Page 24 - TARIF BPJS (Update Nov 2017)

LABORATORIUM RUJUKAN
1 ACA IgG 465,000 4,680 460,320 465,000
2 ACA IgM 481,000 4,680 476,320 481,000
3 ACTH 2,100,000 2,100,000
4 ANA Profile 1,150,000 1,150,000
5 ANA Test 358,000 4,680 353,320 358,000
6 Analisa Batu Ginjal 242,500 6,000 236,500 242,500
7 Analisa Hb (HPLC) 600,000 600,000
8 Anti Amuba 309,000 4,680 304,320 309,000
9 Anti Chikungunya IgM 425,000 425,000
10 Anti ds DNA 390,000 4,680 385,320 390,000
11 Anti HAV Total 318,000 4,680 313,320 318,000
12 Anti HBc IgM 422,000 4,680 417,320 422,000
13 Anti HBc Total 238,500 4,680 233,820 238,500
14 Anti HIV Konfirmasi 725,000 4,680 720,320 725,000
15 Anti Mullerian Hormon 768,400 768,400
16 Anti Tiroglobulin 477,500 477,500
17 Antigen Tuberculosis 148,500 148,500
18 Anti-Thyroid Peroxidase (TPO) 935,000 935,000
19 Apo A1 220,500 4,680 215,820 220,500
20 Apo B 200,000 4,680 195,320 200,000
21 Asam Folat 926,500 926,500
22 Aviditas Anti CMV IgG 523,000 523,000
23 Aviditas Anti Toxoplasma IgG 443,000 443,000
24 C Peptida Puasa & 2 jam PP 298,000 298,000
25 C3 Komplemen 348,000 348,000
26 C4 Komplemen 348,000 348,000
27 Ca 125 300,000 300,000
28 Ca 15-3 422,000 4,680 417,320 422,000
29 Ca 19-9 502,500 4,680 497,820 502,500
30 Ca 72-4 982,000 982,000
31 Calsium Urin 105,000 105,000
32 CD 4 177,000 177,000
33 CD 8 230,000 230,000
34 CD 20
35 Coombs Test Langsung 120,000 120,000
36 Coombs Test Tak Langsung 120,000 120,000
37 CRP Kuantitatif 214,500 214,500
38 Cystatin C 323,500 323,500
39 Ferritin 252,500 4,680 247,820 252,500
40 Free PSA 605,500 605,500
41 Free T3 322,000 322,000
42 Free T4 252,500 4,680 247,820 252,500
43 G6PD 200,000 4,680 195,320 200,000
44 Growth Hormon 333,000 4,680 328,320 333,000
45 HbsAg Kuantitatif 300,000 300,000
46 HBV DNA 2,830,000 4,380 2,825,620 2,830,000
47 HCV Genotif 3,230,000 4,680 3,225,320 3,230,000
48 HCV Genotif + HCV RNA Kuantitatif 6,400,000 4,680 6,395,320 6,400,000
49 HCV RNA Kualitatif 1,582,000 4,680 1,577,320 1,582,000
50 HCV RNA Kuantitatif 3,172,500 4,680 3,167,820 3,172,500
51 HE4 (Tumor Marker untuk Ca Ovarium) 610,000 610,000
52 Helicobacter Antigen 158,000 158,000
53 Helicobacter Pylori 413,500 413,500
54 Homocystein 458,000 458,000
55 hs-CRP 214,000 214,000
56 IgA 320,000 320,000
57 IgE Atofik 1,850,000 1,850,000
58 IgE Total 251,000 4,680 246,320 251,000
59 Inorganic Chemical Air 705,500 705,500
60 Kalium Urin 105,000 105,000