Cara mengukur tingkat penggunaan jasa dihitung berdasarkan ketentuan sebagai berikut:
(1)(2) (3) (4) (5) (6) HEMATOLOGI 1 Hemoglobin Spectrofotometer 2,400 5,600 8,000 Blood Cell Counter 2 Leukosit Blood Cell Counter 2,400 5,600 8,000 3 Hitung Jenis Leukosit Blood Cell Counter 2,400 5,600 8,000 4 Laju Endap Darah Westergreen 2,400 5,600 8,000 5 Eritrosit Blood Cell Counter 2,400 5,600 8,000 6 Trombosit Blood Cell Counter 2,400 5,600 8,000 7 Retikulosit Blood Cell Counter 2,400 5,600 8,000 8 Hematokrit Blood Cell Counter 2,400 5,600 8,000 9 MCV Blood Cell Counter 2,400 5,600 8,000 10 MCH Blood Cell Counter 2,400 5,600 8,000 11 MCHC Blood Cell Counter 2,400 5,600 8,000 12 Golongan Darah + Rhesus Factor Aglutinasi 4,500 10,500 15,000 13 Waktu Perdarahan (BT) Ivy 2,400 5,600 8,000 14 Waktu Pembekuan (CT) Lee & White 2,400 5,600 8,000 15 Rumple Leed Makroskopis 2,400 5,600 8,000 16 Retraksi Bekuan Makroskopis 2,400 5,600 8,000 17 PTT 12,000 28,000 40,000 18 APTT 22,500 52,500 75,000 19 Sel LE Mikroskopis 12,000 28,000 40,000 9 20 Gambaran Sel Darah Tepi/Blood Film Mikroskopis 18,000 42,000 60,000 21 Jumlah Eosinofil Mikroskopis 2,400 5,600 8,000 II URINALISA 1 Urine Lengkap 9,000 21,000 30,000 - pH Carik Celup 1,500 3,500 5,000 - Protein Carik Celup 1,500 3,500 5,000 - Reduksi Carik Celup 1,500 3,500 5,000 - Bilirubin Carik Celup 1,500 3,500 5,000 - Urobilin Carik Celup 1,500 3,500 5,000 - Benzidin Carik Celup 1,500 3,500 5,000 - Keton Carik Celup 1,500 3,500 5,000 - Nitrit Carik Celup 1,500 3,500 5,000 - Berat Jenis Carik Celup 1,500 3,500 5,000 - Lekosit Carik Celup 1,500 3,500 5,000 2 Sedimen Mikroskopis 3,000 7,000 10,000 3 Analisa Sperma Mikroskopis 6,000 14,000 20,000 III KIMIA KLINIK A Fungsi Metabolisme Karbohidrat 1 Gula Darah Spectrofotometer - Puasa 7,500 17,500 25,000 - 2 Jam PP 7,500 17,500 25,000 - Sewaktu 7,500 17,500 25,000 B Profil Lipid 1 Cholesterol Total Spectrofotometer 7,500 17,500 25,000 2 HDL Spectrofotometer 7,500 17,500 25,000 3 LDL Spectrofotometer 7,500 17,500 25,000 4 Trigliserida Spectrofotometer 7,500 17,500 25,000 No. Jenis Pemeriksaan Metode Pemeriksaan Jasa Sarana (Rp.) Jasa Pelayanan (Rp.) Tarif (Rp.)
(1)(2) (3) (4) (5) (6) C Fungsi Hati 1 SGOT Spectrofotometer 7,500 17,500 25,000 2 SGPT Spectrofotometer 7,500 17,500 25,000 10 3 Bilirubin Total Spectrofotometer 9,000 21,000 30,000 4 Bilirubin Direk/Indirek Spectrofotometer 9,000 21,000 30,000 5 Alkalis Phosphatase Spectrofotometer 9,000 21,000 30,000 6 Gamma GT Spectrofotometer 15,000 35,000 50,000 7 Total Protein Spectrofotometer 7,500 17,500 25,000 8 Albumin Spectrofotometer 7,500 17,500 25,000 9 Globulin Spectrofotometer 7,500 17,500 25,000 D Fungsi Ginjal 1 Ureum Spectrofotometer 7,500 17,500 25,000 2 Uric Acid Spectrofotometer 7,500 17,500 25,000 3 Creatinine Spectrofotometer 7,500 17,500 25,000 4 Creatiinine Clearance Test Spectrofotometer 7,500 17,500 25,000 E Eletrolit 1 Calsium Spectrofotometer 10,500 24,500 35,000 2 Phospor Spectrofotometer 10,500 24,500 35,000 3 Natrium, Kalium, Chlorida Spectrofotometer 33,000 77,000 110,000 4 Magnesium Spectrofotometer 10,500 24,500 35,000 F Fungsi Pankreas 1 Lipase Spectrofotometer 16,500 38,500 55,000 2 Amylase Spectrofotometer 16,500 38,500 55,000 G Fungsi Jantung 1 CPK Spectrofotometer 21,000 49,000 70,000 2 CK-MB Spectrofotometer 22,000 52,500 74,500 3 LDH Spectrofotometer 15,000 35,000 50,000 H Iron Spectrofotometer 24,000 56,000 80,000 I TIBC Spectrofotometer 13,500 31,500 45,000 IV IMMUNOLOGI 1 Widal Aglutinasi 16,500 38,500 55,000 2 CRP Aglutinasi 10,500 24,500 35,000 3 Rhematoid Factor (RF) Aglutinasi 10,500 24,500 35,000 4 ASTO (Anti Streptomysin O) Aglutinasi 10,500 24,500 35,000 5 DHF Ig G/ IgM Dengue Blot 30,000 70,000 100,000 Dipstick 45,000 105,000 150,000 11 6 Anti HIV Elisa 30,000 70,000 100,000 Dipstick 21,000 49,000 70,000 7 CD Four Point Care 21,000 49,000 70,000 8 HBsAg Elisa 24,000 56,000 80,000 Dipstick 18,000 42,000 60,000 9 Anti HBsAg Elisa 24,000 56,000 80,000 Dipstick 18,000 42,000 60,000 10 Anti HCV Elisa 39,000 91,000 130,000 Dipstick 43,500 101,500 145,000 11 Anti HAV Total Elisa 39,000 91,000 130,000 Dipstick 43,500 101,500 145,000 12 VDRL Flokulasi 9,000 21,000 30,000 13 TPHA Aglutinasi 7,500 17,500 25,000 14 Chikungunya IgM Dipstick 48,000 112,000 160,000 15 Test Kehamilan Dipstick 7,500 17,500 25,000 No. Jenis Pemeriksaan Metode Pemeriksaan Jasa Sarana (Rp.) Jasa Pelayanan (Rp.) Tarif (Rp.)
(1)(2) (3) (4) (5) (6) 16 Toxo IgG Elisa 45,000 105,000 150,000 17 Toxo IgM Elisa 45,000 105,000 150,000 18 Rubella IgG Elisa 45,000 105,000 150,000 19 Rubella IgM Elisa 60,000 140,000 200,000 20 CEA Elisa 45,000 105,000 150,000 21 T3 Elisa 45,000 105,000 150,000 22 T4 Elisa 45,000 105,000 150,000 23 TSH Elisa 45,000 105,000 150,000 24 LH Elisa 48,000 112,000 160,000 25 FSH Elisa 48,000 112,000 160,000 26 Progesteron Elisa 66,000 154,000 220,000 27 Prolactin Elisa 51,000 119,000 170,000 28 Testosteron Elisa 75,000 175,000 250,000 29 Cholinesterase Elisa 9,000 21,000 30,000 12 V MIKROBIOLOGI A Kultur 1 Angka Kuman Kultur 25,500 59,500 85,000 2 MPN Kultur 22,500 52,500 75,000 3 E. Coli Kultur 19,500 45,500 65,000 4 Salmonella Kultur 27,000 63,000 90,000 5 Shigella Kultur 27,000 63,000 90,000 6 Vibrio cholera Kultur 24,000 56,000 80,000 7 Staphylococcus aureus Kultur 27,000 63,000 90,000 8 Streptococcus faecalis Kultur 27,000 63,000 90,000 9 Clostridium diphteri Kultur 22,500 52,500 75,000 10 Jamur Kultur 22,500 52,500 75,000 11 Kuman Anaerob Kultur 25,500 59,500 85,000 12 MO Kultur 39,000 91,000 130,000 13 GO Kultur 27,000 63,000 90,000 14 Trichomonas Kultur 9,000 21,000 30,000 15 Resistensi tiap MO Kultur 18,000 42,000 60,000 16 Kultur BTA Kultur 25,500 59,500 85,000 17 Resistensi BTA Kultur 28,500 66,500 95,000 B Mikroskopis 1 Malaria (tebal & tipis) Mikroskopis 4,500 10,500 15,000 2 BTA Mikroskopis 4,500 10,500 15,000 3 Gram Mikroskopis 4,500 10,500 15,000 4 Filaria Mikroskopis 4,500 10,500 15,000 5 GO Mikroskopis 4,500 10,500 15,000 6 Jamur Mikroskopis 3,750 8,750 12,500 7 Amoeba Mikroskopis 3,750 8,750 12,500 8 Cell Candida Mikroskopis 3,750 8,750 12,500 9 Trichomonas vaginalis Mikroskopis 3,750 8,750 12,500 10 Clostridium diphteri Mikroskopis 22,500 52,500 75,000 11 Feaces Rutin Mikroskopis 2,250 10,500 12,750 12 Telur Cacing Mikroskopis 4,500 10,500 15,000 13 13 Darah Samar Mikroskopis 7,500 17,500 25,000 14 Reitz Serum/Hanzen/Kusta Mikroskopis 10,500 24,500 35,000 C Air 1 MPN Coliform MPN 22,500 52,500 75,000 2 MPN Coli tinja MPN 22,500 52,500 75,000 3 ALT/Jumlah Kuman Kultur 25,500 59,500 85,000 No. Jenis Pemeriksaan Metode Pemeriksaan Jasa Sarana (Rp.) Jasa Pelayanan (Rp.) Tarif (Rp.)
(1)(2) (3) (4) (5) (6) VI KIMIA LINGKUNGAN Analisa Air A Fisika 1 Bau Organoleptik 1,500 3,500 5,000 2 Kekeruhan Visual 1,500 3,500 5,000 3 Jumlah Zat Padat Terlarut (TDS) Gravimetri 1,500 3,500 5,000 4 Rasa Organoleptik 1,500 3,500 5,000 5 Warna Colorimeter 1,500 3,500 5,000 6 Suhu Termometer 1,500 3,500 5,000 7 Kejernihan Visual 1,500 3,500 5,000 8 Zat Tersuspensi (TSS) Gravimetri 7,500 17,500 25,000 9 Zat Terendap Gravimetri 1,500 3,500 5,000 10 Daya Hantar Listrik Conductivity 3,000 7,000 10,000 11 Benda Terapung Mikroskopis 1,500 3,500 5,000 12 Lapisan Minyak Visual 1,500 3,500 5,000 B Kimia Kimiawi 1 Arsen (As) Spectrofotometer 9,000 21,000 30,000 AAS 30,000 70,000 100,000 2 Fluorida (F) Spectrofotometer 7,500 17,500 25,000 3 Total Chromium (Cr) Spectrofotometer 15,000 35,000 50,000 AAS 22,500 52,500 75,000 4 Chromium Valensi 6 Spectrofotometer 7,500 17,500 25,000 AAS 22,500 52,500 75,000 14 5 Kadmium (Kd) Spectrofotometer 10,500 24,500 35,000 AAS 22,500 52,500 75,000 6 Nitrit (NO2) Spectrofotometer 10,500 24,500 35,000 7 Nitrat (NO3) Spectrofotometer 10,500 24,500 35,000 8 Sianida (CN) Spectrofotometer 12,750 29,750 42,500 9 Selenium (Se) Spectrofotometer 10,500 24,500 35,000 AAS 22,500 52,500 75,000 10 Aluminium (Al) Spectrofotometer 11,100 25,900 37,000 AAS 22,500 52,500 75,000 11 Besi (Fe) Spectrofotometer 10,500 24,500 35,000 AAS 22,500 52,500 75,000 12 Kesadahan (CaCO3) Spectrofotometer 10,500 24,500 35,000 13 Chlorida (Cl) Spectrofotometer 12,150 28,350 40,500 14 Mangan (Mn) Spectrofotometer 16,050 37,450 53,500 AAS 22,500 52,500 75,000 15 pH pH meter 3,000 7,000 10,000 16 Seng (Zn) Spectrofotometer 10,500 24,500 35,000 AAS 22,500 52,500 75,000 17 Sulfat (SO4) Spectrofotometer 7,150 17,850 25,000 18 Tembaga (Cu) Spectrofotometer 8,400 19,600 28,000 AAS 22,500 52,500 75,000 19 Ammonia Spectrofotometer 10,500 24,500 35,000 Gas analyzer 22,500 52,500 75,000 20 Air Raksa (Hg) Spectrofotometer 9,000 21,000 30,000 AAS 22,500 52,500 75,000 21 Timbal Spectrofotometer 15,000 35,000 50,000 AAS 22,500 52,500 75,000 No. Jenis Pemeriksaan Metode Pemeriksaan Jasa Sarana (Rp.) Jasa Pelayanan (Rp.) Tarif (Rp.)
(1)(2) (3) (4) (5) (6) 22 Nikel (Ni) Spectrofotometer 19,050 44,450 63,500 AAS 22,500 52,500 75,000 23 Cobalt (Co) Spectrofotometer 9,000 21,000 30,000 15 AAS 22,500 52,500 75,000 24 Calsium (Ca) Spectrofotometer 9,000 21,000 30,000 AAS 22,500 52,500 75,000 25 Magnesium (Mg) Spectrofotometer 9,000 21,000 30,000 AAS 22,500 52,500 75,000 26 Natrium (Na) Spectrofotometer 9,000 21,000 30,000 AAS 22,500 52,500 75,000 27 Kalium (K) Spectrofotometer 9,000 21,000 30,000 AAS 22,500 52,500 75,000 28 Sisa Chlor Colorimeter 6,000 14,000 20,000 Titrimeter 6,000 14,000 20,000 29 Chlor Bebas Titrimeter 10,500 24,500 35,000 30 Antimon (Sb) Spectrofotometer 10,500 24,500 35,000 31 Salinitas Spectrofotometer 7,500 17,500 25,000 32 Sodium absorption Perhitungan 12,000 28,000 40,000 33 Strontium (Sr) Spectrofotometer 10,500 24,500 35,000 AAS 22,500 52,500 75,000 34 Barium (Ba) Spectrofotometer 15,000 35,000 50,000 AAS 22,500 52,500 75,000 35 Perak (Ag) Spectrofotometer 10,500 24,500 35,000 AAS 22,500 52,500 75,000 36 Residual Sodium Carbonat Perhitungan 9,000 21,000 30,000 37 Timah Spectrofotometer 10,500 24,500 35,000 AAS 22,500 52,500 75,000 38 Uranil (U) Spectrofotometer 10,500 24,500 35,000 AAS 22,500 52,500 75,000 39 Silika (S) Spectrofotometer 10,500 24,500 35,000 AAS 22,500 52,500 75,000 40 Lithium (Li) Spectrofotometer 10,500 24,500 35,000 AAS 22,500 52,500 75,000 41 Asam Borat Spectrofotometer 7,500 17,500 25,000 42 Boron Spectrofotometer 10,500 24,500 35,000 AAS 22,500 52,500 75,000 16 43 Belerang dioksida (SO2) Spectrofotometer 10,500 24,500 35,000 Gas analyzer 22,500 52,500 75,000 44 CO2 Agresif Titrimeter 4,500 10,500 15,000 45 Carbon Monoksida (CO) Spectrofotometer 7,500 17,500 25,000 MDIR 32,700 76,300 109,000 46 Kebasaan Titrimeter 4,500 10,500 15,000 47 Oksidan (O3) Spectrofotometer 10,500 24,500 35,000 Gas analyzer 22,500 52,500 75,000 48 Oksida Nitrogen (Nox) Spectrofotometer 10,500 24,500 35,000 Gas analyzer 22,500 52,500 75,000 49 Oksigen Terabsopsi Titrimeter 9,000 21,000 30,000 Polentimetri 9,000 21,000 30,000 50 Oksigen Terlarut Titrimeter 9,000 21,000 30,000 Polentimetri 9,000 21,000 30,000 51 H2S (Hidrogen Sulfida) Spectrofotometer 15,000 35,000 50,000 Ion Selektif 7,500 17,500 25,000 52 Zat Organik (KMnO4) Spectrofotometer 10,500 24,500 35,000 53 Nitrogen Total Spectrofotometer 19,500 45,500 65,000 54 Fosfat Spectrofotometer 10,500 24,500 35,000 55 Phenol Spectrofotometer 15,000 35,000 50,000 56 BOD Titrimeter 15,000 35,000 50,000 57 COD Titrimeter 15,000 35,000 50,000 No. Jenis Pemeriksaan Metode Pemeriksaan Jasa Sarana (Rp.) Jasa Pelayanan (Rp.) Tarif (Rp.)
(1)(2) (3) (4) (5) (6) VII TOKSIKOLOGI A Bahan Adiktif dan Doping (Nafza) 1 Amphetamin Rapid Test 10,500 24,500 35,000 2 Metamphetamin Rapid Test 10,500 24,500 35,000 3 Morpin Rapid Test 10,500 24,500 35,000 4 Ganja/THC Rapid Test 10,500 24,500 35,000 5 Benzodiazepam Rapid Test 10,500 24,500 35,000 17 B Pestisida 1 Golongan Organochlorin per parameter KLT / GC 60,000 140,000 200,000 2 Golongan Organophosphat per parameter KLT / GC 60,000 140,000 200,000 3 Golongan Karbamat per parameter KLT / GC 60,000 140,000 200,000 No Sarana/Prasarana Penggunaan Waktu Tarif 1 2 3 4 5