 (tanpa permintaan PT) 118,000 11,760 106,240 118,000
13 Kadar Besi 85,000 5,880 79,120 85,000
14 Laju Endap Darah 19,500 2,280 17,220 19,500
15 LE Cell 57,500 11,760 45,740 57,500
16 Masa Pembekuan 30,000 5,820 24,180 30,000
17 Masa Perdarahan 30,000 4,680 25,320 30,000
18 Masa Prothrombin 60,000 7,020 52,980 60,000
19 Masa Prothrombin Sebagian 60,000 7,020 52,980 60,000
20 Retikulosit 26,000 4,620 21,380 26,000
21 Sediaan Malaria / Filaria 38,000 7,020 30,980 38,000
22 Sumsum Tulang 375,000 73,020 301,980 375,000
23 TIBC 72,500 5,820 66,680 72,500
FISIKO KIMIA NON DARAH
1 Analisa Sperma 103,000 17,640 85,360 103,000
2 Benzidin / Hematest Tinja 50,000 2,340 47,660 50,000
3 Glukose (LCS, Acites, Pleura,dll) 19,000 4,620 14,380 19,000
4 Jumlah & Jenis Sel (LCS, Acites, Pleura, dll) 30,000 8,280 21,720 30,000
5 Kadar Kreatinin Urin 27,500 5,880 21,620 27,500
6 Keton / Aceton Urin 12,500 1,140 11,360 12,500
7 Makroskopis (LCS, Acites, Pleura, dll) 7,500 1,140 6,360 7,500
8 Mikroalbumin Urin 210,000 7,020 202,980 210,000
9 Sedimen Urin 30,000 3,480 26,520 30,000
10 Sisa Pencernaan Tinja 20,000 4,920 15,080 20,000
11 Test None Apelt 17,500 3,300 14,200 17,500
12 Test Pandy 17,500 3,300 14,200 17,500
13 Test Rivalta 16,500 3,300 13,200 16,500
14 Tinja Rutin (Makros Mikros) 25,000 3,300 21,700 25,000
15 Total Protein (LCS, Acites, Pleura, dll) 22,000 4,680 17,320 22,000
16 Urin Lengkap (11 parameter) 46,000 15,300 30,700 46,000
17 Uji Kehamilan 38,000 3,480 34,520 38,000
18 Uji Naza Amphethamine Urin (Kualitatif) 59,000 2,340 56,660 59,000
19 Uji Naza Barbiturat Urin (Kualitatif) 59,000 2,340 56,660 59,000
20 Uji Naza Benzodiazepine Urin (Kualitatif) 59,000 2,340 56,660 59,000
21 Uji Naza Cannabinoid Urin (Kualitatif) 59,000 2,340 56,660 59,000
22 Uji Naza Cocaine Urin (Kualitatif) 59,000 2,340 56,660 59,000
23 Uji Naza MDMA (Kualitatif) 76,500 76,500
24 Uji Naza Methadon Urin (Kualitatif) 60,000 2,280 57,720 60,000
25 Uji Naza Methamphetamine Urin (Kualitatif) 59,000 2,340 56,660 59,000
26 Uji Naza Opiate Urin (Kualitatif) 59,000 2,340 56,660 59,000
27 Uji Naza PCP Urin (Kualitatif) 76,500 2,142 74,358 76,500
28 Uji Naza Tricyclic Antidepresan (Kualitatif) 76,500 76,500
29 Transudat Exsudat -
KIMIA KLINIK
1 Albumin 18,500 3,480 15,020 18,500
2 Alfa Amylase 121,000 7,020 113,980 121,000