| No | Bidang | Parameter | Sisa Kuota Siklus 1 | Sisa Kuota Siklus 2 | Tarif (Rp) |
|---|---|---|---|---|---|
| 1 | Hematologi | Kadar Hemoglobin, Hitung Leukosit, Hitung Eritrosit, Hitung Trombosit, Nilai Hematokrit, Nilai MCV, Nilai MCH, Nilai MCHC | 0 | 0 | 3,000,000 |
| 2 | Kimia Klinik | Bilirubin total, Kolesterol, Kreatinin, Glukosa, Protein total, Ureum, Asam Urat, Trigliserida, SGOT, SGPT, Kalsium, Albumin, Fosfatase Alkali, Gama Glutamil Transferase (GGT), Natrium (Na), Kalium (K), Klorida (Cl), Phosphor, CK, Magnesium | 0 | 0 | 2,100,000 |
| 3 | Urinalisa | Berat Jenis, pH, Protein, Glukosa, Bilirubin, Urobilinogen, Darah, Keton, Nitrit, Lekosit, Tes Kehamilan | 0 | 0 | 2,000,000 |
| 4 | Koagulasi | Koagulasi (PT, APTT, Fibrinogen) | 0 | 0 | 1,300,000 |
| 5 | HbA1C | HbA1c | 0 | 0 | 2,300,000 |
| 6 | Mikrobiologi | Mikroskopis BTA | 0 | 0 | 1,200,000 |
| 7 | Mikrobiologi | Mikroskopis Telur Cacing | 0 | 0 | 1,000,000 |
| 8 | Mikrobiologi | Mikroskopis Malaria | 0 | 0 | 1,900,000 |
| 9 | Mikrobiologi | Mikroskopis Pewarnaan Gram | 0 | 0 | 1,200,000 |
| 10 | Mikrobiologi | Mikroskopis Jamur | 0 | 0 | 1,200,000 |
| 11 | Mikrobiologi | TCM TB | 0 | 0 | 2,100,000 |
| 12 | Mikrobiologi | Identifikasi Bakteri dan Uji Kepekaan Antibiotik | 0 | 0 | 2,500,000 |
| 13 | Imunologi | Anti HIV | 0 | 0 | 1,800,000 |
| 14 | Imunologi | HBsAg | 0 | 0 | 1,800,000 |
| 15 | Imunologi | Sifilis | 0 | 0 | 1,800,000 |
| 16 | Imunologi | Anti HCV | 0 | 0 | 1,800,000 |
| 17 | Imunologi | Anti HBs | 0 | 0 | 1,600,000 |
| 18 | Imunologi | HBeAg | 0 | 0 | 1,600,000 |
| 19 | Imunologi | Anti HBe | 0 | 0 | 1,600,000 |
| 20 | Kimia Kesehatan | Kimia Air Minum Logam (4 Logam). (Besi (Fe), Tembaga (Cu), Mangan (Mn), Zink (Zn)) | 0 | 0 | 1,500,000 |
| 21 | Kimia Kesehatan | Kimia Air Minum Logam A (2 logam). Besi (Fe), Mangan (Mn) | 0 | 0 | 800,000 |
| 22 | Kimia Kesehatan | Kimia Air Minum Logam B (2 logam). Timbal (Pb), Kadmium (Cd) | 0 | 0 | 800,000 |
| 23 | Kimia Kesehatan | Kimia Air Minum : Nitrit | 0 | 0 | 900,000 |
| 24 | Kimia Kesehatan | Kimia Air Minum Anion (Sulfat, Klorida, Padatan Terlarut Total) | 0 | 0 | 1,500,000 |
| 25 | Kimia Kesehatan | Kimia Air Minum Fluorida | 0 | 0 | 900,000 |
| 26 | Kimia Kesehatan | Kimia Air Minum pH | 0 | 0 | 800,000 |