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Daftar Tarif

Laboratorium Klinik Prodia


Berlaku Per 1 Januari 2018

Tim Tarif 2018


Anggota : Dr. Indriyanti RS, M.Si - Business and Marketing Director
Dr. Andri Hidayat, M.Kes - Operation Director
Dr. Trilis Yulianti, M.Kes - Product Manager
Dr. Wiwik Rositawati, M.Si - PRNL Head
Dra. Sri Marti S, MM - Consultant
N.P. Limbong, SE - Logistic Manager
Rohayani Kaban, SE - Finance Manager
Teguh Widiasmoro, SE - Accounting Manager
Sally, S.Si - TQA Ass. Manager
Karina Restu Fitriana, S.Si - Product Spesialist
Tri Nurlaela - Research Analysis Coordinator
Endah Perminawati - Secretarial Officer
Narasumber : Dra. Ampi Retnowardani, M.Si - Regional Head III
Dr. Marita Kaniawati, M.Si - Scientific Manager
Tatat Novianti, M.Si - Branch Manager Wastukencana

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

TEST PRICE BUNDLING

11-Deoxycortisol, LC/MS/MS (Quest) 1,800,000 -


17-Ketosteroid (Biokimia) 293,000 -
17-OH Kortikosteroid (Urine 24 jam)(Biokimia FKUI) 293,000 -
17-OH Progesterone (LC-MS/MS) 1,019,000 -
19 Food Allergy IgE 4,500,000 -
21 - Hydroxylase Antibody ( Quest ) 1,950,000 -
5' Nucleotidase (Quest) 947,000 -
5-HIAA (Biokimia FKUI) 146,000 -
96 Food Allergy IgA 3,599,000 -
ACA IgG 811,000 -
ACA IgM 834,000 -
Acetylcholine Receptor Antibodies (ACAB) (NUH) 2,300,000 -
Acetylcholine Receptor Binding Autoabs (Quest) 1,983,000 -
Acetylcholine Receptor Blocking Autoabs (Quest) 1,825,000 -
Acetylcholine Receptor Modulating Antibody (Quest) 3,940,000 -
ACTH (NUH) 2,105,000 -
ACTH,Plasma (Quest) 2,105,000 -
Activated Protein C Resistance (Quest) 1,547,000 -
Adenosine Deaminase (ADA) , Cairan Pleura 450,000 -
Adenosine Deaminase (ADA) ,Ascites 450,000 -
Adenosine Deaminase (ADA) ,CSF 450,000 -
Adenovirus AB(Quest) 3,206,000 -
Adiponektin 611,000 -
Adrenal Total Autoantibodies (Quest) 1,150,000 -
Adrenocotex Stress Profile 1,700,000 -
AFP 403,000 -
Agregasi Trombosit (TAT) 447,000 -
a-HBDH 244,000 -
Albumin 92,000 -
Albumin Urine Kuantitatif (Urine 24 jam) 168,000 -
Albumin Urine Kuantitatif Sewaktu (Rasio Albumin per Creatinin Urine)
168,000 -
Aldolase (Quest) 735,000 -
Aldosteron 1,890,000 -
Aldosterone Urine (Quest) 1,164,000 -
Aldosterone, LC/MS/MS (Quest) 1,164,000 -
Aldosterone, Urine (NUH) 3,000,000 -
Aldosterone/Plasma Renin Activity Ratio(Quest) 8,916,000 -
Alkaline Phosphatase Isoenzymes (Quest) 1,659,000 -
Alkaline Phosphatase, Bone Specifc (Quest) 2,504,000 -
Alkohol/Ethanol Kuantitatif Urine (Rujuk Ekstern) 466,000 -
Alkohol/Ethanol Kuantitatif Whole Blood ( Rujuk Ekstern) 532,000 -
Alpha-1-Acid Glycoprotein (Quest) 1,483,000 -
Alpha-1-Antitrypsin, Quantitative (Quest) 1,000,000 -
Alpha-2-Macroglobulin (Quest) 1,436,000 -
Aluminium (Petrolab) 132,000 -
AMA dan ASMA IF 1,500,000 -
Amikacin (NUH) 1,140,000 -
Amino Acid Analysis, LC/MS, Plasma (Quest) 3,500,000 -
Amniotic Fluid AFP 448,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

TEST Kelapa Gading)


Amonia Darah (RS Mitra Keluarga PRICE
541,000 - BUNDLING
Amphetamin Kualitatif Urine (Doping) 73,000 -
Amphetamin Kuantitatif Serum (Doping) 532,000 -
Amphetamin Kuantitatif Urine (Doping) 466,000 -
Amphetamine/shabu2/ekstasi 166,000 -
Amylase Pancreatic 397,000 -
Amylase Pancreatic (Urine Sewaktu) 394,000 -
Amylase Pancreatic Urine 24 Jam 394,000 -
ANA (IF) 774,000 -
ANA Profile 1,218,000 -
Analisa Batu Empedu (Biokimia) 134,000 -
Analisa Batu Ginjal (FTIR) PRN 284,000 -
Analisa Cairan Ascites (RS. Premier Jatinegara) 563,000 -
Analisa Cairan Otak 585,000 -
Analisa DNA 5 Alfa Reductase 3,328,000 -
Analisa DNA Achondroplasia (Eijkman) 1,331,000 -
Analisa DNA Alpha Tahap 1 2,420,000 -
Analisa DNA Beta Thalasemia Tahap 1 2,239,000 -
Analisa DNA Hypochondroplasia 1,650,000 -
Analisa DNA Prader Willi (Eijkman) 3,025,000 -
Analisa DNA SMA (Eijkman) 5,324,000 -
Analisa DNA Thalassemia (Eijkman) 3,993,000 -
Analisa Faeces (Gastroenterologi-RSCM) 333,000 -
Analisa Gas Darah ( RE ) 331,000 -
Analisa Gen DNA SRY (Eijkman) 1,997,000 -
Analisa Gen P ( Anti Viral Tenofovir & Etacafier ) 2,662,000 -
Analisa Hb (HPLC) 600,000 -
Analisa Kromosom (Eijkman) 2,396,000 -
Analisa Kromosom Cairan Amnion (RE) 3,328,000 -
Analisa Kromosom Cairan CVS (Eijkman) 2,750,000 -
Analisa Kromosom Cairan Kuretase (Eijkman) 3,025,000 -
Analisa Kromosom Darah (FKUI-BIOLOGI) 1,997,000 -
Analisa Kromosom Jaringan Kuretase 3,328,000 -
Analisa Kromosom Jaringan Plasenta 3,025,000 -
Analisa Kromosom Philadelpia (Makmal) 2,130,000 -
Analisa Sperma (SA) 428,000 -
Anaplastic Limpoma Kinase (ALK) 966,000 -
ANCA (Cikini) 400,000 -
Androstenedione, LC/MSMS (Quest) 1,632,000 -
Angiotensin Converting Enzyme (Quest) 1,456,000 -
Angiotensin II (Quest) 1,786,000 -
Anion GAP (NUH) 1,557,000 -
Anti - Thyroglobulin Antibody (Anti-Tg) 1,009,000 -
Anti HIV Rapid 142,000 -
Anti Mitochondrial Antibody (AMA M2) 850,000 -
Anti Mullerian Hormone (AMH) 708,000 -
Anti-Amoeba 453,000 -
Anti-Beta2-Glikoprotein 1 1,066,000 -
Antibodi Filariasis 266,000 -
Antibodi Leptospira (Balivet) 133,000 -
Antibodi Sperma (Biologi FKUI) 632,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Antibodi Trombosit (RE) TEST PRICE


450,000 - BUNDLING
Anti-CCP IgG 834,000 -
Anti-Chikungunya IgM 397,000 -
Anti-Chlamydia trachomatis IgG 840,000 -
Anti-Chlamydia trachomatis IgM 840,000 -
Anti-CMV IgG 362,000 -
Anti-CMV IgG Avidity 554,000 -
Anti-CMV IgM 495,000 -
Anti-Dengue IgG & IgM 557,000 -
Anti-dsDNA-NcX 632,000 -
Anti-EBV EA IgM (NUH) 1,250,000 -
Anti-EBV VCA IgA (Nuh) 828,000 -
Anti-EBV VCA IgG (NUH) 855,000 -
Anti-EBV VCA IgM (Nuh) 1,200,000 -
Anti-Extractable Nuclear Antigen Identification (NUH) 1,650,000 -
Antigen Filariasis 266,000 -
Anti-H. Pylori IgG 760,000 -
Anti-HAV 565,000 -
Anti-HAV IgM 500,000 -
Anti-HBc 416,000 -
Anti-HBc IgM 647,000 -
Anti-HBe 680,000 -
Anti-HBs 215,000 -
Anti-HBs Titer 351,000 -
Anti-HCV 506,000 -
Anti-HIV 465,000 -
Anti-HIV 3 metode (Anti-HIV) 725,000 -
Anti-HIV Konfirmasi (Patologi klinik-RSCM) - -
Anti-HSV1 IgG 420,000 -
Anti-HSV1 IgM 420,000 -
Anti-HSV2 IgG 380,000 -
Anti-HSV2 IgM 380,000 -
Anti-Mullerian Hormone Assessr (Quest) 2,737,000 -
Anti-Neutrophil Cytoplasmic Antibody (ANCA) (Nuh) 1,215,000 -
Antiphospholipid Antibody Panel (Quest) 11,022,000 -
Anti-Rubella IgG 380,000 -
Anti-Rubella IgM 480,000 -
Anti-Salmonella typhi IgM 350,000 -
Anti-Skeletal Muscle Antibody 1,330,000 -
Anti-Tiroglobulin 437,000 -
Anti-Toxoplasma IgG 351,000 -
Anti-Toxoplasma IgM 351,000 -
Anti-TPO 925,000 -
AP Test 780,000 -
Apo-A1 365,000 -
Apo-B 236,000 -
APOE-Genotipe 1,260,000 -
APTT 207,000 -
Aquaporin-4 (AQP) Antibodies 3,190,000 -
Arginine Vasopressin (AVP, ADH) (Quest) 1,994,000 -
Arsenic 24 Hour Urine (Quest) 1,176,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Asam Folat TEST PRICE


954,000 - BUNDLING
Asam Laktat (Plasma) 620,000 -
Asam Urat (Serum) 69,000 -
Asam Urat Urine 24 jam 70,000 -
Asam Urat Urine Pagi Pertama 70,000 -
Aspirin Verify Now 1,426,000 -
ASTO 135,000 -
AT III (Dharmais) 487,000 -
AT III (RE) 540,000 -
AUDIOMETRI 176,000 -
AUDIOMETRI (6 frekuensi) 176,000 -
Audiometri (RE) 176,000 -
Aviditas Anti-Toxoplasma IgG 554,000 -
Badan Inklusi HbH 148,000 -
Barbiturat Kualitatif Urine ( Doping ) 73,000 -
Barbiturat Kuantitatif Serum (Doping) 532,000 -
Barbiturat Kuantitatif Urine ( Doping ) 466,000 -
Bartonella henselae IgG 3,158,000 -
B-Cell Lymphoproliverative Disease (Dharmais) 1,089,000 -
BCR ABL (PRN) 1,157,000 -
BCR-ABL Kuantitatif p210 2,520,000 -
Benzene Metabolite S Phenyl Mercapturic Acid ( Petrolab ) 816,000 -
Benzodiazepin Kualitatif Urine (Doping) 73,000 -
Benzodiazepin Kuantitatif Serum ( Doping ) 532,000 -
Benzodiazepin Kuantitatif Urine ( Doping ) 466,000 -
Benzodiazepine 166,000 -
Besi 205,000 -
Beta 2-Microglobulin (PRN) 737,000 -
Beta 2-Microglobulin bahan Urine (Dharmais) 471,000 -
B-HCG Serum 642,000 -
Bikarbonat (RE) 286,000 -
Bil T/D/I 160,000 -
Bilasan bronkus 347,000 -
Bilirubin Direk 80,000 -
Bilirubin Neonatus 165,000 -
Bilirubin Total 80,000 -
Biopsi bronkus kanan kecil 700,000 -
Biopsi bronkus kiri kecil 700,000 -
Biopsi endobronkial 700,000 -
Biopsi endometrial kecil 700,000 -
Biopsi endoserviks kecil 700,000 -
Biopsi esofagus kecil 700,000 -
Biopsi ginjal kanan kecil 700,000 -
Biopsi ginjal kiri kecil 700,000 -
Biopsi jaringan lunak kecil 700,000 -
Biopsi jarum prostat kecil 700,000 -
Biopsi kandung kemih kecil 700,000 -
Biopsi Kelenjar Getah Bening kecil 700,000 -
Biopsi kelenjar liur kanan kecil 700,000 -
Biopsi kelenjar liur kiri kecil 700,000 -
Biopsi Kolon kecil 700,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Biopsi Konjungtiva kecil TEST PRICE


700,000 - BUNDLING
Biopsi labial kecil 700,000 -
Biopsi laring kecil 700,000 -
Biopsi lidah kecil 700,000 -
Biopsi mukosa hidung kecil 700,000 -
Biopsi mukosa oral kecil 700,000 -
Biopsi omentum kecil 700,000 -
Biopsi otot kecil 700,000 -
Biopsi ovarium kecil 700,000 -
Biopsi pankreas kecil 700,000 -
Biopsi paranasal kecil 700,000 -
Biopsi payudara kanan tanpa tanda batas kecil 700,000 -
Biopsi payudara kiri tanpa tanda batas kecil 700,000 -
Biopsi perikardial kecil 700,000 -
Biopsi peritoneal kecil 700,000 -
Biopsi perut kecil 700,000 -
Biopsi pleura kecil 700,000 -
Biopsi saraf kecil 700,000 -
Biopsi Serviks kecil 700,000 -
Biopsi sinus kecil 700,000 -
Biopsi testis kanan kecil 700,000 -
Biopsi testis kiri kecil 700,000 -
Biopsi Tiroid 700,000 -
Biopsi tonsil kecil 700,000 -
Biopsi trakea kecil 700,000 -
Biopsi transbronkial 700,000 -
Biopsi transtorakal 700,000 -
Biopsi Tumor Thorax 700,000 -
Biopsi ureter kecil 700,000 -
Biopsi uretral kecil 700,000 -
Biopsi usus duabelas jari kecil 700,000 -
Biopsi usus halus kecil 700,000 -
Biopsi vagina kecil 700,000 -
Biopsi vulva kecil 700,000 -
Bordetella Pertussis IgG & IgA Antibodies,Maid (Quest) 6,474,000 -
Borrelia burgdorferi IgG & IgM Abs CSF (EIA) ( Quest ) 2,935,000 -
BTA Mikroskopik (Lain-lain) 98,000 -
BTA Mikroskopik (Sputum 1) 98,000 -
BTA Mikroskopik (Sputum 2) 98,000 -
BTA Mikroskopik (Sputum 3) 98,000 -
Bunda Laktat 620,000 -
C1 Esterase Inhibitor, Protein (Quest) 1,100,000 -
C3 Komplemen 607,000 -
C4 Komplemen 607,000 -
CA 125 740,000 -
CA 15-3 746,000 -
CA 19-9 758,000 -
CA 27.29,CSF (17419X) ( Quest ) 1,456,000 -
CA 72-4 1,019,000 -
Caffein Plasma EDTA (Doping) 466,000 -
Caffein Urine (Doping) 466,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Cairan Ascites (PRN) TEST PRICE


339,000 - BUNDLING
Calcitonin ( RE ) 1,879,000 -
Calcium (Serum) 126,000 -
Calcium Ion 335,000 -
Calcium Urine 24 jam 126,000 -
Calcium Urine Sewaktu 126,000 -
Calsium Ion (RE) 342,000 -
Campylobacter Jejuni Antibody ( Quest ) 1,175,000 -
Cannabis Kuantitatif Serum ( Doping ) 532,000 -
Cannabis Kuantitatif Urine (Dopping) 466,000 -
Carbamazepin 1,121,000 -
Cardiolipin Antibody IgA (Quest) 1,263,000 -
Carotenes 1,400,000 -
Catecholamines Fractionated Plasma (Quest) 2,935,000 -
Catecholamines Fractionated Urine Random(Quest) 2,935,000 -
Catecholamines, Fractionated 24 Hr Urine (Quest) 1,790,000 -
CD 117 (Patologi Anatomi RSCM) 922,000 -
CD 133 (Dharmais) 953,000 -
CD 14 / CD 20 (Dharmais) 303,000 -
CD 34 (Dharmais) 773,000 -
Cd, Blood (Single) 356,000 -
CEA 376,000 -
Ceruloplasmin (Quest) 702,000 -
CHE 188,000 -
Chlamydia Pneumoniae IgG Abs (Quest) 1,667,000 -
Chlamydia Pneumoniae IgG,IgM & IgA ABS (Quest) 4,983,000 -
Chlamydia Pneumoniae IgM Abs (Quest) 1,659,000 -
Chlamydia Psittaci IgG & IgM Abs (Quest) 3,030,000 -
Chlorida (Serum) 141,000 -
Chlorida (Urine 24 jam) 141,000 -
Cholesterol HDL 80,000 -
Cholesterol LDL Direk 123,000 -
Cholesterol Total 60,000 -
Chrome (Cr)-Petrolab 132,000 -
Chromogranin - A (RE) 2,500,000 -
CISH ( Chromogen In Situ Hybridization) 3,493,000 -
CK 232,000 -
CK-MB (Massa) 480,000 -
Clomipramine (Quest) 1,100,000 -
Clonazepam (Quest) 1,176,000 -
Clostridium Difficile (GDH) 307,000 -
Clostridium Difficile (Toksin A/B) 368,000 -
CMV-DNA (Real Time PCR) 1,345,000 -
CMV-DNA, Cairan Amnion (Real Time PCR) 1,345,000 -
CMV-DNA, Urin (Real Time PCR) 1,345,000 -
Co, Serum 352,000 -
Cocain Kualitatif Urine (Doping) 73,000 -
Cocaine Kuantitatif Serum ( Doping ) 532,000 -
Cocaine Kuantitatif Urine (RE) 466,000 -
Cocaine/Benzoylecgonine 166,000 -
Cold Agglutinins (Quest) 960,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Complement , Total (CH50)TEST(Quest) PRICE


2,121,000 - BUNDLING
Complement Componen C1Q (Quest) 2,123,000 -
Complement Component C2 (Quest) 3,238,000 -
Complement Component C5 (Quest) 2,123,000 -
Coombs' Test (PMI) 533,000 -
Copper Serum (Quest) 960,000 -
Copper Urine (Quest) 1,250,000 -
Cortisol (Pediatri) 573,000 -
Cortisol Free Serum (Quest) 3,190,000 -
Cortisol Free, 24 hr urine (Quest) 4,299,000 -
Cortisol Saliva (Nutripath) 1,150,000 -
Cortisol Serum Pagi 573,000 -
Cortisol Serum Random 573,000 -
Cortisol Serum Sore 573,000 -
Cotinine 117,000 -
Cotinine Kuantitatif Urine (Doping) 532,000 -
Coxsackie A Ab Panel Serum (Quest) 2,233,000 -
C-Peptide (Puasa) 500,000 -
C-Peptide 2 jam PP 500,000 -
CRP Kualitatif 229,000 -
Cryptococcal Antigen, Latex Screen W/Reflex To Titer 2,472,000 -
Cryptococcus Antibody (Quest) 1,200,000 -
CT/NG-DNA (Real Time PCR) 1,350,000 -
CTx 522,000 -
Cu, Serum (single test) 356,000 -
Cyclospora (Parasitologi RSCM-FKUI) 266,000 -
Cyclosporin Parent 1,405,000 -
Cyfra 21-1 540,000 -
CYP2C19-Genotipe*2,*3 580,000 -
Cystatin-C 368,000 -
Cysticercus IgG Antibody, Western Blot (Quest) 1,600,000 -
Cytokeratin 878,000 -
Cytomegalovirus Antibody (IGG) (Quest) 2,188,000 -
Cytomegalovirus DNA,Quantitative,Real Time PCR (Quest) 2,900,000 -
Cytopathology 339,000 -
Darah Samar 198,000 -
Data Tambahan SCFA - -
D-Dimer 796,000 -
Dengue NS1 Antigen 445,000 -
Dengue-RNA (Real Time PCR) 658,000 -
Dexametason (Doping) 585,000 -
DHEA-S 784,000 -
DHT Saliva (Nutripath) 1,150,000 -
Diazepam Serum (Doping) 532,000 -
Diazepam Urine (Doping) 466,000 -
Digoxin 1,061,000 -
Dihydrotestosterone (NUH) 1,300,000 -
Diseksi janin sedang 985,000 -
DMD (Duthenne Muscular Distropin)(Eijkman) 5,324,000 -
Dnase-B Antibody (Quest) 983,000 -
EBV - EBNA IgA (RS Dharmais) 329,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Echinococcus Antibody (IgG) TEST PRICE


EIA With Reflex to Western Blot (Quest)
2,228,000 - BUNDLING
ECHOCARDIOGRAFI 666,000 -
Echocardiography(RE) 666,000 -
EKG 128,000 -
EKG (RE) 128,000 -
Elektroforesis Protein (Urine)(Dharmais) 424,000 -
Endomysial Antibody Screen (IgA), With Reflex To Titer(Quest) 1,515,000 -
Endomysial IgA Autoantibodies (Quest) 1,400,000 -
Endomysial IgG (Quest) 1,723,000 -
Entamoeba Histolytica IgG, ELISA (Quest) 1,719,000 -
Eosinofil Absolut 98,000 -
Epidermal Growth Factor Receptor (EGFR),Elisa (Quest) 1,668,000 -
Epinephrine(Quest) 1,400,000 -
Epstein Bar Virus DNA, Quantitative RT PCR 5,060,000 -
Epstein-Barr Virus (PCR) (Mikrobiologi FKUI) 733,000 -
Epstein-Barr Virus Capsid Ag(VCA) IgG Abs (Quest) 855,000 -
Epstein-Barr Virus Capsid Ag(VCA) IgM Abs (Quest) 855,000 -
Epstein-Barr Virus Early Antigen D Antibody (IgG) 1,000,000 -
Epstein-Barr Virus Early Antigen IgA Antibodi (PRN) 828,000 -
Epstein-Barr Virus Early Antigen IgG(NUH) 1,000,000 -
Epstein-Barr Virus Nuclear Antigen (EBNA) Antibody (IgG)
900,000 -
(Quest)
ER (Estrogen Receptor) Patologi Anatomi FKUI 965,000 -
Erythropoietin (Quest) 1,404,000 -
Estradiol 528,000 -
Estradiol Immulite 1000 PRN Anak 528,000 -
Estriol (Quest) 1,535,000 -
Estriol, Unconjugated (Quest) 1,140,000 -
Estroge Metabolite Comprehensive (Nutripath) 1,719,000 -
Estrogen Receptor (ER) - blok 877,000 -
Estrogen Receptor (ER) - unstained slide 877,000 -
Estrogen Total ( Quest ) 2,407,000 -
Estrone, LC/MS/MS (Quest) 2,123,000 -
Everolimus 2,377,000 -
Extractable Nuclear Antigen (ENA) IgG Auto Abs ( QUEST ) 1,193,000 -
Factor II Activity, Clotting (Quest) 1,700,000 -
Factor IX (NUH) 1,479,000 -
Factor V (Leiden) Mutation Analysis 4,053,000 -
Factor V Activity, Clotting (Quest) 1,700,000 -
Factor VIII (NUH) 1,479,000 -
Factor VIII Inhibitor Assay (NUH) 1,650,000 -
Factor X Activity, Clotting (Quest) 1,700,000 -
Factor X Assay (NUH) 2,139,000 -
Factor XI Activity, Clotting (Quest) 2,297,000 -
Factor XII Activity, Clotting (Quest) 1,700,000 -
Faecal Elastase-1 1,260,000 -
Faeces Parasit Lengkap (Parasitologi FKUI) 242,000 -
Faktor IX (RE) 515,000 -
Faktor VIII (RE) 515,000 -
Fatty Acid PROfile 1,050,000 -
Fatty Acide, Free (Non-Esterified) 1,371,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Fe, Serum TEST PRICE


356,000 - BUNDLING
Fecal Calprotectin 744,000 -
Feces Rutin (FR) 107,000 -
Ferritin 308,000 -
Fibrinogen 314,000 -
Fibrinogen Degradation Product (FDP) (Quest) 2,233,000 -
FISH ( Eijkman ) 6,389,000 -
FISH Kromosom 21 1,997,000 -
Fish SRY 2,396,000 -
Fish X,Y (Eijkman) 2,200,000 -
Fisik Dokter (1) 151,000 -
Fisik Mata 151,000 -
Fistula kecil 700,000 -
FNA extra paru 347,000 -
Fosfatase Alkali 97,000 -
Fosfor Anorganik (Serum) 129,000 -
Fosfor Anorganik (Urine 24 jam) 129,000 -
Fragile X (Molekular Gen FMR-1) (Undip semarang) 1,452,000 -
Fragile X (Sitogenetika) (Undip semarang) 1,815,000 -
Fragmentasi DNA Sperma 2,310,000 -
Free Light Chain (RS Dharmais) 607,000 -
Free PSA 927,000 -
Fructosamine (Quest) 895,000 -
FSH 439,000 -
FSH Immulite 1000 PRN Anak 439,000 -
FT3 481,000 -
FT4 375,000 -
FTA-ABS 826,000 -
G6PD (RE) 266,000 -
G6PD-Neonatus 95,000 -
Gabapentin (Quest) 1,340,000 -
Galactomanan 1,089,000 -
Gambaran Darah Tepi (GDT) 225,000 -
Gambaran Sumsum Tulang (SuTul) 964,000 -
Gamma GT 116,000 -
Ganglioside GM-1 Antibodies (IgG&IgM) 2,393,000 -
Ganja/Cannabis,Hash,Cimeng/Marinol (THC Marijuana) 166,000 -
Gastrin ( Quest ) 1,316,000 -
Giardia Lamblia Abs IgG/IgA/IgM (Quest) 2,702,000 -
Gingiva 700,000
Gliadin (Deamidated Peptide) Antibody (IgG, IgA) (Quest) 1,500,000 -
Gliadin (Deamidated Peptide) Antibody IgA 1,483,000 -
Gliadin (Deamidated Peptide) Antibody IgG 1,483,000 -
Glomerular Basement Membrane Antibody (IgG)(Quest) 2,912,000 -
Glucagon (NUH) 3,400,000 -
Glucagon (Quest) 1,842,000 -
Glukosa 1 jam PP 39,000
Glukosa 2 jam PP 39,000 -
Glukosa Jam 11.00 39,000
Glukosa Jam 16.00 39,000
Glukosa Puasa 39,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Glukosa Puasa NAF TEST PRICE


39,000 - BUNDLING
Glukosa Sewaktu 39,000 -
Glutamic Anti Decaxbixylase-65 Antibody =Anti GAD (Quest) 1,600,000 -
Glycated Albumin 191,000 -
Golongan Darah A, B, O dan Rhesus 81,000 -
Golongan darah A, B, O, dan Rh Konfirmasi (PMI) 80,000 -
GOT 64,000 -
GPT 64,000 -
Growth Hormon Stimulation 1 574,000 -
Growth Hormone 574,000 -
GTT 1 Jam 39,000 -
GTT 1 Jam NAF 39,000 -
GTT 2 Jam 39,000 -
GTT 2 Jam PP NaF 39,000 -
GTT Puasa 39,000 -
GTT Puasa NAF 39,000 -
Haemophilus Influenzae B IgG Antibodies (Quest) 2,201,000 -
Haptoglobin ( Quest ) 998,000 -
HbA1c 198,000 -
HBeAg 539,000 -
HBsAg 189,000 -
HBsAg Konfirmasi 986,000 -
HBsAg Kuantitatif 441,000 -
HBV Genotipe (Eijkman) 3,328,000 -
HBV-DNA (Real Time PCR - Header) 1,985,000 -
HCV - Genotipe (NUH) - -
HCV - Genotipe (Sequencing) 3,881,000 -
HCV-RNA (Real Time PCR) 2,739,000 -
HE4 (Architect) 552,000 -
Hema Lengkap 127,000 -
Hema rutin 112,000 -
Hemoglobin 82,000 -
Hepatitis D Antibody, Total (Quest) 1,526,000 -
Hepatitis D Virus (HDV) Antibody Panel,EIA (Quest) 5,694,000 -
Hepatitis D Virus (HDV) IgM Antibody 1,215,000 -
Hepatitis E Antibodies (IgG, IgM)(Quest) 3,908,000 -
Hepatitis E Antibody (IgG)(Quest) 2,408,000 -
Hepatitis E Antibody (IgM) (Quest) 2,408,000 -
HER2 - blok 877,000 -
HER2-unstained slide 877,000 -
HER-2 (RE QUEST) 3,650,000 -
HER2 (RE) 965,000 -
Herpes Virus-6, Human IgG & IgM ABS ( Quest ) 1,386,000 -
Hg, Blood (Single) 356,000 -
Histone Antibodies (Quest) 2,201,000 -
Histopathology (Besar) 1,650,000 -
Histopathology (Kecil) 700,000 -
Histopathology (Sedang) 985,000 -
Histopatologi Aborsi kecil 700,000 -
Histopatologi Abses kecil 700,000 -
Histopatologi Adenoid sedang 985,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Histopatologi Adrenal sedangTEST PRICE


985,000 - BUNDLING
Histopatologi Apendiks kecil 700,000 -
Histopatologi Arteri kecil 700,000 -
Histopatologi Bola mata (b) 1,650,000 -
Histopatologi Cavum Uteri 700,000
Histopatologi Clavus 700,000 -
Histopatologi Debrimen kulit kecil 700,000 -
Histopatologi Divertikula esofagus/usus halus sedang 985,000 -
Histopatologi Femur 700,000
Histopatologi Fibula 985,000 -
Histopatologi Frontal 700,000 -
Histopatologi Ganglion kecil 700,000 -
Histopatologi Hematoma kecil 700,000 -
Histopatologi Hemorrhoid kecil 700,000 -
Histopatologi Hepar 700,000 -
Histopatologi Jaringan lunak sedang 985,000 -
Histopatologi Jaringan perikardial kecil 700,000 -
Histopatologi Kandung empedu kecil 700,000 -
Histopatologi Kandung kemih TUR kecil 700,000 -
Histopatologi Kantung hernia kecil 700,000 -
Histopatologi Katup jantung kecil 700,000 -
Histopatologi Kelenjar Bartholin kecil 700,000 -
Histopatologi Kelenjar Lakrima (k) 700,000 -
Histopatologi Kelenjar liur kanan sedang 985,000 -
Histopatologi Kelenjar liur kiri sedang 985,000 -
Histopatologi Kelopak Mata (k) 700,000 -
Histopatologi Kista ganglion kecil 700,000 -
Histopatologi Kista kulit kecil 700,000 -
Histopatologi Kista sinovial kecil 700,000 -
Histopatologi Kolesteatoma kecil 700,000 -
Histopatologi konisasi serviks besar 1,650,000 -
Histopatologi Kornea kecil 700,000 -
Histopatologi Lambung 700,000 -
Histopatologi Leher 700,000
Histopatologi Limpa sedang 985,000 -
Histopatologi Lipoma kecil 700,000 -
Histopatologi Massa jaringan lunak besar 1,650,000 -
Histopatologi Massa mediastinum kecil 700,000 -
Histopatologi Meninges (non tumor) kecil 700,000 -
Histopatologi Meniskus kecil 700,000 -
Histopatologi Mukosa vagina kecil 700,000 -
Histopatologi Neuroma kecil 700,000 -
Histopatologi Ovarium neoplastik sedang 985,000 -
Histopatologi Ovarium non neoplastik kecil 700,000 -
Histopatologi Palpebra 700,000
Histopatologi Pankreas sedang 985,000 -
Histopatologi Paratiroid kanan kecil 700,000 -
Histopatologi Paratiroid kiri kecil 700,000 -
Histopatologi Parotis 700,000 -
Histopatologi Paru-paru kanan kecil 700,000 -
Histopatologi Paru-paru kiri kecil 700,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Histopatologi payudara kanan TESTdengan kelenjar getah PRICE BUNDLING


1,650,000 -
bening besar
Histopatologi payudara kanan parsial sedang 985,000 -
Histopatologi payudara kanan sederhana kecil 700,000 -
Histopatologi payudara kiri dengan kelenjar getah bening besar 1,650,000 -
Histopatologi payudara kiri parsial sedang 985,000 -
Histopatologi payudara kiri sederhana kecil 700,000 -
Histopatologi Perianal 700,000 -
Histopatologi Periorbita 700,000 -
Histopatologi Polip pada endometrial kecil 700,000 -
Histopatologi Polip pada hidung kecil 700,000 -
Histopatologi Polip pada kolorektal kecil 700,000 -
Histopatologi Polip pada perut kecil 700,000 -
histopatologi Polip pada serviks kecil 700,000 -
Histopatologi Polip pada usus halus kecil 700,000 -
Histopatologi Produk konsepsi besar 1,650,000 -
Histopatologi Prostat sedang 985,000 -
Histopatologi Retina (k) 700,000 -
Histopatologi Sentinel kelenjar getah bening kecil 700,000 -
Histopatologi Sinovium kecil 700,000 -
Histopatologi sterilisasi Tuba falopi kanan kecil 700,000 -
Histopatologi sterilisasi Tuba falopi kiri kecil 700,000 -
Histopatologi Struma Nodusa 700,000 -
Histopatologi Tendon kecil 700,000 -
Histopatologi Tiroid besar 1,650,000 -
Histopatologi Tonsil dan adenoid sedang 985,000 -
Histopatologi Tonsil kecil 700,000 -
Histopatologi Trombus kecil 700,000 -
Histopatologi Tuba falopi kanan kecil 700,000 -
Histopatologi Tuba falopi kiri kecil 700,000 -
Histopatologi Tulang 700,000 -
Histopatologi tulang rawan besar 1,650,000 -
Histopatologi Tumor kelenjar timus sedang 985,000 -
Histopatologi Tumor pituitari kecil 700,000 -
Histopatologi Tumor testis kanan besar 1,650,000 -
Histopatologi Tumor testis kiri besar 1,650,000 -
Histopatologi TUR Prostat besar 1,650,000 -
Histopatologi Umbilical 700,000 -
Histopatologi Ureter kecil 700,000 -
Histopatologi Uterus besar 1,650,000 -
Histopatologi Vena 700,000 -
Histopatologis Embolus kecil 700,000 -
Histopatologis Testis kanan kecil 700,000 -
Histopatologis Testis kiri kecil 700,000 -
Hitung Jenis Leukosit Absolut (HL) - -
HIV-1 Genotype (Quest) 7,034,000 -
HIV-1-RNA (Real Time PCR) 1,545,000 -
HLA - A, B, DR, DQ (Terasaki) 4,700,000 -
HLA - C (Terasaki) 1,545,000 -
HLA A DQ High ress (Terasaki) 1,850,000 -
HLA B DQ High ress (Terasaki) 1,850,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

HLA-A,B (Terasaki) TEST PRICE


2,699,000 - BUNDLING
HLA-A,B,DR (Terasaki) 4,199,000 -
HLA-ABC (Terasaki) 3,499,000 -
HLA-B27 (Terasaki) 2,349,000 -
HLA-DR (Terasaki) 2,359,000 -
Homocysteine 717,000 -
Homovanillic Acid (HVA), random urine 2,169,000 -
HpSA 275,000 -
HPV Genotipe 1,433,000 -
HPV-DNA (High-Risk Type) 656,000 -
hs-CRP 307,000 -
hs-Troponin I (Kuantitatif) 772,000 -
HSV (PCR) - (Mikrobiologi FKUI) 733,000 -
HTLV I/II, Confirmatory Assay (Quest) 1,882,000 -
Hydroxytryptamine,5-(Serotonin) (Quest) 3,053,000 -
Hyperinsulin 5,312,000 -
IFN-Gamma Release Assay (IGRA) 971,000 -
IgA 557,000 -
IgE Atopy (Panel Indonesia) 1,764,000 -
IgE Atopy (panel pediatri) 1,575,000 -
IgE Spesifik Bulu Ayam (Biolisa) 582,000 -
IgE Spesifik Cokelat 635,000 -
IgE Spesifik Daging Ayam 635,000 -
IgE Spesifik Daging Babi (Biolisa) 450,000 -
IgE Spesifik Daging Kambing (Biolisa) 582,000 -
IgE Spesifik Daging Sapi (Biolisa) 396,000 -
IgE Spesifik Debu Rumah 635,000 -
IgE Spesifik Epitel Anjing 680,000 -
IgE Spesifik Epitel Kucing 680,000 -
IgE Spesifik Epitel Tikus 680,000 -
IgE Spesifik Gandum (Biolisa) 370,000 -
IgE Spesifik Ikan (PRN) 630,000
IgE Spesifik Ikan Cod (Biolisa) 630,000 -
IgE Spesifik Jamur Aspergillus 680,000 -
IgE Spesifik Jamur Penicillin 680,000 -
IgE Spesifik Kacang 630,000 -
IgE Spesifik Kacang Kedelai (Biolisa) 370,000 -
IgE Spesifik Kapuk 635,000 -
IgE Spesifik Kecoa 635,000 -
IgE Spesifik Kepiting 635,000 -
IgE Spesifik Kerang 635,000 -
IgE Spesifik Kotoran Burung (Biolisa) 396,000 -
IgE Spesifik Kuning Telur 635,000 -
IgE Spesifik Lobster (Biolisa) 582,000 -
IgE Spesifik Mucor (Biolisa) 370,000 -
IgE Spesifik Nasi (Biolisa) 370,000 -
IgE Spesifik Orange (Biolisa) 370,000 -
IgE Spesifik Pisang (Biolisa) 582,000 -
IgE Spesifik Putih Telur 635,000 -
IgE Spesifik Serpihan Kulit Kuda (Biolisa) 370,000 -
IgE Spesifik Strawberry (Biolisa) 370,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

IgE Spesifik Susu TEST PRICE


635,000 - BUNDLING
IgE Spesifik Susu Sapi (Biolisa) 370,000 -
IgE Spesifik Susu Soya (Biolisa) 370,000 -
IgE Spesifik Tomat (Biolisa) 370,000 -
IgE Spesifik Tuna (Biolisa) 370,000 -
IgE Spesifik Tungau Debu Rumah 635,000 -
IgE Spesifik Udang 635,000 -
IgE Total 458,000 -
IGF BP3 (RE) 1,895,000 -
IGF-1 986,000 -
IgG 624,000 -
IgG Food Sensitivity Profile 5,513,000 -
IgG Subclass 4 (Quest) 2,377,000 -
IgG total w/ Subclass 1,2,3&4 (Quest) 8,932,000 -
IgM 624,000 -
Immune Status Panel-MMR 1,242,000 -
Immunologi Seluler (Makmal) 600,000 -
Immunotyping 1,061,000 -
Imunoelektroforesis (IgG, IgA, IgM, Kappa-Lambda) 866,000 -
Imunofiksasi Serum (Dharmais) 658,000 -
Imunofiksasi Urine (Dharmais) 908,000 -
Imunohistokimia (CD-20)-RE 965,000 -
IMUNOHISTOKIMIA (PANEL LIMFOMA & CYTOKERATIN) (Pat.Anatomi-RSCM)
4,293,000 -
Imunohistokimia CD 15 877,000 -
Imunohistokimia CD3 966,000 -
Imunohistokimia CD68 966,000 -
Imunohistokimia CK 19 (PA FKUI) 800,000 -
Imunohistokimia CK 20 (PA FKUI) 800,000 -
Imunohistokimia CK 7 (PA FKUI) 800,000 -
Imunohistokimia C-KIT (Patologi Anatomi RSCM) 966,000 -
Imunohistokimia Glypican-3 (PA FKUI) 800,000 -
Imunohistokimia HMB-45 878,000 -
Imunohistokimia KI67 966,000 -
Imunohistokimia p53 878,000 -
Imunohistokimia S 100 878,000 -
Imunohistokimia SMA 966,000 -
Indeks Massa Tubuh - -
Inhibin A (Quest) 3,930,000 -
Inhibin B ( Quest ) 3,474,000 -
Insulin 1 Jam PP 479,000 -
Insulin 2 jam PP 479,000 -
Insulin Autoantibody(Quest) 1,189,000 -
Insulin Puasa Architech & Cobas 479,000 -
Insulin Puasa Immulate 479,000 -
Insulin Sewaktu 479,000 -
Interleukin - 2 Receptor 5,168,000 -
Interleukin - 6, Highly Sensitive Elisa (Quest) 3,930,000 -
Interleukin 2 (Quest) 4,386,000 -
Interleukin 6 (Makmal) 1,065,000 -
Interleukin-1 Beta (Quest) 4,524,000 -
Interleukin-10 (IL 10) 2,233,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

TEST ( Quest )
Intrinsic Factor Blocking Antibody PRICE
1,369,000 - BUNDLING
Iodine 24 Hour Urine (Quest) 2,472,000 -
Islet Cell Ab Screen With Reflex to Titer (Quest) 3,300,000 -
IT Ratio 153,000 -
Jabodetabek - Circulating Tumor Cell (CTC) 12,850,000 -
Jamur Mikroskopis 117,000 -
Japanese Encephalitis Virus Antibodies,IgG and IgM (NUH) 8,600,000 -
JC Polyoma Virus DNA Quantitative(Quest) 7,449,000 -
JO-1 Antibody 2,201,000 -
Kalium (Serum) 141,000 -
Kalium Urine 24 jam 141,000 -
Kantung hidrokel kecil 700,000 -
Kerokan Mandibula 700,000 -
Kesan Anti Toxoplasma - -
Kesan Anti-CMV - -
Kesan Anti-CMV IgG / IgM - -
Kesan Aviditas Anti-CMV IgG - -
Kesan Aviditas Anti-Toxo IgG - -
Kesan IGRA - -
Kesan Profil Anti-Toxoplasma IgG & Avidity - -
Kesan Profil Anti-Toxoplasma IgG/IgM - -
Keton Darah (RE) 125,000 -
Ki67 - blok 877,000 -
Ki67 - unstained slide 877,000 -
Kista Duktus Tiroglosus 700,000 -
Kista Ovarium (b) 1,650,000 -
Kista Ovarium (k) 700,000
Kista Ovarium (s) 985,000 -
Kista Popliteal 700,000 -
Klinik-Konsultasi GP 138,000 -
Klinik-Konsultasi GP Plus 193,000 -
Klinik-Konsultasi Nutrisionis (ahli gizi) 94,000 -
Klinik-Konsultasi Spesialis Gizi - -
Klinik-Konsultasi Spesialis Olahraga - -
Klinik-Konsultasi Spesialis Plus 385,000 -
Klinik-Registrasi Baru 50,000 -
Klinik-Vaksin Difteri 185,000 -
Klinik-Vaksin Hepatitis A 743,000 -
Klinik-Vaksin Hepatitis B 743,000 -
Klinik-Vaksin Hepatitis B (satuan) 292,000 -
Klinik-Vaksin Herpes 2,420,000 -
Klinik-Vaksin HPV 3,410,000 -
Klinik-Vaksin HPV (satuan) 1,155,000 -
Klinik-Vaksin Influenza 281,000 -
Klinik-Vaksin Meningitis 743,000 -
Klinik-Vaksin Thypoid 262,000
Kolostomi Stoma kecil 700,000 -
Kondiloma 700,000 -
KRAS Mutation Analysis (Quest) 6,000,000 -
Kreatinin (Serum) 65,000 -
Kreatinin Clearance 160,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Kreatinin Urine TEST PRICE


65,000 - BUNDLING
Kreatinin Urine 24 Jam 65,000 -
KRM-Mammografi - -
Kultur & Resistensi (RE) 543,000 -
Kultur & Resistensi Jamur (RE) 484,000 -
Kultur Anaerob (Mikrobiologi-FKUI) 733,000 -
Kultur BTA (RE-I) 787,000 -
Kultur BTA (RE-II) 353,000 -
KULTUR BTA + RESISTENSI LINI 2 (Persahabatan) 420,000 -
Kultur Cairan 580,000 -
Kultur Darah 543,000 -
Kultur Diphteri 498,000 -
Kultur Feces 566,000 -
Kultur Gall 543,000 -
Kultur GO 396,000 -
Kultur Lain-lain (1) 580,000 -
Kultur Swab Rektal 458,000 -
Kultur Urin 566,000 -
Kultur Vibrio 543,000 -
Kuretase endometrial kecil 700,000 -
Kuretase endoserviks kecil 700,000 -
Lamotrigine (Quest) 1,350,000 -
LCA (Leukocyte Common Antigen) 878,000 -
LDH 153,000 -
Lead, 24-Hour Urine (Quest) 895,000 -
Lead, Random Urine (Quest) 1,450,000 -
LED 57,000 -
Legionella Pneumophila Ag Detection Urine (Quest) 2,211,000 -
Leiomioma, Tanpa Uterus kecil 700,000 -
Leptin (Quest) 4,000,000 -
Leptospira IgM (RE) 124,000 -
Leukemia Phenotyping ( Dharmais ) 1,089,000 -
Levetiracetam (Quest) 2,727,000 -
LH 422,000 -
LH Immulite 1000 PRN Anak 422,000 -
Lingkar Perut - -
Lipase 281,000 -
Lithium (NUH) 1,298,000 -
Liver - Kidney Microsome ( LKM-1 ) IgG Autoabs (Quest) 1,649,000 -
Lobektomi paru-paru kanan sedang 985,000 -
Lobektomi paru-paru kiri sedang 985,000 -
Lobektomi tiroid kanan besar 1,650,000 -
Lobektomi tiroid kiri besar 1,650,000 -
Lp(a) 469,000 -
Lupus Antikoagulan (RE) 642,000 -
Lyme Disease Antibodies (IgG,IgM), Immunoblot (Quest) 2,179,000 -
Lymphocyte Subset ( CD4,CD8,CD 19,NK ) ( Dharmais ) 484,000 -
M Band Quantitative (NUH) 1,200,000 -
M2PK (Multilab) 702,000 -
M2PK (RS Dharmais) 702,000 -
Magnesium (Serum) 133,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Magnesium Urine 24 Jam TEST PRICE


133,000 - BUNDLING
Magnesium Urine Sewaktu 133,000 -
Malaria (Mikroskopik) 125,000 -
Malaria Antigen 205,000 -
Massa Auricular 700,000 -
Mastektomi payudara kanan disertai nodus limpha (b) 1,650,000
MDMA Kualitatif (Doping) 73,000 -
MDMA Kuantitatif(Doping) 466,000 -
Measles IgG (Makmal) 500,000 -
Measles IgG Antibodies (NUH) 1,300,000 -
Measles IgM (Makmal) 500,000 -
Measles IgM Antibodies (NUH) 1,450,000 -
Meatus Akustikus 700,000 -
Melatonin Saliva (Nutripath) 1,200,000 -
Mercury, 24 Hour Urine (Quest) 666,000 -
Merkuri (Hg) Serum/Plasma 610,000 -
Metadone Kualitatif Urine ( Doping ) 73,000 -
Metadone Kuantitatif Serum (Doping) 532,000 -
Metadone Kuantitatif Urine (Doping) 466,000 -
Metanephrines, Fractionated 24 hr Urine (Quest) 1,100,000 -
Metanephrines, Fractionated Urine Random (Quest) 2,169,000 -
Metanephrines, Fractionated,Free LC/MS/MS,Plasma (Quest) 5,035,000 -
Methamphetamine (kerja sendiri) 166,000 -
Methamphetamine Kualitatif Urine (Doping) 73,000 -
Methamphetamine Kuantitatif Serum ( Doping ) 532,000 -
Methamphetamine Kuantitatif Urine (Doping) 466,000 -
Methaqualone Kualitatif (RE) 73,000 -
Methaqualone Kuantitatif Urin (Doping) 466,000 -
Methotrexate (NUH) 1,400,000 -
Methylenetetrahydrofolate Reductase (MTHFR) Variant 1,700,000 -
Methylmalonic Acid (Quest) 3,263,000 -
Mikrofilaria (Mikroskopik) 125,000 -
Minimal Residual Disease (Dharmais) 1,089,000 -
Mn, Serum (Single) 356,000 -
Morphine Kuantitatif Urine (Doping) 385,000 -
MS AFP 448,000 -
MTB/MOTT-DNA (Real Time PCR) 851,000 -
MTHFR, DNA Mutation Analysis 4,945,000 -
Mumps IgG Antibodies (Quest) 983,000 -
Mumps IgM Antibodies (Quest) 1,566,000 -
Musk Antibody Test ( Quest ) 13,500,000 -
Mutasi EGFR CT-DNA (PA Prodia) 4,500,000 -
Mutasi EGFR Jaringan Blok (PA Prodia) 2,750,000 -
Mutasi EGFR Jaringan Paru (PA Prodia) 2,750,000 -
Mutasi EGFR Sitologi (PA Prodia) 2,750,000 -
Mutasi JAK2 V617F 735,000 -
Mycophenolic Acid (Quest) 1,550,000 -
Mycoplasma IgG & IgM Ab (Makmal) 932,000 -
Mycoplasma IgG Ab (Makmal) 500,000 -
Mycoplasma IgM Ab (Makmal) 500,000 -
Mycoplasma pneumoniae antibody IgG (Quest) 1,195,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Mycoplasma Pneumoniae IgG TEST


& IgM ABS ( Quest ) PRICE
2,298,000 - BUNDLING
Mycoplasma Pneumoniae IgM Abs (Quest) 1,195,000 -
Myelin Antibody ( IGG ), IFA ( Quest ) 6,123,000 -
Myelin Associated Glycoprotein (MAG)-SGPG Antibody IgM (Quest)
5,200,000 -
Myelin Basic Protein (Quest) 2,193,000 -
Myeloperoxidase Antibody & Proteinase-3 Antibody (Quest) 4,627,000 -
Myoglobin, Serum (Quest) 1,667,000 -
Na, K, Cl 368,000 -
Natrium (Serum) 141,000 -
Natrium (Urin 24 jam) 141,000 -
Neuromyelitis Optica / Aquaporin 4 IgG (RE) 7,000,000 -
Neutrofil Alkaline Phosphatase (NAP) (RS Dharmais) 432,000 -
Nikotin Kuantitatif (Lab Doping) 585,000 -
N-MID Osteocalcin 554,000 -
NRBC - -
NSE 874,000 -
NT-Pro BNP 758,000 -
Nutrisi dan Logam berat Panel(Mikronutrien Panel) 1,418,000 -
Nutrisi Panel (Trace Element /Penelitian) 1,418,000 -
Oligoclonal Bands IgG (Quest) 2,300,000 -
Omega PROfile 840,000 -
Opiat Kualitatif Urin (Doping) 73,000 -
Opiat Kuantitatif Serum (Doping) 532,000 -
Opiat Kuantitatif Urine (Doping) 532,000 -
Opiates/morfin/heroin/putauw ( kerja sendiri ) 166,000 -
Organic Acids Serum (Quest) 6,460,000 -
Osmolalitas Serum (RE) 67,000 -
Osmolalitas Urine (RE) 67,000 -
Ovarium disertai tuba falopi neoplastik kanan besar 1,650,000 -
Ovarium disertai tuba falopi neoplastik kiri besar 1,650,000 -
Ovarium disertai tuba falopi non neoplastik kanan besar 1,650,000 -
Ovarium disertai tuba falopi non neoplastik kiri besar 1,650,000 -
Oxytocin Saliva (Nutripath) 429,000 -
P2Y12 Verify Now 1,426,000 -
P53 Oncoprotein, IHC With Interpretation (Quest) 3,100,000 -
Paket Imunohistokimia (Kasus Sukar) 3,025,000 -
Pan-ANCA Plus (Quest) 3,000,000 -
Pancreatic Elastase-1 (Quest) 1,700,000 -
Panel breast (ER,PR,HER2, KI67, Topo 2 Alpha) PA FKUI 2,250,000 -
Pap Smear 347,000 -
Pap Smear (New) 347,000 -
Pap Smear (RE) 347,000 -
Parietal Cell Total Autoabs ( Quest ) 900,000 -
Parvovirus B19 IgG & IgM ABS ( Quest ) 1,895,000 -
Patologi Anatomi Besar (RE) 1,650,000 -
Patologi Anatomi Kecil (RE) 700,000 -
Patologi Anatomi Sedang (RE) 985,000 -
Payudara kanan dengan tanda batas pemotongan 1,650,000 -
Payudara kiri dengan tanda batas pemotongan 1,650,000 -
Pb, Blood (single) 356,000 -
PCP Pneumocitis Carini Pneumonia 167,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Pengecatan Gram TEST PRICE


106,000 - BUNDLING
Pengecatan Gram (Swab Vagina) 106,000 -
Pewarnaan Diptheri (RE) 106,000 -
Phencyclidine Kualitatif Urine ( Doping ) 73,000 -
Phencyclidine Kuantitatif Serum (Doping) 532,000 -
Phencyclidine Kuantitatif Urine ( Doping ) 466,000 -
Phenobarbital 1,701,000 -
Phenylalanine (PKU) 2,600,000 -
Phenylalanine and Tyrosine ( Quest ) 2,217,000 -
Phenytoin 1,024,000 -
Plasminogen Activator Inhibitor (PAI-1) 1,752,000 -
Plasminogen Activity (Quest) 2,316,000 -
PNH (Paroxysmal Nocturnal Hemoglobinuria)/ CD55,CD59 968,000 -
Poliovirus AB Neutralization (Quest) 4,913,000 -
Porphyrins, Fractionated Random Urine(Quest) 2,103,000 -
Porphyrins, Total, Plasma (Quest) 1,483,000 -
Prealbumin (Transthyretin) 1,134,000 -
Pregnenolone (Nutripath) 3,200,000 -
Pregnenolone (Quest) 2,772,000 -
Prenatal Diagnosis Thalassemia (Eijkman) 5,990,000 -
Procalcitonin (PCT) 1,146,000 -
Progesteron 557,000 -
Progesteron Immulite 1000 PRN Anak 557,000 -
Progesteron Receptor (PR) - blok 877,000 -
Progesteron Receptor (PR)-unstained slide 877,000 -
Progesteron Receptor (RE) 965,000 -
ProHealthy Gut 630,000 -
Prolactin 406,000 -
Proliferating Cell Nuclear Ag Autoabs (Quest) 860,000 -
Propoxyphene Kualitatif Urine ( Doping ) 73,000 -
Propoxyphene Kuantitatif Serum (Doping) 466,000 -
Propoxyphene Kuantitatif Urine ( Doping ) 439,000 -
ProSafe (NIPT Illumina) 7,999,000 -
Proses slide HE 400,000 -
Prostate Health Index 2,600,000 -
Protein C 924,000 -
Protein Elektroforesis (Minicap) 268,000 -
Protein Elektroforesis (SPE Hydrasys Sebia) 268,000 -
Protein S 924,000 -
Protein Total (Serum) 92,000 -
Protein Total (Urin Sewaktu) 216,000 -
Protein Total Urine 24 jam 216,000 -
PSA 481,000 -
PTH Intact 769,000 -
Questassured(TM)25-Hydroxyvitamin D(D2,D3)-Quest 3,139,000 -
Rasio Protein Total/Kreatinin (Urine Sewaktu) 281,000 -
Renin Activity Plasma,LC/MS/MS 1,930,000 -
Reseksi esofagus kecil 700,000 -
Reseksi ginjal kanan sedang 985,000 -
Reseksi ginjal kiri sedang 985,000 -
Reseksi kandung kemih besar 1,650,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Reseksi Kolon besar TEST PRICE


1,650,000 - BUNDLING
Reseksi laring besar 1,650,000 -
Reseksi perut sedang 985,000 -
Reseksi radikal prostat besar 1,650,000 -
Reseksi regional kelenjar getah bening besar 1,650,000 -
Reseksi segmental kolon (Non tumor) sedang 985,000 -
Reseksi segmental tumor kolon (tumor) besar 1,650,000 -
Reseksi sendi kecil 700,000 -
Reseksi tumor lidah besar 1,650,000 -
Reseksi tumor pada usus halus besar 1,650,000 -
Reseksi tumor perut besar 1,650,000 -
Reseksi tumor tonsil besar 1,650,000 -
Reseksi usus halus besar 1,650,000 -
Reseksi vulva sedang 985,000 -
Respiratory Syncytial Virus Antibody 1,372,000 -
Retikulosit 131,000 -
Retraksi Bekuan (multiple) 97,000 -
RF 152,000 -
Rhesus Genotype 399,000 -
Rickettsia Rickettsii IgM Antibodies 7,836,000 -
Ristocetin Cofactor 2,320,000 -
ROMA (Multiple) 1,212,000 -
Rontgen Abdomen 206,000 -
Rontgen Abdomen 2 posisi 412,000 -
Rontgen Abdomen 3 posisi 605,000 -
Rontgen Ankle Joint Dextra 267,000 -
Rontgen Ankle Joint Sinistra 267,000 -
Rontgen Antebrachii Dextra 267,000 -
Rontgen Antebrachii Sinistra 267,000 -
Rontgen Artic Cubiti (Elbow) Kanan 267,000 -
Rontgen Artic Cubiti (Elbow) Kiri 267,000 -
Rontgen BNO 206,000 -
Rontgen Bone Age 206,000 -
Rontgen Calcaneus Dextra 267,000 -
Rontgen Calcaneus Sinistra 267,000 -
Rontgen Cephalometri - -
Rontgen Cervical 2 posisi 267,000 -
Rontgen Cervical 4 posisi 424,000 -
Rontgen Clavicula Dextra 267,000 -
Rontgen Clavicula Sinistra 267,000 -
Rontgen Coccyx AP - -
Rontgen Coccyx AP-Lat 267,000 -
Rontgen Coccyx Lat - -
Rontgen Cranium AP-Lat 267,000 -
Rontgen Cruris Dextra 267,000 -
Rontgen Cruris Sinistra 267,000 -
Rontgen Femur Dextra 267,000 -
Rontgen Femur Sinistra 267,000 -
Rontgen Genu Dextra 267,000 -
Rontgen Genu Sinistra 267,000 -
Rontgen Gigi - -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Rontgen Hip Joint Dextra TEST PRICE


267,000 - BUNDLING
Rontgen Hip Joint Sinistra 267,000 -
Rontgen Humerus Dextra 267,000 -
Rontgen Humerus Sinistra 267,000 -
Rontgen Lain-lain 206,000 -
Rontgen Lumbosacral 2 posisi 267,000 -
Rontgen Lumbosacral 4 posisi 424,000 -
Rontgen Mandibulla 363,000 -
Rontgen Manus Dextra 267,000 -
Rontgen Manus Sinistra 267,000 -
Rontgen Mastoid 267,000 -
Rontgen Maxilla 363,000 -
Rontgen Orbit 267,000 -
Rontgen Os Nasal 267,000 -
Rontgen Os Zygomaticum 267,000 -
Rontgen Panoramic - -
Rontgen Panoramic Plus Expertise -
Rontgen Pedis Dextra 267,000 -
Rontgen Pedis Sinistra 267,000 -
Rontgen Pelvis 267,000 -
Rontgen Sacrum 267,000 -
Rontgen Scapula Dextra 267,000 -
Rontgen Scapula Sinistra 267,000 -
Rontgen Sella 267,000 -
Rontgen Shoulder Joint Dextra 267,000 -
Rontgen Shoulder Joint Sinistra 267,000 -
Rontgen Sinus Paranasal 267,000 -
Rontgen Sinus Paranasal Caldwell 484,000 -
Rontgen Sinus Paranasal Lateral 267,000 -
Rontgen Sinus Paranasal Waters 363,000 -
Rontgen Sky Line Dextra 363,000 -
Rontgen Sky Line Sinistra 363,000 -
Rontgen Temporo Mandibular Joint (T.M.J) 533,000 -
Rontgen Thoracal 2 posisi 267,000 -
Rontgen Thoracal 4 posisi 424,000 -
Rontgen Thoracolumbal AP-Lat - -
Rontgen Thorax (CR) 230,000 -
Rontgen Thorax (RE) 230,000 -
Rontgen Thorax (Ro Thorax PA) 182,000 -
Rontgen Thorax AP/PA & Lat 363,000 -
Rontgen Thorax Lat 206,000 -
Rontgen Thorax Oblique 206,000 -
Rontgen Top Lordotic 206,000 -
Rontgen Top Lordotic (RE) 206,000 -
Rontgen Wrist Joint Dextra 267,000 -
Rontgen Wrist Joint Sinistra 267,000 -
Rotavirus Antigen (feces) 344,000 -
rT3 (Nutripath) 3,200,000 -
Rubella PCR (Mikrobiologi FKUI) 633,000 -
Rumpel Leede 33,000 -
Saccharomyces Cerevisiae IgG & IgA AntiBodies Detectr (Quest) 2,228,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Salmonella Typhi PCR (RE) TEST PRICE


605,000 - BUNDLING
Saraf simpatik kecil 700,000 -
Saturasi Transferrin - -
SCC 694,000 -
Schistosoma IgG Serum (Quest) 1,978,000 -
Scl-70 Antibody(Quest) 885,000 -
Se, Serum 356,000 -
Sekuensing Alpha Thalasemia Teknik MLPA (Eijkman) 5,324,000 -
Sekuensing Beta Thalassemia (Eijkman) 1,997,000 -
Sel-LE 148,000 -
Serologi Jamur Aspergilosis (Parasitologi) 232,000 -
Serologi Jamur Candidiasis (Parasitologi) 232,000 -
Serologi Jamur Kriptokokosis (Parasitologi) 232,000 -
SHBG 1,452,000 -
Sikatan esofagus 347,000 -
Single Antigen Antibody Identification Class I & II (Terasaki) 8,499,000 -
Sirolimus (NUH) 1,350,000 -
Sitologi Aspirasi 347,000 -
Sitologi Aspirasi kista payudara kanan 347,000 -
Sitologi Aspirasi kista payudara kiri 347,000 -
Sitologi bilasan buli-buli 347,000 -
Sitologi Cairan asites 347,000 -
Sitologi Cairan Cerebrospinal 347,000 -
Sitologi Cairan kista ovarium 347,000 -
Sitologi Cairan perikardial 347,000 -
Sitologi Cairan peritoneal 347,000 -
Sitologi Cairan pleura 347,000 -
Sitologi Cairan Pus 347,000 -
Sitologi Cairan sendi 330,000 -
Sitologi Cairan Tubuh Lainnya 339,000 -
Sitologi endobronkial 347,000 -
Sitologi Serviks Berbasis Cairan 452,000 -
Sitologi Serviks Berbasis Cairan (SSBC) 452,000 -
Sitologi Sikatan bronkus 347,000 -
Sitologi Sputum 347,000 -
Sitologi Urine 700,000 -
Sitologi Urine (Patologi Anatomi RSCM) 626,000 -
Sjogren's Antibody (SS-A) (Quest) 1,100,000 -
Sjogren's Antibody (SS-B) (RE) 1,250,000 -
Sm or Smith Antibody 1,100,000 -
Small-Dense-LDL 363,000 -
Smooth Muscle total Autoabs (Quest) 1,351,000 -
Soluble Liver Antigen (SLA) Autoabs (Quest) 2,201,000 -
Spirometri (RE) 206,000 -
Spirometry (spiro new) 206,000 -
ST2 630,000 -
Status AntioksidanTotal 794,000 -
Stero Pro (LC-MS/MS) 1,500,000 -
Streptococcus Pneumoniae IgG AB Panel (14 Serotypes),Maid (Quest)
1,990,000 -
Striational Total Autoabs (Quest) 1,228,000 -
Strongyloides IgG Antibody (QUEST) 1,866,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

TEST
Subtipe Limfosit (CD4 & CD8) (PRN) PRICE
265,000 - BUNDLING
T3 (Total) 330,000 -
T4 (Total) 330,000 -
Tacrolimus 933,000 -
TBG (Quest) 2,527,000 -
TB-PCR (RE) 810,000 -
Tekanan Darah - -
Telomere Analysis 7,000,000 -
Tes Kehamilan 137,000 -
Testosteron 509,000 -
Testosteron Free & Total (Quest) 1,719,000 -
Testosterone, Free (Nuh) 1,842,000 -
Theophyllin 1,554,000 -
Thrombotest Owren (RE) 299,000 -
Thyroid Autoantibodies (Quest) 1,140,000 -
Thyroid-Stimulating Immunoglobulin ( TSI ), Serum 3,500,000 -
TIBC 387,000 -
Tindakan bedah minor (Berat) 963,000 -
Tindakan bedah minor (Ringan) 242,000 -
Tindakan bedah minor (Sedang) 622,000 -
Tindakan inhalasi/sesak 171,000 -
Tindakan penanganan luka bakar (Berat) 275,000 -
Tindakan penanganan luka bakar (Ringan) 138,000 -
Tindakan penanganan luka bakar (Sedang) 209,000 -
Tindakan penanganan sincope (Berat) 275,000 -
Tindakan penanganan sincope (Ringan) 138,000 -
Tindakan penanganan trauma (Berat) 171,000 -
Tindakan penanganan trauma (Ringan) 105,000 -
Tinggi Badan - -
Tiroglobulin 624,000 -
Tissue Transglutaminase Antibody (IgA) (Quest) 2,123,000 -
Tissue Transglutaminase Antibody (IgG, IgA) (Quest) 4,402,000 -
Tissue Transglutaminase Antibody IgG (Quest) 2,000,000 -
Toksik Panel 1,418,000 -
Toluene (Petrolab) 816,000 -
Topiramate (Quest) 1,350,000 -
Total P1NP (Cobas e601) 585,000 -
Toxoplasma Gondii IgA Antibody (Quest) 1,316,000 -
Toxoplasma PCR (Mikrobiologi FKUI) 633,000 -
TP, Alb, Glob 184,000 -
TPHA 198,000 -
TRAb 562,000 -
Transbronkial aspirasi tumor 347,000 -
Transferrin 415,000 -
Transtorakal aspirasi tumor 347,000 -
TREADMILL 630,000 -
Treadmill (RE) 630,000 -
TREADMILL NEW 630,000 -
Treponema Pallidum Ab (QUEST) 1,515,000 -
Trichomonas Mikroskopis 117,000 -
Trigliserida 65,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

Triple Cardiac Marker TEST PRICE


1,339,000 - BUNDLING
Troponin I 772,000 -
Troponin I Kualitatif 772,000 -
Troponin T (RE) 266,000 -
Trypanosoma cruzi Antibody, IgG 4,091,000 -
Tryptase (NUH) 3,250,000 -
TSHs 301,000 -
TSHS Neonatus 95,000 -
Tuba dan Ovarium 1,650,000 -
Tulang Rahang 700,000 -
Tulang Alveolar 700,000
Tumor Anus 700,000 -
Tumor Bibir 700,000 -
Tumor Coli 700,000 -
Tumor Cruris 985,000 -
Tumor Kulit 700,000 -
Tumor Kulit Kepala 700,000 -
Tumor Labial 700,000 -
Tumor Necrosis Factor-Alpha,Highly Sensitive (Quest) 2,752,000 -
Tumor Regio Oksipital (s) 985,000 -
UIBC 182,000 -
Ultrasensitive-Mutasi EGFR ct DNA (PA Prodia) 5,250,000 -
Urea Breath Test (UBT) 1,701,000 -
Urea N 64,000 -
Urea N 24 Jam 65,000 -
Urea N Urine (Urin pagi) 65,000 -
Urine Rutin (UR) 66,000 -
Urine Rutin Flowcytometri (UF) 108,000 -
USG Abdomen (RE) 666,000 -
USG Buli-buli 484,000 -
USG Coli (RE) 666,000 -
USG Deteksi Cairan Ascites 484,000 -
USG Deteksi Cairan Efusi 484,000 -
USG Ginekologi 484,000 -
USG Ginekologi (RE) 484,000 -
USG Kepala 726,000 -
USG Lain-lain 557,000 -
USG Leher - -
USG Lower Abdomen 484,000 -
USG Mammae 484,000 -
USG Mammae (RE) 484,000 -
USG Mammae + KGB 726,000 -
USG Prostat 484,000 -
USG Scrotum dan Testis 484,000 -
USG Sendi 605,000 -
USG Small Part(RE) 666,000 -
USG Superficial Mass 484,000 -
USG Tiroid 484,000 -
USG Tiroid (RE) 484,000 -
USG Tractus Urinarius 484,000 -
USG Upper Abdomen 484,000 -

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

USG Whole Abdomen TEST PRICE


557,000 - BUNDLING
Uterus disertai tuba dan ovarium besar 1,650,000 -
Uterus disertai tuba kanan dan ovarium besar 1,650,000 -
Uterus disertai tuba kiri dan ovarium besar 1,650,000 -
Uterus-tuba falopi dan ovarium (neoplastik) besar 1,650,000 -
Uterus-tuba falopi kanan dan ovarium (neoplastik) besar 1,650,000 -
Uterus-tuba falopi kiri dan ovarium (neoplastik) besar 1,650,000 -
Vagina berbasis cairan 347,000 -
Valproic Acid (NUH) 379,000 -
Valproic Acid (Quest) 1,070,000 -
Vancomycin (NUH) 1,100,000 -
Varicella Zoster IgG 1,228,000 -
Varicella Zoster IgG (NUH) 1,084,000 -
Varicella Zoster IgG (PRN) 420,000 -
Varicella Zoster Virus IgM (NUH) 1,249,000 -
Varicella-Zoster Virus Antibodies (IGG,IGM) (Quest) 2,193,000 -
Varicella-Zoster Virus Antibody (IgM)( Quest ) 1,228,000 -
Vascular Endothelial Growth Factor (VEGF), Elisa (Quest) 4,976,000 -
VDRL/RPR 124,000 -
Very Long Chain Fatty Acid (Quest) 2,160,000 -
Virus Zika (ZIKV) 2,493,000 -
Viskositas Darah ( RE ) 268,000 -
Vitamin A & E (HPLC Agilent 1200 Series) 580,000 -
Vitamin B1 (Thiamine),LC/MS/MS (Quest) 1,298,000 -
Vitamin B12 953,000 -
Vitamin B12 Binding Capacity (QUEST) 2,058,000 -
Vitamin C, LC/MS/MS (Quest) 1,550,000 -
Vitamin D 25-OH Total (Liaision) 416,000 -
Vitamin D,1,25-Dihiydroxy, LC/MS/MS (Quest) 3,620,000 -
Vitamin K1 (Quest) 2,088,000 -
VMA Urine ( Biokimia ) 120,000 -
Von Willebrand Factor Antigen (RE) 1,928,000 -
Waktu Pembekuan 68,000 -
Waktu Perdarahan (Anak) 68,000 -
Waktu Perdarahan (Dewasa) 68,000 -
Waktu Protrombin 312,000 -
Waktu Protrombin + INR 312,000 -
Waktu Trombin 362,000 -
Warfarin IndivTest 3,100,000 -
WIDAL 208,000 -
Xylene (Petrolab) 816,000 -
Yersinia enterocolitica Antibodies (IgA,IgA) 3,080,000 -
Zn, Serum (single) 356,000 -
Zonisamide (Quest) 1,579,000 -
ANA (IF) 677,000 ANA ( IF ) & ANA Profile
ANA Profile 1,016,000 ANA ( IF ) & ANA Profile
CD 4 (Dharmais) 132,500 CD4 & CD8 (Dharmais)
CD 8 (Dharmais) 132,500 CD4 & CD8 (Dharmais)
Free Testosteron Index - Free Testosteron Index
SHBG 1,373,000 Free Testosteron Index
Testosteron 588,000 Free Testosteron Index

Revisi-09
Dikeluarkan 31 Juli 2018
Hanya digunakan untuk kalangan sendiri

Tarif Pemeriksaan Laboratorium Klinik Prodia - Berlaku Mulai 1 Januari 2018

HCV - Genotipe (Sequencing)TEST PRICE


3,377,000 BUNDLING
HCV RNA (Real Time PCR) & HCV-Genotipe
HCV-RNA (Real Time PCR) 2,250,000 HCV RNA (Real Time PCR) & HCV-Genotipe
Hema Lengkap 99,000 Hematologi Lengkap + IPF
IPF (HL) 99,000 Hematologi Lengkap + IPF
Hema Lengkap 80,400 Hematologi Lengkap + IPF + Retikulosit (Oto)
IPF (HL) 80,300 Hematologi Lengkap + IPF + Retikulosit (Oto)
Retikulosit (Oto) 80,300 Hematologi Lengkap + IPF + Retikulosit (Oto)
Hema Lengkap 110,500 Hematologi Lengkap + Retikulosit
Retikulosit 110,500 Hematologi Lengkap + Retikulosit
Hema Lengkap 118,000 Hematologi Lengkap + Retikulosit (Otomatis
Retikulosit (Oto) 118,000 Hematologi Lengkap + Retikulosit (Otomatis)
Hema rutin 98,500 Hematologi Rutin + Retikulosit (Otomatis)
Retikulosit (Oto) 98,500 Hematologi Rutin + Retikulosit (Otomatis)
Amphetamine/shabu2/ekstasi 147,800 Narkoba 5 Jenis
Benzodiazepine 147,800 Narkoba 5 Jenis
Cocaine/Benzoylecgonine 147,800 Narkoba 5 Jenis
Ganja/Cannabis,Hash,Cimeng/Marinol (THC Marijuana) 147,800 Narkoba 5 Jenis
Opiates/morfin/heroin/putauw ( kerja sendiri ) 147,800 Narkoba 5 Jenis
AMA dan ASMA IF 1,299,300 Panel ProALD
ANA (IF) 699,700 Panel ProALD
Estrogen Receptor (ER) - blok 750,000 Panel ProBreast-Cancer 1 (blok)
Progesteron Receptor (PR) - blok 750,000 Panel ProBreast-Cancer 1 (blok)
Estrogen Receptor (ER) - unstained slide 750,000 Panel ProBreast-Cancer 1 (unstained slide)
Progesteron Receptor (PR)-unstained slide 750,000 Panel ProBreast-Cancer 1 (unstained slide)
Estrogen Receptor (ER) - blok 670,000 Panel ProBreast-Cancer 2 (blok)
Progesteron Receptor (PR) - blok 670,000 Panel ProBreast-Cancer 2 (blok)
HER2 - blok 660,000 Panel ProBreast-Cancer 2 (blok)
Estrogen Receptor (ER) - unstained slide 670,000 Panel ProBreast-Cancer 2 (unstained slide)
Progesteron Receptor (PR)-unstained slide 670,000 Panel ProBreast-Cancer 2 (unstained slide)
HER2-unstained slide 660,000 Panel ProBreast-Cancer 2 (unstained slide)
Estrogen Receptor (ER) - blok 625,000 Panel ProBreast-Cancer 3 (blok)
Progesteron Receptor (PR) - blok 625,000 Panel ProBreast-Cancer 3 (blok)
HER2 - blok 625,000 Panel ProBreast-Cancer 3 (blok)
Ki67 - blok 625,000 Panel ProBreast-Cancer 3 (blok)
Estrogen Receptor (ER) - unstained slide 625,000 Panel ProBreast-Cancer 3 (unstained slide)
Progesteron Receptor (PR)-unstained slide 625,000 Panel ProBreast-Cancer 3 (unstained slide)
HER2-unstained slide 625,000 Panel ProBreast-Cancer 3 (unstained slide)
Ki67 - unstained slide 625,000 Panel ProBreast-Cancer 3 (unstained slide)
TSHS Neonatus 95,000 TSHs Neonatus + G6PD Neonatus
G6PD-Neonatus 95,000 TSHs Neonatus + G6PD Neonatus
Besi 205,000 TIBC Formula : Si + UIBC
TIBC - TIBC Formula : Si + UIBC
UIBC 182,000 TIBC Formula : Si + UIBC

Revisi-09
Dikeluarkan 31 Juli 2018