| No | Bidang | Parameter | Sisa Kuota Siklus 1 | Sisa Kuota Siklus 2 | Tarif 1 Siklus (Rp) |
|---|---|---|---|---|---|
| 1 | Hematologi | Hemoglobin, Lekosit, Eritrosit, Trombosit, Hematokrit, MCV, MCH, MCHC | 390 | 475 | 1,500,000 |
| 2 | Kimia Klinik | Bilirubin total, Kolesterol, Kreatinin, Glukosa, Protein Total, Ureum, Asam Urat, Trigliserida, SGOT, SGPT, Albumin, Fosfatase Alkali, Gama GT, CK Nac, Natrium, Kalium, Chlorida, Kalsium, LDH | 407 | 478 | 1,050,000 |
| 3 | Urinalisa | Berat Jenis, pH, Protein, Glukosa, Bilirubin, Urobilinogen, Darah samar, Keton, Nitrit, Lekosit, Tes Kehamilan | 423 | 482 | 1,250,000 |
| 4 | Mikrobiologi | Mikroskopis BTA | 433 | 488 | 650,000 |
| 5 | Mikrobiologi | Mikroskopis Telur Cacing | 76 | 94 | 450,000 |
| 6 | Imunologi | Anti HIV | 439 | 484 | 750,000 |
| 7 | Imunologi | RPR / TPHA | 660 | 685 | 750,000 |
| 8 | Imunologi | HBsAg | 655 | 688 | 750,000 |
| 9 | Imunologi | Anti HCV | 679 | 690 | 900,000 |
| 10 | Mikrobiologi | Mikroskopis Malaria | 439 | 485 | 825,000 |
| 11 | Kimia Kesehatan | Fe, Mn, Cd, Cu, Zn, Nitri, Klorida (7 Parameter Kimia wajib) | 44 | 61 | 1,300,000 |
| 12 | Kimia Kesehatan | Fe, Cd (2 Parameter Kimia Terbatas) | 800,000 | ||
| 13 | Mikrobiologi | Kulture & Resistensi | 40 | 45 | 1,050,000 |
| 14 | Imunologi | Viral Load (VL) HIV | 99 | 100 | 0 |